V7I4 (Fall 2017) by Redstone Media Group

Integrative VETERINARY CARE VOLUME 7 ISSUE 4

INTEGRATIVE TREATMENTS FOR INHERITED DISEASES IN DOGS WHY INTEGRATIVE MEDICINE IS THE BEST WAY TO SUPPORT PATIENT HEALTH IN DOGS WITH INHERITED DISEASES. — P. 14

PROLOTHERAPY IN VETERINARY PRACTICE

SHOCKWAVE THERAPY This non-invasive modality treats orthopedic

NUTRITION AND GENE EXPRESSION How biomarker testing can help determine an

PET INSURANCE AND YOUR PRACTICE

SUPPLEMENTING WITH SEAWEED Rich in iodine and trace minerals, seaweeds and kelps

WHAT’ S NEW

Often used for human athletes, prolotherapy can treat lameness and even seizures in animal patients. – P. 18

FALL ISSUE 2017

www.IVCJournal.com

optimal diet for each animal. – P. 24

benefit the skin, hooves, digestion and more. – P. 40

and soft tissue problems in horses and small animals. – P. 46

Why encouraging clients to buy pet insurance improves both patient care and practice profits. – P. 52

• Dogs that can detect Parkinson’s disease • Equine locomotor research course comes to US • Key research on feline injection site sarcoma

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contents FEATURES

INTEGRATIVE TREATMENT FOR INHERITED DISEASES IN DOGS By Nancy Scanlan,

DVM, MS, CVA

Because inherited diseases are chronic conditions, integrative medicine has many contributions to make that can help support the canine patient’s health.

PROLOTHERAPY IN PRACTICE By Janell Osborn,

DVM, CVA

Prolotherapy is used to increase tendon and ligament strength and relieve arthritic changes. In veterinary medicine, it can treat lameness and other conditions.

NUTRITION NOOK

RECOVERING CANINE HEALTH: THE NATURAL DOG

INDIVIDUALIZED NUTRITION BASED ON BIOMARKER TESTING

By W. Jean Dodds,

DVM

and Denis M. Callewaert, PhD

Understanding the relationship between nutrition and gene expression enables one to design an optimal diet based on an individual animal’s genotype.

By Michael W. Fox, Deanna L. Krantz

DVM,

INTEGRATIVE PRACTICE

SEAWEEDS FOR ANIMAL HEALTH

A NEW BUSINESS MODEL FOR INTEGRATIVE PRACTICE DVM, CVA, CVSMT, MA

This new model of integrative veterinary practice combines treating patients with educating clients.

By Bill Wolf and Marjorie M. Lewter, DVM

Seaweeds and kelps are proving to be powerful tools for skin, hoof and coat health, digestive improvements, and more.

46 4

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TECH TALK

HOMEOPATHIC MEDICINES CAN ALTER GENETIC EXPRESSION

By Jenny Johnson,

VMD

Shockwave therapy can treat orthopedic and soft tissue problems in animals. Though most commonly used for horses, it also has many applications in small animal practice.

PET INSURANCE FOR HOLISTIC AND INTEGRATIVE PRACTICE

By Katie Woodley,

BVSc

Find out how pet health insurance helps clients and patients while benefiting the veterinary practice.

By Sue Armstrong,

MRCVS, RsHOM

MA, VetMB, VetMFHOM, CertIAVH,

Studies show that homeopathic medicines have an effect at the level of genetic expression, offering another tool for understanding the potential uses of remedies in animal patients.

and

Genetic abnormalities caused by extreme dog breeding are on the rise, while natural aboriginal dogs with robust health are in danger of extinction.

By Odette Suter,

SHOCKWAVE THERAPY

advisory board

40 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 VBMA 35 Industry innovations 45 From the AHVMF 51 From the IVAS 56 Veterinary resource guide 57 From the WAEO 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 AVH 65 Marketplace 66 Events

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

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

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Integrative VETERINARY CARE

FALL 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 Graphic Designer: Kathleen Atkinson Graphic Designer: Sylvia Flegg Social Media Manager: Maddie Maillet Web Design & Development: Brad Vader

COLUMNISTS & CONTRIBUTING WRITERS Sue Armstrong, MA, VetMB, VetMFHom, CertIAVH, MRCVS, RsHom Denis M. Callewaert, PhD Carmen Colitz, DVM, PhD, DACVO W. Jean Dodds, DVM Michael W. Fox, DVM Christopher Kelly Groth Jenny Johnson, VMD Deanna L. Krantz Marjorie M. Lewter, DVM Terri McCalla, DVM, MS, DACVO Jeff Nichol, DVM Janell Osborn, DVM CVA Nancy Scanlan, DVM, MS, CVA Odette Suter, DVM, CVA, CVSMT, MA Bill Wolf Katie Woodley, BVSc

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IVC Journal (ISSN 2291-9600) is published four times a year by Redstone Media Group Inc. Publications Mail Agreement #40884047. Entire contents copyrightÂ© 2017. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: September 2017.

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

IVC Fall 2017

editorial

FOCUSING ON THE

individual A major benefit of the holistic approach to veterinary medicine is seeing my patients as unique individuals, needing different lifestyles and different treatments. I offer dozens of holistic approaches along with a few conventional ones, giving my clients a range of choices to match their budgets, their time constraints, and what they are confident is best for their animals. This holistic approach to life brings me joy, especially as I see more and more veterinarians recognizing the need for individualized patient treatments. In fact, the happiest veterinarians I have met over the last few decades are those who believe there are many ways to structure both practice life and treatment options. This issue of IVC Journal focuses on how we can learn what each individual client and patient needs, even from a genetic standpoint. Some exciting new work is being done with genes. Dr. Nancy Scanlanâ&#x20AC;&#x2122;s article looks at how holistic methods are the most effective when dealing with chronic conditions involving multiple genes. Dr. Sue Armstrong discusses the many new research tools used to study how genes can be turned off and on, thereby producing different proteins. This along with studies about dose-related responses may explain the generational improvements I have seen with holistic approaches. Breeding animals certainly changes their genetics. Dr. Michael Fox encourages us to pause and examine how far we have drifted from the genes of the original natural dog, and the benefits of maintaining genetic pools of these healthy canines. Drs. Callewaert and Dodds continue our genetic education with nutritional genomics and biomarker testing. Each food constituent can act on target genes, thereby altering their

IVC Fall 2017

expression to prevent, mitigate or cure chronic diseases with individualized dietary interventions. Even without specific testing, there are fresh, whole foods known to enhance health. Bill Wolf and Dr. Marjorie Lewter provide excellent information about the nutritional benefits of sea plants, which are powerful collectors of minerals and phytonutrients from the ocean. Practices can also be individualized. As many of us realize, clients may not understand or remember a lot of what we teach them in the exam room. Dr. Odette Suter offers a unique approach to integrative veterinary practice by discussing how she combines patient treatment with client education. Meanwhile, Dr. Kate Woodley explains how encouraging your clients to purchase pet insurance can enhance your practice. Every practice can use approaches to improve performance and decrease pain. Dr. Jenny Johnson describes the benefits of shockwave therapy in equine and small animal practices, while Dr. Janell Osborn shows how prolotherapy can resolve many joint issues and even alleviate seizures. I look forward to seeing you at the AHVMA Conference in San Diego, where we will all find more and more ways to enhance our lives, and those of our patients! Have a happy and healthy fall!

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

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contributors 1

1. SUE ARMSTRONG, MA, VETMB, VETMFHOM, CERTIAVH, MRCVS, RSHOM

Sue Armstrong qualified from Cambridge Veterinary School, England in 1984. She practices in Wetherby, West Yorkshire and runs the Sue Armstrong Consultancy for human and equine patients at Ornhams Hall in Boroughbridge. Sue studied homeopathy at the Royal London Homeopathic Hospital and with the HPTG in Oxford. She obtained VetMFHom status in 1996, and gained her RSHom status in 2007. She is past president of the British Association of Homeopathic Veterinary Surgeons (BAHVS) and the Canadian College of Animal Homeopathy (CAHM), and is Director of Education for the British Academy of Veterinary Homeopathy (BAVH). Sue published A Homeopathic Approach to Cancer in Animals (balancedbeing.com, individualis.co.uk, sue@individualis.co.uk).

2. DENIS M. CALLEWAERT, PHD

Dr. Denis Callewaert is Professor Emeritus of Chemistry and was Founding Director of Oakland University’s Center for Biomedical Research. During his 35-year academic career, he characterized human Natural Killer lymphocytes, and authored textbooks on chemistry and biochemistry. Dr. Callewaert also founded four biotechnology companies, including Oxford Biomedical Research. In 1995, he founded Oxford Laboratories, which developed the TgAA test for early diagnosis of canine autoimmune thyroiditis. For the past ten years his research has focused on the development of novel methods to measure oxidative stress and inflammation.

3. W. JEAN DODDS, DVM

Dr. Jean Dodds received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she established Hemopet (hemopet.org), the first non-profit national blood bank program for animals. Dr. Dodds has been a member of many committees on hematology, animal models of human disease and veterinary medicine. She is also Co-Trustee of the Rabies Challenge Fund, a non-profit project to assess the duration of immunity and safety of current rabies vaccines for animals (rabieschallengefund.org). She recently served on the Board of Directors of the AHVMA, is currently is on the Board of the AHVMF, and is a member of the Editorial Committee for the AHVMA Journal.

Practice at University of Tennessee College of Veterinary Medicine. She has focused on acupuncture and complementary medicine for the past 25 years, completing IVAS certification in 1992 and the IVAS Chinese Herbal medicine course in 1995. Dr. Lewter’s practice in Virginia provides mixed animal services, integrating complementary therapy with conventional medicine. Dr. Lewter is on the board of the AHVMF and is the Scholarship Committee Chair.

8. JANELL OSBORN, DVM, CVA

Dr. Janell Osborn is a graduate of the University of Minnesota. She owned and operated the St. Cloud Animal Hospital in Minnesota until 2008, when she opened a holistic clinic in the Little Falls area. In 2015, she started integrating two decades of medical practice into a diverse style of medicine, and is now at the Bemidji Veterinary Hospital in Northern Minnesota. Dr. Osborn is certified in veterinary acupuncture and the Tui na form of medical massage and manipulation, and is a Reiki Master practitioner. She also works with photonic therapy, osteopathic manipulation, cranial sacral, myofascial therapy, Eastern and Western herbal therapies, essential oils, frequency forks, prolotherapy and conventional therapies.

9. NANCY SCANLAN, DVM, MS, CVA

Dr. Nancy Scanlan is Executive Director for the AHVM Foundation, a board member of the World Association of Traditional Chinese Veterinary Medicine, and a consultant on the Veterinary Information Network. She has been using complementary health therapies in her veterinary practice since 1970, including nutraceuticals, acupuncture, non-classical homeopathy, trigger point therapy, and Chinese and Western herbs. Dr. Scanlan was Executive Director of the AHVMA for three years, president of the VBMA for two years, and is a member of the VBMA, AVBM, AHVMA, WATCVM, AVMA, and CVMA.

10. ODETTE SUTER, DVM, CVA, CVSMT, MA

4. MICHAEL W. FOX, DVM

Dr. Michael W. Fox (drfoxvet.com) writes the nationally syndicated newspaper column “Animal Doctor” and has also authored the best-selling books Understanding Your Cat and Supercat: How to Raise the Perfect Feline Companion.

Dr. Odette Suter graduated from veterinary school in Switzerland in 1994. Early on, she recognized the limitations of conventional medicine and questioned its role in true healing. She researched holistic and functional medicine, including Chinese medicine, veterinary spinal manipulation and chiropractic neurology, applied kinesiology, NAET, animal communication, nutrition, etc. Dr. Suter owns Peak Animal Health Center. She offers intensive training programs, combining holistic treatment and teaching to educate clients on creating longevity for their animals. She authored What Your Vet Never Told You – Secrets to Supporting Peak Health for Your Animal and created a video training course called Animal Longevity Secrets Revealed.

5. JENNY JOHNSON, VMD

11. BILL WOLF

Dr. Jenny Johnson completed her undergraduate studies at Mount Holyoke College in Massachusetts, and earned her VMD in 1986 at the University of Pennsylvania School of Veterinary Medicine. She was awarded an internship in large animal medicine and surgery at New Bolton Center. Dr. Johnson worked at Almahurst Farms of Pennsylvania, then started her own Standardbred racetrack and equine performance practice at Pompano Park in Florida and Pocono Downs in Pennsylvania, then in Wellington, Florida. She completed postgraduate training in animal chiropractic at Options for Animal and earned certification by the IVCA. Dr. Johnson moved to Calabasas, California in 2004 and started Oakhill Shockwave, treating patients with chiropractic and shockwave therapy.

6. DEANNA L. KRANTZ

Deanna Krantz has worked in animal and environmental protection since the 1970s in the US, Europe, Africa and India, and shares her vocation with her husband, veterinarian Dr. Michael W. Fox.

7. MARJORIE M. LEWTER, DVM, CVA

Dr. Marjorie Lewter attended Virginia Tech to receive degrees in animal science and biology. A 1981 University of Georgia College of Veterinary Medicine graduate, she completed an internship at the Department of Rural

IVC Fall 2017

Bill Wolf began harvesting seaweeds in 1971 while studying renewable resources with Buckminster Fuller. He founded and is president of Thorvin Kelp (thorvin.com), leading supplier of seaweed ingredients. Bill also operates an organic farm in Appalachia and is President of Wolf, DiMatteo+Associates (organicspecialists.com), which consults on organic projects with companies and governments. He served as President of the Organic Trade Association (OTA) and is founding President of the Organic Materials Review Institute (OMRI).

12. KATIE WOODLEY, BVSC, CVA

Katie Woodley graduated in 2010 from Massey University, College of Veterinary Science in New Zealand, where she worked in a small animal clinic and developed an interest in natural medicine. While working at a Colorado Springs small animal clinic, she began delving further into herbal and integrative medicine to find the best treatment plans for patients, especially when conventional medicine didn’t help. Dr. Woodley’s personal experience with autoimmune disease encouraged her interest in holistic treatments. She is currently working toward a graduate diploma in Chinese Veterinary Herbal Medicine through the CIVT program, and practices integrative medicine at the Advance Animal Care clinic of Fort Collins.

what’s new PARKINSON’S DETECTOR DOGS Dogs are increasingly being used for their incredible ability to detect diseases in humans. Thanks to their powerful sense of smell, these four-legged “doctors” can detect cancer, blood sugar changes in diabetics, and even dangerous cardiac conditions. Now, they’re even sniffing out Parkinson’s disease. A particular odor is linked to Parkinson’s, though it remains unclear which molecules are responsible for the smell. That’s where dogs come in. In a trial conducted by Manchester University and research charity Medical Detection Dogs, two Labrador retrievers and a cocker spaniel were trained to sniff the skin swabs of 700 people. Using their olfactory skills, the canine team helped the

researchers pinpoint the molecules that generate this unique “Parkinson’s smell”. While there is still no cure for the disease, dogs may be able to detect it years before symptoms arise – a huge advantage for Parkinson’s patients.

medicaldetectiondogs.org.uk

STUDY OF SURGICAL MARGINS FOR FISS Researchers at Oregon State University are working towards more precision in determining surgical margins for feline injection site sarcomas (FISS). Inaccuracy in surgical margins – the tissue cut out along with the tumor to try to ensure all cancerous cells are removed – can have a negative effect on the patient’s health, whether the margin is bigger or smaller than necessary. Understanding how margin length decreases from surgery to pathology – because of how the removed tissue shrinks and tumor cells invade surrounding tissues – can lead to better surgical margin planning and in turn a better prognosis, says corresponding author Milan Milovancev, a board-certified veterinary surgeon at OSU’s College of Veterinary Medicine. “If we can understand the relationship between what the pathologist sees on a slide under a microscope and what the surgeon is taking out in the operating room, and what accounts for the differences between the two, then we can work backward and figure out how much surgical margin to take,” he says.

onlinelibrary.wiley.com/doi/10.1111/vsu.12602/abstract

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what’s new IN MEMORIAM On May 30, Lynn Peck, DVM, MS, peacefully passed away in Gainesville, Florida after a rapid course of metastatic breast cancer. Dr. Peck was born in 1957 in Orange, California. An active competitor in dressage and eventing, she gained certification as an assistant instructor before becoming interested in veterinary medicine. She earned her veterinary degree and a Masters in equine reproduction at the University of Florida. Dr. Peck had over 30 years’ experience in basic and applied research at the University of Florida, and presented at national and international scientific conferences. She did extraordinary pioneering work in the field of holistic healing for animals, particularly in horses and dogs suffering from soft tissue and neuromuscular issues, chronic pain, and behavioral problems. She used a wide variety of alternative modalities, including homeopathy, acupuncture, osteopathy, nutrition, applied kinesiology and more. Her empathy and kindness when relating to animals brought many a chronic case back to a healthy, happy life. Dr. Peck was a huge asset to animals and the veterinary community, and will be deeply missed.

EQUINE LOCOMOTOR RESEARCH COURSE COMES TO THE US

HUMAN ACTIVITY AFFECTS DIET FOR PRZEWALSKI’S HORSES While the habitat of wild horses in the Gobi Desert has hardly changed over the past century, their diet has – mainly as a consequence of human influence.

