V6I1 (Winter 2015-16) by Redstone Media Group

Integrative VETERINARY CARE VOLUME 6 ISSUE 1

CHIROPRACTIC AND THE MUSCULOSKELETAL SYSTEM

HOW THIS MODALITY IS IMPROVING THE LOCOMOTOR SYSTEM IN QUADRUPEDS — PAGE 52

LASER THERAPY IN VETERINARY MEDICINE www.IVCJournal.com

WINTER ISSUE 2015/2016

It has many applications for many conditions, from muscle injuries to skin wounds to arthritis — P. 19

DEGENERATIVE MYELOPATHY

Integrative management can slow, stop or even reverse the progression of DM — P. 12

SUPPLEMENTS FOR OSTEOARTHRITIS

STARTING UP AN INTEGRATIVE PRACTICE

EVALUATING EQUINE POSTURE

WHAT’ S NEW

A look at studies done on Omega-3 fatty acids, SAMe, vitamin E and others, and how they measure up for treating dogs with OA — P. 24

Assessing and understanding a horse’s postural habits can help you diagnose and treat lameness and related issues — P. 40

Setting overall goals is an important first step to launching your new practice — P. 61

•Successful surgery for dog with cleft palate •Equine vets strive for better work/life balance

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contents FEATURES

INTEGRATIVE MANAGEMENT OF DM

LASER THERAPY IN VETERINARY MEDICINE

A multifaceted treatment protocol can slow, halt or even temporarily reverse the progression of degenerative myelopathy.

Light energy at the appropriate wavelength and power density has many applications for many conditions.

NUTRITION NOOK SUPPLEMENTS FOR OSTEOARTHRITIS

A review of the scientiﬁc evidence and research on supplements recommended for dogs with OA, from Omega-3s to SAMe to vitamin E.

ESSENTIAL OILS –A POWERFUL MODALITY

Learn how this veterinarian has successfully used essential oils as natural and effective treatment options for many health issues.

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POSTURAL EVALUATION IN HORSES

Viewing proven therapies like Osteopathic Manipulations, Reiki, and Healing Touch as Energy Medicine gives you a valuable tool for customizing diagnostic and treatment plans.

56 4

TECH TALK ENERGY AS MEDICINE

Assessing habitual postures, along with understanding the signiﬁcance of posture, can yield more accurate diagnosis and treatment of lameness and other issues.

FASCIA AND WHY IT’ S SO IMPORTANT

Restoring the natural intrinsic qualities of a horse’s fascia is the key to pain management, and to unlocking his performance potential.

CHIROPRACTIC AND THE MUSCULOSKELETAL SYSTEM

ANTIOXIDANTS AND CANCER

A look at how this valid health care modality can be used to improve the locomotor system in quadrupeds.

When used correctly, antioxidants can be helpful in cancer therapy. Here’s what you need to know about them.

INTEGRATIVE PRACTICE AN INTEGRATIVE PRACTICE MODEL AS A NEW VETERINARY STARTUP

You need a good sense of your overall practice goals before embarking on this journey – and a good idea of where you see your practice growing and expanding in the future.

advisory board Dr. Richard Palmquist, DVM GDipVCHM(CIVT) CVCHM (IVAS), 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 codirector of the AHVM Foundation. He has published two books, one for conventional veterinarians and a second for clients discussing how integrative thinking works.

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

COLUMNS & DEPARTMENTS

Advisory board

Editorial

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.

s new 11 What’ 23 From the AVH 34 From the AATCVM 38 From the AHVMA

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.

39 Industry innovations 45 From the WAEO 60 Social media 64 Veterinary resource guide 65 From the VBMA 66 Marketplace 66 Events

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

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

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

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Integrative VETERINARY CARE

WINTER 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: Kyle Dupont Web Design & Development: Brad Vader Cover Photography: Pedro Luis Rivera, DVM, FACFN

COLUMNISTS & CONTRIBUTING WRITERS

Joe Bartges, DVM, PhD, DACVIM, DACVN Ihor Basko, DVM Angela Casey, DVM Robin Downing, DVM, DAAPM, DACVSMR, CVPP, CCRP Karen Gellman, DVM, PhD Susan Klein, DVM Melissa McFarland, DVM, CVA Alexandra Mittner, DVM Jeff Nichol, DVM Thomas Pfafman, DVM, CAC Donna M. Raditic, DVM, CVA, DACVN Elizabeth Reese, AmSAT, Med-LMHC Kerry Ridgway, DVM Pedro Luis Rivera, DVM, FACFN Nancy Scanlan, DVM Jochen Schleese, CMS, CSFT, CSE Melissa Shelton, DVM Judith Shoemaker, DVM

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

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editorial

Modalities for

MOBILITY

Near my house there are two trees that, with their leaves gone, look like woody skeletons. Their bony branches squeak and moan as they rub against each other, and I’m reminded that winter is often the worst season for mobility issues – in all species! This used to frustrate me in my veterinary work because I would also see the side effects or ineffectiveness of the drugs I could offer. The joy of integrating holistic modalities is that I now have two approaches to health. I know of multiple ways to relieve symptoms of joint, muscle, tendon, ligament and bone pain, and more importantly, I have the ability to work with patients from an early age, building their general health so they can enjoy long vibrant lives. I remember the first case of degenerative myelopathy I treated. The dog was dragging her feet, crossing over, and had been given fewer than two months before total paralysis. By looking at the history, all the other current symptoms and seeing the dog as a whole, I was able to prescribe remedies, along with supportive chiropractic treatments, which allowed her to slowly recover much of her mobility and live another three years. In this issue of IVC Journal, we focus on how various modalities can both resolve mobility issues and prevent future problems. Drs. Casey, Pfafman, and Mittner look at a multi-faceted approach to degenerative myelopathy, while Dr. Rivera explains how chiropractic treatments address faulty communications from the periphery to the brain. Dr. Ridgeway discusses how the fascia we think covers each muscle is actually a unified whole which interconnects all parts of the musculoskeletal system, and Dr. Downing presents a great read on the benefits of lasers for

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a variety of conditions. Finally, in a continuation of their article from last issue, Drs. Bartges and Raditic look at how effective some nutritional supplements are for mobility issues. In other research, Dr. Scanlan reports on the use of antioxidants when treating cancer patients, and Dr. Klein addresses the science behind “energy” medicine. I’ve spoken to several practice owners recently who have found it challenging to get clients interested in holistic approaches, to net sufficient income, or who are experiencing other practice issues. If any of you are experiencing this, Dr. McFarland’s article will prove a breath of fresh air. This brave veterinarian opened an integrative practice in a small town and, within two years, was able to hire an associate. She can provide some tips on how you can both attract clients who want holistic approaches and be financially successful. I learn so much as I edit these articles, so please email me about modalities that we have not written about that work for you. Share your successes with me and on the IVC Journal website so the whole community can grow and thrive.

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

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contributors 1

1. JOE BARTGES, DVM, PHD, DACVIM, DACVN

Dr Jospeh Bartges is a 1987 graduate of the University of Georgia. He completed an internship and dual residency in internal medicine and nutrition and a PhD from the University of Minnesota. He is board certified in the ACVIM and ACVN, and past president of the American Society of Veterinary Nephrology and Urology. Dr. Bartges is 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. ANGELA CASEY, DVM

Dr. Angela M. Casey graduated in 1992 from the University of Florida College of Veterinary Medicine, trained under Dr. Sharon Willoughby and received her certification in animal chiropractic (AVCA), in 1995. She has extensive training in essential oil therapy, animal nutrition and energy medicine. She teaches classes on feeding raw and homemade diets to cats and dogs and is the co-owner of the Integrative Vet Med Center in Phoenix, Arizona. 3. ROBIN DOWNING, DVM, DAAPM, DACVSMR, CVPP, CCRP

Dr. Robin Downing is Hospital Director of The Downing Center for Animal Pain Management, LLC (DowningCenter.com). She is a Diplomate of the American College of Veterinary Sports Medicine and Rehabilitation, and was the third veterinarian in the world to earn the Diplomate credential in the American Academy of Pain Management. Dr. Downing is an international speaker and author on a wide variety of pain management, physical medicine, hospice/end-of-life care, and anesthesia-related topics. 4. KAREN GELLMAN, DVM, PHD

Dr. Karen Gellman is research director of Maximum Horsepower Research, which studies posture and locomotion in horses and dogs. She is a graduate of Cornell College of Veterinary Medicine, with a PhD from Cornell in animal locomotion biomechanics. She has co-taught the Postural Rehabilitation professional training course for the past eight years, and speaks to veterinarians, chiropractors and physical therapists. She is trained in acupuncture, chiropractic and other modalities and has a integrative veterinary practice in Ithaca, New York (equinesportsmed.com). 5. SUSAN KLEIN, DVM

Dr. Susan Klein received her DVM from Colorado State University in 1988. After practicing on Long Island, she returned to Colorado, working at the Southwest Veterinary Clinic in Denver. She started Alpine Meadows Veterinary Clinic in 1996; it’s a full service clinic with house call capabilities. Dr. Klein’s focus on blending alternative and conventional medicine began over 15 years ago. She has continued to search for the answers that blend science with the innate healing ability we all share. She has completed the IVAS course along with training in other holistic approaches.

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6. MELISSA MCFARLAND, DVM, CVA

Dr. Melissa McFarland is a 2008 veterinary graduate of Michigan State College of Veterinary Medicine and an IVAS certified acupuncturist since 2013. She owns McFarland Veterinary Services, LLC and Cape Horn Veterinary Associates in south central Pennsylvania. She has experience working in all aspects of veterinary medicine and public health, including private clinical (large and small), biomedical research, statistical risk analysis and food safety inspection for the USDA. Dr. McFarland also served internationally in veterinary public health.

Functional Neurology. Dr. Rivera and Michelle Rivera own the Healing Oasis Wellness Center, a nationally accredited and recognized school, providing state approved post-graduate certification programs. They own the Healing Oasis Veterinary Hospital – Equine Services, offering veterinary spinal manipulation, massage, rehabilitation therapy, Chinese and Western herbology. 12. NANCY SCANLAN, DVM

7. ALEXANDRA MITTNER, DVM

Dr. Alexandra Mittner graduated from Ross University Veterinary Medical School in 2014. She is completing her training in veterinary acupuncture and Chinese Medicine at the Chi Institute in Florida. She is on staff at the Integrative Vet Med Center in Phoenix, Arizona.

Dr. Nancy Scanlan is Executive Director for the AHVM Foundation. She has been using complementary health therapies in her veterinary practice since 1969. She uses nutraceuticals, acupuncture (IVAS certified), non-classical homeopathy, Chinese and Western herbs, and homotoxicology. Dr. Scanlan has held multiple leadership roles in holistic veterinary associations. She was Executive Director of the AHVMA for three years, and is a member of the VBMA, AHVMA, AVMA, CVMA, SCVMA.

8. THOMAS D. PFAFMAN, DVM, CAC

13. MELISSA SHELTON, DVM

Dr. Thomas D. Pfafman graduated in 1992 from the University of Florida College of Veterinary Medicine. In 1995, he was the 86th person certified in Animal Chiropractic by the AVCA. He has advanced training in orthopedic and soft tissue surgery, arthritis therapy, rehabilitation therapy and integrative medicine. Dr. Pfafman is co-owner of the Integrative Vet Med Center in Phoenix, Arizona. 9. DONNA M. RADITIC, DVM, CVA, DACVN

Dr. Donna Raditic received her BSc in Animal Science from Cornell University, then graduated with her Doctorate of Veterinary Medicine. She built her own practice in 1997 in 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. 10. KERRY RIDGWAY, DVM

Dr Kerry Ridgway is an internationally known lecturer and clinician in integrative veterinary medicine as well as conventional veterinary medicine. He has a strong background in equine sports medicine and physiology, postural rehabilitation therapies that include acupuncture, chiropractic, equine podiatry, saddle fitting, and has a passion for myofascial research. As a former endurance rider, and student of classical dressage Dr. Ridgway also has a deep understanding of the role of the rider. 11. PEDRO LUIS RIVERA, DVM, FACFN

Dr. Pedro Luis Rivera graduated from Purdue University, School of Veterinary Medicine in 1986. He has been practicing integrative veterinary medicine, in particular Veterinary Spinal Manipulative Therapy, for 20 years. He is a Fellow of the American College of

Dr. Melissa Shelton earned her veterinary degree from the University of Minnesota in 1999, and owns Crow River Animal Hospital in Minnesota. Essential oils and the use of medical aromatherapy became a passion with her in 2008. Dr. Shelton is dedicated to providing accurate information regarding oil use in the animal kingdom. In 2011, she dedicated her practice solely to the advancement of veterinary aromatherapy (oilyvet.com). In 2014, she introduced animalEO, a line of veterinary essential oil products for animals (animalEO.info). 14. JUDITH SHOEMAKER, DVM

Dr. Judith Shoemaker is a practitioner, instructor and consultant in integrative veterinary medicine. She is an IVAS certified veterinary acupuncturist and AVCA certified practitioner. She teaches animal chiropractic and acupuncture through the Diplomat and Continuing Education programs of the AVCA, AAVA, AHVMA, and Maximum Horse Power and has served as a board member and representative for AVCA, AAVA, IVAS, and AHVMA. In 2012 she was the AHVMA’s Practitioner of the Year. Her practice in Pennsylvania utilizes acupuncture, chiropractic, farriery, dentistry, thermography, laser, herbs and homeopathy. 15. ELIZABETH REESE, AMSAT, M.ED, MHC

Elizabeth Reese is a certified Teacher of the Alexander Technique, a dressage rider and instructor, and mental health counselor, working with both humans and horses to explore the relationship of postural stability to emotional resilience. She has been senior faculty at AT-NYC and Postural Rehabilitation, a continuing education program for veterinarians using alternative care in the treatment of dogs and horses. She gives workshops on AT and postural resilience for veterinarians, AT teachers and riders worldwide. She maintains a practice in Sugar Loaf, New York and in NYC.

what’s new SURGERY DONE ON DOG WITH CLEFT PALATE Ruby is a pit bull who was born two years ago with a severe cleft lip and palate. Left untreated, she wouldn’t have survived long, since there was a high risk that food, water and debris could have ended up in her nasal passages and lungs, causing infections and possibly even pneumonia. Rescued by Jenn Clayton, founder of the Utah Animal Advocacy Foundation, Ruby began her life being tube-fed, since she couldn’t suckle like a normal puppy. When she was almost four months old, she underwent surgery to repair her cleft palate so she could eat and drink normally. The operation took over three hours and was done by a team of doctors headed by Dr. Alexander Reiter, Associate Professor and Service Head of Dentistry and Oral Surgery at Penn Vet’s Ryan Hospital. “On examination, a 10mm wide and 9cm long defect was observed in the hard and soft palate,” reported John Donges, Communications Coordinator for Penn Vet. “At the front end, the cleft split into two separate defects like the arms of a Y. Once in surgery, Dr. Reiter used an overlapping flap procedure to close the palate defect. This involved creating a flap from one side of the hard palate that is hinged and sutured underneath a flap on the other side of the palate. The soft palate was then closed by creating fresh edges and suturing them together in two separate layers. The edges of the arms of the Y in the front were cut and sutured together as well.” “One major principle of cleft palate surgery is that the best chance of repair is with the very first procedure,” said Dr. Reiter. “If it fails, scar tissue will develop around the defect. Any future attempts at repair then become more challenging because scar tissue is poorly vascularized and unsuitable for making viable tissue flaps.” Ruby’s cleft lip was left as is since it wasn’t causing her any problems. The operation was a success, and Ruby is now a happy, healthy dog with a unique smile. vet.upenn.edu

EQUINE VETS WANT BETTER WORK/LIFE BALANCE

“Does equine practice need to change to become more compatible with family life?” This motion was debated at the British Equine Veterinary Association (BEVA) Congress in September, and nearly all voters – a whopping 92% – agreed that changes are needed. For a long time, equine veterinarians were primarily male Baby Boomers who tended to put their careers before family life. However, as growing numbers of Generation Ys enter the ﬁeld, many of whom are women, a need for greater ﬂexibility that allows more time for family life, including maternity leave and parenthood, is arising. Among the ideas discussed at the congress was job sharing. Most clients want the same vet to attend their horses, but one solution put forward during the debate would be to have two vets introduced to the owners right from the start, so that if one needs to take time off, the other can provide continued care for the clients’ horses. Read more at horsetalk.co.nz/2015/09/30/equine-vets-seeking-work-lifebalance/#axzz3nFARY2jz

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by Angela Casey, DVM, Thomas Pfafman, DVM, CAC, and Alexandra Mittner, DVM

Integrative Management

of degenerative myelopathy

egenerative myelopathy (DM) is a progressive disease of the spinal cord. It’s found mainly in large breed dogs, with the onset of symptoms typically occurring between seven and 14 years of age. It begins with a wobbly gait (ataxia) in the hind limbs. Affected dogs will sway, cross over, knuckle, stumble up curbs and drag their feet. DM can begin in one hind limb and later affect the other. The clinical course can range from six months to one year, during which the limbs become progressively weaker, with buckling and eventual paraplegia. In later stages, urinary and fecal incontinence can occur, with progression to the front limbs. DM is not associated with pain.

CAUSES OF DM During the 80s and early 90s, Roger Clemmons, DVM, PhD, professor of Neurology at the University of Florida, suspected DM was an autoimmune process, resulting in demyelination of the affected spinal cord segments, as in multiple sclerosis (MS) (Clemmons, 1992). We now know that DM is not simply “doggie MS”, but more closely related to amyotrophic lateral sclerosis (ALS). The lesions invariably start between T3 and L3, presumably because this cord segment is supplied by smaller

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arteries, making it more subject to ischemia and oxidative stress. Super oxide dismutase (SOD-1) is a free radical scavenger, abundantly present in the CNS cytoplasm. Dogs affected with DM have a mutation in the SOD-1 enzyme. Oxidative stress upregulates the synthesis of the mutated SOD-1 enzyme. The mutation results in the mis-folding of proteins, which potentially alters cellular function, substrate selection, and ultimately results in an accumulation of toxic by-products in the axon. It is these toxic by–products that lead to the disruption of axoplasmic flow – “excitotoxicity”. Destruction of myelin and replacement of normal axons with astrogliosis (sclerosis) follows later (Coates and Wininger, 2010).

DIAGNOSING DEGENERATIVE MYELOPATHY DM is a diagnosis of elimination. Radiography, myelography and MRI are used to rule out other causes of weakness, such as intervertebral disc disease, fibrocartilagenous infarct, tumors, cysts and infection. A definitive diagnosis can only be made by an examination of post-mortem tissues. A DNA test has been developed at the University of Missouri-Columbia and is available through the

Orthopedic Foundation for Animals. It clearly identifies dogs that have two normal copies of the SOD-1 enzyme gene; those that are carriers (one normal copy and one mutated copy); and those at high risk of developing DM (two copies of the mutated gene) (Coates and Wininger, 2010). Sixty percent of homozygous affected dogs will eventually express the disease, while 40% remain unaffected. There must be other factors, in addition to the SOD-1 mutation, that lead to the clinical development DM in dogs. (Zeng et al, 2014) Hallmark clinical traits considered uniquely characteristic of DM include: • Disease progression • Asymmetric UMN weakness at onset • Pelvic limb proprioceptive ataxia • Lack of pain These findings are considered sufficient to rule out other disorders, although DM is often paired with other orthopedic or neurological problems that are considered incidental (Coates and Wininger, 2010). Common examples of co-morbidities include: • Disc disease • Degenerative joint disease • Cruciate ligament laxity

THE EVOLUTION OF DM THERAPY The only treatment protocol currently in the literature was formulated by veterinary neurologist Roger Clemmons (see sidebar on pg 14.).

depends on assessing the animal’s personality as well as what body systems are affected. In TCVM, muscles are associated with the Spleen/Earth element and the tendons and ligaments with the Liver/Wood element. Since degenerative myelopathy causes weakness, ataxia and muscle wasting, it is most commonly diagnosed in TCVM as Spleen Qi deficiency with Liver Yin deficiency. Other systems may also be simultaneously out of balance. Acupuncture and herbal therapies may help slow the progression of the disease, while improving quality of life and relieving GI symptoms. Points are chosen for the disease pattern (i.e. Spleen Qi deficiency) as well as the animal’s constitution and secondary symptoms (Xie, 2013).

