V7I1 (Winter 2016-17) by Redstone Media Group

Integrative VETERINARY CARE VOLUME 7 ISSUE 1

TREATING THORACIC DISEASE

TAKE A LOOK AT HOW HYPERBARIC OXYGEN THERAPY AND OTHER INTEGRATIVE MODALITIES CAN ALLEVIATE THORACIC PROBLEMS. — P. 38

LASERS IN CANINE PHYSICAL REHABILITATION

ORAL AND DENTAL HEALTH

KENNEL COUGH AND OTHER TRACHEAL PROBLEMS

NAMBUDIPRAD’ S ALLERGY ELIMINATION TECHNIQUE

EXTRUDED HORSE FEEDS –PROS AND CONS

WHAT’ S NEW

Whether your use a Class III or Class IV laser, proper training in its use is essential, for technicians as well as doctors. — P. 22

www.IVCJournal.com

WINTER ISSUE 2016

Vaccination doesn’t guarantee protection, but homeopathy and TCVM can help treat and even prevent these conditions. – P. 42

Hay or pasture meets the needs of many horses, but if extra support is needed for performance or health issues, extruded feed can be beneficial. — P. 34

Why it’s important to educate clients about integrative and nutritional support for canine and feline oral wellness. — P. 14

NAET combines techniques from acupuncture, kinesiology and other therapies to pinpoint the allergens individual patients react to. — P. 28

•Animal simulators change the way veterinary medicine is taught •Lameness is top health issue in horses •Detection dogs trained to sniff out ovarian cancer

IVC Winter 2016

contents FEATURES

NUTRITION NOOK

INTEGRATIVE AND NUTRITIONAL SUPPORT FOR ORAL HEALTH

By Katie Kangas,

DVM, CVA, CVCP

As veterinary practitioners, it’s important we recognize the value of educating pet parents about proactive options that promote better oral health for their dogs and cats.

TECH TALK

LASERS IN CANINE PHYSICAL REHABILITATION

By Evelyn Orenbuch,

DVM, DACVSMR, CAVCA

Both Class III and Class IV lasers have applications in physical rehab for dogs, but proper training in the use of this therapy is essential, both for veterinarians and technicians.

NAMBUDIPRAD’ S ALLERGY ELIMINATION TECHNIQUE By Donna Kelleher,

DVM

NAET combines techniques from a variety of modalities, including acupuncture and kinesiology, to identify allergens and resolve allergies in dogs and cats.

EXTRUDED HORSE FEEDS – PROS AND CONS

THORACIC DISEASES – INTEGRATIVE TREATMENTS

INTEGRATIVE APPROACHES TO TRACHEAL PROBLEMS

By Madalyn Ward,

DVM

Though they’re not for every horse, extruded feeds offer important benefits in some circumstances.

By Liza Schneider,

BVSC

Hyperbaric Oxygen Therapy and other alternative modalities can be very effective at tackling these conditions.

By Christina Chambreau,

DVM, CVH

How homeopathy and TCVM can help treat kennel cough and collapsing tracheas – and why vaccination doesn’t guarantee protection.

38 4

IVC Winter 2016

TCVM FOR RAO IN HORSES

TCVM PERSPECTIVE AND TREATMENT OF EQUINE METABOLIC SYNDROME

By Huisheng Xie,

DVM, PhD

Acupuncture and Chinese herbal medicine can effectively treat recurrent airway obstruction in equines.

By Cynthia Lankenau,

DVM, CVA, CVCHM, RH (AHG)

More than 20% of all horses are at risk of developing Metabolic Syndrome. This article looks at one case that was successfully treated with alternative therapies.

INTEGRATIVE PRACTICE

EXTEND YOUR REACH WITH PARTNERSHIP

By Terri Symonds Grow,

BIS

Developing a partnership with a local holistic pet supply store can benefit your practice in several important ways.

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’ 20 From the VBMA 33 Industry innovations 51 From the AATCVM 58 Social media 59 Veterinary resource guide 60 From the AVH

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 trained 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.

61 From the AHVMA 65 Marketplace 66 Events

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

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

IVC Winter 2016

Integrative VETERINARY CARE

WINTER 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 Flegg Social Media Manager: Maddie Maillet Web Design & Development: Brad Vader Cover Photo Courtesy of: tbob

COLUMNISTS & CONTRIBUTING WRITERS Christopher Kelly Groth Terri Grow, BIS Katie Kangas, DVM, CVA, CVCP Donna Kelleher, DVM Cynthia Lankenau, DVM, CVA, CVCHM, RH (AHG) Jeff Nichol, DVM Evelyn Orenbuch, DVM, DACVSMR, CAVCA Liza Schneider, BVSC Madalyn Ward, DVM Huisheng Xie, DVM, PhD

ADMINISTRATION & SALES Publisher: Redstone Media Group President/C.E.O.: Tim Hockley Accounting: Karen Jeffries Circulation & Office Manager: Libby Sinden SUBMISSIONS: Please send all editorial material, photos and correspondence to Dana Cox at Dana@redstonemediagroup.com or IVC Journal, 160 Charlotte St., Suite 202 Peterborough, ON, Canada K9J 2T8. We welcome previously unpublished articles and color pictures either in transparency or disc form at 300 dpi. We cannot guarantee that either articles or pictures will be used or that they will be returned. We reserve the right to publish all letters received.

ADVERTISING SALES: Eastern Sales Manager: Ann Beacom (866) 764-1212 ext. 222 annbeacom@redstonemediagroup.com Western Regional Manager: Becky Starr (866) 764-1212 ext. 221 becky@redstonemediagroup.com Multimedia Specialist: Kat Shaw, (866) 764-1212 ext. 315 katshaw@redstonemediagroup.com Subscription Services Manager: Brittany Tufts, (866) 764-1212 ext. 115 brittany@redstonemediagroup.com CLASSIFIED ADVERTISING: Libby Sinden classified@IVCJournal.com US MAIL: IVC Journal, 6834 S University Blvd PMB 155 Centennial, CO 80122 CDN MAIL: IVC Journal, 202-160 Charlotte St. Peterborough, ON, Canada K9J 2T8. The opinions expressed in this journal are not necessarily those of the editor, and different views may appear in other issues. Redstone Media Group Inc., publisher of IVC Journal, does not promote any of the products or services advertised by a third party advertiser in this publication, nor does Redstone Media Group Inc. verify the accuracy of any claims made in connection with such advertisers.

IVCJournal.com

Subscribe to IVC Journal Today! For a limited time only, IVC Journal is available by subscription for FREE. To order your subscription please visit www.ivcjournal.com

IVC Journal (ISSN 2291-9600) is published four times a year by Redstone Media Group Inc. Publications Mail Agreement #40884047. Entire contents copyrightÂ© 2016. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: November 2016.

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

IVC Winter 2016

editorial

NEW YEAR ; A RENEWED

COMMITMENT I love the winter, the snow, and curling up by the fire to read. And come January, I like to take time review my life, both personal and professional. Perhaps you do too. Whatever your New Year’s resolutions might be, it’s always a good time for us to renew our commitment to improving the health of the animals in our practices, and to empowering clients to build the best possible relationships with them. Our Winter issue of IVC Journal can help you do just that. Dr. Evelyn Orenbuch provides great advice for utilizing technicians for the laser therapy part of your practice, and shares the benefits that arise from regular use of this modality. Terri Grow, owner of a healthy pet products business, discusses how partnering with your local stores can build both your businesses and improve the health of your patients. Thoracic ailments can be very challenging, and often prevent individuals from enjoying life and doing their “jobs”. Many riders, for example, have to curtail riding because pulmonary diseases like COPD prevent full performance. Dr. Huisheng Xie shows how TCVM can completely restore health so horses can function maximally. And while kennel cough in dogs is usually self-limiting, it can be prevented (and quickly resolved) with homeopathic and TCVM approaches. I show how these approaches can help physically reshape collapsing trachea in some dogs. Dr. Liza Schneider, meanwhile, uses integrative methods to stabilize serious thoracic ailments, and shows how with a hyberbaric oxygen chamber (HBOT), complete healing is possible in many unresponsive chronic conditions.

IVC Winter 2016

We know that good nutrition is the building block of health. Dr. Katie Kangas introduces us to the new approach of host modulation for oral health, using whole food diets and supplements. And although I have always said “no” to pelleted foods for horses, I was excited to learn from Dr. Madalyn Ward that extruded foods are different, and offer major health benefits for horses. I’ve long been intrigued by the potential healing of NAET, since any organ from the skin to the lungs can be affected by allergic reactions. Dr. Donna Kelleher documents how quickly some animals return to health thanks to NAET. Another serious ailment is Metabolic Syndrome in equines, and Dr. Cynthia Lankenau clarifies the condition and explains many successful modalities to treat it. May this issue bring you good reading – and more importantly, interest you in a few modalities that you can study further. Please share your holistic successes with us at IVCJournal.com and let me know of any topics you would like to see covered in future issues. Healthier patients and happier clients can improve your bottom line! Wishing you a happy and healthy holiday!

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

IVC Winter 2016

contributors

1. KATIE KANGAS, DVM, CVA, CVCP Dr. Katie Kangas owns and operates Integrative Veterinary Care in San Diego, California. She achieved her CVA certification at the Chi Institute in 2008, and followed with additional training in Advanced Acupuncture, Food Therapy, Herbal Medicine and Veterinary Orthopedic Manipulation (VOM). Her areas of interest include nutrition, dental health, and pain management. Dr. Kangas also lectures and writes and has worked as a shelter veterinarian for more than 15 years. She currently works part-time for the San Diego County Department of Animal Services, and previously served as full-time medical director for the San Diego Humane Society and SPCA. 2. DONNA KELLEHER, DVM Dr. Donna Kelleher graduated from Washington State University College of Veterinary Medicine with the Grady Young Scholarship for Acupuncture training with IVAS, and has practiced holistic veterinary medicine since 1994. She is also AVCA trained for chiropractic and her initial herbal training in the late 1990s came from AHG’s certification training. She became NAET trained by 2003 and integrated these modalities into her practice. Dr. Kelleher’s personal experiences with asthma, allergies, and an early exposure to diverse cultures greatly affected her openness towards holistic treatments. Her website, blog and social media case studies can be found at wholepetvet.com. 3. CYNTHIA LANKENAU, DVM, CVA, CVCHM, RH (AHG) Dr. Cynthia Lankenau received her DVM from Cornell University in 1981, and started studying alternative modalities in 1992. She is certified with the IVAS, AVCA and AHV, and in Chinese Herbal Medicine through the Chi Institute and CIVT. She is a registered herbalist through the American Herbal Guild and is currently working on CIVT’s Western Graduate Herbal program. She is Past President of the Veterinary Botanical Medicine Association, and owns a private integrative mixed practice. 4. EVELYN ORENBUCH, DVM, DACVSMR, CAVCA, CCRT Dr. Evelyn Orenbuch is a Diplomate of the American College of Veterinary Sports Medicine and Rehabilitation. She graduated from the Ohio State College of Veterinary Medicine in 1994; since 2003, she has focused on veterinary rehabilitation and pain management, completing additional specialized coursework and certificates in veterinary chiropractic and veterinary acupuncture. Dr. Orenbuch is a member of the American Association of Rehabilitation Veterinarians, the International Veterinary Academy of Pain Management, the American Canine Sports Medicine Association and the AVMA.

IVC Winter 2016

5. LIZA SCHNEIDER, BVSc Dr. Liza Schneider is the Creator & Director of Holistic Vets and Founding Trustee & Chairperson of ARRC Wildlife Trust. Born in South Africa, she moved to New Zealand and began her practice after qualifying as a veterinarian in 2000. She is President of the New Zealand Veterinary Associations’ Complementary Veterinary Medicine Branch. Dr. Schneider regularly presents seminars and international webinars on holistic animal healthcare, and is writing e-books on animal health and her adventures as a veterinarian. 6. MADALYN WARD, DVM Dr. Madalyn Ward graduated from Texas A&M University in 1980. After nine years of practice, four at her own Bear Creek Veterinary Clinic in Austin, she remained frustrated about many aspects of conventional medicine. In 1989, she started seeking out information and training in alternative healing. She is trained in Veterinary Homeopathy, Acupuncture, Bowen Therapy, Network Chiropractic and Equine Osteopathy. She has authored three books including Holistic Horsekeeping and Horse Harmony. Visit holistichorsekeeping.com and horseharmony.com. 7. HUISHENG XIE, DVM, PhD Dr. Huisheng Xie is a clinical associate professor of the Integrative Medicine Service at the College of Veterinary Medicine, University of Florida; and founder and president of the Chi Institute of Chinese Medicine, where over 3,000 licensed veterinarians have studied acupuncture, herbal medicine, and other TCVM disciplines since 1998. He has lectured around the world on veterinary acupuncture and herbal medicine. Dr. Xie has authored 12 books. His textbooks, including Xie’s Veterinary Acupuncture, Xie’s Veterinary Chinese Herbology and Traditional Chinese Veterinary Medicine: Fundamental Principles, have been used for TCVM training programs in many countries. 8. TERRI SYMONDS GROW, BIS Terri Symonds Grow is a speaker and author on integrative holistic health care and has a wealth of experience working with veterinarians, manufacturers and pet owners. She is the founder and president of PetSage, a retail, mail order and online holistic pet store based in Alexandria, Virginia (petsage.com). She completed her certification in Traditional Chinese Herbology in 2005, then completed the Advanced Veterinary Chinese Herbal Course through the Sydney Institute of Traditional Chinese Medicine in Sydney, Australia in 2007. Terri has a degree in international marketing and advertising. She is an affiliate member of the AHVMA and VBMA.

what’s new ANIMAL SIMULATORS ARE A GAME-CHANGER AT CORNELL The new Tetlow and Roy Park Veterinary Innovation Laboratory at Cornell University’s College of Veterinary Medicine is a trendsetter when it comes to how veterinary medicine is being taught. And it’s all thanks to its groundbreaking use of animal simulators. “The lab is the brainchild of Daniel Fletcher, a veterinarian and biomedical engineer…at CVM and Cornell’s Companion Animal Hospital,” writes Claudia Wheatley, senior public affairs officer at CVM. “He was fascinated with the computer-operated human simulators used to train medical students to address symptoms such as rapid heartbeat and labored breathing, [and] wondered why there weren’t animal simulators for veterinary students.” Six years ago, Fletcher bought a human simulator and used the parts to create a “smart” dog. “The simulators…primarily serve to play

out emergency scenarios,” says Claudia. “Teams of students go into a mock exam room where the robotic ‘patient’ awaits, preloaded with symptoms. They have about ten minutes to absorb the patient’s medical history and vital signs, respond to symptoms like a weak pulse or irregular heartbeat, and figure out the underlying cause.” Before long, this technology will be available to veterinary educators worldwide. “Fletcher and his team are creating a new software and hardware platform to drive veterinary simulators that will be available to educators around the world. The new platform will be open source, so users can make improvements and expand the system’s capabilities as they work with it.” news.cornell.edu/stories/2016/10/veterinarystudents-train-simulators-new-lab

HUMAN/ANIMAL BOND LEADS TO BETTER PET CARE “When people find out that pets improve heart health, decrease stress, help alleviate depression and address specific conditions that include autism, PTSD and Alzheimer’s, they become more focused on caring for their pet’s health.” This statement comes from Steven Feldman, the Executive Director of the Human Animal Bond Research Initiative Foundation, which recently worked with the American Animal Hospital Association to conduct a survey asking 2,000 pet owners how animals improve human health. The results showed that the more awareness people have of the benefits of the human-animal bond, the more motivated they are to provide quality care to their pets: Daniel S. Aja, DVM, Banfield’s Chief Medical Officer and Senior Vice President of Medical Operations, opens the report with an overview of the most significant findings: • 9 2% said they were more likely to maintain their animal’s health, including keeping up with preventive medicine. • 8 8% said they were more likely to provide their pets with higher quality nutrition. • 5 1% said they were more likely to purchase pet health insurance. • 6 1% would be more likely to visit the veterinarian if the latter discussed the health benefits of the human-animal bond with them. “More awareness of human-animal bond science improves veterinary care and leads to a healthier pet population,” says Feldman. aaha.org IVC Winter 2016

what’s new CANINE CANCER DETECTORS Dogs have a unique ability to aid in the detection of cancer, thanks to their powerful sense of smell, which can be up to 100,000 times more acute than a human’s. At Penn Vet Working Dog Centre, researchers are taking this phenomenon to the next level. Funded by a grant from the Kaleidoscope of Hope Ovarian Cancer Foundation, three dogs have been trained to harness their cancer-detection ability for the early detection of ovarian cancer, which otherwise often isn’t caught until its late stages. Using a wheel with 12 ports containing one malignant sample, benign and normal samples, and other random distractions, the dogs have been successfully trained to identify the malignant sample 90% of the time. The dogs at Penn Vet have learned to sniff out malignant samples on a 12-port wheel.

This research will allow experts to determine the unique odor signature of ovarian cancer in order to develop early detection technology. vet.upenn.edu

LAMENESS THE NUMBER ONE EQUINE HEALTH ISSUE During this year’s National Equine Health Survey (NEHS), 38% of horses were recorded as suffering from health problems. And of these, one-third (32.9%) were categorized as lame. Consistent with previous surveys, lameness was shown to be more likely caused by conditions such as osteoarthritis in the limb, rather than problems in the foot. It was also seen as the most common syndrome affecting horses. A breakdown of the types of lameness revealed that 47.4% were suffering from proximal limb lameness (the limb above the foot); 31.9% from causes of foot lameness other than laminitis; and 20.7% from laminitis. Degenerative joint disease (including foot and proximal limb) was the most frequently reported single cause of lameness (41.2% of all lameness). The most frequently reported joint affected by DJD was the hock (15.3% of all lameness). Blue Cross carries out the NEHS each year in partnership with the British Equine Veterinary Association (BEVA). This year saw a 14% increase in participation compared to 2015, with survey records returned for almost 16,751 horses, ponies, donkeys and mules, and with 5,635 people taking part. bluecross.org.uk/nehs2016results

IVC Winter 2016

DISCOVERY OF NEW BACTERIA CONNECTED TO SALMON POISONING IN DOGS Researchers at Oregon State University have identified another bacterium that can cause symptoms similar to “salmon poisoning” in dogs. Called “SF agent”, this bacterium has been found for the first time in a salmonid fish, researchers report in a recent study in Veterinary Parasitology. The ﬂuke host for this bacterium is Stellanchasmus falcatus. “SF agent can infect dogs that eat salmon or trout, and it can cause a mild fever in dogs and other symptoms that can resemble salmon poisoning,” said Michael Kent, a professor of microbiology in the OSU College of Science and College of Veterinary Medicine, and co-author of the study. “It can also be treated with antibiotics, but may not offer immunity to dogs that could be later exposed to the actual salmon poisoning bacterium [Neorickettsia helminthoeca]. A pet owner might believe their dog is protected, when it isn’t.” oregonstate.edu/ua/ncs/archives/2016/nov/discovery-newbacteria-complicates-problem-salmon-poisoning-dogs

EDITOR’S NOTE In the article “Noni fruit – food for health” by Dr. Ihor Basko (IVC Journal, Fall 2016), we mistakenly featured a photo on page 36 that is not a Noni plant. Our apologies for the error.

