V8I2 (Spring 2018) by Redstone Media Group

Integrative VETERINARY CARE

INNOVATIVE SOLUTIONS FOR YOUR PRACTICE

VOLUME 8 ISSUE 2

HEALING THE MICROBIOME

A CLOSER LOOK AT INNOVATIVE STRATEGIES TO IMPROVE DIGESTIVE HEALTH.

PANCREATITIS IN SMALL ANIMALS

MICROBIOME RESTORATIVE THERAPY

THE SHARED SPACE PRACTICE MODEL

DO YOUR PATIENTS NEED DIGESTIVE ENZYMES?

CALMING FEARFUL PATIENTS

TREATING DIARRHEA IN HORSES

How diet and herbal medicine can help treat – and even prevent – pancreatitis in dogs and cats. – P. 18

www.IVCJournal.com

SPRING ISSUE 2018

Sharing hospital space with other practitioners offers many benefits, including reduced overhead and a wider array of services. – P. 38

Vet visits can be a real headache if a dog or cat is scared or aggressive. Stocking your pharmacy with these stress-busting therapies can help ensure better behavior. – P. 32

Used with great success for human patients with IBD, MBRT is also healing companion animals – P. 48

A lack of the right enzymes can lie at the root of many digestive issues. Supplementing with these crucial nutrients can give your patients’ GI health a big boost. – P. 12

Equine diarrhea can be challenging to treat; the good news is that alternative therapies can resolve the problem safely and effectively. – P. 42

IVC Spring 2018

contents

FEATURES

DIGESTIVE ENZYMES IN DOGS AND CATS By PJ Broadfoot, DVM

Supplementing with digestive enzymes can enhance the health and well-being of our canine and feline patients in many crucial ways.

STRATEGIES FOR MANAGING PANCREATITIS IN SMALL ANIMALS

By Steve Marsden, DVM, ND, MSOM, Lac., Dipl.CH, CVA, Grad Dip Vet Acup, Grad Dip VCHM, AHG

Herbal medicines and low-fat meat and vegetable diets can prevent pancreatitis in dogs and cats, and can also be used to resolve acute and chronic stages of the disease.

NUTRITION NOOK

PROBIOTICS, THE MISSING NUTRIENTS â&#x20AC;&#x201C; PART 1

By Doug Knueven, DVM

A balanced intestinal microbiome is crucial to good health in small animals as well as humans. Probiotics can play an important role in maintaining this balance.

BUILDING GOOD BEHAVIOR IN YOUR PATIENTS

INTEGRATIVE PRACTICE

MICROBIOME RESTORATIVE THERAPY IN COMPANION ANIMALS

By Holly Ganz, PhD

A procedure in which fecal material is transferred from a healthy individual to the gastrointestinal tract of an ailing individual, MBRT can effectively treat digestive issues.

TECH TALK

COMPLEMENTARY TRAINING FOR TECHNICIANS

By Joni Kamlet, RVT, CCRA

Credentialed veterinary technicians are in short supply. Training in integrative therapies helps empower vet techs and strengthens the field overall.

HOMEOPATHY AND INTEGRATIVE MEDICINE FOR CHRONIC CANINE BOWEL PROBLEMS

By Christopher Day, MRCVS, VetFFHom, MA, VetMB Diarrhea and other bowel conditions are common in canine patients. Homeopathy, along with other therapies such as probiotics and herbs, may effectively resolve these issues.

By Christina Chambreau, DVM, CVH

Fear and aggression in canine and feline patients can make life unpleasant for everyone, especially during vet visits. Try stocking your pharmacy with these stress-easing therapies.

A SHARED SPACE PRACTICE MODEL

By Jordan Kocen, DVM

It takes time to develop a veterinary practice based on a shared space model, but it has many benefits, including a decrease in overhead and an increase in offered services.

INTEGRATIVE APPROACH TO DIARRHEA IN THE EQUINE By Joyce Harman, DVM

Diarrhea is common in horses, and can be stubborn to treat. Alternative therapies offer a safe and effective way to resolve the problem.

38 4

IVC Spring 2018

18 COLUMNS & DEPARTMENTS

5 Advisory board 8 Editorial

advisory board Dr. Richard Palmquist, DVM GDipVCHM(CIVT) CVCHM (IVAS), graduated from Colorado State University in 1983. He is chief of integrative health services at Centinela Animal Hospital in Inglewood, California, president and research chair of the AHVMA, and an international speaker in integrative veterinary medicine. Dr. Palmquist is a consultant for the Veterinary Information Network (VIN) and codirector of the AHVM Foundation. He has published two books, one for conventional veterinarians and a second for clients discussing how integrative thinking works.

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

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

s new 11 What’ 31 From the AHVMF 52 Veterinary resource guide 53 From the IVAS

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.

53 From the VBMA 63 Industry Innovations 64 From the VMAA 64 From the WAEO 64 From the AVH 65 Marketplace 66 Events

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.

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

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

IVC Spring 2018

Integrative VETERINARY CARE

INNOVATIVE SOLUTIONS FOR YOUR PRACTICE

SPRING 2018

EDITORIAL DEPARTMENT Editor-in-Chief: Dana Cox Managing Editor: Ann Brightman Associate Editor: Christina Chambreau, DVM, CVH Staff Writer: Emily Watson Senior Graphic Designer: Dawn Cumby-Dallin Senior Graphic Designer: Kathleen Atkinson Social/Digital Media Manager: Theresa Gannon Web Design & Development: Brad Vader

COLUMNISTS & CONTRIBUTING WRITERS

PJ Broadfoot, DVM Carmen Colitz, DVM, PhD, DACVO Christopher Day, MRCVS, VetFFHom, MA, VetMB Holly Ganz, PhD Christopher Kelly Groth Joyce Harman, DVM Joni Kamlet, RVT, CCRA Doug Knueven, DVM Jordan Kocen, DVM Steve Marsden, DVM, ND, MSOM, Lac., Dipl.CH, CVA, Grad Dip Vet Acup, Grad Dip VCHM, AHG Terri L. McCalla, DVM, MS, DACVO Gary P. Oswald, DVM, DACVIM (Int Med)

ADMINISTRATION & SALES Publisher: Redstone Media Group President/C.E.O.: Tim Hockley Accounting: Susan Smith Circulation & Office Manager: Libby Sinden

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SUBMISSIONS: Please send all editorial material, photos and correspondence to Dana Cox at Dana@redstonemediagroup.com or IVC Journal, 160 Charlotte St., Suite 202 Peterborough, ON, Canada K9J 2T8. We welcome previously unpublished articles and color pictures either in transparency or disc form at 300 dpi. We cannot guarantee that either articles or pictures will be used or that they will be returned. We reserve the right to publish all letters received.

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Subscribe to IVC Journal Today! Subscribe to IVC Journal for just $29.95 and receive a FREE 1 year subscription to Animal Wellness Magazine. To order your subscription visit www.ivcjournal.com IVC Journal (ISSN 2291-9600) is published four times a year by Redstone Media Group Inc. Publications Mail Agreement #40884047. Entire contents copyrightÂ© 2018. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: March 2018.

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

IVC Spring 2018

editorial

TACKLING

DIGESTIVE ISSUES

When I was working at an emergency clinic, during and after

These articles also discuss many products you’ll want to add to

veterinary college, it was common for animals to be rushed in with

your pharmacy. For instance, there are many ways to heal and

diarrhea or vomiting in the middle of the night. Often, these dogs

prevent emotional and behavioral problems in pets – my article

and cats had a history of recurring or chronic problems with their

shows you how to use your technicians as part of a strategy of

digestive systems and the owners were getting frustrated. Though

classes and products you can offer at your hospital.

drugs were very effective at stopping the current symptoms, and even resolving acute pancreatic attacks, there was little I could

Our technicians can be utilized in many other ways as well. Ms.

prescribe to restore these patients’ digestive tracts to full health.

Joni Kamlet covers a range of modalities that veterinary technicians can learn, leading to healthier animals, happier clients, and increased

This issue of IVC Journal looks at the digestive system from several

income. Meanwhile, Dr. Jordan Kocen’s model of shared integrative

perspectives. These perspectives all have one thing in common

practice space offers trained technicians and other healers a place

– they not only treat symptoms so health is fully restored, but

to see clients, thereby offering them a wide variety of treatments

they also improve digestive system health before any obvious

while maximizing use of your physical facility.

symptoms appear. Many veterinary organizations offer continuing education so For example, Dr. Steve Marsden explores pancreatic ailments from

you can learn these different modalities. Even with a busy spring

the Traditional Chinese Veterinary Medicine (TCVM) approach

and summer ahead, I encourage you to follow up on any therapy

of acupuncture and Chinese herbs, thereby deeply curing

that intrigues you in this issue – and be sure to share it with your

pathology. British veterinarian Dr. Christopher Day discusses the

technicians and at clinic meetings!

homeopathic approach of selecting a medicine that matches the unique symptoms of an individual animal with chronic diarrhea.

Enjoy a healthy spring!

Dr. Joyce Harman focuses on equally great responses in horses that are treated holistically for diarrheal diseases. Preventing digestive disorders in the first place makes clients very happy (they no longer have to clean up those messes!). Dr. PJ Broadfoot covers digestive enzymes, while Drs. Doug Knueven and Holly Ganz write about the microbiome’s importance for digestion, nutrient absorption and even the immune system – Dr. Knueven looks at the benefits of supplemental probiotics and Dr. Ganz continues our education with her article on MBRT (microbiome replacement therapy).

IVC Spring 2018

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

IVC Spring 2018

contributors

1. PJ BROADFOOT, DVM

Dr. PJ Broadfoot graduated Cum Laude from Kansas State University School of Veterinary Medicine in 1981, and started her own practice in Van Buren, Arkansas in 1982. She developed an early interest in the nutritional aspects of healing, which progressed over the past 18 years into a holistically oriented practice. Dr. Broadfoot was hired in 2001 as a veterinary consultant for Heel, and has presented lectures on homotoxicology. She has also lectured internationally for the VetriScience Company, a recognized authority in the research and product development of high quality supplements for animals. Dr. Broadfoot is a member of the CIVT faculty, as well as the AVMA, the Arkansas VMA, and the AHVMA.

2. CHRISTOPHER DAY, MRCVS, VETFFHOM, MA, VETMB

British veterinarian Dr. Christopher Day has been using homeopathy in his practice for over 45 years, and runs a specialized veterinary referral practice – the Alternative Veterinary Medicine Centre – in Oxfordshire, England. He qualified from Cambridge University in 1972. He provides an integrative approach, employing different therapeutic techniques, mainly homeopathy, acupuncture, herbs, laser and chiropractic. Dr. Day is currently President of the British Association of Homeopathic Veterinarians, and has twice served as President of the International Association of Veterinary Homeopaths. He is the author of ten books and 20 e-books, and has been featured on television, has conducted clinical research, and teaches worldwide.

3. HOLLY GANZ, PHD

Dr. Holly Ganz is a microbiologist turned entrepreneur. In 2016, she left academic research at UC Davis to create AnimalBiome, a company that provides microbiome assessments for dogs and cats and creates restorative remedies to help promote healthy guts. Dr. Ganz received her PhD from UC Davis, where she studied co-evolution between microbes and animals. After receiving her doctorate, she was a post-doctoral fellow at UC Berkeley, where she studied how bacterial pathogens survive in soil to infect wildlife. She subsequently applied microbial genomics to study the canine oral microbiome, as a visiting scientist at the UC Davis School of Veterinary Medicine. Dr. Ganz is dedicated to improving animal health and wellness through applying the latest innovations in microbiology.

4. JOYCE HARMAN, DVM

Dr. Joyce Harman 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.

IVC Spring 2018

5. JONI KAMLET, RVT, CCRA

Ms. Joni Kamlet worked in integrative veterinary practices in Northern California, becoming certified as a Canine Rehabilitation Assistant and in Applied Clinical Nutrition. She then spent six years as the Northern California Veterinary Representative for Standard Process/MediHerb. Joni is currently developing content on integrative veterinary medicine for VetBloom (vetbloom.com). She lives in South India and is doing humanitarian work with Amma (amma.org).

6. DOUG KNUEVEN, DVM

Dr. Doug Knueven earned his veterinary degree from Ohio State University in 1987 and is the owner and medical director of Beaver Animal Clinic in Beaver, Pennsylvania. He has been practicing integrative veterinary medicine since 1995, and earned certification in veterinary acupuncture, veterinary Chinese herbal medicine and veterinary chiropractic. Dr. Knueven also has advanced training in natural nutrition, Chinese food therapy, massage therapy and homeopathy. He is a long-time member of the AHVMA, and lectures on holistic medicine at veterinary conferences. Dr. Knueven has written two books: Stand by Me: A Holistic Handbook for Animals, Their People and the Lives They Share Together, and The Holistic Health Guide: Natural Care for the Whole Dog.

7. JORDAN KOCEN, DVM, MS

Dr. Jordan Kocen graduated from the University of Missouri College of Veterinary Medicine in 1986, and has been in veterinary practice in the Northern Virginia area ever since. He is certified in Veterinary Acupuncture by the International Veterinary Acupuncture Society and has completed studies in the use of Chinese herbal and homeopathic medicine. Dr. Kocen opened the Veterinary Holistic Center in Springfield, Virginia in 2015, after being the head of the Holistic Medicine Department at VCA SouthPaws Veterinary Specialists in Fairfax, Virginia. He has lectured at many state and national holistic and conventional conferences. Dr. Kocen has taught for the IVAS and is a past AHVMA and AAVA board member.

8. STEVE MARSDEN, DVM, ND, MSOM, LAC., DIPL.CH, CVA, GRAD DIP VET ACUP, GRAD DIP VCHM, AHG

Dr. Steve Marsden received his doctorate in veterinary medicine at the University of Saskatchewan, Canada. At the National College of Naturopathic Medicine in Portland, Oregon, he obtained a doctorate in naturopathic medicine, a Master’s of Science in Oriental medicine, his licensure in acupuncture and Diplomat status in Chinese herbology. He treats both pets and people in his Edmonton, Alberta practice. Dr. Marsden is one of the chief educators of veterinarians in the use of complementary and alternative therapies. He co-founded the College of Integrative Veterinary Therapies and is an emeritus director of the National College of Natural Medicine. His first textbook, Manual of Natural Veterinary Medicine, has been translated into multiple languages, and is a leading resource worldwide.

what’s new VETERINARY EQUIPMENT FOR NON-PROFITS Animals both domestic and wild face struggles worldwide, whether it’s from pet over-population, poaching or environmental disasters. And while animal welfare organizations are doing their best to address these issues, it’s not always easy.

NUTRITION | ANAL YTICS | IN MY EXPERIENC

JUNE 2017 trends.aaha.org

Project V.E.T.S. helps by acquiring veterinary/medical equipment and supplies from hospitals, manufacturers and individuals, then distributing them to veterinarians working for animal non-profits. The Colorado-based organization has two goals: to keep valuable medical items and supplies from being wastefully discarded; and to have them put into the hands of those who are making a difference in the welfare of wild and domestic animals. The equipment and supplies acquired to date would have cost over $1,500,000 for the animal welfare groups to purchase new. Thanks to Project V.E.T.S., these organizations can provide critical services to the animals in their care while saving their precious dollars for additional worthwhile expenses. projectvets.org

No Small Task

Project V.E.T.S. Helps

Animals Around

Puppy’s Fight for

Coyote Attack Highl

the World 22

Life

ights Need for Preve

ntive Care 29

SERVICE DOGS REDUCE PTSD IN WAR VETERANS A preliminary study led by researchers in the Purdue University College of Veterinary Medicine shows that overall symptoms of post-traumatic stress disorder (PTSD) are lower among war veterans with service dogs. Co-funded by the Human Animal Bond Research Institute (HABRI) and Bayer Animal Health, the pilot co-study was led by Maggie O’Haire, assistant professor of human-animal interaction, with the help of K9s For Warriors, a non-profit that provides veterans with service dogs. “We found that veterans with service dogs had significantly lower levels of PTSD symptomology than those who did not have a service dog,” O’Haire says. “They also had lower levels of depression and anxiety and increased social participation.” The complete study was published in the February issue of the Journal of Consulting and Clinical Psychology.

CAN EQUINE STEM CELLS INHIBIT BACTERIAL GROWTH IN WOUNDS?

Previous research has explored the therapeutic value of stem cells in wound healing, but few studies have examined how they can inhibit bacterial growth. Harman and her team are looking at the antibacterial properties of equine stem cells to develop therapies for horses. They take stem cells from the horses’ blood in a minimally invasive procedure, then apply the factors secreted by the stem cells, rather than the cells themselves, to the wounds, which reduces the risk of a host negatively reacting to the therapy. The lab is currently experimenting with different stem cell storage methods, such as freezing and drying, for easier practitioner use. This summer, they’ll be applying the therapy to a herd of Icelandic horses in an attempt to heal a recurring skin condition. If all goes well, this new therapy may prove a more natural and effective alternative to conventional antibiotics. vet.cornell.edu

Photo courtesy Cornell University College of Veterinary Medicine.

Researchers in the Van de Walle Lab at the Cornell University College of Veterinary Medicine are exploring the use of stem cells to treat skin wounds in horses. The study, led by research support specialist Rebecca Harman, has revealed that factors secreted by adult stem cells are able to fight bacteria in skin wounds.

IVC Spring 2018

PEER-REVIEWED

DIGESTIVE

ENZYMES in dogs and cats By P J Broadfoot, DVM

SUPPLEMENTING WITH DIGESTIVE ENZYMES CAN ENHANCE THE HEALTH AND WELL-BEING OF OUR CANINE AND FELINE PATIENTS IN MANY CRUCIAL WAYS.

“Man is not nourished by what he swallows, but by what he digests and uses,” wrote Hippocrates. This is true for all creatures, including dogs and cats – and an important part of what determines that nourishment involves digestive enzymes.

TWO ENZYME CATEGORIES

q Metabolic enzymes are present in every cell, tissue and organ in the body, and act as biochemical catalysts in the momentto-moment function of living cells. They are responsible for keeping the body in proper balance by controlling virtually every chemical reaction associated with metabolism. Because of this, metabolic enzymes are the very basis of the life process.

w Digestive enzymes, the primary focus of this article, can be separated into intrinsic and extrinsic enzymes. Intrinsic digestive enzymes are those the body manufactures and

IVC Spring 2018

secretes to break down food. The salivary glands in the mouth, the gastric glands in the stomach, and specific cells in the pancreas secrete the enzymes that work to digest the proteins, fats and sugars in any food. Examples of extrinsic digestive enzymes are protease, which digests protein; amylase, which digests starch; and lipase, which digests fat.

NORMAL PHYSIOLOGY OF DIGESTIVE ENZYMES Most fresh-grown food contains enough active enzymes to digest the proteins, starches or fats found in that food. For example, avocados and nuts have naturally-occurring lipase or fat-digesting enzymes, while oats have a high level of amylase, or starch-digesting enzymes. The contribution of food-based enzymes to the digestive process is extremely important and too often overlooked.

