IVC SPRING 2017
Integrative VETERINARY CARE VOLUME 7 ISSUE 2
INTEGRATIVE MANAGEMENT OF NEUROLOGIC CONDITIONS How integrative modalities can help treat neurological ailments in dogs and cats. — P. 13
PREVENTING AND TREATING EQUINE HERPES MYELOENCEPHALOPATHY
FEEDING THE INTESTINAL MICROBIOME
CAN PRIMARY OR IDIOPATHIC SEIZURES BE CURED?
Surgery, cage rest, lifetime meds and euthanasia are not the only options – P. 20
www.IVCJournal.com
SPRING ISSUE 2017
INTEGRATIVE VETERINARY CARE JOURNAL
SUCCESSFUL INTEGRATIVE TREATMENT OF SPINAL DYSFUNCTION
Good health requires a healthy gut, so dietary choices play a crucial role for your canine and feline patients. — P. 30
MANAGEMENT TIPS FOR A SUCCESSFUL PRACTICE
Learn to keep the daily pressures, interruptions and business details of running a veterinary clinic from eroding your well-being. — P. 42
What we know about the neurologic form of the EHV-1 virus, and how an integrative approach can help prevent and treat it. — P. 58
Unlike conventional medications, which only control seizure symptoms in dogs and cats, homeopathy offers the possibility of a genuine cure in the majority of cases. — P. 50
WHAT’ S NEW • Wanted: your success stories using herbal medicine • New research looks at microRNA as a way to detect cancer cells in dogs • Study on equine health and management highlights industry trends
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contents FEATURES
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INTEGRATIVE TOOLS FOR NEUROLOGIC DISEASES By Janet Gordon Palm,
DVM, CVCP
Neurological conditions in pets may be managed with a combination of approaches for evaluation, and modalities such as neuronal adjustment, myofascial release and FSLLLT.
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INTEGRATIVE TREATMENT OF SPINAL DYSFUNCTION
By Margie Garrett,
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AN INTEGRATIVE APPROACH TO EQUINE HERPES MYELOENCEPHALOPATHY
By Kimberly Henneman, DABT, CVA, CVC
A look at what is currently known about this neurologic manifestation of the EHV-1 virus, along with integrative therapies for prevention and treatment.
DVM, CVA, CIVCA, CVTN
How acupuncture, homeopathy and other therapies can help in the treatment of intervertebral disc disease (IVDD) and spondylosis in canine and feline patients.
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NUTRITION NOOK
INGREDIENT SOURCING FOR OPTIMAL NUTRITION IN DOGS AND CATS
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By Nancy L. Martin,
MS, DVM, CVA
A look at the intestinal microbiome and why fresh organic food is the healthiest choice for your animal patients.
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PROTOMORPHOGENS By Tom Cameron, Sue Howell, DVM
DVM
and
This novel integrative nutritional approach to neurologic disorders and autoimmunity in cats and dogs uses tissue-specific protein extracts.
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INTEGRATIVE PRACTICE
CREATING A HOLISTICALLYMANAGED PRACTICE
By Cindy Maro,
DVM, CVA, CAC, VMRT
Many factors contribute to a thriving veterinary practice that supports the financial abundance and mental and emotional well-being necessary for long-term success.
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HOMEOPATHIC TREATMENT OF PRIMARY OR IDIOPATHIC SEIZURES
By John Saxton, Vet Med, Vet FF Hom, Cert IAVH, MRCVS Unlike conventional medications, which only control seizure symptoms in dogs and cats, homeopathy offers the possibility of a genuine cure in the majority of cases.
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DVM, DACVSMR, FAAVA,
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advisory board Dr. Richard Palmquist, DVM GDipVCHM(CIVT) CVCHM (IVAS), graduated from Colorado State University in 1983. He is chief of integrative health services at Centinela Animal Hospital in Inglewood, California, president and research chair of the AHVMA, and an international speaker in integrative veterinary medicine. Dr. Palmquist is a consultant for the Veterinary Information Network (VIN) and codirector of the AHVM Foundation. He has published two books, one for conventional veterinarians and a second for clients discussing how integrative thinking works.
Michelle J. Rivera, MT, VDT, is an instructor at the University of Wisconsin and The Healing Oasis Wellness Center, a post-graduate educational institution offering state-approved programs. She is co-owner of The Healing Oasis Veterinary Hospital, offering massage, rehabilitation, chiropractic and Chinese and Western Herbology. Michelle completed the Chinese Herbal Medicine program from the China Beijing International Acupuncture Training Center, and is certified in Chinese Medicine by the Wisconsin Institute of Chinese Herbology.
COLUMNS & DEPARTMENTS
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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’ 27 From the WAEO 41 Industry innovations 48 Veterinary resource guide 49 From the VBMA 56 From the VMAA 63 From the AHVMF
Dr. Steve Marsden, DVM, ND, lectures for the IVAS, the AHVMA and the AVMA, and is co-founder of the College of Integrative Veterinary Therapies. He is a director of the National College of Natural Medicine, and authored the Manual of Natural Veterinary Medicine. Dr. Marsden is extensively 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.
64 From the AVH 65 Marketplace 66 Events
Dr. Barbara Fougere, DVM, CVAA graduated in 1986, and was named the American Holistic Veterinary Medical Association Educator for 2011. Dr. Fougere is the principal and one of the founders of the College of Integrative Veterinary Therapies. She has continued studying over the last 26 years, and has three Bachelor degrees, two Masters degrees, three post Graduate Diplomas, several Certifications and numerous other courses under her belt.
Dr. Christina Chambreau, DVM, CVH, graduated from the University of Georgia Veterinary College in 1980. She is a founder of the Academy Of Veterinary Homeopathy, was on the faculty of the National Center for Homeopathy Summer School and has been the holistic modality adjunct faculty liaison for the Maryland Veterinary Technician Program. Dr. Chambreau teaches classes in homeopathy for animals, and lectures on many topics. She is the author of the Healthy Animal’s Journal and the co-author of the Homeopathic Repertory: A Tutorial.
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Integrative VETERINARY CARE
SPRING 2017
EDITORIAL DEPARTMENT Editor-in-Chief: Dana Cox Managing Editor: Ann Brightman Associate Editor: Christina Chambreau, DVM, CVH Staff Writer: Emily Watson 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: Eraxion
COLUMNISTS & CONTRIBUTING WRITERS
Tom Cameron, DVM Margie Garrett, DVM, CVA, CIVCA, CVTN Marty Goldstein, DVM Janet Gordon Palm, DVM, CVCP Kimberly Henneman, DVM, DACVSMR, FAAVA, DABT, CVA, CVC Sue Howell, DVM Christopher Kelly Groth Cindy Maro, DVM, CVA, CAC, VMRT Nancy L. Martin, MS, DVM, CVA Jeff Nichol, DVM John Saxton, Vet Med, Vet FF Hom, Cert IAVH, MRCVS
ADMINISTRATION & SALES Publisher: Redstone Media Group President/C.E.O.: Tim Hockley Accounting: Karen Jeffries Circulation & Office Manager: Libby Sinden
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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.
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IVC Journal (ISSN 2291-9600) is published four times a year by Redstone Media Group Inc. Publications Mail Agreement #40884047. Entire contents copyright© 2017. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: March 2017.
IMPROVING THE LIVES OF ANIMALS... ONE READER AT A TIME.
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editorial
INTEGRATIVE OPTIONS HELP
“SOOTHE THE NERVES” Neurological complaints may be the most challenging area of veterinary medicine, for both clinicians and clients. Symptoms of ataxia, weakness, and paralysis are so general that we often need expensive diagnostic testing to determine the problem. Some ailments can be fatal, and those that are treatable are expensive for clients. Treatments may need to be used for life and often have side effects. Not surprisingly, it was a huge relief when I learned that holistic modalities are very successful replacements for surgery and drugs, and can be used to improve quality of life in animals treated with pharmaceuticals. In my first year, a Dachshund who presented with such severe spondylosis that he could not bend his body was back to normal flexibility after three months using homeopathy. Such successes are not that unusual. In her article on integrative approaches to neurological ailments, Dr. Margie Garrett presents multiple modalities for both preventing and treating IVDD and spondylosis – it’s eye opening! Understanding the energetic basis behind holistic approaches is especially important for these serious ailments. Dr. Janet Gordon Palm delves into the physics of Newtonian and Quantum sciences to remind us that our goal is bigger than merely resolving symptoms – it’s to guide the cells back to optimal health and harmonic resonance. Often, the conventional neurological exam can be difficult to perform and interpret. Several of our authors explain how doing a holistic exam using all our senses, and adding alternative modalities such as TCVM and chiropractic, can help determine successful treatment strategies. With many dogs experiencing seizures these days, managing them can be challenging for clients, since drugs are expensive,
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lifelong, and often have side effects. Dr. John Saxton shows the effectiveness of homeopathy to rebalance the quantum field so seizures resolve, even when drugs have not worked. Dr. Kim Henneman discusses how a complete return to athletic prowess can be achieved in horses with the neurological form of EHV-1. The key is to maintain a strong immune system, in part by eliminating stressors and using holistic approaches. Since good health can lessen the severity or even occurrence of many neurological problems, Drs. Tom Cameron and Sue Howell explain the science behind Protomorphogens to treat and prevent inflammation. And we can’t talk about good health without discussing nutrition, so Dr. Nancy Martin speaks on a topic close to my heart – making sure we maximize the nutrient levels in our patients’ food by considering ingredient sources. Finally, while we’re helping animals, let’s not forget about our own well-being. Dr. Cindy Maro tells us how to balance personal and family time with running a successful business. Although we all have busy lives, I hope this issue will inspire you to take the time to study a different approach to treating animals with neurological illnesses. Visit IVCjournal.com for past articles and more cases. Let me of know any topics you want to hear about, and share your successfully treated cases with us all.
Christina Chambreau, DVM, CVH Associate Editor, drtina@ivcjournal.com
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contributors
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1. TOM CAMERON,
Dr. Tom Cameron earned his DVM from Michigan State University in 1982. A long-time proponent of canine and feline nutrition, he speaks nationally on the role of therapeutic nutrition in veterinary medicine. After 25 years of private practice, Dr. Cameron spent nine years as Director of Veterinary Education and Technical Support at Standard Process Inc. Other areas of interest include photonic therapy and cold laser treatments. He continues to teach veterinarians and pet owners how to use nutrition and targeted supplementation to optimize health. He owns Cameron Veterinary Consulting (facebook.com/healthycritters).
therapies, veterinary NAET, animal massage, herbology, homeopathy, Bach Flowers and essential oils. She graduated from Ohio State University College of Veterinary Medicine in 1987, is a member of the AVMA, AHVMA, AAVA, IVAS and AVCA, and served on the AVCA Board from 2002 through 2007. She mentors veterinary students and speaks to several colleges’ integrative veterinary medicine organizations. Dr. Maro writes a bimonthly column for the Beaver County Times and Ellwood City Ledger, has been a contributing writer for several Pittsburgh publications, and has appeared on the KDKA Morning Show, WQED and WPXI (ellwoodvet@msn.com).
2. MARGIE GARRETT,
6. NANCY L. MARTIN,
DVM
DVM, CVA, CIVCA, CVTN
Dr. Margie Garrett graduated from Purdue University School of Veterinary Medicine in 1992. She attended the Chi Institute to study acupuncture and Traditional Chinese Veterinary Medicine, herbal therapy, and Tui-na massage. She is certified in animal chiropractic, and is attending the University of Tennessee program for animal rehabilitation. Dr. Garrett practices homotoxicology and is familiar with homeopathy, Bach and other flower remedies, and aromatherapy. She is an active member in the AVMA, AHVMA, AAVA, IVAS, AATCVM, IVCA and SWIVMA.
MS, DVM, CVA
Dr. Nancy Martin obtained her BSc in Animal Science in 1981 from Cal Poly San Luis Obispo in California. While completing a Master’s Degree in Domestic Animal Behavior at UC Davis, she managed the university’s beef research herd for four years. She went on to finish her DVM at UC Davis in 1991. Dr. Martin has practiced rural mixed animal medicine for 25 years in northern California. Her practice has been integrative since she received her certification in veterinary acupuncture from IVAS in 2008. Dr. Martin is considered a specialist in herd animal management and disease prevention.
3. KIMBERLY HENNEMAN, DVM, DACVSMR, FAAVA, DABT, CVA, CVC
7. JANET GORDON PALM,
4. SUE HOWELL,
John Saxton qualified in 1964 from the Royal Veterinary College in London. He spent five years in mixed practice, then set up his own companion animal practice. In the late 1970s, he became interested in homeopathy. From 1995 to 2012, he taught in the UK and abroad with the Homeopathic Professionals Teaching Group. John is a recognised examiner in veterinary homeopathy for the Faculty of Homeopathy, and an examiner and teacher for the IAVH. He is past treasurer and president of the British Association of Homeopathic Veterinary Surgeons; was president of the UK Faculty of Homeopathy; co-ordinator of the IAVH education subcommittee; and veterinary secretary for the Liga Medicorum Homeopathica Internationalis. John co-authored the Textbook of Veterinary Homeopathy, and authored Miasms as Practical Tools and Bowel Nosodes in Homeopathic Practice.
Dr. Kimberly Henneman is a 1986 graduate of Purdue University School of Veterinary Medicine. She is certified in veterinary chiropractic (AVCA), and was the 12th to pass AAVA’s advanced acupuncture exam. She is certified by IVAS in veterinary Chinese herbal medicine; has trained in classical veterinary homeopathy; studied Traditional Chinese and Tibetan Veterinary Medicine in China; and is working on a Master’s degree in TCVM from the Chi Institute and the Southwest Veterinary College in Sichuan, China. Dr. Henneman’s practice in Park City, Utah is 50% performance equine and 50% companion animal, and uses integrative therapies and thermal imaging in sports medicine, rehabilitation and chronic disease (animalhealthvips.com). She is currently the only veterinarian in the US to be boardcertified in both equine and canine sports medicine and rehabilitation. DVM
Dr. Sue Howell has been in small animal veterinary medicine for 20 years and has worked in veterinary practices in Wisconsin and Washington State. She joined Standard Process in 2013 and is a member of the company’s Education and Innovation team. Her clinical practice focuses on nutritional consultation and functional nutrition. She graduated in 1997 with her doctorate in veterinary medicine from Washington State University in Pullman, Washington and has certification pending in acupuncture and food therapy from the Chi Institute.
5. CYNTHIA MARO,
DVM, CVA, CAC, VMRT
Dr. Cynthia Maro owns Ellwood Animal Hospital, Chippewa Animal Hospital and Cranberry Holistic Pet Care, which incorporates acupuncture, animal chiropractic, rehabilitation, myofascial and physical
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DVM, CVCP
Dr. Janet Palm graduated from Kansas State University in 1981, and has practiced medicine and surgery in small animal, avian and exotic species in California, Georgia and Minnesota. She began integrating complementary therapies shortly after graduating. She lectures nationally on Low Level Laser Therapy (with RACE credits) and Enhancing the Veterinary Exam using Natural Horsemanship Principles. Dr. Palm recently relocated her integrative practice to Fruita, Colorado, and offers osteopathy, veterinary neuronal adjustment and myofascial release techniques in addition to LLLT, using the non-heat producing Class 2 Erchonia Frequency Specific Low Level Laser. She includes horses and farm animals in her ambulatory practice, Animobility Integrative Veterinary Services (Animobilityvet.com).
8. JOHN SAXTON,
B Vet Med, Vet FF Hom, Cert IAVH, MRCVS
what’s new DETECTING CANINE BREAST CANCER Early detection is one of the most important keys to battling cancer. The American College of Veterinary Internal Medicine (ACVIM) Foundation has awarded funds to veterinarian Dr. Annette Smith at Auburn University College of Veterinary Medicine for a study titled “Circulating MicroRNA as Predictive Biomarkers for Canine Mammary Neoplasia”. Dr. Smith and her team are exploring if a novel blood test called microRNA can be used to accurately detect cancer cells, and also predict how well patients will respond to treatment. Breast cancer is a common cause of death in both humans and dogs, and the disease shares characteristics at the genetic level across both species. Circulating microRNA has shown promising early results in human studies.
Veterinarian Dr. Annette Smith is studying how microRNA may be used to accurately detect breast cancer cells in dogs.
“These small molecules may provide clues to early diagnosis and prognosis in canine mammary tumors with just a small blood sample,” says Dr. Smith. “Ultimately, therapeutics blocking some of these molecules may also be developed. There will likely be translational applications for human breast cancer.” acvimfoundation.org/grants/grant-resources
LINKING GENES, BEHAVIOR AND COGNITION EmbarkVet, the world leader in dog DNA testing, and Dognition, the pioneering online dog cognition service, have formed a partnership to undertake the largest canine behavioral genetics study to date, with 5,000 dogs involved. The study is being led by Embark’s co-founder and renowned dog DNA expert, Dr. Adam Boyko, also an Assistant Professor in Veterinary Medicine at Cornell; and Dognition’s co-founder, Dr. Brian Hare, an Associate Professor in Cognitive Neuroscience at Duke University and an expert in canine cognition/behavioral issues. By pairing cognitive and behavioral data with genetic information, the researchers are exploring: • The origin of behavioral tendencies • The most effective training methods to use with dogs at different ages and stages of their development • The level to which environment and breed affect each dog’s behavior • The rate of cognitive decline based on genes and breed “The ability to marry vast quantities of genetic and behavioral information in dogs will propel canine research into new territory and make a major contribution to many fields of animal health, including veterinary medicine, animal behavior research, nutrition, and animal psychiatry,” says Dr. Nicholas H. Dodman, Professor Emeritus at Tufts University. embarkvet.com, dognition.com IVC Spring 2017
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what’s new WANTED: YOUR HERBAL MEDICINE SUCCESS STORIES!