IVC Winter 2016

nutrition nook

INTEGRATIVE AND NUTRITIONAL SUPPORT FOR ORAL AND DENTAL HEALTH By Katie Kangas, DVM, CVA, CVCP

It is well known that oral and dental health significantly affects overall systemic health in both animals and humans.1,2 Simply put, chronic disease in the mouth is a constant source of chronic inflammation and bacteria impacting the rest of the body. It is also important to note that periodontal disease is the single most common problem diagnosed in small animal patients.3,4 Yet oral disease is often overlooked when addressing chronic systemic disease. As integrative practitioners, it is extremely

important that we recognize these facts when evaluating and treating our patients. It’s also vital that oral and dental health be considered when promoting preventative health and wellness.

INTRODUCING HOST MODULATION In the interest of integrative and proactive health, host modulation is an exciting new treatment approach in periodontal therapy for humans and animals.3 The term “host modulation” implies supporting the host (i.e. the whole patient) to control the body’s response to inflammation and infection. This is important because although plaque is considered the etiologic agent of periodontal disease, it is actually the body’s response to the plaque (i.e. the ensuing inflammatory cascade) that ultimately leads to periodontal disease and resultant bone loss, etc. If the acute inflammatory response can be resolved quickly, tissue injury is prevented; conversely, inadequate resolution and failure to return the tissues to homeostasis results in chronic inflammation and eventually periodontal disease. There are many options available to affect host modulation and assist the body’s ability to combat gingival and general inflammation. Not surprisingly, supporting oral health starts with the same foundation as general health – i.e. diet and nutrition.

DIET AND NUTRITION Diet and nutrition choices are paramount to overall health, including dental health. Although most of us were taught to believe that dry pet foods are beneficial to dental health, this has been disproven in specific studies.4 In fact, most kibble is too small to require any chewing action, and even when chewed it provides minimal cleaning of calculus (tartar) and only on the incisal tips of the teeth. In other words, chewing kibble does not promote cleaner teeth at the gumline, where it really matters. The myth about dry pet foods being good for dental health stemmed from the belief that tartar was the best indicator to assess the levels of oral disease. It is now known that

IVC Winter 2016

gingival inflammation is a more accurate indicator. Beyond the fact that dry foods do not provide a mechanical “cleaning” benefit, they are also heavily processed via extrusion methods (high heat and pressure). Heavy processing creates AGEs (Advanced Glycation End Products), which are known to be pro-inflammatory. This means that heavily processed foods actually fuel inflammation in the body, including the mouth and oral tissues. Consequently, un/low-processed, species-appropriate diets can be a critical piece of overall wellness, as well as oral health and general resistance to chronic inflammation. There is speculation that raw foods contain enzymes that also help with resistance to bacterial plaque, but this has not been proven in studies. Raw meaty bones do provide an active chewing and gum-cleaning advantage. Cooking bones makes them more brittle, which creates the danger of potential splintering and GI perforation. Another concern regarding bones in general is the risk of damaging or breaking teeth. Veterinary dentists report that large raw bones, such as marrowbones, rarely cause broken teeth – unlike small, thin long bones and similar-shaped objects, which are common culprits in tooth damage. This has to do with canine oral anatomy and the physics of mastication as the dog’s teeth are positioned against the object being chewed. Larger bulky objects do not create the same angle and force on the carnassial teeth as do smaller and longer objects. In fact, common items found to break teeth are nylon bones, cooked bones, antlers, hooves, and bully sticks. In addition to the impact diet type has on oral health, various nutrients and nutraceuticals can help modulate both oral and systemic inflammation.

ANTIOXIDANTS Recent studies have linked chronic oxidative stress with periodontal disease.5 Oxidative stress can be defined as free radical damage to the body’s cells and tissues. In fact, proper equilibrium between free radicals and antioxidants is now thought to be the main prerequisite for healthy periodontal tissues. As such, antioxidants can play an important role in periodontal health, and offer protective benefits.6 Numerous nutritional products are available for increasing antioxidant capacity. These can range from vitamin supplementation (such as vitamins C and E)7,8 preferably from food-based sources as opposed to synthetic vitamins; to specific products providing a more effective increase in total antioxidant capacity. In regards to systemically increasing antioxidant capacity, many recent studies have evaluated the Nrf2 pathway and its tremendous benefits to overall health. Nrf2 is a messenger protein that triggers a natural pathway in the body to stimulate the body’s own antioxidant production. These indirect internally produced antioxidants (vs direct, food-based, externally sourced antioxidants) include very powerful enzymes such as glutathione, superoxide dismutase (SOD) and catalase. These indirect antioxidants are known to be highly protective against free radicals and in reducing oxidative stress.9,10 Stimulating the Nrf2 pathway to create increased production of powerful antioxidants such as glutathione and SOD has benefits for periodontal disease (as well as more than 200 other diseases that have been linked to oxidative stress). A natural plant-based product with a canine specific formulation IVC Winter 2016

Figure 1: How oxidative stress impacts organ systems.

Illustration created by Katie Kangas and Milton Yi. Image from original article by same author.22 Used with permission of AHMVA.

(Canine Health, LifeVantage; the human product version is also used in dogs, cats and horses), has shown the ability to effectively increase the bodyâ&#x20AC;&#x2122;s production of indirect antioxidants.11,12

OTHER NUTRACEUTICALS Recent studies on the use of fatty acid supplements have shown beneficial results for periodontal inflammation.13-18 The anti-inflammatory actions of Omega-3 fatty acids are widely known for their joint benefits, but they have also been shown to support periodontal, heart, kidney and brain health too. Furthermore, due to the high epithelial penetration of fatty acids, topical application appears to be very useful in the treatment of local oral inflammatory diseases, including periodontitis. In particular, 1-Tetradecanol Complex is an esterified monounsaturated fatty acid that has shown very positive effects when applied topically to the gingiva. Studies (in rabbits) demonstrated that it stopped the progression of periodontal disease and resulted in a significant reduction in periodontal inflammation, attachment and bone loss.14,15 In addition, histologic assessment found that it inhibited inflammatory cell infiltration and osteoclastic activity. This product (1-TDC, Elite Science) offers a proactive approach to support host resilience to inflammation, therefore minimizing progression into the periodontal disease cycle. (It is worthwhile to note that 1-Tetradecanol Complex also has a high affinity for joint and muscle/tendon/ligament tissues and is delivered to those tissues systemically after oral absorption or ingestion). A deficiency of Coenzyme Q10 has been found in human patients with periodontal disease,16,17 and supplementation of CoQ10 (both systemic and topical) is shown to have beneficial effects on periodontal health.17-19 Ubiquinol is the bioactive form of CoQ10 and is therefore the preferred form to use as a dietary supplement. Folic acid is another nutrient studied for its effects on oral health, such as preserving gum tissue and

IVC Winter 2016

Figure 2: Internal vs. external antioxidants.

Recreated from image provided courtesy of Joanne Shearer Parkin, MS, RDN. Graphic design by Milton Yi. Image from original article by same author.22 Used with permission of AHVMA.

reducing the incidence of gingivitis and periodontitis.18 In some patients, such as small breed dogs that are prone to periodontal disease, it may be beneficial to provide specific nutrients to support oral bone, connective tissue and immune system. One veterinary-labeled product (Standard Process VF-Biodent) has been designed to provide specific nutrients to support oral health.

PROBIOTICS The benefit of probiotics in supporting both gastrointestinal health and overall immune system function is a subject of growing focus. The mouth and oral cavity are part of the gastrointestinal tract. Furthermore, the bodyâ&#x20AC;&#x2122;s microbiome plays a critical role in systemic immune system function and in chronic inflammation. Recent information supports the use of probiotics both orally and topically to support oral health. Canine and human studies report significant results, with reduced probing depth of periodontal pockets and decreased periodontal inflammatory mediators, using orally ingested and topically applied probiotics.19 Topically applied beneficial bacteria will form colonies that create a healthier biofilm in the mouth and thus help crowd out the bacteria that cause the harmful inflammation leading to periodontal disease.

ACTIVE PLAQUE REMOVAL It would be remiss to not cover one the most effective proactive methods of supporting oral health, which takes us back to the basics of plaque removal. Regular professional dental cleanings are extremely helpful if they are done properly and performed with the patient under general anesthesia. It is estimated that 60% of oral pathology is located under the gumline, which means an awake exam (or attempt at cleaning) will miss the majority of disease problems. General anesthesia is required to perform a complete oral exam and to obtain dental x-rays to find pathology and address it.20, 21 Continued on page 18.

IVC Winter 2016

Continued from page 16. The most effective way to achieve plaque removal via home care is with the mechanical action of regular tooth brushing.20 The product used on the toothbrush is not as important as the mechanical action of disrupting (wiping away) the plaque biofilm.

Coconut oil has antimicrobial properties, and when used on the gums it helps draw out toxins.

That said, a few natural products that can be helpful when applied directly on the gums or used on a toothbrush include coconut oil and/ or therapeutic grade essential oils. Coconut oil is rich in MCTs and lauric acid, making it antimicrobial in its own right, but it has also been shown to help draw out toxins when used on the gums (most notably with the process of “oil-pulling”, which is becoming increasing popular in human health care). Many essential oils (EOs) are known to be antimicrobial, anti-inflammatory, pain-relieving and/or specifically beneficial for oral tissues and mucus membranes. Medical literature supports the use of several different EOs for treatment of oral diseases. This list includes clove, lemon, orange, basil, eucalyptus, tea tree, myrrh and copaiba. It is important to note that only therapeutic grade oils from reputable manufacturers should be employed. Even with pure EOs, caution must be used with proper dilution, depending on the specific use, route of application, species and size of the patient. Most EOs should be diluted with fractionated coconut oil or other carrier oil, and proper references should be consulted for safe dosing and application techniques. A particular EO blend formulated specifically for gingival application to support oral health in dogs and cats (Dog Breath from animalEO) contains fractionated coconut oil, copaiba, peppermint, helichrysum and myrrh.

It can be expected that many pet owners are not likely to perform active dental care for their pets on a daily basis, but they are certainly more likely to make the effort if they are educated about the significant benefit it can provide to their pets’ quality of life (especially small breed dogs!). If more pet parents truly understood how much this daily routine could impact the health and longevity of their pets, compliance rates would be much higher.21

CONCLUSION Current knowledge regarding the impact of periodontal disease on systemic health, and the role chronic inflammation plays in the progression of illness, has made it clear that maintaining a healthy mouth is a vital part of supporting whole body health and wellness. As integrative veterinary practitioners, it is important to recognize the value of educating pet parents about proactive options that promote better oral health for their dogs and cats.

Niemiec BA. “Local and regional effects of periodontal disease”. Veterinary Periodontology, Niemiec BA, Ed., Jon Wiley and Sons, 69-80, 2012.

Bogaard HJ, Natarajan R, Henderson SC, et al. “Chronic pulmonary artery pressure elevation is insufficient to explain right heart failure”. Circulation. 17;120(20):1951-60, 2009.

Niemiec BA. “Systemic manifestations of periodontal disease”. Veterinary Periodontology, Niemiec BA, Ed., Jon Wiley and Sons, 80-91, 2012.

Kesavalu L, Vasudevan B, Raghu B, et al. “Omega-3 fatty acid effect on alveolar bone loss in rats.” J Dent Res. 85:648-652, 2006.

Niemiec BA.“Host Modulation Therapies”. Veterinary Periodontology, Niemiec BA, Ed., Jon Wiley and Sons, 299-304, 2012.

Harvey CE, Shofer FS, Laster L. “Correlation of diet, other chewing activities, and periodontal disease in North American client-owned dogs”. J Vet Dent. 13: 101-5, 1996.

Hasturk H, Goguet-Surmenian E, Blackwood A. “1-Tetradecanol complex: therapeutic actions in experimental periodontitis”. J Periodontol. 80(7):1103-13, 2009.

Dahiya P, Kamal R, Gupta R, Puri A. “Oxidative stress in chronic periodontitis”. Review Article, Chronicles of Young Scientists. 2(4):178-81, 2011.

Hasturk H, Jones VL, Andry C, Kantarci A. “1-Tetradecanol complex reduces progression of Porphyromonas gingivalis-induced experimental periodontitis in rabbits”. J Periodontol. 78(5):924-32, 2007.

Pavlica Z, Petelin M, Nemec A, et al. “Measurement of total antioxidant capacity in gingival crevicular fluid and serum in dogs with periodontal disease”. Am J Vet Res. 65 (11)1584-8, 2004.

Littarru GP, Nakamura R, Ho L, Folkers K, Kuzell WC. “Deficiency of coenzyme Q 10 in gingival tissue from patients with periodontal disease”. Proc Natl Acad Sci U S A. 68(10):2332-5, 1971.

Parrish JH Jr, DeMarco TJ, Bissada NF. “Vitamin E and periodontitis in the rat”. Oral Surg Oral Med Oral Pathol. 44(2):210-8, 1977.

W ilkinson EG, Arnold RM, Folkers K, Hansen I, Kishi H. “Bioenergetics in clinical medicine. II. Adjunctive treatment with coenzyme Q in periodontal therapy”. Res Commun Chem Pathol Pharmacol. 12(1):111-23, 1975.

Stein GM, Lewis H. “Oral changes in a folic acid deficient patient precipitated by anticonvulsant drug therapy”. J Periodontol. 44(10):645-50, 1973.

Kim JE, Shklar G.“The effect of vitamin E on the healing of gingival wounds in rats”. J Periodontol. 54(5):305-8, 1983.

H ybertson BM, Gao B, Bose SK, et al. “Oxidative stress in health and disease: the therapeutic potential of Nrf2 activation”. Mol Aspects Med.32:234-6, 2011.

Lee JK, Kim SJ, Ko SH, Ouwehand AC, Ma DS. “Modulation of the host response by probiotic Lactobacillus brevis CD2 in experimental gingivitis”. Oral Dis. 2015 Sep;21(6):705-12. Epub 2015 Apr 20.

Hale FA. “Home care for the veterinary dental patient”. J Vet Dent 20(1) 52-4, 2003.

D avis K. “Understanding antioxidants: using various arsenals to impact the oral environment”. Dent Today. 31(11):92, 94, 96-7, 2012.

iggs RB, Lobprise HB. Periodontology, in Veterinary Dentistry, Principals and Practice. Philadelphia, PA, W Lippincott – Raven, 1997, pp 186-231.

N elson SK, Bose SK, Grunwald GK, Myhill P, McCord JM. “The induction of human superoxide dismutase and catalase in vivo: a fundamentally new approach to antioxidant therapy”. Jan 15;40(2):341-7, 2006.

K angas, K. “A review of oxidative stress and the NRF2 pathway”. Review Article, Journal of the American Holistic Veterinary Medical Association. 44:8-13, 2016.

IVC Winter 2016

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?

The trillium (Trillium ovatum) is a protected plant and one of our early spring flowers. Its common name is “Beth root”. It grows in old stands of forest, and its habitat is severely restricted today. Trillium was used intensively in the 1800s and into the 1900s for threatened abortions due to vascular engorgement; endometrial bleeding; hemorrhages from mucus surfaces; and as a strong parturient (it increases contractions at birth and promotes contractions in a stalled labor). Trillium has been called birthroot because it lessens the pains and difficulties at time of delivery. It is considered by some to be specific for female weakness, good for prolapses, excessive discharges, hemorrhages and various other female complaints. This herb illustrates the need to protect plants that are endangered. Join United Plant Savers (unitedplantsavers.org)!

CASE REPORT Susie is an old saddlebred mare with a history of slow ineffectual labor. Her last two foals were stillborn, after long slow labor. Homeopathic Trillium 6C was given hourly when Susie started dripping milk, and in three hours she had a normal foal delivery.

DOMESTIC ECO-TOUR UPDATE In June 2016, 30 VBMA members, teachers and companions reveled in the majestic rainforest of Washington State’s Olympic Peninsula. We were up early to greet the grandmother of trees, the world’s largest Sitka Spruce. It was moving to be in the presence of this immense tree as a start to our official Eco-tour.

heal all, twisted knotweed, clasping twisted stalk, false lily of the valley, youth on age, liverwort, Indian plum, pearly everlasting, and more. Dr. Donna Kelleher is a vibrant and knowledgeable herbalist and it was a true joy to spend time in the woods with her. Dr. Liz Hassinger held a workshop on making teas and tinctures, which was followed with a discussion on how to open our hearts and mind to plants. Our last day was filled with mushrooms! After a talk on the most common mushrooms seen in the Pacific Northwest, and their healing abilities, we had an incredible walk with Dr. Ihor Basko and his wife, Jane, sensing, finding, feeling and experiencing mushrooms. This was a totally satisfying trip; a perfect blend of personal peace and tranquility in the forest, a secluded almost exclusive location with great herbal information, and the awesome camaraderie of fellow veterinarians and families.

TELECONFERENCES An upcoming teleconference is being planned with Greg Tilford; please consult vbma.org for more information. All past teleconference are available for sale on the VBMA website.

NAME THIS HERB!

Hana Jordan spoke on the intelligence of the heart and the health benefits seen when using this knowledge in daily life; this was followed by a discussion on nervines, including Bacopa. Our afternoon was filled with hiking in the rainforest, filling ourselves with berries (salmon, thimble and huckle) as we met a huge variety of plants: hedge nettle, devil’s club, foxglove, salal, cleavers, bleeding heart, Scouler’s corydalis, Douglas fir, ferns (bracken, deer, sword, licorice, lady, and maiden), cascara, angelica, field bindweed, elder, dock, trillium, usnea, wild ginger,

IVC Winter 2016

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

IVC Winter 2016

tech talk

By Evelyn Orenbuch, DVM, DACVSMR, CAVCA

rehabilitation 22

IVC Winter 2016

Photo courtesy of Litecure

Lasers in canine physical

BOTH CLASS III AND CLASS IV LASERS HAVE IMPORTANT APPLICATIONS IN PHYSICAL REHAB FOR DOGS, BUT PROPER TRAINING IN THE USE OF THIS THERAPY IS ESSENTIAL, BOTH FOR VETERINARIANS AND TECHNICIANS. My personal experience with lasers in veterinary physical rehabilitation began in 2005 with a 250mW laser used in my mobile rehab practice. At the time, any laser from 5mW to 500mW was considered Class III and was often referred to as a “cold laser” because it could be held in one spot during treatment and not heat the tissues enough to cause damage. Class IV was any laser producing more than 500mW of power. At this higher level, the laser heats the tissues and can cause damage if held in one area too long. It is important that anyone using the laser be properly trained in how to administer the therapy, and that they know animal anatomy.

