V6I4 (Fall 2016) by Redstone Media Group

Integrative VETERINARY CARE VOLUME 6 ISSUE 4

DIABETES

–CAUSES AND NATURAL TREATMENT RESEARCH

STUDIES SHOW THESE NATURAL SUBSTANCES CAN DECREASE OR REVERSE THE EFFECT OF PROBLEMS CAUSED BY HIGH GLUCOSE. — P. 32

HERBS FOR THYROID DYSFUNCTION

PREVENTING JOB BURNOUT

THE CASE AGAINST GONAD REMOVAL

NONI FOR DEGENERATIVE DISEASE

EQUINE ENDOCRINE DISEASE

WHAT’ S NEW

Regulating the thyroid gland is key to preventing problems. Find out which herbs can help your patients. — P. 20

FALL ISSUE 2016

www.IVCJournal.com

Spaying or neutering a dog raises the risk of serious health problems, according to a number of studies. — P. 24

Read about four horses successfully treated with an integrative approach, including homeopathy and veterinary spinal manipulation. — P. 44

Work-related stress can take a toll on you and your staff. These strategies help enhance your mental wellness. — P. 56

This fruit has great potential for the treatment and possible prevention of many diseases, from allergies to cancer. – P. 36

• What breeds are more prone to cancer? • New equine biosecurity standard in Canada • Compassion fatigue in veterinarians • Saying goodbye to a homeopathy pioneer

IVC Fall 2016

contents

FEATURES

STUDY OF CANINE VACCINE ANTIBODY RESPONSES

By Lea Stogdale, DVM,

DIPLOMATE ACVIM

Canine distemper and parvovirus vaccines are high potency, highly effective biological injections that affect the immune system. Their judicious use should maximally beneﬁt patients while minimizing side effects.

HERBAL INTERVENTION FOR THYROID DYSFUNCTION

By Laurie Dohmen, VMD, MS

It is important to keep the thyroid properly regulated, because it affects so many metabolic processes in the body. The herbs discussed here are useful for regulating the gland and hormone pathways.

SPAY-NEUTER CONSIDERATIONS By Chris Zink, DVM,PhD,

DACVSMR, CCRT, CVSMT, CVA

DACVP,

Numerous studies show that removing a dog’s ovary or testicles can increase the risk of orthopedic problems, cancer, behavior issues and other conditions.

TECH TALK

INTEGRATIVE PRACTICE

MANAGING AN INTEGRATIVE VETERINARY PRACTICE

By Michelle J. Rivera, MT, VDT

In order to be successful and prosperous, you must have a well-educated staff and clientele, and a management style that keeps everyone happy and healthy

BUILDING RESILIENCE AND PREVENTING BURNOUT

By Barbara Fougere, BSc, BVMS (Hons), BHSc (Comp Med), MHSC (HERB MED), GDVCHM, GDVWHM, GDVA, CVA, CVBM Learn coherence strategies that enhance your mental wellness, help prevent stress-related disease, and assist you in taking better care of yourself so you can enjoy practice without burning out.

INTEGRATIVE APPROACH TO CUSHING’ S DISEASE By Lena McCullough, DVM, CVA

As Cushing’s becomes more prevalent, more clients are requesting holistic treatments over merely conventional approaches. Building health from a young age can also lessen the risk of this disease.

CAUSES AND NATURAL TREATMENT RESEARCH FOR DIABETES

By Nancy Scanlan, DVM, MS, CVA

A number of natural substances can decrease or reverse the effect of problems caused by high levels of glucose, which lead to glycation. Although they will not cure diabetes, they can slow its advance.

NUTRITION NOOK NONI FRUIT

By Ihor Basko, DVM, CVA

Noni has great potential for the treatment and possibly prevention of many degenerative diseases in pets.

INTEGRATIVE TREATMENT OF EQUINE ENDOCRINE DISEASE

By Jody Bearman, DVM, CVA, CVCH, CVSMT

In horses, the main endocrine diseases are Cushing’s and Equine Metabolic Syndrome/ Insulin Resistance Syndrome. Read four case examples of horses treated successfully with homeopathy and veterinary spinal manipulation.

60 4

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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.

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

COLUMNS & DEPARTMENTS

5 Advisory board 8 Editorial

Dr. Joyce Harman, DVM, MRCVS, graduated in 1984 from Virginia Maryland Regional College of Veterinary Medicine. She is certified in veterinary acupuncture and chiropractic and has completed advanced training in homeopathy and herbal medicine. Her practice in Virginia uses holistic medicine to treat horses. Her publications include The Horse’s Pain-Free Back and Saddle-Fit Book – the most complete source of information about English saddles.

s new 11 What’ 23 From the AVH 29 From the WAEO 41 From the VBMA 42 Veterinary resource guide 48 Industry innovations 49 From the AHVMF

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 IVAS 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

FALL 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: Xxxxx Xxxxxx

COLUMNISTS & CONTRIBUTING WRITERS

Ihor Basko, DVM, CVA Jody Bearman, DVM, CVA, CVCH, CVSMT Laurie Dohmen, VMD, MS Barbara Fougere, BSc, BVMS (Hons), BHSc (Comp Med), MHSc (Herb med), GDVCHM, GDVWHM, GDVA, CVA, CVBM Marty Goldstein, DVM Lena McCullough, DVM, CVA Jeff Nichol, DVM Jeff Pellico Michelle J. Rivera MT, VDT Nancy Scanlan, DVM, MS, CVA Lea Stogdale, DVM, Diplomate ACVIM Chris Zink, DVM, PhD, DACVP, DACVSMR, CCRT, CVSMT, CVA

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

IVC Fall 2016

editorial

Integrative treatments for

ENDOCRINE DISEASES When I graduated from veterinary college in 1980, I saw very few endocrine diseases other than hypothyroidism. And back then, treatment options were limited. Since then, endocrine diseases have become more prevalent, but luckily for me, I learned about a variety of holistic modalities so I can individualize treatments for each patient. An integrative approach to these conditions means we don’t need to assume that when a gland is not functioning properly, it needs replacement therapy for life. In fact, we can actually restore these glands to normal function, improving health and longevity. Curative treatments range from acupuncture to homeopathy and more. For example, in this issue, Dr. Jody Bearman presents four case reports of horses with Metabolic Syndrome who responded well to chiropractic, acupuncture and homeopathy. Dr. Lena McCullough’s success with TCVM (acupuncture and Chinese herbs) gives hope to the increasing numbers of dogs struggling with Cushing’s syndrome. Western herbs, meanwhile, eliminate the need for continued thyroid drugs, Dr. Laurie Dohmen helps us understand thyroid dysfunction and how Western herbal therapies can be useful. And Dr. Nancy Scanlan updates us on the causes of diabetes along with holistic treatments options. In my experience, overuse of vaccines is the underlying cause of many endocrine illnesses, so Dr. Lea Stogdale’s study of antibody titers showing many years of good immunity in most dogs gives more credence to minimizing vaccines. And while population control is critical to stem the number of stray and abandoned animals, Dr. Chris Zink clearly shows that for some breeds, especially athletic dogs, maximum health is

IVC Fall 2016

achieved when you wait several years before removing their hormone-producing glands. Even with multiple treatment options for our patients, we and our staff members can experience exhaustion and stress. Michelle Rivera looks at how an educated staff and streamlined management style can help your practice run more smoothly, while Dr. Barbara Fougere gives us specific strategies to dramatically benefit our mental and emotional health. For our “Nutrition Nook”, Dr. Ihor Basko covers the many health benefits of Noni for animals – this fruit can help human health as well so I have started taking it myself! Part of my strategy for health is to coach veterinarians wanting more – more holistic clients, more options for treatments, more time for their families and themselves, more income. By the time you receive this issue, I hope to have met and talked with many of you at the annual AHVMA conference in Columbus. I always look forward to this conference and healing retreat. The love, caring and commitment to veterinary health and happiness is so evident, along with the huge variety of treatment approaches to keep our patients and clients healthy and satisfied. You can also reach out to me by phone for support, and as always, our inboxes await your suggestions and successfully treated cases! Have a happy and healthy fall!

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

IVC Fall 2016

contributors

1. IHOR BASKO, DVM, CVA Dr. Ihor Basko graduated from Michigan State University’s College of Veterinary Medicine with a special focus in the fields of internal medicine, cardiology, and bone surgery. He managed a busy emergency animal hospital in San Jose, California. In 1971, he had the wonderful opportunity to participate in the first ever acupuncture study to test the efficacy of holistic modalities on physical ailments in pets, conducted at the University of California in L.A. Since then, Dr. Basko has been devoted to the study and practice of acupuncture, herbal medicine, dietary therapy, homeopathy, massage, and other alternative therapies for animals. He is one of the founders of the VBMA, and authored Fresh Food & Ancient Wisdom. 2. JODY BEARMAN, DVM, CVA, CVCH, CVSMT Dr. Jody Bearman graduated from the University of Minnesota College of Veterinary Medicine in 1992. Wanting to help animals that couldn’t be diagnosed or treated with Western medicine, and those that developed severe side effects from Western medicine, she became a Certified Veterinary Acupuncturist in 2005, is also a certified Veterinary Chinese Herbalist, practices Tui-na (Chinese massage and physical therapy) and food therapy, and has instructed at the Chi Institute. She became certified in veterinary spinal manipulation therapy in 2014, and is a member of the College of Animal Chiropractors. She trained in homeopathy and is a member of the AVH. Other modalities include T-Touch and applied kinesiology. She has a three-veterinarian integrative practice in Madison, WI. 3. LAURIE DOHMEN, VMD, MS Dr. Laurie Dohmen graduated from the University of Pennsylvania. She is trained in acupuncture, food therapy, Bach flower essences, and most extensively in Western herbs. She recently downsized her integrative mixed animal practice in Delaware, and lectures regularly on Western herbal veterinary medicine and other holistic topics. Dr. Dohmen is also on the faculty of Maryland University of Integrative Medicine, from which she received her Master’s in Therapeutic Herbalism. She is currently president of the Veterinary Botanical Medical Association. 4. LENA MCCULLOUGH, DVM, CVA Dr. Lena McCullough graduated from Washington State University in 1999 and received her CVA from the American Institute of Traditional Chinese Veterinary Medicine in 2005. She owns an integrative holistic medicine clinic for both people and animals in Seattle, WA. She also operates a small online (etsy) custom herb shop, Kingdom of Basil, for animals, and

IVC Fall 2016

writes a blog on holistic animal health, Pathwithpaws.com. Dr. McCullough loves practicing acupuncture and herbal medicine, especially working with hospice cancer animals. Her book on treating cancer in animals with holistic and integrated medicine will be out soon – an early digital version is available at pathwithpaws.com/cancer-care. 5. NANCY SCANLAN, DVM, MS, CVA Dr. Nancy Scanlan is Executive Director for the AHVM Foundation, a board member of WATCVM (World Association of Traditional Chinese Veterinary Medicine), and a consultant on VIN (Veterinary Information Network). She has been using complementary health therapies in her veterinary practice since 1970. She uses nutraceuticals, acupuncture (IVAS certified), non-classical homeopathy, trigger point therapy, and Chinese and Western herbs. Dr. Scanlan has held multiple leadership roles in holistic veterinary associations. She was Executive Director of the AHVMA for three years, president of the VBMA for two years, and is a member of the VBMA, AVBM, AHVMA, WATCVM, AVMA, and CVMA. 6. LEA STOGDALE, DVM, DIPLOMATE ACVIM Dr. Lea Stogdale graduated from the Faculty of Veterinary Science, University of Melbourne, Australia in 1970. She worked in general practice in Australia and England before teaching veterinary medicine in South Africa and Saskatoon for eight years. Dr. Stogdale passed the veterinary small animal internal medicine specialty board exams in 1981 to become a Diplomate in the American College of Veterinary Internal Medicine. She has worked in emergency and pet practice for over 25 years, taking a special interest in diabetes of dogs and cats, complementary medicine and nutrition (aesopsvetcare.wordpress.com). 7. CHRIS ZINK, DVM, PHD, DACVP, DACVSMR, CCRT, CVSMT, CVA Dr. Chris Zink is a consultant on canine sports medicine who designs individualized rehabilitation and conditioning programs for canine athletes, and presents Coaching the Canine Athlete seminars worldwide. She is the award-winning author of Peak Performance: Coaching the Canine Athlete, Dog Health and Nutrition for Dummies and The Agility Advantage, and co-author of Jumping From A to Z: Teach Your Dog to Soar and the DVD Building the Canine Athlete. Dr. Zink was instrumental in establishing the American College of Veterinary Sports Medicine and Rehabilitation. In 2009, she won the Woman Veterinarian of the Year award. She has a practice in Ellicott City, Maryland and also sees patients at the Veterinary Orthopedic and Sports Medicine facility.

what’s new CANCER RISK BY BREED

STATE OF PET HEALTH

While cancer can affect any dog, certain breeds have a known higher risk for certain types of the disease. Here’s a partial list from the Morris Animal Foundation:

Keeping abreast of disease prevalence in pets is one of the keys to a successful and informed practice. Banﬁeld’s recently published State of Pet Health 2016 Report is a useful resource of details on how diseases statistics are evolving.

• Bernese mountain dogs – A recent study found a relationship between joint disease and later cancer development in the same joints. • Golden retrievers – Researchers have found two genes related to cancer development in golden retrievers. • Boxers – A recent survey of brain cancer in dogs found that boxers were one of the most commonly affected. • Scottish terriers – This breed is at a higher risk of bladder cancer, although a study showed that adding vegetables to their diet reduced that risk by 70%. • Bouvier des Flandres – Bouviers are predisposed to gastric carcinoma. • Rottweiler – Bone cancer can be a problem in these dogs because of their large bone structure. • Rhodesian ridgebacks – They have a high incidence of several types of malignant tumors, including soft tissue sarcomas. • Airedale terrier – Nasal cancer is the most common cause of chronic nasal discharge and bleeding from the nose, and Airedales may be predisposed to nasal tumors. • Irish setter – This breed is predisposed to the development of insulin-producing tumors called insulinomas, which arise in the pancreas. If your patients include any of these breeds, it’s important to be aware of their cancer risk, so you can monitor their health.

State of Pet He 2016 Report alth

Daniel S. Aja, DVM, Banfield’s Chief Medical Officer and Senior Vice President of Medical Operations, opens the reports with an overview of the most significant findings: • Canine diabetes has increased by 79.7% since 2006, while the prevalence of diabetes in cats has increased by 18.1% over the same period. • Heartworm disease continues to be one of the top three health risks for dogs in the southern US, although cases have decreased by 33.1% since 2011, probably due to growing awareness and prevention. • The most common disease in dogs and cats continues to be dental disease, affecting 68% of cats and 76% of dogs. Dental disease has increased by 8% percent in dogs and 9.6% percent in cats since the initial report five years ago, although a better understanding among pet owners of the importance of dental health may be keeping these numbers lower than they might otherwise be. • Otitis externa, flea infestations, and internal parasites in dogs have all decreased in prevalence. For the full report, visit banfield.com/Banfield/media/PDF/ Downloads/soph/Banfield-State-of-Pet-Health-Report-2016.pdf.

morrisanimalfoundation.org

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what’s new NEW EQUINE BIOSECURITY STANDARD IN CANADA

HOMEOPATHY PIONEER PASSES ON

Keeping horses safe from disease is a crucial concern. The Canadian Food Inspection Agency (CFIA), in partnership with Agriculture and Agri-Food Canada (AAFC), Equine Canada and its equine sector organizations, has developed a National Farm and Facility Level Biosecurity Standard for the Equine Sector. This new guidance document can be used as a cost effective way to limit the risk of a disease outbreak on farms and other facilities where horses may be kept.

We were sorry to learn about the passing of Joe Lillard, President of Washington Homeopathic Products, on May 27, 2016. Joe was an innovator in the world of homeopathy and was dedicated to the art of natural medicine.

It provides: • Guidance on effective biosecurity practices to minimize the transmission of diseases • Ways to reduce the frequency, scope and impact of disease outbreaks • Multiple methods to enhance horse health, welfare and productivity “Having these guidelines in place for the equine industry will better equip those who own or care for horses to further protect Canadian horses from diseases,” says Lawrence MacAulay, Canada’s Minister of Agriculture. inspection.gc.ca

Joe purchased WHP in 1991, and along with his wife, Linda, grew the business from a small retail storefront to an international enterprise recognized for quality homeopathic remedies. Although Joe will be sorely missed, WHP is honoring his memory by continuing the work he loved. The company will move forward as a family operated business, thanks to Linda, Joe’s son-in-law, Wais, and his daughter, Belle. Memorial contributions may be made to the National Center for Homeopathy, 7918 Jones Brand Drive, Suite 300, McLean, VA 22102 or Homeopaths Without Borders, 20 Brookside Lane, Hebron, NH 03241.

COMPASSION FATIGUE IN VETS Witnessing a patient die of injury or illness can be devastating. In a veterinary hospital setting, this devastation can happen several times a day, creating a serious emotional toll. Similar to others regularly exposed to trauma and loss, such as animal shelter workers, many people who work in veterinary clinics experience compassion fatigue. In fact, a mental health survey by the AVMA shows that veterinarians are more likely to suffer from psychiatric disorders, experience bouts of depression and have suicidal thoughts. To address the issue, Veterinary Specialty Center (vetspecialty.com) has a fulltime licensed grief counselor to help veterinarians and their staff with compassion fatigue. Becky Murray has developed mandatory staff training and regularly meets with staff to offer support and suggestions on how to cope. She also speaks at veterinary conferences, area kennels and clinics about compassion fatigue and its potentially lifethreatening consequences. Hopefully, grief counselling for veterinarians will become a growing trend.

IVC Fall 2016

Study of canine vaccine antibody responses By Lea Stogdale, DVM, Diplomate ACVIM

he canine distemper and parvovirus vaccines are high potency, highly effective biological injections that affect the patientâ&#x20AC;&#x2122;s immune system. Their judicious use should maximally benefit our patients while minimizing overt and subclinical side effects. This article summarizes a review of canine distemper and parvovirus titer test results for 15 years of patient records. Most dogs remain antibody positive for many years and do not require repeated vaccinations. There are many benefits of titer testing, medically, professionally and financially, for the clinician, the owner and the patient. These results lead to vaccine titer testing and vaccination recommendations.

THE REASONS FOR SELECTIVE VACCINATION Canine distemper virus (CDV) and parvovirus (CPV) vaccines are considered core vaccines due to the severity of these diseases.1 They are modified live, high potency injections that significantly impact the immune health of the patient and can cause adverse reactions.2,3 The immune system is extremely complex, with the cellular and humoral components interacting and balancing each other. When we inject a vaccine, a high

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potency antigenic load, we initiate a series of reactions that initially suppress the immune system over ten to 14 days, then stimulate it over the next two weeks.4,5 In most patients, the immune system rebalances itself back to normal. When the immune system is suppressed, for any reason, there is an increased susceptibility to infections. When the immune system is stimulated, for any reason, there is a risk, in predisposed patients, to the development of allergies or auto-immune disorders.1,3 Current distemper and parvovirus vaccines are modified live virus (MLV), high potency products that are highly effective at immunizing and protecting dogs against these diseases.1,3 These attenuated modified live vaccine viruses multiply in the patientâ&#x20AC;&#x2122;s body, infecting the dog without causing clinical disease. They do result in the production of viral-specific antibodies which can be measured in serum.6,7,8,9,10 These vaccines are now high potency or high titer, with CPV having more than ten million live viruses in each dose. Our clients are questioning why we vaccinate every dog with every vaccine every year. With a selective vaccination approach at the annual examination, we are frequently not giving any injections. To add value to these consultations,

we need to give more attention to a thorough history, nutritional information and physical examination, often including an ophthalmologic examination. We also need to listen to our clients, affirm and compliment their good care of their pets, and show compassion and understanding. Laughing with the client strengthens the vet-client bond. I use the acronym ALL for each appointment: Affirm, Laugh, Learn. As Dr. Ronald Schultz, professor and chair of the department of pathobiological sciences at University of Wisconsin-Madison states: “Be wise and immunize, but immunize wisely”.11,12 Current (2011) American Animal Hospital Association (AAHA) recommendations for canine distemper and parvovirus vaccination are to vaccinate puppies at 12 and 16 weeks of age, booster at one year if the last puppy vaccine was at less than 16 weeks of age, then re-vaccinate greater than or equal to every three years.1 However, AAHA then goes on to say that the efficacy of the vaccines is at least five years: • “Among healthy dogs, all commercially available distemper vaccines are expected to induce a sustained protective immune response lasting at least five years. • “Among healthy dogs, all commercially available MLV-CPV-2 vaccines are expected to induce a sustained protective immune response lasting at least five years.”

