V2I1 (Winter 2011-12) by Redstone Media Group

Integrative Peer Reviewed

veterinary care

expanding your service

introducing integrative treatment options to your practice Page 40

Integrative education This program at LSU’s School of Veterinary Medicine is making them a leader in integrative medicine education.

winter ISSUE 2012

www.IVCJournal.com

Animal depression A behavioral perspective on the condition and how it may be treated without drugs.

Cold laser therapy It’s safe and non-invasive, and can replace medication, most physiotherapeutic modalities, and even surgical approaches.

Feline diabetes A look at diagnostics as well as managing early DM with diet, medication and herbs.

Tech talk Focus on massage: This therapy has numerous applications and is a valuable addition to the integrative practice.

What’ s New · Students head to VetCamp · Heartworm alert · Study on equine aging integrative veterinary care

Integrative veterinary care

Give your clients the Gift of Animal Wellness

winter 2012 Editorial Department Editor-in-Chief: Dana Cox Managing Editor: Ann Brightman Senior Graphic Designer: James Goodliff Graphic Designer: Dawn Cumby-Dallin Cover Photography: Dr. Erin Mayo, DVM, CVA

Advertising Sales National Sales Manager: Ann Beacom (866) 764-1212 ext. 222 annbeacom@redstonemediagroup.com Western Regional Manager: Becky Starr (866) 764-1212 ext. 221 becky@redstonemediagroup.com

Columnists & Contributing Writers Ella Bittel, DVM Margaret Coffey, DVM, MBA Daniel Estep, PhD, CAAB Frank Gravlee, DVM, MS, CNS Joyce Harman, DVM, MRCVS Suzanne Hetts, PhD, CAAB Julie Mayer, DVM, CVA, CVC, CCRP Erin Mayo, DVM, CVA Bill Ormston, DVM Michelle J. Rivera, MT, VDT Lea Stogdale, DVM, Diplomate ACVIM Small Animals

Equine National Sales Manager: John M. Allan (866) 764-1212 ext. 405 john@redstonemediagroup.com

ISSUE 2011

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PREMIERE

NDSg TRE RKE10T tips for buildin . MA with clients Team Effort: a strong

relationship

S NEW g TRITION NU 101: Makin on pet lists Food Labels ingredient sense of ging. food packa

K Find out H TAL TEC To Reiki: support the it to Introduction can use how you you care for. animals

NEW Sarians AT’ notice a WH to economic Equine veterin

ts due ed on the drop in patien being impos challenges industry. horse racing

SEfew SEN HORSE Packing a “hard Nutrition:

eight Equine think. care an underw veterinary pounds on easier than you may integrative keeper” is

MBER 2011

arian winning veterintive approach. for the integra

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IVC Journal (ISSN 1710-1190) is published four times a year by Redstone Media Group Inc. Publications Mail Agreement #40884047. Entire contents copyright© 2012. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: February 2012.

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

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IMPROVP 10 Is your EMENTS dog the ben reaping efits?

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Animal Wellness Magazine is now available for you to give to your clients while they wait in your clinic. Keep the guardians of your precious patients informed and educated regarding integrative health ... they will appreciate that you took the time to care. ANIMAL

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azine.com

over-groomin g?

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integrative veterinary care

Integrative veterinary care

Give your clients the Gift of Animal Wellness

Equine National Sales Manager: John M. Allan (866) 764-1212 ext. 405 john@redstonemediagroup.com

ISSUE 2011

m ournal.co www.IVCJ

PREMIERE

NDSg TRE RKE10T tips for buildin . MA with clients Team Effort: a strong

relationship

S NEW g TRITION NU 101: Makin on pet lists Food Labels ingredient sense of ging. food packa

K Find out H TAL TEC To Reiki: support the it to Introduction can use how you you care for. animals

NEW Sarians AT’ notice a WH to economic Equine veterin

ts due ed on the drop in patien being impos challenges industry. horse racing

SEfew SEN HORSE Packing a “hard Nutrition:

eight Equine think. care an underw veterinary pounds on easier than you may integrative keeper” is

MBER 2011

arian winning veterintive approach. for the integra

For a limited time only, IVC Journal is available by subscription for FREE. 1

To order your subscription please visit www.ivcjournal.com

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

life!

IMPROVP 10 Is your EMENTS dog the ben reaping efits?

YO UR NO T KN VET OW

De-stressin bath-ph g obic dog s

Weddings

TO TH

GO E DOGS

Couples pooches tying the knot in the ceremoninclude thei r ies

NSITIVIT

and wha t to do

YEA ST

about them

IES

INF EC

TIO NS ... Y IK ES !

Herbal & dieta ry reme dies can

13 ISSUE 4

FILE Meet an awardPRO Marsden: with a passion Dr. Steve

NI X TH E IT CH WI TH NA ET

5 FA CT S

MIG HT

FOOD SE

VOLUME

Subscribe to IVC Journal Today!

Y CARE VETERINAR

Price includes shipping,ion Customized labels for your clinic. Published bi-monthly ses it?

For a long , healthy

UE AllerISS gies:

feline WELLNE

help

AUGU Display ST/SEPTEM BER until Sept. 20, 2011 $5.95

LITTERS

USA/C

anada

VOLU

ME 13 ISSU E

TALK

camping 4

EAR

AnimalWe

MITES!

llnessMag

e Integrativ

Y ERAPe10 SERtheTH LAat’s buzz? Pag

CANINE What cau

AnimalWEL LNESS

SPECIAL

MAGAZINE

IVCJournal.com

Order a box of 50 AW magazines for only $49/issue Aggress

WELLNESS

AUGUST/SEPTE

CDN Mail: IVC Journal, 202-160 Charlotte St. Peterborough, ON, Canada K9J 2T8.

ANIMAL

WELLNESS

US Mail: IVC Journal, 6834 S University Blvd PMB 155 Centennial, CO 80122

Administration & Sales Publisher: Redstone Media Group President/C.E.O.: Tim Hockley Office Manager: Lesia Wright Circulation: Libby Sinden

Classified Advertising: Lesia Wright classified@IVCJournal.com

azine.com

over-groomin g?

BONUS FELINE NOW INS SECT IDE! ION

The Natural Pet Health magazine!

Order Today! Phone

866 764 1212 Or Email libby@redstonemediagroup.com Invoice

www.redstonemediagroup.com

integrative veterinary care

contents

advisory board

FEATURES

Columns & departments

Feline diabetes mellitus – part 1

It’s a disease we see all too often in cat patients. Here’s a look at diagnostics as well as managing early DM with diet, medication and herbs.

Cold laser therapy

Also known as L3T, this therapy is safe and non-invasive, and has the potential to replace medication, most physiotherapeutic modalities, and in many situations, surgical approaches.

Horse sense More than skin deep

Conventional treatments are limited when it comes to equine skin disease. A medical approach that includes complementary therapies offers considerably more options.

Rehab for a torn CCL

Whether or not surgery is needed to correct a ruptured cranial cruciate ligament, a combination of mechanical, physical and energetic rehabilitation therapies is necessary to get an injured dog back to normal again.

Leading the way

Since its inception just over a year ago, this unique program at the Louisiana State University’s School of Veterinary Medicine is making the school a leader in integrative medicine education and development.

Is your patient depressed?

The symptoms of emotional depression in animals can be vague and challenging to diagnose. Here’s a behavioral perspective on this condition and how it may be treated, without drugs.

Tech talk Veterinary massage

This increasingly popular and effective therapy has numerous applications and makes a valuable addition to the integrative practice. Be sure to choose an accredited learning program, and be aware of state laws and regulations surrounding animal massage.

Integrative practice Expanding your services

How to get clients, colleagues and staff on board when introducing integrative treatment options to your practice.

Hospice care

40 4

integrative veterinary care

Clients are requesting care for their terminally ill animals that compares to what they receive for human family members. Adding this service to your practice involves many considerations, but may be well worth the effort.

5 Advisory board 6 What’ s new? 33 Industry innovations 39 Spotlight 44 Profile Dr. W. Jean Dodds, DVM 51 Veterinary resource guide 53 Marketplace 54 Events

Dr. Richard Palmquist, DVM, graduated from Colorado State University in 1983. He is chief of integrative health services at Centinela Animal Hospital in Inglewood, California, 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 co-director of the AHVMA 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 co-owner of The Healing Oasis Veterinary Hospital, offering massage, rehabilitation, chiropractic and Chinese and Western Herbology. Michelle completed the Chinese Herbal Medicine program from the China Beijing International Acupuncture Training Center, and is certified in Chinese Medicine by the Wisconsin Institute of Chinese Herbology. Dr. Joyce Harman, DVM, MRCVS, graduated in 1984 from Virginia Maryland Regional College of Veterinary Medicine. She is certified in veterinary acupuncture and chiropractic and has completed advanced training in homeopathy and herbal medicine. Her practice in Virginia uses holistic medicine to treat horses. Her publications include The Horse’s Pain-Free Back and Saddle-Fit Book – the most complete source of information about English saddles.

Dr. Steve Marsden, DVM, ND, lectures for the IVAS, the AHVMA and the AVMA, and is co-founder of the College of Integrative Veterinary Therapies. He is a director of the National College of Natural Medicine, and authored the Manual of Natural Veterinary Medicine. Dr. Marsden is extensively trained in alternative medicine, including Chinese herbology, acupuncture and naturopathic medicine. He has a veterinary and naturopathic practice in Edmonton, Alberta. In 2010, Dr. Marsden was named Teacher of the Year by the AHVMA. Dr. Jean Dodds, DVM, received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she moved to Southern California to establish Hemopet, the first non-profit national blood bank program for animals. Dr. Dodds has been a member of many national and international committees on hematology, animal models of human disease, veterinary medicine, and laboratory animal science. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1994. Dr. Christina Chambreau, DVM, 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. Dr. Chambreau teaches classes in homeopathy for animals, and lectures on many topics. She is co-author of the Homeopathic Repertory: A Tutorial. Bill Bookout is a founding member of the NASC, serving as president and chairman of the board since 2002. He is founder and president of Genesis Ltd., a company that provides feed and health products for animals. He spent 15 years in the human medical device, drug and animal health industries. Bill received his Bachelor’s degree in physical sciences from the University of Wyoming, and an MBA from Pepperdine University. He has been selected by Health Canada to serve on the Expert Advisory Committee for Veterinary Natural Health Products.

Amiee Stubbs is a pet and wildlife photographer from Nashville, TN. She works as the assistant photographer at the Nashville Zoo, and volunteers as a photographer for several animal rescues in her area. She will graduate with a photography degree from MTSU this spring. See her extensive portfolio at amieestubbs.com.

integrative veterinary care

contents

advisory board

FEATURES

Columns & departments

Feline diabetes mellitus – part 1

It’s a disease we see all too often in cat patients. Here’s a look at diagnostics as well as managing early DM with diet, medication and herbs.

Cold laser therapy

Also known as L3T, this therapy is safe and non-invasive, and has the potential to replace medication, most physiotherapeutic modalities, and in many situations, surgical approaches.

Horse sense More than skin deep

Conventional treatments are limited when it comes to equine skin disease. A medical approach that includes complementary therapies offers considerably more options.

Rehab for a torn CCL

Leading the way

Is your patient depressed?

The symptoms of emotional depression in animals can be vague and challenging to diagnose. Here’s a behavioral perspective on this condition and how it may be treated, without drugs.

Tech talk Veterinary massage

Integrative practice Expanding your services

How to get clients, colleagues and staff on board when introducing integrative treatment options to your practice.

Hospice care

40 4

integrative veterinary care

5 Advisory board 6 What’ s new? 33 Industry innovations 39 Spotlight 44 Profile Dr. W. Jean Dodds, DVM 51 Veterinary resource guide 53 Marketplace 54 Events

integrative veterinary care

whatâ&#x20AC;&#x2122; s new Pain management in small animals

Heartworm alert A growing body of anecdotal reports and experimental evidence suggests that heartworm preventives (macrocyclic lactones) may not be completely efficacious in preventing heartworm infection in dogs. Reports of resistance have resulted in confusion about how best to prevent infection in veterinary patients. The Companion Animal Parasite Council (CAPC) recognize this as an important and emerging problem. At the time of writing, reports of resistance appear to be confined to dogs from the south-central United States, where some animals have become infected while on preventives.

Dr. Karol Mathews is a member of the newly formed Global Pain Council. The World Small Animal Veterinary Association (WSAVA) has launched a Global Pain Council (GPC) to raise the standard of pain management in small animals. The Council, comprising leading veterinarians from around the world, aims to develop easily accessible practical guidelines on pain management for veterinary staff, and to create a CE program which can be rolled out around the world.

However, itâ&#x20AC;&#x2122;s clear that the vast majority of heartwormpositive dogs result from failure of compliance rather than product resistance. This means veterinarians should continue to recommend the use of heartworm preventives, where and when applicable, as the best way to prevent infections. Itâ&#x20AC;&#x2122;s also important to continue emphasizing the need for heartworm diagnostic testing at recommended intervals and appropriate times (at least annually). The CAPC will continue to monitor ongoing research and make updated recommendations on best preventive strategies as additional information becomes available. capcvet.org

The Global Pain Council has been set up in response to challenges faced by the profession in diagnosing and managing pain in small animals and because of the unavailability of various analgesic agents around the world. â&#x20AC;&#x153;Assessing and managing small animal pain is an issue of global significance,â&#x20AC;? says Dr. Karol Mathews, Professor Emerita of Emergency and Critical Care Medicine at the Ontario Veterinary College, and a member of the Global Pain Council. â&#x20AC;&#x153;Pain accompanies many of the common ailments affecting these animals but its treatment has not kept pace with its incidence, leading to what we believe to be a â&#x20AC;&#x2DC;treatment gapâ&#x20AC;&#x2122;.â&#x20AC;? This year, the Council will conduct research into existing pain assessment and management procedures. Based on this, it will produce a â&#x20AC;&#x153;Global Pain Treatiseâ&#x20AC;? in early 2013 for veterinarians around the world. The Treatise will provide a comprehensive resource on pain management and will be designed to be of daily clinical relevance. Later in 2013, pain management CE programs will be developed and rolled out globally. wsava.org

integrative veterinary care

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Pet product partnership On December 30, Sumitomo Corporation and Unicharm Corporation closed on a joint venture deal that includes an acquisition by Unicharm of a significant stake in the common share of The Hartz Mountain Corporation, a wholly owned subsidiary of Sumitomo Corporation. â&#x20AC;&#x153;This new strategic partnership brings together the brand power, deep category expertise and existing market share of Hartz with Unicharmâ&#x20AC;&#x2122;s proprietary technology and high-performing innovation,â&#x20AC;? said Mr. Koichi Isohata, a representative at Sumitomo.

