IVC SUMMER 2018
Innovative VETERINARY CARE
INNOVATIVE SOLUTIONS FOR YOUR PRACTICE
VOLUME 8 ISSUE 3
CHRONIC KIDNEY DISEASE IN FELINES WHY THIS COMMON CONDITION IN CATS RESPONDS WELL TO AN INTEGRATIVE APPROACH. – P. 38
OPTIMIZING MOBILITY IN OLDER ANIMALS
HOW ELECTRO-POLLUTION AFFECTS ANIMAL HEALTH
OSTEOPATHY FOR THE EQUINE THORAX
OMEGA FATTY ACIDS FOR DOGS AND CATS
THE IMPORTANCE OF PROBIOTICS
Alternative therapies, on their own or as part of a conventional approach, are showing success in treating megaesophagus. – P. 18
www.IVCJournal.com
SUMMER ISSUE 2018
INTEGRATIVE VETERINARY CARE JOURNAL
MEGAESOPHAGUS – IS IT A DEATH SENTENCE?
Electromagnetic radiation can have a profoundly negative impact on your patients. Here’s what you need to know. – P. 28
Omegas 3 and 6 come from both plant- and animal-based foods -- understand which ones offer optimal benefits to dogs and cats. – P. 34
Addressing the causes of mobility impairment helps us find suitable treatment options for each patient. – P. 12
Learn how this healing modality can alleviate restrictions and immobility in a horse’s thorax and beyond. – P. 44
Find out how probiotics help balance the microbiome to achieve better overall health – P. 24
COVER
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contents
12
FEATURES
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OPTIMIZING MOBILITY IN OLDER ANIMALS
18
ALTERNATIVE APPROACHES TO MEGAESOPHAGUS
By Narda G. Robinson, DO, DVM, MS, FAAMA
Integrative medicine has earned a place as firstline treatment for veterinary patients, especially older animals with pain, neurologic compromise or debilitating arthritis.
By Judith Saik, DVM, DACVP, CVA, CVCH, CVFT
Several alternative therapies are attracting attention for successfully treating megaesophagus, either as a sole therapy or part of a larger treatment approach.
24
NUTRITION NOOK
PROBIOTICS, THE MISSING NUTRIENTS – PART 2 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.
24 28
28
ELECTRO-POLLUTION AND ANIMAL HEALTH
By Katie B. Kangas, DVM, CVA, CVCP
Studies reveal that the homeostasis within all living bodies is dramatically affected by increasing electromagnetic radiation levels, with negative consequences on health.
34 38
OMEGA FATTY ACIDS FOR DOGS AND CATS By Jean Hofve, DVM
A comprehensive look at Omega fatty acid sources for canine and feline patients, and the pros and cons of each.
AN INTEGRATIVE APPROACH TO CHRONIC KIDNEY DISEASE IN CATS
By Barbara Fougere, BSc, BVMS(Hons), BHSc(Comp Med), MHSc(Herb Med), Grad Dip Vet Acup, Grad Dip VWHM, Grad Dip VCHM, CVA, CVBM, CVCP, GD Bus Mgt, Morg D&T, CMAVA, MNHAA CKD is a common but manageable condition in feline patients, and responds well to integrative medicine. Herbs and acupuncture are key therapies.
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OSTEOPATHIC APPROACH TO THE EQUINE THORAX
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GOLDEN YELLOW POWDER FOR WOUND HEALING
52
HOSPICE HOME CARE PRODUCTS FOR PETS
58
HERBAL SUPPORT FOR GERIATRIC ANIMALS
62
INNOVATIVE PRACTICE
By Ann-Marie Hancock, MS, DVM, EDO
There are many reasons why a horse may have restrictions in his thorax. As osteopaths, we know that immobility in one area can certainly influence other regions of the body.
By Michael D. Bartholomew, DVM, MS
How Golden Yellow Powder, an herbal medicine descended from a classical Chinese formula, helped heal a traumatic degloving wound in an Australian Shepherd.
By Sara Render Hopkins, DVM, CVA, CHPV
From mobility support to hygiene to pain management, these products help improve quality of life for palliative patients at home.
By Nancy Brandt, DVM
Health issues often arise as our animal patients age. Herbs offer beneficial effects to a variety of body systems to help prevent these problems.
A SUCCESSFUL VETERINARY PRACTICE USING AN INDIGENOUS HEALER’ S APPROACH By Jaime Gonzalez, DVM, CVA and Susan Blake Gonzalez
How integrating the idea of Shamanism into veterinary practice addresses the emotional and spiritual aspects of healing.
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advisory board Dr. Richard Palmquist, DVM GDipVCHM(CIVT) CVCHM (IVAS), graduated from Colorado State University in 1983. He is chief of integrative health services at Centinela Animal Hospital in Inglewood, California, president and research chair of the AHVMA, and an international speaker in integrative veterinary medicine. Dr. Palmquist is a consultant for the Veterinary Information Network (VIN) and codirector of the AHVM Foundation. He has published two books, one for conventional veterinarians and a second for clients discussing how integrative thinking works.
COLUMNS & DEPARTMENTS
5 Advisory board 8 Editorial
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’ 17 From the VBMA 27 Industry innovations 51 Wellness resource guide
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.
56 From the AHVMA 61 From the AVH 65 Marketplace 65 Events 66 From the VMAA 66 From the WAEO
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 Summer 2018
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Integrative VETERINARY CARE
INNOVATIVE SOLUTIONS FOR YOUR PRACTICE
SUMMER 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
Michael D. Bartholomew, DVM, MS Nancy Brandt, DVM Barbara Fougere, BSc, BVMS(Hons), BHSc(Comp Med), MHSc(Herb Med), Grad Dip Vet Acup, Grad Dip VWHM, Grad Dip VCHM, CVA, CVBM, CVCP, GD Bus Mgt, Morg D&T, CMAVA, MNHAA Jaime Gonzalez, DVM, CVA Susan Blake Gonzalez Christopher Kelly Groth Ann-Marie Hancock, MS, DVM, EDO Jean Hofve, DVM Sara Render Hopkins, DVM, CVA, CHPV Katie B. Kangas, DVM, CVA, CVCP Doug Knueven, DVM Jeff Nichols, DVM Narda G. Robinson, DO, DVM, MS, FAAMA Judy Saik, DVM, DACVP, CVA, CVCH, CVFT
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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 copyright© 2018. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: June 2018.
IMPROVING THE LIVES OF ANIMALS... ONE READER AT A TIME.
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editorial
THEY’RE ONLY AS
OLD
AS THEY FEEL!
M
uch of this issue of IVC Journal addresses the older
For end-of-life patients, Dr. Sara Hopkins’s article focuses on the
end of the aging spectrum. It’s been my experience
growing niche of hospice and palliative care within a home-based
that incorporating an appropriate diet, supplements
setting. She introduces us to many products designed to improve
and various therapies into an animal’s daily regimen can make
a hospice pet’s quality of life, and that have proved useful with
a world of difference. Supplements such as healthy fatty acids,
her own patients.
which Dr. Jean Hofve addresses in her article, and the use of probiotics, covered by Dr. Doug Knueven, can help prevent or
Of course, this issue features other articles related to animals of
delay many discomforts of old age.
all ages. One challenge to health that greatly concerns me is the increasing level of electromagnetic radiation that our bodies, and
Although integrative practices may see fewer cats with renal
our animals’, are exposed to. Dr. Katie Kangas presents research
disease, it’s always helpful to have a variety of approaches for early
on how EMR affects cellular DNA, and how information-carrying
detection and prevention, as well as multiple treatment options, at
radio waves (ICRW) negatively affect cell membrane functions.
your fingertips. Dr. Barbara Fougere covers many of the herbs that, along with acupuncture and a good diet, have greatly extended
Dr. Judy Saik discusses the challenges of megaesophagus, and
the lives of cats and dogs. Dr. Nancy Brandt shows how herbs can
her success in treating it, while Dr. Michael Bartholomew talks
address aging problems in other body systems; more importantly,
about a unique approach to degloving injuries. Finally, Dr. Jaime
she discusses the top ten herbs for longevity and prevention of
Gonzalez and his wife take a look at Shamanism and how these
aging symptoms.
ancient worldwide healing practices may help address emotional and spiritual health in our own clinics. I firmly believe that finding
Since clients of older animals often ask for help with mobility,
joy in our day-to-day lives is important not only to us, but to our
Dr. Narda Robinson’s article looks at how acupuncture, massage,
clients, patients, and the world we live in. My wish for you this
photomedicine (i.e. therapy with laser or light-emitting diodes)
summer is that you find something new that brings joy to your life!
and botanical agents can address some of these concerns. She also reminds us to look at the whole animal; problems with mobility may actually stem from issues related to vision, hearing, obesity,
Yours in health,
poor digestion or neurology. Mobility in equines, as in other species, is related to the interconnecting fascia. Dr. Ann-Marie Hancock focuses on how restrictions in the equine thorax can create mobility problems throughout the body; and how osteopathic techniques can both diagnose and resolve apparently unrelated issues.
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Christina Chambreau, DVM, CVH Associate Editor, drtina@ivcjournal.com
IVC Summer 2018
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contributors 1
2
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1. MICHAEL D. BARTHOLOMEW, DVM, MS Dr. Michael Bartholomew earned his DVM from the University of Illinois in 2001, and went on to earn certifications in Veterinary Acupuncture, Tui-na, Food Therapy and Chinese Herbal Medicine from the Chi Institute. In 2016, he earned a Master’s of Science in TCVM from the Chi Institute. He is an integrative practitioner at The Animal Hospital of Dunedin in Florida. Dr. Bartholomew has been published in the American Journal of Traditional Chinese Veterinary Medicine and is co-author of several chapters in Xie’s Veterinary Herbology. He has been a lab assistant at the Chi Institute since 2008, and became a formal MS program faculty member in 2016.
7. JEAN HOFVE, DVM Dr. Jean Hofve earned her Doctor of Veterinary Medicine at Colorado State University. In addition to conventional veterinary training, she studied veterinary homeopathy, homotoxicology, Reiki and other holistic modalities. She has researched pet food and feline nutrition for more than two decades, and is an expert on holistic pet health and the commercial pet food industry. Dr. Hofve is an official advisor to AAFCO, and co-authored the books Holistic Cat Care and Paleo Dog.
8. SARA RENDER HOPKINS, DVM, CVA, CHPV Dr. Sara Hopkins founded Compassion 4 Paws in 2012 offering in-home acupuncture, laser therapy, hospice/palliative care and euthanasia. In 2017, she became one of the first veterinarians to be 2. NANCY BRANDT, DVM, CVC, CVA, CVMA Dr. Nancy Brandt graduated from the University of Minnesota College of Veterinary Medicine in certified in Animal Hospice and Palliative Care through the International Association for Animal 1990, and later began her studies in acupuncture, Chinese medicine, chiropractic medicine, and Hospice and Palliative Care (IAAHPC). Her husband, Dennis, developed the software program REX, naturopathic modalities. In 1999, she founded her practice, Natural Care Institute. In 2017, Dr. Brandt designed for the mobile, hospice/end-of-life care veterinarian. founded UnBound Center for Animal Wellness, for special needs pets. She pioneered the field of Veterinary Medical Aromatherapy® and founded the Veterinary Medical Aromatherapy Association 9. KATIE KANGAS, DVM, CVA, CVCP (nancybrandtdvm.com and sparkeducationonline.com). Dr. Katie Kangas graduated from the University of Wisconsin Veterinary College in 1993. She achieved her CVA certification at the Chi Institute in 2008, followed by additional training in Advanced 3. BARBARA FOUGERE, BSC, BVMS (HONS), BHSC (COMP MED), Acupuncture, Food Therapy, Herbal Medicine and Veterinary Orthopedic Manipulation. Dr. Kangas MHSC (HERB MED), GDVCHM, GDVWHM, GDVA, CVA, CVBM owns Integrative Veterinary Care in San Diego, California. Her areas of special interest include Dr. Barbara Fougere graduated in 1986 from Murdoch School of Veterinary School in Western Australia. nutrition/food medicine, dental health and pain management. She practices integrative medicine in Sydney, holds a Master’s degree in herbal medicine, and a Bachelor’s degree in complementary medicine. She was named AHVMA Practitioner of the Year in 10. DOUG KNUEVEN, DVM 2010 and Educator of the Year for 2011. Dr. Fougere is a founder of the College of Integrative Veterinary Dr. Doug Knueven earned his veterinary degree from Ohio State University in 1987 and is the owner Therapies. She has served on the board of AHVMA, VBMA and IVAS, and is currently chair of the College and medical director of Beaver Animal Clinic in Beaver, Pennsylvania. He has practiced integrative of Veterinary Botanical Medicine. veterinary medicine since 1995, and earned certification in veterinary acupuncture, veterinary Chinese herbal medicine and veterinary chiropractic. Dr. Knueven has advanced training in natural 4. JAIME GONZALEZ, DVM, CVA Dr. Jaime Gonzalez has practiced veterinary medicine for 29 years. His foray into alternative medicine nutrition, Chinese food therapy, massage therapy and homeopathy. He has written two books: Stand began years ago when he was diagnosed with a malignancy. Following surgery, he chose to forgo by Me: A Holistic Handbook for Animals, Their People and the Lives They Share Together, and The traditional treatments and worked with a Native Indian healer in Mexico. This experience forever Holistic Health Guide: Natural Care for the Whole Dog. changed Dr. G’s approach to medicine and gave him firsthand knowledge of the restorative power of medicinal herbs. He has worked for 20 years in the field of emergency medicine, ten years in two 11. NARDA G. ROBINSON, DO, DVM, MS, FAAMA Chicago specialty practices, and has 25 years of acupuncture experience. Dr. G and Susan are Level 4 Dr. Narda Robinson holds a Bachelor of Arts degree from Harvard/Radcliffe, a Doctorate in Osteopathic Medicine from the Texas College of Osteopathic Medicine, a Doctorate in Veterinary HTA practitioners, incorporating hands-on healing into their practice. Medicine and a Master’s degree in biomedical sciences from the Colorado State University College of 5. SUSAN BLAKE GONZALEZ Veterinary Medicine and Biomedical Sciences. She is a Fellow in the American Academy of Medical Susan Gonzalez was trained as a field biologist, and early on had a kinship with plants and animals. Acupuncture and serves on their Board of Directors. Dr. Robinson is Vice Chair of the American Board She worked in several university settings. She developed a farmers’ market for the City of Bradenton. of Medical Acupuncture and heads the Examination Committee for physician board certification. She Susan and Dr G opened Bear Creek Veterinary Alternatives in Sarasota, Florida. She has studied wrote Canine Medical Massage and Interactive Medical Acupuncture Anatomy. tracking and nature connection, animal communication, shamanism and medical intuition, and is a writer, teacher and animal rights advocate. 12. JUDITH E. SAIK, DVM, DACVP, CVA, CVCH, CVFT Dr Judith Saik received her veterinary degree from Louisiana State University in 1980. She co-owns 6. ANN-MARIE HANCOCK, DVM, EDO Winterville Animal Clinic in Georgia, with her husband, Dr Don Cole. She is a lecturer and participant Dr. Ann-Marie Hancock graduated from Colorado State University with a BS in Equine Science, an MS on specialty boards at the University of Pennsylvania Veterinary School. Dr. Saik is currently in Anatomy and Neurobiology, and a DVM in 2003. She worked at a general equine practice in North specializing in TCVM and is certified in Veterinary Acupuncture and Traditional Chinese Herbs. She Carolina for ten years. She completed the IVAS Acupuncture course in 2007, the Equine Osteopathy provides clinical laboratory instruction in acupuncture at the Chi Institute in Florida and is Editor-inCourse at the Vluggen Institute in Texas, and became certified as an Equine Osteopath. Dr. Hancock Chief of the American Journal of Traditional Chinese Veterinary Medicine. owned Rectortown Equine Clinic in 2013, then relocated to Marshall, Virginia to open True North Equine Veterinary Services, an expanding hub for practitioners supporting equines in any life stage or discipline.
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what’s new DISPOSING OF EXPIRED PHARMACEUTICALS “There’s not much communication going on between veterinary care professionals and their clients on how to dispose of expired pet medicines,” says the study’s corresponding author, Jennifer Lam. According to Sam Chan, a watershed health expert with the Oregon Sea Grant at Oregon State, chemicals from pharmaceuticals and personal care products for people and pets are being found at low levels in groundwater and surface water; anti-inflammatories, antibiotics, insect repellent and antimicrobials are among what’s being detected.
Do you instruct your clients on the correct disposal of expired pet pharmaceuticals? New research from Oregon State University found that more than 60% of veterinary care professionals do not.
The national Sea Grant program is partnering with the American Veterinary Medical Association to promote proper PPCP disposal, by dropping them off at a take-back event or bringing them to a depository such as those in place at some police stations and college campuses. today.oregonstate.edu/ news/more-communication-needed-regarding-disposal-petpharmaceuticals-personal-care-products
NEW VIRUS IN CATS Researchers from the University of Sydney have found a previously undiscovered hepadnavirus in cats. The team, funded by Morris Animal Foundation, recently published their results in the journal Viruses. “This is a very exciting discovery,” says Dr. Julia Beatty, Professor of Feline Medicine at the University of Sydney School of Veterinary Science. “The domestic cat hepadnavirus is in the same family as hepatitis B virus in people. Until now, we didn’t know that companion animals could get this type of infection. We obviously need to understand the impact of this infection on cat health.” Her team first identified the virus in a FIV-positive cat that died of lymphoma. Once they identified it, they tested stored blood samples from adult pet cats. To their surprise, they found evidence of infection with hepadnavirus in the banked samples; it was identified in 10% of FIV-infected cats and 3.2% of non-FIV infected cats
ASPIRIN-RESISTANT HORSES Recent research has indicated that aspirin may not be an effective blood thinner for some horses. Ten horses took part in the five-day study. Each was administered an initial 4.7mg to 5mg/kg dose of aspirin the first morning, with a follow-up dose of 1mg to 1.3mg/kg on the remaining four days. After the first dose, seven horses showed a reduction in clotting that ranged from 37% to 100%. However, the following four days revealed much less reduction along with a huge variation, ranging from zero to 98%. As for the other three horses, there was no sign of clot reduction after the first dose, and only a maximum of 22% reduction over the next four days. This could be an indication of aspirin resistance. These study results indicate a recommendation to test the efficacy of aspirin on a horse before relying on it as a prescription. ncbi.nlm.nih.gov/pubmed/28390056 IVC Summer 2018
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INTEGRATIVE WAYS TO
OPTIMIZE MOBILITY IN OLDER ANIMALS
By Narda G. Robinson, DO, DVM, MS, FAAMA
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W
hen clients complain that their older animals are refusing to go on walks, that they sleep all the time or have even become aggressive, we need to think about problems centering on mobility and pain. In so doing, however, we should reconsider the “easy fix� of gabapentin, tramadol or non-steroidal anti-inflammatories, and seek to do more to help these patients. Each of the aforementioned medications can cause its own set of problems, such as oversedation, inappetance and organ injury. Furthermore, they do little to directly treat the causes of mobility impairment, whether due to osteoarthritis, chronic spinal cord injury, myofascial dysfunction or pain.
ISSUES IN AGING ANIMALS The problem may extend beyond musculoskeletal and neurologic systems, so a whole patient examination and lifestyle analysis is indicated. Taking the time to gently palpate the myofascia and examine neurologic status yields vital differential diagnostic information about the nature and location of discomfort and/or compromise, without having to force the neck or back into extreme and unnatural ranges of motion.
acupuncture, massage, photomedicine (i.e. therapy with laser or light-emitting diodes) or even the cautious inclusion of botanical agents. Each of these techniques, when performed safely and correctly, allows for non-drug and non-surgical options that work on several levels to improve health and restore function. The aforementioned physical medicine approaches yield overlapping benefits through unique mechanisms of action. Despite their differences, laser, acupuncture and massage all share the common mechanism of neuromodulation. That is, each activates somatic afferent fibers in the periphery; peripheral nerves then deliver impulses to the spinal cord and brain to help normalize central, autonomic and peripheral nervous system function. All three also have the capacity to beneficially impact local tissue, promoting blood flow, reducing pain and working in an anti-inflammatory manner. The versatility and acceptability of these approaches to patients make them suitable for both in-hospital and outpatient care. Continued on page 14.
