V3I4 (Fall 2013) by Redstone Media Group

IVC FALL ISSUE 2013

Integrative VETERINARY CARE

TREATING CANINE OSTEOARTHRITIS. WHY A

MULTIMODAL APPROACH IS MOST EFFECTIVE. Page 50

TREATING CORNEAL ISSUES

FALL ISSUE 2013

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INTEGRATIVE VETERINARY CARE JOURNAL

Success means addressing root causes and using both alternative as well as allopathic therapies.

TACKLING OBESITY

Discussing a patient’s weight issues and diet with the owner is an important part of the treatment plan.

OZONE THERAPY

It’s being proven effective for treating viruses, fungi and bacteria, as well as inflammation and tissue damage.

PREPARING FOR DISASTERS

Protect your patients and practice with good planning and a strong team.

HAIR MINERAL ANALYSIS FOR HORSES

Learn how it can reveal imbalances, toxins, overloads and deficiencies in your equine patients.

WHAT’ S NEW

• Genomic science – the next step • Is the incidence of feline cytauxzoonosis increasing? • Microchimerism found in dogs • Antibiotic resistant bacteria on the rise

2 IVC Fall 2013

Integrative VETERINARY CARE

FALL 2013

EDITORIAL DEPARTMENT Editor-in-Chief: Dana Cox Managing Editor: Ann Brightman Associate Editor: Christina Chambreau, DVM, CVH Senior Graphic Designer: Dawn Cumby-Dallin Senior Graphic Designer: Kathleen Atkinson Social Media Manager: Natasha Roulston Social Media Editor: Jasmine Cabanaw Cover Photography: Digital Vision

COLUMNISTS & CONTRIBUTING WRITERS Iris Bell, MD, PhD Sherman O. Canapp Jr., DVM, MS, CCRT Jane Doyle, DVM, CVA Shelley R. Epstein, VMD, CVH Lisa M. Fair, VT, CCRA, CMT Apryl Garcia, DVM, CVA Jack Grogan, CN Patrick Hardigan, PhD Federico G. Latimer, DVM, MS, DACVS Heidi Lobprise, DVM, DAVDC Lisa J. Melling, DVM, CVH Shawn Messonnier, DVM Chad Orlich, DMD Darren Pike, DMD Lucy Postins Donna Ragona, DVM Margo Roman, DVM, CVA, COT, CPT Delena Stout Stephanie Sur DVM, CVH Mayra Urbieta, DMD Dirk B. Yelinek, DVM

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CDN MAIL: IVC Journal, 202-160 Charlotte St. Peterborough, ON, Canada K9J 2T8. The opinions expressed in this journal are not necessarily those of the editor, and different views may appear in other issues. Redstone Media Group Inc., publisher of IVC Journal, does not promote any of the products or services advertised by a third party advertiser in this publication, nor does Redstone Media Group Inc. verify the accuracy of any claims made in connection with such advertisers.

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IVC Prem.ind

IMPROVING THE LIVES OF ANIMALS... ONE READER AT A TIME.

IVC Fall 2013

contents FEATURES

INTEGRATIVE TREATMENT OF THE CORNEA

The primary objectives in treating corneal issues are patient comfort, and saving the eye and vision. This often means addressing deeper causes of the problem and using alternative as well as allopathic therapies.

Nutrition Nook SAFE DIETING–INTEGRATIVE APPROACH TO OBESITY

Along with medications and therapies like acupuncture and herbs, it’s crucial to discuss an obese patient’s diet, diagnose potential underlying medical disorders, and communicate clearly and tactfully with clients about their pets’ weight issues.

OZONE THERAPY IN THE VETERINARY PRACTICE

By bringing easily soluble oxygen to target tissues, ozone therapy is being proven effective for treating viruses, fungi and bacteria, and for general health improvement in cases of inflammation and tissue damage.

PREPARING FOR DISASTERS –VETERINARY STYLE

Protecting your patients and practice during an emergency involves good planning and a strong team that includes family and neighbors as well as colleagues and staff.

STUDY ON PROFESSIONAL OUTPATIENT PREVENTIVE DENTISTRY (POPD™)

Can dental cleaning and procedures be done safely and effectively without the use of general anesthesia?

56 4 IVC Fall 2013

MESSAGES FROM THE MANE

Hair mineral analysis provides a unique perspective on a horse’s biochemical individuality, and indicates imbalances, toxins, overloads, deficiencies and mineral interrelationships that may need correction.

Tech Talk THE GENTLE POWER OF EMPATHY

Your skills as a technician, combined with your ability to understand what fearful patients and clients are going through, can help calm and heal them on both an emotional and mental level.

TREATING CANINE OSTEOARTHRITIS – PART ONE

Managing this common condition must evolve from palliative treatment of established disease using just a few modalities, to early intervention and a comprehensive multimodal approach.

Integrative Practice PEOPLE CRAVE A BEAUTIFUL EXPERIENCE…EVEN AT THE VETERINARY CLINIC

Taking steps to make your clinic more comfortable, soothing and welcoming will reduce anxiety in pets and people and make veterinary visits go more smoothly for everyone.

HOMEOPATHY: A 200 -YEAR-OLD NANOMEDICINE–PART 2

Its acceptance has been hindered by the inability to scientifically explain its mechanism of action. But old assumptions about the lack of particles in high dilutions have been overturned by advances in modern technology.

advisory board 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.

COLUMNS & DEPARTMENTS

5 Advisory board 6 Editorial 10 What’ s new 31 Spotlight

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.

32 From the VBMA 55 Industry Innovations 60 From the IVAS 61 Veterinary resource guide 70 From the AVH 71 Social media 73 Marketplace 74 Events

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 trai ned 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, CVH, graduated from the University of Georgia Veterinary College in 1980. She is a founder of the Academy Of Veterinary Homeopathy, was on the faculty of the National Center for Homeopathy Summer School and has been the holistic modality adjunct faculty liaison for the Maryland Veterinary Technician Program. Dr. Chambreau teaches classes in homeopathy for animals, and lectures on many topics. She is the author of the Healthy Animal’s Journal and the co-author of the Homeopathic Repertory: A Tutorial.

Bill Bookout is a founding member of the NASC, and served as president and chairman of the board from 2002–2012. Mr. Bookout was appointed vice president of global sales for Kemin Industries after Kemin acquired his supplement company, Genesis Ltd. Prior to his work in the animal field, Mr. Bookout spent 15 years in the human medical device, drug and animal health industries. Mr. Bookout 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.

IVC Fall 2013

editorial

Going integrative opens many doors

dding holistic modalities to my practice saved my sanity. I now have many more diagnostic and treatment options to offer clients, including those who have lost mobility from osteoarthritis, the theme of this issue. Dr. Sherman Canapp, writing in both this edition and the next, covers a wide range of treatments for osteoarthritis, such as stem cell therapy and assistive devices. The use of chiropractic, TCVM and homeopathy is also steadily increasing. And Dr. Margo Roman covers ozone, one of the newest ways to manage pain, as well as enhance all healing modalities for a range of ailments. One of the joys of my integrative practice is great communication with clients. We really act as partners in achieving and maintaining health. Dr. Lisa Melling uses great examples from her house call practice to show how technicians and veterinarians can work with clients so even previously “need to be muzzled” dogs and “this one needs the pole” cats can be easily examined and treated in the home or clinic. Communication is also critical when bringing up weight issues with clients, as Dr. Apryl Garcia discusses in her article. A key principle in integrative medicine is to focus on all symptoms presented, not merely the current illness. Each animal with the same problem, therefore, may need a different set of treatments. Dr. Jane Doyle shows how a single topical treatment for corneal ailments is supplemented in each animal with additional, individualized treatments. Dr. Jack Grogan emphasizes how hair analysis can individualize treatments and diet for horses to rectify mineral deficiencies and excesses

6 IVC Fall 2013

as well as eliminate toxic metals. We also continue our look at the efficacy of anesthesia-free dentistry with a study by Dr. Mayra Urbieta. Individualizing our offices is as important as treating each patient as a unique being; Dr. Donna Ragona covers how we can use painting, design and color to enhance the ambience of our clinics. Dr. Dirk Yelnick, meanwhile, shows how we can evaluate our own needs to adequately prepare for disasters. Homeopathy was my introduction to energetic medicine. For decades, I never understood how matching the energetic patterns of a remedy to an animal (or person) could cure so deeply that all problems, from minor to severe life-threatening pathology or behavior issues, could completely resolve. Drs. Iris Bell and Shelley Epstein continue their article from last issue with a scientific explanation of how nanoparticles may explain the power of homeopathy. On the IVC website, we would love to share your cases using integrative modalities as well as your journey towards integrative practice. Stories remind us of where we come from, pitfalls to avoid, joys that are possible in everyday practice, and the many ways we can help animals. Have a great fall. And make a note to stop by our booth at the NAVC conference in Orlando in January!

Christina Chambreau, DVM, CVH Associate Editor

IVC Fall 2013

contributors

1. IrIs BELL, Md, PHd Dr. Iris Bell is a board-certified psychiatrist, professor Emeritus of Family and Community Medicine, psychiatry, psychology, Medicine and public Health at the University of Arizona, and Research professor at the University of Arizona College of Nursing. Her research interests include complementary and alternative medicine (especially homeopathy) and the application of complex systems theory and science to CAM research.

2. sHErMAN O. CANAPP Jr., dVM, Ms, CCrT Dr. Sherman Canapp completed a combined Doctor of Veterinary Medicine and Masters of Science in clinical surgery at Kansas State University. He became a member of the American College of Veterinary Surgeons, and completed his certification in canine rehabilitation, stem cell therapy and TpLO certification. He was named a charter diplomate in the newly recognized American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR). Dr. Canapp practices orthopedic surgery and sports medicine at the Veterinary Orthopedic & Sports Medicine Group (VOSM) in Annapolis Junction, Maryland.

3. JANE dOYLE, dVM, CVA Dr Jane Doyle earned her veterinary degree from the University of Georgia in 1989. After graduation, she immediately took the holistic path, studying homeopathy and acupuncture. From 1989 to 1991, she was Director at Hopi Veterinary Service in polacca, Arizona. She earned certification in veterinary acupuncture from the International Veterinary Acupuncture Society and started her own holistic veterinary practice in Berkeley Springs, West Virginia, where she concentrates on homeopathy.

4. sHELLEY r. EPsTEIN, VMd, CVH Dr. Shelley Epstein is a 1985 graduate of the University of pennsylvania School of Veterinary Medicine. She started practicing at Wilmington Animal Hospital, and has since become the sole owner of the practice. In 1997, Dr. Epstein

8 IVC Fall 2013

became certified in veterinary homeopathy by the Academy of Veterinary Homeopathy. She has studied chiropractic as well, and her practice incorporates many CAVM modalities alongside conventional medicine and surgery.

5. APrYL gArCIA, dVM, CVA Dr. Apryl Garcia is the owner, manager and veterinarian at Bottletree Animal Hospital in Mississippi. She graduated from Auburn Universityâ&#x20AC;&#x2122;s School of Veterinary Medicine and has practiced in several states. For the past three years, she has been doing veterinary relief work in small animal practices throughout Tennessee and Mississippi. In 2012, she became a certified veterinary acupuncturist from the Chi Institute in Florida. Dr. Garciaâ&#x20AC;&#x2122;s special interests include dentistry, dermatology and acupuncture.

6. JACK grOgAN, CN Jack Grogan is a graduate of the University of Toledo, and professional member of the Institute for Functional Medicine, the American Oil Chemist Society, the American College for Advancement in Medicine, and the International Society of Sports Nutrition. He is also Chief Science Officer for Uckele Health & Nutrition. He is a recognized expert in Hair Mineral Analysis, and has considerable experience in the fields of biology, biochemistry and nutrition.

7. LIsA J. MELLINg, dVM, CVH Dr. Lisa Melling graduated from Iowa State University with a Bachelor degree in Animal Science, and later graduated from Tuskegee University School of Veterinary Medicine with a special interest in animal behavior and emergency medicine. She cofounded Best Friends pet Wellness, a house call practice in the Ann Arbor area. She is recognized as a Certified Veterinary Homeopath by the Academy of Veterinary Homeopathy. Dr. Melling offers consultations in classical homeopathy, nutrition, wellness care, medicine and surgery.

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contributors

8. dArrEN PIKE, dMd Dr. Darren pike graduated from the University of Florida with both a Bachelors and Masters of Science degree in Food Science and Human Nutrition. A periodontist, he performs all surgical aspects of implant dentistry and periodontics. He continued at Nova Southeastern University to complete an additional three years of specialty training in periodontology. Dr. pike is a Diplomat of the American Academy of periodontology (AAp) and the Academy of Osseointegration (AO).

9. dONNA rAgONA, dVM Dr. Donna Ragona graduated from the University of Wisconsin and became a certified animal acupuncturist from the Chi Institute of Traditional Chinese Veterinary Medicine. Her Cocoa Village Animal Wellness Center in Cocoa, Florida offers integrative care. Dr. Ragona is also an accomplished artist and created VetMedArt (vetmedart. com) while in veterinary school. Her work can be viewed in several universities around the country, AVMA publications, on Animal Planet and at the annual NAVC.

10. MArgO rOMAN, dVM, CVA, COT, CPT Dr. Margo Roman graduated from the Veterinary College at Tuskegee Institute of Alabama, and was on the faculty of Tufts University, teaching anatomy, physiology and acupuncture. She was the consulting veterinarian in an IACUC for Creative Biomolecule in Hopkinton, Massachusetts, studying osteogenic proteins. Dr. Roman’s integrative practice, Main Street Animal Services of Hopkinton (MASH), offers chiropractic, physical therapy, massage, Reiki, homeopathy, acupuncture, herbs, conventional medicine and more.

11. sTEPHANIE sur, dVM, CVH Dr. Stephanie Sur attended the University of California Davis as an undergraduate. She earned two Bachelor of Science degrees in Medical Microbiology and Neuropsychology. Dr. Sur went on to receive her Doctor of Veterinary Medicine

degree from Ross University School of Veterinary Medicine, then returned to California to practice small animal medicine. She recently completed her IVAS certification in veterinary acupuncture. Dr. Sur uses integrative approaches to animal healthcare, including acupuncture. She is a member of the AVMA, CVMA, AAVA, AHVMA and HSVMA.

12. MAYrA urBIETA, dMd Dr Mayra Urbieta graduated from Georgetown University with a Bachelors in Science in Health Studies and earned her Doctor of Dental Medicine degree with honors from Boston University. She is a periodontist who provides in-office specialty services to dental practices in the Los Angeles and Orange County areas. She has also been working with pet Dental Services for the past five years as their Director of Research and Training. She is a member of the American Academy of periodontology.

13. dIrK B. YELINEK, dVM Dr. Dirk Yelinek is the 2013 president of the AHVMA and the hospital director of Redondo Shores Veterinary Center. He is a graduate of The Ohio State University College of Veterinary Medicine. An integrative veterinarian, he uses conventional therapies and surgery with an interest in TCVM and Veterinary Spinal Manipulative Therapy or “chiropractic”. Dr. Yelinek is employed by the federal government as Deputy Team Commander of the National Veterinary Response Team-4 (NVRT-4) of the Western US region.

LIsA M. FAIr, VT, CCrA, CMT Lisa M. Fair began working with Dr. Sherman Canapp as an orthopedic and surgical technician. She then completed her certification in canine massage and rehabilitation therapy, and provides rehabilitative services part-time. She has authored numerous articles and texts on specific orthopedic conditions in small animals, bandaging and rehabilitation therapy. She is a moderator for a rehabilitation therapy forum, and assists Dr. Canapp with special projects, research, client services and patient care.

IVC Fall 2013

what’s new GENOMIC SCIENCE – THE NEXT STEP Texas A&M University has announced a new research initiative that may revolutionize scientific discovery. The Whole Systems Genomics Initiative (WSGI) is set to define the future of genomic science. While recent advances in technology have led to impactful discoveries in deciphering and engineering genomes, the next era of genomic science will push the frontiers of discovery as researchers work together to identify novel applications for this new knowledge. “Genomic science, as the newest frontier in scholarly research, is throwing open the door to a revolutionary way of approaching our health, the health and welfare of animals, and the sustainability of our environment,” says John Sharp, Chancellor of The Texas A&M University System. The genome revolution will lead to rapid advancements in personalized medicine for human, animal, and plant disease management; genetically engineered organisms for improved biofuel production and environmental sustainability; and enhanced efficiency of food production and security.

Officials from the Texas A&M University and Health Science Center welcome Dr. David Threadgill (sixth from left) to assume the helm as Director of the Whole Systems Genomics Initiative.

BENEFITS OF DOG-FRIENDLY WORKPLACES According to a Virginia Commonwealth University study, employees who bring their dogs to work produced lower levels of the stress-causing hormone, cortisol. Stress is a major contributor to employee absenteeism, morale and burnout and results in significant loss of productivity and resources. But the preliminary study, published in the March 2012 issue of the International Journal of Workplace Health Management, found that dogs in the workplace may buffer the impact of stress during the workday for their owners, and make the job more satisfying for those with whom they come into contact. The VCU researchers compared employees who bring their dogs to work, employees who do not bring their dogs to work, and employees without pets in the areas of stress, job satisfaction, organizational commitment and support. “Although preliminary, this study provides the first quantitative study of the effects of employees’ pet dogs in the workplace setting on employee stress, job satisfaction, support and commitment,” says principal investigator Randolph T. Barker, Ph.D., professor of management in the VCU School of Business. “Pet presence may serve as a low-cost, wellness intervention readily available to many organizations and may enhance organizational satisfaction and perceptions of support.” A recent survey of 50 companies that welcome pets found: 1. Lower stress levels and less absenteeism than in pet-free offices. 2. Productivity and employee morale got a boost when canine companions joined the work force. 3. Employees were more willing to work overtime, thanks to the addition of pets in the workplace. vcu.edu

10 IVC Fall 2013

VOLUNTEER VACATIONS

FOCUS ON SUSTAINABILITY The Pet Industry Sustainability Coalition is a new non-profit that strives for environmental sustainability within the pet industry. It promotes creative collaboration among manufacturers and retailers by encouraging implementation of best practices, and providing tools and resources for authentic environmental improvement. sustainablepet.org

GoVoluntouring.com is a website for travellers looking for volunteer vacations. It works with charities and non-profits around the world. A lot of their projects focus on animal welfare – from TNR in Nepal to humane animal population management in Mexico, and many others.

