Integrative VETERINARY CARE VOLUME 5 ISSUE 4
INTEGRATIVE APPROACHES
TO INFECTIOUS DISEASE
NATURAL AND BIOLOGICAL REMEDIES CAN REDUCE INFLAMMATION, SUPPORT HEALING, AND IMPROVE THE EFFICACY OF CONVENTIONAL THERAPIES. – PAGE 14
CAN SUPPLEMENTS HELP MANAGE OA?
NAET AND ALLERGIES
BUYING AN ULTRASOUND SYSTEM?
THE NUTRITION IMMUNITY CONNECTION
Here’s how to ensure you make the best possible investment for your practice.
Nutritional deficiencies in equines can contribute to immune suppression and lead to disease.
MEDICAL CANNABIS FOR PETS
WHAT’ S NEW
Look at the evidence supporting the use of food and supplements as part of the treatment plan for osteoarthritis.
FALL ISSUE 2015
www.IVCJournal.com
The evidence so far suggests it has promising health benefits for pets.
This modality actually reprograms the brain and nervous system so the immune system does not react severely to allergens.
• Genetic sequencing of cats • Equine anthrax in Texas • Dogs reduce stress in kids • Saving sick shelter dogs
2
IVC Fall 2015
IVC Fall 2015
3
contents FEATURES
14
14
INTEGRATIVE APPROACHES ENHANCE AND SUPPORT HEALING OF INFECTIOUS DISEASES Guidelines for where, when and how these therapies can be used to improve the healing process as well as the efficacy of conventional therapies.
19
Nutrition Nook SUPPLEMENTING FOR MOBILITY
What’s the evidence that certain foods and supplements can help manage osteoarthritis?
22
22
Integrative Practice PURCHASING A VETERINARY ULTRASOUND SYSTEM
Whether you’re buying for the first time or upgrading your existing system, here’s how to make an investment that best fits your clinic’s needs.
28
AYURVEDA IN VETERINARY MEDICINE
Ayurvedic herbs and modalities have been in use for thousands of years and have a proven track record of safety and efficacy.
34
34
Tech Talk INTEGRATING TREADMILLS INTO THE VETERINARY PRACTICE
42
NAET – A CURE FOR THE ALLERGY EPIDEMIC
This modality actually reprograms the brain and nervous system so the immune system does not react severely to allergens.
48
TCVM FOR CHALLENGING ILLNESSES, PART 1: SEIZURES
Traditional Chinese Veterinary Medicine effectively complements current epilepsy medications and improves seizure management.
54
HOMEOPATHIC TREATMENT FOR EPIDEMIC DISEASES – PARVO AND DISTEMPER
Homeopathy helps the body extinguish symptoms without suppressing them, causing the disease to leave the body naturally.
60
NUTRITION AND IMMUNITY IN THE EQUINE
A deficiency of key vitamins and trace minerals may suppress the immune system and increase the risk of disease.
When adding an underwater treadmill, it’s important for assistants as well as doctors to become as familiar with it as possible in order to maximize its potential.
38
MEDICAL CANNABIS FOR ANIMALS
60 4
IVC Fall 2015
There are many issues involved in the consideration of cannabis as medicine, including regulation, product selection and safety.
42
28
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.
38 COLUMNS & DEPARTMENTS
5
Advisory board
8
Editorial
s new 11 What’ 13 From the AHVMF
Michelle J. Rivera, MT, VDT, is an instructor at the University of Wisconsin and The Healing Oasis Wellness Center, a post-graduate educational institution offering state-approved programs. She is co-owner of The Healing Oasis Veterinary Hospital, offering massage, rehabilitation, chiropractic and Chinese and Western Herbology. Michelle completed the Chinese Herbal Medicine program from the China Beijing International Acupuncture Training Center, and is certified in Chinese Medicine by the Wisconsin Institute of Chinese Herbology.
Dr. Joyce Harman, DVM, MRCVS, graduated in 1984 from Virginia Maryland Regional College of Veterinary Medicine. She is certified in veterinary acupuncture and chiropractic and has completed advanced training in homeopathy and herbal medicine. Her practice in Virginia uses holistic medicine to treat horses. Her publications include The Horse’s Pain-Free Back and Saddle-Fit Book – the most complete source of information about English saddles.
21 From the WAEO 37 From the AVH 46 Industry innovations 52 Social media 53 Veterinary resource guide 59 From the IVAS 64 From the VBMA
Dr. Steve Marsden, DVM, ND, lectures for the IVAS, the AHVMA and the AVMA, and is co-founder of the College of Integrative Veterinary Therapies. He is a director of the National College of Natural Medicine, and authored the Manual of Natural Veterinary Medicine. Dr. Marsden is extensively trai ned in alternative medicine, including Chinese herbology, acupuncture and naturopathic medicine. He has a veterinary and naturopathic practice in Edmonton, Alberta. In 2010, Dr. Marsden was named Teacher of the Year by the AHVMA.
Dr. Jean Dodds, DVM, received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she moved to Southern California to establish Hemopet, the first non-profit national blood bank program for animals. Dr. Dodds has been a member of many national and international committees on hematology, animal models of human disease, veterinary medicine, and laboratory animal science. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1994.
65 Marketplace 66 Events
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 Fall 2015
5
Integrative VETERINARY CARE
FALL 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: Kait Gambier Web Design & Development: Brad Vader Cover Photography: Jan Stolarik
COLUMNISTS & CONTRIBUTING WRITERS
ADVERTISING SALES: Eastern Sales Manager: Ann Beacom (866) 764-1212 ext. 222 annbeacom@redstonemediagroup.com Western Regional Manager: Becky Starr (866) 764-1212 ext. 221 becky@redstonemediagroup.com Marketing/Retail Specialist: Michelle Macaulay, (866) 764-1212 ext. 115 michelle@redstonemediagroup.com
Joe Bartges, DVM, PhD, DACVIM, DACVN Todd Cooney, DVM, CVH Henry Dinneen Robert S. Goldstein VMD Deva Khalsa, DVM Naomi Kirby Sismour, DVM, MS Ronald Koh, DVM, MS, CVA, CCRP, CVCH, CVFT Bridget Moran Donna M. Raditic, DVM, CVA, DACVN Neal J. Sivula, DVM, PhD, FAAVA Tejinder Sodhi, DVM, CVC Clair Thunes, PhD
CLASSIFIED ADVERTISING: Libby Sinden classified@IVCJournal.com
ADMINISTRATION & SALES
The opinions expressed in this journal are not necessarily those of the editor, and different views may appear in other issues. Redstone Media Group Inc., publisher of IVC Journal, does not promote any of the products or services advertised by a third party advertiser in this publication, nor does Redstone Media Group Inc. verify the accuracy of any claims made in connection with such advertisers.
Publisher: Redstone Media Group President/C.E.O.: Tim Hockley Accounting: Karen Tice Circulation & Office Manager: Libby Sinden SUBMISSIONS: Please send all editorial material, photos and correspondence to Dana Cox at Dana@redstonemediagroup.com or IVC Journal, 160 Charlotte St., Suite 202 Peterborough, ON, Canada K9J 2T8.
We welcome previously unpublished articles and color pictures either in transparency or disc form at 300 dpi. We cannot guarantee that either articles or pictures will be used or that they will be returned. We reserve the right to publish all letters received.
US MAIL: IVC Journal, 6834 S University Blvd PMB 155 Centennial, CO 80122 CDN MAIL: IVC Journal, 202-160 Charlotte St. Peterborough, ON, Canada K9J 2T8.
IVCJournal.com
Subscribe to IVC Journal Today! For a limited time only, IVC Journal is available by subscription for FREE. To order your subscription please visit www.ivcjournal.com
IVC Journal (ISSN 2291-9600) is published four times a year by Redstone Media Group Inc. Publications Mail Agreement #40884047. Entire contents copyright© 2015. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: September 2015.
IMPROVING THE LIVES OF ANIMALS... ONE READER AT A TIME.
6
IVC Fall 2015
IVC Fall 2015
7
editorial
INFECTIOUS DISEASE and the
INTEGRATIVE APPROACH
Infectious diseases are prevalent in many practices, any season of the year. When I was on clinics at the University of Georgia, I admitted my very first parvovirus case and I will never forget the smell and rapid progression of symptoms. Infectious diseases had specific protocols for symptomatic treatment, usually with anti-pyretics, anti-diarrheals and maintaining hydration and nutrient status. Some animals survived and others did not. In my early days in practice, I wondered what more we could do to improve survival rates, and more importantly to keep patients so healthy they would not get infections, nor continue to suffer with chronic illnesses. Though initially people only came to me when conventional medicine had no option, soon they came with all problems, including early stages of infectious diseases such as parvovirus, FeLK, and leptospirosis. I saw that integrating conventional treatments with holistic modalities would speed recovery and greatly decrease mortality rates. As Dr. Cooney describes in his article on p. 54, I also saw a much lower incidence of parvo, FIV, and other infectious diseases as holistic care assisted with strengthening the immune system. Many modalities can even be used to help the immune system in tandem with conventional therapies, as Dr. Goldstein describes in his article on p. 14. In addition to infectious diseases, over the years, my practice continued to treat many pets with chronic issues like mobility, epilepsy, and allergies that were not responding to conventional treatment. Sometimes clients came to me simply because they preferred more curative approaches. As I studied more, I learned many other approaches like those covered in this issue to heal chronic disease. Dr. Khalsa, for example, shows how allergies can be completely eliminated, rather than merely managed,
8
IVC Fall 2015
with NAET. The centuries old Indian Ayurvedic medicine is well introduced by Dr. Sodhi, who leaves us with combination herbs you could prescribe tomorrow. Dr. Koh documents effectiveness of TCVM, and even cannabis, to improve quality of life for patients with epilepsy, with some pets no longer needing antiepileptics drugs. In the IVC Journal we often show how nutrition improves health, and Drs. Raditic and Bartges present research on how specific components of foods can improve mobility. (They will cover even more supplements to aid mobility in the Winter issue so stay tuned). On the equine front, Dr. Thunes shows that better nutrition can boost the immune system to help prevent infections and heal chronic illness. After 30 years of teaching holistic approaches I am thrilled that the many different approaches we offer to build a healthy immune system can effectively ward off and treat infectious diseases as well as address any chronic problems. There are many classes, webinars and conferences as well as IVC Journal articles so you can continue to learn. Send us your holistic successes to post on the IVC Journal website so our whole community can benefit. Looking forward to seeing you at the AHVMA conference in Augusta.
Christina Chambreau, DVM, CVH Associate Editor, drtina@ivcjournal.com
IVC Fall 2015
9
contributors 1
2
6
7
1. JOSEPH BARTGES, DVM, PHD, DACVIM, DACVN Dr Jospeh Bartges is a 1987 graduate of the University of Georgia and completed an internship and dual residency in internal medicine and nutrition and PhD from the University of Minnesota. He is board certified in the ACVIM and the ACVN, and past president of the American Society of Veterinary Nephrology and Urology. Dr. Bartges is known for his research in veterinary nephrology, urology and nutrition. He has published peer-reviewed manuscripts, articles and book chapters, is the editor of Nephrology and Urology of Small Animals, an Associate Editor of the Journal of Veterinary Internal Medicine, and a consultant for the Urinary and Nutrition boards with the Veterinary Information Network. 2. TODD COONEY, DVM, CVH Dr. Todd Cooney graduated from Purdue University College of Veterinary Medicine. He worked in private practice, and as a USDA veterinarian. After almost 20 years of conventional practice, he took Dr. Richard Pitcairn’s Professional Course in Veterinary Homeopathy and changed the way he viewed health and disease. He began to use homeopathy in his practice before he had even finished the course, and now uses it exclusively on all his cases. His practice is located in north-central Indiana. He also does long distance consulting, and serves as an instructor for the Pitcairn Institute of Veterinary Homeopathy. 3. ROBERT S. GOLDSTEIN, VMD Dr. Bob Goldstein graduated from the University of Pennsylvania School of Veterinary Medicine in 1967. He operates the Healing Center for Animals, Integrative Veterinary Practice and is Director of Veterinary Services and Product Development for Earth Animal in Westport, Connecticut. Dr Goldstein developed the Nutritional Blood Test and has formulated more than 100 nutritional products, remedies and pet foods. He is editor and coauthor of the textbook Integrating Complementary Medicine into Veterinary Practice and coauthor of The Wellness and Longevity Program for Animals. 4. DEVA KHALSA, VMD, CVI, FBIH Dr. Deva Khalsa graduated from the University of Pennsylvania School of Veterinary Medicine and began a holistic veterinary clinic in Bucks County, PA (doctordeva.com). She is certified in acupuncture, prolotherapy, allergy elimination, NAET, advanced JMT, and has advanced training in herbology, alternative cancer treatments, ozone therapy, laser
10
IVC Fall 2015
3
8
4
9
therapy, homeopathy and chiropractic care. Dr. Khalsa has been a Professor at the British Institute of Homeopathy and is a veterinary expert on radio and television, including National Public Radio and Martha Stewart’s Veterinary Satellite Radio. Her books include Healing your Horse and Dr. Khalsa’s Natural Dog. 5. RONALD KOH, DVM, MS, CVA, CCRP, CVCH, CVFT Dr. Ronald Koh is an assistant professor in integrative medicine and physical rehabilitation at the Louisiana State University School of Veterinary Medicine in Baton Rouge, Louisiana. He studied veterinary medicine at National Chung Hsing University in Taiwan, completed a specialty internship in acupuncture, and received his Master’s degree of Veterinary Clinical Sciences at the University of Florida. His primary interests are the treatment of orthopedic and neurological disorders with acupuncture, Chinese herbal medicine and rehabilitation. Dr. Koh’s research endeavors have involved pain management, joint diseases, nerve injury, and cancer management. 6. DONNA M. RADITIC, DVM, DACVN, CVA Dr. Donna Raditic received her Bachelor of Science in Animal Science from Cornell University, then graduated with her Doctorate of Veterinary Medicine. She built her own practice in 1997 in the Berkshires of Western MA, offering integrative medicine while obtaining specialties in acupuncture, chiropractic, and botanical therapies. She is a Diplomat of the American College of Veterinary Nutrition and Assistant Professor in the Nutrition and Integrative Medicine services at the University of Tennessee College of Veterinary Medicine. She has authored and coauthored textbooks and presented at forums on nutrition and integrative therapies. 7. NEAL J. SIVULA, DVM, PHD, FAAVA Dr. Neal Sivula received his DVM from the Ohio State University College of Veterinary Medicine, and completed an internship, clinical residency and PhD from the University of Minnesota College of Veterinary Medicine. He is certified in Animal Chiropractic from the College of Animal Chiropractors and the AVCA; in Veterinary Acupuncture from the IVAS; and in Veterinary Chinese Herbalism and Food Therapy from the Chi Institute of Traditional Chinese Veterinary Medicine. Dr. Sivula is the founder of Dancing Paws Animal Wellness Center in Richfield Ohio. He is an Executive Editor of the American Journal of Traditional Chinese Veterinary Medicine, and Chair of the Advanced Certification Committee of the AAVA.
5
10
11
8. TEJINDER SODHI, DVM, CVC Dr. Tejinder Sodhi is a holistic veterinarian in the Seattle area, where he practices and promotes holistic care of animals. He utilizes Ayurvedic, homeopathy, chiropractic, acupuncture, and offers complete physical therapy at his rehab facility. He also serves on the board of advisors for the Seattle King County Veterinary Association, and has been president twice. 9. CLAIR THUNES, PHD Dr. Clair Thunes attained her PhD in nutrition from UC Davis. After several years working in epidemiology, she started Summit Equine Nutrition LLC (summit-equine.com), a consulting company where she is an independent equine nutritionist. Her clients include horses from competitors at the 2014 and 2010 World Equestrian Games and other events. Dr. Thunes has lectured at events across North America and acts as consulting nutritionist for several feed and supplement companies. She teaches equine nutrition and exercise physiology in the Animal Science Department at UC Davis, and equine health at Cosumnes River College. 10. BRIDGET MORAN, BA Bridget Moran is a veterinary assistant at Mountain Veterinary Hospital in Bellingham, Washington. She recently graduated with a Bachelor of Arts in Special Education from Western Washington University and is continuing her education through the Purdue University College of Veterinary Medicine’s Distance Learning Program in Veterinary Technology. With a background in working with children and adults with disabilities, Bridget intends to apply some of that knowledge to canines. She has worked with therapeutic animals and shows continued interest in learning how animals and people affect each other in positive ways. 11. HENRY DINNEEN Henry Dinneen is Vice President of Operations for Advanced Veterinary Ultrasound (avuetulsa.com), a division of Advanced Ultrasound Electronics. He has served the veterinary industry in various capacities, including sales of holistic veterinary care products, practice management solutions, trade journal advertising , and exhibit sales. His previous background was in trade magazine publishing. He is based in Tulsa, OK.
what’s new GENETIC SEQUENCING OF CATS Scientists recently completed the first ever genetic sequencing of a cat. Now, researchers at the University of Missouri are searching for ways to fund the genetic sequencing of more cats through a project called “99 Lives”. Leslie Lyons, the Gilbreath-McLorn Endowed Professor of Comparative Medicine in the MU College of Veterinary Medicine, says cats suffer from many of the same genetic diseases as humans, and if scientists can sequence the genes of more cats, they can gain a better understanding of how to treat these diseases in cats and in people. “Many cats suffer from obesity, diabetes, asthma, urinary tract infections, cancers, heart disease and infectious diseases, just like humans,” Lyons says. “The responsible DNA variations for any individual birth defect or inherited condition that affects health later in life can now be identified in any individual cat. Tens of thousands of humans and hundreds of dogs have had full genome sequencing, which has helped create a robust, diverse genetic map for those species; however, we currently only have one cat’s genetic map to study. The more cats we can genetically sequence, the better we will understand what causes many genetic disorders and possibly even how to prevent those problems.” felinegenetics.missouri.edu/99lives.
The “99 Lives” project aims to find ways to fund the genetic sequencing of more cats so we can gain a better understanding of both feline and human diseases.
NOTEWORTHY STATISTICS The number of American households with animal companions has risen by 50% over the last 20 years. This is just one of many interesting facts revealed by the American Pet Products Association’s biennial National Pet Owners Survey. Two other noteworthy findings from the 2015-2016 survey: q The economy no longer seems to be a factor in animal spending – 74% of pet owners report they are not influenced by the economy when it comes to giving the best to their animals.
w Another relatively new finding, along with research conducted by the Human Animal Bond Research Initiative, is that more doctors believe animals are good for human health. In a survey of 1,000 family doctors and GPs, 97% believe in the health benefits of having an animal, and 60% would recommend an animal to improve overall health.
“The body of science validating that pets are good for us is growing with strong research in numerous areas of health,” said Bob Vetere, President and CEO of APPA. “Studies now exist that show pets can help improve our cardiovascular health, improve immunity in young children and assist with therapy for autistic children and people suffering from PTSD. Our desire to take better care of our pets and the joys and benefits they provide are continuing to work together to grow pet ownership.” americanpetproducts.org
IVC Fall 2015
11
what’s new SAVING SICK SHELTER DOGS A gift from the Richard Lichter Charity for Dogs is helping save the lives of shelter dogs needing specialized medical care. Through the Shelter Dog Specialty Medical Treatment Project, experts at Penn Vet are providing life-saving specialty care to dogs in partnering shelters. The dogs are selected through the Penn Vet Shelter Animal Medicine Program and treated at Penn Vet’s Ryan Hospital. Once a dog is approved for the program, Penn Vet provides all medical and diagnostic services necessary to treat the condition. After treatment, the dog is placed in foster care and becomes available for adoption. The first dogs saved through the project were four pit bull-mix puppies with severe vaccine reactions. The puppies were having seizures and vomiting, so were rushed to Ryan Hospital’s Emergency Service. They were not actively seizuring upon arrival, but were lethargic and showed signs of abnormal mentation. They were placed on IV fluids, received anti-nausea medications and Benadryl, and were hospitalized with supportive care for two nights. One puppy has already been adopted by a Penn Vet technician. vet.upenn.edu
EQUINE ANTHRAX CASE IN TEXAS The first anthrax case in Texas this year was confirmed in an equine in Uvalde County. Anthrax is a bacterial disease caused by Bacillus anthracis, a naturally-occurring organism with worldwide distribution, including certain parts of Texas. A vaccine is available for use in susceptible livestock in high-risk areas. Acute fever, bleeding from bodily openings, and rapid death are common signs of anthrax in livestock. Carcasses may also appear bloated and decompose quickly. “The Texas Animal Health Commission (TAHC) will continue to closely monitor the situation for possible new cases across the state,” says Dr. T.R. Lansford, TAHC Assistant Executive Director for Animal Health Programs. “Producers are encouraged to consult their veterinary practitioner or local TAHC office if they have questions about the disease in livestock, and their medical professional if they have concerns about anthrax exposure.” To learn more about anthrax, see the TAHC’s brochure at tahc.state.tx.us/news/brochures/ TAHCBrochure_Anthrax.pdf.