Geriatric animals may need more readily digestible food, antiaging nutrients, and caloric intake adjustment. Overweight animals are at greater risk of joint disease and inflammation, while underweight individuals may have difficulty procuring, chewing or digesting food. Both states can cause muscles to weaken and strength to further decline. Time may also rob our patients of vision, audition and overall vitality. Perceived cognitive changes such as disorientation, diminished activity, reduced social interactions, behavioral shifts and incontinence may actually stem from undiagnosed pain and neuromuscular impairment. Furthermore, many common geriatric afflictions, such as neoplasia, infections, immune-mediated illness, organ dysfunction and endocrinopathy can also change the way a dog or cat behaves.
SCIENCE-BASED INTEGRATIVE MEDICINE SUPPORTS MOVEMENT AND REDUCES PAIN After appropriately assessing an animal and identifying the source of his reluctance to rise, walk or otherwise engage in the activities he used to enjoy, the next step is to discuss with the client the pros and cons of conventional and integrative treatment. The latter may involve medical IVC Summer 2018
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Continued from page 13.
10 HOMECARE TIPS FOR CLIENTS
q Ensure adequate traction in the home
(area rugs, carpet runners, non-slip stair treads); consider toe grips or high traction socks or booties for dogs.
w Keep nails well-trimmed and delicately trim matted or soiled fur.
e Give the animal access to warm or cool
surfaces based on his individual needs and preferences; ensure access to fresh, clean air and exercise while avoiding exposure to taxing weather conditions.
r Provide clean and appropriately-
cushioned surfaces for sleeping and relaxing. Many animals with mobility challenges may prefer firmer bedding that offers much-needed structural support.
t Keep animals with elimination problems
clean and ensure they have dry bedding.
y Help severely impaired animals maintain adequate hydration and nutrition by ensuring they have ready access to food and water.
u Consider purchasing a light-emitting
diode (LED) device for home treatment of pain and neurologic challenges. Longer exposure to the less intense light offered by LEDs may be safer and more beneficial for some animals than the short bursts of high-powered laser treatments that have become popular in many veterinary practices. Reports of thermal burns and discomfort during treatment are increasing as the hype around highpowered laser units grows.
i Encourage daily, appropriate exercise and environmental enrichment. Think about an assistive harness for animals that need help with rising and walking. Purchase a ramp for dogs who enjoy car travel.
o L earn simple, safe and supportive massage techniques to improve circulation, digestion, nerve health and pain control. a Examine the pros and cons of botanical medicines such as boswellia, turmeric and cannabidiol to help with pain and inflammation. Consult a veterinarian educated in science-based integrative medicine about options based on facts and research.
Healthcare providers can introduce short, supportive treatments throughout the day to help in-patients relax and recover. Motivated clients can learn easy and safe home care techniques involving touch and light-emitting diodes that aid in keeping their animals active and healthy.
1. Acupuncture Acupuncture incites its somatic afferent stimulation by inducing slight mechanical traction on the tissues near the needle shaft. The metal needle engages with muscle and collagen fibers, leading to a small amount of local tissue deformation capable of causing wideranging results. Fascia extending out from the needle begins to relax, and blood flow within the muscle normalizes. Nerve endings and axons in the vicinity issue action potentials and reflexes that cause re-regulation of firing patterns in peripheral, autonomic and central nervous system pathways.
2. Photomedicine Photomedicine provokes alterations in cellular physiology and neural activity through photonic means. Photoacceptor enzymes within the mitochondria, such as cytochrome c oxidase, absorb photons which then alter the enzyme’s binding patterns with nitric oxide and oxygen. Mitochondrial metabolism increases, as does ATP synthesis. The cavalcade of photochemical events that ensue benefit cellular physiology, intercellular signaling, and tissue repair. What makes laser therapy stand out is this capacity to “kickstart” cellular energy production needed for tissue cleanup and repair.
3. Massage The mechanical effects of massage activate pressure-sensitive mechanoreceptors in the skin and subcutaneous tissue. Massage can calm or stimulate the nervous system depending on techniques, and it facilitates fluid flow through the interstitium. Signals from treated tissue travel to the spinal cord and brain to normalize nervous system balance within central, peripheral and autonomic networks. The movements of massage encourage the flow of fluids (lymphatic, arterial, venous and interstitial) through the body. This improves the health of not only somatic structures but also visceral function.
THE PROBLEM OF INTERVERTEBRAL DISC DISEASE (IVDD) A common condition affecting older dogs is intervertebral disc disease (IVDD). It causes pain, weakness, muscle tension, inflammation, circulatory compromise and even paralysis. Clients facing the expense, fear and psychological trauma of having their dogs undergo surgery need to be educated on what non-surgical alternatives can offer based on science and research, along with appropriate anti-inflammatory pharmaceuticals and analgesics, if indicated. In contrast, weeks-long cage confinement, which is a commonly-recommended mandate, has no supportive scientific research and can lead to negative long-term neurologic and orthopedic consequences. Continued on page 16.
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Continued from page 14. Even if a client seeks surgery for a dog with IVDD, the process of removing extruded disc material does little to directly address changes that take place within the spinal cord in the secondary injury phase, which occurs in the days after injury takes place. It may even worsen the inflammatory cytokine responses in the cord and surrounding tissue, and precipitate biochemicallymediated neuronal death and spinal cord inflammation. In contrast, modalities such as photomedicine and acupuncture stimulate recovery by controlling pain, inflammation and edema. They work to promote neural regrowth and functional restoration through stem cell activation and the encouragement of more normalized neural firing patterns. Massage aids the myofascia in relaxing and provides its own form of neuromodulation.
HOW DO YOU KNOW THE TREATMENT IS WORKING? Acupuncture and massage provide immediate feedback through the delivery device; laser does not. A skillful practitioner inserting an acupuncture needle gauges the amount of resistance the needle encounters as it penetrates one or more layers of muscle. This mechanical information conducted through the needle informs the acupuncturist about the state of tone, tension and tenderness in a muscle. Reactions from the patient further advise the acupuncturist about the degree of stimulation taking place within the patient’s nervous system. An experienced massage therapist develops palpatory techniques that convey other types of information. Feeling the tissues respond to touch and the myofascia melt under one’s palms during indirect release techniques provide moment-to-moment messages about how the patient’s body and mind are responding. Laser, like other instrument-driven methods such as ultrasound therapy, limits the amount of tissue engagement by the practitioner unless s/he makes a point of palpating the patient during or soon after treatment. Despite this limitation, all three modalities can fit seamlessly into integrative pain medicine treatment plans. Blending them maximizes the benefits to the patient by multiplying the mechanisms of action at play.
HOW DOES THE SAFETY OF EACH MODALITY COMPARE? When practiced by a medical/veterinary professional, acupuncture is one of the safest interventional techniques available. As long as one uses sterile needles and avoids inserting a needle into an organ, the spinal cord, a joint or a major vessel, complications are mild and resolve quickly.
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Similarly, properly-performed massage is relatively noninjurious as long as pressure is kept reasonable and the practitioner remains cognizant of any patient behavior that indicates discomfort or stress. However, photomedicine with lasers, in contrast to LEDs, may cause problems. Higher-powered laser therapy devices (i.e. those in the Class IV category, which deliver >500 mW of power) may cause retinal damage with direct ocular exposure (hence the need for protective and specifically designed laser goggles). Furthermore, the race to produce higher-powered devices in the Class IV category is elevating the number of anecdotal reports of thermal burns and patient pain during the procedure. Clearly, more caution is required for veterinary patients than is often recognized, and geriatric animals with impaired ability to escape a painful treatment, or even sense a thermal burn if they have nerve injury, warrant even more caution and care.
CONCLUSION Scientific integrative medicine has earned a place as first-line treatment for veterinary patients across the board, especially for older animals with pain, neurologic compromise or debilitating arthritis. It is time for veterinary medicine to move from a disease-based to a health-supporting paradigm of treatment, and address dysfunction well before it manifests as illness. Performing quick neurologic and gentle myofascial palpation evaluations on patients at every visit will indicate whether and where the animal is developing dysfunction in myofascia, joints or other tissues. We need to stop relying on artificial chemicals to keep animals moving, because their effects are limited and sometimes engender costly and damaging side effects. By working instead through neuromodulation, connective tissue remodeling and photobiomodulation (i.e. acupuncture, massage and photomedicine), the body’s endogenous selfhealing mechanisms are engaged, and the patient regains the ability to recover from injury more fully and quickly.
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? It was American Ginseng (Panax quinequefolius). Wild American Ginseng is endangered, so it’s critical to purchase this herb only from a sustainably farmraised source; it’s imperative that we stop harvesting this herb from the wild. American Ginseng’s properties include its bitter and sweet taste, and its moist nature. It specifically affects the spleen, lungs and heart, and their meridians. It acts as a Yin tonic, moistening and rejuvenating dry mucosa while deeply stimulating the endocrine system by warming it. Hence, it is one of the herbs that can expel a deeply retained pathogen in the Tai Yin level. “It’s virtues are, that it gives an uncommon Warmth and Vigour to the blood, and frisks the Spirits beyond any other Cordial,” wrote William Byrd (1674-1744). He used it “as a help to heal Fatigue, I us’d to chew a root of Ginseng as I Walk’t along.” The early eclectic herbalists used American Ginseng mostly for exhausted digestive systems, and for mental exhaustion from overwork. American Ginseng is classified as an adaptogen, which means it is safe for long-term use and is a great support for situations of chronic stress.
herbal therapy – in which American Ginseng was a leading player – Lola lived to the ripe age of 14 years and died a natural death from old age.
RECENT ACTIVITIES The VBMA hosted a webinar on “Winter Woes”, a panel discussion about the stress of Cold, Damp and Wind invasion, its treatment with internal Western and Chinese herbs, and its external treatment using trigger point therapy with the application of liniments. In May, we were priority participants in an ethnobotanical workshop with David Winston, RH (AHG). Watch for next issue’s write-up on this fantastic event.
FUTURE EVENTS Upcoming lecture topics include a panel discussion on food as medicine, with Drs. Cheryl Schwartz and Clare Middle presenting on food and behavior. Later, Drs. Connie DiNatale and Ihor Basko will be presenting on color and taste and what they tell us about food and herbs. Dr. Nancy Brandt will be discussing veterinary aromatherapy, and last but not least, we’ll hear from the “garlic goddess”, Brigitte Mars. Keep tuned to the VBMA website at vbma.org for the dates of these exciting talks. Past webinars are also available for purchase.
Samuel Henry (1814) wrote that it “invigorates the system and is an excellent restorative to those fatigued by travelling. In all weaknesses from excess in venery.” American Ginseng helps treat bone pain from syphilis, and is strongly indicated to help with recovery from Lyme disease and vaccine-induced conditions.
NAME THIS HERB!
CASE REPORT A dog named Lola was diagnosed with a thymic sarcoma when she was seven years old. After radiation and chemotherapy, she was Yin-depleted, exhausted and close to death. With the use of diet and
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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M
S
INTEGRATIVE APPROACHES TO
EGAESOPHAGU By Judith Saik, DVM, DACVP, CVA, CVCH, CVFT
M
egaesophagus is a disorder of the esophagus in mammals. It’s characterized by esophageal dilatation and an inability of the esophagus to effectively transport food from the throat to the stomach. Megaesophagus occurs predominately in humans and dogs, and is the most common cause of canine regurgitation. Any dog breed can be affected, but certain underlying conditions have breed predilections.1 Experts in general agree that dogs with megaesophagus carry a poor prognosis as they typically die of malnutrition, aspiration pneumonia, or are euthanized because the owners are told there is no hope.2
PATHOPHYSIOLOGY OF THE ESOPHAGUS Dysphagia, or disorder of swallowing, is a major sign of esophageal disease. Swallowing is a complex and highly coordinated physical act that can be divided into three phases: oral, pharyngeal and esophageal.3 The oral phase is usually associated with lesions of the oral cavity and tongue, while the pharyngeal phase is associated with pharyngitis and tonsillitis. When considering the esophageal phase, the first and last part may be impeded by failure of the cricopharyngeus muscle to relax during swallowing (achalasia), or increased tension at the lower esophageal sphincter which impedes the flow of food into the stomach.1,3 Segmental or diffuse dysfunction of the body of the esophagus is classified as megaesophagus. It results from atony of the esophageal muscle and is characterized by flaccidity and luminal dilatation. The esophagus is innervated by the vagus nerve; afferent vagal receptors are stimulated by the presence of food and liquid in the pharynx and upper esophagus, causing a swallow reflex and the esophagus to contract.1 The functional lesion may reside in the upper motor neurons of the central swallowing center or in the afferent sensory arm of the reflex controlling peristalsis, which arises in the esophagus.3
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Whatever the etiology, the result is failure of the peristaltic propulsion of the food bolus through the lower esophageal sphincter. Retention of food in the esophagus leads to putrefaction and esophagitis in dilated/dependent areas. The volume of the dilated thoracic and cervical esophagus may greatly exceed that of the stomach, with displacement of the intrathoracic trachea and heart ventrally. Common signs animals may present include malnutrition, dehydration, rhinitis and aspiration pneumonia.1,3,4,5
CLINICAL ASPECTS OF MEGAESOPHAGUS There are two primary categories of megaesophagus – congenital and acquired. Congenital megaesophagus: In the congenital form of the disease, swallowing dysfunction and regurgitation becomes especially evident with the introduction of solid food.1,3,4 A puppy with congenital megaesophagus characteristically begins to regurgitate at weaning (eight to 12 weeks old) when consistently consuming solid food.4 Initially, the puppy regurgitates immediately after food consumption, but as the esophagus dilates, food is held for longer periods before regurgitation. Commonly, the puppy will present with fever, cough and nasal discharge along with poor weight gain as the syndrome becomes complicated by aspiration pneumonia.4 Congenital megaesophagus is primarily associated with heritable anomalies in either neuromuscular innervation or vascular ring anomalies that entrap the esophagus near the heart base. Prognosis for the resolution of congenital megaesophagus in puppies is only 20% to 40%, although there is potential for improvement up to one year of age.1,6 Acquired megaesophagus: Gastrointestinal, endocrine, immunemediated, neuromuscular, paraneoplastic and toxic disorders have been associated with acquired megaesophagus, with myasthenia gravis being the most common etiology in 25%
USING ACUPUNCTURE FOR MEGAESOPHAGUS CASE #1 A four-month-old intact female five-pound Bichon Frise/ Havanese crossbreed was presented to the Integrative Medicine Service with a diagnosis of megaesophagus. The puppy had a history of chronic vomiting after eating (one to two times a day) and a failure to gain weight since weaning. Conventional treatment resulted in no improvement.
Dog with myasthenia gravis and megaesophagus being fed in a Bailey chair to help prevent regurgitation after eating.
CASE #2 A two-year-old male neutered Siberian Husky crossbreed was presented to the emergency and critical care clinic at the Veterinary Teaching Hospital with a several week history of vomiting and gagging which had initially improved with conventional treatment but had returned along with rapidly deteriorating locomotor activity. The dog was diagnosed with lower motor neuron disease at the teaching hospital and given a diagnosis of presumptive acquired myasthenia gravis of undetermined etiology.
TCVM with dry needle acupuncture and the Chinese herbal medicine, Happy Earth (modified Wei Chang He) was started. The one-week recheck showed significant clinical improvement, and after two more dry needle treatments and nine months of Happy Earth, the puppy was at a normal weight and asymptomatic. She was still normal when rechecked at four years of age.
Treatment included dry needle acupuncture and two herbal formulas, Four Gentlemen (to tonify Qi) and concentrated Hindquarter Weakness (to address Qi and Yin Deficiency), with no change in Western drug doses and continued feeding in the Bailey chair. The protein in the dog’s diet was changed from chicken (Hot) to beef (Slight Warm) for a slightly Cooler diet. Two weeks later, at recheck, there was significant improvement with a good appetite, no regurgitation and conscious proprioception normal in one hind leg. Over the next two months, with acupuncture treatment monthly, all Western medications were tapered and then stopped while the dog returned to a normal neurological status and energy level with no regurgitation. He continues to do well at seven months past initial clinical signs.
The dog responded to treatment with gradual improvement of weakness and decreased regurgitation. Three weeks after the teaching hospital diagnosis, the owner presented her dog to the Integrative Medicine Service for assessment with the goal of decreasing Western medications which were creating side effects such as ravenous appetite, diarrhea, lethargy, and heat intolerance.
to 30% of cases.1,5 Affected animals regurgitate (lack of vigorous abdominal contractions, vomitus with PH>5, lacks bilirubin) and have generally lost weight.6 Respiratory signs may predominate with little or no history of regurgitation. Thoracic radiographs reveal air, fluid or food in a dilated esophagus.1,4 Clinical therapy: Typical treatment involves medical management directed at the etiology, or surgery for vascular ring anomalies. This includes finding a diet that best prevents regurgitation, and this varies between individuals (slurry to more solid). A feeding schedule of small frequent meals from an elevated dish, where the forelimbs are higher than the hindlimbs, along with keeping the dog in this upright position ten to 15 minutes after eating, works best to prevent postprandial regurgitation. The overall prognosis is poor if the IVC Summer 2018
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underlying etiology cannot be corrected, and many affected animals die from aspiration pneumonia.4
ALTERNATIVE APPROACHES TO MEGAESOPHAGUS The morbidity and mortality of dogs affected with megaesophagus depends on the degree and nature of the underlying disease (if known), as well as client compliance. Medical management in general is aimed at relieving clinical signs, such as weight loss and respiratory infections secondary to food aspiration. Alternative therapies are increasingly being used to stimulate the esophagus to move more effectively, either as a sole therapy in mild cases or as an adjunct to Western therapeutic management.7-10 Some promising evidence-based clinical studies demonstrate the efficacy of acupoint stimulation on gastrointestinal motility. Studies have focused on two key acupuncture points – PC-6 and ST-36. Research on PC-6 includes 33 controlled trials (published worldwide as of 1996) for its use for nausea and vomiting, with 27/29 trials showing statistically significant positive results. Stimulating Pericardium 6 (PC-6) in clinical trials produced a significant reduction of perioperative emetic sequelae. ST-36 has been found to have analgesic and spasmolytic effects on the GI tract; it also regulates gastric acidity and has a homeostatic effect in endocrine and metabolic disorders.9,10 Other studies have demonstrated that transcutaneous electrical stimulation (TENS) at LI-4 and SI-3/HT-7 significantly decreased lower esophageal sphincter pressure in humans with achalasia, by creating an increased plasma vasoactive intestinal peptide release. This inhibitory neuropeptide is associated with the relaxation of lower esophageal sphincters.9 Other alternative approaches used successfully in treating megaesophagus include Traditional Chinese Veterinary Medicine (TCVM), homeopathy and laser therapy.
TCVM AND ACUPUNCTURE In TCVM, megaesophagus is considered a Qi Deficiency, due to the inhibition of directional movement of a tubular organ. It can be also be associated with concurrent Blood or Yin Deficiency with subsequent dryness that fails to lubricate the ingesta. With acquired megaesophagus, an exogenous (i.e. distemper virus, trauma, toxins) or endogenous (i.e. hypothyroidism, hypoadrenocorticism, myasthenia gravis) pernicious influence leading to a localized Wei syndrome (weakness without pain) needs to be considered, and the pattern of imbalance addressed. The primary treatment principles are to tonify global and local Qi, assist directional Qi flow, increase body moisture/fluids, tonify Yin, and nourish and invigorate blood.8
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Various acupoint prescriptions for this condition have been presented depending on the TCVM pattern diagnosis as well as results from evidence-based studies. Acupuncture has demonstrated efficacy in the control of vomiting (Stomach Qi rebelling) associated with megaesophagus. In one study on five dogs with idiopathic megaesophagus, a 70% resolution of regurgitation along with increased weight gain was observed when using points PC-6, PC-9, HT-9, ST-36, LI-4, LI-11 and ST-40 with dry needles for ten minutes twice a week for four weeks.8,9,10 Other experts have provided acupoint prescriptions such as LI-4/11, ST-36/41, BL-13/23, PC-6 and HT-9 as beneficial for treating megaesophagus.11 Acupoint selection can also be based on treatment principles and TCVM patterns with Local Points (GB 20/21, TH-17/16, ST-9/10, LI-17/18, CV-22/23) along with Distal Points (LI-4/11, SI-3, LU-7, LIV3) and Qi Tonifying Points (BL-20/21, BL 23/26, Shen-shu, ST-36, SP-9). Electro-acupuncture is also used with success in this condition, with treatments combining CV-23+CV-22, LI-17+GB-21, BL-14 bilateral, BL-20 bilateral, BL-23 bilateral (20Hz/10 min + 80/120 Hz 10 min).12 Chinese herbal medicine as a component of traditional Chinese Veterinary Medicine is used to address the root of the megaesophagus disease syndrome, Qi deficiency, as well as other imbalances such as Yin and Blood Deficiency. Chinese herbal formulas such as Four Gentlemena (modified Si Jun Zi Tang) for Qi deficiency and/or Happy Earth (modified Wei Chang He) for rebellious Stomach Qi (regurgitation) in combination with acupuncture can be used successfully to treat megaesophagus. Pharmaceutical studies demonstrating improved gastric emptying and small intestinal motility by inhibiting the dopamine D receptor and 5-HT receptor as well as improvement in overall health in animal subjects has been demonstrated for Si Jun Zi Tang.13,14,15 Components of the herbal formula Happy Earth have demonstrated specific and significant effects on the gastrointestinal tract such as inhibition of the vomiting center in the brain and antispasmodic effects of the small intestine through modulation of the central nervous system.15, 16, 17
HOMEOPATHY Homeopathy is an individualized therapeutic approach based on the principles that the same illness creates a different set of clinical signs in different individuals.18 Selection of homeopathic remedies follows the medical principles first espoused by Hippocrates – “Like cures like”, known as the “Law of Similars”. Homeopathic medicine has no formal experimental studies on efficacy associated with treatment of megaesophagus. Clinical evidence shows good results using classical homeopathy to find the “similimum” – the
homeopathic medicine that matches the individual animal’s clinical signs associated with the disease condition as well as with general characteristics.