A CONTEMPORARY CLINICAL MODEL AND STRATEGY (MARSDEN, 2014)

cord trauma

oxidative stress

SOD-1 induction

Excitotoxicity

1. CORD INJURY: BEGINS AS THORACIC CORD ILLNESS • Starts in same cord location T3-L3/highest cord:canal ratio • Disc disease/spondylosis • Slip and fall • Autoimmune • Aging of the spine

Clemmons found that dogs placed on an unprocessed diet, supplements and a structured, regular exercise program experienced the slowest progression of the disease, and in some cases stabilized and even improved. An independent study in the UK tested only the supplement regimen. No diet or physiotherapy was implemented. In this case, 70% of the dogs progressed to complete paraplegia within six months.

• Surgery

Treatment goal • Gently restore spinal mobility to distribute motion across all vertebral segments • Break down ligamentous caliciﬁcation that promotes spondylosis and rigidity

In 2006, a physiotherapy efficacy test showed that animals receiving intensive (n=9) physiotherapy had longer (P=< .05) survival times (mean 255 days), compared to those with moderate (n=6; mean 130 days) or no (n=7; mean 55 days) physiotherapy (Kathmann et al, 2006). Physiotherapy, in addition to strengthening the legs, would likely promote general spinal flexibility and circulation, helping to avoid induction of defective SOD-1. Therefore, diet and exercise appear to play key roles in slowing or halting the progression of degenerative myelopathy (Marsden, 2014).

• Preserve muscle tone and strength with early intervention

Degenerative myelopathy is a multifactorial disease in traditional Chinese veterinary medicine; making a diagnosis

• Underwater treadmill

• Start while dogs are still walking

Methods • Chiropractic adjustments to address vertebral ﬁxations from cervical to lumbosacral spine • Massage for circulation, tone and static range of motion/ breaks down calcification • Swimming: alternate day sessions recommended • Walking: can be alternated with swimming • Stretches

Continued on page 14.

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Continued from page 13

2. OXIDATIVE STRESS: THE ROLE OF PROCESSED FOODS • Starchy foods promote inflammatory cyokine production • Inflammation is promoted by excessive increases in insulin • Increased protein kinase C => decreased nitric oxide => failure of inflammation to resolve • Cyclo-oxygenase damage impairs repair cascade • Smouldering inflammation promotes more oxidative stress

THE CLEMMONS* PROTOCOL

Designed to counter immunemediated damage:

Treatment goal • Stop stoking the ﬁre/maintain pliability in tissue

Methods • Avoid overfeeding • Reduce gycemic index: unprocessed, non-starch based. • Homemade diets • Raw diets • Fresh food is more nutritionally complex and higher in antioxidants

3. SOD-1 AND EXCITOTOXICITY Treatment goals

Antioxidants

• Control inappropriate enzyme upregulation and the production of toxic by-products that “clog up” cord

Fibrinolytics • Aminocaproic acid • Limit cord damage

• Buildup of toxins in cord should eventually degrade and be removed if process is slowed and/or halted

Prednisone as needed

• Improve function

(1990s “MS like” • N acetylcysteine, vitamins C and E disease model)

• Reduce inﬂammation

Physiotherapy Fresh (unprocessed) food diet *Roger Clemmons, Assoc. Professor of Neurology, UF, Gainesville.

Methods • Acupuncture: reduce Heat/release Blood Stasis (Marsden, 2014) o Sedate: BL 13, BL 17, ST 37 (below ST 36 on cranial tibialis m. area) (T3 and T7) o Tonify: BL 40 and GV 14 o Sedate Stomach 36 and Gallbladder points 17, 19, 25 o GB 41 regulates the T-L junction dermatomes (treats paraysis) o Treatments may be needed for spring/fall flare-ups that are due to stuck seasonal energy movement • TVCM/Western herbs– Chinese Diagnosis: Blood Stasis o Minor Bleuperum Combination – drives blood flow out yet icepack -like function Xiao Chen Hu Tang – Natural Path Herb Company Opens peripheral circulation Beneﬁts limb function o Minor Invigorate the Collaterals (curcumin-containing) Xiao Huo Luo Dan – Natural Path Herb Company Curcumin crosses blood/brain barrier Inhibits inflammatory mediators o Major Bleuplerum Combination (original use for acute abdomen) Dai Chai Hu Tang – Natural Path Herb Company Removes heat, improves blood flow Anti-inflammatory for gut Relapses can be associated with gut stasis

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Continued on page 16.

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CASE STUDY

Continued from page 14.

Bronko, an award-winning German shepherd police dog, presented in late 2011 with a several-month history of loose stools and crashing when turning at a run. He was knuckling and had a delayed righting response in the hind feet. His radiographs were normal and no improvement was noted with chiropractic adjustments. A presumptive diagnosis of DM was made. The attending veterinarian consulted Dr. Marsden and implemented acupuncture and Chinese herbal medicine treatments (Bupleurum/Curcumincontaining blends). The goal was to reach the year’s end and an early forced retirement. At the end of the year, Bronko was stable. After a few months of therapy, he was no longer falling and his proprioception was normal. He returned to active duty collaring criminals in early 2012, and in September of that year was still on the job. He was happy, active, with a normal gait and able to jump tough obstacles. Bronko was on schedule for his normal retirement date in November of 2012.

• Curcumin – alone or in Minor Invigorate The Collaterals o Inhibits cytokine production in the cord o Inhibits NFkB which leads to proteolysis and gliosis • Milk Thistle (Silybum marianum) o Inhibits gliosis/poweful antioxidant o Prevents final stage of sclerosing in cord • Nerve Tonic Tincture (Pet Health and Nutrition Center) o Blend containing St. John’s wort, oat straw, licorice root, ginger, ginkgo leaf, skullcap, gotu kola and cayenne. o Supports healing of damaged nerve tissue o Improves circulation o Reduces Inflammation • Cold laser (Marsden, 2014) o Daily to twice weekly o Acute anti - inflammatory settings for T3-T7 and St 37 o Chronic anti-inflammatory settings for BL 40 and GV14 • Essential oils • Homeopathy • Omega-3 fatty acids • Myelin sheath (bovine spinal cord glandular)

CONCLUSION A multifaceted treatment protocol is required for this multifaceted disease model. The greatest benefit is seen with early intervention. Case reports suggest that the progress of DM can be consistently slowed, halted or even temporarily reversed.

CASE STUDY Dancer, a 12-year-old F/S Lab mix, presented in September 2014 for lethargy, hind leg weakness, tripping up curbs and exercise fatigue. Her radiographs showed mild arthritis in L5-L6; blood work identified over-supplementation with thyroid medication. Carprofen and Cosequin therapy were initiated for arthritis and her Levothyroxine dose was decreased. Dancer showed no improvement. In December, Dr. Tom saw Dancer and initiated essential oil therapy, Myelin Sheath and Nerve Tonic (Western herbs), Omega-3 FA, homeopathy, chiropractic, and a raw diet. Physiotherapy includes regular walks and neuro reflex postural stimulation exercises at home. Over the next seven months, Dancer had a waxing and waning course, then in August of 2015, her symptoms decreased dramatically. She now has normal energy, is back to full walks with her owners, and has only mild ataxia in her hind limbs.

Clemmons RM. “Degenerative Myelopathy”. Vet Clin North Am Small Anim Pract, July, 2010. Coates JR, Wininger FA. “Canine Degerative Myelopathy”. Vet Clin North Am Small Anim Pract., September 2010. Kathmann I, Cizinauskas S, Doherr MG, Steffen F, Jaggy A. “Daily controlled physiotherapy increases survival time in dogs with suspected degenerative myelopathy”. J Vet Intern Med., July 2006. Marsden S. “Degenerative Myelopathy – A Clinical Model and Strategy”. CIVT, 2014. Zeng R, Coates JR, Johnson GC, Hansen L, Awano T, Kollchenski A, Ivansson E, Perloski M, Lindbald-Toh K, O’Brien DP, Guo J, Katz ML, Johnson GS. “Breed distribution of SOD 1 alleles previously asociated with canine degerative myelopathy”. Journal of Vet Intern Med, March 2014.

IVC Winter 2015

By Ihor Basko, DVM

Treating pain and mobility problems There’s truth to the old adage, “Move it or lose it”. Mobility is essential to building muscle, increasing flexibility, improving alignment, relieving pain and pressure on joints, and repairing damaged tissue.

Generally, there are three types of physical disability that affect mobility in pets: musculoskeletal, neurological, or both musculoskeletal and neurological.

tissues and/or its associated fascia”.1 Within the trigger point area, there is a decrease in muscle fibers and an increase in fat and connective tissue.

•N eurological problems are usually a result of spinal or peripheral nerve injury from trauma, pressure, CNS pathology, or degenerative processes in the spinal cord (degenerative myelopathy).

Besides experiencing pain, the patient has decreased flexibility and range of motion, restricting mobility. If TPs are not treated appropriately, i.e. “inactivated”, this pain (and restriction of motion) will reoccur and persist throughout the animal’s lifetime.

•M usculoskeletal pathologies are many, and recognizing all the causative factors will guide one to the appropriate treatment modalities and supplements. In veterinary medicine, the main causes of mobility problems are: •S tructural problems with a “mechanical” restriction or instability • Avoidance due to pain •L oss of muscle strength due to disuse, sarcopenia, nerve degeneration or injury •M uscle, tendon or ligament shortening due to chronic and acute trigger point activation, deficiencies (nutritional, hypothyroidism, anemia, circulatory blood flow, nerve conduction), and sarcopenia.

It’s important to mollify deficiencies in the body, quell destructive inflammatory processes, and facilitate healing and regeneration. A variety of choices must be considered to treat the “whole” patient: •H erbal formulas to mollify deficiencies (Thyroid, Qi and Blood) •M inerals, essential fatty acids, amino acids and chondro-protective agents to support healing and regeneration • Antioxidants to decrease ROS (reactive oxygen species) production and subsequent inflammation due to cell tissue damage •N utraceuticals and medicinal botanicals to support blood flow and circulation.

Radiographs do not always tell us the causes of pain, or explain problems with movement. A careful assessment must be made of spinal alignment, supporting and compensating muscles, and the tendons and ligaments of the affected joint as well as the presence of trigger points (TPs).

My favorite “joint agents” are perna mussel2 and sea cucumber,3 which not only provide glycosaminoglycans (chondroitins 4 and 6 sulfates) but also chelated minerals (zinc, magnesium, calcium, iron), vitamins C, B12-3 and A, enzymes and amino acids. They also have anti-inflammatory properties.

Trigger points cause pain locally and distally, and are associated with “myofascial pain syndrome”. A trigger point can be described as “a hyper-irritable locus within a taut band of skeletal muscle located in muscle

Treatment of pain and mobility problems in pets is challenging and complex. For best results, consider treating the “whole animal” with a variety of modalities, and supplements.

Travell, Janet G. Myofascial Pain and Dysfunction: The Trigger Point Manual Vol. I. “Systematic review of the nutritional supplement Perna Canaliculus (green-lipped mussel) in the treatment of osteoarthritis”. QJM, 2008 Mar; 101(3):167-79, ncbi.nlm.nih.gov/pubmed/18222988. “High-Value Components and Bioactives from Sea Cucumbers for Functional Foods – A Review”. Marine Drugs Journal, 2011, 9(10): 1761–1805, ncbi.nlm.nih.gov/pmc/articles/PMC3210605.

1 2 3

IVC Winter 2015

Treating the iliopsoas muscle bundle for low-back pain

By Robin Downing, DVM, DAAPM, DACVSMR, CVPP, CCRP

LASER THERAPY IN VETERINARY MEDICINE

— many applications for many conditions. Laser therapy is a treatment modality that has been utilized for decades, but is finally finding its place in mainstream veterinary medicine. Interest in the application of therapeutic laser for the treatment of various conditions has grown dramatically as anecdotal reports, clinical case reports, and systematic study results have become available. Therapeutic laser has been incorporated into treatments that address diverse conditions including:

In order to understand how to best leverage therapeutic laser for appropriate treatment applications, it is important to understand the basics of laser technology, whether using therapeutic laser as a standalone modality or as a part of a larger treatment protocol.

• Skin wounds

The term “laser” is an acronym that stands for “light amplification by stimulated emission of radiation”, and describes a device that emits radiation in the form of a flow of photons of light energy. Therapeutic laser has been referred to as “low level” laser and “cold” laser, but these are considered obsolete terms. They were intended to distinguish therapy lasers from surgical lasers. Surgical lasers rely on different media – gas or solid – to incise or ablate tissues as an alternative to using a scalpel or cautery, respectively.

• Tendon and ligament injuries • Trigger points • Edema • Lick granulomas • Muscle injuries • Nervous system injury and neurologic conditions

LASER FUNDAMENTALS

• Osteoarthritis • Post-operative incisions and tissues • Pain

Therapeutic lasers help modulate cellular functions through a process called photobiomodulation, a photochemical process in which photons from a laser source interact with the target cells via a non-thermal mechanism to cause either IVC Winter 2015

stimulation or inhibition of biochemical pathways. While the precise mechanism for photobiomodulation is not completely understood, it appears that cytochrome C, located in the mitochondria, serves as an important photoreceptor. Once light is absorbed by cytochrome C, mitochondrial respiration and ATP production increase, leading to global tissue effects. Laser light is monochromatic (one wavelength), coherent (all photons travel in the same phase and direction), and collimated (minimal divergence of the laser beam over a distance). These three properties allow the therapy laser light to be focused on a specific area of the body, to penetrate the skin without heating or damaging it, and to interact with tissue with few side effects. The beam should be aimed at 90° to the surface of the area being treated. Wavelength influences the depth of penetration, and longer wavelengths penetrate deeper into the tissues. The optimal wavelength range for tissue photobiomodulation appears to be 650nm to 1,300nm; at longer wavelengths the laser beam penetrates deeper into tissue while minimizing absorption by the pet’s hair and skin pigment. Superficial wounds and joint injuries can be treated with shorter wavelengths, while longer wavelengths are better suited to treat muscle injuries. The power of the therapeutic laser matters in terms of the dose delivered, and the time needed to deliver the treatment dose. Power is a unit of time, and is expressed in watts (W) or milliwatts (mW). One watt is one Joule of energy delivered per second, and the laser dose is typically expressed as Joules/cm2 – the energy delivered over a surface area. The most commonly used therapeutic lasers in veterinary medicine are Class III lasers, which may deliver energy from 1mw to 500mw, and Class IV lasers, which deliver power at greater than 500mw.

BENEFITS OF THERAPEUTIC LASER Most responses of cells and tissues to therapeutic laser have been studied in in vitro models (cell culture). There appear to be many distinct benefits to using therapeutic laser for its tissue effects. Therapeutic laser has been demonstrated to relieve both chronic and acute pain by modulating peripheral nerve function and nerve conduction velocities. Laser energy increases the speed of tissue repair by increasing local microcirculation as well as stimulating the immune system and reducing inflammation. Laser energy also enhances collagen and muscle tissue development, which in turn enhances healing. There are several important “downstream” tissue effects from the application of laser light. These effects include: • Neovascularization • Angiogenesis • Collagen synthesis which enhances wound healing • Stimulation of nerve healing • Enhanced healing of tendons, cartilage, and bones • Reduced swelling from injury • Modulation of degenerative tissue changes • Mitigation of CNS damage following traumatic brain injury and spinal cord injury When creating a treatment protocol for therapeutic laser, it is important to consider these effects in order to maximize patient outcome. The actual time the tissue is exposed to light energy may also affect the outcome.

LASER SAFETY Eyes must be protected during laser therapy.

• A lower watt laser provides less energy delivery to deeper tissues so the time needed to deliver a treatment is longer. A lower power laser is better suited for treating superficial structures because of the limited power density to drive photons into the deeper tissues. • A higher watt laser allows the treatment to be delivered over a shorter period and involves administering the laser energy with a sweeping motion over the affected area. This sweeping motion may provide more complete coverage of the treatment area and may cover surrounding areas that could be causing secondary or referred pain. Pulsing of the laser beam may provide less heating of tissues at the surface while allowing for an adequate level of energy to reach the deeper target tissues, but more research is needed to define the optimal approach to a pulsed laser beam.

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There are some important safety considerations when incorporating therapeutic laser into treatment protocols. Protective glasses with lenses rated to the specific wavelength of the treatment laser are important for both humans and patients in order to protect retinal tissue. Laser energy should not be applied over a pregnant uterus, over tumors, over an open fontanel, over the growth plates of immature animals, or over the thyroid gland. Be careful if the pet has a tattoo, black fur, or black skin because of the potential for light absorption and tissue heating.

WHAT DOES THE RESEARCH SHOW? Most of the basic research done on therapeutic laser has been conducted in cell culture, and conducted in humans; however, extrapolation to veterinary medicine is reasonable. Because of the stimulation of fibroblast activity by laser light, this may affect collagen production to facilitate healing of wounds and burns. Studies suggest a laser dose of 1 J/cm2 to 5 J/cm2. Very high doses appear to inhibit healing. Both bone and cartilage appear to respond well to therapeutic laser. Osteochondral lesions of the stifle responded well to therapeutic laser used intraoperatively. Laser may also support cartilage during times that a joint must be immobilized. In human studies, the application of therapeutic laser for osteoarthritis is controversial. While some study participants appeared to have a positive outcome, overall results were unclear. Likewise, tendon treatment with therapeutic laser is controversial. Overall, however, laser therapy may improve collagen fiber organization, leading to enhanced tendon and ligament healing. The nervous system responds well to therapeutic laser for pain management, although the exact mechanism of suppression of central sensitization via laser is unknown.

APPLYING THERAPEUTIC LASER TO DOGS AND CATS The optimal wavelengths, intensities, and dosages for laser therapy in pets have not yet been adequately studied or determined, but this is sure to change as studies are designed and as more case-based information is reported. To maximize laser penetration, the petâ&#x20AC;&#x2122;s hair should be clipped. When treating traumatic, open wounds, the laser probe should not contact the tissue, and the dose often quoted is 2 J/cm2 to 8 J/cm2. When treating a post-operative incision, a dose of 1 J/cm2 to 3 J/ cm2 per day for the first week after surgery is described. Lick granulomas may benefit from therapeutic laser once the source of the granuloma is identified and treated. Delivering 1 J/cm2 to 3 J/cm2 several times per week until the wound is healed and the hair is re-growing is described. Treatment of osteoarthritis (OA) in dogs and cats using therapeutic laser is commonly described. The laser dose that may be most appropriate in OA is 8 J/cm2 to 10 J/cm2 applied as part of a multi-modal arthritis treatment plan. Finally, tendonitis may benefit from laser therapy due to the inflammation associated with the condition.

LASER THERAPY OF THE FUTURE Therapeutic laser is of special interest in the area of nerve regeneration, particularly in human medicine. Veterinary patients

IVC Winter 2015

TBI kitten following laser therapy - full recovery.

LASER Q&A

Laser technology has been changing over the years. IVC talked to three manufacturers about their products and the changing technology

Q: Have there been any recent changes/ improvements in your technology? Meghan Collins, Cutting Edge Laser Technologies:

“Our newest model features 75 watts of peak power and comes standard with acupuncture and intraoral tips.”

Amanda Hoffmeyer, Litecure (Companion Therapy Laser): “Newer features include built-in, condition-specific treatment protocols with software that changes dosing parameters based on the species being treated, the size of the patient, as well as the patient’s individual body type, skin color, and hair coat color and length. Other recent dosing innovations like Perfect Protocol™ calculate dosage based on user defined preferences for the most customized treatments ever. Our software also tracks patient treatment history, and our patented Deep Tissue Treatment applicator ensures each patient is getting the optimal dose every time.” experience peripheral nerve issues as they age, as osteoarthritis develops and progresses, in the wake of intervertebral disk disease, and when they develop nervous system decline as occurs in degenerative neuropathy/myelopathy. Photobiomodulation has been demonstrated to support nerve regeneration, reinnervation of denervated muscle, and functional recovery following peripheral nerve injury. This is an area of active research that promises to provide a significant impact on both human and veterinary patients.

SUMMARY Therapeutic laser clearly has a role in the treatment and management of multiple conditions in companion animals. There is strong evidence to suggest that light energy at the appropriate wavelength and power density has the ability to provide modulation of tissues at the cellular level to enhance healing. There are multiple important clinical benefits that should be considered, prompting the practitioner to introduce therapeutic laser into specific patient treatment protocols. Therapeutic laser has been thought to be one of the most underutilized treatment modalities in veterinary medicine. As more and more formal studies into the uses of therapeutic laser in animal models are completed, and more and more cases are presented, there is no doubt the use of therapeutic lasers will continue to expand. Therapeutic laser’s time has come in the treatment of many different conditions in companion animals. While it is not a panacea, it can certainly make a positive difference in the outcomes our patients experience.

