V5I1 (Winter 2014-15) by Redstone Media Group

Integrative VETERINARY CARE

ACUPUNCTURE: HOW IT HELPS MANAGE PAIN IN

CANCER PATIENTS

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www.IVCJournal.com

WINTER ISSUE 2014/2015

NATUROPATHIC ONCOLOGY

OSTEOPATHY FOR DISPLACED OVARIES

HYPERBARIC OXYGEN THERAPY

INTEGRATIVE THERAPY FOR BRAIN TUMORS

DIET AND CANINE AGGRESSION

WHAT’ S NEW

Why integrative veterinarians are perfectly positioned to diagnose, treat and help prevent cancer.

Learn how it decreases inflammation, helps with healing, mobilizes stem cells and more.

Studies suggest high-fat beef-based diets lack tryptophan and can lead to aggressive behaviors.

Osteopathic diagnosis and ovary palpation during exams can help make “grumpy” mares more comfortable.

Why innovative new therapies are showing promise.

• New research quantiﬁes health beneﬁts of human/animal bond • Top 5 health issues in small dogs • Research into equine tendon injuries looks at proteins

IVC Winter 2014/2015

contents FEATURES

INTEGRATIVE THERAPY FOR BRAIN TUMORS

Current treatment strategies for central nervous system neoplasias in dogs and cats are often met with poor outcomes, but innovative new therapies are showing promise.

NATUROPATHIC ONCOLOGY

Integrative veterinarians are well placed to diagnose, treat and help prevent cancer using both conventional approaches and natural therapies.

HYPERBARIC MEDICINE IN YOUR PRACTICE

It decreases inﬂammation, enhances cell and tissue function, helps heal slow or non-healing wounds, and proliferates and mobilizes the body’s own stem cells.

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ACUPUNCTURE CAN MANAGE PAIN IN CANCER PATIENTS

This modality effectively alleviates discomfort and improves quality of life, and may even decrease the side effects associated with conventional treatments.

Nutrition Nook HIGH-FAT BEEF-BASED RAW DIETS AND CANINE AGGRESSION

Studies suggest these diets lack tryptophan, a precursor to serotonin, and may therefore lead to aggressive behaviors.

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IVC Winter 2014/2015

NORMAL AND ABNORMAL EQUINE POSTURE

OSTEOPATHY FOR DISPLACED OVARIES IN“GRUMPY”MARES

How Postural Rehabilitation Intervention can optimize the functioning of a horse’s neuro-musculoskeletal system.

Careful osteopathic diagnosis and ovary palpation during colic and reproductive exams can help these horses live a more comfortable life.

HOMEOPATHY FOR CANCER

This gentle treatment approach not only abates or resolves cancerous conditions, but also restores overall well-being, without unpleasant side effects.

Tech Talk HOW ALTERNATIVE MODALITIES CAN BENEFIT YOUR CLINIC

Meeting the growing demand for acupressure and other alternative services is something vet techs can help address and implement.

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.

40 Industry innovations 42 Veterinary resource guide 55 From the WAEO 60 NAVC highlights

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.

62 From the AVH 63 From the AHVMA 64 From the VBMA 65 Marketplace 66 Events

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.

IVC Winter 2014/2015

Integrative VETERINARY CARE

WINTER 2014/2015

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

Steve Brown Carmen M.H. Colitz, DVM, PhD, DACVO Todd Cooney, DVM, CVH Barbara Fougere, BSc, BVMS (Hons), BHSc (Comp Med), MODT, MHSc (Herb Med), CVA, CVCP, CVBM Karen Gellman, DVM, PhD Jill Golgosky, BS, CVT, CAAP Ann-Marie Hancock, DVM, EDO Elizabeth Hershey, DVM, DACVIM (Oncology), CVA Kerri Marshall, DVM Terri L. McCalla, DVM, MS, DACVO Johanna Mejia-Fava, PhD, DVM Lisa Melling, DVM, CVH Kim Perkins, PhD Debby Smith, RPh, Compounding Pharmacist Sarah Stieg, DVM, MRCVS Andrew Turkell, DVM, CVA, CCRT Jeannie Waldron, DVM, DABVP, EDO Dana Whitlock, DVM, MS, CCRP, CVA

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

IVC Winter 2014/2015

editorial

CANCER and the Whole PATIENT

WATCHING THE FIRST SNOW of winter cover the multi-colored leaves, I can’t help but think how this is a metaphor for healing. We sometimes get so focused on blanketing the disease or condition with one approach, we forget to dig deeper and find the myriad of other healing options available. Of course, integrative veterinary medicine is all about looking at the wide range of options we have at hand. Having embraced the holistic perspective since 1982, I am excited that there is a strong push from pet parents and an increasing number of veterinarians to find new ways to achieve health. This approach should include even the most dreaded of diseases – cancer. Some studies show that cancer now causes 50% of all pet deaths, and one out of four dogs will have a tumor during their lifetimes. Though other diseases cause great suffering, our clients react with more fear and dread to a diagnosis of cancer. As a new graduate, I was very scared of cancer and tumors. I would gird myself to fight the war, with my goal being to do anything available to kill the cancer cells. This approach was often fraught with side effects and financial stresses. It didn’t consider the patient’s unique lifestyle or how to bring an animal back into balance. In this issue of IVC, we look at multiple ways to treat animals with cancer, including TCVM, homeopathy, herbs, and hyperbaric oxygen therapy. The joy of using the naturopathic

or integrative approach to heal the individual rather than merely stop the disease is that we can focus on doing no harm, gently treating side effects, and listening to the wishes of the patient and the family. We can empower clients to help their animals themselves with Reiki, herbs, flower essences, acupressure and more, which calms the animal and enhances healing. When death does happen, most of my clients, though sad, are content that they were part of the process. Outside of cancer, we also take a close look at healing possibilities using osteopathy. Just as chiropractic can treat much more than musculoskeletal problems, in this issue we see how manipulating the ovaries can resolve behavioral issues in mares. Learning new approaches and correcting misconceptions is one of the joys of integrative medicine. In our Nutrition Nook you will learn about the benefits of lean beef and protein rotation, and how inflammation and even aggression can occur when fats and amino acids are not balanced. For those who did not attend, the Fall AHVMA and AVH conferences in September were wonderful for both soul and brain, and enjoyed the highest attendance ever. We were delighted to speak with so many of you, and thank you for the support and positive feedback on IVC. As always, please let us know if there is anything you would like to see covered in this publication. Remember to add your successful cases (helped with holistic therapies, not necessarily cured) to our website (IVCJournal.com). Finally, no matter where you are this winter, we hope you enjoy this issue and wish you a happy and safe season!

Christina Chambreau, DVM, CVH Associate Editor, drtina@ivcjournal.com 8

IVC Winter 2014/2015

contributors

6 Meet the IVC gurus! LIKE us on Facebook to learn more about integrative leaders in the veterinary community.

1. ANDREW TURKELL, DVM, CVA, CCRT

Dr. Andrew Turkell graduated from Araneta University in the Philippines in 1979. He acquired four hospitals over the next 15 years, and in September 2006, realized his 25-year dream by opening the Calusa Veterinary Center in Florida. Dr. Turkell is a member of the AVMA, the AHVMA, the IVAS, and the AAHA, Council of 100. He is certified in veterinary rehabilitation and has a special interest in internal medicine, dermatology, exotic animal care and holistic pet health. Dr. Turkell hosted the WPBR radio show “Pet Talk” and was co-producer of the feature-length documentary Why Do They Treat Them Like Animals? by Jane Louder.

2. DANA WHITLOCK, DVM, MS, PT, CCRP, CVA

Dr. Dana Whitlock graduated from the University of California, Davis and did an internship at the University of Georgia, a surgical internship at Dallas Veterinary Surgical Center, an orthopedic fellowship at the University of Tennessee, and surgical training at the University of Missouri. She is a Certified Veterinary Acupuncturist through the Chi Institute in Florida. She currently practices in Oakland, California at the Holistic Veterinary Care and Rehabilitation Center.

3. ELIZABETH HERSHEY, DVM, DACVIM (ONCOLOGY), CVA

Dr. Elizabeth Hershey received her DVM from the University of Minnesota in 1996. She became a diplomate of the American College of Veterinary Internal Medicine, subspecialty of oncology, in 2001. Dr. Hershey opened Integrative Veterinary Oncology in Phoenix in 2005. She received certification in veterinary acupuncture in 2006 and is also trained in Chinese herbal medicine, food therapy, ozone and ultraviolet light therapy, and hyperbaric oxygen therapy. Dr. Hershey has won numerous awards for her research on inhalation chemotherapy and vaccine sarcomas in cats. She is a member of the Veterinary Cancer Society, the AVMA, the Arizona Veterinary Medical Association, the American Association of Traditional Chinese Veterinary Medicine, the AAVA and AHVMA.

4. ANN-MARIE HANCOCK, DVM, EDO

Dr. Ann-Marie Hancock graduated from Colorado State University with a BS in Equine Science, an MS in Anatomy and Neurobiology and a DVM in 2003. She completed the IVAS Acupuncture course in 2007, then the Equine Osteopathy Course at the Vluggen Institute in San Marcos, Texas, becoming certified as an

10 Winter IVC Winter 2014/2015 2014/2015

Equine Osteopath. Dr. Hancock is currently practicing at Rectortown Equine Clinic in Rectortown, Virginia. Her goal is to use integrative medicine (and osteopathy) to treat the whole horse and rider combination. She is also vice president of the Worldwide Alliance of Equine Osteopaths.

5. JEANNIE WALDRON, DVM, DABVP, EDO

Dr. Jeannie Waldron graduated from Tuskegee Institute’s School of Veterinary Medicine in 1975, and founded the Rectortown Equine Clinic in Virginia in 1994. She is on the board of the Worldwide Alliance of Equine Osteopaths. Jeannie competed in eventing, dressage, jumping and rodeo, before settling down for a long run at endurance. The challenging nature of endurance gave her a unique insight into the horse’s freedom of motion, level of soundness, and nutritional requirements as they affect athletic endeavors. Osteopathy was a natural fit for Jeannie, and she graduated from the Vluggen Institute under the guidance of Janek Vluggen. This training, along with her traditional veterinary skills, allows Jeannie to help horses develop the freedom of motion required for peak athletic performance.

6. LISA J. MELLING, DVM, CVH

Dr. Lisa Melling graduated from Tuskegee University School of Veterinary Medicine in 2004 with a special interest in animal behavior and emergency medicine. In 2007, she co-founded Best Friends Pet Wellness, a house call practice serving the Ann Arbor area. Dr. Melling enrolled in Dr. Pitcairn’s Professional Course in Veterinary Homeopathy in 2008, became an assistant instructor for the course in 2010, and was recognized as a Certified Veterinary Homeopath by the AVH in 2011. She guest lectures for the Integrative Medicine Club at Michigan State University’s College of Veterinary Medicine, presents cases at the Annual Meeting in Veterinary Homeopathy, and was a speaker at the 2014 AVH Conference.

7. TODD COONEY, DVM, CVH

Dr. Todd Cooney graduated from Purdue University College of Veterinary Medicine. He worked in private practice, served as an officer in the US Air Force and Army, and worked as a USDA veterinarian. After almost 20 years of conventional practice, he took Dr. Richard Pitcairn’s Professional Course in Veterinary Homeopathy and now uses homeopathy exclusively in all his cases. His practice keeps him busy in north central Indiana; he also does long-distance consulting, and serves as an instructor for the Pitcairn Institute of Veterinary Homeopathy.

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8. KAREN GELLMAN, DVM, PHD

Dr. Karen Gellman is research director of Maximum Horsepower Research, which studies posture and locomotion in horses and dogs. She is a graduate of Cornell College of Veterinary Medicine, with a PhD from Cornell in animal locomotion biomechanics. She has taught the Postural Rehabilitation professional training course with Judith M. Shoemaker, DVM and Elizabeth Reese, MEd-LMHC for the past eight years, and speaks internationally to veterinarians, chiropractors and physical therapists. She is trained in acupuncture, chiropractic and other holistic modalities, and has a private integrative veterinary practice in Ithaca, New York (equinesportsmed.com).

9. SARAH STIEG, DVM, MRCVS

Dr. Sarah Steig completed her Doctorate of Veterinary Medicine at Western University of Health Sciences in Pomona, California, in 2009. She also completed Dr. Richard Pitcairn’s Professional Course in Veterinary Homeopathy and became an assistant instructor for the course in 2010. Dr. Stieg presents at the Annual Meeting in Veterinary Homeopathy on topics including canine mammary cancer, homeopathic practice management, equine sarcoids, laminitis, and chronic thrush. In January 2013, she became Director of the Pitcairn Institute of Veterinary Homeopathy. She is an integrative veterinarian in North Yorkshire, England, with an emphasis on classical homeopathy and nutrition.

10. JILL GOLGOSKY, BS, CVT, CAAP

Jill Golgosky is a Registered Veterinary Technician working in the internal medicine department of a veterinary specialty hospital in Ohio. She is a Certified Equine and Small Animal Acupressure Practitioner and Instructor with Tallgrass Animal Acupressure Institute. She also holds a Bachelor of Science degree in Zoology from Kent State University.

11. STEVE BROWN

Steve Brown is the author of two best-selling books on canine nutrition, See Spot Live Longer (with Beth Taylor) and Unlocking the Canine Ancestral Diet. He is also a commercial dog food formulator and consultant (his clients include Darwin’s Natural Pet Products and Raw Bistro). Through seminars and webinars, he teaches veterinarians and other knowledgeable people how to formulate fresh meat-based diets that meet all US and European nutrient standards. Contact Steve at creekobear@gmail.com.

IVC Winter 2014/2015

what’s new HEALTH OF PET BILL ONEBENEFITS STEP CLOSER TOOWNERSHIP BECOMING LAW The Human Animal Bond Research Initiative (HABRI, habri.org) Foundation has released the results of an innovative survey detailing the views of family physicians on the beneﬁts of pets to human health. HABRI partnered with Cohen Research Group to conduct an online panel survey of 1,000 family doctors and general practitioners. The 28-question survey was conducted in August 2014 and had a margin of error of plus or minus 3.1%. The physicians in the survey had a median of 18 years of practice experience. Among the survey’s key ﬁndings: • 69% of the doctors interviewed have worked with animals in a hospital, medical center, or medical practice to assist patient therapy or treatment. They reported that interactions with animals improve patients’ physical condition (88%), mental health condition (97%), mood or outlook (98%), and relationships with staff (76%).

• 97% of doctors said they believe health benefits result from owning a pet. • 60% have recommended getting a pet to patients – 43% recommended the pet to improve overall health and 17% made the recommendation for a specific condition. • 75% of physicians indicated that one or more of their patients’ overall health improved, and 87% said their patients’ mood or outlook improved. • 74% said they would prescribe a pet to improve overall health if the medical evidence supported it; 8% said they would prescribe a pet for a specific condition.

INTEGRATIVE MEDICINE NEWS FROM UC DAVIS Dr. Jamie Peyton, DVM, DACVECC, CVRT, CVA, has been appointed as Service Chief of Integrative Medicine at UC Davis’s William R. Pritchard Veterinary Medical Teaching Hospital. Dr. Peyton is a member of several integrative medicine associations, including the American Academy of Veterinary Acupuncture, the American Association of Traditional Chinese Veterinary Medicine and the International Veterinary Academy of Pain Management. The Integrative Medicine Service has also been expanded to include more appointment opportunities in physical rehabilitation, acupuncture, and laser therapy.

vetmed.ucdavis.edu/vmth/local_resources/pdfs/heartbeat_pdfs/VMTH_Heartbeat_JulAug14.pdf

NEW DIRECTOR FOR PIVH Left to right: Dr. Sarah Stieg, Dr. Richard Pitcairn, Dr. Lisa Melling, and Dr. Elise Radebaugh.

History was made at the Academy of Veterinary Homeopathy Annual Conference in September when Dr. Sarah Stieg became the new Director of the Pitcairn Institute of Homeopathy. Although still involved in teaching, Dr. Richard Pitcairn has passed the torch to his faculty team of highly experienced and dedicated homeopathic veterinarians, including Dr. Lisa Melling, Dr. Todd Cooney, Dr. Elise Radebaugh and Dr. Andrea Tasi, who now all work under the auspices of Dr. Stieg. PIVH’s Professional Course in Veterinary Homeopathy teaches the art and science of classical homeopathy. It comprises ﬁve four-day teaching sessions held in Portland, Oregon, and is next being offered in September of 2015. Learn more at pivh.org or by contacting Dr. Stieg at info@pivh.org.

IVC Winter 2014/2015

VESICULAR STOMATITIS CAUTION A Kansas State University veterinarian is cautioning residents of Kansas and surrounding states about a highly contagious viral disease that affects horses and livestock — and can sometimes affect humans. At least 170 cases of vesicular stomatitis have been confirmed in Colorado and Texas, according to the U.S. Department of Agriculture’s Animal, Plant and Health Inspection Service. Although only two states are currently affected, Beth Davis, professor and section head of equine medicine and surgery at the university’s Veterinary Health Center, says everyone needs to be cautious, especially when transporting animals. “It is quite contagious,” Davis says. “The most common form of transmission is through insects, specifically biting flies. It also can be spread from one animal to another through direct contact and sharing of stable supplies. Most commonly, it causes painful blisters in horses that can affect the mouth, muzzle and tongue. Additional signs may include lesions on the udder and/or around the top of the hoof where it meets the hairline. Vesicular stomatitis also can affect mules, donkeys, cattle, bison, swine, sheep, goats, llamas and alpacas.”

aphis.usda.gov

IVC Winter 2014/2015

what’s new TOP HEALTH ISSUES IN SMALL DOGS While small dogs typically have long life spans, their small size can correlate with a number of unique health concerns that affect everything from their teeth to their knees. Trupanion (trupanion.com) recently looked into its animal health database to see what health conditions are affecting small dogs most often. Here are the top ﬁve:

 Medial luxating patella – common

in Pomeranians, Chihuahuas and Cavalier King Charles Spaniels  Intervertebral disc disease (IVDD) – common in Dachshunds and French Bulldogs  Pancreatitis – common in Miniature Pinschers and Dachshunds  Conditions relating to the eyes – common in Cocker Spaniels and Pomeranians  Conditions relating to the mouth – common in Pugs and Pomeranians

UNDERSTANDING EQUINE TENDON INJURIES A horse’s tendons are highly prone to injury, and the likelihood of injury increases with age. Why this happens, however, is still poorly understood. Recently, University of Liverpool scientists examined the mechanisms that cause aging in the tendons of horses. Using samples taken from young and old horses, the team of researchers, which also included scientists from Queen Mary University of London, performed a range of tests to proﬁle the types, quantities and proportions of proteins present in tendons. The researchers found marked differences in the proteins of young and old horses. The ﬁndings also showed that certain protein fragments appear in greater quantities in older horses, suggesting they are released as the tissue is slowly damaged over time. In contrast, damaged tendons in younger horses were found to contain more of the proteins used in healing than damaged samples from old horses, suggesting that healing also slows with age.

IN MEMORIAM The integrative community lost two important leaders this past autumn. On September 28, Dr. Sophia Yin, DVM, MS, DACVB, passed away at her home in Davis, California. The author of many books and textbooks, Dr. Yin’s animal behavior modiﬁcation and training programs were based on the science of learning, and she was dedicated to helping people communicate with pets in a positive, scientiﬁcally sound way. In the Summer 2013 issue of IVC Journal, Dr. Yin wrote an article that covered ways to recognize fear in our patients.