PERSISTENCE OF DISTEMPER AND PARVOVIRUS ANTIBODIES AFTER VACCINATION Total immunity against viral diseases includes:

1 Local IgA and IgM 2 Humoral immunity of IgG antibodies, both those present in the blood and those that can be produced quickly when the antigen is present 3 Cellular immunity or memory 4 Other mechanisms. When we measure antibody titers, we are only documenting the IgG antibodies present in the bloodstream. A negative antibody titer does not mean the patient is susceptible to that disease; it means that no antibodies are present in his blood. That patient may or may not be protected.3 At this time in veterinary practice, serum antibody titers are the only tests we can do. We have limited information about the length of vaccine protection as it requires either challenge or large epidemiological studies, both of which are extremely expensive. Although a number of publications have looked at whether dogs have protective neutralizing antibodies present after vaccination, this author was unable to find any that sequentially studied CDV and CPV titers in client-owned dogs with known vaccination histories.

THE STUDY

Objective: To report on the length of time after vaccination that antibodies persist in dogs. Data collection: The patient records of Aesops Veterinary Care were reviewed from 2000 to 2014 for CDV and CPV antibody titers measured at the annual examination. Continued on page 16.

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Continued from page 15. After collection, the serum samples were refrigerated or frozen (if stored for longer than three days) and sent to commercial laboratories by overnight courier. The titers were done at Idexx Laboratories in Ontario or at Hemopet in California. Both laboratories ran positive and negative controls for each batch of samples tested.

consultation, may decide to cease testing since no further vaccinations would be given even if the patient tested negative. This may occur if the patient develops a serious disease such as an auto-immune disorder or cancer. Interestingly, no owner resumed vaccinations at Aesops Veterinary Care once they started titer testing.

The dogs were tested every two to three years. Positive titers can be due to vaccination and/or exposure to virulent virus in the environment. None of the patients had a history of overt disease that was confirmed as either canine distemper or parvovirus. However, subclinical, mild or undiagnosed disease is possible.

Group 1: 15 dogs vaccinated as puppies and not vaccinated since. q All these dogs tested positive for CDV and CPV titers when they were subsequently tested, one or more years later. w One dog was positive at the one-year test, but three years after her puppy vaccination (the last of which was at 12 weeks of age), she was negative for both CDV and CPV. She was an English cocker spaniel diagnosed as a puppy with persistent right aortic arch that had been surgically corrected. However, her severe megaesophagus remained a lifelong problem resulting in variable nutrition. e Of the 14 dogs who always tested positive, tests have been done up to nine years post-vaccination. a) Nine dogs were positive five or more years after their puppy vaccination. b) Five dogs were positive eight or nine years after their last vaccination. Continued on page 18.

For some of these dogs, vaccinations had been given prior to them becoming patients of Aesops Veterinary Care, so the vaccination history came from other veterinarians, shelters, rescues or pound organizations. The vaccination records of new patients were checked; only dogs with known vaccination histories were included. Results: The number of years between the last vaccination and the last titer test varies from one to 12. Patients can be lost to follow-up, may die, or the owner, with veterinary

VACCINATION RECOMMENDATIONS

Findings conﬁrm the updated selective vaccination recommendations of an annual physical examination and health consultation for each dog.1,2,3 If more than one vaccination injection is required at an annual examination, separate these by four weeks in order to minimize the stress on the dog’s immune system and reduce the incidence of adverse reactions.14

Vaccinate at 12 to 13 and 16 to 20 weeks of age, then titer test one year later. Three years after the last vaccination, do a blood titer level to see if this dog requires revaccination. Repeat the titer test every three years. These recommendations are in line with the 2011 AAHA guidelines.1 The beneﬁts of titer testing are that dogs are not being vaccinated when they don’t require it. Owners perceive the veterinarian to be informed, caring and professional. The veterinarian is being rewarded both ﬁnancially and with the satisfaction of practicing good medicine.

PROTECTION CAN LAST MANY YEARS

Positive titer tests indicate the patient is protected from that infection and disease. The length of time this protection lasts is several years, and possibly the lifespan of the pet.1,3,11,13 It is pertinent to remember that the IgG antibodies are just part of the body’s immune protection; it is the part we can measure. In the protected patient, vaccination has no advantages, only potential disadvantages.

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Continued from page 16. Group 2: 31 dogs vaccinated as puppies, given a booster one year later and not vaccinated since. q Two of these 31 dogs tested negative (7%). A Papillion with epilepsy tested negative for CPV five years after his last vaccination. A German shepherd, also with epilepsy, tested negative for CDV six years after his last vaccination. Both these dogs were receiving phenobarbital to control their seizures. w Of the dogs who always tested positive, tests have been done up to 11 years post-vaccination. 27 dogs were positive four or more years after their last vaccination, and all 11 who were tested at eight or more years were positive. Group 3: 30 dogs vaccinated as puppies, given a booster one year later and vaccinated subsequently one or more times. q Three of these 30 dogs tested negative (10%). a) A Weimaraner tested negative for CPV two years after his last vaccination. As a result, he was given a vaccine booster. Two and five years later he tested positive. b) A standard Schnauzer tested negative for CDV six years after his last vaccination. He had inflammatory bowel disease controlled by diet and a low dose of glucocorticoids. c) A French bulldog tested negative for both CDV and CPV seven years after his last vaccination. w Of the 27 dogs who always tested positive, tests have been done up to ten years post-vaccination. a) 25 dogs were tested and all were positive four or more years after their last vaccination. b) 16 dogs were protected eight to eleven years after their last vaccination. Summary of results: Of the 76 dogs, 64 have been tested four or more years after their last vaccination. Of these 64 tested dogs, 61 were positive for a protection rate of 95% Some dogs have remained protected for at least eight years (24) and at least

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ten years (six). Six dogs tested negative for either CDV and/ or CPV. These were all patients with compromised immune systems due either to a medical condition or their breed.

DISCUSSION There are many reasons for decreased or absent antibody responses. Maternal antibody overwhelming the vaccine is an q increasing risk due to the high potency of our vaccines. This explains the current AAHA recommendation for the final dose of the initial series between 14 and 16 weeks.1,2 w Subclinical viral infection at the time of vaccination, or no antibody response in the rare animal for unknown reasons, results in an unprotected dog.1,2 It is wise to titer test one year after the last vaccine to ensure the patient did respond. e Medications with cytotoxic actions can interfere with modified live vaccines, including tetracycline (doxycycline) and clindamycin.2 r Cachectic conditions such as malnutrition and major illness result in a poor or absent immune response.2 These patients should be vaccinated when the problem has been resolved. The same applies to any condition or medication causing immunosuppression.2 t Chronic disorders decrease the antibody response to vaccination. These include any cause of decreased nutrition such as megaesophagus, maldigestion, malabsorption, liver disease, and protein-losing diseases.2 This study adds epilepsy that’s controlled with phenobarbital to the list (two dogs). Some bloodlines in some breeds have decreased immune systems, including Weimaraners and Rottweilers.1,13 These patients should be titer tested every two years. elborn LV, DeVries JG, Ford R, et al.“AAHA canine vaccination guidelines”. Members of the American Animal Hospital Association W (AAHA) Canine Vaccination Task Force. 1-42, 2011 2 Kruth SA, Ellis JA. “Vaccination of dogs and cats: General principles and duration of immunity”. Can Vet J. 39:423-426, 1998. 3 Dodds WJ. “Vaccine issues revisited”. Proceedings AHVMA 79-83 2009. 4 Bodewes R, Fraaij PLA, et al. “Annual vaccination against influenza virus hampers development of virus-specific CD8+ T Cell immunity in children”. J Virology 10:11995-12000, 2011. 5 Siegrist C. “Vaccine immunology”in Vaccines. Saunders 17-37, 2008. 6 Twark L, Dodds WJ. “Clinical application of serum parvovirus and distemper virus antibody titers for determining revaccination strategies in healthy dogs”. JAVMA 217:1021-1024, 2000. 7 Kyle AHM, Squires RA, Davies PR. “Serologic status and response to vaccination against canine distemper(CDV) and canine parvovirus (CPV) of dogs vaccinated at different intervals”. J Am An Pract, June 2002. 8 Bohm N, Herrtage ME, et al.“Serum antibody titres to canine parvovirus, adenovirus and distemper virus in dogs in the UK which had not been vaccinated for at least three years”. Vet Record 154:457-463, 2004. 9 Mouzin DE, Lorenzen MJ, et al. “Duration of serologic response to five antigens in dogs”. JAVMA 224:55-60, 2004. 10 Masayuki T, Kazuhiko N, et al.“Antibody titers for canine parvovirus type-2, canine distemper virus, and canine adenovirus type-1 in adult household dogs”. Can Vet J. 52: 983–986, 2011. 11 Schultz RD. “Current and Future Canine and Feline Vaccination Programs”. Vet. Med. March, 1998. 12 Schultz RD.“An update on what everyone needs to know about canine and feline vaccination programs”. Proceedings of the 2008 Annual Conference of the AHVMA, 333-345, 2008 13 McMurray M. “Weimaraner warning”. Can Vet J. 42:417, 2001. 14 Moore GE, Guptill LF, et al. “Adverse events diagnosed within three days of vaccine administration in dogs”. JAVMA 227:11021108, 2005. 1

Product Proﬁle

Common ORAL CARE ingredients – WHAT YOU NEED TO KNOW By Jeff Pellico, PKB Animal Health

We like to think we know when our pets are unwell. When a dog licks his paws, we know his feet are sore. If he scratches at his ears and wipes his head along the furniture, we might guess his ears are irritated or infected. Unfortunately, few conditions and their symptoms are so transparent. That is why we need to be especially careful when managing a pet’s oral health. Some of the most common oral care ingredients can further compromise a dog or cat’s wellbeing, leaving symptoms that are easily overlooked. Before purchasing or recommending a product, always guarantee no further harm will be done.

BUYER BEWARE

Different species can have wildly different responses to typical oral care ingredients. • Xylitol, a popular sweetener that balances out the bitterness of companion ingredients, may be safe for horses and cats, but to dogs it is almost a hundred times as toxic as chocolate. Rarely are products safe for all animals, so always know how a patient might respond. • Powerful antiseptics, such as Chlorhexidine and Cetylpyridinium Chloride, target a wide range of bacteria in the mouth, upsetting the animal’s natural balance of oral flora, and potentially staining his teeth brown. When healthy bacteria in the mouth are destroyed, harmful bacteria take over, opening the oral ecosystem to bacterial and fungal overgrowth. • Some ingredients can even make application a painful process. Alcohol frequently inflicts a sharp, burning sensation often mistaken as fighting back an infection or bad bacteria. In reality, it adjusts the body’s pain

receptors to become increasingly sensitive to moderate temperatures, causing unnecessary discomfort. • Detergents such as Polysorbate 20, Polysorbate 80 and Sodium Laureth Sulfate cause irritation over time. By disrupting the oral mucin layer, they create an environment for recurring canker sores. Both alcohol and detergents also act as solvents, drying out natural oils and inhibiting saliva production. For pets that already suffer from Dry Mouth (Xerostomia), these ingredients only worsen the condition and its side effects. By even temporarily hindering saliva production, these ingredients promote compounding health issues such as periodontal disease and tooth loss, while creating an environment for bacterial and fungal overgrowth.

A POWERFUL YET GENTLE ALTERNATIVE

Free of Xylitol, Chlorhexidine, alcohol, and detergents, the Oratene Brushless Oral Care line offers pet owners a nontoxic alternative that is safe for all animals of all ages. Together, the patented LP3 and MD2 Enzyme Systems break down plaque bioﬁlm and exclusively target the harmful bacteria and microorganisms of the mouth, helping freshen your patients’ breath while maintaining a healthy oral ecology. Based on 35 years of enzyme research and developed to manage Dry Mouth, Oratene’s enzyme systems replenish the protection and defense mechanism that is naturally found in healthy saliva. Oratene products are made for pets with Dry Mouth, so their owners can rest easy knowing they are in good oral health. IVC Fall 2016

l N a O b TI D r He RVENYROI N O I E H INTOR T UNCT F SF DY S

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n me

M D,

Thyroid disease is very common in cats, dogs and even horses. It is important to properly diagnose and treat thyroid disease, as thyroid hormone affects almost every organ in the body (see figure on page 22).

PHYSIOLOGIC PATHWAY The hypothalamus produces TSH-releasing hormone (TRH), which travels to the anterior pituitary. The pituitary then produces thyroid-stimulating hormone (TSH), which stimulates the thyroid gland. The thyroid gland makes primarily thyroxine (T4) and some triiodothyronine (T3). Most T3 is made in the peripheral tissues via the deionization of T4. T3 is the bio-active thyroid hormone. Both T3 and T4 are stored in the thyroid gland and transported through the blood stream bound to a protein. The protein is easily released when the hormone is transported into the receptor cell. Free T4 or T3 in the blood (unbound to a protein) provides the negative feedback loop to the hypothalamus and pituitary to stop their production of TRH and TSH, respectively. T3 receptors are found in both the nucleus and mitochondria of cells. T3 and T4 are inactivated via the irreversible removal of an inner-ring iodine catalyzed by type 3 deiodinase (D3). Given this intricate pathway, thyroid disorders can occur in a myriad of locations and ways, causing a variety of symptoms. Problems with the hypothalamus or pituitary, issues with the synthesis of TSH or TRH, deficiencies of albumin or globulin (the carrier proteins) all affect the thyroid. Complete bloodwork including a full thyroid panel is the most accurate way to diagnose thyroid hormone abnormalities.

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HYPERTHYROIDISM Cats tend to become hyperthyroid, while dogs and horses become hypothyroid. The diseases generally manifest with age, so testing becomes more important as any animal gets older. Clinical signs of hyperthyroidism include reduced insulin sensitivity, tissue atrophy, increased energy expenditure at rest and exercise, elevated heart rate and palpitations, anxiety and increased thermogenesis. There are also changes at the genetic level: glucose and lipid metabolism, protein synthesis, transcriptional control, signal transduction and mitochondrial energy metabolism via increased mitochondrial uncoupling protein 3 (UPC3). This uncoupling causes a 70% increase in the citric acid (TCA) cycle but no increase in adenosine triphosphate (ATP) synthesis. Thyroid adenoma is the most common cause of hyperthyroidism in cats, but another frequent cause is carcinoma.

HYPOTHYROIDISM Dogs can truly become hypothyroid. Horses are often supplemented with thyroid powder without proper diagnostic testing, which can cause iatrogenic hypothyroidism. Clinical signs of hypothyroidism include weight gain despite inappetance, fatigue, feeling cold all the time, bradycardia, shortness of breath, pericardial, pleural and abdominal effusions, poor memory and concentration, and constipation. In dogs, lymphocytic thyroiditis and idiopathic thyroid gland atrophy are the most common causes of hypothyroidism, but diseases of the pituitary or hypothalamus can also cause secondary hypothyroidism.

HERBAL HELP Most of the herbs discussed below don’t specifically treat “hyperthyroidism” or “hypothyroidism”, but instead regulate the gland and hormone pathways as a whole. Since thyroid disease is so common, there are many herbs that affect the thyroid along with a plethora of research.

Melissa officinalis Also known as lemon balm or bee balm, this member of the Lamiaceae family is a commonly used medicinal herb. As with most mints, its aerial parts are used medicinally. Lemon balm inhibits TSH receptor binding, which causes decreased production of T3 and T4 in the thyroid gland.1 It decreases circulating TSH levels2 but increases levels of circulating T3 and T4.3 This is due to the negative feedback loop in which increased circulation of free T3 and T4 goes to the pituitary and causes decreased production of TSH. “Melissa officinalis increases the level of thyroid hormones probably through increasing albumin synthesis, decreasing fat levels, and eventually decreasing leptin hormone levels. This extract also reduces TSH level probably due to the negative feedback of thyroid hormones.”4 In other words, albumin is one of the proteins that transport thyroid hormone through the bloodstream. “Fats and thyroid levels have an inverse and significant relation. Since M. officinalis extract can reduce blood lipid levels, it is most likely that at least part of this effect is exerted by increasing thyroid hormone.”3 Leptin is secreted from fat cells and binds to receptors in the hypothalamus. “Its main physiological role is decreasing weight via reducing appetite for food and increasing the production of energy from body fat reserves.”4 When the fat level is decreased, there is less fat to produce leptin, so the leptin levels would “eventually” decrease.

EFFECTS OF KELP ON THE

THYROID GLAND

Rezk et al studied the histology of the thyroid gland with radiation and kelp. They broke study rats into four groups:

1 A control group 2 A Fucus vesiculosus

group in which the rats were given 100 mg/kg kelp for 30 days 3 An irradiation group where the rats were irradiated once with 4Gy 4 A combination of 2 and 3 in which the last dose of kelp was administered 60 minutes prior to irradiation. The rats were “sacrificed” seven and 15 days post irradiation. On day seven, Group 3 had “ruptured follicular epithelial cells, ruptured colloid, disappearance of parafollicular cells, and edema. Also, on the 15th day, most follicular cells were disappeared.”12 In Group 4, the kelp normalized the follicular cells in the thyroid gland histologically, and returned the follicles to normal variations of shape and size. In this study, kelp also stabilized T3 and T4 levels in irradiated rats.

Nigella sativa Black seed or black cumin, as it is commonly known, has been used medicinally for thousands of years in Arabian and Indian traditions. Black seed has biochemical and histologic effects on thyroid hormone and the thyroid gland, respectively. It increases

Nigella sativa

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Melissa officinalis circulating T4 levels5 and circulating levels of T3. It also increases the ratio of T4:T3.6 This is because it increases T4 levels more than T3 levels, so the ratio adjusts. Again, the negative feedback loop leads to decreasing circulating levels of TSH.7 Histologically, it protects thyroid tissue from hyperplastic changes secondary to hypothyroidism7 so the thyroid can function more normally.

Commiphora mukul Guggul is a member of the Burseraceae family; its oleogum resin is the part used medicinally. Guggul increases the uptake of iodine by the thyroid gland,8 enhances the activity of thyroid peroxidase enzyme (an iodine liberating enzyme) and protease,8,9 increases T3 production, and generally stimulates the thyroid gland.9 Increased T3 production is due to increased conversion of T4 to T3 in the liver: “Guggulsterone also seems to increase T3 synthesis by increasing the conversion of T4 to T3 and significantly decrease hepatic lipid peroxidation. Since serum thyroxine (T4) is converted to T3 in the liver, researchers concluded that hormone levels and peroxidation are related.”10

Fucus vesiculosus Bladderwrack or kelp is a brown seaweed of the Fucaceae family. It is tempting to think that it’s only the iodine content of kelp that affects the thyroid, but it has other influences as well. “Brown seaweeds are the only known non-animal sources of thyroid hormones. The presence of organically-bound iodine in brown seaweeds as thyroid hormones may explain some of the effects of eating some brown seaweeds…. Fucus species of brown seaweeds have been used as treatment for thyroid disorders. The thyroid hormone present in Fucus is Di-Iodothyronine (DIT); it is weakly active if at all as a thyroid hormone in the mammalian body. Two DIT molecules are condensed in an elegant esterification reaction to produce tetraiodotyrosine (T4, thyroxine). The organically bound iodine in Fucus may enhance T4 production by providing some prefabricated portions of T4…. The therapeutic effects of using powdered Fucus…resemble the therapeutic effects of thyroxine medications.”11 So the body takes the DIT molecules in the kelp and turns them into T4 for use. ee the sidebar on page 21 for a study of the histology of the S thyroid gland with radiation and kelp. There are many other herbs that affect the thyroid gland and all the hormones involved in its metabolic process. It is very important to keep the thyroid properly regulated, as it affects so many metabolic processes in the body.

