V9I1 (Winter 2018-19) by Redstone Media Group

Innovative PEER REVIEWED

VOLUME 9 ISSUE 1

VETERINARY CARE

3 POSTOPERATIVE DENTAL CARE

OPTIONS THAT IMPROVE RECOVERY TIME MODALITIES LIKE ACUPUNCTURE, LASER AND OZONE THERAPY HELP ANIMALS RECOVER MORE QUICKLY AND SMOOTHLY FROM DENTAL PROCEDURES. – P. 48

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WINTER ISSUE 2018/2019

FUNCTIONAL NEUROLOGY IN VETERINARY TREATMENT AND REHABILITATION

CANNABIS FOR VETERINARY PATIENTS

RECOMMENDING RAW BONES

3 INTEGRATIVE APPROACHES TO STOMATITIS IN CATS

HOW CHIROPRACTIC ENHANCES ANIMAL DENTISTRY

RECOGNIZING SOFT TISSUE INJURIES IN DOGS

A closer look at the evolving field of functional neurology. – P. 30

Raw bones are great for dental health, but be sure your clients know how to feed them safely. – P. 18

Using chiropractic care alongside dental procedures can reveal and correct additional problems in your patients. – P. 12

The market is being flooded with medicinal cannabis products. Assist your clients by staying informed. – P. 53

Modalities such as TCVM, stem cell therapy and guided bone regeneration surgery are proving effective for many feline patients. – P. 42

Rehab techniques should consider how the injury developed and how it affects the entire body. – P. 22

IVC Winter 2018/2019

contents FEATURES

INTEGRATING CHIROPRACTIC DURING AND AFTER ANIMAL DENTISTRY

By Rachel Jones, DVM, CVCP, PScD

The use of chiropractic during dental procedures allows you to evaluate the stomatognathic system, reset the nervous system, and pick up on clinical changes.

NUTRITION NOOK

RECOMMENDING RAW BONES IN THE VETERINARY PRACTICE By Jodie Gruenstern, DVM, CVA

Raw bones are a great way to enhance patient nutrition and dental health, but it’s important to educate clients on how to feed bones safely.

RECOGNIZING SOFT TISSUE INJURIES IN DOGS FROM AN INTEGRATIVE PERSPECTIVE–PART 2

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 entire body.

FUNCTIONAL NEUROLOGY IN VETERINARY TREATMENT AND REHABILITATION By Carl DeStefano, DC, CAC, DACNB, FACFN

The evolving field of functional neurology demands training and examination procedures that consider the neurologic health of neuron pools integral to stability and movement.

Tips and ideas for introducing holistic modalities in a traditional veterinary practice setting.

INTEGRATIVE APPROACHES TO FELINE CHRONIC GINGIVOSTOMATITIS

GUIDED BONE REGENERATION (GBR) IN THE TREATMENT OF CAT STOMATITIS

By Jody Bearman, DVM

By Don DeForge, VMD

This treatment alternative completely and permanently reverses the oral inflammation and pain evidenced in feline stomatitis patients.

IVC Winter 2018/2019

Major research projects have been exploring the use of adipose-sourced stem cells in the treatment of this debilitating feline disease.

INTEGRATIVE APPLICATIONS IN VETERINARY DENTISTRY

MEDICAL CANNABIS IN YOUR PRACTICE

WORRIED ABOUT GRAIN-FREE DIETS AND HEART DISEASE?

PROGRAMS AND APPS THAT IMPROVE YOUR PRACTICE

By Katie B. Kangas, DVM, CVA, CVCP

From acupuncture to laser to ozone therapies, a wide range of modalities can speed healing, reduce complications, and relieve discomfort in animal dental patients.

By Angie Krause, CVA, CCRT, DVM

Cannabis holds a lot of promise for treating dogs and cats. It’s important to educate clients by staying informed about the growing number of cannabis products on the market.

By Barbara Royal, DVM, CVA, CIAC

Are grain-free diets really associated with canine dilated cardiomyopathy (DCM)? Here’s how to answer questions from concerned clients.

New programs and apps that digitize records, notes and follow-ups mean you can spend more time educating clients and caring for your patients.

INCORPORATING COMPLEMENTARY THERAPIES INTO CONVENTIONAL PRACTICE

Two case reports show how homeopathy and TCVM can effectively treat FCGS without the need for full mouth extraction.

By Carlisle Froese, MA

INNOVATIVE PRACTICE

By Jamie Moran, DVM, CVA

STEM CELL THERAPY FOR FCGS

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

46 COLUMNS & DEPARTMENTS

5 Advisory board

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.

8 Editorial 29 From the AHVMA 39 From the VBMA 40 Industry innovations 51 From the AATCVM 52 Wellness resource guide 61 From the VMAA

Dr. Steve Marsden, DVM, ND, lectures for the IVAS, the AHVMA and the AVMA, and is co-founder of the College of Integrative Veterinary Therapies. He is a director of the National College of Natural Medicine, and authored the Manual of Natural Veterinary Medicine. Dr. Marsden is extensively trained in alternative medicine, including Chinese herbology, acupuncture and naturopathic medicine. He has a veterinary and naturopathic practice in Edmonton, Alberta. In 2010, Dr. Marsden was named Teacher of the Year by the AHVMA.

Dr. Jean Dodds, DVM, received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she moved to Southern California to establish Hemopet, the first non-profit national blood bank program for animals. Dr. Dodds has been a member of many national and international committees on hematology, animal models of human disease, veterinary medicine, and laboratory animal science. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1994.

63 Marketplace 64 Events 65 News bites

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

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

IVC Winter 2018/2019

Integrative VETERINARY CARE

WINTER 2018/2019

EDITORIAL DEPARTMENT

Editor-in-Chief: Dana Cox Managing Editor: Ann Brightman Associate Editor IVC: Christina Chambreau, DVM, CVH Associate Editor IVC: Laurin Cooke, DVM Associate Editor: Emily Watson Senior Graphic Designer: Dawn Cumby-Dallin Graphic Designer: Anna Dezsi Social/Digital Media Manager: Theresa Gannon Web Design & Development: Lace Insom

COLUMNISTS & CONTRIBUTING WRITERS

Jody Bearman, DVM, CVA, CVCH, CVSMT Donald H. DeForge, VMD Carl J. DeStefano, DC, CAC, DACNB, FACFN Jodie Gruenstern, DVM, CVA Kim Henneman, DVM, DACVSMR, FAAVA, CVA, CVC Rachel Jones, DVM, CVCP, PScD Katie Kangas, DVM, CVA, CVCP Angie Krause, DVM, CVA, CCRT Jamie Moran, DVM, CVA Barbara Royal, DVM, CVA, CIAC

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

ADVERTISING SALES: Western Regional Manager: Becky Starr (866) 764-1212 ext. 221 becky@redstonemediagroup.com Multimedia Specialist: Kat Shaw, (866) 764-1212 ext. 315 katshaw@redstonemediagroup.com Editorial & Multimedia Specialist: Carlisle Froese, (866) 764-1212 ext. 224 carlisle@redstonemediagroup.com Subscription Services Manager: Ericka Carbonneau, (866) 764-1212 ext. 115 ericka@redstonemediagroup.com CLASSIFIED ADVERTISING: Libby Sinden classified@IVCJournal.com US MAIL: IVC Journal, 6834 S University Blvd PMB 155 Centennial, CO 80122 CDN MAIL: IVC Journal, 202-160 Charlotte St. Peterborough, ON, Canada K9J 2T8. The opinions expressed in this journal are not necessarily those of the editor, and different views may appear in other issues. Redstone Media Group Inc., publisher of IVC Journal, does not promote any of the products or services advertised by a third party advertiser in this publication, nor does Redstone Media Group Inc. verify the accuracy of any claims made in connection with such advertisers.

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

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

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

IVC Winter 2018/2019

editorial

HONORING YOUR

COMMITMENT When I graduated from veterinary school in 1980, I was already frustrated with the lack of response some animals showed to any treatments I could offer. Clients asked a lot of questions that had not been covered in veterinary school. Many complained that my treatments did not seem to really improve their animals’ general health. Being open to and mastering new approaches allowed me to help many more animals in my practice. IVC Journal is for those of you who, like me, want to enhance your ability to heal; and it’s committed to offering you more ways to improve patient health. Encouraging clients to do preventative dentistry is still as important as when I started working in veterinary clinics in the mid-1960s. Dr. Katie Kangas discusses many ways to help animals with dental disease, while Dr. Rachel Jones shows us how to use adjustments to prevent alignment problems that may be caused from dental procedures. An increasing number of cats are suffering from severe stomatitis, and many of our clients are very reluctant to have all their cats’ teeth removed as part of the treatment. We look at several approaches to feline stomatitis – Dr. Jody Bearman writes about her experience with both TCVM and homeopathy; Dr. Donald DeForge explains the great success he’s had with guided bone regeneration surgery; and we also report on stem cell therapy, which is showing promise as a way to resolve some cases of stomatitis.

Recently, grain-free diets became cause for concern after a study linked them to heart disease. Dr. Barbara Royal addresses this issue, along with the advantages of fresh food. Meanwhile, Dr. Jodie Gruenstern discusses what you need to know when recommending raw bones for patients. On the rehab side, Dr. Carl DeStefano educates us about functional neurology, showing how joint stability depends on the neurons involved with the joint. Finally, don’t miss Part 2 of Dr. Henneman’s article on the integrative diagnosis and treatment of soft tissue injuries. Check out the use of thermography on the floor where an animal was standing! I am so excited about the wealth of information IVC Journal brings to both holistic and conventional veterinarians. I have loved being the Associate Editor for the last six years and am excited to “pass the torch” to Dr. Laurin Cooke, who will bring a new perspective and focus to the journal. Meanwhile, I will stay actively involved on the Advisory Board. I encourage anyone with ideas for topics, articles or authors to contact Laurin at drlaurin@ivcjournal.com. I know everyone at IVC Journal looks forward to honoring your commitment to healing animals, and will continue to fill each issue with a variety of new approaches you can explore and potentially add to your practice. Have a great winter!

As a veterinary practitioner, you have access to so many products and therapies you can integrate into your practice. Dr. Angie Krause walks you through selecting and using the cannabis products that clients are frequently requesting nowadays, and Dr. Jamie Moran shares how to benefit from having an integratively-trained veterinarian in your practice.

IVC Winter 2018/2019

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

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contributors 1

1. JODY BEARMAN, DVM, CVA, CVCH, CVSMT Dr. Jody Bearman graduated from the University of Minnesota College of Veterinary Medicine in 1992. Wanting to help animals that couldn’t be diagnosed or treated with Western medicine, and those that developed severe side effects from Western medicine, she became a Certified Veterinary Acupuncturist in 2005, is also a certified Veterinary Chinese Herbalist, practices Tui-na (Chinese massage and physical therapy) and food therapy, and has instructed at the Chi Institute. Dr. Bearman became certified in veterinary spinal manipulation therapy in 2014, and is a member of the College of Animal Chiropractors. She trained in homeopathy and is a member of the AVH. She has a threeveterinarian integrative practice in Madison, Wisconsin.

6. RACHEL JONES, DVM, CVCP, PSCD Dr. Rachel Jones is a 1999 graduate of Tuskegee University School of Veterinary Medicine. Her own health issues in 2006 prompted her to incorporate alternative modalities to aid in restoring the health of dogs, cats and horses by addressing the root cause of disease. Over the years, her vast range of cutting edge modalities has established her as the one to see for complicated cases not responding to traditional therapies, and those wanting second options for more holistic therapies. Dr. Jones is now offering mobile services that are exclusively holistic and include dentistry, classical homoeopathy and chiropractic care. Her multimodality holistic care includes ozone therapy, thermal imaging, nutritional medicine, functional medicine and frequency medicine (BICOM).

2. DONALD H. DEFORGE, VMD Dr. Donald Deforge is a Fellow of the Academy of Veterinary Dentistry and President of the Society for Veterinary Medical Ethics. He developed a special interest in oral care after graduating from the University of Pennsylvania School of Veterinary Medicine. Dr. DeForge is co-editor of An Atlas of Veterinary Dental Radiology along with Ben H. Colmery III, DVM, DAVDC. He was an Adjunct at Northwestern Community College’s Veterinary Technology Program, where he established the Department of Oral Radiology and Periodontology for veterinary technology students, in conjunction with Dr. Nancy Marchetti, Program Director. Dr. DeForge is also the Oral Radiology Consultant for E-Vet Diagnostics, a telemedicine reading service for veterinarians.

7. KATIE KANGAS, DVM, CVA, CVCP Dr. Katie Kangas graduated from the University of Wisconsin Veterinary College in 1993. She achieved her CVA certification at the Chi Institute in 2008, followed by additional training in Advanced Acupuncture, Food Therapy, Herbal Medicine and Veterinary Orthopedic Manipulation. Dr. Kangas owns Integrative Veterinary Care in San Diego, California. Her areas of special interest include nutrition/food medicine, dental health and pain management. 8. ANGIE KRAUSE, DVM, CVA, CCRT Dr. Angie Krause graduated from Texas A&M University, College of Veterinary Medicine in 2007. A conventionally-trained veterinarian, she incorporates many holistic modalities into her canine and feline practice. She has a love for Traditional Chinese Medicine and Physical Medicine, using acupuncture and herbal formulas. She also offers laser therapy, myofascial release, physical therapy, nutrition, pharmaceuticals and surgery. Her goal is to use the body’s innate ability to heal to improve the health and longevity of dogs and cats, and to empower pet owners to become medical advocates for their animals. Dr. Angie has a house call practice in Boulder County called Boulder Holistic Vet (BoulderHolisticVet.com).

3. CARL J. DESTEFANO, DC, CAC, DACNB, FACFN Dr. Carl J. DeStefano graduated Cum Laude from the National College of Chiropractic in 1984. He is certified in Animal Chiropractic from the Options for Animals Veterinary Chiropractic Center and the American Veterinary Chiropractic Association (AVCA). He has completed all the educational requirements for the Diplomat program sponsored by the AVCA. Dr. DeStefano is board certified in Chiropractic Neurology through the American Chiropractic Neurology Board, and is a fellow of the American College of Functional Neurology. He is the Founder of the Health Pioneers Institute of Veterinary Chiropractic, and maintains a busy human and animal practice near Chicago. 9. JAMIE MORAN, DVM, CVA Dr. Jamie Moran graduated from Cornell University in 1980. She began her holistic adventure by taking the Chi Institute course in acupuncture in 2008, followed by other coursework, including 4. JODIE GRUENSTERN, DVM, CVA Dr. Jodie Gruenstern graduated from UW-Madison in 1987. She is a veterinary acupuncturist and advanced acupuncture, food therapy and some herbal modules. She has taken a number of food therapist certified by the Chi Institute; vice president of the Veterinary Medical Aromatherapy herbal courses with Dr. Steve Marsden and is currently enrolled in Dr. David Winston’s clinical Association; and a member of the AHVMA. Dr. Jodie sees patients in Arizona and formulates natural herbalist program. pet products. She is a Certified Health Coach for pet parents and teaches them how to integrate personal and pet holistic care. She is a nationally renowned speaker, author, TV and radio personality, 10. BARBARA ROYAL, DVM, CVA, CIAC and wrote the book Live with Your Pet in Mind! Visit DrJodiesNaturalPets.com for more info and Dr. Barbara Royal is an integrative veterinarian and IVAS-certified acupuncturist with extensive iPAWaid.com to support her non-profit charity. experience in veterinary care, including nutrition, acupuncture, emergency medicine, pathology, conventional practices, herbal remedies, physical rehabilitation techniques and alternative 5. KIM HENNEMAN, DVM, DACVSMR, FAAVA, CVA, CVC treatments. The author of three books, including The Royal Treatment, A Natural Approach to Wildly Dr. Kim Henneman is currently the only veterinarian in the US who is board-certified in both Equine Healthy Pets, she has also been featured in the documentary Pet Fooled. Dr. Royal is the founder and Canine Sports Medicine and Rehabilitation. Since first incorporating integrative therapies into and owner of The Royal Treatment Veterinary Center in Chicago and co-founder of the Royal Animal her Western Rockies mixed practice in 1990, she has taught at numerous conferences and veterinary Health University. She is also an adjunct professor at Cal Poly State University in San Luis Obispo. She schools, as well as contributing to several textbooks. She has worked with performance dogs and is the past president of both the AHVMA and the AHVM Foundation, and a Board Member of PAWS horses in environments ranging from Dubai to Alaska (seven times as an Iditarod Trail veterinarian). Chicago, a nationally-renowned no-kill humane animal shelter.

IVC Winter 2018/2019

INTEGRATING CHIROPRACTIC DURING AND AFTER ANIMAL DENTISTRY

The use of chiropractic care during dental procedures allows veterinarians to evaluate the stomatognathic system, reset the entire nervous system, and pick up on clinical changes we would otherwise miss.

The purpose of this article is to shed light on the importance of chiropractic care in general, and more specifically following dental procedures. Though the focus is on dogs and cats, all species that may suffer from spinal subluxations can benefit. In dogs, collar and leash use, rough play, dog park activity, basic training and restraint often cause compensated vertebral issues that, if left unresolved, can lead to chronic orthopedic issues down the road. Cats are also subject to the same issues, due more to jumping up and down from high places and from rougher acrobatic-like play. Cats, even more than dogs, are better at masking such issues, but just a single orthopedic manipulation (as felines are more often out in the lumbar spine) can significantly improve mobility.

care, we are able to make it even more valuable to the whole animal. During each and every anesthetic dental procedure, whether extractions are needed or not, the use of chiropractic care can only enhance the outcome upon discharge, whether the animalâ&#x20AC;&#x2122;s issues are related to dental problems or are preexisting. We are able to provide profound results that most of our clients have never seen before, thus encouraging compliance with future dental health maintenance, and improving caregiver loyalty to the veterinarian. Below, we will review the goals of evaluating structural conformation and performing orthopedic manipulation at the time of dental procedures.

IMPROVED COMPLIANCE

THE STOMATOGNATHIC SYSTEM AND UPPER CERVICAL MANIPULATION

Dental care in itself is one of the most important aspects of a petâ&#x20AC;&#x2122;s overall health. By incorporating orthopedic manipulative

Dental procedures allow us as veterinarians to evaluate the stomatognathic system and reset the entire nervous system.

IVC Winter 2018/2019

Photo courtesy of Refugio Campos

By Rachel Jones, DVM, CVCP, PScD

The stomatognathic system is comprised of teeth, jaws and associated soft tissue. Its effect on the nervous system in general, and conformational integrity, has long been overlooked.1 Anesthetic dental procedures involve manipulation of the head and neck for proper dental cleaning and polishing, radiograph positioning and extractions. Completing these procedures can result in additional subluxation on top of pre-existing ones. This is because the plates of the skull are connected, and sutures allow the skull to move in a very subtle way. The pressure placed on those sutures by the necessary bracing during an extraction process can lead to less than ideal repositioning of the plates. Once a dental procedure is complete, taking the time to palpate the skull to feel for any asymmetry, and gently holding and repositioning sutures in the subtlest of ways, will greatly help each patient.

