V4I4 (Fall 2014) by Redstone Media Group

Integrative VETERINARY CARE

GERIATRIC AND HOSPICE CARE

WHY TREATING SENIOR PATIENTS USING AN INTEGRATIVE APPROACH CAN BE SO EFFECTIVE. PAGE 36

PAIN RELIEF FOR SENIORS

TCVM FOR OLDER PATIENTS

HERB USE IN SPORTING HORSES

MICRO BIOME RESTORATIVE THERAPY

NUTRITIONAL FOOD OPTIONS

WHAT’ S NEW

How therapeutic laser therapy and exercises can work together to reduce discomfort.

FALL ISSUE 2014

www.IVCJournal.com

Herbs have many medicinal benefits, but you and your clients need to know about competition rules and regulations that may prohibit their use.

Why encouraging clients to feed their pets an appropriate diet can benefit both your patients and your clinic.

How Traditional Chinese Veterinary Medicine can improve their quality of life and even extend longevity.

Find out how giving feces from a healthy animal to another of the same species may be the most efficient way to reboot gut flora.

• State-of-the-art system delivers pinpoint radiation • Which holistic treatments are most important to patients? • Veterinary Medicine Mobility Act one step closer to becoming law

IVC Fall 2014

contents FEATURES

THERAPEUTIC LASER THERAPY AND EXERCISES FOR SENIOR PETS

Integrative medicine offers many approaches to soothe and even resolve geriatric pain. Laser therapy and a variety of exercises are two successful modalities to add to your practice.

VACCINATION AND CHANGING PROTOCOLS – PART 2

Titer testing as an alternative to annual boosters; vaccine dosages and duration of immunity; and the latest research projects being done on vaccination.

Nutrition Nook FOOD PRESCRIPTIONS FOR THE AGING PATIENT

Medication through whole food nutrition treats health issues and prevents future problems – without side effects.

Integrative Practice TEGRATIVE APPROACH TO GERIATRIC AND HOSPICE CARE

Pharmaceutical or surgical intervention is often not an option in older patients. Using a variety of integrative therapies can be the best approach.

43 44

WEARABLE PEMF Miniaturized technology puts healing right on painful joints.

HERB USE IN SPORTING HORSES

Medicinal herbs can be beneﬁcial to equine health, but competition rules and regulations may prohibit their use in some cases.

Tech Talk THE VET TECH’ S FRESH FOOD PROGRAM

LASER THERAPY FOR OSTEOARTHRITIS

MICRO BIOME RESTORATIVE THERAPY

SUPPLEMENTAL SUPPORT FOR SENIORS

One of our many tasks is to help clients learn to provide an appropriate diet for their pets. Here’s how to create a plan.

Therapeutic laser works by the mechanism of photobiomodulation, and has several beneﬁcial effects in decreasing inﬂammation and pain.

Research all over the world indicates that MBRT – giving feces from a healthy animal to another of the same species – may be the most efﬁcient way to reboot gut ﬂora.

Nutrients in food are not ideally absorbed in older pets, so adding a safe quantity of necessary vitamins and minerals is essential to health.

NEUTRACEUTICALS AND INFLAMMATION

Botanical ingredients that support a healthy anti-inﬂammatory response.

59 4

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TCVM ASSESSMENT AND CARE FOR OLDER PATIENTS

The primary goal is to promote quality of life rather than cure disease. Traditional Chinese Veterinary Medicine can help accomplish this goal.

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

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.

5 Advisory board 8 Editorial 12 What’ s new

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.

33 From the IVAS 34 Industry innovations & Spotlight 58 Veterinary resource guide 64 From the AVH

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.

72 Marketplace 73 Events 74 From the VBMA

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

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

Dr. Christina Chambreau, DVM, CVH, graduated from the University of Georgia Veterinary College in 1980. She is a founder of the Academy Of Veterinary Homeopathy, was on the faculty of the National Center for Homeopathy Summer School and has been the holistic modality adjunct faculty liaison for the Maryland Veterinary Technician Program. 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.

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Integrative VETERINARY CARE

FALL 2014

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 Webmaster: Brad Vader Cover Photography: Hemera Technologies

COLUMNISTS & CONTRIBUTING WRITERS

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Cathy Alinovi, DVM, CVSMT, CTCVMP Kim Chase Carmen Colitz, PhD, DVM, DACVO Naomi Kirby, DVM, MS Laurie McCauley, DVM, CCRT, CVA, CVC Lisa A. Miller, DVM, CCRT Ian Rawe, PhD Margo Roman, DVM, CVA, COT, CPT Barbara Royal, DVM, CVA Tom Schell, DVM, DABVP, CVCH Michelle Schraeder, DVM, MEd, FAAVA Ronald D. Schultz, BS, MS, PhD, DACVM Beth Taylor, LMT, CVMRT Huisheng Xie, DVM, PhD, MS Andrew G. Yersin, PhD

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

IVC Fall 2014

golden

editorial

THE

YEARS

UTUMN IS ONE OF MY FAVORITE SEASONS here in the Northeast. I love the crisp air and watching the beautiful green leaves turn a more gorgeous color and fall down to replenish the soil. We, and our animals, go through these same life cycles, though sometimes we struggle as the end of life approaches.

In this issue of IVC Journal, we address the challenges that come later in life. You may find, as I did, that the content will help shift your thinking about the process of aging, hospice and death. Before I had any holistic training, I dreaded having to euthanize animals because so often I was not sure they were ready, yet they were clearly suffering to a degree that seemed unacceptable to their families. They were very lame, incontinent, losing weight, having emotional issues (crying in the night) or more. As I began to learn homeopathy in the mid-1980s, I had clients who carefully orchestrated their animals’ deaths – with blankets, family, candles, incense, music and more. Usually, there was no question with these dogs and cats that it was

time to pass on, and I found they needed less solution to still the heart. Then I discovered that most of the pets treated regularly with homeopathic medicines passed in their sleep, or after less than a day of severe discomfort. Hospice patients are defined as having less than six months to live, with no clear treatment available for their illnesses. I began using or suggesting many of the holistic treatments discussed in this issue (fresh food diet, massage, herbs, reducing vaccines, TCVM, chiropractic, laser and more) for cats with severe renal failure symptoms, and dogs ready for euthanasia because of degenerative myelopathy, severe debilitating arthritis, and multiple organ failure. Amazingly, many of these “hospice” patients recovered, living many more months to even years longer. While this issue gives different approaches that can benefit our geriatric and hospice patients, most importantly it expands our awareness of how our patients and clients can act as a team to maximize quality of life at every age. After 33 years of selecting different holistic modalities for patients, and seeing people choosing a variety of different lifestyles, I assert that years lived do not cause geriatric problems. Not finding the right treatments, exercises, foods and emotional support are the cause of most symptoms, so it is usually possible for every person and animal to experience a great quality of life through the autumn of their lives, until it’s their time to die. I hope you enjoy the thoughtful content in this issue as much I have. Happy Autumn!

Christina Chambreau, DVM, CVH Associate Editor, drtina@ivcjournal.com

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contributors

1. DR. CATHY ALINOVI, DVM, CVSMT, CTCVMP

Dr. Cathy Alinovi is a veterinarian, pet lover, frequent media guest and nationally-celebrated author. She is quickly gaining national recognition for her integrative approach to animal health. After graduating from veterinary school, she quickly realized that conventional medicine did not meet enough of her patients’ needs, and became certified in numerous alternative modalities. Dr Cathy treats 80% of what walks in the door, not with expensive prescriptions, but with adequate nutrition. She is owner/veterinarian of Healthy PAWsibilities, and the author of the Kindle ebooks, Dinner PAWsible and Healthy PAWsibilities.

2. LAURIE MCCAULEY, DVM, CCRT, CVA, CVC

Dr. Laurie McCauley is a 1992 graduate of Colorado State University School of Veterinary Medicine. After six years in general practice, she became a pioneer in the field of veterinary rehabilitation, creating the first canine underwater treadmill and starting the first rehabilitation clinic. Since opening TOPS in 1998, it has become one of the world’s most advanced and respected rehabilitation clinics. Dr. McCauley is certified in Acupuncture and Chiropractic and has been teaching rehabilitation since 2004 for the Canine Rehabilitation Institute certification course. She is on the Board of Directors for the AHVMA.

3. 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 Creature Biomolecule in Hopkinton, Massachusetts, studying osteogenic proteins. Dr. Roman’s integrative practice, Main Street Animal Services of Hopkinton (M.A.S.H.), offers chiropractic, physical therapy, massage, Reiki, acupuncture, herbs, conventional medicine and more.

10 IVC IVCFall Fall2013 2014

4. BARBARA ROYAL, DVM, CVA

Dr. Barbara Royal is a veterinarian, IVAS certified acupuncturist, author and lecturer with extensive experience in veterinary care, including zoo, marine and wildlife animals, nutrition, acupuncture, emergency medicine, pathology, conventional practices, herbal remedies, physical rehabilitation techniques and alternative treatments. She is president of the American Holistic Veterinary Medical Association (AHVMA.org) and presidentelect of the AHVM Foundation (AHVMF.org). Author of The Royal Treatment, A Natural Approach to Wildly Healthy Pets, Dr. Royal is also is the founder and owner of The Royal Treatment Veterinary Center in Chicago.

5. RONALD D. SCHULTZ, BS, MS, PhD, DACVM

Dr. Ronald Schultz is a Professor and past Chair of the Pathobiological Sciences Department at the University of Wisconsin-Madison School of Veterinary Medicine. He is also Principal Investigator, along with Dr. Jean Dodds, for the Rabies Challenge Fund. Dr. Schultz is an internationally recognized expert in the field of canine and feline vaccines and regularly participates in international meetings and forums. He is a member of the Vaccination Guidelines Group of the World Small Animal Veterinary Association, the AAHA Canine Vaccination Guidelines Group, and is on the initial AAFP Feline Vaccine Task Force.

7. KIM CHASE

Kimberly Chase is a chartered herbalist, avid equestrian and current CIVT student working towards obtaining her degree as an equine herbal practitioner. She is the proprietor of Vaguely Noble Horse-Keeping, a nutritional/herbal formulation company that provides an equine “green pharmacy” where the focus of health and medicine is shifted from treating symptoms to maintaining wellness. She is also the North American distributor of Ascenta EquineOmega3 available through the Vaguely Noble website.

8. BETH TAYLOR, LMT, CVMRT

Beth Taylor has spent many years learning about food, starting at the age of eight. She is the co-author of Dr Becker’s Real Food for Healthy Dogs and Cats and See Spot Live Longer. She continues to help people with nutrition at The Puddle Aquafitness in Illinois, where she serves as Nutritional Advisor, Bodywork Director and Swim Coach. Beth’s extensive education in bodywork modalities for animals includes Acupressure, Tui na, Cranio-Sacral Therapy, several Myofascial techniques, Reiki, Qigong and more. She is certified in Acupressure, and is a member of the Association of Canine Water Therapy (ACWT) and the International Association of Animal Massage and Bodywork (IAAMB)

6. HUISHENG XIE, DVM, PhD, MS

Dr. Huisheng Xie is a clinical associate professor of the Integrative Medicine Service at the College of Veterinary Medicine, University of Florida; and founder and president of the Chi Institute of Chinese Medicine, where over 3,000 licensed veterinarians have studied acupuncture, herbal medicine, and other TCVM disciplines since 1998. He has lectured around the world on veterinary acupuncture and herbal medicine. Dr. Xie has authored 12 books. His textbooks, including Xie’s Veterinary Acupuncture, Xie’s Veterinary Chinese Herbology and Traditional Chinese Veterinary Medicine: Fundamental Principles, have been used for TCVM training programs in many countries.

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IVC Fall 2014

what’s new BILL ONE STEP CLOSER TO BECOMING LAW On July 8, the U.S. House passed the Veterinary Medicine Mobility Act. This bill will make it legal for veterinarians to transport and use controlled substances beyond their primary places of registration, and across state lines, to treat their patients. The Senate passed its version of the bill back in January, so this action by the House brings the bill one step closer to the president’s desk. The AVMA has been working for over a year on getting this bill passed. Their Governmental Relations Division (GRD) has met numerous times with the Drug Enforcement Administration and members of Congress and their staff to explain why a restrictive provision in the Controlled Substances Act needs to be amended so veterinarians are permitted to use all the tools available to provide the best care for their patients – both at their clinics and beyond. The AVMA has been joined by over 130 veterinary medical and other organizations who have endorsed this bill. avma.org

HEADSHAKING IN HORSES Headshaking is a serious and distressing condition for both equine patients and their owners. Professor Derek Knottenbelt from the Philip Leverhulme Equine Hospital, University of Liverpool, discussed this disturbing condition, and the signs and treatment options, at the Australian Veterinary Association’s Annual Conference in May. “Whatever is said about the disease in terms of cause, diagnosis or treatment, there’s no doubt that horses are very distressed by it,” says Professor Knottenbelt. “Some horses are so badly affected that they can cause themselves serious injuries in an attempt to relieve themselves of the discomfort or pain. There are also major safety implications for riders and handlers of horses.” Common signs include: • Involuntary up/down movement of the head and sideways shaking of the head • Blinking, ear flicking or ear flattening • Facial or nasal rubbing • Snorting or serious nasal discharges “Unfortunately, treatment options are presently very limited,” says Knottenbelt. “The main objective is for the clinician to try and identify the trigger factors and then for owners to devise strategies to avoid them, where possible. While we are far behind in our understanding of this disease and its possible neurological origins, we have to be aware of the welfare implications; research efforts in this area should be a priority.” liv.ac.uk/equine or conference.ava.com.au.

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PINPOINT RADIATION THERAPY A state-of-the-art radiation therapy system delivers precise image-guided radiation, allowing veterinarians to pinpoint a tumor’s size, shape, and location seconds before therapy begins. “TomoTherapy literally means slice therapy,” says Dr. Michael Deveau, assistant professor at the Texas A&M College of Veterinary Medicine & Biomedical Sciences. “While standard radiation therapy is currently delivered using a few static fields, helical TomoTherapy delivers treatment with a rotating beam.” By performing a 360° rotation around the patient, the system accurately directs radiation at the tumor while minimizing the dose to neighboring normal tissues. “This concept evolved to address deficiencies in radiation therapy, and provides more precise radiation delivery to the tumor, allowing for fewer side effects to normal tissue,” says Dr. Deveau. TomoTherapy has the ability to treat tumors that were once considered untreatable, and offers new armament for modernizing the management of cancer in veterinary patients. “Suitable for almost all clinical presentations, it is one of the best, if not the best, machines for treating large complex tumors, or clinical presentations requiring extended treatment fields,” says Dr. Deveau. vetmed.tamu.edu/pettalk

SURVEY ON HOLISTIC TREATMENTS Dr. Nancy Scanlan, DVM, CVA, MSFP, Executive Director of the American Holistic Veterinary Medical Foundation, announces that the AHVMF is using Survey Monkey to see what holistic treatments are most important to pet owners. The survey will also highlight which of these treatments pet owners use (either themselves or from their vets), and what disease conditions are most important to them. “We are using this to guide the way we award research money to veterinary schools,” says Dr. Scanlan. Find the survey at surveymonkey.com/s/DBNBH35.

EQUINE CLIENTS: PRACTICE BIOSECURITY MEASURES The Texas Animal Health Commission (TAHC, tahc.state.tx.us) is stressing the importance of keeping horses healthy by practicing good biosecurity measures. These preventative measures are designed to reduce risk of the introduction and transmission of infectious disease agents, such as Equine Herpes Virus-1 (EHV-1).

• Use your own water and feed buckets. Fill water buckets from a faucet. • Do not share grooming equipment or tack. • Avoid petting and touching other horses. • Avoid letting strangers pet your horse.

Any time horses are congregated at events, they are at higher risk of being exposed to an infectious disease. By working with clients to establish an appropriate vaccination program for their horses, you can help minimize that risk.

• Before returning home from an event, clean up your equipment (boots, tack, grooming supplies, buckets, etc.) to help reduce the risk of transporting an infectious agent back home. Consider washing and disinfecting your trailer when you return home.

It’s also a good idea to encourage clients to follow these guidelines:

• If possible, isolate your returning horse/s for two weeks, or at least prevent nose-to-nose contact with your other horses.

• Tie your horse to your trailer. If using a stall, clean and disinfect it. • Minimize your horse’s direct contact with unknown horses.

IVC Fall 2014

what’s new MARIJUANA-RELATED PET HEALTH CLAIMS Marijuana with a low dose or in some cases no dose of THC (tetrahydrocannabinol) has shown healing benefits in pets. But ingestion of THC-filled marijuana will have toxic effects such as impaired coordination, drooling, vomiting, lethargy, depression, light and sound sensitivity, urine incontinence, and coma.

1. British Columbia

According to Trupanion (trupanion.com), pets in the Canadian province of British Columbia have the most pet health claims related to marijuana toxicity and THC ingestion. Here is the complete list of top ten regions with the most marijuana-related claims:

7. Colorado

2. California 3. Washington 4. Alberta 5. New York 6. Ontario

8. Florida 9. Virginia 10. Massachusetts

HEEL WITHDRAWING FROM NORTH AMERICA In the US, negotiations with MediNatura Inc., a Delaware Corporation, are close to completion, at which time (the end of August) the Heel Group will transfer its stock in Heel Inc. to MediNatura. However, this transaction does not include any of Heel’s leading global brands such as Traumeel, Zeel, Oculoheel, etc.

On August 31, the Heel Group is ceasing business activities in the United States and Canada. In both countries, manufacturers of OTC homeopathic medicinal products have been confronted with accusations through class action lawsuits. Heel Inc., the Heel Group’s US-based subsidiary, was also faced with two such attempts. Both cases were settled without conceding the allegations, but the financial burden on Heel was substantial. In a subsequent risk-benefit analysis, the Heel Group decided to focus on strengthening its position in South America, Central Europe and Eastern Europe, and to withdraw from the US and Canada for the time being.