INTRODUCING CLASS IV LASER TO MY CLINIC In 2011, I moved to the Atlanta area and opened a large rehabilitation-only clinic. In this rehab-dedicated facility, I began seeing a larger and more diversified caseload than I had in my prior traveling practice. I was also able to take advantage of trained veterinary technicians and assistants to treat cases, a luxury I did not have previously. Hoping to speed treatment times and make my technicians more efficient, I purchased a Class IV laser. I quickly began to notice clear differences in case results as the Class IV laser was integrated into treatment plans. I noticed that patients who had been regulars, coming every four to six weeks with consistently good results, were showing great improvement with the Class IV laser.

my travelling practice. Many practices use Class III lasers with good success as well. Proper diagnosis and dosing are the keys to effective treatment. Today, I use two Class IV lasers for treatment within the practice, and rent two Class III lasers to clients who need more intensive but usually more superficial daily dosing.

TREATMENT PLANS FOR DIFFERENT INJURIES AND CONDITIONS Typically, at our clinic, we see approximately 30% orthopedic (post-op CCL repairs, Fx repairs, osteoarthritis), 30% geriatric (osteoarthritis, soft tissue strains and sprains, back pain, weakness), 30% neurologic (DM, IVDD, FCE, etc), and10% sports medicine (maintenance for competition in healthy dogs, soft tissue sprains and strains). If we think about the goals of physical rehabilitation, every one of these cases could benefit from laser. Below, I describe the typical treatment for each type of case. It is important to note that every case is different, and managing and changing the plan along the way based on results is important. Physical rehabilitation should not be a cookbook type of medicine in which every case with the same general problem gets the same treatment. Every patient will progress differently. Continued on page 24.

Any laser therapy should be doctor prescribed but technician driven. There should always be good communication between the doctor and technician about what condition the doctor wants to treat, the reasons for the treatment (pain relief, improving circulation, decreasing inflammation, speeding up healing), the anatomic area(s) to treat (with landmarks clearly defined or previously discussed), as well as any special techniques or other conditions to be aware of for that particular patient. In this way, the technician can always update the doctor on any changes between “recheck examinations” that may require the doctor’s attention. Empowering the technicians so they feel comfortable communicating any challenges they encounter is also critically important. Following the recommendations of the laser company, we often treated patients two or three times per week for a total of six to eight treatments. Some of the improved outcomes I was seeing with the Class IV laser may have come from the increased dosing, as I had not been able to dose that way in IVC Winter 2016

Continued from page 23.

OST-OP P If the incision is still healing, laser with a wound setting directly over the incision. Then laser over the area of surgery two or three times a week for a total of six to eight sessions, making sure to reassess at least every two or three weeks. Often, we need to continue the laser over a surgical area if the patient is still having pain or is healing slowly. As these cases heal, we also sometimes find that they have other areas of pain due to compensations (back pain, hip pain, pain in the other limbs). These areas can also be lasered once or multiple times if needed.

OSTEOARTHRITIS

We start with two or three times a week for six to eight sessions and then find a maintenance plan. We are seeing most dogs every four to six weeks for a recheck during which we may do acupuncture and/or chiropractic; typically, the laser will also be part of that exam. In some cases, patients will also come in between rechecks for a laser-only session with a trained technician, so they are getting lasered every two or three weeks for maintenance. Importantly, the technician has more “face time” with the client when administering the therapy. This is advantageous because it provides the client with time to share details about the animal’s progress or changes observed at home, and to ask questions in a relaxed and unrushed environment. The technician can educate the client on the modality itself, or address other questions or concerns about the treatment plan.

GOALS OF PHYSICAL REHAB AND HOW THEY RELATE TO LASER TREATMENT We need to remember the goals of any veterinary physical rehabilitation case: • Increase range of motion (ROM) • Decrease pain • Increase strength and mobility • Improve proprioception

Technicians can be easily trained to evaluate these goals, along with questioning the clients on how their animals act at home. For instance, a bicep tenosynovitis and a medial shoulder instability will both look like front limb lameness but are treated with different laser protocols and positions. Importantly, the laser alone does not define veterinary physical rehabilitation. Laser is only one aspect of the multi-modal approach required to truly offer veterinary physical rehabilitation. There has been quite a bit of literature over the past 20 years about lasers and their effects on the human and animal model, with the most literature being published in the past five years. We know that lasers reduce COX-2 mRNA expression, therefore reducing pain and inflammation.1 We also know that lasers promote increased circulation.2,3 There have been several studies showing cell regeneration including neurons.4,5,6 All these aspects are important in the goals of physical rehabilitation but they do not accomplish everything. We still must put the joints through ROM and work on strengthening and proprioception through therapeutic exercises. Laser will help us reach these goals, but laser alone will not accomplish it. They both feel as though they are part of the “team” in caring for the patient. Having the opportunity to communicate and educate owners in this environment is unique; and allowing owners to see that their pets are calm and relaxed, and often fall asleep during therapy, reassures them that the treatment is not stressful.

Photo courtesy of Litecure

SPRAINS AND STRAINS

One of the most common and difficult-to-address issues we see in this category is the iliopsoas strain. Those affected can be sport competition dogs, active pet dogs, any patient that slips on ice or hardwood floors, or hip dysplasia patients with or without OA. Patients with hind limb pain should always be assessed by the veterinarian for iliopsoas pain, both at the insertion and origin of the muscle. Suspected muscle or tendon strains can be confirmed with musculoskeletal ultrasound. Once confirmed, we typically

IVC Winter 2016

have our technicians laser one to three times a week, following the entire length of the muscle as well as the dorsal lumbar and sacroiliac joints (SIJs), until the veterinarian finds no more pain when palpating in this area during assessments every two to three weeks. In addition, we have the patients spend several weeks in an active rest mode. They are allowed short (ten to 15-minute) walks two to four times a days. We do not stretch the muscle at first. We give it time to repair. Chiropractic or joint mobilizations around the SIJ, as well as acupuncture, are also imperative to healing. Soft tissue can take longer than bone to heal, so it is important to discuss with the owner that the process may take four to six months, or may even become a chronic waxing and waning situation, as is often seen in cases of severe OA and hip dysplasia. Once the patient is mostly healed, we will start back with UWTM, light stretching and later strengthening to finish off the process and help prevent a recurrence of the injury.

NEUROLOGIC â&#x20AC;&#x201C; DEGENERATIVE MYELOPATHY

In the literature and in our experience, the typical time from the first signs of DM until paralysis occurs is approximately one year, give or take three months.7 The only proven effect IVC Winter 2016

Training and correct use are ESSENTIAL

One of the reasons I resisted the use of Class IV lasers is because I knew many of my colleagues were misusing them. They had been wooed into purchasing this new and exciting toy, but had not been properly trained nor correctly trained their staff in the use of Class IV lasers. Animals were getting burned in some cases, but more importantly, there were no proper diagnoses made. There would be a diagnosis of general lameness without specifically determining the problem, and the technician would be directed to laser an entire limb, something much more easily done with a Class IV than a Class III. In some cases, this worked, but in many cases the core problem was not addressed. The patient might have needed a different area of focus or an additional treatment modality. A proper diagnosis, continued re-assessment, and correct application are the most important parts in utilizing this very powerful tool as part of the physical rehabilitation practice.

any other post-op condition as described earlier. However, with the new information coming out about high dose laser in DM, one must wonder if we should be increasing our dosages to get into the spinal cord enough to make a more significant change. These cases often have areas of pain due to compensations and overuse. Therefore, we also laser over any areas of pain not at the site of injury in the spinal cord, as needed, up to two or three times a week. Whether your practice has a Class III or Class IV laser, you have a very valuable tool at your fingertips. But it’s only as good as the training you and the doctor have received in its use. There are many laser training programs available along with continuing education lectures at various conferences. Adverse reactions with Class IV lasers are almost exclusively caused by improper use from a lack of training and/or understanding of the laser or animal anatomy. Used appropriately, Class IV lasers are safe and very effective.

on DM has been intensive rehabilitation. In a study published in 2006, researchers using physical rehabilitation were able to extend survival time by as much as 200 days in dogs with DM, when compared to dogs who did not receive physical rehabilitation.8 There have been many anecdotal cases of herbs, supplements, and various other treatments that have helped, but no one has been able to show a consistent response that changes the long term outcome of paralysis in approximately one year. We have had good success with electroacupuncture, herbs and intensive physical rehabilitation in improving the quality of life in dogs with DM, and possibly extending the length of time to paralysis to the end of the range. However, a study that is currently still underway has made some preliminary findings that are expected to be published soon: the study is looking at high dose laser (30J/cm2) two times a week on dogs with DM. This is approximately five to six times the typical laser dose for most conditions. So far, the researcher has seen more than 16 dogs continue to ambulate for two years and beyond. In this early study, the researcher is still continuing with regular intense rehabilitation. This is quite promising and we look forward to the published results.

5 26

P ianti AC Jr, Silva JA Jr, Dos Santos RF, et al. “Low-level laser therapy (LLLT) reduces the COX-2 mRNA expression in both subplantar and total brain tissues in the model of peripheral inflammation induced by administration of carrageenan”. Lasers Med Sci. 2014 Jul;29(4):1397-403.

L arkin KA, Martin JS, Zeanah EH, et al. “Limb blood flow after class 4 laser therapy”. J Athl Train. 2012 MarApr;47(2):178-83.

K ubora J. “Effects of diode laser therapy on blood flow in axial pattern flaps in the rat model”. Lasers Med Sci. 2002;17(3):146-53.

Anders JJ, Moges H, Wu X, et al. “In vitro and in vivo optimization of infrared laser treatment for injured peripheral nerves”. Lasers Surg Med. 2014 Jan;46(1):34-45.

A lacantrara CC, Gigo-Benato D, Salvini TF, et al. “Effect of low-level laser therapy (LLLT) on acute neural recovery and inflammation-related gene expression after crush injury in rat sciatic nerve”. Lasers Surg Med. 2013 Apr;45(4):246-52.

Kostek MC, Delgado-Diaz D, Gordon B.“High powered laser therapy enhances muscle healing”. Poster presented at Amer Coll Sports Med Annual Meeting, June 2013.

NEUROLOGIC – IVDD AND FCE

Typically, we have been lasering directly over the area of spinal cord injury two or three times a week, as with

IVC Winter 2016

Coates JR, Wininger FA. “Canine Degenerative Myelopathy”. Vet Clin North Am Sm Anim Pract. Sept 2010;40(5):929-50. K athmann I, Cizinauskas S, Doherr MG, et al. “Daily controlled physiotherapy increases survival time in dogs with suspected degenerative myelopathy”. J Vet Int Med 2006;20:927-932.

IVC Winter 2016

NAET

Nambudiprad’s Allergy Elimination Technique combines aspects of various modalities, including acupuncture and kinesiology, to identify allergens and resolve allergies in dogs and cats. By Donna Kelleher, DVM

I 28

was introduced to the world of NAET by way of a cat named Chloe who had skin allergies. Using herbs and acupuncture, I definitely helped her, but every time we tried to extend the time between treatments, she relapsed. Her bright red itchy patches returned, though less prominently than before.

immune system. However, I stored the information along with my future NAET practitioner’s business card (given to me by Chloe’s person) for several years. Chloe moved to California, and my own asthmatic condition degenerated to the point where any exposure to cats set me off – a tough position for a veterinarian to be in.

One day, her person showed me her own elbow and forearm, and announced they were clear of eczema for the first time in ten years. She said it was thanks to NAET, and described the treatment to me. At the time, I chuckled as I thought of how muscle testing and energy could possibly transfer from a glass vial into the core of a subject’s

I finally began seeing Dr Chiong in the summer of 1997, after many nights of coughing and wheezing. I experienced a healing crisis after my first treatment for egg allergen, with dry heaving off and on for a few hours; but I knew that something had shifted deep within my immune system.

IVC Winter 2016

Photo courtesy of Dawn Cumby-Dallin

Using to treat animal allergies

Basic principles and uses of NAET NAET (Nambudiprad’s Allergy Elimination Technique) is an energetic method combining techniques from chiropractic, acupuncture, nutritional, and kinesiological modalities to identify individual allergens and resolve allergies. For each allergen, specific association points along each side of the spine are stimulated, along with acupuncture, to open the immune gates. Immune-mediated diseases are often a result of allergies. When the body is reacting to pervasive allergens, it cannot be available to respond to infections and often begins to become allergic to itself. By resolving these allergic reactions with NAET, the immune system shifts back to normal function. Common allergy symptoms or conditions I treat with NAET include: • Itchy skin • Digestive problems • Ear infections

An overview of the technique

the specific allergens affecting the individual are 1 First, identified through applied kinesiology (see sidebar on page 55 of IVC Journal, Summer 2015). When working with animals or human infants, a surrogate is used. The surrogate is most often the animal’s guardian. A technician is also acceptable. The surrogate holds a small glass vial of a potential allergen, consisting of water and the allergen’s energetic vibration. These vials can be purchased from the NAET office in California after completing the training. You can make your own samples by placing very tiny amounts of the substance in a glass vial. With one hand, the surrogate holds the vial in direct contact with the pet and extends her free arm towards the practitioner. The surrogate is asked to keep lifting the arm with even, upward pressure as the practitioner gently pushes the arm down. If the surrogate’s arm becomes weak under gentle downward

Immune-mediated and other diseases that respond well to NAET include: • Epileptic seizures • Inﬂammatory bowel disease (IBD) • Masticatory muscle myositis (MMM) • Canine onchodystrophy • Aural vasculiits • Syringomylia in King Charles spaniels • Granulomatous meningoencephalitis (GME) in small breed dogs Using NAET, one can explore other potential allergens like minerals, vitamin A, foods, etc. The single best reason to use NAET over blood testing or saliva testing is that food allergies and triggers change depending on the immune system’s strength. Using the clearing technique, the veterinarian can recognize this with muscle testing before symptoms reflect the shift. When a food allergen has become a problem, NAET can detect it before symptoms get out of control; prevention is the focus, either by shifting the diet to avoid that food or by directly treating the food. IVC Winter 2016

LET GO OF

PRECONCEIVED NOTIONS

Muscle testing for NAET requires working on your ability to step aside from your ego and preconceived notions, and to step into the world of feeling for energy shifts. This was very difficult for me at first because I have always been taught to use my brain over my intuition. In essence, everyone can do NAET if he or she can approach the therapy with a light heart, forgiving oneself for mistakes or misconceptions, diving a bit into the unknown, feeling for and grabbing hold of the deep vital force that heals our patients.

pressure, this indicates sensitivity to the allergen in the vial. This sequence is repeated with several allergens. Some practitioners have learned ways of testing using their fingers, thus eliminating the need for surrogates (Khalsa, Deva Kaur. â&#x20AC;&#x153;NAET, allergies and the immune systemâ&#x20AC;?, Proceedings AHVMA, 1998, p. 126+) I have decreased the time this process takes by simply holding the kit open and touching each allergen myself while performing muscle testing with the surrogate. Within about five minutes, I can obtain a list of allergens specific for that day. second step is the allergen clearing process. The 2 The glass vial containing the identified allergen is secured to a collar-like band around the petâ&#x20AC;&#x2122;s neck. The vial must stay in contact with the patient for approximately 20 minutes. With the vial still in contact, the practitioner then uses massage along the spine of the animal, firmly tapping each of the back association points from neck to sacrum. Acupuncture or acupressure is also used during the treatment to open the immune gates or points. Allergens can be eliminated one at a time. After ten to 20 minutes of clearing, the animal is re-tested to see if the allergen has cleared. animal must avoid the specifically cleared allergen 3 The for 25 hours following treatment. Only one allergen is cleared per visit, using this system. During the next appointment, the original allergen is rechecked to make

IVC Winter 2016

sure it cleared, then the next one is addressed. For more advanced practitioners, in some situations, one can boost an old allergen but then continue to the next one. There is a protocol to doing this which varies a little from a standard clearing. Appointments can be done twice weekly or spread up to one month apart depending on the wishes of the client and the severity of the symptoms.

Repeating treatments The results and number of repeated NAET treatments needed to resolve the allergens are dependent on: • Length of time the animal has been affected by the allergies • Exposure to electromagnetism, radiation and chemicals • Accuracy of muscle testing • General health status of the animal – young animals resolve very quickly without relapse • Quality of nutrition • Tenacity of the owner regarding treatment In an integrative practice, we can offer many different approaches, often combining several. I like to blend herbal

therapies with NAET, thereby increasing the effectiveness of the herbs. If eating a particular food generates maximum inflammation, then the herbs are not as effective because they are up against a daily deluge of inflammatory mediators. But if you can reduce this inflammation using NAET, dietary education, and information about the impending shifts in the immune system, then the effectiveness of the herbs is exponentially optimized. I have helped hundreds of dogs and cats using the combination of NAET and herbs. By adding NAET to your practice, you have a dynamic way to evaluate why an animal is not responding as expected to your other holistic treatments. You can often resolve overt allergies, as well as more subtle ones causing autoimmune diseases.

IVC Winter 2016

Louie

CASE STUDIES

Louie was a nine-month-old rescue standard poodle mix who was adopted from a shelter two months before presentation on May 21, 2012. He was keeping his owners up all night with his scratching. He had been previously diagnosed with demodectic mange, yeast and bacterial skin infections and was being treated with daily oral ivermectin, ketoconazole, prednisone and antibiotics.

hydrolyzed chicken, he was allergic to his food. He was diagnosed with Liver Heat with exhaustion of Liver Qi and subsequent Kidney deficiency. His diet was changed to 7 cups turkey (cooked), and 2 cups of veggies (liver cleanse specific), and was supplemented with chia seeds, coconut oil, and 1,200 mg calcium citrate. For herbs, he was given equal portions of Goto Kola (Centella asiatica), astragalas root and salvia leaf. All conventional meds were discontinued with minimal wean-off period. Louie was very responsive and experienced almost immediate relief. By week two, his eyes were brighter and not as itchy, and his hair was growing back. His liver symptoms moved inward, and he developed minor digestive upset with burping and gas. His second treatment involved NAET clearing of amino acids, and acupuncture (LI 11, LI 4, GB 20, SP 6, LIV 3). It took about four treatments to see results. After eight treatments, Louie had no more symptoms and has stayed symptom-free for several years, with no further treatments.

Lucy

Lucy, a 15-year-old cat, presented in June of 2014 with a several-month history of skin infection and lesions that, despite an E-collar, were not clearing up. Using NAET, her allergies were determined: fish, chicken, beef, grains, minerals, dust and human dander. Top to bottom: Louie on conventional medications, when first presented to our clinic; Louie after two NAET treatments, discontinuation of all conventional medications, diet changes and treatment with simple herbal therapy; six months later, on no medications and with herbal adjustments. No need for further care. Total NAET visits: eight.

