V8I4 (Fall 2018) by Redstone Media Group

Innovative VETERINARY CARE

VOLUME 8 ISSUE 4

HOW VETERINARY REHABILITATION OPTIMIZES CLINICAL OUTCOMES

Rehab therapy improves functional outcomes post-operatively and helps with neurological conditions, intervertebral disc disease and soft tissue injuries. – P. 12

DIGITAL INFRARED THERMAL IMAGING

PHYSICAL REHAB PRODUCTS

UNVACCINATED PUPS THAT MAINTAIN IMMUNITY

MICROALGAE BOOSTS CANINE WELLNESS

DITI helps you keep tabs on the progress of any integrative treatment plan, and can let you know if and where you need to tweak it a bit. – P. 52

Helping clients choose rehabilitation products for their pets can benefit your practice and patients, while avoiding expensive and harmful mistakes. – P. 46

FALL ISSUE 2018

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Once a pup’s residual maternal immunity has waned, he can still maintain measurable levels of immunity, despite not being vaccinated. What are the possible explanations? – P. 30

Aphanizomenon flos-aquae (AFA) is a unique microalgae that can enhance canine health in several ways. – P. 54

PROS AND CONS OF TRADITIONAL SPAY AND NEUTER

ACUPUNCTURE FOR EQUINE ATHLETES

While standard spay and neuter surgery is still the norm, it can have negative impacts on an animal’s health. Take a look at some other options. – P. 32

Find out how acupuncture can help keep performance horses in peak condition by reducing pain, preventing injury, and more. – P. 61

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contents FEATURES

VETERINARY REHABILITATION OPTIMIZES CLINICAL OUTCOMES

HYDROTHERAPY IN CANINE PHYSICAL REHAB

By Dody Tyneway, DVM

Rehabilitation therapy for canine patients improves functional outcomes post-operatively, and helps with neurological conditions, intervertebral disc disease and soft tissue injuries.

By Janice Huntingford, DVM, DACVSMR, CVA, CVPP, CCRT CAVCA

The role of therapy pools and underwater treadmills in physical rehabilitation, and what to consider when adding these to your facility.

RECOGNIZING SOFT TISSUE INJURIES IN DOGS FROM AN INTEGRATIVE PERSPECTIVE – PART 1

By Kimberly Henneman, DVM, DACVSMR (EQ, K9), FAAVA, DABT, CVA, CVC

Applying rehab and physiotherapy techniques to an injured dog should be preceded by consideration of how the injury developed, and how it affects the health of the whole body.

PRESUMED NATURAL OR SHED VACCINE VIRAL EXPOSURE IN UNVACCINATED PUPPIES

By W. Jean Dodds, DVM

Some pet caregivers are reluctant to vaccinate puppies for even serious infectious diseases. Yet once the puppies’ residual maternal immunity has waned, they still maintain measurable levels of immunity. Take a look at how this is possible.

ORTHOTICS AND THE VETERINARY NURSE

Braces and custom orthoses enhance mobility and quality of life. The veterinary nurse can play an important role in helping patients and educating owners in the use of these devices.

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By Jennifer Repac, DVM, CVA, CCRT

When it comes to rehab in the context of integrative medicine, a teaching hospital offers benefits such as access to specialized equipment, research opportunities, and more.

PHYSICAL REHAB PRODUCTS FOR YOUR CANINE PATIENTS

DIGITAL INFRARED THERMAL IMAGING

By Kristen Hagler, BS, RVT, VTS (Physical Rehabilitation), CCRP, CVPP, OACM, CBW

The vast number of rehab products on the market can make it difficult for pet owners to know what to purchase. Helping them make well-informed product decisions helps prevent costly or damaging mistakes.

By Ronald J. Riegel, DVM

Digital infrared thermal imaging (DITI) provides an objective assessment of any integrated treatment plan and its progress.

54 61

NUTRITION NOOK

MICROALGAE FOR DOGS By PJ Broadfoot, DVM

Discover how Aphanizomenon flos-aquae (AFA) can benefit the health of your canine patients.

ACUPUNCTURE FOR PERFORMANCE HORSES

By Megan McCorkel, DVM, cVMA

Acupuncture helps keep equine athletes in top condition by creating analgesia, decreasing the risk of ileus, helping to prevent injuries, and much more.

By Linda Brent, PhD, MBA and Michelle Kutzler, DVM, PhD, DACT

By Mary Ellen Goldberg, BS, LVT, CVT, SRA, CCRVN, CVPP, VTS-lab animal medicine (research anesthesia), VTS-physical rehabilitation

INTEGRATIVE REHAB IN A VETERINARY TEACHING HOSPITAL

ALTERNATIVES TO TRADITIONAL SPAY AND NEUTER

Standard spay and neuter surgery can have negative impacts on a dog’s health. What are some alternative options?

INNOVATIVE PRACTICE

advisory board

18 COLUMNS & DEPARTMENTS

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

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

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

5 Advisory board 8 Editorial 29 From the AAVA 40 Industry innovations

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.

51 From the AHVMF 59 Wellness resource guide 60 From the VBMA 65 Marketplace 65 Events 66 News bites

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.

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Integrative VETERINARY CARE

FALL 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: Anna Dezsi Social/Digital Media Manager: Theresa Gannon Web Design & Development: Brad Vader

COLUMNISTS & CONTRIBUTING WRITERS

Linda Brent, PhD, MBA (Parsemus Foundation, San Francisco, CA) PJ Broadfoot, DVM W. Jean Dodds, DVM Mary Ellen Goldberg, BS, LVT, CVT, SRA, CCRVN, CVPP, VTS-lab animal medicine (research anesthesia), VTSphysical rehabilitation Kristen Hagler, BS, RVT, VTS (Physical Rehabilitation), CCRP, CVPP, OACM, CBW Kimberly Henneman, DVM, DACVSMR (EQ, K9), FAAVA, DABT, CVA, CVC Janice Huntingford, DVM, DACVSMR, CVA, CVPP, CCRT CAVCA Michelle Kutzler, DVM, PhD, DACT (Oregon State University, Corvallis, OR) Megan McCorkel, DVM, cVMA Jennifer Repac, DVM, CVA, CCRT Ronald J. Riegel, DVM, FASLMS, VMLSO Nancy Scanlan, DVM, CVA Dody Tyneway, DVM

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

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editorial

THE EVOLUTION OF

REHABILITATION Rehabilitation has come a long way since I graduated from veterinary college. I remember a small poodle who had lost both rear limbs to cancer running down the hallway in the universityâ&#x20AC;&#x2122;s small animal clinic â&#x20AC;&#x201C; on her front legs! Most other dogs and cats were not able to do that, and we had little to offer them in terms of braces, limb replacements and orthotics. Clients who could not afford orthopedic surgeries had few options other than drug therapy to decrease pain. This issue of IVC Journal is full of the many solutions now available for restoring mobility to animals. With the increasing interest in agility and other competitive sports, preventing injuries and returning athletes to full performance is in growing demand. As always, paying attention to nutrition, whole body balancing and toxin avoidance improves recovery, enhances performance and extends life. Dr. Jennifer Repac shows that when it comes to rehabilitation in the context of integrative medicine, a teaching hospital offers a wide variety of benefits, including a collaboration between services, access to specialized equipment and research opportunities. Many veterinarians recognize and treat functional loss after injuries occur; Dr. Kim Henneman focuses on the importance of evaluating how soft tissue injuries arise in the first place. Treating and managing these causes aids recovery and decreases the incidence of future injuries. With the increasing interest in rehab, a plethora of companies are developing new braces, orthotics, hydrotherapy equipment and many other devices to improve patient mobility. Our clients are searching out mobility-enhancing products themselves and need our guidance to properly select devices that are safe and effective. With this in mind, Kristen Hagler updates us on many specific products. Meanwhile, Mary Ellen Goldberg details the

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great strides that have been made in prosthetics and orthoses, especially custom-fitted ones. And Dr. Janice Huntingford passes on her experience with hydrotherapy options, including costs, maintenance and utilization. Our immediate goal when helping an injured patient is pain management and return to function. Dr. Dody Tyneway discusses how recovery from orthopedic surgeries and neurological conditions, including IVDD, is significantly improved with the use of a variety of rehab techniques. Performance horses can benefit from regular acupuncture to treat and prevent joint-associated injuries and travel-related illnesses. Dr. Megan McCorkel discusses the benefits of acupuncture for equine pain relief, decreasing the risk of ileus and even helping to prevent injury. On other topics, Dr. PJ Broadfoot discusses how microalgae, specifically Aphanizomenon flos-aquae, can enhance the health of your canine patients, while Drs. Linda Brent and Michelle Kuntzler discuss alternatives to traditional spay and neuter surgery. Last but not least, Dr. Jean Dodds continues to improve our knowledge of immunology with a study on viral immunity in unvaccinated dogs. I hope to see you at the AHVMA conference in October and learn what you want to see in future issues of this journal. As always, share your successful cases at IVCJournal.com! Yours in health,

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

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contributors 1

1. PJ BROADFOOT, DVM Dr. PJ Broadfoot graduated Cum Laude from Kansas State University School of Veterinary Medicine in 1981, and started her own practice in Van Buren, Arkansas in 1982. She developed an early interest in nutrition, which progressed over the past 18 years into a holistically-oriented practice. Dr. Broadfoot was hired in 2001 as a veterinary consultant for Heel. She is a member of the CIVT faculty, as well as the AVMA, the Arkansas VMA, and the AHVMA.

7. JENNIFER REPAC, DVM, CVA, CCRT Dr. Jennifer Repac graduated from the University of California Davis School of Veterinary Medicine in 2009. She spent two years working as a veterinarian and teacher for a small animal practice in Beijing. Dr. Repac has been practicing veterinary acupuncture since 2011 and has traveled twice to Guangzhou, China to teach acupuncture with the Chi Institute. She is now a second year Sports Medicine and Rehabilitation resident at the Animal Medical Center.

2. W. JEAN DODDS, DVM Dr. Jean Dodds received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she established Hemopet (hemopet.org), the first non-profit national blood bank program for animals. She is also Co-Trustee of the Rabies Challenge Fund, a non-profit project to assess the DOI and safety of rabies vaccines for animals (rabieschallengefund.org). Dr. Dodds served on the Board of Directors of the AHVMA, is on the Board of the AHVMF, and is a member of the Editorial Committee for the AHVMA Journal.

8. RONALD J. RIEGEL, DVM, FASLMS, VMLSO Dr. Ronald Riegel earned his doctoral degree in veterinary medicine from the University of Illinois and has been the sole owner of a multi-doctor private practice for over 25 years. He purchased his first therapy laser in 1979, the first infrared thermography unit in 1987, and is a co-founder of the American Institute of Medical Laser Applications (AIMLA). Dr. Riegel has lectured on infrared thermography and laser therapy. He is the co-editor and content author of the new textbook, Laser Therapy in Veterinary Medicine: Photobiomodulation (Wiley Publications).

3. KIM HENNEMAN, DVM, DACVSMR, FAAVA, DABT, CVA, CVC Dr. Kim Henneman is currently the only veterinarian in the US who is Board-certified in both Equine and Canine Sports Medicine and Rehabilitation. Since first incorporating integrative therapies into her Western Rockies mixed practice in 1990, Dr. Henneman has taught integrative medicine and thermal imaging at numerous conferences and veterinary schools, as well as contributing to several textbooks. She has worked with performance dogs and horses in environments ranging from Dubai to Alaska (seven times as an Iditarod Trail veterinarian). She also treats non-working cats.

9. DODY TYNEWAY, DVM Dr. Dody Tyneway is a 1992 Graduate of the University of Florida. She is certified in acupuncture by IVAS; musculoskeletal manipulation by the American Veterinary Chiropractic Association and the Integrative Veterinary Medical Institute; physical rehabilitation by the Canine Rehabilitation Institute; herbal therapies by the College of Integrative Veterinary Therapies; Tui na and Chinese Herbal Medicine by the Chi Institute; and is a Certified Veterinary Pain Practitioner via the IVAPM. Dr. Tyneway owns the Holistic Veterinary Center and Calabasas Animal Clinic.

4. JANICE HUNTINGFORD, DVM, DACVSMR, CVA, CVPP, CCRT CAVCA Dr. Janice Huntingford is a 1984 graduate of the Ontario Veterinary College, University of Guelph, Ontario. She is certified in chiropractic, acupuncture, rehabilitation and pain management. She is the owner and medical director of the Essex Animal Hospital, Canine Rehab and Fitness in Essex, Ontario, Canada. In 2015, she became a Diplomate of the American College of Veterinary Sports Medicine and Rehabilitation, and a consultant for the VIN Rehab/Sports Medicine/Chronic Pain board. 5. MICHELLE KUTZLER, DVM, PHD, DACT Dr. Michelle Kutzler graduated from Washington State University College of Veterinary Medicine in 1993. In 1997, she began a residency in veterinary reproduction (Theriogenology) at Cornell University and became board-certified in Theriogenology in 1999. She earned a PhD in Physiology at Cornell University in 2002. Dr. Kutzler is an Associate Professor of Companion Animal Industries at Oregon State University. Her research interests include methods for non-surgical and alternative surgical sterilization, effects of gonadectomy on long-term health, and use of GnRH agonist treatment to improve long-term health of gonadectomized dogs. 6. MEGAN MCCORKEL, DVM, CVMA Dr Megan McCorkel is a practicing veterinarian with a mobile acupuncture practice in Denver, Colorado. She is interested in both large and small animal medicine, alternative therapies, HVHQ surgery, and sports medicine. She graduated from the Western University of Health Sciences with her DVM, and completed her acupuncture certification through One Health SIM, formerly known as MAV, in Fort Collins, Colorado.

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10. LINDA BRENT, PHD, MBA Dr. Linda Brent is a scientist and organizational leader with expertise in non-human primate behavior, animal welfare, non-profit management, project management, preclinical research, grant writing and scientific writing. She is a founder of Chimp Haven, Inc. – a sanctuary for chimpanzees retired from medical research – and served as its President and Director from 2002 to 2012. Dr. Brent is Executive Director for Parsemus Foundation., which funds innovative and neglected medical advancements. 11. MARY ELLEN GOLDBERG, BS, LVT, CVT, SRA, CCRVN, CVPP, VTS-LAB ANIMAL MEDICINE (RESEARCH ANESTHESIA), VTSPHYSICAL REHABILITATION Mary Ellen Goldberg is a graduate of Harcum College and the University of Pennsylvania. She has been the instructor of Anesthesia and Pain Management at VetMedTeam, LLC since 2003 and the Executive Secretary for the IVAPM since 2008. Mary Ellen is a Certified Veterinary Pain Practitioner through IVAPM and a Surgical Research Anesthetist certified through the Academy of Surgical Research. She is on staff at the Canine Rehabilitation Institute as a Certified Canine Rehabilitation Veterinary Nurse. In 2017, Mary Ellen was chosen as NAVTA’s Veterinary Technician of the Year. 12. KRISTEN HAGLER, BS (AN.PHYS.), RVT, VTS (PHYSICAL REHABILITATION), CVPP, CCRP, OACM, CBW Kristen Hagler has been a California Registered Veterinary Technician since 2002 and a Certified Canine Physical Rehabilitation since 2005. She is President of the Academy of Physical Rehabilitation Veterinary Technicians. She has held a VTS (Physical Rehabilitation) since 2017 with training in canine massage, osteoarthritis case management and recognition as a Certified Veterinary Pain Practitioner. Kristen is a technician associate member of the American Association of Rehabilitation Veterinarians and has interests in orthotics, geriatrics, sporting, performance and service dogs, and pain management.

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Rehabilitation therapy for canine patients improves functional outcomes postoperatively, and helps with neurological conditions, intervertebral disc disease and soft tissue injuries. By Dody Tyneway, DVM

Veterinary rehabilitation optimizes clinical outcomes The goal of veterinary rehabilitation is to provide pain management, promote mobility, and return a patient to the most functional outcome possible. Rehabilitation has become an important part of the treatment plan for animals recovering from orthopedic or neurological surgery and soft tissue injury, as well as for chronic osteoarthritis management, neurological conditions, and obesity management. The purpose of this article is to highlight several conditions in which rehabilitation would play an important part in optimizing a patientâ&#x20AC;&#x2122;s condition.

ORTHOPEDIC SURGERY Femoral head ostectomy (FHO) is a surgery for which rehabilitation should be discussed and recommended to the client, preferably prior to the operation, as part of the overall treatment plan. Early postoperative rehabilitation is imperative to optimize range of motion and achieve the most functional outcome for the affected leg. This is especially important in small dogs with an FHO, since it is not uncommon for them

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to resist using their legs after any orthopedic surgery. In the early postoperative period (before sutures are removed), the focus is on pain management. Traditional pharmaceutical pain therapies are augmented with cryotherapy, gentle passive range of motion, and cold laser therapy. After the initial recovery period, acupuncture and musculoskeletal manipulation can help manage compensatory issues such as back pain and local hip pain. A qualified rehabilitation therapist can assist with incorporating appropriate modalities and progressing therapeutic exercises for optimal outcome. Underwater treadmill therapy is very useful in facilitating use of the limb due to the buoyancy and resistance effect of the water. The underwater treadmill is superior to swimming in recovery, because the patient is more likely to actively stretch the hip when he is walking on the treadmill; many dogs while swimming may â&#x20AC;&#x153;dangleâ&#x20AC;? or not properly extend and use the hip.

TPLO and MPL surgeries benefit from rehabilitation to help manage pain and encourage weight-bearing as soon as possible after surgery. Not as beneficial is the approach many clinicians take, which is to recommend rehabilitation for patients experiencing less than optimal outcomes after surgery, including not using the leg after significant time has passed, and encountering significant atrophy and loss of function. This is unfortunate as it is harder to reverse atrophy and preserve range of motion after chronic disuse. In my experience, the best benefit of rehabilitation after stifle surgery is that dogs are less likely to tear the ligament on the nonsurgical leg, which is placed under greater stress during the recovery period. Since recovery is dynamic, it is important that pain is managed thoughout the entire rehabilitation process. A supervised rehabilitation program with controlled return to function optimizes clinical outcomes.

NEUROLOGICAL CONDITIONS Degenerative myelopathy is the disease that prompted me to search for options outside traditional Western medicine, to help patients cope with the devastating decline they endure without intervention. Unfortunately, many patients present after months of being administered a laundry list of medications, dietary recommendations and supplements. Many of these supplements and dietary interventions should, in theory, prevent progression. In the integrative medicine paradigm, there is no standalone therapy for a degenerative myelopathy patient. This is a disease that truly requires an integrative approach, and early intervention with rehabilitation is critical. A study done in the Journal of Internal Medicine showed that physical rehabilitation kept patients ambulatory on an average of 255 days longer. A genetic test offered through the Orthopedic Federation of Animals looks for the genetic markers of degenerative myelopathy. If a patient is homozygous recessive, and is exhibiting signs of neurological decline and hind end weakness, it is highly likely he has the disease. If this is the case, it is critical to develop a program to manage other concomitant painful diseases that may cause pain as weak animals compensate for the degenerative myelopathy by placing stress on the spine and front end, which are overworked trying to stay ambulatory. Spinal manipulation is helpful, as is acupuncture, in managing pain for these animals. Dogs with degenerative myelopathy are often deficient from a Chinese Medical perspective, and need a conservative physical therapy IVC Fall 2018

program that consists of a shorter and more frequent exercise and treatment regimen. Prolonged exercise and aggressive treatment often depletes these dogs. Therapeutic exercises for proprioception and strength, along with underwater treadmill use, are key in keeping patients with degenerative myelopathy ambulatory. Consider having assistive devices at your clinic for patients with hind end weakness. These can include harnesses that support both the front and rear end (Help ‘Em Up), toe up boots (available through handicappedpets.com), and toe grips (Dr Buzby’s). Clients often struggle with fitting harnesses, and a poorly-fitted sling or harness can rub and cause sores and irritation. Helping clients choose and fit a harness is an important service we can provide. Also, trimming nails to an appropriate length and applying toe grips is very helpful; clients appreciate assistance with this. Walking clients through recumbent dog care, including how to prevent decubital ulcers and helping with bladder expression and assisting with bowel movements, is not often thought of, but it’s an important part of helping clients cope with the degenerative myelopathy towards the end. Most importantly, despite the plethora of supplements with antioxidant and neuro-protectant qualities that have been recommended for patients with presumptive degenerative myelopathy, the one modality that stands out for making a significant difference is physical rehabilitation.