IVC Fall 2014

Although Heel is moving out of North America, all their products, with some modifications, will remain available here as a result of a management buyout. The products Heel has made historically in the US will still be made at the same manufacturing plant as in the past. Several products will undergo minor formulation changes to distinguish them from those of Heel. The new formulations will include more natural and environmental friendly ingredients. MediNatura will begin distributing to health and medical professionals starting in January 2015. All this company’s products will have new names and will not be available between September 1 and December 31 of this year.

IVC Fall 2014

Therapeutic

LASER

By Laurie McCauley, DVM, CCRT, CVA, CVC

therapy and exercises for senior pets

How THERAPEUTIC LASER THERAPY and EXERCISE can provide pain relief for GERIATRIC PATIENTS.

s dogs and cats age, joint problems and their associated pain can be a primary problem. Integrative medicine offers many approaches to soothe and sometimes even resolve geriatric pain. Therapeutic laser therapy and many exercises are two successful modalities to add to your practice.

THERAPEUTIC LASER THERAPY

Laser stands for â&#x20AC;&#x153;light amplification by stimulated emission of radiationâ&#x20AC;?. Low Level Laser Therapy (LLLT) involves the stimulation of tissue with low energy lasers to achieve a therapeutic effect.

The effects at a cellular level include changes in ATP production in the cells, ATP release from the mitochondria, enhancing cell respiration by affecting mitochondrial nitric oxide synthase (mNOS), generating reactive oxygen species (ROS) to become secondary messengers, and changing the cellular calcium ion balance. Many studies have been done, including some involving humans on chemotherapy1 and on the healing of burns and wounds in rats2. Considering the variables Variables of wavelength, frequency, and power in mW at the probe or J/cm2 at the tissue can all have an effect on the outcome of laser therapy. Neves observed very different effects using four different probe powers all with the same total power to the tissue.3 In the past, many studies were

IVC Fall 2014

done with low power machines (60mW to 100mW), but more recently we have seen studies looking at 1W to 6W of power. Larkin showed that only one of these high power settings enhanced blood fl ow4. In practice, a range of 250mW to 12W is being used successfully to diminish pain and infl ammation; speed healing; enhance blood fl ow and fi ght infection. Different wavelengths require significantly different amounts of power to create similar effects due to how superficially they are absorbed in the tissue. Less penetration is seen at low (600nm to 700nm) and high (970nm to 980nm) wavelengths so more power is needed to get to the affected tissue if deep penetration is desired. Wavelengths in the 800nm range have been shown to be better at reducing edema, whereas the low 900nm range is better at controlling pain, and the 600nm range is superior for skin infl ammation, pain, healing and infection. As there are no good studies evaluating laser frequency I evaluated what the top-selling five veterinary laser companies used. I found that four out of five used a continuous wave plus a pulsed wave in their therapies. Only one company used greater than 5,000Hz (Hz = pulses per second). All companies used less then 100Hz for acute pain, four out of five used about 5,000Hz for contaminated wounds, and all used 500Hz to 2,500Hz to stimulate healing and diminish edema.

With all the different variables defining the capabilities of each laser, my recommendation would be to start with the laser companyâ&#x20AC;&#x2122;s recommendation, then play with the variables to see what works best in your hands. Laser therapy can be beneficial for geriatric patients by treating pain; speeding the healing of skin, bone and soft tissue; and improving circulation. We commonly utilize laser therapy in patients with chronic back pain, osteoarthritis, acute injuries such as tendinopathy, or post-surgical issues (from cruciate repair to dental extractions), and it can also be used for otis externa, stomatitis/gingivitis, and intra-operatively with tissues with compromised circulation.

THE ROLE OF EXERCISE

Exercises are vital tools that can be utilized with most canine patients, and are beneficial for our geriatrics. Sarcopenia is a normal old age change where the muscle fibers are replaced first with fat (no change in circumference of the limb) and then with fibrous tissue (visible atrophy). This process has been shown to be slowed down with exercises that use resistance, for instance using the underwater treadmill, and concentric weight bearing exercises. Concentric exercises are defined as exercises that shorten the muscle as it is working. There are exercises for core strengthening, individual limb or muscle strengthening, increasing endurance, enhancing balance or proprioception, and for weight distribution reeducation. When it comes to exercise, the following general

Laser therapy can help treat dental issues by reducing pain and speeding the healing process.

IVC Fall 2014

 Physical limitations of the person doing the exercises.  The ability to keep these exercises fun for the patient; positively thinking of them as a game or trick rather than work.

 Control is as important as attitude. You must always have control of the patient to prevent injury both to him and yourself. This can be accomplished by the use of collars, harnesses and leashes.

 Posture of the person doing the exercise. If you do not maintain your posture, you may be injured and not be able to help your canine patients. Keep your arms close to your body, your back straight, and do not hyper-extend or hyper-fl ex any joints. One of the nice things about exercises is that we can tailor them to each individual patient. We can do this by altering several variables, including duration, frequency, speed, and terrain. Some exercises that we perform with our geriatric population include:

considerations need to be factored in along with the patient’s medical needs:

• Ambulating is a low impact exercise utilizing the whole body. By altering speed (walk, trot or run), frequency (once weekly to three times a day), duration (one minute to one hour), and terrain, we can customize this exercise to any canine. Geriatric patients may start by only walking to the mailbox or down the block, but frequently improve their strength enough to be able to go for long walks or runs.

 Patient attitude and ability to be motivated. Motivators include food, a favorite toy, a certain person or another animal.

 The patient’s physical condition. Dogs may resist exercise

• Swimming can be done at a beach where the dog can run in and out of the water, shaking in between dips and

if they are stiff or sore.

Continued on page 20.

BUILD A ROCKER BOARD Use a 1’ by 2’ piece of sturdy wood with a handrail underneath and carpet or other nonslip surface on top. Or, use a baby cradle, garbage can cover, or a hexagon with half of a rubber or wood ball attached underneath. Rocker board exercises can be used for balance, proprioception, strengthening the front or rear limbs, or strengthening an individual limb. The round or octagon shape is most useful when we are looking to increase balance or proprioception. The rectangular board is a great way to start enhancing strength and proprioception, making it great for geriatric patients. Using the rectangular board, you can start with either the front or rear limbs on the board, and then make it harder by raising the level of the opposite limbs. This shifts the dog’s weight to the limbs on the board. Rocking the board side to side in a rhythmic fashion encourages the patient to sway, which is relaxing but not a workout. You need to constantly be changing direction and tempo to keep the muscles ﬁring. 18

IVC Fall 2014

A rectangular rocker board can help an older animal strengthen his limbs.

By Henry Dinneen

Continued from page 18. taking short rests; or in a pool or lake where he works continually to enhance his endurance and strength. Using an underwater treadmill helps with strengthening (water is up to 60 times more resistant then air), balance (in water, weight is more evenly distributed front to back and side to side), and enhancing conscious proprioception. By definition, endurance exercise is walking for greater then 20 minutes or swimming continuously for greater then five minutes. • Backwards walking strengthens the antigravity muscles that support the body, allowing the dog to be able to stand for longer time periods, strengthens the muscles that stabilize the hip for dogs with hip issues, and strengthens the muscles of propulsion aiding running and jumping. • Sideways walking strengthens the muscles surrounding the shoulders and hips. This is beneficial for dogs with hip dysplasia. Stand perpendicular to the dog with your feet between his front and rear feet, put one hand on the dog’s collar and one close to the opposite hip, and use your knees to push the dog sideways as you take small steps for 10’ to 20’. To balance this out, you need to either go to the other side of the dog or turn him around so you are walking in the other direction. Repeat for 10’ to 20’. To use this as

CUTTING EDGE LASER TECHNOLOGIES, CELASERS.COM 1. H ow would your products benefit an arthritic geriatric animal? “MLS Laser Therapy provides a consistent continuous wavelength of light at the spectrum for reducing pain and inflammation,” says Meghan Collins. “There is no heat, making the procedure comfortable. Muscle tension and spasms decrease, providing longer-lasting and cumulative results.” 2. Can you provide an example? “Princess, a 14-year-old cat with stifle arthritis, has a treatment once every 18 weeks. Within 24 hours after treatment, she shows improved mobility and increased activity.” 3. C an lasers help with decubital ulcers in elderly animals? “Shep, a great Dane, was given laser therapy for his ulcers at 1-2x a week intervals; there was significant increase in granulation tissue, which speeds the process of healing and reattachment.” 20

IVC Fall 2014

a weight-shifting exercise, where you want to strengthen one side more then the other, you would only walk the dog in one direction. He will strengthen and weight shift to the side you are stepping out with, the side you are not on. • Snoopies is an exercise used to strengthen the trunk musculature as well as aid in balance. This is great for dogs with back issues, as well as ataxic dogs, or those with paraspinal muscle atrophy. A weak animal is asked to stand with diagonal limbs on blocks. Most of the weight is placed on the limbs on the floor, and the trunk is utilized for stabilization. To make this more difficult, instead of blocks, lift the diagonal limbs 1” to 2” off the ground with one finger at the tarsal and another at the diagonal carpal joints. Do not “grab” as this aids the dog’s balance. If the dog is too weak to pick up the diagonal limbs, lifting just one leg at time can be used to prepare him for this exercise. •G oosing may diminish lordosis, eliminating back pain. Lordosis, or sway back posture, is secondary to weak abdominal muscles and goosing strengthens them specifically. By tickling the abdomen or the flank and getting the dog to contract the abdominal muscles (similar to us doing sit-ups), we can strengthen the dog and change posture in three to five weeks. Try to get the dog to hold this mildly kyphotic, roachy position for three to five seconds. You can work up to 50 “gooses” a day. For dogs that have trouble standing these can also be done over a peanut ball. •C ookie stretches are a great overall exercise that can be used for the detection of cervical and thoracic back pain; it’s good for stretching the cervical and thoracic vertebrae, weight shifting, and enhanced balance. Wherever you put the cookie, the dog will turn to eat it, generating stretching and determining limitations. The cookie is first placed at the shoulder and then follows right next to the body to the hip and then the rear toes. This is done bilaterally. The cookie is then placed at the manubrium, to the floor, and then between the forelimbs to reach headstand position. The last step would be for the dog to have his forelimbs raised, standing on a chair or counter; take the cookie straight up, eliciting a concave surface of the thoracolumbar spine. Signs of pain or problems include stopping before getting there, or having to rotate the cervical spine to get there. • Rhythmic stabilization is one of the first exercises I use for weak or debilitated patients. Having them stand and asking

them to “stay”, we gently push them, holding for several seconds before picking another direction to push. The dogs will need to use their trunk musculature to maintain their balance. You can push in all different directions to stimulate contraction of different muscles. Don’t push them so hard that they have to step out, just hard enough that you can feel their trunk muscles contract under your hand. This is just a handful of useful exercises. The best way to look at creating an exercise program for your canine geriatric patients is to create a list of their problems, determine the goals of the exercises, and then figure out which ones will help you achieve those goals. If you cannot find an exercise that helps you achieve your goals, make one up using sound anatomical, physiological and biomechanical reasoning. Your imagination is your only limiting factor.

Zhuk N A, Levenecho M V, Barinova S E. “Laser therapy of chronic tuberculosis”. 8th Internat Congr of the Eupeurean Medical Laser Assoc, Moscow, Russia, May 2001. 2 Rochkind S, et al. “Systemic Effects of Low-Powered Laser Irradiation on Peripheral and Central Nervous System, Cutaneous Wounds, and Burns”. Laser Surg Med. 1989, 9: 174-182. 3 Neves M A I, Pinfildi C E, Wood V T, et al. “Different Power Settings of LLLT on the Repair of the Calcaneal Tendon”. Photomedicine and Laser Surgery. Vol. 29, Num 10, 2011. 4 Larkin K A, Martin J S, Zeanah E H, et al. “Limb Blood flow after Class 4 Laser Therapy”. Journal of Athletic Training, 2012:47(2):178183; Tuner and Hode. The New Laser Therapy Handbook, Prima Books, 2010. 1

RESPOND SYSTEMS, INC., RESPONDSYSTEMS.COM 1. How would your products benefit an arthritic geriatric animal? “Lasers promote blood flow, release endorphins, and reduce inflammation, stiffness and soreness associated with arthritic and geriatric conditions,” says Ellen Noll. “Quality of life is often improved through pain relief and return to daily activity.” 2. Can you provide an example? “Killian, a nine-year-old golden retriever, was restricted in hock, stifle and hip flexion. Along with several exercises, he was given low level laser therapy, and was able to return to his normal healthy activity levels.” 3. Can lasers help with decubital ulcers in elderly animals? “Laser therapy improves the tensile strength of tissue through increased collagen proliferation. A single treatment will often promote an improvement, although decubital ulcers benefit from daily lasing.”

IVC Fall 2014

VACCINATION

AND CHANGING PROTOCOLS PART TWO

IVC Fall 2014

By Ronald D. Schultz BS, MS, PhD, DACVM n Part 1 of this article (Summer 2014, IVC Journal), we covered the different types of vaccines, including core and non-core vaccines, along with the adverse effects associated with vaccination. In this issue, weâ&#x20AC;&#x2122;ll focus on titer testing as an alternative to annual boosters, as well as vaccine dosages, duration of immunity, and the latest research projects being done on vaccination.

REASONS FOR VACCINE TITER TESTING: • To determine whether an individual animal has responded by producing antibody to a vaccine. • To determine that an animal is protected (positive test result). A response to some antigens does not correlate with protection. For examples, the presence of antibody to Leptospira does not correlate with protection. The microscopic agglutination test (MAT) is used to diagnose disease. • To identify a susceptible animal (negative test). • To determine whether an individual vaccine is effectively immunizing animals. • Available titers to determine immunity for dogs are distemper virus, parvovirus, and adenovirus 2 (hepatitis). • Titers available for cats are panleukopenia virus (FPV), herpes virus (rhinotracheitis virus), and calicivirus serum titers. However, the only serum titer test that correlates with protection is FPV. • Rabies virus for cats and dogs (RFFIT-rapid ﬂuorescent focus inhibition test: non-export). Note: RFFIT is the rabies titer standard established by the Centers for Disease Control within the US (0.1 IU/Ml) and the World Health Organization (0.5 IU/mL) for export to other rabies-free locations to be adequate to protect humans, not dogs, against rabies. There is no established standard for dogs or cats, which means that the human standards must be extrapolated when assessing.

Continued on page 24.

Continued on page 24. IVC Fall 2014

Continued from page 23. • Protection for other species. • Titer tests are accepted for humans for many different diseases, and titer results are also accepted in “rabies free” European countries and Hawaii for animals. • An antibody titer to a complex vaccine indicates the animal has developed an immune response that includes both T cell and B cells. It also demonstrates that the animal is continuing to make antibody months/years after vaccination and therefore memory cells are present. Several state diagnostic laboratories in the US perform canine and feline antibody testing. There are two commercial test kits available.

acciCheck (Biogal Labs/Spectrum Labs, Phoenix V US) tests for canine infectious hepatits (CAV), canine parvovirus (CPV-2), and canine distemper virus (CDV). A feline test for antibody to panleukopenia, herpes virus, and calici virus is also available. This practical test takes less than 30 minutes, uses whole blood or serum, and simultaneously tests for multiple viral antibodies. Excellent for use in shelters or clinics, giving same day results.

An antibody titer to a complex vaccine indicates the animal has developed an immune response that includes both T cell and B cells.

INDIVIDUALIZING PROTOCOL FOR EACH PATIENT This allows veterinarians to help clients make choices about vaccines for each pet. • Understand that all pups/kittens must receive core vaccines. • Understand duration of vaccinal immunity (“protection”). • Decide which non-core vaccines are needed and the best time to administer. • Accept potential for adverse events. • Consider the threat of disease.

Titer Chek (Zoetis Diagnostics, Kalamazoo, MI) tests for CDV and CPV-2. This microplate format is best for use in laboratories.

• Recognize adverse events rather than dismiss or deny them. • Offer titers for core vaccines triennially (or more often if desired). Continued on page 26.

This practical test takes less than 30 minutes, uses whole blood or serum, and simultaneously tests for multiple viral antibodies.

IVC Fall 2014

respond to CDV vaccine. This is based on genetics, so it may be much higher in a speciﬁc litter or breed. When challenged (exposed to a disease), these animals are susceptible. Also, some dogs/cats are low responders, but are generally resistant to disease. When animals do produce antibody reactions after vaccines to distemper, parvo and panleukopenia, they can have lifelong, usually sterile immunity. The presence of antibody, even at low levels, means the immune memory response will kick in, and within hours of exposure, the dog’s body will bring the infection under control. There will be infection, but it won’t cause disease. There’s a big difference between infection and disease. And in fact, re-infection without disease isn’t a bad thing because it leads to natural stimulation of the immune response.

Continued from page 24.

VACCINE DOSAGE Many holistic veterinarians and a large number of clients question giving the same dose to toy and giant breeds. The immunogenic principle of MLV vaccines is not based on body mass, so the same dose is needed regardless of the dog’s size. The temporary discomfort in smaller animals may arise from the amount of diluent, so a smaller volume of the latter could be used to reconstitute the lyophilized vaccine. Currently, some smaller volume vaccines are available in 0.5 ml, that contain a full dose of vaccine.

DURATION OF PROTECTION AND TIMING OF “BOOSTERS” Vaccination and even re-vaccination does not assure that an animal is protected. A small number of dogs/cats may have no antibodies even after being repeatedly vaccinated. These dogs/ cats are non-responders. I estimate approximately 1/1,000 dogs can’t respond to CPV-2 vaccine, and about 1/5,000 can’t

With live viral vaccines, when a “booster” is given to an already immune animal (antibody positive), the virus is immediately neutralized. There is no “boosting” of the antibodies because the virus does not have a chance to infect. When no viral antibody is present, the vaccine will either stimulate both the cellular and humoral response to the virus, or in a nonresponder will have no effect. So, only antibody negative dogs need re-vaccinating. Other vaccine components, such as tissue culture media, can cause harm (hypersensitivity and other adverse reactions), so annual re-vaccination is not recommended when not needed!