IVC Winter 2014/2015

On October 26, Jim Helfter passed away from heart failure while horseback riding. A former aerospace engineer, Jim had long been concerned about the widespread use of antibiotics in animals, and founded Advanced Biological Concepts and Helfter Feeds, Inc. He was a strong supporter of CAVM. Memorial contributions in honor of Jim may be directed to the Jim Helfter Memorial Fund for the Advancement of Research and Education Concerning Nutrition, GMOs and Glyphosate, which was established by the AHVM Foundation. ahvmf.org

ITHERAPY NTEGRATIVE FOR

BRAIN

TUMORS By Dana Whitlock, DVM, MS, CCRP, CVA

Central nervous system neoplasia in dogs and cats causes significant morbidity and mortality. Though the true prevalence is unknown, a postmortem study looking at the incidence of canine intracranial neoplasia over a 24-year period revealed an overall prevalence of 4.5%.1 A significantly higher prevalence of primary intracranial neoplasms were found in dogs of increasing age and body weight.1 The most common intracranial neoplasias in dogs are gliomas and meningiomas, although undifferentiated sarcomas, pituitary tumors, and ventricular tumors also occur. Golden Retrievers and Boxers have a higher risk of developing primary brain tumors, and dolichocephalic breeds are predisposed to meningiomas. Brachycephalic breeds are more likely to develop gliomas. Cats are less likely than dogs to develop brain neoplasia, but meningiomas (most common), gliomas and others do occur.2 Primary CNS neoplasia should be on the differential list of any older dog or cat with slowly progressive neurologic dysfunction, as well as those that develop new onset seizure activity over the age of five years. The site of the neoplasia usually determines the clinical signs observed; however,

hemorrhage and/or edema, or blockage of venous cerebral ďŹ&#x201A;uid, can cause additional symptoms.

DIAGNOSIS AND TRADITIONAL TREATMENT Definitive diagnosis requires histopathology, which may or may not be feasible. A minimum database can help exclude extracranial causes for cerebral dysfunction. Advanced imaging is recommended. MRI is considered superior to computed tomography as it allows visualization of edema, changes in vascularity, hemorrhage, necrosis and overall improved soft tissue detail.2 Goals of traditional treatment include controlling secondary effects such as increased intracranial pressure or edema, and to eradicate the tumor or reduce its size.2 The potential for surgical resection or debulking is determined by the tumorâ&#x20AC;&#x2122;s size, location, and degree of invasiveness. Surgery is the treatment of choice in feline meningiomas, as they are typically encapsulated and lie over convexities of the cerebrum.3 Traditional forms of radiation therapy and chemotherapy, as well as stereotactic radiosurgery, vaccine therapy, and gene therapy are being offered and explored. Continued on page 16. IVC Winter 2014/2015

Continued from page 15.

WHAT DOES THE LITERATURE SAY? A review of the literature does not reveal any placebocontrolled blinded studies on the use of alternative therapies in the treatment of cranial neoplasia in dogs or cats. Since malignant brain tumors affect people and are reportedly the second leading cause of cancer deaths in children and young adults4, there is a very active database of ongoing research as traditional therapies have had less than stellar outcomes. The following discussion presents some of the promising additions to the mainstay of surgical and oncological therapy.

DIET Dietary management is one strategy that integrative veterinarians often use in an attempt to affect the health of their patients. There is mounting evidence that diet may play a role in the management of brain neoplasia.

A 4:1 commercially available ketogenic diet developed for children with uncontrolled epilepsy (Nutricia KetoCalÂŽ) was used in mice inoculated with brain gliomas to determine if a combination of a ketogenic diet plus radiation therapy would have a cumulative effect.7 Mice fed the ketogenic diet lived longer and demonstrated slower tumor growth rates. More impressively, mice fed the ketogenic diet, and that were also irradiated, demonstrated a full regression of their tumors; moreover, the tumors did not recur when the mice where placed back on a standard diet.7 These findings hold promise, and should encourage the integrative veterinarian to include dietary strategies for their patients with cerebral neoplasia. Hopefully, future research will elucidate more specifics and clinical applicability to veterinary species.

HYPERBARIC OXYGEN THERAPY Researchers have studied calorically restricted ketogenic diet therapy for malignant brain cancer using a mouse model.5,6 They implanted a malignant mouse astrocytoma and a human malignant glioma into the cerebral cortex of mice, and fed them a standard high carbohydrate diet; a calorie restricted standard high carbohydrate diet; a ketogenic formula; or a calorie restricted ketogenic diet.5 Calorie restriction was defined as 65% to 70% of the recommended daily allowance. The researchers found that the calorie restricted mice showed a reduction in body weight, but were more physically active and appeared healthier than the unrestricted food group. The calorie restricted groups also had significantly reduced tumor growth (approximately 80% to 86% less) than unrestricted groups. Although plasma glucose levels predicted plasma ketone levels (inverse relationship), it was the glucose levels that were highly significant in predicting tumor growth, with lower levels being associated with smaller tumors.5 Primary brain tumors actively consume glucose and are dependent on glycolysis for energy. Due to mitochondrial defects, tumor cells are unable to metabolize ketone bodies for energy, while normal brain cells are able to utilize ketones for energy. Thus, normal cells were energetically supported with a ketogenic diet, while tumor cells were deprived.6 A ketogenic diet composed roughly of 6:1 (fat: protein + carbohydrate) was shown to increase survival in mice inoculated with brain gliomas when compared to mice given a standard diet. A decrease in the production of reactive oxygen species within the tumor cells was noted. The overall gene expression in the tumors of rodents fed a ketogenic diet was more similar to cells from tumor-free rodents, regardless of their diet.4

This therapy uses 100% oxygen at elevated atmospheric pressure. It is used to increase oxygen tissue delivery via increased dissolved oxygen in the plasma, and treats various conditions from sepsis to certain non-healing wounds. HBOT has been shown to promote angiogenesis in wounds; for this reason, neoplasia was initially considered a contraindication for its use. In actuality, it appears that decreased oxygen tension selects for more malignant cells and promotes multiple cellular adaptations that promote tumor growth.8 Experimental and clinical studies of various cancers have shown that HBOT does not appear to promote cancer growth or metastasis.8 Stuhr, et al, demonstrated that transplanted gliomas in nude rats exposed to HBOT exhibited a reduced vascular density in the central portion of the tumors; a reduction of vessel diameter throughout the tumors; and an increased number of apoptotic cells, as well as a reduction in tumor growth.9 However, the tumors in this study were transplanted into the necks of the animals and not into the brain, so the clinical relevance of these findings in intracranial tumors is unknown. Interestingly, Poff, et al, demonstrated a positive effect on survival when HBOT therapy was combined with a ketogenic diet in mice with systemic metastatic cancer â&#x20AC;&#x201C; including metastasis to the brain.10 The tumor utilized in the study had been noted to occur spontaneously in the brains of the strain of mice used, and had shown multiple growth characteristics similar to the human glioblastoma multiforme.10 Both the ketogenic diet-only group, and the ketogenic diet plus HBOT therapy group, survived longer than control mice. The HBOT therapy plus ketogenic diet group had the longest mean survival rate, though this was not statistically different from the Continued on page 18.

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Continued from page 16. ketogenic diet-only group in this small sample-sized study. In this study, no effect on survival was seen in mice receiving HBOT therapy and a standard diet.10

HERBALS Herbal preparations are a cornerstone of Traditional Chinese Medicine as well as other ancient medical practices. Many claims have been made about their beneficial effects through case studies and anecdotal stories, and fortunately research is validating some of these claims. A review of the literature regarding herbals or portions of herbals specifically targeting brain tumors produces limited results. Two studies that show promise are presented below.

C urcumin, an ingredient of turmeric, has been shown to suppress malignant glioma cell growth and induce apoptosis both in vitro and in vivo, using a mouse model.11 Mice were implanted with intracranial glioma cells and treated with intraperitoneal injections of curcumin or solvent DMSO (control) for 20 days. The curcumin group showed a marked reduction in tumor size, and appeared in better health with less weight loss, more activity, better appetite, and no seizures compared to the control group â&#x20AC;&#x201C; and showed a significant improvement in survival.11 In vitro work showed that curcumin suppressed gene expression of the tumor cell line in a time- and dose-dependent fashion.11 Curcumin was also shown to inhibit the proliferation of the glioma cells, limit migration of the cells, and induce apoptosis.11

CURCUMIN, an ingredient of turmeric, has been shown to suppress malignant glioma cell growth and induce apoptosis both in vitro and in vivo.

Melatonin may be helpful In vitro studies have shown that melatonin, at pharmacologic concentrations, inhibits migration and invasion of glioma cells and acts as an antioxidant by inhibiting elevated production of reactive oxygen species in both normoxic and hypoxic conditions.13,14 A small study demonstrated that humans with glioblastoma treated with radiation therapy plus melatonin (20mg/day PO) had significantly improved survival. As well, toxicities from radiation therapy were lower when compared to those treated with radiation therapy only.15 The recommended dose for veterinary patients with gliomas is 0.1 to 0.2 mg/kg once daily, preferably in the evening.

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Angelicae sinensis radix (Dang gui) has traditionally been used in the treatment of menopausal symptoms, gastric mucosal damage and hepatic injury.12 It has also been shown to exhibit cytotoxic activities in tumor cells. Yu-Ling Lin, et al, looked at the methanol extract of Angelica sinensis (AS-M) and its effect on glioblastoma multiforme (GBM) cells. They injected the tumor cells subcutaneously, and also injected the AS-M subcutaneously.12 Treated mice had significantly smaller tumors than the controls. AS-M induced cell cycle arrest and apoptosis in the GBM tumor cells. Mice treated with AS-M showed no systemic deleterious effects, maintaining their body weight, normal morphology of abdominal organs, and normal blood work values.12 The authors hypothesized that intracranial injections of AS-M may be beneficial in human GBM disease.

CONCLUSION Brain neoplasia presents its own special challenge for treatment due in part to the sensitive nature of brain tissue, its rigid containment within the skull, and the blood/brain barrier. Current treatment strategies are often met with poor outcomes. Innovative therapies are being investigated and these show promise for improved outcomes of this devastating disease.

Song RB, et al. “Postmortem evaluation of 435 cases of intracranial neoplasia in dogs and relationship of neoplasm with breed, age, and body weight”. JVIM 27(5):1143-1152. 2013. 2 LeCouteur RA, Withrow SJ. “Tumors of the Nervous System.” Withrow & MacEwen’s Small Animal Clinical Oncology. 4th ed. St. Louis: Saunders Elsevier. p 659. 2007. 3 Talarico LR, Dewey CW. “Intracranial Neoplasia.” Veterinary Surgery Small Animal Volume 1. St. Louis: Saunders Elsevier. p511-516. 2012 4 Stafford P, et al.“The ketogenic diet reverses gene expression patterns and reduces reactive oxygen species levels when used as an adjuvant therapy for glioma.”Nutrition & Metabolism, 7:74, 2010. 5 Seyfried TN, et al. “Role of glucose and ketone bodies in the metabolic control of experimental brain cancer.”British Journal of Cancer 89:1375-1382, 2003. 6 Zhou W, et al.“The calorically restricted ketogenic diet, an effective alternative therapy for malignant brain cancer.”Nutrition & Metabolism 2007, 4;5. nutritionandmetabolism.com/content/4/1/5. 7 Abdelwahab MG, et al. “The ketogenic diet is an effective adjuvant to radiation therapy for the treatment of malignant glioma.”PLoS ONE 7(5): e36197, 2012. 8 Moen, I, Stuhr L. “Hyperbaric oxygen therapy and cancer – a review.”Targ Oncol 7:233-242, 2012. 9 Stuhr LE, et al. “Hyperoxia retards growth and induces apoptosis, changes in vascular density and gene expression in transplanted gliomas in nude rats.”J Neurooncol. 85(2):191-202, 2007. 10 Poff AM, et al. “The ketogenic diet and hyperbaric oxygen therapy prolong survival in mice with systemic metastatic cancer.”PLoS ONE 8(6): e65522. 2013. 11 Du WZ, et al. “Curcumin suppresses malignant glioma cells growth and induces apoptosis by inhibition of SHH/GLI 1 signaling pathway in vitro and in vivo.”CNS: Neuroscience and Therapeutics 19(12):926-936, 2013. 12 Lin YL, et al. “The methanol extract of Angelica sinensis induces cell apoptosis and suppresses tumor growth in human malignant brain tumors.” Evidence-Based Complementary and Alternative Medicine. 2013. http://dx.doi. org/10.1155/2013/394636. 13 Wang J, et al. “Melatonin suppresses migration and invasion via inhibition of oxidative stress pathway in glioma cells.” J. Pineal Res. 53:180-187, 2012. 14 Zhang Y, et al. “Melatonin antagonizes hypoxia-mediated glioblastoma cell migration and invasion via inhibition of HIF1α.”J. Pineal Res. 55:121-130, 2013. 15 Lissoni P, et al. “Increased survival time in brain glioblastomas by a radioneuroendocrine strategy with radiotherapy plus melatonin compared to radiotherapy alone.”Oncology, 53(1):43-46, 1996. 1

VetzLife All-Natural News Oral care for feline stomatitis Feline stomatitis is a painful chronic oral disease. It’s thought to be an autoimmune condition that involves an overreaction of the immune system to plaque, leading to severe inflammation in the gums and other oral tissues, and even in the bone beneath. Symptoms include behavioral changes, difficulty eating, drooling, foul breath, and pawing at the mouth. At the initial diagnosis of stomatitis in a cat, many veterinarians put the animal on medication, firstly with antibiotics to treat infection and reduce bacteria. If the medication route fails, then a full mouth extraction of all the teeth is performed. This is followed by the cat being put on a soft diet for the rest of his life. As we know, there is virtually nothing on the veterinary market that can treat stomatitis in cats. This is why VetzLife has come out with its new Stomatitis Gel for Cats. Recent clinical studies suggest that topical application of this product alleviates periodontal and dental disease when used not only as a sole treatment, but also in combination with surgical and non-surgical therapies. The studies show that it will not only kill the bacteria found in the mouth cavity, but that it also helps heal mouth sores and gum disease, and reduce the depth of periodontal pockets. The gel will help clean up the cat’s oral cavity and prevent the further loss of teeth. It’s formulated in a salmon oil gel that cats tolerate well. Article provided by VetzLife/PetzLife all-natural products ( VetzLife.com or 1.888.453.4682).

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NATUROPATHIC ONCOLOGY By Barbara Fougere, BSc, BVMS (Hons), BHSc (Comp Med), MODT, MHSc (Herb Med), CVA, CVCP, CVBM

Naturopathic oncology is becoming well developed in human medicine. And as people demand naturopathic services to help them cope with the ravages of conventional cancer care, they are also seeking alternatives for their animals. As integrative veterinarians, we occupy an unprecedented position in the field of veterinary oncology.

always something more that can be done to help our patients, and even more phenomenal to be able to improve their health well beyond expectations, and create a “spontaneous remission” – something that the veterinary paradigm says is impossible given the original diagnosis.

THE NATUROPATHIC APPROACH With our expertise, we can diagnose, treat and help prevent disease using conventional approaches as well as natural therapies, diet, herbs or other remedies that influence the natural healing capacity of our patients. Most owners of pets with cancer are desperate, often on a roller coaster of emotional turmoil, so they search the internet to find approaches to “cure” cancer – a regime or unique product with convincing testimonials. When they ask regular veterinarians or their oncologist for guidance, they are often advised against all alternatives. We can guide these clients through the confusing array of products and assist them in choosing a treatment path for their pets. We can offer therapies that halt or induce apoptosis in cancer cells, mitigate side effects, improve the efficacy of chemotherapy and usually improve quality of life. Taking on the responsibility of treating life-threatening aggressive cancer requires a solid understanding of the standard treatments employed in veterinary medicine and by veterinary oncologists. We need to know the prognosis for different approaches (chemotherapy versus radiation, etc.), different cancers, and for the individual pet and family circumstances. We need to present the best alternatives to maximize quality of life and treat the patient. Often, the prognosis is so grave that conventional medicine provides no further options for treatment. Naturopathic oncology offers options even when an animal is considered in hospice.

Although naturopathic medicine draws on diverse and seemingly very different healing traditions, certain principles are shared across these traditions.

The whole patient

The diagnosis of cancer is important, but the definitive diagnosis is not central to our approach. Naturopathic oncology takes the position of evaluating the whole patient and focusing primarily on improving health and well-being. We need to address all aspects of health promotion, including physical factors (gut function, elimination, inflammation, pain), diet, any specific needs of the patient (dry eye, comorbid renal disease, etc.), the owner/animal bond (including support for the owner), environmental factors, spiritual aspects and even genetic factors. If conventional care is being used, we will look for natural, non-invasive ways to enhance the efficacy of chemotherapy or radiation, minimize side effects, and empower our clients to take control of their animals’ health.

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The great joy of being involved in naturopathic oncology is that our toolbox is so much larger than the one other veterinarians draw upon. It is empowering to know there is

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“First do no harm”

We emphasize therapies that are non-invasive and natural and that do not make our patients less well. These can be the main treatments or used with chemotherapy or radiation.

The healing power of nature

We pay attention to the basics of improving general health. • Moderate or gentle exercise. • Positive thinking by the owner – coaching terms like “living with cancer” or “treating it like a chronic disease” rather than a “war” we are “fighting”.

• Attention to healthy air and environment, avoiding toxins, giving clean water, spending time in nature. • Most importantly, a great diet for that individual’s needs.

Treating the imbalance

We look for underlying contributing factors to the imbalance in health – often, lifestyle (obesity, lack of exercise), exposure to chemicals and some drugs, chronic stress and dietary influences play a role. Special care needs to be taken to avoid assigning blame. From a naturopathic perspective, cancer arises from an imbalance or accumulation of toxicity, causing a lack of immune surveillance or control that allows cancer cells to grow. We therefore prescribe therapies to restore balance.

Teaching and empowering clients Empowering our clients to control the things they can, while listening to them with respect and encouraging and supporting them, can make a difference. If they feel empowered, their animals will sense more positive emotions from them, which can improve their own moods and healing.

Preventative medicine

We need to make sure that everything we recommend or do helps strengthen the immune system and prevent illness. Attention to vaccination, chemical use, parasite control, drug use, etc. is important. If a patient has had any kind of tumor successfully removed, the tendency to produce further tumors has not yet been healed. Now is the time to implement changes to minimize the risk of new tumors.

NATUROPATHIC GUIDELINES Clinical nutrition Recommend the elimination or reduction of dry foods as a key part of the strategy. Highly processed foods may contribute to insulin resistance, the processing of by-products like acrylamides, and may encourage some forms of cancer to grow through their effects on metabolism. Fresh whole foods may enhance the potency of chemotherapy and help protect cells from toxicity. Phytochemicals in plants improve immunity and health. Home-prepared diets are also more palatable and nutrient-rich, often enabling us to hide supplements and herbs in the food. Recommend organic foods, if possible, to minimize chemical exposure. Make sure food is cooked if the pet is on chemotherapy immune-suppressive or gut-damaging drugs. We recommend protein (meat, eggs, fish, chicken), vegetables (especially above-ground vegetables), a small amount of whole grains (<25% of calories), oils and supplements.

Supplements Be conscious of what the owner and animal are capable of. Don’t overdo it. Use products that cover more than one aspect IVC Winter 2014/2015

in order to minimize the number of things that could affect either palatability or the human/animal bond. We recommend a whole food supplement, nutrient-dense and high in antioxidants, containing seeds, calcium, goji berry, spirulina, barley grass, kelp, vitamins and minerals.

