V6I2 (Spring 2016) by Redstone Media Group

IVC SPRING 2016

Integrative VETERINARY CARE VOLUME 6 ISSUE 2

LANDMARK VACCINE STUDY

DO SMALL DOGS NEED THE SAME DOSE OF VACCINE AS LARGER DOGS, OR DOES A HALF-DOSE OFFER SIMILAR PROTECTION? READ THE RESULTS OF THIS STUDY. — P. 20

INAPPROPRIATE URINATION IN CATS www.IVCJournal.com

SPRING ISSUE 2016

INTEGRATIVE VETERINARY CARE JOURNAL

Why an integrative approach, complete with a thorough behavioral history, provides lasting solutions. — P. 14

GARLIC–BUSTING THE MYTHS

Contrary to popular belief, it’s not toxic to dogs and cats – in fact, garlic offers a myriad of health benefits. — P. 40

ESSENTIAL OILS FOR ANXIETY

INTEGRATIVE SPORTS MEDICINE FOR HORSES

TREATING CANINE AGGRESSION

WHAT’ S NEW

Used correctly, quality essential oils can ease anxiety and related behavioral issues in a range of species. — P. 26

Improve the mental state of your patients by incorporating these holistic modalities into your practice. — P. 52

How acupuncture, chiropractic and other therapies successfully treat equine athletes with musculoskeletal conditions. — P. 46 • New rabies vaccine recommendations • Leeches help heal post-op wound • New technique for spaying cats • College for veterinary botanical medicine

IVC Spring 2016

contents FEATURES

Inappropriate urination in cats By Rhea Dodd, DVM

An integrative approach, complete with a thorough behavioral history, provides lasting solutions to litterbox problems.

Half-dose vaccines for small dogs By W. Jean Dodds, DVM

The results of a study using a half-dose canine parvovirus and distemper vaccine in small breed adult dogs will intrigue you.

DVM

In Part 2 of our article on essential oils, learn how quality oils can treat anxiety in a range of species, and are a powerful addition to your behavioral arsenal.

TECH TALK

Tellington TTouch in veterinary practice

By Rikke Schultz, DVM and Linda Tellington-Jones

This system of gentle movements on and with the animal’s body promotes relaxation while improving awareness, physical balance and movement.

NUTRITION NOOK

Garlic–why it’ s well-rounded and safe for your practice! By Lisa S. Newman,

PhD

Understand the myths surrounding garlic’s supposed toxicity, and discover the many health benefits it offers dogs and cats.

52 4

IVC Spring 2016

By Sarah le Jeune,

DACVS, DACVSMR, Cert Vet Acu/Chiro

DVM,

Complementary modalities like acupuncture and chiropractic are increasingly recognized as effective ways to treat equine athletes with musculoskeletal conditions.

Challenges of treating canine aggression By Margo Roman,

CVA, COT, CPT, FAAO

Essential oils ease anxiety

By Melissa Shelton,

Equine integrative sports medicine

DVM,

Integrating holistic modalities into your practice raises your chances of successfully overcoming canine aggression and improving the mental state of your patients.

INTEGRATIVE PRACTICE

Homeopathy in the feline spay-neuter clinic

By Anne Gard, DVM

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

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

5 Advisory board 8 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’ 38 Industry innovations 44 Veterinary resource guide 45 From the WAEO

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.

51 From the AVH 57 From the AHVMF 63 Social media 64 From the VBMA 65 Marketplace 66 Events

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

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

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

IVC Spring 2016

Integrative VETERINARY CARE

SPRING 2016

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: Ca-ssis

COLUMNISTS & CONTRIBUTING WRITERS Rhea Dodd, DVM W. Jean Dodds, DVM Anne Gard, DVM Sarah le Jeune, DVM, DACVS, DACVSMR, Cert Vet Acu/Chiro Lisa Newman, PhD Jeff Nichol, DVM Margo Roman, DVM, CVA, COT, CPT, FAAO Rikke Schultz, DVM Melissa Shelton, DVM Linda Tellington-Jones

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

IVC Spring 2016

editorial

Addressing BEHAVIOR ISSUES n my experience, one of the main reasons people surrender pets or request euthanasia is because of behavioral issues. When I had only conventional veterinary training, I was usually at a loss to help many of the behavior problems I saw in my patients. Decades ago, we had few drugs, and even now with many more to choose from, compliance, cost and side effects limit their success. Fortunately, there are a myriad of alternative approaches available to address behavior, and this issue of IVC Journal touches on a number of them. Dr. Melissa Shelton continues to educate us about the deep healing possible with essential oils, including for behavior problems. Dr. Rhea Dodd’s suggestions on what to do about inappropriate urination in cats is most welcome, since so many of us, myself included, have had to deal with this complex issue. Tellington TTouch experts Linda Tellington-Jones and Dr. Rikke Schultz demonstrate how technicians can play an important role by using this therapy, and teach it to clients to help decrease anxiety in horses, dogs or cats. And Dr. Margo Roman emphasizes the importance of diagnostic testing and also reports on her success using integrative approaches, including MBRT, to treat aggression. It has become clear to me over the last 35 years that behavioral issues may stem from sensitivity to vaccines, so we are thrilled to present Dr. Jean Dodds’ study on half-doses for small dogs. It appears that one size does not, in fact, fit all. I am also excited to present Dr. Anne Gard’s article on the use of homeopathic remedies in her spay/neuter clinic; homeopathy prevents most behavioral problems as well as other post-op challenges. I

IVC Spring 2016

remember how sad I felt in my first year of practice, when a client came in for a suture removal and wanted to know why her dog had become aggressive after being spayed. For the equine practitioners out there, Dr. Sarah le Jeune gives great examples of how an integrative exam can diagnose more ailments than our conventional lameness exam. In addition to resolving current issues, integrative treatments given monthly can maximize performance. And finally, since there is so much disagreement about the use of garlic in pets, Dr. Lisa Newman’s article clarifies some of the history, benefits and uses of garlic, which many people often confuse with onions. Though spring is often a very busy season, I sincerely hope you will take time to integrate some of these methods into your practice. When one “calls” to you, consider taking one or more of the increasing number of courses available – many can be found on the Internet. As always, we love to receive your feedback about what topics you would like to see covered. And please send me your success stories to post in the “Cases” section of the IVC Journal website. Happy spring,

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

IVC Spring 2016

contributors

1. RHEA DODD, DVM Dr. Rhea Dodd earned a Doctorate in Veterinary Medicine from Colorado State University in 1992, and a Master’s Degree in Biology from the University of Colorado at Boulder. She became certified in Veterinary Acupuncture through both CSU and IVAS in 2001, and was selected as a teaching assistant, clinical preceptor and presenter for the Course in Basic Acupuncture for Veterinarians at Colorado State University. In 2008, she became certified in Veterinary Chiropractic through the International Veterinary Chiropractic Society. She owns Gentle Vet, PC, focusing on acupuncture, chiropractic and behavior solutions. Dr. Dodd lectures, teaches and writes about pet behavior, health and pain management. She has served on the Board of Directors for Freedom Service Dogs, Inc., the Coalition for Living Safely with Dogs, and the Africa Network for Animal Welfare. 2. W. JEAN DODDS, DVM Dr. Jean Dodds received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she established Hemopet, the first non-profit national blood bank program for animals. Today, Hemopet also runs Hemolife, an international veterinary specialty diagnostics service. Dr. Dodds has been a member of many committees on hematology, animal models of human disease and veterinary medicine. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1994, has served two terms on the AHVMA’s Board of Directors, chairs their Communications Committee, and currently serves on the Board of the AHVMF, as well as its Research Grant and Editorial Committees. 3. ANNE GARD, DVM Dr. Anne Gard earned her DVM from Iowa State University in 1999, and is the owner of Cat Guardian Spay & Neuter Clinic in Oxford Junction, Iowa. She completed the Professional Course in Veterinary Homeopathy under Dr. Richard Pitcairn in 2002 and regularly uses homeopathic medicines at her practice. 4. SARAH LE JEUNE, DVM, DACVS, DACVSMR, CVA, CERT. VET. CHIRO Dr. Sarah le Jeune is a member of the American College of Veterinary Sports Medicine and Rehabilitation. She focuses on the diagnosis and treatment of lameness and various performancerelated musculoskeletal injuries using an integrative approach including acupuncture and chiropractic. She is chief of the Equine Integrative Sports Medicine Service at UC Davis. Dr. le Jeune is a boardcertified equine surgeon and has been a member of the UC Davis Equine Surgery faculty since 2003. She is a certified veterinary acupuncturist with extensive acupuncture training from the Colorado State University and the Chi Institute. She also obtained certification in veterinary chiropractic from the International Veterinary Chiropractic Association. 5. LISA NEWMAN, PHD Dr. Lisa Newman is internationally renowned as a natural pet care pioneer and formulator of over 100 products, plus over 800 protocols for all types of pet and human conditions. These are used to supplement her Holistic Animals Care LifeStyle®. She is a researcher, educator, author of nine books, and

IVC Spring 2016

has been a speaker/spokesperson since 1982. Dr. Newman has spoken internationally at many venues, including the Equinox National Convention and the Sonoran Veterinary Conference in San Carlos, Mexico. Her work has been used at the Veterinary College, Holistic Animal Care School of Osaka, Japan. Dr. Newman donates products and time to many pet-related organizations. azmira.com 6. MARGO ROMAN, DVM, CVA, COT, CPT, FAAO Dr. Margo Roman graduated from the Veterinary College at Tuskegee Institute of Alabama, and was on the faculty of Tufts University, teaching anatomy, physiology and acupuncture. She was the consulting veterinarian in an IACUC for Creature Biomolecule in Hopkinton, Massachusetts, studying osteogenic proteins. Dr. Roman’s integrative practice, Main Street Animal Services of Hopkinton (M.A.S.H.), offers chiropractic, physical therapy, massage, Reiki, acupuncture, herbs, conventional medicine and more. 7. RIKKE SCHULTZ, DVM, IVAS, EVSO Dr. Rikke Schultz graduated as a veterinarian in 1992. While in school, she also studied and began using TTEAM. She used holistic approaches from the beginning, starting her own mixed practice in Iceland. After five years, she moved back to Denmark and worked in Hoersholm Equine Practice for eight years. She studied acupuncture from 1995 to 1997 with IVAS, osteopathy in 2003 with ISEO, and homeopathy from 2013 to 2016 with FIVM. In 2006, Dr. Schultz opened her complementary and alternative medicine equine practice. Since 2011, she has conducted anatomical dissection research at the Veterinary Anatomical Institute, University of Copenhagen, where she also serves as a censor. The same year, she started an ongoing Master study at the Anglo-European College of Chiropractic Care at the University of Bournemouth. 8. MELISSA SHELTON, DVM Dr. Melissa Shelton earned her veterinary degree from the University of Minnesota in 1999, and has owned Crow River Animal Hospital in Minnesota since 2001. Essential oils became a passion for her in 2008, and she began using medical aromatherapy with patients. Through continued use, research, and documentation, Dr. Shelton is dedicated to providing accurate information regarding oil use in the animal kingdom. In March 2011, she dedicated her practice solely to the advancement of veterinary aromatherapy, and in February 2014 she introduced animalEO, a line of veterinary essential oil products for animals. She has taught internationally, and has written multiple books on the use of essential oils in animals. animalEO.info or oilyvet.com 9. LINDA TELLINGTON-JONES Linda Tellington-Jones, PhD (Hon), created the Tellington Method 40 years ago as a system of animal training, healing and communication. This effective and revolutionary approach to working with animals brought her worldwide recognition, and Tellington TTouch was born. Linda has won numerous awards, written 21 books, and given presentations and demonstrations at veterinary conferences, universities and associations around the world.

what’s new NEW TECHNIQUE FOR SPAYING CATS A new procedure to spay female cats has been shown to be safe and effective, according to a study published in the Journal of Feline Medicine and Surgery and done by Kirk Miller, a clinical instructor with the College of Veterinary Medicine at Oregon State University, and practicing veterinarian with the Oregon Humane Society in Portland. Called a “pedicle tie”, the procedure stops blood flow through two vessels that go to a cat’s ovary, a preliminary step to removing the ovary and uterus. It essentially ties the vessels in a knot; and it works just as well, and is about 30% faster, than a procedure used for decades that required multiple ligatures to do the same thing. There was some concern the new procedure might cause additional bleeding, but a survey of 2,136 kittens and adult cats spayed using the technique showed no significant increase in hemorrhagic complications. The new technique also saves time – two minutes out of an overall operation that can take six to 20 minutes. “That may not sound like much, but when you do thousands of these procedures every year, like we do, it can add up in savings of both time and money,” says Miller. “Over the course of a year, it may free up about two weeks of time for both the surgeon and anesthetist.” The procedure can be taught fairly easily, adds Miller, and with its safety and efficacy now verified, it may soon be used much more broadly.

PTSD SERVICE DOGS AT NAVC “In the US, 22 warriors with PTSD commit suicide every day,” says Rory Diamond, Executive Director for K9s For Warriors. This non-profit organization is dedicated to training shelter dogs to service post-9/11 veterans suffering from PTSD, traumatic brain injury and/or military sexual trauma. On January 17 and 18, while at NAVC in Orlando, Florida, VetSource hosted K9s For Warriors and set the stage for the organization to meet animal health professionals from around the world. Attendees were able to learn more about issues that impact returning veterans, and how service dogs help ease their transition back to normal life. “When we learned about K9s For Warriors and what they do to help veterans suffering from PTSD, as well as shelter dogs, we knew we wanted to help the people and dogs in the program,” says Kurt Green, CEO of VetSource. The company donates and ships veterinary-prescribed pet medications for the service dogs wherever they are located in the US. VetSource.com, k9sforwarriors.org

IVC Spring 2016

what’s new IN MEMORIAM We were saddened to learn that renowned equine veterinarian Dr. Kerry Ridgway passed away on January 3, 2016. Dr. Ridgway practised conventional veterinary medicine for over two decades, then took a more integrative approach by adding equine chiropractic and acupuncture to his services. A founding member and officer of the Association of Equine Sports Medicine, he was a well-known endurance riding competitor, and was elected to the Endurance Hall of Fame for his contributions to the field. Among the latter was his development of the Cardiac Recovery Index, now an international standard in endurance competitions. Dr. Ridgway has written for IVC Journal – his most recent article “Fascia and why it’s so important” was featured in our Winter 2015/16 issue. “The horse community has lost a great man whose innovative work has improved the care of our horses,” says veterinarian Dr. C.M. Newell of North Brookfield, MA. “Dr. Kerry Ridgway will be missed by many.”

NEW RABIES VACCINE RECOMMENDATIONS Cats and dogs exposed to rabies and who are overdue for a vaccine (with documentation of prior vaccine) can now have a booster shot followed by an observation period, rather than be subject to quarantine or euthanasia. This is according to the 2016 Compendium of Animal Rabies Prevention and Control. A study by Dr. Moore, et al, at Kansas State, and published in JAVMA last year, compared anamnestic responses in dogs and cats with both current and overdue status. The study showed that both had similar antibody response to a booster. Serologic monitoring can also be requested. Interestingly, animals with overdue vaccine status brought into practices because of exposure, and then boosted, had a higher increase in titers than dogs with current status. For more details javma.246.2.205.

the

study,

visit

avmajournals.avma.org/doi/abs/10.2460/

Note also that RabiesAware.org provides a national rabies information resource, and will soon have information from all states.

VETERINARY BOTANICAL MEDICINE It’s only two years old, but the American College of Veterinary Botanical Medicine is increasing the proficiency and competence of veterinarians in the use of medicinal plants, and making progress towards its goal of becoming an academic center for the advanced study of plant medicines. The ACVBM is currently working on a petition to gain status as a specialty board in the AVMA. For more information about becoming a diplomate, or in helping with the process, go to acvbm.org.

IVC Spring 2016

LEECHES HELP HEAL POST-OP WOUND Using leeches in medicine sounds downright medieval to some, but there’s real value in the practice and they’re being utilized in modern veterinary medicine, particularly by reconstructive surgeons. Veterinarian Dr. Anemone Andronescu, the medical director of BluePearl Veterinary Partners hospital in Virginia Beach, used leeches to help one of her patients, an eight-year-old chow/border collie mix named Kojak. The dog was brought in with a cancerous tumor on his leg. After removing the tumor, Dr. Andronescu used a skin flap to cover the wound. When she noticed blood pooling underneath the flap, she put in an order for medical-grade leeches. Though it would be her first time working with leeches, she had heard success stories from a few colleagues. Over the course of six treatments, the leeches effectively sucked up the stagnant blood, reduced the swelling in Kojak’s leg and helped promote the flow of fresh, oxygenated blood. “I’ve been really pleased by the way he responded to the treatment,” said Dr. Andronescu. Cheryl Jordana, Kojak’s owner, added that her dog tolerated the leeches much better than he did other aspects of his treatment. bluepearlvet.com

INTEGRATIVE VETERINARY SUMMIT On May 1 and 2, Sundance, Utah will host the Veterinary Summit: Natural Solutions and Integrative Practices. The event, presented in partnership with the Veterinary Medical Aromatherapy Association, hosts a selection of great speakers, including Dr. Ron Schultz on everything you need to know about vaccines. Modalities to be discussed include essential oil therapy, acupressure, TCVM, homeopathy, nutrition, and supplements. The summit is open to veterinarians and licensed technicians and assistants only. For more information, visit veterinarysummit.com.