IVC Winter 2015

Lisa Miksis,

Respond Systems: “We recently added 670nm red laser as an option, and are seeing its use increasing in veterinary dermatology, and for post-surgical healing.We are also see growth potential in the use for laser in assistance with “dentals”, and down the line as a tool for anti-bacterial/anti-microbial applications.”

Q: Briefly describe your equipment and what you see as its main benefit. MC: “MLS (Multiwave Locked System) Therapy Lasers feature patented technology that delivers therapeutic wavelengths, 808nm (anti-edemic and anti-inflammatory) and 905nm (analgesic), allowing a tissue penetration depth of 3cm to 4cm. An energetic synergy is created when delivering these wavelengths that produces greater anti-inflammatory and analgesic effects than either can produce on its own, while minimizing the risk of thermal damage. This unique combination and synchronization of continuous and pulsed emissions characterizes MLS and distinguishes it from other Class IV lasers.”

AH:

“The Companion Therapy Laser provides the perfect balance between user defined treatment protocols and condition-specific treatments creating optimal dosing for consistent clinical outcomes. The vast array of application-specific treatment applicators allows the user to pick the perfect treatment head for each target area. Having this kind of versatility and flexibility optimizes the ability of our laser to treat many different conditions in multiple species and ensure consistent outcomes in decreasing pain and inflammation as well as speeding healing.”

LM:

“Respond Systems has been manufacturing laser therapy and pulsed electromagnetic field (PEMF) therapy systems for veterinarians since 1983. We see our lasers as a “jack of all trades” in the clinic. Using low levels of laser light to stimulate healing, our lasers provide safe fast treatments for animals needing rehab, for

wounds or quick treatment of lick granuloma and otitis, or for faster recovery following surgery. We offer a choice of lasers to fit a wide variety of practice needs; from solo or mobile practitioners, on to the largest referral hospitals.”

Q: What are the most common problems vets/ rehab staff use your equipment for? MC: “Our lasers are used for chronic and acute inflammatory conditions, wounds, and intraoperatively – even over plates and screws.”

AH: “Therapy laser is used most commonly for acute painful/ inflammatory conditions such as otitis, pyotraumatic dermatitis, wounds/abscesses, and for post-operative procedures to help decrease pain and speed incisional healing. Chronic conditions such as osteoarthritis are very commonly treated with therapy laser and benefit from this safe, non-invasive technology. In a rehab setting, therapy laser treats acute soft tissue injuries such as muscular or tendon/ligament strains/sprains, and is used for chronic neurological conditions and rehab as well as postorthopedic procedure rehabilitation therapy.”

LM: “On a daily basis, we receive calls inquiring about soft tissue injury in the athletic dog. The conditions our lasers are treating in agility and working dogs include wound healing, Iliopsoas strains, muscle injury and bicipital tenosynovitis or bursitis. Respond Systems lasers also treat a wide variety of conditions in geriatric patients. Vets and PTs are treating hip and elbow dysplasia, arthritis, IVDD, and cervical spine issues. Our lasers are an excellent adjunct to traditional needle acupuncture.” Anders JJ, Geuna S, Rochkind S. “Phototherapy promotes regeneration and functional recovery of injured peripheral nerve”. Neurological Research, 2004; 26(2):233-239. Anders JJ, Moges H, et al. “In vitro and in vivo optimization of infrared laser treatment for injured peripheral nerves”. Lasers in Surgery and Medicine, published online, DOI 10.1002/lsm.22212,2013. Arany PR. “Photobiomodulation: Poised from the fringes”. Photomedicine and Laser Surgery, 2012; 309;507-509. Chow R, Armati P, et al. “Inhibitory effects of laser irradiation on peripheral mammalian nerves and relevance to analgesic effects: a systematic review”. Photomedicine and Laser Surgery, 2011; 29: 365381.

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 Academy of Veterinary Homeopathy continues to provide benefits to members and is active in educating veterinarians about the powerful healing possible with homeopathy.

Homeopathy at the AHVMA Conference – Oct. 2015 Dr. Sara Fox Chapman gave two talks for the AVH track of the conference, starting with “Introduction to Homeopathy”. She explored the history and basic principles of homeopathy. The effectiveness of homeopathic dilutions is often questioned but recent advances in quantum physics show, unequivocally, that ultramolecular dilutions have unique electromagnetic signatures with observable effects on biological systems, despite there being nothing chemically measurable. In “Homeopathy for Rescue Animals,” Dr. Chapman differentiated homeopathic medicines for diarrhea, since colitis is so common with the stress and diet changes experienced in shelters. She also discussed helpful homeopathic medicines for pain, “kennel cough” and behavioral problems. One benefit of homeopathic remedies is they can be dissolved in water and dripped onto very fearful animals. Many were interested in learning about the homeopathic approaches detailed in Dr. Christina Chambreau’s two lectures on arthritis and digestive disorders. There is growing interest in the ability of homeopathy to cure chronic disorders of the joints and digestive system (versus continuous need for drugs). Good training is needed for success.

Latest webinars Monthly webinars of the Homeopathy Working Group, included in AVH membership, continue to educate and inspire. The last three months covered methods of dosing homeopathic medicines.

de Morais NCR, Barbosa AM, et al.“Anti-inflammatory effect of low-level laser and light-emitting diode in zymosan-induced arthritis”. Photomedicine and Laser Surgery, 2010; 28: 227-232.

2016 AVH Conference

Draper WE, Schubert TA, et al. “Low-level laser therapy reduces time to ambulation in dogs after hemilaminaectomy: a preliminary study”. Journal of Small Animal Practice, 2012; 53: 465-469.

We invite you to join us in Austin, Texas on the lovely campus of St. Edwards for the Annual AVH Conference, June 3 to 5, 2016! For those on a budget, the conference fee is always reasonable and pleasant dormitories are available on campus.

Hamblin MR, Waynant RW, Anders A (eds). Proceedings of SPIE, 2006; Vol. 6140, 614001. Millis DL, Gross-Saunders D. “Laser therapy in canine Rehabilitation”. Canine Rehabilitation and Physical Therapy, Elsevier, 2014. Naeser MA, Hamblin MR. “Potential for transcranial laser or LED therapy to treat stroke, traumatic brain injury, and neurodegenerative disease”. Photomedicine and Laser Surgery, 2011; 9: 443-446. Peplow PV, Chung TY, Baxter GD. “Laser photobiomodulation of wound healing: a review of experimental studies in mouse and rat animal models”. Photomedicine and Laser Surgery, 2010; 28: 291-325. Roberts DB, Kruse RJ, Stoll SF. “The effectiveness of therapeutic class IV (10W) laser treatment for epicondylitis”. Lasers in Surgery and Medicine, 2013; 45:311-317. Rochkind S, El-Ani D, et al. “Increase of neuronal sprouting and migration using 780nm laser phototherapy as procedure for cell therapy”. Lasers in Surgery and Medicine, 2009; 41:277-281. Tumility S, Munn J, et al. “Low level laser treatment of tendinopathy: a systematic review with metaanalysis”. Photomedicine and Laser Surgery, 2010; 28(1):3-16.

It was a pleasure to host the AHV/PIVH booth at the AHVMA Conference this year and see so much genuine interest in homeopathy. From left to right: Todd Cooney, Leslie Brown, Elise Radebaugh, Carolyn Benson

Tuner J, Hode L. The New Laser Therapy Handbook, Prima Books, 2010.

IVC Winter 2015

nutrition nook

Supplements for osteoarthritis:

what’s the evidence? By Donna M. Raditic, DVM, CVA, DACVN and Joe Bartges, DVM, PhD, DACVIM, DACVN

any dietary supplements are recommended for veterinary patients with osteoarthritis.1-14 Very few have been evaluated in a controlled manner, and even fewer have been evaluated in dogs with osteoarthritis. In the last issue of IVC Journal (Fall 2015), we addressed food-derived supplements. In this issue, we will review the scientific evidence and research on other supplements recommended for dogs with osteoarthritis, including Omega-3 fatty acids, S-adenosylmethionine (SAMe), vitamin E, boswellia serrate, chondroprotectants, Zeel®, and Phycox®.

OMEGA-3 (N-3) FATTY ACIDS These decrease inflammation and pain in dogs with osteoarthritis. They reduce expression of cyclooxygenase-2 (COX-2), lipoxygenase-5, aggrecanase, matrix metalloproteinase 3 and 13 (MMP-3, MMP-13), interleukin-1 and β (IL-1β, IL-1β), and tumor necrosis factor β (TNFβ). 15-19 Novel oxygenated products, Resolvins (resolution phase interaction products) and docsatrienes, generated from n-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), resolve inflammation.20-28 N-3 fatty acids support normal cartilage metabolism in the face of degradative enzymes,

IVC Winter 2015

reducing inflammation and matrix degradative response elicited by chondrocytes during osteoarthritis progression.16-18,29 EPA appears to be more effective than DHA and-linolenic acid.15 There are several studies supporting use of n-3 fatty acids with osteoarthritis. An unpublished study performed in dogs showed lower serum concentrations of cholesterol, triglycerides, and phospholipids, lower synovial concentration of prostaglandin E2 (PGE2), better ground reaction forces, and less radiographic changes of osteoarthritis when dogs consumed a high n-3 diet than when dogs consumed a high n-6 diet.30,31 Owners perceive improvement in their pets’ arthritic symptoms when the animals are treated with fatty acids for various dermatologic problems.32 • In a study of 127 dogs with osteoarthritis, dogs fed a high n-3 diet had improved ability to rise from a resting position and play, over a period of six months, than dogs fed a control diet.33 Dogs fed a diet containing 3.5% n-3 fatty acids for 90 days had improved peak vertical force values (PVF) and subjective improvement in lameness and weight-bearing when compared with dogs on a control diet.34

• In a randomized, controlled clinical trial, dogs with stable chronic osteoarthritis treated with Carprofen could take a significantly decreased dosage when fed a diet supplemented with n-3 fatty acids, as compared to dogs on a control diet.35 Based on the results of these studies, there is a rationale for n-3 fatty acid supplementation, or feeding diets containing increased n-3 fatty acid levels to dogs with osteoarthritis. • A placebo-controlled double-blind study of 77 osteoarthritic dogs involved randomly assigning a fish oil supplement or corn oil with fish smell (placebo) to the dogs (added to food). Primary variables were PVF and impulse, the validated Helsinki Chronic Pain Index (HCPI) and the use of rescue non-steroidal anti-inflammatory drugs (NSAIDS). Secondary outcome variables also assessed included locomotion visual analog scale (VAS), Quality of Life questionnaire, veterinary assessment, owner assessment of outcome, as well as guessing the product given. After 16 weeks, there was no significant difference in the primary outcome variables, but owners of dogs in the fish oil supplementation group reported positive outcomes and did significantly better at identifying the supplement as compared to the placebo group. Blood sampling confirmed owner compliance, with significant increases in EPA and DHA and a decrease in arachadonic acid (AA) in the fish oil group, as compared to a significant decrease in AA in the placebo group. Possible study limits were reported: the dosing at 90mg EPA, 20mg DHA, and 10mg eicosatetraenoic acid (ETA) per kg BW could have been too low for this population, and/or the 16-week study period too short. When baselines were compared to the study-end values within the fish oil group, a small but significant improvement was reported in outcomes. The authors concluded that for patients not taking NSAIDs for osteoarthritis, fish oil supplements may provide true but limited relief in pain symptoms.36

S-ADENOSYLMETHIONINE (SAME) This co-substrate is involved in transmethylation, transsulfuration and aminopropylation reactions, which occur primarily in the liver. In controlled trials of humans with osteoarthritis, SAMe is as effective as NSAIDs and better than placebo in reducing pain and improving function, with a lower likelihood of side effects.37-44 However, no difference with an NSAID was found in one study.45 A systematic review was inconclusive and hampered by inclusion of small trials of questionable quality.46 No clinical trials of dogs have been published; however, an in vitro study showed SAMe adversely affected chondrocyte viability.47 SAMe may reduce inflammatory mediators, increase levels of the antioxidant glutathione, are chondroprotective, and maintain DNA methylation.48

OTHER ANTIOXIDANTS • A double-blinded randomized pilot study evaluated vitamin E in a dog OA model. Fifteen adult crossbred dogs, one to four years old, weighing 23.6kg to 30.5kg, were randomly assigned to control with placebo and treated with vitamin E as a liquid-tocopherol acetate at 0.044 ml/kg body weight, equating to about 400 IU vitamin E per dog once a day. This is about ten times the daily amount recommended by the Association of American Control Officials (AAFCO), but considered safe and non-toxic. All dogs were maintained on the same diet starting two months before the study and until the end, with amounts adjusted to maintain optimal weights. After the two-month period, the dogs had transection of their cranial cruciate ligament and placebo and vitamin E treatment initiated next day. Lameness and pain were assessed on Days 0, 28 and 55 after CCL transection using the visual analog scale (VAS), numerical rating scale (NRS), and electrodermal activity (EDA). Blood vitamin E levels were measured at Days 0, 21, 42, 55 post-surgery. Synovial fluid and cartilage histological analysis was evaluated after the dogs were euthanized on day 56. VAS, NRS and EDA were lower in the test group and become statistically significant in the test group for VAS Day 55 and EDA Day 28. Concentrations of PGE2 and nitric oxides (NO) in the synovial fluid of the test group were lower and statistically significant as well as histological scoring and analysis of the cartilage. This study in dogs with OA suggests that higher doses of vitamin E may reduce inflammatory markers and histological expression as well as improve signs of pain.49 • I n another study, large breed puppies fed a diet proportionately higher in protein, calcium, n-3 fatty acids and antioxidants had increased lean body mass and improved cartilage turnover as maturity was attained.50 In greyhounds and sled dogs, supplementation is associated with increased plasma levels; however, there was no difference in muscle damage with exercise.51-53 In dogs, vitamin C administration was found to increase vitamin C plasma levels, but was associated with decreased racing performance in greyhounds.54 In a study of antioxidant cocktail administration in 48 dogs over six weeks, subjects were assigned to four groups: untrained/not supplemented, untrained/supplemented, trained/not supplemented, trained/supplemented. Metabolomic profiling showed that dogs receiving the antioxidant cocktail recovered to baseline values at 24 hours after exercise, while dogs not receiving supplementation did not; therefore, administration of an antioxidant cocktail facilitates recovery from exercise.55

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Continued from page 25.

BOSWELLIA SERRATA (INDIAN FRANKINCENSE) Boswellia, also known as Boswellin or Indian frankincense, comes from the Indian Boswellia serrata tree. Resin from the bark of this tree is purported to have anti-inflammatory properties derived primarily from 3-O-acetyl-11-keto-βboswellic acid (AKBA), which inhibits 5-lipoxygenase and matrix metalloproteinases, and decreases tumor necrosis factor and interleukin 1β.56,57 Boswellia resin has been evaluated in 24 dogs in an open multi-center study.58 Improvement in clinical signs, lameness, and pain was found in 17 of 24 dogs. In five dogs, diarrhea and flatulence occurred.

CHONDROPROTECTANTS These are considered to be slow-acting drugs in osteoarthritis (SADOA) and can be subdivided into symptomatic slow-acting drugs (SYSADOA) and disease-modifying osteoarthritis drugs (DMOAD). Beneficial effects may include a positive effect on cartilage matrix synthesis and hyaluronan synthesis by synovial membrane, as well as an inhibitory effect on catabolic enzymes in osteoarthritis joints.59 Compounds fall under two different categories. One group includes agents approved by the US Food and Drug Administration and can have label claims of clinical effects such as polysulfated glycosaminoglycan (GAG). The second group includes products that are considered to be nutritional supplements, which are not regulated, and legally cannot claim any medical benefits. Examples of this group include glucosamine and chondroitin sulfate. While many of these products are administered as a supplement or alternative treatment, some, such as glucosamine and green-lipped mussels, are incorporated into pet foods.

GLUCOSAMINE AND CHONDROITIN Glucosamine is a precursor for glycosaminoglycans and a major component of joint cartilage; supplemental glucosamine may help rebuild cartilage.60-66 • In a randomized, double-blind, positive-controlled clinical trial comparing glucosamine hydrochloride and chondroitin sulfate to Carprofen in dogs with osteoarthritis, Carprofentreated dogs had improvement in five subjective measures while dogs treated with glucosamine-chondroitin sulfate had improvement in three of five measures but only at the final assessment point.67 • A 60-day, prospective, randomized, double-blinded, placebocontrolled trial of 71 dogs with osteoarthritis assessed subjective and objective measures comparing Carprofen, Meloxicam, glucosamine/chondroitin, and placebo. Results indicated that objectively measured variables improved

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significantly with Carprofen and Meloxicam, but not with glucosamine/chondroitin or placebo. Subjective findings of veterinarians agreed with the results of objective evaluation, but subjective assessment by owners identified improvement only with Meloxicam.68 Based on these results, there is weak clinical evidence of the benefits of glucosamine/chondroitin in dogs with osteoarthritis.69-71

ZEEL® This over-the-counter homeopathic preparation is based on highly diluted extracts from plants, animals, and minerals (sulfur) as well as defined biochemical substances including coenzyme A, DL-alphalipoic acid, sodium diethyl oxalate, and nicotinamide adenine dinucleotide.72,73 In one study in dogs aged >1 year diagnosed with osteoarthritis, Zeel was compared with Carprofen in a multi-center, prospective, observational open-label cohort study in 12 German veterinary clinics.93 In another study in dogs (n=44), aged >1 year diagnosed with osteoarthritis, it was compared with Carprofen and a placebo.73 Clinical signs and several measures of osteoarthritis improved significantly in both studies; however, in one study73, Zeel was not as effective as Carprofen. The composition of the products and the dosage of Zeel differed between the two studies, which confounds interpretation of results.

PHYCOX® A study of the commercially available C-phycocyanin-based (CPC) nutraceutical (Phycox®), its individual constituents, and Carprofen was performed using an in-vitro model of canine osteoarthritis. CPC is a biliprotein containing chromophore derived from cyanobacteria, also known as blue-green algae. Inflammatory conditions were induced using IL-1β in normal canine articular chondrocytes, and 0 to 250 µg/ml concentrations of the nutraceutical, constituents, and Carprofen were evaluated for any reduction in inflammatory mediators and markers of catabolism of the extracellular matrix: PGE2, TNFα, IL-6, MMP-3, nitric oxide and GAGs. Inhibition of COX1, COX-2 and LOX pathways were assessed using assay kits. No statistical difference was seen in the nutraceutical as compared to Carprofen, in the inhibition of TNFα, IL-6, MMP-3, nitrate, nitrite and GAGs production in the OA in-vitro canine model across the concentration ranges tested. Both the nutraceutical and Carprofen failed to significantly decrease the following mediators at the 0.1 to 10 mg/ml: TNF-a, IL-6, MMP-3, nitrate and nitrite. The nutraceutical did significantly reduce the concentration of PGE2 and GAG from the positive control. It was noted that the nutraceutical and many of its constituents appear to display selectivity for COX-2 inhibition and were poor LOX inhibitors.

Continued on page 28.

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Continued from page 26. A multi-center in-vivo efficacy study has been undertaken by this laboratories.74

CONCLUSION The pharmacological management of OA in dogs is dominated by NSAIDs, but adverse side effects can occur and there is concern over long-term administration of these drugs. NSAIDs have not been shown to slow the progression of the disease or to have a positive impact on joint degradation. Dietary supplements are being increasingly studied as the economics

of osteoarthritis in the aging human population is a growing concern. This review is not exhaustive as there are many supplements being evaluated for the treatment of OA. Translational research, new study methodology (nutrogenomics and metabololomics), and well-designed non-inferiority study design may open new horizons for the management of osteoarthritis in dogs. Practitioners need conclusive data to know how to select and integrate supplements into the multimodality management of their patients with osteoarthritis.

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.

Pirotta M. Arthritis disease - the use of complementary therapies. Aust Fam Physician 2010;39:638-640.

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.

Marcus DM. Therapy: Herbals and supplements for rheumatic diseases. Nat Rev Rheumatol 2009;5:299-300.

Xu ZZ, Zhang L, Liu T, et al. Resolvins RvE1 and RvD1 attenuate inflammatory pain via central and peripheral actions. Nat Med 2010;16:592-597, 591p following 597. James M, Proudman S, Cleland L. Fish oil and rheumatoid arthritis: past, present and future. Proc Nutr Soc 2010;69:316-323. Calder PC. Session 3: Joint Nutrition Society and Irish Nutrition and Dietetic Institute Symposium on ‘Nutrition and autoimmune disease’ PUFA, inflammatory processes and rheumatoid arthritis. Proc Nutr Soc 2008;67:409-418.

