IVC SUMMER 2019
Innovative PEER REVIEWED
VOLUME 9 ISSUE 3
VETERINARY CARE
DERM ATOLOGICAL DILEMM AS IN DOGS AND CATS
THE POTENTIAL FOR DIET, CHINESE HERBS AND THE MICROBIOME TO RESOLVE SKIN INFLAMMATION IN SMALL ANIMALS. – P. 14
SEPARATION ANXIETY IN DOGS
AN INTEGRATIVE APPROACH TO DEMODECTIC MANGE
HOW INTERNAL AND EXTERNAL FACTORS AFFECT EQUINE SKIN DISEASE
In the second part of this article, we’ll look at the overall results of KetoPet Sanctuary’s canine cancer program, along with some case studies. – P. 26
www.IVCJournal.com
SUMMER ISSUE 2019
INNOVATIVE VETERINARY CARE JOURNAL
KETOSIS, CANCER AND CANINES — PART 2
An integrative approach using herbs, nutrition and acupuncture provides faster resolution of canine demodicosis while also addressing underlying imbalances. – P. 34
ANAL SAC ANAL GLAND ADENOCARCINOMA Surgery, drugs and nutraceuticals for ASAGACA, from the perspective of the surgeon and oncologist. – P. 40
How using a Certified Separation Anxiety Trainer (CSAT) in your practice can help you successfully alleviate this common canine behavior problem. – P. 48
A complementary medical approach for 5 common skin conditions in horses. – P. 53
ESSENTIAL OILS IN YOUR PRACTICE
Effective modern tools with ancient origins, essential oils are an accessible starting point for adding integrative modalities to veterinary practice. – P. 61
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contents FEATURES
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INTEGRATED APPROACHES TO CANINE CANCER — PART 2 By Demian Dressler, DVM
Three integrative treatment modalities that, when used in conjunction with chemo and radiation, can increase the longevity and life quality of canine cancer patients.
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DERMATOLOGICAL DILEMMAS IN DOGS AND CATS By Steve Marsden, DVM, ND, MSOM Lac. Dipl. CH, CVA, AHG
The potential for diet, Chinese herbs and the microbiome to resolve skin inflammation in small animals.
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KETOPET SANCTUARY: KETOSIS, CANCER AND CANINES — PART 2
By Chelsea Kent; Shannon L. Kesl, PhD; Stacy A. Hodges, DVM; Loren Nations, DVM, DipABVP
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In the second part of this article, we’ll look at the overall results of KetoPet Sanctuary’s canine cancer program, along with some case studies.
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EYES: ILLUMINATING THE AGING PROCESS
By Carmen M.H. Colitz, DVM, PhD, DACVO and Terri McCalla, DVM, MS, DACVO
Aging causes a gradual decrease in gastrointestinal nutrient absorption, so supplementation with antioxidants important for ocular health is essential for healthy eyes.
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AN INTEGRATIVE APPROACH TO DEMODECTIC MANGE
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RECOMMENDING THE RIGHT SUPPLEMENTS TO YOUR CLIENTS
By Alexia Tsakiris-Vasilopoulos, BvetMed, GDipVWHM, CVA
An integrative approach using herbs, nutrition and acupuncture provides faster resolution of canine demodicosis while also addressing underlying imbalances.
How the National Animal Supplement Council (NASC) is improving and standardizing the animal supplement industry with their Quality Seal program.
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ANAL SAC ANAL GLAND ADENOCARCINOMA
By Steve J. Mehler, DVM, DACVS and Craig A. Clifford, DVM, MS, DACVIM (Oncology) Surgery, drugs and nutraceuticals for ASAGACA, from the perspective of the surgeon and oncologist.
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MORRIS ANIMAL FOUNDATION’ S GOLDEN RETRIEVER LIFETIME STUDY
By Kelly Diehl, DVM, MS, Dipl. ACVIM
What 3,000 Golden Retrievers can tell us about cancer.
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AN INNOVATIVE APPROACH TO SEPARATION ANXIETY IN DOGS
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EQUINE SKIN DISEASE
By Moira Hechenleitner, DVM, CSAT
How using a Certified Separation Anxiety Trainer (CSAT) in your practice can help you successfully alleviate this common canine behavior problem.
By Joyce Harman, DVM, MRCVS
A complementary medical approach for 5 common skin conditions in horses.
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JUVENILE HIP DYSPLASIA IN THE CANINE
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ESSENTIAL OILS IN YOUR PRACTICE
By Trisha Allie, BSc, RVT
A case study involving the use of digital thermal imaging.
By Jared Mitchell, DVM
Effective modern tools with ancient origins, essential oils are an accessible starting point for adding integrative modalities to veterinary practice.
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advisory board
61 COLUMNS & DEPARTMENTS
Dr. Richard Palmquist, DVM GDipVCHM(CIVT) CVCHM (IVAS), graduated from Colorado State University in 1983. He is chief of integrative health services at Centinela Animal Hospital in Inglewood, California, 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.
8 Editorial 13 2019 IVC Award Nominees
— call for nominations
25 Business profile
— Hope Science Vet
31 From the AAVA 37 From the AVH 38 Industry innovations 52 From the AHVMA 57 From the VMAA 60 Business profile
— Golden Needle
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.
64 From the VBMA 65 Marketplace 66 News bites
Dr. Barbara Fougere, DVM, CVAA graduated in 1986, and was named the American Holistic Veterinary Medical Association Educator for 2011. Dr. Fougere is the principal and one of the founders of the College of Integrative Veterinary Therapies. She has continued studying over the last 26 years, and has three Bachelor degrees, two Masters degrees, three post Graduate Diplomas, several Certifications and numerous other courses under her belt.
Dr. Christina Chambreau, DVM, CVH, graduated from the University of Georgia Veterinary College in 1980. She is a founder of the Academy of Veterinary Homeopathy, was on the faculty of the National Center for Homeopathy Summer School and has been the holistic modality adjunct faculty liaison for the Maryland Veterinary Technician Program 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 Animal’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.
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SUMMER 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 Senior Graphic Designer: Alyssa Dow Social/Digital Media Manager: Elisabeth Dunphy Web Design & Development: Lace Imson
COLUMNISTS & CONTRIBUTING WRITERS
Trisha Allie, BSc, RVT Craig A. Clifford, DVM, MS, DACVIM (Oncology) Carmen M.H. Colitz, DVM, PhD, DACVO Todd Cooney, DVM Kelly Diehl, DVM, MS, Dipl. ACVIM Demian Dressler, DVM Jodie Gruenstern, DVM, CVA, VP of VMAA Joyce Harman, DVM, MRCVS Moira Hechenleitner, DVM, CSAT Stacy A. Hodges, DVM Chelsea Kent Shannon L. Kesl, PhD Cynthia Lankenau, DVM Steve Marsden, DVM, ND, MSOM Lac. Dipl. CH, CVA, AHG Terri McCalla, DVM, MS, DACVO Steve J. Mehler, DVM, DACVS Jared Mitchell, DVM Loren Nations, DVM, DipABVP Alexia Tsakiris-Vasilopoulos, BvetMed, GDipVWHM, CVA
ADMINISTRATION & SALES Publisher: Redstone Media Group President/C.E.O.: Tim Hockley Accounting: Susan Smith Circulation & Office Manager: Libby Sinden SUBMISSIONS: Please send all editorial material, photos and correspondence to Dana Cox at Dana@redstonemediagroup.com or IVC Journal, 160 Charlotte St., Suite 202 Peterborough, ON, Canada K9J 2T8.
We welcome previously unpublished articles and color pictures either in transparency or disc form at 300 dpi. We cannot guarantee that either articles or pictures will be used or that they will be returned. We reserve the right to publish all letters received. ADVERTISING SALES: Senior Multi Media Specialist Kat Shaw, (866) 764-1212 ext. 315 Multi Media Specialist Cate McPhee, (866) 764-1212 ext. 226 Cate@redstonemediagroup.com Western Media Specialist Becky Starr, (866) 764-1212 ext. 221 Becky@redstonemediagroup.com Digital Media and Editorial Specialist Carlisle Froese, (866) 764-1212 ext. 224 Carlisle@redstonemediagroup.com Subscription Services Manager: Virginia Clinton, (866) 764-1212 ext. 115 Virginia@redstonemediagroup.com CLASSIFIED ADVERTISING: Libby Sinden classified@IVCJournal.com US MAIL: IVC Journal, 6834 S University Blvd PMB 155 Centennial, CO 80122 CDN MAIL: IVC Journal, 202-160 Charlotte St. Peterborough, ON, Canada K9J 2T8. The opinions expressed in this journal are not necessarily those of the editor, and different views may appear in other issues. Redstone Media Group Inc., publisher of IVC Journal, does not promote any of the products or services advertised by a third party advertiser in this publication, nor does Redstone Media Group Inc. verify the accuracy of any claims made in connection with such advertisers.
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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 copyright© 2019. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: June 2019. IMPROVING THE LIVES OF ANIMALS... ONE READER AT A TIME.
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contributors 1
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1. CRAIG A. CLIFFORD, DVM, MS, DACVIM (ONCOLOGY)
Dr. Craig Clifford is a graduate of Mississippi State University College of Veterinary Medicine and received an MS degree in Animal Science/Virology from the University of Delaware. After completing an internship and medical oncology residency at the University of Pennsylvania, he became a diplomate of the American College of Veterinary Internal Medicine (Oncology) in 2003. He is a medical oncologist and Director of Clinical Studies at Hope Veterinary Specialists in Malvern, PA. Dr. Clifford is a renowned oncologist who has authored/co-authored over 60 papers and book chapters, and is a frequent lecturer at major veterinary meetings. He has served on many boards and committees, including the VCS executive board and the Oncology Pathology Working Group.
2. KELLY DIEHL, DVM, MS, DIPL. ACVIM
Dr. Kelly Diehl received her DVM from the University of Tennessee and started her practice career in an emergency clinic in New Jersey. She then completed an internship at the prestigious Animal Medical Center in New York City, after which she moved west, completing a residency in small animal medicine at Colorado State University. Dr. Diehl joined the staff of the Veterinary Referral Center of Colorado as the co-owner of the internal medicine section. After 14 years, she left private practice to pursue a career in medical communication and joined the Morris Animal Foundation team in 2013. Dr. Diehl is a boardcertified small animal internal medicine specialist and a Certified Veterinary Journalist.
3. 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).
4. JOYCE HARMAN, DVM, MRCVS
Dr. Joyce Harman graduated in 1984 from Virginia Maryland Regional College of Veterinary Medicine. She is certified in veterinary acupuncture and chiropractic and has completed advanced training in homeopathy and herbal medicine. Her practice in Virginia uses holistic medicine to treat horses. Her publications include The Horse’s Pain-Free Back and Saddle-Fit Book — the most complete source of information about English saddles.
5. MOIRA HECHENLEITNER, DVM, CSAT
Dr. Moira Hechenleitner graduated in 2007 from Mayor University College of Veterinary Medicine in Santiago, Chile. She is a Certified Separation Anxiety Trainer (CSAT), a postgraduate in Animal-Assisted Therapy, and has completed courses in Bach Flower Therapy for animals, dog training, and Reiki. Dr. Hechenleitner is a founding board member of the Chilean Association of Professional Dog Trainers (APDT Chile), and has worked as a canine behavior consultant for ten years, offering consultation services to pet owners, teaching courses to dog trainers, and giving seminars internationally. She currently resides in Mystic, Connecticut and works remotely with pet owners from several countries.
