V9I2 (Spring 2019) by Redstone Media Group

Innovative PEER REVIEWED

VOLUME 9 ISSUE 2

VETERINARY CARE

EASING CHEMO AND RADIATION SIDE EFFECTS SIX INTEGRATIVE APPROACHES THAT REDUCE THE SIDE EFFECTS OF CANCER TREATMENT IN CANINE PATIENTS. – P. 10

CRUCIATE LIGAMENT INJURIES RESPOND TO PRP

KETOSIS, CANCER AND CANINES

ERGONOMICS IN THE VETERINARY CLINIC SETTING

EQUINE CANCER PATIENTS BENEFIT FROM CST

ESSENTIAL OILS ALLEVIATE ANAL GLAND ISSUES

TREATING CANCER WITH TCVM

Modified Platelet Rich Plasma stimulates tissue repair and draws on the body’s ability to heal itself. – P. 18

www.IVCJournal.com

SPRING ISSUE 2019

Save your back, neck and eyes by addressing three vital ergonomic factors associated with veterinary dentistry and surgery. – P. 24

A range of anal gland problems in dogs and cats respond positively to essential oil therapy – high quality products and the right techniques are keys to success. – P. 48

A non-profit organization tests the efficacy of ketogenic diets as an adjunctive therapy for dogs with cancer. – P. 32

Horses requiring cancer surgery recover more quickly and smoothly with cranial sacral therapy. – P. 42

How Traditional Chinese Veterinary Medicine not only helps treat cancer, but may even prevent metastasis and recurrence. – P. 54

IVC Spring 2019

contents FEATURES

INTEGRATED APPROACHES TO CANINE CANCER – PART 1 By Demian Dressler, DVM

Six integrative approaches to alleviating the side effects of chemotherapy and radiation in dogs with cancer.

OZONE THERAPY FOR CANCER IN VETERINARY MEDICINE By Pema Choepel Mallu, DVM, CVA, MAc, LAc

How ozone contributes to the destruction of cancerous cells, and the formation of healthy ones.

PRP FOR CRUCIATE LIGAMENT INJURIES IN DOGS

ERGONOMICS IN VETERINARY DENTISTRY AND SURGERY

By Meghan Reinders, BSc (Hons) and Sasan Haghighat, DVM, CVA

Modiﬁed Platelet Rich Plasma stimulates the repair of soft tissues and joints without the use of foreign chemicals, and utilizes the body’s own programming for self-healing.

By D.H. DeForge, VMD, Fellow of the Academy of Veterinary Dentistry

The importance of magniﬁcation, illumination and posture for veterinary dentistry and surgical applications.

INNOVATIVE PRACTICE BRIDGING THE GAP IN VETERINARY ONCOLOGY

By Erin Bannink, DVM Diplomate ACVIM (Oncology), GDipl VCHM, CVA (IVAS)

Integrative Oncology leverages the advances of Western biomedicine by downsizing the cancer burden while utilizing the tools available to us from other traditions of medicine.

NUTRITION NOOK

KETOPET SANCTUARY: KETOSIS, CANCER AND CANINES – PART 1

By Chelsea Kent; Shannon L. Kesl, PhD; Stacy A. Hodges, DVM; Loren Nations, DVM, DABVP

Now ﬁve years old, KetoPet Sanctuary is a non-proﬁt organization that has tested the feasibility of using a ketogenic diet as an adjunctive therapy in dogs with cancer.

48 4

IVC Spring 2019

FIGHTING GLAUCOMA WITH NATURAL NEUROPROTECTION

CLINICAL TRIAL ANNOUNCEMENT

CST FOR THE EQUINE CANCER PATIENT

ESSENTIAL OILS FOR ANAL GLAND ISSUES

TCVM: AN INTEGRATIVE APPROACH TO TREATING CANCER

By Carmen M.H. Colitz, DVM, PhD, DACVO and Terri McCalla, DVM, MS, DACVO

Nutraceutical antioxidant therapy shows promise in protecting the optic nerve and retina.

By Erin Bannink, DVM, Diplomate ACVIM (oncology), GDipl VCHM, CVA (IVAS), and Steve Marsden, DVM, ND, MSOM, Lac, Dipl.Ch, CVA

Investigation of a Traditional Chinese Medicine herbal therapy protocol for treatment of dogs with stage II splenic hemangiosarcoma after splenectomy.

By Ann-Marie B. Hancock, DVM, EDO

Cranial sacral therapy decreases side effects associated with cancer treatment, and is especially beneﬁcial for equine patients following surgical intervention.

By Nancy Brandt, DVM, CVC, CVA, CVMA

Over the past 20 years, essential oils have been used in over 800 anal gland problems in dogs and cats. The keys to success lie in oil quality and proper techniques.

By Madeline Yamate, DVM, CVA, CVCH, CVFT, CVTP, CVSMT, MBA

TCVM may be a stand-alone or adjunctive treatment for animal cancer patients. It gives you the ability to not only treat cancer, but to potentially prevent recurrence and metastasis.

HOMEOPATHIC APPROACH TO CANCER IN COMPANION ANIMALS

By Henry Stephenson, BVSc (Hons) Vet M F Hom Dip Acup (IVAS)

A case study involving a senior cat with cancer demonstrates how homeopathy treats cancer and extends longevity.

advisory board

54 COLUMNS & DEPARTMENTS

5 Advisory board 6 Editorial 17 2018 IVC Journal Readersâ&#x20AC;&#x2122;

Choice Innovation Awards

21 Industry watch 29 From the VMAA 37 From the AVH 46 Industry innovations 59 Wellness resource guide 63 From the VBMA 64 From the IVAS 65 Marketplace 65 Events 66 News bites

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, former 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 a past president of the AHVM Foundation. He has published two books, one for conventional veterinarians and a second for clients discussing how integrative thinking works. Michelle J. Rivera, MT, VDT, is an instructor at the University of Wisconsin and The Healing Oasis Wellness Center, a post-graduate educational institution offering state-approved programs. She is co-owner of The Healing Oasis Veterinary Hospital, offering massage, rehabilitation, chiropractic and Chinese and Western Herbology. Michelle completed the Chinese Herbal Medicine program from the China Beijing International Acupuncture Training Center, and is certified in Chinese Medicine by the Wisconsin Institute of Chinese Herbology.

Dr. Joyce Harman, DVM, MRCVS, graduated in 1984 from Virginia Maryland Regional College of Veterinary Medicine. Her practice is 100% holistic, using acupuncture, chiropractic, herbal medicine and homeopathy to treat horses to enhance performance and those with a variety of chronic conditions, with an emphasis on Lyme Disease. Her publications include the Pain Free Back and Saddle Fit Books, and numerous articles in lay and professional magazines. She maintains an informative website: www.harmanyequine.com.

Dr. Steve Marsden, DVM, ND, MSOM, Lac. Dipl.CH, CVA, AHG lectures for IVAS, the AHVMA, the AVMA, and numerous other organizations. He is co-founder of the College of Integrative Veterinary Therapies and is a director emeritus of the National University of Natural Medicine in Portland OR. He authored the Manual of Natural Veterinary Medicine (Mosby); and Essential Guide to Chinese Herbal Formulas (CIVT). Dr. Marsden is extensively trained in alternative medicine, including Chinese herbology, acupuncture and naturopathic medicine. He has holistic veterinary and naturopathic medical practices in Edmonton, Alberta. In 2010, Dr. Marsden was named Teacher of the Year by the AHVMA; and Small Animal Veterinarian of the year by the CVMA in 2009. Dr. Jean Dodds, DVM, received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she moved to Southern California to establish Hemopet, the first non-profit national blood bank program for animals. Dr. Dodds has been a member of many national and international committees on hematology, animal models of human disease, veterinary medicine, and laboratory animal science. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1994.

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

Dr. Christina Chambreau, DVM, CVH, graduated from the University of Georgia Veterinary College in 1980. She is a founder of the Academy of Veterinary Homeopathy, was on the faculty of the National Center for Homeopathy Summer School and has been the holistic modality adjunct faculty liaison for the Maryland Veterinary Technician Program and is the former Associate Editor of IVC Journal. Dr. Chambreau teaches classes in homeopathy for animals, lectures on many topics, speaks on Radio and TV, and is the author of the Healthy Animalâ&#x20AC;&#x2122;s Journal among other titles. She is now on the faculty of the Holistic Actions Academy, which empowers members to keep their animals healthy with weekly live webinars.

IVC Spring 2019

editorial

OPTIMIZING

LIFE

Just this past week, I encountered four dogs and one cat with new cancer diagnoses. I also visited with two patients diagnosed with cancer over a year ago, learned of three veterinary colleagues who faced cancer themselves, and spoke with an inspiring father whose teenage daughter is two years into remission. The family has just welcomed a new golden retriever puppy into their home, and are eager to apply what they’ve learned about health and healing from their daughter’s journey to their new puppy’s care. Truly, cancer is a ubiquitous part of our landscape, and in one way or another, touches us all. However, despite the pervasiveness of cancer, I hope you will find inspiration in the pages of this issue of IVC Journal. You’ll read about different approaches veterinarians are using to help cancer patients live their best lives. As Dr. Erin Bannink so eloquently writes in her piece, “Bridging the gap in veterinary oncology”, treatment becomes less about “the battle against cancer but about how we optimize life”.

Drs. Pema Mallu, Henry Stephenson and Nancy Brandt share their expertise in treating cancer with ozone, homeopathic and essential oil therapies, respectively. TCVM approaches to integrative cancer care, including an ongoing clinical trial, are presented by Dr. Bannink, Dr. Steve Marsden, and Dr. Madeline Yamate. Innovative ways to support the equine cancer patient are discussed in Dr. Ann-Marie Hancock’s piece on Cranial Sacral Osteopathy.

Ketopet Sanctuary shares what they have learned about using ketogenic diets for cancer patients, while Dr. Demian Dressler writes about mitigating the side effects of chemotherapy and radiation through targeted nutritional supplementation.

Laurin Cooke, DVM Associate Editor, drlaurin@ivcjournal.com

IVC Spring 2019

Collaborative medicine is innovative medicine. By integrating the work of many, we become empowered as clinicians to proactively focus on lives well-lived. In so doing, we celebrate the beautiful bond between our patients and their families. With gratitude for the work all veterinarians and their support staff do each and every day,

Integrative VETERINARY CARE

SPRING 2019

EDITORIAL DEPARTMENT Editor-in-Chief: Dana Cox Managing Editor: Ann Brightman Associate Editor IVC: Laurin Cooke, DVM Associate Editor: Emily Watson Senior Graphic Designer: Dawn Cumby-Dallin Graphic Designer: Alyssa Dow Social/Digital Media Manager: Theresa Gannon Web Design & Development: Lace Imson

COLUMNISTS & CONTRIBUTING WRITERS

Erin Bannink, DVM Diplomate ACVIM (Oncology), GDipl VCHM, CVA (IVAS) Nancy Brandt, DVM, CVC, CVA, CVMA Maria Caiozzo, CCRA Carmen M.H. Colitz, DVM, PhD, Diplomate ACVO Todd Cooney DVM, CVH D.H. DeForge, VMD, Fellow of the Academy of Veterinary Dentistry Demian Dressler, DVM Jodie Gruenstern, DVM, CVA Sasan Haghighat, DVM, CVA Ann-Marie B. Hancock, DVM, EDO Stacy A. Hodges, DVM Chelsea Kent Shannon L. Kesl, PhD Pema Choepel Mallu, DVM, CVA, MAc, LAc Steve Marsden, DVM, ND, MSOM, Lac, Dipl.Ch, CVA Terri McCalla, DVM, MS, Diplomate ACVO Loren Nations, DVM, DABVP Meghan Reinders, BSc (Hons) Henry Stephenson, BVSc (Hons) Vet M F Hom Dip Acup (IVAS) Kim Vanderlinden, ND, DTCM Madeline Yamate, DVM, CVA, CVCH, CVFT, CVTP, CVSMT, MBA

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IVC Journal (ISSN 2291-9600) is published four times a year by Redstone Media Group Inc. Publications Mail Agreement #40884047. Entire contents copyrightÂ© 2019. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: March 2019.

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

IVC Spring 2019

contributors 1

1. ERIN BANNINK, DVM, DACVIM (ONCOLOGY), GDVCHM, CVA

Dr. Erin Bannink received her Diplomate ACVIM (oncology) board certification in 2008. She was certified in veterinary acupuncture (IVAS) in 2007 and has completed numerous advanced training courses in Traditional Chinese Veterinary Herbal Medicine, including a Graduate Diploma in Traditional Chinese Veterinary Herbal Medicine through CIVT. She has been Integrating TCVM in a specialty referral hospital setting since 2007. She offers Integrative Oncology Consultations for veterinarians and other integrative information at MettaPets.info. 2. NANCY BRANDT, DVM, CVC, CVA, CVMA Dr. Nancy Brandt graduated from the University of Minnesota College of Veterinary Medicine in 1990, and later began her studies in acupuncture, Chinese medicine, chiropractic medicine, and naturopathic modalities. In 1999, she founded her practice, Natural Care Institute. In 2017, Dr. Brandt founded UnBound Center for Animal Wellness, for special needs pets. She pioneered the field of Veterinary Medical Aromatherapy and founded the Veterinary Medical Aromatherapy Association (nancybrandtdvm.com and sparkeducationonline.com). 3. 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 Marchett, Program Director. Dr. DeForge is also the Oral Radiology Consultant for E-Vet Diagnostics, a telemedicine reading service for veterinarians. 4. DEMIAN DRESSLER, DVM Dr. Demian Dressler is a practicing veterinary surgeon and clinician, continuing education provider, author and consultant. Along with Dr. Susan Ettinger, he wrote the best-selling small animal health book The Dog Cancer Survival Guide. He is the inventor of veterinary nutraceuticals Apocaps CX, Nutrocept and Everpup, as well as Neurawake for people. Dr. Dressler is also an information provider on organizational processes. He graduated from Cornell University with a Doctorate in Veterinary Medicine and Surgery (1997) and from UC Davis with a BS in Physiology and a Minor in Philosophy (1993). 5. SASAN HAGHIGHAT, DVM, CVA Dr. Sasan Haghighat (Hyatt) graduated from Veterinary School in 1995. He went on to take additional training in Germany before preparing for and passing his licensing exams in Ontario in 2003. He is certified in veterinary acupuncture, postural rehabilitation, and spinal manipulation, and holds a post-graduate diploma in Bio-Regulatory Medicine through BioMedic in the United Kingdom. Dr. Haghighat now owns a strictly holistic practice in Newmarket, Ontario. 6. ANN-MARIE B. HANCOCK, DVM, EDO Dr. Ann-Marie Hancock graduated from Colorado State University with a BS in Equine Science, an MS in Anatomy and Neurobiology, and a DVM in 2003. She worked at a general equine practice in North Carolina for ten years. She completed the IVAS Acupuncture course in 2007, the Equine Osteopathy Course at the Vluggen Institute in Texas, and became certified as an Equine Osteopath. Dr. Hancock owned Rectortown Equine Clinic in 2013, then relocated to Marshall, VA to open True North Equine Veterinary Services, an expanding hub for practitioners supporting equines in any life stage or discipline. 7. STACY A. HODGES, DVM Dr. Stacy Hodges is a veterinarian at Block House Animal Creek Hospital in Austin, TX. 8. PEMA CHOEPEL MALLU, DVM, CVA, MAC, LAC Dr. Pema Mallu received her DVM degree from The Ohio State University in 1977. She became certified in Veterinary Acupuncture in 1988 by the IVAS. In 1992, she became certified by the National Association of

IVC Spring 2019

Natural Health Professionals, and then went on to complete a year’s training in Veterinary Homeopathy with Dr Richard Pitcairn. In 1994, Dr. Mallu completed four years of Energy Healing training with the Barbara Brennan Energy Healing School and the School of Enlightenment and Healing. She then furthered her training and received her Master’s degree in Human Acupuncture from Tai Sophia Institute in 2010. Dr. Mallu became certified in Veterinary Ozone therapy and a Fear Free practitioner in 2017. She has an integrative holistic small animal clinic in Germantown, MD. 9. STEVE MARSDEN, DVM, ND, MSOM, LAC, DIPL.CH, CVA Dr Steve Marsden received his doctorate in veterinary medicine at the University of Saskatchewan, Canada. At the National College of Naturopathic Medicine in Portland, OR, he obtained a doctorate in naturopathic medicine, a Master’s of Science in Oriental medicine, his licensure in acupuncture and Diplomat status in Chinese herbology. He treats both pets and people in his Edmonton, Alberta practice. Dr. Marsden is one of the chief educators of veterinarians in the use of complementary and alternative therapies. He co-founded the College of Integrative Veterinary Therapies and is an emeritus director of the National College of Natural Medicine. His textbook, Manual of Natural Veterinary Medicine, has been translated into multiple languages, and is a leading resource worldwide. 10. LOREN NATIONS, DVM, DABVP Dr. Loren Nations owns Veterinary Healthcare Associates in Winter Haven, FL, and sees referral cases in Internal Medicine and Oncology. 11. HENRY STEPHENSON, BVSC (HONS) VET M F HOM DIP ACUP (IVAS) Dr. Henry Stephenson graduated from vet school in Australia in 1979, and after working for two years in mixed practice, began a private small animal practice on the Sunshine Coast in Queensland. This practice has now expanded and includes four vets all using alternative therapies. The main modality utilized in their chronic cases is homeopathy, as it works at a very deep energetic level; they will also use some acupuncture and herbal medicines to add strength. 12. MADELINE YAMATE, DVM, CVA, CVCH, CVFT, CVTP, CVSMT, MBA Dr. Madeline Yamate received her DVM from the University of California, Davis in 2005, and completed a year-long internship in veterinary acupuncture at the University of Florida under Dr. Huisheng Xie. She is certified in veterinary acupuncture, Chinese herbal medicine, Chinese food therapy and Tui-na by the Chi Institute of Traditional Chinese Veterinary Medicine, and veterinary spinal manipulative therapy by the Healing Oasis Wellness Center. In 2006, Dr. Yamate joined the faculty of the Chi Institute, and has taught acupuncture, herbology, food therapy and Tui-na in Florida, California and Spain. She has lectured internationally on integrative veterinary medicine and TCVM and is in private practice at the Center for Integrative Animal Medicine in Davis, CA. 13. CHELSEA KENT Chelsea Kent is a Nutrition and Regulation Research Specialist in the pet food industry, as well as the owner of Food Regulation Facts Alliance and Hero’s Pets in Littleton, CO. 14. SHANNON L. KESL, PHD Shannon Kesl earned her PhD in Medical Sciences from the Morsani College of Medicine at University of South Florida, where she focused on the effects of exogenous ketones for age-dependent impaired wound healing. She currently serves as a scientific advisor for the Epigenix Foundation in Los Angeles, CA, where she focuses on the effects of metabolism and nutritional interventions on canine and human health. 15. MEGHAN REINDERS, BSC (HONS) Meghan Reinders is a strong believer in integrative medicine, and an advocate in encouraging the spread of wide range holistic healthcare approaches to the veterinary world. As a recent Honors Science graduate from Western University, she is currently aspiring to attend veterinary school and to continue educating others on the positive, preventative, and minimally invasive techniques that come with an integration approach.

IVC Spring 2019

Integrated approaches to

CANINE CANCER

Part 1: Mitigation of treatment side effects Six integrative approaches to alleviating the side effects of chemotherapy and radiation in dogs with cancer. By Demian Dressler, DVM

This multi-part article will provide one integrative clinical viewpoint on ways to improve longevity and quality of life for veterinary cancer patients. Functional subjects to be covered include chemotherapy and radiation side effect mitigation; cancer cell suicide induction; immune support; and extracellular matrix therapies. By focusing on each of these functional groups during an extended cancer consultation appointment, the veterinarian can work with the client to develop a high quality cancer care plan for animal patients. In Part 1, we’ll focus on the mitigation of treatment side effects.

CHEMOTHERAPY AND RADIATION SIDE EFFECT MITIGATION Reducing cancer cell burden in the canine patient is a central concern for the veterinarian. It can be accomplished in a variety of ways. The foundation of the conventional cancer approach includes surgery, chemotherapy and radiation. The latter two modalities have traditionally used some version of the Maximum Tolerated Dose (MTD) paradigm. The MTD approach uses the highest possible treatment dose in an effort to eradicate the highest number of cancer cells. Dose ranges are limited by toxicity. A frequent problem is that the gains in predicted patient life expectancy may not be adequate enough to justify this treatment. Side effects, quality of life, logistics and cost are considerations for both owner and clinician. Taking proactive steps to help address this difficulty is, therefore, a logical clinical step.

IVC Spring 2019

SPECIFIC APPROACHES FOR REDUCING SIDE EFFECTS IN CANINE CANCER CARE

1. Metronomic chemotherapy with alternate COX-2 inhibitors “This approach may be at least as effective as conventional chemotherapy with a lower risk of toxicity.” – Veterinary Clinics of North America Small Animal Practice, 2014 One approach to reducing the problems encountered in MTD chemotherapy is the use of metronomic chemotherapy. The goal of this strategy is the management of canine cancer by using lower drug doses than MTD chemotherapy, as well as continuous dosing regimens. Metronomic chemotherapy is oriented toward life quality and the management of cancer as a chronic disease by reducing metastasis and local spread. It may also be advantageous from financial and logistic standpoints, because the agents used in these protocols are oral and administered at home. Cancers such as mast cell tumor, lymphosarcoma, hemangiosarcoma, soft tissue sarcoma, transitional cell carcinoma, osteosarcoma, oral melanoma, fibrosarcoma and mammary adenocarcinoma may all be treated using a metronomic approach. The medications classically used include COX-2 inhibitors, cyclophosphamide and possibly doxycycline. However, lowdose toceranib (Palladia®), lomustine and chlorambucil can also be used in a metronomic fashion.

Traditionally, piroxicam was the COX-2 inhibitor included in metronomic protocol research. However, this drug is rapidly absorbed and has a half-life of approximately 40 hours in the dog. With dosing regimens of every 24 hours, piroxicam tends to accumulate systemically, leading to fairly frequent toxicities. Selecting COX-2 inhibitors with a higher safety margin are preferred by the author for cancer management. High-potency botanical polyphenol COX-2 inhibitors often fit in the context of a life quality-centered (metronomic) cancer plan. These include bioavailability-enhanced formulations of curcumin, boswellia or citrus bioflavonoids. These compounds have additional benefits, including anti-metastatic effects and the sensitization of neoplastic cells to the effects of chemotherapy and radiation treatment. Apocaps® CX is a commonly-used source of botanical COX-2 inhibitors with chemosensitizing and radiosensitizing effects. It is designed for dogs and has a high safety margin. Note that if Apocaps® is administered with corticosteroids or pharmaceutical NSAIDS, it is advisable to use approximately half the labeled dose. This nutraceutical is best given with at least a small amount of food.