TIMING OF VACCINATION • Avoid 30 days before and during estrus; pregnancy; lactation. • Avoid if autoimmune disease or seizure disorder are present. It is well documented that predisposed animals will probably experience adverse reactions to vaccines.

CORRECTION: In the Summer issue of IVC Journal (Vol 4 Issue 3) Dr. Mark Kimsey was incorrectly referenced/quoted in a comment by Dr. Patricia Kuhly in the article “Vaccination and changing protocols: part 1”. IVC Journal asked Dr. Richard Ford, a member of the AAHA Canine Vaccine Task Force and the AAFP Feline Vaccine Advisory Panel, for his comment regarding the number of practices recommending triennial boosters. Dr. Ford states, “Anecdotal information from manufacturer sales representatives in the U.S. suggest that, overall, about 60% of practices recommend annual boosters with core vaccines in dogs and cats; while about 40% recommend triennial boosters. However, there is significant regional variation on this recommendation.”

IVC Fall 2014

Advertorial

CURRENT RESEARCH PROJECTS • New vaccines continue to be developed and old vaccines are improved as needed. • We recently performed studies to compare a live oral bordetella vaccine to the already available live intranasal and killed injectable bordetella vaccines. The oral live vaccine provided good local and systemic protection as did the intranasal live vaccine. The killed injectable is the most easily administered product, but didn’t give as effective upper respiratory tract immunity as the live vaccines. The oral vaccine cannot be combined with the viral kennel cough vaccines (CPI, CAV-2) like the intransal vaccine can, because when given orally the viruses are killed and thus can’t immunize. • Duration of immunity studies continue, looking at dogs that have been vaccinated five or more years ago with the core as well as non-core vaccines. • Does the recombinant canarypox distemper vaccine provide the same long lasting immunity seen with the traditional live canine distemper vaccines? The answer is yes. The recombinant, like the traditional live CDV, gives many years of immunity. This was the first study in a target species showing that duration of immunity was the same for a modified live and recombinant vaccine. • We are also studying “immunologic memory” to most of the other canine vaccines, and have shown that canine adenovirus and canine parvovirus vaccine provide many years (up to a lifetime) of immunity based on antibody and challenge studies. • In general, immunity to viruses is longer than immunity to bacteria, so the viral vaccines are longer lasting – up to a lifetime.

VetzLife All-Natural News Safe and effective oral care As dogs and cats age, they become prone to developing tartar, gingivitis and periodontal disease. There are many ways to treat these issues, but for severe periodontal problems a thorough dental scaling and extractions (as needed) are called for. There are also many dental products on the market that may be effective for use on dogs and cats. However, some contain ingredients that are shown to be harmful to pets, such as sodium benzoate, chlorhexidine, and xylitol. Many veterinarians are using VetzLife oral care products because they offer a safe yet effective all-natural alternative. VetzLife gel and spray are potent preventives that helps stop oral diseases from becoming established. Used for a few days before oral surgery, these products can also help prevent complications by reducing inflammation and infection. Older animals with a variety of oral and other health problems, as well as certain breeds, experience more risks when it comes to surgery. VetzLife products can help reduce these risks when used pre-operatively, and may also be of post-operative benefit, facilitating the healing process. VetzLife oral care gel and spray has an integrative, complementary role in proper oral care delivery for companion animals, and in promoting a professional approach to preventive oral health care maintenance, dental disease prophylaxis, and appropriate oral surgical procedures. Article provided by VetzLife/PetzLife all-natural products ( VetzLife.com or 1.888.453.4682).

IVC Fall 2014

nutrition nook

Food prescriptions for the

AGING PATIENT

By Kathy Alinovi, DVM, CVSMT, CTCVMP

Whole patient care

is about more than just treating symptoms or the clinical presentation. It’s about planning for wellness and preventing future issues, even for the geriatric patient. As integrative veterinarians, we are able to combine the best of everything – the optimal tools for patient health, regardless of the branch of medicine they are derived from. One of my first and top responses to any set of symptoms involves food. Medication through nutrition (whole foods) not only treats health issues; it heals and prevents future issues – without side effects. A comprehensive integrative exam always includes a full discussion about food – nutrition, health, and longevity. Geriatric patients need the best nutrition for the best health. Best nutrition comes from best quality food. This is done with foods we control – real food, “people food”. While each patient may have different health issues, most geriatric animals will have the same underlying issues – general organ system decline or failure. These issues include a weakened immune system, arthritis, kidney dysfunction, heart dysfunction and others, either separately or in combination. Feeding the geriatric patient for health may seem daunting, since older animals are often quite fragile, but real food diets are not that complicated and work with even very compromised pets. Simple, uncomplicated recipes that reduce overall inflammation do the most good, and are quite cost effective for the client. Fears that we won’t provide enough trace nutrients can be alleviated by feeding a variety of foods, just as with humans. Another common concern is that switching foods will lead to diarrhea or will not be accepted by the animal. Most pets have

IVC Fall 2014

no more trouble with diarrhea from eating different foods than people do. Anyone who sneaks people food to their dog will find the transition quick and easy. Converting cats is not always as easy, especially in older, geriatric cats – baby steps and lots of warm broth with a sprinkling of powdered high quality kibble on top may be the start to a late life food change for these patients.

Continued on page 30.

BASIC RECIPES Beef and Sweet Potato for Geriatric Dogs Yield: 1 serving for a 60lb dog ½ cup lean beef, sliced to bite-sized pieces 2 tbs beef liver, sliced to bite-sized pieces 1 tbs olive oil ¾ cup sweet potato, baked, skin on, cubed ¾ cup tomatoes, diced ¾ cup spinach, frozen, thawed, chopped (fresh is best) 1 tbs flax seed oil 400mg calcium Lightly cook the beef and liver in olive oil on medium heat. When the pink is just gone, turn off heat. Add and mix the rest of the ingredients. Serve warm.

Beef and Pumpkin for Geriatric Cats Yield: 1 serving for a 10lb cat ½ cup lean beef round roast, diced to bite-sized pieces ½ tsp pumpkin, canned ½ tsp sunflower seeds, raw, unsalted, ground 1 tsp flaxseed oil 50mg calcium Cook roast (sauté, bake, broil) until the outside is cooked. Rare on the inside is acceptable. Once meat has cooled, mix in the rest of the ingredients. Serve warm for a great aroma.

IVC Fall 2014

Continued from page 29.

RAW OR COOKED? The meat in the above recipes can also be served raw, but that depends on what the patient can tolerate. • For some older animals, especially those who have eaten kibble all their lives, raw is too hard to digest. Other patients have no problems with it. • Feeding raw meat comes with pluses and minuses. Raw meat is ideal for the cancer patient – it is cooling from a TCVM perspective, which counteracts the heat of cancer. • Which cut of meat to serve raw is also a concern: ground meats should not be served raw because the bacteria from the outside of the meat has been ground in. • For easier digestion, most vegetables should be cooked or pureed – vegetables are harder to digest and cooking starts the digestion process. In the wild, most vegetable matter comes from the stomach and intestines of the prey, which chewed and partially digested it. Absorption of vegetable matter takes place in the intestines. The transit time in dogs and cats is too short to absorb any vegetable chunks. You have all seen corn in stools!

RATIONALE FOR DIFFERENT FOOD CHOICES For the patient who is always cold, sleeping under the covers, substitute chicken for beef. For the patient who just can’t cool off, even in winter, substitute fish, like trout or cod. Add ¼ tsp turmeric (curcumin) for anti-inflammatory effects. Or ¼ tsp cinnamon for digestive upset. As recipes become more varied, the general rule of thumb for dogs is 33% meat (muscle and organ), 33% carbohydrates (legumes or root vegetables), and 33% vegetables and/or fruit. For cats, the ratio is 80% to 90% meat (muscle and organ), and 10% to 20% vegetables, fruits and seeds. For the patient who is losing weight, increase the carbohydrates. Weight loss is common on real food diets (and usually this is our goal). Beef is neutral in temperature – a good starting point. Low fat puts less stress on the gall bladder, thus on the digestion. Sweet potato helps moisturize the intestines, pumpkin even more so. Substitute canned pumpkin for constipation or diarrhea, issues. Spinach is good for building blood. Most green vegetables will substitute well.

Because we are trying to feed these dogs and cats for longevity, we want to provide a variety of recipes or ingredients. The variety provides balanced nutrition, and also helps meet environmental changes, mainly seasonal changes. In the summer, when squash is abundant, use that for the vegetables. In winter, when eggplant or Brussels sprouts are available, use them. The foods that are available in a given season are the ones that are healthful for that season. Throw in berries when they are in season – blueberries, strawberries and mulberries all have great medicinal, blood-building effects. If cats will eat all the extra fruits and vegetables, that is wonderful; however, cats are best served with meatbased meals, with minimal supplements for the minor nutrients not found in meat.

THE PROTEIN QUESTION There is a theory that geriatric patients, especially cats in renal failure, should be fed low protein diets because less protein in means less protein out. Protein is the building block for muscle. Dietary protein intake balances the muscle catabolism of old age. While geriatric cats on high protein diets will lose more protein in their urine than those eating a protein restricted diet, they will still have more foundation for muscle health (including the heart muscle). If protein is removed from the diet and replaced with carbohydrates (grains), inflammation is increased. Here’s an option for the geriatric cat in renal failure:

Bone Broth Bones from a chicken or turkey 1-2 tbs apple cider vinegar Water to cover Break long bones in half to expose the marrow and minerals. Boil lightly for four to six hours. Add water as needed. Add the broth to any meal, or serve instead of water for renal failure cats.

PORTION SIZES Portion sizes are always a challenge. The sample dog recipe in this article usually provides enough calories for one meal for a 60lb dog. However, if the geriatric patient is particularly

Continued on page 32. IVC Fall 2014

IVC Fall 2014

Recipe for

ARTHRITIC JOINTS

RECIPE PORTIONS Geriatric dog weight 10lb

Chicken foot soup • Clean chicken feet • Water to cover Bring to a light boil and cook as you would chicken broth. After four to six hours of simmering, remove bones. When cool, the broth will be thick like gelatin. Serve as warm soup, or use as a top dressing to help aching joints.

Portion size (cups) per meal /3

20lb

30lb

60lb

100lb

1¼

Continued from page 30. energetic, it may not yield enough calories. This is a bigger problem for those who feed raw meats without vegetables. Vegetables, especially roots like sweet potato, provide carbohydrates, a calorie source. For some lower energy geriatric dogs, this recipe will provide too many calories – in this case, remove 25% of the sweet potato. Regardless of the type of food (real, canned or dry), any time a dietary change is made, the body condition should be checked every two to four weeks. Portion sizes are not linear (see table). A 30lb dog does not eat half as much as a 60lb dog. A rule of thumb: if the patient is eating high quality kibble, feed as much real food as the portion of kibble used to be.

avoid

Pro-inflammatory foods to include rice, processed grain, pasta and bread. DANGEROUS FOODS There really are only a handful of truly dangerous foods. Chocolate, raw onions, grapes and raisins, and xylitol are examples. Long lists of other foods that can be poisonous can be found on the Internet, but these foods are toxic in only certain circumstances. For example, consider garlic or macadamia nuts. In order to make a dog truly ill, you’d need to feed him an enormous quantity of either of these foods. Most of us could not afford to feed our dogs enough macadamia nuts to make them ill. Practicality says that anything in small amounts, except for the few foods listed at the beginning of this paragraph, are safe to eat. Even moderate amounts of avocado flesh are safe; it’s the pits and skins that are poisonous to some animals (birds). Real food is the fastest way to better health, regardless of the patient’s age. Fundamental recipes and basic food group proportions are the starting point.

IVC Fall 2014

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.

Upcoming events This year, IVAS is celebrating its 40th anniversary. We have been setting the global standard in veterinary acupuncture since 1974. As the oldest veterinary acupuncture organization in North America, IVAS has grown over the years from just a few members to over 1,900 members internationally.

First veterinary technician course IVAS is offering our first ever Introduction to Acupuncture and Traditional Chinese Medicine for Veterinary Technicians course. It will start online on our e-learning platform, and conclude with a weekend in Portland, Oregon on January 24 and 25, 2015.

Join us September 24 to 27 at the Auditorium Sant’ Apollonia in Florence, Italy for the 40th Annual IVAS and 15th Annual ItVAS Joint Congress on Veterinary Acupuncture. This year’s general theme is connective tissue – the joint program committee has put together a range of important topics with an impressive list of speakers and wet labs. The historic city of Florence will be a great place to learn and visit with colleagues. The 2014-2015 IVAS Certification Course in Basic Veterinary Acupuncture will be held in Portland, Oregon beginning October 29. This course is co-sponsored by the Oregon Veterinary Medical Association and qualifies for Continuing Education credits in most states.

CASE STUDY

By Michelle Schraeder, DVM, MEd, FAAVA Aaron is a young whippet who presented for increasing separation anxiety, fearfulness, and restlessness. “Aaron has been a puzzle to me since getting him at six months,” his owner told me in an email. “I suspect his problems stem from being raised in a more isolated environment on Vancouver Island. He did have lots of dog-on-dog interaction, but very little outside exposure until the day I picked him up. So he’s great around other dogs, but riding in vehicles, loud noises, etc., are extremely troubling to him. I’m sure not sure what happened a year ago (it might have started with the construction of a school behind my home), but his phobias and anxiety were making him a miserable dog, and me a very frustrated and desperate owner.”

Aaron was given just one treatment of acupuncture (GV 20, HT 7, BL 20, BL 17, BL 18, BL 20, SP 6, PC 6-R, SP 10-R, LIV 3-L). A TCM food therapy recommendation involved avoiding hot foods like lamb, and feeding cool or neutral foods, Blood and Yin tonic foods, and Qi movers. The following week, Aaron’s owner emailed me again. “Aaron has been a completely different dog since leaving your office. His level of anxiety went from 10+ down to about a 5 that same afternoon, and he continues to improve. We took an extensive trip over the weekend and he has never been easier to handle. He was a joy to be around. I left for work this morning, and instead of running to the fence crying and digging, Aaron just followed the other dogs into the backyard. I haven’t seen that behavior in over a year.”

For more information on IVAS and upcoming events please visit ivas.org.

IVC Fall 2014

industry innovations & spotlight Nix the e-collar

No more odor

Most animals hate wearing e-collars, and that can prompt clients to remove these devices before it’s advisable to do so. Cover Me by Tui makes the e-collar unnecessary and redundant. This one-piece garment is much better tolerated by most post-surgical patients, and has a potty cover to make bathroom breaks easier. The garment is made from breathable, lightweight Peruvian cotton that’s soft and comfortable but also durable.

If you need to get rid of lingering odors in the clinic environment, reach for Nok Out. This heavy duty odor neutralizer eliminates the more persistent odors both from the air and all washable surfaces. The product works by getting rid of odors at the source – not just masking them – and continues working for a long time after application. Can be used to disinfected cages and exam tables or to get rid of the smell of urine, feces or vomit.

TulanesCloset.com

For protein allergies Do you have patients with allergies? severe protein allergies Kindly by The Honest Kitchen is a brand new base-mix without grains, white potatoes or fruits. Just add meat and water for a complete meal. Ingredients include dehydrated carrots, parsnips, peas, celery, pumpkin, chard and kelp as well as organic ﬂaxseed, dried organic coconut, dried marjoram and garlic, vitamins and minerals. For a free sample, contact Vets@thehonestkitchen.com. TheHonestKitchen.com

Joint health for dogs Synovi G4® soft chews help maintain joint health by combining a novel blend of antioxidants, glucosamine, creatine, MSM, turmeric and Boswellia serrata, so getting older doesn’t have to mean feeling older. For more info, call Bayer Customer Service at 800-633-3796

IVC Fall 2014

NokOut.ca or 877-466-5688

Give your patients traction Power Paws traction socks have been giving dogs “The Power to Stand. The Power to Stop. And the Power to Go!” since 2009. Their uses have expanded outdoors to protect paws against snow, ice, and salt in the winter, and burns from hot pavement and sand in the summer. They are also a simple solution for dogs allergic to dust, dirt, grass and pollen. Sizes and foot shapes available for virtually all dogs. WoodrowWear.com

New patent for stem cells covers sports medicine This past May, VetStem, Inc., announced that a major patent was issued to Vet-Stem for New Zealand. The patent covers the preparation methods and use of adiposederived stem cells in treating any type of disease, but of particular interest is its application to the rapidly evolving ﬁeld of Regenerative Sports Medicine. The patent speciﬁcally covers use in injuries or diseases of the musculoskeletal system, such as tendon tears, ligament injury and osteoarthritis. This new patent adds to many others in the Vet-Stem portfolio that cover methods of preparing and using regenerative cells from adipose. Vet-Stem has already had a similar patent issue in the EU and applications are pending in the US and other countries. Vet-Stem.com

Eye and wound care Remend® products help you manage skin wounds, superﬁcial corneal ulcers and dry eyes in dogs and cats. The products deliver cross-linked hyaluronic acid technology to support a pet’s natural healing processes. Try Wound Spray Gel, Corneal Repair Gel and Eye Lubricating Drops. For more info, call Bayer Customer Service at 800-633-3796.