The food should enter the stomach complete with digestive enzymes, which pre-digest the food. The stomach churns the food, pre-digesting as much as 75% of the meal. This process varies in time with any given species, after which hydrochloric acid, produced by the parietal cells in the stomach wall, is introduced, temporarily inactivating all the food-based enzymes and breaking down what is left of the meal. Then, acid-resistant pepsin is introduced. Enzymes, even though they are proteins, are too big and complex to be destroyed by the acid in the stomach, which means they can’t be digested. Most enzymes are rendered temporarily inactive by the high acid environment, then reactivated the moment they enter the more alkaline environment of the intestinal tract. Eventually, the nutrient-rich food concentrate moves into the duodenum, where enzymes produced by the pancreas are responsible for the final digestion of proteins, carbohydrates and fats. Liver secretions neutralize the acidity of the gastric juice and bile emulsifies the fats for better digestion and absorption. Nutrients are absorbed along the surface of the intestine and carried into the blood, which flows to the liver where it is filtered to prevent the circulation of undesirable substances in the body. Nutrients are then delivered to every cell of the body. Finally, waste products, undigested food and bacteria move into the colon to be eliminated.

SUPPLEMENTAL ENZYMES Supplemental enzymes are needed to replace those destroyed by cooking and processing food. Processing and cooking at any heat of approximately 118°F to 129°F (48°C to 54°C), for as few as three minutes, can destroy virtually all enzymes,1

WHAT IS AN ENZYME? Enzymes are proteins found either within cells or dissolved in the mesenchyme and body fluids. They serve as biological catalysts, reducing the amount of energy required for chemical reactions, and controlling metabolic reactions that would otherwise either not take place, or occur very slowly, under normal physiological conditions. There are over 80,000 known enzyme systems, each with a specific function. Life would not exist without them, as the body’s entire metabolic process is based on the activation, inhibition and control of enzymes.

IVC Spring 2018

which results in very little pre-digestion taking place in the stomach. Thus, what’s left of the food mass enters the small intestine largely undigested. This puts the pancreas and other organs of the endocrine system under tremendous stress, since they have to draw reserves from the entire body in order to produce massive amounts of the proper enzymes. Supplemental enzymes are often found in combinations: • Lipase: Fairly acid stable, digests most fats. • Lactase: Digests milk sugar. Most mammals have high intestinal lactase activity at birth, which declines to low levels with age, and causes incomplete digestion of milk and other foods containing lactose. Like humans, some dogs and cats seem more capable of tolerating milk than others; and there is a significant difference in lactose levels between milk products, ranging from zero in cheddar cheese, to 11 grams in a cup of whole milk.2 • Amylase: Aids the breakdown and assimilation of starches and carbohydrates so they can be converted by other enzymes to glucose.3

CHOOSING SUPPLEMENTS Here are two important points to keep in mind when choosing a food enzyme supplement:

q Animal-source enzymes, often called pancreatic enzymes, usually target digestion of protein.

w Plant-source

enzymes are either derived from actual plants, or cultivated on a plant medium. They are more acid stable than animal-sourced enzymes so are active across the entire pH range in the digestive system, and can digest the full range of food groups. The highest quality digestive enzyme supplements are made by simply inserting the enzyme-rich growing medium into capsules. This means there is no extraction involved, no chemicals, and no drying process to damage the integrity of the enzymes or contaminate the final product. The amount, activity and type of enzymes in the final product depend on the medium used and the length of time the organism is allowed to grow under controlled conditions.

There is an ongoing controversy about whether cultivated or pancreatic enzymes are more suitable for our canine and feline companion animals, but both can be used successfully.

• Glucoamylase: Breaks down maltose into glucose molecules.4 • Cellulase and hemicellulase: Break down cellulose (fiber), which allows access to key nutrients in fruits and vegetables (e.g. carotenoids in carrots, polyphenols in berries, enzymes, and folate in beans, spinach and broccoli). Cellulase is produced primarily by fungi, bacteria and protozoans.5 • Maltase: Digests complex and simple sugars, as well as unused glycogen in muscle tissue. Glycogen is converted from sugars and starches and is stored in muscle cells for future use.6 • Invertase: Breaks down sucrose products like refined sugar, a common food source that can contribute to digestive stress.7 • Alpha galactosidase: Helps digest carbohydrates found in certain foods, such as beans, that are not readily digestible in the small intestine. Undigested carbohydrates then pass into the large intestine where they are fermented by bacteria and produce gas, bloating, pain and general discomfort.

DISEASES RESULTING FROM ENZYMATIC DYSFUNCTION Diseases that disrupt the synthesis or secretion of digestive pancreatic enzymes cause mal-digestion with subsequent malabsorption. • Exocrine pancreatic insufficiency (EPI) occurs when there is a loss of 85% to 90% of exocrine pancreatic mass. Without the pancreatic enzymes, severe mal-digestion and malabsorption of starch, protein and most notably fat will occur. EPI in dogs is often complicated by secondary bowel pathogen overgrowth and antibiotic-responsive diarrhea, which further disrupts nutrient digestion and absorption. EPI is relatively uncommon in cats and is most frequently due to chronic pancreatitis. • Lactase deficiency from a brush border enzyme deficiency may cause milk intolerance in adult dogs and cats. • Amylase deficiency from acquired brush border defects may be seen in the course of generalized small intestinal disease. Carnivores are not suited to high carbohydrate diets, as they cannot maintain long term production of the quantity of amylase enzymes necessary to properly digest and utilize them. Proteins in grains are also less easily digested than animal proteins. Allergies and other chronic immune problems may develop, as noted in the subsequent section on CIC issues.8 • Allergies and food sensitivities are common. Allergens are almost always proteinaceous, and undigested particles of food may cross the intestinal barrier into the bloodstream, Continued on page 16.

IVC Spring 2018

Continued from page 14. eliminated through the lymphatic system and kidneys. A glut of CICs can overwhelm the body’s ability to eliminate them, so the body is forced to “store” them in its own soft tissues, resulting in an ongoing allergic immune response that leads to inflammation9 and, ultimately, autoimmune disorders.10 In fact, studies have shown that diseases that present high CIC levels can be improved or even cured by eliminating the excess CICs.11 Furthermore, putrefaction in the gut caused by undigested food may jeopardize the integrity of the intestinal wall, allowing various

Image courtesy of Carola Schleuss, CNC, CMP

where they are identified as foreign substances by the immune system. This wastes precious defense resources on a “false alarm” rather than defending the body from true hazards, and is referred to as food leucocytosis (a fooddriven increase in white blood cells). CICs (circulating immune complexes) start out as undigested large protein molecules (primarily from wheat, corn, dairy and soy) that can be absorbed into the bloodstream. Antibodies couple with these foreign protein invaders to form CICs. At first, these CICs may be neutralized by the immune system, then

IVC Spring 2018

environmental toxins in the food to find their way into the blood and body. There is strong evidence that glyphosate, a common herbicide, can poison the microbiomes leading to a host of other health problems, including systemic illness, digestive issues, malnourishment and fatigue, which are all symptoms considered to be triggered by gluten sensitivity or intolerance. Some research shows that glyphosate inhibits a type of digestive enzyme that helps process and activate vitamins A and D3, along with detoxifying pollutants.12 Based on this research, some scientists have concluded that it’s not the gluten in wheat that’s the problem. It’s the glyphosate, or even both.

PRACTICAL ORAL SUPPLEMENTATION There are many digestive enzyme products on the market, often combined with probiotics. When enzymes are fed with meals, they aid in digestion. When you feed the exact same enzymes at other times, they work systemically for metabolic purposes. If the intent is predigestion, non-enteric coated products are best. Their presence in the upper stomach normalizes the signaling mechanisms that govern the release of stomach acid or the production of bicarbonate and enzymes by the pancreas. Given between meals, non-animal-derived enzymes, such as microbial or fungal enzymes, can be used as anti-inflammatories.13 Research has now shown that proteolytic enzymes can increase the permeability of the mucosal epithelium and facilitate bioavailability by a mechanism of self-enhanced paracellular diffusion.14 They are best given between meals for allergies, as they help to remove or digest circulating proteins that can cause reactivity. As an added bonus effect, proteolytic enzymes have the ability to digest and destroy the protein-based defense shield of every pathogen, allergen and rogue cell, thereby leading to their ultimate elimination. Enteric pathogens often gain access to the body by altering the structure and function of tight junctions to increase permeability of the barrier via the secretion of proteases, which can cleave tight junction proteins, or by altering the cytoskeleton.15

SPECIFIC USES IN CLINICAL PRACTICE Though animals being fed a raw meat diet (frozen or homeprepared) rarely need digestive enzyme supplements, they may be needed during diet transitions, or when part of the diet is plant-based; in the wild, most plant materials would be “pre-digested” in the ingesta of the intestinal tract. Any

animal whose diet is predominately processed will greatly benefit from digestive enzymes, as processed foods are enzymatically dead. Animals with digestive upsets (gas, diarrhea, vomiting), yeast overgrowth and sluggish metabolism clearly benefit while deeper cures are attained. Many animals undergoing stress (travel, anxiety, fear of things like thunder or fireworks) benefit, as do aged animals, since their enzyme systems are probably depleted. Antibiotics or other medications may interfere with the microbiome and enzyme function, so both digestive enzymes and probiotics are routinely indicated.

SUMMARY Recently, research scientists have found evidence that impaired digestion, as well as decreased enzyme activity in the blood, are directly related to the aging process and many of the illnesses and chronic degenerative conditions so prevalent in modern society. These studies suggest that as we and our animals age, the number of enzymes and their activity levels decrease in our bodies. As Dr. Howell said in his book on enzyme nutrition, “A person’s life span is directly related to the exhaustion of their enzyme potential. And the use of food enzymes decreases that rate of exhaustion, and thus, results in a longer, healthier and more vital life.”16 We can certainly enhance the life of our dog and cat patients by considering the contribution of enzymes to their wellness. rawfoodlife.com/cooking-creates-toxins-that-causes-disease/ dogfoodadvisor.com/dog-feeding-tips/dogs-milk-dairy-products/ 3 Singh S, Guruprasad L.“Structure and sequence based analysis of alpha-amylase evolution.”Protein Pept Lett. 2014;21(9):948-56. ncbi.nlm.nih.gov/pubmed/25034346 4 Kelly JJ and Alpers DH. “Properties of human intestinal glucoamylase”. Biochim. Biophys. Acta 315: 113–122. 1973. ncbi.nlm.nih. gov/pubmed/4743896 5 Parada J, Aguilera JM. “Food microstructure affects the bioavailability of several nutrients.” J Food Sci 2007, 72:R21-32. ncbi.nlm. nih.gov/pubmed/17995848 6 Weinik M, Campagnolo D. “Acid Maltase Deficiency Myopathy.” Medscape 25 Mar 2014. (Accessed 21 Jul 2014.) emedicine. medscape.com/article/313724-overview 7 Lieberman, P.“Is allergy or intolerance to sweet or sugar exist, and how to manage or treat it?”AAAA. (Accessed 21 Jul 2014.) aaaai. org/ask-the-expert/allergy-intolerance-sugar.aspx 8 Malabsorption Syndromes in Small Animals, merckvetmanual.com/digestive-system/diseases-of-the-stomach-and-intestines-insmall-animals/malabsorption-syndromes-in-small-animals 9 Arazi A, Neumann AU.“Modeling immune complex-mediated autoimmune inflammation.”J Theor Biol. 2010 Dec 7;267(3):42636. ncbi.nlm.nih.gov/pubmed/20832412 10 Cano PO, Jerry LM, et.al. “Circulating immune complexes in systemic lupus erythematosus.”Clin Exp Immunol. Aug 1977; 29(2): 197--204. ncbi.nlm.nih.gov/pmc/articles/PMC1541106/pdf/clinexpimmunol00234-0013.pdf 11 Stauder G, Ransberger K, Streichhan P, Van Schaik W, Pollinger W. “The use of hydrolytic enzymes as adjuvant therapy in AIDS/ ARC/LAS patients.”Biomed Pharmacother. 1988;42(1):31-4. ncbi.nlm.nih.gov/pubmed/3408806 12 Samsel A, and Seneff S. “Glyphosate, pathways to modern diseases II: Celiac sprue and gluten intolerance.” (2013 December) NCBI. Interdiscip Toxicol. 2013 Dec; 6(4): 159–184. Retrieved from ncbi.nlm.nih.gov/pmc/articles/PMC3945755/ 13 Rachman B.“Unique Features and Application of Non-Animal Derived Enzymes.”Clinical Nutrition Insights. 510 8/97 Vol. 5, No. 10. (Accessed 24 Jun 2014.) cudoc.com/Digestive%20Enzymes.PDF 14 Kolac C, Streichhan P, Lehr C-M. “Oral bioavailability of proteolytic enzymes.” European journal of pharmaceutics and biopharmaceutics. 1996, vol. 42, no4, pp. 222-232 (68 ref.) cat.inist.fr/?aModele=afficheN&cpsidt=3191444 15 Berkes J, Viswanathan VK, Savkovic SD, Hecht G.“Intestinal epithelial responses to enteric pathogens: effects on the tight junction barrier, ion transport, and inflammation”. Gut 2003, 52:439–451. 16 Howell E. Enzyme Nutrition: The Food Enzyme Concept New Jersey: Avery Publishing Group, 1985. 1 2

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STRATEGIES FOR MANAGING

PANCREATITIS IN SMALL ANIMALS By Steve Marsden, DVM, ND, MSOM, Lac., Dipl.CH, CVA, Grad Dip Vet Acup, Grad Dip VCHM, AHG

Herbal medicines and low-fat meat and vegetable diets can prevent pancreatitis in dogs and cats, and can also be used to resolve acute and chronic stages of the disease.

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Pancreatitis is commonly diagnosed and treated in small animal veterinary medicine. However, its causes and pathophysiology remain poorly understood, except to say that it is usually a sterile condition. The acute end of the disease spectrum is associated with high mortality, although there is good potential for complete recovery of organ structure and function if the animal survives. At the other end of the spectrum, chronic pancreatitis in either dogs or cats can cause refractory pain and progressive exocrine and endocrine functional impairment.1 Despite the importance of pancreatitis as a clinical syndrome, almost no trials of diets or drugs exist for its treatment and prevention, except for the critically ill patient. The prescription of low-fat kibble and canned foods, although common, is largely untested. Thus, any attempt to formulate an evidencebased approach to pancreatitis, whether using drugs, diet or natural therapies, must begin with a review of the current understanding of the disease’s pathophysiology. There is confusion in the veterinary literature about the definitions of acute and chronic pancreatitis, and there are very few studies on the pathophysiology of naturally-occurring pancreatitis in dogs and cats. But enough laboratory evidence has accumulated to formulate a likely model of pathogenesis.

PATHOPHYSIOLOGY OF PANCREATITIS Part of the confusion surrounding pancreatitis may stem from the fact that the conditions that incite it vanish once the organ has become inflamed. Nitric oxide (NO) and its impact on micro-circulation appear to play a pivotal role in the pathogenesis of the condition.2,3 The onset of pancreatitis is marked by a lack of NO, whereas the acutely inflamed state is marked by an abundance of NO. Preventing and treating pancreatitis thus require almost opposite approaches. The role of the gut is also being explored as a source of oxidative stress which aggravates existing pancreatic inflammation.

a properly functioning pancreas. When pancreatitis is in full swing, however, inducible NO levels are high. The pancreas becomes engorged with blood and edematous, enzymes are disgorged, and the pancreas becomes congested. Meanwhile, the strong free radical activity of NO further heightens inflammation, making NO an important target for future pharmaceuticals in the treatment of acute pancreatitis. The heightened levels of NO and blood flow during pancreatitis are in opposition to the state of reduced micro-circulation and NO levels that trigger pancreatitis to begin with.6 Before acute pancreatitis develops, there is: • Impairment of pancreatic micro-circulation in the early phase • Reduced blood flow • Increased platelet adhesion and clot formation. These events are caused by a reduction of endothelial NO in the vasculature of the pancreas; this is known as endothelial dysfunction (ED). ED promotes the initiation of inflammation because of its associated: • Increased vascular permeability • Increased leukocyte-endothelial cell adhesion and leukocyte egress. Experimental evidence supports the notion that a lack of endothelial NO, causing associated ED, is what triggers pancreatitis. Endothelial NO synthase reduces the severity of the initial phase of experimental acute pancreatitis.4 NO synthase inhibition by pharmaceuticals has been shown to trigger acute pancreatitis.7 In short, then, to support endothelial NO levels is to prevent ED; and to prevent ED is to prevent pancreatic inflammation. To resolve chronic pancreatitis, and to prevent its incidence in the first place, clinicians need to focus on the cause of ED. For the most part, ED in small animals is caused by diet.

ROLE OF NITRIC OXIDE AND ENDOTHELIAL DYSFUNCTION

DIABETES, INSULIN RESISTANCE, AND ENDOTHELIAL DYSFUNCTION

There are two types of NO germane to the pathogenesis of pancreatitis:4 • Inducible nitric oxide – of importance in the progression of pancreatitis • Endothelial – of relevance in the initiation of pancreatitis

Veterinarians are used to thinking of pancreatitis as a cause of diabetes mellitus (DM), through the destruction of betaislet cells. Diabetes mellitus is also an important precursor to pancreatitis, however, and not just a sequela.8

Inducible NO is found in the pancreas parenchyma, where it regulates normal pancreatic exocrine secretion,5 both by boosting pancreatic microvascular blood flow and by directly regulating enzyme secretion. Normally, its presence is key to

Diabetes often precedes pancreatitis because it is linked to ED. In Type 1 diabetes, ED is consistently found in advanced stages of the disease. For Type II diabetes, ED may even precede it.9 Both types of diabetes are the by-product of insulin resistance. Continued on page 20. IVC Spring 2018

Continued from page 19. Insulin resistance alters gene expression for a number of pathways known to culminate in ED, including: • Increased secretion of pro-inflammatory cytokines • Decreased secretion of adiponectin from adipose tissue • Increased circulating levels of free fatty acids • Post-prandial hyperglycemia.

In the author’s experience, a minimally processed (raw or homemade) balanced diet of meat and vegetables is of the most benefit in preventing pancreatitis in carnivores. Pancreatitis seldom occurs in animals fed these diets. Once acute pancreatitis is present, however, the familiar recommendation of nothing-per-os (NPO) applies.

At the same time, insulin resistance promotes diabetes. Once diabetes is present, increased intracellular concentrations of glucose metabolites in endothelial cells heighten their dysfunction by: • Impairing mitochondria function • Increasing oxidative stress • Activating protein kinase C, causing a halt in endothelial nitric oxide production.

CHINESE HERBS FOR PANCREATIC AILMENTS

The upshot of chronic insulin resistance is that: • Endothelin levels increase • Endothelial NO levels drop • Vessels constrict • White blood cells adhere to and move across blood vessels into the pancreatic interstitium • Platelets adhere to endothelial cells to form clots, aggravating any tendencies to hypoxia. Subclinical pancreatitis can now begin and the animal is also more prone to severe acute episodes. Insulin resistance and subsequent ED are important targets for intervention in resolving chronic pancreatic inflammation, and preventing future episodes. While several herbal formulas can target these self-same pathways, instituting an appropriate diet will help guarantee lasting success in managing these cases.