The Royal Veterinary College (RVC) in England recently launched a graduate diploma program in equine locomotor research. This unique course provides farriers with the necessary skill set to produce original research, increase the evidence base behind farriery, and enhance equine welfare. Following a successful inaugural year, the program will be open to farriers in the US beginning in 2018. The course will be delivered via webinars and podcasts, with face-to-face weekend learning sessions at the University of Pennsylvania’s New Bolton Center. Dr. Renate Weller, one of the professors leading the course, is enthusiastic about its potential. “As an equine clinician, I cannot emphasise enough the importance of farriery in the prevention and treatment of lameness in horses. And as a researcher, I am excited to be able to work with people who have the practical experience and knowledge to generate scientific evidence for farriery strategies.”

rvc.ac.uk, vet.upenn.edu/veterinary-hospitals/NBC-hospital

IVC Fall 2017

Historically, Przewalski’s horses were seen as pasture competitors and were hunted for food. Using tail hair analysis, researchers from the Vienna University of Veterinary Medicine found that these horses ate a mixed diet of grass in the summer and less nutritious bushes in the winter. Because the best grazing land was reserved for domestic sheep and cattle, access to good pasture was difficult for wild horses during the winter. After nearly going extinct, however, Przewalski’s horses in the Gobi are today fully protected and even revered. Thanks to this shift in societal attitude, these horses now have access to richer pastures and grazing land. Whereas they used to be chased into less productive habitats, they now eat high quality grass year-round.

vetmeduni.ac.at/en/infoservice/presseinformation/pressreleases-2017/reintroduced-przewalskis-horses-have-a-differentdiet-than-before-their-extinction-in-the-wild

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This article has been peer reviewed

Integrative treatment for inherited diseases in dogs By Nancy Scanlan, DVM, MS, CVA

BECAUSE INHERITED DISEASES ARE CHRONIC CONDITIONS, INTEGRATIVE MEDICINE HAS MANY CONTRIBUTIONS TO MAKE THAT CAN HELP SUPPORT THE CANINE PATIENT’S HEALTH. An “inherited disease” is officially defined as a condition that has been proven to be inherited, or to be statistically higher in one or more specific breeds than in others.1 Inherited diseases range from mild to life-threatening. Integrative medicine has quite a bit to offer in the treatment and management of these conditions.

INHERITED DISEASES EXPLAINED Over 300 canine diseases are officially proven to be inherited.2 This number is probably low, especially when compared to humans and mice. In humans, over 2,000 genetic diseases have been identified; there are over 1,300 mouse models for human diseases (which means over 1,300 mutations).3 The study of affected animals in pedigrees is the first step to show inheritance of a particular disease. This is followed in a number of cases by identifying the specific genes involved and,

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ideally, developing a test for those genes. Another method is to review prevalence of a disease in a specific breed and to compare it to the prevalence of the disease in the rest of the canine population, but this is less scientifically predictive.4 • A disease caused by the single mutation of a dominant gene is easiest to spot. Any animal with a single copy of that gene will have that disease. Genes that are dominant but with incomplete penetrance may have variable expression, so symptoms of the disease can be anywhere from mild to severe, depending on the degree of gene expression. Type 1 Von Willebrand disease (vWD) in Dobermans is such a disease. Because the variability means many afflicted Dobermans may not show severe signs of excessive bleeding, it has been difficult to get breeders to remove affected animals from the gene pool. In such cases, this type of problem can become widespread throughout a breed.5

• On the other hand, diseases may be caused by a single recessive mutation, which means that until a test is developed to determine carriers, and until a breed association becomes resolved to eradicate that trait from the breed, the trait may become widespread. This is especially true when a popular sire is also a carrier for the disease. Type 3 vWD in Scottish terriers is a classic example as it has autosomal recessive inheritance whereby two obligate carrier heterozygotes can produce clinically affected homozygous offspring that express a severe bleeding tendency. The affected gene has been identified and extensive carrier testing has virtually eliminated most of this problem from the breed.4 All but one type of progressive retinal atrophy (PRA) is another autosomal recessive example. To further complicate matters, this disease can be caused by at least six different mutations.6-11 There are six different DNA tests available. Fortunately, most breeds affected by PRA have the same type: PRCD (Progressive Cone/Rod Degeneration).4 Conscientious breeders involved with breeds afflicted with this problem are actively testing and removing carriers from the breeding pool. • The hardest diseases to control with conventional medicine are those with multiple genes involved; other factors include conformation, nutrition, breed, rate of growth, amount of exercise and others. Hip dysplasia is an example. This type of problem is one where intervention with integrative veterinary medicine can help the most, especially when it’s started at an early age.

BREED CONSIDERATIONS Purebred dogs are more likely to have certain specific inherited diseases than dogs whose ancestors come from two or more breeds. But this does not mean all non-purebred dogs are healthier. They may inherit problems from all their ancestors. In addition, certain body shapes (as in the case of brachycephalic dogs) are associated with specific disease syndromes, regardless of whether a dog is purebred or crossbred. A survey at UC Davis involving dogs affected with 24 of the most common

ONLINE LISTS OF INHERITED DISEASES IN DOGS Dodds, WJ. Guide to Congenital and Heritable Disorders in Dogs (Includes Genetic Predisposition to Diseases). Humane Society Veterinary Medical Association, 2011. Available as a download at hsvma.org/assets/pdfs/guide-to-congenital-and-heritabledisorders.pdf vet.cam.ac.uk/idid/howto, IDID list of inherited diseases, including photos. instituteofcaninebiology.org/genetic-disorders-bybreed.html discoveryspace.upei.ca/cidd/, Canine Inherited Disorders Database ncbi.nlm.nih.gov/omim, Human genetic disorders database of over 2,000 diseases. informatics.jax.org/mgihome/homepages/stats/all_ stats.shtml#allstats_snp, Mice strains including 1,372 human diseases with one or more mouse models. genetic diseases with major health consequences showed that for about half of them, there was no difference in occurrence between purebred versus mixed breed dogs.12,13 Popular breeds are more likely to have a longer list of inherited diseases than less popular breeds. There are a larger number of dogs among the popular breeds, so there will be more individuals with some of the less common forms of the disease, allowing more opportunities for the disease to continue within that breed. In addition, owners of popular breeds may be more likely to breed their dogs with the nearest dogs of the same breed without any genetic screening, increasing the chances of spreading undetected problems.14 Continued on page 16.

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Continued from page 15. One should not rely solely on official surveys of the incidence of inherited diseases. A breed that’s new to a country may not have been present long enough for any problems to become obvious. A rare breed may not have enough members to enable a good statistical sampling, or to show signs of the problem so it can be recognized as being breed-related.2 Pet owners may purchase a dog based on an internet search for “healthiest dog breed” and end up with a rare breed that has a number of unexpected problems.

THE ROLE OF INTEGRATIVE MEDICINE Because these are inherited genetic defects, often associated with anatomical changes, integrative medicine is not going to prevent most of them, unlike diseases associated with the environment or nutrition. However, because the cause (genetic) is present over an animal’s entire lifespan, inherited diseases are chronic conditions. For chronic diseases and those with multiple causes, integrative medicine has many contributions to offer that can help support the patient’s health. Chronic conditions often respond better to integrative medicine than to conventional medicine alone. For some genetic diseases, such as vitamin A-responsive dermatosis and

zinc-responsive dermatosis, the conventionally recognized treatment is already essentially an integrative one involving a single nutraceutical (a vitamin or mineral used in a higher dose than is present in conventional pet food and supplements). Obviously, some dysfunctions and diseases are associated with body structure. Dogs with pendulous ears are much more likely to have chronic otitis than dogs with erect ears. Chondrodysplastic breeds with short legs are more likely to have Type I intervertebral disc disease (IVDD) than breeds with a more wolf-like conformation. In the case of pendulous ears, integrative treatment will not change the shape of the ears but neither will conventional treatment. But often, an integrative treatment can be used to prevent the otitis associated with pendulous ears, with longer-lasting results than conventional treatment. In the case of IVDD, prevention is harder to accomplish, but treatments such as acupuncture can have analgesic effects equal to or even surpassing those of conventional medicine. The same is true of most polygenic conditions that can cause pain, such as hip dysplasia. When the problem is related to conformation or body structure, the pet owner’s idea of “cure” may not be realistic. Dangling dewclaws on the hind legs, with nails that grow and curve around into the tissue, are not going to fall off or allow the nails to wear down normally, no matter what treatment is used. This is where an “integrative” approach applies: the ideal treatment is either regularly trimming the nails or removing any excess toes.

LABS THAT TEST FOR GENETIC DISEASES IN DOGS, INCLUDING PRA ofa.org/dnatesting/rcd4.html optigen.com/opt9_test_prcd_pra.html animalnetwork.com.au/dnatesting/beneﬁts.php

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Advertorial

VetzLife All-Natural News By Christopher Kelly Groth

In contrast, other diseases with multiple contributing factors, such as hip dysplasia, can be improved or even in some cases cured, if proper nutrition and other treatment are started early enough. Inherited skin diseases in general are especially amenable to integrative treatments, including almost half of those identified as being inherited. Some immune disorders also can respond dramatically to integrative treatments. In such cases, a spectrum of treatments is most effective, often involving a combination of nutrition, nutraceuticals, herbal therapy, and/or homeopathy as well as other modalities. In short, integrative medicine can help alleviate the issues caused by or associated with many inherited diseases in dogs.

“Selection of Diseases”, vet.cam.ac.uk/idid/selection.

Dodds, WJ. Guide to Congenital and Heritable Disorders in Dogs (Includes Genetic Predisposition to Diseases). Humane Society Veterinary Medical Association, 2011.

ncbi.nlm.nih.gov/omim

“How are Defects Inherited”, discoveryspace.upei.ca/cidd/how-are-defects-inherited.

Riehl J1, Okura M, Mignot E, Nishino S. “Inheritance of von Willebrand’s disease in a colony of Doberman Pinschers”. Am J Vet Res. 2000 Feb;61(2):115-20.

“Progressive Retinal Atropy – PRCD, animalnetwork.com.au/tests/index.php?testid=20.

Dostal J, Hrdlicova A, Horak P. “Progressive rod-cone degeneration (PRCD) in selected dog breeds and variability in its phenotypic expression”. Veterinarni Medicina. 2011 Jun; 56(5):243-47.

Clements PJ, Gregory CY, Peterson-Jones SM, Sargan DR, Bhattacharya SS. “Conﬁrmation of the rod cGMP phosphodiesterase beta subunit (PDE beta) nonsense mutation in aﬀected rcd-1 Irish setters in the UK and development of a diagnostic test”. Curr Eye Res. 1993 Sep;12(9):861-6.

Kohyama M, Tada N, Mitsui H, Tomioka H, Tsutsui T, Yabuki A, Rahman MM, Kushida K, Mizukami K, Yamato O. “Real-time PCR genotyping assay for canine progressive rod-cone degeneration and mutant allele frequency in Toy Poodles, Chihuahuas and Miniature Dachshunds in Japan”. J Vet Med Sci. 2015 Nov 6. [PubMed: 26549343]

Eliminate calculus from your patients’ teeth – without brushing “But I’ve been brushing his teeth!” How often have you heard this from clients? Yet a checkup reveals that the patient has calculus buildup. You and I can floss and brush our own teeth every day, but the dentist will still find something to scrape off. The same is true for our pets. Typically, a traditional clinic will want to schedule a dental appointment for the pet. But what if you want to avoid inducing the patient with anesthesia for a dental, and tackle the issue another way? What are your options? You could recommend an anesthesia-free scaling from a trusted professional. But what if you don’t have access to that? What is your best recommendation? More brushing? Something you can offer your clients that will actually eliminate existing calculus is VetzLife Oral Care. This allnatural gel and spray will not only prevent plaque from forming, but will also dissolve existing tartar. All your clients need to do is comply with the basic instructions and stick to it. And they will love hearing that they don’t need to brush! They just need to get it in the mouth twice a day, and voila! “Clinical results suggest the topical application of VetzLife oral care products improves periodontal and dental disease not only as a sole treatment but also in combination with surgical and non-surgical therapies,” states the Drexel University College of Medicine.

Moody JA, Famula TR, Sampson RC, Murphy KE. “Identiﬁcation of microsatellite markers linked progressive retinal atrophy in American Eskimo Dogs”. Am J Vet Res. 2005 Nov;66(11):1900-2. [PubMed: 16334947]

Zangerl B, Goldstein O, Philp AR, Lindauer SJ, Pearce-Kelling SE, Mullins RF, Graphodatsky AS, Ripoll D, Felix JS, Stone EM, Acland GM, Aguirre GD. “Identical mutation in a novel retinal gene causes progressive rod-cone degeneration in dogs and retinitis pigmentosa in humans”. Genomics. 2006 Nov; 88(5):55163. [PubMed: 16938425]

Find out more at vetzlife.com.

Bellumori TP, Famula TR, Bannasch DL, Belanger JM, Oberbauer, AM. “Prevalence of inherited disorders among mixed-breed and purebred dogs: 27,254 cases (1995-2010)”. J Am Vet Med Assoc 2013 242: 1549-1555.

Christopher Kelly Groth is the Senior Sales Executive for PetzLife Products.

Bonnett BN, A Egenvall, A Hedhammar & P Olson Mortality in over 350,000 insured Swedish dogs from 1995-2000: breed-, gender-, age-, and cause-speciﬁc rates. Acta Vet Scand 2005 46 : 105-120.

IDID: inherited diseases in dogs: web-based information for canine inherited disease genetics. Mamm Genome. 2004 Jun;15(6):503-6.

IVC Fall 2017

Prolotherapy By Janell Osborn, DVM CVA

A C

Prolotherapy is a non-surgical treatment used to increase tendon and ligament strength and relieve arthritic changes. In humans, it is commonly used in Olympic sports medicine, as well as for the non-surgical treatment of rotator cuff injury, knee problems, and degenerative back and arthritic diseases. Prolotherapy is also becoming a more common practice in veterinary medicine for treating lameness. However, I have found it to be useful in a variety of other cases. I have been using dextrose prolotherapy in my practice since it was introduced to me by Dr. Carvel Tiekart at the AHVMA conference in 2006.1 Regenerative injection therapy is a newer name that reflects the most common theory as to the treatmentâ&#x20AC;&#x2122;s effects. The injection of a substance into a joint or at ligament/ tendon attachments causes a controlled injury with a subsequent healing cascade. This results in the production of new collagen, thus tightening the joint and decreasing pain. I believe that each component of the dextrose solution carries with it specific properties that come together in a healing we are only just

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learning the intricacies of. This healing process continues over a course of six to eight weeks, so if another treatment is needed, I wait until after the six-week recheck to decide. Recently, I have also incorporated plasma therapy, using the same technique, for intervertebral and arthritic joints. The platelets in the plasma contain stem cells that can differentiate to create a healing cascade in degenerative joints. For chronic or specialized cases, I use a combination of dextrose and plasma techniques on the same patient, often using the dextrose for torn knee ligament injuries, and plasma to relieve the associated lower back and/or hip arthritis that often accompanies the degenerative knee problem. I have also found success in using the dextrose solution for the tendons and ligaments of a weak knee with a mild-moderate drawer sign, and using the plasma solution on the arthritic cartilaginous bone surfaces. I also used a combination of therapies in a case of refractive seizures. I tend to use the dextrose solution for primary tendon/ligament issues, and the plasma in areas of arthritic change.

TECHNIQUE IS PARAMOUNT Knowing your anatomy is critical for needle placement. The needle and solution must come in contact with the origin, and I often also tag the insertion, of the tendon or ligament where it connects to the bone, and follow the tendon to the muscle body and the ligament to its attachments. Always pull back on the syringe when you are working near blood vessels. Often, the tendon or ligament will give a very quiet, but palpable and audible, pop sound as you penetrate it. This is my indication that I am in the right spot; then I follow it to its insertion, injecting multiple drops of solution as I go. Once I have found my point of contact, I will walk the needle, injecting as I go, as far as possible before retracting and starting a new puncture. Plasma injections are not walked through like dextrose injections, but are rather given in several small injections onto cartilage surfaces and into joints. I treat the main tendons (patellar in the knee, biceps in the shoulder/elbow, brachiocephalic in the neck and shoulder) and also the respective surrounding collateral ligaments. I finish with local corresponding acupuncture points – for example, GB34 at the knee; TH14, LI15, SI9 at the shoulder; SI8 at the elbow; sometimes TH5 and TH4 for foreleg lameness completion; and GB29, GB30, and BL54 at the hip. I have used 25ge x 1.5” needles in very large dogs, but a 28ge x 1.5” needle for medium and large dogs, and a 30ge x 1” needle for small dogs and cats gives me a better outcome with less pain and more rapid improvement postprocedure. In my opinion, it is worth finding the rightsized needle. Continued on page 20.

Ingredients to make a 15% solution In a 10cc to 12cc syringe, draw up 1cc of 2% lidocaine (without epinephrine). Fill to 4cc with 50% dextrose, and to 10cc with sterile water (saline does not give the same results, in my experience). This is equivalent to 1cc lidocaine, 3cc 50% dextrose, and 6cc sterile water.