EQUINE HEALTH STUDY
When veterinarian Dr. Nancy Scanlan was presented with a dog suffering from an antibiotic-resistant bladder infection, she turned to herbs for treatment. “A Chinese herbal formula I used started working within a week – going both by symptom relief, and later, by culture showing very little bacteria compared with the high numbers seen before,” she says. If you enjoy similar successes with herbal medicine in your practice, then you’ll be interested to know that the American College of Veterinary Botanical Medicine (ACVBM) has petitioned the American Board of Veterinary Specialists (ABVS) to become recognized as a board-certified specialty. “Even though a lot of us have had extensive training and passed exams involving our special areas of holistic veterinary medicine, we can’t call ourselves ‘board certified’,” says Dr. Scanlan, who is also Executive Director of the AHVMF. “That is because we have not been officially recognized by the ABVS.” Dr. Scanlan adds that there are four steps to recognition, and that the ACVBM has passed the first stage. “The second is public comment,” she says. “ABVS wants to hear comments from both veterinarians and the general public that show herbal medicine will ‘fulfill a distinct need in veterinary medicine and provide an essential service to the public’.” For details on where to send comments, along with sample letters, visit ahvmf.org.
The USDA’s National Animal Health Monitoring System has released the first report from its 2015 equine study. The Baseline Reference of Equine Health and Management in the United States 2015 had originally been postponed due to the highly pathogenic avian influenza outbreak that occurred that year. The study provides industry and animal health officials with information on the nation’s equine population. This information serves as a basis for education, service and research related to equine health and management, as well as industry trends. aphis.usda.gov/animal_health/nahms/equine/downloads/ equine15/Eq2015_Rept1.pdf
CAN DOGS EASE PRE-OP ANXIETY IN CHILDREN? The Human Animal Bond Research Initiative (HABRI) has awarded a $79,000 grant to the University of Tennessee College of Veterinary Medicine for a new study entitled “The Effect of Animal-Assisted Intervention on Preoperative Anxiety and Dose of Sedation in Children”. The study will examine the effects of animal-assisted intervention (AAI) on children’s anxiety levels and sedation medication dosages prior to surgery. “The goal is to determine if interaction with a therapy dog 20 minutes prior to surgery has a significant effect on reducing a child’s anxiety levels and, in turn, lowering the dose of medication necessary for sedation,” said the study’s principal investigator, veterinarian Dr. Zenithson Y. Ng. The three-year, cross-over-designed study will examine 72 children between the ages of two and 17 and randomly determine whether the child receives a therapy dog or an iPad tablet 20 minutes before sedation. Dr. Ng’s team will then 12
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evaluate heart rate, blood pressure and medicine levels for sedation and compare the amounts of each group. It is expected that children provided with a therapy dog prior to surgery will have significantly lower pre-operative anxiety and will require decreased medication for sedation compared to children who do not interact with a therapy dog. habri.org
INTEGRATIVE TOOLS FOR TREATING
NEUROLOGIC
AND OTHER DISEASE CONDITIONS By Janet Gordon Palm, DVM, CVCP
“Nothing is so dangerous to the progress of the human mind than to assume our views of science are ultimate, that there are no new mysteries in nature, that our triumphs are complete, and that there are no new worlds to conquer.” (Sir Humphry Davy, 1810)
Neurological ailments can result from various disturbances in the body that ultimately affect different parts of the neurological system. Irritation from a physical, chemical or biological event can result in chemical reactions with inflammatory, infectious or degenerative consequences. Examples include seizures, cerebral vascular accident, encephalomyelitis, intervertebral disc disease (IVDD), degenerative myelopathy, diabetic neuropathy, amputations and sciatica, among others. I have had success managing these conditions using a combination of approaches for patient evaluation and the modalities further explained in this article. The intention here is to inspire the practitioner with the concepts of energy medicine, and its bearing on ultimate treatment success.
NEWTONIAN VERSUS QUANTUM SCIENCE “If you want to understand the secrets of the universe, think in terms of energy, frequency, and vibration.” (Nikola Tesla) Conventional medicine is based in Newtonian science, in which the body is a veritable solid object surrounded by space. Current quantum physics shows that the body is more space than solid matter. Your choice of science will influence your treatment plans and outcomes. The conventional approach is to focus on treating physical symptoms (or organs) rather than the energetic root causes (which will then heal the physical symptoms, often permanently). Continued on page 14. IVC Spring 2017
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Continued from page 13. We are primarily energetic electromagnetic beings, and secondarily physical beings. Consider the following: •C ell division is stimulated by a resonance event. Russian research has demonstrated the presence of photon emission (biophotons) in almost every tested living organism, from bacteria and yeast to plants and vertebrates. This photon emission was dependent on physiologic conditions.1 • S tudies document energy auras radiating from us. • M emory is said to be stored in much of this outer energy field. A true connection to the universe as well as to each other helps explain telepathy, a sixth sense, animal communication, and out of body experiences. • N ikola Tesla, Royal Raymond Rife and Paul Nogier were pioneers who laid the groundwork for discovering that our bodies are in a constant state of vibration, the “language of the universe”. Different organs and tissues vibrate at different resonance frequencies, thereby explaining the benefits of pulse electromagnetic frequency (PEMF) on healing, and a subsequent increase in ATP production.2 • Laser light energy has been well documented for increasing ATP. • N o matter the energy form used (micro-electric current, sound waves or light energy), healing is enhanced as a harmony of resonance frequencies is encouraged. Tuning forks have shown benefits, and even a cat’s purring has been found to be therapeutic.
SYSTEMIC INFLAMMATION AND MITOCHONDRIAL DYSFUNCTION Environmental and ingested pollutants, electromagnetic field radiation (EMFs), genetically modified organism (GMO) grains, and stress all set up systemic inflammation that can affect the gut microbiome, and disturb the normal resonance frequencies of healthy tissues. Vibrational frequencies are altered by the effects of chronic inflammation. 3 Inflammation causes increased free radical oxygen and nitrogen species. Mitochondrial dysfunction is the by-product of chronic reactive oxygen species (ROS), and is ultimately an end result of inadequate ATP production. 3 Based on the awareness that disease conditions result from impaired mitochondria, it would make sense to supply building blocks for healing, along with tools that can repair this dysfunction. Although numerous alternative modalities can and have been used with success, for the purposes of this article we will focus on some of the modalities I have trained in.
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Demonstrating frequency specific LLLT and simultaneous communication of nerve root as well as area of involvement.
INTEGRATIVE EXAMS AND TREATMENTS The healing power of intention Regardless of a patient’s primary complaint, all enlightened veterinarians would agree that the most important tool we can apply to affect outcome and healing success is the power of our intention. Literally falling in love with the animal can be transformative. He receives our positive vibrations through our body language and the relaxation of our energy. Being aware of the animal’s body language and emotional state furthers our goal of decreasing the deleterious effects of the stress hormone, cortisol. Body language is universal in all species. An extrapolation of Natural Horsemanship principles inspired my own animal and owner personality assessment, called AnEmotionalityTM.4, 5 Reading cues and developing an awareness of the emotional state of the animal and owner during a visit creates an ability to minister to the primary need of the patient. Emotional states vary from day to day, as well as moment to moment, possibly due to changing environmental triggers. Learning to “key in” to the emotional currency the individual needs at the time can lower stress; this is important since stress can be an obstacle to the healing benefits of any future modality we attempt to incorporate. • An animal showing fear and insecurity may require that his/ her safety and comfort be managed before he accepts a treat reward, after which play can seem interesting. Offering less eye contact, making postural changes, postponing the handson exam, calming our energy and slowing down before proceeding can be rewarding. • Animals that are in a confident, dominant, playful state may welcome treat rewards, and/or an opportunity to show off their trick repertoire.
• Allowing extroverts to move their feet, and introverts to remain stationary, further establishes this relationship “dance”. The desired outcome is an animal that feels more confident, cared for and understood, allowing for an easier examination. Likewise, the owner feels that he or she is being heard, and will be amazingly present to our diagnostic and treatment plans. The reward is the recipient’s further confidence in our intention, as well as decreased stress for all involved.
Using all our senses In addition to a complete signalment, medical history and neurologic exam to assess cranial nerve signs, as well as to distinguish UMN from LMN disease, a holistic exam incorporates the following senses:
q Vision – needed for most of the conventional exam. w Smell – of a patient’s coat, feet, mouth, excretions and secretions. earing – auditory cues from the heart and lung fields, gut eH sounds, mentation, footfalls for rhythm changes and lameness evaluation, vocalizations and purring. Any environmental contributor is especially important in house call practice. T r ouch – in the form of offering comfort, sometimes requested by the patient prior to evaluation, running your hand over the patient to feel heat patterns, feeling integument, muscle
tone and symmetry, trigger points, texture changes, and observing response to pressure variations. aste – can also play a role in evaluating feed, hay, certain tT medications, presence of essential oils, etc. y I ntuition – or our sixth sense, must not be minimized, and can overrule our subjective observations in some cases. We can generally sense when an animal “just ain’t doin’ right”, well before we have enough evidence to validate that insight. Incorporating our sensory observations with a thorough history and signalment will provide many of the puzzle pieces. I use the analogy that the patient presents as a puzzle to be put together. The more we can learn from the edge pieces of the patient’s history, aided by our subjective and objective information, the less the owner may need to invest in diagnostic testing. This encourages a wealth of data that the owner may have otherwise been too sheepish to admit to.
COMPLEMENTARY TREATMENT TOOLS The practitioner’s choice of tools allows for individualized medicine. Without a doubt, the most important tool for benefiting health and minimizing inflammation is the adoption of good nutritional practices, including a quality organic nonprocessed diet, with appropriate supplementation when indicated. Also, improving the gut microbiome, fecal transfers
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when indicated, the use of ozonated fluids, essential oils, tuning forks for balancing chakras, PEMF, LED red light therapy, and homeopathic remedies have all been used with great success by complementary therapists. For this article, I focus on tools I have used successfully for neurological conditions. a) N euronal adjustment: Everything originates from the nervous system, which is the first system to form embryonically.6 Rehabilitating the CNS, where the insult most likely originates, would be key. There are basically two forms of neuronal adjustment – “direct” and “indirect”. i) Direct includes chiropractic, involving a high velocity thrust to musculoskeletal tissues; acupuncture, which involves the insertion of needles into soft tissue; and Veterinary Orthopedic Manipulation7 (VOM), involving the use of a human chiropractic activator to affect a high velocity low thrust impact to spinous processes. ii) Indirect includes functional indirect osteopathy techniques. This form of manipulation relies heavily on subtle energetic forces to relieve soft tissue, as well as vascular and lymphatic restrictions, and also includes cranial sacral manipulations.
allows for decreased pain and inflammation, as well as increased circulation and lymphatic drainage, without the risk of thermal damage or retinal scarring. The beam is line generated and can affect a larger area by increasing its distance from the patient. The ability to vary the pulsations of the laser beam by programming in different frequencies brings current the science of Tesla, Rife and Nogier. The focused, coherent (in sync) wavelengths of this true laser allow for little energy lost within the ideal treatment range of up to 12”. Another feature of this laser is its ability to affect the autonomic nervous system. It has been used to decrease sympathetic tone to calm fractious or painful animals, as well as increase the parasympathetic tone to promote increased appetite, gut motility, and an increase in homeostasis.7 The ability to treat the nerve root as well as the area of involvement aids in the management of sciatica, IVDD, degenerative myelopathy, amputation and traumatic induced neuropathies. Low power lasers have been found to stimulate stem cells, which can aid in regeneration of nerve and other tissues.8, 9 Since the ultimate end result of laser therapy is to increase ATP production and repair mitochondrial DNA and messenger RNA, it is quite obvious that this tool may be one of the most beneficial in repairing the damage of mitochondrial dysfunction, impacting multiple disease conditions.
SUMMARY
Demonstrating use of chiropractic activator adjusting tool.
b) M yofascial release: There are numerous effective myofascial release techniques. As long as principles of circulatory blood flow, lymphatic drainage and thermal criteria are followed, and the animal’s acceptance and response to this tactile therapy is carefully monitored, this rehabilitation of the muscles and fascia (living matrix) is vital to optimal healing. c) F requency specific low level laser therapy (FSLLLT): There are numerous therapy lasers on the market. The low power laser chosen by myself allows for long-term cellular enhancement without the inherent risks of occult thermal damage. It is a non-heat producing visible light wavelength Class 2 laser, with a power output of 5mW and 7.5mW, depending on the device. This is nearly 100 times less power than that of a Class 4 laser at 500mW. Class 3b lasers are generally 60mW to 200mW. The wavelength provided by FSLLLT is in the visible light spectrum of 635nm (red) or 405nm (violet). No eye protection is needed due to the visible light wavelengths and inherent blink response. This
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Many neurologic conditions can be a symptom of a systemic dysfunction. The new paradigm for healing requires that both an awareness of the universe within our cells and the ultimate connections beyond our physical bodies be taken into consideration for optimal treatment success. Recognizing and managing the emotional state of the animal, his/her owner, and his/her environmental relationships can contribute to our success in forming an optimal diagnostic and treatment plan. Along with mindful practices and genuine intention, alternative modalities are being successfully used to guide the cells in our bodies back to optimal health. With this in mind, non-invasive modalities that would manage the consequences of cellular irritants, psychological stress, and mitochondrial dysfunction could all be used with varying success to return the body to a state of harmonic resonance.
Van Wijk, Roeland. Light in Shaping Life -- Biophotons in Biology and Medicine, Melina, Geldermalsen, The Netherlands, 2014, p 295-375. 2 Meyers, Bryant, BS, MS. PEMF The 5th Element of Health, 2014, p. ix-209. 3 Perlmutter, D., MD.“The Role of Inflammation in Neurodegenerative Disorders: Integrative Approaches to Challenging Neurological Disorders”, FACN, Director, Perlmutter Health Center. 4 Gordon J. “Enhancing the Veterinary Exam Using Natural Horsemanship Principles”, AAV 2013; “Stress Free Small Animal and Equine Communication”, AHVMA 2016. 5 Parelli, Linda, Pat and Handley, Patrick, PhD. Horsenality, Humanality, Pagosa Springs, CO, 2009-2016. 6 DeLahunta. Veterinary neuroanatomy and clinical neurology, 3rd edition, Saunders, Elsevier, 2009, p 23-37. 7 Inman, William, DVM, VOM. Technology, Couer de Alene, Idaho. 8 Tuner, J and Hode, L. Laser Photo Therapy Clinical Practice and Scientific Background, Prima Books, 2014. 9 Yang, C and Wang, J.“Synergistic effects of low-level laser and mesenchymal stem cells on functional recovering rats with crushed sciatic nerves”, J Tissue Eng Regen Med, 2013, 10:120-131. 1
1
CASE REPORTS
Skippy –
a “fractious” 16-year-old male neutered dachshund with a one-week history of posterior paresis secondary to IVDD. He was referred for integrative care because he was currently overdosed on Rimadyl. With little improvement of symptoms, and an inability to safely administer steroids, a guarded prognosis was made. FSLLLT was performed starting with a sympathetic/parasympathetic balance, followed by modules including management of pain, inflammation, circulation, lymphatic drainage, scar tissue, connective tissue, liver, and immune system balance. These were coordinated into four modules that were three minutes long and considered one “treatment”. An accelerated protocol of two treatments per day for three days, then one treatment daily for three days, then one treatment every other day was performed. Skippy immediately calmed and within two days began to walk with minimal CP deficits. After two weeks, he was able to trot. He was weaned off the Rimadyl, as his owner requested more natural ways to manage him.
2
Sugar –
an adult mixed breed spayed female found in an abandoned sugar mill in Kauai. She had been lame on her left front leg since admission to the Kauai Humane Society three weeks previously with a diagnosis of cervical disc disease. Her primary need was safety, so a relationship with her was established by implementing approach and retreat concepts. VOM adjustment was performed using the chiropractic activator. FSLLLT was used over the cervical vertebrae as well as the entire dorsal spine. Two separate three-minute treatment modules were used. The first module used frequency settings specific for decreased pain, inflammation, increased circulation and lymphatic drainage. The second was for scar tissue, chronic inflammation, connective tissue and nerves. She was clinically improved upon completion of the treatment. Case studies continued on page 18.
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Case studies continued from page 17.
Archimedes –
4
Skye –
an eight-year-old husky with Cushing’s hypertension. His response to treatment demonstrated the benefits of performing FSLLLT over the sympathetic ganglion between T1 and L4. Once the laser beam turns off at three minutes, the sympathetic tone decreases and the parasympathetic tone increases. Skye calmed, and his blood pressure went from 220/110 to 148/72 within 25 minutes, even with an attempt at placing an in-dwelling catheter (which is not a calming procedure).
Above: Skye before sympathetic/ parasympathic balance. BP: 220/110 Right: Skye 25 minutes later (after two attempts at IV catheter placement). BP: 148/72
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3
a canary with a history of being down on his hocks for several days, and an inability to perch that indicated lumbosacral disease. Mild tassel foot was present, but not considered to be the cause. No obvious trauma was apparent, but a night fright episode was suspected. A presumptive diagnosis of spinal insult was made. FSLLLT was applied to the entire spine, using settings similar to those used on Sugar. Two 60-second treatments were performed on days one and two, at least two hours apart. By the evening of the second day, Archimedes was able to stand up off his hocks and perch.
Blue –
5
A young adult intact female DMH was thrown from a moving vehicle, resulting in a severe degloving injury. Safety was her primary need and much of the treatments were performed with approach and retreat concepts, as well as sedation for bandage changes. A VOM adjustment was initially performed, along with myofascial release in the form of manual massage, and FSLLLT using the red/violet laser. She received twice weekly laser treatments. MRSA was cultured during the course of healing; however, healing was not set back due in part to the bactericidal benefits of the 405nm violet wavelength. The entire paw regenerated with complete hair growth and minimal scarring within 16 weeks. There was no skin grafting.
