V13I4 (Fall 2023) by Redstone Media Group

Innovative VOLUME 13 ISSUE 4

VETERINARY CARE

TREATING CHRONIC BRONCHITIS IN DOGS CORTICOSTEROIDS ARE THE TREATMENT OF CHOICE FOR THIS CHALLENGING PROBLEM, BUT A VARIETY OF ALTERNATIVE OPTIONS CAN BE USED IN CONJUNCTION WITH THESE DRUGS. — P. 40

HOW AI IS IMPACTING VETERINARY EPIDEMIOLOGY Because AI can provide valuable insights into protecting animal health, it will play a big role in the future of veterinary medicine and epidemiology. — p. 8

USING AN INTEGRATIVE APPROACH TO PAIN MANAGEMENT IN CATS A treatment plan that uses both traditional and alternative therapies is the most effective way to manage pain in your feline clients. — p. 18

FALL 2023

www.IVCJournal.com

5 WAYS VETERINARY PROFESSIONALS CAN MAKE MONEY ONLINE

SHOULD YOU CONSIDER MCT OIL FOR YOUR PATIENTS?

NEW IDEAS ABOUT HEMANGIOSARCOMA IN DOGS

DETOXIFICATION IN EQUINES — AN INTEGRATIVE PROGRAM

From e-books to courses to podcasts…find out how you can start earning a second income online. — p. 23

Why our understanding of this cancer is improving our ability to diagnose and treat it. — p. 26

Medium chain triglycerides (MCTs) have been shown to help improve a variety of medical conditions in pets — from respiratory disease to seizures. — p. 42

Our equine patients are exposed to many toxins that can overwhelm their livers’ ability to deal with them. Here’s why a gentle detoxification program is beneficial. — p. 48

FALL 2023 EDITORIAL DEPARTMENT

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

COLUMNISTS & CONTRIBUTING WRITERS

Nancy Brandt, DVM, MSOM, dipOM, CVC, CVA, CVMA Todd Cooney DVM, CVH Mari Delaney, DVM Kelly Diehl, DVM, MS Dipl. ACVIM W. Jean Dodds, DVM Hannah Godfrey, BVetMed MRCVS Joyce C. Harman, DVM Megan Kelly, BVSc, CCRP Angie Krause, DVM, CVA, CCRT Cynthia Lankenau, DVM Jared Mitchell, DVM, CVMA, CVA, CVFT Judy Morgan, DVM, CVA, CVCP, CVFT Emily Singler, VMD Keith Weingardt, DVM, CVA, CTCVM

ADMINISTRATION & SALES Publisher: Redstone Media Group President/C.E.O.: Tim Hockley Operation Director: Libby Sinden Financial Administration: Rosme Mandal

Customer Satisfaction: Rebecca Veigas, (866) 764-1212 ext. 225 becca@redstonemediagroup.com

Subscribe to IVC Journal Today! Subscribe to IVC Journal for just $29.95 and receive a FREE 1 year subscription to Animal Wellness Magazine.

To order your subscription visit

www.ivcjournal.com

SUBMISSIONS: Please send all editorial material, photos and correspondence to Dana Cox at Dana@redstonemediagroup.com or IVC Journal, 160 Charlotte St., Suite 202 Peterborough, ON, Canada K9J 2T8. We welcome previously unpublished articles and color pictures either in transparency or disc form at 300 dpi. We cannot guarantee that either articles or pictures will be used or that they will be returned. We reserve the right to publish all letters received. ADVERTISING SALES: Senior Media Specialist/Editorial Associate: Kat Shaw, (866) 764-1212 ext. 315 Katshaw@redstonemediagroup.com Business Development/Editorial Associate: Becky Starr, (866) 764-1212 ext. 221 Becky@redstonemediagroup.com Business Development Representative: Luke Pigeon, (866) 764-1212 ext. 228 Luke.pigeon@redstonemediagroup.com SUBSCRIPTION SERVICES MANAGER: Simone Beimbrink, (866) 764-1212 ext. 115 Simone@redstonemediagroup.com US MAIL: IVC Journal, 6834 S University Blvd PMB 155 Centennial, CO 80122 CDN MAIL: IVC Journal, 202-160 Charlotte St. Peterborough, ON, Canada K9J 2T8. The opinions expressed in this journal are not necessarily those of the editor, and different views may appear in other issues. Redstone Media Group Inc., publisher of IVC Journal, does not promote any of the products or services advertised by a third party advertiser in this publication, nor does Redstone Media Group Inc. verify the accuracy of any claims made in connection with such advertisers.

IVCJournal.com IVC Journal (ISSN 2291-9600) is published four times a year by Redstone Media Group Inc. Publications Mail Agreement # 44072015. 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: September 2023.

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

PRINTED IN

CANADA IVC Fall 2023

contents FEATURES

IN ARTIFICIAL 8 ADVANCES INTELLIGENCE (AI) AND VETERINARY EPIDEMIOLOGY

23 14

PETS INGEST POISON — 30 WHEN COMMON HOUSEHOLD TOXINS AND REMEDIES

by Emily Singler, VMD

by Mari Delaney, DVM

Because of its potential for creating valuable insights into protecting animal health, AI will be a big part of the future of veterinary medicine and epidemiology.

Toxin ingestion among pets is common and can quickly become life-threatening. Saving lives relies on prompt action both at home and in the veterinary clinic setting.

STATE OF TELEMEDICINE IN 34 THE THE VETERINARY INDUSTRY

NUTRITION NOOK

CHINESE FOOD THERAPY FOR UPPER RESPIRATORY TRACT DISEASES IN DOGS

by Hannah Godfrey, BVETMED MRCVS

Veterinary telemedicine is likely here to stay. This article takes an in-depth look at its pros and cons, and how it could be improved.

by Judy Morgan, DVM, CVA, CVCP, CVFT In TCVM, three patterns lead to upper respiratory tract diseases in dogs. Based on a patient’s pattern, Chinese food therapy can help treat the problem and resolve symptoms.

TREATMENT FOR 40 INTEGRATIVE CHRONIC BRONCHITIS IN DOGS by W. Jean Dodds, DVM

AN INTEGRATIVE APPROACH TO PAIN MANAGEMENT IN FELINE PATIENTS

Although corticosteroids remain the treatment of choice for chronic bronchitis in dogs, a variety of alternative options can be used in conjunction with these drugs.

by Angie Krause, DVM, CVA, CCRT Helping clients understand the signs of pain in cats, with an integrative approach to pain management that uses traditional and alternative therapies, is the most effective solution.

OIL AND ITS USE IN 42 MCT ANIMAL PATIENTS

by Jared Mitchell, DVM, CVMA, CVA, CVFT

Medium chain triglycerides (MCTs) can be used to help improve the health of animal patients with a variety of medical conditions — from respiratory disease to seizures.

5 WAYS VETERINARY PROFESSIONALS CAN MAKE MONEY ONLINE by Megan Kelly, BVSc, CCRP From e-books to courses to podcasts, there are several ways veterinary professionals can start earning a second income online.

TREATMENT FOR 46 INTEGRATIVE LUNGWORM IN DOGS

by Nancy Brandt, DVM, MSOM, DIP. OM, CVC, CVA, CVMA

IDEAS ABOUT 26 NEW HEMANGIOSARCOMA IN DOGS

From environmental controls and supplements, to ozone or deep inhalation therapy, a variety of integrative treatments are effective against lungworm infections in dogs.

by Kelly Diehl, DVM, MS DIPL. ACVIM

Outcomes for dogs diagnosed with hemangiosarcoma have not changed in decades, but our understanding of this cancer is steadily improving our ability to diagnose and treat it.

48 4

IVC Fall 2023

42 48

DETOXIFICATION IN EQUINES — AN INTEGRATIVE APPROACH by Joyce D. Harman, DVM Our equine patients are exposed to many toxins, and this can overwhelm their livers’ ability to process and eliminate them. A gentle detoxification program is beneficial.

COLUMNS & DEPARTMENTS

7 Editorial 13 Profitable Practice — NutriSource 25 From the AVH 29 From the AHVMA 39 Industry Innovations 45 From the VMAA 51 From the AATCVM & WATCVM 53 From the VBMA IN THE NEWS:

38 Study reveals regional variability in vector-borne infections

38 West Virginia abandons plan for new veterinary school

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.

Michelle J. Rivera, MT, VDT, is an instructor at the University of Wisconsin and The Healing Oasis Wellness Center, a post-graduate educational institution offering state-approved programs. She is coowner of The Healing Oasis Veterinary Hospital, offering massage, rehabilitation, chiropractic and Chinese and Western Herbology. Michelle completed the Chinese Herbal Medicine program from the China Beijing International Acupuncture Training Center, and is certified in Chinese Medicine by the Wisconsin Institute of Chinese Herbology.

Dr. Joyce Harman, DVM, MRCVS, graduated in 1984 from Virginia Maryland Regional College of Veterinary Medicine. Her practice is 100% holistic, using acupuncture, chiropractic, herbal medicine and homeopathy to treat horses to enhance performance and those with a variety of chronic conditions, with an emphasis on Lyme Disease. Her publications include the Pain Free Back and Saddle Fit Books, and numerous articles in lay and professional magazines. She maintains an informative website: www.harmanyequine.com. Dr. Steve Marsden, DVM, ND, MSOM, Lac. Dipl.CH, CVA, AHG lectures for IVAS, the AHVMA, the AVMA, and numerous other organizations. He is co-founder of the College of Integrative Veterinary Therapies and is a director emeritus of the National University of Natural Medicine in Portland OR. He authored the Manual of Natural Veterinary Medicine (Mosby); and Essential Guide to Chinese Herbal Formulas (CIVT). Dr. Marsden is extensively trained in alternative medicine, including Chinese herbology, acupuncture and naturopathic medicine. He has holistic veterinary and naturopathic medical practices in Edmonton, Alberta. In 2010, Dr. Marsden was named Teacher of the Year by the AHVMA; and Small Animal Veterinarian of the year by the CVMA in 2009. Dr. Jean Dodds, DVM, received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she moved to Southern California to establish Hemopet, the first non-profit national blood bank program for animals. Dr. Dodds has been a member of many national and international committees on hematology, animal models of human disease, veterinary medicine, and laboratory animal science. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1994.

52 Rapid diagnostic technique identifies bacterial infections

54 Drug-resistant hookworms spreading among dogs

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 Fall 2023

contributors 1

1. NANCY BRANDT, DVM, MSOM, DIPOM, CVC, CVA, CVMA Dr. Nancy Brandt graduated from the University of Minnesota College of Veterinary Medicine in 1990, and later began her studies in acupuncture, Chinese medicine, chiropractic medicine, and naturopathic modalities. In 1999, she founded her practice, Natural Care Institute, and in 2017, she founded UnBound Center for Animal Wellness, for special needs pets. Dr. Brandt pioneered the field of Veterinary Medical Aromatherapy® and founded the Veterinary Medical Aromatherapy Association (nancybrandtdvm.com, sparkeducationonline.com). p.46

7. MEGAN KELLY, BVSC, CCRP

Dr. Megan Kelly has been a veterinarian for 19 years. After completing a Post Graduate Certificate in Veterinary Rehabilitation at the University of Tennessee, she opened her own practice, Holisticvet, in Diep River, Cape Town. In 2014, Dr. Kelly decided to take a sabbatical from practising and has since been swept up into the online world of veterinary education. She owns and runs onlinepethealth.com, an international continuing education site for veterinary rehabilitation therapists. She creates and provides solutions for vets and veterinary rehab therapists through webinars and online conferences. p.23

2. MARI DELANEY, DVM Dr. Mari Delaney, a graduate of the Cornell University College of Veterinary Medicine, has been practicing small animal medicine and surgery since 1995. Her interests lie in preventative medicine and it is this dedication that led to her development of VetProtect, an easily accessible tool to help prevent accidental poisonings of pets. Dr. Delaney’s focus is to develop tools for pet parents that allow for high quality care and strengthen the pet/ human bond. p.30

3. KELLY DIEHL, DVM, MS Dr. 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.26

4. W. JEAN DODDS, DVM Dr. Jean Dodds received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she established Hemopet, the first non-profit national blood bank program for animals. Dr. Dodds has been a member of many committees on hematology, animal models of human disease and veterinary medicine. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1994. p.40

5. HANNAH GODFREY, BVETMED MRCVS Hannah Godfrey is a small animal veterinary surgeon practicing in Cardiff, UK. She has over ten years of clinical experience, and has undertaken additional training in dentistry and soft tissue surgery. Hannah also provides quality client-facing written communication on common pet health issues; writing content and communications for veterinary professionals; and editing medical and veterinary medical journal articles. She holds the position of Community Lead for VetLed, a Veterinary Human Factors training provider. p.34

6. JOYCE C. HARMAN, DVM Dr. Joyce Harman graduated in 1984 from Virginia Maryland Regional College of Veterinary Medicine. She is certified in veterinary acupuncture and chiropractic and has completed advanced training in homeopathy and herbal medicine. Her practice in Virginia uses holistic medicine to treat horses. Her publications include The Horse’s Pain-Free Back and Saddle-Fit Book — the most complete source of information about English saddles p.48

IVC Spring 2023

8. ANGIE KRAUSE, DVM, CVA, CCRT

Dr. Angie Krause graduated from Texas A&M University, College of Veterinary Medicine in 2007. She incorporates many holistic modalities into her practice, has a love for Traditional Chinese Medicine and Physical Medicine, and offers laser therapy, myofascial release, physical therapy, nutrition, and more. Dr. Angie has a house call practice called Boulder Holistic Vet (BoulderHolisticVet.com). p.18

9. 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.42

10. JUDY MORGAN, DVM, CVA, CVCP, CVFT

Dr. Judy Morgan graduated from the University of Illinois College of Veterinary Medicine in 1984. She is certified in Veterinary Orthopedic Manipulation, and in Acupuncture and Food Therapy from the Chi Institute, as well as acupuncture, food therapy, and chiropractic care. She has authored four books on holistic pet care, and has over 700 educational videos on Facebook and YouTube (drjudymorgan.com). p.14

11. EMILY SINGLER, VMD

Dr. Emily Singler is a 2001 graduate of Penn State University and a 2005 graduate of University of Pennsylvania School of Veterinary Medicine. She has experience in shelter medicine and private practice, and currently works as a veterinary writer, consultant, and mentor. Dr. Singler has written and consulted for Fetch Pet Insurance; her other writing interests include preventive medicine and the human-animal bond. She authored Pregnancy and Postpartum Considerations for the Veterinary Team (CRC Press, November 2023), and shares educational and supportive content on her social media channels, website and blog through her brand Vet Med Baby. (vetmedbaby.com). p.8

editorial

The respiratory system as the

essence of life

Welcome to a new chapter of discovery in this issue of IVC Journal! I am thrilled to guide you through the remarkable realm of the respiratory system — a theme that encapsulates the very essence of life itself. This vital orchestra of airways and lungs serves as a testament to the interconnected design of nature. In the past, our understanding of the respiratory system was confined to the mechanics of breathing, the exchange of gases, and the detection of diseases. But the paradigm has shifted in more recent years. We now stand at the intersection of pioneering research, cutting-edge technologies, and a holistic approach that acknowledges the profound influence of respiration on an animal’s overall well-being. This issue of IVC Journal delves into the intricate function of the lungs, and explores the ways diseases disrupt this harmony, and how innovative interventions can restore balance in your patients. From investigating the role of alternative approaches for maintaining lung health, to unraveling the complexities of respiratory problems and their impact on the animals we care for, our contributors illuminate the myriad connections that characterize the respiratory system’s importance and significance. As we ponder the intricacies of the respiratory system, we should also recognize the broader implications, posed by challenges such as environmental changes, pollution, and zoonotic diseases. Interestingly, technology is reshaping our ability to diagnose, treat, and prevent respiratory ailments. From advanced imaging techniques that give us unprecedented insights into lung structures, to the development of personalized treatment plans based on genetic markers, we live in an

era when innovation is synonymous with enhanced care. The integration of tele-medicine and AI-driven diagnostics amplifies our capacity to monitor and manage respiratory health, ensuring no animal is left behind. With all this in mind, I am delighted to highlight some of the valuable contributions enriching the pages of this issue. Dr. Jean Dodds’ insightful article on chronic bronchitis sheds light on a condition that significantly affects our canine companions. Meanwhile, Dr. Judy Morgan explores the intersection of Chinese food therapy and upper respiratory tract issues in canines, and exemplifies the importance of considering traditional practices alongside modern veterinary medicine. An article by Dr. Nancy Brandt on herbal treatment approaches to lungworm infections in dogs expands our knowledge of alternative treatments for the disease. In the spirit of continuous advancement, I encourage us all to seize the opportunities that lie ahead. Let us embark on an unceasing journey, unraveling the mysteries of different biological systems, and harnessing our knowledge to foster the well-being of animals, humans, and the delicate balance of our shared environment.

Best regards,

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

IVC Fall 2023

ADVANCES IN ARTIFICIAL INTELLIGENCE (AI) AND VETERINARY EPIDEMIOLOGY BY EMILY SINGLER, VMD

Because of its potential for creating valuable insights into protecting animal health, artificial intelligence (AI) will be a big part of the future of veterinary medicine and epidemiology. This means experts in veterinary medicine, epidemiology, and AI will need to work together to ensure the technology is used responsibly and interpreted correctly.

Almost every facet of everyday life has been affected by artificial intelligence (AI), or will be in the near future. From autocorrect features on smart devices to photo editing apps and the increasingly popular ChatGPT, AI is transitioning from a poorly understood topic of science fiction stories to an integral feature of daily life. In many industries, AI has become an essential tool for improving workplace efficiency and advancing new discoveries. It has already started to leave its mark on the fields of veterinary medicine and animal health. In clinical practice, for example, AI is being used to predict the likelihood of renal disease in cats based on serial lab work results.1 AI-assisted radiographic interpretation, called radiomics, has been used in the analysis of digital radiographs and ultrasound images.2 And practitioners are touting ChatGPT as a productivity aid to speed the writing of their medical note templates. Apart from uses in clinical practice, AI has also become an increasingly effective tool in veterinary epidemiology, which is what this article will focus on.

IVC Fall 2023

AI AND BIG DATA Veterinary epidemiology is defined as “a study of the distribution and determinants of animal health-, welfare-, and production-related states or events.”3 Veterinary epidemiology can be helpful in promoting health and well being at the level of the individual, the herd, and the community at large (both animal and human). With the rise of big data in veterinary medicine, AI has become increasingly relevant and necessary. Big data is defined as “large, hard-to-manage volumes of data — both structured and unstructured — that inundate business on a day-to-day basis.”3 Veterinary big data can include animal demographics and lifespan, rates of death or disease, and other factors such as weather patterns, animal movement, and geography.3,4 Sources of veterinary big data include the Dog Aging Project, the Golden Retriever Lifetime Study, and the Veterinary Companion Animal Surveillance System

(VetCompass), among many others.5 AI has the potential to unlock previously unknown insights from this data, to highlight areas where further study is needed, and predict future challenges. AI’s superiority over other forms of data analysis lies in its ability to consume data in large quantities, and draw conclusions from it, without a human having to direct every step the algorithm takes. These advantages can result in faster results, lower costs, and new insights into problems that were previously difficult or cumbersome to address. One form of commonly-used AI is machine learning (ML), defined as “a subfield of AI in which algorithms are trained to perform tasks by learning patterns from data rather than by explicit programming.”5,6 ML can be divided into several different categories depending on the type of data being used, how much is known about the data, and what the goals of the analysis are. Within these different types of ML are various models that can be used individually to evaluate the data.

