Integrative VETERINARY CARE VOLUME 7 ISSUE 3
INTEGRATIVE APPROACH TO DERMATOLOGICAL PROBLEMS IN PETS SKIN DISORDERS CAN BE CHALLENGING TO TREAT BUT INTEGRATIVE OPTIONS, INCLUDING ACUPUNCTURE, HERBALS AND LASER, MAY OFFER EFFECTIVE, LONG-TERM RESULTS. — P. 56
MINDFULNESS IN VETERINARY MEDICINE Learn how a mindful attitude in the practice setting can decrease burnout and fatigue, and even improve patient outcomes. — P. 30
HERBS AND BOTANICALS FOR OTITIS MEDIA Unlike antibiotics, herbs and other botanicals
don’t cause drug resistance, and work well against the bacteria and fungi associated with ear inflammation. – P. 14
www.IVCJournal.com
SUMMER ISSUE 2017
NUTRITIONAL APPROACHES TO SKIN CONDITIONS Improving the overall health of your patients
DEALING WITH LAMINITIS
CHIROPRACTIC AND CATS– PROBLEMS AND TREATMENTS Chiropractic issues in cats are more common than you
WHAT’ S NEW
through nutrition reduces the risk of dermatological conditions and other illnesses. — P. 18
may realize – understanding the incidence of these problems means you can assist in more cases. — P. 26
How an integrative approach can be used to diagnose and successfully treat this common equine disease. — P. 46
• New non-invasive test may help diagnose feline asthma earlier • What you need to know about Powassan virus • Diagnostic services for shelter animals
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contents FEATURES
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WESTERN BOTANICALS FOR OTITIS MEDIA IN ANIMALS by Greg Tilford
Herbs and other botanicals make resistance nearly impossible for even the nastiest pathogens, and are effective weapons against the bacteria and fungi associated with otitis media in animals.
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NUTRITION NOOK
NUTRITIONAL APPROACHES TO DERMATOLOGY CASES
by Martha C. Lindsay, MS, DVM, CVH, CNE Basic nutritional guidelines for improving the overall health of patients and lessening the chance of illness – including dermatological conditions.
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CHIROPRACTIC PROBLEMS AND TREATMENTS IN CATS
by Sue Thompson, DVM, IVCA certified, and John Z. Hossler, PhD Chiropractic problems are often the underlying reason cats are presented. If more veterinarians were trained to recognize this component of cat health, and to realize the wide variety of conditions chiropractic can help, we could assist in many cases.
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INTEGRATIVE PRACTICE
THE MINDFUL PRACTICE OF VETERINARY MEDICINE
by Michele Gaspar, DVM, DABVP (Feline Practice), MA, LPC
Mindfulness has been shown to not only decrease professional burnout and compassion fatigue, and raise distress tolerance, but it actually improves patient outcomes.
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TECH TALK
MAXIMIZING THE ROLE OF VETERINARY TECHNICIANS IN INTEGRATIVE PRACTICE
by Connie Glavan, LVT and Cindy Maro, DVM, CVA, CAC, VMRT Technicians are vital for creating more effective and efficient use of DVM time, and in reducing expenses by managing inventory, improving profits, and improving client communication.
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TAKING AN INTEGRATIVE PERSPECTIVE WITH LAMINITIS
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TREATMENT PROTOCOL FOR EQUINE PROTOZOAL MYELITIS (EPM)
by Megan McCorkel, DVM, cVMA
Understanding how an integrative approach can be used to diagnose and successfully treat laminitis.
by Lu Ann Groves, DVM Diagnosing EPM early, and then improving the immune system, is the best way to prevent serious symptoms of this disease.
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INTEGRATIVE APPROACH TO DERMATOLOGICAL PROBLEMS IN PETS
by Ronald B. Koh, DVM, MS, CVA, CVCH, CVFT, CCRP This article reviews common integrative modalities with a focus on Traditional Chinese Veterinary Medicine for treating inflammation and pruritus of the skin in pets.
INTEGRATING ESSENTIAL OILS FOR SKIN CARE by Jodie Gruenstern, DVM, CVA
The natural chemistry of these 12 essential oils makes them ideal for use in the management of healthy skin for our animal patients.
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advisory board
14 COLUMNS & DEPARTMENTS
5 Advisory board 8 Editorial
s new 11 What’
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.
Dr. Joyce Harman, DVM, MRCVS, graduated in 1984 from Virginia Maryland Regional College of Veterinary Medicine. She is certified in veterinary acupuncture and chiropractic and has completed advanced training in homeopathy and herbal medicine. Her practice in Virginia uses holistic medicine to treat horses. Her publications include The Horse’s Pain-Free Back and Saddle-Fit Book – the most complete source of information about English saddles.
23 From the AVH 33 From the WAEO 39 Industry innovations 54 From the AHVMA 55 From the VBMA 62 Veterinary resource guide 63 From the VMAA
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 AAVA 65 Marketplace 66 Events
Dr. Barbara Fougere, DVM, CVAA graduated in 1986, and was named the American Holistic Veterinary Medical Association Educator for 2011. Dr. Fougere is the principal and one of the founders of the College of Integrative Veterinary Therapies. She has continued studying over the last 26 years, and has three Bachelor degrees, two Masters degrees, three post Graduate Diplomas, several Certifications and numerous other courses under her belt.
Dr. Christina Chambreau, DVM, CVH, graduated from the University of Georgia Veterinary College in 1980. She is a founder of the Academy Of Veterinary Homeopathy, was on the faculty of the National Center for Homeopathy Summer School and has been the holistic modality adjunct faculty liaison for the Maryland Veterinary Technician Program. Dr. Chambreau teaches classes in homeopathy for animals, and lectures on many topics. She is the author of the Healthy Animal’s Journal and the co-author of the Homeopathic Repertory: A Tutorial.
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Integrative VETERINARY CARE
SUMMER 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
COLUMNISTS & CONTRIBUTING WRITERS Michele Gaspar, DVM, DABVP (Feline Practice), MA, LPC Connie Glavan, LVT Lu Ann Groves, DVM Jodie Gruenstern, DVM, CVA John Z. Hossler, PhD Ronald B. Koh, DVM, MS, CVA, CVCH, CVFT, CCRP Martha C. Lindsay, MS, DVM, CVH, CNE Cindy Maro, DVM, CVA, CAC, VMRT Megan McCorkel, DVM, cVMA Jeff Nichol, DVM William L. Schmidt, DC Sue Thompson, DVM, IVCA certified Greg Tilford Amy Van Gels, DVM
ADMINISTRATION & SALES Publisher: Redstone Media Group President/C.E.O.: Tim Hockley Accounting: Karen Jeffries Circulation & Office Manager: Libby Sinden
be used or that they will be returned. We reserve the right to publish all letters received. ADVERTISING SALES: Eastern Sales Manager: Ann Beacom (866) 764-1212 ext. 222 annbeacom@redstonemediagroup.com Western Regional Manager: Becky Starr (866) 764-1212 ext. 221 becky@redstonemediagroup.com Multimedia Specialist: Kat Shaw, (866) 764-1212 ext. 315 katshaw@redstonemediagroup.com Subscription Services Manager: Brittany Tufts, (866) 764-1212 ext. 115 brittany@redstonemediagroup.com CLASSIFIED ADVERTISING: Libby Sinden classified@IVCJournal.com US MAIL: IVC Journal, 6834 S University Blvd PMB 155 Centennial, CO 80122 CDN MAIL: IVC Journal, 202-160 Charlotte St. Peterborough, ON, Canada K9J 2T8. The opinions expressed in this journal are not necessarily those of the editor, and different views may appear in other issues. Redstone Media Group Inc., publisher of IVC Journal, does not promote any of the products or services advertised by a third party advertiser in this publication, nor does Redstone Media Group Inc. verify the accuracy of any claims made in connection with such advertisers.
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
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IMPROVING THE LIVES OF ANIMALS... ONE READER AT A TIME.
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editorial
FOCUS ON
SKIN PROBLEMS I’ve worked in veterinary clinics since I was 12, and skin problems have always been among the health issues we see on a regular basis. As I studied homeopathy and other holistic modalities, however, I discovered that healthy dogs and cats just don’t have chronic low-grade skin problems. A more challenging lesson to learn was that my earlier efforts to quickly stop itching in my patients may have been weakening their immune systems. Later, I found I could gradually restore a dog or cat’s balance holistically; his skin would eventually heal, and he would enjoy a general, long-lasting improvement in overall health and vitality. One of my early homeopathic cases is a good example of this. At four months old, Ben had itchy skin that was treated with steroids. He then developed ulcers in his throat and mouth, became incontinent, and by the age of one year was diagnosed with lupus. He acted like an old dog. During nine months of very careful holistic treatment, Ben started to feel better and regain normal puppy energy. He did get ulcers at his anus, lost 50% of his hair, experienced occasional lameness and frantically chewed his feet before he completely healed, but his owners were very patient and persisted with the holistic regime. Ben was fine for the next 15 years. If you’ve been frustrated by your own clients’ concerns about skin and coat issues, then you’ll want to study this issue, which focuses on effective integrative approaches to skin problems. Dr. Jodie Gruenstern covers the use of essential oils to soothe itchy skin, while herbal expert Greg Tilford looks at treating chronic otitis with herbs and essential oils. Dr. Ronald Koh uses traditional Chinese herbs, acupuncture and other modalities for dermatological problems, and Dr. Martha Lindsay shows how whole food diets from healthy sources
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can both prevent and heal skin problems. You’ll notice that each author focuses on the whole animal – he or she is not just using different treatments to heal the skin, but is soothing the skin while deeply healing the body, so the problems rarely recur and will self-heal. On other topics, Dr. Sue Thompson has done a wonderful study showing the incidence of chiropractic problems in felines, while encouraging us to include chiropractic in every physical exam. And our equine clients will be thrilled to learn that veterinarians can successfully treat laminitis and EPM using an integrative approach. Last issue, we saw how to succeed with multiple holistic practices; this time, Cindy Maro’s technician, Connie Glaven, writes on the key role of technicians in such practices. And Dr. Michele Gaspar shows us the importance of mindfulness in practice, for our personal health as well as our success. Learning the many integrative ways you can help your patients, your practice and yourself may seem as overwhelming as it is exciting. Be mindful and take one new step at a time. Visit IVCJournal.com for even more ways to expand your practice. Have a great summer!
Christina Chambreau, DVM, CVH Associate Editor, drtina@ivcjournal.com
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1. MICHELE GASPAR, DVM, DABVP (FE LINE PRACTICE ), MA, LPC
Dr. Michele Gaspar graduated from the University of Wisconsin Madison School of Veterinary Medicine in 1994. She is a diplomate of the American Board of Veterinary Practitioners (Feline Practice); a consultant in feline internal medicine for the Veterinary Information Network (VIN); and facilitates online VIN CE courses on mindfulness, clinicianship and work-life balance for vets and support staff. She also coordinates an annual mindfulness retreat for veterinarians and is a member of Vets4Vets, a VIN Foundation initiative that provides support to veterinarians and staff with personal and professional concerns.
2. LU ANN GROVES, DVM, CVA
Dr. Lu Ann Groves graduated in 1981 from Colorado State University College of Veterinary Medicine. She opened a mobile equine clinic in 1982, then opened The Whole Horse Veterinary Clinic (thewholehorse. com) in San Marcos, Texas in 2004. She offers osteopathy, acupuncture, chiropractic, craniosacral therapy and ozone therapy along with conventional diagnostics and therapies. Dr. Groves teaches basic classes at The Vluggen Institute of Equine Osteopathy, also in San Marcos, Texas.
3. JODIE GRUENSTERN, DVM, CVA
Dr. Jodie Gruenstern has been practicing veterinary medicine in Muskego, Wisconsin since 1987. She is a UW-Madison graduate and has been a Chi Institute-certified veterinary acupuncturist and food therapist since 2008. Dr. Jodie is the owner of the Animal Doctor Holistic Veterinary Complex, an integrated, fullservice small animal practice. She is an avid writer, speaker and local radio personality. For more info, healthy products or an educational DVD, visit AnimalDoctorHolistic.com.
4. RONALD KOH, DVM, MS, CVA, CVCH, CVFT, CCRP
Dr. Ronald Koh is an assistant professor and section chief of the Integrative Medicine & Rehabilitation Department at the Louisiana State University School of Veterinary Medicine. He received his veterinary degree in Taiwan and completed a specialty internship and Master’s program at University of Florida College of Veterinary Medicine. He is certified in acupuncture (CVA), Chinese herbal medicine (CVCH), food therapy (CVFT), and canine rehabilitation (CCRP). Dr. Koh is currently working toward the board certification of American College of Veterinary Sports Medicine and Rehabilitation (DACVSMR). His interests include using acupuncture, Chinese medicine and rehabilitation for pain management, neurological disorders, geriatric conditions, and hospice.
5. MARTHA C. LINDSAY, MS, DVM, CVH, CNE
Dr. Martha Lindsay graduated from Michigan State University College of Veterinary Medicine in 1979 and completed a Master’s degree in 1980. For 21 years, she practiced conventional medicine and surgery in small animals, avian and exotics at the Andover Animal Hospital in Andover, Massachusetts. In 2000, she began working in behavior medicine for New England Veterinary Behavior Associates in Lexington, Massachusetts. She was certified by the AVH in 2006, and by 2008 had completed Advanced Clinical Training in Nutrition Response Testing. Also in 2008, after three years of study at the National Institute of Whole Health, Dr. Lindsay became certified in Whole Health Nutrition Education.
6. 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 therapies, veterinary NAET, animal massage, herbology, homeopathy, Bach Flowers and essential oils.
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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 (ellwoodvet@msn.com).
7. MEGAN MCCORKEL , DVM, CVMA
Dr Megan McCorkel is a practicing veterinarian with a mobile acupuncture practice in Denver, Colorado. She is interested in both large and small animal medicine, alternative therapies, HVHQ surgery, and sports medicine. She graduated from the Western University of Health Sciences with her DVM, and completed her acupuncture certification through One Health SIM, formerly known as MAV, in Fort Collins, Colorado.
8. SUE THOMPSON, DVM, IVCA CERTIFIED
Dr. Sue Thompson graduated from UC Davis with a BS in Physiology, and graduated from UC Davis School of Veterinary Medicine in 1987. She went to Options for Animals school of animal chiropractic in 2006, becoming certified by the International Veterinary Chiropractic Association (IVCA) in 2007, and completed the advanced course in animal chiropractic in 2016. She is currently seeing chiropractic patients (dogs, cats and horses) at Animal Hospital on the Ridge in Paradise, California from May through October, and does barn outcalls for equine patients (DrSueThompson@gmail.com).
9. GREG TILFORD
Greg Tilford is CEO and formulator of Animal Essentials Inc., and an industry consultant and custom formulator for hundreds of veterinarians worldwide. He is the author of five books, including Herbs for Pets, the Natural Way to Enhance your Pet’s Life. Greg presents educational lectures, seminars and training to veterinarians, vet techs and office staff. He has taught courses at several veterinary medicine institutions and conferences, including the annual AHVMA conference. Greg serves as honorary advisor to the Japan Animal Wellness Association for international pet care professionals. He is a charter member of the Scientific Advisory Committee of the NASC. He founded the Animal Products Committee of the American Herbal Products Association and has served on Health Canada’s Expert Advisory Committee for Veterinary Natural Health Products.
10. CONNIE GLAVAN, LVT
Connie Glavan is a veterinary technician at Ellwood Animal Hospital, Inc. (ellwoodvet.com). She works in integrative veterinary medicine at all three Ellwood Animal Hospital locations in the Pittsburgh area. Connie had years of experience working in veterinary clinics before attending the Median School of Allied Health Careers, where she earned her degree in Veterinary Technology. Her interest in and understanding of energy medicine have made her a valuable asset in the practices she supports.
11. JOHN Z. HOSSLER, PHD
Dr. Hossler got his BS at George Fox University, his MA at University of Montana and his PhD at the University of Montana in 2012. He has been an Assistant Professor of Mathematics at Seattle Pacific University since 2012. In addition to a full teaching load, Dr. Hossler’s research interests include statistical consulting, especially with undergraduate faculty and students; pedagogy and classroom design, such as the flipped classroom or gamification; and probability. He and John Lindberg, associate professor of physics at SPU, were awarded an Academic Innovation Exploratory Grant from SPU for their research into the gamification of STEM courses.
what’s new NEW DIAGNOSTIC TOOL FOR ASTHMATIC CATS breath condensate. They collected condensate from cats with signs of asthma and compared it to condensate from healthy cats, and found components that differed between the two types of sample, which may promise biomarkers to help identify cats with asthma. “The [current] gold standard means of diagnosis requires anesthesia, posing some risk to patients with airway disease, including patients with undiagnosed asthma,” says Associate Professor Carol Reinero, the study’s principal investigator. “Having a non-invasive means of diagnosing asthma early in the course of disease will allow proper targeted therapy that can prevent declines in lung function over time.” A new non-invasive diagnostic test may one day help veterinarians identify and treat feline asthma in its early stages. This could mean fewer acute asthmatic attacks as well as improved lung health in feline patients. University of Missouri researchers, funded with a grant from Morris Animal Foundation, examined biomarkers in exhaled
From their findings, Dr. Reinero and her team have developed a panel of biomarkers to validate their findings in more cats with and without naturallyoccurring asthma. If successfully validated, the panel could become an early diagnostic tool to help veterinarians identify and treat cats before they develop serious lung problems.
CORNELL LAUNCHES PILOT PROJECT TO HELP SHELTER ANIMALS undiagnosed or untreated, or treatment may be delayed while funds are raised. Maddie’s® Shelter Medicine Program at Cornell University College of Veterinary Medicine aims to ease that financial burden with the recent launch of a pilot program to provide diagnostic services for animal shelters. Maddie’s® Shelter Lab offers a 50% discount on diagnostic services and supplies, as well as free shipping, to non-profit humane organizations in New York State. The services are offered in collaboration with the New York State Animal Health Diagnostic Center (AHDC) at the Cornell College of Veterinary Medicine.