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By Marty Goldstein, DVM
HYALURONAN ACID – systemic roles and benefits
Hyaluronan (hyaluronic acid, HA) is a long, unbranched polysaccharide composed of glucuronic acid and glucosamine. While it is found in the bodies of all mammals, the molecule is most recognized for its role in the maintenance of joint health. In this article, however, we will emphasize the systemic roles hyaluronan plays. • Hyaluronan is naturally synthesized locally by synoviocytes within the joint. It binds to collagen and elastin to form articular cartilage. Hyaluronan makes cartilage strong enough to handle compressive forces within the joint. It is also found in unbound form in the synovial fluid, where it provides lubrication allowing for fluid joint movement and protection from frictional grinding. • Within the bone itself, hyaluronan is primarily linked to bone modeling and remodeling. Hyaluronan regulates bone remodeling by stimulating osteoblasts and osteocytes and inhibiting osteoclasts. Intriguingly, hyaluronan taken orally has been shown to reduce urinary markers of bone resorption, indicating that it may suppress this process. • Hyaluronan is found most prevalently in the skin; approximately half the body’s hyaluronan is located within the dermal and epidermal layers. Primary functions of hyaluronan in the skin include moisturization and hydration. Skin turgor results from hyaluronan’s ability to absorb, retain and deliver water. With age, there is a distinct decrease in the percent composition of hyaluronan in epidermal tissue, correlating directly with the skin’s loss of elasticity and moisture content. • The role of hyaluronan in the gastrointestinal tract is varied. Endogenous hyaluronan is vital for intestinal fluid exchange, gastric tissue homeostasis, and innate immune function. Exogenous hyaluronan is a gastric mucosa
protectant. Findings show that a hyaluronan-containing gel significantly protects the gastric mucosa against ulceration. Oral administration of hyaluronan also stimulates PGE2 expression, rectifying the decrease in a prostaglandin often associated with ulceration. • Hyaluronan makes up a large part of the eye’s vitreous humor and is found in the lacrimal gland, cornea, conjunctiva and tears. Hyaluronan’s ocular functions include homeostasis, moisturization and lubrication. • Hyaluronan is a critical molecule for proper structure and function in the urinary tract. It serves as a protective barrier; disruption of this barrier allows for the adhesion of bacteria, causing inflammation, infection and interstitial cystitis. In the kidneys, hyaluronan is largely responsible for body fluid regulation due to its hydrophilicity. It is found in concentrated quantities in the renal medulla and papillae, where it also aids in mechanical support. While studies are ongoing to elucidate the molecular basis for the effects of orally-administered hyaluronan, clinical evidence supports the administration of exogenous hyaluronan to promote endogenous hyaluronan production. The premise for oral supplementation is to naturally restore endogenous hyaluronan. Thus, the multi-faceted roles of systemic hyaluronan support the rationale that daily supplementation can provide long-term maintenance of tissues and systems throughout the bodies of all mammals.
Dr. Marty Goldstein practices at Smith Ridge Veterinary Center in South Salem, NY. He earned his DVM from Cornell University in 1973, was certified by the IVAS in 1977, and was one of the founding members of the AHVMA. Dr. Goldstein has given seminars on alternative therapies nationwide and has appeared on the Oprah Winfrey Show, the Martha Show, and Good Morning America. He is the author of The Nature of Animal Healing, first published in 1999. IVC Spring 2017
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Integrative treatment of
spinal dysfunction
How acupuncture, homeopathy and other therapies can help in the treatment of intervertebral disc disease (IVDD) and spondylosis in pets. By Margie Garrett, DVM, CVA, CIVCA, CVTN I have seen it time and again: a client brings in a sweet beloved pet that cannot use his hind legs. Depending on which segment of the spinal cord is affected, the animal may also be unable to urinate or defecate with control. The client is understandably upset but still holding out hope that something can be done about her pet’s spinal dysfunction, which may signify IVDD, spondylosis, or other conditions. Many pet owners today are asking for an integrative approach to treating spinal dysfunction, in addition to conventional pain management, after learning about successful outcomes through word of mouth, the Internet and social media. It seems the high cost of surgery, plus the time and pain involved in what is called conservative therapy (total cage rest, pain medications, anti-inflammatories) is leading owners to look for alternatives. Even some conventional experts are questioning conservative therapy. In a recent textbook, Curtis Dewey, DVM, MS, states that one study found “no association between duration of cage confinement and success of medical therapy”.1 In my integrative practice, I treat many species with neurological conditions, including intervertebral disc disease (IVDD) and spondylosis deformans. In my experience, localization of the spinal lesion can best be
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done by combining conventional exam and diagnostics, and holistic techniques.
CONDUCTING THE PHYSICAL EXAM The integrative veterinarian may be presented with anything from lameness, organ dysfunction, proprioceptive loss and ataxia, to paresis and paralysis. The first step in diagnosing the condition is a physical exam. This typically means repeating the tests made by any conventional veterinarian with the goal of locating the lesion and delineating the cause.
Conventional Most of the time, pain will impede many normal responses, and muscle stenting and compensatory changes in joint movement are also present, so while examining the dog, avoid anything but gentle palpation in the area. Evaluate the nervous system from head to toe: • Check for cranial nerve deficits. • Palpate to test for painful areas along the vertebrae. Are they lumbar, thoracic or cervical? • Determine if the lesion is Upper Motor Neuron or Lower Motor Neuron. Are the leg reflexes hyper- or hypo-reflexive? Is there a panniculus response?
• Test the integrity of the proprioceptive pathway. Does the brain respond to the foot being turned over?2
Acupuncture The TCVM practitioner interviews the client, observes the patient, takes the history and evaluates the tongue and pulse as part of the exam to determine: • Preferences to hot or cold • Pain behaviors – is the animal in pain or is there weakness without pain? • Wet or dry presentation • Which acupoints are sensitive and what portion of the nervous system are we trying to modulate by stimulating the nerves and the local humoral response?
From these points, the practitioner can differentiate between spondylosis and IVDD to select the most appropriate treatment. IVDD will generally present with a stagnation pattern of pain (in muscles or joints, and/or stiffness in the joints), and also present with the Bi syndrome. (Table 1) Spondylosis is more chronic and slow to progress since it can develop as generalized Bi syndrome over a long period, reflecting spinal instability. Most commonly, the patient presents with ataxia but he/she may present acutely, showing weakness without pain due to loss of neurological function. This pattern is the Wei syndrome. (Table 2) (For more on the TCVM exam, read “The Integrative Physical Examination”, IVC Journal, Volume 6, Issue 3.)
Continued on page 22. Table 1 – Bi Syndrome Pattern3
Bi syndrome patterns
Tongue
Wind-Cold-Damp invasion with external Qi/Blood stagnation
Clinical findings / grade of deficits
Superficial, strong, slow, wiry
Grade 1 acute neck or back pain. No paresis or paralysis.
Deep, weak, worse on left, rapid, thready or wiry
Grade 1 acute neck or back pain. No paresis or paralysis. Panting, cool-seeking, warm ears, back, feet, dry skin.
Purple
Deep, weak, worse on right or wiry
Grade 1 acute neck or back pain. No paresis or paralysis. Heat-seeking, cold ears, back, feet.
Spinal cord Qi/Blood stagnation with Kidney Qi deficiency
Pale purple, wet
Deep, weak, worse on right or wiry
Grades 2-5 deficits acute or chronic. Paresis or paralysis (+/=) neck or back pain.
Spinal cord Qi/Blood stagnation with Kidney Yang deficiency
Pale purple, wet
Deep, weak (weaker on right), slow, Grades 2-5 deficits acute or chronic. Paresis or may be wiry paralysis (=/+) neck or back pain. Heat-seeking, cold ears, back, feet.
Spinal cord Qi/Blood stagnation with Kidney Yin and Qi deficiencies
Pale or red, purple, wet or dry, cracked, chronic
Deep, weak, may be on both sides, rapid, thready, may be wiry
Grades 2-5 deficits acute or chronic. Paresis or paralysis (=/+) neck or back pain. Panting, coolseeking, warm ears, back, feet, dry skin
Spinal cord Qi/Blood with Kidney Yin and Yang deficiencies
Pale, red or purple, wet or dry
Deep, weak pulses on both sides, may be rapid or slow or wiry
Grades 2-5 deficits acute or chronic. Paresis or paralysis (=/+) neck or back pain. Seeks heat or cold, may or may not pant, warm or cold ears, back, feet. May be warm in front and cold in back.
Kidney Yin deficiency with external Qi Blood stagnation
Purple
Pulse
Reddish purple, dry
Kidney Yang deficiency with external Qi Blood stagnation
Table 2 – Wei Syndrome Pattern4
Wei syndrome patterns
Tongue
Pulse
Clinical signs
Damp Heat
Greasy, moist
Rapid, slippery
Obesity, chronic skin problems, edema, weakness in back legs, no paralysis.
Spleen Qi deficiency
Pale, swollen
Deep, weak
Pale, moist
Very deep, weak
Weak and cold lumbus and hind end, difficulty rising. Weakness to immobile rear legs.
Pale or red and dry
Weak, thin
Emaciation, weak hind end, dry skin, false heat, coolseeking, weakness to immobile rear legs.
Kidney Qi and/or Yang deficiency Qi and Yin dual deficiency
Weak limbs, flaccid loose stools, weakness in rear legs.
Differentiating Bi and Wei syndromes facilitates choosing the correct acupuncture points, Chinese herbal formulas, Tui Na massage plans, and food therapy for each animal.
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HOW INTEGRATIVE APPROACHES IMPROVE OUTCOMES Outcomes with a conventional-only approach are often limited. At the least, a patient may experience loss of muscle mass. At the worst, a paralyzed patient can die from the inability of his organs to function due to poor innervation of the sympathetic and parasympathetic nervous systems. An integrative treatment plan (with consultation from experts, if needed) can improve the return to function and keep the neurological status of the patient healthier.
Continued from page 21.
Homeopathy The homeopathic veterinarian looks for idiosyncratic reactions that indicate the best remedy. Signs to consider: • A fear of being touched • Temperature of the paws • Condition of the hair coat • Vaccination history • Reaction to stimuli • Past medical history.5
DIAGNOSTICS After localizing the lesion area with a physical examination, the integrative veterinarian moves to the next phase of diagnostics, which is radiography. The newer digitized radiographs allow us to see late stage inflammatory changes, but not always all the pathology. If Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) is going to be pursued, generally, surgery will be planned.
TREATING IVDD AND SPONDYLOSIS Following case intake, physical exam and diagnostics, a treatment plan is formulated using the appropriate modalities. Different approaches are needed for IVDD and spondylosis.
Treatment options for IVDD Before discussing treatment options, let’s review IVDD pathology. Spinal vertebrae surround the spinal cord. Between the vertebrae sit eight joints, including an intervertebral joint, which contains the nucleus pulposus. This acts like a malleable ball bearing to equalize stress on the disc. With IVDD, calcification of the nucleus pulposus occurs (this can happen as young as three years of age). Quadrupeds have shear force
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along the spinal canal versus compressive force in the human species. Enough shear force can cause the nucleus pulposus to rupture up through the layers of annulus fibrosus lamina and into or around the spinal canal. Type I Hanson’s IVDD occurs acutely, most commonly in short-legged long-bodied dogs. Type II is more degenerative than explosive, often occurring in older dogs and larger breeds. The conventional veterinarian will suggest surgery, antiinflammatories and cage rest for IVDD. However, in his book, A Practical Guide to Canine & Feline Neurology, Dr. Dewey says that in studies, the “glucocorticoid therapy in treating spinal injury is questionable at best, with no beneficial effect”, although NSAIDs in the acute phase have been shown to have an anti-inflammatory effect.6 On the other hand, the integrative veterinarian has many tools available to treat IVDD. Dr. Narda Robinson of Colorado State University states the following in her request for a reevaluation of the Standard of Care for IVDD: “ The old mindset that nothing can cure a dog but surgery and strict cage confinement (with minimal to no analgesia) remains widely held in some circles, even academia…. Acupuncture reduces the extent of damage by helping keep neurons and oligodendrocytes alive. In comparison, what does cage confinement without physical medicine do to a dog with disk disease and back pain? It risks further degrading the disks, increasing muscle tension, and inducing long-term maladaptive gait patterns.”7 Other experts agree with Dr. Robinson. Joaquim et al show that acupuncture has been demonstrated to aid in recovery from IVDD.8 Acupuncture point selection is based on a pattern diagnosis to improve and modulate the nervous system. In addition, TCVM practitioners include Chinese herbal medical formulations for anti-inflammatory and healing effects, as well as Tui-Na massage. A prescription of physical rehabilitation passive exercise during exercise restriction can improve proprioception, motor pattern generators and reduce pain.
Spinal manipulation and stretching Careful consideration is needed before using adjustments on a dog with IVDD. Is there movement in the intervertebral area, or is it too dangerous to gauge movement in the event of a possible nucleus pulposus rupture? We can use spinal manipulations to add movement to other joints around the area, and use stretching to relax spasmodic muscles.9 Continued on page 24.
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An underwater treadmill combined with other integrative therapies such as acupuncture, homeopathy, laser, etc, can help improve the outcome of IVDD and spondylosis.
Continued from page 22.
Homeopathy When the homeopathic medicine matching the individual dog is administered, the vital force begins a self-healing. First the dog will have improved mentation, appetite and energy. Then, even with total paralysis, he will begin to show a return of normal neurological function. Several weeks may be needed if treatment is begun shortly after diagnosis; several months if paralysis has not responded to surgery and drugs. Hypericum and Nux vomica are frequently indicated remedies. One eightyear-old Dachshund presented with a flaccid tail, stool falling out, urine retention and no deep pain. Five doses of Hypericum 12c over a two-week period were needed for full recovery.5
TREATMENT AND PREVENTION OF SPONDYLOSIS What about the pathology of spondylosis? The ligaments of the spine allow it to move within an acceptable range of motion. One of these ligaments – the ventral longitudinal ligament (VLL) – runs beneath the spinal cord and prevents hyperextension of the spine. The VLL can become stretched and unable to support the vertebral joints and spinal cord if the intervertebral joints move too far in any direction and/or the abdominal muscles are consistently weak. This chronic instability of the joints leads to inflammation and, finally, calcification of the ligament. Calcification causes a decrease in nerve health due to: 1. Fewer nutrients, resulting from impeded blood flow; 2. Decreased firing from lack of movement, which is the body’s attempt to keep the spine from moving abnormally (from compromised muscle support, arthritis in the joints and ligaments, and tendons becoming stressed
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A working dog with PTSD receiving PEMf therapy for back pain.
and then fibrotic). Early fibrotic changes will appear on the radiograph as rounding, due to loss of calcification of the bone at those attachments. The conventional approach of using anti-inflammatories and joint modifiers (glucosamine, chondroitin, milk proteins, hyaluronic acid) may not be enough to avoid spondylosis. On the other hand, an integrative veterinarian has a number of techniques available to help reverse or stabilize the changes Continued on page 27.
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CASE REPORTS 1. Daisy is a 12-year-old FS Border Collie who
moved slowly and loved to lie under the car. On New Year’s Eve, her owner did not know she was there, and she sustained fractures in the skull, mandible and foot; a large degloving area; and a painful back. With chiropractic adjustments, Chinese herbal formulations, laser, and great nursing care, she became pain-free and even more mobile than she was prior to the accident, once her wounds were completely healed.
2. Captain is a ten-year-old Jack Russell
terrier who presented in extreme pain due to IVDD. Five years ago, his referral veterinarian gave a poor prognosis after incorrectly diagnosing him with Granulomatous Meningeal Encephalitis (GME). Peripheral nociception (part of the pain response sensation) and LMN disease affected his CNS, causing disorientation. Acupuncture, laser, chiropractic and Chinese herbal formulations alone have been able to keep his mentation and spinal nerves healthy, in spite of two more episodes of IVDD.
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Over the years, Captain’s owners have been willing to treat him only two times at each episode. On the referring veterinarian’s insistence, they stopped all Chinese herbal formulations for Bi syndrome, except the formulation for neck pain. As a veterinarian, I treat what I have at the moment. Each time, “moving the stagnation” and treatment has him back acting as Jack Russells do. Owner compliance with rehabilitation, acupuncture, laser and Chinese herbal formulations are a challenge, as this real case demonstrates.
Occasionally, surgery can fail and owners will seek other options. These cases are by far the more difficult to treat due to the loss of muscle tissue from the surgery and the time lag from recommendations that delay follow-up care with the integrative practitioner.
From the
WAEO
Continued from page 24. in the ligament that lead to this condition.10 Sometimes, even the entire mass of accumulated calcium can be dissolved.5 Since inflammation triggers the production of calcium deposits, multiple modalities can both prevent and possibly resolve spondylosis, by ensuring movement and healthy blood flow to intrinsic muscles, tendons and ligaments. Remember, when the joints move freely, the nerves can fire adequately. Proper ROM also keeps the intrinsic and paravertebral muscles healthy so they in turn can maintain postural input to the sympathetic and parasympathetic nervous systems. Successful approaches include: 1. Regular animal chiropractic work 2. Spinal manipulation and adjustments 3. Stretching, balancing and flexion/extension exercises 4. TCVM – Chinese herbs, acupuncture and Tui-na 5. Homeopathy – individualized selection of remedies. In conclusion, integrative care – joint modification therapeutics, Chinese herbal formulas, and homeopathic remedies, combined with conventional medications in the acute phase – can improve the outcome of IVDD and spondylosis. Many more spinal conditions can also be treated with these integrative modalities. At our clinic, we also use laser therapy, an underwater treadmill, and PEMf therapy with TCVM modalities. By using these integrative modalities, successful return to function without surgery, or post-surgical rehabilitation for muscle, neurological and gait deficiencies, is often achieved. Eschbach, Dennis. “Thoracolumbar Pathology: Based on notes by Sharon Willoughby”, Basic Chiropractic Course, 2007. P.371-37. 2 Dewey, Curtis W. “Chapter 10: Myelopathies: Disorders of the Spinal Cord”, A Practical Guide to Canine & Feline Neurology, 2008, p. 332. 3 Chrisman, Cheryl L. “Spinal Cord Disorders”, Traditional Chinese Veterinary Medicine for Neurological Diseases, 2011. 13th Annual TCVM Convention, pp. 225-266. 4 Ferguson, Bruce and Boggie, Linda. “How I Treat Wei Syndrome”, Traditional Chinese Veterinary Medicine for Neurological Diseases, 2011. 13th Annual TCVM Convention, pp. 455-465. 5 Personal communication with Drs. Pantzer and Chambreau. 6 Jurek, Christine. “The Role of Physical Manipulation (Chiropractic) in Canine Rehabilitation”, Canine Sports Medicine and Rehabilitation, 2013. p. 431. 7 Joaquim JG, Luna SP, Brondani JT, et al. “Comparison of decompressive surgery, electroacupuncture, and decompressive surgery followed by electroacupuncture for the treatment of dogs with intervertebral disk disease with long-standing severe neurologic deficits”. J Am Vet Med Assoc, 2010. pp. 1225-1229. 8 Robinson, Narda. “An Emerging Standard of Care for Thoracolumbar Intervertebral Disk Disease in Dogs”, CuraCore, curacore.org, Sept. 12, 2015. 9 Dewey, Curtis W. “Chaper 3: Performing the Neurologic Examination”, A Practical Guide to Canine & Feline Neurology, 2008, pp. 53-74. 10 Dewey, Curtis W. “Chapter 10: Myelopathies: Disorders of the Spinal Cord”, A Practical Guide to Canine & Feline Neurology, 2008, p. 332. 1
The Worldwide Alliance of Equine Osetopaths (WAEO) promotes the benefits and advances the practice of equine osteopathy. It also provides continuing education for its members, supports scientific research in equine osteopathy, and assists in efforts to establish osteopathy as a distinct titled profession on an international basis.