 Fish oil supplements – DHA 30mg/kg  Green tea – a highly concentrated source of antioxidants  Melatonin – may be useful  Whey protein – improves immune function and maintains body weight

 Mushrooms and mushroom extracts  Turmeric – especially the concentrated extract, curcumin; can enhance effectiveness of chemotherapy

Acupuncture Some people suggest that acupuncture is contra-indicated in cancer treatment. However, research suggests that cancer can improve immunity, reduce nausea and improve well-being during cancer treatment (Deng et al 2013). We use it routinely to enhance energy and well-being.

Herbal medicine Herbal medicine offers animals a variety of benefits in the integrative treatment of cancer. It can reduce toxicity of treatment; support the patient through surgery, chemotherapy or radiation; or provide a palliative option when conventional treatment is declined. Ideally, herbs are prescribed according to the patient’s vitality, energetics, symptoms, concurrent treatment, prognosis and diagnosis. Selecting herbs to support the patient, improve vitality and immunity, and provide anticancer activity is a fundamental. When treating potentially life-threatening disease, it behooves us as practitioners to either refer these cases to qualified veterinary herbalists, or undertake additional study to gain an in-depth knowledge of herbal medicine for cancer treatment.

Adaptogens Many adaptogens such as astragalus, withania, Siberian ginseng and Korean ginseng can strengthen body resistance and enhance vitality, particularly in debilitated animals. These herbs also have anti-cancer properties.

strengthening resistance to the treatment’s side effects or to the cancer, and they may offer anti-neoplastic activity. There are many effective anti-cancer medicinal fungi. Among the recommended medicinal fungi or other immune-supporting herbs are cat’s claw, phytosterols, astragalus, echinacea, cordyceps, and withania. Daily dietary administration of Echinacea purpurea root extract to normal mice, for as little as one week, also resulted in significant elevations in natural killer cells. Such boosting of this fundamental immune cell population suggests a prophylactic role for this herb in normal animals (Currier 2001). Gut function also impacts innate immunity, so appropriate diet and support (probiotics, marshmallow, licorice, glutamine, fiber, antioxidants, or antioxidant herbs) will help immunity.

Alteratives (not to be confused with “alternatives”) Detoxification is an herbal medicine principle in cancer treatment, because cancer is thought to be the end result of accumulated toxins in the body. While some may argue with this theory, the use of alteratives (which improve elimination and physiology) nevertheless appears helpful, particularly in the early stages of cancer when vitality is still good. Essiac is a commonly-used formula that consists of four herbs, three of which are considered mild alteratives. This formula is also beneficial in the palliative care of endstage cancer patients. Other alteratives to consider include dandelion root, yellow dock, poke root (which is toxic and should only be used by experienced herbalists), burdock, red clover, and sheep sorrel.

Antioxidants Antioxidants are important for treatment and palliation. Often the patient is subjected to free radical damage through treatment, and herbs with antioxidant activity can reduce the side effects of both chemotherapy and radiation, as well as the oxidative stress of general anesthesia. The literature includes several promising herbs whose antioxidant activity has been demonstrated in relation to anticancer properties, cancer prevention, and treatment (see sidebar).

STRATEGY FOR HERBAL USE Immune function enhancers Most conventional veterinary chemotherapeutic agents (as well as radiation therapy) are immune-suppressing and cytotoxic in nature and are associated with short- and longterm side effects (McEntee 2006, McKnight 2003). Immunemodulating and immune-stimulating herbs may prevent or minimize the undesired adverse effects of these agents by

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Be strategic about herb selection; the more knowledge one has, the fewer herbs are needed to improve health. Consider rotating through formulas. We routinely use a formula targeted at the needs of the patient, an immune-supporting formula, one for when the animal is undergoing chemotherapy, or formulas for post-surgery or during radiation. An example is Yunnan bai yao – which reduces the risk of bleeding and has

Herbs

WITH ANTIOXIDANT PROPERTIES

 GREEN TEA – an effective chemopreventive agent (Katiyar 1997)  MILK THISTLE  SILYMARIN AND SILIBININ (silybin) – anti cancer effects (Gazak 2007)

 TURMERIC – scavenges free radicals (Tilak 2004)  CURCUMIN – halts carcinogenesis by inhibiting cytochrome

P450 enzyme activity and increasing levels of glutathione-Stransferase (Chauhan 2002)

 DAN SHEN – free radical scavenging activity (Xia 2003); one of

its tanshinone constituents possesses cytotoxic activity against many kinds of human carcinoma cell lines (Yuan 2003)

 SCHISANDRA – lignans act as free radical scavengers (Lu

1992); geranylgeranoic acid, a constituent of Schisandra, has been shown to induce apoptosis in a human hepatomaderived cell line (Shidoji 2004)

 GINKGO BILOBA LEAF EXTRACT – signiﬁcant antioxidant

activity because of its ﬂavonoid and terpenoid components; the anti-cancer properties of ginkgo are related to its antioxidant, anti-angiogenic, and gene-regulatory actions

 ROSEMARY – antioxidant activity (ESCP 1999)

inherent anti-cancer properties – as part of the protocol for treating haemangiosarcoma. The number one goal of treatment is to improve systemic health. Patients can go into remission; but more frequently, they can live with the chronic disease of cancer in a well state. It is important to normalize weight, provide a low-carbohydrate diet, reduce stress, ensure normal elimination processes, and provide exercise opportunities. If the patient has an acute condition such as diarrhea, give that priority and treat it accordingly. The nearer the patient’s vitality is restored to normal, the better the expected outcome. Despite the poorest prognoses based on diagnosis, wellness and vitality are still achievable in some patients. In the author’s experience, clients often remark on their pets being “more well” than they have been in years, despite the presence of cancer.

For additional study More details and references are available in the chapter by Barbara Fougere in Integrating Complementary Medicine into Veterinary Practice, edited by R. Goldstein, and published in 2008. To view a webinar on this topic, or for further training in naturopathic oncology and herbal medicine for cancer, visit civtedu.org. IVC Winter 2014/2015

HYPERBARIC Hyperbaric oxygen decreases inﬂammation, enhances cell and tissue function, helps heal slow or non-healing wounds and provides an oxygen path to tissues without a blood supply.

MEDICINE IN YOUR PRACTICE By Andrew Turkell, DVM, CVA, CCRT

Hyperbaric Medicine, also known as Hyperbaric Oxygen Therapy (HBOT), is the medical use of oxygen as a drug at a level higher than atmospheric pressure. In hyperbaric chambers, the patient breathes 100% oxygen at pressures greater than normal atmospheric (sea level) pressure. This allows the blood to carry more oxygen and deliver 15 to 25 times more oxygen to the tissues and organs of the body. Oxygen has natural healing properties, and increasing the amount that is circulating throughout the body promotes faster and more efficient healing for a wide variety of diseases and ailments1. We have been using HBOT at the Calusa Veterinary Center since 2011 with excellent results.

MECHANISM OF ACTION Under hyperbaric pressure, healing oxygen is dissolved in the blood plasma, cerebrospinal and lymph fluids, enabling oxygen to reach damaged tissue at least three to four times farther than normally diffused by red blood cells. This is especially important in swollen and inflamed tissues where small blood vessels have been spread apart and oxygen from red blood cells is unable to diffuse out far enough to supply the needs of damaged cells. Hyperbaric oxygen decreases inflammation, enhances cell and tissue function, helps heal slow or non-healing wounds and provides an oxygen path to tissues without a blood supply. In addition to healing cells, hyperbaric oxygen proliferates and mobilizes the body’s own stem cells2. These cells are attracted to areas of inflammation in the body where they produce healthy tissues.

HBOT IN VETERINARY PRACTICE The first HBOT chamber for small animal companion

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animals was made available in 2011 by Hyperbaric Veterinary Medicine Company (HVM). Incredible stories of healing are unfolding. I used the chamber 600 times in our first year at Calusa Veterinary Center. Though I did not initially appreciate the broad impact of HBOT, it has become a cornerstone to healing in my practice over the last three years. Saturating the body fluids with up to six times the normal amount of oxygen can have a profound effect on the body’s healing functions. HBOT.3 • “Jump-starts” cells into a hyper-functioning state. These cells perform at an optimal level, improving healing in all ischemic diseases. • Allows oxygen to cross the blood-brain barrier effortlessly, for immediate use by the brain and nerve tissue. • Stimulates the growth of new capillaries, which allows circulation to be restored or improved; this reduces or eliminates hypoxia in affected areas. • Stimulates connective tissue cells, which are rich in collagen, and promotes the growth of new skin. • Increases the ability of white blood cells to remove foreign bodies from the bloodstream, including bacteria, fungi, dead cells and waste by-products. • Stimulates the process involved in the normal remodeling of bone. • Stimulates the immune response. • Has potent anti-inflammatory effects. • Increases the production of glutathione, the body’s main antioxidant powerhouse, by 15%. • Reduces edema and mitigates damage to the surrounding cells, tissues and blood vessels. Therefore, it is a useful adjunct in treating trauma. • Reduces the effect of radiation-induced injury to bone,

soft tissue and organs by triggering the healing response to these areas. • Inhibits the growth of some bacteria and kills anaerobic organisms such as those found in gas gangrene and certain Lyme spirochetes. HBOT improves performance of some antibiotics and medications. • Increases the amount of stem cells circulating in the body.

CONDITIONS RESPONSIVE TO HBOT While many conditions can be helped with HBOT, in my practice we have had good results with: Skin grafts and flaps: The success of transferred skin grafts or flaps (which might include skin, deeper tissue, muscle and bone) is largely dependent on sufficient oxygen supply to the affected area. Hyperbaric treatment can be used to saturate the area with oxygen before and after grafting. Non-healing or difficult to heal problem wounds: Complications of crush injuries, such as those from motor vehicle accidents, are frequent. By increasing oxygen delivery to injured tissues, HBOT reduces swelling, improves healing and helps fight infection. Slow-to-heal wounds show major improvement with HBOT, partly because of the oxygen saturation in areas with poor blood circulation. Osteomyelitis: HBOT inhibits bacterial growth, increases the power of white blood cells and enhances the effects of some antibiotics. Other conditions I routinely treat with HBOT include idiopathic thrombocytopenia, idiopathic vestibular disease, arthritic disease, brown recluse spider bite, snake bite, stroke, athletic injury, pancreatitis, brain and spinal cord issues – edema, injury and compression – intervertebral disc disease, swollen limbs, severe sinusitis or septic rhinitis, blastomyces, avascular necrosis of the femoral head, and radio-ulnar ischemic necrosis. I also use it following orthopedic surgery and for any post-surgical swelling.

TEACHING INSTITUTIONS ARE NOW UTILIZING HBOT IN THEIR OWN FACILITIES Several schools now offer HBOT, and studies are underway. The University of Florida Small Animal Hospital, for instance, has installed a hyperbaric chamber, and so far has used it to treat a number of species, including dogs, cats, ferrets, rabbits, and a monkey. They use hyperbaric oxygen therapy to treat a variety of chronic and acute conditions including: • Swelling – post-operative, crush injuries, snake bite, burns • Trauma – internal, head, spinal cord • Non-healing wounds, especially with blood supply concerns • Smoke inhalation Continued on page 26.

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Continued from page 25. • Carbon monoxide toxicity • Pancreatitis At the Medical College of Wisconsin, researchers are studying hyperbaric therapy alone and in combination with other treatments. In one study, the researchers pioneered the use of hyperbaric oxygen in conjunction with NASA’s near-infrared lightemitting diode technology for treatment of hard-to-heal wounds.3 The University of Tennessee’s Department of Large Animal Medicine uses HBOT for conditions or diseases in which circulation to the diseased tissue has been compromised. According to their website, “Hyperbaric therapy is a primary treatment for some diseases including severe smoke inhalation and burns, Clostridial and other anaerobic infections, and compromised wounds.” The Department also lists dozens of equine conditions they treat with HBOT, including desmitis (ligament disease), tendonitis (bowed or diseased tendons), fractures, exercised-induced pulmonary hemorrhage (bleeders), acute laminitis (founder), colic (intestinal obstruction, colon torsions, volvulus, etc.), enteritis and endotoxemia, Lyme disease, neurologic disease and trauma and severe necrosis (snake and spider bites, toxic substances, etc.).4

CASES HELPED BY THE USE OF HBOT Here are a few example cases from my own practice:

Piper, a seven-year-old Sheltie, was presented with a nonhealing wound infected by an atypical mycoplasma organism resistant to all antibiotics. Along with debridement, surgery, antibiotics and wound vacuum, she had 45 hyperbaric treatments and is now healed and back to normal.

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Jack, a Yorkshire terrier, was attacked by a pack of dogs after Hurricane Sandy. He was paralyzed until his 20th HBOT session.

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Ollie was presented unable to stand after being hit in the head with a Bocce Ball. Upon presentation, she was ataxic and circling to the left when she was aided to stand. She was treated 30 times and was returned to normal. German inventors Bernhard and Heinrich Dräger use pressurized oxygen on divers to successfully treat decompression illness.12

1830s

1861 Compressed air treatments for lung problems become popular in France, and enthusiasts embrace it as a popular “spa” treatment.9

New York neurologist J. Leonard Corning is the first to use compressed air therapy in the U.S. after he visits the Hudson River Tunnel construction site and observes many cases of Caissons disease or paralytic decompression sickness. He resolves many of these cases and then proceeds to treat a broader range of nondecompression-related central brain and spinal cord diseases.11

1917

1860

Photo: Internet Archive Book Images

The first chamber in North America is built in Oshawa, Ontario.10

1774 1660s

Compressed air therapy in a chamber (no oxygen added) is pioneered by British physician Nathaniel Henshaw to prevent lung ailments.7

Sophie, a two-year-old Yorkie, was presented to our practice Piper, 95% healed. for HBOT after an anesthetic accident during a routine overiohysterectomy. She awoke blind and paralyzed and the neurologist referred her to us. She had 40 treatments and her vision and ambulation were restored.

Oxygen is discovered by English scientist John Priestly; this will later effect hyperbaric treatments.8

Piper, upon presentation: a typical mycoplasma infected bite wound, ﬁve months duration.

5 Midnight, pre debridement.

Midnight was a female Lab mix found on the streets of Miami with burns over a third of her body; she was covered in maggots. When presented to me, she was at death’s door. Due to the excellent results seen with burn wounds using hyperbarics, HVM decided to sponsor the veterinary care for this dog and we began treating her on August 20, 2013. We debrided all her wounds, started conventional wound care and began her hyperbaric treatments at 2ATA for 45 minutes at pressure. We continued treatments until she was adopted to her forever home in October 2013.

Midnight, post debridement.

Stella’s jaw was broken after a routine tooth extraction, without enough jaw bone left to heal the fracture. Twenty HBOT treatments postsurgery enhanced the osteoblast proliferation and healing of the mandible.

USING HYPERBARIC IN YOUR PRACTICE

N2 +O2

1999 1956

1937

Photo: Special Collections, Cleveland State University Library

After studying the severe influenza pandemic of the early 1900s, Chairman of Anesthesiology at Kansas State University, Orval Cunningham, observes that the morbidity and mortality rates were greater at higher elevations than at sea level. He builds a chamber and begins treating influenza patients, with very encouraging results. In 1928, he goes on to build the world’s largest hyperbaric facility – a five-storey chamber with 12 bedrooms on each floor. After failing to secure support from the American Medical Association, Cunningham retires in 1935 and the chambers are sold for scrap.13

Albert Behnke and Louis Shaw build on the Drägers’ work for decompression illness and use oxygen in place of compressed air. This leads to use of the first nitrogenoxygen mixtures and hyperbaric treatment being tailored to the severity of the injury.14

Dutch cardiac surgeon Ite Boerema reports on the use of HBO2 as an aid in cardiopulmonary surgery.10 Thereafter, more promising reports on the use of HBO2 surfaced, including one by Boerema’s colleague, Willem Brummelkamp, who reported in 1961 that anaerobic infections were inhibited by HBO2 therapy. 15

Radiation oncologists from Yale report the results of a study combining radiation with HBOT that was conducted 20 years earlier on squamous cell carcinoma in humans. Significant improvements in local response rates and local control are evident, as is local relapse free survival at five years.16

2011

Midnight, after 45 HBOT treatments.

Midnight, after 32 HBOT treatments.

1921

The equipment required to produce hyperbaric oxygen consists of a pressure vessel (chamber) and a means of delivering 100% oxygen. The chamber for small animal companions can accommodate animals up to 180 pounds. Since the treatment requires no

Hyperbaric Veterinary Medicine, LLC makes the first hyperbaric chamber available for small companion animals.17

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anesthetic, the chamber features large view ports, through which the patient can look during treatment. This helps alleviate emotional discomfort and, along with a large video monitor, allows for thorough monitoring of the patient.

another clinic with HBOT if my practice didn’t have the room or structure to support it. HBOT can increase our ability to help our companions heal and stay healthy, and with the number of serious diseases and conditions affecting our animals today, it’s a treatment protocol whose time has finally come.

HBOT treatments are always performed according to a predetermined plan by a trained technician who continuously monitors the patient and may adjust the schedule plan as necessary. At 2ATA, the average treatment time is 45 to 60 minutes. Depending on the condition it will be repeated several times a day, then taper off as healing occurs.5 Treatment is now covered by most pet insurers, as long as the condition itself is covered and HBOT is prescribed as part of the treatment protocol for this condition. One insurer, Trupanion, specifically outlines HBOT treatment under their Additional Care Package.6

HBOT treatments are performed by a trained technician who continuously monitors the patient.

While purchasing HBOT is an option, most clinics partner with HVM. In this scenario, HVM places the equipment in the clinic (clinic infrastructure must meet specific guidelines for weight, power, etc.) at no charge and provides complimentary training to clinic staff. The clinic is responsible for providing oxygen. Revenues are then shared between the clinic and HVM on a per use basis. HBOT treatments pricing varies due to local price of oxygen, overhead, and more.

A SIGNIFICANT MODALITY FOR HEALING Simply put, HBOT helps animals heal much faster than I can achieve with merely holistic or conventional approaches. I cannot imagine practicing without having this therapy available. Though I am fortunate to have HBOT right here on site in my clinic, I wouldn’t hesitate to refer patients to

ACCREDITATION & ASSOCIATIONS In 2011, the National Board of Diving and Hyperbaric Medical Technology created the Certified Hyperbaric Technologist Veterinary Training and Certification Program. www.nbdhmt.org/chvt.asp There is board certification in human medicine for hyperbaric technology, hyperbaric nursing, undersea and hyperbaric medicine (American board of preventative medicine and American board of emergency medicine) vet.utk.edu/vhms/review.html. The University of Tennessee has started the Veterinary Hyperbaric Medicine Society (vet.utk.edu) and equine cases are presented on their site. Jain, KK. The History of Hyperbaric Medicine, Hogrefe Publishers, 2004 Lynne H. Thom et al. Stem cell mobilization by hyperbaric oxygen Am J Physiol Heart Circ Physiol 290:1378-1386, 2006. First published Nov 18, 2005. 3 Brawwell and Crowe, Hyperbaric Oxygen Therapy, VetLearn.com: Compendium. March 2012 4 http://www.vet.utk.edu/departments/LACS/hbot.php 5 Braswell and Crowe. Hyperbaric Oxygen Therapy. VetLearn.com: Compendium. March 2012 6 http://trupanion.com/canada/pet-insurance/complementary-therapies 7 Singh, MD1, Shailendra, Gambert, MD, AGSF, MACP, Steven R. Hyperbaric Oxygen Therapy: A Brief History and Review of its Benefits and Indications for the Older Adult Patient. Annals of Long Term Care, Volume 22 Issue 7-8, July/August 2014. 8 American Chemical Society: http://www.acs.org/content/acs/en/education/whatischemistry/landmarks/ josephpriestleyoxygen.html 9 Jain, KK. The History of Hyperbaric Medicine, Hogrefe Publishers, 2004 10 Edwards, Melissa L. Hyperbaric Oxygen Therapy. Part 1: history and principles. Journal of Veterinary Emergency and Critical Care 20(3) 2010, pp 284-297. 11-15 Singh, MD1, Shailendra, Gambert, MD, AGSF, MACP, Steven R. Hyperbaric Oxygen Therapy: A Brief History and Review of its Benefits and Indications for the Older Adult Patient. Annals of Long Term Care, Volume 22 Issue 7-8, July/August 2014. 16 Haffty BG, Hurley R, Peters LJ. Radiation Therapy with Hyperbaric Oxygen at 4 Atmospheres Pressure in the Management of Squamous Cell Carcinoma of the Head and Neck: Results of a Randomized Clinical Trial. Cancer Journal from Scientific American 1999; 5(6):341-347 17 www.hvmed.com 1 2

Amazingly, animals do not mind sitting in the chambers, and often look out through the windows.