Wynn S, Fougere B. Veterinary Herbal Medicine. St. Louis: Mosby Elsevier, 2007. Duke J. The Green Pharmacy. New York: St. Martin’s Press, 1997. 3 Zarei A, Changizi-Ashtiyani S, Taheri S, Hosseini N. “A Brief Overview of the Effects of Melissa officinalis L. Extract on the Function of Various Body Organs”. Zahedan Journal of Research in Medical Sciences, 29-34, 2015. 4 Zarei A, Changizi-Ashtiyani S, Rezaei A, Taheri S. “Comparison Between the Effects of the Alcoholic Extract of Melissa officinalis and Atorvastatin on Serum Levels of Thyroid Hormones in Hypercholesterolemic Male Rats”. Zahedan Journal of Research in Medical Sciences, 6-12, 2013. 5 Sharif S, Elmahdi B, Mohammed A, Mohammed A. “The Effects of Nigella sativa L. Ethanolic Extract on Thyroid Function in Normal and Alloxan-Induced Diabetic Rats”. Thyroid Research and Practice 9 (2), 48-52, 2012. 6 Habeeb A, El-Tarabany A.“Effect of Nigella sativa or Curcumin on Daily Body Weight Gain, Feed Intake and some Physiological Functions in Growing Zaraibi Goats during Hot Summer Season”. Arab Journal of Nuclear Science and Applications 45 (2), 238249, 2012. 7 Khalawi A, Al-Robai A, Khoja S, Ali S. “Can Nigella sativa Oil (NSO) Reverse Hypothyroid Status Induced by PTU in Rat?” Biochemical and Histological Studies. Life Science Journal 10 (2), 802-811, 2013. 8 Stansbury J, Saunders P, Winston D. “Promoting Healthy Thyroid Function with Iodine, Bladderwrack, Guggul and Iris”. Journal of Restorative Medicine 1 (1), 8390, 2012. 9 Shishodia S, Harikumar K, Dass S, Ramawat K, Aggarwal B. “The Guggul for Chronic Diseases: Ancient Medicine, Modern Targets”. Anticancer Research 28, 3647-3664, 2008. 10 Friedman M. “Thyroid Autoimmune Disease”. Journal of Restorative Medicine 2 (1), 1-13, 2013. 11 Kandale A, Meena A, Rao M, Panda P, Mangal A, Reddy G, Babu R. “Marine Algae: An Introduction, Food Value and Medicinal Uses”. Journal of Pharmacy Research 4 (1), 219-221, 2011. 12 Rezk R, El-Azime A, Sh A. “Fucus vesiculosus Ameliorates Histological and Biochemical Changes in Thyroid Gland and Ovary of Irradiated Rats”. Arab Journal of Nuclear Science and Application 46 (3), 286-296, 2013. 1 2

Thyroid hormone affects almost every organ in the body.

IVC Fall 2016

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) enjoyed a successful conference in Austin, Texas in June. • The opening talk was enthusiastically given by certified veterinary homeopath Dr. Shelley Epstein. Dr. Epstein is the author of the first homeopathic clinical case published in a peer-reviewed veterinary journal. In just two hours, she was able to summarize the year-long course in Dr. Prafull Vijayakar’s Predictive Homeopathy (PH) and how it can be useful in treating animal patients. PH uses understanding of modern sciences like embryology, physiology, and genetics to reinforce Hahnemannian homeopathy. Dr. Epstein discussed Dr. Vijayakar’s amazing recoveries of human patients with what were previously considered incurable diseases. She provided veterinary examples to illustrate the use of embryologic development in fine-tuning understanding of the direction of cure/suppression. She also provided veterinary examples to show how understanding Hahnemann’s chronic miasms in terms of physiology can increase prescribing success. • The second presentation delved into the secrets and intricacies of healing using personalized medicine. Baron von Boenninghausen developed this method hundreds of years prior to our current understanding of genes and epigenetics. He was among the first to understand and describe how modifications to symptoms produced by the body can be used to help it heal. These modalities are very important when diagnosing and treating all species, especially animals. • Austin resident and veterinary homeopath Dr. Will Falconer discussed his success in preventing and treating heartworms without drugs, even in areas where mosquitoes are prevalent, thereby demonstrating the effectiveness of the natural path. There were many other great speakers at the conference – please visit the AVH website at theavh.org to learn more about the benefits of homeopathy in your practice.

The Pitcairn Institute of Veterinary Homeopathy (PIVH) is pleased to announce that the year-long Professional Course in Veterinary Homeopathy held its final session in Portland, Oregon in June, producing a new class of veterinarians trained in the art and science of Classical Homeopathy. The next course begins in the fall of 2017 – more information can be found at pivh.org.

The next conference to provide lectures on homeopathy was the American Holistic Veterinary Medical Association (AHVMA) Conference in Columbus, Ohio from September 10 to 13. Dr. Lisa Melling presented on the morning of September 10 with an introduction to homeopathic prescribing for animals and how to integrate homeopathy into the veterinary practice. Dr. Todd Cooney discussed homeopathic prescribing in the treatment of vaccinosis and contagious disease in the afternoon. The AVH and PIVH also shared a table in the exhibit hall. On the evening of September 12, the AVH and PIVH presented several inspiring homeopathic cases, with complimentary wine to all in attendance. More information AHVMA.org.

can

found

IVC Fall 2016

SPAY-NEUTER considerations to maximize health

By Chris Zink, DVM, PhD, DACVP, DACVSMR, CCRT, CVSMT, CVA

hose of us responsible for the health of dogs need to continually read and evaluate new scientific studies to ensure we are taking the most appropriate care of our canine patients. This article reviews scientific evidence that, taken together, suggests that veterinarians and dog owners need to revisit the current common recommendation that all dogs not intended for breeding have their gonads removed at or before six months of age. The results of a number of studies on the effects that removing the ovary or testicles (gonadectomy) has on orthopedics, cancer, behavior and other health issues are briefly summarized.

ORTHOPEDIC CONSIDERATIONS • Bitches spayed at seven weeks had significantly delayed closure of growth plates as compared to those spayed at seven months, and those spayed at seven months had significantly delayed closure of growth plates as compared to those left intact.1 • In a study of 1,444 golden retrievers, bitches and dogs spayed or neutered at less than a year of

IVC Fall 2016

age were significantly taller than those spayed or neutered after a year of age.2 • In a study of 203 agility dogs, the author demonstrated that the tibia, radius and ulna were significantly longer than the femur and humerus, respectively, in dogs that were spayed or neutered at or prior to eight months of age as compared to intact dogs (C. Zink, unpublished data). • Several studies have shown that spayed and neutered dogs have a significantly higher prevalence of CCL rupture,3–6 even when controlling for body size.3 • In a study of 759 male and female golden retrievers neutered or spayed before six months of age, the incidences of CCL rupture were 5% and 8% respectively, compared to no CCL rupture diagnosed in intact males and females.7 • Dogs neutered at least six months prior to a diagnosis of hip dysplasia were 1.5x more likely to develop hip dysplasia than sexually intact dogs.8 • Spayed/neutered dogs had 3.1x higher incidence of patellar luxation.9

• In Labrador and golden retrievers, neutering before six months of age increased the incidence of one or more joint disorders by 2x and 4x to 5x, respectively.10 • In a study of 1,170 German shepherds, followed through eight years of age, 21% of neutered males and 16% of spayed females were diagnosed with one or more joint disorders compared with 7% of intact males and 5% of intact females.11 Discussion: Dogs spayed or neutered at or before puberty can often be identified by their longer limbs, lighter bone structure, narrower chests and narrower skulls than intact dogs of the same breed. This differential growth frequently results in significant alterations in body proportions and particularly the lengths (and therefore weights) of certain bones relative to others. For example, if the femur has achieved its genetically determined normal length at eight months, prior to a dog being spayed or neutered, but the tibia (which normally stops growing at 12 to 14 months of age) continues to elongate for several months after that point because of the removal of the sex hormones (which contribute to growth plate closure), then the relationship between the femur and tibia will be different than what was genetically determined. This may result in an abnormal angle at the stifle and a longer (and therefore heavier) tibia placing increased stress on the cranial cruciate ligament (of the knee or stifle joint). It is well known that spayed and neutered dogs are more likely to be overweight or obese than sexually intact dogs,12 and this can be an additional contributing factor to orthopedic diseases. Thus, keeping spayed/neutered dogs lean can help mitigate the increased risk of orthopedic conditions.

CANCER CONSIDERATIONS • Spayed females had more than 5x greater risk than intact bitches of developing cardiac hemangiosarcoma; neutered males had 1.6x higher risk than intact males of developing cardiac hemangiosarcoma.13 • Spayed females had 2.2x increased risk for developing splenic hemangiosarcoma.14 • Male and female Rottweilers neutered or spayed before a year of age had 3.8x and 3.1x greater risk, respectively, of developing bone cancer than intact dogs.15 In a second study, spayed/neutered dogs had a 2.2x higher risk of developing bone cancer than intact dogs.16 • Neutered dogs had a 2.8x greater risk for developing prostate cancer than intact dogs.17 Neutered dogs had a 4.3x higher risk of developing prostate carcinoma.18,19 • Neutered dogs had a 3.6x higher risk for developing transitional cell carcinoma of the bladder than intact dogs, and a 3x greater risk of developing any bladder tumor.17 Continued on page 26. IVC Fall 2016

PREVENTING PROCREATION

If we leave the gonads intact, how can we prevent the production of unwanted dogs? In males, it is relatively easy to perform a vasectomy. One possible disadvantage is that vasectomy does not prevent some unwanted behaviors associated with males, such as marking and humping. On the other hand, females and neutered males frequently participate in these behaviors too. Training is the most effective solution to these behaviors. Another potential issue is finding a veterinarian who can perform the procedure. Veterinary schools do not currently teach students how to perform vasectomies. However, the methodology has been described and any veterinary surgeon can learn the technique. In females, the issues are more complex, because having a bitch in heat is inconvenient and leaving the uterus intact substantially increases the risk of pyometra (a serious, potentially fatal uterine infection). One solution is to perform a hysterectomy (removal of the uterus), leaving the ovaries intact. Unfortunately, the effects of this technique on female dogs have never been carefully studied. There is some suggestion that these dogs might continue to ovulate and perhaps show behavioral changes, vulvar swelling, and in some cases a minor discharge. Further, dogs that have this surgery will have intact ovaries, so veterinarians would need to establish an effective monitoring system for early detection of mammary cancer in intact bitches, as is available for women. In addition, there is a possibility of the dog developing stump pyometra if small amounts of uterine tissue are left behind during the hysterectomy. It is to be hoped that the effects of this technique will be appropriately studied to answer some of these questions. For males with retained testicles, there is a logical solution, based on fact. A large prospective study showed that the incidence of testicular cancer in cryptorchid dogs was 12.7/1,000 dog-years at risk.44 In other words, if 100 dogs with retained testicles live to be ten years old, approximately 13 will develop cancer in the retained testicle. The average age at which tumors develop in an undescended testes is 8.7 years.45 These tumors are commonly benign, though they can grow quite large. Based on this study, I recommend that dogs with retained testicles undergo ultrasound examination every two years to determine whether a tumor is developing in the retained testicle(s). If a tumor is detected, which will happen in a minority of dogs, it can be removed at that time. In addition, dogs with one retained testicle should undergo a vasectomy on the remaining spermatic cord. This solution allows the dog to have the benefit of his sex hormones, but prevents passing this likely genetic condition on to offspring.

Continued from page 25. Spayed/neutered dogs had more than 4x greater risk for developing transitional cell carcinoma of the bladder than intact dogs.20 â&#x20AC;˘E arly neutered male golden retrievers were 3x more likely to be diagnosed with lymphoscarcoma than intact males, and late-spayed females were significantly more likely to develop hemangiosarcoma and mast cell tumor than intact females.7 â&#x20AC;˘ I n a survey of 2,505 Vizslas, dogs spayed or neutered at any age were found to have a significantly higher risk of mast cell cancer, hemangiosarcoma, lymphoma and all cancers together than intact dogs.21 â&#x20AC;˘ F emale Labrador retrievers spayed between two and eight years of age were shown to have a significantly increased prevalence of mast cell cancer, hemangiosarcoma, and lymphoma.10 Discussion: One study indicated a slightly increased risk of mammary cancer in female dogs after one heat cycle (8% increase), greater risk with two heats (26% increase) and increased risk with each subsequent heat.22 However, a recent systematic review of the publications that advocate neutering to reduce the risk of mammary tumors in dogs indicated that nine of 13 reports had a high risk of bias, and the remaining four had a moderate risk of bias.23 This study concluded that the evidence that neutering reduces the risk of mammary cancer is weak and does not constitute a sound basis for firm recommendations. Additionally, at the time when several of these studies were conducted (late 1960s), incidence rates for all malignant neoplasms were 453.4/100,000 female dogs. Mammary tumors accounted for half of these tumors, or 198.8/100,000. Thus, the actual overall risk at that time of any bitch getting a mammary tumor was only 0.2%.24 In any case, the figures for increased risk of mammary cancer must be compared with the 200% to 400% increased risk of other cancers in spayed females. While about 30% of mammary cancers are malignant,25 as in humans, when caught and surgically removed early, the prognosis is very good.26 This is in comparison to the other cancers listed, such as hemangiosarcoma, lymphosarcoma and bladder cancer, which are usually fatal. Given the balance of cancer risks listed above, owners of bitches should strongly consider having a hysterectomy (ovary-sparing spay) performed rather than an ovariohysterectomy, thus providing while retaining the benefits of female hormones. In addition, the veterinary field should be developing programs for regular examinations, including imaging, to facilitate early diagnosis of mammary cancer in all intact female dogs, as has been performed in women for decades. Continued on page 28.

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that spayed or neutered dogs were more likely to develop hypothyroidism.2 Neutered male and spayed female dogs had higher relative risks of developing hypothyroidism than intact females.38 •N eutered females had a 22x increased risk of developing fatal acute pancreatitis as compared to intact females.39 •R isk of adverse reactions to vaccines is 27% to 38% greater in neutered dogs as compared to intact.40 • I n a study of female Rottweilers, there was a strong positive association between retention of the ovaries and longevity.41 Continued from page 27.

BEHAVIOR CONSIDERATIONS • Early age gonadectomy was associated with an increased incidence of noise phobias and undesirable sexual behaviors, such as mounting.27 • Significantly more behavioral problems were seen in spayed and neutered bitches and dogs, with fearful behavior being most common in spayed bitches and aggression in neutered dogs.28, 29 • In a prospective study, German shepherds spayed between five and ten months of age had significantly increased reactivity.30 Discussion: A number of early studies claiming to show the positive behavioral effects of spay/neuter were significantly flawed. For example, one of the most-quoted publications to support improvements in behavior, particularly aggression, after gonadectomy does not actually provide any statistical analysis. Additionally, 88% of dog owners in this study stated that their reason for castrating their dogs was to attempt to resolve an existing behavior problem. Owners were also surveyed regarding the dogs’ behavior a mean of 27 months post-castration. These factors likely introduced a significant amount of bias.31 Another study performed a statistical analysis but showed that the age when the dog was neutered was not correlated with the degree of improvement.32 Most critically, neither of these two studies included a control group of intact dogs. One of the more important undesirable behavioral effects of spay/neuter for canine athletes was a finding of significantly lowered energy levels. This was shown in a study that was well controlled and examined over 3,500 dogs.29

OTHER HEALTH CONSIDERATIONS • Female, and sometimes male, dogs that are spayed/neutered before puberty have an increased risk of urinary incontinence; it is more severe in bitches spayed earlier.33-36 • Spayed female dogs displayed a significantly higher risk of hypothyroidism when compared to intact females.37 A health survey of several thousand golden retrievers showed

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SUMMARY I have gathered these studies to show that the veterinary practice of recommending every dog not meant for breeding have his/her gonads removed at or before the age of six months is not a black-and-white issue. Clearly, more studies need to be undertaken to evaluate the effects of spaying and neutering, and in particular to investigate non-gonadectomy alternatives to prevent procreation, such as vasectomy and hysterectomy. After examining the risks and benefits, I have significant concerns with removal of the gonads in both males and females. It is clear that the gonads are not just important for reproduction, but play a critical role in growth, development and long-term health. One study showed that spayed bitches had 30x higher levels of luteinizing hormone than intact bitches,42; given that this hormone has receptors on diverse tissues throughout the body,43 it is possible that the lack of a feedback loop for this hormone might contribute to some of the negative effects of gonadectomy, at least in females. It is important that we assess each dog and his/her living situation individually, weighing the risks and benefits of gonad removal. There is no single solution that fits every dog. Acknowledgment: The author is grateful for excellent in-depth discussions with Samra Zelman on the literature regarding spaying and neutering, and for her careful review of this article.

Salmeri KR, Bloomberg MS, Scruggs SL, Shille V. “Gonadectomy in immature dogs: effects on skeletal, physical, and behavioral development”. JAVMA 1991;198:1193-1203. 2 Glickman L, Glickman N, Thorpe R. The Golden Retriever Club of America National Health Survey 1998-1999. grca.org/healthsurvey.pdf. 3 Slauterbeck JR, Pankratz K, Xu KT, Bozeman SC, Hardy DM.“Canine ovariohysterectomy and orchiectomy increases the prevalence of ACL injury”. Clin Orthop Relat Res. 2004;(429):301-5. 4 Whitehair JG, Vasseur PB, Willits NH. “Epidemiology of cranial cruciate ligament rupture in dogs”. JAVMA 1993;203:1016-1019. 5 Duerr FM, Duncan CG, Savicky RS, Park RD, Egger EL, Palmer RH.“Risk factors for excessive tibial plateau angle in large-breed dogs with cranial cruciate ligament disease”. JAVMA 2007;231:1688-91. 6 Duval JM, Budsberg SC, Flo GL, Sammarco JL. “Breed, sex, and body weight as risk factors for rupture of the cranial cruciate ligament in young dogs”. JAVMA 1999;215:811-814. 7 Torres de la Riva G, Hart BL, Farver TB, Oberbauer AM, Messam LL McC, Willits N, Hart LA. “Neutering Dogs: Effects on Joint Disorders and Cancers in Golden Retrievers”. PLoS ONE 2013;8:e55937. 8 van Hagen MA, Ducro BJ, van den Broek J, Knol BW. “Incidence, risk factors, and heritability estimates of hind limb lameness caused by hip dysplasia in a birth cohort of boxers”. Am J Vet Res 2005;66:3071-2. 9 Vidoni B, Sommerfeld-Stur I, Eisenmenger E. “Diagnostic and genetic aspects of patellar luxation in small and miniature breed dogs in Austria”. EJCAP 2005;16:149-58. 1