One of the goals of any organization offering a new modality is communicating the principles and benefits of that modality. Osteopathy has three therapeutic styles or pillars: Structural (most similar to chiropractic), Cranial Sacral and Visceral. 1. Structural abnormalities are found and named by the direction in which the joint moves or lacks motion, instead of by position. Structural restrictions are often manipulated using long lever techniques instead of short lever techniques, meaning that less force is necessary for the practitioner (this can be really helpful for keeping the practitioner healthy!). 2. Cranial sacral techniques focus on mobility and symmetry in the dura mater and spinal tissues, and how this connects to nerve sheaths and lymphatic tissues throughout the body. 3. Visceral techniques work on the level of the autonomic nervous system – using the sympathetic and parasympathetic portions of the nervous system to help find and release fascial restrictions that can relate to organs and internal fixations.
Updates and news The next WAEO Conference takes place in Green Bay, Wisconsin on September 16 and 17. For information on the program and events, stay tuned to equineosteopathy.org or the WAEO Conference Facebook page. As of this past February, a new graduating class has joined the ranks of equine osteopaths. Their contact information is on our membership page or in the official International Registry for Equine Osteopaths (irequineosteo.org). The next class from the Vluggen Institute in North America begins in December of 2017. Please contact vluggeninstitute.
com for more information. IVC Spring 2017
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Advertorial
Urinary health and incontinence – starting the conversation with your clients By Jeff Nichol, DVM
With patients who speak no human language, we’re left to rely on our clients for full disclosure. Sometimes we have to dig for answers. Simply asking: “What’s going on with Max or Sophie?” can lead the discussion down the wrong path. The owner’s subjective interpretations of his/her pet’s symptoms must be sifted for relevant clinical signs.
Chronic lower urinary infections can be another frustration. Nutritional cranberry supplements may reduce the adherence of E. coli bacteria to the bladder wall, thus improving the effectiveness of long-term antibacterial treatment. Great-tasting Cranmate® tablets can provide an easy and flavorful addition to any pet’s diet.
Urinary problems can be especially confusing. Anxious pet parents can misconstrue indicators of bladder pathology as their failure to properly housetrain. Fearing our judgment, they may omit crucial details – unless they are asked.
We know that good listening skills improve patient outcomes. Left to struggle on their own, sometimes punishing a spayed dog for leaking urine in her sleep or a urine-soiling cat with bladder stones, pet owners can reach terminal frustration. Believing they’ve “tried everything”, many throw up their hands in despair and surrender their cats or dogs to a shelter. A significant number of these former pets are ultimately euthanized. This tragic reality makes undiagnosed urinary disease a leading cause of preventable death in pets.
A checklist for history-taking can help avoid missed diagnoses. In addition to appetite, stool quality, and respiratory signs, you need to know if a pet is straining to urinate or if she dribbles when resting or sleeping. This is an important distinction; as many as 20% of spayed dogs leak urine in their sleep because of urethral sphincter hypotonus (spay incontinence). You can reduce client stress by explaining that most female urine leakers respond quickly and safely to medication, such as Proin Chewable Tablets® from PRN Pharmacal. Pets who pass blood or strain to urinate may be struggling with bladder stones or recurrent bacterial cystitis. Published research1 in both dogs and cats has shown a marked increase in urolithiasis, especially stones comprised of calcium oxalate. With surgery often the only treatment option, preventing recurrence becomes a high priority. In addition to the proper diet,2 a potassium citrate supplement, such as liver-flavored CitraVet® tablets, can reduce this risk.
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Both veterinarians and technicians share significant responsibility for the care of well-loved pets. Those who gather careful histories help keep more dogs and cats in their forever homes. Working together, we can evaluate a complete list of medical rule-outs for urinary and other problems, and treat the whole pet. Today’s clients expect complete care. We can deliver. Minnesota Urolith Center, University of Minnesota College of Veterinary Medicine, urolithcenter.org. Doreen M. Houston, Andrew Moore, Denise A. Elliott, Vincent C. Biourge. “Stone Disease in Animals”, Urinary Tract Stone Disease, 2011, pp. 131-150.
1 2
Dr. Jeff Nichol is a graduate of the Michigan State University College of Veterinary Medicine. He has been a hospital owner for much of his career. He practices general and behavioral medicine in Albuquerque, New Mexico.
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nutrition nook
Ingredient
sourcing for
optimal nutrition in dogs and cats
Why fresh organic food is the healthiest choice for your patients. By Nancy L. Martin, MS, DVM, CVA Many holistic or alternative veterinarians still express some angst regarding their recommendations on the type of food clients should feed their pets. Confusion about what constitutes the appropriate diet for dogs and cats comes from an interesting convergence of food production and labeling politics; marketing strategies in OTC pet foods and veterinary prescription diets; food journalism as it applies to animal and human health; and the science of nutrition. The science of nutrition, rather than adding clarity to the discussion, has obscured our understanding of food with its emphasis on the material contents of food and the internal metabolic machinery of each species.1,2
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THE MICROBIOME, THE BIOSPHERE, AND QI The missing link in our education involves what exactly happens to food as it passes through our patients’ guts. We are only now beginning to understand that the miraculous transformation of food into tissue could not take place without the contribution of an enriched broth of bacteria and fungi we call the intestinal microbiome (each individual’s microbiome outnumbers their own cells by ten to one). Only a few pathogens negatively impact animal health.3 All plants and animals share their functional life with a nurturing and supportive microbiome from birth (or sprout) to decomposition.4 Likewise, the earth
could not support plant or animal life if not for the rich mat of organic material that inhabits its crust.5 The TCVM concept of Qi, the vital life force that encompasses all living things, is remarkably similar to our current understanding of the planet’s robust biosphere, and its continuous cycle of promotion and decay – a cycle that has been taking place in the deepest, farthest, and most extreme places on the planet for billions of years.6 Veterinarians learn that healthy ruminant digestion relies on a partnership with microbial inhabitants. A similar discussion of the microbiome in dogs and cats was largely overlooked in small animal nutritional textbooks, as if it was only marginally involved in digestion and overall health.1,2 In fact, each pet’s microbiome is establishing residence within one hour after birth, and hastily begins directing the development of the structure of the host’s intestines, immune system and neurologic system.4,7 The resident microbiome, in concert with the host’s cells, is responsible for an elaborate communication system that influences nutrient assimilation, tissue growth and repair, body composition, inflammation, neurological development and mental health. At weaning, the microbiome population alters as the food substrate changes. In carnivores, this means that microbes and enzymes associated with carbohydrate digestion begin to naturally diminish, while microbes, intestinal cells, and organs that assist in amino acid and fat digestion flourish and develop.7 The host’s hormonal state during puberty, estrus, pregnancy and lactation influences the bacterial population in the intestines by promoting a shift towards microbes that are more efficient at harvesting energy from the diet. The external environment also influences the microbiome. Research shows that animals and people who spend time outdoors have more robust microbiomes, as do humans that live in multi-generational households, or share their living space with pets.8 Continued on page 32.
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Continued from page 31.
BIO-AVAILABILITY, AND DRY EXTRUDED DIETS What is it about the overcooked dry extruded diets, fed to pets since the 1950s, that are contributing to the marginal health and diminished lifespan of dogs and cats? Perhaps an example concerning the discovery in the 1980s that taurine was deficient in commercial cat foods answers that question (clinical symptoms cats presented with were CHF and blindness). It seems taurine was present in the cat food (according to the guaranteed analysis), but the high cooking temperatures made this essential amino acid unavailable to feline intestinal microbes. This interesting finding illustrates how dynamic the science of nutrition is as it applies to industrialized pet foods. The paradigm of essential nutrients depends on the recognition that a particular disease can be associated with a specific nutrient. As more diseases or clinical conditions are reported and investigated, more nutrients may be defined as essential.2 The paradigm of bio-availability currently compares the concentration of a nutrient or drug before it is ingested, to the blood levels achieved at post-ingestion intervals. We now know that the health and composition of the microbiome influences what crosses from the lumen of the gut into the bloodstream and impacts the analysis of the bio-availability. Currently, fresh food diets (commercial or home-prepared) are being scrutinized by veterinary nutritionists as they compare their guaranteed analyses to industrial processed preparations. This work ignores the concept of microbial-assisted bioavailability which favors amino acids, fats and minerals from fresh uncooked meat, fat and bone diets for carnivores. It is true that processing and cooking improves the digestibility of plants (by making their contents more bio-available to microbial digestion), but one could argue that amplifying the
energy content of pet food will not benefit the health of our largely overweight and obese pets. Dry extruded diets (even grain-free) are deficient in essential amino acids and fatty acids, and excess in plant sugars, because of the high temperatures associated with their cooking and composition. High-fiber, plant-based processed diets designed to reduce a pet’s energy harvest from food (and theoretically help reduce weight) further amplify these deficiencies. These diets increase the volume of indigestible fiber and dilute not only the caloric content of the food, but also its essential amino acid and fatty acid content, leaving pets extremely deficient in both.
ANCESTRAL DIETS, THE BIOSPHERE AND INDUSTRIAL FARMING The current trend towards “ancestral diets” represents an effort to correctly feed the ancestral microbiome of our carnivorous pets. This is not an attempt to take our canine pets back to wolves, or turn apartment-dwelling felines into lynx. It recognizes that the evolution of domestic dogs and cats from carnivorous hunting partners, varmint managers and scavengers to house-dwelling couch potatoes spans just 150 years – a short period when compared to the approximately 20,000 years of domestication. Many variations of ancestral diets are now commercially available, and most are approximately 75% to 80% meat, fat and bone with variable plant material and supplements added. Most are designed to be fed raw or gently cooked; either is biologically appropriate. Many animal owners, with little support from their veterinarians, use the information from books, other publications and the internet to feed their pets combinations of raw meat by-products from human food distributors, such as chicken backs and necks, tripe and various organ meats. Typically, some type of vegetable material is added along with many variations of commercially available supplements. These animal owners are motivated to improve their pets’ health and longevity with fresh species-appropriate food, and most report favorable results. But are these industrially-produced food animals and plants really “ancestral”? After WWII, agriculture used scientific innovations to develop a war on insects, weeds and plant pathogens. The war on famine justified the overproduction of cereal grains, and government subsidies for politically-important crops influenced the development and use of agro-chemicals to maximize production. This focus on the health benefits to plants of being grown in a world free of pathogenic bacteria, fungi and insects now seems unrealistic and short-sighted. The increased yields and profits realized through these farming Continued on page 34.
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Continued from page 32. methods are celebrated, while the costs to beneficial microbes and the environment are largely ignored. The non-target effects of agricultural technological development continue to be realized only as they play out in the laboratory of our world, our pets’ health and our own lives. Authors David Montgomery and Anne Bikle (The Hidden Half of Nature) write about the remarkable similarity between the relationships human and animal hosts develop with their microbiome, and the relationships plants develop with the earth’s biosphere. They note the functional similarities between the roots of plants and the cells of our gut as they interact with a healthy, robust microbiome. These beneficial soil microbes function much like the microbiome of our colons, enhancing the plant’s ability to uptake minerals and additional nutrients. Plants evolved by providing exudates to soil bacteria and fungi through their roots, in exchange for nitrogen the microbes fix from the soil and atmosphere and make available to the plant.
The theoretically-benign herbicide glyphosate is toxic to these critical nitrogen-fixing bacteria and mycorrhizal fungi in the soil. Additional chemical fertilizers are needed to supply nitrogen, phosphorous and potassium to enhance plant growth. Chemically-fertilized plants get lazy and fail to develop robust root systems, which starves soil microbes. The result of 70+ years of chemical fertilization and soil microbe starvation is a substantial decrease in the plant content of most soil micronutrients (vitamins and minerals). One study that looked at changes in the micronutrient content of fruits and vegetables from 1940 to 1992 documented decreases in all micronutrients, with the exception of phosphorous. These decreases ranged from 2% to 97%, depending on the plant type. Studies have shown that magnesium, for example, is necessary for the development of several digestive enzymes. A dietary deficiency of magnesium is related to many human health problems such as ADHD, schizophrenia, bipolar disorder,
TALKING POINTS FOR FRESH FOOD FEEDING CONSULTS WITH CLIENTS q Always get a complete health history (TCVM or CWM) and
All pets on fresh food diets should receive animal-sourced
perform any necessary diagnostics (CBC, chemistry, U/A) on new patients before you start them on a fresh diet, to avoid the potential that chronic health problems (pancreatitis, food allergies, IBD) may cause a healing crisis.
Omega 3 fatty acid supplementation; even grass-fed and free-range livestock aren’t able to consume the variety of plants necessary to ensure they are incorporating these fatty acids into their own fat.
w Discuss stool quality and its relationship to digestion so All pets should be on a well-rounded mineral supplement that clients realize how important it is to daily monitor their pets’ stools.
e Discuss food prep and storage hygiene as well as kitchen management to educate clients on the risks of handling raw meat. Due to enzymatic activity in raw meat, amino acids can be lost during prolonged storage in refrigerators.
r Raw meat should not be fed to animals that have recently been on courses of antibiotics; the disruption this causes to their beneficial microbes leaves them susceptible to pathogenic bacterial invasion. A one- to four-month waiting period on gently-cooked food should be protective.
t Senior patients with compromised GI function may never be able to properly digest raw food.
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to compensate for deficiencies in soil and harvested plants. (Even organic farms are still in the process of building good soil, and mineral deficiencies occur across the US).
All pets should be on a daily pre- and probiotic to provide a source of beneficial bacteria and stabilize and promote GI function and motility.
Whenever
possible, clients should purchase pet foods or ingredients that are organic, non-GMO, free-range or grass-fed, and free of hormones and antibiotics.
Clients
should also be encouraged to establish relationships with local food producers. As more farmers become aware that consumers are willing to pay more for healthy organic food, more will begin farming that way.
Advertorial
depression, and not surprisingly, chronic gut inflammation. It is estimated that most Americans now only get 10% to 20% of the magnesium they need through their diets. Many GMO plants (corn, soybeans) were genetically designed to resist the effects of glyphosate, which means they can be exposed to and uptake this chemical without dying. The toxicity of glyphosate residues to the beneficial microbiota of animals and humans is currently being explored. Researchers have found alterations in the beneficial gut microbiome of poultry and cattle fed GMO corn and soybeans, which leaves the animals vulnerable to pathogenic bacteria.
VetzLife All-Natural News By Christopher Kelly Groth
Lions and tigers – and natural oral health
Industrialized agriculture and the use of glyphosate create the same deficiencies in the plants and animals it produces and in the soil that contributes to their growth. Humans and pets, as predators, are at the top of this deficient food chain. The health of our pets is definitely improved when fresh food is substituted for dry extruded diets, but “ancestral” diets can only begin to restore integrity and balance to the system when the meat, plants and supplements included in these diets are derived from organically-farmed sources.
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.
Veterinarians interested in finding a path to health for their clients’ pets can also promote a path to health for the planet when they advocate fresh organic diets for animals. When consumers pay for the actual environmental costs associated with production of the food we and our pets consume, we begin to bring balance to our relationship with the planet.
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.
Veterinarians are trained to provide clients with a risk benefit analysis for each medical directive or treatment protocol that we recommend. Informed veterinarians can now give clients a risk benefit analysis for organic and fresh food diets versus industrially farmed processed kibble diets by also encouraging them to consider the costs to the health of the planet.
Schenk PA and Strombeck DR. Home-prepared dog and cat diets, 2nd Ed. Ames, Iowa: Wiley-Blackwell, 2010. 2 Gross KL, Yamka RM, Khoo C, Freisen KG, Jewell DE, Schoener WD, Debraekeleer J, Zicker SC. “Macronutrients, micronutrients: minerals and vitamins”. In: Hand MS, ed. Small Animal Clinical Nutrition, 5th Ed. Topeka, Kan: Mark Morris Institute, 2010. 49-148. 3 Freeman L, Chandler M, Hamper B, Weeth L. “Current knowledge about the risks and benefits of raw meat-based diets for dogs and cats”. JAVMA 2013; 243: 1549-1558. 4 Buddington R. “Postnatal changes in bacterial populations in the gastrointestinal tract of dogs”. AJVR 2003; 64:646-51. 5 Montgomery, David R and Bikle, Anne. The hidden half of nature, the microbial roots of life and health. New York: W.W. Norton & Company, Inc., 2016. 6 Legget D. Helping ourselves, our guide to traditional Chinese food energetics, 2nd Ed. Devon, England: Meridian Press, 2005. 7 Hamper BA. “Nutritional adequacy and performance of raw food diets in kittens”. Doctoral Dissertation, University of Tennessee (2012):14-24. 8 Blaser, Martin J. Missing microbes: How the overuse of antibiotics is fueling our modern plagues. New York: Henry Holt and Co., 2014. 1
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.