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For more information about the complete line of Bravo! Raw Diets, Treats & Chews For more information about the complete line of Bravo! Raw Diets, Treats & Chews visit:www.bravorawdiet.com visit:www.bravorawdiet.com integrative veterinary care

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whatâ&#x20AC;&#x2122; s new Pain management in small animals

integrative veterinary care

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Vet camp

A recipe for trouble?

Study on equine aging Scientists have yet to unravel the mysteries of aging and the multitude of health problems that accompany it. The Morris Animal Foundation is funding a study at the University of Kentucky that is looking into why aging leads to the loss of muscle mass in horses, an important consideration particularly in performance equines. The study is focusing on how various age-related diseases affect protein metabolism at muscular and molecular levels. For example, the researchers are testing to see how both inflammation and Cushing’s disease, both common in older horses, relate to protein synthesis. The study is being led by Dr. Kristine Urschel and the results are expected to help extend the life expectancy of horses, and assist horse owners and veterinarians in supporting and caring for aging equines. morrisanimalfoundation.org

Students get hands-on experience at last year’s VetCAMP.

The UGA College of Veterinary Medicine is hosting VetCAMP 2012 from July 8 through 14. VetCAMP, or Veterinary Career Aptitude and Mentoring Program, is open to Grade 11 and 12 students interested in veterinary medicine as a potential career path. The onsite program offers students opportunities to observe and participate in various services at the UGA Veterinary Teaching Hospital, the Poultry Diagnostic and Research Center, and the college’s Veterinary Diagnostic Laboratories. Camp participants will learn about requirements for admission to

Enter nutrigenomics

A recent research study conducted by the Canadian Veterinary Medical Association (CVMA) offers a troubling snapshot of the state of animal health and wellness in Canada. For example:

the UGA College of Veterinary Medicine, research and study abroad opportunities, the college’s veterinary curriculum, and under-served specialties in the field of veterinary medicine.

• Fewer than two in 10 (18%) animal guardians feed their dogs or cats the amount recommended on pet food packages, and only 17% closely review ingredient information.

“We started VetCAMP as a way to expose young people to all the opportunities available to them in a career in veterinary medicine,” said Dr. K. Paige Carmichael, the college’s associate dean for academic affairs. “Through VetCAMP, we hope to broaden the students’ perception of veterinary medicine while increasing their interest in the sciences.” vet.uga.edu/GO/camp

• On an average weekday, animal guardians spend nearly twice as much time surfing the internet (48 minutes) and three times as much time watching TV (79 minutes) as they do playing with/exercising their animals (25 minutes). Educating clients about the importance of diet and exercise is one important way to help improve these numbers.

Nutrigenomics is an exciting new area in the field of nutrition. Basically, it looks at the relationship between diet and an individual’s genetic makeup, and how that relationship contributes to either health or disease. Hemopet recently secured its fourth patent in the field of nutrigenomics, establishing it as the gatekeeper for nutrigenomic pet food technology in North America. The organization is planning to launch nutrigenomic pet food supplements this year – the formulas are currently being tested in Europe. They’ll complement Hemopet’s NutriScan saliva food sensitivity testing, which allows animals to be diagnosed and tested for food sensitivities on an individual basis. “Not all dogs are metabolically and genetically alike and our technology provides for individualized care,” says veterinarian and Hemopet president Dr. Jean Dodds. hemopet.org

integrative veterinary care

Vet camp

A recipe for trouble?

Students get hands-on experience at last year’s VetCAMP.

Enter nutrigenomics

A recent research study conducted by the Canadian Veterinary Medical Association (CVMA) offers a troubling snapshot of the state of animal health and wellness in Canada. For example:

the UGA College of Veterinary Medicine, research and study abroad opportunities, the college’s veterinary curriculum, and under-served specialties in the field of veterinary medicine.

• Fewer than two in 10 (18%) animal guardians feed their dogs or cats the amount recommended on pet food packages, and only 17% closely review ingredient information.

integrative veterinary care

Cat thrives with pacemaker

Behavior specialist honored

An innovative new faculty position at the University of Guelph’s Ontario Veterinary College will ensure that dogs and cats receive the best nutritional care in-hospital, and that student veterinarians have the tools they need to help future clients make healthy choices for their pets.

Board Certified Veterinary Cardiologists frequently implant pacemakers in animals, most commonly dogs. But recently, specialists in the cardiology practice at the VRCC Veterinary Specialty and Emergency Hospital in Englewood, Colorado were introduced to a cat that needed a pacemaker. Mickey was diagnosed with a disease that was causing an abnormally low heart rate, according to veterinarian Dr. Karen Sanderson and her team. They found it would be too dangerous to go through Mickey’s jugular vein for implantation, so his pacemaker was implanted in his belly and attached to his heart. Mickey has been doing well since the operation. Over the past 17 years, VRCC’s Cardiology team has implanted about 100 pacemakers in dogs, but Mickey is the only cat that has received one.

Mickey’s abnormally low heart rate has been corrected with a pacemaker.

New staging system for kidney injury When evaluating early kidney injuries in people, doctors monitor blood level increases of creatinine, a waste product of muscle breakdown. Creatinine is filtered by the kidneys, and small increases are an indication of early damage to vital kidney function. For pets suffering critical illness or injury, University of Missouri researchers have found that even tiny increases of creatinine in blood could also indicate acute kidney damage. Using human blood measurement guidelines for acute kidney injuries, the researchers believe they can now help pet owners better know the severity of their animals’ illness. Along with her colleagues, Marie Kerl, associate teaching professor in the department of veterinary medicine and surgery in the MU College of Veterinary Medicine, performed a retrospective study of creatinine changes in 164 injured dogs admitted to the intensive care unit at the University of Missouri Veterinary Medical Teaching Hospital. The researchers compared the animal medical records and creatinine levels to criteria used to evaluate human acute kidney injury. They then developed a veterinary acute kidney injury staging system, which would indicate to veterinarians how increases of creatinine correspond to the animal’s risk of death. “This kidney evaluation staging system would be another way for veterinarians to share recommendations based on the probable outcomes,” says Kerl. Dr. Marie Kerl helped develop the new veterinary acute kidney injury staging system.

integrative veterinary care

Focus on clinical nutrition

Dr. Sue McDonnell has received the George Stubbs Award from AAEP. Equine behaviorists play a valuable role in horse care. Sue McDonnell, PhD, the founding head of the Equine Behavior Program at Penn Vet, was recently honored with the George Stubbs Award from the American Association of Equine Practitioners (AAEP). Named for the 18th century artist and teacher who played a vital role in veterinary education, the award recognizes contributions made to equine veterinary medicine by individuals other than veterinarians. Dr. McDonnell’s work includes clinical, research and teaching activities focused on horse behavior. In addition to laboratory and field studies, she maintains a semi-feral herd of ponies specifically for the study of equine physiology and behavior under seminatural conditions. The herd affords veterinary and animal behavior students the opportunity for long-term observation of equine social and developmental behavior, and for first-hand comparison of horse behavior under free-running and traditional domestic conditions. vet.upenn.edu/research

“The impact of nutrition on health and disease is an increasingly important area of veterinary science,” says Professor Adronie Verbrugghe, who has been named the first holder of the Royal Canin Veterinary Diet Endowed Chair in Canine and Feline Clinical Nutrition. “By paying attention to nutrition, we can delay the progression of disease and help pets live longer and improve the quality of their lives. That’s what it’s all about.” Verbrugghe trained at Ghent University in Belgium, and graduated as a veterinarian in 2005. For her PhD, she studied feline carbohydrate metabolism and links to obesity and diabetes. She is a diplomate of the European College of Veterinary and Comparative Nutrition and recently completed two years of post-doctoral research and clinical work at Ghent University. “This exciting new position will help us discover new knowledge in clinical nutrition and transfer that knowledge to veterinarians working with pets in primary health care practice,” says Elizabeth Stone, OVC dean. “In addition, Adronie will play a key role in preparing our graduating veterinarians to develop nutritional programs for their patients and to educate their clients on the importance of nutrition.”

First hospice conference The International Association for Animal Hospice and Palliative Care (IAAHPC) held its first annual conference in Fort Worth, Texas last October. The conference was designed to educate animal care professionals on hospice best practices. Animal hospice care is a growing field, and that means more people will be able to keep their companions comfortable and at home during the last weeks or months of their lives. IAAHPC is dedicated to promoting knowledge about and developing guidelines for comfort-oriented care to companion animals as they approach the end of life. IAAHPC.org

Professor Adronie Verbrugghe is filling a new faculty position at OVC, focusing on clinical nutrition. integrative veterinary care

Cat thrives with pacemaker

Behavior specialist honored

Mickey’s abnormally low heart rate has been corrected with a pacemaker.

integrative veterinary care

Focus on clinical nutrition

Professor Adronie Verbrugghe is filling a new faculty position at OVC, focusing on clinical nutrition. integrative veterinary care

and decreased activity. If the diabetes has been present for many weeks, the cat may show hind limb plantigrade stance and joint sensitivity (pain while being restrained for blood collection). Cats are predictably unpredictable, so some diabetic felines are inappetent rather than polyphagic, more active rather than less, and/or gain weight instead of losing body condition. Often, owners are unaware of increased drinking and urinating. Early cases may have only mild weight loss.

Cats are not deficient in, and are not responsive to, chromium, zinc, manganese or vanadium. All these minerals taste bad to cats and therefore decrease their food intake.

Designed specifically for geriatric pets, Cholodin® may help with the following symptoms: Disorientation, confusion • Loss of appetite • Increased sleep time

Feline diabetes mellitus – part 1

It’s a disease we see all too often in cat patients. Here’s a look at diagnostics as well as managing early DM with diet, medication and herbs. by Dr. Lea Stogdale, DVM, Diplomate ACVIM Small Animals

Diabetes mellitus (DM) in cats is similar to human Type 2 diabetes in humans. The causes in cats include: • Obesity • Inactivity • High carbohydrate food • Pancreatitis (probably exacerbated by grain in cat food) • Hyperthyroidism • Hypersomatotropism (large cats) caused by excessive pituitary growth hormone secretion. These conditions all increase blood glucose (BG) or insulin resistance. The first four predispositions can be eliminated by feeding grain-free moist cat food. Hyperthyroidism can be controlled. Hypersomatotropism is untreatable at present except at a couple of universities that ablate the pituitary

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gland using either surgery or stereoscopic radiation therapy. Pathophysiologically, diabetes mellitus in cats is a combination of chronic hyperglycemia due to the feline deficiency in glucose oxidase and excessive carbohydrate ingestion, and/ or thyroid or somatotropin hormone excess, and insulin resistance. Hyperglycemia leads to pancreatic islet beta cell toxicity and exhaustion. Rapidly bringing the BG under control often allows the pancreatic islet beta cells to recover their insulin-secreting ability with resulting normoglycemia.

Diagnosing feline DM The accurate diagnosis of diabetes mellitus and all complications is essential. Typical history and physical findings are polyphagia, polydipsia, polyuria, weight loss

Diagnosis is made on the results of urinalysis, complete blood count (CBC) and differential, serum chemistry and total thyroid (T4) level. A blood glucose above 8 mMol/L = 145 mg/dL is abnormal. If the level is under 11 mMol/L = 200 mg/dL and the cat was stressed by the blood collection, then a confirmation of hyperglycemia is required. Strong glucosuria with some ketones, or a non-stressful ear prick BG, is confirmatory. Very occasionally, we require a serum fructosamine to confirm diagnosis because we are unable to collect a non-stressed blood sample. In uncomplicated diabetes, the CBC may show a mild stress leukon or leukocytosis. The serum chemistry is generally unremarkable, with mild increases in liver enzyme levels in severe cases. Typically in cats, the alkaline phosphatase level is normal due to its short halflife and urinary excretion. The serum creatinine may show a pre-renal, mild elevation due to dehydration. In a cat losing weight, the T4 should be less than 25 nMol/L = less than 2.0 ug/dL.

Consider T4 levels When an animal is ill and losing weight, the body’s reaction is to increase stress hormones. This results in adrenal cortical hyperplasia, hyperactivity and an increase in the serum cortisol level. This suppresses thyroid function, causing sick thyroid syndrome. T4 needs to be considered within the context of the patient’s disease status. In a cat with uncontrolled diabetes, weight loss and dehydration, the T4 level should be low; the cat has sick thyroid syndrome.

•

Impaired hearing

Poor, thin, or dry coat Inappropriate urination

800-856-4648

www.mvplabs.com

Available through your Veterinary Clinic

“I recommend Cranimals Original for patients with high pH levels, post urinary tract infections, and to decrease the incidence of urinary stones. I am also a fan of the antioxidant properties and the dental benefits. Overall, this product has made many of our clients very happy and I am pleased with the results!” Dr. Gary J. Duhr, Ramapo Animal Hospital, New Jersey, USA.

detoxification

antioxidant urinary tract

skin, eye & brain joint + mobility

calming

Visit www.cranimal.com to view our complete line of pet health supplements

integrative veterinary care

Cats are not deficient in, and are not responsive to, chromium, zinc, manganese or vanadium. All these minerals taste bad to cats and therefore decrease their food intake.

Designed specifically for geriatric pets, Cholodin® may help with the following symptoms: Disorientation, confusion • Loss of appetite • Increased sleep time

Feline diabetes mellitus – part 1

integrative veterinary care

Diagnosing feline DM The accurate diagnosis of diabetes mellitus and all complications is essential. Typical history and physical findings are polyphagia, polydipsia, polyuria, weight loss

•

Impaired hearing

Poor, thin, or dry coat Inappropriate urination

800-856-4648

www.mvplabs.com

Available through your Veterinary Clinic

detoxification

antioxidant urinary tract

skin, eye & brain joint + mobility

calming

Visit www.cranimal.com to view our complete line of pet health supplements

integrative veterinary care

Clinical status of the feline patient for T4 levels

nMol/L

ug/dL

My vet lab normal T4 range

20 – 60

1.5 – 4.6

My normal T4 range in cats that are normal on Hx, PE and no weight loss

25 – 40

2.0 – 3.0

My T4 range for cats that are normal on Hx and PE but have weight loss

25 – 35

2.0 – 2.7

< 25

< 2.0

My T4 range for cats PU/PD, dec appetite and weight loss

These thyroid levels overlap so the clinician needs to exercise his/her judgment. With equivocal T4 levels, I recommend re-testing in three months when we have the cat stabilized or recovered.

Early diabetic management Due to the exhaustion and toxicity of the pancreatic islet beta cells caused by hyperglycemia, diabetes becomes a vicious cycle in the cat. Recovery depends on glycemic control, a low carbohydrate diet, weight loss and increased exercise – the sooner the better. Weight loss and increased exercise are long term projects, but we can rapidly change the diabetic cat to a low carbohydrate diet.

1. Diet Diet

A low carbohydrate, high protein diet similar to the cat’s natural diet (i.e. mice), is essential for managing sugar/ glucose levels. Approximately 80% of diabetic cats will recover when fed the correct food. This means insulin may not be required at all, or may be discontinued after a few days, weeks or months. Cats that continue to require insulin are better regulated, act normally and need a lower dose than those eating food high in carbohydrates (such as kibble/dry cat food).