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Continued from page 19. My basic solution is made up of 50% dextrose, sterile water, and 2% lidocaine (without epinephrine). I have used procaine in the past, with the goal of better breaking down scar tissue, but it needs to be compounded, has a shorter shelf life, and doesn’t seem to really make a difference. I use a short-acting injectable anesthetic. The procedure itself tends to only take ten to 20 minutes. For a large dog, I will often use 15cc to 20cc of dextrose solution, for a medium dog 10cc to 15 cc, and for a small dog or cat 5cc to 10cc. The quantity of plasma I use often depends on how much I get from the patient. I aim for 1cc to 3cc for a medium dog with one joint to treat, and 6cc for a large dog with multiple joints needing treatment (each vertebra is a joint). I prefer to draw fresh whole blood into a red top tube, let it clot, spin down and separate. In our area, we are endemic for Lyme disease and anaplasmosis. I always test for these tick-borne diseases prior to the procedure. Previously undiagnosed anaplasma has led to severe bruising in the area post-procedure.

experienced what I see as an 80% recovery – still a little stiff, but almost fully flexible.

CAUTION Movement post-procedure is imperative. For at least the first 48 hours, clients are instructed not to let the animal stay in one position for longer than two hours without a minimal 15-minute walk. They can sleep a full night. One of my few failures with prolotherapy involved a patient that traveled 2.5 hours for a treatment. The client was given direction to stop halfway home to walk the dog, which she did not do. When she got home, the dog was kenneled for the next eight hours with no walks.

Minimum 15 minute walk every 2 hours

EXAMPLES OF USE IN PRACTICE Shortly after Dr. Tiekart’s lecture, I was working with a threeyear-old Shiba Inu named Tiko who was starting to fail at the pole weaves as he advanced in agility. That summer, I attended a rehabilitation conference at which Dr. Christine Zink discussed how to recognize tendon laxity, primarily in the biceps. Tiko was being seen by a veterinary rehabilitator and was prescribed hobbles, much to my client’s dismay. Putting the two conference ideas together, I called the client and asked if we could try prolotherapy on Tiko’s shoulders. We did all four joints – shoulders and knees. Tiko went on and won his grand champion Mach title in agility that fall. I was impressed and motivated.

Although most dogs (and the couple of cats I have treated for low lumbar arthritis) respond to one or at most two treatments, one case took almost six weeks to show improvement, though it finally did. The more cases I see, and the more I treat that are longstanding rural cases rather than on-the-spot agility cases, the more rounded my success curve becomes. Prolotherapy is still a vital part of my practice. It would benefit every practice, especially those with a large caseload of agility or performance dogs. See case study on page 22.

Since then, I have used the dextrose technique on a large number of agility, sporting and pet dogs, ranging from five to 150 pounds. Most pets and owners were happy with the results after just one treatment, though a number of the agility and sporting dogs were given two treatments (“just to make sure they are as strong as possible”). In all cases, the increased thickness and spring of the patellar ligament was palpable at the six-week visit. I have also used this technique to tighten luxating patellae; however, unless it is a traumatic luxation, I haven’t seen prolotherapy alone eliminate it beyond a Grade 1 after four treatments. I have used dextrose prolotherapy treatments in two dogs with fixed knees, one congenital and one on an older rescue dog and with no clear cause. The young dog (20 weeks) had a full recovery. The rescue adult

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WHERE TO GET SUPPLIES Plasma: from the animal you are treating – spin, separate, and draw up into a syringe. Dextrose solution: veterinary supply distributors Needles: we found 28ge x 1.5”, and 30ge x 1” at Air-Tite Products Co., Inc.

T iekert, Carvel G, DVM. “Prolotherapy treats pain by stimulating the body to repair damaged/loose ligaments”. IVC Journal, Summer 2015.

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Prolotherapy Case Study H TREATING SEIZURES WIT

APY PROLOTHERsen ted with Tanner,

pre In February of 2016, I was N German shepherd M/ d r-ol a 97.6-pound six-yea His owner, John, was with a history of seizures. an chiropractor. Tanner referred to me by his hum n severe epileptic-type was experiencing full and ofte e to five weeks since thre ry seizures approximately eve ary clinic exam found September of 2014. The prim rological abnormalities. no musculoskeletal or neu elevated ALP. Tanner had Bloodwork showed a mildly potassium chloride and been put on phenobarbital, the current medication Keppa with no relief. Since severity or frequency of regime did not affect the removed him from all Tanner’s seizures, John had December. The seizures medications by the end of weeks when I met Tanner continued every two to four and John in February. I was working closely strengthening, but also where cord. Tanner was sent muscles from T10 to L3 to the brain stem and spinal On exam, Tanner’s lumbar collar, no neck pulls and ligament was also tight. home with instructions for no times daily. were very tight. The nuchal les, and thin neck ROM exercises using treats several ang ion uct abd eps bic l ma He had nor Dry needle acupuncture and tight patellar ligaments. ure two days postinitial exam findings. I Tanner had a very minimal seiz the to tive rela d iate init was l three-week mark. for the seizures. We procedure, but none at the norma orted there had prescribed a Chinese formula rep herbal formulas every Three months later, his owner ust – a period continued acupuncture and Aug il unt n, I learned that three been no seizures from May r mild seizure the month. While talking to Joh ano had g, Tanner had run of three months! Tanner etin me our to r prio rs yea or four r prolotherapy session ining wall, but little was the end of August, so anothe reta a r ove ed ipp fl and into set up for September ious soreness was gone using the same protocol was thought of it since any obv e until late November 1. Tanner was again seizure-fre within a few days. months. 2016 – almost another three ures lessened over the that night Tanner The severity of Tanner’s seiz continued to occur. John had the carpets cleaned and y the but s, nth mo e thre next mg of phenobarbital d and quiet greenstick seized. He was put on 97.2 mil a d we sho h rap iog rad A n, which has kept the g, mild occipital arthritic daily by his primary veterinaria fracture line on the axis win July 2017, Tanner was Tanner was anesthetized seizures under control. As of changes and inflammation. of phenobarbital. e ine and diazepam i.v. A seizure-free on a minimal dos with a combination of ketam of prepared, using 1cc solution of 15% dextrose was e, and 6cc of sterile tros dex 2% lidocaine, 3cc of 50% x 1.5” sterile needle was water into solution. A 25ge ted 3cc of plasma from put out for use. We also collec n was used in multiple Tanner. The dextrose solutio chments on C2, along taps at the nuchal ligament atta rtion, and the cervical inse the nuchal ligament and its s. The plasma solution vertebral ligament attachment tuberances where the was used on the occipital pro evident, most cranial arthritic changes were more wings – especially C1 vertebral ligaments, and the fracture line to tick ens noting the area of the gre re I chose to use plasma facilitate stem cell healing. He ded more healing than in areas that not only nee Radiographs of Tanner’s neck

IVC Fall 2017

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? “False Solomon’s Seal (Smilacina racemose) is related to Polygonatum in both its botany and properties,” states Matt Wood. “Both of these herbs are useful for inflexible tendons and ligaments, but also Solomon’s Seal has a great influence on the small joints in the hands and feet. It moistens, strengthens and either loosens or tightens depending on the tension on the joints. This herb differs from true Solomon’s Seal in that it is more beneficial for the liver.”

CASE REPORT Flash, a Paint gelding, was born with a severe “club” left forefoot. As he grew, his leg developed a 25° lateral deformity at the carpus, with severe arthritis. He became almost non-weight bearing. Six months ago, Flash’s owner sought alternative care. The horse was treated with monthly acupuncture, and a Chinese herbal formula called Sang Zhi San was reinforced with False Solomon’s Seal, since Flash’s primary pattern of disharmony was Liver Blood Deficiency, Liver Blood Stagnation and Kidney Jing Deficiency. Flash has improved dramatically. He is moving soundly at a walk, and able to bear full weight. His lateral collateral ligaments are thickening and strengthening, thereby straightening the leg, while the arthritis nosodities are resolving.

Teleconferences continue, so consult the vbma.org website for a schedule.

VBMA AT THE AHVMA CONFERENCE The AHVMA Conference takes place in San Diego, California from October 21 to 24. 1. Our herbal adventures start on Thursday, October 19 with the American College of Veterinary Medicine’s (ACVBM) herb walk at 4PM, led by one of our founders, Dr. Ihor Basko. 2. During the late afternoon break on Friday, October 20, VBMA’s herb walk will feature our track speaker, Richard Mandelbaum, RH, a clinical herbalist with a private practice in Brooklyn, New York. Richard is a founding partner, director and teacher at the ArborVitae School of Traditional Herbalism in New York City, and is also on the faculty at David Winston’s Center for Herbal Studies in Washington, New Jersey, and the Tristate College of Acupuncture in New York. His lectures during the AHVMA conference will discuss plant intelligence and zoopharmacognosy. Future events include an ethno-botanical weekend with David Winston in Menla Mountain, to take place in early May of 2018.

NAME THIS HERB!

UPDATE ON ACTIVITIES The VBMA sponsors a track of veterinarians at the International Herbal Symposium, a conference started by Rosemary Gladstar 26 years ago to benefit the United Plant Savers. This year, it featured healers and teachers from around the world, including keynote speaker Robin Wall Kimmerer. On the VBMA track, we featured Ihor Basko, DVM, speaking on cancer, mushrooms, diet and local Hawaiian plants; Donna Kelleher, DVM, speaking on itchy dogs, and native Northwest Pacific plants; Rob Silver, DVM, on the use of cannaboids and practical aspects of dosing small animals; and Cindy Lankenau, DVM, on the energetics of GI and respiratory herbs, and the use of Wu Mei San.

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

IVC Fall 2017

nutrition nook This article has been peer reviewed

Individualized nutrition based on

biomarker testing By W. Jean Dodds, DVM and Denis M. Callewaert, PhD

Understanding the relationship between nutrition and gene expression enables one to design an optimal diet based on an individual animal’s genotype.

Proper nutrition plays a key role in maintaining the health and longevity of human and animal populations and their resistance to disease.1-3 In addition to providing an energy source, food and diet directly influence the expression of our genetic potential. In the last 15 years, medical, veterinary and nutritional scientists have begun applying genomics to the field of nutrition. Nutritional genomics (nutrigenomics) is playing an essential role in assuring the quality and safety of human, livestock and pet foods.4-6 In this regard, foods are evaluated for their functional ingredients. Different diets can alter gene expression, resulting in changes in the production of specific proteins and metabolites. Understanding the relationship between nutrition and gene expression enables one to design an optimal diet based on an individual genotype, which can ultimately have a profound effect on the phenotype and observable traits of the person or animal.1-4 Food constituents can act by “up- or downregulating” target genes, thereby altering their expression. Thus, diets for animals should ideally be tailored to the

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genome or genomic profile of individuals or breeds in order to optimize physiological homeostasis, disease prevention and treatment, growth, reproduction, and athletic and obedience performances. Nutrigenomics can individualize dietary intervention to prevent, mitigate or cure chronic diseases.1-6

INDIVIDUALIZED NUTRITION The foundation for achieving individualized nutrition starts by feeding wholesome, fresh and nutrient-dense foods that are selected and optimized based on an individual’s genomic profile.1,5,6

FUNCTIONAL SUPERFOODS Foods that promote the expression of “healthy” genes are often called “functional superfoods”,1-6 and include certain botanicals, amino acids, vitamins and phytochemicals. All individuals can receive health and longevity benefits from functional superfoods to help prevent or mitigate chronic lifestyle-related diseases, and thus promote a state of optimum health and well-being.2,7,8

Examples of functional superfoods include berries (e.g. blueberries, cranberries), coconut oil, curcumin (turmeric), dark green leafy and yellow orange vegetables, fruits like apples, pears and bananas, medicinal mushrooms, milk thistle, Omega 3 fatty acids, pomegranates, prebiotics (spirulina and soluble and insoluble fiber) and probiotics. Further, to help pets avoid developing intolerances/sensitivities, rotate foods every one to two months using “novel” animal proteins and gluten-free foods.2 Proteins commonly considered “novel” are bison, buffalo, duck, fish, goat, lamb, pork, turkey and venison. While this approach may seem logical, many people don’t realize that an animal protein source that’s “novel” for one dog or cat won’t necessarily be so for another, unless he has never eaten it before. This is because, unlike a food allergy (which is an immediate reaction), intolerances/sensitivities can build due to prolonged consistent exposure to a particular ingredient. For example, kangaroo, emu and ostrich meats contain proteins that are novel for most dogs in the United States, yet are routinely available in countries like Australia. Similarly, lamb, turkey and venison were once considered novel proteins in the United States but now that they are more mainstream, dogs are beginning to manifest food intolerances/sensitivities to them.1,2 Food intolerances cause a delayed-type immune sensitivity reaction that often begin in the gut, but the antibodies involved are also released in secretions of saliva, tears and sweat, as well as from the nasal passages and ear canals, and the mucosal surfaces of the entire GI and urogenital tracts.1,2 Food intolerance is the third most common condition seen in animals, after flea bite sensitivity and atopy (inhalant allergy). Food intolerance is also the cause of 20% of all allergic skin disease.1

NUTRITION, INFLAMMATION AND OXIDATIVE STRESS Oxygen is required to produce the high-energy compound ATP coupled to the breakdown of fats, carbohydrates, etc. This process is not 100% efficient, and a lot of O2 is converted to “reactive oxygen species” (ROS), including hydroxyl and superoxide radicals (see Figure 1 on next page). ROS quickly react with biomolecules, including lipids, proteins and DNA. Although several protective mechanisms have evolved, an excess of ROS (a condition called oxidative stress) is a primary risk factor for a wide variety of diseases. Oxidative stress, in turn, typically promotes chronic inflammation in which tissues or organs receive inflammatory “mediator” messages that cause them to react as though the “trigger” or pathogen was still present. Rather than repairing themselves, these cells remain in an ongoing state of inflammation that can wax and wane for an entire lifetime. Antioxidants are now considered vital for inclusion in diets for humans and pets, and are often heavily promoted. Indeed, IVC Fall 2017

antioxidants are used in pet foods with higher fat and oil content in an effort to reduce lipid oxidation and the resultant rancid, unhealthy lipid oxidation products.9,10 Many antioxidants in pet foods are oxygen scavengers (see Figure 2) and neutralize ROS in 1:1 reactions. However, some functional foods act at the genomic level, especially via the Nrf2 transcription factor, to stimulate production of antioxidant enzymes. The flavonoids, a large family of polyphenolic compounds synthesized by plants, play a pivotal role in the Nrf2 regulatory pathway of oxidative stress. Dietary flavonoids provide multiple health benefits. In addition to being ROS scavengers, they mainly act as activators of the Nrf2 pathways â&#x20AC;&#x201C; stimulating the bodyâ&#x20AC;&#x2122;s own defensive systems.

Figure 1 Oxidative stress due to reactions of superoxide anion radical, hydrogen peroxide and the hydroxide ion with cellular components, is mitigated by the actions of superoxide dismutase and catalase.

Flavonoids comprise the following subclasses: anthocyanidins (pigmented vegetables and berries), flavanols (tea, berries, apples), flavanones (citrus fruits), flavonols (quercetin; tea, onions, kale, broccoli, apples and berries), flavones (parsley, thyme, celery), and isoflavones (genistein; soybeans, legumes).11,12

BIOMARKERS OF OXIDATIVE STRESS Measuring the beneficial or harmful effects of food ingredients in an individual can be accomplished by monitoring certain biomarkers, including levels of ROS scavengers, antioxidant enzymes, and/or byproducts of ROS damage.9-12 Recent human and veterinary research literature has assessed the effects of various factors, including diet, exercise and disease, on the

Figure 2 Many substances have beneficial antioxidant effects. Several small molecules are ROS scavengers, reacting 1:1 with a single ROS. Hence, large quantities are needed to combat oxidative stress. Other components of the diet, including several carotenoids, activate the expression of Nrf2-regulated genes, increasing the levels of several protective enzymes, including catalase and superoxide dismutase (SOD), with each enzyme capable of inactivating huge numbers of ROS for prolonged periods. 26

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product of lipid peroxidations, tumor necrosis factor-alpha (TNF-α) a key inflammatory mediator; and antioxidant enzymes including SOD (superoxide dismutase) and catalase. Recent improvements in biomarker assays are allowing their increased use in developing optimized diets for us and our pets.

Dodds WJ. “Functional foods: the new paradigm based upon nutrigenomics”. J Am Hol Vet Med Assoc 2014; 36: 26-35.

Dodds WJ, Laverdure DR. Canine Nutrigenomics: The New Science of Feeding Your Dog for Optimum Health. 2015. DogWise Publishing, Wenatchee, WA, pp. 323.

cellular biomarkers of oxidative stress, including antioxidants and chronic inflammation. However, applying this research in practical clinical settings has been hampered by the instability of most relevant biomarkers in blood, tissues and other body fluids. Once the specimens contact air, additional reactions occur that obfuscate the in vivo status of the subject, even if samples are stored frozen at -80°C. Sophisticated laboratory equipment and assays have also been required. Standard oxidative stress and antioxidant biomarkers9-12 include glutathione (GSH), a measure of Nrf2 (nuclear factorerythroid-2-related factor 2) activation11,12; total antioxidant capacity (TAC), the sum of low molecular weight scavengers of reactive oxygen species; malondialdehyde (MDA), a by-

Essa MM, Memon MA. Food as medicine. New York: Nova Biological, 2013.