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A NOVEL AND INTEGRATIVE NUTRITIONAL APPROACH TO NEUROLOGIC DISORDERS AND AUTOIMMUNITY By Tom Cameron, DVM and Sue Howell, DVM
Last year, funding for four grants was approved by the AKC Canine Health Foundation as part of an Epilepsy Research Initiative. This initiative is designed “to provide the veterinary community and dog owners with improved methods for preventing and treating epilepsy in dogs”.1 One of the grants will look at the effects of nutrition (ketogenic diet) on the reduction of seizure frequency and/or the severity of seizures in drug-resistant dogs.2 It is exciting that research is starting to focus on nutritional solutions to optimize the health of our pet patients. Functional nutrition through the use of tissue-specific protein extracts (Protomorphogens™) should also be explored as an
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integrative nutritional approach to neurologic challenges. Cells need food to function. To function optimally, nerve cells need to be exposed to the right quality and quantity of a variety of nutrients. These nutrients should ideally come from the food an animal eats. Every part of the animal is important to the health and wellness of the predator: “A victim to a carnivore’s table is frequently eaten entirely.”3 Organ and glandular tissue is especially essential; it has more DNA per gram than skeletal muscle, and it contains protein, vitamin and mineral profiles unique to that organ.4 When an animal consumes the brain and nervous tissue of its prey, that meal will uniquely nourish the brain and nervous tissue of the predator.
PROTOMORPHOGENS Organotherapy, the treatment of disease with organs and glands, was studied by human endocrinologists in the early part of the 20th century. Dr. Royal Lee, DDS, an early pioneer in human nutrition, proposed that glands and organ tissue could be effective beyond their unique vitamin and mineral content. He believed that animal extracts supported cellular health at the level of the nucleus, and in an unbalanced system these extracts could activate cells to repair. In 1947, six years before Watson and Crick defined DNA and the double helix, Dr. Lee proposed his theory of Protomorphology.5
Dr. Lee described Protomorphogens as “cell determinants” from organ or glandular tissue (“proto” = primary or original; “morphogen” = that which organizes form). He believed them to be the smallest functional units of the chromosome – cell-specific nucleoproteins that provided the blueprint and framework upon which a cell was constructed: “Suppose you have a building that is deteriorating. The manager will call in the repair crew. If the crew doesn’t have a blueprint, the repair won’t be adequate.” According to Dr. Lee, Protomorphogens (PMGs) served the cell like the seeds of a plant by helping with normal tissue function and catalyzing cell repair.4,6
AUTOIMMUNITY AND PMGS In Dr. Lee’s opinion, it wasn’t that there were so many autoimmune conditions; it was that so many chronic health challenges reached the autoimmune phase. Autoimmunity is inevitable in chronic disease as tissues became necrotic and decayed. Autoimmunity is the result of a failure to heal. Dr. Lee theorized that when tissue was damaged – as is in the case of a coronary occlusion – nucleoproteins from the necrotic tissue would leak into the bloodstream. Antibodies would respond to these “foreign” antigens and the patient would essentially become “allergic” to his own heart. The patient’s bloodstream would begin to carry antibodies to IVC Spring 2017
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the heart, impairing the repair of the heart itself.6 This is autoimmunity. Dr. Lee envisioned the autoimmune cascade as the body’s attempt to preserve itself, even though its effects could be more deadly than the disease itself. Dr. Lee saw the solution to autoimmunity in the nucleoproteins of the cell. He hypothesized that a heartspecific protein (Cardiotrophin PMG®) could be given orally to lower circulating antibodies to the heart tissue. Once in the gastrointestinal tract, the PMG would act as a decoy to the immune system, drawing cardiac auto-antibodies away from the heart, thus relieving the autoimmune attack on the heart, and giving the heart the opportunity to heal as therapeutic nutritional support is introduced.6
THE THEORY OF ORAL TOLERANCE Dr. Lee’s theory is strikingly similar to research that is being conducted today in the field of Oral Tolerance. Defined in 1977,7 Oral Tolerance is a state of non-responsiveness to an antigen.8 According to Oral Tolerance, when an antigenic protein is ingested orally, it is taken up by the Peyer’s patches in the ileum and presented to the bloodstream via dendritic cells. The body’s natural immune response is then used to induce regulatory cells directed at that antigen.9 Oral Tolerance works by one of three mechanisms:
q activating regulatory cells, which suppresses symptoms; w rebooting the immune system so it doesn’t react to the antigen (anergy); and e d eleting reaction to the antigen altogether (clonal deletion). Results are dose dependent. Higher doses lead to anergy or deletion, and low doses support suppression of symptoms.8 Continuous administration enhances the effect significantly by upregulating IL-10 and TGF-β.10 Oral Tolerance has been used in animal models to block the development of disease. It has been found to have beneficial effects in animal models of arthritis, colitis, diabetes, uveitis, myasthenia gravis, thyroiditis and EAN (Experimental Allergic Neuritis). In inflammatory conditions that have not yet reached the autoimmune phase, Oral Tolerance can protect the body against the self-antigen produced in response to inflammation.10
NEUROLOGIC IMPLICATIONS Nervous system trauma induces auto-antibody production as part of the natural healing process. Research has shown that anti-brain antibodies are produced following traumatic brain injury and spinal cord trauma. They have been found to be
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big players in neurologic disorders like SLE and MS.11 Patients with CNS paraneoplastic syndromes, kids with autism, and people exposed to environmental toxins have been found to have these antibodies in their serum. Some antibodies can be traced back to tissue injury occurring years before the onset of disease. Brain autoantibodies are also a produced as part of the natural aging process.11,12
of other practitioners, PMGs have supported animals dealing with any type of acute tissue injury, toxin exposure, or chronic condition. Many patients see symptomatic improvement when a PMG is added to their nutritional plan.
The following is a guideline for PMG use in veterinary patients: q PMGs should be given on an empty stomach if possible. It’s important for the PMG to reach the Peyers patches in Oral Tolerance can be used to treat some forms of the ileum in order for the immune system to recognize it. neuroinflammation. Tissue-specific antigens like oral MBP w PMGs can be given in twice daily or single daily doses. (myelin basic protein) given orally to rats with induced strokes Oral tolerance suggests a higher single dose will help were shown to decrease stroke size, most likely because of not only with symptoms, but may affect anergy or the downregulation of inflammation. Both small and large clonal deletion. doses of MBP have been shown respectively to suppress EAE e The general dosage is as follows, but should be tailored (Experimental Allergic Encephalomyelitis) and be protective, to the individual: non-detrimental and beneficial in EAE animal models. Findings • Large (>50#) 4/day from these studies indicate that: • Medium (20-50#) 3/day • Small dog or cat (<20#) 2/day the effect of Oral Tolerance is dose-dependent; S q r tart the PMG at half the recommended dose for the first seven to ten days, then increase to full dose (as w purified proteins are most effective; t he more frequently and consistently an oral antigen is tolerated). Histamine response (itch, digestive upset) is e given, the more effective it is; uncommon but can happen. If histamine response occurs, early therapy yields better results; and antihistamines or a beef liver fat extract (VF Antronex®) r combination therapy with medications may provide can help detoxify histamine from the liver; the PMG may t better results.11 be continued at a reduced dose. t Duration of treatment depends on the individual. In the ORAL TOLERANCE AND PROTOMORPHOGENS case of chronic conditions, PMGs may be given long term Protomorphogens are cell-specific proteins. One of the ways (years). In acute situations, the treatment course may be they may work in the body is through Oral Tolerance. Unlike shorter (several months to a year). Oral Tolerance, Protomorphology was outcome-based. Patients who took PMGs experienced symptom relief. Dr. Lee While PMGs contain minerals, nucleotides (the components of did not have today’s science to prove his theory, but he was nucleic acids like RNA and DNA), and peptides (short chains of able to trace heart sounds before and after the administration of a heart PMG. He found the sounds amplified shortly after oral administration of the PMG, which he theorized was due to increased pressure and better cardiac contractility. As with a heart PMG, patients with chronic coughs or TB could take a lung PMG; patients with digestive issues could take a pituitary PMG; and patients with nervous disorders could take a nervous system PMG to support healing.
PUTTING PROTOMORPHOGENS INTO PRACTICE It is not difficult to integrate PMGs into a patient care plan. They come in tablet form, are palatable, and for most animals (even cats) they can be given as treats. Animals with seizure disorders, neuritis, degenerative myelopathy, nerve trauma, head injury and other nervous system-related injuries or conditions are excellent candidates for this type of targeted nutritional therapy. In our experience, and in the experience IVC Spring 2017
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amino acids), they don’t provide the complex nutritional tools the body needs for full function.4 Their job is to help maintain normal cell metabolism and cell cycling, and to potentially enable tissue-specific immune downregulation. It’s important that other whole functional foods are provided along with a PMG to promote full healing and repair to damaged tissues.
CONCLUSION Protomorphogens are proprietary glandular extracts (Standard Process) that offer a novel and safe approach to supporting nervous system health. As a form of Oral Tolerance therapy, they lack toxicity, are easy to administer, and are antigenspecific; current medical therapies for people and animals with autoimmune and inflammatory conditions often depend on non-specific immune-suppression with medications – some of which can have undesirable effects.10 In practice, Protomorphogens can profoundly support patients with nerve-related and other conditions by encouraging healing over time, especially if they are used as an integrative approach to overall patient care.
JAVMA, Sept 1 2014, Vol 245, Number 5:478. ”Canine Health Foundation Awards Six New Grants to Study Epilepsy and Reproductive Diseases in Dogs”. AKC 5/9/2016, akcchf.org/news-events/news/new-epilepsy-and-reproduction-grants.html. 3 Patton, Richard. Ruined by Excess, Perfected by Lack: The paradox of pet nutrition. Nottingham University Press, 2011. 4 ”Protomorphogen™ Extracts Fact Sheet”. standardprocess.com/Standard-Process-Document-Library/MAT/LN0120-PMGFact-Sheet. 5 Royal Lee and William A. Hanson. Protomorphology: The Principles of Cell Auto-Regulation. Lee Foundation for Nutritional Research, Milwaukee WI 1947. 6 ”Dr. Royal Lee on Protomorphogens”. Digital re-recording from source tapes recorded in September 1957. Applied Nutritional Services. 7 Vaz NM, Maia LC, Hanson DG, Lynch JM. 1977. “Inhibition of homocytotrophic antibody responses in adult inbred mice by previous feeding of the specific antigen”. J. Allergy Clin Immunol, 1977, 60(2):110-115. 8 ”Food for Thought: Can Immunological Tolerance Be Induced to Treat Asthma?” Lauren Cohn Department of Internal Medicine, Section of Pulmonary and Critical Care, Yale University School of Medicine, New Haven, CT Am. J. Respir. Cell Mol. Biol. Vol. 24, pp. 509–512, 2001. 9 ”Antigen-Specific Strategies for Auto-Immune Disease Treatment: Oral Tolerance, ImmuneWorks”, uploaded February 2012, youtube.com/watch?v=bf9B0Spc25. 10 Ana M, C. Faria1 and Howard L. Weiner2. “Oral tolerance: Therapeutic implications for autoimmune diseases”. Departamento de Bioquı´mica e Imunologia, Instituto de Cieˆncias Biolo´gicas, Universidade Federal de Minas Gerais, Av. 1Departamento de Bioquı´mica e Imunologia, Instituto de Cieˆncias Biolo´gicas, Universidade Federal de Minas Gerais, Av.Antonio Carlos, 6627, Belo Horizonte,MG 31270-901, Brazil, and 2Harvard Medical School, Center for Neurologic Diseases, Brigham and Women’s Hospital, 77 Avenue Louis Pasteur, Boston, MA 02115, USA ISSN 1740-2522 print/ISSN 1740-2530 online q 2006 Taylor & Francis. 11 Kobeissy FH. “Autoantibodies in CNS Trauma and Neuropsychiatric Disorders: A New Generation of Biomarkers”. Brain Neurotrauma: Molecular, Neuropsychological, and Rehabilitation Aspects. Ch. 29 editor. Boca Raton (FL): CRC Press/Taylor & Francis; 2015. 12 Elamin NE1, Al-Ayadhi LY. “Brain autoantibodies in autism spectrum disorder”. Biomark Med., 2014; 8(3):345-52. doi: 10.2217/bmm.14.1. 1
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CASE STUDIES
1. George the cat was ten months old when he presented in March of 2016 for a nutritional consult due to acute (over the last three weeks) and progressive neurologic symptoms including an inability to jump, weakness, a choppy gait in the rear, and mental dullness. He was an indoor cat who had been adopted from a shelter several months prior. He had been to a veterinary neurologist with no definitive diagnosis despite extensive testing. He tested positive on an FIP blood test, but results were inconclusive for active disease. George was very quiet, subdued and non-painful upon examination. utrition Response Testing® (NRT) revealed blocked autonomic N nervous system regulation and a PNS switch associated with environmental EMFs (electromagnetic fields) and heavy metal/ petrochemical challenges. A biologically-appropriate, meatbased low-carbohydrate diet was recommended. George was also started on a whole food-based mineral supplement (Organically Bound Minerals®), a supplement to support toxin binding (Cholacol II®), and a salivary Protomorphogen (Parotid PMG®) to support detoxification of heavy metals and chemicals. Within a month of initiating nutritional therapy, George’s gait began to improve. He was starting to jump onto low furniture and was more interactive. At his two-month recheck he tested for additional cardiovascular and neuromuscular nutritional support (Feline Cardiac Support), and at his 12-week recheck he was mentally engaged, and able to jump from floor to countertop. After six months of nutritional therapy, his gait was visibly normal and he was back to regular activity, jumping up to multiple levels on his cat tree. Supplements were incrementally decreased. One year later, George remains fully recovered.
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2. M iller, an eight-year-old M/N Sealyham terrier, was diagnosed with GME (Granulomatous meningoencephalomyelitis) in late 2008. He was placed on cyclosporine, prednisone and gabapentin and made a full symptomatic recovery. Within a month of treatment, he experienced gingival hyperplasia and the cyclosporine was discontinued. He then experienced relapses at several-month intervals. Euthanasia was recommended during one episode, though Miller experienced intermittent improvements on drug therapy, which included azathioprine and procarbazine. During his current remission, his owners became concerned with the long-term effects of the drugs on his immune system, and sought nutritional consult. Nutritional recommendations for Miller included: grain-free diet, whole food-based nutritional supplements (Canine Immune Support, Canine Hepatic Support, Canine Whole Body Support) and a nervous system Protomorphogen (Neurotrophin PMG). O ne year later, Miller was reported as active, happy, pain-free and thriving. He was eating a home-cooked diet, was off all medication and continued on his supplement protocol. The supplements were to be decreased to the lowest effective dose, but because GME is a chronic condition, his nutritional therapy and support were recommended to continue lifelong. See more case studies at ivcjournal.com/case-reports/.
industry innovations Probiotics plus If you’re trying to avoid overuse of antibiotics, one way to start is by using probiotics to help keep your patients’ immune systems healthy and strong. Probios® Intelliflora® is a probiotic supplement for dogs and cats that provides an antibiotic-free approach to maintaining healthy immunity. It features four probiotic strains – Enterococcus faecium, Lactobacillus acidophilus, Lactobacillus planetarium and Lactobacillus casei – and offers a fast and convenient way of supporting balanced gut microflora while maintaining a normal immune system. Available in single dose, 1 gm packets. probios.com
Natural stress relief Animals experience stress just as we do. Veterinarian-recommended RESCUE Remedy® Pet is a natural way to relieve pet stress caused by travel, separation, new surroundings, loud noises like thunderstorms and fireworks, and other issues. This alcohol-free blend contains the same five Bach Flower Remedies found in the original RESCUE Remedy stress relief formula developed by a doctor more than 70 years ago. 1-800-319-9151, USACustomerService@nelsons.net
Animation explains PRP Companion Animal Health has pioneered a first-in-class medical animation overviewing platelet biology and the effects of Platelet Rich Plasma (PRP). The animation provides a biological background into this groundbreaking therapy, following the steps of PRP processing to injection, resulting in tissue healing and repair. Educational for both veterinary professionals and pet owners, this animation “brings to life” this clinically effective therapy in a simplified manner. View it at LiteCureInfo.com/HowDoesPRPWork.
Acquisition of animal health assets In industry news, Pegasus Laboratories, Inc. (doing business as PRN® Pharmacal) has acquired Veterinary Products Laboratories’ (VPL) animal health assets. A division of Central Life Sciences, VPL is a companion animal health business focused on veterinary products, including specialties in inflammation support, surgical suite supplies and house/yard parasite control. “Our goal is to serve veterinary niche markets and the underserved needs of the animal health community,” says Donna Logan, Pegasus Laboratories’ General Manager. “With this acquisition we will be able to do this better than ever.” 800-874-9764, PRNPharmacal.com
Natural solution to cataracts Cataracts are common in older dogs and cats, and can indicate surgery. But there’s an alternative in the form of Cineraria Maritima, which has been used homeopathically for over 100 years to safely and effectively treat cataracts. Cataract Crystalline Lens Drops with Cineraria from Natural Ophthalmics, Inc. trigger the body’s ability to clear the crystalline lens. The drops prompt the transfer of oxygen and nutrients from the blood to the aqueous, to nourish and detoxify the living tissue of the lens. Sold only through medical professionals and veterinarians; ask about their Intro Offer and how you can dispense these products to your patients. 877-220-9710, info@natoph.com, NaturalEyeDrops.com IVC Spring 2017
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integrative practice
By Cindy Maro, DVM, CVA, CAC, VMRT
How to Create a Holistically-Managed Practice Like many veterinarians, I derive energy from learning, healing and integrating multiple modalities into my practice. It is significantly more challenging to find the energy for managing office problems. Daily pressures and interruptions related to the business aspects of our profession can negatively impact work-life balance, detracting from the joys of client interactions and patient healing. After 30 years in practice, I own three practices all within 16 miles of one another. My practices are financially successful and show consistent growth. I have arrived at a place where I accept that serenity and peace in daily practice must be cultivated from within. I recognize that systems like the ones detailed in this article help create more predictability and order amid the chaos that can accompany veterinary practice. My definition and view of success is constantly changing as I examine the quality of my personal and family time, and the many facets of practice and home life from varying perspectives. I believe that continued success requires regular analysis, and ongoing learning. We
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must all keep refining our systems to keep pace with evolving needs and our individual development. Having a trusted MBA practice manager and a separate hiring/ training manager, who take care of the big picture, allows me to practice more efficiently. I have more personal time to travel for pleasure, take weekends off and spend more time with my family. My schedule includes three short days of office hours, two longer days with evening hours each week, and a half day three Saturdays per month. My practices employ a core nucleus of 11 team members who have been with the clinics from anywhere between six and 20 years, and they provide consistent and committed staffing. They also train and support the hires who have quicker turnover, including the many pre-vet and veterinary students we mentor and those assistants and receptionists who decide to raise families after a shorter time working with the practice. There are 30 team members who are cross-trained in all positions, and in all offices. This allows flexible positioning for vacations and illness.