With ensemble learning, multiple models are used in synchrony to improve the accuracy and consistency of the results.7 Other forms of AI include data mining (searching through large amounts of data for patterns), natural language processing (AI algorithms that are trained to “understand” written and/or spoken text, such as in medical records), and signal processing (analysis of images, audio or video, and other types of information).5 The use of ML and other forms of AI can significantly improve our ability to diagnose disease, assess patient morbidity IVC Fall 2023

and mortality risk, predict and monitor disease outbreaks, and plan health policy in both human and animal health.8 We’ll now review some of the current and potential uses of AI in veterinary epidemiology, along with some of the obstacles that AI faces in becoming a more useful tool in veterinary medicine.

COMPANION ANIMAL MEDICINE Fetch Pet Insurance recently reported their use of AI to analyze a pool of more than 750,000 insured dogs and 2.4 million claims collected from these dogs over 17 years. The data included breed, age, sex, geographical location, history of previous diseases, and any treatments the dogs received. Using ensemble ML, researchers were able to identify 45 disease groups whose risk of occurring in the next year can be predicted in individual dogs with a high degree of

accuracy. These include 710 specific diseases (82.5% of the claims submitted). Examples of predicted conditions include arthritis, disc diseases, diabetes, thyroid disorders, adrenal gland disorders, and certain cancers. These ML models can be helpful for pet insurance companies to predict the risk of certain conditions, and therefore provide better preventative recommendations to help clients reduce the risk for their dogs. This data may also be useful for other research studies aimed at preventing and treating diseases in dogs.9 Studies have demonstrated the effectiveness of AI in identifying patients who should be tested for Addison’s disease or Cushing’s syndrome.10,11 AI with natural language processing software has also been programmed to “read” medical records and codify them so they are easier to track and draw conclusions from in the future.12

CURRENT OBSTACLES TO AI USE IN VETERINARY MEDICINE Since treatment decisions in veterinary medicine can affect the health and

even survival of our patients, it is essential for veterinary professionals to have confidence in the feedback they receive from any AI technology. In human medicine, AI use is regulated by the FDA, but there is no such oversight for its use in veterinary medicine. Because of the lack of

regulation, there is no requirement for transparency about the source and quality of data, and the models used to generate conclusions. This can leave the door open for misuse of algorithms and the utilization of poor-quality models. The quality of the data being fed to an AI algorithm can greatly affect any conclusions it draws. Therefore, incomplete or imbalanced data may give results that are biased.3 When AI is utilized in the diagnosis or treatment of animals, it’s important to inform clients of its use so that they are aware of the role that AI may play in their animals' treatment outcome.6

Other concerns include risks surrounding security and confidentiality, especially with respect to animal owner information. Costs associated with obtaining the data, selecting appropriate algorithms, maintaining the necessary hardware and software, and hiring the appropriate individuals to evaluate the results can be limiting factors as well.

There are also concerns that AI might be considered a substitute for veterinarians and other animal health professionals in the future. While some of this fear may be rooted in science fiction, where AI became sentient, some is also likely based on the vast and comprehensive information that can be quickly evaluated and/ or generated using AI today. While it will revolutionize the way we practice

veterinary medicine, most experts agree that AI will never replace humans in the practice of veterinary medicine. They do predict that AI will become so intertwined in the various ways veterinary medicine is practiced that it will be virtually impossible to not use it, and the insights gained from it, when treating animals or studying animal diseases.6

IVC Fall 2023

For dogs with neoplasia, AI is helping researchers examine new ways to administer radiation therapy that results in less damage to healthy tissue. Following advances made in human radiation oncology, veterinary researchers are studying ways to use AI technology such as ML and deep learning (DL — a specific type of ML), to clean up the “noise” on CT images used for planning radiation treatment in animals. AI technology is also being combined with information about genetic markers for cancer to more accurately and efficiently create radiation treatment plans with fewer toxic side effects to healthy tissue, a field known as radiogenomics.13

PRODUCTION ANIMAL MEDICINE AI also has many uses for improving the health and production of livestock species. Since measures taken to treat livestock species are usually done at the herd level, AI’s ability to process large amounts of data and incorporate multiple variables is ideal. AI algorithms have been constructed to consider weather patterns, movement of animals, and current disease incidence in a particular geographical location. These algorithms are then used to predict the risk of future disease in populations of animals, and help producers pinpoint which steps would be most appropriate to reduce the risk. One such study in India developed a “disease-climate relationship model” using AI and GIS (geographic information system) to predict 13 “economically important” livestock disease outbreaks.14

Early Warning Systems (EWS) can also be developed using AI and remote surveillance to detect changes in the environment that can negatively affect animal nutrition and health. This can include tracking drought conditions, measuring the amount of water present in a watering hole, and measuring and predicting the growth of vegetation upon which grazing animals depend for food.14,15 Other reported uses of AI include predicting lameness in dairy cows based on milk production and conformation traits; estimating the location, size, and type of poultry operations in the US using drone images; early detection of emerging animal diseases; and identifying predictive factors for farms becoming positive for bovine tuberculosis.9 In addition to disease prediction, AI is a useful tool for livestock disease surveillance in what would otherwise be a very labor-intensive and costly process. Instead of humans visiting or otherwise communicating with producers and recording information on animal population numbers, locations, and disease rates, drones and remote sensors can be used to capture images

and other information that can be analyzed using AIbacked photo recognition software and other programs. This type of photo surveillance is also useful for detecting lesions in animals in slaughterhouses that can serve as sentinels of disease in the animal population.7

ADDITIONAL USES FOR AI IN VETERINARY EPIDEMIOLOGY • AI can be very helpful for answering questions about wildlife health and disease, which can be inherently harder to study. Some

As we continue to use AI more and more in veterinary medicine, it will be essential to maintain reasonable expectations for the AI modality being used. While it is possible to ask certain AI programs like ChatGPT to create a comprehensive list of differential diagnoses for a case based on clinical signs and physical exam findings, this is not the same as predictive modeling. This is just one example of AI technology that has some usefulness for veterinary and other healthcare professionals, but was not created specifically for this purpose and should be utilized with caution.

studies have used it to determine which species of carnivores and bats have the potential to become reservoirs for rabies virus in the future, even if they have not previously been identified as rabies reservoirs. • There is also interest in using AI to identify species of bats that may act as reservoirs for coronaviruses, of which the Sars-CoV2 virus that causes COVID-19 is one.8 • A I has been used to estimate the effects of environmental lead contamination in bald eagle deaths,16 and to determine the impacts of parasites on wild moose populations.17 • In equine medicine, researchers are using AI to try and predict

With so much potential for creating valuable insights that can protect animal health, AI is guaranteed to be part of the future of veterinary medicine. It will be incumbent upon experts in the fields of veterinary medicine, epidemiology, and AI to work together to ensure this technology is used responsibly and interpreted meaningfully.

which racehorses are at higher risk for “catastrophic” breakdown on the racetrack, based on computed tomography images of their legs.18 • AI is also being used in the search for new animal drugs and vaccines by speeding up the evaluation of various potential candidates and for analyzing multidrug res-

Burns K. Creating brighter futures for cats with chronic kidney disease. Published February 1, 2021. Accessed July 12, 2023.

istance in bacteria.19

Hespel AM, Zhang Y, Basran PS. Artificial intelligence 101 for veterinary diagnostic imaging. Vet Radiol Ultrasound. 2022 Dec;63 Suppl 1:817-827.

• O ther studies are analyzing Listeria contamination in

Peake T. Artificial Intelligence in Veterinary Medicine Raises Ethical Challenges. NC State University. Published December 14, 2022. Accessed June 27, 2023. https://news.ncsu.edu/2022/12/ artificial-intelligence-in-veterinary-medicine-raises-ethical-challenges/.

food packing plants, and

Paynter AN, Dunbar MD, Creevy KE, Ruple A. Veterinary Big Data: When Data Goes to the Dogs. Animals (Basel). 2021 Jun 23;11(7):1872.

and find ways to reduce the

Appleby RB, Basran, PS. Artificial intelligence in veterinary medicine. JAVMA Volume 260 Issue 8.

Guitian J, Arnold M, Chang Y, Snary EL. Applications of machine learning in animal and veterinary public health surveillance. Rev Sci Tech. 2023 May;42:230-241.

Kundu R. The Complete Guide to Ensemble Learning. V7 Labs. Published March 1, 2022. Accessed June 27, 2023. www.v7labs.com/blog/ensemble-learning.

using AI to look for patterns risk of contamination and resulting food-borne illness.20

Schwalbe N, Wahl B. Artificial intelligence and the future of global health. Lancet. 2020 May 16;395(10236):1579-1586.

Debes C, Wowra J, Manzoor S, Ruple A. Predicting health outcomes in dogs using insurance claims data. Sci Rep 13, 9122 (2023)

Matere J, Simpkin P, Angerer J, Olesambu E, Ramasamy S, Fasina F. Predictive Livestock Early Warning System (PLEWS): Monitoring forage condition and implications for animal production in Kenya, Weather and Climate Extremes, Volume 27, 2020, 100209

Hanley BJ, Dhondt AA, Forzán MJ, Bunting EM, Pokras MA, Hynes KP, Dominguez-Villegas E, Schuler KL. 2022. Environmental lead reduces the resilience of bald eagle populations. Journal of Wildlife Management 86:e22177.

Zhao Y. 4 Uses of AI in Veterinary Medicine. AI Time Journal. Published August 8, 2022. Accessed June 27, 2023. www.aitimejournal.com/uses-of-ai-in-veterinary-medicine/.

Schofield I, Brodbelt DC, Kennedy N, Niessen SJM, Church DB, Geddes RF, O'Neill DG. Machine-learning based prediction of Cushing's syndrome in dogs attending UK primary-care veterinary practice. Sci Rep. 2021 Apr 27;11(1):9035.

Nie A, Zehnder A, Page RL, Zhang Y, Pineda AL, Rivas MA, Bustamante CD, Zou J. DeepTag: inferring diagnoses from veterinary clinical notes. NPJ Digit Med. 2018 Oct 24;1:60.

Leary D, Basran P. The role of artificial intelligence in veterinary radiation oncology. Vet Radiol Ultrasound. 2022 Dec; Suppl 1:903-912.

Suresh KP, Dhemadri K Rashmi, Dheeraj R, Roy, P Application of Artificial Intelligence for livestock disease prediction. Indian Farming 69(03): 60-62; March 2019.

IVC Fall 2023

Cornell University. MoosePOPd: Population Dynamics in the Presence of Lethal Parasites. Accessed July 22, 2023. https://cwhl.vet.cornell.edu/tools_and_resources/moosepopd-population-dynamics-presencelethal-parasites. Basran PS, McDonough S, Palmer S, Reesink HL. Radiomics Modeling of Catastrophic Proximal Sesamoid Bone Fractures in Thoroughbred Racehorses Using μCT. Animals (Basel). 2022 Nov 4;12(21):3033 Cazer C, Westblade L, Simon M, Magleby R, Castanheira M, Booth J, Jenkins S, Grohn Y. Analysis of Multidrug Resistance in Staphylcoccus aureus with a Machine Learning-Generated Antibiogram. Antimicrobial Agents and Chemotherapy. 2021 Mar 18; 65(4). Barnett-Neefs C, Sullivan G, Zoellner C, Wiedmann M, Ivanek R (2022) Using agent-based modeling to compare corrective actions for Listeria contamination in produce packinghouses. PLoS ONE 17(3): e0265251.

PROFITABLE PRACTICE

HOW NUTRISOURCE G EEDIN FULL CIRCLE F

Y ANIMAL H T L A E H O T S LEAD D PROFITS N A — S T N IE T PA m rcepetfoods.co

https://nutrisou

PROMOTE FULL-BODY HEALTH WITH FULL CIRCLE FEEDING Full Circle Feeding is a dietary approach created by NutriSource. It uses high quality kibble and wet food, rotational feeding, and toppers to support canine brain function, skin and coat health, and gut health. And it’s easy: your clients follow five simple steps to support whole body wellness in their dogs: 1.

Pick any nutrient-dense NutriSource kibble — they are all optimized for bio-availability.

Add a wet food entrée to make meals tastier and provide a wider variety of protein sources for a full spectrum of nutrients.

Add a postbiotic Come-Pooch-a topper for gut health and additional hydration.

Regularly rotate proteins and carbohydrates.

Enjoy the results: less scratching and licking, better health, and more energy

in, ing promotes sk Full Circle Feed al im gut health for an coat, brain, and s ient encouraging cl patients, while sis. ba r la on a regu to buy products

G ENERATE REVENUE WITH REPEAT BUSINESS Full Circle Feeding delivers results, so your patients will thrive. It’s also lucrative for your practice because it prescribes rotational feeding and encourages clients to buy products frequently and consistently. This feeding method promotes the purchase of multiple smaller bags of kibble to ensure freshness, and a

selection of wet foods to keep dogs interested in eating. There are also three Come-pooch-a topper recipes for picky dogs and a variety of healthy, lowcalorie, protein-packed treats.

NutriSource has a large selection of over-the-counter products, so clients will always come back for more. Brands include flagship NutriSource recipes, high protein Element Series recipes grain-inclusive Choice recipes, and single protein source PureVita limited ingredient recipes for dogs with allergies or sensitivities. Every brand contains the company’s proprietary Good 4 Life system, with four key ingredients that work together to support gut health and the overall wellbeing of pets.

I NCOME POTENTIAL The retail margins on NutriSource products range from 25% to 50% depending on distributor pricing and product selection.

T RAINING REQUIREMENTS The company provides extensive product and nutrition training for all their product lines. IVC Fall 2023

nutrition nook

CHINESE FOOD THERAPY for upper respiratory tract diseases in dogs BY JUDY MORGAN, DVM, CVA, CVCP, CVFT

In TCVM, three major patterns lead to upper respiratory tract diseases in dogs. Based on which pattern is presented by the patient, Chinese food therapy can be used to help treat the problem and resolve symptoms.

According to TCVM (Traditional Chinese Veterinary Medicine), disease is due to some type of energetic imbalance in a dog’s body. The goal of TCVM food therapy is to maintain balance, or bring the dog’s body back into balance. As the dog attains and maintains energetic balance, acute and chronic health challenges become less of a problem. This article focus on how Chinese food therapy can be used for upper respiratory tract disorders in our canine patients.

Infectious upper respiratory diseases are among the most common problems diagnosed and treated in small animal practice and shelter medicine. The main disorders seen are nasal congestion or discharge and cough. In TCVM, the Lungs are the organs most susceptible to invasion from external pathogens. The main disease processes seen in veterinary medicine include rhinitis, sinusitis, infectious tracheobronchitis (kennel cough), asthma, and pneumonia.

THE RESPIRATORY SYSTEM FROM A TCVM PERSPECTIVE

Lungs like moisture and dislike dryness, which is why the drying effect of wind has detrimental effects on the Lung system. Foods that moisturize the Lungs are especially important during the winter when the air is dry and forced air heating is used inside homes, or in dry desert environments with extremely low humidity.

The respiratory system is associated with the element of Metal in TCVM, which consists of the Lung and Large Intestine as the target organs. The main function of the Lung is to Govern Qi (energy) and respiration, while also controlling the skin and hair coat that dominate the body surface and influence the protective Wei Qi of the body. The Lung connects to the trachea and opens to the nose.1 A patient with normal Lung Qi will enjoy excellent, unobstructed respiration with a keen sense of smell. When this pathway of Lung Qi is disrupted, pathology manifests as upper or lower respiratory tract disease. The lungs are the first barrier to pathogenic invasion; they filter the air that is inhaled. Healthy lung function forms the first defense against cold and wind that assault the body. Skin forms the outer defensive layer for the body.2

IVC Fall 2023

Moisturizing foods are called Yin tonics and include turkey, duck, cod, clam, rabbit, alligator, shark, egg white, mussel, conch, duck egg, herring, millet, barley, brown rice, flax seed, alfalfa, spinach, broccoli, celery, mushroom, kelp, seaweed, cucumber, radish, asparagus, melons, pear, apple, blueberry, and honey. Three major patterns in TCVM lead to upper respiratory tract disease symptoms: Wind-Cold, Wind-Heat, and Nasal Damp Heat. Wind is the master pathogen because it penetrates everywhere and goes anywhere.3 Wind often carries other pathogens into the body, such as Cold, Heat, Dryness, and Damp. It is a light pathogen, meaning it often affects the upper parts of the body.

1 Wind-Cold External pathogens invade the body through the nose as Wind-Cold. If the Wei Qi and Lung Qi are strong enough, the body will remove the pathogens through sneezing and nasal discharge. If the Qi is not able to clear the pathogen, Cold will lead to stagnation of the discharge flow, resulting in congestion in the nasal passages and sinuses. Clinical signs may include: • Acute onset, less than three-day course • Nasal congestion and clear nasal discharge • Sneezing • Chills, aversion to cold

• Cough • Generalized pain in the body • Fever (may be present) • Wet pale tongue that may be lavender or have a thin white coating

Therapy to treat Wind-Cold is aimed at unblocking the nasal passages and opening the nose. Warming foods such as chicken, lamb, venison, pumpkin, turmeric, oats, shrimp, ginger, fennel, and basil can be added to the diet. Warm ginger tea is an excellent supplement for Wind-Cold invasion. Cold foods such as crab, clams, watermelon, barley, millet, rabbit, duck, celery, cucumber, cod, alligator, dairy, and asparagus should be avoided. For prevention, avoid overcrowding, stress, and excessive cold; always provide good ventilation. The herbal formula Ba Wei Yu Ping Feng San can help prevent pathogen by supporting protective Wei Qi and strengthening the Spleen and Lung. Start the herbal formula two days prior to anticipated pathogen exposure, such as a kenneling situation. Dosage is 0.5 grams per 10 pounds body weight, twice daily for up to 30 days.

2 Wind-Heat Wind-Heat occurs when Wind carries Heat into the body. This pattern can also occur if the Lung Qi and Wei Qi fail to clear the Wind-Cold pattern. The goal is to stop the pathogens before they can move deeper into the Lungs. Phlegm develops when the fluids become dry, congealed, and solidified (thick, sticky mucus). Clinical signs can include: • Less than seven-day course

• Dry stool and dark urination

• Congestion

• Warm air noted on exhalation

• Sneezing

• Nasal congestion with thick yellow discharge that may contain blood

• Strong cough • Trouble breathing • Fever

• Red, dry tongue that may have a yellow coating

Treating Wind-Heat involves clearing heat, stopping cough, resolving Phlegm, and eliminating nasal congestion. Foods to clear heat include turkey, cod, clam, scallop, alligator, rabbit, spinach, asparagus, honey, peppermint, and

white radish. Foods that help resolve Phlegm include clams, pears, ground almonds, Daikon radish, kelp, mustard greens, Shiitake mushrooms, and cabbage. Avoid hot foods or foods that generate Phlegm, including chicken, lamb, shrimp, venison, dairy, white rice, oats, ginger, garlic, pumpkin, and winter squash. An herbal tea of honeysuckle flower, hawthorn berry, and honey can be added to food to activate the immune system.