Apocaps® dosing Body weight (lbs)

With NSAIDs or corticosteroids

Alone

5-10

1 sid

1 bid

10.1-20

1 bid

2 bid

20.1-40

1 AM 1 PM

3AM 2 PM

40.1-60

2 AM 1 PM

3 bid

Over 60

2 AM 2 PM

3 tid

Although close patient follow-up and monitoring is still important, metronomic chemotherapy using alternate COX-2 inhibitors is one way to achieve lower pharmaceutical dosing and improved life quality.

2. Cordyceps

organs, and has been used in dogs for over 15 years. Clinical applications for the use of cordyceps in canine cancer management include kidney toxicity encountered with the use of methotrexate, cisplatin or carboplatin. Evidence indicates that cordyceps may also reduce the risk of a pulmonary toxicity sometimes seen with the use of lomustine and rabacfosadine (Tanovea®). It additionally assists in reducing bone marrow suppression, a common side effect of a wide array of chemotherapy drugs and in some applications of radiation therapy. Cordyceps has not been shown to interfere with the beneficial effects of chemotherapy or radiation; on the contrary, it may enhance them. It may create a mild cortisol increase, which supports it in its role of reducing physiologic stress. However, in cases of untreated hyperadrenocorticism, the author prefers to avoid it. In general, cordyceps has a high safety margin. Cordyceps dosing When using a conveniently-sourced cordyceps formulation labeled for humans, the author typically increases the label dose on a per pound basis by a factor of three for clinical use in the canine.

3. Glutamine Glutamine is an amino acid that is useful in helping to reduce the diarrhea common with both chemotherapy and radiation. There is mixed evidence that glutamine may also help mitigate the oral mucosal ulcers occasionally resulting from radiation. Cancer cachexia is common in advanced canine cancer, representing a loss of muscle mass. Myocytes have a preference for glutamine as a metabolic fuel source, so glutamine supplementation may have an additional benefit in this regard.

Pre-emptive measures to reduce toxicity in canine cancer case management is receiving increased attention. Veterinarians can take anticipatory steps by using supportive strategies specific to toxicity type to preclude or mitigate known toxic events.

Glutamine does not show evidence for interfering with chemotherapy or radiation, and in fact, may have a therapyenhancing effect.

Also known as “caterpillar fungus”, cordyceps has applications in side effect mitigation of various at-risk

In the author’s opinion, however, glutamine should not be used in cases of brain cancer, as it may promote net enhancement of CNS tumor growth. Continued on page 12. IVC Spring 2019

Continued from page 11. It is also advisable not to use glutamine in patients with seizure disorders, since in rare cases it may increase the excitotoxin glutamate, exacerbating pre-existing seizure tendencies (the author has observed this on several occasions clinically). Although it is common to give glutamine on an empty stomach, it is here recommended to be administered with at least a small amount of food, to avoid digestive upset. In general, glutamine has a high safety margin in the dog. The author doses glutamine once a day according to the following dosing schedule.

Glutamine dosing Body weight (lbs)

Dose

5-10

250-500 mg

Over 10, under 35

800-1,000 mg

Over 35, under 60

1,500-2,000 mg

Over 60

2,500-3,000 mg

Apocaps®. Denamarin® has been shown to moderately reduce hepatopathy secondary to lomustine. Silymarin also has protective effects on the kidneys, heart and CNS. Silymarin dosing The author uses both Denamarin® and Apocaps® as labeled, given with a small amount of food to reduce the incidence of digestive upset.

5. Ubiquinone (CoQ10) Cumulative cardiac toxicity is a concern with common chemotherapy drugs such as doxorubicin. CoQ10 has been shown to ameliorate cardiotoxicity and has not been shown to reduce the efficacy of conventional therapy. The most common potential side effect of CoQ10 in dogs is digestive upset, which can be minimized by administering it with a small amount of food.

4. Silymarin Silymarin is a well-known family of compounds commonly extracted from the milk thistle. Often-used veterinary supplements containing silymarin include Denamarin® and

CoQ10 dosing CoQ10 is dosed at 1 mg per pound of body weight once daily, or in divided doses. This supplement is fat soluble and more effective if given at the same time as an oil, such as an Omega3 fish oil supplement.

References Metronomic chemotherapy Gaspar TB, Henriques J, Marconato L, Queiroga FL. “The use of low-dose metronomic chemotherapy in dogs – insight into a modern cancer field”. Vet Comp Oncol. 2018 Mar;16(1):2-11.

Wu CP, Ohnuma S, Ambudkar SV.“Discovering natural product modulators to overcome multidrug resistance in cancer chemotherapy”. Curr Pharm Biotechnol. 2011;12(4):609-20. Cordyceps

Biller B. “Metronomic chemotherapy in veterinary patients with cancer: rethinking the targets and strategies of chemotherapy”. Vet Clin North Am Small Anim Pract. 2014 Sep;44(5):817-29.

Zhu R, Chen YP, Deng YY, et al. “Cordyceps cicadae extracts ameliorate renal malfunction in a remnant kidney model”. J Zhejiang Univ Sci B. 2011;12(12):1024-33.

Maiti R. “Metronomic chemotherapy”. J Pharmacol Pharmacother. 2014;5(3):186-92.

Tuli HS, Sandhu SS, Sharma AK. “Pharmacological and therapeutic potential of Cordyceps with special reference to Cordycepin”. 3 Biotech. 2013;4(1):1-12.

Galbraith EA, McKellar QA. “Pharmacokinetics and pharmacodynamics of piroxicam in dogs”. Vet Rec. 1991 Jun 15;128(24):561-5. Knapp DW, Richardson RC, Chan TC, Bottoms GD, Widmer WR, DeNicola DB, Teclaw R, Bonney PL, Kuczek T. “Piroxicam therapy in 34 dogs with transitional cell carcinoma of the urinary bladder”. J Vet Intern Med. 1994 Jul-Aug;8(4):273-8. Rao CV. “Regulation of COX and LOX by curcumin”. Adv Exp Med Biol. 2007;595:213-26. Review. Daily JW, Yang M, Park S. “Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials”. J Med Food. 2016;19(8):717-29. Deng YI, Verron E, Rohanizadeh R. Molecular “Mechanisms of Antimetastatic Activity of Curcumin”. Anticancer Res. 2016 Nov;36(11):56395647. Review. Vallianou NG, Evangelopoulos A, Schizas N, Kazazis C. “Potential anticancer properties and mechanisms of action of curcumin”. Anticancer Res. 2015, Feb;35(2):645-51. Review. Benavente-García O, Castillo J, Alcaraz M, Vicente V, Del Río JA, Ortuño A. “Beneficial action of citrus flavonoids on multiple cancer-related biological pathways”. Curr Cancer Drug Targets. 2007 Dec;7(8):795-809. Review. Meiyanto E, Hermawan A, Anindyajati. “Natural products for cancertargeted therapy: citrus flavonoids as potent chemopreventive agents”. Asian Pac J Cancer Prev. 2012;13(2):427-36. Review.

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Hsieh CF, Chang HC, Huang SL, Chen CL, Chen WT, Yang CC. “Prescribed Renoprotective Chinese Herbal Medicines Were Associated with a Lower Risk of All-Cause and Disease-Specific Mortality among Patients with Chronic Kidney Disease: A Population-Based Follow-Up Study in Taiwan”. Evid Based Complement Alternat Med. 2017;2017:5632195. Wang Y, Yin H, Lv X, Wang Y, Gao H, Wang M. “Protection of chronic renal failure by a polysaccharide from Cordyceps sinensis”. Fitoterapia. 2010 Jul;81(5):397-402. Ong BY, Aziz Z. “Efficacy of Cordyceps sinensis as an adjunctive treatment in kidney transplant patients: A systematic-review and meta-analysis”. Complement Ther Med. 2017 Feb;30:84-92. Peng Y, Chen Q, Yang T, Tao Y, Lu X, Liu C. “Cultured mycelium Cordyceps sinensis protects liver sinusoidal endothelial cells in acute liver injured mice”. Mol Biol Rep. 2014 Mar;41(3):1815-27. Chen M, Cheung FW, Chan MH, Hui PK, Ip SP, Ling YH, Che CT, Liu WK. “Protective roles of Cordyceps on lung fibrosis in cellular and rat models”. J Ethnopharmacol. 2012 Sep 28;143(2):448-54. Yang L, Jiao X, Wu J, et al. “Cordyceps sinensis inhibits airway remodeling in rats with chronic obstructive pulmonary disease”. Exp Ther Med. 2018;15(3):2731-2738. Wang N, Li J, Huang X, Chen W, Chen Y. “Herbal Medicine Cordyceps sinensis Improves Health-Related Quality of Life in Moderate-to-Severe Asthma”. Evid Based Complement Alternat Med. 2016;2016:6134593.

Liu WC, Wang SC, Tsai ML, Chen MC, Wang YC, Hong JH, McBride WH, Chiang CS. “Protection against radiation-induced bone marrow and intestinal injuries by Cordyceps sinensis, a Chinese herbal medicine”. Radiat Res. 2006 Dec;166(6):900-7. Liu WC, Chuang WL, Tsai ML, Hong JH, McBride WH, Chiang CS. “Cordyceps sinensis health supplement enhances recovery from taxolinduced leukopenia”. Exp Biol Med (Maywood). 2008;233(4):447-55. Nakamura K, Shinozuka K, Yoshikawa N. “Anticancer and antimetastatic effects of cordycepin, an active component of Cordyceps sinensis”. J Pharmacol Sci. 2015 Jan;127(1):53-6. Song J, Wang Y, Teng M, et al. “Cordyceps militaris induces tumor cell death via the caspase-dependent mitochondrial pathway in HepG2 and MCF-7 cells”. Mol Med Rep. 2016;13(6):5132-40. Glutamine Noé JE. “L-glutamine use in the treatment and prevention of mucositis and cachexia: a naturopathic perspective”. Integr Cancer Ther. 2009 Dec;8(4):409-15. Savarese DM, Savy G, Vahdat L, Wischmeyer PE, Corey B. “Prevention of chemotherapy and radiation toxicity with glutamine”. Cancer Treat Rev. 2003 Dec;29(6):501-13. Review. Gaurav K, Goel RK, Shukla M, Pandey M. “Glutamine: A novel approach to chemotherapy-induced toxicity”. Indian J Med Paediatr Oncol. 2012;33(1):13-20. Rao R, Samak G. “Role of Glutamine in Protection of Intestinal Epithelial Tight Junctions”. J Epithel Biol Pharmacol. 2011;5(Suppl 1-M7):47-54. Noé JE. “L-glutamine use in the treatment and prevention of mucositis and cachexia: a naturopathic perspective”. Integr Cancer Ther. 2009 Dec;8(4):409-15. Gaurav K, Goel RK, Shukla M, Pandey M. “Glutamine: A novel approach to chemotherapy-induced toxicity”. Indian J Med Paediatr Oncol. 2012;33(1):13-20. Niklison-Chirou MV. “Glutamine metabolism, the Achilles heel for medulloblastoma tumor”. Cell Death Dis. 2018;9(2):74. Published 2018 Jan 22.

6. Antioxidants The use of antioxidants during chemotherapy and radiation is hotly debated. On one side, there is concern that as a group they may interfere with some chemotherapies and radiation. The other side of the argument stipulates that chemotherapy, radiation, as well as cancer itself, increase harmful free radical loads and that antioxidants are therefore good for cancer treatment.

Simply speaking, the balance of current research shows that, as a group, dietary levels of antioxidants may help cancer patients recover better from surgery, chemotherapy and radiation, improve their life expectancy, and increase longevity. Minimally, harm has not been shown in review. The author, therefore, supports dietary antioxidant intake during chemotherapy and radiation.

CONCLUSION To make the issue cloudier still, antioxidants when viewed as a functional group are very diverse, and have remarkably different net effects. Furthermore, a given antioxidant can have the opposite effect (become pro-oxidant), depending on the dose and circumstance. Finally, the various effects of these compounds above and beyond their redox activity may be more clinically relevant than their antioxidant effects.

Including side effect mitigation strategies as standard of care is beneficial in canine

cancer treatment. Early implementation of these therapies can potentially address adverse consequences of both canine cancer and its treatment. This aids in establishing a sane, compassionate balance between patient life quality and longevity. Disclosure statement: The author of this publication developed the Apocaps® formula and is a paid consultant for Functional Nutriments, LLC. He has no equity interest in either Functional Nutriments, LLC or Apocaps®. Editor’s note: If you are interested in learning more about Dr. Dressler’s approach to managing canine cancer, he has created a private video training series, sponsored by Functional Nutriments, that is free to veterinarians. You can find it at FunctionalNutriments.com/IVC.

Oizel K, Chauvin C, Oliver L, Gratas C, Geraldo F, Jarry U, Scotet E, Rabe M, Alves-Guerra MC, Teusan R, Gautier F, Loussouarn D, Compan V, Martinou JC, Vallette FM, Pecqueur C. “Efficient Mitochondrial Glutamine Targeting Prevails Over Glioblastoma Metabolic Plasticity”. Clin Cancer Res. 2017 Oct 15;23(20):6292-6304. Ramadan S, Lin A, Stanwell P. “Glutamate and glutamine: a review of in vivo MRS in the human brain”. NMR Biomed. 2013;26(12):1630-46. Silymarin Skorupski KA, Hammond GM, Irish AM, Kent MS, Guerrero TA, Rodriguez CO, Griffin DW. “Prospective randomized clinical trial assessing the efficacy of Denamarin for prevention of CCNU-induced hepatopathy in tumor-bearing dogs”. J Vet Intern Med. 2011 Jul Aug;25(4):838-45. Razavi BM, Karimi G. “Protective effect of silymarin against chemicalinduced cardiotoxicity”. Iran J Basic Med Sci. 2016;19(9):916-923. Dashti-Khavidaki S, Shahbazi F, Khalili H, Lessan-Pezeshki M. “Potential renoprotective effects of silymarin against nephrotoxic drugs: a review of literature”. J Pharm Pharm Sci. 2012;15(1):112-23. Review. CoQ10 Conklin KA. “Coenzyme q10 for prevention of anthracycline-induced cardiotoxicity”. Integr Cancer Ther. 2005 Jun;4(2):110-30. Review. Greenlee H, Shaw J, Lau YI, Naini A, Maurer M.“Lack of effect of coenzyme q10 on doxorubicin cytotoxicity in breast cancer cell cultures”. Integr Cancer Ther. 2012;11(3):243-50. Antioxidants Conklin KA. “Dietary antioxidants during cancer chemotherapy: impact on chemotherapeutic effectiveness and development of side effects”. Nutr Cancer. 2000;37(1):1-18. Review. Gröber U, Holzhauer P, Kisters K, Holick MF, Adamietz IA. “Micronutrients in Oncological Intervention”. Nutrients. 2016;8(3):163. Published 2016 Mar 12. doi:10.3390/nu8030163. Sak K. :Chemotherapy and dietary phytochemical agents”. Chemother Res Pract. 2012;2012:282570.

IVC Spring 2019

PEER-REVIEWED

OZONE THERAPY

By Pema Choepel Mallu, DVM, CVA, MAc, LAc

for cancer in veterinary medicine

How ozone contributes to the destruction of cancerous cells, and the formation of healthy ones.

Editor’s Note: An introduction to ozone therapy in veterinary medicine was published in the Winter 2018 issue of IVC Journal. Read Dr. Margo Roman’s article, “Ozone therapy: a way to build and maintain health”, at ivcjournal.com/ozone-therapy-health/ for a comprehensive summary of mechanisms of action, benefits and uses, delivery systems, and methods of administration. BIOCHEMISTRY OF OZONE AND CANCER Discovered in the mid-19th century, ozone has been used medically for over 100 years for its immune-modulating, antibacterial, anti-viral, anti-fungal, anti-inflammatory, and anti-cancer effects.1 “Cancer has only one prime cause…the replacement of normal oxygen respiration of body cells by an anaerobic (oxygen-less) cell respiration,”2 concluded Otto Warburg, who was awarded the Nobel Prize for Physiology or Medicine in 1931. The three-oxygen, unstable molecular structure of ozone challenges cancer cells that have evolved to survive in an anaerobic environment. Research has also shown that while in an oxygen-rich environment, healthy cells produce an enzymatic protective layer around themselves that repels viruses, bacteria and fungi,2 all potential precursors to the development of cancer. Ozone targets cancer cells that do not have this protective cell membrane layer, contributing to apoptosis of the unhealthy cells. Ozone therefore contributes to the formation of healthy cells as well as the destruction of unhealthy ones.

MODES OF DELIVERY FOR VETERINARY CANCER PATIENTS A note on therapy frequency Ozone therapy is performed every one to four weeks, depending on the severity of the disease. In some cases, an initial protocol of twice-weekly treatments is initiated. If

IVC Spring 2019

indicated, daily treatments using rectal ozone or inhalation ozone can be prescribed for home use with client purchase of a home ozone generator. UVB Ozone IV Therapy For cancer treatments, in addition to treatments for kidney and liver disease, infectious disease, and in geriatric patients, ozonated saline and ozone gas oxygenate the blood when given back to the patient intravenously, perfusing the kidneys and liver, increasing filtration, and improving function. To prevent clotting, 3-11cc of blood is drawn from the patient (volume based on patient size) into a heparinized syringe. Bio Ocean, a liquid mineral mix, and ozonated saline and ozone gas, are added to the syringe. The Bio Ocean supports energy metabolism, acid-base equilibrium, and optimal hydration, and acts as a co-factor in enzymatic reactions. It can be purchased at shopbiocean.com. The blood/ozone syringe is passed four to six times through a UVB light in a closed sterile system, while also mixed with ozone gas. The UVB light is a spectrum of ultraviolet light that kills viruses, bacteria, fungi and cancer cells. The UVBozonated blood is then given back to the patient by IV. There are two different techniques for UVB Ozone IV Therapy. The above technique is from Dr. Margo Roman.3 Another

technique from O3Vets4 describes the blood sample being placed in an IV bag, then passed through the UVB light and dripped into the patient intravenously. Alternatively, if the use of heparin needs to be avoided, a technique called the Geneva method involves the blood being pulled directly into the syringe with the ozonated saline and Bio Ocean, and diluted by rocking well. Rectal ozone Useful for cases of prostatic and bladder cancers, in addition to detoxification, ozone is administered rectally through a syringe or insufflation bag attached to a rectal catheter. Ozone gas is absorbed immediately via rectal tissue circulation and can go into the mitochondria of the colon columnar cells. Additionally, rectal ozone is used to reduce the biofilm in the colon prior to the Microbiome Restorative Therapy. Ozonated saline infusions These can be infused into the vaginal canal or urinary bladder for tumors in those locations, or subcutaneously as a general therapy. Infusions can also be used to flush eyes, ears, and wounds, soak infections, and in surgery as an abdominal rinse and throughout dental procedures. Ozone infusions help decrease the risk of infection and mitigate pain. Ozonated gas injection Ozonated gas can be injected directly around and under tumors to shrink them on a weekly or twice-weekly basis. It can also

Left: Ozone generator, oxygen tank/ regulator, and tubing for rectal ozone.

Below: UVB light apparatus to irradiate ozonated blood.

IVC Spring 2019

OZONE USE IN VETERINARY CANCER: 6 case summaries 1. Tiger

1 2 3

Tiger was a 15-year-old male neutered Yorkshire terrier presenting with a persistent severe cough, radiographic evidence of a mediastinal mass ﬁlling the entire anterior chest cavity, and extremely poor prognosis by the referring veterinarian. He was treated with UVB Ozone IV every three weeks, along with diet changes, supportive herbs and supplements. Tiger lived comfortably for another 11 months.

Tiger’s mediastinal mass.

2. Elvira

Elvira was a nine-year-old female spayed Rottweiler cross presenting with a history of osteosarcoma of the right forelimb treated with amputation, and lung masses a year later. She was treated with UVB Ozone IV every three to four weeks, as well as diet changes, supportive herbs and supplements. Elvira was asymptomatic for three years, with no further growth in lung masses. Four years post-diagnosis of the original osteosarcoma, she was euthanized due to metastasis to the left forelimb.

Elvira’s lung masses.

3. Patch

Patch was a 12-year-old male neutered border collie cross presenting with a heart base tumor with pericardial eﬀusion and syncopal episodes. UVB Ozone IV was the only therapy used, on an alternating treatment schedule of weekly therapy for two months, followed by every other week for one month, followed by weekly again for two months. A recheck echocardiogram at ﬁve months of treatment revealed no evidence of pathology. Patch survived another three years and died of age-related problems.

4. Lily

Lily was a nine-year-old female spayed Maltese cross presenting with lung lobe carcinoma with pleural eﬀusion and syncopal episodes. Treatment was initiated with rectal ozone every three days for a month. This was followed by a tapering schedule of UVB Ozone IV weekly for seven weeks, every two weeks for ﬁve months, and then every three to four weeks for 10½ months. Lily had excellent quality of life and a post-diagnosis survival time of 18½ months.

5. Wyatt

Wyatt is an 11-year-old male neutered Basenji who presented with prostate cancer in June of 2018. He has responded well to rectal ozone therapy and is currently urinating well, with only mild episodes of bloody urine and mild increase in prostate size. Daily treatments (with a minimum of three times weekly) resulted in the economic recommendation for his caregivers to purchase their own ozone generator, oxygen regulator, oxygen tank and rectal catheters.

6. Bonnie

6 16

Bonnie was a 15-year old female spayed domestic shorthair cat presenting with soft tissue sarcoma of the nasal passage. She underwent six surgeries to debulk the tumor, which would then regrow every six to eight weeks. From August 2017 until euthanasia in March 2018, her caregiver gave her daily ten-minute ozone inhalation treatments with a mask. The ozone treatments kept her comfortable and breathing well between the debulking procedures.

IVC Spring 2019

be injected intra-lesionally; however, the patient may experience a more severe inflammatory response with this technique. Further, ozonated gas injections can be used in conjunction with prolotherapy (called prolozone) to stimulate stem cells and bring healing to joints and other areas of inflammation, such as lick granulomas. Inhalation ozone This method of ozone therapy is especially useful for nasal and sinus tumors, chronic rhinitis or lung cancer. Ozone gas must first be percolated through olive oil to remove noxious components that could harm the lungs, nasal passages and sinuses. When bubbled with olive oil, ozonides are produced. This avoids direct ozone gas which causes a chemical reaction with oxides in the respiratory tissues that lead to inflammation, damage and scarring. It should never be breathed directly without ﬁrst performing this critical step. The ozone can then be administered to the patient using an anesthetic mask, or by making a tent in a cage. Certification courses for veterinarians can be taken through O3Vets.4 Equipment can be purchased through Longevity Resources5, O3Vets4 and Promolife.6 Ozone therapy provides an economical, easy-to-learn and easyto-implement modality that enhances survival outcomes (see sidebar at left), and most importantly, quality of life, in veterinary cancer patients.