LASER Low-level laser therapy (LLLT) is a therapeutic modality of photobiostimulation that uses the emission of red and near infrared light wavelengths between 400 nm and 905 nm that are optimally absorbed by mitochondrial chromophores (cytochrome C oxidase). This sets up a cascade of events, including upregulated oxidative phosphorylation and increased ATP production, that modulates the activity of a number of cell types and biological mechanisms. In addition to wavelength and power (measured in watts or miliwatts), various frequencies (ranging from 4 Hz to over 10,000 Hz) are used depending on the tissue type and disease condition being treated. It is imperative to know the power (watts) and wavelength (nm) of the laser device being used in order to apply it appropriately to tissues and not cause harm. Some lasers (Class 4) generate thermal changes to tissues that can be tolerated in musculoskeletal issues, but are contraindicated over endocrine and gonads.
The laser system used in the case report on page 22 was a Class 2 visible light wavelength (635 nm, 405 nm) frequency specific low power (5 mW, 7.5 mW) laser. The end result is that laser therapy, when used appropriately, with an understanding of the specifications and applications, can provide a non-invasive, pain-free, drugfree and non-surgical treatment for a variety of conditions.
CONCLUSION Megaesophagus is a debilitating condition that carries a poor prognosis, whether present congenitally or as an acquired condition in adult dogs. Chronic regurgitation accompanied by aspiration pneumonia leaves an affected animal malnourished and in neverending cycles of severe respiratory distress. Several alternative therapies are beginning to attract attention for successfully treating this condition, either as a sole therapy or a part of a larger integrative medicine approach. As these therapies become more mainstream for the approach of megaesophagus treatment, there is cautious optimism that in some cases the condition could be successfully managed with a good quality of life for the affected animal.
View full case studies at ivcjournal.com/megaesophagus-case-studies.
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CASE STUDY #1
CASE STUDY #2
USING HOMEOPATHY FOR MEGAESOPHAGUS
USING LASER FOR MEGAESOPHAGUS
From Ed DeBeukelaer, MVRCS, author of Homeopathy: What to Expect, Including 101 Cured Cases (12edb3@gmail.com)
Two Dalmatian puppies were seen at three weeks of age for milk regurgitation, but were otherwise clinically normal. By five weeks of age, a full diagnostic workup was performed due to increasing dyspnea, yielding a diagnosis of megaesophagus with copious aspiration of milk into the lungs. Phosphorus 30c (tid drops) was started while the owner contemplated whether to continue clinical treatment or euthanize the puppies. The following day, there was a steady improvement in their breathing, accompanied by decreased regurgitation; therefore, treatment was continued. At eight months old, one of the puppies was euthanized due to continued clinical complications. The second puppy is now 2.5 years old, has steadily grown and is taller than her normal littermates. She still regurgitates small amounts of smelly mucus every day but is able to maintain normal nutritional status, with only minor intermittent loss of small amounts of ingesta. She has responded well to the homeopathic medicine Falcon Peregrine (made from Peregrine Falcon) for abdominal enlargement after eating. A year later Ara macau (made from Scarlet Macaw) was prescribed because of her character, mild regurgitation and mild otitis. The ear problem resolved, and she has since taken this remedy every few months in a 30c preparation when the regurgitation increases.
From Janet Gordon Palm, DVM, CVCP (animobilityvet.com) An 11-year-old male neutered Collie presented at New Hope Animal Hospital with evidence of aspiration pneumonia secondary to megaesophagus. The dog had a history of regurgitation and retching multiple times a day for months, and now presented with worsening pneumonia, which had been present for over one week. Radiographs were taken, and a broad-spectrum antibiotic therapy, which included Clavamox and Baytril, was initiated. One week later, the dog presented for recheck. He had not significantly improved and the owner had to go on an international trip. Due to the dog’s deteriorating condition, he was boarded at the veterinary clinic. While at the clinic, the megaesophagus was treated with laser therapy twice daily for two days. On the second day of treatment, the dog was brighter and eating without retching. A total of six treatments were performed over a one-week period. The pneumonia resolved quickly once laser therapy was started, and the dog was relatively cough- and regurgitation-free during the rest of the time he was boarded. The owner was unable to afford the remainder of the recommended 12 total treatments (twice a week for two weeks, followed by once a week for eight sessions). The dog was discharged, and was symptom-free for over five weeks. He then presented with a recurrence of occasional regurgitation, but no further aspiration. Laser treatment was reinstated and the dog was successfully managed with this therapy until euthanasia seven years later, due to unassociated age-related quality of life issues.
KuKanich K. Diagnosis and management of megaesophagus in dogs. In: CVC in Kansas City Proceedings, Aug 01, 2011, Kansas City, Missouri.
1
Schachtel, J. Swallowing protocol and early identification of LES achalasia. Abstract; Annual Conference of American College of Veterinary Radiation, Oct 19-22, 2016, Orlando, FL.
2
Barker I, Van Dreumel A. The alimentary system. In: Pathology of Domestic Animals 3rd Ed, Jubb K, Kennedy P and Palmer N (eds). Orlando, F; Academic Press 1985:26-27.
3
Merck- Aiello S, Mays A (eds). Anomalies of the Digestive System and Diseases of the Esophagus in Small Animals. In: The Merck Veterinary Manual 8th Ed, Whitehouse Station, NJ; Merck & Co Inc 1998:128, 276-278.
4
Mace S, Shelton G, Eddlestone S. Megaesophagus. Web accessed 15Jan2018. Compend Contin Educ Vet 2012 Feb;34(2):E1-E8.
5
Willard M. Recognizing and treating esophageal disorders in dogs and cats. Veterinary Medicine 2004, http://veterinarymedicine.dvm360.com/recognizing-and-treating-esophageal-disorders-dogs-and-cats; 15Jan2018 Web access.
6
Dodd J. Megaesophagus. Web accessed 15Jan2018; https://drjeandoddspethealthresource.Tumbir
7
Clemmons R. Megaesophagus and megacolon. Web access 15Jan2018; dog2doc.com/chi-files/TCVM_Herbs/ August_Chi/Megaesophagus_Megacolon.ppt
8
Schoen A. Veterinary medical acupuncture for gastrointestinal conditions. In: CVC in San Diego Proceedings, Nov 01, 2009, San Diego, CA.
9
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Dill S, Bierman N. Acupuncture for Gastrointestinal Disorders. In: Veterinary Acupuncture, Ancient Art to Modern Medicine, Schoen, A (ed). St Louis, MO; Mosby 2001:239-260
10
Looney A. Acupuncture and canine disc disease, points for treatment of megaesophagus. Atlantic Veterinary Conference 2001. https://www.vin.com/VINDBPub/SearchPB/Proceedings/PR05000/P00271_IMCO3306. htm; Web access 15Jan2018.
11
Xie H, Wedemeyer L, Chrisman C, et al. Practical Guide to Traditional Chinese Veterinary Medicine Small Animal Practice. Chi Institute Press, Reddick, FL, 2014.
12
Ye F et al. Pharmacological study of Si Jun Zi decoction of gastrointestinal tract. Shi Zhen Guo Yi Guo Yao. 2005, 16(1):61. (in Chinese)
13
Kimura Y et al. Effects of an Atractylodes lancea rhizome extract and a volatile component B-eudesmol on gastrointestinal motility in mice. J Ethnopharacol. 2012, 141(1): 530-536.
14
Ma A. Clinical Manual of Chinese Veterinary Herbal Medicine. Gainesville, FL.: Ancient Art Press 2016: 101-102, 208-210.
15
Zhao, YJ et al. Effect of rhizome pinelliae on vomiting in minks. Zhongguo Zhong Yao Za Zhi, 205, 30:227-229.
16
Watanabe K et al, Pharmacological properties of magnolol and honokiol extracted from magnolia officinalis:
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nutrition nook
PEER-REVIEWED
Probi tics – the missing nutrients
Part 2
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. In Part 1 of this series (IVC Journal, Spring 2018), we looked at the discovery of probiotics along with research documenting the importance of a balanced intestinal microbiome. We discovered how many modern medical practices can disturb the balance of gut bacteria in an unhealthy way, and the role probiotics play in mitigating dysbiosis and maintaining intestinal lining integrity. In Part 2, we will explore more detailed research on the health benefits of probiotics.
PROBIOTIC EFFECTS ON HEALTHY PETS Probiotic supplementation can have beneficial effects on healthy animals. In one study, dogs were given probiotics for seven days. Even though the administered strains disappeared within a week after discontinuation, there was a sustained change in the population of indigenous lactic acid–producing bacteria in jejunal contents, with native L. acidophilus strains predominating.1 In another study where dogs were supplemented with L. acidophilus, an associated increase in the numbers of fecal lactobacilli, along with a decrease in clostridial organisms, was observed. Furthermore, there were significant increases in RBCs, HCT, hemoglobin concentration, neutrophils, monocytes and serum IgG, and
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reductions in RBC fragility and serum NO.2 Supplementation of puppies with Lactobacillus caused an increase in appetite and food intake, which led to higher daily weight gain.3 When 15 healthy cats were supplemented with L. acidophilus, populations of fecal bifidobacteria, Clostridium spp and Enterococcus faecalis, decreased. Granulocyte phagocytic activity and eosinophil numbers increased, while erythrocyte fragility and plasma endotoxin concentrations decreased. Other researchers found that “Feeding studies with a Lactobacillus acidophilus probiotic have shown positive effects on carriage of Clostridium spp. in canines and on recovery from Campylobacter spp. infection in felines. Immune function was improved in both species.”5
PROBIOTICS AND GI DISEASE Studies show that chronic GI issues, such as inflammatory bowel disease (IBD), are associated with alterations in the microbiome. There are consistent decreases in Firmicutes and Bacteroidetes and increases in Proteobacteria species. These changes lead to susceptibilities in the innate immune system of dogs and cats with IBD.6 Other research confirms there
is a predictable pattern of dysbiosis in dogs with various GI diseases, and that the bacterial groups commonly decreased are those considered to be important short-chain fatty acid producers.7 This is important because short-chain fatty acids are needed to maintain the health of enterocytes.
PROBIOTICS AND THE IMMUNE SYSTEM The gut associated lymphoid tissue (GALT) makes up 70% to 80% of the body’s immune system. This means the GI tract is the largest organ of the immune system. Multiple studies show that probiotic supplementation can affect the systemic immune system in many ways. When puppies were given the probiotic E. faecium SF68 from weaning to one year of age, their serum IgA concentrations were higher, they had a greater proportion of mature B cells, and they had higher titers after distemper vaccination than control puppies.8 Also, several studies in humans show that probiotics can prevent and/or treat food and atopic allergies.9,10 A study in dogs found that when puppies were given a probiotic supplement before the age of six months, they had decreased allergen-specific IgE and reduced development of atopic dermatitis in the first six months. A three-year follow-up with an allergen challenge demonstrated a low IL-10 for all allergens in probiotics-exposed dogs.11 Other researchers concluded: “Many studies have found that gut microbes are involved in the immunopathogenesis of Diabetes Mellitus. Probiotics strengthen the host’s intestinal barrier and modulate the immune system….”12
THE MICROBIOTA-GUT-BRAIN AXIS An aspect of the microbiome that is often overlooked is its effect on the brain. One study found that the microbiomes of patients with major depressive disorder (MDD) differed significantly from those in healthy controls. When the microbiomes of MDD patients were transplanted into germ-free mice, the mice displayed depression-like behaviors. To the contrary, when germ-free mice were transplanted with microbiomes from healthy patients, there was no behavior change. “The gut microbiome is an increasingly recognized environmental factor that can shape the brain through the microbiota-gut-brain axis.…” concluded the researchers. “This study demonstrates that dysbiosis of the gut microbiome may have a causal role in the development of depressive-like behaviors, in a pathway that is mediated through the host’s metabolism.”13 No doubt, dysbiosis plays a role in canine and feline behavioral issues. One way the microbiome affects the brain is the fact that certain intestinal bacteria produce and deliver neuroactive substances such as serotonin and gamma-aminobutyric acid (GABA).
“Preclinical research in rodents suggested that certain probiotics have antidepressant and anxiolytic activities.”14 In addition, three double-blind, placebo-controlled trials studied the effect of probiotics on the stress responses in healthy medical students before exams. They found that probiotics may reduce stress reactivity in the paraventricular nucleus through vagal afferent signaling. Another study found that chronic administration of probiotic L. rhamnosus (JB-1) to mice caused a reduced level of anxiety and depression-like behavior. The probiotics induced changes in the GABAergic system in regions of the brain known to involve these behaviors. The researchers further found that a vagotomy prevented the effects of the probiotic, confirming the vagal signaling theory. 16
PROBIOTICS AND THE URINARY TRACT In a recent study, five lactobacillus strains (L. gasseri, L. rhamnosus, L. acidophilus, L. plantarum, L. paracasei,) were tested in vitro against four uropathogens common in infantile urinary tract infections. All the Lactobacillus strains showed moderate antimicrobial activities against the uropathogens.21 An intriguing case-controlled study involved the ingestion of fermented milk products in Japan. The researchers concluded: “It was strongly suggested that the habitual intake of lactic acid bacteria reduces the risk of bladder cancer.”22 Continued on page 26.
MICROBIOME AND OBESITY
The metabolic activity of the microbiome is especially demonstrated by its effect on fat accumulation in the body. One study utilized four sets of human twins, one of whom was obese and the other lean. When a fecal transplant of the “lean” bacteria was made into germ-free mice, the mice remained thin. However, a fecal transplant of the “obese” bacteria into germfree mice resulted in obese mice. Moreover, obese mice became thin when housed with thin mice apparently due to coprophagia.17 Another interesting study found that fecal transplants from conventionally raised mice into germ-free mice resulted in a 60% increase in body fat content and insulin resistance within 14 days despite reduced food intake. According to the researchers, “Our findings suggest that the gut microbiota is an important environmental factor that affects energy harvest from the diet and energy storage in the host.”18 IVC Summer 2018
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Continued from page 25.
PROBIOTICS & PANCREATITIS A randomized, double-blind, placebo controlled trial in human patients with acute pancreatitis found that “Supplementary L. plantarum 299 was effective in reducing pancreatic sepsis and the number of surgical interventions.”19 A similar study in dogs looked at experimentally-induced severe pancreatitis and compared ecoimmunonutrition, parenteral nutrition, and elemental enteral nutrition. (Ecoimmunonutrition refers to the feeding of L. plantarum-containing formula.) The probiotic treated dogs experienced lower levels of increase in serum amylase, ALT, AST, and plasma concentrations of endotoxin. They also had suppressed pancreatic and ileal histopathologic changes. Bacterial translocation was also decreased in the probiotic treated dogs.20
PROBIOTICS AND MUTAGEN DETOXIFICATION In an early study of fermented milk products, 11 healthy subjects were put on a standardized diet that included consuming fried beef patties twice daily. For the first three days (Phase 1), the subjects were given Lactococcus (non-probiotic) fermented milk. During Phase 2, the subjects drank L. acidophilus fermented milk. The total fecal and urinary mutagen excretion (a cancer-causing chemical that is, or has been, excreted in the urine) on Day 3 during Phase 2 was 47% lower compared to Day 3 of Phase 1, indicating the possible role of probiotics in preventing cancer.23
PROBIOTICS AS NUTRIENTS According to Stedman’s Medical Dictionary24 a nutrient is “a constituent of food necessary for normal physiologic function.” The term “essential nutrients” refers to “nutritional substances required for optimal health. These must be in the diet, because they are not formed metabolically within the body.” In my opinion, given
the research explored in this article, probiotics meet these definitions. I am not alone in my assertion. “The health and well-being of companion animals, just as their owners, depends on the gut microbes…. Specific probiotic strains and/or their defined combinations may be useful in canine and feline nutrition, therapy, and care.”25 Probiotics are essential nutrients for dogs and cats that are not contained in conventional diets, and must be supplemented regularly throughout life in order to maintain or regain health.
CONCLUSION We have seen that a well-balanced microbiome with numerous, diverse bacteria is important to an animal’s health. We have also explored the many commonly-used modern medications that can disrupt a pet’s GI bacterial equilibrium, leading to dysbiosis and leaky gut. And now we know how the use of probiotics can improve the health of well animals and effectively address a multitude of diseases. Probiotics truly are the missing nutrients in the diets of our dogs and cats.
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Manninen TJK, et al. “Alteration of the canine small-intestinal lactic acid bacterium microbiota by feeding of potential probiotics”. Appl Environ Microbiol. 2006;72(10):6539-6543.
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Evrensel A, Ceylan ME. “The Gut-Brain Axis: The Missing Link in Depression”. Clin Psychopharmacol Neurosci. 2015;13(3):239–244.
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Baillon M-LA, Marshall-Jones ZV, Butterwick RF.“Effects of probiotic Lactobacillus acidophilus strain DSM13241 in healthy adult dogs”. Am J Vet Res. 2004;65.3:338-343.
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Takada M, et al.“Probiotic Lactobacillus casei strain Shirota relieves stress-associated symptoms by modulating the gut–brain interaction in human and animal models”. Neurogastroenterol Motil. 2016 Jul;28(7):1027-36.
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Pasupathy K, Sahoo A, Pathak NN. “Effect of lactobacillus supplementation on growth and nutrient utilization in mongrel pups”. Archiv für Tierernaehrung. 2001;55(3):243-253.
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Bravo JA, et al. “Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve”. Proc Natl Acad Sci U S A. 2011;108(38):16050-16055.
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Marshall-Jones ZV, Baillon ML, Croft JM, et al. “Effects of Lactobacillus acidophilus DSM13241 as a probiotic in healthy adult cats”. Am J Vet Res. 2006;67:1005–1012.
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Ridaura F, et al. “Gut microbiota from twins discordant for obesity modulate metabolism in mice”. Science, 2013; 341(6150):1241214.
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Rastall RA. “Bacteria in the gut: friends and foes and how to alter the balance”. J. Nutr. 2004;134:2022S-2026S.
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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.
Bäckhed F, et al. “The gut microbiota as an environmental factor that regulates fat storage”. Proc Natl Acad of Sci U.S.A., 2004; 101(440;15718-15723.
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Olah A, Belagyi T, Issekutz A, et al. “Randomized clinical trial of specific lactobacillus and fibre supplement to early enteral nutrition in patients with acute pancreatitis”. Br J Surg. 2002; 89:1103-1107.
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Xu GF, Lu Z, Gao J, et al. “Effect of ecoimmunonutrition support on maintenance of integrity of intestinal mucosal barrier in severe acute pancreatitis in dogs”. Chin Med J. 2006; 119:656-661.
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Shim YU, Lee SJ, Lee JW. “Antimicrobial activities of Lactobacillus strains against uropathogens”. Pediatr Int, 2016; Feb 10. Doi: 10.1111/pet.12949.
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Ohashi Y, et al. “Habitual intake of lactic acid bacteria and risk reduction of bladder cancer”. Urologia internationalis, 2002; 68(4):273-280.
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Lidbeck A, et al. “Effect of lactobacillus acidophilus supplements on mutagen excretion in faeces and urine in humans”. Microbial Ecology in Health and Disease, 1992;5(1):59-68.