A physical exam revealed a large amount of white mucus in both eyes, but no redness of the conjunctiva or sclera. He was thin with a black spot on his tongue and had crusty skin with large portions of hair missing from both sides of his trunk (not uniformly). His ALT was 68 but other bloodwork was normal. NAET revealed that Louie was allergic to chicken, grains, mold and yeast, plus an essential amino acid combination. Since his diet was made of 32

IVC Winter 2016

Lucy did not want to consume herbs, but we were able to change her diet to avoid fish and fish oil by using homemade cooked bison and vegetables that clear Heat and boost organ support (dandelion greens, beet greens for the liver; parsley, fennel bulb and asparagus for the kidneys). The total quantity of vegetables was 2 tablespoons a day to 2/3 cup cooked bison, with calcium citrate, taurine and soaked chia seeds. Her person made a topical herbal tea of calendula to apply twice a day. It took six treatments to cure Lucy. She needed testing and tune-ups every two months but after the initial NAET clearings, standard TCM acupuncture was used to boost her Kidney and Liver Qi.

industry innovations Antibiotic alternative for UT infections Overuse of antibiotics is having serious repercussions in the form of resistant bacteria. An independent clinical trial of Cranimals Original Urinary Tract Supplement for dogs and cats, published in the American Journal of Veterinary Research, confirmed that the company’s proprietary organic cranberry extract was 100% effective at preventing E. coli mediated urinary tract infections in vivo (canine test subjects). The product was trialed against cephalexin. In vitro testing showed that Cranimals significantly reduced the adhesion of E. Coli to canine Madin-Darby kidney cells, and that maximum anti-adhesion occurred after 60 days of use. Email distributors@cranimal. com to buy direct. cranimals.com

Chiropractic workbook How can you tell if a patient needs a chiropractic adjustment? Animal Chiropractic: The Visual Workbook by Dr. William L. Schmidt can help you find the answer. Certified by the American Veterinary Chiropractic Association, Dr. Schmidt has 25 years of experience doing adjustments on horses, dogs, cats and other animals. This excerpt from his book explains how a misalignment in the area of the thoracic inlet can affect a horse’s performance: “Moving along the neck on both sides, backwards towards the shoulder, there is hollowness at the front of the scapula or the front of the shoulder blades where the neck attaches to the chest area. This area is the thoracic inlet. A horse that has misalignment of the vertebrae and/or ribs in that area will have spasms and congestion or swelling of the tissues on one side more than the other. When observing a horse walking, they are generally going to be short stepped on that same side. They will have difficulty turning to one or the other side, depending upon how it is affecting the horse. They may become cinchy, as a tight cinch causes an increased pressure on an already irritated horse. Many times when this occurs the horse will lose sensation due to altered nerve function to one or both front legs, causing them not to be sure where their leg is. Observing a horse in a running gait, normally the leg will come to full extension and the hoof should be three to four inches off the ground. When there are problems in the thoracic inlet, the hoof may be in full extension at ten to twelve inches off the ground. Consequently, the horse is losing three to six inches of travel with every step.” drwilliamlschmidt.com

Company procures NASC Quality Seal Ensuring the supplements you recommend to your clients are of top quality is vitally important. The National Animal Supplement Council (NASC)’s Quality Seal Program is a way for people to know that when they buy a product, they buy from a reputable company. The seal shows that the company has gone through a rigorous audit to help minimize and control risk, statistically track all product information, keep the consumer educated with correct labeling information, and make the consumer aware of any possible ingredient complexities through caution and warning statements. TropiClean Pet Products, a manufacturer from Wentzville, Missouri, recently obtained the NASC Quality Seal for their Life by TropiClean Supplements. Formulated for dogs from a balanced and natural blend of fresh oils, the line includes probiotics and multivitamins as well as supplements for immune support and coat/skin health. “The seal is a promise that we’re committed to improving the lives of pets and their people,” says Sharon Biermann, SQF Practitioner/HACCP Manager at TropiClean. To learn more about the NASC Quality Seal, visit nasc.cc;; for info on TropiClean, visit tropiclean.com.

New cold compression system for joint issues Companion Animal Health recently announced the addition of cold and compressive therapy to their line of innovative therapeutic technologies. The Companion Cold Compression system combines icing and intermittent compression in a single easy-to-use device. A small portable pump attaches to a joint wrap with a frozen gel pack to effectively reduce edema and inflammation in the joint. The pumping feature allows oxygenated blood to be moved into the area being treated to enhance healing and reduce swelling. The system is primarily used for post-surgical rehabilitation and to accelerate muscle recovery post-exercise. This product provides veterinarians with a more consistent and versatile alternative to traditional icing techniques. “A major advantage of the Companion Cold Compression system for our busy practice is its ease of use,” says Dr. Debra Canapp of Veterinary Orthopedic and Sports Medicine. “This system takes up minimal physical space in the clinic and is extremely portable. Because it can be moved around the clinic with ease and does not need a constant power source, I’ve found that my staff uses it more frequently and with more patients throughout the clinic.” litecure.com/rehabilitation/ ourproduct_catalog/ compression-solutions/

IVC Winter 2016

EXTRUDED

HORSE FEEDS PROS AND CONS

Though theyâ&#x20AC;&#x2122;re not for every horse, extruded feeds offer important benefits in some circumstances.

By Madalyn Ward, DVM

y first experience with extruded horse feed occurred in the early 1990s. I had an aged Thoroughbred mare who maintained her weight very well on summer pasture, but lost significant weight every winter. No matter how much hay and grain I fed her, she lost all her fat over the winter. Each year she seemed to lose more, and I was concerned that one winter I would lose her. Her teeth were good but she just did not digest hay and grain well.

is created, which is then pushed through a small die while it is still hot; the release of pressure after coming through the die causes the feed to expand. After the final product cools, it will harden and can be broken into appropriate-sized nuggets. The steam process breaks down the feed structures to make the nutrients more available. This pre-digestion process can make feeds up to 30% to 40% more digestible than standard pellets or whole grains. The final extruded feed has a very low moisture content so it will stay fresh longer.1

After extensive searching, I found a horse feed that was extruded. I could not believe the difference in my mare the first winter I gave her the extruded feed. She did not lose any weight and she loved the feed. From then on, I gave her more extruded feed and less hay during the winter, and cut the amounts back in the spring and summer when she had fresh grass to eat. She lived to be 38 years old, and died from an injury she received while playing too hard in the field.

WHAT IS EXTRUSION? Extrusion is a process in which feed is cooked under high pressure with high temperatures for a short time. A feed slurry

IVC Winter 2016

Extruded horse feeds have very little dust.

HOW EXTRUSION CHANGES FEEDS Proteins are made up of chains of amino acids. Horses need the individual amino acids contained in the protein chains. Extrusion breaks down the protein chains into individual amino acids, making them easy for the horse to absorb. This pre-digestion may also make proteins less likely to trigger immune reactions in food-sensitive horses. Extrusion also denatures proteins, such as phytase, which can interfere with starch digestion. Starches are converted to an easily-digested gel by the extrusion process. The expansion of starches during high pressure extrusion gives the feed a lighter, bulkier consistency, unlike the denser pellets produced from low pressure heat processing. Extrusion also makes starches water soluble, so extruded feeds easily break back down into slurry when water is added. Simple sugars and starches in roughage, such as hay, are also made more available to the horse from the breakdown of fibrous material. On the downside, higher heat during processing may damage the natural vitamin content of feeds, necessitating the addition of vitamin premixes. More on this later.

BENEFITS OF EXTRUDED FEEDS

energy for hard-working horses. Much of the starch a horse ingests is not adequately digested in the small intestine, so it is not a good source of energy. The extruded gelatinized starch is easily converted to glucose and absorbed in the small intestine. This prevents undigested starch from reaching the large intestine, where it can disrupt the balance of fiber-digesting bacteria. Horses are not able to break the beta bonds linking the monosaccharides that make up the cellulose, or insoluble, portion of fiber.3 Only the fiberdigesting bacteria located in the cecum and large intestine can break down these bonds. If too much undigested starch reaches the large intestine, the bacteria designed to digest starch will increase in numbers and fiber-digesting bacteria will decrease. This will deprive the horse of his ability to digest roughage, and can result in severe digestive upset. Another good thing about extruded feeds is that they have very little dust. Horses that live in stalls or have to travel in trailers are constantly breathing in dust and mold particles. Many develop lung conditions such as inflammatory airway disease or equine asthma. Feeding an extruded feed along with soaked hay can help avoid lung issues and allow affected horses to breathe better. Continued on page 36.

Native pasture is by far the best food source for the horse. Pasture grazing allows him to move about freely and pick and choose from a variety of foods. Horses will browse weeds, leaves and small branches in a native pasture setting. They are not designed to eat grains. Whole grains as well as many seeds have a hard shell and enzymes designed to prevent them from being digested when the horse consumes them.2 On the other hand, grass and browse are easy for the horse to digest and yield a wide range of nutrients to feed him and his gut bacteria. When we bring horses off pasture and ask them to perform as athletes, we have to give them a suitable feed that provides adequate calories and is safe for them to eat. High roughage diets in a competition horse may not provide adequate nutrition and the added bulk can interfere with performance. Pelleted feeds are less digestible than extruded feeds, and they also have several disadvantages. Horses may not chew pelleted feeds, setting the stage for choke. Less saliva is produced when pellets are consumed; without the buffering effects of saliva, stomach ulcers can become an issue. One of the most valuable aspects of the extrusion process is its effect on starch. While horses in a natural setting do not benefit from much starch in the diet, it can be an important source of IVC Winter 2016

Continued from page 35.

HORSES THAT DO BEST ON EXTRUDED FEEDS • Old horses • Starved equines that have lost the ability to digest • Those with lung problems • Young horses • Competition horses

SUMMARY OF PROS AND CONS PROS • Extruded feeds have a longer shelf life. • More calories are available, with less energy used by the horse. • There’s less bulk in the diet for racing and sport horses. • Expanded, bulky extruded feeds encourage horses to eat slower and chew more, decreasing chances of choke and increasing saliva to help buffer stomach acid. • There’s less chance of digestive upset from undigested starch. • Extruded feeds have less dust, making them good for horses with lung issues. • They’re great for older horses with bad teeth or those who have lost the ability to digest hay. • Horses that have been starved will often colic when feed is first introduced because they have lost many of the cells in the walls of their intestines; the pre-digested nature of extruded feeds works well to get these horses back on feed. • Young horses benefit from extruded feeds to support their growth, especially if they are also in training at a young age.

CONS • The increase in digestibility of extruded feeds can lead to weight gain or boredom if roughage is limited. • Horses with metabolic issues may not be able to handle the starch and sugar content of extruded feeds. • Higher heat during processing may have a deleterious effect on the natural vitamins in the feed.

DISADVANTAGES OF EXTRUDED FEEDS Horses that are easy keepers will often gain too much weight on an easily digested extruded feed. If hay is limited to keep these horses trim, they can develop vices such as wood chewing or cribbing from excessive boredom. Extruded feeds may also not be a good choice for horses with metabolic syndrome. These horses do not have normal carbohydrate metabolism so can react poorly to even minor amounts of sugar and starch. Although the starch in extruded feeds is pre-digested to keep it from reaching the large intestine, it is more easily absorbed into the blood from the small intestine. Unfortunately, the extrusion process needs some starch to function correctly. Metabolic horses may do better with balanced hay cubes that are guaranteed low sugar/ starch if controlled grazing on pasture is not an option. Although extruded feeds are a better choice in many cases than pellets or grains, they are not whole foods. Any processing, especially heat, can interfere with the vitamin content of these feeds. Most vitamin premixes included in the feed are synthetic and do not offer the same benefits to the body as vitamins from whole foods. Whole food sources of vitamins and minerals include raw fruits and vegetables such as broccoli, carrots, sweet potato, kale, cabbage, watermelon, oranges and apples. Super foods include green algae, selected seaweeds and chia seeds. Nutritional herbs and spices can also provide a variety of vitamins and minerals; they include parsley, fennel, rosemary, basil, ginger and turmeric. These are just a few great supplements to consider adding to your horse’s diet to replace nutrients lost during the extrusion processing of feeds. Good quality hay or pasture will meet the maintenance needs of many pleasure horses, but if additional support is needed for performance or health issues, a quality extruded feed has its place. Keep in mind that extruded feeds are only as good as the ingredients used to produce them. Low quality ingredients won’t be improved by extrusion. Feeds made with non-GMO ingredients are always preferable.

prognutrition.com/pn/nutrition-information/beneﬁts-of-extruded-horse-feeds/index.jsp

thrivefeed.com

Lon D. Lewis. Equine Clinical Nutrition. pp 20-21(1995).

IVC Winter 2016

Advertorial

Natural ingredients that support joint health Supporting joint health and complementing treatment protocols for joint pain and inflammation is the number one use for targeted nutritional supplements in traditional, integrative, and holistic veterinary medicine. Numerous non-pharmaceutical ingredients are now backed up by significant clinical studies that confirm their ability to reduce pain, inflammation and lameness, while also supporting healthy joint regeneration. These include: • Glucosamine sulfate – supports the structure and function of joints, and is more effective than other forms of glucosamine. • Chondroitin sulfate – usually used in combination with glucosamine, this nutrient can help with osteoarthritis. • Hyaluronic acid (HA) – helps with joint lubrication by promoting thick, healthy joint fluid. • Omega-3 PUFAS – Omega-3 polyunsaturated fatty acids can help with joint wellness. • Alpha-linolenic acid (ALA) – an Omega-3, ALA is an essential PUFA. • Docosahexaenoic acid (DHA) – necessary for growth in puppies and kittens. • Eicosapentaenoic acid (EPA) – with powerful anti-inflammatory effects, EPA helps with degenerative conditions. • Green-lipped mussel (GLM) – has a very high levelof Omega-3s; can help reduce pain and inflammation. • Sea cucumber – helps relieve joint pain. • Boswellia – has anti-inflammatory properties. • Turmeric – can reduce pain, inflammation and stiffness. Vets First Choice’s latest White Paper summarizes the latest clinical studies on the efficacy of these natural ingredients. It explores some of the leading joint support products containing them, and the latest technology used to ensure maximum patient compliance and successful treatment results. To download your personal copy and receive a free demonstration of a unique online animal health management and home delivery system, visit vetsfirstchoice. com/holistic or call 1-844-205-9140.

IVC Winter 2016

THORACIC

DISEASES – integrative treatments By Liza Schneider, BVSc

AN INTEGRATIVE APPROACH TO THORACIC DISEASES INCLUDES HYPERBARIC OXYGEN THERAPY AND OTHER MODALITIES.

horacic diseases I commonly encounter in New Zealand include pleural effusions, pneumothorax, trauma, asthma, pneumonia, neoplasia and congestive heart failure. (Pleural effusions are often due to infections, rodenticide toxicity, and less often chylothorax). Being an integrative veterinary practice, we combine the “best of both worlds”, making use of conventional veterinary medicine and surgery, as well as complementary therapies, to ensure our patients are treated with the least invasive means to achieve the best possible outcome. We aim to improve and sustain our patients’ quality of life as well as give our clients peace of mind, with our comprehensive approach. Patients frequently present as unstable, with tachypnoea, dyspnoea, hypoxia or cyanosis and collapse. Primary care to stabilize the patient involves a number of mainstream treatments including oxygen, thoracocentesis, placement of a chest drain, surgery, fluid support, and medications such as antimicrobials, diuretics and others. Complementary therapies that I find helpful to assist with the stabilization of a patient include flower essences (Rescue Remedy or Emergency Essence, the Australian version) to help take the edge off stress and anxiety; homotoxicological medicines that can be injected, such as Traumeel, which helps regulate inflammation and promote healing; acupuncture

IVC Winter 2016

and aquapuncture (the injection of agents into acupuncture points) to promote healing; and intravenous vitamin C, which supports immune system function, aids in the resolution of infections, reduces free radical damage, has been shown to induce apoptosis in some neoplastic cells, and assists with tissue healing. Once a diagnosis has been reached and the patient is stable, a treatment plan is strategized. In addition to the above modalities, we are also able to offer Hyperbaric Oxygen Therapy (HBOT). The pros and cons of these different options are evaluated and then presented to clients, taking into account their preferences, which could include financial considerations. Because we have had so much success with HBOT in our clinic, this article will focus on the benefits of this therapy.

INTRODUCTION TO HYPERBARIC OXYGEN THERAPY HBOT has been used in human medicine since the beginning of the 20th century. Based on sound scientific principles, it is an accepted treatment modality for several conditions, including non-healing wounds, compromised skin grafts, refractory infections, gas gangrene, crush injuries, carbon monoxide poisoning, and thermal burns.

The hyperoxygenation provided by HBOT facilitates the optimization of a number of physiological processes. It assists in the resolution of infection (directly and indirectly), supports neovascularization, enhances osteoblast and osteoclast activity, and stimulates tissue regeneration. Additionally, some research suggests it may be of benefit in heart disease and in halting the progression of certain neoplastic conditions. Extensive scientific information, as well as controlled studies (probably more than for many of our better-known conventional treatment modalities), support the use of HBOT, and many have been conducted with animal subjects in order to justify use in humans. Basically, any ischaemic condition may benefit from this form of therapy, either alone or in conjunction with conventional therapies.

PHYSIOLOGY AND APPLICATIONS OF HBOT In a pressurized chamber, humans and animal patients breathe 100% oxygen. Under this increased pressure (usually two atmospheres), the partial pressure of oxygen is greatly increased in the body, leading to increased carriage of oxygen by hemoglobin, but most importantly the dissolution of oxygen in the plasma (a 12 to 15 fold increase), which is carried to areas that may be too poorly perfused with oxygen to heal efficiently under normal circumstances. This raised level of oxygen remains in the tissues for up to four hours post treatment, and healing activity is promoted. Hyperoxygenation facilitates the oxidative white blood cell-killing mechanism and improves basic leukocyte function. Growth of anaerobic bacteria such as clostridia and pseudomonas is inhibited, thereby limiting the production of deadly toxins and aiding in the resolution of clostridial cellulitis and myonecrosis. Together with this action, the activity of aminoglycocides and other antimicrobial agents is enhanced (their transport across the bacterial cell wall is oxygen dependent), making HBOT a very useful adjunctive treatment modality for chronic and deep infections. Neovascularization is supported by HBOT as it provides the necessary pO2 to support collagen deposition, angiogenesis and capillary budding. Vasoconstriction is induced by hyperoxic conditions, and the reduction in blood flow together with the restoration of endothelial integrity decreases edema formation while still achieving sufficient oxygenation of tissues. Since the diffusion of oxygen into tissues is often impaired by edema, scar tissue and vessel damage, HBOT is an effective means of delivering oxygen to target tissues as it overcomes these barriers. The amount of oxygen reaching superficial tissues is easily quantified in humans using transcutaneous measurements, making this a useful non-invasive tool for wound assessment and its likely response to treatment with HBOT. A number of human and animal studies have shown the effects of HBOT on malignant tumors using a variety of treatment protocols. Just fewer than half of these studies showed a regression in tumor growth; half showed no effect, and a few showed apparently enhanced tumor progression. The different protocols used, as well as the type of tumor being treated, may have influenced the results. Animal studies using HBOT to treat sarcomas reported the most beneficial effects. HBOT used in combination IVC Winter 2016

with radiotherapy or chemotherapy has been shown to be more successful in controlling or reversing tumor growth.

