V14I1 (Winter 2023-24) by Redstone Media Group

Innovative VETERINARY CARE

VOLUME 14 ISSUE 1

THE GUT-BRAIN AXIS AND ITS EFFECT ON BEHAVIOR FIND OUT HOW MBRT CAN IMPROVE MENTAL HEALTH AND BEHAVIOR IN DOGS AND CATS. — P. 30

WAYS TO MINIMIZE STRESS IN FELINE PATIENTS

TAKE A NUTRITIONAL APPROACH TO LEAKY GUT SYNDROME

THE EVOLUTION OF VETERINARY SOCIAL WORK

HOW LLLT/PBM REDUCES ORAL PAIN IN DOGS AND CATS

WHY IT'S IMPORTANT TO CONSIDER FASCIA HEALTH

WHAT'S THE BEST APPROACH TO SEPARATION-RELATED BEHAVIORS IN DOGS?

From cat friendly handling techniques to the exam room environment, there are several ways to help keep cats calm during clinic visits. — p. 50

WINTER 2023/24

www.IVCJournal.com

Recent innovations in this relatively new field of practice benefit a range of humananimal interactions, in veterinary medicine and beyond. — p. 16

By supporting this vital network of connective tissue in your animal patients, you can improve their overall health. — p. 38

How functional medicine, including the “5 Rs” protocol for gut healing, effectively resolves leaky gut in dogs and cats. — p. 42

This new technology effectively decreases oral pain and improves quality of life for dogs and cats with dental issues. — p. 24

The goal is to determine the underlying cause of the behaviors, before designing an environment and training protocol that sets the dog up for success. — p. 58

WINTER 2023/24 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, dip.OM, CVC, CVA, CVMA Todd Cooney, DVM, CVH Donald H. DeForge, VMD W. Jean Dodds, DVM Moira Hechenleitner, DVM, CSAT Cynthia Lankenau, DVM Julie Liu, DVM Bethanie Poe, LMSW Lily Richards, BSc (Hons), BVSc, MRCVS Ruth Roberts, DVM, CVA, CVH, CVFT Margo Roman, DVM, CVA, COT, CPT, FAAO Marlene Siegel, DVM, CNHP, ALT Keith Weingardt, DVM, CVA, CTCVM

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

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contents FEATURES

APPROACH TO FELINE GUT MICROBIOME AND ITS 8 INTEGRATIVE 30 THE COMPULSIVE DISORDERS EFFECT ON BEHAVIOR IN DOGS AND CATS by Lily Richards, BSC (HONS), BVSC, MRCVS

Treating compulsive disorders in cats can be challenging, and requires an integrated, multidisciplinary approach to achieve the best outcome.

AND FUTURE 16 INNOVATIONS DIRECTIONS IN VETERINARY SOCIAL WORK by Bethanie Poe, LMSW Veterinary social work has grown into an entire field of practice. Recent innovations benefit a range of humananimal interactions, in veterinary medicine and beyond.

DIRECTION FOR 20 RESEARCH INTEGRATIVE MEDICINE IN DOGS — WHAT NEEDS TO BE DONE? by W. Jean Dodds, DVM A look at the outside factors that negatively impact a dog’s state of health, along with the integrative medicine topics requiring more research to address them.

LLLT/PBM REDUCES ORAL 24 HOW PAIN IN DOGS AND CATS

by Donald H. DeForge, VMD, Fellow of the Academy of Veterinary Dentistry

Unlocking a new technology to decrease oral pain and improve quality of life for dogs and cats with dental issues.

16 50 4

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by Margo Roman, DVM, CVA, COT, CPT, FAAO This article focuses on the gut-brain connection and how MBRT can improve mental health and behavior in dogs and cats.

THE CINDERELLA TISSUE — WHY IT’ S SO IMPORTANT TO 38 FASCIA, YOUR ANIMAL PATIENTS by Marlene Siegel, DVM, CNHP, ALT Fascia is incredibly important to bodily well-being. Supporting this vital network of connective tissue in your animal patients can improve overall health.

NUTRITIONAL APPROACH LEAKY GUT SYNDROME IN 42 ATODOGS AND CATS by Ruth Roberts, DVM, CVA, CVH, CVFT How functional medicine, including the 5 Rs protocol for gut healing, effectively resolves leaky gut in dogs and cats.

CARE FOR CATS: HOW TO MINIMIZE STRESS DURING 50 CALMER FELINE EXAMS by Julie Liu, DVM By considering stressor stacking, the exam room environment, and cat friendly handling principles, you’ll be able to significantly reduce stress in your feline patients during exams.

advisory board

DETERMINING THE BEST APPROACH TO SEPARATIONRELATED BEHAVIORS IN DOGS by Moira Hechenlietner, DVM, CSAT With separation-related behaviors in dogs, the goal is to determine the underlying cause before designing an environment and training protocol that sets the dog up for success.

COLUMNS & DEPARTMENTS

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.

7 Editorial 33 From the AHVMA 34 Best of 2023 Innovative Pet

Products Spotlight

36 Industry Innovations 41 From the VMAA 49 Profitable Practice — Cave Pets 55 From the AVH 57 From the VBMA IN THE NEWS:

37 Dogs show more motivation in response to high-value appetitive stimuli

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.

56 Feline communication via microbial metabolites in anal glands

62 Mysterious canine illness sparks concern

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

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

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contributors

1. DONALD H. DEFORGE, VMD

Dr. Donald Deforge is a Fellow of the Academy of Veterinary Dentistry and President of the Society for Veterinary Medical Ethics. He developed a special interest in oral care after graduating from the University of Pennsylvania School of Veterinary Medicine. Dr. DeForge is a co-editor of An Atlas of Veterinary Dental Radiology. He was an Adjunct at Northwestern Community College’s Veterinary Technology Program, where he established the Department of Oral Radiology and Periodontology for veterinary technology students, in conjunction with Dr. Nancy Marchett, Program Director. Dr. DeForge is also the Oral Radiology Consultant for E-Vet Diagnostics, a telemedicine reading service for veterinarians. p.24

2. 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.20

3. MOIRA HECHENLEITNER, DVM, CSAT

Dr. Moira Hechenleitner graduated in 2007 from Mayor University College of Veterinary Medicine in Santiago, Chile. She is a Certified Separation Anxiety Trainer (CSAT), a postgraduate in Animal-Assisted Therapy, and has completed courses in Bach Flower Therapy for animals, dog training, and Reiki. Dr. Hechenleitner is a founding board member of the Chilean Association of Professional Dog Trainers (APDT Chile), and has worked as a canine behavior consultant for ten years. She currently resides in Mystic, CT and works remotely with pet owners from several countries. p.58

4. JULIE LIU, DVM

Dr. Julie Liu is a veterinarian, speaker, and freelancer based in Austin, TX. She has been a frequent contributor to Fear Free, serves on the Fear Free speakers bureau, and has presented in multiple venues locally and nationally, including VETgirl and the 2022 Mars Asia Veterinary Conference. Dr. Liu also volunteers on the AAFP Cat Friendly Practice committee and serves as Vice President of the Relief Veterinary Medical Association, which supports and advocates for relief professionals in the US. Her special passion is advocating for the emotional health of all pets, especially cats (www.fluxvet.com). p.50

5. BETHANIE POE, LMSW Dr. Bethanie Poe has been involved with the University of Tennessee Veterinary Social Work program for over a decade, first as a graduate student when she helped develop the Veterinary Social Work Certificate Program, and now as an instructor. Dr. Poe is currently the Middle Tennessee Coordinator for UT’s Human-Animal Bond in Tennessee (H.A.B.I.T) program, where she strives to make animal assisted interventions available to victims of crime. p.16

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6. LILY RICHARDS, BSC (HONS), BVSC, MRCVS

Lily Richards qualified from Liverpool University, UK in 2011 and spent five years as a clinical veterinarian working in mixed animal practice. As her passion for exploring more complicated small animal medical cases developed, she stepped into small animal-only practice. By 2018, Lily was leading a busy branch of a large hospital practice, working on both surgical and medical cases. She found a new passion in medical writing, and is dedicated to making medical information accessible to all. She loves finding interesting ways to get colleagues and pet owners excited about pet health topics. p.8

7. RUTH ROBERTS, DVM, CVA, CVH, CVFT

Dr. Ruth Roberts, a veterinarian with 30 years’ experience, is a leading expert in holistic and integrative veterinary medicine. She earned her DVM from North Carolina State University in 1990 and initially practiced Western medicine. Driven by her own dog’s health challenges, she delved into TCVM, becoming certified in acupuncture, Chinese herbology, and food therapy at the Chi Institute in Florida. In 2006, she pioneered "The Original CrockPet Diet," transforming pet health through nutrition. Dr. Roberts transitioned to remote consultations in 2016, serving clients globally. She also offers the Holistic Pet Health Coach certification program with 40 CE hours from the RACE board. p.42

8. MARGO ROMAN, DVM, CVA, COT, CPT, FAAO

Dr. Margo Roman has been a pioneer in studying the microbiome. She uses her own dogs as donors, as they are six generations protected from any antibiotic use or flea and tick products. Dr. Roman’s dogs are naturally birthed and reared in her organic sustainable home amid seven acres of virgin woods. Her home and property are kept free of pesticides and chemicals. Dr. Roman’s dogs are fed a homemade diet made from predominantly plant-based organic ingredients, along with a small quantity of free-range deer meat left over from local hunters during hunting season; the dogs get about 8% animal protein to help feed the microbes that need putrefied flesh to satisfy their nutritional demands. p.30

9. MARLENE SIEGEL, DVM, CNHP, ALT

Dr. Marlene Siegel is an international speaker and innovator in integrative veterinary medicine. Her practice, Pasco Veterinary Medical Center, offers the widest array of alternative therapies and detoxification services in the country. She developed her own raw pet food and supplements company, EvoLoveRaw.com. Passionate about education, Dr. Siegel has online integrative veterinary medicine programs for pet parents and veterinarians. She is launching S’Paws Family Wellness, detox centers for pets and their parents. p.38

editorial

Behavior: Beyond the Surface Animal behavior is a fascinating and complex topic that involves various factors, including genetics, environment, and health. In veterinary medicine, understanding animal behavior and addressing problems leads to the holistic wellbeing of our patients. Normal sociable behaviors exhibited by dogs and cats bring invaluable joy to their “parents”. But if something is out of tune, it can not only upset the pet parents, but also hint at underlying conditions that need attention. This issue of IVC Journal focuses on animal behavior, and brings together esteemed experts who have made significant contributions to the field of integrative veterinary medicine. From feline compulsive disorders to separation anxiety in dogs, we explore a diverse range of behavioral challenges, along with the innovative approaches to these challenges being employed by veterinary professionals. For example, Dr. Lily Richards enhances our understanding of feline compulsive disorders by offering insights into the behavioral challenges of cats. As we explore these disorders in detail, we gain a deeper appreciation for the unique needs and sensitivities of our feline patients. Dr. Moira Hechenlietner shifts our focus to separation-related behaviors in dogs, a common and often distressing issue for both pets and their owners. Thanks to her expertise in behavior modification, she provides invaluable guidance for helping dogs cope with the emotional challenges of being away from their human companions, fostering stronger bonds, and promoting emotional well-being. Veterinary visits can be a source of anxiety for many cats, and Dr. Julie Liu addresses this concern directly. Her insights provide practical strategies to help veterinarians and pet owners create a more positive and stress-free experience for their feline companions.

Meanwhile, Dr. Margo Roman investigates the effects of MBRT on canine behavior. As our understanding of the gut-brain connection deepens, her work underscores the behavioral impacts of microbiome interventions, offering exciting possibilities for improving mental health in our canine friends. Along with timely articles on behavioral issues, this issue includes other valuable contributions on a variety of topics. In Dr. Marlene Siegel’s piece, fascia and fascia decompression take center stage. Dr. Ruth Roberts introduces a nutritional approach to leaky gut syndrome in dogs and cats, while Dr. Bethanie Poe introduces the concept of veterinary social work, which recognizes the emotional and social aspects of veterinary care. For an in-depth look at the future of research in the field of integrative veterinary medicine, be sure to read Dr. Jean Dodd’s contribution. Also featured is an article by Dr. Don DeForge’s that sheds light on the potential benefits of photobiomodulation in veterinary dentistry. This edition brings together a diverse array of perspectives, insights, and innovations from prominent figures in veterinary medicine. The information presented in these articles will not only assist us in gaining knowledge, but also help foster compassionate behavior in veterinary care. And that’s how it is supposed to be.

Best regards,

Omer Rashid, DVM, MSc Parasitology Associate Editor, dromer@redstonemediagroup.com IVC Winter 2023/24

BY DR. LILY RICHARDS, BSC (HONS), BVSC, MRCVS

Treating compulsive disorders in cats can be challenging, and requires an integrated, multidisciplinary approach to achieve the best outcome. Like humans, cats may demonstrate behaviors typical of obsessive-compulsive disorders (OCDs). Since cats are complex creatures with unique nuances and behaviors, how do we know what’s normal and when to be concerned? What does an integrative approach to treating feline compulsive behaviors involve, and why is it the best option when dealing with these complex behaviors?

CATEGORY

BEHAVIOR

Oral behaviors

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Fabric sucking and ingestion

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Pica

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Coprophagy

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Overgrooming

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Feline Hyperaesthesia Syndrome (FHS)

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Compulsive pacing

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Tail chasing

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Circling

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Light/shadow chasing

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Freezing

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Stargazing

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Startling without a trigger

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Repetitive vocalization

Self-mutilation

Locomotory

WHAT ARE FELINE COMPULSIVE DISORDERS? Feline compulsive disorders are rare, but they can be very disruptive and harm the human-animal bond, significantly decreasing quality of life of both cat and owner. Compulsive disorders involve constant, time-consuming, repetitive, exaggerated behaviors without apparent purpose. It can be difficult to diagnose compulsive disorders because the symptoms originate from normal behaviors. The compulsive nature of the behaviors, their frequency and longevity, their occurrence out of context, and the difficulty involved in interrupting them, are what cause concern. It is important to note that not all repetitive behaviors are compulsive.

HOW DO COMPULSIVE DISORDERS PRESENT IN CATS? The most common compulsive disorders in cats are oral behaviors, self-mutilation, locomotory disorders and vocal disorders. To the right is a table of behaviors and their differential diagnoses for consideration.

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Vocal

DIAGNOSIS OF COMPULSIVE DISORDERS IN CATS Diagnosis is based on the cat’s signalment, a detailed medical history, and exclusion of other diseases.

Signalment — breed, age, and neutering status

DIFFERENTIAL DIAGNOSES

Oriental breeds are more likely to suffer from true compulsive disorders, with a typical onset of two to eight months of age. Consider the case of a female kitten, four to six months of age and yet to be spayed, with sudden vocalization. She is likely to have reached sexual maturity and be displaying normal sexual behavior. To a first-time cat owner, however, this can appear quite distressing and be misconstrued as significant illness.

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Primary gastrointestinal disease

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Dermatological disease (parasites, allergies, infection, thiamine deficiency, toxicities — i.e. lead poisoning)

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Pain (neurological, orthopedic, generalized)

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Normal self-soothing if not excessive

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Primary gastrointestinal disease

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Primary dermatological disease (parasites, allergies, drug reactions, infection)

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Pain (neurological, orthopedic, generalized)

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Partial/focal seizures

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Neurological disorders

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Hormonal (hyperthyroidism, diabetes)

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Primary neurological disease

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Partial/focal seizures

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Pain (neurological, orthopedic, generalized)

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Primary dermatological disease

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Primary ophthalmic disease

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Vitamin deficiencies — i.e., vitamin A leading to ocular disorders, thiamine deficiency

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Hypertension

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Normal sexual behavior

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Frustration from confinement

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Normal behavior

6. Are they up to date with antiparasitic medication? What types of antiparasitics are used, how are they administered, and how often?

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Partial/focal seizure

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Primary neurological disease

7. Does your cat have a history of skin disease, excessive itching, or dietary problems?

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Cognitive dysfunction

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Pain (neurological, orthopedic, generalized)

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Hormonal disease (hyperthyroidism)

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Normal sexual behavior

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Auditory dysfunction

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Hypertension

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Renal disease

Older cats with a sudden onset of excessive, repetitive vocalization should be investigated for hypertension, visual deficits, auditory dysfunction, hyperthyroidism, and cognitive dysfunction. Considering the time of day or circumstances in which the behavior initiates is also often useful; e.g. an older cat yowling and pacing at night is likely to be anxious, in pain, or having visual disturbances (such as night blindness). Differentials including hyperthyroidism and/or hypertension should be considered.

History It is vital to get a good history to gain a diagnosis and identify any triggers for compulsive behaviors. A thorough history can also guide any necessary further testing, and solidify your diagnosis before constructing your treatment plan. Questions to ask in the consult room include: 1. Does your cat go outside? 2. D o they come into contact with other animals, wild or pets? 3. Has the cat been to a cattery? 4. Do you see your cat grooming frequently, often until the hair is thinning and the skin red or bleeding? 5. Do you notice your cat scratching a lot?

8. Have you changed their diet? 9. Is your cat on any medications or being treated for any other illnesses? 10. Do they move around your home as normal, jumping onto surfaces like windows as they always have, or has this changed? 11. Are there any other symptoms you are worried about? Is your cat eating, drinking, and toileting normally?

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12. Has your cat’s interactions with you changed — are they withdrawn, aggressive or overly affectionate? 13. Has anything changed in the household recently (for identifying any potential stressors): o

Visitors

New pet in the house

Change of routine

Building work going on

Moving to a new home

The differential diagnosis list will be driven by symptoms, a thorough history, and a clinical exam. Behaviors should be considered in terms of context, triggers, frequency, and duration. Remember, though, that common things are common — if you hear hooves, think horses, not zebras! Oral behaviors may be primarily related to gastrointestinal inflammation and diseases such as gastroenteritis, endoparasite burdens, pancreatitis, dietary intolerances, or inflammatory bowel diseases, which are more common than behavioral pathogenesis. Overgrooming, meanwhile, often results from pruritic skin disease and cannot be diagnosed without a complete skin workup. Alternatively, overgrooming can be due to pain, neurodermatitis or neuralgia, such as in the case of caudoventral abdominal overgrooming due to feline lower urinary tract disease or chronic pancreatitis.

Clinical exam and further testing A thorough clinical exam is critical to diagnosis, as compulsive disorders are a diagnosis of exclusion. The decision to carry out further testing, and which tests are appropriate, should be based on signalment, history, and clinical exam findings. These tests could include: 1. Blood sampling a. A complete blood count (CBC), including biochemistry and hematology b. Hormonal testing (free and total T4) c. Allergy screening

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2. Skin examinations a. T ape strips, hair plucks and skin scrapes b. Microscopic examination of samples and the hair itself c. C ytology d. A llergy testing 3. I maging a. X -rays b. A dvanced imaging, CT, MRI

TREATING COMPULSIVE DISORDERS IN CATS After recognising the potential for compulsive behavior and eliminating any underlying or primary cause, a diagnosis of compulsive disorder can be reached. Treatment is based on an integrative approach, utilising behavioral modification techniques (standardizing husbandry, considering triggers and eliminating them where possible, and educating pet owners) and medical therapy. The aim is to reduce the frequency, intensity, and duration of compulsive symptoms to maintain a good quality of life. Client expectations should be managed from the beginning to ensure you can develop trust to work together well as a team, especially as compulsive disorders are usually lifelong and managed rather than cured. These disorders are complex to treat due to their multifactorial etiology, so it is important that owners understand the diagnostic and treatment process so as not to become disheartened with outcomes or frustrated with progress. Success depends on client understanding, compliance and consistency.