24
Stedman’s Medical Dictionary (27th ed). 2000, Baltimore, MD; Lippincott Williams & Wilkins.
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Grześkowiak L, Endo A, Beasley S, Salminen S. “Microbiota and probiotics in canine and feline welfare”. Anaerobe. 2015;34:14-23.
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Suchodolski JS, et al. “The fecal microbiome in dogs with acute diarrhea and idiopathic inflammatory bowel disease”. PLoS One. 2012;7(12):e51907. Benyacoub J, Czarnecki-Maulden GL, Cavadini C, et al. “Supplementation of food with Enterococcus faecium (SF68) stimulates immune functions in young dogs”. J Nutr 2003;133:1158–1162. Majamaa H, Isolauri E.“Probiotics: a novel approach in the management of food allergy”. J Allergy Clin Immunol. 1997;99(2):179-185.
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Kalliomäki M, et al. “Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebocontrolled trial”. Lancet. 2003;361(9372):1869-1871. Marsella R, Santoro D, Ahrens K. “Early exposure to probiotics in a canine model of atopic dermatitis has longterm clinical and immunological effects”. Vet Immunol Immunopathol. 2012;2:185–189.
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Wang F, Zhang C, Zeng Q. “Gut microbiota and immunopathogenesis of diabetes mellitus type 1 and 2”. Front Biosci (Landmark Ed). 2016;21:900-6.
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Zheng P, et al. “Gut microbiome remodeling induces depressive-like behaviors through a pathway mediated by the host’s metabolism”. Mol Psychiatry. 2016 Jun;21(6):786-96.
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industry innovations Hypoallergenic joint support
Adding acupuncture to your practice?
Food sensitivities often occur in dogs, and that can make choosing supplements challenging. Phycox® HA HypoAllergenic Joint Supplements are for dogs with food sensitivities or intolerances. They feature hydrolyzed vegetable protein derived from soybeans, and no beef, chicken or wheat. This product is also available in a Max formulation with the same hydrolyzed vegetable protein, along with six more ingredients and three times the phycocyanin for maximum joint health support. Contact Dechra Veterinary Technical Support at 866-933-2472.
Incorporating acupuncture into your daily practice may be exactly what you need for a more integrative approach. The International Veterinary Acupuncture Society (IVAS) has been offering Certification in Veterinary Acupuncture since 1974. Their internationally-recognized certification allows you to choose your focus – small animal, equine or both. The course offers hands-on learning at each on-site session, and is RACE-approved. Visit ivas.org for information on when new classes start.
dechra-us.com
Rebuilding the microbiome
Veterinary equipment exchange network
An unbalanced microbiome can contribute to chronic digestive issues in dogs and cats. AnimalBiome’s Gut Microbiome Restoration Systems are designed for pets with these problems. The oral supplements help rebuild the microbiome and support healthy gut function. The kits contain 50 oral capsules (to be given twice a day for 25 days) along with supplies for two microbiome assessments (one for before, and one for two weeks after completing the full course of capsules). Microbiome assessments are based on sequencing all bacteria in the sample, and include a comparison with healthy pets in the database.
If you’re looking to buy or sell veterinary equipment, a Canadian equipment exchange network has expanded into the US. Canmedical Canada and VEENCanada recently launched VEENAmerica. VEEN connects buyers and sellers of surplus veterinary equipment. It provides a forum for vet clinics across North America to link up with each other, and all transactions are brokered by VEENAmerica. It also arranges the logistics, so items can be shipped all over the US and Canada as well as international locations. Contact info@veenamerica.com or 613-358-5658.
animalbiome.com
veenamerica.com
Natural solution to cataracts Cataracts in dogs and cats can indicate surgery. But there is an alternative in the form of Cineraria maritima, which has been used homeopathically for over 100 years to safely and effectively treat this eye disorder. Cataract Crystalline Lens Drops with Cineraria from Natural Ophthalmics, Inc. trigger the body’s ability to clear the lens. They prompt the transfer of oxygen and nutrients from the blood to the aqueous, to nourish and detoxify the living tissue of the lens. The company offers additional eye products, including Tear Stimulation Drops, Allergy Desensitization Drops, and Ortho-K with Calendula for ocular injuries and corneal healing. Natural Ophthalmics’ products are sold only through medical professionals and veterinarians. For a Free Trial Pack, contact 877-220-9710, info@natoph.com. NaturalEyeDrops.com IVC Summer 2018
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EVALUATING THE EFFECTS OF ELECTRO-POLLUTION ON HUMAN AND ANIMAL HEALTH By Katie B. Kangas, DVM, CVA, CVCP
W
ithin the last two decades, wireless technology has exploded onto the global scene. This means most people and their companion animals are now living in a dense sea of electromagnetic energy waves, termed electromagnetic radiation (EMR). Current EMR levels are estimated to be 100 to 200 million times greater than they were a century ago. Numerous studies reveal that the homeostasis within all living bodies is dramatically affected by these increasing EMR levels, with negative consequences on health.
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DEFINING ELECTRIC AND MAGNETIC FIELDS Electric and magnetic fields (also called radiation) are invisible areas of energy produced by electricity; i.e. the movement of electrons, or current, through a wire. An electric field is produced by voltage, and as voltage increases, the strength of the electric field increases. A magnetic field results from the flow of current through wires or electrical devices, and this energy field increases in strength as the current increases.
Electric fields are produced whether or not a device is on, but magnetic fields are produced only when current is flowing, which usually requires a device to be turned on. However, power lines produce magnetic fields continuously because current is always flowing through them. Electric fields are easily blocked or weakened by walls and other objects, but magnetic fields can pass through buildings, living things, and most other materials. It is important to note that the strength of a magnetic field decreases rapidly as the distance from its source increases. There are two main categories of electromagnetic fields (EMFs): 1 Higher-frequency EMFs include x-rays and gamma rays. These EMFs are in the ionizing radiation part of the electromagnetic spectrum. 2 Low- to mid-frequency EMFs include magnetic fields from electric power lines and appliances, radio waves, microwaves, infrared radiation and visible light. These EMFs are in the non-ionizing radiation part of the electromagnetic spectrum.
COMMON SOURCES OF NON-IONIZING EMFS Sources of non-ionizing EMFs can be either natural or manmade. The earth’s magnetic field is an example of a naturally-occurring EMF. Human-made EMFs fall into both the ELF (extremely low frequency EMFs) and radio frequency categories of the nonionizing electromagnetic spectrum, and can come from a number of sources – power lines, electrical wiring, and appliances such as shavers, hair dryers and electric blankets.
Energy within cells
All cells communicate with each other via subtle electromagnetic signals and biochemical reactions. In fact, most biochemical mechanisms, from digestion to brain activities, are powered by the rearrangement of charged particles. Signal pathways carry energetic information that is translated into physiologic processes in the body. Problems arise with continuous exposure to manmade (unnatural) EMR, which distorts and disrupts normal cellular communications, resulting in abnormal cellular metabolism, and ultimately disease. Electromagnetic energy within cells can be described by the term “biofield”. Western science has developed several tools that can demonstrate and even measure the bioenergetic emanation of living cells, tissues and bodies. Science has proven that upon death of cells (or the body), the DNA content remains and can continue to be extracted and evaluated later. In contrast, the energy emanating from the cells is immediately gone once the body or tissue dies, and can no longer be demonstrated or measured. Other cultures in the world use different terms to describe the phenomena of living energy: Qi in China, and Prana in India.
Common sources of radio frequency radiation are wireless telecommunication devices such as cell phones, tablets and laptop computers; they also include Wi-Fi, cell phone towers, radio and TV signals, satellite stations, MRI devices, microwave ovens, and digital electric and gas meters (“smart meters”).
EFFECTS OF ELECTRO-POLLUTION Ionizing EMFs are known to cause direct damage to cells and DNA. Although non-ionizing low frequency EMFs have not yet been “definitely proven” to directly damage DNA or cells, an increasing and overwhelming amount of data suggests they do. Although the wireless industry and the US government claim controversy despite mounting data and research, current evidence is prompting many countries outside the US to issue public health risks regarding mobile devices, and to decrease the number of cell phone towers. They are especially curbing the advertising of wireless devices to adolescents and children, and are outlawing mobile devices and Wi-Fi in classrooms for young children. As an IVC Summer 2018
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important reminder, magnetic field levels are highest near the radiation source, and decrease rapidly the farther away you get from the source. It has been shown that magnetic fields are significantly decreased at a distance of about 12” from most appliances. For computer screens, a distance of 12” to 20” offers a dramatically lowered magnetic field. The World Health Organization International Agency for Research on Cancer classified radio frequency radiation as a possible carcinogen in 2011, and as a probable carcinogen in 2013. Many experts report that electro-pollution-induced biological stress profoundly compromises normal physiology and intercellular communication, leading to the breakdown of healthy cellular processes. Specifically, cell function deteriorates, cell membranes harden, free radical damage occurs, nutrients cannot enter the cell, and toxins cannot be excreted. Numerous studies have shown the harmful effects of EMR on the immune system, enzyme syntheses and nervous system,1,2 as well as on learning, moods and behavioral patterns. All aspects of physiology at molecular, cellular and biochemical levels can potentially be damaged by EMR exposure.
EXPANDING KNOWLEDGE REGARDING EMR TOXICITY In the early days of radiation technology, it was believed the only risk associated with EMR came from a thermal effect (i.e. the heating of tissues, as in a microwave oven). Since cell phones do not produce enough power to heat tissue, the US government did not require any studies to investigate potential health problems caused by these devices. However, emerging science has found that the problem with cell phones does not come from their power output (thermal effect) but rather from the information in the carrier waves. These informationcarrying radio waves (ICRW) use frequency to convey specific packets of information that allow for the transmission of voice, text, graphics, etc.3 This is what creates the problem. ICRW is a frequency that has never before existed in nature. The cells of an animal or human body are totally unfamiliar with it and perceive it as a dangerous foreign invader.
The latest research has clearly identified the biological mechanisms of harm caused by ICRWs. Cells have special receptor sites that sense frequencies and perform signal transduction, converting extracellular signals into intracellular signals. Because cell receptors interpret ICRWs as an unknown “threatening” energy, the cell membrane quickly goes into protective lockdown mode. This means nutrients cannot get into the cell, and toxins and waste products cannot get out. This induced protective mode also prevents vital cell-to-cell communication.4 The effects are immediate and last as long as the cells are exposed to ICRWs. The longer the exposure persists, the greater the biological damage, leading to a loss of cellular energy as well as free radical damage, genetic mutation, premature aging and degenerative disease. In fact, specific studies have identified that information-carrying radio waves trigger protein membrane responses at the cell membrane level, leading to disruption of intercellular communication and the build-up of free radicals inside the cell.5 • Endocrine function appears particularly harmed by the effects of EMR. And we have seen a marked increase in endocrine diseases in pets over the last 20 years. • Electromagnetic radiation is a known to act as a hormone disrupter and specific studies have shown that EMR has a direct effect on melatonin production. In 2001, a Japanese study showed that breast cancer cells treated with melatonin resumed growing when exposed to power-frequency EMR.6 The results demonstrated that magnetic fields disrupt the cells’ signaling system, which explains why reduced melatonin levels from EMR exposure have been shown to cause a number of cancers including breast, prostate and colorectal as well as melanoma, ovarian malignancies and childhood leukemia. • Although melatonin is well known for its association with regulating the circadian rhythms governing the sleep/ wake cycle, this hormone also happens to be one of the most efficient destroyers of free radicals. Through various mechanisms, melatonin supports the immune system and counteracts stress-induced immune suppression. Melatonin not only inhibits the release of estrogen and suppresses the development of breast cancer, it has the ability to increase the cytotoxicity of the immune system’s killer lymphocytes and enhances the ability of vitamin D to inhibit tumor growth. • Neurotransmitters such as serotonin and dopamine play a major role in moods, and decreased serotonin levels
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Addressing solutions to the electro-pollution problem
Leading authorities in the fields of hormone health and EMR safety are recommending three levels of intervention in order to adequately protect against electro-pollution. 1. Primary intervention involves reducing exposure as much as possible. This can be done by tactics such as avoiding constant proximity to EMFs, using headsets for mobile phones, keeping phones in airplane mode as often as possible, etc. 2. Secondary intervention focuses on minimizing the effects of radiation. Specific options include subtle energy technologies, diodes and pendants. These tools are designed to “harmonize” the stressful EMFs. Many of these devices are created by reputable energy design companies. They can be used in offices and homes, attached to mobile phones and other personal devices, and/or placed on animal collars or worn as pendants. 3. The third level of intervention is directed at strengthening the body’s metabolic systems to support correction of cell damage. This is done through a healthy diet and lifestyle. As always, the value of a nutrient-rich diet containing foods and/or supplements that either deliver or promote antioxidant activity are beneficial. Some of the most effective antioxidants include melatonin, N-acetylcysteine, SAMe, lipoic acid, green tea, CoQ10, selenium, and vitamins A,C and E. Interestingly, gingko biloba is the first herbal supplement to be tested against cell phone radiation. Pre-treatment with this brain-protective herb reversed cell phone-induced oxidative stress and depletion of antioxidant enzymes in rodents.8 Resveratrol and grape seed extract are also reported to protect against the oxidative stress induced by cellphones.
are associated with depression. One study that examined the brain function of monkeys exposed to magnetic fields found that serotonin and dopamine levels were significantly depressed immediately following exposure, and only dopamine returned to normal levels several months later. 7 • Numerous studies have found that EMR affects both sperm health and prenatal fetal health. One study involving prenatal mice exposed to cell phones showed that the offspring had higher levels of hyperactivity, decreased memory and less fear. These results point to concerning risks for pregnant women and animals exposed to EMR, as well as for young children and animals. Many studies are also reporting the effects of EMR on wildlife, and their impact on entire ecosystems. A well-known study reported on CNN in 2010 found EMR exposure to be associated with a dramatic decline in honey bee populations. Another study found that within ten days of mobile phones being placed inside hives, worker bees stopped returning. Researchers in northern India performed an additional study in which cell phones were fitted to bee hives and powered up for two 15-minute periods each day. After three months, the bees stopped producing honey, the queen’s egg production fell by half, and the population of the hive dramatically decreased. As early as 2007, the U.S. Fish & Wildlife Service was reporting on concerns about the potential radiation impacts of cellular communication towers on migratory birds and other wildlife. Companion animals are also facing exponentially increasing exposure rates to EMR toxicity, since they (via their human counterparts) are surrounded with multiple devices much of the time. This scenario includes horses too, as many riders and owners are carrying personal devices, even
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Advertorial
attaching them to saddles or leg holsters as they ride. Animals and people who live in (or near) denselypopulated cities are exposed to dramatically higher EMR, since there are many more towers and electric systems in these regions as compared to rural areas.
VetzLife All-Natural News Bt Christopher Kelly Groth
Stomatitis in cats – an alternative to full mouth extraction
As an additional note, veterinary practices using lasers should consider locating the control unit and power source away from people and animals. In conclusion, electro-pollution is a very real threat to both present and future generations of animals and people. Companion animals and pets can be expected to have very high exposure rates due to often constant proximity to their human caretakers’ multiple EMRemitting devices. As animal health advocates and leaders in the integrative veterinary health field, we should be seeking effective interventions to protect animals (see sidebar on page 32), while educating pet owners about this topic of growing concern.
Saunders RD, Kowalczuk CI, Sienkiewicz ZJ. (1991) “Biological Effects of Exposure to Non-ionizing Electromagnetic Fields and Radiation III. Radiofrequency and Microwave Radiation”, NRPB Report R 240, National Radiological Protection Board, Chilton.
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2|ortho.lsuhsc.edu/Faculty/Marino/EL/EL5/Summary5.html. 3Carlo, George. Cell Phones: Invisible Hazards in the Wireless Age. An Insider’s Alarming Discoveries About Cancer and Genetic Damage. 4Bioenergetics Institute, Energy Resonance Technology (ERT): A Targeted Intervention For ElectroMagnetic Radiation (EMR) Induced Biological Effect. 5omega.today.net/20070223. 6Masami Ishido, Hiroshi Nitta and Michinori Kabuto. “Magnetic fields (MF) of 50 Hz at 1.2 T as well as 100 T cause uncoupling of inhibitory pathways of adenylyl cyclase mediated by melatonin 1a receptor in MF-sensitive MCF-7 cells”. Carcinogenesis, Vol. 22, No. 7, 1043-1048, July 2001.
Stomatitis in felines is quickly becoming pandemic in clinics all across the country. You’ve probably had this experience yourself: a young cat comes in with fire engine-red gums and you have to get three staff members to help hold the traumatized feline just so you can diagnose the poor thing. Now you get to tell your client the bad news: the only procedure to stave off further infection is a full mouth extraction, followed by antibiotics and steroids. But is this really the only option? The answer is no. VetzLife offers a healthy, natural alternative that will help save your feline patients’ teeth and prevent the need for extraction. Even if a patient has already had a full extraction procedure, the company’s Feline Stomatitis Oral Care Gel will help solidify the gum tissue and prevent the spread of infection, even into the bloodstream. It works by providing powerful anti-allergen properties, along with anti-inflammatory properties to stop the allergic reaction and bring down inflammation. This allows the product’s antibacterial ingredients to heal gum tissue, and assists the cat’s own immune system to help reverse periodontal gum flare-ups. The daily oral application of VetzLife Feline Stomatitis Oral Care Gel will help reduce pain and save teeth. So when clients ask, “Is there anything else we can do to stop stomatitis?” you now have an answer! Find out more at vetzlife.com or call 888-453-4682 for a free sample. Christopher Kelly Groth is the Senior Sales Executive for PetzLife Products.
7”Serotonin, Suicidal Behaviour, and Impulsivity”, The Lancet p. 949-950, 24 Oct. 1987. 8Ilhan A(1), Gurel A, Armutcu F, Kamisli S, Iraz M, Akyol O, Ozen S. “Ginkgo biloba prevents mobile phone-induced oxidative stress in rat brain”. Clin Chim Acta. 2004 Feb;340(1-2):153-6.
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OMEGA
FATTY ACIDS FOR DOGS AND CATS By Jean Hofve, DVM
A comprehensive look at Omega fatty acid sources for canine and feline patients, and the pros and cons of each.
O
mega fatty acids are vital for health in our animal patients. The most-studied Omega3s are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Both EPA and DHA have strong antioxidant and antiinflammatory properties; cell membranes also need DHA to stay sufficiently fluid for optimal function. This article looks at the main sources of Omega-3s on the market, from the bottom of the food chain, and the pros and cons of each when it comes to dogs and cats.
ALGAL OIL Oil made from certain species of algae has a high DHA content. But natural algae contain little to no EPA. To achieve a better EPA content, certain species have been genetically selected for this ability. But the ratio of DHA to EPA is still upside down compared to most Omega-3 supplements; there is more DHA than the stronger anti-inflammatory EPA. While algal oil is a valid choice for vegan humans, dogs and cats are best served by getting their Omega-3s from an animal source.
PHYTOPLANKTON A relative newcomer to the Omega scene, phytoplankton forms the basis of the marine food ecosystem. A whole food supplement, it offers a beneficial array of vitamins, minerals, amino acids and fatty acids, including EPA. Freshwater
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phytoplankton does not produce EPA. A proprietary combination of freshwater and marine phytoplankton does, but in only miniscule amounts. Neither is a sufficient source of Omega-3s.
FLAXSEED/NUT/VEGETABLE OILS Plant oils contain several fat types. Coconut and palm oil are high in saturated fat. Most other common cooking oils, like corn, sunflower and safflower oils, are more unsaturated. They contain mostly Omega-6. Flaxseeds and a few other seeds and nuts also contain the Omega-3 ALA, which has beneficial effects of its own, particularly on skin and coat health.
COCONUT OIL Many people are confused about this product, but there are no Omega fats in coconut oil. It is almost entirely saturated fat, with very small amounts of oleic and linoleic acids.
KRILL OIL Krill oil is a popular non-fish Omega-3 alternative that is heavily promoted by some of its sellers. Krill are tiny, pinkish shrimp-like crustaceans that are said to comprise the largest biomass on earth. They are a keystone species, and a major food source for multiple species of fish, whales, seals, squid and birds. Krill are harvested for many purposes, but increasingly for Omega-3 oil supplements.
However, even though there are lots of krill in the ocean, warming temperatures and decreasing sea ice pose a dire threat to them. Krill feed on phytoplankton under the sea ice, so less ice means fewer krill. Moreover, krill are often harvested in and around critical feeding grounds for the animals that eat them. These factors are already causing krill depletion in local areas, threatening dozens of species of fish, seabirds and mammals, including whales. Populations of Chinstrap and Adélie penguins in Antarctica have been declining since the 1980s due to the decimated krill population, and that trend is accelerating.
