Integrative VETERINARY CARE VOLUME 6 ISSUE 2
CAN CATARACTS BE DISSOLVED?
A CLOSER LOOK AT HOW CATARACTS FORM AND WHAT INTEGRATIVE OPTIONS ARE AVAILABLE FOR TREATMENT AND PREVENTION. — P. 28
HOW HERBS HELP GLAUCOMA
THE INTEGRATIVE PHYSICAL EXAMINATION
LASER THERAPY IN HORSES
ALTERNATIVE SOLUTIONS FOR SUMMER BUGS
CHINESE FOOD THERAPY
HOMEOPATHY FOR EYE DISORDERS
When incorporated into an integrative approach, herbal formulas can relieve glaucoma in dogs. — P. 14
www.IVCJournal.com
SUMMER ISSUE 2016
Learn about two approaches for treating equine tendon injuries, using laser therapy. — P. 48
From a TCVM perspective, many foods can be used for treating a spectrum of disorders. — P. 60
Exemplary patient care starts with a step-by-step approach. Coordination with conventional practitioners and specialists may be key. – P. 40
More clients are asking for natural ways to protect pets from fleas, ticks, flies and mosquitoes. Here are some effective options. — P. 36
Some of the most common eye disorders seen today respond well to homeopathic remedies. — P. 54
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contents FEATURES
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HERBS AND CANINE GLAUCOMA By Robert J. Silver, DVM, MS, CVA
When used as part of an integrative approach, herbs and herbal formulas can help manage glaucoma in dogs.
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CASE STUDY
TCVM TREATMENT OF UNCONTROLLED GLAUCOMA IN A CAT By Margaret Fowler,
DVM, CERT. TCVM PRACTITIONER
After conventional medicine proved ineffective for a cat with severe, painful glaucoma, a TCVM approach with acupuncture and herbals was used with great success.
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TECHNICIANS FORM THE BACKBONE OF CANINE VETERINARY REHABILITATION
By Michelle Tilghman, DVM, Elizabeth Barrett, RVT, CCRP
CVA, CCRP
By Marc Smith, DVM
Reactive and proactive methods for the laser treatment of equine tendon injuries and related issues.
HOMEOPATHY FOR EYE DISORDERS By Todd Cooney,
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NUTRITION NOOK
By Judy Morgan,
and
CAN CANINE CATARACTS BE DISSOLVED OR “UNFRIED”?
By Carmen Colitz,
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DVM, PHD, DACVO
An in-depth look at cataract formation in dogs, and various options for treatment.
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NATURAL SOLUTIONS FOR SUMMER BUGS By Christina Chambreau, DVM, CVH
Fleas, ticks, flies and mosquitoes are an issue this time of year. Clients are asking about alternative solutions to chemical products – here are some effective options.
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INTEGRATIVE PRACTICE THE INTEGRATIVE PHYSICAL EXAMINATION
By Danielle Conway,
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DVM, CVA, VSMT, CCRP
Steps to a complete integrative physical exam, along with tips on communicating with mainstream veterinarians and specialists.
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DVM, CVA, CVCP, CVFT
From a TCVM approach, different foods can warm or cool the body, resolve stagnation, increase energy, dissolve Phlegm or drain Damp.
By instituting some aspects of physical therapy into your veterinary hospital, you can help increase practice income and client satisfaction.
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DVM, CVH
Homeopathy has shown to be useful for treating some of the most common eye disorders seen in practice today.
CHINESE FOOD THERAPY FOR THE VETERINARY CLINIC
TECH TALK
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48 54
TWO APPROACHES TO LASER THERAPY IN HORSES
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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.
COLUMNS & DEPARTMENTS
5 Advisory board 8 Editorial
s new 11 What’
Michelle J. Rivera, MT, VDT, is an instructor at the University of Wisconsin and The Healing Oasis Wellness Center, a post-graduate educational institution offering state-approved programs. She is co-owner of The Healing Oasis Veterinary Hospital, offering massage, rehabilitation, chiropractic and Chinese and Western Herbology. Michelle completed the Chinese Herbal Medicine program from the China Beijing International Acupuncture Training Center, and is certified in Chinese Medicine by the Wisconsin Institute of Chinese Herbology.
Dr. Joyce Harman, DVM, MRCVS, graduated in 1984 from Virginia Maryland Regional College of Veterinary Medicine. She is certified in veterinary acupuncture and chiropractic and has completed advanced training in homeopathy and herbal medicine. Her practice in Virginia uses holistic medicine to treat horses. Her publications include The Horse’s Pain-Free Back and Saddle-Fit Book – the most complete source of information about English saddles.
23 From the AHVMA 38 Industry innovations 43 From the VBMA 46 Veterinary resource guide 47 From the WAEO 51 Social media 59 From the AAVA
Dr. Steve Marsden, DVM, ND, lectures for the IVAS, the AHVMA and the AVMA, and is co-founder of the College of Integrative Veterinary Therapies. He is a director of the National College of Natural Medicine, and authored the Manual of Natural Veterinary Medicine. Dr. Marsden is extensively trai ned in alternative medicine, including Chinese herbology, acupuncture and naturopathic medicine. He has a veterinary and naturopathic practice in Edmonton, Alberta. In 2010, Dr. Marsden was named Teacher of the Year by the AHVMA.
Dr. Jean Dodds, DVM, received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she moved to Southern California to establish Hemopet, the first non-profit national blood bank program for animals. Dr. Dodds has been a member of many national and international committees on hematology, animal models of human disease, veterinary medicine, and laboratory animal science. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1994.
64 From the AVH 65 Marketplace 66 Events
Dr. Barbara Fougere, DVM, CVAA graduated in 1986, and was named the American Holistic Veterinary Medical Association Educator for 2011. Dr. Fougere is the principal and one of the founders of the College of Integrative Veterinary Therapies. She has continued studying over the last 26 years, and has three Bachelor degrees, two Masters degrees, three post Graduate Diplomas, several Certifications and numerous other courses under her belt.
Dr. Christina Chambreau, DVM, CVH, graduated from the University of Georgia Veterinary College in 1980. She is a founder of the Academy Of Veterinary Homeopathy, was on the faculty of the National Center for Homeopathy Summer School and has been the holistic modality adjunct faculty liaison for the Maryland Veterinary Technician Program. Dr. Chambreau teaches classes in homeopathy for animals, and lectures on many topics. She is the author of the Healthy Animal’s Journal and the co-author of the Homeopathic Repertory: A Tutorial.
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Integrative VETERINARY CARE
SUMMER 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: Sylvia Lisi Social Media Manager: Kyle Dupont Web Design & Development: Brad Vader Cover Photo Courtesy of: Carmen M.H. Colitz, DVM, PhD, DACVO
COLUMNISTS & CONTRIBUTING WRITERS Elizabeth Barrett, RVT, CCRP Carmen Colitz, DVM, PhD, DACVO Danielle Conway, DVM, CVA, VSMT, CCRP Todd Cooney, DVM, CVH Margaret Fowler, DVM, TCVM Practitioner Terri McCalla, DVM, MS, DACVO Judy Morgan, DVM, CVA, CVCP, CVFT Jeff Nichol, DVM Robert J. Silver, DVM, MS, CVA Marc Smith, DVM Michelle Tilghman, DVM, CVA, CCRP
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CDN MAIL: IVC Journal, 202-160 Charlotte St. Peterborough, ON, Canada K9J 2T8. The opinions expressed in this journal are not necessarily those of the editor, and different views may appear in other issues. Redstone Media Group Inc., publisher of IVC Journal, does not promote any of the products or services advertised by a third party advertiser in this publication, nor does Redstone Media Group Inc. verify the accuracy of any claims made in connection with such advertisers.
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IVC Journal (ISSN 2291-9600) is published four times a year by Redstone Media Group Inc. Publications Mail Agreement #40884047. Entire contents copyright© 2016. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: June 2016.
IMPROVING THE LIVES OF ANIMALS... ONE READER AT A TIME.
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editorial
LOOKING AT
summer Recently I learned that, had I worn sunglasses faithfully, I might have prevented the cataracts I am now developing. Finally, I am following many of Dr. Colitz’s suggestions for eye health (see her article on canine cataracts on p. 28), along with other holistic modalities, to try and avoid surgery – and I now wear sunglasses all the time. Unfortunately, most of our animal patients don’t routinely wear sunglasses, but the wonderful suggestions in this issue of IVC Journal can build overall health and sometimes even resolve many eye problems.
address glaucoma through treatment options and case studies, starting on p. 14.
Of course, the best way to have healthy eyes is to have a healthy animal. Dr. Conway demonstrates how an integrative physical exam can more deeply diagnose imbalances and illnesses, thus leading to early interventions. Not surprisingly, maximizing nutrition is a great preventative strategy since each animal has unique needs. Dr. Morgan shows us how Chinese food therapy selects specific ingredients to both heal ailments and build health in general.
Finally, we turn our attention to rehabilitation. With school out and good weather here, horses are being ridden much more frequently. Dr. Smith shows us how to use laser to heal tendon issues and, more importantly, prevent future problems that would limit riding time. If you have canine patients going through rehab for lameness, be sure to take a close look at Dr. Tilghman’s article. Since starting regular physical therapy after surgery can shorten recovery time and even improve outcomes, the technicians in her practice both administer the treatments and train the clients in proper home care so they can continue the therapy at home. Find out how she does that on p. 24.
What if eye problems arise despite our best efforts? As a new graduate I was less than excited about performing eye surgery, even for more simple procedures like entropion and ectropion. There were few ophthalmology specialists, so when I was introduced to holistic approaches to eye care, I was thrilled. Early in my homeopathic training I saw a run of dogs and cats with corneal ulcers, some of them indolent or recurrent. When I selected the correctly matching homeopathic medicine for that individual, one dose would often completely heal the eye, and I noticed the patient was healthier in other ways as well. Drs. Cooney, Ramelemeir and Chalmers discuss how different ocular problems respond to homeopathy. Glaucoma is another serious eye issue for our animal companions. Find out how integrative veterinarians Drs. Silver and Fowler
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Naturally, avoiding toxins is key to maintaining health, and in 35 years of holistic practice, I have seen major health improvements when toxins are minimized. In this issue we address chemical flea, tick, fly and mosquitoes products, and what we can do to avoid and minimize them through a multitude of effective natural solutions.
As always, we love to hear from you, our readers, about what you would like to read about. Don’t forget to send me your reports of animals you have helped with holistic approaches and we will post them on the IVCJournal.com website. Have a happy, safe, healthy summer.
Christina Chambreau, DVM, CVH Associate Editor, drtina@ivcjournal.com
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contributors
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1. CARMEN M.H COLITZ, DVM, PHD, DACVO Dr. Carmen Colitz earned her Doctorate of Veterinary Medicine and a PhD in Comparative and Experimental Medicine from the University of Tennessee in 1993 and 1996, respectively. She became a board-certified veterinary ophthalmologist in 1999. Dr. Colitz worked on the faculties of Louisiana State University School of Veterinary Medicine and The Ohio State University’s veterinary teaching hospital. She has written or co-written over 60 peer-reviewed publications and 19 book chapters, and is past president of the American College of Veterinary Ophthalmologists. In 2006, in collaboration with others, Dr. Colitz developed a vision supplement for canines called Ocu-GLO Rx™ (OcuGlo.com). 2. DANIELLE CONWAY, DVM, CVA, VSMT Dr. Danielle Conway graduated in 2013 from the University of Wisconsin Veterinary College, then pursued her passion for animal nutrition with an internship at North Carolina State, and a fellowship in Integrative Veterinary Medicine at the University of Tennessee. She is certified in veterinary acupuncture, canine rehabilitation, veterinary spinal manipulation therapy and has pending certifications in Chinese herbal medicine. Dr. Conway practices integrative veterinary medicine at the Animal Medical Center in New York City (amcny.org), utilizing nutrition, herbs, rehabilitation, spinal manipulation, acupuncture, traditional Chinese medicine, aromatherapy, and conventional medicine. 3. TODD COONEY, DVM, CVH Dr. Todd Cooney graduated from Purdue University College of Veterinary Medicine. He worked in private practice, and as a USDA veterinarian. After almost 20 years of conventional practice, he took Dr. Richard Pitcairn’s Professional Course in Veterinary Homeopathy and changed the way he viewed health and disease. He began to use homeopathy in his practice before he had even finished the course, and now uses it exclusively on all his cases. His practice is located in north-central Indiana. He also does long distance consulting, and serves as an instructor for the Pitcairn Institute of Veterinary Homeopathy. 4. MARGARET FOWLER, DVM, CVA, CVCH, CVTP, CVFT, CTCVMP Dr. Margaret Fowler graduated Summa Cum Laude from Louisiana State University School of Veterinary Medicine in 1981. She started training with Dr. Xie and the Chi Institute in 2005 and discovered that TCVM was her life’s passion. In 2013 Dr. Xie designated her a Certified TCVM Practitioner, one of only 20 in the world. Dr. Fowler is working towards a Masters Degree in TCVM. She has published multiple articles in the American Journal of TCVM, and is a lab instructor and lecturer at the Chi Institute. She has devoted her practice solely to TCVM for over ten years. Acupuncture & Holistic Veterinary Services of NW Florida has been voted Best of Panama City Beach for eight years in a row. 5. JUDY MORGAN, DVM, CVA, CVCP, CVFT Dr. Judy Morgan graduated from the University of Illinois College of Veterinary Medicine in 1984. She earned her certification for Veterinary Orthopedic Manipulation in 1995, then earned her certifications for Acupuncture and Food Therapy from the Chi Institute of Traditional Chinese Veterinary Medicine. Dr. Morgan is a nationally renowned author, speaker, and holistic veterinarian certified in acupuncture, food
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therapy, and chiropractic care for dogs, cats and horses. She has authored three books on holistic pet care and feeding, and is co-host on the Radio Pet Lady network (DrJudyMorgan.com). 6. ROBERT J. SILVER DVM, MS, CVA Dr. Robert Silver graduated in 1982 from the College of Veterinary Medicine at Colorado State University. He became certified in acupuncture in 1993 by IVAS and developed a passion for herbal and nutritional medicine, leading to the founding of RxVitamins. He established Boulder’s Natural Animal in 1993, and is president of the VBMA. Dr. Silver has become an expert in the veterinary applications of cannabinoid therapies, and authored Medical Marijuana and Your Pet. He is Director of Animal Health for Folium Biosciences, a biotech company that grows and processes hemp into nutraceuticals. He also provides online education to pet owners and veterinarians for CE credit on the use of cannabis in pets (greenflowermedia.com). 7. MARC SMITH, DVM, CVA, CVTP Dr. Marc Smith graduated from the University of Tennessee College of Veterinary Medicine in 1998. He is certified in Veterinary Acupuncture and is working toward Certification in Herbal Therapy, Food Therapy, and Tui-Na. Dr. Smith has been the owner of Natchez Trace Veterinary Services since 2005. He co-founded Pet-Tao Pet Foods, which combines the strengths of Western nutritional science with the theories of Eastern food therapy. Dr. Smith has received the University of Tennessee College of Veterinary Medicine’s Distinguished Alumni Award for service in the field of alternative medicine. 8. MICHELLE TILGHMAN, DVM, CCRP, CVA Dr. Michelle Tilghman has been practicing veterinary medicine since 1982. She is a member of the AVMA, IVAS, AAVA and AHVMA. A graduate of the University of Georgia’s Veterinary School, she was certified as an acupuncturist through IVAS in 1984, and as a canine rehabilitation practitioner (CCRP) at the University of Tennessee in 2004. Dr. Tilghman was an adjunct professor at Virginia-Maryland Regional College of Veterinary Medicine, and has taught acupuncture for IVAS for 13 years. She has been president of the AHVMA and has served on the conference committee, the board for the AAVA, and has chaired international education for IVAS. Dr. Tilghman owns Loving Touch Animal Center, focusing on integrative medicine. 9. ELIZABETH BARRETT RVT, CCRP Elizabeth Barrett has been breeding AKC conformation champion, obedience titled, and nationally ranked agility champion Doberman Pinschers for over 20 years under the kennel name of ADAMAS (ADAMASdobermans.com), as well as professionally handling several other breeds. Graduating with honors as a Registered Veterinary Technician, she was certified in Canine Physical Rehabilitation through the University of Tennessee’s College of Veterinary Medicine in 2006. She has been frequently published in The Doberman Digest, and was a contributing author Another Piece of the Puzzle: Puppy Development by Pat Hastings and Erin Ann Rouse.
what’s new 5 TIPS FOR HOSPITAL STAFF DEVELOPMENT Looking to grow your practice? iVET360 (ivet360.com), a national veterinary management services company, has provided five team member training and development tips for veterinary hospitals.
q Evaluate or create your culture: Inadequate culture and poor environment are becoming the number one reason veterinary employees are leaving their jobs.
w Pay attention to appointment conversion: Training your staff to
use active language and proactively scheduling appointments when speaking with new callers will help capture as many new clients as possible, keeping your active client base robust.
e Address client compliance: No matter how many active clients
your practice has, it means nothing if they don’t comply with your recommendations. An in-depth analysis and overhaul of how treatments are recommended to your clients can shift your care and revenue to the next level.
r Improve team accountability: Ask yourself what consequences people actually face when they make a mistake, and how positive actions are recognized daily (yes, daily!). Adjust your management and communication accordingly.
t Develop supervisor leadership skills: Your supervisors should be a direct representation of the vision for your practice and culture. Making the investment in their success in this role will elevate the supervisors, your team, client service, patient care, and very often, your revenue.