STUDY LOOKS AT HOW DOGS REDUCE STRESS IN KIDS The Human Animal Bond Research Initiative (HABRI) has awarded a $26,000 grant to Yale University for a new study, “Interactions with Animals to Reduce Children’s Stress”. It will examine the effects of interactions with dogs on children dealing with stress and anxiety. “I am hoping to identify ways in which animal-child interaction can reduce stress and, furthermore, wish to understand precisely how that works, how the interaction can be optimized, and how it might translate to what’s being done in animal-assisted interventions and also in everyday life,” says the study’s primary researcher, Dr. Alan Kazdin, professor of Psychology and Child Psychiatry at Yale University. The two-year laboratory-based experiment on behalf of Yale University’s Department of Psychology will examine 73 children between the ages of eight and 13 and randomly assign them support from a dog, support from an object, or no support. Researchers will then employ a series of tests and compare the stress levels in each group. habri.org or psychology.yale.edu
12
IVC Fall 2015
Children suffer from stress and anxiety just as adults do, and this study will look at how dogs can help alleviate these states.
The AHVM Foundation is a 501(c)(3) non-profit charitable organization that benefits the public good through scientific research and education in integrative veterinary medicine. It seeks to be a model of both high quality and high integrity work in integrative therapies. We hope to discover information that improves education and clinical practice for both human and veterinary medicine.
The Foundation’s currently funded studies are beginning to bear fruit. The study using acupuncture for laminitis is showing promising results. Another study looking at the effects of low level laser therapy on equine tendons has yielded opposite results for white-legged and black-legged horses. And the initial findings of a study comparing the effects of non-anesthetic teeth cleaning with cleaning performed under anesthetic do not match the preconceptions of many. We continue to expand our ways to fund integrative research as we receive more applications for research and education grants. We recently received three new grant applications. One proposes to investigate the presence of GMOs, as well as glyphosate residue and its breakdown product (AMPA), in cat and dog food. A second will explore the effects of cold laser treatment on lick granulomas in dogs. A third requests funds to explore the action of agmatine, a nutraceutical, for pain control in dogs with intervertebral disc disease.
human products in pets is whether or not they will really work, and if so, what the dosage should be and if there are any unintended consequences. If agmatine is as successful in dogs as in people, it will be one more tool for treating hard-to-control neurological pain. While the Foundation is able to fund the GMO study, it does not currently have funds for the others. A breakfast meeting at the annual AHVMA conference will present more findings from research funded by the Foundation. We are currently gathering sponsors for the meeting – watch our website and help support those who are helping us! Amazon Smile, iGive, a branded credit card, and a car donation are all ways to donate without spending any of your hardearned money. We would like to thank our sponsors who help us promote the cause of integrative holistic veterinary medicine:
The importance of the GMO study should be obvious, but some may wonder why the other two are necessary.
Platinum sponsor of Research and Education: Mercola Silver sponsors of Research and Education: Darwin and ACES
Acral lick granulomas can be difficult to treat by any q means. Little is published about them, and none of it is
If you have not yet done so, be sure to make your plans for the inspiring 30th anniversary conference of the AHVMA October 17 to 20 in Augusta, Georgia. Events, celebrations and retrospectives will highlight our dedication to holistic medicine, with plenty of focus on the next 30 years to come. The breakfast meetings will fill up quickly, so sign up early. The Healer Heal Thyself retreat will run October 13 to 16. Go to the conference tab at ahvma.org for all the information and inspiration you need, as well as to register.
about cold laser therapy. This research can show how many sufferers could be helped, as well as the specific methods used, which will help low level laser users give patients more precise treatments. in humans has shown the benefits of agmatine w Research for neurological pain. One of the problems with using
IVC Fall 2015
13
HOW INTEGRATIVE APPROACHES ENHANCE AND SUPPORT HEALING OF
INFECTIOUS DISEASES This article describes a general approach to the use of integrative therapies for infectious diseases in dogs and cats. While it is beyond the scope of this piece to offer protocols for specific diseases, I will present general guidelines for where, when and how these therapies can be used to enhance the healing process, as well as improve the efficacy of conventional medical therapies. A review of the veterinary literature on infectious disease in dogs and cats shows an extensive amount of information on causes, prevention and treatment. Early in the last century, small animal veterinary medicine focused on prevention as well as the diagnosis of dogs with distemper, hepatitis and leptospirosis, and of cats for panleukopenia, infectious peritonitis and rhinotracheitis/calici. More modern diagnostics and research have unveiled more and more infectious agents linked with specific new and older diseases. Modern veterinary literature classifies infectious disease of dogs and cats in a long list, such as seen in the table on page 15.
14
IVC Fall 2015
By Robert S. Goldstein VMD
That said, when this list of infectious diseases is reviewed in the veterinary literature for their causes, treatment and prevention, a common theme develops that is quite similar from one condition to another:
q Cause – infectious agent w Prevention – vaccinations e Treatment – supportive
care for the target affected organ (antibiotics, fluid therapy) and symptom-oriented medication (anti-diarrhea, anti-tussive, etc).
What has been strikingly absent from much of the veterinary literature about infectious disease is how to use an integrative approach to support the immune system and the affected organs with natural therapies such as herbs, glandulars, therapeutic nutrition and deeply healing supportive modalities such as homeopathy and TCVM. The good news is this trend is now growing and conventional literature increasingly reports on the many studies for holistic modalities generated by clinician and client demand.
INFECTIOUS DISEASES
INTEGRATIVE APPROACH In conventional veterinary medicine, the underlying cause of infectious diseases is associated with specific infectious agents; however, as we know, not all animals exposed to infectious agents succumb to the disease. In healthy animals, the immune system defense (cellular and humoral), when functioning well, will fight off infectious agents before they establish themselves in the body and cause illness.
Dogs
Cats
Borreliosis (Lyme disease)
Borreliosis (Lyme disease)
Canine Coronavirus Infection Canine Distemper Ehrlichiosis
The integrative approach, therefore, is designed to support that immune surveillance mechanism by using alternative modalities, without compromising the effectiveness of conventional medical therapies. This allows us to use a selected medication to work effectively on the symptoms of the disease while simultaneously nourishing the body by offering energetic and biological remedies that can actually get to the root cause and inflammatory insult. This is necessary in order to achieve a true healing.
Canine Parvo Disease
Here are some of the natural modalities that may be used when treating infectious disease:
Salmonellosis
CHINESE AND WESTERN HERBS Herbal medicine is broadly defined as the use of various botanicals to achieve specific therapeutic and healing results. Both Western and Chinese herbal medicine are used in veterinary practice with great results. Herbs and herbal combinations contain numerous active ingredients that work synergistically to help promote healing without the inherent side effects associated with many medications.
Canine Herpesvirus Infectious Canine Hepatitis (ICH) Canine Infectious Tracheobronchitis Leptospirosis Rabies
Feline Enteric Coronavirus Feline infectious peritonitis (FIP) Feline Immunodeficiency Virus (FIV) Panleukopenia (Feline Distemper) Feline Infectious Anemia Feline Leukemia Pneumonitis Rabies Feline Viral Respiratory Disease Complex Feline Viral Rhinotracheitis (FVR) Toxoplasmosis Salmonellosis
For instance, a Chinese herbal combination, Bai Tou Weng Tang, which contains pulsatilla (Bai tou weng), phellodenron bark (Huang bai), coptis root (Huang lian) and ash bark (Qin pi), has strong antibacterial, antiviral and anti-parasitic properties. It also decreases gastrointestinal inflammation, and therefore helps control diarrhea and abdominal pain in dogs with parvovirus.
COMBINATION HOMEOPATHIC AND HOMOTOXICOLOGY REMEDIES Homeopathic combinations are low-potency, symptom-oriented remedies designed to gently stimulate the body’s own healing mechanisms, reduce inflammation and move the body toward healing and homeostasis. Both homotoxicology Continued on page 17.
IVC Fall 2015
15
Case studies recommended medical therapy of antibiotics. Tidbit improved weekly and his blood was essentially back to normal by October 2013. He has remained on a program of herbal, homeopathic and gland support, and two years later is the picture of health.
2 Tidbit was diagnosed with leptospirosis.
1
Tidbit today, on a program of herbal, homeopathic and glandular support.
Tidbit, now a seven-year-old Papillion, was presented to the local veterinary clinic for “not doing well�; he was off his food, with some vomiting. He was treated symptomatically and improved somewhat, but then relapsed and was referred to the specialty clinic in July 2013. Blood examination showed slight azotemia along with an elevated ALT. Tidbit was discharged back to the family veterinarian on Famotidine and a bland diet. He continued to decline and was re-examined a week later when his blood showed a BUN 238, creatinine 8.3 and ALT of 386 with a positive diagnosis for leptospirosis. Being nonresponsive to fluid therapy and with total renal shutdown, Tidbit was transferred to the Animal Medical Center in New York City for kidney dialysis and supportive care for the treatment of his leptospirosis. He responded well to therapy, and his kidney and liver values were tracking down in early August 2013 upon discharge, and with home therapy of oral medication for the residual issues with his liver and kidneys. ased on the diagnosis of leptospirosis, and his B secondary kidney and liver issues, Tidbit was placed on an integrative therapy program to support his organ health and function and to enhance the healing process. This integrative support included a combination homeopathic (homotoxicology) remedy that contained anti-inflammatory, liver and kidney support; a nutraceutical (Gluta DMG) for liver and immune function and support; a combination of glandulars for liver and kidney health; and a combination herbal remedy (with uva ursi, marshmallow root, gravel root and other herb extracts) to support kidney function; all along with the
16
IVC Fall 2015
Oscar is a 14-year-old American shorthair cat who was diagnosed with FIV when he was five years of age. He developed secondary asthma as well as an immune-mediated pruritic skin condition on his face, secondary to infected teeth that required extraction. The condition started initially as recurrent upper respiratory infections, at which time Oscar tested positive for FIV. More recently, he has developed low grade azotemia.
scar has been maintained in remission for nine years on O natural remedies including L-lysine, an amino acid with anti-viral properties; lactoferrin, which has been shown to help modulate immune function; and symptomoriented remedies such as quercetin (a natural antihistamine) to minimize allergic reactions, and plant sterols to modulate immune function and improve control of viral reactions. In addition, combination homeopathic (homotoxicology) remedies were given to help reduce inflammation, asthmatic and skin allergic episodes. Glandular support for the kidneys, lymph and splenic systems has also been administered to help maintain Oscar’s immune and renal function.
Oscar had developed a secondary pruritic skin condition. Oscar is doing well on his multifaceted integrative treatment program.
Continued from page 15. and combination homeopathic medicines can be targeted for specific infected organs, or specific symptoms.
system often associated with viral disease.
GLANDULARS
In summary, the integrative approach of administering natural and biological remedies – either in combination with medical therapy or as a free-standing protocol – is beneficial for the animal’s day-today quality of life, and for reducing underlying inflammation and enhancing the healing process, even when treating the most devastating infectious diseases.
The administration of whole gland and/or extracts has been shown to be nutritive and have anti-inflammatory effects on the body’s glands. Besides containing vitamins, minerals, enzymes, co-factors and amino acids, they also contain intrinsic factors that are organ-specific, providing the raw materials for organ tissue repair and neutralizing the autoimmune inflammatory process occurring in that particular organ. This reduction of organ inflammation spares the organ, helps prevent the process of degeneration and disease, and promotes healing. (Goldstein 2008, Mowat 2004, 2012) If treating leptospirosis in a dog whose kidneys are compromised, for instance, a kidney glandular could be useful.
NUTRACEUTICALS The term “neutraceutical was coined by Dr Stephen DeFelice in 1989 from the words “nutrition” and “pharmaceutical”. It is broadly used to describe a vast number of nutrientbased compounds that have a beneficial and healing effect on the body. One example of these compounds is quercetin, a flavonoid that has anti-histaminic properties, which can help reduce the inflammation in the upper respiratory
REFERENCES Goldstein R, Broadfoot P, Fougere B, Palmquist R, Wen J. Integrating Complementary Medicine into Veterinary Practice. Wiley-Blackwell, 2008. Kobayashi S, Sato R, Aoki T, Omoe K, Inanami O, Hankanga C, Yamada Y, Tomizawa N, Yasuda J, Sasaki J. “Effect of bovine lactoferrin on functions of activated feline peripheral blood mononuclear cells during chronic feline immunodeficiency virus infection”. J Vet Med Sci, 2008. Maggs DJ, Nasisse MP, Kass PH. “Efficacy of oral supplementation with L-lysine in cats latently infected with feline herpesvirus”. Am J Vet Res. 2003. Mowat A, Pabst O. “Oral Tolerance to Food Protein”. Mucosal Immunology, 2012. Mowat A, Parker LA, Beacock-Sharp H, Millington OR, Chirdo F. “Oral Tolerance: New Insights and Prospects for Clinical Application”. Anals of the New York Academy of Science, 2004. Sato R, Inanami O, Tanaka Y, Takase M, Naito Y. “Oral administration of bovine lactoferrin for treatment of intractable stomatitis in feline immunodeficiency virus (FIV)-positive and FIV-negative cats”. Am J Vet Res, 1996.
IVC Fall 2015
17
Product Profile
DRY MOUTH:
learn to spot the red flags By Naomi A. Kirby Sismour, DVM, MS
Dry Mouth is much more common than many realize. Also known as Xerostomia, it affects not only people, but pets too. Dry Mouth is characterized by an insufficient quantity or quality of saliva. When the quality and quantity of saliva become altered, its important antibacterial and physiological mechanism is disrupted. Regrettably, Dry Mouth is often misdiagnosed and overlooked. Left untreated, it can lead to a serious decline in oral health, creating an environment for bacterial and fungal overgrowth. Dry Mouth is one of the hidden causes of gum disease, and there are several red flags to indicate a potential problem. It is estimated that 17% to 29% of adult humans experience Dry Mouth symptoms. It can be a chronic condition in both pets and people and stem from a range of medical or biological circumstances strongly correlated to age-related issues. Causes of Dry Mouth in both pets and people include many medications and health conditions, such as diabetes and especially radiation to the neck or head in cancer treatments. People and pets are living longer, and aging predisposes them to many health disorders as well as a need for medications in the geriatric years. Some medications are directly linked to Dry Mouth in pets and people. Learning to spot the red flags in pets and offering oral care products to manage symptoms are critical because of the health risks associated with not managing Dry Mouth. Severe Dry Mouth conditions can lead to oral lesions, gingivitis and tooth loss. The risk of systemic infections also increases if bacteria are absorbed into the bloodstream. #1 Red flag: Some common medications that may contribute to Dry Mouth:¹ • Antihypertensives – Furosemide, A.C.E. Inhibitors • NSAIDs • Phenylpropanalomine (urinary incontinence) • Antihistamines • Anti-anxiety meds
18
IVC Fall 2015
#2 Red flag: Some indicators • Plaque accumulation • Halitosis • Periodontal disease #3 Red flag: Some health conditions • Diabetes • Keratoconjunctivitis/Sjogren’s disease
A dog with Dry Mouth will still drool. The ORATENE® Veterinarian Brushless Oral Care line (formerly known as BIOTENE® Veterinarian²) was created by the originators of BIOTENE®, the number one pharmacist and dentist recommended brand of oral care products for people with Dry Mouth. Oratene has been formulated specifically for pets (dogs or cats) and features two patented enzyme systems, based on over 35 years of enzyme technology, to reduce the growth of harmful odor-causing bacteria and fungi, and reduce the plaque biofilm that forms on the teeth, tongue and mucosal surfaces. The products work best together but pet owners have a choice. Products include a water additive, breath freshening spray, an oral gel (works like a brushless toothpaste), and an antiseptic gel for severe oral conditions.
¹ For a more thorough list of signs, causes and medications, contact PKB Animal Health at 603-241-3905. ² Biotene®is now the registered trademark of GlaxoSmithKline.
Dr. Naomi Kirby Sismour is the Technical Services Manager at PKB Animal Health (pkbanimalhealth.com).
nutrition nook
Supplementing for
MOBILITY By Donna M. Raditic, DVM, CVA, DACVN, and Joe Bartges, DVM, PhD, DACVIM, DACVN
What’s the evidence that certain foods and supplements can help manage osteoarthritis? Can we recommend our clients use food to help medically manage osteoarthritis in their dogs? There are many food-derived supplements on the market nowadays for veterinary patients with osteoarthritis,1-14 and using diet and supplements to manage the condition is a growing area of interest in both human and veterinary nutrition. Since nutrition is the foundation of health, it is natural for clients to inquire if specific foods can be used to improve mobility in osteoarthritic dogs. Therefore, the practitioner should be able to evaluate therapeutic foods and supplement claims so he or she can make specific nutritional recommendations to complement the medical management of osteoarthritis. Food-derived supplements can be found in pet diets, treats, and as tablets or chews, often with suggested therapeutic or beneficial effects for canine osteoarthritis.Very few have been evaluated in a controlled manner, and even fewer have been evaluated in dogs with osteoarthritis. This is a brief review of scientific evidence and research for use of these food-derived supplements in dogs with osteoarthritis.
q Avocado/soybean unsaponifiables (ASU): Composed of the
unsaponifiable fractions of avocado and soybean oils in a 1/3 to 2/3 proportion.15,16 ASU offers anti-osteoarthritic properties by inhibiting interlukin-1 and stimulating collagen synthesis in cartilage cultures.16-18
I n one study of dogs, osteoarthritis was induced by anterior cruciate ligament transection. The dogs received placebo or ASU (10 mg/ kg/24h).19 The size of macroscopic lesions of the tibial plateau, severity of cartilage lesions, synovial cellular infiltration, and inducible nitric oxide synthase were all significantly decreased. There was also a reduced loss of subchondral bone volume and calcified cartilage thickness in the group receiving ASU.19 In 14 dogs, surgery was performed to create two osteochondral defects in the lateral aspect of the trochlear groove of the knee
joint. The dogs were randomly assigned to either a treatment group given 300 mg of ASU every three days, or a control group fed a normal diet. Exercise was not restricted and in 15 weeks the dogs were euthanized. Morphometric analysis of cartilage tissue revealed more immature repair tissue with greater collagen and chondral tissue content in the regenerated tissue in the ASU-treated dogs as compared to the untreated dogs. The ASU-treated tissues also showed markedly more immunostaining of transforming growth factor β (TGF- β).20
w B lueberries:
Flowering plants of the genus Vaccinium, which includes cranberries and bilberries. They may have anti-oxidative and anti-inflammatory actions because they contain pterostilbene, anthocyanins, proanthocyanidins, resveratrol, flavonols, and tannins.21 In a study of sled dogs, those receiving a blueberry supplement had higher antioxidant status than those not receiving the supplement; however, there was no difference in creatinine kinase activity and isoprostane levels (a measure of oxidative stress) between dogs that received blueberries and those that did not.22
e N ew Zealand green-lipped mussel (Perna canaliculus): A rich source of glycosaminoglycans and has anti-inflammatory effects.23 In a randomized controlled clinical study of 31 dogs with arthritis, green-lipped mussel powder (0.3%) was added to the diet during processing for one group of dogs.24 Compared to the control group, which was fed the same diet without added green-lipped mussel powder, the treated group showed significant improvement in subjective arthritis scores, joint swelling, and joint pain.