MICROCHIMERISM FOUND IN DOGS Some people have a small number of cells in their bodies that are not genetically their own; the condition is known as microchimerism. It is difficult to determine potential health effects from this condition because of our relatively long lifespans, but researchers at the University of Missouri have discovered that microchimerism can be found in dogs as well. Jeffrey Bryan, an associate professor of oncology at the MU College of Veterinary Medicine, says this discovery will help doctors determine which diseases humans with microchimerism may be more likely to develop during their lifetimes.“Finding microchimerism in dogs allows us to track this condition over a lifespan of about ten years, as opposed to the 70 or 80 years of a human life,” says Bryan. “The pet dog represents an excellent model of many ailments in people, and the presence of fetal microchimerism in dogs will allow studies which further clarify its role in health and disease,” adds Sandra Axiak-Bechtel, an assistant professor of oncology at the MU College of Veterinary Medicine In their study, published in PLOS ONE, Bryan and Axiak-Bechtel, along with MU researchers, studied 90 golden retrievers and found that 36% of the dogs had microchimerism. Axiak-Bechtel and Bryan plan to continue their research to follow the lifespans of dogs with microchimerism to determine what diseases those dogs may be susceptible to. http://munews.missouri.edu/news-releases/2013/0709-mu-researchers-find-condition-in-dogsthat-may-help-further-research-into-human-disease/ IVC Fall 2013

what’s new HORSE SENSE – AND SAFETY Equine authorities from Michigan State University’s My Horse University and eXtension HorseQuest have introduced a new educational program for youth (adults are also encouraged to particpate) called “Horse Sense – Equine Farm Safety Training.” The program contains eleven short courses that include videos, links and activities for participants, designed to provide important horse safety information. Topics include horse behavior and handling, machine safety, biosecurity and more. Students will receive a certificate for each successfully completed course. The courses are self-paced, free of charge, and open to anyone who works with horses. myhorseuniversity.com/youth

MUSTANG MANAGEMENT A National Academy of Sciences (NAS) study has identified ways the Bureau of Land Management (BLM) can modify its program to manage sustainable populations of wild horses on public lands. “It is clear that the status quo of continually removing free-ranging horses and then maintaining them in long-term holding facilities, with no foreseeable end in sight, is both economically unsustainable and discordant with public expectations,” the study states. Birth control, reintroduction of horses to habitats they once roamed, and sanctuary designations are viable options but have been ignored or under-utilized. The NAS study indicates that on-range methods are the most cost-effective and efficient, suggesting that it’s time for the agency to shift its focus to these strategies.

12 IVC Fall 2013

CYTAUXZOONOSIS INCIDENCE INCREASING? Cat owners and veterinarians in rural areas near Chattanooga, Tennessee should know that a rare but serious tick-borne feline disease called cytauxzoonosis may be on the rise. According to veterinarian Dr. Darlene White of the Wolftever Pet Hospital, who has seen three cases of the disease in the last two years, cytauxzoonosis is untreatable and almost always fatal. Characterized by a high fever and hemorrhaging, the disease is caused by a protozoa carried by bobcats – it is passed to cats when a dog tick feeds on a bobcat, then bites a domestic cat. Because prevention is the only defense at this time, veterinarians in the area are urged to advise cat owners to keep their pets indoors or groom them thoroughly and regularly. Dr. Michael Lane of the Regional Institute for Veterinary Emergencies states that research shows the disease doesn’t spread from cat to cat – the tick must bite the cat before it can occur. He adds that research being done outside the US on the effects of anti-malarial drugs on the disease may provide an effective treatment. timesfreepress.com/news/2013/jul/01/ cat-owners-warned-about-fatal-disease Editor’s comment: Using integrative approaches and having clients become your partners in maximizing their cats’ immune systems is the very best way to prevent this illness.

ANTIBIOTIC RESISTANT BACTERIA ON THE RISE In the first half of 2012, nearly 200 US human healthcare facilities found themselves treating carbapenem-resistant Enterobacteriaceae (CRE). This “nightmare bacteria” is basically untreatable. Although CRE has not been reported in dogs and cats, Jane E. Sykes, BVSc (Hons), PhD, DACVIM, of the University of California Davis School of Veterinary Medicine reminds veterinarians that the rate of antibiotic resistance to other bacteria infecting pets has increased to frightening proportions and emphasizes that more than ever before, we need to be prudent with antibiotic use. veterinarynews.dvm360. com/dvm/ArticleStandard/Article/detail/814500 Editor’s comment: Learning about holistic alternatives can greatly decrease our reliance on antibiotics. They can be used when other approaches are not effective.

Enterobacteriaceae

IVC Fall 2013

INTEGRATIVE TREATMENT OF THE

CORNEA By Jane Laura Doyle, DVM

Problems in the eye can go from mild to extreme within a day. As a result of this and the pain that often accompanies corneal issues, any corneal abnormality should be seen immediately whenever possible. Once you have the patient in front of you, there are multiple approaches you can use to treat the condition. While we are taught a few specific conventional methods, using drugs and surgery, to treat each corneal ailment, some can be challenging to heal (herpes infections or complications from Cushingâ&#x20AC;&#x2122;s or other metabolic ailments) or expensive for the clients (surgery for entropion). Holistic options work at a deeper metabolic level as well as topically on the cornea. Given the chance, the cornea can heal quite nicely. Even entropion can often resolve without surgery.

14 IVC Fall 2013

BASICS OF CORNEAL HEALING Like other epithelia, that of the cornea goes through continuous renewal in order to protect its interior layers of the cornea so it can maintain smooth optical properties and transparency. The outer layer of corneal epithelium has tight junctions between cells and protects the rest of the cornea. Cytokines mediate the stromal-epithelial-immune parts of the healing cascade.1 The stroma, or thick middle layer, contains multiple supportive cells, collagen and nerve fibers. The inner epithelium is a single layer of endothelium, allowing net fluid transport from the corneal stroma to the anterior chamber, offsetting stromal tendency to imbibe fluid and swell (edema). Endothelial fluid transport activity allows maintenance of corneal transparency and

thinness. This enables the cornea to clear edema after healing of the surface epithelium. The primary objectives of treatment are patient comfort, and saving the eye and vision. This often means also addressing the deeper causes of the corneal problem, such as ongoing irritation from foreign bodies or abnormally placed eyelashes, dry eye, glaucoma, uveitis, bacterial or fungal infections which can damage the stroma. Integrative approaches soothe the eye while stimulating deeper immune responses like the healing cascade, so the eye is gently and permanently healed. Often, holistic treatments are sufficient; if not, surgery and drugs can still be used effectively.

INTEGRATIVE TREATMENT OPTIONS For speedy healing of any corneal injury, homeopathic Cineraria maritima applied topically in low potency is a real winner. • In the literature, Cineraria is indicated for the treatment of cataracts. While I find it ineffective for cataracts in my patients, it is an excellent remedy for corneal healing. As with any other eye drops, it does not stay in the eye for more than a few minutes, so it is good to give it frequently if possible, especially at the beginning of therapy. I recommend application every two hours the first day after initial trauma, if possible. I have had 24 years of seeing the healing Cineraria stimulates, and it continues to impress me. • If there is blepharospasm and meiosis, chances are good that the reflex arc from the corneal surface to the brain and back to the muscles of the iris are causing pain to the patient, so topical atropine ophthalmic ointment can be applied every 12 hours in addition to Cineraria. Instill the atropine ten minutes prior to the Cineraria. When using Cineraria and other holistic treatments, it is rarely needed more than a few days. In my clinic, the use of topical antibiotics is neither necessary nor effective, but they do not seem to impede healing when paired with Cineraria. • When there is mucus, or purulent discharge, signiﬁcant beneﬁt is gained by gently flushing the eye with saline solutions. You can dispense these to your clients or they can purchase them in human pharmacies. Keeping the animal’s comfort in mind,

There are many ways the cornea can be damaged: • trauma by blunt or sharp objects • caustic substances or foreign bodies in the eye • self-injury by the patient in cases of ophthalmic pruritus • infectious etiology such as in herpes virus infections • chronic irritation from anatomic anomalies (distichiasis, trichiasis entropion, etc.) • autoimmune issues (pannus) IVC Fall 2013

always warm the saline solution to body temperature. Wait ten minutes after flushing to instill the Cineraria solution. • In Paragraph 203 (and elsewhere) of The Organon of the Medical Art, Hahnemann warns against using topical treatments for surface ailments without having internally treated the disease. I have found oral dosing with homeopathic remedies to be a valuable part of the treatment of a variety of corneal ailments, including pigmentation and scarring, foreign bodies, injuries, granulomatous masses, corneal dystrophy, acute or poorly healing corneal ulcers, descemetocoele, KCS (keratoconjunctivitis sicca) and corneal sequestrum. In most cases, I coupled topical Cineraria with the homeopathically-selected internal medicine matching the individual animal’s unique needs. Remember to alert clients about neovascularization. Often, corneal healing requires an infiltration by capillaries. We know it is a good sign of healing, but it can be alarming for clients to see all that redness on the cornea if they are not informed. Frequent re-checks are important to assure healing progression. I rarely need look beyond Cineraria in my practice, but TCVM (Traditional Chinese Veterinary Medicine) and Western herbs can also topically and internally address the deeper causes of corneal problems2. From the TCVM perspective, the eye is connected to the liver. An excess of heat or lack of moisture in the liver can cause dry conditions in the eye, leading to KCS or ulcers. Determining the acupuncture points and Chinese herbs needed to resolve corneal problems depends on identifying which imbalance is present, as well as looking at behavior and concomitant symptoms. Western herbs can also be useful for eye problems. Euphrasia (eyebright) can be used internally as well as topically by making a tea from the dry herb or tincture. Another useful eye rinse is made from equal parts of marigold, dandelion and chamomile. An astringent eye rinse can help prevent infection when conjunctiva and corneas have been irritated by wind or dust – use raspberry leaf, nettle, Oregon grape and goldenseal. The ingredients in the topical Cineraria drops (Homeopathic Cineraria eye drops for cataract from Natural Ophthalmics) are Cineraria Maritima 5X; Euphrasia 6x; Causticum 6X; Calcarea phosphoricum 10x; Sepia 6X; Calcarea flouricum 11X, and Silicea.

Wilson, SE. “The corneal wound healing response: cytokine-mediated interaction of the epithelium, stroma, and inflammatory cells”. Prog Retin Eye Res. 2001 Sep; 20(5):625-37.

Wynn, S and Marsden, S. Manual of Natural Veterinary Medicine, 2003 pp. 499+. Boericke, W. Materia Medica with Repertory, 1927. 4 Kent, J. Repertory of the Homeopathic Materia Medica, 1984. 5 Coleman, R. Journal Academy Veterinary Homeopathy, Spring 2006 2 3

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Bourke, a threeyear-old male neutered Blue Point Himalayan cat, presented with the diagnosis of corneal sequestrum in the right eye. It had been diagnosed two months earlier during which time he had been on conventional treatments with topical antibiotics with steroids. There was no fluorescein stain uptake, indicating that corneal epithelium had grown over the lesion. There was no blepharospasm, nor corneal edema. The lesion was a brown spot occupying about one-quarter of the upper medial quadrant of the cornea. Bourke had become less playful with the appearance of the sequestrum. Two weeks after beginning treatment with Pulsatilla 30c internally (which was individually selected from 4,000 remedies as a match for Bourke with his sequestrum) and topical Cineraria, the eye was improving and Bourke had returned to his playful self. One month after starting treatment, neovascularization had developed on the cornea. This has not been achieved with the conventional treatment. Nine months after beginning treatment, the client reported that Bourke’s eye was normal, sometimes with a little cloudiness. Seven months after that, he was still fine, and would rather eat and play than sit for photos. Harry was a kitten dropped off at the author’s clinic with his mother and three siblings. He developed severe conjunctivitis and dermatitis, most likely due to herpes virus infection. All conventional treatments were exhausted. He cleared up completely after being given homeopathic Euphrasia officinalis 200c. Continued on page 18.

IVC Fall 2013

Continued from page 16.

A Jack Russell terrier pup presented as an emergency after being bitten through the cornea of the left eye by a copperhead snake. The client came in immediately and we could observe the progression of swelling and discomfort. Comparing the signs we were seeing with the different snake remedies in Boericke’s Materia Medica3, a prescription of homeopathic Naja was chosen. The pup recovered uneventfully. Follow-up was at their regular veterinarian. Months later, the client reported that the eye appears totally normal; however, we do not know if it has vision. Shirley Casey has been training wildlife rehabbers for many years and has numerous success stories. One was a young osprey (Pandion haliaetus) injured by a barbed wire fence. The most severe injury appeared to be to the right eye, which was intact but filled with blood. The other injuries responded to homeopathic first aid remedies: Aconite, then Arnica and then Hypericum. After several weeks of care, all the bird’s wounds healed entirely and the blood cleared from the injured eye. There was no further improvement, and signs of poor vision were apparent: the osprey startled easily and seemed a bit mentally dull. Its wings worked properly, but it consistently veered to the right when attempting level flight. The veterinary exam showed a traumatic cataract in the bird’s right eye with a prognosis of permanent sight damage. The homeopathic veterinarian asked about unique symptoms and the rehabber reported that the osprey did not groom well after getting wet, which was very unusual. The way we choose the individual remedy at this time is to find the symptom in the Repertory. The remedies that caused the symptom in testing or have been known to heal that symptom are listed with each symptom.4 The following list may sound odd, as it is in this homeopathic index. The first word refers to the section of the repertory; the rest is more descriptive of the symptom. • Eyes: cataract, opacity of lens • Eyes: Injuries, from • Head: Injuries of the head, after • Mind: Dullness; injuries of head, after • Mind: Starting, startled; easily • Generalities: Bathing, washing; aversion to, dread of They chose Silicea and gave a single one-time dose of a 30c potency. Within a few days, the bird seemed to be flying straighter! Ten days after this first and only dose of Silicea, the ophthalmologist saw only traces of a cataract and was confident the bird would regain full vision. Soon, the osprey was flying normally in the flight cage. Dr. Coleman5 resolved a descemetocoele in a six-year-old Siamese cat. She was surrendered to the veterinary clinic with several problems including depression

18 IVC Fall 2013

and anorexia. For the prior three to four days, her eyes had a copious, excoriating discharge causing alopecia under the eyes. The right eye was severely inflamed with profuse discharge. The cornea of the left eye was red and rough, and the globe was solid white. Homeopathic Hepar sulphur 200c was given repeatedly and by the next day the eye could be examined with no pain. The lesion was now diagnosed as a 5 mm descemetocoele. Within a few days, Azul continued to eat and be happy and the right eye was 100% normal. The descemetocoele enlarged to cover 50% of the cornea. She was given 200c Silicea hourly during the day and the treatment was discontinued the next day. Within four weeks, the eye became 100% normal, with no scarring and no synechia formation after the resolution of the hypopion. The pupillary light reflex was normal and Azul had normal vision. Dr. Christina Chambreau had complete resolution of a conjunctival tumor in a 14-year-old golden. Although the referring veterinarian did no biopsy (per owner), he considered it cancerous. Initially attached to the third eyelid, it had grown into the conjunctiva and attached to the cornea, covering 60% of the eye. It bled profusely and the eye was painful. The owner gave Thuja occidentalis repeatedly, causing the tumor to worsen. Heidi had multiple other symptoms that led to the selection of the first homeopathic prescription by Dr. Chambreau – one dose of Nitric acid 200c. With a repetition of Nitric acid in LM potencies over the next four months, the tumor was 80% improved, Heidi’s energy increased 50%, her hearing returned for a few days, her otitis resolved, and her attitude improved. With a few doses of 1M Nitric acid, over the next four months, the tumor completely resolved, the eye was 100% normal, her snoring ceased and she acted like a puppy.

nutrition nook

Safe dieting – an integrative approach to obesity

By Apryl Garcia, DVM, CVA

Obesity in pets is defined as >36% body fat. Even

more specifically, it can be defined by a high Body Condition Score (BCS). In veterinary medicine, it is important to measure body condition, because it takes into consideration the breed and shape of the body as opposed to just the weight. The prevalence of obesity in dogs and cats is increasing every day. Around the world, about 22% to 40% of pets are obese.1-5 In the United States, approximately one in three dogs seen by a veterinarian is obese.6 Obesity is the leading risk factor for feline diabetes mellitus, an increasingly common disease now affecting one out of every 400 cats. “Overweight or obese cats are two to four times more

likely to develop diabetes than cats with a healthy body weight,” says board-certified veterinary nutrition specialist Dorothy Laflamme, DVM, PhD, DACVN.

Most of my patients are not brought into the hospital because they are overweight, but for other reasons, such as osteoarthritis, skin issues, ear infections, diabetes or hypothyroidism. More and more pet owners have the same physique, so their perception of what a normal weight looks like may be skewed. Some veterinarians even feel uncomfortable discussing weight

issues with overweight owners who have overweight IVC Fall 2013

Case study As a certiﬁed veterinary acupuncturist, I would like to share a case I have been treating for the past two years, to illustrate my integrative approach. Waddles, an eight-year-old spayed female dachshund, is overweight, has a history of chronic skin problems, and was down and ataxic secondary to cervical disc disease. In Traditional Chinese Veterinary Medicine (TCVM), the Chinese believe in the Five Elements and their interaction. Waddles has an Earth personality. She worries and has the tendency to become overweight. She is a nurturer and caregiver. When out of balance, Earth can affect Metal. Metal is responsible for the skin problems she has exhibited. When Metal is out of balance over the long term, it begins to bring on a Kidney problem, which is responsible for the intervertebral disc disease. I chose to use an integrative approach for Waddles. We started with a prescription diet food, used antibiotics and anti-fungals as appropriate to treat the skin infection, and muscle relaxers/Prednisone along with acupuncture and herbal medications to address all three medical problems. The owner was instructed to do acupressure at home to increase the efﬁcacy of treatment. Acupuncture was started when there was no response to traditional medical treatments. Waddles was ataxic and unable to walk, but one hour after beginning acupuncture, she began walking and has been doing quite well. Her skin issues have resolved and she has lost weight. 20 IVC Fall 2013

The author used acupuncture as part of an integrative treatment plan for Waddles’ health problems, including obesity.

pets. When veterinarians are overweight themselves, these discussions may be either easier (shared experience) or more difficult (guilt). Since our patients are our priority, we must find ways to make clients aware of the physical status of their pets in order to get to the root of the problem.