IVERMECTIN TOXICITY IN HERDING DOGS Bristol, a four-year-old Australian Shepherd, was brought to the Cummings School of Veterinary Medicine at Tufts University, barely responsive and experiencing persistent seizures. Her owner suspected the dog was suffering from severe ivermectin toxicity, a condition in which ivermectin, the active ingredient in
some heartworm prevention medicines, crosses the blood-brain barrier and causes neurological damage. Bristol (at left) required immediate and aggressive care, including the assistance of a mechanical ventilator. She remained unconscious for three weeks. Eventually, she began walking with the assistance of a cart and leg splints, and later was able to walk under her own power with support from hospital staff. Many white-footed herding breeds like Bristol have a genetic mutation that makes them sensitive to ivermectin and several other drugs, including some common chemotherapy drugs. Dr. Terri O’Toole, DVM, one of the critical care specialists overseeing Bristol’s care, recommends people have their herding breed dogs undergo a simple genetic test to determine if they have a mutation in the multidrug resistance (MDR1) gene. now.tufts.edu/ news-releases/dog-s-recovery-tufts-highlights-need-genetic-testingowner-vigilance
CORRECTION
In the Spring 2016 issue of IVC Journal, the “Saddle fit checklist” on page 50 of the “Equine integrative sports medicine” article by Dr. Sarah le Jeune should have been credited to Saddlefit 4 Life (saddlefit4life.com). We apologize for the omission. IVC Summer 2016
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what’s new STUDY SHOWS HORSES READ HUMAN EMOTIONS Horses can distinguish between angry and happy human facial expressions, says a landmark study published in Biology Letters. Psychologists studied how 28 horses reacted to photographs of positive versus negative human facial expressions. When viewing angry faces, horses looked more with their left eyes, a behavior associated with the perception of negative stimuli. Their heart rates increased more quickly and they showed more stress-related behaviors. The study says this response indicates the horses have a functionally relevant understanding of the angry faces they were seeing. “It’s interesting to note that the horses had a strong reaction to the negative expressions but less so to the positive,” says study co-leader Amy Smith, a doctoral student in the Mammal Vocal Communication and Cognition Research Group at the University of Sussex. “This may be because it is particularly important for animals to recognize threats in their environment. Recognizing angry faces may act as a warning system, allowing horses to anticipate negative human behavior such as rough handling.” rsbl.royalsocietypublishing.org/content/12/2/20150907
STUDY ON UTI SUPPLEMENT Urinary tract infections in dogs and cats are typically treated with antibiotics. This easily leads to the overuse and misuse of these drugs. Pathogens like E Coli are rapidly becoming resistant to many antibiotics, and other solutions are needed.
A survey conducted at the Colorado State University College of Veterinary Medicine, and published in the Spring 2016 issue of the Journal of the American Holistic Veterinary Medical Association, stated that 64.3% of dog owners and 66% of cat owners believed the consumption of hemp products helped their pets, and not just for pain relief. Here are some of the stats:
An independent in vivo and in vitro veterinary study published in the American Journal of Veterinary Research (77(4), 2016), compared Cranimals Original UTI supplement to the antibiotic cephalexin. Based on both clinical signs and laboratory urinanalyses, none of the dogs receiving the supplement developed a UTI, even though all were expected to contract an UTI during the six-month experimental period, based on their medical histories.
•5 0% of the dogs and 44% of the cats were perceived as having either moderately or greatly improved sleep habits.
Scanning electron microscopy confirmed that Cranimals Original, which contains an antioxidant-rich blend of cranberry, red raspberry, blueberry and algae extracts, significantly reduced the ability of E Coli to attach to canine kidney/uroepithelial cells, and this effect became more pronounced the longer the supplement was administered.
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•W hen it came to anxiety, almost 50% of dog owners reported hemp products helped moderately or a great deal. •F or reducing inflammation in cats, owners perceived the products were helpful in 56% of the felines. •O f the 274 respondents who spoke to their veterinarians about using hemp products, 61.7% reported that their veterinarians responded positively.
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&
CANINE GLAUCOMA By Robert J. Silver, DVM, MS, CVA
WHEN USED AS PART OF AN INTEGRATIVE APPROACH, HERBS AND HERBAL FORMULAS CAN HELP MANAGE GLAUCOMA IN DOGS.
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laucoma in dogs can be a serious emergency. It can result in permanent vision loss in the diseased eye(s), in spite of the best ophthalmological care. Herbs can be helpful in managing a patient with glaucoma, but they should be used at a secondary or tertiary level of care, with pharmaceuticals, to help bring the patient into balance and create better intraocular eye pressure (IOP). Herbal therapies can also reduce the potential of side effects from the topical and systemic glaucoma medication administration. In the dog, glaucoma can take many forms. slowly and chronically with slight reddening 1 Itofcanthe manifest eye, and slight increases in IOP that aren’t enough to create the typical bulged-eye appearance. As the pressure inside the eye increases, the blood supply to the eye decreases and the oxygen-hungry nervous tissue in the eye begins to die. If the increasing IOP is left unchecked, permanent blindness will result.1
TRIGGER
My own dog, Trigger, an eightyear-old Chocolate Lab, suffered from glaucoma. I adopted him shortly after his first enucleation, and suffered with him through his second enucleation. A hard-ofhearing, 95-pound dog with poor hips and knees was a challenge to care for through 18 months of adapting his life and my house to his permanent blindness.
can also have a sudden onset. This acute form can 2 Glaucoma cause rapid loss of eyesight before one can get the dog seen by a veterinarian trained in pharmaceutical or laser/surgical interventions for this disease. With Trigger, even I didn’t know his second eye had lost its sight and gone acutely glaucomatous until he started bumping into walls. Anything we can do to keep the eye intact, with normal vision and no pain, is a success story.
HERBS FOR GLAUCOMA 1. Cannabis sativa L. Studies in both cats and humans have demonstrated the effectiveness of cannabis for lowering IOP.
Feline study2 A group of researchers from the Departments of Ophthalmology and Pharmacology & Toxicology at the West Virginia Medical Center published a study in 1984 involving 55 adult cats. In IVC Summer 2016
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the first part of the study, they measured the cats’ IOP one hour before, immediately after, and at hourly intervals for six hours following the topical application of the cannabinoids – cannabinol (CBN) and cannabigerol (CBG). They applied the drops to one eye, and measured the IOP of both eyes in order to use the contralateral eye as each animal’s control. Three hours after a single application of 1 mg of CBN to the cats’ eyes, the researchers measured a significant reduction in IOP from the baseline value. The lower dose of 500 mcg did not significantly change the IOP. The IOP reduced from 23.5+/2.5 mmHg to 18.7+/0.3 mmHg with a topical ophthalmic dose of 1 mg CBN. In the second part of the study, the researchers measured the IOP daily for 12 days. The cats were hooked up to minipumps to deliver a constant rate infusion of cannabinoids into their eyes. (I hate these kinds of invasive experiments on pets.) This allowed the investigators to see what ocular toxicity would arise from long-term daily administration of topical ophthalmic drops containing the CBN and CBG. Throughout the period of chronic administration, the eyes remained 4 mmHg to 6 mmHg lower than the untreated contralateral eyes. The effect on the treated eyes wore off after the cessation of drops for three days.
Human study3 A more recent study, published in 2006 in the October issue of the Journal of Glaucoma, found that human patients also experienced a significant change in IOP two hours after the administration of sublingual drops containing 5 mg of ∆ -9 Tetrahydrocannabinol (THC). The IOP was significantly lower than after placebo – 23.5 mmHg vs 27.33 mmHg (p=0.026), and stayed that way for about three hours after administration before returning to baseline. Cannabidiol (CBD) was given in the same fashion at 20 mg and 40 mg doses. The higher dose produced a transient elevation of IOP four hours after administration. Of course, the use of cannabis comes with this caveat: in the 24 states that have passed medical marijuana laws, not one allows the
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Gentiana root
Akebia legal prescribing or dispensing of cannabis by a veterinarian. So please stay in compliance with the laws of your state, and work democratically for the rescheduling of Cannabis sativa L. to a lower Controlled Substance classification than its current Schedule One classification.
2. TCVM Formulas The true value of TCVM lies in its ability to effectively address the individual characteristics of a disease manifestation in a patient using an individualized formula. There are a number of effective formulas for patients with glaucoma. The best way to determine which one to use involves taking a TCVM exam, using tongue evaluation, pulses, palpation, and asking questions about the characteristics of the patient (behavior, temperature preferences, times of day when better or worse, food desires and aversions, etc.) Dozens of formulas could apply, depending on the individual presentation. • Acute glaucoma often benefits from the Gentiana formula, which can help until the veterinary ophthalmologist appointment and can be used concurrently with pharmaceuticals. Typically, this dog will have reddened, injected sclera with prominent veins. The eyes may be visibly bulging, and if you press over the eyelid, it may be painful and feel quite turgid. Irritability may also be present. One TCVM diagnosis for glaucoma is Liver Fire Rising, causing red eyes (Liver rules the eyes) which will cause the glaucoma. It may be associated with headaches and even convulsions, depending on how severely Liver Fire is present in a patient. Long Dan Xie Gan Tang (Gentiana Decoction to Drain the Liver),4,5,6 contains raw rehmannia root, dang gui root, gentian root, alisma tuber, akebia, bupleurum, plantain seed, licorice root, scutellaria root and gardenia root. These herbs are very “cooling” and help drain dampness from bulging eyes if the dog’s symptoms match the TCVM prescribing criteria for Gentiana. This formula has a very strong anti-inflammatory activity. Continued on page 18.
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Continued from page 16.
Licorice root
- Scutellaria, gardenia and gentian roots are very bitter and quite anti-inflammatory. - Akebia, alisma tuber and plantain seeds are diuretic. - Bupleurum and scutellaria address the liver heat directly, helping to constrain the Liver Fire from rising. - Raw rehmannia root helps cool the blood. • Chronic glaucoma can be treated with three TCVM formulas in patients who present with a deficiency profile. Remember that there are many different combinations, again depending on the individual’s TCVM evaluation. Deficiency patients may be deficient in Liver Blood and/or Kidney Yin, creating a deficiency heat that can affect the eyes.
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astrodia and Uncaria Formula (Tian Ma Gou Teng Yin)7,8,9 G is a deficiency formula that contains haliotis (conch shell). The calcium carbonate in the shell is very cooling. The main herbs in the formula, gastrodia and uncaria, are meant to reduce the rising Yang from the liver with deficient Blood and Yin. As with Long Dan Xie Gan Tang, gardenia and scutellaria clear heat from the upper part of the body, and are calming as well. Other herbs in this formula help moisten Yin, move the Blood, and bring the Yang back to where it belongs. The rest of the herbs are calming, and help support the balance between Yin and Yang. This formula is also used for deficiency seizures in which Liver Blood deficiency creates an upwards moving Liver Wind resulting in the seizure. It also brings Heat to the eyes, resulting in redness and possibly glaucoma.
The 25 herbs in this large formula can be grouped into five categories of action: - Nourish Blood and generate body fluids – dendrobium, ophiopogon, asparagus root, rehmannia root both cooked and raw, and schizandra - Nourish Yin and Tonify Liver and Kidney Yin – cuscuta, lycium fruit, achyranthes bidentata, cistanches - Tonify the Lung and Spleen to allow for conversion of food Qi to Kidney Yin and Kidney Jing – ginseng root, poria, licorice root and honey - Calm Internal Wind and Clear Heat – aurantium fruit, ligusticum wallichii, chrysanthemum flowers, cassia seed, saposhnikova root, tribulus fruit, and celosia seed - Calm the Liver and Purge the Heart – Chinese coptis root Mu Di Huang San 3 TMing he third deficiency formula is directed toward Kidney and 11,12
Liver Yin and Blood deficiencies that result in deficiency heat rising to cause red eyes and glaucoma. The accompanying article by Dr. Margaret Fowler (see page 20) uses this formula to successfully treat a cat with glaucoma that failed to respond to pharmaceutical therapies. The take-home message with glaucoma, from my own experience, is to not wait around for it to get better on its own. Regular eye pressure readings, and the use of pharmaceutical and herbal strategies to keep the IOP normal, need to be a daily to three times weekly event in order to provide vigilance against relapses and loss of eyesight.
Chrysanthemum
Pill for Night Vision (Shi Hu Ye Guang Wan) 2 is Dendrobium a large formula with 25 herbs for soothing the Liver
10
and calming Liver wind. It also will nourish Yin and brighten vision. This formula is for the patient with Liver and Kidney Yin deficiencies leading to the rise of internal Fire and Wind, impaired vision, photophobia, red and painful eyes, a cloudy lens and tearing.
Lycium fruit 18
IVC Summer 2016
Gelatt, K. Essentials of Veterinary Ophthalmology. Lippincott Williams and Wilkins, 2000:326-328. Colasanti BK, Craig CR, Allara DR. “Intraocular Pressure, Ocular Toxicity and Neurotoxicity after Administration of Cannabinol or Cannabigerol”. Exp Eye Res. 1984;39:251-259. 3 Tomida I, Azuara-Blanco A, House H, Flint M, Pertwee RG, Robson PJ. “Effect of sublingual application of cannabinoids on intraocular pressure: a pilot study”. J Glaucoma 2006 Oct;15(5):349-53. 4 Xie H, Preast V. Xie’s Chinese Veterinary Herbology, 2010. Blackwell Publishing; p.378-379. 5 Chen JK, Chen TT, Beebe S, Salewski M. Chinese Herbal Formulas for Veterinarians. Art of Medicine Press 2012:277-283. 6 Marsden S. Essential Guide to Chinese Herbal Formulas. College of Integrative Veterinary Therapies Publishers 2014:99-103. 7 Xie H, Preast V. Xie’s Chinese Veterinary Herbology, 2010. Blackwell Publishing; p.505-507. 8 Chen JK, Chen TT, Beebe S, Salewski M. Chinese Herbal Formulas for Veterinarians. Art of Medicine Press 2012:797-800. 9 Marsden S. Essential Guide to Chinese Herbal Formulas. College of Integrative Veterinary Therapies Publishers 2014:138-141. 10 Chen JK, Chen TT, Beebe S, Salewski M. Chinese Herbal Formulas for Veterinarians. Art of Medicine Press 2012:521-523 11 Chen JK, Chen TT, Beebe S, Salewski M. Chinese Herbal Formulas for Veterinarians. Art of Medicine Press 2012:518-520. 12 Xie, H. Chinese Veterinary Herbal Handbook: 216 Most commonly Used Veterinary Herbal Formulas. 3rd Ed. 2012. Jin Tang Publishing, Reddick, Fl. P. 119.
1 2
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case study
TCVM TREATMENT OF
UNCONTROLLED
GLAUCOMA IN A CAT
By Margaret Fowler, DVM, Certified TCVM Practitioner
Glaucoma is uncommon in cats and often difficult to treat. Unlike dogs, cats do not tolerate anti-glaucoma medical treatments well, especially when they are administered systemically. Eyepreserving surgical treatment has received little interest among veterinary ophthalmologists, probably because most feline glaucomas are associated with inflammations such as uveitis.1
INITIAL PRESENTATION A four-year-old spayed female cat was presented in October of 2013 for TCVM evaluation of bilateral severe unresponsive glaucoma of four months’ duration. The cat had developed glaucoma secondary to uveitis, the right lens was luxated into the anterior chamber, and that eye was avisual. The left eye was still visual. The cat was in extreme pain. The owner reported that she hid under the bed, refused to eat, often refused to open her eyes, and was constantly rubbing her eyes with her paws.
CONVENTIONAL TREATMENTS UNSUCCESSFUL The owner had sought treatment with her regular conventional veterinarian who confirmed the elevated pressure with a pen tonometer. This doctor treated the cat with Timolol eye drops which were poorly tolerated. After no success, the cat was referred to a board-certified ophthalmologist for evaluation and treatment.
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IVC Summer 2016
The ophthalmologist attempted to treat the glaucoma, but the cat did not respond significantly and the owner had great difficulty administering medications to her. After two visits, the ophthalmologist recommended bilateral enucleation as the best option to control the pain and unresponsive elevated intraocular pressure. At this time, the pressure in the left eye was 40 mm, and the right eye was 59 mm. The owner declined bilateral enucleation, discontinued conventional medications, and sought treatment through alternative medicine in the form of TCVM.
TAKING A TCVM APPROACH The cat was presented two weeks later for TCVM evaluation. Her tongue was red, her pulses were strong and fast, and both eyes had injected sclera – the typical red, angry-appearing glaucomatous eyes. The cat was squinting and periodically attempted to rub her eyes. She was obviously stressed and reluctant to have her eyes examined or her face touched. She was relatively cool-seeking for a cat, according to owner input. The cat was diagnosed with a TCVM Excess pattern of Liver Fire Blazing Upwards. This was supported because the Liver opens in the eyes; and she had red painful eyes, a red tongue, strong and fast pulses, weak vision, and difficulty opening her eyes.2 The principles of treatment were to clear Liver Heat, nourish Liver Yin, and soothe and brighten the eyes.
q Acupuncture:
The treatment plan was formed with some trepidation as the cat had a history of being uncooperative. Nonetheless, local eye acupoints were chosen opportunistically from the following list using Korean hand needles: a. BL-1 and 2 b. GB-1 and 14 c. TH-23, ST-2 d. T ai-yang (located 1 cun caudal to the lateral canthus and dorsal to the zygomatic arch) e. GV-20 and Bai-hui (located on the dorsal midline at L7S1) were needled with ½” 34-gauge needles in order to relax the cat, calm Shen, and have permission granted to continue needling. f. BL-18 (Liver association point) and BL-23 (Yin tonification point) were needled or aquapunctured with vitamin B-12. g. LIV-2 and 3 would have been very useful to clear Liver Heat; however, they were only rarely allowed by the cat.