Elvis, A.M. and Ekta, J.S “ Ozone Therapy: A Clinical Review”, J Nat Sci Biol Med, 2011 Jan-Jun; 2(1): 66–70.

Goldberg, J.G “Ozone Therapy: A Powerful Cancer Treatment and Healing Therapy”, The Truth AboutCancer.com/ozone-therapy-cancertreatment

Roman, Margo “Ozone Therapy”, SOPMED Conference, 2015.

o3vets.com/products/ozone-equipment/

ozonegenerator.com/

promolife.com/ozone/

IVC

2018 Innovative Veterinary Care Journal READERS’ CHOICE INNOVATION AWARDS Innovative Veterinary Care Journal is proud to celebrate the companies that push to make a difference in animal care. This year’s winners have gone above and beyond to make veterinary practice easier on the patients and better for the vets. Leaders like this take risks to present something new to a wider

JOURNAL INNOVATION AWARD

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- 20 1

audience, serving to propel animal care forward through passion, research and innovation.

Congratulations to the following companies! Behavioral Health

Winner: Rescue Remedy Trusted for over 80 years, Bach’s flower remedies help with stress, fear and anxiety in pets. Rescue Remedy is made with all-natural ingredients and helps pets feel their best. Runners Up: AnimalEO, Medical Cannabis Dispensary, Rx Vitamins and Young Living Vets and Pets

Dental Care

Winner: VetzLife VetzLife products are 100% natural and help remove plaque and tartar, fight oral disease and whiten teeth, all while freshening an animal’s breath. Runner Up: Lebalab

Diagnostics

Winner: Digatherm Digatherm offers the only veterinaryspecific software, the highest resolution possible, and an accuracy of +/- 1˚C for your thermal imaging needs. Runners Up: Animal Biome, Equine Infrared and Glacier Peaks Holistic

Education

Winner: College of Integrative Veterinary Therapies CIVT provides innovative education in evidence-based natural medicine, bridging tradition and cutting-edge science, to help veterinarians expand their treatment options.

Lab Equipment

Winner: VEEN VEEN offers veterinarians the chance to buy equipment from each other, to find a dealer for their used equipment, or to get help refurbishing equipment they want to sell. Runner Up: International Win

Nutrition

Winner: Your True Companion Your True Companion is dedicated to delivering natural healthy food that pets can depend on for a balanced diet. Runners Up: Ketogenic Pet Foods and NOW Foods

Ozone Therapy

Winner: O3 Vets O3 Vets supplies quality ozone therapy equipment to holistic veterinarians looking to expand their practice, and provides the training to use every piece with confidence. Runners Up: Ozone Generator and Ozone Therapies Group

Services to Build Your Practice

Winner: Gyms for Dogs™ Gyms for Dogs™ helps you build the best outdoor play area for your canine patients to enjoy, including services like COLORPLAY™ to customize your equipment to match your practice, and DURADOG™ to help it last!

Runners Up: International Veterinary Acupuncture and The Vluggen Institute

Runners Up: AquaTread, Vets Plus, Inc., and Pegasus Laboratory

Eye/Ear/Nose Care

Skin/Coat Care

Winner: VetRx – Goodwinol VetRx has been solving respiratory complaints for 100 years and continues to offer specific care for your patients’ needs. Runner Up: Natural Ophthalmics

Winner: DERMagic™ Providing all-natural skin care for animals, DERMagic™ promotes fuller coats, protects skin and restores good skin condition for animals suffering from dermatological issues. Runners Up: Woodrow Wear and The Edge

Supplements

Winner: Phycox® Joint Supplements Phycox® Joint Supplements provide a comprehensive blend of beneficial ingredients including Phycocyanin, a natural antioxidant derived from bluegreen algae, and glucosamine, MSM, additional antioxidants, creatine and more. Runners Up: Baie Run, Animal Necessity and NOW Pets

Technology

Winner: Dragon Veterinary Developed by a veterinarian, Dragon Veterinary speechto-text technology saves you time by recording your notes and connecting directly to your practice management system in order to organize and store them. Runners Up: iFetch and Portion Pro X

Pain Management

Winner: LiteCure Companion Animal Health provides a partnership in bringing laser therapy to your practice. Light energy from their products reaches target tissue and helps decrease inflammation and pain, and increase healing. Runners Up: Pulse Veterinary Technology, Rx Vitamins, and Orthokine Stay tuned for the announcement of our 2019 nominees for the IVC Editor’s Choice Awards, coming soon! Do you know a company that should be nominated for one of our awards? Reach out! Email us at info@ivcjournal.com and your pick could receive the Reader’s Selection Award.

IVC Spring 2019

PEER-REVIEWED PRP stimulates the repair of soft tissues and joints without the use of foreign chemicals, and utilizes the body’s own programming for self-healing.

MODIFI ED PLATELET RICH PLASMA (PRP)

for cruciate ligament injuries in dogs By Meghan Reinders, BSc (Hons) and Sasan Haghighat, DVM, CVA

Platelet Rich Plasma therapy has been applied to many different medical fields, such as cosmetics, dentistry, sports medicine, pain management – and now veterinary medicine. PRP is blood that has been processed, usually by centrifuge, to contain a higher concentration of platelets than whole blood (McCally, 2015). An interesting feature of the physiologic function of platelets is their role as vehicles for the local delivery of growth factors in wound healing. At sites of vascular injury, platelets adhere, aggregate, and also generate thrombrin, which triggers tendon and ligament growth and repair (Sánchez, 2007). In veterinary medicine, PRP is most often use for tendon/ligament injuries and osteoarthritis. Along with a higher concentration of platelets, PRP contains more than 1,500 bioactive proteins, which include many growth factors and substances normally found in plasma. These additional growth factors play a key role in reducing the expression of inflammatory cytokines, and encourage proliferation and differentiation of resident cells (McCally, 2015). This enhanced blood encourages the body’s natural healing process by directly targeting the site of injury.

CRUCIATE LIGAMENT INJURIES Among the common injuries found in dogs today are ruptured cruciate ligaments. Caused by chronic inflammation and the highly active lifestyles of many dogs, these hind leg tears

IVC Spring 2019

hinder daily mobility while also creating stress on the rest of the compensating body. Specifically, within the knee joint, the two cruciate ligaments that cross the joint – the cranial cruciate and the caudal cruciate – compare to the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) in humans. It is important to note that CCL injuries are less likely to occur in dogs that have not yet been sterilized, supporting recommendations for the delay of sterilization procedures until dogs are two years of age and fully developed (Haghighat, 2014). This allows for proper formation of collagen and musculoskeletal structure, and avoids hormone imbalances that could harm development. With a conservative approach comprised of a good home-prepared diet, exercise program, and specific bioregulatory medicine, including PRP, patients can strengthen and prevent further damage to the knee.

WHAT IS BIOREGULATORY MEDICINE? The body is full of complex biological processes that need consistent attendance in order to stay in a healthy and homeostatic state. The main idea behind bioregulatory medicine is using therapeutics and natural healing processes to regulate these biological processes during imbalances, without having to use conventional pharmaceutical medicines.

The difference between conventional and bioregulatory medicine is that the conventional route to dealing with illness aims to reduce symptoms and minimize inflammation through anti-inflammatories. This becomes problematic when viewing inflammation as a key critical response of the immune system when it is trying to fix and treat the illness at hand. In contrast, bioregulatory medicine helps the body heal itself through re-establishing normal feedback systems and stimulating healing processes (Demers, 2014). As integrative veterinary medicine becomes better known, it is important to understand that patients can live a long and full life with quick recoveries by promoting immune responses such as fever and inflammation rather than reducing such symptoms (Demers, 2014). It is important when treating dogs with PRP that they are not on any anti-inflammatory medications; these suppress the effects of PRP and the activation of that immune system response on the injury site.

A centrifuge is used to spin whole blood into its various components.

The first step in treating a patient with PRP is to draw a small quantity of his own blood into a vacutainer. That blood then is placed in a centrifuge. The centrifuge spins the blood, separating it into three different layers: the platelet-poor layer, the buffy coat (which contains the platelets and white blood cells) and the red blood cells (Lehman, 2011). The buffy coat is then obtained with the use of a syringe and injected into the injury site. The high concentration of platelets becomes activated upon contact with the collagen and other substances at the injection sites and where there is a release of growth factors (McCally, 2015).

BENEFITS OF PRP Through the support of many talented researchers, PRP has proven very successful in many different aspects of rehabilitation. Hyunchul, et al, conducted a study using PRP for arthroscopic repair of large to massive rotator cuff tears, and found that the re-tear rate of the PRP group versus the conventional method group was 35.6% lower (20% in the PRP group versus 55.6% in the conventional group). It was found to significantly improve structural outcomes for patients with large to massive rotator cuff tears. Many positive effects have been observed when using PRP as a treatment for tendon and ligament healing. After conducting a study on PRP versus Autologous Whole Blood for the treatment of chronic lateral elbow epicondylitis, Thanasas, et al, demonstrated that through the action of PRP it may be possible to initially inhibit excess inflammation while stimulating proliferation and maturation. This is especially important in preventing the fibrous scar tissue healing that occurs with macrophagemediated tendon-to-bone healing (Thanasas, et al, 2011). PRP has also been found to successfully reduce pain in patellar tendon donors. In a randomized controlled trial, De Almeida, et al, concluded that the use of PRP in the patellar tendon harvest site reduced donor site morbidity after ACL reconstruction. More importantly, results showed that the patellar tendon harvest site non-regenerated area (gap area) in the IVC Spring 2019

WHY CHOOSE PRP? PRP has been found to support the body’s healing processes in many effective ways, including:

The platelet-rich plasma from the patient’s own blood can be seen in white.

Positive long-term results in pain • Enhanced quality of tendon repair • Reduced healing time • Less scar tissue after healing process • Enhanced infection control as platelets store specific proteins important in infection prevention. •

• Reduction

PRP group patients was 4.9mm, versus 9.4mm in the control group patients, which is a significant difference; it indicates that PRP enhanced tendon healing (De Almeida, et al, 2012). PRP is an all-natural process that stimulates the repair of soft tissues and joints without the use of foreign chemicals. This technique uses solely the patient’s own blood, eliminating the risk of rejection or negative side effects. PRP is one step closer to stem cell therapy and uses the body’s own programming for self-healing on an amplified scale. It is another example of an effective, non-invasive procedure presented and successfully implemented by veterinary integrative medicine to support health and longevity in our animal patients.

IVC Spring 2019

References Demers, J. “Bioregulatory Medicine and Homotoxicology”, Integrative Veterinary Care, 2014. Haghighat, S. “Cranial Cruciate Injury in Dogs – A Second Option”, Vitality, 2014. Jo, C. Hyunchul, Shin, J. S., Lee, Y. G., Shin, W. H., Kim, H., Lee, S. Y., & Shin, S. “Platelet-rich plasma for arthroscopic repair of large to massive rotator cuff tears: a randomized, single-blind, parallel-group trial”, The American Journal of Sports Medicine, 2013. Lehman, R. “The 5-Steps Behind Platelet-Rich Plasma Injections”, U.S. Center For Sports Medicine, 2011. McCally, R. E. “Platelet Rich Plasma (PRP) in Canine Orthopedics”, Veterinary Health Center, 2015. Sánchez, M., Anitua, E., Azofra, J., Andía, I., Padilla, S., & Mujika, I. “Comparison of surgically repaired Achilles tendon tears using platelet-rich fibrin matrices”, The American Journal of Sports Medicine, 2007. Thanasas, C., Papadimitriou, G., Charalambidis, C., Paraskevopoulos, I., & Papanikolaou, A. “Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis: a randomized controlled clinical trial”, The American Journal of Sports Medicine, 2011.

INDUSTRY WATCH

INNOVATION

THAT’S MOVING THE INDUSTRY FORWARD

Innovators drive change, take risks and make things happen. This year, Innovative Veterinary Care Journal went on the road, visiting the VMX (Veterinary Meeting & Expo) and the Western Veterinary Conference, so we could uncover unique products and connect with leading edge organizations. Here’s what to watch out for in 2019!

AMBITIOUS NEW CANCER PROTOCOL

LOW DOSE, HIGH IMPACT

FidoCure, a division of One Health Company, blew us away at VMX with their ambitious goal of ending canine cancer forever. Since almost half of all companion dogs will suffer from cancer, this could change the future of veterinary care. The experts at FidoCure use genetic testing to understand the root of the problem and connect veterinary patients directly to the latest scientific advancements to help them heal. www.theonehealthcompany.com

MERCK knows that veterinary professionals and pet owners want the safest options when it comes to keeping dogs happy and healthy, so they’ve introduced a line of half-dose vaccines. Nobivac EDGE™ delivers the same efficacy as a conventional 1 ml vaccine but in a 0.5 ml dose. The Novibac EDGE™ options include DAPPv for parainfluenza, distemper, adenovirus type 1 and parvovirus; LEPTO(4), the first and only 0.5 ml leptospirosis vaccine shown to be effective against disease mortality and leptospiruria (urinary shedding) for dogs of all sizes; and DAPPv+L(4), the only combo vaccine for parainfluenza and four-way leptospirosis protection. Just as effective but half the size! www.merck.com

LIFE-SAVING STUDIES The Morris Animal Foundation was started 70 years ago and has worked to change veterinary care every year since. In 2019, Morris continues to fund studies which will change how we think about the lives and treatment of animals, including their ground-breaking golden retriever lifetime study (3,000+ participants). Information is starting to emerge that will identify the nutritional, environmental, lifestyle and genetic risk factors for cancer and other canine diseases. www.morrisanimalfoundation.com

EFFICIENT PRACTICE MANAGEMENT Distributor Henry Schien and Vets First Choice recently merged to create Covetrus, an innovative new company that’s working to change the face of animal care technology. Covetrus provides an end-to-end PIMS system of client management, and uses analytical insights to help veterinary practices identify gaps in their patient care and better manage them. Their system will also help maintain good client relations. www.covetrus.com

What did you see at VMX & WVC that you felt was innovative?

Email us at info@ivcjournal.com with innovative products you think we should check out next!

IVC Spring 2019

ADVERTORIAL

THE TRUTH By Kim Vanderlinden, ND, DTCM

ABOUT JOINT CARE

It has to be the toughest decision facing a pet owner – whether to keep a suffering pet alive or end his suffering and have him euthanized. My family adopted our dog Lucky from a no-kill shelter nine years ago, and I’m already starting to dread having to make such a decision in the next few years. When these life or death scenarios involve bad hips and achy joints, however, there is a new natural option available that few veterinarians have heard of, let alone used. Thanks to this option, numerous pets have been able to enjoy an extra year or more of quality life.

combination.1 All treatments were found to have the same effect – none whatsoever.

Conventional treatment

As for Lucky, we think of him as “lucky” because we have been proactive by giving him Active Again. We reasoned that at his age, why wait for joint discomfort? Better to keep him feeling youthful as long as possible by making these lubricating oils part of his health plan.

Many veterinarians, when confronted with joint trouble and wanting a natural solution, have been taught to automatically reach for glucosamine. Glucosamine, and its usual companion chondroitin, are found in the natural structure of joints; this leads people to think that, as the joints deteriorate, supplementation will keep them healthy.

Marketing vs. science When it comes to marketing, we are all susceptible to the jargon. For example, we often hear or read about products that “contain clinically proven ingredients”. This sounds good at first glance; however, if we stop to think about what this phrase really means, we realize that the actual product was likely never tested clinically, but that only some of the ingredients were. Perhaps more importantly, we need to ask, “What was proven?” Glucosamine, for example, has been proven to be safe, but not proven to be effective.

Where glucosamine fails The British Medical Journal published a meta-analysis review of ten studies, involving over 3,800 patients, which compared placebo, glucosamine, chondroitin and their

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Cetylated oils A supplement backed by award-winning clinical research is Active Again, a joint care product made of unique highlylubricating cetylated oils. With Active Again, outstanding science is the basis for real hope that your clients’ pets can enjoy life to the fullest again.

A veterinarian’s experience with Active Again When making choices for dealing with your patients’ joint health, the best place to go is the research. In-depth clinical research has shown that natural Active Again will provide more effective care than any alternative. Veterinarians across the country, including Dr. Forster-Blouin (seen in a video at youtube. com/watch?v=lhEY9SJ-PBE&app=desktop), have observed these results within their own practices. Get informed and feel better about your patient’s joint health treatment today.

“Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network metaanalysis,” BMJ 2010; 341 bmj.com/content/341/bmj.c4675.

Dr. Kim Vanderlinden almost drowned when he was six – then his uncle’s black Lab jumped in, grabbed him and swam him to shore. He’s grateful to be giving back by providing to animals formulas he developed for people. Dr. Vanderlinden has degrees in both Naturopathic and Chinese medicine, and wrote a book on IP6 for cancer, bone density and sugar metabolism – for a free electronic copy, email drkimv@hopescience.com.

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Ergonomics in veterinary dentistry & surgery The importance of magnification, illumination and posture for veterinary dentistry and surgical applications. By D.H. DeForge, VMD, Fellow of the Academy of Veterinary Dentistry

Ergonomics involves the design of equipment, devices and processes that support productive, effective, safe and comfortable use. The benefits of structuring the workplace with ergonomics in mind include the reduction of fatigue and discomfort as well as elimination of repetitive stress injuries. Ergonomics can be applied to many fields, including that of veterinary dentistry and surgery. Work-related musculoskeletal injuries resulting from poor posture have been reported in surgeons, dentists, technicians, assistants and nurses.1 The veterinary generalist as well as the veterinary surgical and dental specialist are likewise subject to various back and neck disorders from poor ergonomics. This review article highlights basic positive ergonomic design principles for magnification, illumination and posture for veterinary dentistry and surgical applications.

MAGNIFICATION AND ILLUMINATION Veterinary surgeons, generalists and dentists are often very defensive about the use of magnification systems because they seem to imply vision impairment and/or a sign of aging. This vanity can be challenged by citing the decreased practicerelated incidence of musculoskeletal and neurologic disorders that have been measured in direct proportion to the use of proper magnification and illumination during procedures.2,3 Awkward and torque-producing operator positions, resisted by prolonged static muscle contractions, are significant occupational hazards to a surgeonâ&#x20AC;&#x2122;s or dentistâ&#x20AC;&#x2122;s physical well-

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being. However, there are steps you can take to support better health in your clinic setting.

Surgical telescopes The three most important ergonomic factors to consider when investigating surgical telescopes are weight, frame design, and declination angle. Lighter scopes are more comfortable to wear, especially during longer procedures. Frames must be ergonomically designed and nose pads should conform to facial features. When considering clinical ergonomics, an adjustable declination angle option is the most important feature. The declination angle is defined as the angle between the line of sight made by the neutral eye position, and the actual line of sight made by the declined eye chosen by the clinician. The declination angle of the telescope is too small if the operator has to tip his or her chin into the chest, and too large if the operator has to decline the eyes or flip the neck backward. When purchasing a surgical telescope, ensure you can select and adjust the correct declination angle of the telescope to decrease neck fatigue. The magnification system should allow the user to avoid neck and shoulder pain, eyestrain, muscle strain and headache.

Surgitel magnifying loupe

Third generation vertically adjustable front lens mounted (FLM) telescopes are the most ergonomically beneficial. The vertical adjustment unique to these telescopes is advantageous since it allows you to adjust the declination angle to accommodate varying work distances during different stages of the procedure. This will help minimize eye, head, neck and back pain and strain.

Illumination In order to avoid eye fatigue, operators should avoid intense illumination that exceeds the adaptation capability of the eye. A co-axial illumination system parallel to the operator’s line of sight, clipped directly on the surgical telescope, is recommended to avoid misalignment of light on the focal spot. Halogen and fiber optic lights are available for telescopes and controlled by portable battery packs.

POSTURAL CONSIDERATIONS In addition to magnification and illumination systems, clinicians should give serious consideration to seating options. Pain in the lower back, neck and shoulders increases as a direct function of time while sitting in an ergonomically unsuitable position. Pain occurs when the spine cannot maintain its natural curvature. The saddle-sitting position or posture has been described in many decades of medical literature as the most healthful posture for the spine. Saddle seating allows controlled movement of the pelvis, resulting in an ideal spinal position with maintenance of the lumbar curve. The saddle seat reproduces the upright standing position while the operator, dentist or surgeon is sitting down. The Bambach surgeon can bend forward and still saddle seat be supported to maintain normal spinal conformation. The molded saddle design keeps the spine in the proper alignment, while allowing operator mobility. This results in the thighs, shoulders and arms finding a relaxed neutral position, and provides a mechanical advantage for AUTHOR’S NOTE: Dr. DeForge wishes to thank The General Scientiﬁc Corporation, manufacturer of Surgitel Ergovision Systems and Health by Design distributor of the Bambach Saddle Seat, for providing images for this article. IVC Journal and the author acknowledge that other manufacturers may provide similar products of equal efﬁcacy. Dr. Don DeForge is an independent clinical investigator and animal dentist – he can be contacted at DonDeForge100@gmail.com.

the forearms and hands during delicate movements. Back pain is reduced because the operator on the saddle seat assumes a position that minimizes abnormal intradiscal pressure.

CONCLUSION When ergonomic considerations are put into play, the career of the operator, dentist and/or surgeon can be extended and work satisfaction improved. Vertically adjusted FLM telescope magnification systems, correct illumination, and the utilization of a saddle seat will remove the negative postural considerations that cause acute and chronic pain in the lower back, neck and shoulders. 1

Cornell University Ergonomics Web, ergo.human.cornell.edu.

Chang BJ. “Ergonomic benefits of surgical telescopes: selection guidelines”. Special Ergonomics Issue. J California Dental Association, Feb 2002.

Chang, BJ. “Ergonomics of Surgical Telescopes and Headlights”. General Scientiﬁc Corp., Pub No: 120100.

Further references Chang BJ. “New advances in surgical telescope and ergonomics”. Presented at the International Intradiscal Therapy Society and International Society for Minimal Intervention in Spinal Surgery-Combined Meeting. St John’s College, Cambridge, England, August 1999; 1-5. Gale M. “The seated spine and the Bambach Saddle Seat”. National Library of Australia, ISBN: 0646-32703-8. Chairs, Chair Design, Human Engineering, 1997; 22,26. Gale M, Feather JS, Coster G. “A Multidisciplinary approach to the design of a work seat to preserve lumbar lordosis”. Australian Occupational Therapy Journal. 1989; 36: 45-52. Pheasant S. Ergonomics, Work, and Health. Gaithersburg MD: Aspen Publishers, 1991.