RESETTING THE SPHENOID AND PALATINE BONES This can be done by palpation within the roof and along the inside of the mouth and temporal mandibular joint. Place one index finger on each TM joint to check for symmetry within the jaw, and then apply a steady gentle pressure to realign the area. As you start to check these with each dental procedure, you will become more comfortable and skilled at realigning. When you perform this technique during a normal dental cleaning without any extractions (with anesthesia), you can start to identify and correct pre-existing problems. During this time, it is prudent to complete the exam by checking both ear canals with the otoscope, and removing any preexisting wax, foxtails or other foreign bodies that may have been overlooked.

BEFORE ANESTHETIC Prior to full sedation, perform a pre-op physical exam that includes an orthopedic vertebral evaluation: Evaluate each pet from the front from afar (at least 2’ or 3’) and get accustomed to subtle changes that can have a profound effect on the area of the brain stem. Allow the animal to hold his or her head in its natural position and evaluate the lower eyelids for subtle changes. By drawing an imaginary thin line across the lower aspect of the lids, you will often see that one of the eyes is ever so slightly off and lies a bit lower than the other. Some cases are dramatically offset, as seen below – both dogs show a low right and left eye respectively: Some cases are dramatically clear while others are not so easy to pick up. At top right are examples of two dogs that are off on

Figure 1

Figure 2

alternate sides. The Bulldog (Figure 1) has a lower right eye, which most often is the result of the left atlas being displaced dorsally. The Yorkshire Terrier (Figure 2) is lower in the left eye, resulting in the right atlas being displaced dorsally. In the simple displacement of the atlanto-occipital joint (AO), the atlas is displaced dorsally at the left and right sides respectively. Viewed and palpated from behind the animal, the displacement is seen structurally and palpated as below (Figures 3 and 4): Figure 3 Figure 4

Confirmation of a simple displacement is done by standing behind the animal and placing the right index finger at the wing of the right atlas, and the left index finger at the wing of the left atlas. Careful practice of palpation will reveal one wing higher than the other when the animal is still. By dorsal palpation with each index finger, you can feel a tightening in the obliqus capitis cranialis and the major and minor rectus capitis dorsalis muscle groups. Human neurology shows that ¾ of a degree of a protractor (the thickness of just three fingernails) can have a huge effect on the muscle centers of relaxation being inhibited, and therefore abnormal vital muscular contracture. From above the spinal cord, the Red nucleus, the vestibular apparatus, and the lateral and medial reticulo spinal tracts control the two muscle centers that in turn control the Para spinal muscles from the poll to the pelvis, in the process of relaxation or contraction.2 These muscles relax or contract when the atlas is misaligned. Once corrected, additional subluxations can be cleared in the vertebral spine. A simple AO misalignment as in the Bulldog above, where the eye is low at the right and the atlas is high at the left, has the IVC Winter 2018/2019

The highest neurological interference comes from an occiput misalignment. If this is the case, such corrections should always be done once the animal has recovered from the dental procedure and is awake. The reason is that once the occiput is corrected (which is done from the front of the animal), his or her natural head position must be evaluated prior to proceeding with the AO correction. This is critical because such secondary or complex misalignments are a challenge even for the most experienced. Such complex misalignments will show the following during initial exam: Figure 7

Figure 8

IVC Winter 2018/2019

The dog at left (Figure 7) with a complex misalignment will reveal a dorsal displacement on the same side at which the eye is low. You would expect to see a low left eye if the atlas is simply displaced dorsally at the right (Figure 8). But in fact, the occiput is jammed in at the right atlas (Figure 9) so the right eye ends up being low on the right. This finding should be double and triple checked by close and careful repalpation of the major and minor rectus capitis dorsalis muscle groups, and reevaluation of the dog in a natural head position with no assistance from the holder. In other words, the neck should

I recommend that dogs Figure 9 be muzzled during such corrections, but not during the evaluation portion. After each attempt at any upper cervical correction, dogs should be allowed to move freely in the room, shake their heads, and be given a break. Often, they can complete the rest of the correction with this natural head shaking. After Figure 10 this repositioning, you can reevaluate to see if any more manipulations are needed to fully correct the misalignment. Upon successful correction, an immediate release of the major and minor rectus capitis dorsalis muscles will take place, and no one side will feel tense to the touch. These secondary or complex misalignments occur because not only is the atlas displaced dorsally on the one right side (in the case of this dog above), but the occiput is also misaligned at the right side, with occiput also jammed in at the right, causing the eye to be low at the right.

VERTEBRAL SUBLUXATIONS These can be easily corrected by use of the activator, or by hand. When using an activator, the goal is to apply a small concentrated force

Figure 11

Photo courtesy of Dr. Rachel Jones

Figure 6

Authorâ&#x20AC;&#x2122;s note: Vertebral adjustments should be done when the dog is standing. The dog in the images in this article is sitting because he is geriatric (with two bad knees) and a tripod.

Photo courtesy of Refugio Campos

Figure 5

Photo courtesy of Refugio Campos

Photo courtesy of Dr. Rachel Jones

Again, the initial evaluation must be done prior to sedation so that an occiput misalignment can be identified, if present. Such misalignments involving the occiput in addition to the atlas are called secondary or complex misalignments.

be free. Treats can be used from afar to hold the animalâ&#x20AC;&#x2122;s attention and keep the head forward. In such cases, the occiput should be aligned by coming in front of the animal and placing the left index finger in front of the wing of the atlas on the left side, and directing gentle pressure caudo-medially on the ridge of the occiput. This motion is like rolling a ball; just a gentle push results in movement (Figure 10). Once this is successfully completed, you can continue with the correction of the AO misalignment.

Photo courtesy of Refugio Campos

following pathology going on as seen in Figure 5. It is corrected by bracing caudal right side of atlas and gently flicking the left atlas down and around, starting from the most cranial or anterior aspect going ventral caudally (Figure 6).

Photos courtesy of Refugio Campos

to the dorsal spinal process from a 90° angle with cervical vertebra (Figure 11), 45° for thoracic (Figure 12) and 90° for lumbar (Figure 13).

Figure 12

Figure 13

Figure 14

Figure 15

It is common to do three passes, with the initial pass showing us which vertebral bodies are reactive and out of alignment; and the following passes showing what has or has not been cleared. Vertebral bodies that don’t clear after the third pass are most likely due to the chronicity of the subluxation. Such subluxations are usually cleared through subsequent treatment. It is often necessary to recheck these patients again in one week, and then follow up with another correction two weeks later, then three weeks after the second. The pelvis is addressed by correcting the cranial point of the ileum (Figure 14) and addressing the most caudal point on the ischium (Figure 15) at both the right and left sides of each.

Once the subluxations are corrected, it is helpful to treat the lateral sides where visceral nerves and blood supplies exit the vertebral bodies. This is easily accomplished Figure 16 by placing the middle finger on the spine and moving the activator on either side, alternating sides as you move down the vertebral bodies (Figure 16) or using your index and middle finger over each transverse process down the thoracic and lumbar spine. Manual treatment involves using the index and middle fingers over each transverse process down the thoracic and lumber spine. Continued on page 16. IVC Winter 2018/2019

Continued from page 15. Photo courtesy of Refugio Campos

FASCIAL RELEASE The final process to solidify the adjustment is releasing the fascia. The fascia, known as the “dura” within the cranium, is called “fascia” when it comes out of the vertebral column. This thin but durable layer covers all the organ and muscular surfaces of the body and forms a huge communication network within. It also is the primary reason why adjustments don’t hold – because of positional memory along with emotional energy that requires release. With the animal standing, I use the Vetrostim™ device for evaluation and release purposes – going down the dorsal neck, the base of each side, and down the dorsal spine and long epaxial muscles.

Figure 17

Freeing up the fascia allows muscles to release the memory held from chronic subluxation (which they have long been compensating for) (Figure 17). The use of this unit is not limited to canines and equines, but the noise can be startling for most feline patients. Releases in cats should be kept brief. The detox from the muscular release should be used with caution on any animal with a severe heart murmur. Dogs are often placed in right and left lateral recumbence, resulting in further release along the epaxials, biceps femoris, tensor fascia lata, cleidocephalicus, brachiocephlicus (clavical intersection), obliques and the latissimus dorsi.

Figure 18

In closing of the full adjustment, the tail, when available, can be gently pressed on both sides with a slight traction applied (Figure 18) and held till the pet releases through a deep breath, sigh, yawn or licking motion. This is an indication that the limbic system is clearing and processing the full adjustment. Finally, to check the pelvis and any legs that might be short and not corrected from the AO correction, leg length can be evaluated (much easier in the small to medium dog). Extend both hind legs at the same time, when possible, and determine which side is shorter by looking at the pads and how they line up (Figure 19). Upon identifying the short side, place the thumb along the side of the anus (making contact with the area of the sacral tuberous ligament), and direct the tip of the thumb laterally (Figure 20). Apply gentle and steady pressure laterally and dorsally until the thumb is slowly released and comes off the patient as the ligament relaxes. This isn’t always a comfortable process so have a handler present in case the animal reacts. Once released, allow the patient to walk a few strides and then recheck to ensure the correction is sufficient. This completes the full range of an orthopedic manipulative exam, which is easily done following a dental procedure.

Figure 19

Dental procedures allow us as veterinarians to evaluate the stomatognathic system and reset the entire nervous system. Remember…for everything missed for not knowing, a hundred things are missed for not looking.3 During such a procedure, however, we can address a close evaluation of the AO misalignments for brain stem clearing. Clearing the brain stem is crucial and will have one of the most profound effects on the animal as it plays a huge role with its impingement on the vagus nerve, which affects the parasympathetic nervous system and arteriole dilation. To heal properly, the vagus nerve must be functioning for proper innervation to the lungs, the heart, and other organs (the exception being the adrenal gland.)

hcbi.hlm.nih.gov. “The Relationship Between the Stomatognathic System and Body Posture”, NCBI-NIH Schwartz, Candell, et al. Principles of Neuroscience 3 Crediting the late Dr. Cuthbert Padmore, Large animal professor, Tuskegee University School of Vet Med. vomtech.com/veterinary-myofascial-release I would like to recognize Dr. Sherry Gaber, DC (sherrygaberdc.com), who has taught and mentored me in learning upper cervical techniques. 1 2

Figure 20

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nutrition nook PEER-REVIEWED

RECOMMENDING

RAW

BONES in the VETERINARY PRACTICE By Jodie Gruenstern, DVM, CVA

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aw bones are a great way to enhance patient nutrition and dental health, but it’s important to educate clients on how to feed bones safely.

Consumers once accepted at face value whatever recommendations were made by their physicians or veterinarians. Today, Google and social media afford them information and advice on a wide variety of health-related topics – such as feeding raw bones to their dogs and cats. As the animal doctor, you need to be informed on this topic. Just saying “don’t do it” will not be well received. Many people regularly give raw bones to their pets as a substantial part of their diets. Others feed conventional pet foods or commercial raw diets, but choose to supplement with occasional raw bones. The safety and efficacy of raw bone consumption depends on proper bone selection.

Raw bones need to be the right size Basically, a pet parent must choose the right-sized bones for his or her animals. It is not as simple as small pet/small bone or large pet/large bone. Owners should be encouraged to observe how their dogs and cats chew and ingest bones. It might come as a surprise to find that an 80-pound Golden Retriever daintily savors and nibbles a small chicken neck, while a Pomeranian ravenously sucks it down whole! The best bone for both these breeds might be a long, slim duck neck. The vertebral size of the neck must be small enough so as not to lodge in the esophagus or the small intestine. Even most hard-core bone feeders agree that turkey necks should never be fed to any domestic dog. Turkey necks are too large. A longer bone, such as a duck neck, means the animal needs to chomp it to get it down.

The major purpose of feeding pets whole, raw bones is to clean their teeth. This can only be accomplished if the animal gnaws the bone. Gulping is not beneficial. Although the Golden mentioned above would do well with a chicken neck, most large dogs will gulp short bones. Again, the duck neck is ideal as it promotes chewing. Bones need to be small for a dog or cat under 15 pounds, as well as for brachycephalic breeds. I have found whole quail and perhaps Cornish hens to be options. Short marrow bones are other options for these pets. Clients should use caution and watch their animals while they’re eating bones.

Different bone types The consumption of different types of bone is necessary for cleaning multiple tooth surfaces. • A duck neck may effectively clean the incisors and molars. • A dog needs to stick his canines into a femur bone to remove the marrow. Cut marrow bones usually range in length from 2” to 5”. The size of the bone determines the quantity of marrow contained within. Unlike duck necks, marrow bones are minimally ingested; they’re gnawed, but only the marrow is eaten. Note that marrow bone rings can catch around teeth or lodge in the roof of the mouth, so they should never be fed! • K nuckle bones are generally scraped clean, through use of the molars and canines, and eventually eaten. Even large dogs use their incisors to nibble the cartilage off these large bones. Continued on page 20. IVC Winter 2018/2019

Continued from pahge 19. Some pet parents hold the bone while the dog chews. This can also facilitate cleaning the incisors.

in mind that some who say “yes” may be incorrectly referring to rawhides shaped like bones!

Bone composition

Reported problems with raw bones

A variety of bone types are generally fed on a daily basis as part of the raw meaty bone diet. In addition to flesh and organs, these raw-fed dogs need to ingest a range of bones that also contain meat, marrow and cartilage, to satisfy their nutritional needs. When bones are simply fed for recreational purposes, their composition becomes less important, but has an impact on safety and enjoyment. Any bone is emotionally satisfying!

Diarrhea “I can’t feed raw bones to my dog because they cause diarrhea.” If a client says this, the doctor can almost always guess the bone type being fed was a marrow bone. Bone firms stool, but marrow does not. Advise these clients to thaw the marrow bone, spoon out most of the marrow, and leave a tiny bit in the center so the dog has something to work for. Throw the rest of the marrow away. This will alleviate the diarrhea problem.

When large dogs are fed whole, raw meaty bones as part of their daily meals, the bone contributes to a proper calcium and phosphorous ratio. These dogs get used to eating bones routinely and can handle wings and necks and backs. They are less likely to gulp or to compete with other animals in the household. Gnawing and eating slowly are more likely. Remember, a rawhide is not a bone. A rawhide does not clean teeth. It provides for chew time, but as most are chemically processed and many are indigestible, I discourage their use. When you ask your clients if they feed their pets bones, keep

Too much marrow, like any fat, could stimulate pancreatitis. However, raw fat is safer than cooked fat. There also seems to be a correlation between the consumption of carbs with fats, and the development of pancreatitis. Dogs on high-fat, moderateprotein, no-carb diets do not seem to develop pancreatitis. Obstipation A hard dry stool can mean too much bone consumption. This may occur if a dog is allowed to eat a large knuckle bone. Advise the client to limit the amount of bone ingestion. To avoid obstipation, think about the size of the dog and the proper size of his prey. Even a Great Dane shouldn’t eat a beef or bison knuckle bone in one sitting. The bone should be taken away and refrozen. This is a remarkably safe practice that mimics the behavior of wild canines who partially consume a prey animal or bone, then bury the rest of it and save it for later! Warn clients that stool passed after bone consumption will be drier and of a pale gray color. This is normal. Cracked or broken teeth Dogs can chip or break teeth on bones. But this can also occur when dogs chew on rocks or pull on cages. Most pet guardians who feed raw bones feel the benefits outweigh the risks. An otherwise healthy mouth with fewer anesthetic episodes for dental prophylaxis is highly desired by the pet-loving community. And raw bones are safer than other bone alternatives. Smoked or boiled bones

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become brittle, and cooked bones should never be fed. Raw bones should be taken away when they become dry and brittle.

TWO MORE HELPFUL TIPS ABOUT BONES the 1. Know radiograph

Bacterial contamination When feeding a pet raw food and bones, bacterial contamination is a possibility. Salmonella is ubiquitous. According to medical microbiologists, “in healthy individuals, the number of ingested salmonellae is reduced in the stomach, so that fewer or no organisms enter the intestine.” Author Ralph A. Gianella explains further that an animal host has many natural mechanisms to prevent colonization and prevent potential disease caused by salmonella. He also adds that antibiotic treatments damage this natural defense. Use some caution with dogs who are immunecompromised due to steroid use or chemotherapy. Most commercial raw bone manufacturers rinse their products in lactic acid for additional safety. However, local butchers may not. You could consider advising your clients to rinse raw bones in healthy water with a well-diluted essential oil blend such as cinnamon, clove, eucalyptus and lemon or lime. All raw meat products should be frozen for a minimum of two weeks before feeding; this kills parasites, but not bacterial organisms. GI obstruction Explain to clients the warning signs of gastrointestinal obstruction, and when they should seek to have radiographs taken. Synthetic or edible fake bones commonly cause the foreign body obstructions seen at many veterinary hospitals. Raw bones do not pose a greater risk.

appearance on a of bone presence and passage. Radiopaque densities are normal throughout the GI tract of dogs consuming bones, and even those ingesting commercial diets that contain ground bone.

bone eaters are 2. Recreational often so excited to receive a

bone that they gobble it up way too fast. To alleviate this intensity, suggest that clients precede the bone with a “veggie meal” or slather the bone with some type of blended fibrous vegetation. Canned pumpkin or green beans work great! Not only does this technique slow down the carnivorous appetite, but the mixing of fiber and chewed bone will aid safe passage. This suggestion mimics nature, since wild carnivores consume fur, feathers, leaves and sticks as well as meat and bones.

Conclusion Bone consumption has been a part of the carnivore lifestyle for eons. Although our dogs and cats have changed phenotypically, their biologic needs have not evolved. We can help our clients provide for their carnivorous fur babies by being knowledgeable and supportive guides, especially when it comes to feeding bones. Encourage their efforts to feed their pets safely and appropriately, and be sure they understand the importance of buying the right bones. IVC Winter 2018/2019

PEER-REVIEWED

Recognizing

SOFT TISSUE INJURIES IN THE DOG from an integrative perspective â&#x20AC;&#x201C; part 2

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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IMAGE 1 (below)– The accessory carpal bone lies just under the carpal pad. The best way to palpate this is with the carpus in 90ª ﬂexion and holding the bone on either side with thumb and a finger, moving it side to side. There should be more movement medially than laterally, and no crepitus. The end feel laterally should be distinctive and firm. In carpal extensive, the accessory carpal bone should have a very limited range of motion.

he care of the canine athlete in performance and working disciplines is finally getting much-needed attention and awareness. With the recent growth of agility, flyball, obedience, herding, sled racing and nose-work as competitive canine “hobbies”, more dogs than ever are considered to “have jobs”. Additionally, dogs are working in patrol/protection, detection, search and rescue (SAR), avalanche rescue/recovery and more. Part One of this article (Fall 2018) covered the integrative approach to diagnosing and managing the many musculoskeletal issues that can affect these working dogs, along with specifics about the shoulder. Part Two continues with a focus on injuries involving other body parts.