Despite her history, the needles were surprisingly well tolerated. erbals: The Chinese herbal formula Ming Mu Di Huang wH (manufactured by Jing Tang Herbal) was chosen at a dose of 0.5 g once daily because of its ability to nourish Liver Yin, clear Heat, and brighten the eyes. This herbal formula is also indicated specifically for glaucoma. Despite her aversion to oral medications, the cat readily ate the powdered contents of the capsule in canned food.
her eyes were no longer red, the tongue was a normal pink color, the pulses had completely normalized, and she was no longer cool-seeking. • At seven months, her pressures were near normal – 19 mm in the left eye and 26 mm in the right eye. • At her one-year follow-up TCVM evaluation in October of 2014, the cat still had a pink tongue, normal pulses, and resolved scleral injection. At this point, acupuncture was discontinued and the cat was maintained on Ming Mu Di Huang alone. • In September of 2015, the cat was doing extremely well with no signs of glaucoma or pain, and stable intraocular pressures. Weaning off the Ming Mu Di Huang was recommended, but the owner feared the possibility of the glaucoma returning. Because the formula was well tolerated and without side effects, it was continued at the same dose of 0.5 g daily. This case demonstrates how well medical problems that are unresponsive to conventional treatment can respond to TCVM treatment alone. It was imperative for success that the cat tolerate acupuncture and willingly take her herbs. And as is the case with cats,
TREATMENT RESULTS • After just one week of acupuncture and herbals, the cat’s intraocular pressure dropped from 40 mm to 36 mm in the left eye, and from 59 mm to 47 mm in the right eye. Although she was still painful, it was at a reduced level. She was clearly more relaxed at her one-week follow-up acupuncture session. • At two weeks, the pressures had dropped to 30 mm in the left eye and 40 mm in the right eye. By this time, the cat was no longer painful and the Heat signs had improved significantly. Her pulses had nearly normalized and her eyes were much less red. Needling was even more acceptable to the cat at this time, presumably because the pain had decreased. The owner reported that she had discontinued hiding under the bed, was once again eating well, and was playing with her owners and toys. She no longer squinted or rubbed her eyes or feared having her face touched. • The cat continued to tolerate the TCVM treatment and steadily improved with continuous use of Ming Mu Di Huang and acupuncture every one or two months. By the third treatment, IVC Summer 2016
21
Cornus
Dioscorea
Tribulus
Moutan
Angelica
Rehmannia
Ingredients and Actions of Ming Mu Di Huang
Bupleurum
Schisandra
Alisma
Poria
English name
Chinese Pin-Yin
Action
Rehmannia
Shu Di Huang
Nourishes Yin, Blood and Jing
Rehmannia
Sheng Di Huang
Nourishes Yin, cools Blood, clears Heat
Cornus
Shan Zhu Yu
Nourishes Yin
Lycium
Gou Qi Zi
Nourishes Liver Yin, benefits the eyes
Schisandra
Wu We Zi
Consolidates and nourishes Lung Yin
Angelica
Dang Gui
Nourishes Blood
Dioscorea
Shan Yao
Tonifies Qi, nourishes Kidney Jing
Moutan
Mu Dan Pi
Cools Liver
Poria
Fu Ling
Drains Damp, strengthens Spleen
Alisma
Ze Xie
Drains Damp, clears Kidney False Fire
Bupleurum
Chai Hu
Soothes Liver, clears Wind-Heat
Tribulus
Bai Ji Li
Clears Heat, brightens eyes
Lycium
it is best to ask for their cooperation and perform acupuncture only with their permission. Forcing or struggling with this glaucomatous cat would have only yielded more poor results. It is also noteworthy that few if any cases of TCVM treatment of glaucoma in cats have been published. Almost three years after the initial conventional diagnosis of glaucoma, the cat presented with acute pain in the previously visual left eye. Examination revealed that the lens had luxated into the anterior chamber secondary to increased intraocular pressure, and the eye once again had the red angry appearance typical of glaucoma. The cat was distressed and fractious due to pain. The owner declined referral to a veterinary school for full evaluation and treatment because this course had been unproductive in the past. Instead, the cat was masked down with isoflurane, and her own blood without anticoagulant was drawn into an insulin syringe. Using aquapuncture, 0.1 mls of the blood were immediately injected into each acupoint, ST-1 and LIV-2, both indicated for Liver Heat. This technique is a common practice in TCVM and is effective for inflammatory disorders.3 Within 48
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IVC Summer 2016
TCVM treatment results Starting Pressure
L 40, R 59
Very painful
At one week
L 36, R 47
Little pain
At two weeks
L 30, R 40
No pain
At seven months
L 19, R 26
No pain
At 21 months
L 17, R 29
No pain
hours, the pain and redness in the eye resolved. The owner was advised to continue the herbal formula Ming Mu Di Huang and to periodically have the cat rechecked. Presumably, the eye pressure will increase again at some point, and the single technique of aquapuncture with the cat’s own blood will effectively control acute exacerbations.
Gelatt, Kirk. Essentials of Veterinary Ophthalmology. Lippincott Williams and Wilkins 2000: 326-328. Xie H, Preast V. Traditional Chinese Veterinary Medicine Fundamental Principles, 2nd Edition. Chi Institute Press 2013: 320-321. 3 Xie H Preast V. Xie’s Veterinary Acupuncture. Blackwell Publishing 2007: 333. 1 2
From the AHVMA
The mindful leader elevating the veterinary profession through innovation, education and advocacy of integrative medicine.
The AHVMA Board is entering the final phase of the strategic planning initiative started by Dr. Royal and Dr. Boudreaux before Dr. Charles “Chuck” Emely became our new Executive Director. Dr. Emely has worked tirelessly to help move the AHVMA forward on our new path. April’s onsite meeting in Chicago was dedicated to a thorough review and update of all policies and operating procedures.
ANNUAL CONFERENCE This year’s AHVMA Annual Conference will be held in Columbus, Ohio, from September 10 to 13. The keynote speaker is David Waters, DVM, PhD, Professor of Surgery and Comparative Oncology at Purdue School of Veterinary Medicine; he will be speaking on Healthy Aging, Longevity and the Aging-Cancer Connection. Thanks to member demand, Dr. Laurie McCauley will be returning with labs and lectures on Skull and Spine Manual Therapy. These labs fill up fast, so register early. Even veterinarians new to holistic modalities will benefit from Dr. McCauley’s practical approaches to improving patient health.
seasoned integrative practitioners who will attest to great satisfaction as they continue to learn and grow.
AHVMA RETREAT Share in a personal wellness experience and return home fully revitalized! The Council of Elders invites you to a restorative retreat immediately following the conclusion of the conference. The Retreat runs from the afternoon of Tuesday, September 13 through noon on Wednesday, September 14. No need to pack up and go to a different location – we’ll return to the Hyatt Regency in the evening. The Retreat requires separate advance registration, so be sure to sign up. Led by Dr. Susan Wagner, you can explore how energetic patterns relate to our understanding of illness and wellness, then share a meal with peers. On Wednesday morning, experience Tai Chi, walking meditation, the Hawaiian practice of Hoʻoponopono, and spend quality time with others.
2017 CONFERENCE The 2017 AHVMA Annual Conference will take place at the newly renovated Town and Country Resort in beautiful San Diego, California from October 21 to 24 next year. Save the dates and check our website for updates!
NEW MEMBERSHIP CATEGORIES AHVMA is proud to introduce Veterinary Technician and Support Staff level memberships as well as Associate Memberships for our ever-supportive business allies. Visit ahvma.org for more information about joining the AHVMA family!
AHVMA BOARD
Additional lecture topics include: Geriatric Medicine, Homeopathy, Traditional Chinese Veterinary Medicine, Integrative Dentistry, Nutrition and Integrative Cancer Treatments. There are introductory talks on each of the major modalities, so even if you have not yet studied any holistic modalities, you will acquire a wealth of practical information and meet
Gary Stuer has been nominated as our VP. Since that puts him on track for President in 2018, we have a wonderful executive committee for the next three years, with Tricia Stimac as President in Columbus, Debbie Decker the year after, then Gary. Ann Swartz has been nominated to continue as Secretary. We have three excellent candidates to fill the two open Board positions.
See you in Columbus! IVC Summer 2016
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tech talk
Why technicians
b o n k e c a b e h t form
of canine veterinary rehabilitation By Michelle Tilghman, DVM, CVA, CCRP and Elizabeth Barrett, RVT, CCRP
A
larger variety of conditions benefit from physical therapy (PT) than many veterinarians realize. As a technician, by instituting some aspects of PT into the veterinary practice, you can help greatly increase practice income and client satisfaction. Veterinary physical therapy for rehabilitation uses non-invasive techniques to benefit canine patients in a number of ways. • Aids in improving physical capabilities and lessening pain in dogs after injury, illness or surgery. • Maximizes a dog’s functioning, and minimizes pain in chronic conditions like arthritis. • Improves the results of weight management (under or overweight) and general conditioning, especially for the canine athlete. • Educates owners in proper management techniques for a long and flexible life for their dogs. Conditions and concerns must be diagnosed by the veterinarian, then as a technician, you can implement a treatment protocol based on the diagnosis, the patient’s condition, his abilities/ limitations, and the available equipment and tools. You can also educate the client on home care, and help design information handouts outlining the benefits of the rehabilitation regimen, as well as home care procedures. On a more regular basis, you can do most of the work when PT is used for conditioning show and performance dogs, as well as with weight loss programs and geriatric support. Of course, medical problems such as fractures, any injuries/ illnesses requiring prolonged immobilization/crating, postsurgical cases, hip/elbow dysplasia, back injuries/herniated discs/IVDD, neurological cases (degenerative myelopathy, spondylosis), arthritis/degenerative joint diseases and gait
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IVC Summer 2016
abnormalities/uneven movement patterns will need much more veterinary oversight.
Overview of the canine body The body is made up of bone, muscle, water and connective tissue called fascia. It is an entire moving organism that is 96% oxygen, hydrogen, nitrogen and carbon, mostly made up of water. The remaining 4% of the body is made up of other elements like calcium and phosphorus. Since these parts and components all work together as a unit, PT that addresses one aspect can help the entire body.
Bones The entire canine body is connected, just as in the children’s song: “The head bone is connected to the neck bone.” The skull is a collective of many bones in the head, and the mandible and the maxilla make up the jaw. The thoracic limb skeleton is comprised of the thoracic girdle, whose bones include the scapula and clavicle (may be absent). The brachium bone is the humerus and then we move down to the antebrachium, radius and ulna. The forepaw is composed of carpal and metacarpal bones, and phalanges. The pelvic limb has a pelvic girdle, and the bones are the ilium, ischium and pubis. The thigh consists of the femur, and the leg includes the tibia and fibula. The hind paw is composed of the tarsal and metatarsal bones, and phalanges. The vertebral column is composed of seven cervical, 13 thoracic, seven lumbar, three sacral and 20+ coccygeal bones.
Fascia Also known as myofascia (see the late Dr. Kerry Ridgeway’s fascia article in the Winter 2015/16 issue of IVC Journal), fascia is the most fluid form of connective tissue, in its
normal state. It has the highest proportion of elastic fibers of all the connective tissues of the body. It also has the highest percentage of ground fluid, which is primarily composed of water, glycosaminoglycans (most notably hyaluronan), proteoglycans and glycoproteins. Because of its water content, fascia requires the highest level of hydration to remain healthy.
Tendons and ligaments Tendons are extensions of the fascia that run through the muscle, attaching the muscle to the bone. As the muscle nears the bone, the fascia becomes less elastic and more strap-like. The fascia of tendons is composed of collagen, elastic fibers, and ground fluid. The percentage of elastic fibers and ground fluid is much lower than in myofascia, giving tendons their strap-like consistency and function. Tendons are actually an extension of the fascia that permeates muscle. The fascia in these areas simply loses the elastic fibers and ground fluid as it nears its attachment to bone. Tendons do not stretch much, if at all. Ligaments are very similar to tendons. They are also made up of mostly collagen with very little in the way of elastic fibers and ground fluid. Ligaments attach bone to bone as is seen in the knees and other joints. Ligaments also do not stretch.
Manual techniques Manual techniques in PT entail the physical manipulation of tissues and joints. They involve using the therapist’s touch to stretch and massage compromised areas. Stretching and range of motion – Maximizes flexibility of joints and extensibility of periarticular tissues, muscles and tendons. Diminishes effects of disuse and immobilization.1 Massage/soft tissue work – Reduces muscle spasms and trigger points due to compensation or favoring of limbs. Increases joint range of motion. Releases toxins, increases blood flow and the production of endorphins.
Therapeutic exercises Therapeutic exercises are designed to improve strength and flexibility for the animal and are directed at the individual’s physical condition. Balls and wobble boards – Excellent for stretching the back, shoulders, hips and psoas, and improving flexion in the elbows, hips and stifles. Also useful for encouraging the use of favored limbs, and building core strength to increase stabilization. Resistance bands – Increases muscle mass and strength. By increasing resistance or “drag” on a limb, you can prolong stance phase during walking on a favored limb.
Cavalettis – Multiple functional benefits include the promotion of flexion and extension in the shoulders, elbows, hips and stifles. For patterning proper stride length, weight shifting and conscious proprioception.2 Weave cones – Improve flexion of the spine and supporting musculature for increased trunk stability and balance. Weight shifting promotes improved muscle mass and conscious proprioception.3 Hill work – By having the dog walk up/down, zigzag or walk across the face of a hill, you can target his front or rear assembly and his bilateral or unilateral limbs to improve strength. For example, walking up an incline strengthens quadriceps, semitendinosus, semimembranosus and gluteal muscles while promoting extension of the hip and stifle. Walking down an incline promotes flexion of the hock, stifle and hip.2 Sit to stands – Equivalent to a human squat, this exercise strengthens the quads and hamstrings. Uneven surface walking – Challenges core balance, promotes use of favored limbs and conscious proprioception. Underwater treadmill – Multiple functional benefits include exaggeration of joint motion, extension of stride length due to treadmill action, reduced load-bearing due to buoyancy effect, and muscle output increases due to resistance created by the water’s viscosity, friction and turbulence. Many practices are now recommending or offering water options that technicians can use, especially for geriatric population.
Additional PT modalities There are many different PT modalities that are beneficial for reducing injury and pain. Heat/cold – Cold is used for acute trauma/injury to reduce inflammation and pain through vasoconstriction, reduced cellular metabolism and decreased sensory and motor nerve conduction velocity. Heat is used for chronic conditions and to warm muscles and superficial joint capsule structures to facilitate stretching.2 Therapeutic ultrasound – Warms muscles at a deeper level than topical heat application can reach. It is useful prior to deep stretching. Electrical stimulation – Interferes with the sensation of pain. It also stimulates muscles with nerve damage to decrease the rate of muscle atrophy. Continued on page 27. IVC Summer 2016
25
4 EFFECTIVE JOINT EXERCISES Before attempting these exercises, remember: 1. Always keep the dog’s limb in a natural plane of normal function. 2. Keep one hand above the joint, and one hand below the joint, in order to isolate your efforts to that one joint. Do not try to stretch multiple joints at the same time. 3. Work within the dog’s comfort zone. DO NOT FORCE THE STRETCH AND DO NOT FIGHT WITH THE DOG!
While pushing into the dog’s rump with the hand above the hip joint, draw the thigh up with the opposite hand to “sandwich” (close) the hip between your hands. When you get to the point where the hip naturally stops closing, add GENTLE pressure to encourage the joint to close a TINY fraction more.
While pushing toward the dog’s feet with the hand above the shoulder, draw the upper arm forward with the opposite hand to straighten (open) the shoulder. When you get to the point where the shoulder naturally stops opening, add GENTLE pressure to encourage the shoulder to open a TINY fraction more.
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IVC Summer 2016
4 HIP EXTENSION
Shoulder extension
SHOULDER EXTENSION
2
3
Stifle extension While pushing into the front of the dog’s thigh with the hand above the stifle, push the lower leg (calf) forward with the opposite hand to straighten (open) the stifle joint. When you get to the point where the stifle naturally stops straightening, add GENTLE pressure to encourage the stifle to open a TINY fraction more.
STIFLE EXTENSION
HIP FLEXION
1
Hip flexion
These exercises should not hurt – if the dog reacts then you are pushing too hard! Hold the stretches for ten to 15 seconds, release for a few seconds and repeat three to five times. Have someone use treats to distract and reward the dog if needed during these exercises.
Hip extension While pushing into the dog’s rump with the hand above the hip joint, push the thigh back with the opposite hand to straighten (open) the hip joint. When you get to the point where the hip naturally stops straightening, add GENTLE pressure to encourage the joint to open a TINY fraction more.
Continued from page 25. Cold laser – Therapeutic lasers send photons, or packets of light energy, deep into tissue without damaging it (read Dr. Robin Downing’s article in the Winter 2015/16 issue of IVC Journal). These photons are absorbed within the mitochondria of the cells and induce a chemical change called “photo-bio-modulation”. This light energy then inspires production of ATP in the cell. Increased ATP production leads to healthier cells, healthier tissue, and healthier animals.4 Shockwave therapy – The shock waves (high energy waves) work at a cellular level, releasing proteins that accelerate healing. Neovascularization takes place, leading to increased blood supply to the treated tissue, resulting in tissue regeneration in tendons, joints and bone.5
Role of technicians in client education Home care and owner assistance is crucially important in rehabilitation, especially with long-term chronic care. Under supervision of the veterinarian, you can decide on the needed daily exercises and demonstrate them to the client until he/she feels comfortable doing them with the dog on a daily basis between clinic treatments. Clients are greatly helped when taught about environmental changes and adaptive equipment that can assist dogs with their mobility needs. Since patience is often needed with rehabilitation programs, teaching clients about pertinent anatomy/pathology will assist with their understanding of the disease process and/or injury recovery. Technicians can also design handouts tailored to the practice, including pictures demonstrating how to properly and improperly do the main exercises. You can also, with the veterinarian’s guidance, create a unique handout for uncommonly-recommended exercises. As a technician, being trained in physical therapy can greatly improve the health of patients in your practice and be an income source for the clinic and even an extra income stream for you, depending on state laws.