IVC Winter 2014/2015

Advertorial

GUARD HIS

joints

By Carmen MH Colitz, DVM, PhD, DACVO, Terri L McCalla DVM, MS, DACVO, Johanna Mejia-Fava, PhD, DVM, and Debby Smith RPh, Compounding Pharmacist

rthritis should not be accepted as a natural course of aging. Joint pain reduces a dog or cat’s ability to physically perform at his best, and affects his mental well-being. The following can help: BOSWELLIA SERRATA: Potent anti-inflammatory, analgesic, and sedative properties; increases effectiveness of glucosamine and chondroitin. BROMELAIN: Occurs naturally in pineapple and inhibits prostaglandin and kinin synthesis.

CHONDROITIN SULFATE: Slows down joint cartilage destruction and stimulates production of new cartilage. GLUCOSAMINE: Helps increase synthesis of proteoglycans, GAGS, and collagen. May also act as an anti-inflammatory agent. OPTI-MSM™ (methylsulfonylmethane): Helps form the collagen that maintains skin elasticity. TURMERIC: Antioxidant and anti-inflammatory. Curcumin contains salicin that converts to salicylic acid. Joint Guard Vet™ offers natural, safe therapy for joint disease. This blend of 11 vitamins and natural plant extracts, including those above, addresses the inflammation and pain of arthritic conditions, and provides nutrients that help restore depleted collagen levels. It can help maintain your patients’ activity and comfort levels.

Dr. Carmen Colitz is a board certified veterinary ophthalmologist with a PhD in Comparative and Experimental Medicine. Dr. Terri McCalla is a board certified veterinary ophthalmologist and a member of Animal HealthQuest LLC. Dr. Johanna Mejia-Fava is a graduate of the Mississippi State University College of Veterinary Medicine. Debby Smith is a compounding pharmacist with over 30 years professional experience as owner of Ballard Plaza Pharmacy in Seattle. IVC Winter 2014/2015

ACUPUNCTURE can manage pain in cancer patients By Elizabeth Hershey, DVM, DACVIM (Oncology), CVA

ain is one of the most prevalent symptoms in veterinary patients with cancer. Pet owners are increasingly concerned with how much pain their pets may be experiencing. In people, a full 40% of patients with early or intermediate stage cancer, and 90% with advanced cancer, have moderate to severe pain, with bone pain the most common type.1

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Pain in the cancer patient often occurs from the tumor compressing or infiltrating surrounding tissues, or from skin, nerve and other changes caused by hormone imbalance or immune response. The presence of pain often depends on the type, location and stage of the cancer, as well as the pain tolerance of the individual animal. Treatments such as surgery, radiation therapy and/or chemotherapy may also cause pain.

Most chronic pain in the cancer patient is caused by the cancer itself, whereas acute pain is more often caused by treatment or diagnostics. However, in some patients, radiation and chemotherapy can cause painful side effects that persist long after treatment has ended.2,3

PAIN – THE FOURTH VITAL SIGN Pain is now considered to be the fourth vital sign – after temperature, pulse, and respiration (it’s the fifth vital sign in humans, after blood pressure), and should be integrated into patient evaluations so that the veterinarian can recognize, assess, prevent and treat the pain.4 Traditionally, pain has been categorized as acute or chronic, based on duration. The more contemporary approach is to consider pain as either adaptive or maladaptive. • Adaptive pain is a normal response to tissue damage. It includes acute inflammatory pain that often occurs with surgery or trauma. Inflammatory pain may also occur in chronic pain states such as osteoarthritis or cancer. If adaptive pain is not appropriately managed, physical changes occur in the spinal cord and brain, leading to pain that is termed maladaptive. • Maladaptive pain includes neuropathic and central pain. Pain-induced changes can occur in the nervous system causing it to become more sensitive rather than less sensitive. The longer pain is unmanaged, the more likely the neurophysiologic processes involved will result in a switch from adaptive to maladaptive pain, which is more serious and difficult to control.4 Acupuncture can be an important adjunct to managing the maladaptive pain often associated with cancer. Continued on page 32.

ACUPUNCTURE POINTS FOR PAIN • Bone: KID 1/3/6/7; BL 11 • Abdominal: BL 22/24/25; CV 4/5/6/7, LI 10 • Gastric and epigastric: SP3 • Lumbosacral: BL 26/27/28/36 • Thoracic: LU 1; HT 1; BL 14/15/16; CV 17/22 • Mouth: SI 7/8/19; TH 17 • Head: GB20; LI4 • Cervical: SI 3/7/8; TH 17 • Generalized: LIV 3/13; SI 9; GB 34; SP21 ; LI4 IVC Winter 2014/2015

Continued from page 31.

THE ROLE OF ACUPUNCTURE A recent systematic review of 33 randomized human clinical trials, evaluating the effectiveness of acupuncture in palliative care for cancer patients, suggests promising results. It also showed that acupuncture may help reduce the side effects of chemotherapy or radiotherapy.5 Auricular acupuncture in humans has been shown effective in treating neuropathic pain in cancer patients.6 The use of acupuncture in 286 patients with bone metastasis of cancer, meanwhile, reduced the need for analgesic or sedative drugs.7 The National Comprehensive Cancer Network (NCCN) guidelines for adult cancer pain now recommend acupuncture as an integrative intervention in conjunction with pharmacologic intervention, especially in frail, elderly and pediatric patients in whom standard pharmacological interventions may be less tolerated.8 In addition to pain management, additional benefits of acupuncture include enhancement of immunity9,10; alleviation of side effects from Western therapies (chemotherapy and radiation therapy)11; alleviation of symptoms of the cancer itself; and improvements in response to Western therapies. Approximately 70% of human cancer patients do not receive adequate pain relief. Many dog and cat cancer patients are “stoic” and do not always exhibit recognizable signs of pain, so it is likely that both owners and veterinarians underestimate a patient’s pain. Many conventional medication options exist for treating pain in veterinary patients. However, these medications may have side effects, and some owners are resistant to the idea of overmedicating their pets. Additionally, some patients do not experience adequate pain relief with conventional therapies at maximum doses, and additional therapies are needed to improve pain control and quality of life.

Acupuncture is a useful adjunct for pain management in the veterinary cancer patient. It can greatly reduce pain and the doses of conventional pain medications needed, thereby enhancing the patient’s quality of life. In many animals, a better outcome may be achieved if a combination of acupuncture and conventional pain medications is used. Acupuncture may also be beneficial in reducing the side effects of conventional pain medications, such as constipation, pruritis and nausea/vomiting.

HOW IT WORKS The physiological responses associated with acupuncture for pain include serotonin release from the upper brain stem region and hypothalamus, and stimulation of endogenous opiate release (B-endorphin, enkephalin, endomorphin and dynoprhin), which can then alleviate pain.12 In addition, some neurohormones like g-aminobuyrin acid and glutamate, neuropeptide Y and brain-derived neurotrophic factor can lead to euphoric sensations and treat the psychological aspects of pain in cancer patients.13,14 The main mechanism of the analgesic effect caused by acupuncture may be related to its ability to decrease substance P and upregulate plasma B-endorphin levels. In Traditional Chinese Medicine, Qi deficiency (weakness of immune function) is the fundamental or root pattern for cancer. Pain is a manifestation of the tumor and is associated with Qi or blood stagnation. Qi deficiency with blood stasis is a key factor leading to the development of tumor and metastases.15 Triggering acupuncture points promotes the flow of Qi and blood and regulates visceral function. (See chart on page 34.) Dry needle, aquapuncture and/or electroacupuncture techniques may be used in the veterinary cancer patient. Continued on page 34.

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Continued from page 32. Care is taken to avoid needles directly in or around a malignant tumor. When using electroacupuncture, care must also be taken to avoid crossing the electroacupuncture wires over the tumor. Between ten and 20 acupuncture needles are placed on the body, depending on the tolerance levels of the patient. Acupuncture sessions are 20 to 30 minutes long, with sessions repeated every one to three weeks, depending on the severity of the patient’s pain and his duration of response to the acupuncture treatment. Initially patients may be treated more frequently until improved pain control is achieved; then, intervals between sessions are lengthened. Patients with osteosarcoma, an extremely painful cancer, generally require more frequent treatments.

ACUPUNCTURE POINTS FOR QI AND BLOOD DEFICIENCY These points are selected for treating the main pattern of Qi or blood deﬁciency and the manifestation of Qi or blood stagnation (pain): TCVM Pattern

Point

Action

KID QI Deﬁciency

KID 3

Yuan Source point of kidney toniﬁes kidneys

KID 7

Jing-River point of kidney toniﬁes kidneys, resolves dampness

BL 23

Back-Shu point of the kidney – one of most effective points to tonify kidneys; tonify kidney yang, nourish kidney yin and essence

SP 3

Yuan Source point for spleen; Shu Stream point for spleen; strengthens the spleen, harmonizes spleen and stomach, resolves dampness; one of the major tonifying points of the body

SP 6

Crossing point of spleen, liver and kidney meridians; strengthen spleen and stomach, resolve dampness; nourishes blood and yin

BL 20

Back Shu point of spleen; toniﬁes spleen/stomach; nourishes blood; resolves dampness; regulates SP/ST Qi

ST 36

He-Sea point of the ST meridian – most important points to tonify Qi and blood and promote general wellness; strengthens the body and Wei Qi

LI 10

Regulates Qi and blood; toniﬁes Qi

SP 6

Nourishes the blood and yin, cools and invigorates the blood

SP 10

Major point for treating any disorder of the blood; invigorates, moves and cools the blood

BL 17

Converging point of blood; invigorates, cools and nourishes the blood

BL18

Back Shu point for liver; regulates and nourishes liver blood

BL20

Toniﬁes spleen/stomach; nourishes blood

SP Qi Deﬁciency:

In summary, acupuncture is a useful adjunct for the treatment of pain in veterinary cancer patients. In combination with conventional pain management, acupuncture may improve pain control and enhance quality of life. It may also decrease the side effects associated with conventional pain medications, and may allow for decreases in overall dosages of pain medications. Additional benefits include enhanced immunity, decreased side effects from chemotherapy and radiotherapy, decreased symptoms from the cancer, and improved response to Western therapies.

Blood deﬁciency

Daut RL, Cleeland, CL. “The prevalence and severity of pain in cancer.”Cancer Nov 1;50(9):1913-8, 1982. Bokhari, F, Sawatzky JV.“Chronic Pain in Women After Breast Cancer Treatment.”Pain Manag Nurs.;10(4):197-205, 2009. 3 Lew MH, Chwistek M, Mehta RS. “Management of chronic pain in cancer survivors.” Cancer J. NovDec;14(6):401-9, 2008. 4 Hellyer P, Rodan I, Brunt J, Downing R, Hagedorn JE, Robertson SA. “AAHA/AAFP Pain Management Guidelines for Dogs and Cats.”JAAHA, 43:235-248, 2007. 5 Lian WL, Pan MQ, Zhou DH, Zhang ZJ. “Effectiveness of acupuncture for palliative care in cancer patients: a systematic review.”Chin J Integr Med Feb;20(2):136-47, 2012. 6 Alimi D, Rubino C, Pichard-Leandri E, et al. “Analgesic effect of auricular acupuncture for cancer pain: a randomized, blinded, controlled trial.”J Clin Oncol, 21, 4120-6, 2003. 7 Guo R, Zhang L, Gong Y, Zhang B. “The treatment of pain in bone metastases of cancer with the analgesic decoction of cancer and the acupoint therapeutic apparatus.” J Tradit Chin Med, 15, 262-4, 1995. 8 National Comprehensive Cancer Network. “NCCN Clinical Practice Guidelines in Oncology.” Adult Cancer Pain. Version 2, 2012. Available from accn.org/professionals/physician_gls/f_guidelines.asp#pain. 9 Johnston MF, Ortix Sanches E, Vujanovic NL, Li W. “Acupuncture May Stimulate Anticancer Immunity via Activation of Natural Killer Cells.” Evid Based Complement Alternat Med 2011. 10 Wu B, Zhou RX, Zhou MS “Effect of acupuncture on immunomodulation in patients with malignant tumors.” Zhongguo Zhong 1996 Mar;16(3):139-41. 11 Tas, D, Uncu D, Sendur MA, Koca N, Zengin N. “Acupuncture as a complementary treatment for cancer patients receiving chemotherapy”. Asian Pac J Cancer Prev 15 (7), 3139-3144, 2014. 12 Lin JG, Chen WL. “Acupuncture analgesia: A review of its mechanism of actions.” AM J Chin Med 36:635-45, 2008. 13 Yu LL, Liu RP, Gao XY, et al. “Development of studies on neurochemical mechanism of acupuncture underlying improvement of depression.”Zhen Ci Yan Jiu 36:383-7, 2011. 14 Wang XJ, Wang LL. “A Mechanism of endogenous opioid peptides for rapid onset of acupuncture effect in treatment of depression.” Zhong Xi Yi Jie He Xue Bao 8:1014-7, 2010. 15 Wu W and Yu E. “Advances in the researches on the blocking effect of Chinese drugs on tumors.” J Traditional Chinese Med. 2001 Sep;21(3):236-40 1 2

IVC Winter 2014/2015

Advertorial

CHRONIC infections and biofilms By Kim B. Perkins, PhD

Indiscriminate antibiotic use has caused a dramatic rise in antibiotic-resistant bacteria. To determine which antibiotic is most appropriate, many veterinarians will send samples for culture and sensitivity testing. The classic antibiotic sensitivity testing assay is based on the disk diffusion method, whereby antibiotic-soaked disks are placed on plates inoculated with the sample bacteria. The size of the zone of inhibition (an area of no growth surrounding the disk, which results from bacterial sensitivity to the antibiotic) is measured. Additional assays using microtiter plates or automated antibiotic-sensitivity test cards are also commonly used. Although rapid and reproducible, these tests only determine the effectiveness of antibiotics on bacteria present in the planktonic or free-floating state. It is now known that in most cases of chronic infection, the bacteria are not in the planktonic state but are primarily present as a biofilm, a complex community of bacteria encased in an extracellular matrix composed of proteins, DNA and polysaccharides. This matrix acts as a physical barrier, protecting the bacteria inside from a variety of environmental insults. Because of this protective matrix, as well as the associated intercellular signaling that occurs between bacteria in the community, biofilm bacteria are significantly more resistant to antibiotics (in some cases more than 1,000-fold) than planktonic bacteria. Although antibiotic treatment may initially decrease symptoms, once it is discontinued the remaining bacteria will renew the biofilm and symptoms may recur. The recently developed becSCREEN assay is designed to determine the antibiotic resistance profile of both planktonic and biofilm bacteria. It features a microtiter plate containing 96 pegs projecting from the lid. These pegs allow for bacterial adherence and biofilm formation so the antibiotic sensitivity analysis may be performed.

Following biofilm formation, the pegs are incubated in growth media containing several concentrations of a variety of antibiotics. The pegs are then washed and further incubated in a recovery plate. The sensitivity or resistance of the bacteria to each antibiotic is assessed by observing the growth in the microtiter plate. Once completed, the assay gives antibiotic sensitivity results for sample bacteria in both planktonic and biofilm states, allowing for easy comparison. This assay has been used to successfully treat a variety of chronic infections including recurrent pyoderma and pyogenic otitis externa in dogs, and hemorrhagic cystitis and sinusitis in cats. In each case, traditional antibiotic testing was performed and the initial therapeutic course of action failed to resolve the condition. Following becSCREEN testing, an alternate therapeutic course of action was determined and, in all cases, the condition was resolved within two months.

Regeneration of biofilms following antibiotic treatment. Taken from: Drenkard, E. â&#x20AC;&#x153;Antimicrobial Resistance of Pseudomonas Aeruginosa Biofilm.â&#x20AC;? Microbes and Infection, 2003, 5: 1213-9.

Kim Perkins joined the Spectrum Group in early 2012 and is currently the Laboratory Director where he oversees the development, optimization and manufacture of veterinary diagnostic assays. He obtained his PhD from Arizona State University while studying the molecular mechanisms of viral pathogenesis, focusing on the role viral dsRNA-binding proteins play in disease. He has presented at several conferences and was an invited speaker at the International Angiogenesis Conference in Greece. IVC Winter 2014/2015

nutrition nook

CAN

HIGH-FAT

BEEF-BASED

RAW DIETS

LEAD TO BEHAVIORAL ISSUES AND AGGRESSION IN SOME DOGS? By Steve Brown

More people are feeding their dogs homemade and commercial fresh meat-based or raw diets. It’s therefore increasingly important for veterinarians to be able to guide their clients on how to make meat-based diets that meet nutritional standards.1 Nutrient analyses of high-fat beef diets reveal that they may contribute to potential health and especially behavioral problems in dogs. Lean meat diets correct these issues. Good recipes start with good bases and build from there. The base is the primary meat used in the recipe and is often ground meat in ruminant recipes, and bone-in parts in poultry recipes. Using fatty meats as a base can result in diets that fall short of minimum recommended amounts of protein for puppies; exceed safe upper limit recommendations for total fat; and have poorly balanced fats. More concerning is that a base of 70% lean beef does not provide even half of the minimum recommendations for the essential amino acid tryptophan, which some studies2 suggest may lead to aggressive behaviors.

of the time, and are especially important for pregnant dogs and puppies. I also believe that poorly-formulated raw diets are less nutritious than recently-made, basic (without fish oils) kibble, with some sardines added weekly.

NOT ENOUGH PROTEIN IN A 100% BEEF DIET? Many people present to me a scenario like this: “I got this great deal on ground beef. Can you help me build a complete and balanced food?” Sometimes the ground beef is 60% lean (that means 40% fat), and sometimes 70% or 80% lean. I am using 70% lean in this example (“Recipe” in the charts). A 70% lean ground beef diet provides 43 grams of protein per 1,000 kcal – recommended minimums are 56.3 grams for puppies and 45 grams for adults. The 70% lean beef provides 91 grams of fat per 1,000 kcal, exceeding the NRC safe upper limit of 82.5 grams (see chart 1). Even if one were to add 10% liver and 20% vegetables, the diet still would exceed standards for total fat, and would be well short of minimum protein recommendations for puppies.