Vitetta L, Cicuttini F, Sali A. Alternative therapies for musculoskeletal conditions. Best Pract Res Clin Rheumatol 2008;22:499-522.

Ernst E. Complementary treatments in rheumatic diseases. Rheum Dis Clin North Am 2008;34:455-467.

Ernst E. Complementary or alternative therapies for osteoarthritis. Nat Clin Pract Rheumatol 2006;2:74-80.

Calder PC. n-3 polyunsaturated fatty acids, inflammation, and inflammatory diseases. Am J Clin Nutr 2006;83:1505S-1519S. Curtis CL, Harwood JL, Dent CM, et al. Biological basis for the benefit of nutraceutical supplementation in arthritis. Drug Discov Today 2004;9:165-172. Bartges JW, Budsberg SC, Pazak HE, et al. Effects of different n6:n3 fatty acid ratio diets on canine stifle osteoarthritis. Orthopedic Research Society 47th Annual Meeting 2001.

Rosenbaum CC, O’Mathuna DP, Chavez M, et al. Antioxidants and antiinflammatory dietary supplements for osteoarthritis and rheumatoid arthritis. Altern Ther Health Med 2010;16:32-40.

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.

Budsberg SC, Bartges JW, Pazak HE, et al. Effects of different N6:N3 fatty acid diets on canine stifle osteoarthritis. Veterinary Orthopedic Society 28th Annual Meeting 2001. Miller WH, Scott DW, Wellington JR. Treatment of dogs with hip arthritis with a fatty acid supplement. Canine Pract 1992;17:6-8.

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.

Morelli V, Naquin C, Weaver V. Alternative therapies for traditional disease states: osteoarthritis. Am Fam Physician 2003;67:339-344.

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.

Mathie RT, Baitson ES, Hansen L, et al. Homeopathic prescribing for chronic conditions in feline and canine veterinary practice. Homeopathy 2010;99:243-248.

Clayton JJ. Nutraceuticals in the management of osteoarthritis. Orthopedics 2007;30:624-629; quiz 630-621.

Hurst S, Zainal Z, Caterson B, et al. Dietary fatty acids and arthritis. Prostaglandins Leukot Essent Fatty Acids 2010;82:315-318.

Curtis CL, Hughes CE, Flannery CR, et al. n-3 fatty acids specifically modulate catabolic factors involved in articular cartilage degradation. J Biol Chem 2000;275:721-724.

Curtis CL, Rees SG, Cramp J, et al. Effects of n-3 fatty acids on cartilage metabolism. Proc Nutr Soc 2002;61:381-389.

Curtis CL, Rees SG, Little CB, et al. Pathologic indicators of degradation and inflammation in human osteoarthritic cartilage are abrogated by exposure to n-3 fatty acids. Arthritis Rheum 2002;46:1544-1553.

Zainal Z, Longman AJ, Hurst S, et al. Relative efficacies of omega-3 polyunsaturated fatty acids in reducing expression of key proteins in a model system for studying osteoarthritis. Osteoarthritis Cartilage 2009;17:896-905.

Serhan CN, Arita M, Hong S, et al. Resolvins, docosatrienes, and neuroprotectins, novel omega-3-derived mediators, and their endogenous aspirin-triggered epimers. Lipids 2004;39:1125-1132.

Hong S, Gronert K, Devchand PR, et al. Novel docosatrienes and 17S-resolvins generated from docosahexaenoic acid in murine brain, human blood, and glial cells. Autacoids in anti-inflammation. J Biol Chem 2003;278:14677-14687.

Meduri GU, Carratu P, Freire AX. Evidence of biological efficacy for prolonged glucocorticoid treatment in patients with unresolving ARDS. Eur Respir J Suppl 2003;42:57s-64s.

Xu ZZ, Ji RR. Resolvins are potent analgesics for arthritic pain. Br J Pharmacol 2011.

Lima-Garcia J, Dutra R, da Silva K, et al. The precursor of resolvin D series and aspirin-triggered resolvin D1 display anti-hyperalgesic properties in adjuvant-induced arthritis in rats. Br J Pharmacol 2011.

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Roush JK, Dodd CE, Fritsch DA, et al. Multicenter veterinary practice assessment of the effects of omega-3 fatty acids on osteoarthritis in dogs. J Am Vet Med Assoc 2010;236:59-66. Roush JK, Cross AR, Renberg WC, et al. Evaluation of the effects of dietary supplementation with fish oil omega-3 fatty acids on weight bearing in dogs with osteoarthritis. J Am Vet Med Assoc 2010;236:67-73. Fritsch DA, Allen TA, Dodd CE, et al. A multicenter study of the effect of dietary supplementation with fish oil omega-3 fatty acids on carprofen dosage in dogs with osteoarthritis. J Am Vet Med Assoc 2010;236:535-539. Hielm-Bjorkman A, Roine J, Elo K, et al. An un-commissioned randomized, placebo-controlled doubleblind study to test the effect of deep sea fish oil as a pain reliever for dogs suffering from canine OA. BMC Vet Res 2012;8:157.

Caruso I, Pietrogrande V. Italian double-blind multicenter study comparing S-adenosylmethionine, naproxen, and placebo in the treatment of degenerative joint disease. Am J Med 1987;83:66-71.

Maccagno A, Di Giorgio EE, Caston OL, et al. Double-blind controlled clinical trial of oral S-adenosylmethionine versus piroxicam in knee osteoarthritis. Am J Med 1987;83:72-77.

Glorioso S, Todesco S, Mazzi A, et al. Double-blind multicentre study of the activity of S-adenosylmethionine in hip and knee osteoarthritis. Int J Clin Pharmacol Res 1985;5:39-49.

Muller-Fassbender H. Double-blind clinical trial of S-adenosylmethionine versus ibuprofen in the treatment of osteoarthritis. Am J Med 1987;83:81-83.

Vetter G. Double-blind comparative clinical trial with S-adenosylmethionine and indomethacin in the treatment of osteoarthritis. Am J Med 1987;83:78-80.

Najm WI, Reinsch S, Hoehler F, et al. S-adenosyl methionine (SAMe) versus celecoxib for the treatment of osteoarthritis symptoms: a double-blind cross-over trial. [ISRCTN36233495]. BMC Musculoskelet Disord 2004;5:6.

Soeken KL, Lee WL, Bausell RB, et al. Safety and efficacy of S-adenosylmethionine (SAMe) for osteoarthritis. J Fam Pract 2002;51:425-430.

De Silva V, El-Metwally A, Ernst E, et al. Evidence for the efficacy of complementary and alternative medicines in the management of fibromyalgia: a systematic review. Rheumatology (Oxford) 2010;49:1063-1068.

Kim J, Lee EY, Koh EM, et al. Comparative clinical trial of S-adenosylmethionine versus nabumetone for the treatment of knee osteoarthritis: an 8-week, multicenter, randomized, double-blind, double-dummy, Phase IV study in Korean patients. Clin Ther 2009;31:2860-2872.

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Rutjes AW, Nuesch E, Reichenbach S, et al. S-Adenosylmethionine for osteoarthritis of the knee or hip. Cochrane Database Syst Rev 2009:CD007321.

Steinmeyer J, Burton-Wurster N, Lust G. Effects of three antiarthritic drugs on fibronectin and keratan sulfate synthesis by cultured canine articular cartilage chondrocytes. Am J Vet Res 1992;53:2077-2083.

Hosea Blewett HJ. Exploring the mechanisms behind S-adenosylmethionine (SAMe) in the treatment of osteoarthritis. Crit Rev Food Sci Nutr 2008;48:458-463.

Rhouma M, de Oliveira El Warrak A, Troncy E, et al. Anti-inflammatory response of dietary vitamin E and its effects on pain and joint structures during early stages of surgically induced osteoarthritis in dogs. Can J Vet Res 2013;77:191-198.

VetzLife All-Natural News

Schoenherr WD, Macleay JM, Yamka RM. Evaluation of body composition and cartilage biomarkers in large-breed dogs fed two foods designed for growth. Am J Vet Res 2010;71:934-939.

Scott KC, Hill RC, Lewis DD, et al. Effect of alpha-tocopheryl acetate supplementation on vitamin E concentrations in Greyhounds before and after a race. Am J Vet Res 2001;62:1118-1120.

Piercy RJ, Hinchcliff KW, DiSilvestro RA, et al. Effect of dietary supplements containing antioxidants on attenuation of muscle damage in exercising sled dogs. Am J Vet Res 2000;61:1438-1445.

Baskin CR, Hinchcliff KW, DiSilvestro RA, et al. Effects of dietary antioxidant supplementation on oxidative damage and resistance to oxidative damage during prolonged exercise in sled dogs. Am J Vet Res 2000;61:886-891.

Marshall RJ, Scott KC, Hill RC, et al. Supplemental vitamin C appears to slow racing greyhounds. J Nutr 2002;132:1616S-1621S.

Waldron MK, Reynolds AJ, Kochhar S, et al. Metabolomic approach to assessing the efficacy of an antioxidant cocktail in trained and untrained dogs following an exercise bout. Compend Contin Educ Vet 2007;29:25 abstract.

Sengupta K, Alluri KV, Satish AR, et al. A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee. Arthritis Res Ther 2008;10:R85.

Ernst E. Frankincense: systematic review. BMJ 2008;337:a2813.

Reichling J, Schmokel H, Fitzi J, et al. Dietary support with Boswellia resin in canine inflammatory joint and spinal disease. Schweiz Arch Tierheilkd 2004;146:71-79.

McNamara PS, Johnston SA, Todhunter RJ. Slow-acting, disease-modifying osteoarthritis agents. Vet Clin North Am Small Anim Pract 1997;27:863-881.

Chan PS, Caron JP, Orth MW. Effects of glucosamine and chondroitin sulfate on bovine cartilage explants under long-term culture conditions. Am J Vet Res 2007;68:709-715.

Lippiello L, Han MS, Henderson T. Protective effect of the chondroprotective agent Cosequin DS on bovine articular cartilage exposed in vitro to nonsteroidal antiinflammatory agents. Vet Ther 2002;3:128-135.

Gouze JN, Bordji K, Gulberti S, et al. Interleukin-1beta down-regulates the expression of glucuronosyltransferase I, a key enzyme priming glycosaminoglycan biosynthesis: influence of glucosamine on interleukin-1beta-mediated effects in rat chondrocytes. Arthritis Rheum 2001;44:351-360.

Dodge GR, Jimenez SA. Glucosamine sulfate modulates the levels of aggrecan and matrix metalloproteinase-3 synthesized by cultured human osteoarthritis articular chondrocytes. Osteoarthritis Cartilage 2003;11:424-432.

Ali AA, Lewis SM, Badgley HL, et al. Oral glucosamine increases expression of transforming growth factor beta1 (TGFbeta1) and connective tissue growth factor (CTGF) mRNA in rat cartilage and kidney: Implications for human efficacy and toxicity. Arch Biochem Biophys 2011.

Phitak T, Pothacharoen P, Kongtawelert P. Comparison of glucose derivatives effects on cartilage degradation. BMC Musculoskelet Disord 2010;11:162.

Silbert JE. Dietary glucosamine under question. Glycobiology 2009;19:564-567.

McCarthy G, O’Donovan J, Jones B, et al. Randomised double-blind, positive-controlled trial to assess the efficacy of glucosamine/chondroitin sulfate for the treatment of dogs with osteoarthritis. Vet J 2007;174:54-61.

Moreau M, Dupuis J, Bonneau NH, et al. Clinical evaluation of a nutraceutical, carprofen and meloxicam for the treatment of dogs with osteoarthritis. Vet Rec 2003;152:323-329.

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.

Sanderson RO, Beata C, Flipo RM, et al. Systematic review of the management of canine osteoarthritis. Vet Rec 2009;164:418-424.

McKenzie BA. What is the evidence? There is only very weak clinical trial evidence to support the use of glucosamine and chondroitin supplements for osteoarthritis in dogs. J Am Vet Med Assoc 2010;237:1382-1383.

Neumann S, Stolt P, Braun G, et al. Effectiveness of the homeopathic preparation Zeel compared with carprofen in dogs with osteoarthritis. J Am Anim Hosp Assoc 2011;47:12-20.

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).

Hielm-Bjorkman A, Tulamo RM, Salonen H, et al. Evaluating complementary therapies for canine osteoarthritis--Part II: a homeopathic combination preparation (Zeel). Evid Based Complement Alternat Med 2009;6:465-471.

Martinez SE, Chen Y, Ho EA, et al. Pharmacological effects of a C-phycocyanin-based multicomponent nutraceutical in an in-vitro canine chondrocyte model of osteoarthritis. Can J Vet Res 2015;79:241-249.

IVC Winter 2015

ESSENTIAL OILS TO MAXIMIZE HEALTH AND TREAT DEGENERATIVE DISEASE - PART 1 By Melissa Shelton, DVM

lmost every aspect of animal care can benefit from the addition of essential oils. In veterinary practice, I have been able to use these oils to provide natural and effective options for many health issues. I have utilized them for flea and tick prevention, immune system support, anti-bacterial, anti-fungal, anti-tumor and anti-viral properties, replacing NSAID and steroid use, providing anti-inflammatory effects that are also gastro-protective,1 enhancing the healing of wounds and surgical sites, increasing circulation, treating resistant infections, supporting organ systems, and improving clotting function and resolution.2 All essential oils also have energetic and emotional benefits. Supporting all aspects of the animal’s well-being, essential oils are a powerful modality to add to your arsenal.

Steam distillation of essential oils is generally considered the best for veterinary and medical purposes. It is my belief that essential oils should be used in their most natural and complete ratios – and that practices such as fractionation should not be used to enhance or separate different chemical components of the oil.

PREPARATION

Trusting your supply source is key to obtaining true essential oil quality. Even “certified” quality statements may not be accurate. Ask an experienced medical practitioner you trust.

Essential oils are volatile aromatic chemical compounds derived from selected plant materials. The oils help protect the plant against bacteria, fungi and pests. These characteristics are transposed to the effects desired from the use of an essential oil.3 Essential oils are lipophilic, and non-soluble in water. They do appear to have the ability to penetrate tissues quite effectively, and physical medical responses can be witnessed even through inhalation.4

IVC Winter 2015

QUALITY Quality is highly important when selecting essential oils for medical and veterinary use, especially with smaller and exotic animals. The use of a lower quality essential oil is analogous to spraying perfume, so negative effects would not be surprising. Since many essential oils are distilled or marketed for the perfume industry, some companies may not know or care to know the difference.

Other keys: 1. High quality oils can be expensive; do not seek the lowest cost. 2. Bottles should be tamper-evident, without rubber dropper tops. 3. Each bottle should have lot numbers or tracking information.

The best way to learn about variations in quality is to invest in oils from many sources, comparing them side by side. Use the oils on yourself and your own pets to form a relationship with them. I relate my experience with essential oils to learning about wine. Until I went on wine tasting tour, I really hadn’t a clue. Many people have never done an “essential oil” tour. To me, it should be mandatory. Developing the skill of evaluating essential oils can take several years – all good skills can take a bit of time to master. Do not become discouraged, but do practice the skills daily. Although it may take years to hone advanced skills, you will often have notable results with even beginning approaches. More will be covered in Part 2 of this article, in the Spring 2016 issue of IVC Journal. It is important to recognize that even poor quality, synthetically created or altered essential oils will be effective for physical conditions. In this way, synthetic oils are similar to traditional medications like aspirin or steroids. But they often have many side effects and do not work at the deep natural level we desire. The fact that an essential oil “worked” for an animal does not indicate its quality level; it merely indicates the presence of active and effective chemical compounds. Cats have gained notoriety as the most controversial species when it comes to essential oil use,5 but in practice we have witnessed the aggressive use of oils in felines without harm. The cat’s apparent deficiency in the Cytochrome P450 pathway, and other liver metabolism quirks and concerns, seem more of an issue with the processing of synthetics and man-altered chemical compounds than with true and balanced essential oils.6

DOSING METHODS The application of essential oils in veterinary medicine provides amazing flexibility in treatment options. I usually recommend starting with the most basic, light, and easy methods of application and use, and advancing to more aggressive or layered approaches if it proves necessary. Oils can be used “neat” (undiluted, often directly from the bottle) or in diluted form. Essential oils can be diluted in a fatty carrier oil or water. Common carrier oils include coconut oil, olive oil, almond oil, sunflower oil, etc. I prefer the use of edible and organic carrier oils as much as possible. Fractionated (so it does not turn solid at cool temperatures) coconut oil (FCO) is my current favorite for use in diluting essential oils for animals. A high quality cooking grade oil can be selected, and FCO appears to be the most “fur friendly” oil in my opinion, leaving much less of an oily residue and not damaging furniture and fabrics.

Continued on page 32. IVC Winter 2015

Continued from page 31. 1. Water-based diffusion of essential oils remains one of the easiest and most benign methods of exposure – and it’s surprisingly effective. Hair and fur do not appear to inhibit the absorption of oils transdermally, and hair follicles coated with natural sebum may even enhance lipophilic absorption into the body. Animals with more hair follicles per square inch of dermis appear to be more “sensitive” to smaller amounts of essential oils – possibly due to this enhanced absorption. Diffusion requires little handling of the animal – the cool mist carrying essential oil particles can permeate fur, feathers or skin and allow for systemic absorption. “Tented” diffusion into a carrier with an animal in it can ensure deep inhalation, and even topical contact with surfaces such as a cornea or conjunctiva.

USE IN YOUR PRACTICE

2. “Petting” consists of placing an essential oil in the hands, diluted or neat, and rubbing them together until a light film of the desired concentration is on the hands. The animal is then “petted” with those hands. Even if the oil seems to be completely absorbed into the skin, there is an effective transfer and amazing amount of scent and action.

• For topical treatments, use diluted oils. A 1% to 5% concentration of essential oil(s) to carrier oil is a nice starting point. If not effective, a higher concentration can be tried. Drops can vary in volume depending on the dropper used and the viscosity of the essential oil – however, this is still the most widely reported method of measurement for essential oils. For example, 1 drop of oil in 5mL of carrier oil would be a 1% concentration, 2 drops in 5mL would be a 2% concentration, and so on. Although carrier oils can often be measured with a syringe, essential oils are quick to degrade the plunger; it is advisable that essential oils be measured in a glass graduated cylinder when exact measurements are desired.

3. Water-misting. 4. Direct topical applications. 5. Oral administration, rectal instillation, injection, and IV administration, which should be reserved for research or in extensively monitored veterinary cases.

• Procure quality oils. • Test each method and oil on yourself first. If I plan to spray an animal with essential oils in a water mist, I mist my face with the recipe first. If I plan to add essential oils to drinking water or food, I too add them to my own food and water to see how the effects feel. • Initially, use tried and true recipes and recommendations. Over time, I was able to modify these methods even further, with veterinary knowledge and experience, into what I felt was even more appropriate for the animal species in question. • Use the easiest, most dilute methods first. Water-based diffusion is one of the easiest methods to use, and can be layered with other methods to provide even more effects.

• Essential oils can be used alongside medications, athough the use of the oil could reduce the need for the “traditional drug , leading to side effects from overuse of the medication. Multiple patients of mine have required far less of their prescription medications or herbal remedies once essential oil use has been initiated, so it is important to monitor closely to see if patient dosing needs to be adjusted, especially in cases where the animal is on insulin. Witnessing liver or kidney values improve with the use of essential oils is encouraging, and will continue to add to our knowledge of safety and efficacy. The amazing flexibility essential oils provide is to be duly noted. There are not many medications, where if an animal will not consume it, that we can just “throw” into the air, pet onto the fur, or add to a shampoo, and still see effects from it. We all know how difficult it can be to pill a cat; wouldn’t it be great if we could just rub that pill on our hands, pet the cat and see similar effects? Well, with essential oils this often seems to be the case.7 I clearly see benefits in using essential oils with my patients and consults. The results speak for themselves, and frustrating

IVC Winter 2015

ADDITIONAL CONSIDERATIONS

Whenever medical grade essential oils have raised concern, I usually ﬁnd it’s due to overuse or inappropriate use. Signs that an animal may be overwhelmed could include increased respiratory rate, reddened or irritated skin, avoiding the diffuser, lethargy, inappetence, soft stools, or anything else considered out of the ordinary. In these cases, stopping further use of essential oils, even through diffusion, and diluting a site of irritation (especially directly on the skin) with a fatty carrier oil is the most effective route of relief. Washing off essential oils with water can increase irritation in some situations, as the essential oil is not soluble in water, and can be spread over the dermal surface, potentially increasing the area of exposure. With cases of questionable essential oil response, I will check a blood panel and run other indicated lab tests, but often ﬁnd them to be normal or similar to pre-oil laboratory data. I do feel it is important that we as veterinarians begin to collect pre-, during, and post-essential oil use data in the form of laboratory tests for our patients. As I routinely do this, it has increased thousands-fold my understanding and comfort levels in the use of essential oils with medical cases.

cases that appear to have no other options have definitely shown amazing responses to essential oil use. Although all the “scientific proof” may not be directly available, it is clear from a quick search on pubmed.gov8 that essential oils have a dominant presence and a lot of promise. Paiva LA, et al. “Gastroprotective effect of Copaifera langsdorffii oleo-resin on experimental gastric ulcer models in rats”. J Ethnopharmacol, 1998 Aug; 62 (1): 73-8.