Brody LT. “Mobility impairment” in Hall CM, Brody LT, editors, Therapeutic Exercise: Moving Toward Function, Williams & Wilkins, 1999, Philadelphia. 2 Millis DL, Levine D, Taylor R. “Therapeutic Exercises.” Canine Rehabilitation & Physical Therapy. St. Louis, Mo.: Saunders, 2004. pp. 244-286. 3 Gross DM. “Therapeutic Exercise.” Canine Physical Therapy – Orthopedic Physical Therapy. East Lyme: Wizard of Paws, 2002; 124. 4 “Common Questions”, Companion Therapy Laser, Litecure LLC. n.d. Web. 16 June 2015. litecure.com/companion/ for-pet-owners/common-questions. 5 “VersaTron 4Paws – Shock Wave Therapy of dogs.” PulseVet, Pulse Veterinary Technologies. n.d. Web. 16 June 2015. pulsevet.com/versatroncanine/about-versatron-equine. 1
Advertorial
VetzLife All-Natural News By Christopher Kelly Groth Business Development, VetzLife/PetzLife
Enhancing the effects of professional dental care An integrative approach to dental care has been shown to improve oral health by combining professional care and cleaning with natural oral health products. “An evaluation was done of cats and dogs with and without professional cleaning below the gum tissue,” says Kimberly Wasko, CVT, VTS, ALAT, SRS Drexel University College of Medicine. “Significant improvements were seen, including reduced gingivitis, less bleeding on periodontal probing, gingival enzyme activity, and tartar reduction in treated areas. “Further clinical results demonstrated that topical application of VetzLife oral health products was effective in reducing the depth of periodontal pockets – similar to the effects of flossing in people. As well, healing was so accelerated that after five to eight days of treatment the diseased gingival sites were difficult to locate. We also utilized the spray formula as a ‘flush’ solution in the pockets of extracted teeth and the deep periodontal pocketed areas of surgical cases. Instead of ‘finishing off’ the oral cavity with a fluoride foam or gel after dental cleaning, we used the company’s oral care gels. “This suggests the topical application of VetzLife oral care products improves periodontal and dental disease not only as a sole treatment, but also in combination with surgical and non-surgical therapies.” VetzLife oral health products prevent plaque from forming, and also dissolve existing tartar. They’re also the perfect solution for elderly patients that are not candidates for scaling under anesthesia. Article provided by VetzLife/PetzLife all-natural products (VetzLife.com or 1-888-453-4682).
IVC Summer 2016
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Can canine cataracts be
dissolved or “unfried”? By Carmen Colitz, DVM, PhD, DACVO
An in-depth look at cataract formation in dogs, and options for treatment. 28
IVC Summer 2016
C
ataracts are common in older dogs. This article will look at the process behind their formation, along with integrative treatment options.
A CLOSE-UP LOOK AT THE LENS The “crystalline lens” is the living lens in host bodies. The adult crystalline lens is a unique structure; it lacks blood vessels and innervation yet is metabolically active. Because it is avascular, the lens must be bathed with aqueous humor to provide nutrients and remove waste products.
Cataracts or nuclear sclerosis
Clinically, a cataract is any opacity of the lens capsule or its cortex or nucleus, or any combination of these. In dogs, agerelated changes in the lenses begin to show after six years of age.14-17 Nuclear sclerosis progresses gradually with time and, in most cases, vision is not clinically affected due to this change. Many veterinarians mistakenly diagnose cataracts in aged dogs presenting with a history of reduced vision in dim light, when they actually have nuclear sclerosis and age-related (or senile) retinal degeneration, a slowly progressive loss of night vision common in aging dogs.16,17 True nuclear sclerosis will not typically result in significant daytime vision loss, unless the dog is extremely old and therefore has extreme nuclear sclerosis.
Unhealthy lens fibers contain crystallin proteins that aggregate and become insoluable, forming cataracts.
The lens can cause self-destruction of the eye, under the right circumstances. Proteins inside the lens are essentially “hidden” from the immune system, which means if lens proteins escape from the lens into the surrounding ocular fluid, the immune system can then detect them, misinterpret them as being foreign, and attack the eye. This is called lens-induced uveitis, common in canine eyes with any stage of cataract. The lens is also unique in that it must change shape (accommodate) in order to optimally focus light. It is made up largely of special proteins called “crystallins”. In fact, the lens has the highest concentration of proteins in the body – over 40%. The oldest, or embryonic, lens tissue rests in the very center of the lens. The lens is the only structure in the body that displaces cells inwards, rather than sloughing or shedding cells outwards. Early in life, the “nursery” or germinative lens epithelial cells, or LECs (which continuously migrate peripherally and mature to form overlapping layers of lens fiber cells), lie at the outermost aspect of the lens. The LECs live for the entire life of the host, or until cataract surgery removes the lens. New lens fiber cells IVC Summer 2016
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by sunlight and also by endogenous and exogenous oxidative stressors, which challenge the antioxidant status of this most delicate and unique structure.
CATARACTS AND ANTIOXIDANTS
Left eye of a dog with a late immature cataract, approximately 80% to 85% cataract.
Lens damage that causes cataracts is irreversible. Healthy lens fibers contain healthy transparent crystallin proteins. Unhealthy lens fibers contain crystallin proteins that are aggregating and becoming insoluble. Just as the clear protein in a raw egg turns white when cooked, as the proteins denature, clear lens proteins similarly turn white when the proteins inappropriately and permanently aggregate. Eggs cannot be unfried and cataracts cannot be reversed with conventional approaches. Holistic approaches can slow the progression and occasionally resolve small opacities. In order to maintain its transparency and minimize the effects of oxidative stress, the lens has a variety of protective factors, including antioxidants and “chaperones”, to help keep the proteins soluble (and, therefore, the lens clear) as long as possible. Additionally, dogs with cataracts have been shown to possess lower glutathione and the antioxidant ascorbate than dogs without cataracts.1-3
Right eye of a dog with a hypermature cataract that has become unstable due to chronic lens-induced uveitis and is anteriorly luxated. There is an aphakic crescent from 10 o’clock to 3 o’clock.
are continually laid down as complex interlocking straps over the older ones. With time, the newer outer cells compress the older inner cells, resulting in increased density of the inner cells, which contributes to refraction of light. Most proteins in the body only exist for a few hours to a couple of days. However, due to post-translational modifications, lens proteins become terminally modified and remain encased in the lens fiber cells. Therefore, they are immortal proteins as far as the host body is concerned; lens proteins must “live forever” and remain in an insoluble state in order to retain lens transparency and vision. In addition, the lens is exposed on a daily basis to profound oxidative stress caused
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• A variety of nutritional antioxidants can complement the diet in order to enhance continuous regeneration of glutathione to its reduced state. These include vitamins C and E, selenium, bioflavonoids including carotenoids and polyphenols, coenzyme Q10, curcumin, and alpha lipoic acid.4-7 Supplementation with these antioxidants would benefit canine breeds at risk for cataract formation, or in the early stages of cataract development. Even if cataracts progress in affected dogs, the antioxidants will make their eyes and bodies better candidates for cataract surgery. • What else can be done to improve the chances of avoiding or slowing the onset of cataract formation? In humans, the quality of the diet affects the risk of age-related cataract formation. Aging lowers antioxidant levels throughout the body, including in the lens. By the age of 40 in humans, lens antioxidants are completely depleted; the analogous age in dogs is approximately five to six years, depending on the breed. Therefore, supplementing the diet with a variety of antioxidants known to be protective for the lens and against sunlight and other oxidative stressors may be helpful as well. While not yet researched in dogs, it is possible that a low fat grain-free diet that integrates colorful vegetables (which contain high levels of lutein and other carotenoids and flavonoids), along with excellent protein sources, may slow aging lens changes in dogs. Continued on page 32.
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Progressive retinal atrophy
Progressive retinal atrophy (PRA) is an inherited disease affecting numerous breeds. Unlike genetic cataracts, many of the gene mutations causing PRA have been identified in a variety of breeds; DNA testing is available from OptigenÂŽ and the Animal Health Trust. Many dogs with PRA develop secondary toxic cataracts. Supplementation with specific antioxidants that benefit retinal degeneration, including lutein/ zeaxanthin, Omega-3 fatty acids, vitamin E, zinc, coenzyme Q10, and green tea extract (EGCG), may slow or delay the progression of PRA. Even if cataracts do develop, the retinas would be optimally stabilized prior to cataract surgery, allowing for the return of optimal vision following surgery.
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Continued from page 30. •A ntioxidants such as vitamins C and E, lutein/ zeaxanthin and grapeseed extract have been shown to protect the lens against a variety of oxidative stressors. These antioxidants reduce reactive oxygen species, lessen lipid peroxidation, and therefore, decrease the risk of cataract development or progression.8-10 - Lutein and zeaxanthin are oxycarotenoids or oxygenated carotenoids (i.e. xanthophylls) that selectively accumulate in the lens. Lutein may inhibit lipid peroxidation in both the lens and other ocular structures.11 Research has shown that lutein and zeaxanthin supplementation in cultured lens epithelial cells protects lens lipids, proteins and DNA from oxidative damage, comparable to that of alpha-tocopherol (vitamin E). - Grapeseed extract attenuates pathways associated with cataractogenesis including MAPK and PI3K. As has been shown in rodent models, there is potential for dietary modulation of these pathways to slow or inhibit cataract formation.10,12,13
CAUSES OF CATARACTS The three leading causes of cataracts in dogs are: Genetic predisposition Cataracts secondary to diabetes mellitus Toxic cataracts secondary to progressive retinal atrophy (PRA – see sidebar opposite).14
1 2 3
Other causes include: - excessive exposure to oxidative stressors (including ultraviolet radiation from sunlight, in addition to other forms of radiation) - normal aging changes - nutritional and metabolic imbalances - toxins15 Trying to maintain healthy eyes (and especially healthy lenses) in spite of exposure to daily oxidative stress and aging involves multiple strategies. Therefore, when faced with cataracts of any cause, it may be next to impossible to avoid cataract progression and possible cataract surgery.
THE DIABETES CONNECTION Diabetes mellitus is as prevalent in dogs as in humans; one in three dogs is estimated to become diabetic. As in humans, the obesity epidemic is the primary factor causing diabetes in dogs. Besides optimizing nutrition, losing weight, and getting proper daily exercise, daily insulin is needed in most patients to control hyperglycemia unless optimally treated with homeopathy or TCVM. It is estimated that 68% to 75% of dogs with diabetes will develop cataracts within a year of diagnosis, despite the best of care.18,19 Cataracts usually form very quickly, in both eyes simultaneously, causing lensinduced uveitis sometimes resulting in sterile endophthalmitis, glaucoma, absolute vision loss and removal of the eye(s), unless cataract surgery is performed as soon as possible. Once diabetes is diagnosed, support includes specific antioxidants, proper diet, homeopathy, TCVM and aldose reductase inhibitors. Inhibition of aldose reductase has been shown to prevent or delay diabetic cataract formation.20 An ophthalmic drug is in development, in the form of an eyedrop called Kinostat™, which can significantly delay diabetic cataract progression in dogs by inhibiting aldose reductase.21 This eyedrop is not yet commercially available. However, aldose reductase activity can also be inhibited by using natural supplements including alpha lipoic acid, quercetin, rutin, and possibly turmeric.22,23 Combining these with other antioxidants possessing strong anti-inflammatory, free radical-scavenging effects and lipid peroxidation inhibition, further help control oxidative stress. A recent study evaluating a commercially available antioxidant blend, OcuGLOTM, showed that it significantly delayed cataract formation in diabetic dogs administered the supplement on a daily basis.24
MORE ABOUT CATARACTS What is important to understand is that once a cataract begins, many genes become activated or down-regulated in the LECs, and many are the same genes involved in neoplastic transformation. In addition, any stage of cataract can cause lens-induced uveitis, which further exacerbates cataract progression. The ultimate outcome is a progressing cataract. Many antioxidants including grapeseed extract, lutein, IVC Summer 2016
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Omega-3 fatty acids, alpha lipoic acid, curcumin, and green tea extract (EGCG) possess anti-inflammatory properties and may be helpful in controlling this type of uveitis.25,26 Thus far, there is no conventional medical means of clearing or curing an existing cataract that impairs vision. Anecdotally, homeopathic veterinarians have seen resolution of cataracts
with careful prescription of the homeopathic medicines that match the constitution of the dog or cat.27 N-Acetylcarnosine is a pro-drug of l-carnosine, which has been extensively studied in humans for age-related cataract.28 A study evaluating the effect of N-acetylcarnosine in dogs with a variety of lens opacities, ranging from nuclear sclerosis to mature cataracts, showed no significant reduction of lens opacity in lenses with advanced cataracts.29 Clinically, no board-certified veterinary ophthalmologist has witnessed success with these drops and sadly, many of the eyes “treated” with these drops progress to develop complications that do not allow surgery. Valuable time is lost in these dogs during which cataract surgery could have been performed, but instead, lensinduced uveitis relentlessly damages the eye. Once a cataract is evident, referral to a veterinary ophthalmologist is recommended to most accurately diagnose ocular disease(s) and manage clinical and sub-clinical lensinduced uveitis. If the cataract progresses, only surgery to remove it will sufficiently address vision impairment. Careful monitoring for changes by veterinarians using homeopathy or TCVM, or frequent exams by a veterinary ophthalmologist, are recommended to avoid negative changes that can occur due to lens-induced uveitis.
Post surgery (notice the shaved hair around the eyes) – this dog has had his sight restored after successful removal of cataracts in both eyes.
Barros PS, Padovani CF, Silva VV, et al. “Antioxidant status of dog aqueous humor after extracapsular lens extraction”. Braz J Med Biol Res 2003;36:1491-1494. 2 Barros PSM, Angelotti AC, Nobre F, et al. “Antioxidant profile of cataractous English Cocker Spaniels”. Veterinary Ophthalmology 1999;2:83-86. 3 Barros PS, Safatle AM, Queiroz L, et al. “Blood and aqueous humour antioxidants in cataractous poodles”. Can J Ophthalmol 2004;39:19-24. 4 Milesi MA. “Oxidative stress, diseases and antioxidants”. Agro Food Industry Hi Tech 2006;17:6-9. 5 Mandelker L. “Introduction to oxidative stress and mitochondrial dysfunction”. Vet Clin North Am Small Anim Pract 2008;38:1-30. 6 Nordman T, Xia L, Bjorkhern-Bergman L, et al. “Regeneration of the antioxidant ubiquinol by lipoamide dehydrogenase, thioredoxin reductase and glutathione reductase”. Biofactors 2003;18:45-50. 7 Raman T, Ramar M, Arumugam M, et al. “Cytoprotective mechanism of action of curcumin against cataract”. Pharmcol Rep 2016;68:561-569. 8 Chandler HL, Colitz CMH. “Protection of canine lens epithelial cells from ultraviolet radiation induced apoptosis with grape seed extract”. 41st Annual Meeting of the American College of Veterinary Ophthalmologists 2010;422. 9 Head KA. “Natural therapies for ocular disorders, part two: cataracts and glaucoma”. Altern Med Rev 2001;6:141-166. 10 Barden CA, Chandler HL, Lu P, et al. “The effect of grape polyphenols on oxidative stress in canine lens epithelial cells”. Am J Vet Res 2008;69:94-100. 11 Xue C, Rosen R, Jordan A, et al. “Management of Ocular Diseases Using Lutein and Zeaxanthin: What Have We Learned from Experimental Animal Studies?”Journal of Ophthalmology 2015;2015:523027. 12 Balu M, Sangeetha P, Murali G, et al. “Modulatory role of grape seed extract on age-related oxidative DNA damage in central nervous system of rats”. Brain Res Bulletin 2006;68:469-473. 13 Williams DL. “Oxidation, antioxidants and cataract formation: a literature review”. Veterinary Ophthalmology 2006;9:292-298. 14 Davidson MG, Nelms SR. “Diseases of the Canine Lens and Cataract Formation” In: Gelatt KN, Gilger BC,Kern TJ, eds. Veterinary Ophthalmology. 5 ed. Ames: John Wiley & Sons, Inc, 2013;1199-1233. 15 Colitz CMH, Bomser JA, Kusewitt DF. “The Endogenous and Exogenous Mechanisms for Protection from Ultraviolet Irradiation in the Lens”. Int Ophthalmol Clinics 2005;45:141-155. 1
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Bellows J, Colitz CMH, Daristotle L, et al. “Common physical and functional changes associated with aging in dogs”. J Am Vet Med Assoc 2015;246:67-75. 17 Bellows J, Colitz CMH, Daristotle L, et al. “Defining healthy aging in older dogs and differentiating healthy aging from disease”. J Am Vet Med Assoc 2015;246:77- 89. 18 Beam S, Correa MT, Davidson MG. “A retrospective-cohort study on the development of cataracts in dogs with diabetes mellitus: 200 cases”. Vet Ophthalmol 1999;2:169-172. 19 Wilkie DA, Gemensky-Metzler AJ, Colitz CMH, et al. “Spontaneous lens capsule rupture secondary to diabetes mellitus: Surgical outcome in canine eyes”. Vet Ophthalmol 2006;9:In press. 20 Kador PF, Akagi Y, Kinoshita JH. “The effect of aldose reductase and its inhibition on sugar cataract formation”. Metabolism 1986;35:15-19. 21 Kador P, Webb TR, Bras D, et al.“Topical KINOSTAT™ ameliorates the clinical development and progression of cataracts in dogs with diabetes mellitus”. Veterinary Ophthalmology 2010;13:363-368. 22 Veeresham C, Rao AR, Asres K. “Aldose reductase inhibitors of plant origin”. Phytotherapy Research 2014;28:317-333. 23 Ou P, Nourooz-Zadeh J, Tritschler HJ, et al. “Activation of aldose reductase in rat lens and metal-ion chelation by aldose reductase inhibitors and lipoic acid”. Free Radic Res 1996;25:337-346. 24 Williams DL, Fitchie A, Colitz CMH.“An oral antioxidant formulation delaying and potentially reversing canine diabetic cataract: A placebo controlled masked pilot study”. International Journal of Diabetes and Clinical Research 2015;2:1-5. 25 Kidd PM. “Bioavailability and activity of phytosome complexes from botanical polyphenols: the silymarin, curcumin, green tea, and grape seed extracts”. Altern Med Rev 2009;14:226-246. 26 Shoda H, Yanai R, Yoshimura T, et al. “Dietary Omega-3 Fatty Acids Suppress Experimental Autoimmune Uveitis in Association with Inhibition of Th1 and Th17 Cell Function”. PLoS One 2015;10:e0138241. 27 From cases by Drs. Betty Jo Black & Todd Cooney. 28 Babizhayev MA, Khoroshilova-Maslova IP, Kasus-Kacobi A.“Novel intraocular and systemic absorption drug delivery adn efficacy of N-acetylcarnosine lubricant eye drops or carnicine biologics in pharmaceutical usage and therapeutic vision care”. Fundamental and Clinical Pharmacology 2012;26:644-678. 29 Williams DL, Monday P. The effect of a topical antioxidant formulation including N-acetyl carnosine on canine cataract: a preliminary study. Veterinary Ophthalmology 2006;9:311-316. 16
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Natural SOLUTIONS
for summer bugs
By Christina Chambreau, DVM, CVH As the hot weather settles in, what are your thoughts on the insect pests that cause disease and irritation in your patients? Do you use a 12-month protocol of chemicals to prevent fleas, ticks, heartworm, mites, and flies? Are your clients beginning to question these chemicals? Do you have any alternatives on your shelves?