Recovery depends on glycemic control, a low carbohydrate diet, weight loss and increased exercise – the sooner the better. Only canned cat food with less than 10% of metabolizable energy from carbohydrates is recommended for diabetic cats. The best food has less than 5% calories from carbohydrates. This information is not available on product labels, however, and very few websites have it – in most cases

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you must contact the manufacturer, some of whom will reply. To obtain up-to-date information, you can go to binkyspage.tripod.com/canfood.html. Even these foods do not provide reliable low carbohydrate intake. If a cat’s blood glucose levels are “all over the place”, suspect the food and change it. It is best to feed diabetic cats twice a day, but if you’re dealing with an older, fussy cat that prefers to snack or “graze” all day, the owner can leave the canned food out by adding some water and mixing it into a “cat food soup”. This will prevent the food from drying up and will provide the cat with extra fluid. Foods to absolutely avoid due to their high carbohydrate content (grains and, in some cases, sugar) include: • Any dry cat food • Dry or soft treats • Any canned food with more than 10% of calories from carbohydrate sources In addition to low carbohydrate canned cat food, I suggest that owners add some meat, especially cooked or canned fish. Wild salmon and sardines are very low in carbohydrate and rich in the active Omega 3s, EPA and DHA. Most cats love fish. No commercial cat treats are suitable except dried meat. I recommend treats be low carbohydrate canned cat food, meat or fish. The occasional cat is a dry food addict. For the cat that will not eat what the owner and I select, we try to change the food slowly. If this is unsuccessful, I will prescribe appetite stimulants for three months. I select from Rx Cyproheptidine, Rx Mirtazapine or Rx Clonazepam.

2. Herbs Herbs

Rapid glycemic control is important for the recovery of feline diabetics, so I recommend that herbs be used in addition to diet and medications. The action of most herbs is to stabilize blood glucose and stimulate insulin release. For Western, Ayurvedic and Chinese herbs, the recommendations are based on human experience; there is no research in cats. The appropriate dose is unknown, and it is often difficult to get herbs into cats because they taste bad.

• Fenugreek (Trigonella foenum-graecum) • Bilberry (Vaccinium myrtillus) • Aloe (Aloe vera) • Rehmannia (Rehmannia glutinosa) • Turmeric (Curcuma longa) (References: Veterinary Herbal Medicine by Susan G. Wynn and Barbara J. Fougère and Manual of Veterinary Herbal Medicine by Susan G. Wynn and Steve Marsden.)

3. Rx Glyburide Rx Glyburide

The same caution applies to the oral hypoglycemic medication Rx Glyburide. It increases insulin release and sensitivity, but may not be sufficiently effective at bringing the BG into the normal range to allow the islet cells to recover. Glyburide pills can usually be hidden in the cat’s canned food. It is a sulfonylurea that is safe in cats and has no side effects. The tablets are 5 mg. I start at ½ tablet twice a day, and may go up to one tablet twice a day. I only use Rx Glyburide if: • The cat is in good condition • The cat is eating well • There are no ketones in the urine • The hyperglycemia is moderate, < 20 mMol/L or < 360 mg/dL • I judge that the diabetes is early or mild • The owner is reluctant to inject insulin into the cat • The owner has financial limits and will not pay for insulin and home BG monitoring Part 2 of this article (next issue) will cover insulin stabilization with home monitoring; and long-term management and complications.

Dr. Lea Stogdale, DVM, Diplomate ACVIM, graduated from the Faculty of Veterinary Science, University of Melbourne, Australia in 1970. She worked in general practice in Australia and England before teaching veterinary medicine in South Africa and Saskatoon for eight years. Dr. Stogdale passed the veterinary small animal internal medicine specialty

The most commonly recommended herbal options are: • Ginseng (Panax ginseng) • Gymnema (Gymnema sylvestre)

1981 to become a Diplomate in the American College of Veterinary Internal Medicine. She has worked in emergency and pet practice for 25 years, taking a special interest in diabetes of dogs and cats, complementary medicine and nutrition (aesopsvetcare.wordpress.com). board exams in

Feeding cats for health and diabetes prevention Integrative medicine is most effectively practiced as preventive medicine. In cats, this includes nutrition. In my experience and opinion, the worst thing we can do to damage the health of cats is to feed them dry kibble. Cats are not small dogs. They are carnivores whose ideal diet is four mice a day – approximately 75% water, 15% to 20% protein, a little fat and soluble fiber, 4% carbohydrate (the glycogen within the cells), vitamins and minerals. The mice are consumed raw with digestive enzymes and intestinal bacteria intact, and eaten during the mornings and evenings. Dry cat food is dehydrated, high in carbohydrates, contains insoluble fiber, is cooked at high temperatures, and is usually fed continually. Why do owners feed such an inappropriate diet to their feline pets? Because it’s convenient. Four fat mice a day may be the ideal diet for cats, but owners are not about to go this route. The next best cat food is a home prepared raw or cooked diet – also inconvenient for most busy owners and finicky cats. Manufactured raw is a time-saving alternative, provided it’s properly balanced. Next best is grain-free canned cat food with some meat offered daily. Most cats will eat some raw or cooked beef, pork, chicken or turkey, or canned or cooked tuna or salmon. Some adult cats are such dry food addicts that they become intolerable if they are not fed some kibble. For these cats, I suggest a maximum of ¼ cup good quality grain-free kibble fed at bedtime. Domestic house cats are descendants

of the African wildcat. As such they are desert animals and generally dislike drinking. I recommend water be mixed into their moist cat food. The quantity of water depends on the cat; everything always depends on the cat. I suggest that owners gradually increase the amount of water they mix into the food, aiming at a 1:1 ratio of moist cat food to water. The goal is that the owners never see their cat actually drinking water, the litter boxes are heavy with urine, and the cat’s urine specific gravity is between 1.020 and 1.030. In my experience, dry cat food containing grain predisposes cats to many health problems – diseases that can be prevented and often solved merely by getting the cats off this food. These problems include: • Obesity • Allergic reactions – dermatitis, especially around the neck • Alopecia, including lick granulomas • Eosinophilic granulomas • Gingivitis and dental tartar • Gastritis with vomiting; inflammatory bowel disease • Pancreatitis or triaditis • Chronic diarrhea • Diabetes mellitus • FLUTD, bladder crystals (due to chronic dehydration) • Constipation (due to chronic dehydration and insoluble fiber). I am suspicious about chronic dehydration contributing to chronic kidney disease due to the very high urine specific gravity (SG) in kibblefed cats. These cats often have urine SG >1.080. If nothing else, this results in enhanced levels of toxins and acid in the renal tubules. integrative veterinary care

Clinical status of the feline patient for T4 levels

nMol/L

ug/dL

My vet lab normal T4 range

20 – 60

1.5 – 4.6

My normal T4 range in cats that are normal on Hx, PE and no weight loss

25 – 40

2.0 – 3.0

My T4 range for cats that are normal on Hx and PE but have weight loss

25 – 35

2.0 – 2.7

< 25

< 2.0

My T4 range for cats PU/PD, dec appetite and weight loss

These thyroid levels overlap so the clinician needs to exercise his/her judgment. With equivocal T4 levels, I recommend re-testing in three months when we have the cat stabilized or recovered.

1. Diet Diet

integrative veterinary care

2. Herbs Herbs

3. Rx Glyburide Rx Glyburide

The most commonly recommended herbal options are: • Ginseng (Panax ginseng) • Gymnema (Gymnema sylvestre)

collagen synthesis in fibroblasts, increased action potential of nerve cells, stimulation of the formation of DNA and RNA in the cell nucleus, local effects on the immune system, increased formation of capillaries by the release of growth factors, increased activity of leukocytes, transformation of fibroblasts to myofibroblasts, and a great number of other measured effects.”

Cold laser therapy

Photo courtesy of Ruckersville Animal Hospital & Veterinary Laser Therapy Center

Three parameters of laser therapy

Also known as L3T, this therapy is safe and non-invasive, and has the potential to replace medication, most physiotherapeutic modalities, and in many situations, surgical approaches. by Bill Ormston, DVM

ow level light therapy (L3T), or cold laser therapy, is becoming an important component of many integrative veterinary practices, and is most often used for pain control and tissue healing. A laser produces electromagnetic radiation in the visible and near infrared light band (400 to 10,000 nanometers). Cutting lasers are usually over 1,500 nm, while therapeutic lasers will be under 1,500 nm.

All living cells emit units of light (biophoton emission) at the point of excitement (when the mitotic split occurs). Biophoton emission can be an important source of information about an organism’s status. When muscles or nerves are activated, the intensity of biophoton emission increases. Characteristics of biophoton emission indicate the health of the cells and whether they are multiplying or dying.1 It is possible to discriminate between cancer cells and normal cells by measuring the spontaneous low level luminescence. Electromagnetic radiation reacts two ways; partially as a wave

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movement with all the typical properties of waves (wavelength, etc.) and partially as a flow formed of particles with their properties of mass, quantified energy, etc.2 Ancient Qigong texts speak of absorbing light energy from the sun, moon and stars and of the body radiating varying degrees and qualities of light depending on the individual’s state of health and consciousness.1 L3T is based on the quantum physics premise that each living cell or matrix has an inherent vibration, or coherent radiation. “Treatment with laser therapy is not based on heat development but on photochemical and photobiological effects in cells and tissues,” say Tuner and Hode.3 “Therapeutic lasers cannot penetrate the tissue more than a fraction of a millimeter, so there is no other primary responding tissue other than the outer part of the dermis.” Still, such irradiation has “secondary systemic effects.” Therefore, the light “leads in turn to a number of secondary effects (secondary responses), which have been studied and measured in various contexts: increased cell metabolism and

Power is probably the most talked about parameter in lasers. Its impact determines the treatment time needed to deliver an adequate dosage to the target. Lasers, like ultrasound, stimulate at lower levels. At higher levels, they become destructive.4 Most cutting lasers are over 100 W and only penetrate 1 cm at a time. Robert Becker, MD, noted in his 1985 book, The Body Electric, Electromagnetism and the Foundation of Life,5 that plants could regenerate severed branches at three times the normal rate by applying two to three microamperes for five days. A microampere is one-millionth of an ampere. “Larger amounts of electricity killed the cells and had no growth-enhancing effect,” says Dr. Becker. In his experiments with cellular regeneration, he noted: “The best window [of current] was somewhere between 200 and 700 picoamps. This was an infinitesimal tickle of electricity, far less than anything a human could feel even on the most sensitive tissue, such as the tongue, but it was enough to goose the cell into unlocking all its genes for potential use.”

LED therapy lacks the mono-chromaticity and coherence qualities of a laser but is much cheaper to purchase and operate. With normal wounds, LED gives 3% acceleration in healing, compared to 30% for laser.12 Possibly the most important article to be aware of regarding the effects of the energy output of lasers was published in the January 2006 issue of the authoritative journal Lasers in Surgery and Medicine.6 This article noted that a lower dose of laser irradiation “has a stimulatory influence on wounded fibroblasts with an increase in cell proliferation and cell viability without adversely increasing the amount of cellular and molecular damage. Higher doses were characterized by a decrease in cell viability and cell proliferation with a significant amount of damage to the cell membrane and DNA.” These authors further noted that by spreading the light out over 3.3 cm, “the light is divergent and is not as harmful as a narrow parallel beam that allows the entire volume of intense laser light to be focused or concentrated on one small area.” The laser discussed in this study used only 3 MW of power. The FDA approves class 3a, 3b and 4 lasers based on the amount of radiation exposure. Class 4 lasers usually create heat.

Dosage measures the total amount of energy delivered per unit of area and is expressed in J/cm2. Tuner and Hode recommend 1 to 10 J/ cm2 for the treatment of superficial or deep pain conditions; 16 J/cm2 integrative veterinary care

Cold laser therapy

Photo courtesy of Ruckersville Animal Hospital & Veterinary Laser Therapy Center

Three parameters of laser therapy

integrative veterinary care

CASE STUDY

has been reported to cause irreversible cellular and genetic damage.6 The energy delivered equals the power of the machine multiplied by the length of treatment. Take the energy delivered and divide it into the area being treated to arrive at the energy density.7 1 W delivers 1 joule in 1 second 1 MW delivers 1 joule in 1,000 seconds (16 minutes) 100 MW delivers 1 joule in 10 seconds In a study at the Biological and Medical Research Department in Riyadh, Saudi Arabia, Farouk Al-Watban utilized surgically induced wounds in rats to conclude that 10 J/cm2 achieves the highest stimulated rate of healing, and that increasing the dose will result in an inhibited healing rate.8 There seems to be significant evidence to show that biostimulation effects are governed by the Arndt Shultz law of biology. Weak stimuli excite physiological activity while strong stimuli retard it.

Mike Keck, president of Hyper Flight, first started using a 5 MW, 635 nm cold laser several years ago on an older border collie with chronic shoulder pain. He now uses the same cold laser therapy regularly on many types of injury. At the 2011 U-FLI Flyball Championships, his team used the cold laser on all their competition dogs. They started the night before racing to relax the dogs after a long travel day, then again after the first day of racing to again relax the dogs and help the recovery process before the second day of the tournament. The cold laser was also used between races for one dog with a sore neck (dogs typically race four to six times a day).

Wavelength is another key parameter. Laser is pure light and has only one wavelength.9 Other light is very disorganized. Just as pure sound can cause glass to self-oscillate and break, pure light can enable cells to self-resonate.

L3T has no recorded side effects in over 1,700 publications. Its application to tissue is totally safe, non-invasive and non-toxic, and should (could) replace medication, most physiotherapeutic modalities, and in many situations, surgical approaches.11

Photo courtesy of Ruckersville Animal Hospital & Veterinary Laser Therapy Center

Wavelength determines how deep laser energy penetrates into tissue.6 The energy of photons is inversely related to wavelength. Physics formulas can be used to show how particles react, and demonstrate that the bigger the wavelength of a photon, the smaller its energy.10 “Any wavelength will have a biological effect,” notes Turner. Karu adds: “The 632.8 nm and the 820 nm are the most common wavelengths used in therapeutic light sources.” Turner and Baxter both note: “Shorter wavelengths have higher energy.”

The dogs raced very well on the second day of the tournament, going undefeated. Mike is a firm believer that cold laser therapy is one of the reasons dogs recover well after these very intense days of racing.

Resources ¹ Cohen, Kenneth S. The Way of Qigong – The Art and Science of Chinese Energy Healing, Ballantine Books, New York,1997. ² Pekka, L, The Physics of Laser – Low Level Laser Therapy as a Medical Treatment Modality. ³ Tuner, Jan and Hode, Lars. Laser Therapy Clinical Practice and Scientific Background, Prima Books, 2002. “Understand the Tech Before Buying a Laser”, DCPI Staff, Dynamic Chiropractic.