Tognolini M, et al. “Protective effect of Foeniculum vulgare essential oil and anethole in an experimental model of thrombosis”. Pharmacol Res. 2007 Sep; 56 (3): 254-60, Epub 2007 Jul 14.

Bowles, E. Joy. The Chemistry of Aromatherapeutic Oils. Third Edition. NSW Australia. Allen & Unwin, 2003.

Satou T, et al. “Daily inhalation of α-pinene in mice: effects on behavior and organ accumulation”. Phytother Res. 2014 Sep; 28 (9): 1284-7.

Bischoff K and Guale F. “Australian Tea Tree (Melaleuca Alternifolia) Oil Poisoning in Three Purebred Cats”. J VET Diagn Invest, 1998 10: 208-210.

Williams, David G. “The Chemistry of Essential Oils; An Introduction for Aromatherapists”, Beauticians, Retailers and Students, Second Edition, New York, Micelle Press, 2008.

Herman A, Herman AP. “Essential oils and their constituents as skin penetration enhancer for transdermal drug delivery: a review”. J Pharm Pharmacol, 2015 Apr; 67 (4): 473-485.

Zomorodian, et al. “Chemical Composition and Antimicrobial Activities of Essential Oil of Nepeta Cataria L. Against Common Causes of Oral Infections”. Journal of Dentistry, Tehran University of Medical Sciences, July 2013; Vol. 10, No. 4: 329-337.

IVC Winter 2015

From the

AATCVM

The American Association of Traditional Chinese Veterinary Medicine (AATCVM) is a non-profit organization founded in 2006 to support practitioners of Traditional Chinese Veterinary Medicine (TCVM). It promotes high quality research in all aspects of TCVM, including acupuncture, Chinese herbal medicine, Tui-na and food therapy. The AATCVM also promotes the practice of evidence-based TCVM by funding high quality studies of the basic science and mechanisms of action of treatments, and randomized clinical trials of treatment efficacy.

ANNUAL CONFERENCE HIGHLIGHTS

AJTCVM ABSTRACT

The 17th Annual TCVM Conference sponsored by AATCVM and WATCVM took place at the Chi Institute of Chinese Medicine’s new conference center in Reddick, Florida, from November 12 to 15. The theme was “Lameness, Pain Management and TCVM Diagnosis”. Keynote speakers included Shen Xie, DVM, PhD; Bruce Ferguson, DVM, MS, CVA, CVCH; Constance DiNatale, DVM, CVA: and Aituan Ma, DVM, PhD. The event also featured over 20 presenters from Asia, Europe, South America and the US.

The peer-reviewed American Journal of TCVM, published twice a year, is a venue for the dissemination of information on research findings, continuing education for TCVM practitioners, issues of interest to the TCVM community, and TCVM news. Here’s a sample abstract.

Small Animal, Equine and Mixed Practice tracks were offered for the first time. These allowed attendees to focus on areas of particular interest. Two days of additional workshops followed the lectures, with more specialized and hands-on training in Chinese Herbal Medicine, Use of the Channel Balance Method for Pain Relief, and Food Therapy. Participants earned up to 42 CE hours in the two lecture tracks and three workshops.

LOOKING AHEAD For members planning ahead, the 18th Annual TCVM Conference will take place in Bejing, China from August 27 to 31, 2016. The main themes include: TCVM for Inflammatory/ Infectious Diseases, TCVM for Behavior Disorders, Spirit-MindBody and Clinical Application of TCM Four Schools for Internal Medicine Diseases. Attendees who want to experience the land and its people can participate in pre-conference tours – camping on the Inner Mongolia Grassland, riding with Mongolian herders, visiting famous Chinese attractions such as the Great Wall, the Prohibited City, and Tian-an-men, and participating in other activities such as local herbal identification and herbal markets.

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Peterman, Uwe, DVM. “Combination of Laser Acupuncture and Low Level Laser Therapy for Treatment of Non-Healing and Infected Wounds”. AJTVVM, Volume 10, Number 2, August 2015, pp 33-42: “Pulse-controlled laser acupuncture involves the combination of laser acupuncture with low level laser therapy. These are effective individual therapies, but when used together, there is a synergy which provides clinically effective therapy for many types of nonhealing traumatic or surgical wounds. The author has successfully used laser therapy for the past 25 years to treat several hundred cases of non-healing and/or infected wounds, including wound infections populated by organisms resistant to multiple antibiotics. This paper describes successful treatment of large non-healing wounds using laser acupuncture and low level laser therapy without additional surgical or medical interventions.”

JOIN OR RENEW TODAY Visit our website to see what else the AATCVM offers, such as PowerPoint lectures for introductory TCVM presentations, a library of articles and studies, quarterly practice tips, and more. Visit aatcvm.org, email support@aatcvm.org, or call 1-844-422-8286.

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tech talk By Susan Klein, DVM

ENERGY AS MEDICINE This is a very exciting time to be a practitioner of Whole Body Healing. Advances in technology continue to provide opportunities for a better understanding of the science behind the tools we use as holistic practitioners. A paradigm shift is occurring in the way we view well-being and disease. Alternative medical approaches such as acupuncture (Clemmons R, 2012) and homeopathy (Bell IR, 2012) are at the forefront of a growing body of evidence that proves these approaches to be valid therapies with a scientific foundation. To go even further is to embrace the concept of energy as medicine – examples of this are Osteopathic Manipulations, Reiki, and Healing Touch for Animals. Viewing these proven theories as Energy Medicine gives the practitioner a valuable tool in customizing a diagnostic and treatment plan for each individual patient. My objective with this article is to provide scientific evidence to support the use of Energy Medicine in clinical practice and a method of how to apply it today.

DIFFERENT ENERGIES AFFECT THE BODY Studies show that energies such as sound (Clumeck C, 2014) and light (Bonmati-Carrion M, 2014) have an impact on biological functions. Energy has the power to heal or cause disease – an excess or deficiency of “parts” creates discord in the harmonic field in the physical realm of the body. Cold lasers work beneficially to promote healing, while too much sun exposure can lead to skin cancer. Long term imbalances in the body’s energetic systems lead to adaptive patterns that create disease (Kubzansky L, 2011) and behavioral problems (Mahdavi S, 2014). The ability to “interpret” these imbalances and “resonate” with the innate healing mechanism in order to restore homeostasis is the foundation of Energy Medicine.

CONVENTIONAL VS. ALTERNATIVE MODELS The currently accepted Western medical model is based on concepts of Newtonian physics, meaning the body functions in

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a mechanical style – i.e. it’s a biological computer. The approach of cause (virus, bacteria, trauma) and effect (illness) theoretically explains disease states and dictates treatment recommendations. Evidence of the fallacy of this model is seen every day in practice when a patient does not respond to a standard treatment protocol, or diagnostic tests are inconclusive. Recent discoveries of the primo-vascular system as possible physical proof of acupuncture meridians open up more opportunities to understand the movement of energy and the effects of energetic restrictions (Park DY, 2014). A simple scar becomes a source of backup into the local tissue environment, creating an imbalance in the flow of information through that area – over the course of time, this area loses communication with the rest of the body, cells revert to a primitive metabolism, and the potential for cancer increases. The medical model of Alternative Medicine is one that considers the whole individual. This comes closer to the physics theory of Mass-Energy Equivalence put forth by Albert Einstein. His well-known equation of E=mc2, which is widely accepted to be true, states that energy is equal to matter. This theoretical perspective, applied biologically, means that the physical body is also comprised of non-physical energy fields. These energy fields are magnetic and electric, interwoven into a complex system that allows us to function without much conscious awareness of our biological processes. These energy fields are measured by devices like EKGs, MRIs, and magnetoencephalograms. This energetic system exists in the complex cellular matrix, intra and extracellular, that provides the body with a physical shape. The constant influx of information, whether it is physical such as a drug, or vibrational such as a homeopathic medicine, has the potential to affect the whole “symphony” of the body, for better or worse. An understanding of what is “restricting” the return to flow creates a starting point from which to help unravel

the impact of the processes that have contributed to the disease state. The clues are held in the physical story of each individual’s life, their medical history, and their unique energy field, which sets the tone for the response of that “body”.

TESTING TOOLS There are many tools available for the open-minded to “test” if our sense about something is correct – for example, muscle testing, pendulums, biofeedback machines, etc. I found the principles of Applied Kinesiology (Walther DS, 200) worked best for me – I went through a few different models and settled on the use of interlocking fingers to determine “yes” versus “no”. Each practitioner is best served in finding their own way to the system that helps them feel energy – there are a growing number of classes for veterinarians and laypeople alike, including Reiki, Osteopathy, TTouch, HTA, etc. Once you are able to develop a sense of how your own body reacts, i.e. intuition or gut feelings, then you can move towards using this sense to help guide a patient’s course of action re diagnostics, therapy, nutrition – whatever “resonates” with you as a practitioner.

MIND-BODY-SPIRIT CONNECTION The mind-body-spirit connection can be explained through a medical model. The brain is the “mind” and allows us consciousness, the “body” is our physical structure and physiology, and the “spirit” is the non-physical energy that interfaces with the body through the Autonomic Nervous System. There exists a three-dimensional perspective to the living being – emotion (senses), structure, and physiology – which is overlooked by the current medical model. For example, chronically stressed people have upset stomachs and/or back pain. It is the interplay of these systems that dictate what is going on with the body at any given moment.

AREA OF GREATEST RESTRICTION Using this understanding as a starting point, a practitioner can narrow down an area of focus for diagnostics and treatment. While it is important to have a diagnosis, a treatment plan based on energetics and medical science is most effective if it starts by removing the impediment to healing that is part of the physical symptom. This Area of Greatest Restriction (AGR) is the point at which the body can safely “unravel” these imbalances; a treatment protocol evolves as the “frequency” of healing for each patient is revealed. Treating more deeply in the body before it is ready is one possible reason for a lack of/diminished response to treatment. It’s also a possible explanation for why a first treatment gives astounding results, but subsequent ones do not – if it is no longer the right frequency for supporting that patient, it will not be as effective.

This may explain as well the unexpected outcomes that can occur when too much toxicity is released into an already overloaded system. Remember that homeostasis is a dynamic flow system; if your intuition is “right”, it will be reflected in the improved health and vitality of your patients. An open mindset allows each practitioner to design a customized treatment plan versus treating with a standard protocol.

VIBRATIONAL THERAPIES WILL VARY Treatments will vary at each visit as more layers are revealed – going deeper into the cellular matrix to uncover other causative factors may require a variety of tools. It is beneficial to have an understanding of the various modalities that exist, especially vibrational therapies such as homeopathy, Bach Flower remedies, etc. For example, many of my patients ask for blueberries – in researching why, I discovered they are high in the mineral silicone, which is a key component of insulin.

Continued on page 38.

CASE STUDY

“Luke” Segerberg was an 11-year-old N/M Lab who presented with a onemonth history of ADR and weight loss, violent sneezing, wheezing and coughing. Exam findings revealed a very anxious dog with a severe arrhythmia – I was concerned about him going into cardiac arrest, yet he was bouncing around the room with no apparent distress. Lab findings were within normal limits other than low thyroid (T4 – 0.3, fT4 – <2), and eosinophilia 2744. Radiographs revealed microcardia with no pulmonary edema or interstitial changes. EKG results – sinus rhythm with frequent salvos of VPCs. UA – USG >1.040, sediment – NSF, pH 8.0. Due to the severity of his arrhythmia, Luke was started on Sotalol, a competitive beta-adrenergic blocker that lowers the heart rate and blocks the effects of adrenaline (Wikipedia). The priority was to normalize his homeostatic mechanism in order for the therapies to benefit his healing ability. As Luke’s case progressed, and based on what tested at each visit using the AGR system, he was treated with a varying combination of herbs, homeopathic medicines, osteopathy, acupuncture, chiropractic and massage. He was placed on a home-cooked diet of 50% meats, 30% veggies, and grain-free kibble. He continued to come for follow-ups at ever-increasing intervals, with treatment modifications as needed. Over the course of the next four months, he continued to improve and was successfully weaned off the Sotalol. At his one-year check-up, Luke’s arrhythmia was resolved, he was on no medications, and he continued to go for two to three-mile walks in the woods. He continued to do well for another two-and-a-half years, passing of old age at 15 years. Using the principles of Energy Medicine and good conventional support, and by clearing Luke’s bioenergetic field, his vitality and longevity confirmed for me the effectiveness of Energy Medicine. IVC Winter 2015

Continued from page 37. As you focus more on Energy Medicine, you will find that some patients will head towards wellness, others need palliative care, and still others require conventional diagnostics and medication. Using the skills of both sides of the medical realm enables practitioners to practice to their fullest potential. Using this system, and staying open to the intuitive thoughts that come up, can lead you to a place of greater knowledge and sense of purpose. Utilize both the tools you know as well as other resources for information to support your sense of what each patient needs. As you set your energetic field to “hear” where the imbalance is and what the most effective tool to release it will be, you will notice that your patients get better with less effort. The success of any tool we use as integrated practitioners, be it acupuncture needles or a cold laser, is related to the frequencies at which they resonate, the timing of their application in the unraveling of restrictive patterns, and their ability to correct disease-causing imbalances in cellular signaling mechanisms. The end result is to lead the body towards the best state of homeostasis it can achieve. Many disease states can be reversed by simply restoring balance to the optimal frequencies so that the correct information can flow. Energy Medicine, coupled with the tools and benefits of Western medical thinking, has been extremely rewarding in my experience. At last, the use of intuition or gut feeling can be said to be based in science. The concept of Energy Medicine is supported by the theories of Albert Einstein and the evidence provided by Quantum Physics principles.

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

he AHVMA welcomed Dr. Charles “Chuck” Emely as the new Executive Director, effective October 1, 2015.

Dr. Emely was formerly President and C.O.O. of Comprehensive Business Consultants, Inc., an international consulting firm serving association, government and business clients. Dr. Emely is an experienced association executive, and has served as chief executive of several not-for-profit organizations. He holds advanced

degrees in corporate communications and management.

ANNUAL CONFERENCE AND RETREAT The AHVMA 2015 Conference ended on October 20, 2015 with plaudits from many attendees. Over 360 members and others attended the many lectures and wet labs enhancing clinical knowledge, nurturing the clinician and providing opportunities for personal and professional growth. Over 90 exhibitors also helped educate attendees at the Augusta, Georgia Marriott. Twelve of the Association’s supporters and exhibitors presented special Breakfast learning opportunities and almost 200 attended the Newcomer’s Social on Saturday. At the Annual Meeting President Dr. Mona Boudreaux passed the baton to President-Elect Dr. Larry Bernstein. Dr. Tricia Stimac moved up to President-Elect and Dr. Debbie Decker

Maria Angeles Bonmati-Carrion, Raquel Arguelles-Prieto, Maria Jose Martinez-Madrid, Russel Reiter, Ruediger Hardeland, Maria Angeles Rol, Juan Antonio Madrid. “Protecting the Melatonin Rhythm through Circadian Healthy Light Exposure”. Int J Mol Sci. 2014 December; 15(12): 23448–23500. Published online 2014 December 17. Seyed Mohammad Mahdavi, Hedayat Sahraei, Parichehreh Yaghmaei, Hassan Tavakoli Biomol Ther. “Effects of Electromagnetic Radiation Exposure on Stress-Related Behaviors and Stress Hormones in Male Wistar Rats”. (Seoul) 2014 November; 22(6): 570–576. Published online 2014 November 30. Walther DS. Applied Kinesiology. 2. Pueblo: Systems DC, USA; 2000. Park DY, Lee HR, Rho MS, Lee SS. “Effective isolation of primo vessels in lymph using sound- and ultrasonic-wave stimulation.” J Acupunct Meridian Stud. 2014 Dec;7(6):298-305. Bell IR, Koithan M. “A model for homeopathic remedy effects: low dose nanoparticles, allostatic crossadaptation, and time-dependent sensitization in a complex adaptive system”. BMC Complement Altern Med. 2012 Oct 22. Clemmons, R. IVAS Course Notes, 2012. Clumeck C, Suarez Garcia S, Bourguignon M, Wens V, Op de Beeck M, Marty B, Deconinck N, Soncarrieu MV, Goldman S, Jousmäki V, Van Bogaert P, De Tiège X. “Preserved coupling between the reader’s voice and the listener’s cortical activity in autism spectrum disorders”. PLoS One. 2014 Mar 24. Laura D. Kubzansky, Gail K. Adler. “Neurosci Biobehav Rev”. Author manuscript available in PMC 2011 May 23. Published in final edited form as “Neurosci Biobehav Rev”. 2010 January; 34(1): 80–86. Published online 2009 July 22.

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became Vice President. Dr. Neal Stivula and Thesea SaLee joined the Board as new members. Visit our website for more information on our officers. Supporting students is a major priority of AHVMA throughout the year. The silent auction conducted by the AHVMA Foundation raised over $12,000 for student programs.

AHVM FOUNDATION The Annual AHVMF Fundraiser will begin in early December as the Foundation continues to fund cutting-edge integrative research and provide grants for students of holistic medicine. For more information go to AHVMF.org. Save the date for the 2016 Annual Conference – September 1013 at the Hyatt Regency Hotel in downtown Columbus, Ohio!

industry innovations Scratching and stress

Ease the effects of aging

It can be a vicious circle – itchy skin can cause stress in dogs, which may lead to excessive scratching, more itching and irritation, and so on. Breeder’s Formula® is a concentrated nutritional supplement formulated by veterinary nutritionists that promotes healthy skin, calms nervous behavior, and also supports joint mobility in dogs.

Older dogs and cats often become host to health issues associated with aging. Cholodin® and Cholodin®-Fel are natural supplements for geriatric canine and feline patients. Both contain choline, amino acids, vitamins and trace minerals.

The supplement contains nutrients that strengthen connective tissue proteins, especially collagen. This results in stronger and healthier skin that is more resistant to dermatitis. It also contains tryptophan and magnesium, which produce a calming effect on dogs without sedation.

Cholodin® and Cholodin®FLEX have been shown to improve problems with hearing, memory, decreased appetite, hair coat, arthritis, and other issues related to aging. Cholodin®FLEX and CholoGel™ Oral are the newest additions to the line and contain hyaluranic acid (HA) for joint health. mvplabs.com 800-856-4648

LifeDataLabs.com

Study on skin and coat health If you have canine patients with skin issues, a grain-free diet might help, according to a new study published by The Honest Kitchen in conjunction with veterinarian Diana D. Drumm, DVM, CVA, CVCP. The study showed that when a grain-free dehydrated fish-based diet (Zeal from The Honest Kitchen) was fed to dogs identified by their owners as ≤5 out of 10 on a Pruritus Scale, the condition of the animals’ coats and skin improved and itching was abated. Eight of the 11 dogs (73%) experienced improved skin issues, with three (27%) out of those eight having their symptoms resolve completely. Several additional and unexpected positive physiological and behavioral findings were seen in nine (81%) of the dogs. For more details on the study, visit thehonestkitchen. com/media/wysiwyg/ cms/healthy-pet/VetSkin-Write-Up-1.pdf.