Curcumin to the rescue Curcumin is one of the most heavily researched anti-inﬂammatory herbs, but quality and synergism are key to results. Nouvelle Research, Inc. introduces its Cur-OST® line of curcumin-based formulas, designed to manage a healthy inﬂammatory response in companion pets and horses. The formulas are research developed, formulated and clinically utilized by Tom Schell, DVM. Cur-OST® utilizes BCM-95®, a patented curcumin extract with proven absorption and bioavailability. curost.com or 1-800-476-4702

Anal gland and digestive supplement Glandex® is an all-natural supplement specifically designed for anal gland problems. It works from the inside out to support healthy anal gland and digestive function. This proprietary formula contains a unique fiber blend to bulk and firm the stools and help the anal glands empty naturally every time the pet defecates. It also contains natural anti-inflammatories to address the underlying inflammation and allergies that trigger anal gland problems, as well as probiotics to support digestive health. Glandex is formulated as a highly palatable once-a-day powder and is available in three different sizes. Glandex.com

DNA breed test With the simple swipe of a cheek swab, Wisdom Panel 2.0© Dog DNA Breed Test can determine the ancestry of a mixed breed dog from among more than 200 breeds, including 100% of AKC breeds. The cost is $74.00 (includes two-day shipping) and the results are available in two to three weeks. To learn more about the Dog DNA Breed Test and other related Canine DNA services, or to order a cheek swab kit, please visit dog-dna.com. IVC Fall 2014 35

INTEGRATIVE INTEGRATIVE APPROACH TO

HOSPICE

GERIATRIC AND HOSPICE CARE GERIATRIC By Barbara Royal, DVM, CVA

As veterinarians, we are often faced with situations beyond the scope of what we were taught in veterinary school. I learned this early in my career when working with wildlife and zoo animals. But even in small animal practice, our veterinary training, strong in teaching about medicine and surgical procedures, falls short as we deal with aging, chronic conditions, or hospice. That is where I look to my integrative training. In my integrative practice, I treat many geriatric pets. My clients tell me that our alternative approach provides a reasonable course of action for their aging animals, and that by having a commonsense plan they feel less helpless and worried about their pets’ condition. They feel empowered by improving not just the quantity, but the quality of their pets’ lives. The final decision for the pet is therefore made with a clearer conscience. In geriatric medicine, pharmaceutical or surgical intervention is often not an option, but veterinary care is still needed. Integrative options, both modern and ancient, have offered owners and pets a better answer than “oh, she’s just getting old”. With a growing volume of geriatric and hospice cases, it is essential to have a plan that can provide the foundations of health for each patient. Geriatric cases can be daunting, with long histories of chronic and cumulative problems. But I think about each geriatric case

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as an opportunity to make a big difference in the animal’s quality of life. With excellent nutrition as the foundation, other conditions associated with aging are easier to manage. That’s why an earnest and very specific conversation about nutrition is the largest part of every geriatric exam in my practice. The owner must be invested in the science and sense of supporting the animal with an appropriate diet in order to ensure the kind of successes I expect. I have refined the strategies I use for my aging patients into a system that creates a plan for each individual. Starting with a foundation of an excellent, high protein diet with proper moisture content, I can then focus on the integrative options for each individual. These might include supplements, homeopathy or herbs, acupuncture, chiropractic, laser, physical rehabilitation and massage therapies, exercise, and simple ideas for the logistics of home care. Even in hospice care, elements of integrative medicine can improve life for both patient and owner.

FOOD IS MEDICINE No matter how old, problematic or unwell an animal may be, try food as medicine. An elderly pet that eats a well balanced raw food will be more spry, vital and energetic, and have less pain from inflammatory conditions, than an animal eating dry processed kibble. Treats must also comply with the rules.

Protein: Older animals need more rather than less protein in their diets to maintain their muscle mass and body condition. For most of my geriatric patients, I suggest a diet that is at least 40% protein on a dry matter basis.

DMSO with natural lotions like calendula, arnica or even Manuka honey, or homeopathics like Traumeel®, and antibiotics or anti-inflammatories. Keeping an open mind about medications is essential.

Carbohydrates: Should be a very low percentage (less than 30%) of what a geriatric patient eats. A diet high in carbs can cause and worsen inflammatory conditions such as arthritis, autoimmune conditions, hormonal imbalances, allergies, poor hair coat, cognitive issues, obesity, diabetes, gastrointestinal disorders, etc.

Pill vehicles

Fat: It’s essential for mental health, proper nerve function, hormonal balance, metabolism, skin and hair coat, and many other body functions. Appropriate fat content (over 25%) in the diet of an aging dog or cat is much healthier than a high carb diet. Eating appropriate amounts of fat does not mean the animal will become overweight. Avoiding carbohydrates and eating proper amounts of food and treats is more important for weight management than avoiding fat. Here is my food ranking for dogs, from 1 to 5. (Food suggestions for cats are the same, but with less force because the “catveat” is: there’s no rule about cats – cats will eat what they will eat).  Commercially prepared well-balanced raw food  Balanced homemade meals (for most clients this is unsustainable)  Freeze dried or air dried raw foods  Canned foods  If you must, a dry kibble food

RETHINK ALL MEDICATIONS AND SUPPLEMENTS Re-evaluate all medications and supplements at least monthly. Make sure not to mistake side effects for signs of serious health decline. I have seen this with antibiotics, pain medications, supplements, anti-inflammatories, and thyroid medications. I have had clients discussing euthanasia because they felt their animal had lost the will to go on, only to be shocked by the reappearance of their energetic pet when a pain medication or antibiotic was discontinued. Sometimes, doses need to be decreased as animals age and wither; sometimes they need to be increased to keep up with current conditions. Avoid oral medications where topical meds might work. Many skin conditions, resistant infections and even odd lumps can be more safely treated topically than orally. If you need to increase absorption of a medication, add dimethyl sulfoxide (DMSO) as a great carrier for topical medication. As long as the owner or pet isn’t sensitive to sulfas, DMSO topical mixtures can be a great option. I will often combine

Many owners resist giving supplements or medications because they dread giving pills to their aging friends. Our older pets get wise to us, and it can be difficult to push down pills or hide them in a meal. I avoid most commercially-made “pill pockets” because they tend to contain grains or peanut butter, which contribute to inflammation.

Some animals, even geriatric ones, love to eat and will eat anything. Many others who already have developed poor appetites, especially cats, may completely stop eating if anything at all is added to the food. Work with the owner to use pill pockets even if the treatment is a powder or liquid. Offering the medicated “treat” when the pet is hungry may also help. Your goal is quality of life for the whole family, so treatments need to be easy to administer. For healthy “pill pocket” options, try plain butter (make a butter pat/pill sandwich, put it in the freezer for a minute, and it slides right down), goat cheese, sliced unprocessed meats, sardines, natural liverwurst, and even vanilla ice cream. I never recommend putting a medication, even flower essences, in drinking water. Water should just be water. Hydration is essential to older animals. I don’t want to risk an animal drinking less because the water tastes bad.

WHAT GOES IN, MUST COME OUT – FECAL AND URINARY INCONTINENCE Many approaches can improve quality of life for an elderly animal that has fecal or urinary accidents. When conditions like infections, estrogen deficiency, anal gland issues, parasites, cancers, or bladder stones have been ruled out, the next step IVC Fall 2014

is to manage the condition by improving the quality and decreasing the quantity of defecation and urination, or by using holistic approaches to actually resolve the incontinence. At my clinic we say (half joking) that when animals eat raw food, even the poop is cute. Firm stool makes fecal-incontinent animals much less burdensome for the owners. Eating a once-daily meal of raw food can be the most helpful solution for fecal incontinence. In many cases, the animal doesn’t have accidents in the house anymore. And if they do, they are easier to predict and clean up. Raw food once daily is also effective for urinary incontinence. An animal that is not processing dry kibble, but is eating a moistureappropriate food, will drink a more normal amount of water and will not overfill the bladder, thereby decreasing the urge to urinate.

The four F’s of fecal incontinence Owners may think of an F-word I won’t mention here, when fecal incontinence is discovered. Here are four other F-words that can help owners recover their dogs’ dignity.  Food – Decreasing the amount of filler (prevalent in kibble) in food will usually decrease the volume of feces. Raw food really shines here.

 Frequency – Feeding once a day gives a clear signal about defecation when the food all arrives in the colon at once. If the pet still gets the signal crossed, at least it’s easier for an owner to predict when the animal might need to go.

 Focus – There are constant distractions from the outside world when an animal goes on a walk. The signal to defecate may not be strong enough to override all the fun stimuli. “The Double Walk” can get the dog to focus on the job at hand. After the first walk, come in for a few seconds. Then head back out the door. The second walk will be less interesting. The first walking will have stimulated the colon, and the dog may have more success.

 Floor – This technique is based on the principle that you can

Barneygirl (top) and Oliver receive acupuncture – this modality can provide relief from a range of age-related issues.

cause a dog to defecate by taking his temperature rectally, which stimulates the pelvic floor. Just before the last bedtime walk, use a thermometer, or a gloved finger or Q-tip with some lubrication. Put it in the anal opening and gently press a few times on the pelvic floor. Sometimes it just takes a mild stimulation around the anal opening to make a dog poop. Be ready to go right outside. If the owner is not squeamish, this is an effective method for preparing a dog for a good night’s sleep.

MOBILITY – MOVE IT OR LOSE IT Becoming sedentary with arthritis, general weakness or secondary lethargy can trigger a dangerous downward spiral. Disuse atrophy of leg and back muscles destabilizes the joints and spine, causing unbalanced, hesitant or stilted gait patterns, and increasing discomfort. Even gentle

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weight-bearing exercise strengthens the muscles and circulates nutritive synovial fluid over the surfaces of the joint. Confidence in the limbs comes from using the limbs, pure and simple. This is one of the reasons I use underwater treadmill treatments to improve muscle mass and coordination. With the underwater treadmill, the animal is buoyant, and feels weightless while working the whole body, without the risk of falling. The improvement in ambulation, even with infrequent treatments, is surprising.

Take a walk on the wild side I recommend that clients go on walks where their pets can experience/ smell/see something new. Keep the mind engaged and the body will follow suit. Even if the pace is very slow, do the walks – and make them interesting. For animals that are having cognitive problems, I have had great success using Cholodin to improve mentation and cognition.

Try moving off the beaten track Dogs and cats benefit from challenging terrain. If walks are only on flat surfaces, flat may be the only surface the pet can navigate. Make games that include varying surfaces for indoor pets. Outdoors, maneuver the pet over tree roots, gravel, and irregular ground. Step up and down curbs, go around posts, walk in short figure-eight patterns and go up or down inclines or driveways.

Encouragement Place toys or treats in places where it requires some effort to retrieve them, and don’t forget to play with your aging cats. People play games with dogs at many life stages, but mature cats are often left to sleep all day. Don’t just put treats under their noses; make them do a little work for them. Place treats up a flight of stairs or on top of some climbing toy. Those wire-bouncing fobs and little mouse toys are not just for kittens. And the cat may shed some unwanted weight as well.

Stepping up with conﬁdence Put in an extra light fixture over the stairs, and perhaps carpet them too. This may sound like a home decor solution, not a veterinary one, but it can be crucial for an aging pet with an optical condition. Animals with lenticular sclerosis can have trouble with low light conditions and depth perception. It may appear that a pet’s arthritis makes him hesitant on stairs when in fact it might be a vision issue. Make sure that irregular surfaces or steps for the older pet are well lit. The pads on older canine and feline feet can slip more on smooth surfaces. Adding area rugs and other non-skid floor coverings can help them get up and move more confidently. ToeGrips, adhesive foot pads, waxes or non-slip booties, if they aren’t too bulky, can also help. Place carpets, runners, non-skid tape, rough paint, rubber mats or even yoga mats in slippery spots.

Continued on page 40.

Two of Dr. Royal’s senior patients. Isabella (top) is wearing non-skid booties to help her maintain traction on slippery ﬂoors. Emma (bottom) receives non-skid toe grips.

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Alternatives to COX 1 or COX 2 inhibitors • Cold laser treatments, boswelia, turmeric, cayenne, hyaluronic acids, white willow bark, yucca, rhus tox 30c, ruta grav30cv, Traumeel®, arnica, symphytum, topical preparations with arnica, injectable Adequan® or Ichon®. • The over-the-counter product Dog Gone Pain (DGP) is a lovely herbal combination of antiinﬂammatory herbal remedies. • Don’t forget that ice is a great anti-inﬂammatory treatment. • For eye irritation, try using a slightly used, cooled tea bag (chamomile, green tea, sage tea) as a topical compress. Continued from page 39.

MASSAGE – ONE OF THE BEST KEPT SECRETS IN ALTERNATIVE MEDICINE Massage is effective for so many conditions – musculoskeletal pain, chronic pain, poor healing, scar treatments, postoperative recovery, cognitive issues, chronic conditions, circulation problems, autoimmune problems, allergies, sinus issues, anxiety disorders, neurologic conditions and more. I will hear owners say, “I’m not giving my dog a massage till I get a massage,” which I absolutely understand. We should all have a good massage now and again. But it is unfortunate that we are more comfortable recommending costly medications, surgery and other treatments with potential unwanted side effects, than recommending a simple massage.

Simple massage techniques to teach owners

 Feet – Once a day, gently squeeze the feet and pull slowly along the toes of a geriatric dog or cat. This physical therapy trick can strengthen the neurological connections from the brain to the foot, improving conscious proprioception (proper foot placement) and leg mobility.  Face/head – A light pressure of small circles around the base of the ears can improve circulation and ear health. Facial, cheek and head massage can calm anxious older cats and even improve cognition. Spine/tail – Use light pressure with fingertips in little circles (a  la Tellington Touch™) all the way down on either side of the spine to help with overall circulation, lymphatic drainage, and spinal health. Little massage circles invigorate nerves, muscles, lymphatics, tendons and ligaments. Gentle traction in a smooth massaging stroke down the tail can help stretch spinal tendons and ligaments and improve inter-vertebral circulation. A supple spine can mean a more active dog or cat.

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Massage is an effective modality that, among other things, can alleviate pain and circulation problems as well as speed healing and help with post-operative recovery.

THE AGING LARYNX When dogs start to develop laryngeal paralysis as they age (this typically occurs in large breeds), the condition is considered progressive and difficult to treat. Laryngeal paralysis can be lifethreatening because a dog may have trouble keeping cool in the heat if his larynx can’t fully open and allow panting to cool him down. It can even eventually cause airway obstruction. The options in conventional medicine are surgical – the laryngeal tie back – or perhaps trying a tricyclic antidepressant (Doxepin). Owners may first notice a sort of phlegmy clearing cough when pets first get up (the “old man cough”). This is typically because saliva has pooled around the slightly lax/open larynx and dripped down toward the trachea while the dog was sleeping. Once cleared, the dogs doesn’t usually continue coughing during the day. When I see this sign, I recommend alternative treatments as well as checking the thyroid condition of the dog. Hypothyroid conditions can predispose a dog to have laryngeal paralysis. It is wise to check the thyroid status of any dog with signs of laryngeal paralysis.

Sometimes properly treating the thyroid problem (supplement twice a day on an empty stomach) can slow the progression of paralysis. I use acupuncture â&#x20AC;&#x201C; there are effective acupuncture points lateral to the larynx â&#x20AC;&#x201C; to improve laryngeal function. I have found both dry needles and aquapuncture with vitamin B12 to be helpful. While success can be subjective in this condition, owners feel acupuncture makes a noticeable difference in respiration effort, and are pleased with the treatments.

Acupuncture The best thing about acupuncture in an older animal is that it is an effective treatment without major side effects, and can be tailored to any patient. The geriatric patient often suffers from arthritis pain, anorexia, and multiple other chronic conditions. Acupuncture has been shown to be effective an all these and more. Most older pets tolerate treatments well, and have amazing improvements.

Vitamin B12 aquapuncture In some cases, injecting a small amount of vitamin B12 into appropriate acupuncture points is useful in older animals because they tend to be deficient in vitamin B12 and the effects can last longer than dry needling. In fact, I recommend single vitamin B12 injections, sometimes weekly, as a tonic for many elderly patients. It can improve energy and appetite.

Chiropractic This is commonly and successfully used for the geriatric patient. Regular chiropractic adjustments

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are recommended for musculoskeletal issues, stilted gait, neurologic disorders, or animals with amputations. Chiropractic treatments can also improve overall mentation, attitude and sometimes resolve other chronic ailments.

dogs just have dry noses. After ruling out any underlying medical cause, there are a few options to try. My clients feel that Vaseline on the nose is the most reliably effective topical treatment for an elderly dog’s dry nose. I have also had some success with shea butter or coconut oil topically. Vitamin E or fish oils make the nose sticky, not smooth. Bag Balm can be too irritating, and its pungent odor can irritate a dog’s keen sense of smell. Coconut oil taken orally (about 1 tsp daily per 30 lb to 50 lb dog) can ameliorate dry noses somewhat, and improves dandruff, dull hair coats and general gastrointestinal health.

Dr. Stimac gives a chiropractic adjustment to an elderly patient. Chiropractic can help with musculoskeletal issues, mental attitude and neurological problems.

Cold laser light therapy This therapy has been extremely effective and well researched. There are protocols to decrease swelling and inflammation, reduce scarring, and increase healthy circulation. Laser can be used for many chronic painful conditions of the joints, edema, and also for many chronic skin conditions, including nonhealing wounds, resistant infections, and even mites.

Laser treatment is another non-invasive way to address painful joint issues, and to improve circulation, while reducing inflammation and swelling.

ON THE NOSE – DRYNESS AND CRUSTINESS Crusty noses can be a sign of a significant autoimmune condition or nutritional deficiency, but sometimes older

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Dry, crusty noses are common in older dogs. If there are no underlying medical causes, topical treatments such as shea butter and coconut oil can help.