6. STACY A. HODGES, DVM
Dr. Stacy Hodges is a veterinarian at Block House Animal Creek Hospital in Austin, Texas.
7. 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.
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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.
8. STEVE J. MEHLER, DVM, DACVS
Dr. Steve Mehler received his DVM degree from MSU-CVM. He completed an internship and surgery residency at the Veterinary Hospital of the University of Pennsylvania (VHUP). He is a past member of the faculty at MSU-CVM, and has taught surgery at UCDavis and VHUP. Dr. Mehler is a surgeon at Hope Veterinary Specialists and is the Chief Medical Officer of Veterinarian Recommended Solutions, which develops nutraceuticals and therapeutic pet food. He has published many scientific articles and textbooks and is an internationally recognized author and lecturer. His clinical interests include minimally invasive surgery and the role of nutrition in treating inflammation.
9. JARED MITCHELL, DVM
Dr. Jared Mitchell graduated from Mississippi State University’s College of Veterinary Medicine in 2004. In 2010, he opened his practice, Mitchell Animal Clinic, in Mobile, Alabama. Wanting more for his patients, he began incorporating holistic modalities into his practice. Dr. Mitchell is currently completing certification to become a Certified Veterinary Medical Aromatherapist through the Veterinary Medical Aromatherapy Association. He plans to achieve certifications in herbal medicine, acupuncture, veterinary chiropractic and other holistic modalities.
10. LOREN NATIONS, DVM, DABVP
Dr. Loren Nations owns Veterinary Healthcare Associates in Winter Haven, Florida, and sees referral cases in Internal Medicine and Oncology.
11. ALEXIA TSAKIRIS-VASILOPOULOS, BVETMED, GDIPVWHM, CVA
Dr. Alexia Tsakiris-Vasilopoulos received her BVetMed from the Royal Veterinary College, University of London, in 2005. She received her Certification in Veterinary Acupuncture from the Chi Institute in 2009; her certificate in Veterinary Herbal Medicine in 2015 from the College of Integrative Veterinary Therapies; qualified with a Graduate Diploma of Veterinary Western Herbal Medicine (CIVT) in 2017; and attended the Health Pioneers Institute in 2017. Dr Tsakiris completed David Winston’s Herbal Studies course in 2016. The same year, she established an exclusively holistic small animal practice.
12. TRISHA ALLIE, BSC, RVT
Trisha Allie completed her Bachelor of Science at the University of Guelph and shortly thereafter became a Registered Veterinary Technician with special interest in companion animal rehabilitation. She joined the Grey Bruce Pet Hospital as a rehabilitation technician in February of 2017, and enjoys learning new and exciting therapies including the use of Digatherm, stem cell, PRP and fear-free strategies.
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, Colorado.
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, California, where she focuses on the effects of metabolism and nutritional interventions on canine and human health.
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editorial
COMMITMENT TO LEARNING, COMMITMENT TO HEALTH “BEAUTIFUL SKIN REQUIRES COMMITMENT, NOT A MIRACLE.” — Erno Laszlo Why begin a veterinary journal with a quote from a dermatologist whose exclusive consultations were sought by the likes of Marilyn Monroe, Audrey Hepburn and Grace Kelly? Well, Monroe remarked that Laszlo not only healed her skin…he also soothed her soul. Thanks to the prevalence of pruritic dogs we see in our practices these days, there’s more than one soul out there who needs soothing, since itchy canines can make even the most patient pet parents miserable, not to mention the dogs themselves. While a soft sweet-smelling coat radiates health, vitality and balance, persistently unhealthy skin reveals a much deeper disturbance. Health and beauty are truly much more than skin deep. As Dr. Laszlo simply yet powerfully expressed, healing the skin requires commitment. And as we learn in this issue of IVC Journal, skin disease in our animal patients can be astonishingly complex. By making a commitment to understanding what’s currently being discovered about the intricate and elegant dance between the immune system and skin health; by making a commitment to learning innovative ways to integrate new modalities into our dermatology cases; and by compassionately communicating this need for commitment with pet parents, progress can be made, not only in skin health, but in overall well-being. For new pearls of wisdom to incorporate into your daily practice, this issue offers contributions from Dr. Steve Marsden on TCVM approaches to immune-mediated
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dermatitis; Dr. Alexia Tsakiris on integrative treatments for stubborn cases of demodectic mange; and Dr. Joyce Harman on holistic options for commonly-seen equine skin diseases. Continuing with innovative cancer treatments in this edition, Drs. Steve Mehler and Craig Clifford discuss anal sac anal gland adenocarcinomas from the perspective of both the surgeon and oncologist. Researchers at KetoPet Sanctuary present cancer case studies that benefited from a ketogenic diet, while Dr. Demian Dressler addresses augmentative treatments that are beneficial for patients undergoing chemo and radiation. Also in this issue, Dr. Moira Hechenleitner shares an innovative way to help patients with separation anxiety using a unique, remote practice model. And Dr. Jared Mitchell shows how incorporating essential oils into your cases is a simple and effective way to introduce integrative modalities to your practice. The practice of veterinary medicine involves a lifetime commitment to learning and growing. By continually seeking out the best ways to help our patients, we contribute to the beautiful miracle of health. With gratitude for the work all veterinarians and their support staff do each and every day.
Laurin Cooke, DVM Associate Editor, drlaurin@ivcjournal.com
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INTEGRATED APPROACHES TO CANINE CANCER
PART 2:
Augmentative treatment strategies Three integrative treatment modalities that, when used in conjunction with chemo and radiation, can increase the longevity and life quality of canine cancer patients. By Demian Dressler, DVM
Conventional treatments for canine cancer include surgery, chemotherapy and radiation. In recent years, however, evidence has been mounting that additional treatment modalities can increase patient longevity and life quality. Including other modalities can also increase owner acceptance of the proposed clinical plan. This article focuses on three additional functional treatment categories — immune support; apoptosis (cancer cell suicide); and extracellular matrix therapies — that can be used alongside conventional cancer treatments.
1. IMMUNE SUPPORT “…treatment with combination chemotherapy caused a significant and persistent decrease in B cell numbers (in dogs).” Journal of Veterinary Internal Medicine, 2006 Compromised immunity is common in cancer patients, and a strong oncological research trend is underway to deliver immune-targeted therapies. Cancer itself is known to be immuno-suppressive. It has been shown that dogs with cancer (lymphosarcoma and osteosarcoma) experience reductions in circulating T cells. This not only promotes the development and progression of cancer itself, but also increases the risk of infection. Neoplasia may be immune-compromising, but it is also immune-deranging. Abnormal circulating immune complexes seem to impede effective immune responses in dogs with mammary carcinomas.
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Immune support can be found in several forms:
• One
existing immune therapy for canine cancer is the plasmid DNA melanoma vaccine; several other anticancer vaccines in development have also shown promise.
• COX-2 inhibitors currently used in metronomic protocols, whether pharmaceutical or botanical, reduce immunosuppressive prostaglandins.
• T he
use of immune-stimulating modified bacteria has shown to be beneficial in increasing remissions and durability of stable disease in a research setting.
• Low-dose chemotherapy and local radiation can increase immune destruction of cancers without systemic immune compromise.
• Beta
glucans are another tool the clinician can use for immune support (see sidebar on page 12).
2. APOPTOSIS: CANCER CELL SUICIDE INDUCTION “One of the few areas in the cell death field that everyone does agree upon is that having cancer cells undergo apoptosis would be a good thing.” Carcinogenesis, 2005 Cancers uniformly lack the normal cell suicide response (apoptosis) seen in damaged, aged, infected or otherwise deranged cells. Triggering normal apoptosis in these deficient cells is a targeted approach to decreasing cancer cell
burden. In fact, traditional oncologic therapies for canine cancer, such as chemotherapy and radiation, trigger apoptosis or programmed cell death of neoplastic cells. “Owing to the fact that apoptosis causes minimal inflammation and damage to the tissue, apoptotic cell death-based therapy has been the centre of attraction for the development of anticancer drugs.” Cell Death and Disease, 2016
chemotherapy and radiation when used concurrently. These include curcumin, silymarin and luteolin, among others. The author uses Apocaps ® as a combination source of bioavailabilityenhanced dietary apoptogens. This formula may also be used alongside conventional therapies such as surgery and chemotherapy.
The author typically discontinues most therapeutic supplements, including adaptogens, at least four days prior to surgery until ten to 14 days postoperatively. When anti-inflammatory treatments such as corticosteroids or NSAIDS are used, the author will reduce the labeled Apocaps® dose by approximately half, since this product’s constituents have mild to moderate COX-2 inhibiting effects. Continued on page 12.
However, both chemotherapy and radiation have additional effects that are not specific to neoplastic cells. The resulting toxicity leads to dose limitations. Other compounds, called apoptogens, are capable of inducing apoptosis. An array of naturally-occurring, lowtoxicity, phytochemical apoptogens selectively induce cancer cell suicide. In general, they are limited by oral bioavailability, which should be enhanced to obtain a therapeutic effect. Common phytochemical apoptogens include curcumin, silymarin, EGCG, luteolin, lycopene, capsaicin, resveratrol and many others. Interestingly, these and other apoptogens can be extracted from dietary sources. These naturallyoccurring dietary apoptogens act at multiple sites in the intracellular cascades involved in activating normal apoptosis. “A long list of such dietary constituents is known to induce apoptosis of cancer cells without affecting normal cells.” Biochemical Pharmacology, 2008 Additionally, several dietar y apoptogens are chemo- and radiosensitizers, enhancing the effects of IVC Summer 2019
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BETA GLUCANS FOR ADDITIONAL IMMUNE SUPPORT Beta glucans are a group of D-glucose monomers linked by a β-glycosidic bond, found in fungal and plant cell walls. Common sources are extracts derived from various mushrooms, oats and yeast. These compounds have demonstrated strong immunomodulatory activities based on animal and human-based research. “β-glucans are known to exhibit direct anticancer effects and can suppress cancer proliferation through immunomodulatory pathways.” Investigational New Drugs, 2017
Immune-supporting beta glucans have been shown to bind to pattern recognition receptors (PARRs) on a variety of immune cells. In this way, they activate an array of immune pathways. In humans, these compounds have been shown to increase adaptive and innate immune responses, as well as decrease cancer metastasis. As immune-stimulating molecules, they activate macrophages, granulocytes, dendritic cells — and of particular interest in cancer immunity, natural killer cells. This leads to downstream stimulation of both T and B cells. Beta glucans (β-1,3/1,6) extracted from yeast and administered orally to dogs elicited an immune response (and competency) similar to that of a kennel cough vaccination. Beta glucans from oat were shown to balance canine vaccination immune response by maintaining cellular immunity alongside humoral immunity. (Cellular immunity is in general the main effector branch of anticancer immune responses.) It was previously assumed that oral delivery of these compounds did not yield appreciable results. However, it is now known that
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pinocyte microfold (M) cells, located in the small intestine, actively transport beta glucans to the Peyer’s patches. “Glucan effects on cancer inhibition are well established.” Anti Cancer Research, 2018
In clinical practice, the author uses both K-9 Immunity® as well as Im-Yunity® as beta glucan sources. K-9 Immunity contains a spectrum of beta glucans from a variety of medicinal fungal sources. The encapsulated formulation is preferred. Im-Yunity ® contains various glucans along with a protein component, which together comprise the active ingredient, PSP. Cases of canine hemangiosarcoma deserve special mention. At 100 mg/kg PO daily, Im-Yunity ® was shown to increase median survival times to 199 days in a small cohort of dogs with splenic hemangiosarcoma. To the author’s knowledge, this is the highest median survival time reported for splenic hemangiosarcoma treatment. Transfer factors found in low molecular weight lymphocyte extracts are thought to enhance the binding of beta glucans to immune system cells, particularly T cells, which are active in cellmediated immunity. Transfer Factor is available commercially and the author uses it concurrently with beta glucans. The beta glucans as a group have a high safety margin, with only rare cases of digestive upset that can be minimized by administration with food. The same can be said for Transfer Factor. However, the author avoids these immune therapies in cases of historical or active immune-mediated disease.