Adding acupuncture to your practice? If so, get certified by the International Veterinary Acupuncture Society (IVAS), which has been setting the global standard in veterinary acupuncture for over 40 years. “Offering acupuncture and TCVM options…can benefit your business,” says Dr. Nell Ostermeier, veterinarian and IVAS-certified veterinary acupuncturist. “Acupuncture and herbs can be incorporated into Western medicine protocols for common conditions, such as low back pain and rear limb lameness. By adding in a few local acupuncture points and perhaps an herbal formula, you can increase patient comfort and improve mobility, creating a lasting impact on your client. Your practice benefits because you are contributing to the human/animal bond and the quality of life of your patients.” Visit ivas.org to learn more or sign up for the Certification Course in Veterinary Acupuncture ivas.org

TheHonestKitchen.com

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POSTURAL EVALUATION: TECHNIQUES AND SIGNIFICANCE by Karen Gellman, DVM, PhD, Judith M. Shoemaker, DVM, and Elizabeth Reese, AmSat, MEd-LMHC

o you have an equine patient that responds well to your treatments for musculoskeletal pain – but keeps presenting with the same signs? Some conditions like joint fusions can only by managed, not resolved. But there might be an overlooked factor re-creating the same pattern of pain and dysfunction. That factor could be the horse’s habitual posture. Posture is the “elephant in the room”! Horses often stand for 20 to 23 hours each day, only lying down briefly for REM sleep. Yet the significance of posture is largely ignored in our veterinary training, our evaluation of lameness, and in veterinary literature.

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NNP AND DEVIATIONS In 2014, Maximum Horsepower Research conducted a study, funded by the American Holistic Veterinary Medical Foundation, which sought to characterize normal neutral posture (NNP) and abnormal compensatory posture (ACP) in horses.1 It was found that three factors are predictably responsible for deviations from NNP in most domestic horses: 1. Integration of the head-neck-back neuromuscular function2, 3 2. Distorted hoof balance4, 5 3. Dental malocclusions6, 7 Correcting the distorted structures through farriery and dentistry, and addressing the functional changes (with manual

therapies, acupuncture, extended turnout and/or appropriate exercise) can be highly effective in restoring NNP, and can allow horses to heal these chronic pain syndromes instead of our having to treat recurring signs.

• Overly developed gluteal muscles, “bubble butt”

Normal neutral posture is metabolically less costly to maintain, an important factor for large animals. NNP is observed as the default posture in most wild/feral horses that self-manage their feet and teeth by grazing over large ranges. NNP is primarily characterized by limbs positioned with Metacarpal 3/Metatarsal 3 (cannon) bones perpendicular to level ground, or to the center of the earth on a slope.

• Often “lame” leg is heavily loaded at rest

A normal compensatory posture (NCP) is one in which a horse maintains good mechanical balance, using minimal energy with maximal stability, while accommodating an injury or resting a limb. If a horse stands frequently with more than one leg camped in from the vertical, it can be a sign of abnormal compensatory posture (ACP).

SIGNS ASSOCIATED WITH DIFFERENT POSTURES Normal neutral posture (NNP) • Cannon bones vertical to ground • Lowest point of back located just behind withers

• Tight hamstring muscles (semi-membranosus/tendonosus) • Front frogs less wide than hind, asymmetrical feet of a pair, front or hind

CHARACTERISTICS OF ABNORMAL COMPENSATORY POSTURE It has been observed clinically that many horses with chronic ACP tend to fidget, shifting their position often, especially on hard ground surfaces. Stalled horses with ACP will often mound their bedding to create a standing surface that feels more comfortable and consistent with their altered neurologic information and organization. Our research suggests that horses with ACP recruit muscles normally used for locomotion to support themselves during quiet stance. The muscles most commonly affected are the cranial thoracic limb muscles, the caudal thigh muscles and the longissimus muscles, which become overused, sore and eventually even fibrotic. These muscles contain predominantly fast twitch fibers for powering locomotion, and are not well suited for constant use for stance.

• Frog width of front feet at widest point equal to or greater than that of hind feet

This pattern is similar to horses suffering from Equine Motor Neuron Disease, a condition that selectively attacks Type 1 (slow oxidative) fibers in postural muscles, and results in an identical habitual posture, and similar “restless” behaviors, because their postural muscles can’t be used to stand still.8 However, unlike EMND patients, who have a primary muscle physiology dysfunction, horses with ACP caused by structural/ functional distortion of the postural control system can regain normal posture rapidly by normalizing structural input and “reprogramming” their functional postural control systems.

Normal compensatory posture (NCP) • Associated with injury, allows healing

TECHNIQUE FOR EVALUATING POSTURE – PHOTOGRAPHY

• Straight spinal contour (at rib heads) from just behind withers to lumbosacral junction • Relaxed cervical postures with minimal muscular definition • Longissimus muscles soft and evenly developed, with no pain or spasm • Symmetrical feet of a pair, front and hind

• Three out of four legs close to or at vertical • Limbs arranged to make stable tripod • Often same (injured) leg off-loaded Abnormal compensatory posture (ACP) • Usually ≤ one vertical leg • Sum of limb angles >12° (positive measured angle towards center of horse) • Muscle soreness on back and haunches, most frequently at thoracolumbar and lumbosacral junctions

Whether in the field or the veterinary clinic, it is most useful to measure habitual posture, or how the horse tends to stand on his own, while resting or feeding. Photography can be very useful for this, as it allows assessment of posture from across a field, or in a stall, when our presence or handling has not affected the horse. Many factors affect posture, including neuromuscular integrity, proprioceptive input from hooves, dentition and unfamiliar ground surfaces, as well as non-mechanical influences including emotions, external stressors, handling and changing environments. The best procedure is to take IVC Winter 2015

multiple “snapshots” of the patient’s posture. A pattern of the most common postures should emerge for that horse, and that can be correlated to information gleaned from the hooves. When using this method, two common confounding factors are non-level ground and distortions created by the angle of lens trajectory. Bringing the horse into a barn or clinic for assessment will usually solve the problem of level ground, but often changes the horse’s relationship with his environment. To mitigate these factors, it can be helpful to allow the horse to equilibrate to the environment for 20 minutes or more. Some horses will require the presence of a companion horse before settling to their habitual posture. In a flat-floored stall, they can demonstrate feeding postures if hay is on the floor, and possibly even sleep/resting postures if they are comfortable. Each of these postures can be evaluated and documented as they are significant in the forensics of structural/functional balance distortions, altered gaiting patterns and lameness.

Photographs should be taken with the camera accurately parallel to the spinal axis of the animal, perpendicular to the center of the animal and/or each pair of legs being examined and preferably close to the horizontal plane of the legs and feet to avoid distortion. Vertical and horizontal references in the picture such as plumb structures, posts or trees and truly flat, level standing surfaces are important as shown in Figure 1. Measuring the angle each cannon bone makes with the ground can be done with a simple protractor, a digital program like ImageJ, or the smart phone app “Angle Meter”.

If the animal is held, the handler should be neutral, and have no expectations about how the horse should stand, as most animals will sense this and fidget or “pose”. The handler should not restrain the position of the horse’s head in any way. The horse should be held with a “light” hand until he settles to stillness and the default posture is noted, videoed or photographed. He then can be walked at an easy pace on level ground, and as the handler stops, the horse is allowed to come to a full stop on his own, and to wait till he is calm. This sequence should be repeated three to five times until the evaluator feels comfortable that the posture exhibited is consistent. At each “full stop”, a lateral photograph can be taken.

Figure 1 - Proper positioning shows horse on level ground with vertical and horizontal references.

Figure 2 - Overlay of measurements on a horse with ACP ground with vertical and horizontal references. The Angle Meter smartphone app can be used on live animals or on photos displayed on a screen. The program has a level, as well as an angle measure, to avoid picture distortion.

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From lateral photographs, or using a protractor application while taking photos or video, measure the center of each cannon bone’s angle with respect to level ground from directly lateral to a pair of limbs or to the whole horse from a sufficient distance to minimize distortion. By convention, a positive angle is considered caudal from the vertical on the forelimbs and rostral from the vertical on the hind limbs. The sum of all four angles of the legs is totaled, giving a postural score. A score of more than 12° is suspect for abnormal compensatory posture (ACP). Any leg not fully weight bearing is not added to the total.

MEASURING LIMB ANGLE Using the smart phone app, “Angle Meter”, one can measure the cannon bone angle in real time or on a screen photograph. The program has a level, as well as an angle measure, to avoid picture distortion. Tilt the phone to line up the angle measure with the leg. In Figure 2, 89.55° is the angle the phone is making with the ground, and 11.93° is the tilt around the axis. The forelimb angle measured 8.32° and hind limbs measured 5.63°. The total of all four limb angles equals 27.9°.

Figure 3 - With ACP.

In Figures 3 and 4, measurements were made using an open source image processing program, “ImageJ” (available on-line from the NIH at imagej.nih.gov/ij/). Developing skill with these measuring tools – “Angle Meter”, “ImageJ” or protractor – can be challenging; but in general, these measurements usually turn out to be sensitive enough for their margin of error, because most horses with clinically significant ACP have a total limb angle score in excess of 20. In a postural analysis that is close to the minimum deviation, other factors can usually help confirm or disprove ACP, such as hoof measurements or dentition asymmetries.

SIGNIFICANCE OF IDENTIFYING ACP The forensics of sports injury begin with posture. A neutral posture (NNP) symmetrically strengthens the musculoskeletal system in the configuration that experiences the greatest loading at high speed movements, which is when the cannon bones are vertical to the ground surface. When a horse has chronic ACP, the loaded legs, often for 20 hours a day, are at angles and asymmetrical, which does not remodel the

Figure 4 - After correction showing NNP.

Measurements of a horse with ACP (Figure 3) and NNP after correction (Figure 4). Figure 3: Abnormal Compensatory Posture (Armani) Limb angle measurements using ImageJ o

LF: 15.8 o RF: 13.3 o LH: 10.6 o RH: 7.6 o Total= 47.5

Figure 4: Normal Neutral Posture (Armani) Limb angle measurements using ImageJ o

LF: -1.2 (angle is in front of the vertical) o RF: 2.2 o LH: -2.8 (angle is behind the vertical) o RH: -3.8 (angle is behind the vertical) o Total= -5.6 IVC Winter 2015

bones appropriately for movement stresses. Here are the most common stance patterns seen: 1. Normal neutral posture: Four limbs squarely placed, cannon bones vertical, frog width equal side to side, forelimb frog width at widest point at heel up to 10% larger than hindlimb frog width. 2. Lateral bend pattern: Limbs not symmetrically placed, legs consistently closer together on one side, frog widths uneven side to side, though not always so; front to hind frog width ratio can vary: F>H, F=H, H>F. 3. Pace pattern: Limbs not symmetrically or squarely placed, often with legs on same side in advance of legs on opposite side, frog widths uneven side to side, larger frogs fore and hind on same side. Front to hind frog width ratio can vary: F>H, F=H, H>F. 4. Diagonal pair pattern: Frog widths uneven side to side, larger frogs on a diagonal pair of legs (LF/RH or RF/LH), front to hind frog width ratio can vary: F>H, F=H, H>F. 5. “Goat-on-a-rock”: Legs “camped in”, front limbs placed behind vertical, hinds in front of vertical, hind frog width 5% to 20% larger than fore. These correspond generally to gaiting patterns produced by central pattern generators in the spine which can be elicited by balance changes or abnormal supraspinal input.9, 10

CONCLUSION Awareness and evaluation of our patients’ habitual postures, along with accurate quantification and understanding of the significance of posture, can lead to much more accurate diagnosis and treatment of lameness and other mechanical, physiologic and emotional issues. Postural evaluation can give us an objective tool for evaluating the effectiveness of our interventions over time and for educating ourselves and our clients. Gellman, K. “Normal and abnormal equine posture”. IVC Journal, Winter 2014/2015, 44. Massion J, Alexandrov A, Frolov A. “Why and how are posture and movement coordinated”. Prog Brain Res. (2004) 143:13-27. 3 Richmond FJR, Thomson DB, Loeb GE. “Electromyographic studies of neck muscles in the intact cat: I. Patterns of recruitment underlying posture and movement during natural behaviors”. Exp Brain Res. (1992) 88:41-58. 4 Kavounoudias A, Roll R, Roll JP. “The plantar sole is a ‘dynamometric map’for human balance control”. Neuroreport (1998) 9(14):3247-52. 5 Bowker RM. “The growth and adaptive capabilities o the hoof wall and sole: Functional changes in response to stress”. Proc AAEP (2003) 49:146-168. 6 Buisseret-Delmas C, Compoint C, Delfini C, Buisseret P. “Organization of reciprocal connections between trigeminal and vestibular nuclei in the rat”. J Comp. Neurol. (1999) 401:153-168. 7 Milani RS, DePeriere DD, Lapeyre L, Pourreyron L. “Relationship between Dental Occlusion and Posture”.Cranio (2000) 18(2): 127-34. 8 Palencia P, Quiroz-Rothe E, Rivero JL. “New insights into the skeletal muscle phenotype of equine motor neuron disease: a quantitative approach”. Acta Neuropathol (2005) 109: 272–284. 9 MacKay-Lyons M. “Central Pattern Generation of Locomotion: A Review of the Evidence”. Physical Therapy January 2002, 82(1) 69-83. 10 Duysens J, Van de Crommert HA. “Neural control of locomotion; Part 1: The central pattern generator from cats to humans”. Gait and Posture(1998) 7:131-41. 1 2

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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.

From the

WAEO What a wild few months it has been! In September, we hosted our second annual conference in Waldfeucht-Obspringen, Germany. With over 50 attendees, we enjoyed great demonstrations, lectures and meals. Here are some of the details from this year’s conference: • Janek Vluggen, EDO, MRO spoke about the history of osteopathy, explaining the philosophy of Dr. Andrew Taylor Still when he built the first college for osteopathy in Missouri. He also discussed the principles of osteopathy: how structure and function are so intimately connected, how the body wants to self-regulate and heal, and how dynamic living organisms really are.

• Andre Teunissen, DO-MRO discussed the osteopath’s role in treating cancer, what natural medicines are out there, and how mobility can help prevent cancer. He explained programmed cell death and how oxygen and nutrients in the body can change the body’s ability to control cancer. He also discussed Salvestrol and its effect on MRNA and apoptosis.

• Dr. Steffi van der Laarse spoke about using Chinese medicine to treat pain in horses. She discussed Yin and Yang, pulse diagnosis, Bi syndrome and how important looking at patterns associated with pain is in Chinese medicine. She also reviewed the gate control theory of pain, the autonomic nervous system, and fascia.

• Dr. Diana Stucke, DVM gave an excellent presentation on pain assessment in horses, along with a great tool to measure pain, assess treatment effects, or the effects of disease. This pain scale is easy to use even without osteopathic training. Download the app for free on your Smartphone: Horse Grimace Scale at animalwelfarehub.com.

• Dr. Jeannie Waldron, DVM, EDO, ABVP talked about the worldwide prevalence of Lyme disease, its different forms, how it becomes cystic and how the different proteins on the surface change over time. She spoke about how symptoms seen with disease have changed, from swollen joints to hypersensitivity, weight loss and behavior issues, and reviewed testing, treatment and vaccines for the disease.

• Andre Teunissen and Janek Vluggen did a mind-blowing demonstration in which we looked at a crooked horse and rider, then worked on both to see how they influence each other. It was amazing to watch the horse and rider go from leaning to one side and being unable to turn easily, to moving freely – and then to watch how a crooked saddle almost instantly made everything stiff again. Quite a learning experience!

• Dr. Ann-Marie Hancock, DVM, EDO reviewed the anatomy of the jaw, hyoid and poll in detail, and discussed how training influences movement and mobility at the jaw. She also gave a brief history of changes in training methods over the centuries.

At our annual meeting, we talked about starting a European chapter so that local decisions can be managed more easily, and voted to renew all memberships annually in June.

Next year’s conference will be held in Calgary, Alberta on July 5 and 6, so join the WAEO, come for the conference, and stay for the Calgary Stampede! Check out our website at equineosteo.org for details. IVC Winter 2015

By Kerry Ridgway, DVM

FASCIA and WHY it’s so IMPORTANT

A 46

spider web provides an interesting analogy when it comes to understanding fascia. If you touch one part of a spider web, the whole net moves, providing instantaneous information for the spider to act on or react to. This analogy

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serves as a tensegrity model. “Tensegrity is a design principle that applies when a discontinuous set of compression elements is opposed and balanced by a continuous tensile force, thereby creating an internal pre-stress that stabilizes the entire structure.”1

A TENSIONING NETWORK Fascia in all mammals works similarly to the spider web. It provides a tensioning network that allows functional movement. You could say that it functions as a system of “guy wires”, enabling us to move about in the gravitational field. Without it, we would be like a building that starts to tilt. The building would eventually fall. However, because of our ability to utilize this guy wire system, we can make incredibly difficult and fine-tuned functional movements that enable dexterity and athleticism. This is true in the case of a human who becomes a great violinist, gymnast, athlete or simply accomplishes the task of being able to walk in a functional way. It is what allows a horse to become an Olympic level competitor. Fascia is, in fact, what creates any given posture – good or bad – in humans and animals. Fascia, like our spider web analogy, is a whole body communication system which, if stimulated, transmits a signal to every part of the body. We are all familiar with fascia as that shiny layer covering a muscle, but it is so much more. This connective tissue substance covers even the tiniest muscle fibers, called fascicles, and forms ligaments, periosteum and joint capsules. Every organ in the body, including the brain, is encapsulated in this unique connective tissue. It actually provides and determines the shape and volume of each organ.

“Fascia is becoming the Cinderella of orthopedic science.” – Robert Schleip (one of the driving forces behind the International Fascia conferences promoting the scientific study of fascia)

THE ULTIMATE CONNECTIVE TISSUE In basic biology, we learned the term “connective tissue” to describe certain cell types. However, when applied to fascia, the term “connective” takes on a whole new meaning. It is the connective tissue that links together every tissue in the body to every other tissue or organ in the body. For example, it connects the skin to the muscles, the muscles to the tendons, the tendons to the periosteum and the periosteum to the bone. It also connects all the organs one to another. For centuries, anatomists and surgeons have cut up the body to isolate and define organs, ligaments, muscles and bones – but the body is really parts and organs linked by fascial connective tissue. There is no separation of parts when we view the body IVC Winter 2015

on a microscopic level. In a living human or animal being, everything is linked together by fascial connective tissue. “Fascia is your body’s soft tissue scaffolding,” says Jill Miller,2 a yoga and fitness therapy expert. “It provides the matrix that your muscle cells can grow upon and it also envelopes, penetrates and surrounds all your joints.”

FASCIA’S INFLUENCE ON POSTURE AND MOVEMENT Described for centuries as a passive structure, fascia is now known to actively contract in a smooth muscle-like manner, and consequently influence musculoskeletal dynamics. The influence fascia plays on posture and movement is now being extensively researched, at least in the human field. Thomas Myers,3 an American myofascial specialist, has shown that this connective tissue presents itself as a whole body system, and not 600 separate muscles. He describes the body as only having “one muscle, hanging out in 600 or more fascial pockets”. Forces induced by injury can immediately cause imbalances in the fascial system, or in the case of repetitive micro-trauma sustained over a period of time, cause imbalances in the fascial system. The involved fascia may then shorten, thicken, become dehydrated, and consequently affect muscle function and joint mobility. This in turn is displayed as pain, discomfort, stiffness or decreased mobility and altered movement. Under these circumstances, fascia not only loses its ability to communicate via bio-tensegrity, but it also loses its ability to lubricate, insulate, envelope and functionally support all the body systems. It becomes excessively contracted or stretched and cannot respond rapidly to required functional changes in posture or movement.

Thoracolumbar fascia

A localized area of pain or a scar might create adhesions in the fascial planes, which will become significantly detrimental if not treated and released. Treatment through movement, bodywork, and other therapies like acupuncture, chiropractic, osteopathy, etc., will ensure the fascia retains its essential and inherent qualities. Leon Chaitow,4 a leader in fascial research, is a practicing naturopath, osteopath and acupuncturist in the UK. He describes fascia as “the new frontier in bodywork”. Fascia is the organ of posture, whether we are referring to static or dynamic posture. It will adjust to good or bad posture. When inappropriate chronic posture is present, it will “lock” the body into that posture and cause it to function in a reduced capacity. Our observations are the same in the horses that we see and treat daily.5 “Dysfunctional movement patterns may be at the root of your pain,” writes Kelly Starrett,6 a doctor of physical therapy, in his book Becoming A Supple Leopard. He emphasizes that a lot of common musculoskeletal problems and fascial restrictions that clinicians encounter result from poor or improper movement. The first thing he addresses is correction of the individual’s dysfunctional movement patterns and biomechanical inadequacies. He does this via correct movement therapy, which results in the restoration of full range of motion. Once the joints are properly aligned, the muscles and soft tissues can perform better, and will typically resolve the initial dysfunction. This, Starrett states, will put the patient in a position and posture where he can safely exercise at higher levels of intensity. We are finding the same manifestations in in the horses we see.