Karu, Tina. “Low-Power Laser Therapy”, Chapter 48 in Biomedical Photonics Handbook, Tuan Vo-Dinh, CRS Press, 2003.

Harrington, Phil, DC. “Physics for Chiropractors, Part 3. Can Laser Therapy Damage Tissue?” Dynamic Chiropractic, January 1, 2010, Vol. 28 Issue 01.

Harrington, Phil, DC, “Physics for Chiropractors. Calculating the Energy Density of a Therapy Laser,” Dynamic Chiropractic, January 1, 2009, Vol. 27, Issue 01.

Al-Watban, MSc, PhD, FASLMS and Delgado, Glenda D. “Erchonia Laser on Healing Scapel Wound on Rats”, Laser Medical Section, Biological and Medical Research Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.

Kauffman, Rick, DC, CCEP, CAC.“Veterinary Cold Laser Therapy. The animal’s path to wellness and anti-aging”, Cold Laser Seminar, Denver, CO, August, 2009.

Dr. Bill Ormston graduated from Iowa State University College of Veterinary Medicine in 1988. After attending Options For Animals in 1998 he received certification from the AVCA and began using chiropractic to treat his animal patients. Jubilee Animal Health is a mobile mixed animal practice in the Dallas Metroplex area where he cares for pets and horses using mostly alternative methods. He is one of the founding instructors of the post graduate course

Parker Chiropractic College in Dallas. Dr.O has lectured Animal Chiropractic and biomechanics and gait analysis in the quadruped. He has written booklets on chiropractic care in the dog and horse and a book about blending traditional and alternative care in pets. in

Animal Chiropractic

Kahn, Fred MD, FRCS(c) and Fitz-Ritson, Don. “Lasers Heal. Chiropractors Could Benefit from this Technology”, Dynamic Chiropractic, November 18, 1996, Vol. 14, Issue 24.

both nationally and internationally on

Pointinen, Pekka J., MD,PhD. Low Level Laser Therapy as a Medical Treatment Modality, Art Urpo Ltd, Tampere, 1992, page 17.

integrative veterinary care

Bryant, Rebecca. “Low-level laser outshines other modalities”, Cosmetic Surgery Times Special Report, July1, 2004.

integrative veterinary care

CASE STUDY

Photo courtesy of Ruckersville Animal Hospital & Veterinary Laser Therapy Center

Karu, Tina. “Low-Power Laser Therapy”, Chapter 48 in Biomedical Photonics Handbook, Tuan Vo-Dinh, CRS Press, 2003.

Harrington, Phil, DC. “Physics for Chiropractors, Part 3. Can Laser Therapy Damage Tissue?” Dynamic Chiropractic, January 1, 2010, Vol. 28 Issue 01.

Harrington, Phil, DC, “Physics for Chiropractors. Calculating the Energy Density of a Therapy Laser,” Dynamic Chiropractic, January 1, 2009, Vol. 27, Issue 01.

Kauffman, Rick, DC, CCEP, CAC.“Veterinary Cold Laser Therapy. The animal’s path to wellness and anti-aging”, Cold Laser Seminar, Denver, CO, August, 2009.

Animal Chiropractic

Kahn, Fred MD, FRCS(c) and Fitz-Ritson, Don. “Lasers Heal. Chiropractors Could Benefit from this Technology”, Dynamic Chiropractic, November 18, 1996, Vol. 14, Issue 24.

both nationally and internationally on

Pointinen, Pekka J., MD,PhD. Low Level Laser Therapy as a Medical Treatment Modality, Art Urpo Ltd, Tampere, 1992, page 17.

integrative veterinary care

Bryant, Rebecca. “Low-level laser outshines other modalities”, Cosmetic Surgery Times Special Report, July1, 2004.

integrative veterinary care

horse sense

More than skin deep Conventional treatments are limited when it comes to equine skin disease. A medical approach that includes complementary therapies offers considerably more options. by Joyce Harman, DVM, MRCVS

quine skin diseases are a significant problem in many parts of the country, especially those with warm and humid summers. Horses in northern climates get a break from some of these diseases during colder weather, but in the southern United States, many continue to be an issue through the winter. Treatment can be frustrating from a conventional perspective because the drug selection is limited. If the commonly used medications fail, there are not many other choices to turn to. Conversely, complementary medicine offers the practitioner many choices, and if one modality fails to help the horse, there are usually many other options. Even then, some cases can be very refractory to treatment.

Allergic skin reactions The most common skin cases that present to the veterinarian are allergic, pruritic horses in the summertime. Allergic reactions can be mild to severe, ranging from itching to raw, bloody eruptions.

The author examines an equine patient.

integrative veterinary care

Many factors can be involved, including pollens, foods, Culicoides mites, topical reactions to weeds, reactions to shampoos and detergents in saddle pads, dust, molds and more. A good history, with information about the onset of symptoms, can help determine the basic class of allergen involved (e.g. tree pollens in the early spring, ragweed in late summer). Allergy testing can be done, using skin tests for inhalant allergens and blood tests for both inhalant and food allergens. With food allergens, it may be hard to determine the cause without some form of allergy test.

Conventional treatment is generally done with corticosteroids and sometimes antihistamines. If the skin has significant eruptions, antibiotics may be used to prevent secondary infections. Steroids do have some considerable risk and are not suitable for long-term use, year after year. They can cause or worsen gastric ulcers, and suppress the immune response so the horse is more susceptible to bacterial or viral infections. Many other side effects can occur. The most severe complication with the use of steroids is in horses with Insulin Resistance or Cushing’s. Though laminitis is not often seen in research settings, it’s seen in clinical practice after steroid treatment. I have observed a number of cases where even a small dose (as from a joint injection) caused lifethreatening laminitis. Complementary treatment offers many possible solutions to allergic skin disease. Simple cases may respond quickly to a single modality, but refractory or long-standing cases may require the treating veterinarian to have extensive training in homeopathy or herbal medicine. • Most allergic skin cases will benefit from high levels of Omega 3 fatty acids in the form of flax, hemp or chia seeds, either as an oil or in seed form. Omega 3 fatty acids support and regulate the immune system. Overweight humans have been found to have reduced immune function, and the same is likely true to some extent with the horse. Most horses exhibiting pruritis from allergies will improve significantly with fatty acid supplementation. Flax and hemp oil can be supplemented at a rate of two to four ounces per day, or whole seeds fed at eight to 12 ounces per day. Naturally stabilized ground seeds can be used; if they’re not stabilized, they will oxidize as soon as they are ground.

Allergic skin reactions, such as the severe hives on this horse, often respond well to alternative therapies.

• Both Chinese and Western herbal formulas can provide the tools to help heal these cases. In Western medicine, pruritis is usually considered a single condition, with many possible allergic triggers. In Chinese medicine, there are many different medical patterns seen with this one condition. An example of a formula for treating itchy, raw, oozing skin would be the classical formula Long Dan Xie Gan Tang, a formula that clears the Chinese condition of Damp Heat. This formula is effective in the hot, humid summers of the East Coast and South. Western herbal formulas often include soothing herbs such Buckwheat, Nettle, Chamomile, Garlic and Calendula. These herbs are easy to feed horses, as they usually like the flavors and are able to digest them with minimal processing on the part of the manufacturer. integrative veterinary care

horse sense

The author examines an equine patient.

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Allergic skin reactions, such as the severe hives on this horse, often respond well to alternative therapies.

• Most of the healing that needs to be done is accomplished by internal means. However, some topical relief is often desired and useful. Strong black tea acts as an astringent and is easy to apply over a large portion of the skin for some relief. Herbal preparations of Calendula, Noni, Aloe Vera and Plantain leaves (Plantago officinalis) can all help relieve the itch until the internal treatment restores the immune system.

Sarcoids Sarcoids are generally benign tumors that appear in the skin and may have a bovine papilloma virus origin. They are generally only locally invasive and often will not spread and cause a problem. However, due to location or excessive growth they need to be treated. Those in areas where tack can rub, or that are encroaching on the eyelids, definitely need treatment. Some tumors are very aggressive locally, though seldom metastasize.

Most allergic skin cases will benefit from high levels of Omega 3 fatty acids in the form of flax, hemp or chia seeds, either as an oil or in seed form. Conventional treatment includes surgical removal or cryosurgery, but both these techniques often lead to reoccurrence. Sometimes the reoccurrence can be more aggressive than the original tumor. BCG (bacillus of Calmette and Guerin) is frequently given by injection into the tumor. This treatment carries a certain amount of risk, particularly since the tumors that seem most responsive to it occur near the eye. Horses can react adversely to the protein in the injection and develop a serious inflammatory reaction. It has been noted in England that tumors on the lower limbs injected with BCG can get significantly worse. One promising conventional treatment is the use of Imiquimod, a topical drug used for human papillomavirus infections and skin tumors.1

of tenderness at the lesions in two weeks, a second round of three days can be done. • Topical applications called escharotics or Black Salves, made with the herb Bloodroot, have been used for many years. Tumor tissue is selectively destroyed by the salve; however, it can leave a large wound that will heal slowly, but usually without incidence. • Chinese herbal formulas can be used to help stimulate the immune system to remove large masses. • An extract of Mistletoe (Iscador P) has been shown to reduce or eliminate sarcoids in 41% of cases treated.2 There are no side effects, but a small injection needs to be done into the lesion several times a week until it has healed.

Rain rot Rain rot (dermatophilosis), scratches, greasy heel, mud rash and many other regional names are given to lesions on the back and lower legs, often seen in wet conditions and frequently in colder climates and seasons. Conventional treatment usually involves baths in antimicrobial shampoo and picking off the scabs that form. This can be problematic in cold, wet conditions as the horses do not dry well and may become chilled. It also can be very painful to keep picking scabs. More severe cases are usually treated with antibiotics, which also kill the beneficial bacteria in the gut. Complementary treatment • Homeopathics offer a simple solution that does not require bathing. For lesions on the back, oral remedies such as Tellurium, Sepia, Thuja and occasionally Sulphur usually stop the infection in a week or so. The scabs become dry and naturally fall off during grooming. For lesions on the legs, the more common remedies are Antimonium Crud, Graphites and Sulphur.

Complementary treatment includes homeopathic medicine, herbal supplements and topical applications of herbal preparations.

• Topically, salves can help lessen soreness and promote tissue healing, but usually they are not the primary factor in curing the condition.

• Homeopathic medicines are usually prescribed according to the appearance of the tumor along with any other symptoms the horse has. Remedies such as Thuja, Causticum and Sulphur are commonly prescribed.

¹University of Minnesota, cvm.umn.edu/cic/completedstudies. ²“Treatment of clinically diagnosed equine sarcoid with a mistletoe extract (Viscum album austriacu)”, J Vet Intern Med, Nov-Dec 2010, 24(6):1483-9. doi:10.1111/ j.1939-1676.2010.0597.x. Epub 2010 Oct 12.

The dosing of homeopathic remedies for horses is about six to eight pellets of a 30 or 200 potency (strength), given once a day for three to seven days. In many cases, three days at a time is enough for the response to begin. If there are still signs

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Joyce Harman, DVM, MRCVS, graduated in 1984 from Virginia Maryland Regional College of Veterinary Medicine. She is certified in veterinary acupuncture and chiropractic, and has completed advanced training in homeopathy and herbal medicine. Her practice in Virginia (harmanyequine.com) uses 100% holistic medicine to treat all types of horses. Her publications include The Horse’s Pain-Free Back and Saddle-Fit Book – the most complete source of information about English saddles – and The Western Horse’s PainFree Back and Saddle-Fit Book.

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Complementary treatment includes homeopathic medicine, herbal supplements and topical applications of herbal preparations.

• Topically, salves can help lessen soreness and promote tissue healing, but usually they are not the primary factor in curing the condition.

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Rehab for a

torn CCL

Key symptoms to watch for Typical signs include acute three-legged lameness or toetouching, and barely any use of the limb. Occasionally, the lameness will be intermittent and chronic, then progressively worsen as the joint disease worsens. A CCL tear can also lead to injury of the meniscus. This is a cartilage cushion that sits inside the knee and serves as a shock absorber when a dog walks. “If the meniscus tears, it can very painful for the dog and must be treated surgically,” says Kurt Schulz, DVM, MS, DACVS, associate professor of surgical and radiological sciences at the University of California-Davis School of Veterinary Medicine. “About 50% of completely torn cruciate ligaments lead to meniscal injury. When the meniscus is torn, the knee will make a characteristic popping sound when the dog is walking.” A CCL rupture is usually diagnosed by manipulating the femur and tibia and detecting knee instability. X-rays may determine if there is any pre-existing arthritis and joint effusion, and to look at the positional relationship of the femur and tibia.

Surgical options Treatment typically involves surgery with post-op rehabilitation. Some patients benefit from rehabilitation and medical management alone, if the condition is not severe, and depending on how unstable the knee is. However, if there is a lot of laxity in the stifle joint and/or a meniscal tear as well, then it is imperative to correct the situation with surgery.

by Julie Mayer, DVM, CVA, CVC, CCRP

The purpose of any surgery for the cranial cruciate deficient knee is to eliminate too much movement between the femur and the tibia, and remove the whole or part of the meniscus if needed. Because this is a disease and progression usually results in osteoarthritis, correcting the biomechanics of the knee can help slow down degeneration.

forward under the femur, and also prevents internal rotation of the tibia. In dogs, unlike humans, cranial ligament rupture is typically not a result of trauma. The fibers of this ligament may fray over time from wear and tear, and when there is chronic mild inflammation and disease in the joint, enzymes deteriorate and weaken these tissues. Joint instability ensues and leads to osteoarthritis and/or a rupture/ tear of the ligament. Genetics and neutering pets too early may cause weak ligaments that can lead to rupture.

There are two categories of such surgeries performed in dogs. Repair with suture/rope material (Lateral Suture Stabilization, Tight Rope). Holes are drilled through the bone to thread synthetic material from the femur to the tibia. Repair with a cut in the bone (Tibial Tuberosity Advancement, Tibial Plateau Leveling Osteotomy) or repositioning the fibula bone (Fibular Head Transposition). TTA and TPLO involve cutting part of the tibia and repositioning it with plates and screws to change the anatomy and biomechanics so the stifle can function without the CCL. FHT surgery repositions the fibula and the attached lateral collateral ligament to mimic the CCL.

An exercise ball can be used for rehabilitation purposes.

any orthopedic surgeons and rehabilitation veterinarians report that cranial cruciate ligament ruptures or tears are the most common limb issues they treat. There are two cruciate ligaments – cranial and caudal – inside the stifle (knee) joint. They connect the femur to the tibia, which is needed for weight bearing. They form an “X” pattern relationship with each other to stabilize the knee. The cranial ligament is injured the most. This ligament prevents the tibia from gliding

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Rehab for a

torn CCL

by Julie Mayer, DVM, CVA, CVC, CCRP

An exercise ball can be used for rehabilitation purposes.