However, this data must not be over-interpreted. In a randomized, double-controlled and double-blinded clinical trial, 45 dogs with osteoarthritis were evaluated. Dogs receiving green-lipped mussel experienced improvement in mobility when compared with placebo; however, it was not as effective as Carprofen.25
Continued on page 20. IVC Fall 2015
19
Continued from page 19. I n a study of 81 dogs with presumptive osteoarthritis, clinical signs improved in both the green-lipped mussel and placebo-treated groups when compared with baseline. On day 56 of the study, dogs receiving green-lipped muscle had improved clinical signs but not musculoskeletal scores.26 An uncontrolled study of 85 dogs fed a green-lipped mussel supplemented diet for 50 days showed reduction of a composite arthritic score when compared with baseline scores on various diets dogs were consuming.27 In systematic reviews of agents used to treat canine osteoarthritis, the data regarding the benefits of green-lipped mussel extract in dogs was promising, but the scientific quality of the data is questionable and no definitive relationship has been proven between clinical improvements and therapy.28, 29
r S pecial milk protein concentrate: Prepared from the milk of hyper-
immunized cows. Milk contains a number of biologically active compounds including immunoglobulins, cytokines, enzymes, hormones and growth factors. The milk protein concentrate exerts anti-inflammatory properties;30 they do not appear to be due to the inhibition of arachidonic acid metabolism, but to the suppression of neutrophil migration from the vascular space.31 randomized, controlled clinical trial evaluating special A milk protein concentrate (Microlactin, Stolle Milk Biologics, Cincinnati, OH) in dogs with naturally-occurring osteoarthritis resulted in an improvement in subjective clinical signs and owner global assessment when compared with dogs receiving placebo.32
t Tumeric
– curcumin and P54FP: P54FP is an extract of Indian and Javanese turmeric (Curcuma domestica and Curcuma xanthorrhiza) that contains a mixture of active ingredients possessing anti-inflammatory activity, including curcuminoids and essential oils.33 Specifically, curcumin has been shown to inhibit PGE2, COX-2 and nuclear factor β, and upregulate MMP-3 and IL-1β induced proteoglycan degradation.34-36
proliferation and activation of fibrinolysis were noted in the curcumin group and not the NSAID group. These results suggest that oral curcumin may have a complementary anti-inflammatory effect in OA that differs from a NSAID’s.37 Conventional medical management of OA in dogs is dominated by NSAIDs, but adverse side effects can occur and there is concern about long term administration of these drugs. They have not been shown to slow the progression of the disease, or have a positive impact on joint degradation. Diet and dietary supplements are being increasingly studied since the economics of osteoarthritis in the aging human population is a growing concern. Pet owners will also be questioning practitioners on the use of dietary supplements in animals. Understanding the current literature allows you to understand the evidence, application, mechanism of action, and potential use of dietary supplements in the medical management of the osteoarthritic dog. De Silva V, El-Metwally A, Ernst E, et al. “Evidence for the efficacy of complementary and alternative medicines in the management of osteoarthritis: a systematic review”. Rheumatology (Oxford) 2011;50:911-920.
1
Pirotta M. “Arthritis disease – the use of complementary therapies”. Aust Fam Physician 2010;39:638-640.
2
Efthimiou P, Kukar M. “Complementary and alternative medicine use in rheumatoid arthritis: proposed mechanism of action and efficacy of commonly used modalities”. Rheumatol Int 2010;30:571-586.
3
Marcus DM. “Therapy: Herbals and supplements for rheumatic diseases”. Nat Rev Rheumatol 2009;5:299-300.
4
Vitetta L, Cicuttini F, Sali A. “Alternative therapies for musculoskeletal conditions”. Best Pract Res Clin Rheumatol 2008;22:499-522.
5
Ernst E.“Complementary treatments in rheumatic diseases”. Rheum Dis Clin North Am 2008;34:455-467.
6
Ernst E.“Complementary or alternative therapies for osteoarthritis”. Nat Clin Pract Rheumatol 2006;2:74-80.
7
Rosenbaum CC, O’Mathuna DP, Chavez M, et al. “Antioxidants årheumatoid arthritis”. Altern Ther Health Med 2010;16:32-40.
8
Henrotin Y, Lambert C, Couchourel D, et al. “Nutraceuticals: do they represent a new era in the management of osteoarthritis? – a narrative review from the lessons taken with five products”. Osteoarthritis Cartilage 2011;19:1-21.
9
20
IVC Fall 2015
Dunlap KL, Reynolds AJ, Duffy LK. “Total antioxidant power in sled dogs supplemented with blueberries and the comparison of blood parameters associated with exercise”. Comp Biochem Physiol A Mol Integr Physiol 2006;143:429-434.
22
Gibson RG, Gibson SL, Conway V, et al. “Perna canaliculus in the treatment of arthritis”. Practitioner 1980;224:955-960.
23
Bui LM, Bierer TL.“Influence of green-lipped mussels (Perna canaliculus) in alleviating signs of arthritis in dogs”. Vet Ther 2003;4:397-407.
24
Hielm-Bjorkman A, Tulamo RM, Salonen H, et al. “Evaluating Complementary Therapies for Canine Osteoarthritis Part I: Green-lipped Mussel (Perna canaliculus)”. Evid Based Complement Alternat Med 2009;6:365-373.
25
Pollard B, Guilford WG, Ankenbauer-Perkins KL, et al. “Clinical efficacy and tolerance of an extract of green-lipped mussel (Perna canaliculus) in dogs presumptively diagnosed with degenerative joint disease”. N Z Vet J 2006;54:114-118.
26
Servet E, Biourge V, Marniquet P. “Dietary intervention can improve clinical signs in osteoarthritic dogs”. J Nutr 2006;136:1995S-1997S.
27
Aragon CL, Hofmeister EH, Budsberg SC. “Systematic review of clinical trials of treatments for osteoarthritis in dogs”. J Am Vet Med Assoc 2007;230:514-521.
28
Ameye LG, Chee WS. “Osteoarthritis and nutrition. From nutraceuticals to functional foods: a systematic review of the scientific evidence”. Arthritis Res Ther 2006;8:R127.
29
Morelli V, Naquin C, Weaver V. “Alternative therapies for traditional disease states: osteoarthritis”. Am Fam Physician 2003;67:339-344.
30
10
ne randomized, blinded study in dogs with osteoarthritis found O no difference in objective ground reaction forces, but did see some improvements in certain subjective outcome measures.33 In another study, 18 dogs with OA were randomly assigned to three groups: the test group received a curcumin supplement at 4mg/kg; the positive control received oral Fibrocoxib at 5mg/kg; and a negative control group of healthy dogs was untreated. Data analysis of gene expressions was compared between these three groups of six dogs at Day 0 and Day 20. After 20 days, gene markers for inflammatory response and connective tissue development and function decreased in the curcumin and Fibrocoxib groups compared to the non-treated dogs. Specific molecular targets identified in the curcumin group, not observed in the NSAID group, were the TNRF-1 signaling pathway down-regulating TNFα and IL-18 while upregulating 1kB. In addition, inhibition of macrophage
Burdulis D, Sarkinas A, Jasutiene I, et al.“Comparative study of anthocyanin composition, antimicrobial and antioxidant activity in bilberry (Vaccinium myrtillus L.) and blueberry (Vaccinium corymbosum L.) fruits”. Acta Pol Pharm 2009;66:399-408.
21
11
Li RW, Myers SP, Leach DN, et al. “A cross-cultural study: anti-inflammatory activity of Australian and Chinese plants”. J Ethnopharmacol 2003;85:25-32.
12
Sanderson RO, Beata C, Flipo RM, et al. “Systematic review of the management of canine osteoarthritis”. Vet Rec 2009;164:418-424. Gingerich DA, Fuhrer JP, Kiser KM, et al. “Milk protein concentrate from hyperimmunized cows expresses anti-inflammatory activity and clinical utility in osteoarthritis”. J Vet Intern Med 2001;15:305. Stelwagen K, Ormrod DJ. “An anti-inflammatory component derived from milk of hyperimmunised cows reduces tight junction permeability in vitro”. Inflamm Res 1998;47:384-388.
Mathie RT, Baitson ES, Hansen L, et al. “Homeopathic prescribing for chronic conditions in feline and canine veterinary practice”. Homeopathy 2010;99:243-248.
31
Clayton JJ.“Nutraceuticals in the management of osteoarthritis”. Orthopedics 2007;30:624-629; quiz 630-621.
32
13
14
Verbruggen G. “Chondroprotective drugs in degenerative joint diseases”. Rheumatology (Oxford) 2006;45:129-138.
15
Henrotin Y. “Avocado/soybean unsaponifiable (ASU) to treat osteoarthritis: a clarification”. Osteoarthritis Cartilage 2008;16:1118-1119; author reply 1120.
16
Boumediene K, Felisaz N, Bogdanowicz P, et al. “Avocado/soya unsaponifiables enhance the expression of transforming growth factor beta1 and beta2 in cultured articular chondrocytes”. Arthritis Rheum 1999;42:148-156.
17
Dinubile NA. “A potential role for avocado- and soybean-based nutritional supplements in the management of osteoarthritis: a review”. Phys Sportsmed 2010;38:71-81.
18
Boileau C, Martel-Pelletier J, Caron J, et al. “Protective effects of total fraction of avocado/soybean unsaponifiables on the structural changes in experimental dog osteoarthritis: inhibition of nitric oxide synthase and matrix metalloproteinase-13”. Arthritis Res Ther 2009;11:R41.
19
Altinel L, Sahin O, Kose KC, et al. “Healing of osteochondral defects in canine knee with avocado/soybean unsaponifiables: a morphometric comparative analysis”. Eklem Hastalik Cerrahisi 2011;22:48-53.
20
Gingerich DA, Strobel JD. “Use of client-specific outcome measures to assess treatment effects in geriatric, arthritic dogs: controlled clinical evaluation of a nutraceutical”. Vet Ther 2003;4:376-386. Innes JF, Fuller CJ, Grover ER, et al. “Randomised, double-blind, placebocontrolled parallel group study of P54FP for the treatment of dogs with osteoarthritis”. Vet Rec 2003;152:457-460.
33
Lev-Ari S, Strier L, Kazanov D, et al.“Curcumin synergistically potentiates the growth-inhibitory and pro-apoptotic effects of celecoxib in osteoarthritis synovial adherent cells”. Rheumatology (Oxford) 2006;45:171-177.
34
Kwon Y, Magnuson BA. “Effect of azoxymethane and curcumin on transcriptional levels of cyclooxygenase-1 and -2 during initiation of colon carcinogenesis”. Scand J Gastroenterol 2007;42:72-80.
35
Henrotin Y, Clutterbuck AL, Allaway D, et al.“Biological actions of curcumin on articular chondrocytes”. Osteoarthritis Cartilage 2010;18:141-149.
36
Colitti M, Gaspardo B, Della Pria A, et al. “Transcriptome modification of white blood cells after dietary administration of curcumin and nonsteroidal anti-inflammatory drug in osteoarthritic affected dogs”. Vet Immunol Immunopathol 2012;147:136-146.
37
From the
WAEO The Worldwide Alliance of Equine Osteopaths (WAEO), established in February of 2013, is a non-profit corporation that seeks to unite the profession of Equine Osteopathy. We intend to serve as a resource for practitioners, researchers, educators and students of Equine Osteopathy. We aspire to be the link that allows Equine Osteopaths from all over the world to connect and converse. There is much to learn about each other and the profession of Equine Osteopathy as it is practiced throughout the world.
The WAEO was excited to hold its second Annual Conference and Membership Meeting September 5 and 6 at The Vluggen Institute for Equine Osteopathy and Education in Waldfeucht-Obspringen, Germany. Topics included the measurement and management of pain in horses; fascial techniques in horses; cancer; Lyme disease; connections between the anatomy of head and jaw; training the horse; and bits and bridling with lameness. A demonstration showed how the individual immobility issues of horse and rider impact each other. This annual conference is open to any interested parties; for more information, go to equineosteopathy.org. • On October 16, 17 and 18, in Rectortown, Virginia, the WAEO offers a post graduate course “The Influence of the Horse and Rider on Each Other”, led by Andre Teunissen, DO, MRO-NL, EDO. The focus is osteopathic issues that can be transferred and influenced from horse to rider and vice versa. It’s for postgraduate EDOs only, and should be eligible for IREO credit.
• Rectortown Equine Clinic and Anatomy of the Equine will be offering a whole horse dissection on October 19 and 20, open to any horse health care providers. It focuses on functional anatomy, movement and fascia. For more information visit rectortownequineclinic.com or anatomy-of-theequine.com. • Post graduate courses in canine osteopathy are in the process of being offered in Texas and Germany at the Vluggen Institute for interested parties. Contact the institute for further information. • A new Equine Osteopathy Course will be offered in Texas from November 20 to 24. We would like to encourage more veterinarians to get involved and take the courses. This information is invaluable and we need more veterinary osteopaths out in the horse world advocating for an integrative whole horse approach to health and wellness care. Check it out online at vluggeninstitute.com.
CASE REPORT Theo, a Quarterhorse stallion, was lame ever since a laceration to his right shoulder. On motion exam, he did not bring his shoulders through and held his head tilted and rotated to the right.
The jaw was also contributing to the ilium and sacral issues in the hind end. The sternum was creating pain because it did not follow the postural pattern predicted by the sacrum and poll.
Osteopathic exam revealed a twisted sternum/withers, and restrictions in the sacrum, left ilium, right jaw, and C0, C1 and C2. The sternum and shoulder were tighter on the left side, from supporting his weight on the right. The jaw and C0, C1, C2 immobility is being influenced by slanted incisors, which are preventing symmetrical motion. The owner says Theo had always chewed sideways. His jaw was so restricted that mobilization was impossible to achieve at the time.
Treatment started with dentistry: balancing and leveling the incisors improved mobility in Theo’s neck, shoulders and hind end. The sternum and withers were treated osteopathically. Immediately after osteopathic treatment and dentistry, Theo started eating straight up and down for the first time in his life. He remains sound at one month post treatment.
IVC Fall 2015
21
integrative practice
PURCHASING A VETERINARY
ULTRASOUND SYSTEM By Henry Dinneen
Veterinarians use many modes of imaging: X-rays, CT scans, MRI and ultrasound. CT and MRI units are rarely seen outside large specialty practices, but ultrasound technology has become more common, and many clinics use ultrasound machines on a daily basis for diagnosis and other procedures.*
Do I need to purchase a “veterinary” ultrasound system, or a “human” one? Some manufacturers offer both human and veterinary systems, and they are marketed differently. They are fundamentally the same, but the difference lies in their software and presets.
“Ultrasound can provide a lot of information for its cost, and is often more readily available compared to other imaging modalities,” says Dr. Drew Sullivan, Medical Director of the Medical District Veterinary Clinic at Illinois, a small animal clinic in Chicago run by the University of Illinois College of Veterinary Medicine.* “Fluid can be distinguished from soft tissue masses or foreign bodies, which are sometimes difficult to differentiate on X-rays. Using ultrasound and X-rays together form a great diagnostic tool.”
Human systems are generally better and cost more because they must have FDA compliance. The images are clearer and more clinically correct because they have to hit minimum human parameters. Manufacturers build into their pricing the added expense they incur to avert risk and liability issues common to human machines. With that said, the image quality between “apples to apples” systems is negligible.
Purchasing an ultrasound system for the first time, or upgrading your existing system, can be a challenge. To make the investment that best fits your clinic’s needs, consider the following questions:
Very definitely. Human ultrasound systems, when used with the proper transducers (probes), can perform the same functions as a veterinary system, and often have a greater selection of probes to meet your needs.
22
IVC Fall 2015
Can a human system without “animal” presets meet the ultrasound needs of my clinic?
Human systems do not necessarily have to cost significantly more than veterinary systems. Shop carefully. Many human hospitals upgrade their systems routinely, thus offering “used” systems that are excellent.
What other equipment criteria need to be considered?
Photo courtesy of GE Medical Systems
Is a cart-based or portable system the best? If you have a mixed practice, you might want to consider a portable system with a battery power option that can go into the “field”. However, are you willing to subject your new system to the rugged demands of in-the-field large animal work? Would a refurbished one be better? Do you need the same capabilities in the field as you need in the clinic? Some portables are as sophisticated as cartbased in-the-office systems. Are you willing to pay for a more comprehensive warranty to cover potential machine damage, if you can get it? Archive data management must also be considered. Will you be transferring your data to the office computer; archiving data for future use and referral; or sending data elsewhere for evaluation and consultation?
What vendor should I choose when buying an ultrasound system?
The GE Logiq E Compact portable ultrasound system is just one example of the many products on the market.
You can purchase through basically four types of vendors. a) Original Equipment Manufacturers (OEMs): These are the companies manufacturing the machines. Big names are GE, Philips, Siemens, Toshiba, Esaote, etc. Pros and cons: OEMs are the manufacturers, and as such offer the latest new systems with full service warranties. Most have a full service field sales force to maintain your equipment. Those that have licensed dealers in the veterinary market are showing their dedication to serving this industry. b) OEM dealers: In some cases, the big OEMs assign licensing rights for distributors to the veterinary market. For example, GE sells through Sound Elkin (now Sound), and Esaote sells through Cuattro. Pros and cons: OEM dealers in the veterinary market each sell only one brand of equipment. Therefore, both OEMs and OEM dealers will promote and feature only their brand of equipment, and will have an inherent bias. c) Veterinary products distributors: Examples you are familiar with, such as Animal Health International, MWI, IVC Fall 2015
23
Depending on the demographics of a clinic’s customer base, and the complexity of the scan, veterinarians charge anywhere from $100 to $400 for an ultrasound procedure. For the sake of this analysis, let’s say each customer is charged $150. Let’s also assume your practice does two scans a week. $150 per procedure x 2 procedures per week x 50 weeks per year = $15,000 If you purchase a system for $30,000, the ROI is two years. Additional initial costs of an ultrasound also need to be considered. Does the system have “add-on” options you will want? Most come with a full one-year warranty. As well, you will be offered the option to purchase longer-term warranties. You must also consider what transducers (probes) you want with the system, depending on the medical needs of your practice. Will your staff need training for the new system? Sales tax can also be a factor. Once you have selected the system, along with options, warranty, probes, and tax (if any), you should have the final cost. Next, decide if you want to purchase the system outright, make time payments, or possibly lease the equipment. Solicit the advice of your accountant.
q For an outright purchase, it is pretty much general policy for vendors to sell a system and expect 50% of the total payment at the time of order and 50% at time of delivery.
w Some
vendors offer payment plans – for example, 20% down, and monthly payments for 24 or 36 months. Vendors automatically build preventive maintenance agreements into the cost of the system to protect your investment (and theirs).
e Leasing can be done many ways – money down, 24 or 36 months, etc., and you can have the option to buy the equipment at the end of the lease. There are two key things to know about leasing:
a The IRS does not consider an operating lease to be a purchase, but rather a tax-deductible overhead expense. Therefore, you can deduct the lease payments from your business income.
b Because an operating lease is not considered a long-term debt or liability, it does not appear as debt on your financial statement, thus making you more attractive to traditional lenders when you need them.
Shop for the best rates, whether through the vendor, your bank, or a recommended finance company.
24
IVC Fall 2015
MidWest, Schein, PennVet, Webster, etc., sell ultrasound equipment as part of their desire to provide full service to their customers. Pros and cons: Veterinary products distributors generally offer one or two brands to select from. The advantage of buying from them is that you already have a business relationship and a favorite salesperson. The disadvantage is that they are not ultrasound specialists, so their salesforce is not well-versed in the equipment. And, very importantly, veterinary products distributors do not repair ultrasound equipment, but send it to third party vendors. d) Third party vendors: These companies specialize in the sale of medical equipment, in many cases not just ultrasound but also x-ray, anesthesia, monitors, etc. Some examples are Advanced Ultrasound Electronics, DRE, Core Imaging, Choice Medical, and others. Search for those specializing in ultrasound. Pros and cons: Third party vendors are medical equipment specialists. They are knowledgeable about the Continued on page 26.
Human ultrasound systems, when used with the proper transducers (probes), can perform the same functions as a veterinary system, and often have a greater selection of probes to meet your needs.
Photo courtesy of Advanced Veterinary Ultrasound
A BUSINESS INVESTMENT
IVC Fall 2015
25
Left: An abdominal scan can help with the diagnosis of many illnesses and conditions. Below: The equipment makes it easy to do scans on equines.
Photos courtesy of Advanced Veterinary Ultrasound
Continued from page 24. equipment they sell. They work with many manufacturers, so do not have a specific loyalty to any one company, which makes them an asset in specifying the system that best meets your needs. Third party vendors sell new systems that meet your needs, at competitive prices. They also sell “used” systems that have been checked and/or refurbished to meet OEM specs with warranties. Often, the cost of a refurbished system is a fraction of the cost of a new system, which allows you to “upgrade” to a more sophisticated “human” system if so desired, while still staying within your budget. On the minus side, third party vendors do not have the large sales and service support teams the big OEMs have. This means, in some cases, that the system will have to be shipped in, rather than being repaired on site. Also, third part vendors are not able to offer warranties on refurbished systems that are as lengthy as those on new systems. Question your fellow veterinarians and learn of their experiences with various vendors. Use the internet for comparing companies – DOTmed.com lists medical equipment suppliers. Check out the ones with 5-star ratings and/or DOTmed 100 ratings. These are reviews by customers. Also, go to any regional or national veterinary conference and visit with the exhibitors. If a company is exhibiting, they are serious about serving the veterinary market.
What criteria should you look for in a manufacturer and/or vendor?
How many years have they been in business? What is their reputation in the market, both human and veterinary?