HBOT COMPLICATIONS Oxygen toxicity inducing neurological symptoms is rare, but may occur when pressures higher than three atmospheres are used for prolonged periods. One potential negative effect of hyperoxygenation is the formation of oxygen-derived free radicals, although these may be counteracted with the administration of antioxidants. Additionally, HBOT augments host cell enzyme activity to assist in the degradation of free radicals, minimizing their negative effects. Potential complications of HBOT include tympanic membrane rupture and generalized discomfort because of the increased pressure. Development of pneumothorax due to the presence of lung bullae is also possible, so a thorough examination, especially of the patient’s thorax, should be conducted before therapy is begun. Unstable patients should not be treated. In most hyperbaric facilities, there is a time lag involved in directly accessing an animal being treated (due to the need to safely decompress), so HBOT should not be used to treat unstable animals unless an attendant is in the chamber with the patient.

USE IN THE CLINIC Clinical experience suggests that most animals tolerate the hyperbaric chamber without the need for sedatives, and experience very little discomfort for the duration of therapy. Treatment generally lasts 60 to 90 minutes (usually 15 minutes of compression, 60 minutes at the desired pressure, and 15 minutes of decompression), and may be done once or twice a day depending on the severity of the condition being treated. The number of treatments required is also dependent on the nature of the condition, but animals typically respond very well to between one and five sessions, although up to ten may be required for severe conditions. While HBOT may make a significant difference to a patient’s survival and quality of life, it is not always practical (especially for an unstable animal) or affordable (see the sidebar of case studies opposite). As with many conditions, there is not necessarily a “magic bullet” when it comes to managing thoracic disease. However, a holistic approach – addressing the animal’s diet and lifestyle, and making use of appropriate treatments that integrate drugs and nutraceuticals – provides a variety of possibilities for treating thoracic issues.

References Depenbusch FL, Thompson RE, Hart GB. “Use of hyperbaric oxygen in chronic osteomyelitis”, Journal of Trauma 12:807-812, 1972 Borukhov SA, et al. “HBO effect on clinico-biochemical blood indexes in patients with ischemic heart disease”. In: Abstracts VII Int. Cong. HBO Medicine, Moscow, Sept. 2-6, 1981, pp. 271-272. Cabigas BP, Su J, Hutchins W, et al. “Hyperoxic and hyperbaric induced cardioprotection: Role of nitric oxide synthase 3”. Cardiovascular Res 2006;72:143 Elkins AD. “Hyperbaric Oxygen Therapy: Potential Veterinary Applications”. The compendium May 1997. Esterhai JL, Clark JM, Morton HE, et al. “Effect of hyperbaric oxygen exposure within medullary canal in the rabbit tibial osteomyelitis model”. Journal of Orthop Res 4:330-336, 1986. Fossum TW. “Pleural Effusion: Recent Advances in Diagnosis and Treatment”. Veterinary Quarterly, 20:sup1, S9S10, DOI: 10.1080/01652176.1998.10807382 (1998). Hosgood G, Elkins AD. “Hyperbaric Oxygen Therapy: Mechanism and potential applications”. The compendium May 1990. Jain KK. Textbook of Hyperbaric Medicine. Seattle, Hogrefe & Huber, 1996. Kerwin SC, Hoggood G, Strain GM, et al. “The effect of hyperbaric oxygen treatment on a compromised axial pattern flap in the cat”. Vet Surg 22:31-39, 1992. Lian QL, et al. “Effects of hyperbaric oxygen on S-180 sarcoma in mice”. Undersea Hyperb Med 1995;22:153-160. Mader JT, Brown GL, Guckian JC, et al. “A mechanism for the amelioration by hyperbaric oxygen of experimental staphylococcal osteomyelitis in rabbits”. Journal Infectious Diseases 142:915-922, 1980. Morrey BF, Dunn JM, Heimback RD, Davis JC. “Hyperbaric oxygen and chronic osteomyelitis”. Clin Orthop 144:121-127, 1979. Robertson SA, Stoddart ME, Evans RJ, Gaskell CJ, Gibbs C.“Thoracic empyema in the dog; a report of twenty-two cases”. The Veterinary Clinics of North America. Small Animal Practice [1979, 9(2):357-362]. Tufano, R, et al. “Hyperbaric oxygen effects on pain relief in patients with vascular disease”. Journal Hyperbaric Medicine, Vol. 3, No. 1, 1988. Wallyn RJ, Gumbiner SH, Goldfein S, Pascale LR. “Treatment of anaerobic infections with hyperbaric oxygen”. Surg Clin North Am 44:107-112, 1964.

IVC Winter 2016

r. He was BEANIE is a 12-year-old male Fox Terrie ic cough, presented for a third opinion regarding a chron lower ious infect after a specialist diagnosed allergic or y of variet a with d airway disease. He had been treate , ycline doxyc nes, stami medications, including antihi his ve impro d helpe none but fenbendazole and others, condition.

with initial HBOT was recommended if he didn’t improve seed grape supportive treatments that included vitamin C, dy. extract (proanthocyanidins) and a Heel reme

MUNTER,, a one-and-a-halfyear-old MN Pomeranian, had a history of chronic lethargy. A diagnostic workup with radiographs revealed pleural effusion of unknown duration. Thoracocentesis showed noncoagulating blood and the cell count confirmed regenerative anemia consistent with rodenticide toxicity.

has been Beanie’s cough improved significantly and need for no was there so subsequently well managed, other therapies.

ticide MAGGIE, a two-year-old FS Kelpie, had eaten roden white , five days prior to presentation with a cough lung the of n mucus membranes, crackles on auscultatio e erativ regen a led field, and melena. A cell count revea with iated assoc loss anemia consistent with the blood anticoagulant toxicity.

, daily Vitamin K therapy was initiated along with HBOT by a ed for three days. Each session of HBOT was follow a made He anor. marked improvement in Munter’s deme full recovery. presented MARLEY, a five-year-old MN Burmese Cat, ted by aspira was uid ﬂ ml 200 with a pyothorax; high with place in put was drain chest A thoracocentesis. as well as BID) s gram (2.5 C in vitam enous dose intrav and e cultur antibiotics based on sensitivity.

Vitamin K therapy was instituted immediately.

hours and Maggie became severely lethargic within 12 following the was treated with HBOT that evening. By , and cantly signifi ved morning, her demeanor had impro HBOT of n sessio er Anoth she was bright and responsive. on to make was repeated the following day, and she went a full recovery. had trauma JACK, a two-year-old MN Border Collie Cross, lung and leading to a pneumothorax, with a collapsed left subcutaneous emphysema. cocentesis, He was stabilized with intravenous ﬂuids, thora pockets, air of tion aspira a pressure bandage, intravenous vitamin C, Traumeel and NSAIDS. HBOT wasn’t to be used in this instance because of the pneumothorax. Aside from small remaining pockets of subcutaneous air, there was a marked improvement within 24 hours, and Jack made a full recovery.

Marley’s fractiousness compromised the chest drain position so it was removed. His response to therapy (probably the Vitamin C) was profound and Marley was treated as an outpatient with full recovery.

Christina ISIS, a male Bengal and a patient of Dr. a. He asthm e sever with ve fi age at Chambreau, presented nonwas that s week eight since cough had a mild chronic and-a Oneents. treatm al ntion conve any responsive to l annua his half years prior to presentation, Isis was given (he es vaccin vaccines and the first of two suggested FIP Hours was an indoor cat owned by a 75-year-old man). a. asthm e sever and lips later, Isis was on oxygen with blue but s, attack e sever nted Multiple medications preve gic and Isis continued with mild coughs, became lethar h of mont One ines. medic in ase decre could tolerate no were drugs the as Thuja with ent treatm homeopathic another tapered off resulted in a deep healing. He lived one only and 15 years, had no more respiratory problems episode of rodent ulcer.

IVC Winter 2016

By Christina Chambreau, DVM, CVH

Integrative approaches to

tracheal problems Kennel cough and collapsing tracheas were among the conditions that showed me the benefits of integrative medicine. While an extern at the Foxhound breeding colony at the NIH in 1979, my job was to culture every coughing dog. Amazingly, there were few similar organisms present in each dog and over a dozen different bacteria present in the kennel. Though we ran no tests, viruses were also certainly implicated. I began to wonder how any vaccine could be effective against kennel cough. When I was a new graduate, I worked in over ten clinics as a part time and relief veterinarian. I noticed that each clinic had very different protocols for treating kennel cough (infectious tracheobronchitis), ranging from honey to multiple drugs. “Collapsing tracheal” coughs were fairly common in these clinics, and again there were differing treatment options. Most (in 1980) merely tried to manage the coughing (by teaching people how to pick their dogs up, getting them to choose harnesses instead of collars for walks, etc.). A few recommend radiology, then stenting surgery. Merck Manual1 reminds us there are multiple organisms residing in the respiratory tract. They cause no clinical signs unless triggered by stressors like viruses, smoke, crowding, poor ventilation, etc. By deeply improving the health of each dog, respiratory symptoms rarely develop. Many congenital abnormalities can also be resolved with integrative approaches. Dr. Brad Fenwick reported in 2005:2 “The frequency of kennel cough outbreaks have not diminished and in certain situations have increased in both frequency and clinical severity.”

THE ISSUE WITH VACCINATION Because of the variety of organisms present, vaccination has focused on Bordetella bronchiseptia. Vaccines (different organisms, different formulations) have been used since 1970,

IVC Winter 2016

yet J. Ellis3 says many questions about this vaccine and natural exposure are still not answered. Studies continue on vaccine efficacy, especially with newer formulations4,5,6. A study done in 2004 “compared the effectiveness of intranasal (IN) vaccines containing Bordetella bronchiseptica and canineparainfluenza virus, with (IN-BPA) or without (IN-BP) canineadenovirus type 2, for prevention of kennel cough at a humane shelter…. The IN-BP and IN-BPA vaccines were 20.7% and 24.4% effective, respectively, in reducing coughing compared with a placebo vaccine.”7

INTEGRATIVE APPROACHES Anecdotally, once a majority of clients in a veterinary practice are using various holistic approaches to maintain health, very few cases of kennel cough are seen, even in situations with high numbers of dogs. Most of the cases reported were in newly adopted dogs. Treatments may focus both on symptom relief and on correcting the underlying imbalance allowing the condition (infection or collapse) to occur. TCVM (acupuncture, Chinese herbs, Tui Na, food therapy) and homeopathy are the most likely modalities for resolving the tendency to get any infection, as well as correcting anatomical problems, so they will be primarily addressed in this article. Western herbs, Reiki, flower essences, chiropractic, osteopathy and supplements can be used to resolve any one episode of kennel cough, or to decrease the cough frequency of collapsing trachea, as well as build health over time. In my homeopathic practice, the few cases of kennel cough I’ve seen resolved within 48 hours with one of a variety of different homeopathic remedies. Fewer than five animals (out of 20 homeopathic veterinarians interviewed) needed multiple

remedies or took over a week to resolve. Many small dogs with mild problems of collapsing trachea become asymptomatic with constitutional treatments and general health improvements.

TCVM The selection of acupuncture points and Chinese herbs (below) is based on the individual characteristics of the dog as well as the pathology. Some can be used in a less tailored way in face of exposure. • Xue Fu Zhu Yu Tang – one veterinarian has had nice results with coughs from kennel cough and collapsing trachea, often along with using allopathic medications. • Wei Chi Booster – helps the immune system. • Lonicera and Forsythia (commonly used for colds and ﬂu in people) – a remote town that had no kennel cough for years was visited by a coughing dog, after which most dogs began coughing. This herb worked in a few days for most of them. • Jade Screen Eight (Ba Wei Xiao Feng) – prevents viral infections in horses that are showing or travelling, especially when other horses show clinical signs. When very healthy, this would not be necessary. • Yin Qiao San – for the early stage of infection with fever and red tongue with yellow coating. • Qing Fei San – for phlegm heat with fever. Dry, red tongue with surging rapid pulse. • Zhi Shou San – can stop coughing in many animals. Continued on page 44.

CASE STUDY

In August 2015, Dr. Grace Calabrese treated a seven-month-old Italian Greyhound puppy that presented with an intrathoracic collapsing trachea. The problem had developed several weeks after a severe URI that was treated with antibiotics and cough suppressants. As a younger pup, he had been treated with rather high doses of steroids for a skin problem. A surgery consult had been suggested, but given the poor prognosis, the owner declined. On presentation to Dr. Calabrese, the puppy was on antibiotics, hydrocodone and prednisone. He coughed frequently and had virtually no exercise tolerance. He was given high doses of glucosaminechondroitin and Sam-E, and an appropriate Chinese herbal formula – Xiao Chai Hu Tang (Triple Burner Obstruction and Rebellious Lung Qi). Within eight weeks, he became a nearly normal pup, running and playing with his Italian Greyhound companion, coughing only rarely, and experiencing normal exercise tolerance. Nine months after initiating treatment, he was x-rayed again; his tracheal lumen is now of normal size, with very obvious remodeling at the former area of stenosis.

IVC Winter 2016

Continued from page 43.

HOMEOPATHY Historically, homeopathy has been a superior approach for human epidemic situations such as influenza, typhoid and yellow fever. In animals, parvo, distemper and kennel cough frequently resolve quickly, even in cases not already under constitutional holistic care. Each homeopathic medicine is chosen based on symptoms shown in the animal. Common symptoms of kennel cough include sudden onset of sneezing, spontaneous hacking, dry coughing that may induce gagging, easily inducible cough, and sometimes mandibular lymphadenopathy, nasal and/ or ocular discharge. What helps with the remedy selection is how each animal is acting differently with these symptoms. Does the cough occur in the morning, on exposure to cold air, after eating a cracker or other dry food, etc.? Any one of the 4,000+ medicines could be needed to treat kennel cough, and a few seem to help with many dogs as reported by a number of homeopathic veterinarians: • Aconitum – given at the very beginning of any infection, especially in group settings to prevent or minimize symptoms. Often, the dogs are acting more fearful and may be febrile. • Belladonna – lots of redness anywhere on the body, including the skin and mucus membranes, as well as fever, panting, feeling hot and seeking cold areas, and a harsh strong cough. • Bryonia – each cough hurts because it moves the body, and every motion hurts these patients. • Drosera – a common internet suggestion that focuses on the larynx. For a spasmodic, dry cough that’s worse after midnight.

IVC Winter 2016

ADDITIONAL HOLISTIC MODALITIES

You can also recommend some of the approaches your holistically-oriented clients may be purchasing on their own, such as: • Vitamins C (500 to 2,000 mg per day, divided) and E (800 to 2,400 IU daily) • Colostrum at 500 mg per 25 pounds • Honey, or honey and lemon juice, or coconut oil can be soothing and any amount is safe; average dose is 1 tsp per 20 pounds • Marshmallow root is gentler than commonly-used slippery elm; dissolve 1 tsp in 8 ounces warm water and give a teaspoon at a time • Kennel cough nosode – a nosode is made from the sputum of an infected dog. There are many differing opinions about the use of nosodes in preventing illness. When symptoms are not clear, some homeopathic veterinarians begin with these (more on nosodes below). • Pertussinum – a nosode made from whooping cough. Sometimes used preventatively; other times as part of the homeopathic treatment. • Phosphorus – dogs exhibit fear of loud noises, better for being petted and the center of attention, a thirst for cold water, and a tickling cough from an irritated throat or larynx. • Lachesis – aversion to having the throat touched, cough on touching the throat, seeking cold, averse to abdominal palpation, thirsty and irritable. • Morgan Bach – congestion, and as support for other remedies. • Rumex – tickling in throat and larynx, worse from barking, and worse when going out in cold weather.

Advertorial

• Spongia – dry croupy cough, larynx sensitive to touch, better from eating or drinking, worse in the wind. • Other remedies recently reported as successful include Antimonium-tartaricum, Euphrasia, Conium, Cocculuscacti, Bromium, Ipecac pulsatilla and Rhu-toxicodendrum. Over the last few decades, experienced homeopaths have reported that if they could find the similimum (medicine that matches the individual) they achieved almost 100% success in multiple cases. Interestingly, several found that the dog’s constitutional medicine does not seem to be as effective in these acute cases. Many others successfully use nosodes in treatment, either alone or along with other homeopathic medicines. Nosodes may protect against future infection. One practitioner used the kennel cough nosode at hunt kennels in England, with 100% success, by medicating the water weekly with 30c potency from just before the autumn equinox until midOctober. Another practitioner is testing the same nosode with Nobivac KC and finding equal protection. Christopher Day studied a kennel in England that had been afflicted with rampant kennel cough for years, and the kennel cough nosode dramatically decreased infections.8 Training in homeopathic and TCVM methodology will maximize success and result in deeper healing, but if you are challenged in your practice with tracheal diseases, you can work with a trained practitioner to implement some specific strategies. One joy of seeing each dog as unique is that we can resolve acute infections as well as more challenging tracheal diseases, while building overall health. Clients are very happy with the results for their individual animals. This approach can also prevent problems, as well as inhibit further spread of infection in group settings such as kennels, day care or training facilities.

merckvetmanual.com/mvm/respiratory_system/respiratory_diseases_of_small_animals/overview_of_respiratory_ diseases_of_small_animals.html. 2 Fenwick, Brad, DVM, diplomate ACVM, PhD, ivis.org/proceedings/navc/2005/SAE/470.pdf?LA=1. 3 Ellis, JA. How well do vaccines for Bordetella bronchiseptica work in dogs? A critical review of the literature 1997-2014. The Veterinary Journal, 204 (2015), pp. 5-16 4 Edinboro CH, Ward MP, Glickman LT. “A placebo-controlled trial of two intranasal vaccines to prevent tracheobronchitis (kennel cough) in dogs entering a humane shelter”. Prev Vet Med, 2004 Feb 26;62(2):89-99. 5 Kawakam, Kazuo. “Nosocomial Outbreak of Serious Canine Infectious Tracheobronchitis (Kennel Cough) Caused by Canine Herpesvirus Infection”. Journal Clinical Microbiology, April 2010, vol 48 6 LJ Larson, BE Thiel, P Sharp, RD Schultz. “A comparative study of protective immunity provided by oral, intranasal and parenteral canine Bordatella bronchiseptica vaccines”. Intern J Appl Res Vet Med, 2013. 7 Edinboro CH, Ward MP, Glickman LT. “A placebo-controlled trial of two intranasal vaccines to prevent tracheobronchitis (kennel cough) in dogs entering a humane shelter”. Prev Vet Med. 2004 Feb 26;62(2):89-99. 8 Day, Christopher. “Isopathic prevention of kennel cough – is vaccination justiﬁed?” International Journal of Veterinary Homeopathy, 1987, 2: 45. 1

VetzLife All-Natural News By Christopher Kelly Groth

Lions and tigers – and natural oral health When a big cat lives in the wild, he inevitably needs to hunt in order to feed. Hunted prey is about as raw as a diet can be, and is how nature intended big cats to eat. Fresh, raw meat is the ideal diet for these felines, and helps support their oral and dental health as well as their overall wellness. Hunting fresh prey is not possible for big cats in conﬁnement. So whether they are being cared for in a zoo or at a sanctuary, looking after their oral health is very important. Enter veterinarian Dr. Clayne White from Bayview Animal Hospital in Farmington, Utah. He is a caretaker for exotic cats living in captivity in the Utah area. His patients include lions, tigers, mountain lions, black panthers and more. As a veterinarian, Dr. White knows and understands the importance of proper oral health not only for the family pets that come to his facility, but also for the exotic cats he cares for. For years now, he has been using VetzLife Oral Care, and by doing so has successfully avoided the process of giving the big cats anesthesia for dental cleanings. VetzLife oral health products are ideal for every clinic to utilize on every level. They prevent plaque, and naturally dissolve existing tartar. They’re the perfect solution for clients who have elderly patients that are not candidates for anesthesia. Christopher Kelly Groth is the Senior Sales Executive for PetzLife Products.