INTERVERTEBRAL DISC DISEASE Dogs with intervertebral disc disease come in a diverse variety of presentations: F or the acutely painful dog without proprioceptive deficits, consideration should be given to nonsteroidal anti-inflammatories and gabapentin. Cold laser is helpful in managing both acutely painful dogs and those with chronic pain. Care must be given when one is considering musculoskeletal manipulation at acutely affected sites. Acupuncture and electroacupuncture are helpful in managing the acutely painful patient. wners of painful dogs with rapid proprioceptive O decline must be aware that surgery is a consideration. Dogs that had surgery and received electroacupuncture and Western medicine recovered faster than those that received electroacupuncture alone. Cold laser in the postoperative period is helpful for healing the incision, and for pain management.

I t is possible to help a patient with no deep pain to achieve spinal walking, but the majority will not walk again without surgical intervention. These dogs are good candidates for carts. Assisting clients with making measurements and fitting carts is a useful service to offer. As mentioned above, a poorly-fitted cart leads to skin chafing and improper biomechanics that may cause discomfort. It is also important to address diet in patients with intervertebral disc disease as they are often on restricted activity and more likely to gain weight during this time. Switching from a higher-carbohydrate processed kibble diet to a raw or home-cooked balanced diet is helpful. Consideration should be given to cutting daily calories fed by 25% to 30%. Omega 3 fatty acids should be considered. Along with traditional pain management (gabapentin and nonsteroidal anti-inflammatories), numerous anti-inflammatory herbal formulas contain herbs such as boswellia and curcumin. Traditional Chinese medical formulas include Acute and Chronic Back formulas from Evergreen, and Jingtang Herbs Double P formula. Pulse Magnetic Therapy is being used more and more for patients with intervertebral disc disease.

SOFT TISSUE INJURIES Veterinarians and physical therapists trained in animal rehabilitation focus heavily on pinpointing the specific soft tissues involved in an injury, so that a targeted program can be implemented. This contrasts to the old school approach of “cage rest” for a generic diagnosis of soft tissue injury. While cage rest is an important part of rehabilitation, what’s more important is incorporating controlled activity designed to help with healing, pain management and preservation of range of motion. There is a fine balance between encouraging a gradual return to function and offsetting the development of scar tissue, disuse atrophy and compensatory changes as a result of the injury. Often there are subluxations present in the spine as the animal compensates for soft tissue injury. Weakness or injury to an extremity creates a high likelihood that the animal will sustain an injury to his core trying to compensate for the injury. Common soft tissue injuries seen in active dogs and canine athletes Following are some of many soft tissue injuries, along with their most common presentations: Carpal laxity: Hyperextension at the carpus can present with varying degrees of pain, and dogs that perform in Continued on page 16.

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Continued from page 14.

Learning more about

VETERINARY REHAB As with many areas of integrative medicine, there is no single cookbook protocol to rehabilitating a patient. Veterinarians, veterinary technicians and physical therapists pursue advanced training in rehabilitation to better understand what is appropriate for each individual dog’s situation. For those interested, advanced training may be pursued through the University of Tennessee Northwest Seminars (utvetce.com), and the Canine Rehabilitation Institute (caninerehabinstitute.com).

flyball and agility are predisposed. Carpal support wraps help dogs with instability (therapaw.com). Bicipital tenosynovitis, supraspinatus tendinopathy and medial shoulder instability: These injuries result from repetitive activities and overuse of the limb. Modalities such as ultrasound, shock wave, cold laser, platelet rich plasma and stem cell therapy are utilized to facilitate healing. Home exercises are designed to challenge the tissues after the acute phase when ice, rest and gentle massage and stretching may be the only things indicated. Manual therapy encompasses cross friction massage and stretching, home exercises to strengthen the limb, underwater treadmill, progressing to trotting and walking downhill, and wheelbarrowing on the front legs. Iliopsoas strain: Pain occurs on extension of the hip with slight abduction and internal rotation. When one of these strains is suspected, look for other issues such as anterior cruciate ligament disease, meniscal tears, hip issues and lumbosacral disease. After the diagnosis is confirmed and the dog is comfortable with appropriate pain management, a rehabilitation program can begin. Modalities include cold laser and massage. Gentle stretching focusing on hip extension can involve an active hip stretch by having the dogs’ paws up on a surface and luring him forward to open the hip. Core strengthening exercises may also be prescribed. Anterior cruciate ligament tear: Rehabilitation should be considered for dogs with partial tears if surgery is not an option. The best outcome is likely in dogs that weigh less than 45 pounds. Dogs that are poor surgical candidates may benefit from a custom brace. Trauma to toes: Don’t forget to look at toes as a source of lameness, especially in athletes that turn tight; longer nails can catch on equipment and surfaces when dogs dig in to turn. Also look at the pads closely for corns.

Images courtesy of Penny Kittlitz

In conclusion, rehabilitation therapy has proven to be safe and effective for improving functional outcomes post-operatively, for neurological rehabilitation, and soft tissue injuries. Physical therapy has long been the standard of care for these conditions in human medicine versus the veterinary medicine approach of forced rest. While there is always a place for crate rest, incorporating rehabilitation as a part of our treatment plan speeds healing and provides improved chances for long-term mobility.

References “Safety and functional outcomes associated with short-term rehabilitation therapy in the post-operative management of tibial plateau leveling osteotomy”. Canadian Veterinary Journal. 2015 Volume 56:942-946. ofa.org/diseases/dna-tested-diseases/dm I Kathmann, S. Cizinauskas, MG Doherr, et.al. “Daily controlled physiotherapy increases survival time in dogs with suspected degenerative myelopathy”. J Vet In Medicine. 2006 July-August;20(4): 927-32. Jean GF Joaquin, Stelio PL Luna, Juliana T Brondani, et al. “Comparison of decompressive surgery, electroacupuncture and decompressive surgery followed by electroacupuncture for the treatment of dogs with intervertebral dis disease with long-standing severe neurologic deficits”. J Am Vet Med Assoc. June 2010;236:1225-1229.

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IN CANINE PHYSICAL REHAB By Janice Huntingford, DVM, DACVSMR, CVA, CVPP, CCRT CAVCA

HE ROLE OF THERAPY POOLS AND UNDERWATER TREADMILLS IN PHYSICAL REHABILITATION, AND WHAT TO CONSIDER WHEN ADDING THESE TO YOUR FACILITY.

PROPERTIES OF WATER

When planning an aquatic rehabilitation program, it is necessary to understand the basic properties of water, including relative density, buoyancy, viscosity, resistance, hydrostatic pressure and surface tension, as they relate to rehabilitation.1 • Relative density or specific gravity is the ratio of the density (mass of a unit volume) of a substance to the density of a given reference material — usually water. The specific gravity or relative density of a canine patient varies with body composition, with lean muscle having a lower specific gravity and fat having a higher specific gravity. Objects with a specific gravity lower than 1 (the specific gravity of water) will sink, while those with a higher specific gravity will float. A lean animal that is not moving in the water will sink, while an obese animal will tend to float. This principle needs to be remembered when doing aquatic therapy, since the deeper the water, the less weight is being carried on the limbs.2

would on dry land. With less load on painful joints, the dog is able to exercise more comfortably. Research on women who exercised in a pool in waist-deep water three times a week showed an 18% increase in muscle strengthening and functional fitness. Range of motion (ROM) and muscle strength were both improved in this group while minimizing damage to soft tissue structures.2 • Water’s viscosity also provides resistance to movement. Viscosity is defined as a “measure of the frictional resistance caused by cohesive or attractive forces between molecules in a liquid”. The viscosity of water makes it more difficult for the animal to move through water than through air. This resistance is used to strengthen muscles and improve fitness. Along with the property of buoyancy, the viscosity of the water provides support for unstable joints. A paralyzed dog, for example, is more willing to walk in water than on land because the water holds him up and prevents falling. This greatly reduces the patient’s anxiety about exercise. If a patient is quite weak, he is able to move more comfortably in water than on land. The resistance of the water allows him to get a more intense workout in a shorter period of time.2

• When a dog is immersed in water, the water exerts pressure on all parts of the animal. Hydrostatic pressure (the pressure of water) follows Pascal’s principle (a pressure change in one • Buoyancy is defined as “the upward thrust of water acting part is transmitted without loss to every portion of the fluid). on a body that creates an apparent decrease in the weight This pressure is exerted constantly while the dog is in the of a body while immersed”. This is Archimedes’ principle, water, providing a superior environment for the treatment which states that if a body is fully or partially submerged in of swollen joints or limbs and other edematous tissue. Not a fluid, it experiences an upward thrust equal to the weight only does the water pressure reduce edema, but it also of the fluid displaced. The buoyancy of water aids in the provides stimulation to skin afferent sensory receptors and rehabilitation of weak muscles and painful joints. It allows reduces surface nociceptor activity. This type of stimulation the patient to stand and exercise while minimizing weightdecreases the animal’s pain perception and allows him to bearing on sore joints. If a dog is immersed in water to midexercise with considerably less discomfort.2 chest, his joints are bearing only 38% of the weight they

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• Surface tension is defined as the mutually-attractive force of water molecules at the surface of the water. Water molecules are more tightly adhered to each other at the surface than underneath the water. At the surface of the water, therefore, there is a higher resistance to movement. It takes more energy to break the limb free of the water. The therapist can take advantage of this principle by varying the water in an underwater treadmill.2

BENEFITS OF HYDROTHERAPY Exercising in water has many benefits. It improves strength and muscular endurance, cardiovascular fitness, range of motion, and well-being. Most dogs find water exercise, particularly swimming, to be fun! Dogs recovering from anterior cruciate surgery, fractures, neurological conditions, tendon or ligament injuries benefit greatly from aquatic therapy as part of their rehabilitation. Overweight, arthritic and senior dogs, and those with hip dysplasia or spondylosis, are also good candidates. Aquatic therapy engages muscles that are difficult to recruit with land exercises alone. It is less strenuous for the patient as it does not cause concussive forces on injured joints. Even dogs that do not suffer from any of these diseases can benefit from the increased level of fitness that aquatic therapy provides. Swimming or hydro treadmill sessions are often added to the conditioning regimes of canine athletes in the off season, in order to maintain appropriate cardiovascular fitness.3

Ideas for generating revenue with an underwater treadmill 1. Obesity clinics for weight loss, for geriatric dogs in particular 2. Packages including underwater treadmill for rehab clients 3. Packages for spa days 4. Packages for fun swims 5. Conditioning packages for canine athletes 6. Get referrals from other practices and social media for rehab or wellness care

PRECAUTIONS TO KEEP IN MIND Some precautions need to be taken before instituting a hydrotherapy program. Dogs with open wounds or sores, and those that have breathing difficulties or heart disease, are not candidates for aquatic therapy. Additionally, if a dog panics in water, aquatic therapy may not be right for him; he may injure himself thrashing in the water. Lifejackets, swim buddies, and competent aquatic therapists may be able to help such a dog get used to swimming. Alternatively, the underwater treadmill may be a better choice. The therapist must determine the dog’s fitness level as swimming in particular can be very strenuous. After surgery, a dog may only be able to swim or walk in an underwater treadmill for a short period, due to fatigue.4

HYDROTHERAPY EQUIPMENT Although rehabilitation can be done effectively without hydrotherapy, clients have an expectation that a rehabilitation practice will offer hydrotherapy. Most small animal practices with rehabilitation services will offer an underwater treadmill, pool sessions or sometimes both. Successful marketing of a hydrotherapy program can accelerate the growth of a clinic’s rehabilitation service. This marketing should be aimed at the general public as well as veterinary

What to look for when purchasing an underwater treadmill • Long enough belt for patients expected • Incline or decline • All glass in and out doors and large viewing windows • Programmable • Slowest speed 0.1 mph • Jet for resistance • Hooks to allow attachment of slings for neurological patients • Wide enough to allow a therapist in with every patient • Quick release for ease of cleaning • Displays time, speed and distance • Good reliable company to help with training, onsite service and maintenance.

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surgeons within a certain geographic radius. Investing in equipment such as underwater cameras and video are critical; it allows for the documentation of a patient’s progress, which can be easily shared on the clinic’s social media page.2,4 A comparison of the benefits of swimming and underwater treadmills is shown in the table opposite. Pools can either be custom built or prefabricated “drop in” models. They come in a variety of sizes and can be completed with decking for easy access. Pool jets can be added to increase resistance and therefore the work done by the patient. Disadvantages to swim therapy include the expense of installation, the space required to house the pool and associated pumps and equipment, and the costly water quality and air quality equipment needed to ensure the comfort and safety of both dogs and therapists. Daily costs of heating and maintaining the pool also need to be considered. Several companies now market underwater treadmills, so you can explore the options before choosing a brand. All underwater treadmills should have an entrance and exit door, a reservoir tank for water, a heater and filter. Some of the extra options available with these units include incline/ decline, and therapy jets. Other useful equipment includes either a mirror or camera with a projection screen, so the therapist can visualize the patient’s gait while she is in the treadmill. A treadmill-specific bench is also a good piece of equipment to have, since with neurological patients, the therapist often has to assist with gait patterning. Life jackets, harnesses, slings, head wraps, leg weights, pool noodles and toys are essential for hydrotherapy. 2,4 The

sidebar on the previous page summarizes what to look for when purchasing an underwater treadmill. Underwater treadmills are complicated and expensive pieces of equipment that need to be properly maintained. Daily maintenance and cleaning protocols need to be put in place to ensure the machine continues to run efficiently. Before purchasing, talk to other rehabilitation professionals in your area to gauge the service availability for each particular treadmill, and what problems they have encountered. Even if the manufacturer offers stellar service, it is a good idea to have an ongoing relationship with a local pool company with maintenance people who can assist in the event of a plumbing issue or pump failure.

INDIVIDUALIZING PATIENT PROTOCOLS With any rehabilitation patient, the therapist and dog owner must develop specific goals for recovery. Underwater treadmill and swim therapy both involve interval training with frequency of exercise, length of exercise session, and how many repetitions occur in each session. These parameters will change as the patient progresses through therapy. Protocols for canine athletes will vary depending on the owner’s goal and the level of fitness that needs to be maintained. Varying resistance with jets, incline or decline, the height of water and speed of activity will be needed to challenge these patients.3

MAXIMIZING REVENUE WITH HYDROTHERAPY Running a pool or underwater treadmill is associated with significant costs, which means income should be maximized for a good return on investment. Assuring your aquatic therapy is delivered at a time convenient for clients is key. Offering early or late appointments and weekend sessions may be necessary. Setting up obesity clinics for overweight pets, or conditioning clinics for canine athletes, may be another way to maximize investment. Introducing puppy swims along with puppy training classes is another way to showcase your facility. Having prepaid packages that clients can purchase for any type of hydrotherapy is another good marketing strategy. See sidebar on previous page for ideas on revenue generation with an underwater treadmill. Aquatic therapy has many benefits for our canine rehabilitation patients. Scientific research into aquatic therapy as applied to humans has revolutionized sports medicine; and as more canine research is forthcoming, further benefits of aquatic therapy will become apparent.

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COMPARISON OF THE BENEFITS OF SWIMMING AND UNDERWATER TREADMILL (after Chiquoine et al, 2013)

THERAPEUTIC SWIMMING

UNDERWATER TREADMILL

Totally non-weight-bearing

60% weight-bearing

Max active ROM of joints

Improved active ROM compared to land

No gait retraining as is non-weight-bearing

Proprioceptive gait training in neurological patients

Improved core and trunk strength

Improved balance

Cardiovascular fitness

Better for cautious fracture loading – not ballistic

Builds endurance

Builds lean muscle in the limbs

Fun for patients who enjoy swimming

Helps timid or new swimmers

Facilitates all PROM and body work

Speeds gait retraining

Levine D, Marcellin-Livttle DJ, Millis DL, et al. “Effects of partial immersion in water on vertical ground reaction forces and weight distribution in dogs”. AJVR 70:1444–1449.

Tomlinson R. “Use of canine hydrotherapy as part of a rehabilitation program”. Vet Nurse 3(10):624–629, 2013.

Chiquoine J, McCauley L, Van Dyke J. In Aquatic Therapy. Canine Sports Medicine and Rehabilitation, 2nd Edition. Zink and VanDyke (eds). Wiley Blackwell, 2018.

Egan P, Fitzpatrick N. “Therapeutic Exercises Part 2”. Hydrotherapy (Aquatic Therapy) In Physical Rehabilitation for Veterinary Technicians and Nurses. Goldberg ME and Tomlinson JE (eds). Wiley-Blackwell Hoboken NJ 2018, 308–328.

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RECOGNIZING

SOFT TISSUE INJURIES IN THE DOG FROM AN INTEGRATIVE PERSPECTIVE

â&#x20AC;&#x201C; part 1

By Kimberly Henneman, DVM, DACVSMR (EQ, K9), FAAVA, DABT, CVA, CVC

Applying rehab and physiotherapy techniques to an injured dog should be preceded by a proper consideration of how the injury developed and progressed, and how it affects the health and function of the entire body.

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he care of the canine athlete in performance and working disciplines is finally getting muchneeded attention and awareness. While this seems to be a new and rapidly-growing aspect of veterinary medicine, working dogs have needed extra care and consideration since humans first started using them over 2,000 years ago. The selective manipulation of natural canine behavior and body types to produce dogs that perform specific tasks for humans has created various problems often not recognized by current conventional orthopedics. And with the recent growth of agility, flyball, obedience, herding, snow/dry-land sled racing, and nose-work as competitive “hobbies”, more dogs than ever before are considered to “have jobs”. Additionally, due to increased public security concerns and population use of recreational venues, new demands are developing for the use of dogs in patrol/protection (Shutzhund, French Ring), detection (explosives, drugs, arson, mold, termites, bed bugs, food, poachers, wildlife management), urban/ back-country search and rescue (SAR), and avalanche rescue/recovery. With greater use and value (both monetary and emotional) comes an increased need for different ways of thinking regarding the health management of these dogs. While the number of veterinary practitioners trained in physiotherapy (or PT, rehabilitation) is growing rapidly, the techniques of applied healing after injury can’t achieve their maximum value without proper consideration of the chronological progression to, and the global body health repercussions created by, any one injury. Currently, the veterinary world seems to be putting more emphasis on the sequelae of injury (surgical corrections and physiotherapy management) rather than thorough diagnosis of primary and secondary injuries. Integrative veterinary practitioners with functional biomechanical, neurologic, structural, manipulative, herbal, homeopathic, acupuncture and nutritional knowledge are uniquely positioned to play significant roles in the healthcare and management of the canine athlete.