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innovative practice

PEER-REVIEWED

BRIDGING THE

GA P

IN VETERINARY ONCOLOGY Integrative Oncology leverages the advances of Western biomedicine by downsizing the cancer burden while simultaneously utilizing the tools we have available to us from other traditions of medicine. The goal is to make the body a less hospitable environment for cancer and support its natural healing processes.

By Erin Bannink, DVM Diplomate ACVIM (Oncology), GDipl VCHM, CVA (IVAS) Research is accumulating on how diet, exercise, lifestyle, stress, herbal medicine and acupuncture impact the development of and recovery from cancer in humans. Recent studies also show that the health of the gut microbiome may impact individual responses to conventional cancer therapies like chemotherapy and immunotherapy. By combining the strengths of the Western biomedicine paradigm with those of traditional medicine paradigms, which have a long history of supportive lifestyle and natural medicine therapies, we open the door to improving outcomes for our animal cancer patients. My clinical experience shows that when lifestyle and nutritional interventions, including diet, exercise, emotional wellness, select supplements, acupuncture and herbal medicines, are appropriately implemented alongside thoughtfully-applied patient-specific biomedicine therapies, patient well-being improves – and often, so do patient outcomes. When patient well-being improves, client satisfaction improves, and the experience of the whole veterinary team becomes more rewarding. When clients are presented with broader options and supported in taking an active role in their pets’ healing, the experience of cancer treatment can become one of empowerment and hope rather than despair and hopelessness.

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TOWARD A PARADIGM OF INTEGRATIVE CANCER CARE At its root, cancer is a chronic disease characterized by the dysregulation of multiple body processes, including chronic unmitigated inflammation, the failure of appropriate immune responses, and aberrant molecular signaling resulting in an alteration of the body’s “ecosystem”. These shifts in the body’s internal environment lead to epigenetic changes, which ultimately result in altered gene expression, abnormal tissue growth, and the creation of a tumor microenvironment that supports the survival, growth and metastasis of dysregulated cells. In many veterinary patients, cancer does not manifest appreciable signs until it is in advanced stages or has become a life-threatening medical emergency. Given that cancer is a multifactorial manifestation of disease, a comprehensive approach to support healing also needs to be multifactorial. Systemic inflammation, angiogenesis and immune dysfunction are all recognized factors contributing to cancer development, growth, persistence and metastasis. When I discuss the role of herbs in cancer management with clients, I explain that many herbs have been shown to mitigate inflammation, inhibit angiogenesis, and bolster

anti-cancer immune responses. These actions are in addition to their potential uses in alleviating the side effects of conventional cancer therapies or the clinical signs resulting from the cancer itself.

A TCM APPROACH TO INTEGRATIVE ONCOLOGY – FACTORS TO INCLUDE

EVIDENCE-INFORMED CHINESE HERBAL MEDICINE IN CANCER CARE

Diet leveraging food as medicine

As my specialized training lies in oncology and Chinese Herbal Medicine, I will focus on the role the latter can play in an evidence-informed integrative approach to cancer patient care.

ifestyle factors such as exercise and L weight management Limited exposure to toxins and carcinogens

Within the Traditional Chinese Herbal Medicine (TCHM) paradigm are plant-based treatments containing compounds that are currently being researched and exploited for their anti-cancer actions. Many of these actions parallel the mechanisms of metronomic chemotherapy, immunotherapy and targeted cancer treatments, while offering more balanced, or broader-acting and adaptogenic actions in the body as a whole.  A number of herbs exhibit the potential to prevent or reverse multiple drug resistance (MDR), the main cause for chemotherapy resistance, and are under heavy investigation for development as pharmacological agents. For these reasons, they present an attractive option for maintenance therapy after the completion of conventional treatments, and also hold the potential for effective additions to our combination therapy protocols. Integrative therapy utilizing TCHM has been associated with prolonged survival in a number of human cancer types, such as metastatic mammary carcinoma, lung cancer, pancreatic cancer and gastric cancer. Conversely, evidence also indicates that careful patient-specific considerations are warranted. For instance, some herbal therapies might promote the growth of certain types of cancer, such as hormone responsive breast cancer; and other specific herb-chemotherapy combinations could potentially interfere with the efficacy of certain chemotherapy drugs. It is, therefore, important to respect the importance of patient-specific prescribing. An extensive review of herb pharmacokinetics and drugherb interactions is beyond the scope of this article. However, we need to acknowledge that the importance of appropriate patient-oriented TCHM diagnosis and prescribing cannot be overemphasized. And in an evidence-informed approach to Integrative Oncology, efforts to stay up to date with the current literature on this topic, especially when combining herbal medicines with conventional treatments, are vital to safe, effective and informed integrative treatment.

Herbal therapies Acupuncture Immune support Gut microbiome health Select vitamins and supplements Emotional health of pet and family

A substantial amount of research can be found on individual herbs and herb-derived compounds in cancer care. Following are a few select examples of TCHM formulas that may be helpful in cancer patient care and in vivo research supporting their use.

Supporting immune function 1D ang Gui Bu Xue Tang: Oral administration modulated immune activity in tumor-bearing mice through: increased cytotoxic T lymphocytes and NK cell numbers • down-regulated activated T helper cells (CD4+/CD25+). 2 Xiao Chai Hu Tang: Improved immune function in tumorbearing mice. •

Supporting body condition Xiao Chai Hu Tang: Oral administration in tumor-bearing mice at a dose of 50 and 100 mg/kg resulted in: • slowed tumor growth • prevented loss of body condition • l owered tumor-related elevations in serum IL‑6 •a ttenuated muscle atrophy by affecting myoblast proliferation and differentiation •s uppressed pro-cachectic inflammatory cytokine production via inhibition of nuclear factor‑κB. Continued on page 28. IVC Spring 2019

Continued from page 27.

Supporting appetite iu Jun Zi Tang: Oral administration improved appetite L through: •e nhanced ghrelin signaling, which is involved in appetite regulation • i mproved gastric motility via hesperidin content. Pharmacokinetic evaluation of the formula suggests that its effects on ghrelin are: •e xerted via synergistic action of multiple ingredients rather than attributable to one ingredient alone •d ue to local direct action in the stomach.

Supporting energy Tao Hong Si Wu Tang: Oral administration prevented fatigue in mice.

Supporting immunotherapy Shi Quan Da Bu Tang: Oral administration improved in vivo tumor vaccine antigen-specific immune response over vaccination alone, resulting in: • slowed tumor growth • improved survival time • enhanced antigen presenting ability of dendritic cells (in vitro) • improved phagocytosis (in vitro).

Decreasing treatment-related toxicity Liu Jun Zi Tang: Used along with standard antiemetic therapy, and evaluated in a randomized phase II study in humans, this herbal formula showed additive relief of chemotherapy-related vomiting, nausea and anorexia compared to standard antiemetic therapy alone.

•

Xiao Chai Hu Tang: Treated and prevented induced gastritis and gastric ulceration in rats. •L ong Dan Xie Gan Tang: Sorafenib (in the same class of drugs as the veterinary tyrosine kinase inhibitor Toceranib) was evaluated with co-administration of Long Dan Xie Gan Tang. When given together, there was no significant alteration in chemotherapy blood levels or metabolism, but the liver toxicity induced by Sorafenib was mitigated. •

Preventing cancer development and growth Shi Quan Da Bu Tang: Oral administration prevented development of hepatic carcinoma in rats. •X iao Chai Hu Tang: Oral administration inhibited hepatocellular carcinoma growth in vivo. • X ue Fu Zhu Yu Tang: Oral administration significantly improved survival time and demonstrated anti-tumor activity in experimentally-induced liver sarcoma in mice. •

OPTIMIZING LIFE After over 12 years of clinical veterinary oncology practice, the wellness benefits I’ve seen with my patients receiving an integrative approach are so consistent that it has become ethically difficult for me to practice without offering these options. Integrative practice has significantly improved my job satisfaction, and my clients are grateful to have their requests for assistance in selecting effective supplements, natural medicine options, nutritional interventions and stress management supportively addressed. Even in cases where “cure” isn’t achieved, quality of life can improve. I have seen patients live comfortably with cancer for extended periods of time, far beyond the prognosis we typically see with conventional treatments. I have seen prolonged disease stabilization with herbal treatments. And although it doesn’t happen for every patient, I have seen tumors shrink with aggressive herbal medicine and lifestyle interventions alone when our initial intent was palliative care.

Roxy is currently in remission after right forequarter amputation for osteosarcoma in June of 2017. Treatment: chemotherapy, herbs, acupuncture, supplements, and a clean, balanced, varied homecooked diet.

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I now practice Integrative Oncology almost exclusively. I also offer Integrative Oncology Telemedicine Consultations to provide integrative assistance to veterinarians and support those managing patients with cancer. This arises from a desire to help bridge the gap between conventional and alternative medicine world-views, in the hope of bringing pet owners and the veterinary profession together on a comprehensive and effective path to wellness. When we learn to more effectively bridge this gap, these treatments will become more accessible to our profession as a whole.

As we develop a broader view of health and healing, we are empowered to take an active role in treatment and recovery. Treatment then becomes not about a “battle against cancer” but about how we optimize life. This focus is emotionally healthier both for us as clinicians and for our clients as pet guardians. It allows us to focus on wellness rather than disease, while effectively supporting the human-animal bond. And in the end, whether the cancer itself is the cause of death, or whether it is eliminated, the quality of the life that is lived during the treatment journey is almost always improved.

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.

References Chen, X. “Anti-Helicobacter pylori and Anti-Inflammatory Effects and Constituent Analysis of Modified Xiaochaihutang for the Treatment of Chronic Gastritis and Gastric Ulcer”, Evidence-Based Complementary and Alternative Medicine, 2018. Cheng YY. “Concurrent administration of anticancer chemotherapy drug and herbal medicine on the perspective of pharmacokinetics”, Journal of Food and Drug Analysis, 2018. Fujitsuka, N. “Rikkunshito, a ghrelin potentiator, ameliorates anorexia–cachexia syndrome”, Front Pharmacol, 2014. Hsieh, CC. “Dang-Gui-Bu-Xai-Tang modulated the immunity of tumor bearing mice.” Immunopharmacol Immunotoxicol, 2003. Hung, KF. “Complementary Chinese herbal medicine therapy improves survival of patients with gastric cancer in Taiwan: A nationwide retrospective matched-cohort study”, J Ethnopharmacol, 2017. Kim, A, et al. “Sosiho-tang ameliorates cachexia-related symptoms in mice bearing colon 26 adenocarcinoma by reducing systemic inflammation and muscle loss”, Oncol Rep, 2016. Kitagawa, H. “Pharmacokinetic Profiles of Active Ingredients and Its Metabolites Derived from Rikkunshito, a Ghrelin Enhancer, in Healthy Japanese Volunteers: A Cross-Over, Randomized Study”, PLoS one, 2015. Kuo, YT. “Complementary Chinese Herbal Medicine Therapy Improves Survival of Patients With Pancreatic Cancer in Taiwan: A Nationwide Population-Based Cohort Study”, Integr Cancer Ther, 2018. Liu, W. “Mechanisms of Antiulcer Effect of an Active Ingredient Group of Modified Xiao Chaihu Decoction”, Evidence-Based Complementary and Alternative Medicine, 2018. Mao, Y et al. “Network pharmacology-based and clinically relevant prediction of the active ingredients and potential targets of Chinese herbs in metastatic breast cancer patients”, Oncotarget, 2017. Ohnishi, S. “Additive effect of rikkunshito, an herbal medicine, on chemotherapy-induced nausea, vomiting, and anorexia in uterine cervical or corpus cancer patients treated with cisplatin and paclitaxel: results of a randomized phase II study (JORTC KMP-02)”, J Gynecol Oncol, 2017. Suzuki, H. “Cancer cachexia pathophysiology and translational aspect of herbal medicine”, Jpn J Clin Oncol, 2013. Tatsuta, M. “Inhibition by shi-quan-da-bu-tang (TJ-48) of experimental hepatocarcinogenesis induced by N-nitrosomorpholine in Sprague-Dawley rats”, Eur J Cancer, 1994. Takeno, N. “Immune adjuvant effect of Juzentaihoto, a Japanese traditional herbal medicine, on tumor vaccine therapy in a mouse model”, International Journal of Oncology, 2015 Wang, BR..”Coprescription of Chinese herbal medicine and Western medication among female patients with breast cancer in Taiwan: analysis of national insurance claims”, Patient Prefer Adherence, 2014. Wang, P. “Overcome Cancer Cell Drug Resistance Using Natural Products”, Evidence-Based Complementary and Alternative Medicine, 2015. Wang, Q. “Maintenance Chemotherapy with Chinese Herb Medicine Formulas vs. with Placebo in Patients with Advanced Non-small Cell Lung Cancer After First-Line Chemotherapy: A Multicenter, Randomized, Double-Blind Trial”, Front Pharmacol, 2018. You, JS. “Effects of Xuefu Zhuyu Tang and Mitomycin C on Liver Tumors in Mice”, Chang Gung Med J, 2003. Zheng, N. “Current Understanding on Antihepatocarcinoma Effects of Xiao Chai Hu Tang and Its Constituents”, Evidence-Based Complementary and Alternative Medicine, 2013.

ESSENTIAL OILS TIP FOR THE SEASON Fruit peels can be cold-pressed to yield healthful essential oils. Citrus oils in particular are high in d-limonene. This natural chemical constituent is responsible for most of the medicinal properties of these oils. Consider bergamot for skin issues, grapefruit for fatty depositions, tangerine for edematous tissues, orange for clarity, lemon for detoxification, and lime for staff margaritas! As veterinarians, we know safety is always dosedependent. One drop of any pure oil rubbed into your palms and then applied or inhaled goes a long way! Citrus oils are often used in combination and diffused. Use them in solutions with healthy soap for spring cleaning. They’re recommended for veterinary facilities, grooming salons, doggy daycares, training kennels and pet households. Remember, if citrus oils are used topically for their antiseptic benefits, they can cause photosensitivity, so keep even furry skin out of the sun! And always use extra caution with cats! Contact a VMAA member for guidance on how to implement safe and effective essential oil use for your pets and patients! Visit vmaa.vet to learn more. Submitted by Jodie Gruenstern, DVM, CVA, and VP of VMAA IVC Spring 2019

PRODUCT PROFILE

CLASS 4 LASER THERAPY

DECONSTRUCTED By Maria Caiozzo, CCRA

Wavelength, dose and power – but not heat – are the most important variables affecting the benefits of laser therapy.

Figure 1

Scientific Figure on ResearchGate.

New concepts of laser in orthodontics -

So much information on Class 4 laser therapy (or photobiomodulation) is circulating at conferences, in trade journals, and in materials distributed by laser therapy manufacturers, that it is hard to distinguish what the most valuable and relevant data points are. When considering a Class 4 system, three main variables are most crucial to the beneficial effects of laser therapy: wavelength, dose and power. Note that heat is not one of the variables – we will touch more on that later.

1. WAVELENGTH A delicate balance exists between wavelength, the absorption of that wavelength by tissue, and the resulting therapeutic effect.1 Melanin, fur, hair, cell fluid and muscle all have different absorption factors of light at different wavelengths. The goal is to find a wavelength that is most effective for the desired target tissue. The ideal wavelength for skin conditions falls within the 670nm range. For deeper conditions, an 800nm to 900nm range is necessary for ideal penetration to ensure the energy is getting to the target tissue. Specifically, wavelengths around 808nm have proven penetration through tissue and even bone.2

2. DOSE Just as in pharmaceutical medicine, dose makes a difference in laser therapy. Too little, and there is no impact at all. Too much, and there is risk of causing damage to the cell or tissue (Figure 1).3 The World Association of Laser Therapy (WALT)4

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has defined ideal dose parameters to achieve the desired therapeutic effect, and is currently undergoing a rigorous process to update these parameters to reflect current updates in research.

3. POWER The main benefit of higher power is faster dose delivery. Dose is key, and power will impact the speed of that dose’s delivery. Higher power can also get the dose deeper into tissue as a function of treatment time. However, a major unwanted side effect of higher power is heat, which prevents one from holding a high-power continuous wave laser on one spot long enough to get the dose deeper into the tissue. With many Class 4 high-power therapy lasers, the probe must be moved non-stop to avoid too much heat. This method of treatment is inefficient as energy is lost to the ambient surroundings between the lens and the tissue. Often, a highpower Class 4 laser must be turned down to avoid burning, or treatment must be delivered in contact mode to ensure the energy is reaching the target tissue.

SUPER PULSE VS. CONTINUOUS WAVE One way to get power and penetration without heat is with a super pulse laser.3 A true super pulse laser has a diode with a very high peak power (anywhere from 30W to 200W) and it pulses completely on and off in microseconds (Figure 2) so it never heats up. It is this peak of very high power that increases the penetration into tissue;3 this is very different from pulsed lasers that simply take a 20W laser beam and chop or “pulse” it.

Figure 2

Maria Caiozzo has been a faculty member of the Canine Rehabilitation Institute since 2004. She founded Balanced Canine Products in 2007 and continues to consult and provide high quality rehabilitation equipment to veterinarians, physical therapists and animal owners worldwide. Maria joined the team at Respond Systems, LLC in 2017 as the client growth consultant. Her passion is education and sharing her knowledge of photobiomodulation and pulsed electromagnetic field therapy.

Respond Systems’ Aurora Class 4 Laser Therapy System was engineered based on the above parameters, with safety and results at the core of the design. “We enlisted an expert design team to help build the most effective and userfriendly Class 4 on the market,” says Lisa Miksis, VP at Respond Systems and the Aurora project development leader. “We needed battery backup, portability, stability and durability, all while producing the best results for the patient. The Aurora checks all the boxes without the risk of burning that too much power can create.” Thanks to the plethora of conditions a therapy laser can treat, it is one of the most beneficial additions to a practice, not only for the patients but also for the financial bottom line. Finding the right one does take a bit of homework, but focusing on the core parameters mentioned in this article will ensure that your therapy laser, whether Class 3b or Class 4, delivers the best experience and results for all. 1

Chung H, Dai T, Sharma S, Huang Y, Carroll J, Hamblin M. “The Nuts and Bolts of Low-level Laser (Light) Therapy”. Ann Biomed Eng. 2012 Feb; 40(2): 516–533.

Anders, Juanita, PhD, USUHS. “The Potential of Light Therapy for Central Nervous System Injury and Disease”. Photomedicine and Laser Surgery. 2009; 27(3): 379-380.

Samith Ahmed, Gregory Bewsh, Shankaranarayana Bhat, Ramesh Babu. “Low level laser therapy: healing at the speed of light”. Journal of Evolution of Medical and Dental Sciences. 2013 Sept 30; 2(39): 7441-7463.

orld Association of Laser Therapy. waltza.co.za/documentation-links/ W recommendations/dosage-recommendations/

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nutrition nook

KetoPet Sanctuary: ketosis, cancer and canines, part 1

Now five years old, KetoPet Sanctuary is a non-profit organization that has tested the feasibility of using a ketogenic diet as an adjunctive therapy in dogs with cancer. By Chelsea Kent, Shannon L. Kesl, PhD, Stacy A. Hodges, DVM and Loren Nations, DVM, DABVP

Each year, about six million dogs in the US are diagnosed with cancer. In fact, cancer is the leading cause of death in canines. Yet current therapies tend to be only marginally effective. In this article, we will explore the effects of a ketogenic diet (KD) as part of a protocol for treating cancer. For nearly a century, the ketogenic diet has been used as a therapy to control seizures in children with drug-resistant epilepsy.1,2 Moreover, recent research is showing that a KD is a promising therapy for improving human health and performance, weight loss, Alzheimerâ&#x20AC;&#x2122;s, amyotrophic lateral sclerosis (ALS), type-2 diabetes, traumatic brain injury (TBI), and even cancer in humans.3,4,5,6,7,8,9,10,11,12

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Most of the current research involving cancer and the ketogenic diet was inspired by Nobel Prize recipient, Otto Warburg, who identified that almost all cancer cells utilize energy differently than normal cells. These studies showed that cancer cells favor the use of glucose, even in the presence of oxygen, an observation known as the Warburg effect.13 Cancer requires somewhere between 20 and 200 times as much sugar as normal healthy cells. Since this hallmark finding, Dr. Thomas Seyfried, Dr. Dominic Dâ&#x20AC;&#x2122;Agostino, Dr. Angela Poff and others have demonstrated that lowering dietary intake of glucose via a KD, thus exploiting the metabolic weakness of cancer, has the potential to slow tumor progression.14,15,16,17,18 Dropping blood glucose levels from 90+ mg/dL down to 60 to 70 mg/dL

cuts sugar supply by as much as 50%. Lack of glucose slows cancer growth, and potentially kills some cancers, through metabolic starvation. This process of starvation, known as ketosis (see sidebar at right) also makes cancer cells more susceptible to Hyperbaric Oxygen Therapy (HBOT) and other treatments. In addition to acting as a fuel for the body, ketone bodies act as signaling molecules that down-regulate many cancer pathways, including mTOR, IGF-1 and inflammatory levels. Further, healthy cells are protected by ketone bodies when exposed to chemo-radiation.19 Ketones have been shown to reduce the effects of radiation on blood and bone marrow by as much as 50%. These studies became the foundation of the work done by the KetoPet Sanctuary, a 501c3 non-profit organization formed in 2014, and the first to systematically test the feasibility and applicability of using a KD adjunctive therapy in canines.

THE KETOPET SANCTUARY PROGRAM KetoPet Sanctuary began aiding dogs with many forms of cancer, who were set to be euthanized, from shelters near Austin, Texas. All dogs undergoing therapy resided exclusively at the Sanctuary. All dogs accepted into the program received formulated nutritional therapy (KD), veterinary and oncology care (surgery, chemotherapy and/or radiation), fluorodeoxyglucose positron emission tomography (FDG-PET) imaging (typically used only in humans), metabolic conditioning, hyperbaric oxygen therapy (HBOT), and of course, lots of love. Through the process, the team ensured seamless control over every aspect of the dogs’ metabolic therapy protocol. To date, most of the dogs have since been adopted. They all receive continued care and support from KetoPet Sanctuary’s veterinarians and scientists. KetoPet observed that a KD could improve survivorship beyond the initial prognosis of some forms of cancer when used as adjunctive therapy with standard of care. KDs do not guarantee a cure for cancer. Nevertheless, 55% of the dogs who graduated from the KetoPet program are still going for long walks, enjoying play, and experiencing a quality of cancer-free life far beyond their original prognosis. KetoPet is now committed to sharing what they’ve learned about metabolic therapy, HBOT and other cancer therapies with pet parents around the world.