A MULTI-PRONGED APPROACH Over the last 35 years of being an integrative veterinarian, I have developed a different approach to bugs on my patients and in my yard/home. Healthier animals rarely attract many pests, especially fleas and mosquitoes, and flies in horses. If and when they do get infected with an insect-transmitted illness, they recover rapidly with holistic approaches. My goal, then, is to build health and have a multitude of gentle, safe options (for animals, humans and the planet) to offer clients, reserving the “chemical of the year” for unique circumstances. Clients feel confident buying their essential oils from me (as they trust the source of ingredients) or using my link to the internet products I don’t carry in my inventory (vibrational tags). Most alternative pest repellent products involve essential oils, flower essences, nutrition, herbs, ultrasonic devices and mechanical means, and can be topical or orally administered and/or used to also treat the environment.
w Noni2 is also very palatable and effective, for all species. e TickZ is a combination of herbs that is added to food to repel all insects.
r Apple cider vinegar (organic is best) can be added to food and water (as long as clients are sure their animals are drinking enough) or applied topically for flies and mosquitoes.
ULTRASONIC, MAGNETIC OR SCALAR PRODUCTS Each company is using unique technology. For example, Zero Bug Zone imbeds magnetic strip “tags” with very low threedimensional frequencies in the electromagnetic spectrum; there are frequencies unique for each bug and host species. Several studies (one from Texas State University3) document the efficacy of these tags, and holistic veterinarians report good results when they’re put on the collar/mane early in the season. These “tags” would be the first product to offer clients in lieu of conventional chemicals since they are so easy to use. The tags are specific for ticks, fleas, mosquitos, chiggers, flies and midges, and also specific for humans, dogs, cats and horses. They can be braided into the base of a horse’s mane, put on collars or halters, worn as a necklace, etc.
NUTRITION AND HERBS
ESSENTIAL OILS
Since improving health is key to preventing attack from many pests, nutritional supplements need to boost health as well as repel bugs. q Garlic has been used for centuries to prevent infestations in people and animals, as well as to eliminate parasites. While there are some safety concerns if huge quantities are fed (see IVC Journal, Spring 2016), garlic has been proven safe and effective in many animals. Add to food or give in supplement form; apply topically and use it to spray the yard. Duration lasts up to a month with some products.1
Most of the newer products in the last decade have been different combinations of essential oils for topical use, along with internet recipes for making your own combinations. Quality is critical for essential oils as most pets will be ingesting some of the product (IVC Journal, Winter and Spring 2016) if you are purchasing single oils. Base your purchase of combination sprays on the company’s reputation. Multiple companies carry combination essential oil products. Base your purchase on the company’s reputation. Look for products that are organic and
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sustainably harvested, and carry at least two in your practice that have totally different ingredients. Many essential oils repel bugs. For example: • Rose Geranium is known for repelling ticks. I can put one drop diluted in a carrier oil on my hands, rub my cat around the neck and shoulders, and see no ticks for a few weeks. • Cedar is another good pest repellent. Companies specialize in cedar oil products have very effective products for yard, house and animals.
FLOWER ESSENCES While it seems improbable that flower essences with no odor can repel bugs, they are often effective. I have clients who report that they have eliminated fleas from their homes and yards, or flies from their stables, using essential oils. All companies have “bug” essences and all are 100% safe.
MECHANICAL Mechanical ways to deal with pests include:
q Tick pullers – new ones appear yearly w Diatomaceous earth products – they must be food grade and able to be applied topically and in the house As your clients’ concerns about toxic chemicals escalate, an integrative approach allows you to offer them many alternatives to try. For a barn, you may offer essential oils in addition to fly larvae-eating nematodes. If a client lives near a swampy area filled with mosquitoes, you could sell a combination of ultrasound tags and yard spray (using garlic or cedar oil) when they bring their dog or cat in for an annual heartworm check.
Demand FOR
ALTERNATIVE PEST PRODUCTS IS GROWING
Even the pet store industry is recognizing the need for more natural solutions to pests. The January 2016 issue of Pet Age reported that in 2010, the EPA released results from an extensive study, basically saying that most problems arising from pest chemicals were caused by client misuse, but that there were still concerns about the safety of both active and inert ingredients. Since then, consumers have been asking for safer products from pet stores.4 In their March 2016 issue, Pet Age even stated: “Natural remedies… over the past few years [can be]…just as effective as chemicals….”5 The Natural Resources Defense Council recently sued the EPA to have propoxur and tetrachlorvinphos removed from the market, and further cutbacks will happen with other chemicals. Dr. Karen Becker has discussed the over 600 deaths from spot-ons while offering alternatives,6 and clients also have environmental concerns about multiple chemicals. So now is the time to offer alternative pest control options.
When it comes to alternative pest control treatment, you need to offer more than one so clients can find one that is both effective and convenient for them to use regularly.
garlicbarrier.com; mosquitobarrier.com; garlicvalleyfarms.com real-noni.com/Noni-for-Pets-Top-4-Reasons-why-your-Pet-needs-Noni/ 3 0bugzone.com/study/ 4 Pet Age, 1:2016. 5 Pet Age, 3:2016. 6 products.mercola.com/healthypets/pest-repellents 7 Fipronil T. “Pesticide residues in food. Food and Agriculture Organization Plant Production and Protection Paper”. 1997. epa.gov/pets/epa-evaluation-pet-spotproducts-analysis-and-plans-reducing-harmful-effects. 1
2
WHAT ARE THE
drawbacks?
Chemical approaches – toxicity (often from a failure to administer properly), fears of harm to young children or the environment, and the mutation of fleas causing poor results.7 Holistic approaches – the need for more frequent usage, which some clients are not willing to do. Alternatives work for some animals, but not all (but this is true for chemicals, too). IVC Summer 2016
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industry innovations Joint supplements receive NASC Seal of Quality
Clients want natural approaches to fleas and ticks
Dechra Veterinary Products has been awarded the National Animal Supplement Council’s (NASC) Seal of Quality for its PHYCOX® joint health supplements for canine and equine patients.
The American Pet Products Association’s 2015-2016 National Pet Owners Survey said that the use of all-natural, chemicalfree flea and tick products has been on a steady uptick since its 2010 survey. “The use of all-natural, chemical-free flea and tick products is creating its own niche, with 8% of dog owners and 9% of cat owners purchasing this kind of product,” reports the survey.
PHYCOX® is a patented joint health formula containing phycocyanin and other antioxidants. Phycocyanin is a natural antioxidant that has powerful free radicalscavenging properties and supports the body’s normal defense against the harmful effects of free radicals. Clinically, this may help ease discomfort associated with normal daily exercise and activity. Dechra-us.com
Correlation between asthmatic kids and dogs The AKC Canine Health Foundation has awarded a research grant for a study that aims to better understand the occurrence of skin and respiratory diseases in inner-city dogs living in the homes of children with asthma. Veterinarian Dr. Meghan F. Davis of Johns Hopkins University has been awarded the $158,367 grant for the project. The investigators will study bacterial communities on the dogs’ skin, evaluate how these change with time, and whether or not the changes are associated with skin or respiratory diseases in the dogs. Additionally, the team will look at how the children and dogs in each household share bacteria, and whether there are human health benefits to owning a dog if a child already has asthma. AKCCHF.org
Stop ocular allergies naturally Allergies are among the most common problems seen by veterinarians. Suppressing symptoms with steroids, mast cell stabilizers and antihistamines hinders the same process the body uses to fight allergens. Allergy Desensitization Eye Drops from Natural Ophthalmics stop allergy symptoms such as itching, burning, watering, edema and general ocular sensitivity. The drops are a sterile, non-preserved, pH balanced isotonic solution containing four homeopathic ingredients. They do not sting, work immediately and are easy to administer. Sold only through medical professionals and veterinarians. NaturalEyeDrops.com
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PetProductNews.com
Now in nine states Pet Depot Veterinary Group Hospitals are individually owned by veterinarians, but offer the advantage of organized buying power in hospital build-out, equipment acquisition, diagnostic cost management and pooled pharmaceutical cost control. They offer vets the independence to practice as they see fit, with the tools to help them compete and generate profit while keeping client costs affordable. These hospitals are now in nine states – Arizona, California, Florida, Louisiana, Maryland (just opened this spring), Massachusetts, Ohio, Virginia, and coming soon, Wisconsin. PetDepot.net/vet
Interested in how horses can help people? The Horses and Humans Research Foundation, which funds studies investigating the therapeutic effects of horses on humans, is offering a grant for a maximum of $100,000 for a one-and-a-half-year period. Grant applications are due by July 15 – contact info@horsesandhumans.org or go online to learn more. HorsesAndHumans.org
industry innovations Novel sustained release technology Pegasus Laboratories, Inc./PRN Pharmacal has announced the grant of a patent on a novel modified release technology for solid oral dosage drug products. The technology incorporates amphipathic lipids, which are used to encapsulate various drugs and active ingredients. “This novel delivery system will not only provide modified release properties, it will allow for palatability and taste masking without having to coat the tablet,” says Scott Howard, Director of Technical Services. PRNPharmacal.com
Acupuncture – another tool for your toolbox Acupuncture has many applications in the integrative veterinary practice. It can help reduce pain and inflammation, improve blood flow and oxygenation, and more. By becoming certified in veterinary acupuncture, you add another tool to your toolbox. The International Veterinary Acupuncture Society (IVAS) has been certifying veterinarians in acupuncture since 1974. Go online to learn more about becoming certified. IVAS.org
New humanization trend in pet world Study shows sex and extreme disease resistance linked to elite aging in dogs A study conducted by scientists at the Gerald P. Murphy Cancer Foundation’s Center for Exceptional Longevity Studies reports that exceptional longevity in pet dogs is associated with female gender and exceptional disease resistance. “In this first study of exceptional longevity in pet dogs, we discovered a female longevity advantage of 5:1 over males in dogs that achieve the most extreme longevity,” said David J. Waters, DVM, PhD, the scientist who led the study. The study focused on Rottweiler dogs that lived at least 13 years, which is more than 30% longer than the breed average and equivalent to humans reaching 100. The investigators found that canine centenarians display profound resistance to cancer, with a cancer mortality rate of only 8% in dogs with the most extreme longevity, compared to more than 70% in dogs with usual longevity. This profound longevity in dogs is accompanied by what researchers refer to as “morbidity compression,” or a squeezing of major age-related diseases into the final years of life. Among dogs with the most extreme longevity, 76% are “escapers” – free of all major diseases for the equivalent of the first 100 years of life.
Many clients regard their dogs and cats as family. The pet industry has reflected this with higher-quality products such as gourmet pet food lines, and products targeted at specific lifestyles and health conditions. This humanization trend is widening to include other pet species, such as birds and small mammals, according to U.S. Pet Market Outlook, 20162017. This expansion is most apparent in the food and treat segment, and includes natural diets made with human-grade ingredients. PackagedFacts.com
News from Virbac A leading laboratory that develops, manufactures and distributes companion animal health products, Virbac recently launched MOVOFLEX™ Soft Chews, a canine joint health supplement. Formulated with BIOVAFLEX® Egg Shell Membrane, an innovative, hydrolyzed, water-soluble eggshell membrane powder rich in collagen, elastin, glycosaminoglycans, and essential amino acids to support joint flexibility and elasticity, the chews also feature ZANTHIN® Natural Astaxanthin, a powerful antioxidant; Boswellia serrata to support the integrity of joints and connective tissue; hyaluronic acid for lubrication and shock absorption; and vitamin D3 for healthy bones. VirbacVet.com
Gpmcf.org
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integrative practice
The integrative physical examination
By Danielle Conway, DVM, CVA, VSMT, CCRP
Steps to a complete integrative physical exam, along with tips on communicating with mainstream veterinarians and specialists.
T
he first step in excellent patient care starts with a thorough history and physical examination. This article presents a step-by-step walkthrough of a thorough integrative physical exam, with tips on how to coordinate conventional and holistic examinations, and how to communicate effectively to both conventional practitioners and veterinary specialists. Veterinarians who can integrate conventional and complementary medicine may be better prepared to identify and understand the relationship between patient symptoms and their underlying pathology. When working closely with specialists and conventional referring practitioners, the integrative practitioner must also be able to effectively communicate holistic findings in conventional scientific terminology.
START WITH OBSERVATION The first part of the integrative physical examination entails observation. Before touching the patient, the practitioner observes how he moves, breathes, and interacts with his environment, including any people in the exam room. We watch for clues about Traditional Chinese Veterinary Medicine (TCVM) constitution, signs of lameness, appropriate mentation, overall musculature, quality of hair coat, and patient symmetry. For example, a simple observation of head carriage can clue the practitioner in about a chiropractic malalignment of the atlas. Clients are always impressed with the insightful questions asked about their pets before the integrative practitioner even
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sets her hands on a patient. For example, you might ask, “Is your dog an avid ball chaser?” as you note the suggestive head carriage of an occipital malalignment – potentially caused by the dog crashing into stationary objects to obtain the ball.
A THOROUGH EVALUATION The physical examination continues with a thorough evaluation of the eyes, ears, nose and mouth, including the cranial nerves.
Tongue Those trained in TCVM may pay extra close attention to the patient’s tongue, which can provide many clues to underlying medical conditions and overall health status.
1. A tongue with a white coat could indicate the presence of phlegm or inflammation in the body. Explaining that this finding is often indicative of inflammation will make more sense to a conventional colleague than a description of “TCM Phlegm”.
2. A
purple or lavender tongue may indicate blood stagnation or deficiency, and may prompt the submission of a complete blood count.
3. A
tongue with a curled red tip will clue the TCVM practitioner into careful auscultation of the heart, as variation of color or tone in the tip of the tongue can indicate a possible cardiac condition in Chinese Medicine.
Eyes Conjunctival hyperemia may indicate allergic conjunctivitis or glaucoma, but the eyes can also provide subtle clues about the patient’s “Shen” or emotional well-being. The aforementioned condition may be due to TCVM Liver Heat Rising, informing the integrative practitioner to pay more attention to the musculoskeletal examination and the liver enzymes in the patient’s blood work. Liver Heat Rising is a challenging TCM pattern to communicate to conventional practitioners, but requesting baseline laboratory tests and bile acids is the “gold standard” in conventional medicine that all veterinarians understand.
pain when gentle cervical traction is applied could alert the practitioner to a developing intervertebral disc lesion.
Lymph nodes, integumentary system, musculature, body condition As the TCVM practitioner continues with the examination, these areas are evaluated next. •A dry, flaky or oily hair coat means blood deficiency and/or stagnation to the TCVM practitioner – a finding that is easily conveyed to a conventional practitioner as a subtle and early sign of faulty peripheral circulation. •C onventional muscle condition scoring should be a quick and essential part of every physical examination. Muscle condition scoring is based on a scale of 3 (3/3 indicates perfect musculature, 0/3 indicates muscle wasting or sarcopenia). The best locations at which to evaluate muscle condition scoring are over bony prominences of the scapula, head, spine and pelvis. These areas include the temporalis, epaxials, and hind end muscles (gluteals, quadriceps and hamstrings). I n some cases, the patient can be assigned two different muscle condition scores. For example, a patient recovering from a cruciate injury might be assigned a 3/3 overall, but
Cervical region When moving into this region, the integrative practitioner palpates for pain, range of motion and cervical hypo- or hypermobility, and continues with the hyoid apparatus, thyroid, and jugular fill. The author has palpated early evidence of a ventral cervical mass before clinical manifestation by noting the hypomobility of the hyoid apparatus. Although this was not a typical finding, the internist on call was told that the hyoid apparatus did not appear to palpate or move normally; it seemed there was some tissue restriction in the cervical region. This type of palpation may not be usual, but applying it to basic anatomy allows colleagues to understand and appreciate the palpation skills of the integrative practitioner. The patient may later be diagnosed with a cervical abscess on CT scan. Continuous adjustments of the same listing should clue the astute practitioner into searching for a primary cause of these secondary compensatory listings. For example, a dog that repeatedly requires adjustment of the left ilium may indicate pain in a structure within the right forelimb as weight is shifted from right to left. A patient that presents with sudden IVC Summer 2016
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2/3 locally over the hamstring and quadriceps muscles on the right. Discovery of muscle wasting or sarcopenia should always garner the attention of the clinician and prompt a more thorough workup and referral to a rehabilitation practitioner. • Since obesity is a growing problem, body condition score (BCS) is another essential part of the physical examination that is often ignored. The 9-point scoring system is preferred, with 5 out of 9 being the ideal score. For accurate and consistent recordkeeping, it is handy and convenient to keep a reference chart in every exam room. • After auscultation of the cardiopulmonary system, and palpation of the abdomen, the TCVM practitioner will palpate and assess the patient’s pulses for these various TCVM characteristics:
1. A “wiry” or “guitar string-like” pulse on the patient with hyperemic conjunctiva may further prompt the practitioner to consider TCVM Liver, and the need to request a bile acids test.