MUSCULOSKELETAL ISSUES IN PERFORMANCE AND WORKING DOGS With the increased use of dogs in sport and work, musculoskeletal injuries similar to those seen in human and equine athletes should be thought to be inevitable – so why aren’t they diagnosed more? While much is changing with the increasing awareness of performance and function-limiting

Athletic dogs involved in canine sports such as ﬂyball are more susceptible to musculoskeletal injuries.

This article will review unique considerations involving the canine athlete, as well as some of the more common injuries that an integrative veterinary sports medicine and/or rehabilitation practitioner might encounter in practice. (For additional in-depth information regarding “the working dog”, readers are referred to the author’s chapter in the new edition of Canine Sports Medicine and Rehabilitation, Zink and Van Dyke, Editors.)

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and physiotherapy techniques can only provide better diagnosis and care for these amazing canine athletes.

Canine drive

injuries, and their importance in canine athletes (whether “pros” or weekend warriors), there are still limitations in the identification and prevention of these injuries, especially soft tissue ones. Many muscle, tendon, ligament and fascial injuries still go undetected or receive inadequate treatment. Some ligaments are so small that damage is written off as meaningless by everyone but the dog! There is also a marked lack of knowledge about the unique emotional and physical demands placed on dogs in different disciplines, especially when it comes to the biomechanical interactions between various body parts. This affects the practitioner’s ability to make proper recommendations for future injury prevention, as well as follow-up treatment and rehabilitation when an animal finally goes back into work. Also, extra physical and mental performance demands are placed on these dogs, similar to those seen in the equine world. When a title or important event takes place, dogs that may not be 100% healthy are still expected to perform, especially if subtle symptoms of problems go unrecognized by either handler or veterinarian. Use of performance-enhancing medication is not banned in these animals, and medication use, overuse and side effects are not well worked out in the canine athlete (especially the effects of medication on the ability to scent). Rehabilitation, PT and physiotherapy in the working and performing dog have gained in use and recognition, but sadly, it is usually limited to addressing functional loss after an injury. Veterinarians with integrative modality training and thinking are much better placed to evaluate the true cause of an injury (posture, gait biomechanics, functional neurology, human/ animal interface) when an animal is presented for treatment. Veterinarians and allied professionals with training in manual and manipulative techniques usually have a deeper grasp of global body biomechanics, structural relationships, functional anatomy and neurology than colleagues without this training. Integrating this knowledge with more conventional surgical

Working and performance dogs are selectively bred and trained to have a high drive (desire to do a task). They will continue to work through all but the most severe injuries. All the sporting and working aspects that a dog is trained to manifest have their origins in either the stalking or hunting drives. Training is meant to enhance and channel the various behavioral components of stalking, hunting and killing drives into activities that are beneficial to humans. In the wild, dogs will rest in between hunting activities. The signs of mental fatigue are just as varied in the dog as they are in the human, and are often ignored until the animal either shuts down or suffers a physical injury. Clients and handlers may lose perspective on their animals’ rest needs due to performance and work demands, so high drive owners of high drive dogs need help and advice on how to recognize mental fatigue. There’s a joke about drive in distance sled dogs. When a sled dog realizes his leg has fallen off, he just says, “No worries! I’ll just pick it up on my way back.” This attitude isn’t found solely in Alaskan Huskies. Herding dogs, hunting dogs, police/protection and many detection dogs will continue to finish their goals of getting the “prey” despite serious musculoskeletal injuries. Caretakers and veterinary healthcare practitioners cannot rely on obvious pain signals from the animal to alert them that something is wrong; a three-legged canine athlete usually means something serious, such as significant pain or an unstable leg. A working dog’s high pain threshold means he’ll ignore the little things that might stop a pet dog – thus turning a small injury into something more devastating. Educating handlers and caretakers about the importance of regular manual therapy maintenance for canine athletes (especially with weekend warriors) is beneficial to the owner, the veterinary practitioner, and most of all, the dog.

Trans-neural degeneration (TND) This is a well-recognized physiotherapy issue and should always be in the forefront of any practitioner’s mind when evaluating an injured patient, especially if that patient is a little older or is otherwise compromised. TND is the death of neurons resulting from a disruption of either the input or Continued on page 26.

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DIAGNOSTIC TOOLS

– the challenges and benefits • Radiology: Lameness diagnosis in the canine has been driven for so long by the use of radiology that many practitioners may actually have a “black and white” bias without realizing it. The emphasis with radiographs is to look at bones only and ignore the black void of “nothing” – the soft tissue. • Ultrasonography: While the use of musculoskeletal ultrasonography is growing, it is difficult to know where to put the ultrasound probe as it has a very narrow focus. Even one limb is too big to ultrasound in its entirety, and few clients would want the entire leg to be shaved. This is where digital thermography can be a valuable tool. • Digital thermography: This is a very valuable and flexible tool. It measures emitted infrared heat from a body, so any inflammatory or circulatory-restricting event will cause a deviation away from a normal pattern. Because a large surface area can be scanned quickly, localization of an affected area can be quickly performed, allowing for more focused palpation and anatomical imaging such as radiology or ultrasonography. Note: While it is beyond the focus of this article to delve into the integration of thermal imaging with other modalities in the canine athlete, all cases presented in Parts 1 and 2 of this article are real, clinical cases demonstrating diagnosis of sports medicine and active dog injuries. For reader reference, the ultrasounds are done with a Fuji Fazone machine, using a linear probe usually set between 12 Hz to15 Hz for higher resolution images. The thermal images are taken with a FLIR T620 camera with a rotating lens to assist in better positioning for hard-to-reach spots such as ventral groins and caudal forearms.

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Continued from page 24. output to other nearby neurons – a type of excitotoxic process that occurs when a neuron is overstimulated by a particular neurotransmitter. The systems particularly at risk are those that use glutamate as an excitatory neurotransmitter – the subtypes of glutamate receptors are NMDA, AMPA/kainate and mGLUR (metabotropic receptor). Glutamate is primarily an intracellular neurotransmitter kept closely in check by regulatory processes. If too much glutamate is extracellular, it over-binds to nerve cell membranes, creating toxic effects on cells via overstimulation and the production of free radicals, increased metabolic wastes, and the exhaustion of fuel needed for aerobic metabolism. Nerve cells need oxygen, glucose and frequency-of-firing (being told what to do) in order to stay healthy. Neurons that are directly or indirectly affected by trauma may be compromised by lack of oxygen, deficient glucose, and intracellular dysfunction of oxidative mechanisms within the mitochondria. Overstimulation (frequencyof-firing) from manipulative treatment, soft tissue body work, rehab exercises, acupuncture, or too much voluntary movement on the animal’s part can lead to loss of neurons. A young animal can tolerate this with few obvious clinical signs…yet at a cost. The “credit” of the body’s functional nerve cells is depleted and losses may not be apparent for several years. In an older animal with fewer tissue reserves, TND can lead to significant compromise of the entire neurologic system. TND manifests by muscle and cognitive fatigue and slow recovery after therapy. Animals are not better after rest, and may actually worsen (which differentiates from the endorphin effect seen after a beneficial adjustment). To avoid TND, older animals, animals immediately post-operative (with exposure to anesthesia neurotoxins), or those with significant healing needs should be carefully assessed to determine how therapy fits into the whole picture. It may be better to only work on one or

An integrative examination can take place anywhere; here, the author is examining an international level sheep dog in a quiet spot at the competition venue.

two issues with one, maybe two, therapies at a time, allowing a few days to weeks for rebalancing and healing in between sessions. Any additional therapies that the owner/caretaker may be performing must also be taken into account. For example, scheduling a chiropractic treatment on the same day as a rehab or acupuncture session may create TND and not be in the best interest of the animal. Those trained in the manipulative and manual modalities have unique training and knowledge in functional neurology and are often more aware of the pitfalls of TND than those trained in other modalities. These practitioners should work to become an integral part of an animal’s recovery and health maintenance while educating other health professionals.

Physiotherapy (rehabilitation) vs. manipulative therapies (chiropractic or spinal manipulation, osteopathy) and massage

approach their evaluation of canine athletes with an open mind and the attitude that anything, anywhere, can tear if the right force happens to be on it, even if just for a moment. While some injuries tend to be more common, the strength of integrative training is that it is non-linear – practitioners are trained to get to the same place through many different routes. That same attitude needs to be taken with injuries and lamenesses – not all hind limb lameness issues are from cruciate ligament injuries, just as not every front leg lameness is a shoulder problem. This is where a deep knowledge of functional anatomy (fascia, tendons, ligaments, muscles) and biomechanics (functional fascial lines, muscle agonists/ antagonists) is critical for the practitioner who wants to work with canine athletes.

CONCLUSION The fields of canine sports medicine and rehabilitation are growing rapidly. Even without rehabilitation training or certification, integrative practitioners can contribute much, thanks to non-conventional training in problem-solving, structural alignment perspectives and neuromuscularfascial systems. See sidebar on page 28.

The current mindset surrounding rehabilitation comes from the human physical therapy world, where it’s all about fixing deficiencies caused by physical damage to tissue (postsurgical or caused by activity). The goal is to get the animal back to a “function” – whatever that was. However, those trained in manipulative and manual therapies understand that the function before the injury may have been deficient or unbalanced, leading to the presenting injury. Bodywork and manipulative therapies aim to restore structural equilibrium, which involves proper health and function of the complex neuromyofascial-skeletal system. Repetition of strengthening exercises eventually reaches a point of diminishing returns if there are unaddressed joint and soft tissue areas (especially spinal). Repetition of exercises using a checklist mentality will only exacerbate muscular imbalances of contraction and stretching without addressing the source problem. This is where integrative practitioners and/or structural alignment techniques should be considered integral to injury rehabilitation and body maintenance in canine athletes. Their focus is on the individual dog, and they look beyond merely the current injury.

UNDERSTANDING FUNCTIONAL ANATOMY It is beyond the scope of this article to discuss each and every injury a working dog could end up with. Practitioners should IVC Fall 2018

Diagnostic approaches for specific areas In this issue, we will discuss diagnostic approaches for shoulder problems. In Part 2, in the next issue of IVC Journal, we will continue with diagnostic approaches for the carpus, toes, lumbosacral spine, iliopsoas, stifle, common calcaneal tendon, tarsus and metatarsals. It will also briefly cover integrative treatment approaches for the canine athlete. Readers are encouraged to review (in detail) the functional anatomy and biomechanics of each discussed area.

Shoulder problems The rotator cuff muscles of the canine shoulder are the supraspinatus, infraspinatus, teres minor and subscapularis muscles, with additional stability provided by the medial and lateral glenohumeral ligaments. An important fact to remember is that the accessory spinal nerve (CN XI) innervates the extrinsic muscles of the shoulder (trapezius, omotransversarius, sternocephalicus and cleidomastoideus), which are critical for scapular stabilization to the trunk as well as scapula movement. Therefore, an upper neck injury can cause problems in the proximal forelimb. The biceps tendon insertion merges with the elbow medial collateral ligament. Damage to one can affect the other and put a great deal of mechanical stress and potential bone trauma on the medial ulnar coronoid process. Shoulder problems seem to be the “diagnosis of the month” due to recent awareness of various problems such as medial compartment (or shoulder) instability (MCI/MSI), biceps tenosynovitis, supraspinatus insertionopathy, contracture of the infraspinatus muscle, OCD (juvenile osteochondritis dessicans), and osteoarthritis from rotator cuff laxity leading to instability (especially of the teres minor). Inflammation of the supraspinatus tendon at the insertion can impinge on the biceps tendon, causing a tenosynovitis to that tendon; however, the biceps injury cannot be fully addressed until the supraspinatus muscle damage is addressed. • Medial compartment problems are one of the most common issues reported in the canine athlete, and are thought to be caused by gradual tissue fatigue from repetitive shoulder stresses – especially at the end of abduction range-of-motion (such as weave poles in agility). One-time events such as slipping on wet or frozen surfaces, or well-placed kicks in herding dogs, are also thought to be possible causes of MSI, as well as injuries to the teres major and minor muscles. • Biceps tenosynovitis is probably the next most common problem. The biceps tendon can be injured a couple of ways. First, damage can occur near its origin due to pressure and rubbing from an inflamed supraspinatus insertion tendon (which

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often isn’t checked by surgeons). Second, the biceps muscle, because it crosses over two large joints (and is intraarticular) can be injured (muscle belly and both tendons) by excessive jumping, or slipping while turning on wet ground. • If a physical exam in a dog with shoulder lameness fails to find any pain or injury to any of the above mentioned tissues, the neck should next be examined closely for loss of lateral flexibility, scar tissue or asymmetry in muscle development. These can all be signs that the problem might be more associated with cervical spinal causes than direct trauma to the joint. Spinal fixation trouble areas are often seen at C5-C6, C6-C7, and at the atlanto-occipital joint. The author finds C4 is often cranial (anterior) and rotated left in flyball and obedience dogs.

Diagnostic tests for the above lesions • MSI (medial shoulder instability): Significant abduction of the shoulder joint from the torso, arthroscopic verification of damage to the subscapularis tendon and medial glenohumeral ligament. • Biceps tenosynovitis: The classic test is to flex the shoulder while extending the elbow; with the shoulder flexed, the elbow should to extend to about 110° to 120° with a definite soft tissue end-feel. In torn biceps, the elbow may extend significantly more than normal, or the joint will lose its normal soft tissue end-feel, extending until the anconeal ulnar process locks in the humeral notch. Restrictions from old injuries and scarring will decrease the elbow extension to 90° or less. Ultrasound, thermal imaging and palpation can identify areas of pain and trauma. If the injury is mostly at the insertion, thermal imaging is helpful; many of these injuries are easily palpated at the medial elbow. There may be a link between fractured coronoid processes and chronic biceps insertional tendonitis. (Note to equine practitioners: the author has diagnosed biceps insertional tendinopathy injuries with thermal imaging and ultrasound; this area is not recognized as an injury in the horse but certainly can occur there.) • Supraspinatus insertionopathy: Ultrasound is the diagnostic technique of choice. Palpation may pick up those injuries that are painful (not all are painful), and radiographs may identify chronic injuries that have progressed to the point of tendon calcification. Thermal imaging will pick up those that are inflammatory but not degenerative. • Infraspinatus muscle or insertional tendon trauma: In these dogs, the leg is functionally abducted at the shoulder with marked resistance to adduction; ultrasound can be diagnostic for early injury where abduction has not yet

From the AAVA The American Academy of Veterinary Acupuncture is committed to improving animal health care by the advancement of veterinary acupuncture, Traditional Chinese Veterinary Medicine and Traditional Asian Veterinary Medicine, through education, research and leadership.

Photo 1

Photo 2A

Photo 2B Photo 1: Ultrasound showing impingement of a biceps tendon by the supraspinatus tendon (longitudinal view of medial shoulder at 14 Hz). Photos 2A & 2B: Image 2A is an ultrasound of a very active ten-month-old MI hound. The puppy was initially diagnosed with shoulder JT OCD although no signs were present on an x-ray. Dye contrast study showed no issues and made the dog significantly lamer. Ultrasound showed normal joint margins and normal biceps tendon, but a significant tear of the teres minor muscle. Image 2A shows the affected shoulder, while 2B shows a normal shoulder for comparison. We were unable to thermal image the pup due to the clipped hair artifact from the shoulder joint injection.

occurred. Once mature or calcified scar tissue has formed, these cases are much more difficult to manage. • Teres minor muscle injury: If there is resistance to scapular and shoulder extension, with the dog standing but unweighting the affected leg, encircle the triceps muscle both medially and laterally with thumb and forefinger until both fingers are in the dip cranial to the triceps, but behind the shoulder joint. Pinch gently both with the joint flexed and extended.

The American Academy of Veterinary Acupuncture (AAVA)’s seat within the AVMA House of Delegates (HOD) gives us multiple opportunities to represent veterinary acupuncture. At our 2018 annual conference in Santa Fe, New Mexico, Dr. Bonnie Wright, a recognized expert in pain management, was our keynote speaker. She presented scientific principles of veterinary acupuncture along with many clinical pearls and applications of her favorite acupuncture points. The annual Lifetime Achievement Award was presented to Dr. Mona Boudreaux, an AAVA Past President, IVAS teaching assistant and course host, and a tireless promoter of holistic veterinary medicine. The AAVA hosts smaller, regional, hands-on meetings for equine and small animal participants. For the second consecutive year, our equine wet lab took place in June, with Dr. Chris Cahill, in South Carolina. We were again hosted by the Equine Rescue of Aiken. This group works tirelessly to rescue horses while providing community service to at-risk youth and military veterans – we are proud to partner with this organization. Keep an eye out for announcements about a small animal regional wet lab in the fall/winter. If you have ideas, concerns, or feel the call to become more involved, we’d love to talk with you. Please connect with us through the AAVA office at office@aava.org.

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Report:

presumed natural or shed vaccine viral exposure in

unvaccinated puppies By W. Jean Dodds, DVM

Some pet caregivers are reluctant to vaccinate their young puppies for even the more serious communicable infectious diseases, like canine distemper virus (CDV) and canine parvovirus (CPV). Once the residual maternal immunity from the dam has waned, typically at or after 14 weeks of age, families caring for these unvaccinated pups have reported that they remain healthy. In some cases, serum antibody titers have been measured at 12 to 24 weeks of age, and most have some measurable levels of CDV and CPV immunity.

This gives rise to the following question: how do these unvaccinated animals have measurable immunity to these two viruses? Presumably, they have been exposed to low levels of shed vaccine virus from other vaccinates they encountered, and/or experienced natural viral exposure from low amounts in the surrounding area. To look at this question, a review of our serum antibody testing for CDV and CPV at Hemopet/Hemolife over the prior 18 months revealed the following:

Age of dogs at testing

Number of CDV + CPV samples (Jan 1, 2017 to June 30, 2018)

Remarks

All ages

4,181

>96% adequate immunity

Six months

All adequate

Less than six months

160

91% adequate

Four months

90% adequate; six had no vaccines; immunity present*

Less than four months

78% adequate CPV; 100% CDV

Three months

67% adequate CPV; 100% CDV

Less than three months

Residual maternal immunity present

*Immunity level was VG/VG for one, and A/A for the other five (VG = very good; A = adequate)

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This data shows that six of 62 pups tested for CDV and CPV serum antibodies at four months of age had measurable titers – but only one had very good antibody levels by that age. These results suggest there was some exposure to the natural CDV and CPV viruses, as residual maternal immunity should have been undetectable or low by that time, although this possibility could not be completely ruled out. Of the 4,181 dogs of all ages that were serum antibody titertested, only 0.14% had received no vaccines. Five of the six four-month-old puppies that had not been vaccinated had only adequate serum titers, and so subsequently received one dose of a bi-valent distemper /parvovirus vaccine. All five had developed very good serum antibody titers to both viruses when rechecked a month later. Further study of unvaccinated puppies is needed, however, because even with the informed consent of their guardians, the risks of viral exposure and illness in unvaccinated puppies creates an ethical dilemma for clinical researchers.