What is

KETOSIS?

In the modern canine diet, the dominant fuel for the body is sugar/glucose metabolized from carbohydrates. To survive in varied conditions, all living beings are physiologically adapted to use more than one form of fuel: glucose and ketones. During fasting, starvation, vigorous exercise and caloric restriction (when glucose and insulin are low), the metabolism naturally shifts towards the breakdown of fat into usable energy, called “ketone bodies” or “ketones” in the form of acetoacetate (AcAc) or beta-hydroxybutyrate (βHB). This fat can be derived directly from the diet or adipose tissue stored throughout the body (aka body fat). The lowering of glucose and insulin, plus the elevation of ketones in the blood, produces the healthy and natural metabolic state called ketosis. It was once believed that dogs could not achieve ketosis; however, modern research shows that dogs do enter this state, though it may take longer to achieve. Blood glucose levels tend to lower at the same rate as those in humans on the diet; however, blood ketone levels do not elevate as high in dogs when compared to humans. KetoPet observed an overall average blood glucose level of 62.7 mg/dL and blood ketone level of 0.7 mM βHB. Some medications, like prednisone, can spike blood glucose, making it challenging for a dog to enter into ketosis.

WHAT IS A KETOGENIC DIET? A ketogenic diet (KD) is a nutritional strategy that intentionally manipulates the macronutrient ratio of carbohydrates, fats and proteins to induce a state of ketosis. The average American canine diet (kibble) is greater IVC Spring 2019

Nutritional fact panels on pet foods do not list carbohydrates, which makes it difficult to determine how much digestible carbohydrate a product contains without sending it to a lab for detailed analysis. Even products that claim to be grain-free and raw can still contain high amounts of carbs in the form of fruit, sweet potatoes, carrots and other ingredients.

IMPLEMENTING A KETOGENIC DIET IN CANINES

The Ketopet Sanctuary (KPS) opened its doors in September 2014 on a 53-acre plot of land in Georgetown, Texas. It includes a built-in miniature water park, track and playground outside, as well as large living and play areas inside. Additionally, KPS was equipped with onsite veterinary care, around the clock care and monitoring, exam rooms, and specialized dog treadmills.

than 45% carbohydrate. The KD shifts the carbohydrate component to less than 10% and increases fats to 60% to 80% of the total daily calories. Thus, a KD is high in fat, adequate in protein, and low in carbohydrates. For canines, a KD can range from 69% to 90% fat, 9% to 30% protein, and 1% carbohydrates, depending on the dog and purpose. KDs with a higher percentage of fats (87%+) are favored for seizure control in dogs with epilepsy; however, these higher percentages are not needed to induce ketones, nor do they appear to significantly increase ketone levels in the blood. KetoPet observed that canines routinely entered ketosis using an 82% fat/17% protein/1% carbohydrate formulation. After a period of time (120 days minimum), dogs may be able to maintain ketosis on a lower formulation (69% fat/30% protein/1% carbohydrates), allowing for more protein intake, although each dog is different. Optimization of carbohydrate and protein intake must be validated through dietary monitoring and modification, along with ketone and glucose testing, to determine what works best for each dog. Additionally, optimal blood ketone levels for cancer therapy are not yet known. As compared to other low-carb diets such as Atkins, the KD requires only adequate protein. As with carbohydrates, the body can convert excess protein into sugar, thus disabling ketogenesis. Commercially-packaged dog foods can contain up to 80% of calories from carbohydrates. Therefore, all processed kibble diets are too high in carbohydrates to induce ketosis.

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Some commercially-available raw food products, or a meticulous homemade diet, can allow pet owners to implement a ketogenic diet at home. However, the math required to calculate the meal plan can be daunting. KetoPet has created a free online calculator that helps pet parents formulate ketogenic meal plans for their dogs (ketopetsanctuary.com/calculator). Despite the KD’s clear therapeutic potential, the success experienced at KetoPet is largely attributed to the strict protocols that were followed. The KD can also contribute to success at home when strict protocols and adjunctive therapies are consistently implemented. These include: •R igorous macronutrient control and elimination of glucose sources • Repeated blood glucose and ketone testing • Dietary adjustments based on glucose/ketone results and canine body composition • 20 to 30 minutes of metabolic conditioning twice daily. Daily exercise increases heart rate, burns calories and stimulates mitochondria. These benefits also keep insulin low, thus helping to battle cancer • Use of HBOT • Use of standard of care when deemed appropriate by veterinary oncologists • Regular FDG-PET diagnostic testing and evaluation.

9 COMMON KETOGENIC DIET MYTHS

q “ The diet is unpalatable.” Fats contain more calories

per gram of food. Therefore, less volume is consumed to attain satiety. This decreased need for volume is often perceived as appetite loss or disdain for the diet. “High fat causes pancreatitis.” Oxidized phospholipids (oxPLs) accumulate at sites of inflammation and are involved in a wide range of inflammatory diseases. Combined with high insulin, anti-nutrients and heat, lipid compounds can generate a massive neutrophil infiltration within necrotic areas of peripancreatic adipose tissue, thus aggravating pancreatic conditions. Processed kibble diets are heated, high in glucose, and high in anti-nutrients,

r “ It This is Cali, KPS’s first graduate. She was diagnosed with hemangiosarcoma in 2014 and given eight to 12 weeks to live. Five years later, Cali is still cancerfree and thriving with her adoptive family in Texas.

causes excessive weight loss.” KDs cause a purging of excessive water stores, a loss of white fat and gain in brown fat, thus altering body composition. Loss of retained water (sometimes as much as 10% to 15% of body weight) is sometimes perceived as excessive weight loss. Rigorous weight monitoring and dietary adjustments prevent this weight loss.

t “The KD causes constipation.” Loss of excessive water stores causes losses in electrolytes. A lack of appropriate electrolyte supplementation can potentially lead to side effects.

y “Raw Cali enjoying metabolic conditioning with a romp around the grounds.

meeting all the parameters of pancreatic stress. Adding fat from fresh food sources may then push an already struggling pancreas over the edge. Despite the thought that high-fat diets in dogs often lead to pancreatitis, this is rarely, if ever, the case with a raw uncooked KD. Natural, raw unprocessed fats are easily digestible in a normal healthy canine intestinal tract. Cooked fats create highly inflammatory volatile fatty acids, causing the only instances of pancreatitis KetoPet vets have seen.

foods are full of salmonella and pathogens.” All forms of food may contain pathogens. Since 2006, according to FDA and CDC publications, dry kibble is the only category of pet food validated to have caused illness in humans, sickening 190 people.20 FDA references also indicate that 27.6% of dogs shed salmonella in their feces, regardless of diet; 56% of dogs fed salmonella do not shed it in feces; and only 0.6% of dogs fed salmonella exhibit any symptoms. Healthy dogs tolerate moderate levels of pathogens well. Dogs with suppressed immune systems are statistically less likely to be exposed to pathogens when fed commercially-available raw foods rather than kibble. Grocery store meats are more likely to harbor pathogens, as they are intended to be cooked for human consumption. Therefore, care must be taken to attain clean sourcing and nutritional adequacy when creating homemade diets. Continued on page 36.

e “High fat causes diarrhea and vomiting.” Dietary transitions commonly cause digestive detox, particularly when transitioning from processed to fresh foods. Digestive upset regurgitation, and occasional loose stool or diarrhea can occur as a result of positive changes in the gut microbiome and intestinal bacterial population when starting a different macronutrient profile diet. A quality probiotic, fiber source, or digestive enzyme supplement can assist the transition.

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Continued from page 35.

u “The

KD can cause fatty liver disease.” Deterioration of hepatic function can result in abnormal bile flow and accumulation of toxins in the bloodstream. High fat consumption does not cause hepatic deterioration. However, a KD may exacerbate previously diagnosed fatty liver conditions.

i “ The

KD causes ketoacidosis.” When insulin is not present, or there is resistance to it, glucose levels rocket above 300 mg/dL. Alternatively, ketosis or fasting results in glucose levels averaging 50 to 100mg/dL. Additionally, ketoacidosis causes the body to uncontrollably produce ketones, with levels reaching 15 to 25 mM versus the maximum of 7 mM induced by ketosis.

o “ Fats increase cholesterol, triglyceride and atherosclerosis risk.” The majority of recent studies have suggested that the KD can lead to significant benefits in biomarkers of metabolic health, including blood lipid profiles. In these studies, the KD positively altered blood lipids, decreasing total triglycerides and cholesterol while increasing the ratio of HDL to LDL.

BLOOD KETONE AND GLUCOSE VALIDATION One of the many benefits of a KD is that the pet parent can validate the diet at home by measuring blood glucose and blood ketones (specifically BHB) with a simple blood meter. This is the same method used by diabetics to measure their blood glucose levels, except it uses an interchangeable ketone blood strip instead of a glucose strip. Only specific commercial blood meters offer a dual operating mode. If the dog’s blood glucose levels are at or below 75 mg/dL and his blood ketone levels at or above 0.3 mM, then he is in a state of ketosis. Although KetoPet uses 0.3mM as their guideline, your clients may find that their dogs’ ketone levels will be much lower when compared to a human’s, especially if the dogs are active. Thus, a dog may have an average blood ketone reading of 0.2 mM. If the blood glucose is within range, this may be that particular dog’s average level of ketosis. KetoPet hypothesizes that dogs may use ketones for fuel more efficiently than humans do, meaning there is less circulating in the blood. However, this theory has yet to be proven. At the beginning of the program, KetoPet tested blood glucose and blood ketone levels often (as frequently as every day, depending on the dog) to optimize their meal plan. Once the numbers were seen consistently, testing was reduced to once or twice a week. Infographic courtesy of Marilyn K. Rodriguez

Pet owners must understand that even a small quantity of carbohydrates or excess protein, or overfeeding, can rapidly inhibit ketosis. Furthermore, enhanced ketone production and utilization can take up to several weeks (keto-adaptation). Patients may experience mild hypoglycemic symptoms during this transitional period. In some cases, canines may also require a reduction in the quantity of vegetables consumed in order to produce higher levels of ketones. In severe health conditions, such as cancer, it is optimal to maintain a KD for a minimum of 120 days.

Note: Certain conditions are either less affected or exacerbated by implementing ketogenic diets. Working under the direct supervision of a veterinary clinician experienced in ketogenic diets is imperative to achieving the desired outcome.

In the modern canine diet, the dominant fuel for the body is sugar/glucose in the form of carbohydrates. During fasting, starvation, vigorous exercise, caloric restriction, and/or carbohydrate restriction via a ketogenic diet (when glucose and insulin are low), the metabolism shifts towards de novo ketogenesis. In the liver, fat is broken down into ‘ketone bodies’, or ‘ketones’ in the form of acetoacetate (AcAc) and beta-hydroxybutyrate (βHB), which are transported systemically to extra hepatic tissues such as the brain, heart and muscles to be used as energy.

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It’s important to note that urine ketone strips are not a reliable indicator for dogs, since small amounts of ketones can be found in normal dog urine. Even in humans, ketone urine test strips are only

effective for the first few days of a ketogenic diet, if at all. In the early stages of a KD, the body will produce a small number of ketones, and they may not be detectable in the urine. It takes time/adaptation for the body to efficiently use ketones for fuel. As a result, they are temporarily passed in the urine. Once keto-adapted, ketones will no longer be present in urine because the body will use them as fuel. Although not an individual diagnostic test for ketosis, blood glucose measures may be lower than average because of the decreased need for glucose as the primary energy source, making it essential to measure both glucose and ketones. Part 2 of this article will be published in the next issue of IVC Journal, and will present case studies from KetoPet Sanctuary. For more information, the KetoPet eBook, resources and publications, visit KetoPetSanctuary.com.

T hiele, Elizabeth. “Assessing the Efficacy of Antiepileptic Treatments: The Ketogenic Diet.” Epilepsia 44 Suppl 7 (2003): 26-29.

Wilder, RM. “The Effect of Ketonemia on the Course of Epilepsy.” Mayo Clin Bulletin 2 (1921): 307-08.

Boden, Guenther, et al. “Effect of a Low-Carbohydrate Diet on Appetite, Blood Glucose Levels, and Insulin Resistance in Obese Patients with Type 2 Diabetes.” Annals of internal medicine 142 6 (2005): 403-11.

Broom, Gina M., Ian C. Shaw, and Julia J. Rucklidge. “The Ketogenic Diet as a Potential Treatment and Prevention Strategy for Alzheimer’s Disease.” Nutrition (Burbank, Los Angeles County, Calif.) 60 (2018): 118-21.

Kossoff, E. H. , and A. L Hartman. “Ketogenic Diets: New Advances for Metabolism-Based Therapies.” Current Opinion in Neurology 25 (2012): 173-8.

Mancinelli, Kristen. The Ketogenic Diet: A Scientifically Proven Approach to Fast, Healthy Weight Loss. The Ketogenic Diet: A Scientifically Proven Approach to Fast, Healthy Weight Loss: Ulysses Press, 2015.

cDonald, Tanya J. W. J. W., and Mackenzie C. Cervenka. “Ketogenic Diets for Adult Neurological M Disorders.” Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics 15 4 (2018): 1018-31.

Paoli, A., et al. “Beyond Weight Loss: A Review of the Therapeutic Uses of Very-Low-Carbohydrate (Ketogenic) Diets.” European journal of clinical nutrition 67 8 (2013): 789-96.

Prins, Mayumi. “Cerebral Metabolic Adaptation and Ketone Metabolism after Brain Injury.” Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism 28 1 (2008): 1-16.

hite, Hayden, and Balasubramanian Venkatesh. “Clinical Review: Ketones and Brain Injury.” Critical care W (London, England) 16 2 (2011): 219.

Y ancy, William, et al. “A Low-Carbohydrate, Ketogenic Diet to Treat Type 2 Diabetes.” Nutrition & metabolism 2 (2005): 34.

Z hao, Zhong, et al. “A Ketogenic Diet as a Potential Novel Therapeutic Intervention in Amyotrophic Lateral Sclerosis.” BMC neuroscience7 (2006): 29.

Warburg, O. “On the Origin of Cancer Cells.” Science (New York, N.Y.) 123 3191 (1956): 309-14.

P off, A. M., et al. “Ketone Supplementation Decreases Tumor Cell Viability and Prolongs Survival of Mice with Metastatic Cancer.” International journal of cancer. Journal international du cancer 135 (2014): 1711-20.

Poff, A. M., et al. “Non-Toxic Metabolic Management of Metastatic Cancer in Vm Mice: Novel Combination of Ketogenic Diet, Ketone Supplementation, and Hyperbaric Oxygen Therapy.” PloS one 10 6 (2015).

Poff, Angela, et al. “The Ketogenic Diet and Hyperbaric Oxygen Therapy Prolong Survival in Mice with Systemic Metastatic Cancer.” PloS one 8 6 (2013): e65522.

Seyfried, Thomas, et al.“Cancer as a Metabolic Disease: Implications for Novel Therapeutics.”Carcinogenesis 35 (2014): 515-27.

Seyfried, Thomas, and Laura Shelton. “Cancer as a Metabolic Disease.” Nutrition & metabolism 7: 7.

oolf, Eric C., et al. “The Ketogenic Diet Alters the Hypoxic Response and Affects Expression of Proteins W Associated with Angiogenesis, Invasive Potential and Vascular Permeability in a Mouse Glioma Model.” PloS one 10 6 (2015).

Kent, Chelsea, “Risk statistics regarding categories of pet foods.” AAFCO Feed Bin. (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.

PEARLS FROM PRACTICE: CANCER AND HOMEOPATHY Cancer is a word that strikes fear into most people. It has become a leading cause of death in our pets, something that wasn’t true when I began practice 33 years ago. If I had only one remedy to treat this condition, I would choose Thuja occidentalis (arborvitae). I give this remedy at the outset of any cancer case to remove the influence of previous vaccines, which stimulate tumor growth. I follow Dr. Pitcairn’s method of giving a single dose and waiting one month. I then reevaluate the case, seeking a remedy that fits the total symptom picture. This approach serves me very well in most patients, as many cancer cases are sycotic with underlying psora. Next, finding the antipsoric remedy that fits the symptom totality is a much better approach than focusing on individual symptoms. For example, it might seem that Euphrasia fits particular eye symptoms best, or Pulsatilla GI symptoms, better than an antipsoric fits the whole picture – but it’s still best to find the one antipsoric most similar to the whole patient, because it is better fitted to the generals. The more you prescribe for various groups of symptoms rather than the whole patient, the worse it is for the patient. If cure is not possible, homeopathy offers an excellent tool for palliative care as well, enhancing the patient’s quality of life. Submitted by Todd Cooney, DVM, CVH IVC Spring 2019

FIGHTING

GLAUCOMA WITH NATURAL NEUROPROTECTION By Carmen M.H. Colitz, DVM, PhD, DACVO and Terri McCalla, DVM, MS, DACVO

The eye is a unique organ because it is constantly exposed to light and oxygen, which generate high levels of reactive oxygen species (ROS). The “oxygen paradox” is that higher aerobic organisms cannot exist without oxygen, yet oxygen is also dangerous because of its ability to form ROS. The two body tissues with the highest oxygen demand are the central nervous system and the retina, making them uniquely susceptible to cellular damage by ROS. Significant demands are placed on the eye to create barriers to ROS damage. Oxidative stress plays a critical role in the pathogenesis of glaucomatous optic nerve damage. Glaucoma comprises a group of diseases that, if not controlled, ultimately results in optic nerve head circulation damage, retinal ganglion cell death, and irreversible blindness. Glaucoma is also believed to inflict migraine headache-like pain in animals when the intraocular pressure (IOP) is elevated. While affected patients often appear to be pain-free, the reverse is true. Nearly 2% of dogs suffer from glaucoma. Over 40 breeds are genetically predisposed to the condition. There are three types of primary glaucoma in dogs: narrow/closed angle, open angle, and pectinate ligament dysplasia. Secondary glaucoma may also result in irreversible blindness if the underlying cause is not identified and aggressively treated. Causes of secondary glaucoma include anterior uveitis, lens-induced uveitis, lens instability, retinal detachment, and intraocular neoplasia. The goals of the practitioner should be to determine if: (1) glaucoma is present; (2) it is primary or secondary; (3) it is acute or chronic. Once these goals are achieved, a treatment plan can be initiated. Traditional medical and surgical therapies have been reviewed elsewhere. However, traditional therapy is not enough. Nutraceutical antioxidant therapy shows promise in protecting optic nerve and retinal ganglion cells from the harmful effects of glaucoma-

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induced oxidative stress, which has been shown to be an important part of this disease. In the presence of glaucoma, lamina cribrosa cells generate more intracellular ROS, and have lower antioxidant expression and higher intracellular calcium levels when compared to normal cells. NF-E2 related factor (Nrf2) is a key transcription factor triggered by oxidative stress. It plays a pivotal neuroprotective role against retinal ganglion cell death in the presence of glaucoma. If oxidative stress is sufficiently controlled in glaucomatous eyes, Nrf2 levels are not elevated. Nrf2 is only upregulated in the presence of huge oxidative stressors. An antioxidant blend including green tea extract, coenzyme Q10, polyphenols (grapeseed extract) and lipoic acid has been shown to protect the retina, decrease oxidative stress, and decrease IOP in glaucomatous DBA/2J mice. The mice treated with the antioxidant blend had almost no Nrf2; conversely, the untreated mice had high levels. The antioxidant blend almost completely halted the upregulation of Nrf2 and its movement from the cytoplasm to the nucleus of retinal ganglion cells, which means it was not coding for secondary inflammatory mediators. Thus, the oxidative stress in the treated eyes was almost completely halted. Oxidative stress is a crucial factor in the pathogenesis of glaucoma. Consistent use of nutraceutical support gives hope to this devastating disease by preserving vision longer and “buying time” to allow for surgical intervention. Dr. Carmen Colitz is a board-certified veterinary ophthalmologist with a PhD in Comparative and Experimental Medicine. She has extensively researched antioxidants in eye health. Based out of Florida, her work has helped countless dogs, cats and aquatic mammals over the last 20 years. Dr. Terri McCalla has been a board-certified veterinary ophthalmologist for nearly 30 years, and has an MS in Comparative Pathology. Her special interests include both retinal disease and the effects of stress on ocular health in animals. Her private referral practice is located in Bellingham, WA. Carmen and Terri are founders of Animal Health Quest Solutions and formulators of Ocu-GLO, a vision supplement for dogs and cats comprised of 12 antioxidants.

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CLINICAL TRIAL ANNOUNCEMENT:

INVESTIGATION OF A TRADITIONAL CHINESE MEDICINE HERBAL THERAPY PROTOCOL FOR TREATMENT OF DOGS WITH STAGE II SPLENIC HEMANGIOSARCOMA AFTER SPLENECTOMY By Erin Bannink, DVM, Diplomate ACVIM (oncology), GDipl VCHM, CVA (IVAS), and Steve Marsden, DVM, ND, MSOM, Lac, Dipl.Ch, CVA

Funding and donations for this clinical trial are provided by an American Holistic Veterinary Medical Foundation (AHVMF) research grant, Natural Path and Rx Vitamins. Canine splenic hemangiosarcoma (HSA) is a uniformly aggressive disease with a high metastatic rate and grave prognosis, despite aggressive treatment with surgery and chemotherapy. Reported median survival time (MST) for stage II disease treated with splenectomy alone is two months (range is 1.6 to 3.4 months). With the addition of chemotherapy, the reported MST for stage II disease ranges from 3.1 to 5.9 months. The published overall one-year survival rates for stage II are 6% to 13% with surgery alone, and 12% to 20% with the addition of chemotherapy. Given the minimal overall survival benefit seen with the addition of chemotherapy, and the high rate of early mortality, novel and affordable treatment options are needed for this aggressive disease. Many herbal medicines have demonstrated mechanisms of action relevant to tumor progression pathways known to be important in the development, progression and metastasis of canine HSA. To assess the potential impact of palliative treatment with Chinese herbal medicine in managing dogs with stage II splenic HSA, a retrospective evaluation was done of dogs matching this diagnosis and treated with surgery and personalized Traditional Chinese Herbal Medicine (TCHM) at Oakland Veterinary Referral Services (OVRS) between 2007 and 2015, and at the Edmonton Holistic Veterinary Clinic (EHVC) between 2011 and 2016, for whom standard chemotherapy was declined. A total of ten patients from OVRS and four from EHVC met the inclusion criteria. The median survival time was 8.7 months with a 64% six-month survival rate, a 43% one-year survival rate, and a 21% two-year survival rate. No toxicities were reported. Median survival time along with one- and two-year survival rates in this small patient population show improvement compared to published statistics for splenectomy and chemotherapy. Based on the results of this patient population, a funded multi-institutional prospective clinical trial is currently underway. To date, 17 dogs have been enrolled; we aim to enroll a total of 50. Funding was not sufficient for a chemotherapy arm, and for compassionate care reasons there is no placebo control, so all patients enrolled will receive the study protocol.