This is in sharp contrast to my first years of practice ownership, when I worked approximately 90 hours a week and had difficulty hiring and retaining staff. There was no time for family and every seven days spilled into the next seven without end. The worst part was that I saw little financial gain for all my efforts.
Cash flow, rapid growth followed by recessions (three times), employee theft, staffing (both associate and support staff), attracting new clients, team training, marketing through social media, and identifying with/motivating employed younger generations (including millennials), are just a few of the issues that have required creative problem solving.
Unfortunately, veterinary education provides minimal business training, even though our profession requires us to develop business acumen, salesmanship and client hospitality protocols. Our combined roles of salesperson, business manager (even associates need to manage caseloads, payment considerations and staff) and medical professional can overwhelm us with challenges, including:
We all need to find personal motivators for tackling problems and my early ones were:
1 Overtime, causing conflicts with personal and family life Inconsistent client numbers/revenue to support the 2 employment of additional staff High staff turnover or difficulty hiring/training or retaining qualified team members Client communications interrupting office hours Staff training communication problems High debt or unpaid client accounts Low client numbers or difficulty obtaining new clients Poor cash flow Overwhelming paperwork, regulatory and HR demands on the business side of the practice Feelings of burnout and/or compassion fatigue Competition with online pharmacies, corporate clinics and low cost clinics that impact revenue Inventory management headaches.
3 4 5 6 7 8 9 10 11 12
Veterinary conferences offer management tracks that address these problems, while the American Animal Hospital Association, AVMA, Veterinary Information Network, and online publications like DVM360 provide professional resources for dealing with business issues. Increasing numbers of practice management consultants offer services to help us define and create successful practices.
1 2
F inancial necessity (my first employer had been embezzled from, requiring me to start my own practice sooner than planned) Desire to provide for clients, patients and a financially burdened community.
My mentors imparted lessons that illuminated the need for a holistic approach to the business of veterinary medicine, beyond simply treating patients. I learned from their examples that clients want to be heard and have someone to identify with. Understanding the range and expression of human emotion, developing empathy, and communicating well creates a strong foundation for bonding clients and establishing a thriving practice. I developed a clear vision of my life and practice goals from working with others.
PROFESSIONAL AND PERSONAL PLAN Many factors are required in creating a thriving business that supports the emotional and financial abundance necessary for long term practice, as well as mental and emotional health. Providing for patients, our communities, staff, families, and ourselves as veterinary professionals requires a well thought out and written plan. I suggest writing out both a personal and professional plan, complete with your vision, mission statement, financial plan and budget, and then scheduling frequent reviews of those plans. Continued on page 44.
Over the past 30 years as a veterinarian, Iâ&#x20AC;&#x2122;ve built five practices and worked in large and small animal medicine, emergency and shelter medicine and integrative veterinary medicine. The practice of medicine has been rewarding, but until I gained a recognition of and solutions for business conundrums, there was little time or money to enjoy life outside the clinic. Over the years, the diagnostician in me had to seek solutions to these problems, which changed depending on the economy and availability of human and other resources. IVC Spring 2017
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Continued from page 43. The hard part is scheduling time to create these plans. My advice is to just block out the time and lock your office door. Not doing this will be more devastating to your practice evolution and success than skipping CE attendance. The good news is that many of us have family, friends and clients with business training. They can help guide us through the creation of these plans once we get through the initial stages of writing out our goals for both our lives and practices. After roughing out what you want to create in life, you can move on to writing a mission statement. Your mission statement can be modified at any time, so feel free to refine it as needed.
MISSION STATEMENTS Mission statements include the healing you are bringing to patients, the financial exchange you require between yourself and your clients, your role in the community, and the involvement of your staff. Here’s an example of my mission statement: “Our exemplary staff offer more options for health, happiness and hope to pet owners for the enjoyment of their companions through integrative veterinary medicine. We provide enrichment for our community through education, and develop loyal clientele who refer others and pay their bills on time. We strive to improve our practice with medical advancements and the development of an enthusiastic staff team.”
Tips for creating budgets in veterinary practice
Incorporate all your current costs and salaries into your budget, including taxes. Set your salary based on what you would have to pay to replace yourself for all the jobs you do. If other family members work in the practice, how much would you have to pay to replace those team members? Add an estimated projected cost for CE, future growth, equipment repair and future equipment purchases, life insurance for key team and family members, disability insurance, and future retirement savings. Set target revenue numbers for each week and hour you are open. Hourly projections will help you set fees for the integrative and energy work you perform.
As you plan for more enjoyment of your practice, along with increased prosperity, write your own mission statement including your vision for your clients and patients, as well as for your staff. Include this information in employee manuals and at the staff entrance to your practice, so everyone in your clinic will be reminded of your joint goals. Staff will shift from merely wanting to help animals to understanding their roles as part of a larger vision. An abbreviated mission statement could be shared with the public in your client education materials, interviews, waiting room and more.
BUSINESS MODEL The next step to solving practice headaches is to think about your practice as a business entity, with only one part being your treatment of patients. Regardless of the size of your practice, you can create a better business model simply by identifying which areas of your practice are in need of attention/modification. Consider your practice as you would a sick patient. The first thing you need before diagnosing problems and creating a treatment plan is a clear understanding of the fundamental elements of business structure – this is the anatomy of the business. During early years in practice, I rated my practice’s success based on the number of happy clients and patients I was seeing. This rather narrow view did not produce a healthy lifestyle, nor did it support me financially. After two years of working seven days a week with little time off, a lack of funds for adequate staffing, and no savings, I began taking business courses. Those courses helped me shift my views about my role as a practice owner. I began recognizing that many of my business problems resulted from unidentified and unfilled positions in the company. After I began looking at business models in successful corporations, I saw how far my practice was from being run as a real business. My solution was to copy these models and mimic organizational charts in my own office. This approach really helped me shift and expand my thinking about the clinic, the role it played in the community and how important it was for everyone to create expectations for clients and staff. Problems decreased as we became proactive. Within a year of creating organizational changes, revenue for practice growth and additional staff became available, and I had more time for professional growth courses and for my family. My clearer vision also meant I no longer experienced guilt when Continued on page 46.
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Continued from page 44. HR & Communications Department
clients wanted to shift their lack of compliance or their financial irresponsibility onto me and the practice.
DVM On Boarding Office
Well/Sick
Office Policy
Imaging
Surgery
Procedures Protocols Equipment In order to create a more holistic system of managing your practice, Dental Suzanne Bruce Dr. Maro CT Laboratory Dr. Maro Radiography my suggestion is to identify and break down all jobs into separate Megan Pam Laura departments, represented by pages or poster boards, vital to a well-run The author created organizational charts for every facet of business. business. The following examples are See more online at ivcjournal.com. not all-inclusive in the business area. You will also want to create a similar list of all medical and healing-related job duties. Finance department e. Budget creation a. Accounts payable Human resources and internal communications f. Tax filing b. Accounts receivable a. Hiring, recruiting, staff training, reviews g. Bookkeeping c. Payroll b. IT, communications and all communications equipment d. Accounting c. IT consultants d. Scheduling staff Veterinary medicine: service delivery/pharmacy and e. Scheduling clients product sales
3
1
4
a. DVMs and their duties b. Technicians, assistants, kennel staff and their duties c. Energy workers and subcontractors who work within your clinic d. Consultants (veterinary, such as traveling radiologists and off-site consultants)
2 Marketing a. Internal marketing programs b. External marketing c. Social media integration d. Website development and maintenance
Preventing burnout and compassion fatigue
1 Identify what is causing feelings of stress/fatigue. 2 Target the causes by seeking support and outside motivation. 3 Make policy/procedural changes. 4 Get staff on board to change situations causing energy 5 6
depletion. If they wonâ&#x20AC;&#x2122;t change, then change staff. Know you are not alone; every practitioner goes through emotional ups and downs. Use wisdom/advice from colleagues. Find ways to recharge on a daily basis: family, humor, meditation, motivational recordings. They are all around us and easily available. Build breaks into your schedule. If youâ&#x20AC;&#x2122;re too busy to take a break, review your fees and your timewasters.
If practice is not bringing joy to you, your clients, patients, staff and/or family, adjust the demographic you are attracting, eliminate the people who drag you down, and find time for family, travel and hobbies to bring more happiness and abundance into your life. 46
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e. Equipment and building maintenance f. Inventory control, ordering g. Controlled substances control and record keeping h. Safety and OSHA
Western Veterinary Conference
5 Public Relations/community work (these efforts raise awareness of your presence and are not designed to produce a high financial return on investment) a. Adult community civic presentations b. Schools c. Shelter support
6 Patient retention and follow-up (quality control) a. Check out questions at the desk b. Follow-up calls and surveys
7 Planning and executive board (creation of short term and long term business goals, budgets, policies and procedures) a. Ownership and executive board (if you are a sole owner, this is you) b. Consultants c. Attorneys d. Accountants e. Banking/bankers Take time to list each job; this is needed to create a fullyfunctioning department. In small practices with five or fewer employees, you may have as many as 40 individual jobs in each department with names repeated many times. I suggest creating an electronic file, so you can keep modifying as your business grows and adds staff. Ask your practice manager and staff members to list every job they do. Most practitioners who use this organizational chart will end up adding staff after they realize how many duties a few team members are being burdened with. Often, this recognition leads to fee analysis and adjustments, so the practice can budget for additional team members. Improving organization, filling important roles and acknowledging the value of team members brings esteem to the entire practice and will aid your ability to charge competitive fees for your services. These steps will increase prosperity for your entire team.
A desert
oasis
for
CONTINUING
EDUCATION
When veterinarians first discover WVC’s Oquendo Center, they are astounded that a facility like this exists in the Nevada desert. This state-of-the art medical and continuing education center in Las Vegas has hosted thousands of veterinary professionals since 2009. Courses are taught by expert instructors, and range from Advanced Spinal Surgery to Flexible and Rigid Endoscopy to Small Animal Dentistry, and much more. The facility is designed to be versatile and provide the optimum environment for CE, so it lends itself to a variety of learning experiences, from hands-on classes to small lectures and auditorium-style learning. This July, the Oquendo Center will host the Women’s Veterinary Summit. Last year’s summit welcomed more than 50 veterinary professionals (both men and women) for a two-day workshop-based course that addressed financial, personal and inspirational topics. This event is unique to the profession in that it focuses on lifetime learning, teaching coping skills as well as providing practical information from a wide range of experts. “I was greatly impressed by the conference,” said one of last year’s participants. “I feel my future endeavors are attainable.” This year’s summit will include inspirational keynote speakers, workshops, and a personal review to highlight individual behaviors and values, while exploring strategies to achieve short and long term goals. For more information about the Women’s Veterinary Summit, along with lodging details for the luxurious Green Valley Ranch Resort and Spa, visit wvc. org/wvs. For a list of other courses at Oquendo Center, visit wvc.org/ce. IVC Spring 2017
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Veterinary Resource Guide ASSISTIVE DEVICES Best Friend Mobility Myrtle Beach, SC USA Phone: (503) 575-9407 Email: sylvan@sylvancompany.com Website: www.bestfriendmobility.org HandicappedPet.com Amherst, NH USA Phone: (603) 577-8858 Website: www.handicappedpets.com
ASSOCIATIONS 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
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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
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? Skunk
cabbage,
Symplocarpus
foetidus, is a spasmolytic herb. It has been used as a diaphoretic expectorant
as
well
as
for
stagnation pain from toxicosis, fatigue,
malaise,
aches
and
pains. It is a very strong herb and should not be taken at full doses for more than two months; if used excessively, it has an emetic effect. Native American tribes used skunk cabbage herb as a poultice for swellings and wounds, and for pain. Knight, a warmblood gelding in his mid-20s, was suffering from chronic Lyme disease. One of his favorite things to do was to stand on the skunk cabbage in his pasture. His owner realized that the more Knight was in the pasture, the better the horse felt. He gained perceptible pain relief from the skunk cabbage.
VBMA UPDATE • Our teleconference series for the year finished with Dr. Barbara Fougere’s talk on “The Latest Evidence Base for Veterinary
Strauss, a renowned herbalist, naturalist and organic farmer. Paul is the co-founder of United Plant Savers, and will be leading us on daily hikes when (as he says) “the plants are just bursting with energy”. On Friday and Saturday, we will hike through his property and the United Plant Savers’ Goldenseal Botanical Sanctuary. On Sunday, we will spend the morning learning about ginseng farming with Chip Carroll. This event is limited to 15 VBMA members only, so sign up soon!
2. The
International Herbal Symposium takes place June 9 to 11 at Wheaton College in Norton, MA. This is a gathering of top herbal speakers from around the world, and the VBMA supplies veterinary speakers for a track dedicated to animals. The symposium is a must-attend event for any herbalist! A registration link can be found on the VBMA website.
3. The ACVBM conference will be held on October 20, the day before the AHVMA conference in San Diego, CA, and will feature Drs. John Chen and Subhuti Dharmanda.
Herbal Medicine”. Recent reviews of published literature reveal a vast treasure chest of science across all species. Dr. Fougere has a magical way of blending recent scientific research into clinical practice. All past teleconferences can be
NAME THIS HERB!
purchased at vbma.org. • On February 15 of this year, Greg Tilford spoke on liver tonic herbs. Greg is the CEO and formulator of Animal Essentials Inc., and serves as an industry consultant and custom formulator for hundreds of veterinarians worldwide. He is the author of five books, including the acclaimed Herbs for Pets, the Natural Way to Enhance your Pet’s Life.
UPCOMING EVENTS 1. Join us from May 12 to 14 for a spectacular Eco-tour in the Appalachias of southeastern Ohio. Our leader is Paul
Join the VBMA at vbma.org to find out. The answer will also be published in the next issue of IVC Journal.
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Homeopathic treatment of
PRIMARY OR IDIOPATHIC
SEIZURES By John Saxton, Vet Med, Vet FF Hom, Cert IAVH, MRCVS
Primary or idiopathic seizures are commonly lumped under the diagnosis of â&#x20AC;&#x153;epilepsyâ&#x20AC;?. Secondary seizures linked to various other pathologies are entirely different, and require different approaches based on treatment of the primary condition. The conventional approach of anti-convulsant drugs may provide a quick solution in that fits are controlled (and clients are happy). However, such treatment can never amount to more than symptomatic control. These drugs must be given for life, with their attendant costs, monitoring requirements and often side effects for the animal. In addition, there are many animals in which, for a variety of reasons, complete control cannot be achieved.
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HOMEOPATHY OFFERS POSSIBLE CURE Homeopathy, on the other hand, offers the possibility of a genuine cure in the majority of cases, and in certain circumstances it can be combined with conventional methodology. There are, however, important differences between these two approaches, and these must be appreciated for the best results. The first thing to remember is that in homeopathy, there is no such thing as one remedy indicated for every case. Each prescription is individual, and is selected using criteria involving the general characteristics of the patient and the
modalities (factors that modify the intensity) of the symptoms not usually considered by the orthodox world. We must also appreciate that from a homeopathic approach, seizures are the acute manifestation of an underlying chronic condition, and the latter must be addressed if there is to be a successful cure. Even with accurate details of the fit, it must be remembered that these are essentially local symptoms and must be considered as such. They represent the means whereby the body exteriorises the underlying condition. Too much concentration preventing that manifestation, whether by purely locally-acting remedies or conventional medication, results in suppression of the external symptom, which leads to the disease process either finding another external outlet, or involving the deeper organs of the body.
Controlling seizures may lead to the animal developing chronic skin problems, diarrhea, or in time, an apparently unconnected, deeper and possibly life-threatening condition. Successful homeopathic treatment addresses the underlying chronic condition without merely suppressing external symptoms. The patient will then be free of seizures and healthier overall, with the chance of a longer life. Often, he will not need to stay on medications; conventional drugs can usually be stopped or the dosages dramatically reduced.
The second problem is that most cases of idiopathic epilepsy fall into the homeopathic category of “one-sided diseases”, in which only one symptom presents, or one symptom is so dominant that it overshadows any others that may be present. Homeopathically, this presents a challenge, so different strategies are needed to select the curative remedy. Taking the case includes the symptoms of the convulsions, possible causes in the individual, and any concomitant symptoms.
CAUSES OF EPILEPSY Trauma, infection, toxins and hereditary factors are all recognized and easily-understandable causes of epilepsy, but two other causes account for many cases. The first is vaccination, which can cause neurological problems shortly after the vaccine is given. Homeopathic veterinarians recognize seizures as one possible manifestation of this chronic condition, known as vaccinosis. Since over-vaccination can lead to the condition, booster vaccines should not be given unnecessarily. Under no circumstances should a booster be given to an animal with a history of fits from any cause. Primary vaccines given too early, while the animal’s immune system is still extremely immature, can lead to vaccinosis and seizures. The condition can also be triggered by the suppression of a normal acute reaction to the challenge of vaccination, such as a sore ear, patch of eczema or attack of diarrhea appearing shortly after vaccination. Mental factors such as fright, and particularly grief, can also be significant in triggering fits. It is easy to understand bereavement arising from a death, but it must also be remembered that a separation that’s explicable in human terms may well seem like a bereavement to an animal. The departure of a child to college, for example, while producing a sense of temporary loss in the parents, can produce grief-induced fits in a closely-attached animal who cannot understand what is happening. Continued on page 52.