Fekete SG, Brown DL. “Veterinary aspects and perspectives of nutrigenomics: A critical review”. Acta Vet Hung 2007; 55(2): 229-239.

Kaput J, Rodriguez RL. Nutritional genomics: Discovering the path to personalized nutrition. Somerset, NJ: John Wiley & Sons, 2006.

Swanson KS, Schook LB, Fahey GC. “Nutritional genomics: Implications for companion animals”. J Nutr 2003;133(10): 3033-3040.

Laflamme DP. “Nutritional care for aging cats and dogs”. Vet Clin N Am: Sm An Pract 2012; 42(4): 769-791. German JB, Roberts MA, Fay L, Watkins SM. “Metabolomics and individual metabolic assessment: the next great challenge for nutrition”. J Nutr, 2002; 132: 2486-2487.

McMichael M. “Timely topics in nutrition. Oxidative stress, antioxidants, and assessment of oxidative stress in dogs and cats”. J Am Vet Med Assoc. 2007; 231: 714-720.

Wang J, Schipper HM, Velly AM, et al. “Salivary markers of oxidative stress: a critical review”. Free Rad Biol Med 2015; 85: 95-104.

Dodds WJ, Callewaert DM. “Novel biomarkers for oxidative stress for veterinary medicine, Parts 1 and 2”. Proceedings AHVMA, Columbus. OH; Sept 2016.

Kangas K. “A review of oxidative stress and the Nrf2 pathway”. J Am Hol Vet Med Assoc 2016; 44: 8-13.

IVC Fall 2017

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URINARY TRACT DISEASE IN DOGS AND CATS By Jeff Nichol, DVM

Of the 74 million pet dogs in the US, 80% are kept indoors – with limited elimination opportunities. According to a VPI Top Media Conditions study, urinary signs are the number one reason cats are brought to veterinary clinics, and the ninth biggest presenting complaint from dog owners. A history of house soiling accounts for 18.5% of the shelter population, making urinary signs a leading cause of pet loss. Many of our clients know firsthand the misery of urinary disease. Once they understand the physical causes of their pets’ “accidents”, they’ll be ready to help us, as veterinarians, make a difference.

tablets, like CitraVet® tablets from PRN Pharmacal, can make a long term difference.

Uroliths in pets are a growing problem. According to the Minnesota Urolith Center, calcium oxalate has increased to 60% of canine uroliths and 55% of the calculi found in cats. Described as an epidemic, oxalates are now the most common urolith in each species.

Nobody’s happy with recurring bacterial cystitis either; it’s uncomfortable and can lead to struvite stones. Controlling bacterial adherence to the canine and feline bladder wall has been made easier with cranberry extract tablets like chewable CranMate®, a cost effective cranberry supplement also from PRN. Components found in cranberry supplements are postulated to inhibit fimbrial adhesion of bacteria, including uropathogenic E. coli. Bacteria are then flushed out during urination.

There are breed and sex predispositions. Calcium oxalate stones are more common in middle aged to older neutered male dogs. They occur more frequently in miniature Schnauzers, Lhasa apsos, Pomeranians and Shih tzus. In Bichon frises, young adult males face a higher risk. While there is no apparent sex predisposition in cats, ragdoll, British shorthair, foreign shorthair, Himalayan, Havana brown, Scottish fold, Persian, and exotic shorthair breeds have a higher incidence. Idiopathic hypercalcemia in cats, along with obesity and acidic highly concentrated urine in either species, are predisposing factors. They’re often subclinical, but when calcium oxalate cystoliths do cause physical signs they always warrant surgery. Postoperatively, these pets need our best efforts at preventing reoccurrence. Therapeutic diets and potassium citrate

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Chewable CitraVet® increases citrate levels in the bladder. According to research from the Minnesota Urolith Center, calcium binds to the citrate instead of the oxalate. Urate and cystine stones can also be controlled by the same mechanism. The supplemental potassium citrate in CitraVet® also increases urine alkalinity, which can further inhibit formation of oxalate cystoliths.

CranMate® is produced by a patented extraction process that eliminates unwanted sugar and oxalic acid – making it suitable for dogs and cats with diabetes mellitus. Pet owners are delighted with chewable CitraVet® and CranMate® because they are highly palatable and cost effective. Our work as practitioners is as rewarding as it is challenging. Client buy-in makes it easier to improve patient outcomes. Everybody wins.

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.

Recovering canine health: the natural dog By Michael W. Fox, DVM, and Deanna L. Krantz

Genetic abnormalities caused by extreme dog breeding are on the rise, while natural aboriginal dogs with robust health are in danger of extinction.

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The burden of genetic abnormalities in Canis familiaris, the first animal species that humans domesticated, has reached a critical state. Selective breeding for extreme abnormal traits, along with subsequent inbreeding, are to blame. “An associated cost of selection for specific traits in breed dogs is an enhanced likelihood of (inherited) disease,” states a study published in December of 2015 in the Proceedings of the National Academy of Science. UCLA geneticist Clare Marsden and her colleagues examined the genomes of 46 dogs from 34 distinct breeds, and compared them with the genomes of 19 wolves, 25 village dogs and one golden jackal (a more distant relative of wolves and dogs). They found that, compared to wolves, breed dogs had 22% more cases of genes that had not one, but two, copies of a harmful mutation, because it was inherited from both parents. Compared with wolves, breed dogs averaged around 115 more mutations that posed some risk to their well-being. The researchers concluded that their results “highlight the costs associated with selective breeding, and question the practice [of] favoring the breeding of individuals that best fit breed standards…. Considering that many modern breeds have been selected for unusual appearance and size, which reflects fashion more than function, our results raise ethical concerns about the creation of fancy breeds.” The growing popularity of “designer dogs”, cross-breeds of two or more pure breeds, is in part generated by consumer demand for certain traits such as nonshedding and small or large size. The probability that such mixed breeds may have fewer inherited disorders than pure breeds because of “hybrid vigor” is undermined by the possibility that both parental lineages from two separate breeds carry similar recessive harmful genetic mutations. It is advisable for people purchasing a pure breed or designer dog to receive assurances of progeny testing for hereditary diseases from the breeder/supplier; and when purchasing either very small or large breeds, or those with extreme body conformation and skull shapes, to purchase a veterinary health insurance policy that covers pre-existing conditions of hereditary origin.

THE DARK SIDE OF THE HUMAN-ANIMAL BOND

In a conference on the human-animal bond (Veterinary Record, December 5, 2015 p 558-559), University of Copenhagen bioethics professor Peter Sandoe observed that some people are attracted to and exhibit higher attachment to breeds with extreme (inherited) health problems requiring a higher level of care than healthy dogs. This observation implies there may be a Munchausenby-proxy dynamic in some peoples’ choice of particular pure breeds and that “an owner’s love towards an animal does not necessarily translate into good welfare for that animal.” Sandoe concluded: “There is a dark side to human attachment to companion animals, alongside some of the benefits of ownership.” One favored dog gene has a human counterpart that has been implicated in Williams-Beuren syndrome, where it causes exceptional gregariousness and friendliness toward strangers.

COMPARING SELECTIVELY BRED DOGS WITH NATIVE OR PARIAH DOGS Veterinarian Dr. Wayne H. Riser was one of the first to identify health problems arising from selective breeding for sizes and shapes that did not conform to what he saw as the ancestral aboriginal/pariah dog. (See his monograph “The Dog: His Varied Biological Makeup and Its Relationship to Orthopaedic Diseases”, American Animal Hospital Association, 1985. For further details, see M.W. Fox, The Dog: Its Domestication and Behavior, Dogwise Publications). This article will focus on my experience with the native dogs of the Nilgiris, South India, which I became familiar with while running an animal shelter and providing community veterinary services for a decade, starting in the late 1990s.

A PROFILE OF THE NATURAL DOG Natural, aboriginal dogs can still be found in many developing countries, especially in rural communities, as well as in the US, as detailed in my books Dog Body, Dog Mind and The Dog: Its Domestication and Behavior. One example is the so-called IVC Fall 2017

CLONING AND GENE EDITING Like it or not, the age of bioengineering cybergenetics is upon us. Chinese biotechnology firm Boyalife and South Korea’s Sooam Biotech are building what will be the world’s largest animal cloning facility in China. But genetically engineered/ edited and cloned animals often have genetic and developmental abnormalities and new diseases that cannot be justified for the novel pet trade. Dogs have joined the list of species that have been genetically edited; that list includes pigs, goats, monkeys, rabbits and rats. In December of 2015, Laura Jacques and Richard Remde of Yorkshire, England, received two new puppies, Chance and Shadow, who were cloned using their deceased dog Dylan’s DNA. The couple paid roughly $100,000 to have Dylan cloned at the Sooam Biotech Research Foundation in South Korea. Meanwhile, in another cloning project, scientists in China used what is called CRISPR/Cas9 gene editing technology, which enables multiple genes to be simultaneously altered to create two beagles that lack some or all of the muscleinhibiting protein, myostatin, resulting in dogs with largerthan-normal muscles. These activities raise profound ethical concerns. For more info, see my article “Don’t clone your dog”, as well as my DVD concerning earlier developments, at drfoxvet.net. 32

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An Indian villager feeding community dogs, some of which have homes/owners. Note the coat color diversity, but similar size and conformation.

Carolina dog or American dingo, originally a landrace or naturally selected type of dog that was discovered living as a wild or free roaming dog by Dr. I. Lehr Brisbin. A breed standard has been developed by the United Kennel Club that now specifies the appearance of these dogs, which could be their undoing if genetic diversity declines. We have met very similar dogs from some of the Native American Indian reservations in Minnesota and the Dakotas. In appearance, these dogs vary in size from 25 to 50 pounds, with many adults being undersized and underweight due to chronic malnutrition. They are long of limb, with usually erect or semi-erect ears. Tails are normally long and straight and are curled upward or downward in display, though some dogs have more permanently up-and-curled “Spitz” tails. Normally, all these dogs are protective and very faithful to their owners. They have good musculature, and the males are clearly more robust and have more powerful jaws than the females. All have characteristically small paws relative to their size, as compared to most modern breeds. The females are more protective

towards their puppies than non-native breeds; they will choose to whelp in a secluded place and may sometimes burrow a den. They will often nurse their pups for several weeks longer than other dogs do – pups may continue to be accepted as old as four to five months of age. The native dog’s sense of smell and tracking abilities are considered superior to that of most imported European breeds. They are skilled hunters, and tribal people rear these dogs to guide them in the forest and to hunt smaller animals. These dogs also instinctively alert to the scent tracks of potentially dangerous panthers, tigers, wild boar and cobras, and are especially on the alert after dark. They are noted for their courage and tenacity, and will defend their owners from wild boar and sloth bear attacks. Around other domestic animals, such as chickens, calves and goats, with which they normally live in villages and tribal settlements, they are gentle and even protective, most probably as a result of selective breeding and training. These dogs have great stamina and better resistance to many diseases when compared to imported breeds and cross-

breeds. They are able to sustain themselves as scavengers, often existing on a subsistence diet that for other dogs would frequently mean rickets, stunted growth and other deficiency diseases. They show innate nutritional wisdom, and have often been seen eating mineral-rich dirt, and the feces of suckling calves, which are rich in enzymes, bacteria and protein.

Typical Nilgiris red dogs.

The native dogs’ vocal repertoire varies considerably, and is generally rich and subtle in terms of sound combinations (like growl-whines, yelp-barks and pant-huffs), giving a clear indication of an animal’s emotional state and intentions. Some emit low “huffs” and growls when sensing danger, while others give full voice (not preferred when in the potentially dangerous jungle). They will give different barks when alerting to wild boar in the bush versus monkeys in trees, and will engage in coyote-like yip-yap howls when they sing in choral groups. One distinctive sound some of these dogs make in greeting is a coo-like twitter with high notes that sound like whistling, much like the whistle-call of the Dhole or Asiatic Wild dog. The Nilgiris native dogs’ coat colors include black, red, tan, white, piebald and brindle. The most characteristic coat color is red (or ruddy tan), possibly a parallel or convergent adaptive coloration seen in the indigenous wild dog (Cuon alpinus), also known as the Dhole or Chennai, one of the few wild canid species that hunts in packs. (For more details, see India’s Animals: Helping the Sacred & the Suffering by D. L. Krantz and M.W. Fox, Createspace Books, Amazon.com, 2016). Continued on page 34.

The bell-shaped curve illustrates how the susceptibility and severity of orthopedic diseases increase as size and shape either increase or decrease from the ancestral size. Changes greater than three standard deviations in either direction are capable of being lethal.

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Continued from page 33.

SAVING INDIGENOUS DOGS The Nilgiris native dogs, like other indigenous dogs around much of the world, are in a state of potential extinction due to breeders introducing foreign “exotic” European breeds that are seen as a status symbol. Many of these purebreds are deliberately crossed with the Nilgiris native dog, in part to help them adapt better to local conditions, which further dilutes and “contaminates” the genetic lineage of the indigenous dogs. Spay/neuter “birth control” programs have further reduced their numbers. Outside breeds contaminating the gene pool of this native lineage in the Nilgiris include the German shepherd (Alsatian), Doberman, Labrador retriever, Rottweiler, terriers and hounds brought in decades ago by British people, and more recently by affluent Indian citizens. A policy decision to not neuter classic phenotypes of this now-threatened domestic dog variety would be a wise move in this and other bioregions where there are viable populations of relatively “pure” indigenous aboriginal dogs. This would allow the conservation of an ancient lineage, and preserve the beauty and temperament of the Nilgiris native dog (and other indigenous dogs), which some believe is the classic prototype of the earliest domesticated dog.

The author has two indigenous dogs from Nilgiris (left and right).

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IN THE WEST Concerted efforts in the West to reduce indigenous/ aboriginal dog numbers by various means (both humane and inhumane) for public health reasons (especially rabies control) may actually lead to the disappearance of landraces and the loss of genetic diversity in regional canine populations. Bingo is a prototypical Nilgiris aboriginal “country” dog.

industry innovations Nutritional support for the immune system

Veterinary equipment exchange network

A healthy immune system is one of the best ways to help prevent disease and maintain optimal wellness. NOW® Pets Immune Support for dogs and cats is designed to help support a pet’s immune system and his innate resistance to pathogens. It also helps enhance liver and kidney function. This product is made with natural botanicals, including an organic mushroom blend, turmeric root extract and licorice root, and has been formulated by renowned veterinarian Dr. Barbara Royal, DVM, CVA, founder of The Royal Treatment Veterinary Center. nowfoods.com/pet-health

If you’re looking to buy or sell veterinary equipment, a Canadian equipment exchange network has recently expanded into the US. Canmedical Canada and VEENCanada are proud to announce the launch of VEENAmerica. VEEN connects buyers and sellers of surplus veterinary equipment. It provides a forum for vet clinics across North America to link up with each other, and all transactions are brokered by VEENAmerica. It also arranges the logistics, so items can be shipped all over the US and Canada as well as international locations. This is the first North American network of its kind, and has been successfully operating in Canada for four years. VEENAmerica and VEENCanada are underwritten and managed by Canmedical (Canada) which has been in business for over 35 years. Contact info@veenamerica. com or 613-358-5658 or visit veenamerica.com.

Do you or your clients feed raw diets? Feeding dogs and cats a raw diet offers multiple health benefits in most cases, although many people are deterred from this dietary choice due to the risk of foodborne pathogens. But how often do humans actually get sick from handling raw pet food? The DOGRISK research group at the University of Helsinki is calling on those who feed or have fed raw diets to their dogs and cats to complete a brief questionnaire. The results will help determine the true incidence of human illness arising from the handling of raw food pet diets. Visit elomake.helsinki.ﬁ/ lomakkeet/80691/lomake.html to complete the survey.

Want to learn about essential oils? Used correctly, high quality essential oils can have powerful healing effects. Adding them to your practice can widen your client base and result in supplemental income. YLVets and Pets is comprised of three holistic veterinarians and a certified clinical aromatherapist. Drs. Susan Albright, Debra Rykoff and John J Hanover, along with Sherry LaMarche, CCA, each have over 15 years of experience integrating essential oils into their clinical practices. They offer assistance with incorporating Young Living essential oils and wellness products into a healthcare regimen tailored for individual people and pets. By providing “Lunch and Learns”, webinars, educational and business tools, YLVets and Pets assists you in forming a solid professional foundation in the use of essential oils. Contact LisaYL@outlook.com or 630-205-6226. IVC Fall 2017

integrative practice

A new business model for

INTEGRATIVE

VETERINARY PRACTICE This new model of integrative veterinary practice combines treating patients with educating clients. By Odette Suter, DVM, CVA, CVSMT, MA

Many integrative and holistic veterinary practitioners share similar frustrations. Even though we provide as much education and explanation as we can for the reasons behind holistic and proactive care, clients still often look for a quick fix. Many come to us with limited funds, having already spent hundreds on diagnostics and failed treatments. Even clients with young animals wait until an obvious illness occurs rather than following our guidelines for building health and preventing problems.

teeth properly. It wasn’t until she heard me speak at a lecture that addressed teeth, the TMJ and hyoid apparatus that the coin finally dropped. That’s when I realized clients don’t hear half of what I explain to them when their animals are present. Maybe they are worried, the material is too new to them, or they’re too emotional, so the knowledge doesn’t stick?