Animal shelters often struggle to pay for diagnostic testing, making it difficult to determine the right course of treatment for their charges. Many illnesses may go
“This service will allow for assistance in diagnosing outbreaks in animal shelters – from canine influenza to gastrointestinal conditions such as parasites, parvovirus and panleukopenia,” says Elizabeth Berliner, DVM, the Janet L. Swanson Director of Shelter Medicine at Cornell. sheltermedicine.vet.cornell.edu IVC Summer 2017
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what’s new IN MEMORIAM Mary Ellen Finger DVM, LMT, HHC passed away on February 8, 2017 after a long battle with cancer. Dr. Finger graduated from Kansas State University College of Veterinary Medicine in 1976, and was one of only four women in her class. She founded East Village Veterinary Clinic in New York City, and was in practice for over 20 years. After a diagnosis of cancer in 1993, Dr. Finger devoted the rest of her life to helping people and animals through their own health crises by sharing the knowledge and experience she gained from her own health journey. She volunteered with the ambulance corps, and spoke at many conferences hosted by the AVH, AHVMA, the Northeast Organic Farming Association and the Pennsylvania Association for Sustainable Agriculture. With her husband, Dave Vickery, she founded the Red Chapel Center for healing in Putnam County, New York. “I have seen my children grow up, I have had no prolonged suffering and no regrets,” Dr. Finger said in her last month of life. To quote her follow veterinarians: “To know Mary was to know that anything is possible.” Dave is continuing his work with the Red Chapel Center. redchapelcenter.com
RATE OF FATAL INJURIES DECLINES IN RACEHORSES For the fourth consecutive year, the Equine Injury Database (EID) reveals a reduction in the rate of fatal injuries in Thoroughbred racehorses. This amounts to a 23% drop since 2009, according to The Jockey Club, which launched the EID in 2008. The data analysis was performed by Dr. Tim Parkin, a veterinarian and epidemiologist from the University of Glasgow, who serves as a consultant on the EID. “One of the primary objectives of this project from the outset was to build a comprehensive data source we could utilize to improve safety and prevent injuries, and we are now clearly achieving that goal,” he says. “The racetracks, horsemen and regulators who have implemented safety initiatives over this time period deserve a great deal of credit for this encouraging trend.” EID statistics are based on injuries that result in fatalities within 72 hours from the date of a race. The stats are for Thoroughbreds only and exclude races over jumps. Summary statistics for the EID are subject to change due to a number of considerations, including reporting timeliness. jockeyclub.com 12
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TICK-BORNE DISEASE HAS EXPERTS WORRIED Along with Lyme disease, veterinarians now have another reason to learn about the many natural ways of preventing ticks on their patients and clients (see “Natural solutions for summer bugs”, Summer 2016, IVC Journal). The number of cases of Powassan virus reported in humans, though still rare, is increasing, especially in the Northeast and Midwest US. The virus is now being transmitted by deer ticks and has severe, sometimes fatal, neurological health consequences in people. Powassan can be transmitted in just 15 minutes and there is currently no treatment. To date, there isn’t a lot of information about the virus’s impact on dogs and cats, but educating clients on how to build a healthy immune system in their pets (and themselves) is more important than ever. cdc.gov/powassa
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WESTERN BOTANICALS FOR TREATING
OTITIS MEDIA IN ANIMALS
By Greg Tilford
Unlike conventional drugs, herbs and other botanicals make resistance nearly impossible for even the nastiest pathogens, and are effective weapons against the bacteria and fungi associated with otitis media in dogs, cats and horses.
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Otitis refers to dermal or epidermal inflammation of the ear. Otitis externa or media are not diseases in themselves, but are symptoms of one or more preexisting conditions – and like dermatitis that occurs elsewhere on the body, the causes are rarely just skin deep. The primary difference between otitis and any other skin condition involves the unique environment in which inflammation and infection occur. The ear canal is like a fermentation vessel for pathogenic bacteria and fungi, especially if copious ear wax, dirt or other debris is present. This article looks at the herbs and other botanicals that can effectively treat otitis media in dogs, cats and horses.
TOPICAL INTERVENTIONS Begin by cleaning the ears with a rinse solution that serves a dual purpose of removing dirt while inhibiting pathogenic bacteria and fungi residing in the ear canal. I prefer a base of cider vinegar, aloe vera juice and distilled water, to which a variety of essentials oils and herb extracts can be added. The overall solution should be fairly dilute, especially in the case of essential oils, which can otherwise be irritating to the point of aggravating rather than relieving inflammation. To prevent this and to assure optimal effectiveness of the formula, I recommend limiting essential oil components of any formula to ≤3% of total volume of the formula. Most herb extracts (tinctures) can be used more liberally, depending of course on the choice of herbs. “Hot” herbs, such as garlic or peppermint, should not be used in concentrations exceeding 5%. Calendula on the other hand is quite forgiving, especially if used as a glycerite – my preferred form of any herb extract used in or on the ears. Glycerin lends its own healing benefits to a formula. Both antimicrobial and humectant, glycerin serves to absorb drainage and prevent pooling of exudate in dermal tissues.
BOTANICALS FOR AN EAR RINSE All of the botanicals presented in this article are best used as components of the aforementioned ear rinse, twice a day. Here are some of my favorites, and how they work.
q C IDER
VINEGAR – Well known for its yeast-fighting antifungal and antibacterial actions,1 it’s an excellent cleanser that cuts through ear wax while inhibiting yeast and bacterial reproduction. Vinegar containing 5% acetic acid, in a concentration of ≤20% of the total formula, can be safely used with minimal risk of increased irritation.
w C ALENDULA
EXTRACT (Calendula officinalis) – The activities of Calendula extract have been compared to those of Fluconazole, a drug commonly used to combat blastomycosis, histoplasmosis and various other fungal infections.2,3 It is also antibacterial and serves as an excellent vulnerary agent, bringing soothing relief and accelerating cell reproduction and granuloma at the site of open sores, insect bites and other minor injuries. TEA TREE OIL (Melaleuca alternafolia) – Tea tree oil is especially useful in the ears, and has strong activity against a broad variety of pathogenic fungi and bacteria.4,5 It can be safely used in concentrations of ≤3% on dogs, horses and most other animals; however, in my opinion, tea tree oil should not be applied consecutively for more than three days in cats, who tend to be hypersensitive to tea tree oil, especially when they lick it from their fur. Although I have yet to see any actual adverse events from the use of tea tree oil, a number of reports warn of acute hepatotoxicity, neurotoxicity and nephritic events when the oil is ingested in higher concentrations over non-specific periods of time. More is not better, and caution always rules – use this one sparingly on felines, and try to avoid direct ingestion of whatever formulation you use.
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r L AVENDER
OIL (Lavendula off.) – This oil has been shown to be effective against at least 120 strains of pathogenic bacteria,6 and is among the safest essential oils for use in animals. It is also a remarkable healing agent and “carrier” for other botanical medicines; it serves as a quick-acting vasodilator that quickly increases blood circulation into the dermis. Lavender oil also lends a much welcomed calming effect, often to both the patient and practitioner!
t THYME OIL (Thymus off.) – Thyme oil is stronger and more reliable than lavender as a broad spectrum antimicrobial agent6 in solutions below 0.5%. This is due to its high concentrations of highly active thymol and carvacrol. As an example of how “less is sometimes better”, pick up a bottle of Listerine mouthwash and read the label. Thymol is a primary IVC Summer 2017
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active ingredient – at a concentration of just 0.064%. Being an herbalist who believes that “the whole plant is greater than the sum of its parts”, I prefer to use thyme in the form of a whole leaf ethanol tincture. To use thyme in the ears, simply dilute 5ml of the 1:2 alcohol based oil into 250ml of a distilled water solution containing 20% cider vinegar. Rinse the ear liberally with the solution, twice daily. GOLDENSEAL (Hydrastis canadensis), OREGON GRAPE (Mahonia spp.) and COPTIS SPECIES – The roots of these plants are rich with berberine, a bright yellow, protoberberine-type isoquinoline alkaloid. Berberine offers a very broad spectrum of
y
a ntibacterial, antifungal and antiviral activity. Several studies support this claim. In one, berberine was shown to be highly active against Fluconazole-resistant yeasts.7 It is also effective against a wide variety of pathogenic bacteria, including drug resistant staphylococcus aureus. Although most of these studies are in vitro, the usefulness of berberine stems from its ability to strongly inhibit, if not completely kill, pathogenic microbes on contact. This puts goldenseal and other berberine-bearing plants at the top of my list of resources for direct application. They also make a beautiful yellow dye – a feature that may be scorned by pet owners who don’t like temporarily stained fur, but welcomed by the herbalist who sees the staining as assurance that active principles of the plant remain present at the site of application.
DIETARY CHANGES Many cases of otitis media are influenced by food allergies, so any holistic approach will require a critical assessment of diet. • Begin by removing all the “usual suspects” from the diet: wheat, soy, corn and their by-products. • Meat by-products (leftovers from the human food slaughterhouse) and meat meal (parts of virtually any animal, from virtually anywhere but a human food process) should also be avoided in favor of whole, human-grade meats (e.g. turkey, fish, beef, chicken, lamb, duck, etc.). • Artificial dyes or preservatives should also be eliminated. Instead, opt for foods that are preserved with natural vitamin E, rosemary oil, or other natural antioxidants. • Supplementation should include immunotonics, such as Echinacea, to help boost the body’s fight against infection, and antimicrobials. Both can be used topically for direct intervention at surface tissues, and systemically to chase and inhibit pathogens from the inside out.
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LIVE uO
LEAF (olea europaea) – Perhaps the “king” of antimicrobial herbs, olive leaf is simply amazing. Its healing powers have been known for a very long time. In the early to mid-1800s, olive leaf was found to be a very effective febrifuge remedy, and was seen as much more effective than quinine in the treatment of malaria. In 1962, Italian researchers recorded that oleuropein, one of several active components in olive leaf, could reduce blood pressure in both humans and animals. In 1969, the Upjohn Company, in recognition of a growing body of evidence illuminating not only the broad-spectrum antibacterial and antifungal properties of the plant, but also its remarkable activity against numerous protozoa and viruses, went to work to develop a new antiviral drug. As pharmaceutical research often goes, Upjohn focused on isolating a single component of olive leaf (oleuropein) in hopes of creating a new, patentable antimicrobial/antiviral super drug. They realized that olive simply does not work in the absence of a more complete representation of the plant’s chemistry. Hence, “the whole plant is greater the sum of its parts”. Like all herbs, the “entourage effect” of multiple chemical components, including (among others) coffee acid, verbascoside, luteolin 7-O-glucoside, rutin, apigenin 7-O-glucoside, luteolin 4’-O-glucoside, maslinic acid, hydroxutyrosol and oleocantha, all contribute to the wonders of this amazing botanical. Upjohn abandoned its
pursuit, leaving behind a very impressive list of in-vitro activities. In fact, every germ that was inoculated in their studies was killed by olive leaf extract, including but not limited to multiple strains of Herpes virus, Candida yeast, and dozens of pathogenic bacteria. In a more recent invitro study, a scant 0.6% (v/v) dilution of olive leaf tea was shown to kill E coli within three hours. Candida albicans was completely killed by a 15% (v/v) extract.8 Olive leaf is effective in many forms (aqueous, ethanol or glycerin extracts) and is very safe. For applications against Otitis media, I recommend a 1:4 glycerite, diluted to concentrations between 10% to 20% in distilled water and up to 20% cider vinegar.
i R OSEMARY
OIL (Rosmarinus off. L.) – No article on Western botanical interventions against Otitis media would be complete without a strong mention of rosemary oil. There is good reason why this oil is used as a natural preservative in hundreds of natural foods and medicines. It can be applied safely and is very effective at inhibiting reproduction or killing (depending on concentration) an impressive variety of troublesome bacteria. In a 2003 study published
an all-out battle against infection. Fortunately, we have herbs to turn to. Unlike conventional antimicrobial drugs, herbs present complex chemistries that make adaptation and resistance nearly impossible for even the nastiest pathogens. Best of all, these herbs are easy to access and very safe to use.
Aminifarshidmehr N. “The management of chronic suppurative otitis media with acid media solution”. Am J Otol. 1996;17:24–25.
1
Preeti KC, Kulttan R. “Wound Healing activity of flower extract of Calendula officinalis”. J Basic Clin Physiol Pharmacol. 2009:20(1): 73-9.
2
in The Brazilian Journal of Biosciences, rosemary oil was found to be effective against 18 isolates of Staphylococcus pseudintermedius isolated from dogs.9 In another study, the oil was shown to be effective against six microbial species, including gram-positive bacteria (Staphylococcus aureus and Bacillus subtilis), gram-negative bacteria (Escherichia coli and Pseudomonas aeruginosa), a yeast (Candida albicans), and a fungus (Aspergillus niger). Rosemary oil can be used with a broad margin of safety in dilutions of ≤3%. Like lavender, it may impart a calming effect upon an otherwise pain-tormented animal – or a nervous veterinarian. However, I find that stronger dilutions will sometimes result in an opposite, energizing effect. As many strains of pathogenic bacteria and fungi become increasingly resistant to our antibiotic arsenal, what may once have been a “simple case” of Otitis media can now become
Efstratiou E, Hussain AI, Nigam PS, Moore JE, Ayub MA, Rao JR. “Antimicrobial activity of Calendula officinalis petal extracts against fungi, as well as Gram-negative and Gram-positive clinical pathogens”. Complement Ther Clin Pract. 2012 Aug;18(3):173-6. doi: 10.1016/j.ctcp.2012.02.003. Epub 2012 Apr 25.
3
Nenoff P, Haustein UF, Brandt W. “Antifungal activity of the essential oil of Melaleuca alternifolia against pathogenic fungi in vitro”. Skin Pharmacol 9 (6):388-394, 1996.
4
Reichling J, Fitzi J, Hellmann K, Wegener T, Bucher S, Saller R. “Topical tea tree oil effective in canine localised pruritic dermatitis -- a multi-centre randomised double-blind controlled clinical trial in the veterinary practice”. Dtsch Tierarztl Wochenschr. 2004;111(10):408–414.
5
Sienkiewicz M, Lysakowska M, Ciećwierz J, Denys P, Kowalczyk E. “Antibacterial activity of thyme and lavender essential oils”. Med Chem. 2011 Nov;7(6):674-89.
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Anderson Ramos da Silva, João Batista de Andrade Neto, Cecília Rocha da Silva, Rosana de Sousa Campos, Rose Anny Costa Silva, Daniel Domingues Freitas, Francisca Bruna Stefany Aires do Nascimento, Larissa Nara Dantas de Andrade, Letícia Serpa Sampaio, Thalles Barbosa Grangeiro, Hemerson Iury Ferreira Magalhães, Bruno Coêlho Cavalcanti, Manoel Odorico de Moraes, and Hélio Vitoriano Nobre Júnior. “Berberine Antifungal Activity in Fluconazole-Resistant Pathogenic Yeasts: Action Mechanism Evaluated by Flow Cytometry and Biofilm Growth Inhibition in Candida spp”. Antimicrob Agents Chemother. 2016 Jun; 60(6): 3551–3557.Published online 2016 May 23. Antimicrob Agents Chemother. 2016 Jun; 60(6): 3551–3557.
7
Markin D, Duek L, Berdicevsky I. “In vitro antimicrobial activity of olive leaves”. Mycoses. 2003 Apr;46(3-4):132-6.
8
Catiana Oliveira Lima , Humberto Medeiros Barreto , Edeltrudes de Oliveira Lima , Evandro Leite de Souzaand José Pinto de Siqueira Júnior. “Antimicrobial effect of the essential oil from Rosmarinus officinalis L. against Staphylococcus pseudintermedius isolated from dogs”. Brazilian Journal of Biosciences. August 19, 2013.
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nutrition nook
NUTRITIONAL APPROACHES TO DERMATOLOGY CASES By Martha C. Lindsay, MS, DVM, CVH, CNE
Basic nutritional guidelines for improving the overall health of patients and lessening the chance of illness – including dermatological conditions.
Transitioning an animal with skin problems to a fresh food diet can sometimes bring about a rapid improvement in itchiness. More commonly, however, the inflammation reduces slowly and gradually, which over time lessens the need for conventional medication. If a pet is itchy year-round, then a diet change might bring about a gradual resolution; if a pet is seasonally itchy, then altering the diet may reduce the level of allergens in the body, necessitating less medication when that season arrives. We have seen some skin cases completely clear up with diet changes. In the first month, most itchy animals show a 30% to 50% improvement, which can still leave enough itchiness to require additional alternative treatment. In our office, this treatment might include homeopathy, Traditional Chinese Veterinary Medicine, chiropractic or Nutrition Response Testing. Some skin problems are related
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to internal problems other than food or environmental sensitivities, so a full diagnostic laboratory workup is always important. This allows the client to make an informed choice from conventional and/or alternative therapies. The purpose of this article is to provide some basic nutritional guidelines to improving the overall health of patients and lessening the chance of illness, including dermatological conditions. Each animal is unique and may require additional nutritional supplementation in the long run, but the basic food changes covered in this article can be a good start for many. Exceptions to these guidelines must always be considered depending on the severity of clinical pathology that may exist when the case is presented to you. Skin conditions in
conjunction with advanced kidney, cardiac or liver disease, for example, may require further conventional and/or alternative treatments to initially stabilize the case, and may require particular considerations for nutritional supplements. Above all, it is important to keep the basic food changes and preparation simple enough so that clients can and will continue to comply over the long-term.
KEYS TO GETTING CLIENTS STARTED
1
Food quality is very important.
a. F resh: We discuss with clients the incredibly improved nutrition of fresh food over processed foods.1,2,3,4 We also provide a onepage synopsis of the book Pottenger’s Cats, which helps clients understand the value of raw diets.5 You can request a copy of this synopsis page by emailing our office. b. C lean: Many chemicals are used in animal and plant farming.6,7,3 The term “natural meat” is defined as containing no antibiotics or hormones, but it will still have pesticides, herbicides and fungicides in it. c. C ost: The client’s financial situation will determine if organic or natural meats are affordable. d. Availability: The Weston A Price Foundation8 produces a compact paperback Shopping Guide, updated each year, that lists reliable meat sources around the country. You or your clients may know of local community-supported farms with organic or minimally chemically-treated meat and produce. There may also be local pet food co-ops that your clients can join to purchase meats less expensively.
2
he basic diet for dogs is 50% to 75% meat and 25% to T 50% high calorie cooked vegetables.
a. P rotein: This makes the diet about 17% to 25% animal protein, a minimal amount and also suitable if the pet has renal disease. We can increase the percentage of meat for growing, athletic, cachectic and pregnant or nursing animals. Continued on page 20.
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Continued from page 19. b. V egetables: Fresh food contains approximately 75% water, whereas dry foods are without moisture. So we need high calorie vegetables along with the meat. The harder the vegetable is, the more calories it contains. Examples would be potatoes, sweet potatoes, cauliflower, beets, winter squashes, turnips and parsnips. If a dog has arthritis, we stay away from nightshade vegetables in case he has a sensitivity to glycoalkaloids or steroid alkaloids. Nightshade vegetables include white potatoes, all types of tomatoes and peppers, and eggplants. The basic diet for cats is 100% meat. One can add some well-cooked vegetables for variety if the cat likes them. Some cats are so conditioned to the taste, texture and smell of dry foods that it can take time – sometimes months – to change their diet. If a cat will not eat any type of fresh meat at all, the client is advised to ever so gradually add water to the dry food. Once the dry food is soft enough, we start adding minute amounts of cooked minced meat, gradually increasing the amount of meat and decreasing the dry food. Then over time, the client can cook the meat less and less.
Some cats will eat canned or cooked minced food when the dry food is powdered and “salted” over the top.
3
4
We usually start with cooked meat since the pet’s intestinal microflora have been conditioned to processed food and might not easily digest raw meat at first. This can result in loose and frequent stools. We gradually cook the meat less and less until it’s being served raw. Not every pet can eat every kind of meat protein. We tell clients that if any observable problems occur after their pets eat a particular type of meat, not to feed that meat. If a pet cannot digest any meat, we recommend alternative treatment to correct that problem. provide very basic supplements for most pets. We We use reliable whole food product companies such as Standard Process9 and Animal Essentials6 for nutritional supplementation. Their quality controls are excellent and Standard Process’ facilities and products are annually FDA inspected at the company’s request.
a. C alcium is needed to balance the high phosphorus content of meat. Animal Essentials’ Natural Calcium comes from seaweed; a heaping half-teaspoon provides 600mg calcium to balance the phosphorus in each cup of meat. The high sodium in seaweed may be contraindicated. Standard Process has many concentrated beet calcium products for specific health issues. Processed bone meal and other calcium carbonate products may be indigestible for some animals and the company should ensure the bone meal is clear of heavy metals. I have seen two dogs that were fed meat with bone diets whose incisors looked like glass, with a line of pink pulp inside clearly visible. The teeth became white again after some months of providing a more bioavailable calcium supplement for each dog (Standard Process). b. For vitamins and minerals, we advise whole food products in which you will see only food names listed in the ingredient
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list – not chemical names for vitamin fractions. Daily doses vary with the size of the animal and consultants with whole food vitamin companies can advise you. Most commercial diets have artificial fractions of vitamins and non-chelated minerals added after cooking. These are not usable by the body unless it adds the missing phytonutrients to create the complete biologically-active vitamins we get in fresh foods.1,2 And in some cases, these artificial fractions can be toxic to the body.1,4 c. O mega 3 fatty acids are very important for itchy dogs as they are needed to modulate inflammatory conditions. If the client can afford to feed pasture-raised animal products, there may be sufficient Omega 3 in the food and additional supplementation won’t be needed.