PREVENTING PANCREATITIS WITH DIET Typically, veterinarians think to limit only fat intake in the animal’s food, but insulin resistance, obesity and a heightened predisposition to pancreatitis are not caused by high fat intake alone. Processed starch-based canned and kibble diets are arguably the most common cause of insulin resistance in veterinary medicine. Pancreatitis becomes a rare event when these diets are avoided. Commercial canned and kibble diets are rapidly absorbed and frequently carbohydrate-based, provoking a surge in post-prandial glucose that leads to chronically high insulin levels and eventually insulin resistance, with its attendant sequelae, including a systemic tendency to inflammation, including in the pancreas. Insulin resistance does not just result in diabetes mellitus, and can be presumed to be present in all overweight animals.

Targeting insulin resistance – Damp Heat formulas Three Seeds Combination (San Ren Tang) Three Seeds Combination has a clinical reputation for reversing insulin resistance and Type II diabetes mellitus, particularly in the feline. Coix markedly increases insulin sensitivity and has been shown to reduce adipose tissue weight, leptin and insulin levels.10 The formula is anti-inflammatory, but also reduces predisposition to ED, thus helping to both resolve chronic pancreatitis and reduce the risk of future episodes. Animals needing this formula often have a wet, swollen and lavender tongue, although it can also be a mild red color. The pulse is usually deep and toned. Four Marvels Combination (Si Miao San) This formula is used to manage acute pancreatitis, whether mild or severe. It increases insulin sensitivity and studies have verified its benefits in pancreatitis through its antioxidant effects.11 The patient that benefits from Si Miao San has a tendency towards acute inflammation, oxidation and associated insulin resistance, usually manifesting as inflammation at multiple epithelial surfaces (especially the ears, skin, colon, biliary tree and bladder). Signs of Cushing’s can also occur. The tendency to acute inflammation is marked by a superficial and toneless pulse. The tongue is often red or purple-red. Targeting endothelial dysfunction Minor Bupleurum Minor Bupleurum interferes with the production of cytokines that promote ED.12 It is most helpful in resolving sub-acute to chronic pancreatitis, especially when due to systemic infection or immune dysregulation. These cases will often have inflammation manifesting in other organs, especially the liver and kidneys (as glomerulonephritis), but also including the eyes (glaucoma, uveitis), lungs (pneumonia, pneumonitis), nervous system (disc disease, vestibular disease), and even the skin. Occasionally, the animals have a prior history of cancer. Animals benefiting from Minor Bupleurum almost invariably have deep, toned strong pulses. One or more vagal symptoms Continued on page 23.

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CASE EXAMPLE: Falco Teefy Falco is a nine-yearold male neutered Border Collie cross who presented with a chief complaint of pancreatitis. Recent history included removal of an infiltrative lipoma from the caudal thorax, and episodes of a nocturnal hacking cough ending in the vomiting of foamy material. The pancreatitis seemed to gear up over a long period, with nausea, vomiting and pica occurring since the summer of 2016; it did not respond to antacids or anti-emetics. A protocol was eventually settled on, consisting of 0.2 mg/ kg prednisone, a round of metronidazole and milk thistle. Two herbal formulas, Yi Guan Jian and San Ren Tang, were also initiated.

Over the long term, prednisone was discontinued, and the combination of Minor Bupleurum and Three Seeds Combination proved sufficient to eradicate all symptoms. This use of herbs continues to date, as does the processed kangaroo diet.

CASE DISCUSSION It is common for veterinarians to manage problems in an integrative fashion, using both herbs and drugs together. In Falco’s case, the low doses of prednisone would have favored insulin resistance and ED, but were successfully countered with Yi Guan Jian and San Ren Tang, two formulas for chronic GI inflammation. When first one and then the other of these formulas were discontinued, the negative effects of the prednisone were no longer countered, and the pancreas erupted with inflammation, fueled by a highfat, albeit raw diet.

Falco de-stabilized in October of 2016 when herb use became less consistent. Yi Guan Jian alone was resumed along with metronidazole and continued prednisone use. Although Falco seemed at first to improve again, he had to be hospitalized in November for pancreatitis. Clinical signs at that time included lethargy, fever, diarrhea and abdominal pain. ALP was increased to several times the normal value, and an enlarged liver was seen on ultrasound. A snap test showed a strong positive result for CPL and pancreatitis. Physical examination showed strong-toned mid-depth pulses that responded well to acupuncture of prominent Gall Bladder channel points. In addition to acupuncture, Falco was given anti-emetics, fluid therapy, hydromorphone and the typical low-fat bland processed diet. A derivative of Minor Bupleurum was introduced as the new herbal formula. Falco gradually improved over the next two weeks, but had no appetite for a bland diet, so a low-fat processed kangaroo diet was fed instead. Improvements in laboratory data steadily accrued even as improvements in symptoms were more erratic.

Response of Falco’s ALP and CPL to Minor Bupleurum Minor Bupleurum was the main intervention that arrested symptoms and disease progression in Falco. Its use was indicated by the characteristic pulse, history of cancer, nausea, and the history of a chronic cough that ended in vomiting. Herb use should be continued as long as processed diets are fed, to counter the latter’s tendencies to promote inflammation and ED.

The author acknowledges the contributions to this case study of Jana Teefy, AHT, RLAT, and Jennifer Marshall, BSc, DVM, both of Edmonton Holistic Veterinary Clinic.

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Continued from page 20. are common, including chronic cough, vomiting, bloating and constipation. Glehnia and Rehmannia Glehnia and Rehmannia Combination, known also as Yi Guan Jian, contains two plants, Angelica and Rehmannia, that counter ED to restore normal micro-circulation and actively resolve chronic inflammation in a number of tissues.12 The formula is contraindicated in acute active pancreatitis, since the organ is now severely congested and edematous. It can resolve mild low-grade pancreatitis, and prevent recurrences. Animals that benefit from this formula have reduced circulation to epithelial surfaces, creating dryness, mild gastric inflammation, and irritable bowel syndrome. Animals often display mild to moderate liver enzyme elevations; older animals may have mild to moderate azotemia. Anemia and chronic weight loss may be present, as well as a tendency to timidity or anxiety. The pulse is often thin and the tongue pale, perhaps with a lavender center.

Targeting bacterial causes Agastache Combination (Huo Xiang Zheng Qi San) Patients often have Damp Heat tendencies, yet do not respond to San Ren Tang and Si Miao San. Huo Xiang Zheng Qi San should be considered next, in case bacteria are inciting the inflammation. Agastache is a strong antimicrobial formula with a broad spectrum of effect against many species of viruses, nematodes, fungi and bacteria. 13,14,15 Agastache also interferes with cell adhesion,16 thereby reducing white blood cell ingress into the interstitium, and subsequent inflammation. Consider this formula for chronic pancreatitis in young animals, especially if the disease is, or has been, associated with chronic refractory small bowel diarrhea or suspected small intestinal bacterial overgrowth. Continued on page 24.

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Continued from page 23.

USING HERBS – ADMINISTRATION VIA ENEMA

CONCLUSION

While injectable forms of herbal medicine are not yet available for the NPO patient, quantities of the appropriate formula can be delivered to an acutely ill dog via enema. A patient’s response to an herbal formula delivered by enema is often rapid and dramatic, with enzyme elevations subsiding significantly and the patient stabilizing within a couple of days. Compounds in the formulas are absorbed across the large intestine mucosa into the portal circulation, and from there move rapidly to the systemic circulation, bypassing any gastroparesis.

Pancreatitis can be prevented in carnivores by using herbal medicines and low-fat meat and vegetable diets. Once these therapies are instituted, episodes of pancreatitis consistently cease. Herbal formulas may also be used to resolve acute and chronic stages of the disease, and work along with diet to eliminate the inciting factor of recurrent and chronic pancreatitis – reduced endothelial nitric oxide.

Method • Use two to three times the normal dose for the patient (see chart below), and give TID to QID. • Suspend each dose in a maximum of 10 ml to 15 ml of warm water. • Instill into the transverse colon using a small rubber French feeding tube. • Use only granular extracts or crushed tablets, never liquid extracts, for administration via enema.

For more info: Much more detail on veterinary clinical uses of these and other products can be obtained from the College of Integrative Veterinary Therapies (civtedu. org), and from the Essential Guide to Chinese Herbal Formulas: Bridging Science and Tradition (S Marsden, 2014, published by CIVT).

ORAL DOSING Weight (kg)

Weight (lbs)

BID dose (mls)

BID dose (550 mg tabs)

BID dose (tsp granular extracts)

0.30

1.00

0.25

0.45

1.50

0.50

0.60

2.00

0.75

0.90

3.00

1.00

1.20

4.00

1.50

150

1.80

6.00

2.00

120

250

2.40

8.00

3.00

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All the formulas in this article can be obtained in various formats from nphc.ca.

Watson P. “Pancreatitis in dogs and cats: definitions and pathophysiology”. J Small Animal Practice. 2015 Jan; 56(1):3-12. 2 Mansfield C. “Acute pancreatitis in dogs: advances in understanding, diagnostics, and treatment”. Top Companion Anim Med. 2012 Aug; 27(3):123-32. 3 Mansfield C. “Pathophysiology of acute pancreatitis: potential application from experimental models and human medicine to dogs”. J Vet Intern Med. 2012 Jul-Aug;26(4):875-87. 4 DiMagno MJ. “Nitric oxide pathways and evidence-based perturbations in acute pancreatitis”. Pancreatology. 2007;7(5-6):403-8. 5 Yago MD, Mañas M, Ember Z, Singh J. “Nitric oxide and the pancreas: morphological base and role in the control of the exocrine pancreatic secretion”. Mol Cell Biochem. 2001 Mar;219(1-2):107-20. 6 Sunamura M, Yamauchi J, Shibuya K, Chen HM, Ding L, Takeda K, Kobari M, Matsuno S. “Pancreatic microcirculation in acute pancreatitis”. J Hepatobiliary Pancreat Surg.1998;5(1):62-8. 7 Poulson JM, Dewhirst MW, Gaskin AA, Vujaskovic Z, Samulski TV, Prescott DM, Meyer RE, Page RL, Thrall DE. “Acute pancreatitis associated with administration of a nitric oxide synthase inhibitor in tumor-bearing dogs”. In Vivo. 2000 Nov-Dec;14(6):709-14. 8 Davison LJ. “Diabetes mellitus and pancreatitis -- cause or effect?” J Small Anim Pract. 2015 Jan;56(1):50-9. 9 Rask-Madsen C, King GL. “Mechanisms of Disease: endothelial dysfunction in insulin resistance and diabetes”. Nat Clin Pract Endocrinol Metab. 2007 Jan;3(1):46-56. 10 Huang BW, Chiang MT, Yao HT, Chiang W. “The effect of adlay oil on plasma lipids, insulin and leptin in rat”. Phytomedicine. 2005 Jun;12(6-7):433-9. 11 Shang SW, Yang JL, Huang F, Liu K, Liu BL. “Modified Si-Miao-San ameliorates pancreatic B cell dysfunction by inhibition of reactive oxygen species-associated inflammation through AMP-kinase activation”. Chin J Nat Med. 2014 May;12(5):351-60. 12 Marsden S, Dodds J. “Chinese herbal medicine in autoimmune disease: case reports and speculated mechanisms of action”. JAHVMA, 2015 Winter; 38(31-37). 13 Yang JL, Wang JL, Huang F, Liu K, Liu BL. “Modified Si-Miao-San inhibits inflammation and promotes glucose disposal in adipocytes through regulation of AMP-kinase”. Chin J Nat Med. 2014 Dec;12(12):911-9. 14 Fan J, Liu K, Zhang Z, Luo T, Xi Z, Song J, Liu B. “Modified Si-Miao-San extract inhibits the release of inflammatory mediators from lipopolysaccharide-stimulated mouse macrophages”. J Ethnopharmacol. 2010 May 4;129(1):5-9. 15 Luo TJ, Wang KZ, Zhao WW, Shang SW, Ye LF, Liu K, Liu BL, Huang F, Wang X. “Modified Si-Miao-San regulates adipokine expression and ameliorates insulin resistance by targeting IKKβ/Insulin receptor substrate-1 in mice”. Chin J Integr Med. 2014 Apr 16. 16 Zielińska S, Matkowski A. “Phytochemistry and bioactivity of aromatic and medicinal plants from the genus Agastache (Lamiaceae)”. Phytochem Rev. 2014;13:391-416. 1

BEYOND INSULIN

– strategic management of diabetes in dogs and cats By Carmen Colitz, DVM, PhD, DACVO and Terri L McCalla, DVM, MS, DACVO Diabetes mellitus in dogs and cats is commonly associated with obesity. But there are other risk factors, including pancreatitis and hyperlipidemia. Some dog breeds are more prone to the disease. An additional risk factor in both dogs and cats is systemic steroid (glucocorticoid) medication; any glucocorticoid excess can lead to insulin resistance and eventually cause pancreatic “burnout”. Other conditions associated with diabetes mellitus include blindness in dogs due to rapidly developing cataracts. Diabetic dogs are also often affected with dry eye, Horner’s syndrome, hyperadrenocorticism, systemic hypertension, renal insufficiency, immune deficiency, urinary tract infections and cognitive dysfunction. Besides insulin therapy, diabetic patients need proper nutrition. It is very important to feed diabetic patients a consistent, high quality palatable diet. The optimal diet also depends on whether the patient has other risk factors like obesity, hyperlipidemia, pancreatitis, etc.

In addition to diet, many nutraceuticals have supportive properties that help improve glucose utilization or decrease insulin resistance, such as vitamin B6, biotin, vitamin K-1, chromium, magnesium, vanadium, zinc, alpha lipoic acid, L-carnitine, Cassia nomame, cinnamon and quercetin. Several antioxidants help diminish diabetes-associated oxidative stress, including grapeseed extract, epigallocatechin gallate, vitamins C and E, N-acetyl cysteine, astaxanthin, cat’s claw, coenzyme Q10, beta-glucans and quercetin. Improved digestion is important as patients age, especially when they have diabetes. Pancreatic enzymes act as digestive aids. Improving the beneficial microflora of the gastrointestinal tract is also important, and can be done by providing arabinogalactan and beta-glucans to diabetic patients. Drs. Colitz and McCalla are board-certified veterinary ophthalmologists with private referral practices in Jupiter, FL (All Animal Eye Care in Jupiter Pet Emergency and Specialty Center) and Bellingham WA (Animal Eye Care LLC), respectively. Dr. Colitz’s special interests include diseases of the lens and cornea, as well as marine mammal ophthalmology. Dr. McCalla’s special interests include antioxidant support of ocular health, and feline ocular herpesvirus disease.

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nutrition nook

PEER-REVIEWED

Probi tics – the missing nutrients Part 1

By Doug Knueven, DVM

A BALANCED INTESTINAL MICROBIOME IS CRUCIAL TO GOOD HEALTH IN DOGS AND CATS, AS WELL AS IN HUMANS. PROBIOTICS CAN PLAY AN IMPORTANT ROLE IN MAINTAINING THIS BALANCE.

aintaining a healthy and balanced intestinal microbiome in our patients (and in ourselves) is becoming increasingly difficult. This can lead to a multitude of health issues, in which probiotics can be of significant assistance. In the first of this two-part article, we’ll look at the discovery of probiotics (see sidebar on page 28) and how they can alleviate microbial imbalance in the gut and support the integrity of the intestinal lining.

THE MICROBIOME “The intestinal microbiota is the collection of the living microorganisms (bacteria, fungi, protozoa, and viruses) inhabiting the gastrointestinal tract.”1 The term “microbiome” includes the organisms, their interactions and their environment.

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Microbiomes are extremely unique between even closely-related individuals. Each gut hosts thousands of bacterial species and strains. There are between 100 and 150 times more bacterial genes than human genes in our bodies. And there is an intricate interaction between the host and both the intestinal bacteria and their genes. About 500 cultivable species of bacteria exist in the gut. An additional 1,000 species have been identified by modern molecular techniques (specifically ribosomal RNA sequencing, known as metagenomics). “This microbial community…varies quantitatively and qualitatively along with the different environments from the stomach, small and large intestines…. This complex community is metabolically active and contributes to homeostasis.”2 A functional microbiome breaks down foods to liberate more nutrients, manufactures several vitamins, inhibits disease-causing bacteria, and nourishes the enterocytes by producing the short-chain fatty acids used for fuel. Thus, the intestinal microflora maintains the integrity of the intestinal lining that protects the entire body from the inflammation associated with leaky gut syndrome.3 Furthermore, the microbiome acts as a detoxification organ; an imbalance in the bacteria can stress the liver. Gut bacteria influence the systemic immune system. They also affect brain chemistry and structure. Animals have co-evolved with their microbiomes, and so they have developed a symbiotic relationship with them.4 In fact, some researchers assert that the microbiome should be considered an organ of the body5 – an organ as vital as the kidneys or liver. At a phylogenetic level, the gastrointestinal microbiomes of humans, dogs and mice are similar.6 This indicates that microbiome research from one of these species applies to the others. In dogs and cats, more than ten bacterial phyla have been identified, with Firmicutes, Bacteroidetes, Proteobacteria, Fusobacteria and Actinobacteria constituting more than 99% of all gut microbiota.7 Some of the gut bacteria that are beneficial for people are also helpful for dogs. In one study, Lactobacilli were isolated from the jejunal chyme of five fistulated beagles. They found that Lactobacillus acidophilus was dominant.8 According to recent research, “The symbiotic relationship that exists between GI microbes and the host is critical for proper function of nutritional, developmental, immunological, and physiologic processes in animals, and thus contributes to host health… Decreased GI pH also results in IVC Spring 2018

THE DISCOVERY OF

PROBIOTICS

The story of probiotics begins with Elie Metchnikoff (18451916). This Russian-born biologist was the first to understand the importance of white blood cells for immunity, which earned him the Nobel Prize in medicine in 1908. In fact, Metchnikoff is considered the “Father of Natural Immunity”. He noticed that Bulgarian peasant farmers were healthier, more robust, and lived longer than their city-dwelling countrymen. He insightfully realized their consumption of fermented foods, more specifically the bacteria those foods contained, was responsible for the farmers’ good health. Metchnikoff coined the word “probiotics” (literally “for life”) for the beneficial bacteria in fermented foods. He reasoned that for health, the intestines must harbor more “good” than “bad” bacteria. He said that “Death begins in the colon.” This statement echoes that of Hippocrates who said: “All disease begins in the gut.” The fermentation of food dates back 6,000 years when the Chinese began fermenting cabbage. A critical component of food safety, fermentation has been embraced by almost every culture around the globe. From Korean kimchi and Indian chutney to African garri and European pickled vegetables, to Hawaiian poi and the ubiquitous yogurt and sauerkraut, fermented foods are utilized worldwide. In some countries, the fermentation process involves burying the food, reminiscent of carnivores that bury their uneaten prey. When you think about it, it seems obvious that any other carnivore that wandered past a shallow grave would smell, exhume and consume its contents. So if predators don’t bury their leftovers to hide them, then why do they do it? Perhaps it’s to support fermentation, so the carnivores can benefit from probiotic bacteria. At the very least, it must be acknowledged that our pets’ ancestors of did not eat sterile food. Fermenting food involves creating an environment that promotes the growth of acid-forming bacteria. These microbes convert sugars into organic acids. The low pH that is created inhibits the growth of pathogenic bacteria, and thus keeps the food from spoiling. The formation of acid is also responsible for the ability of probiotics to kill off pathogenic bacteria in the gut. The balance of intestinal microﬂora has broad effects on an animal’s health, and on ours. There are 100 trillion microbial cells in our bodies. In fact, we consist of ten times more bacterial cells than human cells. So, at the cellular level, we are more bacterial than we are human! The same is no doubt true for pets. 28

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decreased solubility of bile acids, thus decreased reabsorption and enterohepatic circulation of bile acids, increased absorption of minerals, and reduced absorption of ammonia.”9

DYSBIOSIS AND LEAKY GUT The term “dysbiosis” is used to indicate a state of gastrointestinal microbial imbalance or maladaptation. Another common factor of dysbiosis is a serious decrease in microbiota diversity. According to recent research, molecular interactions link the gut microbiota with host energy metabolism, lipid accumulation and immunity. These researchers go on to state: “Altered gut microbial ecosystems have been associated with increased metabolic and immune disorders in animals and humans.”10 An unbalanced gut microbiome is associated with disorders such as obesity, diabetes mellitus, schizophrenia, autistic disorders, anxiety disorders, and major depressive disorders.11 Many GI diseases linked to dysbiosis lead to an increase in intestinal permeability, a condition commonly known as “leaky gut syndrome”. Certain pathogenic bacteria damage tight junctions and produce toxins that then pass into the systemic circulation. According to research, leaky gut may allow the passage of toxins, antigens or bacteria into the portal circulation and may play a pathogenic role in advanced liver cirrhosis and its complications. Furthermore, translocated bacterial antigens can result in a cross-reaction with the self-antigens and the induction of autoimmunity. A growing number of diseases have been shown to involve an increase Continued on page 30.