The more I learned about true healing and what it really takes to achieve it, the more frustrated I became with what I offered my clients and what they were willing to do. I felt as if I was working with both hands tied behind my back, unable to help my animal patients the way I’d be able to if their guardians would only let me. Attempting to educate clients during the short time they spent in my office yielded limited results, because despite my efforts to emphasize prevention, I often wouldn’t see them again until something else went wrong with their pets.

These frustrations didn’t really change when I opened my own practice, because now I also had to face my lack of business skills. In search of better ways to practice, I asked myself: “What if I could train people so their animals stayed healthy until they die of old age, just like my grandparents did?”

One experience gave me a new perspective on running my practice. I had been talking repeatedly to one of my clients about the importance of proper dental work for her horse, but on some level she still didn’t understand how crucial it was to work with an equine dentist who knew how to balance

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In addition, I kept meeting animals in their eleventh hour when their people were distraught and financially drained.

Luckily, that’s when I came across an opportunity to learn about an entirely different business model that has changed the way I work. My new model of integrative veterinary practice combines treating my patients with educating my clients. I still mostly see patients in desperate need of healing, with the occasional holistically-minded client who already cares for his/her animals in proactive ways. The difference is that I now train clients in the art of health and prevention. This benefits their sick pets

while building health for any other animals they have or will share their life with in the future. The format of my treatment and teaching practice has five distinct parts: q Pre-education w Initial consultation e Treating and teaching r Graduation t Membership

1. PRE-EDUCATION

When potential clients call my office, I briefly explain that I work differently than most veterinarians. Currently, I have no staff. I ask them to watch a video lecture or invite them to one of my in-person talks so they better understand what I do and why I do it. During this pre-education, I take them step by step from the “quick fix” belief to knowing what it will really take to truly turn their animals’ health around. By the end, they know the true meaning of symptoms and that to restore their animals’ health they need to address the root cause of problems. I explain some basic physiologic needs to point out that everything is connected and that the body needs to be taken care of as a whole. I also go through the six pillars of health with them: nutrition, GI tract, detox, hormones, nervous system, fitness and exercise. This helps them recognize that if they address all these aspects of healing together, they will get much better and faster improvement than if they only work with one body part at a time. This approach was key to my own personal healing from auto-immune disease. This pre-education process prepares potential clients for understanding the need to invest time and money into their animals’ healing and future health-building. Pre-education also helps me weed out people who are looking for something else, and saves me time during consultations. At the end of a live talk, potential clients get the option to sign up for an initial consultation. Those who watch the video at home are usually already scheduled for an appointment.

2. INITIAL CONSULTATION

In preparation for our first consultation, I email the client a questionnaire to send back to me along with veterinary records and lab results. This allows me to prepare for the consultation with a plan of action for his or her animal. The purpose of this first meeting is to go over the questionnaire, explain the treatment plan I envision for the patient, and talk about the program I recommend for the animal depending on IVC Fall 2017

age and level of health. In a way, it is a bit like an interview for both parties. The investment for the program is explained. If the client decides this is the path she wants to take, we get started with lab work. The physical exam is usually done once the lab results are in and we meet again. I offer three different programs, each of which includes an education component.

Odette giving a public pre-education lecture in a pet store.

COST/INVESTMENT All my program costs are bundled. This allows me to offer outside financing and also takes money off the table to focus on healing rather than the cost of supplements, etc. As a result, I can give patients what I deem most helpful without their guardians having to worry about expenses every time I see them. The investment can range anywhere from $2,500 to $4,000+ depending on the size of the animal and the duration of the program. Three payment options are available: q One time investment at initial visit; clients receive an extra 5% off. w Three monthly payments with the first due at the time of initial visit. e Outside financing for up to 60 months. This fee covers the following: • Individualized program design, including any research I need to do • Initial lab work • Supplements and neutraceuticals • All treatments and consults • One-on-one mentoring and support outside of appointments • Educational materials • Eight classes Additional lab work necessary to re-check progress is charged extra. Supplements usually last at least three months. There might be extra cost depending on what the animal needs. To offset any interest clients might incur from outside financing, I deduct 10% from the total program investment for everyone. 38

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• “Jump Start to a Healthy Life” is for puppies, kittens and foals. Depending on how old the animal is, the duration of this program can be as long as 12 to 15 months. Initially, the animal gets a little more attention just to get him or her on a good diet, detox some of the vaccines he might have received, and assure that his nervous system is innervating all parts of the body properly so he can grow up with good alignment and decreased risk of injury. Follow-up visits take place about every other month depending on need. This program allows me to help prevent over-vaccination and the application of other toxic substances, and to be sure the client is continuing to take steps to maximize his/ her animal’s health. • The “Optimizing Health” program is for adult animals with no health issues and a guardian who wants to prevent illness from arising down the road. The duration is 16 weeks and includes approximately four visits, during which I walk the client through nutrition, GI health, detox and the rest of the six pillars, all individualized for his/her animal. • The “Wellness Program” is for animals with more significant health issues. Its duration is six months and includes more visits, treatments and supplements.

3. TREATING AND TEACHING

The goal here is to restore and maximize a patient’s health while the client goes through an educational series of classes. By the time he/she graduates from this program, he/she understands what is required to create and maintain health. • The treatment part always starts out with a physical exam and a review of lab results. The client receives a binder containing important information, as well as the initial supplements included in his/her program fee. Optimizing nutrition and healing the gastrointestinal system is the first step for all programs. Once a good degree of stability is achieved, most patients go through a detox program. From the first visit, to support bodily healing, patients receive a variety of treatments such as chiropractic care, acupuncture,

microbiome restorative therapy, NAET treatments, ozone therapy, and hormonal support. In the first half of the program, I see patients approximately every two weeks, more often if necessary. After that, the consults usually spread out to every three to four weeks. • The education part is key to my success. While patients are receiving treatment, their guardians go through a series of eight classes. The sessions take place at a local juicery every other week in the evenings for about one to one-and-a-half hours. These classes also introduce people to some healthy support for themselves. Alternately, clients can choose the online option and watch the classes in the comfort of their own homes. This series of videos is also available to other holistic veterinarians to incorporate into their own practices. The classes include: • Nutrition Basics • Nutrition Application • GI Health • Detox • Nervous System • Hormones • Heartworm • Vaccines • Fitness/Exercise with an outside trainer specializing in balance and correct muscle development to enhance performance and avoid injuries

4. GRADUATION AND MEMBERSHIP

Once they complete the program, most people will continue on for maintenance or further healing if necessary.

At that point, I offer three membership options including four to 12 visits per year and different discount levels for labs and supplements, depending on the plan they choose.

CHALLENGES AND WINS Of course difficulties are never lacking. This method of practicing comes with its own set of challenges, depending mostly on the practitioner’s strengths and weaknesses. For me, marketing and getting people to sign up for the program is the most challenging part. I’ve had to make many adjustments to find a way that suits me best. On the bright side, it has pushed me to learn about many business-related considerations I had no clue about. As with any patient’s care, I have to be very creative and flexible and find ways to think outside the box. It is an ongoing process, for sure, and as they say: “no pain, no gain”. When I first switched over to this approach, I was only offering the programs. Realizing that I was turning away too many patients who either couldn’t afford the whole package, or still needed a little more time to get on board, I now recommend the program as a starting point of the financial discussion, and then work with people at the level they’re comfortable with. All in all, it is exciting to try on a new business model. I’ve been much happier with the results I see in my patients, and feel more fulfilled practicing this way, because I can give everything I have. It’s heartwarming to see how my clients change as they learn. Many have even applied the education they receive to their own health. In addition, getting paid for all the hours I spend researching and teaching is certainly nice!

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Seaweeds By Bill Wolf and Marjorie M. Lewter, DVM

F O R A N I M A L H E A LT H

Seaweeds and kelps are proving to be powerful tools for skin, hoof and coat health, digestive improvements, and more.

Seaweeds have been an important component of mammalian diets throughout evolutionary history. They provided the one sure way for humans to avoid the goiter and cretinism caused by iodine deficiency – and they have proven useful for companion animal health as well. Knowing why, when and how to use quality seaweeds can you help best deliver the benefits of the powerful nutrients they contain. “Seaweed” is a general term for marine macro-algae. Most of the earth’s oxygen comes from seaweeds.1 Phycologists, the scientists who study macro-algae, divide them into three groups: brown algae, red algae and green algae, which together comprise over 20,000 different seaweeds. Names for marine ocean macro-algae mentioned in recent IVC Journal articles include “sea vegetable”, “kelp”, “bladderwrack” and “fucus”. Most of the seaweed used in pet foods and supplements are brown algae from the Laminaria and Fucus families.

HOW SEAWEEDS DIFFER FROM LAND PLANTS Land plants draw only on the limited resources of the footprint of soil in which they are growing. In contrast, seaweeds collect nutrients through their fronds from the abundant resources in circulating seawater. The fronds of seaweeds are like plant leaves and the holdfasts are like the roots of terrestrial plants. While land plants use roots to absorb nutrients, sea plants use their fronds. This absorption method gives seaweeds a nutrient

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profile advantage because they are such powerful collectors of the minerals and phytonutrients in the areas where they grow. Ocean water is literally the lifeblood of the planet, containing all essential nutrients in similar ratios to those in the mammalian bloodstream.2 Thus, seaweeds can deliver a very consistent and powerful mineral profile. In turn, there are vast differences in the minerals and biochemicals each species of seaweed collects and stores. The difference between land and sea plants makes seaweeds a more powerful source of micronutrients and phytonutrients, providing they are properly selected, harvested and processed to retain the targeted nutrient profile. Knowing the genus and species of the “kelp” or “seaweed” you are using can guide you to its nutrient content. However, feed labeling laws do not require species identification and allow broad terms like “seaweed” and “kelp” in ingredient panels. The term “seaweed” can refer to any marine macro-algae, while the term “kelp” is permitted to include any Laminaria or Fucus species, according to feed control officials.

EVALUATING QUALITY What about ocean pollution, radiation, heavy metals, sustainability and quality? How do you know what you are getting? Look for sources harvested from clean waters

in remote locations, and that are quickly processed and dried. USDA Organic certification is one way to assure site and processing have been inspected for cleanliness and sustainability. Kosher certification of the original harvest is another way to assure third party inspection for purity.

Mowing machine harvesting Ascophyllum in managed organic beds in Iceland during a certiďŹ ed organic inspection.

Some harvest sites are richer in baseline nutrients; these include bays with geothermal vents and mineral-rich estuaries or rivers. This converts to higher nutrients in the harvestable seaweed. Rapid collection and drying are important because many of the minerals, including iodine, are freshwater soluble and can be washed away if improperly handled.3 Carefully reducing the moisture content to less than 10% helps assure stability and deliverability to animals. Ascophyllum nodosum, a brown Fucus seaweed growing in the tidal zones of the North Atlantic from New England to Canada, Iceland and northern Europe, is the most common species harvested for animal nutrition. Harvest methods range from hand-cutting with a seaweed knife, to custom vacuum cutters, to mowing (like cutting hay) at midtide. Thousands of tons of wet wild harvested Ascophyllum are dried using methods such as outdoor windrowing (similar to drying hay in the field), high-temperature drum drying, and lower temperature conveyor belt drying using geothermal heated air. The highest quality, most consistent, effective and sustainable products rely on mapping the beds, mowing on a four to five-year cycle, and converting geothermal energy to hot air for controlled drying.

WHATâ&#x20AC;&#x2122;S IN SEAWEED? Interestingly, macro-algae or seaweeds are most notable as a source of micro-nutrients, including over 60 mineral elements. Iodine: Seaweeds are historically known as a rich source of iodine, an essential nutrient for thyroid and metabolic health. Iodine content can range from 50 ppm in some of the fast-growing seaweeds, such as red algae of the genus Pyropia (used for sushi nori), to 7,500 ppm in true deep-water kelps like Laminaria digitata. The range for Ascophylum is 300 to 1,200 ppm. Consistent and reliable delivery of a uniform quantity of iodine depends on careful harvest and post-harvest handling and drying. Some suppliers provide detailed specifications and analysis as well as custom blending and formulations to uniformly target iodine delivery levels. Iodine in kelp is present as iodide,4,5 which is easily absorbed. Too much or too little iodine in the diet can cause a range of problems, including goiter, hyperthyroidism and hypothyroidism, infertility, and cognitive dysfunction.6 Iodine is an essential nutritional element required in very small amounts by animals. It is a constituent of the thyroid hormones thyroxine (T4) and tri-iodothyronine (T3), which play a major role in cell differentiation, growth and development in growing animals and in the regulation of metabolic rates in adult animals. Clinical signs of iodine deficiency Continued on page 43.

Annie Gardiner of Berkeley, CA with one of her favorite chickens; both love kelp.

Gusâ&#x20AC;&#x2122; coat condition before kelp was added to his diet.

Gus after six months of kelp supplementation.

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REPORTS FROM CLINICAL PRACTICE15

Kelp, specifically A. nodosum, is recommended by leading holistic veterinarians as a supplement in homemade diets for dogs and cats, and by large animal vets as a nutritional supplement for poultry, cattle, goats, alpacas and horses. It is one of the few dietary ingredients that contain essential iodine for the thyroid gland and immune system. Many commercial and raw food diets, including The Honest Kitchen, Sojos, and Fresh Pet, use kelp as a source of natural iodine rather than the synthetic sources such as calcium iodate or potassium iodide found in commercial kibble. Many practitioners realize that seaweeds are different than other green supplements because they deliver different nutrients from land vegetation and microalgae grown in fresh water. Because of their concentrated trace minerals, only a small quantity is needed, and seaweeds are appropriate for daily use. Freshwater microalgae and land plants like alfalfa have their own health benefits and can be used along with seaweed species for veterinary patients. • Most practitioners recognize that low thyroid function is rampant in our canine population. Many of the problems we see daily, such as skin conditions, allergies, obesity and even seizures, are related to low thyroid function. The usual blood tests are poor at detecting early thyroid dysfunction. Dr. Jean Dodds notes that kelp can be used to aid in correcting hypothyroidism. Providing the essential nutrients of iodine and selenium for optimal thyroid gland function is critical for returning the animal to health before irreversible changes occur. • Practitioners also recognize that along with the benefits seaweed offers in the daily diet as a source of iodine and trace minerals, it can additionally be used to help treat disease conditions in veterinary patients. The salty taste is valued in Chinese Food Therapy for therapeutic support. For example, Dr. Connie Dinatale has used red algae seaweed P. yezoensis L (nori) to shrink lipomas in her food therapy practice. The salty taste of seaweed enhances palatability and is well accepted by patients of all species. • Dr. Cynthia Lankenau states that kelp is a balanced supplement with a strong Yin quality, but also a strong Qi moving ability. In particular, it is a Kidney Qi mover with a Spleen Qi mover, and cleanses lymphatics. She finds it beneficial for dogs with lymphoma, congestive heart failure, diabetes, renal dropsy and poor coats. Horses with founder benefit from an improvement in the lamina of the hoof. Dr. Lankenau’s alpaca clients have stated that kelp species such as Ascophyllum nodosum improve the fiber quality of the alpaca diet. • Other practitioners like kelp because of its benefits to cancer patients. As holistic practitioners, we know that giving patients the fuel they need for a fully functioning immune system is critical to managing every disease, including cancer. • Dr. Rick Palmquist shares the case of an aged dog that was mauled by a coyote. After a protracted recovery, the dog’s coat was poor and his hair did not grow back. His thyroid tests were below normal. When a small amount of kelp was added to the dog’s diet, his hair began growing back darker and thicker, within two weeks. • Dr. Barbara Royal finds kelp especially useful in younger patients that tend to be overweight after spaying or neutering. She feels that removing the gonads, which are important endocrine organs, leads to a system-wide imbalance of many other organs and endocrine tissues, which must compensate for the rest of the patient’s life. Holistic veterinarians want the purest available source of kelp for their patients. Kelp that is certified organic and carefully harvested from colder ocean waters is more likely to be a reliable product that does not vary in quality. All in all, seaweeds and kelps are proving to be powerful and useful tools for skin, hoof and coat health, digestive improvements, and even improved conception rates. Supporting the thyroid gland with quality kelp allows the endocrine and immune systems to function at their best to maintain wellness and resist disease.

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Continued from page 41. include goiter (enlargement of the thyroid gland), alopecia (hair loss), dry sparse hair coat, and weight gain. An all-meat diet can produce iodine deficiency.7 Too much iodine can be toxic. Clinical signs may include excessive lacrimation, salivation, nasal discharge, and a flaky dry skin. Paradoxically, goiter can be a sign of iodine excess as well as deficiency. High plasma concentrations of iodine can inhibit the production of thyroid hormones by the thyroid gland. Seaweed supplements should be correctly dosed to obtain the most benefits from their nutrient content (see sidebar on page 44). Routine inclusion of seaweed is easiest when it is used as an ingredient in a reliable prepared food. But it can also be added, top-dressed, or in limited cases, provided as a free-choice supplement. Assuming a guaranteed and consistent analysis of 750 ppm, kelp should make up a very small amount of the total dry ration. For dogs and cats, we are talking about 0.25% of their dry matter intake, 0.1% for horses, and 0.5% for goats and chickens. Eggs from chickens fed kelp show darker yolks and higher nutrition including iodine.8 Rabbits are special, with a minimum iodine requirement of only 0.2 ppm of diet.9 The iodine requirement for any animal will be higher if the diet includes substantial amounts of cabbage or other Brassica species, which contain natural goitrogens and increase the need for iodine.10 Trace minerals and complex phytonutrients: The vast array of 60 other trace minerals and complex phytonutrients found in seaweeds is incredibly valuable to animal health. Complex bioactive compounds such as polysaccharides promote digestive activity and immune function. Trace levels of vitamin E have been attributed to improved conception rates. Continued on page 44.