5
6
7
he water we provide should be filtered through T activated charcoal, at the very least. Pitcher-type filters can be found in many department stores. Tap water contains many chemicals, metals and unhealthy organic compounds.8,6,10,11 Helpful information about different water filtration systems can be found at mercola.com and idealearthwater.com. e ask the client to keep a log of weekly body weights W and to call us if there is any weight loss. We then increase the food volume. It is also a great idea to keep a record of the pet’s clinical illness signs. For example, the client can rate the animal’s itchiness on a scale of 0-10 (none to horrible) on a weekly or bi-weekly basis. This is very useful for deciding when to add alternative therapies and for tracking progress. One useful resource for keeping such records is the Healthy Pet Journal.9 ne more very important point. The doses of products O chosen for basic support or for specific medical conditions may need to be reduced over time. Comparing excellent whole food nutrition support products containing concentrated vitamins and minerals with non-whole food supplements, is like comparing espresso coffee to decaf. For example, if a person who needs espresso each morning to get going began a health improvement program, that caffeine pick-me-up would eventually no longer be necessary. At that stage, drinking a morning espresso might cause shaking and other side effects of too much caffeine. Similarly, once the pet’s body is in a healthier condition and builds up reserves, the concentrated nutrient product seems to overstimulate the system, so a dose reduction may be required. We are not yet aware of the mechanism for this phenomenon.
WHOLE FOOD DIETS Pet supply stores now carry many frozen meat, meat/ vegetable or meat/vegetable/bone diets. Varying the nutrients is more difficult, though one could rotate different frozen diets. The amount of each nutrient required by a given animal is determined by many factors, including whatever inflammatory or disease processes the pet is experiencing; the lifestyle and financial capability of the client; the animal’s genetic predispositions; the microbiome of his intestinal tract; and any stressors in the household.
CONCLUSION Consuming adequate protein and healthy fats with a variety of fruits and vegetables, while staying away from processed foods and refined sugar, is still the healthiest way for both animals and people to eat. Fresh diets help maintain great health. They can heal skin conditions on their own, or become a key part of an integrative approach. Over the past 15 years, we have had success in our clinic using the strategies discussed in this article. See case reports on page 22.
ADDITIONAL RESOURCES Animalessentials.com marcopharma.com natures-balance.com Standardprocess.com WestonAPrice.org
DeCava, J. The Real Truth About Vitamins & Anti-Oxidants, Selene River Press, Inc., 2006.
1
Medford, L. Why Do I Need Whole Food Supplements? LDN Publishing, 2002.
2
Pitcairn, RH. and Pitcairn, SH. Pitcairn’s Complete Guide to Natural Health for Dogs and Cats, Holtzhrinck Publishers, 2005.
3
Shayne, V. Whole Food Nutrition – The Missing Link in Vitamin Therapy, iUniverse.com, Inc., 2000.
4
Pottenger, FM. Pottenger’s Cats: A Study in Nutrition
5
Cimperman, S. “Environmental Toxins and PreDiabetes”, Well Being Journal, March/April 2014.
6
Jensen, B. Empty Harvest, Avery, 1990.
7
Bryson, C. The Fluoride Deception, Seven Stories Press, 2004.
8
Chambreau, C. Healthy Animal’s Journal, TRO Productions, 2003.
9
Moody, J. Water, Water Everywhere But Is It Safe to Drink? Wise Traditions, Spring, 2014.
10
Teller, M. Lead in the Water: Flint’s Cautionary Tale, Wise Traditions, Spring , 2016.
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1. Maggie is a ten-yearold spayed Labrador retriever. For most of the previous three to five years, she had been on antibiotics and antiinflammatory medications for interdigital cysts and inflammation of the feet and ventral abdomen. After a month of eating a fresh food diet and taking basic calcium, vitamin/ mineral and Omega-3 supplements, Maggie’s itchiness had decreased by about 50%. More recent biopsies showed yeast in the tissues of the feet, so we started her on two products from Standard Process – Zymex capsules and Lact Enz. The swelling in Maggie’s toes gradually reduced and the licking and itchiness lessened. However, after some weeks, the licking increased again. It is standard practice in our office to be sure the client knows to stop the adjunct treatment products if they see an increase in physical or mental signs, and to let us know. Maggie’s owner stopped the Zymex and Lact Enz, and in two days the licking subsided again. She is off all conventional medications and her owner does not feel additional alternative therapy is needed as yet. 2. Duke, a neutered male boxer, came to us at six years of age with chronic diarrhea and constant scratching of the ears, neck and chest. Two weeks into the diet transition, his diarrhea resolved and the itchiness reduced to the point where he could sleep through the night. The client saw this as a 50% decrease in itchiness. However, Duke was still so itchy during the day that his 22
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owner wished to hurry up the process. So we gave him Nutrition Response Testing and found he had mercury poisoning. Mercury, arsenic and aluminum toxicity commonly underlie skin conditions in Massachusetts, where Duke lives. We gave him concentrated cilantro (Nature’s Balance), and the mercury in Duke’s body’s gradually decreased over the next six weeks; as well, his itchiness gradually subsided and has not returned over the past three months. Duke’s owner will monitor him over the next year for any seasonal return of itchiness. 3. Oliver, a male neutered seven-year-old Bichon/ Shihtzu cross, presented with a diagnosis of atopy and recurrent ear inflammations that started when he was 1½ years old. Spring and fall brought on more itchiness. By the third week of diet transition, Oliver no longer needed Benadryl, and the client reported an itchiness rating of 2/10 to 3/10 compared to the initial 10/10. Two weeks later, the itchiness increased to 6/10 and Nutrition Response Testing showed his medications to be a problem. Solidago (Marco Pharma) was used to start the detoxification process. Six weeks later, Oliver’s itchiness had reduced to 2/10 to 3/10 again – this was significant as the fall had been particularly problematic for him in previous years. A few weeks later, the itchiness increased so the Solidago was discontinued and the itchiness subsided over the next two days. Currently, the owner feels Oliver does not need any alternative treatment. His itchiness is still 3/10 but she feels this is tolerable. We will continue to monitor him.
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 2017 Academy of Veterinary Homeopathy (AVH) Conference will be held in San Diego, California from Friday, October 20 through Sunday, October 22, in conjunction with the AHVMA Conference. Our theme is “Focus on Fundamentals”. In addition to a selection of great speakers at the AVH Conference, you can attend homeopathic presentations at the AHVMA Conference. Topics include “Reasons 21-30 to be a Veterinary Homeopath” on Saturday evening, and a three-hour lecture introducing the basics of homeopathy and acute prescribing on Sunday morning.
AVH OUTREACH AND HOMEOPATHIC TRAINING Homeopathy is becoming increasingly popular because clients want safer, more effective therapies for their animals, and because veterinarians are looking for treatment options other than surgery, antibiotics and steroids. The Pitcairn Institute of Veterinary Homeopathy (PIVH) and the AVH have collaborated to bring homeopathy to interested veterinarians by sharing a booth at several conferences over the past year, including last year’s AHVMA Conference, and the Midwest Veterinary Conference in February of this year. During the Midwest Conference, a full day of strongly-attended lectures on homeopathy was provided by Lisa Melling, DVM, CVH. These six hours of presentations included an introduction to veterinary homeopathy as well as an overview of acute prescribing for illness, trauma and post-surgical analgesia. The lectures concluded with a discussion of the effectiveness of homeopathic treatment for chronic disease conditions such as cancer, masticatory myositis and congenital disorders. Homeopathic training is provided to veterinarians through the PIVH, and the next course begins in September. For additional information and registration, visit pivh.org/professional-course.
The AVH also provides financial support, including scholarship opportunities for PIVH students, and money to support homeopathic lectures at veterinary schools. The AVH works directly with the PIVH to promote homeopathy at major conferences in exhibit halls and at lectures. And because the AVH is the principal source of continuing education in homeopathy for most of our members, we also provide a journal on classical homeopathy and run regular webinars for our members. Additional information on the benefits of AVH membership is available at theavh.org.
CASE: HOMEOPATHIC TREATMENT OF BITE WOUNDS IN A CAT On April 14, 2017, a 14-year-old spayed female DSH returned home with injuries to her head that were consistent with bite wounds. A thorough exam was performed by her homeopathic veterinarian, the wound was clipped and cleaned, and Arnica 1M (a homeopathic remedy for pain, trauma and bruising) was prescribed every eight to 12 hours as needed. Three days later, the patient was re-evaluated for soft tissue swelling at the wound site. She demonstrated no evidence of pain, and was eating and drinking well. The scab was removed and 3mls of pustular exudate were expressed from the wound. The wound was flushed with dilute Calendula solution, and one dose of Silicea 1M (a remedy that promotes healing of abscessed wounds) was administered orally. At recheck the following week, the cat’s injury had completely healed.
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Advertorial
URINARY INCONTINENCE IN SENIOR DOGS By Jeff Nichol, DVM
Canine “bed-wetters” may be hard to recognize because dog owners seldom mention the problem. Many assume it’s behavioral, believing they’ve failed to properly train their pets. In fact, as many as 20% of spayed dogs leak urine while resting or sleeping but only 2% of dogs brought to veterinary clinics are presented for incontinence. As veterinarians, our job is to diagnose first and treat second. Geriatric dogs in particular should have a careful review of their medical histories. Rule-outs like spinal injuries, disc herniation, lower urinary disease and cystic calculi can smolder or reoccur. Serum chemistries, CBC, urinalysis and abdominal radiographs are essential. Be sure urine leakers also get a thorough abdominal palpation and neurologic exam. For example, pain when the tail is lifted can be associated with the LMN signs of lumbo-sacral disease. Hematuria may indicate neoplasia in a geriatric dog. A history of confusion and changes in relationships suggest cognitive dysfunction syndrome. And obesity and joint pain make it hard for an old-timer to get outside to eliminate. The whole dog matters. Canine seniors who leak when resting or sleeping may have urethral sphincter hypotonus. There is no specific test for this condition. We know that medium to large breed females are more commonly affected, but all reasonable differentials should be ruled out before a spayed urine leaker is diagnosed. Patients can then have their treatment directed at the primary etiology: reduced urethral tone Senior urine leakers may respond well to medications like phenylpropanolamine, the alpha adrenergic agonist contained
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in liver-flavored Proin® tablets from PRN Pharmacal. Proin® stimulates proximal urethral alpha receptors. Clinical response has been reported as excellent in 98.1% of affected dogs. As dogs age, their owners cherish them more than ever. We can help spayed girls with urethral sphincter hypotonus enjoy cleaner and more comfortable lives. Our diagnosis and treatment make a very real difference to our patients and those who love them. IMPORTANT SAFETY INFORMATION: Proin is not for human use. Keep out of reach of children, and contact a physician immediately if accidental human ingestion occurs. Proin is only for use in dogs under veterinary supervision. Store securely, away from pets, to prevent accidental overdose – dogs may willingly consume too many tablets or chew through closed vials and eat the contents, causing overdose and possibly death. Contact a veterinarian immediately if overdose occurs, if other pets consume Proin, or if restlessness, irritability, appetite loss, continuing incontinence, or any other unusual signs occur. Most common side effects are vomiting, appetite loss, diarrhea, excessive salivation, agitation, tiredness, vocalization, confusion, increased thirst, weight loss, weakness, fever, panting, and reversible skin color changes (bright pink). In some cases death, including euthanasia, has been reported. Sudden death was sometimes preceded by vocalization or collapse. The safety of Proin in breeding, pregnant or lactating dogs has not been evaluated. For a copy of the Safety Data Sheet (SDS), or to report suspected adverse drug events, contact Pegasus Laboratories at 1-800-874-9764. 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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CHIROPRACTIC PROBLEMS AND TREATMENTS IN DOMESTIC CATS By Sue Thompson, DVM, IVCA certified, and John Z. Hossler, PhD Chiropractic problems are often found as the underlying reason feline patients are presented. If more veterinarians were trained to recognize this component of cat health in physical exams, and to realize the wide variety of conditions chiropractic can help, we would be able to assist in many cases.
Very few studies relate to chiropractic issues in cats. Anecdotally, we see and treat them frequently, so this article shows both the incidence of these problems in cats, and some of the treatment approaches we use.
BACKGROUND INFORMATION A search of the literature revealed no published data relating specifically to chiropractic issues in domestic cats, but it did offer a body of information on arthritis/DJD/spondylosis. The first, in 1964, was a radiographic presentation of spondylosis. The next grouping of reports ranged from the late 1990s to a 2001 study looking at the efficacy of Meloxicam in pain control for arthritic cats. There have been other reports of arthritis pain management since, but nothing relating to chiropractic problems or treatment (that we could find). The general conclusion of these studies was that cats get radiographically visible arthritis by the age ten to 12 on average, with some as young as six, and that more joints are affected as they get older.
OUR INCIDENCE STUDY
Methods Using some of these arthritis studies as a model, I (Dr. Thompson) evaluated the next 200 cats that came into the hospital for any reason, sick or well, indoor and/ or outdoor, and of any age, from eight weeks to 20 years old. These cats included hospital patients, vaccination clinic animals, and barn cats seen on equine ambulatory calls. Each was palpated for both static mal-alignments and changes in motion at the same locations as in the arthritis studies, namely along the entire spine, elbows, shoulders and hips. I added the sternum, as I have found in clinical practice that this is a common and significant site for arthritic changes, and is not looked at by radiologists.
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Findings
1. I found one eight-week-old kitten with no discernable subluxation complexes. A subluxation complex refers to a joint with abnormal or restricted motion and all of its surrounding soft tissue support structures. This would include the muscles, their attachments, tendons, ligaments, blood vessels, lymphatics, nerves, joint capsule, etc.
2. S ubluxation complexes were more common with age. 3. T hese complexes were present at younger ages than at which arthritis was found in previous studies.
4. 3 3.5% of cats had sternum involvement; those cats also had a statistically significant increase in subluxation complexes than those of the same age without sternum involvement.
5. T his increase is seen in both spinal segments and extremities.
Discussion As the sole practitioner gathering data, there should be consistency in the data from animal to animal. It would have been beneficial to have multiple practitioners gathering data in additional locations to get a better variety of cat populations and a larger number of participating cats. This would require that we all agreed on and practiced our protocol before collecting data. The information we gathered sparks a number of additional questions to be answered:
1. Is there a difference between indoor and outdoor kept cats? 2. Can we effect a change in the development of arthritis in older cats by keeping them regularly adjusted with chiropractic from a young age?
3. If yes, what is the optimal maintenance protocol? 4. Do these trends hold true in other species?
As chiropractic practitioners, we know our treatments can have an important impact on the lives of our patients, and their owners. It is my hope that this basic information provides a starting point for further research that will help all of us educate and encourage our colleagues, co-workers and owners about the benefits of early chiropractic treatment and continued preventative maintenance in our feline patients.
TREATMENT Most of my patients are referred in-hospital to me by the other practitioners, while some come from other practices. Colleagues who have utilized my suggestions for incorporating a few easy additions to their physical exam routines often find muscular/skeletal problems. I offer free chiropractic exams to any puppy or kitten I see and check all litters and their moms during wellness appointments. This allows us to start the conversation about lifetime preventative chiropractic maintenance. Once existing problems are resolved, we evaluate maintenance needs for the animal. Often, twice yearly chiropractic treatments keep them comfortable. I see active working or competitive animals more frequently, once every four to six weeks as needed, depending on their workloads or show schedules. As the case studies to the left will show, many chiropractic problems are a part of (or the only) reason some of our patients are presented. So if more veterinarians were trained to recognize this component in physical exams, and to realize the wide variety of conditions that chiropractic can help, we would be able to assist in many cases. Chiropractic is a wonderful addition to any practitioner’s treatment options. IVC Summer 2017
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CASE STUDIES For those not familiar with the notations used for recording chiropractic findings and treatments, here are a few hints. It all started with human anatomical terminology and is now a blend of human and animal terminology since we veterinarians Examples: C1PL = C1 posterior (dorsal) on the left side C1SR = C1 superior (cranial) on the right. C1 = Atlas
1
have been taught chiropractic by human chiropractors. The notations indicate the location and direction of correction of a subluxation complex.
C2 =Axis P = posterior = dorsal A = anterior = ventral S = superior = cranial
I = inferior = caudal L = left R = right PI and AS refer to iliac spine
Gillyweed, a female DSH, was first seen at eight weeks of age (4/2013) at her post adoption exam by one veterinarian at the practice. She was found to have a congenital deformity of her left front leg, including a missing radius, a short and twisted ulna, and a few missing carpals. She was spayed at 11 months (1/2014) with no complications. When seen at 16 months (6/2014) for her annual exam, she was referred for chiropractic treatment. Two weeks prior to the chiropractic appointment, she stopped climbing on her cat tree and seemed painful when picked up. At her conventional exam (7/2014), Gillyweed was found to be depressed and dehydrated with a moderately painful abdomen, an arched back and tight spinal muscles. IV fluids overnight improved her attitude and hydration, but she was still resistant to being handled. Permission for a chiropractic exam and treatment was obtained. Subluxations were found and treated with manual adjustments at C7BR, C6BL, T1PR, T8PL, T12P, L1PL, L2P, L6PL, Sternum R, and R femoral head cranial. At Gillyweed’s check two weeks later (8/2014), her owner reported improvement in her activity level and attitude and that she was using her left elbow when she ran. At her chiropractic exam, she was stiff in both extension/flexion and lateral/flexion mid-back with a stiff and high right pelvis. TX: T6P, T8PL, T12P, T13PR, L1PL, RPI. Two weeks later (9/2014), her owner reported that Gillyweed was better overall, but starting to seem stiff again. She was found to be stiff with motion palpation in all three main areas: cervical/thoracic/lumbarpelvis. TX: C7BR, T1PL, T8PL, T11PR, T12P, T13PL, L4PL, RPI, Sternum L. Two weeks later, Gillyweed was improved in attitude and behavior. A chiropractic exam showed VSC cervical/thoracic/lumbar-pelvis (VSC=vertebral subluxation complex). TX: C5BR, T5PR, T12P, L1PL, L2PR, SAR, SBPL (SA=sacral apex, SB=sacral base). At another recheck in two weeks, she was much improved, purring again and sociable with all family members. The exam showed VSC cervical/mid-back .TX: C1PR, C2P, C6BL, T5PL, T13PR, L4PL. She was rechecked again in two weeks (10/2014) at which she was reported to be more active and social. During the exam, her back was found to be flat – for the first time since was first seen for abdominal pain. VSC was found in cervical/mid-back areas. TX: C7BR, T1PL, T6P, T12PL, L1PR, L5PL. Another recheck in three weeks (11/2014) found Gillyweed doing well. TX: T2PL, T4PL, L3P, L6P, RPI (PI= sacral-iliac joint stuck in flexion, AS=sacral- iliac joint stuck in extension). Gillyweed continues to be a long-term patient and is comfortable and active with maintenance chiropractic treatments three or four times a year. Her main trouble areas have stayed consistent, probably due to her compensations for her deformed left front leg. So far, her follow-up radiographs have not shown any signs of arthritic changes.