26
IVC Fall 2015
Do they offer warranties? Do they stock replacement parts? Do they offer loaner systems? Do they offer training on systems new to you? Do they do repair work themselves, or farm it out? Do they repair “human” systems to manufacturer specs? Do they offer field service? Be sure to continue to work with whichever company you choose for help in training yourself and your technicians, and providing your staff with information to communicate to clients. If this is your first ultrasound, your clients will appreciate written material, or links to web-based information, to learn about the procedure. A written description of how you do an ultrasound would also be good to have on your practice website. Purchasing an ultrasound system should be considered a business investment, not an expense (see sidebar on page 24). Ultrasound services represent a billable charge to your patients’ owners, while improving your diagnostic capabilities.
*Geese, Melissa. “Ultrasound Has Many Uses in Veterinary Care”. Pet Health Columns, vetmed.illinois.edu/petcolumns.
Beta glucans: keeping the
balance
of GREAT HEALTH
By Dr. Carmen Colitz, PhD, DVM, DACVO The immune system is a complicated intricate network that protects the body against exogenous or endogenous stressors, infections, cancer and other diseases. When the immune system becomes imbalanced, disease risk is increased. A weak or impaired immune system can predispose the body to infections, impaired healing and even cancer, while an over-exuberant immune system can result in allergies, immune-mediated diseases and, again, cancer. The majority of the immune system resides in the gastrointestinal tract, therefore food, medications, etc. can affect systemic immunity. Maintaining an optimal immune system is critical to overall health. Beta glucans are naturally-obtained high molecular weight polysaccharides that modulate the immune system, which is why they are known as “biological response modifiers�. They are found in various mushrooms; rice bran; plants including Poaceae (Gramineae) and Dioscoreaceae (yams); algae; seaweed; and cell walls of yeast. Beta glucans help regulate the immune system by triggering a cascade of events that promote immune cell activation, and stimulate macrophages and lymphocytes to destroy target cells. They can also enhance overall activity of natural killer cells, T cells and B cells. Beta glucans have the ability to simultaneously stimulate the immune system to fight disease while having appropriate anti-inflammatory and medicinal properties. Dr. Carmen Colitz is a board certified veterinary ophthalmologist with a PhD in Comparative and Experimental Medicine. IVC Fall 2015
27
Ayurveda in veterinary medicine By Dr. Tejinder Sodhi, DVM, CVC
riginating in India, Ayurveda is perhaps the oldest system of holistic medicine, dating back to 6000 BC. Ayurvedic medical textbooks were written in Sanskrit, one of the oldest recorded languages of the world. Ayurveda literally means “science (ved) of life (ayur)”. According to the texts, Ayurveda in veterinary medicine has traditionally focused on animal welfare, treatment therapies, management and surgery. In the Rigvata (2000 to 4000 BC), physicians described treatments for both animals and humans. Salihotra was the first to be credited as an animal healer when he wrote Ayurveda Materia Medica in Veterinary Medicine and Mrig [animal] and Hasti [elephant] Ayurveda. The first recorded veterinary hospital, opened by King Ashoka in 1463 BC, used Ayurvedic botanicals. Ayurvedic herbs and modalities have been in use for thousands of years and have a proven track record of safety and efficacy. The majority of Ayurvedic herbs are well researched and backed by clinical trials. Combinations of herbal products stabilize the energetics of other ingredients, leading to a balanced product. The combination herbs can be easily prescribed to treat many problems, even before the clinician studies the basic theory,
28
IVC Fall 2015
philosophy and principles of Ayurveda to allow deeper healing.
DETERMINING YOUR PRAKRITI (BODY TYPE) Body typing in Ayurvedic medicine is based on the five elements theory and is expressed as the Tridosha. The Tridosha are the three humors, or metabolic forces, that make up the mind and body. They’re called Vata, Pitta and Kapha. At the time of conception, permutations of Vata, Pitta and Kapha determine the constitution of the new individual, controlling all biological, psychological and physio-pathological functions of the body (including anabolism (Kapha), catabolism (Vata) and metabolism (Pitta)), as well as the mind and consciousness. Each one has subtle properties, and together they determine personality traits and physiological structure. Maintaining balance within the dosha is necessary for optimal health.
CHARACTERISTICS OF VATA IN ANIMALS Vata is considered the leader of the three Ayurvedic principles in the body. Vata governs all movement in the mind and body. • Vata types are the most slender of the three body types, and are taller or shorter than normal.
• Chests are flat, with veins and muscle tendons visible. • They have a tendency toward cold paws, and discomfort in cold climates. • Nails are dry and brittle. • Skin is cool, rough, dry and prone to cracking. • They have variable appetites and digestive efficiency. • Urine is scanty, and feces are dry, hard and small in quantity. • Sleep is short and restless. • They experience high energy in short bursts; they tire easily and overexert energy. • Respond to stress with fear and worry when out of balance • Quick to learn and grasp new knowledge, but also quick to forget. • Changeable moods are likely. • Full of joy, excitable, lively, fun and enthusiastic when in balance
CHARACTERISTICS OF PITTA IN ANIMALS Pitta is a force created by the dynamic interplay of water and fire. These forces represent transformation. • Medium to slender physique, and the body frame may be delicate. The Pitta animal shows a medium prominence of veins and muscle tendons. The bones are not as prominent as in the Vata pet. • Fur is soft and warm. • Claws are softer. • They display a medium prominence of eyes. • Sleep is of medium duration but uninterrupted. • Paws are warm, bothered by hot weather – it makes them tired, and skin feels warm. • They pass a large amount of urine. • Strong metabolism, good digestion with resulting strong appetite and thirst, are typical. • May display irritability if they have to wait for their food, or are stressed. • They have sharp minds and good powers of concentration • They are assertive, self-confident, aggressive, demanding, even pushy when out of balance. • Competitive and enjoy challenges, so Pittas make good pack leaders.
CHARACTERISTICS OF KAPHA IN ANIMALS Kapha is the combination of water and earth. it provides both structure and lubrication. One can visualize Kapha as the stirring force that keeps the water and earth from separating. Continued on page 30. IVC Fall 2015
29
Continued from page 29. • Kaphas are physically strong with a sturdy, heavier build. • They are aversive to cold, damp weather and may have asthma, allergies. • Have the most energy of all constitutions, but this energy is steady and enduring, not explosive. • Are slow-moving and graceful • Have soft fur and tendency for large “soft” eyes and a soft temperament. • Often overweight though they may eat little; may also suffer from sluggish digestion. • Soft stools, pale in color, and slow evacuation are typical. • Kaphas sleep sound and long. • They have excellent health, good stamina, and resistance to disease. • Are easy-going, relaxed, slow-paced, happy. • May be slower to learn, but they never forget so they can be possessive; good long-term memory. • Kapha animals are affectionate and loving, forgiving, compassionate, non-judgmental, stable, reliable, faithful, and are peacemakers.
• Is an adjunct therapy to seizure disorders. • Helpful for thyroid problems.2 • I have successfully used Ashwagandha liquid for chronic renal failure in cats and for inappropriate urination (behavioral) in cats. I have also used it for stress-related issues such as travel, addition of a new pet or family member, etc.
Case study: Cassie
AYURVEDIC HERBS
A ten-year-old German shepherd named Cassie came to my clinic with severe non-regenerative anemia and myelofibrosis. A biopsy revealed hemosiderosis of the bone marrow. Her condition was considered irreversible by veterinary pathologists. Initial blood work showed the PCV at 12.7% (normal 37 to 55). I prescribed Ashwagandha and Boswellia, and the blood count gradually increased from 13.1 to 28.1, at which point the improvement stopped. I quadrupled the dosage of the herbs, and saw a remarkable response. Cassie’s blood count increased to 39.8%, and has remained at 40.3% for the last two years. Originally, this dog had been given very little time to live, but with Ayurvedic supplementation, her diseased condition was reversed and Cassie was able to enjoy a high quality of life.
1. Ashwagandha (Wilhania somnifera) Ashwagandha, or Indian ginseng, is indicated as a daily rasayana, or anti-aging therapy. It is one of the most highly regarded and widely used Ayurvedic herbs, believed to increase energy and overall health as well as longevity. Ashwagandha literally means “to impart the strength of a horse”. The key constituents of Ashwagandha are called withanaloids, and play an important role in the herb’s ability to promote physical and mental health. Ashwagandha can be used on a long-term daily basis without the risk of side effects. Benefits include:
2. Boswellia Serrata (Salai, shallaki) This is one of Ayurvedic medicine’s most potent antiinflammatory herbs. Boswellia is a promising alternative to conventional NSAIDS, with the added advantage of sparing the GI lining. It is therefore useful for inflammatory disorders of the intestines, respiratory tract and skin.3 Boswellia significantly reduces the production of prostaglandins E2, cycloonxgenase-2 and prevents collagen degradation.4 The most common use is for osteoarthritis, degenerative disc disease and any inflammatory condition of bones, joints and spine.4 It is also neuroprotective, analgesic and antifungal.
• Acts as an adaptogen and immunomodulator; supports the activity of lymphocyte and macrophages.1 • Is neuro-protective, so helps with nervous tissue injury and inflammation. • Offers potent anti-inflammatory properties – beneficial for osteoarthritis and other inflammatory conditions. • Has anti-carcinogenic activity and is supportive during chemotherapy and radiation. • Possesses high iron content and steroidal lactone which affects bone marrow – helpful for anemia. • Supports cognitive and brain function in geriatric patients.
3. Turmeric (Curcuma longa) Turmeric is a perennial herb-rhizome commonly used as a cooking spice. Curcumin is the yellow pigment extracted from turmeric. In Ayurvedic tradition, turmeric is a general tonic and blood pacifier. A potent anti-inflammatory agent with analgesic properties, curcumin’s essential oil has shown anti-microbial activity against gram positive and gram
30
Continued on page 32. IVC Fall 2015
Don’t forget yourself
Determining and working with your own body type, as well as that of your patients, allows you to achieve balance in your mind, body and spirit, thus maintaining optimal health. Maximizing our own well-being is very important as we push ourselves to heal our patients. You will find that when you are functioning at optimal levels, you benefit not only yourself, but also the world around you. Continued from page 30. negative bacteria in vitro studies.5 Curcumin also possesses anti-asthmatic, antioxidant, hepatoprotective and anti-cancer activity. It is also known to have strong anti-ulcer activity due to its strong immune modulation and immune-stimulant properties, thus making it very effective in IBD cases.6 Curcumin maintains healthy cyclooxygenase-2 (Ld4) activity while supporting prostaglandins, leukocytes and thromboxane metabolism. Like Boswellia, it has neuroprotective properties, so our local neurologists use it for spinal injury and inflammation. 4. Neem (Azadirachta indica) Neem has attracted worldwide attention in the medical community due to its wide range of medicinal, insecticidal and fungicidal properties. Practically all parts of the Neem tree are used in Ayurvedic medicine. Fresh new leaves are used in concoctions for a variety of skin and other inflammatory disorders. Oil extracts from the leaves and seeds are potent antiseptics and insect repellants.7 Neem has immuno-modalities, anti-inflammatory, antifungal, antibacterial and antiviral properties. It is also considered anti-hyperglycemic.8 Since it is considered a valuable insecticidal, it can be used for external parasites. All parts of the Neem plant – leaves, bark and oil-based products – are used for this purpose.
32
IVC Fall 2015
Advertorial
VetzLife All-Natural News 5. Trifla This is a combination of three herbs – Terminalia chebula (Haritaki), Terminalia belerica (Bahera), and Emblica officinalis (Amla). This long-revered herbal blend has been used for thousands of years and is referred to in almost every Ayurvedic textbook. This mixture is considered adaptogenic. It has synergistic action as well as digestive properties. It is also considered a powerful antioxidant.9 Terminalia chebula is rich in tannins, amino acids, succinic acid and beta-sitosterol. Terminalia belerica is rich in tannins. Emblica officinalis supports the immune system and is one of the best available sources of vitamin C. Trifla has bowel-regulating and mild laxative properties and aids both digestion and elimination (constipation/diarrhea, IBD, pancreatitis). It is useful for respiratory and allergic illnesses as well as heavy metal toxicity. It is anti-ulcer, anti-cancer, anti-mutogenic, and promotes healthy eyes.10 While fewer of your clients may ask for Ayurvedic medicines than for Western herbs or acupuncture, carrying a variety of Ayurvedic combinations for specific problems will offer gentle and powerful alternatives to your patients.
Archana R, Namasivayam A. “Antistressor effect of Withania somnifera”. J. Ethnopharmacol, 1999, 64:91-93. Jatwa R, Kar A.“Amelioration of metformin-induced hypothyroidism by Withania somnifera and Bauhinia purpurea extracts in type 2 diabetic mice”. Phytother Rs., Aug. 2009, 23(8):11140-1145. 3 Madisch A, Miehlke S, Eichele O, Mrwa J, Bethke B, Kuhlishc E, Basteline E, Wilhelms C, Morgner A, Wigginghaus B, Stolte M. “Boswellia serrata extract for the treatment of collagenous colitis: A double-blind, randomized, placebo-controlled, multicenter trial”. Int J Colorectal Dis., Dec 2007, 22(12):1445-1451. 4 Umar S, Umar K, Sarwar AH, Khan, A, Ahmad N, Ahmad S, Katiyar CK, Husain SA, Khan, HA. “Boswellia serrata extract attenuates inflammatory mediators and oxidative stress in collagen induced arthritis”. Phytomedicine, May 2015, 21 (6): 847-56. 5 Ammon HPT, Wahl MA. “Pharmacology of Curcuma longa”. Planta Medica, 1991, 57(1):1. 6 Nishida M, Nishiumi S, Mizushina Y, Fujishima Y, Yamamoto K, Masuda A, Fujita T, Morita Y, Katsumi H, Yoshida H, Azuma T,Y oshida M.“Monoacetylcurcumin strongly regulates inflammatory responses through inhibition of NF-kappaB activation”. Int J Mol Med., May 2010, 25(5): 761-767. 7 International Institute of Rural Reconstruction, Ethnoveterinary Medicine in Asia. An Information Kit on Traditional Animal Health Care Practices, Part 1, General Information (Silang, Phillippines: IIRR, 1994). 8 Khosla P, Bhanwra S, Singh J, Seth S, Srivastava RK. “A study of hypoglycaemic effects of Azadirachta indica (Neem) in normal and alloxandiabetic rabbits”. Indian Journal of Physiology and Pharmacology, 2000, 44(1):69. 9 Vani T, Rajani M, Sarkar S, Shishoo CJ, “Anti-oxidant properties of the Ayurvedic formulation Triphala and its constituents”. International Journal of Pharmacognosy, 1997, 35(5):313. 10 Sudrik UV.“Management of Anjananamika in amavastha with Swedana and Sookshma Triphala”. Med. Aromat. Plant Abs., 1995, 18(5):514. 1 2
Enhancing the effects of professional dental care An integrative approach to dental care has been shown to improve oral health by combining professional care and cleaning with natural oral health products. “An evaluation was done of cats and dogs with and without professional cleaning below the gum tissue,” says Kimberly Wasko, CVT, VTS, ALAT, SRS Drexel University College of Medicine. “Significant improvements were seen, including reduced gingivitis, less bleeding on periodontal probing, gingival enzyme activity, and tartar reduction in treated areas. “Further clinical results demonstrated that topical application of VetzLife oral health products was effective in reducing the depth of periodontal pockets – similar to the effects of flossing in people. As well, healing was so accelerated that after five to eight days of treatment the diseased gingival sites were difficult to locate. We also utilized the spray formula as a ‘flush’ solution in the pockets of extracted teeth and the deep periodontal pocketed areas of surgical cases. Instead of ‘finishing off’ the oral cavity with a fluoride foam or gel after dental cleaning, we used the company’s oral care gels. “This suggests the topical application of VetzLife oral care products improves periodontal and dental disease not only as a sole treatment, but also in combination with surgical and non-surgical therapies.” VetzLife oral health products prevent plaque from forming, and also dissolve existing tartar. They’re also the perfect solution for elderly patients that are not candidates for scaling under anesthesia. Article provided by VetzLife/PetzLife all-natural products (VetzLife.com or 1-888-453-4682).
IVC Fall 2015
33
tech talk
Charley suffers from osteoarthritis and loves the underwater treadmill. This therapy is very helpful for issues with mobility and flexibility.
INTEGRATING
TREADMILLS
INTO THE
VETERINARY PRACTICE By Bridget Moran A veterinary assistant’s many roles include supporting the doctors as they integrate new services and treatments into the practice. Incorporating something brand new into an already busy practice comes with quite a learning curve, but as with all the therapies veterinary clinics provide, the benefits far outweigh any challenges. Adding an underwater treadmill to our own rehabilitation arsenal took hard work, but with encouragement and constant support from our doctors, our highly motivated assistants happily put in the many hours required to learn the ins and outs of this new tool. At this point, we have successfully implemented the treadmill into our integrative practice and continue to explore the ways in which it can help our patients. The treadmill has already proven itself to be a highly modifiable hydrotherapy option for a variety of canine conditions we see at our clinic. With its customizable features (side sidebar on page 36), it can easily be used for dogs of different sizes, ages and abilities. The challenge was for our doctors and assistants to become as familiar as possible with the treadmill in order to maximize its potential.
34
IVC Fall 2015
THE LEARNING CURVE WAS STEEP The treadmill we use (the Oasis) is a complex device, completely customizable for each patient. Having no previous experience with the treadmill, our assistants spent many hours researching and reading scientific publications, as well as several rehabilitation textbooks, in order to become familiar with the machine. We took extensive notes during training sessions, and while poring over the manual. Some of us spent time outside of work educating ourselves, and all of these efforts helped to build much needed confidence. Once we completed our research, our team gathered willing subjects with whom we were able to do several “test drives” – safely working through the various speeds, incline heights, water levels, etc. Only then did we feel comfortable offering this service to other patients. Because we couldn’t see longterm progress right away, we relied on scientific studies and patient history to help us create regimens for success for each dog. Today, we continue to monitor all our patients
and make adjustments as necessary in order to support their long-term rehabilitation. One of the most interesting challenges we encountered was working with canines that weren’t quite sure of the machine. The assistants came up with some very creative ways to motivate wary patients, including tempting them with frozen peanut butter cups, goldfish crackers, floating toys, and for those with a prey drive, rocks painted to resemble cats. It’s these little details that make the experience effective and enjoyable for everyone involved.
EQUIPMENT MAINTENANCE AND MARKETING In addition to operating the treadmill itself, our staff had to become familiar with the design and maintenance of the machine. We had to learn the proper care and cleaning procedures. We had to monitor and maintain adequate chemical levels for the water. We had to think about the most efficient layout for the treadmill and all the equipment it would require. These may seem like minor details, but in order to get the most out of this new tool, they required diligent practice and attention. Given that the treadmill is still a relatively new product on the canine rehabilitation market, our assistants were also
faced with the task of creating literature, such as educational brochures for interested clients, instructional flyers for firsttime appointments, referral forms, letters to surrounding clinics informing them of our new service, etc. This publication process required many hours of brainstorming, drafting, writing and editing. With the help of our doctors, fellow assistants and technicians, we successfully distributed our literature to clients and spread the word about our new service. We received a warm reception from our previous clients, and a long list of potential treadmill patients showed interest as well, so we got the encouragement we needed to validate all the challenges we had worked through.
STELLAR RESULTS Our practice has several canine patients who regularly visit the treadmill every week, and we continue to add new patients. Our current patients’ conditions range from cruciate injuries to osteoarthritis and even stem cell therapy. As we are faced with new cases, our assistants work closely with the doctor to review patient history and determine the best course of treatment. We continue to spread the word about our treadmill, and have gained dozens of enthusiastic patients from around the area. Our staff has worked very hard to include the treadmill as a regular rehabilitation tool, and we remain dedicated to the rehabilitation of our patients. Continued on page 36.
Left: Some dogs are wary at first. Omar had to be tempted into the water with peanut butter. Below: May is recovering from a hip injury that was treated with stem cell therapy.
IVC Fall 2015
35
HIGHLIGHTS AND BENEFITS OF AN UNDERWATER TREADMILL The treadmill has been proven through various clinical studies to be a powerful hydrotherapy tool for a variety of canine cases, including rehabilitation, fitness training, and weight loss.1,2,3,5 Our clinic is dedicated to the treatment of postoperative canines, those with injuries requiring rehabilitation, patients with symptoms related to osteoarthritis, and certain neurological conditions.