CASE TAKING – COLLECTING USEFUL SYMPTOMS TO INDIVIDUALIZE TREATMENT The first big problem with epilepsy is that animals have fits. The often spontaneous and violent nature of a seizure can lead to outright panic on the part of the animal’s owner. Even without such an extreme reaction, the owner may demand that “something must be done immediately to ensure a fit never happens again”. Unless care is taken, this demand can lead to a concentration on the presenting symptom when selecting treatment. At the same time, amid the general upset and confusion, useful information relating to the nature of the seizure may be missed by the attendants. IVC Spring 2017
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Continued from page 51. Additionally, a history of any skin disease cases associated with head trauma; Ignatia that quickly responded to drug therapy or Natrum Muriaticum when there is (or even to holistic treatments) can grief; or Thuja or Silica to counter be a clue. When the vital force a vaccinosis (each of these rubrics expresses its imbalance with has a much longer list of possible skin symptoms which are then homeopathic medicines). A useful supplement quickly stopped (suppressed), for seizures more serious problems like If the appropriate remedy is Taurine, a neurotransmission inhibitor epilepsy may result. a polycrests (a remedy with that raises the threshold for fits, can be a a broad symptom picture, valuable supplement at a daily dose of SELECTING THE multiple indications and deep 200 mgm to 1,000 mgm, depending HOMEOPATHIC action), then that single remedy on patient size. Interestingly, cats, MEDICINE may be all that’s required since who need taurine as a dietary The goal is to use the collected it will address both the local and requirement, tend to have a lower incidence of fits. symptoms to select from over 4,000 constitutional levels of the case. homeopathic medicines the one that best matches all the symptoms of the individual Cases in which anti-convulsive drugs have animal. Sometimes there will be one clear-cut unique completely or partially controlled the fits pose symptom (e.g. seizures only occur at the full moon and/or at particular problems because the symptom picture has been night), or else all the symptoms clearly point to one remedy (the supressed or modified, and restoring the genuine picture causes similimum). A repertory is used; this is an index of all symptoms considerable case/client management challenges. NWS can be of each medicine derived from both testing and clinical practice (a useful in these situations to select remedies that can influence rubric is a list of medicines showing a particular symptom listed the cycle before the control provided by drugs is lifted. under the name of that symptom). Acute-acting remedies (i.e. Belladonna or Aconite) can replace At other times, the homeopathic technique known as “Never anti-convulsants and gain time in which to address the deeper Well Since” (NWS) is needed. In these cases, a clear connection aspects of a case. The bowel nosode Proteus can be of particular between the onset of fits and a particular event can be use because its theme of sudden nervous involvement mirrors established; this event must form part of the totality of the the broad epilepsy picture; its use will often prevent the case and should be included in the repertorisation (rubrics seizures and lead to a change in the symptom picture that will under “Ailments from” in the repertory). For example, Arnica, indicate a clear choice of a further remedy. Natrum Sulphuricum, Helliborus or Opium may be indicated in
Taurine
POTENCY AND FREQUENCY OF DOSING
Although the energy of a fit is high, care must be taken with potency selection since an aggravation can trigger a stasis epilepticus situation. Once trained in homeopathy, people develop a preference for administering single doses only, perhaps repeated for a few days to stimulate the curative effect, or repeated liquid dilutions. Since the goal of homeopathy is to stimulate the body to heal itself, to rebalance, remedies should not need to be given for life. If the animal is not getting healthier in addition to not having fits, then any new symptoms should be added to the list and a new similimum selected. See case reports on page 54.
References Blasig T and Vint P. Remedy relationships. Hahnemann Institut, 2001. Saxton J. “Do we truly understand vaccine reactions and vaccinosis?”Homeopathy 94, 200-201 2005. Saxton J. Bowel nosodes in homeopathic practice, 2nd ed. Saltire Books, 2012. Saxton J and Gregory P. Textbook of veterinary homeopathy. Beaconsfield Publishers, 2005. Swayne J (ed). International dictionary of homeopathy. Churchill Livingstone, 2000.
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1
Rosie was a four-year-old spayed female Labrador who had been living with a couple and their two teenage sons
since she was eight weeks old. She was vaccinated and wormed annually. Her first convulsion happened unexpectedly one afternoon, shortly after a walk. Thereafter, they occurred every three to four weeks. They were single fits lasting around three to four minutes, always during the day but with no time pattern. Stimulus from light or noise would trigger further fits. Rosie exhibited spasms and a lot of muscle twitching but no vocalization or incontinence. Recovery was followed by deep sleep if she was left quietly. On two occasions, she vomited while recovering. Her appetite and thirst were average and not affected by the fits. The only other medical history involved occasional patches of eczema (no laterality) during the previous year that responded to local treatment with a steroid/antibiotic cream. Rosie’s seizures were being conventionally treated with phenobarbitone BID for 48 hours following each fit. Homeopathic treatment was sought after the fourth episode. osie was initially treated with Belladonna 200c, to be administered immediately when a fit started. With this, R her fifth attack settled in around 1½ minutes. Further investigation revealed a pattern in which the fits occurred on or around the full moon. Rosie was a friendly animal who became nervous in new situations but was upset by nothing when at home. Two weeks after her fifth fit, she was prescribed Calcarea carbornicum 30c BID. A short mild fit occurred day days later (no Belladonna was needed). One week after this short sixth attack, Rosie was given Calcarea carbonicum 30c twice in one day. This resolved the fits; and her eczema, which was not present once the fits started, did not return. elladonna: Single fits. Great sensitivity to external stimuli. Heartbeat strong and rapid. B Calcarea carbonicum: The “chronic remedy” to Belladonna. Aggravation at full moon. Love of home. Anxiety in new situations and a need for security.
2
Smudge was a seven-year-old neutered male domestic shorthaired cat. He lived with a single lady in a small
semi-detached house in the suburb of a large city. A cat flap gave him free access to a small garden. His semi-feral mother had given birth in an animal shelter and Smudge had been adopted into his current home at nine weeks of age. He was vaccinated at eight and 11 weeks old, and was regularly boosted and wormed since then. There was no history of major health problems. Smudge had a close bond with the woman, sleeping on her bed and enjoying being fussed over. Around two years before his seizures began, the lady formed a relationship with a man who became an increasingly regular visitor to the house. Smudge seemed quite happy to see him and would accept food and some stroking from him, but he was never as affectionate as he was with the woman. He even seemed indifferent when the man occasionally spent the night. Smudge’s fits began suddenly about two months after the man moved into the woman’s home. Although he at first occasionally urinated on the man’s possessions, he otherwise appeared unmoved and this behavior ceased after a few weeks. The fits consisted of a cluster of three or four closely-spaced episodes that would occur at any time. Smudge screamed during the seizures, though there was no incontinence. Attempts to comfort him were difficult and to no avail, but did not appear to aggravate the situation. Several clusters could occur over a day, and then none for a week or more. Staphysagria 200c BID was administered for three days. The pattern of Smudge’s fits changed, becoming single fits at seven- to ten-day intervals. He also developed a distinct facial twitch. He resumed urinating on the man’s possessions, but would now also urinate, in full view, directly on the man. Smudge was prescribed Hyoscyamus 1M, three doses in 24 hours. The fits ceased and so did the direct urination, but the twitch and surreptitious urination continued. Hyoscyamus was repeated after three weeks, and all symptoms resolved over the next month. No further treatment was needed. Staphysigria: Ailments from anger and humiliation. Sexual passion. Nervous excitability. Sensitivity to insults. Hoscyamus: Lewd behavior in public. Jealousy. Muscle twitches, especially of face.
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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 level of 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.
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From the VMAA
The Veterinary Medical Aromatherapy® Association (VMAA) is an organization of veterinarians and veterinary technicians dedicated to the responsible use of aromatherapy in animal practices. Their mission is to promote standards of excellence in animal aromatherapy, to provide outreach and education to veterinarians and axillary animal practices, and to promote continual improvements in Veterinary Medical Aromatherapy®. The VMAA is elevating the veterinary profession through innovation, education, and advocacy of integrative medicine.
Aromatherapy is very beneficial for dogs and cats. These animals have abundant nasal receptors, and simple inhalation may achieve effective blood levels of the chemical constituents present in the oils. In addition, their hair acts as a wick and is not a deterrent to effectiveness.
thickening. The enlarged nodes decreased to half their pathologic size (4.0mm to 4.6mm). The mesentery was non-reactive.
OIL SPOTLIGHT
In the spring of 2016, the VMAA began hosting an online CE taught by President Dr. Nancy Brandt. She begins her course teaching you how to recognize and select quality oils and how to blend them based on their “notes”.
Frankincense Among the oils most revered for their emotional, spiritual and physical support is frankincense. It’s distilled from resin from the slashed bark of the Boswellia tree. There are over a dozen frankincense species, including Boswellia sacra, Boswellia carterii and Boswellia frereana. Boswellic acids are terpenes known to have anti-inflammatory and antibacterial properties – frankincense is composed of over 50% terpenes. Additionally, the natural chemical constituents of this essential oil can cause apoptosis. ncbi.nlm.nih.gov/pubmed/27117114
CASE REPORT Snoops was a middle-aged feline who presented unkempt, anorexic, and with vomiting and diarrhea. Blood work and an abdominal ultrasound were performed. The imaging showed diffuse small bowel thickening and large mesenteric nodes (9mm to 10mm), consistent with intestinal lymphoma, or less likely, severe IBD. An invasive biopsy was not performed and a grave prognosis was given. Snoops was prescribed a raw diet with no chicken or synthetic vitamins. Added supplements included probiotics, cod liver oil, artemisinin and vitamin D. We began with one drop of frankincense (Boswellia sacra) orally in a capsule, increasing slowly to ten drops daily. Additionally, three drops were massaged onto his belly and several drops placed in a nebulizing diffuser each night. Snoops improved rapidly. His appetite returned and he gained weight. A follow-up abdominal ultrasound, 5½ months after initiation of treatment, revealed a nearly complete resolution of small bowel
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Snoops is alive and well three years post diagnosis.
VMAA UPDATE
Dr. Ron Schultz talked about Titer Testing as a keynote speaker at our Veterinary Summit 2016 at Sundance Resort. Other topics included Pharmacology of Oils, Frankincense Injections, Oils in the Vet Clinic, Oils for Behavior Modification and Oils for Sled Dogs, providing 12 CEUs to participants. Our next Summit is planned for February 2018 with hands-on oils training in Las Vegas. We held our first annual meeting at the AHVMA Convention in Ohio last fall. We also had an exhibit booth and will do so again at the AHVMA Convention this year in San Diego.
WHY YOU SHOULD JOIN VMAA Membership includes access to educational courses, discounted classes, conferences, online webinars, an informative newsletter and fun relationships with other members who are knowledgeable and enthusiastic about the many benefits of oils for animals. Follow us on Facebook: Veterinary Medical Aromatherapy® Association. We also have an exclusive members-only group. VMAA offers certification as a Veterinary Medical Aromatherapist® and courses approved by the AAVSB RACE to offer a total of 24 CE credits. This is a self-paced online course. Visit vmaa.vet.
Name the oil distilled from this plant!
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By Kimberly Henneman, DVM, DACVSMR, FAAVA, DABT, CVA, CVC
An integrative approach to
EQUINE HERPES MYELOENCEPHALOPATHY (EHM)
A look at what is currently known about this neurologic manifestation of the EHV-1 virus, along with integrative therapies for its prevention and treatment.
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Integrative therapies aren’t often considered for the treatment of infectious disease. However, many integrative modalities can integrate smoothly and beneficially into established treatment protocols. In the face of a disease outbreak, where the best that conventional medicine can do is provide physical support, many nutritional and integrative modalities such as acupuncture, herbal medicine and homeopathy could possibly assist with prevention, acute disease treatment and recovery. One such disease facing equine practitioners is Equine Herpes Virus-1 (EHV-1), especially in its neurologic form of Equine Herpes Myeloencephalopathy (EHM). This article will provide a brief review of what is currently known about the EHV-1 virus and its neurologic manifestation, along with possible integrative intervention strategies that can be added for prevention and treatment.
What is EHM (neurologic EHV-1)? The neurologic variant of EHV-1 was first officially identified in the US during a serious outbreak at a college in Ohio in 2003 (although potential outbreaks may have occurred in Kentucky in the 1970s). Of the 135 affected horses, 86% showed clinical signs and 39% showed neurologic signs. Twelve horses died or were euthanized. Since then, there have been numerous outbreaks, especially in California, Florida, Connecticut and Utah. This rise in reported outbreak incidence of the formerly uncommon EHV-1 and even rarer EHM could represent a concerning change in virus virulence and host susceptibility. To date, while no increased virulence has yet been demonstrated, the genomic areas of variation (the variants are now identified as D752 and N752) have been identified. While each can cause both illness and neurologic symptoms, the D752 variant has a higher correlation with clinical EHM symptom onset. Horses can be infected and become carriers of both variants at the same time, thus a latent infection with one does not prevent infection with the other. Most importantly, EHV-1, like all other herpes viruses, has a strong ability to lie latent in the body until stress stimulates reactivation. It tends to hide in both the lymphoreticular system and the trigeminal ganglion. Latency studies show viral presence in up to 66% of horses with an unknown exposure history, and 54% of Thoroughbred broodmares. Once activated in neurologic disease, the spinal cord gray and white matter are most commonly affected, resulting in ischemic necrosis. (The author wonders if there is a link between trigeminal neuralgia syndrome [head shakers] and latent EHV-1.) EHV-1 is transmitted via shedding from the nose (or infected fetal membranes); via fomites such as hands, brushes, blankets,
Managing stress
Managing stressors that can affect emotional, mental and immunologic health is where integrative therapies shine. Most competitive horses have probably been exposed to natural EHV-1. If a horse is stressed by trailering, travel or leaving his/her herd, try to scale back if there has been a potential exposure or cases reported in the area. Be aware of a horse’s training schedule and counsel clients when their horses might need a break. In the world of sports medicine, rest is considered as important as exercise in the overall picture of conditioning and fitness, but with high drive clients or with a big show in the works, it can be easily overlooked or skipped. Remember that horses younger than five may be more susceptible to training stress than seasoned campaigners. Also be cautious of overusing non-steroidal antiinflammatories (Bute, Banamine) as well as steroidal medications such as prednisone and dexamethasone. These medications can affect immune cell function or cause additional inflammation and stress in the digestive system (the location of 80% of the body’s immune cells). Vaccinations can create a transient drop in immunity within three to ten days afterwards. The more viruses combined into one vaccine, the greater the transient drop. Many labs now run antibody titers so it’s easier to determine if an animal even needs to be vaccinated (because, isn’t the point of a vaccination to create immunization?). There are now accurate and cost-effective tests for EEE, WEE, WNV and rabies.
feed or water buckets; or via aerosol. The virus can survive in the environment for several days up to a couple of weeks, depending on conditions. Subclinical shedding is not considered a factor in the development of clinical outbreaks – rather, this type of exposure probably leads to latent infection in exposed animals. Continued on page 60. IVC Spring 2017
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Continued from page 59. Both the abortive and neurologic manifestations are thought to occur only when latent disease is activated to full clinical disease, or there is exposure to a clinically sick animal. Protection from reinfection after recovery is thought to last only three to six months. The development of clinical neurologic disease in any individual horse seems to be linked to the level of viremia (a prerequisite for the development of both neurologic and abortive clinical signs), the degree of pyrexia, the length of time since vaccination (see more in vaccine section) and stress. The incubation period is approximately three to seven days. The viremia can last as long as 14 days, peaking approximately five to nine days after intranasal exposure. A high fever (>103.5°F) that recurs several days after the initial onset of fever is thought to be predictive for the onset of EHM. Risk factors for EHM appear to be different from those associated with EHV-1 respiratory illness. Older and larger horses are more susceptible (ponies, of course, seem to be particularly resistant). Mares, especially pregnant ones, are also more likely to be affected. Abortion symptoms are more likely to occur in the last trimester.
Symptoms of EHM Initial symptoms may be vague – fever, lack of appetite and lethargy – and can progress rapidly to the neurologic form. Neurological symptoms include incoordination, leaning against walls for stability, urinary incontinence or dribbling, loss of tail tone, paralysis, and eventually an inability to stand.
To vaccinate or not to vaccinate? In general, vaccinating in the face of an outbreak is always controversial. In some situations, when there is enough time for the occurrence of an immune response to the vaccine stimulus, vaccination might provide for enough antibody response. However, it has been demonstrated that many vaccinations can cause a transitory period of immune-suppression, so an animal could be at greater risk if exposed during that period. Currently, the standard EHV-1 vaccine for the respiratory or abortive infection is not thought to stimulate cross-protection to the EHM variant. There is some controversy as to whether or not increasing the presence of Killer T lymphocytes at the nasal mucosal boundary by performing parenteral EHV-1 vaccination may prevent the viremia that is a critical step in the development of EHM. The following excerpts were taken from a presentation given by Dr. Julie Watson (Internal Medicine) at an American Association of Equine Practitioners meeting in December of 2005:
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“Conventional IM (intramuscular) vaccines usually require at least one week for measurable humoral responses to a booster or a second dose and similar time period in naive animals. This time lag has discouraged the use of vaccines in exposed animals, yet vaccination has been successful in protecting adjacent groups not yet exposed. “In a California outbreak of neurologic EHV-1 infection, horses vaccinated with either type of vaccine within the previous year were nine to 14 times more likely to develop neurologic signs than non-vaccinated horses. Because the vasculitis associated with the neurologic form is immune-mediated, vaccination after exposure raises concerns of producing a more severe disease. Consequently, vaccination in the face of a confirmed outbreak of EHV-1 neurologic disease has been controversial.” (Wilson, 2005) In the 2003 Finley University (Ohio) outbreak, Dr. Stephen Reed (an equine neurologist) discovered that animals vaccinated against EHV-1/4 had both higher morbidity and mortality rates than horses that had received no parenteral vaccinations at all. To be fair to all perspectives, some argue that this is because older animals are more susceptible, but no one has argued that perhaps older animals are more susceptible because they have had more vaccinations. Because EHV-1 viremia is mononuclear cell-associated, and EHM is associated with a significant inflammatory and immunemodulatory vasculitis, integrative practitioners, especially those who might be new to the various modalities, might want to delay vaccination in the face of exposure and resort to therapies that can boost activity of immune cells, especially lymphocytes and modulate inflammation. (Note: when dealing with competitive horses in which EHV-1 vaccination is mandatory, the author recommends using an intranasal vaccination.)