Hart BL, Hart LA, Thigpen AP, Willits NH.“Long-term health Effects of Neutering Dogs: Comparison of Labrador Retrievers with Golden Retrievers”. PLoS ONE. 2014:9:e102241. 11 Hart BL, Hart LA, Thigpen AP, Willits NH. “Neutering of German Shepherd Dogs: associated joint disorders, cancers and urinary incontinence”. Veterinary Medicine and Science 2016;2:191-199. 12 Lund EM, Armstrong PJ, Kirk CA, Klausner JS. “Prevalence and risk factors for obesity in adult dogs from private US veterinary practices”. Intern J Appl Res Vet med 2006;2:177-86. 13 Ware WA, Hopper DL. “Cardiac tumors in dogs: 1982-1995”. J Vet Intern Med 1999 13(2):95-103. 14 Prymak C, McKee LJ, Goldschmidt MH, Glickman LT.“Epidemiologic, clinical, pathologic, and prognostic characteristics of splenic hemangiosarcoma and splenic hematoma in dogs: 217 cases (1985)”. JAVMA 1988;193:706-12. 15 Cooley DM, Beranek BC, Schlittler DL, Glickman NW, Glickman LT, Waters D. “Endogenous gonadal hormone exposure and bone sarcoma risk”. Cancer Epidemiol Biomarkers Prev. 2002 11(11):1434-40. 16 Ru G, Terracini B, Glickman LT. “Host related risk factors for canine osteosarcoma”. Vet J. 1998 156(1):31-9. 17 Bryan JN, Keeler MR, Henry CJ, Bryan ME, Hahn AW, Caldwell CW.“A population study of neutering status as a risk factor for canine prostate cancer”. Prostate 2007;67:1174-81. 18 Teske E, Naan EC, van Dijk EM, Van Garderen E, Schalken JA.“Canine prostate carcinoma: epidemiological evidence of an increased risk in castrated dogs”. Mol Cell Endocrinol 2002;197:251-5. 19 Sorenmo KU, Goldschmidt M, Shofer F, Ferrocone J. “Immunohistochemical characterization of canine prostatic carcinoma and correlation with castration status and castration time”. Vet Comparative Oncology. 2003 Mar; 1 (1): 48. 20 Knapp DW, Glickman NW, Denicola DB, Bonney PL, Lin TL, Glickman LT. “Naturally-occurring canine transitional cell carcinoma of the urinary bladder A relevant model of human invasive bladder cancer”. Urol Oncol 2000;5:47-59. 21 Zink MC, Farhoody P, Elser SE, Ruffini LD, Gibbons TA, Rieger RH. “Evaluation of the risk and age of onset of cancer and behavioral disorders in gonadectomized Vizslas.”JAVMA 2014;244:309-319. 22 Schneider R, Dorn CR, Taylor DO. “Factors influencing canine mammary cancer development and postsurgical survival”. J Natl Cancer Inst 1969;43:1249-61. 23 Beauvais W, Cardwell JM, Brodbelt DC. “The effect of neutering on the risk of mammary tumors in dogs – a systematic review”. J Small Anim Pract 2012;53:314-322. 24 Dorn CR, Taylor DO, Schneider R, Hibbard HH, Klauber MR. “Survey of animal neoplasms in Alameda and Contra Costa Counties, California. II. Cancer morbidity in dogs and cats from Alameda County”. J Natl Cancer Inst. 1968 Feb;40:307-18. 25 Misdorp W. “Tumors of the Mammary Gland” in: Meuten DJ. Tumors in Domestic Animals. 4th Edn. Iowa State Press, Blackwell Publishing Company, Ames, Iowa, p. 575. 26 Lena L, De Andres PJ, Clemente M, Cuesta P, Perez-Alenza MD. “Prognostic value of histological grading in noninflammatory canine mammary carcinomas in a prospective study with two-year follow-up: Relationship with clinical and histological characteristics”. Vet Pathol 2012; June 11. [Epub ahead of print.] 27 Spain CV, Scarlett JM, Houpt KA. “Long-term risks and benefits of early-age gonadectomy in dogs”. JAVMA 2004;224:380-387. 28 Serpell JA. “Measuring behavior and temperament in dogs”. American Kennel Club Canine Health Foundation Biennial National Parent Club Canine Health Conference. 2005. St. Louis, MO. p. 46-8. 29 Duffy DL, Serpell JA. “Non-reproductive effects of spaying and neutering on behavior in dogs”. Proceedings of the Third International Symposium on Non-surgical Contraceptive Methods for Pet Population Control. 2006. acc-d.org/2006%20 Symposium%20Docs/Session%20I.pdf. 30 Kim HH, Yeon SC, Houpt KA, Lee HC, Chang HH, Lee HJ.“Effects of ovariohysterectomy on reactivity in German Shepherd dogs”. Vet J 2006;172:154-9. 31 Hopkins SG, Schubert TA, Hart BL. “Castration of adult male dogs: effects on roaming, aggression, urine marking, and mounting”. JAVMA 1976;168:1108-10. 32 Neilson JC, Eckstein RA, Hart BL. “Effects of castration on problem behaviors in male dogs with references to age and duration of behaviors”. JAVMA 1997;211:180-2. 33 Stocklin-Gautschi NM, Hassig M, Reichler IM, Hubler M, Arnold S. “The relationship of urinary incontinence to early spaying in bitches”. J. Reprod. Fertil. Suppl. 57:233-6, 2001. 34 Aaron A, Eggleton K, Power C, Holt PE. “Urethral sphincter mechanism incompetence in male dogs: a retrospective analysis of 54 cases”. Vet Rec 1996;139:542-6. 35 Thursfield MV. “Association between urinary incontinence and spaying in bitches”. Vet Rec. 1985;116:695. 36 Thrusfield MV, Hold PE, Muirhead RH. “Acquired urinary incontinence in bitches: its incidence and relationship to neutering practices”. J Small Anim Pract 1998;39:559-66. 37 Milne KL, Hayes HM Jr. “Epidemiologic features of canine hypothyroidism”. Cornell Vet. 1981;71:3-14. 38 Panciera DL. “Hypothyroidism in dogs: 66 cases (1987-1992)”. JAVMA 1994;204:761-7. 39 Hess RS, Kass PH, Shofer FS, Can Winkle TJ, Washabau RJ. “Evaluation of risk factors for fatal acute pancreatitis in dogs”. JAVMA. 1999;214:46-51. 40 Moore GE, Guptill LF, Ward MP, Glickman NW, Faunt KK, Lewis HB, Glickman LT. “Adverse events diagnosed within three days of vaccine administration in dogs”. JAVMA 2005;227:1102-8. 41 Waters DJ, Kengeri SS, Clever B, Booth JA, Maras AH, Schlittler DL, Hayek MG. “Exploring mechanisms of sex differences in longevity: lifetime ovary exposure and exceptional longevity in dogs”. Aging Cell 2009;8:752-5. 42 Beijerink NJ, Buijtels JJ, Okkens AC, Kooistra HS, Dieleman SJ. “Basal and GnRH-induced secretion of FSH and LH in anestrous versus ovariectomized bitches”. Theriogenology 2007;67:1039-45. 43 Zwida K, Kutzler MA. “Non-reproductive long-term health complications of gonad removal in dogs as well as possible causal relationships with post-gonadectomy elevated luteinizing hormone (LH) concentrations”. J. etiology An Health 2016;11-11. 44 Reif JS, Maquire TG, Kenny RM, Brodey RS. “A cohort study of canine testicular neoplasia”. JAVMA 1979;175:719-23. 45 Nieto JM, Pizarro M, Balaguer LM, Romano J. “Canine testicular tumors in descended and cryptorchid testes”. Dtsch Tierarztl Wochenschr. 1989;96:186-9. 10

From the

WAEO The Worldwide Alliance of Equine Osetopaths (WAEO) promotes the beneﬁts and advances the practice of equine osteopathy. It also provides continuing education for its members, supports scientiﬁc research in equine osteopathy, and assists in efforts to establish osteopathy as a distinct titled profession on an international basis. The Worldwide Alliance of Equine Osteopaths hosted its third annual international osteopathy clinic in Olds, Alberta, Canada, from July 5 to 7. The conference has grown each year and had 65 participants this year! We also had our annual meeting and voted to continue with our continuing education requirements as they are posted, so we can maintain a professional level in members who choose to register with the International Registry of Equine Osteopathy. July was also exam and certification time! We are happy to welcome four new members in North America, and 12 new members in Europe, to the IREO. Speakers at the July conference showed the wide range of health benefits osteopathic training provides. • Carol Brett from Balance Saddles demonstrated the anatomy most affected by poor saddle fit. She showed us how important the combination of padding and saddle fit are to the ability of the horse’s back to adapt and build new muscle. She also discussed the pros and cons of static versus dynamic saddle fit. What a difference! Observing our patients under saddle as part of our exams can be key to diagnosis. • Dr. Andrea Nissen demonstrated how inertial sensors can be used to evaluate osteopathic treatment. She is currently studying multiple systems: Equi Gait, Lameness Locator, Equimetrix, Pegasus and the Copenhagen system. She uses force plates and kinematic cameras as the gold standard to compare to in her research. • Dr. Laura Taylor spoke about the benefits of visceral osteopathy in her practice. Gastric and small intestinal ulcers can be treated more effectively, especially by decreasing recurrences, when combined with osteopathic diagnosis and therapy. Osteopathic disorders are also associated with hind gut ulcers and dysbiosis, and bladder and urinary problems. For more information, go to EquineOsteopathy.org. IVC Fall 2016

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7)2-36 (3+7 ;,3

WET THEIR BEDS By Jeff Nichol, DVM

For a senior dog, urinary incontinence during sleep could be caused by a behavioral issue, age-related dementia, or a physical problem. Nearly 20% of spayed female dogs leak while they sleep. Tom and Andrea Armstrong love their dog Clara, an eightyear-old retriever who enjoys playing ball and snuggling. A few years ago, they started finding wet spots in her bed and took her to the veterinarian. A careful history revealed that this well-behaved dog leaked urine only when resting or sleeping, that she always passed a normal stream outside, and that she never strained. Suspecting an incontinence problem, her doctor explained the importance of ruling out other problems before prescribing treatment. Bladder stones and infections, kidney disease, diabetes, neurologic disorders, and behavior problems were all considered. Following a thorough exam, blood and urine profiles, and abdominal x-rays, Tom and Andrea were pleased to learn that Clara checked out fine. The diagnosis: urethral sphincter hypotonus, often called spay incontinence. Some spayed dogs, most often middle-aged and older, don’t produce quite enough estrogen to maintain control of the sphincter muscle in their bladders. After drifting off to sleep, they leak. Some lick themselves to clean up the mess, leaving their skin reddened. Urethral sphincter hypotonus is actually a “good” diagnosis because nearly every affected dog does fine. Clara was given Proin tablets from PRN Pharmcal and her leaking stopped in just a few days.

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Veterinarians prescribe chewable Proin because it tastes great and is the only non-hormone medical option for this condition. There may be cases, due to pet irritability, restlessness or certain medical conditions, where Proin may be inappropriate. For those dogs, hormone therapy may be the choice. IMPORTANT SAFETY INFORMATION: Not for human use. Keep out of reach of children. Contact a physician immediately if accidental human ingestion occurs. Proin is only for oral use in dogs under veterinary supervision. Store securely away from pets to prevent accidental overdose. Dogs may willingly consume too many tablets or chew through closed vials and eat the tablets, causing overdose and possibly death. Advise clients to contact you immediately if overdose occurs, if other pets consume Proin, or if restlessness, irritability, appetite loss, continuing incontinence, or any other unusual signs occur. Common side effects are vomiting, appetite loss, diarrhea, excessive salivation, agitation, tiredness, vocalization, confusion, increased thirst, weight loss, weakness, fever, panting, and reversible skin color changes (bright pink). In some cases, death, including euthanasia, has been reported. Sudden death was sometimes preceded by vocalization or collapse. Proin safety in breeding, pregnant or lactating dogs has not been evaluated. For a copy of the Safety Data Sheet (SDS) or to report suspected adverse drug events, contact Pegasus Laboratories at 1-800874-9764. For more information, including important safety material, visit prnpharmacal.com/proin.

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

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Causes and natural treatment research for

By Nancy Scanlan, DVM, MS, CVA

TYPE I AND II DIABETES Type I and II diabetes share the same long-term consequences in dogs and cats. These consequences involve glycation and inflammation, which can lead to cataracts, neuropathy, retinopathy, kidney disease, liver disease, and other organ and tissue malfunction. Type I in dogs is an endocrine disease. Type II in cats is a metabolic disease associated with obesity and a high carbohydrate diet, so a big part of its treatment includes dietary and lifestyle changes. With those alone, a cat may return to normal metabolism. For poorly controlled Type I diabetes, and resistant Type II diabetes, long-term consequences can be ameliorated by a number of natural treatments.

GLUCOSE PROCESSING In the wild, most carbohydrates are associated with fiber, which slows their digestion and absorption. Blood sugar may rise slightly, but there are no big spikes. Since there are no sugar spikes, there is no insulin spike and the processing of blood glucose is a slow and gradual affair. Most dry cat food does not have high fiber, so glucose increases in the form of spikes in the bloodstream, instead of being gradually raised. Carbohydrates from dry food are rapidly absorbed, rapidly

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processed, and stored as fat. Cells become resistant to normal amounts of insulin, and higher and higher amounts are necessary for a cell to be able to process glucose. As glucose increases, it causes side effects: • Glycoslation – Enzymes add sugars to fat or protein molecules, a normal bodily function. • Glycation - When excess sugar is available in the presence of proteins or lipids, sugar molecules are added to fats or proteins in a haphazard manner. • Maillard reaction – the same thing happens when foods high in protein and/or fat are cooked with sugars or simple carbohydrates at high temperatures or for long periods. In humans, up to 10% of the diet is formed from these substances.1 This process is responsible for the brown crust on roasts and breads, which though tasty, are not good for people or pets. • AGEs – Advanced Glycation End Products is the term for these abnormal proteins and fats. They form gradually in healthy bodies where some are processed while others gradually accumulate, but they form rapidly and in large Continued on page 34.

STUDIES ON NATURAL TREATMENTS A number of natural substances can decrease or reverse the effect of problems caused by high levels of glucose, which leads to glycation. Although they will not cure diabetes, they can slow its advance, and mild Type II diabetes may respond well enough to not need drugs. Studies of the effects of natural products on diabetes and its complications include human, rat, mouse, and in vitro. Of these, the human studies are likely to be most pertinent. Human studies impacting the liver cannot extrapolate to cats. Since we know that cat metabolism does not have as close a correlation to human metabolism as dog metabolism does, we must take care to use only those substances that have been shown to be non-harmful to cats. • Increased vitamin C lowers A1c, the form of hemoglobin created by AGEs.9 Still to be determined is if oral vitamin C can create high enough blood levels to drive this reaction. • An in vitro study of erythrocytes showed that curcumin prevented AGEs and lipid peroxidation.10 This is supported by studies in lab animals and humans. One study identified a specific AGE that curcumin can prevent. • An in vitro study of berberine showed a significant increase of nitrous oxide, and decreased AGE formation.11 Like the vitamin C study, it holds promise but does not give us doses for cats and dogs. • Curcumin and turmeric decreased blood sugar levels, oxidative stress, and AGEs in diabetic rats, which helps validate the in vitro study. Curcumin works better than turmeric to achieve this effect.12,13 Curcumin has a high margin of safety and a wide range of uses, especially for diseases related to inflammation (such as arthritis and cancer). The biggest problem with turmeric and curcumin is that they are excellent dyes, and can permanently discolor a rug if a patient vomits or defecates on it. • A number of other traditional herbs, including Embelia ribes (an Ayurvedic herb named Vidanga), Cinnamomi cassiae and Rhodiola rosea,14,15 have been shown to be useful in rats and mice. Before trying these or other herbs in the literature on cats, I would recommend

further testing to be sure they are not toxic to the feline liver. • In contrast, histidine, carnosine and l-arginine are amino acids, and l-arginine is already being used for feline herpes. Histidine and carnosine given at the rate of 1 gram per liter of drinking water increased insulin levels and decreased lipid oxidation levels in mice. It also suppressed increase of interleukin 6 and tumor necrosis factor Alpha in diabetic mice.16 L-arginine (1.51%) in the drinking water of diabetic obese rats decreased fat.17 It would be worth trying these in diabetic cats who need more help, and possibly in dogs as well. • Pyridoxamine, a B vitamin, inhibits diabetic retinopathy and neuropathy in rats.18 • Curcumin administered at 500 mg/day to Type II diabetic humans decreased urinary excretion of albumin. It also regulated several bacteria in the gut important for maintenance of gut barrier integrity and function.19 • Sesame oil used in humans lowers blood pressure and improves antioxidant status in hypertensive and diabetic-hypertensive patients.20 (It might be the easiest supplement to administer to cats.) • The form of CoQ10 known as ubiquinol improves insulin secretion in humans with Type II diabetes.21 • Pyridoxamine has support for its anti-AGE action, and glucosamine helps support basement membrane function.22 • Ginger has more research supporting its benefits in humans than many other herbs. Three grams of powdered ginger in capsules given daily for three months improved glycemic indices and total antioxidant capacity in humans. It also decreased C-reactive protein,23 AGEs and insulin resistance.23 • Fenugreek has been shown to improve glycemic control, and decrease insulin resistance and hyperlipidemia, although the research used an alcoholic extract.24

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Continued from page 32. amounts in a diabetic animal or person.2 This has a toxic effect on the body, since glycated products cannot function normally, and promote inflammation.

AGE EFFECTS In human medicine, some believe the deleterious action of AGEs starts before diabetes develops. An increase in AGE levels increases the appetite, thus promoting obesity. AGEs are pro-oxidant and promote inflammation. Decreasing oxidative stress in mice by decreasing AGEs in the diet decreases inflammation and prevents diabetes mellitus.3 Excess body fat can change metabolism. We used to think mammalian body fat was inert. Now we know that it makes dozens of proteins. One is the enzyme leptin, which normally

signals satiety. Obese animals have higher levels, but are less responsive to them.4 Inducing weight loss (carefully) in an obese animal can decrease this problem, and increase insulin sensitivity. Best is a low-carbohydrate diet, either canned or homemade. A low glycemic index diet can improve the levels of AGEs and hyperglycemia.5,6 AGEs can develop in many cell types, adversely affecting their structure and function. Almost all diabetic complications result from the action of AGEs. They form cross-links in the cells of basement membranes. They activate receptors for AGEs (RAGES). RAGES activate transcription factor nuclear kappa B and its targets. Monocytes are activated but are prevented by AGEs from passing basement membranes. The biggest effect of these actions is on the endothelium of blood vessels.7 This affects circulation to vital organs such as the retina and kidneys.8 Given the increased number of diabetic dogs and cats, it is encouraging to see studies indicating natural approaches that may even prevent the need for drug therapy. In addition to the above-mentioned studies, clinical anecdotal experience shows that both Type I and II diabetes, in some dogs and cats, can be eased with constitutional homeopathy or TCVM (Traditional Chinese Veterinary Medicine). Type II may even be resolved with this approach, especially when obesity is corrected. Three good books with overviews of this approach to health include Manual of Natural Veterinary Medicine: Science and Tradition edited by Wynn and Marsden; Complementary and Alternative Veterinary Medicine edited by Wynn and Schoen; and Integrating Complementary Treatment Options with Traditional Veterinary Medicine edited by Goldstein.