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Preventing tears or ruptures Several risk factors have been associated with CCL tears – breed, bodyweight, gender and conformation. The client should be advised to investigate the dog’s breeders (if applicable and possible), maintain good body weight and fitness levels in the dog, avoid early spay and neuter, and give him appropriate nutrition throughout his life. If the dog is a competitive athlete, he needs to be properly conditioned to help avoid this devastating and costly disease.

Case study

Harvey is a four-year-old standard poodle. One day while frolicking with his friends at the park he came up lame and was taken to his veterinarian. He was examined then sent to an orthopedic surgeon for a consult. He had torn a cranial cruciate ligament in the right stifle (knee). The orthopedic surgeon viewed the damage via arthroscopy and performed a Tibial Plateau Leveling Osteotomy (TPLO). By the third week post-op, Harvey was still reluctant to put weight on his injured leg and was in discomfort. The surgeon examined him and took some x-rays. The surgical site and implants were fine and there was no reason in the surgeon’s mind why Harvey was regressing. He was put on pain meds and anti-inflammatories and restricted to minimal activity. Harvey still didn’t heal as well as planned, so the surgeon called me to check him out. When I saw Harvey, he was happy and alert but barely using or touching the floor with his “bad” leg. I examined him and found that although the incision was completely healed and felt normal, he was resisting extension of his right hip (surgical side) because the muscles were very tense with spasms. His leg muscles were severely atrophied on the operated leg. He was sensitive to touch around his sacrum and sciatic nerve. I concluded he would not bear weight on his leg because he had sciatica along with issues higher up in his pelvis. I prescribed a protocol of weekly low level laser treatments, with massage and therapeutic exercises for the client to perform. Harvey was also kept from activity and jumping. In addition, I prescribed a homeopathic remedy for neuritis. By the second week, Harvey was already showing signs of improvement. We continued the therapies for five weeks and he continued to improve. At every session, I added more exercises to his regimen and he gradually gained strength, muscle mass and range of motion. He continued to use the leg and bear weight on it. Harvey is now back to playing with his friends. Medications can help deal with the pain and inflammation of this type of injury, but do not get rid of the root cause like physiotherapy can.

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Regardless of the type of surgery chosen, arthroscopy to approach the joint should definitely be considered since it is less invasive, and magnification with the instruments helps visualize the anatomy better. Each patient should be individually evaluated on the severity and chronicity of the situation, and the expected outcome. Then a decision can be made whether to take a surgical approach with post-op rehabilitation protocol, or perform veterinary rehabilitation and medical management only.

The role of rehabilitation With or without surgery, rehabilitation will benefit the pet by returning the limb to function, hasten recovery from surgery or injury, and improve the patient’s overall body condition, preventing the other CCL from rupturing.

occurs and scar tissue is laid down by the body, therapeutic exercises can be made more challenging, with longer, more intense sessions. However, there should be no jumping for about two to four months to allow enough scar tissue to become organized and help stabilize the knee. Chiropractic adjustments are beneficial for correcting subluxations resulting from compensation and long term lameness. • At about 12 to 16 weeks post-op or post injury, there should be an increase in muscle mass and strength as well as stamina and endurance, an improved use of the limb at higher speeds, and a near normal gait and return to full function (pre-injury level).

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Expected outcomes 1 Stifle is free of inflammation.

Rehab modalities encompass the following: • Mechanical – low level laser, therapeutic ultrasound, electric stimulation, shock wave therapy, pulsed electromagnetic fields • Physical – therapeutic exercises, hydrotherapy, chiropractic, massage • Energetic – acupuncture, medicinal compounds

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4 Progression of osteoarthritis is delayed. A combination of these modalities will help decrease pain, inflammation, spasms and edema, and will stimulate repair, improve muscle and nerve tone. Each customized rehab program is done in stages and must advance as the tissues heal and become stronger. • The focus for the first two weeks after surgical repair or acute injury is to decrease inflammation, pain and swelling. This can be done with a combination of any of the following: cold compression, low level laser, acupuncture, electric stimulation, pulsed therapeutic ultrasound, pulsed electromagnetic field, massage, anti-inflammatories and restricted activity. After surgery, depending on the procedure performed, the patient is encouraged to weight shift to restore proprioception, ward off muscle atrophy in the operated leg, and maintain normal posture and range of motion. Once most of the inflammation has subsided, hydrotherapy (underwater treadmill and pool swimming) and easy therapeutic exercises can be introduced. • By the third week post-op, you want to encourage and increase range of motion, improve limb usage and gait, resolve lameness, halt muscle atrophy, and increase strength, endurance and proprioception. As tissue remodeling

5 Gait is normal at a walk and trot. 6 Surgery limb is completely healed with improved function, and the opposite limb has improved fitness. Lifetime management with joint protective nutraceuticals, Omega 3 fatty acids, and natural anti-inflammatories is an important consideration. As with any physical rehabilitation program, all care should be directly supervised by veterinarians experienced in animal rehabilitation, and performed by a staff of trained animal rehabilitation therapists. In my professional opinion (based on my clinical experience), every pet should have a confirmed diagnosis by a sports medicine orthopedic surgeon or rehabilitation veterinarian before they undergo surgery. The surgical procedure should be performed by a Board Certified Surgeon because his/her level of training and skill set makes him/her the expert in this field. Dr. Julie Mayer has been practicing veterinary medicine since 1991. She has dedicated most of her career to holistic medicine and rehabilitation. She owned Integrative Pet Care and operated Therapet, two rehabilitation and holistic centers in Illinois. Now located in Arizona, Dr. Mayer is certified in veterinary acupuncture, veterinary chiropractic and canine rehabilitation, and is a Reiki practitioner. She has appeared on numerous network news programs and radio shows, and also serves as a guest lecturer at veterinary continuing education seminars on rehabilitation and complementary veterinary medicine.

Dr. Mayer

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She also She serves on the Board of Directors of the American Association of Rehabilitation Veterinarians and is a member of the American Canine Sports Medicine Association, the American Association of Veterinary Nutrition, and many other associations. regularly moderates webinars on nutrition.

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Case study

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Expected outcomes 1 Stifle is free of inflammation.

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2 Full range of motion is restored.

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3 Limb circumference is symmetrical.

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Dr. Mayer

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For more information and a Veterinarian price list contact:

speaks at colleges and events on

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Leading the way Since its inception just over a year ago, this unique program at the Louisiana State University’s School of Veterinary Medicine is making the school a leader in integrative medicine education and development. by Margaret Coffey, DVM, MBA In November, 2010, the LSU School of Veterinary Medicine was offered a unique opportunity when we were approached by a potential donor interested in incorporating integrative medicine into LSU’s clinical services, teaching and research programs. A memo of understanding brought together all the parties involved and the donor agreed to a large financial commitment to the school over a period of five years. Since most veterinary schools currently don’t offer integrative medicine, this program has generated a high level of excitement among faculty, staff and students. In little more than a year, a variety of integrative medicine initiatives have been established at the school. • The Dean’s Cabinet (school leadership cadre) is endorsing integrative medicine as part of the school’s mission. • An active student club for integrative medicine called PARM (Preventive Alternative Rehabilitative Medicine) had been established. The students meet monthly, engage guest veterinarians and run “hands on” training sessions. Guests to date have included Dr. Bridget Kelly of Acadiana Equine, talking about equine acupuncture, and Dr. Larry McCaskill, who did an acupuncture demonstration on a canine patient.

CVCH, with a talk on nutraceuticals and alternative diets. Upcoming speakers for 2012 include Dr. Richard Palmquist, DVM and Dr. Huisheng Xie of the Chi Institute. • One faculty member, Associate Professor Rebecca S. McConnico, has already become fully certified as a Traditional Chinese Veterinary Medicine (TCVM) practitioner, with three more clinicians, including the Department Head of Veterinary Clinical Sciences, Dr. Dale Paccamonti, scheduled for training this coming year. • Focus modalities currently include TCVM, acupuncture, massage, rehabilitation and nutrition. • Dr. Rick Palmquist, the past President of the American Holistic Veterinary Medicine Association (AHVMA) kicks off 2012 as our guest speaker for Dean’s Rounds, a wellattended college colloquium. • Over 30 LSU faculty, students and staff have attended two AHVMA conferences, and are planning to go again this year. • We are sponsoring student internships in integrative medicine. Students submit written requests for financial assistance to attend training classes at other locations.

clinicians and staff, this team will oversee the growth of integrative veterinary medicine-related activities at LSU’s School of Veterinary Medicine. • We are including integrative medicine services such as acupuncture, nutritional counseling and massage therapy in our small animal lobby/primary care expansion plans. • We are testing and researching specific equine neutraceutical components, including evaluations of efficacy and palatability. • Our web presence is being updated to include integrative service alternatives, and we have just launched a Facebook page – search ‘LSU - VTH Integrative Medicine Services’.

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• A ten-member Veterinary Teaching Hospital (VTH) Integrative Medicine Oversight Team/Committee has been set up. A steering committee made up of VTH

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• In the coming year, PARM and the Integrative Medicine Team will sponsor integrative veterinary medicine guest speakers on a monthly basis to address the School of Veterinary Medicine, and in some cases, the broader community. Our forays into the integrative medicine arena are dynamically impacting the education of our veterinary students, improving the clinical care of the animals entrusted to our care, and creating new opportunities and avenues for clinical research in integrative veterinary medicine. Our long term goal is to establish an Institute/Center for Integrative Veterinary Medicine at LSU, identifying the school as a leader in integrative veterinary medicine development and inquiry.

Margaret Coffey, DVM, MBA, is the Hospital Director at LSU’s School of Veterinary Medicine in Baton Rouge, Louisiana. She is a genuine proponent of integrative veterinary medicine and has been trained in advanced integrative

• Invited guest speakers are addressing staff, faculty and students in integrative veterinary medicine topics. Speakers to date include Dr. Susan G. Wynn, DVM, RH, CVA,

Plagued by Aches and Pains. . . .

She received an MBA from Harvard University and her Cornell. Prior to LSU, she was the Hospital Director Veterinary College, University of Prince Edward Island in

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• A ten-member Veterinary Teaching Hospital (VTH) Integrative Medicine Oversight Team/Committee has been set up. A steering committee made up of VTH

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• Invited guest speakers are addressing staff, faculty and students in integrative veterinary medicine topics. Speakers to date include Dr. Susan G. Wynn, DVM, RH, CVA,

Plagued by Aches and Pains. . . .

She received an MBA from Harvard University and her Cornell. Prior to LSU, she was the Hospital Director Veterinary College, University of Prince Edward Island in

medicine modalities.

veterinary degree from

Atlantic Charlottetown. at the

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Is your patient

? d e s s e

r p De

The symptoms of emotional depression in animals can be vague and challenging to diagnose. Here’s a behavioral perspective on this condition and how it may be treated, without drugs.

by Suzanne Hetts, PhD, CAAB,

nnie didn’t seem herself. She was grumpy and didn’t have much appetite. She seemed lethargic and uninterested in activities she had always enjoyed. Once outgoing, confident and happy, she was now reluctant to do much of anything, preferring to just watch life go by. Who is Annie? From those vague behaviorial signs, she could be a horse, dog, cat or even a person. It’s not often you’ll be presented with a patient whose owner’s primary complaint is that his animal isn’t happy and may be suffering from mental depression. Nevertheless, decreased appetite and activity along with increased irritability are behavior changes most clients will be concerned about, and which can be associated with a myriad of diseases or illnesses. Some veterinarians use the “ADR” or “ain’t doing right” shorthand for these and other non-specific signs. As a veterinarian, you’re accustomed to conducting a range of diagnostic procedures when animals present to you with general behavior changes. Before considering a patient’s symptoms the result of mental depression, you know that any medical conditions that could precipitate them must first be eliminated.

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and Daniel Estep, PhD, CAAB

combat zones are showing depressionlike behavior changes, including a reluctance to engage in tasks for which they were trained. These problems can easily result from classically conditioned fears. The average pet, however, is more likely to experience a number of insidious conditions that can contribute not only to a depressed mental state but to other behavior problems that compromise his welfare. Decreased activity, lack of interest, and general passivity are a cluster of behaviors linked to depression. Two risk factors for this behavioral cluster are a lack of control over the environment, and traumatic experiences that also result in a loss of control. It is sad but true that several common animal rearing and training procedures have the potential to create these conditions.

Defining animal depression Depression can be defined as a decrease of functional activity, a decreased interest in one’s surroundings and/or a decreased response to external stimuli. In people, depression is typically categorized as situational or chronic (sometimes called endogenous). Situational depression results from a specific event such as the death of a loved one, a divorce, a traumatic experience, or other stressful life events. Chronic depression is not tied to specific events but is more the result of individual, internal risk factors. Whether animals can have “depressive personalities” is not known. However, research suggests that animals, like people, do have differences in their mental outlooks – similar to the “glass half full or half empty” perspective. In one study, dogs were trained to expect food under a cup in one location but not in another. When the cup was placed midway between the two locations, dogs with separation anxiety were less likely to search the cup for food than dogs without the condition. In another study, rodents were trained to expect different tones that predicted either an unpleasant noise or a food reward. When a tone intermediate between the two was played, rats raised in a stable environment were more likely to behave as though they expected a reward than those raised in unpredictable conditions. These differences in expectations likely result from interplays between early experiences and rearing conditions, environmental experiences and learning, and inherent genetic tendencies. Thus, if you suspect an otherwise healthy animal is suffering from a depressed emotional state, the first step is to obtain a behavior history to attempt to identify any contributing events or risk factors.

If you determine the animal is medically healthy, yet the behavior changes persist, then other possibilities, including depression, should be explored. However, according to Dr. Margie Knoll, a veterinarian and certified veterinary acupuncturist at Airpark Animal Hospital in Westminster, Maryland, there isn’t much information available to general practice veterinarians about the diagnosis and treatment of mental depression in animals.