OMEGA-3s – PLANT OR ANIMAL? Perhaps the most common point of confusion about Omega-3s is the difference between plant and animal sources. Many plants are a good source of LA; some, like flaxseed, hemp, walnuts, canola and soybeans also contain ALA. Hemp also contains gamma-linoleic acid (GLA), an anti-inflammatory Omega-6.
GREENLIP MUSSEL OIL New Zealand greenlip mussels (Perna canaliculus, GLM) are grown in the Marlborough Sound under a Sustainable Farming Program. This ensures the long-term viability of the greenlip mussel industry, with minimum impact on the environment. GLM are bivalve mollusks that provide a rich source of 33 fatty acids, including all 18 known forms of Omega-3s (including EPA, DHA and ALA). Among the GLM’s unique array of Omegas is ETA (eicosatetraenoic acid). ETA – which is not found anywhere else to any measurable degree – has extremely powerful anti-inflammatory properties. GLM oil has less saturated fat and more mono- and polyunsaturated fat, than fish or cod liver oils. When cold-pressed and packaged at the source, GLM oil appears to be more bioavailable than fish oil, so a smaller amount can be used to get the same benefits.
It’s important to know that adult dogs and cats can’t readily convert ALA into EPA and DHA. Very young puppies can manufacture DHA, but they lose that ability at weaning. At best, dogs can convert only 1% to 2% of ALA to EPA, and they convert virtually no ALA to DHA. Cats are even more limited.
MOXXOR (moxdirect.com) is a good source of greenlip mussels.
CALAMARI OIL This is another new kid on the block. Calamari is a marine animal, and a close relative of the clever octopus. They are abundant, and their population is growing. Like algae, calamari are much higher in DHA than EPA. As the more powerful antiinflammatory, EPA is probably more suited to most dogs than DHA, which is important primarily during fetal development, and again later as the aging brain starts to decline. Squid live in a variety of water temperatures and conditions. Cold water dwellers have much more Omega fatty acids than those in warmer waters, where the temperature allows for more fluid membranes. Therefore squid from northern and extreme southern waters are likely more beneficial. There is always the potential for over-harvesting, but at this time the population is robust.
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REQUIREMENTS FOR DOGS AND CATS Adult dogs and cats require linoleic acid (LA, an Omega-6), and alpha linolenic acid (ALA, an Omega-3) in their diets. Cats also need arachidonic acid, an Omega-6. Both EPA and DHA are considered essential for young puppies and kittens. It’s not that adult dogs and cats don’t also need EPA and DHA for good health. It’s just that the National Research Council, upon whose work the AAFCO pet food nutritional standards are based, couldn’t agree on a necessary minimum level, so they just left them out of the recommendations. Still, we know that providing these nutrients provides many health benefits, so it’s wise to supplement them to animal patients.
FISH-BASED OILS Fish body oil and cod liver oil are the most common sources of EPA and DHA. Small fish get it from eating algae, plankton and aquatic plants; predatory fish eat small fish and accumulate it. The advantage of fish oil is that species at the top of the food chain have a higher concentration, so it takes less fish oil to get the same quantity of Omega-3. Most salmon oil (especially from Canada and the Atlantic Ocean, Scotland and Norway) comes from farm-raised salmon. These factory-farmed fish are grown in polluted, overcrowded pens; they are heavily vaccinated, are fed dyes, antifungals, parasiticides and antibiotics, and contain up to ten times more mercury, dioxins, PCBs and other toxins than wild fish. Farmed salmon also pose a serious threat to wild species in both Atlantic and Pacific oceans due to the interbreeding of escaped fish, parasites and infectious diseases. Farmed salmon are extremely fatty due to their diet and lack of free movement. Oil from farmed fish contains about the same amount of Omega-3s as wild fish – but far more Omega-6s,
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thanks to the unnatural corn, soy and trash fish they are fed. Even salmon labeled “Alaska”, “wild” or “wild-caught” may not be truly wild. About a third of both Pacific and Atlantic salmon are bred and raised in hatcheries. Their release into the ocean is threatening both wild salmon and other fish. Cod liver oil is a good choice when properly produced. But cod liver oil for humans is commonly supplemented with vitamins A and D at levels that could easily become toxic in cats and dogs. Moreover, a loophole in the law allows non-cod species to be labeled as cod. Inexpensive mass-produced fish oils usually contain filler oils (such as sunflower, safflower, canola and olive oil), which add undesirable Omega-6s. They may also be processed with harsh chemicals because of cost considerations. It may make sense to stay away from top-level predatory fish to avoid the pollutants that accumulate in their fat. Menhaden is the source of most “fish oil” not identified by species. Unfortunately, it is also a threatened keystone species. Sardine, herring and anchovy oils are more sustainable and cleaner than most other fish oils. While a product made specifically for pets may not have the additives found in human products, many are quite low in potency, and may not be sufficient for your patients’ needs. Processing is the final wild card in the game. Make sure the fish oil products you choose are safely extracted without high heat or solvents, and are tested by an independent laboratory for PCBs, mercury and other pollutants. One company I recommend for quality fish oil is Nordic Naturals (nordicnaturals.com/petVet/nnpet_collection.php). When recommending Omega-3 oils for canine and feline patients, it’s important to be aware of your sources, and to do some research to ensure you’re suggesting the healthiest possible choices.
References Boelen P, van Dijk R, Sinninghe Damsté JS, et al. “On the potential application of polar and temperate marine microalgae for EPA and DHA production”. AMB Express. 2013, 3:26. Hinke JT, Cossio AM, Goebel, et al. “Identifying Risk: Concurrent Overlap of the Antarctic Krill Fishery with KrillDependent Predators in the Scotia Sea”. PLoS One. 2017; 12(1): e0170132. Pawlosky R, Barnes A, Salem Jr N. “Essential fatty acid metabolism in the feline: relationship between liver and brain production of long-chain polyunsaturated fatty acids”. J Lipid Res. 1994; 35:2032-2040. Rule DC, Broughton KS, Shellito SM, Maiorano G. “Comparison of muscle fatty acid profiles and cholesterol concentrations of bison, beef cattle, elk, and chicken”. J Anim Sci. 2002 May;80(5):1202-11.
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AN APPROACH TO CHRONIC KIDNEY DISEASE By Barbara Fougere, BSc, BVMS(Hons), BHSc(Comp Med), MHSc(Herb Med), Grad Dip Vet Acup, Grad Dip VWHM, Grad Dip VCHM, CVA, CVBM, CVCP, GD Bus Mgt, Morg D&T, CMAVA, MNHAA
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hronic kidney disease (CKD) is a common problem in cats, and one which all veterinarians encounter in practice. An integrative approach that includes herbs and acupuncture can help treat and even reverse this condition in feline patients. CKD can be detected early through careful monitoring at annual wellness programs. IRIS (International Renal Interest Society) staging allows for the conventional staging of treatment, including any dietary changes. Key treatment strategies for feline CKD include supporting hydration, reducing phosphorus (usually through protein restriction), regulating blood pressure and controlling calcium levels. The intensity of intervention increases with disease progression.
INTEGRATIVE TREATMENT GOALS Using integrative approaches to CKD, we have observed cats moving from IRIS Stages 2 and 3 to Stage 1, and remaining there for years. This reversal implies that nephrons are hypoxic and under-functioning, and that improving their functional capacity is a key goal. See sidebar on page 39 for integrative treatment goals for CKD. Herbs can optimise kidney cell function by reducing oxidative stress, improving renal blood flow and mitigating fibrosis,
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thereby maintaining patients in early stages for extended periods. Acupuncture, manipulative therapies and other modalities can also be a part of the integrative approach. With acute renal disease, the goals are modified to regulate/ decongest the kidneys by reducing blood flow, and provide anti-inflammatory support to inflamed glomeruli. This may be a starting point with pyelonephritis, for example. Most cats, however, benefit from increased perfusion unless the renal disease is acute in onset (inflammatory).
DIETARY CONSIDERATIONS Despite numerous experimental studies and clinical trials, questions about feeding protein to cats with chronic kidney disease (CKD) remain. What is the optimal amount of protein for a cat with CKD? How much restriction is necessary? Do different types of kidney disease require different dietary therapies? At what point in disease progression should protein restriction be implemented? Does the type of protein make a difference? Does every meal have to be restricted? Will a cat in IRIS Stage 3 or 4 benefit if phosphorus is restricted by other means? Might some cats with advanced disease benefit from increased protein levels?1 These concerns remain despite the common practice of prescribing therapeutic renal diets to cats in any stage of CKD.
Integrative practitioners provide, or are requested to provide, natural feeding advice to cat owners. Excellent resources include the veterinary Diplomats in Nutrition; Balance It and several software programs that can be used for formulating diets while taking feline preferences into account. See page 40 for an example of a low-phosphorus diet for cats with CKD.
Fresh Rehmannia is utilised in Ba Wei Di Huang Wan and Zhi Bai Di Huang Wan. Interestingly, a recent study supports the use of fresh over prepared Rehmannia; the former acts more powerfully on attenuating interstitial fibrosis by downregulating the expressions of transforming growth factor, a smooth muscle actin, and Type 1 collagen.7
From an integrative perspective, real food is considered to have many benefits, including palatability for ill cats, and these benefits may outweigh those offered by processed foods. In IRIS Stage 1 and early Stage 2, the diet may not need to be modified, although serum phosphorus and the phosphorus content of the diet should be evaluated. From late Stage 2 onwards, consideration may be given to reducing protein by diluting with fat and carbohydrates.
2. A stragalus membranaceus is known as a Qi tonic in Chinese medicine, and as a major immune-modulating herb in Western herbal medicine. It should also be known as a major kidney herb. Its major constituent, astragaloside, ameliorates renal interstitial fibrosis in vivo by inhibiting inflammation.8 It has major antioxidant effects.9 Astragalus has been reviewed by Cochrane and was found to offer some promising effects in reducing proteinuria and increasing haemoglobin.10 Its nephroprotective effects against oxidative stress include anti-inflammatory and
HERBAL HELP Herbs can delay the onset and progression of CKD in cats by improving mitochondrial function, and providing antioxidant protection and ACE-inhibiting effects. Many herbs are antiinflammatory, anti-fibrotic and nephroprotective, and several improve renal blood flow. A principle of herbal medicine is that formulations containing multiple plants can have greater effects than the same herbs taken separately. These synergistic effects enhance the desired action.2
Integrative treatment goals for feline CKD •M itigate oxidative stress by using antioxidant herbs • Improve renal perfusion (in most cases) • Prevent fibrosis, which is a natural consequence of renal disease • Optimise systemic health and well-being
Following are several herbs to be considered and included in formulas for renal treatments. 1. Rehmannia glutinosa occurs in many Chinese herbal formulas, including Rehmannia Eight Combination (Shen Qi Wan, Jin Gui Shen Qi Wan, Ba Wei Di Huang Wan), which is very useful for cats with CKD and weight loss, loss of strength, polyuria, polydipsia, and that are seeking warmth. It is also included in Zhi Bai Di Huang Wan, which is useful in cats with CKD and hyperthyroidism, particularly in those tending towards constipation, agitation and weight loss, along with polydipsia and polyuria. Rehmannia has a long history of research and effective use in CKD. In humans, studies have found that it has a 91% efficacy in reducing renal damage from nephritis, due to the enhancement of renal blood flow and glomerular filtration.3 In a model of renal ischemia, ligated rats that received Rehmannia extract showed improved renal blood flow (to near normal levels) and reduced mortality and hypertension compared to controls, through either ACE inhibition or juxtaglomerular desensitization.4 Rehmannia reduces oxidative stress and can promote red blood cell production through bone marrow stimulation; reduce serum creatinine and urinary protein excretion and glomerulosclerosis in compromised patients; and inhibit the expression of Angiotensin II as well as Type IV collagen in the renal cortex.5, 6 IVC Summer 2018
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Example of a lowphosphorus diet for cats with CKD 50 grams or 1/4 cup pearl barley 200 grams raw chicken breast meat 10 grams chicken liver 1 large egg yolk 2 cups raw sweet potato 4 teaspoons salmon oil plus 4 teaspoons flaxseed oil. Cook barley, sweet potato, chicken and liver are on low heat with water. When warm, mix in egg yolk to lightly cook it (and preserve the choline). When cool, the recipe is divided into four meals (average 250 kcals) with the addition of 1 teaspoon of salmon oil and 1 teaspoon of flaxseed oil daily. The meals are divided. The whole recipe provides 1,029 kcal, 36% carb, 40% fat, 24% protein and 724 mg of phosphorus. It needs to be supplemented as it is low in a number of minerals and vitamins, and is still low in choline. Any supplement added should be evaluated for its phosphorus content. This should demonstrate the complexity of balancing diets. Another excellent strategy is to have several recipes and vary the composition of diets over time. More protein can be utilised alongside phosphorus binders in later stages of kidney disease.
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anti-apoptotic mechanisms.11 In a systematic review of Astragalus on diabetic nephropathy in animal models, this herb was able to reduce blood glucose and albuminuria levels and reverse the glomerular hyperfiltration state, thus ameliorating pathologic changes.12 3. Angelica sinensis contains polysaccharides that inhibit oxidative stress injury in mouse kidneys.13 Like Astragalus, its nephroprotective effects include anti-inflammatory and anti-apoptotic mechanisms.11 Renal microvascular lesions can contribute to the progression of glomerular sclerosis and tubulo-interstitial fibrosis in chronic kidney diseases. Both Astragalus and Angelica can improve microvascular lesions by increasing local renal blood flow to lessen hypoxic renal injury, promoting the recovery of renal blood flow and glomerular filtration rate after ischemia-reperfusion; modulating the imbalance of vaso-activators such as nitric oxide and angiotensin; increasing the expression of vascular epithelial growth factor; inhibiting the release of the intracellular calcium ion; and promoting DNA synthesis in endothelial cells to improve the function of endothelial cells. The evidence suggests that both herbs may retard the progress of renal diseases through the above-mentioned mechanisms.14 In one study involving rats with an obstructive uropathy, Astragalus and Angelica were administered with Enalapril and compared to monotherapy. Enalapril with Astragalus and Angelica decreased tubulointerstitial fibrosis to a significantly greater extent than did treatment with Enalapril alone.15 4. Cinnamon is readily accepted by cats and offers a mono-herbal treatment for fussy felines. It occurs in the Wei Ling Tang formula, which is useful for overweight CKD cats with proteinuria, hematuria, urolithiasis, azotemia, glomerulonephritis and pyelonephritis. Cinnamon can inhibit advanced glycation end products (AGE) and can ameliorate AGE-mediated pathogenesis in diabetic nephropathy.16 Cinnamon is a major antioxidant and anti-inflammatory spice, and has had over 178 papers published on it from 1995 to 2015.17 Cinnamon at a dose of 50 mg/kg for two weeks was given to dogs; the systolic blood pressure and heart rate in the treated dogs was significantly lower than in the normal group.18 5. Silybum marianum is one of our preeminent nephron-protective herbs. It should be considered an adjunct to ameliorative potential effects against drug-induced kidney disease, particularly in chemotherapy.19 It is also an herb that could be considered for CKD support. It is a potent antioxidant and free radical scavenger that inhibits lipid peroxidation and stabilizes cell membranes. It also increases intracellular glutathione, which plays a crucial role in the body’s antioxidant capacity, and it has anti-inflammatory properties inhibiting T-cell proliferation and cytokine secretion.20 There is also evidence that Silybum has a regenerative effect on renal tissue after injury.21
MUSHROOMS – GANODERMA AND CORDYCEPS Mushrooms are well tolerated by cats when given in the form of powders or concentrated tinctures added to food. Ganoderma lucidum is a medicinal mushroom that has been widely used in China and Japan for hundreds of years for its immune-modulating, anti-inflammatory and anti-tumor effects. Ganoderma compounds are renoprotective.22. The active peptide in Ganoderma counteracts oxidative stress from renal ischemia, and in an animal model of diabetic nephropathies has renal protective effects.23 Likewise, Cordyceps sinensis is extensively used by Chinese physicians to treat chronic renal diseases and to stimulate the immune system. It also displays anti-oxidative activities. It is commonly used in renal transplant patients; it has been shown to significantly improve renal fibrosis.24
ACUPUNCTURE AND MOXIBUSTION A recent single blinded randomized controlled study in patients with CKD showed that acupuncture at bilateral LI4, ST36 and KI3, and electroacupuncture to right ST36 and KI3 and left ST36 and KI3, once a week for 12 weeks, led to reduced creatinine levels and increased glomerular filtration rates.25 Moxibustion at Bl 23 in patients with CKD reduced renal vascular resistance.26
Most of the benefits that acupuncture offers in renal failure are undoubtedly due to the ability of these points to manipulate blood flow. Local blood flow is manipulated using BL23, BL22 and GB25, while systemic blood flow is manipulated with GB34, BL40 and KI3. Systemic blood flow greatly impacts renal function. Peripheral vasoconstriction can be induced to drive more blood to the kidneys. Peripheral vaso-relaxation can be induced to decongest the kidneys. For animals in Stage II renal failure (using the IRIS classification system), and particularly where UPC ratios are greater than 2.5, use GB25, BL22 and GB34. These animals will typically have benefited from hypotensive drugs and low-protein diets, but won’t show an immediate improvement from fluid therapy. For animals in Stage I renal failure, or where UPC ratios are less than 2 to 2.5, use KI3, BL40 and BL23. These animals will typically not benefit from low-protein diets and hypotensive drugs, but will show an overt improvement from fluids.27
CONCLUSION Chronic kidney disease in cats is a manageable condition that responds well to integrative medicine. In the author’s experience herbal medicine and acupuncture are key. Many integrative practitioners have reported success with other additional therapies, including homeopathy, cell salts, flower essences and osteopathy.
Song JY1, Meng LQ, Li XM. “Therapeutic application and prospect of Astragalus membranaceus and Angelica sinensis in treating renal microvascular lesions”. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2008 Sep;28(9):859-61. [Article in Chinese].
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2 Bangar OP, Jarald EE, Asghar S, Ahmad S. “Antidiabetic activity of a polyherbal formulation (Karnim Plus) [J]”. Int J Green Pharm, 2009, 3(3) : 211-214.
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Su ZZ, He YY, Chen G. “Clinical and experimental study on effects of man-shen-ling oral liquid in the treatment of 100 cases of chronic nephritis”. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih. 1993;13(5): 259–260,269–272.
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Yi NY, Chu W, Koang NK. “Pharmacologic studies on Liu Wei Di Huang Wan: its action on kidney function and blood pressure of rats with renal hypertension”. Chin Med J-Peking. 1965;84(7):433–436.
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Larsen JA. “Controversies in Veterinary Nephrology: Differing Viewpoints: Role of Dietary Protein in the Management of Feline Chronic Kidney Disease”. Vet Clin North Am Small Anim Pract. 2016 Nov;46(6):1095-8.
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Yuan Y, Hou S, Lian T, Han Y. “Rehmannia glutinosa promotes the recovery of RBC and Hb levels in hemorrhagic anemia by promoting multiplication and differentiation of CFU-S and CFU-E bone marrow cell line”. Chung Kuo Chung Yao Tsa Chih. 1992;17(6):366–368. 5
Wojcikowski K1, Wohlmuth H, Johnson DW. “Effect of Astragalus membranaceus and Angelica sinensis combined with Enalapril in rats with obstructive uropathy”. Phytother Res. 2010 Jun;24(6):875-84. Muthenna P1, Raghu G1, Kumar PA, et al. “Effect of cinnamon and its procyanidin-B2 enriched fraction on diabetic nephropathy in rats”. Chem Biol Interact. 2014 Oct 5;222:68-76. Mollazadeh H1, Hosseinzadeh H2. “Cinnamon effects on metabolic syndrome: a review based on its mechanisms”. Iran J Basic Med Sci. 2016 Dec;19(12):1258-1270. Kaffash Elahi R. “The effect of the cinnamon on dog’s heart performance by focus on Kortkoff sounds”. J Animal Veterinary. 2012;11:3604–3608.
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Dashti-Khavidaki S1, Shahbazi F, Khalili H, et al. “Potential renoprotective effects of silymarin against nephrotoxic drugs: a review of literature”. J Pharm Pharm Sci. 2012;15(1):112-23.
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Lee BC, Choi JB, Cho HJ, Kim YS. “Rehmannia glutinosa ameliorates the progressive renal failure induced by 5/6 nephrectomy”. J Ethnopharmacol. 2009;122(1):131–135.