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2
Harry Pawter, a neutered male Maine Coon born in 2000, was first referred for chiropractic care at his annual exam on 7/11/2014. His owner reported that he was arthritic and he was found to have tense back muscles and pain with palpation. Other findings included being overweight, a benign mass on his ventral abdomen, and early stage renal disease. A later chiropractic exam found that Harry had decreased lateral/flexion cervical and thoracic and decreased extension/flexion in his lumbar segments. Manual adjustments were performed at the following segments: C1PR, C7BL, T1PR, T4PL, T12 and T13PR, L1PR, L4P, L6PL, SAL, Sternum L, left ribs 11 and12 P, R rib 9 dorsal/caudal. A recheck was suggested in two weeks; the appointment made was for three weeks later (9/23/2014). Harry’s neck was stiff to the left, and he had decreased lateral/flexion mid-back, stiff ribs on the L, and decreased motion in his pelvis. TX: C7BL, T1PR, T6PL, T12PR, L2PL, L6PR, R SA, caudal sternum L, Right rib10 P. On 5/1/15, Harry’s owner reported that he was lying down slowly and carefully, and had been chewing at his mid-back area a few days earlier. A chiropractic exam found a slightly oily area dorsal mid-back with a strong panniculus response at T10-L1, stiff ribs on the L, sternum shifted L, L pelvis high, decreased lateral/flexion cranial lumbar through midthorax, and decreased motion L and R cervical. TX: C1PR, C2P, C3BR, C7BL, T4PR, T6PL, T9PR, T11PL, T13PR, L1P, L3PR, L PI, SA L, sternum L. RX: Dasuquin Cats #60 1 SID on food. A recheck with bloodwork was suggested for seven to ten days later. Harry was seen again on 7/28/15; his owner reported that he had been doing well up until a couple of weeks prior. The exam showed decreased lateral/flexion and extension/ flexion mid-back and lumbar with a strong panniculus response mid-back, and a pain response with palpation over his pelvis and hip joints. Harry’s coat was thin and oily along his dorsal midline and pelvis. He had an increased heart rate with normal rhythm along with weight loss. Bloodwork showed a slight decrease in WBC and an increased T4. RX: Methimazole transdermal gel 5mg SID, and a continuation of Dasuquin. TX: C2P, C6BR, T1PL, T6P, sternum R, T11PL, T12P, L1PL, L3PL, L5PR, R SA. We discussed adding low dose Meloxicam when traveling and/or Body Sore (Chinese herb mixture). A chiropractic recheck and a check for T4 was recommended in a month’s time. Harry was seen a month later for a T4 re-check only. The Methimazole was increased to BID. He was next seen for chiropractic care on 7/7/16. He was found to have a painful back. A chiropractic exam revealed even ribs, decreased lateral/flexion mid-back and lumbar, and a neck stiff to the L. TX: C7BL, T1PL, T5PR, T6PR, T8PL, T10P, T12PL, T13PR, L2PR, L3PL, L5PR, L6PL, R rib 7P, R radial head lateral, L femoral head caudal. I continue to see Harry Pawter once or twice a year as needed. Unfortunately, this isn’t often enough to help increase the stability of his back, but it does seem to keep him comfortable for significant periods of time. His symptoms are interesting because the first thing his owner noticed were the changes in his coat and grooming behavior.
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integrative practice
THE MINDFUL PRACTICE OF
VETERINARY MEDICINE
By Michele Gaspar, DVM, DABVP (Feline Practice), MA, LPC Mindfulness is not only a gift to ourselves. It’s a way of being that can have far-reaching, positive effects for our patients and clients. Mindfulness is a practice that truly “pays itself forward”; it has been shown to not only decrease professional burnout and compassion fatigue, and raise distress tolerance, but it actually improves patient outcomes.1
and self-reflection are the fruits of attentiveness. When we give attention to another, we suspend our initial judgments, hold them in abeyance, and see with what can be called “beginner’s mind”. This is a mind that is engaged, curious and open to possibilities; it lacks the often very narrow constraints of “expert’s mind”.
THE FOUR ATTRIBUTES OF MINDFULNESS
The attentive mind is a courageous one that is not afraid to challenge what we thought we knew, and replace it with what we now see with new clarity. It allows us to respond to things that may be missed with an “automatic” approach; it helps us resolve to consider anew each patient and client before us, regardless of the number of times we have seen them. When we choose to pay attention to someone, we imbue them with importance. Attending allows us to make each patient and client important; no one’s concerns or suffering matters more than another’s. Attending allows
I consider mindful practice to be based on four attributes: attending, listening, empathy and self-compassion. Each attribute by itself helps us to be present professionally and personally; together, they are a powerful quartet that allows us to be engaged with those we meet wherever we are, in the consultation room or elsewhere.
1. Attending allows us to “check in” with our own mental processes as we observe what is before us. Self-observation
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us to be engaged with another in equanimity so we are attuned to but not engulfed by their needs.
both feet, we lose the connection to ourselves from which empathy springs. Empathy requires an “I-thou” relationship of two forging a connection based on understanding.
2. Listening mindfully allows us to hear the concerns of another without using the lens of our own personal bias as a filter. It is common for clinicians to “hear” a client concern against a backdrop of algorithms, whether we practice from a single theoretical basis or utilize several modalities. When we listen with intention, we are able to construct a narrative of the patient and client that is rich and meaningful. We can be present to the cadence of a client’s report, and hear undercurrents of anxiety, resignation and hope; these are all helpful in meeting the client where he or she is and ultimately being of greater service to the patient. Listening removes us from judging a client who may not be completely adherent to our recommendations, and encourages us to consider that he or she, due to personal circumstances, is doing the best they can. When we listen with intention, we give another that which we all yearn for – the opportunity to be heard deeply without judgment or suggestion. This type of deep listening is only possible when our own minds are clear enough to hear only what is before us. In our contemporary world where so few are actually listened to, having our words truly heard by another is a particularly welcome gift. Listening also makes room for silence, which allows another to speak his or her mind and heart unencumbered by the listener’s filter. This feeling of being completely held, and of mattering to another, can be transformative.
4. S elf-compassion means treating ourselves during times of stress as a good friend would. It is one of the most difficult aspects of mindful practice for many veterinarians, due to our innate perfectionism. Perfectionism is considered a maladaptive schema, one of many unhelpful ways of thinking that are learned and introjected (taken in) at an early age (typically before we are five years old). Perfectionism develops either from a feeling of defectiveness, so that we continually strive harder and harder to prove our self-worth, or from being validated for having been good, so that we continually work to attain that external validation. Although perfectionism carries some benefits, including the academic achievement necessary to attend veterinary school, perfectionists are not only intensely vulnerable to external criticism but are also beholden to a particularly vicious internal critic. The truth is that we can only do what time and resources allow. While many times we turn our attention (and blame) to external factors that limit our ability to practice in accordance with our wishes, self-compassion allows us to see that we are sometimes the
3. Empathy is an attribute many of us wish to demonstrate. However, much professional burnout and compassion fatigue can be traced to a misunderstanding of what it means to be empathic. We may think we are being empathic when we are merely resonating with another’s emotions. This is not empathy; rather, it involves oscillating with another in a way that is not helpful and may even be detrimental. Empathy can be defined as understanding another, even when our life journeys vary. With empathy, we can imagine what another is feeling and experiencing. It does not require that we have experienced the same things; it only requires that we be open to another’s experience and search our own for a feeling or thought that resonates with it. To be truly empathic, we need to have one foot firmly entrenched in our own reality, with one immersed in the other’s. When we enthusiastically jump into another’s situation with IVC Summer 2017
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limiting factor, perhaps because of a deficient knowledge base, the limitations of what our hospitals can offer patients and clients, etc. Perfectionists typically believe that self-compassion reduces motivation for excellence or is a sign of weakness. However, research done by Dr. Kristin Neff2 and others has shown that treating ourselves with kindness does not diminish a desire to perform to the best of our ability and actually helps build courage and resilience. When we are self-compassionate, we are more willing to think “outside the box”; and errors (while they are to be avoided as much as possible) are not personally destructive. Ultimately, mindful practice is a continual journey. We only fail at mindfulness if we assume there is a goal to be achieved, and that at some time in the future we will have fully attained it.
SITTING PRACTICE FOR MINDFULNESS A daily sitting practice is the cornerstone of this intentional lifestyle. Western culture typically involves and rewards constant activity and multi-tasking, so the very act of devoting time each day to simply being with our breath and allowing thoughts to come and go without grasping at them is a counter-cultural and revolutionary way of being. Most of us wish to be mindful as we go about our daily lives so we seek to walk, cook, eat and work with intention. While we might be able to incorporate mindful practice into all these activities in time, sitting practice allows us to begin the hard work of tolerating a wide range of emotions, including boredom, anger, frustration, happiness and contentment. Time spent watching the breath is a laboratory of sorts, in which we practice for life beyond the cushion or chair. Sitting practice allows us to observe whatever comes up, reflect on it and let it go. In the process, we become increasingly able to tolerate thoughts and emotions without needing to escape from them or hold onto them. 32
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Mindful veterinary practice involves each of us living moment to moment, trying to be an attentive listener who practices empathy for others, and holding oneself gently and with selfcompassion. If we come up short one moment, we have the opportunity to try again in the very next moment.
Krasner MS, Epstein RM, et al. “Association of an education program in mindful education with burnout, empathy and attitudes among primary care physicians”. JAMA 2009. Sep 23;(302), 12; 1284-93. doi 10.1001/jama.2009.1384
1
self-compassion.org
2
The Worldwide Alliance of Equine Osteopaths (WAEO), established in February of 2013, is a non-profit corporation that seeks to unite the profession of Equine Osteopathy. We intend to serve as a resource for practitioners, researchers, educators and students of Equine Osteopathy. We aspire to be the link that allows Equine Osteopaths from all over the world to connect and converse. There is much to learn about each other and the profession of Equine Osteopathy as it is practiced throughout the world.
From the
WAEO We’re introducing a new section in this column called “Connect this location”. We’ll look at how the anatomical pieces in a certain location of the body are connected. This is how osteopaths think and work – if we can mobilize and treat all these areas, then we achieve a much longer-lasting result. In this issue, we’ll look at the liver: Connect this location The liver lies under the diaphragm, more on the right than the left, between the sixth and fifteenth ribs. It has fascial connections with the diaphragm and with what travels through it – i.e. aorta, vena cava, esophagus. It is connected with the stomach and duodenum directly through the lesser omentum, and to the esophagus near the diaphragm. The liver also has a fascial connection with the right kidney. Because of the umbilicus, the falciform ligament connects the liver to the ventral body wall and the bladder. The liver is a filter for the blood and body; produces bile to emulsify fat in the GI tract; stores iron, B12 and folic acid; is important in glycogen storage and use; and helps with vitamin D, carotene and iron regulation. Para-sympathetic innervation comes from the vagus nerve, while sympathetic innervation comes from the celiac ganglion (with root involvement from the sixth to sixteenth thoracic vertebrae).
The liver is also often identified with anger and aggression, as we see in TCM. In vascular connections, the arterial flow is from the celiac trunk of the aorta, which forms the hepatic and gastric and splenic arteries. Venous flow is unique: blood leaves through the hepatic vein, but venous blood from the organs of the abdomen and pelvic region drains into the liver through the portal venous system as well. Common symptoms associated with liver immobility include headaches, photophobia, lack of smell, dandruff or greasy coat, skin hypersensitivity or allergies, excessive sweating, fatigue or digestive disturbances. Sensitivity along the ribs behind the elbow on the right side is most common, but sensitivity in the girth and just behind it on the left can be associated with nutritional and toxic events.
Case study A ten-year-old TWH mare was resistant to pressure with the right leg and resented being saddled. She was easily angered and nippy. Osteopathic exam showed tightness in the right shoulder, the girth region on the right and ribs, sacrum, right jaw and third and fourth lumbar vertebrae. Her LDH and GGT were in the high normal reference range and no icterus was noted. She was placed on milk thistle and dandelion, and treated osteopathically to mobilize all bony structures and the fascia around the liver. By her next visit, her LDH and GGT were more in the middle of the reference range and the sensitivity on the right rib cage had gone.
Upcoming events
Visceral peritioneum around the liver is innervated by the phrenic nerve (from the fourth, fifth and sixth cervical roots). Common cranio-sacral connections include restrictions to the occiput, falx cerebri and fronto-nasal sutures.
Our next conference runs September 16 and 17 in Green Bay, Wisconsin. It features great speakers on TMJ, nutrition, new osteopathy techniques and more. For more details, visit equineosteopathy.org and facebook.com/Worldwide-Alliance-of-EquineOsteopaths-Conference-2017-925465864198115/?hc_ref=SEARCH. A post-graduate Cranio-Sacral Course is being offered October 19 to 21 in Texas – see vluggeninstitute.com/homepage. IVC Summer 2017
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INTEGRATING
Essential oils
for SKIN CARE By Jodie Gruentstern , DVM, CVA
Most abnormal skin conditions include some amount of inflammation or infection. As allopathic veterinarians, we were trained to utilize anti-inflammatory drugs such as prednisone, immunosuppressives such as cyclosporine, antibiotics such as cephalosporins, or parasiticides such as ivermectin to manage these conditions. We have watched our cases become more difficult to manage due to medication side effects and the development of drug resistance. This has caused a resurgence of treatments which were used in the “olden days”. Some view this as a fad, but essential oils, some of which have been revered since biblical times, can be very effective and safe if selected and utilized properly. Essential oil usage is often the modality of choice now requested by many natural-minded pet parents!
WHAT IS AN ESSENTIAL OIL? These oils are not the lipid or fatty oils from the plant, but rather the life blood of the plant. An essential oil is a concentrated hydrophobic liquid which contains the volatile aromatic compounds from the plant. Using oils to manage skin conditions is where essential oils shine the most! Many skin conditions produce an odor, so what could be better than using a treatment that smells good too? It is the volatility of the essential oils which makes them aromatic. The aromatic oil carries the components which protect the plant from adversaries. A natural chemical might repel an insect or kill a fungus. These same plant constituents can be used protect us or our animal patients. It is also these same constituents that can be analyzed with tools such as gas chromatography to identify the specific “finger print” of an essential oil. The combination of these natural chemical constituents is what gives particular oils their unique properties for use, effectiveness, safety or danger.
DO THEY WORK? Natural product producers cannot make claims that their products are used to prevent, manage or cure disease. The FDA only allows that these claims be made by drug manufacturers. But, as a holistic veterinarian, I can tell you that my experience using essential oils has been so positive, I would never want to go back to practicing without them! Additionally, there are many testimonials and studies which support efficacy or safety of essential oils.
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TOP 12 OILS FOR SKIN There are a dozen top oils that I use to support healthy skin. Each oil possesses different percentages of natural chemical constituents. These chemical constituents have been found in research to have anti-inflammatory, antimicrobial, or immune supportive properties. Indeed, pharmaceutical companies have isolated some of these constituents in order to manufacture drugs. Further study of each chemical constituent can guide you toward additional uses of the oil. For this, Google is your friend; also some of the oldest oils reference books are the most useful.
1 Lavender Almost every essential oil discussion begins with lavender because its applications are so universal. It is soothing emotionally and physically. It does not burn irritated skin when applied topically, even if the skin is burned, chafed or rashy. It can help to relax a pet that is frenzied due to chronic itching. It has been used internally, but make sure that it is pure and not perfume grade. Lavender may refer to Lavandula angustifolia or the hybrid lavandin. Their chemical constitution is similar but different. Both are high in linalyl acetate and linalool. Lavandin contains camphor which differentiates it from the original Lavandula.
shake before spraying. This is a great way to cover a larger body surface area. My favorite method to apply essential oils for overall body care is with soaks. I do not call this a bath, as you do not lather, spray or rinse! It is a peaceful procedure. Fill the tub or basin with warm water, add a ‘healthy’ soap, and add the selected essential oils. I use a toxin-free soap which contains coconut oil. The soap allows for the dispersion of the essential oils. This soap does not need to be rinsed off. It is ideal because then the coconut oil and essential oil residue remains on the pet. This can be soothing and provide immediate relief. It is not drying, so this procedure can be performed daily if needed and desired, or weekly as maintenance. The skin is a huge surface area which allows for the transfer of chemical constituents into the body and toxins out of the body. All of the oils discussed in this article can be utilized in a soak, separately or in various combinations depending on the goal.
2 Frankincense Frankincense is distilled from resin and includes several varieties such as Boswellia carteri or Boswellia sacra. It is high in alpha-pinene and limonene. This has been used for centuries to support healthy skin and immune systems. Continued on page 36.
METHODS OF APPLICATION When applied “neat” (undiluted) to the skin, the smell and the taste of lavender can deter licking. Clients love this feature as they may not need to use an E-collar. Lavender on a pet might help an exhausted pet parent get some rest, as both can benefit from the aroma. Lavender not only penetrates the skin but also the nasal passages and the blood brain barrier. Fur is a wick, not a deterrent to effectiveness. This oil can be diffused actively with a cold-air diffuser, or passively through the air even when only applied topically. Never use heat with quality essential oils. This will damage the natural chemistry. Sometimes lavender is diluted to disperse it or to dilute the potency. An essential oil may be diluted with a fatty vegetable oil such as coconut oil, olive oil, almond oil, grapeseed oil, wheat germ oil, sesame seed oil or even avocado oil. (These are called carrier oils.) You can also dilute essential oils with water if you add some healthy soap to emulsify. Remember, water and oil don’t mix. So the oil will float on top of the water. If you are using a mister, don’t forget to add soap to the water and oil, and IVC Summer 2017
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5 Citronella Citronella is also steam distilled, but from its leaves. It is high in geraniol and limonene. Citronella is antibacterial, antifungal, anti-inflammatory, an insect repellent and a deodorant.
6 Tea tree Also called, Melaleuca alternifolia, this oil is commonly used and commonly feared. It is very high in terpinene and terpinenol. It is antimicrobial, anti-inflammatory, antiparasitic, immunostimulant, analgesic, a neurotonic and protects against radiation. Fears may be unfounded and due to negative experiences with contaminated or poorly distilled product. Continued from page 35.
3 Copaiba
Copaiba is sold as an essential oil, but is essentially a sap from a tree in an Amazonian culture where this is their antiinflammatory medicine. It is very high in beta-caryophyllene.
4 Chamomile (Roman) Chamomile is ideally steam distilled from its flowers. Roman chamomile is very high in isobutyl angelate and isoamyl methacrylate. These have anti-inflammatory, anti-parasitic and skin regenerative properties in addition to being calming.
7-11 A Blend of Clove, Lemon, Cinnamon, Eucalyptus radiata, and Rosemary
This popular combination contains oils which are antiseptic, anti-inflammatory and can numb tissues on contact. Clove can be as high as 87% eugenol. Cinnamon is also high in eugenol, but approximately 50% trans-cinnamaldehyde. These natural chemicals make this a “hot� oil, which can burn skin, but at the same time be antimicrobial and increase blood flow. It is best used diluted or within a blend. Eucalyptus radiata, also distilled from leaves, is up to 75% eucalyptol, making it antiinfectious and anti-inflammatory. Rosemary is Rosmarinus officinalis 1,8 cineol or vervenon. The former contains a much greater concentration of 1,8 cineol which is a eucalyptol, again, making this antimicrobial. The verbenon variety is much higher in alpha-pinene. Both can help decrease hair loss. Avoid using if a pet is epileptic. Lemon oil is cold-pressed from rinds and is up to 73% limonene, a most common terpene. Limonene has been shown to be safe and multipurpose for the body due to the nature of terpenes. I have used this blend dozens of times to soak a paw in need. Mix a few drops in warm water with a healthy soap.