PRN HAS NEW GENERAL MANAGER An employee-owned company, PRN Pharmacal has been developing specialized therapeutics for the veterinary medicine community since 1978. This past December, PRN Pharmacal and Pegasus Laboratories, Inc. promoted Donna Logan, who joined the company in 2000, to General Manager. Logan has devoted the majority of her career to formulating and bringing to market the highest quality pharmaceutical products, with a focus on animal health. PRNPharmacal.com

IVC Spring 2016

Integrative treatment for

inappropriate urination

in cats By Rhea Dodd, DVM

ats are the most popular pet in the US, and although we love them, litterbox issues are the most common complaint among cat parents. In fact, it is estimated that among cats with behavioral disorders, 40% to 75% involve elimination problems (Overall, 1997). Unfortunately these issues often lead to abandonment or euthanasia. Honing your diagnostic and therapeutic skills around this problem can help you save lives, and what is more rewarding than that? A stepwise holistic approach, complete with a thorough behavioral history, will help identify common patterns and lead to lasting solutions to litterbox problems. The first step in addressing inappropriate urination is to conduct a complete physical exam, urinalysis, CBC, and metabolic panel. Common rule-outs include cystitis, FLUTD, FIC, crystalluria, calculi,

IVC Spring 2016

metabolic disorders (such as hyperthyroidism, diabetes, renal failure) and geriatric problems (such as dementia and DJD). Once medical problems have been ruled out, the behavioral sleuthing begins. Your job as a feline forensics specialist is to uncover what the cat is communicating via his behavior. I highly recommend Dr. Karen Overallâ&#x20AC;&#x2122;s Behavioral Questionnaire for Cats with Elimination Disorders (Overall, 1997). It outlines the process of taking a thorough behavior history that will allow you to make an accurate behavioral diagnosis. I have highlighted the key questions and behavioral red flags in this article, based on my 24 years in practice and my successful mitigating of hundreds of cat litterbox cases. To begin the behavioral investigation, differentiate whether the cat is urine marking or housesoiling.

MARKING

Marking almost always involves stress, often caused by other cats, either within the household or outdoors. Marking can present as either vertical spraying or horizontal marking, usually in small spots around the perimeter of the room. Treatment involves minimizing stress by meeting the cat’s behavioral needs. In a multi-cat household especially, the goal is to provide plenty of space and privacy in order to minimize conflict. Establish separate zones with food, water, litterboxes, climbing towers, wildlife viewing areas, beds, treats and toys. Prevent outdoor cats from having visual contact with indoor cats, by drawing blinds or using chemical deterrents such as Ropel®, Boundary® or mechanical deterrents like ScareCrow®, a motion activated sprinkler. It is imperative that clients clean soiled areas very thoroughly. The product proven most effective in clinical trials is Anti-Icky Poo™, a professional carpet cleaner that utilizes live bacteria to break down urine odor (Pryor, 2001). Very soiled areas may require professional cleaning, carpet replacement, or sealing with several layers of Kilz® primer. Steam cleaning is not recommended as it may lock urine scent into the carpet. If the soiled surface is tile or concrete, a ten to one water to bleach solution may be used for cleanup.

with environmental management, the acupuncture may only be needed once or twice. Some cats will need ongoing treatment. Botanicals • Catnip (Nepeta cataria) is a fragrant herb that induces relaxation in a genetically based sub-population of cats. Fresh or dried catnip, or concentrated sprays such as KONG® Naturals Catnip Spray, can be used for those patients that find catnip calming. It can also be used as an attractant for toys or resting spots, to give alternative, relaxing and engaging activities to spatting cats. • Some of my patients have found relief from stressful situations with Bach Flower Remedies. One such product is Rescue Remedy®, a combination of flower essences for traumatic or stressful situations. Because these tinctures are made with alcohol, they should be

Clients can also place food and water or toys near the soiled area, to change the significance of this area for the cat. Spots used for marking can also be sabotaged with upside down plastic carpet runners or strong essential oils (clove, cedar, citrus) near the soiled area, discouraging use. In addition to environmental management, a number of holistic approaches can modulate stress in cats. TCVM, Western botanicals, homeopathy, flower essences, osteopathy and chiropractic can be effective. Not all of these will work for all cats; they should be used on a successive trial and error basis. Frequent communication with clients will help you decide which modalities are most helpful. Acupuncture By activating the nervous system, acupuncture releases endorphins, hormones and neurotransmitters, thereby rebalancing emotions. Although it may seem counter-intuitive, cats are often good candidates for acupuncture. In my 16 years of experience using this modality, I’ve found that most cats tend to respond well to acupuncture and enjoy their treatments. Inject GV20 with 0.1cc injectable B12. Repeat every three to four weeks as needed (Schoen, 2001). If used in conjunction IVC Spring 2016

diluted in spring water for use in cats (four drops Rescue Remedy per ounce of spring or filtered water). Serve four drops, four times daily on a treat. Refrigerate for up to two to three weeks. Supplements and nutritional therapies • Composure™ chews are a tasty supplement formulated to promote relaxation, without inducing sedation or personality changes. The three main ingredients work synergistically: thiamine (vitamin B1), C3™ (Colostrum Calming Complex) and L-theanine (Suntheanine® brand). I have used these chews successfully over many years with my patients. The lack of sedation and lower stress levels allow for valuable learning to take place. • While some readers may object to a dry, commercial food as not ideal for feline patients, Royal Canin Veterinary Diet® Feline Calm dry cat food is an interesting product. It utilizes a milk protein called alpha-casozepine to induce a state of calm. This food also incorporates L-tryptophan, an amino acid required for the body to produce melatonin and serotonin, which can decrease anxiety and enhance sleep. Because it is a food product, it may also be easier to administer to fractious cats.

• Zylkene® supplement is pure alpha-casozepine. It is water soluble and can be added to the cat’s normal diet. Pheromones Feliway® is a commercial product containing a synthetic pheromone that mimics cheek gland secretions from a cat. It is intended to produce a state of calm and induce facial marking versus urine marking behaviors. Use it daily on areas where cats have sprayed urine, or use a diffuser in areas of spraying, or where cats are most likely to interact. This product is a good option for finicky or fractious cats that may be hard to medicate.

HOUSESOILING

Domestic cats descended from the Middle Eastern wildcat, Felis sylvestris, a desert dweller that roamed the wild expanse of the Fertile Crescent of Mesopotamia. It stands to reason, and has been borne out by research (Overall, 1997), that if given the choice, most cats will naturally pick clean sandy litter, lots of space, privacy, and a quiet low-stress environment. Unfortunately, many cat parents misinterpret their cats’ housesoiling activities as a demonstration of spite or anger. In fact, a housesoiling cat is simply expressing his innate preferences. Educate clients that punishing a cat is not effective in correcting soiling problems and may lead to increased stress and further problems. Although there are four main categories of litterbox problems, these conditions may overlap and defecation is sometimes involved as well.

1. Litterbox aversion Litterbox aversion is the most common elimination problem in cats (Overall, 1997). In general, most cats do not like covered boxes, plastic liners, strong scents (malodorous or fragrant) or competition from other cats. The mere scent of another cat may cause litterbox aversion, as can feline aggression from housemates. The key question is: will the cat use a freshly cleaned litterbox? Behavioral red flags: Most often, the cat will urinate near the litterbox. In some cases, though, if the box is in an inconvenient, noisy or fear-inducing location, the cat may avoid the box entirely. Action plan: • Use unscented clumping litter. • Use at least one more box than the number of cats in household. • Use only unscented Ivory liquid soap or similar to clean box (no bleach, Lysol, Pinesol, citrus cleaners, etc.).

IVC Spring 2016

In general, most cats do not like covered boxes, plastic liners, strong scents (malodorous or fragrant) or competition from other cats.

• Scoop twice daily. • Replace litter once a month, or when crumbs are visible. • Get an extra large box, especially if you have an extra large cat. • Place the new boxes where the cat is inappropriately eliminating. Once litterbox habits are well established, move the box 1” to 2” a day to a more appropriate location. • Clean soiled areas as outlined above. • Use scent to attract the cat, such as a small amount of organic potting or garden soil in box; or Dr. Elsey’s Cat Attract™, which contains a proprietary herb mixed with a premium scoopable litter.

2. Substrate aversion Behavioral red flags: The cat may scratch at adjacent, preferred textures (such as smooth surfaces or carpet). He may run from the box or shake his paws after using it. I have even had patients that perch on the edge of a box to avoid touching the litter. Action plan: • Follow the suggestions given for litterbox aversion. • Use unscented clumping litter in a second box, adjacent to the current box. • Provide a third box with a different substrate, such as Dr. Elsey’s Cat Attract or World’s Best Litter Original formula, made from ground corn. In my experience, most cats dislike scented litters, sawdust type litters, clay litter, recycled newspaper litter and litter crystals. • Depth may be an issue. Most cats prefer about 2” of litter, but you can tilt the box to create a gradient from shallow to deep so the cat can choose. • Add litter as needed to keep depth at 2”.

3. Surface preference Behavioral red flags: The cat will eliminate on a preferred texture, such as carpet, bathmat, sink or bathtub, potting soil or fabric. He may scratch his preferred surface if it is adjacent to the box, or may scratch the inside of the box.

Action plan: • Provide the preferred substrate within the litterbox. If a smooth surface is preferred, use an empty litter box, sprinkled with a small amount of litter. If soft surfaces are preferred, place a small square of carpet, bath mat, old T-shirt, synthetic fleece or hand towel in the empty litter box. Gradually replace it with smaller squares of fabric, while simultaneously adding increasing amounts of litter. • If feasible, simply restrict the cat’s access to the soiled area or preferred surface (e.g. keep bedroom door closed, keep laundry picked up, put ½” of water in bathtub, cover soil on potted plants with pinecones or foil).

4. Location preference Behaviorial red flags: The cat may choose a quiet, low traffic or private area in which to eliminate. This can indicate a fear of people, other animals or unwanted noises, such as a furnace or washer and dryer that suddenly turn on. Action plan: • Place an uncovered box in a quiet, easily accessible location. Locating it under a card table or behind a plant provides privacy and a feeling of security. Although it is not always easy to get inside the mind of a cat, behavioral clues can help you understand your patients and get to the bottom of litterbox issues. Taking a thorough, stepwise approach can help resolve elimination problems in cats, ensuring longer, happier lives and stronger human-feline bonds.

References Overall, KL. Clinical Behavioral Medicine for Small Animals, Mosby, 1997. Pryor PA, Hart BL, Bain, MJ, Cliff KD. “Causes of urine marking in cats and effects of environmental management on frequency of marking”. JAVMA; 219 (12): 1709-1713, 2001. Schoen, AM. Veterinary Acupuncture, Ancient Art to Modern Medicine, Mosby, 2001.

IVC Spring 2016

Advertorial

URINARY TRACT

DISEASE IN DOGS AND CATS By Jeff Nichol, DVM

Of the 74 million pet dogs in the US, 80% are kept indoors – with limited elimination opportunities. According to a VPI Top Media Conditions study, urinary signs are the number one reason cats are brought to veterinary clinics and the ninth biggest presenting complaint from dog owners. A history of house-soiling accounts for 18.5% of the shelter population, making urinary signs a leading cause of pet relinquishment.

Chewable CitraVet® increases citrate levels in the bladder. According to research from the Minnesota Urolith Center, calcium binds to the citrate instead of the oxalate. Urate and cystine stones can also be controlled by the same mechanism. The supplemental potassium citrate in CitraVet® also increases urine alkalinity, which can further inhibit formation of oxalate cystoliths.

Uroliths in pets are a growing problem. According to the Minnesota Urolith Center, calcium oxalate has increased to 60% of canine uroliths and 55% of the calculi found in cats. Described as an epidemic, oxalates are now the most common urolith in each species.

Nobody’s happy with recurring bacterial cystitis either; it’s uncomfortable and can lead to struvite stones. Controlling bacterial adherence to the canine and feline bladder wall is easier with cranberry extract tablets, like chewable CranMate®, a cost-effective cranberry supplement also from PRN. Components found in this cranberry supplement are postulated to inhibit fimbrial adhesion of bacteria, including uropathogenic E. coli. Bacteria are then flushed out during urination.

There are breed and sex predispositions. Calcium oxalate stones are more common in middle-aged to older neutered male dogs. They occur more frequently in miniature Schnauzers, Lhasa apsos, Pomeranians, and Shih tzus. In Bichon frises, the young adult males face a higher risk. While there is no apparent sex predisposition in cats, the ragdoll, British shorthair, foreign shorthair, Himalayan, Havana brown, Scottish fold, Persian, and exotic shorthair breeds have a higher incidence. Idiopathic hypercalcemia in cats, obesity, and acidic, highly concentrated urine in either dogs or cats are predisposing factors. They’re often subclinical, but when calcium oxalate cystoliths do cause physical signs they always warrant surgery. Postoperatively, these pets need our best efforts to prevent reoccurrence. Therapeutic diets and potassium citrate tablets, like CitraVet® tablets from PRN Pharmacal, can make a longterm difference.

IVC Spring 2016

CranMate® is produced by a patented extraction process that eliminates unwanted sugar and oxalic acid – making it suitable for dogs and cats with diabetes mellitus. Pet owners are delighted with chewable CitraVet® and CranMate® because they are highly palatable and cost-effective. Our work as practitioners is as rewarding as it is challenging. Client buy-in makes it easier to improve patient outcomes, and everybody wins.

Dr. Jeff Nichol is a graduate of the Michigan State University College of Veterinary Medicine. He has been a hospital owner for much of his career. He practices general and behavioral medicine in Albuquerque, New Mexico.

IVC Spring 2016

By W. Jean Dodds, DVM

Vaccination is the single most important reason pet owners bring their pets to veterinarians for an annual, or more often “wellness visit”.1,2 Despite evidence indicating that annual vaccinations are not necessary for previously immunized pets, many practitioners are reluctant to change their current vaccination programs, even with AVMA recommendations for every third year. This is likely because they are rarely taught applied clinical immunology and may not understand the principles of vaccinal immunity (that portion of immunity conveyed by vaccines).2,3 The accumulated evidence clearly indicates that vaccination protocols should no longer be considered a “one size fits all” program.4

IVC Spring 2016

BACKGROUND The rationale for the present study, which investigates using a half-dose canine parvovirus and distemper vaccine in small breed adult dogs, was prompted by the fact that adverse reactions to vaccines, also called vaccine-associated adverse events (VAAE), can still cause serious illness, suffering and death.2,5-7 Viral vaccines are intended to provide an immune response similar in duration to that following a natural infection. These anti-viral adaptive immune responses typically result in the development of sterilizing immunity that not only prevents clinical disease but also prevents infection; and the duration of immunity (DOI) generated here is often lifelong. Older dogs and cats rarely die from vaccine-preventable infectious diseases, especially when they have been vaccinated and immunized as young adults.1,7,8 Young animals, however, can still become seriously ill and die from these infectious diseases, most often because vaccines were given too early in life when the presence of residual maternally-derived antibody partially neutralized the effects of the vaccine, leaving the youngster inadequately protected. Studies in dogs7,8 and cats9 assessed the DOI in previously vaccinated pets that had not received a booster vaccination in as long as nine years. When the dogs were challenged with CDV, CPV and CAV-2, and the cats challenged with feline panleukopenia virus (FPV), feline calicivirus (FCV) and feline herpesvirus (FHV), both species resisted infection and/ or disease. Thus, even a single dose of these MLV canine or feline â&#x20AC;&#x153;coreâ&#x20AC;? vaccines, when administered at 16 weeks or older, should provide long-term immunity in a very high percentage of animals, while also increasing the overall herd (population) immunity.7-9

AGE AND WEIGHT CONSIDERATIONS Factors associated with the age and weight of animals being vaccinated are also important, not only for affording protection against these diseases, but also for helping to assure the wellbeing of those vaccinated. The risk of a VAAE in the canine study was inversely related to the dogâ&#x20AC;&#x2122;s weight, such that for dogs weighing <10 kg, the actual VAAE rate was underestimated.7 This weight-response relationship was previously suggested by a study in which dogs of toy breeds had significantly more suspected VAAEs than other dogs, although body weight was not reported.7 Vaccines, in contrast to virtually all veterinary pharmaceuticals, are prescribed on a one-dose-fits-all basis, rather than by body weight.1,5,8 Even when adjusted for body weight, there was a nearly linear increase in VAAE rate when the number of vaccine antigens given simultaneously was increased.7 This suggests that vaccine components other than the primary antigen may contribute to adverse events.7,9,11 In a IVC Spring 2016

published study,3 eight of 18 dogs that developed immediatetype allergic reactions had high concentrations of specific serum IgE against the vaccines, and seven also had specific IgE antibodies against fetal calf serum.3,8,11 Further, the canine study found that young adult small breed neutered dogs receiving multiple vaccines per office visit were at greatest risk of a VAAE within 72 hours after vaccination.7 The authors concluded that these factors should be considered in risk assessment and risk communication with clients regarding vaccination of dogs.7 Parallel data were documented by these same investigators two years later for cats,9 where the risk of VAAE significantly increased as the number of vaccines administered per office visit increased. The risk was greatest for cats about one year of age, and overall risk was greater for young adult neutered versus sexually intact cats.9 The most commonly diagnosed VAAE was lethargy with or without fever.