Continued from page 11.
3. EXTRACELLULAR MATRIX THERAPIES Reducing cancer spread is central to mitigating mortality and morbidity. Cancer spread occurs through a complex series of events, including mutation, loss of cancer stem cell anchoring points, migration, vascular invasion, immune dysfunction, alterations in the extracellular matrix (ECM), adhesion, and proliferation of distant tumor cells. One possible reason for loss of remission after chemotherapy or radiation is an altered microenvironment that results from these conventional treatments. This altered matrix actually favors metastasis. In particular, the injury of cancerous tissues seems to favor conditions for regenerative responses, including aberrant neoplastic cell migration. “Several studies demonstrated that ionizing radiation might promote migration and invasion of tumor cells” Critical Reviews in Oncology/Hematology, 2016 “Chemotherapy by itself can instigate metastatic spread while simultaneously restraining growth of the primary tumor.” Cancer Research, 2015 It is the author’s opinion that substantially increased attention should be placed on this subject in veterinary cancer patients.
Modified citrus pectin The use of modified citrus pectin is one way to address this problem. Modified citrus pectin (MCP) is a complex watersoluble indigestible polysaccharide obtained from the peel and pulp of citrus fruits. To increase oral bioavailability, the citrus pectin has been modified by means of high pH and temperature treatments.
“Modified citrus pectin (MCP), a complex watersoluble indigestible polysaccharide…has emerged as one of the most promising anti-metastatic drugs.” Carbohydrate Research, 2009 MCP has anti-adhesive properties relative to metastatic mobile cancer cell attachment. After neoplastic cell detachment and vascular invasion, endothelial attachment and neoplastic accumulation is mediated by galectin-3. MCP appears to antagonize galectin-3 adhesion. Galectin-3 also mediates mobile neoplastic cell extravasation from blood vessel to adjacent tissue extracellular matrix, where MCP appears to be active as well. Finally, MCP has the potential for increasing apoptotic responses of tumor cells to various events such as loss of anchoring, chemotherapy and radiation. Inducing normal apoptosis of cancer cells by MCP is also mediated, at least in part, by inhibiting galectin-3 anti-apoptotic function. It has been shown in humans that high doses of MCP over one to three weeks, or modest doses long-term, increase urinary excretion of the toxic heavy metals lead, arsenic and cadmium, without increased excretion of normal dietary mineral elements. MCP is exceptionally safe, with few to no clinical side effects. Digestive upset or allergic response is possible,
but the author has not seen adverse effects clinically. The author uses approximately two to three times the human adult labeled doses pound for pound, mixed in food. Bear in mind that MCP is a pectin, so it can form a clear gelatinous substance in the presence of moisture, including dog rations.
SUMMARY When it comes to cancer, relative to other disease states, dog owners are often concerned about adverse survival metrics and life quality concerns. This can lead to dissatisfaction with canine cancer management, and treatment refusal. By practicing cancer care that includes immune support, cancer cell suicide induction, and extracellular matrix therapies, the clinician may experience increased opportunity for more favorable treatments. References available at IVCJournal.com 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. 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®.
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Dermatological problems in dogs and cats are among the most common and frustrating cases that veterinarians see. Successfully resolving these issues involves understanding new models of skin disease, and the roles that diet, herbs and the microbiome can play in their resolution.
CURRENT CONVENTIONAL TREATMENT APPROACHES Apart from Omega 3 fatty acids influencing cytokine production, the current use of diet to manage skin inflammation involves the avoidance of antigenic food molecules, particularly proteins. Antigenic proteins are believed to be absorbed intact through the gut mucosa and viewed as foreign by immune cells residing in the lamina propria. Sensitized Helper T cells circulate to the skin, stimulating immune cells residing there to incite inflammation. In short, these animals are understood to be suffering a Type IV hypersensitivity mediated by T cell activation.
Dermatological dilemmas in dogs and cats The potential for diet, Chinese herbs and the microbiome to resolve skin inflammation in small animals. By Steve Marsden, DVM, ND, MSOM Lac. Dipl. CH, CVA, AHG
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Typical strategies to address this problem include suppressing the immune system using pharmaceuticals, and using extruded diets in which molecular sizes are too small to incite a response. Novel protein diets are also used to avoid antigens to which the system has been previously sensitized. No conventional treatments are used to address the increased porosity of the digestive tract that allows entry of antigenic molecules; or the ability of circulating immune cells to enter the interstitium of the skin. Some of the perceived efficacy of natural therapies in dermatitis appears to be due to a targeting of these aspects of pathogenesis. Despite conventional therapy, success is often inconsistent, even where a link between skin disease and diet appears to be present. In many cases, inflammation continues unabated when the animal is on extruded diets. New food allergies commonly develop, necessitating a parade of diets featuring ever more exotic protein sources. Immune suppression with drugs often has immediate dosedependent side effects, as well as delayed side effects like predisposition to infections and tumors. It is for these reasons that owners seek out alternative perspectives and treatments for their pets’ skin diseases.
NEW MODELS OF SKIN DISEASE Ironically, one can start with current medical research when looking for a new context in which to view small animal dermatitis cases. The knowledge that gave rise to the therapeutic approaches noted above has been added to
significantly to create a schema that embraces this preexisting model; but also goes well beyond this to suggest many new potential avenues for managing dermatitis. These new directions in research provide support for, and help explain the utility of, alternative therapies such as “real food” (e.g. homemade or raw) as well as various supplements and herbs. Two broad models are emerging of the main mechanisms by which dermatitis arises.
1
We can call the first model inf lammation dysregulation, which appears secondary to the metabolic consequences of feeding processed diets. The high insulin levels that result promote inflammation in and of themselves, but also lead to the accumulation of abdominal fat, often culminating in obesity. The fat accumulations are not inert, but secrete adipokines and cytokines involved in the generation of inflammation. This spawning of inflammation from a state of over-nutrition has long been recognized by Classical Chinese Medicine, which terms the phenomenon “Damp Heat”. Inflammation arising from insulin resistance and obesity can be countered through insulin-sensitizing herbs and the use of less processed diets. It is likely directly aggravated through the use of existing processed diets, including extruded foods.
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The second model we can term immune dysregulation and involves the Type IV hypersensitivity reaction veterinarians are familiar with. If a less processed diet does not materially improve the condition, then immune dysregulation is more likely to be present, but instead of managing the condition with just novel protein and extruded diets, practitioners can resolve these conditions through manipulation and deliberate support of the microbiome using various herbs, supplements and food sources. The focus of the diet probably needs to be on fiber, rather than just on novel protein sources. We’ll now take a closer look at each of these models in turn, outlining the most effective therapies for each.
INFLAMMATION DYSREGULATION The Damp Heat model
The notion that inflammation is linked to metabolism is an old one, appearing many centuries ago in an albeit more poetic guise, namely the Damp Heat model of Chinese medicine. In that model, the digestive tract (i.e. the Spleen) plays the role of converting raw materials into useful
substances that can be used by the body, such as Blood, joint fluid and plasma. If the Spleen is weak due to excessive demands being placed on it, conversion is incomplete, and an unusable fluid known as Dampness accumulates. Dampness is not used by the body, and goes wherever normal fluids are distributed, to accumulate in joint spaces, urine, and the walls of the blood vessels. Any accumulating unused tissue also qualifies as Dampness, including adipose within the abdomen. Within the vessels, Dampness is imagined to slowly encroach upon and obstruct the flow of Blood, releasing the kinetic energy of flowing Blood as a sort of heat or friction that Chinese medicine terms Damp Heat. If allowed to continue, the Blood stops moving altogether, leading to Blood Stasis and compromised circulation to the associated tissue. Different treatment approaches are applicable at different stages of the disease’s progression. In the earlier stages, herbs that strengthen the Spleen and drain Damp are more appropriate. As problems progress, cooling and Bloodmoving treatments are called for. If this model were to have any relevance outside of Chinese medicine, there would have to be evidence that inflammation (i.e. Heat) was linked to overconsumption of food and the accumulation of body fat. We’d also want to see a link between chronic inflammation and the disruption of circulation within tissues. Modern nutritional research has confirmed both of these relationships. The disruption of circulation that attends chronic inflammation is termed “endothelial dysfunction” and is beyond the scope of this article, although it should be stated that high insulin levels are a driver of the condition, so dietary recommendations made in this article are as applicable to endothelial dysfunction as the treatment of inflammation and Damp Heat. This article will focus on the link between overconsumption and inflammation, central to which is the phenomenon of insulin resistance.
Insulin, weight gain and inflammation Veterinarians certainly recognize insulin resistance as occurring in cats, culminating in the development of Type II diabetes. They may not, however, associate it with their canine patients at all. The reality is that both dogs and cats are prone to insulin resistance, which only requires a chronic surfeit of energy within cells to develop. In humans, this is most often due to a surplus of free fatty acids in the diet, but any excess caloric intake can produce IVC Summer 2019
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the phenomenon, including an excess of carbohydrate intake in dogs.1 The energy surplus ramps up ATP production in the cell’s mitochondria, producing mitochondria over-activation and excesses of ATP. In response, AMPK is up-regulated, triggering pathways that inhibit further lipid and glucose uptake and oxidation by cells.1 Some of this energy glut is stored as fat instead, with circulating insulin levels correlating strongly with the tendency for future weight gains. 2,3 Simply gaining some weight might not be a problem in itself, were this anabolic state not associated with inflammation. As body score increases, so do fasting plasma levels of inflammatory mediators like interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1). As feeding of energy-rich easily-digested foods continues, dogs enter a state of chronic inflammation.4 The situation only worsens as they eventually become obese. As in humans, the incidence of obesity in small animals has achieved epidemic proportions. As reviewed by Laflamme, 5 obesity in the dog or cat arises from the overconsumption of calories from any source, to the point where accumulated body fat is starting to impair health and body function. In a human, obesity is achieved when body weight increases to 20% to 25% above the ideal for his/her frame. The same is generally presumed for dogs and cats, and even moderately overweight dogs are at greater risk than their lean-fed siblings for earlier morbidity and necessary medication for chronic health problems. Obese cats likewise face increased health risks, including arthritis, diabetes mellitus, hepatic lipidosis, and early mortality. The risk for developing diabetes increases about two-fold in overweight cats and about four-fold in obese cats. Decades ago, extra weight was viewed simply and vaguely as producing extra physical strain on the heart and joints. Modern research has clarified that this added health risk is due to the elaboration of inflammatory cytokines and adipokines by body fat stores themselves. Leptin, resistin, tumor necrosis factor-α, IL-1β, IL-6 and C-reactive protein all increase in obese dogs and cats, resulting in a persistent, low-grade inflammatory state. This inflammatory state has been shown to play a causal role in chronic diseases such as osteoarthritis, cardiovascular disease, diabetes mellitus and many others. The oxidative stress that results from chronic inflammatory states serves as an additional
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aggravating factor, predisposing the animal to tissue damage and tumor formation. 5 While weight gain is associated with the development of chronic inflammation in dogs and cats, weight loss produces reductions in circulating inflammatory cytokines. In one study of the effects of weight loss in 26 cases of naturallyoccurring obesity in a range of breeds, body fat mass before weight loss was positively correlated with both plasma insulin concentrations and serum insulin to glucose ratios. Both these parameters decreased after weight loss, confirming the presence of insulin resistance. As weight loss progressed, notable decreases in plasma tumor necrosis factor-alpha (TNF-alpha), haptoglobin and C-reactive protein concentrations were observed.7 It’s important to note that in all respects, the link between diet, insulin, body fat and inflammation in dogs and cats is identical to that demonstrated in humans, to the point that dogs and cats have served as the animal models for researching these phenomena in humans. Since obesity with its secondary inflammatory effects in humans has been repeatedly and consistently linked with the consumption of processed foods,6 it is thus entirely reasonable to postulate the same is true for dogs and cats. The notion of processed foods contributing to small animal disease and fostering an obesity epidemic has been understandably unpopular among veterinarians, given the reliance of the profession on these foods for the management of medical conditions, as well as routine feeding. Also denied in the past was the notion that carbohydrates could Continued on page 18.