Water
The water is kept at a therapeutic 85°F to 90°F, and the water level is adjusted to each patient’s needs. For example, a dog that has recently undergone shoulder surgery would receive initial treatment with the water level above his shoulder joint in order to cushion the joint and ease him back into activity. The water level may gradually decrease as the patient becomes able to support more of his body weight. The water temperature relaxes sore joints and muscles through hydrostatic pressure, while buoyancy reduces impact and improves joint mobility.4 The additional support of the water has also been shown to correct gait patterns.6
Speed
Modifiable speed enables us to customize each patient’s metabolic demand, whether he needs a high intensity workout for strength training or weight loss, or a lower intensity for rehabilitation. The treadmill’s speed is the first element to change as the course of treatment goes on. For example, a dog that has received stem cell therapy for arthritic conditions may
start off at a slow walk of 0.6mph. After a few weeks of treadmill therapy, the patient has had time to heal and is working on regaining strength, so the doctor will increase the speed with each visit.
Incline
An adjustable incline allows us to focus a patient’s weight on the affected limb. For example, a dog with a rear cruciate injury may initially be inclined one or two inches to focus the weight to that leg. This increases the demand on the rear legs, thus building strength.
Jets
Optional underwater jets provide greater resistance for a high intensity workout. We have also found the jets useful for encouraging forward movement from more hesitant patients. The underwater treadmill with warm water, variable speed, incline and resistance jets is more strenuous than a canine pool, which in turn leads to shorter treatment times.6 The treadmill also requires the patient to bear more of his body weight, leading to increased bone strength.6 In fact, many of our clients have reported that their dogs seem more tired after a treadmill session than after spending time in the pool.
Continued from page 35. Despite all the work our practice has put in so far, the doctors and staff will need to make a continuing effort to study and learn what we can about the treadmill. As with any therapeutic service, newer and better practices will continue to come to light, and we intend to remain current with those practices. There are always new textbooks to read, scientific publications to study, and manuals to peruse in order to provide the most up-to-date and effective therapy for our patients. Incorporating new therapeutic services into an integrative practice can be difficult, but as assistants, our role is to support the practice in whatever way we can. Whether we do research and study outside of work, create literature for clients, or aid the doctor during treatment time, we can ease the process of adding a new service to a practice.
Chauvet A, Laclair J, Elliott DA, German AJ. “Incorporation of exercise, using an underwater treadmill, and active client education into a weight management program for obese dogs”. The Canadian Veterinary Journal, 2011, 52(5), 491–496. 2 Glasson S, Larkins N. “APPA provides symptom relief in clinical canine osteoarthritis”. Osteoarthritis and Cartilage, 2010, 20, S287-S287, dx.doi.org/10.1016/j.joca.2012.02.494. 3 Lee, William Robert. “The Effects of an Underwater Treadmill Physical Therapy Program on Two Dogs with Osteoarthritis”University of Tennessee Honors Thesis Projects, 2000, trace.tennessee.edu/utk_chanhonoproj/402. 4 Millis D. (n.d.). “Aquatic Therapy”. Retrieved July 8, 2015 from delawarevalleyacademyvm.org. 5 ”Oasis Treadmill For Dogs – H2O for Fitness”. (n.d.). Retrieved May 8, 2015, from h2oforfitness.com/oasis_pro/oasis.html. 6 Zink M. “Aquatic Therapy”. Canine sports medicine and rehabilitation , 2013, pp. 158-174. Ames, Iowa: Wiley-Blackwell. 1
36
IVC Fall 2015
The underwater treadmill is helpi ng Marcus O’Malley recove r from a torn cruc iate.
From the AVH
The Academy of Veterinary Homeopathy is comprised of veterinarians who share a common desire to restore true health to their patients through the use of homeopathic treatment. Members of the Academy are dedicated to understanding and preserving the principles of Classical Homeopathy.
The 18th Annual AVH Conference in Sweet Briar, Virginia was great fun, with a solid educational program and the conviviality of a holistic veterinary gathering. Sweet Briar Campus is gorgeous, and the historic Boathouse on the lake was a popular meeting site for the Friday night reception, Speaker’s Dinner and early and late night swims.
The AVH monthly webinar series continues to feature leading prescribers. The June webinar featured Dr. Paul Herscu on the cycles and segments approach to homeopathic medicine selection, while July covered the conference as well as various approaches to dosing.
The AVH will share a booth with the Pitcairn Institute of Veterinary Homeopathy (year-long class starts September • the use of homeopathic medicines, tinctures, monitoring and 17 to 20 in Oregon) at the AHVMA meeting in Augusta, analysis for cardiac and circulatory disease Georgia, from October 17 to 20. Please stop by to say • complex treatment of a young dog with severe neck pain, hello and learn more about veterinary homeopathy and pruritis, parasites and unexplained bleeding training opportunities! • how to raise food humanely and sustainably Join us for the AVH Annual Case Conference in Austin, Texas • care and feeding of our food and companion animals in May of 2016. • treatment for complicated digestive disease • homeopathic case management of food animal ailments (rectal prolapse, pneumonia, injury, abortion/weak offspring, CASE OF SUDDEN BLINDNESS umbilical hernia) AND HYPERACTIVITY • a large double-blind study evidencing gastric ulcers in pigs By Lisa Brienen, DVM, CVH induced by GMO feed Early in my experience with homeopathy, I had a memorable • treatment of autoimmune diseases and cancer experience with my 16-year-old male neutered retriever • latest statistical data in homeopathic clinical trials mix, Sampson. I noticed him frantically running along the yard’s fence line, occasionally bumping into things. Once • understanding how the vital force works in relation to disease confined to the garage, he ran around the edge of the and homeopathic treatment room, bumping into items as he ran. He’d never had any • medicines for neurologic and mental disease neurologic abnormality before and recently had a normal • a discussion of working with state boards as related to blood panel and urinalysis. holistic practice • a complete set of guidelines for the veterinary homeopathic On physical exam, Sampson was agitated, and from what I observed, blind. His eyes were dilated and his code of conduct, advising on all options and standard of care.
Topics included:
During the annual AVH membership luncheon, members approved group membership in the International Association of Veterinary Homeopaths. This solidifies our international ties and improves our members’ ability to network, receive feedback on patient case questions, and access international publications and conferences.
head radiated heat. After rapidly reviewing his signs and selecting the homeopathic medicine Belladonna 30C, I managed to spoon several pellets into his mouth. Within a minute, he stopped his hyperactivity and panting, calmly looked around the room and ran to his food dish. He was generally fine over the next six months until his death at age 17.
IVC Fall 2015
37
MEDICAL CANNABIS for animals By Neal J. Sivula, DVM, PhD, FAAVA Cannabis and marijuana are the common names for Cannabis sativa. This annual flowering herb has a long history of being used as a recreational drug as well as for hemp fiber and oils. It also has a long history as medicine. Cannabis seeds have been found in Siberian burial mounds dating back to 3000 B.C. The plant was used in ancient China, and Hippocrates recommended cannabis extracts for use as medicine. Queen Victoria’s physician, Sir Russell Reynolds, prescribed cannabis for the Queen’s menstrual cramps. He was quoted in The Lancet, a prestigious British medical journal, as calling cannabis “one of the most valuable medicines we possess”. In the United States, both Presidents Washington and Jefferson grew cannabis as hemp, used to make ropes, paper and clothing.2 In recent years, there has been a resurgence of interest in the medical uses of this versatile plant, for both humans and animals. There are many issues involved in the consideration of cannabis as medicine, however, including regulation, product selection and safety.1
38
IVC Fall 2015
IT’S ILLEGAL TO PRESCRIBE CANNABIS TO ANIMAL PATIENTS IN THE US Cannabis was made illegal in the United States in 1937. In the 1970s, the THC portion of the plant was classified by the Drug Enforcement Administration (DEA) as a Schedule I drug, which by definition means the DEA feels it has no medicinal use and a high potential for abuse. Other drugs classified as Schedule I include heroin, LSD and Ecstasy. Schedule I drugs are prohibited from being prescribed by physicians and veterinarians. Interestingly, the drug Marinol, which is composed entirely of synthesized THC, is classed as Schedule III. Public pressure has more recently driven the legalization of cannabis for both medical and recreational uses. For example, 23 states and the District of Columbia have legalized cannabis for some human medical uses, and the states of Colorado and Washington have legalized recreational cannabis for people over the age of 21. As of this writing, however, no state allows veterinarians to prescribe cannabis for animals. Veterinarians risk disciplinary action for prescribing or even recommending medical cannabis for pets. However, in states where cannabis is legal either for human medical or recreational use, people can administer it to their own animals since pets are considered property under the law.
FOR MORE PRODUCT INFO Treatibles (AD Remedies Inc.) – www.treatibles.com Canna-Pet – www.canna-pet.com CannaCompanion – www.cannaforpets.com
EFFECTS DEPEND ON THE SPECIES There are three separate species within the Cannabis genus – indica, sativa (meaning cultivated), and ruderalis.2 Historically, specific physiologic effects were attributed to each species.3
q Indica – Relaxing, calming. Best used at night. Grows best indoors. w S ativa – Uplifting, increased energy, hallucinogenic effects. Best for daytime use. ybrids – 95% of all cannabis strains today are hybrids. eH Different strains mean the possible medical benefits may vary widely.
COMPONENTS AND COMPOUNDS There are hundreds of known compounds in the cannabis plant, including cannabinoids, terpenoids, and noncannabinoid phenols. The most important psychotropic part of the cannabis plant is its tetrahydrocannabinol (THC). Cannabidiol (CBD) is important from a medical perspective and has no psychoactive properties. In 1992, Raphael Mechoulam discovered anandamide; it’s made within the human body and occupies THC receptors. Continued on page 40.
IVC Fall 2015
39
Continued from page 39. It was the first of several endocannabinoids found to interact with the neural network in the body, just as endorphins and serotonin do.4 Mechoulam found that exercise increased endocannabinoid levels in the body, probably causing what is referred to as the “runner’s high”. He found that endocannabinoids have important roles in memory, balance, immune function and neuroprotection.5,6 There are more than 85 cannabinoids in the cannabis plant. The THC content of cannabis grown in the 1960s doesn’t come close to equaling THC levels in the modern plant. Botanists have increased the amount of THC from 3% to 5% in the 60s to around 28% now. THC binds to a receptor in the cerebral cortex known as C-1 and is responsible for the psychoactive effects of the plant. THC is also useful for appetite stimulation and is involved in pain control. CBD comprises approximately 40% of the plant’s total cannabinoid makeup. It preferentially binds to C-2 receptors but has a low affinity for binding to C-1 receptors. CBD and terpenes can reduce the actions of THC, which in turn serves to reduce the paranoia and increased heart rate associated with larger doses of THC. CBD creates most of its clinical effects by binding to the 5HT1A receptor, which produces antidepressant, anti-anxiety and neuro-protective effects. CBD also has strong antioxidant and anti-inflammatory properties. Terpenoids are organic compounds found in the plant’s resin, and are present in the essential oils of cannabis. There are over 200 terpenes found in cannabis. In nature, terpenoid oils serve to repel insects and occasionally prevent fungal infection. Terpenes are not only important in producing the smell and taste associated with different strains of cannabis, but are also involved in the effects produced by consumption. For example, beta-caryophyllene is a terpene that binds to a CBD receptor and is useful for both inflammatory conditions and auto-immune disorders. Human patients who have changed strains of cannabis for medical reasons in order to optimize either THC or CBD levels may find that the new strain does not work as well because of a different terpenoid
40
IVC Fall 2015
profile. This “entourage effect”, or synergism, of the more than 400 compounds in the cannabis plant highlights the importance of the therapeutic value of the whole plant over its individual constituents.
CLINICAL USE Because cannabis is classified as a Schedule I drug, there is a lack of research on its clinical use in animals. The effects of THC and CBD have been mostly studied in a laboratory setting. THC has been shown to be useful for many conditions, including epilepsy, cerebral ischemia, motion sickness and cancer treatment. Research has identified CBD as helpful for psychosis, seizures, anxiety, stress, irritable bowel syndrome, arthritis, pain, vomiting, diabetes mellitus, cancer, and the repair of traumatized tissue, among others.7,8 CBD has also been shown to improve sleep quality. Research has shown that CDB and THC work best in combination, improving each other’s clinical effects. In humans using marijuana for medical use, it is suggested that a THC:CBD ratio of 1:1 be used for both pain relief and appetite stimulation. For those in extreme pain, a ratio closer to 3:1 may be beneficial. The low THC/high CBD strains have the potential to treat PTSD, multiple sclerosis, osteoporosis and dementia. As stated earlier, the synergistic effects of the combined components of the cannabis plant favor using the whole plant over its individual parts. There are differences between the cannabidiol found in medical cannabis and that in industrial hemp. In medical cannabis, the cannabidiol is extracted from plants grown to be high in CBD and low in THC, and is a Schedule I substance. Cannabis-based CBD oil from these plants is only legal in
states that have medical cannabis laws. Conversely, high CBD oil extracted from industrial hemp can be sold in any state, and over the internet. In the last 50 years, consumers have come to demand a higher THC content in strains for recreational use, so CBD was markedly reduced in the gene pool. As demand then increased for a good medical cannabis product that contained lower amounts of THC and higher concentrations of CBD, Harborside Health Center in Oakland began in 2008 to use gas chromatography and mass spectrometry to identify highCBD cannabis strains for their clients. Currently, several dozen laboratories in states where medical cannabis is legal provide testing services so the consumer can be aware of the CBD and THC content of the products they are consuming. Cannabis dispensaries are providing CBD-rich herbs, edibles, tinctures, extracts and oils. At least one company is also providing CBDrich treats for dogs.
TOXICITY IN ANIMALS Because of legal restrictions regarding research, few studies have been done regarding the safety of cannabis in animals. There have been no published reports of deaths from the ingestion of cannabis in animals, but there are increasing reports of animals being treated for cannabis overdose, especially in states such as Colorado where cannabis has been decriminalized. Pets are most often exposed to toxic doses because of deliberate administration of edible products, by inhalation of second hand smoke, or by ingestion of unattended quantities of the plant.
(capsule, edible, tincture), the ratio of THC:CBD desired, and the condition being treated. In general, patients with cancer or increased levels of pain require more THC than those with anxiety or seizures. Because of the lack of research, there are no good dosing guidelines available for medical cannabisderived products for animals. A commonsense approach would be to start with very small doses in order to avoid any adverse side effects. When offering edibles to pets, it would be wise to avoid those with potentially toxic ingredients such as chocolate or Xylitol. An alternative approach would be to use a commercially available hemp product for pets (Treatibles [AD Remedies Inc.], Canna-Pet or CannaCompanion). By definition, the THC level should be low enough to avoid any significant psychogenic effects, while utilizing the benefits of potential CBD levels. Each company proposes dosing for their products based on body weight, and while clinical response can be variable there are very few reported side effects.
SUMMARY Medical cannabis has great potential for clinical use in animals suffering from a wide range of ailments, including pain, seizures, digestive disorders and anxiety. As long as it is classified as a Schedule I drug, however, it will be difficult for veterinarians to safely or legally recommend its use for their patients. Commercially available hemp-derived products have the potential of being very useful, especially with cancer patients.
Most pets exposed to toxic amounts of cannabis become sedated and uncoordinated, but it is reported that up to 25% of pets suffering from overdose exhibit agitation. In extreme cases, pets need to be rehydrated with intravenous fluids and have their cardiac status monitored while they recover. For humans, it has been said that cannabis is one of the safest therapeutically active substances known to man. Cannabis has been shown to be non-addictive and safe for human use. The risk of reaction to medical cannabis is much less than the morbidity and mortality associated with the use of opioid analgesics and non-steroidal pain medications. The use of CBD as part of an integrative pain management protocol can potentially reduce the amount of traditional medication needed.
CLIENT EDUCATION The dosage of cannabis for people or animals is highly individualized. Considerations include the form of the product
Guy GW, et al. “The Medicinal Uses of Cannabis and Cannabinoids.”2004, Pharmaceutical Press: 74-80. Silver RJ. “The Botany & Biological Effects of Cannabis sativa L. in the Veterinary Patient: Information Regarding this Emerging Palliative Therapy.”Proceedings of the 2014 annual meeting of the AHVMA: 444-452. 3 Williamson EM, Evans FJ. “Cannabinoids in clinical practice.”Drugs, 2000; 60(6): 1303-14. 4 Witkamp R, Meijerink J. “The endocannabinoid system: an emerging key player in inflammation.”Curr Opin Clin Ntru Metab Care, 2014; 17(2): 130-138. 5 Pagoda U ,et al. “The emerging role of the endocannabinoid system in endocrine regulation and energy balance”. Endocr Rev, 2005; 73-100. 6 De Laurentiis A, et al.“Endocannabinoid system participates in neuroendocrine control of homeostasis.”Neuroimmunomodulation, 2010; 17: 153-156. 7 De Mello Schier AR, et al.“Cannabidiol, a Cannabis sativa constituent, as an anxiolytic drug.”Rev Bras Psiquiatr, 2012; 34; S104-110. 8 De Mello Schier AR, et al.“Antidepressant-like and anxiolytic-like effects of cannabidiol: a chemical compound of Cannabis sativa.” CNS Neurol Disord Drug Targets, 2014; 13 (6): 953-960. 1 2
IVC Fall 2015
41
NAET
– a cure for the allergy epidemic By Deva Khalsa, DVM
llergies can manifest as gastrointestinal problems, skin conditions, respiratory issues…almost any illness. Over the past 30 years, the incidence of medical problems relating to allergies has skyrocketed. Overvaccination, GMO foods and environmental chemicals and toxins have contributed to this allergy epidemic. The good news is there are treatments that can completely eliminate allergies in your patients, and make IBD and atopic allergies relatively easy to treat.
UNDERSTANDING ALLERGIES The easiest way to understand allergies is to compare the immune system to a computer. This immune system computer registers various “enemies”, and never
42
IVC Fall 2015
forgets their identities. Consider the young child who has a severe reaction to peanuts. Most of his friends can eat peanut butter sandwiches without any ill effects. That’s because the “computer programs” in their immune systems haven’t programmed in the peanut as an enemy. The problem is not in the peanut itself, but in the way the peanut is registered in the system. We are seeing more allergies in our patients because there are more ways to confuse the immune system, and this increases the number of items logged in as enemies. Nature never designed the immune system to be exposed to so many vaccinations, chemicals and pesticides on a routine basis.
With bona fide food and environmental allergies, specific antigenic components produce an abnormal, exaggerated and usually immediate immune response reaction: producing IgE and IgG. Phenolics, compounds that are naturally present in foods, lead to intolerances and sensitivities, resulting in a delayed response in the immune system and causing the production of IgA and IgM type antibodies in the gut mucosa. Phenolics serve as some of the most basic building blocks of food – they are responsible for a food’s taste and smell – and one single phenolic can be in hundreds of different foods.
A SHORT HISTORY OF NAET Nambudripad’s Allergy Elimination Technique (NAET) was discovered by Dr. Devi Nambudripad. She became both a chiropractor and an acupuncturist while searching for solutions to her lifelong allergies, and surviving on the two foods she could safely eat – white rice and broccoli. One day, after eating a carrot (a known antigen for her), she developed an immediate and severe allergic reaction. She quickly needled some of her own acupuncture points, but passed out while still holding onto the carrot. Upon awakening, she reported a great feeling of peace, and discovered she was no longer allergic to carrots. From this serendipitous discovery, Dr. Nambudripad subsequently developed and refined the therapy for allergy sufferers she dubbed NAET.
IDENTIFYING ALLERGENS Dr. Nambudripad and myself both assert that food allergies are the most common and must be treated first, with environmental allergens next on the list. I have personally found that applied kinesiology is much more accurate than conventional tests for identifying allergic components. You can learn applied kinesiology (or muscle testing as it is more commonly referred to) in an allergy elimination course, or one solely devoted to applied kinesiology. It’s important to become very accurate with this technique as it not only determines the allergen, but also whether or not it has been fully been cleared after treatment is complete. The allergen should be completely cleared before the dog or cat resumes contact with it or an aggravation can occur.
REPROGRAMMING THE NERVOUS SYSTEM After identifying the allergen(s), the NAET practitioner works on correcting the source of the blockage or imbalance in the body that’s causing the allergy. This is done by correcting the misperception of the autonomic nervous system, which enables the body to heal itself by restoring an unrestricted flow of energy – a sort of corrective reprogramming that harmonizes and therefore normalizes the reaction to an allergen. This technique moves the treatment of allergies out of the world of biology and into the world of physics. Continued on page 45.