Immune system support

For prevention, avoid stress and overcrowding, and excessive heat. Provide good ventilation. The herbal formula Yin Qiao San has antiviral activities and is effective for Wind-Heat. Dosage is 0.5 grams per 10 pounds body weight, twice daily for up to 30 days.

3 Nasal Damp Heat This pattern occurs when Wind-Cold or Wind-Heat combine with Phlegm. Prolonged exposure to Damp and Heat (dietary or environmental) can predispose a dog to this pattern. Nasal Damp Heat is more difficult to resolve than Wind-Cold or Wind-Heat. Clinical signs can include: • • • • • • •

In TCVM, a strong immune system means strong Spleen Qi, a free flow of Qi and Blood, and strong Wei Qi. More emphasis should be placed on the immune system itself than the bacteria and viruses that may invade the body. Pathogens are always present in the environment; but they can only harm the patient if the immune system is too weak to defeat them. As soon as Wei Qi weakens or is insufficient, the pathogenic bacteria and viruses easily invade the body and cause disease. Herbal formulas such as Si Jun Zi Tang and Wei Qi Booster (Jing Tang herbal) help tonify Qi, Blood, Yin and Yang, thereby boosting Wei Qi. The main ingredients of Wei Qi Booster are Bai Hua She She Cao and Ban Zhi Lian to inhibit cell mutation and tumor growth; Chen Pi to move Qi and transform Phlegm; Dang Gui to tonify Blood; Dang Shen to tonify Qi and boost Wei Qi; Huang Qi to tonify Qi in the whole body; Wu Yao to move Qi and clear Stagnation, and Xuan Shen to cool Blood and nourish Yin. The formula should not be used in conditions with excess Heat such as acute inflammation, infection, or high fever.5 Foods that support a healthy immune system include: • B lueberries – nourish Blood and Yin, clear Heat, antioxidant; anthocyanin flavonoid plays an essential role in the respiratory tract’s immune defense system6 • T urmeric – antioxidant, anti-inflammatory, Qi tonic, resolves Stagnation • O ily fish – rich source of Omega-3 fatty acids, antiinflammatory, Blood and Qi tonic

• B roccoli – source of vitamin C, sulforaphane (which helps vitamin C get into cells), antioxidant, tonifies Yin and Blood, clears Heat

• S weet potato – reinforces Spleen and Stomach, antioxidant, rich source of carotene and vitamin A • S pinach – rich in vitamins C and E, flavonoids, and carotinoids; Blood tonic

• G inger – anti-inflammatory, antioxidant, warms the Lung, arrests cough, warms the Middle Burner • G arlic – reinforces Stomach, aids digestion, warms the Middle Burner

• R ed bell pepper – source of vitamin C, warms the Stomach and promotes circulation • Almonds – regulate Qi circulation, moisten the Lung, transform Phlegm

IVC Fall 2023

A more chronic state Thick, yellow nasal discharge/congestion Anorexia (lack of appetite) Ulceration of the gums Obesity Diarrhea Red tongue with a greasy coating

Treatment is aimed at clearing Damp and Heat, resolving congestion, and promoting appetite. Foods that are cooling and drain Damp include asparagus, celery, cucumber, pear, lettuce, clam, turkey, cod, scallop, rabbit, duck, turnip, apple, barley, ground almonds, honey, and Shiitake mushroom. Avoid dairy, sweet foods, lamb, and venison. The herbal formula Zhu Shi Tong Qiao Fang can be used for this condition.4 Dosage is 0.5 grams per ten pounds body weight for up to 30 days. This formula clears Wind-Cold and Damp Heat, and transforms Phlegm. Small additions to the diet, based on TCVM pattern presentation, can make a big difference in the pet’s ability to fight off pathogens and remain healthy in the face of stress and exposure during kenneling, showing, and daycare situations.

1Xie H, Fowler M. Food Therapy for Metal Disorders. In: Integrative and Traditional Chinese

Veterinary Medicine Food Therapy. Florida: Chi University Press, 2020; pp413-420.

2Morgan J, Grant H. Metal. In: Yin & Yang Nutrition for Dogs. United States: 36 Paws Press, 2017;

p. 188.

3Xie H, Preast V. Primary Diagnostic Systems. In: Traditional Chinese Veterinary Medicine

Fundamental Principles. 2nd ed. Florida: Chi University Press, 2013; p. 336.

4 Ma A. Formulas to Clear Heat. In: Clinical Manual of Chinese Veterinary Herbal Medicine. 5th ed.

Florida: Ancient Art Press, 2020; p. 299-300.

5Ma A. Formulas to Tonify Qi, Blood, Yin and Yang. In: Clinical Manual of Chinese Veterinary Herbal

Medicine. 5th ed. Florida: Ancient Art Press, 2020; p. 81-84.

6Somerville V, Braakhuis A, Hopkins W. Effect of Flavonoids on Upper Respiratory Tract Infections

and Immune Function. In Advances in Nutrition. 2016 May; 7(3): 488–497.

ADVERTORIAL

ADVANCING VETERINARY CARE THROUGH MICROBIOME RESTORATION & INTEGRATIVE MEDICINE Nurturing resilient microbiomes can prove to be a game changer for the health of companion animals.

The intricate relationship between an animal's microbiome and their overall health is becoming increasingly apparent in the field of veterinary science. A diverse community of micro-organisms that inhabits the body, the microbiome plays a pivotal role in supporting an animal’s natural healing processes.

PRESERVING THE MICROBIOME BALANCE The human-animal bond is deeply intertwined with the well-being of our beloved companions. The source of the microbiome is of exceptional importance, particularly in the face of numerous external factors such as antibiotics, NSAIDs, pesticides, herbicides, and chemical agents that can significantly disrupt this delicate internal balance. Enter Touch of Life Microbiome, an extraordinary microbiome source that has been nurtured over six genera-

tions of dogs spanning three decades to safeguard this invaluable internal ecosystem. This legacy of protection ensures that the canine microbiome remains resilient, robust, and capable of supporting optimal health.

V ISIONARY VETERINARIAN At the forefront of this revolutionary approach is Dr. Margo Roman, a visionary veterinarian based in the Boston area. With a career marked by pioneering accomplishments, Dr. Roman's practice, Main Street Animal Services of Hopkinton (MASH), has been offering integrative veterinary care since 1983. Through her groundbreaking work, she has championed the use of MicroBiome Restorative Therapy (MBRT) and medical ozone therapy, which have shown promising results in aiding seriously ill pets on their path to recovery. Dr. Roman’s contributions extend beyond the clinic as she participates in microbiome conferences and collaborates on innovative research studies, including canine microbiome and nutrition investigations at MIT.

H OLISTIC APPROACH TO NURTURING MICROBIOME HEALTH A hallmark of Dr. Roman’s approach lies in her commitment to healthy living standards for her animal donors. These standards encompass natural births with organic bedding, extended maternal nursing, minimal vaccination protocols with regular titer monitoring, consistent organic raw diets, and chemical-free environments that exclude conventional medications that may suppress the microbiome. This holistic approach to nurturing healthy donors over multiple generations ensures the perpetuation of robust, thriving microbiomes. The symbiotic relationship between the microbiome and the overall health of animals has immense potential to enhance the well-being of our patients. More information can be found at mbrt.life and mashvet.com, both invaluable resources at the forefront of microbiome research and integrative veterinary care.

IVC Fall 2023

AN INTEGRATIVE APPROACH TO PAIN MANAGEMENT IN FELINE PATIENTS BY ANGIE KRAUSE, DVM, CVA, CCRT

Because cats are good at hiding discomfort, pain is sometimes missed and undiagnosed. Helping clients understand the signs of pain in cats, along with an integrative approach to pain management that draws on traditional and alternative therapies, is the most effective solution. Feline pain management is a critical aspect of veterinary care. It significantly impacts a cat's overall well-being and quality of life. Cats are skilled in hiding their pain and have long been neglected by society and veterinary medicine. An integrative approach to pain that combines multiple modalities and innovative treatments can provide the most comprehensive and effective solution. In this article, we will explore both traditional and alternative methods for managing pain in the feline patient.

ASSESSING PAIN Feline pain can be difficult to assess in the clinic setting, especially as many cats are stressed from transport and may be fractious about having an examination. Often, cat guardians are the most valuable resource for assessing pain. Combining tools such as the Feline Grimace Scale, diagnostic imaging, as well as history and physical examination can give the most accurate picture of a feline patient’s pain level.

IVC Fall 2023

Guardian history Feline guardians are a valuable source of behavioral data that aids in pain assessment. The following are important and often overlooked signs that feline patients are experiencing discomfort, and should be included in your history: •

Litter box issues — cats that are too painful to step into the litter box, or to posture to urinate and defecate, may show signs of distress by eliminating outside or near the litter box.

•

Avoiding stairs — osteoarthritis of the spine or extremities is common in cats and may cause them to become less mobile.

•

Hiding — many cats in pain will hide under beds and behind couches. This can be a missed sign in cats that are generally less social.

•

Refraining from jumping on couches, beds, and other furnitue — these behaviors may change slowly over time and may be difficult to perceive by cat guardians.

•

Overgrooming — this common symptom may be caused by many factors, including nerve, musculoskeletal or visceral pain.

Feline Grimace Scale The Feline Grimace Scale (FGS) is an essential tool for objectively assessing pain in cats. It can be used by both practitioners and cat guardians. This non-invasive method involves observing the cat's facial expressions for specific changes indicative of discomfort. Common parameters include ear position, orbital

PHYSICAL MODALITIES ACUPUNCTURE Acupuncture has been used for thousands of years to bring pain relief to humans and animals alike. Many cats tolerate acupuncture very well, especially in the home setting. As house call practices gain popularity, they’re becoming a more accessible option for cats and their guardians. Acupuncture is used to help with many types of pain in cats, including neurological, musculoskeletal and soft tissue pain. A recent study showed that cats receiving preoperative acupuncture experienced better pain control for the first 24 hours post ovariohysterectomy.8 There are more studies investigating acupuncture in humans and dogs that can be extrapolated to cats.

tightening, muzzle tension, whisker change, and head position. A study done in 2021 validated the Feline Grimace Scale as an effective and reliable tool for pain assessment in cats. The research found that veterinarians, veterinary nurses and pet guardians could all reliably use the Grimace Scale to accurately assess pain in cats.1 A complete guide to using the Feline Grimace Scale can be found at www.felinegrimacescale.com.

Radiographs Radiographs are an important diagnostic tool in the assessment and diagnosis of feline osteoarthritis (OA). In a study of 100 cats over the age of six, 61% had radiographic signs of osteoarthritis.2 While feline patients may have radiographic changes consistent with degeneration, these findings may not be clinically significant. It’s important to consider the cat’s behavior at home in combination with a physical examination to understand the importance of radiographic findings.

Physical examination A physical examination can be of limited value when done in a clinic setting. Stress hormones and fear can cause many cats to mask pain. Mobile veterinarians may be beneficial in helping diagnose gait abnormalities at home. Alternatively, having the guardian make a video of the cat walking may be useful. Confident cats may feel more relaxed in a clinic setting and may allow a full orthopedic examination.

PHYSICAL THERAPY Canine physical therapy and rehabilitation is a growing sector of veterinary medicine. Physical rehabilitation has been shown to improve outcomes for both dogs and humans, and would be expected to show the same benefits for cats. While more studies are needed to evaluate the modalities physical rehabilitation encompasses, it’s reasonable to use them post operatively and to improve daily function and decrease pain in cats. Myofascial release, massage, therapeutic laser, therapeutic ultrasound, hydrotherapy and therapeutic exercises may all be applied to treat feline pain in many settings.

TREATING PAIN Weight management It’s estimated that up to half of all household cats are overweight or obese.3 This common problem can contribute to body pain and worsen osteoarthritis. Providing guardians with weight loss strategies should be a top priority for the treatment of pain for cats that do not have an ideal body condition. Below are examples of weight loss strategies that can be provided to clients: •

Replace kibble with canned or commercially prepared raw diets.

•

Eliminate free feeding and replace with three to five smaller meals per day.

•

Feed cats with the aid of food puzzles or games.

•

Add play before mealtime.

•

Encourage more activity with interactive toys and games.

Pharmaceuticals Gabapentin This is an anticonvulsant medication also used to manage neuropathic pain in cats. While some studies have investigated the pharmacokinetics of Gabapentin in cats, and its use for stress reduction, there are disappointingly few studies focusing on its efficacy as a tool for pain management. However, a study done in 2018 revealed that cat guardians noticed a perceivable IVC Fall 2023

improvement in their cats’ activity levels when Gabapentin was used twice daily at 10 mg/kg.4 However, most clinicians in the US use a dosing schedule of 2.5-5 mg/kg every 12 hours. It’s important to note that cats with kidney disease have higher serum levels of Gabapentin. Doses should be adjusted accordingly in cases of moderate to advanced renal disease.5

Solensia This new pharmaceutical option is gaining popularity in the US for the treatment of osteoarthritis in cats. It is an injectable monoclonal antibody, called frunevetmab, that effectively decreases pain in cats caused by osteoarthritis.9 Injections are given subcutaneously once a month. Solensia has not been extensively studied in cats with renal disease. Renal values should be monitored closely while using this therapy. The most common reported side effect is vomiting and pain at the injection site. This is an important treatment option as daily medications in cats can be prohibitive.

Maropitant Also known as Cerenia, Maropitant is an anti-emetic used in cats. However, its use for visceral pain relief is under investigation. A study performed in 2021 investigated the use of Maropitant for pain relief following ovariohysterectomy in cats,6 and was found to decrease post operative pain. It may be useful for pain management in cats with chronic pancreatitis and inflammatory bowel disease.

Nutraceuticals/herbs

CBD Phytocannibinoids have gained popularity and acceptance in veterinary medicine and are used to treat pain and inflammation. Initial studies have mostly focused on dogs; however, in 2022, a pharmacokinetic study was published using eight cats for one week.11 Anecdotal success has been reported using full or broad spectrum hemp extract rich in CBD to treat arthritis and body pain. More studies are required to determine therapeutic doses and efficacy. The author uses a dosing range between 0.5-2 mg/kg of CBD twice daily with food. CBD may also prove beneficial for managing the pain and nausea associated with inflammatory bowel disease. Cats are seen by veterinary professionals less frequently compared to dogs and are often under diagnosed and under treated for many conditions, including pain. When cats make it to an examination room, a complete orthopedic examination is often unrealistic and may yield inaccurate results. It’s important for veterinary professionals to educate cat guardians about the often occult symptoms of feline pain. Information from the cats’ health history as provided by guardians may be valuable in the diagnosis and treatment of chronic pain. Creating individual and multimodal plans will help increase clinical success when it comes to pain management in feline patients.

Evangelista MC, Steagall PV. Agreement and reliability of the Feline Grimace Scale among cat owners, veterinarians, veterinary students and nurses. Sci Rep. 2021 Mar 4;11(1):5262.

Slingerland LI, Hazewinkel HA, Meij BP, Picavet P, Voorhout G. Cross-sectional study of the prevalence and clinical features of osteoarthritis in 100 cats. Vet J. 2011 Mar;187(3):304-9.

Colliard L, Paragon BM, Lemuet B, Bénet JJ, Blanchard G. Prevalence and risk factors of obesity in an urban population of healthy cats. J Feline Med Surg. 2009 Feb;11(2):135-40.

Omega fatty acids Safety and efficacy data for the use of Omega fatty acids is lacking in cats. However, some published abstracts and studies investigating diets rich in Omega fatty acids, along with other nutrients such as glucosamine and chondroitin, revealed clinical improvement in cats with degenerative joint disease.7 While data for guide dosing schedules is limited, an Omega 3 fatty acid supplement may be a good addition to a multimodal approach to pain management.

Adequan This injectable polysulfated glycosaminoglycan is commonly used in clinical practice for cats with osteoarthritis and interstitial cystitis. While these therapies are anecdotally successful, there are no studies investigating their efficacy. A popular dosing regimen is 5 mg/kg subcutaneously twice weekly for four weeks, followed by 5 mg/kg once weekly for four weeks, then once monthly dosing.

IVC Fall 2023

Guedes AGP, Meadows JM, Pypendop BH, Johnson EG, Zaffarano B. Assessment of the effects of gabapentin on activity levels and owner-perceived mobility impairment and quality of life in osteoarthritic geriatric cats. J Am Vet Med Assoc. 2018 Sep 1;253(5):579-585.

Quimby JM, Lorbach SK, Saffire A, Kennedy A, Wittenburg LA, Aarnes TK, Creighton KJ, Jones SE, Paschall RE, King EM, Bruner CE, Wallinger JN, van Haaften KA. Serum concentrations of gabapentin in cats with chronic kidney disease. J Feline Med Surg. 2022 Dec;24(12):1260-1266.

Corrêa JMX, Niella RV, Oliveira JNS, Silva Junior AC, Marques CSDC, Pinto TM, Silva EBD, Beier SL, Silva FL, Lavor MSL. Antinociceptive and analgesic effect of continuous intravenous infusion of maropitant, lidocaine and ketamine alone or in combination in cats undergoing ovariohysterectomy. Acta Vet Scand. 2021 Nov 27;63(1):49.

Bauer JE. Therapeutic use of fish oils in companion animals. J Am Vet Med Assoc. 2011 Dec 1;239(11):1441-51.

Nascimento FF, Marques VI, Crociolli GC, Nicácio GM, Nicácio IPAG, Cassu RN. Analgesic efficacy of laser acupuncture and electroacupuncture in cats undergoing ovariohysterectomy. J Vet Med Sci. 2019 May 31;81(5):764-770.

Gruen ME, Myers JAE, Tena JS, Becskei C, Cleaver DM, Lascelles BDX. Frunevetmab, a felinized anti-nerve growth factor monoclonal antibody, for the treatment of pain from osteoarthritis in cats. J Vet Intern Med. 2021 Nov;35(6):2752-2762.

Sharp B. Feline physiotherapy and rehabilitation: 1. principles and potential. J Feline Med Surg. 2012 Sep;14(9):622-32.

Wang T, Zakharov A, Gomez B, Lyubimov A, Trottier NL, Schwark WS, Wakshlag JJ. Serum Cannabinoid 24 h and 1 Week Steady State Pharmacokinetic Assessment in Cats Using a CBD/CBDA Rich Hemp Paste. Front Vet Sci. 2022 Jul 22.

ADVERTORIAL

HOW TO CHOOSE THE

The use of medicinal mushrooms in animal health continues to be a hot topic. But not all products deliver on their lofty promises. Here’s how to choose those that do.

RIGHT MEDICINAL MUSHROOMS

FOR PET PATIENTS BY DR KEITH WEINGARDT DVM, CVA, CTCVM

Medicinal mushrooms hold some of the most potent immune-supporting compounds available to health practitioners. This is hardly a secret, with more and more veterinarians embracing mushrooms as part of their patients’ wellness journeys. Perhaps lesser known, however, is the fact that not all parts of the mushroom are equal in their concentration or bioavailability of therapeutic compounds. Sourced and processed correctly, medicinal mushrooms are a powerful aid to an animal’s optimal immune function. Medicinal mushrooms can also provide effective support to patients with diseases such as: •

Allergies

•

Autoimmune disorders

•

Respiratory disease

•

Digestive disorders

•

Neurologic disease

•

Cancer

The current animal health supplement market is flooded with medicinal mushroom products, making it difficult

IVC Fall 2023

to determine which are the most potent and effective. Here’s what to consider:

SOURCING To start with, it is important to make a distinction between supplements that are produced from mycelium versus the fruiting body of the mushroom.