IVC Winter 2016

TCVM FOR

RAO Learn how acupuncture By Huisheng Xie, DVM, PhD and Chinese herbal medicine can effectively treat recurrent airway obstruction in equines.

Recurrent airway obstruction (RAO) is one of the most common pathologies leading to respiratory diseases in horses.1 Conventional Western therapy requires both long-term medication and an adjustment of the stable environment to remove the likely inciting cause.2 Clinical studies indicate that acupuncture and Chinese herbal medicine are useful in controlling the clinical signs of heaves, dyspnea and cough in horses.3-6 This article reviews how to use acupuncture and herbal medicine to treat RAO in horses.

Evidence-based studies Tai, et al, demonstrated that electro-acupuncture (EA) at acupoints LU-1 and CV-22 significantly increased the rate of tracheal mucociliary transport in quails when compared to a control group. EA at these acupoints significantly reversed the decrease in mucociliary transport caused by the administration of human neutrophil-derived elastase.7 The analgesic and anti-inflammatory effects of acupuncture (AC) and EA are well recognized in both somatic and visceral tissues.8,9 Major acupoints indicated for these purposes include LI-4, LI-10 and ST-36.8,10,11 EA reduced inflammatory cell infiltration in the peribronchial tissue and in the pulmonary perivascular spaces.12 AC at LI-11, GV-14, ST-36 and SP-10 in healthy human volunteers reduces circulating leukocytes and lymphocytes

IVC Winter 2016

IN HORSES

without affecting the level of circulating corticosteroid.13 Another study demonstrated that EA at LI-4 and LU-6 normalizes the patterns of leukocytes in granulocytosis/ lymphocytopenia and granulocytopenia/lymphocytosis.14 EA at ST-36 corrects the spleen NK cell activity suppression induced by a lesion at the anterior hypothalamus.15 Several studies suggest that acupuncture treatments normalize the population of circulating leukocytes. Besides this, acupuncture stimulation at ST-36 has been demonstrated to increase phagocytic activity of rat peritoneal macrophages and to attenuate TNF-a release in vitro.16 The suppression of activated macrophage TNF-a production by EA can be partly antagonized by naloxone, the opioid antagonist.17 EA at LI-11 significantly increases the respiratory burst of peripheral-circulating neutrophils.18 Neutrophils possess a highly phagocytic activity and are capable of eliminating pathogens. This innate immunological activity is an important primary immune response in both peripheral circulation and local tissues. A clinical study of human asthma found that acupuncture stimulation at LU-7, LI-4, PC-6, ST-40, LI-11 and PC-3 for 15 minutes induces bronchodilation manifested by an increase in forced expiratory volume in the first second (FEV1).19 A total of 60 patients with acute upper respiratory tract infection were randomly divided into group A (n=30) and group B (n=30). Each patient in Group A received granules of the newly-

Table 1 – TCVM for treating common patterns of RAO in horses Pattern type

Clinical signs

Acupuncture point/herbal medicine

• Allergic heaves, worse in summer • Cool-seeking, tongue red and dry • Pulse: strong and fast

GB-20, LU-5/10/11, BL-10/13, GV-14, LI-1/4/11, CV-22, Ding-chuan

Lung Yin deficiency

• Chronic heaves/asthma, emaciation • Dry and thick nasal discharge • Dry cough, cool-seeking, dry skin • Tongue: red/dry • Pulse: thready/rapid

LU-7/9, SP-6/9, KID-3, BL-13/42,CV-22, Ding-chuan, Fei-men, Fei-pan

Lung Qi deficiency

• Chronic heaves/asthma • Dyspnea worse when moving • Weak voice, fatigue • Tongue: pale/wet • Pulse: deep/weak

CV-17, ST-36, SP-6/9, ST-40, BL-13, LU-7/9, LU-8, CV-22, Ding-chuan

• Prolonged course of asthma • Feeble asthma with weak respiration • Exercise intolerance, loss of breath • Worse asthma when moving • Obvious heaves/asthma groove • Tongue: pale • Pulse: deep/weak

Shen-shu, Shen-peng, Shen-jiao, BL-13/26, CV-17, ST-36,LU-7/8/9, CV-22, Ding-chuan

Allergy Heat

Kidney & Lung Qi deficiency

Schisandra 5

Lily Combination

Bu Fei San

Breathe Easier B

Acupuncture points based on clinical signs3-6

Nasal congestion or/and discharge: LI-4, LI-11, LU-9, LI-20, Bi-tong, Long-hui Cough: LU-1, LU-6, LU-7, LU-9, CV-17, CV-22, BL-12, BL-13, BL-42, Ding-chuan Heaves: LU-1, LU-7, CV-17, CV-22, BL-13, BL-23, BL-26, Ding-chuan, Fei-men, Fei-pan

developed herbal medicine Chaige Qingre, while each patient in Group B received Fufang Shuanghua granules. The patients in each group took their assigned formula 30 minutes before a meal, 6 g four times daily for three consecutive days. After three days of herbal treatment, the overall response rates of Chaige Qingre and Fufang Shuanghua were 93.10% and 96.55% respectively.20

TCVM pattern differentiation and treatment In Traditional Chinese Veterinary Medicine (TCVM), the Lung dominates Qi, and respiration regulates the water pathway and controls the body surface. The pathological changes of the Lung affect the physiological activities leading to respiratory disorders. Main clinical signs include cough, asthma, dyspnea, nasal discharge or congestion; these are considered TCVM Lung pathogenic changes. The most commonly seen patterns of respiratory disorders include Wind-Cold, Wind-Heat, Lung Heat, Damp-Phlegm, Lung Yin Deficiency, Lung Qi Deficiency, Lung Qi+Yin Deficiency, and Kidney+Lung Qi Deficiency (see Table 1 above).

Top herbal medicine for RAO in horses Four major herbal formulas commonly used to treat chronic respiratory diseases in horses are Wei Wu Zi 5 (Schisandra 5), Bai He Gu Jin (Lily Combination), Bu Fei San, and Ren Shen Ge Jie (Breathe Easier B).21 Continued on page 48. IVC Winter 2016

Continued from page 47.

 Schisandra

5 is the most recently developed formula. Its TCVM indications include heaves, heat-associated allergy, and general allergies.  Lily Combination is modified from the classical antecedent Bai He Gu Jin Tang from Yi Fang Ji Jie written by Wang Ang in 1682.21 The TCVM indications for Lily Combination include dry cough without phlegm, cough due to Lung/ Kidney Yin deficiency, red tongue without coating, and fast thin pulse. Indications for its use in conventional veterinary medicine include dry cough, chronic bronchitis, and recurrent airway obstruction (RAO).  Bu Fei San is modified from the classical antecedent Bu Fei Tang from Yong Lei Qian Fang (Everlasting Categorization of Seal Formulas), written by Li Zhong Nan in 1331.21 Its TCVM indication includes Lung Qi deficiency, shortness of breath, chronic cough or asthma, pale wet tongue, deep weak pulses, and exercise intolerance. Chronic cough and/or asthma are indications for its use in conventional veterinary medicine.  Breathe Easier B is modified from the classical antecedent Ren Shen Ge Jie San from Yuan Heng Liao Ma Ji (Yuan Heng’s Therapeutic Treatise of Horses), written by Yuan Heng in 1608.21 Its TCVM indications include dyspnea/asthma/ cough due to Lung/Kidney Qi deficiency, pale and swollen tongue, and weak, deep pulse. Contemporary veterinary medicine indications include RAO and dyspnea.

Case #1

On initial examination Joe’s body felt hot. His cough was loud and deep. His breath was superficial and labored with a respiratory rate of 45 per minute. He showed a cool-seeking behavior and stayed under a tree. His pulse was thin and fast, and his tongue was red and dry. The TCVM pattern diagnosis was Lung Yin Deficiency with Heat. Treatment was as follows: • Dry needle: LU-7, LU-5, LI-11 • Electro-acupuncture: at pairs of Fei-men + Fei-pan, Dingchuan + BL-13 and CV-22+LU-1 (20 Hz for 30 minutes). IVC Winter 2016

• Acupuncture and herbal medicine are effective for the treatment of equine “heaves” or recurrent airway obstruction. • Basic acupoints are GV-14, BL-13/42, 12/41, 23/52, Feimen, Fei-pan, Ding-chua, CV-22/17 and LU-1/7. Dry needle, aquapuncture, or electro-acupuncture can be used. • The basic herbal medicine is Ren Shen Ge Jie modification (Breathe Easier B) which can be used for any bad heaves cases, especially with Kidney/Lung Qi Deficiency. a. Add Bai He Gu Jin (Lily Combination) for coughing horses (Lung Yin Deficiency/Phlegm), or b. Add Wu Wei Zi 5 (Schisandra 5) during summertime when horses are presented with Yin Deficiency and Heat.

CASE EX AMPLES

Joe was a 15-year-old Arab gelding. He had been a 50-miles endurance riding horse, but was retired to pleasure riding due to worsening RAO, which had been diagnosed four years prior. He had an acute onset of coughing, high fever and severe heaves for two weeks. The two-week course of antibiotics helped control Joe’s body temperature, but the cough and heaves were getting worse. He was referred to TCVM on October 16, 2006.

Concluding points

• Herbal medicine: Schisandra 5, 45 g twice daily by mouth, and Lily Combination, 30 g twice daily by mouth. • Food therapy: The Cold foods, including watermelon rind, cucumber, celery and barley, were recommended. Joe was not fed sweet feed, oats or corn. At Joe’s second TCVM visit on October 30, his dyspnea was significantly improved, with a respiratory rate of 20 per minute. His body felt much cooler. He had no more coughing. His tongue was pink and his pulse was fast. The same TCVM treatments were given again. Outcome: Joe did not show any dyspnea and had a respiratory rate of 15 per minute after three months of herbal medications and two more acupuncture sessions (on November 29 and January 17). He remained a pleasure riding horse until 2014 during which time his heaves were well controlled by the herbal meds and acupuncture (three to four sessions during the summertime). Since 2015, Joe has been a pasture horse and is now aged 25. Continued on page 50.

IVC Winter 2016

Continued from page 48.

Case #2

Jan, a nine-year-old Thoroughbred stallion, presented with a three-year history of COPD. He was a pleasure riding horse (45 minutes twice a week). He appeared to wheeze during the summertime, and his heaves seemed to worsen over time. Jan wheezed so loudly that he could be heard outside the barn. Upon examination, he looked strong and perspired normally, yet both front hooves were cracked and his eyes were red and dry. His urine was thick and stinky and he drank large amounts of water. His appetite and defecation were

A combination of acupuncture and herbs helped relieve the breathing difficulties caused by Jan’s COPD.

T angjitjaroen W, Xie H, Colahan P. “Possible mechanisms of acupuncture for the treatment of chronic inflammatory disorders of the equine lower airway”. American Journal of Traditional Chinese Veterinary Medicine. 4(2): 37-48, 2009.

Leguillette R. “Recurrent airway obstruction -- heaves”. Vet Clin North Am Equine Pract 2003;19:63-86, vi.

normal. No cough or lameness was noticed. His ears were warmer than normal and he blew hot air from the nostrils. Severe dyspnea was observed (both his nostrils moved very violently and fast). A “heaves line” was obvious on both sides. No sensitivity at Back Shu Association or Front Mu Alarm points was found. Jan’s tongue was red and dry, and his pulse was thready, weak and rapid. The TCVM Diagnosis was Lung Heat with Yin Deficiency. The following acupuncture treatments were given once a month for three sessions: • Dry needle: LU-11, LI-1, LI-4, LU-5, GV-14 • Electro-acupuncture: Ding-chuan (bilateral) and BL-13 (bilateral) • Aquapuncture: vitamin B12 applied 5 cc per point at LU-5, LI-11, GV-14 • Herbal medicine: Lily Combination, 15 g PO BID for three months (nourishes Lung Yin) and Schisandra 5, 15 g PO BID, for two months (clears Heat). Outcome: The owner noticed Jan was breathing more comfortably about two weeks after the initial acupuncture treatment and daily herbal medication. He was breathing almost normally six weeks after the TCVM treatment, and his wheezing significantly decreased in the summer of 2000. The same treatment plan helped manage Jan’s heaves throughout the summers of 2001, 2002, 2003 and 2004. He was then retired and has been a pasture pet since 2005.

B arlas P, Ting SL, Chesterton LS, et al. “Effects of intensity of electro-acupuncture upon experimental pain in healthy human volunteers: a randomized, double-blind, placebo-controlled study”. Pain 2006;122:81-89.

C arneiro ER, Carneiro CR, Castro MA, et al. “Effect of electro-acupuncture on bronchial asthma induced by ovalbumin in rats”. J Altern Complement Med 2005;11:127-134.

Z heng, YC. “Acupuncture and Yin Qiao San for treatment of upper airway infectious diseases in horses”. Chi J of Trad Vet Sci. 2: 23, 1994. (In Chinese).

Li, ZW, Li ZQ. “Acupuncture and Chinese Herbal Medicine for the treatment of influenza in horses”. Chi J of Trad Vet Sci. 3: 7, 1994. (In Chinese)

L iu, YH. “The Traditional Chinese Veterinary Medicine for cough”in The Complete Works of Secret Recipe of Chinese Veterinary Medicine, C. Yu and L. Zhang (eds). Shanxi Science & Technology Press, Shanxi, China, 1992, p.230231. (In Chinese).

C hen GJ. “The Traditional Chinese Veterinary Medicine for dyspnea in horses” in The Complete Works of Secret Recipe of Chinese Veterinary Medicine, C. Yu and L. Zhang (eds). Shanxi Science & Technology Press, Shanxi, China, 1992, p.226-227. (In Chinese).

T ai S, Wang J, Sun F, et al. “Effect of needle puncture and electro-acupuncture on mucociliary clearance in anesthetized quails”. BMC Complement Altern Med 2006;6:4.

B aek YH, Choi DY, Yang HI, et al. “Analgesic effect of electroacupuncture on inflammatory pain in the rat model of collagen-induced arthritis: mediation by cholinergic and serotonergic receptors”. Brain Res 2005;1057:181-185.

S chneider A, Streitberger K, Joos S. “Acupuncture treatment in gastrointestinal diseases: a systematic review”. World J Gastroenterol 2007;13:3417-3424.

Maenaka T, Tano K, Nakanishi S, et al. “Positron emission tomography analysis of the analgesic effects of acupuncture in rhesus monkeys”. Am J Chin Med 2006;34:787-801.

IVC Winter 2016

Kou W, Bell JD, Gareus I, et al. ”Repeated acupuncture treatment affects leukocyte circulation in healthy young male subjects: a randomized single-blind two-period crossover study”. Brain Behav Immun 2005;19:318-324. ori H, Nishijo K, Kawamura H, et al. “Unique immunomodulation by electro-acupuncture in humans possibly M via stimulation of the autonomic nervous system”. Neurosci Lett 2002;320:21-24. H ahm ET, Lee JJ, Lee WK, et al. “Electro-acupuncture enhancement of natural killer cell activity suppressed by anterior hypothalamic lesions in rats”. Neuroimmunomodulation 2004;11:268-272. Z hao R, Ma C, Tan L, et al. “The effect of acupuncture on the function of macrophages in rats of immunodepression”. Zhen Ci Yan Jiu 1994;19:66-68.

A oki E, Kasahara T, Hagiwara H, et al. “Electro-acupuncture and moxibustion influence the lipopolysaccharideinduced TNF-alpha production by macrophages”. In Vivo 2005;19:495-500.

K arst M, Scheinichen D, Rueckert T, et al. “Effect of acupuncture on the neutrophil respiratory burst: a placebocontrolled single-blinded study”. Complement Ther Med 2003;11:4-10.

C hu KA, Wu YC, Ting YM, et al. « Acupuncture therapy results in immediate bronchodilating effect in asthma patients”. J Chin Med Assoc 2007;70:265-268.

C hang J, Zhang Y, Mao B, Wang L, Li TQ, Zhang RM. “A double-blind, randomized controlled trial of Chaige Qingre Granule in treating acute upper respiratory tract infection of windheat syndrome”. J Chin Integr Med/ Zhong Xi Yi Jie He Xue Bao. 2007;5(2):141-146.

Ma A. Clinical Manual of Chinese Veterinary Herbal Medicine. Ancient Art Press, 2016. p 60-70, 272-280.

From the

AATCVM

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

In August 2016, approximately 84 veterinarians from China and over 100 veterinarians from 20 other countries gathered in Beijing for the 18th Annual International TCVM Conference. The event was co-hosted by the World Association of TCVM (Traditional Chinese Veterinary Medicine), Chi Institute, Beijing Small Animal Veterinary Association, and China National Society of TCVM. Over the duration of three days, speakers presented on topics including clinical application of TCVM schools, behavioral problems (spirit-mind-body), infections, inflammation and cancer.

TORONTO SKYLINE

NEXT YEAR’S CONFERENCE The 19th Annual International TCVM Conference will be held in downtown Toronto from August 18 to 20, 2017. It will be the first time the event has ever been held in Canada. The main theme of next year’s conference will be TCVM for geriatric, pediatric, rehabilitation, and terminal life care. This conference is co-sponsored by the World Association of TCVM and Chi Institute. The Annual International TCVM Conference has been taking place every year since 1999. It provides a great opportunity for veterinarians to learn from the top TCVM experts, meet TCVM practitioners from all over the world, and enjoy hands-on experience with Chinese medicine. Additionally, TCVM practitioners and research scientists from around the world are invited to speak about their clinical experiences and research findings.