WHAT DOES AN INTEGRATIVE APPROACH ENTAIL? An integrative approach uses multiple modalities to address the symptoms of a condition to maximise the chances of a successful outcome. As compulsive disorders have a multifactorial etiology, it is often necessary to treat in combination with different departments of vets, and those offering complementary therapies (i.e. physiotherapists, acupuncturists, and behaviorists). As well, it’s important to consider concurrently prescribing different classes of medical treatment options to address all areas of the condition and improve patient outcomes.

A. BEHAVIORAL MODIFICATION AND ENVIRONMENTAL MANAGEMENT 1. Set up a routine 2. Reduce environmental stress 3. Identify triggers and eliminate them where possible 4. Ignore symptomatic behavior if feasible 5. Consider enrichment Working with a veterinary behaviorist is advised to support clients with making changes, observing their effects, and continuously modifying treatment plans in order to maximise success at treating compulsive disorders. Some techniques for behavioral modification and environmental management are detailed below: 1. S et up a routine: This helps regulate the cat’s schedule, making it more predictable and eliminating anxiety triggers. Set a time for pet owners to feed their cats, even when the owners aren’t able to be around — using automated feeders can help regulate this. Encourage owners to put aside some time each day to interact and play with their cats; this helps build their bonds and also adds structure and enrichment to the day. 2. Reduce environmental stress: If owners are expecting a forced temporary change in their cats’ routine, such as building work or a temporary change in work patterns, they should try to keep as much as possible stable for the cat. If possible, have a partner remain constant, feed, and initiate play with the cat. In the case of building work, provide a safe, quieter area away from the work for the cat to be fed in. 3. I dentify triggers: Compulsive behaviors are often specific and contextual,

meaning they may be triggered in specific places within the cat’s environment more than in others. It is important to identify situations, activities, or locations that trigger the behavior in order to be able to make efforts to block or remove them. M ake sure there are enough resources for the number of cats in the household. One of the primary causes of compulsive disorders is a cat feeling their needs aren’t being met. Make sure there are enough litter trays, access to food and water, toys, and scratch posts. I f there has been a change in routine, it can be reversed if it’s temporary, or medication/supplements can ease the transition to the new routine. Try to pre-empt these changes so they can be done slowly and with the right support. 4. Ignore symptomatic behavior: Compulsive behaviors are often displayed during periods of acute conflict or high arousal. It is theorized that they develop as a coping or self-soothing mechanism. Attempts to use punishment or negative reinforcement exacerbates the problem by increasing the unpredictability of the cat’s environment, and may increase the conflict, high arousal, fear, and aggressive behavior triggering these disorders. Where possible, when there’s no risk of safety concerns for the cat or owner, ignore the behavior to prevent accidentally rewarding it with attention. 5. Consider enrichment: Inviting the cat to play, or distracting them by offering a change of activity, could be the release the cat needs to stop compulsive behavior and redirect it. Mental stimulation is a great way to prevent these behaviors from becoming chronic problems. Avoid

laser pointers or blinking lights; these types of toys cause frustration because they simulate the cat’s natural hunting instincts of catching and killing prey, but prevent them from ever succeeding at catching and eating the prey.

prescribing for those with narrow-angle glaucoma, reduced gastrointestinal motility, or urinary retention. tudies have shown the use of clomipramine to be superior S to that of amitriptyline in dogs and cats, in treating OCD.

B. MEDICATION Few studies detail medication and its effects on compulsive disorders in cats. Therefore, there is no licenced medication used to treat these disorders. Any medication prescribed for the treatment of OCD in cats will be off-label and must be prescribed as per the veterinary cascade.

•

D oses of 0.5-1mg/kg q24hrs are recommended. Side effects include frothing or foaming at the mouth on administration, drowsiness, GI disruption (constipation, diarrhea or vomiting) and odd behavior.

As in humans, medication use is aimed at treating the underlying neurochemical imbalance in the brain when an animal experiences an anxiety-associated behavior disorder. Medication is often lifelong; relapses are not uncommon when medication is ceased. Client expectations should be managed as such. Although several antidepressant and anxiolytic medications are available, those showing the most efficacy for treating compulsive disorders in animals are clomipramine, amitriptyline, and fluoxetine. •

his drug should not be used in breeding males, pregnant T females, lactating females or those with cardiovascular dysfunction or epilepsy. Care should be taken prescribing for those with narrow-angle glaucoma, reduced gastrointestinal motility, or urinary retention. •

Clomipramine is licenced to treat OCD in humans, and is a tricyclic antidepressant (TCA). Although the veterinary formulation Clomicalm (Virbac) is licenced for separation anxiety in dogs in the UK and US, it has also been approved for use in dogs with compulsive disorders in Australia and Canada. Studies have shown efficacy in cats also, but use in cats would be off-label and prescribed as per the veterinary cascade. C lomipramine blocks the reuptake of serotonin and noradrenaline at synapses in the brain; there is also an anticholinergic effect due to antagonism of cholinergic muscarinic receptors. Increasing the levels of these neurotransmitters is seen to have the effect of regulating mood and behavior.

his drug should not be used in breeding males, pregnant T females, lactating females or those with cardiovascular dysfunction or epilepsy. Care should be taken when

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Fluoxetine (Reconcile, Prozac) is an anxiolytic in the class of selective serotonin reuptake inhibitors (SSRIs) approved for use in the treatment of OCD in humans. SSRIs increase the level of the synaptic neurotransmitter serotonin in the brain by inhibiting presynaptic serotonin reuptake, so more serotonin is available in the neural synapse to pass messages to nearby nerves. It is thought to have an effect on mood, emotion, and sleep. It can take four to six weeks for drug levels to stabilise, so cat owners should expect to dose for that long before seeing a significant change in the frequency and intensity of the compulsive behaviors. oses of 0.5-1mg/kg q24hrs are suggested. Side effects D include loss of appetite, vomiting, decreased appetite, lethargy, restlessness, trembling and GI disturbances. Owners should be warned of a potential increase in aggression in response to medication. If side effects are severe or last longer than one week, the medication should be discontinued.

Clomipramine dosing is 0.25-1mg/kg q24hrs. A trial of two months is suggested, as it can take four to six weeks to take effect. If no clinical improvement is seen after two months, treatment should be ceased. Side effects are rare and include vomiting, reduced appetite, and lethargy. Vomiting may be reduced by coadministration with a small quantity of food.

Amitriptyline is also a tricyclic antidepressant (TCA) but is not licenced for use in cats or dogs in any country, so it would be prescribed as off-label and as per the veterinary cascade.

Fluoxetine should not be used in those with epilepsy or patients taking aspirin/anticoagulants, due to the risk of increased bleeding in the case of trauma. •

Benzodiazepines (Diazepam, Xanax) are a group of medications that increase GABA activity within the central nervous system (CNS), resulting in anxiolysis and a range of cognitive effects, including the inhibition of memory. Best used for preventing acute fear-inducing

event anxiety, they are particularly useful in cases where compulsive disorder triggers could be phobias.

the treatment of neuropathic pain and anxiety in humans and companion animals. In addition to its anticonvulsant properties, there are reports of a potential beneficial effect in the treatment of obsessive-compulsive disorders and self-mutilation in humans, and idiopathic ulcerative dermatitis in a cat.

Doses for Xanax are 0.125-0.25mg/kg as needed up to twice daily, while Diazepam is 0.5-0.2mg/kg as required. Side effects include sedation, muscle weakness and ataxia. These medications should be avoided in patients with CNS or respiratory depression, severe muscle weakness, and hepatic impairment. They are not recommended in the treatment of long-term behavioral disorders due to the risks of disinhibition and interference with memory and learning. •

Gabapentin is a structural analogue of gamma-aminobutyric acid (GABA) neurotransmitter. It was originally designed as an anticonvulsant but has been found to be more effective in

WHY DO CATS DEVELOP

THESE PROBLEMS? Cats with compulsive disorders are thought to develop a trigger for the initiation of these behaviors. The trigger (or stressor) is often driven by environmental factors (a change in routine, limited resources, or a conflict of needs) or cat intrinsic factors (such as illness or injury leading to pain). Owner interactions have been found to exacerbate the condition in some circumstances. There could be a genetic component, as some breeds, such as Oriental and Asian breeds, are more commonly diagnosed. Compulsive disorders are more common among indoor cats due to the stress of limited living space/ territory and perceived confinement. Environmental changes are common stress triggers, including moving house or disruptions to the daily routine such as building work. Compulsive disorders can be considered a coping mechanism developed when the cat perceives a frustrating situation, increasing anxiety levels, or a conflict with their needs. The behavior can become chronic for many reasons: • T he trigger remains, leading to ongoing compulsive behavior • The behavior itself can become self-soothing via the release of endorphins and dopamine; over time, therefore, symptoms can initiate without the need for the trigger • The owner, likely unintentionally, reinforces the behavior by trying to prevent the symptoms with inappropriate interactions and distractions.

oses of 0.5-10mg/kg PO q8-12hrs are recommended. Mild D side effects are reported, including sedation and ataxia. •

Other medications that can be used to treat the symptoms caused by compulsive behaviors include: o

G lucocorticoids (steroid —Prednisolone) — For use as an anti-inflammatory in skin diseases; 0.5-1mg/ kg PO q 12-24hr taper to 0.5mg/kg q 48hrs.

ntihistamines (Piriton, used off-label) 2-4mg/cat PO A q8-12hrs. Used for the management of allergic disease.

on-steroidal anti-inflammatories (NSAIDS — N Meloxicam) — Dose 0.05mg/kg PO q 24hrs (Robenacoxib) then 1-2mg/kg PO q24hrs for up to six days. Used to treat painful inflammatory conditions — i.e. orthopedic (not advised in the case of GI pain or disturbances and not in conjunction with steroids).

C iclosporin (Atopica) — For the treatment of atopic dermatitis at a dose of 7mg/kg q24hrs.

O clacitinib (Apoquel, used off-label) — For the treatment of puritis associated with allergic dermatitis. Dosing 0.4-0.6mg/kg PO q12h for 14 days then q24hrs maintenance.

I t may be necessary to treat the symptoms of compulsive disorders, depending on the clinical signs, prior to dealing with the underlying disorder. For example, cases of OCD presenting with selfmutilation, injury to the skin, secondary infections and inflammation may need to be treated as these continue to drive the behavior and could now be a secondary trigger. Long term, I would expect the addition of symptomatic medication to be unnecessary as the incidence of the behaviors lessen. Pheromones, including the feline facial pheromones, are detected by the cat’s vomeronasal organ, resulting in anxiolytic activity within the limbic system in response to threats to physical resources. They promote a sense of well-being in cats and come in the form of plug-in diffusers and topical sprays. They are good to use alongside behavioral modification and other prescribed medication. IVC Winter 2023/24

C. FOOD SUPPLEMENTS AND NATURAL CALMING PRODUCTS

Other natural remedies to promote calmness •

Prescription diets such as Royal Canin’s Calm contain hydrolysed milk protein and L-tryptophan to help soothe cats in stressful situations. Also containing psyllium to help control hairballs, and having a s/o index, they create an inhospitable environment for urinary stones to form, thereby helping with the common complications of a stressed cat.

Flower essences – Some calming products for cats include multiple flower essences. Rescue Remedy, which comes as a plug-in diffuser or spray, is a stress-relieving supplement containing the essence of five different plants: - Helianthemum nummularium - Clematis vitalba - Impatiens glandulifera

Natural dietary supplements (Zylkene, Calmex, Yumove calming care) are all advertised to support calming pathways in the brain and promote relaxation and happiness.

- Prunus cerasifera - Ornithogalum umbellatum. •

Catnip — Available in many forms, including sprays, treats, and parts of the plant itself. It doesn’t work for all cats, but for those it does, it creates a “natural high”, promoting happiness and relaxation.

•

Hemp oil — Reportedly useful for pain management, anxiety and stress reduction, anti-inflammatory effects, epilepsy and seizure management, appetite stimulation and nausea relief in cats. Side effects include Gi upset, sedation, and changes in behavior such as pacing and restlessness. Little research has been done in this area, but hemp oil appears safe in cats at recommended dose rates.

•

L-theanine — An extract of green tea, thought to work by increasing serotonin, dopamine, and gamma-aminobutyric acid (GABA) levels in the brain.

•

L-tryptophan — May reduce stress by altering bacterial populations in the gut.

•

Magnesium — Prevents the buildup of cortisol and other stress-associated hormones, promoting calmness.

•

B vitamins — Thiamine (vitamin B1) and vitamin B6 reduce stress by affecting neurotransmitters associated with anxiety and reducing cortisol secretion.

•

Melatonin — Associated with the circadian rhythm, it is also involved in reducing stress.

D. COMPLEMENTARY THERAPIES

•

Milk proteins — Alpha-casozepine, a type of milk protein, is thought to bind to the same receptors used by antianxiety medications like diazepam, promoting calm.

Physiotherapy

Calming herbs •

Chamomile — Thought to work by altering neurotransmitter levels in the brain — for example, by binding to the same receptors used by medications like diazepam.

•

Lemon balm — Used in Yumoves calming care and other supplements, it reduces anxiety and improves overall mood.

•

Skullcap — Used for centuries to reduce stress and anxiety, it may influence neurotransmitter levels within the brain, promoting stress relief.

•

Valerian root — Very commonly used, and has been shown to promote happiness and calmness.

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We are starting to explore and understand the many benefits and uses of physiotherapy in veterinary medicine. It is invaluable and has been used in cats with chronic pain or after significant musculoskeletal injury. Therapeutic massage could also have a role in treating some cats with compulsive disorders. It may be beneficial when the trigger is pain, allowing reduced use of medications; but also in receptive patients, where it could have a positive impact on well-being and stress reduction. Pet owners can be taught to practice therapeutic massage at home, which helps build their relationship with their cats, reduce stress and introduce therapeutic enrichment to the routine.

Acupuncture Acupuncture treatments are shown to improve circulation, release hormones (endorphins), relieve muscle tension and

stimulate nerves. It is usually well tolerated in feline patients. It is used for managing pain, decreasing inflammation, and reducing anxiety in cats. Studies have shown acupuncture to be an effective treatment for anxiety in humans, so we would also expect a good response in receptive cat patients.

CONCLUSION Treating compulsive disorders can be a challenge and requires an integrated, multidisciplinary approach to achieve the best outcome. While it may appear that the incidence of compulsive behaviors decreases when pets are reprimanded a number of times, in reality they are simply removing themselves from view and committing the behavior elsewhere. Studies support the existence of this evasive behavior pattern, which could result in the underdiagnosis of compulsive disorders. The fact that cats are cognitive enough to understand and alter behavior patterns demonstrates the complexity of the condition, and explains why it can be so difficult to treat. Treatment is likely to be a lifelong commitment for which success depends on client understanding, compliance and consistency in working alongside medical intervention and complementary therapists.

REFERENCES Anxiety and Compulsive Disorders in Cats, PetMD Oct10, 2008. Bennett S, Khan M. Managing Compulsive Disorders in Cats, Todays Veterinary Practice, Aug 4, 2021. Griffiths K. How I Approach Over Grooming In Cats, Vetfocus, Royal Canin, April1, 2021 (26.2). Seksel K, Lindeman MJ. Use of clomipramine in the treatment of anxiety-related and obsessive-compulsive disorders in cats, Australian Veterinary Journal Mar 10, 2008. Titeux E, Gilbert C, Briand A, Cochet-Faivre N. From Feline Idiopathic Ulcerative Dermatitis to Feline Behavioral Ulcerative Dermatitis: Grooming Repetitive Behaviors Indicators of Poor Welfare in Cats, Frontiers in Veterinary Science, April 16, 2018 (5). Amat M, Camps T, Manteca X. Stress in owned cats, Behavioural changes and welfare implications, Journal of Feline Medicine and Surgery. 2016, 18(8), 577-586. d'Angelo D, Sacchettino L, Carpentieri R, Avallone L, Gatta C, Napolitano F. An Interdisciplinary Approach for Compulsive Behavior in Dogs: A Case Report. Front Vet Sci. Mar22, 2022, (9) Frank D. Repetitive behaviours in cats and dogs: are they really a sign of obsessive-compulsive disorders (OCD)? Can Vet J. Feb 2013, 54(2), 129-31. Overall KL, Dunham AE. Clinical features and outcome in dogs and cats with obsessive-compulsive disorder: 126 cases (1989–2000). Journal of the American Veterinary Medical Association, Nov15, 2002, 221(10), 1445-1452.

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Innovations & Future Directions in Veterinary Social Work BY DR. BETHANIE POE, LMSW

Over the past two decades, veterinary social work has grown into an entire field of practice. Recent innovations have yielded significant developments that benefit a wide range of human-animal interactions, in veterinary medicine and beyond. It’s been over 20 years since the launch of the Veterinary Social Work program at the University of Tennessee, Knoxville. Born out of a collaboration between the UT College of Social Work and the College of Veterinary Medicine, the program has grown from clinical services in the veterinary teaching hospital to an entire field of practice that has spread not only across the United States, but internationally. Recently, veterinary social work has undergone a growth spurt that has resulted in some significant developments in the field.

CHANGES TO THE MODEL Veterinary social work is a specialty area that addresses human needs arising at the intersection of veterinary medicine and social work practice. Veterinary social work is inherently interdisciplinary, because in every human-animal interaction there is at least one person and one non-human animal. Social workers have the skills and expertise to work with the human needs that may impact this interaction, and rely on those in animal-related professions to address the needs of the non-human animal. By working together in a comprehensive collaborative approach, it is more likely the needs of everyone involved, no matter the species, will be met. Approaching human-animal interactions from a One Health lens, the model for veterinary social work divides these needs into four general overlapping categories of practice:

1. Animal Assisted Interventions (AAI) 2. Animal-related grief and bereavement 3. The link between human and animal violence 4. Intentional well-being (the recently renamed area) 16

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Formerly known as “compassion fatigue and conflict management”, the fourth area of the veterinary social work model has always been dedicated to the health of animalrelated professionals, particularly in response to the stressful nature of the work. However, as the field grew and more research was conducted, it became clear that while compassion fatigue and conflict management are still highly relevant, the title for this area of practice was not broad enough to encompass all the topics impacting the wellness of people in animal-related professions, such as trauma, burnout, communication, moral distress, organizational climate and culture, to name a few. The new name of this area of practice — intentional well-being — highlights the goal of creating healthy individuals and systems within the human-animal sphere, while also acknowledging that creating health requires purposeful action.

EXPANDING SETTINGS FOR PRACTICE While many people assume veterinary social workers only work in veterinary clinics, they may be found wherever people interact with animals. While you might typically think of people and their pets when you think about human-animal interactions, the reality is that human-animal interactions

New Center for Veterinary Social Work On June 2, 2023, the University of Tennessee celebrated the opening of the new Center for Veterinary Social Work (CVSW). The center is an interprofessional collaborative with the vision of “attending to the welfare of all species through excellence in global interprofessional practice” through research, education and service, using adaptive, participatory, and transdisciplinary (APT) approaches in the four areas of veterinary social work practice. The center’s goals are to: •

Lead and deliver innovative interprofessional education and training.

•

Employ access to care strategies that provide direct services for enhancing welfare and well-being in humans and animals.

•

F acilitate connections and collaborative opportunities among human and animal science and welfare professionals and teams.

•

Create and disseminate adaptive, participatory, and transdisciplinary (APT) research and scholarship.