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Continued from page 16. produce insulin resistance in dogs and cats, but this has been verified in clinical trials. A case in point was the analysis offered by a study looking at the efficacy of a high-protein medium-carbohydrate diet for weight loss in dogs that had become obese on a commercial high-carbohydrate medium-protein kibble. Insulin sensitivity and body composition were evaluated before and after weight loss using a euglycaemic-hyperinsulinaemic clamp and the deuterium oxide dilution technique, respectively. Postprandial plasma glucose and insulin concentrations were substantially lower with the high-protein medium-carbohydrate diet than the commercial kibble, which the researchers felt was readily explained by the difference in carbohydrate content between the two diets.8
Weight loss, real food and the biome Weight loss is a primary goal in overweight animals suffering chronic inflammation. Weight loss with its attendant reduction in inflammation is achieved in association with, and even because of, shifts in the biome.16 For example, gut flora have been shown to play a crucial role in influencing metabolism, predisposition to weight gain, and blood lipid levels. Changing the microbiota by altering the diet may eliminate its role in creating a pro-inflammatory metabolism. Raw and real food diets are being fed on an increasing basis to reduce body weight and tendencies to inflammation. Commercial high protein and high fiber diets produce weight loss with associated characteristic shifts in the microbiome that are identical to what real food diets achieve, suggesting they may work in a similar manner.9,14 The lower glycemic index of real food diets that stems from their higher protein and lower carbohydrate contents seems to promote a metabolism conducive to weight loss and an anti-inflammatory effect in many dogs and cats. A crossover study was performed to examine the effect of raw diets and their functional opposites (namely, highly processed extruded diets) on the microbiome. Raw diet effects included:
• Reduced fatty acid synthesis
• Increased balance and diversity of the micrbiome
• A shift in microbiome metabolites towards those associated with a healthy gut
• Increased lactic acid and pH of the stool. 18
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The results of extruded diets on skin inflammation are commonly disappointing, but are perhaps explicable since in the above study, they had a deleterious and opposite effect on the microbiome.14
Beneficial effects on the microbiome were also seen in dogs fed a minced beef diet, and these changes were reversed when the diet was replaced with commercial kibble.15 Additional prospective research is needed to confirm whether raw and real food diets may promote weight loss and reduce systemic inflammation in overweight animals.
Herbal approaches While real food diets are employed to induce weight loss and favorable shifts in the microbiome, Damp Heat formulas can be used to reduce excess insulin levels and counter inflammation. San Ren Tang (Three Seeds Decoction) and Si Miao San (Four Marvels Powder) are both Damp Heat formulas used for the management of dermatitis (see Tables 1 and 2). Si Miao San, by some estimates, is the most widely used herbal formula in veterinary medicine, testifying to its utility in managing inflammation. Si Miao San is used more for acute inflammation, where a decongesting effect is needed on the body periphery; San Ren Tang is used for more chronic inflammation, where a return of blood supply is required to help actively resolve chronic lower-grade inflammation. Si Miao San and San Ren Tang are not the only two Damp Heat formulas used in the management of skin disease, and the differences in their indications are more numerous and nuanced than is represented here. The reader is referred to professional reference texts 38 for more information on how to use these two formulas safely and effectively. Both formulas exemplify, however, the strategy of combining insulin-sensitizing and anti-inflammatory herbs within the same formula. This innate synergy is likely what has driven their popularity, and provides corroboration for the role of insulin resistance in driving the development of inflammation. Since the ingredient list of both formulas
reflects several centuries of refinement to achieve maximum efficacy, we can conclude that insulin as a driver of inflammation is not strictly a phenomenon of modern society but has been a problem throughout human history. It is only our awareness of the problem that is recent. To act on the knowledge requires us to overcome the inertia produced by standard industry practices. Both Si Miao San and San Ren Tang contain Coix, an antiinflammatory herb. 39 The effects of this herb stem from its ability to inhibit nitric oxide synthesis, as well as superoxide production and release by macrophages. Coix also contributes to insulin sensitization. It has been shown to reduce adipose tissue weight, leptin and insulin levels in rat models of metabolic syndrome.40 Si Miao San is a more potent anti-inflammatory insulinsensitizing formula, and is also antioxidant due to its Phellodendron content. Phellodendron has demonstrated
antioxidant activity in numerous studies41 and also has an anti-inflammatory effect through its inhibition of the production of inflammatory cytokines and nitric oxide. It also inhibits expression of the gene for iNOS, as well as tumor necrosis factor (TNF-alpha).42 Si Miao San improves insulin sensitivity by protecting and enhancing insulin signalling. 35.36 Berberine, a plant compound extracted from Phellodendron in Si Miao San, has been shown through a systematic review of clinical trials to improve multiple aspects of Type II diabetes and insulin resistance, including blood glucose markers such as HbA1c, hyperlipidemia and hypertension. 34 Phellodendron as a whole has been shown to directly combat the central mechanism by which insulin resistance is generated, by reversing
Table 1 SAN REN TANG (THREE SEEDS COMBINATION) Xing Ren
Apricot seed
Yi Yi Ren
Coix seed
Hua Shi
Talc
Ban Xia
Pinellia rhizome
SI MIAO SAN (FOUR MARVELS COMBINATION)
Bai Dou Kou
Round cardamon
Cang Zhu
Atractylodes rhizome
Dan Zhu Ye
Lopatherum
Huai Niu Xi
Achyranthes root
Hou Po
Magnolia bark
Yi Yi Ren
Coix seed
Tong Cao
Rice paper pith
Huang Bai
Phellodendron bark
Table 2
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the inhibition by AMPK of glucose and lipid oxidation, 37 facilitating the removal of adipose stored in hepatocytes.43 Si Miao San also contains Atractylodes, which has been shown to improve several metrics in diabetic patients. 37
IMMUNE DYSREGULATION
suppress gut immunity through increased secretion of cortisol, promoting dysbiosis. Only after enteropathogens have proliferated is the immune system once again incited into activity, producing a cell-mediated inflammatory response that damages the gut wall and leads to secondary skin inflammation.
The connection between the gut and skin
Restoring a healthy biome
While the microbiome likely plays a key role in inflammation due to weight gain, its role in immune dysregulation is probably even more central. Gut microflora are important drivers of host immunity, help protect against invading enteropathogens, and provide nutritional benefits to the host. Their role when things go awry is still being unraveled, but so far, the discoveries for dogs and cats parallel what has been discovered for humans.
Determining all the immune mechanisms that might be involved within a given patient may be difficult, but significant improvement can be achieved by simply following the central tenet of naturopathic medicine to “restore the causes of health” by:
Specifically, shifts in the microbiome can:
• Cause synthesis of metabolites that have
• Promoting species diversification within the microflora while controlling pathogens • Reducing gut permeability • Minimizing stress to avoid immune suppression and overgrowth of pathogens.
an epigenetic role in immune dysregulation
• Increase gut permeability, causing sensitization to antigens within the gut lumen that then propagates to the skin • Stimulate ongoing inflammation in the gut wall (i.e. inflammatory bowel disease or IBD) which propagates to the skin. Cell-mediated immune reactions are important in the latter two mechanisms. Helper T cells stimulated into action at gut level through excess exposure to microflora then circulate, eventually prompting Effector T cells in the skin to secrete interleukins that prod macrophages and neutrophils to ramp up their inflammatory response to local skin irritants. In other words, inflammation from one cause in the gut ramps up the inflammatory response to antigens from other sources in the skin. Since exposure to the inciting antigen or pathogen is ongoing, inflammatory responses in the skin persist or continue to grow.18,19 Conventional treatment with antiinflammatory and immune-suppressive therapies often provides only temporary relief but may potentiate increased permeability and dysbiosis, ironically resulting in inflammation becoming perpetuated.16 Reducing background inflammation produced by gut dysbiosis may be the primary consideration for allowing skin inflammation to subside. Stress can amplify the role of the gut in inducing skin inflammation. It acts through the “brain-gut-skin axis” to
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As reviewed by Craig,16 a healthy microbiome can be supported by feeding a species-appropriate diet using real foods wherever possible. As a highly adaptive species, dogs (like humans) can thrive on a great variety of foods, at least in the short term, allowing debate among veterinarians and consumers of just what the ideal diet is for a dog. From the perspective of gut microflora, however, the definition of the ideal diet becomes narrower. In carnivores, use of higher-protein diets promotes greater stomach acidity, reducing the predisposition to small intestinal bacterial overgrowth and deleterious shifts in the biome. Craig notes that “animal-sourced roughage” such as scales, skin, hair, teeth, tendon, bone and cartilage from real food diets may have a prebiotic effect even if not digested. Craig also states that “low carbohydrate cereal-free diets should be considered in the investigation of any chronic skin disorder [in dogs], whether or not there is evidence of gastrointestinal disease”. His concerns extend from the presence of gluten and fermentable carbohydrates within cereal grains. Fermentable carbohydrates lead to dysbiosis and secondary impairment of the GI barrier. Gut bacteria species have been shown to create metabolites from gluten that increase gut permeability, prompting immune dysregulation. While fermentable carbohydrates can increase gut permeability, foods containing soluble fiber can help Continued on page 22.
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Continued from page 20. strengthen the GI barrier by having a prebiotic effect. Short-chain fatty acids, such as butyrate, produced by gut flora from these fiber sources tighten the junctions between gut mucosal epithelial cells, thereby reducing the priming of the immune system by lumen contents. Fecal IgA is also increased, helping to bind and inhibit the activities of enteropathogens. 20 Example fiber sources include those from beans and potatoes. 20,21 Note that overweight inflamed animals do not apparently experience the same boost in fatty acid synthesis from high protein high fiber diets that immune dysregulation dogs do.13 Indeed, their fatty acid synthesis may drop. Fiber supplementation thus appears a much more important consideration for the immune dysregulation animal.