INTRODUCING OUR NEWEST “CASE FORUM” ADMINISTRATORS As one of its many member benefits, the AATCVM provides case consultations via the online Discussion Forum. This year, the Forum has two exciting new moderators:

Connie Clemons-Chevis DVM, MSTCVM received her Master’s Degree in TCVM (MSTCVM) in 2015 from the Chi Institute and South China Agricultural College in Guangzhou, China on “The Application of TCVM to Atlantic Bottlenose Dolphins (Tursiops truncatus). Since 2010, Dr. Clemons-Chevis has been a Chi Institute instructor or teaching assistant in Reddick, Florida and Guangzhou, China, as well as Spain and Costa Rica, and a teaching assistant with the International Veterinary Acupuncture Society (IVAS). She has a TCVM-only practice in Bay St. Louis, Mississippi and the Republic of Panama, and serves as Veterinary Consultant for the Institute for Marine Mammal Studies in Gulfport, Mississippi. Dr. Rieko Miura Tran was born and raised in Hokkaido, Japan. After she graduated from Obihiro University of Agriculture and Veterinary Medicine (Japan), she began practicing small animal medicine and surgery in Northern Virginia in 1999. She is certified in veterinary acupuncture (CVA), Tui-na (CVTP), and Chinese Herbal Medicine (CVCH) through the Chi Institute. She is an owner of Pearl Veterinary Holistic Medicine (division of Internal Medicine) at the Referral Center of Northern Virginia, where she provides Chinese medicine to companion animals. She is a teaching assistant at the Chi Institute.

We hope our members get a chance to contact these wonderful clinicians. We also thank Dr. Koh for all his years of service working with members and their difficult cases.

IVC Winter 2016

Advertorial

URINARY PROBLEMS

– know the rule-outs and make the right call By Jeff Nichol, DVM

For dog owners, urine soiling is a seriously frustrating problem. This makes differentiating physical from behavioral causes a critically important practice skill. Of the 74 million pet dogs in the US, 80% are kept indoors, with limited elimination opportunities. A history of house soiling accounts for 18.5% of the shelter population, making urinary issues a leading cause of pet surrender.1 Urinary signs in a dog may have behavioral causes, can signal a physical disorder, or possibly both. We need to ask when and where the dog urinates. Has she failed to wake the owner to let her out? Is there sudden urgency or pollakiuria? Are there indicators of pain when urinating? There may be predisposing factors. Indoor dogs are at higher risk of bacterial cystitis and urolithiasis. Obesity and painful joint disease make it difficult to access the outdoors. Pet owners can unwittingly obstruct the diagnostic process if they incorrectly assume they have failed to properly housetrain. In fact, behavioral causes are often involved. Comorbidities like generalized anxiety disorder or separation distress often contribute to urine soiling. Elderly dogs (over eight years) may suffer from cognitive dysfunction syndrome. These old-timers have actually forgotten the bathroom rules.

obesity. Nearly every one of these girls will respond safely and reliably to Proin® chewable tablets (phenylpropanolamine) from PRN Pharmacal. A skilled diagnostician never assumes. Consider bladder disease, diabetes mellitus or insipidus, hepatopathies, hyper/ hypo adrenocorticism, hypokalemia, hypercalcemia, renal failure, neoplasia, and ectopic ureters (often comorbid with urethral sphincter hypotonus). Evaluate the bladder and do a rectal for detection of urethral calculi. Rule out spinal pathology in cases of incontinence, and palpate the joints. Behavioral causes should be addressed after physical differentials have been investigated. Every dog that inappropriately urinates needs a serum chemistry profile, CBC, and urinalysis. Radiographs and ultrasound are indicated when spinal lesions or cystic calculi are suspected. Our clients rely on us to distinguish behavioral from physical disorders. They need answers, not short cuts. We’re good at evidence-based medicine. With a thorough history, diagnostic workup, and a personalized treatment plan, nearly every urine leaker and soiler can improve. Kass P, Scarlett J. “Behavioral Reasons for Relinquishment of Dogs and Cats to 12 Shelters”. Journal of Applied Animal Welfare Science, 3(2), 93-106. 2 Von Goethem B, Schaefers-Okkens A, Kirpensteijn J. “Making a rational choice between ovariectomy and ovariohysterectomy in the dog: a discussion of the beneﬁts of either technique”. Vet Surg 2006; 35:136-143. 1

There is an often overlooked differential. As many as 20% of spayed female dogs leak urine while resting or sleeping,2 but only 2% of dogs brought to veterinary clinics are presented for incontinence. Urethral sphincter hypotonus (spay incontinence) is more common in large breeds and those who struggle with

IVC Winter 2016

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

IVC Winter 2016

TCVM perspective and treatment of equine metabolic syndrome By Cynthia Lankenau, DVM, CVA, CVCHM, RH (AHG)

IVC Winter 2016

n the last few decades, the overall quality of health in our equine patients has been deteriorating.1 We are seeing an increase in several chronic conditions, including those indicative of immune-mediated inflammatory diseases such as recurrent uveitis. We are also seeing diseases that indicate significant failure of normal function, such as the complex of conditions known as Metabolic Syndrome. “Metabolic Syndrome” is a term used to describe horses with both a metabolic and hormonal disorder characterized by obesity, regional adiposity, insulin resistance and laminitis. According to figures from the American Association of Equine Practitioners, we are facing an epidemic of over 20% of all horses at risk of developing Metabolic Syndrome. Many breeds are also at increased risk of developing immune-mediated diseases; for example, the Appaloosa has an 8x risk over other breeds of developing recurrent uveitis and is responsible for 25% of all cases.2 Recurrent uveitis is often incited by viral, bacterial or spirochete organisms.2 These diseases are becoming difficult to control and cure, even with the help of alternative modalities. The Six Stages of disease were first developed by the great master of Chinese Herbology, Zhang Zhong Jing (142 to 220 ACE) when he wrote the Shang Han Lun on Cold Damage. When examining these diseases in the context of the Six Stages of disease, conditions found at the level of the Jue Yin are serious and occurring at the deepest stage in the body. A Jue Yin disease reflects the separation of Yin and Yang and the collapse of Zheng Qi. Metabolic Syndrome with concurrent signs of Heat in the upper body or in the extremities is indicative of a Jue Yin syndrome.

ASSESSMENT AND TREATMENT CHALLENGES OF METABOLIC SYNDROME Snowflake is a 19-year-old Appaloosa mare, a companion and trail horse. Her early history only made note of a tendency toward obesity, a full complement of yearly vaccines (tetanus, rhino, flu, EEE and WEE, West Nile and rabies), and frequent administrations of anthelmintic drugs. She had an initial episode of uveitis in April of 2006 which was treated with conventional steroidal eye medications and a triple antibiotic ophthalmic ointment. This initial episode resolved within a month. Over the next six years, Snowflake continued to have periodic episodes that were progressively more severe with poorer resolution and longer recovery times. Her worst episodes seemed to occur during the change of seasons in the spring and fall. Concurrent with the intermittent use of corticosteroids, Snowflake was experiencing weight gain.

Throughout this time, her other health issues included periodic high fecal egg counts that were unresponsive to the conventional veterinarian’s “power pack”, and two mild episodes of colic characterized by poor bowel motility. In 2013, Snowflake’s owner had received a grim long-term prognosis. Her vision was deteriorating, with significant cataract formation seen in both eyes, and her conventional veterinarian stated the outlook was “hopeless”. In 2014, her owner decided to investigate alternative forms of treatment. In September, she presented to me with unresolved hyperemia in the conjunctival tissue of both eyes, with marked cataract development in the right eye, and mild development in the left. She had significant blepharospasm, worse in the right eye, with excessive lacrimation in both. She was very reactive on BL-18, her tongue was red and swollen with copious phlegm, her pulse was fast but wiry with tone. There was strong evidence for Liver Fire, but Snowflake was also Spleen Qi Deficient and had Qi Stagnation. Her initial acupuncture treatment included dry needling of BL-18, BL-19, BL-20, LIV-3, GB-20, ST-36, BL-1 and ST-2. She received an autosanginous injection of Aqua-AP of Traumeel (Heel) in the local eye points. Her TCVM diagnosis was Liver Damp Heat with Liver Fire Rising, and a slight Spleen Qi Deficiency with Stagnation. Due to the intense Damp Heat in her eyes, her herbal formula was Long Dan Xie Gan Tang (JT) to clear the Liver Damp Heat. Within a week after her treatment, Snowflake’s eyes were much less red, with the blepharospasm resolved. Over the next year, Snowflake was treated four times. Although much better, she still exhibited signs of Liver Damp Heat with increased tearing and slight redness in her conjunctiva, and her underlying Qi Deficiency and Stagnation seemed to worsen. Her tongue was still swollen with marked phlegm. It was felt that the draining effect of Long Dan Xie Gan Tang was contributing to this further weakening of her Qi. Yet if she was taken off of Long Dan Xie Gan Tang, her eyes would immediately worsen. To treat this underlying Qi deficiency, several herbal modifications were made with moderate response: Si Miao San (JT) was incorporated; increased percentage of Poria, Fu Ling; and finally Wei Qi Booster (JT). Although these herbal modifications helped diminish signs of Qi deficiency, Snowflake continued to show signs of simmering Heat in her eyes with the slow progression of cataract formation. There were more signs of Qi Stagnation as her tongue was slightly lavender and her adipose deposits were increasing. During the summer months, Snowflake started to exhibit overt signs of insulin resistance with increased weight grain, increased fat deposition and a subtle increase in digital pulses in all four hooves. There was definitely a deeper unresolved issue. Continued on page 56. IVC Winter 2016

Continued from page 55. On October 24, 2015, the day after the first heavy frost, Snowflake was out on an eaten-down pasture for an hour. Later that day, she could hardly walk. On physical exam, her pulse was very toned, wiry and rapid, her tongue was purplish red, swollen with phlegm. She was showing signs of acute laminitis, with bounding digital pulses. She was standing in the classic foundered posture with her forelegs extended, was constantly shifting her weight and seemed agitated. Her eyes were acutely red, with marked swelling in the infraorbital fossa. She was reactive on BL-15, BL-18, BL-19 and BL-22. This time, Snowflake was diagnosed with a Jue Yin pattern. She was in a critical state with a deficient but stagnated immovable Yin; her Yang energy was evident as Heat in her extremities and upper body. This Yang entrapment in the upper body was reflected in her purple red tongue, restlessness and agitation; the acute eye redness and inflammation; and the heat forced to her extremities in the signs of laminitis. Her immovable Yin energy was characterized by the building signs of insulin resistance, adipose deposits and weight gain.

CHINESE MEDICAL ETIOLOGY AND ATHOGENESIS A Jue Yin stage is characterized by a marked dysfunction of the Liver and Pericardium. The pattern occurs when there is an accumulation of Jue Yin (Liver). The Yang energy is unable to penetrate into the Yin and is then squeezed outward and upward. The Yang energy is then trapped in the extremities and upper body. This is a critical stage as Yin and Yang are separated and will become unable to produce Zheng Qi.3 This is a potentially life-threatening state; if Yin and Yang separate, death will occur.

The theory of the Six Stages was written by Zhang Zhong Jing in response to an epidemic that killed over 200 of his relatives. The Shang Han Lun attributes Cold damage to the invasion in the body by pathogenic evils. “In the four seasons, all qi that is not right qi is called cold damage”.4 As an Appaloosa, a breed known for its higher rate of immune-mediated diseases, Snowflake is genetically susceptible to the ills of an invading pathogen. She would have even greater difficulty clearing an invading pathogenic “evil”, allowing for the establishment of uveitis, an auto-immune condition. When pathogenic evils are not cleared as they enter the body, they can move into deeper stages in the body. There are many possible inciting pathogenic factors, including vaccine antigens or adjuvants, GMO particles, or one of the other recognized predisposing pathogens of uveitis – viral, bacterial or spirochete organisms. Regardless of which specific pathogenic factor is involved, it’s theorized that this invading “evil” progressed through the various channels until it reached the Jue Yin stage in Snowflake This stage generally develops some time after the onset of Cold damage disease. It is more complicated and severe than disease in any other channel.

HERBAL MEDICINE USED Wu Mei Wan (Mume Plum Pill) is the formula indicated for a Jue Yin state characterized by Yang trapped upward, with Cold impenetrable Yin. (see table 1 below). This herbal formula contains both Hot and Cold ingredients to address the ColdHeat complex, and also includes ingredients that are sour, bitter and acrid. Ginseng rhizome (Ren She) restores Qi formation, while ginger rhizome (Gan Jiang), prickly ash bark (Hua Jia) and aconitum prepared root (Fu Zi) inject Yang into the accumulation of Yin. Acrid and sweet ingredients together can warm Yang. Bitter

Chinese Pin-Yin

English name

Action

Wu Mei

Mume plum

Calms parasites; softens Jue Yin

Huang Lian

Coptis rhizome

Clears Heat in the upper body

Gan Jiang

Ginger rhizome

Injects Yang back into Yin; warms the interior and dispels Cold

Hua Jiao

Prickly ash bark

Injects Yang back into Yin; warms the interior and dispels Cold

Huang Bo

Phellodendron bark

Clears Heat accumulated and descends it downward

Fu Zi

Aconitum root (prepared)

Injects Yang back into Yin; warms the interior and dispels Cold

Gui Zhi

Cinnamon twig

Promotes the expansion of Jue Yin

Ren Shen

Panax ginseng

Tonifies Qi and Blood; restores Qi

Dang Gui

Angelica root

Softens Jue Yin and tonifies Qi and Blood

Table 1: Composition of Wu Mei Wan (EG)

IVC Winter 2016

Cold coptis rhizome and phellodendron clear Heat accumulated in the upper body, and descends Yang back to where it can be integrated. Angelica root (Dang Gu) and Mume plum (Wu Mei) soften Jue Yin while cinnamon promotes its expansion.5 Wu Mei Wan contains sour and sweet to enrich Yin, sour and bitter to drain Heat; acrid and sweet to warm Yang; acrid and bitter to open and bear downwards. This formula should be considered the primary choice for treating reverting Yin Cold-Heat complex patterns. Wu Mei Wan is designed to resist the extreme Jue Yin state with cinnamon by strengthening the next phase of Yin development associated with the Lung. Dosage: 2 tsp. twice a day Concurrent therapy: Snowflake also received dry needle acupuncture with her primary points being LIV-1, LI-4, SP-4 and PC-6 to treat her Jue Yin state; PC-9 for a local fore foot point; and ST-36 for general harmonizing. Follow-up/outcome: Within 24 hours, Snowflake’s digital pulse had resolved and she was walking normally! The redness in her eyes was gone, although there was still some infraorbital swelling. Her owner felt she was acting her best since 2006. This was felt to be a truly rapid response to treatment. Her re-check six weeks later, on December 2, 2015, showed clear eyes, no digital pulses, a pinker and not-so-swollen tongue, and pulses that were still slightly wiry. Overall, she was much better and the plan was to continue Wu Mei Wan. On February 12, 2016, Snowflake’s eyes were at their best ever. She was still struggling with obesity, so has continued with Wu Mei Wan.

Snowflake in December of 2015 – the “best her eyes have been since 2006.”

DISCUSSION Snowflake is an example of a horse that had subtle signs of a Jin Yin stage a decade ago. She had a tendency toward obesity, a persistently high parasite count – both signs of excessive Yin accumulation – with concurrent signs of Yang energy being entrapped upward, leading to uveitis. Although the initial herbal and acupuncture treatments palliated the signs of her Yang entrapped energy, it was not resolved and her accumulation of Yin continued. During the approaching winter of 2015/16, with the extra sugar stress of recently frosted grass, she exhibited a final acute aggravation of her underlying chronic disease, and her Jue Yin stage was finally recognized. Classical literature considers Wu Mei Wan a formula for parasites.6 The main clinical manifestations are ascariasis characterized by Heat in the Stomach and Cold in the Intestines. The presence and movement of roundworms cause a disruption in normal Qi flow and, if severe, the flow of Yin and Yang Qi will be disrupted. The clinical manifestations of a Jue Yin stage is a feeling of energy rising to the chest, pain and a sensation of heat in the heart region.7 But this formula should not only be considered for roundworm reversal; it should also be the primary formula for treating reverting Yin Cold-Heat complex patterns.4 Continued on page 58. IVC Winter 2016

Continued from page 57. When looking at the energetics of a disease in the Jue Yin stage, Wu Mei Wan is the formula of choice since it treats conditions in which there are signs of overt Heat and Yang energy in the extremities and upper body, along with signs of extreme Jue Yin accumulation in the lower abdomen. The Yang energy is squeezed out and is forced up and out. Jue Yin states are often aggravated in the winter as Yang energy naturally tends to move toward the interior. (Snowflake had some of her worst episodes in the fall.) As Yang energy migrates inward, it is repelled out and up from the impenetrable accumulation Yin in the abdomen. This was seen in Snowflake’s final aggravation, when the sugar stress increased her Yin accumulation while the cold weather aggravated the inability of her Yang energy to penetrate her Yin; she had an acute separation of her Yang and Yin.

The absence of Yang energy in the abdomen prevents proper Spleen function; this is a characteristic symptom of Metabolic Syndrome. This Yang energy can instead accumulate in the Heart, giving the very common symptom of laminitis. When recognizing the serious nature of a Jue Yin stage, it becomes clear the peril our horses are in with Metabolic Syndrome; not only is it a barometer of the overall poor level of health of horses, but it also explains why it’s so difficulty to cure this syndrome. (See Fall IVC Journal for four more cases.)

Lankenau C. “The Deterioration in Equine Vital Health”. The Academy of Veterinary Homeopathy, 2008 Annual Meeting; pp. 63-69.

Gilger B. “Equine Recurrent Uveitis in Appaloosa Horses”. Equine Ophthalmology 2 ed., Saunders; 2011: p. 307.

Tierra M, Tierra L. East West Herb Course, Ben Lomond, CA; p.32-21, 2011.

Zhang Zhong Jing Shang Han Lun on Cold Damage; translations and commentaries by Mitchell C, Ye F, Wiseman N. Paradigm Publications, 1999; p. 9.

Marsden S. “Chinese Medical Diagnoses Common in Winter”, NAVA Conference, 2015, p.32.

Chen J and T, Beebe S, Salewski M. Chinese Herbal Formulas for Veterinarians. Art of Medical Press; City of Industry, 2012, pp. 1054-1057.