MYCELIUM Products derived from mushroom mycelium can contain therapeutic compounds but they are often present in much lower quantities than are found in the fruiting body of the mushroom. Mycelium-derived products also usually have a growing medium (usually grains) incorporated into the product. This dilutes the concentration of the mushroom’s most bioactive therapeutic compounds, such as beta-d-Glucan, other important polysaccharides, fatty acids, and amino acids.

FRUITING BODIES By ensuring we use a product made from the fruiting bodies of mushrooms, we can be confident that the most important bioactive therapeutic compounds are present in their highest concentrations.

PROCESSING The next step is to determine how the therapeutic compounds are accessed. It is critical to look for products in which hot water extraction is the processing method: •

Hot water extraction breaks down the chitin cell wall of the mushroom, allowing all the potent bioactive compounds to be extracted.

•

When combined with an alcohol extraction (also called double extraction), other important compounds that are not water-soluble — such as the triterpenoids from Reishi and Chaga — can also be liberated.

A WISE CHOICE ThorneVet’s Mushroom Medley, formulated using the organic medicinal mushrooms Reishi, Cordyceps, Turkey Tail, Chaga and Maitake, checks all the boxes to ensure the highest concentration of therapeutic bioactive compounds: S ourced from the fruiting body P rocessed using double extraction F ormulation potency verified by third-party testing to ensure betaglucan content is greater than 20%. This attention to detail makes Thorne Vet’s Mushroom Medley a potent tool for veterinarians treating a wide variety of conditions and diseases in which vigorous support of the animal’s immune function is key. Dr. Keith Weingardt, a graduate of Cornell University College of Veterinary Medicine, International Veterinary Acupuncture Society, and Chi Institute of Traditional Chinese Veterinary Medicine, has started successful integrative veterinary practices in San Diego, CA, and Portland, OR. A dedicated herbalist, he currently consults for ThorneVet, specializing in product development and continuing education.

5Ways

veterinary professionals can make money online BY MEGAN KELLY, BVSC, CCRP From e-books to courses to podcasts, there are several ways veterinary professionals can start earning a second income online.

Veterinary professionals, like everybody else, can benefit from diversity in their income streams. You may love your job and feel you make a good enough income from it — but why not diversify a little? An online business on the side is a great way to earn a second income in ways that align perfectly with what you’re already doing. The key is to think creatively and commercially! There are all sorts of ways veterinarians can earn money online. Before we get into them, let’s address what you may be thinking: “I’m not computer savvy — and I don’t have a massive budget!” That was me when I started. But in the last eight years, online software has advanced so much. You don’t need to be especially computer savvy to make a success of an online business. Nor do you need a huge budget — the main cost is time. Everything you need you already have at your disposal. All you require are a smart phone, a laptop and an internet connection. Great software options are available that allow you to run your whole business with one, easy-to-use piece of software. And you can start for free and upgrade as you start earning money. E-books, online courses, podcasts, membership-only groups and affiliations with companies and products are all ways to build a business that does not require your constant presence and effort. So where do you start? By finding a problem you can solve (see sidebar on page 24).

5 STARTER IDEAS 1. Write and publish an e-book and sell it online This is where I would start. The reason is that the barrier to entry is really low. It’s easy to put out an e-book. I’ve even created a course that gives you step-by-step instructions on how to do this. I also have Canva templates, so if you don’t want to design the book yourself, or pay a designer to do it, you can quickly and stylishly create a beautiful e-book that looks professional. Templates save you time and money in the long run. What I love about creating an e-book is that you have an audience to sell to straight away — your current clients. You can also sell your e-book on your social media platforms, thus reaching a whole new audience that follows you but are not currently clients. Selling e-books on social media platforms is a win–win. The current algorithms used on most social media mean you only ever reach 3% to 5% of your audience with any one post. In fact, I often have my doubts whether the time we invest on social media is worthwhile anymore. Well, selling an e-book on social media makes it worthwhile. The price point for an e-book can be from USD $3 to $50, depending on the value you offer in the book. IVC Fall 2023

You won’t be able to stop practising after one e-book, but it’s a great start to building your audience and getting an additional income. You could put this towards your student loans, or towards that house deposit, or maybe you want to buy a piece of equipment and are saving up for it. The proceeds from your e-book would make a great start to achieving that goal.

needs are. You might offer group calls, for example, or Q&A sessions. Whatever you offer, you will be there to support the members, and it is this sense of being supported — along with great content — that people will pay for. This is exactly how I set up @onlinepethealth.

4. Start a podcast 2. Create and sell an online course We help clients get from point A to point B (see sidebar). But there are usually a few stops on the way from A to B. Your clients will need to embark on a bit of a journey to see any real change. Let’s say you want to help a client strengthen their agility dog and improve their time by a few seconds. What would that path look like? Your e-book content might take them to the first stop. By implementing what you teach them in the e-book, they will see some of the changes they’re looking for. Having experienced some success, they now want more, and want you to help them to the next stage. At this point, you sell them your online course. The online course is a lot more thorough than the e-book, and could include PDFs, videos, downloads, tables, group and oneon-one training, mentorship, etc. A course is usually run over six to 12 weeks, and at the end of it, your client achieves their goal and sees the change they want to see. You have taken them to B. The price point for an online course can be anywhere from USD $47 to $2,500, depending on the value you offer.

3. Create a membership group Once your clients have achieved their change, they will want to maintain it, and possibly become part of a community that will help them maintain it. This is where you can add in a membership group. What’s great about a membership group is that you get recurring revenue. You create additional content each month, and members pay you a monthly fee to access the new content plus the library of content from previous months. What you offer to members will depend on your niche and what their

IVC Fall 2023

You could start a podcast as a stand-alone offering, or in combination with the three options above. I started my veterinary rehabilitation podcast in 2017. In 2022, it was voted the third best veterinary podcast in the world. I monetise it by charging sponsors for airtime. What people are prepared to pay for sponsoring a podcast depends on your following, your niche and your audience. I get $800 a month in sponsorship fees and am booked nearly a year in advance. Podcasting is the long game, though. You need to be consistent and publish a podcast every week for quite a while before

Find a problem and solve it • The great thing about veterinary professionals is that we are, by nature and training, problem solvers. To be successful in the online world, begin by finding a problem and then solving it. • Ours is also one of many professions that form part of the change industry, which, generally speaking, helps clients go from point A to point B. Lots of people are seeking information, practical skills or online support for animal-related queries. As veterinary professionals, we’re already doing this every day. So this part will be easy for you! • Find a topic you’re passionate about and love teaching, then put this information into different packages and sell them online. The great thing is that most of the work happens at the beginning. Once you’ve established your systems, you only need to maintain your marketing to begin earning a passive income. It’s not 100% passive, but how much you put into it — and receive in return — is really up to you.

you start reaping the benefits. I started mine not to make money but because I loved the subject and thought it would be fun. Even now, it’s the number one thing I do each day. I would do it even if it did not generate any income!

5. Become an affiliate Sell products on your website or social media platforms that give you a commission on the sale. Dr Buzby’s ToeGrips® is a great example of a company that has an affiliate program. Look at products you recommend to your clients. Are there any companies where you regularly send clients that you could make a commission from? Many companies would be interested in such an arrangement — you’re boosting their sales, and it would be worth their while to keep you doing so.

JUST BEGIN If you’re serious about making a second income, think about the above possibilities, select your niche skill and interest, and just get started! Selecting something you’re really interested in and will enjoy talking about is key. I have built my online business by just loving what I do, only endorsing products I believe in, and being motivated to get the message out. Now, eight years later, I can honestly say I work the hours I want to. During school holidays, I take time off to do fun things with my kids. We can take a three-week holiday while my business continues to run. I earn more than I would as a vet and work about four to five hours a day, four days a week.

From the AVH The Academy of Veterinary Homeopathy is comprised of veterinarians who share a common desire to restore true health to their patients through the use of homeopathic treatment. Members of the Academy are dedicated to understanding and preserving the principles of Classical Homeopathy.

HOMEOPATHY AND RESPIRATORY DISEASE IN ANIMALS The mammalian respiratory system is an amazing interface between the breathing organs and the outside world. The air we and our animals breathe links us all together in an invisible energy exchange. The body naturally tries to maintain an open airway and a buffer against the outside world. Symptoms of respiratory “dis-ease” are the result of this effort. Upper respiratory symptoms include sneezing, congestion, sore throat, sinusitis, laryngitis, and pharyngitis, while lower respiratory symptoms are limited to coughing and breathing difficulties (wheezing, increased effort). Instead of trying to stop these symptoms, homeopathy tries to help the body in its healing work, eliminating the need for the symptoms. Mini repertory for respiratory disease • Dry coughing spasms — Belladonna, Bryonia, Drosera, Pertussin • Cough with vomiting — Ipecachuana • Cough with retching/gagging — Drosera, Nux vomica, Spongia • Hoarseness/laryngitis — Bryonia, Causticum, Phosphorus • Dry tickling cough — Aconitum, Nux vomica, Pulsatilla, Rhus tox • A sthma — Apis (wants fresh air), Arsenicum album (restless), Spongia (worse with warmth), Sulphur (worse with heat, plus skin trouble) Mini Materia Medica for respiratory disease Upper respiratory • A llium — acute sneezing • Arsenicum — watery, burning discharge; restlessness • Hepar sulph — ulcerated nose, foul odor, painful to touch

Overheads are really low, work times are flexible, and there is no ceiling for what you can earn. Plus you can do it from any place, at any time! Yes, it was hard work at first, but now I have my systems up and running, it’s pretty much peaches and cream — with a little maintenance work thrown in. If you’re interested in creating an online business, join the Veterinary Professionals Making Money Online community at www.facebook.com/groups/2281455585357172. If you have questions, you can also email me at meg@onlinepethealth.com.

• Mercurius (viv or sol) — similar to Hepar sulph, but more irritable • Pulsatilla — thick yellow/green discharge, clingy, thirstless • Silicea — chronic of Pulsatilla; weakness, poor reaction • Sulphur — watery, profuse, irritating discharge; red eyes, nose, anus Lower respiratory • Aconitum — acute coughing, esp. after cold exposure • A ntimonium tart — great amount of mucus, rattling cough, hard to expel • Drosera — violent, nonproductive cough; kennel cough • Dulcamara — aggravated by damp weather • P hosphorus — specific for lung problems; bleeding with cough; chilly, thirsty, startles easily • Spongia — croupy, harsh cough; cardiac related cough

Submitted by Todd Cooney, DVM, CVH IVC Fall 2023

New ideas about

HEMANGIOSARCOMA

in dogs — are we closer to improving diagnosis and treatment? BY KELLY DIEHL, DVM, MS DIPL. ACVIM

Although the outcomes for dogs diagnosed with hemangiosarcoma have not changed in decades, our understanding of this cancer is slowly but steadily improving our ability to diagnose and treat this deadly disease. The data is clear: hemangiosarcoma is a deadly cancer. Within one year of diagnosis, 90% of dogs with hemangiosarcoma will die — even with treatment. At two years, mortality reaches almost 100%. This prognosis hasn't budged in nearly 30 years, despite decades of research. However, newer advances in technology are enabling researchers to explore hemangiosarcoma in ways previously impossible, and there is reason to hope that new discoveries could change the way veterinarians diagnose and treat this terrible cancer in dogs.

NEW IDEAS ON PATHOGENESIS For decades, it was thought – and taught – that hemangiosarcoma arose from vascular endothelial cells, which explained the tumor's predilection for areas with a rich blood supply. This commonly-held belief was first challenged just over ten years ago, and many veterinary oncologists feel hemangiosarcoma arises from endothelial cell precursors in the bone marrow, and then spreads to other areas of the body.1-3 Another concept being explored is the idea that hemangiosarcoma is not one tumor but includes different subtypes. In 2014, a team at University of Minnesota reported they had identified three subtypes based on genetic signatures:4 •

Angiogenic – vascular form

•

Inflammatory – immune component

•

Adipogenic – lipid characteristics

It is still unclear whether the subtype influences prognosis or treatment, but more work is planned in this area.

IVC Fall 2023

NEW IDEAS ON RISK FACTORS AND GENETICS Another long-held belief is that hemangiosarcoma has a predilection for large breed dogs, and many studies suggest this is true. But recently, some researchers have called this into question; they believe the data showing this may simply reflect breed popularity (A. Borgatti, oral communication, June 2023). The question of breed predilection is being explored by looking at the genetics underlying hemangiosarcoma, but this work is still an area of active research. Breeding the disease out of a particular breed, so to speak, might be impossible, but finding a genetic marker that could identify dogs at higher risk, along with precautionary measures or closer monitoring of the dogs, might be indicated. Having this information could also influence breeding decisions. At Morris Animal Foundation, we have funded past and current studies that aim at looking for a gene or genes associated with hemangiosarcoma. •

One of the first groups to publish on heritability of hemangiosarcoma was the MADGiC study, a collaborative effort between the University of

Minnesota, the Broad Institute, the University of Uppsala, and North Carolina State University. The team studied Golden Retrievers and identified two regions of interest that together explain part of the risk for hemangiosarcoma and lymphoma in this breed.5,6 •

A more recent study in progress leverages advances in genomics to build on this work. A team from the University of Utrecht will use genomic information collected from participants in Morris Animal Foundation's Golden Retriever Lifetime Study (see sidebar below) to look for genetic markers that develop hemangiosarcoma as another step toward diagnostic testing and possibly targeted therapy.

ADVANCES IN DIAGNOSTIC TECHNIQUES As most veterinarians know, hemangiosarcoma is rarely diagnosed until the disease is advanced enough to become an emergency. Finding a way to diagnose this cancer early would allow for quicker intervention and possibly improve the odds for dogs with hemangiosarcoma. The term "liquid biopsy" is ubiquitous in the media and has both positive and negative connotations in our imaginations. However, the basic concept is that cancer cells shed unique substances in the blood that differ from products made by non-cancerous cells; this concept is supported by accumulating evidence from numerous studies. Developing a reliable and accurate method to

detect these products is an area of active research, and a growing number of companies are offering tests based on this principle. The compounds most commonly detected and measured in liquid biopsy tests include circulating tumor DNA and circulating tumor cells. MicroRNA and extracellular vesicles are also being looked at as possible diagnostic testing items. In addition, some researchers are looking at the "omics" — such as proteomics and metabolomics — to craft new diagnostic tests for cancer detection. Some experts feel that in addition to their benefit as an early diagnostic modality, these tests could provide a means to monitor a patient’s response to therapy, or detect if and when a patient relapses. Lastly, liquid biopsy results might help guide therapies. Liquid biopsy results have been used to determine a specific therapeutic approach in some human cancer patients and could hold a similar promise for our veterinary patients.

The

At the study's inception, four cancers were considered of

●

Hemangiosarcoma

●

Lymphoma

●

Osteosarcoma

●

High-grade mast cell tumor

GOLDEN RETRIEVER LIFETIME STUDY and hemangiosarcoma

primary interest:

As of July 15, 2023, 331 dogs have been diagnosed with

The Golden Retriever Lifetime Study is one of the largest

hemangiosarcoma, accounting for roughly 61% of the

and

health

cancers of primary interest. Of all deaths to date, 75% are

studies in the US. Its purpose is to identify the nutritional,

most

comprehensive

prospective

canine

cancer related; of those deaths, almost 70% are due to

environmental, lifestyle and genetic risk factors for cancer

hemangiosarcoma.

and other diseases in dogs. Each year, with the help of veterinarians and dog owners, the Foundation collects

The Foundation is making the samples and/or data available

health, environmental, and behavioral data from 3,000+

to researchers on a rotating cycle throughout the year. In

enrolled Golden Retrievers.

addition, researchers applying for funding through the Hemangiosarcoma Initiative also are encouraged to use study samples and data.

IVC Fall 2023

NEW THERAPIES ON THE HORIZON Only a handful of treatments are available for dogs with hemangiosarcoma. Although surgery will still be an important treatment for many of these dogs, the hunt is on to find more effective therapies. Several interesting developments made in the last few years are beginning to make their way into clinical practice. One of the most intriguing discoveries centers around the use of anti-hypertensive medication in the treatment of canine cancer. The most well-known and promising is the use of betablockers, specifically propranolol. Thinking back to the subtypes of hemangiosarcoma described earlier, researchers found that, in vitro, the addition of propranolol sensitized vascular sarcoma cells to doxorubicin.7

ADDITIONAL RESOURCES Podcasts and videos TEDxMileHigh - Hemangiosarcoma: what every dog owner needs to know and research insights Fresh Scoop podcast Episode 50: Repurposed and translational drugs Fresh Scoop podcast Episode 52: New ideas on hemangiosarcoma in dogs

Publications Dow S. A role for dogs in advancing cancer immunotherapy research. Frontiers in Immunology. 2020;10. doi:10.3389/ fimmu.2019.02935. An excellent review of immunotherapy; includes a table of studies previously published. Kim JH, Graef AJ, Dickerson EB, Modiano JF. Pathobiology of hemangiosarcoma in dogs: Research advances and future perspectives. Veterinary Science. 2015;2(4). doi:10.3390/ vetsci2040388. The team from University of Minnesota reviews basic research with an excellent discussion of their work on identifying tumor subtypes. Sarver AL, Makielski KM, DePauw TA, Schulte AJ, Modiano JF. Increased risk of cancer in dogs and humans: a consequence of recent extension of lifespan beyond evolutionarily-determined limitations? Aging and Cancer. 2022;3(1). doi:10.1002/ aac2.12046. An interesting thought piece providing a possible explanation for increasing cancer rates.

IVC Fall 2023

A new multi-center study is in progress, looking at the combination of these two drugs in clinical cases of hemangiosarcoma. L osartan, an angiotensin II receptor blocker used to treat hypertension, is also getting a second look as a potential adjunct therapy for cancer in dogs. Work done at Colorado State University demonstrated that losartan, in combination with toceranib, showed a clinical benefit in dogs with metastatic osteosarcoma.8 A clinical trial underway at Schwarzman Animal Medical Center is studying the effect of losartan in combination with doxorubicin in dogs with hemangiosarcoma. he Shine On Study, an ambitious project entering its T final phase at the University of Minnesota, is focused on early diagnosis and treatment of hemangiosarcoma. In the study’s first phase, the team developed a new blood test aimed at diagnosing hemangiosarcoma. In the second phase, the team wanted to see if this test could detect treatment failure, or recurrence of disease in dogs undergoing treatment. The answer was yes! Now, in phase three of the study, the team is using the test to find dogs at high risk of hemangiosarcoma. In those dogs, the team is using a drug called eBAT as a preventive measure. Ultimately, the group will determine if eBAT was successful at preventing cancer development in this group. In addition, eBAT was shown to be safe and improve survival in dogs with hemangiosarcoma.9-11 new cancer immunotherapy, developed at Yale UniverA sity, is in clinical trials. The EGFR/HER2 vaccine study is enrolling patients at participating clinics. The vaccine exploits the overexpression of EGFR common to several tumor types by stimulating antibody production against EGFR through immunization, using a peptide of EGFR that shares similarities to HER2.12

IMPROVING ODDS FOR DOGS WITH HEMANGIOSARCOMA At Morris Animal Foundation, hemangiosarcoma is one of our top focuses for research. The Foundation launched its Hemangiosarcoma Initiative in the fall of 2022 to specifically address the many knowledge gaps around the disease. This multiyear, multimillion-dollar effort is providing funding and resources to advance the prevention, detection and treatment of hemangiosarcoma.