Steps to take during an EHV-1 outbreak Whether a veterinarian primarily uses conventional or integrative therapies, one thing common to both approaches is basic infectious disease management. First and foremost, clients should avoid transporting horses to areas where the transmission of active virus could occur. If the horse has already been exposed, then he should be isolated and quarantined from contact with other horses, and strict disinfection protocols should be started (biosecurity). A clinically ill animal can continue to shed the virus for 21 days (possibly longer) after initial infection. New PCR tests (especially live time) are now available to help identify potentially exposed individuals early on, allowing for both conventional and integrative interventions that can help lower viremia and boost immune function. Second, remember that the animal’s own immune system is still the best protection. In the face of environmental or
performance stresses, immune support may delay, decrease or prevent clinical signs. There are a variety of ways an integrative veterinarian can support immune function: • Manage and try to avoid things that can suppress the immune system, such as stress (travel, strange places, separation from herd buddies), alterations to gut microbiome (antibiotics, NSAIDs), and suppressive medication (hormones, steroids for skin problems, sedatives or tranquilizers, over-vaccination before travel). • Stimulate and support immune function with nutrition, acupuncture and herbs. For example, moxibustion has been shown to increase the activity of cytotoxic T-lymphocytes and promote the production of anti-inflammatory cytokines (Takayama, 2010).
Integrative medicine for prevention and treatment The difference in infectious disease perspective between conventional medical practitioners and more integrative ones is the emphasis on the body’s role in preventing disease. Conventional medicine often has to rely on either vaccinations (which may worsen the EHM) or a more wait-and-see approach in the face of possible exposure. Integrative medicine has many nutritional, herbal and homeopathic options to help prevent and also treat symptoms that may appear. There are many ways to stimulate the immune system. While there are products on the market that are advertised to boost the immune system, they are very general and coarse ways of stimulating a system that is so complex and specifically fine-tuned. In the author’s experience of treating chronic immune deficiencies, these products can cause chronic health problems and immune sensitivities that can last long past the initial need. It is much like an usher getting a smoker to put out his cigarette by yelling “FIRE” in a theater. The smoker has put out the offending burning object, but there are also people screaming and causing undirected havoc all around him. In other words, significant collateral damage can occur, with hypersensitization in some areas and deficiencies in others. The best way to boost the immune system is by doing it from the ground floor, through nutrition. After addressing diet, acupuncture and herbs can be used to increase immunity.
• Vitamin C: double the dose if there has been a recent potential exposure. • Vitamin E: give a minimum of 4,000 IU/day. Vitamin E is a potent fat-soluble antioxidant and has been shown to act as an anti-inflammatory in nerve tissue. • Omega 3 fatty acids: numerous studies show the antiinflammatory and neurologic protective effects of Omega 3s. • Zinc: found in supportive levels in hoof and skin supplements. • Caretenoids: the precursor to vitamin A, which boosts activity of virus-fighting killer T cells. • Probiotics: a plethora of research in just the past few years shows links between healthy gut bacteria, lymphatic cell, body cytokine (inflammatory and anti-inflammatory) production, and total body immune function. This indicates probiotics should be among the first things an integrative practitioner thinks of. Continued on page 62.
Homeopathy for EHV-1
While homeopathy doesn’t work well as a preventive, it might be extremely effective in treating the initial stages of disease, especially when combined with conventional supportive care. During the cholera epidemic of WWI, homeopathic hospitals in Philadelphia had a16% mortality rate versus 60% for the general hospital population. OTC remedies can be purchased online from homeopathic pharmacies or from most health food stores. Remedy potencies are 6C or 30C. • Belladonna: the best remedy for sudden onset of high fevers with neurologic symptoms. • Aconitum: sudden, vague fevers with lethargy. • Gelsemium: initial stages of viral infection with neurologic symptoms and fatigue. • Oscillococcinum from Boiron: specifically for human flu symptoms such as lethargy and fever – symptoms very similar to the early signs of EHV-1. The author has used this OTC remedy (or had clients use it) with excellent outcomes in horses with these symptoms.
Using nutrition to boost immunity Feeding whole, clean, quality grains is important – be cautious using overly processed feeds with ingredients made from byproducts, since these actually increase oxidative stress in the body. In addition, I recommend the following supplements: IVC Spring 2017
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Continued from page 61.
Immune-boosting herbs (Western and Chinese) • Ginseng (Korean or Siberian): both types (American ginseng is weaker) support the adrenal glands, which when stressed or exhausted are unable to support the body’s stress functions. For a practitioner trained in Traditional Chinese Medicine, many immune-supporting Chinese herbal formulas contain ginseng (Panax or Eleuthro) and can be custom blended at a Chinese herbal pharmacy (the author uses either Mayway or Jing Tang). • Echinacea: needs to be on-board at the time of exposure. Also, to be effective, it needs to be given at least three times a day. Human research has shown that Echinacea is more effective if given as a water extract (tea). • Goldenseal: has antiviral activity, but can only be used short-term. • Astragalus: this Chinese herb is extremely effective as an immune booster, especially when combined with Ligustrum. An Astragalus and Ligustrum formula has been used in Chinese Medicine for almost 1,000 years. Today, it has been shown to be very effective in treating HIV and Epstein-Barr virus. • Gan Mao Ling: a traditional Chinese formula that’s effective in preventing or reducing the symptoms of rhino virus in humans. • Garlic: has been shown in several studies to increase the activity of virusfighting lymphocytes. If you use garlic in your horse, since it is a “warm” herb in the Chinese pharmacy, make sure you combine it with other herbs that are a bit more cooling, such as mint, elderberry or lemon balm. • Turmeric (curcumin): from the ginger family, this Asian herb is backed by strong data demonstrating its antimicrobial and anti-inflammatory properties (in humans it has been shown to reduce C-reactive protein). Smokejumpers have a saying: “Every fire starts small.” The best way to avoid having to treat a horse seriously ill with EHM is to prevent the disease in the first place. Many of the therapies we can use to support an animal exposed to EHV-1 can also be used in more general and preventive circumstances in competitive and traveling equine athletes. All it takes is for the integrative veterinarian to start a dialogue for educating horse caretakers.
References Allen GP. “Risk factors for development of neurologic disease after experimental exposure to equine herpesvirus-1 in horses”. American Journal of Veterinary Research, 2008. Goehring LS, Brandes K, Ashton LV, et al. “Anti-inflammatory drugs decrease infection of endothelial cells with EHV-1 in vitro”. Equine Veterinary Journal, 2016. Henninger RW. “Proceedings of the equine herpesvirus-1 Havermeyer workshop 2004”. Veterinary Immunology & Immunopathology, 2006. Henninger RW, Reed SM, Saville WJ, et al. “Outbreak of a neurologoic disease caused by equine herpesvirus-1 at a university equestrian center”. Journal of Veterinary Internal Medicine, 2007. Kydd JH, Townsend HG, Hannant D. “The equine immune response to equine herpesvirus-1: the virus and its vaccines”. Veterinary Immunology and Immunopathology, 2006. Kydd JH, Slater J, et al. “Third International Havemeyer Workshop on equine herpesvirus type 1”. Equine Veterinary Journal, 2012 Lee MJ, Jang M, Choi J, et al. “Bee venom acupuncture alleviates experimental autoimmune encephalogmyelitis by upregulating regulatory T cells and suppressing Th1 and Th17 responses”. Molecular Neurobiology, 2016. Lunn DP, Davis-Poynter N, Flaminion MJBF, et al. “Equine herpesvirus-1 consensus statement”. Journal of Veterinary Internal Medicine, 2009. Lunn DP, Morley P. EHV-1 Information. Colorado State University, Dept Clinical Sciences, 2011. Muller N. “Essay on protecting your horse for EHV-1”, Los Caballos Equine Practice (Galt, CA). ePub. Takayama Y, Itoi M, Hamahashi T, et al. “Moxibustion activates host defense against herpes simplex virus type 1 through augmentation of cytokine production”. Microbiology and Immunology, 2010. Traub-Dargatz JL, Pelzel-McCluskey AM, et al. “Case-control study of a multistate equine herpesvirus-1 myeloencephalopathy outbreak”. Journal of Veterinary Internal Medicine, 2013. Walter J, Seeh C, Fey K, et al. “Prevention of equine herpesvirus myeloenceophathy - is heparin a novel option?”Tierärztliche Praxis Großtiere, 2016. Williams JE. “Review of antiviral and immunomodulating properties of plants of the Peruvian rainforest with particular emphasis on Uña de Gato & Sangre de Grado”. Alternative Medicine Review, 2001. Reed S. “Data on Finley EHV1 Outbreak”, personal communication with Dr. Julie Wilson, 2004. Wilson J. “Vaccine Efficacy and Controversies”. AAEP Annual Proceedings, 51: 409-420. 2005.
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The AHVM Foundation is a 501(c)(3) non-profit charitable organization that benefits the public good through scientific research and education in integrative veterinary medicine. It seeks to be a model of both high quality and high integrity work in integrative therapies. We hope to discover information that improves education and clinical practice for both human and veterinary medicine.
WINTER FUNDRAISER A SUCCESS! A big thank you to Lorraine and Dr. Carvel Tiekert for their generous donation of a $50,000 matching donation for the AHVMF’s winter fundraiser. The donation came with the following restriction: $25,000 had to come from the public, and the other $25,000 from veterinarians. The Veterinary Botanical Medicine Association also gave a $5,000 matching donation, to be raised from VBMA members only, as well as $10,000 additional funds for research in veterinary botanical medicine. Both matches were successful, so over $100,000 was raised. The VBMA funds are restricted to botanical medicine research, so for the first time we can offer money to veterinary schools, for herbal research only. This approach increases research in veterinary botanical medicine (if we just say “we have research money” we are more likely to get applications for the most popular type of CAVM at that college). We hope to be able to take similar approaches for other modalities, especially those needing more research. But this can only happen when donations are specifically restricted to one type of research, and large enough to make a meaningful research project possible.
w Another study at Michigan State University will look at the effects of curcumin on ventricular cardiac arrhythmias – the type suffered by boxers and Dobermans. This is being done by the university’s cardiology department and includes the use of Holter monitors, which are necessary for studying this type of arrhythmia. (This brings the number of US veterinary schools that we have supported to 11. Our goal is to be involved with at least two-thirds of the veterinary schools in the US.) e A third proposal is to help with a large-scale study of raw food at the University of Helsinki veterinary school. This study has hundreds of pet owners participating and involves a very long questionnaire, as well as the collection of fecal samples for microbiome analysis, and blood tests to measure general health. Visit ahvmf.org or our Facebook page for descriptions of the research we support, and sign up for our “Research Roundup Hope” newsletter to keep abreast of research we are watching. Send in your treatment successes so clients will know there are multiple options for a variety of illnesses.
For example, some people want to support research that does not involve animals; but there aren’t many, and they make small donations. We are reserving those donations, but the total we have received for non-animal research since 2011 has been less than $1,000. Others have said they will send money only after we stop supporting research that uses animals. We never fund research where disease is induced, but we do support research that helps treat animals that are already sick, so we will never qualify for a donation from them.
THREE NEW RESEARCH PROJECTS q One study will research the effects of aromatherapy in shelter dogs. Nine single essential oils as well as a combination of all nine will be tested for their abilities to soothe anxiety.
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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) will hold its annual meeting, Focus on the Fundamentals, during the 2017 AHVMA Conference at the Town and Country Resort in San Diego, California. Our meeting runs October 20 to 22, and boasts speakers such as Richard Pitcairn, Kim Elia, Jackie Sehn, Lisa Melling and Wendy Jensen. SAN DIEGO
Topics of discussion will include the successful treatment of canine seizures using homeopathy, and the use of homeopathy to cure symptoms of pemphigus foliaceus. There will also be three hours of lectures at the AHVMA conference on Sunday, October 22, featuring an introduction to homeopathy to help holistic veterinarians easily integrate homeopathy into their practices. For more information and to register, visit theavh.org.
REMEMBERING ARTHUR YOUNG Dr. Arthur Young, a beloved veterinary homeopath, died in November of 2016 at the age of 86. He will be greatly missed by his friends and colleagues. Dr. Richard Pitcairn fondly remembered Arthur’s first day at the Professional Course in Veterinary Homeopathy: “Many of you will have met Arthur Young, a veterinarian in New Jersey. He first took the Professional Course in 1995 and emerged from it a dedicated homeopathic practitioner. I remember him walking in on the first day of the first class, taking an aisle seat in the front row. He was older, appeared conservatively dressed, and I fully expected he would not continue with the course (as has happened with some others).
y homeopath, Beloved veterinar ssed away in Arthur Young, pa year. t las of er Novemb
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But I was wrong and Arthur became one of our strongest supporters. He often referred to himself as ‘the oldest living veterinary homeopathic practitioner’ and as ‘working in the trenches’, which indeed he did by taking the position of a homeopathic practitioner in areas where he was very much alone in this work.”
MORE NEWS AND NOTES • The AVH offers monthly webinars to members on the second Wednesday of each month at 8 PM E.S.T. This is a great opportunity to earn CE for maintaining certification requirements and to grow our knowledge in veterinary homeopathy. Information is available at theavh.org. These webinars are recorded and AVH members can review them at any time. • Members continue to enjoy this year’s membership in the International Association of Veterinary Homeopathy. The listserve shares concerns and successes from veterinary homeopaths the world over. • Members also benefit from the AVH listserve, where they share ideas on treating cases, managing practice, and speaking at conventional conferences and other venues such as veterinary colleges, to educate veterinarians. • Interested in becoming a veterinary homeopath so you can cure many conditions, including but not limited to acute illness and injury, as well as immune-mediated diseases, allergies, and cancer? Registration is now open for the 2017 Professional Course in Veterinary Homeopathy, beginning in September in Portland, Oregon. For more information, visit pivh.org.
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events
To post your event, email us at: info@IVCJournal.com
133rd CVMA Annual Meeting & Convention
2017 Massachusetts VMA Spring CE Conference
At this meeting and convention you will find a variety of different programs offered, including the Small Animal Practitioners Program covering feline and canine lower urinary tract disease as well as the Large Animal Practitioners Program, Practice Management Program and Technician/Assistant Program.
MVMA’s mission is to promote the veterinary profession, improve animal well-being and public health and provide programs and services that enhance the ability of member veterinarians to succeed.
March 28 – 29, 2017 – Westbrook, CT
For more information: (860) 635-7770 info@ctvet.org www.ctvet.org
Veterinary Emergency & Critical Care Spring Symposium April 6 – 9, 2017 – Maui, HI
VECCS is committed to offering its members the highest quality of Continuing Education regardless of venue. This year’s symposia will be held at the Hyatt Regency Maui Resort and Spa, a breathtaking and luxurious destination resort property. The resort is just three miles north of historic Lahaina town and a short walk from Whaler’s Village for shopping, dining, art, boating excursions and night life. For more information: (210) 698-5575 info@veccs.org https://veccs.org/spring2017/event-information/
May 10, 2017 – Marlborough, MA
Join the Continuing Education conference in May 2017! For more information: (508) 460-9333 staff@massvet.org www.massvet.org
Maryland VMA Mid-Atlantic State Veterinary Clinic May 18, 2017 – West Friendship, MD
If you are a practitioner of small animal or equine veterinary medicine, this is a premier opportunity for continuing education, business information and networking. There are also educational opportunities for technicians, farriers and students. For more information: (443) 507-6500 mvma@managementalliance.com www.mdvma.org
CVC Conference for Veterinary Care
West Virginia VMA 2017 Annual Spring Meeting April 7 – 9, 2017 – White Sulphur Springs, WV
We have worked with our sponsors and nearby veterinary schools this year to provide a forum which should inform and excite everyone. Featured speaker is Dr. Daniel Smeak from Colorado State University College of Veterinary Medicine. Dr. Smeak will cover many common surgical procedures that you will be able to employ in your daily practice. As always, The Greenbrier is providing a legendary venue with entertainment for the whole family, including a bowling event Saturday evening sponsored by Elanco! For more information: (804) 346-0170 kitty@wvvma.org http://www.wvvma.org
2017 Spring NYS Veterinary Conference
May 18 – 21, 2017 – Virginia Beach, VA
For more than 20 years, CVC’s vision has been to provide veterinarians, veterinary technicians, practice managers and team members the best convention experience possible by offering premium educational programming, expert clinical education, hands-on labs and workshops, practice management programs, and team training sessions from the award-winning editors and doctors behind DVM Newsmagazine®, Veterinary Medicine®, Veterinary Economics®, Firstline® and dvm360.com. With expert speakers and exceptional service that is affordable and accessible and offered at three convenient locations annually: Virginia Beach, Kansas City, and San Diego. For more information: (800) 255-6864 cvc@advanstar.com www.thecvc.com
April 21 – 23, 2017 – Tarrytown, NY
2017 ACVIM Forum
Don’t miss this conference hosted jointly by the New York State Veterinary Medical Society (NYSVMS) and Cornell University College of Veterinary Medicine (CUCVM) at the DoubleTree by Hilton in Tarrytown, NY.
Join your colleagues in National Harbor, MD to explore the latest research, best practices and strategies in veterinary specialty medicine at the 2017 ACVIM Forum.
Choose from 4 tracks and 84 education sessions and earn up to 21 credits. Visit the exhibits that feature a variety of products and services. Plus, enjoy a festive complimentary reception each night.
June 8 – 10, 2017 – National Harbor, MD
Online registration ends April 10.
Whether you’re looking to inject a big dose of the latest scientific research into your practice, or just want to seek out the trends that will keep you a cut above the rest, the ACVIM Forum’s invigorating blend of leading-edge scientific research, state-of-theart lectures and exclusive networking connects you with the best and brightest in the veterinary industry. CE credit hours available.
For more information: (607) 253-3201 keh36@cornell.edu http://www.cvent.com/d/bvq0fb
For more information: (303) 231-9933 Forum@ACVIM.org http://www.acvim.org/ACVIM-Forum/ACVIM-Forum-Home
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IVC Spring 2017
For more events, visit: Facebook.com/IVCJournal/events
IVC Spring 2017
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IVC Spring 2017