CARPUS AND TOES The palmar accessory carpal bone is an important structure in the creation of the palmar carpal canal by acting as a meeting point for several important soft tissues, such as the flexor carpi ulnaris muscle, the palmar carpal metacarpal ligaments, and the flexor retinaculum. The extensor carpi radialis extends across the cranial aspect of the carpus to attach on the proximal metacarpals. Hyperextension injuries to the carpus are common in active dogs. Most carpal and phalangeal problems are subclinical. Left undetected, they can lead to compensatory problems more proximally in the leg and caudal cervical spine; these are often missed until they are very progressed. Compensation from muscle soreness and tightness in the elbow or shoulder can, in turn, lead to chronic carpal problems. Dogs that are working in deep footing (sand), or that must turn a lot, can develop painful and tight extensor carpi radialis muscles, which can lead to loss of articular congruency and fixations of the carpal bones. Laxity of the accessory carpal bone can gradually develop from repetitive hyperextension trauma to the supportive soft tissue structures of the palmar carpus; this can occur in dogs that run or jump frequently (e.g. sled, obedience, agility, flyball, protection dogs or companion pets that run with the owners a lot). The flexor carpi ulnaris has two heads. The author has had two cases of one head tearing, leading to slight ventral sinking of the carpal joint. Accessory carpal bone laxity can be tested by flexing the carpus approximately 90°, then moving the accessory carpal bone gently back and forth medial to lateral (Photo 1). There should be no crepitus, and more movement medially than laterally. The end feel laterally should be very distinctive and firm. In carpal extension, the accessory carpal bone should have a very limited range of motion.

2C 2b

IMAGE 2 – (a) A sevenyear-old FS Labrador who started limping on the left front limb after a long and active hike. Thermal imaging localized the lesion to the left carpus, while a physical exam localized swelling and sensitivity to the distal ulna and proximal carpal canal. (b) Ultrasonography identified muscle injury to the ﬂexor carpi ulnaris and deep digital ﬂexor at the tendon junction. (c) The normal limb is presented for comparison.

Thermal imaging is an excellent way to initially identify carpal and digital issues. Despite the small size and angularity of most dogs, this area also can be ultrasounded with a small, linear high-frequency transducer and a stand-off (Image 2). Last but not least, toes should always be examined in the forelimb – always! Toes are usually overlooked, but they’re of critical importance as the interface between the dog and the ground. The foot dissipates load upon landing, and generates IVC Winter 2018/2019

propulsion on takeoff. Nail length should be evaluated to make sure they only touch the ground when the foot is active and not when standing still – the practitioner should be able to slide a credit card between the ground and the nail when the dog is standing on a firm level surface. The length of the toes should also be examined from above; a single digit sticking out longer could be an indication of a torn superficial or deep digital flexor tendon. And, of course, the pad surfaces should be carefully examined for any abnormalities or injury (Image 3).

IMAGE 3 – The third digit in this Cattle Dog’s front foot is extended cranially past the fourth digit. This can be a sign of a torn or stretched deep digital ﬂexor tendon or suspensory ligament.

Thermal imaging is an excellent way to identify toe problems; not only can the dorsum of the foot be scanned, but so can the palmar or plantar surfaces. It’s often easier to thermal scan a smooth-surfaced floor where the dog has been standing, than to try and scan the bottom of the foot directly (Image 4). Any dog displaying soreness on palpation or heat on thermal imaging should have radiographs taken. Sesamoiditis, phalangeal luxations, phalangeal fractures and flexor tendon damage/ruptures are all common problems in the feet of active dogs. Sesamoiditis is a refractory problem often resolved conventionally by surgically removing the sesamoids. The author has had excellent success using chiropractic therapy to resolve chronic toe and sesamoid injuries.

IMAGE 4 – Thermal image of a paw print on a smooth, tile ﬂoor after the dog has been standing still for several seconds. An asymmetric heat pattern can be seen. This is especially useful in cats.

LUMBOSACRAL SPINE For the most part, the working dog’s back (except in the case of iliopsoas issues) rarely shows signs of acute problems except for the odd pulled muscle. Working and performance dogs rarely show disk problems (probably due to better core muscle development), although spondylosis is common in these dogs

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as they age. A practitioner is much more likely to see repetitive stress injuries that are gradual and insidious, finally resulting in facet changes and spondylosis. A common diagnosis is “lumbosacral syndrome”. While this term is meant to refer to lumbosacral stenosis, it is often currently used as a “garbage can” diagnosis for generalized back pain. Integrative practitioners combining the unique palpation skills developed through manipulation and acupuncture examinations, with the advanced imaging of thermography, ultrasound and MRI, are uniquely positioned to fine-tune back pain diagnoses in active dogs. The author has found that many cases labeled “lumbosacral syndrome” ended up being muscles tears, fascial strains and vertebral fixations, with very few actually showing stenosis on MRIs. The majority of these dogs respond well to acupuncture, Chinese and Western herbal use, homeopathics (Ruta graveloens, Symphytum, Hypericum and others), CBD, manual and manipulative therapies, and core muscle conditioning. Many working breeds have such high drive and pain tolerance that they will ignore minor twinges, allowing problems to build until finally a major event occurs. Common guarding signs of back soreness include lumbar kyphosis and loss of “square” neutral stance (the “stable table”). In the dog, neutral stance is evaluated when the front carpi are placed under the elbow and the hind leg metatarsals are perfectly perpendicular to the ground. Any time a dog is seen in a stance or posture other than the “stable table”, with any lumbar kyphosis, he should be evaluated more thoroughly, even if he’s symptom-free. The presence of kyphosis can often be a sign of inadequate core conditioning and strength in a particular dog. Appropriate and flexible core strength is indicated by the dog’s ability to naturally stand in a neutral posture with a neutral (flat) spine. Very athletic and high-drive animals can cheat through their sports with speed and strength rather than using their bodies correctly. If not monitored with proper interventional chiropractic care, improper use will catch up with these dogs, either through aging or when a great effort must be made to avoid or recover from a slip or fall, an event in which tissue strength may be exceeded, leading to injury. Lumbar lordosis occurs when there is poor core strength. It is often compounded by poor conformation, such as poor hind limb angulation or underlying joint defects like dysplasia. Dogs with lordosis can also benefit from regular manipulative or manual therapy care, combined with appropriate rehabilitation and core conditioning guidance to strengthen the hypaxial and abdominal muscles that counter gravitational sag. Continued on page 26.

Continued from page 24.

INTEGRATIVE TREATMENT APPROACHES It seems to be the nature of today’s medicine to rely on recipe-like checklists for treatment protocols. The success of such protocols can easily lead practitioners to ignore or miss individual variations and responses to treatment. Integrative practitioners have numerous tools to meet the individual needs of a patient. Acute injury tools such as cold laser, acupuncture, homeopathy and herbs can be very eﬀective in all phases of healing. Structural alignment, manual and manipulative therapies can be easily integrated into rehabilitation visits and protocols, adding supportive therapies to healing that assist in speeding up recovery by removing tissue stressors from imbalanced movement, blood ﬂow restrictions and neurologic impingement.

ILIOPSOAS Strains and tears of the iliopsoas muscle are more recognized now in the canine athlete; they account for up to 30% of injuries in human sports medicine practices, and are commonly categorized as a groin pull. The presenting signs can be varied, ranging from a dog starting to knock rails while jumping, to chronic vague back pain, to acute weight-bearing lameness. “Iliopsoas” is the name given to the insertional combination of the psoas major and the iliacus muscles on the lesser trochanter of the femur (proximal, medial aspect). In the abdomen, both the psoas major and iliacus are separate muscles. The psoas major originates on various mid-caudal lumbar vertebrae, and the iliacus originates on the cranioventral aspect of the ilium. Both muscles are innervated by the femoral nerve, which originates from the cranial parts of the lumbosacral plexus (L3-L5) and travels through the fused iliopsoas, thus often making injury to this area painful. Since the iliopsoas muscle complex works as a hip flexor, an initial diagnosis can be made through the clinical test of extending the hind leg behind the dog, then externally rolling the leg out so the stifle swings laterally (and the hip rolls internally). While some clinicians do this by rolling the stifle medially (and the hip externally), the author finds that a lateral stifle rotation isolates the test to just the iliopsoas, and excludes potential diagnostic confusion if gluteal muscles are also injured. Abduction can be added for a further stretch. Ensure when the leg is extended that the stifle joint is supported by the tester’s hand (the twist has to come from the hip, not the stifle). A positive response is displayed by an attempt to pull the leg back, be unable to hold the leg in extension for long or to try to bite the examiner. Additional diagnostics include the use of diagnostic ultrasound by which core lesions and chronic fibrosis are often found in performance canines. Avulsion fractures of the insertion on the lesser trochanter are uncommon but can be seen on radiographs (Image 5). Chronic core lesions are sometimes treated with ultrasound-guided PRP injections. Avulsion fractures are not surgically repaired. Regular and routine focused core conditioning, combined with manipulative or manual therapies of the lumbar and sacroiliac areas of the spine, are critical to keeping the iliopsoas muscle healthy and active and minimizing the potential for injury (as well as caring for the entire lumbar spine). Once an iliopsoas is determined to be injured, it is helpful to be able to stage it with ultrasonography before performing any manipulative therapy. High force chiropractic adjustments should not be applied over any area where there is significant muscular injury (even if suspected) or in the presence of any avulsion or periosteal injury.

Image 5 –A lesser trochanter avulsion fracture is marked by the yellow arrow.

COMMON CALCANEAL TENDON While full-blown Achilles (common calcaneal) tendon ruptures are uncommon, the increased use of ultrasonography as a

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musculoskeletal diagnostic tool will probably be able to identify Grade 1 and 2 levels of injury, making earlier recognition more prevalent. In the dog, the calcaneal tendon is made up of three components – the gastrocnemius tendon (the largest component); the common tendons (convergence) of the biceps femoris, gracilis and semitendinosus muscles; and the superficial digital flexor tendon (SDFT). The common tendons make up relatively small insertions of the total calcaneal tendon; the SDFT originates between the two heads of the gastrocnemius muscle and mostly travels on the craniomedial aspect of the gastrocnemius tendon until just proximal to the calcaneus. There, the SDFT fans out and becomes superficial to the gastrocnemius tendon as the SDFT passes over the plantar surface of the tarsal joint. There is also a bursa under the common calcaneal tendon just proximate to the calcaneus torsal bone that can be injured or inflamed. While most calcaneal tendon injuries are due to acute tendon trauma, associations exist with Cushing’s, obesity, diabetes, and the use of fluoroquinilone antibiotics such as orbafloxacin, enrofloxacin, ciprofloxacin or marbofloxacin. The use of these antibiotics in working and performance dogs is discouraged, although if they’re needed for a life-critical issue, the owners need to be warned that their dogs should not be worked heavily for at least 12 weeks after cessation of the drug therapy. The author also puts those dogs on vitamin C protocols for at least three to six months to support tropocollagen production. Dosage depends on GI response, GI history and age. Common calcaneal tendon (CCT) insertion strain in the opposite weight-bearing limb can commonly result from a non-weight-bearing lameness. Significant proprioceptive nerve fibers serve the calcaneal tendon. Research in humans has shown that creating vibration of the calcaneal tendon while an individual’s vision is blocked can have a major impact on stance and posture. This is due to the IMAGE 6 –This shows a central tarsal bone displacement (a common injury in racing greyhounds) in a working sheepdog that was unidentified by an emergency clinic. The dog had been competing when it suddenly became non-weight-bearing. Surgical correction was successful and the dog returned to national competition within a year.

stimulation of both muscle spindle cells (MSCs) and Golgi tendon organs (GTOs) in the numerous muscles that combine to make the calcaneal tendon. In humans, mechanical stretching of the common calcaneal tendon results in a stance that leans posteriorly in anticipation of forward movement. The calcaneal tendon may be just as important, or even more important, in a quadruped, yet its current role in quadruped proprioception is currently unknown. Body work and structural rebalancing of any tissue involved with the hindlimb is sure to make profound rebalancing changes to the hindquarters (and no doubt also to systemic movement). Calcaneal tendon injuries other than ruptures typically have a vague history of low grade, consistent or off-and-on lameness. Rarely is there palpable thickening, heat or sensitivity at the area of the lesion. Diagnosis is made by identifying the location using thermal imaging, then documenting it with ultrasonography. Chronic-active injuries should be approached with caution when applying any manipulative force across the area, due to the possibility of fiber degeneration at the periosteal insertion. If the tissue shows itself able to handle manual or acupuncture modalities, these can positively affect the hind limb neuromuscular and neurofascial tissue dialogue.

TARSUS/METATARSALS The tarsus in the athletic dog is usually overlooked. Often, abnormal radiographic appearance is not recognized (Image 6). Like the carpus, the tarsus is a complex joint that dissipates shearing and concussive stresses by transferring them through the large cartilaginous surface area created by the small bones. There are numerous small ligaments, as well as the larger plantar fascia/ ligament on the caudal aspect of the distal tarsus, the flexor tendons and the interosseous muscle (equivalent to human plantar fascia and equine suspensory ligament). Recognizing potential injuries in this area is important. Racing greyhound sports medicine recognizes and has published papers on several conditions of the tarsus, many of which are also seen in active companion and working dogs. Recently, the author treated a racing dog at the Iditarod for a lateral collateral tarsal ligament injury; early recognition, withdrawal from competition and prompt stabilization resulted in a rapid recovery and return to full function. The plantar interosseous muscle and individual digital flexor muscles can also be injured. These can be recognized through very soft and thorough palpation, and/or thermography and diagnostic ultrasonography (Image 7).

STIFLE (FEMOROTIBIAL JOINT) LIGAMENT INJURIES Stifle joint ligament injuries include those of the cranial cruciate, medial and lateral collateral ligaments. Not every case of hind IVC Winter 2018/2019

limb lameness involves the cruciate ligament. Groin muscles (especially of the adductor insertional tendon) and collateral ligaments can also look like stifle injuries. When testing the stifle, make sure that both the cranial drawer and the tibial thrust tests are performed, with the dog both standing and lying down as well as with the limb extended and flexed – this can help determine the status of the cranial cruciate ligament (partial or full tear). It is beyond the scope of this article to discuss surgical repairs to the canine CCL, but consider surgical options mindfully. Current surgical techniques seem to be suggested almost too casually, and are not without long-term problems. The cruciate ligament probably plays a significant role in total limb proprioception and 7A “joint position sense”. Ligamentous injury that leads to laxity in the human knee joint (animal stifle joint) has been shown to not only affect the injured leg, but can also set the body up IMAGE 7 - (a) A ten-year-old for kinematic differences in other joints FS greyhound participated (including in the unaffected leg) as well in weekend lure coursing. She became 5/5 (NWB) lame as for systemic proprioceptive loss and on the RH on the morning significant gait asymmetries. Several after a weekend of racing (during which she won all human studies have reported a loss of her races). Thermal imaging proprioceptive function and increased of plantar metatarsals shows significantly increased heat of laxity in the normal uninjured knee in the right plantar metatarsal. conjunction with an ACL injury. (b) Transverse ultrasound of the normal L metatarsal area. (c) Transverse ultrasound of the affected area, showing significant loss of muscle, presence of scarring (increased echogenicity in muscle area) and possible rupture of the MT2 ﬂexor tendon (yellow arrows).

Unlike in the active human, not much research has been done in dogs to examine the potential involvement of complex biomechanical forces and events being involved in stifle injuries. Dogs can definitely injure the propulsion (hamstring complex) and braking (quadriceps, tensor fascia lata) muscles of the hind leg. More thorough examination recording, combined with the use of soft tissue imaging such as thermography and diagnostic ultrasound, may reveal what many integrative sports medicine practitioners report – many active dogs that eventually have a cranial cruciate ligament failure have also had previous chronic muscular injuries. How could one not affect the other? Integrative practitioners, especially those trained in chiropractic, osteopathy and myofascial techniques, could be on the front line of developing better early-warning protocols for stifle ligament injuries.

individual more than conventional, reductionist modalities do. The combination of all perspectives, conventional and integrative alike, provides the practitioner with a larger picture of the individual within the population. As with any veterinary treatment, it is just as imperative with integrative therapies to first have a diagnosis. The goal of this article has been to encourage rehabilitation, integrative, and even conventional practitioners to take a more focused and detailed diagnostic look at any animal that presents with lameness, no matter how vague. All

CONCLUSION

practitioners should be willing to create a bigger and better

Injuries sustained during activity can be as complex and varied as life itself; integrative therapies recognize the picture of the

picture for any individual patient through a more detailed and

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knowledgeable approach.

From the AHVMA

The mindful leader elevating the veterinary profession through innovation, education and advocacy of integrative medicine.

2018 CONFERENCE HIGHLIGHTS The AHVMA’s Annual Conference from October 4 to 7 in Kissimmee, Florida had the most RACE-approved credits in AHVMA history! While the majority of attendees were practicing veterinarians, we were once again amazed by the high number of veterinary technicians and students. As always, the conference offered a wide range of topics, including Traditional Chinese Veterinary Medicine, botanical medicine, the microbiome, homeopathy, self-care and more. Presenters included keynote speaker Richard Palmquist, along with Barbara Fougere, Steve Marsden and many others. This year’s AHVM Foundation Silent Auction included items ranging from jewelry and books to vacation property getaways, and raised over $12,000 for the AHVM Foundation’s student scholarship fund. The AHVM Foundation’s end-ofyear fund drive runs until December 15. Visit ahvmf.org for more information. Our exhibit space at the conference increased approximately 5% over last year. Our exhibitors are an essential part of AHVMA, providing the products and support we need to offer alternatives to our patients. Exhibitors sponsor many special events, including Breakfast and Lunch & Learn Meetings, and the ever popular AHVMA Conference Mobile App. This year’s sponsors included: Vet Classics, Darwin’s, CuraCore, animalEO, VDI Laboratories, Aventix, Integrative Veterinary Innovations, Radagast, AnimalBiome, Steve’s Real Food, O3 Vets, Primal Pet Foods, Assisi Animal Health, Standard Process, ElleVet Sciences, Options for Animals, Glacier Peak, Multi-Radiance, New Zealand Deer Velvet, A Time To Heal, Animal Necessity, Herbalist & Alchemist, CocoTherapy, Qest, CryoProbe, Affordable Pet Testing, Evermore, Thorne Research, Golden Flower Chinese Herbs, Hippo Manager Software, Bemer and Dr. B’s Longevity. AHVMA has already received advance commitment from many of these sponsors for the 2019 conference! We are grateful to all our sponsors and exhibitors who helped make this year’s conference an amazing success.

AHVMA remains a proud member of the AVMA House of Delegates. Because we are an AVMA Constituent Organization, many states grant blanket approval for AHVMA CE. The 2018 AHVMA Annual Conference featured a grand total of 104 hours of lectures and labs to choose from. We once again received AAVSB RACE Approval for 95 hours of continuing education credits!

CONTINUED RISE OF HOLISTIC VETERINARY MEDICINE AHVMA’s membership continues to rise across all categories, from licensed veterinarians to students to our newest category of Associate Members. This is a strong indicator that the demand for holistic approaches to treat infections, viruses, cancer, and overworked immune systems also continues to rise. Pet owners are looking to holistic medicine for first line defense rather than as a last resort when conventional medicine has failed. Acupuncture, herbal medicine, nutrition, and many other modalities are being introduced in conventional clinics. These modalities (and more) are being researched, with studies published in the Journal of the American Holistic Veterinary Medical Association on a quarterly basis. The AHVMA continues to provide members with effective holistic solutions for the multitude of challenges facing all veterinary practitioners.

Save the date! Join us for next year’s AHVMA Annual Conference in Nashville, Tennessee!