Change plastic bowls to ceramic, metal, or glass bowls, and clean them regularly. Plastic bowls may be a low level chronic irritant to an older animal’s oral/nasal skin. If the older pet doesn’t seem hungry and is looking thin, it may be that she just can’t smell the food. Loss of interest in food with age may be a sign of some significant illness such as cancer, systemic diseases, or dental problems – or the answer may be under her nose. Smell is an important appetite stimulant. Aging animals can have trouble with their sense of smell due to many causes, including previous respiratory disease, or side effects of medication such as some anti-inflammatory meds. These animals may be idly wondering what those scentless clumps are in their food dishes, but dinner doesn’t come to mind – or their olfactory lobes. To enhance smell, try warming up the food, or mix in some hot water, chicken broth, tripe, or a slurry of meat baby food (one that doesn’t contain onion or onion powder). The dog will more likely come running for supper if you supersize the aroma. Add something new like vanilla ice cream or sardines. When owners have been feeding fresh food, they can offer

any “bribe” foods they have learned to use over the years. I’ve noticed that many aging dogs skip their morning meals. Even with enticement and fabulous-smelling food, they just say no. Yet, by supper, they quickly clean their bowls. As long as everything else seems normal – and there’s no vomiting or other signs – many older dogs can do just fine skipping breakfast, if that’s what they choose, and their weight is stable. In addition to watching a pet’s weight, actively make him slim. If a dog is overweight and his thyroid is normal, believe me, it’s the food. Don’t worry about exercising more, or health issues that preclude exercise. Weight loss is all about food. Decrease the amount fed. Even cut the amount in half. Dogs, as scavengers, don’t go into starvation mode when there is less food. They just eat their fat, a benefit of the species that we don’t take advantage of nearly enough. A recent study stated that over 50% of dogs in our country are obese. We can improve this frightening statistic as we control everything they eat. An aging and overweight pet faces many health, mobility, energy, and mental issues. Remember, for every pound a dog loses, he feels four pounds less torque on each leg. This is a good incentive to keep an older pet thin. Every pound truly counts! We can’t make our patients live forever, or extend their lives to match ours. However, there are many simple, common sense actions we can take to improve on their lifespan, and mitigate the effects of old age. Offering multiple options involves clients in the process, thereby increasing client retention and satisfaction. Using these approaches may significantly extend the life of some animals (even ones officially in hospice), and always increases quality of life.

References Bittel, Ella. “Integrating Animal Hospice at your Work Place”, Wild West Veterinary Conference, 2009. Chambreau, Christina, DVM, CVH. “Holistic and Homeopathic Treatment of Arthritis”, Atlantic Coast Veterinary Conference, 2012. Joiner T. “An holistic approach to nursing”, Veterinary Nursing, Volume 15 No 4, July 2000. Messonnier, Shawn, DVM. “Results of a Study Using a Dietary Supplement to Treat Canine Cognitive Disorder (Alzheimer’s)”, J Am Holistic Vet Med Assoc, Oct-Dec 2004; 23(3):43-44. Richtel, Matt. “All Dogs May Go to Heaven. These Days, Some Go to Hospice”, The New York Times, November 30, 2013. Royal, Barbara, DVM, CVA. The Royal Treatment: A Natural Approach to Wildly Healthy Pets, Simon and Schuster, 2012. Sharkey, Leslie DVM, PhD, DACVP (Clinical pathology). “The Biology of Obesity in Dogs and Cats”, ACVIM, 2011. Tellington-Jones, Linda; Taylor, Sybil. The Tellington TTouch: A Revolutionary Natural Method to Train and Care for Your Favorite Animal, 1993. Xie, Huisheng. “Holistic Approach for Geriatric Patients”, Western Veterinary Conference, 2010.

Portable PEMF devices reduce inflammation and pain.

Wearable

PEMF Miniaturized technology puts healing right on painful joints.

By Ian Rawe, PhD The aches and pains of aging aren’t fun. For our patients, limited mobility can reduce quality of life and become a lifethreatening crisis. Painful joints caused by inflammation and swelling make animals unwilling to walk or unable to stand. In large breeds especially, loss of mobility is the most common reason pets are put down. For decades, veterinarians and trainers successfully treated swelling and pain with pulsed electromagnetic field therapy (PEMF). While effective, its usefulness was limited by the size and cost of the devices. Advances in technology and innovation have transformed traditional PEMF therapy into small wearable patches. These devices deliver continuous, sensation-free, fixed extended low-dose PEMF therapy with no side effects. The electromagnetic field is carried on a shortwave radio frequency, and emitted rapidly at 1,000 pulses per second. These pulses interact with the body’s electrical noise to activate sensory nerve fibers, and in a feedback loop motor nerves. The effects are decreased pain awareness, increased blood flow to enhance oxygen and nutrient availability to injured tissues, and removal of edema. This technology has been successfully used to treat joint, muscle and tendon pain, hip dysplasia, IVDD, arthritis, suspensory injuries, and to aid in postoperative recovery. Dr. Ian Rawe is Director of Clinical Research, BioElectronics Corporation, and the manufacturer of HealFast® Therapy, portable PEMF patches for horses, dogs and cats, and similar shortwave devices for human musculoskeletal pain and post surgical wounds. healfasttherapy.com IVC Fall 2014

Nutraceuticals and inflammation By Andrew G. Yersin, PhD

Pain management caused by inflammation is an important part of veterinary care. Musculoskeletal pain can result from tissue damage to muscles, tendons, ligaments, bone and articular surfaces. Depending upon location, function and innervation, musculoskeletal pain can have varying characteristics and patterns:

inhibitors of the pro-inflammatory enzyme 5-lipoxygenase, and also act via the inhibition of prostaglandin E synthase-1 and the serine protease cathepsin G. In animal and human studies, boswellia has shown to exhibit analgesic and antiinflammatory effects.

• Radiates from one area to another (referred pain)

Yucca is dried powder from the plant Yucca schidigera. Active molecules include trans-3,3’,5,5’-tetrahydroxy-4’methoxystilbene, alexin and reseveratrol, as well as additional saponins and phenolic compounds. These molecules have been demonstrated to act as potent antioxidants and antiinflammatory agents. One of the primary mechanisms of action for its anti-inflammatory activity is proposed to occur via inhibition of NF-κB and nitric oxide synthase (iNOS).

• Cycles from one joint or muscle to another • Aggravated by climatic changes (rain/wind/cold) • Acute trigger point pain in muscles, ligaments, and tendons • Aggravated with movement • Improved with movement • Mollified by cold/ice • Assuaged by heat/water

Various types of tissue injury can lead to chronic inflammation and pain through a complex cascade of signaling events. Injured cells release arachidonic acid, a membrane lipid, which is converted through enzymatic reactions to leukotrienes and prostaglandins that can trigger further inflammatory responses and increase the sensitivity of pain receptors. Simultaneously, the release of reactive oxygen species (ROS) and pro-inflammatory cytokines from damaged cells triggers the activation of the transcriptional factor NF-�B. This protein serves as a major control point in the inflammatory process, and further perpetuates the cycle of inflammation and pain by increasing the expression of a variety of pro-inflammatory cytokines and enzymes.

MSM (methylsulfonylmethane) occurs naturally in fresh fruit, whole grains, vegetables and animals. It serves as a source of sulfur necessary for the health and maintenance of mammalian connective tissues. MSM has been demonstrated to inhibit the activity of NF-κB, leading to a decrease in pro-inflammatory cytokines, nitric oxide, and prostaglandin E2.

Nutraceutical support includes the use of antioxidants, Omega-3 fatty acids, and specific botanical ingredients that target the enzymes and other mediators of the inflammatory signaling cascade, and support a healthy anti-inflammatory response.

Nutraceuticals may be used to support health and well-being. Whatever treatment strategy you choose, it is important to continue assessing pain and other health indicators to ensure the patient stays comfortable and general health is maintained.

Boswellia is powdered gum resin of the plant Boswellia serrata. Active molecules include a variety of triterpenoids, collectively called boswellic acids, that have been demonstrated to be potent

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Meadowsweet is the common name for the herb Filipendula ulmaria. Key classes of molecules identified in meadowsweet include salicylates, tannins, flavonoids, phenolic acids, and phenolic glycosides. Meadowsweet’s analgesic effects are largely attributed to salicylic aldehyde, a precursor for acetylsalicylic acid (aspirin).

Andrew G. Yersin, PhD, is president of the companion animal health division of Kemin Industries.

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TCVM ASSESSMENT AND CARE FOR OLDER PATIENTS

By Huisheng Xie, DVM, PhD, MS

s the life spans of companion animals increase, geriatric health care becomes a focus of veterinary practice. With geriatric patients, the primary goal is to promote their quality of life rather than cure their diseases. A number of reports have demonstrated that Traditional Chinese Veterinary Medicine (TCVM) can help accomplish this goal.1-3

MEASURING QUALITY OF LIFE The life quality score (LQS) system we created measures a geriatric patient’s quality of life (see table on page 48). This scoring system may be used to assess the patient’s baseline status as well the response to treatment. Instructing the pet owner to record the score on a daily to monthly basis can provide a valuable record of the patient’s ongoing status.

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After using LQS with over 500 geriatric patients, we developed a guide explaining how the LQS numbers relate to a patientâ&#x20AC;&#x2122;s quality of life. We feel that geriatric cases with an LQS over 500 often have an excellent quality of life. However, patients with an LQS less than 100 generally have such a poor quality of life that we suggest the owners consider euthanasia for the sake of animal welfare. (See sidebar on page 49 for an example of how we used the LQS system for a canine patient with renal failure.)

THREE-STEP METHODOLOGY FOR DIAGNOSIS AND TREATMENT The three-step methodology for diagnosing and treating a geriatric patient includes: 1) data collection, including conventional Western diagnostics; 2) TCVM pattern identification; and 3) treatment protocol. Step 1: Use conventional Western diagnostics (e.g., physical exam, blood work, radiographs) whenever possible to make a definitive diagnosis. Step 2: Use the four TCVM diagnostic methods (inspecting, hearing and smelling, inquiring, and palpating) to differentiate the TCVM pattern of disease. Step 3: Use an appropriate and integrative treatment protocol based on the Western diagnosis and TCVM pattern.

The following example demonstrates how to approach this process: A 14-year-old spayed female Labrador mix presented with acute onset of rear limb paresis, bilateral conscious proprioception deficits, and urinary incontinence (Deficiency). Her painful back and purple tongue suggested Qi-Blood stagnation (Excess). At this point, the veterinarian could have offered the owners three options, depending on the latterâ&#x20AC;&#x2122;s goals and monetary constraints. A neurological work-up, radiographs, myelogram, and/ q or MRI may definitively demonstrate the location and

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severity of the lesion. Assuming that the diagnostics indicate intervertebral disc disease, there are two possible treatments: 1) give the dog a trial course of steroids and monitor the efficacy of the anti-inflammatory treatment; or 2) surgically remove the disc in hopes that it will relieve enough spinal compression to permit return of normal hind-end function. onduct a TCVM work-up to identify the wC TCVM pattern, then base the treatments on the pattern. In this case, the treatment strategy is to tonify the rear weakness (Deficiency) and resolve Qi-blood stagnation in areas that are painful on palpation. A combination of acupuncture, herbal therapies and Tui-na are non-invasive and provide analgesic and antiinflammatory effects for the patient. Typically, three to six treatments can restore normal hind-end function.4

e Utilize a combination of the first two options. So which treatment is best? The radiographs, myelogram and/or MRI best demonstrate the lesionâ&#x20AC;&#x2122;s location. However, using TCVM to treat Continued on page 50.

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EVALUATING LIFE QUALITY SCORE (LQS) IN A GERIATRIC PATIENT Life Activity

Score

a. Mental Status

(0 to 100)

b. General Activity Level2

(0 to 100)

c. Appetite3

(0 to 100)

Life Activity Score 0 (very poor) to 100 (excellent)

d. Defecation

(0 to 100)

e. Urination

(0 to 100)

f. Overall Well-Being

Life Activity Score Subtotal (add a. through f.)

(0 to 100) (0 to 600)

Pain Score

Amount of pain (0 to 100) 0 (no pain) to 100 (severe pain)

Life Quality Score (LQS)

Life Activity Score Subtotal â&#x20AC;&#x201C; (Pain Score x 2)

(-200 to 600)

A happy, alert patient would have a higher score than a depressed or irritable patient. A patient with normal, daily outdoor exercise and indoor activity has a higher score. 3 A patient with a normal, enthusiastic appetite has a higher score. 4 Difficulty with defecation or leakage of feces will lower the score. 5 Difficulty with urination or leakage of urine will lower the score. 6 A patient with great enjoyment of daily life (interactions with people or other animals, exercise, food, etc.) has a higher score. 1 2

CASE STUDY Jake, a 13-year-old castrated male Alaskan Malamute, presented with acute onset of renal failure. He received intensive care and IV fluids, which pulled him through the crisis. However, after treatment, he was still anorexic and very weak. He had lost about 30 pounds in two weeks. His BUN was 98 mg/dL (normal is 7-27 mg/ dL) and his creatinine was 7.7 mg/dL (normal is 0.81.7 mg/dL). At night, Jake had to wear diapers because of a three-year history of nighttime urinary incontinence. On physical exam, Jake’s ears and back were cool to the touch, his pulse was deep and weak, and his tongue was pale and wet. The owner indicated that he currently walked about half a mile when he used to walk about three miles daily. Jake preferred warm places. His TCVM diagnosis was Spleen Qi and Kidney Qi Deficiency. Owner observations were used to generate Life Activity Scores and determine Jake’s quality of life. • Because Jake had nighttime urinary incontinence, he received a score of 10 for the “Urination” Life Activity Score. • His defecation was normal so his score was 100. • Jake was anorexic and thus received an “Appetite” score of 5. • Because he was weak and could only walk one-sixth of the distance he had formerly walked, he received a “General Activity Level” score of 20. • Because his mental status was about 20% of his normal state, he received a score of 20 there. Adding together his Life Activity Scores produced a subtotal of 225. Jake’s pain score was 20, so 40 points were subtracted from the Life Activity Score Subtotal to generate a Life Quality Score of 185. This LQS score indicates a poor quality of life, and the attending veterinarian felt this could be improved using TCVM therapy. Jake received treatment, including acupuncture and herbal medicines based on his TCVM diagnosis: • Acupuncture: Dry needle at GV-20, Bai-hui and Shan-gen. Twenty minutes of electro-acupuncture (ten minutes at 20 Hz followed by ten minutes at 80-120 Hz) stimulation of the

following points: a) BL-20, bilateral; b) BL-21, bilateral; c) BL26, bilateral; and d) ST-36 + GB-34 • Herbal Medicines: 1) Xiang Sha Liu Jun Zi (Eight Gentlemen), ten pills twice daily for four weeks and 2) You Gui Wan, five pills, twice daily for four weeks. Jake responded well to acupuncture. He ate an entire bowl of food immediately after the needles were withdrawn. This was the first time he had eaten this much food in one sitting since his acute illness. After two bi-weekly acupuncture sessions and one month of daily herbal medicine, his appetite became normal, he could walk about one-and-a-half miles daily, and he gained about ten pounds body weight. The LQS system was used again to determine Jake’s quality of life following four weeks of TCVM treatments. His “Urination” score remained the same since he continued to have urinary incontinence. His “Appetite” score increased to 60 because his appetite had improved. His “General Activity Level” score also increased because he had been able to walk farther than before treatment. His mental status had improved to about 50% of normal. Jake had minimal pain and 20 points were subtracted from the Life Activity Score Subtotal to generate an LQS of 330. Based on this score, his life quality had increased to be in the moderate range. Two months after his initial visit, Jake was doing well. His appetite had returned to normal, and he had gained another ten pounds. He also appeared happy and enjoyed his daily walks. Thus his scores for “General Activity Level”, “Mental status”, “Overall Well-being” and “Appetite” increased. But he still had an episode of urinary incontinence and had to wear a diaper. Clinically, his tongue was pale and his pulse was still weak. Although he was still azotemic (BUN = 88 mg/ dL and creatinine = 8.1 mg/dL), his LQS had increased to 510 which suggested he now had an excellent quality of life. After three months, the urinary incontinence stopped. Jake continued to be treated with acupuncture once every three to five months as needed for the rest of his life. Overall, he had a great quality of life. He had a normal appetite and water intake, and enjoyed long daily walks. His BUN and creatinine levels continued to range from 80 to 100 mg/dL and 8 to 12 mg/dL, respectively, but the goals of TCVM treatment had been achieved: to improve Jake’s life quality rather than cure the renal failure. Jake died three years later at the age of 16, due to congestive heart failure. IVC Fall 2014

Continued from page 48. a differentiated pattern is a good choice because it is a) less invasive, b) less expensive, c) less likely to have deleterious side effects than more aggressive therapies (surgery and steroids), and d) possibly just as effective as conventional treatments. In this case, the owner chose the second option because it was less invasive and less expensive. The dog’s TCVM diagnosis was Qi Deficiency with Local Qi-blood Stagnation. The following treatment regimen was applied: • Electro-acupuncture (20 Hz for ten minutes and 80-120 Hz for another ten minutes) at the following pairs of points: Liufeng, BL-20, BL-21, ST-36 + GB-34, and KID-1 + BL-23. • Herbal medicine: 1) Bu Yang Huan Wu, six capsules twice daily, and 2) Double P #2, six capsules twice daily. • Instructing the owner in Tui-na so that he would use Ca-fa (rubbing) on the paws of both hind limbs for 15 minutes per paw, twice daily. On the return visit one week later, this dog walked and ran like a puppy. The owner even feared he would lose his pet the day before the re-check because the dog was feeling so good she tried to attack an 8’ alligator!

CONCLUSION Pain management and life quality are important aspects of long-term geriatric patient care in veterinary medicine. TCVM offers many benefits to geriatric patients and their owners. As seen in the case examples with this article, acupuncture releases endogenous opioid-like substances from the central nervous system to aid in pain relief, thus improving quality of life.5

H. Xie, C Ortiz. “What acupuncture can and cannot treat”. J Am Anim Hosp Assoc., 2006 Jul-Aug; 42(4):244-8. Xu L, Lao LX, Ge A, Yu S, Li J, Mansky PJ. “Chinese herbal medicine for cancer pain”. Integr Cancer Ther., 2007 Sep; 6(3):208-34. 3 H Xie. “Geriatric Medicine: An Integrated Medical Approach”. Proceedings of CVC-Central, Kansas City, August 26 to 29, 2006, page 36-39. 4 Xie H, Preast V. Xie’s Veterinary Acupuncture. Iowa Ames: Blackwell Publishing, 2007. 5 Cantwell SL. “Traditional Chinese veterinary medicine: the mechanism and management of acupuncture for chronic pain”. Top Companion Anim Med., 2010 Feb; 25(1):53-5.