References American Animal Hospital Association (AAHA). Canine Vaccination Task Force: Ford RB, Larson LJ, Schultz RD, Welborn LV. 2017 “AAHA canine vaccination guidelines”. J Amer Anim Hosp Assoc. 2017; 47(10): 26-35. Dodds WJ. “Vaccination protocols for dogs predisposed to vaccine reactions”. J Amer Anim Hosp Assoc. 2001; 38: 1-4. Dodds, WJ. “Efficacy of a half-dose canine parvovirus and distemper vaccine in small adult dogs: a pilot study”. J Amer Hol Vet Med Assoc. 2015; 41:12-21. Winter Issue. Dodds, WJ. “Vaccine issues and the World Small Animal Veterinary Assocation (WSAVA) guidelines (2015-2017)”. Israel J Vet Med 2018; 73(2): 3-10. Twark L, Dodds WJ. “Clinical application of serum parvovirus and distemper virus antibody titers for determining revaccination strategies in healthy dogs”. J Am Vet Med Assoc. 2000; 217: 1021-1024.

IVC Fall 2018

ALTERNATIVES TO TRADITIONAL SPAY AND NEUTER Evolving best practices in dog sterilization By Linda Brent, PhD, MBA and Michelle Kutzler, DVM, PhD, DACT

tandard spay and neuter surgery can have negative impacts on a dog’s health. What are some alternative options?

In the United States, broad scale pet sterilization has been advocated to decrease pet overpopulation and euthanasia rates at shelters. This practice has become standard, with shelter animals being sterilized before adoption and most pet owners spaying or neutering their animals even if not adopted from a shelter. The decrease in the number of pets entering shelters (estimated at six to eight million currently, down from 13 million in 1973), and the resulting decrease in euthanasia rates, are cited as successful outcomes of spay/neuter programs.1,2 However, removing an animal’s reproductive organs can have adverse effects as well as benefits. This article looks at some alternatives to spay and neuter surgery.

PROS AND CONS OF GONADECTOMY In the US, sterilization involves removal of the reproductive organs (gonadectomy), usually through ovariohysterectomy (spay) of females and orchiectomy (castration) of males. These procedures eliminate the hormones produced by these organs. While gonadectomy makes it impossible for the pet to reproduce, what other impacts does a lack of sex hormones have on the pet? Research projects to answer this question first evaluated the difference between early and later gonadectomy, usually supporting the early sterilization practice of sheltered pets.3,4 More recently, research has broadened to compare large numbers of gonadectomized dogs with intact dogs.5,6 This area of study is relatively new, but the research indicates that gonadectomy confers a mixture of benefits and adverse

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effects, depending on age at neutering, breed and sex.7 Eliminating sex hormones has the positive effect of reducing mammary, ovarian and testicular cancers, pyometra, perineal and inguinal hernias, prostatitis, benign prostatic hyperplasia, prostatic cysts and squamous metaplasia of the prostate. Intact dogs have a higher incidence of infectious disease and sterilized dogs have higher cancer rates, with the latter often reported as having longer lifespans.8 On the other hand, gonadectomized dogs have been reported to have a higher incidence of obesity, urinary incontinence, urinary calculi, atopic dermatitis, autoimmune hemolytic anemia, hypoadrenocorticism, diabetes mellitus, hypothyroidism, immune-mediated thrombocytopenia, inflammatory bowel disease, hip dysplasia, cranial cruciate ligament rupture, aggressive and fearful behavior, cognitive dysfunction syndrome, prostate adenocarcinoma and transitional cell adenocarcinoma.6,9–12 Musculoskeletal issues may be especially significant for large breed dogs gonadectomized before they have finished growing, as bone physeal closure is delayed. A significant contributor to the negative health impacts of removing the gonads in dogs is that the natural hormone feedback mechanisms become unregulated. Normally, the pituitary gland releases luteinizing hormone (LH), which then stimulates the production of steroid hormones from the gonads. Without the gonads, there is no feedback signal to reduce production so LH concentrations remain very high for the remainder of the dog’s life. Receptors for LH are present in the urinary tract, skin, thyroid, blood vessels, ligaments, bone, synovium, immune cells and brain.12 Elevated LH concentrations resulting in activation of these receptors may predispose gonadectomized dogs

to developing the health problems listed previously.

ALTERNATIVE OPTIONS TO TRADITIONAL SPAY/ NEUTER Responsible pet ownership It is interesting to note that while gonadectomy is viewed as the standard in the US, it is relatively uncommon in other regions of the world. In Norway and Sweden, for example, there are virtually no stray dogs and neutering is very uncommon, usually only allowable due to health concerns.13 To avoid unwanted pregnancies, responsible pet owners of intact dogs must take special precautions. Females go into heat for a few days once or twice a year and need to be confined in an area without access to intact males. Male dogs should not be allowed to roam freely, as they are incredibly persistent in reaching a female in heat. Other issues to consider include females bleeding while in heat; behavior changes that may be triggered by changing hormones; the logistics of having both male and female intact dogs in the same house; and health monitoring for diseases of the reproductive organs. Responsible dog owners are expected to manage these issues. Hormone-sparing sterilization Not all pet owners are ready to keep an intact dog and guarantee that no unwanted pregnancies will occur. Luckily, there are options that will ensure a dog is incapable of reproducing while keeping his/her natural gonadal hormones to protect his/her health. Females: A hormone-sparing option that sterilizes a female dog involves conducting a hysterectomy (also called ovary-sparing spay or partial spay) by removing the uterus and leaving the ovaries intact. It is important to remove all the uterus to ensure that stump pyometra does not occur. Continued on page 34.

An ethical dilemma Questioning whether gonadectomy is really in the best interest of the dog has raised the hackles of many veterinarians and organizations who work hard to sterilize animals in the US to reduce pet overpopulation. Interpretation of research results has been hotly debated, with many arguing that differences in the long-term health of gonadectomized dogs are negligible, and others arguing that they are serious enough to reconsider the wisdom of widespread spay/neuter programs. The issue represents a common ethical dilemma – is the welfare of the population more important than the welfare of the individual? In other words, is the positive impact of gonadectomy on reducing pet overpopulation more important than the possible negative impact on an individual dog’s long-term health and welfare? Stepping back from the debate, it is not surprising that the loss of natural gonadal hormones has signiﬁcant health implications for the dog. As veterinary practitioners, it makes sense for us to understand and discuss the pros and cons of gonadectomy with clients when decisions about sterilization are made. This individualized approach is supported by the American College of Theriogenologists.10 This doesn’t require locking into adversarial positions or giving up spay/neuter. Fortunately, there are a number of alternative methodologies to consider, including methods for sterilizing dogs while maintaining hormone levels. The next step is to evaluate the different options available to the dog owner or adopter, and determine the best option for the particular dog and situation.

A note on behavior Gonadal hormones can have behavioral effects, and hormone-sparing options are appealing to dog owners who do not want changes in behavior (e.g., for performance or hunting dogs). On the other hand, many express the concern that leaving dogs with natural hormone levels will produce undesirable behaviors. This sentiment is common in animal welfare and rescue/shelter communities, with the rationale that dogs may display more inter-male aggression, urine marking, mounting and roaming, which may result in owners abandoning or returning their pets and thus increasing shelter populations. We are beginning to understand that behavior is under the inﬂuence of a number of psychological and physical stimuli, and that no simple straight-line relationship between hormones and undesirable behaviors exists. For example, eliminating testosterone may not make a dog less aggressive. In fact, a recent large survey reported that gonadectomized dogs did not differ from intact dogs in terms of aggression directed toward familiar people or pets, and they actually showed higher levels of aggression toward strangers.5 Dog aggression is a main reason for relinquishment to shelters17 and neutered male dogs were more often surrendered for such behavioral reasons.18 Gonadectomized dogs may also develop more anxiety and fear, and show more cognitive decline than intact dogs.19,20 The dog’s age, breed, personality and environment will impact his/her behavior. When choosing a hormone-sparing method, if a dog evidences behavioral issues later, traditional spay or neuter can then be considered. Keep in mind that castration of adult male dogs may decrease reproductive-related behaviors (urine marking, mounting and roaming) but impacts on other behaviors are variable.21 IVC Fall 2018

Continued from page 33. making it an ideal target for hormone-sparing sterilization procedures. Injection of a necrotizing agent, such as calcium chloride in alcohol, can effectively disrupt the ability to produce sperm. Leoci and colleagues reported success with this non-surgical approach using ultrasound guidance (personal communication, 2018). The dogs retained normal Ovarian cancer is often cited as an argument for hormone profiles, yet were sterile. Other options, such as removing ovaries — but ovarian cancer is epididymal ligation15 or therapeutic ultrasound,16 are rare, and the small risk does not outweigh Parsemus.org promising approaches that require more refinement the health benefits of preserving offers information on for use in companion animals. hormones. However, the dog should After the procedure, the female dog is sterile and bleeding is eliminated. The female will still go into heat due to the influence of hormones produced by her ovaries, possibly showing behavioral changes around this time.

hormone-sparing options,

be monitored for mammary tumors including extensive online MOVING FORWARD after middle age. An owner can do this training material for As our understanding of the long-term health when he/she rubs the dog’s tummy. veterinarians on ovaryconsequences of gonadectomy in dogs grows, These tumors are usually benign sparing spay. the demand for alternative options increases. but should be removed promptly. Unfortunately, the supply of practitioners experienced Veterinarians may wish to establish/offer in alternatives has not met the demand. In most mammary examination as part of annual veterinary schools in the US, students are not taught how to wellness checkups for senior dogs. do hysterectomy or vasectomy, and the number of veterinarians Tubal ligation has also been practiced in dogs, but pyometra remains an issue, as well as bleeding during heat, making ovarysparing spay a better option. Males: For male dogs, a vasectomy sterilizes while sparing testosterone. The procedure involves severing or ligating the vas deferens, the duct that transports sperm. The procedure is quick, less invasive than castration, and not difficult for veterinarians to master.

making these options available is small. At the 2017 AVMA conference, 81 veterinarians were surveyed about the use of nontraditional sterilization methods. Only 7.4% percent reported performing hysterectomies or vasectomies in dogs, whereas 73.4% reported discussing long-term health risks of traditional spay and neuter with dog owners prior to surgery. Parsemus Foundation is doing its part to encourage education, dialogue and communication with pet owners and practitioners. Their website (parsemus.org) offers information on hormone-sparing options, including extensive online training material for veterinarians on ovary-sparing spay. They also maintain a list of veterinarians who offer alternatives to traditional spay/neuter; many have reported

What are the downsides of testicular preservation? Leaving the testicles and hormones intact means that testicular cancer, perianal gland tumor, and enlarged prostate may occur — but if they arise EFFECT OF GONAD REMOVAL ON CIRCULATING LUTEINIZING HORMONE CONCENTRATIONS later in life, they are typically treated via castration. In such Gonadectomized Postpubertal Mammal Intact Postpubertal Mammal a case, the dog’s health still benefitted from years of natural hormones prior to castration. Also, prostate enlargement can now be treated non-invasively with finasteride (Proscar®, Merck) or by using pulsed electromagnetic therapy.14 Hormones will also influence the male dog’s behavior and interest in females in heat, a complex issue discussed in the sidebar on opposite page. Other experimental approaches: The epididymis is the sperm maturation and storage area,

IVC Fall 2018

In the intact postpubertal mammal, the hypothalamus secretes gonadotropin releasing hormone (GnRH), which stimulates the anterior pituitary to release luteinizing hormone (LH). LH stimulates the secretion on gonadal hormones, which negatively feedback to the hypothalamus and anterior pituitary to decrease the secretion of GnRH and LH, respectively. Because there is no negative feedback in the gonadectomized postpubertal mammal, LH will remain persistently elevated at supraphysiologic concentrations for the remainder of the animal’s life.

receiving referrals from this service. Parsemus Foundation envisions a win-win future, when veterinarians offering choices are sought out by dog owners and adopters who want the most appropriate method of sterilization for their individual pets. More vets are needed to turn this innovative trend into an impactful movement. To join the growing list of clinics that Humane Society of the United States. “Pets by the numbers”. No date ; downloaded 6/27/18 from: humanesociety.org/issues/pet_overpopulation/facts/pet_ownership_statistics.html.

Marsh P. “Replacing myth with math: Using evidence-based programs to eradicate shelter overpopulation”. 2010; Town and Country Reprographics, Inc., Concord, New Hampshire.

³ Howe LM1, Slater MR, Boothe HW, Hobson HP, Holcom JL, Spann AC. “Long-term outcome of gonadectomy performed at an early age or traditional age in dogs”. JAVMA 2001;218:217–21. ⁴ Spain CV, Scarlett JM, Houpt KA. “Long-term risks and benefits of early-age gonadectomy in dogs”. J Am Vet Med Assoc 2004;224:380–7. ⁵ Farhoody P, Mallawaarachchi I, Tarwater PM, Serpell JA, Duffy DL, Zink C. “Aggression toward familiar people, strangers, and conspecifics in gonadectomized and intact dogs”. Front Vet Sci 2018;5:1–13. ⁶ Sundburg CR, Belanger JM, Bannasch DL, Famula TR, Oberbauer AM. “Gonadectomy effects on the risk of immune disorders in the dog: a retrospective study”. BMC Vet Res 2016;12:278.

offer safer alternatives to traditional spay and neuter, contact info@parsemusfoundation.org.

ACKNOWLEDGEMENTS

The authors thank Elaine Lissner, founder and trustee of Parsemus Foundation, for her review of an earlier version of this paper, and advocacy for innovative and alternative methods of pet sterilization. Zwida K, Kutzler MA. “Non-reproductive long-term health complications of gonad removal in dogs as well as possible causal relationships with post-gonadectomy elevated luteinizing hormone (LH) concentrations”. J Etiol Anim Health 2016;1(1):1–11, article number JEAH-1–002.

Sallander M, Hedhammar Å, Rundgren M, Lindber JE. “Demographic data of a population of insured Swedish dogs measured in a questionnaire study”. Acta Vet Scand 2001;42:71–80.

Leoci R, Aiudi G, Silvestre F, Lissner E, Lacalandra GM. “Effect of pulsed electromagnetic field therapy on prostate volume and vascularity in the treatment of benign prostatic hyperplasia: a pilot study in a canine model”. Prostate 2014;74:1132–41.

Tamadon A, Nikahval B, Sepehrimanesh M, Mansour ian M, Naeini AT, Nazifi S. “Epididymis ligation: a minimally invasive technique for preparation of teaser rams”. Vet Surg 2010;39:121–7

Leoci R, Aiudi G, Silvestre F, Lissner EA, Marino F, Lacalandra GM. “Therapeutic ultrasound as a potential male dog contraceptive: Determination of the most effective application protocol”. Reprod Dom Anim 2015;50:712–718.

⁷ Kustritz MVR. “Determining the optimal age for gonadectomy of dogs and cats”. J Am Vet Med Assoc 2007;231:1665–1675.

⁸ Hoffman JM, Creevy KE, Promislow DE. “Reproductive capability is associated with lifespan and cause of death in companion dogs”. PLoS One 2013;8(4):e61082.

⁹ Reichler IM. “Gonadectomy in cats and dogs: a review of risks and benefits”. Reprod Domest Anim 2007;44(Suppl. 2):29–35.

Society for Theriogenology, Board of Directors, and the American College of Theriogenology. “Basis for Position on Mandatory Spay-Neuter in the Canine and Feline”. 2013; downloaded 6/27/18 from: c.ymcdn.com/sites/ www.therio.org/resource/resmgr/docs/spay-neuter_basis.pdf.

Zink, C. “Spay neuter considerations to maximize health”. IVC Journal 2017;Feb. 6, 2017.

Weiss E, Gramann S, Spain CV, Slater S.“Goodbye to a good friend: An exploration of the re-homing of cats and dogs in the US”. Open J Anim Sci 2015;5:435-456. Salman MD, Hutchison J, Ruch-Gallie R. “Behavioral reasons for relinquishment of dogs and cats to 12 shelters”. J Appl Anim Welfare Sci 2000;3:93–106. Hart BL. “Effect of gonadectomy on subsequent development of age-related cognitive impairment in dogs”. J Am Vet Med Assoc 2001;219:51–6. Kim HH, Yeon SC, Houpt KA, Lee HC, Chang HH, Lee HJ. “Effects of ovariohysterectomy on reactivity in German Shepherd dogs”. Vet J. 2006;172:154–9.

Neilson JC, Eckstein RA, Hart BL.“Effects of castration on problem behaviors in male dogs with reference to age and duration of behavior”. J Am Vet Med Assoc 1997;211:180–2.

IVC Fall 2018

ORTHOTICS AND THE

VETERINARY NURSE

Physical rehabilitation and veterinary medicine have become intertwined over the past 20 years.1 Assistive devices play a large part in making the lives of veterinary patients comfortable, especially those who may not be surgical candidates for orthopedic repair, or whose owners cannot afford surgical repair.

CLASSIFICATION OF BRACES AND ORTHOSES 1. Braces A brace is an orthopedic appliance or apparatus applied to the body, particularly the trunk and lower limbs, to support the weight of the body, to correct or prevent deformities, or to control involuntary movements.2 Generic braces are prefabricated. Braces are placed across a joint, usually to limit its range of motion or promote its stability.4 Premade braces are affordable and best suited to patients with normal anatomy and healthy skin (See Figures 1, 2, 3 and 4). An assistive device such as OrthoPets™ Toe Ups can be used to good effect in dogs and cats that knuckle over on their back legs because of reduced neural input from degenerative myelopathy, peripheral nerve injury, or proprioceptive deficits.1 Care needs to be taken that the patient can lift the leg sufficiently. The elastic straps are placed under tension and as the animal brings the leg forwards, the elastic aids the foot being moved up into dorsiflexion. This device assists with increasing tarsus (hock) flexion while also keeping the hind paw in a corrected normal standing position (see Figure 5). Also see Table 1 for a list of conditions that respond well to braces. Companies that make premade braces include: Back on Track (backontrackproducts.com) Biko™ Progressive Resistance Bands (animotionproducts.com) DogLeggs Therapeutic and Rehabilitative Products (dogleggs.com) L’il Back Bracer™ (lilbackbracer.com)

By Mary Ellen Goldberg, BS, LVT, CVT, SRA, CCRVN, CVPP, VTSlab animal medicine (research anesthesia), VTS-physical rehabilitation

Prefabricated braces and custom orthoses enhance mobility and quality of life in many patients. The veterinary nurse can play an important role in helping these patients and educating their owners in the use of these devices. 36

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OrthoPets™ (orthopets.com) Thera-Paw Assistive and Rehabilitative Pet Products (therapaw.com)

2. Orthoses An orthosis is defined as any medical device attached to the body to support, align, position, immobilize, prevent or correct deformity, assist weak muscles, or improve function.3

Figure 3 Custom orthoses are usually necessary in patients with abnormal anatomy (limb deformity, abnormal skin contours) and in very small or very large patients.4 Orthoses can be used as preoperative, postoperative or “no-operative” solutions. If surgery must be delayed, orthoses allow the patient to move comfortably, give support to the limb, and reduce disuse atrophy.5

Figure 1

Custom orthoses are made from casts of the patient’s limb or are fabricated directly on the patient using a moldable thermoplastic polymer.6 Heat moldable polymers come in numerous varieties depending on the clinical need and can be designed for use with aquatic therapy. Orthoses can be hinged to stabilize or limit the motion of joints.6 Hinged orthoses are custom made because they must fit precisely. Orthotic prescription should consider skin integrity and cleanliness, hair coat, and other concurrent diseases or medications that may

Companies that make custom orthoses: Animal Ortho Care, LLC (animalorthocare.com) Handicapped Pets.com (handicappedpets.com/k9dog-orthoticsprosthetics) Figure 4

K-9 Orthotics and Prosthetics Inc. (k-9orthotics.com) My Pet’s Brace (mypetsbrace.com) Orthopets™ (orthopets.com)

potentially affect skin strength and thickness, such as Cushing disease or chronic prednisone treatment6 (See Figure 6, 7 and 8). Each company that makes custom orthoses will have a variety of measurement forms to be filled out. This requires the client to bring in the patient so measurements may be taken. Continued on page 38.