September 7–10, 2019

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PEER-REVIEWED

FUNCTIONAL NEUROLOGY in veterinary treatment and rehabilitation By Carl DeStefano, DC, CAC, DACNB, FACFN

A colleague recently told me that she spent 90% of her time in veterinary school learning how to treat problems that are seen only 10% of the time. This was a doctor with many years of practice experience. What she was referring to was the emphasis placed on pathological problems, when most of what we see are functional problems. While a mastery of disease processes and pathology is important, there seems to be a lack of appreciation for functional issues, for tissues that are not functioning at optimal levels. When an animal is injured or recovering from a neuromusculoskeletal condition, the first question before treatment should be, â&#x20AC;&#x153;Why did the injury happen?â&#x20AC;? To answer this question, a thorough understanding of the neurological systems involved in joint stabilization is necessary. Evolution has provided a means to stabilize joints against gravity and other vector forces. This creates a ballet of activity involving pools of neurons within the central nervous system. An understanding of those pools and their central integrative state explain, in the

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absence of direct trauma, why joints fail. These joints may be in the extremities or spinal structures, allowing damage to soft tissues and neurological structures. To a large degree, the stability of a joint depends on the firing frequency of the muscle-tendon units that cross the joint. This frequency depends in turn on the firing frequency of the presynaptic pool of neurons. These are the alpha and gamma motor neurons living in the spinal ventral horn and motor nuclei of the brainstem. Further, the firing frequency of these neurons depends on the firing frequency of their integrative presynaptic pool. There are 10,000 to 12,000 pre-synaptic integers coming from spinal cord circuits and descending brain structures.1 Some of these neurons are excitatory and some inhibitory, all with different firing rates. This is the motor ballet that keeps the animal safe and stable during his lifetime. Any aberrancy in one or more of these presynaptic pools increases the probability of injury. If, when

rehabbing an animal, those pools of neurons are not evaluated and corrected, an increased probability of re-injury occurs. This also may be why, even with the best rehabilitative intervention, an animal fails to totally recover.

EVOLUTION OF A NEW FRONTIER – FUNCTIONAL NEUROLOGY The field of functional neurology has evolved as our understanding of neurophysiological processes grew. The explosion of research and knowledge surrounding these processes in the 1990s have made terms like “neuroplasticity” and “long-term potentiation” common in the national lexicon. Application of this knowledge in practice is an exciting and very practical new frontier in neurology and rehabilitation. This article describes how the brain and the rest of the neurologic system, along with the synapses with muscles, affect movement and stability. This knowledge enables a trained practitioner to know where to most effectively manipulate the musculoskeletal system to return animals to normal function.

MOTOR BALLET AND JOINT STABILITY For efficient motor control of posture and volitional activity, we are looking for the most effective expression of motor output from ventral horn cells. In addition, the peripheral nervous system must be free to carry those messages to the muscles. The ventral horn cells of the spinal cord and the brainstem motor neurons to the muscles of mastication and facial expression can be identified as alpha and gamma motor neurons. The alpha motor neurons provide the axons that excite muscles at the motor end plate. The gamma motor neurons dictate the sensitivity of the muscle spindle cells that share sensory information about the length and rate of change in muscle length to the central nervous system.1,3,4,5,6,7,8 As mentioned earlier, the firing frequency of alpha and gamma motor neurons depends on the firing frequency of their integrated pre-synaptic pools of neurons coming from a multitude of areas within the CNS, as well as incoming sensory data from sensory receptors.1

THE SYSTEMS INVOLVED A multitude of systems must coordinate for successful stability and movement. Cortically, there is a decision to move. This decision is shared with many areas of the nervous system even before the motor act begins. This sharing of information is known as efferent copy.6,7 Some of these areas include the IVC Winter 2018/2019

For a volitional motor command, the cortex sends a “copy” of the motor plan to multiple areas of the central nervous system.

basal ganglia (nuclei), the cerebellum, and many structures in the brain stem. The basal ganglion is a deep cortical organ that gates motor activity. It is a very complex structure but can be described simply as a “brake” to cortical output. Once a motor command is made the foot is taken off the brake for that specific activity.1,3,4,5,6,7,8 The cerebellum can be thought of as a “comparer”. It receives sensory feedback about the actual performance of a motor act. It compares the desired outcome with the actual outcome. It then sends messages about the mismatch back to the cortex and other brain structures so that corrections can be made. In addition, the cerebellum creates neural networks within itself about the motor act. This eventually leads to learning the motor act so that the cerebellum can initiate future expression of the activity.1,3,4,5,6,7,8 This is an important aspect of learning new, novel motor programs, such as dressage movements for horses or the navigation of weave poles for agility dogs. Within the brainstem are important regions and structures that contribute to motor activity of the head, eyes and body. A few are discussed here: • The red nucleus is in the mesencephalon. Some of the output from the red nucleus will fire down the rubrospinal pathways to control mostly volitional flexor muscles. This pathway is highly developed in our animal patients. 1,3,4,5,6,7,8 • The vestibular nuclei are in the floor of the fourth ventricle in the medulla. They receive information regarding head position from the vestibular apparatus in the temporal bones. In addition, they receive information from the visual system, neck proprioceptors, and from the feet/paws/hooves. They also receive sensory data from proprioceptors located throughout the body. The vestibular nuclei are known as “neural integrators” as they are comparing different sources of sensory input. When a “sensory mismatch” occurs, clumsiness, dizziness and sometimes vertigo can take place.1,3,4,5,6,7,8 Dysautonomia is also a common result of sensory mismatch. The vestibular nuclei send their flow

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of information to numerous brain structures, including the cerebellum, the extra-ocular eye muscles, and to ventral horn cells responsible for posture and core muscle tone.1,3,4,5,6,7,8 •R eticular neurons of the brainstem reticular formation also receive information from the cortex, basal nuclei, cerebellum and vestibular nuclei. They receive sensory data from all sensory systems but especially from those concerned with gravitational forces. The reticular system has broad influences on the nervous system, including brain arousal, pain inhibition and autonomic regulation. Our interest at this point is in its influence on postural muscles, mostly extensor, as it provides a foundation for volitional activity. This activity occurs through reticulo-spinal pathway influences, directly and indirectly, on ventral horn cells.1,3,4,5,6,7,8

REFLEXES A reflex can be defined as an involuntary and nearly instantaneous movement in response to a stimulus. A reflex is hardwired. Animals are born with their reflexes intact. Examples include the “withdrawal reflex”, the “tonic stretch reflex” and the “crossed extensor reflex”. Reflexes are the simplest of neurological motor expressions. Although reflexes are simple in nature, their impact is profound. The tonic stretch reflex initiated by the muscle spindle cell maintains an appropriate muscle tone in postural muscles as well as muscles involved in movement, preventing moments of instability and injury.

CENTRAL PATTERN GENERATORS (CPGS) I describe CPGs as being like small computer chips with wiring commands for different stereotypical movements. Rather than the brain coordinating all movements via direct ventral horn modulation of the trunk and extremities, it delegates those responsibilities to packets of interneuronal pools. These pools or CPGs send commands to specific alpha and gamma motor neurons to orchestrate a particular stereotypical movement. We know that chewing, breathing and gaiting are all under the control of specific central pattern generators.1-8

THE HIERARCHY OF MOTOR CONTROL I believe the evolutionary job of the brain is to be vigilant for survival. To that end, sensory systems monitor the external

world and the bodyâ&#x20AC;&#x2122;s own internal environment. Integration of this incoming sensory information, and the filtering through the lens of past experience and memory, should lead to efficient output systems that serve and keep the body safe. These output systems go to the muscles and the autonomic nervous system (endocrine, enteric and immune systems). Our animal patients need to stand and move in response to a constantly changing demand for movement and postural stability against gravity. This activity must be supported with food and oxygen provided by the autonomic system. Although this article is essentially about joint stability, it must be recognized that the central nervous system must also simultaneously provide for the autonomic support of movement.

THE BRAIN COMMAND OF MOVEMENT In this simplified diagram the many longitudinal levels of neural integration can be seen. Executive commands from the cortex are sent to many other brain regions and the spinal cord. The basal ganglion BG allows escape of the motor command. The brainstem fires to postural muscles for support of volitional activity. The CPGs involved in the movement are modulated by higher centers. Feedback is via proprioceptors and vision, and the cerebellum compares the desired outcome with actual outcomes and sends corrections back to higher brain structures.

When considering the neurology of joint stability the two different motor systems must be considered â&#x20AC;&#x201C; postural and volitional.

1. POSTURAL CONTROL We know that gravity was the most significant contributor to the evolution of the mammalian nervous system. To overcome the force of gravity, a neuromuscular system evolved that supported the animal, providing stability and a foundation for volitional movement. Continued on page 34.

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Continued from page 33.

METHODS OF

EVALUATION To maximize our clinical approach to treatment, we need a methodology to access the different neurological mechanisms involved in normal movement and stability. Technology provides tools that can access information about the external expression of central and peripheral nervous system health, but do not allow direct access to those neurological systems directing the movement. Force plates, treadmills, electromyography, etc. are useful tools for evaluating normal from abnormal, and are certainly very valuable research tools. Imaging devices are helpful in localizing pathology but are not valuable for evaluating the functional health of different neuroanatomical areas involved in motor activity.2

Ventral horn cells to postural muscles receive pre-synaptic input primarily from descending reticulospinal and vestibulospinal pathways. These cells also receive input from muscle spindle cells, golgi tendon organs, joint mechanoreceptors and other proprioceptors in the muscle, or in the tissues surrounding the joints that the involved muscles support. Chiropractors and osteopaths describe dysafferentation syndromes in which faulty joint mechanics send aberrant sensory data into the central nervous system. This dysafferentation affects spinal cord circuitry and has suprasegmental consequences.3 In addition to supporting the animal against gravity, the postural control muscles are also intimately linked to stereotypical movements controlled by central pattern generators (CPG) and volitional activity from the sensorimotor cortices.

Manual muscle testing as in applied kinesiology, in combination with history and neurological exam procedures, have proven to be very helpful in localizing the longitudinal level of pathological and functional lesions of the nervous system. Although limited in their application, these hands-on diagnostic tools can provide valuable localizing information about the status of neuron pools in speciﬁc parts of the nervous system.

2. VOLITIONAL CONTROL

It is important to approach each patient with the following goals and considerations:

“Neural representation” and “internal model” are terms used almost synonymously with “motor program”. Are large movements made up of stereotypical smaller movements? Do motor circuits such as central pattern generators make movement almost robotic? What effects do “hard-wired” reflexes have on movement? Probably all are involved in movement, with sensory feedback from the environment having a large impact on the modulation of ongoing movements. Changes in terrain, wind resistance, available light and sound all alter motor acts while in process.

• Diagnosing the longitudinal level of the physiological or pathological lesion should always be our primary goal. Without this information, our treatment will be arbitrary with a lower probability of success. • Our second serious consideration is whether the lesion is pathological or physiological (i.e. functional). We can greatly benefit animals with frank pathology, but we must also keep in mind that changes in motor activity can be secondary to aberrancies in the firing frequency of pools of neurons. • Once we have addressed the above two aims, we can proceed with integrative therapies that address those pools of neurons. • Prescribed owner-administered therapy, rehabilitation therapy and other modalities will now be more effective as they are directed more specifically to the affected neuromuscular anatomy.

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Volitional control of movement starts at the motor cortex. The cortex contains sensory and motor maps of our environment so that it is aware of where we are in space. It also contains body maps so it knows the relationship of one body part to another. The cortex also integrates past experience and the consequences of a motor act.1,3,4,5,6,7,8

VOLITIONAL MOTOR ACTIVITY It appears that volitional motor activity begins in the motor cortex, with flavoring from all other areas of the brain. • The motor command leaves through the motor cortex, and cycles through the basal ganglion and thalamus before returning to the cortex. This circuitry primes specific neuronal pools in the motor cortex to refine a particular motor act or movement.

• As mentioned earlier, these signals travel to many different brain and spinal centers as efferent copies. • The brainstem, receiving the motor command from the cortex, sends signals to postural muscles to provide the postural base of support for the motor act involving the extremities. • Sensory signals from the environment are integrated into the somatomotor system, keeping the motor cortex abreast of constantly changing contexts of external conditions and moving body part data. • Feedback from the cerebellum is a flow of information describing the differences of what was expected from the motor act as compared to what actually occurred. Thus the motor cortex can constantly fine tune its commands to elicit the most efficient muscle response to the motor commands. • For novel motor acts as well as frequently used motor operations, neuroplastic strengthening of neuro-networks occur. Gene expression-driven feed-forward and feedback mechanisms build neurological networks that might be defined as new motor programs. • It is believed that neuroplastic changes occur along the entire length of connections within all neuroanatomical areas participating in motor acts.

CONCLUSION Animals presenting for veterinary care deserve the best “state of the art” acute care and rehabilitation. In addition, the veterinary neurological exam and applied kinesiology may be used as tools to evaluate functional lesions of the central and peripheral nervous system. These are pools of neurons that are not functioning properly due to injury or a loss of a pre-synaptic frequency of firing. This demands a different kind of training and examination procedures that consider the neurologic health of neuron pools integral to stability and movement. This is the evolving field of functional neurology.

H all, J. E. 1. (2016). Guyton and Hall textbook of medical physiology (13th edition.). Philadelphia, PA: Elsevier.

Back W, Clayton HM. Equine Locomotion, W.B. Saunders. 2001.

Beck RW. Functional Neurology for Practitioners of Manual Therapy, Churchill-Livingstone, 2008.

Binder MD, ed. “Peripheral and Spinal Mechanisms in the Neural Control of Movement”. Progress in Brain Research, Vol.123; Elselvier, 1999.

Haines DE, ed. Fundamental Neuroscience for Basic and Clinical Applications, 3rd edition ChurchillLivingstone, 2006.

K andel ER, Schwartz JH, Jessell TM, Siegelbaum SA, Hudspeth AJ. Principles of Neural Science, 5th edition, McGraw-Hill. 2013.

Latash ML, Zatsiorsky VM. Biomechanics and Motor Control. Elselvier, 2016.

Purves D, Augustine GJ, Fitzpatrick D, Hall WC, LaMantia A, McNamara JO, Williams SM. Neuroscience, Sinauer Associates. 2004.

Henneman, K., Recognizing Soft Tissue Injuries in the Dog from and Integrative Perspective, Part 1, Innovative Veterinary Care, vol.8, Issue 4, 2018.

From the AVH

The Academy of Veterinary Homeopathy is comprised of veterinarians who share a common desire to restore true health to their patients through the use of homeopathic treatment. Members of the Academy are dedicated to understanding and preserving the principles of Classical Homeopathy.

Fall was in the air during our annual Homeopathy Meeting in the North Carolina mountains. 58 veterinarians enjoyed great views, a fantastic group of speakers, and topics such as the homeopathic treatment of problems from vaccines, successful approaches for cancer, and treating insulin resistance and Lyme disease in horses. The AVH continues to host monthly informational webinars to members, taught by a variety of homeopathic practitioners (TheAVH.org). An example of the deep healing possible with homeopathy involved Isis, a nine-year-old Bengal cat. He had a poor quality of life, having been on various conventional drugs over a two-year span for severe asthma that began after vaccinations in his fifth year. Careful selection of a homeopathic medicine, repeated as needed over a month as the drugs were withdrawn, allowed this cat to live another ten years of great quality life – with no recurrence of asthma. The Pitcairn Institute of Veterinary Homeopathy recently completed the last session of the year-long training program. We welcome the 15 new graduates to AVH. Check out pivh.org for details on the next course, to gain more information on homeopathy, or to contact us with questions about further training in homeopathy. IVC Winter 2018/2019

integrative practice Incorporating

COMPLEMENTARY THERAPIES into conventional practice

TIPS AND IDEAS FOR INTRODUCING ALTERNATIVE MODALITIES WITHIN A TRADITIONAL VETERINARY PRACTICE SETTING. By Jamie Moran, DVM, CVA

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or many years, I have practiced at a conventional, mixed, multi-doctor practice in southeast Pennsylvania. I gradually shifted into small animal work, leaving the cows, horses, sheep, llamas and pigs to my colleagues. Soon, I began to desire new ways to treat my patients. With the permission of management, I started by learning acupuncture at the Chi Institute. While I still cover regular appointments that include annual checkups, medical procedures, dental procedures, soft tissue surgery and emergencies, I have continued to explore holistic diagnostics and treatments in this conventional practice setting. The holistic approach can be used for assessment in every patient, no matter the type of appointment scheduled. Even if clients do not yet have an interest in holistic medicine, I can offer them various holistic as well as conventional treatment options. Fortunately, I work for a practice owner who has been very supportive of my alternative way of practicing.

which toxic products they are exposed to, what kind of stressors exist in their lives.

Reviewing vaccine options. One of the messages I try to advance is that we need to have respect for our patients and their bodies. The body is amazing at taking care of itself; and by building health to help the process, there is less chance of infection. When pets come in for vaccinations and medical exams, I stress choosing a plan that takes each patient’s needs into consideration. We discuss vaccinations from this perspective. After discussing the risks and benefits, the client will choose what they feel is best. I try to be supportive of clients by offering vaccine titers and safer vaccine options, such as splitting up vaccinations and avoiding over-vaccinating, especially in fragile patients.

Managing fleas and ticks. Many clients have been using chemicals for flea and tick control, but after a brief discussion, a large percentage will use these chemicals more sparingly, add in (or replace with) essential oils like rose geranium, and dust off the old flea comb.

Adding holistic treatments. I have a limited amount of time in a regular check-up or medical exam appointment

8 WAYS TO INTEGRATE A HOLISTIC APPROACH Below are six methods I have used to successfully incorporate this approach into our conventional practice:

Evaluating lifestyle. For me, this means ferreting out what my patients’ home lives are like – what they eat,

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slot. I still look for ways to insert food therapy, nutritional support and herbs into the treatment plan. Many clients are very enthusiastic about using herbal remedies rather than pharmaceutical medications, or about adding an herbal formula to a conventional Western medical treatment. Even when there is not enough time to delve too deeply, I find that many clients are willing to come back for a follow-up.

Doing a TCVM evaluation. Every physical exam can include a TCVM energetic exam, so I can offer alternative options if the owners wish it.

elping manage surgical patients. Other doctors often H refer cases involving tumor removal, and I always try to include integrative strategies. Many of my clients who would not normally seek alternative options will consider lifestyle and medical changes when faced with cancer in their pets, especially modalities like food therapy, herbal formulas and medicinal mushroom.

Minimizing side effects of pharmaceuticals. Herbs can be fabulous adjuncts to conventionally-prescribed pharmaceuticals with toxic renal and hepatic potentials. This can result in a new way to manage patients while they’re on drugs.

I ncluding emergency medicine. Many of my emergency phone calls will also involve herbal and homeopathic ideas to try in the hope of avoiding emergency visits.

RESPONSE FROM OTHER DOCTORS While the other doctors still practice conventionally, they are open to referring cases to me. We now stock raw food diets and the doctors often reach for them. Our staff members recommend herbs, especially Western formulas, including Standard Process. How well do I fit into the overall framework of this Western practice I call home? I have often thought of doing solely holistic medicine, yet the desire to be able to share my perspectives with all types of client is important, so I have chosen to stay.

CONCLUSION It has been a bit of an uphill climb, and I’ve had to have a thick skin at times, but I think it’s been worth it. It’s a joy to talk to clients who were already on the holistic road to health, but it’s also rewarding to find someone who has been waiting for their veterinarian’s permission to do something different.

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Sometimes I see new clients who just want an open-minded doctor who would listen to their thoughts about food or supplements. In the end, I think it’s not always so much about what we use to treat our patients, but about much we care for them and how well we listen.