SHOULD TOY AND GIANT BREEDS RECEIVE THE SAME DOSE? It makes little immunological sense to vaccinate toy and giant breed puppies and adult dogs, to exemplify the two size extremes, with the same dose of vaccine. These vaccines are stated to provide a sufficient excess of antigen for the average-sized animal so they are likely to be either too much for toy breeds or too little for giant breeds.3 Although the minimum immunizing doses have been established,1,3,12 the optimum dosages required for disease protection have yet to be determined. Researchers are still uncertain as to whether these dosages should be based on body mass.2,12 It apparently depends to some extent on whether the vaccine is of modified live virus (MLV) attenuated origin, or killed inactivated viral origin because of the differing immunogenic principles involved.1-3,6 According to some experts, killed inactivated vaccines should be adjusted for body mass, and yet even today, rabies vaccine â&#x20AC;&#x201C; the most potent of all such vaccines â&#x20AC;&#x201C; is required by law to be given at a full dose to dogs of all sizes.3 More field evidence and clinical data are still needed on this important issue. Similarly, the administration of identical vaccine dosages for animals in all age groups is questionable.3,10,12

can be reduced to 50%, but not more, for small breed and mixed breed type dogs, based on body weight, and still convey full duration of immunity.1,2,13,14 This applies to puppies and older dogs of small breeds and breed types that weigh 12 pounds or less as adults. Serum vaccine antibody titers have also been performed three or more weeks after vaccination. As reported for dogs given a full dose of vaccine,8 more than 95% of the dogs given a full or half dose mounted what is considered to be protective antibody titers to both CDV and CPV.2,8,14 To the authorâ&#x20AC;&#x2122;s knowledge, there are no parallel published data on half-dose vaccines given to cats.9,10

STUDY OVERVIEW While clinical experience and research demonstrated that small breed dogs could be protected from CDV and CPV with lower vaccine dosages, the author was interested in pursuing a study to prove these results. Small breed adult dogs, being at least three years and not more than nine years of age, participated in this clinical research study to determine whether giving them just a half-dose of a bivalent canine distemper and parvovirus vaccine (DPV) generated a protective serum antibody titer response one and six months later in comparison to pre-vaccination titer levels. None of these dogs had received a vaccination for at least three years and all were healthy. The half-dose vaccine generated increased serum vaccine antibody titers for all the dogs studied. Results varied quantitatively when titers measured on the undiluted serum were compared to endpoint titers determined on the same samples when the serum was serially diluted. The median titer and endpoint titer levels had a sustained increase in all dogs six months post-vaccination. Results confirmed that receiving a half-dose of bivalent DPV was efficacious for this study cohort. Further investigations could address a larger number of smaller breed canines.

STUDY METHODS Prior to receiving a half dose of the bivalent DPV vaccine, a prevaccination whole blood sample (3ml to 5ml) was measured for serum antibody levels for CDV and CPV using previously established enzyme-linked immunosorbent assay (ELISA) methodology and optical density (OD) readings obtained with a spectrophotometer.4 Re-sampling was done at four weeks and six months after each dog had received a half dose of DPV vaccine.

WHAT OUR EXPERIENCE TELLS US

STUDY RESULTS

Based upon nearly five decades of clinical and research experience with vaccinations in companion animals, we have accumulated the following information: the dose of canine distemper virus (CDV) and canine parvovirus (CPV) vaccines

The 13 enrolled dogs completed the pre-vaccination testing and the four-week post half-dose DPV testing, with eight of them completing the six-month post-vaccination follow-up titer measurement.

IVC Spring 2016

Results indicated that all 13 dogs (not vaccinated for at least three years) had measurable serum antibody titers to both CPV and CDV. Titers measured on the undiluted serum (standard method) Canine parvovirus (CPV) Figure 1a shows that: q Pre-vaccination titers for CPV were all above the positive control. F w our weeks post half-dose vaccination, titers went up in nine of the 13 dogs and stayed essentially the same in the other four dogs, whose pre-booster titers were already high or very high. e Six months post half-dose vaccination, titers showed a rise for six of the eight dogs from the four-weeks sample, and the other two dogs had lower six-month titers for CPV, although one of these dogs had essentially the same high titer level at all three time points. Canine distemper virus (CDV) Figure 1b shows that: q P re-vaccination titers were high for only five dogs. w F our weeks post half-dose vaccination titers were significantly boosted for 11 of 13 dogs, and the other two dogs had slightly lower post-vaccination titers but their pre-

vaccination titer levels were already high or very high. S ix months post half-dose vaccination, titers were higher than at four weeks post-vaccination for three of the eight dogs, and the other five had lower readings than at four weeks, though were still high except for one dog.

Endpoint titers on serially diluted serum Canine parvovirus (CPV) Figure 2a and Table 1 (page 24) show that: q Pre-vaccination endpoint titers for CPV were all above the positive control with 12 of 13 being well above that optical density level, when measured on the diluted serum samples, and the median endpoint titer level was 116 (range 32-256). w Four weeks post half-dose vaccination, endpoint titers were boosted for two of 13 dogs with a high titer level of 1:256. Seven of the 13 dogs had essentially the same endpoint titer levels at four weeks as they had pre-vaccination, with the highest level at 1:256. The other four of 13 dogs had lower endpoint titer levels at four weeks than they had prior to the half-dose vaccination. The median endpoint titer level was 94 (range 32-256). e S ix months post half-dose vaccination, titers were boosted for seven of the eight dogs with endpoint titer dilutions as high as 1:512. The median titer level was 240 (range 64-512). Continued on page 24.

PreVaccine PreVaccine

4 week check (after booster)

6 month check (after booster)

Figure 1a: Small Breed Vaccine Study Serum Vaccine Titers for CPV on Undiluted Serum.

Figure 1b: Small Breed Vaccine Study Serum Vaccine Titers for CDV on Undiluted Serum.

IVC Spring 2016

Continued from page 23.

…given that vaccines are known to cause adverse events, especially in smaller dogs, results of this study conﬁrmed that receiving a half dose of bivalent DPV vaccine was efﬁcacious for this study cohort.

Canine distemper virus (CDV) Figure 2b and Table 1 show that: q Pre-vaccination endpoint titers for CDV were lower than those of CPV relative to the positive reagent control optical density reading with two just below the positive reagent control but above the negative control optical density reading, and another six at or slightly above the positive control optical density reading. Only three dogs had higher prePreVaccine 4 week check (after booster) 6 month check (after booster) vaccination CDV endpoint titers than Figure 2a: Small Breed Vaccine Study the positive control Serum Vaccine Endpoint Titers for CPV on Diluted Serum. level. The median endpoint titer level was 21 (range 2-64). w Four weeks post half-dose vaccination, titers were significantly boosted for nine of 13 dogs and the other four dogs had equivalent or lower post-vaccination endpoint titers but their pre-vaccination endpoint titer levels were already high. The median endpoint titer level was 80 (range 32-128). Six e months post half-dose vaccination, titers were markedly boosted for four of eight dogs with the highest level at 1:256. The median endpoint titer level was 97 (range 8-256).

CONCLUSIONS

This study addressed whether small breed adult dogs, not vaccinated for at least three years previously, could be adequately immunized and protected by receiving less than a full dose of a bivalent DPV vaccine. A half dose of this vaccine was given and generated increased serum vaccine antibody titers for all the dogs studied. Results varied quantitatively when titers measured on the undiluted serum (standard method) were compared to endpoint titers determined on the same samples when the serum was serially diluted. The median titer and endpoint titer levels had a sustained increase in all dogs at six months post-vaccination. Table 1. Small Breed Half-Dose Vaccine Study for CPV & CDV Titers * Serum Titers

Pre-Vaccine Titers n =13

4 Week Post-Vaccine Titers n =13

6 Months Post-Vaccine Titers n=8

CPV, Undiluted

125 ± 22 (73–156)

136 ± 14 (110–162)

169 ± 58 (96–257)

CPV, Endpoint Dilution

116 ± 87 (32–256)

94 ± 65 (32–256)

240 ± 183 (64–512)

CDV, Undiluted

89 ± 31 (55–143)

148 ± 33 (106–199)

148 ± 71 (110–257)

CDV, Endpoint Dilution

21 ± 26 (2–64)

80 ± 38 (32–128)

97 ± 87 (8–256)

* Median ± SD and Ranges

IVC Spring 2016

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ew NBEHAVIORAL HEALTH supplement PreVaccine

4 week check (after booster)

6 month check (after booster)

Figure 2b: Small Breed Vaccine Study Serum Vaccine Endpoint Titers for CDV on Diluted Serum.

As the presence of measurable CPV and CDV serum antibody titers reflects immunity to these viruses, and given that vaccines are known to cause adverse events, especially in smaller dogs, results of this study confirmed that receiving a half dose of bivalent DPV vaccine was efficacious for this study cohort. Further investigations could address a larger number of smaller canines.

Schultz RD. “Current and future canine and feline vaccination programs”. Vet Med. 1998; 93:233-254. Dodds WJ. “More bumps on the vaccine road”. Adv Vet Med. 1999; 41:715-732. 3 Phillips TR, Jensen JL, Rubino MJ, Yang WC, et al. “Effects on vaccines on the canine immune system”. Can J Vet Res.1989; 53:154-160. 4 Schultz RD, Ford RB, Olsen J, Scott F. “Titer testing and vaccination: a new look at traditional practices”. Vet Med. 2002; 97:1-13 (insert). 5 Dodds WJ. “Vaccination protocols for dogs predisposed to vaccine reactions”. J Am An Hosp Assoc. 2001;38: 1-4. 6 Tizard I. “Risks associated with use of live vaccines”. J Am Vet Med Assoc. 1990; 196:1851-1858. 7 Moore GE, Guptill, LF, Ward, WP, et al. “Adverse events diagnosed within three days of vaccine administration in dogs”. J Am Vet Med Assoc. 2005; 227:1102–1108. 8 Twark L, Dodds WJ. “Clinical application of serum parvovirus and distemper virus antibody titers for determining revaccination strategies in healthy dogs”. J Am Vet Med Assoc. 2000; 217:1021-1024. 9 Moore GE, DeSantis-Kerr AC, Guptill LF, et al. “Adverse events after vaccine administration in cats: 2,560 cases (2002– 2005)”. J Am Vet Med Assoc. 2007; 231: 94-100. 10 Schultz RD, Thiel B, Mukhtar E, et al. “Age and long-term protective immunity in dogs and cats”. J Comp Pathol. 2010; 142 Suppl 1:S102-S108. 11 Gray LK, Crawford PC, Levy JK, Dubovi EJ. “Comparison of two assays for detection of antibodies against canine parvovirus and canine distemper virus in dogs admitted to a Florida animal shelter”. J Am Vet Med Assoc. 2012; 240:1084-1087. 12 Taguchi M, Namikawa K, Maruo T, et al. “Booster effect of canine distemper, canine parvovirus infection and infectious canine hepatitis combination vaccine in domesticated adult dogs”. Microbiol Immunol. 2012; 56: 579–582. 13 Mouzin DE, Lorenzen M J, Haworth, et al. “Duration of serologic response to five viral antigens in dogs”. J Am Vet Med Assoc. 2004; 224:55-60. 14 Tizard I, Ni Y. “Use of serologic testing to assess immune status of companion animals”. J Am Vet Med Assoc. 1998:213:200-203. 1 2

Do you have canine and feline patients that exhibit nervousness and discontentment in response to environmentally-induced stress? Nutramax Laboratories Veterinary Sciences, Inc. introduces Solliquin™ Behavioral Health Supplement for dogs and cats. Intended to help support normal behavior and facilitate a calming effect, it’s the first and only veterinary behavioral health product that brings together a unique combination of L-theanine, magnolia and phellodendron extracts, and a select concentrated whey protein (NMXSLQ05™). The supplement provides the benefits of all four ingredients in a convenient, once-daily soft chew or chewable tablet. The effects of theanine have been evaluated in dogs and cats, and they indicate that this ingredient may reduce signs of anxiety in cases of noise phobia, travel anxiety, urine marking, and fear of humans. NMXSLQ05 is a unique purified milk whey extract containing sources of amino acid precursors necessary for the synthesis of antioxidants and certain neurotransmitters. Finally, the combination of magnolia and phellodendron extracts was found to reduce anxiety in a laboratory model of beagles in a placebo-controlled clinical trial on noise-induced anxiety. Solliquin is available in three different presentations to meet the needs of any size of pet: • Soft Chews for small dogs and small cats – 60 count • Soft Chews for small to medium dogs and large cats – 75 count • Chewable Tablets for medium to large dogs – 45 count

Nutramax Customer Service

This supplement is only sold through veterinarians. For more information, visit solliquin.com or call at 888-886-6442.

IVC Spring 2016

ESSENTIAL OILS â&#x20AC;&#x201C; Part 2 Treating anxiety

Behavior problems and emotional health issues arising from anxiety can be effectively alleviated with the correct use of essential oils.

By Melissa Shelton, DVM

IVC Spring 2016

In the Winter 2015/2016 edition of IVC Journal, I discussed the concerns and benefits of using essential oils with animals. In this issue, we look at how essential oils, when properly used, can give wonderful benefits for behavior problems. Quality is critical, as one essential oil may bring true and wonderful health benefits, while another is akin to spraying perfume directly onto the animal! In this way, essential oils can be paralleled to the variation of health responses we see from feeding a “dollar store” brand of pet food versus a premium version.

ANXIETY AND BEHAVIORAL ISSUES A COMMON CONCERN Behavioral concerns contribute to an amazingly high number of relinquished animals. There are great opportunities for veterinarians to aid these issues with essential oils.1,2,3,4 Anxiety presents in all species in many different ways, from dogs who tear up couches, carpets and doors when an owner is not at home, to birds who pluck and chew at their feathers. Symptoms such as increased respiratory rate, shaking, diarrhea, excessive vocalization, hiding, over-grooming, inappropriate urination, and even biting or aggression have all been attributed to fear, stress and anxiety.

ESSENTIAL OILS AFFECT EMOTIONAL HEALTH Within integrative medicine, essential oils are, in my eyes, one of the most complete and holistic modalities I have encountered. There are true and documented physical effects5 that also complement the emotional planes, whether it is our intention or not. Gut health and inflammation of the gastrointestinal system are becoming increasingly recognized as contributing to anxiety and behavioral concerns, as well as a plethora of other physical relationships.6 In clinical practice, we often noticed that when essential oil therapies were instituted to help with nausea or diarrhea, a calming effect was duly noted. Single essential oils such as Geranium,7 Lavender,8,9 Bergamot,8,9 and Roman Chamomile9 are commonly thought of when referencing essential oils with anxiolytic capabilities. However, even essential oils that are not commonly considered, such as Cinnamon,10 Lemon,11 and members of the Anise family12 have behavioral benefits. Other essential oils such as Orange are very uplifting, and Clary Sage is well regarded for supporting the hormones, and seems to aid in hormonally-related behavior issues.