We recently completed our first call for proposals, with six projects advancing for additional review and final approval. All projects are slated to begin in late 2023 or early 2024. Topics submitted include novel tests for early diagnosis; novel therapies; and the development of genomic breeding values to reduce the incidence of hemangiosarcoma. Although the outcomes for dogs diagnosed with hemangiosarcoma have not changed in decades, our understanding of this cancer has made slow but steady progress toward improving our ability to diagnose and treat this deadly cancer. Recent discoveries are raising hopes that we’ll be able to offer our patients and clients a path to a longer and better quality of life.

Mullin C, Clifford CA. Histiocytic Sarcoma and Hemangiosarcoma Update. Vet Clin North Am Small Anim Pract. 2019;49(5):855-879. Doi:10.1016/j.cvsm.2019.04.009.

Lamerato-Kozicki AR, Helm KM, Jubala CM, et al. Canine hemangiosarcoma originates from hematopoietic precursors with potential for endothelial differentiation. Exp Hematol. 2006;34(7):870– 8. Doi.org/10.1016/j.exphem.2006.04.013.

Fosmire SP, Dickerson EB, Scott AM, et al. Canine malignant hemangiosarcoma as a model of primitive angiogenic endothelium. Lab Invest. 2004;84(5):562–72. Doi.org/10.1038/labinvest.3700080.

Gordon BH, Kim JH, Sarver AL, et al. Identification of three molecular and functional subtypes in canine hemangiosarcoma through gene expression profiling and progenitor cell characterization. Am J Pathol. 2014;184:985-995. Doi.org/10.1016/j.ajpath.2013.12.025.

Tonomura N, Elvers I, Thomas R, Megquier K, Turner-Maier J, Howald C, et al. Genome-wide Association Study Identifies Shared Risk Loci Common to Two Malignancies in Golden Retrievers. PloS Genet. 2015;11(2): e1004922. Doi.org/10.1371/journal.pgen.1004922.

Thomas R, Borst L, Rotroff D, et al. Genomic profiling reveals extensive heterogeneity in somatic DNA copy number aberrations of canine hemangiosarcoma. Chromosome Res. 2014;22(3):305-319. Doi:10.1007/s10577-014-9406-z.

Saha J, Kim JH, Amaya CN, et al. Propranolol Sensitizes Vascular Sarcoma Cells to Doxorubicin by Altering Lysosomal Drug Sequestration and Drug Efflux. Front Oncol. 2021;10:614288. Published 2021 Feb 1. Doi:10.3389/fonc.2020.614288.

Regan DP, Chow L, Das S, et al. Losartan Blocks Osteosarcoma-Elicited Monocyte Recruitment, and Combined With the Kinase Inhibitor Toceranib, Exerts Significant Clinical Benefit in Canine Metastatic Osteosarcoma. Clin Cancer Res. 2022;28(4):662-676. Doi:10.1158/1078-0432.CCR-21-2105.

Borgatti A, Koopmeiners JS, Sarver AL, et al. Safe and Effective Sarcoma Therapy through Bispecific Targeting of EGFR and uPAR. Mol Cancer Ther. 2017;16(5):956-965. Doi:10.1158/1535-7163.MCT16-0637.

Oh F, Modiano JF, Bachanova V, Vallera DA. Bispecific Targeting of EGFR and Urokinase Receptor (uPAR) Using Ligand-Targeted Toxins in Solid Tumors. Biomolecules. 2020;10(6):956. Published 2020 Jun 25. Doi:10.3390/biom10060956.

Borgatti A, Fieberg A, Winter AL, et al. Impact of repeated cycles of EGF bispecific angiotoxin (eBAT) administered at a reduced interval from doxorubicin chemotherapy in dogs with splenic haemangiosarcoma. Vet Comp Oncol. 2020;18(4):664-674. Doi:10.1111/vco.12590.

Doyle HA, Gee RJ, Masters TD, et al. Vaccine-induced ErbB (EGFR/HER2)-specific immunity in spontaneous canine cancer. Transl Oncol. 2021;14(11):101205. Doi:10.1016/j.tranon.2021.101205.

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

Join us for the 2023 AHVMA Annual Conference and Exhibition in San Diego, California, from October 7 to 10. If you have not yet registered, onsite registration will be available at the conference. Expect over 100 hours of complementary and integrative CE sessions, hands-on labs, and special events. The conference will include lectures on cannabis and mushrooms, homeopathy, rehabilitation, TCVM, ozone, and much more! Look for introductory talks on various holistic modalities. Not only will you be exposed to a wealth of knowledge; you will also acquire information on how to integrate these modalities into your practice. We encourage students from AVMA Accredited Veterinary Schools to attend these lectures as a way to broaden their veterinary education. The program is approved by AAVSB RACE for 98 hours of continuing education credits (22 max being available to any one veterinarian); and/or 98 veterinary technician CE credits (22 max). The AHVMA has also been awarded 41 IVAS CE credits, as well as approval from AVCA for 17 CEUs, with a maximum of 14 CE credits per individual (two clinical, 15 scientific). Unwind and renew at the post-conference retreat, which takes place on Tuesday, October 10, from 2 pm to 7 pm, immediately following the conference. The retreat will be held at the Santa Clara Recreation Center, located on the water in Mission Bay, and will be led by Dr. Kimberly Pope-Robinson. The 2023 Connections Retreat has also been approved by AAVSB RACE for 4 CE credits.

INTERESTED IN SPEAKING AT THE 2024 CONFERENCE? The Conference Program Committee is still currently taking speaker submissions for the 2024 Annual Conference and Exhibition. AHVMA is excited to announce that the Call-forPapers Portal has been upgraded and is now more user-friendly! For consideration, submit your proposal(s) via the online portal no later than the November 1 deadline. Those selected will be contacted by the AHVMA CPC.

Submitted by Melissa Kellagher, AHVMA Director of Operations

IVC Fall 2023

WHEN PETS INGEST POISON — COMMON HOUSEHOLD TOXINS AND REMEDIES BY MARI DELANEY, DVM

Toxin ingestion among pets is a common problem and can quickly become a lifethreatening situation. Saving lives relies on prompt action both at home and in the veterinary clinic setting.

The homes of our veterinary clients contain many potential toxins. On an almost daily basis, I seem to be responding to questions about the safety of various foods, drugs, cleaning products, and plants. In this article, I will highlight the most common household items that are toxic to dogs and cats (see sidebar on page 32), then cover recommendations for treatment and prevention.

EMERGENCY AT-HOME INSTRUCTIONS With any potential toxin ingestion, time is critical. If the owner notices the patient eating the offending item, and has the wherewithal to call the veterinary hospital, we can help in a few ways. First, we can determine if toxicity has actually occurred. Some ingestions are non-toxic because the patient is large; for example, a Great Dane eating one Hershey’s Kiss. But other ingestions are immediate emergency situations, such as a Chihuahua eating a container of gum containing xylitol. In the latter situation, if the owner can induce vomiting right away, it would mean the difference between life and death for the dog, since xylitol can dangerously lower blood glucose in 30 minutes. For dogs (but not cats — see sidebar on page 31), we can aid clients by walking them through how to induce vomiting at home. They can dose the dog with 3% hydrogen peroxide at 1 teaspoon per

IVC Fall 2023

5 pounds of body weight. If the client doesn’t have 3% hydrogen peroxide, they can make a strong salt solution by mixing 4 tablespoons of table salt in an 8-ounce glass of water. If the pet has not eaten within two hours of ingesting the poison, a small meal before inducing vomiting may help bring up the toxin. Inducing vomiting in the above manner can take up to 20 minutes for results. I usually recommend that clients repeat the dose if the dog has not vomited in that time. If this fails, they must bring the dog into the veterinary hospital, or go to the nearest emergency facility if after hours. If the induction is successful, the dog may be nauseated for another 45 minutes. It is only appropriate to recommend the induction of vomiting if the patient is not already throwing up; is not too lethargic to swallow; or has not eaten anything corrosive or sharp. If there is any doubt, it is best to recommend the client bring the animal into the hospital for imaging or professional emesis induction.

TREATING A POISONED PET IN THE CLINIC SETTING Unfortunately, in many cases, the owners are not home at the time the toxin exposure occurs. Others may fail to understand the gravity of the situation. When a patient is presented at the veterinary hospital for a toxin exposure, the critical information we need to get from the client is type of toxin, quantity, and when the ingestion occurred. Ideally, asking the owner to bring in product packaging can save a lot of time and confusion. This is particularly important in the case of rodenticides, since bromethalin works very differently from anti-coagulant types. If a pet has grabbed a dropped prescription drug, ask the owner to bring in the bottle. If they do not know which pill they dropped, ask them to bring them all. The more data you have at the beginning of the case, the better you will be able to manage the patient.

If a short length of time has elapsed after the ingestion, we can induce emesis in a few different ways. a.

y favorite for dogs is IV apomorphine. I use the M VIN Veterinary Drug handbook to determine dosing, utilizing 0.05mg/kg IV. I find this works quickly, and typically see results in less than five minutes.

F or cats, we use dexmedetomidine, 8ug/kg intramuscularly, according to the VIN boards.

rally administering activated charcoal post emesis O can help prevent further absorption of the ingested toxin. It is important to control vomiting before giving charcoal, since the risk of aspiration is high if the animal is still nauseated. Be careful to give the one recommended dose of 1-4g/kg. Overdosing, or repeated dosing more than every eight to 12 hours, can cause hypernatremia.

PEROXIDE AND SALT NOT SAFE FOR CATS When inducing vomiting in a poisoned animal, it’s important to keep in mind that peroxide and salt aren’t safe for cats. The risk for gastric lining sloughing and hypernatremia from salt is too great. If inducing emesis is indicated in a cat, it is best done at the veterinary clinic.

Once a toxin has been absorbed by the animal’s body, we must determine which systems will be affected by that food, drug, or plant. Typically, we see gastrointestinal signs, hepatic damage, renal damage, CNS signs and cardiac and circulatory collapse. a.

complete blood count, chemistry panel, electrolytes A and urinalysis are basic values needed to properly address the patient’s situation.

Imaging can be helpful, as can FAST ultrasound to determine if a GI perforation has occurred. IVC Fall 2023

TOP 10 POISONS

If the patient is severely dehydrated, quickly replacing the fluids is indicated. I will usually double the maintenance rates until the patient is rehydrated. According to the AAHA, fluid maintenance rates for cats are 2-3ml/kg per hour; for dogs, they’re 2-6ml/kg per hour. Monitoring hydration through serial urine concentration and volume assessments is vital to adjusting fluid therapy as needed. Checking chemistry panels every other day is also wise.

The following list is a combination of the top ten poisons for 2022, as compiled by the ASPCA Animal Poison Control (www.aspca.org/pet-care/animal-poisoncontrol) and the pet Poison Helpline (www.petpoisonhelpline.com). OTC human medications: Advil, Tylenol, vitamin D3 Human foods: grapes, raisins, onion, xylitol-containing gum/ candy, protein bars and other snack bars Prescription human medications: antidepressants, anticonvulsants and cardiac drugs were most common Chocolate Plants/flowers: lilies, philodendron, etc. Cleaning products: bleach, sticky products Veterinary products: carprofen, other chewable drugs odenticides: bromethalin and R anti-coagulant types Insecticides: ant traps, fly tape Marijuana

IVC Fall 2023

IV fluid therapy is necessary to flush the toxin from the patient’s system as well as support them through the effects of the poison. Good fluid choices include Normosol-R, LRS and Plasmalyte-148 for the dehydrated patient. Fluid selection should be based on the blood work, paying particular attention to sodium levels. Fluid rates depend on the level of dehydration. If you multiply the percentage of dehydration times the patient’s body weight in kilograms, you determine the liters of fluid they need to correct the dehydration.

nce you have established an IV treatment plan, the next order O of business is to determine the medications needed to support the patient’s recovery. Gastro-protectants such as misoprostol at 2-5mcg/kg IV every eight hours, or famotidine at 0.5-1mg/kg IV every eight to 12 hours will help prevent gastric ulceration in the event of NSAID overdose. Oral sucralfate at 0.5-1g every eight to 12 hours is wonderful once the patient has stopped vomiting. Other oral medications must be given at least one hour after sucralfate due to its superior gastric coating action. Oral famotidine at 0.5-1mg/kg every 12 hours is indicated for up to a week post hospitalization. Treatment to control seizures in patients with chocolate toxicity are as follows: IV diazepam at 0.5-1mg/kg or intra-rectal diazepam at 0.5mg/kg. Midazolam may also be used IV at 0.5-1mg/ kg or 0.2mg/kg intranasally. If diazepam and midazolam fail, then try IV propofol slowly until the seizures stop, then as a continuous rate infusion (CRI) of 0.1-0.6mg/kg/min. Slowly lower the rate until the patient resumes consciousness.

Treatment duration depends on the type and quantity of the toxin the animal ingested. Some patients require weeklong intensive care, while some can be discharged after emesis induction. Once the animal has produced the concerning item, I will give them Cerenia (maropitant) at 1mg/kg. This will stop the vomiting and make for a happier client with a clean car. As always, prevention is our main goal when it comes to poisoning! To assist you and your clients, I have developed an app called VetProtect (available through Android and Apple) that lists a wide variety of human foods and drugs, and whether or not they are toxic.

THE STATE OF TELEMEDICINE IN THE VETERINARY INDUSTRY— ALONG WITH POSSIBLE MPROVEMENTS BY DR. HANNAH GODFREY, BVETMED MRCVS

The COVID-19 pandemic marked the beginning of a new phase of veterinary medicine. Previously, telemedicine took the form of telephone or e-mail communications between veterinary surgeons to discuss cases, or with clients to provide test results, formulate treatment plans, or address other concerns.1 However, the pandemic presented an urgent need for the widespread use of telemedicine. Many, if not all, veterinary clinics had to offer some level of telemedicine service to comply with the COVID-19 guidelines on social distancing imposed by the government in their country or state. Since then, veterinary telemedicine has expanded beyond its original use, becoming a seemingly permanent feature of veterinary medicine. While telemedicine undoubtedly has benefits, veterinary professionals also have concerns regarding its safe and appropriate use.

HOW DOES TELEMEDICINE APPEAL TO PET OWNERS? Life has become very convenient for consumers in terms of access to products and services, with smartphones and other portable devices allowing instant answers to questions and one-tap purchasing. Most of us are accustomed to the recreational use of technology, which allows us to make personal appointments, do research, or browse online shops, all from the comfort of our sofa or while riding the bus. Additionally, telehealth has long been a feature of human medicine, and its use has grown substantially in response to and following the COVID-19 pandemic, with electronic and telephone consultations now being commonplace.2 Therefore, it’s no surprise that clients may appreciate the same convenience from veterinary services, and may soon come to expect it.

IVC Fall 2023

Veterinary telemedicine is likely here to stay. This article takes an in-depth look at its pros and cons, and how it could be improved.

WHY MIGHT CLIENTS WANT TO AVOID IN-PERSON VETERINARY VISITS? Aside from convenience, there are several other reasons why a client may prefer to use telemedicine rather than visit the veterinary clinic. If they have a pet who is generally very nervous, or who experiences extreme stress or anxiety at the veterinary clinic, a telemedicine consultation from home where the animal feels safe and secure is likely to be preferable to an in-person visit. Similarly, certain issues such as a pet being over- or underweight, or displaying challenging behaviors, may make the client feel sensitive or defensive, especially if they have perceived judgment from veterinary staff before. Clients may also avoid visiting the clinic due to busy schedules, transportation issues, frailty, concerns about veterinary costs, or a perception that the pet’s health issue is minor, so they don’t want to waste their time or ours. Ultimately, this could lead to a delay in clients seeking veterinary help in the absence of a telemedicine option.

WHAT DO VETERINARIANS LIKE ABOUT DELIVERING A TELEMEDICINE SERVICE? The benefits of telemedicine are not just centered around clients. Telemedicine allows veterinarians to use their time more efficiently, leading to less fatigue and improved well-being,3 and it also allows for the flexibility and comfort of remote work. Veterinary leaders and clinic owners who embrace telemedicine also experience improved staff and client retention, as well as client satisfaction, and increased revenue.3

WHAT ARE THE LIMITATIONS OF VETERINARY TELEMEDICINE? While the general view of telemedicine among veterinarians is positive,4,5 there are some concerns. A major issue is whether or not it is safe to prescribe treatment for a patient without a physical examination. While clients can be guided on how to show gum color or demonstrate skin tenting, this cannot be a reliable substitute for a hands-on veterinary physical examination. Similarly, although superficial wounds, skin lesions, and other minor ailments may be witnessed via a webcam, there’s a risk of missing complicating factors that aren’t as clear. For these reasons, the use of telemedicine in an emergency situation, other than to triage, would not be appropriate and could delay critical treatment.

WHAT LEGISLATION OR GUIDANCE IS IN PLACE REGARDING VETERINARY TELEMEDICINE? Consistent themes exist in the legal framework for veterinary telemedicine as provided by governing bodies worldwide. In the UK, the Royal College of Veterinary Surgeons launched its Under Care Review in 2019, and released its updated guidance earlier this year.7 The update clarifies that an animal is “under care” of a veterinary surgeon if they are “given, and accept, responsibility for the health of an animal”, and that any veterinary surgeon with an animal under their care must have a 24/7 provision in place for in-person examination and treatment, either by themselves or as formally arranged with another practitioner.7 The new guidance also states that to safely prescribe medications, a veterinarian must perform a clinical assessment, which may or may not include a physical examination, depending on the clinical particulars and risks.7 The American Veterinary Medical Association’s policy on telemedicine states that “veterinary telemedicine should only be conducted within an existing Veterinarian-Client-Patient Relationship (VCRP), with the exception for advice given in an emergency until that patient can be seen by a veterinarian.”8 This in turn impacts appropriate prescribing, since a VCRP is required by law before a veterinarian can prescribe treatment. In Western Australia, the guidelines for providing telemedicine services again focus on the establishment of a “Veterinarian/ Client/Patient Relationship” and the veterinarian's clinical judgment on whether a physical examination is required.9

Other potential drawbacks of telemedicine may include technological or internet connection issues, which can cause delay and frustration, and less social pressure on the client to behave with the same courtesy they would in person.

including general puppy and kitten care, behavior issues, dental care, obesity, and diet.

Theoretically, telemedicine may make veterinarians feel powerless; if they are unable to prescribe, examine, operate, or administer treatment, this means there will be a large number of cases for which the appropriate next step is to visit the veterinary clinic, which may lead to client frustration. Consequently, there is a widespread calling from veterinarians for more clarity regarding the legal framework for telemedicine use (see sidebar on page 35).6

Despite its potential risks and pitfalls, veterinary telemedicine is becoming increasingly popular with clients, and is viewed favorably by many veterinary staff. Using the guidance available from veterinary governing bodies, as well as their own clinical judgment, veterinary surgeons can experience the benefits of telemedicine without taking undue risks.