PRACTICAL

tips

1. I feel that visits for acupuncture and holistic consults work best when separated into their own group of appointments, or tucked in at the end of regular appointment blocks. Ideally, it would be best to have a dedicated place for patients looking for complementary therapies. Quiet music goes only so far! 2 . As far as dispensable products are concerned, I now buy all my own supplies and utilize the office staff to enter prices and inventory into the computer. I pay for the products and receive the income minus a small clinic fee. These include Chinese, Western and Ayurvedic herbs, nutritional supports, natural eye drops, algae products, etc. I add a few new products each year and direct my clients to buy some directly online (e.g. medicinal mushrooms). I hope that in every appointment my clients will learn about new products to enrich their pets’ lives.

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? Witch Hazel (Hamamelis virginiana), as a testament to its effectiveness, has never been removed from the ofﬁcial Medical Pharmacopeia. The dried or fresh leaves, or dried bark, are used medicinally as an astringent, hemostatic, venotonic, anti-inflammatory and vulnerary, with a venoconstrictive effect. Witch Hazel is indicated whenever the veins are feeble and inclined to dilate, as well as for varicosities, passive hemorrhage, and any thickened mucous membranes with enfeebled circulation. The tissues needing this herb will be soft, feeble and swollen. Witch Hazel can be used internally as a tincture, or topically as a liniment. It is useful for many conditions: ulceration of the stomach and intestines; GI irritability; abraded and inflamed mucosa; persistent vomiting with food mixed with mucus; hemorrhoids, whenever venous circulation is enfeebled; full and doughy abdomen as well as relaxed perineum, prolapse of the bowels, fullness about the anus; difficult evacuation of feces; swelling of vulva or prepuce; edema of legs; colitis; anal furunculosis; local inflammation of the skin and mucous membranes; soggy otitis; post-episiotomy; and stomatitis. In Chinese Medical terms, Hamamelis treats a deficiency of Spleen Qi with the production of internal Damp. Therefore, it is effective in treating sinusitis, mucous-filled diarrhea, and leucorrhea. As a capillary stimulant, Witch Hazel should be used for treating irritated or inflamed dermal and mucosal surfaces.

On physical exam, Guido’s bladder filled his entire abdomen, with large, palpable, distorted and dilated vessels on the dorsal aspect of the bladder. These vessels seemed to be acting as a functional obstruction. Guido was diagnosed with pelvic varicosities and started on Witch Hazel, ten drops twice a day, supported with Shao Fu Zhu Yu Tang and Lady’s Mantle. By that night, he was able to produce at least a dime-sized amount of urine; by the time a week was up, he was able to produce normal urination and fully empty his bladder.

VBMA NEWS • The VBMA hosted another fascinating webinar, based on food therapy and led by Drs. Clare Middle and Cheryl Schwartz. On December 5, Drs. Ihor Basko and Connie DiNatale will discuss the sense of taste as applied to food therapy and plant identification. • The VBMA is going to Scotland! Join us June 29 to July 6, 2019 for a week of exploring the Scottish Highlands. We’ll study woodland, river and coastal mud flat habitats; learn about a wildcat breeding program as well as unique plants, herbs and birds; and enjoy a boat trip with dolphins. To register for this wonderful trip, and learn more about all the VBMA’s programs, visit vbma.org. You can register for webinars, become a member and purchase past webinars.

NAME THIS HERB!

Witch Hazel possesses effective stabilizing and solidifying qualities that tighten up Central Qi – useful where there’s a tendency to internal prolapse. It excels for dull aching pains in the pelvis, reproductive organs or rectum.

CASE REPORT Guido is a six-year-old male DSH cat with a three-month history of constant and chronic urinary tract blockages. The owner could not afford the cost of perineal urethrostomy surgery.

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

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industry innovations Superior supplements When recommending supplements for your patients, it’s important to ensure you’re also recommending quality. In business for 50 years, NOW® Pets parent company is one of the natural product industry’s oldest and most respected manufacturers. With formulas developed by Dr. Barbara Royal, DVM, CVA, an expert in integrative animal care, these supplements help address today’s common pet health concerns. The products are specially formulated to support animal health and well-being, and are certified by the National Animal Supplement Council (NASC). NowFoods.com/pet-health

Getting to the root of allergies Discovering the root cause of a dog or cat’s allergies can be more than a little challenging. The Pet Wellness Life Stress Scan from Glacier Peak Holistics uses a biofeedback device with your patient’s hair and saliva samples to ascertain what food and environmental stressors are causing allergy-type symptoms. With well over 23,000 scans run to date, the company has the experience to help you help your patients. A scan for equine patients is also available. GlacierPeakHolistics.com/collections/stress-scan-products

Shock wave therapy

Home dental care made easy Clients whose dogs or cats don’t like having their teeth brushed are less likely to comply with recommendations for home dental care. Oxyfresh makes it easier with their Dental Care Pet Gel. This no-brush gel is tasteless and odorless, and can be applied directly to the gums to clean teeth, remove plaque, condition and deodorize gums and freshen breath. Along with the company’s Pet Water Additive, which also freshens breath and improves dental health when added to a dog or cat’s drinking water, home dental care becomes a snap for your clients. Oxyfresh.com

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Shock wave technology is a non-invasive, high-energy sound wave therapy that can improve and speed the quality of healing, relieve pain, stimulate bone and tissue growth, and improve mobility. Appropriate for both small and large animals, this therapy is utilized by leading veterinary clinics, universities and rehab centers worldwide. PulseVet is a global leader in veterinary shock wave technology, backed by over 15 years of proven clinical research and committed to the highest standards in product quality and innovation. PulseVet.com

For digestive and immune health A strong digestive system and good immunity are important keys to patient health. Tasco® is a feed ingredient derived from the marine plant, Ascophyllum nodosum; its complex bioactives provide a more potent prebiotic action than traditional terrestrial plant derivatives. Beneficial for all life stages, this product improves GI tract and immune health. It works well with animals prone to digestive sensitivity (e.g. soft stools or diarrhea) and older animals suffering from decreased immune system function. Also promotes healthy coat and skin, and a calm disposition. Tasco.ca/en-us/

Therapeutic pet bed with PEMF technology The Assisi Loop Lounge™ is a total body non-pharmaceutical, anti-inflammatory device designed to accelerate healing, reduce inflammation, and alleviate pain in small animals. Assisi Loop® technology is nestled in the plush bedding of Sleepypod Air or Sleepypod Atom carriers, creating a contained and comfortable treatment space for use at home or on the go. It’s the only therapeutic pet bed incorporating an FDA-cleared, prescriptiononly, pulsed electromagnetic field (PEMF) technology that has proven effective in both human and pet research.

Sleepypod.com/assisi-loop-lounge

Evidence of ancient equine dentistry Archeologist William Taylor was studying horse bones in Mongolia when local researchers told him about a unique form of oral health care that modern-day Mongolian herders use. They extract premolars called “wolf teeth” from a horse’s mouth before they turn two years old to make the bit more comfortable. Taylor wondered whether more ancient versions of equine dentistry might help explain some of the “funky specimens” at the museum, so he began examining specimens found across the country.

The-Scientist.com/notebook/ancient-teeth-tell-the-history-of-equinedentistry-64801

A specimen dated to 1150 BCE indicated that the horse’s milk teeth had been sawed down, probably with a stone instrument. A form of this practice still exists today, where these baby teeth are extracted to allow for the unobstructed development of permanent teeth and the use of a bit. This is considered one of the earliest known instances of a veterinary dental procedure. A second procedure was noted on a horse skull from around 750 BCE, which indicated that the first premolar tooth on either side of the upper jaw had been extracted – the same practice carried out today.

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INTEGRATIVE APPROACHES TO

FELINE CHRONIC GINGIVOSTOMATITIS By Jody Bearman, DVM

Approach #1

Two case reports show how homeopathy and TCVM can eﬀectively treat FCGS without the need for full mouth extraction.

Feline Chronic Gingivostomatitis (FCGS) is a frustrating and painful problem in veterinary medicine. According to the Cornell Feline Health Center, the immune system of affected cats overreacts to plaque, causing severe inflammation that can extend to the gingiva and all the mucus membranes of the mouth and oropharynx. Tooth resorption, ulcers, swollen and bleeding gums, hypersalivation and halitosis are common symptoms. Cats may paw at their mouths and have difficulty eating and drinking. As eating becomes too painful, FCGS can become life-threatening, leading to dangerous weight loss and hepatic lipidosis. This article looks at how two alternative modalities – homeopathy and TCVM – can effectively treat FCGS.

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HOLISTIC APPROACHES – TWO CASES 1. Homeopathy: Samson, a foul-mouthed feline Homeopathy is a system of medicine that allows the practitioner to use carefully described current and historical symptoms of an individual patient (not merely those of the presenting complaint) to find the homeopathically-prepared medicine most similar to the totality of those symptoms. As the patient responds to this meticulously selected, individualized medicine, healing occurs

throughout all levels of the patient, resulting in improved vitality and overall well-being in addition to a resolution of the presenting complaint. Samson, a five-year-old male Siamese-cross feral cat, was taken in by a foster family after being trapped. They described him as unpredictable – social at times, biting and puncturing their hands at others. He appeared confident and unconcerned, not reacting to any of the other cats in the home. Samson was very thirsty, frequently drinking large amounts of water, and he was able to eat both canned and dry food. His stool was consistently too soft. His initial physical examination revealed halitosis with a profuse, thick and stringy saliva tinged with pink and green, draining from the right side of his mouth. A dark red ulcerated swelling of his right mandibular caudal gingiva obscured the cheek teeth. Samson’s nose was dry and pale pink, and his tongue was dark pink to purple. He would not tolerate further oral exam, and the client declined sedation. The rest of his physical exam was within normal parameters.

2. TCVM: Sassy, a quiet kitty Traditional Chinese Veterinary Medicine (TCVM) is a system in which the entire individual is examined and treated based on the knowledge of energy channels in the body (meridians) and points along those channels associated with internal organs. The Qi, or life force, along with blood, flow along the channels to keep the entire being healthy. Blockages or weaknesses in these channels correspond with illness and pain, and are treated with acupuncture, Chinese herbal medicine, diet and Tui-na (Chinese massage techniques), based on the individual animal’s TCVM diagnosis, which is determined by pulse, tongue and full body examination, along with knowledge of the animal’s behavior and environment.

A homeopathic analysis was performed using the following symptoms characterizing Samson’s unique presentation of his disease:

Sassy, a ten-year-old spayed female DSH feline, received TCVM that resolved her FCGS. Prior treatment had included removal of ten teeth. Following surgery, her voice changed, becoming quiet and hoarse. Over the ensuing months, she became a picky eater and lost weight. Because of the post-operative changes, her guardian wished to avoid full mouth extraction if possible.

• Right-sided inflammation • Excessive thirst • Soft stool • Profuse green-tinged saliva • Red ulcerated gums • Confident demeanor with tendency towards aggression

Initial examination revealed red swollen gingiva, warm ears and head, a red dry tongue, a wet cold nose, deep slippery pulses that were weaker on the left, and deep diagnostic points at Bladder 18 and 23, indicating weakness in the liver and kidneys. Her body condition score was 3/9, and the rest of her exam was unremarkable.

Based upon this particular presentation of symptoms, Samson was given one dry dose of homeopathic Mercurius viv 30c. Within two days, his mouth appeared less red and inflamed, with decreased salivation.

Sassy’s TCVM diagnosis was Yin deficiency with Qi deficiency (loss of voice) and local stomach (mouth) heat. Often, an animal presumed to have excess heat on initial examination is later found to be Yin deficient, so be sure to perform a full TCVM exam of the patient each time.

A month later, his salivation had begun to increase slightly. There were no new symptoms. Therefore, the same remedy in a higher potency was selected, and Mercurius 200c was given. The client reported, “His whole demeanor changed almost immediately. He became more vibrant and seemed much happier. Over the next day or two, the green ooze completely stopped. His mouth looked great.” Since that time, Samson has become calmer and more relaxed and is no longer biting. The excessive salivation and halitosis have resolved. His gingiva are normal, with no redness or swelling.

Sassy presented differently than most cats, with excess heat in the mouth, as she was older and Yin deficient. She was lacking coolness, rather than having excess heat. Excess might be seen in a younger cat with a strong voice and strong pulses. The following acupuncture points were selected: • SP 6 and BL 60/KID 3 to aid Yin deficiency • ST 36 to strengthen Qi and help the mouth • LIV 3 to relieve pain • LI 4 could have been used to relieve local heat and stagnation in the mouth, but was not due to her Yin deficiency; ST 6 or

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7, local points for the mouth, could also have been used, but were not because of Sassy’s age, vitality and temperament. Aggressive use of acupuncture on weak animals can exacerbate the weakness for a couple of days following treatment, so a conservative approach was selected for Sassy. In addition, using the minimum number of points necessary helps earn a cat’s cooperation during future treatments.

CONVENTIONAL DIAGNOSIS AND TREATMENT

Conventional diagnostics for FCGS have included testing for FeLV, FIV, calicivirus and bartonellosis, all of which can complicate the inflammation but have not been found to be the primary etiology. The latter remains unknown, and is most likely multifactorial. Comprehensive oral cavity examinations under anesthesia, with full dental radiographs, are required for an accurate conventional diagnosis. Treatment is challenging, often starting with antibiotics, anti-inflammatories, pain medications and dental cleanings, and progressing to full mouth extractions. According to Cornell, 40% of feline patients continue to experience inflammation and pain, even with correctly-performed, radiographicallyconfirmed full mouth extractions, requiring continued medical intervention. Occasionally, pre-existing conditions present an obstacle to safe anesthesia for affected cats, eliminating the option for full mouth extractions.

Due to processing, dry kibble contains no Yin, so Sassy’s dry food was discontinued. Her diet was changed to canned food with cooling ingredients such as turkey. BPA-free cans were recommended to prevent increasing Sassy’s risk of hyperthyroidism. In Yin deficient animals, cooked or puréed dark leafy greens or microalgae can be added to the diet to add Yin – cooling and moistening the body, including the gums. Microalgae such as BioPreparation Core can be given by mouth or sprinkled into the food. For a cat, beginning with 1/8 to 1/4 of a capsule per day is enough, and is often taken readily in canned or raw food. Other Yin tonics include seaweed, kelp, clams and mackerel. Because our oceans are over-polluted with mercury, radioactive iodine and other substances, it is imperative to evaluate sourcing. Laboratory-made supplements may be safer options. Aloe vera juice (labeled for human consumption) can also be given in the food, or on a cotton swab to relieve pain and locally cool the mouth. Begin with no more than 1/2 tsp per day, as more may lead to loose stool. George’s brand of aloe vera juice by Warren Laboratories has no taste and cats tend to accept it mixed in canned or raw food. Sassy’s guardian was instructed to use the Tellington TTouch™ technique. Often, TTouch in a cat with FCGS begins on the top of the head in front of the ears on the midline (a calming spot), and if the cat allows, is moved down to the mouth area. This can help relieve pain, promote circulation and improve appetite. TTouch was performed around Sassy’s mouth (this can include the lips and even gingiva if the cat allows) with one or two fingers very gently moving clockwise in oneand-a-quarter circles. Of course, avoid painful areas. Two further acupuncture treatments resolved Sassy’s FCGS symptoms and prevented further tooth extractions. Her guardian performed TTouch daily, continued with the canned food, and added a microalgae supplement, which aided in her healing. She did well for two years until she was lost to follow-up. For clients interested in non-traditional options – and if it is in the best interest of the patient to avoid tooth extractions and drugs – the modalities described in this article offer alternatives for resolving this painful and debilitating condition. If you are not yet trained in homeopathy or TCVM, offer them as options for Feline Chronic Gingivostomatitis by referring clients to colleagues with experience in these methods of treatment.

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GUIDED BONE REGENERATION (GBR) IN THE TREATMENT OF

CAT STOMATITIS By Don DeForge, VMD Approach #2 Animal dentists have been investigating feline stomatitis for over 25 years. The etiology of this very painful pathology has yet to be determined. The classic treatment in general practice has revolved around the usage of corticosteroids and antibiotics to suppress the immune system and treat soft tissue infection-inflammation, and the extraction of some – or often all – of the teeth. Only about half the felines with this type of extraction surgery reach full recovery. My studies have confirmed that feline stomatitis (FS) is a disease of the bone, probably a polymicrobial bone pathology. As a treatment alternative, I have developed a procedure called feline stomatitis guided bone regeneration. It completely and permanently reverses the oral inflammation and pain evidenced in feline stomatitis patients. All FS felines should first be scrutinized for other non-related medical problems. FeLVpositive cats are not good candidates for this surgery. The procedure uses oral digital radiology to identify areas of sclerosing osteomyelitis, condensing osteitis, sclerotic alveolar crestal bone loss, and hypertrophic bone reaction with resorption. Once the pathology is identified, radiowave radiosurgery is used to cut all soft tissue and expose all the pathology identified by digital radiology. The pathologic bone is then removed, using surgical length burs and diamond instruments. This is followed by a guided tissue regeneration procedure. The GBR surgical technique shows that all abnormal soft tissue does not need to be removed at the time of surgery. The inflammation in soft tissue quickly resolves once the osseous surgery is completed. Antibiotics after surgery are utilized to treat septic soft tissue and bone that cannot be surgically treated because of proximity to vital anatomy. Pain control is paramount both intra-operatory and post-operatory. The pain comes not from the surgery itself, but from the oral inflammation and ulcerations present pre-surgery. Anti-inflammatory therapy is short-term and can be accomplished with traditional Western medicines or alternative Eastern medicine protocols. I do not recommend non-steroidal anti-inflammatory therapy. All medicines cease 30 days post-operatively. This cat exhibits Class IV stomatitis. Note ulcerations on tongue and in oropharynx. Final diagnosis of stomatitis must include histopatholoy to rule out oral cancer.

All patients have an esophagostomy tube placed two weeks prior to surgery, and which is removed two weeks after surgery. This tube is for alimentation and administration of medicines.

See approach #3 on page 46.

PERSONAL NOTE

I want to take this opportunity to honor the late Dr. Harold Loe. I was humbled to meet Dr. Loe, known as one of the fathers of human periodontology, at the UCONN Dental School. Without his work in the 1960s, our knowledge of the pathogenesis of periodontal disease in humans would have been significantly delayed. A “ten-minute” meeting with Dr. Loe to discuss cat stomatitis lasted two hours, as he questioned me about the disease. He told me I had reached an important threshold by identifying that cat stomatitis is a bone disease and not a dental disease. I left that meeting with excitement and have never stopped educating veterinarians about GBR surgery for cat stomatitis. Dr. Loe died at his home in Norway in 2008, at the age of 82.