USES AND APPLICATIONS – DIFFUSION A single calming oil or a blend of several (my preference) may be applied to handlers and/or animals prior to a nail trim, car ride, thunderstorm, or other stressful event. Water-based diffusion can be utilized to expose the entire household to IVC Spring 2016

calming benefits on a more consistent and widespread basis. Generally, three or four drops of undiluted essential oil(s) are added to one cup (8oz) of water to be diffused. Humans and animals alike can experience calming effects, which are always helpful when dealing with an emotional situation. When possible, bridging the use of essential oils with positive experiences prior to their use is especially helpful. For instance, exposing the animal to the scent of the essential oil while he is eating or spending “happy time” with his guardian, can link the scent of the oil(s) with positive and calm feelings. Although the physical and emotional responses to the essential oil chemistry will still be present, we can ensure a larger response when positive reinforcement bridging has been initiated. Examples of recipes that can be used vary, and almost any combination can affect an animal in a positive way. One of the greatest things about essential oils is that you are rarely wrong with a selection. For example, if you only selected Lavender, and used it for a cat scared during a car ride, a dog who is aggressive at a vet visit, and a horse timid about the farrier, you would most likely see results in all of them, to varying degrees. However, if you blended Lavender, Bergamot and Roman Chamomile together – you would find that a larger portion of animals responded to the blend, and likely with more results than with one essential oil alone.

IVC Spring 2016

CONSIDER THE PATIENT’S SPECIES As with most aspects of veterinary medicine, there are species variations in how we should proceed. Whether we are administering anesthesia, medications, or even restraint techniques, we proceed far differently with a bird, cat, dog or horse. The same approach should be used for essential oil use – in both selection and methods of administration. For birds, exotic animals and cats, I prefer water-based diffusion of essential oils. Essential oils such as Roman Chamomile, German Chamomile, Lavender, Bergamot, Geranium, Clary Sage, Lemon and Orange tend to be milder in nature, so are therefore appropriate selections for use with these delicate species. They can be utilized singly or combined in any pleasing combination for diffusion. Inaccurate statements abound in regards to cats, citrus oils, terpines, and a variety of other chemical constituents, but when used properly, I do not find these cautionary statements to be clinically accurate. Many of my own personal felines, as well as veterinary patients, have experienced long-term exposures to “contraindicated oils” through diffusion (as well as other routes) with only benefits noted. If there are ever changes in an animal that we feel may not be beneficial – such as increased respiratory rate, squinting,

SAMPLE BLENDS

Blend for diffusion: Equal parts Lavender, Orange, and Lemon essential oils. Lavender-based calming blend: Three parts Lavender, two parts Lemon, one part Roman Chamomile, one part Geranium. German Chamomile calming blend: One part German Chamomile, three parts Clary Sage, six parts Bergamot. repeated sneezing, or avoidance of the diffusion area – diffusion should be ceased and the situation re-evaluated. In my experience, the majority of situations where diffusion is not well tolerated results from poor quality essential oil use, or from the overuse of the essential oil(s).

USES AND APPLICATIONS – TOPICAL

Both calming blends may be diffused or diluted to a 1% to 5% concentration in fractionated coconut oil for topical “petting”.

While dogs, horses, and other large animals will still benefit from diffusion in their environments, we can also explore topical applications of essential oils. Selecting a variety of essential oils known for calming effects, and mixing them together (in any combination that results in a pleasing scent to human and animal) can create a base blend for your use. For most situations, additional dilution of the essential oils into a fatty carrier oil (I prefer fractionated coconut oil) should be performed for topical use. I would recommend using a concentration of 1% to 5% essential oil to carrier oil for most applications. When creating a base blend or a diluted blend, I recommend rocking the blend to mix it several times a day, and allowing the oils to “marry” for 24 hours or more prior to use, as this seems to result in a more harmonious and effective end product. Petting would be the method most often used for topical applications. In this situation, we would place several drops of the diluted blend into our hands, and rub them together. For a horse who is anxious around the farrier, I may “pet” the essential oil blend onto my own clothing prior to handling the horse. Each individual is different, so it is nice to use a blend prior to the “necessary event” to make sure the animal issues a noticeable and positive response to it. And ideally, I would bridge the scent of the essential oil blend with prior regular activities that the horse does not perceive as stressful, whenever possible. In some situations, I may layer multiple application methods to the calming blend; wearing the blend on my person, and also “petting” the blend onto the horse or other animal. Depending on the sensitivity of the animal, I may use one to five drops or more in my hands, allowing them to be absorbed to varying degrees, before petting. I will often “pet” the oils onto the shoulder and heart areas – and focus on taking calming breaths alongside the animal. Continued on page 30. IVC Spring 2016

CASE EXAMPLES

•S PIKE, a 15-year-old male Sulfur Crested Cockatoo, was exhibiting excessive screaming in the household. The owners had already been using a single Lavender essential oil in a diffuser, as they had heard of the calming effects Lavender could provide. They experienced only minimal effects. A blend of equal parts Lavender, Orange, Lemon and Clary Sage was substituted for diffusion, and the owners reported a much improved and more consistent reduction in the amount of screaming. They also felt that Spike’s hormonally-charged behaviors towards the owners (biting and chasing feet) were also reduced. • THOLLIE, a five-year-old intact female American Staffordshire Terrier, was abandoned at a veterinary clinic. While attempting to examine, sedate, draw blood or restrain her, the dog would thrash and violently twist her body in an attempt to escape. A blend of equal parts Roman Chamomile, German Chamomile and Blue Cypress (an essential oil known for grounding properties) was “petted” onto the handlers and Thollie’s chest and back area 20 minutes prior and immediately before attempted handling. Significant differences were noted, and the dog could be restrained, allowing injections to be given for her spay surgery. With continued use of the oils, combined with positive bridging, Thollie was able to have her nails trimmed with minimal restraint or struggle, after several weeks. • ABBIE is a 13-year-old Arabian/Quarter Horse mare. She is known to be very cranky, especially during heat cycles, is afraid of loading into a horse trailer, and gets “stress diarrhea” after a transport event. The owners used a blend of three parts Lavender, one part Roman Chamomile, and one part Clary Sage in a petting method, 20 minutes prior to attempting to load her. They noticed a significant difference in her stress level, she loaded into the trailer easier than they had ever seen, and she did not exhibit her normal stomping and kicking while inside the trailer. The owners also sprinkled several drops of this blend into her manger, so she would smell the essential oils during the trailer ride. The owners also noted that she did not get her normal episode of post-transport diarrhea. 30

IVC Spring 2016

Continued from page 29. In most situations, I will attempt to use essential oils approximately ten to 20 minutes prior to the known stressor. I may repeat applications, typically every 20 minutes – but will titrate the frequency and amount of the applications based on the individual response and duration of response presented by the individual animal. With properly diluted, high quality essential oils, we are able to apply or administer “as needed” – but often strive to achieve the “lowest effective dose”.

CONCLUSION Essential oils are never the only therapy I focus on for cases in which we want behavioral improvements. All aspects of diet, health, nutritional supplements, training and behavioral modification should be addressed; however, even when we “only” use essential oils, we can see results.

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In clinical practice, we have seen a wide variety of behavioral improvements through implementing essential oil use: reduction of excessive grooming in cats, greater acceptance of new animals in a household, more relaxed and calmer car rides, less reaction to fireworks or thunderstorms, easier crate training of puppies, less screaming from birds, low-stress veterinary visits and nail trims, greater focus and attention during training, and so much more. As integrative veterinarians, I believe we have an even greater opportunity to help animal guardians with behavioral concerns when we offer multiple modalities and solutions. Essential oils can be a powerful addition to your behavioral arsenal.

Liu AD, et al. “Anxiolytic effect of essential oils of Salvia miltiorrhiza in rats”. Int J Clin Exp Med. 2015 Aug 15; 8(8): 12756-64. Kasuya H, et al.“Intracerebral Distribution of a-Pinene and the Anxiolytic-like Effect in Mice Following Inhaled Administration of Essential Oil from Chamaecyparis obtuse”. Nat Prod Commun. 2015 Aug; 10(8): 1479-82. 3 Goes TC, et al. “Effect of Lemongrass Aroma on Experimental Anxiety in Humans”. J Altern Complement Med. 2015 Dec; 21(12): 766-73. 4 Karadag E, et al. “Effects of aromatherapy on sleep quality and anxiety of patients”. Nurs Crit Care. 2015 Jul 27. doi: 10.1111/ nicc.12198. 5 Mizuno D, et al. “An In Vitro System Comprising Immortalized Hypothalamic Neuronal Cells (GT1-7 Cells) for Evaluation of the Neuroendocrine Effects of Essential Oils”. Evid Based Complement Alternat Med. 2015:343942. 6 Keightley PC, et al. “Pathways in gut-brain communication: evidence for distinct gut-to-brain and brain-to-gut syndromes”. Aust N Z J Psychiatry. 2015 Mar;49(3):207-14. 7 Rashidi Fakari F, et. al. “Effect of Inhalation of Aroma of Geranium Essence on Anxiety and Physiological Parameters during First Stage of Labor in Nulliparous Women: a Randomized Clinical Trial”. J Caring Sci. 2015 Jun 1;4(2):135-41. 8 de Sousa DP, et al. “A Systematic Review of the Anxiolytic-Like Effects of Essential Oils in Animal Models”. Molecules. 2015 Oct 14; 20(10): 18620-60. 9 Setzer, WN. “Essential oils and anxiolytic aromatherapy”. Nat Prod Commun. 2009 Sep;4(9):1305-16. 10 Cheng BH, et al. “Evaluation of anxiolytic potency of essential oil and S-(+)-linalool from Cinnamomum osmophloeum ct. linalool leaves in mice”. J Tradit Complement Med. 2014 Dec 16;5(1):27-34. 11 Komiya M, et al. “Lemon oil vapor causes an anti-stress effect via modulating the 5-HT and DA activities in mice”. Behav Brain Res. 2006 Sep 25;172(2):240-9. 12 Aydin E, et al.“The Effects of Inhaled Pimpinella peregrina Essential Oil on Scopolamine-Induced Memory Impairment, Anxiety, and Depression in Laboratory Rats”. Mol Neurobiol. 2016 Jan 14. [Epub ahead of print] 1 2

CHANGING EMPLOYMENT OPPORTUNITIES IN VETERINARY CARE

– where will you ﬁt in?

The veterinary industry is becoming the target of acquisition companies. These companies are aggressively buying out single and multi-location veterinary operations in order to grow market share. How will you be affected? It could be determined by the business model you choose to work for. As the larger companies buy out or open more corporate locations, your choices narrow. Most veterinarians will eventually work for one of these corporations, either now or in the future, as the buying accelerates. There is stability in being an associate veterinarian under a larger corporate umbrella. It could be the safe path to choose. Yet some veterinarians realize that working as an associate for a corporation may limit their drive and possibly their success; they value their freedom in how to practice, and will thus consider opening their own hospitals. Going it alone is a riskier path, but potentially more rewarding. Other DVMs may strive to increase the odds of competing with well-organized corporations and join a franchise model that offers the freedom they seek in ownership – freedom in how to practice medicine, and a model with the necessary tools to take market share by offering total animal care, from pet food and supplies to veterinary care. If you are of the latter mindset, consider a Pet Depot veterinary/retail hybrid franchise. It could set you on a balanced risk-to-reward path, and lets you have a direct impact on your level of success. petdepot.net/vet IVC Spring 2016

tech talk

TELLINGTON TTOUCH Photo courtesy of Happy Animales Tellington TTouch

in veterinary practice

By Rikke Schultz, DVM and Linda Tellington-Jones The Tellington TTouch Method1 recognizes an inextricable link between posture, the nervous system and behavior. It uses a system of gentle, non-habitual movements on and with the animal’s body, including the skin, to promote relaxation while improving awareness, physical balance and movement. The non-invasive TTouches elicit profound changes in an animal’s emotional state and relieve tension and anxiety. When clients use TTouch at home, and your staff also uses it in the clinic, counterproductive stress responses are minimized and trust is built. “TTouch… allows us to treat without creating iatrogenic stress,” says Dr. Tom Beckett. “Handling actually reduces existing stress rather than adding more stress. The animal, thus freed from stress, can respond appropriately to staff, owners, home environment and to disease – he can participate fully in his own healing.” With TTouch, we and our clients can effectively convey our healing intent to the animal and suggest to him ways in which

IVC Spring 2016

he can help himself get well or function better. Compliance improves as animals become easier to treat at home.

USES IN THE CLINIC – DOGS AND CATS TTouches can be used on any animal regardless of age or species. Even animals that do not naturally seek human contact (such as reptiles, feral cats or wildlife) settle more quickly when TTouch is applied. When direct hand contact is threatening to an animal, TTouch can be done using feathers, dressage schooling sticks or long paint brushes to stroke and calm the animal before he is handled. TTouches can be used to aid both assessment and treatment, and to help an animal recover more quickly from sedation, injury and surgery. TTouch can reduce the need for chemical restraint drugs for minor procedures. While useful, most drugs require time to take effect, and time for recovery. They may be contraindicated and there may be adverse reactions. They generally dull learning processes so that it is difficult to train an animal to accept repetitive treatments.

As well as offering ways to approach, initiate contact, handle and manage the animal, Tellington TTouch can be used for specific situations such as preparing the animal to be handled around the neck prior to microchipping, injecting, and taking blood. When you accomplish a medical event peacefully, quietly and pleasantly, it is much more rewarding than when it’s accompanied by scratches, bites, sweat, poop and tears. TTouch is a wonderful tool for animals that don’t understand that we just need to do a little nail trim/wrap change/injection/exam and then it will be over. And it makes clients feel good when we don’t have to engage in a small war with their animals.

USES IN THE BARN – HORSES As an equine vet working with acupuncture, osteopathy and craniosacral therapy for many years, Dr. Rikke Schultz is still astonished by how well the Tellington TTouch method fits into explanatory models about the body and mind in humans and animals. Of course, much of the discussion for equines applies equally to all species. Rolfer and massage therapist Thomas Myers’ explanation of the muscular chains,2 which was also demonstrated in horses,3 and the importance of fascia, explains why circular TTouches and skin rolling have such a huge effect on large areas of the body [see IVC Journal, Winter 2015/16 for an article on fascia by the late Dr. Kerry Ridgeway]. The TTouches work on different layers of the fascia depending on the finger positions. The lifts release the subcutaneous tissue and give space for blood vessel function, which impacts the pulse and respiration in endurance horses. Releasing the fascia around the carpal and hock joint improves joint mobility and may decrease some cases of lameness. Craniosacral system (C-S system) The central nervous system is surrounded by multiple layers, including the pia mater and dura mater. The dura is very rigid, attaching to the inside of the cranium, the atlas and the sacrum. All peripheral nerves leaving the spinal cord go through the dura. A static dysfunction of the skull, atlas, sacrum or the other vertebrae can result in a pull on the dura, influencing nerve roots, spinal fluid flow, the mentioned bones and craniosacral rhythm. Doing circles with the horse’s tail can release the sacrum, while pulling gently on the tail stretches the whole spine and also affects the dura. I think this is why horses often shake their heads when the tail circles are performed. This also emphasizes why a gentle pull and slow release is so important. Continued on page 34. IVC Spring 2016

Doing the TTouches

C-S SYSTEM

TTouch should not be confused with massage. In TTouch, the skin is moved lightly in one and a quarter circles using the tips of the fingers. The majority of animals prefer the circles to be in a clockwise direction. The object is to simply move the skin, not press down into underlying tissue. The animal learns, remembers the experience, and accepts handling more quickly and easily the next time. The body work movements are broken down into three groups – circles, slides and lifts. Tension held in the animal’s body increases reactive responses and these passive, non-invasive movements release tight muscles and skin. • Circular TTouches can be done anywhere on the animal’s body and can teach him to accept and enjoy contact. They also help alter an animal’s expectations of what hand contact might mean. • Gently stroking an animal’s ears from the base to the tip lowers heart rate and respiration. It is calming, decreases fear and can prevent or reduce shock if the animal is traumatized or in pain. Owners/carers can be easily instructed to work their animals’ ears while waiting for the vet or on their way to the surgery. Working an animal’s ears can also make examinations or treatments more tolerable and, provided it is safe to do so, can be done in most situations, even if forceful handling is unavoidable. Sometimes just ten minutes of gentle ear slides from the base to the tip of the ear is enough. Ear slides are also appropriate for gently bringing all species of animal out of general anesthesia without the usual period of disorientation. • Examining the muzzle/mouth can trigger a stressed animal to bite. Working gently around the jaw, using the tips of the fingers to move the skin in small one and a quarter circles prior to oral examination, can release tension from the mouth and can be combined with ear slides. Mouth work is also valuable for animals that are reluctant to eat. Soft paintbrushes or cotton buds can be used for very small animals. If there is a chance that the animal may bite, a fake hand on a long wooden stick can be used.

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Tail TTouch: With a steady hold using the left hand, approximately 8” from the root of the tail, and the right hand at the base of the tail, gently pull, hold and mindfully release. This can give the horse a solid connection from poll to tail, improving mental, physical and emotional balance.