Some veterinarians feel uncomfortable discussing weight issues with overweight owners who have overweight pets.

While clients know that obesity causes many ailments in people and pets, they have many excuses and reasons to skirt around the issue, or else may totally deny their animals’ weight. One approach is to not mention weight at the outset, but rather focus on the whole animal and any health concerns, even small ones, he has.

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Nutrition and

TCVM By Delena Stout

• Ask clients in a genuinely inquiring way about their feeding regimens. What diet are they feeding their pets? Is it a processed diet, homemade, raw or cooked meat, commercial frozen raw meat, dehydrated raw, etc.? How much and how often are they feeding their pets? What size cup are they using to measure out portions? Do the pets get table food or scraps in addition to their main meals? How many and what types of treats are being given daily? On the annual physical reminder card, suggest clients bring in the labels from any processed foods or treats they are feeding, and include these in their files. At this time, you can address the actual weight. • The next thing to consider is whether or not there is an underlying medical issue that has caused the pet to be overweight. Most of my patients are not brought into the hospital because they are overweight, but for other reasons, such as osteoarthritis, skin issues, ear infections, diabetes or hypothyroidism. Usually when the underlying problem is identified and resolved or managed, the pet begins to lose weight without any changes in diet or exercise. • When feeding rituals and medical issues are ruled out as reasons for obesity, a more integrative approach may be necessary. This could include medications to decrease appetite, or acupuncture and herbals to help balance the body and rid it of phlegm (fat).

1 2

L, Ancel J, Benet JJ, et al. Risk factors for obesity in dogs in France. J Nutr 2006;136:1951S-1954S. McGreevy PD, Thomson PC, Pride C, et al. Prevalence of obesity in dogs examined by Australian veterinary practices and the risk factors involved. Vet Rec 2005;156:695-702.

Edney AT, Smith PM. Study of obesity in dogs visiting veterinary practices in the United Kingdom. Vet Rec 1986;118:391-396.

Crane SW. Obesity treatment and prevention in companion animals. Tijdschr Diergeneeskd 1992;117(Suppl 1):44S-45S.

Kronfeld DS, Donoghue S, Glickman LT. Body condition and energy intakes of dogs in a referral teaching hospital. J Nutr 1991;121(11 Suppl):S157-S158.

German AJ. The growing problem of obesity in dogs and cats. J Nutr 2006;136 (7 Suppl):1940S-1946S.

Nutrition is often overlooked by pet owners. “Dog food is dog food,” they think, and this attitude has permeated mainstream pet culture. Even today, Dog Chow is as synonymous with dog food as Xerox is for copying or Coke for soft drinks. Educating your clients can give them broader options and make the lives of their pets much better. One of the more obscure things they should learn about involves foods that are heating, cooling or neutral. Traditional Chinese Veterinary Medicine (TCVM) emphasizes that issues like allergies stem from imbalances and disharmonies within the body. Nutritional adjustments are then sought to restore harmony and balance. TCVM asserts that certain foods have warm, cool or neutral properties, and corresponding effects on the body. For example, neutral protein sources that harmonize the body include beef, goose, pork, tripe and bison, while cooling foods, used to help pets with dry skin, restlessness or abnormal thirst, include rabbit and duck. At Brookside Barkery, educating customers in TCVM is a priority. Our staff trains in TCVM methodology. From talking to customers about nutrition to explaining TCVM views on the relationship between Qi and Blood, we help pet owners feel informed about this alternative view of health. Bettereducated customers make better choices, including food, and that leads to healthier pets.

Delena Stout is one of the owners of Brookside Barkery & Bath, currently celebrating its 10th year with the launch of a new online store and veterinarian listing at barkerybath.com. IVC Fall 2013

OZONE THERAPY in the

veterinary practice By Margo Roman, DVM, CVA, COT, CPT

Ozone therapy is an excellent adjunct to surgery as it decreases inﬂammation and pain, is antiseptic and promotes cellular healing. Any saline lavage can be improved by adding ozone.

Ozone

and other oxygen therapies have been used for over 100 years around the world for human and animal healing. These therapies continue to gain popularity, as scientists learn about the health benefits of increased oxygen in the body. Currently, ozone therapy and hyperbaric treatments, which bring easily soluble oxygen to target tissues, are being proven effective for treating viruses, fungi and bacteria, and for general health improvement anytime there is inflammation and damaged tissue. In addition to medical uses, ozone is a great disinfectant used for livestock water tanks, cattle embryo transfer(tt), swimming pools, spas and the water treatment systems of over 2,000 municipalities around the world.

How it works Ozone contains three oxygen atoms, which react in the tissue as it breaks down to ordinary oxygen (O2) and a reactive singlet oxygen molecule that can combine with chemicals and other

22 IVC Fall 2013

Ozone therapy is effective for all species, even Dr. Roman’s own chicken.

molecules. Free from side effects, this is an extremely safe therapy that works in a number of ways by:

 Decreasing inflammation. When you have inflammation, swelling, bruising, infection, cancer and trauma to the tissue, there are higher amounts of carbon dioxide within the tissue. This increase of carbon dioxide contributes to inflammation and pain. Increasing the amount of oxygen delivered to the tissue in the form of reactive ozone decreases inflammation, pain and swelling, and helps increase healing.

 Activating the immune system. Ozone therapy has also been shown to activate the immune system by stimulating cytokine production. Cytokines are “messenger cells”, such as interferons and interleukins, which “set off a cascade reaction of positive changes throughout the immune

Auricular ozone for vestibular disease and otitis from any cause. Ozone kills yeast on contact.

system.”(t). Ozone also promotes the production of glutathione peroxidase, catalase, reductase and super-oxide dismutase, the enzymes forming the cell wall coating; thereby enhancing cellular immunity.

 Inactivating bacteria, viruses, fungi, yeast and protozoa. Healthy cells are surrounded by an enzyme coating, which ozone does not penetrate, but bacteria and viruses have no such coatings. Ozone therapy disrupts the integrity of the bacterial cell envelope through oxidation of the phospholipids and lipoproteins (peroxidation). In viruses, this peroxidation disrupts the reproductive cycle and damages the viral capsid. In fungi, ozone inhibits cell growth. Consider chronic otitis, which often has multiple organisms as primary or secondary invaders; this explains the efficacy of ozone treatment.

Administration options Since ozone helps with the healing of any problem, it can be added to any treatment protocol.

 Percolate into saline fluids to be used as a flush (decreases inflammation and pain) to wounds, bladder, rectum, ear, nose, mouth; enema; IV or SQ fluids to be absorbed through the capillaries of the subcutaneous tissue.

 As a gas via a catheter, internally, or by sealing a wounded area in a bag (old fluid bags work well). It will be absorbed through the caudal rectal vein.

 Injected as a gas into joints with a prolotherapy injection (prolozone). Human study1 showed efficacy in pain relief for many conditions. Continued on page 24.

History of Ozone Therapy Ozone therapy was used in World War I as an effective disinfectant for wounds and skin diseases. Later, scientists discovered ozone had the ability to damage the membranes of viruses, yeasts, bacteria and abnormal tissue cells by producing oxidative free radicals. In the 1930s, it was successfully used to treat humans with a range of immune GIT ailments. Since the 1960s, ozone therapy has been used on millions of patients in Europe.

 Percolate through olive oil with or without essential oils for the skin.

IVC Fall 2013

Ozone preparation Oxygen as a single molecule is highly unstable and exists for only microseconds in nature. However, when two oxygen atoms unite to share electrons, they form an oxygen molecule, referred to as O2. This molecule is very stable, and comprises the form of oxygen found in the atmosphere. To create ozone, pure surgical oxygen (ordinary air cannot be used as it has 20% nitrogen which would be converted to nitrous oxide and nitric oxide, both highly toxic) is ﬂowed through a glass tube (do not use models with plastic tubing). A low voltage electrical spark is then applied through the outside of the tube. This brieﬂy splits the paired oxygen atoms, most of which reform into pairs within microseconds. A small percentage of the individual oxygen atoms form triplets – ozone (O3). The ozone produced exists in a very active form for about 30 minutes before breaking down (dismutating) into two atoms of oxygen, which are very easily absorbed into the cells, by giving up one atom of singlet oxygen. Ozone will dismutate at a rate of 50% every 45 minutes in glass, and every 30 minutes in plastic. Therefore the ozone cannot be stored and used later.

Flushing the mouth before, during and after dentistry decreases bacteria and inﬂammation, speeds healing of gums and eliminates the need for pre and post antibiotics. Continued from page 23.

An added technique using ozone is Biophotonic Blood Therapy (BBT), in which blood is infused with ozone, exposed to ultraviolet light in a crystal cuvette, and then given back to the patient. Also called Ultraviolet Blood Irradiation, it has been used worldwide for over 50 years for an array of medical conditions. It may be more effective than mere ozone for stimulating cytokines and activating the mitochondria in each cell to strengthen an animal’s immune system.

Uses are many and varied Any time there are infections or inflammation, tissue damage or abnormal cellular proliferation, ozone can be use to support treatments, conventional or holistic. A few examples are:

 Skin – wounds, especially degloving ones and deep abrasions; hot spots; pyodermas; allergic dermatitis; abscesses

 Pain relief  Head trauma, spinal cord inflammation–ozone and oxygen go through the blood/brain barrier so it is an excellent way to aid treatment of any neurological issue photo 1

photo 2

photo 1. A Wheaton Terrier developed MRSA secondary to a minor bite wound. After antibiotics and major reconstructive surgery he was sloughing the skin. photo 2. Daily subcutaneous ozone injections along with other integrative treatments resulted in full hair re-growth and normal locomotion

 Chronic and acute Lyme disease  Mouth–stomatitis, gingivitis, abscesses; ozone therapy is ADAapproved for dental abscesses

 Cancer and autoimmune problems  Ears – chronic and acute otitis from bacteria or yeast; aural hematomas Continued on page 26.

24 IVC Fall 2013

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Note: A study in people2 in 2005 showed that intraforaminal ozone was significantly more effective than periradicular steroidal infiltrations for lower back pain.

Renny, a three-year-old male Chihuahua, presented with 24 hours of vomiting and abdominal distress after eating a popsicle stick. He was dehydrated, had congested mucous membranes, a temperature of 101.8°F, and a sensitive and doughy abdomen. 40cc of ozonated saline were given SQ, relaxing him enough so he slept for the first time in 24 hours. He even slept through an acupuncture treatment. Herbs and homeopathy were also administered.

Stovin, a three-year-old neutered male standard poodle, presented with emaciation, loss of temporal muscles and generalized weakness. The owners had been pursuing treatment for chronically soft stools since he was a puppy (spending $16,000 to date). Stovin was diagnosed several months before with Addison’s disease, so was started on DOCP and Prednisone. He had deteriorated since then, with several episodes of vomiting, diarrhea, lethargy, muscle wasting and tarry stools. Five days prior, he was assessed to be azotemic with a possible GI bleed and an E. coli bladder infection. He was transfused and prescribed cyanocobalamin, mirtazapine, dexamethasone, metronidaxole, sucralfate, cerenia, prilosec and amoxicillin. The plan was for exploratory surgery, but four days later he started with focal facial seizures and head tremors. The owners now chose a more integrative approach.

Penelope, a ten-year-old female spayed long-haired miniature dachshund, was unable to stand and dragging her rear legs. She was diagnosed 24 hours earlier at a specialty hospital with a probable disc issue between T3 and L1, and a recommendation for further testing and immediate surgery.

a) There was no localizable pain on palpation of the spine (if there had been,

ozone would have been injected directly at that location), so ozonated saline was injected subcutaneously from T3 to L1. Then, acupuncture needles were placed appropriately, along with Moxa and homeopathic remedies.

b)The following morning (12 hours post ozone therapy), Penelope was

c)Chiropractic was done three times a day with an activator. d) Four days later, Penelope was supporting some weight on the rear legs

b) c) Day 2 and 4 – Stovin had ozone therapy (followed with vitimains B and C). d) Day 3 – He passed a brown stool after two months of melena.

dragging herself slightly and seemed ataxic and not mentally alert. Often, a high dosage of ozone can cause some lightheadedness as the body begins to detox. A different homeopathic remedy was given, and by 17 hours posttreatment Penelope was eating and felt much better.

and there was slight pain at T11 to T13. Acupuncture and ozone treatment were repeated.

Day 1 – Ozone therapy rectally and subcutaneously (and vitamin B and C injections) with acupuncture, homeopathy, herbal and nutritional supplements, colostrum, a Chinese herb and a raw meat diet. Only the dexamethasone and carafate were continued. Weight was 42 pounds.

Day 5 – Stovin passed his first normal stool since eight weeks of age and weighed 50 pounds.

e) Three days later (eight days post-diagnosis), Penelope was walking normally

Ozone treatments were continued three times a week along with the oral supplements and diet.

with normal bladder and bowel functions. Continued from page 24.

 Eyes – infections and allergic reactions  Upper respiratory ailments  Potentiates acupuncture, homeopathy and chiropractic treatments as it brings more needed oxygen to the body

 GI tract – constipation, diarrhea, IBS (decreases inflammation)  Equine infectious anemia Integrating ozone into your veterinary clinic protocols gives you a wonderful opportunity to use something very natural and sustainable that can reduce and possibly prevent the overuse of antibiotics and drugs. Technicians can administer ozone in most of its applications. As a holistic integrative veterinarian, I think it potentiates some of the other natural modalities I use, such as acupuncture, homeopathy, herbs and chiropractic. Antibiotics are also more effective with ozone as an adjunct. It is also a practice builder, since clients are searching for supportive ways to help their pets. With training, pet owners can get an ozone unit and administer it in a variety of ways themselves. Because ozone is antiviral, it

26 IVC Fall 2013

should be a must for any animal shelter that deals with a lot of infectious viruses. A veterinary certification course is now offered by the American Academy of Ozonotherapy AAOT (aaot.us).You can also contact veterinarians using ozone therapy for their own experiences and case reports at the AHVMA (ahvma.org).

References Altman Nathaniel. The OXYGEN Prescription, The Miracle of Oxidative Therapies. Healing Arts Press, Rochester, Vermont, 2007. McCabe Ed. Flood Your Body with Oxygen. Energy Publications LLC, 2010. Bocci, Velio. Ozone– A New Medical Drug, 2nd edition, Springer, London, New York, 2011. Shallenberger, Frank. Principals and Applications of Ozone Therapy – A Practical Guideline for Physicians, Shallenberger 2011. (t)R. Viebahn Haensler, The Use of Ozone in Medicine, 3rd English edition, page 132 (tt) John L. Curtis, Cattle Embryo Transfer Procedure, Academic Press, 1991 1

Shallenberger, Frank MD, HMD, ABAAM. “Prolozone™ Regenerating Joints and Eliminating Pain”. Journal of Prolotherapy, Volume 3, Issue 2, May 2011.

Bonetti, M. “Intraforaminal O2 – O3 versus periradicular steroidal infliltrations in lower pain: randominzed controlled study”. Am J Neuroradiolog, May 2005, 26(5) 996+.

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By Shawn Messonnier, DVM

IN YOUR pRACTICE Vaccines have been ONE OF THE MOST SIGNIFICANT FACTORS in reducing serious infectious diseases. Although all veterinarians agree vaccines are necessary, studies showing minimum duration of immunity (DOI) of at least three years (and likely longer) are causing veterinarians to question the frequency with which these vaccines are administered. Based on current research, we know that most vaccines, specifically the core canine vaccines (parvo, distemper, and adenovirus) can produce long-lasting immunity, thus making regular vaccination unnecessary. Core vaccines should not be given any more often than every three years after the 12-month booster injection following the puppy/kitten series, because the DOI lasts many years, even up to the lifetime of the pet. In order to ensure the existence of DOI, and determine if/when booster vaccinations are needed, titer testing may be used. For canine core vaccines, there is excellent correlation between the presence of antibody and protective immunity, and there is long DOI for these products. The benefits of titer testing include the prevention of unnecessary vaccination, allowing the doctor to individualize vaccine protocols and encourage vaccination when needed. Since the purpose of titer testing is to demonstrate protective immunity, it should be done in the following instances: any

adult animals (over one to two years of age), strays, at shelters/ rescues, in pets with lapsed vaccinations, and in puppies two or more weeks after the last puppy vaccine at 14 to 16 weeks. When antibody is present, there should not be a need to revaccinate the dog for the specific disease being tested. If antibody titer is absent, the dog should be revaccinated unless there is a medical basis for not doing so. Until recently, a perceived drawback in performing antibody tests was the cost and time it took to obtain results. Titer testing usually required sending blood samples to a lab, which entailed a relatively expensive test and results obtained days or weeks later. Recently approved by the USDA, VacciCheck® is intended to be used as an in-house diagnostic tool to evaluate the antibody response to the core vaccination or infection by canine hepatitis, parvovirus and distemper virus. It is a “self-contained” dot ELISA titer test kit, with no need for any reagent preparation. Results are available in 21 minutes. With VacciCheck®, practitioners can offer a quick and easy test that can be performed at a reasonable cost to pet owners. It is simple to perform, and can serve as a profit center for the practice. Dr. Shawn Messonnier authored the Natural Health Bible for Dogs and Cats, The Natural Vet’s Guide to Preventing and Treating Cancer in Dogs, and 8 Weeks to a Healthy Dog. He’s the pet care expert for Martha Stewart Living’s “Dr. Shawn – The Natural Vet” on Sirius Satellite Radio, and creator of Dr. Shawn’s Pet Organics. His practice, Paws & Claws Animal Hospital (petcarenaturally.com), is in Plano, Texas. IVC Fall 2013

PREPARINGFORDISASTERS

–veterinary style By Dirk B. Yelinek, DVM

It’s early on a cold, rainy morning. There’s no power, sirens are screaming, and the phone circuits are overloaded so it’s impossible to place a call. Smoke billows in the distance in the predawn darkness. Fortunately, your family is fine, if shaken. You have a radio with fresh batteries tuned to the National Oceanic and Atmospheric Administration weather and hazards channel. You have a working generator with adequate fuel. You have systems in place to take care of your family, your animals, and your veterinary practice, when disaster strikes.