DOES TOO MUCH FAT MAKE IT DIFFICULT FOR High-fat meats are not part of the ancestral diet. As discussed DOGS TO LEARN AND PAY ATTENTION? in Unlocking the Canine Ancestral Diet, wild prey animals upon “You are what you eat” applies to fat more than anything which the dog evolved were leaner, with different fat profiles else. The reason for this is that the fats the dog eats than feedlot-fed or even pastureChart 1. A recipe of 70% lean ground beef compared to standards (shaded area is outside standards) raised animals.3 Dog: Growth Dog: Maintenance 2006 NRC European European European (upper Adult Early Growth Late Growth Recipe 2014 AAFCO 2014 AAFCO Macronutrients I firmly believe that wellmin. min. safe limit) min. min. min. formulated fresh meat-based diets, Grams fat per 1,000 kcal 91 21.3 13.8 82.5 13.75 21.25 21.25 raw or lightly cooked, are by far the best way to feed most dogs most Grams protein per 1,000 kcal 43 56.3 45 45 62.5 50

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become incorporated into the membranes of every cell in his body. Among their many vitally important functions, cell membranes let food into the cells and release waste products. Healthy cell membranes are the essence of good cellular health; unhealthy cell membranes decrease the overall efficiency of the cells, and therefore of the organs and entire body. When consuming balanced fat diets, dogs learn faster and remember more, are better behaved, have stronger hearts, better skin and coats, and experience decreased chances of cancer and allergies. Many studies over decades have documented the benefits of balanced fat diets4, 5, 6

THE DATA SUGGESTS THAT HIGH-FAT BEEFBASED DIETS MAY BE A CONTRIBUTING FACTOR TO BEHAVIORAL PROBLEMS Prolonged exposure to a high-fat diet is correlated with changes in the brain chemistry of mammals â&#x20AC;&#x201C; and in particular, brain systems that regulate motivation and willingness to work for food7. Consumption of a high-fat diet as a fetus and in early growth stages appears to have long-lasting effects on learning and memory during adulthood.8 Even though this all-beef diet contains too much fat, it does not provide sufficient amounts of any of the essential fatty

acids: LA, ALA, AA, EPA and DHA. If one rotates ruminant and poultry, there may not be a worry about LA. But if not rotating, a source of LA needs to be added. Lack of LA has been correlated with skin and coat problems. Lack of EPA has been linked to depression and sadness in mammals; and without DHA, the dogâ&#x20AC;&#x2122;s brain, eyes, hearing, thinking, and memory will not as good as it could be. It is difficult to add these essential fats to a diet that already has too much fat. One has to reduce the total amount of fat first, and then add the fish or fish oils.

HIGH-FAT BEEF DIETS LACK TRYPTOPHAN, A PRECURSOR TO SEROTONIN It is also important to consider the amino acid profile of the diet. A diet of 70% lean ground beef provides only 0.22 grams/1,000 kcal of tryptophan. The AAFCO minimum recommended amount for puppies (growth) is 0.5 gram, and the European minimum is 0.58 grams (see Chart 2 on page 38). Several published, peer-reviewed studies suggest that lack of tryptophan in high protein9 diets can be linked with certain types of aggressive behaviors. Tryptophan, the precursor of serotonin, may affect the incidence of aggression, selfmutilation and stress resistance. Continued on page 38.

IVC Winter 2014/2015

Chart 2. The amino acid profile of 70% lean beef (Recipe) compared to standards, (g/1,000 kcal Metabolizable Energy (ME))

Caloric basis Amino Acids Tryptophan

Recipe 0.22

Dog : Dog: Growth + Repro Maintenance 2014 AACO 2014 AAFCO min. min.

0.50

0.40

Dog: Adult European min.

Dog: Dog: Early Growth Late Growth European European min. min.

0.43

Continued from page 37. Hopefully, not many people feed their dogs only 70% lean ground beef, but many people add fatty ground beef to their dogs’ dry food. If one feeds a cup of dry food and a cup of 70% lean ground beef, 60% to 70% of the calories will be from the ground beef, and the total amount of tryptophan will be in the range of 0.35 to 0.45 grams/1,000 kcal, well short of standards for puppies, and may not reach minimum recommendations for adult dogs (0.4 AAFCO, 0.43 European).

0.58

0.53

fat beef-based diet. It’s a good idea to ask each client, at every visit, what she is feeding her dogs, including treats. If your client is making her own foods or adding meat to dry foods, you need to estimate the total fat content. This is especially important when it comes to potentially aggressive dogs.

Other common mistakes made with homemade raw diets include using the wrong calcium and fat sources, and not supplementing with the proper trace minerals. I address these issues in Guidelines for Helping Clients Formulate Meat-Based Diets that Meet AAFCO, NRC and European Standards, which can be found on the IVC Journal website (ivcjournal.com).

Long-term implications for aggression in dogs can result. Consider a breed with a genetic predisposition to aggression, for example. If the pregnant dam eats a dry food diet supplemented with very high-fat beef, but not with fish or fish oils, and then her puppies eat the same diet and are not well socialized with other dogs and people, the puppies could have an increased risk of being aggressive. If one of the puppies goes to new home where he is fed half dry kibble and half 70% lean ground beef with no added fish, and he does not get properly socialized and trained, severe aggression could result. The owners think they are helping the puppy’s health by adding ground beef, but could actually be putting him at risk.

START WITH 85% TO 90% LEAN GROUND BEEF, AND BUILD A GREAT BASE You can build a superb diet by starting with a base of 85% lean ground beef for adults, and 88% lean for puppies. The total fat amounts are within all standards and the diet has ample tryptophan. It’s a good start and it now becomes easy to balance the fats and add the necessary minerals and vitamins. Rotating ruminant and poultry meats is best. As I show in my formulation seminars, one can rotate two relatively inexpensive meats – 80% lean ground beef (which on its own lacks tryptophan), and chicken necks with the skin and separable fat removed (on its own it has too much Ca and P), to produce an excellent base. Rotating these meats – one day beef, the next day chicken – helps balance the fats, minerals, and amino acids. It’s important to be aware of the potential behavioral issues that may arise in dogs when their owners feed them a high-

IVC Winter 2014/2015

A merican Association of Feed Control Officials (AAFCO), proposed revisions for 2014 Official Publications, The National Research Council of the Academies of Science (NRC)“Nutrient Requirements of Dogs and Cats”2006, and The European Pet Food Industry Association “Nutritional Guidelines for Complete and Complementary Pet Food for Cats and Dogs”, July 2013. 2 DeNapoli JS, Dodman NH, Shuster L, Rand WM, Gross KL. “Effect of dietary protein content and tryptophan supplementation on dominance aggression, territorial aggression, and hyperactivity in dogs.”J Am Vet Med Assoc. 2000 Aug 15;217(4):504-8. 3 Brown, Steve. Unlocking the Canine Ancestral Diet – Healthier Dog Food the ABC Way. Dogwise Publishing, 2009. 4 J. Schumann et al. “Treating canine atopic dermatitis with unsaturated fatty acids: the role of mast cells and potential mechanisms of action”. JAPAN online, March 2014. Doi: 10.1111/jpn.12181. Weaver et al. “Effect of dietary fatty acids on inflammatory gene expression in healthy humans”. Journal of Biological Chemistry, 2009. Retrieved June 2, 2009 from sciencedaily.com/releases/2009/05/090529183250.htm. 5 University of California – Los Angeles Scientists. “Learn How Food Affects The Brain: Omega 3 Especially Important.” 2008, July 11. Science Daily. Retrieved July 14, 2008 from sciencedaily.com/releases/2008/07/080709161922.htm. 6 For complete references, I refer the reader to three recently published review articles that reference the hundreds of studies upon which these conclusions were built: Gomez-Pinilla, Fernando. “Brain foods: the effects of nutrients on brain function”. Nature Reviews Neuroscience. 9, 568–578, July 2008; McCann, Joyce and Ames, Bruce. “Is docosahexaenoic acid...required for development of normal brain function? An overview of evidence from cognitive and behavioral tests in humans and animals”. Am J Clin Nutr. 2005; 82: 281–95; and Carlson, Susan “Early determinants of development: a lipid perspective”. Am J Clin Nutr. 2009; 89(suppl): 1523S–9S. 7 Endocrine Society. “Adolescents’ high-fat diet impairs memory and learning”. ScienceDaily. Retrieved June 18, 2013 from sciencedaily.com/releases/2013/06/130617110813.htm. 8 Endocrine Society. “High-fat diet during pregnancy contributes to offspring’s increased weight”. ScienceDaily. Retrieved June 18, 2013, from sciencedaily.com/releases/2013/06/130617142033.htm. 9 Even though a 70% lean ground beef diet lacks sufficient protein for any dog, it may be considered a“high protein”diet because, on a dry matter basis, it is 32% protein. When compared to the protein content of most dog foods, 32% protein is higher than most. The high protein diets in the studies were 32% protein. 1

Advertorial

Pet medical INSURANCE

– giving clients financial access to integrative care By Kerri Marshall, DVM Pete, a Basenji-Corgi mix, was diagnosed with Immune Mediated Hemolytic Anemia when he was nine years old. His treatment regimen included strong medication, weekly testing, and alternative therapies from several veterinarians specializing in emergency care as well as conventional and holistic medicine. Pete’s owners had medical insurance for him, so their dog had access to all the options he needed to treat his condition and extend his life. In total, they submitted over $15,170 in claims, but only had to pay $4,119 of the costs, including the deductible. They credit their ability to continue Pete’s treatment to this financial coverage, and stated that without the treatment, he would not have lived as long as he did – a further two years after diagnosis, despite his low chances of survival. Pet owners like Pete’s have access to an unprecedented level of veterinary care, and many are taking the integrative approach, combining conventional and alternative therapies to optimize the care their animals receive. However, this approach comes with financial restrictions; an integrative treatment program that could make a huge difference for a pet may fall outside a client’s budget, rendering them inaccessible and forcing pet owners and veterinarians to compromise on care. Sometimes economic euthanasia becomes the only option, and this can take an emotional toll on both owner and veterinarian.

TOUGH DECISIONS CAN BE MADE EASIER Fortunately, medical insurance for pets is changing this scenario. As insurance companies adjust their policies to better fit client needs and the veterinary industry, more pet owners are enrolling in coverage, helping to eliminate financial burden and increase access to the best veterinary medicine. Some policies now offer coverage for alternative therapies like rehabilitative therapy, acupuncture, hydrotherapy, chiropractic, behavioral modification, homeopathy, and naturopathy. Every provider is different, however, and offers

How insurance increases vet visits In an analysis1 of 83,908 insured and uninsured pets, the mean annual revenue for veterinary practices increased from $437 per uninsured pet to $837 per insured pet, while mean annual visits increased from 2.4 for uninsured pets to 4.4 for insured pets. varying coverage with differing plans, payment options, pricing options and limitations. While most companies use a reimbursement model, some, such as Trupanion, offer a vet-direct pay option that pays the veterinarian directly so clients only need to pay a small portion of the bill up front. While some companies require annual contracts, others use a monthly subscription model. Before deciding to recommend or enroll with a provider, practices should ask relevant questions such as: • What percentage of the veterinary bill is covered? Are there limits or a benefit schedule? • How will a pet’s species, age, and breed influence the cost and coverage of the policy? Is there a deductible? • What treatments are included in coverage? Is there an option for alternative therapies? • Does the policy cover hereditary and congenital conditions? • What constitutes a pre-existing condition? Great coverage builds a flexible base for you and your clients to work from, allowing you to make decisions based on the well-being of the pet rather than the client’s finances.

Trupanion, 2014

Dr. Kerri Marshall graduated with her Doctorate in Veterinary Medicine from Washington State University. She worked for 16 years at Banfield Pet Hospitals and joined Trupanion in June of 2011 as Chief Veterinary Officer. IVC Winter 2014/2015

industry innovations New acquisition for Virbac

New natural remedies

Virbac Corporation has entered into an agreement with Eli Lilly and Company to acquire US veterinary products currently marketed by Novartis Animal Health. Virbac would acquire a combination of titles and rights for the US on trademarks, patents, know-how, customer lists and other assets related to two parasiticides for dogs: Sentinel® Flavor Tabs and Sentinel® Spectrum. The completion of this transaction is subject to approval by the Federal Trade Commission; as of this writing, Virbac expects this approval to be received in the near future.

The F.C. Sturtevant Company, known for the Columbia brand of products, is re-launching and expanding its consumer Veterinary Health Division under the name of Sturtevant’s Veterinary Remedies. Made in the US with domestically-sourced premium quality ingredients, the initial products are designed to treat skin ailments and include a Canine Formula and Large Animal Formula. They incorporate novel reﬁnements to the proprietary formula used in the company’s Columbia Veterinary Antiseptic Powder, and consist of zinc oxide and phenol among other ingredients. Designed to protect and restore the skin, they provide safe and effective healing without the side effects found in many other products. Products for other animals are in the ﬁnal phases, as are novel treatments for chronic dermatological conditions.

VirbacVet.com

ColumbiaSkinCares.com

Help for crusty noses

Biomarker-based blood tests

Nasodigital hyperkeratosis is an idiopathic condition that causes excessive formation of keratin on a dog’s nose. The result is a dry, crusty nose that looks unsightly and feels uncomfortable for the animal. Many breeds, such as Bulldogs, Pugs, Boston Terriers, Boxers, Chihuahuas, Mastiffs, Labs, Golden Retrievers and German Shepherds, develop the problem. The Blissful Dog’s Organic NOSE BUTTER® is a fact-acting solution. Handcrafted from organic ingredients like Shea butter, castor oil, coconut oil, beeswax, olive oil, cacao seed butter, avocado oil, and a dash of the best essential oils, this all-natural product quickly moisturizes and clears up crusty noses.

VDI Laboratory provides biomarker-based blood tests to be used for diagnosis and monitoring in the fields of cancer, inflammation, infection and immunity. These comprehensive, non-invasive blood tests aid clinical decision-making in a variety of settings, from wellness screening and diagnostic workups to therapeutic monitoring and acute care triage. The company’s growing number of unique specialty tests are designed to help you quickly find answers in the most costeffective manner.

TheBlissfulDog.com

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VDILab.com

Focus on dental issues

Herbal bites

For practitioners exploring the option of anesthesia-free dental cleanings, Pet Dental Services, which currently provides the procedure in more than 200 veterinary hospitals in the United States, offers a proprietary, 11-step Professional Outpatient Preventive Dental™ (POPD) process. It includes periodontal probing, supragingival scaling, subgingival curettage, machine polishing, and irrigation of all surfaces, as well as detailed charting, pre-screenings and initial oral exams for dogs and cats. Practice owners who incorporate POPD into their practices see beneﬁts such as an increase in the sales of ancillary services and products.

Here’s an herbal solution designed for easy administration that cats and dogs will love. Herbsmith Herbal Bites combine herbal formulas with a complimentary US-sourced meat in one easy-to-administer freeze dried medallion. Each delicious morsel delivers a quarter teaspoon of herbs without any grains, preservatives, additives, ﬁllers or fuss. Herbsmith Herbal Bites are available in 16 popular core formulas that address common issues seen by holistic veterinarians. HerbsmithInc.com

PetDentalServices.com

Whole body comfort for dogs Alenza® Chewable Tablets offer a multi-system approach to support daily comfort, condition and quality of life in active and aging dogs. It is formulated with Vexadol®, a proprietary blend of naturally-occurring bioﬂavonoids, to help maintain a healthy inﬂammatory response. You know the important role Omega-3 fatty acids play in supporting general body health. But not all fatty acids are the same. Free Form™ is a concentrated formulation of Omega-3 fatty acids blended to help support vital bodily functions in dogs and cats. For more information, call Bayer Customer Service at 800-633-3796.

Spotlight Speed wound healing

Virginia veterinarian Ron Fessler, DVM, stated that he is happy with how a HealFast Therapy device sped healing for a quarter horse with an ugly skin tear that went untreated for the ﬁrst four days. The wound was more than 6” wide and deep. Dr. Fessler cleaned and stitched the tear and used a HealFast Loop to control the swelling and pain. Despite the severity of the wound, the horse is now completely sound. Learn more online. HealFastTherapy.com

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

ASSOCIATIONS

East York Animal Clinic Toronto, ON Canada Phone: (416) 757-3569 Email: eyac@ca.inter.net Website: www.holisticpetvet.com

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

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 Website: www.civtedu.org

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

THERMAL IMAGING

INTEGRATIVE THERAPIES

Dr. Shawn Messonnier Paws and Claws Vet Clinic Plano, TX USA Phone: (972) 712-0893 Email: shawnvet@sbcglobal.net Website: www.pettogethers.net/healthypet

Traditional Chinese Veterinary Medicine TCVM Reddick, FL USA Phone: (352) 591-5385 Email: register@tcvm.com Website: www.tcvm.com

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

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

INTEGRATIVE VETS

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

Veterinary Information Network - VIN Davis, CA USA Phone: (530) 756-4881 Email: vingram@vin.com Website: www.vin.com

EQUINE NATUROPATH

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

Pitcairn Institute of Veterinary Homeopathy - PIVH Portland, OR USA Phone: 760-230-4784 Email: info@pivh.org Website: www. pivh.org

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

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

qualit y ofin cancer life patients Advertorial

Improving

Cancer patients often experience pain and other serious issues that affect their overall well-being. Pain is caused primarily by tumor growth, a spreading cancerous disease, or the negative side effects of chemotherapy or radiation. Cancer-related pain may be acute or chronic. You may also have to watch for behavioral changes that can be associated with the pain.

THE HHHHHMM SCALE1 Assessing and optimizing a cancer patient’s quality of life is an important part of the ongoing treatment regime. Assigning a score of 1 to 10 on each of the following criteria helps determine a patient’s quality of life. A score higher than 35 signifies an acceptable quality of life. Hurt – Adequate pain control, including breathing ability, is first and foremost on the scale. Is the pet’s pain well managed? Can he breathe properly? Hunger – Is he eating enough? Does hand-feeding help? Does he require a feeding tube? Hydration – Is the patient dehydrated? For patients not drinking enough water, use subcutaneous fluids daily or twice daily to supplement fluid intake. Hygiene – Is the patient brushed and cleaned, particularly after elimination? Are there any pressure sores? Are wounds kept clean? Happiness – Does the pet express joy and interest? Is he responsive to things such as family or toys? Is he depressed, lonely, anxious, bored or afraid? Mobility – Can the patient get up without assistance? Does he feel like going for walks? Is he having seizures or stumbling? More good days than bad – When bad days outnumber good, quality of life might be compromised. I’m-Yunity® is an herbal supplement for immune health and used in complementary and integrative cancer therapy. I’m-Yunity® is also used to improve the quality of life for cancer patients. It contains a proprietary Coriolus versicolor mushroom extract, which has been clinically tested at UPENN Vet School for dogs diagnosed with hemangiosarcoma. The results shows promise to improve immune health in dogs with cancer and their quality of life. I’m-Yunity® can help to improve: • Hurt: Reduces and manages pain • Hunger: Improves appetite • Happiness: Helps calm the dog • Mobility: Improves energy levels • More good days than bad: Raises this score

Adapted from original concept, Oncology Outlook, by Dr. Alice Villalobos, “Quality of Life Scale Helps Make Final Call”, VPN, 09/2004.

IVC Winter 2014/2015

NORMAL AND ABNORMAL EQUINE POSTURE How PRI can help performance and health By Karen Gellman, DVM, PhD

Why should we care about posture in horses? Because it informs us about how their complex neuro-musculoskeletal system is functioning. Recognizing abnormal compensatory postures as a cause of multiple neurological, muscular and behavior problems is key to improving equine health.

distortion, chronic lameness, impaired proprioception, poor gait timing, predisposition to injury, delayed healing and pervasive physical and emotional stress.