IVC Fall 2014

Product Profile

Managing feline

STOMATITIS By Naomi Kirby, DVM, MS

ingivitis (inflammation of the gums) or stomatitis (inflammation of the oral mucous membranes) is commonly referred to as feline gingivostomatitis or lymphocytic plasmacytic gingivitis stomatitis (LPGS). Severe inflammation is seen at the tooth and gum line junction, and can even affect the throat and tongue of an afflicted cat. This disease can affect cats of any age, and certain breeds are predisposed to it (Siamese, Abyssinian, Persian, Himalayan, Burmese and Somali). Feline stomatitis is most likely of multifactorial etiology, although the primary thought it is an inflammatory condition, a hypersensitivity reaction to the presence of plaque and bacteria, referred to as “plaque intolerance”. It is also speculated that certain viral or bacterial infections such as calicivirus, herpesvirus and Bartonella henselae can play a role. In addition, it is estimated that 15% of cats that are immuno-suppressed due to viral infections, including feline leukemia virus (FeLV), feline immunodeficiency virus (FIV), or both, are diagnosed with feline stomatitis. Stomatitis can cause severe pain, and symptoms include hypersalivation, difficulty eating, weight loss, halitosis, and in severe cases, bleeding of the gums. Behavioral changes include depression, aggression, irritability, decreased grooming, and pawing at the face or mouth. The inflammation that accompanies feline stomatitis is usually treated with oral or injectable steroids; antibiotics are added to treat bacterial overgrowth. Extreme surgical intervention can include the extraction of all “cheek teeth”, sometimes even involving the canines and incisors. Along with surgery, many animals still require regular doses of anti-inflammatory

medication and potent immuno-suppressive drug therapy (cyclosporine) to keep the disease at bay. Early identification, management and being proactive with daily dental home care are extremely important in keeping this disease under control. Feline stomatitis can be managed with Oratene Veterinarian Antiseptic Oral Gel, a “brushless” dental hygiene product for both dogs and cats of any age. It contains natural antibacterial enzymes that inhibit harmful odor-causing bacteria and help remove plaque biofilm. Its gentle formulation relieves, soothes, and protects mouth tissues against dryness, irritation, inflammation and redness. The patented LP3 Enzyme System present in this formula is shown to be antibacterial, antifungal, and antiviral, and aids in the management of stomatitis, gingivitis, and periodontal disease. One component of Oratene Veterinarian Antiseptic Oral Gel is lactoferrin, an iron-binding protein with immunomodulation capabilities that can help reduce the excessive response of the immune system associated with inflammation of the mouth. This product doesn’t contain alcohol, antibiotics, xylitol or chlorhexidine. Utilizing the Oratene Veterinarian Antiseptic Oral Gel on a daily basis may help control the inflammation and pain associated with feline stomatitis and may help prevent the need for early surgical tooth extraction. Dr. Naomi Kirby is the Technical Services Manager at PKB Animal Health (pkbanimalhealth.com). She can be reached at nkirby@petkingbrands.com.

IVC Fall 2014

GINKGO

Herb USE IN

SPORTING HORSES By Kim Chase

Sporting horses used in 800 BC were fed supplements to increase endurance and through the centuries, war horses and medieval steeds were given “remedies” to boost strength and stamina (Higgins 2009). Rules prohibiting the use of “exciting substances” appeared in England by 1666 (Higgins 2009).

PHYSICAL EFFECTS OF TRAINING Many modern competitive horses never completely adjust to the pressures of competition and remain in a state of chronic stress (CS) throughout the show season. The subtle signs are often overlooked or misinterpreted as behavioral issues (King 2006). The resulting cortisol increase causes: q Lowered athletic performance. w Gastric ulcers. (a) 58% of horses that had been transported to at least one event in the 30 days prior to endoscopy (McClure, Glickman and Glickman 1999). (b) 93% of endurance horses had squamous gastric ulcers (Tamzali et al 2011). e Increased susceptibility to infections and slow recovery from illness and injury (King 2006).

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RESEARCH IN HERBS Evidence is accumulating for the benefits that can be gained by inclusion of medicinal herbs in managing equine health. Ergogenic effects of equine herbal products include boosting the immune system, improving antioxidant status, increasing coping abilities and concentration (Bergero 2006). Herbs showed benefit in several equine disorders, including recurrent obstructive pulmonary disease, allergic dermatitis and joint inflammation, in addition to modulating immune responses in healthy horses (Pearson 2008).

HERBAL PROPERTIES WITH RELEVANCE FOR PERFORMANCE HORSES Herbal supplements that affect the immune system can be classified as adaptogens (increase resistance to stressors), immunostimulants (activate the nonspecific, or innate, defense mechanisms), or both. A common problem for performance horses is “sport horse anemia”. This reduces oxygen delivery to the muscle cells during effort, thus decreasing the anaerobic threshold with the ultimate result being loss of performance. Ginkgo (Ginkgo

biloba) is used in this case with good result (Bergero 2006). A number of herbs demonstrate antiinflammatory and pain relieving activity.

Ginseng (Panax ginseng) exerts an inhibitory effect on pro-inflammatory cytokines and COX-2 expression (Williams and Lamprecht 2007). The main components include glycosidal saponins.

Equine studies have also tested the antiinflammatory effects of a single dose of ginger (Zingiber ofﬁcinale) suggesting that post-exercise cardiovascular recovery time is reduced (Nettie 2004). Since ginger is also an antiulcerongenic, many ulcer-relief herbal supplements for horses contain ginger as a major ingredient.

Yucca (Yucca schidigera) contains steroid-like saponins that produce anti-inflammatory, antioxidant and anti-spasmodic effects to reduce pain associated with arthritis (Cheeke et al 2006).

Devil’s claw (Harpagophytum procumbens) is often called “herbal bute” (James Hart) and is primarily sold for its pain reducing properties (Williams and Lamprecht 2007). One equine study in horses with naturally occurring osteoarthritis looked at the effect(s) of a proprietary polyherbal composite joint supplement containing devil’s claw. An anti-inflammatory effect was observed in the horses due to a reduction in prostaglandin e2 synovial ﬂuid content (Pearson 2008).

White willow, meadowsweet and capsaicin also have anti-inflammatory and/or analgesic properties (King 2006).

GINSENG

Adaptogenic studies on exercise capacity in many species have produced conflicting results. Some studies showed a positive effect on exercise capacity, while others showed no effect King (2006). An effect is most likely in unfit subjects and is IVC Fall 2014

most consistently seen as an increase in endurance. Most studies in “fit” human athletes show no effect on performance. So far, practical use in performance horses supports a similar conclusion: that adaptogenic herbs should not be considered performance enhancing substances, but rather substances which simply support optimal health and function.

DRAWBACKS IN THE USE OF HERBS IN HORSES Most herbs have not been clinically tested, especially in the horse. Adulteration is a common cause for toxic or adverse reaction to herbs. Adulteration includes substitution of herbs and intentional or unintentional contamination with active components, drugs, pollutants or pathogens (Fors 2009 cited in Mills and Bone 2005).

CONCERNS WITH HERBS IN COMPETITION Herbal products contain ingredients able to affect body systems and thus can, by definition, be prohibited substances in competitions. An excerpt from one research study illustrates how drugs and herbs in equine competition are sometimes perceived as one and the same: “The future of equine drug metabolism in the area of doping research will be influenced by several factors including the increasing threat of ‘designer’ and herbal-based products” (Scarth, Teale and Kuurane 2010). At the 2008 Beijing Olympics several riders were disqualified from competition for testing positive for capsaicin (Capsicum frutescens). Capsaicin is banned by the Federation Equestre Internationale (FEI) as it stimulates P substance and has painrelieving properties. The theory is that after the initial burning sensation, which is associated with heightened sensitivity, follows a period of reduced sensitivity. If rubbed onto a horse’s shins just before competing, a rider can time the period of heightened sensitivity associated with the burning to encourage the horse to pick up his legs over the jumps to avoid hurting himself, thereby potentially improving performance (Birch 2011). However, capsaicin does not appear on the FEI Medication Class A list of banned substances with other herbs such as valerian, so confusion does exist. Part of this may be that only recently has a test been developed to detect it (Farrington). One competitor’s CAPSAICIN positive came from capsaicin in an anti-chewing product he had put on his horse’s bandages and stall (Hart nd).

RULES OF EQUESTRIAN SPORT AFFECTING HERBAL USAGE FEI (the world governing body for equestrian sports) distinguishes between medication (i.e. veterinary treatment provided to safeguard the animal’s health and welfare) and doping (i.e. the deliberate intent to affect the performance of a horse or to mask an underlying health problem). There are presently three classes of offence: Doping, Medication Class A and Medication Class B. Medication Class A (therapeutic agents that could influence performance, e.g. relieving pain, sedating, stimulating or producing/modifying physiological or behavioral effects) is the category for most herbs (Higgins 2009). United States Equestrian Federation (USEF 2010) rules are subject to the Therapeutic Substance Provisions. It states in part: “Trainers, owners, exhibitors are cautioned against the use of medicinal preparations, tonics, pastes, powders, and products of any kind, including those used topically, the ingredients and quantitative analysis of which are not specifically known, as they might contain a forbidden substance. This is especially true of those containing plant ingredients. The plant origin of any ingredient does not preclude its containing a pharmacologically potent and readily detectable forbidden substance.” A further caution (USEF 2010) states: “Persons administering a so-called herbal or natural product to a horse or pony to affect its performance, having been comforted by claims that the plant origin of its ingredients cause it to be permitted by the rules as well as undetectable by drug tests, might have been misled. Trainers should be most skeptical about any claims by manufacturers or others that their preparation is ‘legal’ or permissible for use at competitions. It is the longstanding policy of USEF that it does not approve, endorse or sanction herbal, natural or medicinal products of any kind.” Forbidden herbal substances listed in the USEF’s Drugs and Medications Guidelines handbook include: belladonna, camphor, capsaicin, chamomile, comfrey, devil’s claw, hops, kava kava, lavender, lemon balm, leopard’s bane, night shade, passion flower, rauwolfia, red poppy, skullcap, valerian and vervain. The United Kingdom (UK) Rules of Racing (2010) state that medications, including herbal products, may be used during training but that they must be withdrawn so that their ingredients are not present on race days, and must not be administered on race days.

DETECTION The objective of analytical screening is to detect any trace of drug exposure (parent drug or metabolites) using the most

IVC Fall 2014

powerful analytical methods, generally chromatographic/ mass spectrometric techniques (Toutain 2010). Problems are now arising because the high level of sensitivity in current screening methods allows the detection of totally irrelevant plasma or urine concentrations of legitimate drugs for long periods after their administration. Therefore new approaches for legitimate compounds based upon pharmacokinetic/pharmacodynamic (PK/ PD) principles are being developed (Scarth, Teale and Kuuranne 2010). The detection time (DT) is the approximate period of time for which a drug (or its metabolite) remains in a horseâ&#x20AC;&#x2122;s system such that it can be detected by laboratory analysis. The withdrawal time (WT) for a drug must be decided upon by the treating veterinarian and is likely to be based on the DT plus a safety margin, chosen with professional judgment and discretion to allow for individual differences between horses such as size, metabolism, degree of fitness, etc. FEI (2010) states that veterinarians have to advise owners or trainers on appropriate WTs to guarantee that their horses may safely compete after drug administration. DTs typically range between three and ten days. There is no mention of WTs for herbs or herbal extracts.

A pilot study in the UK of tail-hair analysis suggests that this method could be used as a diagnostic tool in the investigation of drug abuse. Hair analysis is complementary to urine/blood testing and is noninvasive, impersonal and can facilitate retesting. The data presented suggest that hair analysis may become a usable technique for the retrospective detection of drug administration in horses (Dunnett and Lees 2004).

INCONSISTENCIES IN BANNED SUBSTANCES There are many discrepancies between the lists of the various equestrian organizations. The USEF banned substance list contains herbs by their common names and is more extensive than either those of FEI or the Jockey Club UK. In contrast, FEI does not list the herb by name, rather it identifies prohibited substances according to their active constituents and the physiological systems upon which they act. Lobeline, an alkaloid of the Lobelia plant found in Indian tobacco (Lobelia inflata), cardinal flower (Lobelia cardinalis) and star of Bethlehem (Hippobroma longiflora), is listed as a respiratory stimulant. Valerenic acid, a sesquiterpenoid constituent of the valerian plant is listed as a tranquilizer. FEI states that it reserves the right to alter the list at any time without prior notice, and USEF makes clear that its current list of banned substances is

IVC Fall 2014

ECHINACEA

only partial, perhaps in a concerted effort to stay ahead of potential abusers. Equistro (2009) reported that one of the authorized FEI analytical laboratories announced that it had the possibility to test for “harpagosides”, the presumed active ingredient found in devil’s claw. This may be true, but the process whereby an herb officially becomes an illegal substance is vague and as a result keeps all competitors guessing. It has been suggested that devil’s claw and chamomile are likely to be the next herbs added to FEI’s prohibited list. Consistent regulations regarding herbs may be far off, since the governing bodies for equestrian sports have not come to an agreement on even which drugs should be permitted in competition. Phenylbutazone, along with Regumate, Gastroguard and antibiotics are now allowed in FEI competitions, yet continue to be banned by the German Equestrian Federation. These medications are now included on the FEI Progressive List as they are no longer considered performance enhancing. Following this logic, it stands to reason that adaptogenic herbs, having been found not to be performance enhancing substances in fit subjects, should also be permitted.

HERB/DRUG INTERACTION The most common medications used in on-track horses are furosemide, anti-inflammatories and bronchodilators.

Interactions have been reported. A number of herbs have been associated with adverse reactions with bronchodilators including St John’s wort (Hypericum perforatum), ginkgo (Ginkgo biloba) and cardospermum (Cardospermum halicacabum). (Pearson 2008). Studies in many species have indicated drug interactions with Echinacea (Robinson 2006); ginseng (species); any herbs containing salicin such as white willow (Salix alba) or meadowsweet (Filipendula ulmaria); ginkgo, garlic, ginger, bilberry, dong quai, feverfew, turmeric, chamomile, motherwort, horse chestnut, fenugreek and red clover (Abebe 2002).

SUMMARY Herbs have been used for centuries to enhance the performance of many sporting horses. Herbal medicine will continue to be used alone or as an adjunct to drug therapy for the sport horse. Under the current rules of the numerous official national and international equestrian committees, the use of herbs and herbal extracts in competition remains an under-researched and controversial topic. Greater understanding and knowledge of herbal medicine within the equine industry will hopefully dispel some concerns and lead to more appropriate use to help improve equine health and wellbeing.

References Abebe W (2002). Herbal medication: potential for adverse interactions with analgesic drugs. J Clin Pharm Ther, 27, 6:391- 401.

King C (2006). Stress, Performance, and Adaptogenic Herbs. The Healthy Horse, Horses Inc.

Authie EC, Garcia P, Popot MA, Toutain PL and Doucet M (2010). Effect of an endurance-like exercise on the disposition and detection time of phenylbutazone ad dexamethasone in the horse: application to medication control. Equine Vet Journal, 42, 3:240-7.

inflammation following intense exercise in horses. Graduate Program in Animal Science, Thesis, OCLC no. 61657929, Rutgers University, New Brunswick, NJ.

Bell RJ, Mogg TD and Kingston JK (2007). Equine gastric ulcer syndrome in adult horses: a review. NZ Veterinary Journal, 55, 1:1-12. Bergero D and Valle E (2006). A critical analysis on the use of herbs and herbal extracts in feeding sport horses. Pferdeheilkunde, 22, 4:550-7. Birch H (2011). Chemistry in its element- capsaicin. Royal Society of Chemistry, viewed June 30 2011. http:// www.rsc.org/ chemistryworld/podcast/CIIEcompounds/ transcripts/Capsaicin.asp British Horseracing Authority BHA, viewed June 26 2011. http://www. britishhorseracing.com/ Dunnett M (2009). Withdrawal times-the move towards standardization across Europe. Trainer Magazine, 26 August, viewed 28 June 2011. http://www. trainermagazine.com/europe/news/198 Dunnett M and Lees P (2004). Hair analysis as a novel investigative tool for the detection of historical drug use/ misuse in the horse: a pilot study. Equine Vet Journal, 36, 2:113-7. Equistro, Equistro, viewed June 25 2011. http://www.equistro.com/Prodsname/ Products.asp

Liburt N (nd). Effects of ginger and cranberry extracts on markers of

McClure SR, Glickman LT and Glickman NW (1999). Prevalence of gastric ulcers in show horses. J Am Vet Med Assoc, 215, 8:1130-3. Panossian A and Wikman G (2009). Evidence-based efficacy of adaptogens in fatigue, and molecular mechanisms related to their stress-protective activity. Current Clinical Pharmacology, 4, 3:198-219. Pearson W (2009). Concurrent use of veterinary drugs and herbal medicines in racing Standardbreds. Canadian Veterinary Journal, 50, 1283-5. Robinson (nd). Evidence-based Herbal Medicine & Drug-Herb Interaction. Manuscript, Colorado State University, Colorado. Scarth P, Teale P and Kuuranne T (2010). Drug metabolism in the horse: a review. Drug Testing and Analysis: Special Issue; Advances in equine sports testing, 3, 19-53. Tamzali Y, Marguet C, Priymenko N and Lyazrhi F (2011). Prevalence of gastric ulcer syndrome in high-level endurance horses. Equine Vet Journal, 43, 2:141-4.