Does this describe you? Or did the emergency catch you unprepared? Disasters usually do not give us much warning before they happen. But it helps if you are aware of the potential threats most likely to occur in your area. In my own region, earthquakes, fires, floods and weather extremes are likely to be at the top of the list. But emergencies can also occur due to hazardous material spills, riots, terrorist activities and other crises. You need to be prepared when these situations occur – as they will.

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A strong plan is a team effort When planning how to face and survive a disaster, start with the team you interact with in your daily life: family and friends, neighbors, your religious group, school affiliations, veterinary colleagues and staff members at your practice. Add your financial adviser or banker, contractor, attorney, insurance agent and any local response groups.

Meet with neighbors and nearby business leaders. Choose someone to lead the group, make an outline of what needs to be planned, and set dates for follow-up meetings. Make it a priority to plan and conduct a practice exercise with the community, or at least with your clinic. And it should be fun. Your planning should enable you to survive an emergency – and thrive – for at least a few days or even weeks. This will put you in position to make good decisions about your future after the initial crisis of a disaster is behind you.

Preparing your practice for a disaster Bear in mind that you cannot help other people or pets if you have not taken care of your family first. And just as you need input from family members on a household disaster plan, you will need input and cooperation from your hospital staff and neighbors to make your practice emergency plan work well. Once you have a plan, everyone at your clinic should be familiar with it. Post it in a prominent place and make sure everyone reads it. Like the planning you do at home, you should practice what you need to do – and it should be fun. Once your plan is in place, do a trial run at least once a year. And be sure new employees are briefed. Your plan could include other veterinary practices in your area to provide a uniform, cooperative response to a crisis. Coordinate your practice drills with them, if possible. A “buddy” system can be used both within your own practice and with another practice. You might want to establish reciprocal agreements with a nearby practice/s to take animals from your clinic (or accept them from theirs) when services are disrupted. • Should you have to leave animals behind in your clinic in an emergency evacuation, separate dogs and cats and provide enough food and water to last 48 hours. Leave only dry food for them and provide water in nonspill containers. Make sure they are in rooms with adequate ventilation in areas that can be cleaned easily. Fill sinks and bathing tubs half full of water – and, yes, leave the toilet seat up! Put notices on doors advising that there are animals inside, with the location of their medical details, your telephone number and information on your evacuation site. • If you cannot evacuate livestock, try to relocate them out of harm’s way. Move them to high ground if there is flooding. Provide food and water but do not rely on automatic

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IVC Fall 2013

watering systems (since power may be lost). If you have time, secure or remove outdoor objects that could be become dangerous missiles with high winds. • Before you evacuate, leave messages on your business answering machine and cell phone listing contact numbers so clients will know the status of your practice and where their pets are located. Post information on a web or Facebook page for more general access. How your practice responds to the medical needs of injured patients and the emotional care of both pets and people is an important part of handling a disaster. Have an open-door policy that includes seeking care when needed. Offer professional counseling to address anxiety and fear. Use the many holistic approaches for shock, terror, fear, grief, anxiety, worry, frustration, anger, etc. Rescue Remedy and other flower essences should be a part of your response plan, along with instructions so anyone can administer them, until you can assess each animal and person’s unique needs. Having teams of Reiki practitioners (locally or in other states) that you can call on when emergencies happen can be very helpful. Homeopathy, TCVM and other healing modalities will prove essential after emergencies. After the crisis is over, consider what you must do to rebuild or repair your clinic. You might have to remodel or relocate, or temporarily share space with another hospital. Or you might need to temporarily set up shop in a trailer, mobile veterinary clinic or other space. You can find a detailed list to print and hand out to your clients for their own preparedness and their pets’ safety on the IVC website and redondoshoresvet.com.

Should you have to leave animals behind in your clinic in an emergency evacuation, separate dogs and cats and provide enough food and water to last 48 hours.

DISASTER TO-DO LIST  Your insurance policy should be checked and updated at least every two years, or when substantial changes have occurred in your practice.

 Coordinate with other veterinary practices (and local businesses) ahead of time.

 Determine how communication will be handled: via cell phone, through an out-of-state or out-of-area contact who will relay messages, via e-mail or message machine, or by other means. Your employee call list can be done alphabetically or by order of priority.

 Appoint a backup person for each designated responsibility.  Decide who will be responsible for transportation, including fuel and maintenance, should you need to evacuate your hospital; who will be responsible for security; and who will be responsible for the safety of animals.

 Designate a crisis manager who will be in charge of communications with other hospitals and authorities, and will advise your practice team of changes in the disaster situation.

 Decide who will provide emergency medical treatment for animals.

 Know what your alternatives will be for power, refrigeration, waste management, and contingencies for dead animals if you remain at your hospital.

 Designate a shutdown manager and an assembly site manager who will be in charge of evacuating your practice or maintaining operations there, working with your planning group.

 Decide where, if necessary, you will reassemble, should need to evacuate. Some possibilities include: livestock show grounds or fairgrounds, religious structure, community college, a mall or grocery story parking lot. Use global positioning technology to log the positions of your base hospital as well as animal clinics, shelters, emergency clinics, boarding and grooming facilities, equine stables and mobile clinic home bases, so you will be able to find them when roads are closed.

 List the most valuable items you will need, should you evacuate:

• Your computer backup; keep a second backup in a separate location.

• Treatment logs for currently hospitalized animals. • Have three copies of the following, keeping one in your reception area, one in the treatment area and the third with your evacuation supplies: your emergency contacts list, supply and business contacts; a list of pet-friendly hotels

• Emergency holistic supplies packaged for transport and refreshed every three months or as needed – homeopathic first aid remedies, acupuncture needles, lasers, Yunan Pio, Rescue Remedy and other flower essences.

• Animal handling equipment: leashes, ID tags, muzzles, roll of gauze, etc.

30 IVC Fall 2013

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IVC Fall 2013

From the VBMA The Veterinary Botanical Medicine Association is a group of veterinarians and herbalists dedicated to developing responsible herbal practice by encouraging research and education, strengthening industry relations, keeping herbal tradition alive as a valid information source, and increasing professional acceptance of herbal medicine for animals.

DID YOU GUESS LAST ISSUE’S MEDICINAL HERB? In the last issue, we tested your herbal knowledge with a picture of Solomon’s Seal, Polygonatum multiﬂorum. Solomon’s Seal has an extraordinary influence on the muscular and skeletal system and can affect a wide variety of problems relating to tendons, ligaments, bones, and joints. It truly is an herb of intelligence as it can strengthen lax tendons and relax fibrous strictures. It can help to facilitate fracture repair; Gerard says, “it sodoreth and glues together the bones in very short space”. In addition to skeletal issues, Solomon’s Seal has a mild cardioactive glycoside that is very helpful to tonify a “senile heart”; it has an overall Yin tonic effect and can help nourish coughs and constipation from a Yin deficiency; and it has a tonic influence on Kidney Jing essence. William Cook was one of the physiomedical physicians in the 1800s who had great knowledge of this herb. He used this herb principally as a moistening mucilaginous agent to coat and soothe any mucosa; especially in female reproductive issues.

HERB WALK & ECO-TOUR In the Winter Issue of IVC we will report on the conference herb walk led by Dr. Barbara Fougere (a leading veterinary herbalist) and annual VBMA meeting, held recently at the AHVMA conference in Kansas City. Plan to join us at the Conference in 2014 as we always have an herb walk. Start planning now for the eco-tour to Hawaii in March of 2014 and an ethnobotanic event with David Winston in May of 2014 (this event is restricted to VBMA members only; an excellent reason to join!).

FURTHER INFO We have many other educational resources, conferences, teleconferences and active list-serve. Recordings and future events are available at vbma.org. They cover a variety of topics including: organic farming, cancer, IBS, metabolic disease, skin disease and Materia Medica studies. Through the VBMA, you can receive a discount on Herbal Training through CIVT.

NAME THIS HERB!

This is an herb with restricted growth needs. Make sure to use a company that practices sustainability when purchasing this wonderful herb!

CASE STUDY: Ivan is now a 30-year old TB gelding. When he was 23 years old he fell through a wooden bridge, trapping his left hind leg. It took a Mercy flight helicopter to lift him out of the wreckage. He was left with severe strictures in his tendons and ligaments on the lateral aspect of his left hind hock, which created a severe mechanical lameness. Three years later his owner requested alternative care. He was given ½ tsp. of Solomon’s Seal, ground rhizome, twice a day for three weeks. These strictures fully resolved as did his lameness. He is still being ridden today.

32 IVC Fall 2013

Hint: It may be discussed on our upcoming teleconference in November of 2013 on Herbs for the (very, very) Nervous!

IVC Fall 2013

Editor’s note: In our last issue of IVC Journal (Summer, 2013), we referenced an as yet unpublished study on anesthesia-free dentistry in the article “Anesthesia-free dentistry: veterinarians weigh in on the pros and cons” (p. 32). The following is an abbreviated version of the study. For the full study, visit ivcjournal.com/ research-studies.

Study on profeSSionAl outpAtient preventive dentiStry (popd™): Can it be done safely and eﬀectively without the use of general anesthesia? By Mayra Urbieta, DMD, Stephanie Sur, DVM, Patrick Hardigan, PhD, Darren Pike, DMD, MS and Chad Orlich, DMD A double-blind study of 12 dogs and 12 cats, randomly selected and divided by age group and history of anesthetic dental treatment, were used in the study. Subjects were treated with an experimental intervention (POPD) by a trained Pet Dental Services (PDS) technician and subsequently examined under general anesthesia by a board-certified veterinary dentist (control). The examination consisted of inspection for any remaining subgingival calculus using compressed air, exposed full mouth radiographs and a complete oral exam. Parameters examined by both groups included recession, furcation, hyperplasia, resorption, missing teeth, fractures/attrition/ abrasion, supernumerary teeth, and probing depths. Results showed that the trained technicians and the veterinary dentist were both able to identify the seven dental conditions, although the technician appeared to report more pathology. After the POPD was successfully completed, no residual plaque or calculus was detected on any of the dogs or cats and there were no post-treatment complications. Although a POPD is not intended to be a substitute for anesthetic dentistry, it may prove to be a valuable supplemental treatment.

34 IVC Fall 2013

The methods for the study included first grouping the 24 animals by age and prior dentistry within the preceding two years. All were examined by a board certified veterinary dentist to determine the appropriateness of a POPD, and evaluated with lab work to determine eligibility for general anesthesia. All subjects were deemed to be healthy and capable of undergoing the procedures required for this trial. The experimental intervention (POPD) was performed on all patients by PDS technicians who are qualified by examination from the American Society of Veterinary Dental Technicians (ASVDT), First Aid/CPR certified by the American Red Cross, and with a minimum of three years of experience working in a veterinary hospital. They were instructed over a six-month period, with a training program developed in part by a boardcertified periodontist and PDS, and overseen by multiple veterinarians. The POPD 11-step protocol used by PDS technicians follows; however, steps 3, 10 and 11 were omitted in order to maintain the double-blind study design.

STEP 1: Medical and behavioral history check. STEP 2: Pre-exam – physical and oral. A check of joint discomfort or pain is conducted to determine a pet’s candidacy for the procedure since restraint is necessary during a POPD. A complete extra-oral and intra-oral exam is completed, with a specific focus on tooth symmetry, swelling and pain. An evaluation is also performed on each tooth, and surrounding gingiva, for pathology including calculus levels, compromised teeth, gingival condition and periodontal pockets. At this point, in a clinic setting, for 62.5% of the subjects, the technician would have stopped the procedure after the exam and discussed the findings with the veterinarian because he/she would be recommending an anesthetic dental treatment. STEP 3: Treatment plan – a treatment plan is then generated through a staff-doctor-client partnership. Treatment plans can range from simply completing the POPD procedure to recommending that the professional oral hygiene procedure be performed under general anesthesia. The treatment plans include home care instructions and a recall date for an anesthetic dental treatment or a maintenance POPD procedure, if necessary. This step is crucial in ensuring the patient receives the proper care for his/her periodontal and health condition. STEP 4: Supra-gingival scaling – a POPD begins with the removal of supra-gingival deposits of plaque and calculus from the buccal, lingual and interproximal surfaces. A combination of forceps, hand instruments and ultrasonic piezo scaling are used for plaque and calculus removal. STEP 5: Sub-gingival scaling and curettage – plaque and calculus deposits are thoroughly removed from the sub-gingival areas. This procedure is not performed on a patient with stage three or four periodontal disease. This reinforces the need for a pre-examination (Step 2) for patient candidacy. STEP 6: Post dental probing – a six-point probing of each tooth is performed. A thorough probing is vital for recognizing and communicating areas of concern to the doctors and clients. All abnormal pocket depths are noted for the final chart. STEP 7: Machine polish – hygienists then perform a machine polish using a pumice or polishing paste. Polishing will assist in smoothing out minor defects of the enamel which may have occurred during the procedure, thus aiding in the prevention of future plaque accumulation. It will also help with the removal of certain enamel stains. STEP 8: Oral rinse – any diseased tissue, plaque or paste remnants are removed through an irrigation of the oral cavity. The oral cavity and gingival pockets or sulcus are flushed with a chlorhexidine-based solution. IVC Fall 2013

Step 9: Post-check and charting – a complete evaluation of each tooth is performed, checking for any retained calculus with a periodontal probe and/or explorer. The dental chart is completed. Step 10: Veterinarian and staff communication – a veterinarian examines the oral cavity with a corresponding evaluation of the dental chart to ensure complete pathological notation. A posttreatment oral health care plan is prepared for the patient. Step 11: Client education – finally, the hygienist educates clients about the importance of maintaining good oral health in their pets. They will also review the pet’s dental experience and chart, review the importance of continuous recalls and explain to them the many options regarding home care. They also provide brushing demonstrations with their pet, when necessary. Following the completion of POPD treatment by the trained technician, all patients were immediately put under general anesthesia and examined thoroughly by a veterinarian. The veterinarian used compressed air to dry the gingival margins and properly inspect for any remaining subgingival calculus, exposed full mouth radiographs, and filled out a pre-designated chart. The same chart was used by the veterinarian for their pre-treatment examination. Also noted was gingival recession, furcation involvement, gingival hyperplasia, tooth resorption, missing teeth, supernumerary teeth, fractures/attrition/abrasion, and probing depths. The veterinary staff also took before and after pictures of each patient (See Figures 1 and 2 below for examples). All the patients for which the technician recommended anesthetic dental treatment were found to have radiographic findings by the control group’s examination.

Figure 1 Photograph (A) of the right maxillary feline teeth of a two to seven-year-old cat before the POPD was performed. The same teeth can be seen (B) after the procedure, while the patient is under general anesthesia for examination.

Photo A

Photo B

discussion Since plaque is the initiating cause of gingivitis and subsequent periodontitis, assessment of plaque reduction is a key step in determining the efficacy of canine and feline dental health products and procedures. The present pilot study implies that performing a dental prophylaxis on a cat or dog without the use of general anesthesia can be done in a safe and efficient manner by an appropriately trained technician. Not only were the dental prophylaxes completed on all 24 patients, but also there was no residual calculus remaining supra- or sub-gingivally upon thorough inspection by the veterinarian. In addition, there were no post-treatment complications, which again attest to the possibility of performing such a procedure in a safe manner. This procedure must be performed under the supervision of a licensed veterinarian. Therefore, it is crucial to keep in mind the scope of a procedure such as POPD. Like any other procedure performed by an auxiliary, POPD is to be used at the discretion of the veterinarian, for he or she is ultimately responsible for the overall health of each patient. It is not intended at any time to replace anesthetic dentistry, but to support it, meaning that it is up to the doctor to decide when and for what patients the service is appropriate. Also, it should be noted that if this were not a research setting, the technician would have stopped the POPD after the exam in 62.5% of the patients, all of which were also found to have radiographic findings, and discussed the findings with the veterinarian due to the nature of the present pathology.

Figure 2 Photograph (A) of the left maxillary canine teeth of a two to seven-year-old dog before the POPD was performed. The same teeth can be seen (B) after the procedure, while the patient is under general anesthesia for examination.

Photo A References: Harvey CE, 1998. “Periodontal disease in dogs: Etiopathogensis, prevalence, and signiﬁcance”. Veterinary Clinics of North America: Small Animal Practice. 28(5), 1111-1128. Jones W, O’Leary T, 1978. “The eﬀectiveness of in vivo root planing in removing bacterial endotoxin from the root of periodontally involved teeth”. J Periodontol. 49, 337-342.

Photo B

36 IVC Fall 2013

Page RC, Schroeder HE, 1982. Periodontitis in Man and Other Animals. A Comparative Review. Basel and New York: S. Karger. 1–330.

IVC Fall 2013

Messages from the

Mane

Hair mineral analysis provides a unique perspective on a horse’s biochemical individuality.

Hair mineral analysis (HMA) is a laboratory test that measures the mineral content of the hair. A small sample of hair (one tablespoon) taken from the mane closest to the horse’s skin can accurately give an overview of the mineral levels in his body tissues. It can also indicate any imbalances, toxins, overloads, deficiencies and key mineral interrelationships that may need correction, whether caused by stress, medication, pollution or feeding problems.

A well-established test HMA is scientifically well-established and has gained widespread acceptance among health professionals for the insight it offers into mineral and metabolic status. The Environmental Protection Agency states that hair is one of the tissues of choice in determining toxic metal exposure. A 1980 report confirmed the findings of other studies, here and abroad, which concluded that hair is better than blood or urine for studying exposure to some trace minerals. When properly interpreted, HMA yields an enormous amount of very useful information regarding the body’s mineral status. Hair, nails, teeth and bones are tissues in which trace minerals are stored and available on a cellular level. The levels of minerals in the hair closely correspond with levels in the tissues and organs. Because minerals are essential to numerous functions of all phases of metabolism, HMA can be an invaluable screening tool to determine the correct program of diet and supplementation for each individual horse’s needs. HMA is not a tool for the diagnosis of disease states, but it is a very good indicator of functional changes. From there, nutritional imbalances and deficiencies can be addressed,

38 IVC Fall 2013

By Jack Grogan, CN

as well as other factors contributing to them. Metabolic imbalances can be identified before they emerge as a major full-blown health challenge.