Continued from page 33. Ear work Ear work affects the acupuncture points in the local area and relaxes the tentorium (the membrane separating the cerebrum from the cerebellum, also a part of the dura), which attaches to the temporal bone. Major nerves, arteries and veins pass through the lacerum foramen. Tension here can affect multiple systems since the vagal nerve connects to most inner organs, and the accessory nerve innervates some of the muscles around the shoulder blade, thereby impacting front leg movement. Impaired blood flow to and from the brain will have a huge impact on the horse, including many behavioral issues. Continued on page 36. EAR WORK

Ear work: Hold the side of the halter with the right hand, place the left hand at the base of the ear, and slide from the base to the tip -- either at 90° from the head or slightly forward as shown here. Ear TTouch has been shown to prevent or bring horses out of shock, shorten recovery from anesthesia, reduce colic pain and re-establish peristalsis in the intestine. The slide over the ear influences all parts of the body, thus developing trust and calmness.

IVC Spring 2016

TTOUCH AND TENSION

FIGHT & FLIGHT REFLEXES

TTouch also engenders an increased awareness by the handler of the animal’s posture and therefore his likely responses. Tension through the neck can make injections and microchipping uncomfortable and is often present in dogs that are threatened by contact on the collar. Heat on the head and in the middle of the back can indicate a dog that is highly stressed and therefore more likely to bite. Tension through the hindquarters is common in animals that are noise sensitive, have difficulties in the car, and react to having their tails or hind legs handled. Tension in the tail will naturally make an animal react to having his temperature taken or to being examined internally. A few gentle slides, circles and lifts are often enough to achieve a happy conclusion; the calming work can usually be done on the animal in the time it takes to explain the procedure to the client. They can then relax their animals at home.

Fight & flight reflexes: Lowering a horse’s head with one hand on the nose and one on the crest behind the ears, so the poll is lower than the withers but not lower than the horse’s nose at knee level, helps calms the horse. It shifts the horse from the influence of the sympathetic state (fight/flight/freeze/fool around/faint) to the parasympathetic state (cooperative/ learning). This establishes trust that will allow a veterinarian to treat a horse safely and without trauma.

Continued from page 34. This understanding makes one realize the power of ear work, but also why it has to be gentle, and why one should never pull hard on the ears. Ear and head shyness may therefore not be behavioral, and can be resolved by the rider with gentle ear slides or TTouches. Fight and flight reflexes Linda Tellington-Jones has always spoken about the importance of bringing the horse’s head down in order to overcome fight, flight or freeze reflexes and increase learning ability. This happens because the parasympathetic (relaxation) nervous system is activated, or the sympathetic (stress) nervous system is deactivated. TTouch can bring horses very much into a parasympathetic state, and the ground work into social engagement. The more Dr. Schultz works with complementary medicine, the more she realizes how much “deeper” the treatments work when it is possible to bring the horse into a parasympathetic state. TTouch, acupuncture and craniosacral therapy are some of the methods that can do that. Rib release TTouch rib releases can normalize rib and diaphragm tension and dysfunction. These are commonly-overlooked problems

CASE REPORTS

• A small dog had not eaten for a couple of days following surgery. A variety of foods had been offered with no interest. After doing mouth work on the dog for no more than a few minutes, he wolfed down all the food in his bowl. The dog continued to eat with no further treatments. •W e currently have a stray feral kitten in the hospital who needs a home. Newly trained nurses saw the benefits of TTouch for calming and bonding with the kitten within days.

IVC Spring 2016

in a lot of horses, both in Western medicine and chiropractic. They could be why many horses have an aversion to saddling or handling along the back, bending properly, moving with good rear impulsion, or other training issues. Rib releases together with back lifts bring the back into flexion; most lesions in the spine are extended lesions in which the horse tries to avoid using the back in flexion.

SUMMARY The Tellington TTouch method offers a wide range of ways to promote relaxation, lower stress and make treatments more enjoyable. Clients can easily be taught specific moves to benefit their individual animals so home treatments are not stressful. This allows animals the freedom to relax and continue the deep healing process we begin in the veterinary clinic. When clients regularly explore TTouch methods at home, their animals will be less stressed when visiting the veterinary clinic, allowing for better diagnosis and hospital treatments. Using Tellington TTouch, we and our clients can effectively convey our healing intent to the animals, and suggest to them ways in which they can help themselves get well or function better.

TellingtonTTouch.com anatomytrains.com 3 Elbrønd VS, Schultz RM.“Myofascia – The unexplored tissue: Myofascial Kinetic Lines in horses, a model for describing locomotion using comparative dissection studies derived from human lines”. Medical Research Archives, 2015, Issue 3. 1 2

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industry innovations Effective help for oral health

Good oral health is vital for the overall well-being of your patients, but client compliance can be an issue when it comes to home-brushing or scheduling dental cleanings. From deep in the icy waters of the North Atlantic comes a breakthrough technology in the treatment of veterinary oral health issues. Easy-to-use Kalvatin™ Dental Spray and Dental Gel from Adartis Animal Health feature a powerful cold-adapted marine enzyme; the enzyme works with an animal’s own natural defenses to create an active barrier that reduces microbial adhesion, providing gums and teeth a defense against the bacteria that cause

Support aging brains

gingivitis, plaque, and tartar. The result is better oral health for pets with the potential for fewer anesthesia-based dental surgeries – all while growing the profitability of your practice. Free of synthetic chemicals, the Dental Spray and Gel are trusted, veterinarian-recommended products that help owners easily and effectively take control of their pets’ oral health. Kalvatin was featured as a “top ten” new technology by the NAVC, AVMA and Western Veterinary Conferences. Kalvatin.com

As dogs and cats age, they lose proteins that support their brain cells. This can affect learning, memory and concentration. In fact, behavior changes may be the first indication of declining health in aging pets. Early identification of these signs allows for effective intervention. During veterinary visits, subtle signs that may be indicative of declining health or cognition often go unreported, so clinicians must be proactive in asking about behavioral signs. As a noted veterinary behaviorist stated: “Do the pet a favor and ask about behavior.” Neutricks® is an exciting new approach to healthy brain aging for the senior pet. This supplement for the cognitive health of senior dogs and cats is based on the success of the protein apoaequorin in research and clinical trials. Apoaequorin has been proven to protect brain cells during and after ischemia, and Neutricks once a day has been shown to significantly improve learning and accuracy and to enhance attention. Neutricks.com

IVC Spring 2016

Wanted: oncology patients

Cancer is a major health concern in dogs and cats, and the more we can learn about it, the closer we get to being able to save more lives. Thanks to The Smiling Blue Skies® Cancer Fund, the Ontario Veterinary College is currently recruiting animal oncology patients for 12 studies they’re undertaking. The studies are organized into three categories – canine oncology, feline oncology, and oncology-related studies. Here are just a few of the study topics: • Acute myeloid leukemia in dogs • Prognostication of canine T-cell lymphoma • Effects of Benadryl in dogs with mast cell tumors undergoing surgery • Analysis of cytokines in dogs with osteosarcoma treated with amputation, radiation and/or chemo. • Oncolytic Maraba vaccination and standard-of-care surgery for treating mammary carcinoma in cats To learn more about The Smiling Blue Skies®, visit online or contact founder, Suzi Beber, at suzib@smilingblueskies.com. SmilingBlueSkies.com

Natural help for respiratory ailments

Sneezing, sniffling, wheezing and nasal discharge…they’re all signs of a respiratory problem, whether triggered by allergies or some other cause. Using a proven formula that’s over 100 years old, VetRx Veterinary Aid is an effective, natural way to care for the upper respiratory health of dogs, cats, horses and other animals. In dogs and cats, it relieves symptoms caused by congestion and allergies. In horses, it improves respiratory function by stimulating the depth of ventilation and helps relieve a range of symptoms caused by fungal, viral, bacterial and unknown etiology. Goodwinol.com

Super-pulsed laser therapy

Painful, arthritic hips or hind-end weakness is a common condition in older dogs. Veterinary diagnosis is necessary to determine the cause, and once the patient is under professional care, laser therapy can provide relief from pain and inflammation, and help the dog regain quality of life. However, not all laser systems are created equal. Most can only penetrate no more than 2” below the surface of the skin with a continuous wave probe. Respond Systems Super-Pulsed laser probe pulses high power wattage, delivering therapeutic laser light deep into the tissue and then turning off in between pulses so it remains cool to the touch. RespondSystems.com

IVC Spring 2016

nutrition nook

Garlic

â&#x20AC;&#x201C; well-rounded and safe for your practice!

By Lisa S. Newman, PhD

IVC Spring 2016

When it comes to your patients’ health – preventatively or curatively – you need accurate information about safety and benefits. Garlic, long used as a beneficial herb, and listed by the FDA as approved for pet food, is still under attack in spite of a 2004 follow-up study recommending garlic for dogs by the majority of scientists involved in a 2000 study done by Japan. Even the ASPCA’s poison hotline information recently added garlic to its list of toxins, although they report no individual cases linked to garlic ingestion in 2014, as they do for most other toxins. While it is understandable that you may hesitate to prescribe garlic, the facts below may shift your thinking.

BENEFITS For centuries, humans have used herbs, and garlic has been a primary remedy for a large number of symptoms. As long as people have been using garlic, they have also been feeding it to their animal companions; some animals enjoy foraging for it, as my dog, Lady, loved to do. Garlic’s properties have proven far-reaching, easily assimilated, and safe. In the past 80 years, during holistic medicine’s rebirth in the United States, garlic has been in the forefront of both human care and animal husbandry. Every textbook I have researched on herbal medicine that also mentions pet care recommends it, especially for its incredible anti-parasitic, anti-carcinogenic, and antiseptic properties. In my own experience, garlic has also benefited animals with valley fever (Coccidioidomycosis), heartworm/fleas/ticks, IBS, diabetes, liver, heart and kidney disease, allergies, uncontrollable staph infections (that are non-responsive to all antibiotic protocols), and a host of other conditions. Garlic is also a staple in my preventative protocols. Garlic has been widely and safely used by hundreds of thousands of Azmira pet parents for over 30 years, with no reported serious negative side effects – except on the breath.

SEPARATING FACT FROM FICTION For the last few decades, primarily as a result of the onion’s reputation for triggering Heinz body hemolytic anemia because of its higher concentration of thiosulphate, garlic (the onion’s “kissing cousin”) was also said to be toxic. Garlic simply does not contain the same thiosulphate concentration as the onion does. In fact, it is barely traceable and readily excreted. “In the testing of onions and garlic on (the dog’s) blood cell oxidation, onions have about 15 times the ability of garlic to damage red blood cells,” states nutritionist Dr. Dave Summers on IndigoPetz.com.1 Almost all the “evidence” against garlic for dogs comes from a 2000 study at Hokkaido University.2 Four dogs were each given 1.25 ml of garlic extract per kg of body weight for seven straight days. For example, if the dog weighed 50 pounds, he would be given approximately 25 large raw garlic cloves. None of the dogs showed any outward toxicity symptoms, but there was an effect on their red blood cells, even though at these highly-elevated doses none of the dogs developed anemia. “We believe that foods containing garlic should be avoided for use in dogs,” the researchers stated. However, a study published by Chang, et al in 20043 clearly showed that allicin is beneficial to mammals’ health, and there was no report of hemolytic anemia in spite of the high concentrations of IVC Spring 2016

garlic provided during the study. “In contrast, the maximal aggregation percentage returned to the control level at 1mM of all(en)yl thiosulfates in both canine and human platelets,” rather than remaining high enough to be a problem as originally thought. This encouraged the scientists to reverse their earlier 2000 recommendations against garlic for dogs and actually recommend garlic to promote immune functions and prevent cardiovascular diseases. There can be multiple causes for Heinz body hemolytic anemia. Wendy Wallner, DVM, reminds us that other substances such as acetaminophen (Tylenol) and benzocaine-containing topical preparations can also cause Heinz body hemolytic anemia in the dog. These preparations probably account for many cases since ingredients in creams are absorbed through the skin, allowing toxins to build up in the bloodstream.

USE OF GARLIC IN YOUR PRACTICE Garlic works through physical means. It can interfere with medications, especially blood thinners, so it is best to research possible drug interactions. Although herbs and supplements may be “natural”, they should be respected and researched so you can understand and evaluate their full value to your practice.

Powdered garlic, and indeed encapsulated dry herbs of any kind, are so weak that they barely perform. “Deodorized” garlic lacks active allicin (enzymatic actions are noticeably stinky), and tableted supplements weaken digestive processes with potentially toxic binders (brewer’s yeast, flavoring). Glycerol-suspended garlic products, although tasty, form a moisture barrier inhibiting mucous membrane and cellular assimilation. Cold pressing garlic maximizes the benefits – Azmira’s Garlic Daily Aid is 1,000 mg of cold pressed garlic plus 500 mg of parsley oil in individual gelcaps, which also protect against oxygen exposure.

SAFE RAW GARLIC DOSAGES FOR DOGS AND CATS Many veterinary practitioners and authors follow the dosage recommendations in Juliette de Bairacli Levy’s book, The Complete Herbal Book for the Dog. She recommends: • 10 to 15 pounds – ½ clove • 20 to 40 pounds – 1 clove • 45 to 70 pounds – 2 cloves • 75 to 90 pounds – 2½ cloves • 100 pounds and over – 3 cloves A 2008 report published by the National Research Council is more conservative in its dosage information. While the committee that prepared the report was unable to determine the safe upper limit of garlic intake for dogs, cats and horses, it could “use available research to recommend a range of acceptable intakes according to historical safe intakes (HSI) and estimated presumed safe intakes (PSI)”.4 Based on a clove weighing 3 g, the PSI for: • A 50 lb. dog is 1.2 g or .045 ounces/day, which is equivalent to approx. ½ clove per day • A 15 lb. cat is .12 g or .004 ounce/day, which is equivalent to approx.½5 clove per day • An 850 lb. horse is 34.8 g or 1.2 ounces/day, which is equivalent to approx. 11 cloves.

IVC Spring 2016

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VetzLife All-Natural News

Garlic’s

By Christopher Kelly Groth Business Development, Vetzlife/Petzlife all-natural

Garlic contains multiple sulphur-inclusive compounds

Enhancing the effects of professional dental care

SULPHUR-INCLUSIVE COMPOUNDS

– alliin, a noted sulfoxide; and alliinase, an enzyme. When garlic is chopped, crushed, minced or chewed, the alliinase enzyme is activated, and combines with the alliin protein to produce allicin, the therapeutic component of garlic. Heat inactivates enzymes, so by waiting at least ten minutes after chopping so the enzyme has completed the reaction with the alliin, the therapeutic value is maximized. Allicin is heat stable.

Remember that garlic cloves vary greatly in size, with one clove garlic = 3 g to 7 g. As with any herbs, I believe it is always a good idea to take a week off from garlic every couple of months.

PRECAUTIONS While garlic is safe to use, keep the following in mind when selecting and prescribing it for your patients: • Select companies that avoid sourcing garlic extract from China, as it is often contaminated with high levels of arsenic, lead and added sulfites. • Raw garlic fed directly is high in insoluble fiber and certain sulfur compounds, so it could be a potential issue for dogs that have oral ulcerations, esophageal obstructions, reflux, IBS or colitis. • When used in the dosages given above, garlic is safe even for pregnant dogs. The only caution is that overly large ingested quantities may flavor the milk of lactating females and turn off the pups from nursing, so start with small doses if nursing problems exist. Summers D. “Understanding Garlic”. IndigoPetz.com or facebook.com/permalink.php?id=125654427474116&story_ fbid=643173565722197; October 10, 2013. 2 Lee KW, Yamato O, Tajima M, Kuraoka M, Omae S, Maede Y. “Hematologic changes associated with the appearance of eccentrocytes after intragastric administration of garlic extract to dogs”. Am J Vet Res. 2000 Nov:61 (11): 1446-50. 3 Chang HS, Yamato O, Sakai Y, Yamasaki M, Maede Y. “Acceleration of superoxide generation in polymorphonuclear leukocytes and inhibition of platelet aggregation by alk(en)yl thiosulfates derived from onion and garlic in dogs and humans”. Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, 060-0818 Sapporo, Japan, 2004. 4 Riviere Jim E, Boothe Dawn M, Czarnecki-Maulden Gail L, Dzanis David A, Harris Patricia A, Hendriks Wouter H, Kirk Claudia A, Warren Lori K, Lewis Austin J, Arieti Ruth S. “Safety of Dietary Supplements for Horses, Dogs, and Cats”. Committee on Examining the Safety of Dietary Supplements for Horses, Dogs, and Cats, The National Academy of Sciences, 2008. 1

An integrative approach to dental care has been shown to improve oral health by combining professional care and cleaning with natural oral health products. “An evaluation was done of cats and dogs with and without professional cleaning below the gum tissue,” says Kimberly Wasko, CVT, VTS, ALAT, SRS Drexel University College of Medicine. “Significant improvements were seen, including reduced gingivitis, less bleeding on periodontal probing, gingival enzyme activity, and tartar reduction in treated areas. “Further clinical results demonstrated that topical application of VetzLife oral health products was effective in reducing the depth of periodontal pockets – similar to the effects of flossing in people. As well, healing was so accelerated that after five to eight days of treatment the diseased gingival sites were difficult to locate. We also utilized the spray formula as a ‘flush’ solution in the pockets of extracted teeth and the deep periodontal pocketed areas of surgical cases. Instead of ‘finishing off’ the oral cavity with a fluoride foam or gel after dental cleaning, we used the company’s oral care gels. “This suggests the topical application of VetzLife oral care products improves periodontal and dental disease not only as a sole treatment, but also in combination with surgical and non-surgical therapies.” VetzLife oral health products prevent plaque from forming, and also dissolve existing tartar. They’re also the perfect solution for elderly patients that are not candidates for scaling under anesthesia. Article provided by VetzLife/PetzLife all-natural products (VetzLife.com or 1-888-453-4682).