Figure 2

Table 1: Conditions that are responsive to braces1 Cervical

Thoracic

Pelvic

Spinal/neurological

Cervical neurologic patients

Medial shoulder instability

Achilles tendon disruption

Intervertebral disc disease

Swim snood

Swim puppy syndrome

Tarsal instability/sprain or strain injury

Spinal pain

Aural hematoma

Carpal hyperextension

Tarsal osteoarthritis

Degenerative myelopathy, wobblers

Osteoarthritis

Immune mediated joint disease

Peripheral nerve injury

Post-op management of carpal arthrodesis

Angular limb deformity

Proprioceptive deficits

Avulsion fractures

Chondrodystrophic dogs in need of tarsal support IVC Fall 2018

Figure 5

Team roles when using orthotics on patients The ideal team for an animal in need of an orthotic device includes the pet owner, the veterinarian, a certified rehabilitation therapist, a veterinary orthotic and prosthetic (V-OP) specialist skilled in the custom design, fabrication and fitting of devices for the intended species – and a veterinary rehabilitation nurse. The veterinarian is the key person in determining what the patient needs, but the veterinary nurse/ technician assists with fitting and helps with client education. The rehabilitation therapist plays an integral part in uniting the body mechanics (muscle and nerve activation, and integration patterns) and the device into the complex biomechanics of locomotion.3 The veterinarian will design a program to incorporate the physical rehabilitation while the patient wears the orthotic device. The device may eventually be removed with enough progress, or it may be a permanent aid for the patient. There are entire continuing educational courses devoted to teaching veterinarians and veterinary nurses about orthoses and prostheses (caninerehabinstitute. com/Orthotics_Prosthetics.lasso).

Continued from page 37.

PHYSICAL REHABILITATION WITH AN ORTHOTIC Most veterinary patients adapt quickly, and behavioral techniques can facilitate this. Device-specific rehabilitation focuses on specific skills. Skills include transitions (sitting, lying down and getting up), navigating stairs, getting into and out of vehicles safely, managing on different surfaces (ground, carpet, hardwood floor, etc.), and managing dog doors. Orthopedic injury leads to compensatory abnormal movement and associated muscle strain and weakness. Gait re-education focuses on resolving these issues.7

The veterinary rehabilitation nurse will work directly with the certiﬁed rehabilitation therapist throughout the process.7 Assistance with ordering, ﬁtting, and answering owner questions are all part of the veterinary rehabilitation nurse’s job.

Initial training sessions should last a few minutes and be designed and managed so the patient has a positive experience. Training companion animals to use orthoses is akin to managing limb disuse. It relies on habituating patients to

Table 2: Conditions of thoracic limb responsive to orthoses5 Elbow

Carpus

Paw

Subluxation

Osteoarthritis

Congenital deformity

Osteoarthritis

Hyperextension

Digital tendon laceration

Vargus and valgus

Digital amputation

Failed arthrodesis

Digital supination or pronation

Carpal support for contralateral thoracic limb amputation Flexor carpi ulnaris strain

Other: Radial neuropathy (carpus distad) 38

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Table 3: Conditions of the pelvic limb responsive to orthoses5 Stiﬂe

Tarsus

Paw

Peripheral neuropathy

Cranial cruciate ligament rupture

Osteoarthritis

Congenital deformity

Degenerative myelopathy

Patellar luxation (grades 1 and 2)

Hyperextension

Digital tendon laceration

Sciatic nerve trauma

Collateral ligament injury

Digital amputation

IVDD, spinal canal stenosis, and cervical spinal instability

Patellar tendon injury

Achilles tendon strain, rupture or avulsion

Digital supination or pronation

Fibrocartilagenous embolus

Tibial crest avulsion

Failed Achilles tendon repair

Sciatic neuropathy causing failure of digital dorsiﬂexion

tolerate the device when at rest and also when loading it (using it) when standing, walking slowly (indoors), walking more rapidly (outdoors), trotting, galloping, and during other activities of daily living (e.g. climbing and walking down steps, jumping up or down, and playing).6 Ideally, the orthotic prescription should incorporate a predictive component or a ‘‘vision’’ for the wearer’s future. Reassessment of objectives and timely orthotic modifications should accompany changes in the patient’s neurologic or musculoskeletal status.8 Cost will undoubtedly be a major concern that presents a challenge to providing effective orthotic management.

Figure 7

Figure 6

Figure 8

CONCLUSION There are advantages to both prefabricated braces and custom orthoses. Many injuries are amenable to these devices. Patients and owners must be trained to use them, but they can have a profound beneficial impact on the mobility and quality of

Goldberg ME and Tomlinson JE. Chapter 10: The Disabled Patient Part 1: Assistive Devices and Technology, Physical Rehabilitation for Veterinary Technicians and Nurses, First Edition. Edited by Mary Ellen Goldberg and Julia E. Tomlinson, John Wiley & Sons, Ames, IA, 2018, 145-162

The Free Medical Dictionary by Farlex, medical-dictionary.thefreedictionary.com/brace, accessed on July 2, 2018.

3 Mich PM and Kaufmann. Chapter 11: Veterinary Orthotics and Prosthetics, Canine Sports Medicine and Rehabilitation, Second Edition. Edited by Chris Zink and Janet B. Van Dyke, John Wiley & Sons, Ames, IA, 2018, 265-293. 4

Marcellin-Little DJ and Levine D. Chapter 17: Devices for Ambulation Assistance in Companion Animals. Canine Rehabilitation and Physical Therapy, 2nd Edition, Editors: Darryl Millis and David Levine, Elsevier, Philadelphia, PA, 2014, 305-311.

life of companion animals. The veterinary rehabilitation team works as a unit in aiding the patient (see sidebar on page 38) – and the veterinary nurse is a key member of that team.

5 Mich PM. The Emerging Role of Veterinary Orthotics and Prosthetics (V-OP) in Small Animal Rehabilitation and Pain Management, Topics in Companion Animal Medicine, 2014, 29: 10-19 6 Marcellin�Little D J, Drum M, Levine D, and McDonald SS. Orthoses and exoprostheses for companion animals. Vet Clin Small Animal, 2015, 45:167–183 7 Goldberg ME. The Veterinary Nurse Working with Orthotics or Prosthetics, Proceedings from Atlantic Coast Veterinary Conference, Atlantic City, New Jersey, 2016, 1-4 8 Adamson C, Levine D, Millis DL, Marcellin-Little DJ. Assistive Devices, Orthotics, and Prosthetics. Vet Clin Small Animal, 2005, 35, 1441–1451

IVC Fall 2018

industry innovations Surgical stretcher

Most veterinary surgeons perform operations on standard mats. The PoochPad is an eco-friendly, easy-to-use surgical stretcher featuring proprietary microﬁne fabric technology. After performing a procedure on the pad, slide the lightweight poles in through the fabric openings, thereby turning it into an easy-to-handle, washable/reusable pet stretcher. The odor-inhibiting mechanism in the fabric stops bacteria from proliferating, reducing smell from bodily ﬂuids such as blood and urine. After use, throw the pad in the wash with warm water and Tide (or similar detergent) and it’s like new again. PoochPad.com

No more tangled IV lines

Unlike human doctors, veterinarians can’t tell their patients to stay still when they’re hooked up to IV. The Flex-coil® Swivel System eliminates the problem of tangled IV lines. A reusable shoe with adhesive backing is mounted to the top center of the patient’s cage. A primary IV set from the fluids or infusion pump leads to the product’s swivel, and the swivel with attached coil and injection site snaps into the shoe. The end of the coil attaches to a releasable or traditional collar, and an extension set attaches between the end of the coil and an IV catheter. The result is an animal that can move, roll and even spin without cutting off the flow of fluids. InternationalWin.com

Supporting the canine microbiome

The microbiome plays a vital role in canine digestion. Every dog has a unique population of gut bacteria, and a diverse bacterial population helps keep him healthy. The DoggieBiome Gut Microbiome Restoration System is a microbiome supplement intended for dogs with chronic digestive issues. It helps create an optimal microbial makeup in the gut by introducing caninespeciﬁc bacteria sourced from healthy dogs. 510-250-9797 AnimalBiome.com

Help for unwanted cat scratching

Damage caused by cat scratching is one of the most common pet owner frustrations, with up to 70% experiencing this unwanted behavior. Veterinarians now have a solution to help cats scratch in the right places, preventing requests for declaw procedures, improving feline welfare and reducing cat relinquishment. New FELISCRATCH by FELIWAY® is clinically proven to stop or prevent destructive scratching in the home by redirecting cats to the scratching post. Feliway.com

IVC Fall 2018

Ketogenic diet for dogs and cats

According to the Association for Pet Obesity Prevention, a startling 52.7% of US dogs and 57.9% of US cats are overweight or obese. Excess carbohydrates are the fundamental source of this health disaster. Ketogenic Pet Foods™ are an alternative to carb-based pet foods. Exceptionally high in protein, high in fat, and low in carbohydrates, these true meat diets for dogs and cats are enhanced with healthful oils and micronutrients, and contain no carbohydrate/starch ﬁller ingredients. KetogenicPetFoods.com

Improve immunity

Aging dogs need a way to improve their immunity and quality of life. I’M-YUNITY® is a proprietary medicinal mushroom extract that helps strengthen immune functions, reduce pain and fatigue, and improve energy levels, mobility, appetite and general well-being. Backed by over 20 years of research, the product effectively delivers proprietary extract from the Coriolus versicolor (Mycelia) COV-1® strain with standardized ingredient polysaccharopeptide (PSP). Read the promising results from UPenn School of Veterinary Medicine published in Evidence-Based Complementary & Alternative Medicine, Volume 2012, and at IVCJournal.com.

Effective bleach alternative

Bleach is excellent at killing pathogens, but can be harmful to people and pets as well as damaging to clinic surfaces. Star brite’s ClO2-based PERFORMACIDE Disinfectant & Deodorizer doesn’t contain bleach, but it’s just as effective. It can disinfect exam rooms exposed to parvovirus in ten minutes, while foul odor caused by explosive diarrhea can be eliminated immediately. The product can be allowed to air-dry; unlike quatbased cleaners, it does not leave a residue. This EPA-registered solution can be applied via sprayer or mop. 800-327-8583 Performacide.com

IVC Fall 2018

innovative practice

Integrative rehab

in a veterinary teaching hospital By Jennifer Repac, DVM, CVA, CCRT

When it comes to rehabilitation in the context of integrative medicine, a teaching hospital offers many benefits, including a collaboration between services, access to specialized equipment, research opportunities, and a sharing of information between teachers and students.

ue to the wide variety of therapeutic options, rehabilitation in integrative veterinary medicine varies tremendously among practices. It can include, but is not limited to, exercise therapy, laser therapy, regenerative medicine, acupuncture, herbal therapy, assistive device fitting, and nutraceutical guidance. This multitude of treatment options naturally lends itself to an element of creativity that colors day-to-day veterinary practice. Working in a teaching hospital offers unique features, such as collaboration between specialty services, accessibility of specialized equipment, and the opportunity to contribute to the veterinary community through research and education.

NUTRACEUTICAL GUIDANCE Nutraceutical guidance plays a significant role in daily integrative and rehabilitation medicine. Itâ&#x20AC;&#x2122;s not uncommon for owners to arrive toting hefty shopping bags of various supplements purchased online. Veterinarians often struggle with critically evaluating the endless array of over-the-counter supplements and herbs marketed for pets. The reality is that these products are not regulated by the Food and Drug Administration and therefore their safety and contents cannot be confirmed unless the nutraceutical company voluntarily uses third party laboratory testing. A study performed by the University of Maryland on glucosamine and chondroitin supplements found that product contents varied significantly

Photos: (Left) Many patients require creative adaptations of equipment in order to accommodate their varied levels of mobility. (Middle) This patient was treated with pulsed electromagnetic field therapy, acupuncture and therapeutic laser for his chronic rhinitis. (Right) A quad cart enabled this patient to maintain independent mobility well into the later stages of his degenerative myelopathy.

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from their label claims – as low as 0% to 115% (Adebowale 2000)! Verification of such testing is demonstrated by the presence of Good Manufacturing Practices (GMP), United States Pharmacopeia (USP) or National Animal Supplement Council (NASC) seals. Bear in mind that these labels only verify the contents and quality control of the product, not its bioavailability and efficacy.

RESEARCH OPPORTUNITIES Practicing specialty medicine offers us the unique opportunity to make contributions to veterinary science through research. Admittedly, this can be challenging to implement in dayto-day practice and would be difficult without the support of an academic environment. Many integrative medicine therapies lack robust clinical trials (low subject numbers, conflicting results, poor study designs), which provides limitless opportunities for innovation. Conducting research has changed the way I practice in that it has made me more critical and methodical in my evaluation of new technologies and therapies. This is imperative for integrative medicine to gain a wider acceptance in veterinary specialty medicine.

ASSISTIVE DEVICES The use of assistive devices for animals with impaired mobility is an area of rehabilitation that is rapidly growing and expanding as technology improves. Examples include carts, orthoses and prosthetics. For many patients with nonsurgical or degenerative conditions, the availability of these devices often plays a vital role in their long term quality of life. Product selection is particularly important, as different products possess different strengths and weaknesses. In particularly challenging cases, customized devices often require extensive measurement and fitting visits with repeated follow-ups. In such cases, it is especially crucial to work with a company offering high quality customer service and follow-up care. Rehabilitation plays a complementary role in employing the new device in gait retraining. While some of these devices are intended for permanent use, we also employ these tools for patients experiencing a temporary decline in mobility, in order to facilitate recovery. A typical example would be using a cart to provide a post-op hemilaminectomy patient with controlled independent mobility.

REGENERATIVE MEDICINE Regenerative medicine, including platelet rich plasma (PRP) and stem cell therapy, is a rapidly growing area of interest and often a source of referral for nonsurgical orthopedic conditions. The most common conditions treated with regenerative medicine are osteoarthritis and tendinopathies. The primary mechanism of action of these therapies is through the growth

factors and anti-inflammatory cytokines in PRP and released by stem cells (Pelletier 2013, Caplan 2006). In a recent study, stifles that received PRP injections demonstrated evidence of repair and less synovitis as compared to saline control (Cook 2015). Stem cell therapy in dogs currently requires harvesting from adipose tissue (falciform or subcutaneous) or bone marrow. Platelet rich plasma is extracted from the patient’s whole blood using an onsite concentration system. Both these therapies require only mild sedation and can be performed on an outpatient basis. Many owners who are adverse to the chronic use of pharmaceuticals are attracted to the concept of regenerative medicine, as it employs the patient’s natural biological materials to self heal.

CARE FOR ACUTE ILLNESSES Although often overlooked, rehabilitation and integrative medicine can play an important role in critical care. While the majority of our cases involve treatment of chronic conditions, rehabilitation can sometimes be key in the recovery of acutely ill hospitalized patients. While the patient may have recovered from their primary systemic condition, underlying weakness, orthopedic or neurological conditions can result in mobility changes that prevent discharge from the hospital. We often say “movement is life,” and the effects of prolonged recumbency can have a dramatic negative effect on a patient’s circulation, respiratory system, musculoskeletal system, and mental well-being. These changes can result in life and Customized death decisions rigid orthoses depending on the can offer patients level of care owners with joint instability an alternative to are equipped to surgery provide at home. In these cases, intensive rehab and often acupuncture therapy and owner discussion of at-home care play a vital role in the patient’s recovery.

EDUCATIONAL OPPORTUNITIES Working in a teaching hospital provides unique mutual benefits resulting from the exchange of information between students and teachers. Many students and interns IVC Fall 2018

ConventionaL and

integrative medicine We always make a point to clearly state that we practice integrative medicine. Integrative medicine does not necessarily have better tools than conventional medicine does; but it offers a larger variety. We emphasize the importance of choosing the “best tool from the box”, and often marry the best elements of both Eastern and Western approaches to achieve effective results. For example, many of our patients with osteoarthritis are managed with a multi-modal combination of non-steroidal anti-inﬂammatories, acupuncture, herbs and rehabilitation. Excluding prescription medications such as NSAIDs from our practice would be a disservice to our patients, and would limit their ability to engage in therapeutic exercise. By always offering the best treatment options with a truly integrative approach, our patients receive the maximum beneﬁts possible.

rotating through our service have had limited previous exposure to both rehabilitation and integrative medicine. We try as much as possible to open their eyes to the variety of treatment options available for cases they will likely often encounter. Our hope is that their experience during rotation will help spread knowledge about alternative approaches among this new generation of doctors. Teaching also provides the teacher with new learning opportunities and challenges one’s own knowledge. The continuous circulation of new graduates provides us with the benefit of new perspectives from other practices and teaching institutions, and that furthers our own growth as well.

Evidence-based

medicine

One of the most important features of performing integrative rehabilitative medicine in a specialty practice is the focus on evidence-based medicine. According to the AVMA Guidelines for Complementary and Alternative Veterinary Medicine, it’s the veterinarian’s responsibility to critically evaluate existing literature demonstrating the efﬁcacy of offered therapies. This is especially critical in a teaching hospital. Internal referrals from other specialty departments are particularly dependent on the availability and knowledge of supporting evidence demonstrating both the safety and efﬁcacy of various therapies. For this reason, it is crucial to remain current on the literature for a variety of relevant topics, including physical therapy, acupuncture, nutraceuticals and other modalities. This is both challenging and fun, since methods of practice are constantly evolving. For example, there have been several studies pertaining to the use of laser therapy with variable results (Draper 2012, Bennaim 2017). Part of this variation may be attributed to differences in the power delivered, and the laser type. Results from future studies such as these will continue to shape the way we practice so we can more effectively treat our patients. 44

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Cavalettis are a common tool in rehabilitation and are used to improve proprioception, retrain gait, and improve joint range of motion.

References Adebowale, Abimbola O., et al. “Analysis of glucosamine and chondroitin sulfate content in marketed products and the Caco-2 permeability of chondroitin sulfate raw materials.” J Am Nutraceutical Assoc 3.1 (2000): 37–44. AVMA guidelines for Complementary and Alternative Veterinary Medicine. www.avma.org. Bennaim, Michael, et al. “Preliminary evaluation of the effects of photobiomodulation therapy and physical rehabilitation on early postoperative recovery of dogs undergoing hemilaminectomy for treatment of thoracolumbar intervertebral disk disease.”American Journal of Veterinary Research 78.2 (2017): 195–206. Caplan, Arnold I, and James E. Dennis. “Mesenchymal stem cells as trophic mediators.” Journal of Cellular Biochemistry 98.5 (2006): 1076–1084. Cook, James L., et al. “Multiple injections of leukoreduced platelet rich plasma reduce pain and functional impairment in a canine model of ACL and meniscal deficiency.” Journal of Orthopaedic Research 34.4 (2015): 607–615. Draper, WE, et al. “Lowr level laser therapy reduces time to ambulation in dogs after hemilaminectomy: a preliminary study.” Journal of Small Animal Practice 53.8 (2012): 465-469. Pelletier MH, Malhotra A, Brighton T, Walsh WR, Underman R. Platelet function and constituents of platelet rich plasma. Int J Sports Med (2013) 34:74–80.