Craig states that probiotics have been effective in clinical trials of human atopy, and early exposure to probiotics reduces the intensity of symptoms in models of canine atopy. As reviewed by Miraglia del Guidice and De Luca, many clinical trials have shown that probiotics have the ability to alleviate allergic inflammation, as evidenced by both the control of clinical symptoms and a reduction of local and systemic inflammatory markers.17
Other prebiotics exist besides fiber, including inulin and oligosaccharides, which are resistant to host digestion, allowing them to be fermented in the colon, producing beneficial metabolites. They are widely used in pet foods, although their efficacy in animals has not been researched.
At times, antimicrobials may be necessary to correct a dysbiosis, though efficacy is inconsistent. More popular among veterinarians recently has been the use of fecal microbiota transplantation (FMT) to restore normal gut flora populations.
Also commonly used are probiotics, which help change flora composition and activity to improve host health. Probiotic benefits include:
Based on the foregoing, there are three main ways an herbal medicine can address immune dysregulation manifesting as immune-mediated dermatitis.
When the microbiome is suspected as being operative in an animal’s inflammatory condition, certain pharmaceuticals, including antacids and antimicrobials, should be used only with great care to avoid perpetuating or worsening the problem.
Herbal approaches
• Inhibition of pathogen adherence
1. Support a normal local immune response within the gut to correct dysbiosis
• Killing pathogens through bacteriocins
2. Modulate the cell-mediated immune reaction being propagated to the skin
• Sealing of the intestinal barrier produced by commensal flora
• Increasing immunity and the intestinal barrier by stimulating IgA production
• Downregulation of cytokine secretion.
3. Reduce stress as a cause of immune suppression and secondary enteropathogen proliferation. Astragalus-based formulas such as Ginseng and Astragalus Combination (Bu Zhong Yi Qi Tang) are used to support or
Table 3 BU ZHONG YI QI TANG (GINSENG AND ASTRAGALUS COMBINATION)
Table 4
Ren Shen
Ginseng root
XIAO CHAI HU TANG (MINOR BUPLEURUM COMBINATION)
Dang Gui Shen
Chinese angelica root
Chai Hu
Bupleurum root
Huang Qi
Astragalus root
Ban Xia
Pinellia rhizome
Bai Zhu
White atractylodes rhizome
Gan Cao
Licorice root
Chai Hu
Bupleurum root
Sheng Jiang
Ginger rhizome
Chen Pi
Citrus peel
Da Zao
Jujube
Gan Cao
Licorice root
Ren Shen
Ginseng root
Sheng Ma
Cimicifuga rhizome
Huang Qin
Scutellaria root
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restore normal and local immunity within the gut, while Minor Bupleurum (Xiao Chai Hu Tang) derivatives work through all three pathways (see Tables 3 and 4). Astragalus Several studies illuminate the role of astragalus (A. membranaceus) in the correction of dysbiosis. Polysaccharide extracts from the plant have been shown to alter gut microbiota and the SCFAs they synthesize in diabetic mice.22 Another study in broiler chickens showed a reduction of pathogenic gut flora and a concomitant increase in commensal and symbiotic species.23 Indeed, astragalus (Huang Qi) is much studied for its ability to improve productivity in farm animals by correcting the microbiome. The plant was shown in pigs to reduce diarrhea secondary to dysbiosis, leading to enhanced growth rates and improved digestibility of food. Improved microbiota health was also indicated by an increase in species diversity and was likely due to an improved immune response against enteropathogens, as evidenced by increases in IL-2 and TNF-alpha. 24 The same general impact was seen in a study on chicks, where the plant extract was used in tandem with probiotics to successfully combat pathogenic strains of E.coli.25 Minor Bupleurum Minor Bupleurum consists of three key herbs: bupleurum (Chai Hu), scutellaria (Huang Qin) and panax ginseng (Ren Shen). It is an herbal powerhouse for the management of immune dysregulation caused by “leaky gut�, with all three plants showing efficacy independent of each other in all three areas of correcting dysbiosis: 1. Reducing predisposition to, and the adverse effects from, stress on microflora 2. Modulating the immune system to support local immunity or reducing the intensity of cell-mediated immune reactions. Dysbiosis With respect to dysbiosis, bupleurum was shown in the context of another formula, Bupleurum Soothe the Liver Combination (Chai Hu Shu Gan San), to protect microflora from pathogenic overgrowth. 26 Scutellaria (in the formula Huang Lian Jie Du Tang) has been shown to help restore normal gut flora in rats by reducing pathogens and increasing the presence of bacteria that do not incite inflammatory responses. SCFA synthesis increased accordingly.27 Many studies support the use of ginseng for the correction of dysbiosis secondary to antibiotic use. 28
Brain-gut-skin axis Ginseng is widely known as an adaptogenic herb that can normalize and optimize adrenal gland output of cortisol, lessening its secretion in times of repetitive stress, but increasing it when increased alertness is required. Normalization of cortisol secretion reduces immune suppression allowing enteropathogenic bacteria overgrowth. Scutellaria species likewise have research support for their long history of use in treating anxiety and other CNS organic and mood disorders. 29 Bupleurum has likewise been shown to reduce depression and anxiety in animal models of repetitive stress. 30 Immune dysregulation Wogonin, found in scutellaria, has been analyzed for its ability to support normal immunity and reduce inflammatory bowel changes in colitis in rats. Levels of protective IgA were increased, while IgE levels associated with hypersensitivity were maintained at low levels. The ability to induce local immunity in the gut was increased in rats given wogonin, but the intensity of the inflammatory response during colitis was reduced, making scutellaria a true immune modulator. 31 A decrease in bowel wall integrity can increase exposure of the immune system to endotoxins (LPS), sparking an inflammatory response that can propagate to the skin. Administration of bupleurum tempers the proinflammatory effects of LPS exposure, while supporting phagocytosis and removal of the offending antigens. 32 Bupleurum’s tempering effect of an immune response has been widely studied and demonstrated at other mucosal surfaces as well, including for the reduction of allergic responses at respiratory epithelia. 33
CONCLUSIONS On a fundamental basis, the typical strategies in small animal dermatitis have changed very little over the last several decades and are still centered around the feeding of IVC Summer 2019
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extruded or novel protein processed diets; and/or the use of immune suppressant medications. Research into the role of diet in dermatitis has progressed, however, illuminating the primary role that metabolism and the microbiome play in driving skin inflammation. Use of unprocessed diets and herbs undermines the role of insulin and weight gain as drivers of inflammation; while manipulation of the microbiome using diet, herbs, prebiotics and probiotics holds significant promise for the relief of immune-mediated skin disease. These strategies are deserving of much more research attention, and appear to offer significant hope of advancing the veterinary profession in an arena that it has historically found highly frustrating. You can view Dr Marsden’s webinar series on “Dermatological Dilemmas” by visiting: civtedu.org/steve-marsden-skin-diseases-webinar-series/.
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Maria APJ, Ayane L, Putarov TC, Loureiro BA, Neto BP, Casagrande MF, Gomes MOS, Glória MBA, Carciofi AC. The effect of age and carbohydrate and protein sources on digestibility, fecal microbiota, fermentation products, fecal IgA, and immunological blood parameters in dogs. J Anim Sci. 2017 Jun;95(6):2452-2466.
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21 Panasevich MR, Kerr KR, Dilger RN, Fahey GC Jr, Guérin-Deremaux L, Lynch GL, Wils D, Suchodolski JS, Steer JM, Dowd SE, Swanson KS. Modulation of the faecal microbiome of healthy adult dogs by inclusion of potato fibre in the diet. Br J Nutr. 2015 Jan 14;113(1):125-33. 22 Liu Y, Liu W, Li J, Tang S, Wang M, Huang W, Yao W, Gao X. A polysaccharide extracted from Astragalus membranaceus residue improves cognitive dysfunction by altering gut microbiota in diabetic mice. Carbohydr Polym. 2019 Feb 1;205:500-512.
Qiao H, Song Y, Shi H, Bian C. Fermented Astragalus in diet altered the composition of fecal microbiota in broiler chickens. AMB Express. 2018 Sep 25;8(1):151.
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24 Che D, Adams S, Wei C, Gui-Xin Q, Atiba EM, Hailong J. Effects of Astragalus membranaceus fiber on growth performance, nutrient digestibility, microbial composition, VFA production, gut pH, and immunity of weaned pigs. Microbiologyopen. 2018 Aug 16 25 Li SP, Zhao XJ, Wang JY. Synergy of Astragalus polysaccharides and probiotics (Lactobacillus and Bacillus cereus) on immunity and intestinal microbiota in chicks. Poult Sci. 2009 Mar;88(3):519-25.
Meng Yu, Hong-Mei Jia, Chao Zhou, Yong Yang, Li-Li Sun, Zhong-Mei Zou. Urinary and Fecal Metabonomics Study of the Protective Effect of Chaihu-Shu-Gan-San on Antibiotic-Induced Gut Microbiota Dysbiosis in Rats. Sci Rep. 2017; 7: 46551
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Lee B, Yun HY, Shim I, Lee H, Hahm DH. Bupleurum falcatum prevents depression and anxiety-like behaviors in rats exposed to repeated restraint stress. J Microbiol Biotechnol. 2012 Mar;22(3):422-30.
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34 Lan J, Zhao Y, Dong F, Yan Z, Zheng W, Fan J, Sun G. Meta-analysis of the effect and safety of berberine in the treatment of type 2 diabetes mellitus, hyperlipemia and hypertension. J Ethnopharmacol. 2015 Feb 23;161:69-81 35 Liu K, Luo T, Zhang Z, Wang T, Kou J, Liu B, Huang F. Modified Si-Miao-San extract inhibits inflammatory response and modulates insulin sensitivity in hepatocytes through an IKKβ/IRS-1/Aktdependent pathway. J Ethnopharmacol. 2011 Jul 14;136(3):473-9. 36 Yang JL, Wang JL, Huang F, Liu K, Liu BL. Modified Si-Miao-San inhibits inflammation and promotes glucose disposal in adipocytes through regulation of AMP-kinase. Chin J Nat Med. 2014 Dec;12(12):9119.
Shi J, Hu Y, Wang Q. Fufang cangzhu tang for treatment of senile obesity or overweight complicated with impaired glucose tolerance --a clinical observation in 32 cases. J Tradit Chin Med. 2006 Mar;26(1):33-5.
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Marsden S. Essential Guide to Chinese Herbal Formulas- Bridging Science and Tradition in Integrative Veterinary Medicine. CIVT Publications, 2014. http://www.civtedu.org/dr-steve-marsdens-essentialguide-to-chinese-herbs/
12 Forster GM, Stockman J, Noyes N, Heuberger AL, Broeckling CD, Bantle CM, Ryan EP. A Comparative Study of Serum Biochemistry, Metabolome and Microbiome Parameters of Clinically Healthy, Normal Weight, Overweight, and Obese Companion Dogs. Top Companion Anim Med. 2018 Dec;33(4):126-135.