Uribarri J, et al. “Advanced Glycation End Products in Foods and a Practical Guide to Their Reduction in the Diet”. J Am Diet Assoc. 2010 June ; 110(6): 911–16. 2 Peppa M, et al. “Glucose, Advanced Glycation End Products, and Diabetes Complications: What Is New and What Works”. CLINICAL DIABETES, Volume 21, Number 4, 2003 3 Vlassara H, Gary E, Striker GE. “AGE restriction in diabetes mellitus: a paradigm shift”. Nat Rev Endocrinol. 2011 Sep ;7(9):526-39. Epub 2011 May 24. 4 Oswal A, Yeo G. “Leptin and the control of body weight: a review of its diverse central targets, signalling mechanisms, and role in the pathogenesis of obesity”. Obesity (Silver Spring), vol. 18, no. 2, pp. 221–229, 2010. 5 Nisak M, et al. “Improvement of dietary quality with the aid of a low glycemic index diet in Asian patients with type 2 diabetes mellitus”. J Am Coll Nutr. 2010 Jun;29(3):161-70. 6 Haimoto H, et al. “Effects of a low-carbohydrate diet on glycemic control in outpatients with severe type 2 diabetes”. Nutr Metab (Lond). 2009;6:21. Epub 2009 May 6. 7 Goldin A, et al. “Advanced Glycation End Products, Sparking the Development of Diabetic Vascular Injury”. Circulation. 2006;114:597-605. 8 Koschinsky T, et al. “Orally absorbed reactive glycation products (glycotoxins): an environmental risk factor in diabetic nephropathy”. Proc. Natl. Acad. Sci. U.S.A. 94 (12): 6474–9, June 1997. 9 Kositsawat, J, Freeman, VL. “Vitamin C and A1c Relationship in the National Health and Nutrition Examination Survey” (NHANES) 2003-2006. J Am Coll Nutr. 2011 Dec ;30(6):477-83. 10 Jain SK, Rains J, Jones K. “Effect of curcumin on protein glycosylation, lipid peroxidation, and oxygen radical generation in human red blood cells exposed to high glucose levels”. Free Radic Biol Med. 2006 Jul 1;41(1):92-6. Epub 2006 Mar 30. 11 Hao M, et al. “Amelioration effects of berberine on diabetic microendothelial injury model by the combination of high glucose and advanced glycation end products in vitro”. Eur J Pharmacol. 2011 Jan 13. Epub 2011 Jan 13. 12 Arun N, Nalini N. “Efficacy of turmeric on blood sugar and polyol pathway in diabetic albino rats”. Plant Foods Hum Nutr. 2002;57(1):41-52. 1

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J agtap AG, Patil PB. “Antihyperglycemic activity and inhibition of advanced glycation end product formation by Cuminum cyminum in streptozotocin induced diabetic rats”. Food Chem Toxicol. 2010 Aug-Sep;48(8-9):2030-6. Epub 2010 May 6. 14 Bhandari U, et al. “Beneficial effect of Embelia ribes ethanolic extract on blood pressure and glycosylated hemoglobin in streptozotocin-induced diabetes in rats”. Biofactors. 2008;33(1):49-60. 15 Kim SH, et al. “Antioxidative effects of Cinnamomi cassiae and Rhodiola rosea extracts in liver of diabetic mice”. Biofactors. 2006;26(3):209-19. PMID: 16971752 16 Lee Y, et al. “Histidine and carnosine delay diabetic deterioration in mice and protect human low density lipoprotein against oxidation and glycation”. Cont Lens Anterior Eye. 2008 Jun;31(3):141-6; quiz 170. Epub 2008 Mar 4. 17 Fu WJ, et al. “Dietary L-arginine supplementation reduces fat mass in Zucker diabetic fatty rats”. J Nutr. 2005 Apr;135(4):714-21. PMID: 15795423 18 Miyazawa T, et al. “Amino Acids. Lipid glycation and protein glycation in diabetes and atherosclerosis”. 2012 Apr;42(4):1163-70. doi: 10.1007/s00726-010-0772-3. Epub 2010 Oct 19. 19 Yang H, et al. “Curcumin attenuates urinary excretion of albumin in type II diabetic patients with enhancing nuclear factor erythroid-derived 2-like 2 (Nrf2) system and repressing inflammatory signaling efficacies”. Exp Clin Endocrinol Diabetes. 2015 Jun ;123(6):360-7. Epub 2015 Apr 14. PMID: 25875220 20 Sankar D, et al.“Sesame oil exhibits synergistic effect with anti-diabetic medication in patients with type 2 diabetes mellitus”. Clin Nutr. 2011 Jun ;30(3):351-8. Epub 2010 Dec 16. 21 Mezawa M, et al.“The reduced form of coenzyme Q10 improves glycemic control in patients with type 2 diabetes: An open label pilot study”. Biofactors. 2012 Aug 8. Epub 2012 Aug 8. 22 Williams ME1. New potential agents in treating diabetic kidney disease: the fourth act. Drugs. 2006;66(18):2287-98 23 Shidfar, F et al. The effect of ginger (Zingiber officinale) on glycemic markers in patients with type 2 diabetes. J Complement Integr Med. 2015 Feb 10. Epub 2015 Feb 10. 24 Mozaffari-Khosravi, H et al. The effect of ginger powder supplementation on insulin resistance and glycemic indices in patients with type 2 diabetes: A randomized, double-blind, placebo-controlled trial. Complement Ther Med. 2014 Feb ;22(1):9-16. Epub 2014 Jan 8. 13

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Ancient Healing Meets Modern Technology to Increase Patient Care, Client Satisfaction and Practice Revenues Integrative veterinary medicine practitioners regularly combine ancient healing methods like acupuncture with modern technology like lasers. But when it comes to ensuring compliance for the important products they recommend, many otherwise tech-savvy practitioners are stuck in the pastâ&#x20AC;&#x201D;scrawling recommendations on a slip of paper, hoping clients will buy in-clinic. With in-practice compliance rates at 34%1, this strategy isnâ&#x20AC;&#x2122;t working. Clients are either not buying at all, or are purchasing from retailers or online discounters, possibly receiving unsafe, expired or recalled products. This is not good for the patient or the veterinary practice, which loses valuable revenue and the ability to ensure continuity of patient care. Technology: the Culprit and the Cure Technology has forever changed consumer buying behavior. Smartphones and the Internet give your clients the power to compare prices at their fingertips, and to shop anywhere, anytime at their convenience. Fortunately, technology now exists that enables veterinarians to compete using their own competitively priced online store. But beware. Not all solutions are created equal. When Considering a Technology Partner, Look for the Following: q A full range of safe, quality products guaranteed by the manufacturer w A complete digital prescription management system that ensures first fills, refills and renewals e Convenient home delivery and free auto-shipments r Client incentives and marketing programs that help drive purchases To learn how digital prescription management technology can help you increase product compliance, practice revenues and better health outcomes for your patients. Visit info.vetsfirstchoice.com/IVC or call 844-205-9140. 2016 Compliance Impact Study available at www.info.vetsfirstchoice.com/IVC

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nutrition nook

NONI FRUIT By Ihor Basko, DVM, CVA

– food for HEALTH

Noni has great potential for the treatment and possible prevention of many degenerative diseases in pets. For centuries, the Noni fruit has been used across the Pacific as food and for health. It has been utilized in the treatment of many aliments, including kidney disease, diabetes, fish poisoning, tonsillitis, abdominal swelling, burns, broken bones, and inflammation of the toes and fingers. It is reported to have a broad range of therapeutic effects – antibacterial, antiviral, antifungal, anti-tumor, anthelmintic, analgesic, hypotensive, anti-inflammatory, and immune-enhancing.1

used Noni to survive famine, modern scientific and medical communities are beginning to study the medical knowledge and pharmacopoeia compiled by the Polynesians. Documentation of Noni fruit consumption in the Fiji Islands was found in an 1866 publication in London.2 By the 19th century, it was realized that Noni fruit was an important part of the diet throughout the Pacific Islands, Southeast Asia, Australia, and India.

In animal studies, no toxicities have been reported with the use of Noni fruit. While tests show antioxidative activity in extracts from leaf, fruit and root, I recommend only using fruit products.

The Noni plant contains a broad spectrum of nutrients, antioxidants, and anti-inflammatory, anti-neoplastic, antiparasitic, tranquilizing and immune-modulating substances. Different parts of the plant have different chemical compositions.

HISTORY

Noni contains over 160 phytochemicals, including phenolic compounds, organic acids, and alkaloids.3 Researchers are also finding some additional novel compounds. The following are a few major components that may be responsible for Noni’s benefits.1

Noni is the common name for Morinda citrifolia. It’s also called Indian mulberry, Nono or Nonu, cheese fruit, Mengkudu, Bingkudu and Nhau in various cultures around the world. In addition to Polynesian stories of heroes and heroines who

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CHEMISTRY

• Xeronine – a critical normal metabolic co-regulator. In 1985, Heinicke4,5,6 reported this plant alkaloid in Noni; it’s similar to the bromelain found in pineapple. Xeronine activates proteins and enzymes such as pro-collagenase and protease, which help heal damaged tissues, therefore preventing further disease. Heinicke also concluded that the ingestion of Noni caused a feeling of well-being because it increased the release of endorphins from the brain. • Scopoletin – dilates vasculature, and is antibacterial, antifungal, anti-inflammatory, analgesic, histamine-inhibiting, and a serotonin modulator. • Octoanoic acid, amino acids, caproic acid, caprylic acid, ursolic acid. • Terpenoids, alkaloids, proxeronine, sitosterol. • Anthraquinones – antiseptic and antibacterial. • 1-methoxy-2-formyl-3-hydroxyanthraquinone from the roots – antiviral. • Carotene, vitamins A and C, potassium, rutin, flavone glycosides – free radical scavengers. • Essential fatty acids. • Alizarin, acubin, L-asperuloside – antibacterial. • Polysaccharides – noni-ppt, galactose, arabinose, rhamnose, glucuronic acid. Immunostimulatory, immunomodulatory, anti-tumor; may play a role in the cancer-fighting benefits of Noni.

Antimicrobial activity

Various research1 has showed significant antimicrobial and antifungal activity against Pseudomonas aeruginosa, Proteus morgaii, Staphylococcus aureus, Baciilis subtilis, Escherichia coli, Salmonella, Shigela, H. pylori, A. niger, C. albicans, T. mentagrophytes and Mycobacterium tuberculosis. Noni also interferes with the serum-induced morphological conversion of Candida albicans from a cellular yeast into a filamentous form in vitro, and inhibits the germination of Apergillus nidulans spores. I have successfully treated bacterial diarrhea, ear and skin infections merely with Noni.

Cancer Research has shown that Noni has great potential for scavenging reactive oxygen free radicals and decreasing lipid peroxidation,1 thus reducing cancer risk. Therefore, it would be useful to include in the daily diet of breeds or breed lines susceptible to cancer, and in dogs living with heavy cigarette smokers. Unspayed geriatric female cats or dogs may benefit from daily Noni to prevent breast cancers. Once cancer is diagnosed, Noni is a useful addition to any treatment protocol because of its synergistic properties affecting the immune system. Although I could not find any studies using Noni IVC Fall 2016

DOSAGES FOR NONI

Noni is commercially available in the following forms: fermented or unfermented juice of fruit/mixed with fruit juices; fermented (traditional) ripe Noni fruit; juice extract of unripe fruit; powdered capsules of unripe fruit; and leather made from unripe fruit. Among manufacturers, there is some controversy over the best way to process Noni to retain its medicinal properties:

q High heat water extraction dehydrated into a powder. w Mixed with fruit juices and ﬂavors. e Fermented juice – today’s Hawaiian healers (La’au lapa au) claim beneficial results. r Fresh (unripe) fruit leather.

There’s a concern that processes using high heat or fermentation may destroy the enzymes and bioactive ingredients. Mixing with other fruit may form unwanted compounds. More research on all forms is needed to address these concerns. In addition to a need for standardization of the chemical consistency of the Noni product, the variability of clinical and research results may be attributable to the chemical profile of the product used, and the degree to which different ingredients are absorbed and excreted in the patients participating in clinical studies. My dosing experience is based on using unripe Noni fruit leather (Real Noni) or fermented juice, and only recently, the dried extract powder from Maui, Hawaii (Noni Maui™) that is being used in several clinical trials (Phase I by Huang studying prostate cancer is complete,12 while Issell studied the maximum tolerated dosages in cancer patients13). Because Noni’s compounds are known to react with proteins, the herb should be taken on an empty stomach. I recommend the following dosing schedules: Fruit leather: 1” by 1” square piece = 750 mg Tiny dogs and cats

750mg divided over two doses

Dogs 20lbs to 35lbs

1,500mg per day

Large dogs 50lbs to 90lbs

3,000mg per day

Giant breeds

4,500-6,000mg per day

Fermented juice Tiny dogs and cats

5ml bid

Medium sized dogs

10ml to 15ml bid

Large dogs

30ml bid

Giant breeds

60ml bid

in combination with other phytopharmaceuticals, antioxidants, TCM herbs, or homotoxicology, I would encourage veterinarians to try this herb in the treatment of mammary and lung cancers, lymphoma and liver cancers. Several clinical studies have demonstrated Noni’s synergistic actions with chemotherapeutic drugs,7 so it may be another complementary botanical to use without side effects and at “suboptimal” drug (lower) dosages.

Pain control When patients present unresponsive to pain drugs for their inﬂammation, Noni can be used alone or in combination with other herbs such as Boswellia serrata or Cannabis. Making lotions and shampoos with either fruit or leaf extracts may help clear localized skin pain.

Liver detoxification and protection Because Noni contains many different kinds of antioxidants, it may act synergistically when used with other antioxidants and hepatoprotective botanicals, and could prove beneficial in the treatment of liver cirrhosis, acute and chronic hepatitis, and possibly liver cancer. The just-discovered neolignan compound in Noni, Americanin, was found to be a strong free radical scavenger.8

Parasite control While I have not used Noni to treat parasites, it has a long history of insecticide and anthelminthic use.9,10 According to Cipollini,11 many ripened fruits such as Noni contain octanoic acid, which is toxic only to parasites when eaten. Hunting dogs are regularly treated with Noni by Hawaiian hunters who “swear” it controls roundworms, hookworms and parasites from raw wild pork. Other Hawaiians use it to prevent or treat heartworms.

If Noni was proven to be an effective anthelmintic, owners of animals infested with heartworm who are limited in funds or have “issues” with chemical Continued on page 40.

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EVALUATING THE QUALITY OF NONI PRODUCTS

The quality of a Noni product and its nutritional components are directly related to how and where the plant is grown. Concentrations of active constituents rely heavily on the quality of the soil, water, and the geographical location, terrain and the weather. In general, plants growing in their undisturbed natural environments (“in the wild”) have a higher concentration of nutrients and phytochemicals than those grown on plantations. Weather changes such as drought can adversely affect the nutrient concentration in the plants. Continued from page 38. worming methods, may improve the quality of life and longevity of their pets by administering Noni daily. Many veterinarians on the VBMA eco-trip to Kauai reported that Noni acted as a successful tick repellent in people and animals.

Topical use I have used a topical 90% Noni and water lotion on cats with allergic skin reactions (to food and fleas), with decreased inﬂammation after the third application. Licking off the Noni lotion is also beneficial; ingested Noni has been demonstrated to facilitate the repair of skin and tissue by increasing local collagen production. When used as a regular dietary supplement, it can heal minor and often unnoticed tiny injuries. Topical lotions made from Noni fruit or leaves can relieve pain quickly and should be considered an “enhancer” to add to a shampoo or veterinary lotion. Noni extract could be mixed with other topical analgesics to better mollify pain. Clients have reported “curing” scratches disease in horses with applications of Noni lotion made from ripe ground-up fruit. A company in Kauai (Real-Noni.com) makes the lotion by air drying a mash of fruit pulp, then pouring hot water (below 115°F) over it. When cooled, it’s mixed with purified water, lavender oil and grapefruit seed extract. I make a salve as follows: 3 large fresh Noni leaves, chopped up 1 turmeric root (the size of one’s thumb), grated fresh raw ½ cup coconut oil Simmer, but don’t burn, until mixture is a yellow/green color (not brown) – about ten to 20 minutes. Filter out all plant material and store in a wide-mouthed glass jar.

FINAL THOUGHTS My lecture from the 2006 AHVMA (American Holistic Veterinary Medical Association) Conference covered all the

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research done on Noni, which is extensive. Some researchers believe, as do many conventional veterinarians, that herbs should be fully studied before use. Unfortunately, if we waited for every plant to achieve definitive “scientific” support before we use it, many animals could suffer. Many VBMA (Veterinary Botanical Medical Association) members are treating animals based on information gathered from other practitioners, herbalists, healers, books, ethnobotany, and from “researching the research” that is available. We have taken the steps to begin integrating herbal medicines into treatment protocols, making systematic observations and recording the results, as well as sharing these observations with the herbal and scientific communities. In my opinion, Noni is safe, with great potential for the treatment and possibly the prevention of many degenerative diseases. Given the widespread use of Noni plants without serious accompanying warnings, it seems doubtful that a major concern would arise. Practitioners are encouraged to begin integrating herbal treatments into current protocols while critically evaluating the quality of new products and dose-response relationships over time.

Wang MY, West BJ, Jensen CJ, Nowicki D, Su C, Palu AK, Anderson G. “Morinda citrifolia (Noni): A literature review and recent advances in Noni research”. Acta Pharmacologica Sinica [Acta Pharmacol Sin] 2002; 23(12): 1127-1141. 2 Seeman B, Flora V. A description of the plants of the Viti or Fiji Islands with an account of their history, uses, and properties. London: L Reeve and Co; 1986. p. 1865-73. 3 Chan, Chan-Blanco Y, Vaillant F, Perez AM, Reynes M, Brillouet JM, Brat P. “The noni fruit ( Morinda citrifolia L.): A review of agricultural research, nutritional and therapeutic properties”. J Food Compost Anal. 2006;19(6-7):645-654. 4 Heinicke RM. “The pharmacologically active ingredient of Noni”. Bulletin of the National Tropical Botanical Garden, 1985. 5 Heinicke RM, Gortner W A. “Stem bromelain--A new protease preparation from pineapple plants”. Economic Botany 1957;11: 225-234. 6 Heinicke RM, Levand O. “Ferulic acid as a component of a complex carbohydrate polymer of bromelain”. Phytochemistry 1968; 7:1659-1662. 7 Hirazumi A, Furusawa E. “An immunomodulatory polysaccharide-rich substance from the fruit juice of Morinda citrifolia (Noni) with antitumour activity”. Phytotherapy Research: PTR [Phytother Res] 1999; 13(5):380-387. 8 Su BN, Pawlus AD, Jung HA, Keller WJ, McLaughlin JL, Kinghorn AD.“Chemical constituents of the fruits of Morinda citrifolia (Noni) and their antioxidant activity”. Journal of Natural Products [J Nat Prod] 2005; 68(4): 592-595. 9 Murdiatia et al, 2000. 10 Rangadhar Satapathy, 2007. 11 Hirazumi A, Furusawa E, Chou SC, Hokama Y. “Anti cancer activity of Morinda citrifolia on intraperitoneally implanted lewis lung carcinoma in syngenic mice”. Proceedings Western Pharmacology Society. 1994;37:145-146. 12 manoa.hawaii.edu/kaunana/uh-cancer-center-evaluates-noni/ 13 ncbi.nlm.nih.gov/pmc/articles/PMC4439249/ 1

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 clematis (Clematis chinensis; Wei Ling Xian), which has been deemed an invasive species in a few areas of the US. In Chinese medicine, one of clematis’ common uses is for Bi Zheng or “painful syndrome”. Acrid and warm, Wei Ling Xian has excellent dispersing and penetrating functions. It disperses and dispels Wind and Dampness from the muscles, penetrates and opens peripheral channels and collaterals, and relieves Bi Zheng. It has a strong affinity for the neck and throat area and is credited with relaxing the throat muscles in cases of foreign body obstruction in the throat, especially involving fish bones. Modern research has shown Clematis to possess antiinflammatory activities; potent antioxidant activity; an ability to inhibit the production of cytokines NO and PGE2; and strong antimyocardial ischemia activities. Its root is used medicinally.

CASE REPORT Brandy, a Welsh pony mare, was in her mid-teens when she tumbled down a steep embankment. She fractured the wing of her second cervical vertebrae with displacement of the body of C2. She was severely ataxic and her regular veterinarian demanded euthanasia for humane and safety reasons. But she was a loved member of her family, so an alternative approach was taken. Her family attached mats on the stall walls that allowed Brandy to safely bounce from side to side. They had strict management safety rules for her care to ensure no one was fallen on.

they can improve cognitive function, restore immune and endocrine balance, and promote increased mental and physical well-being. These herbs are useful for both our patients and ourselves. This teleconference recording is available for purchase at vbma.org. There are plans for an upcoming avian teleconference. • On September 9, before the AHVMA conference in Columbus, OH, the ACVBM (American College of Veterinary Botanical Medicine) hosted popular speaker, Master Jeffrey Yuen, on Modern Applications of Classical Formulas. In the afternoon, we held our ever-popular herb walk. At the conference (September 10 to 13), our VBMA track featured Phytopharmacology with Dr. Rona Sherebrin. Other herbal experts spoke on other tracks throughout the conference. • Next issue, we’ll have a report on our eco-tour to the Washington State Rain Forest! Come and join the VBMA! We have an awesome website with a very interactive list-serve. Information can be found at vbma.org.

NAME THIS HERB!

Brandy was also treated with acupuncture and herbal medicines. One of her main herbs was a patent Chinese formula called, appropriately, Neck Formula, which contains Clematis chinensis. After four months, Brandy regained all motor control of her limbs. She was being ridden in ﬁve months.