NUTRACEUTICALS AS PART OF REHABILITATION

By Carmen Colitz, DVM, PhD, DACVO and Terri L. McCalla, DVM, MS, DACVO Integrative and Sports Medicine isn’t just for humans anymore! Our beloved dog children often sustain musculoskeletal injuries, often requiring surgical correction. Whether or not surgery is needed, arthritis can occur due to these injuries and/or from natural aging. But surgery alone is not enough – rehabilitation and nutraceutical support of healing bones, muscles, and joints must be addressed. The goals of physical rehabilitation are to regain mobility and alleviate pain and weakness. This is achieved by both physical therapy and nutraceutical support. The aim of nutraceutical support is to diminish inflammation, improve flexibility, enhance joint fluid viscosity, provide healing antioxidants, and promote synthesis of proteoglycans to support collagen synthesis. Some key ingredients that should be included as part of any rehabilitation regime include: Boswellia, bromelain, chondroitin, glucosamine, methylsulfonylmethane (MSM),

turmeric, and white willow bark. These all diminish inflammation. Vitamin C, manganese, MSM, and turmeric possess potent antioxidant capabilities to scavenge damaging free radicals and combat oxidative stress. Turmeric contains curcumin, which is one of the most potent naturally occurring anti-inflammatory substances, and also helps fight cancer and diabetes. Glucosamine, MSM, and chondroitin provide the building blocks for new collagen formation and improving joint lubrication. By diminishing inflammation and improving joint lubrication, flexibility and improved movement will follow!

Dr. Carmen Colitz, PhD, DACVO and Dr. Terri McCalla, MS, DACVO are consulting veterinarians for Animal Necessity and are co-founders of Animal HealthQuest LLC. Dr. Colitz is one of the world’s leading authorities on antioxidant and nutritional health of the canine and feline eye, and also on marine mammal ophthalmology. Dr. Colitz is in private referral practice (Jupiter Pet Emergency & Specialty Center) in Jupiter FL. Dr. McCalla has special interests in antioxidant support of retinal disease, stress-associated ocular disease, and ocular manifestations of feline herpesvirus, and is in private referral practice (Animal Eye Care LLC) in Bellingham WA

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Selecting physical rehab products for your canine patients By Kristen Hagler, BS, RVT, VTS (Physical Rehabilitation), CCRP, CVPP, OACM, CBW • Common orthopedic conditions (e.g. cranial cruciate ligament insufficiency, osteoarthritis, congenital disorders) • Common neurological conditions (e.g. intervertebral disc disease, degenerative spinal conditions) • Common musculoskeletal conditions (e.g. tendonitis, muscle sprains and strains)

RECOMMENDED EQUIPMENT FOR A REHAB FACILITY While the surrounding environment can often provide basic needs for therapeutic exercise through the use of hills, slopes, short flights of stairs, varied terrains and curbs, equipment (Figure 1) that’s specific for the individual’s exercise goals, Image courtesy of Kristen Hagler.

Over 85 million families have a pet, according to the 20172018 National Pet Owners Survey from the American Pet Products Association. The number of working dogs, or those in canine sports, has also grown. These dogs are involved in everything from hunting and gathering livestock, to patrolling with soldiers, detecting explosives, searching for missing people, providing assistance for the disabled, and competing in dozens of canine sports. Injuries often occur in these dogs, and rehabilitation is needed to bring them back to health, which means the rehabilitation product industry has also grown exponentially. The thousands of products on today’s market may lead to overspending, and/or inappropriate product choices. This means dog owners often look to assistance from veterinary professionals to help make well-informed product decisions based on fit, activity goals, or in many cases, injury prevention or recovery. You can help guide your clients through the marketplace, avoid costly overstocking, and provide for your patients’ needs by considering the following points: • Intended use of assistive product • Sizing and style availability • Breed-related structural differences • Behavioral differences between animals • Ease of equipment modification

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Figure 1 Cavaletti rail equipment helps improve overall joint range of motion and proprioception during movement.

What follows is a list of recommended essential items for a rehabilitation facility treating animals of various sizes recovering from injury, in addition to those participating in canine performance sports. Practitioners are encouraged to review the most common conditions seen at their facilities to determine the needs of the surrounding pet population. For example, big cities tend to have larger populations of small breed dogs compared to large or giant breeds, so keeping high numbers of inventory items for larger animals is not wise. • Thermal therapy (cryotherapy and heat therapy) to treat multiple sized joints • 12” road cones with holes drilled at varying heights • Wooden dowels 2’ to 3’ in length, or agility poles for use with road cones • Balance cushions or discs of at least two sizes (large and small) • Physioballs or peanut-shaped inflated therapy balls of various sizes • Training platforms or exercise steps of varying heights • Foam wedges • Balance boards • Balance pods or wedges (air-filled) • Balance beam rail or walkway

Protective footwear Protective footwear for animals may serve multiple purposes, including traction for slippery surfaces, and protection from environmental abrasions, such as in the case of neurological injury or a working dog conditions on glass, chemicals or sharp surfaces. Depending on the animal’s level of strength, footwear can help or hinder ambulation. When used for protection against the environment during work, uninjured animals easily accommodate to wearing it. Using protective footwear for animals with disability presents challenges in movement, as well as obstruction of proprioception through the foot pads, and general poor fit due to the the patient’s disability. Booties tend to twist, slip distally, or are cumbersome, causing frustration for all involved. Most have Velcro straps at the top and rubberized soles to prevent slipping, and are machine washable (Figure 2). Continued on page 48.

Figure 2

Image courtesy of Sticky Paws

and is of the appropriate size for the animal, improves overall efficiency and effectiveness.

Balloon type traction booties may help pets gain traction on slippery flooring and lower injury risk.

“WARDROBE ESSENTIALS” – STRUCTURAL ASSESSMENT AND FIT Assistive technology is an umbrella term that includes assistive, adaptive and rehabilitative devices for individuals with disabilities, and also includes the process used in selecting, locating and using them. Determining what a patient needs is determined by the type of injury, the chronic condition being treated, level of independence or need for assistance, prevention of further injury based on environment, and therapeutic or activity goals. Structure and function are intimately linked. The recognition of abnormal structural components during rehabilitation therapy or early risk assessment for athletic performance activities may help reduce risk of injury based on structural predispositions. Understanding basic canine anatomy and structural components helps guide treatment for injury or injury prevention, in addition to helping guide selection of equipment based on the animal’s conformation. Practitioners can help pet owners navigate products such as body harnesses, protective footwear, footing or traction aides, and even mobility carts. IVC Fall 2018

Continued from page 47.

All protective footwear should be removed several times daily to assess the skin condition and, if possible, during therapeutic exercise to increase proprioception through the bottom of the pads. The following features are recommended in protective shoes for dogs: • Flexible sole • Fabric breathability • Grip “zone” for the paws or nails • Overall weight (this is especially important for animals with weakness or incoordination) • Overall length, and ability to adhere to either the hock or metatarsals • Ease of use for caretaker • Overall purchase on the plantar/palmar aspect of the paws At least three different footwear examples should be recommended for dog owners to evaluate. If using a rubberized nail covering, it’s advisable to keep at least one of each available size on hand. Recommended footwear companies include:

and

traction

product

• PawzTM • Cushy-Paw SlippersTM • Ruffwear bootsTM and Bark’N Boot linerTM • Lewis Brand Vented Rubber Dog BootsTM • FoufoudogTM • Dr Buzby’s ToeGripsTM • MediPawTM • Handicapped PetsTM • TheraPawTM • DogLeggsTM • Sticky PawsTM • Woodrow WearTM Power Paws

Assistive harnesses Animals may require the aid of an assistive device for a variety of reasons, such as temporary post-surgical recovery,

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weakness secondary to age, or for activities carrying certain physical risk (e.g. hiking or swimming). Length of use, the handler’s ability to put on the harness, and the animal’s life stage should all be taken into consideration when choosing an appropriate assistive device. Post-operative patients that require assistance getting in and out of enclosures or cars, or geriatric patients requiring assistance getting up and down off the floor, each require a different harness style. The post-operative patient will likely only require a harness for several weeks until the surgical area is healed and there’s a lower risk of surgical failure from slipping or falling; therefore, a lightweight, simply-designed abdomen sling-style harness is most appropriate for short periods of use. Geriatric patients require significantly more physical assistance for essential daily activities and will likely continue to use the harness throughout the remainder of their lives. When choosing a harness for patients with disability, professionals should consider harness handle placement and patient needs. The most ideal location for a handle is near the thoraco-lumbar junction just behind a dog’s center of gravity, behind the shoulder blades. This location helps handlers guide animals into a standing position from lying down by providing forward momentum and preventing overcompensation in the thoracic limbs (Figure 3). Animals with an even higher degree of disability, low strength in the pelvic limbs or amputation of a limb, may require assistance from two lift points over the shoulders and hips. While abdominal sling-style harnesses are useful, they produce vertical lift against the abdominal region, including the bladder, and lumbar spine (Figure 4). A more ideal lift location point is directly under the pelvic region, because the sacrum helps distribute pressure points. Image courtesy of Kristen Hagler

Customized grip socks are also available and have rubberized tread under the paw surface. These may serve the patient better when on surfaces where traction only is desired. In addition to protective footwear, rubberized coatings are available to increase the nails’ “grip”. It is essential that these items fit correctly, and that owners are instructed on care and use to prevent the development of sores or ineffective utilization.

Figure 3 The RuffWearTM WebmasterTM is a harness with the handle in the middle of the animal’s back – ideal for providing assistance for the pet during movement.

Assistive harnesses should not obstruct movement, or protraction or retraction of a limb. They should allow voiding and have a soft lining against the animal’s skin to avoid sore development. Most importantly, they should be washable, and animals should be given periods throughout the day when they’re not wearing them.

Having a variety of assistive devices in a clinical setting is advisable to help owners decide what will work for their needs, in addition to their dogs’. The following are recommended as essential items for the clinical setting: • GingerLead SlingTM (Abdomen slings) • FourFlags Quick LIftTM (Abdomen slings) • RuffWearTM Webmaster or Front Range (Thoracic harness) • HelpEm UpTM harness (Two lift point harness system) • Walkabout harnessTM and Handicapped PetsTM (Forelimb support, hindlimb and abdomen support harnesses) Continued on page 50. Image courtesy of Kristen Hagler

Image courtesy of Blue Dog Designs. HelpEm Up Harness TM

Using a supportive harness will also help patients with motor function keep from falling, as well as providing the benefits of gait repatterning and strengthening. In addition to handle locations, slings and harnesses may be fitted for the forelimbs, hindlimbs, or both (Figure 5). They should have long, handheld straps attached to allow proper body mechanics for the handler, thereby Figure 4 avoiding personal The HelpEm UP HarnessTM provides assistance through the sternum and injury when supporting underneath the pelvis, so less strength the pet. is needed by a handler.

Figure 5 The HelpEm UP HarnessTM provides assistance to both the front and rear legs for pets with higher levels of disability or weakness.

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Image courtesy of Kristen Hagler

Fitness vs. function

Therapeutic exercise involves specific movement patterns prescribed for a patient with the goals of injury recovery and/ or preventing further injury. They are performed gradually to return a patient to the highest level of function possible. Physical rehabilitation reverses various physical conditions associated with injury or dysfunction. Activity is generally performed in a controlled stepwise manner with regular assessment intervals to ensure that functional progress and therapeutic goals are being met, and the animal is being restored to a desired level of physical function. Body systems respond to physical stress by undergoing adaptations that ultimately improve their functioning. Rehabilitation is the process of applying stress to healing tissue in accordance with specific stresses that the tissue will face on return to a particular activity. Although rehabilitation exercise may appear similar to conditioning, it’s not the same. When exercises are performed to enhance an already learned skill or activity, or to improve performance during activity, they are considered fitness training or conditioning exercises. Activity increases occur as soon as the animal demonstrates proficiency, and successes are measured during competition or performance of the sport. Exercises are typically performed at home in between skill training classes. In contrast, therapeutic exercises are done in a clinical setting with a trained professional, and are for patients recovering from injury.

Continued from page 49.

Mobility carts While mobility carts serve a smaller population of animals, in a clinical setting they are extremely useful for multiple reasons. They provide alternative options for clients with severely disabled dogs, act as therapeutic aids when performing therapeutic modalities, allow functional independence for impaired animals, and aid in ambulation (Figure 6). They are normally suggested for paretic or paralyzed animals, those with severe arthritis or obesity, and may be used with other devices such as protective shoes and assistive harnesses. Some animals with long-term balance issues may also benefit from a mobility cart. Cart fitting can be challenging and time-consuming, but this improves with equipment familiarity. Mobility carts can

Figure 6 Mobility carts are used for animals with severe disabilities which make movement with a harness assistive device extremely difficult.

be either completely custom made for the animal, requiring multiple measurements and custom fabrication, or semicustom made, where equipment parts can be interchanged to generally fit the animal’s needs. It’s also necessary to consider the overall weight of the equipment, its ease of transportation in vehicles or within the household, the overall wheel base if the cart is to be used in the home, and the handler’s ability to place the animal properly in the cart. For most practitioners, it is not extremely beneficial to keep a wide variety of mobility carts in the clinical setting because properly fitting dogs to the carts is extremely important, and storage takes up critical space. It is, however, recommended that you offer at least two manufacturer examples (e.g. semi-custom and custom) and two size options (e.g. small and large) to help clients visualize using the equipment. While several companies manufacture mobility carts, the following are listed based on the author’s experience: • Doggon’ WheelsTM • Eddie’s Wheels for PetsTM • K9 cartsTM • Walkn’ WheelsTM

CONCLUSION By understanding basic canine anatomy and structural components, as well as the needs of your practice’s population, you can help guide your clients through the assistive technology marketplace, provide for your patients’ needs, and avoid costly overstocking.

Read the unabridged version of this article at ivcjournal.com/rehab-products.

References Dale RB. Physical Rehabilitation of the Injured Athlete, 4th Edition. Edited by James R. Andrews, Gary L. Harrelson, Kevin E. Published 2012 by Elsevier-Saunders, 42.

Nicolson A, Moir L, Millsteed J. “Impact of assistive technology on family caregivers of children with physical disabilities: a systematic review”. Disabil Rehabil Assist Technol, 2012, 7(5):345–349.

Goldberg ME, Tomlinson JE. The Disabled Patient 1: Assistive Devices and Technology. Physical Rehabilitation for Veterinary Technicians and Nurses, 1st Edition. Edited by Mary Ellen Goldberg, Julia E. Tomlinson. Published 2018 by John Wiley & Sons, Inc. 148-150.

Rafferty A. Davidson JR. Home Exercises. Physical Rehabilitation for Veterinary Technicians and Nurses, 1st Edition. Edited by Mary Ellen Goldberg, Julia E. Tomlinson. Published 2018 by John Wiley & Sons, Inc. 83.

Gross, DM. “Introduction to Small Animal Physical Therapy”. In Woodman, RM ed. Canine physical therapy – orthopedic physical therapy. Connecticut: Wizard of Paws, 2002, 8.

Zink CM. Introduction to the Agility Dog. The Agility Advantage – Health and Fitness for Canine Athletes. Clean Run Productions, LLC. South Hadley, MA. 2008; 6-11.

McDonald JW, Sadowsky C “Spinal-cord injury”. Lancet 359, 2002, 417–425.

Zink MC. “What Is a Canine Athlete?” In Zink CM, Van Dyk JB, eds. Canine Sports Medicine and Rehabilitation. Wiley-Blackwell, 2013.

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Saunders DG, Walker JR, Levine D. “Joint Mobilization In Vet Clinics of North America”. Small An Practice, 2005, 1295.

From the

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

By Nancy Scanlan, DVM, CVA

he American Holistic Veterinary Medical Foundation had another successful fundraiser this past spring, with donations totaling 14% more than last year. The Foundation uses these funds to help fund research grants.

STUDY ON RAW VS. KIBBLE DIET We have received a grant proposal to study the physiological effects and fecal microbiome of dogs fed a raw diet versus dogs fed kibble. This will provide research-based insights based on metabolite and inflammatory profiles, as well as fecal microbiome data, to identify the health benefits and risks of both methods of feeding. Blood, urine, and fecal analyses as well as regular physical exams will be used to identify these factors. Special emphasis will be placed on the ears, eyes and oral health, with a specific numerical grading system used for each of these parts of the exam. The dogs in this study will be pets who have been fed either a raw diet or kibble for at least a year before entering the study. For four weeks beforehand, and continuing throughout the study, all dogs fed a raw diet will be given the same diet, and all dogs fed kibble will be given the same high quality kibble. This will standardize the exact diet, while making sure that any effects from long-term feeding of a kibble or a raw diet will also be taken into account. The aim is to answer specific questions, which have not yet been adequately addressed, concerning claims about the effects of these diets on health.

VETERINARY LIBRARY DONATION Dr. Shelly Altman has donated his entire library of veterinary books, including those concerning veterinary acupuncture, to the AHVMF. These books will be on sale at the AHVMF booth during the AHVMA Conference in Florida from October 4 to 7, and some may also be included in the Silent Auction. For those unfamiliar with Dr. Altman, he played a big role in the early history of veterinary acupuncture in the US, especially in California. He was a participant in the UCLA study on the effects of acupuncture for pain control, and one of the founders of the National Association of Veterinary Acupuncture (NAVA), as well as its Director of Research. NAVA’s main objective was to establish acupuncture as a valid treatment modality. Dr. Altman was also an instructor for IVAS, and received the CorteseLippincott Award from the Animal Health Foundation in 2014. Please help honor him by bidding high on his donations, and by helping with donations of your own for this year’s Silent Auction. The auction funds scholarships and classes to help educate veterinary students about holistic modalities, in addition to funding research. You can download donation forms at ahvmf.org/images/stories/Files/2018SAdonorform.pdf.

WATCH FOR THIS SURVEY The AHVMF is looking for your help in determining what kind of research we should support in the future. Watch for an invitation to complete a quick three-question online survey – it will help us help you solve problems in your practice.

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Ronald J. Riegel, DVM

Digital infrared thermal imaging provides an objective assessment of any integrated treatment plan

The practice of integrated medicine focuses on the healing of the entire patient through multimodal therapeutic approaches. Digital infrared thermal imaging (DITI) provides an objective measurement, visually and numerically, of the progress, or lack of, at any point in the treatment plan.