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Salas-Mani A, Jeusette I, Castillo I, Manuelian CL, Lionnet C, Iraculis N, Sanchez N, Fernández S, Vilaseca L, Torre C. Fecal microbiota composition changes after a BW loss diet in Beagle dogs. J Anim Sci. 2018 Jul 28;96(8):3102-3111.
39 Seo WG et al. Inhibitory effects of methanol extract of seeds of Job’s Tears on nitric oxide and superoxide production in RAW 264.7 macrophages. Immunopharmacol Immunotoxicol 2000 Aug;22(3):545-54
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Sandri M, Dal Monego S2, Conte G3, Sgorlon S4, Stefanon B4.BMC Vet Res. 2017 Feb 28;13(1):65. Raw meat based diet influences faecal microbiome and end products of fermentation in healthy dogs.
14
Herstad KMV, Gajardo K, Bakke AM, Moe L, Ludvigsen J, Rudi K, Rud I, Sekelja M, Skancke E. A diet change from dry food to beef induces reversible changes on the faecal microbiota in healthy, adult client-owned dogs. BMC Vet Res. 2017 May 30;13(1):147. 15
Yin J, Zhang H, Ye J. Traditional Chinese medicine in treatment of metabolic syndrome. Endocr Metab Immune Disord Drug Targets 2008 Jun;8(2):99-111
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41 Kong LD, Yang C, QuiXi, Wu HP, Ye DJ. Effects of different processing products of Cortex Phellodendri on scavenging oxygen free radicals and anti-lipid peroxidation. Zhongguo Zhong Yao Za Zhi 2001 Apr;26(4):245-8.
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Craig JM. Atopic dermatitis and the intestinal microbiota in humans and dogs. Vet Med Sci. 2016 Feb 23;2(2):95-105
Park YK, Chung YS, Kim YS, Kwon OY, Joh TH. Inhibition of gene expression and production of iNOS and TNF-alpha in stimulated microglia by methanol extract of Phellodendri cortex. Int Immunopharmacol. 2007 Jul;7(7):955-62. Epub 2007 Apr 2
Miraglia del Giudice M, De Luca MG. The role of probiotics in the clinical management of food allergy and atopic dermatitis. J Clin Gastroenterol. 2004 Jul;38(6 Suppl):S84-5.
43 Chiu HF, Lin CC, Yang CC, Yang F. The pharmacological and pathological studies on several hepatic protective crude drugs from Taiwan(I). Am J Chin Med 1988;16(3-4):127-37
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42
Hope Science Vet
BUSINESS PROFILE
— real hope thanks to great science
D
r. Kim Vanderlinden, a naturopathic physician and doctor of Chinese medicine, knows about the power of alternative medicine. When a patient who suffered from debilitating pain for many years was given a new treatment that not only greatly reduced his discomfort, but ended his suicidal thoughts and restored his hope, Dr. Vanderlinden was inspired to start Hope Science, a company that provides effective joint pain relief for humans. Backed by years of research in labs and universities across North America, Hope Science’s cetylated oil-based formula for its joint product, Active Again, stands out for how easily it’s absorbed by inflamed and painful tissues, and how effective it is in fighting pain. In published peer-reviewed clinical trials, patients reported feeling the effects within half an hour of applying the topical cream. Encouraged by the growing number of pain-free human patients, Dr. Vanderlinden decided to bring cetylated oil’s pain-ending qualities to the world of pet care as well. An animal lover since he was saved from drowning at the age of six by his uncle’s Lab, Cindy, he feels grateful to be able to give back by helping pets in pain. Since he started with a natural product — Active Again is derived from a patented blend of food oils — Dr. Vanderlinden felt safe about making the transition to animal care. The formula proved to be a far more effective treatment for joint trouble in pets than glucosamine treatments, improving quality of life and extending longevity for animals across the country.
Dr. Vanderlinden also introduced another cetylated oil product for pets called DentaPet, to manage and improve the state of red bleeding gums, and organized a series of clinical trials to evaluate its effectiveness. He says it was very important to him to be able to show at every step that this treatment was actually making a difference in the health of patients. And it did. Red bleeding gums were seen to quickly become pink and healthy again. As Active Again has done for those with joint pain, DentaPet gives real hope for pets with oral health concerns. Active Again and DentaPet continue to end pet pain, keep cats and dogs moving, and even save their teeth. “People are so profoundly grateful when we are able to reduce their pets’ suffering,” says Dr. Vanderlinden, when he speaks about the joy of providing relief to animals in pain and the families who love them. “I get to hear from veterinarians and pet parents all the time about how Active Again or DentaPet has helped, and it always makes my day.” This drive to improve lives and give hope when it has been lost has remained at the center of Hope Science Vet’s work from the beginning. Check out their products and extensive research at HopeScienceVet.com. IVC Summer 2019
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KetoPet Sanctuary: KETOSIS, CANCER AND CANINES, PART 2
Non-profit organization KetoPet Sanctuary has tested the feasibility of using a ketogenic diet as an adjunctive therapy in dogs with cancer. In the second part of this article, we’ll look at the overall results of the program, along with some case studies. By Chelsea Kent; Shannon L. Kesl, PhD; Stacy A. Hodges, DVM; Loren Nations, DVM, DipABVP Cancers exhibit an altered energy metabolism characterized by glycolytic dependency and glucose fermentation in the presence of oxygen (the Warburg effect). Studies by Poff, et al, demonstrated that this metabolic phenotype can be targeted therapeutically with co-administration of a ketogenic diet (KD) and hyperbaric oxygen therapy (HBOT). To further explore this potential therapeutic regimen, KetoPet Sanctuary (KPS) open-enrolled 40 dogs with advanced cancer, which allowed them to examine survivorship beyond initial prognosis when adjunctive therapies such as a KD and HBOT were used with standard of care. KPS was structured as an open-registry, un-blinded, case history pilot study. The trial consisted of 120 days of therapy, followed by 180 days of follow-up, for a total of 300 days.
(Below) Buster relaxing during his HBOT session. (Inset) Izzy modeling the PET/CT Scanner with KPS staff.
METHODS Facility: Opening its doors in September of 2014, KPS was located on a 53-acre plot of land in Georgetown, Texas, 25 miles north of Austin. KPS included an outside miniature water park, playground, track and specialized dog treadmills. Additionally, KPS was equipped with large indoor living and play areas, onsite veterinary care, around the clock care/ monitoring, and exams rooms.
Standard of care: All dogs received standard veterinary care to safeguard their overall health and well-being, as well as oncological standard of care defined as surgical resection, radiation, chemotherapy, and the combination thereof. Various adjuvant supplements such as Metformin, Yunnan Baiyao, Pepcid and Benadryl were utilized on a veterinarianmonitored case-by-case basis to help dogs achieve ketosis and support standard of care.
Metabolic conditioning (MetCon): Metabolic conditioning (MetCon) can help prevent cancerrelated muscle loss and can boost the immune system while fighting cancer. Dogs at KPS were exercised one or two times per day for 20 to 30 minutes. All dogs received individual MetCon regimens based on their physical abilities or limitations.
Ketogenic diet (KD) therapy: A ketogenic diet is any nutritional program that can be validated to induce nutritional ketosis, via twice-daily measurement of blood ketones and glucose, with glucose levels consistently around 75 mg/dL and blood ketones consistently around 0.3 mM. KPS diets were formulated based on weight, body composition (to maintain a BCS of 4 out of 9), MetCon,
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DETAILS ON THE DOGS INCLUDED IN THE PROGRAM Most of the dogs at KPS were rescued from shelters in areas surrounding the sanctuary; however, a few were owned dogs who were returned to their families at the completion of the program.
Inclusion criteria:* 1. A confirmed neoplasia by histological evaluation (or less preferably, by cytology) 2. At least one PET/CT scan positive tumor 3. A measurable malignancy of at least 1 cm in diameter
Exclusion criteria:* 1. Brain metastasis 2. Significant cardiac, renal or neurologic comorbidities 3. An active state of malnutrition 4. No gallbladder 5. An estimated life expectancy of less than 12 weeks. *There were a few exceptions to these criteria on a case-by-case basis.
(Left) The 40 dogs enrolled at KPS were diagnosed with 14 types of cancer, encompassing 50 tumors as some dogs exhibited more than one type of cancer.
most recent PET/CT results or disease progression, blood glucose/ketone results, and other diagnostics. Caloric intake and macronutrient ratios were adjusted as often as necessary to attain metabolic goals. All dogs were fed a 0.5:1-4:1 ketogenic ratio. Dogs were fed variances of the following ingredients depending on diagnostic outcomes and personal needs: Protein: 70/30 raw beef, ground chicken breast or ground turkey Fat: Medium Chain Triglyceride (MCT) powder, coconut oil powder, avocado oil, avocado mayo, unsweetened coconut cream, heavy cream, red palm oil, ghee, grass-fed butter Low carb fibrous veggies: cabbage, green beans, broccoli, brussels sprouts Additions: prebiotics, probiotics, essential fatty acids, vitamins and minerals
Pet/CT Scans: Using a GE Discovery,16 slice PET/CT, dogs were scanned upon arrival at KPS (Day 0), then again at 60 and 120 days
into the program. Additionally, some dogs received a fourth post-treatment follow-up scan at day 300.
Hyperbaric oxygen therapy (HBOT): Dogs receiving HBOT were administered 100% Oxygen at 2.0-2.2 ATM, in a Sechrist 2500 Chamber, for 90 minutes per session (hatch to hatch), with 60 mins spent at depth. KPS dogs received their HBOT sessions alternating three days of treatment — one day off, two days of treatment, one day off — for 120 days.
KPS open-registry results KPS enrolled 40 dogs ranging from four to 14 years old, spanning 18 different breeds from small to large, and including 14 types of cancer, which encompassed 50 tumors. All dogs demonstrated reduced blood glucose (62.7 ±4.4 mg/dL) and elevated blood ketones (0.7±0.2 mM) while on the KD. In collaboration with Dr. Nations, KPS demonstrated that the observed blood glucose levels of 62.7 ±4.4 mg/dL were significantly lower when compared to dogs fed kibble alone, wet food alone, or a combination of kibble and wet food. At the end of the 120-day trial, 22 of the 40 dogs IVC Summer 2019
27
PROGNOSIS OUTCOMES SUMMARY Surpassed Prognosis = 11 (27.5%)‥
Haven’t Reached Prognosis = 3 (7.5%)
Did Not Reach Prognosis = 2 (5%)
Prognosis Not Available = 6 (15%)
Percent determined from the 40 dogs that entered the program.
completed the program, with eight dogs showing no evidence of disease; four showing decreased evidence of disease; five showing stable disease; and five showing increased evidence of disease. Additionally, six dogs passed away from cancer; two passed away from reasons other than cancer; and ten were unable to complete the program. Over four years later, eight dogs still have no evidence of disease; three have active cancer; and 11 have passed away (five
CANCER SURVIVAL AND PROGNOSIS OUTCOMES DOG
CANCER
PROGNOSIS*
1. Arnold
Mast Cell, Melanoma, 770 days Hemangiosarcoma, Squamous Cell Carcinoma
from cancer and six from other causes). Of the 22 dogs that completed the program, 11 have surpassed the original standard of care prognoses; two did not reach their prognoses; three have not yet reached their prognoses; and six were unable to receive prognoses due to lack of evidence-base on tumor type. These preliminary observations support the potential use of standard of care in combination with KD and HBOT as adjuvant therapies for dogs with advanced cancer. Continued on page 31.