WHY FELINE STOMATITIS IS A BONE DISEASE, NOT A DENTAL DISEASE In all ages of FS patients, digital oral radiology shows characteristic changes in the bone. Soft tissue biopsies describe an inflammatory infiltrate, primarily of plasma cells, neutrophils and lymphocytes. The fact that all patients respond to aggressive osseous surgery sheds light on the bone origin of FS. If FS pathology was of dental origin, all patients – rather than only 50% to 60% – would fully respond to whole mouth exodontia, with a complete and permanent resolution of inflammation. IVC Winter 2018/2019

STEM CELL THERAPY FOR FCGS By Carlisle Froese, MA

Approach #3

A promising area of research in treating feline chronic gingivostomatitis syndrome (FCGS) involves stem cell therapy. Major research projects have been exploring the use of adiposesourced stem cells in the treatment of this debilitating feline disease. Researchers at the Veterinary Institute for Regenerative Cures (VIRC) at the UC Davis School of Veterinary Medicine (SVM) are seeking innovative ways to treat refractory cases of FCGS through the use of the patientâ&#x20AC;&#x2122;s own stem cells. Stem cells form the building blocks of development in animals. They have the ability to either self-renew or differentiate into highly specialized cells with particular roles throughout an animalâ&#x20AC;&#x2122;s body.1 This ability to both replenish and differentiate has made stem cell regenerative medicine very promising as a potential therapy for chronic inflammatory diseases. The UC Davis studies use feline mesenchymal stem (or stromal) cells (MSCs). The first use of these cells was made possible in 2002 by research done at the Scott-Ritchey Center at Auburn University, where researchers isolated MSCs from feline bone marrow. When properly induced, these cells were found to be capable of differentiating into adipocytic, osteocytic, and neuronal phenotypes.2 Since this breakthrough, it has also become possible to isolate MSCs from fatty tissue, thanks to a 2012 study by Webb, Quimby and Dow showing

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the similarity in growth between the two sets of cells from different sources. These researchers concluded that MSCs coming from adipose tissue (aMSCs) would be beneficial for clinical use that depends on rapid growth.3 They are also easier to attain, making therapy less painful for the patient. Researchers at VIRC, led by director Dori Borjesson, DVM, PhD, DACVP, have been driving efforts to apply the regenerative properties of stem cells to FCGS. Their work depends on the use of culture-expanded aMSCs, meaning the cells are harvested and then allowed to grow and multiply; therefore, when they are injected back during treatment, there are millions ready to work on reducing the painful inflammation caused by FCGS.

Before

After

In two aMSC clinical trials, 14 cats in different stages of disease progression were treated at UC Davis. Trials were divided into two groups of seven cats who received two intravenous (IV) injections of 2 x 107 aMSCs, spaced three to four weeks apart.4 The first group was injected with cells sourced from their own adipose tissue (autologous).5 The second group was injected with tissue from donor cats (allogeneic). Researchers found a very positive response rate from treatment. The autologous infusions were slightly more effective, with more rapid signs of improvement than the allogeneic infusions, especially for the most severely affected patients. Substantial improvement or complete cure was seen in 64% of the patients treated. Unpublished data discussed in The Journal of Feline Medicine and Surgery quotes a positive response rate of 72% with no regression or relapse.6 The studies have been expanded to create a multi-center clinical trial with Cornell University.7 The expansion will include the recruitment of cats unaffected by FCGS to serve as a control group.8 As of August 2018, enrolment of new patients was ongoing. Since FCGS is such a painful disease that has gone so long without a direct cure, interest in this area continues. Other clinical studies currently in development will focus on the stages of FCGS, addressing the question of the most effective time to introduce stem cell therapy.9 With such positive results to date, these next steps promise to be even more exciting for those who treat cats suffering from FCGS. For more information, email dosclinicaltrials@ ucdavis.edu. closerlookatstemcells.org/learn-about-stem-cells/stem-cell-basics

ncbi.nlm.nih.gov/pubmed/12160839

ncbi.nlm.nih.gov/pubmed/22314096

www2.vetmed.ucdavis.edu/virc/local_resources/pdfs/JFMS%20stem%20cell%20therapy.pdf

ncbi.nlm.nih.gov/pubmed/26582907

www2.vetmed.ucdavis.edu/virc/local_resources/pdfs/JFMS%20stem%20cell%20therapy.pdf page 211

vetmed.ucdavis.edu/news/uc-davis-advances-regenerative-cures

www2.vetmed.ucdavis.edu/virc/local_resources/pdfs/JFMS%20stem%20cell%20therapy.pdf

vetmed.ucdavis.edu/news/uc-davis-advances-regenerative-cures

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INTEGRATIVE APPLICATIONS IN

VETERINARY DENTISTRY

By Katie B. Kangas, DVM, CVA, CVCP

From acupuncture and herbal medicine to laser and ozone therapies, a wide range of modalities can speed healing, reduce complications, and relieve discomfort in animal dental patients.

The importance of dental health is gaining recognition thanks to our growing knowledge that oral disease significantly affects systemic health in both animals and humans.1,2 It is also important to note that periodontal disease is the single most common medical problem diagnosed in small animal patients.3,4 Despite these facts, oral disease is often overlooked in veterinary medicine, especially when it comes to addressing chronic systemic diseases. It is not possible to achieve “whole body” health if poor oral health exists. As integrative practitioners, it is extremely important that we emphasize oral and dental health to our clients, and discuss its impact on wellness. Furthermore, many integrative approaches can maintain oral health and support patients needing dental care.

CLIENT EDUCATION It really all starts here. It is imperative to have a brief discussion with clients about the importance of oral health to whole body health. It is also beneficial to discuss the advantages of being proactive with homecare and professional cleanings. Clients really need to know that they shouldn’t wait for advanced pathology in order to take action with either of these steps. I also find it helpful to explain the reasons anesthesia is required for proper dental

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treatment, along with the health risks associated with leaving dental disease in the body, especially if clients are very keen on avoiding anesthesia. It may be helpful to encourage clients to consider pet health insurance, as many plans include dental coverage; this may dramatically increase client compliance for prophylactic cleanings, whether annually or as needed.

INTEGRATIVE TREATMENTS FOR DENTAL DISEASE Many integrative modalities are very effective when used perioperatively to support improved healing, recovery and patient comfort. These therapies can also provide a gentler experience for the patient, and increase client compliance if presented and discussed as such.

Acupuncture/acupressure Acupuncture can be utilized for its analgesic and antiinflammatory benefits. Clients can be shown acupressure points to do at home during the initial stages of recovery after a dental procedure. Gentle pressure applied to LI 4 (Large intestine 4) on the front foot/paw is an excellent choice for oral pain, if tolerated by the pet.

Laser therapy Cold laser therapy, also called Low Level Laser Therapy (LLLT) promotes tissue repair and reduces pain and inflammation16 by enhancing cellular energy production and blood flow. Consequently, laser therapy is an excellent option to speed the healing of oral tissues, reduce swelling/pain, and support post-operative recovery.17 Laser treatments should be done immediately post-op, and ideally a second laser treatment performed a minimum of one hour later. According to Dr. Bill Inman, it has been found that performing two laser treatments at least one hour apart is three times more effective than just one laser treatment alone. This protocol also provides a great advantage in avoiding the need to bring the client and patient back within the next few days after the dental procedure. In my practice, I use an Erchonia class II laser which is equipped with both red and violet beams and has settings designed for gingivitis and stomatitis. Dr. Inman recommends specific frequencies that are useful for dental procedures, including 300, 100, 111 and 279, which correspond to increased capillary vascularity, increased blood supply, scar tissue and inflammatory pockets. The violet beam offers more bacteriostatic and bacteriocidal properties than just the red beam alone. The red beam (635nm) offers anti-inflammatory effects, decreases pain and stimulates ATP production. The violet beam (405 nm) has antibacterial/antiviral effects which help the body’s defenses to eliminate infection.

Ozone therapy Ozone (O3) therapy is extremely beneficial for oral treatments and is utilized by most biologic/natural dentists in the US, with even more acclaimed use in Europe. In fact, ozone therapy is actually approved by the ADA (American Dental Association) for dental abscesses. The therapeutic effects of ozone extend well beyond its ability to kill pathogens; it also increases oxygen delivery to tissues, even those that are hypoxic.18 Ozone acts on the tissues to decrease inflammation, pain and swelling, and increase healing. Saline and/or olive oil are percolated with ozone for 30 minutes to achieve therapeutic solutions, which are then stable for about 30 minutes before the ozone breaks down (dismutates). Therefore, ozone cannot be stored and used later. Ozone therapy applications in dentistry include: flushing the gums and oral lesions with ozonated saline pre- and post-procedures; flushing periodontal pockets before and after dental cleaning; injecting ozonated gas around an infected tooth; and using ozonated olive oil topically on the gums post-operatively, as a homecare protocol. Dr. Margo Roman reports good success treating dental abscesses with injections of ozone gas intra-periodontally. One example involves a 15-year-old canine patient diagnosed with liver cancer and dental infection. In order to avoid an anesthetic dental procedure, ozone

HOST MODULATION

The key to addressing periodontal disease from a holistic perspective is host modulation.5 Covered by this author in previous issues of IVC Journal, this approach supports the whole patient to control the body’s response to inflammation and infection. Although bacterial plaque is considered the etiologic agent of periodontal disease, it is actually the body’s inflammatory cascade triggered by the plaque that causes both local periodontal disease and chronic illness in other organs.

Nutrition and supplements are the cornerstone to a healthy mouth as well as a healthy body.6 Diet is a key topic that has been covered in more depth in previous articles.7 The important points include:

q Dry food (kibble) does not improve oral health, as demonstrated in specific studies.8

w Processed foods inherently promote inflammation and contain higher percentages of carbohydrates/sugars.

e Fresher, less-processed food actually promotes better oral health, especially with the addition of food items that require actual chewing. Nutritional supplements can also provide valuable benefits. • Antioxidants such as vitamins C and E play an important role in periodontal health, protecting oral tissues from inflammation.9 • Supplementation of CoQ10 (both systemic and topical) also has beneficial effects on periodontal health.10,11,12 • Another option includes a particular fatty acid called 1-Tetradecanol complex. This is an esterified monounsaturated fatty acid that inhibits inflammatory cell infiltration.13 This product (1-TDC, Elite Science) offers a proactive approach to supporting host resilience to inflammation, and therefore minimizes the progression in the periodontal disease cycle. • Recent information promotes the use of probiotics, both orally and topically, to support oral health. A growing awareness of the microbiome focuses on the critical role it plays in systemic immune system function and chronic inflammation. Canine and human studies show significantly reduced probing depth of periodontal pockets, and decreased periodontal inflammatory mediators, with the use of orally-ingested and topically-applied probiotics.14 IVC Winter 2018/2019

Dental care performed by clients at home can be an effective way to achieve plaque removal, if done consistently. The greatest benefit comes from the action of regular tooth brushing.15 The product used on the toothbrush is not as important

Injecting ozone gas into an abscessed third premolar.

Photo courtesy of Margo Roman

ROUTINE DENTAL HOMECARE

as the mechanical action of disrupting (wiping away) the plaque biofilm. That said, several natural products are helpful when applied directly onto the gums or used on a toothbrush. These include coconut oil and/or therapeutic grade essential oils. Coconut oil is rich in lauric acid, has effective antimicrobial properties, and the additional bonus of being palatable! Many essential oils (EOs) have powerful antimicrobial, antiinflammatory, pain-relieving benefits, so are specifically beneficial for oral tissues. Medical literature supports the use of several different EOs for treating oral diseases, such as clove, lemon, orange, myrrh and copaiba. Mixing EOs with coconut oil (for dilution and better palatability) is a great option for a customized toothpaste that can be made and sold by the veterinary practice, or

therapy was chosen to treat this dogâ&#x20AC;&#x2122;s abscessed lower third premolar. The dental abscess healed after two ozone injection therapies. Follow-up over two years shows no recurrence.

Herbal medicine Many different herbal options can be chosen to address pain/inflammation and improve healing. These may include California poppy, corydalis, boswellia, turmeric and CBD oil. I have had great success using both CBD oil post-operatively, as well as the Poppy Scutellaria formula from Animal Essentials/Animal Apawthecary. Patients appear more comfortable in the initial and extended recovery phases, and return to eating more quickly. Yunnan Baiyao can be used to mitigate any post-operative bleeding, and is often given pre-operatively if bleeding is expected. Some veterinary dental specialists are now using Yunnan Baiyao for jaw surgeries, neoplasia removals and complicated extractions.

Homeopathy Homeopathy provides an excellent treatment option for addressing pain, inflammation and bleeding following dental procedures. Liquid or pellets are applied directly onto the gums and absorb quickly with no ingestion required, generally making them easy to administer immediately after dental surgery. Good choices include Arnica to address swelling/bruising and blunt trauma; Hypericum for nerve pain resulting from gingival incisions/suturing, extractions etc.; and Phosphorus to address bleeding post-operatively/post-trauma. Homeopathic remedies can be used frequently in these circumstances, such as every 30 minutes post-operatively for an initial four doses, followed by a few times daily for three days.

made by the pet owner. A particular EO blend, Dog Breath, has been formulated specifically for gingival application in the support of oral health in dogs and cats. It contains fractionated coconut oil, copaiba, peppermint, helichrysum and myrrh.

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When homeopathic medicines are prescribed for the whole individual, various dental issues may resolve, such as retained deciduous teeth, abscesses (even in the tooth root) and gum problems.

Chiropractic/veterinary orthopedic manipulation (VOM) The activator tool provides an excellent option for addressing TMJ issues, and cervical chiropractic adjustments can support improved nerve conduction and

blood flow to the mouth and facial structures. TMJ pain can result from unilateral joint fixation, which causes decreased ROM. Massaging the masseter muscles on the affected side can restore ROM and correct the problem. Additionally, misalignments in the cervical spine can lead to TMJ problems, and specifically adjusting C1 may be beneficial. It can also be very helpful to perform chiropractic therapy on post-operative dental patients, especially if extractions or other surgical techniques involved head or neck manipulation during the procedure. Many human dentistry patients seek chiropractic care within a few days after a lengthy procedure, to address cervical pain or discomfort resulting from extended periods of head and neck tension and/or awkward positioning for dental procedures.

From the

AATCVM The American Association of Traditional Chinese Veterinary Medicine (AATCVM) is a non-profit organization founded in 2006 to support practitioners of Traditional Chinese Veterinary Medicine (TCVM), and promote high quality research in all aspects of TCVM.

In the spring of 2018, the American Association of TCVM and the World Association of TCVM teamed up to offer practitioners a single all-inclusive membership with exciting new benefits and a refreshed, updated site design.

CONCLUSION The application of various integrative techniques in veterinary dentistry can provide improved outcomes for our patients – with faster healing, decreased complications (such as infection/hemorrhage/pain) and improved levels of comfort.

Niemiec BA. “Local and regional eﬀects of periodontal disease”. Veterinary Periodontology. Niemiec BA Ed), Jon Wiley and Sons, 69-80, 2013.

Niemiec BA. “Systemic manifestations of periodontal disease”. Veterinary Periodontology. Niemiec BA Ed), Jon Wiley and Sons, 80-91, 2013.

Companion Animal Study. University of Minnesota Center for Companion Animal Health. Uplinks: pp 3, 1996.

Lund EM, Armstrong PJ, Kirk CA, et al. “Health status and population characteristics of dogs and cats examined at private veterinary practices in the United States”. J Am Vet Med Assoc. 1999;214:1336-1341.

Niemiec BA. “Host Modulation Therapies”. Veterinary Periodontology. Niemiec BA Ed), Jon Wiley and Sons, 299-304, 2012.

Kangas K. “The Importance of Oral Health on Whole Body Health: Methods of Integrative Oral Health Care”. AHVMA Journal Vol 48, Fall 2017

Kangas K. “Integrative & Nutritional Support for Oral & Dental Health”; IVC Journal, Winter 2016

Harvey CE, Shofer FS, Laster L: Correlation of diet, other chewing activities, and periodontal disease in North American client-owned dogs. J Vet Dent. 13: 101-5, 1996.

Pavlica Z, Petelin M, Nemec A, et al. “Measurement of total antioxidant capacity in gingival crevicular fluid and serum in dogs with periodontal disease”. Am J Vet Res. 65 (11)1584-8, 2004.

Wilkinson EG, Arnold RM, Folkers K, Hansen I, Kishi H. “Bioenergetics in clinical medicine. II. Adjunctive treatment with coenzyme Q in periodontal therapy”. Res Commun Chem Pathol Pharmacol. 12(1):11123, 1975.

Hanioka T, Tanaka M, Ojima M, Shizukuishi S, Folkers K. “Eﬀect of topical application of coenzyme Q10 on adult periodontitis”. Mol Aspects Med. 15 Suppl:s241-8, 1994.

Wilkinson EG, Arnold RM, Folkers K. “Bioenergetics in clinical medicine. VI. adjunctive treatment of periodontal disease with coenzyme Q10”. Res Commun Chem Pathol Pharmacol. 14(4):715-9, 1976.

Hasturk H, Goguet-Surmenian E, Blackwood A. “1-Tetradecanol complex: therapeutic actions in experimental periodontitis”. J Periodontol. 80(7):1103-13, 2009.

Lee JK, Kim SJ, Ko SH, Ouwehand AC, Ma DS: Oral Dis. 2015 Sep;21(6):705-12. Epub 2015 Apr 20. Modulation of the host response by probiotic Lactobacillus brevis CD2 in experimental gingivitis.

Hale FA: Home care for the veterinary dental patient. J Vet Dent 20(1) 52-4, 2003.

Cotler HB, Chow RT, Hamblin MR, Carroll J.“The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain Orthop Rheumatol”. 2015;2(5). pii: 00068. Epub 2015 Jun 9.

Calderhead RG, Kim WS, Ohshiro T, Trelles MA, Vasily DB. “Adjunctive 830 nm light-emitting diode therapy can improve the results following aesthetic procedures”. Laser Ther. 2015 Dec 30;24(4):277-89.

Isik A, Peker K, Gursul C, Sayar I, Firat D, Yilmaz I, Demiryilmaz I. “The eﬀect of ozone and naringin on intestinal ischemia/reperfusion injury in an experimental model”. Int J Surg. 2015 Sep;21:38-44.

Members can now access all past issues of the TCVM newsletter for continued education and review; stay up to date on current news and activities with the WATCVM blog; access TCVM research material and texts in the new electronic library; and download personalized membership certificates to commemorate their role as valued members of the AATCVM/WATCVM. The refreshed site design is user-friendly and easy to navigate. Individual country associations mean you can easily receive updates from each association under the WATCVM umbrella. Members can now also access current and past issues of the American Journal of Traditional Chinese Veterinary Medicine, the Case Discussion Forum, and the Practitioner Directory with the click of a mouse.

UPCOMING CONFERENCE The 21st Annual International TCVM Conference will be hosted in the beautiful and historic city of Shanghai, China from August 30 to September 2, 2019. The conference focuses on the clinical application of TCVM in dogs, cats, horses and exotics – learn more at watcvm.org.