CAUSES OF ACP Being domesticated causes the following problems for horses:

Horses can be returned to normal neutral posture (and maximum performance!) by using Postural Rehabilitation Intervention, a manual therapy to restore correct responses in the upper cervical righting mechanisms, and accurate balancing of hoof proportions and dental occlusion. Maximum Horsepower Research’s recent study, funded by the American Holistic Veterinary Medical Foundation, proposed that an optimal neutral posture exists for all animals. Preliminary results from the study have shown a clear relationship between posture and “cost of stance”. Abnormal compensatory postures (ACP) are associated with somatic

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q Restricted exercise – usually lacking appropriate ground surfaces and varied terrain.

w Dietary changes – eating precut forage and concentrates alters digestion and changes masticatory patterns, thus affecting TMJ function.

e Use

of force by humans – getting shanked, corrected, “rollküred” or pulling against cross-ties can damage the delicate muscles of the poll.

r Improper hoof trimming – especially long toes. t Inadequate dental care – especially retention of malocclusions that restrict anterior-posterior jaw movement.

These human interventions result in damage to the upper cervical spine and musculature, leading to suboptimal function for stance and locomotion. The structural distortions in feet and teeth can distort the neural signals that inform the brain about the body’s position in relation to gravity. Surprisingly, horses spend much more time standing than they do moving. The average domestic horse is ridden for an hour a day, lies down briefly for REM sleep, but spends the rest of his time standing – typically, around 22 hours a day. Therefore, his stance can have a lot more influence on overall soundness than his exercise program.

research has shown certain postures to be associated with specific behaviors in horses, and spinal pain to be associated with aggressiveness.8

SIGNS OF ACP Abnormal compensatory postures (Figure 1b) are commonly manifested with several of the following characteristics: • Limbs (MC3, MT3) consistently non-perpendicular with respect to the ground • Unwillingness to stand and bear weight on all four limbs simultaneously Continued on page 46.

NORMAL NEUTRAL POSTURE The standing posture observed in a normal, sound horse at rest is called normal neutral posture (NNP). Neutral stance balances and stabilizes the body’s center of mass, allowing rapid, accurate mobilization when necessary. NNP is the functional output of sensory and gravitational information processed through the CNS 1 and is a prerequisite for wellness in all animals, including humans. The CNS regulates the activities of the mind and body as a complex system – an integrated, dynamic interaction of neurons, receptors, bones, muscles, connective tissue, and visceral functions. When standing on level ground, all four cannon bones (MC3) should be perpendicular to the ground, like a table (Figure 1a). Equine anatomy is adapted so that upright posture optimizes passive support mechanisms, making NNP metabolically economical to maintain. Limbs in this posture are positioned identically to maximize vertical loading during locomotion. Standing for long periods with perpendicular limbs best prepares the bones, muscles and ligaments for the higher forces experienced during high speed gaiting.

Figure 1a: Normal neutral posture When a horse is standing on level ground, all four cannon bones should be perpendicular to the ground, like a table. Equine anatomy is adapted so that this posture is the most energy efficient – any other posture takes more muscular energy to maintain, and puts strain on tendons and ligaments.

MECHANISM OF ABNORMAL COMPENSATORY POSTURES ACP is generated by the postural control system2 in response to flawed proprioceptive signaling from anatomic distortion, and misuse in regions rich in mechano-receptors: the upper cervical region, especially the small musculature; the occiput; C1-C2 and dural attachments1, 3; the feet4 ; and the dentition and temporo-mandibular joints5, 6. ACP is also observed to be associated with impairment of emotional regulation, hyper-vigilant or dissociative behaviors, and presumed dominance of the sympathetic axis of the ANS. This ANS imbalance may be tied into long-term disruption of mind-body-emotion integration, parallel to that seen in human victims of illness, trauma, abuse and neglect7. Recent

Figure 1b: Abnormal compensatory posture One of the most common causes of poor posture is imbalanced hooves, especially long toes. When toes are too long, the flexor tendons are taut and put pressure on the heels, resulting in the compensatory posture we call “goaton-a-rock”, where both front and hind legs are camped in. Chronic compensatory posture causes sore backs, hind limb lameness and heel pain (navicular syndrome). IVC Winter 2014/2015

CORRECTING THE PROBLEM How can we improve abnormal standing postures in horses? Many therapeutic modalities alter neural regulation to make changes in a patient’s physiology, mechanics and emotion – these include osteopathy, acupuncture, chiropractic and physical therapy as well as allopathic medicine. The Postural Rehabilitation Intervention (PRI), a manual therapy protocol developed by Dr. Judith M. Shoemaker, is similar to the Alexander Technique in humans and seeks to:

q Lengthen the spine w Release compression and increase stability at critical transitional regions of the spine e Allow expansion and ease of use of the musculoskeletal system, making physical function, especially breathing, more balanced and effective6. Long term success also requires addressing and correcting distortions of hooves and dentition. STUDY RESULTS SHOW VALUE OF POSTURE CORRECTION The eight horses in the MHPR study were chosen because they exhibited one or more of the most common signs of ACP. They were sound, barefoot horses who stood in ACP on level ground and had hind frog width greater than or equal to fore frog width, suggesting their ACP was chronic enough to influence hoof morphology. When analyzing the data, every horse was found to have anterior-posterior movement restrictions in his/her dental occlusion, and distorted anterior to posterior proportions in weight-bearing surfaces (long toes). The horses underwent three clinical interventions over a tenweek period, with five weeks between baseline, interim and final measurements. Extensive measurements were taken of their hooves, teeth and weight-bearing parameters3. The first intervention was a balanced hoof trim and accurate occlusal equilibration. Hooves were trimmed according to specific criteria at five-week intervals for the remainder of the study. The second and third interventions were applications of PRI manual therapy.

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Analysis of these enormous data sets has just begun, but already some exciting results are emerging, confirming prior clinical observations:

q The force plate recordings have confirmed our theoretical understanding that standing in ACP is more energetically costly than in NNP. When a horse’s legs are camped in, to maintain this ACP, extra muscular effort is necessary to prevent collapse. w Application of PRI hoof trim principles resulted in rapid improvements in the front to rear frog width ratios. e S ubjectively, spinal contours were observed to alter through the course of the experiment. S r ubjective changes in behavior and emotion were observed by researchers. t ACP is commonly associated with long toes and A/P movement restrictions of dental occlusion. Whether they were caused by ACP, or are the result of ACP, would require a different study design. Many challenges to our understanding were presented during this study. For instance, even though being sound and barefoot were inclusion criteria for the experimental cohort, every horse revealed significant foot pathology in their radiographs, despite feet that seemed superficially healthy. We also found that the handler holding the horse had enormous influence on the animal’s posture, showing that recording “habitual posture” can be quite tricky in experimental circumstances. Our most elderly subject, a 29-year-old Arab mare with compromised dentition, poor condition and evidence of chronic laminitis (Figure 2a), looks 20 years younger after the study (Figure 2b).

Photo courtesy of Elizabeth Reese

Continued from page 45. • Unwillingness to stand symmetrically, with limbs aligned, i.e. a leg at each “corner” • Chronic asymmetrical weight-bearing, as evidenced by disparate hoof size • Aberrant or asymmetrical neck and head position, including eyes not held level • Distorted or asymmetrical spinal contour • Performance problems • C hronic or recurrent lameness, with no known structural damage

Figure 2a: Abnormal compensatory posture 29-year-old Arab mare before study.

Photo courtesy of Elizabeth Reese

osteopathic that promote the neutral, unrestricted movement of the upper cervical region (skull, C-1, C-2), can help the horse reset to his normal neutral posture.

Figure 2b: Normal neutral posture

For more on posture and performance, see our Facebook pages: “Postural Rehabilitation for Horses and Dogs”, and “Maximum Horsepower Research”. The Maximum Horsepower Research team includes Karen Gellman, DVM, PhD, Judith M. Shoemaker, DVM, Elizabeth Reese, MEd-LMHC, and Daisy Bicking of Daisy Haven Farms School of Integrative Podiatry.

Same mare at end of study. Humphreys BK, Kenin S, Hubbard BB, Cramer GD. “Investigation of connective tissue attachments to the cervical spinal dura mater.”Clin Anat. (2003) 16(2):152-9. 2 Massion J, Alexandrov A, Frolov A. “Why and how are posture and movement coordinated.”Prog Brain Res. (2004) 143:13-27. 3 Richmond FJR, Thomson DB, Loeb GE. “Electromyographic studies of neck muscles in the intact cat: I. Patterns of recruitment underlying posture and movement during natural behaviors.”Exp Brain Res. (1992) 88:41-58. 4 Kavounoudias A, Roll R, Roll JP. “The plantar sole is a ‘dynamometric map’ for human balance control”. Neuroreport (1998) 9(14):3247-52. 5 Buisseret-Delmas C, Compoint C, Delfini C, Buisseret P. “Organization of reciprocal connections between trigeminal and vestibular nuclei in the rat.”J Comp. Neurol. (1999) 401:153-168. 6 Dessem D, Luo P.“Jaw-muscle spindle afferent feedback to the cervical spinal cord in the rat.”Exp Brain Res.(1999) 128(4):451-9 7 Perry B, Pollard B. “Homeostasis, Stress, Trauma and Adaptation: A Neuro-developmental View of Childhood Trauma.” Child Adolesc Psychiatr Clin N Am. (1998) 7:33-51. 8 Fureix C, Menguy H, Hausberger M.“Partners with bad temper: reject or cure? A study of chronic pain and aggression in horses.” PLoS One (2010) 26;5(8):e12434. 1

Recognizing ACP in clinical practice is critical to restoring health and soundness in horses, especially while they’re healing from injury. Even without training in specific PRI procedures, the veterinarian can help ameliorate these pervasive structural distortions with an accurate dental occlusal equilibration (OE); balancing the horse’s weight-bearing surface around the center of articulation of the coffin joint; providing the most natural diet; and turn-out in an unrestricted area, with varied terrain. In addition, manual therapies such as chiropractic or

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USING

OSTEOPATHY

by Jeannie Waldron, DVM, EDO, ABVP, and Ann Marie Hancock, DVM, EDO

TO DIAGNOSE AND CORRECT A DISPLACED OVARY IN THE “GRUMPY” MARE

Osteopathy is a manual therapy that helps horses maintain health despite the unnatural demands placed on them by people. It is based on a precise knowledge of the structural and functional anatomy of bones, muscles, the circulatory system, and especially the nervous system. Osteopathic manipulation stimulates the body so that the musculoskeletal system, behavior and all other systems are optimized. A.T. Still, who pioneered the modality in the 1800s, stated that in osteopathy “the cause of disease is considered chiefly from one standpoint, viz.: disease is the result of anatomical abnormalities followed by physiological discord.”1 In modern days, Janek Vluggen of the Vluggen Institute for Equine Osteopathy and Education, has used his expertise in visceral osteopathic principals, which relate to the autonomic nervous system and cranio-sacral system, to deepen the healing potential of osteopathy.

“HARD TO REACH” OVARIES We have all experienced the mare with “hard to reach” ovaries. At first, Dr. Waldron thought this was just a variation from the normal, and prayed nightly for longer arms. It wasn’t until she started studying osteopathy that she discovered not only the cause of these high, tight ovaries, and how to correct them, but also an incredible way to change mare behavior. Over the last few decades, many authors have related ovarian dysfunction to personality problems in the equine. Ovarian

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tumors, cysts and granulomas were thought to contribute to hypersensitivity and aggression. After these issues were corrected, behavior improved as cycling normalized, so the behaviors were thought to be merely hormone-related.2,3,4,5 Chronic pain is now being considered as part of the issue.6,7 In 2010, a French researcher, Fureix, described an experiment which proved that chronic back pain could cause increased aggression or violent behavior.7 As veterinarians, we have worked with mares who have a “grumpy” disposition that often seems present or accentuated during their heat. Most of these mares have sensitive ovaries during this phase of their cycles, and a significant number have “out of reach” ovaries. These mares are difficult to palpate due to sensitivity, and in general seem irritable and high strung. In the “out of reach” ovary, the mesovarium has wrapped around the ovary and pulled it forward and dorsally. Pain is caused by pressure from the mesovarium. The abnormal location and pain can be further explained by the functionality of the autonomic nervous system. According to Mayhew6, visceral pain may be transmitted through free nerve endings in the organ wall. Though the sympathetic and parasympathetic systems are efferent systems, they share pathways that are also used by the afferent pain sensors. Increased sympathetic or parasympathetic influence can change the base activity of the segments they supply. Increased sensitivity of the spinal nerves, and sympathetic and parasympathetic pathways going to the ovary, alter the ovary’s

mobility and its ability to slide within its fascia. The ovary and associated ligaments become very sensitive to pressure and overstretching. The pain this causes will continue for a lifetime unless we, as veterinarians, address the situation.

OSTEOPATHIC PALPATION OF UTERUS AND OVARIES The ovary is held in position by the mesovarium and the suspensory ligament. In the normal mare, these ligaments are soft and stretchy, and the ovary is mobile in our fingers so we can determine the presence of follicles, CLs and CHs. An osteopathic exam consistent with immobility in the ovary shows immobility in the lumbar vertebrae L1 to L3, possibly T17 and T18, and in the sacrum and poll. Tension and sensitivity are seen in the flank inner thigh and stifle areas, and

possibly in the perineal area, with contraction of the psoas and abdominal muscles. On rectal exam, one ovary is pulled forward and usually held tight up against the body wall. The information provided by this ovary, in pre-ultrasound days, was available to our fingertips only, but was just out of normal reach. At this point, the problem ovary is actually wrapped in the mesovarium and is unable to swing like a normal ovary. The goal is to unwrap this ovary and let it drop freely into the pelvic room and regain its lost softness and stretchability, allowing palpation similar to the other ovary. The following series of pictures8 demonstrates normal osteopathic palpation of the uterus and ovaries, so the veterinarian is able to recognize any immobility, adhesions, abnormal feel or location. Continued on page 51.

STEPS TO PALPATING THE EQUINE FEMALE UROGENITAL TRACT:

Normal uterus

Move cervix lateral left and right: mobilization of restrictions in ligament, latum and parametrium. As you enter the rectum, begin to palpate ventrally for the cervix. Once you find it, place the flat of your hand lateral to the cervix and attempt to move the cervix across midline until you reach resistance. Repeat on the other side. Each side should have an equal range of motion. If not, first use gentle pressure to move the side with greater mobility to the full extent of its motion. Then move the opposite side through its resistance to an equal range of motion.

Move corpus to the right and left: mobilization of mesometrium and broad ligament. Continue this same technique up the body of the uterus, using your flattened hand on the outside of the uterus to push towards and across midline. The corrections are also the same.

Lift bifurcation: test and mobilization of the uterine body.

When you reach the bifurcation, scoop under the uterus and lift it dorsally off the bladder; release the uterus and scoop under the cranial aspect of the bladder, lifting the ventral side of the bladder dorsally and away from the pubic bone. Next, move your hand to the right cranial edge of the bladder and lift it caudo-dorsally and towards midline. Move your hand to the left cranial edge and lift it caudo-dorsally and towards midline. IVC Winter 2014/2015

1 2

Move uterine horn in longitudinal direction and around its own axis: mobilization mesometrium and teres ligament.

Come back to the base of the uterine horns, scoop one side up and grasp in your hand. You will be doing two motions at once. Hold the uterus in your hand and use your arm to move the uterus cranial, ventral and slightly towards midline. Simultaneously bend your wrist so your fingers point towards the inside of your forearm and roll the uterine horn cranio-ventral. Continue this technique all the way up the tip of the horn.

Stretch the suspensory ligament of the ovary

When it comes to the ovaries, start by holding an ovary in the palm of your hand. Use your most cranial fingers to stroke or stretch the suspensory ligament of the ovary. Start with a light touch â&#x20AC;&#x201C; this is where mares are most sensitive. Stretch the suspensory ligament and move the ovary caudo-ventral and to midline. Some variation in this motion occurs with decreased mobility in the ovaries. The ovary should be mobile enough to move with little to no resistance to an area on midline at the level of the body of the uterus, or even the bladder, just cranial to these structures. You also rotate the ovary while making this motion. Start with your palm facing the lateral wall of the abdomen (flank) and end with your palm up and knuckles down. Once you have mobilized the ovary to this position, rotate it cranially and caudally 180Â° in your hand, like turning a doorknob half a turn each way.

Rotate the ovary to medial: mobilization of the mesovarium and mesosalphynx. Rotate the ovary to lateral: mobilization of the mesovarium and mesosalphynx and ligament ovarian proprium.

Rotate ovary to endorotation. Then lift the ovary dorsally by bending your wrist. Move from a knuckles-down palm-up position to a knuckles-up palm-down position and raise the ovary. Then once again rotate the ovary cranially and caudally 180Â° in your hand (half a turn of a doorknob each way).

Rotate ovary to exorotation. Repeat the palpation of the uterine horn and ovary on the opposite side and mobilize any restrictions until the uterus and ovary are free.

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Continued from page 49.

IN SUMMARY Visceral pain is transmitted through free nerve endings in the wall of the ovary, via the sensory neurons that use the same pathway as the sympathetic and parasympathetic systems. Although the sympathetic and parasympathetic systems are efferent systems, they share pathways with afferent pain sensors and can influence each other. When this base activity increases, both the ovary and ligaments become sensitive to a change in position and overstretching, and may also have decreased mobility.

This problem can be diagnosed through immobility of the first three lumbar vertebrae, along with immobility in the sacrum and poll. This loss of mobility at the level of the spinal lumbar nerve results in irritation and hypertonicity of the tissues supplied by the nerves leaving the spinal canal at these restricted points. This can influence not only the ovaries, but also the uterus, bladder and ureters, and consequently cause behavior issues. Careful osteopathic diagnosis and ovary palpation during colic and reproductive exams can help a large number of mares live a normal and more comfortable life. Illustrations courtesy of Janek Vluggen, DO, MRO, EDO and the Vluggen Institute for Equine Osteopathy and Education

Still, A.T. Osteopathy Research and Practice, Journal Printing Company, Kirksville, MO, 1910, p. 15. Donna Judy E. Curtin. “Ovarian Hematoma In An 11-Year-Old Thoroughbred-Hanovarian Mare”. Can Vet J. 2003 July; 44(7): 589–591. PMCID: PMC349373. 3 Maurice KT. “Diagnosis And Surgical Removal Of A Granulosa-Theca Cell Tumor In A Mare”. Can Vet J. 2005 Jul; 46(7):644-6. Source Ontario Veterinary College, University of Guelph, Guelph, Ontario N1G 2W1. 4 Smith LJ, Mair TS. “Unilateral And Bilateral Laparoscopic Ovariectomy Of Mares By Electrocautery”. Bell Equine Veterinary Clinic, Butchers Lane, Mereworth, Kent. Source ME18 5GS. PUBMED ID: 18776175. 5 Bosu WT, Van Camp SC, Miller RB, Owen RR. “Ovarian Disorders: Clinical And Morphological Observations In 30 Mares”. Can Vet J. 1982 Jan;23(1):6-14. PUBMED ID: 7066859. 6 Mayhew IG. Large Animal Neurology, 2nd Ed., Wiley-Blackwell, 2008. 7 Barral JP, Mercier P. Visceral Manipulation, Revised Edition, Eastland Press, Inc. 2005, p53-59. 8 Vluggen J. Classifications Of The Visceral Motions According The Origin Of Existence. AIEO, San Marcos, TX 2012. 1 2

IVC Winter 2014/2015

for cancer: gentle

Homeopathy By Sarah Stieg, DVM, MRCVS, Lisa Melling, DVM, CVH, and Todd Cooney, DVM, CVH

IVC Winter 2014/2015

approach to a cure

ancer is a diagnosis dreaded by practitioners and pet owners alike. In allopathic medicine, cancer treatment does not result in a cure, but rather the destruction of the tumor and related cells through radiation, chemotherapy, or surgery. These treatments frequently create side effects, which require additional drug therapy to manage. Allopathic cancer treatment most often leads to temporary remission; the greatest success rates are found in the treatment of lymphoma using combination chemotherapy, resulting in six to 11 months of remission in 65% to 90% of patients.1

Homeopathy, conversely, offers a gentle approach to cancer, treating not just the lesion or condition, but the patient as a whole. General well-being is first restored while the cancerous condition is being abated or resolved, and is followed by a return of good health. This article will discuss the principles of homeopathy in the treatment of cancer and why it is a good alternative to the allopathic approach.