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One main limitation to retrospectively evaluating the efficacy of TCHM treatments is that prescribing according to patient-specific TCHM principles results in a non-homogenous treatment regimen. Not only does this make evaluation of the impact of specific formulas more difficult, it also prevents the use of this treatment by practitioners who are not trained in TCHM. The One of the first study patients goal of this study is to prospectively evaluate to be enrolled, Chocie the impact of a standardized bupleurum-based (pictured with her family) is 15 months post-diagnosis at herbal formula administered with vitamin D the time of this report. supplementation, Yunnan Pai Yao, and coriolus mushroom granular extract, in canine patients diagnosed with stage II splenic HSA following splenectomy. It is too early to determine efficacy of the study protocol, although of the 17 patients enrolled, two are currently out over one year after diagnosis. Survival times for the nine patients who have passed away to date range from two weeks to 6.7 months. An additional eight patients are ongoing, ranging three weeks to over 15 months after splenectomy. No toxicities from the treatment have been noted to date, including one patient who received a significant repeated overdose of the herbal formula due to client non-compliance. Dogs for whom chemotherapy has been declined, and who have had a spleen tumor that ruptured, causing documented hemoabdomen, with the tumors surgically removed and no evidence of distant metastasis, are potential candidates for enrollment. To enroll, patients must be able to travel monthly to one of the clinical trial centers (see sidebar at right) for management by one of our participating veterinary oncologists. Dogs must be enrolled and starting treatment with the study protocol within three weeks of spleen removal. Early referral is, therefore, important. Full inclusion and exclusion criteria and study details can be found at MettaPets.info/clinicaltrials.

HSA CLINICAL TRIAL STUDY CENTERS Michigan Primary investigator: Erin Bannink, DVM,

Diplomate ACVIM (oncology) Michele Sauerbrey, DVM, Diplomate ACVIM (oncology) Oakland Veterinary Referral Services 1400 Telegraph Road Bloomfield Hills, MI 48302

California

Trina Hazzah, DVM, Diplomate ACVIM (oncology), CVCH VCA West Los Angeles Animal Hospital 1900 S. Sepulveda Blvd Los Angeles, CA 90025

Louisiana

Amanda Beck, DVM, Diplomate ACVIM (oncology) University Veterinary Hospital 7700 E Kings Hwy Shrevport, LA 71115 Phone: 318-797-5522 (work)

New York

Alexandra Sahora, DVM, Diplomate ACVIM (oncology) Katonah Bedford Veterinary Center â&#x20AC;&#x201C; VCA 546 Bedford Road Bedford Hills, NY 10507

Washington State

Luminita Sarbu, PhD, DVM, Diplomate ACVIM (oncology) Veterinary Oncology Center 636 Shattuck Ave South Renton, WA 98057

New Jersey

Kendra Pope, DVM, DACVIM (Oncology), CVA, CVCH, CVFT, CVTP Integrative Oncology and Veterinary Wellness 252 Broad Street, Suite 3 Red Bank, NJ 07701

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CRANIAL SACRAL

OSTEOPATHY Left: This horse is undergoing a temporal bone release, using the ears to help stretch the internal acoustic meatus as it connects with the rest of the temporal bone. Right: Here, the horse’s TMJ is being manipulated.

Why CST is a valuable tool for the equine cancer patient By Ann-Marie B. Hancock, DVM, EDO Cranial sacral therapy (CST) has shown efficacy in treating inflammatory bowel disease, migraines, post-traumatic stress disorder, cranial skeletal trauma, concussion, and psychological disorders such as depression in humans. It is also an effective tool to use in conjunction with other modalities during cancer treatment. In veterinary applications, CST offers a way to decrease the side effects associated with chemotherapy or radiation. And following surgical interventions, especially in the equine where induction, movement and recovery are not without physical and structural risks, CST and osteopathic manual manipulation can be especially beneficial.

HISTORY OF OSTEOPATHY AND CRANIAL SACRAL THERAPY Osteopathy began in the 1850s when Dr. Andrew Taylor Still observed how the motion of the body’s structures correlated

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with overall health. He proposed that by manipulating the structures of the body to create optimal motion, the overall autonomic function of the body could be improved, and the body could be supported to correct itself and heal. Dr. Still introduced the concept of “terrain”, an area of the body adversely affected by immobility in bones that border the blood supply, lymphatics and nervous structures to a particular area. This can result in congested capillary beds, increased contraction in muscles, decreased viscosity in the serum surrounding the fascia, and/or hypersensitization of the nerves – all of which have an effect on overall tissue vitality in an area and can lead to degeneration, injury and illness. Osteopathy is divided into three major areas: structural manipulation, visceral manipulation, and cranial sacral manipulation. An osteopathic manual manipulation treatment (OMM) that includes all three of these pillars of therapy is considered the most effective.

In cancer patients, structural and visceral manipulation may be limited because of risks associated with metastasis. Many cancer patients (animal and human) suffer side effects associated with cancer therapies while also requiring the best functioning immune system possible. CST can be a great tool to both reduce the side effects of conventional therapies and support the overall health of the immune system. Studies have shown that even a single osteopathic session can dampen the acute stress response in healthy individuals by affecting the autonomic and neuroendocrine response, lowering cortisol and decreasing the sympathetic response. CST can result in less muscle contraction and cramping, reduced drying out of fascia, and less congestion in the periphery, allowing the body’s responses to be directed more towards digestion and healing. A retrospective look at the use of OMM for inflammatory bowel disease in 2014 showed positive outcomes in treating irritable bowel syndrome, another common sequelae to many cancer treatments. Other research has shown a direct effect on cerebral tissue oxygenation and on migraine headaches thanks to cranial sacral osteopathic techniques. Applying this research to animals demonstrates how we can provide optimal palliative care, minimizing side effects and pain and boosting overall immunity, with the help of osteopathic therapies, including cranial sacral techniques. Cranial sacral therapy was first discussed by Dr. William Sutherland in the early 1900s. He published the first explanation of his theories during the 1940s in The Cranial Bowl, in which he explained the anatomy of the human skull. He felt a palpable “filling” and “emptying” motion of the skull that seemed to occur regularly, eight to 12 times per minute, in human beings. He was able to use light manual therapeutic techniques to influence and decrease asymmetries in this movement. Since then, John Upledger, John Martin Littlejohn, and recently, Tad Wanveer in his book Brain Stars, have added to our understanding of cranial sacral therapy. The motion that can be felt in the skull has been called the Primary Respiratory Mechanism (PRM) or the Cranial Rhythmic Impulse (CRI). Using Doppler, a measurement was made to compare CRI to the Traube-Hering-Mayer oscillation, the cyclical change in arterial blood pressure, and it appears to be measurable and similar. Further study using Doppler flow was able to show a statistically significant lowering of frequency following cranial sacral manipulation. The authors of the research proposed that cranial sacral therapy affected the autonomic nervous system and lowered blood flow, since the low frequency oscillations associated IVC Spring 2019

HOW TO START WITH CST: A STEPWISE APPROACH 1. CV4 Maneuver: Compression of the fourth ventricle affects the drainage of the sagittal sinus just above the foramen magnum. This manipulation opens up the flow of cerebrospinal fluid and acts like a reset to the system, so we start and end with this manipulation. 2. Examination of the body for structural restrictions and immobilities in the skeleton: This could include structural manipulation or a cranial sacral manipulation of the five diaphragms of the body (pelvic, abdominal, thoracic inlet, throat and head). 3. Manipulation of the paired bones of the skull: This mobilizes the meningeal structures attaching to those bones. It can be done in a pumping manner to help open and drain the sinus spaces within the meninges of the brain. 4. Manipulation of the SSB: The SSB is examined for asymmetry in motion and manipulated so that it moves rhythmically and symmetrically. 5. Manipulation of the TMJ: This is examined and corrected for proper range of motion. 6. Manipulation of the sacrum: As a part of any CST, the sacrum and any underlying restrictions affecting the nerves or CNS would also be addressed. 7. Repetition of the CV4 Maneuver to close the session. NOTE: This is often referred to as a ten-step procedure. I have given a simplified summary here. 44

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with the Traube Hering Mayer oscillation appear to be associated with the autonomic nervous system as well. A recent study in veterans showed that osteopathic therapy consisting of visceral, neural and cranial manipulation improved visual and motor accuracy, increased range of motion, decreased pain and improved sleep patterns.

TREATING THE HORSE WITH CRANIAL SACRAL OSTEOPATHY As an equine veterinarian, I am keen to apply the same principles to my patients. I see many horses presenting with traumatic injuries affecting the head, jaw or first few cervical vertebrae. I am sure the same can be seen in small animal practice. Cranial sacral therapy in these cases may help decrease pain, improve overall range of motion, and possibly change the behavior of the animal when responding to requests from his owner or trainer. In addition, CST may decrease terrain and improve vitality of the overall body. In equine practice, our exposure to cancer is somewhat minimal, primarily involving skin tumors, benign hypoplasia of the pituitary gland, and occasionally lymphoma. Treating these would include minimal structural work near the tumor, along with CST.

A REVIEW OF ANATOMY: PAIRED, UNPAIRED AND SUTURES The equine skull is made up of paired (parietal, temporal, frontal) and unpaired (occipital, sphenoid, ethmoid) bones; paired bones should move together in synchrony. The portion of the skull surrounding the brain is the the most important, but all the bones will be mobile, and a restriction in a suture between any two bones can cause asymmetry. The smallest restriction is often the one causing the largest problem. The most important of these for motion is the joint between the occipital bone and sphenoid bone on the base of the skull, the spheno-basilar synchondrosis, or SSB. There are many other bones in the skull that can indirectly affect the mobility of the brain case: the unpaired vomer bone at the level of the nasal septum, and the paired maxillary, incisive, pterygoid, palatine, lacrimal, zygomatic, and nasal bones and mandibles. The hyoid cartilages also play a role in the mobility of the skull and cervical spine. The most common areas affected in horses are the temporal bones, occipital bones, parietal bones and mandibles. When a restriction is found in a suture between two bones, it is usually corrected using a distraction or spread technique to open up the area and decrease tension at the level of the suture line. Depending on the angle of the suture, this can be directly or indirectly applied, possibly in one to two different directions. An example of an easy one-direction suture that can be manipulated would be the lacrimal suture between the lacrimal bone and maxillary bone. If a horse has mild ocular discharge that necessitates flushing of the lacrimal duct, a distraction of the lacrimal suture could help to open up the duct within the sinus cavity, yielding improved drainage from the eye into the lacrimal duct, and through the duct to the nasal opening at the level of the nostril. A more complicated suture to release is the squamous suture, lying between the parietal and temporal bone. This suture has a slanted joint. In order to mobilize

it, the parietal bone must be manipulated medially and then dorsally to release it, using a squeezing and lifting motion instead of a simple spreading of the suture.

ANIMAL-SPECIFIC CONSIDERATIONS When it comes to animals, we must deal with patients that will probably not lie down and meditate during the procedure, so creative hand placement may be necessary as he moves his neck and head. However, in this author’s experience, most animal patients will relax and quiet themselves during therapy.

patient). It can also be a great way to help with very young animals, in whom light touch is likely to be safer. It can be effective in cases of trauma to the head, including concussive force injuries. More research needs to be done in humans to assess efficacy for other symptoms and diseases, and since very little research in clinical veterinary medicine has been published, similar studies need to be conducted in veterinary circles.

References Biondi. “Cervicogenic headache”, JAOA, Vol 100, No 9. September, 2000. S7-S14.

The most sensitive areas appear to be related to the temporal bones and the ears. This is most likely due to multiple cranial nerves with sensory innervation to different portions of the ear. If the animal has a restriction to the cranial base (skull, TMJ, first three cervical vertebrae), it can manifest as a reactive or sensitive ear. Sometimes, mobilization of the occipito-mastoid suture or parietal suture can decrease the ear sensitivity. Often, an immobility in the TMJ will also have a component related to the SSB. Mobilizing the jaw can be helpful, but for full mobility in the TMJ and poll, the SSB will need to be addressed as well.

Pujol, Lynnete A. Menefee and Daniel Monti. “Managing Cancer Pain with Non-pharmacologic and Complementary Therapies”. JAOA, Vol 107, No 12. December 2007 ES15-ES21.

In conclusion, cranial sacral therapy can be a relaxing and easy way to start your therapy on any animal, and can be helpful in cases where structural or visceral work could be dangerous (in the case of metastasis) or too intense (in the older, debilitated

Wetzler, Gail, M Roland, S Fryer-Dietz, D Dettman-Ahern. “CranioSacral Therapy and Visceral Manipulation: A New Treatment and Intervention for Concussion Recovery.” Med Acupunct, 2017 Aug 1; 29(4): 239-248.

Wanveer, Tad, “Brain Stars: Glia illuminating craniosacral therapy”. Upledger Productions, 2015. Sergueef N, Nelson, KE, Glonek T. “The effect of cranial manipulation on the Traube-Hering-Mayer oscillation as measured by laser-Doppler flowmetry.” Altern Ther Health Med, 2002 Nov-Dec;8 (6); 74-76. Nelson KE, Sergueef N. Lipinski CM. Chapman AR, T. Glonek. “Cranial rhythmic impulse related to the Traube-Hering-Mayer oscillation: comparing laser-Doppler flowmetry and palpation.” JAOA, 2001 mar;101 (3); 163 -173. Shi X. Rehrer S, Prajapati P, Stoll ST, Gamber RG, HF Downey. “Effect of cranial osteopathic manipulative medicine on cerebral tissue oxygenation.” JAOA, 2011;111 (12); 660-666. Christine DC. “Temporal bone misalignment and motion asymmetry as a cause of vertigo: the craniosacral model.” Altern Ther Health Med, 2009 Nov-Dec;15 (6); 38-42. Downey Pa, Barbano T, Kapur-Wadhwa R, Sciote JJ, Siegel MI, MP Mooney. “Craniosacral therapy: the effects of cranial manipulation on intracranial pressure and cranial bone movement.” J Orthop Sports Phys Ther. 2006 Nov;36(11); 845-853.

Vluggen, Janek, DO, MRO-EU, EDO. Cranial Sacral Osteopathy. November 2010. Budras, Klaus-Dieter, WO Sack, Sabine Rock. Anatomy of the Horse, Schlutersche Verlagsgesellschaft mbH and Co. 2009.

IVC Spring 2019

industry innovations Whole foods as a medical tool

When a patient is facing a difficult health crisis, it’s important to give him every bit of support available. One emerging tool is a diet that furnishes enhanced nutrition. Raised Right offers lightlycooked, limited-ingredient whole food formulas that are far superior to traditional veterinary kibble. These formulas provide complete species-appropriate nutrition that has been proven to improve an animal’s immune system. Directing your clients to feed Raised Right will help their pets thrive and not just survive when facing health issues such as diabetes, cancer, IBD, pancreatitis, seizures, thyroid disorders, obesity, allergies, arthritis, inflammation and immunemediated diseases. Available in adult dog, puppy, and adult cat recipes. RaisedRightPets.com/Vets

Add acupuncture to your practice

Clients want the best for their animals, and integrating acupuncture into your daily practice is one way of meeting their needs. It’s best to learn acupuncture by doing acupuncture; in other words, veterinary acupuncture education should be “hands on”. The International Veterinary Acupuncture Society (IVAS) has been offering Certification in Veterinary Acupuncture since 1974, and is proud to offer muchneeded hands-on experience to their students. To find out when classes start, visit ivas.org.

IVC Spring 2019

Enhancing veterinary care

Clear imaging is vital when diagnosing health problems in your patients, while efficient workflow helps you stay on track. Samsung Ultrasound systems provide extraordinary image quality and enhanced workflow tools for veterinary care. Their advanced imaging technologies help reduce signal noise and artifacts, providing clear detailed images. Offering a versatile portfolio from portable laptop to premium consoles, Samsung Ultrasounds deliver durability, reliability and efficiency. The company’s workflow enhancing tools, meanwhile, aid you in efficiently moving through exams so you can keep your focus where it needs to be – on your patients. samsunghealthcare.com

Phycocyanin for joint support

Phycocyanin is a natural antioxidant with powerful free radical-scavenging properties. Free radicals cause cellular damage and inflammation; phycocyanin supports the body’s normal defense against the harmful effects of these free radicals. Clinically, this may help ease the discomfort associated with normal daily exercise and activity. (The use of phycocyanin in canine joint supplements is covered by US Patent 7,025,965). Phycox® Joint Supplements contain a comprehensive blend of beneficial ingredients for joint health, including phycocyanin, glucosamine, MSM, antioxidants, creatine and more. They’re available in a variety of formulations for moderate and advanced joint support needs in animal patients. The entire line of Phycox® Joint Supplements carries the NASC Quality Seal from the National Animal Supplement Council. dechraus.com/products/dog/phycox

Help for anal glands

Clients complaining about buttscooting pets? Gland-ease™ is veterinarian recommended to stop the scoot! The hypoallergenic proprietary blend features ingredients (including probiotics) that promote proper stool consistency, allowing for regular anal gland emptying during defecation. Each batch is tested by a third-party lab for label claim accuracy, quality and safety, including for Salmonella sp. and multiple pesticide panels. The hydrolyzed chicken-based ingredients test DNA PCR negative for the presence of poultry DNA. Veterinarian Recommended Solutions® (VRS) is a veterinarian-owned and operated company. Their evidence-based products are sold exclusively through veterinary recommendation and their website. The home delivery model offers the company’s partners increased client compliance and revenue. vrshealth.com

Ocular health product now in capsule form

Eye health is a key to patient well-being. Now available in a powder blend capsule, Ocu-GLO™ vision supplement is formulated by veterinary ophthalmologists and backed by clinical research. Ocu-GLO PB provides 13 key antioxidants (including grapeseed extract, lutein, Omega 3 fatty acids, astaxanthin and rutin) to strengthen and support healthy vision in dogs and mature cats. It mixed easily in food for the finickiest of eaters, and is safe for perioperative ocular support. Check out all products at Ocuglo.com.

New name, same dedication to health

Sustaining health is as important as gaining it. Herbs for Life is reintroducing its product lines to the animal care industry as Sustenance Herbs. This switch serves to celebrate a decade-long dedication to helping pets get and stay healthy. The company’s non-GMO, certified organic or wild-harvested ingredients will remain the same; only the name is changing. Those who regularly use the company’s adaptogens and tonic herbs will be happy to know they can still reach for the same products they have come to depend on. Sustenance Herbs’s new name reflects the company’s dedication to not only helping pets regain health – but to sustain that health for the rest of their lives. sustenanceherbs.com

IVC Spring 2019

Essential oils for

ANAL GLAND ISSUES By Nancy Brandt, DVM, CVC, CVA, CVMA

Over the past 20 years, essential oils have been used in over 800 anal gland cases in dogs and cats, ranging from pruritus to cancer. The keys to success lie in oil quality and proper techniques.

“The effectiveness of essential oil treatments stems from our common biochemical and cellular heritage with plants.” Kurt Schnaubelt, PhD, VMAA Conference 2019

Anal gland issues, ranging from pruritus and scooting to neoplasia, account for a large portion of an average veterinarian’s monthly visits, and solutions are limited. Essential oil clinical research and serial case studies over the last 20 years reveal tremendous success in all stages of anal gland disease (in both dogs and cats). Biologically-active essential oils, or essential oils with a strict adherence to GMP and QC standards above the industry standards, are capable of changing the environment of anal gland cells and tissues. With attention to oil quality and the technique used, specific protocols have proven consistently successful in restoring the gland to normal function, with minimal side effects.

AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE Given the pathophysiology of anal gland tumors, the use of specific essential oil techniques are warranted early in the progression of cancer pathologies, lessening the need for manual expression. Considering the possibility of iatrogenically-caused anal sacculitis and cellulitis (especially with external expression), early intervention with essential oils is again warranted.

PROGRESSION AND PATHOPHYSIOLOGY OF ANAL GLAND DISEASE Signalment and history Preexisting factors contributing to a higher incidence of anal gland disease include:

q Breed: Some breeds seem to have retained anatomically large anal glands, even though the breed itself is now a smaller version. Yorkies are a great example.

IVC Spring 2019

w Diet: Foods lacking in fiber and probiotics will increase susceptibility to anal sac issues.

e Obesity: Too much excess weight creates increased fat tissue in the anal area that obstructs proper expression of the glands during a bowel movement. r Behavior: From an evolutionary perspective, anal gland expression serves as a behavior strategy to mark territories and boundaries. Some pets simply do not wish to leave their mark.  Stress: In addition to food changes, stress can also alter stool consistencies, with subsequent softening of the stool and decreased anal gland release. Pruritus Initially, the primary historical report is scooting, licking the rear end, or biting at the tail. The primary physical signs are inflamed painful tissue with full or partially full anal glands. All the following etiologies should be considered when chronic anal gland expression is needed or unsuccessful: • Above-mentioned signalment or historical factors along with inflammatory conditions such as dysbiosis, atopy or topical irritants. • Iatrogenically-induced problem from incorrect or toofrequent expression of the glands. • Neuritis such as tail head subluxations or neuropathology involving the anal glands. • Parasites or other forms of dermatitis. Treatments at this stage may include consistent, appropriatelyspaced manual anal gland expression. However, external expression seems to carry more risk of partial release and induced cellulitis than correctly-performed internal expression.

Spinal manipulation is highly effective if neuritis is involved. Acupuncture to help relieve stagnations resulting in anal gland sacculitis is also helpful. Additionally, specific essential oil suppositories are highly successful at restoring cellular function, and eliminating the inflammation and scarring that lead to further stagnations, dysfunction and mass production. Note: Do not hyperextend the tail head region to express the glands – this leads to neuritis. Chronic anal sacculitis Historically, the patient requires anal gland expression every one to four weeks. Progression of physical changes has led to thickening and scarring of the glandular tissue and ducts. At this stage, the anal gland is now anatomically and physiologically dysfunctional. Probiotics and diet changes are still recommended along with spinal manipulations, laser or TCM approaches. The addition of specific essential oil techniques at this stage helps eliminate scarring, thickening and smoldering infections, with a dramatic decrease in pain and swelling on manual palpation. Further, the author has observed a decrease in the frequency of expressions from weekly to every three to six months. Anal gland abscessation and/or fistulation Manifestation may include tissue rupture or cellulitis. Injection techniques using specific essential oils have proven highly successful, resulting in an elimination of infections without recurrence, and minimal to no scarring of the gland. Usually, no surgical intervention is needed following these treatments. Dysfunction/fibrosis As disease progresses untreated, both anatomical and physical dysfunction continue, with chronic tissue irritation, inflammation and stagnation. Fibrosis ensues with the potential for subsequent mass formation (see sidebar on page 51).