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Liu DG, Zeng M, Gao HY, et al. “Rehmanniae Radix and Rehmanniae Radix Praeparata Ameliorates Renal Interstitial Fibrosis Induced by Unilateral Ureteral Occlusion in Rats and Their Mechanism”. Zhong Yao Cai. 2015 Dec;38(12):2507-10.
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Zhou X1, Sun X1, Gong X1. “Astragaloside IV from Astragalus membranaceus ameliorates renal interstitial fibrosis by inhibiting inflammation via TLR4/NF-кB in vivo and in vitro”. Int Immunopharmacol. 2017 Jan;42:18-24. 8
Shahzad M, Shabbir A, Wojcikowski K. “The Antioxidant Effects of Radix Astragali (Astragalus membranaceus and Related Species) in Protecting Tissues from Injury and Disease”. Curr Drug Targets. 2016;17(12):1331-40.
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10 Zhang HW1, Lin ZX, Xu C, et al. “Astragalus (a traditional Chinese medicine) for treating chronic kidney disease”. Cochrane Database Syst Rev. 2014 Oct 22;(10):CD008369. 11 Shahzad M1, Small DM2, Morais C. “Protection against oxidative stress-induced apoptosis in kidney epithelium by Angelica and Astragalus”. J Ethnopharmacol. 2016 Feb 17;179:412-9. 12 Zhang J1, Xie X, Li C, et al. “Systematic review of the renal protective effect of Astragalus membranaceus (root) on diabetic nephropathy in animal models”. J Ethnopharmacol. 2009 Nov 12;126(2):189-96. 13 Fan YL, Xia JY, Jia DY. “Protective effect of Angelica sinensis polysaccharides on subacute renal damages induced by D-galactose in mice and its mechanism”. Zhongguo Zhong Yao Za Zhi. 2015 Nov;40(21):422933. [Article in Chinese].
Sedighifard Z1, Roghani F1, Bidram P, et al. “Silymarin for the Prevention of Contrast-Induced Nephropathy: A Placebo-Controlled Clinical Trial”. Int J Prev Med. 2016 Jan 22;7:23. Sonnenbichler J, Scalera F, Sonnenbichler I, et al. “Stimulatory effects of silibinin and silicristin from the milk thistle Silybum marianum on kidney cells”. J Pharmacol Exp Ther. 1999 Sep; 290(3):1375-83.
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Wang XL1, Zhou FJ2, Dou M3, et al “Cochlearoids F-K: Phenolic meroterpenoids from the fungus Ganoderma cochlear and their renoprotective activity”. Bioorg Med Chem Lett. 2016 Nov 15;26(22):5507-5512.
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Joob B1, Wiwanitkit V2 Linzhi. “(Ganoderma lucidum); evidence of its clinical usefulness in renal diseases”. J Nephropharmacol. 2015 Dec 27;5(1):9-10.
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Du F1, Li S2, Wang T, et al. “Cordyceps sinensis attenuates renal fibrosis and suppresses BAG3 induction in obstructed rat kidney”. Am J Transl Res. 2015 May 15;7(5):932-40.
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Yu JS1,2,3, Ho CH4,5, Wang HY6,7, et al. “Acupuncture on Renal Function in Patients with Chronic Kidney Disease: A Single-Blinded, Randomized, Preliminary Controlled Study”. J Altern Complement Med. 2017 Apr 19.
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Matsumoto-Miyazaki J1, Miyazaki N1, Murata I, et al “Traditional Thermal Therapy with Indirect Moxibustion Decreases Renal Arterial Resistive Index in Patients with Chronic Kidney Disease”. J Altern Complement Med. 2016 Apr;22(4):306-14.
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27 Marsden S. “Introduction to veterinary acupuncture course notes’> College Integrative Veterinary Therapies, 2017.
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Advertorial
URETHRAL SPHINCTER
HYPOTONUS IN SENIOR DOGS By Jeff Nichol, DVM
What dog owner hasn’t experienced urine “accidents”? In senior dogs, it could signal be a behavior issue, age-related dementia, or a physical problem. Additionally, nearly 20% of spayed female dogs leak while they sleep. Tom and Andrea Armstrong started finding wet spots in their eight-year-old retriever’s bed. Clara had been reliably housetrained but now, when she got up, she would sometimes sniff her wet bed and sheepishly skulk away. She seemed to know she’d made a mistake. The couple took Clara to their veterinarian. A careful history revealed that she leaked urine only when resting or sleeping, that she always passed a normal stream outside, and she never strained. Suspecting an incontinence problem, Clara’s vet explained the importance of ruling out other problems before prescribing treatment. Bladder stones and infections, kidney disease, diabetes, neurologic disorders and behavior problems were all considered. Following a thorough exam, blood and urine profiles, as well as abdominal x-rays, Tom and Andrea were pleased to learn that Clara checked out fine. The diagnosis was urethral sphincter hypotonus, often called spay incontinence. Some spayed dogs, most often middle-aged and older, don’t produce quite enough estrogen to maintain control of the sphincter muscle in their bladders. After drifting off to sleep, they leak. Some lick themselves to clean up the mess, leaving their skin reddened.
Veterinarians prescribe chewable Proin tablets from PRN Pharmacal because they taste great and it’s the only nonhormone medical option for urethral sphincter hypotonus. For more information on Proin, including important safety material, visit the manufacturer’s website at prnpharmacal.com/proin. There may be cases, due to irritability, restlessness or certain medical conditions, in which Proin may be inappropriate, and hormone therapy may be better. To Tom and Andrea’s relief, Clara’s leaking stopped just a few days after taking Proin. IMPORTANT SAFETY INFORMATION: Not for human use. Keep out of reach of children. Contact a physician immediately if accidental human ingestion occurs. Proin is only for dogs under veterinary supervision. Store securely away from pets to prevent accidental overdose. Dogs may willingly consume too many tablets or chew through closed vials and eat the tablets, causing overdose and possibly death. Contact a veterinarian immediately if overdose occurs, if other pets consume Proin, or if restlessness, irritability, appetite loss, continuing incontinence, or any other unusual signs occur. Most common side effects are vomiting, appetite loss, diarrhea, excessive salivation, agitation, tiredness, vocalization, confusion, increased thirst, weight loss, weakness, fever, panting and reversible skin color changes (bright pink). In some cases death, including euthanasia, has been reported. Sudden death was sometimes preceded by vocalization or collapse. Safety of Proin in breeding, pregnant or lactating dogs has not been evaluated. For a copy of the Safety Data Sheet (SDS), or to report suspected adverse drug events, contact Pegasus Laboratories at 1-800-874-9764.
Dr. Jeff Nichol is a graduate of the Michigan State University College of Veterinary Medicine. He has been a hospital owner for much of his career. He practices general and behavioral medicine in Albuquerque, New Mexico
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OSTEOPATHIC APPROACH
TO THE EQUINE THORAX, ITS VISCERA, THE FORELIMB, POLL AND JAW
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By Ann-Marie Hancock, MS, DVM, EDO
here are many reasons why a horse may have restrictions within his thorax. Not the least of these is that the saddle may be resting on his withers. As osteopaths, we know that immobility in one area can certainly influence other regions of the body. Working on the viscera in the thorax is difficult, however, because of the anatomical restrictions. I will first explore the different anatomical features of the thorax and its closely-related structures, then speak about indications for osteopathic treatment.
BASIC ANATOMY OF A HORSE’S THORAX
• Lateral: Rib, parietal pleura and intercostal muscles • Cranial: Suspensory ligament of the thoracic dome and all soft tissue connections between the first ribs, pleura, first thoracic vertebrae and surrounding structures. The heart contains a vast neural network, and secretes neuropeptides and hormones, including oxytocin. It has many more afferent than efferent fibers running to it, and appears to have some function in short and long term memory. Studies in human medicine have shown that the nervous system around the heart can independently influence the brain, and vice versa.
The thorax contains two lungs, separated into left and right lobes by the mediastinum. Many species have two or three lobes on each side, but horses have very small cranial lobes (a little larger on the right than the left), and one accessory lobe that is more connected to the right than the left. The heart sits cranio-ventrally and slightly to the left. It is encased in a firm double parietal pericardial layer and parietal pleural layer called the pericardial sac, which prevents the heart from getting too enlarged. Following are the borders of the thorax: • Dorsal: The ventral portion of the vertebrae and hypaxial muscles of the spine • Ventral: Sternum, costo-sternal junctions and lower ribs • Caudal: Diaphragm (excluding opening for aorta, vena cava and esophagus)
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The parietal pleura is tightly attached to the underside of the ribs and intercostal muscles.
With the right lung removed, you can visualize the azygous vein, cranial and caudal vena cava and its branches. You can also see how the phrenic nerve travels with the mediastinal and pericardial tissues to the diaphragm. The esophagus and aorta lie further to the left and dorsal to the vena cava.
Above photos: A view from above plus a close-up of the organs in the chest, and how they sit. Note how the diaphragm and liver are as far cranial as the seventh thoracic rib ventrally.
The lungs and heart have autonomic, motor and sensory innervations from the region of T 1-5, the cervical ganglions, cardiac plexus, pulmonary plexus and vagus nerve. The intercostal regions and esophagus are innervated segmentally through the thorax. Lymph vessels drain the pelvic limbs and abdomen by draining into the cisterna chyli and then travelling on the left side of the body, opposite the azygous vein, to empty into the left subclavian venous trunk and travel in to the vascular system. The right side only drains the lymph of the thorax, head and neck on the right. Restrictions affecting the left shoulder may have a greater influence on drainage of lymph from the hind limbs. The forearm covers the thorax. It also is innervated from similar segments of the spine. The scapula and humerus cover the region of the first four or five ribs and protect the heart. The innervation and blood vessels to the forearm (brachial plexus) leave from the region of the sixth cervical to the second thoracic vertebrae. Problems in one area will affect the other.
This picture shows the second rib still in place. You can imagine the cervicothoracic and medial thoracic ganglions sitting in between the first and second ribs just below the spine. The cervicothoracic ganglion (or stellate ganglion) is important for regulating blood flow to the pituitary gland and base of the brain. Large lymph nodes and vessels, the brachiocephalic trunk of the aorta, venous trunk, cardiac plexus, brachial plexus, vagus nerve, phrenic nerve and esophagus are all squeezed together in this area and surrounded by fascia that connects the parietal pleura to the scalenus muscle in the neck.
Each nerve going to the axilla (cranial pectoral, suprascapular, subscapular, thoracodorsal, axillary, musculocutaneous, median, radial and ulnar) and exiting the vertebrae from C6 to T2 has its own group of functions. Because they are so closely connected through the fascia in the brachial plexus, and also from restrictions in movement in the pleural dome, immobility in one may affect another. Generally, the branches from C6 and C7 go the pectoral muscles, scapula and latissiumus dorsi (area of saddle/girth sensitivity behind the withers). C7 and C8 innervate the forearm and flexors of the forearm. C8 to T1 innervate the radial nerve, which stimulate the extensors of the limb. T1 and 2 is the ulnar nerve, which includes digital flexors of the limb. Many of these nerves move through the area on the forearm with the muscle bellies of these flexors. Opening the space between these muscles using fascial release can improve mobility of the fetlock, carpus, scapula and thoracic vertebrae in the withers, and the temporal mandibular joint.
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Continued from page 45. Superficial innervation also interconnects, including an area over the scapula that is innervated from the third and fourth thoracic spinal segments, which may indicate a possible visceral thoracic disorder. Lymphatic flow moves to the medial side of the forearm and continues into the axilla and then the thoracic duct, so it may also be influenced by restrictions in the thorax. The next area that connects with the thorax is the neck, and then the TMJ. From the pectoral region and forelimbs, we see an influence on the subclavius muscle. From the sternum, we see influence on the sternohyoideus, sternothyroideus, sternocephalicus and brachiocephalicus muscles. This will influence mobility in the hyoid, larynx, mandible and temporal bone, as well as the occiput and many others. Sympathetic cervical ganglions will influence blood flow to the head, as well as the function of the many glands in the head, the baroreceptors for the heart and more. Movement restriction in the TMJ may influence the cranial nerves exiting through the jugular foramen (CNN 9, 10, 11) and those leaving through the petrous temporal bone, such as CNN 7 (facial), that innervates the digastricus muscle and also the muscles of facial expression.
1. Sternothyroideus and sternohyoideus muscles coming from the manubrium of the sternum and attaching to the hyoid and thyroid cartilages.
OSTEOPATHIC DIAGNOSIS AND TREATMENT First check for structural immobility in the thoracic vertebrae, ribs, sternum and shoulder girdle. Also check more distally for restrictions in rotational movement in the forelimbs. Palpate for mobility and motility in the lungs (pleural restrictions). If you find disorders in this region, you may want to treat the thoracic visceral and thorax. Many times, you might find liver or stomach immobility from the restrictions in the thorax, as well as a loss of mobility in the esophagus. Pain or immobility (sometimes even lameness) associated with most caudal cervical vertebrae could be a sign of thoracic visceral involvement. Horner’s syndrome or any other autonomic nervous system signs that could be related to dysfunction of the stellate ganglion could be related. Conditions and situations treated by releasing restrictions in the thorax include: 1. Horner’s syndrome 2. Loss of mobility 3. History of respiratory disease – all such horses could benefit from an examination of the pleura for mobility and motility 4. Girthiness and resistance to saddling 5. Resistance to going forward or downhill 6. Lameness or imbalance in the front limbs.
METHODS OF TREATMENT Osteopathic treatment can involve direct or indirect techniques. Often, a combined approach is more effective. Myofascial release is helpful as both a diagnostic aid and therapy adjunct.
2. Brachiocephalicus muscle from temporal bone of skull to the deltoid tuberosity and crest of the humerus.
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3 3. Sternocephalicus muscle from mandible to manubrium of sternum.
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The photos below and opposite show two examples of myofascial releases for the thorax and shoulder girdle.
Find the area between the triceps and deltoid where there is a small hollow. Gently follow the depression to its deepest part and hold for 60 seconds. This releases the shoulder and withers.
I usually follow up any myofascial releases by the structural release of any further immobilities. Adding flexion of the neck and rotation of the sternum to vertebral manipulations can make them much more effective. I believe this is because these manipulations have an indirect impact on the intrathoracic fascia and mediastinum. In young horses, treatment of the thorax with an eye to its visceral components can be very effective because it can stimulate thymus development. At any age, improving lymphatic flow and function of the organs of the thorax can help mobility and immunity. Movement of the forelimbs, neck and jaw can be improved, and manipulations of the jaw and poll can be more easily perfomed, thereby yielding longerlasting results when combined with attention to the thorax and thoracic viscera.
This technique is great – placing a hand on each side of the forearm opens up and frees the space between the flexor tendon muscle bellies on the forearm. The leg must be flexed in order to get your fingers deeper into these tissues. This will mobilize forearm, chest, withers and jaw – an easy and effective treatment!
References Visceral Manipulation, Jean-Pierre Barral and Pierre Mercier. Eastland Press 2005. Rooney’s Guide to the Dissection of the Horse, 7th edition, Orsini and Sack. Veterinary Textbooks, 2003. Atlas of Equine Anatomy, 3rd Edition, Pasquini. Sudz Publishing, 1991. Clinical Anatomy of the Horse, Hilary Clayton, Peter Flood and Diana Rosenstein. Elsevier Limited, 2005. Brain Stars: Glia illuminating craniosacral therapy, Tad Wanveer. Upledger Productions, 2015. Anatomy of the Horse 6th ed, Klaus-Dieter Budras, W.O. Sach and Sabine Rock. Schlutershe Verlagsgesellschaft, 2011. Champeroux P, Fesler P, et al. “High Frequency Autonomic Modulation: a new model for analysis of autonomic cardiac control”, Br J of Pharmacology, 2018 May 3.
Wetzler G, Roland M, et al. “Craniosacral Therapy and Visceral Manipulation: a New Treatment Intervention for Concussion Recovery”, Med Acupuncture. 2017 Aug1: 239-248. Castro-Sanchez AM, Mataran-Penarrocha GA, Sanchez-Labraca N, et al. “A randomized controlled trial investigating the effects of CranioSacral therapy on pain and heart rate variability in fibromyalgia patents”. Clin Rehabili. 2011;25 (1) 25-35. Roger VL. “The heart-brain connection from evidence to action” Eur Heart Journal, 2017 Nov 14;38 (43) 3229-3231. Skalec A, Egerbacher M. “The deep fascia and retinacula of the equine forelimb-structure and innervation”. Journal of Anatomy, 2017 Sep;231 (3) 405-416.
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Using
GOLDEN YELLOW POWDER
to help heal a partially open traumatic degloving wound in an Australian Shepherd
By Michael D. Bartholomew, DVM, MS
A
ten-year-old spayed female Australian Shepherd presented to the Animal Hospital of Dunedin on May 17, 2017 after suffering a traumatic degloving wound on her right rear foot. Deep tissues were exposed. After inhouse laboratory values were found to be unremarkable, the dog was sedated with Dexdomitor and received an injection of Ampicillin and Rimadyl. While the dog was under sedation, it was found that a large section of tissue was missing from the site of the injury, and full closure of the wound could not be obtained. The owner declined referral for skin grafts. Lidocaine was used to block the wound site, and the area was thoroughly cleaned and debrided. Fortunately, it appeared that the deeper tissues had been spared from damage.
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The wound was closed using a simple interrupted suture pattern at the distal and proximal ends, as seen in Photo 1. The center of the wound was left open to heal by second intention, since it could not be closed. Before the dog woke, Golden Yellow Powder was applied to a Telfa Pad which was then bandaged to the wound. The patient was sent home with a seven-day supply of Rimadyl and a 14day supply of Cephalexin (from a local pharmacy) with the agreement that the bandage should be changed at the hospital at least every three days, with cleaning and application of Golden Yellow Powder, until the wound healed. The first bandage change took place two days later and the wound was reported to be healing nicely. On May 23 (Photo 2),
the patient was walking well, a granulation bed was forming and the tissue looked healthy. As the dog was normally highly active, the herbal formula Calm Spirit was started at this visit to quell his anxiety about being on strict rest at home. Bandage changes and applications of Golden Yellow continued on a regular basis, the wound continued to granulate in from the edges, and the dog continued to do well. The last bandage change took place on June 19 (Photo 7), about one month from the initial injury. At this time, it was decided to remove the bandage as the healing process was complete.
HERBAL DISCUSSION Golden Yellow Powder is an herbal medicine descended from Ru Yi Jin Huang San, a classical Chinese formula. Ru Yi Jin Huang San was first recorded in Wai Ke Zheng Zong, written by Chen Shi Gong during the Ming Dynasty.1 It is meant for topical use in acute inflammatory conditions accompanied by heat, swelling, pain, open wounds, and skin ulcerations, among other things.1 From a TCVM perspective, corresponding patterns are Damp-Heat, Heat Toxin, and Blood Stagnation. It is formulated in both raw powder and salve preparations. Clinical research has shown Ru Yi Jin Huang San can be effective in treating phlebitis, skin ulcers and swelling, and that it has antibacterial activity and can increase the pain threshold.1
Photo 3 Wound on June 2 – note the decreased size of the open area and wound healing via second intention.
Photo 5 Just three days later, on June 9, wound healing is accelerating.
Photo 4 This photo taken on June 6 shows continued healing of the wound with the granulation bed continuing to heal toward the center.
Photo 6 Further healing is seen on June 13.
• The ingredient Huang Bai, when administered with Gan Cao, displays a synergistic inhibition of MRSA (Methicillin Resistant Staphylococcus Aureus), while Huang Bai alone has
Photo 1 Wound on May 17, 2017 after surgical repair of areas that could be sutured together, with a large portion of the degloved area left open in the middle.
Photo 2 Wound on May 23 at the second bandage change, prior to cleaning. The wound shows early healing.
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moderate antibacterial effects against bacteria such as Staph aureus, B-hemolytic Strep, Bacillus anthracis, Bacillus dysenteriae and Diplococcus pnuemoniae.1,2 • Huang Lian also has a broad spectrum of antibacterial activity, against E.coli, Pseudomonas aeruginosa, Bordatella pertussis, Leptospira, Salmonella typhi and Mycobacterium tuberculosis, among others. It also has been shown to have antiinflammatory and antipyretic activity.2 • Jiang Huang addresses the pain and swelling with an injury and has a marked anti-inflammatory effect in rats.2
Photo 7 By June 19, the wound had resolved. Another bandage was placed at this time due to the owner’s concern that the dog would lick at the site.