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MESSING WITH THE

MICROBIOME

Continued from page 28.

Modern medicine has found many ways to disturb the delicate balance of the microbiome. Obviously, antibiotic therapy of any kind indiscriminately kills the “good” bacteria along with the “bad”.10 Other drugs also cause a deleterious change in the gut bacteria – these include NSAIDs, proton-pump inhibitors, antidepressants and laxatives. Researchers have concluded that, “Bacteria in the gastrointestinal tract reflect the combinations of medications that people ingest.”11 Just about any pharmaceutical can lead to a state of intestinal dysbiosis.

in intestinal permeability related to changes in tight junction competency.12 In fact, when translocated bacterial antigens affect metabolically-active tissues, it may result in a chronic inflammatory state and impaired metabolic function.13 The solution to this problem is probiotics. Multiple studies show that probiotics decrease intestinal permeability.14,15

HEALTH BENEFITS OF PROBIOTICS Probiotics are defined as “live microorganisms, which when administered in adequate amounts confer a health benefit on the host.”16 The most commonly-used probiotic bacteria are species belonging to the genera Lactobacillus and Biﬁdobacterium for humans and Aspergillus, Bacillus, Enterococcus, Lactobacillus and Saccharomyces for animals.17 One key to the efficacy of a probiotic supplement is that it must provide an adequate number of bacteria. For people, the agreed upon range is 5-10 X 109 Colony Forming Units (CFUs), while pets need at least 1 X 108 CFUs. An ideal probiotic should have microbes that originate in the species being treated, and should also be nonpathogenic, resistant to digestion by gastric acid and intestinal enzymes, able to adhere to the intestinal epithelium, and capable of influencing host immune responses.18

CONCLUSION In this article, we have reviewed the discovery of probiotics, as well as research documenting the importance to health of a balanced intestinal microbiome. We have seen how modern medical practices can disturb the microbiome, and looked at the role that probiotics play in mitigating dysbiosis and maintaining the integrity of the intestinal lining. In Part 2 of this series (IVC Journal, Summer 2018), we will delve more deeply into the research on probiotics and how

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they affect the immune system, microbiota-gut-brain axis, and systemic detoxification. We will further explore the influence of probiotics on such diverse conditions as chronic gastrointestinal disease, mood disorders/behavior, obesity, pancreatitis, diabetes mellitus and cancer. The sum of this research will allow the conclusion that probiotics are essential nutrients that are missing from modern conventional diets in both humans and pets.

Honneffer JB, Minamoto Y, Suchodolski JS.“Microbiota alterations in acute and chronic gastrointestinal inflammation of cats and dogs”. World J Gastroenterol. 2014;20(44):16489-97. 2 Ferreira CL, et al. “Terminology concepts of probiotic and prebiotic and their role in human and animal health.” Rev Salud Anim. 2011;33(3):137-139. 3 Suchodolski JS. “Companion animals symposium: microbes and gastrointestinal health of dogs and cats”. J Anim Sci. 2011;89(5):1520-30. 4 Hooda S, Minamoto Y, Suchodolski JS. “Current state of knowledge: the canine gastrointestinal microbiome”. Anim Health Res Rev. 2012:13(1);78–88. 5 O’Hara AM, Fergus S. “The gut flora as a forgotten organ”. EMBO reports. 2006;7(7):688-693. 6 Swanson KS, et al. “Phylogenetic and gene-centric metagenomics of the canine intestinal microbiome reveals similarities with humans and mice”. ISME J. 2011;5(4):639-649. 7 Suchodolski JS. “Companion animals symposium: microbes and gastrointestinal health of dogs and cats”. J Anim Sci. 2011;89(5):1520-30. 8 Tang Y, Manninen TJ, Saris PE. “Dominance of Lactobacillus acidophilus in the Facultative Jejunal Lactobacillus Microbiota of Fistulated Beagles”. Appl Environ Microbiol. 2012;78(19):7156–7159. 9 Hooda S, Minamoto Y, Suchodolski JS. “Current state of knowledge: the canine gastrointestinal microbiome”. Anim Health Res Rev. 2012:13(1);78–88. 10 Boulangé CL, Neves AL, Chilloux J, Nicholson JK, Dumas ME. “Impact of the gut microbiota on inflammation, obesity, and metabolic disease”. Genome Med. 2016 Apr 20;8(1):42.11 11 Evrensel A, Ceylan ME. “The Gut-Brain Axis: The Missing Link in Depression”. Clin Psychopharmacol Neurosci. 2015;13(3): 239–244. 12 Fasano, Alessio. “Leaky gut and autoimmune diseases.”Clin Rev Allergy Immunol. 2012;42(1):71-78. 13 Brown K, et al. “Diet-induced dysbiosis of the intestinal microbiota and the effects on immunity and disease”. Nutrients. 2012;4(8):1095-1119. 14 Rosenfeldt V, et al. “Effect of probiotics on gastrointestinal symptoms and small intestinal permeability in children with atopic dermatitis”. J Pediatr. 2004;145(5):612-616. 15 Madsen K, et al. “Probiotic bacteria enhance murine and human intestinal epithelial barrier function”. Gastroenterology. 2001;121(3):580-91. 16 Nomoto K. “Prevention of infections by probiotics”. J Biosci Bioeng. 2005;100:583–592. 17 Ferreira CL, et al. “Terminology concepts of probiotic and prebiotic and their role in human and animal health”. Rev Salud Anim. 2011;33(3):137-139. 18 Dotan I, Rachmilewitz D. “Probiotics in inflammatory bowel disease: possible mechanisms of action”. Curr Opin Gastroenterol. 2005;21:426–430. 1

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.

he American Holistic Veterinary Medical Foundation wishes to thank all those who participated in the Winter Fundraiser at the end of last year, either as a private donor or a company. This fundraiser makes it possible to continue supporting research projects that focus on integrative holistic veterinary medicine. Medical research is primarily supported by large drug companies and the government. There is much less support for veterinary research, and almost none for holistic veterinary medicine. The Winter Fundraiser finally made it possible to fully fund Dr. Erin Bannink’s research using a Chinese herbal formula in addition to conventional therapy for dogs with hemangiosarcoma. We eagerly await news about the first phase of this trial. The AHVMF only supports humane research, and will not fund any projects that involve animal models (where diseases are created in order to study them). One consequence is that since our type of research involves natural disease, studies often take longer than initially planned. There can be a problem getting enough pet owners to sign up, especially if it’s a doubleblind study. Occasionally, when multiple clinics are involved, some drop out before a study is completed. Sometimes an investigator changes the university where he/she started the study or leaves the university to go into a private practice. Another reason that news about the studies we support is delayed is because peer-reviewed journals – the types indexed in Medline (PubMed) – are often reluctant to publish studies involving integrative medicine. This is true even of topics that

are being increasingly accepted by human medical journals. A study that showed dramatic results using acupuncture in horses with founder was rejected by several journals, and was finally published in the Canadian Veterinary Medical Journal, after more than a year of submissions. Thanks to the investigator’s persistence, it is now part of the public record. The Foundation would especially like to thank Dr. Carvel Tiekert and his wife Lorraine for two generous contributions. Once again, they pledged $50,000 in matching funds for our Winter Fundraiser. The funds were divided into two parts: $25,000 to be matched by veterinarians, and $25,000 to be matched by the general public. The public reached the goal sooner than veterinary donors, but the entire amount was matched, including a little extra that gave the AHVMF over $100,000 in funds for 2018. In addition, Dr. Tiekert and Lorraine contributed to our first endowment, donating $102,500 to create the Founders Scholarship. A total of $100,000 will be retained in the endowment in order to generate enough funds for the scholarship every year, while a scholarship of $2,500 will be awarded to a veterinary student to attend the AHVMA Conference. If the student is frugal, he/she will also have some money to help pay for school expenses. Recipients of our similar expense-paid scholarship have all agreed that this is a life-changing event for them. The veterinary students who attend the AHVMA Conference on this scholarship become very aware of the possibilities of integrative holistic veterinary medicine.

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BUILDING

GOOD BEHAVIOR IN YOUR PATIENTS

– strategies for stocking your pharmacy By Christina Chambreau, DVM, CVH

Most animals are relinquished to shelters because of behavioral issues. Many clients simply tolerate unwanted behaviors in their pets, while you and your staff are often stressed by poor patient behavior in the clinic. And it doesn’t stop there. Studies have documented the impact of emotional and mental health in animals on physical ailments. Addressing these issues can provide a major income source for your practice, and also increase client retention. The key is to create a receptionist-technician-veterinarian team to identify problem animals, treat them, then follow up on a regular basis. Starting conversations with clients when they first acquire young animals or adopt older ones is mandatory if your goal is to maximize patient health in your practice. You probably already suggest basic training classes, or perhaps offer them at your clinic. You also suggest treatments for animals with specific behavior problems or refer them to specialists.

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Three approaches can improve your success in this area: • Therapeutic product sales •C lasses and associated services – Reiki, Tellington T-Touch, massage, basic training. • Treatment with holistic modalities.

1. THERAPEUTIC PRODUCTS THAT HELP WITH EMOTIONAL AND BEHAVIORAL ISSUES Create a sales strategy based on the behavior problems you see in your clinic. Start with “Build Good Behavior”, then move to treatment of specific behavior problems. I’ll cover a few common conditions and some products that would help. Companies will be mentioned below, and you will discover more as you read and learn about different modalities. Articles in IVC journal, Animal Wellness, Equine Wellness and JAHVMA, along with speakers at the annual AHVMA conference address in more detail the different modalities for treating training and behavior issues.

egin by looking at the companies you already order from. B They may have behavior products you have not considered. For example, you may be using VeteriScience’s Glycoflex, but have never ordered Composure (for calming, barking, help with training). Next, pick one of the following categories and explore the different companies whose products address that approach. •F lower essences – I would suggest starting with these since there are never any side effects and the products are labeled for their use (e.g. Scaredy Cat, Training, Anxiety, Aggression, etc.). There are many companies that offer flower essences, including Bach, Living Tree Orchid Essences, Perelandra and the Flower Essence Society (for training). If you’re looking for essences labeled for specific animal problems you can check out Jackson Galaxy Essences, Green Hope Essences, Anaflora (the formulator is also an animal intuitive), Pet Essences and Alaskan Essences. • Essential oils – These are excellent for emotional problems and can facilitate learning as well. Good quality is essential, even within reputable companies. Some study is needed to learn how to select oils, how to use them with cats, and their multiple uses for physical

and behavioral issues. You can find out more from the Veterinary Medical Aromatherapy Association, Dr. Melissa Shelton (animalEO) and Doterra. Oils can be administered multiple ways, including orally, on collars or crates, or through petting and diffusion. One good source of these support products is Blue Sky Textiles. Mellow Dog Essential Oil Spray and Blend by LifeFORCE Pet Health are formulated to soothe dogs in times of stress. Its counterpart, Mellow Cat, has been safely tested on felines. •C annabis – It’s proving to offer amazing results for anxiety and stress problems, along with its many physical benefits. Check out books and products by Dr. Robert Silver at Well Pet Dispensary, or look into Therabis’ Calm and Quiet, or oils from the Medicinal Cannabis Dispensary. •W estern herbs – They can be used in two main ways: individual herbs chosen from your studies, and combinations labeled for specific behavior problems. Again, quality is critical. Are the herbs raised organically and sustainably? If wild-crafted (harvested from the wild), is it being done in a sustainable way? Continued on page 34.

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Continued from page 33. Many courses are available, on-ine and onsite, from the Veterinary Botanical Medical Association (VBMA), the College of Veterinary Botanical Medicine and the College of Integrative Veterinary Therapies. When purchasing herbal combinations, be sure ask about sourcing. Greg Tilford of Animals’ Apawthecary is a leader in the herbal field for animals, and his combination herbal products are labeled for specific conditions; he has also authored an excellent book, Herbs for Pets. Herbalist & Alchemist has high quality single herbs and has been a regular vendor for decades at the AHVMA conferences. Other companies to check out include Veterinary Botanicals and Pet Wellness Blends. • Nutritional supplements – Are often needed, especially when pets are on a commercial diet. Again, quality is critical, as is palatability. Herbs or oils are often included in nutritional supplements. VetzLife, Rx Vitamins (products include vitamins and herbs, including hemp), Nutramax, Vet Classics and VetriScience are some examples of quality supplement companies.

2. BUILDING BASIC GOOD BEHAVIOR WITH TRAINING AND EDUCATION Our clients and staff often struggle because many dogs and cats are fearful or aggressive in the clinic, or will not let their feet, ears, mouth, belly, etc. be examined or treated, often even at home. They may have trouble riding in the car to and from the clinic (or anywhere else). Addressing this during every visit with every client – whether it’s a new puppy/kitten, a new adult, or a current patient – until you have a super well-behaved animal, is well worth it. Step one: Have a staff member in charge of a program to train clients in helping their animals actually enjoy being handled by anyone, including themselves. This includes handling for nail trims and dental checks. This program could include selling products to calm pets, increase trainability and break bad behaviors. Step two: Set up a system to identify each client who has not yet been through the program, and to follow up on progress. This is best done by the receptionist, who can also recognize training issues in the waiting room. Include a check box on the client’s file, or a tag in the digital records, so reminders can be easily sent. Step three: Encourage this training at every wellness exam, in blog posts, with annual exam cards, or on social media.

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It can be offered as a free clinic benefit, or charged for minimally, as it will make your job easier and increase client retention. This would be a job for all members of your team. The receptionist may have photos and testimonials in the office (on a bulletin board or in a scrapbook) and add them to the website as well.

Classes and products • Offer classes in Reiki, animal communication, Tellington T Touch, massage and basic behavior training. • Have staff make videos of the classes or stage ones that demonstrate how to trim nails, take an animal’s temperature, brush teeth, clean the ears, hot pack and express the anal glands, examine the lymph nodes and extremities and maybe even take the pulse and palpate the abdomen. These videos can be sold or used as a practice promotion. Include transcripts of the videos for those who learn best from the written word. • Choose what therapies and companies you want to work with: Flower essences: Remind people that some animals respond well while others seem unaffected. Flower essences are 100% safe and can be used frequently. You may decide to stock a few essences for basic good behavior that can be sold OTC at the front of the clinic. Since clients can usually buy them cheaper on the internet, you may opt to not carry them and provide websites in your handout. Some companies have affiliate programs so you can still monetize client purchases (usually only 5% to 20%). Administering flower essences one to five times a day for three weeks is a good trial; if those from one company do not seem as effective, try essences from another. ach Rescue Remedy (or emergency essences from other B companies) can be used as follows – put four drops in one ounce of water (you could also sell empty dropper bottles) and administer in water (but not the water bowl), in food, per os, or topically (especially for itchy skin and other skin and ear lesions). This can decrease anxiety in any situation, including veterinary visits. Continued on page 36.

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Continued from page 34. o help pets learn faster, other flower essence combinations T and single remedies can be tried by you or your clients. Have them keep good notes, maybe in a journal that you can sell, and schedule consults to evaluate the patient’s changes. Too often, the client focuses merely on the main complaint, so you or your staff can keep them looking at the whole animal in context. Some products to try include Training Formula (Jackson Galaxy Essences), Good Dog, Happy Feet, for nail trimming training and problems (Anaflora), Courage (Anaflora), Anxiety, Neediness (Green Hope Essences), Calm My Focus (Calm My Pet Inc.), Easy Learning (Alaska Essences), Best Behavior (Blackwing Farm) Essential oils can also decrease anxiety and increase learning ability. Until you have studied with, or spoken to, experts in the field, use hydrosols for cats. Lavender is great to decrease anxiety, while lemon is used to increase cognitive awareness. You can also try Focus (for dog and trainer) from Dr. Shelton, or LifeFORCE’s Good Dog Essential Oil Blend, which promotes mental balance and function. erbs to try include the Tranquility Blend by Animals’ H Apawthecary; it’s useful for training problems caused

by anxiety. Also consider Cognitive Function from Pet Wellness Blends. Encourage the best possible diet (fresh ingredients are ideal) with minimal chemicals, GMOs or glyphosates, and consider selling general health supplements. Mental and emotional health need a good basic set of amino acids; Steve Brown reminds us that low tryptophan from too much fat in the diet could increase aggression in genetically inclined dogs. (ivcjournal. com/can-high-fat-beef-based-raw-diets-lead-to-behavioral-issuesand-aggression-in-some-dogs/?hilite=%22steve%22%2C%22b rown%22). There are many wonderful sources to boost the nutrition of a fresh food diet, including: • Herbal Multivitamin: Animal Essentials – Green Alternative • Blue Green Algae – The Edge Up • Mushrooms – Mushroom Wisdom • C AS Options – Vet Classics: mushrooms and more • Kelp: Thorvin • Daily defense powder for cats and dogs: Glacier Peak Holistics

3. TREATING BEHAVIORAL PROBLEMS Some animals present for behavior problems so severe that there is no time for the above training approach. You need to have products on hand to temporarily address these issues while more individualized treatments are begun (homeopathy, TCVM, osteopathy, chiropractic, client training, referral to a behavioral specialist, etc.). Quantify each symptom along with the trigger and duration. Your intake needs to probe. The patient may present as aggressive, yet your questioning reveals timidity, fear biting, protective growling but no real anger. You would make different choices based on your assessment. One joy of prescribing the following is that they offer broad emotional support, so they don’t have to be as precise as the more curative modalities. Have clients keep a daily record of changes in all symptoms, not merely those that are of concern. Selling a journal or giving one to new clients can encourage record-keeping. Aggression – can have many triggers, including reactions to rabies vaccination. Regardless of the cause, any of the following can be helpful for fear or aggression. Flower essences • Bully, Scaredy Cat, Safe Space, Self-Esteem, Grouch, Nervous Nelly – Jackson Galaxy Essences

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Advertorial

• Anxiety, Jealousy, Outburst – Green Hope Essences • Aggression, Buddha Nature, Courage, Calm Kitty –Anaflora • Out of Control, Anxiety and Fear, Calming Solution, Emotional Stability – Pet Essences • Calm My Dog, Calm My Cat – Dr. Pam Fisher’s Calm My Pet • Fruits of Courage – Living Tree Orchid Essences • Drama Trauma, Confidence – Blackwing Farms Essential oils, single or in combination: • Calm-a-mile – Dr. Melissa Shelton • Chill-Out – Silk Road Oils Herbs • Hemp, Tranquility Blend – Animal Essentials • Pet Calming – Pet Wellness Blends • Calm and Quiet (hemp with nutritional additions) – Therabis Nutritional supplements can be offered singly, or in combinations: • NutriCalm, NutriCalm for dogs, Rx B12 – Rx Vitamins • Soliquin (a combination many trainers find useful for helping anxious dogs and cats) – Nutramax • @Eaze calming gel (herbs, oil and nutrients) – VetzLife Sound therapy can also help: • Sound and Beginning – Silk Road Oils • Calm my Pet CD – Calm My Pet Separation anxiety – many of the above products will work, but also try: Flower essences • Separation Anxiety – Jackson Galaxy • Drama Trauma, Home Alone! – Blackwing Farms • Loneliness/Home Alone – Pet Essences Music, EMF protection, hydrosols, and ﬂower essences are also effective for separation anxiety. Becoming certified in a deep healing modality will help you resolve most behavioral problems. While you are studying homeopathy, TCVM, chiropractic, botanical medicine or osteopathy, the gentle therapies highlighted in this article can help your patients much more safely than most drugs. They are also a great addition to conventional practices whose clients may be asking for alternatives to drug treatments for behavior problems.