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Hall J. “The Most Important Organism?” 2011 [cited 2017 4 August]; Available from ecology.com/2011/09/12/ important-organism/.

Thompson DJ. “Seawater: A blood plasma substitute?” Nexus Magazine, 2006. 13(6).

Teas J, et al, “Variability of iodine content in common commercially available edible seaweeds”. Thyroid, 2004. 14(10): p. 836-41.

Kupper FC, et al. “Iodide accumulation provides kelp with an inorganic antioxidant impacting atmospheric chemistry”. Proc Natl Acad Sci U S A, 2008. 105(19): p. 6954-8.

Lin L, Chen G, Chen Y, “Determination of iodine and its species in plant samples using ion chromatographyinductively coupled plasma mass spectrometry” Se Pu, 2011. 29(7): p. 662-6.

Continued from page 43.

Office of Dietary Supplements National Institutes of Health. “Iodine – Fact Sheet for Health Professionals”. June 24, 2011 [cited 2017 August 3]; Available from ods.od.nih.gov/factsheets/Iodine-HealthProfessional/.

Along with iodine, seaweeds can help with subtle dietary deficiencies, providing very trace quantities of a range of micronutrients. Consider selenium. Kelp accumulates selenium from seawater, and converts as much as 85% of it into organic selenium species11 of high biological activity. In animal studies, kelp has been found to protect against the mammary carcinogenic effect of dimethylbenz[a]anthracene (DMBA).12 These findings suggest that selenium may be responsible for the low incidence of breast cancer in Japanese women, who consume a diet with iodine-rich and seleniumcontaining seaweed.13,14 Seaweed is most useful as a baseline preventative nutrient source in the diet. In some cases, it is also an effective treatment when specific problems indicate thyroid iodine deficiency.

National Research Council, Nutrient Requirements of Dogs and Cats. 2006, Washington, DC: The National Academies Press.

Jacob J. “Seaweed in Poultry Diets” 2015 [cited 2017 4 August]; Available from: articles.extension.org/ pages/65717/seaweed-in-poultry-diets.

National Research Council Committee on Animal Nutrition, “Nutrient Requirements of Rabbits”, 1977, National Academy Press.

Chesney AM, Clawson TA, Webster B. “Endemic goitre in rabbits. I. Incidence and characteristics”. Bull Johns Hopkins Hosp, 1928. 43: p. 261-277.

Yan X, et al. “Enriched accumulation and biotransformation of selenium in the edible seaweed Laminaria japonica”. J Agric Food Chem, 2004. 52(21): p. 6460-4.

Maruyama H, Watanabe K, Yamamoto I.“Effect of dietary kelp on lipid peroxidation and glutathione peroxidase activity in livers of rats given breast carcinogen DMBA”. Nutr Cancer, 1991. 15(3-4): p. 221-8.

Smyth PP. “The thyroid, iodine and breast cancer”. Breast Cancer Res, 2003. 5(5): p. 235-8.

Cann SA, van Netten JP, van Netten C. “Hypothesis: iodine, selenium and the development of breast cancer”. Cancer Causes Control, 2000. 11(2): p. 121-7.

Clinical Practice Interviews: Dr. Constance Dinatale, Veterinary Acupuncture and Complementary Therapy, Winter Park, FL; Dr. Cynthia Lankenau, Holistic Center for Veterinary Care, Coldon, NY; Dr. Rick Palmquist, Centinela Animal Hospital, Inc., Inglewood, CA; Dr. Barbara Royal, The Royal Treatment Veterinary Center, Chicago, IL; Dr. Jean Dodds, Hemopet, Garden Grove, CA.

Kelp feed rates for companion animals Based on a kelp product with an iodine content of 750 ppm Ideal application is by inclusion in formulation, but controlled dosing is acceptable. Suggested feeding rates per day Species

Quantity by weight

% of Dry Matter Intake (DMI)

Quantity of kelp per animal per day

Minimum-maximum daily iodine range by DMI (*6,7)

Dogs

per 25 lbs of body weight

0.25%

220 mg

0.9 - 5 mg/kg

Cats

per 5 lbs of body weight

0.25%

65 mg

1.4 - 5 mg/kg

Horses

per 500 lbs of body weight

0.1%

7 g (¼ oz)*

0.4 - 5 mg/kg

Goats

per 50 lbs of body weight

0.5%

7 g (¼ oz)*

0.5 - 50 mg/kg

Chickens

per 25 lbs of grain

0.5%

113 g (4 oz)*

0.35 - 300 mg/kg

National Research Council recommended iodine daily allowance range. *⅛ oz = ¾ tsp; ¼ oz = 1½ tsp; ½ oz. = 1 tbsp Generally not recommended for nursing young when the mother is already on kelp. Dogs: Add kelp at 0.25% of Dry Matter Intake (DMI), sprinkle on or mix into food daily. Cats: Add kelp at 0.25% DMI, or sprinkle a pinch of kelp on food daily. Reduce rates if the food or supplement already meets iodine requirements. Horses: Mix in feed at 0.1% of Dry Matter Intake (DMI). Feed ¼ oz of kelp per 500 lbs of body weight, generally not to exceed ½ oz per head per day. Mix into grain ration or apply as top dressing. Reduce rates if your feed or feed supplement already meets iodine requirements. Goats: Mix in feed at 0.5% of Dry Matter Intake (DMI). Feed ¼ oz of kelp per 50 lbs of body weight. Kelp can also be fed free choice, alone or with salt. Chickens: Mix in feed at 0.5% of Dry Matter Intake (DMI) or mix 4 oz of kelp into 25 lbs of grain ration, or apply as top dressing.

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From the

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

News and updates Although we didn’t have a major donor this year, our Spring Fundraiser generated $21,722 in cash donations, $2,000 in-kind donations, and a pledge for $2,000. In other news, the Foundation funded a pilot study of GMO and glyphosphate in dog foods. AHVMF’s Executive Director, Dr. Nancy Scanlan, will complete the report, extend the study, and submit it to a peer-reviewed journal.

Grant proposals Three new grant proposals were received:

q Erin

Bannink, board-certified veterinary oncologist, submitted a proposal to study herbal therapy in dogs with hemangiosarcoma (in addition to conventional therapy).

w North Carolina State University wants to study the effects of laser therapy in increasing the speed of shell healing in turtles hit by cars. With standard care, it can take over a year for them to heal.

e Dr.

Scanlan has proposed an online database of GMO and glyphosphate levels in pet foods. This would be an extension of the original GMO study mentioned above.

All proposals were approved for partial or full funding by the grants committee. Because we do not have enough money to fund all three studies, the Executive Director will do extremely targeted fundraising for each one, including potential untapped sources. There will be an individual webpage on the AHVMF website (ahvmf.org) for each study, so those with a special interest in any of the three topics (integrative medicine for hemangiosarcoma (HSA), turtle rescue and treatments, or GMOs in pet foods) can go directly to the page of their choice and find ways they can help fund these projects.

• Those interested in contributing to hemangiosarcoma research can read information about the disease, including the fact that research has not found drugs that markedly extend the lifespan of HAS victims. • Those interested in turtles will be directed to the box turtle research page. We hope to attract a new category of donors who like reptiles and show them the benefits integrative medicine can offer them. • Those interested in GMOs will be encouraged to donate to test a specific pet food. We believe pet owners should have access to information about GMOs in the food they are giving their pets, so once enough foods have been tested they will be posted online as a database. The database will be available by subscription, and dues will be applied to the testing of more pet foods. The ultimate goal will be to test all foods on the market.

Student support This important part of our mission also needs funding. SAHVMA delegates are supported along with scholarships to students wanting integrative training. Help us by bidding at our Silent Auction at the AHVMA conference in October.

Education support Producing high quality research supports deans who favor integrative courses that are evidence-based. Sue Howell has joined our Research committee. She was the official veterinarian for Standard Process, and has already created new opportunities for the AHVMF to begin discussions about nutraceuticals research. We welcome anyone who is interested in promoting research in integrative holistic veterinary medicine to join us. Contact office@ahvmf.org.

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By Jenny Johnson, VMD, IVCA Certified in Animal Chiropractic

SHOCKWAVE THERAPY

This non-invasive modality can successfully treat a range of orthopedic and soft tissue problems in animals. Though most commonly used for horses, shockwave therapy also has many applications in small animal practice. 46

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â&#x20AC;&#x201C; a great adjunct to the veterinary practice

Shockwave therapy is a non-invasive treatment that can speed the healing of many types of orthopedic and soft tissue injuries and conditions. It has been used in Europe in human medicine to treat tennis elbow, plantar fasciitis, rotator cuff injuries, calcifying tendonitis of the shoulder, femoral head necrosis, non-union fractures, wounds, burns, osteomyelitis with draining tracts, myofascial pain and more. New research has shown potential applications in treating periodontal disease, infected wounds, and to help speed fracture healing and reduce the incidence of nonunion fractures. In the United States, shockwave therapy has been successfully used for many years in veterinary medicine to treat animals with both acute and chronic soft tissue injuries, bone and joint disease, and back pain. It is also used to aid in wound healing, with and without infection, and to stimulate bone healing, particularly in the case of nonunion fracture cases. Shockwave therapy is widely accepted in equine practice and is commonly used to treat many orthopedic conditions, both bony and soft tissue. While its use is less common in small animal practice, the applications are still numerous. One key to success is an accurate diagnosis and a clearly defined area of injury so you can direct the shockwave to the appropriate area.

SHOCKWAVE USE IN EQUINE PRACTICE In my practice, shockwave therapy is most often used for suspensory ligament injuries, even with avulsion fractures. It can be used on its own for acute injuries or in conjunction with stem cell therapy, PRP injections, or IRAP. It can also be very effective in managing chronic suspensory inflammation of either the body or the branches of the suspensory ligament. It can be a key component in the therapy and rehabilitation of hind limb suspensory ligament injuries, which present a challenging diagnosis at best. In addition to the initial series of treatments in the case of an acute injury, I will also often periodically use shockwave therapy as the horse comes back into work, in an effort to continue to help stimulate healing and remodeling of the injured area. Good response is also seen in horses with sore backs, including those with muscular pain and pain related to kissing spines. It may be used on its own or in combination with other therapies such as corticosteroid injection of the back musculature, or of the interspinous spaces in the case of kissing spines. I also frequently use shockwave therapy to treat horses with neck pain, including in the upper cervical region and at the poll. I often combine shockwave therapy with chiropractic care in horses with neck, poll or back pain; I find that this combination of therapies can be very effective in managing and relieving pain in these areas.

as stem cell or PRP, I would ideally complete one shockwave treatment prior to the regenerative therapy and then would do the second shockwave at three to four weeks after the regenerative treatment, then the third shockwave three weeks after the second treatment. In cases of osteoarthritis, the protocol is similar, depending on the severity of the degenerative changes. Typically, I would recommend a series of three treatments, spaced at threeweek intervals. However, if I don’t see at least a modest improvement by three weeks after the second treatment, I would not do a third. In cases of osteoarthritis that respond well to shockwave therapy, I frequently find it useful to do single “booster” treatments at intervals ranging from three to six months, depending on the individual, his or her workload, and overall response to treatment. In some cases of ringbone, I have had a response lasting up to two years from the initial series alone, and have then come back and done a second series of three, also with positive results. More commonly, I recommend re-treating the horse at a shorter interval in an effort to stay ahead of any decline in comfort. In cases of The author most often uses shockwave therapy for her equine patients. It’s helpful for both acute and chronic conditions.

Other uses include: • Tendon tears and strains • Osteoarthritis • Collateral ligament injuries • Navicular syndrome • Ringbone • Joint inflammation and pain • Neck pain • Muscle tears and strains • Infected or large wounds • Burns

Treatment protocol in equines The precise treatment protocol depends on the diagnosis of each individual patient. Treatment varies in the number of shockwaves administered and the energy of those shockwaves. Most acute soft tissue injuries are treated a total of three times spaced at two to three week intervals. I typically recommend a re-check exam at three to four weeks after the third treatment to assess the healing that has taken place. In some cases, additional treatments are needed. If shockwave therapy is being used in conjunction with a regenerative therapy such IVC Fall 2017

navicular disease, I also typically recommend a series of three treatments done at shoeing intervals (the frog needs to be pared down and the foot soaked overnight prior to treatment), with “booster” treatments done at three to six month intervals. The treatments are easily performed at the horse’s home barn, typically with the horse under mild sedation. Sedation may not be necessary, such as when shockwaving the back, neck, or chronic suspensory branches. In cases of acute or recent injuries, sedation is almost always required. Typically, the horse will start to experience some reduction in pain and/or swelling within hours. This relief will generally last two to four days, then the horse will return to almost his original status. Over the next two to three weeks, however, actual healing will take place. The early response or improvement in comfort is seen both in horses with recent injuries and those with more chronic problems. Major medical insurance policies for equines will reimburse owners for the cost of focused shockwave therapy. Each policy differs in the coverage offered.

Equine case report Mary was an 18-year-old Welsh Cob mare used in competitive trail riding (mountainous terrain). She had ringbone RF and was approximately +2 of 5 lame, despite treatment involving corrective shoeing and NSAID therapy. I treated Mary with a series of three shockwave therapy sessions and she was able to return to her previous level of performance for a period of two years, with only intermittent NSAID use. Two years after her initial shockwave therapy series, I did a second series of three treatments and Mary was able to continue competing for one additional year. At that point, the owner opted to retire her. Ringbone is a particularly challenging diagnosis, with limited therapeutic options, so an additional three years of competing thrilled Mary’s owner.

SHOCKWAVE USE IN SMALL ANIMAL PRACTICE Shockwave therapy has been successfully used to treat many soft tissue and bony problems, both acute and chronic, in small animals. These include, but are not limited to: • Hip dysplasia • Non-union fractures • Degenerative joint disease • Spondylosis • Lumbosacral pain • Osteoarthritis

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• Tendon and ligament injuries • Bursitis • Muscle tears and strains • Wounds • Lick granulomas

Treatment protocol in small animals As with horses, the precise treatment protocol depends on the diagnosis of each individual patient. I work with several small animal practices in my area and have helped educate the clinicians about cases that may benefit from a referral for shockwave therapy. If, after learning the details of the case, I think it may be useful, I will then speak with the pet’s owner by phone to discuss the therapy and the expected results, as well as protocol and cost. Some pet insurance companies will cover shockwave therapy for small animals; this is frequently a determining factor in whether or not the owner will opt for it. If the owner decides to proceed with shockwave therapy, I schedule an appointment at their regular veterinarian’s clinic, and request that the pet come prepared for anesthesia (eight-hour fast). I will then examine the animal and finalize discussions with the owner. We proceed with anesthesia and the treatment is carried out. For follow-up, I request that the owner keep the pet quiet, with leash walks only, for three days after the treatment, then gradually (over a week) return to a normal level of activity. I typically will re-check at ten days and three weeks. At the three-week visit, I again ask that the pet come in fasted and prepped for anesthesia. If, at the three-week exam, the pet has achieved an excellent result, I will opt not to do an additional treatment. If the pet has not achieved the

desired improvement, then I will do a second treatment with the same follow-up schedule. It is rare that I would do more than two treatments. The results are typically quite long-lasting, with a range of six to 18 months of pain relief in most cases. As with horses, some pets/cases will benefit from a schedule of “booster” treatments at six-month intervals.

MECHANISM OF ACTION

Small animal case report

A shockwave is a pressure wave – it displaces its surrounding medium. The ripple created when a stone is thrown into a pond is a shockwave. Shockwaves used in veterinary medicine are generated in a fluid medium inside a transducer head, and are then transmitted readily through skin, fat and muscle. The high-energy waves are focused within the transducer head so that the shockwave can be directed to the precise area of an injury. When shockwaves hit an area of higher acoustic impedance, such as bone, they slow dramatically and a large amount of energy is released into the surrounding tissue. Shockwaves are modified or focused for medical/veterinary use so that their energy is released at a specific distance from the point of origin.

Ginger was a 12-year-old mixed breed spayed female dog, weighing approximately 40 pounds, that I saw on a monthly basis for chiropractic care. She had severe degenerative joint disease in both hips and became increasingly uncomfortable. I had discussed shockwave therapy for Ginger’s hips with the owners on multiple occasions, and when Ginger presented +4 of 5 lame on the RH, they finally approved it. On the day Ginger was

Typical characteristics of a shockwave include a short rise time; within nanoseconds, the wave reaches a peak pressure of up to 1,000 times atmospheric pressure. This is followed by a longer period of decreasing pressure, and a return to negative pressure – 10% of the maximum positive pressure – the hallmark of a true shockwave.*

Multiple areas can be treated at one time. As with equines, many pets almost immediately experience a remarkable reduction in pain. Typically, the animal will start feeling a reduction of pain and/or swelling within hours. This will generally last two to four days before the animal returns to nearly the original status. Then, over the next two to three weeks, actual healing takes place.