In line with its dedication to interdisciplinary collaboration, the CVSW is led by an interprofessional council consisting of three social workers and three veterinary professionals, as well as two interprofessional advisors, one each from the UT Colleges of Social Work and Veterinary Medicine. The members of the inaugural CVSW council are: •

Elizabeth Strand, PhD. LCSW

•

Pamela Linden, PhD, LMSW

•

Bethanie Poe, PhD, LMSW

•

India Lane, DVM, MS, EdD, DACVIM (SAIM)

•

Mary Passmore, LVEMT, VTS (LAIM), MSSW

•

Zenithson NG, DVM, MS, DABVP (Canine and Feline)

•

Council advisors: o

J. Douglas Coatsworth, PhD

Marcy Souza, DVM, MPH, MPPA, DABVP (Avian)

The council makes decisions using a collaborative decision-making process that reflects the Interprofessional Education Collaborative’s competencies within four domains:

Values and Ethics

Roles and Responsibilities

Communication

Teams and Teamwork

By establishing degrees of agreement on proposed actions, the council is able to ensure that everyone has a voice on every topic, and the perspectives of both human and animal professionals are taken into account. Described by center director Dr. Elizabeth Strand as the “match.com” for human and animal science researchers and practitioners, the CVSW is an interprofessional space that brings together professionals and organizations from different fields to solve problems impacting all living beings. To learn more, check out the website at https://vetsocialwork.utk.edu. IVC Winter 2023/24

occur in myriad ways. Whether it is a police officer and his K9 officer; a farmer and his herd; someone with a disability and their service dog; a lab researcher and the mice they are testing; an adoption counselor in a high-volume animal shelter; or a wildlife rehabilitator — challenges can arise in each of the four areas of veterinary social work practice. As more people become aware of the field of veterinary social work, and the services veterinary social workers can provide, the greater the demand for them becomes. In addition to more veterinary social workers being hired in veterinary clinics and hospitals, there has been a greater demand for mental health professionals in private practice who specialize in veterinary social work. A recent study by Pew Research found that 97% of pet owners consider their pets to be part of the family, and nearly half say their pets are equal to human family members. With that in mind, it’s easy to understand why more people may be seeking pet loss support. Veterinary social workers in private practice are also a great resource for animal-related professionals seeking mental health support. Because veterinary social workers are educated on the realities of working in a veterinary or animal welfare field, animal professionals are spared having to explain why their job might be stressful and may be able to more quickly build rapport with their therapist. Veterinary social workers are also becoming more common in animal shelters. As animal shelters strive to prevent pets from being surrendered, veterinary social workers have the knowledge and skill set to help keep families together, whether it is by connecting pet owners with financial resources or emergency boarding, or making referrals to mental health, medical, or domestic violence services. Animal shelter staff also benefit from organizational well-being initiatives and individual consultations with veterinary social workers, which can improve morale and decrease turnover.

VETERINARY SOCIAL WORK INFORMED PRACTICE As the field of veterinary social work has grown, so has the interest and desire from veterinarians and veterinary nurses to become involved. Many find themselves asking: “Do I need to go back to school to become a social worker?” The answer to that question is: it depends! If you’re a veterinary professional, but want to change your focus to the people side of the human-animal relationship, you might

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8th International Veterinary Social Work Summit If you would like to learn more about this growing field, and connect with people who share your interest in veterinary social work, you should attend the 8th International Veterinary Social Work Summit. This interdisciplinary conference brings together professionals from both mental health and veterinary fields to explore the latest information in the four areas of veterinary social work practice. For the first time since the pandemic, people will have the opportunity to attend the summit in person — it will be held September 13 and 14, 2024 at Cleveland State University, in Cleveland, Ohio. For those who cannot attend in person, there will also be a virtual option. Look for more information on the International Association of Veterinary Social Work’s website.

(https://iavsw.org).

consider becoming a mental health professional. A mental health professional is somone with the required education and licensing to assess, diagnose, and treat mental illness. If this sounds like what you want to do, you will need to go back to school. Social work is a title protected pro-fession in most states, which means that in order to be a social worker, you need a degree in social work from a college or university accredited by the Council on Social Work Education. A master’s degree and a license to practice, which may require 2,000 to 4,000 hours of supervised practice depending on your location, as well as passing an examination, are required to be able to practice independently. However, if you want to stay in the veterinary profession but still help support people in your practice and field, you can do that, too! The idea of Veterinary Social Work Informed Practice means that a veterinary professional or clinic approaches the work they do through the lens of veterinary social work values and the four areas of practice. In doing so, one is able to support clients and staff within the veterinary setting, while being aware of when more intensive services might be needed, and referring to mental health professionals as appropriate.

TOP WAYS TO SUPPORT MICROBIOME HEALTH IN YOUR ANIMAL PATIENTS

ADVERTORIAL

Supporting microbiome health is the key to health and longevity in your canine and feline patients. Learn how functional treats, supplement powders, and microbiome testing kits can help. The microbiome health of dogs and cats is critical to their overall well-being. It helps regulate the immune system, supports disease resistance, healthy digestion and metabolism, and reduces allergies and inflammation. The microbiome can also impact behavior via the gut-brain axis. In other words, supporting healthy guts can make your patients healthier and your clients happier. Here are the top ways to support microbiome health in your canine and feline patients.

RECOMMEND A COMPLETE AND BALANCED DIET

manage weight, and enhances overall health. What's more, it may modify the microbiome by increasing the number of bacterial species and increasing diversity among microbiota.

PREVENT PARASITIC INFECTIONS

Complete and balanced diets for dogs and cats contain what they need for optimal health, including vitamins, minerals, fats, carbohydrates, amino acids, and proteins, as well as fiber-rich ingredients that support the microbiome. Clients can supplement diets with fresh, whole foods for additional gut support.

Many parasites, such as Giardia, can change and disrupt a dog or cat’s microbiome. Educate your clients about parasite prevention, including fleas, ticks, worms, and protozoa.

AVOID UNNECESSARY ANTIBIOTICS

Gut microbiome testing for dogs and cats can provide insights into their digestive health, including whether or not their diet promotes the right microbes. Testing can help you understand the state of your patients’ gut health so you can take steps to improve it if necessary.

Antibiotics kill the good bacteria as well as the bad, and can disrupt the balance of gut flora. It’s important to prescribe them only when necessary, and to recommend probiotics when you must use antibiotics.

PRESCRIBE REGULAR EXERCISE Exercise supports cardiovascular and brain health, promotes good sleep, helps

CONSIDER MICROBIOME TESTING

supplement powders made with nutrient-dense, high quality ingredients, and microbiome-supporting probiotics.

SUPPORT MICROBIOME HEALTH WITH CAVE PETS PRODUCTS Microbiome health is the foundation of all Cave Pets products, which include dog treats, Regenerative Organic Certified® mushroom and probiotic powders, multi-glandular powders, and microbiome testing kits. The formulas are crafted to nourish an animal’s body and foster a healthy balance of gut bacteria, supporting digestion, nutrient absorption, and overall health. Visit cavepets.com to learn more about their microbiome-supporting products and test kits.

USE FUNCTIONAL TREATS AND POWDERS Functional treats and powders are tasty snacks that also help support animal health. The trick is to find treats and IVC Winter 2023/24

BY W. JEAN DODDS, DVM ID 0000-0002-0058-8516

RESEARCH DIRECTION FOR INTEGRATIVE MEDICINE IN DOGS –

WHAT NEEDS TO BE DONE? The integrative approach often involves therapies outside mainstream medicine, since symptoms are secondary to a dog’s physical and psychological state. Outside factors can negatively impact this state of health — this article looks at these factors, along with the integrative medicine topics requiring more research in order to address them. Integrative medicine in humans and other species endeavors to achieve a proper balance in life to achieve health and wellbeing.1 It means that whole beings have an existence beyond the sum of their parts.2 Integrative medicine often involves therapies outside the mainstream, as symptoms are secondary to one’s physical and psychological state.2 When health and well-being are imbalanced, life can negatively impact upon health, whether it be due to physical, emotional, or spiritual issues.3 This article looks at the main issues affecting animal health and well-being in today’s world, and the direction that research in integrative medicine needs to take as a result.

THE EFFECTS OF ENVIRONMENTAL POLLUTION ON ANIMAL HEALTH Environmental pollution of the air, land, and seas is increasing and should be foremost in our minds.9 Just look at the global effects of undernourished people and animals in the African continent, and the effects of smoking, as well as second-hand and third-hand smoke exposure, in people and pet dogs, cats, guinea pigs, hamsters, rabbits, gerbils, birds, and even fish, resulting in increased risk of cancers, obesity, microbiome imbalance, and other adverse effects.9-11 Tobacco smoke residues, like nicotine, accumulate in house dust, carpets and rugs, on skin, fur and clothing, and the floor and furniture. Children and pets not only breathe in these residues, but are also exposed by licking and grooming hair, and licking or chewing skin, fur, clothes, and toys. Further,

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long-nosed dog breeds exposed to smoke have more nasal tumors, whereas short-nosed dogs and cats have more asthma and lung tumors.11 Another element of environmental degradation involves nutritional deficiencies in our food and that of our animals. Can food production be maintained with a multipronged approach involving water management, soil regeneration, farming and landscape diversification, and alternate food sources such as insects and seaweeds? 9,10 We also cannot assume that the nutrients needed for people work in parallel for dogs, cats, and other species.9,10

FIVE FREEDOMS ALL ANIMALS SHOULD HAVE Respected author, professor of animal science, animal behaviorist, and human-animal bond pioneer and proponent, Temple Grandin, discusses how animals make us human.12 Follow-up articles in 2017 and 2021 addressed improving the quality of science through better animal welfare.7,13-14 According to Grandin, the British government issued the Brambell Report in the 1960s and listed five freedoms animals should have: freedom from hunger and thirst; freedom from discomfort; freedom from pain, injury, or disease; freedom from fear and distress; and freedom to express normal behavior.12 After all, as she states, people and animals have the same core emotion systems in the brain.12

ANIMAL WELFARE ISSUES

TOPICS NEEDING MORE INTEGRATIVE VETERINARY RESEARCH AND TEACHING

The use of animals in research

With all the above in mind, what research approaches and solutions are needed in veterinary integrative medicine, beyond education, education, education?

1. GENE EDITING AND THERAPY

Document the positive and negative impacts of CRISPR gene editing technology in companion animals, with emphasis on the transparency of findings.

EFFICACY AND 2. VACCINE SAFETY 15,16

a. D efine the reasons for pet caregiver vaccine hesitancy, and address the need to overcome the trends in veterinary practice and the industry to promote unnecessary vaccines.

b. G ather more documentation on the potential harm of polyclonal vaccines, including rabies vaccine, given simultaneously, and the use of heavy metals as adjuvants.

c. E stablish the scientific benefits and safety of reducing vaccine doses for very small and tiny pets.

COUNTERING THE MARKETING STRATEGIES OF BIG PHARMA AND PET FOOD INDUSTRIES9,17

a. Document the reasons for avoiding common

Over the past decades, much published literature on the topic of issues affecting animal well-being applies to research animals used as models for human disease. Others have pointed out that certain animal models, such as those of gene function and human disease, “may not provide appropriate information, particularly for rapidly evolving genes and systems.”4-8 The original approach to using animals in biomedical research, education and testing stemmed from the 1959 3Rs thesis of Russell and Burch, and the application of their “reduction, refinement and replacement” principles.4 But recent opinion has diverged widely and controversially about the original intent and current application of these principles.4-7 As summarized cogently by Tannenbaum and Bennett in 2015, it was not the use of animals that Russell and Burch found problematic, but the subjecting of research animals to “unnecessary or avoidable pain, fear, stress, anxiety, bodily discomfort, and other significantly unpleasant feelings”.4

Animal well-being on a larger scale These views can be applied equally to society’s general use of animals in any context, including agriculture, livestock production for food and other needs, wildlife management, zoos, companion animal breeding, athletic and conformation competitions, and pleasure as family members. Can scientific advances, agriculture, and consumer expectations find a common ground, especially in this era of worldwide climate change, amid issues of environmental health and ozone layer depletion? 9-11

pro-inflammatory foods such as chicken and venison.

b. P rovide more scientific evidence of the benefits of supplements and treats, pre- and pro-biotics, and cannabinoids.

c. S cientifically address the safety of parasiticides widely promoted as preventives.

d. C onduct more studies on the alternate management and treatment of osteoarthritis in pets and other species. IVC Winter 2023/24

IMPROVED VETERINARY DIAGNOSTICS AND APPROPRIATE USE OF ARTIFICIAL INTELLIGENCE15,18,19 Create and implement novel diagnostics that identify specific diagnoses and risk factors for latent and subclinical health conditions, including behavior, in animals.

and tissue-based products, and issues stemming from deliberate animal genomic alterations. Unmet needs in both human and animal health will focus particularly on the absence of specialized therapeutics approved for use in animals.18

• Randomized, controlled trials in scientific and clinical research: These trials are important not only in mainstream medicine but also in integrative medicine to establish the effectiveness of prevalent new integrative modalities.21 These trials are prospective assessments that reduce bias and can identify any cause-and-effect relationship between study interventions and outcome.

5. OTHER RESEARCH NEEDS

17-20

• M edicinal mushrooms: The innate immune systems of people and animals provide non-specific immunity, which doesn’t require prior antigen exposure; adaptive immunity, meanwhile, reflects prior exposure and longterm cellular immunological memory. Pets also have what is called “trained memory” from pattern recognition receptors that allow the innate immune system to gain immunological memory. Trained immunity is promoted by functional mushrooms that contain high concentrations of beta-glucans, soluble fibers that support heart health, the gut, and the immune system.17

The field of integrative medicine continues to grow and evolve, and factoring in the issues affecting animal health and welfare is an important directional signpost for ongoing and future research.

www.webmd.com/balance/what-is-integrative-medicine

www.thefreedictionary.com›wholism

Got Questions Ministries. What does it mean that God gave humanity dominion over the animals? January 4, 2022. Accessed October 29, 2023.

• Snuffle gardens: This term describes any enclosed,

Tannenbaum J, Bennett BT. Russell and Burch’s 3Rs then and now: The need for clarity in definition and purpose. J. Am. Assoc. Lab. Anim. Sci. 2015, 54, 120–132.

safe garden or other space that gives a dog the freedom to be curious and explore the environment at his own pace through sniffing and sight. It offers many positive benefits to the dog’s physical and mental well-being by releasing calming hormones such as dopamine, serotonin, endorphins and oxytocin, although research documentation of these effects is needed.20

• M odernized approach to evaluating and supporting innovative animal and veterinary products: The FDA

recently announced its intention to modernize its approaches to evaluating and supporting innovative animal and veterinary products.18 This worthwhile effort is aimed at enhancing flexibility, predictability, and efficiency. The FDA’s Animal and Veterinary Innovation Agenda will foster product development and establish intelligent, risk-based regulatory methods for modern animal and veterinary products, in order to keep up with ongoing scientific and technological advancements while ensuring the market availability of safe and effective products.

Lynch VJ. Use with caution: developmental systems divergence and potential pitfalls of animal models. Yale J Biol Med. 2009 Jun; 82(2):53-66.

Dodds WJ. One health: Animal models of heritable human bleeding diseases. Animals, 2022, Dec 26;13(1):87. doi: 10.3390/ani13010087.

Prescott MJ, Lidster K. Improving quality of science through better animal welfare: the NC3Rs strategy. Lab. Anim. 2017, 46, 152–156.

Uddin F, Rudin CM, Sen T. CRISPR gene therapy: applications, limitations, and implications for the future. Front. Oncol. 2020, 10. doi:10.3389/fonc.2020.01387.

Dodds WJ. Perspectives. Alternative food sources to help protect against global warming. J Amer. Hol. Vet. Med. Assoc., 2022, 60; Fall Issue, 10-14. Ginta D. Food production in the age of gene-editing technologies: why awareness and transparency matters. www.alive.com, 2023, November; 49-51.

www.fda.gov/consumers/consumer-updates/secondhand-and-third-hand-smoke-may-be-makingyour-pet-sick.

Grandin T, Johnson C. Animals make us human: Creating the best life for animals. 2010, Mariner Books, New York, January 12, 2010, 352 pp.

Maclean EL, FineA, Herzog H, Strauss E, Cobb ML. Perspective Article. The new era of canine science: Reshaping our relationships with dogs. Front. Vet. Sci. 2021, 8:675782. doi:10.3389/fvets.2021.675782.

Rodriguez KE, Herzog H and Gee NR. Variability in human-animal interaction research. Front. Vet. Sci. 2021, 7:619600. doi: 10.3389/fvets.2020.619600.

Dodds WJ. How veterinary diagnostics have advanced over the last 50 years. IVC Journal, 2023, August 9.

Dodds WJ. Vaccinating your adult dog or cat: what you need to consider. Animal Wellness Magazine, 2021, June 8, 2021.

Silver RJ. How functional mushrooms support trained immunity. Animal Wellness Magazine, 2023, September 21, 2023.

Rashid O. FDA improves its support for innovation in the veterinary domain. IVC Journal, 2023, October 12.

• A variety of products, including novel food ingredients designed to improve nutritional efficiency in the digestive system of animals, as well as cultured food ingredients, will be covered in this initiative, along with biotechnology products like animal cell

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da Silva EMG, dos Santos TR, Silva MJB. Identifying the risk factors for malignant mammary tumors in dogs: a retrospective study. Vet. Sci. 2023, 10, 607. doi.org/10.3390/vetsci10100607,

www.sensorygarden4dogs.com

Hariton E, Locascio JJ. Randomised controlled trials - the gold standard for effectiveness research: Study design: randomised controlled trials. BJOG. 2018 Dec;125(13):1716. doi: 10.1111/1471-0528.15199.

A HOLISTIC APPROACH TO ELEVATING HEART HEALTH BY DR KEITH WEINGARDT, DVM, CVA, CTCVM

The profound connection between the health of our patients and the emotional well-being of those who love and cherish them means that, as veterinarians, ours is a dual responsibility. We are not only nurturing robust cardiovascular health in pets, but in their human companions as well. The best approach to achieving success? Empower your clients with knowledge about the essential components of a heart-healthy lifestyle, so they can play a role in their pets’ cardiac care.

1. EMPHASIZE THE ROLE OF DIET Diet forms the cornerstone of cardiovascular well-being in pets. No surprises here. A heart-healthy diet should prioritize lean proteins, essential Omega-3 fatty acids, and a balance of vitamins and minerals. Encouraging dog and cat parents to opt for high quality pet foods with natural ingredients can significantly contribute to overall heart health.

3. RECOMMEND THORNEVET’S HEART HEALTH FORMULA One such supplement is ThorneVet’s Heart Health Formula (formerly BioCardio). Vet formulated with meticulous attention to heart-healthy ingredients, Heart Health Formula offers optimal cardiovascular support courtesy of: •

Taurine, L-Carnitine, and CoQ10 — a powerful trio renowned for promoting optimal heart function.

•

Magnesium and potassium for maintaining healthy cardiac muscle contractions and rhythm and promoting blood flow along with oxygen utilization.

Specific nutrients stand out for their positive impact on cardiovascular function. Taurine, an amino acid, is vital for heart health in cats and some dog breeds. Additionally, coenzyme Q10 (CoQ10) plays a crucial role in cellular energy production throughout the body, but particularly benefitting heart muscles. Educating clients about these essential nutrients — and guiding them with suggestions for supplements that incorporate these vital building blocks — can make all the difference.

A synergistic blend of the botanical ingredients Hawthorn, Siberian Ginseng (Eleutherococcus), and Arjuna — for promoting optimal cardiac function and reducing oxidative stress.

A RI

Caring for the cardio vascular well-being of our animal patients also includes safeguarding the hearts of their devoted owners. You only need to witness the heartbreak of a pet parent with a terminally ill dog or cat to know the truth in this.

•

TO ER

2. PROMOTE ESSENTIAL NUTRIENTS FOR CARDIOVASCULAR SUPPORT

DV A

Addressing heart health in our pet patients transcends routine checkups. It demands a comprehensive strategy that encompasses diet, nutrients, and supplements formulated specifically for cardiovascular support.

4. PROVIDE VERSATILE SUPPORT FOR UNIQUE NEEDS Every pet is unique, and their cardiovascular needs can vary based on factors such as breed, age, and overall health. Whether managing a specific heart condition or promoting preventative care, ThorneVet’s Heart Health Formula offers a holistic solution packed with versatile ingredients that can be aligned with the diverse needs of pet patients. If our furry companions hold the key to our own hearts, then keeping their hearts beating with a robust rhythm enhances the happiness and health of both pet and parent. Heart Health Formula can do exactly that.