WHAT IS DITI? Traditionally, subjective assessments are made that don’t provide a comprehensive evaluation of the patient. Phrases like: “He is now able to walk up the back steps.” “Today he is using his leg more than he has in quite some time.” “I am palpating less swelling within the left stifle joint.” These subjective observations are useful but don’t offer an accurate status of the patient’s whole well-being. DITI provides non-invasive, objective, quantitative, and qualitative visual and numerical measurement of the physiological status of the entire patient irrespective of the multimodal therapeutic plan. In a matter of a few minutes, images can be captured that represent the physiological state of the patient at that exact moment. This is what is physiologically happening to the patient right now! This is in contrast to radiographic, ultrasonic, and MRI studies which tell us what has already happened to the patient. These images not only monitor and quantify the efficacy of the treatment plan, but will also detect any other areas in need of further diagnostics, serve as visual proof to the client of the patient’s current status, and provide baseline data for future reference. This visualization of the physiological state of the patient provides you with a “roadmap” to maximize your therapeutic plan and provides proof to the client of the efficacy of your treatment. An educated client will be more compliant to further diagnostics, multimodal treatment approaches, and even more frequent visits. Interpretation of the thermal images is not difficult. Any increase or decrease of >1.0°C within the thermal symmetry

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of contralateral anatomical areas is significant. Areas depicting an increase (hyperthermic) or decrease (hypothermic) in thermal asymmetry require further evaluation and possibly further diagnostics. Areas of hyperthermic activity correlate to an inflammatory process, resulting in an increase in blood flow, whereas areas of hypothermic activity correlate to a vasoconstrictive state usually in response to a dysfunction within the sympathetic nerve pathway to the vasculature. Digital infrared thermal imaging provides an accurate visual assessment and objective quantification of the clinical response of the patient. When clients are provided with a visualization of the progress of their pets, they have a better understanding and are more compliant to the individualized treatment plans.

HOW

THERMOGRAPHY WORKS

Quanta of infrared thermal radiation being emitted by the patient are measured by an infrared scanning device and then converted into electrical impulses that can be visualized in various color palettes, with corresponding numerical temperature values, on a screen. This visual thermal map, referred to as a thermograph, has a sensitivity of <.02°C measured over 327,680 points of temperature, pixels, indicating increases or decreases within the amount of thermal radiation being emitted from the patient. The literature states that there is a high degree of thermal symmetry in the normal body. Therefore, subtle abnormal temperature asymmetries of decreases or increases in the thermal gradients within similar contralateral anatomical structures are easily recognized.

CASE STUDY Presentation: Feline patient with a history of a gradual reduction in activity. A physical examination did not localize any sites of discomfort. Digital infrared thermal images were captured utilizing a Digatherm 640 unit. Interpretation of the thermal images Both hind limbs exhibited increases within the thermal gradients associated with the stifle joints. The left stifle revealed an increased hyperthermic asymmetry when compared to the right. Interpretation indicates inflammation within both stifle joints. In the right hind limb increases in thermal gradients were noted within the soft tissues radiating out from the stifle joint, particularly over the sartorius and biceps femoralis muscles. Indication of not only an inflammatory process within the joint but an illustration of the strain on the surrounding compensatory soft tissue structures. In the left hind limb areas of hyperthermia were noted directly over the stifle joint and decreased in intensity as they radiate to surrounding soft tissues (Fig 1). Interpretation suggests a lesser amount of inflammation within this joint as the compensatory soft tissue structures surrounding the joint are exhibiting reduced areas of hyperthermic activity when compared to contralateral structures on the right. After this visual representation of their pet’s physiological state to the client, permission was granted to do a radiographic study of both stifles. This led to a diagnosis of osteoarthritis.

Figure 1. – Lateral thermograph of left hind limb.

tPEMF therapy was prescribed using the Assisi Loop. This was done three times per day for one week, once per day the second week, and every other day the third week. Interpretation of thermal images After an interpretative analysis of the images: The right stifle experienced a 91% decrease in the hyperthermic activity. Also, there was an increase within the thermal gradients throughout the distal limb. Interpretation: a decrease in inflammation within the original hyperthermic areas and a re-establishment of normal circulation throughout the distal limb. The left stifle underwent a 96% decrease within all of the hyperthermic areas observed originally (Fig 2). There was also an increase within the thermal gradients associated within the phalangeal structures. Interpretation: a decrease within the inflammatory state of the stifle joint and the surrounding structures and a re-establishment of the circulatory pattern within the distal limb.

SUMMARY The treatment plan successfully reduced the inflammatory response within all of the hyperthermic regions and objective measurements are recorded to monitor this patient again in thirty days. Clinically, the patient has regained movement that has not been observed in years. Go to ivcjournal.com/digital-infrared-thermal-imaging for more images and further case studies.

Figure 2. – Lateral view of left stifle post three weeks of tPEMF therapy.

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nutrition nook

By PJ Broadfoot, DVM

MICROALGAE FOR DOGS

Discover how Aphanizomenon flos-aquae (AFA) can benefit the health of your canine patients. For the past several decades, people have been enthralled by the “green foods” revolution, which includes nutrients such as barley grass, microalgae (e.g. Chlorella, Spirulina and Aphanizomenon flos-aquae), wheat grass juice and sprouts. In this article, we’ll look specifically at Aphanizomenon flos-aquae (AFA) microalgae, and the role it can play in the health of your canine patients.

similarities and several important differences. The subtleties of their differences are evident when sophisticated methods of analysis are employed. AFA, the focus of this paper, has been used in our practice since 1995.

APHANIZOMENON FLOS-AQUAE (AFA)

Microalgae have been part of the human diet for thousands of years, based on archaeological evidence from 14,000 years ago in Chile,1 and early written accounts (e.g. in China, 300 A.D., and Ireland, 600 A.D.2)

AFA is the “greenest” superfood known, because it contains more of the green photosynthesizing pigment, called chlorophyll. It can be considered a homeostatic enabler, as it provides critical balancing nutrients in a very bio-available form easily assimilated by the body.3 A ten-gram portion of AFA algae contains 300mg of chlorophyll, whereas a ten-gram portion of Spirulina has only 115mg.

The two most popular blue-green algae are Aphanizomenon ﬂos-aquae and Spirulina. Both are considered superfoods, with

The source for AFA algae is Klamath Lake, the largest freshwater lake in the Oregon watershed, exceeding 3,800 miles. Most

A SHORT HISTORY OF MICROALGAE

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estimates indicate that the spring waters flowing into Klamath Lake come from Crater Lake, after a journey of approximately 15 miles through mineral-rich underground aquifers. Generally, wild algae are found in bodies of water that are stagnant or deteriorating, but Klamath Lake is an exception, and supports not only a tremendous biomass of AFA but also fish, waterfowl and predatory bird species. Klamath Lake is rather pristine, devoid of industrial activities and surrounded by national parks. AFA is unique in its ability to fix atmospheric nitrogen, creating an enormous bloom that is virtually 100% pure AFA. The lake contains 30 feet of mineral-rich sediment at its bottom, primarily from the eruption of Mount Mazama; the average depth is less than ten feet with a median depth of about five feet. The lake’s longitudinal shape fosters strong winds and turbulence, which forces turnover and brings up the mineralrich sediment, further promoting algae blooms. Chlorophyll quickly degrades and loses quality, so good AFA harvesting and production methods are paramount. Water pH levels must be monitored closely, and testing should be done to assure there are no dangerous bacteria or toxicities, and no heavy metals.

Although the biochemical pathway that allows the transformation of chlorophyll into hemoglobin has never been investigated, eating foods high in chlorophyll could stimulate the synthesis of hemoglobin in the body. An experiment induced severe hemorrhage in dogs; the experimental group receiving daily doses of chlorophyll showed much higher blood hemoglobin content than the controls. Chlorophyll improves cardiac efficiency. Chlorophyllin, a water-soluble form of chlorophyll, protects against certain forms of liver cancer at a concentration similar to what is found in green leafy foods. It also stimulates the regeneration of damaged liver cells, and increases circulation to all organs by dilating blood vessels. Chlorophyll helps balance the pH of the blood by increasing alkalinity and reducing acidity. Even slight shifts toward acidity can cause the formation of free radicals and oxidative damage, which promotes risk of disease. Acidity also causes calcium to be leached from bone. Chlorophyll may also protect against environmental toxins. These findings may have important implications in intervention and dietary management of cancer risks.5

Amino acids and proteins In the 1960s and 70s, concerns were raised regarding the possible neurotoxicity of AFA from other sources. In Klamath Lake, nearly ten years of intense testing has failed to reveal the presence of any neurotoxins; scientists determined that the original samples which gave rise to the concerns were not AFA.4

NUTRIENT INFORMATION FOR AFA

AFA algae have 20 amino acids that contribute to lifesustaining cellular functions. This source of protein is nearly 60% identical to human protein composition and is c.85% bio-assimilable. The body must convert lipoproteins (meat and regular vegetable protein) to glycoprotein in order to utilize it. These algae are already in the form of glycoprotein – thus, no biochemical conversion is needed.

Minerals AFA’s mineral content includes boron, calcium, chloride, A specific protein from AFA, called cyanovirin-N (CV-N), chromium, cobalt, copper, fluoride, germanium, iodine, iron, has been shown to reduce the ability of the human magnesium, manganese, molybdenum, nickel, phosphorus, potassium, selenium, At 7,100 feet above sea level, Klamath Lake is located in the caldera of former Mount Mazama. For decades, Klamath Lake’s water has been used as a silicon, sodium, tin, titanium, vanadium standard for water purity. 5 and zinc.

Chlorophyll The green pigment found in plants, chlorophyll is responsible for the transformation of light energy into chemical energy. Chlorophyll has a similar molecular structure to heme, the oxygencarrying pigment in blood. Magnesium is the central atom in chlorophyll, while iron is the central atom in hemoglobin. Thus, chlorophyll acts as a powerful oxygenator. IVC Fall 2018

immunodeficiency virus (HIV) to infect cells. It also inhibits Ebola virus infection. CV-N inhibits viral infection by binding to the outside of the virus and physically blocking it from entering cells. The protein is known to attach to a particular sugar molecule on the virus surface. “CV-N is the first molecule known to inhibit Ebola infection by interfering with the virus’ ability to enter cells.”6

Research confirms that carotenoids reduce the incidence of lung, stomach, colon, bladder, uterus, ovarian and skin cancers. AFA algae contains both forms of beta-carotene – the CIS form, found in fruits and vegetables, and the TRANS form, found in synthetic supplements and root vegetables. When both forms are eaten simultaneously, the rate of absorption can be over ten times that of the TRANS form alone.

Phycocyanins

Carotenoids are helpful in preventing cardiovascular diseases. Epidemiological studies suggest that high dietary intake of naturally occurring beta-carotene decreases the risk for atherosclerotic vascular disease by protecting LDLs from oxidation. A 13-year study showed that men with the highest blood levels of carotenoids had 36% fewer heart attacks and deaths than those with the lowest levels of carotenoids. AFA also contains lutein and lycopene, two carotenoids known to protect against certain forms of cancer.

The blue pigment present in all cyanophyta, phycocyanin serves as a protein storage unit and antioxidant, protecting the cell from certain wavelengths.7 In animal models of inflammation, phycocyanin was shown to reduce or prevent inflammation, and can prevent some forms of colitis. One mechanism of action that has been identified is phycocyanin’s ability to block the production of the inflammatory eicosanoid leukotriene B4, a compound involved in the pathophysiology of asthma, and a target of recent drug developments. Recently, phycocyanin has also been shown to be one of the strongest natural COX-2 (cyclo-oxygenase) inhibitors.8 Phycocyanin works in concert with bilirubin to keep the liver functioning optimally, and aids in the digestion of amino acids. It has also been shown to inhibit the formation of cancer colonies.

Beta-carotene and other carotenoids AFA is an exceptional source of highly bio-available carotenoids. It activates enzymes that produce vitamins E and K. Beta-carotene is an anti-infective protector, and a powerful antioxidant against skin disorders, night blindness, environmental pollutants, allergies and immune system dysfunction.

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Polyunsaturated fatty acids, especially Omega 3 Lipids provide the most concentrated source of energy, function as carriers for fat soluble vitamins A, E and K, and are important for the conversion of plant beta-carotene to vitamin A. These lipids nourish the nerves and blood vessels and lubricate skin and tissues. Microalgae are primary sources of DHA and EPA for zooplankton, fish and other multicellular organisms, and these essential fatty acids (EFAs) become increasingly concentrated as you move up the food web. Nearly 50% of the lipid content in dried AFA is composed of Omega 3 essential fatty acids (mostly alpha-linolenic acid).

polysaccharide fraction of AFA was found to be many times more potent than arabinoxylan, which is extracted from rice and is one of the most potent NK cell activators known. In a double-blind crossover study, the immediate effect of AFA on natural killer (NK) cells was evaluated on 21 healthy volunteers. Within two hours, the ingestion of AFA resulted in a significant decrease (40%) of NK cells in the blood and was interpreted as the migration of NK cells from the blood to the tissue, promoting immune surveillance. After a few weeks of daily consumption of AFA, migration increases and reaches its maximum effect.10

2.5

Soybean Coconut Algae 10%

EFA (% of lipids)

2 1.5 1

Stem cell activity

0.5 0

a-linolenic

EPA

DHA

Omega 3 essential fatty acids are beneficial to the immune, cardiovascular and nervous systems. They can alleviate depression, may help in neuropathic conditions associated with diabetes, and prevent platelet aggregation. Omega 3s inhibit many forms of cancer, namely breast, prostate, pancreatic and colon. They are precursors to a whole family of compounds (prostaglandins) responsible for modulating immune system function and preventing or eliminating inflammation.5

Embryonic stem cells (ESC) are harvested from embryos and when transplanted into adults, have the ability to heal and repair any organ into which they are transplanted, providing an extremely useful tool for the treatment of various degenerative diseases. Drapeau et al recently proposed the Stem Cell Theory of Healing, Regeneration and Repair.11 This breakthrough theory suggests that bone marrow stem cells leave the bone marrow and travel throughout the body, providing for healing and regeneration of damaged organs during the entire lifetime of an individual. If true, there is no need to harvest, grow and reinject stem

Phenylethylamine (PEA) is an endogenous neuromodulator responsible for triggering or sustaining wakefulness, alertness, and excitement, and can help with alleviating depression while increasing concentration and elevating mood. PEA has been used as a training aid in dogs.

SUMMARY OF SELECTED SCIENTIFIC RESEARCH ON AFA Since the mid-1990s, studies performed in collaboration with various universities and research centers have provided a significant amount of data supporting and explaining the benefits of AFA. A comprehensive retrospective study of more than 200 cases strongly suggested that AFA acts on the immune and nervous systems and prevents the process of inflammation.9

Immune modulation NK cell activity is defined as the ability to kill virally-infected cells and cancer cells. NK cells identify the site of an infection or cancerous cell growth by chemotaxis. They then trigger apoptosis, or programmed cell death. In one study, the IVC Fall 2018

cells. Regeneration could take place simply by stimulating the release and subsequent migration of stem cells from the bone marrow into tissues. AFA is the only natural compound known to stimulate this (at a dose of 5 grams of AFA daily in humans).12,13 A patent has been filed and recently obtained for the use of AFA for treating Parkinson’s disease, Alzheimer’s disease, diabetes, multiple sclerosis, cardiac arrest recovery, and regeneration. AFA also contains 4% RNA and DNA, which are needed to make new cells and repair damaged ones. These decrease with age, resulting in a weakened immune system.

CO2

Sunlight

Other Minerals

The Algae Biofactory Lipids Carotenoids Vitamins

Proteins Phytonutrients

Chlorophylls Carbohydrates

Chemoprotection A substance is “chemoprotective” when it protects against the toxic effects of chemicals or compounds in our food or environment. Various species of microalgae have been demonstrated to absorb heavy metals. Scientific studies have shown that cyanophyta offer significant protection against heavy metal toxicity in the kidneys. A sugar present on the cell membrane of microalgae has also been confirmed to bind and eliminate pesticides in the intestine. Phycocyanin, the blue pigment present in AFA, has been shown to have chemoprotective properties as well.

SOURCING AND CLINICAL APPLICATIONS FOR AFA The author has used AFA algae for decades, starting with the original harvesters, CellTech (now New Earth). There are a number of other harvesters with differing methodologies of production and toxin testing. A relative newcomer to the stage is Edge Technologies, based in Canada. We use AFA routinely for a number of conditions, including allergy, immune imbalance, chronic inflammation, as an epigenetic booster, and as a general wellness strategy. It is remarkably useful, particularly when combined with other gut and liver sparing/repairing nutrients, probiotics, and immune modulators.

in your practice. In a recent study at Yale New Haven Hospital, 257 brands of multivitamin supplement pills were evaluated and 80% found to be inadequate, incomplete or imbalanced. However, the wild blue-green algae was found to be in perfect harmony with biochemistry for maximum utilization.14 Microalgae such as AFA are a nutritional resource that are very useful to practitioners and their patients.

Dillehay TD, Ramirez C, Pino M, Collins MB, Rossen J, Pinot-Navarro JD. “Monte Verde: seaweed, food, medicine and the peopling of South America”. Science 2008, 320:784–789.

Aaronson S. “A role for algae as human food in antiquity”. Food Foodways 1986 1:311–315.

Gilroy DJ, Kauffman KW, Hall RA, Huang X, Chu FS. “Assessing potential health risks from microcystin toxins in blue-green algae dietary supplements”. Environ Health Perspect. 2000 May;108(5):435-9.

Kay RA. “Microalgae as food and supplement”. Crit Rev Food Sci Nutr. 1991;30(6):555-73. Review.

Drapeau, Christian. Primordial Food: Aphanizomenon flos-aquae: A Wild Blue-Green Alga with Unique Health Properties. One World Press (January 1, 2003) ASIN: B000M0IK6O.

NIH/National Cancer Institute. “Anti-HIV Protein From Blue-green Algae Also Inhibits Ebola Infection”. Antiviral Research ScienceDaily. ScienceDaily, 5 March 2003. Molecular Targets Discovery Program, sciencedaily.com/ releases/2003/03/030305081547.htm.

Benedetti S, Benvenuti F, Pagliarani S, Francogli S, Scoglio S, Canestrari F. “Antioxidant properties of a novel phycocyanin extract from the blue-green alga Aphanizomenon flos-aquae”. Life Sci. 2004 Sep 24;75(19):2353-62.

Romay C, Ledon N, Gonzalez R. “Phycocyanin extract reducesleukotriene B4 levels in arachidonic acid-induced mouse-ear inflammation test”. J Pharm Pharmacol. 1999;51(5):641-642.

Krylov VS, et al. Retrospective epidemiological study using medical records to determine which diseases are improved by AFA, 2002.

Jensen GS, Ginsberg DI, et al. “Consumption of Aphanizomenon flos aquae has rapid effects on the circulation and function of immune cells in humans”. JANA. 2000;2(3):50-58.

Drapeau, C. The Stem Cell Theory of Renewal: Demystifying the Most Dramatic Scientific Breakthrough of Our Time, First Edition. Sutton Hart, (March 30, 2009) ISBN-10: 0981502792 ISBN-13: 978-0981502793.

Gitte S Jensen, Aaron N Hart, Lue A M Zaske, Christian Drapeau, Niraj Gupta, David J Schaeffer, J Alex Cruickshank. “Mobilization of human CD34+ CD133+ and CD34+ CD133 stem cells in vivo by consumption of an extract from Aphanizomenon flos-aquae – related to modulation of CXCR4 expression by an L-selectin ligand?” Cardiovasc Revasc Med 8(3):189-202 (2007) PMID 17765649.

Shytle DR, Tan J, Ehrhart J, Smith AJ, Sanberg CD, Sanberg PR, Anderson J, Bickford PC. “Effects of blue-green algae extracts on the proliferation of human adult stem cells in vitro: a preliminary study”. Med Sci Monit. 2010 Jan;16(1):BR1-5.