Federation Equestre Internationale FEI, viewed June 28 2011. http://www. horsesport.org/

Toutain PL (2010). Veterinary medicines and competition animals: the question of medication versus doping control. Handbook Exp Pharmacol, 199, 315-39.

Fors M (2009). Herbs for horses. Litteraturstudie, Swedish University of Agriculture Science, Department of Animal Nutrition and Management, SLU, Uppsala.

United States Equestrian Federation USEF, viewed June 27 2011. http://www.usef.org/

Higgins A (2009). Doping and the Competition Horse: Current and Historical Perspectives, European Veterinary Conference, Voorjaarsdagen, 2009. James Hart equiceuticals (nd). James Hart, New Zealand, viewed June 29 2011. http:// jameshartequine.com/ index.html

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Williams C and Lamprecht E (2007). Some commonly fed herbs and other functional food in equine nutrition: a review. The Veterinary Journal, 178, 21-31.

ADVERTORIAL

CURCUMIN Anti-inflammatory and Antioxidant

By Tom Schell, DVM, DABVP, CVCH

hronic inflammation is a major contributor to many conditions impacting the health of horses and pets. The process is multifactorial, but often leads to ongoing health problems, continued deterioration, joint dysfunction, soft tissue injuries, allergies and a failure to heal. In today’s veterinary world, we often have little to offer patients with chronic health conditions and injuries such as joint issues, back discomfort and tendon injuries. Many veterinarians resort to the long-term administration of medications that often only partially control the problem.

of curcumin and other synergistic herbs in these formulas, research indicates we can down-regulate several pathways, returning them to a more normal level and most often without side effects. Curcumin exerts its anti-inflammatory properties by down-regulating the transcription factor NF-B, which results in a lowering of several inflammatory cytokines, including COX enzymes, interleukins, prostaglandin PGE-2 and several MMPs. Curcumin reduces the cytokines down to a more basal or normal level; this yields clinical results for the patient, but due to the lack of total inhibition, side effects are uncommon.

Inflammation is a part of life, but is accelerated by stress, training, competition, poor diet and genetic influences. If the process is over-expressed, it results in heightened levels of proinflammatory proteins that impact cellular function on many levels. Joints, soft tissue structures, and even neurological function can be negatively impacted, resulting in degeneration and dysfunction. By addressing the inflammatory response and returning it to a more normal level, cellular function can be restored, resulting in improved comfort, tissue regeneration, enhanced overall performance and better quality of life.

Cur-OST® formulas are researched and developed by Tom Schell, DVM, and have had over eight years of clinical usage assisting patients with chronic health conditions and injuries. These formulas utilize potent levels of patented BCM-95® curcumin, which has been shown to have superior absorption and bioavailability. Through the synergistic combination of BCM-95® curcumin with Boswellia serrata and other antiinflammatory herbs, results are often quickly achieved, resulting in improved quality of life, overall health and recovery for the patient.

Curcumin is a heavily-researched herb known for its anti-inflammatory and antioxidant properties. It impacts inflammation by down-regulating specific transcription factors, resulting in lower levels of several pro-inflammatory proteins and reducing damaging free radicals.

Health challenges in pets and horses come in many shapes and sizes, and are often a result of uncontrolled inflammation. Considering that inflammation is a fact of life and a contributor to health and tissue deterioration, it makes sense to control that process. With the management of a healthy inflammatory process, and support of overall cellular function, health can be restored.

The inflammatory process is complex, and today’s pharmaceuticals often only address one or two pathways, often with side effects over long-term use. The Cur-OST® line of curcumin-based formulas is designed to manage a healthy inflammatory response in pets and horses. Through the use

Dr. Tom Schell is head of research and product development for Nouvelle Research, Inc., manufacturers of the Cur-OST line of curcumin-based anti-inflammatory formulas for pets and horses. He has been researching inflammation and the use of herbs, including curcumin, for over eight years. Contact tschelldvm@gmail.com or curost.com IVC Fall 2014

Veterinary Resource Guide ASSISTIVE DEVICES Best Friend Mobility Myrtle Beach, SC USA Phone: (503) 575-9407 Email: sylvan@sylvancompany.com Website: www.bestfriendmobility.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

HandicappedPet.com Amherst, NH USA Phone: (603) 577-8858 Website: www.handicappedpets.com

ASSOCIATIONS

NATURAL PRODUCT

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

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 American Veterinary Chiropractic Association - AVCA Bluejacket, OK USA Phone: (918) 784-2231 Email: avcainfo@junct.com Website: www.animalchiropractic.org Association of Veterinary Acupunturists of Canada - AVAC Beaconsfield, QC Canada Phone: (514) 697-0295 Email: office@avac.ca Website: www.avac.ca

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

INTEGRATIVE THERAPIES Healfast Therapy North Caldwell, NJ USA Phone: (551) 200-5586 Email: support@healfasttherapy.com Website: www.healfasttherapy.com

IVC Fall 2014

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

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

College of Integrative Veterinary Therapies - CIVT Rozelle, NSW Australia Phone: (303) 800-5460 National Animal Supplement Council - NASC Website: www.civtedu.org Valley Center, CA USA Phone: (760) 751-3360 Website: www.nasc.cc

EQUINE NATUROPATH

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

MVP Laboratories Omaha, NE USA Phone: (402) 331-5106 Email: mvplabs@mvplabs.com Website: www.mvplabs.com SmartPak Plymouth, MA USA Phone: (774) 773-1125 Email: customercare@smartpak.com Website: www.smartpak.com The Honest Kitchen San Diego, CA USA Phone: (858) 483-5995 Email: info@thehonestkitchen.com Website: www.thehonestkitchen.com

THERMAL IMAGING ThermoScanIR Toronto, ON Canada Phone: (416) 258-5888 Email: info@ThermoScanIR.com Website: www.ThermoScanIR.com Equine IR Bonsall, CA USA Phone: (888) 762-2547 Email: info@equineIR.com Website: www.equineIR.com

tech talk

THE VET TECH’S

FRESH FOOD PROGRAM By Beth Taylor, LMT, CVMRT

fresh food program is one of the foundations of most integrative practices. However, clients walking in the door for the first time may have never considered alternatives to “pet food” in its processed grocery store form. Some may be highly informed, yet missing some key knowledge, while others may be completely ignorant about food. As veterinary technicians, one of our many tasks is to help clients learn to provide an appropriate diet for their pets. While this process may begin with the veterinarian, educated staff can provide ongoing and frequent support and monitoring. The attitudes people have towards food are some of the most basic and primitive in their repertoire, so we don’t want to scare them. We need to make sure we are not striking at their most closely held beliefs and prejudices – at least until we have showed them a better way that they can understand. Effective food education and management is a much-needed service that’s a great boost for any practice.

PRACTICE GOALS FOR NUTRITION When a practice is able to supply information about ideal diets for each animal, and provide support for clients making these changes, compliance and success with dietary programs will soar and pets will heal better. We can provide information that’s more accurate and less biased than other sources clients may be using. People look to their veterinary practice to be informed – and yours can be one of the few places that does an excellent job. The definition of “good nutrition” may vary in each practice and is usually set by the veterinarian. Many veterinarians are open to being educated by you, the technician. One goal of our practice is for patients to eat a “real food” diet, and one that’s appropriate for the animal’s body condition. This means the food is minimally processed, and raw or lightly cooked, depending on the animal. We want our clients to make their own food whenever possible. To achieve these goals, what is needed for implementation? Do you have a simple, complete, AAFCO and NRC compliant program to offer your clients? There are many “cookbooks” IVC Fall 2014

available, but most writers have not gone to the trouble of analyzing their results, or are not quite putting things together properly. Use a program that’s complete. Nutrition software can really help with this process, and back you up to make sure you have it right, but some programs are quite difficult to use. Steve Brown is perfecting his program (it should be available by mid-September) – it’s developed with the goal of helping veterinarians and support staff to formulate diets that meet nutrition needs (including ingredients for a raw diet). Playing with a nutrition program is also an excellent way to learn. What happens to the mineral content of your diet if you use higher-fat meats? What happens to the calorie count if you use sweet potatoes instead of broccoli? What happens if you add a cup of rice to one pound of a meat and veggie diet? Some clients are excited to see the steps while others merely want actual recipes they can follow. Dr Becker’s Real Food for Healthy Dogs and Cats was written with this goal in mind – people making food at home can be sure they are including all the components. Dr. Jean Hofve’s new book, Paleo Dog, is another excellent resource. If you give clients a simple and correct plan, it is much more likely they will do what you suggest. Some clients are unable to go all the way to a fresh food diet, and some animals require a slow transition. In these situations, you can greatly reduce stress for both clients and staff if you offer information about commercial food, so your clients will not have to rely on material from possibly uninformed sources.

STEPS FOR CLIENT PARTICIPATION 1 Write it down! A thorough and detailed journal of one week’s diet prior to the beginning of treatment is an essential component of a successful program. The journal will sometimes provide clues that wouldn’t be elicited even with the most careful questioning or detailed form. Whether it’s on index cards and scraps of paper or an Excel spreadsheet, this daily record is priceless.

Clients walking in the door for the first time may have never considered alternatives to “pet food” in its processed grocery store form.

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With this information in hand, we can evaluate the current status of the pet’s diet before meeting with the client. How many kcal is this animal consuming? What is the balance of the diet? What is the caloric percentage of protein, carbohydrate and fat? What caloric percentage of the diet is coming from treats? What exactly are those treats and how big are they? What kind of cup does the client use to measure food? Is the food fed wet or dry? Is the animal “free fed”? (If so, any estimate of the total food involved is suspect, so clients need to measure the amount they put in the bowl.) How much water is being consumed? All

supplements should also be included. Even the most obsessive clients discover things they didn’t tell you when they keep a journal. The journal also frequently gives us insight into the client’s level of understanding, which helps us know where to start. The journal also provides a real-life foundation on which to compare other foods and ideas, like the difference between an average 50% starch dry dog food and a frozen diet, or the fact that a grain-free diet is still 40% starch.

2 Meet the client: where to start? Prior to meeting the client, evaluate the results of the journal and make a plan that includes some choices. Be able to show the client how you arrived at your conclusions. These skills can be taught to interested clients, but you need to be able to communicate this information so that clients really get it, even if they can’t do the numbers themselves.

COMMERCIAL FOODS: CHOOSING AND ELIMINATING PRODUCTS

Simple is good. Five meat sources and four starches do not make for an easily controlled diet, no matter how good the ingredients. Even raw diets may be prone to this complication. Rotation through at least a few simple foods is optimal, whether it’s fresh local, frozen or dry food. In order to achieve real rotation, so that the next food does not have the same meats or carbohydrates, it may be necessary to go to a different brand. Since some foods are very prone to misleading front labeling, you need to develop excellent skills in sorting out what all those claims and buzzwords mean in order to effectively help clients. Being able to first interpret and then simplify the information takes time and experience, but there are excellent references and resources online and in books. For more information, consider the following books: See Spot Live Longer Unlocking the Canine Ancestral Diet Dr Becker’s Real Food for Healthy Dogs and Cats

Reading the food journal tells us what steps may be needed. Sort through the information and sit down with the client (have a phone consult if absolutely necessary, but in person is better). You may have an idea of the goal for this meeting, but this is the time to gently help the client understand rather than merely telling them what to do.

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Present the results of your evaluation and help the client understand them. This proactive step is, in my opinion, one of the best relationship builders you can implement. It establishes the understanding that: “In this practice, we really mean we are a team. Here is your first experience with us, helping you find the best way to move through the process of improving your food program for your animal. We decide together.”

3 Stock some food options When transitioning to raw food or any other different diet, clients need products for each step. Your team research will provide recommendations for what to carry at the clinic, what to recommend to clients, and where they can buy products. You can research the cost per animal, and find ways to help clients bridge the conceptual gap between thinking that pets should be cheap to feed, and understanding that good food costs money. Cost is an issue for most of our clients.

Set goals. The first might be as simple as eliminating three giant dog treats and picking up the food bowl. You both may decide to begin with introducing real food along with digestive enzymes and probiotics. Will these be done one at a time or all together? It has to make sense to the client, be within his or her capacity, and it has to be clear. Clients should go home with a written plan that will hold them until the next visit. Ask clients to check in weekly, even if it’s just to drop by for a weight check.

YOUR ROLE IS IMPORTANT!

It’s useful to have a separate folder for food and supplement tracking that you can use with the client. You and the client both contribute to this file. Notes and changes are a lot easier to see if they are not mixed with the medical notes in the main patient file. You will hear about everything, and you will probably see both cell phone poop pictures and pictures of food preparation, which it is all part of the learning process. Clients love this personal relationship and we hear a lot more about what’s happening with their animals.

This article is a short overview of a complex idea, and is not intended to give you a complete blueprint on how to develop this area of your practice. Indeed, each practice is so different that each plan will be unique.

The best way to be sure the products you recommend get into the hands of your clients is to sell them.

The veterinarians in your clinic will be involved at various points in this process, as decisions are made and new directions explored. Veterinary supervision, support and participation are critical, but for ongoing help with the animal and the learning process, support staff can provide a gigantic boost to the effectiveness of nutrition programs.

…ﬁnd ways to help clients bridge the conceptual gap between thinking that pets should be cheap to feed, and understanding that good food costs money.

A TEAM APPROACH One person in the practice is often the “expert” on topics related to diet, but everyone needs to develop some depth of understanding about food in general. Each staff person could be responsible for one topic, collecting information and staying current on new research and products to regularly share with the rest of the team.

IVC Fall 2014

LASER THERAPY FOR OSTEOARTHRITIS By Lisa A. Miller, DVM, CCRT

There are many conditions in geriatric patients for which laser therapy would be advantageous, but the most common one is certainly osteoarthritis. This condition often leads to a maladaptive pain scenario, and other physical issues due to compensation, all of which should be managed in order to achieve the best results for the patient. Effectively managing pain with a multimodal approach, including laser therapy along with pharmacologic and nutraceutical interventions when possible, is best implemented prior to, or alongside, physical modalities such as rehabilitation. Therapeutic laser works by the mechanism of photobiomodulation, and has several beneficial effects in decreasing inflammation and pain. The ability to safely utilize laser therapy alongside other standard-of-care treatment

options for geriatric pets makes it an ideal tool in managing pain. In some situations, laser may even reduce the need for certain medications. As always, a complete orthopedic and neurologic examination should be performed prior to laser therapy. All areas of pain and discomfort should be identified and continually reassessed so that effective management of the patientâ&#x20AC;&#x2122;s pain and physical issues may be addressed. The use of objective pain scoring is encouraged. Geriatric patients respond well to laser for osteoarthritis and should be positioned in such a way that they are comfortable during treatment, whether recumbent on a padded mat or soft bedding, or standing on a non-slip surface. Often, patients will relax or even sleep during treatment.

Dr. Miller is a graduate of the University of Tennessee, College of Veterinary Medicine, and was certified at the Canine Rehabilitation Institute.

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From the AVH

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

The AVH Foundation has full IRS approval! This past May, the Academy of Veterinary Homeopathy Foundation, incorporated in 2013, was officially recognized as a tax exempt 501c(3) nonprofit foundation by the United States Internal Revenue Service. The Foundation’s main purpose is to promote veterinary homeopathy through education, awareness and research. Donations to the Foundation are tax deductible and can be unrestricted or tasked to a specific purpose. We have recently begun updating our website at AVHF.org to better explain the goals of the Foundation and can accept donations directly, through PayPal or by check. We are excited to get started on our mission to further veterinary homeopathic education, awareness and research.

Annual case conference – “Practical Homeopathic Philosophy” The AVH will be sharing the AHVMA Conference venue at Red Lion Hotel on the River in Jantzen Beach, Portland, Oregon, from September 12 to 14; we are overlapping with the AHVMA meeting (September 13 to 16) to enable participants to attend both conferences. AHVMA and AVH members are offered a complimentary day pass to both conferences. If you are new to homeopathy, Dr. Shelley Epstein, past president of the AVH, will give an “Introduction to Veterinary

Homeopathy” lecture on Saturday, September 13, as part of the AHVMA Conference. Her focus will be on the range of conditions that can be cured with homeopathy. On Saturday evening, the AVH will host a wine and cheese reception accompanied by a lively and informative presentation for those new to veterinary homeopathy: “Helping More Patients: Top 10 Reasons to be a Homeopath”. We will share some great homeopathy cases and suggestions on how to use homeopathy in practice. The overall focus of the upcoming AVH Conference is how our knowledge of Samuel Hahnemann’s The Organon of the Medical Art has helped in the diagnosis, treatment and management of cases. This text is the foundation of the practice of classical homeopathy. First published in 1810, it details the observations drawn from Dr. Hahnemann’s medical discoveries of how a medicine able to produce disease signs in a healthy individual could heal these signs in a sick individual. The book serves as a timeless reference to the practice of homeopathy. We are excited about this fantastic opportunity to spend time with our fellow holistic veterinary friends, and have timed our breaks on Saturday and Sunday to coincide with AHVMA’s meeting breaks. Please remember to check out the vendor booths, including the AVH/PIVH (Pitcairn Institute of Veterinary Homeopathy) booth.

For more speaker details and a schedule, visit theavh.org/conference-2014-main. Stop by to say “hi” and check out our updated brochures and literature.