CONSIDERING THE WHOLE BODY The allopathic approach to cancer is to identify the lesion, assess the body system(s) affected, and then stage the cancer. The homeopathic approach views the patient as one disease, comprised of his totality of symptoms – mental, emotional, and physical.2 Functional changes or lesions, such as fibrosis and tumor growth, are merely one aspect of the patient’s disease. While allopathic nomenclature may be helpful in understanding a clinical situation, general disease labels are not needed to find an accurate prescription in homeopathy since they do not describe what is unique to the individual patient. For example, “lymphoma” describes a disease condition, but does not give us any details about the individual case. In order to identify the precise homeopathic remedy needed to treat the patient, out of all the homeopathic remedies that treat this type of disease process (i.e. lymphoma), the practitioner needs to examine what makes this patient unique. Continued on page 54.

CASE STUDY #1 By Lisa J. Melling, DVM, CVH Howie, a ten-year-old neutered male Shih Tzu, presented for in-home euthanasia on October 26, 2012. He had received a tentative diagnosis of leukemia, along with a splenic mass, anemia, and protein-losing nephropathy diagnosed by an internal medicine specialist. Blood test values demonstrated severe leukocytosis with band cells and metamyelocytes, non-regenerative anemia, and thrombocytopenia. At the euthanasia appointment, the owner asked if there were any other treatment options available, and homeopathic treatment was offered. On examination, Howie was weak and hypothermic at 97.4°F. His mucous membranes were pale and dry, and there was palpable splenomegaly in his abdomen. The homeopathic remedy Phosphorus was selected because of its reputation for the treatment of hemorrhagic conditions, polycythemia, cancerous affections and albuminuria. Phosphorus is best suited to patients suffering from anemia and cancers that bleed profusely.3 It is also important that the remedy match the changes in mental symptoms that occur in sickness. When Howie was well, he was an outgoing sociable dog. When he became ill, he was timid, anxious, and weak. He also had a history of thunderstorm anxiety. All these symptoms made him an excellent match to Phosphorus, and a single dose of 30c was administered. The owner was also given instructions to prepare a balanced fresh food diet to replace Howie’s processed dog food.

signs of more normal behavior. An exam and diagnostics the following week found a feisty dog with a normal temperature and white blood cell values that were also approaching normal. Three weeks later, another exam revealed a bright, energetic dog with light pink mucous membranes. His owner reported he was eating well and even had to be cautioned that he was looking overweight. Howie’s white blood cell values were within normal limits, his red blood cell numbers were climbing towards the normal range, and the proteinuria had resolved. One month after his first dose of Phosphorus 30c, Howie’s white blood cell values were normal, but he still had a mild, regenerative anemia. Three months after his initial prescription, his splenomegaly was no longer palpable. From 2012 to 2014, Howie was re-evaluated every three to six months and found to be in good health. His blood and urine tests were monitored regularly, and a second dose of Phosphorus 30c was administered in November of 2012 to address the persisting anemia. By January 2013, the splenomegaly was no longer palpable and Howie’s mucous membranes were pink. In March of that year, Phosphorus 200c was administered to address the persisting, mild anemia. One month later, his red blood cell value had risen to just below the normal range. At this point, it was decided that no further Phosphorus was needed, as Howie showed no return of his leukemia, splenomegaly or protein-losing nephropathy. With the help of homeopathic treatment, Howie lived a healthy life until he passed away peacefully in September of 2014.

Five days after he was given the remedy, Howie’s owner called to say he’d gradually improved and was exhibiting

IVC Winter 2014/2015

CASE STUDY #2 By Todd Cooney, DVM, CVH Rosie, a 12-year-old spayed female German Shorthair Pointer, had been very healthy until early 2012, when she developed symptoms of vomiting, diarrhea, weight loss, persistent panhypoproteinemia, and anemia. She became less active, and her abdomen was noticeably swollen. In April of that year, her local veterinarian diagnosed protein-losing enteropathy and suggested referral to the Purdue Teaching Hospital. Her owner declined referral, and began a program of homemade diet and probiotics. Rosie partially improved, but still had a swollen, fluid-filled abdomen with occasional diarrhea. On October 11, 2012, Rosie presented to her local veterinarian with a very large, tightly swollen abdomen with ascites, severe panhypoproteinemia, PCV of 20, and leukopenia. She was diagnosed with lymphoma, offered referral to Purdue with a poor prognosis, and had her abdomen drained. The next day, Rosie presented to my clinic looking very thin, weak and wobbly (almost ataxic), with an extremely large abdomen tight with fluid. Her abdomen was tender on palpation and her gums were pale pink. Her owner reported a dull attitude and behavior akin to “a patient with dementia”. She was thirstless, even after walking in warm weather. Taking all her symptoms into account, I prescribed one dose of Apis mellifica 200c. Apis mellifica is made from the honeybee, and its symptoms include ascites, great soreness of the abdominal walls, peritonitis, and dropsical swellings without thirst. Over the next two weeks, Rosie improved overall; the ascites slowly decreased and her appetite improved. On November

5, she seemed much brighter, and her ascites had nearly resolved. However some new symptoms appeared: she now seemed very thirsty, slightly grumpy towards other dogs, and a little skittish around gunshots, all of which were out of character. The abatement of her acute crisis along with the change in symptoms indicated a deeper-acting remedy was needed. Rosie was prescribed one dose of Natrum muriaticum 200c. Natrum muriaticum is considered the “chronic” or complementary remedy to Apis and is noted for unquenchable thirst, irritability, anemia, watery stools, emaciation, and cancerous affections.3 On November 29, her owner reported that Rosie’s appetite and attitude began to improve within a few days of the remedy; she was now eating very well, looking significantly better, had normal stools, and the abdominal swelling was totally gone. Over the next two years, Nat-mur was given twice as Rosie’s symptoms indicated: 200c in February 2013 and 1M in October 2013. Rosie improved quickly after each dose, with increased vitality and symptom resolution. She displayed all the signs of a curative response – she returned to good health, the ascites never returned, and when her symptoms briefly flared, indicating a re-dose, they were mild in nature (e.g. loose stool). No further treatments have been needed since 2013, and as of October 2014, Rosie’s owner reported that she is doing very well, running and playing with other dogs, and enjoying life.

Continued from page 53. Once the homeopathic remedy is administered, the patient’s response is closely monitored. The remedy stimulates the recovery of health over the time necessary for the body to repair damaged tissues. This can take weeks to months, depending on how long the total illness (not merely the cancer) has been present.

THREE POSSIBLE OUTCOMES Any treatment, homeopathic or allopathic, can result in three possible outcomes: palliation, suppression, or cure. It is important to understand how these differ, and how to interpret patient response post-prescription. 1. P alliation is the most common outcome of allopathic treatment, and is seen as a rapid response or alleviation of some, but not all, of the physical symptoms. A hallmark of palliation is a quick return of symptoms when treatment is stopped, requiring more frequent repetitions of medicine in higher doses to maintain any “improvement”.

IVC Winter 2014/2015

The benefits of palliation with homeopathy, in cases where a curative remedy cannot be found, is the gentleness of this medicine when compared to the immunosuppressive doses of prednisone often used in allopathic palliation. 2. H omeopathic practitioners view suppression as the worst possible outcome of medicine or surgery. This is because the patient’s well-being is not enhanced, and while some symptoms or lesions disappear, there is no improvement of mental/emotional aspects. After a period of time, a new, more severe set of symptoms will result; for example, metastasis to the lungs or heart base following surgical excision of a hemangiosarcoma lesion from the spleen. 3. The goal of all homeopathic treatment is to cure the patient by returning the body to health. This is characterized by increased overall well-being, with physiological resistance to disease. The mental/emotional sphere will improve first, followed by the resolution of physical symptoms. For instance, a cat with mesenteric lymphoma will have more

energy and improved appetite soon after the remedy is administered, while the gastrointestinal symptoms diminish over time.

From the

WAEO

ADDITIONAL BENEFITS Unlike allopathic treatments for cancer that use multiple drugs at one time, a homeopathic veterinarian will only prescribe a single dose of a remedy. To decide which remedy to use, the homeopath will create a list of the patient’s current symptoms in combination with his entire health history. Therefore, it is possible to have five lymphoma patients all receiving different remedies because their symptom pictures vary, even though allopathic treatment would use the same chemotherapy protocol. Homeopathic treatment aims to cure the patient and have the cancer completely resolve, without causing harmful side effects or requiring repeated medication. In cases where the destruction of the cancer pathology is too advanced to affect a true cure, i.e. full restoration of health, homeopathic treatment when prescribed in a curative manner can still provide a gentle approach to alleviating symptoms and improving vitality and quality of life. The case studies accompanying this article demonstrate how the homeopathic treatment of cancer successfully returned the patients to health and provided an increased quality of life without surgery, chemotherapy, or harmful side effects. To read about them in greater detail, you can view them on the PIVH Case Blog at pivh.org/blog. If you are interested in becoming a trained veterinary homeopath, contact the Pitcairn Institute of Veterinary Homeopathy (PIVH). It is the only homeopathic training program for veterinarians in the US that’s approved by the Academy of Veterinary Homeopathy, which provides national accreditation and certification. The next Professional Course in Veterinary Homeopathy starts in September of 2015. Please visit the PIVH website at pivh.org or email info@pivh.org.

The Worldwide Alliance of Equine Osetopaths (WAEO) promotes the benefits and advances the practice of equine osteopathy. It also provides continuing education for its members, supports scientific research in equine osteopathy, and assists in efforts to establish osteopathy as a distinct titled profession on an international basis. The Worldwide Alliance of Equine Osteopaths (WAEO) is an exciting new organization formed in 2013. Its First Annual Conference and Membership Meeting was held last April 26 and 27 in Rectortown, Virginia, in the heart of horse country. Veterinarians from around the world were excited to see the great responses horses exhibited following osteopathic treatment. A wide range of conditions that can respond to osteopathic treatment were discussed – these include gastrointestinal issues such as colon dysbiosis, as well as musculoskeletal and behaviorial issues. Also part of the discussion was how osteopathy can help the horse by treating the rider. The second morning of the conference featured a wet lab on dissection of the whole horse, clearly showing the connective tissue relationships throughout the body. A post-graduate course titled “Cranio-Sacral in Equine Osteopathy – Fascia, Fluid and Fulcrums” was held in September of 2014. A major benefit offered by the course involved practicing on fellow students, getting feedback and experiencing the changes that light touch adjustments create. As skills improve, it is possible to determine primary lesions, so fewer treatments are needed. While WAEO’s mission focuses on horses, osteopathy is very effective for small animals as well, so classes on canine osteopathy have also been offered. The WAEO’s 2015 Annual Conference and Membership Meeting will run September 5 and 6 at the Vluggen Institute for Equine Osteopathy and Education in Germany. Janek Vluggen is a pioneer in equine osteopathy and the Institute has played a

Cote, Etienne, DVM; Mosby, Elsevier. Clinical Veterinary Advisor, Dogs and Cats, 2nd ed., St. Louis, MO; 2011: pp676. 2 Hahnemann, Samuel, ed. Brewster O’Reilly, Wenda, PhD. Organon of the Medical Art 6th ed., by Dr. Birdcage Books, Palo Alto, CA; 1996: pp141 3 Murphy, Robin, ND. Nature’s Materia Medica, 3rd ed. Lotus Health Institute, Blacksburg, VA; 2006: pp 1502-1512. 1

key role in bringing osteopathy to the equine world. For more information, go to EquineOsteopathy.org. IVC Winter 2014/2015

tech talk

How offering

acupressure and other

alternative modalities can BENEFIT your

clinic as well as your patients by Jill Golgosky, BS, CVT, CAAP

A growing number of clients are requesting alternative therapies for their pets, and more veterinarians are realizing that offering multiple approaches can better help animals. As a result, our role as CVTs is becoming increasingly important. As a veterinary technician, you can demonstrate the effectiveness of holistic modalities, increase revenue to the hospital, and even create your own business within the clinic.

IVC Winter 2014/2015

Ten years ago, I started working at a small animal clinic. The veterinarian I worked with offered alternative modalities. She practiced conventional medicine, but was also trained in Cranio Sacral Therapy (CST) and Nambudripad Allergy Elimination Techniques (NAET). I was able to speak freely about acupressure and other modalities, and we had a strong client base that specifically came to the clinic for these therapies.

When I applied for a veterinary technician job at a specialty hospital four years later, the internal medicine doctor who was interviewing me saw that I was certified in equine and small animal acupressure, and requested I not tell clients about this modality. Over the past few years, however, there has been a distinct, though not complete, shift in perception at my hospital. When I started, I had to be a sort of “undercover acupressurist”. I used acupressure points during the sedation process to help animals transition more smoothly and quickly during the excitatory phase. In preparing a dog for an ultrasound procedure, I was able to reduce his anxiety by using specific calming points. Other veterinary technicians as well as the doctors began to notice and asked what I was doing. They became interested because they could see how effective the acupressure was. Nowadays, I have the opportunity to provide acupressure sessions for clients, as long as my other work is covered. The doctors can see how acupressure helps the animals. After I worked with an allergic Airedale, for example, his medication dosage was decreased from six tablets twice a day to half a tablet twice a day. In another case, the doctors planned to place a Greyhound on numerous painkillers when she suffered a hip injury after falling down stairs. Two acupressure sessions later, the dog walked without a limp and was able to go up and down stairs again with no drugs. While every clinic is different, younger doctors seem more open to offering acupressure, rehabilitation, and other modalities, so these may be the ones to begin educating about the holistic skills you have. [Associate Editor’s note: Across the US, both new and experienced veterinarians seem equally attracted to holistic options.] As time progresses, I’m seeing a change in thought that’s leading us toward the acceptance of a wider scope of medicine and a more integrative approach to veterinary care.

POTENTIAL FOR CVT HOLISTIC SERVICES IN YOUR PRACTICE • Expanding CVT services can enhance patient health and clinic income. Although I’m seeing an increasing receptivity to acupressure and other complementary care possibilities, the owners of my practice are choosing not to charge clients for the additional service; hence, they are not paying me anything beyond my regular salary. Yet it would be ideal if I could offer an acupressure clinic within the practice. We see so many patients with acute issues such as broken legs, torn ACLs, and gastroenteritis; acupressure could assist in their recovery and the clients charged, possibly with a portion coming to me. Other patients dealing with chronic and terminal diseases such as kidney failure, cancer, congestive heart failure, and endocrine issues could receive a better quality of life, increased longevity, and comfort care through acupressure. Hospice care is increasingly requested by clients and these patients can benefit from many integrative modalities. Continued on page 58.

As a veterinary technician, you can demonstrate the effectiveness of holistic modalities, increase revenue to the hospital, and even create your own business within the clinic.

IVC Winter 2014/2015

SPECIFIC ACUPRESSURE POINTS Acupressure, like all modalities, can be individualized. Or, you can begin with points “for a condition”. The following are a few that seem to help a wide range of animals.

1. Anxious or stressed dogs: Ht 7 and Pe 7 (which can be worked together)

and CV 17. My coworkers have even commented on how the patients’ eyes have softened while in the clinic.

2. Post op points: Bl 60, Ki 3, and Sp 21.

The author performs acupressure on a canine patient. This modality has many applications that veterinary technicians can make use of.

3. I mmune mediated diseases, strengthening immune systems: LI 4, LI 11, St 36 and Sp 6.

4. D ogs that are seizing in conjunction with medical management: Ht 7, Liv 3 and Bl 18.

Acupressure and other modalities also have much to offer animals during hospice care. There are acupressure points that can increase the patient’s quality of life, sometimes extend his life, or allow him to pass more easily and comfortably. Some points are individually selected according to the symptoms and the animal’s unique characteristics, while others are more standard. In one example, a dog near death was having difficulty breathing, and the owner had stipulated “Do Not Resuscitate” (DNR). I gently applied two acupressure points and in less than 30 seconds, the dog’s breathing relaxed; he took two deep breaths and was gone.

Post Operative Acupoints

Acupoints to Reduce Anxiety

Sp 21 CV 17 Ht 7

Medial

Lateral

Medial

Lateral

Points Location

Ht 7 Found at the transverse crease of the carpal joint, in depression lateral to flexor carpi ulnaris. Opposite Pe 7.

Sp 21 Found on lateral aspect of the chest at about the 7th intercostal space, same level as the point of shoulder.

Pe 7 Caudal to the tendon of the flexor carpi radialis and directly above the carpal bone.

Diagrams courtesy of Tallgrass Animal Acupressure Institute.

BI 60

Ki 3

Pe 7

CV 17 On ventral midline, at the level of the caudal border of the elbow, 4th intercostal space.

BI 60 Caudolateral aspect of hind limb, at the thin, fleshy tissue at the hock, opposite Ki 3. Ki 3 In a depression between medial malleolus of the tibia and calcaneal tendon. Opposite BI 60.

Acupoints for Seizures

Immune System Strengthening

BI 18

LI 11 Lateral

Sp 6 LI 4

St 36

Medial

Ht 7 Lateral

Points Location LI 4 At the webbing of the dew claw.

Lateral

Liv 3 Medial

Lateral

Points Location

LI 11 With the elbow bent, the point is found at the lateral end of the cubital crease.

Ht 7 Found at the transverse crease of the carpal joint, in depression lateral to flexor carpi ulnaris. Opposite Pe 7.

St 36 Located just lateral to the tibial crest on the outside of the hind leg.

BI 18 1.5 cun lateral to the caudal border of the dorsal spinous process of the 10th thoracic vertebra.

Sp 6 Found 3 cun above the tip of the medial malleolus on the caudal border of the tibia.

Liv 3 Above Liv 2, between 2nd and 3rd metatarsal bones at the junction of the metatarsophalangeal joint.

IVC Winter 2014/2015

Continued from page 57. •A nother possibility would be to have a separate or partner clinic to provide these services, through a financial agreement with the hospital. The practice laws governing what technicians can do are different in every state, so the legislation needs to be considered before presenting a plan to your hospital. Most hospice programs already offer veterinary technician house calls as part of the service, and being able to do acupressure and other modalities can be an added benefit. • A brief internet search shows veterinary websites that list the holistic certifications of their technicians, but don’t mention acupressure and massage in the services offered. Changing this would increase traffic to the hospital as people Google “acupressure pet care”. Listing these options in the services dropdown menu, describing the modalities, and including case examples will also bring in new clients. As I continue to offer acupressure to our patients, I think even the most skeptical doctors will be able to see the value of giving animals a broader array of medical options. After all, we all share the same goal – to provide animals with optimal healthcare. Integrating holistic and traditional medicine gives animals the best of both worlds, and my main goal is to provide the best care to our patients.