IVC Spring 2016

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 Spring 2016

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

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 The last few months at the WAEO have brought in 30 more new members, as veterinarians and animal health care providers worldwide realize that osteopathy is not just for treating musculoskeletal problems. Three new classes have begun at the Vluggen Institute this year, and our Facebook page will become a place to share cases and discuss new classes and therapies. • One of our post-graduate classes trains osteopaths to work with dogs and cats. It teaches students how to enhance physical exams by adding osteopathic evaluation to treat a variety of problems, such as preventing ACL surgery and providing significant improvement in cats with renal and pancreatic dysfunction. • The next class on canine osteopathy begins November 30. • A class on equine colon health and support will run September 26 to 29 in San Marcos, Texas. Visit vluggeninstitute.com for information.

Case report Here is one example of how osteopathy can correct multiple problems. First, know that temporomandibular motion restrictions and incisor misalignment in horses can affect the pelvis, and vice versa. Many horses have some immobility in the right sacral-iliac joint, restricted motion in the right ilium and sensitivity in the right flank. Often, there is also a restriction in the lumbar spine at the level of L3-L4. When doing an osteopathic exam, we often find a problem at the level of the right temporalmandibular joint, a problem with the atlantial–occipital joint, sensitivity to palpation on the base of the right ear, and incisors that are too long or slanted. Check teeth and address incisor balance for reoccurring problems with the hind end or shoulder.

shoulder and had difficulty picking up his canter leads. Conventionally, we would assume one side is weaker and the hocks are responsible for problems with leads. With the osteopathic knowledge above, it is clear how everything is connected. Treatment started by mobilizing the jaw and examining the teeth. This horse quickly responded by becoming balanced and easily picking up leads.

More info Dr. Ann-Marie Hancock has also shown that horses with asymmetry in their gait based on lameness locator data could significantly change and balance following osteopathic treatments. The data set showed an initial increase in inflammation two days after treatment, followed by improvement above initial baseline values at one week, and more improvement at the two-week mark. To learn more about the power of osteopathy, join us at our next conference at Olds College in Alberta, Canada from July 5 to 7. Topics will include epigenetics, water toxins and their effects on horses, saddle fitting, the use of cold salt water spas, equine treadmills and ProScopes in equine rehabilitation. To register and for more information, go to equineosteopathy.org, or visit our Facebook page at facebook. com/Worldwide-Alliance-of-Equine-Osteopaths-Conference2016-925465864198115/?fref=ts.

One owner’s complaint was that their horse didn’t seem to turn his head as easily to the right, bowed out his right IVC Spring 2016

integrative EQUINE

SPORTS MEDICINE By Sarah le Jeune, DVM, DACVS, DACVSMR, Cert Vet Acu/Chiro

ecent advances in sport horse medicine and rehabilitation have made it possible for equine athletes to reach new levels of excellence. Client demand for superior diagnostics and innovative treatment strategies require equine practitioners to be more informed than ever before. In addition to Western advances in sport horse medicine, complementary modalities such as acupuncture and chiropractic have become increasingly recognized as effective and valuable ways to treat equine athletes with musculoskeletal conditions associated with the demands of intensive physical conditioning and performance. Blending the best of traditional and complementary medicine provides an integrative approach to treating the whole horse, rather than focusing on a specific region or structure.

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A 2008 survey conducted by the American Association of Equine Practitioners stated that 20% of equine practitioner respondents perform some form of complementary medicine treatment modality themselves (most commonly acupuncture and chiropractic). Of those that do not, 80% refer cases specifically for complementary medicine to veterinarians who have this expertise. Multiple veterinary institutions including the University of California, Colorado State University, the University of Florida, Oregon State University, and Virginia Tech, to name a few, are including acupuncture and chiropractic in their clinical services and veterinary curricula.

ACUPUNCTURE CAN BOTH TREAT AND DETECT LAMENESS Horse owners are attracted to acupuncture because it is very safe, has minimal detrimental side effects, and is well tolerated by most horses. Horses experiencing performance issues associated with musculoskeletal pain, and who must comply with prohibited substance policies mandated by show associations, can benefit show-side from acupuncture and/or chiropractic treatments. This occurs at most elite competitions in compliance with the FEI.

exam to identify if they are lame, and if so, the cause of their lameness. Acupuncture can certainly be used to help relieve pain, particularly muscular pain, in many lameness conditions. But it is critical that the primary cause of lameness is also addressed with traditional methods. In the author’s experience, performance horses undergoing regular acupuncture treatments have a decreased necessity for joint injections, particularly of the distal hock joints. The author speculates that acupuncture helps the horse travel in a biomechanically sound manner, which may stress distal joints less than when the horse is compensating for muscle pain.

BACK PAIN – COMMON BUT DIFFICULT TO DIAGNOSE Back pain is very common in riding horses and can be very difficult to diagnose and treat with conventional methods. “Back pain” is a good example of a term that encompasses a wide variety of conditions, with just as many etiologies. The clinical signs are non-specific and the most consistent feature of

Lameness is the most common cause of poor performance in sport horses. Lameness typically results from pain associated with the musculoskeletal system, including joints, bones, tendons, ligaments, muscle and nerves. The majority of lameness cases are localized to areas within the distal limb; however, the sources of lameness are diverse and the causes numerous; they include, but are not limited to, wear and tear, overuse and trauma. Acupuncture can be used not only in the treatment but also in the detection of lameness in horses. It is interesting to note that most horse owners cannot adequately detect lameness until it is severe, that is, present at the walk. The author recently conducted a prospective study to answer the question of whether an acupuncture scan could be useful in screening for lameness in performance horses.1 The study population consisted of 102 performance horses (jumpers, dressage horses and Western performance horses) evenly distributed into lame and sound groups. These horses first underwent an acupuncture scan and then a routine lameness exam. The results of the study showed that when using an acupuncture scan, 78% (40/51) of the sound horses were negative, whereas only 18% (9/51) of the lame horses were negative (P < 0.001). This indicates that acupuncture scanning has a sensitivity of 82.4% in detecting lameness and a specificity of 78.4%. This suggests that horses with a positive acupuncture scan should undergo a lameness IVC Spring 2016

fit, shoeing, conditioning programs and rider ability should be assessed when dealing with such a case. Several studies report that acupuncture is effective in treating back pain in horses.6,7 In the authorâ&#x20AC;&#x2122;s experience, it takes at least three consecutive (weekly) treatments to obtain a long-lasting clinical resolution of back pain, and these horses benefit from regular (monthly) acupuncture treatments. The duration and quality of the therapeutic effect may be improved by incorporating chiropractic treatments in addition to acupuncture, but clinical studies are needed to confirm this impression.

a back problem is a loss of performance. Acute soreness is often associated with falling or some other traumatic incident, but this is rarely the case. Horses experiencing back pain may have a multitude of non-specific clinical signs: difficulty posturing to urinate, a reluctance to lie down or roll, a reluctance to saddling, grooming or picking up their feet, an appearance of collapsing behind while ridden, apparent stiffness, trouble backing, or apparent unilateral or bilateral lameness when working, with stiffness in the hind end. Behaviorally, the horse may refuse to work on the bit, or to bend or perform certain movements while ridden, or may exhibit another form of evasion. Horses experiencing chronic pain can also exhibit withdrawn social behavior, and possibly experience decreased appetite and nutritional intake. This is due to the effect of chronic pain on the emotional centers of the limbic system, which motivates the individual to withdraw from damaging situations, protect a damaged body part while it heals, and avoid similar experiences in the future.2-5 The human model of spinal rehabilitation includes a multidisciplinary approach in the management of back problems. Advances in the treatment of equine back pain incorporate some of the same philosophies. The difficulty lies in indentifying the exact cause of back pain, as it is often multifactorial. Back pain is commonly associated with lameness, and it is critical to identify whether the horse is indeed suffering from primary back pain or if the pain is secondary to distal limb lameness. Horses with back pain should therefore undergo a full lameness exam, potentially with limb blocks to rule out lower limb lameness. In addition, factors such as saddle

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The anatomy of the horse has evolved to allow him to move as efficiently as possible, with as little stress as possible. Any imbalance in the system will cause asymmetrical loading of limbs, and over time, this asymmetrical and unbalanced use will cause the overloaded structures to become inflamed, thus creating lameness. Traditional methods of diagnosis and treatment rely on pain and inflammation to locate a problem. Gait analysis, blocking, palpation, hoof testers, flexion tests, etc. all rely on pain and inflammation. Conventional treatments therefore most often center on anti-inflammatory medication, either locally and/or systemically, shoeing changes and rest, and pay too little attention to the biomechanics and efficiency of movement. Positive results are seen when the patient appears to be moving without pain or apparent lameness, at which point he is released from care.

THE INTEGRATIVE SPORTS MEDICINE EXAMINATION An integrative sports medicine exam is multifaceted and includes the following:

q Detailed history: emphasis on duration of clinical problem, previous treatments, diet, dental care, shoeing, type/ intensity/change of work, warm-up/cool-down, access to turnout, social behavior.

w Static

exam: emphasis on stance, foot balance, muscle symmetry, careful palpation of topline and all limbs, passive range of motion of all limbs, passive range of motion of TMJ, cervical flexions, hoof testers on all four feet.

e DAPE: Diagnostic acupuncture palpation exam. Continued on page 50.

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Saddle fit checklist

Balance: The center of the seat should be parallel to the ground. Withers clearance: Two or three fingers should fit between normal withers and the saddle. (Low “mutton” withers may allow a little more; very high withers, a little less.) Clearance should be all around, not just at the top. It is important to check that there is sufficient wither clearance even with the weight of the rider. Gullet width: The gullet should be three or four fingers wide, so it won’t interfere with the spinal processes or the muscles of the horse’s back. Panel contact: Panels should rest evenly on the horse’s back from front to back, without overstuffing in the middle (the saddle will rock) or bridging (with a gap in the middle). Billet alignment: Billets should hang perpendicular to the ground so the girth is not angled. This way, the girth will always find its correct position at the sternal groove, the narrowest point behind the elbow. Shoulder ﬁt: Panels at the front should be parallel to shoulder. Tree points (the front tips of the saddle frame) should be behind both shoulder blades. Straightness: The saddle should not tilt to one side when viewed from the back. Saddle length: The saddle should not be so long that it puts weight on the shoulder or loin area. The rider’s weight should be carried on the support area over the rib cage.

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Continued from page 48.

r Dynamic

exam: careful evaluation of walk, trot, canter in straight line and circle, on soft and hard ground (no canter on hard ground), followed by an evaluation of the horse ridden by a regular rider/trainer if performance problem is subtle.

 Stress tests: Lower and upper limb flexions.  Chiropractic exam of entire axial skeleton.  Evaluation of saddle. The integrative approach (incorporating acupuncture and chiropractic) to diagnosis and treatment focuses on the functionality and biomechanics of the whole horse and how this can change over time. This approach focuses on the entire horse and can potentially detect and address preclinical problems before actual structural damage has occurred. Due to the increased strain placed on equine athletes, it is important to examine sport horses on a regular basis every six to 12 weeks, depending on the intensity of work and the presence of clinical problems.

le Jeune SS, Jones JH. “Prospective Study on the Correlation of Positive Acupuncture Scans and Lameness in 102 Performance Horses”. American Journal of Traditional Chinese Veterinary Medicine, 2014. 2 Lynn B: Cutaneous nociceptors. In: Winlow W, Holden AV. The neurobiology of pain: symposium of the Northern Neurobiology Group, 1983, Manchester University Press, 1984, ISBN 0-7190-0996-0. p. 106. held at Leeds on 18 April 1983 3 Raj PP: Taxonomy and classiﬁcation of pain. In: Niv D, Kreitler S, Diego B, Lamberto A. The Handbook of Chronic Pain. Nova Biomedical Books; 2007. ISBN 1-60021-044-9. 4 Vernon H, Aker P, et al. “Pressure pain threshold evaluation of the effect of spinal manipulation in the treatment of chronic neck pain: a pilot study”. J Manip Physiol Ther 1990; 13:13-16. 5 Kandel, Eric R, et al. Principles of Neuroscience, McGraw-Hill, 1991. 6 Xie H, Colahan P, Ott EA. “Evaluation of electroacupuncture treatment of horses with signs of chronic thoracolumbar pain”. J Am Assoc. 2005 Jul 15;227(2):281-6. Vet Med Assoc 7 P Kulchaiwat, H Xie. “Effect of EA on chronic back pain in Sporthorses”. AJTCVM, Vol 4(1) 200 1

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.

Circle June 3 to 5 on your calendar. The Academy of • The AVH has joined the International Association of Veterinary Homeopathy invites you to their 19th Annual Veterinary Homeopathy. Membership in this international Case Conference in Austin, Texas that weekend. Among the group has many benefits, including an online discussion speakers is Tim Couzens, a British equine veterinarian and forum. For more information go to iavh.org. author of Homeopathy for Horses. Will Falconer promotes the success of homeopathy, while return speaker Kim Elia, CEO of Whole Health Now, shares his deep knowledge on the topic. USE OF HOMEOPATHIC ARNICA FOR OLD Susan Beal, meanwhile, is a staunch supporter of sustainable INJURY AFTER PARTURITION agriculture with the use of homeopathy for a kinder life for livestock. For more information on the conference, visit By Betsy Harrison, DVM, CVH, DipHom theavh.org.

CASE REPORT

Reprinted from the AVH Journal, Winter 2016

Homeopathy can cure a wide range of conditions. The 2015 Annual AVH Case Conference covered homeopathic treatment for rectal prolapse in pigs; pneumonia in cattle; digit amputation; abortion and weak offspring; umbilical hernia; feline gingivitis/stomatitis; chronic rhinitis; feline renal failure; lymphoma; non-healing ulcer on the face of a dog after a snake bite; and restrictive cardiomyopathy.

On a farm call, my attention was drawn to a cat squatting and crying out, as if in pain. I asked the clients about her. They responded that she had been crying with urination ever since she had kittens over a year ago. They had taken her in to the conventional veterinarian. No abnormalities were found on urinalysis, radiographs and blood work. She had undergone a routine spay as well. Still the yowling continued any time she tried to urinate.

Successful cases written about in the AVH Journal, meanwhile, have included: • Closure of cleft palate and improved body condition of a nine-week-old puppy • Resolution of recurrent diarrhea in a 12-year-old dachshund • Resolution of chronic stomatitis in a two-year-old cat • Healing of chronic digestive disease in goats and horses

The other thing that had changed was her petability. Before the parturition, she had been their daughter’s favorite cat, always cuddling and snuggling, wanting to be petted. Since that time, however, she would not allow anyone to touch her.

ADDITIONAL NEWS • The Homeopathy Working Group – a forum for lively and interactive discussion of homeopathy case management, homeopathic medicine description, selection and help on individual cases – has moved to the second Wednesday of the month at 8 pm EST.

These two factors – never well since parturition, combined with the fear of being touched – led me to recommend a dose of Arnica in 200C potency. They gave the first dose in cheese; after three days, there was no response. I recommended that they give it again, this time in milk. The following morning, she squatted to urinate normally, with no crying. She soon returned to being the cuddle-cat she had been prior to her traumatic queening experience.