MECHANISM OF ACTION This non-invasive method actually reprograms the brain and nervous system by use of acupuncture philosophy, so the immune system does not react in a severe fashion to allergens. The brain, or more accurately, the autonomic nervous system, reinterprets what it used to think was an allergen, seeing it as a harmless, acceptable substance. A new response is created to the allergen, leaving your patient relatively allergy-free. We earlier compared the immune system to a computer, so this technique might be compared to a virus search program that corrects a malfunction. Studies in humans report subsidence of severe anaphylactic symptoms and resolution of allergy-induced autism, using NAET.1 IVC Fall 2015
43
Case reports The following case reports were provided by three of my clients. “Truman is my Bouvier des Flandres, who is now six years old. We brought him home in October of 2008 at seven weeks old, and in November he began frantically biting at his rear legs, and licking and chewing his feet raw. He had ear infections and suffered from terrible gas with soft, runny stools. After countless visits to different veterinarians, the episodes of chewing and gas continued. “We tried different foods, grain-free and limited ingredient diets, with no improvement. In January of 2014, I had Truman tested for allergies. The test came back saying that beef was the only protein he did not have an allergic reaction to! After I received these conventional allergy test results, I switched Truman to an all-beef raw diet. I gave the raw diet over two months for him to adjust, but the stool problems, gas and itching remained a problem. “After the holistic allergy elimination treatments, I started slowly introducing different foods into Truman’s diet. Finally, over six years after we brought Truman into our lives, he is finally itch-free, no longer chewing his feet, and the horrible gas episodes are over. He is still on a raw diet and eating protein sources other than strictly beef with no negative results. I add vegetables and garlic to his diet and he is a happy, healthy boy. After years of suffering, numerous veterinarian visits and tests…all it took was going through a course of allergy elimination treatments.” “When she was a little over a year old, our golden retriever began licking her paws and running her face along the carpets. We took Nellie to a veterinarian, who diagnosed the problem as an allergy and started her on Predisone. But even on a really high dose, Nellie didn’t improve. We then tried antihistamines, but they didn’t help either. Nellie was then tested for a thyroid condition, and put on another drug called Soloxine, along with more steroids and antibiotics. Things seemed to improve for a while, but the steroids made her drink water constantly; when we tried to cut back on them, she got very itchy again. “We decided to try another veterinarian, and went home with a new steroid and more antibiotics. Soon, Nellie’s chest hair was gone and her skin had become
44
IVC Fall 2015
thick and greasy. Her paws didn’t look so good, either. We then went to a third doctor, who took a blood sample, sent it away to determine what exactly Nellie was allergic to, and provided us with a serum that they injected under her skin every week. We were told it would take at least nine months for the injections to work, but she was no better over a year later. “The next stop was a veterinary school hospital where Nellie was given a skin test for allergies. From this test, another serum was developed for Nellie, and she was also put back on antibiotics along with antihistamines. But she just kept getting worse. “By this time, we were getting pretty disgusted. The hair was gone from Nellie’s paws, which had developed black skin with red, irritated areas. It was the same under her neck, which also had begun to ooze. She still itched all the time, her skin burned, she had no energy, and we were getting desperate and disillusioned. “It seemed that Nellie would be doomed to a life of irritation and misery, until we took her to Dr. Khalsa. She immediately started Nellie on homeopathic remedies, a rotating diet, and an allergy elimination technique. The improvement was noticeable after the very first visit! As the treatments progressed, Nellie scratched less and less, the hair grew back under her neck and on her paws, and her skin returned to normal. After a few months, she stopped scratching altogether. Her coat is now soft and bright, and she obviously feels like a brand new dog!” “Maddie, our female bulldog, was three years old when she began to suffer from terrible chronic diarrhea. We finally took her to a veterinary school specialty clinic where an intestinal biopsy diagnosed her with IBD. By this time, she was very thin and all her ribs stuck out. Her albumen was very low and she had to go on a special IV preparation called Hetastarch. Maddie also needed IM injections of calcium. The university told us that Maddie was the worst case of IBD they had ever seen, so after more than a month at the hospital she was sent home to die. “With little hope left, we went to see Dr. Khalsa. After Maddie’s second allergy elimination treatment, she appeared to have more energy and feel better. By the fourth visit, her stools were normal, we had her off IV, and the albumen in her blood was returning to normal levels. Halfway through the allergy elimination treatment, Maddie appeared in every way to be a normal healthy bulldog. She had gained her weight back and had tons of energy. It’s been seven years now and Maddie is just fine.”
Continued from page 43.
Photo courtesy of Aurora Cumby-Dallin
The treatment is performed by applying acupressure to specific meridian points – the Back Shu Points – along the patient’s spine. At the same time, the identified allergen (always placed in glass, such as a vial) is held next to the patient during and for several minutes after the treatment. It’s best to treat each allergen separately when first learning the technique. As pets are always allergic to multiple allergens, repeated visits are necessary. In the case of autoimmune disease, the tissue being attacked can be used with an allergy elimination treatment; as an example, a dog with autoimmune hemolytic anemia can be treated with his own blood in a glass tube. Over the years, many modifications have been made to this technique, and it’s referred to by several different designations or names. I’ve tweaked the process for my own patients over a period of 30 years, so I can’t really call what I do pure NAET. But no matter which combination of “allergy elimination” processes I use, success is relatively consistent. Taking a comprehensive course in one or more allergy elimination techniques is critical to being able to effectively practice this modality. When the harmony of the body is restored and balanced, illness and disease resolves. IBD, chronic pancreatitis, arthritis, autoimmune disease, and of course all the allergy problems we commonly encounter, can be relieved with the administration of NAET or a related allergy elimination technique. Visit naet.com for more information. 1
Nambudripad, Roy, MD. “Alleviation of Peanut Allergy Through Nambudripad’s Allergy Elimination Techniques (NAET): A Case Report”. Global Advances in Health and Medicine, July 2014, Volume 3, Number 4, gahmj.com/doi/abs/10.7453/gahmj.2014.025.
IVC Fall 2015
45
industry innovations No more cones for cats Most animals hate wearing e-collars following surgery, and cats can be especially resistant and problematic. Tulane’s Closet has solved the problem with their new Kitty Cover Me by Tui. Specifically designed for the feline anatomy, it’s a one-piece garment made from 100% Peruvian cotton. It’s breathable, lightweight and very comfortable, and ideal for use after surgery or if the cat has other problem areas where licking is a concern. It’s much easier on the cat than an e-collar, and helps increase owner compliance. TulanesCloset.com or 636-447-1659
Considering anesthesia-free dental cleanings? 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. PetDentalServices.com
Test for H3N2 available
Natural solution to cataracts
In the Summer issue of IVC Journal, we featured an article on H3N2, a rare new strain of canine influenza that has caused concern among pet owners and veterinarians in several states. IDEXX Laboratories subsequently developed and validated a new test for the detection of H3N2. The H3N2 Influenza Virus RealPCR Test allows rapid, reliable and specific testing for the strain responsible for the outbreak. IDEXX has added the H3N2 Influenza Virus RealPCR Test to their existing Comprehensive Canine Respiratory Disease (CRD) RealPCR panels at no additional cost. The H3N2 test is also available as a stand-alone test.
Cataracts are common in older dogs and cats, and usually mean surgery. But there is an alternative in the form of Cineraria maritima, which has been used homeopathically for over 100 years to safely and effectively treat cataracts. In fact, it’s the treatment of choice in Europe, India and South America. Cineraria Homeopathic Eye Drops from Natural Ophthalmics, Inc. trigger the body’s ability to clear the crystalline lens. They prompt the transfer of oxygen and nutrients from the blood to the aqueous, to nourish and detoxify the living tissue of the lens. Ask about our Intro Offer and how you can dispense this product to your patients. The company also offers a variety of other eye products, including Tear Stimulation Drops, Allergy Desensitization Drops, and Ortho-K with Calendula for injuries and corneal healing.
idexx.com/canineh3n2
NaturalEyeDrops.com or 877-220-9710
46
IVC Fall 2015
A L LERGI ES By Kim Perkins, PhD
AND THE BENEFITS OF SERUM TESTING The best definition of an allergy is: “a classic overreaction by the immune system to an otherwise harmless substance”. Pollen from Bermuda grass, for example, is typically harmless, but in atopic patients, the immune system may identify it as harmful. This sets off a cascade of events in the immune system resulting in the increased production of allergen-specific IgE. Like all antibody isotypes, IgE is composed of two fragments: Fab and Fc. The Fab fragment has a high affinity to the allergen against which it was produced, while the Fc fragment has a high affinity to specific receptors on the surface of mast cells. IgE bound to mast cells via the Fc fragment can bind its specific allergen via the Fab fragment, resulting in the release of histamine, bradykinin, serine proteases and other factors that result in an onset of symptoms (Figure 1). There are two methods of identifying allergens that are causing symptoms – intradermal and serum allergy tests.
1
Intradermal testing involves introducing a small amount of a specific allergen into the patient’s skin and observing whether or not a reaction occurs.
2
Serum allergy testing involves quantifying the amount of IgE in serum that specifically recognizes an allergen of interest.
Both methods have their merits, but this article will summarize the benefits of serum testing.
The goal of serum allergy testing is to measure the amount of allergen specific IgE in the serum. Individual allergens are coated onto the bottom of a 96-well dish and the serum exposed to each individual allergen. An ELISA assay is performed, allowing for the quantification of IgE antibody specific to a particular allergen. Allergens that bind large amounts of IgE are considered the most allergenic. Due to the relatively low abundance of serum IgE and interference from other antibody isotypes, especially IgG, standard ELISA assays are subject to dramatic false negatives. The SPOT Platinum assay improves on the standard ELISA. It optimizes the coating of allergen to the plate by retaining the three-dimensional structure of the allergen for maximum antibody binding. Concurrently, blocking the allergen plates has been improved by reducing the binding sites for all antibody isotypes other than IgE. These two steps increase the specificity and sensitivity of the test to more than 97%. Add to this the modifications in reagents at other steps in the assay, and you have a test that not only answers past criticisms but surpasses them. While food allergy testing has had its share of criticism, studies have shown a 53% decrease in symptoms simply by introducing a diet change based on testing results. When combined with hyposensitization to inhalant allergens, improvement rates can exceed 85%.
Figure 1
Dr. Kim Perkins joined the Spectrum Group in early 2012 and is the Laboratory Director, overseeing 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. IVC Fall 2015
47
TCVM FOR CHALLENGING ILLNESSES Part 1: Seizures
By Ronald Koh, DVM, MS, CVA, CCRP, CVCH, CVFT The rapidly increasing prevalence of chronic illness in pets has irrevocably altered veterinary care. Much of conventional medicine struggles to care for growing numbers of patients with ongoing and challenging health problems. Meanwhile, the use of integrative or complementary medicine in the treatment of chronic diseases has increased in popularity over the last few decades. Traditional Chinese Veterinary Medicine (TCVM) has become one of the most frequently requested integrative therapies to be used by itself or in conjunction with conventional medicine or other treatments to treat a variety of challenging illnesses, including pain, seizures, Cushing’s disease, skin problems, and cancer. Practitioners of TCVM use many different modalities, including acupuncture, Chinese herbal medicine, moxibustion, Tui na massage, and dietary therapy to treat or prevent health problems, improve outcomes, and enhance quality of life.1
CONTROLLING SEIZURES IN PETS
To date, there is no cure nor ideal treatment for epilepsy. While antiepileptic drugs (AEDs), such as phenobarbital and potassium bromide (KBr), can be very helpful in the control of seizure activity, they reduce the clinical signs but do not treat the cause,2 and not all treatments provide absolute control. Approximately 20% to 40% of epileptic dogs may become refractory to phenobarbital and KBr.3 In addition, some animals are less tolerant of their side effects, which include lethargy, polyuria/polydipsia, polyphagia, vomiting, sedation, and weight gain (phenobarbital).4
Seizure disorder or epilepsy is one of the most challenging neurological conditions affecting pets, and represents a significant number of referrals to veterinary neurologists. It is estimated that 1% of the canine population has some form of seizure disorder.2 The incidence of idiopathic (inherited) epilepsy in certain breeds of dog can be as high as 15% to 20%.2
Regardless of the causes of epilepsy, TCVM is an effective treatment to help complement current medications and improve seizure management. Indications for TCVM therapies include side effects caused by AEDs, refractory seizures, and quality of life of the patient.
48
IVC Fall 2015
COMMON ACUPUNCTURE POINTS FOR SEIZURES Action
Acupoint
Description
BL-18 BL-19
Back-shu association point for the gallbladder
LIV-3
Shu-stream (earth) of the LIV channel; subdues Liver Yang
TH-5
Subdues Liver Yang
Soothe Liver and calm Liver Yang
Er-jian GV-14
Extinguish Wind
Back-shu association point for the liver
Clear Heat and subdues Yang; hemoacupuncture this point Extinguishes interior Wind
GV-16
Extinguishes both interior and exterior Wind, especially when the Wind affects the brain
GB-20
Extinguishes Wind and subdues Yang
BL-17
Influential point for Blood; activates Blood to dispel Wind
SP-10
Sea of Blood; activates Blood to dispel Wind
Da-feng-men GV-20 HT-7
Calm the Shen
An-shen Nao-shu
Classical point for Wind pattern Calms the Mind, extinguishes interior Wind, and subdues Liver Yang Calms the Mind and opens the Mind’s orifices Classical point for calming the Mind Brain association point for calming the brain
Transform Phlegm
ST-40
Resolves Phlegm and opens the Mind’s orifices
Special point
GV-1
Opens the Mind’s orifices and extinguishes interior Wind
During seizure
GV-26
Opens the Mind’s orifices, extinguishes interior Wind, and promotes consciousness
Notes: Additional acupoints based on pattern diagnoses as follows: 1) Wind-Phlegm: BL-20, BL-21, ST-36 2) Phlegm-Fire: LIV-2, ST-36, Wei-jian 3) Blood Stagnation: LI-4, GB-41 4) Yin-Blood Deficiency: BL-23, LIV-8, SP-6, KID-3
• A number of published studies demonstrate the antiepileptic effects of acupuncture as an adjunctive treatment for seizures in animal models and humans.5-13 Different modalities of acupuncture have been used to treat seizures, including needle insertion,5,10 electrostimulation,14 scalp acupuncture,12 auricular acupuncture,6,7,15, and gold bead/ wire implants on acupuncture points.8,11 Accumulating data have showed that acupuncture may have an effect on epilepsy by increasing the release of inhibitory neurotransmitters, such as serotonin, GABA, nitric oxide, or opioid peptides.15 • Herbal medicine is another major component of TCVM and has been advocated as an adjunctive therapy in seizure control, usually in conjunction with acupuncture.16 TCVM practitioners usually prescribe combinations of herbal medicines. The most frequently used Chinese herbal medicine in the management of seizures is Di Tan Tang (Chinese herbal equivalent of phenobarbital). It contains Uncaria, Arisaemi, Acorus, Poria and Glycyrrhiza, which have been shown to possess anti-epileptic activity in animal models.17 Nux vomica, Illicium henryi, betelnut and mulberry are only a few herbals that should be avoided as they have been found to induce seizures.18
THE TCVM PHILOSOPHY OF SEIZURES The philosophy of disease treatment in TCVM differs from that of Western medicine. TCVM treats the individual, not the disease. From the TCVM standpoint, seizure is caused by “internal Wind” invading the channels of Liver due to Heat generated by the Liver (known as Liver Yang rising). The metaphor of “Wind” implies the shaking of tree leaves in a strong breeze, which resembles seizure activity. The Heart and Kidneys are also involved in seizures. The Kidney, in TCVM, is Water. Water nourishes Wood (Liver) and hinders Fire (Heart), so if the Kidneys are out of balance, it could influence the Liver or Heart imbalances that trigger seizures. TCVM treatment for seizures involves calming the Liver, eliminating Wind, calming the Mind, clearing Phlegm, and restoring consciousness (see table above).1 It is IVC Fall 2015
49
also important to balance the Qi, Blood, Yin and Yang if they are involved. Acupuncture can be given once every two to four weeks for five to eight sessions initially, along with Chinese herbal medicine. After that, the treatments can be spaced out to once every three to six months for maintenance. Once the seizures are under control, you can gradually reduce the dosage of phenobarbital, potassium bromide, or other AEDs to the lowest effective dose (one at a time). Gold bead or wire implant can be considered for refractory epilepsy as a last resort. In one study, nine of 15 dogs had at least a 50% reduction in seizure frequency after gold wire implantation in acupoints.8 Acupuncture and herbal medicine should be tried before permanent materials are implanted, since metal implants may interfere with future MRI testing.
OTHER CONSIDERATIONS
1
2
S-adenosyl methionine (SAMe) or milk thistle (Silybum marianum) provide hepatocellular protection by stabilizing hepatic cell membranes. The author uses SAMe (15 to 20 mg/kg q24h) and/or milk thistle extract (5 to10 mg/ kg q24h) or silybin (1 to 2 mg/kg q24h) to prevent liver damage from medications.
3
Hemp-based cannabidiol (CBD) is an extract from industrial hemp plants that contains mainly non-psychoactive CBD with minimal to no psychoactive THC. Emerging data support its use as a therapeutic option for refractory epilepsy in humans.19 The author may add hemp-based CBD (2.5 to 10 mg/kg q12h) for refractory seizure patients that do not respond well to TCVM and conventional treatment. The regulations of CBD can be varied in each state, so veterinarians should consult their state veterinary association before prescribing it. Huperzine A is a compound isolated from Chinese club moss Huperzia serrata, and is available as an over-the-counter supplement to enhance memory. It has been shown to have anti-seizure action in animal models.20 Huperzine A is given orally (1 Âľg/kg q8-12h) and was associated with no major side effects in a canine case report.21
4
Other nutraceuticals advocated as an adjunctive therapy for epilepsy in humans include dimethylglycine (DMG), taurine, betaine HCl, proanthocyanidin complex, pyridoxine (vitamin B6), folic acid (vitamin B9), magnesium, manganese, zinc and choline.22 The author commonly supplements with pyridoxine (25 to 50mg q24h) and folic acid (400 to 800Âľg q24h) for epileptic patients. High dose pyridoxine may decrease phenobarbital serum levels. Continued on page 52.
50
IVC Fall 2015
Case study A five-year-old male neutered Weimaraner presented with a four-year history of grand mal seizures due to idiopathic epilepsy. The seizures were not well controlled by increased doses of KBr and phenobarbital therapy, and were continuing to occur once every five to seven days. Since being put on increased doses of phenobarbital and KBr, he had also been restless, ataxic, and had no stamina. He often panted and looked for cool places to lie. His tongue was red and wet. His pulses were fast, slippery and bounding. The hair coat was dry with small dandruff. The TCVM diagnosis was Phlegm-Fire and Yin deficiency. Therapies included acupuncture once every two weeks for five sessions, and daily herbal therapy with Ding Xian Wan and Tian Ma Plus II (JingTang). Two weeks later, the owner reported that the dog had only one minor seizure. After five sessions, he had seizures only once every six to eight weeks and the owner noticed that he had better activity levels and less restlessness. Phenobarbital dosage was reduced by 25%. The dog continues receiving acupuncture and herbal therapy once monthly. The goal is to minimize the frequency of seizure to once every six to 12 months.
Left: Most pets pay no to little attention to the needles being placed, and often fall asleep during treatment. Below: Havoc received acupuncture for epilepsy and a cruciate ligament injury. It has been six months with no signs of a seizure.
IVC Fall 2015
51
Continued from page 50.
SUMMARY TCVM may prove to be an excellent adjuvant to conventional therapy in the treatment of seizures in animals, especially those with poorly controlled seizures. In mild cases, TCVM can be used on its own to help prevent and minimize the occurrence of further seizures. It may reduce the requirement for anti-epileptic medication. Nevertheless, there is a need for evidence-based research in the study of acupuncture or herbal medicine for managing seizures in animals. A pet owner looking at TCVM and acupuncture for epilepsy should ensure their pet is treated only by a certified veterinary acupuncturist in addition to having the animal evaluated by their primary veterinarian or a veterinary neurologist.