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. IVC Winter 2023/24

How

Low Level Laser Therapy/ Photobiomodulation (LLLT/PBM)

reduces oral pain in dogs & cats BY DONALD H. DEFORGE, VMD, FELLOW OF THE ACADEMY OF VETERINARY DENTISTRY

Unlocking a new technology to decrease oral pain and improve quality of life for dogs and cats with dental issues. When veterinary dentists hear the word “laser”, they often think of a hard or soft tissue laser used to cut enamel or soft tissue. Low Level Laser Therapy (LLLT) or Photobiomodulation (PBM) is a new subset of laser therapy that can improve clinical outcomes and decrease the pain felt by a dog or cat after a dental appointment.1 LLLT accomplishes this by stimulating endorphins; reducing the conduction of nerve fibers that can carry pulpal pain (c-fiber); stimulating fibroblasts, osteoblasts, and odontoblasts; and increasing circulation and lymphatic drainage.

LLLT/PBM AND ITS EFFECTS ON BODY TISSUES LLLT, PBM, cold laser, or red light therapy5 is a form of medicine that applies low-level (low-power) lasers or lightemitting diodes (LEDs) to the surface of the body. The effects of PBM are a result of photons — packets of electromagnetic energy — interacting with cells. In the clinical setting, therapy lasers that emit near infrared light are most often used. Different from LEDs (light-emitting diodes), therapeutic diode lasers emit invisible light in the 800 nm to 1,000 nm range. These therapeutic wavelengths are less absorbed by water and other non-target chromophores within the tissue,

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and therefore achieve greater depth of penetration. They also interact with target chromophores to produce photochemical changes within the tissue.6 The key to PBM is the absorption of photonic energy by chromophores within cells. The chromophore cytochrome oxidase is concentrated within mitochondria; it absorbs the energy in photons and delivers it into metabolic processes, including the Krebs cycle. This results in increased ATP production, as well as increased levels of nitric oxide and reactive oxygen species, important in cellular signaling. Metabolic activity increases, and cell growth and reproduction are accelerated.6

CLINICAL APPLICATIONS IN HUMAN DENTISTRY In his clinical studies, Dr. Gerry Ross, DDS, lists some of the most frequently used applications of LLLT/PBM in human dentistry. For example, LLLT/PBM decreases pain, swelling, bruising and inflammation after an extraction. This decreases and can even eliminate the need for post-operative analgesics. Dr. Ross adds that the speed of healing at the extraction site is increased.

LLLT/PBM can ease the pain caused by extraction or oral surgery in animal patients.

LLLT/PBM not only reduces pain, but also hastens covering of the exposed bone through the stimulation of fibroblasts.

THE HISTORY OF LLLT/PBM IN VETERINARY MEDICINE

Dr. Ross goes on to say that LLLT/PBM can be applied to the submandibular lymph nodes to increase lymphatic flow in the infected area; reduce the inflammatory cells; and bring neutrophils to the site of infection for faster healing. Laser therapy will not preclude the use of antibiotics in most cases, but will help potentiate the uptake of antibiotics into the bloodstream.

LLLT/PBM is a rapidly growing treatment modality used for a variety of medical conditions in companion animals. It’s painless, noninvasive, and easily administered in a primary care setting. It’s estimated that therapeutic laser devices are used by 20% of all companion animal practices in North America. LLLT/PBM accelerates healing in a number of tissues, provides analgesia, and decreases inflammation through the modulation of immune and inflammatory responses. It has been used in both human and veterinary medicine to improve wound healing, treat snake bites, decrease pain and inflammation resulting from musculoskeletal conditions, improve neurologic function after trauma or injury, treat stomatitis and other oral inflammatory conditions, treat intraoperative and postoperative inflammation, and enhance healing of sport-related injuries.4

One of the most interesting and useful aspects of LLLT/PBM, Dr. Ross adds, is that it only elicits responses from cells that can use the energy produced, and will therefore have no negative effect on healthy cells. In the hundreds of studies done on laser therapy, no clinical side effects have been reported. The very nature of what dentists do causes pain and inflammation, but LLLT/PBM requires a paradigm shift; instead of using drugs to treat the pain after it has started, a dentist now has the opportunity to treat the pain immediately in the dental office. Further, LLLT/PBM may reduce third molar surgery pain.2 According to the results of a clinical trial recently published in BMC Oral Health, administering a session of extraoral low level diode laser after exodontia of the third molar may decrease patient pain.

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PILOT STUDY ON LLLT/PBM FOR REDUCING ORAL PAIN The Oral Care Department at Silver Sands Veterinary in Milford, CT is in the midst of a pilot study to determine the benefits of LLLT/PBM in reducing pain and decreasing healing time for multiple oral problems. The areas of consideration in multiple clinical oral applications in companion animal dentistry include: •

Post extraction, post oral surgery, and convalescence

•

Advanced periodontal surgery

•

Post care of patients being treated for gingival hyperplasia with radiosurgery

•

Pain control following oral surgery for feline and canine stomatitis. (LLLT/PMB is being studied for adjunct pain and inflammation control in these patients, and is not being advocated as a primary treatment in these conditions)

•

Post oral orthopedics: after the repair of oral trauma.

The present trial’s small sample size limits definitive statements on treatment recommendations by the author — the study is ongoing. The study includes an assessment of various areas after LLLT/ PBMT treatment: •

Edema and swelling post surgery

•

Healing time

•

Pain assessment through subjective reviews with clients via telemedicine, in conjunction with objective evaluation onsite by the SSV Health Care Team.

LLLT/PBM should not be used without a complete intraoral and extraoral examination and a definitive diagnosis of the pathology present in the patient. It should not be considered the “silver bullet” of oral care, but rather, another innovative tool in the treatment of oral pain. Never substitute LLLT/PBM for the proper oral care diagnostics and treatment as recommended by the American Veterinary Dental College (AVDC) — see their position paper on non-sedation oral prophylaxis7

COMPANION ANIMAL DENTAL SCALING WITHOUT ANESTHESIA7 In the United States and Canada, only licensed veterinarians can practice veterinary medicine. Veterinary medicine includes

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surgery, medicine and dentistry. Anyone other than a licensed veterinarian, or a supervised and trained veterinary technician, may not provide dental services; if they do, they’re practicing veterinary medicine without a license and will be subject to criminal charges. This position statement addresses dental scaling procedures performed on pets without anesthesia, often by individuals untrained in veterinary dental techniques. Although the term “anesthesia-free dentistry” has been used in this context, AVDC prefers the more accurate term “nonprofessional dental scaling” (NPDS) to describe this combination. Pet owners are naturally concerned when anesthesia is required for their dogs and cats. However, performing NPDS on an unanesthetized pet is inappropriate for the following reasons: Dental tartar is firmly adhered to the surface of the teeth. Scaling to remove tartar is accomplished using ultrasonic and sonic power scalers, plus hand instruments that must have a sharp working edge to be used effectively. Even a slight head movement from the patient could result in injury to their oral tissue, and the operator may be bitten when the patient reacts. Professional dental scaling includes scaling the surfaces of the teeth both above and below the gingival margin (gumline), followed by dental polishing. The most critical part of a dental scaling procedure is scaling the tooth surfaces within the gingival pocket (the subgingival space between the gum and the root), where periodontal disease is active. Because a human patient cooperates, dental scaling performed by a trained professional can be completed successfully without anesthesia. However, access to the subgingival area of every tooth is impossible in an unanesthetized canine or feline patient. Removing dental tartar on the visible surfaces of the teeth has little effect on a

Using LLLT/ PBM technology

Treatment with LLLT/PBMT may help alleviate edema and swelling after dental surgery, and improve healing time.

It’s important to contact the manufacturer of the LLLT/PBM unit for their recommendation on usage, and the length of time needed to treat the site or problem. Note as well that some lasers require eye protection for both the operator and the patient. Again, the manufacturer can guide the veterinarian or veterinary dentist concerning eye protection. However, even in units cleared to be used without eye protection, the laser beam should never be aimed at the patient’s or operator’s eyes.3

pet’s health, and provides a false sense of accomplishment. The effect is purely cosmetic. Inhalation anesthesia using a cuffed endotracheal tube provides three important advantages: the patient’s cooperation during a procedure they do not understand; elimination of the pain resulting from examination and treatment of affected dental tissues during the procedure; and protection of the airway and lungs from accidental aspiration. A complete oral examination, an important part of a professional dental scaling procedure, is not possible in an unanesthetized patient. The surfaces of the teeth facing the tongue cannot be examined, and areas of disease and discomfort are likely to be missed. The safe use of an anesthetic or sedative in a dog or cat requires an evaluation of the general health and size of the patient to determine the appropriate drug and dose, and continual monitoring of the patient. Veterinarians are trained in all these procedures. The prescription or administration of anesthetic or sedative drugs by a nonveterinarian can be very dangerous, and is illegal.

Although anesthesia will never be 100% risk-free, modern anesthetic and patient evaluation techniques used in veterinary hospitals minimize the risks, and millions of dental scaling procedures are safely performed each year in veterinary hospitals. The AVDC supports the guidelines of safe administration of general anesthesia to animals for dental procedures as outlined by the American College of Veterinary Anesthesiology and Analgesia (ACVAA) at https://acvaa.org/veterinarians/guidelines/.

CONTRAINDICATIONS OF LLLT/PBM For over 40 years, a list of contraindications around LLLT/ PBM has accumulated and been passed down, often repeated in publications and device manuals, without consideration of whether they are valid. IVC Winter 2023/24

•

Currently, the one absolute contraindication is exposing the retina to a direct or reflected beam transmitted through the pupil. Scattered photons reaching the retina via adjacent tissue treatment are not the concern; penetration through the pupil is.6

•

Since there is no knowledge about how different wavelengths of light interact chemically with medications, and one does not want to alter the rate of medication absorption, do not treat over areas into which medication or vaccines have been injected. Apply laser therapy to tissue before injecting, and do not treat the area again until the injection has been absorbed.6

•

It is contraindicated to treat over a malignancy, or the surgical site from which a malignancy has been removed. Contradictory data from the laboratory indicates that some malignant cell lines are stimulated, some are inhibited, while LLLT/PBM has no effect on others. There is no contraindication for treating a site distant to a malignancy, and it is valid to treat areas of malignancy, with informed owner consent, for pain management in hospice care.6 Historically, treating over a gravid uterus has been contraindicated. This was based on studies done decades ago, in which chicken embryos showed cellular

Recommending home dental care To minimize the need for professional dental scaling procedures, and maintain optimal oral health, the AVDC recommends daily home dental care from an early age. This should include brushing or the use of other effective techniques to retard accumulation of dental plaque, such as dental diets and chew materials. Combined with periodic examination of the patient by a veterinarian, and dental scaling under anesthesia when indicated, this will optimize lifelong oral health for dogs and cats.

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changes when exposed to high doses of visible red light through an eggshell window. This has no practical application to the clinical treatment of patients. Near infrared light is neither mutagenic nor teratogenic, and an embryo or fetus within a gravid uterus is well protected from photons which are readily absorbed by multiple layers of chromophores in the surrounding tissues.6 •

Do not treat areas of active hemorrhage, since transient vasodilation is induced. Once hemorrhage has stopped, laser therapy will not reactivate it.6

•

Treatment over active epiphyses, the testicles, or the thyroid glands all require similar consideration. Treatment with high doses for a prolonged time has been demonstrated to produce change in these tissues. However, negative effects are not reported with lower dose treatment over shorter periods.6

This article acknowledges the proposed benefits of LLLT/ PBM in companion animal oral care, based on present data from human dentistry. The present pilot study at SSV concerns only oral applications in the dog and cat. Even with positive results to date, the pilot study numbers are too small to advocate the use of LLLT/PBM in all oral applications under consideration in the study. Contact

a veterinary dentist in your community, review the LLLT/PBM units now available to veterinarians, and follow their recommendations. No recommendations concerning the usage of LLLT/PBM in veterinary dentistry is being provided by the author at this time. Efficacy will be accomplished through continued data collection. LLLT/PBM is the “new kid on the block” as an adjunct to human and veterinary oral care. The pilot study will continue to evaluate efficacy, safety, and patient benefits in reducing oral pain.

To learn more •

For general information on the performance of dental procedures on veterinary patients, please read the AVDC Position Statement on Veterinary Dental Healthcare Providers, available at www.AVDC.org. You can also send an e-mail to the AVDC Executive Director at ExecSec@AVDC.org.

•

For further information on effective oral hygiene products for dogs and cats, visit the Veterinary Oral Health Council website (www.VOHC.org).

Disclosure: Dr. DeForge’s research on LLLT/PBM in veterinary dentistry is being conducted in the absence of any commercial or financial relationship that could be construed as a potential conflict of interest.

Ross, Gerry, DDS; Ross, Alana, BScH. Oral Health — Low Level Laser Therapy: An Untapped Resource in the Dental Industry. Dr. Ross is the President of Laser Light Canada and works with multiple phototherapy equipment manufacturers.

Round of Laser Therapy: May Reduce 3rd Molar-Surgery Pain. BMC Oral Health. www.drbiscupid.com/Dental Specialties/Oeofacial -Pain/ article-1.

B-Cure Laser Vet — Instruction for Usage — Good Energies Ltd, Kensington, London. info@Bcurelaservet.com, www.bcurelaservet. com.

Huntingford, Janice L, DVM, MS, DACVSMR. Laser Therapy for Treatment of Joint Disease in Dogs and Cats. Today’s Veterinary Practice. https// Today’s Veterinary Practice.com, 2019-10.

Hamblin, Michael R. History and Fundamentals of Low Level Light Therapy — Handbook of Photomedicine 0CRC Press-doi:10. 1201/b15582-10ISBN 978-0-429-19384-2.

Godbold, John, DVM. TVP – Today’s Veterinary Practice, ,Issue July-August 2019

AVDC Position Paper — Companion Animal Dental Scaling Without Anesthesia. AVDC Board of Directors, April 2004.

IVC Winter 2023/24

THE

GUT MICROBIOME & ITS EFFECT ON BEHAVIOR IN DOGS & CATS BY MARGO ROMAN, DVM, CVA, COT, CPT, FAAO

The gut-brain connection is now a real area for scientific research. Since 2012, Microbiome Restorative Therapy (MBRT) has made positive changes in the mental health and behavior of our animal patients, which has been so rewarding. Let’s reflect on some of the early, and more recent, cases demonstrating the gut-brain connection, and how healing the microbiome improves behavior in dogs and cats.

CASE

STUDIES ARCHIE AND AGATHA – RELIEVING AGGRESSION Archie and Agatha were Wire Fox Terriers and litter mates, both diagnosed with immune endocrine imbalance. Allergy testing using applied kinesiology along with food elimination kept Archie’s GI tract in check, yet he exhibited severe aggression, especially toward Agatha. He would attack her throat and they would both end up in the ER with multiple wounds. His thyroid and cortisol levels were monitored using Plechner’s testing. After he had his first MBRT transplant,

IVC Winter 2023/24

We’ve learned a lot about the gut microbiome over the past 20 years, and important discoveries are still being made. This article focuses on the gutbrain connection and how MBRT can improve mental health and behavior in dogs and cats.

his behavior changed in 30 hours. He lost his anxiety and aggressive behavior and was grooming his sister, cleaning her eyes and ears. This was the litmus test that he was in balance. Archie had acquired the nurturing qualities of the donor, who was a loving mother dog. He could also eat foods that normally gave him loose stools. He did really well until he was given his monthly heartworm medication (Interceptor). One day later, he returned to his former behavior; he attached Agatha and they ended up in ER again. After another MBRT, his affectionate and loving behavior returned. The implication here is that heartworm preventatives, as well as flea and tick products, kill off some of the gut microbiome. Archie had 12 MBRT, then was given a pregnant poop (poop from a pregnant donor) and regained a lot more balance. The pregnant poop seemed to carry the most balanced diversity of bacteria he needed.

MBRTCAN ALSO 1. HAVE AN IMPACT ON HORMONES

She was a scientist and wanted to see how

Maine Coon cat

good he could get. Two days after the third

with atopic derma-

fecal transplant, she called to announce he

titis and recurring

had a problem and thought it was his anal

struvite crystals who

glands. She brought him in, where we found

lived in a E-collar for

the glands were not impacted. Upon closer

2½ years. He had

explanation, along with the owner’s descrip-

scabs and bald areas

tion of his behavior, we realized Mojo was

during most of that time. He had been neu-

sexually attacking her arm and trying to

tered as a nine-week-old kitten. Mojo had

hump it. He was acting like a male cat who

been on a range of medications — Ketacon-

was younger and sexually active.

& SEXUAL BEHAVIOR

Mojo

was

azole, Revolution, Tresaderm, Mometamax, TrizEDTA ear, Triamcinalone, Cyclosporine,

The owner continued to give Mojo fecal

and Convenia. He displayed some aggressive

transfers from a friend’s young female cat

behavior with his feline housemate, Muffin.

every one to two weeks. He has been less aggressive, and his skin has stayed healthy;

We gave Mojo MBRT when he was seven

when he gets a slight itch around his ears

years old. He was started on a raw food diet

she puts on his E-collar, cleans the area with

two months before. He was also started on

green tea, and it resolves.

gut support, including Epizyme, Nutrigest, Colostrum, Rx Vitamin Ultra FA, Standard

The hormonal response from the MBRT

Process canine immune support, and our

showed up in the way Mojo regained his

MASH mix. We gave him an oral piece of

sexual behavior, and also became happier.

stool from my donor cat. Trapper, who was just one year old and had just been neutered, so the hormones in his body were those of an adult intact male. Mojo was

Baxter was a 14-year-old, neutered, male Lab shepherd cross who pre-

sented with liver cancer and was recom-

also given LM 1 Thuja due to being over-

mended for euthanization. We started

vaccinated, and for detoxification.

giving him ozone therapy, MBRT, acupuncture and other holistic support. Baxter

The owner called two days later

regained a lot of his energy and was very

to say Mojo had stopped itching

functional. Then he had a sudden abdomi-

after 2½ years. She called again

nal bleed from the liver tumor and crashed.

five days later and reported that

The emergency clinic told his owner that he

his fur was coming back in areas

should be euthanized.

where he hadn’t had any for more than two years. She also said he

As his liver enzymes went up to 5,000,

was happy and more playful.

we performed hyperbaric, oxygen, ozone therapy, acupuncture, and homeopa-

After five weeks, the owner called and re-

thy. All these alternative tools got Baxter

quested another piece of poop for Mojo to

through this crisis, and he was actually re-

take orally, to see what other changes would

gaining his strength. We decided to give

occur. Since that second fecal transfer, he

him a rectal fecal transplant, fresh from

became more playful, curious and indepen-

my own dogs who were in heat. Two days

dent. He was playing and eating nicely, less

later, at almost 15, he was humping his

aggressive, and more affectionate.

bed, something he stopped doing at the age of five. Again, hormonal expression

Five weeks after the second MBRT, Mojo’s

within the microbiome is a real event.

owner called again and asked for a third one.

Baxter lived to 16½.

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CASE STUDIES CONT.