UPDATE ON ACTIVITIES • On June 22, the VBMA hosted David Winston, who spoke on the use of adaptogens, herbs used for strength, stamina and stress relief. We learned the definition of adaptogens, and the rational and effective clinical use of each adaptogenic herb. We also learned differences between them and how

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

IVC Fall 2016

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

ASSOCIATIONS Academy of Veterinary Homeopathy - AVH Leucadia, CA USA Phone: (866) 652-1590 Website: www.theavh.org American Veterinary Chiropractic Association - AVCA Bluejacket, OK USA Phone: (918) 784-2231 Email: avcainfo@junct.com Website: www.animalchiropractic.org Association of Veterinary Acupunturists of Canada - AVAC Beaconsfield, QC Canada Phone: (514) 697-0295 Email: office@avac.ca Website: www.avac.ca International Veterinary Acupuncture Society - IVAS Fort Collins, CO USA Phone: (970) 266-0666 Email: office@ivas.org Website: www.ivas.org

Website: www.healfasttherapy.com

INTEGRATIVE THERAPIES

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

INTEGRATIVE VETS Dr. Shawn Messonnier Paws and Claws Vet Clinic Plano, TX USA Phone: (972) 712-0893 Email: shawnvet@sbcglobal.net Website: www.pettogethers.net/healthypet East York Animal Clinic Toronto, ON Canada Phone: (416) 757-3569 Email: eyac@holisticpetvet.com Website: www.holisticpetvet.com

NATURAL PRODUCT

MANUFACTURERS & DISTRIBUTORS GenesisValley Center CA USA Phone: (760) 751-3360 Website: www.genesispets.com Harrisonsâ&#x20AC;&#x2122; Pet Products West Palm Beach, FL Phone: (800) 946-4782 Website: www.vet.HEALx.com

VETERINARY OPHTHALMOLOGY

National Animal Supplement Council - NASC Dr. Nancy Park Valley Center, CA USA Board Certified Veterinary Ophthalmologist Phone: (760) 751-3360 Integrative Ophthalmology For Pets - IOP Website: www.nasc.cc Los Angeles, CA, USA Phone: (855) 623-3937 (EYES) CLINIC FOR SALE Email: info@iopeyes.com Website: www.iopeyes.com Reeves Veterinary Clinic Tyler, TX USA Phone: (903) 595-1088 SCHOOLS & WELLNESS Email: drbarj@aol.com EDUCATION Website: www.reevesvetclinic.com FOR SALE: Small Animal integrative practice, Animal Spirit Network established for 44 years. Owner willing to stay Pekin, IL USA a while for smooth transition! Great location Phone: (815) 531-2850 on loop. Great Clientele that is very desirous of Email: carol@animalspiritnetwork.com holistic modalities. We are the only integrative Website: www.animalspiritnetwork.com practice in East Texas, many people in the area are health conscious. Owner wishes to retire. College of Integrative Veterinary Therapies - CIVT EQUINE NATUROPATH Rozelle, NSW Australia Phone: (303) 800-5460 Cassie Schuster, ND, MH Website: www.civtedu.org Waller, TX USA International Veterinary Acupuncture Phone: (713) 502-0765 Society - IVAS Email: cassie.schuster@yahoo.com Fort Collins, CO USA Website: www.wellranch.com Phone: (970) 266-0666 Email: office@ivas.org Website: www.ivas.org

IVC Fall 2016

PetMassage Ltd. Toledo, OH USA Phone: (419) 475-3539 Email: info@petmassage.com Website: www.petmassage.com Pitcairn Institute of Veterinary Homeopathy - PIVH Portland, OR USA Phone: 760-230-4784 Email: info@pivh.org Website: www. pivh.org Tallgrass Animal Acupressure Institute Castle Pines, CO USA Phone: (303) 681-3033 Email: nancy@animalacupressure.com Website: www.animalacupressure.com Traditional Chinese Veterinary Medicine TCVM Reddick, FL USA Phone: (352) 591-5385 Email: register@tcvm.com Website: www.tcvm.com Veterinary Information Network - VIN Davis, CA USA Phone: (530) 756-4881 Email: vingram@vin.com Website: www.vin.com

SUPPLEMENTS Herbsmith Inc. Hartland, WI USA Phone: (262) 367-1372 Email: mail@herbsmithinc.com Website: www.herbsmithinc.com MVP Laboratories Omaha, NE USA Phone: (402) 331-5106 Email: mvplabs@mvplabs.com Website: www.mvplabs.com SmartPak Plymouth, MA USA Phone: (774) 773-1125 Email: customercare@smartpak.com Website: www.smartpak.com The Honest Kitchen San Diego, CA USA Phone: (858) 483-5995 Email: info@thehonestkitchen.com Website: www.thehonestkitchen.com

THERMAL IMAGING ThermoScanIR Toronto, ON Canada Phone: (416) 258-5888 Email: info@ThermoScanIR.com Website: www.ThermoScanIR.com Equine IR Bonsall, CA USA Phone: (888) 762-2547 Email: info@equineIR.com Website: www.equineIR.com

By Dr. Marty Goldstein, DVM

THE EFFECTIVENESS

OF ORAL HYALURONAN

FOR JOINT HEALTH Joint health is an important concern for both pet owners and veterinarians. Aging in companion animals causes a natural deterioration of the joint structure. As a result, pets begin to experience pain, loss of function and mobility, and often a decrease in quality of life. A naturally safe alternative for optimizing joint health in animals is oral hyaluronan supplementation. Hyaluronan is the accepted nomenclature for hyaluronic acid (HA). It is classified as a glycosaminoglycan (GAG) composed of repeating disaccharides units of glucuronic acid and glucosamine. Hyaluronan can range in molecular weight from hundreds up to millions of Daltons. It is found throughout the body and known for its role in maintaining joint health. Scientific studies define the use of hyaluronan in the treatment of joint conditions. A randomized, double-blind, placebocontrolled study evaluated the efficacy of intra-articular hyaluronan for knee osteoarthritis. Three-week post-treatment outcomes were significantly improved in treatment vs. control groups. Analysis of knee synovial membrane biopsies in human patients who had received hyaluronan intra-articularly showed decreased numbers of hypertrophic cells, edema, and an increase in collagen deposition. Addition of hyaluronan to damaged bovine cartilage explants led to full restoration of proteoglycan levels. Hyaluronan has also been shown effective in inhibiting cartilage degeneration in early osteoarthritis and in speeding anterior cruciate ligament (ACL) injury healing. ACL injury in the dog has successfully been treated with hyaluronan administered intra-articularly and intravenously. Findings show that chondrocyte apoptosis was lessened by either treatment. This was consistent with previous results showing effectiveness of intravenous hyaluronan in the amelioration of osteoarthritis in horses

and humans. Clinical data are consistent with the notion that exogenous hyaluronan promotes endogenous hyaluronan production. This may explain not only the consistently observed efficacy of exogenous hyaluronan but also the timelimited effectiveness of intra-articular hyaluronan. Studies are ongoing to establish the molecular basis for the observed effects of oral hyaluronan. Areas of investigation include absorption, distribution, and favorable metabolic effects. Studies with labeled oral hyaluronan show distribution to joints in two hours. What is clear is that high molecular weight hyaluronan in hyaline cartilage and synovial fluid is critical for the mechanical and metabolic integrity of diarthrodial joints. Continued mechanical insult, whether due to acute or repetitive injury, can lead to hyaluronan fragmentation and pro-inflammatory signaling. The underlying basis for oral supplementation is to restore endogenous hyaluronan integrity over the course of time, thereby interrupting deleterious processes. The roles of hyaluronan in healthy joint function provide the basis for daily supplementation with hyaluronan. The favorable physico-chemical properties of hyaluronan underlie the cycle of load-bearing and nutrition necessary for proper joint mechanics. For animals in which traditional therapeutic options such as NSAIDs and other anti-inflammatory agents are contraindicated, supplementation with hyaluronan provides a clear and natural alternative to pharmacotherapy. For long-term maintenance of critical structures needed for optimum joint function, peer-reviewed research provides the rationale for daily supplementation with oral hyaluronan. Dr. Marty Goldstein practices at Smith Ridge Veterinary Center in South Salem, NY. He earned his DVM from Cornell University in 1973 and was certified by the IVAS in 1977. He was a founding member of the AHVMA. Dr. Goldstein has given seminars on alternative therapies nationwide and has appeared on the Oprah Winfrey Show, the Martha Show, and Good Morning America. He wrote The Nature of Animal Healing, first published in 1999. IVC Fall 2016

Integrative treatment of

EQUINE ENDOCRINE DISEASE By Jody Bearman, DVM, CVA, CVCH, CVSMT

n horses, the main endocrine diseases are Cushing’s and Equine Metabolic Syndrome/ Insulin Resistance Syndrome. Equine Cushing’s disease, or pituitary pars intermedia dysfunction, is a common syndrome in older horses that can cause hirsutism, laminitis, polydypsia/polyuria, weight loss and other symptoms. Equine Metabolic Syndrome is insulin resistance with obesity and laminitis. The following four horses have been treated successfully with homeopathy and veterinary spinal manipulation (“chiropractic”).

CASE 1: DINANT Dinant, a 31-year-old Dutch Warmblood gelding, presented with a history of vaccination reaction (neck stiff, swollen, head down, lethargy) at a young age. In 2013, due to a history of hirsutism, fat pads with weight loss, front end stiffness especially when worked, and multiple infections, he had baseline cortisol testing; it was elevated and pergolide was begun. However, Dinant became listless, stiff and could barely walk, so the pergolide was discontinued.

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– 4 CASE EXAMPLES

In January 2016, he had just finished sulfa antibiotics for respiratory infection, and white nasal discharge was seen again. His manure was occasionally soft, his penis no longer extended with urination, his appetite was finicky and he didn’t want to work. He had refused all supplements for six months. He had many tooth extractions, leaving merely a few teeth. On integrative exam, Dinant had very shallow feet, a bruised right front medial sole, tight front feet with heat, slight crepitus in the right stifle, a stiff right cervical spine and stiff lumbar spine, white nasal discharge and a long coat, with deep weak pulses. Laser treatment of his right stifle and veterinary spinal manipulation (chiropractic) was performed. In three weeks, Dinant was no longer stiff while working. Though the limberness continued, he was still finicky, had continued nasal discharge, mild ocular discharge, and a very thick coat. While the stiff lumbar and cervical spine were adjusted, his guardian elected for homeopathic treatment. Based on Dinant’s history and physical symptoms, he was given one dose of homeopathic Sulphur 30C. Immediately after the remedy was given, he began to shed out “half a wheelbarrow every other day”, much better than he had for years. He was no longer sluggish, “had an opinion” like his younger self, and was no longer stiff.

Dinant began to shed immediately after this dose, and at six months after the original dose, his well-being is excellent. On rides, he looks better than most of the horses at the barn. His coat is normal, his front coffin joints remain slightly tight but there is no heat in his feet, his lumbar spine needed slight adjustment, and his cervical spine was supple and comfortable.

CASE 2: SIENNA Sienna is an eight-year-old Rocky Mountain mare. During the summer of 2015, she had pulses in all four feet and was painful. She was treated by the farrier and kept in a dry lot with hay. Her soles were growing but not exfoliating normally since the laminitis. She experienced a severe injury to her right hind fetlock in October of 2015 – down to the bone with a severed nerve – needing IV and oral antibiotics and raw honey. It healed with proud flesh and swelling. Continued on page 46.

One month after the one dose of Sulphur, Dinant’s neck was a bit stiff on the left; his lumbar spine was less stiff but still needed adjustment. He was now well muscled, his pulses were strong, his tongue was pink and he had no diagnostic points on Chinese medicine scan. At two months post remedy, he underwent sedation and a dental exam. There was nothing abnormal in his mouth – a first in five years. One tooth needed floating because there was no opposing tooth. At three months after the dose, Dinant began to relapse a bit, with continued hair growth, a slight clear nasal discharge and some stiffness that needed adjustment. Though his guardian said he felt “strong and vibrant when ridden”, the 30c Sulphur was repeated. There was no improvement, so a stronger dose (200c) of homeopathic Sulphur was administered several months later (four months after initial dose). IVC Fall 2016

Continued from page 45. She was not fully weight-bearing on exam in February of 2016 and kicked out when the foot was touched. Her right hind hoof was growing out crooked. She had been “spooky” since the injury, could not be ridden, was cranky when worked, hot to the touch and the underside of her neck had become harder. In the last year, she developed a hard cresty neck, fat pads at the shoulder, elbow and croup. She gained weight very easily. Sienna had white discharge from her left eye, broken hair at the base of her tail (her owner reported she was nearly always in heat with tail rubbing, presenting, “winking”, squealing), hot proud flesh swollen ½” from above the right hind fetlock to the hoof wall (with golden colored discharge at the caudal aspect), and a frostbitten right ear tip. The right side of her neck and occiput were stiff, and she wouldn’t allow manipulation of her front legs proximal to the elbows or her hind legs. She was diagnostic at BL18 and Dan tian on Chinese exam scan, had a weak left pulse and strong right pulse. She was adjusted at this time. In April of 2016, Sienna had gained some weight, and continued to have heat on her body, worse on the left. She also didn’t sweat on the left. Her right hind foot was beginning to contract. Her body condition score was 7/9, her thoracolumbar spine and right side of the neck were stiff, and she still didn’t allow her hind legs to be manipulated though did allow her entire thoracic limbs to be manipulated. On further questioning, her guardian said Sienna would shake and twist her head and neck when given a new or challenging task, and had the most trouble in hot and humid weather. She would also boss other horses but never bit or kicked them. At this time, her guardian requested homeopathic treatment, and she was given a single dose of Platina 200C. Two months post treatment, Sienna’s work ethic had increased, she stopped head and neck twisting when given a task, her body cooled down, she was comfortable and not as sweaty in hot humid weather, her fat pockets at the shoulder, elbow, neck and croup had disappeared, her proud flesh had decreased (and was normal and not painful), and she had only had one brief heat cycle without any squealing. On exam, her left pulse was deep, her feet smelled awful, L1 to L3 were slightly stiff and she now allowed mild manipulation of her right hind foot. With homeopathic treatment, healing happens from the inside out, so discharges are often seen (and smelled!) during this process.

Sienna’s foot one month post remedy.

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CASE 3: MOONSHINE Moonshine is an 11-yearold miniature horse gelding. When he was five years old, he developed Lyme disease; the next year he developed Ehrlichia, which turned into severe laminitis with much pain. Initially, his laminitis was much worse in the winter, but by 2015 he was lying down almost all the time. Since he had been on antibiotics he also developed diarrhea, which was worse at the end of summer and the beginning of autumn. Probiotics were not helpful. Moonshine loves to lie in the sun, and is an easy keeper. On exam, he had some tightness in his lumbar and cervical spine, all his feet were hot, his hooves were long and his BCS was 7/9. His pulses were deep and weak, his tongue was red and his diagnostic scan was positive for his front feet. His coat was extremely long. Moonshine was adjusted, received acupuncture for his Chinese diagnosis of Liver Qi Stagnation with Damp Heat, and received the Chinese herbal formula Hot Hoof 2 from Jing Tang Herbal. Two months later, Moonshine was significantly improved, standing on the manure pile with his hind end and his front feet on the ground. He was much better with the farrier and was standing most of the time with a “perkier” attitude. On exam, all his hooves were warm, his stifles were stiff, he continued to have lumbar and cervical stiffness, and had developed slight edema in his axillae. He was adjusted and received acupuncture. He did well until the following fall, when his symptoms (pain, lying down, lethargy, poor appetite and thirst, diarrhea) became worse than previously. He began Hot Hoof 2, but with no improvement prior to his appointment for homeopathy on December 23, when he was given one dose of Hepar sulph 30C. Two weeks after the dose, Moonshine’s diarrhea was resolved, and he was lying down much less. His lumbar spine was slightly stiff, he was painful on manipulation of his front feet, his coat was good with normal thickness, his left pulse was weak and his BCS was 6/9. By February 11, 2016, all his manure was normal, he was no longer lying down or standing in the sun – he was now staying by the hay. On exam, only L1 needed adjustment, he allowed

full manipulation, his feet were cool with visual bruising on the front soles (he had been trimmed the day before), his coat was normal and BCS 5/9. On April 14, his guardian started noticing some loose manure mixed with the regular. Moonshine also lay down once, but got up right away when fed. She felt he was 65% better, and said he always developed loose manure when the grass began growing in spring. He no longer appeared “sad” but was his regular “ornery” self with the farrier, and had his spirit back. On exam, his front heel bulbs were warm, his coat was normal and shiny, his right cervical spine was tight and he allowed full manipulation of his limbs. Due to the loose manure and lying down episode, he was given a second dose of Hepar sulph 30C. On July 2, his diarrhea was resolved, and he was no longer lying down, but his front feet seemed painful during and after a trim. His toes were much too short on the fronts, all feet were warm, he was bearing weight mostly on the hinds, his lumbar spine was tight and his BCS was 6/9. He received one dose of Hepar sulph 200C (a stronger potency), and on follow up communication his guardian reported he is better than ever.

CASE 4: HARLEY Harley is a 20-year-old Quarter/ Morgan cross gelding. His main issue was squamous cell carcinoma (SCC) of the penis, but he also had Cushing’s, determined by bloodwork. He had multiple masses all over the penis, which received several cryotherapy treatments along with 5-fluorouracil. The SCC continued to recur and worsen until he would no longer drop his penis or allow anyone near his hind end. In 2011, when his SCC was first diagnosed, he also had a body condition score of 9/9 and a painful left front foot, which had calcification around the navicular bursa as shown on radiographs. In January 2016, Harley had warm limbs distal to carpi and hocks, tight lumbar spine and poll, internal rotation of the left glenohumeral joint, right scapula dorsal, wouldn’t allow the left hind to be manipulated proximal to the hock, and had a toe bruise on that foot. His pulses were strong on the right, weaker on the left, he had a long coat, cresty neck, pot belly and BCS

5/9. He was on pergolide at the time. Harley had occasional diarrhea and coughing. He was adjusted, and homeopathic Thuja 30C was recommended, but his guardian did not give the remedy at that time. He was moved to a new barn, had one more round of cryotherapy and 5FU, but the pergolide was stopped when it ran out. Then he had a severe reaction to the anesthetic given when cryotherapy was performed; his guardian decided she didn’t want it repeated, and was ready to try homeopathy. In June 2016, Harley had a BCS 7/9 with a grazing muzzle. His pulses were fast and his tongue was purple. He continued to have lumbar spinal stagnation and would not allow an exam of his penis. He was given Thuja 30C at this appointment. One month later, his penis was comfortable, he allowed unsedated cleaning of his sheath by his guardian, and had much less smegma with no drainage onto his legs. His belly was firm, he no longer had a cresty neck, his feet had no heat, no diagnostic points were found on scan, his muscle condition score was 3/3 and his coat was beautiful. He is due for another recheck in two weeks, but the owner’s e-mail reports say he is doing very well. IVC Fall 2016

industry innovations Natural pet foods a growing trend

Indian sandalwood for skin care

Data recently released by GfK shows that natural pet food cornered well over half (58%) of the US’s total $13 billion spent in the “pet specialty” market last year, while grain-free foods came in just short of the 30% mark. The growth of natural and grain-free pet food is not limited to the US either – the UK, Czech Republic and Greece all showed notable demand within both product areas.

Roxy’s Remedies launches the first skin care brand for dogs based on pharmaceutical grade East Indian Sandalwood Oil (EISO). This lightweight gel comforts and soothes both canine and equine skin. Roxy’s Remedies has the only grade of EISO shown to be antibacterial, antiviral, anti-inflammatory and anti-proliferative in preclinical tests. Roxy supports Pets of the Homeless and local shelters with products and promotion. Roxy’s Remedies has been tested extensively on human skin, and is currently being studied by an veterinary dermatologist. Roxy’s is formulated without parabens, tea tree oil, antibiotics, fragrance or colorants. RoxysRemedies.com

“Consumers have been aware for some years of the health benefits of a natural diet for themselves – and that thinking is jumping across into what people choose to feed their pets,” says Pushan Tagore, vice president of global marketing for pet care at GfK. gfk.com

Water-based cremation Did you know you can generate more revenue by providing waterbased cremation? With the PET-400 Alkaline Hydrolysis system, each pet is placed in a private compartment to ensure families receive only their own pets’ ash remains. This eco-friendly system has a small footprint, and involves less than two hours of labor for up to 14 pet cremations. It offers fast ROI, and has no zoning restrictions. bioresponsesolutions.com, bioresponsefuneral.com, bioliquidator.com

Urinary Health Summit Urinary tract issues are among the most commonly-seen health problems in veterinary practice. On June 16, PRN® Pharmacal welcomed leading urinary health specialists and educators to their annual Urinary Health Summit in Pensacola, Florida. The group looked at urinary product market trends, advised on strategic development plans, and discussed the PRN urinary health portfolio, which includes flagship product PROIN® (phenylpropanolamine hydrochloride), as well as urinary nutritional support products CranMate® and CitraVet®. These three products all help with different urinary health issues in companion animals. The Urinary Health Summit is slated to become a biennial event. prnpharmacal.com/ urinaryhealth.