12 Neem Because neem oil is highly revered as a natural skin care product, I will mention it here to clear up any confusion. It is not an essential oil. It is a cold pressed vegetable oil which contains
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DOSING The amount of water and the number of drops of oil will depend on the species, size and age of the pet, and the oil. Certainly it would be difficult to do a full body soak on a horse or a mastiff; but surely you can soak a hoof or a paw. Horses respond fabulously to essential oils. On the other spectrum, we can soak a small dog or even a cat, but we must be cognizant of a potential sensitivity to an oil, and treat small animals as we would an infant. One drop of oil can go a long way! Sometimes we use the ‘tooth pick method’. A toothpick is placed into the center hole of your oils bottle in order to dispense less than a drop. The oil on the tip is then delivered to the area of concern or even blended with a carrier oil to dilute further. Roughly, I would suggest beginning with one drop per 10 pounds into the soak water. Multiple oils can be combined.
essential fatty acids (EFAs), triglycerides, vitamin E, calcium, steroids and some essential oil constituents. Because of its EFAs and vitamin E, neem oil penetrates deep into the skin to moisturize and heal. The primary essential oil constituents are terpenoids. The EPA explains that in cold-pressed neem oil the most common terpenoid, azadirachtin, is now a federally registered active ingredient pesticide. You can see how the natural chemistry of this dermal dozen make them ideal for utilization in the management of healthy skin for our animal patients. REFERENCES
The Chemistry of Essential Oils Made Simple. David Stewart, PhD, D.N.M. Essential Oils Integrative Medical Guide. D. Gary Young, ND Linalyl acetate as a major ingredient of lavender essential oil relaxes the rabbit vascular smooth muscle through dephosphorylation of myosin light chain. J. Cardiovasc Pharmacol, 2006 Jul;48(1):850-6. Anti-inflammatory activity of linalool and linalyl acetate constituents of essential oils Phytomedicine, 2002 Dec;9(8):721-6. Composition and antibacterial activity of the essential oils of four commercial grades of Omani luban, the oleo-gum resin of Boswellia sacra FLUECK. Chem Biodivers., 2012 Mar;9(3):615-24. doi: 10.1002/cbdv.201100189. Copaiba Oil-Resin Treatment Is Neuroprotective and Reduces Neutrophil Recruitment and Microglia Activation after Motor Cortex Excitotoxic Injury. Evid Based Complement Alternat Med. 2012; 2012: 918174. Published online 2012 Feb 19. doi: 10.1155/2012/918174 Bioactive Products in chamaemelum-nobile.html.
Chamomile.
sigmaaldrich.com/life-science/nutrition-research/learning-center/plant-profiler/
Efficacy of citronella and cinnamon essential oils on Candida albicans biofilms. Acta Odontol Scand. 2016 Jul;74(5):393-8. doi: 10.3109/00016357.2016.1166261. Epub 2016 Apr 21.
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Continued from page 37. Antimicrobial activity of the major components of the essential oil of Melaleuca alternifolia. J. Appl Bacteriol, 1995 Mar;78(3):264-9. Clove (Syzygium aromaticum): a precious spice. Asian Pac J Trop Biomed, 2014 Feb; 4(2): 90-96. D-Limonene: safety and clinical applications. Altern Med Rev, 2007 Sep;12(3):259-64. Antimicrobial efficacy of eucalyptus oil and 1,8-cineole alone and in combination with chlorhexidine digluconate against microorganisms grown in planktonic and biofilm cultures. J Antimicrob Chemother, 2009 Dec;64(6):1219-25. doi: 10.1093/jac/dkp362. Epub 2009 Oct 16. Chemical composition and antifungal activity of rosemary (Rosmarinus officinalis L.) oil from Turkey. Int J Food Sci Nutr, 2008 Nov-Dec;59(7-8):691-8. doi: 10.1080/09637480701777944. Cold Pressed Neem Oil Fact Sheet. www3.epa.gov/pesticides/chem_search/reg_actions/ registration/fs_PC-025006_07-Apr-10.pdf National Pesticide Information Center Fact Sheet. http://npic.orst.edu/factsheets/neemgen.html Chemical Characteristics of Toilet Soap Prepared from Neem. http://www.imedpub.com/ articles/chemical-characteristics-of-toilet-soap-prepared-from-neemazadirachta-indica-ajuss-seed-oil.pdf.
Jodie Gruenstern, DVM,CVA graduated from UW-Madison in 1987. She is a certified veterinary acupuncturist and food therapist by the Chi Institute. She is Vice-president of the Veterinary Medical Aromatherapy® Association (VMAA) and has been a member of the AVMA, AHVMA, WVMA and MVMA. Dr. Jodie founded the Animal Doctor Holistic Veterinary Complex, is a nationally renowned speaker, author, TV and radio personality. For more info, you can purchase her book, “Live with Your Pet in Mind” on Amazon or visit www.DrJodiesNaturalPets. com for meat-based treats, natural products, to schedule a consult, or speaking engagement. Please support her non-profit, Integrating People for Animal Wellness at www.iPAWaid.com. Dr. Jodie resides in Scottsdale, Arizona with a lot of fabulous rescues! Follow her on Facebook!
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PROBIOTIC SUPPLEMENT HELPS MAINTAIN HEALTHY IMMUNITY IN DOGS AND CATS Using probiotics to help maintain a healthy immune system in your patients reduces the risk of illness, thereby decreasing the need for antibiotics. Probios® Intelliflora® is a probiotic supplement for dogs and cats from Vets Plus, Inc. (VPI) in Menomonie, Wisconsin. It offers pet owners a fast and convenient way of supporting balanced gut microflora while maintaining the immune system. Probios Intelliflora contains 200 million colony-forming units (CFUs) of four strains of beneficial bacteria: Enterococcus faecium, Lactobacillus acidophilus, Lactobacillus planetarium and Lactobacillus casei. These strains offer various benefits, such as the production of B vitamins, improved digestibility of food, and the production of enzymes that help digest proteins. The simple product design – it comes in single-dose 1gm packets – makes it easy to use. This probiotic supplement joins the Probios family of products, the world’s most widely researched and tested animal health
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probiotics, and is available through major animal health distributors. Visit probios.com for more information. Vets Plus, Inc. is a leading manufacturer of animal health and nutrition supplements for livestock and companion animals. Founded in 1990, the company creates custom formulations for innovative probiotics, nutritional supplements, and pet treats in a wide variety of formats. VPI is committed to quality and maintains SQF Level 3 certification, NASC membership and AAFCO compliance.
industry innovations Fighting otitis without antibiotics Ear infections are among the most common problems veterinarians see in their canine and feline patients. ZYMOX Otic Enzymatic Solutions are highly effective in the management of acute and chronic otitis due to bacterial, fungal and yeast infections – and they work without antibiotics. The powerful enzymatic action provided by the patented LP3 Enzyme System naturally cleans and disinfects while destroying even the most resistant microbes. These products are safe for pets of any age, and are available with and without hydrocortisone. The Advanced Formula ZYMOX Otic PLUS features additional enzymes to destroy tough biofilmproducing microbes, such as pseudomonas. petkingbrands.com
Pharmaceutical company expands its footprint In April of this year, veterinary pharmaceutical company Virbac announced that it’s locating its North American product warehousing and distribution center in Kansas City, Missouri, thereby increasing its footprint in the Kansas City Animal Health Corridor. The center will be situated in a 150,000-square foot facility in Hunt Midwest SubTropolis, the world’s largest underground business complex. Virbac selected SubTropolis due to its central location, transportation access, and unique underground environment; its constant temperatures meet the company’s climate-controlled requirements. “By choosing this Midwest location, we’re better aligning ourselves within the animal health industry, adds Paul R. Hays, Virbac’s president and CEO. The company expects its new facility to be fully operational before the end of the year. virbac.com
Learn about Chinese herbal medicine Chinese herbal therapy is an excellent modality to add to your practice. You can become certified in Veterinary Chinese Herbal Medicine (VCHM) through the International Veterinary Acupuncture Society. To make it as convenient as possible for busy practitioners, they offer online training to you can learn in the comfort of your own home or office. By the end of this 160-hour course, you will have enhanced your clinical skills and be able to prescribe appropriate Chinese herbal medicine to your patients, safely and effectively. You will also be taught about classic Chinese herbal formulas so you can obtain them virtually anywhere in the world. The course is RACE approved. Visit ivas.org to learn more and for info on how to enroll.
Light therapy poll cap for equine patients Light therapy, using both visible red and infrared light, has been shown to deliver powerful therapeutic benefits to living tissues and organisms. The Poll Cap from RevitaVet is a hands-free, self-contained, AA battery-powered device for treatment of the poll region. It is a very effective tool for calming horses down and is excellent for the nervous horse, especially during travel or when you or the horse’s farrier are visiting the client’s barn. Simply place it over the poll, under the halter, and you’re good to go. The Poll Cap addresses stress and behavioral problems as well as stiffness, headaches, tooth grinding, TMJ, head tension and tilting, the frontal sinuses and the first and second vertebrae. revitavet.com/product/poll-cap IVC Summer 2017
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tech talk
MAXIMIZING the role of
VETERINARY TECHNICIANS
in integrative practice By Connie Glavan, LVT and Cindy Maro, DVM, CVA, CAC, VMRT
The support roles veterinary technicians fill in both traditional and integrative veterinary practice settings are as varied as the practices themselves. Technicians are vital for creating more effective and efficient use of DVM time, and in reducing expenses by managing inventory, improving profits, bonding with clients and improving client communication.
SURVEYING VETERINARY TECHNICIANS FOR THEIR INSIGHTS
The aim of this article is to help DVMs and technicians create an effective dialog surrounding shared goals of professional, practice and personal growth, while improving income for the practice and its staff. Sharing insights can help generate efficient systems and procedures, which ultimately improve service delivery, patient care, work-life balance and revenue generation, while achieving a more cohesive team effort.
2. What one change would make your job more rewarding?
Connie has been an LVT with Dr. Maro’s practice for 19 years. We co-authored this article to present the perspectives of both owner and technician when it comes to successful actions that can enhance operations in integrative practice.
7. How do you see yourself most significantly enhancing revenue generation?
In our daily work, we can make many assumptions and take much for granted. As veterinarian and technician, we have worked together a long time, but while preparing this article we learned a great deal about each other’s independent and mutual goals and objectives. These are not often discussed in our daily work with patients and clients. Practitioners need to be cognizant of the fact that technicians have insights that may not always be expressed, since technicians tend to assume a role of deference to veterinarians. Asking for technician input, and having bi-annual meetings with technicians, along with surveys of their views and practice goals, can enhance employment satisfaction. A 360° evaluation of management and ownership also improves staff communication and operations.
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Practitioners can survey LVTs with questions like these, while technicians can use surveys to reflect and create a dialog with ownership/management: 1. What do you enjoy about your current position? 3. What services/roles can you provide to free up the DVM or make her more efficient and productive? 4. Which modalities do you enjoy, and are there any in which you would like to pursue advanced training? 5. What do you least enjoy about your job? 6. List a talent we have overlooked or underutilized.
8. What suggestions would you give each DVM to enhance his/ her effectiveness/skills in benefiting the practice and patients? After reviewing the technician’s answers, ownership should schedule a prompt meeting (within two weeks) to discuss changes that mutually benefit the practice and LVT.
THE LVT’S ROLE IN CLIENT COMMUNICATIONS An LVT with experience and an understanding of conventional practice can help clients who may have fears about what to expect when seeking integrative care for their pets. This type of communication is a vital part of a technician’s duties. Dr. Maro says her most valuable daily client interactions result from Connie’s exam room preparation with new and existing clients. “Before walking into the exam, I receive concise information regarding both the owner’s and the animal’s medical, emotional and mental state, financial expectations and limitations, scheduling abilities, and attitudes towards
conventional and holistic care,” says Dr. Maro. “This preparation helps prevent surprises and allows me to budget my time from the moment I enter the room.” To prepare a thorough briefing of relevant information, an LVT should: 1. Become well-versed in practice philosophies, modalities and client expectations. Teach clients how to be compliant; when and how to communicate between visits; and to understand the quantity of DVM time the schedule entitles them to. 2. Develop, along with the DVM, efficient and relevant history and intake questions. 3. Obtain and read prior records, highlighting illnesses, vaccines and medications. 4. Introduce clients to the practice, policies, and DVM’s goals for the animals. 5. Interview clients about their expectations and goals for their animals’ health. 6. Discover what prior knowledge and exposure first-time clients have had to alternative care. If a client has had a bad experience with a personal chiropractic adjustment, or lacks familiarity with Applied Kinesiology, and the DVM
starts performing an adjustment or muscle testing his or her animals, the visit can become complicated and dissatisfying for all. 7. Explain what will happen during the exam, highlighting the value of the practice’s services. For example, a DVM who performs an Eastern and Western exam, along with spinal evaluation, may be assessing a great deal about the patient, while the client may simply see it as “petting the dog”. An LVT can introduce these valuable assessments before the DVM enters. 8. Develop proficiency in discussing finances, estimates and expectations regarding frequency and duration of care for chronic and terminal cases.
MAINTAIN STATISTICS/RESULTS OF PATIENT CARE Technicians who maintain logs of patient diagnoses, treatments and follow-up results create valuable information for DVMs tracking responses to integrative care. This information improves credibility for your practice when clients ask, “How many cases have you treated this way and what was the average survival time after diagnosis?” The LVT can also enter this information into the database at CuredCases.com, beginning with the very first client visit. Continued on page 42.
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FOR TECHNICIANS CURIOUS ABOUT ALTERNATIVE THERAPIES, AND DESIRING TO LEARN MORE 1. Find an alternative practice where you can shadow or work. 2. Read IVC Journal, and publications like Animal Wellness. 3. Join the AHVMA and attend conferences and CE events. 4. Explore books available through the AHVMA bookstore. 5. Become certified in an alternative modality, physical therapy, Reiki or other energy medicine. 6. Take courses in herbology, massage, or courses for technicians through the Chi Institute or online with CIVT. 7. Work with the practice owner to learn how you can utilize your skills, with considerations for legality and your state’s practice act, in the best way possible for the practice.
Continued from page 41. This database is available to all veterinarians for help with cases or research purposes.
DELIVERING SERVICE WITH JOY Match passion and purpose with the roles each technician fills in the practice. If you are regularly doing the survey mentioned earlier, technicians can ponder what brings them the most joy in the practice. For example, if you are a technician who loves hands-on work with patients, rather than running anesthesia, speak with your practice owner about attending rehabilitative therapy certification classes. Depending on the size of your practice, you may still be running anesthesia as needed, but developing a new skill and revenue center will improve profits and job satisfaction.
INVENTORY AND FINANCIAL MANAGEMENT Inventory management can make or break cash flow in a practice. Though many practices have computer systems that track inventory, the nature of prescribing in integrative practices makes it difficult to quantify every acupuncture needle and homeopathic pellet. Assigning a primary technician to each DVM helps the LVT keep mental track of ordering. In our practice, three different technicians are assigned to maintaining inventory supplies: 1. One maintains and orders TCVM supplies, homeopathics and essential oils. 2. One maintains conventional drugs. 3. One maintains laboratory and surgical supplies and reagents. Between these three technicians, we seldom have excess inventory or outdated items. Technicians often facilitate “closing the deal” for cases requiring involved and chronic care. Train technicians to become comfortable with discussing the need for care, as well as the costs involved. Teaching support staff to address concerns with specific positive language saves the DVMs time, and determines the central issue for clients who are hesitant about proceeding with services. For example, after the DVM discusses a diagnostic and treatment plan, the technician can review a cost estimate with the client. When the client indicates uncertainty, the LVT can ask specifically what is causing the hesitation. If it’s about understanding the tests and treatments involved, the discussion can proceed. When clients still won’t commit, the technician can ask if they are concerned about the time or cost involved. This direct question often gets to the central issue more quickly.
PATIENT SCHEDULING Ideally, every veterinarian should have every appointment filled, with a lunch break in the middle of the day. Unfortunately, gaps
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in schedules, late appointments, nervous animals and long problem lists can keep the schedule from flowing well. LVTs can add value to their roles by reviewing the next several days’ schedules and looking for potential problems, such as patients requiring consultations on grave diagnostic results.
HOW PRACTICE OWNERS CAN IMPROVE UTILIZATION OF THEIR SUPPORT TEAMS
Here are some technician tips for improving schedules during their review of upcoming days:
1. E valuate each LVT’s strengths and desires, and build his or her role around those qualities.
1. C all clients during one of the lighter days/times preceding their appointments to get an update or thorough history, thereby reducing interview times in exam rooms.
2. S ponsor attendance at CE and alternative courses, for interested technicians.
2. I f a particular case sounds complicated during one of these calls, suggest the client schedule a more extended appointment time (with an increased fee) or break the appointment into two visits a few days apart.
3. H ost staff meetings with CE in which you share your integrative philosophies and knowledge.
3. E ncourage clients to visit during non-peak times by offering slightly longer appointment times or shorter wait times.
4. C reate educational goals with your technicians, to prevent stagnation and facilitate pursuit of their passions.
4. W hen demand is high, give feedback to the DVM about scheduling, which can then be modified to better fit client demands. 5. C onsider increasing office visit fees for peak times, and keep fees stable for non-peak times. 6. I f your DVM has openings and gaps in the schedule, call clients who have not recently received services. Gaps will often be filled once animal chiropractic and rehabilitative clients are reminded of the need for maintenance care. 7. C reate workshops and educational events, both in the clinic and at animal venues, such as 4-H clubs and pet stores. Education and awareness draw clients to integrative practices to fill schedule gaps.
MATTERS OF COMPENSATION When a technician approaches a manager looking for reviews and raises, he or she should take specific and measurable information into the meeting. This information should detail how revenue and operations have been directly enhanced by the technician’s actions since the prior review: 1. K eep metrics regarding client contact, enhanced sales and client feedback. 2. D etail how a scheduling activity, service or promotion of service has directly impacted the practice with client numbers, client satisfaction and revenue increases. 3. I f you would like the practice to pay for a course of study, research how you could add a new service and how much money would be generated by this service. For example, let’s say you take a course in nutrition and begin calling clients for 30 minutes daily to tell them about your DVM’s new information regarding supplements. You can document the clients called and the resulting sales.
If you have begun taking action to improve schedule flow and history taking, resulting in decreased staff overtime, document those numbers for your next review.
CONSIDERATIONS FOR PRACTICE OWNERS If you would like to spend more time with your family, and have more revenue so you can enjoy your hobbies, find a technician who shares your vision and goals, communicates well, and has the desire to learn and the ability to heal. Help him or her explore the many facets of integrative practice and allow his or her skills to grow.