DAYS SINCE DAYS SURVIVAL CURRENT (01/01/2019) CANCER STATUS DIAGNOSIS PROLONGED 1068
298
Cancer Free
2. Bill Murray Hemangiosarcoma, Mast Cell
780 days
804
24
Deceased 12/09/16, Day 804, Cancer
3. Blazer
Mast Cell
>1500 days
1363
-137
Cancer Free
4. Buster
Mast Cell
>1500 days
1414
-86
Cancer Free
5. Cali
Hemangiosarcoma
60-120 days
1527
1407
Cancer Free
6. Conan
Lymphoma
180-360 days
325
-35
Remission when released to owners (12/19/15, Day 177), Owners did not maintain dietary therapy, Deceased 4/19/16, Cancer
7. Dora
Mixed Mammary Tumor
90 days
1092
1002
Active Cancer
8. HoHo
Mast Cell
120 days
540
420
Deceased 05/20/16, Day 420, Necrosis and Infection
9. Izzy
Mixed Mammary Tumor
Not Available
1433
Not Available
Cancer Free
10. Kahlua
Mixed Mammary Tumor
Not Available
1209
Not Available
Deceased 06/15/17, Degenerative Joint Disease (Cancer Free)
11. Leo
Mast Cell
90 days
572
482
Deceased, 05/07/17, Cancer
12. Maverick
Hemangiosarcoma
780 days
1328
548
Active Cancer
13. Mini Mia
Mixed Mammary Tumor
Not Available
213
Not Available
Deceased 12/03/15, Day 213, Amonia Build Up on Brain Due to Liver Failure
14. Nera
Lymphoma
180-360 days
1286
926
Cancer Free
15. Percy
Squamous Cell Carcinoma Not Available
1087
Not Available
Deceased 11/28/18, Day 1087, Canine Cognitive Dysfunction (Alzheimers)
16. Rudy
Mast Cell
Less than 180 days
359
179
Deceased 8/18/16, 359 days, Cancer
17. Sally
Mast Cell
>1500 days
1149
-351
Deceased 11/25/15, Day 1149, Sand Ingestion
18. Shinobi
Anal Gland Adenoma
Less than 30 days
1455
1425
Cancer Free
19. Smoochie
Mixed Mammary Tumor
Not Available
570
Not Available
Deceased 7/26/16, Day 570, Cancer
20. Trixi
Mast Cell
>1500 days
1289
-211
Active Cancer
21. Trooper
Hemangiosarcoma
172 days
533
361
Deceased 01/19/17, Day 533, Foreign Body
22. Zoey
Mixed Mammary Tumor
Not Available
1232
Not Available
Cancer Free
*with surgical resection only, all prognoses determined by veterinarian, oncologists and/or pathologists. 28
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KPS CASE STUDIES ARNOLD
Mixed Breed/Pitbull Age: 12 Sex: male Diagnosed with: cutaneous G2 mast cell (MCT), cutaneous hemangiosarcoma, cutaneous melanoma, papillary squamous cell carcinoma Standard of care: Surgery Adjuvant therapies: KD, HBOT Additional medical issues: degenerative joint disease, idiopathic epilepsy
Arnold in a Hawaiian shirt while on vacation with his adoptive family. On 01/25/16, Arnold had surgery to remove 14 external masses, four of which came back malignant for four different types of cancer: cutaneous G2 mast cell, cutaneous hemangiosarcoma, cutaneous melanoma, and papillary squamous cell carcinoma. On 02/18/16, he received his first PET/CT scan, which showed two areas of uptake. His subsequent scans demonstrated decreasing areas of uptake and Arnold was PET/CT negative on his third scan on 06/23/16. On 09/28/16 (Day 243), three new MCTs were identified by fine needle aspirate (FNA). Arnold suffered idiopathic seizures commencing before 01/25/16. In April 2016, he was put on Keppra, 500mg TID, to control seizures. Keppra was reduced to 500 mg BID in December 2016; 500 mg SID in January 2017; and 250 mg SID in February 2017. By March 2017, he was completely weaned off his medication with no seizure recurrence. Arnold was given a prognosis of 770 days; yet, as of 01/01/2019 (298 day beyond prognosis), he is thriving cancer- and seizure-free with his adopted family in Texas.
DATE OF DIAGNOSIS
DATE OF KPS ENTRY
PROGNOSIS
SURVIVAL TIME (AS OF 01/01/2019
120-DAY AVERAGE BLOOD GLUCOSE
120-DAY AVERAGE BLOOD KETONE
01/29/2016
02/18/2016
770 days
1,068 days
48.5 +/- 10.4 mg/dL
0.8 +/- 0.4 mM
PET/CT SCAN DATE
DAY OF PROGRAM
2/18/16
AREA #1
AREA #2
AREA #3
Location
SUV
Size (cm)
Location
SUV
Size (cm)
Location
SUV
Size (cm)
0
Lateral sides of skull
4.44
-
Midline scrotal area
2.7
-
N/A
N/A
-
4/21/16
60
Lateral sides of skull
$0.0
-
Midline scrotal area
$0.0
-
Rear of skull
4.5
-
6/23/16
120
Lateral sides of skull
$0.0
-
Midline scrotal area
$0.0
-
Rear of skull
$0.0
-
CALI
Cali was KPS’s first program graduate. Her cancer was discovered by her previous owner when she was Age: 10 pregnant. On 09/30/14, what Sex: female was expected to be a large litter of puppies was revealed by Diagnosed with: ultrasound to be only one puppy epithelioid and a 6 cm abdominal tumor. hemangiosarcoma The vet conducted an FNA which Standard of care: revealed a possible epithelial neoplasm, surgery possible carcinoma. On 10/27/14, Cali Adjuvant therapies: received surgery to remove the tumor, KD, HBOT, IV Vitamin C which was later diagnosed as epithelioid Additional medical issues: none hemangiosarcoma. The histopathology (Above) Cali enjoying a dip in the water feature at KPS report noted that the tumor was intimately Vizsla
adhered to the distal duodenum, left ureter and aorta. On 12/17/14, Cali entered the KPS program where her first PET/CT scan showed two areas of uptake suggestive of neoplasia. Her subsequent PET/CT scans showed decreased uptake and Cali was PET/CT negative at 120 days. As of 01/01/2019, Cali has reached 1,527 days since her histopathological diagnosis, 1,476 days since the start of the program, and has surpassed her prognosis by over 1,400 days. She is thriving cancer-free with her adopted family in Texas.
DATE OF DIAGNOSIS
DATE OF KPS ENTRY
PROGNOSIS
SURVIVAL TIME (AS OF 01/01/2019
120-DAY AVERAGE BLOOD GLUCOSE
120-DAY AVERAGE BLOOD KETONE
10/27/2014
12/17/2014
60-120 days
1,527 days
63.1 +/- 8.3 mg/dL
0.6 +/- 0.2 mM
PET/CT SCAN DATE
DAY OF PROGRAM
AREA #1
AREA #2
Location
SUV
Size (cm)
Location
SUV
Size (cm)
12/17/14
0
Sternal Lymph
2.7
2.0
Ventral abdomen
4.4
-
2/19/15
60
Sternal Lymph
$0.0
$-
Ventral abdomen
$2.7
-
4/15/15
120
Sternal Lymph
$0.0
$-
Ventral abdomen
$0.0
-
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29
KPS CASE STUDIES JUNIOR Pitbull
Age: 4 Sex: male Diagnosed with: splenic hemangiosarcoma Standard of care: surgery Adjuvant therapies: KD, HBOT, IV Vitamin C Additional medical issues: none Junior was a four-year-old pit bull who was diagnosed with splenic hemangiosarcoma on 3/21/2015 via biopsy. He entered the KPS program and received his first PET/CT scan on 04/29/15, which revealed one area of uptake. However, the scan did not show any abnormalities of the spleen. On 7/9/15, PET/CT showed no abnormal areas of uptake. This scan was completely devoid of any abnormalities on the spleen or elsewhere. On 08/08/15, an ultrasound revealed a large cavitary splenic mass, which lead to an immediate splenectomy. About a month after his splenectomy, Junior became lethargic with white gums. An ultrasound revealed blood in his abdomen. He received
Junior enjoying time outside at KPS. a blood transfusion and his abdomen was drained to make him comfortable. An additional ultrasound revealed multiple bleeding masses in his abdomen. On 09/07/15, Junior passed away as a result of an internal hemangiosarcoma hemorrhage. Necropsy confirmed evidence of tumors throughout much of the abdominal cavity. Even though Junior passed away due to cancer, he successfully surpassed his initial prognosis of 120 days. This case evidences the necessity of multiple diagnostic technologies in cancer detection, as certain technologies identify abnormalities in some areas of the body more effectively than others.
DATE OF DIAGNOSIS DATE OF KPS ENTRY
PROGNOSIS
DECEASED (CANCER) ON 09/07/2015
03/21/2015
60-120 days
Day 180
04/25/2015
120-DAY AVERAGE BLOOD GLUCOSE
120-DAY AVERAGE BLOOD KETONE
74.6 +/- 22.6 mg/dL
0.6 +/- 0.3 mM
PET/CT SCAN DATE
DAY OF PROGRAM
4/29/15
AREA #1 Location
SUV
Size (cm)
0
Medial Left Rib
4.8
2x1
7/9/15
60
Medial Left Rib
$0.0
$-
N/A
120
N/A
N/A
$-
Reference Drake, A. “Should my dog with cancer still exercise?� Dog Cancer Blog. 2018. Available at dogcancerblog.com/articles/full-spectrumcancer-care/brain-chemistry/dog-with-cancer-exercise/.
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HYPERBARIC OXYGEN BENEFITS The delivery of supra-physiological levels of oxygen under pressure:
•S uper-saturates the blood plasma and hypoxic tumor microenvironment
• I nhibits HIF-1 • I ncreases ROS production •D own-regulates inflammatory pathways HBOT is modestly effective as monotherapy.
Continued from page 28.
SUMMARY Case studies (see sidebars on pages 29-30) selected from KetoPet Sanctuary represent the most dramatic examples of what can be learned from integrating novel adjuvant therapies with standard of care when addressing various tumor models in canine cancer. The primary takeaway lesson from this integrative approach is that while powerful for extending survivorship and quality of life, inducing sustained nutritional ketosis via a ketogenic diet and the consistent application of HBOT does not constitute a cure-all. Additional observations are needed to determine and optimize how these adjuvant therapies help various tumor types. Addressing cancer successfully requires early detection, a multi-modality approach to intervention, and the meticulous care of a veterinary oncologist in partnership with passionate pet parents. Notably, some standard of care diagnostics (PET/CT) and adjuvant therapies (HBOT) that KPS utilized are not commonly feasible in a veterinary clinical setting, nor particularly reproducible in the home. Despite these limitations, the central pillars of a metabolic approach to addressing cancer, including caloric and macronutrient control and metabolic conditioning (rigorous exercise), are highly accessible, should pet parents and medical practitioners be excited about committing to them. The KetoPet team of veterinary oncologists and research scientists gained unprecedented insights from addressing cancer as a disease of metabolism. Incorporating this approach with standard of care offers a new potential for dogs to live long vibrant lives.