TOBER – ESTABLISHING CONFIDENCE AND HAPPINESS

KAYLEE – GETTING RID OF FEARS Kaylee, a six-year-old beagle mix, had hemangiosarcoma in her abdomen and her right hind leg. She had been on antibiotics and pain medications and was recommended for euthanasia because she could no longer be managed for pain and was going to die within days. After treatment including MBRT, ozone therapy, UVBI, gut and immune support, the change in Kaylee’s health status was nothing north of a miracle. Two days after treatment, her abdominal swelling went down and she no longer had pain in either her abdomen or her leg. But most amazing was the complete change to her personality. For four years, she had been a seriously anxious and clingy dog, like Velcro, never interested in chasing vermin and scared of water and puddles. After the MBRT, she was jumping and playing in the lake, going through puddles, chasing squirrels and chipmunks, and being really playful and happy. She started digging holes, which she had never done before, and was smiling. She was acting like the crazy, smiling pup (Vienna) from whom she got her microbiome transplant. Kaylee lived another six years with that same energy and zest for life, and became a therapy dog for the elderly. Her outgoing spirit and normal beagle behavior showed her owner she was much happier. She later died after starting conventional chemotherapy for lymphoma.

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Tober, a ten-year-old spayed calico cat, suffered with diarrhea for years, with up to ten stools a day spraying the litter box. She endured extensive ultrasound, blood work, fecal exams, and years of on and off Metronidazole. This cat appeared very thin and fragile. Twenty-four hours after MBRT, Tober’s stools were normal, and the cat that used to hide in the basement and was afraid of the dog was sitting confidently on the couch upstairs and was playing with the dog. Tober is being maintained on a high quality, protein-specific raw diet, and occasionally gets MBRT, as she has also tested positive for immune endocrine issues. Her owner said when he “picked her up she always felt like a piece of paper, yet just three days after the MBRT, she had some body strength and seemed so much happier.” Seven years later, Tober continues with her contented demeanor, although she became hyperthyroid at 17.

DANTE – ELIMINATING ANXIETY AND AGGRESSION This dog’s owner said he was blinded by aggression and anxiety, and she wanted to have him euthanized. Although she had been working with a trainer, and Dante was a little better, she was giving up as it was too dangerous. When Dante entered the exam room, he tried to attack me and even attempted to jump into my lap and bite my face. All attempts to talk to him through his intense anxiety was very hard, even as a Fear Free doctor.

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

Dante was given a Plechner test, UVBI, rectal ozone and MBRT, vitamin C, D, and B-complex, and nutritional support. He experienced pain from the vitamin shot, and one day of bloody diarrhea, suspected as being a detox from years of antibiotics and Prozac. His owner reported that Dante used to focus on the front door for hours, barking if anybody came up to it. This behavior dissipated. As well, the sclera of his eyes had always been slightly yellowish but were now white. Dante was able to pay attention to his owner, and no longer tried to kill every dog on a walk. “Changing his microbiome and putting him on thyroid meds made him 1,000% better,” said his owner. We have so much more to learn about all the gut-brain connections, and the importance of preserving and caring for this microbiome. We also need to do more research on the gut-thyroid relationship. In 2000, there was just one research article on the microbiome; in 2017, there were 17,000. As of April 2023 there were 250,000 PubMed research articles on the microbiome! This is the new frontier, and hopefully veterinarians are able to preserve it and find ways to help animals heal not just physically, but mentally and behaviorally as well.

REFERENCES Chinna Meyyappan A, Forth E, Wallace CJK, et al. (2020). Effect of fecal microbiota transplant on symptoms of psychiatric disorders: a systematic review. BMC Psychiatry 20, 299. https://doi. org/10.1186/s12888-020-02654-5. Tan Q, Orsso CE, Deehan EC, Kung JY, Tun HM, Wine E, Madsen KL, Zwaigenbaum L, Haqq A M. (2021). Probiotics, prebiotics, synbiotics, and fecal microbiota transplantation in the treatment of behavioral symptoms of autism spectrum disorder: A systematic review. Autism Research, 14(9), 1820–1836. https://doi.org/10.1002/aur.2560. Stephen C, Zain K, Premys, B. (2013).The adoptive transfer of behavioral phenotype via the intestinal microbiota: experimental evidence and clinical implications, Current Opinion in Microbiology, Volume 16, Issue 3, 2013, Pages 240-245, ISSN 1369-5274, https://doi.org/10.1016/j.mib.2013.06.004.

Thank you to all the attendees, sponsors, and exhibitors of the 2023 AHVMA Annual Conference and Exhibition. We received positive feedback from all those who attended. There were some exciting changes made this year that we can’t wait to bring back for future conferences!

2024 ANNUAL CONFERENCE Save the dates for the 2024 AHVMA Annual Conference and Exhibition, taking place September 28 through October 1. Expect over 90 hours of complementary and integrative CE sessions, hands-on labs, and special events. Over the past seven years, AHVMA has applied for and received AAVSB RACE approval for over 80 hours of continuing education. AHVMA will be returning to the eco-conscious Peppermill Resort Spa Casino in Reno, Nevada. This beautiful hotel boasts 1,621 luxurious guest rooms, a three-story, 33,000-square-foot Spa and Salon Toscana, nine awardwinning restaurants, and a caldarium.

INTERESTED IN EXHIBITING? Current exhibitors and sponsors should be receiving a copy of the 2024 AHVMA Exhibitor Prospectus by the end of the year. Please contact the AHVMA office if you have any questions. For all other exhibitors, be on the lookout for registration at the beginning of the year. 2023 was an amazing year for all our exhibitors, and we can’t wait to have an even better year in 2024!

SPEAKING AT THE 2025 CONFERENCE The Conference Program Committee is no longer accepting submissions for the 2024 annual conference: however, be on the lookout in the spring for the 2025 Call for Papers portal to open. Submitted by Melissa Kellagher, AHVMA Director of Operations

Jacqueline, C. (1985) Exploratory behavior models of anxiety in mice, Neuroscience & Biobehavioral Reviews, Volume 9, Issue 1, Pages 37-44, ISSN 0149-7634, https://doi.org/10.1016/0149-7634(85)90030-2.

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BEST

F 2023

Innovative Pet Products Spotlight

NUTRITION SOURCING IMPACTS PET NUTRITION Some dog foods are delicious, some are nutritious, some are neither. And a rare handful are both. Like Earth Animal WisdomTM Air-Dried Dog Food. What’s the WisdomTM difference? Earth Animal knows that the source of each ingredient that goes into their recipes matters. Which is why they: * Are committed to 100% transparency about their ingredients. * Make it a priority to source only sustainable, thoughtfully grown and nurtured ingredients in the US and, where recipes require a specific ingredient unavailable in the US, to use only suppliers who meet the same high standards. * Use only G.A.P. certified chicken and turkey, and only OceanWise, Chain of Custody MSC, or MSC Certified seafood.

All of which adds up to dog food designed to prioritize so much more than just a full belly. Empower pet parents to make wise nutrition choices with Earth Animal WisdomTM Air-Dried Dog Food.

www.earthanimal.com POWER OF MEDICINAL MUSHROOMS

Cave Pets introduces the first Regenerative Organic Certified® (ROC™) mushroom powders for dogs. Regenerative agriculture improves soil and food quality through sustainable practices. The mushrooms are cultivated on a nutrient-dense ROC™ growth medium, and include Turkey Tail, Reishi, Lion’s Mane, and others. The powders are combined with probiotics to support immunity, the microbiome, and healthy digestion.

ORAL HEALTH MADE EASY

Help your clients support their pets’ oral health with ProDen PlaqueOff System™ Holistic Soft Bites. These delicious vegan treats help maintain clean teeth and fresh breath and are made from sweet potatoes, peanuts, and other natural ingredients. They contain no grain, gluten or soy. The ProDen PlaqueOff system has a clinically proven positive effect and is recommended by veterinarians.

cavepets.com

SEE MORE INFO ONLINE: IVC Winter 2023/24

us.swedencare.com

WWW.IVCJOURNAL.COM

It’s been an amazing year for products in the pet industry! Research, technology and consumer demand have created better options so your clients can live longer, healthier lives. Check out some of this year’s best:

SUPPLEMENTS PROTECT AND PRESERVE HEALTHY NERVE FUNCTION IN YOUR PATIENTS

Nervous system health in humans and animals depends on how resilient the nerve cells or neurons are. These cells can be damaged by lethal genetic changes or adverse environmental conditions. One way to help them recover is with fortifying nutrients that sustain the molecular mechanisms underlying their viability and survival capabilities. Gilad&Gilad, a company competent in neuroscience, developed the exclusive Agmaceuticals™ product line based on their breakthrough discovery that a unique molecule called agmatine possesses robust neuroprotective properties. Agmatine exerts its beneficial effects by targeting multiple molecular mechanisms vital for proper nervous system function. Agmatine® (the company’s proprietary brand of agmatine) supports proper sciatic nerve function, and healthy spine-nerve structure/function interactions. Along with products for humans, Gilad&Gilad also formulated AgmaVet® for nerve- and joint-related pain in animals.

fornervehealth.com. CBD FOR SMALL AND MEDIUM DOGS

High ratios of CBD:THC often cause sedation in small and medium-sized dogs. Canna Companion's Whole Plant Hemp Oil for Small and Medium Dogs (<40 pounds) is especially formulated to support the endocannabinoid systems of your smaller patients. Made from organic ingredients, it not only contains balanced ratios of major cannabinoids (CBD:THC 3:14:1), but also combinations of minor cannabinoids and small and medium dogspecific terpene profiles.

HEART SUPPORT FOR SMALL ANIMALS

Optimize the cardiac health of your canine and feline patients with Heart Health Formula (formerly Bio-Cardio) from ThorneVet. This formula combines the antioxidant potential of CoQ10 with other cardioprotective nutrients and botanicals such as vitamin E, L-carnitine, taurine, hawthorn, Siberian ginseng, and more. It not only supports the heart muscle, but also enhances stamina in small animals by promoting oxygen utilization.

CannaCompanionusa.com

thornevet.com

SPONSORED CONTENT IVC Winter 2023/24

WINTER SAFETY SAVE THEIR PAWS THIS WINTER

Conventional ice melts are hard on dog and cat paws, and even more toxic if ingested. Tell your clients about Safe Paw, a pet-friendly ice melt that won’t burn their animals’ feet or poison them if they lick it off their paws or coat. Free of salt, chloride and acetate, this dual-effect compound features a liquid component with a crystal core that work together to quickly melt ice. It’s environmentally safe, and won’t harm plants or waterways.

safepaw.com

EYE CARE HELP YOUR PATIENTS SEE MORE CLEARLY

Cataracts are common in older pets, and surgery may not be practical or affordable for many owners. LumenPro Pet Cataract Eyedrops contain lanosterol, a naturally-occurring molecule proven to slow, halt, and reverse the progression of cataracts. Formerly, lanosterol could only be administered by injection due to its insolubility; however, a method has been discovered to make it soluble, which means it can now be delivered topically in an easy-toadminister eyedrop solution.

lumenpro.com

IVC Winter 2023/24

TESTING GET ANSWERS WITH MICROBIOME TESTING

Identifying the microbiota in a dog or cat’s gut is key to understanding the cause and effect of many chronic and persistent diseases in our patients. The GI Microbiome Panel from VDI Lab provides quantified analysis of bacteria and fungi, diversity, pathogen identification, and antibiotic resistance information using Next Generation Sequencing (NGS) — the gold standard for detecting and identifying microorganisms.

vdilab.com/microbiome/

STRESS RELIEF ADRENAL SUPPORT FOR TIMES OF STRESS

A dog’s adrenal glands help his body adapt to stress through the release of corticosteroids and hormones. This affects many body systems, including the pituitary and thyroid glands, autonomic nervous system, liver, duodenum, and kidneys. Canine Adrenal Support from Standard Process helps the adrenals rebuild, regenerate, and respond normally to stress and metabolic demands, while providing vital nutritional support to related bodily organs.

standardprocess.com

In the news

Dogs show more

motivation in response to high-value appetitive stimuli In a recent study centered around canine cognition, researchers have uncovered compelling evidence that family dogs possess the ability to associate different sounds with appetitive stimuli of varying incentive values. The study, conducted over two experiments involving both behavioral paradigms and functional magnetic resonance imaging (fMRI) studies, sheds light on the relationship between auditory cues, appetitive stimuli, and neural responses in dogs. In the first experiment, 20 family dogs participated in a problem-solving behavioral paradigm, demonstrating a remarkable ability to associate specific sounds with different food rewards. The dogs exhibited quicker problem-solving abilities when presented with the sound associated with higher-reward-value food, suggesting a clear link between auditory cues and the motivational state of the dogs. Building on these findings, the researchers conducted a second experiment involving both behavioral paradigms and fMRI studies. Twenty specially-trained family dogs participated, allowing for a deeper exploration of the neural mecha-

nisms underlying their associations between sounds and appetitive stimuli. Surprisingly, in the second study, the behavioral difference observed in the first experiment was not significant. However, the neural responses told a more nuanced story. The researchers focused on two key brain regions: the caudate nucleus (CN) and the amygdala. Post associative training, the CN in the dogs exhibited higher activation in response to the sound associated with higher-reward-value food, as compared to the sound linked to lower-rewardvalue food. The amygdala, another crucial brain region, displayed an increased response to both sounds after the associative training, indicating heightened neural activity in connection with the learned associations.

reveals the neural processes involved. The right caudate nucleus emerges as a key player, integrating motivation and reward representation based on associative learning. The findings not only deepen our understanding of canine cognition but also open doors to further exploration of the canine mind. www.nature.com/articles/s41598-023-40539-1

A whole-brain representational similarity analysis further highlighted the distinct cerebral patterns in the caudate nucleus after training, emphasizing the dogs’ ability to differentiate between the sounds based on learned associations. The study not only showcases dogs’ remarkable ability to associate sounds with specific appetitive stimuli, but also

IVC Winter 2023/24

BY MARLENE SIEGEL, DVM, CNHP, ALT

the Cinderella tissue – WHY IT’S SO

IMPORTANT TO YOUR ANIMAL PATIENTS

Fascia is incredibly important to bodily well-being. Supporting this vital network of connective tissue in yourself, your pets, and your animal patients can improve overall health. Until about 20 years ago, the fascia — the network of connective tissue in our bodies and those of our animal patients — was disregarded for its true beauty and intelligence. Now, however, the fascia has been revealed as a brilliant living sensory fabric that covers and connects every aspect of the body: muscles, bones, nerves and organs. Fascia is the skin of the body’s cells. It connects trillions of cells, creating mobility, stability, and communication between all cells in the body. It is constantly adapting to environmental stresses and changing to meet the body’s structural demands. Nutrients travel through this matrix to the cells and waste products from the cells are removed and transported through the lymph system to be excreted. This article looks at the fascia’s crucial role in the body, what can go wrong, and how to remedy it.

Around a century later, at the Fourth International Fascia Research Congress, held near Washington, DC in September 2015, two definitions of fascia were proposed: it was called both “a fascia” and “the fascial system”.

THE CINDERELLA TISSUE IS RECOGNIZED AND HONORED

The first definition is morphological/anatomical, while the second is functional.1

Andrew Taylor Still (1828-1917), physician, surgeon, and the founder of osteopathy, noted that the fascia covers, permeates, divides and subdivides every portion of the body. He further declared that healthy functioning fascia supports life, where the failure of fascia to function properly leads to death.

Fibroblasts are the predominant cell population of the fascia tissue. Their primary role is to respond to stimuli. In doing so, they maintain the structural integrity and organization of the tissue. Fibroblasts are involved in mechanotransduction, and in secreting precursors of the extracellular matrix.

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A fascia is “a sheath, a sheet, or any other dissectible aggregations of connective tissue that forms beneath the skin to attach, enclose, and separate muscles and other internal organs”.

The fascial system “consists of the three dimensional continuum of soft, collagen- containing, loose and dense fibrous connective tissues that permeate the body, providing an environment that enables all body systems to operate in an integrated manner”.

Mechanotransduction refers to the biological phenomenon wherein mechanical stresses applied to cells are translated into chemical signals that elicit adaptive responses, such as vasodilation of blood vessels, interpreting sound/hearing, postural balance, sensation of joint position, muscle contraction, and touch.2 Simply put, through our lifestyle choices we are communicating to our cells what is happening on the “outside” so they know how to respond to ensure our survival. How awesome is that!

WHAT DAMAGES FASCIA? Scar formation, whether from injuries, chronic inflammation, or previous surgical procedures, creates impeded “flow” through the fascia and lymphatics. The “scar” grips and spirals in, creating adhesions that create stability in the tissue. Wherever there is contracture, there is an equal and opposite “ballooning out” to compensate for the structural imbalance. Over time, gravity compresses the fascia, causing the body to spiral downward and inward. If people are not actively focusing on their breath (diaphragmatic breathing), posture and healthy lifestyle (diet and exercise), they will get shorter and wider over time. Their shoulders roll forward, their upper body collapses into the lower body, and they breathe more from their chest muscles than the diaphragm. The fascia begins to compress, spiraling inward and downward, gripping onto whatever it can in an attempt

The fascia team The fascia is commonly described in terms of three primary types: superficial fascia, deep fascia, and visceral fascia. All three serve distinct functions and are found in different regions of the body:

Superficial fascia is located under the skin and in the adipose tissue. It is responsible for offering structural support and protection, regulating temperature and transporting nutrients.

Deep/muscular fascia is found throughout the body, surrounding individual muscles and groups of muscles. It gives structural support, helps transmit forces generated by muscles, and aids in coordinating movement. Deep fascia can also compartmentalize muscles to prevent excessive movement and maintain efficiency.

The visceral fascia covers the organs — helping to anchor them in place, allowing them to move against each other, and providing a framework for the passage of blood vessels and nerves to the organs. IVC Winter 2023/24

to continue supporting the body’s posture and movement. The resulting adhesions hold the body out of natural alignment and further restrict “flow” through the fascia and lymph system. Sitting for extended periods of time — i.e. lack of movement and exercise — is a problem of epic importance. The lymphatics (which are housed in the fascia) do not have a pump to move lymph the way the heart moves blood. The lymph system relies on movement and muscular contraction to pump waste products. As lymph becomes stagnate, toxins build up, leading to inflammation and “disease”.

OTHER FACTORS CONTRIBUTING TO FASCIA COMPRESSION The Standard American Diet (S.A.D.) (which is no longer unique to Americans and exists worldwide) contributes to fascia dysfunction. Processed food diet, excess sugar, and nutrient depletion, as well as toxin overload, chronic stress, high sympathetic tone, sleep deprivation, poor posture (slumped in front of a computer or TV screen), shallow chest breathing (instead of diaphragmatic breathing), injuries, fear, and stress all contribute to a growing problem. I recently traveled through Europe and found processed junk food everywhere. All these

factors cause the fascia to “spiral down”, creating adhesions in an attempt to stabilize the body. The adhesions also block normal blood flow to the cells, resulting in decreased oxygen and nutrient flow. Cell detoxification is also compromised. The goal is to live a long and healthy life, and the key is to keep the fascia healthy and functioning so cells are in alignment and functioning at their highest potential.

THE PATHWAY TO THRIVING AND LONGEVITY

Choose to live and behave in a way that supports health. This is truly about deciding what your lifestyle will look like, no excuses, just results. Own it! Your pets have no choice in the matter, since they depend on you to make good lifestyle choices that will determine their health and longevity. So think about them as well.

Eat an appropriate diet along with essential nutrients. Feed your pets well too, and encourage your clients to do the same. For dogs and cats, this is a balanced raw diet (meat, fat, bone, and organ meat). Beware of diets that are “complete and balanced” since most have added synthetic vitamins and minerals!

Reduce toxin exposure from food, water, your environment, EMF and even your negative thoughts — yes, you might have some “stinkin thinkin” that needs to be reprogrammed!

Move! Regular movement (exercise, high intensity movement, dance, etc.) is critically important for lymphatic and fascial health.

Problems in our 5. animal patients Over my past 20 years as a veterinarian, I have observed an alarming increase in degenerative disc disease in my animal patients. Radiographs document the narrowing of vertebrae in animals as young as two years of age. This narrowing of disc spaces is caused by the paravertebral muscles contracting in an attempt to create stability, but it also restricts “flow” and results in a lack of proper circulation to the organs and limbs. It is my belief that the dramatic increase of cruciate injuries in pets reflects directly on a lack of nourishment and waste removal to the joints, due to the restricted flow of energy and cellular nutrition from the spinal column. 40

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Practice diaphragmatic breathing! This involves deep belly breaths that push the abdomen out with inhalation and brings it in and up on exhalation. Proper diaphragmatic breathing acts like a furnace, keeping proper warmth in the abdomen.