Philippe Potin, James Craigie. “Algae as nutritional and functional food sources: revisiting our understanding”. J Appl Phycol December 2016, researchgate.net/publication/316428443.

CONCLUSION As client demand for functional foods or nutraceuticals increases, supplemental foods with bioactive compounds that may benefit health beyond the role of basic nutrition (e.g., anti-inflammatories, disease prevention) are important to have

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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

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

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

GenesisValley Center CA USA Phone: (760) 751-3360 Website: www.genesispets.com

Veterinary Information Network - VIN Davis, CA USA Phone: (530) 756-4881 Email: vingram@vin.com Website: www.vin.com

Harrisons’ Pet Products West Palm Beach, FL Phone: (800) 946-4782 Website: www.vet.HEALx.com

Vluggen Institute for Equine Osteopathy and Education San Marcos, TX USA Phone: +49 (0)151 40750572 Email: office@vluggeninstitute.com Website: www.vluggeninstitute.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 National Animal Supplement Council - NASC Phone: (815) 531-2850 Valley Center, CA USA Email: carol@animalspiritnetwork.com Phone: (760) 751-3360 Website: www.animalspiritnetwork.com Website: www.nasc.cc College of Integrative Veterinary Therapies Website: www.healfasttherapy.com - CIVT INTEGRATIVE THERAPIES Rozelle, NSW Australia Phone: (303) 800-5460 Healfast Therapy Website: www.civtedu.org North Caldwell, NJ USA Phone: (551) 200-5586 International Veterinary Acupuncture Email: support@healfasttherapy.com 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

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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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? Beautyberry, Callicarpa americana, is a shrub native to the southern US. Native people used a decoction of its roots and branches in sweat baths for rheumatism, malarial fevers, dysentery, vertigo, urine retention and stomachache. The berries were used for colic, while the plant, roots and stem bark were used for snake sickness and itchy skin. One can bruise beautyberry leaves and rub them on the skin as a topical mosquito repellent. As a folk remedy, beautyberry “helps keep biting insects away from animals such as horses and mules”. Recent research has shown it offers significant repellent activities against mosquitoes, ticks and fire ants. Anti-cancer research is currently underway.

CASE REPORT A 61-year-old woman was hiking in Payne Prairie in Florida and was being eaten alive by mosquitos. She crushed some beautyberry leaves and rubbed them on her exposed skin with a drastic decrease in mosquitos stress.

RECENT ACTIVITIES The VBMA had a foundation webinar on essential oils by Dr. Nancy Brandt, followed by a food therapy webinar given by Drs. Clare Middle and Cheryl Schwartz. Both are available for purchase with other VBMA webinars at vbma.org.

Mase to speak at its track during the AHVMA Conference in Orlando, Florida on October 4. Dr. Hobbs is a fourth-generation internationally-renowned herbalist, licensed acupuncturist, author, clinician, botanist, mycologist and research scientist with over 35 years of experience in herbal medicine. Please consult vbma.org for registration information.

SCOTLAND ECO-TOUR! From June 30 to July 6, 2019, the VBMA is going to Scotland! Visit Glen Strathfarrar, an ancient pine forest for golden eagles, as well as other birds and wildflowers. Black Isle features native woodland and agriculture, and coastal mud flats; you can even enjoy a boat ride to see dolphins. Strathconon offers a chance to see red kites, goosanders, dippers, tufted ducks, Slavonian grebes and roe deer. On a tour of the west coast, you may be able to see Britain’s rarest breeding raptor – the white-tailed sea eagle – possibly along with the red- and blackthroated diver, gannet, black guillemot, twite, a variety of waders and – if you’re very lucky – otters exploiting the vast shoreline, as well as spectacular scenery, beaches, lochs and mountains. Aigas native pinewoods is home to the twinflower translocation project, and workshops such as owl pellet dissection and foraging will be held. This is going to be an amazing trip, but availability is limited! Registration information can be found at vbma.org/ecotours.html.

NAME THIS HERB!

The VBMA also enjoyed a special event shared with the NY CAVMA. David Winston, world-renowned herbalist, gave a four-day seminar at a retreat in the lower Catskill Mountains, New York State. It was incredible, filled with herb walks, great nature, fantastic lectures on herbal analgesics, Lyme disease, adaptogens, alteratives and more. A PDF file can be purchased through nycavma.org.

UPCOMING EVENTS In addition to the VBMA’s amazing webinar series, the organization is also hosting Christopher Hobbs and Guido

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

Photos have been provided by Megan McCorkel, DVM cVMA

acupuncture for performance horses

Acupuncture helps keep equine athletes in top condition by creating analgesia, decreasing the risk of ileus, helping to prevent injuries, and much more. By Megan McCorkel, DVM, cVMA Article starts on page 62.

Dr. McCorkel assessing trigger points and needle placement.

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ccording to a 2017 economic study by the American Horse Council, the US is home to over seven million horses. Roughly three million participate as performance horses, race horses and “work” horses.1 Complementary medicine therapies such as acupuncture can keep these equines in peak condition. It can also decrease the use of pain-relieving medications and joint injections, help with the ileus that may develop when traveling to shows, and prevent sports injuries.

Acupuncture can treat the whole body, in addition to having potent and consistent analgesic effects. It has been proposed that using acupuncture in conjunction with joint injections can decrease the frequency of needling intraarticular injections, which also decreases the amount of steroid administered into the body as well as the associated risks with entering a joint. Acupuncture is a safe alternative to medication, and is accepted even at show side by the Federation Equestre Internationale.

Endogenous analgesia

Treatment of ileus

It is imperative to understand the termination and synapsis of these fibers and nerves in order to conceptualize the release of endogenous analgesia, and how it relates to maintaining performance horses without added pharmaceuticals.

One of the unfortunate sequels that can happen when traveling to and from horse shows is ileus. Gastrointestinal motility can be broken down into three basic mechanisms. The first is neurogenic, and involves the intrinsic nervous system or extrinsic nervous system input causing changes in motility. The next mechanism is humoral, and includes neurotransmitters, polypeptides, and the non-adrenergic non-cholinergic nervous system. Finally, the myogenic aspect is associated with mechanical distention and reflexes of the intestines.6

Endogenous opioids such as dynorphin and enkephalins, as well as adrenocorticotropic hormone, are released in the hypothalamus, and beta endorphin is released by the pituitary. Serotonin, dopamine and norepinephrine (NE) are neurotransmitters involved in both pre- and postsynaptic inhibition of central pain pathways, and aid in our patients’ “feel good” response during treatment. These neurotransmitters may also suppress the release of a neuropeptide called substance P, a neurotransmitter for nociceptive nerve terminals. Additionally, the hypothalamus releases acetylcholine (ACTH), stimulating the release of cortisol from the adrenal glands, which also may contribute to the anti-inflammatory effects of acupuncture.2,3,4 By decreasing inflammation in the body, providing endogenous opioids, and decreasing the effects of the pain pathway, we are consequently lowering the need for pharmaceuticals such as Phenylbutazone, Flunixin meglamine and exogenous steroids used in intraarticular injections. Intra-articular injections come with associated risks including joint sepsis, flare, lack of effect, overuse and periarticular cellulitis, among others. In a recent clinical study involving intra-articular hock injection accuracy, published by the Equine Veterinary Journal, it was noted that the centrodistal (CD) joint was only 42% accurate, whereas the TMT joint was 96% accurate.4 This variation between accuracy leaves something to be desired.

Ileus can have several causes, such as paralytic (adynamic), spasmodic (dynamic), mechanical (obstructive) or idiopathic.6 As we know, acupuncture helps maintain a level of homeostasis throughout the body, and the external placement of needles has a direct impact on the associated internal visceral structures. To treat ileus in horses using acupuncture, one needs to perform a thorough DAPE/ palpating exam, assess the animal’s yin constitution, determine which of the five elements are being affected, and finally assess deficiencies and excesses of Qi.6,7 Some acupuncture points beneficial for ileus include ST 25, ST 26, BL 20, BL 21, BL 25 and San Jaiung.2 Travel can cause added stress to horses, directly affecting changes in cardiovascular function, digestion, immunity and overall homeostasis. By performing acupuncture prior to travel, we can stimulate the parasympathetic nervous system to decrease many of these responses. Road transport and exercise were assessed in a recent study performed on five Thoroughbred race horses.8 Round one of the study was the “control”, and included transporting and racing the horses, then assessing glucose, lactate and erythrocyte osmotic fragility (EOF). The second part of the study involved performing acupuncture on the horses prior to transport and racing, then doing the same assessment. Continued on page 64.

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Acupuncture’s mechanism of action Acupuncture works by targeting trigger points and specific locations along 12 paired meridians. These meridians course along neurovascular bundles throughout the body. The neurovascular bundles contain free nerve endings, an artery, vein, lymphatic channel and numerous mast cells.3,4 They are surrounded by a loose connective tissue sheath, which binds water and acts as an ion exchanger. Additionally, acupuncture points are often located along the pathways of major peripheral nerves or their branches. At these acupuncture point locations, cutaneous nerves are emerging from deep fascia, bony foramina, at the bifurcation of peripheral nerves, or along tendons or ligaments. The insertion of small stainless steel needles stimulates these structures, and starts the healing cascade. Multiple types of peripheral nerves throughout the body are targeted by the insertion of the acupuncture needles. We will primarily focus on A-delta and C fibers, sensory nerves that play a large role in the analgesic aspect of acupuncture. It is said that cutaneous nerves have more than a fourfold higher number of A-delta and C fibers when compared to A-beta fibers, which derive from cutaneous tactile receptors and endings of muscle spindles.2,3,4 Once a noxious stimulus affects the nociceptors associated with the A-delta or C fibers, transmissions of nervous impulses are sent to the dorsal horn of the spinal cord, activating the spinal cord, brainstem and hypothalamus, triggering release of neurotransmitters. The main functions of A-delta fibers are to carry mechanical and thermal pain, activating neurons of the neospinothalamic tract. These neurons have long axons that cross to the opposite side of the spinal cord, ascending to the reticular areas such as the brainstem and thalamus, sending signals to the somatosensory cortex, giving input as “fast-sharp” pain fibers. Comparatively, C fibers carry their information through the substantia gelatinosa, terminating primarily in the brainstem. These fibers are “slow-chronic” pain fibers that have poor localization properties.2,3,4

This patient is experiencing some of the relaxing and analgesic effects of acupuncture that take place during needle placement.

To higher centers in brainstem and thalamic nuclei Slow–chronic pain fibers

Fast–sharp pain fibers Tract of Lissauer Pain fibers

Spinothalamic tract

Ganglion

Substantia gelatinosa (II & III)

II I

III

IV V

Dorsal root

VI VII IX

X VIII

Ventral root

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Continued from page 62. Performing acupuncture prior to transport and racing was shown to increase blood glucose, and reduce both lactate and EOF. These findings suggest that performing acupuncture prior to transport improves the horse’s physiological adaptation to stress and also enhances physical performance.8

Acupuncture as prevention Finally, acupuncture can be used as a preventative method for keeping equine athletes in top shape. As we know, horse owners are asking more of their performance animals, and are subsequently calling on acupuncture along with traditional Western medicine to help achieve these goals. The placement of needles into the appropriate points along the 12 paired meridians aids in the movement of Qi, decreases wind-up pain, treats myofascial trigger points, and creates homeostasis throughout the whole body.2 When working with performance horses, it’s a good idea to also assess the rider for imbalance; assess saddle fit; ensure properly shod hooves; and evaluate for mouth pain from sharp teeth or incorrect bit. These factors can all play a large role in performance-related problems that can cause subtle discomfort or pain, and should be addressed appropriately using whole-body acupuncture assessments and 2 needle placement.

back soreness can cause distal limb lameness.2 When assessing back pain, performing a full body exam is recommended, with particular focus on assessing the bladder meridian for tension, trigger points, bracing, etc. Chiropractic care has been used in conjunction with acupuncture to aid in the health and proper function of the spinal column by returning spinal motor units to normal function.7 One should also contact the rDVM to discuss medication, joint injections, whole body pharmaceuticals used (i.e. Legend, Adequan, NSAIDs), and imaging. By incorporating each of these considerations into the treatment plan, we are setting these athletes up to perform and excel.

Conclusion Equine acupuncture is a highly sought-after modality for keeping working and companion horses in top shape. It decreases the need for joint injections and medication by creating analgesia, decreasing wind-up pain, and releasing endogenous substances to directly affect the central and peripheral nervous systems. Additionally, acupuncture decreases stress during travel, aiding in digestion and decreasing the frequency of associated ileus. Finally, acupuncture is used as a direct assessment for overall body health and prevention of sportsrelated injury. By integrating holistic approaches such as acupuncture with Western medicine, we help keep our equine athlete patients in peak performance condition.

Bai Hui and BL line points are

helping to keep this performance Soft tissue back and neck pain are horse in peak condition. extremely common problems that affect Acupuncture exam performance and behavior. The back and neck are central to the musculoskeletal system, and directly change the horse’s movement, and the biomechanics When beginning an acupuncture session, it is necessary to carry a rider appropriately. For a horse to travel important to obtain a thorough traditional history, properly, his abdominal muscles, iliopsoas, tensor fasciae latae PE and DAPE examination. A DAPE examination and quadriceps are all fully engaged, with the longissimus dorsi is derived from a traditional Japanese approach to acupuncture. Palpation is used to assess the whole muscle relaxed to freely move the back and keep the hind legs body for trigger points, regions of pain, loss of engaged underneath the horse. Once his back loses its normal sensation, change in range of motion, heat in areas movement and flexibility, the distal limb must compensate for of the body, and general pathologies.2 these changes in movement. For this reason, many believe that

Rizzo, Maria, et al. “Acupuncture Needle Stimulation on Some Physiological Parameters After Road Transport and Physical Exercise in Horse”. Journal of Equine Veterinary Science, Volume 48 , 23–30.

“Economic Impact of the United States Horse Industry”. American Horse Council, 2017, www.horsecouncil.org/ economics/.

6 Crisman, Mark V. “Equine Acupuncture — Beyond the Qi Concept”. Proc. of ABVP 2012, Blacksburg, Virginia, Web. 1 Feb. 2017.

Boldt Jr., Ed., “Veterinary Acupuncture and Chiropractic: What, When, Who?” Am. Assoc. Equine Practitioner, 2016.

7 Schoen A. Veterinary Acupuncture: Ancient Art to Modern Medicine. 2nd ed. Mosby; St. Louis, MO, USA: 2001.

East, Leslie M. “Equine GI Motility: Eastern Medicine Meets Western Medicine”. ACVIM 2002. www.vin.com/ members/cms/project/defaultadv1.aspx?id=3845051&pid=8873&.

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Eckermann-Ross, Christine. “Mechanisms of Acupuncture Anagesia”. www.vin.com/Members/Cms/Project/ defaultadv1.Aspx?Id=7546431&Pid=16051&, ABVP 2016.

8 Seabaugh, KA, et al. “Clinical study evaluating the accuracy of injecting the distal tarsal joints in the horse”. Equine Vet J, 49: 668-672, 2017. doi:10.1111/evj.12667.

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events Annual ABVP Symposium

October 11–14, 2018 – Tampa, FL The ABVP Symposium is a leading CE event for veterinarians, veterinary residents, veterinary technicians and students that offers 23 hours of attainable CE per person. Increase your knowledge base and have some fun! Visit our website to view the conference schedule. For more information: (800) 648-4462 www.abvp.com

2018 Veterinary Cancer Society Annual Conference October 18–20, 2018 – Louisville, KY This conference provides a wonderful forum for you to refresh your knowledge base and offers plenty of networking opportunities with leading scientists, researchers, practitioners, friends and colleagues, as well as sponsors and exhibitors.

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

Please return to the website frequently for Conference updates and abstract submission deadlines. For more information: (573) 823-8497 http://vetcancersociety.org/conference/

2018 CVC San Diego December 13–16, 2018 – San Diego, CA

• Staff on-hand to help plan your CVC experience • Registration and travel costs that make sense • Registration includes “lunch bucks” to cover the cost of lunch and snacks • Hotel rates and hotel extras negotiated to deliver convenience and comfort at the best possible price For more information: www.thecvc.com

Experience exceptional veterinary continuing education in a central location. Outstanding convention hotels, dining, shopping, and entertainment all within a short walk of the San Diego Convention Center. Take a break from the traditional and join us at CVC San Diego to experience an unconventional, attendee-centric approach to veterinary continuing education conventions.

AAVA Annual Meeting

• Maximum CE in minimum time • Exceptional programming, led by the profession’s most accomplished educators and experts • Simple to plan and navigate

For more information: ofice@aava.org www.aava.org

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

April 5–7, 2019 – Portland, OR

Plan to join us at the 14th annual meeting in Portland, Oregon at the Benson Hotel. We are planning the speaker line up now, and it’s sure to be an engaging meeting at a fun location! Visit our website for more information and to register.

IVC Fall 2018

news bites VET STUDENT ESSAY COMPETITION WINNERS The VIN Foundation (VINFoundation.org/Resources) recently announced the results of its second annual Solutions for the Profession Competition. This year’s competition gave veterinary students an opportunity to share their views on what would have helped them to know before applying to veterinary school. It also asked them to suggest ways veterinary schools could better communicate the challenges students face, and the realities of the veterinary profession.

• Second place: Cheyenne Cannarozzo made the innovative suggestion of adding resilience to the core competency requirements for veterinary students. She is entering her third year at the Cornell University, College of Veterinary Medicine. • Third place: Linnea Thraen’s essay highlighted the need for improved business management education in veterinary school. She has just graduated the University of Minnesota, School of Veterinary Medicine.

Over 100 entries were submitted, with student debt and mental health among the most common problems addressed. Three winners were awarded cash prizes to help with educational expenses: • First place: Paige Livingston wrote an essay on ways to improve student debt education. She is entering her fourth year as a student at the University of California at Davis, School of Veterinary Medicine.

SINGLE GENE MUTATION RESPONSIBLE FOR PACING GAITS IN SOME EQUINES How are some horses able to pace without special training, and why are these gaits more common in certain breeds like the Icelandic? Leif Anderson, from the Department of Animal Breeding and Genetics at the Swedish University of Agricultural Science, led a research team examining the genetic components connected to a horse’s gait. They studied the genomes of 70 Icelandic horses, and discovered that 40 could pace – a lateral, two-beat gait where two legs on the same side of the horse move forward together. The remaining 30 could perform other alternate gaits. A single mutation in a gene labelled DMRT3 was determined to be the common factor. “Horses without this mutation cannot move their right hindleg and right foreleg at the same time,” Anderson explains. “But with the mutation, the movement is not regulated so strictly and becomes more flexible.” equinescienceupdate.com/articles/smahg.html

KITTEN HEALTH INSURANCE ON THE RISE The number of kittens enrolled in pet health insurance is increasing – up 62% between 2012 and 2016, according to data from Crum & Forster Pet Insurance Group™. The usage of health insurance is also increasing as cat owners close the gap on claims submissions for kittens less than a year old. In 2012, only 26% of kitten owners filed claims, compared to 41% in 2016. “This growing interest presents veterinarians with many opportunities to provide improved pet care while increasing revenue,” says Dennis Rushovich, Senior Vice President of Crum & Forster. “Pet health insurance makes it easier for clients to adhere to veterinary recommendations. It’s never too early to start talking with cat owners about pet health insurance.” cfpetinsurance.com or aspcapetinsurance.com.

IVC Fall 2018