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Guests at the summit enjoy beautiful Pensacola Beach in Florida. Back row, left to right: Dr. Dennis Chew, Corey Shigematsu, Dr. Gary Oswald, Dr. Jeff Nichol, Nicole Westfall, Dr. Tómas Martin, Dr. Duane Maye, Dr. Ralph Claxton. Front row, left to right: Scott Howard, Dr. Jody Lulich, Dr. Sarah Steinbach, Dr. Julie Byron, Donna Logan, Dr. Heidi Lobprise, Dr. Meryl Littman.

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

Our Research Roundup is becoming increasingly popular. The Roundup is a summary, oriented towards the pet owner, of research on a holistic topic that comes to AHVMF Executive Director Dr. Nancy Scanlan’s attention during the two weeks prior. We have also started a newsletter with links to references for the Research Roundup topic, as well as animal news.

FUNDING NEEDED FOR PROPOSED STUDIES Funding AHVMF is critical because the NIH offers a small fraction of their total research budget for research directed towards CAVM, mostly for mind-body studies, which are much less applicable to animals. We currently have four applications from universities for new research that we cannot fully fund, even after the latest fundraiser. •C ornell University proposes a study on the use of turmeric and rosemary for feline oral squamous cell carcinoma, done on tissue culture so no cats are involved. Currently, the only conventional treatment that is effective is radiation therapy, and life expectancy is only about three months. •C ornell also proposes a study of acupuncture and electroacupuncture to treat Chiari syndrome in King Charles spaniels. Due to lack of funds, we will be appealing to King Charles spaniel organizations to see if we can collect enough money for this study. We encourage you to reach out to your clients who own King Charles spaniels, and encourage them to donate to this particular study. •D octors at the University of California at Davis propose studying the ability of Tellington TTouch and Petitation to decrease anxiety in dogs with such disorders. TTouch and Petitation, a form of meditation using animals, can be taught to pet owners for use with behavior issues.

•T he University of Florida proposes a study of the use of aquapuncture for treating rhesus monkeys with a form of incurable diarrhea seen in about 6% of the monkeys in captivity. Even with conventional treatment, these monkeys rarely live more than one to two years. The study will investigate aquapuncture with a substance that may work for up to three months. It has previously been investigated and shown minimal irritation, so we can envision its use in other situations where weekly stimulation may not be possible, such as in shelter dogs.

HOW YOU CAN HELP The spring fundraiser successfully raised over $50,000 with the help of matching funds contributed by Mercola. We thank them and Dr. Karen Becker, who first called Mercola’s attention to our efforts. Other donations continue to come in since the fundraiser ended, including some new monthly and quarterly ones. We encourage everyone to consider making recurring donations. One of our donors put out a jar and collected money for us during the month of the fundraiser, resulting in a donation of over $200. This particular donor collects money for a different charitable organization each month. Last year, they raised over $4,000 for different charities using this method. We think this is a great idea and encourage all readers to do something similar. You can direct your donations to specific areas, such as research or scholarships, a specific project, or give us general instructions such as “no research using animals”. In the latter case, research could use tissue culture, such as in the first Cornell proposal. Please make a donation at ahvmf.org/donate.

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tech talk

Managing an

INTEGRATIVE VETERINARY PRACTICE By Michelle J. Rivera MT, VDT

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The veterinary profession has grown by leaps and bounds over the decades, and I have personally seen many exciting changes over that time. We’ve gone from traditional stark white veterinary hospitals in the 1970s, to state-of-the-art facilities in the 1990s, to new and colorful integrative practices that are increasing in number all over the country in the 21st century. In order to be successful and prosperous, you must have a welleducated staff and clientele, and a management style that keeps everyone happy and healthy. Having enjoyed a very successful integrative veterinary practice for over 20 years, I can tell you that maximizing the use of your technicians is one of the keys to a thriving practice.

EDUCATION In my opinion, education is of the utmost importance. Education for the doctors on staff as well as all employees in the practice is the only way you can stand apart from other practices in your surrounding area. And because clients are truly the key to our success in keeping their animals healthy (and our practices successful), they must be educated in the different modalities you offer so they can make the best informed decisions for their beloved pets. Remember, people bring to us their cherished and loved animals for our expertise and opinion. We owe it to them to give the best care we can. The doctor(s) at your practice decide which modalities they would like to use, so it is up to the entire staff to become educated on the “who, what, where, when and how” of newly added treatments. The number one way to get staff to understand what you are offering in the practice is to have their own pets experience it. Allow the staff to be part of the process and they can then answer almost any question clients may have, with certainty and authority. The front office staff are the “gatekeepers” and “orchestrators” of the practice’s flow on a day-to-day basis. An educated and confident front office staff member is invaluable to a practice. They are answering the phone and listening to the concerns of clients, so if they are well-educated on each modality as you introduce it in the clinic, they will suggest options to your clients. Many clients hear about treatments from friends or the internet, and call to request that treatment even if it is not necessarily the most beneficial for their pet. The well-educated receptionist can gently guide these clients, rather than merely scheduling an appointment. Clients appreciate this interest in their individual needs, and the subsequent bond of trust and caring will ensure success for the lifetime of the relationship. Having periodic educational staff meetings can ensure that every member on the team understands what is being offered IVC Fall 2016

and why. This should also be a safe place for the team (staff and doctors alike) to ask questions without judgment. It is during these meetings that every person can become clear on what his or her role will be in utilizing each modality of integrative medicine offered at the clinic. Educational opportunities (conferences, CE, courses) for staff to further their training and knowledge can also be discussed. Many companies will be happy to have “lunch and learn” meetings at your facility to help make sure all members of your practice fully understand what you are offering. Instructors of every modality will often hold training sessions at your clinic, in your town or by Skype.

UNIQUENESS OF AN INTEGRATIVE PRACTICE I have been blessed to work in a variety of veterinary facilities and have experienced many styles of practice. An integrative medicine practice does have some very unique,

CLIENT EDUCATION

With an educated clientele, your practice will continue to grow at a pace everyone can enjoy. There are many ways to educate our clients. We have already mentioned that the initial phone call is number one. The role of the receptionist is not merely to schedule an appointment. By suggesting possible treatment options, the receptionist may prompt clients to do some research before the appointment. Compliance improves when a client is directly involved in choosing approaches to care. The technician will continue that education. This is where it is imperative for your staff to have had direct involvement with the modalities offered at the practice, so they can help guide and make suggestions to the client based on personal experience. Client education evenings are another way to educate your clients, staff and anyone from the community. We have been having client education evenings for years. We pick a topic and invite our clients and their friends and family for an evening of learning. We charge a nominal fee and supply coffee, tea and pastry. We have hands-on lab, if appropriate, supply our guests with a written handouts, and leave a large portion of time for questions and answers. This is a good way to have your trained staff involved, and give them the opportunity to head up an education talk with something they are trained in and feel passionate about. Dog clubs, cat clubs, horse shows, newspapers and social media are all further ways to educate the public. Many clubs have a budget for education so you can charge a nominal fee and potentially gain new clients. My thought is, the more educated our clients are, the better our team approach for bettering patient care, which is why we are doing what we do!

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positive and negative management issues that must be considered. Receptionists and technicians have key roles in managing these issues. Gone are 15-minute appointment times. Holistic medicine takes time and many questions need to be asked and answered in order for the doctor to decide what modality they would like to use. Time is also needed to review all medical records, perform additional diagnostics if needed, formulate a treatment protocol, start the treatment, and eventually prescribe at-home care. This is why time management is so important. The initial phone call to book the appointment, the time in the exam room, the discussion of findings and explanations before the client leaves, payment of the bill and making the follow-up appointment all need to be flawless.

Initial appointment booking

Several key areas include services to be scheduled, length of the appointment, and bill estimates. New client calls can be especially challenging, so having well-educated front desk staff is critical. You may even want one or two people whose main task is scheduling appointments. Services: New clients may have an idea of what services they would like – for example, they would like a massage appointment. In listening to the history being given by the client, the receptionist realizes the animal may need radiographs and has not had a complete physical exam in two years. They would then suggest a full veterinary exam before the massage is given. So front office staff members need to know hospital policies, such as which services will only be done if there has been an exam within the last year. If a new client has been merely using conventional services (with your hospital or another) and is calling with a medical issue, the receptionist would be able to suggest the holistic approaches now available, and of course allow the client to schedule for whatever they wish. The doctor may be able to encourage holistic approaches more easily because this was already introduced to the client. Returning clients will need less coaching, but the receptionist may still suggest one of the newer services – for example, “Did you know we now offer ozone treatments that may help heal Fido’s ear problems?” Timing: Integrative medicine practice appointments run anywhere from 30 minutes to an hour in duration. This should give the client all the time they need from the initial assessment to diagnostics and treatment. A suggestion I give for all first time appointments is that any records and diagnostics be sent in ahead of the scheduled appointment so the doctor and technician have ample time to review them, at Continued on page 54.

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Continued from page 52. their convenience, and try to formulate a treatment strategy. This has greatly helped my practice keep appointment times on schedule, which keeps the flow of the practice smooth and waiting times in reception to a minimum. Cost estimate: The front office staff should be able to give a rough estimate of costs over the phone, so when the client leaves they are prepared for the bill. I would suggest always “over-estimating” costs, since the front desk team are not doctors and do not know definitively what is going to be done. I always instruct my staff to state something to this effect: “I am aware that your regular doctor has done blood work, but if our doctor needs current lab work the charge would then be….” In the 23 years I have had our practice open, we have had no receivables. We have never had anyone unable to pay for services rendered because we gave them thorough estimates over the phone ahead of time, and there were no surprises for the client. This is very important for the health of a practice. In order to keep the facility open and employ educated staff there must be more profit than loss.

Exam room and treatments

The better trained a technician is in each holistic modality (just as they need to be trained in passing a catheter), the more successful your practice and the happier the RVT as they assume more responsibility. If they are attuned to Reiki, the client and animal will be more receptive to the treatments offered. If they know to offer calming essential oils, flower essences or Tellington TTouch, the happier the animal will be. While taking the initial TPR, techs can be introducing clients to

new ways of thinking about holistic approaches, or increasing the knowledge of those more experienced in thinking holistically. Listening to the client’s successes and failures with prior treatments may help technicians make useful suggestions to the doctor. After the doctor is finished, technicians can spend a lot of time making sure the client understands the selected modality, answering any questions, and underlining what the doctor says about possible healing reactions. Technicians also need time for the critically important task of training clients for home care: doing acupressure, administering homeopathic medicines, massaging carefully, etc. Follow-up appointments: Technicians can make sure the client realizes how important follow-up appointments are when using holistic approaches, since the goal is deep healing, not merely symptom relief. They can actually walk them out to the front desk and make sure an appointment is made. If no appointment is made, the tech can let the doctor know so follow-up phone calls can be scheduled. Statistics show that if a client makes a follow-up appointment at the end of the initial visit, they will be more apt to call and reschedule if they cannot keep it. In conclusion, integrative medicine has kept my passion for my career alive. Working in a practice that offers such exciting modalities is beyond a dream come true. Being able to combine treatments and modalities has allowed us to be successful and get results we did not see when we only had conventional treatments. Many cases deemed untreatable are made comfortable with all the choices we now have at our fingertips. A healthy practice makes for a healthy staff – and most importantly, our patients are also kept as healthy as possible.

References Marchall Liger LVT, CVPM. “How Integrative Medicine can Change your Veterinary Practice”. Veterinary Practice News, 2015. LA Times. “Why Vets are Adopting Nontraditional Approaches to Healing your Pet”. California Life and Style, 2015. Allen M. Schoen MS, DVM. “Clinical Applications of Holistic Medicine for Veterinary Technicians” (proceedings), DVM360, 2009. “Working in Alternative Veterinary Medicine”, veterinarytechnician.com. “Scope of Practice: Complementary and Alternative Veterinary Medicine (CAVM) and other practice act exemptions”. AVMA.org, 2016. Vet Tech Career Guide; The Truth about Vet Tech Burn Out. Indeed.com, 2013. Let’s Talk Veterinary Technology, Veterinary Technicians; Don’t Let Burn Out Bring you Down, 2013. Amanda L. Donnelly, DVM, MBA; AAHA. 101 Veterinary Practice Management Questions Answered. 7 Essentials for a Happy and Fulfilling Career, Forbes.com, 2013. Catherine Jessen. The Muse; 37 Ways to be Happier at Work

IVC Fall 2016

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integrative practice

Building resilience

and PREVENTING

BURNOUTwith coherence

STRATEGIES

By Barbara Fougere, BSc, BVMS (Hons), BHSc (Comp Med), MHSc (Herb med), GDVCHM, GDVWHM, GDVA, CVA, CVBM

Feeling jaded? Worried you can’t cope? What with compassion fatigue, running a busy practice and taking care of family, how can we do it all? This article focuses on coherence strategies to enhance your mental wellness, help prevent stress-related disease, and take better care of yourself and your body so you can enjoy practice without burning out. Research shows that those who care for others, out of vocation or compulsion, are often challenged in caring for themselves. In the last decade, there have been several interesting, though ominous, studies on the morbidity and troubles of veterinarians. Veterinarians are more likely to experience mood disorders and suicide than other occupational groups.1 Stress also affects our support staff. Workload, death and dying, and conflict with veterinarians are prominent sources of stress for veterinary support staff that affect health.2 Many causes of stress can be outside the workplace. The death of people or animals, relocation, relationship breakdowns, serious illness in the family, accident, financial disaster and many more can take an incredible toll on our wellness – mentally, emotionally and physically. It’s easy to get caught up in the day-to-day operations of clinical practice and forget about taking care of our own heads and hearts.

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THE GUT BRAIN AND HEART BRAIN We possess intelligence that goes beyond the brain. Neurotransmitters and their receptors are situated in the brain, gut, skin and heart, and complex intra-organ nervous systems are being found in other organs. So it is no surprise that our mental states are capable of promoting or suppressing healing mechanisms in different regions of the body. Positive or negative states of mind are locally experienced and can impact regulatory functions. Emotional experiences and memories are stored in many parts of the body, not just the brain. Neuropharmacologist Dr. Candace Pert famously stated: “Your body is your subconscious mind. Our physical body can be changed by the emotions we experience…. And unexpressed emotions are literally lodged in the body.”3 Dr. Pert says that a feeling sparked in the mind or body will translate as a released peptide. Organs, tissues, skin, muscle and endocrine glands all have peptide receptors that can respond to, access and store emotional information. The way a peptide stimulates a receptor determines whether an experience arises in conscious awareness or stays at the level of the subconscious. A survey of 700 people showed that different emotional states are associated with topographically distinct and culturally universal bodily sensations.4

THE PHYSIOLOGY OF THE HEART The heart is now recognized as a highly complex system with its own functional “brain.”5 Research shows that the heart is a sensory organ and a sophisticated center for receiving and processing information. Signals from the heart to the brain influence the function of higher brain centers involved in perception, cognition, hormonal and emotional processing.6 The nervous system in the heart (“heart brain”) enables it to learn, remember, and make functional decisions independent of the brain’s cerebral cortex, and afferent information from the heart can influence brain activity in the subcortical, frontocortical, and motor cortex areas.7 The heart generates the largest electromagnetic field in the body. Electrically it is about 60 times greater per ECG in amplitude than brain waves per electroencephalogram. The magnetic component of the heart’s field, which is around 100 times stronger than that produced by the brain, is not impeded by tissues and can be measured several feet away from the body with Superconducting Quantum Interference Device (SQUID)-based magnetometers. McCraty6 found that the clear rhythmic patterns in beat-to-beat heart rate variability are distinctly altered when different emotions are experienced.

INTRODUCTORY HEART COHERENCE TECHNIQUE

Use the following to increase and sustain your personal coherence. You may choose to schedule times to do it, and/or use it when you notice yourself or staff becoming stressed or challenged in any way. • Breathe and calm yourself in whatever way you choose. • Choose something you appreciate and radiate the feeling of appreciation toward it for about two minutes. • Evoke a genuine feeling of compassion and care for the planet, yourself, the practice, your staff. • Breathe the feelings of compassion and care out from your heart to the planet or to a speciﬁc area of immediate need. • See yourself joining with other caretakers to participate in the healing process and generating peace for the clinic, a patient, a client, your town, country or world. These changes in electromagnetic, sound pressure, and blood pressure waves produced by cardiac rhythmic activity are “felt” by every cell in the body, further supporting the heart’s role as a global internal synchronizing signal. McCraty8 also provides evidence that this energy is not only transmitted internally to the brain but is also detectable by others within its range of communication. McCraty9 also presents data which shows that a transference of electromagnetic energy produced by the heart occurs when people touch or are in proximity. If the electromagnetic field generated by the heart can affect those around us, the implications are huge. How we affect people in our proximity (clients, staff, vendors) and how they affect us is related to our emotions. Pioneering researchers in neurocardiology coined the term coherence to describe a “mental and emotional state that people experience when they are in-sync – when the heart, brain, and nervous systems work with more harmony and efﬁciency”. Extensive research into the rhythms of the heart demonstrates that feelings will dictate heart rhythms. When we experience positive emotions such as joy, gratitude and love, a pattern of cardiac coherence is seen. Anxiety, stress, anger or sadness create a pattern of chaos in our cardiac frequencies. Positive emotions feel better subjectively, but also tend to increase synchronization of the body’s systems. This improves energy levels and enables us to function with greater efficiency and effectiveness, creating a system-wide coherence. Continued on page 58. IVC Fall 2016

Continued from page 57. Correlates of physiologic coherence include:10 •Increased synchronization between the autonomic and parasympathetic nervous system •A shift toward increased parasympathetic activity •Increased heart-brain synchronization •Increased vascular resonance •Entrainment between diverse physiologic systems

MEASURABLE BENEFITS OF COHERENCE The ability to alter one’s emotional responses is central to overall well-being and to effectively meeting the demands of life’s challenges. McCraty found that regular practice of intentionally simple self-regulation techniques, most of which instruct users to place their attention in the center of the chest and then self-activate a feeling of calmness or a positive emotion, can lead to lasting increases in the ability to selfregulate and maintain composure, leading to: • Reduced stress, anxiety and depression • Decreased burnout and fatigue • Hormonal balance • Enhanced immunity • Lower blood pressure • Improved digestion • Increased energy • Improved cognitive performance and enhanced learning, including access to intuitive capacities.

MOVING FROM HEAD TO HEART Practicing coherence techniques can assist us in moving from head to heart in all aspects of our practice. We need to assess ourselves. Are we practicing out of chaos or coherence? How do we influence our patients, clients, team and family members? We can teach ourselves the benefits of emotional self-regulation strategies and mind-body coherence (Heartmath.org) using the techniques outlined below as well as many others to suit each individual.

The Quick

Coherence Technique

Use this 60-second technique whenever you recognize energy-draining moments, however subtle. • Heart focused breathing – Focus your attention in the area of the heart. Imagine your breath ﬂowing in and out of your heart or chest area. Breathe a little slower or deeper than usual. • Activate a positive feeling – Make a sincere attempt to experience a regenerative feeling such as appreciation or care for someone or something in your life.

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SUSTAINABLE HEART-BASED PRACTICE By reconnecting to ourselves and our hearts we can help prevent burnout and greatly improve work satisfaction. We need to take the time to build authentic connections and rapport. Self-care is the foundation of care for others, so we must make it a priority in order to achieve a work-life balance. This is truly walking the talk of holistic medicine. Coherence also means using heart intelligence alongside analytical mind modes in all aspects of our business practice, including marketing and planning; finding our niche; valuing our services and charging appropriately; training our staff and ourselves; creating the best physical environment to support our vision; developing authenticity and trust in our uniqueness; and recognizing our deeper purpose in serving others.

TECHNIQUES FROM HEARTMATH The HeartMath website gives you many visuals, graphs and techniques. If you follow these simple techniques, you will make great strides to improved health and success. Then you can opt to learn even more.