Anal gland masses Pathophysiology of masses, according to many medical systems, demonstrates that the longer the tissue is in a state of irritation and stagnation, the more likely the cellular structure will be compromised. In simple terms, chronic tissue inflammation will lead to fibrosis and then the formation of masses. These masses can be benign or neoplastic. Diagnosis of cellular type is important. Anal gland carcinomas Current treatment approaches include surgical excision and chemotherapy. The utilization of specific essential oil techniques has yielded the following results in my practice:

q With surgery: Application of essential oils during surgery significantly lessens pain, discomfort and postoperative infection. There is also a decreased occurrence of tumor regrowth at the site and/or metastasis to area lymph nodes (post op exams at one month and then every three months for two years). wW ithout surgery: The mass seems to go into a “hibernation” of sorts. Repeated specific essential oil injections are needed every one to three months. The use of rectal suppositories administered at home will also decrease metastases to local lymph nodes.

USING ESSENTIAL OILS FOR ANAL GLAND DISEASE Considerations q Make prevention the cure. Anal gland care should include prophylactic essential oil therapy. w The use of essential oils during surgery may decrease recurrence and metastasis post op. With specific techniques, there is significant reduction in post op infections and dehiscence, and a decrease in poor healing. e Essential oils are safe with chemotherapy. If radiation is used, a different protocol is needed. Continued on page 50.

Left to right: Rectal catheter being used to administer essential oil suppositories; Correct angle for holding tail during anal gland expression; Hyperextended incorrect angle for holding tail during anal gland expression.

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Continued from page 49.

r If there is no evidence of malignancy, the use of laser

Case study – Lulu

therapy with the essential oil protocol seems to enhance the beneficial effects of both.  Some techniques are appropriate for in-home use.

LuLu was diagnosed with apocrine gland anal sac adenocarcinoma. She enjoyed 18 months without incident and a good quality of life with the use of an essential oil protocol only (no other intervention). Eighteen months following diagnosis, she was humanely euthanized for paralysis following the death of her partner.

Specific essential oil techniques Topical technique: Dilution is important to decrease tissue irritation. For dogs: Dilute in 2 ounces organic coconut oil: • 10 drops Boswellia sacra* • 5 drops proprietary blend† • 5 drops Copaifera ofﬁcinalis* For cats: Dilute in 4 ounces organic coconut oil: • 10 drops Boswellia sacra* • 5 drops proprietary blend† • 5 drops Copaifera ofﬁcinalis* Apply on location 1 drop per cm2 once a day for three weeks, and then as needed, no more than three times a week. Rectal suppositories: These offer an effective technique for clean-up post operatively as the oils follow circulatory and lymph flow patterns of metastasis.

Anal gland disease injection points for essential oils

For dogs: Dilute in 2 ounces organic coconut oil: • 60 drops Boswellia sacra* • 30 drops proprietary blend† • 30 drops Copaifera ofﬁcinalis* For cats: Dilute in 6 ounces organic coconut oil: • 10 drops Boswellia sacra* • 5 drops proprietary blend† • 5 drops Copaifera ofﬁcinalis* Make into suppository molds and freeze, or use rectal catheter or bulb syringe to administer. Give rectally, 0.5 cc for every 25 lbs (10 lbs still gets 0.5 cc) once a day for five days, followed by three times a week until resolved, and then weekly as a preventative. Injectable: For administration by veterinarian only: • cc Boswellia sacra* undiluted • 0.6 cc sterile saline Inject into the abscess, fistula or mass at multiple angles, every one to three months. If you can get your fingers around it, you can inject it. Surgical site: • 0.05 cc or 1 drop per 1 cm2 of Boswellia sacra* undiluted, placed directly onto tissue Use a sterile syringe or glass dropper to drop essential oil onto the area of exposed tissue after homeostasis is achieved and before closing the subcutaneous tissue and skin. Do not cauterize once essential oils are placed as they can be flammable.

*A Biologically Active® essential oil that meets all the stringent qualiﬁcations of both GMP and QC, as outlined in the book The Dig Deep Method by Nancy Brandt DVM, CVC, CVA, CVMA (2018), safe4animals.com/ shop?olsPage=products%2Fthe-dig-deep-method.

IVC Spring 2019

A custom-formulated proprietary blend of essential oils, including Melaleuca alternifolia, Melaleuca quinquenervia and Rosmarinus oﬃcianalis CT 1,8 cineol and Syzygium aromaticum.

†

Essential oils

– mechanisms of action • Antimicrobial • Cytoprotective/regenerative • Anti-inflammatory • Anti-cicatricial • Epigenetic effects on DNA expression

Progression of anal gland disease 1. Pruritus 2. Anal sacculitis 3. Anal abscessation, cellulitis or fistulation 4. Anatomical and/or physiological dysfunction 5. Mass formation

Potential side effects and their management Topical If techniques are followed with appropriate essential oils, the risk of dermatitis is minimal. If dermatitis does occur, discontinue essential oil therapy and use Epsom salts topically three times a day for three days. (Dilute 1 tbsp of Epsom salts into 1 cup warm water – make a poultice from the solution.)

apply the essential oils. Furthermore, if the oils do not meet the stringent GMP/QC standards, the risk of introducing infection and tissue irritation goes up exponentially. Many well-known brands of essential oils are diluted with carrier oils and should never be used in these techniques. In fact, the primary causes of side effects in Veterinary Medical Aromatherapy® are the use of poor quality oils and/or misdirected techniques.

Rectally If local rectal irritation occurs – this is prevalent with poor quality essential oils – discontinue use. It is important to adhere to “less is better” with these techniques. If irritation results, it’s helpful to discontinue for three weeks then resume at once per week.

CONCLUSIONS

Injectable Two mechanisms of action with the injectable essential oil technique are tissue irritation and immune stimulation, resulting in pain, inflammation and/or rupture of the mass. Prepare the owner for this possibility. The use of steroids or NSAIDS should be avoided for better results. It is advisable to use opioids, like tramadol, at least six hours prior to injection and then for three days post injection to decrease pain and discomfort. Owners should be advised to use Epsom salt poultices three times a day for three days if there is discomfort or discharge post injection. Topical Traumeel® cream is helpful. Infusions into abscesses or fistulations: Conditions of injection apply – see above paragraph. Surgical site considerations: Do not use cautery or a surgical cutting laser if essential oils have been applied, as these oils may be flammable. Level 4 and lower warm/cold lasers work well after essential oil application, enhancing the results of both. Do not use laser over malignant masses. Essential oils are strongly antimicrobial and promote tissue regeneration and faster healing times. The oils do not introduce infection. However, good surgical technique should be used to

At the time of this writing, the techniques covered in this article have been used in over 800 cases spanning a 20-year period. However, controlled double-blinded studies need to be performed. For those new to essential oil therapy, keep the following in mind:

q These techniques are easy to integrate into your current protocols.

w They are highly safe and low in risk when the rules are followed.

e Both in-hospital and at-home techniques can be used on their own or in combination.

r The OTC nature of essential oils makes understanding the techniques of use and the pharmacognosy of Veterinary Medical Aromatherapy® essential to their safe and effective application. Remember: Good oils + bad technique = bad outcomes Bad oils + good techniques = bad outcomes Good oils + good technique + critical thinking (knowing how to course correct) = best outcomes To learn more: The Veterinary Medical Aromatherapy Association (VMAA.vet) is setting the standards for the safe and effective use of essential oils in pets, and offers a RACEapproved course in Veterinary Medical Aromatherapy®. References available at IVCJournal.com IVC Spring 2019

ADVERTORIAL

The lightly cooked

WHOLE FOOD DIET How this unique diet can help optimize outcomes for immunecompromised patients.

Nutrition – especially a fresh food diet – can be an effective way to support the immune function of any pet battling disease. Whole fresh food delivers complete and bioavailable nutrition with every bite, and offers a respite from over-processed, dried and difficult-to-digest commercial kibble. A whole food diet also offers an additional important tool to treatment protocols prescribed for a wide range of chronic conditions, as well as for serious health issues.

Defining the lightly cooked whole food diet Balanced whole food recipes consist of quality protein sources, vegetables, fruits, herbs and oils. The food is lightly cooked at a low temperature. Low temp cooking meets the USDA pathogen kill step, while maintaining high levels of moisture and nutritional integrity. A lightly cooked whole food diet offers an effective alternative for those not comfortable feeding or recommending raw diets, as well as for patients with compromised immune systems.

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“As a proactive veterinarian, I would say this is the perfect diet for preventing many degenerative diseases plaguing pets today,” says Karen Becker, DVM. “But an excellent quality, speciesappropriate fresh food diet is also critical for disease recovery, including animals dealing with chronic inflammatory issues (allergies, arthritis, immune-mediated diseases) and metabolic diseases (diabetes, cancer, thyroid disorders, obesity), as well as age-related degeneration.”

How it supports the immune system In 2014, a study done at the California Polytechnic University followed a group of 21 relatively healthy dogs, who had been fed commercial extruded kibble their whole lives.1 The researchers fed them a lightly cooked whole food diet for a year. Each participant received a physical exam, complete blood cell counts, and a chemistry panel at 0 days, 180 days and 365 days. The information collected was then analyzed using paired t-tests. Results showed a mean increase in white blood cell count, including an increase in mean granulocytes.

They also showed an increase in circulating globulins, and while there was no change in red blood cell count, there was an increase in mean hemoglobin and hematocrit levels. Researchers concluded the dogs had increased immune function, indicating that fresh food is more beneficial than kibble.

The lightly cooked whole food diet in practice Many veterinarians now recognize the impact a lightly cooked whole food diet can have in helping patients with a variety of health issues, including pancreatitis, IBD, diabetes, seizures, food intolerances, skin issues, inflammation and cancer. They credit diets such as Raised Right for helping their patients optimize health outcomes. “By nourishing animals the way nature intended, we reduce metabolic stress, which in turn reduces the incidence and expression of metabolic diseases, including type-2 diabetes, obesity and many types of cancer,” explains Dr. Becker, who specializes in species-appropriate nutrition. Carefully prepared lightly cooked whole food diets ensure patients receive the nutrition they require. The complete and balanced recipes by Raised Right, a family owned human-grade pet food company, were developed with Dr. Becker, whose approach recommends looking closely at individual ingredients. “We believe every ingredient should have a purpose,” adds Raised Right’s CEO, Braeden Ruud, whose family has been ranching for centuries. “Veterinarians appreciate that our food starts with USDA certified human-grade meats and organs in large enough amounts to meet the high protein requirements for dogs and cats. We chose veggies that specifically support cellular and bowel health. Cranberries support immune health and provide antioxidants such as proanthocyanidins which have also been linked to a healthy cardiovascular system. Omega fatty acids from non-GMO sources are also key.” There are no fillers providing empty calories, or over-processed ingredients that turn sick animals off from eating the food they need. Raised Right’s anti-inflammatory diet provides the necessary nutrition to keep a pet healthy and responsive even during cancer treatment.

Transparency is another important consideration When recommending a diet to your clients, look for one dedicated to producing transparent, safe and healthy food. At Raised Right, for example, each batch of food is thoroughly tested for Escherichia coli, Salmonella and Listeria monocytogenes. This extra care separates the company from an industry that experienced 30 food recalls last year.2 Consumers can also log on to the Raised Right site to use their interactive map, which displays the geographic origin of every ingredient used in the company’s pet food. A lightly cooked whole food diet answers the needs of your patients at every step. It is an easy and accessible choice that you can provide to your clients as you work together to protect and treat the animals in your care. For more information visit RaisedRightPets.com/Vets. 1

“ Effects of Fresh Prepared, Whole Food Canine Maintenance Diets on Clinically Measurable Blood Parameters in Healthy Dogs”. Oscar E. Chavez, Lee A. Pettey, Broc A. Sandelin, John Tegzes. California State Polytechnic University, Pomona, CA, Western University of Health Sciences – College of Veterinary Medicine, Pomona, CA.

Susan Thixton. “2018 was a busy year in pet food”. truthaboutpetfood.com/2018-was-a-busy-year-in-pet-food/.

PEER-REVIEWED

TCVM: An integrative approach to treating cancer

TCVM may be a stand-alone or adjunctive treatment for animal cancer patients. It not only treats cancer, but can potentially prevent recurrence and metastasis. By Madeline Yamate, DVM, CVA, CVCH, CVFT, CVTP, CVSMT, MBA

IVC Spring 2019

ancer is one of the most despised and feared words in the medical vocabulary. It’s also one of the biggest health concerns facing not only humans, but also our canine and feline patients. Cancer afflicts one in every three1 to one in every four dogs,2 with incidence increasing to almost 50% in dogs over the age of ten years.2 In fact, it is the leading cause of death in dogs and cats in the United States; as many as 50% of our companion canines and felines die from cancer. Conventional medicine seeks to kill cancer cells by utilizing surgery, chemotherapy, radiation therapy and immunotherapy. Treatment is based on the particular type of cancer a patient has, and focuses more on the disease itself than on the overall health of the individual patient. Conventional treatments often cause collateral damage to the body, with impacts ranging from mild to severe. In contrast, Traditional Chinese Veterinary Medicine (TCVM) treats the disease pattern identified in an individual patient (irrespective of the conventional biomedical diagnosis), taking into consideration the overall condition of the patient at that time. TCVM treatments work with the body rather than against it, and the side effects, if any, are typically mild. TCVM may be used as a stand-alone treatment or an adjunctive treatment for cancer patients. It gives the veterinary practitioner the ability to not only treat active cancer, but to potentially prevent recurrence and metastasis.

TRADITIONAL CHINESE MEDICINE ETIOLOGY OF CANCER According to Traditional Chinese Medicine (TCM), cancer develops from three primary sources: exogenous factors, endogenous factors, and emotional factors. If Zheng Qi (Upright Qi, Antipathogenic Qi) is strong, these pathogenic factors will be defeated and the body remains unharmed. However, if Zheng Qi is weak, the pathogenic factors invade the body, creating a disharmony that develops into cancer. Cancer is therefore a pattern of both excess and deficiency with an underlying Zheng Qi deficiency.

2. Endogenous factors include internal organ (Zangfu) disharmony(ies), an imbalance of Yin/Yang and Qi, and Blood deficiency (weak constitution). 3. Emotional factors result in emotional stress or heightened emotions (e.g. lack of exercise or social interaction, changes in household schedule or members, etc.). Any of these factors, singly or in combination, may cause stagnation of Qi/Blood, Phlegm, Dampness or Toxicity, which may then develop into cancer. Often, a root deficiency of Qi, Qi/Yang, Blood or Yin have enabled the external factors to have a strong impact, or are the actual cause of Zang-fu disharmony. In veterinary medicine, some of the most common TCM etiologies of neoplasia include: • Trauma and/or Cold-Damp, leading to Blood Stasis • Inappropriate diet, which may result in Food Stagnation, leading to Accumulation of Phlegm and/or Heat Toxin • Environmental changes (household changes, boarding, travel, etc.), leading to Qi Stagnation • Invasion of the six pathogenic factors, leading to Stagnation of Blood/Qi, accumulation of Phlegm, Heat, Heat Toxin, and/or Damp • Disharmony of Zang-fu (internal) organs, leading to Zheng Qi deficiency, which then leads to Stagnation of Blood/Qi, accumulation of Phlegm, Heat, Heat Toxin, and/or Damp. Note: Vaccines and chemicals are Toxins/Heat Toxins. Their administration may bypass the normal route of TCM pathogenic invasion; thus, the body is unable to “fight” these pathogens, and they can have a strong negative impact on the body. Additionally, as these exogenous toxins may be introduced to the body at the deepest (Xue) level, they may remain latent as a pathogenic factor, only to emerge in the future when the body’s Zheng Qi is weakened. Continued on page 56.

1. Exogenous or external factors include toxins such as heat toxin, food toxin, radiation, chemicals, heavy metals, and the six pathogenic factors (Wind, Heat, Summer Heat, Cold, Dryness, Dampness). IVC Spring 2019

Continued from page 55.

STRATEGIES FOR TREATING CANCER WITH TCM 1. Tonify Zheng Qi If Zheng Qi is deficient, the body’s resistance to pathogenic factors is weak. Zheng Qi deficiency is ultimately the root cause of cancer. • Tonify Qi • Tonify Spleen • Nourish Blood • Nourish Yin 2. Move Qi and Blood Stagnation of Qi and Blood is the basic pathologic change seen in the development of cancer. 3. Clear internal Heat and toxins Infection and chronic inflammation are predisposing factors in the development of cancer. In TCM, Heat-toxin is a major cause of cancer. 4. Dispel Phlegm and Dampness Damp obstructs the smooth flow of Spleen Qi. This means the Spleen’s ability to transform food into Food Qi (Gu Qi) and transport Gu Qi to the Upper jiao (Lungs for distribution to the rest of the body, and Heart where the transformation into Blood occurs) is impaired. The Spleen hates Damp; when there is Damp, the Spleen must work extra hard to eliminate the pathogen. Damp is the origin of Phlegm, and when Phlegm accumulates, masses develop. • Support Spleen to drain Damp • Drain Damp • Transform Phlegm 5. Bring the body back to balance The fundamental basis of TCM is balance and harmony. When the body is out of balance, disharmony occurs and disease is manifested. Treatment therefore seeks to help the body come back into balance, eliminating excesses and supplementing deficiencies.

THE FIVE MAIN BRANCHES OF TCM The strategies discussed above are accomplished through the five main branches of TCM: acupuncture, herbal medicine, dietary or food therapy, Tui-na, and Tai-chi/Qigong. In this author’s opinion, the best results are achieved when at least two branches are utilized concurrently, and a kibble diet is eliminated.

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1. Acupuncture: To date, the full effects of acupuncture are not completely understood. Its physiological effects cannot be explained by a single mechanism; however, there is evidence that acupuncture stimulates a series of interactions among the nervous system, endocrine system and immune system, resulting in somato-somatic, somato-visceral and somato-autonomic reflexes. Acupoints and needling technique should address the TCM pattern of disharmony as well as the side effects from current treatment protocols, such as chemotherapy-associated nausea and diarrhea, or pain secondary to the cancer or subsequent to the treatment modality. Insertion of a needle at or very close to a known malignant mass is contraindicated, as is electro-acupuncture across a neoplastic mass. 2. Chinese herbal medicine: Herbal formulas may be used separately or in tandem with conventional therapies. Strategies to employ prior to and after conventional therapies should focus on supplementing Qi, nourishing Blood, and tonifying the Spleen, Liver and Kidneys. During conventional therapies, herbal formulas may be utilized to mitigate negative side effects. When used as the primary therapy, formulas to dispel pathogenic factors to directly address the tumor should be used in tandem with formulas that supplement Qi, nourish Blood and tonify Spleen, Liver, Kidneys and other affected Zang-fu. In this author’s experience, as the TCM patterns change with the disease state, formulas are typically modified or changed altogether. Continued on page 58.

CANCER CASE STUDIES

ILLUSTRATING THE PRINCIPLES OF TCVM AMYNTA Amynta, a 4½-year-old spayed female Rhodesian ridgeback, was presented for TCM treatment following exploratory surgery with resection and anastomosis for an ileal intussusception. Histopathology of the resected small intestine and cytology of an abdominal lymph node were consistent with high grade lymphoma. One month post-surgery, the patient was started on CHOP-based chemotherapy with a board-certified oncologist, as well as Chinese herbal medicine, nutraceuticals, and a home-cooked diet for support during chemotherapy. Amynta’s owner also started her on alkalinized water. The patient received dry needle and aqua-acupuncture with vitamin B12 and lyophilized thymus extract on a regular basis, but after four months, her owner discontinued chemotherapy due to the negative side effects. Since then, Amynta has been maintained on regular dry needle and aqua-acupuncture, Chinese herbal medicines, nutraceuticals, daily oral thymus extract with colostrum, DLLV (lily extract), and a primarily home-cooked diet to address her TCM patterns of disharmony. After the owner moved out of town, she and her local veterinarian added rectal ozone therapy with microbiome restorative therapy to address Amynta’s chronic intermittent diarrhea (often secondary to dietary indiscretion). Chinese herbal medicines and nutraceuticals have been changed over time to address her changing TCM patterns of disharmony. To date, two years and two months since initial presentation, Amynta is doing extremely well, and is lively and active, with no evidence of recurring disease. Treatment strategies utilized: Tonify Spleen Qi and drain Damp, nourish Blood and Yin, move Qi and Blood, and support Kidney Jing.

CAMILLE Camille, a ten-year-old spayed female domestic shorthair cat, was presented for TCM treatment following duodenal resection for a mast cell tumor one month prior. She was also in the early stage of chronic renal disease at the time of diagnosis.

Camille has been maintained for four years and four months on prednisolone, Chinese herbal medications, nutraceuticals, a commercially-prepared raw meat diet (slightly and gently cooked) and monthly aquaacupuncture with vitamin B12, bioregulatory medicine, and lyophilized thymus extract. Her renal values have remained stable, and no signs of MCT recurrence or metastasis have been identified on repeat abdominal ultrasounds. Chinese herbal formulas and nutraceuticals have been changed over the years to address Camille’s changing TCM patterns of disharmony. Treatment strategies utilized: Tonify Spleen Qi, nourish Blood, move Qi and Blood, tonify Kidney Qi.

MAGNUS Magnus, a 4½-year-old neutered male boxer, was presented to the emergency service for hemoabdomen. The day before, an approximately 8cm complex mass was seen on abdominal ultrasound. No metastasis was appreciated on thoracic radiographs, and biopsy of the spleen and liver revealed splenic hemangiosarcoma but no apparent hepatic involvement. The owner opted for follow-up TCM treatment only and presented with Magnus one month after surgery. The patient was prescribed two Chinese herbal medications, coriolus mushroom extract, and a home-cooked diet to address his TCM diagnosis. He was also treated twice with aqua-acupuncture using vitamin B12, bioregulatory medicine, and lyophilized thymus extract. The patient moved out of state one month after presentation, but was continued on herbal medication for one year. Three years and five months after initial presentation, the owner informed us that Magnus was still alive and thriving. She ran out of herbs but continued the TCM diet and added colloidal silver and several drops of food grade hydrogen peroxide to his drinking water. Treatment strategies utilized: Tonify Qi, tonify Spleen, nourish Blood, move Qi and Blood, support Kidney Jing.