WHEN IS TELEMEDICINE USEFUL AND APPROPRIATE?

Telemedicine carries particular strengths that make it a beneficial modality in specific situations. For example, it can be used as an out-of-hours triage service to determine whether an in-person appointment is needed, and within what timeframe. With an initial specific list of primarily closed questions, a true emergency case will not be substantially delayed from getting required treatment, while cases that can wait or be resolved remotely will not attend the clinic, easing the burden on out-of-hours staff.

SUMMARY

Mars M, Auer REJ. Telemedicine in veterinary practice. Journal of the South African Veterinary Association. 2006; 77(2):75–78. doi: 10.4102/jsava.v77i2.348. McMaster T, Wright T, Mori K, et al. Current and future use of telemedicine in surgical clinics during and beyond COVID-19: A narrative review. Annals of Medicine & Surgery. 2021;66:102378. doi: 10.1016/j. amsu.2021.102378.

Kastelic J, Ogilvie T. Veterinary Telemedicine is not only here to stay, it’s poised to grow and likely exponentially. Canine Veterinary Journal. 2021;62(12):1277–1279.

Hawk C. Veterinary Telemedicine Perception and Utilization Intention. Chancellor’s Honors Program Projects. 2018. https://trace.tennessee.edu/utk_chanhonoproj/2234.

Lundahl L, Powell L, Reinhar CL, et al. A Pilot Study Examining the Experience of Veterinary Telehealth in an Underserved Population Through a University Program Integrating Veterinary Students. Frontiers in Veterinary Science. 2022;9. doi: 10.3389/fvets.2022.871928.

Becker B, Tipold A, Ehlers J, et al. Veterinarians' perspective on telemedicine in Germany. Frontiers in Veterinary Science. 2023;10:1062046. doi: 10.3389/fvets.2023.1062046.

Royal College of Veterinary Surgeons. RCVS Council approves new guidance on ‘under care’ and 24/7 cover. Published January 20, 2023. Accessed June 6, 2023. www.rcvs.org.uk/news-and-views/news/rcvs-councilapproves-new-guidance-on-under-care-and-247-cover/?&&type=rfst&set=true#cookie-widget.

American Veterinary Medical Association. Telemedicine. Published 2021. Accessed June 6, 2023. www.avma. org/resources-tools/avma-policies/telemedicine.

Additionally, remote appointments may not have the same time constraints, meaning vets can dedicate more time to giving comprehensive advice on complex or routine topics,

Veterinary Practice Board of Western Australia. Guidelines on Veterinary Telemedicine. Published February 2023. Accessed June 6, 2023. www.vsbwa.org.au/common/Uploaded%20files/vet%20Guidelines/Guidelines-onVeterinary-Telemedicine.pdf.

WHAT IMPROVEMENTS COULD BE MADE TO CURRENT TELEMEDICINE SERVICES? Several improvements could enhance the current state of veterinary telemedicine. The relationship between telemedicine services and veterinary clinics could be improved by more effective and open communication, especially if clients use different service providers. Currently, there may be an element of secrecy, perhaps encouraged by the client if they do not want to appear disloyal. However, the sharing of clinical notes and other relevant communications between telemedicine services and physical veterinary services is paramount to the safe, thorough, and efficient delivery of veterinary care. In order to manage client expectations, avoid frustration, and prevent delays in emergency treatment, it’s recommended that pre-appointment information be provided to clients, stating that telemedicine may not be appropriate in life-threatening emergency cases of collapse, loss of consciousness, excessive bleeding, etc. This information should also include contact details of the designated facility for in-person assessment. Perhaps the ultimate goal for veterinary telemedicine is that every clinic adopts telemedicine alongside inperson veterinary services, thereby easing the in-house workload through triage, and dealing with minor issues while ensuring consistency of clinical notes and provisions to visit the clinic in person if required.

IVC Fall 2023

Over 80% of pet parents know it’s important to take care of their animal companions in an environmentally friendly way. That means they want to make responsible choices when it comes to pet food, treats, and supplements. Regenerative organic agriculture practices and regenerative organic certified products are ideal for pet parents looking for products that support the health of their animals and give back to the planet.

AN INTRODUCTION TO REGENERATIVE ORGANIC AGRICULTURE Regenerative organic agriculture is a sustainable farming practice. It works in harmony with nature to improve soil health and food quality. Some of the central tenets of regenerative agriculture include: •

Permaculture practices to create regenerative food forests

•

Holistic grazing and livestock management

•

Crop rotation to optimize soil nutrients

•

Amending soil with compost

•

Rotational grazing to fertilize soil with manure

ADVERTORIAL

Get Better Quality Ingredients with Regenerative Organic Agriculture

Regenerative agriculture helps the environment by improving soil quality, and it can also create better quality ingredients for pet food, treats, and supplements.

What's more, many companies that use regenerative organic certified (ROC) ingredients incorporate similar principles into their business models. For instance, they might use accessible waste material and by-products from the manufacturing process to produce more compost to enrich soil and grow new crops.

REGENERATIVE AGRICULTURE IS GOOD FOR ANIMALS AND THE ENVIRONMENT The practices of regenerative agriculture help to build soil organic matter, capture carbon, reverse forest loss, combat climate change, and transform the environment. Beyond that, regenerative agriculture may produce food that contains higher quantities of vitamins, minerals, phytochemicals, and other nutrients. Pet parents care about their animals and the environment. ROC ingredients give them the best of both worlds: better quality pet products for healthier animals and environmental benefits. However, until now, ROC ingredients haven’t been available in the pet space.

BRINGING ROC INGREDIENTS TO PET PRODUCTS Cave PetsTM believes in the power of primitive nutrition for modern pets and understands the importance of environmentally responsible practices. They are revolutionizing the industry by bringing ROC ingredients to pet food, treats, and supplements, as well as to the holistic veterinary space.

Cave PetsTM uses ingredients sourced with integrity and transparency that leave the planet better for future generations. They use regenerative farming practices to produce and manufacture their products, including nutritional treats, food toppers, and powdered supplements. Their products feature functional ingredients like organic turmeric, organic ashwagandha, and organic hemp. Their popular MultiMushroom formula contains regenerative organic certified mycelium from: •

Chaga

•

Cordyceps

•

Lion's Mane

•

Maitake

•

Reishi

•

Shiitake

•

Turkey Tail

The mushrooms are grown using a patented fermentation technology that ensures quality and functionality. They’re also cultivated on a regenerative organic certified, nutrient-dense growth medium. When you combine these technologies, it produces a mushroom product for pets unlike anything else on the market. It satisfies pet parents’ desire for healthpromoting products and environmentally sustainable business practices. Visit Cave Pets (https://cavepets.com/) to learn more about regenerative agriculture and ROC ingredients for pets.

IVC Fall 2023

In the news New study reveals regional variability in vector-borne infections in shelter dogs across the Eastern US

ector-borne infections pose a significant health threat to humans, domestic animals, and wildlife. A comprehensive recently-published study conducted from 2016 to 2020 by veterinary researchers sheds light on the prevalence, risk factors, and co-infections associated with several zoonotic vector-borne pathogens in shelter dogs across the Eastern US. The study, which examined blood samples from 3,750 shelter dogs across 19 states, utilized tests to assess the seroprevalence of infections. The results un-

veiled intriguing insights: the seroprevalence of Dirofilaria immitis, a causative agent of heartworm disease, stood at 11.2%, while Anaplasma spp., Ehrlichia spp., and Borrelia burgdorferi, responsible for various tick-borne illnesses, exhibited seroprevalence rates of 2.4%, 8.0%, and 8.9%, respectively. Regional disparities in prevalence were evident, with heartworm infection (17.4%) and Ehrlichia spp. infection (10.7%) being most prevalent in the Southeast, while Lyme disease (19.3%) and Anaplasma spp.

infection (5.7%) showed higher incidence in the Northeast. Remarkably, co-infections were identified in 4.8% of dogs, with D. immitis/Ehrlichia spp., B. burgdorferi/Anaplasma spp., and B. burgdorferi/Ehrlichia spp. combinations being the most frequent. The study identified key risk factors such as location and breed group, which significantly influenced infection rates across the evaluated pathogens. https://pubmed.ncbi.nlm.nih.gov/37301970/

WEST VIRGINIA ABANDONS PLANS FOR NEW VETERINARY SCHOOL

he state of West Virginia has decided to abandon its plans to establish a veterinary school, due to a significant projected initial investment of $321 million. Instead, the state is exploring alternative strategies to address its veterinarian shortage. This decision stands in contrast to the overall U.S. trend toward expanding veterinary education; around ten new veterinary schools are in development, potentially increasing the total number of schools to 43 within a decade. Dr. Danny Montgomery, President of the West Virginia Veterinary Medical

IVC Fall 2023

Association, explained that while the state initially considered starting a veterinary school to address the shortage of veterinarians, the financial requirements and staffing challenges made it unfeasible. West Virginia aims to encourage students from the state to return and practice there by offering scholarships and increasing the number of subsidized seats in out-of-state veterinary programs, which would allow residents to pay in-state tuition rates. West Virginia currently provides over $1 million annually to subsidize seats for 52 students at veterinary schools both

in the state and in Mississippi. They are now working on securing funding for an additional 25 seats annually. Many East Coast veterinary schools have expressed interest in accommodating West Virginia students, which offers potential avenues for education.

https://news.vin.com/default.aspx?pid=210& Id=11639755&f5=1

industry innovations Legacy of microbiome protection A healthy and balanced microbiome is critical for allowing your patients’ bodies to heal from within. The source of the microbiome is very important, so it’s vital to have donors with a legacy of protection from antibiotics, NSAIDs, pesticides, herbicides, chlorine, fluoride, and the array of other chemicals that kill the microbiome. Touch of Life Microbiome is just that source — Mash Vet has spent 30 years spanning six generations of dogs to protect this amazing internal garden of life. www.mbrt.life, www.mashvet.com

Superior joint mobility supplement Joint pain and stiffness are common in pets as they age. NOW® Pets UC-ll® Advanced Joint Mobility for dogs and cats is a health supplement formulated with Lonza’s clinically studied UC-II® ingredient, a unique form of collagen with undenatured type II collagen. UC-ll® supplementation is shown in clinical trials to ease joint stiffness due to normal daily exercise. Other ingredients include glucosamine HCI, MSM, and Boswellia extract. This product is formulated by Dr. Barbara Royal, DVM, CVA, founder of The Royal Treatment Veterinary Center. www.nowfoods.com/pets

Subtract dental disease from the health equation It’s estimated that only 2% of pet owners brush their dog or cat’s teeth daily. The result? More than two-thirds of your patients over the age of three will suffer some degree of periodontal disease. Brushing pet teeth regularly is essential to preventing this and all other oral diseases, along with their associated health issues. Help your patients’ parents embrace this essential routine by introducing PawReady's BiteBlock and BrushMate Dual-Ended toothbrush. PawReady takes pets from doggy breath (and worse) to fuss-free freshness. www.pawready.com

Sustainable mushroom products Mushrooms have a myriad of health benefits for dogs and cats. Cave Pets’ Multi-Mushroom formula combines seven functional mushrooms: Chaga, Cordyceps, Lion's Mane, Maitake, Reishi, Shiitake, and Turkey Tail. Ideal for clients who care about the environment, the mushrooms are cultivated using patented fermentation technology on a regenerative organic certified, nutrient-dense growth medium. Cave Pets is the first to bring ROC ingredients to pet products and the holistic veterinary space. They deliver formulas that will satisfy clients’ demand for functional, health-promoting products that are also environmentally responsible. https://cavepets.com/

IVC Fall 2023

Integrative treatment for chronic bronchitis in dogs BY W. JEAN DODDS, DVM Although corticosteroids remain the treatment of choice for chronic bronchitis in dogs, a variety of alternative options can be used in conjunction with these drugs.

Chronic bronchitis is one of the most common causes of cough in dogs, along with airway collapse and eosinophilic lung disease. Combinations of these disorders also occur, such that the inflammatory and mechanical insults to the lower airways continue and perpetuate the cough cycle. They are irreversible, progressive, and have a guarded prognosis. Confirmed diagnosis of these inflammatory airway diseases often requires costly bronchoscopy along with bronchoalveolar lavage cytology and microbial culture. Corticosteroids remain the primary successful treatment, although alternative options are available and have been used in conjunction with steroids or apart from them. These management and treatment strategies do not cure the problem but are aimed at minimizing the severity of cough, thereby improving the quality of life for dogs and their caregivers, and hopefully limiting the progression of inflammatory airway injury.

DEFINING CHRONIC BRONCHITIS Unlike acute bronchitis, which has bacterial and viral causes, chronic bronchitis is not contagious, and neither form is zoonotic. Chronic bronchitis may be difficult to diagnose and is often reached by excluding other diseases. Bronchitis is considered chronic if it’s present on most days, with a minimum duration of two months, in the absence of other underlying diseases. Regardless, any form of bronchitis can be aggravated by stress, extreme or prolonged environmental temperature changes, and a weakened or compromised immune system due to ongoing disease or metabolic and/or gastrointestinal dysbiosis (e.g. gut-brain, gut-bowel, gut-lung axis imbalance and disruption).

POTENTIAL CAUSES OF CHRONIC COUGH There are many possible causes of chronic cough in dogs, of which chronic bronchitis is only one: • B acterial pneumonia • Breed predisposition — e.g. Cocker Spaniel; Poodles; northern breeds with eosinophilic lung diseases such as Siberian Husky,

IVC Fall 2023

Alaskan Malamute and sled dogs; small and toy breeds; brachycephalic breeds, especially French Bulldog, Pug, Pekingese and Shih Tzu with chronic obstructive airway disease/syndrome; and West Highland White Terriers with pulmonary fibrosis • Canine infectious respiratory disease complex — e.g.Bordetella bronchiseptica, canine influenza • Chronic bronchitis • Congestive heart failure • Fungal pneumonia — secondary to histoplasmosis, blastomycosis, coccidiomycosis, leishmaniasis • Interstitial lung disease • Lung tumors • Parasitic pneumonia — e.g. lungworm, heartworm, neospora • Pleural effusion • Protozoal infections, coccidiosis, giardiasis • Tracheal collapse (isolated) • Upper airway dysfunction, including anatomically incomplete tracheal rings

DIAGNOSING CHRONIC BRONCHITIS Dogs with chronic bronchitis have more than 12% neutrophils based upon bronchoalveolar lavage, whereas dogs with eosinophilic lung disease have more 14% eosinophils. Bacterial infection is typically absent from their microbial cultures.

Laboratory testing: • Complete blood count and serum biochemical profile • Thyroid profile • Urinalysis, cystocentesis preferred • Heartworm antigen testing • Fecal analysis with oocyte numbers • NT pro-BNP, to rule out cardiac-related disorders

Diagnostic imaging: • Chest radiographs • Fluoroscopy, for concurrent tracheal collapse

• Ultrasound, if isolated lesion or pleural effusion is found • Computed tomography (CAT scan) • Bronchoscopy (requires anesthesia so caution may be needed)

Airway sampling: cytology and culture (anesthesia required) • Tracheal wash (transtracheal or endotracheal) • Blind bronchoalveolar lavage • Bronchoscopic bronchoalveolar lavage preferred

Lung function testing • Arterial blood gas samples and/or pulse oximetry • Six-minute walk test (dog should walk at least 400 meters)

TREATMENT OPTIONS FOR CHRONIC BRONCHITIS A variety of alternative approaches and therapies can be used in conjunction with conventional treatment for dogs with chronic bronchitis. 1. Limit exposure to airborne pollutants (e.g. cigarette and cigar smoke, dust, grass, aerosols, strong odors and perfumes) and sick animals. 2. I nstall a humidifier. 3. T reat obesity aggressively and/or prevent it. 4. Limit exercise and barking; harnesses should be used instead of collars 5. M inimize leash time. 6. A void situations where the dog gets overexcited 7. U se natural approaches • Medicinal mushrooms such as Reishi improve oxygen utilization and are adaptogenic; Cordyceps, Coriolus, Agaricus are anti-inflammatory and bronchodilatory.

• Teas such as green tea and mullein tea are helpful. Brew to boiling and steep, then add to food or drinking water, or give by syringe without needle. • Lemon, ginger, raw honey, licorice root, eucalyptus oil and mustard can be used. • Additional therapies include steam diffusing, rest, lifestyle changes as needed, warm water, and sunlight for vitamin D. 8. Two classes of medications are commonly prescribed for chronic bronchitis: bronchodilators (theophylline, aminophylline, pentoxifylline and terbutaline) and corticosteroids (prednisolone, prednisone, methylprednisolone and fluticasone). Bronchodilators should help dilate or open the airways by relaxing the muscles around the airway walls. Inhaled corticosteroids (e.g. AeroDawg spacing chamber™) have been used successfully to help control cough in chronic bronchitis, and in some dogs with eosinophilic lung disease. • The chronic use of glucocorticoids predisposes the dog to fungal and urinary tract infections and iatrogenic Cushing’s disease. • Antibiotics and cough suppressants may also be used. Chronic bronchitis is a common disorder in dogs for which there is no cure, but alternative therapies used alongside, or sometimes even in place of, conventional medications can help effectively manage the problem and improve quality of life.

References Bexfield NH, Foale RD, Davison LJ, Watson PJ, Skelly BJ, Herrtage ME. (2006) Management of 13 cases of canine respiratory disease using inhaled corticosteroids. J Small Anim Pract. 47(7):377-382. Canonne AM, Bolen G, Peeters D, Billen F, Clercx C. (2016) Long-term followup in dogs with idiopathic eosinophilic bronchopneumopathy treated with inhaled steroid therapy. J Small Anim Pract. 57(10):537-542. Casamian-Sorrosal D, Silvestrini P, Blake R, et al. (2020) Clinical features and long-term follow-up of 70 cases of canine idiopathic eosinophilic lung disease. Vet Rec. 187(8):e65. Chan, JC, Johnson, LR. (2022) Prospective evaluation of the efficacy of inhaled steroids administered via the AreoDawg spacing chamber in management of dogs with chronic cough. J Vet Intern Med. 37,660-669. Clercx C, Peeters D, Snaps F, et al. (2000) Eosinophilic bronchopneumopathy in dogs. J Vet Intern Med. 14(3):282-291. Hawkins E, DeNicola D, Plier M. (1995) Cytological analysis of bronchoalveolar lavage fluid in the diagnosis of spontaneous respiratory tract disease in dogs: a retrospective study. J Vet Intern Med. 9(6): 386-392. Hawkins EC, DeNicola DB, Kuehn NF. (1990) Bronchoalveolar lavage in the evaluation of pulmonary disease in the dog and cat. J Vet Intern Med. 4(5):267-274.

CLINICAL SIGNS OF CHRONIC COUGH DISORDERS

Johnson LR, Pollard RE. (2010) Tracheal collapse and bronchomalacia in dogs: 58 cases (7/2001-1/2008). J Vet Intern Med. 24(2):298-305. Johnson LR, Singh MK, Pollard RE. (2015) Agreement among radiographs, fluoroscopy and bronchoscopy in docu-mentation of airway collapse in dogs. J Vet Intern Med. 29(6):1619-1626. Kumrow KJ, Rozanski EA. (2012) Canine chronic bronchitis. A review & update. Today’s Veterinary Practice Nov/ Dec, 12-17.