IN CONCLUSION Remember that the most valued technicians seek the highest level of action they can take, relative to their abilities, during both busy and slow clinic times. This means action that will generate the most return for their efforts, while delegating cleaning tasks to less highly-trained assistants. This action leads to more efficiency and revenue generation, resulting in clear justification for salary enhancements. IVC Summer 2017
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Advertorial
Inflammation is complex but managing it doesn’t have to be By Amy Van Gels, DVM
Inflammation involves the interaction of many different cell types, physiologic processes, and inflammatory mediators. Inflammatory mediators – the chemical communication signals that direct the inflammatory process – often have multiple, interconnected, and redundant physiologic effects. Initially, these effects heal injured tissues and eliminate foreign organisms and damaged cells. In the process of healing, however, collateral damage occurs to surrounding cells due to the release of lysosomal enzymes, reactive oxygen species, and additional inflammatory mediators. In addition, if inflammation does not resolve properly, its effects become harmful and can result in permanent tissue damage. Just because inflammation is complex doesn’t mean managing it has to be. By asking a few basic questions, veterinarians can determine the best treatment plan for each patient. 1) I s there inflammation? The presence of inflammation is obvious in patients that display its classic signs: redness, heat, swelling, pain and loss of function. Likewise, conditions that end in “-itis” have an inflammatory cause. However, other inflammatory conditions might be less evident. Veterinary patients often hide their pain; those with internal inflammation may exhibit few if any clinical signs. In fact, tissue damage from any cause triggers the release of inflammatory mediators and the inflammatory process. If inflammation – especially chronic inflammation – is present, treatment is usually indicated. 2) H ow long has it been present? Acute inflammation typically lasts a few days, whereas chronic inflammation can last weeks, months or even years. The cellular infiltrate can also help identify the chronicity. Neutrophils predominate in acute inflammation, whereas macrophages prevail in chronic cases. Finally, evidence of attempted repair is apparent in chronic inflammation, in the form of fibrosis, scarring and tissue remodeling. Treatments
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aimed at alleviating pain and minimizing the progression of inflammation are appropriate for any type of inflammation. However, patients with chronic inflammation may require longterm treatment, and therapies with a lower risk of side effects are preferable whenever possible. 3) How severe is it? Severe inflammatory conditions require aggressive therapies, such as immunosuppressive drugs for immune-mediated diseases. Multimodal therapies may also be appropriate for severely affected patients to maximize improvement and minimize side effects. In contrast, patients with mild inflammation may improve with the use of nutraceuticals alone. 4) Is the inflammation managed? Choosing an initial treatment depends on the patient; the cause, severity and chronicity of the inflammation; the affected location; and the prognosis. Antiinflammatory drugs, such as corticosteroids and NSAIDs, have profound effects on the inflammatory process and clinical signs. Alternatively, supplements that manage inflammation, such as Duralactin® brand products or Omega-3 fatty acids, may be indicated for patients that need adjunctive or alternative therapies. As treatment progresses, clinicians should evaluate whether treatments should be added, adjusted or discontinued. Finally, scheduling recheck appointments can assess whether the treatment plan remains effective. Uncontrolled inflammation damages healthy tissues, often permanently. By asking these simple questions, veterinarians can ensure they are managing any inflammation afflicting their patients. Dr. Amy Van Gels is a veterinarian and medical writer in Phoenix, AZ. She graduated with her Doctor of Veterinary Medicine from Colorado State University in 2007 and practiced companion animal medicine for seven years. She now writes informative pieces for pet owners, educational documents for veterinary sales teams, and technical papers for veterinarians.
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TAKING AN INTEGRATIVE PERSPECTIVE WITH LAMINITIS Understanding how an integrative approach can be used to diagnose and successfully treat laminitis. By Megan McCorkel, DVM, cVMA
Laminitis is a frustrating disease commonly encountered by equine practitioners. In a 2000 USDA-NAHMS study, laminitis was noted on 13% of horse operations. Fortunately, integrative methods such as acupuncture and related techniques can help treat this difficult disease.
LAMINITIS EXPLAINED Laminitis is defined by Gary M. Baxter, VMD, MS in Adams and Stashak’s Lameness in Horses, 6th Edition (Wiley-Blackwell, 2011) as “a disease in which failure of the soft tissue structures that suspend the distal phalanx within the hoof wall, the interdigitation between the dermal and epidermal laminae of the digit, commonly results in a crippling lameness due to displacement of the distal phalanx within the hoof capsule.” There are several important structures within the equine limb. The equine digit is composed of four main bones: the navicular bone (distal sesamoid) and the first (proximal), second (middle) and third (distal) phalanges. The primary nerve that innervates the distal thoracic limb is the median
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nerve, which arises from C6-T2, and splits into the median and lateral palmar nerves just distal to the carpus. Once the nerves reach the metacarpophalangeal joint, they’re termed the palmar digital nerves. There is also some contribution from the ulnar and musculocutaneous nerves. The equine foot has no motor nerves, but it does have significant input from autonomic, sensory and autonomic vasomotor nerve fibers. An understanding of the anatomical structure of the hoof, nerves and neurovascular bundles is imperative when performing acupuncture on a laminitic equine patient. The majority of laminitic episodes originate in the thoracic limb. During a laminitic episode, the distal phalanx can be displaced and/or rotated due to lamellar separation or failure. I explain this concept to horse owners using a trampoline analogy. I describe the outer support structure of the trampoline as similar to the hoof wall; the springs equating to the lamina; and the black center of the trampoline as the coffin bone. Once inflammation occurs, fibrosis, or a metabolic event that causes the lamina (springs) to lose their
ability to function properly, the coffin bone will begin to rotate or displace.
CAUSES OF LAMINITIS Laminitis is commonly a consequence of five primary clinical events. These include: 1. Disease associated with sepsis and/or endotoxemia 2. Excessive weight placement on a limb 3. Cushing’s disease 4. Equine Metabolic Syndrome (EMS) 5. Ingestion of black walnut bedding. Cushing’s disease and EMS can be difficult to differentiate, but they contribute to laminitis with equal intensity. Hyperadrenocorticism, Cushing’s disease, causes excessive glucocorticoid production, as well as vascular changes within the body. The most notable outward signs associated with Cushing’s disease is a long curly coat, cresty neck, and polyuria/polydipsia. Equine Metabolic Syndrome is an insulin resistant disease predisposing horses to laminitis through vasoregulatory processes that insulin helps to regulate. EMS horses are typically obese and middle-aged.
AN INTEGRATIVE PHYSICAL EXAM • To perform an integrative physical exam, practitioners must obtain a thorough history of the horse. As veterinarians, we must ask for information regarding illnesses, diet changes, management changes, and prior treatment for similar events, as well as the clinical signs the owner is noticing. Historically, one of the first signs most owners mention is that their horses are “walking on egg shells”.
• Many laminitic patients will need their Qi-Blood to move in order to resolve stasis/stagnation. If the flow of Qi is interrupted, there is noted insult or disease within the body. Qi is the energy that flows through the body’s meridians. These 12-paired meridians connect and unify the internal organs with the external body, allowing the body to experience harmony. Significant scientific support emphasizes the connection between meridians and peripheral nerve pathways. According to TCM, it is also important to check the pulse and tongue appearance to see if there is any excess Heat, Qi deficiency, Blood deficiencies, stagnation, etc. associated with different organs in the body. These portions of the integrative physical examination are important to helping assess the patient for whole body wellness and deficits. • Finally, radiographs are highly recommended for any horse with laminitis, or suspected laminitis, in order to help assess the staging and rotation/displacement angles.
ACUPUNCTURE FOR LAMINITIS Acupuncture can help achieve whole-body wellness, provide better control of chronic disease processes, aid in healing and manage pain. It has been of great benefit to our laminitic patients. Originally, acupuncture points were based on a human model. These ting points have been modified to fit our equine counterparts, who have single digits as opposed to five phalanges. Around the horse’s digit, there are six ting points. These points are located around the coronary band in a rich web of joint, ligament, tendon and neurovascular input.
• Once a thorough history is obtained and the traditional PE is performed, we assess the horse using integrative medicine and a DAPE examination. A DAPE examination is derived from a traditional Japanese approach to acupuncture by means of palpation; it’s used to assess the whole body for noted trigger points, regions of pain, loss of sensations, change in range of motion, areas of heat, and general pathologies. When performing a DAPE examination, it is important not to use more than three pounds of pressure to find reactive or painful areas. Palpation of the myofascial planes, bony insertions and trigger points will guide the practitioner in an assessment of the horse. According to Traditional Chinese Medicine, we want to achieve uninterrupted “Qi” with our patients. • Using TCM, we must also assess the patient based on the Five Elements – Wood, Fire, Earth, Metal and Water. These elements help the practitioner pick up on individual characteristics as well as the horse’s personality, and can guide him or her in an appropriate assessment for treatment.
As previously stated, the meridians are in direct correlation with peripheral nerve pathways. When assessing the equine thoracic limb, the LU meridian is correlated to the musculocutaneous nerve; PC is correlated with the median nerve; and HT is associated with the ulnar nerve. The ting IVC Summer 2017
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SI 1 LI 1 TH 1 HT 9
LU 11 PC 9
points for the front limb are: HT 9, LU 11, SI 1, LI 1, TH 1 and PC 9. The ting points for the pelvic limb are: ST 45, SP 1, GB 44, BL 67, KI 1, LR 1. Laminitis treatment is based on local as well as systemic pain, myofascial dysfunction, and the need for inflammation management. This can all be achieved through dry needling and electric stimulation. Taking into consideration that forelimb laminitis is most common, it is also important to assess the thoracic limb, shoulders and cervical spine for point selection. Additionally, one should take into consideration any myofascial tension and windup that can occur, especially over the bladder meridian.
Conventional treatment for LAMINITIS Conventional approaches for laminitis include
LR 1 SP 1
ST 45 GB 44
BL 67 KI 1
ADDITIONAL TREATMENT The goal of all laminitis treatment methods is to make our patients comfortable, halt disease progression, and stabilize the horse. • Horses suffering from laminitis should always have deep bedding in their stalls to give them as much support as possible. • The team of horse owner, veterinarian and farrier should all be in contact. • Dietary management is a key topic to discuss with clients. Horses going through a laminitic episode should not be fed high concentrate feeds or lush pasture. Devices such as grazing muzzles, in cases where horses lives outside on pasture, may be a suitable recommendation to offer owners. Forage is a great alternative for feed concentrates, and monitoring hydration status should be a priority since most patients are reluctant to move during agonizing laminitic episodes.
analgesics, vasodilators, hypertensive agents, cryotherapy, and a reduction of mechanical forces on the lamellae. Monitoring total protein intake is important when giving analgesics such as phenylbutazone and flunixin meglamine. Both these analgesics, when used for long-term pain management, can lead to edema and colitis.
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• Chiropractic care works well in conjunction with acupuncture, primarily when focusing on the spinal column to decrease joint dysfunction and help the animal find homeostasis. It has been noted that when animals have a misalignment, they enter a state of stress that can lead to a metabolic decline. Equine metabolism is directly associated with laminitis, which it why it is important to keep our equine patients well-balanced, both physically and physiologically.
• Moxibustion involves burning an herb called mugwort. It can be used on or over an acupuncture point. The heat from the herb helps modulate pain and loosen muscle tension. • Additional herbal supplements that can aid in treating laminitis include Move Freely and Four Marvels Combination. Four Marvels is a combination of Atractylodes rhizome, Achryanthes root, Coix seed and Phellodendron bark. It should only be used in acute cases of laminitis. Move Freely is a combination of Cyathula root, Chinese angelica root, safflower, tumeric rhizome, Corydalis tuber, Persica seed, Ligusticum rhizome, licorice root, myrrh, and Sappan wood. This combination is beneficial for chronic inflammation and increasing peripheral circulation, but should not be used in pregnant mares. When using herbal supplements, it is very important to first assess what stage the laminitis is at. (see sidebar at left).
THREE STAGES of laminitis progression 1. The first stage is developmental, in which the horse is undergoing one of the primary disease processes mentioned in the article, but is considered “at risk” and has not developed clinical symptoms.
2. The condition then progresses to the acute phase, where there is no radiographic evidence of changes
• Cold laser therapy or low-level laser therapy (LLLT) has recently gained popularity in the equine community. LLLT can aid in sole and heel growth during laminitis episodes, as well as cause autonomic nervous system stimulation. LLLT is based on photochemical and bio-stimulation, without the generation of heat. As outlined in this article, acupuncture is not just a supplemental tool for treating equine laminitis; it is also a way to achieve whole body wellness in horses. In addition to acupuncture, several other holistic modalities that go beyond Western medicine can be used for treating laminitis. Laminitis is a difficult disease process to treat and requires teamwork by the owner, veterinarian and farrier. By integrating Western with holistic medicine, and working as a team, we can give our equine patients long and healthy lives.
to the coffin bone. The acute phase is considered to last 72 hours.
3. Finally comes the chronic stage. At this point, radiographic evidence of coffin bone displacement can be seen. Patients in the chronic stage of laminitis can be extremely frustrating and difficult to maintain with conventional medicine. These horses tend to have ongoing structural and hoof problems that can change the shape of the hoof, cause chronic pain, or generate
Baxter GM, Adams OR. Adams and Stashak’s Lameness in Horses (6th ed). Oxford: Wiley-Blackwell, 2011. Boldt Jr., Ed. “Veterinary Acupuncture and Chiropractic: What, When, Who?” Am Assoc Equine Pract, 2016. Crisman, Mark V., DVM, MS, CVA, DAVVIM. “Equine Acupuncture – Beyond the Qi Concept”. Proc. of ABVP 2012, Blacksburg, Virginia. n.d. Web. 1 Feb. 2017.
visible rings. Horses with chronic laminitis should be managed with a combination of medical, dietary, exercise and holistic approaches.
Haussler K. “Equine chiropractic: general principles and clinical applications”. Proceedings Am Assoc Equine Pract. 2000;46:84-93. Holt, Tim, DVM. “Implementing Equine Manual Therapy”. Western Veterinary Conference 2008. Fort Colling, CO. n.d. Web 1 Feb. 2017. Lancaster, Lisa S, Bowker, Robert M. “Acupuncture Points of the Horse’s Distal Thoracic Limb: A Neuroanatomic Approach to the Transposition of Traditional Points”. Animals : an Open Access Journal from MDPI 2.3 (2012): 455-471. PMC. Web. 18 Mar. 2017. Palm, Janet Gordon, DVM, CVCP. “LLLT in the Management of Laminitis, and Inflammatory Equine Conditions”. Proc. of Wild West Veterinary Conference 2015, Animobility, Minneapolis, MN. n.d. Web. 1 Feb. 2017. Parks, Andrew Hugh, MA, Vet MB, MRCVS, DACVS. “Acute and Chronic Laminitis – An Overview”. Proc. of 64th Convention of the Canadian Veterinary Medical Association, Athens, GA. n.d. Web. 1 Feb. 2017. Schoen A. Veterinary Acupuncture: Ancient Art to Modern Medicine. 2nd ed. Mosby; St. Louis, MO: 2001. Schott, Hal, DVM, PhD, DACVIM “Fat, Foundered Horses: Equine Metabolic Syndrome and Laminitis”. Proc. of Pacific Veterinary Conference 2015, East Lansing, MI. n.d. Web. 1 Feb. 2017.
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TREATMENT PROTOCOL FOR EQUINE PROTOZOAL MYELITIS (EPM) By Lu Ann Groves, DVM Equine Protozoal Myelitis (EPM) has been around since the 1960s in the US. It’s caused by two protozoal parasites.
1. S arcocystis neurona is the most common, and causes multiple symptoms.
2. Sarcocystis hughesi affects less than 1% of horses. It invades the central nervous system.
Horses in the US seem to have developed some immunity to EPM, since fewer than 1% of exposed horses develop a clinical disease. The horses I see with severe symptoms are usually very weak, stressed or old.
COMMON SYMPTOMS OF EPM The symptoms I see with my equine patients in Texas include: • hind limb weakness • problems with proprioception • performance problems
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• gait abnormalities • un-coordination • stiffness • head tilt • general ataxia • extreme irritability for no reason. My differential diagnosis includes wobbler syndrome, trauma, equine herpesvirus myeloencephalopathy, equine degenerative myelopathy, and West Nile Encephalomyelitis. Over 85% of the horses test positive for antibodies to EPM, but many do not show any symptoms, or at least none recognized by their owners. Perhaps some were a little “off” for a week or two while their immune systems produced antibodies; or perhaps they were strong enough to mount an immediate response when the protozoa were introduced into their bodies.
HOW EPM DEVELOPS The life cycle of the sporocyst is complicated. Briefly, it involves many intermediate hosts (domestic cat, raccoon, skunk, armadillo, other mammals, and maybe even passerine birds and sea otters) who are then ingested, often as “road kill”, by opossums. The opossum is the definitive host (reservoir) in which the sporocyst develops. This animal excretes both oocysts and sporocysts (environmentally resistant stage) in its feces. Horses are subsequently infected when they eat feed or water contaminated with sporocysts from opossum feces. The horse itself is a dead-end host, and does not pass sporocysts in his manure. The sporocysts in his body migrate from the GI tract into the bloodstream, where they can cross the blood/brain barrier into the CSF. This means that an infected horse cannot infect another horse. The infected horse can show symptoms immediately after exposure, or can harbor the organism for months and develop signs at a later date, often during periods of stress.
IS ENVIRONMENTAL PREVENTION POSSIBLE? Except for the horse, most of the animals involved in the life cycle of EPM are scavengers, and will eat any dead animal. One way for owners to protect their horses is to keep feed locked up in a manner that prevents feces from getting into it. Cats see stalls as giant litter boxes, so this poses the question about whether or not to keep barn cats to control mouse populations. There is really no reasonable way to protect pastures from the feces of these animals. I have heard of giant vacuum cleaners being used in pastures, but this is not very practical for most horse owners. One thing horse owners can and should do is pick up any dead animals they find in their pastures.
CONCURRENT PARASITISM Most horses who come down with EPM have weakened immune systems. This allows the protozoa to enter the CNS and cause inflammation. In Texas, one condition that weakens the immune system involves an abundance of L4 strongyle larvae at the anterior mesenteric artery. Our Texas climate does not desiccate the eggs with heat, nor freeze them with cold, and this results in a huge parasite problem. On osteopathic diagnosis, these horses will be stiffer on the right side of their spines, moreso than a horse with just EPM. They will still have the same reaction to a hand squeeze across the front of the atlas, dropping the head ventrally and rotating to the side. I always question owners about the deworming status of their horses. It is my belief that Texas and Florida cannot follow AAEP guidelines for using fecal egg counts to determine which horses need a de-wormer. In Texas, many horses are kept on small pastures where strongyle eggs could be high in number. Since it can take six to seven months for the eggs to develop into egg-laying worms, the L4 larvae have plenty of time to accumulate and do damage to the tissue around the anterior mesenteric artery while the horses maintain a low egg count in their feces.
CONVENTIONAL TREATMENTS There is no vaccine for EPM. Conventionally, horses are treated with Ponazuril (Marquis), Pyrimethamine-Sulfadiazine products, and Diclazuril. Like me, many of you probably remember treating horses 20 years ago with Diclazuril bagged up to be added to chicken feed. It now comes in many new packages, with many new names, but it is the same ingredient. I have not had much luck with any of these treatments lasting more than about four months without a relapse. Some farms use these products as a preventative, but what is this longterm treatment doing to the horses? I am certain it creates gastrointestinal imbalances over time, thus weakening the animals’ immune systems. Continued on page 52. IVC Summer 2017
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LIFE CYCLE OF SARCOCYSTIC NEURONA Intermediate hosts:
Armadillo, striped skunk, raccoon, cat and others
Definitive host:
Opossum
Sarcosyst in skeletal muscle
Dead end host: Horse
Lesions can occur in the spinal cord and brain
Ingests feed or water contaminated with the sporocysts.