IVC Spring 2016

AGGRESSION

By Margo Roman, DVM, CVA, COT, CPT, FAAO

t our clinic, we see dogs whose behavior ranges from good to fearful. Many dogs exhibit behaviors that only their owners will tolerate, but they wouldnâ&#x20AC;&#x2122;t be considered dangerous. Some dogs, however, become very aggressive (a few even seem to be this way from birth). Statistics tell us more than 4.5 million dog bites occur every year in the U.S. alone.1 What is our job as veterinarians when dogs bite?

RESOLVING AGGRESSION Our goal is to completely resolve the aggression so the dog is 100% trustworthy, or at least able to

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have a reasonable quality of life in a caring home. When assessing an aggressive dog, it is important to discover the triggers so the owners can live more safely while deeper cures are working. Sometimes, merely recommending a good trainer and using consistent rewards for positive behaviors is sufficient treatment, and certainly a good first step. Many clicker and positive trainers even specialize in treating aggressive dogs. But what if there is an underlying issue? As conventional veterinarians, our options are limited to drugs, referral to behavioral specialists,

POSSIBLE CAUSES OF AGGRESSION INCLUDE:

q One or a series of traumatic events in the dog’s life w Mental triggers e Poor training r Hypothyroidism, low tryptophan or other medical condition

t Poorly functioning intestines with an weak

microbiome, which causes a weak immune system

iet and food choices, D which cause “allergies”

In the future, tests will be available to evaluate microbiome species that may cause neurotransmitter difficulty.

MANY APPROACHES TO A COMPREHENSIVE PHYSICAL EXAM A careful history and physical exam is critical to determine the possible cause of aggression, and to guide us towards a modality selection. Chiropractic and osteopathic evaluation may reveal pain or other fascial issues causing the aggression. TCVM diagnostics, including tongue and pulse examinations, may point to specific Qi imbalances that may be the culprit. We have even found input from a medical intuitive or animal communicator to be useful.

TREAT THE GUT As an integrative veterinarian, I treat the whole animal. I always start with the gut–brain connection, healing the intestines so the dog’s stronger immune system will improve mental health. The microbiome is critical for brain function, so we need to nurture and support the entire gastrointestinal tract. Intestinal microbes have many functions and are the precursors of neurotransmitters, which are key to mood issues.3,4 Consider the options that follow and remember to keep a journal to record changes with each treatment.5 Continued on page 54.

u Vaccine damage i Instability, with no

known reason for the mental situation

o Anxiety rather than true aggression.

physical restraint, pulling all the teeth, and euthanasia. Fortunately, we can integrate holistic modalities into our practice to increase the chances of improving the mental state of any dog or other domestic species.

DIAGNOSTICS FOR AGGRESSION Diagnostics may reveal an underlying cause that can be treated, so it is important to run thorough tests. Blood work must include a comprehensive thyroid screen including total T4 and T3, free T4 and T3, T3 and T4 auto-antibodies, thyroid stimulating hormone and thyroglobulin auto-antibody (see Figure 1 at right). I recommend the services of Hemopet, Michigan State, or Antech. A complete profile may reveal a toxic liver or other medical issues, which can then be treated with holistic options. Another diagnostic I have found very useful is Dr. Plechner’s endocrine blood immune panel, performed by National Veterinary Diagnostic Services (national-vet.com – call for submission procedures). This panel measures the relationship of IgA, IgM and IgG to the thyroid, cortisol and estrogen levels. Measuring these values will identify dogs whose aggression may respond to the Plechner protocol.2 Dogs with weak immune-globulins, specifically IGA, cannot absorb nutrients from their gut mucosa. This can lead to a weakened immune endocrine system, which may be a cause of aggression. Continued on page 54.

Figure 1: This thyroid screen from Hemolife (Hemopet) shows a positive result for autoimmune thyroiditis.

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Continued from page 53.

q Feed a whole food diet with lots of green vegetables (kale,

bok choy, zucchini, celery) and yellow/orange vegetables (butternut squash, carrots, beets), a minimal amount of grain (use high protein choices like quinoa or millet if needed), and a raw meat protein source that is “cooling” in nature from a TCVM food therapy perspective (fish or rabbit). Prolonged exposure to a high fat beef diet should be avoided because it can cause low tryptophan, which can lead to aggression in some dogs (Steve Brown, “Can high-fat beef-based raw diets lead to behavioral issues in some dogs?” IVC Journal, Vol 5 Issue 1, Winter 2014/15).

w Increase the gut flora with probiotics, digestive enzymes, colostrum, enteric glandulars, antioxidants and phytonutrients, as well as high quality Omega-3 oils that are supportive for gut flora.

e Since dogs (and cats) increasingly need dramatic treatment to restore normal intestinal flora, consider MBRT (microbiome restorative treatment), also called fecal transplant (Margo Roman, “Microbiome restorative therapy healing the immune system”, IVC Journal, Fall 2014). In my practice at MASH in Hopkinton, MA, we have seen aggressive dogs become more congenial and behave better with MBRT. (MBRT can decrease generalized inflammation, which is known to cause depression.6) Sometimes the benefits last for months and sometimes it is only a temporary fix. We have access to the stool of dogs that are calm and sweet; raw fed for generations; never had an antibiotic, commercial dog food or chemicals; and are minimally vaccinated.

CASE STUDY

Archie, a six-year-old neutered wirehaired fox terrier, had been aggressive and anxious since puppyhood. He had gastrointestinal issues and puritis, and would attack his sister, pinning her down and dominating her.

Archie was diagnosed with an immune endocrine imbalance via an endocrine blood immune panel. He had low IgA, IgM and IgG, as well as low thyroid and elevated estrogen. He lived on a restricted diet containing a lot of tripe.

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SUPPORTIVE HOLISTIC TREATMENTS While analyzing the diagnostics and formulating the treatment plan, and while the owners are working with a positive trainer, these approaches may ameliorate aggressive symptoms:

q Emotional Freedom Technique (EFT)

and Animal Talk – these two methods use tapping and Applied Kinesiology to shift the mental state. The tapping can be done on the dog (if safe) or on the owner. Tapping on the front of the dog’s head or yours, while thinking of positive reasons why the dog will be well behaved, can have amazing results. This extrapolates to reminding the owners to always use positive talk with their dogs. Classes are available online or you can add an income stream to your practice by teaching classes to your clients.

w Flower essences – this therapy is 100% safe and can be used along with conventional or alternative therapies. Rescue Remedy (always important to sell in your clinic) and other specific anxiety and aggression single or combination essences (Bach, Spirit Essences,

After ozone therapy and a fecal transplant, Archie’s personality changed within 30 hours. He began licking and grooming his sister, and his anxiety was gone. His amiable personality and ability to eat anything resulted in very grateful clients. Two-anda-half weeks post microbiome treatment, he was dosed with Interceptor Milbemycin oxime – 30 hours later, he attacked and almost killed his sister. Interceptor is an intestinal antibiotic that kills many organisms in the gut. In Archie’s case, a reduction in aggression was directly associated with the microbiome. Another MBRT brought him back to more amiable balanced health. Archie needed fecal transplants every three weeks until he received one from Lilly, a pregnant donor, which lasted five months. Having all the growth hormones and tissue-building activity really made a difference on his gut.

Green Hope Farms, Anaflora) can be rubbed on the ears, put in a dosing water bowl so the dog can self-select, added to food, put on dog beds, etc. Dosing can be repeated as frequently as is helpful.

e Essential oils â&#x20AC;&#x201C; specific oils, including

lavender and possibly chamomile, may also be very calming to the animal (Dr. Shelton discusses anxiolytics on page 26 of this issue). Peace and Calming by Young Living, or similar combos from other oil companies, can be diffused or used as a light spray in water suspension. The quality of the oils is important, as discussed by Dr. Shelton in the Winter 2015/16 issue of IVC Journal.

DEEPER TREATMENTS The joy of integrative medicine is being skilled in many approaches, or referring to other veterinarians who specialize in complementary modalities, such as: While aggressive animals q TCVM:

may initially be poor candidates for acupuncture, treatment at home can include herbs in the food, Tui na, selection of foods according to Chinese Food Therapy, and acupressure when the dog is calm.

w Homeopathy:

Remedies can be very successful when the symptom

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pattern is clear. When the aggression seems related to vaccinosis, homeopathy is the ideal approach.

LAST RESORT TREATMENT

When every attempt to correct aggression has failed, the American Veterinary Dental College (avdc.org/aggressivetreatment.html) has three recommendations – full mouth extraction, crown reduction to the gingival margin, or euthanasia. They comment that full mouth extraction needs general anesthesia, pre and post radiographs, and post-op pain medications. Crown reduction at the gingival margin also necessitates root canals for each tooth. Root canals can abscess, be a source of infection or inflammation for other parts of the body, and cause other issues as they lie along acupuncture meridians.8,9 Costs for these procedures are high, up to $4,000 for the canines and two incisors. I have had excellent success using a diamond blade to file the canines, upper and lower incisors, and the third upper incisor, but not to the gum margins. If the dog’s teeth are mature, the dental pulp and nerves are closer to the root, so root canals are not needed. Younger dogs have very extended pulps, so may need extraction or root canals. I have done over 20 dogs, and only one adult dog with retained lowered canines where the pulp did not retract, therefore needing extraction. All options are offered and most clients have chosen this modified filing method as there is no risk from root canals and the cost averages $400. Filing seems to even decrease aggression as perhaps the dogs feel they don’t have the bite they used to, so become more trainable.

e Chiropractic

and Osteopathy: These treatments can resolve aggression when it is due to pain or even to past pain (Jeannie Waldron, Ann Marie Hancock, “Using osteopathy to diagnose and correct a displaced ovary in a ‘grumpy’ mare”, IVC Journal, Winter 2014/15).

r Drug therapy: When indicated by lab tests, thyroid medication can resolve

aggression. Several large studies have shown significant resolution of aggression within a short time of beginning the medication.7 In addition, many veterinary animal behavior therapists recommend prescription medications for either aggression or anxiety. Considerations here include side effects, cost and administration concerns.

Treating aggressive animals is a challenge that often requires the attention of both veterinarians and animal behaviorists. Keeping an open mind to a variety of integrative options may stop an animal from hurting someone, and ultimately save his or her life.

cdc.gov/features/dog-bite-prevention/index.html Plechner, Al. “Cortisol Abnormality as a Cause of Elevated Estrogen and Immune Destabilization”, drplechner.com/pdf/elestrogen.pdf, p 1. 3 Beaver, Bonnie, DVM. Canine Behavior. Elsevier Pub, p 150. 4 sciencedirect.com/science/article/pii/S1369527413000787; articles.mercola.com/sites/articles/archive/2014/01/02/food-affects-mood.aspx. 5 Chambreau, C. Healthy Animal’s Journal. TRO Productions, 2003. 6 drperlmutter.com/depression-microbiome-leaky-gut. 7 Dodman et al. “The effect of thyroid replacement in dogs with suboptimal thyroid function on owner directed aggression”. J Vet Behav, 2013: 8:225-230. 8 Kulacz, Robert, DDS and Levym JD, MD. “Toxic tooth: How a root canal could be making you sick”. November 1, 2014. 9 Meinig, George E. Root Canal Cover Up, March 3, 2008. 1

IVC Spring 2016

The AHVM Foundation is a 501(c)(3) non-profit charitable organization that benefits the public good through scientific research and education in integrative veterinary medicine. It seeks to be a model of both high quality and high integrity work in integrative therapies. We hope to discover information that improves education and clinical practice for both human and veterinary medicine.

STUDY UPDATES The Foundation has supplied funding for 15 research studies. Of those, four are now finished:

q Rodale study of baseline information on pastured hogs. w Study on the coagulant properties of Yunnan Baiyao in horses, which characterized increased action of a number of items involved in coagulation. e Equine postural study, which provided information on a method to objectively measure changes in posture before and after manipulative therapy. r Half-dose vaccine for small dogs pilot study, to determine whether dogs weighing less than ten pounds can mount an immune response with half the recommended dose of vaccine. (The details of the results are featured on page 20 in this issue of IVC Journal.) In addition, Dr. Jean Dodds’ study on antibody detection for food allergies in equine saliva was initially approved for funding by the Foundation. Dr. Dodds generously donated the cost back to the Foundation. Other studies still being carried out include: • Aloe vera compared to Omeprazole for equine ulcers. • GMOs in dog and cat food. • Comparison of non-anesthetic versus anesthetic teeth cleaning using technicians trained by human dental technicians.* • Use of fat stroma in cats with chronic kidney disease (similar to stem cells, but simpler extraction). • Use of the Banerji Protocol for canine osteosarcoma. • Action of low level lasers on equine tendon fibroblasts. • Acupuncture to alleviate side effects of cancer chemotherapy. • Acupuncture for equine laminitis. • Acupuncture and Chinese herbs – standard protocol for lymphoma.

*There has been difficulty in finding a university to host the dental study. Preliminary evaluations by boarded veterinary dentists in a blinded assessment indicated that non-anesthetic teeth cleaning procedures in dogs, done by properly trained technicians, are just as good as those done under general anesthetic. The Foundation feels the question of whether or not it works should be settled by research, not speculation. We have two other studies that have been approved but not yet funded. They include the use of Nagalase as a test to follow the success or failure of cancer treatments; and the use of low level laser therapy for canine acral lick granuloma. The Grant Committee is reviewing two additional applications for funding for agmatine in IVDD, and low level laser therapy to ameliorate aggression in shelter dogs.

OTHER NEWS •O ur winter fundraiser successfully raised over $72,000. We are starting to receive a number of monthly and quarterly recurring donations, and average donation amounts are beginning to increase. The Foundation’s fundraising seasons have been from spring/fall to summer/winter. The next event will be from mid-May to mid-June. • J udging by the number of times our Facebook page is shared, we are reaching about one million people! •T he Foundation plans to increase its number of blogs, and to reach out more directly to individual veterinarians to elicit both veterinary stories and pet owner stories. We will also begin a review section, listing research on various holistic modalities. Abstracts will be rewritten in laymen’s language to make them more accessible to the general public.

IVC Spring 2016

integrative practice

Using

By Anne Gard, DVM

in a feline spayneuter clinic

IVC Spring 2016

“This is the pain medicine you will be giving your cat at home. It is tasteless and very easy to give, so medicine time won’t be a big chore. This medicine will not alter behavior, and it will not make your cat feel sick. He will act and feel completely normal. You cannot overdose him with it, and it will not harm people or pets in the home if they accidently ingest it. It’s very safe.”

I begin all client discussions about take-home medicine with the above paragraph. It usually elicits an expression of relief, since many clients have had bad experiences giving medication to their cats. I don’t have to shove a pill down his throat? Correct. He won’t drool, vomit, or hide under the bed? Correct. He won’t be wobbly? Correct. It won’t hurt my other cat or my two-year-old son if they get into it? Correct. I have been using homeopathy for over 15 years, and have found that the easiest and most rewarding application for it is in the surgical arena. This is especially true when dealing with feline patients and the unique challenges that accompany their care. I choose to use homeopathic drugs over conventional pharmaceuticals because they do a superior job at ensuring a pain-free recovery. Homeopathy is a singular, very specific type of medical treatment. It is distinct from other categories of complementary medicine. Homeopathic treatment requires the use of special medicines, called remedies, which are prepared in a unique, deliberate manner in order to make them homeopathic.

T he harmlessness of homeopathic medicines is also valuable when considering the typical feline patient. A substantial percentage of these cats are strays in less-than-optimal health (accompanied by owners with minimal finances for veterinary care, precluding the option for pre-anesthetic bloodwork or medical correction of pre-existing health conditions). Homeopathy is a tremendous tool under these circumstances because it is gentle and will not exacerbate any disease conditions.

Homeopathy is more affordable than pharmaceuticals omeopathic remedies are extremely affordable. They can H be purchased in various quantities costing around $9 for a 2 dram (1/4 oz) vial and $40 for a 4 oz bottle.1 A 4 oz bottle will conservatively yield over 3,000 doses, which translates to one penny per dose.2 Comparatively, Metacam and Torbugesic each cost about $1.50 for a single injection for an adult cat.3 Continued on page 60.

THE BENEFITS OF HOMEOPATHY Homeopathic medicines possess numerous beneficial properties that traditional pharmaceutical medications often lack. They are very easy for both owners and practitioners to administer, and are extraordinarily safe, inexpensive, and extremely effective when appropriately used.

It’s a safe pain management option Pain management in feline patients is full of challenges. Analgesic options are limited and associated with substantial toxicity risks and unpleasant side effects. Homeopathy is an appealing option for feline postoperative analgesia because the concerns that surround NSAID and opioid use are nonexistent with homeopathy. Homeopathic medicines do not cause injury to organs, and do not provoke side effects such as sedation, ataxia, and nausea. These safety attributes are also important when considering unintentional exposure events involving humans and other pets in the home. Accidental poisoning is a non-issue. IVC Spring 2016

Continued from page 59. It’s effective for pain and healing Homeopathic medications are very effective for surgical needs. Analgesia is the primary surgical use, but homeopathic analgesics additionally possess antiinflammatory, anti-suppurative, and pro-healing properties, making them additionally rewarding. Homeopathic medicines exert their effect quickly after administration and are long lasting. Often, only one dose of medicine is needed to achieve a successful, permanent result.