Xie H, Preast V (eds). Xie’s Veterinary Acupuncture. Ames: Blackwell Publishing. 263-265, 2007. 2 Bollinger-Schmitz K, Kline K. “An Overview of Canine Idiopathic Epilepsy for the Small Animal Practitioner”, Iowa State University Veterinarian. Vol. 62, 23–29, 2000. 3 O’Brien D, Simpson S, Longshore R, Kroll R, Goetze L. “Use of nimodipine in canine epilepsy”. Journal of the American Veterinary Medical Association, 210:1298–1301, 1997. 4 Kline K. “Complementary and Alternative Medicine for Neurologic Disorders”. Clinical Techniques in Small Animal Practice, Vol 17, No 1: 25-33, 2002. 5 van Niekerk J, Eckersley N. “The use of acupuncture in canine epilepsy”. J S Afr Vet Assoc., 59(1):5, 1998. 6 Janssens LAA. “Ear acupuncture for treatment of epilepsy in dogs”. Progress in Veterinary Neurology. 4 (3):89-94, 1993. 7 Panzer RB, Chrisman CL. “An auricular acupuncture treatment for idiopathic canine epilepsy: a preliminary report”. Am J Chin Med, 22(1):11-17, 1994. 8 Goiz-Marquez G, Caballero S, Solis H, Rodriguez C, Sumano H. “Electroencephalographic evaluation of gold wire implants inserted in acupuncture points in dogs with epileptic seizures”. Res Vet Sci., 86(1):152-161, 2009. 9 Klide AM, Farnbach GC, Gallagher SM. “Acupuncture Therapy for the Treatment of Intractable Idiopathic Epilepsy in Five Dogs”. Acupuncture Electrotherapy Research, 12 (1):71-74, 1987. 10 Kloster R, Larsson PG, Lossius R, Nakken KO, Dahl R, XiuLing X, Wen-Xin Z, Kinge E, Edna Røssberg. The effect of acupuncture in chronic intractable epilepsy. Seizure 8:170174, 1999. 11 Zhang J, Li YZ, Zhuang LX. “Clinical observation on catgut implantation at acupoint for treatment of generalised tonic-clonic epilepsy”. Journal of Clinical Acupuncture and Moxibustion, 22(6):8–10, 2006. 12 Shi JF. “Absence seizures of epilepsy treated by scalp acupuncture combined with hydro-acupuncture at renying point”. Shaanxi Journal of Chinese Traditional Medicine, 22(1):43–44, 2001. 1
HAVE YOU
CONNECTED WITH US ON OUR LINKEDIN PAGE YET?
Join us
FOR ARTICLES, INFORMATION, NETWORKING, AND MORE.
linkedin.com/company/ integrative-veterinary-care-journal
52
IVC Fall 2015
Zhang JL, Zhang SP, Zhang HQ. “Antiepileptic effect of electroacupuncture vs. vagus nerve stimulation in the rat thalamus”. Neurosci Lett. 2008 Aug 22;441(2):183-187. 14 Shu J. “The effects of ear-point stimulation on the contents of somatostatin and amino acid neurotransmitters in brain of rat with experimental seizure”. Acupuncture and Electrotherapeutics Research 29 (1–2), 43–51, 2004. 15 Liu J. “Changes of amino acids release in rat’s hippocampus during kainic acid induced epilepsy and acupuncture”. Zhen Ci Yan Jiu 20, 50–54, 1995. 16 Conry JA, Pearl PL.“Herbal therapy in epilepsy”in Devinsky O, Schachter S, Pacia S, (eds). Complementary and alternative therapies for epilepsy. New York: Demos Medical Publishing. 129-142, 2004. 17 Schachter SC, Acevedo C, Acevedo KA, et al.“Complementary and alternative medical therapies” in Engel J, Pedley TA, (eds). Epilepsy: a comprehensive textbook, 2nd ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. 1407-1414, 2008. 18 Wu M, Fang M, Hu Y, Wang X. “Four types of traditional Chinese medicine inducing epileptic seizures”. Seizure. 21(5):311-315, 2012. 19 Devinsky O, Cilio MR, Cross H, Fernandez-Ruiz J, French J, Hill C, Katz R, Di Marzo V, Jutras-Aswad D, Notcutt WG, MartinezOrgado J, Robson PJ, Rohrback BG, Thiele E, Whalley B, Friedman D. “Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders.”. Epilepsia. 55(6):791-780, 2014. 20 Tonduli LS, Testylier G, Masqueliez C, Lallement G, Monmaur P. “Effects of Huperzine A used as pre-treatment against soman-induced seizures”. Neurotoxicology. 22:29–37, 2001. 21 Schneider BM1, Dodman NH, Faissler D, Ogata N. “Clinical use of an herbal-derived compound (Huperzine A) to treat putative complex partial seizures in a dog”. Epilepsy Behav. 15(4):529-534, 2009. 22 Wynn SG, Schoen AM. Complementary and Alternative Veterinary Medicine: Principles and Practice, Vol 1 (ed 1). St. Louis, MO, Mosby, 159-163, 1998. 13
DO YOU HAVE A STORY TO SHARE?
WE WANT TO PUBLISH YOUR STORIES OF MIRACULOUS RECOVERIES, HUMOROUS MISHAPS, AND FASCINATING CASES. Submit your story to: socialmedia@redstonemediagroup.com for a chance to have it featured!
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 Academy of Veterinary Homeopathy - AVH Leucadia, CA USA Phone: (866) 652-1590 Website: www.theavh.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 International Veterinary Acupuncture Society - IVAS Fort Collins, CO USA Phone: (970) 266-0666 Email: office@ivas.org Website: www.ivas.org
Website: www.healfasttherapy.com
INTEGRATIVE THERAPIES
Healfast Therapy North Caldwell, NJ USA Phone: (551) 200-5586 Email: support@healfasttherapy.com
INTEGRATIVE VETS Dr. Shawn Messonnier Paws and Claws Vet Clinic Plano, TX USA Phone: (972) 712-0893 Email: shawnvet@sbcglobal.net Website: www.pettogethers.net/healthypet East York Animal Clinic Toronto, ON Canada Phone: (416) 757-3569 Email: eyac@holisticpetvet.com Website: www.holisticpetvet.com
NATURAL PRODUCT
MANUFACTURERS & DISTRIBUTORS GenesisValley Center CA USA Phone: (760) 751-3360 Website: www.genesispets.com Harrisons’ Pet Products West Palm Beach, FL Phone: (800) 946-4782 Website: www.vet.HEALx.com
VETERINARY OPHTHALMOLOGY
National Animal Supplement Council - NASC Dr. Nancy Park Valley Center, CA USA Board Certified Veterinary Ophthalmologist Phone: (760) 751-3360 Integrative Ophthalmology For Pets - IOP Website: www.nasc.cc Los Angeles, CA, USA Phone: (818) 962 - 0467 CLINIC FOR SALE Email: info@iopeyes.com Website: www.iopeyes.com Reeves Veterinary Clinic Tyler, TX USA Phone: (903) 595-1088 SCHOOLS & WELLNESS Email: drbarj@aol.com EDUCATION Website: www.reevesvetclinic.com FOR SALE: Small Animal integrative practice, Animal Spirit Network established for 44 years. Owner willing to stay Pekin, IL USA a while for smooth transition! Great location Phone: (815) 531-2850 on loop. Great Clientele that is very desirous of Email: carol@animalspiritnetwork.com holistic modalities. We are the only integrative Website: www.animalspiritnetwork.com practice in East Texas, many people in the area are health conscious. Owner wishes to retire. College of Integrative Veterinary Therapies - CIVT EQUINE NATUROPATH Rozelle, NSW Australia Phone: (303) 800-5460 Cassie Schuster, ND, MH Website: www.civtedu.org Waller, TX USA International Veterinary Acupuncture Phone: (713) 502-0765 Society - IVAS Email: cassie.schuster@yahoo.com Fort Collins, CO USA Website: www.wellranch.com Phone: (970) 266-0666 Email: office@ivas.org Website: www.ivas.org
PetMassage Ltd. Toledo, OH USA Phone: (419) 475-3539 Email: info@petmassage.com Website: www.petmassage.com Pitcairn Institute of Veterinary Homeopathy - PIVH Portland, OR USA Phone: 760-230-4784 Email: info@pivh.org Website: www. pivh.org Tallgrass Animal Acupressure Institute Castle Pines, CO USA Phone: (303) 681-3033 Email: nancy@animalacupressure.com Website: www.animalacupressure.com Traditional Chinese Veterinary Medicine TCVM Reddick, FL USA Phone: (352) 591-5385 Email: register@tcvm.com Website: www.tcvm.com Veterinary Information Network - VIN Davis, CA USA Phone: (530) 756-4881 Email: vingram@vin.com Website: www.vin.com
SUPPLEMENTS Herbsmith Inc. Hartland, WI USA Phone: (262) 367-1372 Email: mail@herbsmithinc.com Website: www.herbsmithinc.com MVP Laboratories Omaha, NE USA Phone: (402) 331-5106 Email: mvplabs@mvplabs.com Website: www.mvplabs.com SmartPak Plymouth, MA USA Phone: (774) 773-1125 Email: customercare@smartpak.com Website: www.smartpak.com The Honest Kitchen San Diego, CA USA Phone: (858) 483-5995 Email: info@thehonestkitchen.com Website: www.thehonestkitchen.com
THERMAL IMAGING ThermoScanIR Toronto, ON Canada Phone: (416) 258-5888 Email: info@ThermoScanIR.com Website: www.ThermoScanIR.com Equine IR Bonsall, CA USA Phone: (888) 762-2547 Email: info@equineIR.com Website: www.equineIR.com
IVC Fall 2015
53
By Todd Cooney, DVM, CVH
HOMEOPATHIC TREATMENT
FOR EPIDEMIC DISEASES FOCUS ON PARVO AND DISTEMPER
54
IVC Fall 2015
E
pidemic diseases plague animals and humans, just as they have through recorded history. They include malaria, influenza and Ebola in humans; and foot and mouth disease, bird flu and parvo in animals. These diseases have a huge impact on our society, both economically and in the number of lives affected. Treatment and control are challenging, because of the rapid onset and large numbers of individuals affected by these diseases. Homeopathy treats and prevents these infectious diseases with much greater success than conventional medicine. The influenza pandemic of the early 20th century is an example: during this 1918 to 1920 event, the mortality rate was 30% and 25,000 deaths occurred in America alone under conventional treatment. The homeopaths, meanwhile, showed a death rate under 1%. Any system of treatment that cures so rapidly and completely is worth checking out.1
Homeopathy is a safe, gentle, yet powerful method of restoring health that has been used worldwide for over 200 years. In the 1800s, Dr. Samuel Hahnemann cured many people and animals of various acute and chronic ailments, and was very successful treating serious epidemic diseases such as cholera, malaria and typhoid. President McKinley dedicated a large monument to him in 1900, which stands today in D.C. as the only one to honor a physician. His followers in the United States, such as Hering, Kent, Allen and Boger, demonstrated the power of homeopathy in curing serious diseases, especially epidemic ones.
EPIDEMIC DISEASES IN DOGS Two major infectious diseases in dogs are distemper and parvovirus. Distemper has been known for a long time, while canine parvovirus first “appeared� IVC Fall 2015
55
in the late 1970s. Vaccines are available and encouraged by most conventional veterinarians for both these viral diseases, even though continued vaccination in adult animals is highly debatable.2 I compiled clinical data in my own practice over an 18-month period, and found that vaccinated pups had lower survivability than non-vaccinated pups when sick with parvovirus, and pups protected with homeopathic nosodes had the highest survival rate of all.3 Treatment of both these viral diseases is largely supportive, with intravenous fluids providing the main benefit. Other conventional treatment is largely suppressive – “anti” drugs like anti-emetics, anti-diarrheals, anti-nausea meds, antibiotics and antiinflammatories. Homeopathy views symptoms as the body’s best attempts to correct its imbalance, so suppressive treatment is seen as the worst thing to do when trying to heal an individual. Suppression leads to deeper disease expression, as the body attempts to find another avenue to “vent” the “disease”. Homeopathy looks for a remedy with similarity, and helps the body extinguish symptoms without suppressing
them, causing the disease to leave the body naturally. Homeopathy is also suited very well to treating the individual. No two pups with parvovirus will be ill with exactly the same symptoms, so homeopathy selects a medicine to fit each one’s current state. Even this can change rapidly. I will often give several different remedies to a parvovirus case in the course of a day, depending on changes in the symptom picture. Acute illness is like a thunderstorm moving rapidly through the body, and in most cases the patient either lives or dies in short order. With homeopathic treatment, there is a much greater chance of surviving and generating a healthier immune system.
A. PARVO Epidemic diseases generally present in a consistent, predictable way. The symptoms are usually characteristic for that particular illness. In the same way, certain homeopathic
PARVO CASE STUDIES 1. Mia is a five-month-old female pit bull who presented with vomiting and diarrhea of two days duration, along with lethargy and no appetite. Hydration was normal, gums were pink, and the abdomen seemed slightly tender on palpation. The parvovirus test was positive (Idexx SNAP Elisa). I gave one dose of Nux vomica 10M in the exam room, and sent the same remedy home in solution, for the owner to give in repeated doses as needed. I chose this remedy because Mia’s symptoms were mainly nausea and vomiting, and she had become much more irritable than normal since becoming ill, a characteristic of this remedy. The client reported next day that Mia improved after the first dose, and began eating and drinking a few hours later with no further vomiting or diarrhea. This is not unusual, in my experience. 2. Pudgey, a five-month-old male beagle mix, presented with a history of vomiting and diarrhea. The stool was very foul-smelling with blood (cadaverous odor), and he exhibited restlessness in the cage (getting up and down and changing position often). Parvovirus test was a strong positive. Pudgey was moderately dehydrated, so I gave Arsenicum 10M and began IV fluid therapy (lactated Ringer’s with 5% dextrose and vitamins B and C) over the
56
IVC Fall 2015
next 24 hours. Next day, his restlessness and foul diarrhea were improved, but he seemed more nauseated (vomiting and heavy drooling), and was becoming more irritable. I gave Nux vomica 10M, and these symptoms resolved over the next six to eight hours. The next morning, Pudgey was barking in the cage, ate and drank without vomiting, and went home that afternoon. 3. Two female sibling Chihuahuas lived in the same household. Four-month-old Pepper became ill and came in first, tested positive for parvovirus, and received one dose of Arsenicum 10M, (for very foul-smelling stools, restlessness, nausea and vomiting). She began eating and drinking that afternoon, and went home without any further treatment. Her sister, Precious, came in five days later and tested positive, with slightly different symptoms, mostly nausea and vomiting, and irritability. I gave her Nux vomica 10M and began IV fluids, as she was dehydrated. The next day, Precious’ symptoms shifted to more of an Arsenicum state (restless, foul-smelling diarrhea with blood), so I gave her Arsenicum 10M – a total of three doses over the next three days, as she stayed in this state without really deteriorating further or changing symptoms. On the last day, she improved quickly and went home.
remedies will tend to fit a disease, being a good match for the total symptom picture of the majority of cases in the epidemic. The most likely remedy to fit a certain epidemic is called the genus epidemicus. For example, many parvovirus cases present with nausea, vomiting, restlessness, very foulsmelling stools, and often a desire for small sips of water. These symptoms are characteristic for Arsenicum album, which happens to be a very good remedy for treating pups with parvovirus. So Arsenicum could be called the genus epidemicus, if most parvovirus cases in your practice seem to match the symptoms fairly well. However, each individual case could shift into other remedy states, such as Nux vomica, or Phosphorus, and might respond better to one of those remedies. The prescriber must observe carefully how the patient is responding after each dose. Homeopathy is always based on treating the individual. I often get calls such as: “Do you have a remedy for Cushing’s disease in dogs?” I reply: “No, but I can find a remedy for a dog with Cushing’s symptoms!” This is a truth of homeopathy; it is based on treating the individual, and not the disease label. Dr. Samuel Hahnemann states in aphorism 72 of the Organon: “Acute diseases are rapid illness-processes of the abnormally tuned life principle which are suited to complete their course more or less quickly, but always in a moderate time.”4 Most parvovirus cases I’ve seen resolved in one to five days, so this would be an acute disease. The cases in the sidebar at left were treated with homeopathy and supportive care only. These cases show how parvovirus disease is readily treated with homeopathy and fluid therapy alone, and how the treatment can be individualized based on unique symptoms. In addition to Arsenicum and Nux Vomica, other useful remedies may include Phosphorus (lots of bleeding, startling to noises, vomiting 30 minutes after eating or drinking), Cinchona (very dehydrated), Rhus Toxicodendron (has to start moving but then feels better) and Thuja, to name a few. Since beginning to use homeopathy in 2008, I’ve treated hundreds of pups with parvovirus homeopathically, and am convinced the response and recovery time is much better than seen with conventional treatments used in the past.
B. DISTEMPER Distemper is a well-known disease of dogs, although less common than parvovirus in most areas. I have only seen a few cases in almost 30 years of practice. There is also a lack of recent clinical reports from other veterinarians, although homeopathy yields the only hopeful outcomes in most cases. Veterinarian Dr. Horace B. F. Jervis was the IVC Fall 2015
57
These cases show how PARVOVIRUS DISEASE is readily treated with homeopathy and fluid therapy alone, and how the treatment can be INDIVIDUALIZED based on unique symptoms. first to use Distemperinum in 1929. This is a nosode, potentized like all remedies, made from the discharge of a dog with the actual disease. Dr. Jervis’ monograph, “Treatment of Canine Distemper with the Potentized Virus”, describes the tremendous success he had with this nosode:5 “After a period of about 25 years of fruitless struggling with distemper, having to contend with it day after day in an (extensive) small animal practice ever and always having the same disappointing results, losing the same large percentage of my patients all the time, I was led to earnestly seek some way out of this most trying predicament. So of late years I have turned absolutely from the old and dominant school of medicine, and have taken up the study in earnest of homeopathy. And right here I wish to say that my one regret is that I did not take it up years before…. “My results were, and are, so much beyond my expectations that I am sorry not to be able to interest more veterinarians to take it up and give it a trial. Anyone doing so, I venture to say, will never go back to the old school again. “To have case after case brought to one and see so many, despite one’s earnest efforts, die, whilst one stands by without any way of stopping this terrible archfiend, is simply heartbreaking to say the least…. The thought naturally came to me that as I had taken up the practice of homeopathy; why not turn to her in my dilemma?” Dr. Jervis had strain L distemper virus potentized by Ehrhart and Karl, an old homeopathic pharmacy in Chicago, in the 30th, 200th and 1,000th potencies. The death rate in the distemper ward decreased dramatically and he “…felt a sort of load being lifted from my shoulders”.
58
IVC Fall 2015
The nosode often aborted the development of clinical distemper if given in the incubative stage. It also stopped the putrid diarrhea, convulsions in the cerebral form, and even reversed the dying stage seen later in the disease. As we discussed with parvovirus, Dr. Jervis cautions that some animals need other remedies. I give all pups coming into our clinic a dose of Distemperinum 200c, and have seen zero cases of clinical canine distemper since beginning this practice. I also send home a bottle of Parvo nosode 30c for the client to give once weekly until at least six months of age, to provide optimal protection against parvoviral disease. This weekly dosing interval follows closely the recommendations of Drs. Pitcairn and Hamilton in their books.6,7 These are the only “immunizations” pups receive in our practice. In summary, epidemic disease treatment and prevention is an area where homeopathy really shines, and has an excellent record! Dr. Dorothy Shepherd said it well in her book, Homeopathy in Epidemic Diseases: “As Homeopaths we should not be backward in pressing our claim of being able to cure, really CURE acute epidemic diseases.” I second that, Dr. Shepherd, and invite any open minded person to explore these concepts for themselves, and further their own knowledge of the wonderful healing art of homeopathy.
Shepherd, Dorothy, MD. Homeopathy in Epidemic Diseases, 1967. Schultz, Ron. “Dog vaccines may not be necessary”. news.wisc.edu. 3 Cooney, Todd. “Parvo Virus Survival and the Influence of Nosodes and Vaccination”. Dogs Naturally Magazine, July/August 2014. 4 Hahnemann, Samuel. Editor Brewster O’Reilly, Wenda, PhD. The Organon of the Medical Art, 6th edition. 5 Jervis, Horace BF. “Treatment of Canine Distemper with the Potentized Virus”, 1929. 6 Dr. Pitcairn’s Complete Guide to Natural Health for Dogs and Cats, 2005, Rodale Press. 7 Hamilton, Don, DVM. Homeopathic Care for Cats and Dogs. 2010, North Atlantic Books. 1 2
From the IVAS The mission of the International Veterinary Acupuncture Society (IVAS) is to provide, promote and support veterinary acupuncture and related treatment modalities through quality basic, advanced and continuing education, internationally recognized certification for veterinarians, and responsible research.
Upcoming events IVAS and AAVA are hosting a joint continuing education event on September 26 and 27 in Fort Collins, Colorado. Speakers include Linda Boggie, DVM, CVA, FAAVA on “Bi and Wei Syndromes: Advanced Strategies for Those Difficult Patients”; Cheryl Adams, DVM, CVA, CCRT, CVSMT presenting on “The Combination of Acupuncture and Stem Cells for Arthritis”; and Jessica Rychel, DVM, DACVMSR on “Acupuncture and Physical Medicine: Healing With Your Hands”. Look at your 2016 calendars and save June 8 to 11 for a joint congress on veterinary acupuncture in Tacoma, Washington, hosted by both IVAS and AAVA. You won’t want to miss this one!