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Four different Trodes (penetration focused at 5mm, 20mm, 35mm, and 80mm).

SUMMARY

VersaTron with 20mm Trode.

brought in for shockwave therapy, she was non-weight bearing on her RH. I had some reservation about proceeding with the treatment, but felt that any improvement in comfort would be a success. When Ginger was discharged several hours after waking up from the anesthesia, she was able to walk out of the clinic. At the ten-day re-check, she was bearing 50% weight on her RH, and at the three week re-check, she was bearing 75% of normal weight. I did a second shockwave treatment, and at the three-week check after that, Ginger was bearing 85% to 90% of her full weight on her RH. This improvement in comfort is not attainable with conventional medications. Ginger passed away several months later due to unrelated causes, but remained comfortable on her RH until the end. This case demonstrates the rather dramatic improvement that can be achieved with shockwave therapy.

SELECTING YOUR SHOCKWAVE MACHINE In this article, I have focused on shockwave therapy, rather than radial shockwave. The physics of the radial wave are completely different. Equine major medical insurance coverage typically will cover only focused shockwave therapy. Some focused shockwave machines on the market advertise a deeper penetration of the shockwave into the tissue. Considerations here include whether the focal point for the release of the shockwave is so concentrated that there is potential for tissue damage, or a greater likelihood of missing the desired target tissue or injury.

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Shockwave therapy is well-accepted in equine practice as a treatment modality for soft tissue injuries, as well as for a variety of degenerative bony conditions, and neck and back pain. In small animal medicine, there are many indications for which shockwave therapy is very effective, but there is some resistance to it due to the fairly standard requirement for general anesthesia. Shockwave therapy is an excellent option for animals that can’t tolerate daily anti-inflammatory medication, or are difficult to treat on a daily basis. My practice is currently comprised of approximately 40% shockwave therapy and 60% chiropractic work, and is approximately 85% equine overall. As a veterinarian who does not compete with local colleagues in the traditional care market, I have been able to develop a very effective working relationship with the other veterinarians in my area. The shockwave portion of my practice originally began solely on a referral basis from other veterinarians. As I have become known in my area for both shockwave therapy and chiropractic care, my shockwave caseload is made up of a mixture of cases referred to me by other veterinarians; cases in which the owner or trainer contacts me directly; and cases that I identify while doing chiropractic work that I feel may benefit from shockwave therapy. In each case, I make a substantial effort to keep the owner’s regular veterinarian “in the loop” about the shockwave therapy I have done, as well as any findings I think may benefit from his/her attention. In that way, I help the animal, the owner and the veterinarian by being an “extra set of eyes” on the patient. Through this consistent effort and respect for practice boundaries, I have been able to establish an excellent working relationship with the other veterinarians in my area. Shockwave therapy is one of the most exciting therapies to become available to veterinary medicine in quite some time. *McClure and Dorfmuller. Clinical Techniques in Equine Practice, Dec, 2003.

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

From August 23 to 26, we celebrated our 43rd annual Congress in Cairns, Queensland, Australia. The event was held jointly with the Australian Veterinary Acupuncture Group (AVAG). Attendees from all over the globe participated in various handson wet labs and listened to many interesting presentations. This year’s Keynote Presenter was Allen Schoen, DVM, MS, PhD (hon.), CVA (IVAS).

Acu in Practice We would like to introduce you to “Acu in Practice”. Each week, the IVAS Facebook page offers a weekly abbreviated version of a case presented by Nell Ostermeier, DVM, CVA (IVAS), from the Lombard Animal Hospital in Portland, Oregon. You can follow each week at https://m.facebook. com/InternationalVeterinaryAcupunctureSociety. These posts are intended for informational use only, not to replace veterinary medical advice.

Case study

the ear, mainly the intersection of the Gall Bladder Channel and Yang Channel. Acupuncture point prescription: GV 20 – Crossing point of all Yang channels, grounding, clears Wind GB 20 – Eliminates internal Wind GB 2 – Clears Wind and benefits the Channel BL 23 – Tonifies Kidney and YIN BL 18 – Tonifies Liver BL 17 – Nourishes Blood ST 36 right/SP 6 left – Nourishes and moves Blood and Qi HT 7 – Calms Shen KI 3- BL 60 – Nourishes KI/KI yin, general anti-inflammatory (many of these patients are older and sore!) Lumbar BH – Tonifies KI, activates Qi and Blood, relieves pain Stranger is a long-time patient and one hour later, while still off balance, he was definitely brighter, much less anxious, and more at ease!

Stranger is a senior canine patient who presented with Idiopathic Vestibular Disorder (IVD). From a Western medicine perspective, symptoms are due to inflammation or a problem associated with the vestibular nerve or center within the inner ear.

Membership with IVAS

From a Chinese Medicine perspective, IVD usually involves a root deficiency in the Kidney meridian/organ leading to the invasion of Wind. The Kidney opens to the ear (physical location of the vestibular center) and is the holder of Yin and Essence.

Membership with IVAS has several benefits. We offer a quarterly newsletter with interesting case reports, case logs and “Name that Point”. You can access all the research and presentations from our yearly Congress Proceedings. And access to IVAS Canine and Equine Flashcards helps you continue your education and meet other members.

In Stranger’s case, a Kidney Yin/Essence Deficiency led to subsequent Liver Blood Deficiency and Invasion of Wind into the empty space left by lack of Blood and Yin. It is important to choose points to address these root patterns while also addressing the more superficial or local points located around

To learn more about veterinary acupuncture, to become certified in veterinary acupuncture or veterinary herbal medicine, or find continuing education events in your area, please visit our website at ivas.org or contact the IVAS office at office@ivas.org.

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tech talk S E C I CT

PR E V TI A R G

TE N I D

N A C ISTI

L O H OR

Find out how pet health insurance helps clients and patients while benefiting the veterinary practice. By Katie Woodley, BVSc As a veterinarian, I always believed that if I set aside a certain amount of money for my pets, I would be able to afford whatever was thrown my way in terms of their care. Why would I need to spend extra money each month on pet insurance? However, my latest job over the past nine months has shown me how important it is to carry pet insurance, not only for maintaining my own pets’ health, but also for benefiting our practice financially and providing our clients with gold standard care. Our integrative small animal clinic in Fort Collins, Colorado, pays towards our pet insurance policies as an employee benefit; this allows the entire staff to see the true advantages of having pet insurance and how it can help our clients and patients. Many pet insurance companies offer some coverage for alternative medicine. The challenge is to evaluate the different companies in every area of their plan coverage.

THE ADVANTAGES OF PET INSURANCE According to the NAPHI State of Industry Report 2017,1 close to 1.8 million pets were insured at the end of 2016. This translates to an average annual growth rate of 11.5% from 2015. DVM360 recently posted an article titled “The changing

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pet owner: 5 trends driving change in veterinary practice”2 which places financial stress at the top of the list. Pet insurance is the number one way we can help our clients and patients and benefit everyone. About 50% of clients stated they would purchase pet insurance if veterinary clinic staff discussed it with them during an appointment! A veterinary clinic needs to decide which insurance plan or plans to recommend. Technicians can do the research, compiling information so the hospital manager or owners can make the final decision. The technicians in our own clinic play a large role in informing and enrolling our clients in pet insurance. During every appointment, the technicians discuss how pet insurance can help people’s animals and make it easier for them to afford the best care. Having pet insurance also allows clients to do more with preventative medicine – for example, seasonal acupuncture tune-ups and regular chiropractic/ osteopathic before and after agility. Our technicians know the benefit of pet insurance first hand because their own animals are on it. We have technicians who would have spent over $30,000 on surgeries and medical treatment out of pocket if they had not had pet insurance. As it was, they spent only 10% of that amount, thanks to their insurance plans!

WHAT TO EVALUATE WHEN LOOKING FOR PET INSURANCE q Make sure alternative medicine is covered if you offer these services at your practice. The level of compliance for the integrative services I offer increases exponentially when clients have pet insurance. With some companies, you don’t have to pay for alternative services separately, but it’s an important factor to be aware of when delving into the pet insurance

world. Trupanion requires an alternative rider, and additional cost, for alternative services. Similarly, PetPremium’s Level 3 plan covers alternative therapies. Embrace covers the greatest number of alternative therapy types. PetsBest, PetPlan, HealthyPaws, Nationwide and Embrace all include alternative therapies in their routine plans.

w Check

if there are annual deductibles, per incident deductibles and/or lifetime limits. If there is a yearly cap on a plan, the amount a client can spend that would be covered could be severely limited. Also, a plan can have a per incident deductible, which can add up. Numerous companies will have annual deductibles. Most will allow you to pick the deductible amount. Usually, a higher deductible will come with a lower monthly premium.

e Read the fine print for any exclusions or to see if there are time periods mentioned before certain conditions will be covered. Numerous companies, such as PetPlan and PetFirst, have a time delay of six to 12 months before a cruciate tear or disc disease will be covered if it occurs after a pet is on the insurance plan. Some of these plans allow that exclusion to go away, however, if the pet is examined within 30 days of starting an insurance plan. For example,

Comparison between popular pet insurance companies Graph courtesy of Pet Insurance U (petinsuranceu.com)

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Some pet insurance companies will cover holistic therapies. Charlie, our clinic cat, receives laser therapy for his arthritis, while Pebbles gets weekly acupuncture treatments to help with her back issues â&#x20AC;&#x201C; both are covered by Trupanion.

PetPlan will remove the time exclusion if the pet is deemed to have healthy knees by a veterinarian within 30 days of starting a plan. Numerous companies will exclude nutritional supplements and vitamins although they will cover alternative treatments such as acupuncture.

r B e sure to check if there may be price changes during the year. With Trupanion, the plans are on a monthly contract and can thus increase. Other companies, such as Embrace and PetPlan, cannot change the rates for a yearâ&#x20AC;&#x2122;s contract. Also, confirm how clients are paid. The easier it is to be reimbursed, the happier the client will be. Trupanion has an Expresspay option by which the clinic submits the charges directly to Trupanion

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and the client only pays the co-pay. Other companies, like HealthyPaws, have mobile apps that allow clients to submit their bills easily and quickly via their phones.

t Finally, check customer reviews on different pet insurance companies. You want to be comfortable with who you are using. There are many great insurance companies out there. It is a matter of finding what works best for what you are looking for in a pet insurance plan. The graph on page 53 compares the main pet insurance companies. It was made by an independent reviewer (petinsuranceu.com) to limit bias towards any one company.

A CASE IN POINT

My nine-year-old German shepherd, Finn, showed me why it is very helpful to have pet insurance. About three months into my job, I noticed Finn was limping on his rear leg. Because he was covered by insurance with no pre-existing conditions, I did not have to worry ﬁnancially about doing radiographs to rule out hip, spine and knee issues. Finn does have a partial cruciate tear which may need surgery in the future, but I am able to afford rehabilitation, acupuncture, laser therapy, herbal medicine, supplements – and eventually the surgery if it’s needed – all because the treatments are covered!

Companies will compare themselves to others, but be wary of any bias that may skew one to look better than another. It is important to always call the insurance company to clarify all details once a plan has been chosen, to confirm everything that is included and the actual cost. The average rating includes Yelp, BBB and consumer reviews to determine that number. The differences between basic and best coverage refer to the different plans the companies offer, and can vary greatly for the services and amounts that are covered. The independent reviewer for the graph found HealthyPaws to be the best, but this will vary for everyone; this is why it’s so important for technicians to research all the information to figure out what is best for their clinics to recommend to clients.

CONCLUDING THOUGHTS Our overall success rate of enrolling clients in pet insurance is due to our technicians. They are able to showcase how beneficial pet insurance is to our clients, and because they have it for their own animals, they are able to share success stories on how it helped them. Our accounts receivable are very minimal because our clients can follow our gold standard recommendations for their pets and not worry about paying for it, while their pets get the best treatment possible. As a clinic, it is important to research a company that everyone feels passionate about, and then dive in. Your profits will rise, anxiety over collecting payments will decrease, and you will be able to practice the way you want, whether your focus is alternative, integrative or conventional medicine! 1

State of the Industry Report. North American Pet Health Insurance Association, 2017. Retrieved from naphia.org.

“The changing pet owner: 5 trends driving change in veterinary practice”. DVM360 Magazine, May 20, 2017. Retrieved from veterinarynews.DVM360.com.

If your patient needs surgery, he needs

antioxidants By Carmen Colitz, DVM, PhD, DACVO and Terri McCalla, DVM, MS, DACVO

Why do our patients need special antioxidants for their eyes? The same reasons we do! Oxidative stress is prevalent everywhere, particularly when the eye is injured or undergoes surgery. Any surgical procedure creates inflammation, which in turn creates free radical species, collectively called oxidative stress. Oxidative stress is present both at the surgical site due to tissue manipulation, and throughout the body due to the effects of general anesthesia. General anesthesia lowers tear production as well as the total antioxidant activity in the tears. It also affects the brain, regardless of the patient’s age. For these reasons, it is important to complement our patients’ diets with key antioxidants that not only fight daily normal oxidative stress, but also protect them before and after eye surgery. Inflammation inside the eye (uveitis) can create an unregulated and unrelenting cycle of inflammation that damages cells and tissues. This can lead to blindness and even necessitate removal of the eye. Besides traditional anti-inflammatory therapy, it is imperative to include specific antioxidants and free radical scavengers in the treatment protocol. These antioxidants include vitamins (C, E, B1, B2), carotenoids (lutein, zeaxanthin, astaxanthin), aldose reductase inhibitors (ALA), and flavonoids (grapeseed extract and green tea extract). They attack oxidative stressors to rebalance innate defenses and provide the support necessary to address free radical production. Many also provide anti-inflammatory benefits. Antioxidants that support the aging eye also support the aging brain. Therefore, lifetime use of antioxidants is important to control oxidative stress and inflammation. Drs. Carmen Colitz and Terri McCalla are Consulting Veterinarians for Animal Necessity, and Co-Founders of Animal HealthQuest LLC. Dr. Colitz is one of the world’s leading veterinary ophthalmologists. Dr. McCalla is a board-certified veterinary ophthalmologist and owns Animal Eye Care LLC. IVC Fall 2017

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 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

CLASSIFIED Main Street Veterinary Services is located in London, Ontario, Canada. We are a busy integrative office seeking a part time associate Veterinarian to add to our well established, growing practice. We are passionate about what we do. We’re a small, closely knit team of kind hearted humans interested in making a positive impact in the world of our clients, and patients, every single day. For the right doctor, a longterm relationship with the potential for full time employment is an option. To see the full ad please go to www.http://mainstreetvetservices. ca/job-opportunities/

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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

The Worldwide Alliance of Equine Osteopaths (WAEO), established in February of 2013, is a non-proﬁt corporation that seeks to unite the profession of Equine Osteopathy. We intend to serve as a resource for practitioners, researchers, educators and students of Equine Osteopathy. We aspire to be the link that allows Equine Osteopaths from all over the world to connect and converse. There is much to learn about each other and the profession of Equine Osteopathy as it is practiced throughout the world.

From the

WAEO The WAEO Annual Conference is just around the corner. It runs September 15 to 17 in Green Bay, Wisconsin. On Friday afternoon, there will be demos by Dr. Neal Valk, DVM and Janek Vluggen, DO, EDO. The lectures will cover osteopathy for dentistry, thoracic viscera, cranial sacral, TMJ, EPM, equine nutrition, natural hoof care and more. You do not need to be already trained in osteopathy to benefit. To learn more about the conference, visit equineosteopathy.org or check out our Facebook page (Worldwide Alliance of Equine Osteopathy Conference 2017).

Connect this location What’s under the 17th thoracic to the 3rd lumbar on the left, and the 15th thoracic to the 1st lumbar on the right in the equine? (In the dog or cat, it’s in the 11th to 13th thoracic region.) The kidney! And which kidney has a direct connection through its venous system with the ovary/testicle on the same side? The left one. The left kidney is often called the reproductive kidney; the left gonadal vein drains directly onto the left renal vein instead of the caudal vena cava. The azygous vein also drains onto the left renal vein. These two details make immobility and congestion in the pelvic organs more likely to have an effect on the left kidney than the right. The right kidney (called the digestive

kidney) is closely connected to the liver (in the renal impression) and to the cecum and colon. Digestive inflammation or ventral caudal pull of the colon (as in gestation and delivery) can help pull the left kidney caudal and ventral. Did you know that kidneys slide up and down with every breath you take? Research in humans has shown that just mobilizing the kidneys can alleviate lumbar pain, cystitis and more. The kidneys sit between two layers of peritoneal tissue. The outer layer also connects with the quadratus lumborum, the muscles of the spine and the psoas muscles (this might affect rotation of the hind limb). The inner layer covers the kidney and supports its cranial pole, along with the adrenal gland. The caudal pole of the kidney is loosely supported and can sometimes begin to drop ventrally and laterally. Over time, this can create strain on the renal artery and vein, and the ureter. The left kidney also connects with the stomach, pancreas, duodenum and spleen. Mobility restrictions affect digestion and metabolism, not to mention overall immunity. Both kidneys connect with ilio-inguinal, ilio-hypogastric, genitofemoral and femoral nerves. These areas can affect lower back pain, gluteal muscles, the hip, stifle and cuboid bone in the tarsus. The left kidney is more sensitive to immobility; the right more sensitive to metabolic and visceral changes. The left kidney can be correlated with a restriction in the coccyx, first rib on the same side, or the lower cervical spine on the same side. From an emotional standpoint, kidneys are often associated with fear (more on the right) and with roots to past ancestors or reproduction (more on the left).