Become educated. Your clients can learn more about diet, lifestyle, detoxification, and mitochondrial health by visiting www.drmarlenesiegel.com and clicking on “The Empowered Pet Parent Course”. There’s also a training course for veterinarians, about how to incorporate alternative medicine into your practice — see “Transforming Vet Medicine”.

FASCIA DECOMPRESSION — BRINGING CELLS BACK INTO PROPER ALIGNMENT •

Enroll in programs that teach how to create/recreate space by applying pressure (with hands or blocks) to “melt” the

adhesions holding tissues out of alignment. Time and pressure increase heat, melt adhesions, and improve blood flow into the area. Visit https://kd167.isrefer.com/ go/sampler/DrSiegel/ to learn more. •

Inflate the space with proper diaphragmatic breathing. Proper breathing moves the diaphragm up and down and massages the abdominal organs. When we are not practicing diaphragmatic breathing, the diaphragm muscle gets weak and the weight of everything above causes us to collapse in and slump forward, leading to displacement of internal organs and tissues.

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The evidence is a ballooning belly! The muscles of the upper chest, the secondary breathing muscles, take over and do most of the breathing work. The result is shallow breathing and less than optimum oxygenation of the lungs which then leads to decreased oxygen intake for the cells. Proper diaphragmatic breathing can supply up to six times more oxygen to the body/ cells. Improper breath occurs in pets as well.

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Shift into parasympathetic (out of sympathetic). Pain, fear and stress cause us to reactively hold our breath. Traumatic events and repeated traumas cause us to “freeze” and keep us in high sympathetic tone. Here are a few of my favorite activities to help shift into parasympathetic: entrain to proper frequency (PEMF), breath work, meditation, EFT (emotional freedom technique), and hyperbaric oxygen therapy. Find the ones that work for you and have your pet nearby as they will entrain to the frequencies and your energy.

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

ESSENTIAL OILS AND THEIR INFLUENCE ON ANIMAL BEHAVIOR The use of Biologically Active Essential oils (not just any essential oils) is well documented in psychology for their help with learning and accessing memories. Olfaction is the only sense that is directly wired to the limbic system. The sense of smell, especially in animals, is known to be responsible for locking in memories; and as used in psycho-neurology, for unlocking buried memories to assist with human behavior changes. Animals lock in memories — and thus their adaptive behavior — using scent. The smell of a veterinary clinic will often set off a panic attack in a pet, due to memories of surgery or other procedures. I have used essential oils in my practice since 1997 to

Pull the cells back from where they have migrated and into proper alignment by using awareness, diaphragmatic breathing and Block Therapy/Fluid Isometrics to release adhesions, improve breathing, improve blood and oxygen delivery, maintain the extra space and correct the tissue alignment.

adjust the smell of the place, and thus relax the animals. I can vary the scents to help pets become imprinted with “good and kind” memories of our facility. The number one comment from new guardians is that their pets are usually stressed, but are very relaxed at our clinic. Just changing the scent and imprinting gentle energy during

Become educated and empowered! The “Fascia Decompression For Your Fur Family Course” teaches you how to improve an animal’s diaphragmatic breathing. For details, go to www.drmarlenesiegel.com and click on “Fascia Decompression For Your Fur Family”.

a pet’s first visit allows them to come in time after time with memories of safety and trust. From this experience, we have taught our trainers to use different essential oil blends to imprint positive behavior. This is especially helpful in desensitization training. Scent can lock in a new behavior faster than training alone. For more information, visit VMAA.vet.

Int J Mol Sci. 2021 Feb; 22(3): 1411.Published online 2021 Jan 30. doi:10.3390/ijms22031411 PMCID: PMC7866861.

PMID: 33573365 https://www.sciencedirect.com/topics/medicine-and-dentistry/mechanotransduction.

Reference: Glaser, Gabrielle. The Nose, https://gabrielleglaser.com/books/the-nose.

Submitted by Nancy Brandt, DVM, MSOM, dip.OM, CVC, CVA, CVMA

IVC Winter 2023/24

A NUTRITIONAL APPROACH TO LEAKY GUT SYNDROME IN DOGS & CATS BY RUTH ROBERTS, DVM, CVA, CVH, CVFT

How functional medicine, including the 5 Rs protocol for gut healing, effectively resolves leaky gut in dogs and cats.

Gut health is critical to a pet’s overall well-being.1 Impaired gut function can impact an animal’s digestion, immune system, and behavior. Therefore, veterinarians must understand the factors leading to abnormal gut function, and how to restore the gastrointestinal system to optimal health.2,7 This article provides a comprehensive guide to restoring gut health in pets by using nutritious whole foods and the principles of functional medicine. The causes and manifestations of abnormal gut function, including intestinal permeability (also known as “leaky gut syndrome”), will also be described. The author outlines the “5 Rs” protocol for gut healing, which involves the five steps of removing, replacing, re-inoculating, repairing and rebalancing/reintroducing. The article also highlights the importance of using testing to guide therapeutic approaches to gastrointestinal issues, including leaky gut syndrome, as well as incorporating supplements (such as certain types of probiotics, fecal microbial transplant capsules, adsorbents, Chinese herbal formulas, and other individual and combination products) as part of a gut healing protocol.

INTRODUCTION A comprehensive understanding of gut health requires a multifaceted perspective, as many factors can contribute to abnormal gut function, including poor diet, medications, aging, and exposure to chemicals or other toxins. Accordingly, a multimodal approach to treatment that reflects the principles of functional medicine and incorporates an elimination and rotation diet, along with the use of selected supplements, can be a powerful

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tool to help restore gut health and thus prevent and/or improve chronic health issues. Hipocrates’ sage advice to let food be thy medicine is the underpinning of this approach.

FACTORS CONTRIBUTING TO ABNORMAL GUT FUNCTION The digestive process starts well before food enters the mouth. It begins when the pet sees food, which leads to the release of ghrelin, a hormone that causes the animal to sense hunger. The production of insulin also begins in anticipation of a need to store the blood sugar that will increase from eating a meal. In the mouth, saliva lubricates the food and mechanical chewing breaks it down, making it easier to digest; saliva also has antimicrobial activity. When the chewed and partially digested food reaches the stomach, the stomach acid has several critical roles, which include breaking chemical bonds in the food molecules for more complete digestion, activating digestive enzymes in the stomach and small intestine, and destroying harmful bacteria.4

Various factors commonly disrupt optimal digestive function. For example, many pets who consume dry commercial pet food rarely chew and break down the food nuggets, placing an extra burden on the stomach and disrupting the digestive process. Some medications can reduce the production of stomach acid, which is crucial for supporting digestion and protecting against harmful bacteria. As pets age, their levels of digestive enzymes naturally decrease, making it more difficult for them to break down food in preparation for the absorption of nutrients needed by the body. Poorly absorbed nutrients can lead to health problems, including intermittent or chronic diarrhea.5 For these reasons, I recommend a nutritionally complete and balanced home-cooked diet for dogs and cats to support both the digestion of food and the absorption of nutrients. Cooking the food slowly at low temperatures provides the gastrointestinal system with the most easily digestible food and absorbable nutrients. Such “slow and low” cooking methods also prevent the creation of advanced glycation end products (AGEs), which form when certain foods are cooked at high temperatures. The accumulation of AGEs in the body negatively affects gut structure and function, causes inflammation, and damages other systems of the body.

Factors external to the body can also adversely affect the gastrointestinal system. The gluten protein found in wheat and the zein protein in corn can cause an inflammatory response in the gut that directly damages the enterocytes, causing severe gastrointestinal symptoms. Exposure to chemicals such as herbicides and pesticides can also alter the normal gut flora and disrupt essential gut functions.3 Furthermore, stress and anxiety can disrupt gut function by causing excess production of “fight-or-flight” hormones (such as cortisol), which can impact the gastrointestinal system in multiple ways. Chronic stress can lead to chronically elevated cortisol levels, wreaking havoc on the immune system, the production of normal hormones, and the gut flora. In particular, excess cortisol can lead to either over- or underproduction of stomach acid and/or gastrin (the hormone that stimulates the secretion of stomach acid). The production and release of digestive enzymes can also be markedly reduced due to elevated cortisol. Gut motility is affected by stress, leading to either diarrhea or constipation. Chronic stress can impact bile production and fat digestion, blood flow to the digestive organs, and the gut microbiome, leading to dysbiosis. An additional consequence of increased cortisol is compromised integrity and function of the intestinal barrier, leading to “leaky gut” syndrome. Intestinal permeability, or leaky gut syndrome, occurs when a weakening of the tight junctions between enterocytes allows undigested food to be absorbed into the bloodstream and directly presented to the immune system, causing an inflammatory response in the gut. Leaky gut and the resulting immune response can lead to autoimmune diseases as well as the destruction of beneficial microflora in the gut, allowing pathogenic bacteria to take over. Additionally, leaky gut has been shown to precede IBS.6

SUPPLEMENTS TO SUPPORT GUT HEALING •

Probiotics

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Zinc carnosine

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Sarcomyces Boulardii

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Mixed tocopherols of vitamin E

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L-Glutamine

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Si Jun Zi Tang (Four Gentlemen)

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Omega-3 fatty acids IVC Winter 2023/24

RESTORING GUT HEALTH USING FUNCTIONAL MEDICINE Functional medicine focuses on treating the root cause of health issues rather than simply treating the resulting symptoms. In the context of gut health, functional medicine aims to identify and remove factors contributing to intestinal permeability while also supporting and restoring optimal function of the gastrointestinal system.9 These aims are put into practice through the “5 Rs” gut health framework for restoring gut health,16 as mentioned above. 1.

The first step is to remove any factors contributing to gut dysfunction, such as food allergens or toxins.

Next, we replace these adversely contributing factors with healthy alternatives, such as fresh whole foods.

We then re-inoculate the gut with beneficial bacteria by using probiotic supplements and/or fermented foods that contain probiotics.

Following this, we repair the gut using various supplements to create a seal from outside (the lumen of the intestine) to inside (the immune system, gut activated lymphoid tissue or GALT).

Finally, we rebalance lifestyle and reintroduce previously eliminated foods individually in order to identify specifically which foods are causing adverse reactions, and to understand what foods are now tolerated.

Each of these five steps is described in further detail in the following sections.

Step 1 – Remove This essential initial step of the 5 Rs protocol involves removing all factors that contribute to intestinal permeability. This includes removing any foods a pet is sensitive or allergic to and replacing them with fresh whole foods. Please note the difference between the words “allergen” and “sensitivity”. It is estimated that 3.5% of dogs have true food allergies,8 while up to 32% of dogs presenting with signs of atopy have food sensitivities.8 Understanding this difference underscores

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the importance of healing the leaky gut so the immune system can stop responding to improperly digested food particles crossing through to the GALT, creating sensitivities. It is also important to avoid histamine-releasing foods, nightshade vegetables, and fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), as each of these can irritate the gut lining. Food sensitivity testing can be performed to help identify specific foods that may be associated with adverse effects in an individual pet, bearing in mind that all such tests are best considered a general “road map” rather than a definitive determination. In my practice, I have encountered false-positive and false-negative results in all types of food sensitivity tests, including tests that use blood samples, saliva, and hair/fur. Currently, I use a bioresonance test that uses saliva and hair/fur samples for food sensitivity testing; the benefits include the simplicity of sample collection by the pet owner at home, and a lower cost compared to other sensitivity tests. If food sensitivity testing is not feasible, an elimination diet is the alternative brute-force method for identifying foods that are potentially associated with an allergy or sensitivity. An elimination diet involves removing any specific protein (e.g. chicken, beef), carbohydrate (e.g. rice, potatoes), or fat (e.g corn or soybean oil) the pet has eaten within the past six months. This method requires thoroughly reviewing the ingredient listings for all foods, treats, supplements, etc. that the pet has consumed during this period. The elimination diet is typically continued for approximately two to three months, although the length may vary depending on the severity and duration of the pet’s symptoms. Once potential food allergens and sensitivities have been identified (either by testing or an elimination diet), the next step of the 5 Rs protocol can begin. This subsequent replacement step builds upon the foundation of essential information gathered during the removal stage.

Step 2 - Replace The replacement step includes developing a rotation diet designed specifically for the individual pet. This diet involves rotating on a regular basis (e.g. daily or weekly) the

specific sources of protein, carbohydrate, and fat the pet is eating. The benefits of this strategy include giving the body a break from exposure to specific foods as the gut heals. The rotating periods of exposure to newly introduced foods help to prevent the immune system from developing an immune response to the new foods, thereby avoiding the emergence of additional sensitivities to the new foods being eaten. A rotation diet can also help more accurately identify foods that cause adverse reactions for the pet, and foods that are safe for the pet to eat.

Keeping a journal to track both the foods eaten, and any reactions that occur during the following two to three days, is strongly recommended during the use of a rotation diet. Notably, symptoms of a food sensitivity may not appear until up to 72 hours after the food is eaten. If the pet owner notices adverse reactions that are regularly associated with a particular diet, the individual foods included in that diet should be reassessed as possible sources of a food sensitivity and potentially removed from the diet.

To implement a rotation diet as a part of the 5 Rs protocol, three distinctly different diets (i.e. using different protein, carbohydrate, and fat sources as ingredients) should be designed, avoiding all foods to which the pet has a known or suspected sensitivity. Home-cooked diets are preferable for use in a rotation diet, as home cooking allows for complete control over the ingredients in the food, and also uses fresh whole foods that are less likely to contribute to intestinal permeability. If commercial foods are used, it is essential to identify products with ingredients that exclude all foods to which the pet may have an allergy or sensitivity. The pet should be fed a different diet every 24 hours, rotating among the three different diets. Treats should also be limited to the same ingredients included in the diet the pet is eating in a given 24-hour period. Simple treats can be made by dehydrating small amounts of the foods in the diet designated for the day. The rotation diet should be maintained for at least three to six weeks, or until the pet’s symptoms are completely resolved. In some cases, the removal and replacement phase of the 5 Rs protocol may extend up to 12 weeks.

I have found it helpful to introduce a sporebased probiotic supplement during the replacement step as soon as the pet’s symptoms have been reduced through an elimination and rotation diet. However, prebiotics should be avoided during the replacement step, as they can cause food sensitivity reactions.

Step 3 – Re-inoculate Specific supplements, including probiotics, can be used to promote the restoration of gut health. The aim of probiotic supplements is to populate the gut with additional organisms that will support the scaffold of the gut microbiome and create a more hospitable environment in which the existing beneficial gut bacteria can thrive.10 Sporeforming probiotic bacteria can survive the harsh acidic environment in the gut and may colonize the intestines. Compared to non–spore-forming (or “regular”) probiotics, those that include spore-forming strains often have lower colony-forming unit (CFU) counts and contain fewer bacterial species. Dosing guidelines for these supplements should be followed carefully to ensure optimal results.11

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Another option for re-innoculaing the gut involves the use of fecal microbial transplant (FMT) capsules. These capsules, which contain freeze-dried stool specimens from healthy pets, can help restore gut health by introducing the correct species and a balanced variety of bacteria to the gut. Although the concept of a fecal microbial transplant may sound unappealing, this strategy has been shown to be effective in treating conditions such as inflammatory bowel disease and chronic diarrhea. With the commercial availability of FMT freezedried capsules, this has become a great option for pets with chronic long-standing disease. In my experience, however, before introducing FMT, it is critical to ensure the pet is eating a higher-fiber whole foods diet and that a foundational level of gut health has been achieved in preparation for supporting the addition of healthy microbes to the gut.

Step 5 – Rebalance/ reintroduce “Rebalance” refers to the idea that returning to the lifestyle that led to leaky gut will create it all over again. For humans, reducing stress, practicing meditation, having a good work/life balance, and making time for play are all recommended for preventing the recurrence of leaky gut and any symptomatology related to it.

Step 4 – Repair A variety of supplements has been demonstrated to be beneficial in supporting gut health and healing the gut barrier. •

Saccharomyces boulardii is a yeast that can help control diarrhea, improve gut barrier function, and stimulate the production of secretory IgA.

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S. boulardii also acts to modulate the microbiome and gut motility.

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Omega-3 fatty acids are a commonly-used supplement for supporting gut health, since their anti-inflammatory properties can help reduce inflammation, thereby improving gut barrier function and modulating the microbiome.12,18

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L-glutamine and zinc carnosine are helpful for supporting gut health.

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Combinations of slippery elm bark, marshmallow root, aloe vera, and deglycyrrhizinated licorice are commonly found in supplement products developed to support gut healing.13,14

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Lastly, certain Chinese herbal formulas, such as Si Jun Zi Tang (also known as Four Gentlemen), have been shown to be effective in supporting the Spleen (the organ associated with digestion in TCM) and improving gut health. The Four Gentlemen formula contains a combination of four herbs that work together to improve digestion and strengthen the immune system.15

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How can we apply that to our pets? We know human stress levels and emotions impact our dogs.17 So stress management for dogs and cats begins with managing our own stress. Studies have shown the positive impact pets can have on the stress levels of humans.19 What if humans could minimize the stress levels of their pets by practicing mindfulness? A short three-minute period without the interruption of mobile devices, television and other distractors has been helpful for many clients with anxious pets. Daily exercise, especially outdoors, also provides environmental enrichment and stress reduction.20,21

USING TESTS TO IMPROVE GASTROINTESTINAL HEALTH

Testing can be a valuable tool for guiding strategies to improve gut health in pets. •

icrobiome tests, which measure the quantity M and diversity of microbes present in the gut, provide valuable information about a pet's gut health and can help identify imbalances and/ or deficiencies in the microbiome. Microbiome tests involve extracting bacterial DNA from a stool specimen to determine which microbes are present; the quantities and types of microbes in the pet’s stool are compared to the microbiome profile of healthy patients to identify relative imbalances in any particular microbial species. This information can be used to make recommendations regarding the use of foods and/or supplements to better support a healthy microbiome.

•

s mentioned in the article, food and/or A environmental sensitivity tests can provide helpful insights for identifying potential allergens or irritants that may be present in the pet's diet or environment. Sensitivity testing can be performed on blood, saliva, or hair/fur specimens. These tests are particularly useful as a guide for making elimination and rotation diets more efficient and simpler to carry out.

•

Additional functional medicine tests can provide information on various factors, including digestion, nutrient absorption, detoxification, inflammation, and immune function and/ or reactivity. Specifically, immune reactivity is often increased in patients with leaky gut syndrome, resulting from weakening of the tight junctions in the epithelial barrier between the gut lining and the bloodstream. Testing for markers of gut health (such as secretory IgA, zonulin, calprotectin, and pancreatic function) can help direct further strategies for supporting the patient’s gastrointestinal health.

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The reintroduction of previously eliminated foods can begin once all symptoms have resolved. This step is applicable if the pet owner wants to increase the number and variety of food ingredients included in their pet’s diet. However, this step is not essential and can be omitted. During this phase, it is critical to reintroduce foods individually, making note of any reactions that occur, and waiting at least 72 hours before reintroducing another food.22 If a reaction to a newly reintroduced food occurs, the reintroduction of another new food should not occur until at least 72 hours after the reaction has resolved. No further attempts to reintroduce the food that caused the reaction should occur for at least 18 months; if the pet again reacts to the food at that time, they will likely never be able to eat that food without experiencing a reaction.

Scarsella, E., Stefanon, B., Cintio, M., Licastro, D., Sgorlon, S., Monego, S. D., & Sandri, M. (2020). Learning machine approach reveals microbial signatures of diet and sex in dog. PLOS ONE, 15(8), e0237874. https://doi. org/10.1371/journal.pone.0237874.