2. A “slippery” or “cooked spaghetti-like” pulse could indicate early (or advanced) signs Chiropractic and TCVM palpation of the cervical region may yield additional clinical information.
Learn how to assign muscle condition scores by palpating your own facial muscling while smiling. 3/3 MCS – corresponds to the “apples” of the cheeks while smiling 2/3 MCS – corresponds to the chin 1/3 MCS – corresponds to the brow between the eyes 0/3 MCS – corresponds to the bony bridge of the nose
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3. 4.
of inflammation or phlegm within the body. A subtle “slippery” pulse is common in patients that suffer from seasonal allergies in the early spring. Prophylactically treating the inflammation/phlegm at this time could avoid or lessen severity of symptoms later in the season when the allergen is at its peak. A “surging” or “forceful” pulse in a West Highland terrier with a cough would place kennel cough higher on the differential diagnosis list than a more chronic condition such as pulmonary hypertension. Pulse diagnosis is also very positional. A TCVM practitioner will address the finding of a pulse weakening in the right proximal pulse position of a Cavalier King Charles spaniel, as it can indicate early cardiac dysfunction. The optimal and most successful holistic intervention occurs before the full pathologic manifestation of the disease.
ORTHOPEDICS AND NEUROLOGY The practitioner with advanced training in rehabilitation will perform full orthopedic and neurologic examinations on every patient. Accurate knowledge of anatomy and careful palpation of the shoulder tendons, their insertion and origin, can help identify a supraspinatous or biceps tendinopathy in an athletic dog, while careful digit palpation can identify a thickening or crepitus of the metacarpal phalangeal joints that may be contributing to a geriatric patient’s discomfort. Most importantly, demonstrating how to gently work out compensatory myofascial trigger points to a devoted owner in order to provide pain relief for their companion will further enhance the human-animal bond between them.
CONCLUSION The complete and thorough physical examination always ends with a recorded temperature to be included in the traditional TPR, as well as a rectal examination. The chief complaint of arthritis in a geriatric patient quickly becomes secondary when a fever is noted or a recto-anal mass is detected. Integrating the results of both a conventional and holistic multi-modal physical examination defines an excellent veterinary diagnostician. Using the integrative physical examination in combination with conventional treatment plans and holistic principles can be interpreted as the “science and art” of integrative medicine. Using this approach, it is clear that there is no one “fit for all” treatment for Bony Bi or hip dysplasia or Damp Heat in the Lower Jiao or chronic urolithiasis. Effective communication and collaboration between conventional veterinarians, specialists and integrative practitioners results in optimal care for all patients. These concepts embrace best practice veterinary medicine.
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 blue cohosh (Caulophyllum thalictroides), a native of the old growth hardwood forests of eastern North America. Blue cohosh is an old American Indian female remedy. It has been used in small doses as a tonic during the last few weeks of pregnancy, as a labor preparatory. It acts on the nervous system, which controls the uterus and pelvic region, to coordinate the muscular powers of contraction. It also can treat many manifestations of uterine irritation. In large doses, blue cohosh can initiate labor, so use it with respect and understanding. Blue cohosh has been used to increase or restore fertility in older animals. It appears to be a remedy for low estrogen. It is a specific for pain and stiffness in the digits and can be used as a general muscle relaxant for cramps. This herb is indicated in debilitated females who are worn out, with pain, heaviness and weakness in their lower extremities.
CASE REPORT Annie is a 14-year-old Belted Galaway cow. Five years ago, she suffered from a difficult calving, suffered from severe muscular cramps in her low back, and was unable to breed back. Last year, she was treated with acupuncture, chiropractic and placed on ten drops daily of a 1:5 alcohol tincture of Caulophyllum thalictroides. Today she is bred back and walking normally.
Andes and Amazon. We will learn of healing traditions from Incan spiritualists, see a great diversity of plants, and visit with members of several indigenous communities.
UPCOMING TELESEMINARS AND MEETINGS The board of the VBMA has been very busy planning upcoming teleconferences. The next talk will feature Dr. Melissa Shelton, who will be speaking about essential oils. She will address the history of their use, how the oils are made, and how to select a good quality essential oil. The talk will show you how essential oils are another format of herbal medicine. Dr. Shelton will conclude her talk about the applications of these oils. One of our superstars, Dr. Erin Bannink, speaks in the fall. The American College of Veterinary Botanical Medicine’s annual conference take place September 9, just before the AHVMA conference in Columbus, Ohio. It features Jeffrey Yuen on “Modern Applications for Classical Formulas”. This information can be found in no book; you must come and hear it from the master. Dr. Rona Sherebrin speaks on phytopharmacology on the annual VBMA day on Monday, September 11. You can also enjoy a wide range of incredible herbal talks throughout the main AHVMA conference. For more information, and to register, go to VBMA.org.
NAME THIS HERB!
DOMESTIC AND INTERNATIONAL ECO-TOURS 1. This year, the VBMA is going to the woods – the rainforest of Washington State – from June 12 to 15. The world’s largest Sitka spruce awaits us! A report of this event will be featured in our next issue.
2. From July 20 to 30, the VBMA eco-tour goes to Cusco, Peru to explore the plants and healing traditions of the Peruvian
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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URINARY
Advertorial
INCONTINENCE in spayed dogs By Jeff Nichol, DVM
N
early 20% of those who relinquish their dogs to shelters give inappropriate house-soiling as the reason.1 A significant number of these former pets are ultimately euthanized.
Urethral sphincter hypotonus is a condition that often goes undiagnosed. Sometimes called spay incontinence or urethral sphincter mechanism incompetence, it’s more common than client complaints suggest. As many as 20% of spayed dogs leak urine while resting or sleeping,2 but only 2% of dogs brought to veterinary clinics are presented for incontinence. Few pet owners are aware that managing this problem is usually simple, safe and reliable. Medication can improve the lives of most of these girls and their families. Some clients fail to mention this incontinence because of their own anxiety. Believing they’ve failed to properly housetrain their dogs, they may not disclose “accidents” during an exam because they fear judgment. This gap in communication can become an animal welfare issue; some canine urine leakers are punished or severely reprimanded at home. By asking about urination behavior, we can help our clients avoid damaging their relationships with their dogs. Urethral sphincter hypotonus is seen more often in large breeds and those with obesity. Many lick their perineums excessively, resulting in perivulvar dermatitis. They pass a normal volume of urine outside without signs of stranguria
or pollakiuria. Ectopic ureters are comorbid in some cases. Elderly dogs, on the other hand, may urine soil because of joint pain or cognitive dysfunction syndrome. Spayed females are most commonly affected but urethral sphincter hypotonus can also occur in males, usually those that have been neutered. Suspect cases of either sex should have a neurologic evaluation, urinalysis (possible culture), serum chemistries, CBC, and abdominal radiographs to rule out common differentials. Treatment can be directed at the primary etiology: reduced urethral tone. Liver-flavored Proin® chewable tablets from PRN Pharmacal contain phenylpropanolamine, an alpha adrenergic agonist that stimulates proximal urethral alpha receptors. Clinical response has been reported as excellent in 98.1% of affected dogs3 treated with Proin®. Twice daily Proin® is palatable, easy to dose, and already on most veterinary pharmacy shelves. We can help a whole lot of canine leakers and their people – and save some lives -just by starting the conversation with something like: “Have you noticed any bed wetting?”
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, NM.
Kass P, Scarlett P. “Behavioral Reasons for Relinquishment of Dogs and Cats to 12 Shelters”. Journal of Applied Animal Welfare Science, 3(2), 93-106. Von Goethem B, Schaefers-Okkens A, Kirpensteijn J.“Making a rational choice between ovariectomy and ovariohysterectomy in the dog: a discussion of the benefits of either technique”. Vet Surg 2006; 35:136-143. 3 ”Clinical Evaluation of the Long Term Effectiveness and Safety of Phenylpropanolamine Chewable Tablets for the Control of Urinary Incontinence in Dogs”, Pegasus Laboratories, Inc. – CL-002 2010. 1 2
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Veterinary Resource Guide ASSISTIVE DEVICES Best Friend Mobility Myrtle Beach, SC USA Phone: (503) 575-9407 Email: sylvan@sylvancompany.com Website: www.bestfriendmobility.org HandicappedPet.com Amherst, NH USA Phone: (603) 577-8858 Website: www.handicappedpets.com
ASSOCIATIONS Academy of Veterinary Homeopathy - AVH Leucadia, CA USA Phone: (866) 652-1590 Website: www.theavh.org American Veterinary Chiropractic Association - AVCA Bluejacket, OK USA Phone: (918) 784-2231 Email: avcainfo@junct.com Website: www.animalchiropractic.org Association of Veterinary Acupunturists of Canada - AVAC Beaconsfield, QC Canada Phone: (514) 697-0295 Email: office@avac.ca Website: www.avac.ca International Veterinary Acupuncture Society - IVAS Fort Collins, CO USA Phone: (970) 266-0666 Email: office@ivas.org Website: www.ivas.org
Website: www.healfasttherapy.com
INTEGRATIVE THERAPIES
Healfast Therapy North Caldwell, NJ USA Phone: (551) 200-5586 Email: support@healfasttherapy.com
INTEGRATIVE VETS Dr. Shawn Messonnier Paws and Claws Vet Clinic Plano, TX USA Phone: (972) 712-0893 Email: shawnvet@sbcglobal.net Website: www.pettogethers.net/healthypet East York Animal Clinic Toronto, ON Canada Phone: (416) 757-3569 Email: eyac@holisticpetvet.com Website: www.holisticpetvet.com
NATURAL PRODUCT
MANUFACTURERS & DISTRIBUTORS GenesisValley Center CA USA Phone: (760) 751-3360 Website: www.genesispets.com Harrisons’ Pet Products West Palm Beach, FL Phone: (800) 946-4782 Website: www.vet.HEALx.com
VETERINARY OPHTHALMOLOGY
National Animal Supplement Council - NASC Dr. Nancy Park Valley Center, CA USA Board Certified Veterinary Ophthalmologist Phone: (760) 751-3360 Integrative Ophthalmology For Pets - IOP Website: www.nasc.cc Los Angeles, CA, USA Phone: (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
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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 have brought in more members, as veterinarians realize osteopathy is not just for treating musculoskeletal problems. For both new and existing members, we are working on a plan to start a newsletter and share case studies on Facebook – stay tuned. Upcoming classes • The Vluggen Institute’s post-graduate classes train osteopaths to work with dogs by translating basic equine osteopathic skills to canines. The next class in North America runs November 30 to December 3. • From September 26 to 29, we offer a review on holistic therapy for the gastrointestinal system. • Finally, a new basic osteopathy class is coming up, with Module One beginning October 2. More information can be found at equineosteopathy.org. The International Registry for Equine Osteopathy will be conducting exams in Europe and North America this July. We are hoping to welcome many new members to our registry. Good luck to our examinees!
Annual conference Our annual conference takes place July 5 to 7 in Olds, Alberta, Canada. We are thrilled to welcome Dr. Andrea Louise Nissen from Denmark! Her PhD thesis is entitled “Movement symmetry and the influence of long-term exercise – a study in elite endurance horses at competitions”. For the WAEO congress, Dr. Nissen will share her knowledge about objective gait assessment in horses along with various measurement methods. The aim is to stimulate a discussion about using objective methods to evaluate the effects of osteopathic treatment in horses. For more information about Dr. Nissen, go to facebook.com/Worldwide-Alliance-of-EquineOsteopaths-Conference-2016-925465864198115/?fref=ts.
Case study Cruz is a four-year-old Quarter Horse that had an accident in his pasture as a yearling. He has restricted motion in his left carpus, and cannot completely flex his carpus due to the accessory carpal bone being pulled medially. He also has a restriction in motion at the level of the jaw and poll, as well as at C6-7.
The radiograph prior to manipulation (Figure 1) shows a visual hyperextension of the atlas (lack of flexion). As well, the occiput is translated dorsal and unable to move to ventral. In this case, Cruz only flexed between the atlas and axis (where he should only have had rotational motion). In the radiograph following manipulation (Figure 2), you can see a more correct position. Because of myofascial connections, we felt it necessary to remove any tension in the jaw or poll before trying to manipulate the accessory carpal bone. In order to free up this region, great care needs to be taken to address the hyoid, temporomandibular joint, occiput, atlas and axis, as they all function as one unit. After freeing up this area and the base of the neck, it was much easier to then mobilize and create full flexion in the carpus. To learn more about the power of osteopathy, join us at our next conference, open to all interested therapists.
Figure 1 - Notice how the cranial aspect of atlas is hyper-extended in a neutral position. The occiput has translated to dorsal and is preventing the atlas from flexing.
Figure 2 - Notice how the cranial aspect of atlas has translated ventral and extension is now less extreme in atlanital occipital joint. TMJ is also visualized on this xray–jaw is not even from left to right. IVC Summer 2016
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Two approaches to
in horses
By Marc Smith, DVM
H
ave you ever treated a horse for a tendon injury, only to run out of treatment options? You’ve tried shoeing changes, a modified exercise program, hot and cold therapy. In fact, you’ve tried everything you know how to do, and although the horse is better – much improved – he’s not fixed.
threatening to an equine athlete’s future career than fractures,” writes Carol L. Gillis, DVM, PhD in her book Rehabilitation of Tendon and Ligament Injuries.1 A horse owner’s greatest fear is a tendon injury; laser therapy can be an effective treatment so a horse’s performance life is not curtailed.
From your years of experience, you know this horse will likely improve with rest, but “give it time” is not what your client wants to hear. She wants solutions, and it’s nerve-wracking because she can always go to another vet if she gets too frustrated.
“Laser” stands for Light Amplification by Stimulated Emission Rays. Lasers direct highly concentrated light at a specific wavelength to muscles, tissues, organs and connective tissue. As with other veterinary equipment, not all lasers are created equal. Some are technically easier to operate than others. Some work faster and deliver more efficient energy. And some have settings that allow you to simply push a few buttons and wait for the laser to do the rest. Prices vary too, ranging from $7,500 to $25,000.
While regular veterinarians run out of options at this point, proactive, integrative, progressive veterinarians have multiple therapies from which to choose. One treatment you should always consider is the laser. In this article, I’ll look specifically at two laser protocols – one reactive and one proactive.
Laser for tendon injuries Tendon injuries can be short-lived, debilitate the horse for six to 12 months, or wreck his career. Along the way, they can cause intermittent, nagging lameness, which is frustrating for owners, trainers and veterinarians. “Many owners and trainers of performance horses have regarded injuries to tendons and ligaments as being potentially more
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How laser heals Light from a laser induces specific biological changes in the tissue, including: • Altered electrical activity in the cells • Increased circulation to affected tissues • Increased lymphatic drainage • Increased supply of oxygen and other nutrients to diseased tissue • Increased microcirculation for healing
Virtually all lasers work their magic through the same mechanism – that is, emission of light at a specific wavelength to facilitate the horse’s innate ability to heal himself. Laser therapy for tendon injuries can be approached in two different ways.
1. Reactive approach to tendon injury
Photo courtesy of Jill Todd, DVM, CVA, CVCP
A reactive approach responds to a problem. A client calls with an issue, and you motor out with a solution. With tendon issues, the reactive veterinarian may employ a combination of methods such as NSAIDs or nutraceuticals, hot and cold therapy, and a change in shoeing. Some veterinarians may even use intra-lesional injections such as stem cell, platelet-rich plasma or some other novel technique. As a general rule, I use NSAIDs, laser therapy, and hot and cold compresses on every tendon injury I treat. Only if the response is inadequate do I ever consider intra-lesional injections. Monitoring is accomplished with your trusty ultrasound. Scanning the injury every three to four weeks helps evaluate the size of the lesion as well as tissue remodeling and overall healing, which guides you in choosing future treatment. Ultimately though, you are left to guess at the best time for this horse to go back to work. In this situation, using laser therapy aggressively on an every other day schedule can facilitate healing and help this horse recover. Most importantly, though, you are doing something on an ongoing basis to
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facilitate the healing process, and make the horse and his owner feel better. Let’s say you have a ten-year-old Quarter Horse that competes in Western pleasure events. This horse has a right front lameness isolated to the deep flexor tendon and suspensory ligament, based on a physical exam. The following would be my laser recommendations: • Laser treatments three times weekly for a total of nine treatments. If the swelling and pain are severe, or if the horse fails to respond to the first treatment, I may do the laser daily. As an added incentive, I usually give a package discount for multiple treatments.
2. Proactive approach to tendon issues The majority of tendon injuries arise from overuse, so using a laser proactively on tendons and ligaments may be the best use of laser in equine practice.