Also in 2016, the IVAS Certification Course in Basic Veterinary Acupuncture will now offer students the ability to focus on either large or small animals for certification. Students will be able to focus their labs on either all small animals or all equines, or still choose to become dual certified. The next course starts in April 2016 at the Options for Animals facility just outside Kansas City. For more information on IVAS and upcoming events, visit us at ivas.org. IVAS has been setting the global standard in veterinary acupuncture since 1974.
CASE REPORT – CHRONIC OTITIS, SKIN AND URINARY SYMPTOMS By Nell Ostermeier, DVM, IVAS Certified Veterinary Acupuncturist Keely, a five-and-a-half-year-old female Lab, first presented in September 2013 for recurring otitis externa. On exam, the pinnas and canals of both ears were inflamed, she had abrasions from scratching, and cytology revealed marked yeast overgrowth.
Keely’s current treatment plan includes acupuncture and laser therapy every four to six weeks. She continues to eat a home-cooked diet that prevents Damp Heat. Thanks to her integrative medicine plan and her owners’ dedication, Keely has been virtually otitis free for almost two years!
She was treated with acupuncture (SI 19, GB 2, TH 17, GB 20, GV 14, ST 36, SP 6, BL 60/KID 3) and laser therapy approximately once a week for three weeks. In addition, she was placed on topical antifungal/ anti-inflammatory ear ointment for two weeks, as well as a regular regimen of bi-weekly ear cleansing, and a Chinese herbal formula to prevent Damp Heat. Traditional Chinese Medicine (TCM) food therapy recommendations were made to avoid Hot foods like lamb and to feed Cool or Neutral foods. Grains were discouraged and mushrooms added as homecooked toppings.
“After my wife and I experienced many frustrating efforts with local vets and specialists to address Keely’s multiple ear infections and skin allergies, we decided to look for an experienced doctor who could provide an integrated and holistic approach to care,” says her co-owner, John. “Within a few quick months of Dr. Nell treating Keely with acupuncture, special diet, laser and herbs, we saw a remarkable improvement that has sustained itself over the past year. She no longer has skin rashes and hot spots, bouts of incontinence, urinary and ear infections. Keely is a very happy and healthy Labrador retriever who loves life with us and her animal housemates.”
For more information on IVAS and upcoming events please visit ivas.org.
IVC Fall 2015
59
A deďŹ ciency of key vitamins and trace minerals may suppress the immune system and increase the risk of disease.
Nutrition
immunity
and in the
EQUINE By Clair Thunes, PhD
Nutrition is an important part of immune function. Research on the effects of nutrition on equine immune response is fairly limited, but the field has been researched heavily in humans and other species over the past 15 years. Inadequate intakes of key vitamins and trace minerals may lead to immunosuppression, increasing the risk of infections which may further reduce nutrient intake, creating a vicious cycle (Maggini, 2007, Wintergerst et al, 2007).
THE IMMUNE SYSTEM HAS TWO BRANCHES The immune system is a complex network of specialized tissues, cells, organs and chemicals that protect all species from bacterial, viral and environmental insults. There are two branches to the immune system (see chart on page 63): that which we are born with (the innate, natural or non-specific immune system) and that which we acquire (the specific or adaptive immune system). They are made up of three forms of defense: physical barriers, immune cells and antibodies.
ď ą Present from birth, innate immunity is the first line of defense against invading pathogens. Providing a barrier in the form of skin, mucus membranes and stomach acidity, it works
60
IVC Fall 2015
to prevent entry. Should it fail in its attempts to hold off threats, it rapidly attempts to eliminate them.
ď ˇ Acquired
later in life, adaptive immunity is highly specific and involves lymphocytes that have receptors for specific antigens. Slower to respond than the innate immune system, adaptive immunity may take several days from initial insult to activation, but it remains active after the initiating antigen is removed. This gives rise to an important difference between the two branches: the acquired immune system has memory, leading to a more powerful response should the body face the same antigen again.
PERFORMANCE HORSES AND IMMUNOSUPPRESSION Suppressed immunity may be an issue in performance horses because the effects of exercise can stress the immune system and potentially increase the risk of disease susceptibility. While regular low to moderate exercise can have a beneficial impact, acute bouts of high intensity exercise or exercise that continues for long durations may have negative consequences on the innate immune system (Warren, 2008). Additionally, the travel incurred by performance horses adds further stress, putting them at greater risk.
KEY NUTRIENTS IN IMMUNE FUNCTION Some of the important nutrients for a properly functioning immune system include amino acids such as methionine, arginine and glutamine; trace minerals zinc, copper and selenium; water soluble vitamins (folate, B6, B12, vitamin C), fat soluble vitamins (A, D and E); and polyunsaturated fatty acids. (See sidebar on page 62 for more information). The typical equine diet provides ample precursors to vitamin A, and a healthy equine digestive tract generates a plentiful source of B vitamins, while the liver generates vitamin C. But the equine diet may not provide adequate sources of copper, zinc, selenium, vitamin E, Omega-3 fatty acids or some essential amino acids.
ARE THEY GETTING ALL THE NUTRITION THEY NEED? The diet of all horses should have a solid foundation in forage, since approximately 60% of the digestive tract’s volume is dedicated to the fermentation of complex carbohydrate material. Forages vary in form and quality. Good quality pastures provide ample quality protein and therefore essential amino acids. They are also an abundant source of natural vitamin E and Omega-3 fatty acids. However, when pasture quality drops in the winter, or if forage is put up for hay, the levels of vitamin E and Omega-3 fatty acids may no longer be adequate.
‌the equine diet may not provide ADEQUATE sources of copper, zinc, selenium, vitamin E, Omega-3 fatty acids or some ESSENTIAL amino acids.
Levels of zinc and copper tend to be low in forages, due to low levels in soil. Selenium availability depends on geographic location, with coastal states (especially the Pacific Northwest) having low levels, and some Mid-Western states having very high levels. To complicate matters, the balance of trace minerals is unlikely to be optimal for absorption within the horse’s digestive tract. Zinc should be three to five times higher than copper for optimal absorption. Other relationships (for example, between iron and copper, and between manganese and copper) may impact the availability of copper
IVC Fall 2015
61
Nutrient functions within the
IMMUNE SYSTEM
Water soluble vitamins Vitamin B6 – In combination with B12 and folate, it plays a role in the biosynthesis of nucleic acids and proteins. Adequate intake maintains a Th1 immune response. Folate – Works to maintain innate immunity in concert with vitamins B6 and B12. Vitamin B12 – Impacts biosynthesis of nucleic acids and proteins together with folate and vitamin B6. Vitamin C – Stimulates leukocyte functions and is an effective antioxidant, protecting cells from reactive oxygen species generated during inflammatory response. Vitamin C acts to regenerate other antioxidants such as vitamin E. Deficiencies have been shown to impair leukocyte function in other species. Fat soluble vitamins Vitamin A – Essential for normal differentiation of epithelial tissue, which means deficiency impairs innate immunity. Vitamin A contributes to Th2 anti-inflammatory response. Deficiencies may lead to excessive pro-inflammatory response with a reduced ability to defend against extracellular pathogens. Vitamin D – Most cells within the immune system, except B cells, express vitamin D receptors. When metabolized to 1,25(OH)2D3, vitamin D acts as an immune system modulator. Vitamin D also helps enhance innate immunity by increasing differentiation of monocytes to macrophages. Deficiencies lead to an increased risk of infections due to reduced innate immunity and antigenspecific cellular immune response. Vitamin E – Vital to protecting cell membranes from oxidative damage, vitamin E also helps reduce production of immune suppressive factors such as PGE2 in macrophages. Vitamin E also enhances Th1 response. While rare in humans, vitamin E deficiencies are becoming more commonly identified in the equine population, likely due to reliance on dried forages. Trace minerals Copper – Provides defense against reactive oxygen species and in maintaining intracellular antioxidant balance through the key enzyme Cu/Zn-superoxide dismutase. Copper also supports Th1 response, which is impacted by both excesses and deficiencies. Zinc – Has an impact on both innate and acquired immunity and is essential for highly proliferating cells, especially in the immune system. It plays a crucial role in immune cell signaling, gene expression, protein synthesis and apoptosis. Deficiency results in increased oxidative stress and reduced Th1 response. Selenium – Maintains immune cell integrity via glutathione peroxidase and other selano-proteins. Selenium is involved with B cell differentiation, antibody production and expression of some cytokines, and as a result influences both innate and acquired immunity. Iron – Involved in the regulation of cytokine production and action as well as being essential for cell differentiation and the growth of cells critical for immune function. While deficiencies can be common in the human population, high levels of iron in forages means deficiency is rare in equines. (Maggini et al, 2007, Wintergerst et al, 2007, and Warren 2008) 62
IVC Fall 2015
and subsequently zinc in the ration. Iron levels in forages tend to be very high (and rarely require supplementation) so even a forage that provides adequate copper and zinc to meet the horse’s requirements may need supplementation. While hay generally provides more than adequate amounts of crude protein, there may be a low concentration of essential amino acids (those that must be provided in the diet). Higher quality sources of protein may need to be added to meet a horse’s needs for lysine, methionine and threonine. Soybean meal is a common ingredient in many commercial feeds, but some owners choose to avoid soy due to concerns over GMOs and pesticide use. When they stop soy, however, they need to use other equally good sources of amino acids (or find organic or locally raised clean soy).
MEETING NUTRITIONAL NEEDS IN TIMES OF STRESS As workloads increase, or physiologic demands such as lactation and growth occur, stressors increase and dietary needs change (NRC, 2007), so forage alone may not be adequate. Increasing the level of stress placed on the horse decreases the dietary margin of error. The impacts of an unbalanced or deficient diet are more likely to be seen in all areas of performance, including immune function. Due to the potential deficiencies that may arise from an all-forage diet, a supplemental source of key nutrients is advised. This may be achieved through the provision of good quality supplements and/or fortified feed. Selecting the correct commercial feed for the individual horse is key to meeting adequate dietary requirements. If less volume is fed than recommended, key nutrients may not be provided in adequate quantities. For example, complete senior
sense suggests that supplementation with a B vitamin may be beneficial when a horse is showing symptoms suggestive of hindgut disruption or immune compromise.
Divisions of the immune system (Warren, 2008)
feeds are commonly fed by owners at a rate of one to two pounds per day. These have a very dilute mineral and vitamin package because they are formulated to be given as the horse’s sole feed, typically at a minimum of 1.5% of body weight per day. Feeding only one to two pounds a day leaves the horse short of key essential nutrients. Ration balancers with a daily intake of one to two pounds may be a better choice. They have protein levels of around 30%, and are highly fortified with essential vitamins and minerals, since they’re designed to provide the nutrients typically missing or out of balance in forage without providing large amounts of additional calories. If clients are unable to maintain condition on forage alone, a commercial feed providing a good source of calories, such as a performance feed, is a good choice. Again, it is important to feed recommended quantities to ensure all nutritional requirements are met. A qualified equine nutritionist can help ensure the correct feeds are selected by determining the horse’s nutritional requirements, and selecting the correct products to meet those requirements and work with the specific forage being fed. Blood work to determine selenium and vitamin E status is beneficial. Assimilation of vitamin E varies greatly between individual horses and therefore certain horses may remain deficient. Test results will show whether additional supplementation is necessary. Supplemental vitamin E should be fed in the easily absorbable d-alpha tocopherol form, in a water soluble supplement. Thanks to the microflora living in the equine hindgut, no deficiencies of B vitamins have been identified in the horse other than thiamine and riboflavin (NRC, 2007). However, common
Unlike humans, horses have no nutritional requirement for vitamin C; they appear able to produce the enzyme L-gulonolactone in the liver, which enables conversion of glucose to vitamin C (NRC, 2007). Limited research shows that senior horses may have a reduced ability to create vitamin C and may benefit from supplementation. Certainly, horses showing signs of immune compromise may also benefit. Vitamin C is not easily absorbed in the equine intestinal tract, so over three grams per day are necessary to make a difference in serum ascorbate. There is some concern that supplementation may downregulate natural production over the long term, and for this reason supplemental sources should be reduced gradually. Vitamin D is typically not given much consideration due to its synthesis in the epidermal strata and its addition to commercial feeds. However, horses kept in stalled environments, turned out for short periods, wearing blankets, or living in northerly latitudes are being diagnosed with low blood vitamin D levels. Therefore, in certain management situations, supplementation may be necessary. The daily requirement is set at 6.6 IU per kg body weight per day, with an upper limit of 22 IU per kg body weight per day (NRC, 2007). Ensuring a horse’s diet is balanced and meeting all requirements will help develop a strong immune system. Nutritional support may aid horses suffering from conditions that negatively impact the immune system. Working with a knowledgeable and qualified equine nutritionist can help insure your clients’ horses are receiving fully integrated care and that nutritional needs are being met and optimized for health and performance.
Resources Maggini S, Wintergerst ES, Beveridge S, and Hornig DH. “Select vitamins and trace elements support immune function by strengthening epithelial barriers and cellular and humoral immune responses”. British Journal of Nutrition (2007), 98, Suppl. 1, S29-S35. National Research Council (NRC) Nutrient Requirements of Horses, Sixth Revised Edition, 2007, The National Academies Press, Washington, DC. Warren LK. “Potential immune-stimulatory nutrients for the equine athlete”. Proceedings of the 4th European Equine Nutrition & Health Congress, April 18-19, 2008, The Netherlands, 28-45. Wintergerst ES, Maggini S, Hornig DH. “Contribution of selected vitamins and trace elements to immune function”. Annals of Nutritional Metabolism, 2007, 51, 301-323.
IVC Fall 2015
63
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?
• In July, Dr. Rob Silver gave a teleseminar on cannabis: the
It was jewelweed, Impatiens capensis. When you’re exposed to
botanical compounds were described along with how they
poison ivy or poison oak, this herb may prevent that annoying
interact with the mammalian endocannabinoid system to
rash. Immediately take a jewelweed plant, slice the stem open (or
produce specific biological effects and medical benefits.
merely squish stems and leaves into a pulp), and rub it directly on the exposed parts of the skin. This will often be enough to prevent
• The VBMA will be very active during this year’s AHVMA
a reaction, or at the very least offer significant symptom relief. If
conference, starting with the American College of Veterinary
you inhale smoke from a patch of burning poison ivy, Susan Weed
Botanical Medicine’s first annual seminar on Friday, October 16
recommends boiling jewelweed root for ten to 15 minutes until the
(register at acvbm.org), followed by the VBMA herb walk (register
water is orange, and drinking the liquid.
at vbma.org). The VBMA day will feature Dr. Laurie Dohmen speaking on Herbal Medicine and Sports Physiology. Check
Chopped jewelweed can be brewed in boiling water to produce a
out the ahvma.org website for other herbal speakers presenting
dark orange infusion, which can then be stored for later use. It can
throughout the conference.
be frozen into ice cubes, which can then be rubbed directly onto skin rashes for healing relief. The liquid can also be canned in a
LOOKING AHEAD
pressure cooker. Frozen jewelweed infusions remain potent for up
The VBMA will be doing some travel and exploration in 2016.
to a year, while canned infusions remain potent until opened.
Our domestic eco-tour takes place June 11 to 15 at Lake Quinault, Washington, right after the AAVA/IVAS conference. We are staying at the Rain Forest Resort Village and have planned a wonderful few days of learning and mind/body/spirit connection. Dr. Laurie
Case report:
Dohmen is also working on an additional eco-tour to Peru!
Copernicus is a mature male (castrated) cat who loves to roll in a patch of poison ivy. His owner quickly discovered he was the source of her constant cases of poison ivy. She started spraying jewelweed infusions on him whenever he came inside, and washing herself wherever he contacted bare skin. Her cases of poison ivy stopped!
NAME THIS HERB!
UPDATE ON ACTIVITIES The VBMA has been very active during the past few months. • Our first teleconference of the year featured Dr. Joyce Harman speaking about Lyme disease. All of VBMA’s past teleconferences are available at vbma.org. • The
International
Herbal
Symposium
features
leading
herbalists and healers from around the globe. For the past three symposiums, the VBMA has had the privilege of sponsoring a track of veterinary speakers to attract more veterinarians to attend this amazing event. This year on our veterinarian track, we had Drs. Barbara Fougere, Rona Sherebrin, Jordan Kocen and Cindy Lankenau.
64
IVC Fall 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 Fall 2015
65
events
To post your event, email us at: info@IVCJournal.com
2015 AAFP Conference
October 1-4, 2015 – San Diego, CA Material will include presentations geared towards the experienced feline practitioner, as well as sessions for newer practitioners or those looking to expand their knowledge in feline medicine. For more information: (800) 874-0498 info@catvets.com www.catvets.com/education/conference
2015 Veterinary Cancer Society Annual Conference
October 15-17, 2015 – Tysons, VA The primary focus of the meeting will be a program highlighting advances in clinical oncology. The keynote speakers have diverse interests and focus on translational medicine with applications of their research into clinical practice. For more information: (573) 823-8497 vetcancersociety@yahoo.com www.vetcancersociety.org
American College of Veterinary Surgeons Symposium
October 21-24, 2015 – Nashville, TN The ACVS Veterinary Symposium offers the most advanced information on a wide range of surgical procedures as well as pre-operative patient care, post-operative complications and advanced diagnostic techniques. You are guaranteed to come away with new information that will improve your veterinary surgical practice. For more information: (301) 916-0200 acvs@acvs.org www.surgicalsummit.org
November 8-14, 2015 – Longmont, CO This event is open to Veterinary Professionals ONLY. (NCBTMB, RAIVE and CACVT CE candidate information see our course catalog) This program consists of 7 modules to be completed on site. The 7 Modules of the Level 1 program encompass the following topics: • Traditional Chinese Medicine Concepts and Origins (TCM) IVC Fall 2015
Students will receive their Practitioner Certification once they have sufficiently completed all post class work including electives. 32 hours of electives are required. These may be taken at RMSAAM or another school and credit may be given for previously taken courses. Examples: Massage, Essential Oils, Aromatherapy, Reiki, Animal Communication, Flower Therapy, Nutrition, T-Touch, HTA, etc. This class takes place at an equine facility. Work will take place on horses and dogs. For more information: Ginger Currie (303) 660-9390 info@rmsaam.com www.rmsaam.com
20th Annual ABVP Symposium
November 12-15, 2015 – New Orleans, LA Registration includes access to lectures, Regents Track Reception, Welcome Reception, Friday and Saturday luncheons, online proceedings and more. Visit our website to view the conference schedule.
Large & Small Animal Acupressure Level 1
66
• Landmark Anatomy of Equine and Canine Partial self-study required prior to class. Register at least 2 weeks prior to give yourself time to complete the work. • Acupressure Points, Pressure and Manipulation Techniques • Energy Meridian Pathways, Theory and Application Introduction • Yin and Yang Theory • Shiatsu • The Study of Chi • Introduction to Eight Guiding Principles • Introduction to Five Phases of Transformation • Introduction to Five Element Theory • Important AcuPoint Groups • Signs, Signals and Evaluation • Written Exam and Live Practical • Take Home Case Studies
For more information: (615) 254-7047 abvp@xmi-amc.com www.abvp.com
Hawaii Veterinary Medical Association Convention
November 12-15, 2015 –Oahu, HI This convention is an outstanding program offering over 68 hours of Continuing Education excellence. Some of the highlights include, Wet
Labs, Training Modules for accreditation, and three days of lectures. Come and join us for a wonderful weekend in Paradise. For more information: (808) 733-8828 hvma1309@hawaii.rr.com www.hawaiivetmed.org
2015 CVC San Diego
December 3-6, 2015 – San Diego, CA Experience exceptional veterinary continuing education in a central location. Outstanding convention hotels, dining, shopping, and entertainment all within a short walk of the San Diego Convention Center. Take a break from the traditional. Join us at CVC San Diego and experience an unconventional, attendee-centric approach to veterinary continuing education conventions. Smart. • Maximum CE in minimum time • Exceptional programming, led by the profession’s most accomplished educators and experts Easy. • Simple to plan and to navigate • Staff on hand to help plan your CVC experience Affordable. • Registration and travel costs that make sense • Registration includes “lunch bucks” to cover the cost of lunch and snacks • Hotel rates and hotel extras negotiated to deliver convenience and comfort at the best possible price For more information: (800) 255-6864 cvc@advanstar.com www.thecvc.com
61st Annual AAEP Convention
December 5-9, 2015 – Las Vegas, NV At this conference you will find over 100 CE credits to choose from. With over 4,000 veterinarians gathered and nearly 400 exhibitors, this will be one of the most comprehensive CE experiences you want to attend. You will be able to network with professional colleagues and have the chance to raise your expertise across the entire spectrum of equine medicine. For more information: aaepoffice@aaep.org www.aaep.org
For more events, visit: Facebook.com/IVCJournal/events
IVC Fall 2015
67
68
IVC Fall 2015