IVC Winter 2018/2019

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

Traditional Chinese Veterinary Medicine TCVM Reddick, FL USA Phone: (352) 591-5385 Email: register@tcvm.com Website: www.tcvm.com Veterinary Information Network - VIN Davis, CA USA Phone: (530) 756-4881 Email: vingram@vin.com Website: www.vin.com

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

PetMassage Ltd. Toledo, OH USA Phone: (419) 475-3539 Email: info@petmassage.com Website: www.petmassage.com

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Tallgrass Animal Acupressure Institute Castle Pines, CO USA Phone: (303) 681-3033 Email: nancy@animalacupressure.com Website: www.animalacupressure.com

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

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

Pitcairn Institute of Veterinary Homeopathy - PIVH Portland, OR USA Phone: 760-230-4784 Email: info@pivh.org Website: www. pivh.org

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

Medical Cannabis IN YOUR PRACTICE By Angie Krause, CVA, CCRT, DVM

PEER-REVIEWED

CANNABIS HOLDS GREAT PROMISE FOR TREATING MANY DISEASE STATES IN DOGS AND CATS. IT’S IMPORTANT FOR VETERINARIANS TO EDUCATE CLIENTS BY STAYING INFORMED ABOUT THE GROWING NUMBER OF CANNABIS PRODUCTS APPEARING ON THE MARKET.

he legalization of cannabis in the United States is expanding every year. Many pet guardians are turning to their veterinarians for counsel about the medicinal benefits and appropriate use of cannabis for their dogs and cats. As the market becomes flooded with products labeled for pets, it has become critical that veterinarians are able to have open and informed discussions with clients about cannabis.

CANNABIS NOMENCLATURE Many common misconceptions about cannabis products can be eliminated by understanding the terminology associated with the industry. • Cannabis is the plant’s genus classification – hemp and marijuana are varieties of cannabis sativa L.1 • Cannabis plants that contain high levels of delta-9tetrahydrocannabinol (THC) are termed marijuana. THC is the psychoactive cannabinoid that causes a “high”. • Cannabis plants with low levels of THC (less than 0.3%) are

termed hemp plants. Hemp plants can be used for medicinal or industrial purposes. • Medicinal hemp plants are rich in cannabinoids like cannabidiol (CBD). While CBD is receiving most of the attention, medicinal hemp plants contain other therapeutic compounds such as terpenes and flavonoids.2

THE ENDOCANNABINOID SYSTEM The endocannabinoid system is made up of cannabinoid receptors and endogenous lipid ligands called endocannabinoids. These receptors are located in the central and peripheral nervous system as well as other tissues such as immune cells. These receptors can be bound by cannabinoids made by the body called endocannabinoids. Cannabinoids from plant sources, phytocannabinoids, can also bind these receptors. The endocannabinoid system regulates and influences many physiologic processes involved in homeostasis in the body, including pain, mood, and immune function.3 Several endocannabinoid receptors have been identified. The most IVC Winter 2018/2019

TOXICITY CONCERNS Medicinal and recreational marijuana is becoming more prevalent in households due to its increasing availability. As cultivation technology advances, the concentration of THC in available products has risen significantly over the last few decades. As a result, the number and severity of marijuana toxicosis cases seen in veterinary practice has increased.5 Dogs are the most common species seen for marijuana toxicosis. Dogs have a higher concentration of THC (CBD1) receptors than other species. A dose of THC causing a comfortable dysphoria in a human would cause severe static ataxia and other clinical signs in a dog. The onset of clinical presentations varies greatly, depending on the route of exposure (inhalation vs. ingestion), dose and type of product (cannabis products mixed with THC-infused butter maybe more dangerous).5 Symptoms can include hypersalivation, urinary incontinence, static ataxia, vomiting, depression, hyperactivity, and bradycardia. Rarely, death caused by marijuana toxicity has been reported. Most dogs recover with supportive care, including intravenous fluids, judicious induction of emesis and activated charcoal, benzodiazepines if indicated, and monitoring of vital signs.6

PRODUCT SELECTION Due to the legal limitations of products with THC, this author recommends using products with less than 0.3% THC and high levels of CBD. There is currently no federal regulation of these products (the U.S. Farm Bill is still pending at the time of writing), so when selecting a product to recommend, or researching a product found by a client, it is important to consider several factors:

w E xtraction method. Two predominant types of extraction method exist in the cannabis industry – alcohol extraction and CO2 extraction. While each method has benefits, most large companies use CO2 extraction to ensure that the highest levels of medicinal components are preserved. uaranteed analysis (GA). The manufacturer should be eG able to provide a GA that shows the concentration of THC, CBD and terpenes present in the hemp extract. The GA should also include testing of heavy metals, solvents and pesticides. elivery method. Hemp extract can be added to oil or made rD into a chewable form. It is important to take note of the other ingredients for patients with food sensitivities. oncentration. To keep consumer costs low, many tC manufacturers create products with very low CBD concentrations. As a result, pets may be getting subtherapeutic doses. In this author’s experience, a minimum of 15 mg of CBD per 1 ml of oil is necessary to administer a therapeutic dose at a reasonable volume. A recent pharmacokinetic study done at Colorado State University revealed that oral absorption of oil with hemp extract was superior to transdermal application.8 More studies are needed to investigate transdermal administration to local lesions. CBD isolate is available in most states and has anecdotally been less effective compared to full spectrum hemp extracts.

WHAT CONDITIONS IS CBD MOST EFFECTIVE FOR? In this author’s clinical experience, full spectrum CBD products have been most effective in cases of anxiety, osteoarthritis and seizure disorders in both dogs and cats. For the purposes of these case studies, HempRx Forte was used. Anxiety CBD-rich cannabis is the most effective natural method for treating anxiety in both dogs and cats, in this author’s practice. ANXIETY CASE STUDY

q Plant cultivation. Organic farming practices are important to avoid unnecessary chemical exposure. While hemp can be sourced from China and Europe, hemp grown in the United States is regulated at the state level. This allows for better quality control and a safer substrate.

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Pugsley’s anxiety and dog aggression improved dramatically with the use of CBD.

Pugsley is a nine-year-old MN Pug weighing 14 pounds. He has a history of anxiety and dog aggression that began at the age of two. He was reactive when seeing other dogs, both in the home and on a leash. Pugsley was started on 5 drops (5 mg of CBD) of HempRx Forte, twice daily with food. After three doses, Pugsley’s leash reactivity improved by approximately 50%. Pugsley has continued to show significant improvement with continued use of CBD.

Photo courtesy of Angie Krause

studied receptors are CBD1 and CBD2. CBD1 receptors are bound by THC and are concentrated in the nervous system including the cerebellum. This is why our canine patients present with static ataxia after the ingestion of cannabis containing THC.3 CBD is a CBD1 antagonist and can therefore lessen the effects of THC. CBD2 receptors are found primarily in immune cells and the central nervous system. CBD’s antiinflammatory properties are a result of its inverse agonist action on CBD2.4 CBD has been shown to have antioxidant properties and reduces pain.2 These properties make CBD and other therapeutic phytocannabinoids of great interest for treatment of common disease in dogs and cats.

Start at a dose of 0.5 mg/kg by mouth every 12 hours with food, and increase every three days to the desired effect. Most guardians notice improvement within 12 to 24 hours. In refractory cases, this author has administered CBD with SSRIs. However, there are no studies proving their combined safety. Osteoarthritis A recent study at Colorado State University demonstrated that dogs with osteoarthritis had improved pain scores with 2 mg/kg of CBD every 12 hours.7 It’s this author’s clinical experience that CBD improves the mobility and comfort of dogs and cats experiencing pain from osteoarthritis and neurogenic causes. Many traditional pharmaceuticals such as gabapentin, tramadol and amantadine have questionable efficacy and undesirable side effects. While non-steroidal anti-inflammatories are effective, many of the side effects make their long-term use prohibitive. Epilepsy CBD-rich hemp extracts have gained popularity for treating children’s seizure disorders. Due to the lack of THC, these children can enjoy life without the sedative effects of traditional anticonvulsants. Many pet guardians are hesitant to use drugs like potassium bromide and phenobarbital long-term due to their undesirable side effects. Other drugs like levetiracetam have questionable efficacy and dosing schedules that make compliance difficult. CBD may provide a safe and efficacious alternative for some animals. It may also help reduce dosage in conventional pharmaceuticals.

LEGAL QUESTIONS

Marijuana is legal in several states for medicinal and recreational use, but remains illegal at the federal level. At this time, it is illegal for veterinarians to prescribe or dispense products derived from marijuana plants. The legality of hemp products containing CBD varies by state. To find the current legislation in a specific state, visit http://norml.org/states.

ADDITIONAL APPLICATIONS FOR CBD

CBD has proven efficacious (anecdotally) in the following disease processes: • Chronic upper respiratory infections in cats • Poor appetite in cats • Atopy • Feline asthma • Chronic pancreatitis • Inflammatory bowel disease (IBD)

Photo courtesy of Angie Krause

In this author’s experience, many animals with refractory seizures may require doses of up to 2 mg/kg to 4 mg/kg of CBD every 12 hours. CBD is metabolized by the icytochrome P450 system and may therefore alter metabolism of anticonvulsants such as phenobarbital.7 Continued on page 56. EPILEPSY CASE STUDY

Oliver’s seizures decreased from one or two a month to less than one every six months when he was on CBD.

Oliver is an eight-year-old MN DSH cat weighing 11 lbs. He presented after having one or two seizures a month for five months. His guardian was reluctant to start anticonvulsants due to the possible side effects. Bloodwork and physical examination were within normal limits and imaging was not performed. Oliver was started on 0.2 mls of HempRx containing 3 mg of CBD, twice daily with food. After starting CBD, Oliver stayed seizurefree for six months. At that time he had one seizure. His current seizure frequency is approximately twice yearly. IVC Winter 2018/2019

CANNABIS IN CANADA By Katherine Kramer, DVM Although cannabis has recently been legalized for people in Canada, Canadian veterinarians are still not allowed to recommend or prescribe any cannabis products. The Canadian Veterinary Medical Association and the Canadian Association for Veterinary Cannabinoid Medicine are working with Health Canada to provide a legal pathway for veterinarians but it still may be several years before there are any veterinary approved products. One benefit of legalization is that we should begin to see many more companion animal studies as the legal barriers have been removed. Anecdotal evidence is certainly mounting as veterinarians across Canada are reporting that seeing benefits in their patients for a wide range of issues: arthritis and chronic pain, cancer and chemotherapy, inflammatory bowel disease, asthma, allergies, diabetes, seizure disorders, anxiety, etc. Unfortunately the rate of accidental toxicity is increasing due to easy access to cannabis products and pet guardians hoping to see the same therapeutic benefits in their pets as seen in people. Cannabis pet products are readily available online, in dispensaries and pet stores. These products are illegal and not regulated so finding a safe, quality controlled product can

Continued from page 55.

DOSE/ADMINISTRATION/SIDE EFFECTS Very few studies have been published that explore the pharmacokinetics and optimum dosing schedule for CBD in cats and dogs. One pilot study investigating the pharmacokinetics of CBD found that the half-life of the particular oil used was around four hours.7 In the author’s clinical practice, starting with a dose of 0.2 mg/ kg to 0.5 mg/kg twice daily, and increasing to efficacy, has been generally successful. For longterm treatment, higher doses (2 mg/kg to 4 mg/ kg) for large dogs can be cost prohibitive. Finding the lowest dose that gives the desired effect can increase compliance. In this author’s experience, adverse effects are rare and may include vomiting and diarrhea (more common in cats) and mild sedation.

CONCLUSION Cannabis holds great promise for the safe and effective treatment of many disease states caused by inflammation, immune dysfunction and neurotransmitter imbalance in dogs and cats. It’s the author’s hope that the ever-changing legal landscape will allow for further investigation into the use of phytocannabinoids for dog- and catspecific disease processes.

be challenging. Dosing is experimental and widely variable depending on the patient, medical condition, concurrent medications and product being used. Starting with a low dose and titrating slowly is the best option. Cannabis therapy has tremendous potential for our patients. Education will be key in helping pet guardians find and use pet products safely and effectively until veterinarians are allowed to prescribe cannabis.

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https://plants.usda.gov/java/ClassiﬁcationServlet?source=display&classid=CASA3, (accessed on 9/22/18).

Podell M. “Highs and lows of medical marijuana in the treatment of epilepsy”. Proc Am Coll Vet Intern Med Forum, 2015.

Murillo-Rodriguez, Eric. The Endocannabinoid System. 1st ed. London: Academic Press; c2017. Chapter 2, “Cannabinoid Receptors and Their Signaling Mechanisms”, p26-28.

Thomas A, Baillie GL, Phillips AM, Razdan RK, Ross RA, Pertwee RG. Cannabidiol displays unexpectedly high potency as an antogonist of CB1 and CB2 receptor agonists in vitro. Br J Pharmacol. (2007) Mar;150(5):613-23

Meola SD, Tearney CC, Haas SA, Hackett TB, Mazzaferro EM. “Evaluation of trends in marijuana toxicosis in dogs living in a state with legalized medical marijuana: 125 dogs (2005-2010)”. J Vet Emerg Crit Care. (2012) 6:690-696.

Fitzgerald KT, Bronstein, AC, Newquist, KL. “Marijuana Poisoning”. Topics in Compan An Med. (2013) 28(8-12).

Bornheim LM, Everhart ET, Li J, Correia MA. “Induction and genetic regulation of mouse hepatic cytochrome P450 by cannabidiol”. Biochemical Pharacol. (1994) 48:1(161-171).

Gamble LJ, Boesch JM, Frye CW, Schwark WS, Mann S, Wolfe L, Brown H, Berthelsen ES, WakShlag JJ. “Pharmacokinetics, safety and clinical eﬃcacy of Cannabidiol treatment in osteoarthritic dogs”. Front Vet Sci. (2018) 5:165.

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WORRIED ABOUT GRAIN-FREE DIETS & HEART DISEASE?

TAKE HEART! By Barbara Royal, DVM, CVA, CIAC

rain-free. These two words are the focus of a recent media storm creating trouble for pet food. The confusion originates from a July 2018 report by the Federal Food and Drug Administration (FDA) and research conducted by Dr. Joshua Stern, DVM, PhD, DACVIM, Chair of the Department of Veterinary Cardiology at UC-Davis. Dr. Stern is investigating the possible reasons specific “grain-free” dry kibble foods have been implicated in cases of canine Dilated Cardiomyopathy (DCM). Alarmed by media reports, clients feeding grain-free foods to their pets may have serious questions. Let’s get to the heart of the matter and examine the issue more closely.

WHAT DOES GRAIN-FREE REALLY MEAN?

formulas themselves and the way the food was manufactured and processed have been sources of concern. The market responded to these questions by simply replacing grains with other inappropriate ingredients, and a huge market for grain-free food was born. This strategy assumed that the only complaint about kibble foods was the inclusion of grain, and that by removing the grain, the diet would be healthier. This turned out to be a great marketing strategy, but didn’t necessarily create healthier foods. Instead of creating foods with healthy meats and fresh ingredients, the added niche of “grain-free” only added a new burden to the overload of inappropriate pet food on the market.

The term “grain-free” does not refer to any specific type of food. The grain-free label simply means that the food contains no grains. The term itself does not define anything really important about a pet food.

The market was flooded with foods that were “grain-free” but just as flawed. High heat-processed, nutritionally damaged, industrially sourced pet food too high in carbohydrates and too low in quality proteins and healthy fats is still an unhealthy diet, regardless of the grain-free label on the bag.

WHY DID GRAIN-FREE FOODS BECOME POPULAR IN THE FIRST PLACE?

WHY ARE GRAIN-FREE FOODS BEING LINKED TO HEART DISEASE IN DOGS?

As veterinarians, most of us were taught that grains are an acceptable, significant part of the canine diet. However, large quantities of grains in dog food were never a good idea. The

The new substitutes for grain (potatoes, tapioca, legumes/ beans, and many other plant-sourced carbohydrates) may be triggering a worse and more dramatic problem.

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Because they provide some protein, these plant-based grain substitutes allow manufacturers to lower the amount of meatbased protein in their formulas. But these plant-based proteins do not possess a complete amino acid profile, most notably lacking in taurine, an amino acid required for cardiac health in dogs and cats found in animal-based foods. The link between dietary taurine deficiency and heart disease is well described in the cat. Cats can’t make taurine from other sources and cats deficient in taurine can develop heart disease. In contrast, dogs with the right building blocks can make it themselves. Therefore, taurine is not considered an essential amino acid for dogs. Taurine content was ignored in AAFCO recommendations for dog foods. There is little data and no guidelines about taurine in dogs available from the Association of American Feed Control Officials (AAFCO), FDA, or the U.S. Department of Agriculture. Often these organizations don’t concern themselves with every component of a food. We had not seen significant taurine-related canine heart problems in the past. Until recently, the majority of dog foods were formulated with enough meat-sourced proteins to provide the base amount of taurine needed for most dogs. Now with “grain-free” dry foods, pet food quality has reached a new low. Without minimum recommended levels of taurine for dog foods, companies making these foods have not been held accountable for poorly conceived diets. Other factors also affect the bioavailability of the taurine that is present in the diet.

ADDITIONAL CAUSES OF DIETARY TAURINE DEFICIENCY Food preparation Cooking meats degrades and drastically reduces the bioavailability of taurine in the food. If meats are cooked in water and the water is discarded, most of the taurine can be lost. Moisture removal to make a dry food further depletes taurine

in foods already deficient. Taurine amounts can be diminished somewhat when foods stay frozen for long periods of time as well, but not as much as the loss from cooking. If there is enough fresh meat, typically there will be enough taurine in a short-term frozen raw food. Bile salt conjugation Both dogs and cats constantly lose taurine through bile salt conjugation, especially if bile salts are not recycled by the body because they are bound by starchy compounds like rice bran or beet pulp. Both ingredients can be found in grain-free and grained foods. Dogs and cats will have an increased need for taurine if they are eating foods with these components. Microbiome Microbiome deficiencies cause the body to absorb taurine and other vital nutrients inadequately. Highly processed, heat-treated, poorly balanced dry foods high in carbohydrates and starch not only overfeed the wrong species of bacteria for a dog’s gut, but also fail to replenish appropriate bacteria or strengthen the microbiome. Many pet food companies source ingredients from industrial farming where antibiotics and chemicals are used. These will be present in the pet food and affect the microbiome of the pet. Packaging The diet’s packaging also affects the bioavailability of taurine. Conscientious manufacturers of canned foods for cats typically double the amount of taurine in the food due to concerns that taurine availability may be affected by the canning process.

WHAT DOES THIS MEAN FOR OUR PATIENTS ON GRAIN-FREE DIETS? Pet owners searching for better answers are swayed by marketing, catch phrases, convenience, fancy packaging and perhaps overwhelmed by the glut of good and bad information online. But we all have the same intention. We want to provide our pets and patients with a happy and healthy long life. The circulating news stories suggest that if we all revert to feeding our pets grains in their dry kibble foods, health will return. However, we are not to assume that ALL grain-free food is unhealthy or that ALL grain-free food causes heart disease. Continued on page 60.

Taurine’s molecular structure IVC Winter 2018/2019

Continued from page 59. Keep the basics in mind about diet. Don’t let clients run back to a diet with grain thinking it is protective to the heart. That is not the answer. What is in the food matters certainly as much as what is kept out of it.