How HMA works The methodology of HMA uses inductively coupled plasmamass spectrometry and quality control samples that include blanks, duplicates and calibration standards. A typical HMA tests for 18 nutrient minerals and eight toxic minerals, and calculates the seven key ratios between specific nutrient minerals. The important nutrient elements are identified as low, balanced or excessive, as are the key ratios. Toxins are shown as within acceptable range or excessive. In today’s environment, animals are exposed to any number of toxic metals on a daily basis, so measuring excessive levels before they cause overt illness is important. HMA measures levels of aluminum, mercury, cadmium, lead, arsenic, uranium and beryllium. Low mineral values can be caused by inadequate intake, malabsorption syndromes or other metabolic imbalances. High mineral values can indicate excessive consumption, storage of one or more minerals, or other imbalances. The relative ratios of minerals in the hair can also indicate an individual’s specific metabolic function such as trends for blood sugar patterns, stress response and recovery, detoxification rate, the effect of toxic metal processing, and enzyme and endocrine function. HMA also factors in energy production, inflammatory tendencies and the rate of metabolism.

Inflammatory indicators In many respects, the most important piece of information shown by HMA is the type and degree of excessive inflammatory stress the horse’s body is attempting to manage. This inflammatory stress can, at some point, cause a genetic weakness to show itself.

Indications of excessive inflammatory stress appear in many ways. As we constantly emphasize in integrative practice, each horse is unique. Different horses can display completely different sets of issues according to their genetic weaknesses, since each animal is genetically unique. Allergic reactions in horses are of great concern, and are an example of individualized manifestations of excessive inflammation. For example, a horse with hives is manifesting an inflammatory pattern associated with the skin; breathing distress is an inflammatory pattern manifesting in the respiratory system; a joint issue arises from an inflammatory stress pattern affecting the joint, and so on. It is important to keep in mind, however, that inflammation in and of itself is not all negative. The horseâ&#x20AC;&#x2122;s body uses specific forms of inflammation to destroy viruses, bacteria and parasites. In addition, certain kinds of inflammation are essential for normal immune function and wound healing.

MINERAL TOXINS AND IMBALANCES The presence of toxic minerals automatically increases inflammation and uniquely affects aspects of the body and the metabolism. â&#x20AC;˘A luminum is the single most common mineral toxin. Exposure can occur from airborne aluminum, certain feed processing techniques, and the effect of acid rain on soil that increases the uptake of aluminum into pasture. This toxic mineral affects calcium metabolism, bone mineral reserves, and will further shift the metabolism in the direction of the dominant imbalances. For example, if the basic metabolism is imbalanced on the slow side, aluminum toxicity will slow it to a greater degree; if the metabolism is imbalanced on the fast side, aluminum will increase the imbalance by increasing the speed of metabolism. The result is an automatic increase in inflammatory stress.

Before

After

â&#x20AC;˘A rsenic can also generate major inflammatory stresses and is the second most common toxic mineral in horses. It can also occur in airborne exposures, even IVC Fall 2013

if the source of the arsenic is several hundred or thousand miles away. Well water contamination is a very common source of arsenic exposure. In some states, up to 70% of wells are estimated to be contaminated with arsenic. Arsenic affects the gastrointestinal tract, immune function, hormonal balance, and can mimic gastritis and ulcer issues. Recently, acceptable levels of arsenic in the hair were reduced by a factor of five. •L evels of nutrient minerals can also indicate increases in inflammatory stress. Nutrient minerals that are either too high or too low can directly affect inflammatory trends. For example, selenium, a well-known antioxidant and antiinflammatory, allows the horse’s body to effectively control inflammatory stress and is often excessively high or low during periods of increasing inflammatory stress. Interestingly, selenium is also involved in allowing the horse’s body to manage excess arsenic.

INTERVENTIONS FOR TOXIN PROCESSING AND ELIMINATION A properly interpreted HMA can be a storehouse of information. Interventions can rebalance the metabolism, reduce toxic minerals and ultimately stabilize inflammatory stress patterns.

40 IVC Fall 2013

Nutritional strategies using HMA can include supplementation, and detoxification with a focus on balance. For example, malic acid aids the elimination of aluminum from the tissues. Malic acid occurs naturally in fruits such as berries and apples; however, to get adequate amounts to detoxify aluminum, a supplement is preferred. Doses of malic acid required to help process aluminum can vary substantially, with a typical dose in the 5 gram to 15 gram range, which is one teaspoon to one tablespoon per horse. The sulphur-containing amino acid DL-methionine is an effective detoxifier of arsenic, with the normal dose ranging from one to two tablespoons per day. MSM, another sulphur-containing ingredient commonly used for joint support, is also effective at supporting arsenic elimination, usually at a dose of 10 grams or two teaspoons per day per horse. Other specific, key ingredients can support healthy toxic processing and elimination, as well as provide support for the detoxification systems and a more balanced metabolism. These ingredients can play a major role in re-establishing a normal healthy metabolism and balanced liver function for toxic removal.

MINERAL IMBALANCE EFFECTS • Fatigue

• Blood sugar imbalances

• Diarrhea or constipation

• Impaired immunity

• Tissue aging

• Muscle pain/tightness

• Inflammation

• Birth defects

• Glandular or hormonal imbalances

• I ncreased metabolic and tissue stress

•M SM supports healthy detoxification processes, kidney and liver function and oxidative reactions. •B eta alanine supports healthy muscular function, detoxification and metabolism. •M agnesium supports cellular energy production, healthy glucose metabolism and acts as a buffer for the acids from toxic exposure and elimination. •T rimethylglycine (TMG) and dimethylglycine (DMG) work synergistically to support basic detoxification mechanisms by contributing the amino acid glycine, as well as supplying valuable methyl groups, which are essential for the inactivation and elimination of toxic substances. •A cetyl L-carnitine is essential to the healthy processing of fatty acids as a source of energy. It contributes to healthy endocrine balance, aids in the detoxification of many common environmental pollutants and supports healthy metabolic function. •T he B vitamins niacin (B3), calcium pantothenate (B5), thiamine (B1), pyridoxine (B6), riboflavin (B2) and vitamin B12 support healthy liver function, energy production, metabolic balance, stress recovery and detoxification. •M ixed tocopherols including vitamin E support healthy cellular function, help reduce excessive oxidative stress and protect against free radical damage. •Z inc and copper have synergistic roles in helping combat environmental toxic effects, reducing excessive oxidation and supporting tissue integrity. •C hromium supports normal, healthy glucose metabolism and energy production. •S elenium directly supports healthy detoxification mechanisms, supports liver function, helps fight the effects of environmental toxins and exhibits a cellular protective benefit.

COMMON CAUSES OF MINERAL IMBALANCE • I mproper feeding; excessive intake of sugars or other imbalanced feeding programs •G iving vitamins and minerals that are not compatible with the current body chemistry • Stress • Accumulation of toxic metals from the environment • Genetic inheritance of mineral patterns • Medications IVC Fall 2013

dietAry fActorS

Flax Seed

These include a low-glycemic diet with low sugar and starch, adequate protein content and essential, unrefined oils. Feed changes include paying close attention to the glycemic index (GI), which measures the influences on glucose availability in the bloodstream, with optimal amounts of unrefined oil to stabilize blood sugar and the associated hormones. Feeds with a high GI contain sugars that break down rapidly during digestion, releasing glucose rapidly into the bloodstream. Feeds with a low GI contain carbohydrates that break down slowly, releasing glucose gradually. Sweet feed has the highest glycemic effect of all. Feeds with a lower GI have more positive health benefits and result in reduced free radical formation, less stress and a more stable, healthy blood sugar level. Low glycemic feeds include rice bran, flax seed meal, lowmolasses beet pulp and some commercial low-starch, high-fiber prepared feeds. Unrefined oil or essential fatty acids, when added to the diet, can have a dramatic effect on slowing the glycemic response. Non-sugar sweeteners are recommended in

place of molasses to prevent rapid rises and falls in blood sugar and support healthy glucose metabolism. These dietary factors can play a major role in re-establishing a normal healthy balance in hormone and energy production, along with a positive mineral balance.

References: Asano R, Suzuki K, Otsuka T, Otsuka M, Sakurai H. “Concentrations of toxic metals and essential minerals in the mane hair of healthy racing horses and their relation to age”. Journal Veterinary Medical Science, 2002. Casey, CE.; Hambidge, KM. “Trace Element Deﬁciencies in Man”, Advances In Nutritional Research Vol.3, 1980. Combs, DK. “Hair analysis as an Indicator of Mineral Status of Livestock”, Symposium on Assessment of Mineral Status in Domestic Animals, 1986. Flynn, A, Hill, OA, Pories, WJ, Strain, WH. “Trace Element Nutriture and Metabolism Through Head Hair Analysis”, Trace Substances in Environmental Health, 1972. Gilbert, RI. “Trace Elements in Human Hair and Bone. Hair, Trace Elements and Human Illness”, Praeger Publications, 1980. Hagag Y, Karpas Z, Kurttio P, Lorber A, Paz-Tal O, Salonen L, Sela H. “Measurement of the 234U/238U ratio by MC-ICPMS in drinking water, hair, nails, and urine as an indicator of uranium exposure source”, Health Phys, 2005. Miekeley, N. “Elemental Anomalies in Hair as Indicators of Endocrinologic Pathologies and Deﬁciencies in Calcium and Bone Metabolism”, Trace Elemental Medical Biolology, 2005. Spallholz JE, Boylan LM, Palace V, Chen J, Smith L, Rahman MM, Robertson JD. “Arsenic and Selenium in Human Hair; A comparison of Five Countries With and Without Arsenicosis”, Biolology Trace Element Resources, 2005. “Toxic Trace Metals in Mammalian Hair and Nails”, United States Environmental Protection Agency Publication, 1979. Wright, RO, “Metals and Neurotoxicology”, Journal of Nutrition, 2007.

By Federico G. Latimer, DVM, MS, DACVS Joints are composed of articular cartilage, synovial fluid, and soft tissues. Joint cartilage is nourished by synovial fluid for proper function. Osteoarthritis is common in dogs. Causes include developmental orthopedic diseases (e.g. hip dysplasia, medial patellar luxation and osteochondrosis). These negatively impact joint health early in life, especially in large breeds. Other causes include cranial cruciate ligament injury, joint fractures or dislocations, autoimmune disorders, infections, age and obesity. These diseases involve inflammation and loss of joint fluid, resulting in poor lubrication and cartilage nutrition. Adult cartilage has a limited healing capacity. When damaged, it is replaced by scar tissue that cannot withstand the wear and tear that healthy cartilage can easily accommodate. If left unchecked, this process becomes a cycle of joint damage with

42 IVC Fall 2013

inflammation, further reducing cartilage nutrition and leading to more damage and inflammation. Ways to keep joints healthy include maintaining a healthy weight and being active, reducing inflammation in injured or severely affected joints, and feeding proper nutrition to promote cartilage health. Omega-3 fatty acids enhance joint fluid quality, while chondroitin sulfate and glucosamine protect cartilage. These and boswellia, willow bark, and bromelain have anti-inflammatory effects for inflamed joints. Innovative therapies using platelet-rich plasma extracts and culture-expanded stem cells, combined with hyperbaric oxygen therapy, improve joint health and magnify and prolong beneficial clinical effects. Dr Federico Latimer is a Board-Certified Veterinary Surgeon. He earned his Doctorate in Veterinary Medicine from The Ohio State University in 1984 and entered into private practice in Puerto Rico until 1987. He has worked on the surgical faculties at the University of Tennessee, North Carolina State University, Oregon State University, Louisiana State University, and The Ohio State University.

IVC Fall 2013

Advertorial

How many

drugs are your

patients on?

By Heidi Lobprise, DVM, DAVDC

The older our patients get, the more medications or supplements they take – and the greater the risk of interactions between them. Add to this a senior’s potential diminished capacity for absorption, metabolism or elimination, and a particular drug or compound can become either toxic or ineffective. • Sucralfate and other aluminum-containing antacids may decrease drug absorption by forming complexes with them in the GI tract (ciprofloxacin, tetracycline, theophylline and digoxin, to name a few). Absorption of H2 blockers may also be slowed (but not decreased), so they are often given together. • Cimetidine, an H2 blocker, is a cytochrome P450 inhibitor (potent) and can decrease the renal excretion of many drugs (theophylline, lidocaine, propranolol and midazolam). • Ketoconazole, another cytochrome P450 (CYP3A) inhibitor (P-glycoprotein inhibition), may increase blood cyclosporine and double ivermectin exposure, as well as clomipramine, amitriptyline, alprazolam and others. • Fluoroquinolones can inhibit theophylline clearance, leading to toxicity, but can also have inhibition of its own absorption by aluminum, calcium carbonate, oral zinc, oral iron and magnesium supplements. • Phenobarbital is a major P450 enzyme inducer in dog, accelerating the metabolism and/or clearance of drugs such as ketoconazole, clomipramine and mitotane, decreasing effectiveness or requiring increased doses. Cats are not as affected. • C lomipramine (tricyclic antidepressant) inhibits norepinephrine and serotonin uptake, potentially leading

44 IVC Fall 2013

to serotonin syndrome if used with MAOIs (selegiline and amitraz) or SSRIs. • Omeprazole inhibits some cytochrome P450 enzymes, potentially inhibiting clearance of diazepam, midazolam and others. At a recent ACVIM conference, Dr. Dawn Boothe noted that being able to make the distinction between endogenous nutraceuticals (typically found in the body and more “natural” to the patient) and exogenous ones (herbs and biologics) is important. Exogenous products may be more likely to produce a protective mechanism by the individual, potentially leading to induction or inhibition. In contrast, the active ingredient in NOVIFIT® (NoviSAMe®) Tablets from Virbac Animal Health contains S-adenosyl-Lmethionine, a chemical produced in the body from the amino acid methionine. Early research showed that SAMe is involved in brain and liver functions. While reported side effects of SAMe are uncommon, it is possible that interactions may occur with drugs and dietary supplements that increase the levels of serotonin (antidepressants, L-tryptophan, St John’s wort), but the evidence for this is limited. NOVIFIT Tablets are recommended for the management of behavioral disorders linked to brain aging. Dr. Heidi Lobprise, Diplomate of the American Veterinary Dental College, graduated as a DVM from Texas A&M University in 1983. She became a board certified veterinary dentist in 1993. In 2010, she joined Virbac Animal Health as Senior Technical Manager. She has authored and co-authored dental texts, chapters, and numerous articles, lectured internationally and is an adjunct associate professor at University of Tennessee and Washington State University.

IVC Fall 2013

tech talk

gentle empathy The

power of

By Lisa J. Melling, DVM, CVH

“W

ill you give me that rabies pole thing to hold my dog down so you can do his exam?” asks the nervous owner the first time she sets up a house call appointment for her dog. “My dog is really bad at the vet, and we’ve been told we can’t take him there again unless we sedate him first. But he’s really great with us at home. He’s just scared, and each year he gets worse.”

I explain that I do not have a rabies pole and have never felt the need for one. In my house call practice, owners will often say their dogs are terrible at the Harley relaxed enough to be veterinarian’s office, using descriptions examined once his anxiety that range from “purely terrified” to triggers were removed. “absolutely psychotic”. Some have been asked to wait outside the clinic with their

46 IVC Fall 2013

dogs. A few have been told not to return. Most of these dogs are fearful, and will only bite if they are cornered. In many of these cases, the anxiety from the owners is sensed by the dogs, which further contributes to the behavior. As veterinarians, technicians and staff, we can use a variety of methods to calm these animals, including the art of deception – most of my own patients don’t even realize they are getting an exam. The techniques I use in my house call practice can be easily modified in the veterinary clinic by starting with one simple concept…empathy. Empathy is the ability to relate to someone, to put ourselves in another’s shoes, so to speak. In this case,

let’s see if we can walk a mile in our patients’ paws. We’ll begin by taking an average day at a veterinary clinic with an anxious dog or cat. It’s busy, the doctor is running behind (again!) and you need vitals on the dog in room two. He is lying between his owner’s legs, tail tucked beneath him and trembling. How do you handle this patient? The easiest, fastest thing is to pull the dog by the leash into the center of the room and lift him onto the table. If he growls or snaps, a second assistant may be brought in with a muzzle to handle him firmly while he is assessed. Sound familiar? As integrative practitioners, we are held to a higher standard because we do not simply treat an animal’s physical symptoms, but consider their emotional and mental states as well. In the Summer 2013 issue of IVC, Dr. Sophia Yin covered ways to recognize fear in our patients. It is important to realize that just as the veterinarian can cure physical illness, your skills as a technician combined with your ability to empathize with these patients can heal them on an emotional and mental level. Here are a few tricks that allow you to put your empathy to good use in the veterinary clinic.

Identifying and removing the triggers that heightened Harley’s anxiety allowed for a veterinary visit that was minimally stressful for everyone involved.

Come

…Into the room and introduce yourself to the owner, but do not immediately approach her pet. This gives the dog a chance to greet you on his terms, sniff and get to know you before you reach for him. Speak with the owner while avoiding direct eye contact with the dog, as this may be intimidating to him. After a moment, you may also kneel down, speak softly and let the dog sniff you, but don’t pet him yet. During this time, while it looks like you are simply introducing yourself to the owner, you are assessing this dog’s behavior: is he nervous, outgoing, shy, aggressive or timid? This helps you create a plan for the visit so that everyone is comfortable. If the animal acts aggressive, calmly inquire about any previous bites, and whether or not he has good bite inhibition (if there was a bite, was the skin broken?).

Speak

…Softly and slowly to a nervous dog. If treats are okay with the owner, each time he shows interest in you, softly say “yes” or “good” and offer him a treat. While food rewards are not always possible because the patient may be sick or injured, praise is always a good idea. For cats, you can snap your fingers and imitate the sounds a cat makes when he is curious or chatty: usually a soft inquisitive purr, followed by a single scratch of the ears or chin is enough to engage them. Remember that these calm interactions are not just soothing the patient, they are helping you gain the trust of the owner too.