• W heezing • G agging • D yspnea with shortness of breath • T achypnea • F ainting, gasping for air • B luish gums from poor oxygenation

• C oughing up mucus and saliva • E xercise intolerance • R estlessness • P neumothorax • W eight loss or gain • A norexia • W eakness, lethargy

Levy A, Reinero C, Masseau I. (2022) Ventilator-assisted inspiratory and expiratory breath-hold thoracic com-puted tomographic scans can detect dynamic and static airway collapse in dogs with limited agreement with tracheobronchoscopy. Animals 12(22):3091. Macready DM, Johnson LR, Pollard RE. (2007) Fluoroscopic and radiographic evaluation of tracheal collapse in dogs: 62 cases (2001-2006). J Am Vet Med Assoc. 230 (12):1870-1876. Padrid P. (1992) Chronic lower airway disease in the dog and cat. Prob Vet Med. 4(2), 320-344. Padrid PA, Hornof WJ, Kurpershoek CJ, Cross CE. (1990) Canine chronic bronchitis: a pathophysiologic evaluation of 18 cases. J Vet Intern Med. 4(3):172-180. Today’s Veterinary Practice (accessed Sept 11, 2022). Lower airway and lung disease. www.todaysveterinarypractice.com. Trudell Animal Health (accessed Sept 11, 2022). Canine chronic bronchitis. www.trudellanimal health.com/learn/furtherreading/dog-respiratory-problems, Vet Int Med 37,660-669. doi:10.1111/jvim.16673 Volhard Dog Nutrition (accessed June 15, 2023). www.volharddognutrition.com/blog/natural-remedies-for-a-dog-withbronchitis/.

IVC Fall 2023

MCT OIL AND ITS USE IN ANIMAL PATIENTS BY JARED MITCHELL, DVM, CVMA, CVA, CVFT

Medium chain triglycerides (MCTs) can be used to help improve the health of animal patients with a variety of medical conditions — from respiratory disease to seizures to canine cognitive disorder.

In today’s world of human and

important factor. Short chain fatty acids (SCFA) have fewer than

animal health maintenance, discuss-

six carbon atoms linked on a chain. Falling in the middle — and

ions about fatty acids are commonplace.

the main focus of this article — are the medium chain triglycer-

Most know about fatty acids from a strictly

ides (MCTs). These fatty acids have six to 12 carbon atoms linked

dietary standpoint; which ones are better to cook

on a chain. The longest of the group, the long chain triglycerides

with and which provide the greatest health benefits

(LCTs), have more than 12 carbon atoms.3 The sidebar on page 43

when used within the diet. But besides their dietary advantages, what do we know about long chain fatty acids versus short and medium chain fatty acids? More specifically, what are the health benefits of medium chain triglycerides

describes the four types of MCTs.

COMPARING MCT OIL AND COCONUT OIL

(MCTs) and why should we consider them for integrative health care approaches in companion animals?

Coconut oil is obtained from the kernel of harvested mature coconuts.4 There are three major forms — refined coconut oil,

WHAT ARE FATTY ACIDS?

copra oil and virgin coconut oil. The fatty acid profile of all three is the same, but some forms, in particular virgin coconut oil,

Fatty acids are energy sources and membrane constituents. Their

contain a higher level of monoglycerides, diglycerides and other

biological activities influence cell and tissue metabolism, function,

beneficial constituents, such as antioxidants.5

and responsiveness to hormonal and other signals. More speci1

fically, fatty acids have structural functions as constituents of

Coconut oil contains both long chain and medium chain fatty

phospholipids which are the “building blocks” of cell membranes;

acids. Many of its properties can be accounted for by lauric acid,

as part of neutral lipids, they serve as storage materials in cells,

which makes up approximately half its fatty acids. Likewise,

and their derivatives are involved in cell signaling.

medium chain triglycerides that contain lauric acid account for

approximately half of all triglycerides in coconut oil.5 Numerous classification methods are used for determining the characteristics of a fatty acid and to what extent it would benefit

Medium chain triglycerides (MCTs) contain medium chain

the diet for both humans and animals. Chain length is one such

fatty acids esterified to the glycerol backbone. This means all

IVC Fall 2023

three positions on the glycerol backbone are occupied by medium

chain

fatty

acids

(MCFAs). These MCFAs have a shorter chain length and are quickly metabolized in the body, serving as an immediate energy

4 types of medium chain triglycerides (MCTs) 1. Caproic acid: 6 carbon atoms

source.6 Thanks to their physiological and

2. Caprylic acid: 8 carbon atoms

functional characteristics, MCTs can help manage various health conditions. Most of these benefits

3. Capric acid: 10 carbon atoms

appear to come from the capra fatty acids, which include caproic acid, caprylic acid, and capric acid. In

4. Lauric acid: 12 carbon atoms

fact, research has demonstrated that these MCTs help burn fat and reduce inflammation.3 In contrast, lauric acid has been shown to have pro-inflammatory effects.7

MCT OIL FOR RESPIRATORY CONDITIONS Respiratory cases in our animal patients can be challenging. They can present as a simple runny nose but then progress to severe lung disease with catastrophic results. Respiratory disorders

been

have many causes, and a barrage of conventional and integrative

demonstrated to

treatment options are available. Inflammation and infectious

down-regulate the production

agents play a pivotal role in the development of these conditions.

of pro-inflammatory cytokines while elevating certain anti-inflammatory cytokines,

MCT oil can be a beneficial tool in the treatment of respiratory

thereby reducing inflammation.8

conditions in companion animals, because it has anti-inflammatory and antibacterial properties. This can allow for improved

MCT oil has shown effectiveness against viral lung conditions

respiration and easier breathing by reducing inflammation, mucus

such as SARS Coronavirus-2 by changing the metabolism of the

buildup, and decreasing cough and wheezing.

virus’s lipids. Viral replication relies on energy from long chain fatty acids, which also aid in attaching the viral envelope with the

With chronic inflammation being at the root of so many

host cell. MCT oil interferes with this by decreasing the formation

diseases, it is important to have tools available to help reduce

of long chain fatty acids, making them unavailable to the virus and

the inflammatory process in the patient’s body. MCT oil has

leading to viral death.9

IVC Fall 2023

OTHER USES AND BENEFITS OF MCT OIL

2. Benefits heart health Heart disease can have different clinical presentations with varying degrees of severity. According to an article published in

1. Has anti-inflammatory properties

2022 by the Journal of the American Veterinary Medical Association (JAVMA), the most common cause of heart failure in dogs is

It is common knowledge that most disease processes occur due to

myxomatous mitral valve disease (MMVD), accounting for

chronic inflammation within the body. This chronic inflammation

75% of canine heart disease.10 Dogs with heart disease can have

weakens the immune response and causes imbalances in the

decreased mitochondrial energy metabolism as well as increased

homeostatic mechanisms, thus allowing pathogens and disease

inflammation and oxidative stress. Medium chain fatty acids

to develop. Studies have demonstrated that MCT oil down-

and ketones derived from medium chain triglycerides provide

regulates the production of pro-inflammatory cytokines and

an alternative energy source for cardiac mitochondria, and help

elevates anti-inflammatory cytokines.

reduce free radical production.10

Dosing recommendations for MCT oil •

To avoid dietary upsets, slowly introduce MCT oil to the pet, especially if adding it to the diet.

•

Dosing will vary based on age, weight, nutritional content of the current diet, health status, and disease process.

•

3. Helps with seizures/epilepsy Seizure disorders and epilepsy appear to be increasing within the pet population. There are many causes, from environmental factors and nutritional stressors to specific brain disorders. For years, conventional medications have been the mainstay of seizure treatment; however, drugresistant epilepsy is becoming more commonplace. Additionally, clients wishing for a more integrative approach to managing seizure disorders are turning to alternative options. A study published in the Journal of

Approximately 6% to 9% of a dog’s diet can

Veterinary Internal Medicine discussed positive evidence

safely be composed of MCTs. This is why it is

for the use of MCT oil as a dietary supplement added to

important to know the nutritional content of

a stable base diet as a potential therapeutic management

the diet, especially the total fat content.

option for dogs with epilepsy.11

Sources indicate a good starting dose would be ¼ teaspoon per 10 pounds of body weight daily.

•

Over time, this could be further broken down into more specific dosing guidelines: 10-20 pounds: ½ to 1 teaspoon per day 30-50 pounds: 1 to 2 teaspoons per day 60-100 pounds: 2 to 4 teaspoons per day

4. S upports brain health/slows canine cognitive disorder (CCD) Canine cognitive disorder (also known as cognitive dysfunction syndrome or CDS) has become a common disorder in aging pets. It mimics human dementia and

IVC Fall 2023

From the VMAA Alzheimer’s disease with similar neuropathological changes, including severe cortical atrophy, cerebral amyloid angiopathy, and ventricular enlargement.12,13 It is also important to note that as healthy humans and animals age, the brain’s ability to metabolize glucose changes. In human Alzheimer’s patients and animals with cognitive dysfunction, cerebral glucose metabolism is significantly decreased. The use of dietary MCT oil is able to improve learning, memory, and executive function in senior dogs.14

IN SUMMARY MCT oil has shown amazing benefits for improving the health of animal patients with a variety of medical conditions. Its ease of administration along with its versatility make it an excellent addition to integrative veterinary practice.

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.

ESSENTIAL OILS FOR A DOG WITH VALLEY FEVER — A CASE STUDY Essential oils are well suited for the respiratory systems of our animal patients. They have an aerosol delivery system, which means we can achieve deep penetration into the lung tissue. In the clinic setting, I will use tents to increase contact with the essential oils, while in the home I will use a small bathroom or laundry room. I use a diffuser that runs on a timer, or will set a timer to limit the contact.

Calder PC. Functional Roles of Fatty Acids and Their Effects on Human Health. JPEN J Parenter Enteral Nutr. 2015 Sep;39(1 Suppl):18S-32S. doi: 10.1177/0148607115595980. Epub 2015 Jul 15. PMID: 26177664.2de.

Mandy is a 12-year-old

Carvalho CCCR, Caramujo MJ. The Various Roles of Fatty Acids. Molecules. 2018 Oct 9;23(10):2583. doi: 10.3390/molecules23102583. PMID: 30304860; PMCID: PMC6222795.4.

She has a chronic cough

de la Harpe T. MCT Oil For Dogs: A Miracle Supplement For Brain And Heart Health? Dogs Naturally. March 30, 2023.

cise. Oral antifungal medi-

Maltese with Valley Fever. and is intolerant to exer-

Kappally Shijna, Arun Shirwaikar, Annie Shirwaikar. Coconut oil -- a review of potential applications. Hygeia JD Med 7, no. 2 (2015): 34-41.

cation was not helpful. I

Dayrit, Fabian M. "Lauric acid is a medium-chain fatty acid, coconut oil is a medium-chain triglyceride." Philippine Journal of Science 143, no. 2 (2014): 157-166.

tial oil deep inhalation

Jadhav HB, Annapure US. Triglycerides of medium-chain fatty acids: a concise review. J Food Sci Technol. 2023 Aug;60(8):2143-2152. doi: 10.1007/s13197-022-05499-w. Epub 2022 Jun 22. PMID: 35761969; PMCID: PMC9217113.

for five minutes each session. This was done for five

introduced tented essentherapy, three times a day days, then weekly. Mandy’s cough was minimized and

Rogero MM, Calder PC. Obesity, Inflammation, Toll-Like Receptor 4 and Fatty Acids. Nutrients. 2018 Mar 30;10(4):432. doi: 10.3390/nu10040432. PMID: 29601492; PMCID: PMC5946217.

the radiographs showed diminished infiltration.

Yu S, Go GW, Kim W. Medium Chain Triglyceride (MCT) Oil Affects the Immunophenotype via Reprogramming of Mitochondrial Respiration in Murine Macrophages. Foods. 2019 Nov 5;8(11):553. doi: 10.3390/foods8110553. PMID: 31694322; PMCID: PMC6915711.

Each treatment included ½ cup of filtered water in

Laflamme DP. Key nutrients important in the management of canine myxomatous mitral valve disease and heart failure. J Am Vet Med Assoc. 2022 Oct 8;260(S3):S61-S70. doi: 10.2460/javma.22.07.0319. PMID: 36191141.

Berk BA, Law TH, Packer RMA, Wessmann A, Bathen-Nöthen A, Jokinen TS, Knebel A, Tipold A, Pelligand L, Meads Z, Volk HA. A multicenter randomized controlled trial of medium-chain triglyceride dietary supplementation on epilepsy in dogs. J Vet Intern Med. 2020 May;34(3):1248-1259. doi: 10.1111/ jvim.15756. Epub 2020 Apr 15. PMID: 32293065; PMCID: PMC7255680.

Borras D, Ferrer I, Pumarola M. Age-related changes in the brain of the dog. Vet Pathol. (1999)36:202–11. doi:10.1354/vp.36-3-202.

Uchida K, Nakayama H, Goto N. Pathological studies on cerebral amyloid angiopathy, senile plaques and amyloid deposition in visceral organs in aged dogs. J Vet Med Sci. 1991 Dec;53(6):1037-42. doi: 10.1292/ jvms.53.1037. PMID: 1790213.

Pan Y, Landsberg G, Mougeot I, Kelly S, Xu H, Bhatnagar S, Gardner CL, Milgram NW. Efficacy of a Therapeutic Diet on Dogs With Signs of Cognitive Dysfunction Syndrome (CDS): A Prospective Double Blinded Placebo Controlled Clinical Study. Front Nutr. 2018 Dec 12;5:127. doi: 10.3389/fnut.2018.00127. PMID: 30619873; PMCID: PMC6299068.

an ultrasonic diffuser, with five drops of Eucalyptus polybractea, five drops of Fragonia, eight drops of Hops, and three drops of Hyssop decombens. The diffuser was placed outside a pet carrier containing Mandy, then the carrier and diffuser enclosed in a large garbage bag tent. The diffuser was run for five minutes in the enclosed space, after which the bag was opened and the diffuser allowed to finish. Mandy had natural lubricating tears placed in her eyes for protection. This selection of essential oils is based on those found to be successful for resistant TB strains. Nine months post treatment, Mandy’s cough continues to be minimal and her exercise tolerance has improved. Submitted by Nancy Brandt, DVM, MSOM, dipOM, CVC, CVA, CVMA

IVC Fall 2023

INTEGRATIVE TREATMENT FOR LUNGWORM IN DOGS

BY NANCY BRANDT, DVM, MSOM, DIP. OM, CVC, CVA, CVMA

From environmental controls and supplements, to ozone or deep inhalation therapy, a variety of integrative treatments are effective against lungworm infections in dogs.

Lungworm infections in dogs are more prevalent in specific environments that support the life cycle of the organism. Since this life cycle depends on the snail or slug, moist environments are essential. There are a variety of lungworm species — Oslerus osleri is the most common. They live in the dog’s trachea and are transmitted via saliva or nasal secretions after reaching adulthood. This article looks at how lungworm in dogs can be treated using an integrative approach.

HOW DOGS CONTRACT LUNGWORM The act of either ingesting a snail or slug, or eating another animal that consumed a snail or slug, can initiate an infection. The organism will move through the dog’s digestive tract and mature the lungworms in various areas of the respiratory tract, depending on their species. Signs can be incidental and non-specific, and include chronic cough or asthmatic symptoms. The symptoms will be worse in puppies, since their infestations are often passed along by being licked by the mother. Puppies will have a high parasitic load along with an immature immune cycle, which could appear as failure to thrive or any number of respiratory symptoms.

TESTING AND TREATMENT There are no current blood tests for these parasites. Fecal tests are often unable to detect the presence of the lungworm larvae,

IVC Fall 2023

1. Definitive host becomes infected by ingesting first-stage larvae. 2. Larvae cross the intestinal wall and travel to the lungs via lymphatics or blood. 3. Larvae migrate to the trachea and develop into adult parasites. 4. First-stage larvae are released into the tracheal lumen. 5. Larvae move to the pharynx and are swallowed, passing out in feces.

which can be passed in feces or saliva and nasal discharges. One special test, called the Baermann test, can detect larvae in the feces. Doing a transtracheal wash may also identify them. Normal therapy for lungworm involves antiparasitic medications like ivermecin, fenbendazole, milbemycin oxime + praziquantel or moxidectin + imidacloprid. Recovery is considered good in the majority of cases, though reoccurrence can occur depending on environmental controls. There is also some evidence that partial immunity or protection may occur.

INTEGRATIVE APPROACHES SHOULD INCLUDE THE FOLLOWING

Environmental controls such as using essential oils in the yard to repel snails. Using Cedrus atlantica, Hyssop officinalis and Pinus sylvestris around plants can repel snails and slugs.1 Use a 10% solution of one or all of these oils, and mist the yard daily to repel the snails.

2 3

se of above mentioned antiparasitic medication, U with supportive therapy for any chemical side effects. Supportive therapy should include supplements to help with detoxification, reduce inflammation, and provide neurologic protection.

Including high levels of essential fatty acids, green tea extract, turmeric, cat’s claw and Reishi mushroom. Proportional dosing and long-term use are best for supporting the immune system and limiting inflammation.

PERFORMING DEEP INHALATION THERAPY WITH ESSENTIAL OILS Deep inhalation therapy is as simple as putting the dog in a carrier and then tenting the carrier with something like a garbage bag. Once the dog is in an enclosed space that will not allow the essential oils to diffuse into a larger area, place an ultrasonic diffuser inside. Use ointment on the eyes to decrease any discomfort. Make sure you can observe the dog. Place ten drops of one of the above-mentioned Biologically Active Essential Oils™ (oils known to be safe for pets, from reputable companies) into the diffuser water (1/4 cup of water) and run it in the controlled space for ten minutes. This should be done once a day for ten to 14 days. Ozone inhalation should never be done at the same time as they will cancel each other out. Normally, ozone should be done before the two-week oil therapy, and then again afterwards, as it will help the dog’s body with parasite die-off and lessen the Herxheimer reaction.

he use of ozone, which when done with proper training T is helpful via both IV therapy and inhalation. Ozone inhalation, when done appropriately, will decrease inflammation and selectively damage the parasites. Inhalation is often the best method for coming into contact with the parasites, especially Oslerus osleri. IV ozone therapy, when performed properly, will support the oxidative state of infection. Using products for detoxification during ozone therapy can support the die-off of parasites. Deep inhalation of essential oils, daily for two weeks. This method (see sidebar) has been found to be effective against parasites. “The lipophilic nature of essential oils allows them to cross the membranes of parasites.”2 This will induce oxidative stress in the parasites. Essential oils that show promise against respiratory parasites by inhalation include: a. A rtemisia campestris (use with caution) b. Cymbopogon citrate c. Thymus vulgari d. Kunzea ambigua e. E ucalyptus citriodor f. Curcuma longa A variety of chemical constituents seem to contribute to heightened effectiveness, including beta-pinene, limonene and thymol.These can be harsh in cats; therefore, this author would use Melissa officinalis.