Post-operative pain research shows that pain is greatest within the first 24 hours after surgery, and behavioral changes indicative of pain typically persist for at least three days in dogs and cats following routine ovariohysterectomies.4 The tabulation of post-operative pain scores, using either the Botucatu Multidimensional Composite Pain Scale or the Colorado Acute Pain Scale, is recommended by some pain management experts to objectify pain and help veterinarians make prescribing decisions.4 When applying either pain scale tool to my patients while using homeopathy, I find that the vast majority receive a perfect pain-free score of zero. Homeopathy is doing a very good job at providing analgesia in my patients.

MATCHING THE PATTERN OF DISEASE The one drawback to using homeopathic medications is that they do not always have the desired effect on the patient. The reason is that in order for a homeopathic medicine to exert its effect, it must match the patient’s pattern of disease. This pharmacologic principle is unique to homeopathy and warrants a brief explanation for clarification. Compare a puncture wound injury (e.g. stepping on a nail) to an injury caused by blunt trauma (e.g. something heavy dropping on the foot). The nature of the tissue damage, likelihood of infection, quality of pain, and expected course of healing are very different between these two insults. In other words, punctures induce a different pattern of disease in the body than blunt trauma does. The homeopathic medicine that would best treat most puncture wound patients is not the same as the one that would best treat most blunt trauma wound patients. This is a very different approach than the one used in conventional prescribing, and recognition of this concept is integral to success in homeopathic medicine. Over 600 homeopathic remedies are available to treat illness, and to practice homeopathic medicine correctly requires education. However, any surgeon can use homeopathy effectively without the need for deeper schooling. Surgical procedures insult the body in a relatively similar manner in all patients, so matching the patient’s symptom pattern with the correct remedy is a relatively easy task in most surgical patients.

IVC Spring 2016

Arnica or other indicated remedies can be administered onto the gums after surgery.

HOMEOPATHY IN THE FELINE SPAY-NEUTER CLINIC Homeopathy can be easily assimilated into a spay-neuter practice. Any anesthetic drug protocol being used can continue “as is” without modification. Homeopathy is simply added to the preexisting protocol. • Homeopathic medications are available in different pellet sizes and in different strengths called potencies. For animal use, the small poppy seed-sized pellets (#15 or #10) are recommended because they are easiest to work with. The 6C potency is good for spay-neuter use. These pellets come in glass containers of various sizes, and all are multi-dose. • The most common way to provide an individual dose of medicine from a multi-dose vial is to remove the lid and pour

enough pellets into it to make a single layer covering the bottom. In cats, the ½ dram vial size works well to provide a good dose of medicine (yielding about 40 pellets per dose). • The single layer of pellets is poured from the lid directly into the mouth by lifting the upper lip and depositing the pellets

onto the gingiva or buccal mucosa where the pellets stick to the saliva film and dissolve. • For cost efﬁciency, commonly-used medicines such as Arnica can be purchased in larger sizes (e.g. 4 oz bottle) and transferred to a few ½ dram vials for ready in-clinic use. Continued on page 62.

DISPENSING HOMEOPATHIC MEDICINES

It is common for pet owners to inquire about at-home pain management for post-operative needs. There are three options you can consider:

Dispense individual doses in large (size 00) gelatin capsules in a 10 dram amber pill vial. This method is familiar to owners and easy to use, but labor intensive for you. Directions are one dose q24hr x 3 days, then as needed. I demonstrate pulling off the top of the capsule, pouring the pellets directly into the mouth, and discarding the capsule. Cost: 60 cents

Fill individual paper envelopes with single doses. Owners can shake the loose pellets into one corner, generously cut this corner off from the rest of the envelope and, using the cut corner like a pointed cup, pour the pellets it contains into the mouth. Cost: 30 cents

Dispense a multi-dose quantity into an amber ½ dram glass vial. This is excellent for clients with multiple cats and takes the least time to process. However, some clients may be uncomfortable using a vial because they negatively associate this atypical means of dispensing medicine with illegitimate drug use, which means compliance is lowered. A single layer of pellets is poured into the vial lid, then directly into the mouth. Cost: 40 cents

IVC Spring 2016

Continued from page 61. The 4 oz bottles are too awkward to use for dispensing individual doses, but the ½ dram vials are quite manageable and minimize waste. Empty glass vials of all sizes can be obtained online. • A unique attribute of homeopathic medicines is that the exact amount of each dose does not need to be precisely determined. A two-pound kitten will receive the same amount as a 15-pound tomcat. The patient’s body simply needs to be exposed to “some” medicine in order to be appropriately affected, and this vial lid single-layer dose has become a common, arbitrary unit of measure for dosing homeopathic medicines in animals. • The tastelessness and dissolvability of these medicines make it easy for owners to give them at home. The medicine works most effectively if given by mouth, directly and unadulterated, but it can also be sprinkled onto a dollop of wet food, added to a small serving of milk, or be mixed with water and syringed into the mouth if needed. • Dosing intervals are determined on an as-needed basis, another way in which homeopathy differs from conventional medicine. In homeopathy, a single dose of medicine is administered to a patient, and additional doses are typically not given unless symptoms return or fail to abate. In acute care situations like surgery, one or two doses are generally sufficient to keep the patient symptom-free.

SPECIFIC REMEDIES Arnica montana The most valuable remedy in surgery is Arnica montana. It is given prior to surgery to provide pre-emptive analgesia, minimize inflammation and hemorrhaging, and prevent suppuration. It is also given immediately after surgery to help boost the first dose and provide long-lasting effects. Practitioners can effectively implement homeopathy into their practices by using only Arnica and no other homeopathic remedies. In the majority of routine sterilization procedures, no further pain medicine needs to be given; these two doses of Arnica are sufficient to ensure a pleasant and comfortable pain-free recovery. Occasionally, however, Arnica is not sufficient, and a patient does need the additional benefits of a different homeopathic medicine. Patients can

IVC Spring 2016

be reassessed after fully awake, and any cats exhibiting discomfort should be given another analgesic remedy based on their particular symptoms. Secondary analgesics B ellis perennis – Patients are tired and sore. Useful for postovariohysterectomy patients that exhibit no remarkable guiding symptoms.

w R hus

toxicodendron – Symptoms may include hind leg weakness, muscle twitches, body tremors, frequent changes in position, abdominal flank contraction, heavy sleeping (may have taken a long time to awaken from surgery).

e S taphisagria – Patients are often nervous, very reactive to stimuli, and do not like incision sites touched. Best choice for incision site discomfort. Supplementals C alendula topical gel – Soothes inflammation, prevents infections. Apply thin film to incisions.

w H ypericum perforatum – For injuries involving nerves. Very useful after declaw procedures and after amputation of the tail.

e Millefolium – For oozing of blood from incisions. r Carbo vegetabilis – Used for post-operative shock. t L edum - For human staff with serious, deep cat bite wounds. BILLING FOR HOMEOPATHY I do not charge for in-house homeopathy use. My patients receive any needed treatment when it is indicated at no additional cost. However, it is a more common practice for veterinary facilities to charge an additional fee for in-house adjunctive pain management, and this additional fee is expected by most clients. Homeopathy can be very profitable when offered in this manner. The option of homeopathic perioperative analgesia (i.e. Arnica) as an add-on service can be offered to owners. Simply charging a nominal fee of 25 cents per patient yields a healthy 92% profit margin.2 Charging a more

STORING HOMEOPATHIC MEDICINES

Homeopathic medications do not expire like conventional pharmaceuticals do, but their efficacy is diminished by strong odors and electrical appliances. They should therefore be stored in a closed cabinet away from electronics and any strong odors.

realistic fee of $1 or $5 for this optional in-house homeopathic analgesia can easily generate a substantial ancillary income.

HOW TO ORDER HOMEOPATHIC REMEDIES Four parameters need to be specified: name, potency, pellet size, and quantity. As previously mentioned, the small poppy seedsized pellets (#15 or #10) and 6C potency are recommended. The 2 dram vial size provides hundreds of individual doses and is a good starting quantity for practitioners interested in experimenting with homeopathy.

SUMMARY Homeopathy can be a wonderful tool for the veterinary surgeon, and its use can be particularly valuable for feline patients. The affordability of homeopathic medications creates a very feasible analgesic option for tightly-budgeted spay-neuter clinics, and the additional benefits of efficacy, ease of administration, and safety make it worthwhile for any veterinary surgeon to experiment with.

Prices from Natural Health Supply (a2zhomeopathy.com). Retrieved 11/7/2015. Calculation determination: #10 pellets in typical dose (½ dram vial lid single layer) comes to 40 pellets; #10 pellets in ½ dram vial is 2,000 pellets; #10 pellets in 4 oz $40 bottle is 128,000 pellets (3,200 doses at 40 pellets per dose), which costs $0.0125 per dose. 3 Torbugesic price from shopmedvet.com. Retrieved 11/7/2015. Torbugesic 10mg/mL 10 mL vial = $102.72, yields about 70 doses; cat dose is 0.2mg/lb (7lb cat: 1.4mg = 0.14 mL = $1.46 injection). Metacam price from midwestvet.net. Retrieved 11/7/2015. Metacam 5ml/mL 10mL vial = $90.75, yields about 50 doses; cat dose is 0.14mg/lb (7lb cat: 0.98 mg = 0.2 mL = $1.82 injection) 4 Murrell, Jo. (2015, February 23). “Managing Postoperative Pain in Companion Animals”. Veterinary Times, February 23, 2015. vettimes.co.uk/article/managing-postoperative-pain-in-companion-animals. 1 2

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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? It was Devil’s Club (Oplopanax horridus). This herb from the ginseng family is found only in the Pacific Northwest – where this June’s Domestic Eco-Tour will be held. The root bark is the part mainly used medicinally; but whole rhizomes, roots, stem and leaves have also been used. Devil’s Club is a very prickly plant and “warns you to stay your distance”; it is a very “protective” plant. These classic “signatures” of the plant and its relationship to the ginseng family make it easy to understand its use as a tonic and adaptogen, meaning it helps us handle stress and the ill effects of long-term stress. This wonderful plant has also been found to have anti-arthritic, hypoglycemic, antibacterial, antifungal, and antiviral effects. Devil’s Club is also a circulatory stimulant that has strong anti-proliferative effects. Applications for the plant include its use for depression secondary to stress. It can be used for individuals who are depressed, stressed, irritable, withdrawn or aggressive. It also has applications for acute respiratory infections (it is a strong respiratory stimulant and expectorant), and for more chronic respiratory symptoms that don’t abate following an acute episode. Devil’s Club can be used for diabetes or insulinoma. This herb has hypoglycemic and insulin-sensitizing effects and can help stabilize blood glucose in patients with insulin resistance. Please note: This is an over-harvested herb; use only sustainable sources.

DOMESTIC AND INTERNATIONAL ECO-TOURS

The American College of Veterinary Botanical Medicine was established in 2014 to increase the proficiency and competence of veterinarians in the use of medicinal plants, ultimately leading to diplomate status in the specialty of veterinary botanical medicine. We are currently working on a petition to gain status as a specialty board in the AVMA and would appreciate help – contact cyndvm@ gmail.com for more info. The 2nd Annual Conference will be held September 9 before the AHVMA conference, in Columbus, Ohio. Find out more at ACVBM.org.

CASE REPORT

Tieo, a seven-year-old male Sun Conure, became very aggressive and stressed when his owner went away to college, and started attacking the caregiver he was left with. For his irritability secondary to stress, Tieo was given two drops twice daily of a Devil’s Club tincture, which settled this emotional little bird down.

NAME THIS HERB!

• This year’s Domestic Eco-Tour will be held after the IVAS/ AAVA meeting in Tacoma, Washington June 11 through 15. The event will be held at the Rain Forest Resort Village at 516 South Shore Road in Quinault. Topics will include herbal treatment of mental health; local herb walks and learning about local plants, including Devil’s Club; a mushroom hunting adventure; and Liz Hassinger’s advice on how to connect with plants and make tinctures from them. Register now at vbma.org. • This year’s International Eco-Tour will be in Peru. For more information, check the VBMA website for details and specifics.

OTHER NEWS Our first teleseminar for 2016 was on Backyard Chickens. As responsible veterinarians, we need to encourage our clients to establish backyard flocks of chickens, which can decrease fleas and ticks. Purchase the recording at our website.

IVC Spring 2016

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

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IVC Spring 2016

events

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

132nd CVMA Annual Meeting & Convention

West Virginia VMA 2016 Annual Spring Meeting

At this meeting and convention you will find a variety of different programs offered including the Small Animal Practitioners Program covering feline and canine lower urinary tract disease as well as the Large Animal Practitioners Program, Practice Management Program and Technician/Assistant Program.

We have worked with our sponsors and nearby veterinary schools this year to provide a forum which should inform and excite everyone. Featured speaker this year is Dr. Guillermo Couto. Dr. Couto has 35 years of experience in clinical and comparative hematology, oncology, transfusion medicine, clinical pathology, and is an expert in greyhound and sighthound medicine. As always, The Greenbrier is providing a legendary venue with entertainment for the whole family, including a bowling event Saturday evening sponsored by Elanco!

March 29 - 30, 2016 – Hartford, CT

For more information: (860) 635-7770 info@ctvet.org www.ctvet.org

April 15-17, 2016 - White Sulphur Springs, WV

American Animal Hospital Association Annual Conference

For more information: Kitty Ball 804-346-0170 kitty@wvvma.org http://www.wvvma.org

This year there is a refreshing line-up of new and unique continuing education, along with some of the educational staples you’ve always loved from AAHA. This is the only veterinary conference that focuses exclusively on companion animal care and you’ll receive top education and exceptional networking.

2016 Massachusetts VMA Spring CE Conference

March 31 – April 3, 2016 – Austin, TX

For more information: (800) 883-6301 aaha@aahanet.org www.aaha.org/austin

May 11, 2016 – Westborough, MA

MVMA’s mission is to promote the veterinary profession, improve animal well-being and public health and provide programs and services that enhance the ability of member veterinarians to succeed. Join the Continuing Education conference in May 2016!

Feline Veterinary Dentistry

For more information: (508) 460-9333 staff@massvet.org www.massvet.org

This course focuses on the most practical lecture and lab material available for the general practitioner to maximize feline patient care in veterinary dentistry. Please visit our website for more information. 15 hours of RACE accredited Continuing Education. Instructor: Brett Beckman, DVM, FAVD, DAVDC, DAAPM

CVC Conference for Veterinary Care

April 9-10, 2016 – Orlando, FL

For more information: (941) 276-9141 annielvt@hotmail.com http://veterinarydentistry.net/vets/

Veterinary Emergency & Critical Care Spring Symposium April 14 - 17, 2016 – Cabo San Lucas, Mexico

VECCS is committed to offering its members the highest quality of Continuing Education regardless of venue. This year’s symposia will be held at the Sheraton Hacienda del Mar Golf and Spa Resort on the Pacific coast, a breathtaking and luxurious destination resort property. Attendees can tour the Baja coastal region, shop and dine in nearby Cabo San Lucas, or San Jose del Cabo; take ATV excursions, experience deep sea fishing or just relax in the sun on the beaches or at one of the five pools onsite. Be sure to register early since there is limited registration for VECCS members-only. For more information: (210) 698-5575 info@veccs.org http://2016springce.iveccs.org/

IVC Spring 2016

May 12-15, 2016 – Virginia Beach, VA

For more than 20 years, CVC’s vision has been to provide veterinarians, veterinary technicians, practice managers, and team members the best convention experience possible by offering premium educational programming, expert clinical education, hands-on labs and workshops, practice management programs, and team training sessions from the award-winning editors and doctors behind DVM Newsmagazine®, Veterinary Medicine®, Veterinary Economics®, Firstline® and dvm360.com. With expert speakers and exceptional service that is affordable and accessible and offered at 3 convenient locations annually: Virginia Beach, Kansas City, and San Diego. For more information: (800) 255-6864 cvc@advanstar.com www.thecvc.com

Maryland VMA Mid-Atlantic State Veterinary Clinic May 19, 2016 – West Friendship, MD

If you are a practitioner of small animal or equine veterinary medicine, this is a premier opportunity for continuing education, business information and networking. There are also educational opportunities for technicians, farriers and students. For more information: (443) 507-6500 mvma@managementalliance.com www.mdvma.org

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

IVC Spring 2016