VetzLife All-Natural News By Christopher Kelly Groth

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. Find out more at Vetzlife.com. Christopher Kelly Groth is the Senior Sales Executive for PetzLife Products.

IVC Spring 2018

integrative practice A SHARED SPACE

PRACTICE MODEL By Jordan Kocen, DVM

It takes time to develop a veterinary practice based on a shared space model, but it has many benefits, including a decrease in overhead and an increase in offered services. Most veterinary practices have owners and associates. New services can only be offered if someone at the practice learns them, or patients are referred out. If clients are looking for services that the existing staff cannot offer, a shared space practice model can help solve the problem.

problem, but I didn’t know the hours, fees or areas of service of these mostly house-call practitioners. And I frequently ran out of their cards to give to clients.

REACHING OUT TO OTHER PRACTITIONERS

For many years, I ran the Holistic Medicine “department” at a large specialty hospital in the Northern Virginia area. While the public saw the facility as one practice with one name, the group was actually a collection of separate practices working out of a shared space. The proximity to other service providers can offer a variety of treatment options to clients, and also lets them know about your own services for future use.

While the arrangement I had was working, the limitation to offering additional services prompted me to think about opening my own practice. I wasn’t in a positon to hire practitioners to provide other services. So I thought about developing my own holistic practice based on the shared space model. I called some of the practitioners I was already referring clients to, and asked if they would be interested in using my proposed new facility a day or two per week.

At the specialty hospital, our practice offered acupuncture, homeopathy and Chinese herbal medicine. There was another practice offering rehab, but if I thought patients would benefit from therapeutic massage or chiropractic, for example, I had to refer them to someone outside the practice. This wasn’t a

Several of these practitioners worked with horses as well as small animals, so they were based away from areas of denser population; this reduced their ability to work with small animals, required lots of driving, and limited the number of clients they could see in a day. The advantage of sharing

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a space meant they would be able to use an existing small animal facility without having to build and maintain one themselves, or pay full time rent for a space they would use only part time. I explained that a shared space facility would also increase exposure to their services among clients coming in to see someone else. Those clients might consider using their services or inform friends that these services were available. In turn, those referrals would be exposed to our other services. The advantage to the practice owner is that fees from the associates help defray expenses. In our case, the expenses were to be used to build out and maintain a clinic. We would all benefit from the clients of other practitioners seeing the services we offer, and the referrals they would send. As you may imagine, the prospective associates had many questions: they wanted to know what limitations there might be on the services they could offer, what services they could get for their fees, what access they could have when we weren’t there, and how much it would cost.

PROTOCOLS IN A SHARED SPACE PRACTICE Coming from the world of the “referral hospital”, I was used to clients having diagnostics done before they arrived for initial consultations. I also recommended that they have their regular vet do any follow-up diagnostics. We also did not do annual exams, nor dispense conventional medications. Since clients returned to their “regular vets” for these services, it let the conventional veterinarians follow the progression of holistically-treated cases and see the pets getting better. Since I was not competing with them for the services they offer, they were more likely to refer cases to me.

Each associate makes his/her own appointments and takes his/ her own fees. We list all the practitioners on our website, with links to their own websites, so clients can learn more about them and what services they offer. We all try to mention the other practices in our space whenever we are at promotional events, so that everyone benefits.

BUILDING A GROUP TAKES TIME Over time, I have found that each associate views the arrangement differently. Some have complained about slow growth of their clientele. For each individual practice to grow, however, the practitioners should ideally reach out to the public, to human practitioners in their fields, and to the general veterinary community. It is unrealistic to think that increased clients will come entirely from internal referrals. Not working to grow an individual practice can have a negative impact on the other practices in the shared space. Therefore, even though each practice is separate, there should be an understanding that supporting the facility as a whole will help everyone. We have had a few practitioners start and leave, but most have stayed. A few I spoke to decided that what we had was not for them. In time, however, I think the “right” group of people will find us, and help us develop this practice to reach its full potential.

In our current shared space practice, practitioners are allowed to offer any treatment options they think the patient needs, apart from conventional therapies. They may do diagnostics but we are not staffed to provide conventional medicine assistance. The two associates who offer chiropractic are also certified in acupuncture, so even though my own practice already offers acupuncture, the associates are not limited to offering just the therapy they list as their primary therapy. It is also understood that no one has an exclusive right to any therapy. We have two chiropractors and two massage therapists, but they come in on different days. We have another practitioner who offers acupuncture and Chinese Herbal Medicine, as does my practice. She has a strong interest in cancer treatment so we are happy to refer cases to her. I don’t see any of this as competition, but as providing a wider array of services. Ultimately, it would be great to have all therapies available every day.

Top: In a shared office space, rooms can be chosen that are appropriate for the modality. This room is often used for chiropractic (Dr. Bierly) and physical therapy. Bottom: Dr. Kocen treating a dog with acupuncture. Rooms are designed to be comfortable for the animals so they are easier to treat.

IVC Spring 2018

COMMON

URINARY

ISSUES IN SENIOR DOGS

By Gary P. Oswald DVM, DACVIM (Int Med)

As dogs age, urinary tract disorders may be diagnosed more often. Urinating in the house or other unusual locations (periuria) is a common complaint. There are several reasons why an adult dog may exhibit urinary signs; these include primary lower urinary tract disease causing increased urgency and urine volume (polyuria); orthopedic or neurologic issues that impair walking and micturition posture; and cognition disorders. A thorough patient history, including a cognitive questionnaire, should be completed. As well, a complete examination is needed, with an emphasis placed on caudal abdominal palpation; evidence of perivulvar or preputial wetness or skin/haircoat change; digital rectal palpation of the prostate (male) and pelvic urethra (female); and orthopedic and neurologic evaluations. Complete initial diagnostics include standard laboratory evaluation (CBC, CHEM); urinalysis, including sediment exam; and survey radiographs of the abdomen, thoracolumbar spine and pelvic regions. Additional diagnostics may be indicated, including urine culture, abdominal cavity ultrasound exam, endocrine testing and urinary endoscopy. Dogs with confirmed or suspected involuntary urinary incontinence usually have a weak urethral sphincter apparatus. An alpha-adrenergic agonist, such as phenylpropanolamine, should be used; this drug is proven to enhance effective sphincter tone and improve or resolve involuntary leakage. It may also prevent recurrent ascending urinary tract infection. Bacterial infection of the lower urinary tract is common in senior dogs, especially if they have concurrent incontinence, uroliths or a history of frequent antibiotic therapy. Periuria, pollakiuria, stranguria and dysuria are frequent clinical signs. Urine should be collected by cystocentesis and a urinalysis, and a urine culture should be performed. Appropriate antibiotic therapy should be initiated based on ISCAID guidelines and culture results. Antibiotic selection, treatment duration and clinical follow-up are extremely important in geriatric patients to resolve infection and

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prevent development of a multi-drug-resistant bacterial urinary infection. A strategy to prevent recurrent infection should also be considered. Improving urethral sphincter tone with phenylpropanolamine, and supplements that reduce bacterial adhesion to the uroepitheium, such as American cranberry extract (vaccinium marcocarpon), may be useful. Unfortunately, neoplasia is present in some senior dogs with abnormal urinary signs. Transitional cell carcinoma develops within the urinary bladder and urethra. Male dogs may develop prostatic carcinoma. Periuria, pollakiuria, stranguria, dysuria and hematuria are usually present. Urinalysis generally demonstrates hematuria, leukouria and proteinuria; atypical transitional cells may be observed. Radiographs and ultrasound should be performed, especially if the response to treatment for presumed bacterial urinary tract infection was poor. Polyuria and polydipsia are frequently documented in senior dogs with metabolic or endocrine issues. Increased urine volume may lead to periuria and be confused with lower urinary tract disease. Appropriate testing and treatment to identify the primary disorder should be performed. Periuria resulting from osteoarthritis or other neuromuscular issues should be treated with pain management or other interventions as needed, to help the patient improve mobility. Many senior dogs experience a loss of cognitive function. Behavioral and environmental modification along with pharmacologic therapy may improve periuria associated with this issue. Senior dogs with abnormal urinary tract signs require our full diagnostic and clinical attention. Many can be treated, and quality of life improved for both dog and owner. Dr. Gary P. Oswald, a Diplomate of the American College of Veterinary Internal Medicine, is a boardcertified specialist in veterinary internal medicine. He is the department head of Internal Medicine and Emergency Medicine at Tampa Bay Veterinary Specialists & Emergency Care Center.

IVC Spring 2018

PEER-REVIEWED

By Joyce Harman, DVM

INTEGRATIVE APPROACH TO

DIARRHEA

IN THE EQUINE Diarrhea is common in horses, and can be stubborn to treat. Alternative therapies offer a safe and effective way to resolve the problem.

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The horse’s digestive tract is very complex, sensitive to its environment, and prone to complications. It is also abused with an overabundance of antibiotics, non-steroidal anti-inflammatories, de-wormers and many other drugs. Additionally, horses are often under stress, either for performance or in the way they are housed and handled. One of the common signs of an imbalanced digestive tract is diarrhea. An integrative approach to treatment is the most effective way to manage most cases.

DIARRHEA SYMPTOMS A horse’s manure can vary significantly though the year, depending on the main roughage source. Hay-fed horses can have very dry fecal balls, while fresh spring grass-fed horses almost always have loose wet stool. Alfalfa hay-fed horses may have naturally loose manure. If you are unsure about the effects of the feed on a patient, check the other horses on the same roughage regime. From a holistic perspective, it is important to ask and observe the details of the stool condition – odor, frequency and consistency. Ask about signs of discomfort before, during and after the stool passes. This could be seen as restlessness, moving around quickly as the stool ends, circling the stall before defecating, or making grimacing faces during the passing. It is helpful to observe the color and moisture of the tongue and gums. TCVM practitioners are trained to incorporate that information, but all practitioners can benefit from this information. As treatment progresses, how does the tongue color and moisture change? Clients can be taught to observe these details and report changes.

ACUTE DIARRHEA Diarrhea diseases in the horse can be life-threatening and are most often treated in hospital settings. The most serious are Salmonella, Clostridium difficile and Potomac Horse Fever. Coronavirus is being recognized as not just an opportunist, but an actual pathogenic cause of diarrhea. Parts of the country with sandy soil also see diarrhea associated with sand ingestion and accumulation. Antibiotics have been shown to be one of the most important causes of serious colitis in horses.1

Ulcers are commonly associated with loose stool in some horses. These are usually hind-gut ulcers, but can occur anywhere in the digestive tract. Testing with the Succeed Fecal Blood Test is a non-invasive, low-stress method to determine if ulcers could be the cause. Endoscopy can also be performed. One of the most common complaints is stool that is partially formed, but accompanied by a significant amount of acrid, brown watery fluid that can build up in the tail and is difficult to remove in the winter. This is most common in the cooler seasons of the year. Some horses seem to be triggered by eating hay, and are non-symptomatic on grass. Older horses, especially those in their 20s and above, may have poorly-formed stool or the above symptoms of partially formed combined with watery fluid. These horses may have an aging digestive tract, with a weaker microbiome, or a poorly-functioning enzyme system. Horses fed a wet diet due to a lack of teeth may be getting more water than they can process, with diarrhea as the result.

THE HORSE’S MICROBIOME The genetic makeup of the microbiota is called the microbiome.2 The microbiota grow on prebiotics, not on the intestinal wall. Populations of microbiota are quite variable between horses, even among those kept on similar feeding programs.3,4 There is a great deal of variation throughout the digestive tract of each horse. Because they reproduce rapidly, microbial populations

organic garden for your horse

A new idea I have for restoring the natural soilbased microbiome in horses is to plant a corner of the property as a high quality organic garden, using grasses and herbs that horses naturally will eat. Allow ten minutes of grazing per day to provide natural microbe populations that cannot be supplied from a package.

CHRONIC DIARRHEA The symptoms of chronic diarrhea in horses range from watery fluid passing with formed feces to projectile diarrhea. The majority of cases seen by integrative practitioners are chronic and non-life threatening, with some being very longstanding and unresponsive to conventional treatment. IVC Spring 2018

are susceptible to changes in diet and environment. Research into equine microbial populations using DNA testing is just beginning, as is the understanding of how the balance of microbes relates to health and disease.5,6,7 The normal pH of the intestinal tract changes from acidic in the stomach and upper small intestine, to alkaline in the large intestine. The microbial balance helps keep the pH in the correct range, and and pH keeps the microbes in balance. When microbial populations move to incorrect locations in the gut, the tissue may become inflamed, leading to diarrhea.

General review of

TCVM & digestion A useful way to understand the workings of the gut is to take a Traditional Chinese Veterinary Medicine (TCVM) perspective. The treatment choices do not need to be Chinese. It is beyond the scope of this article to give a complete lesson in Chinese Medicine, but here is a summary. • The Stomach (ST) receives and ripens incoming food and drink. The pure or clear part descends to the Spleen (SP) while the turbid part goes to the small intestine. The energy of the ST needs to move in a downward direction to accomplish this. • The SP is responsible for generating and containing the Blood and keeping fluids in the proper place. A SP Qi deficiency can allow too much fluid to escape through the digestive tract, leading to diarrhea. • The Kidney (KI) Yang provides Fire for digestion and vaporizes the water in the lungs, allowing it to descend and dispersing the fluids in a downward direction (the natural direction of the lungs). The KI Yang also assists the SP Yang in vaporizing the fluids. If the Yang is deficient, the fluids escape downwards. • The Liver (LV) governs the smooth movement of Qi through the vessels and organs and also stores the Blood. The SP has a close relationship with the LV. The LV maintains an upward Qi flow and releases bile to help digestion. When the LV Qi stagnates (a common occurrence in the equine) it over-controls the SP and damages it. This can lead to ulcers, and loose stool. The LV is the Chinese organ most affected by stress, hence the prevalence of ulcers in modern horse-keeping. • The Large Intestine (LI) reclaims and excretes downward the more solid parts of the food and drink, and reabsorbs water from the waste material.

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CAUSES OF DIARRHEA Many factors can lead to loose stools or diarrhea in horses.

2 3 4

Feeds, feed changes and variations in forage have been shown to change the microbiota significantly.8 Some horses adapt well, while others develop wetter-thannormal manure. Excessive grain affects the microbiota and can lead to changes in stool consistency. Food allergies or intolerances to common feed ingredients, especially alfalfa, can lead to inflammation and diarrhea.

Glyphosate, the herbicide used in genetically modified organism (GMO) feeds has been shown to increase ulceration of the intestinal tracts of pigs.9 Diarrhea was not one of the symptoms in the pigs; however, inflammation of the intestinal tract in the equine can lead to loose stool. Drugs, especially NSAIDs, can lead to diarrhea in sensitive individuals. Along with antibiotics, these drugs are implicated in inflammatory lesions throughout the digestive tract, and changes in the microbiota.1 Weather changes, especially cold and damp conditions, lead to stool changes. TCVM pays particular attention to weather effects, and clinically this author sees many more cases of diarrhea during such conditions. Large swings in temperature and barometric pressure are also a factor.

TREATING EQUINE DIARRHEA Acute, severe cases are best treated in a hospital setting with access to intravenous fluids, along with acupuncture, probiotics, fecal transplants and antibiotics if needed. In some cases, the antibiotics are the cause of severe diarrhea and the treatment needs to be done without them. Replenishing the microbiome is perhaps the most important aspect of treatment, since the microbial population has been compromised.

ACUPUNCTURE Acupuncture has been clinically shown to be an effective adjunct to treating acute diarrhea, and is used at several universities with trained clinicians.10

Acupuncture can also be a first-line treatment for many chronic cases, and may be all that is needed. To be effective, an accurate TCVM diagnosis is made and points are selected based on the diagnosis. Several universally useful points include ST 36, BL 20 and 21, SP 6 and 9, LI 10 and GV 1.

PROBIOTICS The most important GI supplement is a good probiotic formula. Horses in general are treated with antibiotics for every little cut and scrape, not to mention every upper respiratory infection. In many cases, supplementation with a probiotic will be the key to repairing gut function and may be the only extra supplement needed. Any horse showing signs of ill health would do well with at least two months of probiotic treatment. Useful probiotics usually contain some or all of these beneficial bacteria: Lactobacillus acidophilus, L. plantarum, L. casei, Enterococcus faecium, Bifidobacterium thermophilum and B. longum. A Lactobacillus Acidophilus fermentation product can also be used to stimulate bacteria growth. Many probiotics are poorly-made and unstable, so by the time they are purchased and used, they may or may not contain active ingredients. Beware of heavily-preserved formulas and those with artificial flavorings and sweeteners.

PREBIOTICS Prebiotics are usually short-chain fructo-oligosaccharides that support the growth of probiotic bacteria. They can be quite beneficial in a formula. The microbiome is often best supported with some of the newer products that include soil organisms, the spores of the microbes or the minerals that form the communication network for the bacteria.

FECAL TRANSPLANTATION Fecal transplantation has been performed for many years in equine practice.11 Most of the research and clinical papers have focused on severe, acute cases, or antibiotic-induced colitis. As microbiota DNA analysis becomes more available, it will be possible to accurately select healthy donor horses, and potentially commercialize a fecal microbiota for easy administration.

HERBAL SUPPLEMENTATION Herbs from many traditions can be used to treat diarrhea. Horses are easy to feed with herbs since they are capable of digesting raw plant material. In many cases, horses will selectively choose the herbs they need and reject those they donâ&#x20AC;&#x2122;t. Some horses IVC Spring 2018

are quite picky and will not eat any form of the herb, but they are usually the exception rather than the rule. A horse that eats herbs well, then refuses them, likely does not need that formula anymore.