…there isn’t much information available to general practice veterinarians about the diagnosis and treatment of mental depression in animals. Causes can be complex Clear but probably uncommon events that could contribute to a depressed mental state in an animal include traumatic experiences such as surviving a fire, a car or trailer accident, or being caught in a tornado or hurricane. A more common trigger is the loss of another animal or person, through death or separation, to whom the patient was attached. Abuse and neglect may be other factors. It has also been proposed that military dogs serving in integrative veterinary care

Is your patient

? d e s s e

r p De

The symptoms of emotional depression in animals can be vague and challenging to diagnose. Here’s a behavioral perspective on this condition and how it may be treated, without drugs.

by Suzanne Hetts, PhD, CAAB,

integrative veterinary care

and Daniel Estep, PhD, CAAB

Decreased activity, lack of interest, and general passivity are a cluster of behaviors linked to depression. • Excessive crating, too much stall time, or other close confinement means the animal is not able to successfully use his own behaviors to affect any change in his circumstances. Such conditions are often unavoidable at many animal shelters and boarding facilities. However, too many pet dogs are subjected to excessive crating, often more than ten hours a day – either as a routine practice without justification or because unwanted behaviors that precipitated the crating have gone unaddressed. Horses spending too much time in stalls experience similar conditions. • Secondly, certain “pack leader” or “dominance” theories of pet-people relationships recommend ignoring all the animal’s attempts to interact or solicit play or attention, requiring instead that the owner be the one to initiate all social contact. This removes any way for the animal to ask his owner for what he wants or to have his needs met through his own behaviors. • Even more likely to cause problems is non-contingent, inescapable, and/or unavoidable punishment. Situations in which an animal’s behavioral response cannot stop or prevent bad things from happening are among the leading causes of the passivity and disengagement

often labeled as depression. Outdated training techniques that focus on harsh and abusive physical confrontations and threats that a pet cannot control or predict, produce an animal that is fearful or aggressive. The animal may alternatively adopt a strategy of passivity because the fewer behaviors he shows, the lower the risk of bad things happening.

Behavioral treatment strategies So what are the practical treatment applications of these findings? Some cases of mental depression may resolve on their own over time. Telling clients to be patient and kind to their animals may allow the depression to resolve. This has been our experience, particularly in cases resulting from the death or loss or another individual. This is borne out by statistics from the human field that show about one third of patients improve without intervention. Another relatively easy strategy is to create circumstances that allow an animal to receive frequent, high value reinforcement for engaging in simple behaviors, with the goal of getting him moving and interacting again. Simply teaching an animal to use his nose or paw to touch a person’s hand or something held in the hand (a dowel, plastic plate, etc.) creates predictable circumstances,

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a reinforcement history, and the ability to successfully act on the environment. Obviously, all harsh training techniques should be stopped. Owners should be instructed to reinforce each and every spontaneous occurrence of active, desirable behaviors with food, play and/ or petting and praise. Physical exercise is known to enhance mood, so simply walking dogs regularly, riding or walking horses, allowing cats safe outdoor time, and engaging pets in play can have a beneficial effect. Close confinement or crating should be minimized. Certified behavior consultants or experienced certified trainers skilled in the use of both operant and classical counter conditioning and desensitization techniques can teach owners how to implement additional techniques to overcome the fear or anxiety that often contribute to depressive symptoms.

Blood, D.C. and Studdert, V.P., Saunders Comprehensive Veterinary Dictionary, Second Edition, W. B. Saunders, NY, 2000. Harding E.J., et al, “Animal behavior: Cognitive bias and Affective state”, Nature: 427: 312, 2004. Hetts, S., Estep, D., and Marder, A.R., “Psychological Well-Being in Animals”, pps. 211-220 in McMillan, F., (Ed.), Mental Health and Well-Being in Animals, Blackwell Publishing, Ames, IA, 2005. King, L. and Rowan, A. N. Rowan, “The Mental Health of Laboratory Animals”, pps. 259-276 in McMillan, F., (Ed.), Mental Health and Well-Being in Animals, Blackwell Publishing, Ames, IA, 2005. Mendl, M. et al., “Dogs showing separation related behavior exhibit a ‘pessimistic’ cognitive bias”, Current Biology 20 (19): R839-840, 2010. Seligman, M.E.P., “Learned Helplessness and Depression in Animals And Men”, pps. 111-126 in Spence, J.T., Carson, R., Thibaut, J. (Eds.), Behavioral Approaches to Therapy, General Learning Press, Morristown, NJ, 1976.

Dr. Suzanne Hetts, Ph.D., CAAB and her husband Dr. Daniel Estep, Ph.D., CAAB are award winning speakers and authors, having lectured on four continents to animal parents and professionals. Their company, Animal Behavior Associates, Inc., provides pet behavior education to animal professionals at BehaviorEducationNetwork.com and animal parents at SensibleDogTraining.com and CatBehaviorHelp.com.

industry innovations An encouragement to neuter Despite the ongoing pet over-population problem, many clients still balk at having their animals neutered because the operation alters their appearance. Neuticles can help encourage them to do so. These patented testicular implants for dogs, cats and other animals were researched and developed almost 20 years ago, and are designed so that the animal continues to look intact after surgery. Since then, more than half a million animals have received the implants from over 25,000 participating clinics and hospitals worldwide. According to the company, implanting Neuticles is a two to three minute procedure, and is normally performed when the pet is neutered. Implants should be done at eight months of age or older to ensure full growth and correct sizing. neuticles.com

Improving mobility and traction Hip dysplasia, arthritis, and other conditions causing mobility issues are all too common among dogs. Woodrow Wear has a product that can help improve your canine patients’ quality of life. Power Paws is a sensible, sock-based traction solution for dogs with hip and/or mobility problems. They help dogs get around on smooth floor surfaces without slipping. They can also be used to protect foot injuries, prevent dogs from chewing at wounds or stitches, and eliminate the need for E-collars. Power Paws can be used outdoors to protect a dog’s feet from allergens, extreme temperatures, salt and ice. woodrowwear.com

New diagnostic kit for lymphoma A new diagnostic kit takes the uncertainty out of diagnosing lymphoma. Developed by PetScreen, it differentiates between patients with lymphadenopathy due to lymphoma or other ailments such as lymphoid hyperplasia.

Make bandaging a breeze Every vet knows the stress and hassle of bandaging wounds, whether it’s hot spots, surgical sites and more. PawFlex comes to the rescue with its award-winning line of non-adhesive, fur friendly, super stretch and super soft “all in one” disposable bandages. They’re water resistant and breathable, as well as quick and easy to use. The quick catch and release double Velcro fasteners and unique non-slip grip assures the bandages will stay on and in place. Available in five designs, each PawFlex bandage is ideally created for a specific wound care area. pawflex.com

The launch of the kit signals a partnership between PetScreen and Tridelta Development. PetScreen has established the first reference laboratory offering the Advanced Lymphoma Blood Test (ALBT), utilising the Tri-Screen Canine Lymphoma assay kit. The kit is now available to laboratories worldwide. For the past two years, PetScreen’s research team has been characterising and identifying the biomarkers used in their earlier lymphoma blood test. They found that two of the markers are Acute Phase Proteins (APPs). Although APPs have been investigated in veterinary medicine for some time, PetScreen has developed a multi-marker approach leading to the development of patented and copyrighted analytical algorithms which combine the relative values of both Haptoglobin and C-Reactive Protein (CRP) in serum. pet-screen.com or tri-screen.net.

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tech talk

Veterinary massage

of pathologies treated with massage therapy. The doctors (MDs) there told me that the number one treatment in human medicine in China is massage therapy and herbs, followed by acupuncture for pain, and finally Western medicine!

by Michelle J. Rivera, MT, VDT

While studying there, I was allowed to ask patients what they were being treated for. The majority of ailments were not musculoskeletal, as is common with massage in the West, but major medical conditions. Epilepsy, brain tumors, colon issues and skin eruptions were among the many types of things being treated with massage therapy. It was in China that I learned that many behavioral problems can also be alleviated or eliminated with the addition of massage therapy. In my own practice, the majority of issues I successfully work with using massage are behavior problems and seizures. Some of the conditions and issues that might benefit from massage (depending on the condition of the patient and the stage the disease process is at) are:

Tight and contracted tendons • • Ligament and muscle injuries • Chronic inflammatory conditions • Scar tissue and edema • Post-surgery or trauma (recovery) • Maintenance of competitive levels

You must find advanced training, preferably from an accredited institution or one that is recognized by the state it’s located in. Michelle uses massage on a patient.

The goals for any form of manual therapy, such as massage, are:

eterinary massage has become one of the most popular rehabilitation therapy aids over the last five years. Although it is used every day in many hospital settings, its primary success and information come from clinical responses and minimal (double blind) scientific research studies on animals.

Massage therapy occupies the biggest portion of rehabilitation therapy, which involves not just the use of “instruments” or “machines”, but whatever means are necessary to “recondition” muscles. In modern veterinary practice, massage therapy can be done using all sorts of implements, but the most important tool of all is the trained hands of the therapist.

1 Relief of pain 2 Reduction of swelling and edema 3 Reduction of muscle tension 4 Improvement of circulation 5 Promotion of tissue healing 6 Reduction of fibrous tissue and adhesions 7 Improvement of range of motion

The normal definition of massage and rehabilitation therapy is as follows: the use of fingers, hands, and machines to manipulate the soft tissues, or stimulate at the cellular or neurological level of the body to improve healing and recovery.

Massage has many applications

A good modality for vet techs

Many conditions can benefit from massage and rehabilitation therapy. When I studied Tui Na (a massage technique) and Chinese herbology in China, I was amazed at the types

In veterinary practices, the logical person to perform massage therapy is the technician. As we all know, many doctors in practice are spread too thin. Many seek training in other

integrative veterinary care

tech talk

Veterinary massage

by Michelle J. Rivera, MT, VDT

You must find advanced training, preferably from an accredited institution or one that is recognized by the state it’s located in. Michelle uses massage on a patient.

The goals for any form of manual therapy, such as massage, are:

Massage has many applications

A good modality for vet techs

Many conditions can benefit from massage and rehabilitation therapy. When I studied Tui Na (a massage technique) and Chinese herbology in China, I was amazed at the types

In veterinary practices, the logical person to perform massage therapy is the technician. As we all know, many doctors in practice are spread too thin. Many seek training in other

integrative veterinary care

modalities such as acupuncture, spinal manipulation or nutrition, and cannot juggle all that is necessary to add yet another modality. We also know that many clients will confide in the staff before they confide in the doctors.

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Having a veterinary technician perform massage or rehabilitation therapies is the ultimate in a complete holistic approach to patient care. As an added bonus, the facility is generating additional income that wouldnâ&#x20AC;&#x2122;t be available if only the doctor was providing the service but rarely had time to actually do it. Hereâ&#x20AC;&#x2122;s an example of how this could work. Say the doctor performs surgery on an animal and there is now a need for multiple rehabilitation visits. The doctor and trained technician can work up a protocol by which the technician can take on scheduled visits for the patient, bringing in more income and optimizing patient care. One of the things necessary for you to be successful in adding massage therapy to the practice is to make receptionists aware of the variety of things that can be treated and worked with using massage and rehabilitation therapy.

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Before you decide to practice animal massage, you should seek advanced training from an accredited source. Since there are no medical or veterinary medical schools teaching massage therapy to professionals, there has been a resurgence of â&#x20AC;&#x153;overnight schoolsâ&#x20AC;? cropping up that give attendees fictitious degrees of Animal Neuromuscular Therapist, Animal Massage Therapist, or Pet Massage Therapist. There are also many â&#x20AC;&#x153;weekendâ&#x20AC;? seminars available, but the only thing they are good for is to open your eyes and realize that as a licensed health care professional, one weekend does not make you an expert. You must find advanced training, preferably from an accredited institution or one that is recognized by the state itâ&#x20AC;&#x2122;s located in. If any health care modality is provided incorrectly and not side by side with conventional veterinary medical care, it could be potentially dangerous and jeopardize the welfare of patients. We owe them the best care and training we can find. Some of the questions to consider when choosing a program include:

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Does it give you a vast knowledge of functional anatomy and biomechanics? Will it give you an understanding of the primary and combined effect of massage and related modalities on a patient already compromised by surgery or a musculoskeletal problem?

If the institution is teaching using machines, how does the machine work? This will determine its usage on particular patients.

integrative veterinary care

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If the institution is teaching using machines, how does the machine work? This will determine its usage on particular patients.

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Does the program teach the various diagnostics needed to determine if any massage can be performed (i.e. blood work, x-rays, MRIs, etc.)?

Does the program offer enough lab time with real life cases and animals to work on? After all, this is a handson modality!

Laws and regulations Complementary and alternative veterinary medicine (CAVM) has literally exploded in recent years, and with this explosion comes many pros and cons. As briefly stated above, many “schools of massage” are starting and many self-proclaimed “therapists” are invading our field, which is why the American Veterinary Medical Association (AVMA) has a chart of key provisions of state veterinary practice acts and accompanying regulations relating to many of the

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most common CAVM treatments such as massage, manipulation and physical therapy. At this time, about 20 states follow the AVMA Model Practice Act. Approximately another 20 have enacted specific or general exemptions for the regulated therapies. There is also a handful of states that do not have any provisions specifically addressing CAVM. Because of this diversity, before considering any CAVM modality, you must do your homework and review a comprehensive analysis of practice act scope and exemptions in your particular state. You should also look into the acts written for the “human” practice of that modality. For example, if you work for a veterinarian interested in adding spinal manipulation (animal chiropractic) to his or her scope of practice, not only must she or he look at the practice act in veterinary medicine, but also

at the human chiropractic acts and definitions. The current laws and regulations can be found on most state legislative websites and are changing at an alarming rate. In general, if a properly trained technician or massage therapist trained in animal massage works on animals under direct supervision, direction, or indirect supervision (depending on the state laws), s/he will be successful under the law and can add a wonderful modality to the practice. In conclusion, today’s veterinary climate is one of embracing a more holistic approach to our treatment care options. Eventually, it will be considered incompetent and negligent not to offer these health care modalities. Veterinary technicians are ideally positioned to be professionally trained and provide massage therapy for the health care of pets.

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Michelle J. Rivera, MT, VDT, is an instructor at the University of Wisconsin and The Healing Oasis Wellness Center, a post-graduate educational institution offering state-approved programs as set forth by the Wisconsin Educational Approval Board. She is also the co-owner of The Healing Oasis Veterinary Hospital, Inc. a holistic veterinary practice offering massage and rehabilitation therapy, chiropractic and Chinese and Western Herbology. Michelle has completed the Chinese Herbal Medicine program from the China Beijing International Acupuncture Training Center, and has been certified in Chinese Medicine by the Wisconsin Institute of Chinese Herbology.

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It’s important to keep in mind that although veterinary massage may be considered “innocuous” or “harmless”, this is a misconception. It should not be performed on any animal with the following conditions:

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1 Fever problems 2 Any infectious disease (bacterial or fungal) 3 Internal organ problems 4 Gross fractures (or suspected fractures) 5 If the patient is on any medications that would cause major side effects if their absorption rate was increased 6 Under no circumstances should massage be performed on any kind of mass that has not been diagnosed as benign 7 On the area of any recent surgical intervention A skilled and trained professional is not just one who can carry out the techniques and perform the “movements” of massage, but who also knows when not to perform this modality, and why.

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Continued from page 36

Does the program teach the various diagnostics needed to determine if any massage can be performed (i.e. blood work, x-rays, MRIs, etc.)?

Does the program offer enough lab time with real life cases and animals to work on? After all, this is a handson modality!

According to ‘Gospel’...