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Continued from page 56. 3. D ietary or food therapy: From a TCM perspective, the poor ingredient quality and processing of commerciallyprepared dry and canned pet foods are at the root cause of many cancers. Kibble has an astringent effect on the Stomach and engenders Food Stagnation and Damp Heat in the body. Damp Heat congeals with time and forms Phlegm. Additionally, the Spleen gets overtaxed dealing with the extra Dampness and becomes weakened. The high pressure and temperature used in processing canned foods releases more heat energy and alters Qi, creating a food that is warmer than its original contents and damages/ decreases Qi and Blood. There are also concerns that bisphenol A (BPA) or bisphenol F (BPF), contained in the lining of most canned foods, may be carcinogenic. Freezedried foods tend to be Qi deficient and drying, leading to Blood deficiency and Body Fluid deficiency when used longterm. Considering that the patient with cancer is already in a state of deficiency with excess, the optimum diet is one that will help tonify the Spleen/Stomach to create good

Qi and Blood, as well as address the other disharmonies specific to the patient. In this authorâ&#x20AC;&#x2122;s opinion, fresh foods, either home-cooked or from a gently-cooked, commercially-prepared, frozen raw diet, are critical to the treatment of cancer in our companion animals. Historically, we have designed TCM diets utilizing 60% to 70% high quality protein, 10% to 20% primarily low-glycemic index carbohydrates, and 20% to 30% lightlycooked vegetables in tandem with nutraceuticals such as digestive enzymes, pre- and probiotics, fish oil or algaebased EPA/DHA, microalgae, medicinal mushrooms, and whole food vitamin-mineral supplements. Current research utilizing a ketogenic diet is promising, and when combined with the tenets of TCM may yield the best results yet.3 4. Tui-na: Other veterinary substitutions for Tui-na include body work such as massage, chiropractic and craniosacral therapy. 5. T ai-chi/Qi-gong: Daily exercise, ideally in environments with minimal chemicals and electromagnetic fields, is recommended as a â&#x20AC;&#x153;substituteâ&#x20AC;? for Tai-chi/Qi-gong.

CONCLUSION The use of TCM, either independently or in an integrative approach with conventional medicine and other holistic modalities, enables the practitioner to address the changing landscape of health and disease our cancer patients exhibit as they progress through treatment. By identifying and addressing disharmonies, the body is provided with an enhanced and supported chance of survival.

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wearethecure.org/

vetcancersociety.org/pet-owners/faqs/

ketopetsanctuary.com/

Veterinary Resource Guide ASSISTIVE DEVICES Best Friend Mobility Myrtle Beach, SC USA Phone: (503) 575-9407 Email: sylvan@sylvancompany.com Website: www.bestfriendmobility.org HandicappedPet.com Amherst, NH USA Phone: (603) 577-8858 Website: www.handicappedpets.com

ASSOCIATIONS American College of Veterinary Internal Medicine - ACVIM Denver, CO USA Phone: (800) 245-9081 Email: acvim@acvim.org Website: www.acvim.org American Holistic Veterinary Medical Association – AHVMA Abingdon, MD USA Phone: (410) 569-0795 Email: office@ahvma.org Website: www.ahvma.org Academy of Veterinary Homeopathy - AVH Leucadia, CA USA Phone: (866) 652-1590 Website: www.theavh.org American Veterinary Chiropractic Association - AVCA Bluejacket, OK USA Phone: (918) 784-2231 Email: avcainfo@junct.com Website: www.animalchiropractic.org International Veterinary Acupuncture Society - IVAS Fort Collins, CO USA Phone: (970) 266-0666 Email: office@ivas.org Website: www.ivas.org

INTEGRATIVE VETS Dr. Shawn Messonnier Paws and Claws Vet Clinic Plano, TX USA Phone: (972) 712-0893 Email: shawnvet@sbcglobal.net Website: www.pettogethers.net/healthypet East York Animal Clinic Toronto, ON Canada Phone: (416) 757-3569 Email: eyac@holisticpetvet.com Website: www.holisticpetvet.com

NATURAL PRODUCT

MANUFACTURERS & DISTRIBUTORS

Pitcairn Institute of Veterinary Homeopathy - PIVH Portland, OR USA Phone: 760-230-4784 Email: info@pivh.org Website: www. pivh.org Tallgrass Animal Acupressure Institute Castle Pines, CO USA Phone: (303) 681-3030 Email: nancy@animalacupressure.com Website: www.animalacupressure.com Traditional Chinese Veterinary Medicine TCVM Reddick, FL USA Phone: (352) 591-5385 Email: register@tcvm.com Website: www.tcvm.com

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

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

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

Vluggen Institute for Equine Osteopathy and Education San Marcos, TX USA Phone: +49 (0)151 40750572 Email: office@vluggeninstitute.com Website: www.vluggeninstitute.com

VETERINARY OPHTHALMOLOGY Dr. Nancy Park Board Certified Veterinary Ophthalmologist Integrative Ophthalmology For Pets - IOP Los Angeles, CA, USA Phone: (855) 623-3937 (EYES) Email: info@iopeyes.com Website: www.iopeyes.com

SCHOOLS & WELLNESS EDUCATION

Animal Spirit Network Pekin, IL USA National Animal Supplement Council - NASC Phone: (815) 531-2850 Valley Center, CA USA Email: carol@animalspiritnetwork.com Phone: (760) 751-3360 Website: www.animalspiritnetwork.com Website: www.nasc.cc College of Integrative Veterinary Therapies Website: www.healfasttherapy.com - CIVT INTEGRATIVE THERAPIES Rozelle, NSW Australia Phone: (303) 800-5460 Healfast Therapy Website: www.civtedu.org North Caldwell, NJ USA Phone: (551) 200-5586 International Veterinary Acupuncture Email: support@healfasttherapy.com Society - IVAS Fort Collins, CO USA Phone: (970) 266-0666 Email: office@ivas.org Website: www.ivas.org PetMassage Ltd. Toledo, OH USA Phone: (419) 475-3539 Email: info@petmassage.com Website: www.petmassage.com

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

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

IVC Spring 2019

PEER-REVIEWED

HOMEOPATHIC APPROACH

TO CANCER IN COMPANION ANIMALS By Henry Stephenson, BVSc (Hons) Vet M F Hom Dip Acup (IVAS)

A case study involving a senior cat with cancer demonstrates how homeopathy treats cancer and extends longevity. At our veterinary surgery on the Sunshine Coast in Queensland, Australia, chronic skin disease and cancers represent the majority of our daily caseload. On average, we have about 50 cancer cases ongoing at any one time. We treat most of them with alternative medicines, predominantly homeopathic ones. In this article, I will provide an overview of our therapeutic approach to cancer, and illustrate this approach through a case study involving a feline patient named Miss Kitty.

pushed sideways and could only be auscultated on the right side of her chest dorsally. An exact histopathological diagnosis was not pursued by the owners; however, homeopathic treatment was begun using her history, presenting symptoms, physical exam, and preliminary diagnostics.

BEGINNING A CANCER CASE When cancer cases are presented at our surgery, they have commonly just finished an intensive diagnostic or surgical regime. Often, they are still in the process of receiving chemotherapy. For each animal that presents to our surgery with a cancer diagnosis, we begin by addressing the following general aims: 1. To slow tumor growth 2. To address pain and discomfort 3. To strengthen the body so it can begin to heal 4. To improve the patient’s overall mental and physical well-being 5. To gently lead the body to cure, if it is able. As we work towards each of these goals, while the patient is on homeopathic treatment, we observe several different outcomes. Some will hold a cancer in a steady state, unchanged, for many years. Some will experience a slowdown in the growth of their cancer. And still others will be led to cure, with a complete shrinking of their cancers.

MISS KITTY – CASE STUDY August 2012 Miss Kitty first presented at our surgery at ten years of age. She had recently become quite breathless with any exertion. Her usual vet recommended euthanasia because thoracic radiographs revealed large growths on her lungs. Miss Kitty’s heart had been

IVC Spring 2019

Lateral chest view of Miss Kitty in August of 2012.

Treatment began with two homeopathic medicines, Lycopodium Clavatum 200c and Carcinosin 200c. These two medicines were used in alternation, one for three days, then the other, using the methods devised for human cancer treatment by A.U. Ramakrishnan Ventrodorsal chest view, also and Catherine Coulter taken in August of 2012. and outlined in their book A Homeopathic Approach to Cancer, a distillation of Dr. Ramakrishnan’s treatment of over 10,000 people.1 The Ramakrishnan approach uses an organ-specific remedy that has an affinity for cancer in that area, alternating with a more general cancer homeopathic medicine like Carcinosin or Scirrhinum.

Dr. Ramakrishnan uses the remedies in 200c potency as he has found it matches the energy of the cancer in most cases. The potency is then increased as the being heals. Several other homeopathic medicines were used with Miss Kitty over the following year. They were prescribed depending on the presenting symptoms at her monthly visits. During one visit, she became quite cyanotic during handling and was treated with a homeopathic medicine called Carbo vegetabilis in a 1M potency; this helped with her general breathing for many months.

March 2016 Miss Kitty’s breathing remained stable. The lump in her abdomen had shrunk somewhat, but was still palpable at around 6cm in diameter. Behaviorally, her owners reported a return to her original nature, similar to how she was when she first came to live with them. She had become more affectionate, and was now wanting to lie on the bed with them again. She even worked out a manageable relationship with the other cat in the household. However, at the March 2016 recheck, it was evident that her mammary lumps were enlarging. In addition, she had new symptoms – changes in her appetite, and some weight loss.

April 2014 After almost two years of homeopathic treatment, a new growth the size of a lemon was palpated in Miss Kitty’s abdomen behind the liver. It was not causing any symptoms but had grown rapidly over the past month. Her owners declined further diagnostic work. Her breathing was now quite stable, but there was no great change in chest auscultation, with the heart only audible on the right dorsal side. Based on the location of the new mass, Miss Kitty’s homeopathic protocol was changed to homeopathic Phosphorus 200c and Tuberculin 200c, to be given in three-day alternation. Often, a change of remedy in a chronic case will stimulate the healing mechanisms again, as opposed to using the same medicine at the same strength. Miss Kitty’s case was re-analyzed with the new symptom of the liver tumor, allowing determination of a new homeopathic prescription.

Mammary growths in November of 2016.

Continued on page 62.

June 2014 Almost four years post initial presentation, a new lump appeared in Miss Kitty’s mammary area; it had some firm nodules inside it. This mammary tissue was managed over the next two years with homeopathic Sepia officinalis, alternating with Carcinosin, both in 200c potencies.

Mammary growth in June of 2014.

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DIRECTION OF CURE ACCORDING TO HERING’S LAW

Often, homeopathic treatment will shift cancer in such a way that it halts deepening of the disease and moves the cancerous process to a more superficial area, from vital organs to less vital ones, making longer survival times feasible. In such cases, healing follows an identifiable direction of cure based on Hering’s Law, which dictates that the body heals in a consistent predictable pattern if supported to do so and if obstacles are removed. Meticulously observing and documenting this direction of cure enables us to know if our homeopathic prescription is working in a curative healing way, or is just suppressing the disease further. Miss Kitty’s case illustrates precisely this; her cancer was managed over a long period of time, and although she was hindered by a weakened immune system, the cancer changed from lung to liver and finally to skin, becoming quiescent in the internal organs.

DRUG REGIMEN Often, the animals we treat are on a multitude of drugs, including antibiotics, anti-inflammatories, flea/ tick preventatives and worming medicine, to name a few. While they recover from cancer, we try to use as little suppressant medication as possible.

IVC Spring 2019

Continued from page 61. Her owners reported that all she wanted to eat or drink was cream. An older childless couple, her owners informed me at this visit that when they got her as a rehomed cat at two years of age, she was like their baby. They held and cuddled her like an infant for many years, until they got their second cat. They told me she would even put her front feet around their necks like a real baby.

desire for cream is a symptom experienced many times in patients who have benefited from a homeopathic medicine called Lac humanum, derived from human breast milk.

Unusual information like this is important in a homeopathic consultation. It assists the prescriber in individualizing the case so s/he can select the homeopathic medicine most similar to that particular patient. Miss Kitty’s owners had previously mentioned her desire for cream, but an assumption was made that this was not an individualizing symptom, as many cats like cream. However, her almost exclusive craving for cream at this point in her therapy demanded further investigation. The emphasis placed on this symptom led to a closer analysis using a computer repertory search tool called MacRepertory.2 This database offers an easy method of searching symptoms unique to a case, and identifying homeopathic medicines that exhibit those same symptoms.

June 2016 The growth in Miss Kitty’s abdomen was no longer palpable at this visit. Her breathing had continued to improve. Her energy was good, and her appetite had also improved. While she continued to enjoy cream, she was less focused on that food alone.

For Miss Kitty, the remedy Sepia was now changed to Lac humanum in a 200c potency, to be given every three days in alternation with Carcinosin 200c.

February 2017 Almost five years after treatment was begun for large lung tumors, followed by an abdominal tumor and then mammary tumors, Miss Kitty succumbed to general age-related weakness and debility, with further ulceration of her skin tumors. She was euthanized at 16 years of age.

CONCLUSION

In Miss Kitty’s case, homeopathic treatment followed Hering’s Law of cure (see sidebar at left), gradually shifting her disease from deep within vital organs to more external locations. As aspects of her illness resolved, other symptoms surfaced, allowing us to individualize her Homeopathic analysis of one symptom – a craving for cream homeopathic prescriptions – in the MacRepertory database further, improving her These repertory databases hold all the vitality and physical and mental well-being. information that has been obtained from either A homeopathic approach to Miss Kitty’s care provings (data obtained from the intentional allowed her to live a long and full life with her taking of a substance by healthy persons to family. observe the symptoms), accidental poisonings, or the clinical use of potentised medicines, 1 Ramakrishnan AU, Coulter, Catherine R. A Homeopathic Approach to Cancer. collected over the past 200 years. In this case, Berkeley Springs, West Virginia: Ninth House Publishing, 2001. 2 MacRepertory (Computer Software), 2017. it was observed that, at least in humans, a huge

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? Ginger (Zingiber ofﬁcinale) is a pungent, sweet, warm, moist, diffusive and stimulating herb helpful in treating the combined tissue state of depression, constriction and atrophy. This herb modulates the appetite and improves salivation. It is effective in the treatment of inactive gastrointestinal mucosa with indigestion, flatulence (caused by rotten ingesta), colic, diarrhea, dysentery, peptic ulcers, diarrhea for a relaxed bowel, or spasm with intestinal fermentation and putrefaction.

CASE REPORT With the sudden onset of cold weather last winter, both these horses, Sundance and Red, suffered from intestinal “cold”. They were slightly off their feed with slow GI motility. Both were given bran mashes with ginger, and experienced an immediate improvement in appetite and resolution of the situation.

HERBAL WALK AND LECTURES During the AHVMA convention last fall, Christopher Hobbs led the VBMA on an herbal walk. Dr. Hobbs is a renowned clinical herbalist, mycologist and research scientist. Although we stayed on the well-manicured grounds of a Gaylord resort complex, we found free-growing plants and many medicinal plants on the edge of a cattle pasture, including beauty berry (Callicarpa americana L) with its bright purple berries; bidens, a common herb found in Florida and a major player in the treatment of Lyme; senna, a stimulating laxative; ragweed; cyperus, whose tuber treats Liver Qi stagnation; as well as mallows, pine, palms, bitter melon and sow thistle.

2019 EVENTS

INTERNATIONAL HERBAL SYMPOSIUM The VBMA will be holding its speaker track at the International Herbal Symposium from June 7 to 9 at Wheaton College in Norton, Massachusetts. The IHS is one of the foremost herbal symposiums in the country, originally established by renowned herbalist Rosemary Gladstar as support for United Plant Savers. When signing up for the veterinary track, you will receive CE and be able to attend any of the nine speaker tracks. The registration link is available at vbma.org.

ECO-TOUR TO SCOTLAND From June 29 to July 6, the VBMA is going to Scotland on an international eco-tour. We will be staying at the Aigas Field Centre, south of Inverness. Our diverse itinerary includes visiting the Caledonian pine forest, looking for golden eagles, dippers and migrant birds; studying bog flowers; learning about the Centre’s Scottish wildcat breeding program; learning about the European beaver; going to the shores to view rare wildflowers and wading birds; seeing the reintroduced red kite; taking boat rides with dolphins; watching red deer; exploring the Aigas Loch and River Beauty where kingfishers, sand martens, ospreys and peregrine falcons play; exploring the rugged Highlands; watching for the white-tailed sea eagle, other water birds and otters; and exploring Glen Affric and Glen Cannich. A few spots are still available! Join us for an unforgettable experience with like-minded colleagues.

NAME THIS HERB!

The VBMA enjoyed three hours of lectures by both Dr. Hobbs and clinical herbalist, Guido Mase.

WEBINAR SERIES The VBMA held another webinar on food therapy, called “Sense of Taste”, with Drs. Ihor Basko and Constance DiNatale. Recordings are available at vbma.org. Stay tuned to the VBMA website for an announcement of our 2019 webinar series.

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

IVC Spring 2019

From the IVAS

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

Make plans to attend the 45th annual IVAS Congress from September 12 to 15 at the University of Environmental and Life Sciences in Wroclaw, Poland. It will give you an opportunity to enhance your knowledge and skills, and network with colleagues! Also happening this fall is the next IVAS Certification Course in Veterinary Acupuncture, to be held in Portland, Oregon. For more information about the IVAS Congress, IVAS Veterinary Acupuncture Certification, Certification in Veterinary Chinese Herbal Medicine or IVAS membership, visit ivas.org or contact our office at office@ivas.org.

Case report Ladybug, a pug, presented to Nell Ostermeier, DVM, CVA after a mast cell tumor (MCT) diagnosis. Her owner felt that a combination of Western oncology and TCM would give her the best chance for a happy life. The mainstays of Ladybug’s TCM treatments were to tonify Spleen, nourish and move Blood, and clear Blood Heat when present. During

the different phases of treatment, we modifi ed herbs, supplements and food therapy based on what her body needed to stay in balance. Patients diagnosed with MCT are prone to Blood stagnation and Blood Heat due to an underlying cause; in Ladybug’s case, the cause was an underlying, longstanding Spleen Qi defi ciency which predisposed her to Damp accumulation, Blood deficiency and Blood stagnation, with Heat secondary to stagnation. In addition, we knew that radiation and chemotherapy would likely worsen these patterns. We used integrative medicine with the goal of preventing side effects and keeping Ladybug as balanced as possible. She experienced no side effects, internal or external, to the radiation treatments. This was remarkable, according to her oncologist. Ladybug recently celebrated being MCT-free and has more energy than before her diagnosis!

Join our Facebook page The IVAS Facebook page offers a weekly abbreviated version of a case presented by Dr. Ostermeier from the Lombard Animal Hospital in Portland, Oregon – follow us at www.facebook. com/InternationalVeterinaryAcupunctureSociety. These posts are intended for informational use only, and not to replace veterinary medical advice.

Dr. Nell Ostermeier with Ladybug.

IVC Spring 2019

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Paciﬁc Veterinary Conference June 21–24, 2019 — Long Beach, CA Join us under the sun at a worldclass destination while earning continuing education units and listening to the veterinary profession’s best speakers. Explore a four-day Vet Expo with the latest innovations from the veterinary

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

industry, mingle with future colleagues, and discover the city in your downtime! For more information: (800) 655-2862 info@pacvet.net www.pacvet.net

IVC Spring 2019

news bites Photo courtesy of Sarah Carey

CANINE OPEN HEART SURGERY PROGRAM The University of Florida College of Veterinary Medicine will be launching an open heart surgery program for dogs this year. The college is working in collaboration with Dr. Masami Uechi, DVM, PhD, of the JASMINE Veterinary Cardiovascular Medical Center in Yokohama, Japan. Procedures are starting this spring and will eventually build up to the point where six dogs will be treated every two months -- an exciting goal for what will be the only canine open heart program in the country. As the program moves forward, Dr. Uechi and his team will be training the UF team in mitral valve repair surgery. Eventually, the UF staff will be able to maintain the program themselves, helping dogs all over the US who have been affected by degenerative mitral valve disease. vetmed.ufl.edu/2019/01/11/uf-college-ofveterinary-medicine-to-launch-new-open-heart-program/

Dr. Simon Swift examines Zoey, a 12-year-old Maltese, while her owner, Janette Jordan of Oviedo, looks on. Zoey received a mitral valve repair procedure from Dr. Masami Uechi approximately one year ago in France, and has subsequently come to UF for check-ups.

KEEPING CATS BOTH SAFE AND STIMULATED

Photo courtesy of CatioSpaces

Veterinarians are keenly aware of the “indoor/outdoor dilemma” many cat owners experience. The consequences of unsupervised outdoor time can be costly and even catastrophic; yet an un-enriched indoor-only life also has downsides that veterinarians see every day, such as obesity, aggression, furniture destruction, and inappropriate elimination. So what’s the answer? Increasingly popular practical solutions include catios, aesthetically-designed outdoor enclosures that give cats both safety and enrichment. Veterinarian Dr. Penny Olson, who has seen many injured outdoor cats in her 20 years of practice, decided to invest in a catio for her own three cats, turning to a company called Catio Spaces for the design. She credits the catio with decreasing fighting among her cats, as well as loud nocturnal vocalizing and door dashing. Catio Spaces offers resources to veterinarians, including DIY flyers and free tips for clients interested in a catio. For more information, email info@catiospaces.com.

The UC Davis School of Veterinary Medicine broke ground earlier this year when they performed the first successful PET scan on a standing horse. This is a huge step forward in the field of clinical equine imaging, which until now required equine patients to be under general anesthesia. Sedation is still required to keep horses still, but the ability to perform the scan while they’re standing will allow for more routine use. “The ability to perform PET on standing horses will open many new clinical applications, such as following up on injury healing, and screening for lesions at risk for catastrophic breakdown in racehorses,” says Dr. Mathieu Spriet, leader of the UC Davis PET research group. The team is also excited to see how this new technology is used in the assessment of laminitis, a condition for which anesthesia is not recommended. vetmed.ucdavis.edu

IVC Spring 2019

Photo courtesy of UC Davis Veterinary Hospital

FIRST PET SCAN PERFORMED ON STANDING HORSE PET images are captured using detectors arranged in a ring. For standing PET, the clinician places the hoof of the sedated horse into the ring. This allows the foot to be imaged without it being too high for the horse to safely step out.

IVC Spring 2019