Products for diagnosing and treating equine diarrhea Succeed Fecal Blood Test, succeedfbt.com

Dosing is generally two to four times the human dose, whether the herbs are raw or in tincture form. Horses are quite sensitive to the energy of herbs, and in many cases will respond to even lower doses. Herbs can be mixed with palatable feeds or mixed with liquid and syringed into the mouth.

Spore Probiotics, microbiomelabs.com/products/ megasporebiotic/

Western herbal mixes can contain herbs such as yarrow, mullein, hops, marshmallow, meadowsweet or cinnamon if a warming herb is needed. Formulations prepared with the knowledge of the energetics of herbs are usually more effective than just symptomatically using them. High cannabinoidcontaining hemp has anti-inflammatory action in the gut, and early usage in the equine shows promise as an herbal support to the gut.

Psyllium-based product – Assure Plus, arenus.com/assure-plus/

Minerals for bacterial communication – Restore, restore4life.com Western herbal formula – Digest Support, hiltonherbsusa. com/us-horse-supplements-es/digestion-supplements-forhorses-es/digest-support-for-optimum-digestive-health

Organic enzyme product, abcplus.biz/Organic_Equine_ Digestion_Enzyme_Product

CHIROPRACTIC

Chinese formulas are selected based on the TCVM diagnosis, which can be SP Qi Deficiency, SP Yang Deficiency, or a formula to clear Heat in an infectious cause of diarrhea.

Chiropractic is not often thought of as a treatment for diarrhea, but it should be considered in chronic situations. A horse that is not responding well to other treatment, should be checked to ensure his spine has normal motion throughout, especially in areas from the sixth thoracic vertebra and down, where various spinal nerve roots affect the digestive tract.

ADDITIONAL SUPPLEMENTS

CONCLUSION

Simple nutritional supplements can be very effective depending on the clinical presentation. Psyllium and probiotics can help not only with sand accumulation, but also with soothing and healing the gut wall.12 Enzymes can be useful especially for older horses whose overall body functions are failing, or those that have long-standing absorption problems.

Diarrhea in the equine is a common, and at times, challenging condition. Daily assaults on the digestive tract through extensive use of drugs, poor feeding regimes and stress affect the microbiome in a negative manner. Natural approaches to treatment are more cost-effective, successful and healthier for the horse than the typical drug regimen. Many horses need ongoing support, since the conditions surrounding the diarrhea are often unavoidable, and a natural approach offers safe and effective therapies.

HOMEOPATHY Homeopathy can be very useful in the treatment of diarrhea. Simple cases can be treated with remedies such Arsenicum Alb, Sulphur, Veratrum Alb and Lycopodium. There are many choices in the Materia Medica, so it is important to use the details of the condition to pick the remedy. For example, Arsenicum Alb works very well with projectile diarrhea in Potomac Fever, or in horses that are restless and thirstless, while Sulphur works with cases that have extremely offensivesmelling diarrhea, that may or may not be profuse.

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Gustafsson, Agneta. “Antibiotic associated diarrhea in horses”. Acta Universitatis agriculturae Sueciae. Veterinaria, 14016257; 166 (2004). 2 Costa MC, Weese JS. “The equine intestinal microbiome”. Animal Health Research Reviews 13(1); 121–128. 3 Al Jassim RAM, Andrews FM (2009). “The bacterial community of the horse gastrointestinal tract and its relation to fermentative acidosis, laminitis, colic, and stomach ulcers”. Veterinary Clinics of North America: Equine Practice 25: 199–215. 4 Perkins et al.“Equine Stomachs Harbor an Abundant and Diverse Mucosal Microbiota”. ncbi.nlm.nih.gov/pmc/articles/PMC3318809/. 5 Ericsson AC et al. “A Microbiological Map of the Healthy Equine Gastrointestinal Tract”. journals.plos.org/plosone/ article?id=10.1371/journal.pone.0166523. 6 Venable EB. “Role of the gut microbiota in equine health and disease”. animalsciencepublications.org/publications/af/ articles/6/3/43. 7 Proudman CJ et al. “Characterization of the faecal metabolome and microbiome of Thoroughbred racehorses”. Equine Vet J. 2015 Sep;47(5):580-6. Epub 2014 Sep 29. ncbi.nlm.nih.gov/pubmed/25041526. 8 Respondek F, Goachet AG, Julliand V. (2008) “Effects of dietary short-chain fructooligosaccharides on the intestinal microflora of horses subjected to a sudden change in diet”. J Anim Sci 86, 316–323. 9 Carman JA et al. “A long-term toxicology study on pigs fed a combined genetically modified (GM) soy and GM maize diet”. Journal of Organic Systems, 8(1), 2013. 10 Xie H. 2010. “Treatment of Diarrhea in hospital settings”. Personal communication. 11 Mullen KR, Yasuda K, Divers TJ, Weese JS. (2016). “Equine faecal microbiota transplant: Current knowledge, proposed guidelines and future directions”. Equine Vet Educ. doi:10.1111/eve.12559. 12 Sahagun AM, Vaquera J, Garcia JJ, Calle AP, Diez M, Fernandez N, Loro JF, Portilla HO, Sierra M. “Study of the protective effect on intestinal mucosa of the hydrosoluble fiber Plantago ovata husk”. BMC Complement Altern Med. 2015; 15: 298. 1

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Our animal patients live in a world of sterile processed foods, frequent antibiotic use, flea and tick treatments, regular vaccinations, low activity levels, and deep cleaning baths in pristine disinfected environments. They’re exposed almost daily to a barrage of pesticides, fungicides and herbicides in our gardens and in their food, as well as additives and other inappropriate ingredients in their diets. All these factors can contribute to the disruption of an animal’s normal bacterial flora and fauna, or “microbiome”.

Unfortunately, they’re often not properly replenished because we’re using sterile foods. The good bacteria are also chronically malnourished by inappropriate foods, or injured and diminished by toxins and chemicals in foods.

Beneficial bacteria live in harmony on and in the bodies of all animals (including humans), improving and maintaining health in many ways. In fact, most healthy animals have over 1,000 unique species of bacteria in their bodies, and about ten times more bacterial cells (over a hundred trillion) than their own cells.

Along with fresh foods, a GI-support probiotic that includes several species of beneficial bacteria along with prebiotic support can make a big difference for many pets. Look for probiotic products that are formulated with prebiotics, such as inulin or fructooligosaccharides (FOS), which nourish existing gut bacteria and help increase the chances of a successful recolonization of good bacteria.

When this symbiotic bacterial/animal relationship becomes unbalanced due to forces that indiscriminately destroy bacterial populations, or allow undesirable populations to grow in the body, the animal’s health suffers. Many of us don’t really appreciate the impressive work these bacteria are doing to protect the health of our animals. We’re likely still prejudiced by the way we were historically taught to think. “Bacteria” is a bad word that brings to mind germs, pathogens, Salmonella, E. coli and more. In reality, there are both good and bad bacteria, and problematic bacterial activities are more likely to occur when good bacteria are not present in sufficient numbers to fight for health. Instead of thinking about killing all bacteria, research is beginning to show that we should instead be focusing on ways to foster healthy bacterial populations in each animal species. Bacterial populations in our patients’ bodies are often randomly destroyed by medical and environmental factors.

An appropriate and healthy population of bacteria in the GI tract is essential. These bacteria are instrumental for digestion and nutrient absorption. They provide enzymes and vitamins, and help create small-chain fatty acids by digesting dietary fiber.

NOW® Pets G.I. Support is a probiotic/prebiotic supplement that contains two billion CFUs each of eight different probiotic species, including Lactobacillus acidophilus, Bifidobacterium animalis, Lactobacillus plantarum, Lactobacillus casei, Lactobacillus salivarius, Streptococcus thermophilus, Bifidobacterium breve, and Bifidobacterium longum, as well as the prebiotic ingredients fructooligosaccharides (FOS) and organic inulin powder.

References Belkaid Y, Hand TW “Role of the Microbiota in Immunity and Inflammation”. dx.doi.org/10.1016/j.cell.2014.03.011. Belkaid Y, Naik S.“Compartmentalized and systemic control of tissue immunity by commensals”. Nat. Immunol. 2013; 14: 646–653. Deng P1, Swanson KS1.“Gut microbiota of humans, dogs and cats: current knowledge and future opportunities and challenges”. Br J Nutr. 2015 Jan;113 Suppl:S6-17. doi: 10.1017/S0007114514002943. Epub 2014 Nov 21. Devkota et al. “Other organisms such as Bilophila wadsworthia can take advantage of dietary-induced bile acids to dominate the intestine, contributing to disease in mouse strains prone to colitis, providing a glimpse at how diet may trigger IBD via its profound impact on the microbiota”. E.B.Nature. 2012; 487: 104–108. Inness VL1, McCartney AL, Khoo C, Gross KL, Gibson GR. “Molecular characterization of the gut microflora of healthy and inflammatory bowel disease cats using fluorescence in situ hybridisation with special reference to Desulfovibrio spp”. J Anim Physiol Anim Nutr (Berl). 2007 Feb;91(1-2):48-53. Marshall BJ, Warren JR. “Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration”. Lancet. 1984; 1: 1311–1315.

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MICRO By Holly Ganz, PhD

The microbiome is a characteristic community of microorganisms (bacteria, fungi, viruses and other microbes) occupying a well-defined habitat, such as in or on an animalâ&#x20AC;&#x2122;s body.1 Mammals are exposed to their first microbes during birth and through breastfeeding.2 These early life events contribute to each animal having a unique gut microbiome signature. The microbes that are first to arrive in a particular habitat can affect which new species will be able to colonize later on. In other words, these early life events are foundational and will influence a cat or dogâ&#x20AC;&#x2122;s health for the rest of his life. Research on the gut microbiome suggests it plays essential roles in host digestion, immunity, the central nervous system, behavior (including anxiety and depression), skin health, obesity and other metabolic disorders.3

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THE MISSING MICROBES A young animal may fail to get the full complement of beneficial microbes if the mother is missing them herself, or if the young animal is orphaned or weaned too early. Even if a healthy microbiome is established early in life, microbes in the gut will change with age, diet and lifestyle. The gut microbiome may also be depleted or harmed by exposure to broad spectrum antibiotics that kill both harmful and beneficial microbes. The widespread use of antibiotics and antimicrobials may be contributing to increased incidences of conditions such as inflammatory bowel disease (including Crohnâ&#x20AC;&#x2122;s disease and ulcerative colitis), esophageal reflux, Type 1 diabetes, asthma, and food allergies in human populations.4 Food additives and non-steroidal antiinflammatory drugs (NSAIDs) have also been shown to alter the

BIOME Restorative Therapy in companion animals

composition of the gut microbiome,5 and may further contribute to the development of chronic digestive conditions in companion animals. The widespread use of antibiotics and other medications may also contribute to why digestive issues are a top reason for veterinary visits in both cats and dogs.

DO FERAL CATS HAVE HEALTHIER MICROBIOMES? In a citizen science project called KittyBiome, microbiome samples were collected from domestic cats living in shelters, households (both indoor and outdoor cats), and outside (feral). Samples from wild cats, including black-footed cats, cheetahs, 6

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 Hemorrhagic

 Constipation  Inappetence and poor

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 Fecal incontinence

treatment

body condition

gastroenteritis

 Skin conditions, including atopic dermatitis

and difficulty passing hairballs

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lions and leopards, were also collected. Many house cats had depleted microbiomes with low bacterial diversity when compared to adult feral cats and their wild cousins, and 20% suffered from a chronic digestive condition.

Participants in the study wanted to know how to restore their cats’ health. Many had already tried using antibiotics, steroids and dietary modifications, including prescription diets, and were looking for other solutions.

The research showed that diet played a large role in the composition and diversity of gut bacteria. Cats fed a raw diet tended to have greater bacterial diversity and increased representation of bacteria associated with the production of the short chain fatty acid, butyrate.7 Butyrate is produced by bacterial fermentation of dietary fiber and is a critical mediator of the inflammatory response in the gut microbiome.

MBRT CAN REPLACE MISSING MICROBES One approach to rebuilding the gut microbiome is Microbiome Restorative Therapy (MBRT), a procedure in which fecal material is transferred from a healthy individual to the gastrointestinal tract of an ailing individual. Although its use in human medicine has only begun to increase in recent years, MBRT (also known as transfaunation or fecal microbiota transplantation [FMT]) has been used in veterinary practice

CASE REPORT – an application of MBRT for IBD Finally, Laila was tried on oral Gut Restoration capsules for MBRT. Slowly, the consistency of her feces changed from a yellowish liquid to a healthy brown solid, and she has since been tapered off all prescription medications. Most importantly, her health and happiness have improved beyond measure. The chart shows Laila’s gut microbiome prior to taking the capsules, compared with that of a healthy dog. Her sample indicated an absence of bacteria commonly found in dogs, including Prevotella, Fusobacterium, Bacteroides and Megamonas, which are found in 84%, 95%, 97% and 93% of healthy dogs, respectively.

Laila, an active boxer mix, was the picture of health until she turned five. Over the course of just a few months, she developed severe diarrhea and vomiting. She was given antibiotics, antacids, probiotics and prescription diets, but nothing seemed to alleviate her symptoms and she continued to worsen. After an official IBD diagnosis, she began a high daily dose of prednisone in addition to her other medications. Her diarrhea temporarily resolved, but after lowering the prednisone dosage to minimize side effects, Laila relapsed. She once again developed watery diarrhea, and it was not alleviated even after significantly increasing the prednisone dosage. Instead of resolving her digestive issues, in fact, the prednisone increase prompted an onset of medication-induced Cushing’s disease, turning this once energetic muscular dog into a frail low-energy one. Despite the steroid, her digestive issues persisted. 50

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since at least the 18th century for cattle, horses, sheep and other animals suffering from rumination disorders, indigestion and colitis.8,9,10 Interest in the application of MBRT in small animal practice is growing, particularly for digestive disorders. Despite pioneering integrative veterinarians like Dr. Margo Roman (mashvet.com), who has performed >2,000 MBRT procedures in the past ten years, MBRT is still not widely used at this point in conventional practice.11 In contrast, there has been tremendous interest in the application of FMTs in human medicine, particularly in the treatment of Clostridium difficile infections that are not responsive to antibiotics, as well as Crohn’s disease, ulcerative colitis, constipation and enterocolitis. Studies have shown that it is possible to introduce microbes from a donor into the microbiome of a recipient, where they are maintained, at least for a period of time. A growing number of integrative veterinarians offer MBRT as a way to provide microbial supplementation to patients from a healthy live donor of the same species. One factor restricting the growth of MBRT in practice is the availability of screened fecal material from healthy donors. To create a bank of carefully-screened fecal material from healthy donors, a variety of factors must be considered. In addition to standard pathogen and parasite screening, donors must have no current or past health concerns, whether physical or behavioral; and they must have no history of systemic antibiotic use. These “golden-poo pets” must also be old enough to have developed a sufficiently diverse microbiome, but young enough for that diversity to still be intact. Fecal transplants may be administered in three ways, often depending on the severity of the ailment: • Rectally, via enema and colonoscopy (typically uses fresh or frozen material). This method may be needed in more critical cases. • Orally, via nasoduodenal intubation and enteroscopy (typically uses fresh or frozen material). • Orally, via enteric-coated capsules sold only to veterinarians. The capsules contain pre-screened material prepared with all-

natural ingredients that remain stable at room temperature while retaining high viability. Enteric coatings are made of long-chain carbohydrates that prevent capsule contents from being destroyed by stomach acid.

WHY MBRT? Scientists haven’t even begun describing many of the common organisms living in the microbiomes of healthy dogs and cats. For example, recent research identified more than 20 bacterial strains that are new to science, in a single sample of cat poop. This makes it difficult to develop a supplement that contains the full spectrum of genera found in healthy dogs and cats. Probiotic strains that are not cat- or dog-specific may be helpful for controlling clinical signs of disease, but will not typically colonize the host. This means they must be given continuously in order to see an effect. MBRT provides a “complete package” because it reflects the abundance of bacteria, fungi and bacteriophages in the relative ratios found in a healthy cat or dog. For more information visit AnimalBiome.com and mashvet.com, and read Dr. Roman’s article on MBRT in IVC Journal, Volume 4, Issue 4, or at ivcjournal.com/mbrt-immune-system.

Whipps JM, Lewis K, Cooke, RC. 1988. “Mycoparasitism and plant disease control” 161-87.in NM Burge Editor, Fungi in Biological Control Systems. Manchester University Press. 2 Pannaraj PS, Li F, Cerini C, Bender JM, Yang S, Rollie A, Adisetiyo H, Zabih S, Lincez PJ, Bittinger K, Bailey A. 2017. “Association Between Breast Milk Bacterial Communities and Establishment and Development of the Infant Gut Microbiome”. JAMA pediatrics. 3 Yong E. 2016. I Contain Multitudes: The microbes within us and a grander view of life. Random House. 4 Blaser MJ. 2014. Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues, Macmillan. 5 Igarashi H, Maeda S, Ohno K, Horigome A, Odamaki T, Tsujimoto, H. 2014. “Effect of oral administration of metronidazole or prednisolone on fecal microbiota in dogs”. PloS one, 9(9), p.e107909. 6 Dahlhausen K, Krebs BL, Watters JV, Ganz, HH. 2016. “Crowdfunding campaigns help researchers launch projects and generate outreach”. Journal of microbiology & biology education, 17(1), p.32. 7 Ganz, H.H. et al. 2018. KittyBiome: a citizen science project to explore variation in the gut microbiome in domestic cats. Unpublished manuscript. 8 Brag S, Hansen HJ. 1994.“Treatment of ruminal indigestion according to popular belief in Sweden”. Revue scientifique et technique (International Oﬃce of Epizootics), 13(2), pp.529-535. 9 Rager KD, George LW, House JK, DePeters EJ. 2004. “Evaluation of rumen transfaunation after surgical correction of left-sided displacement of the abomasum in cows”. Journal of the American Veterinary Medical Association, 225(6), pp.915-920. 10 DePeters EJ, George LW. 2014. “Rumen transfaunation”. Immunology Letters, 162(2), pp.69-76. 11 Chaitman J, Jergens AE, Gaschen F, Garcia-Mazcorro JF, Marks SL, Marroquin-Cardona AG, Richter K, Rossi G, Suchodolski JS, Weese JS. 2016. “Commentary on key aspects of fecal microbiota transplantation in small animal practice”. Veterinary Medicine: Research & Reports, 7, pp.71-74. 1

IVC Spring 2018

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

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

IVC Spring 2018

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

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

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

From the 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.

Now in its 44th year, the IVAS Annual Congress on Veterinary Acupuncture will be held in the Colorado Rocky Mountains from September 5 to 8. The venue is the Beaver Run Resort and Conference Center in Breckenridge, Colorado, so save the date and plan to attend! This invigorating Congress brings together a talented and diverse audience from around the world, including the best hearts and minds. It features a Keynote Speaker, Speakers of Special Interest, Speaker Tracks, Poster Presentations, Wet Labs, Exhibitors, a Welcome Reception, and a Gala Banquet with fun and dancing. It presents a broad overview of the very latest scientific information, cutting edge discoveries and insightful applications in everyday clinical practice.