HERE ARE SEVERAL PRACTICAL IDEAS AND TIPS ABOUT DIETS AND TAURINE TO HELP CLIENTS AVOID MORE HEALTH RISKS WITH EACH NEW “PET FOOD FAD.” • I suggest veterinarians strive to provide the building blocks of health, evaluate pet food recipes, and focus on prevention. • L ook for fresh, balanced, moisture-appropriate food for a carnivore. We can keep animals and their hearts healthy with the foods they are designed to feast upon. Use a fresh, speciesspecific diet as a sensible starting place to create health. • R emember that taurine is nearly non-existent in many plantbased proteins. We must evaluate ingredients in both dog and cat diets for taurine, regardless of the AAFCO standards. • L ook for quality, organic, non-GMO meat sources of protein high on the pet food label. • D on’t focus on choosing between a dry kibble that has either grains or is grain-free (two bad choices) – choose balance and freshness wherever possible. • A dd a fresh meat source to pet food — taurine is typically high in many animal-based proteins, especially sardines, shrimp, clams, scallops, fresh uncooked dark meat poultry, and heart muscle. Tuna is not a source of taurine. If a fully fresh diet is not possible, try to at least supplement with something fresh. Fresh healthy foods will keep pets healthy! I t interesting to note that cats who eat mice are not likely to have any taurine deficiency as mouse muscle and particularly a tiny mouse heart contain very high concentrations of taurine. •A dd a probiotic/prebiotic or healthy goat yogurt/milk to help regain a healthy microbiome for better absorption of nutrients. • Consider using a well-balanced, well-sourced fresh raw food recipe in your pet’s weekly rations. Remember that variety helps provide balance too. Many people in the pet food industry are recognizing that the future of pet food is moving towards functional pet food

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nutrition — ingredients designed and combined for optimizing the individual’s health needs, using software tools like the Animal Diet Formulator™ (animaldietformulator.com). The data available in the Animal Diet Formulator™ (ADF) software provides a tool used by Royal Animal Health University to teach veterinarians and technicians to evaluate and create recipes and diets. It is an unusually complete and useful tool, in that it includes taurine as well as corrected USDA data on many other ingredients to help us find optimal levels for nutrients and keep up with these health concerns. Hopefully the current research by Dr. Stern will add to our understanding and knowledge about these important micronutrients.

WHAT ABOUT SUPPLEMENTATION? If an animal has a heart condition and taurine might be a factor, consider suggesting a taurine supplement to a diet. For cats the literature suggests about 75 mg to 100 mg of taurine daily. For dogs, the levels are typically extrapolated, but it is difficult to overdose (it is excreted rather than stored in the body). Literature references about 500 mg for a 30 lb dog up to three times a day as a good place to start. It can take several months to see cardiac improvement, but if a taurine deficiency was at the heart of the problem, it may fully resolve with supplementation. Use organic and well-known sources. Certainly breeds predisposed to Dilated Cardiomyopathy (DCM) that can be more strongly affected by taurine deficiency might benefit from added taurine – either in foods or supplements. These breeds include Golden Retrievers, Doberman Pinschers, Great Danes, American Cocker Spaniels, Boxers, and other large breed dogs. Consider using freeze dried heart treats to help increase amino acids, including taurine.

From the VMAA

The Veterinary Medical Aromatherapy® Association (VMAA) is an organization of veterinarians and veterinary technicians dedicated to the responsible use of aromatherapy in animal practices. Their mission is to promote standards of excellence in animal aromatherapy, to provide outreach and education to veterinarians and axillary animal practices, and to promote continual improvements in Veterinary Medical Aromatherapy®. The VMAA is elevating the veterinary profession through innovation, education, and advocacy of integrative medicine.

Dogs with urate or cystine stones should consider taurine supplementation because the body uses these as building blocks for taurine synthesis. Finally, we must remember that food is medicine. While a good diet cannot cure all ills, a poor diet will always create problems. With proper nutrition, there is a strong tendency for health.

ADDITIONAL INFORMATION TO TEST A PET’S AMINO ACIDS/TAURINE LEVELS: https://www.vetmed.ucdavis.edu/labs/amino-acid-laboratory

ESSENTIAL OILS TIP FOR THE SEASON

DIET AND TAURINE RESEARCH:

Wintergreen oil is composed of more than 85% methyl salicylate. This natural chemical constituent is responsible for most of the medicinal properties provided by this oil. Aspirin is derived from a synthetic version of this chemical. This is why the use of wintergreen oil is concerning for cats, although as veterinarians, we know safety is always dose-dependent.

Wójcik OP, Koenig KL, Zeleniuch-Jacquotte A, Costa M, Chen Y. “The potential protective effects of taurine on coronary heart disease”. Atherosclerosis. 2010 Jan; 208(1):19-25. doi: 10.1016/j. atherosclerosis.2009.06.002. Epub 2009 Jun 11. Ko KS, Fascetti AJ. “Dietary beet pulp decreases taurine status in dogs fed low protein diet”. J Anim Sci Technol. 2016 Aug 2;58:29. doi: 10.1186/s40781-016-0112-6. eCollection 2016. Backus RC, Cohen G, Pion PD, Good KL, Rogers QR, Fascetti A.J. Taurine deficiency in Newfoundlands fed commercially available complete and balanced diets. J Am Vet Med Assoc. 2003 Oct 15;223 (8):1130-6. Fascetti AJ, Reed JR, Rogers QR, Backus RC. Taurine deficiency in dogs with dilated cardiomyopathy: 12 cases (1997-2001). J Am Vet Med Assoc. 2003 Oct 15;223(8):1137-41. Torres CL, Backus RC, Fascetti AJ, Rogers QR. Taurine status in normal dogs fed a commercial diet associated with taurine deficiency and dilated cardiomyopathy. J Anim Physiol Anim Nutr (Berl). 2003 Oct;87(9-10):359-72 Belanger MC, Ouellet M, Queney G, Moreau M. Taurine-deficient dilated cardiomyopathy in a family of Golden Retrievers. J Am Anim Hosp Assoc. 2005 Sep-Oct;41(5):284-91. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4971673/ Journal of Animal Physiology and Animal Nutrition. 87(7-8):251-62, September, 2003 https://www.petfoodindustry.com/articles/7473-the-next-big-thing-in-pet-food-functionalingredients?v=preview MICROBIOME RESEARCH: https://www.aaas.org/news/missing-gut-bacteria-raises-infants-asthma-risk https://www.cmaj.ca/content/190/37/E1097 https://health.ucsd.edu/news/releases/Pages/2018-05-15-big-data-from-worlds-largest-citizenscience-microbiome-project-serves-food-for-thought.aspx https://americangut.org/ https://americangut.org/ppublications/ MITOCHONDRIA + MICROBIOME: https://drive.google.com/open?id=0B9c8LZOhi7gFQzBaNXBORG1vQkdsdXVSc25mM3VoVmdVcEhJ

One drop first rubbed into your palms, and then applied, goes a long way! Wintergreen oil is often used in combination, diluted and used topically, with due caution, for musculoskeletal support in our pet patients. Remember, carrier oils often encourage ingestion. If used, they must be healthy fatty oils, as the essential oil will carry toxins from the carrier oil into the body. Massage or “petting with intent” is a great modality to combine with the application of essential oils. Oils can be layered. Apply copaiba over the spine and stifles, cover that with helichrysum, then clove, and lastly, wintergreen for that warm/cool feel that makes winter aches melt away! Contact a VMAA member for guidance on how to implement safe and effective essential oil use for your pet patients – visit vmaa.vet. IVC Winter 2018/2019

PROGRAMS & APPS

that improve your practice New programs and apps that digitize records, notes and follow-ups mean you can spend more time educating clients and caring for your patients.

The shift towards relying on practice management programs started as a simple debate over whether or not to switch to electronic medical records (EMR). In just a short time, this shift developed into a new and well-populated market, offering everything from EMR to personalized and branded apps for client download. As more programs develop, it becomes easier to transition to a more efficient way of managing your practice. The resulting opportunity to spend a little extra time answering questions, training with your staff, or expanding your own knowledge will help create a better client experience overall – so why not give it a try? Here’s a quick look at some of the efficiency tools currently available.

Electronic records and the Cloud A good first step to improving your management system is to make the change from paper to EMRs. This gives your team members direct access to a patient’s entire record at the tips of his or her fingers. EMRs can be updated immediately, and be seen by the whole team – an important stepping stone toward improved communication and efficiency. Making the switch can feel intimidating, so start by balancing both systems. Enter all new information in your electronic records and keep the paper for reference. Another advantage of embracing EMRs is the ability to store them safely within your own system or in the Cloud. Cloudbased management systems mean records are not subject to the same risk of misplacement as physical records; there is always a back-up. They also allow you to access files from home – a convenient perk that many veterinarians find useful.

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There’s an app for that These days, you can access almost anything with the touch of a phone screen. So why not offer veterinary care that way? New programs have been developed that help you organize client communication through an app that can be branded for your practice. This means appointments, reminders and follow-ups all go through one direct channel. Some apps even have options that allow you to schedule and send out communications automatically. Nothing gets overlooked, and your time is free for face-to-face interactions.

Talk-to-text technology A high-paced environment makes sitting down to document notes from an appointment, referral or client call nearly impossible. Incorporating talk-to-text technology into your everyday routine can allow you to record appointments and ideas as they happen. Dragon Veterinary Software, for instance, has a curated veterinary vocabulary system that allows you to record, then transfers those recordings automatically to your files. Inspired by busy veterinarians, this technology keeps track of every detail so you don’t have to waste your time scribbling down notes and trying to remember what transpired. Our dependence on technology grows every day. In some cases, this dependence is dangerous. But in a veterinary clinic setting, it allows us to be more efficient and more connected to what we do. By freeing up time from administrative duties, you can make yourself more available to clients, and that gives them the sense of trust they need to ask more questions, absorb more information, and help their pets live long, healthy lives.

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events 2019 AVMA Veterinary Leadership Conference January 10–13, 2019 – Chicago, IL Enhance your leadership skills and expand your professional network while attending the Veterinary Leadership Conference. The VLC offers three days of networking and workshop opportunities and is open to any veterinary professional interested in learning more about leadership and team building. Continuing education credit is available for attending select sessions. For more information: https://www.avma.org/Events/ LeadershipConference/Pages/ default.aspx

VMX Veterinary Meeting & Expo January 19–23, 2019 – Orlando, FL The VMX: Veterinary Meeting & Expo, formerly the NAVC Conference, welcomes almost 16,000 attendees from more than 70 countries, offers more than 30 hands-on laboratories, and provides 1,300 Continuing Education credits. You will also see more than 350 nationally renowned speakers. This is the first large veterinary conference of the year where the most current medical and product advances are first released. Featuring Little Big Town, Rob Lowe, Brooke Shields and Brandon McMillan! For more information: (352) 375-5672 info@navc.com https://navc.com/vmx/

Ontario Veterinary Medical Association Conference January 31–February 2, 2019 – Toronto, ON The 2019 OVMA conference offers more than 100 hours of continuing education options to choose from as well as top-rated

IVC Winter 2018/2019

To post your event, email us at: info@IVCJournal.com speakers from Canada and the United States. This 3-day event is the largest annual veterinary conference in Canada and combines education with a tradeshow filled with products and equipment. For more information: (800) 670-1702 info@ovma.org www.ovma.org

CenCan Veterinary Conference February 1–3, 2019 – Winnipeg, MB Hosted by the Manitoba VMA and the Manitoba Animal Health Technologists Association, this event will be a prime opportunity to connect face-to-face with the veterinary community. Have a new product or service to promote? Want to meet with existing or potential clients? Then this is the conference for you! For more information: (204) 832-1276 www.mvma.ca

Minnesota VMA 122nd Annual Meeting February 7–19, 2019 – Rochester, MN The 122nd Annual Meeting and Convention of the Minnesota Veterinary Medical Association offers an outstanding continuing education program and great opportunities to network with friends, veterinarians, veterinary technicians, hospital staff, and veterinary students. Also, enjoy multiple seminars and a silent auction. For more information: info@mvma.org www.mvma.org

91st Annual Western Veterinary Conference February 17-20, 2019 – Las Vegas, NV The WVC provides comprehensive continuing education to veterinary professionals and is an

interactive educational opportunity for networking with the veterinary community. WVC grows in size each year adding new speakers that present stateof-the-art hands-on labs in a comfortable environment. Conference registration automatically enrolls the registrant as an association member for the following year. For more information: (702) 739-6698 carolyn@wvc.org www.wvc.org

2019 Virginia Veterinary Conference February 21–23, 2019 – Roanoke, VA The 2019 Virginia Veterinary Conference offers two full days of continuing education in small animal, equine, technician, public practice (Friday only) and complementary medicine (Saturday only). If you attend the conference Friday and Saturday, you may earn the necessary 15 hours to renew your Virginia veterinary license. For more information: (804) 346-2611 www.vvma.org

Midwest Veterinary Conference February 21–24, 2019 – Columbus, OH The Midwest Veterinary Conference (MVC), hosted by the Ohio Veterinary Medical Association, is a growing, regional veterinary conference packed with educational, networking and social opportunities for every member of the veterinary team. Bringing together highly regarded experts from around the world and hundreds of industry vendors, the MVC is a national-calibre conference.

80th Annual Conference for Veterinarians March 30–31, 2019 – Fort Collins, CO This event will take place on the Colorado State University’s new building – C. Wayne McIlwraith Translational Medicine Institute (TMI) and will provide 16 hours of CE in small animals, equine, and livestock medicine tracks. Featuring a combination of speakers and CSU veterinarians, including: Livestock Medicine (Invited Speaker): Dr. Mike Apley, Professor, Production Medicine/ Clinical Pharmacology Frick Professorship, Kansas State University Equine (Invited Speaker): Dr. Teresa Burns, Assistant Professor, Equine Internal Medicine, Ohio State University Small Animal (Invited Speaker): Dr. James Noxon, Professor, Iowa State University For more information: (970) 297-1273 vetce@colostate.edu www.cvmbs.colostate.edu/ce/ annual-conference

AAVA Annual Meeting 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. For more information: ofice@aava.org www.aava.org

For more information: (800) 662-6862 info@mvcinfo.org http://mvcinfo.org

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

news bites TRICLOSAN CAUSING COLON PROBLEMS Triclosan (TCS) is an antimicrobial ingredient found in over 2,000 consumer products such as toothpaste, cosmetics, kitchenware, children’s and dogs’ toys, beds and shampoos. This chemical is also incorporated into plastic pet food bag liners, and the plastic wrap on certain meats. Recent studies show that brief exposure to TCS, at relatively low doses, can cause low-grade colonic inflammation, increases colitis, and exacerbates colitisassociated colon cancer.1 These findings pose another concern regarding the cause of dysbiosis and inflammatory bowel disease in dogs and cats. Chronic exposure and ingestion of TCS may also contribute to skin and thyroid problems as well as food allergies. For more background information on Triclosan, see: Pat Thomas. “The Dawn of the domestic superbug”. The Ecologist, theecologist.org/2005/jul/01/dawndomestic-superbug. 1

H. Yang, et al. “A common antimicrobial additive increases colonic inflammation and colitis-associated colon tumorigenesis in mice”. Science Translational Medicine, 30 May 2018: Vol. 10, Issue 443, eaan4116 DOI: 10.1126/scitranslmed.aan4116).

RESEARCH INTO EQUINE VISION A study that examined equine vision, carried out by the University of Exeter, may result in improved safety at British racecourses. The object of the study was to enhance obstacle visibility for equine athletes and improve the safety of both horses and riders. The research concluded that the colors currently used on hurdles

HUMAN

HORSE

How humans perceive an orange fence as compared to horses.

and fences (mostly orange) are based on human vision, and that safer alternatives should be used. Horses have reduced color perception and can only differentiate objects in palettes of blues and yellows. To horses, the orange markers appear as a shade of green that dangerously blends in with the grass. It has been recommended that a trial be carried out using fluorescent yellow for all hurdles and guardrails, and fluorescent white for take-off boards at fences. These colors have maximum visibility for both horses and humans. “From riding over the different colored fences it was clear to me that over some colors the horses reacted differently and showed the obstacle more respect,” says Ian Popham, a former jockey involved in the trial.

exeter.ac.uk/news/research/title_686716_en.html

PLEDGE TO GO “SCRUFF FREE” Scruffing may successfully restrain a cat, but it can be highly intimidating, causing fear and panic, and often provoking or escalating defensive aggression. Gentle handling techniques are much less stressful and allow the cat to have some sense of control, which is important for his or her well-being. The International Society of Feline Medicine (ISFM) and its parent charity, International Cat Care, are against the use of scruffing because of the distress it can cause in cats. Both the ISFM and the American Association of Feline Practitioners (AAFP) have provided educational resources to help veterinary staff use safe, stress-free handling techniques that are better for a cat’s welfare – see https://bit.ly/2HGYluI and https://bit.ly/2EVxQyN. Improve the welfare of the cats in your care by pledging not to scruff at your clinic. To find out more and make your pledge, visit icatcare.org/scruffing. Once you have pledged, you can download “scrufffree” posters to show clients that your staff handles their cats gently and with respect. IVC Winter 2018/2019

news bites 10,000-YEAR-OLD DOG CANCER Ancient dog populations in the Americas almost totally disappeared following the arrival of European settlers – but not before leaving behind a cancerous tumor still found in their descendants today. A team of international researchers, including Anna Linderholm, assistant professor of anthropology at Texas A&M University, collected genetic information from 71 ancient dog remains from the Americas. They found that early dogs arrived with humans who settled throughout North, Central and South America. But closer study of the ancient dog genomes shows they almost completely disappeared after European settlers arrived on the scene, leaving few or no traces in more modern American dogs. That is, apart from a cancerous condition, which spread via mating and is still present today.

“It is ironic that the only vestige of a population that was likely wiped out by disease is the genome of a transmissible cancer,” the team said in a joint statement. “This is the biggest twist I have seen in any project I have done,” says Linderholm. “In a weird way, the ancient dogs of America live on through these cancerous cells.”

today.tamu.edu/2018/07/05/texas-am-study-ancient-dog-cancerstill-around-today-after-10000-years/

CANINE HEART DISEASE LINKED TO BIRTH MONTH JULY

JUNE

AUGUST

Can the month a dog is born in put him at greater risk of disease? A recent study says yes. Published by researchers at the University of Pennsylvania’s Perelman School of Medicine, the study suggests that dogs with no genetic predisposition to cardiovascular disease are at greater risk of heart problems if they’re born in the summer. Outdoor air pollution is highest from June through August, and researchers theorize this might be the culprit. The researchers studied nearly 130,000 dogs across over 250 breeds, and concluded that for breeds genetically predisposed to heart disease, the month they were born in didn’t make much of a difference in determining the fate of their heart health. However, certain breeds with no genetic predisposition to heart problems were at highest risk of heart disease if born in the summer. In fact, they found that dogs born in July have a 74% greater risk for heart disease than those born in the winter, fall and spring.

pennmedicine.org/news/news-releases/2018/may/dogs-born-in-the-summertime-more-likely-to-suffer-heart-disease

AHVMA CELEBRATES ACCOMPLISHED MEMBERS This year’s AHMVA conference honored several members of the veterinary community for their outstanding achievements. Congratulations to the following award recipients: Glee Anderson – Newbie Award

Joyce Harman’s Harmany Grazing Muzzle

Dr. Christina Chambreau – Carvel Tiekert Lifelong Achievement Award Dr. Joyce Harman – Holistic Inventor of the Year Dr. Doug Knueven – Holistic Teacher of the Year Dr. Karen Marsden – Holistic Practitioner of the Year ahvma.org

Correction

Dr. Christina Chambreau

On page 36 of the article “Orthotics and the veterinary nurse” by Mary Ellen Goldberg, BS, LVT, CVT, SRA, CCRVN, CVPP, VTS (Fall 2018, IVC Journal), we mistakenly featured a photo of a prosthetic rather than an orthotic. Our apologies to Mary Ellen for the error.

IVC Winter 2018/2019