Sit

…On the floor. Patients and owners absolutely love it. This is one of the best ways to win them both over. Not only are the pets less fearful when all four paws are on the ground, but you can observe their movements more accurately; you are much more likely to identify the cause of lameness or pain if the animal is allowed to move freely IVC Fall 2013

Stay calm even when the owner and the pet are stressed or fearful – they are looking to you for guidance.

in the room. He is also less likely to act fearful while on the floor, since many pets have negative memories of events that happened once they were placed on an exam table.

and applied to nervous or injured patients to help relieve pain and fear. Avoid scruffing and over-restraining cats; often wrapping them in a towel is enough. When you give injections, scratch the area of the skin for several seconds before inserting the needle; this will often keep the pet from noticing the pin prick. If you …Calm even when the owner and the pet are stressed or fearful – have to muzzle an animal, try to hold him as gently as possible. they are looking to you for guidance. Most owners and pets who Have a second person stroke his ears, over his eyes, or on the have had prior negative experiences at clinics are anxious. They will top of his muzzle during IV catheter placement or a blood draw, often say their dog or cat should be immediately muzzled or reach speaking slowly and softly as you give him praise for being so to hold them tightly for the exam. I think we’ve all been brave. This approach is soothing and distracting enough to bitten badly enough once or twice to be very, lower the animal’s fear and reduce the need for very careful, but unless a pet is showing excessive restraint. A side effect of this clear signs of aggression, it’s always technique is that your energy sends put in the nice to give him a chance, even a message to those around you, patient’s place with a history of bad behavior. reminding them to be as gentle Imagine you go to your own doctor for ﬂ u-like Part of the challenge of our and kind to these animals as if symptoms. You are feverish and irritable, and your job is to create a new, they were their own. doctor is running behind (again!). As you wait, shivering in a plastic chair because the table with the paper cover is so positive experience for uncomfortable in your thin disposable gown, a nurse rushes into the patient and his the room, mumbles a greeting, and pushes a thermometer into …For telltale triggers that human, and we have to your mouth. When you protest at her abruptness, she calls security. A person in uniform enters the room, lifts you onto the table, and holds heighten or diminish a establish a bit of trust you there while your vitals are taken. When you try to push them away, pet’s anxiety. For example, before this can happen. they seem irritated that you are not more cooperative. Harley is a four-year-old It is unlikely you would choose to go back to this office, because you Saint Bernard in my house have the free will to make that decision. But what if you had no …The patient gently, call practice who is being choice and were taken back to that office, year after year, with the same unpleasant experience? How would you react? Wouldn’t calming him with treated homeopathically you become more fearful and perhaps even more defensive massage and using for anxiety and digestive at the next visit? pressure no stronger than issues. Harley’s behavior is Once you translate this experience to dogs and cats the weight of a quarter. fear-based, and he has never at the veterinary clinic, you may have a greater TTouch is one form of massage bitten anyone, always opting to run empathy for the anxiety and resultant behaviors that often occur in therapy that can be easily learned away when approached. While Harley

Stay

yourself

Watch

Touch

the exam room.

48 IVC Fall 2013

is very anxious in the presence of his owners and will pace, bark and snarl at visitors, he becomes almost completely relaxed in their absence. At his most recent visit in June, his owners watched through a small window as Harley allowed me to enter their porch and perform a full examination with no growling or barking. His posture and eyes were softer, and his overall demeanor was much more relaxed than just a few minutes earlier in the presence of his owners. At the end of the exam, we even engaged in a short game of play, and he gave me a friendly lick when we finished. When I brought him back inside to his owners, however, he went right back to growling and barking at me again. Identifying and removing the triggers that heightened Harley’s anxiety allowed for a veterinary visit that was minimally stressful for everyone involved.

Heal

...Your patient emotionally and mentally, and create a positive experience for the pet and his human. In addition to minimizing the fear during the visit by adjusting your behavior, there are other forms of therapy that can help with a pet’s anxiety as well. For example, homeopathic treatment is improving Harley’s behavior issues. At the end of my visit, he was given a single dose of a homeopathic medicine that matched all his symptoms of illness, including his anxiety. Within five minutes of his treatment, he settled down on the floor behind his owner’s chair and fell asleep only a few feet from me. This type of pacifying response is commonly seen in patients within minutes of receiving a homeopathic remedy for their symptoms. Another option to calm a nervous animal is to spray a small amount of Rescue Remedy on your hands or clothing before entering the room. As practitioners of integrative medicine, we will always be more successful in healing our patients if we understand the full extent of their illnesses. Empathizing with their emotional and mental state as well as their physical symptoms is a holistic approach that will have clients and their pets looking forward to their next veterinary visit.

Resources On Talking Terms with Dogs: Calming Signals by Turid Rugaas The Other End of the Leash by Patricia McConnell, PhD The Tellington Ttouch by Linda Tellington-Jones, TTouch.com Complete Guide to Natural Health for Dogs and Cats by Richard Pitcairn, DVM, PhD, DrPitcairn.com IVC Fall 2013

part one

Treating Canine

Osteoarthritis By Sherman O. Canapp Jr., DVM, MS, CCRT, and Lisa M. Fair, VT, CCRA, CMT

Osteoarthritis (OA) is the most common joint disease in dogs. It is reported that one in every five dogs greater than a year old is affected. Incidents increase as dogs age with one in every two dogs ten years or older affected. Given these statistics, our focus on managing osteoarthritis must evolve from simply palliative treatment of well-established disease using just a few modalities to early intervention and a comprehensive multimodal approach. Multiple etiologies are suspected to contribute to the formation of OA, including congenital and developmental abnormalities, joint instability, joint trauma, defective articular cartilage structure and biosynthesis, and inflammatory conditions. In our experience, congenital and developmental abnormalities and joint instability are the leading cause of OA. Early intervention offers the best prognosis for minimizing OA. Early intervention includes screening for developmental orthopedic diseases, especially in breeds with known risk, and thorough investigation of seemingly indistinct clinical signs in young dogs. Too often presenting complaints such as slow moving, clumsy gait, less playful or lazy and even intermittent lameness are attributed to â&#x20AC;&#x153;growing painsâ&#x20AC;? when in reality these are often early signs of underlying joint disease. This is the most often missed opportunity for early identification and treatment

50 IVC Fall 2013

of joint diseases that could have a profound impact on the dog’s longevity and quality of life.

Shoulder OCD, a common cause of lameness in young dogs (six months to two years), can lead to shoulder OA if untreated. Early treatment via arthroscopy offers an excellent long-term prognosis.

When owners have these complaints it is critical to discuss the potential implications and offer a comprehensive evaluation. In some cases an orthopedic examination and radiographs can provide diagnosis (i.e. hip dysplasia), however more advanced diagnostics such as CT, MRI or arthroscopy may be needed (i.e fragmented coronoid processes (FCP) of the elbow may not be evident on routine radiographs). Depending on findings, surgical intervention may be warranted. Early intervention is also imperative for traumatic injuries including those that leave joints unstable. This can include cruciate ligament insufficiency, traumatic FCP, medial shoulder syndrome/instability (MSS/MSI) and carpal and tarsal sprain/ strain injuries. Although these injures can occur acutely, joint instability can also result from repetitive activities and these types of injuries are common in sporting and working dogs. Early and appropriate management of these injuries can greatly reduce development and advancement of OA.

well as specific natural ingredients to enhance development are all essential elements to reduce the risk of developmental skeletal disease. In all dogs, providing proper nutrition during growth and maintaining a healthy weight throughout life can help minimize the development of OA. Beyond providing age-appropriate nutrition, diets that include or are supplemented with certain nutritional factors may reduce inflammation, slow degradation, enhance cartilage repair and provide relief from the associated discomfort. • Omega 3 fatty acids are essential fatty acids. Two components of Omega 3 fatty acids, eicosapentaenoic acid and docosahexaenoic acid, better know as EPA and DHA, found in cold water fish have been shown to reduce inflammation and reduce pain associated with OA. EPA specifically has been shown to suppress the degradative enzymens associated with cartilage destruction. • Glucosamine is a precursor for glycosaminoglycans (GAGS), which are a primary component of joint cartilage. Supplemental glucosamine may influence cartilage structure and restore synovial fluid. GAGs may also aid in the prevention of OA.

Regardless of whether surgical or conservative management is pursued, a complete management program should be multifaceted. Components of a comprehensive program may include: • Diet, nutrition and supplements • Weight management and exercise • Assistive devices • Acupuncture and physical manipulation (chiropractic) • Regenerative medicine therapy • Rehabilitation therapy • NSAIDs and adjunct medications • Disease modifying agents and corticosteriods In this issue, we will discuss diet, nutrition and supplements, weight management and exercise, and assistive devices.

The role of diet and supplements Diet and nutrition have significant impact on health and disease. Nutrition has been shown to play a role in developmental skeletal disease. An excess of specific nutrients can exacerbate musculoskeletal disorders, and fast-growing, large breed puppies are at particular risk. For these dogs, controlled growth, optimum levels of calcium and phosphorus and essential fatty acids as

IVC Fall 2013

• Chondrotin sulfate is an important structural component of cartilage and provides resistance of cartilage to compression. Supplemental chondrotin sulfate may reduce inflammation, stimulate synthesis of proteoglycans and hyaluronic acid as well as decrease catabolic activity. • ASU (avocado/soybean unsaponifiables) has been demonstrated to help protect cartilage from degradation. Studies have shown a synergy when glucosamine hydrochloride, chondrotin sulfate and AUS are combined. Together they provide improved inhibition in expression of agents involved in cartilage breakdown. • MSM (methylsulfonylmethane) is an organosulfur compound and although the biochemical effects of supplemental MSM are poorly understood, some research has suggested that MSM has antiinflammatory effects. Research suggests there may be increased benefit when it is combined with glucosamine and chondrotin. • SAM-e (S-Adenosyl methionine) is naturally made by the body and plays an important role in normal bodily functions. Often used as a supplement for liver support, studies have demonstrated that supplemental SAM-e can also reduce discomfort associated with OA. Some studies even found SAM-e to be as effective for relieving pain as NSAIDs. • Vitamin E is the primary lipid-soluble antioxidant present in plasma, erythrocytes and tissues. Oxidative damage to essential cell components caused by oxygen free radicals is a mechanism in the pathobiology of degenerative joint disease. Vitamin E inhibits lipid oxidation. Research indicates that levels of Vitamin E must be higher than minimal requirements to achieve biologic benefits. Further, supplementation with Vitamin E is needed when supplementing with fatty acids as these fatty acids can deplete Vitamin E in the body. • Vitamin C (ascorbic acid) is an essential nutrient well known for its antioxidant activity. Although dogs can synthesize enough vitamin C to meet minimal requirements, supplementation may improve antioxidant performance. However, it is important to note that vitamin C supplementation can contribute to calcium oxalate crystal formation in susceptible dogs. In addition, over supplementation can cause loose stools.

52 IVC Fall 2013

• DLPA (DL-phenylalanine) is a natural amino acid used to treat chronic pain. DLPA inhibits several enzymes that are responsible for the destruction of endorphins. Endorphins are pain-killing hormones and by inhibiting their destruction, pain relief is prolonged. It can also potentiate opiate analgesia and prolong the effects of acupuncture. DLPA can be used as an alternative to NSAIDs. DLPA cannot be used with any MAOI drugs such as Anipryl (used for treatment of Pituitary-Dependent Hyperadrenocorticism (PDH)/Cushing’s Disease and Canine Cognitive Dysfunction) or Amitraz (used in tick collars). • Traumeel is a homeopathic formulation of 12 botancial substances and one mineral substance. It has been diluted beyond the molecular level, probably with nonoparticle effects as the MOA. It is purported to have anti-inflammatory, anti-edematous and anti-exudative properties. Although the exact mechanism of action is not well understood, it appears to be the result of modulation of the release of oxygen radicals from activated neutrophils, and inhibition of the release of inflammatory mediators (possibly interleukin-1 from activated macrophages) and neuropeptides (2). Traumeel is often used as an alternative to NSAIDs. • GLM (Green-Lipped Mussels) has been shown to contain antiinflammatory components and other nutrients that may benefit joint health. Exact mechanisms of action are unknown, however, clinical studies of GLM powder added to diets either by way of incorporating into food using low-temperature processing (heat processing of GLM has been shown to destroy its activity) or sprinkling on top of food showed GLM to be effective in reducing symptoms. • Herbs – There are several herbs that have anti-inflammatory and analgesic properties, as well as various herbal formulations purported to aid dogs suffering with OA. Commonly used herbs include: • Boswellia • Yucca root • Turmeric • Hawthorn • Nettle leaf • Licorice • Meadowsweet • Willow bark It is important to note that herbs can have side effects as with any drug. In addition, herbs may have interactions with other herbs, supplements and medications. Consultation with a qualified botonical medicine professional can be beneficial in determining which herbs and at what doses those herbs can offer benefit to your patient. Continued on page 54

IVC Fall 2013

Continued from page 52

When considering supplementation, it is important to consider the whole dog and any concurrent diseases or conditions. Many dogs being treated for OA are geriatric and may have impaired organ function. Prior to adding any supplementation, especially in the geriatric dog, a physical examination, baseline urinalysis, complete blood count and blood chemistry is recommended. Research potential contraindications, drug interactions and appropriate dosing of any supplement considered prior to administration. Many dog foods formulated specifically for OA contain several of these supplements; therefore additional supplementation may require dosing adjustments. For owners that like to supplement their dogâ&#x20AC;&#x2122;s diet with table scraps or treats, a discussion of the implications of doing so is recommended. For those owners a recommendation of appropriate foods and treats should be given. For dogs on a weight management program, pumpkin puree added to food can help dogs feel fuller and aid in weight loss efforts. Certain foods are believed to be proor anti-inflammatory. Nightshade foods are pro-inflammatory; these include potatoes, tomatoes, peppers and eggplant. Antiinflammatory foods that may offer benefit include celery, ginger, alfalfa and tropical fruits such as mangos and papayas.

Weight management and exercise Obesity is a known risk factor for OA in dogs. Owners must be educated on the importance of maintaining their dogs at a healthy weight and each visit should include evaluation of weight and body condition score (BCS). Dogs with excess weight should be placed on a diet management program, which may include food restriction, change in diet, exercise and behavior modification. As discussed above, many owners give treats without thought to caloric implications. Compliance to weight management programs is often a challenge so be sure to discuss and include treats when formulating weight management programs. Weight management alone may result in significant clinical improvement.

54 IVC Fall 2013

Light to moderate low impact exercise is recommended to reduce stiffness and maintain joint mobility. Specific exercise requirements can vary based on the individual dog, however short walks (15 to 20 minutes) performed two to three times daily are typically recommended. Swimming is an excellent low impact activity that can improve muscle mass and joint range of motion. The most critical aspect is consistency. Exercise should be performed on a routine basis and excessive and/or high impact exercise should be avoided.

Assistive devices These provide assistance with mobility for walking, rising and maneuvering. Booties can provide traction for slippery surfaces. Orthotics can provide support to joints which can also improve comfort. Slings and harnesses can be used to assist pets when rising, walking, performing stairs and during eliminations. Carts can provide independent mobility for dogs that have difficulty walking. Canine osteoarthritis is an incurable condition, however, with early intervention, when possible, and a multimodal approach we can extend the longevity and quality of life for our canine patients. In the next issue (Winter 2014), we will discuss acupuncture and physical manipulation; regenerative medicine therapy; rehabilitation therapy; NSAIDs and adjunct medications; and disease modifying agents and corticosteriods.

Orthotic devices can offer support and stability for unstable or arthritic joints. Top image: StiďŹ&#x201A;e orthoses Bottom image: Hinged tarsal orthoses

industry innovations Under the skin

Heads down

Breeder’s Formula® is a concentrated nutrient source formulated by veterinary nutritionists to promote healthy skin and relieve itching in dogs. It also supplies nutrients for a glossy hair coat and general well-being. Additional nutrients include L-tryptophan, thiamine and magnesium to reduce anxious behavior and lessen compulsive licking and skin chewing. Recommended for dogs of all breeds and ages, including pregnant dogs. Available in 17.6 oz. and 70.4 oz. bags. lifedatalabs.com

The natural way for the equine to eat is with his head down. He can only salivate when in this position, thereby decreasing ulcers, and is likely to get dust and hay into his lungs. You can tell if your patients are eating from a “heads up” position by the way the molars are wearing, and by the development of the muscles. The Health E-Z Hay Feeder is hung low to the ground for the correct feeding posture; it also slows down hay consumption and improves digestion. healthezhayfeeder.com

Be the

leader

When providing massage and bodywork – including vet care – to canine patients, you must be the pack leader. Dog Handling in Canine Massage from petMassage teaches gentle yet powerful skills that help you earn their respect and invite their cooperation in ways they understand, by staying in the present and speaking through yoga breathing, posture and focus. You’ll have the confidence to offer your services to more dogs, and in a greater variety of situations.

Joint relief

petmassage.com

proMotion® is an original joint nutrient with potent antioxidants, glucosamine and hydrolyzed collagen. This fast-acting formula typically yields a 50% improvement in only ten days and has a five-day loading dose. It comes in vegetarian-bacon flavored chewable tablets or liver-flavored soft chews for cats and dogs, and tunaflavored sprinkle capsules for cats. An equine version is available in alfalfa crumbles and as a 60-day supply. animalhealthoptions.com IVC Fall 2013

integrative practice

PEOPLE CRAVE A

beautiful EXPERIENCEâ&#x20AC;¦

EVEN AT THE

VETERINARY CLINIC

By Donna Ragona, DVM

56 IVC Fall 2013

Let me start with a question for my fellow veterinarians. How many of your clients tell you they love how you decorated your clinic? Do they tell you how at ease they feel? Do they say “even my pet loves it here”? You really do want and need to hear these compliments. Why? Simple. If your clients’ perception of your clinic evokes a comfortable and happy feeling, their anxiety will be lower; in turn, their pets’ anxiety will also be lower. Minimal anxiety and happy feelings in both the owner and pet makes a veterinarian’s job that much more pleasurable and less stressful. As well, clients are more likely to make return visits. Creating a wonderful experience for your clients can be easily achieved before you even speak a word.

Choose the right

color for your spaces

Many studies have proven the impact of color on mood. Do you want your clients, employees and yourself to have positive feelings while in your work space? Why not enhance your walls with colors that will bring out the best in everyone? You can find several resources for enhancing mood with color. If in doubt, choose the colors of the seven chakras, or a rainbow. Interestingly, changing colors from room to room will help keep the office stimulating and improve workflow (see table on next page for some examples). If choosing colors is overwhelming for you, hire a professional if you have to: it is that important and I promise you won’t regret it.