CASE REPORT

Daria, an 11.5-year-old Irish Wolfhound, presented to Nell Ostermeier, DVM, CVA after a life-threatening case of pneumonia that was cleared with Western medication. She was having difficulty returning to her previous state of well-being. Her owner was concerned that without some other form of help, she would succumb to a recurrent infection and lose the will to live. Acupuncture, herbs and food therapy were used to boost Daria’s general Qi as well as her Wei Qi. She recovered within three visits and has continued with acupuncture tune-ups. Her wellbeing is better than ever, and she is amazing for her age!

CERTIFICATION COURSE THIS FALL

The next IVAS Certification Course in Veterinary Acupuncture will be held in Corpus Christi, Texas, starting this fall. Choose your area of focus – small animal, equine or both. This course is RACE approved and provides hands-on learning each day.

JOIN OUR FACEBOOK PAGE

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 m.facebook.com/ InternationalVeterinaryAcupunctureSociety. ivas.org or office@ivas.org.

From the VBMA The Veterinary Botanical Medicine Association is a group of veterinarians and herbalists dedicated to developing responsible herbal practice by encouraging research and education, strengthening industry relations, keeping herbal tradition alive as a valid information source, and increasing professional acceptance of herbal medicine for animals.

DID YOU GUESS LAST ISSUE’S MEDICINAL HERB?

Alpine Bistort (Bistorta vivipara) is common all over Iceland. In the past, it was used as food – the entire plant can be eaten and the seeds mulled or baked. Though not used often in Western herbal medicine today, Alpine Bistort, traditionally used as a rinse for sore throats and gingivitis, to ease diarrhea, and as a hemostatic/vulnerary to stop bleeding and heal wounds, was used for conditions such as snake bite, plague, cholera, typhoid, colitis, bleeding and hemorrhoids. Today, a relative of Alpine Bistort called Polygonum bistorta is a well-known medicinal herb in the West.

RECENT ACTIVITIES

This year’s VBMA herb walk at the AHVMA convention was led by Registered Herbalist, Richard Mandelbaum. We learned that plants use fungi to break down nutrients, the way we use GIT bacteria. Richard was also the lecturer for the VBMA speaker track. He gave a fascinating discussion on the intelligence of plants as well as lectures focused on the cleverness of animals in treating themselves with botanical medicines. The AHVMA has these lectures for sale.

FUTURE EVENTS

In 2018, our VBMA webinar series features Jeff Chilton, the “BC Mushroom Guy”; Dr. Kayla Golan, to speak on avian and exotics; Dr. Erin Bannink on oncology and botanical medicine; Dr. Nancy Brandt on veterinary aromatherapy; and finally, herbalist Brigitte Mars, the “garlic goddess”. Keep tuned to vbma.org for the dates of these exciting talks. You can also purchase past webinars. This May, VBMA members have a priority registration at a David Winston in-depth event in the lower Catskill Mountains of New York state. For more info, visit nycavma.org.

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

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tech talk

INTEGRATIVE TRAINING FOR TECHNICIANS

By Joni Kamlet, RVT, CCRA

Credentialed veterinary technicians are in short supply. Training in integrative therapies helps empower vet techs and strengthens the ﬁeld overall. Technicians are leaving the veterinary field in alarming numbers. According to a 2016 survey by the National Association of Veterinary Technicians in America (NAVTA), the industry is dealing with a shortage of credentialed veterinary technicians. A major complaint among veterinary practices is the difficulty in finding new qualified personnel. This trend is apparent in the integrative veterinary practice as well.1

WHY ARE TECHNICIANS LEAVING? Wages are a big factor. Under-utilization is also a common complaint.2 It is my experience that both these issues can be overcome through proper training and a team effort. In a nutshell, none of us will succeed unless all of us succeed. I have found that the practices which embrace this concept are successful. There is more satisfaction among the staff, and everybody benefits. Clients are happier and the bottom line financially is sound. The practice manager or veterinarian/owner would benefit by recognizing the long-term beneficial effects of training technicians, thereby empowering them in the practice, having them continuously learning new skills, and thereby increasing their desire to stay.

CERTIFICATION AND TRAINING PROGRAMS FOR VET TECHS

veterinarians tell them is best for their animals’ nutrition. They are making more of their own decisions about how to feed their pets, which leads to some good decisions as well as some very bad ones. Raw pet food is currently the fastest growing market in the pet food industry.4 Given the popularity of PetFooled, a documentary that came out early in 2017, I suspect this trend will continue. In general, interest in integrative veterinary options continues to grow at a rapid pace.5 Join any Facebook raw feeding group and you will see the good, the bad and the ugly of this movement. Many are doing it right, but even more are doing it wrong. Regardless of how you feel about this type of diet, it is imperative that we stay on top of this as veterinary professionals, and be able to offer healthy, balanced ways to feed raw and fresh food. The extreme need for proper nutritional education opens a gaping hole that can be filled by technicians. A nutrition technician, expertly trained in how to properly balance a diet, can be invaluable, not only in an integrative practice, but also in a conventional practice that is trying to retain millennial clients who don’t want to feed their pets out of a bag or can. A number of certification programs can address this need:

Nutrition There’s a revolution happening in the pet food industry, and it’s being driven mostly by millennials.3 This generation is starting to question how we have been feeding pets for the past 50+ years, and are not as willing to blindly accept what

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• Royal Animal Health University (RAHU): Founded by Drs. Barbara Royal and Natasha Lilly, this university launched in April of 2017. It plans to offer modules covering many aspects of integrative medicine, including nutrition,

restraint, herbal medicine and more. Classes will be offered both online and in classroom format throughout the year. There will be certification offered for RVTs, DVMs and pet parents. rahu.education • Companion Animal Nutrition and Wellness Institute (CANWI): Founded by Drs. Karen Becker and Donna Raditic, this organization will be offering a certification program in nutrition for RVTs, DVMs and pet parents. CANWI is also doing clinical studies on pet food. companionanimalnutritionandwellnessinstitute.org/home.html • The College of Integrative Veterinary Therapies (CIVT): This international university offers a Natural Nutrition Program, which can be taken by DVMs, technicians and receptionists. This is not a certification program. Susan Wynn’s recent lectures will soon be available as webinars/ podcasts, along with a course on the east coast next year. A number of webinars on real food nutrition, nutrigenomics, etc. are available for purchase from their library. civtedu.org

Herbalism Herbs can be incredibly beneficial for dogs, cats, horses and other animals. Whether Chinese, Western or Ayurvedic, education in this area can create great opportunities for technicians. • The Chi Institute: This prestigious school of Chinese Medicine has been around since 1998. Founded by Dr. Huisheng Xie, it offers a certification course in TCVM for veterinary technicians. This class is offered once a year and fills up quickly. Classes are both online and onsite. Technicians can also take courses in business management. tcvm.com/Programs/TCVMforVetTechs.aspx • College of Integrative Veterinary Therapies (CIVT): This college is government-accredited and offers opportunities to learn a number of different integrative therapies, including Western herbs, environmental animal health, nutrition, anatomy, physiology and professional communications. The courses are accredited and some are at the post-graduate level. Classes are offered both online and onsite. This school offers an excellent curriculum and world-renowned teachers. civtedu.org

Rehabilitation Technicians drawn to this path do well if they like lots of interaction with clients. Unlike some other technician roles, the rehabilitation tech spends a lot of time not only with the patient, but also with the pet parent. Sometimes you are seeing these patients multiple times a week. This sets up wonderful continuity and the opportunity to really bond with the patient. Continued on page 56.

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Continued from page 55.

INVESTING IN YOUR

TECHNICIAN

My own experience is a great example of how investing in your technician will yield great results. In 2005, I was offered a job at a veterinary practice with a canine rehabilitation component. I had only recently graduated from RVT school and had student loans to pay. The DVM owner I worked for had the foresight to see my potential and made an agreement with me. The practice would pay for half my education to become a CCRA plus the airfare to attend school. I had to complete my certification within a specific period of time. If I left the practice within 12 months of completing my certification, I would be responsible for paying back a portion of the tuition. I stayed at the practice for six years and it was a win for all of us. There is a veterinary practice in Northern California that I greatly admire. It consists of an integrative veterinarian and her assistant. The practice always has a waiting list, and is very well-respected in the community. The veterinarian/owner realized early on the importance of having a well-trained assistant, and has supported continuing education for the six years that the assistant has been there. This assistant now has certification and/or skills in craniosacral therapy, massage, Tui na, acupressure, osteopathy, Reiki, and animal communication. The veterinarian in this practice feels supported, and says it has taken a lot of pressure off to have such a knowledgeable assistant who can step in and provide these valuable treatments. The assistant feels empowered, is making more money, and has a sense of ownership. The clients feel safe and taken care of, and trust the assistant to understand the details of their pets’ issues. A continuity of care resonates through the entire practice. Both of the above examples are easily achievable. There are plenty of technicians, assistants, receptionists, etc. who would jump at the chance to be trained. It’s important to think outside the box when looking for staff. Some of the finest integrative staff I have seen are career change individuals. I was 43 years old when I went to school to become an RVT and truly feel my maturity gave me an extra advantage with working in veterinary practice. Wisdom and compassion grow with age and life experience. 56

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It is also important to understand that there is a lot of hospicetype work that comes with rehabilitation. A good strong back is a plus! Here are some certification programs for canine and equine rehabilitation: •U niversity of Tennessee Certification Program: This program has many opportunities for veterinary technicians to excel. There are also certification courses in pain management, nutrition, rock taping, business management and more. Technicians work side by side with DVMs and physical therapists in these classes. Technicians need to be licensed to take these courses, but in rare cases, exceptions can be made. ccrp.utvetce.com •C anine Rehabilitation Institute (CRI): Full disclosure – this is the certification course I took and I absolutely loved it! It was an incredibly positive experience for me, and set me up very well for my career in canine rehabilitation. Technicians work alongside DVMs and physical therapists. This class is very popular and sells out quickly. Following the coursework, technicians do a 40-hour internship with a CRIapproved rehab facility. caninerehabinstitute.com/CCRA.html •F ull Spectrum Canine Therapy: Physical therapist Patricia Kortekaas has been teaching these wonderful classes since 2006. She has a passion for helping technicians understand the importance of proper handling techniques for pets under anesthesia, having blood draws, or undergoing dental work. A technician properly trained by Patricia would be a great asset to any veterinary practice. This school offers osteopathy as well as craniosacral therapy. fullspectrumcaninetherapy.com

Homeopathy Created by Dr. Samuel Hahnemann in the late 1700s, homeopathy is a safe and effective form of alternative medicine for animals. It can be incredibly rewarding to observe an animal’s response to the correct homeopathic remedy. Technicians working in a clinic can actually manage cases even if the veterinarian is not trained in homeopathy. More and more clients are requesting this deep healing modality. •P rofessional Course in Veterinary Homeopathy: The veterinary world is blessed with an amazing classical homeopathic teacher, Dr. Richard Pitcairn. He created this year-long (five weekends) training course for DVMs, vet techs and a few other professionals. pivh.org/professionalcourse/course-outline/

Muscle testing/applied kinesiology Muscle testing, also known as applied kinesiology, is based on the concept that the body’s energy field will be strong in the

presence of something that is good for it, and weak in the presence of something that is not. This modality is gaining ground in the veterinary world. I have seen some excellent results and know of some veterinarians who use muscle testing almost exclusively. I also know of technicians who are getting into this unregulated area. A good muscle-testing technician could be priceless in the right practice. •M orphogenic Field Technique (MFT): This technique was developed by Frank Springob, DC. He travels around the country giving seminars and offering certification courses. morphogenicfieldtechnique.com •N utrition Response Testing (NRT): Developed by chiropractor Freddie Ulan, NRT teaches a 13-step process of muscle testing. Classes are taught at locations around the country. unsinc.info/aboutus.html

Acupressure • The Tallgrass Institute: Founded by Amy Snow and Nancy Zidonis, Tallgrass offers a 300-hour certification program in acupressure. animalacupressure.com/index.htm

Massage •T he Lang Institute for Massage: Canine and equine massage courses are offered here. Located in Lovelend, Colorado, it’s the only state-approved training program offering veterinary medical massage. There is a 663hour class requirement – four days are handson and the rest is done through videos, books and DVDs. Students study at their own pace. dogmassage.com •C anineology and Equinology: This school offers four different progressive levels of Equinology Equine Body Worker certification. It also has two Caninology Canine Body Worker certification programs. The school offers both onsite and distance programs. equinology.com/default.asp •E quissage: Students who successfully complete this program will receive 50 CE hours through The National Certification

Board for Therapeutic Massage and Bodywork. (Note – this is not veterinary CE.) equissage.com

Reiki Reiki classes are available in most communities and online. This therapy is used in many human shock trauma centers and hospitals and is practical for pain relief and emotional support. Many shelters have increased adoption rates through the use of Reiki – find out more at ShelterAnimalReikiAssociation.org. Meanwhile, a new research project will study preand post-op use of Reiki on animals (visit AnimalReikiAlliance.com). •A nimal Reiki Source: A pioneer in Animal Reiki, Kathleen Prasad offers training, classes, workshops and more. AnimalReikiSource.com

Healing Touch • The Healing Touch for Animals® (HTA): Healing Touch has been used for decades by RNs in many human hospitals. HTA offers a certification course. healingtouchforanimals. com/default.asp

SUMMARY Poll your clients and staff to see which of these many modalities are most desired, and create incentive programs for carefully-selected technicians/receptionists. Because integrative medicine is still a fairly new area for technicians (the Maryland Technician program has been teaching an integrative required class for over a decade), I have started a Facebook page called “TheTribe – A Community of Integrative Veterinary Technicians”. There are currently 433 members, all technicians who either work in integrative veterinary medicine or have an interest in it. This is a much-needed forum on which you can safely discuss any holistic issues.

Top to bottom: Companies will often give in-clinic seminars for technicians and staff; Technicians can be trained to give laser treatments – here, a Respond Class 3b laser is being used on a patient; Technicians trained in rehab can be an integral part of the practice – balance exercises are being used to help a dog recovering from an injury that left him with weakness and a neurological issue in his rear limbs.

“Why Vet Techs are the Veterinary Profession’s Backbone”. Veterinary Practice News. veterinarypracticenews.com/why-vet-techs-are-the-veterinary-professionsbackbone/ Oct 11, 2016. 2 Velasquez LVT J, 2016, Nov 27. “Four Reasons Techs Leave the Field”. drandyroark.com/four-reasons-techs-leave-the-field/. 3 Wall T, 2017, Apr 27. #tbt “Raw pet food growth continues despite concerns” petfoodindustry.com/articles/6431-tbt-raw-pet-food-growth-continues-despiteconcerns. 4 “PetLife: Millennial Pet Owners Leading Charge in Rapid Growth of Holistic Pet Care”. Business Wire. businesswire.com/news/home/20170324005105/en/PetLifeMillennial-Pet-Owners-Leading-Charge-Rapid, Mar 24, 2017. 5 ”PetLife: Holistic Pet Health is Next Big Trend in Veterinary Medicine”. Business Wire. businesswire.com/news/home/20170412005301/en/PetLife-Holistic-PetHealth-Big-Trend-Veterinary, Apr 12, 2017. 1

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TREATING

CHRONIC BOWEL PROBLEMS IN DOGS USING HOMEOPATHY AND INTEGRATIVE MEDICINE By Christopher Day, MRCVS, VetFFHom, MA, VetMB

Diarrhea and other bowel problems are common among canine patients. Homeopathy, along with other therapies such as probiotics and herbs, may effectively resolve these issues.

Chronic bowel problems are very prevalent in the canine population, and a cause for great anxiety and stress among many clients. These clients have to face not only the inconvenience of diarrhea in the home, but also the worry that their dogs are potentially malnourished, may lose weight and are clearly not in optimum health. Beyond these concerns, financial commitments can be heavy. Often, clients come to us looking for alternative treatments after having tried a long string of medications, including antibiotics.

GENERAL POINTS ABOUT THE CANINE BOWEL It is difficult to provide a general overview of the issues facing the holistic veterinarian in such cases, as there is a wide spectrum of presentations and one attempt at description cannot cover all. However, we can make several general points. The lining of the

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bowel serves a similar immune function to that of the skin – i.e. keeping the inside in and the outside out. It is part of the immune fortress’s ramparts. In addition, it has a digestive and absorptive duty that requires it to act as gatekeeper of the fortress, allowing the “good guys” in and keeping the “bad guys” out. The mucosal lining is furnished with myriad villi, massively increasing the surface area exposed to ingesta. In addition to those structural and functional considerations, we have the population of microscopic organisms that necessarily populate the bowel, in a symbiotic or commensal relationship with the body. These serve digestive, immune, synthesising and regulatory functions. It is only relatively recently that the absolute vital necessity of a healthy biome to the host’s health and well-being has been widely recognised. Gut flora represents the vast majority of this biome.

WHAT HAPPENS IN CHRONIC BOWEL DISEASE? There are three main categories of local damage we have to face in patients with chronic bowel disease:

q The result of inflammatory processes in the mucosal lining and bowel structure w Destruction or withering of the villa e Changes to the biome. These factors give focus to some of the adjunctive treatments we have to consider. They present a challenge to both our therapeutic skills and communication skills; we need to bring the client alongside the need for overcoming the structural results of long-term damage, which does not necessarily respond immediately to treatments.

CAUSES OF CHRONIC BOWEL DISEASE IN DOGS Chronic bowel disease can result from a failure to overcome an acute infection caused by a bowel pathogen, such as Salmonella, Giardia, Parvovirus, Distemper or Campylobacter. Since the bowel is such an integral and large part of the immune “system”, bowel disease can result from any stimulus that damages the immune system and bodily balance in general. Under this heading, we would have to consider such disturbing influences as systemic viral or bacterial infection and adverse vaccination reaction. Problems can result from an unhealthy and unsuitable diet, or even be triggered by a failure to recover properly from a one-off dietary indiscretion or toxic event. There is also much evidence, particularly in the case of colitis, IBD or IBS, that Mycobacterium avium (subspecies paratuberculosis) infection is responsible, possibly arising from dairy products or meat.

HOMEOPATHIC TREATMENT In homeopathy, we have over 4,000 described medicines, and the prescriber can make further special medicines as required or indicated. This presents a challenge in prescription selection in our quest to stimulate full recovery from chronic bowel disorders in canine patients. Herbs, auto-nosodes, bowel nosodes, probiotics and prebiotics, along with diet, also aid in management. For the homeopathic intervention, we have to use a selection process that suits our way of working. The correct prescription will be the homeopathic medicine that best fits the whole symptom picture. The patient’s own individual characteristics are very important in developing a prescription for chronic disease. The “picture” of the homeopathic medicines, which has to be matched to that of the patient, is recorded in the

Homeopathic Materia Medica. Many remedies are available, with dissertations on the individual medicines varying in depth and detail. The most obvious technique for medicine selection, and one that can be taught relatively easily, is that of repertorisation. This involves the use of a repertory, or index of symptoms. There are several such works available; one of the most commonly used is Synthesis. It relies heavily on the accurate definition of symptomatology. Accurate symptom identification is important, both of “local” signs and of patient characteristics and mental indicators. If the information fed into a computer program is incorrect, then the answer is likely to be incorrect.