HeartMath Appreciation Tool An effective way to improve mental, emotional, physical and spiritual well-being is to invoke and sustain sincere appreciation. The greater your capacity for sincere appreciation, the deeper the connection to your heart, where intuition and unlimited inspiration and possibilities reside. Heart-focused, sincere, positive feeling states boost the immune system, while negative emotions can suppress the immune response for up to six hours. The website includes actual heart monitor readouts showing the big difference between frustration and appreciation. After appreciation, the heart rhythm becomes smooth, and this coherent pattern is a sign of good health and emotional balance. You and your staff may want to try some of the following techniques prior to entering the exam room or beginning a procedure. You may want to hold a brief one-minute staff meeting several times a day to use the slightly longer tools; in a big clinic, you can have each team take several breaks.

1 Heart breathing and focus – Focus your attention on your heart area and breathe a little deeper than normal, in for five to six seconds and out for five to six seconds. Picture yourself slowly breathing in and out through the heart area.

2 Heart

feeling – Activate a positive feeling as you maintain your heart focus and breathing. Recall a time when you felt good inside, and try to re-experience the feeling. Remember a special place or the love you feel for a close friend, relative, or cherished animal companion. The key is to focus on something you truly appreciate. Appreciation list – Make a list of things you appreciate such as people, places, activities and pets, and choose one or two each morning to hold in your heart during the day. Encourage staff to list what they appreciate about working at this wonderful clinic – e.g. great clients or patients. Choose one to hold in your heart throughout the night while you rest. Appreciation breaks – Take multiple appreciation breaks each day, ideally in the early morning, several while at work, once you’re home or before bed. Breathe through your heart as you focus on one or more items on your list. Appreciation in the moment – Keep your list close by all day, so when stress or negative emotions occur you can choose something from your list that will quickly (in 30 seconds) evoke a feeling of appreciation.

1 Fritschi, Morrison, Shirangi, et al. 2009; Platt, Hawton, Simkin, Mellanby. 2010; Cited in J Occup Health Psychol 2014 Apr;19(2):123-32. 2 Foster SM, Maples EH. “Occupational stress in veterinary support staﬀ ”. J Vet Med Educ 2014 Spring;41(1):102-10. 3 Pert C. Molecules of Emotion: The Science Behind Mind-Body Medicine. candacepert. com Accessed May 28, 2015. 4 Nummenmaa L, Glerean E, Hari R, et al. “Bodily maps of emotions”. PNAS 2014 111 (2) 646-651. 5 Armour JA.“Potential clinical relevance of the‘little brain’on the mammalian heart”. Exp Physiol 2008;93:165–176 6 McCraty R. “The Energetic Heart: Bioelectromagnetic Communication Within and Between People”. Clinical Applications of Bioelectromagnetic Medicine, edited by P. J. Rosch and M. S. Markov. New York: Marcel Dekker, 2004;541-562. 7 McCraty R, Shaﬀer F. “Heart Rate Variability: New Perspectives on Physiological Mechanisms, Assessment of Self-regulatory Capacity, and Health Risk”. Glob Adv Health Med 2015 Jan;4(1):46-61. 8 McCraty R, Atkinson M, Bradley RT. “Electrophysiological evidence of intuition: part 1. The surprising role of the heart”. J Altern Complement Med 2004 Feb;10(1):133-43. 9 McCraty R, Atkinson M, Tomasino D, et al. In K. H. Pribram, ed. “Brain and Values: Is a Biological Science of Values Possible”. Proceedings of the Fifth Appalachian Conference on Behavioral Neurodynamics. Mahwah, NJ: Lawrence Erlbaum Associates, Publishers, 1998;359-379. 10 McCraty R, Zayas M. “Cardiac coherence, self-regulation, autonomic stability, and psychosocial well-being. Front Psychol 2014;5:1090.

IVC Fall 2016

INTEGRATIVE

APPROACH to

Cushing’s disease By Lena McCullough, DVM, CVA

As Cushing’s becomes more prevalent in veterinary practice, more clients are requesting holistic treatments over merely conventional approaches. Building health from a young age can also lessen the risk of this disease.

which stops the production of adrenal hormone by blocking its release. This can be risky because if too much hormone is blocked, the animal can become seriously ill, or develop the more serious Addison’s disease.

With an adrenal tumor, removal is usually recommended. With pituitary tumors, however, removal is too difficult, so the treatment of choice is to use a drug such as Trilostane,

The main symptoms of Cushing’s disease are a potbellied appearance, excess hunger, increased water consumption and symmetrical hair loss. Cushing’s disease can also cause weakness and panting. These dogs have a weakened immune system and are prone to infections and cancers. People will

ushing’s disease is caused by an overactive adrenal gland that’s producing too much adrenal hormone. This is most frequently due to a benign pituitary tumor, which signals the adrenal to produce more hormone than it needs. Occasionally, it is caused by an adrenal tumor in the actual gland.

IVC Fall 2016

often report increased agitation and some dogs will have issues with sleeping through the night. Many dogs have a tragic look to them.

THE CUSHING’S/DIABETES LINK The thinking these days is that Cushing’s disease appears to be closely related to type II diabetes. Some believe that both diseases are the same syndrome, but are just manifesting differently. When brain scans were done of cats with insulin-

resistant type II diabetes, pituitary tumors characteristic of Cushing’s disease were found.* Wow! Both diseases seem to be induced by an overload of nutrients of the carbohydrate variety. Animals with Cushing’s disease and diabetes develop what is called metabolic syndrome. Their body cannot handle the amount of carbohydrates and high glycemic index ingredients in many processed diets. These high glycemic index diets cause high levels of inflammation in

CASE STUDIES

Clancy A few years back, I treated a cute, spunky little Cairn terrier named Clancy. We were able to catch his Cushing’s disease very early, just after he was diagnosed. His main symptoms were an increase in weight, panting, excessive jumpiness when touched, and easy startling. He also drank a lot of water and was always hungry.

With acupuncture, herbs and diet, we have been able to keep Clancy happy and symptom-free for about two years. Occasionally, he would have a little ﬂare-up of symptoms, but we were able to treat them with acupuncture and some herbal and dietary changes. Clancy received acupuncture about every eight weeks; I needled tien men, fei shu, pi shu and ming men. He was on Si Miao San with corn silk and after a year I also started him on ginkgo.

Pattywas a lovely 11-year-old golden retriever diagnosed

with pituitary Cushing’s. She presented with excessive drinking, urinating, a ravenous appetite and panting. She had bilateral hair loss with complete baldness on both sides. She also had arthritic hips and a lot of hind end weakness. She originally came to me for just a couple of acupuncture treatments while her regular holistic vet was away, and was already on ginkgo and mai men dong tang. I switched her over to Eight Treasures with added corydalis for hip pain, and cang zhu, yi yi ren and huai niu xi to treat her dampness. I started acupuncture treatments, needling tien men, fei shu, gan shu, pi shu, ming men, bai hui, hou san li and ba shan. Within a month, Patty’s hair started growing back and her hips improved. She had a small stroke a couple months after I started treating her and her Western vet started her

on Trilostane. At that point, Si Miao San and bai ji li were added to the acupuncture, ginkgo, and her original formula. Over the next year, she had three Trilostane toxicity events (vomiting and diarrhea) as we regulated her Cushing’s with acupuncture and herbs. and each time we reduced her dosage until she was completely off the drug and controlled just through acupuncture and herbs.

Sunshine was an energetic 13-year-old Lab mix

who presented with pu/pd, a potbellied appearance, excess heat and restlessness. She was also prone to digestive issues, which included gas and sometimes vomiting. She received acupuncture – tien men, fei shu, gan shu, pi shu, shen shu, bai hui, hou san li and ba shan – and was started on Si Miao San. Her person already made her an excellent grain-free homemade diet so I made no changes there. After a few months, Sunshine’s symptoms had improved but the restlessness and night anxiety were still present, so I added in Chai Hu Jia Long Mu Li Tang with added Dang Gui and devil’s club, and a little later a mixture of hawthorn berry, ﬂower and leaf with ginkgo and ashwagandha. Through her ﬁnal years, Sunshine received monthly acupuncture and her Cushing’s remained stable without drugs. We shifted treatments slightly as new old age issues emerged. She lived to 16 years of age, when she tragically died of bloat one evening. IVC Fall 2016

their bodies, which lead to problems in the endocrine system. This can lead to insulin resistance, development of pituitary tumors, and other inflammatory diseases.

DIET IS A FACTOR No one knows for sure why there has been such an increase of Cushing’s disease in dogs, but dietary issues are definitely a big factor. Inflammation seems to play a large role as well, whether it arises from poor diet, or other factors such as overvaccination, overuse of pesticides, or the overall increase of chemicals in our environment. Over years of practicing holistic medicine, I have gone from thinking I could help control the side effects of Cushing’s disease in dogs on drugs, to having dogs in my care that are completely controlled with diet, herbs and acupuncture. My preference is always to begin treating dogs early in the disease and before they are put on drugs. I sometimes even have success with dogs who have been chronically ill. My first goal is to change the patient’s diet. I pull all grains and most carbohydrates out of the diet, feeding the dog the least processed diet he can tolerate. This may take major coaching so the client will see how easy and inexpensive feeding fresh can be. Raw, high protein diets are best. If raw is not possible, then feeding a grain-free, potato-free, high protein, high quality homemade or purchased cooked food is second best. Canned food with these qualities can also be an acceptable option. Do not feed these dogs dry food! I have found that changing

IVC Fall 2016

the diet alone can make a huge difference in these dogs, so if you can only work with diet you can still help these animals.

HERBAL TREATMENT Secondly, I treat the dampness and inflammation through herbal treatments. This is the best way to get the endocrine system back to normal regulation. • I n most dogs, the best Chinese herbal formula for this is Si Miao San. It helps to decrease inflammation in the body, regulates insulin, and improves digestion. I sometimes add corn silk to this formula to help with insulin resistance. Not surprisingly, this is also one of the main formulas I use for diabetes. Si Miao San works best for the hot, panting, overweight Cushing’s dog. • For thin, weak, deficient dogs, especially if there is emaciation, I often start with a formula called Eight Treasures which treats qi and blood deficiency and helps with digestion and absorption. • I also will sometimes work with the kidney-tonifying formula Liu Wei Di Huang Wan if the emaciation is not so severe and there are issues with empty heat and panting. • I put almost all my patients with Cushing’s disease on ginkgo biloba. Ginkgo slows the release of adrenal hormone and can help control some of the symptoms of this disease. I almost always use it in a formula with hawthorn (leaf, flower and berry). This combination of herbs helps quite a bit with the sundowner’s nighttime anxiety. Sometimes this formula makes the difference between good and mediocre control of the disease. It’s also great for helping with dementia, high blood pressure, and protecting against heart disease and stroke. Because of this I often recommend it in my older animals even when they don’t have Cushing’s disease.

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ACUPUNCTURE ALSO ASSISTS Most of my practice centers around acupuncture. I love to needle dogs with Cushing’s because they have such a great response. Acupuncture helps regulate the endocrine system and reduce inflammation in the body. I have found that many dogs will only need acupuncture about every two months once we get them stable, unless we are treating other health issues as well. I practice Traditional Veterinary Acupuncture and some of the points I have found to be helpful for Cushing’s are fei shu (BL13), gan shu (BL17 or BL18 depending on your style of acupuncture), pi shu (BL20), ming men (GV4) and hou san li (ST36). I also always needle tien men (GV17) and bai hui to open up the body to receiving. I always caution my clients to be aware that natural treatments can change the amount of Trilosten and other drugs needed to control Cushing’s. If a dog stops eating, becomes lethargic, or has sleep disturbances or vomiting and diarrhea, this could be a sign of overdose. While I have not been able to get all my Cushing’s patients controlled without Western drugs, I am usually at least able to significantly reduce clinical signs and/or the dose of drugs needed to regulate the illness. In a disease without many good, safe options for treatment, I love having effective natural options to offer my patients.

Stomatitis in felines is quickly becoming pandemic in clinics all across the country. You’ve probably had this experience yourself: a young cat comes in with fire engine-red gums and you had to get three staff members to help hold the traumatized feline just so you could diagnose the poor thing. Now you get to tell your client the bad news: the only procedure to stave off further infection is a full mouth extraction, followed by antibiotics and steroids. But is this really the only option? The answer is no. VetzLife offers a healthy, natural alternative that will help save your feline patients’ teeth and prevent the need for extraction. Even if a patient has already had a full extraction procedure, the company’s Feline Stomatitis Oral Care Gel will help solidify the gum tissue and prevent the spread of infection, even into the bloodstream. It works by providing powerful anti-allergen properties, along with anti-inflammatory properties to stop the allergic reaction and bring down inflammation. This allows the product’s antibacterial ingredients to heal gum tissue, and assists the cat’s own immune system to help reverse periodontal gum flare-ups. The daily oral application of VetzLife Feline Stomatitis Oral Care Gel will help reduce pain and save teeth. So when clients ask, “Is there anything else we can do to stop stomatitis?” you now have an answer! Find out more at vetzlife.com or call 888-453-4682 for a free sample.

* Elliott DA1, Feldman EC, Koblik PD, Samii VF, Nelson RW. Prevalence of pituitary tumors among diabetic cats with insulin resistance. Am Vet Med Assoc. 2000 Jun 1;216(11):1765-8.

IVC Fall 2016

From the IVAS The mission of the International Veterinary Acupuncture Society (IVAS) is to provide, promote and support veterinary acupuncture and related treatment modalities through quality basic, advanced and continuing education, internationally recognized certification for veterinarians, and responsible research.

This year, the IVAS celebrated its 42nd annual International Veterinary Acupuncture Society’s Congress in Tacoma, Washington. Our keynote presenter was Linda Boggie, DVM, CVA, FAAVA, and the topic was “Expanded use of the Ancestral Sinews in Treatment of Internal Medicine Patterns”. The Ancestral Sinews in small animals were first used to treat musculoskeletal problems such as hip dysplasia and intervertebral disc disease. Over the years, their application in Dr. Boggie’s practice has been not only for patients with musculoskeletal problems but also for problems in internal medicine and behavior. Dr. Boggie’s presentation provided a brief explanation of the Ancestral Sinews for those who were not familiar with them, followed by a number of case presentations representing their usage in internal medicine problems, including inflammatory bowel disease and chronic cystitis, as well as the treatment of behavioral problems ranging from aggression to separation anxiety. Other presentations at the Congress from various integrative veterinarians included: “Common Acupuncture Points Explained with both TCVM and Scientific Definitions”, “Chinese Herbal Remedies in Transdermal Gel – The Best Way To Treat Animal

Skin Conditions”, “Acupuncture for Thoracolumbar Intervertebral Disc Disease in Dogs”, “Osteopathic Acupuncture” and “The Use of Xiao Chai Hu Tang in Acute and Chronic Renal Failure”. In 2017, we will host our 43rd annual Congress in Cairns, Australia, from August 23 to 26, at the Hilton Cairns. Mark your calendars and join us in the land down under! This is not only a great excuse to visit Australia but a wonderful way to learn new and different ways to approach cases. There will be presentations on a wide variety of topics and time to spend with other colleagues. In addition to general interest presentations, we have both small and large animal tracks, poster presentations, hands-on wet labs, and our gala dinner which will be held at the Tjapukai Aboriginal Park. Now you have an excuse to go to Australia for work! No worries, mate, if you are not able to attend the Congress. As a member of IVAS, you have access to our Congress Proceedings each year on our website in the Members Only Section. This means you can read each presentation from our last ten years of Congresses and continue to learn new approaches to treating almost every possible problem. Continuing Education Events you can attend cover many topics, including Laser Acupuncture, Food Therapy, and more. If you are new to acupuncture and want to learn how to integrate it into your practice and improve the return on your investment, we have an online class for that too. To learn more about IVAS, visit our website at ivas.org or email office@ivas.org.

IVC Fall 2016

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IVC Fall 2016

events

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

Large & Small Animal Acupressure Level 1 October 2-7, 2016 – Longmont, CO

This event is open to Veterinary Professionals ONLY. (NCBTMB, RAIVE and CACVT CE candidate information see our course catalog) This program consists of 7 modules to be completed on site. The 7 Modules of the Level 1 program encompass the following topics: • Traditional Chinese Medicine Concepts and Origins (TCM) • Landmark Anatomy of Equine and Canine - Partial self-study required prior to class. Register at least 2 weeks prior to giving you time to complete the work. • Acupressure Points, Pressure and Manipulation Techniques • Energy Meridian Pathways, Theory and Application Introduction • Yin and Yang Theory • Shiatsu • The Study of Chi • Introduction to Eight Guiding Principles • Introduction to Five Phases of Transformation • Introduction to Five Element Theory • Important AcuPoint Groups • Signs, Signals, and Evaluation • Written Exam and Live Practical • Take Home Case Studies Students will receive their Practitioner Certification once they have sufficiently completed all post class work including electives. 32 hours of electives are required. These may be taken at RMSAAM or another school and credit may be given for previously taken courses. Examples: Massage, Essential Oils, Aromatherapy, Reiki, Animal Communication, Flower Therapy, Nutrition, T-Touch, HTA, etc. This class takes place at an equine facility. Work will take place on horses and dogs. For more information: Beth Pelosa (303) 660-9390 info@rmsaam.com www.rmsaam.com

2016 Veterinary Cancer Society Annual Conference October 20-22, 2016 – Orlando, FL

The primary focus of the meeting will be a program highlighting advances in clinical oncology. The keynote speakers have diverse interests and focus on translational medicine with applications of their research into clinical practice. For more information: (573) 823-8497 vetcancersociety@yahoo.com www.vetcancersociety.org

2016 AAFP Conference

November 3-6, 2016 – Washington, DC The material will include presentations geared towards the experienced feline practitioner, as well as sessions for newer practitioners or those looking to expand their knowledge in feline medicine. For more information: (800) 874-0498 info@catvets.com www.catvets.com/education/conference

Hawaii Veterinary Medical Association Convention

November 10-13, 2016 – Honolulu, HI This convention is an outstanding program offering over 68 hours of Continuing Education excellence. Some of the highlights include Wet Labs, Training Modules for accreditation, and three days of lectures. Come and join us for a wonderful weekend in Paradise. For more information: contact@hawaiivetmed.org www.hawaiivetmed.org

American College of Veterinary Surgeons Symposium October 5-8, 2016 – Seattle, WA

The ACVS Veterinary Symposium offers the most advanced information on a wide range of surgical procedures as well as pre-operative patient care, post-operative complications, and advanced diagnostic techniques. You are guaranteed to come away with new information that will improve your veterinary surgical practice.

62nd Annual AAEP Convention December 3-7, 2016 – Orlando, FL

At this conference, you will find over 100 CE credits to choose from. With over 4,000 veterinarians gathered and nearly 400 exhibitors, this will be one of the most comprehensive CE experiences you want to attend. You will be able to network with professional colleagues and have the chance to raise your expertise across the entire spectrum of equine medicine.

For more information: (301) 916-0200 acvs@acvs.org www.surgicalsummit.org

For more information: aaepoffice@aaep.org www.aaep.org

21st Annual ABVP Symposium

December 8-11, 2016 – San Diego, CA

October 6-9, 2016 – San Antonio, TX

The Symposium is open to all veterinarians, veterinary technicians, and veterinary students. Registration includes access to lectures, Regents Track Reception, Welcome Reception, Friday and Saturday luncheons, online proceedings and more. Visit our website to view the conference schedule. For more information: (800) 648-4462 www.abvp.com

2016 CVC San Diego

Experience exceptional veterinary continuing education in a central location. Outstanding convention hotels, dining, shopping, and entertainment all within a short walk of the San Diego Convention Center. Take a break from the traditional. Join us at CVC San Diego and experience an unconventional, attendee-centric approach to veterinary continuing education conventions. • Maximum CE in minimum time • Exceptional programming, led by the profession’s most accomplished educators and experts • Simple to plan and to navigate • Staff on hand to help plan your CVC experience • Registration and travel cost that make sense • Registration includes “lunch bucks” to cover the cost of lunch and snacks • Hotel rates and hotel extras negotiated to deliver convenience and comfort at the best possible price For more information: cvc@advanstar.com www.thecvc.com

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IVC Fall 2016