You benefit because you get to examine the horses on a regular basis. The owner benefits by staying ahead of the game as you keep her horse sound. And the trainer looks good because his reputation for keeping horses sound and serviceable remains intact. In a typical stable, the trainer calls you anytime something seems wrong. The horses are worth a lot of money and the owners view them as not only friends but also as their most important hobby. They do not want their horses laid up. They want to show, compete and have fun, so owners will pay for proactive care. Horses can benefit from proactive laser treatments every few weeks. Since 43% of horses with one tendon injury have bilateral disease,2 and many have hind leg suspensory issues, lasering all four limbs makes perfect sense. Since tendon injuries can occur before pain, swelling or even detectable lameness arises, it is even more important to consider proactive laser therapy. You can stay ahead of the game and so can the horses because laser light therapy works at the cellular level, affecting the whole body. Proper organ function is enhanced, further reducing the tendon disease process and helping the legs regain strength and mobility. An unmaintained tendon is an endangered tendon. The following is an example of a proactive approach: • First, I laser the tendons on both the front and back legs using the same frequency I would for an injury. The routine is exactly the same as for an injury; the only exception is that the treatment is performed only every two or three
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Advertorial
weeks. Next, I laser points on the liver meridian. From a TCVM perspective, the liver is responsible for tendon and ligament strength. Therefore, tonifying liver points aids in the prevention of tendon injury. Most lasers would require customized settings for proactive protocols, including laser acupuncture. Reininger recommends 442 Hz along the liver meridian. Applying the laser to the meridian takes about 45 to 60 seconds per point. The specific points are BL 18, BL 47 and LIV 14.
Summary Laser therapy is effective for treating tendon injuries and shortening recovery time, but more importantly, proactive laser treatments can prevent injuries. Caring owners can improve both the comfort and productivity of their horses with regular laser visits.
Gillis, Carol L., DVM, Phd. “Rehabilitation of Tendon and Ligament Injuries”. A carefully controlled rehabilitation program combined with a regular ultrasound examination provides the best chance for equine athletes to return to full performance following tendon or ligament injury. Author’s address: Dept. of Surgical and Radiological Sciences, School of Veterinary Medi- cine, University of California at Davis, Davis, CA 95616. 1997 AAEP. 2 Smith, Roger K.W. and Avella, Charlotte.“Recent advances in the diagnosis of tendon disease”. Dept. of Veterinary Clinical Sciences, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts. AL9 7TA, UK. 1
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MLS LASER TECHNOLOGY
Reducing pain, inflammation and edema while improving quality of life and performance in horses are the goals of laser therapy. “Our patented Class IV Multiwave Locked System (MLS) Therapy Laser features peak power of 75 watts and a 6 cm target area for fast treatment times,” says Meghan Collins, Director of Marketing of Cutting Edge Laser Technologies (celasers.com). “The technology delivers two proven therapeutic wavelengths – 808 nm (anti-edemic and anti-inflammatory) and 905 nm (analgesic). An energetic synergy is created when delivering these wavelengths, produceing greater anti-inflammatory and analgesic effects than either can produce on its own. “MLS technology was developed to produce an efficient and simultaneous effect on pain, inflammation and edema. It is the unique combination and synchronization of continuous and pulsed emissions that characterizes MLS and distinguishes it from other Class IV lasers. It provides more accurate therapeutic dose delivery, which means consistent and repeatable results.”
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Advertorial
ANTIOXIDANTS for ocular diseases
By Carmen Colitz, DVM, PhD, DACVO and Terri McCalla, DVM, MS, DACVO
Ocular diseases have an oxidative stress component. Free radicals readily damage the delicate tissues of the eye. The impact of free radicals can be diminished by daily exercise, optimizing diet and body weight, and supplementing with antioxidants and natural anti-inflammatory extracts. • Keratoconjunctivitis Sicca (aka KCS or dry eye) should be addressed with daily traditional therapy (e.g. topical cyclosporine or tacrolimus) and daily supportive antioxidants and vitamins including lutein, B vitamins, vitamins C and E, and Omega-3 fatty acids. KCS in dogs is primarily an immunemediated disease that gradually destroys lacrimal glands. By addressing lacrimal inflammation, these glands can regain function and secondary corneal fibrosis and vascularization can be alleviated, and even resolved in some patients. Allergies exacerbate KCS, so daily supplementation with turmeric, boswellia and grapeseed extract would be of great benefit. Beta-glucans help all diseases of the immune system, including allergies and other immune-mediated diseases. Joint Guard Vet contains all these natural ingredients. •C ataracts are often caused by normal age-related lens changes. Three other primary causes are genetics, diabetes mellitus, or progressive retinal atrophy (PRA). Supplements including lutein, alpha lipoic acid, grapeseed extract, lycopene, green tea extract and Omega-3 fatty acids may help slow aging changes, control oxidative stress occurring during cataract formation, and thwart the hyperglycemic effect of diabetes. OcuGLO prevents cataracts from forming in diabetic dogs. •P rogressive Retinal Atrophy is a progressive degenerative disease affecting the retina. Many of the same antioxidant ingredients supportive for lens health may help protect the remaining rod and cone photoreceptors
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from further degeneration. OcuGLO contains all these natural ingredients in addition to several others to best support lens and retinal tissues. •G laucoma affects many purebred dogs. Research has shown that oxidative stress pathways cause ongoing damage to the trabecular meshwork, and eventual death of retinal ganglion cells. This results in gradual blindness, often despite clinical control of intraocular pressure. When glaucoma is present, the cells of the lamina cribrosa generate more intracellular reactive oxygen species, have lower antioxidant expression, and higher intracellular calcium levels compared with normal cells. NF-E2 related factor (Nrf2) is a key transcription factor that plays a critical role in endogenous protection against oxidative stress. Nrf2 activation has a neuroprotective effect against oxidative stress-induced retinal ganglion cell death. In addition to tradition medical and surgical therapy, antioxidant supplementation should be part of the treatment protocol for dogs with glaucoma of any cause. •U veitis patients are diagnosed 50% of the time with autoimmune-mediated disease of unknown cause. Inflammation causes widespread oxidative stress-related damage to both affected cells and neighboring tissues. The use of free radical scavengers and supplements that help rebalance the immune system and promote healing and repair is imperative. In addition to traditional therapy, beta-glucans in combination with antioxidants can be beneficial. A combination of grapeseed extract, lutein, Omega-3 fatty acids, green tea extract, alpha lipoic acid and ubiquinol, etc., helps address inflammation, and promotes cellular recovery and return of function. Drs. Carmen Colitz and Terri McCalla are Consulting Veterinarians for Animal Necessity, and Co-Founders of Animal HealthQuest LLC. Dr. Colitz is one of the world’s leading veterinary ophthalmologists. Dr. McCalla is a board-certified veterinary ophthalmologist and owns Animal Eye Care LLC.
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HOMEOPATHY
By Todd Cooney DVM, CVH
FOR EYE DISORDERS We say the eyes are the window to the soul. One can gauge an individual’s health with a thorough gaze into this amazing organ. Eyes are also a window to the outside environment, and crucial to most animal species. Eye disorders are a regular part of veterinary practice, and homeopaths treat eye symptoms as part of the individual’s total symptom picture, or totality. Let’s consider how homeopathy is useful in treating some of the most common eye disorders seen in practice today, after this quick overview of homeopathy basics.
HOMEOPATHY 101 Homeopathic treatment is based on true natural laws of healing, which do not change over time. Homeopaths study the same textbooks used over 200 years ago, and practice according to the same principles outlined by the old masters of this healing art. Three basic laws undergird all of homeopathy: 1. T he Law of Similars states that any substance that produces symptoms in a healthy individual can cure the same symptoms in disease. For example, the watery nasal and ocular discharge of hay fever or a cold may respond well to Allium cepa, a remedy made from onions, because sliced raw onions cause similar symptoms (it may help any individual with watery ocular discharge). Another good example is parvo virus in puppies, with its
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characteristic nausea, vomiting, and foul liquid diarrhea, often helped by Arsenicum album, which causes the same syndrome in healthy individuals. Symptoms are the body’s attempt to restore homeostasis, or balance, and the correct homeopathic remedy supports this process, rather than opposing it. Opposing symptoms or surgery often lead to suppression, forcing the natural disease deeper into the body.
2. H ering’s Law states that disease tends to develop in a certain direction, and leave in the opposite direction. All cure starts from within and moves out, from the head down, and in reverse order as the symptoms appeared, or were suppressed. This translates to symptoms moving from more vital to less vital organs, from the interior to exterior of the body (think skin), and from the top down (or head to tail in animals) as healing occurs. For the eye, a cure would move from a cataract to an ocular discharge. This direction of cure is universal, and happens regardless of the type of medicine doing the curing. 3. T he Law of Dilution/Potentization states that repeated dilutions and succussions (forceable mixing) of remedies results in a greater strength of effect. A 6c potency is diluted 1:100 six times and succussed each time; the much more potent 200c is diluted 1:100 a total of 200 times with succussions. Quantum physics is shedding some light
on possible explanations for this phenomenon, as is nanotechnology (see the two-part article “Homeopathy: a 200-year-old nanomedicine” by Shelly Epstein, DVM, CVH and Iris Bell, MD in the Summer and Fall 2013 issues of IVC Journal), and clinical experience confirms this law.
OPHTHALMOLOGY AND HOMEOPATHY A noted human homeopathic ophthalmologist, Edward Kondrot MD, CCH, DHt (healingtheeye.com), believes that the largest cause of all eye disease in people is suppression caused by modern medicines and treatment methods. I feel this also translates to our animal patients.1 The following are a few contributing factors: • Antibiotics for conjunctivitis • Treatment of chronic blepharitis • Steroid eye drops and ointments • Cataract surgery • Laser surgery and injections for retinal disease These “opposite” treatments cause the disease to go deeper into the body, resulting in more serious eye problems. A good example are the “side effects” listed for steroid eye drops, which are actually the result of suppression – corneal ulcers, infections, cataracts, increased intraocular pressure, to name a few. This is also true in our veterinary patients, as antibiotic/steroid medications are the first line of allopathic treatments for most eye conditions seen in practice. How do we address some common veterinary ophthalmological conditions with homeopathy?
A. Conjunctivitis Up to 90% of eye cases have some degree of this inflammatory symptom. Many clients present an animal with eye discharge and want an antibiotic, fearing infection. However, true infections are rare. The ocular organs given the body a IVC Summer 2016
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route of cleansing and detoxification (lacrimal system), along with the saliva, lungs, skin, gastrointestinal tract, urine, etc.
• Sulphur – end of upper respiratory infection; acrid discharge; itchy eyes and lids; rubs eyes and face a lot
The most common causes of conjunctivitis are poor diet, toxin accumulation from vaccinations (vaccinosis), GI imbalance, and possibly tight dog collars (harnesses improve many health conditions). Bathing the eye with soothing solutions can be taught to clients.
B. Corneal ulcers
• Saline: ¼ teaspoon salt in one cup clean, distilled water. • In severe cases, add up to ten drops per cup of water of one of the following herbal tinctures: goldenseal, euphrasia, calendula or hypericum.
• Euphrasia – a very good remedy for many ulcers; used topically in saline eye wash, or given orally in potency (or both)
Here are a few of the most useful homeopathic medicines for conjunctivitis, with common indications (the symptoms of the patient should be present in the remedy, but not all the remedy symptoms need to be present in the patient): • Aconitum – sudden onset; intense fear; exposure to bright sunlight/ snow reflection or cold weather; early stages with intense painful inflammation; profuse watery discharge; bloodshot eyes • Allium cepa – minor irritations; watery, bland tears • Apis mellifica – swelling is key; chemosis; thick, sticky discharge; thirstlessness • Argentum nitricum – young animals; copious yellow/green discharge • Arsenicum album – yellow/watery discharge; chilly, restless, thirsty patient • Belladonna – sudden, intense inflammation; dry eyes; dilated pupils • Euphrasia – also known as “eyebright”; acrid tears leaving a stain; chronicity • Mercurius (vivus or solubilis) – acrid, thin discharge; pus in anterior chamber; green nasal discharge; irritable nature; sensitive to hot and cold • Pulsatilla – bland yellow discharge; itchy eyes, mild inflammation; resolving upper respiratory infection • Rhus toxicodendron – yellow, profuse discharge; intense inflammation; painful; gluey discharge sticking lids together
These are common, and often a sequel to conjunctivitis, ranging in severity from superficial to deep, or even indolent.
• Aconitum – if the ulcer is very painful, and developed recently • Apis, Argentum nitricum, Arsenicum alb., Hepar sulph., Mercurius, Rhus tox., Silicea, Sulphur, Thuya – other remedies to help heal ulcers • Silicea or Thuya – to complete healing of stubborn, indolent ulcers
C. Eye injuries Scratches, abrasions, lacerations and bruising are some of the most commonly seen injuries. These cases will usually respond very well to the correct remedy, without needing any other treatment. Consider the following: • Arnica montana – patient extremely touchy; traumatic injuries of any kind • Calcarea sulph. – excellent for splinters or foreign bodies in soft tissue around eye • Calendula – used internally or topically • Conium – cataract developing after trauma • Euphrasia – corneal edema post injury • Ledum – bruising; blood pooling under sclera/cornea, in anterior chamber • Staphysagria – corneal scratches/lacerations • Symphytum – blunt trauma to eye (“Arnica for the eye”)
D. Entropion This is a very painful condition, which often requires surgical correction. The following remedies may be helpful in some cases, and even prevent surgery: • Borax – patient displays extreme noise sensitivity; fear of falling (avoids going down stairs or panics when picked up) • Calcarea carbonica – other developmental problems present; soft, flabby, big-boned patients; slow dentition in history Continued on page 58.
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CASE STUDY – CATARACTS IN A HUSKY PUPPY
Nine months later, she presented again with excessive discharge and matting of the right eye, decreased vision
(couldn’t see her ball as well), and a “cloudy” look to the eyes. The eyes had seemed normal just three weeks ago. On exam, I found a mature cataract in the right eye, and a developing cataract in the left eye. She was blind on the right side, with some vision on the left side. No other symptoms were noted, so I prescribed a remedy based solely on the cataracts, using the following rubrics from Kent’s Repertory:
I chose Silicea as it is also an important vaccinosis remedy, which I felt was a big factor still with this pup. I gave her one dose of 200c potency. The client noticed improved vision within a week, and felt it was still improving. One month later, the right eye was about 75% improved, and the left eye about 50%. I chose to
wait and recheck in one month, due to the continuing remedy action. One month later, the client phoned to say the puppy’s vision seemed “back to normal”, and no cloudiness was seen in either eye. This was a very satisfying case, as the client had declined a referral to an ophthalmologist, opting for homeopathy instead.
In 2010, I treated a two-month-old female husky pup for diarrhea. She already received three vaccines by this age (by the breeder and another clinic). I gave her Thuya based on the symptom picture, and the problem quickly resolved.
CASE STUDY – INDOLENT ULCER IN A CAT
In November 2012, a specialist diagnosed an herpetic keratitis in the right eye of an 11-year-old Siamese mix named Emma Morse, which had progressed into an indolent ulcer. He recommended surgery to repair it, and dispensed topical and oral antibiotics. Dr. Jennifer Ramelmeier prescribed Hepar sulphuris calcareum 1M to be given QD on November 17, 18 and 19 because of the severe pain and ulceration.
Emma before homeopathy treatment
On recheck on December 3, the ophthalmologist reported the cat had improved significantly so surgery was no longer needed. A second prescription of one dose of Hepar sulph 10M was administered once, and by January 14 the ulcer was healed. There was a small milky spot remaining.
Emma after homeopathy treatment
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CASE STUDY – RECURRENT UVEITIS IN A MARE By Stephanie A. Chalmers, DVM, Diplomate ACVD, CVH Haleakala is a Rocky Mountain Mare. Born in December of 1994, she had been a brood mare before being purchased in September 2005. She had multiple (12) vaccines between October 2005 and May 2007 (at which time her owner stopped vaccinating). She had a hoof abscess in March 2008. Ocular pain, eyelid swelling and mild scleral injection were noted in the left eye on April 17 of 2008. The local vet made a diagnosis of uveitis and administered Banamine and a topical antibiotic eye ointment. Symptoms recurred on May 25, again in the left eye. This time the vet administered an intravenous steroid and prescribed a topical antibiotic/steroid ointment. When her owner contacted me on June 9, mild conjunctivitis and squinting were still present in Haleakala’s left eye. She also had early cataract development in the right eye. Her owner described her as a mild-mannered horse, sensitive and responsive when ridden. She liked to be brushed and petted. Though she had been a good mother, she seemed unattached to the other horses on the property. My assessment was that this was a manifestation of vaccinosis. Drugs temporarily covered up the eye
symptoms, but had not resolved the underlying vital force imbalance that continued to generate this symptom. Silica 30c was prescribed to be given once, based on the symptoms of uveitis, the cataract, the suspected role of vaccination, the history of a hoof abscess and the mildness of Haleakala’s nature. We discontinued the eye ointment. A complete resolution of her ocular symptoms occurred within one week after administering the single dose of homeopathic medicine. Her owner also noted that her coat looked better. The uveitis returned in 2010 in the same eye and resolved with one dose of Silicea. The same thing happened again the following year (2011), but the disease never progressed to pathology. During that period, I treated her with Sulphur to resolve a hoof abscess. I was unable to continue prescribing to completely cure Haleakala, because the owner decided to treat the mare herself when the eye inflammation recurred in 2013.
Continued from page 56.
E. Ectropion Many cases can tighten up enough to not need surgery, and involve many of the same remedies listed above, as well as: • Calcarea carbonica – if often needed • Apis, Argenticum n., Mercury, Sulphur
also describes five cured cases in his wonderful book, Fifty Reasons for Being a Homeopath. Dr. Richard Pitcairn3 lists the following remedies as useful for cataract treatment: Conium (especially indicated in cataract following eye trauma, and in older patients), Silicea, Pulsatilla, Sulphur and Euphrasia.
CONCLUSION
F. Cataract Some cases respond well to homeopathic treatment, especially when the total symptoms shown by the individual are included. Dr. Compton Burnett, a British homeopath in the late 1800s,2 used various remedies, depending on the patient’s symptom totality, and had good success with many cases. He
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The healing responses of many eye cases I’ve treated since I began to practice homeopathy encourage me to use this modality first when presented with eye issues. Eye problems often appear to be isolated from the rest of the body, but must be seen holistically to choose a successful prescription. Kondrot, Edward MD, CCH, DHt. (healingtheeye.com)
1
Burnett, J. Compton. Cataract: Its nature, causes, prevention, and cure. 1889.