WHICH HOMEOPATHIC MEDICINES TO USE? The correct homeopathic prescription needs to be selected on the basis of the patient’s individual expression of the disease, rather than for a specific syndrome. The following are a few commonly applicable medicines used in cases of chronic bowel disease, along with some of their individual characteristics to help guide your study.1,2,3 • Arsenicum album – Stools profuse, watery, bloody, excoriating, painful, fetid odor and mucus. Unhealthy IVC Spring 2018

Case 1

CASE REPORTS Daisie, an 11-month-old female boxer with chronic diarrhea First seen on July 13, 2006, with colitis and chronic diarrhea of a variable nature, with very poor condition (bony appearance). The problem had started on May 26, and there had been problems ever since. Daisie was ravenous and ﬂatulent. She had been vaccinated in October of 2005, was spayed before her first season, and had been fed a fresh organic diet. Daisie visibly liked cuddles and warmth, had little thirst, a ravenous appetite, few fears, barked at animals on television and was quite excitable. Her left ear was crusty but not smelly. She had right pelvic misalignment (lumbo-sacral distortion). Prescription: Homeopathic Pulsatilla and Mutabile. Chiropractic-type manipulation. Probiotic. Both Pulsatilla and the Bowel Nosode Mutabile suited the patient’s changeability and symptomatology. Pulsatilla also suited Daisie’s character to a tee. Each was given one time, orally. July 17, 2006: A fecal sample revealed possible E. coli. July 19: Daisie is so much better it’s amazing – no diarrhea since 24 hours after being seen. Different dog, energy levels brilliant, gaining weight, symptom-free. July 21: Slight “blip” – asked to go out twice in night, with normal motion each time. In the morning, the motion

appearance, dejected, restless especially at night, seeming near to death, fearful. Frequently thirsty for small sips of water. • Bryonia – Very thirsty for large amounts of water. Worse from being jostled, or from any movement – even the motion of the stool coming out can be painful. These dogs cannot tolerate heat. Stools are large, dry and even burntlooking. The dog can have chronic diarrhea as well, and may be irritable. • Lycopodium – Constipation or diarrhea. Flatulence common, loud and smelly. Dog is fear aggressive, yet acts guilty. Wants to be near owner but not petted that much. Often has a history of or concurrent urinary tract problems. Associated with liver disease. • Mercurius solubilis – Straining, never feels done so the dog squats continuously in the yard or on a walk. Mucus and blood. Does not want to be too hot or too cold. • Natrum sulphuricum – Diarrhea occurs on rising, and is worse in cold, wet weather. Concurrent asthma or liver disease. Sadness.

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was a bit soft and contained mucus (she’d been given two lamb bones the day before). July 24: Stools either 100% or just tiny bit soft, much better in herself, vomited a tiny bit of potato and chicken bone on the Sunday morning. July 27: Daisie doing really well. Every now and then, she passes a very firm stool with a bit of mucus/slime coating – otherwise all normal. She is great in herself, energy like you wouldn’t believe, even in very hot weather. She has definitely put on weight, so will carry on and keep in touch. May 14, 2007: Daisie is seen for residual skin problems (recurrent eruptions, non-severe, with rumbling ear problems). Prescribed homeopathic Thuja. Her owner is nonetheless delighted, as Daisie is so well, in such good condition and has no problems with bowels/digestion. This case illustrates “Hering’s Order of Cure”, in that the skin problem was almost certainly related to the diarrhea and was a more “superficial” expression of the health disturbance. This progression from “internal” to “external” signs was very encouraging for the prospects of a long-term cure. In fact, Daisie’s “skin problem” resolved uneventfully and she had no further GIT problems.

• Nux vomica – Diarrhea or constipation with frequent, ineffective urging. Normally sweet animals, these dogs become very irritable when ill, so as the chronicity of the GIT illness progresses they become grumpier. Desire for heat. • Phosphorus – Seeks company, outgoing, vocal. Startles to noises. Thirsty for cold water. Can vomit after water or food warms a bit in the stomach. Blood is common in any discharge. Open, protruding anus. • Pulsatilla – Sweet, affectionate, likes cuddles and feels better from attention. Prefers cold and open air, has very little thirst and discharges, even stools are bland with little odor, and change a lot. Constipation may alternate with diarrhea. Worse after eating or at night. • Silicea – Often used for a longer duration of problem. These dogs prefer heat. It’s hard to push out the stool so they often feel constant urging. Sensitive animals. • Sulphur – Worse in the morning. As with Arsenicum, the stool can be excoriating with itching or pain. Dog is very thirsty. Prefers cold. Looks messy and unkempt.

NOSODES AND TAUTODES A Nosode is a medicine made by the homeopathic dilution/ succession process, from diseased material, in this case from

Harvey was first presented on February 23, 2006. He had suffered from chronic diarrhea since September of 2005. He was in extremely poor condition, and his coat was dull. The diarrhea persisted despite dietary changes. He was passing profuse watery stools with blood and mucus, likely indicating colitis. He had a sad, dejected and unhealthy appearance. He could be described as “hangdog”. His family was close to considering euthanasia. He had been vaccinated in July of 2005. Harvey was given homeopathic Arsenicum and Gaertner (Bowel Nosode, selected in view of his severe malnutrition), supported by probiotic and followed by E. coli Nosode. The Arsenicum was prescribed on the basis of his condition, his appearance and the apparent lack of hope among all concerned, including the patient. Harvey failed to respond fully until after the Nosode. March 3, 2006: Much perkier and happier, bouncing when on walks – had diarrhea today. March 7: Absolutely great. Hungry all the time. Passed a proper motion today. On a natural diet.

March 10: Doing really well. Back to normal self and eating well. Eats everything but won’t touch scrambled egg. March 13: Small amount of diarrhea at the weekend -- ate some treats given by a family member.

Case 2

Harvey, a 10½-month-old Weimaraner with chronic diarrhea and digestive problems

March 15: Everything settled well again. April 20: Bowels normal. Harvey is a much more cheerful and happy dog who enjoys life. No remedies since the beginning of April. July 20: Doing really well -- brilliant – a different dog. Enjoying natural diet and bowels fine. March 28, 2007: Has been brilliant but diarrhea again this week. Repeated medication. June 29, 2009: Owners reported that Harvey is doing brilliantly. “Thanks for saving his life.” As we all know, case anecdotes prove nothing individually. However, the weight of multiple cases can begin to add up to a pattern.

the bowel. A Tautode is made the same way but from a substance considered to be part of the cause, such as a toxin, dietary ingredient or vaccine. In stubborn cases, I have sometimes resorted to making an Auto-Nosode (in which a medicine is made from the diseased material of the ill individual).

ADDITIONAL MANAGEMENT THERAPIES If the bowel is structurally damaged, which is highly likely in such a chronic condition, homeopathy alone may not be sufficient to bring about a cure. While searching for the remedy that will help healing, other management tools should be considered. An inflamed and sore bowel lining may be soothed by herbs such as slippery elm or marshmallow. Another herb that serves to soothe the bowel, firm the stool and act as a valuable prebiotic is psyllium husk. A vicious spiral occurs in chronic diarrhea problems. When inflammation damages the digestion process, more higher quality nutrients progress to the lower parts of the bowel. Continued on page 62. IVC Spring 2018

Continued from page 61. This results in increased populations of bacteria in those lower regions; owing to population expansion, the bacteria begin to migrate further up the bowel than normal. The products of their fermentation are alien to those higher portions of the bowel and inflict damage on the villi and mucosa. This results in a further failure of digestion and even more higher quality nutrients escaping the attentions of the proximal bowel, leading to further population growth and migration of flora from lower portions of the bowel. The process is selfaggravating, and if it has persisted for a considerable time, presents a challenge to the veterinarian who has to try to achieve restoration of more normal microbial distribution and function, and restore structural normality to the bowel lining. Large doses of high quality probiotic are possibly the best ally in this endeavor. Large numbers of microorganisms and a wide spread of species are needed. Just giving the dog live yoghurt, kefir or sauerkraut is unlikely to be sufficient. The client must understand that this restorative process will not be instant. (Micro Biome Restorative Therapy can often help restore normal gut flora.) If modern pharmaceuticals have already been tried without success, then they probably have no further part to play. Antibiotics, of course, are deadly to the friendly biome and present a risk of generating dangerous antibiotic-resistant strains (AMR). One should be very cautious with their usage. In chronic cases, the use of pharmaceuticals in the past may have resulted in the suppression of symptoms/signs, thereby increasing the risk of the disease becoming chronic. There is also the risk of “side effects” which have to be considered against the possible benefits (e.g. sulphur drugs and keratoconjunctivitis sicca). Anti-diarrheals, such as Kaolin, may

prevent or delay the necessary elimination of toxic and damaging material. Allergy testing may help find foods that irritate the bowel further. However, allergy is a fundamental immune malfunction and triggers can alter from time to time. This means that relying on the results of allergy testing may be an unproductive route to follow. Likewise, desensitising treatments may not get to the source of the problem. Generally speaking, a dog should be able to eat a species-suitable fresh diet, with no chemical additives, without it leading to diarrhea. If he can’t, then there is an immune problem and bowel microflora balance issue that need to be corrected.

SUMMARY In acute disease, attending to symptoms/signs alone may reduce owner anxiety and increase patient welfare (as long as no adverse event follows), while the body sets about healing. However, this amounts to suppression and can lead to a chronic condition. Once the chronic situation sets in, little more than temporary palliation can be offered by pharmaceuticals that target symptoms/signs. The aim must be to stimulate a true healing process within the body, so that a real cure may be achieved. This appears to be the role that homeopathy plays in so many cases of chronic disease. However, it is also important to attend to potential “obstacles to cure”, such as diet, overvaccination, environment, management, disturbed bowel flora etc., in order to enable healing. Day, Christopher. Homeopathic Treatment of Small Animals. Hamilton, Don. Homeopathic Care of Cats and Dogs. North Atlantic Books, 1999. 3 Clarke, J.H. Dictionary of Practical Materia Medica. B. Jain Publishers, 1990. 1 2

In memoriam The veterinary world has lost another important ﬁgure. Dr. Lori Tapp passed away on November 20, 2017 at the age of 58. Since 1993, when she became trained, followed by a two-year internship in Eugene, Oregon, Dr. Tapp made huge contributions to integrative medicine by treating animals with homeopathy. Dr. Tapp was on the board of the Academy of Veterinary Homeopathy, practiced in North Carolina, and taught many classes to both veterinarians and pet owners. She then became chair of ABTech’s Veterinary Medical Technology Program; as a result, it was recognized as one of the top 30 programs in the nation in recent years. She also used homeopathy at the Elephant Sanctuary in Tennessee. Dr. Tapp’s gentle loving spirit made a signiﬁcant difference in the lives of many people and animals.

IVC Spring 2018

industry innovations Essential oils for your practice Adding essential oils to your veterinary toolbox is a valuable move for every integrative practice. Young Living offers authentic grade essential oils, along with support on how to include them in your small or large animal practice. We also offer expert assistance in incorporating essential oils and wellness products into an individually-tailored healthcare regimen for pets, yielding both physical and behavioral benefits. ylvetsandpets.com, 630-205-6226

Infrared digital thermal imaging We all strive to provide the best care possible for our animal patients. Whatever the choice of treatment, a quantifiable measurement of a patientâ&#x20AC;&#x2122;s progress, or lack of same, can be visualized at any time thanks to infrared digital thermal imaging. Using this technology, visual and numerical results can be immediately recorded posttherapy, whether youâ&#x20AC;&#x2122;re using acupuncture, photobiomodulation, or targeted pulsed electromagnetic field therapy. The images quantify the therapeutic efficacy of a therapy, serve as proof to the client of what has been accomplished, and provide baseline data to monitor the patient and ensure the best clinical outcome. digatherm.com

IVC Spring 2018

From the VMAA DID YOU NAME THE OIL DISTILLED FROM THE PLANT PICTURED IN THE LAST ISSUE? It was peppermint (Mentha piperita)! Peppermint essential oil has a light, cooling action, which can provide gastrointestinal comfort and support normal digestion. It has a great taste and is often used as a flavoring agent, tea or dietary supplement. Peppermint oil is also used topically as it supports the musculoskeletal system. VMAA members use it last when layering oils for a pet massage, or in conjunction with acupuncture.

CASE REPORT Zayda, a F/S dachshund, was six years old when she was presented for euthanasia. She had intervertebral disc disease with a rupture that led to no deep pain, as diagnosed by the ER vet. Surgery offered a grave prognosis, so acupuncture was suggested, but was declined. Zayda’s ownership was relinquished to a vet tech. Acupuncture, essential oils and oral anti-inflammatory Western and Chinese herbals were used to manage Zayda’s condition. She was restored to full mobility, with only a wiggle in her walk. Essential oils of Copaiba, Helichrysum, Clove, Wintergreen and Peppermint were used topically with massage before, after and in between acupuncture treatments. This combination of oils supported Zayda’s musculoskeletal and nervous systems. Copaiba is high in beta-caryophyllene, which has anti-inflammatory properties. In our last column, we mentioned that according to the Journal of Ethnopharmacology, “regarding Helichrysum italicum in vivo activity… the anti-inflammatory properties exhibited by its flavonoids, acetophenones and phloroglucinols, is seen in animal models.”1 Clove has long been known for its numbing properties and has been used by dentists to numb gingival tissue. Wintergreen is revered for its deep tissue penetration and cooling impact. It is the source of salicylic acid, which has been used in the pharmaceutical industry to

manufacture aspirin. Peppermint is often considered a “driver” and with the animal’s coat as a wick, drives the other oils deep into the tissues when used last in a layering method. Multiple modalities worked synergistically to restore and maintain Zayda to her awesome and still current quality of life at 11 years of age! – Jodie Gruenstern, DVM,CVA To share your essential oils contact@DrJodiesNaturalPets.com.

success

story,

CONTINUING EDUCATION VMAA R.E.A.C.H took place in Las Vegas from February 23 through 25. It featured keynote speaker Kurt Schnaubelt and a hands-on workshop at Dr. Nancy Brandt’s clinic. For more information on educational courses, discounted classes, online webinars, books and our newsletter, visit VMAA.vet. There are even online classes. 1

ncbi.nlm.nih.gov/pubmed/24239849

NAME THE OIL DISTILLED FROM THIS PLANT! The answer will appear in the next issue.

From the

From the AVH

WAEO

AVH UPDATES

UPCOMING EVENTS

Our next annual conference will run from October 26 to 28 in the Blue Ridge Mountains near Asheville, North Carolina. A great program is planned; the next issue of IVC Journal will share some of the speakers and topics. AVH has a low cost “prix fixe” package that includes conference tuition, threenight hotel stay and six meals for a mere $475 per person, double room occupancy. If you’re not a member of AVH, you need to join to get this awesome deal, which includes all the other benefits of membership, including our monthly online webinars. Contact Sid Storozom at vetoracle@earthlink.net to register, or for more information.

Stay tuned for a great reason to travel to Europe! The WAEO presents its annual conference from September 6 to 8 in Germany. Please check out our new website for information about the conference, becoming a member, or to learn more about other upcoming events.

IVC Spring 2018

We are starting a small osteopathic journal with two editions this year. If you would like to receive a copy, please become a member. If you would like to submit any material for the first year, please contact us through our website at equineosteopathy.org.

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events

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

Veterinary Emergency & Critical Care Spring Symposium

At Fetch dvm360 conference, every non-laboratory session is available to every attendee, regardless of registration type.

April 12 – 15, 2018 — Playa Del Carmen, Mexico VECCS is committed to offering its members the highest quality of continuing education regardless of venue.

Challenge yourself to work through difficult cases alongside your peers and the profession’s most highly regarded clinicians. Tailor your schedule to match your interests, preferred learning style, and available time.

This year’s symposia will be held at the Hyatt Regency Maui Resort and Spa, a breathtaking and luxurious destination resort property. The resort is just three miles north of historic Lahaina town and a short walk from Whaler’s Village for shopping, dining, art, boating excursions and nightlife.

All this is an atmosphere that will both relax and rejuvenate you! Fetch dvm360 in Virginia Beach is truly a learning opportunity you won’t want to miss.

For more information: (210) 698-5575 info@veccs.org https://veccs.org/spring2018/

For more information: (800) 255-6864 www.fetchdvm360.com/fetch-virginia-beach/

2018 ACVIM Forum

West Virginia VMA 2018 Annual Spring Meeting

June 14 – 16, 2018 — Seattle, WA Join your colleagues to explore the latest research and the best practices and strategies in veterinary specialty medicine at the 2018 ACVIM Forum.

As always, The Greenbrier is providing a legendary venue with entertainment for the whole family, including a bowling event Saturday evening sponsored by Elanco!

Whether you’re looking to inject a big dose of the latest scientific research into your practice, or just want to seek out the trends that will keep you a cut above the rest, the ACVIM Forum’s invigorating blend of leadingedge scientific research, state-of-the-art lectures and exclusive networking connects you with the best and brightest in the veterinary industry. CE credit hours available.

For more information: (804) 346-0170 victoria@wvvma.org www.wvvma.org

For more information: (303) 231-9933 Forum@ACVIM.org http://www.acvim.org/ACVIM-Forum/HOME

2018 Spring NYS Veterinary Conference

132nd Annual MDVMA Summer Conference

April 12 – 15, 2018 — White Sulphur Springs, WV We have worked with our sponsors and nearby veterinary schools this year to provide a forum which should inform and excite everyone.

May 4 – 6, 2018 — Tarrytown, NY Don’t miss this conference hosted jointly by the New York State Veterinary Medical Society (NYSVMS) and Cornell University College of Veterinary Medicine (CUCVM) at the Westchester Marriott in Tarrytown, NY. The Spring NYS-VC offers 87 hours of continuing education during the threeday event. The maximum CE credit per person is 22 hours. For more information: (607) 253-3201 keh36@cornell.edu www.nysvc.org/

June 18 – 20, 2018 — Ocean City, MD If you are a practitioner of small animal or equine veterinary medicine, this is a premier opportunity for continuing education, business information, and networking. For more information: (443) 507-6500 www.mdvma.org

2018 AAFP Annual Conference

2018 Massachusetts VMA Spring CE Conference

May 9, 2018 — Marlborough, MA MVMA’s mission is to promote the veterinary profession, improve animal wellbeing and public health and provide programs and services that enhance the ability of member veterinarians to succeed. Join the continuing education conference in May 2018! For more information: (508) 460-9333 admin@massvet.org www.massvet.org

September 27 – 30, 2018 — Charlotte, NC The 2018 AAFP Conference will be held from September 27 – 30, 2018 at the Charlotte Convention Center and will focus on Senior & Geriatric Care and Emergency Medicine & Critical Care. Multiple tracks will be available, with one of them being a Para-professional Track for technicians and other practice staff. There will also be a separate registration for the Pre-conference Day and Lunch and Learn sessions. Our distinguished speakers will provide valuable and cutting-edge feline-focused information that is unique only to the AAFP conference. 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 of feline medicine. For more information: (908) 359-9351 info@catvets.com www.catvets.com/education

Fetch dvm360 East

May 17 – 20, 2018 — Virginia Beach, VA CVC is now Fetch, a dvm360 conference. Don’t you worry! Fetch dvm360 will still provide the same high-quality CE veterinarians and team members expect.

IVC Spring 2018

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

IVC Spring 2018