• Cang Zhu and Chen Pi have been shown to have anti-inflammatory effects.1 For further ingredients, see the table below. This is an excellent case showing the benefits of using Golden Yellow Powder in the healing of a non-closed wound. The complete healing process was about one month in duration and required dedication and patience from the owner, dog and practitioner. The dog required no pain medication or antibiotic past the first prescriptions, and enjoyed an excellent quality of life during the healing process. Complications such as tissue necrosis, infection and poor healing were absent. Degloving wounds can often be fraught with complications, including delayed necrosis in tissues that may have lost blood supply, requiring repeated debridement.3 This case shows the benefits of using integrative care to achieve a quality outcome for our patients.
NAME
PIN YIN
PARTS USED
TCVM ACTIONS
Tricosanthes
Tian Hua Fen
Root
Clear Heat, promote body fluid
Chinese rhubarb
Da Huang
Root and rhizome
Clear Heat, dissipate swelling
Phellodendron
Huang Bai
Stem bark
Clear Heat, detoxify
Turmeric
Jiang Huang
Rhizome
Activate Blood, relieve pain
Fragrant angelica
Bai Zhu
Root
Relieve pain, clear Wind-Cold
Atractylodes
Cang Zhu
Rhizome
Dry Damp
Tangerine
Chen Pi
Dried rind of mature fruit
Move Qi, relieve pain
Chinese licorice
Gan Cao
Root and rhizome
Harmonize
Magnolia
Hou Po
Bark of stem, twig and root
Dry Damp, move Qi
Coptis
Huang Lian
Rhizome
Clear Heat, detoxify
Borneol
Bing Pian
Not a plant
Clear Heat, relieve pain
Ma, Aituan. Clinical Manual of Chinese Herbal Medicine, Ancient Art Press, Gaineville, Fl, 2016 300-301.
1
Chen, John K, et al. Chinese Medical Herbology and Pharmacology, Art of Medicine Press, City of Industry, CA. 2004. 143,146, 623-624.
2
The Merck Veterinary Manual, Ninth Ed, Merck & Co., Inc., Whitehouse Station, N.J., 2005. 1424.
3
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Veterinary Resource Guide ASSISTIVE DEVICES Best Friend Mobility Myrtle Beach, SC USA Phone: (503) 575-9407 Email: sylvan@sylvancompany.com Website: www.bestfriendmobility.org HandicappedPet.com Amherst, NH USA Phone: (603) 577-8858 Website: www.handicappedpets.com
ASSOCIATIONS American College of Veterinary Internal Medicine - ACVIM Denver, CO USA Phone: (800) 245-9081 Email: acvim@acvim.org Website: www.acvim.org American Holistic Veterinary Medical Association – AHVMA Abingdon, MD USA Phone: (410) 569-0795 Email: office@ahvma.org Website: www.ahvma.org Academy of Veterinary Homeopathy - AVH Leucadia, CA USA Phone: (866) 652-1590 Website: www.theavh.org American Veterinary Chiropractic Association - AVCA Bluejacket, OK USA Phone: (918) 784-2231 Email: avcainfo@junct.com Website: www.animalchiropractic.org 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
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
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HOSPICE HOME CARE PRODUCTS FOR PETS From mobility support to hygiene to pain management, these products help improve quality of life for palliative patients at home. By Sara Render Hopkins, DVM, CVA, CHPV
A
pet’s end-of-life journey can be extremely taxing for the client, both emotionally and physically. People are concerned about the suffering their pets may experience, and want to extend and improve their quality of life for as long as possible. We often see clients shift their approach from cure to comfort, with a focus on care from the time of a terminal diagnosis until the end of the patient’s life. A growing niche in veterinary medicine focuses on hospice and palliative care within a home-based setting. Clients are asking for a transition to home-based end-of-life (EOL) care – at this point, they no longer want to take their pets to a brick-and-
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mortar veterinary hospital. They may have already received a terminal diagnosis, or have seen such a decline in their pets’ quality of life that they just want to “keep him home and comfortable”. The growing trend towards in-home hospice and palliative care has generated a surge in products designed to improve a pet’s quality of life and aid in the management of his care.
MOBILITY SUPPORT Mobility issues are among the most common concerns we see in our aging canine population, whether due to osteoarthritis, neurological conditions/degeneration or other disease processes. Any non-carpeted areas in the home can be a
challenge to navigate and increase the risk of injury. There are many products on the market to help with mobility – the best will be dependent on the pet’s environment and his tolerance level. For example, dogs who hate having their feet touched may not be candidates for certain footwear or related products. I have found the following to be very helpful:
4. Strollers:
1. Slip preventives:
a. Booyah (booyahstrollers.com) – This company makes several different types of pet stroller. b. Pet Gear (petgearinc.com) – They also have a variety of strollers, along with other products such as ramps and stairs that may be helpful for dogs with limited mobility.
a. Dr. Buzby’s Toe Grips for Dogs (toegrips.com) – These small, durable rubber rings fit onto a dog’s toenails. The rubber engages with the floor, giving traction for the paw. A small dab of super glue may be applied to the Toe Grips for added security in pups who drag their feet. b. Pawfriction (pawfriction.com/new-products/) – This non-toxic adhesive is applied to the pads of the feet to prevent slipping on floors. It is easy to apply and well-tolerated by dogs. The frequency of reapplication will depend on the dog’s activity.
2. Harnesses: a. Help ‘Em Up Harness (helpemup.com) – This harness is not only comfortable for the dog, but is easy and comfortable for the owner to use. Front and back harnesses may be used separately or together. Definitely one of my favorite mobility aids. b. The Walk About Back End Harness (walkaboutharnesses.com/ products/the-original-walkabout-back-end-harness) – Another tried-and-true harness that’s helpful for dogs with limited hind end mobility. With any harness or sling-type product, care must be used when fitting the dog, and frequent checks made to watch for any rubbing or sores.
3. Wheelchairs/carts: While wheelchairs may not be for everyone, they can provide both physical and mental stimulation for some dogs, which can be invaluable. a. K9 Carts (k9carts.com) and Eddie’s Wheels (eddieswheels.com) – Both these companies offers durable high quality carts and wheelchairs for dogs. b. HandicappedPets.com (handicappedpets.com/walkin-drag-bag/) – For times when a pet is not in a cart or wheelchair, the Drag Bag protects the hind limbs and chest from scraping against the ground. Incidentally, HandicappedPets.com is a wonderful resource for both veterinarians and clients; the website features many products to help pets and owners with a variety of conditions that affect aging animals.
Mental stimulation is so important for aging pets. For dogs who can no longer go for walks, a stroller-type product can help get them outside for fresh air and mental stimulation. A growing number of products with different features and price ranges are available to dog owners.
5. Footwear: For dogs that will tolerate footwear, a number of options may help in a variety of environments. Not only are we concerned with slipping on smooth surfaces, but we also need to protect the feet from dragging wounds or pressure sores. It’s important that clients realize they need to monitor the condition of their pets’ feet and not leave the booties/socks on for extended periods of time. a. Neopaws (neopaws.com) and Woodrow Wear (woodrowwear. com) – Both these companies make reliable products.
6. Mats and rugs: Many homes with geriatric dogs have an assortment of nonslip carpet runners and rugs across the floors to prevent slipping. Interlocking foam squares/tiles may be helpful, since their design allows them to go around corners, down hallways, etc. As a bonus, they are easy to clean. You can find them online or in home improvement box stores. Strategically-placed mats or non-slip rugs are helpful not only for navigating slippery floors, but also for jumping up and off of furniture. A well-placed mat or rug sometimes gives a pet enough confidence to jump on and off his favorite chair.
Continued on page 54.
BENEFITS OF IN-HOME CARE There are many benefits to in-home care – the most significant being a reduction in stress for the patient. A pet is naturally more comfortable in his home environment and, as a veterinarian, I can more accurately assess his comfort or pain without the added stress caused by transport to a veterinary clinic. I can also assess the pet’s environment and make recommendations for improving his comfort, while at the same time helping to ease some of the challenges an owner may face with EOL care.
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Continued from page 53.
BEING A MOBILE HOSPICE VETERINARIAN
One of the biggest challenges I have faced as a mobile hospice/end-of-life care veterinarian is a lack of awareness of our services. Many people do not realize these in-home services are even an option! We have worked hard to cultivate relationships with our local primary care veterinary clinics – we want to work with them, not against them, in order to offer hospice/EOL services to their clients. The mobile hospice practice model is unique because our business needs are somewhat different from those of a general mobile veterinary practitioner. We need to send out notices of euthanasia to primary care veterinarians to let them know we helped their clients say goodbye to their pets. We need to correspond with local crematoriums to arrange aftercare for pets, and complete tasks such as sending off sympathy cards. We need to track our hospice cases based on trajectory of illness. We do not do vaccinations, so don’t need a system to send out reminder notices. A business software program called REX (mypartnerrex.com) was specifically designed to meet all these needs for the mobile hospice/EOL care veterinarian. Desktop, tablet and iPhone versions all integrate to manage the practice. DVM Center (dvmcenter.com) is a specialized client support company that helps end-of-life care veterinarians answer their phones and schedule visits. They also offer social media support and startup services for veterinarians launching their own EOL care practice. The field of hospice/EOL care as a whole is growing and becoming recognized as its own specialty. In 2016, the International Association for Animal Hospice and Palliative Care (IAAHPC, iaahpc. org) launched a rigorous 16-month certification program, so veterinarians and licensed veterinary technicians may now become certified in Animal Hospice and Palliative Care. I believe this additional education and training is added assurance for primary care veterinarians that our advanced training has value for their clients and pets.
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7. Navigational aids: Weoftenseechallengesinpatientswhoareblindandhavedifficultynavigating their environments. Muffin’s Halo Guide for blind dogs (muffinshalo.com) is an aid that helps blind dogs maneuver without risk of injury. Tracerz (innovetpet.com/products/innovet-pet-products-tracerz-scent-markers-for-blinddogs-training-aids-3-pk) are scent-based markers used to help a blind dog navigate his surroundings and reduce confusion within the home.
PAIN MANAGEMENT While not home hospice products per se, integrative therapies are invaluable when managing palliative care in companion animals. • I have found that animals are quicker to relax during acupuncture treatments when they’re at home instead of a brick-and-mortar practice. I try to integrate acupuncture into the majority of my hospice cases. • Laser therapy is another valuable tool for managing pain. With proper training, in fact, small handheld laser units may be rented to the owner to allow for more frequent laser therapy sessions. • Using pulsed electromagnetic field therapy, the Assisi Loop (assisianimalhealth.com) can also be an important tool in the pain management toolbox. It’s also something that clients can use at home on their own.
COGNITIVE DYSFUNCTION, ANXIETY AND SLEEP DISTURBANCES These problems affect a large number of our geriatric patients and become a quality of life issue, not only for the pet, but for the human family as well. While many medications and supplements may help manage these issues, some in-home products are also useful. Anxiety may arise from a combination of senility and loss of senses. Any time we see symptoms of anxiety and cognitive dysfunction, it’s also important that we reassess pain management to rule out discomfort as a contribution to the behaviors. Pheromone-containing products such as Feliway (feliway.com) for cats and Adaptil (adaptil.com) for dogs may help ease anxiety and are available in a number of different forms (sprays, diffusers, collars, etc.). As pets age, they may undergo a change in sleeping preferences and habits. Seeing a pet curled up in a cozy bed is very comforting to a client. The choices in bed styles, shapes and price points seem endless, so it’s helpful for us as veterinarians to offer clients guidance in selecting beds based on the needs of their pets. I have seen many situations where an owner is disappointed because their geriatric dog won’t use the fancy $200 orthopedic memory foam dog bed they purchased for him. It may be that the dog finds it difficult to navigate the bed; he doesn’t feel steady walking on it to lie down, so he often lies on the floor instead. A thinner bed may actually be more comfortable for these dogs.
Doshka is a 10-year-old female Golden Retriever who uses toe grips to help with traction on slippery floors. Doshka’s mobility is compromised because of an osteosarcoma. Her comfort is being managed though a combination of herbs, acupuncture, and Western medications.
Jake was a 10-year-old male Corgi who received acupuncture to manage discomfort related to IVDD. He also suffered from degenerative myelopathy but LOVED his wheelchair. His corgi ‘sister’ Hannah also has DM and uses the wheelchair daily.
Temperature may also dictate where a pet chooses to sleep; many dogs seek heat or coolness and many old kitties prefer warmth. K&H (khpet.com) produces a variety of cooling and heated beds for both dogs and cats. Some of the heating beds are pressure sensitive so will only warm up when the animal is on the bed. I love recommending these beds to owners who have thin, geriatric cats.
HYGIENE CONCERNS
Shadow is a 15-year-old male Black Lab. He has been receiving acupuncture to manage osteoarthritis. The owners use the Help ‘Em Up harness to help manage his mobility.
Pepper is a 17-year-old female Heeler who receives regular acupuncture and laser therapy for osteoarthritis. Her mom ‘walks’ her in her stroller so Pepper can enjoy smells and her environment.
much more compassion fatigue while in general practice. As a mobile hospice/end-of-life care veterinarian, I get to see the best of the human-animal bond every single day, and experiencing it within a home-based setting makes it more intimate. And thanks to the growing number of products designed to help owners maintain and improve their pets’ quality of life, we’re able to make recommendations to sustain the bond we’re so privileged to witness.
Hygiene can be an issue in aging pets for a variety of reasons. Fecal and urinary incontinence, inappropriate elimination, pressure sores and tumors may all compromise hygiene. Educating clients on the care of wounds and sores is critical in managing these cases. A variety of diapers and belly bands are available for dogs. When using diapers for fecal incontinence, or for female dogs in general, care must be taken to keep the surrounding hair and skin as clean and dry as possible, to prevent urine scald or infection. HandicappedPets.com has a wide variety of diapers and belly bands to keep pets clean. They also offer the SleepPee bed for incontinent dogs. The design helps keep these dogs clean and dry as they sleep. We may also see inappropriate elimination in feline patients due to disease processes such as kidney failure or diabetes, as well as mobility constraints. The old kitty who has trouble going up and down stairs may need access to a litter box on all levels of the house. Sometimes, cutting down the side of the litter box can make it easier for the cat to get in and out.
CONCLUSION I have had general care veterinarians ask me how I deal with compassion fatigue. My honest answer is that I experienced IVC Summer 2018
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From the AHVMA The mindful leader elevating the veterinary profession through innovation, education and advocacy of integrative medicine.
ANNUAL CONFERENCE
The AHVMA is holding this year’s conference from October 4 to 7 in Kissimmee, Florida, at the beautiful Gaylord Palms Resort and Convention Center. Dr. Richard Palmquist, our Keynote Speaker, will discuss our “Search of Healing Stuff”, and describe how microscopic to macroscopic relationships build a better healing community. Medicine is a vast endeavor that involves seeking, discovering, validating, teaching, learning, and possibly most important of all, refining our ability to help one another. In addition to Dr. Palmquist’s Keynote speech, there will be over 100 hours of lectures on topics ranging from Traditional Chinese Veterinary Medicine, to Self-Care, to Suicide Awareness. Also look for our insightful introductory talks on various holistic modalities. Not only will you be exposed to a wealth of knowledge, you will also acquire information on how to integrate these modalities into your practice. We strongly encourage students from AVMA Accredited Veterinary Schools to attend these lectures as a way to broaden their veterinary education. The 2017 AHVMA Conference experienced great success with its vendor-hosted “Lunch & Learn” meetings. Due to the popularity of these lunches, AHVMA will continue them this year, giving attendees a temporary break from the busy exhibit hall. Don’t miss the opportunity to learn about the sponsors’ newest products and services while enjoying an exclusive sit-down lunch.
AHVMA SILENT AUCTION
The future of holistic medicine will be greatly impacted by today’s veterinary students. The AHVMA Silent Auction proceeds benefit students interested in integrative medicine. It may include jewelry, books, art, and vacation getaways, just to name a few. The auction runs concurrently with our Annual Banquet. Visit AHVMF.org for donation opportunities.
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Gaylord Palms Resort, Kissimmee, Florida
GROWING ALL THE TIME
We are pleased to share that the AHVMA continues to grow in membership, programs and influence. Thanks to our members, we proudly maintain our seat in the AVMA House of Delegates. Although exciting, growth forces change and brings new challenges. It will involve expanding to a larger “conference hotel” that will provide enough accommodation and meeting space for our ever-increasing group and programs. Rising interest and attendance from veterinary students at the AHVMA Conferences means we need to ask for your help to continue providing students with these unique educational opportunities. The AHVMA would like to extend our gratitude to those sponsors who have already given directly to our student fund. The AHVMA would not be able to overcome these growing pains without the dedication of our members, exhibitors and sponsors. Thank you for your continued support!
LEADERSHIP DEVELOPMENT
AHVMA would like to extend a warm welcome to our new emerging leaders. Member veterinarians and recent graduates with university or community leadership experience who would like to serve on a volunteer committee can send a brief bio and statement of interest to office@ahvma.org for consideration. Let us know why you would be a great fit. Please join us in Kissimmee in October! And don’t forget to mark your calendars for next year’s Annual Conference at the Gaylord Opryland in Nashville, Tennessee, from September 7 to 10, 2019!
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By Nancy Brandt, DVM
HERBAL SUPPORT
FOR
GERIATRIC ANIMALS By Nancy Brandt, DVM
G
erontology is the study of declining function as an individual ages. The big picture approach to geriatrics in veterinary medicine involves supporting the ongoing effort to maintain and repair body tissues as they become more and more inefficient. A variety of herbs can play an important role in the mitigation of aging in veterinary patients.
CAUSES OF AGE-RELATED ILLNESSES There are many theories of aging. According to an Anatomy & Physiology textbook1 used to teach OMD (Oriental Medical Doctor) students, aging from a Western perspective may be caused by one or a combination of the following: 1. Limit on cell reproduction 2. Nutrition, injury, disease and environmental factors (epigenetics) 3. Slow-acting “aging” viruses 4. The “aging” genes that regulate apoptosis or other cell functions (pre-programmed aging) 5. Autoimmunity, when the immune system attacks its own tissues 6. Mitochondrial degeneration, which means less ATP and an increase in free radical production.
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Health issues, from cognitive to musculoskeletal to cardiovascular, often arise as our animal patients age. Herbs offer beneficial effects to a variety of body systems to help prevent these problems.
THE PREVENTION OF AGING Western and Traditional Chinese herbs have a strong tradition of increasing longevity and preventing aging. For centuries, they have been used as elixirs of longevity. Western herbal supplements are now routinely started in older patients; an example is the use of glucosamine for the prevention and palliation of arthritic symptoms. What more could we start recommending to our animal patients to delay the aging process before symptoms arise? Many body systems will begin to show wear and tear as animals age. The integrative veterinarian can slow this “inevitable” decline by choosing from an herbal smorgasbord of system-supportive ingredients. The primary systems needing support in aging pet include:
• Cognition/special senses: Poor cognition in many pets will manifest as abnormal gaits, vocalization or incontinence, and may even be overlooked as a primary cause. Herbal preparations like Ginko biloba, Rhodiola rosea or Bacopa monniera should be part of a preventative program. Special senses like hearing, sight or even smell may diminish and suffer poor repair, declining slowly and unnoticed.
Antioxidants play a major role in slowing aging within all tissues, especially the special senses. • Neuroendocrine/adrenal: Neuroendocrine and adrenal support is crucial to a healthily functioning autonomic nervous system. Rhodiola rose, Panex ginseng, Ashwagandha and Eleutherococcous can support the overall system of regulation and control. Use tonic herbal blends for everyday support and repair.
• Musculoskeletal/connective tissue: Supporting these tissues with herbs like boswellia and turmeric may enhance the properties of glucosamine products and Adequen®. • Renal: The renal system is often neglected, yet in most humans, over 50% of functioning nephrons are lost by the age of 50.2 The kidneys serve as the organ of excretion for the majority of pharmaceuticals used over the lifespan of our patients, aging the nephrons even faster. Supportive herbs include Rheum officinale, Codonopsis and Eleutherococcous.
• Free radical damage/mitochondrial: Free radical prevention and repair is crucial to the anti-aging process. Mitochondrial support is needed to continue supplying an ample amount of ATP, or “Chi” for the body. Herbs like bilberry, milk thistle, grape seed extract, green tea extract and lycopene taken as prophylactics can both prevent and repair the decline in these aging mechanisms. • Cardiovascular: Support can delay congestive heart disease, even in inherited mitral murmur cases. Feed the organ system vital nutrients in the form of herbs such as lycopene, hawthorn berry, Astragulus and Coleus forskolii.