Infective sporocyst in feces
Sexual reproduction in digestive tract (intestinal epithelium)
Continued from page 51.
INTEGRATIVE DIAGNOSIS Diagnosing EPM early, and then improving the immune system, is the best way to prevent serious symptoms. Treating EPM when it’s first entering the horse, before the protozoa can damage the neurological system, is preferable. I diagnose EPM using osteopathy. A horse with EPM will first present with performance problems, such as not getting to the bottom of their stops, not sitting at their barrels, being clumsy or irritable, hitting jumps, showing hind limb instability, difficulty with proprioception, or an inability to engage their backs, etc. When I examine the spines of these horses in an osteopathic manner, one side will be very flexible, actually too flexible, and the other side very stiff. If I find this on an osteopathic exam, I put EPM in my differential diagnosis. Horses suffering from an inflammation of the spinal cord associated with EPM will be painful between CO and C1. If I squeeze that area with my hand, the horse will duck his head
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and twist it to one side. These horses are often positive on a tail pull, giving to one or both sides. Additionally, I almost always see atrophy of the postural muscles. These horses appear thin at first, but when you evaluate them, you find an atrophy of the postural muscles (often the gluteals and quadriceps). To confirm my preliminary diagnosis, I prefer to use the Indirect Fluorescent Antibody test (IFAT), offered at UC Davis. Some clinics prefer to submit both blood and CSF, measuring the ratio of antibody in the blood to that in the CSF. Using this osteopathic preliminary diagnosis, and a positive IFAT test, I can be relatively certain that the horse has EPM. I have treated over 300 cases of EPM in this manner, mostly diagnosing them with my osteopathic techniques.
TREATMENT SCHEDULE I begin treating a horse with EPM and L4 larvae at the anterior mesenteric artery (see sidebar on page 51) with a commercial de-wormer. If he does not have a history of de-worming within
PREVENT EPM WITH A STRONG IMMUNE SYSTEM A strong, healthy immune system will help protect horses from contracting EPM. Keeping my client horses on Chlorella (species vulgaris, broken cell wall) helps remove heavy metals from their systems and provides them with a healthy food source. The more stress a horse is under, the more likely he is to have a weakened immune system. I see more cases of EPM in young horses who are just going into training and dealing with the stress of leaving home and being trained; and in performance horses that travel a lot. I like to keep these horses on the immune and digestive health booster, Karbo Combo. It comes as a small pellet that is fed in small amounts every day. All methods that maximize health will decrease the risk of neurological EPM – a high quality diet, fewer chemicals, stress management with appropriate time outdoors or a decreased show schedule, regular osteopathic treatments, etc.
When a horse presents with a mild case of EPM, is not in a stressful situation, and has a history of regular deworming, I begin with Karbo Pellets and Epic Liquid. I feed two scoops of the pellets and 60cc of the liquid two times a day for three months. If the horse is in a stressful situation, or the EPM is coming in fast and strong, I will add a product called Sefacon for ten days. The horse is usually very improved by the end of three weeks. It is very important to treat the horse with sufficient Sefacon for his weight. I will use double doses in a large horse (over 1,200lb). If the horse is already very ataxic and wobbly, I begin with Marquis to kill off some of the protozoa as quickly as possible before I start my regular treatment. I have not seen much true cure with Marquis. Often, the horse will get better for around four months, then relapse, or never return to his previous level of performance. My method of treatment allows for early diagnosis, so the horses return to their previous levels of performance. For those interested in pursuing osteopathy (which I highly recommend as it’s the best tool in my toolbox) visit vluggeninstitute.com. Janek Vluggen teaches equine osteopathy at my clinic in San Marcos, Texas.
the past four months, my recommendation is to begin with a dose of Ivermectin. Because Ivermectin causes a slow kill, it will prevent a worm impaction if the horse has a large number of worms. Three weeks later, I move forward with the rest of my L4 larvae protocol:
1. Because of the EPM, I also immediately start the horse on an immune system booster called Karbo Pellets, and another called Epic Liquid (from Gomer’s Inc). They feature some components that help with the digestive system as well.
2. I use a Panacur Powerpak with sufficient dosage for the horse’s weight. Ideally, this paralyzes the L4 larvae but does not kill them. This is a daily double dose of fenbendazole for five days in a row.
3. Next, I wait ten days to allow the horse to recover from the Panacur. Then I administer Quest Plus in an amount equal to the horse’s weight. Quest Plus enters the bloodstream and kills the L4 larvae that are already paralyzed and unable to move away from the blood vessels carrying the chemical.
4. After waiting ten more days, a regular Quest is administered to ensure as many L4 larvae as possible are eliminated.
5. After the last dose of de-wormer, I recommend waiting at least five days before starting Sefacon, an equine herbal health supplement that actually kills the protozoa (Endocrine Technologies).
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From the AHVMA The mindful leader elevating the veterinary profession through innovation, education and advocacy of integrative medicine.
Mark your calendars! This year’s AHVMA Annual Conference will take place in San Diego, California, from October 21 to 24. The keynote speaker, Dr. Ihor Basko, will share personal experiences from his decades in veterinary medicine. Dr. Erin Bannink returns with updates on informed integrative management in cancer treatment, while Dr. Bill Bengston will discuss a variety of healing with intent experiments, effects and techniques. Additional topics featured at this year’s conference include Traditional Chinese Veterinary Medicine, the Microbiome and Herbal Medicine. Introductory talks are offered on many major modalities. Even if you are new to holistic medicine, you will acquire a wealth of practical knowledge, and learn how you can integrate holistic modalities into your own practice. The AHVMA is launching “Lunch & Learn” meetings at this year’s conference. These meetings, sponsored by individual exhibitors, allow for a more relaxed lunch, away from the hustle and bustle of the exhibits. Attendees will learn about each host’s newest products and services while enjoying a sit-down lunch. Pre-registration is required since space is limited.
AHVMF SILENT AUCTION
The Silent Auction is held during the AHVMA Annual Banquet. Auction items range from handmade jewelry to vacation getaways. Proceeds benefit veterinary students interested in Integrative Veterinary Medicine. For donation information, visit AHVMF.org.
POST-CONFERENCE RETREAT
This year’s post-conference retreat runs from late afternoon on October 24 to noon on October 27 and takes place at Camp Stevens in Julian, California, 65 miles northeast of San Diego. This serene setting will be host to a variety of programs to help rejuvenate your mind, body, and spirit. The retreat’s positive effects may change your view of what is important in your life. Registration is on the conference attendee form – again, space is limited.
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GROWING PAINS AND THE 2018 CONFERENCE
AHVMA is growing in terms of membership, programs, activities and influence. Along with this positive growth come several challenges, not the least of which is planning for our conferences and selecting sites that meet our changing needs. We are growing too large for all but a handful of hotels, but are not yet large enough to afford large convention centers. Next year and beyond will see us transition to a larger “conference hotel” that includes enough sleeping rooms for our group, as well as enough meeting space for all our programs. Looking ahead, the 2018 Conference will take place at the Gaylord Palms in Kissimmee, Florida, from October 4 to 7. Plan for a fantastic experience! Stay an extra day to reconnect with friends, relax by the pool or explore nearby attractions.
LEADERSHIP DEVELOPMENT
AHVMA is working to develop strong leadership. If you are a Member Veterinarian and would like to serve on a volunteer committee, send a brief bio and statement of interest to office@ahvma.org. Please include any experience or special skills that would make you an exceptional candidate for consideration. Recent graduates with university or community leadership experience are encouraged to begin their AHVMA leadership journey. For more information, visit ahvma.org.
From the VBMA 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? Sumach (Rhus aromatic) has been widely used as a condiment in Middle Eastern cooking, and as a foraged drink substitute. Fragrant, smooth and staghorm sumach all have similar indications. According to Matt Wood, sumach is the superlative remedy for excessive flux from any channel of elimination – skin, kidneys, colon or lungs. It is indicated for debilitating fluid losses. Phyllis Light states that sumach is very useful for “kidney anemia”. It strengthens the kidney, helping it retain water in both diabetes insipidus and diabetes mellitus type II, in which it also helps the cells absorb blood sugar, stabilizing blood sugar levels. It has been used for dribbling urine and lack of urine retention. Sumach acts on vasopressin and has a profound influence on high blood pressure. It is indicated when excessive saliva stimulates a “drippy cough”. The tongue is often dry in the center and wet on the edges, indicating that the core is drying out as fluids are being lost. Upland sumach (Rhus glabrum) exerts a direct influence on the processes of waste and repair. It is useful for some cases of protracted dysentery and diarrhea with debilitated mucous surfaces. It has been found to be useful in atonic ulcerations of the stomach and intestinal canal, as well as in all affections in which a relaxed condition of mucous membranes is a prominent feature. It is a diuretic, antiseptic, refrigerant, tonic and astringent, and is indicated in the putrescence of excretions, with a tendency to ulceration, as in typhus and typhoid fevers, diarrhea, dysentery and leucorrhea.
albuminuria, and high normal creatinine. Red had been treated with a variety of herbal formulas, with modest improvement. His winter pasture area had a large number of staghorn sumach (Rhus typhina) in it. Red was seen eating large numbers of the berries, after which he dramatically improved. His edema totally resolved and there was a big improvement in his blood protein and RBC level.
SUPPORT HERBAL MEDICINE You have until September 1 to write your letters in support of herbal medicine becoming a specialty in the AVMA. The following from the solicitation for public opinion may help you craft your letter, as will samples at ahvmf.org and additional information at ACVBM.org: The value of a specialty in veterinary botanical medicine is confirmed by the fact that herbal therapy is one of the most common topics offered in CAVM courses at veterinary schools. Faculty members with training in botanical medicine are increasing, externship sites for 18 veterinary schools use botanical medicine, and it is included in most national veterinary conferences, including those of ABVS-recognized specialty organizations. For VBMA conferences and webinars, visit vbma.org.
NAME THIS HERB!
CASE REPORT Red is a 24-year-old Appendix Quarter Horse gelding who tested positive for Lyme disease, and had symptoms compatible with protein-losing nephropathy. He presented with a 4” deep plaque of ventral edema that extended from his girth area to his prepuce; and with anemia, neutropenia, low blood albumin,
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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INTEGRATIVE APPROACH TO DERMATOLOGICAL PROBLEMS IN PETS By Ronald B. Koh, DVM, MS, CVA, CVCH, CVFT, CCRP Integrative therapies for skin disorders in pets encompass many treatment modalities. These include, but are not limited to, Traditional Chinese Veterinary Medicine (acupuncture, Chinese herbs and food therapy), laser, homeopathy, Western herbs, nutraceuticals, essential oils, and hyperbaric oxygen therapy. In general, it may take a combination of treatments to manage a patient’s skin disorders. It is important to have patience when treating skin problems, especially if the condition is chronic and severe. This article reviews common integrative modalities with a focus on Traditional Chinese Veterinary Medicine for treating inflammation and pruritus of the skin in pets.
Skin problems in pets The skin is the largest body organ and serves as a protective barrier against harmful effects from the environment. Many internal imbalances manifest in the skin. When a pet’s skin is
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healthy, the client rarely thinks about it, but when problems occur, they can take a serious toll on the animal’s health. In veterinary practice, skin diseases, including food allergies, atopy, ear infection, and auto-immune dermatitis, are the most challenging problems to treat. Pruritus (itching of the skin) is the most common clinical sign associated with skin disease, and it can cause serious disruptions to the pet’s wellbeing. It can also cause significant distress in the owner.1 Although Western medication will help relieve skin itch and inflammation, effective long-term control of pruritus is often not achieved.2 As well, some medications could potentially cause undesirable adverse effects.3 Both pet owners and veterinarians recognize a need for additional safe and efficacious therapeutic options to treat skin disease – especially complementary and integrative therapies.
Traditional Chinese Veterinary Medicine (TCVM)
Herbals
TCVM, which uses acupuncture combined with herbal medicine and food therapy, seems to be effective for treating various skin disorders in animal patients. It stresses the importance of catering therapy to the needs of each individual, unlike Western therapeutic approaches that are standardized for all patients.
Herbals are a rich source of active ingredients and can be effective for the treatment for different skin diseases. Recent research indicates that some herbs offer considerable medicinal benefits. Herbal substances can possess an anti-inflammatory action by inhibiting the formation of cytokines and eicosanoids, and inflammatory reaction cascade.7 A few randomized, controlled trials have demonstrated significant results in the use of herbal therapies for the treatment of dermatologic disorders in humans and dogs.8-11
In TCVM, external pathological factors such as Wind, Dampness, Dryness or Heat can invade the body and cause skin disorders. Internal imbalances are differentiated into patterns such as Blood Stagnation, Disharmony of Liver and Kidney, or Blood Deficiency, and are often reflected in skin disorders. When skin problems are generated by internal imbalance, the underlying problem must be addressed in order to clear up the surface manifestation and prevent future problems. The pattern diagnosed will determine the best mode of treatment using herbs, acupuncture and diet therapy.
While most herbs are generally considered safe, many can be quite toxic if taken incorrectly. It is recommended that herbs only be used under the direct recommendation and supervision of a certified veterinary herbalist. Followings are some acupuncture and Chinese herbal medicine treatment methods for skin problems:12-15
Acupuncture
B Wind-Heat
Acupuncture (which includes dry needling, aquapuncture, electro-acupuncture, acupressure, moxibustion, and laser application) aims to restore the body’s natural balance by stimulating homeostasis.
Patients with a Wind-Heat pattern tend to be worse in the spring and summer, have dry hair coat and skin, and are often thirsty and cool-seeking. Most often, these are young to middle-aged individuals with allergic hypersensitivities
In humans, the meta-analysis demonstrates acupuncture’s potential for the treatment of dermatological conditions in achieving positive patient outcomes, including dermatitis, urticaria, chloasma, pruritus and hyperhidrosis, compared with placebo acupuncture, alternative treatment options, and no intervention.4 In dogs, acupuncture has been shown to enhance the efficacy of antibiotics treatment for otitis.5 At one-year follow-up, 93% of the dogs that received acupuncture did not have recurrent disease, compared with the 50% that received placebo acupuncture.6 While the exact mechanism remains unclear, studies have shown that acupuncture can exert anti-inflammatory effects through a complex neuro-endocrino-immunological network of actions, including inhibition of histamines and down-regulation of pro-inflammatory cytokines, neuropeptides and neurotrophins that enhance and prolong inflammatory response in the body. Acupuncture is well tolerated by most animals and is generally safe with no to mild side effects when performed by a certified veterinary acupuncturist. Typically, six to ten acupuncture treatments are needed in a short period, initially, after which the spacing of sessions may be lengthened once the skin condition has improved. Some patients may require long-term therapy with acupuncture. IVC Summer 2017
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OTHER INTEGRATIVE THERAPIES a) L aser therapy, with 630nm (red) and 830nm (near infrared) wavelengths, appears to have a wide range of applications for skin conditions, especially where the stimulation of healing, reduction of inflammation and cell death, and skin rejuvenation are required.16 Laser therapy at 808nm once a day for five days significantly improved pyogranulomatous pododermatitis in dogs even at two months of follow-up.17 b) Homeopathy may offer an effective and side effectfree treatment for various skin conditions, especially seborrheic, atopic and auto-immune dermatitis. It may help reduce pruritus, and in some cases showed complete resolution of the skin condition, allowing for the discontinuation of conventional treatments.18 c) T opical administration of essential oils and fatty acids, either as a daily spray (Dermoscent Atop 7) or a weekly spot-on (Dermoscent Essential 6) has shown to decrease pruritus in canine atopic dermatitis.19 d) H yperbaric Oxygen Therapy was reported to successfully treat some inflammatory diseases, including atopic dermatitis, implying that HBOT may exert immuneregulatory effects in skin diseases (for general discussion of HBOT, see the Winter 2015 issue of IVC Journal).20 e) O mega 3 fatty acids have anti-inflammatory effects and are shown to have beneficial effects in various skin diseases. DHA and EPA inhibit the activation of proinflammatory cell signals, and reduce the leukotrienes and prostaglandins that play a role in dermatitis.21 f) P robiotic supplementation (bifidobacteria and lactobacillus) could be considered an integral part of the multimodal therapy for the long-term efficient management of canine atopic dermatitis22 by modulating the immune response and mitigating allergic reactions.23 g) A ntioxidants and flavonoids, found in dark berries and some plants, protect against free radical damage, have anti-inflammatory properties, strengthen connective tissue, and may help reduce allergic reactions.23 Antioxidant agents to be considered include melatonin and vitamins A, C, D and E.23 Melatonin can be used to facilitate a better night’s sleep and to reduce skin inflammation. Vitamin A is involved in the growth and repair of epithelial cells. Vitamin C is vital for the production of collagen and can act as an antihistamine. Vitamin D helps boost immunity and heal damaged tissues. Vitamin E removes free radicals and helps ease dryness. Quercetin, a naturally-occurring polyphenol, shows antioxidant, anti-inflammatory and anti-allergic activities for atopic dermatitis.24 h) Bovine colostrum, rich in immunoglobulins, growth factors and other active compounds that stimulate the immune system, has been used anecdotally to successfully treat various skin conditions in animals.
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and atopic dermatitis. Violent scratching may cause oozing blood and crust formation. The tongue is red and dry, and the pulse is superficial, wiry and rapid. Treatment principles: Clear Heat, cool Blood, eliminate Wind to stop itching. Acupoints: LI-4, LI-11, TH-5, GB-20, GV-14, SP-10, Er-jian. Formula: Xiao Feng San or Wind Toxin. Dose at 0.5 gm per ten pounds orally twice daily. Food therapy:* Cooling foods such as duck, rabbit, turkey, white fish, broccoli, celery, cucumbers, kelp, spinach, watermelon, bananas, blueberries, brown rice and tofu. Avoid warm and hot foods such as chicken, lamb, venison, ginger, pumpkin, oats and white rice.
C Damp-Heat The Damp-Heat pattern is commonly seen in warm humid climates and is often exacerbated during periods of high humidity. Patients often have greasy, malodorous, sebaceous or waxy exudates from the skin or ears. Most often, these cases have localized or generalized skin papules/pustules, pyodermatitis, wet hot spots, or chronic otitis. They are also cool-seeking, restless, have a red tongue with a yellow greasy coating, and a fast and forceful pulse. Treatment principles: Clear Heat, eliminate Damp, and stop itching. Acupoints: LI-4, LI-11, GB-34, GB-41, SP-6, SP-9, ST-40. Formula: Long Dan Xie Gan Tang, Qing Shi Re Tang or Damp Heat Skin for generalized skin lesions; Si Miao San or Lower Jiao Damp Heat for lesions around lower jiao, flank and genitals; Four Paws Damp Heat for lesions on paws; Qing Er Tang or Ear Damp Heat for otitis. Dose at 0.5 gm per ten pounds orally twice daily. Food therapy:* Cooling foods as mentioned above; also add foods that eliminate Dampness such as barley, celery, kidney beans, mushrooms and turnip. Avoid fatty, oily, sweet, high carbohydrate and dairy foods because they can lead to Damp.