Keep it

simple and comfortable

You can put wonderful colors on your walls, but to enhance them you must let the beauty show. Try not to cover your wall spaces with flyers, announcements or posters. Always frame everything you put on your walls, as clients will be uneasy seeing papers taped and tacked. Choose frames that match the theme of your clinic. Use metal for a modern streamlined look or wood for a homelike feel. You want to convey a professional and orderly presentation in the office at all times. Therefore, if you are running a special or have an announcement, it is best to place these papers at the front desk, not on your walls. Realistically, clients will be much more likely to see them when checking out, and will have a dialog with your receptionist for further impact. Continued on page 58. Paintings courtesy of Donna Ragona, DVM

IVC Fall 2013

Continued from page 57.

Always provide comfortable seating for your clients. Although you probably do your best to stay on schedule, they will be much happier waiting in attractive, easy seats. Clearly, humans feel more comfortable in a neat, tidy, orderly and aesthetically pleasing environment, but what about our furry companions? How do you think they feel about getting up on a slippery metal table? Simply adding a rubber-backed carpet square to your exam table can make a huge improvement in your patients’ comfort. Do the old dogs in your practice slip and slide on the floors? Purchasing easy-to-care-for runners will really help them walk much more comfortably and confidently through the clinic. I guarantee your clients will see and appreciate your efforts to spoil their pets.

Let your art speak

positively

Your clients do not want to view posters that illustrate parasites, cut open hearts or gastrointestinal innards. Veterinarians love this cool stuff, but our clients do not want to see it. We think it is educational, but they think it is grotesque and creepy. You need to communicate to your clients that you love animals and honor their bond with their beloved pets. Often, a painting of an animal portrays a beauty we cannot describe in words. There are hundreds of beautiful paintings and artistic photos of animals to choose from. These can range from realistic to very artistic and at a cost to fit your budget. You need your clients to see that you adore animals as much as they do! Choose art that fits you and your personality. Hang the images you want to share with your clients and staff. Then, about every three months, rotate your art to add a whole new look to your clinic. Surprisingly, the variety will help clients and staff maintain their interest in the practice.

Professional documents

In addition to your art, hang your diploma, your personal mission statement, and the Veterinarian’s Oath to illustrate your professional lifelong commitment to the health of animals. Your clients will love viewing something that comes from your heart. However, do not feel the need to hang every certificate from every CE you attend. People will get bored of this even though we think it is cool. Why not place your CE certificates in a photo album and place it in the waiting room, if you would like to share your achievements? Most states require the display of several documents in your waiting room. Placing them all in one large frame with glass looks very neat and satisfies the inspectors. Remember, no tacking or taping to the walls. Lastly, be careful of the bulletin board. Selling puppies, kittens and cars is not your profession! Bulletin boards are often an eyesore that clients take over for their personal agenda and business cards. Take charge of what you want displayed and give your clients a business card album and separate “notices” album that you keep in your waiting room for reference. As veterinarians, we feel for our patients and clients very deeply at times. The experience your clients have at your clinic translates to how they feel about you. A relaxed, clean and inviting environment, along with your exceptional care, will evoke such a wonderful feeling that your clients will enjoy their visits, and you’ll keep seeing them again and again.

Watch out for

Color code

Choose a different color for each room to fit the mood of the work you are performing. Here are some examples. room

Color

Effects

Waiting room

Yellow

Inviting/energizing/cheering

Exam room

Green

Soothing/natural

Light blue

Relaxing/calming

Treatment and surgery room Office Holistic room

58 IVC Fall 2013

Orange purple

Stimulating/fatigue reducing Relaxing/meditative

smells

One of the first things our clients will notice is the smell of our working space. Is it a good smell or a bad one? There is nothing wrong with having a natural air freshener, purifier or fresh ﬂowers in the waiting room. A bad odor translates to a dirty or unhealthy hospital. You work too hard to allow this unfair interpretation. Give your clients the benefit of fresh and pleasant olfactory stimulation, and ensure their confidence in your medical practices.

Healing Through Hyperthermia

The I-Therm is a revolutionary system that safely heats tissue and promotes healing with depths of penetration not observed with any other treatment modality. The I-Therm activates molecular motion 1000 times smaller than the capability of ultrasound. It is this molecular motion that induces hyperthermia. w and thereby Molecular hyperthermia increases bl promotes a dramatically more e cient delivery of oxygen and nutrients and the more rapid removal of toxins in the targeted area. The I-Therm delivers the exact dose prescribed to animals by means of a non-invasive applicator which includes temperature sensors that safely monitor and control internal and external temperatures.

Hyperthermia • Increased metabolic rate to accelerate wound healing • Vasodilatation • Increased oxygen, plasma and nutrient delivery • Rapid removal of toxins and cell waste • Repolarization of cell membrane • Polarization of water •

ry response

• Alteration in sensory nerve conduction / pain perception • Apoptosis

I-Ther : 360 mm (14.17") x 200 mm (7.87") x 395 mm (15.55"), 23 lbs.

instrumental in the pain management and • Cancer

• Soft Tissue Rehabilitation

• Arthritis

• Orthopedic Rehabilitation

• Internal Medicine

• Neurologic Pain & Rehabilitation

• Auto Immune Disease

• Infectious & Endocrine Disease

If you are looking for ways to CLINICALLY ENHANCE your practice If you are looking for ways to SIGNIFICANTLY INCREASE REVENUE in your practice If you are looking for EXCLUSIVITY OVER YOUR COMPETITION All For:

NO CAPITAL OUTLAY REQUIRED!

• Cytoxicity • Anti-edema activity • Incr

Please inquire about our Usage Based Licensing and Exclusivity Programs (KLD Medical’s USAGE BASED LICENSING AGREEMENT). Contact us at info@kldmedical.net for more information.

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

Integrated courses

IVAS Vision The vision of the International Veterinary Acupuncture Society (IVAS) is to be the professional, proactive worldwide advocate for veterinary acupuncture and related treatment modalities.

Pancreatitis case study Quilpie, an 11-year-old female spayed German Spitz presented to Dr. Barbara Fougere, BSc, BVMS (Hons) MODT, MHSc, CVA, CVBM, CVCP, in January, 2011 with a ten-day history of pancreatitis, which had been treated by the regular veterinarian in hospital but still wasnâ&#x20AC;&#x2122;t normal. Quilpie had mild jaundice and was dehydrated on presentation so was sent for observation and IV fluids to an overnight referral facility. She deteriorated over the next 48 to 72 hours, developing hepatobiliary stasis, liver failure, with the ultrasound revealing occlusion of the bile duct. Her prognosis was grave and surgery was considered risky, so the owners opted for TCVM. She was treated rectally with Xiao Chai Hu Tang four times daily. Two days later her bile acids and liver values were improving and she received two acupuncture treatments while in the hospital. By day four her appetite was returning. She was discharged from the hospital seven days after admission. To date she has completely recovered. She has a history of autoimmune scleritis which has also resolved on this formula.

The American Veterinary Medical Association recognizes veterinary acupuncture as a valid modality with the practice of veterinary medicine and surgery. The basic veterinary acupuncture course taught by the International Veterinary Acupuncture Society (IVAS) in the United States has the longest history of a comprehensive study of veterinary acupuncture in the Western world. Our courses integrate a balanced background of the fundamentals of the scientific basis and application of acupuncture, as well as a background in the fundamentals and applications of traditional Chinese medicine and acupuncture. Our program prepares the veterinarian for integration of acupuncture into everyday clinical practice. The IVAS certification program has been internationally recognized for over 38 years. The basic veterinary acupuncture course includes over 160 hours of education and hands on labs that prepare the student for both the written and practical examinations that are required for IVAS certification. The next course in the U.S. begins October 2013 and will be held in San Antonio, Texas; Session II is November 20-24, 2013. Session III is January 22-26, 2014. Session IV is February 26 - March 2, 2014. Mentored Internship is April 2-3, 2014 and the Exams are April 5-6, 2014.

To learn more about our courses and membership please visit our website at ivas.org email us at office@ivas.org or contact us at (970) 266-0666.

60 IVC Fall 2013

Veterinary Resource Guide ASSISTIVE DEVICES HandicappedPet.com Amherst, NH USA Phone: (603) 577-8858 Website: www.handicappedpets.com Best Friend Mobility Myrtle Beach, SC USA Phone: (503) 575-9407 Email: sylvan@sylvancompany.com Website: www.bestfriendmobility.org

ASSOCIATIONS Academy of Veterinary Homeopathy - AVH Leucadia, CA USA Phone: (866) 652-1590 Website: www.theavh.org American Academy of Veterinary Acupuncture - AAVA Glastonbury, CT USA Phone: (860) 632-9911 Email: aava@cttel.net Website: www.aava.org

EverGlo-Naturals Gloria Dodd, DVM Gualala, CA USA Phone: 707-785-9171 Email: everglo@mcn.org Website: www.holisticvetpetcare.net Mark Newkirk, VMD Margate Animal Hospital & Alternative Care Center Egg Harbor Township, NJ USA Toll Free: (609) 645-2120 Phone: (609) 645-2120 Website: www.alternativevet.com Steven Marsden, DVM Edmonton Holistic Veterinary Clinic Edmonton, AB Canada Phone: 780-436-4944

NATURAL PRODUCT

MANUFACTURERS & DISTRIBUTORS GenesisValley Center CA USA Phone: (760) 751-3360 Website: www.genesispets.com

RESOURCE DIRECTORY

American Veterinary Chiropractic Association - AVCA Bluejacket, OK USA Phone: (918) 784-2231 Email: avcainfo@junct.com Website: www.animalchiropractic.org

INTEGRATIVE VETS Dr. Shawn Messonnier Paws and Claws Vet Clinic Plano, TX USA Phone: (972) 712-0893 Email: shawnvet@sbcglobal.net Website: www.pettogethers.net/healthypet East York Animal Clinic Toronto, ON Canada Phone: (416) 757-3569 Email: eyac@ca.inter.net Website: www.holisticpetvet.com

Traditional Chinese Veterinary Medicine TCVM Reddick, FL USA Phone: (352) 591-5385 Email: register@tcvm.com Website: www.tcvm.com Veterinary Information Network - VIN Davis, CA USA Phone: (530) 756-4881 Email: vingram@vin.com Website: www.vin.com

SUPPLEMENTS Herbsmith Inc. Hartland, WI USA Phone: (262) 367-1372 Email: mail@herbsmithinc.com Website: www.herbsmithinc.com

SmartPak Plymouth, MA USA Phone: (774) 773-1125 Email: customercare@smartpak.com Website: www.smartpak.com

National Animal Supplement Council - NASC Valley Center, CA USA Phone: (760) 751-3360 Website: www.nasc.cc

Cassie Schuster, ND, MH Waller, TX USA Phone: (713) 502-0765 Email: cassie.schuster@yahoo.com Website: www.wellranch.com

Tallgrass Animal Acupressure Institute Castle Pines, CO USA Phone: (303) 681-3033 Email: nancy@animalacupressure.com Website: www.animalacupressure.com

MVP Laboratories Omaha, NE USA Phone: (402) 331-5106 Email: mvplabs@mvplabs.com Website: www.mvplabs.com

Association of Veterinary Acupunturists of Canada - AVAC Beaconsﬁeld, QC Canada Phone: (514) 697-0295 Email: ofﬁce@avac.ca Website: www.avac.ca

EQUINE NATUROPATH

PetMassage Ltd. Toledo, OH USA Phone: (419) 475-3539 Email: info@petmassage.com Website: www.petmassage.com

SCHOOLS & WELLNESS EDUCATION Animal Spirit Network Pekin, IL USA Phone: (815) 531-2850 Email: carol@animalspiritnetwork.com Website: www.animalspiritnetwork.com

The Honest Kitchen San Diego, CA USA Phone: (858) 483-5995 Email: info@thehonestkitchen.com Website: www.thehonestkitchen.com

THERMAL IMAGING

College of Integrative Veterinary Therapies - CIVT Rozelle, NSW Australia Phone: (303) 800-5460 Website: www.civtedu.org

Integrated Touch Therapy, Inc Offering Small, Hands-On Intensive Classes in Animal Massage and Bodywork 1-800-251-0007 wshaw1@bright.net www.integratedtouchtherapy.com

IVC Fall 2013

Advertorial

BEHAVIOR PROBLEMS OFTEN CAUSED BY

ANXIETY By Heidi Lobprise, DVM, DAVDC

1 2 3 4 5 6

As veterinarians provide a more integrative approach to patients, they need to incorporate some basic knowledge of canine behavior that they can share with clients. Dr. Valarie Tynes, a Diplomate of the American College of Veterinary Behaviorists, gives seminars on “Ten Tips for Improving Your Relationship with Your Dog”, outlined here.

happen again. Teach useful, specific commands (e.g. “come” or “stay”).

Learn to read canine body language – e.g., flattened ears, tucked tail, lowered body, averted gaze and avoidance behavior are signs of anxiety or fear. Stand sideways to the dog without direct eye contact, or kneel down and speak in a quiet, happy tone. Let the dog approach you first.

Use the “Take Away” method; remove something the dog values when unwanted behaviors are first displayed. Get up and walk away from a puppy that is playing too aggressively; this teaches him that aggression makes the play stop.

Never force a dog into a situation when he is acting afraid. Combine positive experiences (treats) with novel stimuli, and let him go at his own pace. Understand how animals learn. They don’t know the difference between right and wrong, but respond to rewards for good behavior. Encourage clients to set their dogs up to succeed by removing temptations and ensuring plenty of exercise. Your client’s relationship with her dog will be more pleasant if she rewards appropriate behaviors rather than punishing unwanted ones. Praise the dog when he obeys a command; turn away and ignore him if the unwanted behavior persists. “No” is not a command. It may stop the dog momentarily, but it won’t teach him that the client expects the action never to

62 IVC Fall 2013

7 8 9 10

Don’t repeat a command multiple times when a dog is excited, as it makes the word meaningless. Use teachable moments (quiet, short periods) to reinforce wanted behaviors.

Avoid punishment. Yelling, swatting, water squirting, etc. should never be used in teaching a dog.

It’s not about dominance! There is no evidence that domestic dogs attempt to establish firm hierarchies if left to their own devices. Dominance is not a trait – it defines a relationship between two individuals that can change depending on the circumstances. Social hierarchies can actually help keep the peace in multi-dog environments.

Most behavior problems are due to fear or anxiety. For mild to moderate cases, ANXITANE® (L-Theanine) Tablets may be considered in conjunction with behavioral modification. They contain pure L-Theanine, also known as Suntheanine®, an amino acid that acts neurologically to help keep animals calm and well behaved. It has been clinically proven as a first-line treatment option, along with behavioral training modification, to reduce fear and anxiety. It has also been shown to help reduce stress-related disruptive behaviors that can interfere with the human-animal bond.

IVC Fall 2013

Homeopathy: â&#x20AC;&#x201C; part 2

By Shelly Epstein, DVM, CVH and Iris Bell, MD

New evidence is emerging on the

a low dose of the simillimum to an animal already exhibiting these signs of illness will trigger the system to mount compensatory responses to counteract effects of the medicine and thereby reverse the overall disease pattern. In physiology, the capacity for a reversal of symptoms and signs when exposed to a stressor different from the original stressor is known as cross-adaptation or cross-resistance.

Part 1 of this article (from the Summer 2013 issue of IVC) discussed the main principles of homeopathic practice. These concepts include finding the single substance (simillimum) whose associated symptom pattern from testing best matches the total clinical picture of the individual person or animal. Giving

Understanding adaptation, cross-adaptation and hormesis

nature and properties of homeopathic medicines, or remedies. These findings indicate that the science of homeopathy is a form of nanomedicine, with the medicines capable of initiating changes in the physiological and biochemical dynamics of the animal as a complex adaptive system.

64 IVC Fall 2013

In the fields of pharmacology-toxicology, the capacity of a low or mild stressor to generate responses in the opposite direction of what it can cause at higher levels or amounts is termed hormesis. Hormesis

has now been documented in over 8,000 different scientific studies of stressors known as â&#x20AC;&#x153;hormetinsâ&#x20AC;?, which include many different drugs and chemicals as well as physical and psychological stressors. In formal terminology, hormesis is a nonlinear adaptive dose-response relationship in which low, typically non-toxic doses stimulate, whereas higher doses of the same agent inhibit a particular effect. In general, understanding how a drug acts is not simple. The direction of a drugâ&#x20AC;&#x2122;s effects depends partly on the dose level. Conventional medicine tends to use large doses of drugs, expecting molecules to bind to specific cell receptors enzymes As a or enzymes. result, conventional pharmacology does not take advantage of hormesis for clinical treatment. In contrast, researchers in hormesis believe the phenomenon is an organismwide, adaptive response to prepare for or counteract biological stress. For example, if a person or animal is first exposed to low temperatures and given time to adapt, he will later exhibit a cross-adapted tolerance for exposures to high altitudes, even though he may not have previously encountered the altitude as a stressor. If the level of the initial stressor is too high, too prolonged, or too frequent for his ability to adapt, the effects would end up damaging his health rather than promoting resilience. In homeopathy, the remedy that is administered is the hormetin. It is not the same stressor as the original cause of the disease. Rather, whatever disturbances the remedy can trigger in the adaptive stress response networks of the body rely on similar pathways that the original cumulative stressors (biological, physical and/or emotional) already mobilized. In IVC Fall 2013

Using sophisticated electron microscope methods and other conﬁrmatory laboratory tests, they showed the presence of the original remedy source material in nanoparticle forms at 6C, 30C and 200C. essence, the well-chosen homeopathic remedy works with the pre-existing condition and the unique features of the individual’s adaptive processes to set the reversal of adverse manifestations into motion. The correct homeopathic remedy is a mild salient (i.e. relevant) stressor for the organism as a whole. Living systems are complex adaptive networks of interconnected, interdependent parts. Change in one part can lead to a cascade of additional changes in parts far from where the stressor first impacted. Once the organism receives the hormetic signal, the body’s adaptive defenses swing into action across the biochemical and cellular networks of the stress response pathways. Immune, endocrine, autonomic, metabolic and central nervous system mediators signal and inter-regulate one another, making adjustments for what is going on elsewhere in the larger system. Thus, a properly timed and positioned signal, even though small, can disrupt the unhealthy dynamics of disease – and allow the system to reorganize toward a new and healthier dynamic pattern. The new pattern allows the possibility for continuing changes to evolve across the organism over time.