DeGruttola AK, Low D, Mizoguchi A, Mizoguchi E. Current Understanding of Dysbiosis in Disease in Human and Animal Models. Inflamm Bowel Dis. 2016;22(5):1137-1150. doi:10.1097/MIB.0000000000000750.

Počta S, Svoboda M. (2007). Incidence of Canine Hypersensitivity in the Region of North Eastern Bohemia. Acta Veterinaria Brno, doi:10.2754/avb200776030451.

Chesney C. (2002). Food sensitivity in the dog: a quantitative study. Journal of Small Animal Practice, 43(5), Volume 43 (5) – May 1, 2002 10.1111/j. Doi1748-5827.2002.tb00058.x.

Thomas M Strobel, Christine Nguyen, Taylor Riggs, Sarah N Horst, Amy Motley, Spencer Upadhyaya, Sarah Campbell, Emily Spring, Robin L Dalal, Elizabeth Scoville, Baldeep Pabla, David A Schwartz, Dawn B Beaulieu, Functional Medicine Approach to Patient Care Improves Sleep, Fatigue, and Quality of Life in Patients With Inflammatory Bowel Disease, Crohn's & Colitis 360, Volume 4, Issue 3, July 2022, otac032, https://doi. org/10.1093/crocol/otac032.

Debora Compare, Costantino Sgamato, Olga Maria Nardone, Alba Rocco, Pietro Coccoli, Carmen Laurenza, Gerardo Nardone; Probiotics in Gastrointestinal Diseases: All that Glitters Is Not Gold. Dig Dis 12 January 2022; 40(1): 123–132. https://doi. org/10.1159/000516023.

Conclusion Abnormal gut function, including leaky gut syndrome, can negatively impact a pet's digestion, immune system, and behavior. Restoring and maximizing gut health is crucial for a pet’s overall well-being. A nutritious diet composed of whole foods can play a significant role in achieving optimal gut health. Additionally, by implementing the 5 Rs protocol for gut healing, and incorporating the use of testing and supplements, veterinarians can develop effective strategies to restore healthy gut function in dogs and cats. With the assistance of a veterinarian who applies these principles of functional medicine, pet owners can help ensure their furry friends live long, healthy, and happy lives.

Muhammed Majeed, Shaheen Majeed, Sivakumar Arumugam, Furqan Ali, Kirankumar Beede, Comparative evaluation for thermostability and gastrointestinal survival of probiotic Bacillus coagulans MTCC 5856, Bioscience, Biotechnology, and Biochemistry, Volume 85, Issue 4, April 2021, Pages 962–971, https://doi.org/10.1093/bbb/zbaa116.

Calder PC. Omega-3 fatty acids and inflammatory processes: from molecules to man. Biochem Soc Trans. 2017;45(5):1105-1115. doi:10.1042/ BST20160474.

Aleman RS, Paz D, Cedillos R, Tabora M, Olson DW, Aryana K. Attributes of Culture Bacteria as Influenced by Ingredients That Help Treat Leaky Gut. Microorganisms. 2023; 11(4):893. https://doi. org/10.3390/microorganisms11040893).

Wang B, Wu G, Zhou Z. et al. Glutamine and intestinal barrier function. Amino Acids 47, 2143–2154 (2015). https://doi. org/10.1007/s00726-014-1773-4.

Bi Z, Zheng Y, Yuan J, Bian Z. (2019). The Efficacy and Potential Mechanisms of Chinese Herbal Medicine on Irritable Bowel Syndrome. Current pharmaceutical design, 23(34), 5163-5172 doi.org/10.2174/1381612823666170822101606. https:// www.ifm.org/news-insights/5r-framework-gut-health/.

Höglin A, Van Poucke E, Katajamaa R. et al. Long-term stress in dogs is related to the human–dog relationship and personality traits. Sci Rep 11, 8612 (2021). https://doi.org/10.1038/s41598-021-88201-y.

Bischoff SC. Gut health: a new objective in medicine?. BMC Med. 2011;9:24. Published 2011 Mar 14. doi:10.1186/1741-7015-9-24.

Cerquetella M, Spaterna A, Laus F, et al. Inflammatory bowel disease in the dog: differences and similarities with humans. World J Gastroenterol. 2010;16(9):1050-1056. doi:10.3748/wjg.v16.i9.1050.

Karen Chiu, Genoa Warner, Romana A Nowak, Jodi A Flaws, Wenyan Mel. The Impact of Environmental Chemicals on the Gut Microbiome, Toxicological Sciences, Volume 176, Issue 2, August 2020, Pages 253–284, https://doi.org/10.1093/toxsci/kfaa065.

Fan Z, Bian Z, Huang H, Liu T, Ren R, Chen X, Zhang X, Wang Y, Deng B, Zhang L. Dietary Strategies for Relieving Stress in Pet Dogs and Cats. Antioxidants. 2023; 12(3):545. https://doi.org/10.3390/antiox12030545.

Catherine E. Amiot, Brock Bastian (2023) What is Beneficial in Our Relationships with Pets? Exploring the Psychological Factors Involved in Human–Pet Relations and Their Associations with Human Wellbeing, Anthrozoös, 36:4, 579-603, DOI: 10.1080/08927936.2023.2210437.

Tiira K, Lohi H (2015) Early Life Experiences and Exercise Associate with Canine Anxieties. PLoS ONE 10(11): e0141907. https://doi.org/10.1371/journal.pone.0141907.

Clark, J. Derrell; Rager, Dawn R.; Crowell-Davis, Sharon; Evans, Donald L. (1997) Housing and Exercise of Dogs: Effects on Behavior, Immune Function, and Cortisol Concentration. Comparative Medicine, Volume 47, Number 5, October 1997, pp. 500-510(11).

Lin CY, Jha AR, Oba PM, et al. Longitudinal fecal microbiome and metabolite data demonstrate rapid shifts and subsequent stabilization after an abrupt dietary change in healthy adult dogs. anim microbiome 4, 46 (2022). https://doi.org/10.1186/s42523-022-00194-9.

Scarsella E, Stefanon B, Cintio M, Licastro D, Sgorlon S, Monego SD, Sandri M. (2020). Learning machine approach reveals microbial signatures of diet and sex in dog. PLOS ONE, 15(8), e0237874. https://doi. org/10.1371/journal.pone.0237874.

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G Vighi, F Marcucci, L Sensi, G Di Cara, F Frati, Allergy and the gastrointestinal system, Clinical and Experimental Immunology, Volume 153, Issue Supplement_1, September 2008, Pages 3–6, https://doi.org/10.1111/ j.1365-2249.2008.03713.x.

PROFITABLE PRACTICE

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Super Chomp Tablets from Cave Pets are rich in the proteins, vitamins, minerals, and probiotics your patients need for optimal wellness, good gut health, healthy digestion, and balanced gut bacteria.

Savvy pet parents like your clients are increasingly concerned with the state of their dogs’ microbiomes, since they’re seeing so much information on how 80% of the immune system resides in the gut. This product is timely, with three formulas to support overall health. The company behind the product is also committed to environmental sustainability and is the first to bring Regenerative Organic Certified® ingredients to the pet space.

Each formulation has a unique benefit for dogs: reducing inflammation, promoting relaxation, or supporting immunity, making them suitable recommendations for a wide range of patients.

PREMIUM INGREDIENTS AND EASY-TO-DIGEST BIOAVAILABLE NUTRIENTS Formulated with nutrient-dense organ meats (heart, kidney, and liver) and a mineral blend from organic spirulina, glandular Super Chomp Tablets are an excellent source of the following: •

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Omega-3s

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Get your piece of the pie by offering Super Chomp Tablets at your clinic. When prescribed as a daily supplement, these functional tablets will become a recurring source of revenue. Visit Cave Pets (https://cavepets.com) to learn more about supporting your patients’ microbiome health with Super Chomp Tablets.

THE SUPER CHOMP TABLETS LINE-UP FEATURES A VARIETY OF

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Each pack contains 60 tablets. The recommended daily dose is one tablet per 15 pounds of body weight.

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CALMER CARE FOR CATS: HOW TO MINIMIZE STRESS DURING FELINE EXAMS BY JULIE LIU, DVM

Reducing examination fear for cats starts well before the visit itself. By considering stressor stacking, the exam room environment, and cat friendly handling principles, you’ll be able to significantly reduce stress in your feline patients. g is a life skil trainin l for rier ress associated c r a w t c s i th v ats, a e ive reduc et t i vis nd s s its Po elp . h

Veterinary care has traditionally prioritized the physical needs of the feline patient, giving little thought to their fear, anxiety, and stress during a clinic visit. However, with Low Stress Handling,1 AAFP Cat Friendly,2 and Fear Free3 initiatives, we now realize that by minimizing stress in our feline patients and advocating for their emotional needs, we can provide them with better care. In this article, we focus on ways to reduce feline stress associated with veterinary examinations.

PRE-HANDLING CONSIDERATIONS A cat’s visit doesn’t start and end with the exam table. Stressor stacking, a phenomenon outlined in the 2022 AAFP/ISFM Cat Friendly Veterinary Environment Guidelines,4 describes how multiple stressors can accumulate and cause the cat to reach threshold faster. Always consider what the cat has experienced prior to the exam — at home, during transport to the clinic, and within the clinic itself. Picturing a

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cat friendly visit from beginning to end, emailing clients information5 on how to decrease stress for vet visits, verifying that pre-visit medications are refilled and timed appropriately, and letting the client wait in the car so their cat can go straight into an exam room when ready, will help keep the patient as calm as possible. Another vital aspect to reducing feline stress is considering the exam room itself. The AAFP/ISFM 5 Pillars of a Healthy Feline Environment4 should be on your mind whenever you handle a patient; in particular, pillars 1 (“provide a safe place”) and 5 (“provide an environment that respects the cat’s sense of smell and other senses”) come into play for the exam. Remove all traces of the previous pet with an unscented cleaner, especially olfactory triggers like urine, feces, or anal glands. Elevated surfaces and hiding options can make cats feel safer,4 so ask clients to place the carrier on the exam table when entering the room and drape a towel over the carrier before handling. Towels are one of the most important tools for the cat friendly exam, providing a warm, cozy surface and a means to cover the cat if they prefer to be hidden. In addition, stocking the exam room with a variety of treats,6 toys, and catnip will help serve as a distraction and hopefully change the emotional state of your patient. The exam table surface should be comfortable and non-slip. If commercial exam table mats are out of your price range, yoga mats cut to the length of the table are a budget-friendly option for providing stability. Similarly, the scale used to 4

weigh your patients during the exam should have a non-slip and non-tilt surface. This can be achieved with a simple shelf liner or cozy bathmat placed on the scale and tared prior to weighing the cat. Finally, avoid using cat gloves, cat muzzles, E collars, cat burritos, and cat bags for the exam, due to their impact on feline welfare.7 If you find yourself using these routinely, consider changing your approach and goals, and rescheduling with previsit medications or injectable sedation.

FELINE HANDLING CONCEPTS The 2022 AAFP/ ISFM Cat Friendly Veterinary Interaction Guidelines 7 describe two types of emotional states we can see in cats: engaging (positive) emotions and protective (negative) emotions. Each of these states leads to behavioral responses we can observe during vet visits. Responses with underlying engaging emotions could include approaching a staff member for petting or treats, and exploring the room. Responses arising from protective emotions include avoidance, inhibited behavior, and distance-increasing, repelling behavior like hissing/swatting. • Reframing the emotional state of a cat in these terms — rather than using words like “fractious” or “spicy” — is an important first step to understanding your patient. The “Unlabel Me” campaign8,9 by Applied Behavior Analyst, Dr. Susan Friedman, cautions against the use of labels and

If your cat chooses to stay in their carrier, avoid lifting or dumping them out as this will significantly increase stress and could lead to injury. Instead, take the top off the carrier and let them hide in a towel.

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constructs for several reasons, including the inability of abstractions to cause behavior, and the danger of labels predisposing us to the use of aversive methods. For example: “This cat is spicy, so I have to use cat gloves and a muzzle.” • Another cat friendly principle you should keep in mind during any interaction is giving the patient as much control and choice7 as possible. We routinely move and handle pets in the clinic setting, while giving very little thought as to what they would prefer. Cats that choose to stay in their carriers get unceremoniously dumped and shaken out, while those that are relaxed in semi-lateral get scruffed and stretched into full lateral recumbency to access the medial saphenous. Supporting choice and control in every feline encounter has a remarkable effect on decreasing stress. Cooperative care10 takes those concepts to the next level, and through training, allows the pet to have agency in their own care. By indicating to the handler when they are ready to start and stop a procedure, such as an exam or blood draw, the pet has the greatest sense of choice and control, producing a calmer patient and safer handling. • Additionally, I urge you to use minimal restraint when possible,7 and take the “scruff-free” pledge as outlined by International Cat Care.11 Not only does scruffing a cat take away control, but research has shown that cats placed into full-body restraint were 8.2 times more likely to struggle than cats that were minimally restrained.12 Additionally, cats that were scruffed were more likely to show negative behavioral and physiological responses than passively restrained

Providing every feline patient with choice and control will significantly decrease stress during their exam. This includes coaxing them to come out of their carrier on their own.

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cats.13 While not scruffing cats can seem like a paradigm shift for some, it’s one of the most profound steps you can take towards minimizing stress for your feline patient.

In-carrier assessment provides clues on how to approach your patient. This cat is showing several signs of stress, including flattened ears, dilated pupils, and a tense muzzle.

IN-CARRIER ASSESSMENT Instead of jumping straight into the exam when you

• E ar position. Cats that are more relaxed typically have

enter the room, take a few seconds to peek at your pa-

forward-facing ears. As stress levels increase, the ears

tient in their carrier and assess their body language. It’s

start to flatten horizontally to the sides, and eventually

best to approach them from the side and avoid staring

may even be completely pinned back.

at them directly, as the latter can increase stress.7 As you become more familiar with the cat’s body language,

• S igns of extreme fear and stress. Hissing, growling,

you’ll be able to quickly judge from a distance how you

striking/swatting, urination, defecation, expressing

might want to approach them. Always evaluate the cat

anal glands, and open-mouthed breathing (when

as a whole, and as soon as you lay eyes on them, get

they’ve been breathing normally at home) are clues

into the habit of continually re-assessing their body lan-

your patient is already experiencing high levels of

guage since stress levels can change quickly during

stress even prior to handling. For cats with these body

a visit.

language signs, it’s essential to initiate a conversation with the client about what you’re seeing and their

• P osition in carrier. Is the cat towards the front of the

wants vs. needs before continuing. This is a Fear Free

carrier? This could mean the cat is approaching for

concept3 in which you explore what you’d like to get

petting, or feeling frustrated because they’re not pos-

done (wants) vs. what is truly medically necessary

itively carrier trained. Is the cat in the back of the

for that cat (needs) when deciding how to proceed

carrier? Cats feeling fear, anxiety, and stress tend to

with the cat. Much in general practice is a “want”,

stay in the back, and may even attempt to hide by

and in order to protect the emotional welfare of the

facing the back of the carrier.

cat and the safety of your staff, deferring the visit and rescheduling the patient to come back with

• G eneral posture. Fearful cats may appear frozen and

gabapentin on board is usually a much better option.

tense, with a hunched back and tail tucked tightly

For true medical needs, you may have to proceed with

against their body.

in-carrier sedation depending on the patient’s body language and history. Animals are constantly learning,

• P upil dilation. Calmer cats tend to have slit-shaped or

so continuing to handle a cat when they’re in a highly

almond-shaped pupils. When cats start to get more

stressed state will make their next vet visit much

stressed, their pupils can become dilated.

more difficult.

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THE CAT FRIENDLY EXAM Be ready to examine the cat wherever they feel most comfortable.7 You should also have a plan for what will occur during the visit, going from least stressful to most stressful procedures, which means in most cases you’ll want to perform your exam first. Ask your technician to avoid obtaining a weight or TPR before the exam, as these will often increase stress, particularly in a fearful cat whose “safe place” is the carrier. In addition, use the fewest number of

PEARLS FOR FELINE FRIENDLY EXAMINATIONS 1 2

Think through the cat’s visit from beginning to end. Address as many pre-visit stressors as possible to keep the cat calm before the exam.

and always monitor your patient as changes can occur quickly. Use pre-visit medications and sedation routinely, not

Avoid scruffing when handling.

Examine the cat wherever they feel most comfortable.

Honor choice and control during the interaction, and

as a last resort.

facilitate hiding. Be prepared to reverse course, proceed with injectable

Using the Fear Free principle of Touch Gradient,3 the second you make contact with your patient, maintain that contact to avoid a startle response, and use a gliding motion. Starting in a neutral location such as the dorsal shoulders before gliding to another area helps the cat know where you are. Continually evaluate the cat for changes in body language while you gradually increase touch intensity. Be gentle with your pressure and aim for slow movements, taking care to avoid hyperextending, hyperflexing, and moving body parts in an unnatural direction. Many cats prefer to be petted/massaged in the area of their facial glands,7 and this type of touch rather than brisk petting can help decrease stress and arousal during the exam.

sedation, or defer portions of the exam for a follow up with pre-visit medications. Watch this recommended AAFP webinar: “Cat Friendly Interactions: Improving Visits for You and Cats” by Dr. Ilona Rodan.14

Cats that are minimally restrained for their exam will struggle less, leading to a more thorough exam and lower stress levels for everyone involved.

You can encourage your feline patient to emerge from their carrier by extending a soft hand as an invitation, placing a treat trail in front of the carrier, and engaging the client to help coax them out. Avoid eye contact and leaning over the cat. Asking the cat to come out on their own gives them choice and control. If they do come out, you can start your exam, but avoid the “nose-to-tail” approach many of us learned in vet school. Instead, similar to the visit plan, proceed in order of least stressful to most stressful areas of the body. Handling the face/head (especially the mouth and ears), abdomen, feet, and perianal/genital region are usually the most aversive to cats, so try to save these, as well as any potentially painful areas, until the end of the exam.

Know the body language of fear, anxiety, and stress,

people possible. When employing cat friendly principles and minimal restraint, only the doctor is often needed for the exam itself. As much as clients want to be involved with restraint, this should be discouraged for the sake of safety and liability. Instead, ask them to soothe their cat by talking to them or feeding them a treat, such as Churu, from a distance.

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If the cat chooses to remain in the carrier, pulling or dumping them out is highly discouraged since removal from their “safe place” will increase stress and may lead to injuries. Instead, take the top off the carrier and use a towel to loosely cover the cat to allow for hiding. Many cats will burrow deeper into the towel to hide further. For fearful cats that choose to be covered, the entire visit can then be performed in the bottom of the carrier, including the exam, sample collection, and vaccination, saving face handling until the end. Tachypnea, tail position/movement, and growling will help alert you to increasing stress levels even when the cat is mostly hidden. Remaining fluid with your approach and reversing course will often allow increasing stress levels to de-escalate. Understand that you may not be able to safely examine every aspect of a cat’s body during a visit. Sending home a pre-visit

anxiolytic such as gabapentin, administering analgesics, or progressing to injectable sedation can help facilitate a more thorough exam while caring for the cat’s emotional well-being. Unfortunately, many cats are brought to the clinic in carriers that prevent cat friendly access for exams; e.g. when the screws are rusted shut. Client education on the best type of carrier to minimize stress for their next visit is an essential part of preparing for a cat friendly exam.

SUMMARY Reducing examination fear for cats starts well before the visit itself. By considering stressor stacking, the exam room environment, and cat friendly handling principles, you’ll help bring a compassionate approach to your patient, and invest in their emotional health for the future.

Low Stress Handling University. CattleDog Publishing. Accessed October 7, 2023. https://university.lowstresshandling.com.