D Blood Heat Blood Heat is often due to chronic Blood Stagnation in chronic skin disease. Heat is accumulated when Blood becomes stagnant and results in abnormal skin manifestations, such as red spots, ulcerations, crusting, erythema, depigmentation, bruising or blood spots under the skin without an obvious reason. This pattern is often seen in patients with immune-mediated dermatologic disorders. The tongue is red or purple, or has red or purple spots on it, sublingual veins may tend to be purple, and the pulse is rapid and surging. Treatment principles: Clear Heat and invigorate Blood to expel Stagnation. Acupoints: SP-6, SP-10, PC-4, LI-4, LIV-3, BL-17. Formula: Liang Xue Jie Du or Blood Heat Formula. Add Mu Dan Pi if Blood stagnation is severe. Dose at 0.5 gm per ten pounds orally twice daily. Continued on page 60.
CASE STUDY: An 11-year-old, neutered male, domestic short hair cat presented with five-year atopic dermatitis and extremely itchy and inflamed skin, causing redness, crusting, scaling, and alopecia (A). Conventional medicine was of little or no avail. Based on TCVM, a pattern of Damp-Heat was diagnosed. Two months after bi-weekly acupuncture, a Cooling wet diet, and daily oral supplementation of Long Dan Xie Gan Tang, Omega-3 fatty acids, and probiotics, the cat showed marked improvement (B). Same cat receiving acupuncture treatment (C).
A
C
B
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Continued from page 58. Food therapy:* Cooling foods as mentioned previously; also add foods that help resolve Stagnation, such as ginger, vinegar, turmeric, celery, eggplant, shiitake, hawthorn berry, and pepper. Avoid cold and raw foods as they would stagnate circulation.
E Liver and Kidney Yin deficiency Yin deficiency in the Kidney and Liver is commonly seen in chronic skin disorders, especially in geriatric animals. It is often characterized by itching that’s worse at night and in the summer, dry skin with small dandruff, alopecia, excessive panting, coolseeking behavior, anxiety and restlessness, especially at night. The tongue is red, dry with a thin or no coating, and the pulse is deep, thready, and rapid (weaker on the left side). Treatment principles: Nourish Yin, Kidney and Liver. Acupoints: KID-3, SP-6, LIV-8, BL-18, BL-23. Formula: Yang Yin Zhi Yang or Zhi Bai Di Huang. Dose at 0.5 gm per ten pounds orally twice daily. Food therapy:* Cooling foods as mentioned previously; add Yin tonic foods, such as tofu, black beans, kidney beans, honey, asparagus, spinach and tomato. Avoid warm and hot foods such as chicken, lamb, venison, ginger, pumpkin, oats and white rice.
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F Liver Blood deficiency Liver Blood nourishes and moistens the skin and a deficiency is often at the root of many skin diseases. Liver Blood deficiency is also commonly a result of deficient Liver and/or Kidney Yin. When Liver Blood is deficient, “Wind” can form in the skin, resulting in itching and skin lesions that suddenly appear or disappear or that move from place to place. It also causes a dry brittle hair coat and skin with dandruff, alopecia, and cracked nails or hooves. The patient has a pale dry tongue and a pulse that is deep, thready and weak (weaker on the left side). Treatment principles: Nourish Blood and Liver. Acupoints: SP-10, BL-17, ST-36, BL-18, LIV-8. Formula: Si Wu Xiao Feng or Yang Xue Qu Feng Tang. Dose at 0.5 gm per ten pounds orally twice daily. Food therapy:* Blood tonic foods such as beef, liver, heart, pork skin, sardines, salmon, eggs, carrots, kidney beans, black beans, beets, parsley, dates. Avoid cooling and raw foods. *All food therapy must be formulated by a veterinarian or veterinary nutritionist to meet the individual patient’s nutritional needs.
In summary, integrative medicine can be an excellent adjunctive or primary therapy for dermatologic disease, especially in chronic cases unresponsive to conventional therapy. In addition, integrative modalities such as TCVM can also help restore the body’s balance, offering a more permanent resolution to chronic cases. Nevertheless, there is a need for more research to evaluate and confirm the efficiency and safety of various integrative therapies.
1
Halliwell RE, Schwartzman RM. “Atopic disease in the dog”. Vet Rec 1971;89: 209–14.
2
Scott DW, Miller WH, Griffin CE. “Skin immune system and allergic skin disease”. In: Muller and Kirk’s Small Animal Dermatology. Philadelphia: WB Saunders; 2001. p. 543-666.
3
Paradis M, Scott DW, Giroux D. “Further investigations on the use of nonsteroidal and steroidal antiinflammatory agents in the management of canine pruritus”. J Am Anim Hosp Assoc 1991;27:44–8.
4
Ma C, Sivamani RK. “Acupuncture as a Treatment Modality in Dermatology: A Systematic Review”. J Altern Complement Med. 2015 Sep;21(9):520–9.
5
Sa ‘nchez-Araujo M, Puchi A. “Acupuncture prevents relapses of recurrent otitis in dogs: a 1-year follow-up of a randomised controlled trial”. Acupunct Med 2011; 29:21–6.
6
McDonald JL, Cripps AW, Smith PK, Smith CA, Xue CC, Golianu B. “The anti-inflammatory effects of acupuncture and their relevance to allergic rhinitis: a narrative review and proposed model”. Evid Based Complement Alternat Med. 2013;2013:591796.
7
Xu XJ, Banerjee P, Rustin MH, Poulter LW. “Modulation by Chinese herbal therapy of immune mechanisms in the skin of patients with atopic eczema”. Br J Dermatol. 1997 Jan;136(1):54–9.
8
Sheehan MP, Atherton DJ. “A controlled trial of traditional Chinese medicinal plants in widespread nonexudative atopic eczema. Br J Dermatol 1992;126: 179-84.
9
Sheehan MP, Rustin MH, Atherton DJ, et al. “Efficacy of a traditional Chinese herbal therapy in adult atopic dermatitis”. Lancet 1992;340:13–7. Nagel TM, Torres SM, Horne KL, et al. “A randomized, double-blind, placebo- controlled trial to investigate the efficacy and safety of a Chinese herbal product (P07P) for the treatment of canine atopic dermatitis”. Vet Dermatol 2001;12: 265-74.
10
Ferguson EA, Littlewood JD, Carlotti DN, et al. “Management of canine atopic dermatitis using the plant extract PYM00217: a randomized, double-blind, placebo-controlled clinical study”. Vet Dermatol 2006;17:236-43.
11
De-Hui S, Xiu-Fen W, Wang N. Manual of Dermatology in Chinese Medicine. Seattle, WA. Eastland Press 1995:1–50.
12
Yan Zhou-Ping, Liu Dai-Hong. Zhong Yi Pi Fu Bing Zhi Liao Xue. Chinese Medicine for Dermatology. Beijing, China. China Traditional China Medicine Publisher 2011:18-42.
13
Huisheng Xie. Chinese Veterinary Herbal Handbook (2nd edition). Reddick, FL. Jing Tang Publishing 2008:36–7.
14
Xie H, Priest V. Xie’s Veterinary Acupuncture. Ames, Iowa: Blackwell Publishing 2007:316–8.
15
Avci P, Gupta A, Sadasivam M, Vecchio D, Pam Z, Pam N, Hamblin MR. “Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring”. Semin Cutan Med Surg. 2013 Mar;32(1):41-52.
16
Perego R, Proverbio D, Zuccaro A, Spada E. Low-level laser therapy: Case-control study in dogs with sterile pyogranulomatous pododermatitis. Vet World. 2016 Aug;9(8):882–7.
17
Hill PB, Hoare J, Lau-Gillard P, et al. “Pilot study of the effect of individualized homeopathy on the pruritus associated with atopic dermatitis in dogs”. Vet Rec 2009;164:364–70.
CONFORMATION vs. STRUCTURAL ALTERATIONS By William L. Schmidt, DC
After 25 years on the racetrack, I have found that most people, owners and trainers alike, cannot tell the difference between conformation and structural alterations in their horses. Conformation is one thing and involves genetics. Structural alteration is another thing entirely and is due to pain, or causing pain. Watching a horse’s movement is an integral part of determining structural alterations as well as certain types of injury. You may notice there is an alteration in the function of the skeletal system and supporting soft tissue. It’s important to learn how to recognize and diagnosis the different types of alterations. A horse that has a deviated sternum either to the left or right will have a hollowed-looking spine between his withers and pelvis. Many times the ribs will be prominent, as if the horse is underfed. One cause of sternal deviation is riding “acey deucey” (one iron lower). This will always cause deviation and pain, then alter the horse’s gait, affect his breathing and his ability to turn his neck left or right, or to change leads. Girth edema and cinchiness can also develop. Correcting these structural alterations will undoubtedly improve the horse’s conformational appearance.
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Tretter S, Mueller RS. “The influence of topical unsaturated fatty acids and essential oils on normal and atopic dogs”. J Am Anim Hosp Assoc. 2011 Jul-Aug;47(4):236–40.
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Kim HR, Kim JH, Choi EJ, et al. “Hyperoxygenation attenuated a murine model of atopic dermatitis through raising skin level of ROS”. PLoS One. 2014 Oct 2;9(10):e109297.
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Mueller RS, Fieseler KV, Fettman MJ, et al. “Effect of omega-3 fatty acids on canine atopic dermatitis”. J Small Anim Pract. 2004 Jun;45(6):293–7.
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Marsella R, Santoro D, Ahrens K. “Early exposure to probiotics in a canine model of atopic dermatitis has long-term clinical and immunological effects”. Vet Immunol Immunopathol. 2012 Apr 15;146(2):185–9.
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“A double-blind, placebo controlled-trial of a probiotic strain Lactobacillus sakei Probio-65 for the prevention of canine atopic dermatitis”. J Microbiol Biotechnol. 2015 Nov;25(11):1966–9.
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If the horse has an injury, you need to know. Otherwise, you have to work with what you have, while knowing that conformation is not the entire story. Dr. William Schmidt is a 1967 graduate of the National College of Chiropractic in Lombard, Illinois, and holds certification in Animal Chiropractic from the American Veterinary Chiropractic Association. He has been adjusting animals, particularly thoroughbreds, for 25 years. Dr. Schmidt has written four books on animal chiropractic.
Ji H, Li XK. “Oxidative Stress in Atopic Dermatitis”. Oxid Med Cell Longev. 2016;2016:2721469.
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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 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.
DID YOU NAME THE OIL DISTILLED FROM THE PLANT PICTURED IN THE LAST ISSUE? It was Lavandula angustifolia, often called the Swiss Army knife of oils because it is so versatile. Lavender is commonly diffused for relaxation. The fragrance has an emotionally calming impact and the oil is soothing when applied to the skin. It’s a useful topical thanks to its natural chemistry of linalool and linalyl acetate. Remember that all topical oils used on animals need to be safe to ingest.
CHASER – A CASE REPORT
– Dr. Barbara Fox, Beyond Tradition Animal Healing Center, Wadena, Iowa. Chaser, a seven-year old Arabian gelding, was successfully treated for a chronic injury to his left rear suspensory ligament. The injury had initially been misdiagnosed as degenerative suspensory ligament desmitis (DSLD). Symptoms included significant swelling proximal to the metatarsophalangeal joint, weakness in the limb, and heat in the area of the sesamoids. Details of the injury were not available; however, it appeared that an entrapment injury may have occurred due to the scarring on the front of Chaser’s leg. He had been confined to stall rest for the past year, with five minutes of hand-walking per day. Chaser’s new treatment approach included essential oils of wintergreen, peppermint, copaiba, cypress and lemongrass, combined and applied three times daily, undiluted, over the metatarsophalangeal joint. A prescription-grade joint supplement containing glucosamine (four types), chondroitin sulfate, potassium citrate, ascorbic acid, a proprietary blend of green chlorella, and licorice root extract was given once daily in one pound of straight oats. A loose mineral mixture was offered free-choice, along with hay containing one-third alfalfa and two-thirds quality pasture grass. For the first two weeks, Chaser was turned out in a large round pen to regain his muscle strength; he was then given full turnout.
NEWS AND NOTES • April 22, 2017 – VMAA board members convened in Nephi, Utah to host a Meet and Mingle for essential oil enthusiasts. Member authors were available for book signing and sales. Dr. Nancy Brandt, VMAA Founder, answered questions about oils for first aid and her online certification course. Dr. Richard Palmquist met with several VMAA board members to discuss essential oil research options. • October 2017 – Check out the VMAA Exhibit Booth and Annual Meeting at the AHVMA Conference in San Diego. • February 2018 – The VMAA Summit in Las Vegas, NV is tentatively scheduled for February 23 to 25. Express your interest at facebook.com/vmaa.vet. For more information on educational courses, discounted classes, conferences, online webinars, and for an informative newsletter, visit vmaa.net.
Name the oil distilled from this plant! The answer will appear in the next issue.
One month later, Chaser was rideable and showed no signs of weakness, lameness or pain.
If you have an essential oils success story of your own, email docjodie@animaldoctorholistic.com.
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FROM THE AAVA The American Academy of Veterinary Acupuncture is committed to improving animal health care by the advancement of veterinary acupuncture, Traditional Chinese Veterinary Medicine and Traditional Asian Veterinary Medicine, through education, research and leadership.
Our annual meeting from March 24 to 26 was very well received. The city of Savannah was most accommodating and friendly. The programs were varied and included: • Acupuncture in zoo medicine • Food therapy for different syndromes • Herbal support for patients • Tui Na therapy • Acupuncture for rehabilitating injured animals • Electro-acupuncture for horses, based on evaluating upper body lameness instead of meridian-based acupuncture • How to integrate acupuncture into veterinary practice for upper level sport horses • Evaluation and rehabilitation of neck and back pain • Acupuncture use on the Iditarod trail • Laser therapy for equine back pain We instituted our first two “Table Top Lectures”, which were also very well received. Many of these lectures reinforced the “treat the whole animal” approach that most of us in acupuncture/integrative medicine have taken. We must feed the patient properly, exercise him properly, and rehabilitate his injuries by treating the whole animal. It was wonderful to see lectures from different certification programs and university staff. We are all different yet all on the same mission of “healing our patients”.
NEW MEMBER ON BOARD OF DIRECTORS Michelle Tilghman, DVM, is our newly elected member to the Board of Directors. Michelle lectures extensively throughout the country on acupuncture and rehabilitation for companion
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animals. She complements the other board members who include Lynelle Graham (Vice President), Keum Hwa Choi (immediate Past President), Mili Bass (Secretary/Treasurer) and Robert Schwyzer, Carol Grifford and Kevin May.
ADDITIONAL NEWS AAVA has already accomplished several important things since our annual meeting. First and foremost, we have satisfied the requirements to maintain our seat on the AVMA. Big thanks go to the Chi Institute, as their support in this very important endeavor was critical. Having a seat on the AVMA gives acupuncture credibility, as well as a giving us a chance to make friends and alliances for our future goal of having acupuncture accepted as a Specialty Board. We also approved a hands-on “Wet Lab” for equine practitioners on June 24 at the Aiken Horse Rescue in Aiken, South Carolina. Dr. Chris Cahill, a renowned veterinary acupuncturist and a past president of the AAVA, will be the presenter. Dr. Cahill has an acupuncture practice in Lexington, Kentucky where he has worked on many top Thoroughbred horses, both on the racetrack and in the breeding shed. He brings over 35 years of practical experience with acupuncture to share with us. For more information, go to aava.org. During my (Dr. Maurice Casey) tenure as President, one of our main goals is to see the AAVA become the “umbrella organization” for all US veterinary acupuncturists, regardless of their certification or training. We welcome IVAS, Chi Institute and MAV graduates to our organization and annual meetings, and invite you to submit papers for the 2018 annual meeting, to be held next April 13 to 15 in Santa Fe, New Mexico.
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events
To post your event, email us at: info@IVCJournal.com
Pacific Veterinary Conference
CVC Conference for Veterinary Care
Join us under the sun at a world-class destination while earning continuing education units and listening to the veterinary profession’s best speakers. Explore a four-day Vet Expo with the latest innovations from the veterinary industry, mingle with future colleagues, and discover the city in your downtime! We want to see you in Long Beach for #PacVet2017.
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 profession’s most highly regarded educators.
For more information: (800) 655-2862 info@pacvet.net www.pacvet.net
Offered at 3 convenient locations annually: Washington (DC), Kansas City, and San Diego.
June 29—July 2, 2017 – Long Beach, CA
August 25—28, 2017 – Kansas City, MO
For more information: (800) 255-6864 cvc@ubm.com www.thecvc.com
2017 CVMA Convention
July 13—16, 2017 – Charlottetown, PEI The 2017 Convention, in collaboration with the Atlantic Veterinary College and the Registered Veterinary Technologists and Technicians of Canada, offers four days’ worth of sessions in wet labs, and concurrent sessions exploring companion animal, ruminant, equine, practice management and animal welfare issues. Over 40 speakers and up to 127 RACE-accredited hours of CE. Continue your learning journey by wandering through the lanes of our exhibit hall to discover state-of-the-art products and services, in addition to the learning opportunities. For more information: (800) 567-2862 admin@cvma-acmv.org www.canadianveterinarians.net
2017 AVMA Annual Convention July 21—25, 2017 – Indianapolis, IN
AVMA Convention 2017 has something for every background and interest. Gain an educational edge through interactive CE opportunities, hands-on labs, panels and lectures taught by the best and brightest in veterinary medicine. Network with your peers, and discover products and services that will enhance your veterinary practice and career. For more information: (800) 248-2862 convention@avma.org www.avmaconvention.org
11th Keystone Veterinary Conference August 10—13, 2017, Hershey, PA
We are looking forward to seeing you in the “Sweetest Place on Earth” this summer! This conference will be taking place at the Hershey Lodge in Hershey, PA and offers veterinarians and veterinary technicians a total of 24 hours approved CE credits by the PVMA. Some other key events include a Hall of Fame Luncheon, Marketplace Happy Hour, ZooAmerica After Dark, a Silent Auction to benefit the Pennsylvania Veterinary Medical Association and much more. Continental breakfast and lunch, as well as beverage breaks, will be provided each day of the conference for all attendees. Registration is now open.
2017 IVECC Symposium
September 13—17, 2017 – Nashville, TN Veterinary Emergency & Critical Care Society (VECCS) is once again proud to conduct IVECCS 2017 in conjunction with the ACVECC, the AVECCT, the American College of Veterinary Anesthesia and Analgesia, the Academy of Veterinary Technicians in Anesthesia and Analgesia, the International Veterinary Academy of Pain Management, and the Association of Veterinary Hematology and Transfusion Medicine. IVECCS is attended by many of the world’s most progressive, forward thinking clinical veterinarians, technicians and practice managers searching for the latest advances in equipment, instruments, pharmaceuticals, and information management tools. IVECCS is known to be an intense clinical symposium and offers the highest-quality continuing education available at any national or international meeting. For more information: (210) 698-5575 info@veccs.org www.veccs.org
2017 AHVMA Annual Conference October 21—24, 2017 – San Diego, CA “Holistic Medicine – What Else is Possible?” Keynote Speaker: Ihor Basko, DVM San Diego, California is the site of the American Holistic Veterinary Medical Association’s 2017 Annual Conference. The newly renovated and remodeled Town and Country Resort and Convention Center will host AHVMA for a larger than ever integrative education experience. Over 100 hours of lectures, labs, your favorite exhibits, and special before and afterhours opportunities. There are introductory sessions on many major modalities. Even if you are new to holistic medicine, you will acquire a wealth of practical knowledge and learn how you can integrate holistic modalities into your practice. Early-Bird Registration special rate available until June 30, 2017. For more information: (410) 569-0795 office@ahvma.org www.ahvma.org
For more information: (888) 550-78620 cgacono@pavma.org www.keystonevetconference.org
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