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•reduce recovery time •reduce pain •heal soft tissue injury •treat sore muscles •reduce arthritis pain •increase circulation Illuminating the future of equine care

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integrative practice

Expanding your services How to get clients, colleagues and staff on board when introducing integrative by Erin Mayo, DVM, CVA treatment options to your practice.

nterest in integrative medicine is rising every year in both the human and veterinary fields. Adding integrative treatment options to your practice helps your bottom line, and can boost your success rate with even the most difficult cases.

But how do you get clients, colleagues and staff to go from “not interested” to “yes, I want to try that”? Introducing others to these new treatments requires a combination of education, marketing and finesse. The client ultimately decides what is best for his/her animal, but there are several techniques for introducing new options that won’t intimidate or turn people away from potentially beneficial therapies.

Education You know the feeling: you get home from a conference and want to tell the world all the new things you learned. Don’t fight this feeling. You’ve spent the time and effort to learn a new treatment method, so now it’s time to teach others around you. Educating your colleagues and staff members is an important first step to incorporating new techniques into your practice.

Every exam should be viewed as an opportunity to use an integrative approach, even if the client decides not to pursue integrative treatments. Colleagues can be your best friend or worst enemy when it comes to adding new services. If a fellow veterinarian takes a dim view of a new treatment, or simply does not understand it, s/he is less likely to recommend it to a client. Take the time to help colleagues understand when and how these treatments can be applied, even if they have no interest in performing them. Put aside an hour during a quiet time of the day to discuss indications and contraindications. Even a harsh skeptic will have greater respect if your presentation is even-handed and includes potential side effects, such as interactions with conventional treatments. If you feel you are not the best teacher, encourage colleagues and staff members to attend introduction lectures for integrative medicine.

Dr. Mayo demonstrates acupuncture for her tech, Marie.

integrative veterinary care

Staff members also need education about new treatment options, though your presentation to them should include practical considerations such as cost and how much time is needed to schedule sessions. It is especially important for your staff to have

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Expanding your services How to get clients, colleagues and staff on board when introducing integrative by Erin Mayo, DVM, CVA treatment options to your practice.

Dr. Mayo demonstrates acupuncture for her tech, Marie.

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room, the client is hopefully brimming with interest and questions. Now it’s time for you to shine. First, do a thorough examination using conventional as well as any new techniques; for example, an evaluation of the tongue and pulse as done in Traditional Chinese Medicine. Every exam should be viewed as an opportunity to use an integrative approach, even if the client decides not to pursue integrative treatments.

Look for the Seal of Quality

After the examination, discuss your findings and the diagnostics you feel are necessary. Once you feel comfortable with a diagnosis, offer what you believe are the best options for treatment, including any and all integrative approaches. Never be afraid to offer – let the client be the one to decide. Make sure to explain each option fully, but do not overwhelm the client with jargon. Just as you would not use complicated medical terms, do not expect a client to understand the finer points of integrative or holistic medical philosophy.

Dr Mayo shares information on new therapies with her techs and other staff.

a positive attitude toward any new treatment, since they are the first people to talk to clients. One way to make a staff member an ambassador for a new therapy is to use it to successfully treat his/ her own animal. Once clients hear the miraculous story of how you saved the receptionist’s pet, they will happily consider the new treatment for their own animals. When your staff has good experiences with their own pets, it can result in positive and free advertising for you and your new services.

Marketing Marketing can be a dirty word, especially if done incorrectly and unethically. However, there are many ways to get the word out without compromising your integrity. Start by making sure every client who comes in the door knows about your new services. Flyers, signs and brochures will alert clients and educate them about the uses and benefits of these new services. A mass mailing of flyers or postcards to existing clients is another option. Do not forget to include messages printed on the bottom of invoices. The greater number of times the client sees the message, the more likely it will make a lasting impression and spark interest. Reaching people who are already clients is easy, but how do you reach non-clients? It must be done carefully, especially if you want referrals from colleagues who currently do not offer these services.

integrative veterinary care

A letter to local hospitals introducing yourself and the new service is one way to break the ice. Follow up with a phone call and offer a face-to-face meeting to answer questions. Reaching out to holistic practitioners in human medicine might also be helpful. Human practitioners frequently have patients who ask for similar services for their pets and would be willing to refer these patients. If the direct approach is not your style, write a column for a local paper. Make sure to keep the article generally about integrative medicine. You do not want to be seen as trying to advertise your services in this particular forum. Consider guest lecturing for local groups, such as 4H or other animalrelated associations. If your local veterinary medical association publishes a newsletter, write a case report in which you treated a patient using integrative techniques. Any of these options will help you make people aware of the existence of integrative treatment options for their pets.

Preventive care visits are a great opportunity to offer integrative options. Puppy and kitten visits can be used to educate clients about ways to keep their pets healthy that may not be considered mainstream. Take the time to discuss dental hygiene, nutrition and supplements, such as probiotics. Visits with healthy adult pets can include discussions about exercise and weight control. An owner who complains their pet is stiff after a long play session can be shown massage techniques and offered joint supplements rather than immediately given a pharmaceutical.

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Remember…it’s the client’s choice While it’s exciting to be able to offer your clients a wide array of treatment options, it is ultimately their decision which ones they choose. You might think a certain herb will cure a particular cat, but if the owner is unable to get the concoction in the uncooperative feline’s mouth, it will do no good. It might even cause harm if the owner or cat sustains injury during the treatment process! Helping your clients make correct treatment choices, however, is something you definitely can influence. Using the right combination of education, marketing and good communication in the exam room, you can open your clients’ eyes to a whole new world of treatment options for pets.

The final hurdle The final step is the most important – convincing the client. Hopefully, your educational flyers and brochures get the ball rolling. The next step is a positive attitude and additional information from your staff. By the time you enter the exam

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Dr. Erin Mayo graduated from the North Carolina State University College of Veterinary Medicine in 2002. She received her veterinary acupuncture and Chinese herbal certification from the International Veterinary Acupuncture Society, and runs a house-call based business providing holistic and TCVM services for companion animals in central New Jersey.

For more information visit www.NASC.cc integrative veterinary care

Look for the Seal of Quality

Dr Mayo shares information on new therapies with her techs and other staff.

integrative veterinary care

Not all supplements are alike...

For more information visit www.NASC.cc integrative veterinary care

profile Dr. W. Jean Dodds,

DVM

Dr. Dodds is the brainchild of Hemopet and the Rabies Challenge Fund.

By Ann Brightman

oming from a medical family, Dr. Jean Dodds was exposed to the field of medicine and healing from a very early age. In fact, it’s this background that drew her to become a veterinarian. “I decided to work with animals rather than human patients once I grew up, much to the consternation of my late father!” she says. Dr. Dodds graduated with honors from the Ontario Veterinary College at the University of Toronto in 1964. A year later, she accepted a position with the New York State Department of Health and began comparative studies of animals with inherited and acquired bleeding diseases. Unlike a lot of veterinarians, Dr. Dodds moved towards integrative medicine early in her career. It was the early 1970s, when doctors offering alternative therapies were few and far between. “I was prompted by my concerns about the apparent increasing adverse reactions to vaccines in companion animals and why we needed to give so many vaccines so often,” she explains. “I was also becoming more and more concerned about the use of chemicals, pesticides and drugs with their known potential side effects.” It’s a concern that has remained with Dr. Dodds to this day. Now based in California, she specializes primarily in alternatives to vaccines, drugs and pesticides. She

integrative veterinary care

also puts a lot of emphasis on wholesome and balanced nutrition. “As well, I specialize in developing and using clinical diagnostic testing and interpretations that promote screening for heritable traits, and point to therapeutic approaches that include alternatives to conventional drugs, whenever feasible,” she adds. One of Dr. Dodds’ most significant contributions to veterinary medicine has been the founding of Hemopet (hemopet.org), the world’s first non-profit animal blood bank. “Before I moved to California, I was a senior administrative scientist at the New York State Department of Health, just when AIDS and blood safety issues became critical,” she explains. “I was put in charge of the blood regulatory program for the State of New York (as a veterinarian no less; that’s what happens when you’re the only experienced hematologist on staff!). Coming home one night from an advisory committee meeting with the regional Red Cross, I thought: ‘We just have to start proper blood banking for animals and teach animal transfusion medicine in veterinary schools.’” Dr. Dodds began by lobbying the National Institutes of Health to allow veterinary schools to compete for their Transfusion Medicine Academic Awards. “Then I wrote to the deans of all vet schools and suggested they put forward their best candidates. That year (1982, I believe), four veterinary candidates competed along with eight medical school candidates for four slots; we were awarded two of them (the late Dr. Joseph Smith from Kansas State University and Dr. Susan Cotter from Tufts University). After that, four more veterinarians won these teaching awards (fully funded by NIH). It amounted to $1.5 million to veterinary medicine all told!” Encouraged, Dr. Dodds created Hemopet in 1986, and the organization has made significant contributions to the field of veterinary care. “It has established the ‘gold standard’ for veterinary transfusion medicine in a commercial yet non-profit setting,” she says. “We also rescue greyhounds unsuitable for or retired from the racing industry to serve as blood donors for a finite time, and then be adopted as family companions. Only dogs of so-called ‘universal’ blood type (DEA 4) and free of blood-transmissible diseases are accepted into the program, which began in 1991 with 29 dogs. More than 3,000 greyhounds have been adopted out and the facility houses about 200 dogs now.”

“[The Rabies Challenge Fund] was a natural offshoot of my commitment to vaccines, especially when rabies vaccine is the most likely to produce severe, chronic and even fatal adverse reactions.” Not surprisingly, Dr. Dodds received the Holistic Veterinarian of the Year Award from the AHVMA in 1994. She modestly says she isn’t sure what led to her receiving the award. “Perhaps it was just my ongoing commitment to alternative approaches to maintain health and promote longevity,” she muses. “And, not being afraid to speak out about this philosophy, despite naysayers.” Dr. Dodds’ concern with the problems of over-vaccination has also played a big role in her career, motivating her to become the supervisor and co-trustee of the Rabies Challenge Fund (rabieschallengefund.org), a research project that aims to scientifically demonstrate that the duration of immunity for rabies vaccines is much longer than previously thought – from five to seven years. “It was a natural offshoot of my commitment to vaccines, especially when rabies vaccine is the most likely to produce severe, chronic and even fatal adverse reactions.” The research began in 2007 under the direction of Dr. Ronald Schultz and the University of Wisconsin Foundation.

“My original background was in clinical pathology with an emphasis on hematology, immunology and genetics (animal models of human disease),” she says. “More recently, my interests have broadened to include endocrinology (especially thyroid disease and diagnosis) and nutrition (especially nutrigenomics). So in 2009, we began our own diagnostic lab at Hemopet, called Hemolife. Since then, we have received several more patents in these fields, with emphasis on non–radioisotopic assays that are environmentally safe. Our latest innovation is a unique, patented diagnostic test called NutriScan for canine food sensitivity and intolerance using saliva [nutriscan.org].” Dr. Dodds has also co-authored a book entitled The Canine Thyroid Epidemic (Dogwise Publishing, 2011). It’s clear Dr. Dodds is passionate about her vocation. “I love helping others by helping their animals,” she says. “Animals give and share such joy with us.”

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Holistic First Aid Kits

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Hospice Ca

ospice care for terminally ill animals and their families is showing steady growth in demand and supply, and veterinarians are receiving more requests from clients for this type of support.

Unfortunately, there’s still a lack of veterinary-geared educational resources for hospice care. As the provider of a nationwide volunteer-based, non-veterinary animal hospice helpline for the last five years, I have witnessed the disheartening dichotomy between client expectations (for patient care comparable to human hospice) and the provided or refused veterinary services (once euthanasia suggestions were not accepted by the client). More of us are following in the inspiring footsteps of pioneer veterinarian Dr. Eric Clough. “In hospice, we never say there’s nothing more we can do,” he stated more than a decade ago. “There’s always something in the way of comfort.” Are you up for it?

remains elusive, and “hospice” outcomes will yield near 100% euthanasia rates. It does not have to be that way.

Hospice is defined by embracing death as “nothing to be feared nor avoided, not to be postponed nor hastened”, while providing for the highest quality of life possible. The more we know about achieving comfort for the dying, the lower euthanasia rates fall among patients in hospice. On last count, 67% of hospice patients in my holistic practice, while also remaining in the care of their primary conventional veterinarian, died in their own time. The owners were deeply grateful, and prone to re-elect

Changing our outlook on death Most veterinarians (including myself) and clients agree with what is said the AVMA Guidelines for Veterinary Hospice Care – that euthanasia may still be required when giving hospice to an animal if he cannot be kept comfortable. Nonetheless, for a public aware of the many benefits of human hospice, it can be difficult to hear veterinarians say that euthanasia alone is the greatest gift they can give terminally ill animal family members.

While for the dying. tite, common of fered pe od ap fo r r he fo n st io lo e an except had mostly e ad lli m co e sh er rd d, te bo t ill. This indica ould be contra h before she go force feeding w treat she had come to cheris a on chopsticks,

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Those already familiar with the unfolding of an unhurried death also recognize that the quality of life scales some utilize in veterinary medicine, at times even in the name of hospice, are based on nonacceptance of the dying process. Modern hospice is defined by embracing death as “nothing to be feared nor avoided, not to be postponed nor hastened”, while providing for the highest quality of life possible. For practitioners not resonating with this principle, yet offering palliative care to terminally ill patients, the term “end-of-life care” can be used. In his article “The ethics of influencing clients”, J. M. Yeates suggests that “Withholding options is arguably the strongest form of coercion.” Veterinarians not inclined to assist the dying and their families without euthanasia can still point out all the options to their clients, and refer them as needed. Otherwise, truly informed consent

Allowing an animal to die at home, surro unded by both human and animal loved ones, eases the proc ess for all concerned.

ch of a human han atmosphere, and the tou A comfor table soothing ce. ient pass in pea helps this terminally ill pat

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Hospice Ca

ospice care for terminally ill animals and their families is showing steady growth in demand and supply, and veterinarians are receiving more requests from clients for this type of support.

remains elusive, and “hospice” outcomes will yield near 100% euthanasia rates. It does not have to be that way.

integrative veterinary care

Allowing an animal to die at home, surro unded by both human and animal loved ones, eases the proc ess for all concerned.

ch of a human han atmosphere, and the tou A comfor table soothing ce. ient pass in pea helps this terminally ill pat

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for times when the animal’s owner goes to work, travels or needs respite. A social worker can help the caregiver solve daily logistics, while a bereavement counselor can help the family with their grief, including anticipatory grief. An animal chaplain can provide comfort, help the family process spiritual concerns, and deliver memorial services. Family, friends and experienced clients with an interest in volunteering can be engaged in sharing the workload and daily household tasks. • Inform clients of end-of-life options early, before their animals face a terminal illness.

ill patients at home. caring for terminally in ts en cli aid n ca House call visits

the same option for their other pets. The sooner these owners learned about end-of-life options, the higher the percentage of those who chose to hospice their animals. It rose from zero to 56% once I realized it could be done; clients were much more likely to choose hospice if they knew of the option well before they entered into the distress of their animals being diagnosed as terminally ill.