Use of specific Traditional East Asia Medical formulas for parasites in the blood. There is research supporting the use of these formulas for lungworm. The unique nature of these parasites is that they seem to be more resistant due to their unique locations in the body. Formulas that are successful for malaria would be great choices, and include Chai Hu Gui Zhi Gan Jiang Tang, Qing Gu San, and Xiao Chai Hu Tang.

Taking an integrative approach that includes conventional medications along with alternative therapies is an effective way to treat lungworm in our canine patients.

1Chemical Free Pets; Raising Our Standards, Dr Nancy Brandt, www.safe4animals.com, page 90. 2www.ncbi.nlm.nih.gov/pmc/articles/PMC9735941/; www.dvm360.com/view/canine-and-feline-

lungworms-proceedings; www.hawaii.edu/news/2022/12/06/rat-lungworm-diagnosis-treatment/;www. youtube.com/@NancyBrandt/videos (deep inhalation technique).

IVC Fall 2023

he word “detoxification”, or just “detox”, is tossed around all the time, but most horse owners likely don’t understand what it really means. Most of the time, people do not intentionally expose their horses to toxic substances, but the reality is that many management practices can lead to exposure. This article will clear up the definitions and discuss the benefits of a healthy integrative detoxification program for your equine patients.

DETOXIFICATION IN EQUINES —AN

INTEGRATIVE APPROACH BY JOYCE C. HARMAN, DVM Our equine patients are exposed to a host of toxins in their daily lives, and this can overwhelm their livers’ ability to process and eliminate them. A gentle detoxification program that uses an integrative approach is a beneficial way to support the overall health of your clients’ horses.

IVC Fall 2023

WHY DETOXIFY? The liver is an organ with a huge chemical factory. One of its many purposes is to process the ingredients broken down in the digestive tract, making sure everything is safe and appropriate for the body. This includes normal food particles as well as anything else that has been taken in through digestion. The liver also acts as a filter for the blood as it flows around the body, so any chemicals or contaminants are ideally cleaned up.

Horses are often exposed to a variety of environmental toxins depending on their habitat, diet, and the management practices at their facilities (see sidebar on page 49). Since most horse owners do not have a detailed background of where their horses lived before they purchased or adopted them, any past exposure to toxins or chemicals is unknown. The concept of detoxification is to support the liver with its chemical processes through natural supplementation. It is important to understand what a safe detox program is before tossing a lot of products at the liver, since it is possible to overload the liver even with natural supplements, herbs, and nutritional compounds. Problems arise when there’s an imbalance, excessive production, or when the body’s mechanisms for handling toxins are compromised.

PHYSIOLOGY OF DETOXIFICATION A natural set of chemical reactions occur in the liver when it goes to work on anything it considers toxic. When foreign chemical substances enter the liver, they undergo a biotransformation that changes them from harmful compounds to less toxic or inert molecules.

play. Many compounds, especially fat-soluble ones, can overwhelm the cytochrome P-450 enzymatic cluster. The goal of Phase II is to remove any harmful free radicals from Phase I. This conjugation phase involves the liver incorporating compounds such as glutathione and glycine onto the products of Phase I. This process increases the water solubility of the compounds, preparing them for excretion.

Phase I: The first phase of detoxification engages various enzymatic reactions such as oxidation, reduction, and hydrolysis with the enzyme cytochrome P-450 as a primary component. The goal here is to oxidize the offending compound and make it water soluble for easy excretion. Excess oxidation and the free radical production that comes with it can damage the liver.

Phase III: The third phase essentially involves the excretion of these prepared compounds into the bile and intestines, or the kidneys and bladder, for elimination from the body.

Phase II: If the antioxidant reservoir becomes depleted, and toxin levels exceed the ability of Phase I to handle, Phase II comes into

Each phase needs to proceed to the next for proper detoxification to occur. If one stage is blocked or not functional, detoxification

DETOXIFICATION SUPPORT

TOXIN EXPOSURES Horses can be exposed to toxins from many sources, both by directly ingesting compounds such as herbicides sprayed on hay and grain, to breathing in pollutants in the air. Some of the more common exposures are listed here, but almost anything in the environment can end up inside the horse. 1. P esticides and herbicides: The use of chemical treatments in pastures, grains, and overhead fly sprayers is common practice. Furthermore, pesticides sprayed in the air can be inhaled, or settle on the horse's skin, which when groomed or licked, can lead to ingestion. Runoff from nearby agricultural land can contaminate water supplies in pastures. 2. Heavy metals: Contaminated water or soil, often a result of industrial runoff or poor waste management, can expose horses to heavy metals such as lead and mercury. Hay or grains grown on soil that has been applied with sludge (human waste from sewage systems) will carry heavy metals. Many vaccines also contain heavy metals as adjuvants. 3. M ycotoxins: Fungi can grow on feeds or forage and can be hard to detect.

6. E ndocrine-disrupting chemicals: Common in plastics and some types of hay netting, these toxins can affect a horse's hormonal system. 7. C ontaminated water: Whether due to industrial runoff, agricultural residues, or natural bacterial growth, contaminated water sources can add to the toxin load. 8. Mold: Moldy hay or grains can be a significant source of toxins. 9. M edications and drugs: While intended for therapeutic purposes, the overuse or misuse of medications can have detrimental effects on the liver, both directly or indirectly affecting the detox phase. 10. T reated wood: Some wood treatments contain chemicals like arsenic, which are toxic to horses. Horses chew wood frequently, so this is an often overlooked and significant source of toxins.

4. I ndustrial pollutants: Horses living near industrial zones might be at risk of exposure to various chemicals and by-products. These can be airborne or contaminate the soil and water sources.

11. E ndotoxins and by-products of illness: When a horse is ill, not only are a significant number of drugs often used, but the liver must deal with internal metabolic by-products.

5. A ir pollutants: Emissions from vehicles, factories, and other industrial activities can contain a myriad of harmful compounds. Smoke contamination is becoming more common, with many chemicals being released into the air.

12. P hytotoxins: Some plants consumed by horses contain toxins that interfere with metabolism. For instance, fescue grass can carry an endophytic fungus that produces alkaloids harmful to horses.

Pb Lead

Mercury

IVC Fall 2023

HOMEOPATHIC DETOXIFICATION Homeopathic remedies have a different action on the body than the direct support given by nutritional and herbal supplementation. For those who have not studied homeopathy, the body is basically responding to the energetic effect of the remedy. Many remedies have an effect on the liver, but it’s often best to work up a constitutional remedy for an individual horse to address their symptoms. A few remedies have fairly universal effects, and given in low potencies (usually a 30C) are safe detoxification remedies for inexperienced homeopaths. Combination remedies prepared as detox formulas may or may not be helpful for an individual horse. This author prefers to work with a single remedy constitutionally selected for that individual. One of the favorite remedies for its effects on the liver is Nux vomica. This remedy has been used for many acute toxic situations, as well as for spring time detox. Usually, giving the remedy once a day for three days is sufficient for this purpose. Thuja Occidentalis is another remedy often given to help correct some of the imbalances that occur after many vaccines have been used.

The remedy, Nux vomica, is prepared from the seeds found in the fruit of the Strynos Nux vomica tree

cannot proceed correctly. The idea of supporting detoxification is to move each phase along appropriately. In human functional medicine, it is possible to perform laboratory testing to determine the exact phase that needs support. In equine practice, that type of information is not available, so detoxification needs to proceed gently so as not to overload any one phase. Some practitioners feel the horse needs to eliminate toxins dramatically, with diarrhea or excessive urination or sweating. In this author’s opinion, that is generally a sign the process is proceeding incorrectly. It is normal to see a change in manure characteristics, a mild increase in drinking and urination, or perhaps an odor to the sweat, but if there are significant signs or discomfort involved, it’s time to back off and reevaluate the process. Support can be herbal (there are many different herbal protocols from Western, Chinese, native American, and Ayurvedic traditions), homeopathic (see sidebar at left) or nutritional. It is best to start with a single approach, then add another if desired. Do not use two or three different things at one time. Many products combine a number of ingredients, and many are well thought out and designed by experienced practitioners. These are the ones to select, rather than a “kitchen sink” formula with 25 to 30 ingredients that will overwhelm any liver. Generally, the goals of nutritional support are to provide antioxidants for Phase I and amino acids for Phase II. Many herbs provide balanced support for detoxification and have been well researched. Most of the time, a detox program is best done for a month or two, then the liver is given a rest. In more extreme cases, it may be valuable to continue for longer periods, especially when heavy metals are involved. Hair analysis can be used to determine the presence of these. Phase I supplements Antioxidants: vitamins C, E and A, selenium, copper, zinc, manganese

Identified as a remedy by indigenous people in North America, the homeopathic form of Thuja occidentalis is prepared from the leaves and twigs

IVC Fall 2023

Phase II conjugation supplements Amino acids: glutamine, glycine, taurine, cysteine, methionine, N-acetylcysteine

It is possible to use foods to supply many of these compounds, and horses often like them. The cruciferous vegetables, brassicas, alliums like garlic, and dark leafy greens can all be fed as part of the diet.

HERBAL DETOXIFICATION This article cannot cover all the approaches to herbal detoxification, since each branch of herbal medicine has many formulas available. However, several herbs have been heavily researched for their effects on liver support. These include milk thistle and turmeric, as well as dandelion, licorice, and burdock. Astragalus, gingko and red sage (Dan Shen) have also been heavily researched for liver support. For support in the elimination part of the process, herbs such as cleavers, nettle and dandelion help make a balanced formula. In the springtime, horses crave fresh dandelion after a winter with few fresh greens to eat. They will eat the leaves and the root right out of the ground, performing their own detox from the winter.

CONCLUSION The world our horses is exposed to is full of potential toxins, and this can lead to the liver detoxification pathways becoming overloaded. Adding a mild detoxification program to an overall health protocol is beneficial for horses in general. For a safe detox program, it’s important to proceed gently and without overloading the liver. Horses look and feel better after detoxification, and respond better to other therapies when their livers are fully functioning.

From the AATCVM & WATCVM The American Association of Traditional Chinese Veterinary Medicine (AATCVM) is a non-profit organization founded in 2006 to support practitioners of Traditional Chinese Veterinary Medicine (TCVM) and promote high quality research in all aspects of TCVM, including acupuncture, Chinese herbal medicine, Tui-na and food therapy. Members of AATCVM also enjoy dual membership with the World Association of Traditional Chinese Veterinary Medicine (WATCVM). One of the benefits of being an AATCVM/WATCVM member is access to the American Journal of Traditional Chinese Veterinary Medicine, which publishes clinical research studies, case reports and continuing education articles.

CLINICAL CORNER — FROM AJTCVM’S AUGUST 2023 ISSUE Treatment of Primary Pulmonary Carcinoma with Traditional Chinese Veterinary Medicine After Conventional Therapy Failure A ten-year-old castrated male German Shorthaired Pointer was referred to a veterinary teaching hospital (VTH) with a fourmonth history of anorexia, hind limb weakness and occasional coughing. The coughing was minimally responsive to various antibiotic/steroid combinations prior to thoracic radiographs identifying pulmonary masses. Diagnostic workup and imaging by the VTH oncology service confirmed two pulmonary masses, 4.8 cm x 3.7 cm and 1.4 cm x 1.6 cm, in the left and right middle lung lobes, respectively. Fine needle aspirate diagnosis was primary mucinous bronchoalveolar carcinoma. With masses in two lobes, the condition was not amenable to surgery, therefore, chemotherapy was suggested along with Traditional Chinese Veterinary Medicine (TCVM) therapy to improve quality of life. Initial TCVM patterns were Spleen Qi Deficiency, Kidney Qi Deficiency and Lung Blood Stasis. Therapy was designed to stimulate the dog’s appetite, counter chemotherapy negative side effects, and strengthen the hind limbs. Acupuncture, Tui-na, and Chinese herbal medicines (CHM) were initially started along with chemotherapeutics. The Tui-na and CHM treatments quickly became the main therapy when the dog was unable to tolerate chemotherapeutics or acupuncture. Survival was expected to be six to nine months with chemotherapeutics, or two to five months without. Using TCVM therapies, the dog survived 19 months after diagnosis, with an excellent quality of life. This case demonstrates the potential benefits of combining TCVM with conventional therapy for oncology patients to extend survivability while improving quality of life.

IVC Fall 2023

In the news

RAPID DIAGNOSTIC TECHNIQUE IDENTIFIES BACTERIAL INFECTIONS

A groundbreaking rapid diagnostic technique for bacterial infections in dogs has garnered significant attention for its potential to revolutionize treatment timelines and mitigate antimicrobial resistance (AMR). Developed by researchers at The University of Edinburgh, this method employs DNA extraction and sequencing methods to swiftly detect bacterial presence, offering results within hours.

The researchers, who detailed their findings in Microbial Genomics, believe this approach could have far-reaching implications not only for animals but also for humans. According to senior clinical researcher, Natalie Ring, it could become standard practice in the future, with widespread adoption across various medical fields. While the new technique has primarily been evaluated for urinary tract and skin

IVC Fall 2023

infections in dogs, the researchers anticipate its adaptability to different species, including humans, and to a range of sample types such as blood and viruses. Plans for expanding the research across different species are in progress, and medical professionals at a London hospital are reportedly exploring potential human applications. The process involves metagenomic DNA extraction, nanopore sequencing for DNA code generation, and a data analysis tool to identify bacteria from DNA samples. Preliminary results showed that this technique could identify bacteria within five hours, a stark contrast to the 48 to 72 hours typically required by current methods. Furthermore, it demonstrated the ability to identify bacterial species that are hard to detect through culturing, and to predict antibiotic sensitivity with impressive accuracy, potentially reaching up to 95% for urine samples.

The researchers assert that this expedited diagnostic process will enable veterinarians to prescribe more targeted and effective antibiotic treatments, alleviating the need for ineffective treatments that can contribute to AMR. This is particularly significant for addressing the escalating concern of antimicrobial resistance in the farming industry. While this new method might be more expensive for veterinary practices compared to existing techniques, its potential to benefit both animals and humans through a unified approach will likely drive its adoption. Its applicability across various species and infection types predicts it will have a significant role in promoting responsible antimicrobial use and controlling antimicrobial resistance.

www.microbiologyresearch.org/content/journal/ mgen/10.1099/mgen.0.001066

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? Japanese barberry (Berberis thunbergii) is a dense shrub that was originally planted as hedges for landscaping, but which has since spread to native habitats. It is capable of changing the characteristics of the soil to outcompete native plants, and the leaves emerge early in spring, allowing it to overshade nearby competitors. Deer do not favor Japanese barberry and will selectively avoid it while overeating native plants. Turkeys and other birds love the berries and effectively disperse the seeds. The result is a rapid dominance of Japanese barberry in our native habitats. On the plus side, Japanese barberry has many medicinal benefits. It has hepatoprotective effects, and is specific for liver stagnation with impaired fat digestion and biliary dyskinesis. It clears damp heat infections (bacterial, fungal or viral), including candida overgrowth in the GI tract as well as sinus infections. Barberry contains a chemical compound called berberine that is helpful for gastritis, bacterial diarrhea, urinary tract infections, and prostatitis. Berberine has also been shown to reduce blood sugar and cholesterol levels, and can improve serum lipids and inflammatory markers. Additionally, one could use Japanese barberry to make a saline eyewash for conjunctivitis or blepharitis; it can also be used as a poultice or fomentation for topical staph infections (e.g. boils, styes). The root is the plant part traditionally used, but research has shown that using barberry leaves along with the root inhibits the multi-drug resistance (MDR) efflux pumps in bacteria, thus preventing resistance to berberine.

acne, and hypertension. Eli Jones, MD, used it for back pain (in the small of the back) caused by kidney infections. Barberry is commonly used in alterative formulas, such as Hoxsey Formula, to treat cancer, arthritis, skin conditions and autoimmune diseases. Dr. Bastyr, ND, used barberry (1 part) with red root (4 parts) to treat splenomegaly (David Winston, 2018-2020 professional class). Samuel Thomson’s bilious/digestive tonic is an old but still valid recipe. Take 4 oz of dried ground barberry root, poplar bark and wild cherry bark and macerate them in 1 gallon of hard cider for two weeks. Strain and take 1 tbsp TID for biliousness or dyspepsia. It is important that herbalists stay informed about both invasive and endangered herbs so they can be responsible with their prescriptions. One way to learn more is to join the United Plant Savers (https://unitedplantsavers.org/).

RECENT AND UPCOMING EVENTS • T he VBMA-sponsored Veterinarian Track at the International Herbal Symposium was incredible — recordings are available through VBMA.org. • T he VBMA will host an herbal walk on Friday, October 6 at 5:15 pm, ahead of the AHVMA conference — the sponsored speaker is John Chen, Lac, PhD. Register at vbma.org. Submitted by Cynthia Lankenau, DVM

GUESS THIS HERB!

There are many species of barberry, and all have similar effects. Japanese barberry has higher levels of berberine than B. vulgaris. Unlike many other herbs, Japanese barberry is an invasive so it should be harvested and used. Barberry species have a long history of medicinal use. The berries are used in Iranian and Unani-Tibb herbal traditions for lowering fevers, to treat bleeding gums, for arrhythmias,

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

IVC Fall 2023

In the news

DRUG-RESISTANT HOOKWORMS SPREADING AMONG DOGS An issue of concern is emerging in veterinary medicine as drug-resistant hookworms spread among dogs in the United States. Veterinarians are encountering cases in which the standard anthelmintic drugs approved by the FDA for treating hookworm infections are proving ineffective against certain isolates of Ancylostoma caninum, a common canine hookworm species. First reported in 2019, this development has prompted parasitologists to raise awareness about this emerging threat, and recommend modified approaches to screening, testing, and treatment. Veterinarians are encountering cases like that of a Border Collie puppy in Ohio, which persisted in harboring hookworms despite multiple rounds of treatment with different anthelmintics. This resistance phenomenon has been linked back to Greyhounds retired from racetracks and adopted as rescues, with studies indicating that multidrug-resistant hookworms have spread to various breeds.

IVC Fall 2023

To address the issue, the Hookworm Task Force, established by the American Association of Veterinary Parasitologists (AAVP), is working to raise awareness among veterinarians about resistant hookworms, and provide guidance on effective screening and testing strategies. Parasitologists are calling on clinicians to share their observations and experiences to better understand the extent of the problem.

quently, and consider adopting quarterly fecal flotation screenings for all dogs. As asymptomatic dogs can still spread resistant hookworms to other dogs, early detection is crucial to prevent further transmission. While dog parks are a potential source of transmission, veterinarians emphasize that the benefits of visiting such parks usually outweigh the risks, and regular fecal screenings and appropriate preventive measures can mitigate the threat.

Veterinarians are advised to modify their approach to heartworm treatment. Parasitologists recommend conducting fecal egg count reduction tests (FECRTs) within ten to 14 days after treatment. If the egg reduction rate is greater than 95%, the treatment is deemed effective. Reduction rates between 75% and 95% indicate the need for repeated treatment, while a rate below 75% suggests drug resistance.

The rise of drug-resistant hookworms poses a significant challenge to veterinary medicine. The collaboration between researchers, parasitologists, and veterinarians is crucial to addressing this issue, and developing effective strategies for detecting, treating, and preventing the spread of multidrug-resistant hookworms among dogs.

Veterinarians are additionally encouraged to screen for hookworms more fre-

https://news.vin.com/default.aspx?pid= 210&Id=11639755&f5=1