Gluteal fascia Femoral fascia

Cervical fascia Omobrachial fascia Antebrachial fascia

Fascia latae Abdominal fascia Crural fascia

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Everything in the body is linked by fascia since it is a whole body system.

EQUINE APPLICATIONS In the horse world, some of the best classical dressage trainers we know, like Manolo Mendez, Charles De Kunffy, Klaus Schöenich,7 Colonel Christian Carde and Dr. Gerd Heushmann, all pay special attention to balance and straightness and the role that fascia plays in the biomechanics of the ridden horse. Every day in our practice, we see the fascial constrictions, gait aberrations and dysfunctional movement patterns. These are present in both backyard horses and top athletes. We have learned, far too often, that these fascial or soft tissue dysfunctions lead to pain and lameness. Once we understand that the fascia of the horse and/or rider is going to adjust to existing posture or body imbalances, we need to realize that the balance of the natural horse is far from adequate for the ridden horse.5,6 Unless the inherent crookedness we now know as a manifestation of “laterality” (the state of left or right limb dominance), is addressed, the rider will forever encounter resistance and be forever compensating for it. It is imperative to change the biomechanics of the horse when starting a young horse or when remedially “straightening” an older horse. In addition, riders absolutely must address their own faulty body posture and biomechanical inadequacies if these are not to be carried into their equitation. No wonder riding is such an art! Even though the muscles and bones are definitely relevant components, we need to look deeper into the bodies of our horses and address their posture, gait aberrations, living arrangements and training, if we truly want to keep them sound and pain-free. The key message from this article is: restoring the natural intrinsic qualities of fascia (your horse’s and your own) is the key to pain management, and to unlocking your and your horse’s performance potential!

Ingber D, Landau M. “Tensegrity”. Scholarpedia, 2012, 7(2):8344.

Miller J. The Roll Model – A Step-by-Step Guide to Erase Pain, Improve Mobility and Live Better in your Body. Victory Belt Publishing, Inc., 2014. 2

3 Myers TW. Anatomy trains – myofascial meridians for manual and movement therapists –1st edition. New York. (Elsevier) Churchill Livingstone, 2012. 4 Chaitow L, Schleip R, Findley TW, Huijing PA. Fascia: the tensional network of the human body – 78 authors, 1st edition. New York. (Elsevier) Churchill Livingstone, 2012. 5 Ridgway, KJ. “Fascia: Its Role in the Crooked Horse Syndrome and in Straightness Training”. The Bowker Lectures 2015, Proceedings Feb. 2015, Australian College of Equine Podiatry, Merrijig, Vic, Australia; “The Secret Life of Acupuncture.” Proceedings IVAS Congress, 2014, Florence, Italy; “Understanding Laterality/ Limb Dominance in the Equine Laterality’s Relationship to Musculo-Skeletal Problems”. Proceedings IVAS Congress, 2011.

Starret K, Cordoza, G. Becoming A Supple Leopard – 2nd edition. Victory Belt Publishing, 2015.

Schoeich K, Schoeneich G. Correct Movement in Horses - Improving Straightness and Balance. Trafalgar Press, 2007. 7

A HORSE’S WHISKERS ARE

MORE THAN JUST HAIR

By Jochen Schleese, CMS, CSFT, CSE

t isn’t a good idea to have a horse’s whiskers shaved off for “cosmetic appearances”. Whiskers are a lot more than just hair. Also called vibrissae, they are typically larger than normal hairs, have a large and well-innervated hair follicle, and an identifiable representation in the somatosensory cortex of the brain. In short, whiskers are used for tactile sensing (other types of hair have more crude tactile sensors). Horses use their lips and whiskers to explore and identify things. A horse’s brain contains cells that receive information from these whiskers. Each time his whiskers touch something, the nerves fire off an electrical impulse to the brain to help determine what it is that’s being touched. Horses breathe through their noses. When a horse curls his top lip up to help him smell something, he’s engaging in what is called the “flehmen response”. The nose traps pheromonal scents in the vomeronasal organs so they can be analysed more closely. A horse’s upper lips are prehensile – which means they can be used for grasping, touching or feeling something. Horses cannot see what’s right below their noses because of the positioning of their eyes, and that means they use their whiskers to help them differentiate between edible and hazardous objects. If you remove a horse’s whiskers it is almost as if you were cutting off your fingertips. You would lose all sense of touch. Encourage your clients to reconsider shaving off these sensory organs on their horses, and do what’s right for the animals.

Jochen Schleese is a Certified Master Saddler who graduated from Passier and came to Canada as Official Saddler at the 1986 World Dressage Championships. He registered the trade of saddlery in North America in 1990. Jochen’s study of equine development, saddle design, the bio-mechanics of horse and rider in motion, and the effects of ill-fitting saddles, led to Saddlefit 4 Life in 2005 (saddlefit4life.com), a global network of equine professionals dedicated to protecting horse and rider from long term damage. IVC Winter 2015

Advertorial by Jeff Nichol, DVM

URINARY HEALTH IN DOGS AND CATS

How the practitioner can uncover problems and set them right Preventive care is an important priority to pet owners. And while many are pretty good about reporting symptoms, few are medically trained. Their misperceptions, while understandable, can get our patients into trouble. It’s our job to get it right, so wellness exams need to be thorough.

So as practitioners, we need to ask about urine soiling. Careful case histories, thorough palpation, serum chemistries, CBC, and urinalysis are diagnostic recommendations that today’s savvier clients are willing to accept. Even radiographs and ultrasounds are no longer foreign to the general public.

Beyond the dental calculus, skin lesions, smoldering • Nearly every female dog who graces our exam rooms has been spayed. As many as 20% of them otitis, and suspicious lumps, there are many leak urine in their sleep from urethral sphincter pathologies we can miss if we don’t ask the right incompetence. It’s more common in large breeds questions. We’ve all been in a hurry and simply and those who struggle with obesity. Ectopic ureters asked: “How’s she doing at home? Active? Eating are often comorbid with nighttime incontinence. well? Normal stools?” That actually covers a lot – Twice daily chewable Proin®, an alpha adrenergic however, urinary disease can be left out for some agonist, can make a very big lifelong difference. important, and often personal, reasons. Urine soiling, in particular, is an uncomfortable and • Published research in both dogs and cats has shown a marked increase in urolithiasis, especially embarrassing topic for some people. Many assume calcium oxalate stones. With surgery often the it’s a behavioral problem and believe they’ve failed only treatment option, preventing recurrence to properly train their pets. No one wants to admit becomes a high priority to clients. Liver-flavored that. Urinary symptoms are also a major destroyer CitraVet® tablets contain potassium citrate to of the human/pet bond; 18.5% of dogs in shelters increase citrate levels in the bladder. Calcium then were surrendered due to house soiling. Punishment binds to the citrate instead of the oxalate. Other can’t solve lower urinary tract infections, cystic less common stones, such as urate and cystine, can calculi, or incontinence due to urethral sphincter also be controlled. hypotonus, and it won’t correct behavioral causes either. A confused or painful pet may get relegated to ecurring lower urinary infections are a huge a solitary life in the yard, or relinquished to a shelter. • R frustration. Consider adding Cranmate® to reduce the adherence of E. coli to the bladder wall, Predisposing factors may be involved in urinary thus improving the effectiveness of long-term problems. Dogs are at higher risk of bacterial cystitis antibacterial treatment. if seldom allowed outside to eliminate. Cats who are crowded and lack adequate environmental Today’s veterinary clients expect more. We can enrichments are at risk of stress-related, inflammatory deliver. (nearly always sterile), and obstructive lower urinary disease. Elderly dogs and cats may urine or fecal soil Dr. Jeff Nichol is a graduate of the Michigan State University College of Veterinary Medicine. He practices general and behavioral medicine in Albuquerque, NM. due to cognitive dysfunction syndrome.

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VETERINARY SPINAL MANIPULATION

or Animal Chiropractic and the musculoskeletal system – its influence in quadruped locomotion By Pedro Luis Rivera, DVM, FACFN

ocomotion is crucial and integral for animals surviving in the wild. It is equally as important to our animal companions, who need to perform their jobs (agility, service, work-related, etc.) correctly, accurately and flawlessly, and with minimal chance of injury or re-injury. Veterinary Spinal Manipulation Therapy (VSMT) or Animal Chiropractic (AC), when practiced by a trained doctor (be it a licensed Doctor of Chiropractic or licensed Doctor of Veterinary Medicine who has successfully completed post-graduate training), provides a safe, valid and effective health care modality. It can be used as both a multimodal approach to improve the quality of life of our animal companions and athletes, and as a way to maintain optimal health of the locomotor system. In this article, I will provide a list of definitions followed by a brief history and ways this valid health care modality can be used to improve the locomotor system.

HEAD Right side articular facet Right and left articular facet

HEAD

Disc

4. Vertebral subluxation complex: A basic cascade of physiological changes that can occur or lead to a hypomobile (vertebral or peripheral) motion unit with their individual functional or pathological changes. Please note that the components are inter-related and the main denominator is kinesiopathology (movement changes). VSC Vertebral Subluxation Complex

Kinesiopathology

DEFINITIONS 1. Chiropractic medicine (AC): “Chiropractic is a health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health. Chiropractic care is used most often to treat neuro-musculoskeletal complaints, including but not limited to back pain, neck pain, pain in the joints of the arms or legs, and headaches.” (From the American Chiropractic Association, acatoday.org/level2_css. cfm?T1ID=13&T2ID=61.) 2. Veterinary Spinal Manipulative Therapy: Legal term in many states for “animal chiropractic”. 3. Motion unit: Anatomical description of a three-joint complex (two articular facets and a specialized joint [disc]), including all the intra and peri-articular components (ligaments/ tendons/blood supply/lymphatics/nerves). Although the peripheral motion unit differs slightly in definition, for the sake of simplicity we will use it synonymously.

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Myopathology

Neuropathology

Vascular pathology Connective tissue pathology

I nflammator y response Pathoanatomy

Pathophysiolgy

Pathobiochemistry

Gatterman, Meridel. Foundations of Chiropractic Subluxation, 2nd Ed., Elsevier, 2005, ISBN 0323026486. 5. Hypomobile motion unit: Can refer to either a vertebral motion unit or peripheral motion unit (e.g. sacroiliac joint, radio-carpal joint).

6. I ntervertebral foramen: Osseous anatomical opening created when two vertebrae connect to one another. This osseous foramen is bordered by the cranial and caudal pedicles (their periosteum to be specific); cranial and caudal vertebral bodies (their periosteum); joint capsule (specifically, the most ventro-medial aspect covered by the ligamentum flavum); and disc. The dorsal longitudinal ligament and intercapital ligament can also be included as boundaries.

Inter-vertebral foramen with small accessory process

HEAD

intervertebral disc

Components of the intervertebral foramen (what goes 7. through the foramen): Dorsal root ganglia; dura; CSF; recurrent meningeal nerve; spinal nerve; blood supply (artery and veins); lymphatics; connective tissue (including fat) and trans-foraminal ligaments. influence: Stimulation that affects the motion unit. 8. Local 9. S egmental influence: Any ascending stimulation that affects the spinal cord.

descending

10. S upra-segmental influence: Any information that originates from areas of the cortex, midbrain, pons and medulla and their modulation of the ventral horn cells. The neuronal health of the above mentioned “supra-segmental areas” are also directly dependent on all afferent information that enters the dorsal horn. 11. Adjustment: A high velocity, low amplitude and short lever (preferably) thrust provided into the specific joint plane of the joint being assessed or treated.

HISTORY Manual therapy has been around for centuries, although Chiropractic Medicine, specifically, has been presented as such since the mid to late 1800s, with credit given to Dr. Daniel David Palmer. Palmer started the first “Veterinary Chiropractic” program, which was discontinued due to the negative connotations the term “horse doctor” brought to the newlyformed chiropractic profession.

Fortunately, veterinary chiropractic didn’t end there. Dr. Tom Offen, a licensed chiropractor in the province of Ontario, Canada, and the late Dr. Sharon Willoughby, a licensed veterinarian and chiropractor in the U.S., developed their own techniques for quadrupeds, and these laid the foundation for the “Animal” or “Veterinary Chiropractic” profession. I consider Dr. Willoughby a mentor and those of us who were taught by her will forever be grateful. Chiropractic medicine has undergone massive changes since its basic beginnings, when the simplistic explanation of a “pinched nerve” was viewed as the primary cause of the chiropractic cascade. Please note, though, that at the same time “chiropractic medicine” was started as such, “human medicine” was still treating patients with heavy metal purgatives and utilizing “blood-letting” as a treatment protocol. Research and explanations of chiropractic effects have greatly expanded with the advent of magnetic resonance imaging (among other adjunct diagnostic instruments) and funding by the National Institute of Health (NIH).

FUNCTIONS OF THE LOCOMOTOR SYSTEM The locomotor system can be described as an intimate symbiotic relationship between the skeletal (articular aspect included as well), muscular, connective, vascular and nervous systems. It is like a symphony orchestra. The orchestra is made up of individual musicians with different instruments. Each musician might sound okay by himself, but when the orchestra is brought together, and each plays his part at the right time and in a specific sequence, it provides the audience with a flawless and enjoyable sound called music. The same goes for the entire locomotor system, with the end result culminating in a coordinated and purposeful motion (or “music”). When the above components of the locomotor system are brought together, they provide the patient with: • I nformation necessary to maintain muscle tone and fire each individual muscle or group of muscles in correct sequence. This latter information provides further and crucial joint stability. • Balance* •C orrect distribution of compression or distraction of the connective system. •T he ability of the skeletal and articular system to grow and adapt correctly to both internal and external forces, now and in the future. •A nervous system that can benefit from the afferent/efferent stimulation which facilitates nourishment by the proper stimulation of the autonomic nervous system. •A n end result of cortex stimulation.

Continued on page 54. IVC Winter 2015

Once the above cascade provides motion to the patient or pet, the motion itself will provide constant and necessary feedback to create a controlled, appropriate, purposeful and accurate efferent (motoric) response. This response (efferent motoric) is the ultimate expression that the nervous system can offer in response to a stimulation (be it internal, external, reflexogenic or limbic). VSMT/AC is based on the effects that hypomobility have on the local, segmental and supra-segmental aspects of the nervous system. A trained doctor will identify the specific motion unit and provide a quick controlled thrust into the specific angle of the motion unit. This controlled and specific thrust is called an “adjustment”. The adjustment stimulates primarily golgi tendon organs (via a fast stretch), which send their afferent stimulation via “Ib” nerve fibers into the local spinal cord segment. This influences the divergent effects that the afferent information has on the spinal cord (and ultimately the supra-segmental levels). Some of the well-known effects of an adjustment include modulation of pain, increased range of motion, and improved articular health. This is achieved through influencing the ascending tracts, stimulating the autonomic nervous system, modulating the lower motor neurons, and stimulating the muscle spindle cells (which fire back to the spinal cord via “Ia” and “II” fibers) with their individual afferent influences.

Higher Control Neuron CPG EffectorOrgans

Sensory Feedback

*Although balance is influenced by the vestibular system, visual system, musculoskeletal system (including the temporo-mandibular joint and peripheral feedback), spinothalamic (trigeminal system included) and cerebellum, we will only be briefly addressing “peripheral feedback” for the sake of simplicity.

Central Feedback

Continued on page 53.

Reflex Feedback

Environment and cortical lobes, to name a few suprasegmental regions.

Some of this feedback information will: • Influence the local spinal cord pattern generators. • Send information to the cerebellum. This informartion must do so as fast as possible, which is why the spinocerebellar tracts have a two-neuron connection. • Send information to the primary sensory cortex, thalamus, and brain stem, utilizing the dorsal columns (medial lemniscus)

and

the

spino-thalamic

tracts. These latter two tracts transmit through a three-neuron connection. As mentioned previously, it is important to understand that the ultimate modulation of all the lower motor neurons (hence providing flawless locomotion) occurs through the function of the cortex.

Photo courtesy: en.wikipedia.org/wiki/Muscle_spindle

EFFECTS OF AFFERENT INFORMATION One response not frequently discussed is how the afferent information originating from the joint mechanoreceptors, golgi tendon organs, and muscle spindle cells will influence some of the areas of the central nervous system (CNS) that modulate or control motoric responses. In other words, providing continuous feedback to the “main computer” which delivers the constant information that allows us to determine if we are “on” or “off” course with the motor task at hand. Information that provides constant feedback to the CNS on a moment-tomoment basis enters the spinal cord in order to influence the cerebellum

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VSMT/AC provides a safe and efficient way to allow peripheral afferent feedback to enter the spinal cord and send accurate information to the “computer centers” used for balance. By allowing these computer centers to receive accurate information, the chances for the patient to be injured (during a field trial for example) will be minimal. Accurate information will also provide further stabilization of joints (and surrounding soft tissues) as the patient is moving will and provide adequate sensitivity to the muscles so that motion becomes fluid and purposeful.

For post-graduate training in VSMT/ AC, contact: American Veterinary Chiropractic Association: animalchiropractic.org or animalchiropractic.org/animal_chiropractic_ certification.htm for a list of AVCA approved programs College of Animal Chiropractors: collegeofanimalchiropractors.org or collegeofanimalchiropractors.org/en/approvedprograms/ for a list of CoAC approved programs Healing Oasis Wellness Center: healingoasis.edu or contact@healingoasis.edu; a nationally-accredited institution under the US Dpt. Of Education, provides State Approved Post-Graduate Certification Programs. The VSMT program has been approved by both the associations listed above, the MN Board of Chiropractic Examiners, and Veterans Affairs Office, among others. Adrian CP, et al. “The Role of Muscle Activation in Cruciate Disease”. Vet Sur 2013;42:765-773. Beck R, Functional Neurology for Practitioners of Manual Therapy. Elsevier, 2008; ISBN 9780443102202. Cassidy JD, et al, “The Immediate Effect of Manipulation versus Mobilization on Pain and Range of Motion in the Cervical Spine: A Randomized Controlled Trial”. J Manip Physiol Ther, 1992; 15:570-75 Cassidy JD, et al. “Risk of Vertebrobasilar Stroke and Chiropractic Care – Results of a Population-Based Case-Control and Case-Crossover Study”. Spine, 2008; Volume 33, Number 4S, pp S176–S183. Cramer G. “Anatomy of the Cervical Spine with Respect to Head Pain”. Topics in Clinical Chiropractic , Vol 5 (1);1-10. Cramer G, et al. “Basic Science Research Related to Chiropractic Spinal Adjusting: The State of the Art And Recommendations Revisited”. JMPT, 2006; 29:726-761. Cramer G, Darby S. Clinical Anatomy of the Spine, Spinal Cord and ANS; 3rd Ed., Elsevier, 2014. Gatterman MI., Foundations of Chiropractic – Subluxation, Second Ed., Elsevier/Mosby, 2005 Pickar JG. “Neurophysiological effects of spinal manipulation”. Spine, 2002 Sept-Oct;2(5):357-71. Pickar JG, et al. “Response of lumbar paraspinal muscles spindles is greater to spinal manipulative loading compared with slower loading under length control”. Spine, 2007 Sept-Oct;7(5):583-95 Pickar JG, Wheeler JD, “Response of muscle proprioceptors to spinal manipulative-like loads in the anesthetized cat”. J Manipulative Physiol Ther., 2001 Jan;24(1):2-11. Sidhman JD, Bulbulian R. “Spinal reflex attenuation associated with spinal manipulation”. Spine, 2000 Oct 1;25(19):2519-24. Takakusaki K. “Neurophysiology of Gait: From the Spinal Cord to the Frontal Lobe”. Movement Disorders, 2013; 28(11):1483-1491. Terrett AG. “Misuse of the Literature by Medical Authors in Discussing Spinal Manipulation Therapy Injury”. J Manip Physiol Ther, 1995;18:203-10. Yate RT, et al. “Effects of Chiropractic Treatment on Blood Pressure and Anxiety: A Randomized, Controlled Trial”. J Manip Physiol Ther, 1988;11:484-88.

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ANTI OXIDANTS and CANCER By Nancy Scanlan, DVM

The use of antioxidants in cancer research and treatment has been debated over the years. In humans, there is general agreement that a diet rich in large quantities of plants with high levels of antioxidants is associated with a lower incidence of cancer. Research in the past, especially from Japan and Eastern Europe, involving the use of multiple antioxidants in the treatment of cancer generally, showed improved quality of life and longer survival times. A CLOSER LOOK AT SPECIFIC ANTIOXIDANTS Lycopene and resveratrol are two plant-derived antioxidants that can play a large part in cancer therapy.