Next issue:

How can we change toed-in conformation by examining and treating mobility in the chest?

IVC Fall 2017

Homeopathic medicines can alter

GENETIC EXPRESSION By Sue Armstrong, MA, VetMB, VetMFHom, CertIAVH, MRCVS, RsHom

Studies are showing that homeopathic medicines have an eďŹ&#x20AC;ect at the level of genetic expression, thereby giving the homeopath another tool for understanding the potential uses of remedies in their patients.

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Over the course of more than 30 years as a practising veterinary surgeon, veterinary homeopath and human homeopath, I have witnessed the mainstream conventional scientific world slowly changing its perspective. Science is realizing that life is much more complex than the largely mechanistic models that assumed everything was merely a series of chemical reactions, where proteins act in a series of physical lock and key interactions, and DNA is believed to be housed in the nucleus of the cell with the genes simply coded for the chemicals of life. We now know that if genes are present and have not been irrevocably damaged, they are capable of being switched on and off according to interactions with a multitude of factors, including diet and environmental changes. We also know that different arrays of over 25,000 genes code for the more than 100,000 proteins that make up the material of life. We’re now beginning to understand how the interface works whereby electrical signals are transformed into chemical ones.1 Researchers are currently able to measure changes occurring at the level of genetic switching. Homeopaths may now be able to measure and, in effect, “observe” the action of a dynamic medicine generating a change in the living body that then becomes material. Molecular biological tools, such as DNAmicroarrays and the ability to utilise specific cell line cultures, are making these studies possible, and the limited numbers of studies to date are providing some positive results.2 A significant number of studies have shown a positive response, while some have not. It is important to critically evaluate the positive and negative results in studies within the context of the remedy and potencies used, the cell lines, etc.3

Even before homeopathic medicine becomes mainstream, we will begin to see the use of therapeutic microdoses, and the use of the same substance given to inhibit or stimulate a body response according to dose, and perhaps according to the genetic makeup of the individual receiving the dose.

SIGNIFICANT STUDIES • One study5 looked at the gene expression of RWPE-1 cells (prostate epithelial cells) when exposed to Apis mellifica mother tincture – 3C, 5C and 7C potencies for 24 hours.2 Apis mellifica is a very well-known remedy to homeopaths and is made from the honey bee, including the venom. This remedy is commonly used for many different presentations of allergy – edema, redness, pain and inflammation. The researchers looked at the expression of genes involved in cytokine expression, inflammatory processes, anti-oxidative responses and protease degradation. Not only did they find clear effects, but they also saw different effects from the mother tincture versus potentised dilutions. For instance, the mother tincture increased expression of the IL1b gene, which codes for a potent pro-inflammatory cytokine, whereas the potentised remedies reduced expression of the same gene. Continued on page 60.

While beyond the scope of this article, there is another important aspect of many of these and related studies. A greater understanding of the hormesis concept (dose-response relationship that shows how substances can be either inhibitory or stimulatory at different dose rates) challenges the way conventional pharmacology has evaluated drug dose rates.4 IVC Fall 2017

Homeopaths may now be able to measure and, in effect, “observe” the action of a dynamic medicine generating a change in the living body.

Continued from page 59. • A number of studies have looked at Gelsemium sempervirens and gene expression.6 Bellavite et al exposed human SHSY5Y cells (neuroblastoma cells) to potentised dilutions of Gelsemium (2C, 3C, 4C, 5C, 9C and 30C) for 24 hours and found that the expression of 56 genes was significantly changed (49 down-regulated and seven up-regulated). Gelsemium sempervirens has long been recognised by homeopaths as having its centre of action on the nervous system and muscles. The plant from which the remedy is derived contains strychnine-like alkaloids, such as gelsemine, that act within this sphere. The study authors suggest that the pain-relieving and anti-anxiety effects associated with the remedy may be attributed to the negative modulation of some neuronal excitatory signalling pathways. • Using micro-array and RT-PCR techniques, Preethi et al investigated the expression of genes associated with cytotoxicity and apoptosis (programmed cell death) in Dalton’s lymphoma tumor cells and other tumor cell lines.7 They exposed the cells to ten different potentised medicines, including Ruta 200C, Carcinosinum 200C, Hydrastis 200C, Conium 200C, Podophyllum 200C and Thuja 200C. They found different effects in different remedies and with different potencies. Conium 200C was more cytotoxic than its mother tincture; Carcinosinum was more cytotoxic at 200C than at 30C. The researchers were able to demonstrate clear gene induction in some cases – Carcinosinum 200C significantly induced p53 gene expression (pro-apoptotic gene). Continued on page 62.

Homeopathically-prepared DNA DNA taken from a variety of sources (e.g. fish and cattle) has had a number of provings over the years (e.g. Julian, Jenaer and Robbins). Not surprisingly, homoeopathically-prepared DNA has been found to have affinities with the mind, nerves, endocrine and reproductive systems.9 Recently, there has been a lot of interest in Sequence Specific Homeopathic DNA medicines, which use specific DNA sequences (300 to 400 base pairs in length) potentised to 6C and aimed at targeting genes known to have sub-optimal expression in certain disease states or processes. For instance, the KL gene is recorded to have reduced expression with age, and is associated with impaired immunity, signs of aging and increased susceptibility to autoimmune disease.10 While these medicines are not being used in the classical homeopathic tradition, it will be interesting to follow published results of their use.

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Continued from page 61. • Khuda-Bukhsh et al used HeLA cells (HPV18 positive cells) to test the effects of the ultra-high dilutions Condurango 30C and Hydrastis canadensis 30C on gene expression when compared to controls.8 They were able to demonstrate significantly different gene expression patterns of genes associated with carcinogenesis for the ultra-high dilutions, when compared to controls. Hydrastis canadensis and Condurango are both commonly used as homeopathic medicines in cancer cases. Classical homeopathic forefathers such as Clarke cited Hydrastis as the remedy that has cured more cases of cancer than any other single remedy. Although homeopaths (in the UK at least) can make no claims of efficacy for homeopathic treatment, we are beginning to see the evidence in a form that is acceptable to the scientific world, thereby beginning to confirm what homeopaths have known for centuries. These studies not only show the effects homeopathic medicines have at the level of genetic expression, but they can also give the homeopath another tool for understanding the potential use of a remedy in a patient, in addition to traditional provings, cured case reports and toxicology studies. The results to date align with what we already know regarding which systems and processes homeopathic remedies can

affect. Now we may begin to understand a little more of how they are doing it. Through this understanding of switching genes on and off, conventional medical and homeopathic communities may have found a mutual ground for further consideration and comprehension.

 Constantin C., Muller C., et al., “Identiﬁcation of Cav2-PCKβ and Cav2-NOS1complexes as entities for ultrafast electrochemical coupling” Proceedings of the National Academy of Sciences, 2017  Dei A. & Bernadini S. “Hormetic effects of extremely diluted solutions on gene expression” Homeopathy, (2015) 104 3

Thangapazaham RL., Gaddipati JP. et al. “Homeopathic medicines do not alter growth and gene expression in prostate and breast cancer cells in vitro” Integrated Cancer Therapy (2006), 5

 Calabrese E. “Hormesis within a mechanistic concept” Homeopathy (2015) 104  Bigagli E., Luceri C. et al., “Exploring the effects of homeopathic Apis Mellifica preparations on human gene expression profiles” Homeopathy (2014) 103  Olioso D., Marzotti M et al, “ Effects of Gelsemium sempervirens L. on pathway-focused gene expression profiling in neuronal cells” Journal of Ethnopharmacology (2014) 153  Ellanghiyil S., Preethi K et al., “Induction of apoptosis in tumour cells by some potentiated homeopathic drugs: implications of mechanism of action” Integrated Cancer Therapy (2012) 11  Saha S., Khuda-Bukhsh A. et al., “Ultra-highly diluted plant extracts of Hydrastis canadensis and Marsdenia condurango induce epigenetic modifications and alter gene expression profiles in HeLa cells in vitro” Journal of Integrative Medicine (2015) 13  Abha, “Advances in homeopathy: targeting of health promoting genes using sequence specific homeopathic DNA remedies” Homeopathy 360, www.bjain.com/homeopathy360-wp/2017/02/18  Rosenblatt & Kuro O., “Klotho, an aging suppressor gene” Horm. res. (2007) 67

IVC Fall 2017

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? Clove (Syzygium aromaticum)) is best known for its power to numb. It is the only member of the myrtle family in which where the oil is distilled not from the leaves, but rather the buds and stems. Historically, dentists have found clove oil useful because of its high proportion of eugenol, which provides anesthetic, antiseptic and anti-parasitic properties. Veterinary practitioners can massage a toothpick tip of clove oil onto painful gingival tissue. It is commonly used in a diluted blend with other “hot” oils for sanitizing clinic surfaces or as a paw or body cleansing soak.

CASE REPORT

By Jodie Gruenstern, DVM, CVA Snoopy presented at three years of age for euthanasia due to severe allergies. Without an E-collar, he would excoriate his face to the point of bleeding, chew all four paws and rip patches of fur from the skin on his flanks and tail. His guardian had “tried everything”. Indeed, Snoopy’s allergy test confirmed sensitivity to an array of environmental allergens,

and many brands of kibble had been tried, including prescription versions recommended by the dermatologist. This was a case in which I knew oils alone would not be the solution, but they would be a helpful adjunct. Snoopy could only sleep with a dose of chlorpheniramine, so my first goal was to replace this medication with something natural. Snoopy taught me that lavender is dose-dependent. One drop on his tail did nothing, but several drops “neat” on every affected location at bedtime soothed his skin, deterred licking, calmed his mind and allowed all of us to sleep! (Yes, he was in my bed then, 16 years ago, and he still is today!) Snoopy was fed a variety of commercial raw foods and probiotics over the years to address an underlying leaky gut, and his “allergies” disappeared. If you have an essential oils success story of your own, email docjodie@DrJodiesNaturalPets.com.

NEWS AND NOTES • October 2017: Visit us at the VMAA Exhibit Booth and attend our VMAA Annual Meeting on Saturday, October 21 at 5:30 pm at the AHVMA Conference in San Diego.

Name the oil distilled from this plant! The answer will appear in the next issue.

• February 2018: Register now for VMAA R.E.A.C.H in Las Vegas from February 23 through 25, featuring keynote speaker Kurt Schnaubelt and a hands-on workshop at Dr. Nancy Brandt’s clinic. To follow, “like” facebook.com/vmaa.vet. For more information on educational courses, discounted classes, online webinars, books, and the newsletter, visit VMAA.vet. IVC Fall 2017

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 AVH Annual Conference takes place in San Diego, California from Friday, October 20 through Sunday, October 22. The theme is “Focus on Fundamentals”, and attendees will enjoy a joint conference with the AHVMA. In addition to great speakers at the AVH conference, there will be homeopathic presentations at the AHVMA conference, including “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.

Calendula officinalis, also known as the pot marigold, promotes the healing of cuts, abrasions and lacerations, and stimulates healthy granulation tissue and rapid healing by first intention while preventing and treating infection. Calendula is known by homeopaths and herbalists as “the great herbal antiseptic, it restores the vitality of a wounded part, making it impregnable against the forces of putrefaction. Indicated in lacerated and suppurative wounds.”1

CASE EXAMPLE VETERINARY HOMEOPATH ACHIEVES AVH CERTIFICATION Congratulations to Dr. Rosemary Manziano of Colts Neck, New Jersey for her recent successful completion of the AVH certification process! After completing the one-year course in veterinary homeopathy, graduates may pursue AVH certification, for which two acute and two chronic cases treated curatively with homeopathy are submitted for review. Once the cases have been accepted, the applicant must pass a written exam. Additional information on the benefits of AVH membership and a list of certified veterinary homeopaths is available at theavh.org.

HOMEOPATHY PROVIDES ALTERNATIVES TO ADDRESSING ANTIBIOTIC RESISTANCE There is increasing concern in the veterinary field about the development of antibiotic resistance in animals, and the harmful effects of antibiotic drug residues in milk and meat tissues consumed for food. Homeopathy offers alternatives to antibiotic therapy in treating wounds in animals – it not only prevents and treats infection, but also stimulates healing.

IVC Fall 2017

On July 3, 2017, a two-year-old neutered male Goldendoodle received a wound in his right flank, caused by a clipper injury during grooming. The laceration extended through the dermis into the subcutaneous tissue, and measured 1.5” in diameter. The attending veterinarian prescribed topical antibiotic therapy, but after seven days the wound didn’t show any signs of healing. The owners sought treatment with a homeopathic veterinarian on July 10; the vet prescribed homeopathic Calendula 200c by mouth once daily to stimulate the healing process. Within three days, the owner observed that the wound had shrunk considerably, and Calendula was discontinued. The wound continued to improve, and on July 15 measured 0.9” in diameter with healthy granulation tissue. Calendula was repeated once daily on July 19, and again on July 21 and 22, when wound healing stalled at 0.5” diameter. Following these treatments, the wound healed rapidly, and on re-check on July 31, nothing more than a small discoloration of the skin was observed. Murphy R. Nature’s materia medica: 1,400 homeopathic and herbal remedies. Blackburg, VA: Lotus Health Institute; 2006: 436-437.

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events

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

Annual ABVP Symposium

Canine Massage Level 1

The ABVP Symposium is a leading CE event for veterinarians, veterinary residents, veterinary technicians and students that offers 28+ hours of attainable CE per person. Increase your knowledge base and have some fun in the beautiful, southern city of Atlanta. Visit our website to view the conference schedule.

What better place to start than level 1! This level offers a great beginning to your canine massage career! Four days of instruction will include the following:

October 5–8, 2017 – Atlanta, GA

November 1–4, 2017 – Longmont, CO

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

• Introduction to Anatomy and Physiology • Pre-massage considerations • Strokes and techniques of maintenance and therapeutic massage • Post-massage considerations for companion animals and their guardians • Specific conditions relating to companion animals • Building and marketing your practice including confidentiality, ethics, developing/ maintaining records, preparing case histories, developing case studies, marketing strategies, and insurance • Pathologies – Gait observation and its relation to muscle imbalances and abnormalities, common canine diseases, discussing medications, nutrition, and treatments both holistic and modern • Animal Handling – Behavior, communication, intention, and pack psychology • Introduction to acupressure, essential oils, and nutrition

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

On the final day of class you will be prepared to perform a live practicum and take a written final exam. Following your four day class you will have post coursework in the form of case studies. These act as your “real-life” experience, and this is how you will get your final certification.

2017 AAFP Conference

This class takes place at an equine facility. Work will take place on horses and dogs.

The material will include presentations geared towards the experienced feline practitioner, as well as sessions for newer practitioners or those looking to expand their knowledge in feline medicine.

For more information: (303) 660-9390 info@rmsaam.com www.rmsaam.com

For more information: (800) 648-4462 www.abvp.com

American College of Veterinary Surgeons Symposium October 12–14, 2017 – Indianapolis, IN

October 19–22, 2017 – Denver, CO

For more information: (800) 874-0498 info@catvets.com www.catvets.com/education/conference

62nd Annual AAEP Convention

November 17–21, 2017 – San Antonio, TX

2017 Veterinary Cancer Society Annual Conference October 26–28, 2018 – Portland, OR

The primary focus of the meeting will be a program highlighting advances in clinical oncology. We are excited to have already confirmed three great keynote speakers and will be finalizing themes for each half-day session and SOTA speakers in the near future. For more information: (573) 823-8497 www.vetcancersociety.org

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

2017 CVC San Diego

Hawaii Veterinary Medical Association Convention October 26–29, 2017 – Honolulu, HI

This convention is an outstanding program offering over 68 hours of continuing education excellence. Some of the highlights include wet labs, training modules for accreditation, and three days of lectures. Come and join us for a wonderful weekend in paradise. For more information: contact@hawaiivetmed.org www.hawaiivetmed.org

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

December 7–10, 2017 – San Diego, CA Experience exceptional veterinary continuing education in a central location. Outstanding convention hotels, dining, shopping, and entertainment all within a short walk of the San Diego Convention Center. Take a break from the traditional. Join us at CVC San Diego and experience an unconventional, attendee-centric approach to veterinary continuing education conventions. • Maximum CE in minimum time • Exceptional programming, led by the profession’s most accomplished educators and experts • Simple to plan and to navigate • Staff on hand to help plan your CVC experience • Registration and travel costs that make sense • Registration includes “lunch bucks” to cover the cost of lunch and snacks • Hotel rates and hotel extras negotiated to deliver convenience and comfort at the best possible price For more information: www.thecvc.com

IVC Fall 2017

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IVC Fall 2017