Maciocia M. Diagnosis in Chinese Medicine, a Comprehensive Guide. Elsevier, 2004; p. 968

References Evergreen Herbs & Medical Supplies, City of Industry, CA Heel, Albuquerque, NM Dr. Xie’s Jing Tang Herbal, Inc., Reddick, FL

CHECK OUT

OUR FACEBOOK PAGE!

DO YOU HAVE A STORY TO SHARE? WE WANT TO PUBLISH YOUR STORIES OF MIRACULOUS RECOVERIES, HUMOROUS MISHAPS, AND FASCINATING CASES. Submit your story to: socialmedia@redstonemediagroup.com for a chance to have it featured!

Join us

FOR ARTICLES, INFORMATION, & MORE. 58

IVC Winter 2016

facebook.com/IVCJournal

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 American College of Veterinary Internal Medicine - ACVIM Denver, CO USA Phone: (800) 245-9081 Email: acvim@acvim.org Website: www.acvim.org American Holistic Veterinary Medical Association – AHVMA Abingdon, MD USA Phone: (410) 569-0795 Email: office@ahvma.org Website: www.ahvma.org 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 National Animal Supplement Council - NASC Valley Center, CA USA Phone: (760) 751-3360 Website: www.nasc.cc

EQUINE NATUROPATH Cassie Schuster, ND, MH Waller, TX USA Phone: (713) 502-0765 Email: cassie.schuster@yahoo.com Website: www.wellranch.com

Website: www.healfasttherapy.com

INTEGRATIVE THERAPIES

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

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

NATURAL PRODUCT

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

VETERINARY OPHTHALMOLOGY Dr. Nancy Park Board Certified Veterinary Ophthalmologist Integrative Ophthalmology For Pets - IOP Los Angeles, CA, USA Phone: (855) 623-3937 (EYES) Email: info@iopeyes.com Website: www.iopeyes.com

SCHOOLS & WELLNESS EDUCATION Animal Spirit Network Pekin, IL USA Phone: (815) 531-2850 Email: carol@animalspiritnetwork.com Website: www.animalspiritnetwork.com College of Integrative Veterinary Therapies - CIVT Rozelle, NSW Australia Phone: (303) 800-5460 Website: www.civtedu.org International Veterinary Acupuncture Society - IVAS Fort Collins, CO USA Phone: (970) 266-0666 Email: office@ivas.org Website: www.ivas.org

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

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

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

IVC Winter 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) was excited • Members continue to enjoy this year’s membership in the International Association of Veterinary Homeopathy, which to share their knowledge of veterinary homeopathy at the includes an active list serve in addition to our AVH list serve. AHVMA Conference in Columbus, Ohio in September. • Interested in becoming a veterinary homeopath? Registration is now open for the upcoming 2017 Professional Course in AVH Lectures on Saturday: Attendance started off strong in Veterinary Homeopathy at pivh.org. the first lecture, and grew steadily with each presentation – • For more information on veterinary homeopathy, please the afternoon lectures boasted over 100 attendees! visit theavh.org. • Dr. Lisa Melling gave an introduction to the use of homeopathy in the treatment of acute illnesses, injuries, and post-surgical analgesia. Attendees learned which remedies to stock in their practices, as well as about proper – EQUINE STRANGLES administration, and evaluation of patient response. By Sarah Stieg, DVM, MRCVS • Dr. Todd Cooney lectured on the topics of contagious disease, On August 4, 2012, Marmite, a two-year-old filly vaccinosis (illnesses related to administered vaccines), and (Standardbred x French Trotter) presented for evaluation alternatives to vaccination, including titer testing, homeopathic of acute submaxillary lymph node swelling. She lived at remedies during epidemics, and nosodes. a horse breeding/dealing facility where Strangles (S. equi) was endemic on the property, with recurrent outbreaks. AVH/PIVH booth in Exhibition Hall: The AVH and the Pitcairn Physical exam findings included submaxillary lymph Institute of Veterinary Homeopathy (PIVH) collaborated to node swelling, with the left side most severely affected, promote homeopathy. Hundreds of veterinarians visited and soft tissue swelling underneath the left maxilla that the booth to learn more about homeopathic treatment for extended to the left cheek and throatlatch region. The animals, the upcoming course in veterinary homeopathy, and patient demonstrated lethargy, malaise and decreased the benefits of membership in the AVH. appetite. The client declined further diagnostics.

CASE STUDY

AVH/PIVH Presentation: “Helping Our Patients: 10 More Reasons to be a Homeopath” was a presentation of ten successful cases from the practices of Drs. Sarah Stieg, Lisa Melling and Todd Cooney. Attendees enjoyed wine, appetizers and raffle prizes. One of the cases is shared at right.

MORE NEWS AND NOTES

• More lectures on homeopathy will be featured at the Midwest Veterinary Conference in Columbus, Ohio from February 23 to 26. Dr. Lisa Melling will offer six hours of homeopathy lectures, with topics ranging from introductory homeopathic prescribing to advanced cases involving cancer, masticatory myositis, atopic dermatitis, lupus and more. Information on this conference is available at mvcinfo.org.

IVC Winter 2016

A single dose of Calcarea carbonica 10M was administered. This homeopathic medicine was selected because of its affinity for glandular swelling below the jaw and neck, abscesses in deep muscles, and painful swelling and suppuration of submaxillary glands. Just 24 hours following treatment, Marmite was much brighter, had a returned interest in feed, and the swelling had reduced around her cheek and throatlatch region. At 48 hours following treatment, the abscess ruptured, the swelling reduced further, and the patient returned to normal behavior.

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

2016 CONFERENCE HIGHLIGHTS

The AHVMA’s Annual Conference from September 10 to 13 in Columbus, Ohio was the most inclusive to date. We had over 440 attendees from seven different countries. While the majority of attendees were practicing veterinarians, we were glad to see an increase in student (including strong SAHVMA representation) and veterinary technician participation. As always, the 2016 conference offered a wide range of topics including Traditional Chinese Veterinary Medicine, cancer treatments using herbs and supplements, homeopathy, updates on rabies virus protection and much more. Other favorite conference activities include the Newcomers’ Social (sponsored by Hemp Health), the VBMA Herb Walk, and the annual Retreat. During the 2016 Retreat, 39 participants joined Dr. Susan Wagner to explore energetic patterns and how they relate to our understanding of illness and wellness. During this year’s Annual Banquet, AHVMA paid special tribute to Dr. Marvin Cain, a pioneer of holistic veterinary medicine. Dr. Cain and his family attended the banquet where he received the Carvel Tiekert Lifetime Achievement Award. This year’s AHVM Foundation Silent Auction raised over $15,000 for the AHVM Foundation student scholarship fund. The AHVM Foundation’s end-of-year fund drive runs November 15 to December 15. An AHVMA member veterinarian has pledged to match up to $50,000 of donations made during this fund drive! Our exhibit space increased by 30% over last year! Our exhibitors are an essential part of AHVMA, providing the products and support we need to offer alternatives to our patients. Exhibitors sponsor many special events including Breakfast Meetings, socials, and the New AHVMA Conference Mobile App! This year’s sponsors included BIOAGE, Darwin’s Natural Pet Products, Vet Classics, Primal Pet Foods, Vets First Choice, Standard Process, animalEO, Kan Herb, Radagast Pet Food, Hemp

Dr. Marvin Cain accepts the Carvel Tiekert Lifetime Achievement Award.

Health, Cutting Edge Laser, AniCell BioTech, MultiRadiance Medical, O3 Vets, Options for Animals, Calm My Pet, Herbalist and Alchemist and Animal Nutritional Products. AHVMA remains a proud member of the AVMA House of Delegates. Because we are an AVMA Constituent Organization, many states grant blanket approval for AHVMA CE. The 2016 AHVMA Annual Conference featured a grand total of 104 hours of lectures and labs to choose from. One of this year’s proudest achievements was a record-breaking 94 RACE-approved Continuing Education Credits!

ON THE RISE

AHVMA’s Annual Conference registration and membership continue to rise. This is a strong indicator that the demand for holistic approaches to treat infections, new viruses, cancer, and overworked immune systems also continues to rise. Pet owners are looking to holistic medicine for prevention and first line defense rather than as a last resort when conventional medicine has failed. Acupuncture, chiropractic, nutrition, physical rehabilitation, herbal medicine, and many more modalities are being introduced in conventional clinics. These modalities (and more) are being researched, with studies published in the Journal of the American Holistic Veterinary Medical Association on a quarterly basis. The AHVMA continues to be a positive force, providing members with effective holistic solutions for the multitude of challenges facing all veterinary practitioners, and improving the health and lives of all pets. IVC Winter 2016

integrative practice

EXTEND YOUR REACH THROUGH PARTNERSHIP DEVELOPING A PARTNERSHIP WITH A LOCAL HOLISTIC PET SUPPLY STORE CAN BENEFIT YOUR PRACTICE IN SEVERAL IMPORTANT WAYS.

By Terri Symonds Grow, BIS

USE INFLUENCERS TO YOUR ADVANTAGE

Did you know your local holistic pet store or health food store can help you improve client relations, extend the reach of your practice and address client compliance? Already part of your clients’ pet care network, these potential business allies position themselves as resources to their customers. Above all else, these stores know your clients are consumers with decisive buying power and unlimited access to products and information in the growing pet industry.

Pet food companies, pharmacies, web stores, brick and mortar stores, and lifestyle services invest heavily in attracting and persuading your clients. The US pet product retailing market has never been more competitive, placing your clients in the driver’s seat. The desire for premium products and the client’s emotional involvement in purchase decisions show that today’s pet owner is willing to invest in the health care and even indulgence of her pet.

Today’s clients, especially those seeking holistic care, are wellinformed, more proactive in seeking health information, and no longer willing to be the veterinarian’s captive audience. Online access puts products and information at their fingertips, social media and personal connections are proven influencers – and local specialty and holistic pet stores offer relationships and personal services.

Clients shop through different channels for a variety of reasons: convenience, brands, store rewards and price. While price isn’t always the bottom line, price shopping is on the rise, and is an increasing challenge to community stores. Understanding your clients’ purchase decisions (see sidebar on page 64), and what steps are involved in shaping those decisions, may help you reduce your time and overhead requirements.

Whether veterinarians approve or not, pet industry sales demonstrate that clients are seeking alternatives to traditional veterinary product outlets. Partnering with your local holistic pet or health food store may open new opportunities for your practice, your clients, your bottom line, and the community.

A RESOURCE DESTINATION

IVC Winter 2016

Although holistic pet supply stores began to appear in the early 1990s, it wasn’t until the massive pet food recall of 2007 that the concept was embraced and a surge of holistic stores emerged to meet customer demands.

The success of a holistic pet supply store is based on its competitive edge in the market. This requires the store to become a destination resource, offering premium, innovative and environmentally-safe products, product knowledge, and value added service. It requires qualified personnel and a store philosophy that takes the time to educate clients – which means the store can be a valuable asset to you, your clients, and the community. To protect their competitive edge, these stores work with manufacturers to offer products not available in mass-market stores, along with price competitive buying programs, and also work to support their animalstrong community.

5 BENEFITS OF PARTNERSHIP

Client access. The holistic pet supply store sees your client a minimum of 12 times a year. In some cases, the client will visit her preferred local pet store once a week. A key tool in advertising is frequency, the number of times a consumer needs to be exposed to an advertisement to remember, respond to, or purchase a product. Typically, a customer needs to be exposed to a product seven times in order to become motivated enough to even think about purchasing it. Consider this when you think about how often and by which methods you communicate with clients beyond their yearly wellness checkup reminders. Does your local holistic pet supply store display your brochure? What about offering ways to have your clinic’s information included in the store’s ongoing promotions?

“Often a client comes in looking for a natural remedy for their pet’s health issue, and it’s not until I ask a number of questions that they admit they are under the care of a homeopathic veterinarian. If we had sold a recommendation without knowing this information, we could have interfered with the therapy. Not to mention we could have been seen as irresponsible by the veterinarian. I’ve had this happen repeatedly with drugs and supplements. So it often falls on our shoulders to help clients understand and navigate holistic health care.” – Pet store owner

Product traceability. When was the last time your client returned a product? Specialty stores take note of what products are returned, why they are returned, and how the manufacturer responds to product complaints. These stores are also the first to know about unlabeled changes in foods and products, through client comments and feedback. Creating an up-to-date reference on adverse product issues and sharing concerns helps support your clients in making better decisions and will save you time, frustration and maybe your patients’ health. Continued on page 64.

Client relationships. These stores know your clients by name and/or their pets’ names, and even know some of their personal history – sometimes too much. They know who follows your protocols and who adds their own treatments. More importantly, though, they have the ability to extend the reach of your clinic and reinforce your role in the care of that client’s pet. Clients value trusted referrals and appreciate a support network or team approach. One of the greatest opportunities a partnership can offer is to help educate clients on a more integrative approach. Have you offered to give talks at the store, or invited store staff and/or their customers for a tour? Maybe you could share a case study in their newsletter, showing your collaboration. Another thing to keep in mind: when you know your clients will be buying products at other locations, it is a good idea to advise them to first let the store’s staff know how their animals are being treated for any conditions. IVC Winter 2016

UNDERSTANDING YOUR CLIENTS AND CONSUMER BEHAVIOR

Clients come from many walks of life and their decisions are inﬂuenced by a range of factors, such as ethnicity, gender, lifestyle, experience and age. Currently, women inﬂuence 80% of consumer purchases in the US. The female shopper requires in-depth information, handholding, attention to detail and even resource relationships. Male shoppers, on the other hand, seek solutions, minimal interaction, and often rely only on written guidance. Looking ahead, the diversity of the next generation of pet owners is shifting, bringing new opportunities for innovative communications relating to products and services. Continued from page 63. After a highly recognized, high protein, low carbohydrate brand was re-launched in new glamorous packaging, the extensive formula and guaranteed analysis changes went unnoticed until health issues surfaced, including dramatic weight loss and seizures.” – Online retailer

Product knowledge. Clients want the latest and best for their pets. Product knowledge goes beyond the items on the shelf, beyond knowing the manufacturer, sourcing, and quality controls. Understanding the product’s application, contraindications and limitations, and knowing how to help the client choose what is best for her pet, is vital.

“Many clients are referred for food therapy recommendations, i.e. Cooling or Warming. With commercial foods it’s not that simple to recommend a specific protein. Unless your client can read a pet food label to understand that while the protein in the food is Cooling, the balance of the formula is Warming, your food recommendations are not going to be fulfilled.” – Store staff

IVC Winter 2016

Industry knowledge. Pre-empting the newest trends requires researching the industries that are in turn influencing the pet industry, including environmental issues, cosmetics, human health and natural foods, regulatory issues and safety. You are busy enough staying current with the many treatment modalities you offer, so let your pet store ally help you and your clients in these areas.

Clients seek information destinations either through brick and mortar locations or online. Help guide their need to know, and their advocacy, by being proactive in generating resources that partner with you in furthering your patients’ health care. Recognize that your role can be pivotal, but understand that it is also weighed, evaluated and compared against the client’s consumer experiences. Acknowledge your client’s decision-making and consumer behavior and use them to your advantage. Develop strategies to help shape purchases, enforce client care compliance, reduce your frustrations, and help your patients to healthy well-being. Acknowledge that veterinary clients and pet store customers are not mutually exclusive. Developing partnerships with holistic pet supply stores can extend the reach of your care, enhance the positioning of your exclusive veterinary products, and possibly protect a valuable community resource. Better yet, you have the opportunity to introduce your clients to holistic and integrative care approaches through a network within the community. Not to mention you can reduce your clinic’s time and inventory investments, allowing for the expansion of your range of specialty services.

marketplace

ADVERTISE

HERE! 866-764-1212

IVCJournal.com

Subscribe to IVC Journal Today! For a limited time only, IVC Journal is available by subscription for FREE. To order your subscription please visit

IVCJournal.com

IVC Winter 2016

events

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

2017 AVMA Veterinary Leadership Conference

Minnesota VMA 119th Annual Meeting

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

This Annual Meeting offers many opportunities, including continuing education, networking with friends and colleagues, a silent auction and two breakfast seminars. You will have the chance to participate in:

January 12 - 14, 2017 – Chicago, IL

For more information: vlc@avma.org www.avma.org/vlc

Ontario Veterinary Medical Association Conference January 26 - 28, 2017 – Toronto, ON

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

CenCan Veterinary Conference February 3 - 5, 2017 – Winnipeg, MB

Hosted by the Manitoba VMA & the Manitoba Animal Health Technologists Association, this event will be a prime opportunity to connect face-to-face with the veterinary community. Have a new product or service to promote? Want to meet with existing clients or potential clients? Then this is the conference for you!

February 23 - 25, 2017 – Minneapolis, MN

3 Full Days of Practice Management Sessions 3 Small Animal Tracts Offered Daily Veterinary Practice Plus Track Bovine, Equine & Swine Programs Public Health Program Industrial and Small Ruminant Seminars For more information: (651) 645-7533 info@mvma.org www.mvma.org

Midwest Veterinary Conference February 23 - 26, 2017 – Columbus, OH

The Midwest Veterinary Conference (MVC), hosted by the Ohio Veterinary Medical Association, is a growing, regional veterinary conference packed with educational, networking and social opportunities for every member of the veterinary team. Bringing together highly regarded experts from around the world and hundreds of industry vendors, the MVC is a national-caliber conference. For more information: (800) 662-6862 info@mvcinfo.org http://mvcinfo.org

89th Annual Western Veterinary Conference March 5 - 9, 2017 – Las Vegas, NV

The WVC provides comprehensive continuing education to veterinary professionals and is an interactive educational opportunity for networking with the veterinary community. WVC grows in size each year adding new speakers that present state-of-the-art handson labs in a comfortable environment.

For More Information: Tracy Rees (204) 832-1276 trees@mvma.ca www.mvma.ca/ce/cencan-conference-2017

Conference registration automatically enrolls the registrant as an association member for the following year.

North American Veterinary Conference February 4 - 8, 2017 – Orlando, FL

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

2016 Virginia Veterinary Conference

For more information: (702) 739-6698 carolyn@wvc.org www.wvc.org

AAHA Nashville 2017

March 30, 2017 - April 2, 2017 – Nashville, TN Join us to experience something new and unique at AAHA Nashville 2017. This annual veterinary conference offers the opportunity to learn practices from industry experts, discover the latest and greatest in products & services, and network with fellow veterinarians and technicians from around the country. Austin’s magic draws you in. The innovative CE you receive at the AAHA conference will delight you. For more information: (800) 883-6301 www.aaha.org

February 16 - 18, 2017 - Roanoke, VA

The 2016 Virginia Veterinary Conference offers two full days of continuing education in small animal, equine, technician, public practice (Friday only) and complementary medicine (Saturday only). If you attend the conference Friday and Saturday, you may earn the necessary 15 hours to renew your Virginia veterinary license. For more information: (804) 346-2611 www.vvma.org

IVC Winter 2016

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

IVC Winter 2016