2
Pitcairn, R and Hubble, S. Complete Guide to Natural Health for Dogs and Cats
3
FROM THE AAVA The American Academy of Veterinary Acupuncture is committed to improving animal health care by the advancement of veterinary acupuncture, Traditional Chinese Veterinary Medicine and Traditional Asian Veterinary Medicine, through education, research and leadership.
HUMAN ACUPUNCTURISTS FOR ANIMALS? The AAVA and other members of the veterinary acupuncture community are working on a position statement regarding human acupuncturists treating animals. This is a concern because some state practice acts allow human acupuncturists to treat veterinary patients. It is our position that human acupuncturists are not appropriately trained to handle animals. They are not educated in what constitutes an emergency presentation of a patient, how to properly restrain and handle veterinary patients, or what would constitute a public health concern in animal patients. Acupuncture point location in animals is partly anatomically transpositional, but not entirely. Anatomical transpositional point location involves placing the points based on anatomical locations that describe human points, but this isn’t true for all acupuncture points. In fact, many animal point locations are specific to quadrupeds. Treatment of a patient with acupuncture falls under the description of diagnosis and treatment, so in most veterinary practice acts it is the practice of veterinary medicine. The veterinary acupuncture community feels that for these reasons and others, veterinary acupuncture needs to be practiced by veterinarians. However, this isn’t the way the law is written in some states. If these states are willing to allow human acupuncturists to treat animal patients, then we feel that these human acupuncturists should be required to be appropriately trained. As of right now, there is no approved course in animal acupuncture for human acupuncturists. We also feel that these practitioners should be required to maintain
continuing education hours in animal acupuncture, and be directly supervised by the referring veterinarians. Currently, there are three main programs that certify veterinary acupuncturists. The Chi Institute and IVAS offer courses based on Traditional Chinese Veterinary Medical (TCVM) theory and the neurophysiologic basis of acupuncture. The other course, offered by OneHealth SIM, is based exclusively on the neurophysiology of acupuncture and consists of about 80+ veterinary continuing education hours. All three of these courses are a beginning to the extensive training many veterinarians get in veterinary acupuncture. There are many advanced courses in veterinary acupuncture, as well as Masters degree courses in acupuncture and TCVM. The combination of extensive training both in veterinary school and afterwards, with advanced training in acupuncture, makes veterinarians the preferred practitioners of veterinary acupuncture.
FUN FACT ABOUT ACUPUNCTURE Acupuncture works at the level of the fascia, nerves and even the cells. Many papers are coming out that demonstrate acupuncture partly supports the nervous system through the mitochondria. In fact, as many dachshunds can attest to, it provides excellent support to the spinal cord and intervertebral disks. For more information on veterinary acupuncture training, advanced continuing education, or how you can get involved with AAVA, visit our website at aava.org.
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nutrition nook
CHINESE FOOD THERAPY for the veterinary clinic
By Judy Morgan, DVM, CVA, CVCP, CVFT
“You are what you eat” is a phrase that can be traced back to the early 19th century. It was originally attributed to the famous gastronome, Anthelme Brillat-Savarin, when he said, “Tell me what you eat and I will tell you what you are.” This certainly applies to our patients. In my practice, we follow the philosophy that food is the foundation of life. We educate our clients about the benefits of feeding a high quality diet to help them understand how food affects their pets. The better the nutrients we put into the body, the better the body will perform. It’s impossible for our patients to attain good health if they are being fed processed foods, sugars, dyes, and high-carbohydrate diets. Not only do I advocate the use of real foods for my patients, I also advocate foods that help heal specific conditions. From a TCVM approach, each food affects the body in multiple ways. The major categories I use for food therapy include the ability of the food to warm (Yang) or cool (Yin), resolve stagnation, increase energy, dissolve Phlegm, or drain Damp.
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COOLING DIETS Many of our patients have diseases that cause inflammation in the body, like arthritis, Cushing’s disease, diabetes and infections. These dogs commonly drink and pant excessively, in an effort to cool their bodies. Their tongues will usually be red or dark on examination. By changing the diet, we can cool these pets internally, decreasing the annoying symptoms that cause anxiety for their owners. I like to use a protein base of rabbit, wild caught fish, or duck for these animals. Grains like millet or barley would be good choices. I try to get these pets off dry kibble, as kibble promotes heat and drying in the body. For treats, I like to use pieces of melon or banana, which are also cooling and moisturizing.
WARMING DIETS Other patients may seem cold, seeking sunny spots to sleep or hiding under blankets in an attempt to get warm. These pets need to be
warmed internally, so proteins like lamb, venison, or chicken will contribute Yang energy. If grains are being used in the diet, oats would be a good choice. I find that many of my older patients in renal failure really enjoy a warm bowl of oatmeal with cinnamon to warm them first thing in the morning.
CHRONIC SKIN AND ALLERGIES Many veterinarians will choose “novel” proteins like lamb or venison for dogs with chronic skin inflammation and allergies. While these may be novel proteins for the pet, they may not be the right choice for the disease from a TCVM perspective. For heat, inflammation, and itchy, red skin, a cooling protein would be a better choice. Again, many of these pets will respond better when taken off dry kibble. Personally, I am a big fan of feeding a well-balanced raw or home-prepared diet for these patients. Rabbit is my favorite cooling, novel protein for most patients with dry, itchy, inflamed skin. Luckily, there are now many rabbit-based raw and canned diets available. For those in the south, alligator might be another good choice.
QI TONICS In addition to warming or cooling the body, foods can be used as Qi tonics to add energy. Qi is the energy of life, which means old or weak dogs and cats need foods that will increase this energy. These pets commonly have pale, wet tongues. Some common Qi tonics include meats like beef, chicken, rabbit, lamb and tripe, and vegetables like pumpkin, squash, sweet potato and Shiitake mushrooms. These ingredients can be used to make home-cooked meals or to make a “topper” to add to the pet’s current diet.
may be suffering from Liver Qi stagnation. These are forms of stagnation in which blood and energy have become “stuck”. Commonly, pets with these problems will have a lavendercolored tongue. The easiest way to remember this is to think of a bruise, an area where blood has pooled or become stagnant. It has a lavender color and is painful to the touch. To help move the blood and decrease stagnation, the dog or cat can be given foods like lamb, venison, crab, shrimp, radishes, ginger, turmeric and vinegar. Golden Paste, made with organic ground turmeric, black pepper, Ceylon cinnamon, and coconut oil is a great supplement when trying to resolve stagnation.
DAMPNESS There is a saying in TCM: “The Earth element creates Damp and the Metal element stores it.” The organs associated with the Earth element are the stomach and spleen. The organs associated with the Metal element are the lungs and large intestine. When Dampness is created by impaired digestion, it likes to end up in the lungs and large intestine. When the
DISSOLVE PHLEGM Food can also be used to dissolve Phlegm. Phlegm is thick, sticky and mucoid. It is seen in pets with pneumonia or upper respiratory disease, and can be found in lumps, bumps and nodules internally or under the skin. Bladder and gallbladder stones are also forms of Phlegm. The thick, sticky discharge seen in dry eye (Keratoconjunctivitis sicca) would also be considered Phlegm. Phlegm can be seen on the tongue as thick bubbles or a greasy, sticky coating. Phlegm is formed when the secretions in the body become too dry. Dogs on dry kibble diets tend to have more issues with Phlegm. Foods like clams, radishes, kelp, pears, apples and peppermint are great for dissolving mucous. Foods to avoid would include any dairy products, since milk is really just a form of mucous.
STAGNATION Many tumors, lumps, bumps and swollen internal organs fall into the category of stagnation. IVDD is a localized area of Qi and Blood stagnation. Pets with seizures, anxiety or aggression IVC Summer 2016
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CASE STUDY
Myra is a six-year-old Cavachon who presented with chronic allergies, oxalate bladder stones, otitis externa, dental disease, lethargy, and a decreased desire to interact with family members. Her skin was red, thickened, malodorous, and alopecic along all four limbs and her ventrum. The external ear canals were swollen almost completely closed, with a waxy, foul-smelling discharge. From a TCVM perspective, Myra had excess Yang Heat in her skin and bladder. She had Phlegm in the form of bladder stones and waxy discharge in her ears. She had stagnation contributing to the bladder stones as well. The swelling and edema in her skin and ears constituted a form of Dampness. Myra had been fed a commercial, low quality, corn-based, dog food kibble her entire life. One ingredient in the kibble was animal digest, a rendered product that can be made from any species of animal found at the rendering plant. One of the least likely animal proteins in animal digest, that would be easily accessible as a novel protein, is rabbit. Rabbit is cooling and also acts as a Qi tonic; both actions would be beneficial for Myra. A stew was designed using rabbit, rabbit organs, pumpkin (Qi tonic), turnips (to resolve stagnation), carrots (to resolve stagnation), pears (to resolve Phlegm), radishes (to resolve Phlegm), Shiitake mushrooms (to drain Damp), and barley (to drain Damp). All ingredients were cooked at low heat in a crockpot. Within a few weeks, Myra’s itch score decreased from 10 to 2. Initially, her ears were too painful to allow cleaning or treatment, but after ten days on the new diet, the swelling in the ear canals was gone and there was no more discharge or odor. The ears were healed by food therapy alone. Thera-clean baths were instituted twice weekly; this is an innovative system that does not use any soap. The bladder stones were removed surgically to increase comfort for the patient. Myra has been eating a rabbit-based diet, with modifications as needed, for over a year now. She has grown a thick coat, with no further itching. She has had no recurrence of bladder stones or ear infections. Her energy level is great and she loves to play and interact with other dogs and family members.
Dampness is stored in the large intestine, we see mucoid stools, loose stools, sticky stools that are difficult to clean up, or diarrhea with undigested bits of food. Damp diseases include ascites, edema, or anything that causes fluid retention in the body. The tongue will generally be swollen with a thick white coating. There may be indentations along the edges of the tongue where it contacts the teeth. Foods that promote Damp conditions include dairy products, pork, lamb, cucumber, and melons; these should be avoided in pets with Dampness. Foods that drain Damp include seaweed, mushrooms, celery, barley, turnips, radishes, and asparagus. Food therapy gives us one more tool in our box of magic to treat our patients. Many clients enjoy knowing they are helping their pets to improved health by preparing ingredients at home and seeing the benefits of wholesome, delicious meals.
References Myra presented with severe allergies with poor hair coat and bad skin. Changes to her diet included the addition of rabbit, a cooling protein, and vegtables to resolve Phlegm, stagnation and Damp. She is now a healthy dog (right).
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Xie, Huisheng. Traditional Chinese Veterinary Medicine – Fundamental Principles, 2nd Edition, 2013. Xie, Huisheng, et al. Xie’s Veterinary Acupuncture, 2007. Xie, Huisheng, et al. Practical Guide to TCVM – Emergencies and Five Element Syndromes, 2014.
From the AVH
The Academy of Veterinary Homeopathy is comprised of veterinarians who share a common desire to restore true health to their patients through the use of homeopathic treatment. Members of the Academy are dedicated to understanding and preserving the principles of Classical Homeopathy.
The Academy of Veterinary Homeopathy (AVH) offers many exciting opportunities for veterinarians interested in adding homeopathy to their practices. The annual AHVMA conference in Columbus, Ohio from September 10 to 13, 2016 includes a homeopathy track with the following highlights: • Todd Cooney, DVM, CVH, discusses vaccinosis (resolving illnesses that result from sensitivity to vaccines) and homeopathic treatment for contagious diseases. • Shelley Epstein, VMD, will present the homeopathic method of interpreting patient responses to therapy. • Lisa Melling, DVM, CVH, speaks on homeopathic prescribing and integrating homeopathy into your practice. The discussion will include concepts such as homeopathic treatment for trauma, post-operative analgesia (read more in the Spring 2016 issue of IVC Journal on the use of homeopathy in a feline spay-neuter clinic), and infectious illness. • On the evening of Monday, September 12, join the AVH and the Pitcairn Institute of Veterinary Homeopathy (PIVH) as we present several interesting homeopathic cases, with complimentary wine to all in attendance! Our monthly webinars continue. Visit theavh.org for more information on upcoming events, benefits to membership in the AVH, and more exciting case reports.
CASE REPORT
DOG WITH PARVO-VIRAL ENTERITIS Treated by Lisa Melling, DVM, CVH A 20-week-old female Rottweiler with parvo-viral enteritis was in decline. Her owners had relinquished her rather than euthanizing her. On March 13, 2016, when her condition was discussed during rounds at the emergency clinic, she was vomiting and regurgitating despite two days of IV fluid therapy with crystalloids and colloids, CereniaTM, Famotidine, Ondansetron and Metoclopramide. Episodes of vomiting were occurring at least twice an hour, and she was having frequent bouts of diarrhea. A naso-esophageal feeding tube had been inserted, but the patient regurgitated each time trickle feeding was administered. She showed no interest in food, and was withdrawn and quiet. After examining the patient and noting that even gentle abdominal palpation induced eructations of gastric fluid, a single dose of Nux vomica 1M was administered dry by mouth. This homeopathic medicine is indicated for gastrointestinal complaints when the patient has extreme sensitivity to any pressure, is worse with eating, has eructations and possible adverse responses to drugs. Within 15 minutes of receiving the Nux vomica, the eructations resolved and the patient’s energy level improved. She subsequently pawed out her feeding tube, and a small quantity of food was offered which she ate readily without nausea. The patient continued to eat every few hours without regurgitation, and the anti-vomiting drugs were discontinued. The diarrhea improved rapidly as well, the episodes becoming less frequent and the stool more formed. Twelve hours after the homeopathic medicine was administered, the veterinarian at the next shift change found her to be alert and active, with no abdominal pain on palpation. She continued to do well and was adopted by an employee at the clinic. An exam on the dog performed on April 14 found the patient was healthy and thriving in her new home.
The British Association of Homeopathic Veterinary Surgeons (BAHVS) holds their 2016 Conference from September 9 to 11 at Bath Spa University in the UK. To learn more, visit bahvs.com. 64
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events
To post your event, email us at: info@IVCJournal.com
Pacific Veterinary Conference June 13-26, 2016 – San Francisco, CA
Join us under the sun while earning continuing education units and listening to the veterinary profession’s best speakers. Explore a two-day Vet Expo with the latest innovations from the veterinary industry, mingle with future colleagues, and in your down time discover the city! We want to see you in San Francisco for #PacVet2016.
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: Washington (DC), Kansas City, and San Diego. For more information: (800) 255-6864 cvc@advanstar.com www.thecvc.com
For more information: (800) 655-2862 info@pacvet.net www.pacvet.net
2016 IVECC Symposium
2016 CVMA Convention
September 7-11, 2016 – Grapevine, TX
July 7-10, 2016 – Niagara Falls, ON The 2016 Convention, presented in partnership with the Canadian Association of Animal Health Technologists and Technicians (CAAHTT), offers you a variety of new discoveries. Choose from sessions that focus on small animal, equine, bovine and ruminant medicine, animal welfare and business management. Specialized workshops, including a Level 2 dental lab and an orthopedic lab, are available. Continue your learning journey by wandering through the lanes of our exhibit hall to discover state-of-the-art products and services. In addition to the learning opportunities. For more information: (613) 236-1162 admin@cvma-acmv.org www.canadianveterinarians.net
VECCS is once again proud to conduct IVECCS 2016 in conjunction with the ACVECC, the AVECCT, the American College of Veterinary Anesthesia and Analgesia (ACVAA), the Academy of Veterinary Technician Anesthetists (AVTA) and the International Veterinary Academy of Pain Management (IVAPM). IVECCS has grown to over 2500 attendees and continues to be known as an intense clinical symposium and will again feature comprehensive programs on Small Animals, Exotics, and Large Animals for veterinarians, technicians, assistants, and practice management staff. The Symposium is highly critiqued to offer the highest-quality continuing education available at any national or international meeting. For more information: (210) 698-5575 info@veccs.org www.veccs.org
2016 AVMA Annual Convention August 5-9, 2016 – San Antonio, TX
AVMA’s Annual Convention mission is to advance the knowledge and skills of veterinarians and related professionals by providing: superior and diverse continuing education, a platform for dissemination of research, a forum for associated organizations, and an opportunity for collegial interaction. You will find everything from education to entertainment, events to exhibits and you’ll be informed, inspired and in touch with the brightest minds in the profession. For more information: (800) 248-2862 convention@avma.org www.avmaconvention.org
British Veterinary Homeopathy Conference September 9-11, 2016 – Bath, United Kingdom
Do you continually medicate your patients without considering cure? Do you wonder why they became ill, each in their own way? Do you want to expand your options and explore something amazing? These vets first highlighted the over-vaccination of dogs in 2003. They used nutraceuticals before most vets knew what they were. They prescribed for the now accepted fact that mental stress causes disease. They advised raw natural feeding 20 years ago to great benefit. Epigenetics has grounded their practice for 200 years. The learning experience of the year plus bar, band, dance, debate, listen, contribute, enthusiasm and fresh ideas.
August 11-14, 2016, Hershey, PA
For more information: +0 776-832-2075 www.bahvs.com
This conference will be taking place at the Hershey Lodge in Hershey, PA. More event information will become available at a later date. Register online.
2016 AHVMA Annual Conference
10th Keystone Veterinary Conference
September 10 -13, 2016 – Columbus, OH
This year the AHVMA conference will be taking place in Columbus, Ohio and over 100 hours of CE are available, including several labs. Online registration for the 2016 Annual AHVMA Conference is now available.
For more information: (888) 550-78620 cgacono@pavma.org www.keystonevetconference.org
CVC Conference for Veterinary Care August 26-29, 2016 – Kansas City, MO
For more than 20 years, CVC’s vision has been to provide veterinarians, veterinary technicians, practice managers, and team members the best convention experience
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For more information: (410) 569-0795 office@ahvma.org www.ahvma.org
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