• Immune: The immune system is often treated as overactive, using immunosuppressive drugs. Adaptagenic herbs like green tea extract, Astragalus, Larch arabinogalactian and a variety of medicinal mushrooms can support an often-overloaded immune system.
• Hepatic/detoxification management: Support is crucial for keeping waste products from building up in the body. Many pets are subjected to multiple pharmaceutical and chemical products throughout their lifetimes, which stresses these pathways. Gentle herbal tonics like green tea, turmeric, dandelion and milk thistle can repair and keep these systems operational.
• Gastrointestinal: The gastrointestinal system is subjected to a variety of foods, often not from the diet of natural selection, so it can become less and less functional as the years pass. Chronic inflammation in the digestive tract can lead to malabsorption, maldigestion, cancer and many other GI mishaps. How many pets are put down because of digestive issues like anorexia and chronic diarrhea? Administration of herbs like marshmallow, rosemary, cinnamon, ginger and slippery elm, along with antioxidants can increase the health of pets significantly. Many other microbiome-supporting supplements can be very beneficial.
TOP 3 AGING ISSUES MOST LIKELY TO LEAD TO EUTHANASIA 1. Anorexia of aging/wasting disease 2. Lack of energy/disorientation 3. Musculoskeletal deterioration
TOP 10 HERBS FOR LONGEVITY AND PREVENTATIVE MEDICINE PROGRAMS 1. Rosemary has positive effects on appetite, memory and hair growth. Processing meats at high temperatures (especially for dry food) creates HCAs (heterocyclic amines), potent carcinogens implicated in several cancers. HCA levels are significantly reduced when rosemary extract is mixed into beef before cooking, say Kansas State University researchers. “Rosemary contains carnosol and rosemarinic acid, two powerful antioxidants that destroy the HCAs,” explains lead researcher J. Scott Smith, PhD.3 Rosemary extract helps prevent carcinogens that enter the body from binding with DNA, the first step in tumor formation, according to several animal studies. “Rosemary has shown a lot of cancer-protective potential,” says study author Keith W. Singletary, PhD.4 2. Turmeric is a strong antioxidant for the GI system and helps prevent gastritis and arthritis symptoms. Turmeric contains curcumin, a powerful anti-inflammatory that works similarly to Cox-2 inhibitors, drugs which reduce the Cox-2 enzyme that causes the pain and swelling of arthritis.5 According to a small clinical trial conducted by the Johns Hopkins University School of Medicine, curcumin can help shrink precancerous lesions known as colon polyps.6
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Continued from page 59.
LOOK FOR QUALITY PRODUCTS Herbal supplements are classified as dietary supplements by the U.S Dietary Supplement Health and Education Act, which means they’re not tested to prove their safety and efficacy, unlike prescription drugs. Some manufacturers sell herbal products that aren’t completely pure. When buying herbs, investigate the company’s GMP and QC. This ensures you get high quality products that aren’t weakened with less expensive additives, or grown with pesticides or contaminated with heavy metals. Botanical medicine may also cause allergic reactions or interact with conventional drugs.
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Researchers at UCLA also found that curcumin helps clear the brain of the plaques characteristic of Alzheimer’s disease.7 Both these studies indicate antiinflammatory properties tissue-wide. More studies need to take place in animals to fully substantiate these correlations. 3. Ginger affects metabolic vigor and tonifies digestion. A powerful antioxidant, ginger works by blocking the effects of serotonin, a chemical produced by both the brain and stomach when you’re nauseated, and by stopping the production of free radicals, another cause of upset in the stomach.8 4. Rhodiola rosea is helpful in maintaining muscle mass.9 This herb is also used for fatigue, poor attention span and decreased memory. A review published in the American Botanical Council’s journal reported that numerous studies in humans, animals, and in cells have shown that Rhodiola helps prevent fatigue, stress and the damaging effects of oxygen deprivation. The evidence suggests that Rhodiola has an antioxidant effect and enhances immune system function.10 5. Cordyceps sinensus, according to Andrew Weil, MD,11 is used as a tonic and restorative. This Chinese fungus can help overcome general weakness and fatigue and increase physical stamina, mental energy, vigor and longevity. 6. Eleutherococcus senticosus can help address lethargy, fatigue and low stamina, according to Dr. Weil.12 Both Cordyceps and Eleutherococcus have a long history of use in TCM. 7. Milk thistle extracts have been used as traditional herbal medicine remedies for almost 2,000 years. Milk thistle contains high levels of bioflavonoids that increase immunity and slow down oxidative stress. The herb is also used for its anti-inflammatory properties. It can aid digestive function, increase bile production, boost skin health, fight the appearance of aging and help detoxify the body. A review of clinical trials evaluating the safety and efficacy of milk thistle found that it has protective effects in certain types of cancer; data shows it can also be used for patients with liver diseases and hepatitis. Milk thistle extracts are known to be safe and well-tolerated.13 8. Green tea extract studies have shown that tea polyphenols offer a protective effect against free radicals, cardiovascular damage, some cancers and infections. 9. Boswellia is known to reduce pain and inflammation in both the joints and tendon and ligament attachments. It is also known to strengthen connective tissue resiliency. Boswellia serrata offers many benefits, such as reducing body inflammation and helping to treat conditions like osteoarthritis, rheumatoid arthritis and inflammatory bowel disease. It’s also a painkiller, and can help inhibit cartilage loss. Boswellia can be used to alleviate asthma and may have protective effects against diseases like leukemia and breast cancer.14
10. Ashwagndha and Astragalus are adaptogenic herbs. In TCM, Astragalus is used as an immune adaptogen. It is strongly antioxidant, antimicrobial and heart protective. Ashwagandha is used in Ayurvedic medicine for its high antioxidant levels and infection-fighting properties, and is also used to address depression and reduce the effects of stress. In addition to the herbs discussed above, nutritional supplements like CoQ10, probiotics and vitamin D3, as well as TCVM herbal tonics like Liu Wei Di Huang Wan or Sheng Mai San, are routinely used in longevity medicine. The best cure for aging issues is prevention, so offer these herbs and supplements to your clients early on.
From the AVH
The Academy of Veterinary Homeopathy is comprised of veterinarians who share a common desire to restore true health to their patients through the use of homeopathic treatment. Members of the Academy are dedicated to understanding and preserving the principles of Classical Homeopathy.
Case report – persistent cough Rose, a 2.5-year-old SF Labrador Retriever, presented on April 3, 2018 with a progressively worsening cough that began within two weeks of vaccination in mid-January for rabies, DA2PP and Bordetella. The initial cough occurred after exercise or play, then progressed to a frequent, spasmodic, honking cough that led to gagging and retching of phlegm. The cough was inducible by tracheal palpation and aggravated by excitement and activity. The patient coughed frequently through the consultation. Her allopathic veterinarian had performed radiographs demonstrating a diffuse bronchial pattern, and fecal flotation and heartworm tests were negative. Several rounds of drugs including broad spectrum antibiotic therapy had no effect, and Rose was taking no medications on presentation.
Patton and Thibodeau. Anatomy & Physiology, 8th edition, Elsevier 2013. Pages 1118-1119.
1
Her symptoms were most consistent with the homeopathic remedy, Drosera rotundifolia. It markedly affects the respiratory organs, resulting in a spasmodic cough that resembles whooping cough. Every attempt to raise phlegm ends in retching, and the coughs are barking or choking in nature. (Nature’s Materia Medica, by Robin Murphy, ND).
Patton and Thibodeau. Anatomy & Physiology, 8th edition, Elsevier 2013. Page 1120.
2
Kanithaporn Puangsombat and J. Scott Smith. “Inhibition of Heterocyclic Amine Formation in Beef Patties by Ethanolic Extracts of Rosemary”, Journal of Food Science, 75, 2, (T40).
3
Keith W. Singletary, Joan T. Rokusek. “Tissue-specific enhancement of xenobiotic detoxification enzymes in mice by dietary rosemary extract”. Feb 1997, Plant Foods for Human Nutrition.
4
Prevention Magazine, June 2007, Page 195.
5
“Curcumin in Treating Patients With Familial Adenomatous Polyposis”. National Cancer Institute (NCI), Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, Maryland, United States, 21287, September 2017.
6
7Prevention Magazine, June 2007, Page 195. 8Suzanna Zick. “Can Ginger Ale Really Soothe Nausea?”The Atlantic, October 30, 2016. 9Frank Mayer, et al. “The Intensity and Effects of Strength Training in the Elderly”. Deutsches Aerzteblatt international, May 2011 DOI: 10.3238/arztebl.2011.0359. Richard P. Brown, Patricia L. Gerbarg, Zakir Ramazanov. “Rhodiola rosea: A Phytomedicinal Overview” HerbalGram. 2002; 56:40-52 American Botanical Council.
10
Andrew Weil MD, drweil.com/vitamins-supplements-herbs/herbs/cordyceps/.
11
Andrew Weil MD, drweil.com/vitamins-supplements-herbs/herbs/siberian-ginseng/.
12
A first dose of Drosera rotundifolia 200c was administered to Rose at the end of the consultation, and the client reported that the coughing ceased completely for several hours, despite increased activity and running outside to meet the children at the school bus. Over the next two days, Rose’s cough continued to rapidly improve. A total of five doses of Drosera were administered from April 3 through 5, based on client reports to the prescribing veterinarian, at which time the symptoms had nearly resolved. As homeopathic medicines are intended to stimulate a healing response in the patient, no further remedies were needed beyond the fifth dose, and the patient rapidly returned to health.
Andrew Weil MD, drweil.com/vitamins-supplements-herbs/herbs/milk-thistle/.
13
Dr. Mercola, articles.mercola.com/herbs-spices/boswellia.aspx.
14
For more information on homeopathy and the benefits of AVH membership, please visit theavh.org. IVC Summer 2018
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innovative practice
SUCCESSFUL A
and healthy veterinary practice using an indigenous healers’ approach By Jaime Gonzalez, DVM, CVA and Susan Blake Gonzalez
M
ost of us will agree that the word “stress” has acquired new meanings that go far beyond what it meant even ten years ago. In veterinary medicine, stress has a major impact, and compassion fatigue and burnout continue to make headlines. Stress is known to lead to a number of chronic illnesses in people. Of course, animals can be affected by stress too, and not just due to their own issues. Because we are so strongly connected to our animals, they can become overwhelmed and even ill because of our stress. Handling this in a positive way is part of the focus of our practice.
ADDRESSING EMOTIONAL-SPIRITUAL HEALTH The emotional-spiritual aspect of health is often neglected, and may cause frustration for both clients and doctors, especially when improvement does not occur as quickly as expected. In our practice – which is made up in large part of animals with chronic illnesses such as cancer, arthritis, skin issues and allergies of all types – clients come from all over the state. Understandably, they are eager for their companion animals to be healed, but we often see them expressing anger or a lack of understanding regarding the emotional-spiritual components
Integrating the idea of Shamanism into veterinary practice addresses the emotional and spiritual aspects of healing.
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of disease. They don’t yet understand that disease is not just a physical manifestation of symptoms, and that there may be other underlying issues. Our interconnectedness with the wholeness of life is sometimes easy for us to forget in our busy lives. It seems esoteric, but our connection to plants and animals, and to nature, is inherently part of us as a human species. It is in our DNA. Our ancestors did not separate themselves from this wisdom; in fact, the ancient practice of Shamanism, which crossed many cultures, honored this belief system. So how can the idea of Shamanism be integrated into veterinary practice, as a way to address the emotional and spiritual components of healing? Let’s take a closer look at the principles of this ancient practice, and how some are still relevant today.
BEHAVIORAL ISSUES
If a client’s pet is acting out, take a look at what is happening with all the people in the animal’s life. In every case, we see that behavior issues are linked to changes in the client’s life. Taking the time to deal with these human issues is key.
PRINCIPLES OF SHAMANISM Shamanism in indigenous cultures around the world dates back at least 5,000 years, and is universal in its principles. According to Sandra Ingerman, a biologist, shamanic practitioner and teacher, all shamanic practices have several beliefs in common: 1. Everything is alive and has spirit. 2. Humans can talk to and communicate with the spirit in all things. 3. Shamans are able to communicate with plants and animals in diverse ways, which taught early humans about healing and medicine. 4. There is a relationship between humans and the spirit of all beings. How does this inform the healing treatments of our primarily dog and cat patients? Animals communicate all the time, with each other, the world, their guardians and with us as healers. Creating a space that emotionally supports and honors an animal’s message is very important, and when clients embrace this, we help them create a space for healing in their own lives, as well as that of their dogs or cats. How does this translate into practice?
INCORPORATING SHAMANISM INTO THE EXAM ROOM At our hospital, we create a sacred space to give clients and patients a place to breathe, relax and feel safe. Our exam rooms are adorned with photographs and talismans IVC Summer 2018
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Dr G on a meditative walk with his Shelties, Pearl and Spenser.
from our ancestral lineages, both Native American and Celtic. Representations of power animals and helping spirits hang on walls. Clients can rest on a carpeted area with their animals, or on cushions and comfortable furniture in all the exam rooms. Gentle music, soothing colors and essential oil diffusers help set the tone for a healing atmosphere.
USING ENERGY WORK TO ADDRESS EMOTIONAL HEALING
THINGS YOU CAN DO EVERY DAY FOR HEALTH AND WELL-BEING By improving your own health and well-being, you can offer the best to your patients. Here are some tips:
1. Set boundaries. Take a one- to two-hour lunch and don’t eat at your desk. Take the time to nurture yourself.
2. Be in nature. Go outside and breathe, feel the grass, listen to the blowing leaves.
3. Meditate. Take even a few minutes to close your eyes, breathe deeply, still your thoughts or just notice them like clouds floating by, with no attachment.
4. Call in your helping spirits, your power animals, your angels, etc. Create a connection to the vast knowledge that is available to us all the time.
5. Be grateful. Give thanks for the ability to help others.
6. Forgive yourself for past mistakes. 7. Listen to your inner voice. We all know how
In addition to creating healing surroundings, we use energy work, including acupuncture, laser, Healing Touch for Animals™, and Reiki, and/or remedies such as herbs, flower essences, homeopathy and essential oils, to match the energy of the patient. If an animal’s energy is severely depleted, careful steps are taken to not overwhelm his system. Initially, only one or two modalities will be chosen until improvement is seen. A great deal of trust is involved in this approach, and guardians come to understand and build on that relationship of trust – even if the healing is an honoring of the end of life.
RELATIONSHIP BETWEEN PET HEALTH AND CLIENT LIFE CHANGES When educating our clients about this approach, we teach them to recognize their own part in it, and to view their situation with compassion. The ability to recognize the prevailing energy in our fellow humans, and connect with them as we share a space, is critical. This allows the process of healing to begin. Incorporating some of the principles of indigenous healing into veterinary practice helps open the door to the connection between physical, emotional and spiritual health.
intuition has guided our actions for the better.
S m u d g i n g to o
ls
SHAMANIC HEALING RITUALS
References Polizzi N. The Sacred Science, An Ancient Healing Path for the Modern World, 2018. Ingerman S. Awakening to the Spirit World: The Shamanic Path of Direct Revelation, 2015, sandraingerman.com.
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• Smudging – clearing space • Sacred fire ceremony – releasing and gratitude • Prayer • Shamanic journeying • Drums/rattles • Tuning forks
marketplace
Advertise Here! 866.764.1212, IVCJournal.com
Acute Homeopathy & Holistic Pet Health Workshop June 23-24, 2018 Send your clients and staff! Online streaming and in-person classes taught by Dr. Christina Chambreau and Dr. Jeff Feinman
Holisticactions.com/june-training
events Fetch dvm360 Central
August 17–20, 2018 — Kansas City, MO 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. At Fetch dvm360 conference, every non-laboratory session is available to every attendee, regardless of registration type. 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.
To post your event, email us at: info@IVCJournal.com
WAEO International Conference
September 7– 9, 2018 – Waldfeucht, Germany We are proud to announce that the next WAEO International Conference will be taking place at The Vluggen Institute in Germany in September! For more details, please see the WAEO website or the WAEO Conference Facebook page ( facebook.com/Worldwide-Alliance-of-Equine-Osteopaths-Conferen ce-2018-925465864198115).
All this is an atmosphere that will both relax and rejuvenate you! Fetch dvm360 in Kansas City is truly a learning opportunity you won’t want to miss.
Also, if you liked what you saw in the “From the WAEO” column in this issue, please check out Anatomy of the Equine online (anatomy-of-the-equine.com). True North Equine will be hosting a two-day dissection course with Paige Poss from Anatomy of the Equine September 17 and 18 in Marshall, Virginia. Please contact Anatomy of the Equine for more details.
For more information: (800) 255-6864 www.fetchdvm360.com/fetch-virginia-beach/
For more information: info@equineosteopathy.org www.equineosteopathy.org
For more events, visit: Facebook.com/IVCJournal/events
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The Worldwide Alliance of Equine Osteopaths (WAEO), established in February of 2013, is a non-profit corporation that seeks to unite the profession of Equine Osteopathy. We intend to serve as a resource for practitioners, researchers, educators and students of Equine Osteopathy. We aspire to be the link that allows Equine Osteopaths from all over the world to connect and converse. There is much to learn about each other and the profession of Equine Osteopathy as it is practiced throughout the world.
From the
WAEO Immobility in the fascia around a horse’s ovary can affect her motion and posture as follows: 1. Though only a mare has ovaries, their suspensory ligaments are a component of the vaginal tunic in testicular tissue. This means restrictions in the internal vaginal tunic of the inguinal ring in geldings or stallions can have similar symptoms. 2. Sacral restriction brings the cranial aspect of the sacrum ventral on the same side as the ovary. This may restrict movement in lumbar 4, 5 and 6. 3. Tuber coxae may be sensitive, especially just cranial ipsilateral to the ovarian restriction. This coincides with the location of the “ovary point” in acupuncture. The cranial portion of the ovary’s suspensory ligament appears to connect to the body wall at this location. 4. The horse may be sensitive to palpation on the inner side of the thigh, or show reactivity to any palpation of the udder. (This area has the same spinal innervation as the fascia of the ovary, so the two areas influence each other). 5. The stifle on the same side may not rotate completely, limiting ability to extend and push off. 6. The hind limb on the same side of the body as the ovarian restriction will be pulled forward and not extend back as well, leading to a perceived height difference in the hindquarters from side to side, when watching the horse walk or trot from behind. 7. Lumbar spin bends around the lesion. Most often, the restriction on the right ovary pulls it towards the lateral body wall, preventing medial motion. The horse curves to the right. 8. The diaphragm may be affected, so the horse may sit with the spine in extension (slightly sway-backed). 9. The base of the neck may be restricted, and the TMJ may be in a compensatory pattern based on restrictions in the hind end.
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From the VMAA DID YOU NAME THE OIL DISTILLED FROM THE PLANT PICTURED IN THE LAST ISSUE?
Rosemary (Rosmarinus officinalis) is a flavorful herb popular in Italian dishes. The oil can be put in food or applied topically with a mister. The diffused aroma is potent when the oil has been steam-distilled from the plant’s needle-like leaves. Rosemary’s natural chemical constituents of eucalyptol and alpha-pinene make it a favorite dietary supplement for maintaining wellness.
CASE REPORT
Shelly, a 10-year-old F/S Shepherd mix, presented for severe chronic anal sacculitis with recommendation for surgical removal. Suppositories were prepared consisting of carrier coconut oil (15 ml), with Boswellia carterii (40 drops), Copaiba (ten drops) and MQN (five drops). MQN (Naiouli or Melaleuca quinquenervia) is stronger than tea tree oil (Melaleuca alternifolia) and supports healthy skin. One suppository was administered rectally BID for five days, then three times per week for six weeks. On day ten, the pain and thickening had resolved. The six-week reassessment showed Shelly’s glands to be functioning normally, with no pain, scooting or licking! Maintenance includes manual expression every three months, and a suppository every one to two weeks. This approach has been used for 20 years in over 500 cases.
CONFERENCE NEWS The 2018 VMAA Conference in Las Vegas was a great success. Thanks go to keynote speaker, author Kurt Schnaubelt; Dr. Nancy Brandt, who did a great job explaining the difficult topic of essential oil pharmacology; and presenters Candace Hoke, ND and Jodie Gruenstern, DVM, CVA, who demonstrated essential oil use in practice. If you have an essential oils success story of your own, email contact@DrJodiesNaturalPets.com.
Name the oil distilled from this plant! The answer will appear in the next issue.
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