Cat Friendly Recognition Programs. American Association of Feline Practitioners. Accessed October 7, 2023. https://catvets.com/cfp/cat-friendly-recognition-programs.

Fear Free Veterinary Certification Program. Fear Free Pets. Accessed Oct 7, 2023. https://fearfreepets.com/fear-free-veterinary-certification-program/.

Taylor S, St Denis K, Collins S, et al. 2022 ISFM/AAFP Cat Friendly Veterinary Environment Guidelines. Journal of Feline Medicine and Surgery. 2022;24(11):1133-1163. doi:10.1177/1098612X221128763.

Getting your cat to the veterinarian. Cat Friendly Homes. Accessed October 7, 2023. https://catfriendly.com/be-a-cat-friendly-caregiver/getting-cat-veterinarian/

Top 10 Treats to Win Pet Hearts. Fear Free Pets. Accessed October 7, 2023. https://fearfreepets.com/top-10-treats/.

Rodan I, Dowgray N, Carney HC, et al. 2022 AAFP/ISFM Cat Friendly Veterinary Interaction Guidelines: Approach and Handling Techniques. Journal of Feline Medicine and Surgery. 2022;24(11):1093-1132. doi:10.1177/1098612X221128760.

Friedman, SG. How Behavior Works: Living and Learning with Animals course. Accessed October 7, 2023. https://www.behaviorworks.org/htm/lla_info_links.html.

Friedman, SG. Unlabel Me. Behavior Works. Accessed October 7, 2023. https://www.behaviorworks.org/files/downloadable_art/unlabel-me.tiff.

Dixon S, Fraser L, Edlund S. What is Cooperative Care? IAABC Foundation Journal. Accessed October 7, 2023. https://journal.iaabcfoundation.org/cooperative-care/.

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.

CANINE BEHAVIOR AND HOMEOPATHY Behavior issues are among the most common reasons dog owners seek veterinary or other expert advice. I find the vaccine factor is key to behavior problems in dogs, so I must mention it first. People often say: “We have to wait until his puppy shots are finished to start training classes.” It breaks my heart each time I hear this. Puppies have a very limited window in which they learn what’s fun and what’s scary in the world, as part of their built-in survival instinct. What they learn during this period often becomes permanent, which means scary things learned during this time are very hard to “unlearn” or forget. This window of time ranges from about three to 14 weeks of age, although this can vary slightly with breed and individual. It’s called the “critical period” because it’s critical to the puppy’s development. So critical, in fact, the American Veterinary Society of Animal Behavior says this in their statement on puppy socialization: “Behavioral problems are the greatest threat to the owner-dog bond. In fact, behavioral problems are the number one cause of relinquishment to shelters. Behavioral issues, not infectious diseases, are the number one cause of death for dogs under three years of age.”

Pledge to Go ‘Scruff-Free’. International Cat Care. Accessed October 7, 2023. https://icatcare.org/our-campaigns/pledge-to-go-scruff-free/.

Moody CM, Picketts VA, Mason GJ, et al. Can you handle it? Validating negative responses to restraint in cats. Appl Anim Behav Sci 2018; 204: 94–100. https://doi.org/10.1016/j.applanim.2018.04.012.

Socialization is a very important “immunization” against behavior problems. The pitfalls of conventional vaccines can be avoided with good constitutional treatment with homeopathy and nosodes, resulting in optimal immunity. Further, Thuja, Silicea and Lachesis are major remedies for dealing with vaccinosis-related behavior problems in young dogs (and cats).

Moody CM, Mason GJ, Dewey CE, Niel L. Getting a grip: cats respond negatively to scruffing and clips. Vet Rec. 2020;186(12):385. doi:10.1136/vr.105261.

Find a homeopathic vet at theAVH.org.

Rodan, I. Cat Friendly Interactions: Improving Visits for You and Cats. American Association of Feline Practitioners. Accessed Oct 7, 2023. https://catvets.com/education/online/webinars/cat-friendlyinteractions-improving-visits-for-you-and-cats.

Submitted by Todd Cooney, DVM, CVH

IVC Winter 2023/24

In the news

Feline communication via microbial metabolites in anal glands

Cats use their anal glands to produce unique odors that repel rivals, attract mates, and mark territory. Now, researchers have deciphered the role the microbiome plays in this form of feline communication. A recent study, employing metagenomic sequencing mass-spectrometry-base metabolomics, and culturing, identified the organisms potentially responsible for these odors. The findings revealed a diverse microbiome within the anal glands of domestic cats. The dominant bacteria identified included Corynebacterium, Bacteroides, Proteus, Lactobacillus, and Streptococcus, with significant variation among individual cats. Strikingly, microbiome profiles were found to vary with both the age and weight of the feline subjects. Metabolites such as fatty acids, ketones, aldehydes, and alcohols were detected in the glandular secretions, suggesting a relationship between bacterial activity and the resultant compounds responsible for the distinct scent associated with cats. Notably, the study demonstrated a modest correlation (r = 0.17) between the microbiome

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and metabolome profiles, hinting at a potential relationship between the bacteria in the glands and the volatile compounds produced. Through metagenomic data analysis, the researchers generated 85 high quality metagenome assembled genomes (MAGs), including four standout candidates for further investigation: Corynebacterium frankenforstense, Proteus mirabilis, Lactobacillus johnsonii, and Bacteroides fragilis. These bacteria, identified as abundant in the larger microbiome dataset, were also successfully recovered as cultured isolates. • C orynebacterium, a common inhabitant of various mammalian glands, has been implicated in cleaving odorant precursors and releasing key components of axillary odor. • P roteus mirabilis, known for attracting blowflies to animal carcasses, was found to secrete indoles, carboxylic acids, and phenols. • L actobacillus johnsonii, though not typically found in anal gland secretions,

can produce volatile compounds such as acetate and ethanol. • B acteroides fragilis, isolated from a Bengal cat’s anal gland, produced the same volatile compounds found in anal gland secretions. This study not only provides valuable insights into the world of domestic cats but also establishes the groundwork for future research into the broader field of animal communication and microbiome interactions. As the research unfolds, the roles of microbiota may continue to captivate scientists and bring forward more valuable discoveries. www.nature.com/articles/s41598-023-45997-1

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? Foxglove (Digitalis purpurea) is a common ornamental plant native to Europe. In the US, it often escapes its confinement and can be found growing “feral”. This plant is famous for its cardiac glycosides. Digitalis was a mainstay in conventical medicine, although its toxicity issues mean it’s not commonly used today. In the 1800s, Harvey Felter, MD, stated that “in proper dose, the rhythm is slowed, and the ventricles empty themselves more perfectly and by their increased force pump more blood into the vessels. The diastole being greatly prolonged, and the fore of the systole increased, there is produced a larger though less frequent pulse wave. Altogether circulation is improved.” Digitalis in homeopathic form avoids the toxicity issues and is very safe to use. Below are some of the specific characteristics that would indicate the need for Digitalis: •

All diseases where the heart is primarily involved, where the pulse is weak, irregular, intermittent, abnormally slow, with dropsy of external and internal parts

•

Weakness and dilation of the myocardium

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Auricular flutter and fibrillation

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Heart block, very slow pulse, other symptoms of organic heart disease such as great weakness and sinking of strength, faintness, cardiac irritability.

Also seen: •

Tearing sharp stitches in the back, aching, and cutting in nape, stiffness in nape and side of neck

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Limbs: rheumatic joints, cold hands and feet, muscular debility

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Upper: fingers go to sleep easily, numbness, heaviness, or paralytic weakness; nocturnal swelling of fingers; cold limbs.

his physical exam, he was: “in his own world, had a normal pupillary response but not aware of his surroundings, standing off by himself with his head against the barn wall, oblivious to all else.” His heart rate varied, from very slow to very rapid, his pulse was very weak and fluttery, and his tongue was purple. The presumptive diagnosis was Lyme Carditis. Digitalis was selected because of Red’s additional specific symptoms: spontaneous nighttime sweating, a distended abdomen, significant atrophy of his hip flexors, weakness, and a difficult time standing after being down. Digitalis LM 1 was prescribed, one dose daily, increased to LM 2 in January. Red had a fantastic last year of life. His mental awareness returned along with some physical strength, but his age finally caught up with him and he was humanely euthanized at 33.

RECENT EVENTS •

he VBMA joined an eco-tour event from August 3 to 6 at T the Healing Spirit Herb Farm in Avoca, NY. We experienced a total seed-to-store tour, visiting their cultivated fields, wild crafting area, drying room, and mushroom house, and learning how they process their herbs. The finale was a sweat lodge. A wonderful experience!

•

The VBMA hosted an herbal walk on Friday, October 6, prior to the AHVMA conference. The sponsored speaker was John Chen, LAc, PhD.

Submitted by Cynthia Lankenau, DVM

GUESS THIS HERB!

CASE REPORT Red, a 24-year-old appendix Quarter Horse gelding, had an undiagnosed case of Lyme disease with symptoms for over seven years. He was treated “successfully” in 2012. In August of 2020, now 32 years old, Red’s chief complaint was emotional withdrawal. On

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

IVC Winter 2023/24

HOW TO DETERMINE THE BEST APPROACH TO SEPARATIONRELATED BEHAVIORS IN DOGS BY MOIRA HECHENLEITNER, DVM, CSAT

When dealing with separation-related behaviors in dogs, the goal is to determine the underlying cause before designing an environment and training protocol that sets the dog up for success.

here has never been a time when the terms “separation-related behaviors” and separation anxiety” were as widely used as they are now. Sixteen years ago, when I was starting to learn about dog behavior, I remember reading about these issues in only a handful of books available at the time. The term “separation-related behaviors” wasn’t even on my radar, or those of any of the dog guardians. Nowadays, thanks to globalization, the internet, and highly accessible resources and education, this term is commonly used and applied to dogs by both professionals and dog guardians alike. However, since dog behavior and training is a somewhat recent field of study, large areas remain unregulated and lack an entity that unifies terminologies and labels, not only at an international scale, but also within the

same country (see sidebar on page 59). This also applies to behaviors related to dogs left home alone and/or separated from other humans and dogs. Understanding these behaviors and what causes them, before implementing an approach to deal with them, offers the best chances of a successful outcome.

WHAT ARE SEPARATION-RELATED BEHAVIORS? Separation-related behaviors are defined as those a dog displays when left home alone — behaviors that are undesirable to the dog and/or the humans. The term “home alone” is usually used in the context of a house without any humans present, and less commonly to denote dogs separated from other dogs living in the same household. These undesirable behaviors can be multiple; however, they commonly refer to vocalizing, inappropriate urinating and/ or defecating, and destroying household objects. Lesserknown examples can include pacing, panting, vomiting, hyper-salivating, and pupil dilation, among others. As we can conclude from the above, these behaviors are nonspecific, which means they can be displayed in a great variety of situations; and more importantly, due to many underlying motivations. Therefore, the term “separation

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related behaviors” is used as an umbrella to encompass behaviors with a negative connotation that could be triggered by multiple causes, including medical problems. With this in mind, we can start observing behaviors as symptoms of something deeper. An underlying cause or motivation that is triggering for a particular dog, if not addressed, will continue to promote behaviors that are undesirable to the dog and/or the humans involved. As in the medical field, the first step in successfully developing a particular treatment is to determine what is causing the undesirable outcome when the dog is left home alone.

UNDERLYING MOTIVATIONS FOR SEPARATION-RELATED BEHAVIORS Environment There are multiple ways in which the environment could be impacting a dog’s behavior: • The house might be in a busy neighborhood where the dog can see people and other dogs walking by throughout the day while home alone, which could trigger vocalizations at those times. • The dog could be left alone for too many hours every day, triggering destructive behaviors or even vocalization out of boredom. • The house could also lack spaces specifically designed for the dog to urinate and/or defecate, and when left alone for too long, the dog might not be able to wait to relieve themselves. • The size of the house or space also matters. Dogs of different energy levels, ages, and breeds might need a bigger space than the one assigned to them in order to be successful when left alone.

Individual challenges When a dog has just been adopted, we need to not only consider a normal adjustment period, but also the baggage the dog might be bringing to the table. Unfortunately, we can only explain to the dog through repetitive actions and routines that this is home, that we will always return after we leave, and that this new life is safe. Many dogs experience a stress response when left alone in a new home for the first time, which might translate into stressed body language and behaviors such as vocalizing and pacing. However, if the underlying motivation is a temporary lack of adaptation to the situation, you will see a decrease in these behaviors over time, as the dog gradually learns that the event isn’t life-threatening. A lack of training about what’s expected of them and what objects aren’t meant as toys, along with the age and genetics of the dog, might also cause undesirable behaviors, although in these cases, the behaviors might be displayed without body language that suggests distress.

THE IMPORTANCE OF DEVELOPING A UNIVERSAL LANGUAGE The first step in designing a successful modification plan for a specific behavior would be to create standardized terms and labels. By doing so, professionals will be able to speak the same language, which will increase the likelihood of success when seeking to implement an integrative approach developed by a multidisciplinary team, which is often needed in this line of work. Unifying the meaning of these concepts will allow us to give specific characteristics to each label, which can

In these cases, the behaviors likely won’t last for the whole duration of the humans’ absence, nor will they be associated with a body language that suggests panic or fear. Although a stress response might exist in some of those situations, the common denominator will be the capacity of the dog to eventually cope with the situation that elicited discomfort, and to successfully self-regulate, getting back to their normal behavior baseline after the stimuli has been removed from the environment.

include differences in body language, environment, individual learning experiences and challenges, but most importantly, underlying motivations or causes for a particular behavior in the first place. In this context, we can appreciate how one of the current, most widely used terms — “separation-related behaviors” — is one of the most misunderstood and mislabeled, which can easily translate into mistakes when choosing the best approach for helping a dog.

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Medical When the onset of a behavior is sudden, the root can often be medical. Ruling out both medical and environmental causes when observing separation-related behaviors is always a priority. To achieve this, a thorough anamnesis and alone time assessment (online or by videos) are needed. Among the medical issues that could cause these behaviors are: • Pain • Conditions that cause discomfort and could lower the threshold for tolerance to certain situations and environments • C onditions that alter the dog’s perception of the environment • Urinary and/or digestive issues that could promote signs such as vomiting, urinating and/or defecating in undesirable areas. The dog’s body language might vary depending on the medical condition and how they are feeling, which creates the need for thorough examination prior to concluding that the signs have a behavioral root.

Other behavior conditions Several additional behavior challenges can elicit a stress response, both when humans are and are not in sight. Some of these challenges have a high correlation with separation anxiety, and will require an integrative approach if that’s the case. However, they can also exist separately, and will have to be ruled out before setting up a training and management plan.

Among these challenges are noise sensitivity to storms, trucks, construction, fireworks, or fire alarms, to name just a few, as well as reactivity to certain outside stimuli like other dogs, cats, and strangers. In these cases, dogs will show a stress response, and sometimes even body language that suggests fear and anxiety, which is a response to the specific aversive stimuli. If the dog happens to be alone when exposed to these stimuli, it might look as if they are responding to being left on their own. However, if the dog is fine when left alone but not exposed to these stimuli, we can think of the underlying cause as being only these other behavior challenges. Confinement issues, which are connected to the environment where the dog is left alone, means the dog finds being confined to a small area, crate, or room to be aversive, eliciting a stress response that doesn’t necessarily improve with subsequent exposures. Although this can be experienced in conjunction with a fear of being left alone, it can also happen on its own, which will translate into a dog able to stay relaxed while alone as long as they have free range to roam the house, or at least a large part of it.

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Separation anxiety

The strategy behind separation anxiety training

Hopefully by now, it is clear that the term “separation-related behaviors” isn’t the same as “separation anxiety”, but rather encompasses it. A dog with separation anxiety suffers from a stress response when left alone, which doesn’t improve with subsequent exposures. Instead, it escalates over time, triggering more fear and anxiety when exposed to the event. Separation anxiety is a condition in which the dog is unable to determine that the situation isn’t a threat anymore, thereby causing them to display a fight or flight response that doesn’t subside until the exposure ends. The corresponding body language shows that dog is in discomfort and unable to cope with the stimulus.

For separation anxiety, management will involve suspending real absences while the training protocol is implemented. This means the dog won’t be left home alone without humans, unless a training session is being performed. Training will include daily desensitization sessions in which the humans leave and stay outside for progressively longer durations. These sessions are designed strategically and performed in a supervised, controlled manner to keep the dog safe and under threshold, so over time, they are able to develop tolerance to absences, and self-regulating mechanisms to cope with the situation.

IMPLEMENTING A SUCCESSFUL BEHAVIOR MODIFICATION PLAN For most cases, the training plan will include two main aspects: management and training. The reason why we spend so much time analyzing definitions and terminologies is because both the management and training plan portions will vary and depend solely on the root of the behavior. Once you address the underlying motivation feeding the behavior, the signs or “symptoms”, such as vocalizing, destroying, and eliminating, will naturally decrease and/or disappear.

Ultimately, when dealing with separation-related behaviors, the goal is to determine the underlying cause and correspondingly design an environment and training protocol that sets the dog up for success, allowing them to feel safe and stay below threshold. Complying with these conditions will increase the likelihood of learning to occur, and over time, as the primary cause is addressed, the undesirable behaviors will subside.

How the approach matches the cause For example, if the underlying motivation for barking when alone is living in a busy neighborhood, management at times when training isn’t possible might include closing blinds, blocking access to certain windows, or adding noise blocking sounds such as white noise, TV or music. Training might look like short, supervised sessions when the dog is exposed to the triggering stimuli at an intensity (visual, audial) that is still somewhat easy to handle, while pairing it with something the dog really enjoys (food, toys) to eventually create a positive association to the exposure. The goal is to always keep the dog below threshold (below the intensity at which the stimulus becomes aversive and/or triggers an overt behavior response) so learning is more likely to happen, and a good association with the situation is eventually possible. If the dog suffers from confinement issues but not separation anxiety, leaving them alone with full range of the house might be enough to solve the issue. If the root is medical, addressing the cause first will provide a better understanding of what we are dealing with, and if addressing the behaviors in themselves is really needed after the medical issue has been resolved. IVC Winter 2023/24

In the news

MYSTERIOUS CANINE ILLNESS SPARKS CONCERN A puzzling canine illness has been spreading across multiple states in the US, leaving veterinarians and pet owners worried. Characterized by a persistent cough, lethargy, and fever, the disease lasts for an extended period of four to six weeks. The American Veterinary Medical Association (AVMA) is urging veterinarians to report any cases they encounter in order to gather more information about the ailment. The exact number of cases remains unknown due to variations in reporting requirements for veterinarians. However, the Oregon Department of Agriculture alone has received over 200 case reports since August, indicating that the illness is not an isolated incident. Termed Atypical Canine Infectious Respiratory Disease Complex, it encompasses various clinical syndromes, including tracheobronchitis, chronic pneumonia, and acute pneumonia.

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Experts are grappling with the underlying cause of this ailment. It could potentially be bacterial, viral, or even a variant of the commonly known kennel cough. The lack of a definitive answer adds to the complexity of diagnosing and treating affected dogs. The AVMA stresses the importance of vigilantly monitoring a dog’s health and urges pet owners to consult their veterinarians if any concerning symptoms arise. Signs that warrant immediate veterinary attention include a persistent cough, weakness, loss of appetite, difficulty breathing, and a worsening of the illness. Some experts suggest the illness may be due to a previously undiagnosed, longstanding cause rather than a newly emerged and highly transmissible pathogen. Disease patterns observed so far do not align with the emergence of a new infectious agent. This implies that

the illness may have been present but undetected for some time. Further research and diagnostic investigations are needed to decode the exact nature and origin of the disease. While the risk of humans contracting this Atypical CIRDC from dogs is considered extremely low, it is still advisable to practice good hygiene. Thoroughly washing hands after handling dogs can help minimize any potential transmission of pathogens. www.avma.org/news/making-sensemystery-illness-found-across-us