Product Profile

Unhealthy saliva can arise from HEALTH ISSUES and MEDICATIONS

By Naomi A. Kirby, DVM, MS Patients with certain health conditions need extra oral care. In these animals, saliva can lose its protective properties, predisposing the pet to increased bacterial, fungal and plaque overload. Saliva provides an effective barrier against drying and is primarily composed of water – but it also includes antibodies, enzymes and mucoproteins, all of which work to protect the teeth. Saliva reduces the pH of plaque waste products and limits tooth decay. It also flushes the mouth and clears food debris that would otherwise provide nourishment to the bacteria found in plaque. An overload of plaque can lead to halitosis, an increased risk of periodontal disease, tooth loss or even a systemic infection if bacteria is absorbed into the bloodstream.

In patients with health problems, such as those listed above, it becomes very important to pay extra attention to oral care. Oratene® Veterinarian Brushless Oral Care products can help manage xerostomia because they contain two complete patented enzyme systems backed by over 35 years of enzyme research. The enzymes work to replenish the protection and defense mechanisms found in healthy saliva, and to eliminate the offending bacteria and/or fungi while also rendering plaque biofilm water-soluble and unable to bind to tooth surfaces. Oratene’s gentle formulation provides soothing protection without harmful alcohols, xylitol or tooth-staining chlorhexidine.

Many health conditions and diseases, and even the medications needed to manage them, can affect saliva quality or flow and lead to xerostomia/dry mouth. These include: aging, obesity, diabetes, autoimmune diseases, endocrine disorders, pancreatitis, hypertension, FIV, anxiety disorders. The following common medications used in the management of a variety of disorders can also causes salivary glands to reduce the quality and quantity of saliva: • Arthritis meds: NSAIDs • Anticonvulsants: Diazepam, • Antihistamines: Diphenhydramine, Chlorpheniramine, Hydroxyzine • Antihypertensives: Amlodine, Atenolol, Benzapril, Enalapril, Furosemide, Spironolactone • Anxiety meds: Amitripyline, Diazepam, Clomipramine, Fluoxetine • Incontinence meds: Phenylpropanalomine

Dr. Naomi Kirby is the Technical Services Manager for Pet King Brands Animal Health, Inc. (petkingbrands.com), makers of ZYMOX® Enzymatic Products for chronic ear, skin and oral conditions. She can be reached at Naomi.kirby@gmail.com.

IVC Winter 2014/2015

NAVC Conference Highlights

NAVC CONFERENCE 2015

VetzLife – Booth 439

We provide all-natural health products to the veterinary market. VetzLife Oral Health Care is a valuable tool when it comes to proper home oral care. Wound Care is for skin issues such as scratches, minor wounds, abrasions, ringworm and post-surgery. Complete Coat is a topical flea and tick treatment that is 100% safe for pets. Our new Salmon Oil flavored Gel for Stomatitis in Cats helps treat gum disease, mouth sores, and cuts down on extractions. Vetzlife products are carried by major veterinary product distributors. 1-888-453-4682

Vetzlife.com

Orlando, FL January 17-21, 2015 NAVC brings the global veterinary community together to share ideas, sharpen skills and learn about the latest innovations in animal care. Every species is covered. Every specialty is represented. FEATURES: • Acupuncture stream and Holistic medicine stream as well as the latest in conventional therapies and equipment.

HandicappedPets.com — Booth 3823

• Master classes

Life doesn’t have to be a drag for a handicapped pet.™ HandicappedPets.com provides products, services and support for elderly, disabled and injured pets. The company’s signature product is the Walkin’ Wheels dog wheelchair – a fully adjustable canine cart. It easily changes height, length and width to fit different sizes of dog, and to accommodate a range of rear leg mobility problems, from partial to complete paralysis.

• Meet the Professor luncheons

1-888-337-8387

• Hands on laboratories and workshops

• Latest products and services available for your practice

HandicappedPets.com

For more info, visit NAVC.com

Standard Process – Booth 1126

Whole food supplements provide a complex matrix of nutrients in their natural form to help support canine, feline, and equine body systems. They are ideal complements to allopathic therapies and can be used short- or long-term. Stop by our booth to chat with our experts about your challenging cases. StandardProcess.com

IVC Winter 2014/2015

Orlando, Florida, January 17 - 21, 2015

Spectrum Labs – Booth 1300

We have been providing high quality, accurate allergy testing and highly effective hypo-sensitization treatment to thousands of veterinarians around the globe for 25 years. We are now proud to offer a sublingual treatment option as an alternative to injections! Visit us at our booth to learn how you can get started, including a complimentary retest on any of our competitors, as well as information on VacciCheck, a rapid, in-clinic canine vaccine titer test! VetAllergy.com

Animal Necessity, LLC – Booth 217

Now patented, Ocu-GLO Rx continues to lead the industry as the first and only Canine Vision Supplement formulated by Board Certified Veterinary Ophthalmologists. Visit our booth to learn about our growing list of clinical studies and speak with our doctors about the benefits of antioxidants to your patients. We are celebrating our 10th year by expanding our line of high quality, specialty supplements – stop by for a free gift and to learn more about our protocols. 1-800-721-1310

Ocuglo.com, AnimalNecessity.com font: Myriad pro + Helv 25 Ultra Light + Jenkins v2.0 INDEX COLORS

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Trupanion – Booth 505

Our mission is to partner with veterinarians to help the pets we love receive the best medical care. We are an industry leader of pet medical insurance in North America. Trupanion’s policy offers one simple plan that pays 90% of actual costs for the treatment of injuries and illnesses, including hereditary and congenital conditions -- with no payout limits per incident, per year, or over the lifetime of the pet. 1-855-587-7716

Trupanion.com

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PKB Animal Health – Booth

613

At the core of ZYMOX® Enzymatic Dermatology and Oratene® Veterinarian Brushless Oral Care products is the patented LP3 Enzyme System – proven antibacterial, antifungal and anti-yeast. Safe, non-toxic, enzymatic formulas target offending microbes only. Zymox includes otics, skin/wound care and shampoo/ cleansers. Demonstrated antibiotic alternatives for managing chronic infections. Oratene offers brushless care in three delivery system options: water additive, gel or mister. Features two patented enzyme systems to inhibit odor-causing bacteria and fungi, balance oral flora and eliminate plaque biofilm. 1-888-752-5487

PKBAnimalHealth.com

Bayer HealthCare Animal Health – Booth 1513

We are expanding our veterinary dermatology portfolio with the addition of the Dermoscent® family of skin and coat care products for dogs or cats. Dermoscent® products combine the benefits of naturally-derived essential oils and essential fatty acids with the simplicity and flexibility of convenient topical delivery systems for on-the-go clients. Visit our booth to learn about easy-touse Dermoscent® products. 1-800-633-3796

Respond Systems – Booth 1729

We have set the standards for veterinary lasers and PEMF equipment in the US for over 30 years. We offer several laser models to suit the needs of your practice, regardless of size or location. Stop by our booth for a demo. For an in-depth look at the treatment and diagnosis of special injuries often associated with Field Trial and Hunting dogs, don’t miss Dr. Spoo’s presentation on Saturday, January 17 at 3:55 pm at the Gaylord Palms. 1-800-722-1228

RespondSystems.com

IVC Winter 2014/2015

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.

It was a marvelous opportunity for interaction and learning. The joint conferences hosted by the Academy of Veterinary Homeopathy and the American Holistic Veterinary Medical Association attracted legions of veterinarians and other professionals to Portland, Oregon from September 12 to 16.

CASE REPORT Treatment of a severely injured golden eagle: case report from Tara Timpson, DVM, CVH, Best Friends Animal Society, Kanab, UT

“I first examined the mature female golden eagle the day after she had been hit by a car, tossed to the other side of the road, The AVH Reception “Helping More Patients: 10 Reasons to and hit by another car. Initial therapy included Metacam and be a Homeopath”, was an overwhelming success, with a Vitamin K. Upon exam, she was moribund, non-visual, and packed audience of veterinarians interested in learning more had a heavy lice load. She did not respond when handled. about what homeopathy can do. Four faculty members from the PIVH (pivh.org) – Drs. Richard Pitcairn, Sarah Stieg, Her therapy began with fluids and B-vitamins. After Lisa Melling and Elise Radebaugh – discussed the ability homeopathic analysis for trauma and concussion, the of homeopathy to treat patients, ranging from the very following medicines were at the top of the analysis: Arnica, young to the very old, with problems deemed incurable by Hypericum and Ruta. conventional medicine. Day 2: The eagle was given Arnica 200C – two doses at 11:15am and 5pm. A very memorable case involved a four-year-old working dog Day 3: Although she was still very ill, she was alive, which treated for behavioral issues. On physical exam, it was noted was incredible. Her therapy plan involved a dose of that he had such a severe overbite that his tongue constantly Arnica 200C every six hours. hung out of his mouth. During homeopathic therapy, not only did he become the nicest and most skilled herding dog Day 4: She was still not visual but otherwise stable. I decided that Hypericum 1M would address the head trauma of the pack, but he grew a proportional mandible, resulting more effectively. in a perfect bite! Many of the reception participants showed interest in further studying homeopathy. We thank our Day 5: After two doses of Hypericum, the eagle was visually generous sponsors, Standard Process and Helen Rich with tracking and doing so well she no longer needed the On the Wings of Angel Rescue, for providing the food and oxygen cage. raffle items for this popular event. Day 6: She was attacking the caretakers and no one could handle her or clean her cage. She eagerly ate four to The AVH Foundation has teamed up with AmazonSmile six mice. – Amazon donates 0.5% of the price of your eligible AmazonSmile purchases to the charitable organization of Day 7: She appeared to be adequately visual and was released into a flight cage. your choice. We are excited to be part of this program. The AVH Foundation’s mission continues to be the support Day 14: The eagle was released into the wild and has been of homeopathic education, outreach and select research thriving.” (avhf.org).

IVC Winter 2014/2015

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

CONFERENCE HIGHLIGHTS The AHVMA’s Annual Conference was held in Portland Oregon this year with record-breaking attendance. The more than 400 attendees exceeded our expectations! Here are some highlights of the conference: • Pre-conference “Healer, Heal Thyself” Mind, Body and Spirit Retreat at the Breitenbush Center in Willamette National Forest • Annual Herbwalk with Kevin Spelman, at Hoyt Arboretum • Spirited newcomers’ social, a mingling of experienced holistic practitioners with the youthful (not age-related) enthusiasm of our newcomers • An impressive and comprehensive array of lectures • Exhibitors with fascinating information on products, methods and ideas that help us maintain and further our excellence as practitioners • Interactive labs, which inspired so much interest we had to add sessions, both impromptu and arranged • Breakfast meetings were standing-room only – even on Sunday • Beautiful location on the river and a wonderfully entertaining city with organic and local meals created with flair and variety • A lively and productive auction, delicious banquet and impromptu Presidential DJ with dancing till all hours of the night

Council of Elder awards were given to individuals whose stellar service and accomplishments represent the mission statement of the AHVMA. • Dr. Bernie Fischer – Behind the Scenes • Dr. Mona Boudreaux – Butt-Busting • Dr. Shelley Epstein – David and Goliath • Dr. Neal Sivula – Holistic Teacher of the Year. • Dr. Mushtaq Memon – Global Practitioner of the Year. • Dr. Ihor Basko – Carvel Tiekert Lifetime Achievement. This award is given to a practitioner who has exhibited a lifelong pursuit, both professionally and personally, of a holistic approach to life.

Record your cases online Practitioners and researchers often request evidence for the effectiveness of holistic therapies. Lab studies exist and needed clinical trials happen after many successful cases are reported. Dr. Steve Marsden has announced the launch of a website that can track all cases treated by any holistic modalities (curedcases.com). You can begin by entering every case you approach from a holistic perspective, then record the progress – good or bad. The forms are simple enough that your staff can do most of the entries. With the help of Dr. Barbara Fougere and the College of Integrative Veterinary Medicine (CIVT), the data will be easily accessible to practitioners and researchers, even if they have to contact the practitioners for follow-up reports.

• A dynamic Annual Meeting, bringing past and present together for the future in a new Strategic Plan created by the Board and presented to the membership by Dr. Barbara Royal and Dr. Mona Boudreaux (immediate past and next Presidents, respectively) – read more in the JAHVMA • An atmosphere in which we all could learn, teach, meet old friends and find new ones, support, connect with, and rekindle our AHVMA family ties.

We at the AHVMA are delighted to provide services and education that continually brighten the future for our members. We are looking forward to another phenomenal year.

Dr. Steve Marsden

IVC Winter 2014/2015

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?

If you didn’t, you were not alone. Even several of the country’s top herbalists were not sure what this herb was. The point is, be very careful if you are wild harvesting herbs. If they are young as the herb in this picture, it can be nearly impossible to properly identify the plant. The herb pictured in the last issue happened to be wild lettuce leaf, Lactuca virosa, taken on an herb walk with Matthew Wood at the Haverkos Farm. This herb can calm the spirit, relieve anxiety and irritability, promote urination and relieve edema. It can be used as a nervous sedative with hypoglycemic effects. It has a fairly specific profile in that it can be used for conditions of cerebral or nervous stress, and is effective for relieving uncontrollable, nervous, irritation coughs with lung heat.

Case study

Helena was an overweight heifer who looked like a ketosis candidate when she freshened. She was placed on a slimming diet, in a pasture full of wild lettuce, with an exercise plan. Helena gained muscle tone, lost weight and freshened with no complications.

July, 2013

featuring Dr. Sagiv Ben-Yakir on Transdermal Skin Treatments and Dr. Joyce Harman on Lyme Disease and its Treatment. Our most recent event was our annual conference, which was held during the AHVMA conference in Portland, Oregon. We went on a very interesting herb walk led by Kevin Spelman on Friday, September 12. On Saturday, we had the true honor of hearing Jeffrey Yuen lecturing about essential oils. You can order Jeffrey’s tapes from the AHVMA (AHVMA.org). It was a very profound lecture. On Sunday, we were treated to a talk by Kevin Spelman on Ayurvedic medicine and new findings on Echinacea. The AHVMA also offered many other herbal talks, including Rob Silver on medicinal cannabis. Drs. Barbara Fougere and Steve Marsden were also speakers at the event.

Upcoming event

Mark June 12 to 14, 2015 on your calendar – they’re the dates for the International Herbal Symposium at Wheaton College in Norton, MA!

NAME THIS HERB!

September, 2013

Report on activities

The VBMA did two wonderful teleconferences that were taped and are available at vbma.com – one on GI issues given by Dr. Rob Silver, and the other on Herbal Food Therapy given by Dr. Connie DiNatale. We already have an exciting lineup for 2015,

IVC Winter 2014/2015

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

marketplace

IVC Winter 2014/2015

events

To post your event, email us at: info@IVCJournal.com

2014 AVMA Veterinary Leadership Conference

from as well as top rated speakers from Canada and the United States.

January 8 - 11, 2015 – Chicago, IL

This 3 day event is the largest annual veterinary conference in Canada and combines education with a tradeshow filled with products and equipment.

Enhance your leadership skills and expand your professional network while attending the Veterinary Leadership Conference. The VLC offers 3 days of networking and workshop opportunities and is open to any veterinary professional interested in learning more about leadership and team building. Continuing education credit is available for attending select sessions. For more information: vlc@avma.org www.avma.org/vlc

January 17 - 21, 2015 – Orlando, FL The annual NAVC Conference welcomes almost 16, 000 attendees from more than 70 countries and offers more than 30 hands-on laboratories as well as provides 1,300 Continuing Education credits. You will also see more than 350 nationally renowned speakers and being in January, it is the first veterinary conference of the year where the most current medical and product advances are first released. The NAVC Conference is a nonprofit organization whose mission is to provide world-class continuing education for all members of the veterinary healthcare team. For more information: (352) 375.5672 info@navc.com www.navc.com

This Annual Meeting offers many opportunities, including continuing education, networking with friends and colleagues, a silent auction and two breakfast seminars. You will have the chance to participate in: 3 Full Days of Practice Management Sessions 3 Small Animal Tracts Offered Daily Veterinary Practice Plus Track Bovine, Equine & Swine Programs Public Health Program Industrial and Small Ruminant Seminars For more information: (651) 645-7533 info@mvma.org www.mvma.org

CenCan Veterinary Conference February 6 - 8, 2015 – Winnipeg, MB

Multidisciplinary Advanced Therapies Symposium January 23 - 25, 2015 – Napa, CA This symposium will be covering Clinical Oncology, includes 8 continuing education credits and is sponsored by UC Davis Veterinary Medicine Center for Continuing Professional Education. For More Information: Karl E. Jandrey, DVM, MAS, DACVECC (530) 752-3905 kejandrey@ucdavis.edu www.vetmed.ucdavis.edu/ce/

Hosted by the Manitoba VMA & the Manitoba Animal Health Technologists Association, this event will be a prime opportunity to connect faceto-face with the veterinary community. Have a new product or service to promote? Want to meet with existing clients or potential clients? Then this is the conference for you! For More Information: Colleen Ferguson, Manitoba VMA (204) 832-1276 cferguson@mvma.ca www.mvma.ca

86th Annual Western Veterinary Conference February 15 - 19, 2015 – Las Vegas, NV

Ontario Veterinary Medical Association Conference January 29 – 31, 2015 – Toronto, ON The 2014 OVMA conference offers more than 100 hours of continuing education options to choose IVC Winter 2014/2015

Minnesota VMA 117th Annual Meeting February 5 - 7, 2015 – Minneapolis, MN

North American Veterinary Conference

For more information: (800) 670-1702 info@ovma.org www.ovma.org

Conference registration automatically enrolls the registrant as an association member for the following year. For more information: (702) 739-6698 carolyn@wvc.org www.wvc.org

2015-2016 Professional Courses in Veterinary Homeopathy Session 1: September 17-20, 2015 Portland, OR The Pitcairn Institute of Veterinary Homeopathy (PIVH) offers a year-long introductory course in veterinary homeopathy, comprising of five fourday lecture sessions and qualifies graduates for certification through the Academy of Veterinary Homeopathy. The course places a strong emphasis on the guiding principles and science of classical homeopathy while providing practical clinical application and exposure. Experienced veterinary faculty join Dr. Richard Pitcairn to offer over 130 hours of classroom instruction and a broad range of knowledge in small and large animal medicine. Students will learn to: perform a thorough intake and exam; utilize essential computer software and reference material to streamline and guide prescription selection; select potency and treatment schedules; differentiate patient responses – palliation, suppression or cure; decide on follow-up prescriptions; develop case strategies; keep effective records, appropriately bill for your time; handle emergencies and complex cases. Session topics are: Session 1 (Sept. 17-20, 2015): Basic Conceptual Framework of Homeopathy Session 2 (Nov. 12-15, 2015): Difference between Acute & Chronic Disease Session 3 (Feb. 4-7 2016): Vaccination & Epidemic Disease Session 4 (Apr. 7-10, 2016): Treatment of Suppressed Cases Session 5 (Jun. 16-19 2016): Treatment of Cancer, Palliation vs. Cure For more information: 760-230-4784 info@pivh.org www.pivh.org

The WVC provides comprehensive continuing education to veterinary professionals and is an interactive educational opportunity for networking with the veterinary community. WVC grows in size each year adding new speakers that present state-ofthe-art hands-on labs in a comfortable environment.

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

IVC Winter 2014/2015