What to know about offering hospice • I t has to come from your heart. Otherwise, locate and provide referral resources (no shame, no blame!). Being prepared to refer if hospice services cannot be provided is also suggested in the AVMA Guidelines on Veterinary Hospice Care.

67% of hospice patients in my holistic practice, while also remaining under the care of their primary conventional veterinarians, died in their own time. The owners were deeply grateful, and prone to re-elect the same option for their other pets. •S eek out the best animal hospice education for both veterinarians and technicians. The aim is to be as adept in offering support through the patient’s dying process as you already are in delivering euthanasia. • Locate team members also outside your practice: in hospice, both the patient and his family receive care! Recommend reliable pet sitters with experience in special needs care

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• Offer house call visits for hospice patients; where state regulations allow, most such visits can be done by a tech under “indirect supervision”. Alternatively, partner with or refer clients to a house call veterinarian. • Ask for and listen to the caregiver’s beliefs, needs, goals and concerns as much as you pay attention to the animal’s needs. One affects the other, always. • Educate the caregiver on the animal’s health condition. Whenever a disease progression is discussed, illuminate available comfort care measures. Keep in mind that an invasive procedure can at times provide the most effective and suitable comfort care – for example, a thoracocentesis to relieve respiratory distress, or using an esophageal tube when an animal, though still hungry, can no longer eat on his own due to a mouth tumor. Just remember that force feeding an animal that has lost his appetite is contraindicated in hospice care.

“hands on” inclined clients by teaching them simple acupressure techniques helpful to their animals. • Always equip hospice clients with comfort kits for their animals in case a crisis arises outside business hours. The kit should contain medications to be kept in the patient’s home in the event of emergency. It contributes to peace of mind for the caregiver – and for you even if none of the contents have to be used. A comfort kit may save the day – or the night, if an emergency arises when veterinary help is not within immediate reach.

the latter should always remain a part of the comfort kit. • Even if you momentarily think it, don’t say: “Nothing else can be done to make your animal (more) comfortable,” just because you are stepping into unfamiliar territory. If pain is the issue, consider multimodal approaches. Make sure to know how to treat neuropathic pain. If all available knowledge and experience fail, approach the situation with a “beginner’s mind”. Relax to allow the solution to come to you. It may be a lot simpler than you can imagine.

• The hospice kit should contain a strong fast-acting pain medication such as morphine. Also include an anxiolytic (consider lorazepam, as it can be safer than diazepam in medically fragile animals), and any medication that may be required if the patient’s particular condition suddenly progresses. • If you are already practicing integrative medicine, you may be able to offer patients homeopathics and/ or herbs or essential oils that may alleviate symptoms without the use of conventional medications. However,

Many owners take comfor

r their dying pets.

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• The caregiver’s perspectives, capabilities and circumstances are taken into consideration when shaping the treatment plan. Constant pain needs constant treatment – prn dosing is unsuitable for those situations, and pain levels should not be allowed to spike. Demonstrate palliative care techniques to owners; often, this can be done by a technician. • Encourage the caregiver to keep a daily health log to track the animal’s current situation and any changes as well as treatments. This will help with care evaluation, allow others to smoothly take over the care on a temporary basis, and aid in distinguishing medication side effects from disease progression. • Include lower budget options. Consider effective solutions that are easily available to the average household, such as pumpkin and rectal hydration for constipation. Another example are heat packs and cold packs, which can be remarkable pain relievers where indicated. Or empower integrative veterinary care

ill patients at home. caring for terminally in ts en cli aid n ca House call visits

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Many owners take comfor

r their dying pets.

t in being able to sleep nea

• Aim to provide 24/7 access to advice. Trained techs on rotation, other hospitals, or house call vets may partner with you. Consider special agreements with emergency clinics, or a local pet hospice team, if available. If all else fails, simply limit the number of patients you accept for hospice service. Your health comes first! • Always arrange for 24/7 access to in-home euthanasia in case it’s needed. Here too, rotating those on call is key. Generally, hospice patients are only euthanized if their comfort levels cannot be sufficiently maintained despite best available palliative care. • As needed, provide emotional support for the family after the death of their animal companion (this also applies in non-hospice end-of-life care). • Take good care of yourself, whether you decide to engage in hospice or not! Embrace death and celebrate life! • Don’t let a lack of experience keep you from considering hospice care. A willingness to serve and search for solutions can often counterweigh limited experience as long as there is clear communication with clients.

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As we allow ourselves to delve into delivering support beyond where we have gone before, we may start seeing with the eyes of one of my Spirits in Transition seminar participants, who wrote: “Slowly, one by one, a shift is beginning. I do many ‘things’ but this hospice is my crusade. Working in a very Western-minded veterinary clinic, it does continue to be quite challenging. But any chance I get, I offer the option to consider hospice – guiding [clients] along the path, helping however I can, until the time when, the needle ‘robbed’ of its task, the spirit departs, and I can look into the eyes of one who has just lost a very beloved companion and see, not raw grief, but a sense of wonder and peace…. It is so worth it!”

Veterinary Resource Guide

Dr. Ella Bittel graduated from veterinary school in Hannover, Germany, in 1994. Specializing in holistic modalities, she studied homeopathy in her home country, certified with the American Veterinary Chiropractic Association (AVCA) in 1998 and the International Veterinary Acupuncture Society (IVAS) in 1999. Now living and working in California and Arizona, Dr. Bittel also offers craniosacral work and herbal approaches. She presents on integrative animal hospice care at

International Symposium for Veterinary Hospice Care, and is on the advisory board for the Nikki Hospice Foundation for Pets (NHFP). Being aware of the lack of educational resources in the area of her greatest passion, Dr. Bittel has also created weekend seminars and online classes on animal hospice care (spiritsintransition.org). veterinary conferences and the

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References

Armer, J., Bittel, E. “When is end-of-life care for animals truly hospice? The (almost) invisible difference determining life and death”, The Latham Letter, Fall 2011. American Veterinary Medical Association (AVMA), Guidelines for Veterinary Hospice Care, update April 2011.

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Clough, E. and J. “Helping clients say good-bye – hospice for pets”, AVMA conference proceedings, 1997.

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De Louise, D., Lane, M. S. “Pet hospice – caring until the end”, ASPCA Animal Watch, 2001.

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NHPCO Facts and figures: Hospice care in America, National Hospice and Palliative Care Organization, 2010. SpiritsInTransition.org (animal hospice communications), 2006 to present.

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Tremayne, J. “Focusing on the end”, Veterinary Practice News, July 2008. Yeates, J. M. “The ethics of influencing clients”, J Am Vet Med Assoc, 237(3), 263-7, 2010.

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References

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Clough, E. and J. “Helping clients say good-bye – hospice for pets”, AVMA conference proceedings, 1997.

Not all supplements are alike...

De Louise, D., Lane, M. S. “Pet hospice – caring until the end”, ASPCA Animal Watch, 2001.

Companies displaying the NASC Seal of Quality are independently audited and their Quality System Requirements (QSR) have been verefied.

NHPCO Facts and figures: Hospice care in America, National Hospice and Palliative Care Organization, 2010. SpiritsInTransition.org (animal hospice communications), 2006 to present.

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For more information visit www.NASC.cc

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Tremayne, J. “Focusing on the end”, Veterinary Practice News, July 2008. Yeates, J. M. “The ethics of influencing clients”, J Am Vet Med Assoc, 237(3), 263-7, 2010.

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Feeding the PSSM horse by Dr. Frank Gravlee, DVM, MS, CNS

olysaccharide Storage Myopathy (PSSM, EPSM) is a neuromuscular disorder that affects a wide range of breeds, from quarter horses to warmbloods to drafts. Low carbohydrate and low glycemic index feedstuffs, combined with frequent small meals is the best feeding program for horses with this condition. Why? Since PSSM involves the deposition of a non-bioavailable form of glycogen into the muscle tissue, the best diet is one that minimizes glycogen formation. If a horse needs a calorie source in addition to the cellulose provided by pasture hay to maintain body condition score, you can consider vegetable oil or sugar beet pulp. Vegetable oil is converted to “energy dense” volatile fatty acids in the hindgut, and bypasses glucose metabolism. An adult horse of average weight can be given as much as 1 cup (240 ml) three times per day if needed to maintain weight; however this amount of oil must be gradually increased from one third cup (80 ml) per feeding. Sugar beet pulp is another low glycemic index feedstuff that, when digested by the hindgut microbes, will provide a safe calorie source. Sugar beet pulp is the product that remains after the sugar has been extracted and is a high cellulose feeding stuff for horses. The cellulose is converted to usable energy in the hindgut of the horse and therefore bypasses sugar and glycogen formation. Dr. Frank Gravlee graduated University School of Medicine

from

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A new immunotherapy for dogs with advanced non-Hodgkin lymphoma (NHL) has been shown to improve survival and maintain quality of life, according to a study published in Scientific Reports. The study arose from a collaboration between The University of Texas MD Anderson Children’s Cancer Hospital, and Texas A&M University College of Veterinary Medicine. Using a T-cell therapy developed at MD Anderson, veterinarians from Texas A&M saw a nearly four-fold improvement in tumorfree survival in dogs with NHL, compared to those who received only chemotherapy. The median tumor-free survival increased by close to nine months.

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To accomplish the T-cell therapy, researchers took a sample of peripheral blood from each dog entering the study. The T-cells were separated and expanded in the laboratory over several weeks. As the T-cells grew, the dogs received a chemotherapy regimen similar to what humans with NHL receive – a combination of cyclophosphamide, vincristine, doxorubicin and prednisone. The T-cells were then given back intravenously after chemotherapy to improve the anti-tumor effects.

in t

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“The therapy was well tolerated in all dogs who received the infusions,” said Heather Wilson-Robles, DVM, DACVIM(Oncology). “We saw fewer side effects than with traditional chemotherapy, and the pet owners were pleased with how their dogs tolerated the protocol.”

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Feeding the PSSM horse by Dr. Frank Gravlee, DVM, MS, CNS

from

Auburn

and practiced

veterinary medicine for several years before attending graduate school at

MIT. During

a three-year residency in nutritional pathology,

The Premier School for

Recommend to your patients for post-op care and for debilitating injuries and conditions.

T-cell therapy for

canine lymphoma

Animal Healing Arts Education & Professional Study Programs Teleclasses, Webinars and On-Site courses

?ahÛ\qkhdYkaYÛÝÛ::CÛ@fbmja]k Yjl`jalakÛÝÛj]YjÛd]_ÛYehml]]k

Animal Spirit

Healing Education

DogTreader.com 888-966-2824

Animal Communication Animal Reiki and Energy Balancing Animal Loss and Grief Support AnimalSpiritNetwork.com

815.531.2850

Dawgs on the Go The ultimate leash accessory for Dawgs on the Go. Designed to hold poop bags, cell phone, keys and more.

in t

he received a masters degree in nutritional biochemistry and intermediary metabolism.

1973,

he founded

Life Data Labs

to determine

equine nutritional deficiencies through laboratory testing, and developed individualized feeding programs to correct the deficiencies he discovered.

After

ten years of research, he launched

Formula. lifedatalabs.com

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events 84th Annual Western Veterinary Conference February 19-23, 2012 Las Vegas, NV Now in its 84th year, the Western Veterinary Conference is the largest gathering of Veterinarians and Veterinary Technicians in the world. Nearly 950+ hours of cutting edge programming covering a wide spectrum of topics and species with specially designed courses for the Veterinarian, Veterinary Technician, and Practice Manager. All presentations are located at the Mandalay Bay Convention Center, on Levels 2 & 3, just steps away from the Exhibit Hall. For more information: (866) 800-7326 www.wvc.org

Canine Heartworm Disease February 28, 2012 Online, USA Join this online event for 90 minutes of updates on Canine Heartworm Disease. For more information: VetVine â&#x20AC;&#x201C; Dr. Sheri Berger (646) 489-7830 ce@vetvine.com www.vetvine.com

look at leadership, creativity, innovation and the issues facing academic veterinary medicine. For more information: (202) 371-9195 www.aavmc.org

Animal Chiropractic Program Module 1 â&#x20AC;&#x201C; Sacro-Pelvic March 8-11, 2012 Dallas, TX Parker University is proud to offer the only continuing education Animal Chiropractic Program taught by an accredited chiropractic college in North America. With Parkerâ&#x20AC;&#x2122;s 25+ years experience in offering quality chiropractic continuing education, we feel we are the number one choice for doctors wanting to learn animal chiropractic. The diagnosis and management of injured animals is an area of increased interest for both chiropractors and veterinary practitioners. Register for Parkerâ&#x20AC;&#x2122;s Animal Chiropractic continuing education class today! For more information: (800) 438-6932 askpostgrad@parker.edu www.parker.edu/Acupuncture-200-HourProgram

AAVMC Annual Conference March 7-11, 2012 Alexandria, VA The conference is shaping up to have focus on leadership, academic food supply veterinary medicine, the future of clinical veterinary education, and more. A featured leadership session will cover how different people play different roles in innovation and creativity and what this means for teaching, the work environment, or reaching out to stakeholders of academic veterinary medicine. Please consider inviting colleagues, faculty, or staff in areas such as admissions or communications who might also benefit from an in-depth

AAHA Denver 2012 Yearly Conference March 15-18, 2012 Denver, CO The only conference dedicated exclusively to companion-animal care. This year, you can combine the quality CE youâ&#x20AC;&#x2122;ve come to expect from AAHA with an adrenaline rush as you learn to kayak or rock climb at the AAHA Adventure Center.

Practice Makes Perfect: Essential Soft Tissue Surgery in the Dog & Cat â&#x20AC;&#x201C; Oquendo Center March 16-17, 2012 Las Vegas, NV In the format of an intense and extended learning opportunity, this course provides participants direct skill building with selected basic and advanced soft tissue canine and feline surgical procedures that are needed in private practice. Procedures are selected from those that may be required in emergency clinics and elective settings. A personalized approach to intra-operative instruction, a low faculty ratio and ample time per procedure allows the necessary time for participants to build precision and speed. Pre-laboratory demonstrations and coaching points will occur immediately prior to each exercise. The result of unhurried practice should be the mastery of new procedures highly useful to expand the range of surgical therapeutics in small animal practice. This is a 2.5 day course. For more information: (702) 739-6698 www.oquendocenter.org

Atlantic Provinces Veterinary Conference 2012 April 20-22, 2012 Marriott Harbourfront Hotel, Halifax, NS Join more than 800 delegates, over 55 exciting companies and a world class list of speakers in an environment of true maritime hospitality.

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V2I1 (Winter 2011-12)

Articles inside

Is your patient depressed?

Tech Talk

Leading the way

Rehab for a torn CCL

Cold laser therapy

Feline diabetes mellitus – part 1