LYCOPENE

induces apoptosis. It regulates and normalizes the effect of IGF-1R (which is anti-apoptotic, allowing cancer cells to live indefinitely). With insulin, lycopene also processes glucose; cancer cells process far more glucose than normal cells. Blocking the activity of IGF-1R can help slow down the metabolism of cancer cells.

RESVERATROL inhibits telomerase in cancer

cells, but not in normal cells. Normally, telomeres (at the ends of chromosomes) shorten with each cell division. Eventually, a limit is reached and the cell will die. Telomerase in cancer cells replaces the shortened part of the telomere, and allows cancer cells to avoid this method of cell death. With telomerase inhibited, cancer cell telomeres shorten with each division and cannot avoid this means of cell death.1

Continued on page 58. 56

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Continued from page 56. Resveratrol also blocks anti-apoptotic IGF-1R and, with proanthocyanidin (grape seed extract – another antioxidant) is also anti-angiogenic. This helps decrease the blood supply available to cancer cells.2 Antioxidants have also been connected with increased mortality of GI cancers.3 However, while another review showed they can help with chemotherapy toxicity, in other cases they were found have either no effect, or to interfere with the chemotherapy given for some kinds of cancers, especially in smokers.4 There can also be downsides to using antioxidants in treating cancer. • Negative reviews began with a study of the use of beta carotene for the prevention and treatment of lung cancer. This was a gold standard, double blind, placebo controlled study enrolling large numbers of subjects; but it was stopped early because it became obvious that survival time was shorter in patients using beta carotene, than in those who did not use it.5 Part of the post-mortem procedure analyzed the lungs of deceased patients for beta carotene content. They were found to contain very high levels of the pro-oxidant form of beta carotene. When antioxidants perform their function, they change to their pro-oxidant form. Those forms are not eliminated from the body as waste products. Instead, they are recycled back to their antioxidant form. Cycling back to the antioxidant form requires co-factors, and if those cofactors are not in place, the pro-oxidant forms increase. Pro-oxidants are pro-inflammatory, and inflammation increases the severity of cancer. • More recently, the same problem occurred with a study of the use of vitamin E as the sole antioxidant as a potential aid in treating cancer. High doses of vitamin E were given to prostate cancer patients, without any co-factors, and the prooxidant form of E accumulated, shortening survival times for patients whose treatment included it. However, when vitamin E and selenium were given together, there was no such effect.6 Vitamin C is a primary co-factor in recycling vitamin E back to its antioxidant form. One wonders whether adding vitamin C to vitamin E plus selenium therapy would have shown an increase in survival time. One study that used a combination of vitamins E and C did so by using both of them only every other day, which is not the way generally recommended

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by practitioners who use antioxidant therapy for cancer. As one would expect, this study showed no difference in the incidence of nine types of cancer.7 On the other hand, vitamin E has been shown to enhance the action of gemcitabine, a chemotherapeutic drug.8 When used with glutathione, it can decrease the severity of inflammation in oral mucosa occurring with chemotherapy and radiation.9 So the use of vitamin E in combination with other drugs or supplements has been shown to be beneficial. • In contrast, increased selenium in the diet of elderly beagles resulted in less DNA damage in prostate cells and peripheral lymphocytes,10 and had a favorable effect on six markers associated with decreased cancer risk.11 One wonders whether the benefit comes from the fact that recommended dietary levels of selenium are too low (because of toxicity fears). Users of nutritional supplements for various types of therapy have long advocated using natural sources of antioxidants, which contain a spectrum of each type. For example, using carrot powder as a source of carotenoids gives a full spectrum rather than just beta carotene alone. These practitioners would recommend this as the best use of antioxidants in cancer therapy – i.e. a broad spectrum of natural antioxidants would

carrot powder

be better than one or two single antioxidants. This is an area that needs more research, but from some initial findings such as the vitamin E studies, one expects this to be true.

ANTIOXIDANTS AND CHEMOTHERAPY The other thing to be aware of is the way in which antioxidants interact with chemotherapy and radiation therapy. If antioxidants are given on a daily basis along with chemotherapy, the result can be worse than when using chemotherapy alone.4 One of the ways that chemotherapy works is with the production of high levels of free radicals, which have a

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antioxidant supplement Over the last decade, krill oil has become a popular supplement for human consumption, and is used by roughly one-ﬁfth of all US households. It’s a good source of antioxidants, which help ﬁght oxidation. Disruptions to the normal oxidation process, which takes place primarily during digestion, can release highly unstable and potentially damaging molecules called “free radicals”. Left unaddressed, these molecules can damage the body’s cells.

If antioxidants are pulsed in between chemotherapy doses, they can help normal cells recover faster without decreasing the levels of free radicals produced by chemotherapy.

SUMMARY Antioxidants can be useful in cancer therapy, when used correctly. They are best used in combination rather than singly. When using them with chemotherapy, proper timing is important to get the best results. 1 Shay JW, Bacchetti S. “A survey of telomerase activity in human cancer”. Eur J Cancer, 1997 Apr;33(5):787-91. 2 S.M. Sagar, MD, D. Yance, MH, and R.K. Wong, MD. “Natural health products that inhibit angiogenesis: a potential source for investigational new agents to treat cancer – Part 2”. Curr Oncol., 2006 June; 13(3): 99–107. 3 Bjelakovic G, Nikolova D, Simonetti RG, et al. “Systematic review: primary and secondary prevention of gastrointestinal cancers with antioxidant supplements”. Aliment Pharmacol Ther, 2008; 28:689–703. 4 Lawenda BD, Kelly KM, Ladas EJ, et al. “Should supplemental antioxidant administration be avoided during chemotherapy and radiation therapy?” Journal of the National Cancer Institute, 2008; 100(11):773-783 5 Cortes-Jofre M, Rueda JR, Corsini-Mun˜oz G, et al. “Drugs for preventing lung cancer in healthy people”. Cochrane Database Syst Rev, 2012, (10) CD002141. 6 Klein EA, Thompson IM Jr, Tangen CM, et al. “Vitamin E and the risk of prostate cancer: the Selenium and Vitamin E Cancer Prevention Trial (SELECT)”. Journal of the American Medical Association, 2011; 306(14):1549–1556. 7 Gaziano JM, Glynn RJ, Christen WG, et al. “Vitamins E and C in the prevention of prostate and total cancer in men: the Physicians’ Health Study II randomized controlled trial”. JAMA, 2009;301(1):52-62. 8 Husain K, Francois RA, Yamauchi T, et al. “Vitamin E delta-tocotrienol augments the antitumor activity of gemcitabine and suppresses constitutive NF-kappaB activation in pancreatic cancer”. Mol Cancer Ther, 2011, 10:2363–72. 9 Block KI, Koch AC, Mead MN, et al. “Impact of antioxidant supplementation on chemotherapeutic toxicity: a systematic review of the evidence from randomized controlled trials”. Int J Cancer, 2008; 123:1227–39.

Both human and dog krill oil supplements rely on freshly harvested krill from the Antarctic Ocean. Both contain Omega-3s and antioxidants. However, human grade krill oil focuses on the Omega-3s, with some antioxidants. Grizzly Krill Oil, a unique, recently-developed supplement for dogs created by Grizzly Pet Products (known for its bestselling salmon and pollock oils), puts the focus on antioxidants, front and center. The company’s unique extraction method yields up to eight times more antioxidants (in the form of astaxanthin) than the human version of krill oil. “I hesitated to introduce krill oil because it is extracted from Antarctic krill, a major food source for many whale species,” says Harald Fisker of Grizzly Pet Products. “However, when we located a sustainable harvesting source endorsed by both the World Wildlife Fund and the Commission for the Conservation of Antarctic Marine Living Resources, it became an easy decision.” Grizzly Krill Oil’s extremely high levels of antioxidants make it an excellent choice for anyone wanting to help safeguard pets against the malicious actions of free radicals.

10 Waters DJ, Shen S, Cooley DM, et al. “Eﬀects of dietary selenium supplementation on DNA damage and apoptosis in canine prostate”. J Natl Cancer Inst, 2003; 95:237–41. 11 Waters DJ, Shen S, Kengeri SS, et al. “Prostatic response to supranutritional selenium supplementation: comparison of the target tissue potency of selenomethionine vs. selenium-yeast on markers of prostatic homeostasis”. Nutrients, 2012; 4:1650–63.

IVC Winter 2015

Single agent PSP delays metastases and improves survival in hemangiosarcoma patients “Dogs with hemangiosarcoma were given a compound (I’m-Yunity) derived from a type of mushroom, Coriolus versicolor… [and] had the longest survival times ever reported for dogs with this form of cancer. This mushroom compound could offer an alternative to chemotherapy or a complementary treatment to traditional cancer therapies for dogs and people.” – ABC News, CBS News, and Huffington Post

This quote refers to a 2012 study published in Evidence-Based Complementary and Alternative Medicine by researchers Dorothy Cimino Brown and Jennifer Reetz of the University of Pennsylvania School of Veterinary Medicine. Fifteen dogs diagnosed with hemangiosarcoma participated in the trial, receiving different doses of 25, 50 or 100 mg/kg/day of I’m-Yunity, a polysaccharopeptide formulation. The researchers took blood samples and conducted ultrasounds on a monthly basis to determine how the tumors developed and spread. Based on the ultimate endpoints – how quickly the tumors progressed

and how long the dogs lived – the results suggest I’m-Yunity was effectively ﬁghting the tumors. Prior to the study, the longest reported median survival time of dogs with hemangiosarcoma of the spleen, given no further treatment, was 86 days. Dogs in the trial lived beyond a year with nothing other than I’m-Yunity. The researchers are in the process of completing a second trial of I’m-Yunity in dogs with splenic hemangiosarcoma. Read the full article at imyunityfordogs.com.

Research published in Evidence-Based Complementary and Alternative Medicine, Volume 2012, Article ID 384301. The above article includes excerpts from PENN News, September 10, 2012 (media contact: Katherine Unger Baillie, kbaillie@upenn.edu, 215-898-9194).

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integrative practice

An integrative practice model

AS A NEW VETERINARY STARTUP

by Melissa McFarland, DVM, CVA

eterinary medicine is becoming a competitive sport. Too many veterinarians are graduating. Pressure from online retail sales and low-cost spay/neuter and vaccine clinics are driving veterinary practitioners to seek new business model options, but these new models are generally not in the best interests of overall patient health and wellness. More pet owners are only seeking acute or emergency care from veterinary clinics, and not just because of financial constraints. They have not been educated about the importance of a veterinary/ client/patient relationship, and about mitigating problems before they start through professional care. Recently, I made the jump from lowly associate to practice owner. I left an affluent conventional small animal practice before it was sold to a major corporation. I decided it was time to develop a practice of my own, where I was free to practice the type of medicine that actually put my patientsâ&#x20AC;&#x2122; needs first. My main goal was to introduce a focus on health and preventive care into my community, while balancing patients with nutritional approaches and strengthening the human/animal bond between owners and their pets. It has been a challenging transition, but now I feel able to practice honest medicine. I can also support my newly-added associate in her efforts to practice medicine the way she sees fit for each client and patient. Starting a fully integrative veterinary hospital was no small endeavor. It was a giant leap of faith. Faith that I could get a loan to start a business (while being a few hundred thousand dollars in debt from veterinary school alone); faith that I was tough enough to endure the IVC Winter 2015

bombardment of decisions I must sort through to make the basics of a veterinary practice happen; faith that I was doing the right thing; faith that my family would support me and that as a soon-to-be-first-time mother I would have the time and energy to get things up and running; and, of course, faith that the community would support our novel practice concept. Originally, I started writing this article with the intent to educate readers on the process of opening an integrative clinic; however, anyone with enough ambition can open a clinic. Location, design, finances, staffing, and inventory are all key factors you must take into consideration when opening a business anywhere. There are many types of practice model to consider: house call, clinic setting, barn setting, limitedservice hospital, full-service hospital, or a larger referral service hospital. A practice owner must have a good sense of their overall practice goals before embarking on this journey, and a good idea of where they see the practice growing and expanding into the future.

This decreases inventory and allows us to supply clients who travel great distances and may not have full access from their local clinics to some of the products we prescribe. We have trained our clients to give us advance notice of refill needs in the event products need to be special ordered. It’s very difficult to be prepared for everything that walks through the door and I have been known to call other local clinics and emergency facilities to obtain medications we didn’t start out with (for example, the first week we opened we had a rodenticide toxicity and I had neither vitamin K nor Yunnan Bai Yao on hand). We keep prescription diets to a minimum, but still stock them as they may need to be utilized when clients refuse other treatment options. One problem with all five pharmacies is that some clients seek lower-priced but often lower-quality products on the internet or elsewhere. This can lead to treatment failures and poor clinical outcomes.

PHARMACY

SCHEDULE

My choice was to be a full-service veterinary clinic, not just an alternative practice. We slowly purchased the best equipment on the market. From x-ray to surgery to kennel space, there is a lot of equipment needed, at a high cost. By starting off with the basics of what we thought we would need for day-to-day diagnostics, and staying well within our budget, we slowly grew and added equipment as we became busier. Adding in-house laboratory equipment allowed us to see urgent care and emergency cases and initiate treatment more efficiently and quickly. As an integrative practice, we use five different pharmacies: 1. General conventional medications 2. Herbals 3. Supplements 4. Homeopathics 5. Prescription diets

Our schedule varies and currently alternates through the week. To be a full-service hospital, you must be open full-time. We do surgery two mornings a week on the days we are open later in the evening, to accommodate later discharge times. We try to limit our new acupuncture consultations to two or three a week, and schedule acupuncture consults and re-check appointments at about 40 to 60 minutes. We do try to receive records prior to visits in order to get better case histories for patients.

Juggling a broad inventory is risky – the more that sits on the shelf, the more dollars are wasting away. It is really frustrating when products expire before they sell. Keeping a minimum stock of products is important since each distributor has minimum orders for which shipping rates vary greatly. We can also special order and often dropship herbals and supplements.

IVC Winter 2015

Because new client alternative medical consults and rehabilitation consults take up so much time, we give clients a “one strike” notice – if they no-show-no-call for their appointment, they must pre-pay for the next scheduled appointment. Most clients understand they are paying for our time and consultation (usually second or third opinions on cases) and are willing to do so.

Expansion

Embrace change. I originally built out a 3,500 square foot lease-hold clinic with four exam rooms, a private surgery suite, dental area, separate day-kennel spaces for dogs and cats, and a low-stress private recovery/ICU area for intensive care, post-surgical and hospitalized cases. We do no boarding. In just over a year-and-a-half, I feel we have outgrown our “little” space and our plans are to expand into an additional 1,500 square foot space within the next year, and utilize more room for rehabilitation, water therapy, exercise classes, lecture and meeting space, and more.

We offer discount packages for cases that are going to be repeat clients for laser, acupuncture, spinal manipulation and rehabilitation. We try to fit in general wellness and regular sick appointments where we can. We stagger the schedule slightly so there is some time for emergencies and lunch. On a general day, we stay fairly busy. I expect my clients to trust me and follow my directions if I ask them go directly to the local emergency facility if I am not able to handle a case or fit them in promptly.

EDUCATION I owe our success to the community that has so openly welcomed our practice model. While we have not “miraculously saved” every patient that has walked through our doors, we have educated many clients on the ability to take better care of their pets through diet, nutrition, and use of vaccine titers or very customized schedules. We individualize medicine and don’t require everything of every pet that walks through our doors. We have helped pets by looking deeper into their pathology before merely treating symptoms with drugs and surgery. We reduce drug therapy by using the vast array of modern diagnostics and alternative medical approaches that fit each case. Clients have realized that medicine shouldn’t be just an in-and-out-the-door process and that their pets are thriving because they have a deeper understanding of what it takes to keep their animals healthy. We often get to the root of the disease process and interrupt the disease pathway before it develops into something more severe. In this way, we are truly practicing more preventive medicine and improving clinical outcomes.

SUMMARY Integrative practice isn’t easy, and it takes quite a bit more effort than I ever remember putting into conventional practice. I utilize more of my whole brain and not just the logical side. We strongly practice evidence-based medicine but stay open to treating cases with alternative therapy approaches. I’m still fascinated when something truly puzzling walks, crawls, or is carried through our doors. Being able to utilize energetic treatments such as acupuncture and herbals and/or watch the energetic pathways patients experience when treated with conventional medications, as well as taking a deeper, more thorough and complete history from the owners, we are often able to provide a more comprehensive diagnostic and treatment plan. I can’t imagine practicing any other way. I do not think I will ever give up on conventional medicine, as I feel it still has its place in the world, but the more alternative techniques I encounter and learn, the less I seem to need conventional medical approaches and the healthier my animal patients become. IVC Winter 2015

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 Harrisonsâ&#x20AC;&#x2122; 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: (855) 623-3937 (EYES) 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

IVC Winter 2015

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

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?

UPCOMING EVENTS

We featured bloodroot (Sanguinaria Canadensis). This herb is

• Beginning on June 11, 2016, we will travel to Rain Forest Resort

classified as an expectorant, antispasmodic, anticatarrhal, a

Village in Quinault, Washington to enjoy three days of hiking

circulatory stimulant, and a febrifuge that is also cardioactive.

in the rainforest, while learning herbal and native lore. Go to

This herb also has emetic, cathartic, nervine, alterative, stimulant,

vbma.org for more information and to register.

diuretic and sedative properties, and is a bitter hepatobiliary tonic, cholagogue, and uterine regulator.

• Our teleconference series is continuing – go to vbma.org for the next date, featuring Dr. Steve Blake discussing gemmotherapy

Energetically, bloodroot can

– medicines made from plant buds, not gems! For more

1. Clear Lung Phlegm Cold, tonify Heart Qi

information, listen to this very interesting talk; it’s herbal

2. Warm, tonify and move Liver Qi, clear Liver Cold and Damp

medicine at its most energetic, or homeopathic medicine at its

3. Warm and regulate Uterus, clear Phlegm Cold.

most physical level.

Today, bloodroot is used extensively as a topical escharotic, though traditionally it was used in severe respiratory conditions. “It is a good remedy in atonic condition of the lungs or bronchi with imperfect circulation and relaxed mucous membranes, with general inactivity of the nervous system and lack of nerve force,” stated Ellington. “It will assist in overcoming Hepatization of lung structure and restoring normal tone and normal functional action. It acts as a stimulant on the stomach, liver and portal circulation to exercise an alterative influence within the blood.”

NAME THIS HERB!

CASE REPORT

Spirit is a 200-pound, three-month-old female Holstein calf who was unresponsive after several weeks of antibiotic therapy for severe pneumonia clinically characterized by hepatization of her pulmonary tissue. She was in severe respiratory distress with consolidated lung tissue resulting in poor oxygenation. Bloodroot was incorporated into Spirit’s herbal formula. Speciﬁcally, bloodroot is indicated in COPD as it will help remove pulmonary accumulation. It is a tonic and stimulant to the bronchial membranes. It stimulates the capillaries and overcomes congestion of the lung structure after a severe cold in the chest from exposure. In hoarse bronchial coughs or stridulous laryngitis, or in the early stages of croup, it equalizes the circulation of the entire system, inducing warmth in the skin and extremities. It has been traditionally used for convalescence from pneumonia with exhaustion and coughing; and is indicated in severe, chronic bronchial, hepatic conditions presenting as a deﬁciency, cold with phlegm and mucus discharges. Although long term use of bloodroot is not recommended, as there have been some toxicity issues, a daily dose of 5 mg/kg body weight has been reported as safe. Research has shown that bloodroot extracts have potential as therapeutic immunomodulators, and can inhibit platelet aggregation.

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

With the assistance of bloodroot, Spirit made a remarkable recovery and is currently a milking ﬁrst calf heifer. IVC Winter 2015

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events

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

2016 AVMA Veterinary Leadership Conference January 7 - 10, 2016 – Chicago, IL

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

North American Veterinary Conference January 16 - 20, 2016 – Orlando, FL

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

Ontario Veterinary Medical Association Conference January 28 - 30, 2016 – Toronto, ON

The 2016 OVMA conference offers more than 100 hours of continuing education options to choose from as well as top rated speakers from Canada and the United States. This 3 day event is the largest annual veterinary conference in Canada and combines education with a tradeshow filled with products and equipment. For more information: (800) 670-1702 info@ovma.org www.ovma.org

IVC Winter 2015

Minnesota VMA 119th Annual Meeting February 4 - 6, 2016 – Minneapolis, MN

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

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

IVC Winter 2015