Unlocking the mystery of homeopathic remedies For many years, homeopathic researchers have suspected hormesis might provide an explanation for how the remedies, which involve low doses given at widely spaced intervals, work. However, no one had shown an experimentally demonstrable stressor in remedies that could be an individually relevant hormetin to set hormesis into motion.

66 IVC Fall 2013

Most of the debate was focused on the assumption that “higher” potencies – that is, more serially diluted medicines greater than 12C or 24X – would eventually leave no plausible amounts of the original remedy material in solution. Skeptics have long argued that homeopathic remedies can only be elaborate placebos without any capacity for initiating biological effects. Defenders of homeopathy arrived at a focus on what came to be called “the memory of water” hypothesis. In turn, critics of a water-structure based model for homeopathic remedies pointed out various limitations and flaws in the argument. One obvious challenge is that low potencies of certain homeopathic medicines are made without water or other liquid by crushing the source material in lactose, and even higher liquid potencies are often sprayed or dried into lactose or lactose-sucrose pellets for easier storage and administration. Clinicians still report that such dried pellets work; and many, though not all, clinical research studies in people and animals using those dry delivery forms for remedies have been positive. In addition to practical experience and clinical studies, several research groups had already published welldone laboratory experiments on homeopathic remedies compared with control solutions of water or ethanolwater prepared either with or without succussions. Despite the debates over dilution in homeopathy, a key procedural step in preparing remedies in liquids is also to succuss or intensively agitate the solution in its container multiple times. Succussion breaks larger molecules into smaller ones. Using objective tools to measure heat release, electrical conductivity, thermoluminescence (light emission) and certain spectroscopy patterns, all experiments Continued on page 68.

IVC Fall 2013

Using objective tools to measure heat release, electrical conductivity, thermoluminescence (light emission) and certain spectroscopy patterns, all experiments found that homeopathically-prepared remedies were diﬀerent from control solutions. Continued from page 66.

found that homeopathically-prepared remedies were different from control solutions. In some studies, the remedy solutions even seemed to retain the physical chemistry “fingerprint” properties of the original source material. How could something so diluted possibly have such individualized properties? The answer is that remedies contain small but detectable amounts of nanoparticles (NPs). Nanoparticles are simply extremely small particles of the original source material. A nanometer is 10-9 meter in length in any dimension. NPs can be similar in size to viruses, and can enter the body and its cells very easily. The properties of nanoparticles are very different from their bulk forms of the “same” material. When “down-sized”, NPs can acquire new electromagnetic, optical, thermal, biochemical and even atom-like quantum mechanical properties that their bulk forms do not possess.

The discovery of nanoparticles in homeopathic remedies In 2010, basic scientific research on homeopathic remedies made major strides toward understanding the nature of the medicines. First, Dr. John Ives and colleagues from the Samueli Institute reported finding measurable amounts of silica in solutions succussed in glass containers. The silica and its precursors dissolve or break off from the inside walls of the glassware during agitation in solution. Of course, even with silica and nano-silica in homeopathic remedy solutions, it would be present in every glass-made remedy and could not account for individually specific effects. Nonetheless, newer research has shown that silica has remarkable properties of its own as a drug- or herb-delivery vehicle, and an immune amplifier of the effects of even small amounts of antigens in vaccines or natural treatments like snake venoms in cancers. For high potency remedies, silica might serve as a carrier and amplifier.

68 IVC Fall 2013

But what else could be present in remedies even at very low potencies made in lactose? Dr. Jayesh Bellare and colleagues at the Indian Institute of Technology published a startling new finding in 2010. They noted that many homeopathic remedies are often ground up or milled (originally with a mortar and pestle) for hours in lactose during the early stages of manufacturing. Extensive grinding or milling of the original bulk form material is currently one of many well-known modern techniques for manufacturing nanoparticles. The Bellare group investigated six different commercially made homeopathic metal remedies from two different well-known Indian manufacturers. Using sophisticated electron microscope methods and other confirmatory laboratory tests, they showed the presence of the original remedy source material in nanoparticle forms at 6C, 30C and 200C. At dilutions above 12C, no source material should have been present. Quantities varied from batch to batch and from manufacturer to manufacturer, and they were estimated as quite small. But they were there for the eye to see using state-of-the-scientific instrumentation. Another group from India later found nanoparticles and demonstrable amounts of silicon/silica in samples of three different plant remedies they studied at potencies from 1C to 15C. Further research by Dr. Bellare’s group demonstrated that succussions will cause the nanoparticles to accumulate unevenly in layers toward the top of solutions. When a remedy maker then samples the last bottle in order to put a fraction of the succussed material into the next bottle of solvent, they are actually carrying the nanoparticles from bottle to bottle. The bulk form may be diluted out of solution past 12C or 24X potencies, but the remedy nanoparticles remain.

A third research team at a different university in India performed a series of studies in which they were able to use four different homeopathic plant mother tinctures to biologically synthesize silver nanoparticles from silver precursors in solution. Years before, conventional researchers had already discovered that certain plants and sponges can also biologically synthesize silica nanoparticles from their precursors.

moisture

The beneﬁts of

in pet food By Lucy Postins

Conclusions The discovery of nanoparticles in homeopathic remedies is only the beginning. More research is needed to confirm and extend the original observations. Homeopathy is now positioned to use the vast and growing tools of modern nanoscience to understand and improve homeopathic remedy manufacturing and optimize remedy actions. In classical homeopathy, the overall goal is to cure rather than palliate the condition by stimulating the organism as a whole to recover from health problems. The field is now poised for major advances in both basic and applied clinical research to help more people and animals in more effective ways than ever before.

References Al-Sadoon MK, Abdel-Maksoud MA, Rabah DM, Badr G. (2012) “Induction of Apoptosis and Growth Arrest in Human Breast Carcinoma Cells by a Snake (Walterinnesia aegyptia) Venom Combined With Silica Nanoparticles: Crosstalk Between Bcl2 and Caspase 3”. Cell Physiol Biochem 30: 653-665. Armstead AL, Li B. (2011) “Nanomedicine as an emerging approach against intracellular pathogens”. Int J Nanomedicine 6: 3281-3293. Bell IR, Schwartz GE. (2013) “Adaptive network nanomedicine: an integrated model for homeopathic medicine”. Frontiers in Bioscience (Scholar Ed) 5: 685-708. Bell IR, Schwartz GE, Boyer NN, Koithan M, Brooks AJ. (2013)“Advances in integrative nanomedicine for improving infectious disease treatment in public health”. European Journal of Integrative Medicine 5: 126-140. Biswas A, Gomes A, Sengupta J, Datta P, Singha S, et al. (2012) “Nanoparticle-conjugated animal venom-toxins and their possible therapeutic potential”. J Venom Res 3: 15-21. Calabrese E, Iavicoli I, Calabrese V. (2013) “Hormesis: Its impact on medicine and health”. Hum Exp Toxicol 32: 120-152. Chikramane PS, Kalita D, Suresh AK, Kane SG, Bellare JR. (2012) “Why Extreme Dilutions Reach Non-zero Asymptotes: A Nanoparticulate Hypothesis Based on Froth Flotation”. Langmuir 28: 15864-15875. Chikramane PS, Suresh AK, Bellare JR, Kane SG. (2010) “Extreme homeopathic dilutions retain starting materials: A nanoparticulate perspective”. Homeopathy 99: 231-242. Das S, Das J, Samadder A, Bhattacharyya S, Das D, et al. (2013) “Biosynthesized silver nanoparticles by ethanolic extracts of Phytolacca decandra, Gelsemium sempervirens, Hydrastis canadensis and Thuja occidentalis induce diﬀerential cytotoxicity through G2/M arrest in A375 cells”. Colloids and Surfaces B: Biointerfaces 101: 325-336. DeCastro CL, Mitchell BS. (2002) “Nanoparticles from mechanical attrition”. In: Baraton MI, editor. Synthesis, Functionalization, and Surface Treatment of Nanoparticles. Valencia, CA: American Scientiﬁc Publisher. pp. 1-15. Demangeat JL. (2010) “NMR relaxation evidence for solute-induced nanosized superstructures in ultramolecular aqueous dilutions of silica-lactose”. Journal of Molecular Liquids 155: 71-79. Iavicoli I, Calabrese EJ, Nascarella MA. (2010) “Exposure to nanoparticles and hormesis”. Dose Response 8: 501-517. Koithan M, Bell IR, Niemeyer K, Pincus D. (2012) “A complex systems science perspective for whole systems of CAM research”. Forschende Komplementarmedizin und Klassische Naturheilkunde 19: 7-14.

“Kibble” diets are convenient. They take no time to serve and require no thought or effort. They also yield smaller, harder stools that are less bothersome to pick up. But pet food choices should be about what’s right for the animal, not what’s convenient or easy for the owner. For example, mammals need to consume moisture to digest their food properly. • Many pets don’t drink enough water to properly compensate for dry food diets, and are suffering from chronic, low-grade dehydration, which can give them that telltale “bloated” look. In humans, studies have shown that dehydration can result in problems with digestion, elimination, kidney function and more. •In an effort to compensate for the lack of moisture in kibble, many dogs gulp down large amounts of water after eating, which can cause the pellets to swell, increasing the risk of bloat or gastric torsion in dogs. Foods that contain sufficient moisture do not swell up in the stomach. • Many holistic vets have linked long-term feeding of dry kibble to the increasing prevalence of urinary and kidney disorders in dogs, and especially cats. Moisture-rich food is beneficial for pets prone to urinary tract infection, blockages or kidney problems, because the moisture helps keep the urinary system flushed out. Ideally, kibble should be eliminated in pets prone to health problems that result from (or are exacerbated by) lack of dietary moisture. Failing that, incorporating at least some fresher, less processed, wet foods into the diet can help provide essential food-based fluids.

Pincus D, Metten A. (2010) “Nonlinear dynamics in biopsychosocial resilience”. Nonlinear Dynamics Psychol Life Sci 14: 353-380. Szalay MS, Kovacs IA, Korcsmaros T, Bode C, Csermely P. (2007) “Stress-induced rearrangements of cellular networks: Consequences for protection and drug design”. FEBS Lett 581: 3675-3680. Upadhyay RP, Nayak C. (2011) “Homeopathy emerging as nanomedicine”. International Journal of High Dilution Research 10: 299-310. Wang T, Jiang H, Zhao Q, Wang S, Zou M, et al. (2012) “Enhanced mucosal and systemic immune responses obtained by porous silica nanoparticles used as an oral vaccine adjuvant: Eﬀect of silica architecture on immunological properties”. Int J Pharm 436: 351-358.

Lucy Postins is co-founder and CEO of The Honest Kitchen, which makes dehydrated natural dog and cat food, treats and supplements. Lucy has long been interested in the benefits of home cooked and raw food for pets and started researching healthy nutrition for dogs and cats after adopting a Rhodesian ridgeback puppy in 2000. She began formulating pet food products a year later and launched The Honest Kitchen in 2002. thehonestkitchen.com IVC Fall 2013

From the AVH The Academy of Veterinary Homeopathy is comprised of veterinarians who share the common desire to restore true health to their patients through the use of homeopathic treatment. Members of the Academy are dedicated to understanding and preserving the principles of Classical Homeopathy. â&#x20AC;? The highest ideal of cure is the rapid, gentle, and permanent restoration of health . . . in the shortest, most reliable and most harmless way . . .â&#x20AC;? Samuel Hahnemann, M.D. (1755-1843), founder of homeopathy.

AVH Annual Case Conference The Academy of Veterinary Homeopathy met in April in Clearwater, Florida for its 16th annual conference and meeting. The majority of members attending this conference have been studying and successfully applying homeopathic medicine in their practices for 15 to 30 years. Lectures spanned a range of topics: improving prescribing abilities, learning more about available homeopathic remedies, and providing updates on the research and the science of homeopathy. The conference featured top names in the field of veterinary homeopathy:

Susan Beal, a veterinary homeopath who helps organic farmers care for their livestock in a holistic way, explained that homeopathy is critical to rearing livestock organically. She reminded us that to remove any disease without recognizing and treating the patientâ&#x20AC;&#x2122;s relationship to that disease will lead the patient to find a new manifestation to fill the void. Susan also shared numerous cases where homeopathy enhanced health and led to increased production: Arnica after parturition or a traumatic trailering experience; Sepia for the droopy-bodied, sprung-uddered, grumpy cow; Nux vomica for vomiting pigs after eating contaminated feed, as well as pigs with rectal prolapse; Calc-carb for poor milk production in a cow, even one who lived far beyond the average culling age; Carbo-veg for bloated cattle after too much fresh and green feed.

Sid Storozum,

a practicing homeopathic veterinarian and lawyer, discussed relationships as a method to sort out complementary remedies for follow-up prescriptions. An important aspect of prescribing homeopathic medicines is understanding which ones can successfully be prescribed after

70 IVC Fall 2013

certain ones have worked partially, completely, or not at all. This lecture could be likened to the study of pharmaceutical drug interactions.

Shelley Epstein,

a veterinary homeopath, owner of an AAHA practice and a recognized international authority on research in homeopathy, shared the latest, cutting edge research related to homeopathy. Read more in this issue of IVC (page 64 as well as the Summer 2013 issue). Nanoparticles can be measured in homeopathic remedies, which may explain the MOA. She reviewed veterinary clinical trials, including mastitis in cattle, diarrhea in piglets, atopy and pseudopregnancy in dogs.

Sue Armstrong,

a veterinary and human homeopath and past president of the British Association of Homeopathic Veterinary Surgeons, presented an interesting quandary. Homo sapiens are wired to the dominance of immediacy yet to deeply heal one must take time for a deeper type of thought to foresee long-term consequences. She addressed the pros and cons of treating the pathogenic invader versus using homeopathy to strengthen the infected patient. Homeopathically treating an 18-month-old mixed breed puppy with extreme and debilitating hemorrhagic diarrhea resulted in resolution within the day. Read a more detailed summary of the conference at the IVC website, IVCJournal.com or order proceedings at avhsupport@gmail.com. Next AVH/AHVMA Conference: September 2014 in Portland, OR. For general updates, how to become certified and more,visit facebook.com/healthypetcare and our main site theAVH.org. Join our monthly webinars with the Homeopathy Working Group at vethomeopathyhelp.org

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IVC Fall 2013

events Individualized Analog Medicine Courses Ongoing Analog medicine is an integrated amalgam of several different alternative medical modalities. It shows exactly how integration can be effectively accomplished and demonstrates its many benefits. This is a course for those individuals who want to go beyond the bounds of classic material medicine to explore the science and art of holistic healing. This is a four or five day course, in a rural Idaho setting, for very small groups or individuals on the fundamentals of integrated holistic healing. Contact Dr. Ronald Hamm to schedule your course. For more information: Dr. Ronald Hamm (208) 427-6233 analogdr@ida.net

The 15th TCVM Annual Conference September 12-15, 2013 – Madrid, Spain The main theme of this conference will be Advances and TCVM approach to Geriatric Medicine, Oncology and Quality of Life for small animals, horses and farm/exotic animals. This conference will be featuring three major speakers, post-conference tours and much more. For more information: Jessica Bruegger (800) 891-1986 register@tcvm.com www.tcvm.com

2013 Learning DOG Conference September 14-15, 2013 – Swansboro, NC This conference is for Veterinarians, Veterinary Technicians, Shelter Staff & Rescuers and features 16.5 Continuing Education credits and three keynote speakers. Attendance is limited to 100 participants so sign up today! For more information: Jan Sorenson (252) 422-0943 www.safeharborfarm.org/conference.html

2013 AAFP Conference September 26-29, 2013 – Dallas, TX This conference will focus on Feline Dentistry, Pain Management and Nutrition and will include presentations geared towards the experienced Feline practitioner, as well as sessions for

newer practitioners or those looking to expand their knowledge in feline medicine.

Emergency & Critical Care 10th Annual Conference

Tara Dalrymple (800) 874-0498 tdalrymple@association-partners.com www.catvets.com/2013conference

November 3, 2013 – Grafton, MA This event will be held at Cummings School of Veterinary Medicine at Tufts University in Grafton, Massachusetts. The school of Veterinary Medicine is an AVMA-approved provider of continuing medical education for veterinarians.

2013 Veterinary Cancer Society Annual Conference October 17-20, 2013 – Minneapolis, MN The primary focus of the meeting will be to promote the highest standards of care in the management of veterinary patients with cancer and highlight recent discoveries and research opportunities in the field of comparative oncology. Featuring 3 Keynote Speakers and The Robert Everest Expedition will perform during the Annual Awards Banquet. For more information: Sandi Strother (573) 823-8497 vetcancersociety@yahoo.com www.vetcancersociety.org

American College of Veterinary Surgeons Symposium October 24-26, 2013 – San Antonio, TX The ACVS Veterinary Symposium offers the most advanced information on a wide range of surgical procedures as well as pre-operative patient care, post-operative complications and advanced diagnostic techniques. You are guaranteed to come away with new information that will improve your veterinary surgical practice. For more information: Teresa Perrell (301) 916-0200 tperrell@acvs.org www.surgicalsummit.org

2013 Annual ABVP Symposium October 31,–November 3, 2013 Phoenix, AZ Registration includes access to lectures, Regents Track Reception, Welcome Reception, Friday and Saturday luncheons, online proceedings and more. Visit our website to view the conference schedule.

The office of continuing education offers lectures and all-day symposiums for animal owners and breeders covering veterinary medical problems of companion animals, farm animals and wildlife. For more information: (508) 887-4723 vetceinfo@tufts.edu www.tufts.edu/vet/ce

Hawaii Veterinary Medical Association Convention November 7-10, 2013 – Honolulu, HI This convention is an outstanding program offering over 68 hours of Continuing Education excellence. Some of the highlights include, Wet Labs, Training Modules for accreditation, and three days of lectures. Come and join us for a wonderful weekend in Paradise. For more information: Diane Shepherd, DVM (808) 733-8828 hvma1309@hawaii.rr.com www.hawaiivma.org

59th Annual AAEP Convention December 7-11, 2013 - Nashville, TN At this conference you will find over 200 presentations and discussions during 34 educational sessions. You will be able to network with professional colleagues and have the chance to raise your expertise across the entire spectrum of equine medicine. For more information: Amity Brannock aaepoffice@aaep.org www.aaep.org

For more information: Amy Garrou (615) 345-9550 abvp@zmi-amc.com www.abvp.com

P o s t y o u r e ve n t o n l in e at: IVCJournal.com 74 IVC Fall 2013

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