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MICRO BIOME RESTORATIVE THERAPY

HEALING THE IMMUNE SYSTEM By Margo Roman, DVM, CVA, COT, CPT

Science is increasingly recognizing the importance of the Micro Biome, which is endogenous to the gastrointestinal tracts of cats, dogs and other mammals. Research shows that flora in the GI tract play a profound role in the development and maturation of the immune system after birth. It is also widely asserted that approximately 80% to 85% of the immune system is located in the gut. This figure is not surprising, given the vast quantity of microorganisms in the body. A human body has over 100 trillion microbes, made up of over 500 species, which works out to about two to five pounds of microorganisms per person.1,2 There are more microbes than actual cells, since they are so much smaller than human cells. Yet when we administer probiotics to support gut health, we use only one to 20 species of microorganisms. This may be completely inadequate, considering that hundreds of species may need to be replaced. Since this diversity of flora is responsible for the health of the immune system, a lack of these normal symbiotic

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microbes could be the reason for a failing immune system, which results not only in GIT disease, but cancer, allergies and autoimmune issues as well as mental health problems. If probiotics have limited effect, how do we restore the Micro Biome? While our first reaction might be abhorrence, research all over the world indicates that Micro Biome Restorative Therapy (MBRT) – giving feces from a healthy animal or human to the same species – may be the most efficient way to reboot the gut flora. MBRT enables the immune system to use the body’s own innate mechanisms to utilize the newly introduced microbes to start a new symbiosis, which in turn can help with healing. MBRT can improve a range of gastrointestinal-related health issues in dogs and cats, including irritable bowel disease,

diarrhea, skin disorders, an aggressive disposition and more. MBRT can be administered orally or by enema, transplanting feces from a healthy donor into the immunecompromised animal.

RESEARCH SHOWS POSITIVE RESULTS Multiple peer reviewed articles have shown that both oral and rectal infusion of fecal material in humans has been able to create a balanced GI tract and stop a Clostridium difficile overgrowth.3,4 Early evidence points to MBRT as key to future treatments for gastrointestinal and immune system problems in mammals. At Main Street Animal Services of Hopkinton (MASH), over 350 MBRTs on dogs and cats have produced major health improvements and even cures. While the idea of using feces as a therapy may be foreign, consider that doctors have been therapeutically using other body fluids and parts like breast milk, blood, bone marrow and even organs, for years. Other cultures have used urine therapeutically for centuries. For dogs and cats, the contents of a prey animalâ&#x20AC;&#x2122;s intestinal tract are a part of their ancestral diet. In the wild, the intestines and organs of the prey are often the first parts eaten. They contain pre and probiotics from the digested plant material. Dogs also scavenge rotting meat, thereby obtaining even more microorganisms.

USING MBRT IN YOUR PRACTICE This protocol is very easy and can be integrated into conventional and holistic practices. The most important step is selecting a healthy fecal donor. This is critical. Preparation needs no special equipment. Administration is easy yet does need to be tailored to the needs of the animal, especially cats.

SELECTING THE DONOR

Fecal donors need to be healthy, pesticide and drug free, and match the following criteria: 1. Are minimally vaccinated with vaccines that do not contain mercury preservations and aluminum hydroxide. 2. Drink filtered well water with no chlorine or fluoride. 3. Have no use of oral or topical pesticides for fleas and ticks; minimal heartworm preventatives; no lawn chemicals or fertilizers used on the property. 4. Fed a raw meat diet from sources free of antibiotics, pureed organic vegetables and organic non-GMO grains (oats, millet, quinoa).

Continued on page 68. IVC Fall 2014

Continued from page 67. 5. Be physically active, spending extensive time outdoors. 6. Have never been on antibiotics, NSAIDS and other GIT suppressive medicine. 7. Are treated with herbs, nutraceuticals, TCVM, homeopathy or other natural modalities for any illnesses. 8. Have negative fecal parasite exams and normal immunoglobulin A, G and M levels per Plechner’s Endocrine Immune Evaluation.5 9. Have periodic fecal evaluations to provide information about the gut composition, looking for species of Clostridium dif and perfinges, and Camphlobactor. 10. Have their reproductive organs intact to help with the balance of natural immune system ebb and flow.

2 CASE STUDY 1 Olivia was a 12-year-old

golden retriever with recurrent lung cancer and a previous lung lobe removed. She was given three days to live and was hemorrhaging in the lungs. She received ozone, ultraviolet blood therapy, nutritional and herbal support, and MBRT several times, and enjoyed a good quality of life for nine more months.

2 Archie

is seven-year-old

wire fox terrier that from a puppy behaved aggressively and had a sensitive gastrointestinal tract. Conventional treatments failed and nutritional support and restrictions barely helped. He had an Immune Endocrine Imbalance (low gut IgG, IgA, IgM, thyroid, elevated estrogen and abnormal cortisol) per Plechner’s protocol. After the MBRT, he quickly became calm and loving to his sister, and he could eat all foods with no digestive issues. This positive behavior persisted until he was given his monthly Interceptor (Milbymcin Oxime and all monthly heart worm medications are antibiotics), when he attacked his sister so badly they both ended up in the veterinary hospital. He needed repeated MBRT every two to three weeks to maintain progress. In March, 2014 he had a MBRT from a pregnant donor and the benefits persisted until the end of June.

COLLECTION

The fecal sample for donation is simply collected on an observed walk or from the litter box right after defecation, placed in a plastic bag, then labeled and refrigerated. In the clinic, you can simply take a glove with some aloe as lubricant, insert a finger and take a sample. The freshest daily samples are used.

ADMINISTRATION TO THE PATIENT

The feces are given fresh, from a sample taken that day, or if desperate from frozen stock. • Push the dosage amount of feces into the back of the throat. • Make a “meatball” by wrapping some raw ground meat around the fecal material. • Give as an enema, especially for cats. The blender method is the best. a. Blender method: Using a small personal blender, add two tablespoons feces and about 60cc normal saline, just enough to create a slurry. Blend for as short a time as needed to prevent any extra heating. Strain into a cup and then dose as below in “e”. b. Cup method: Pierce the bottom of a plastic cup multiple times with an 18 gauge needle to create a sieve. Into a second cup, place about one tablespoon of feces and mix with 20cc of normal saline, stirring well until it is a slurry. Place the pierced cup into a third cup and pour the slurry through the sieve cup into the final cup. c. Before introducing this into the colon, ozone/ oxygen gas (dose dependent on weight and condition) is given as a rectal insufflation via a catheter (using

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natural lubricants like aloe gel since any antibacterials in the lubricant will nullify the procedure) to reduce the intestinal biofilm that exists in most intestines. d. Remove the catheter. Tuck the patient’s tail, holding it for about 15 minutes to prevent leakage of the ozone insufflation. The dog is taken out and the cat allowed access to a litter box to pass any stool. e. Pull up the dose of strained feces into a 35cc to 60cc syringe, leaving about 5cc to 10cc of air behind to help clear the feces from the catheter. f. Dosage of the slurry in small dogs and cats is 10cc to 20cc; for larger dogs, it’s 30cc to 50cc. g. Replace the naturally lubricated catheter and infuse the fecal slurry. h. Again, hold the tail down and massage the animal’s abdomen, trying to bring the stool into the descending colon, then up into the transverse colon. For small animals, you can raise the rear end and gently shake. i. Do not allow the dog to walk around outside your clinic – get him in the client’s car and try to keep him from defecating for four hours, and if possible, not until the next day. Most do not defecate.

FECAL TRANSPLANTS IN VETERINARY PRACTICE To increase the success of a fecal transfer, prime the gut flora with digestive enzymes, probiotics, whole food glandulars, green tripe and a raw meat diet for a least two weeks, if the patient’s condition allows. The animal should be off antibiotics for at least a week so as to not destroy the newly introduced Biome. Some patients can also be supported with additional antioxidants, organic spirulina, or prescription ultra fatty acids. This improves survival of the new microbes and promotes normal symbioses in the patient’s system. We found that MBRT accelerates positive outcomes in patients also receiving other treatments, such as chemotherapy, acupuncture, homeopathy, and chiropractic work. As we always do with any holistic approach, we tailor the treatment to the patient and his response. Some of our cases have needed only one dose for complete and sustained recovery. Others have a two-week improvement then seem to slightly relapse, so need repeat doses every few days to weeks. What we think is happening is that the replenishing is occurring, but the surface of the gut does not have the ability to bind to the intestinal wall because that wall is not strong. We may need a “Binder of Feces” to help hold on to the intestinal mucosa.

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Therefore, caretakers will take home the MBRT material, keeping it frozen and removing pieces to be given repeatedly. More study is needed from more veterinary clinics along with MASH to determine how much fecal matter should be transferred and over what period to optimally rebalance gut Micro Biome. Diseases/signs we have successfully treated in our practice include chronic diarrhea and vomiting; inflammatory bowel disease; severe ataxia with very elevated hepatic values; hypothyroid disease; severe aggression; anxiety; a variety of skin conditions; multiple types of cancer; Lyme, kidney issues and nausea; recurrent cystitis with chronic ear, skin and GIT issues; chronic Giardia duodenalis with emaciation, limping, vomiting and anorexia; atopic dermatitis; and demodex. Make MBRT client friendly. We are being a little silly about this serious procedure. We call it “fecal friends” and “no shit...yes shit”. We call the samples that come from donor dogs named Lilihana and Geneva, “Lili-poops” or “Geneva Peace Poops” respectively.

THE FUTURE OF MBRT Through research in fecal bacterio-therapy, we will someday identify the 500+ species and thousands of subspecies of microbes present in the entire digestive tract. Someday there will be catalogues of bacteria/microbes that you can purchase to fill the gaps in an individual’s GI tract. We will also someday understand the symbiotic relationships of different species. We will appreciate that certain species of microbe stimulate the immune system with specific functions. For example, could a specific immune system function need support from a microbe whose interaction prevents cancer or strengthens the body against Lyme disease? A first step could be to start a fecal donor directory that can match up healthy dogs and cats with animals in need of re-establishing a reboot of their own Micro Biome.

Power SE, O’Toole PW, Stanton C, et al. “Intestinal microbiota, diet and health”. British Journal of Nutrition, 2014; 111(03): 387-402. 1

Fujimura KE, Slusher NA, Cabana MD, et al. “Role of the gut microbiota in defining human health”. Expert Rev Anti Infect Ther, 2011; 8(4):435-454. 2

van Nood E, Vrieze A, Nieuwdorp M, et al. “Duodenal Infusion of Donor Feces for Recurrent Clostridium difficile.” N Engl J Med, 2013; 368:407-415. 3

Forsythe P, Chew MV, Escaravage E, et al. “Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve”. PNAS, 2011; 108(4):16050-16055. 4

Plechner, Al. “Plechner’s Syndrome or Atypical Cortisol Estrogen Imbalance Syndrome (ACEIS)”. drplechner.com/learn/ plechner-syndrome, Accessed 25 May 2014. 5

SUPPLEMENTAL SUPPORT

for seniors

By Carmen Colitz, PhD, DVM, DACVO

ging is not a disease! Yet it comes along with less than perfect immunity, reduced nutrient absorption, and the cumulative effects of a lifetime’s exposure to oxidative stressors. Combined, these increase the risk of agerelated diseases in dogs and cats, including diabetes mellitus, thyroid disorders, obesity, arthritis, cancer, cognitive dysfunction, and Cushing’s disease in dogs. With aging, nutrients in food are not ideally absorbed, so adding a safe quantity of necessary vitamins and minerals is essential to health. These include beta-carotene, vitamins C, D, E and the Bs, iron, iodine, magnesium, zinc, selenium, and a balanced ratio of calcium and phosphorus, among others. Certain antioxidants and plant extracts also benefit the aging brain and body: • Huperzine, or selagine: protects mitochondria and has neuroprotective effects, improving alertness and energy. •S -adenosyl-L-methionine (SAM-e): a co-substrate used in the production of nucleic acids, proteins, and lipids; has anti-inflammatory effects and supports the formation of joint cartilage. •A lpha lipoic acid: a potent antioxidant found in spinach, broccoli and liver. Restores vitamins C and E to their functional states. Used for diabetic neuropathies, hepatic and heart disease, and is a heavy metal chelator. Aging cannot be avoided, but complementing your patients’ diets with vitamins, minerals and natural plant extracts will help them fight the ever-present free radical damage occurring in their bodies, and allow them to lead longer, healthier lives.

Dr. Carmen Colitz is a board certified veterinary ophthalmologist with a PhD in Comparative and Experimental Medicine. IVC Fall 2014

marketplace

IVC Fall 2014

events 2014 AAFP Conference September 18-21, 2014 – Indianapolis, IN This conference will focus on Gastroenterology and Endocrinology 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.

To post your event, email us at: info@IVCJournal.com For more information: 615) 254-7047 abvp@xmi-amc.com www.abvp.com

Large & Small Animal Acupressure Level 1 November 2-8, 2014 – Longmont, CO

For more information: (800) 874-0498 info@catvets.com www.catvets.com/education/conference

This event is open to Veterinary Professionals ONLY. (NCBTMB, RAIVE and CACVT CE candidate information see our course catalog) This program consists of 7 modules to be completed on site.

2014 Veterinary Cancer Society Annual Conference

The 7 Modules of the Level 1 program encompass the following topics:

October 9-11, 2014 – St. Louis, MO

Emergency & Critical Care 10th Annual Conference 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. 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.

• Traditional Chinese Medicine Concepts and Origins (TCM) • Landmark Anatomy of Equine and Canine - Partial self-study required prior to class. Register at least 2 weeks prior to give yourself time to complete the work. • Acupressure Points, Pressure and Manipulation Techniques • Energy Meridian Pathways, Theory and Application Introduction • Yin and Yang Theory • Shiatsu • The Study of Chi • Introduction to Eight Guiding Principles • Introduction to Five Phases of Transformation • Introduction to Five Element Theory • Important AcuPoint Groups • Signs, Signals and Evaluation • Written Exam and Live Practical • Take Home Case Studies Students will receive their Practitioner Certification once they have sufficiently completed all post class work including electives. 32 hours of electives are required. These may be taken at RMSAAM or another school and credit may be given for previously taken courses. Examples: Massage, Essential Oils, Aromatherapy, Reiki, Animal Communication, Flower Therapy, Nutrition, T-Touch, HTA, etc.

For more information: (508) 887-4723 vetceinfo@tufts.edu www.tufts.edu/vet/ce

October 30, 2014 – November 2, 2014 – Nashville, TN

This class takes place at an equine facility. Work will take place on horses and dogs.

For more information: aaepoffice@aaep.org www.aaep.org

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.

For more information: Ginger Currie (303) 660-9390 info@rmsaam.com www.rmsaam.com

The primary focus of the meeting will be a program highlighting advances in clinical oncology. The keynote speakers have diverse interests and focus on translational medicine with applications of their research into clinical practice. For more information: Sandi Strother (573) 823-8497 vetcancersociety@yahoo.com www.vetcancersociety.org

American College of Veterinary Surgeons Symposium October 16-18, 2014 – San Diego, CA 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

2014 Annual ABVP Symposium

For more events, visit: Facebook.com/IVCJournal/events

Hawaii Veterinary Medical Association Convention November 6-9, 2014 –Oahu, 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: (808) 733-8828 hvma1309@hawaii.rr.com www.hawaiivetmed.org

60th Annual AAEP Convention December 6-10, 2014 – Salt Lake City, UT At this conference you will find over 100 CE credits to choose from. With over 4,000 veterinarians gathered and nearly 400 exhibitors, this will be one of the most comprehensive CE experiences you want to attend. You will be able to network with professional colleagues and have the chance to raise your expertise across the entire spectrum of equine medicine.

IVC Fall 2014

From theVBMA 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?

The herb photo in our Summer issue showed the unripe fruit of the the Noni tree, Morinda citrifolia. During the VBMA’s eco-tour in Kauai, Hawaii, we spent a day with Steve “the Noni Guy” to learn about this incredible “canoe plant”. This indispensable plant was brought to Hawaii via canoe during the initial migration of humans from the Polynesian Islands. The fruit has analgesic, antiascariasis, antibacterial, anodyne, cathartic, diuretic, emmenagogue, hypotensive, laxative, purgative, sedative, and tonic effects. From a TCM perspective, it tonifies Lung and Kidney Qi and Yin; clears Dampness from the Middle Burner; calms Liver Wind rising; and clears Heat and toxins. The Noni fruit has many impressive uses. It can treat pain, including joint pain from Lyme disease, or rheumatoid pain leading to arthritis, and pain from inﬂammation caused by gingivitis, mouth ulcers, conjunctivitis, and headaches. While nourishing Lung and Kidney Qi, it can treat respiratory difficulties, asthma and coughs. While clearing heat from the Middle Burner, it helps stabilize blood sugar, assisting in the treatment of diabetes, and improving appetite, dysentery, and bloody diarrhea. With its Kidney Qi and Yin tonification abilities, Noni is a general energy/metabolic tonic. One of Steve’s observations was that people, dogs, cats and horses who ate Noni had a lack of ﬂea and tick problems. There is no toxicity associated with this fruit. Noni can also be used topically and is very effective against rain rot.

Report on activities In May, we held our three-day domestic eco-tour with masters Cheryl Schwartz, DVM, and Matthew Wood, RH (AHG), at the Haverkos Family Farm in Indiana. It was a remarkable herbal event that featured an interplay of Cheryl’s Traditional Chinese knowledge on herbal energetics, with Matt’s wealth of knowledge on the traditional physio-medical and eclectic uses of scores of herbs.

Coming up at the AHVMA conference in Portland, Oregon: • We start with an Herb Walk on Friday, September 12, led by world-renowned herbalist Kevin Spelman. • On Saturday, we are honored to have Jeffrey Yuen speaking on essential oils. • Join our annual membership meeting during lunch on the Saturday. • On Sunday, Kevin Spelman is again our speaker. Sign up for these AHVMA conference events on the VBMA website.

NAME THIS HERB!

Since our eco-tour, many have been using Noni with good clinical success. Join the VBMA and share in discussions on our list-serve about this interesting fruit and its applications.

Case study Sundance is a 30-year-old gelding, a Connemara cross pinto that had rain rot on all four distal extremities during a very wet spell in October of 2013. After three daily topical applications of Noni, his eruptions resolved.

IVC Fall 2014

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

IVC Fall 2014