From the AAVA The American Academy of Veterinary Acupuncture (AAVA) is committed to improving animal health care through the advancement of veterinary acupuncture. The AAVA’s seat within the American Veterinary Medical Association (AVMA) House of Delegates (HOD) gives us multiple opportunities to represent veterinary acupuncture. The AAVA strives to bring veterinary acupuncture practitioners together to promote acupuncture to veterinarians and the public.
This year marked the AAVA’s 14th Annual Meeting, which ran from April 5 to 7 in Portland, Oregon. It challenged attendees to look at veterinary acupuncture from different perspectives. Speakers included experts from both traditional and scientific approaches to veterinary acupuncture. The annual AAVA Lifetime Achievement Award was presented to Dr. Linda Boogie, DVM, who lectures for many acupuncture courses around the world. She has been an active member of both the International Veterinary Acupuncture Society (IVAS) and the AAVA. AAVA and IVAS have joined forces this year to provide CE meetings. A small animal regional meeting, co-sponsored by the Ohio Veterinary Medical Association, is scheduled for June 22 and 23, featuring Dr. Laurie McCauley, DVM. On October 6, AAVA and IVAS will sponsor a one-day equine regional meeting in Del Mar, California, featuring Dr. Kevin May, DVM. The AAVA’s 15th Annual Meeting will be held April 16 to 19, 2020 at the Peabody Hotel in Memphis, Tennessee. Visit aava.org to learn more.
Acknowledgements The authors of this paper want to acknowledge the veterinarians, veterinarian oncologists, veterinarian technicians and workers who spent tireless hours making sure the dogs had the best quality of life at KPS. In memory of the canines that have passed, thank you for letting us be a part of your story. This open registry was supported by the Epigenix Foundation. IVC Summer 2019
31
EYES:
ILLUMINATING THE AGING PROCESS By Carmen M.H. Colitz, DVM, PhD, DACVO and Terri McCalla, DVM, MS, DACVO
While aging is a natural part of life, genetic and environmental factors dictate the aging process and the eyes reflect how well we (and our animal patients) age. Nowhere is this truer than in the lens, which contains cells from every stage of our lives, including even embryonic and fetal cells within the nucleus. The living lens literally encapsulates the aging process, making our eyes the window through which to observe the body’s health. Eyes are exposed to constant oxidative stress from sunlight, allergens, pollution and diet. Every individual ages a little differently and at different rates depending on his or her overall health and genetics. Vision declines gradually with age in some patients, and faster in others. “Cataract” is a term commonly used to describe cloudy eyes, but many abnormalities can cause your patients’ eyes to look opaque. From external (cornea) to internal (lens and vitreous) structures, any of these normally clear tissues can appear cloudy with natural aging. The aging cornea can accumulate lipid or cholesterol deposits, which are exacerbated if high serum cholesterol and/or triglyceride levels are present. Older dogs commonly develop non-healing (“indolent”) superficial corneal ulcers (erosions). Aberrant calcium deposits can occur, which may trigger corneal ulceration in aged animals; severely affected dogs are usually older and have very deep ulcers or even perforated corneas. Sadly, sometimes enucleation or euthanasia is needed because therapy is not effective or even possible. Nuclear sclerosis is a hardening of the aging lens nucleus and manifests as a bluish hazy appearance. This does not typically interfere with sight. Cataract formation increases with age. Though older dogs are commonly presented for cataract evaluation, they often have nuclear sclerosis and not cataracts. Elderly dogs have senile retinal degeneration due 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.
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to rod photoreceptor loss, which causes poor vision in dim light, especially at night. The vitreous can develop opacities with age through liquefaction (“syneresis”) or by forming multiple “floaters” (“asteroid hyalosis”). Natural aging in all cells is hypothesized to occur through a variety of pathways, including damage to cell membranes, shortening of telomeres, accumulation of oxidative stress, mitochondrial decline, excessive physiologic stress resulting in damage to the hypothalamus, and many others. Natural dietary antioxidants protect mitochondria and cell membranes and slow telomere shortening.
• Grapeseed
extract is a potent free radical scavenger that protects lens cells from UV damage.
• Lutein,
zeaxanthin and astaxanthin carotenoids protect against lipid peroxidation, accumulating in the cornea, lens and retina; and act as blue light filters in the retina.
• Omega
3 fatty acids protect the retina against oxidative stressors, including light and aging.
• Vitamins
C and E protect the retina against blue light damage. Vitamin C is present in the lens and aqueous humor, while vitamin E is highly concentrated in the retina.
• Alpha
lipoic acid potentiates vitamin C and E levels and increases the body’s production of glutathione.
• Coenzyme Q10 protects against lipid peroxidation, which decreases with aging. Aging causes a gradual decrease in gastrointestinal nutrient absorption, so as our patients age, daily dietary supplementation with antioxidants that are important for ocular health is an essential strategy for healthy eyes. 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.
PEER-REVIEWED
An integrative approach to DEMODECTIC MANGE Canine demodicosis can be a frustrating disease state to treat in small animal practice. An integrative approach using herbs, nutrition and acupuncture provides faster resolution of the presenting problem, while also addressing underlying imbalances. By Alexia Tsakiris-Vasilopoulos, BvetMed, GDipVWHM, CVA
Canine demodicosis is a non-contagious parasitic dermatosis commonly seen in small animal practice. It is characterized by excessive proliferation of the commensal mite, Demodex canis, within the hair follicles and sebaceous glands.1 Demodecosis can be localized or generalized, with localized cases being easier to resolve. Generalized demodicosis is typically more difficult to treat and often complicated by secondary bacterial infections. 2 However, an integrative approach to treatment that draws on herbs, nutrition and acupuncture can be effective.
HOW DOES CANINE DEMODICOSIS ARISE? The progression to pathological disease is influenced by many factors, including genetic defects, alteration of the skin’s structure and biochemistry, immunological disorders, immuno-suppressive therapies, hormonal status, breed, age, nutritional status, oxidative stress, length of hair coat, stage of oestrus cycle, parturition, endoparasitism and the presence of debilitating diseases.1,3 Typically, the number of mites is kept low by the dog’s immune system, but overpopulation of host-specific follicular Demodex mites results in demodicosis, with the cutaneous microenvironment playing a role in the development of disease. 3 There are typically multiple reasons why the Demodex mites are able to multiply beyond the control of these patients’ immune systems. Many are under extreme stress, experiencing relocation to a foster home or shelter after having been shipped and sterilized the same day, while simultaneously adjusting to new diets, routines, caregivers and environments. Other patients have an underlying disease such as cancer, hypothyroidism or hyperadrenocorticism. An integrative approach to demodicosis should address as many of these predisposing factors as possible, as well as environmental stressors.
CONVENTIONAL TREATMENTS LEAD TO FRUSTRATION Practitioners are often frustrated when it comes to treating canine demodicosis, since current therapeutic treatment options are of variable efficacy, none has been deemed most effective, and they’re often are associated with potentially severe side effects.4,5 A recent (2019) detailed search of the literature recommends not using Amitraz topical, since it is backed by only a single study. Moxidectin has a 37% chance of severe side effects, and the oral use of Afoxolane also has only one research reference. 5 A common conventional treatment, oral Ivermectin, which is known to have potential neurotoxicity side effects, is often used alongside a benzoyl
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Left: Josie, at time of adoption, when she was one year of age. She had just completed a round of antibiotics for severe demodicosis and secondary bacterial infection, and had been on oral Ivermectin for one month. Below: Josie, five months later, following integrative treatment that included Si Miao San, ashwagandha tincture, gotu kola, calendula, passion flower, Echinacea, and astragalus. Probiotics and a dehydrated diet were also utilized. She was bathed weekly with a medicated shampoo followed by a rinse of calendula tea. Josie’s guardian also diffused essential oils of chamomile, lavender, ylang ylang and bergamot to help with her anxiety.
peroxide shampoo, followed by topical Amitraz. Treatment may go on for months in severe cases, leading to frustrated owners and suffering patients. To effectively treat the current condition as well as resolve the predisposing factors, holistic modalities including herbal medicine, nutrition and acupuncture should be utilized.
HERBAL MEDICINE When formulating an herbal combination for demodicosis, pre-existing conditions of immunodeficiency, poor gut health, secondary bacterial infections, circulation to the integument, stress and allergies should be addressed.
Immuno-modulation The inclusion of herbal immuno-modulators such as ashwagandha (Withania somnifera), punarnava (Boerhaavia diffusa), aloe vera, turmeric (Curcuma longa) and tulsi (Ocimum sanctum) resolved demodicosis in four weeks when combined with conventional treatments, as compared to eight weeks to using Ivermectin and Amitraz alone.1 Demodex canis mites have the ability to down-regulate CD4+ T cells, with increased apoptosis of peripheral leukocytes, contributing to the progression of clinical disease manifestation. Olive leaf extract (Olea Europaea) is an example of an herb known to modulate CD4+ T cells and increase the production of leukocytes.6 Eleuthero root (Eleutherococcus senticosus) increases T lymphocytes, especially helper T cells, as well as cytotoxic and natural killer cells.7 Cat’s claw (Uncaria tomentosa) is an immune stimulant that normalizes lymphocytes, possibly with cytokine modulation, and stimulates the transition of immature CD4+ and CD8+ T cells into mature CD4+ helper lymphocytes.8 Mites also elevate Tumor Growth Factor beta (TGF-β) and inhibit Tumor Necrosis Factor alpha (TNF alpha) mRNA expression.3 TNF alpha is an inflammatory cytokine produced by macrophages/monocytes during acute inflammation, and
is responsible for a diverse range of signaling events within cells, leading to necrosis or apoptosis. The protein is also important for resistance to infection and cancers.9 Olive leaf extract modulates TGF-β and TNF-α mRNA expression.6 Maitake (Grifola frondosa) supports TNF production while enhancing T-4, T-8 and NK function.10 It has been hypothesized that elevated IL-10 levels account for the occurrence and recurrence of demodicosis in dogs.3 Olive leaf extract has been found to decrease levels of IL-10, which serves to maintain the equilibrium between IL-10 and IL-17, an important factor in the prevention of chronic inflammatory, autoimmune and allergic diseases.6,11 Other immunemodulating herbs helpful in these cases include astragalus (Astragalus membranaceus), Asian ginseng (Panax ginseng), reishi (Ganoderma lucidum), maitake (Grifola frondosa), shitake (Lentinus edodes), turkey tail (Trametes versicolor), cordyceps (Cordyceps sinensis), and Echinacea (Echinacea purpurea).
Addressing secondary infections and supporting the liver When utilizing integrative therapeutic approaches, it is important to address secondary infections as well as provide gut and liver support, especially in cases where pharmaceuticals are also being used. Secondary bacterial infections can be addressed with Echinacea (Echinacea purpurea), Oregon grape (Mahonia aquifolium) and Pau d’Arco (Tabebuia spp.). The liver can be supported with a combination of calendula (Calendula officinalis), milk thistle (Silybum marianum), dandelion leaf (Taraxacum officinale), cleavers IVC Summer 2019
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HERBS USEFUL IN THE TREATMENT OF DEMODECTIC MANGE Immuno-modulating herbs Ashwagandha (Withania somnifera) Punarnava (Boerhaavia diffusa) Aloe vera Turmeric (Curcuma longa) Tulsi (Ocimum sanctum) Olive leaf extract (Olea Europaea) Eleuthero root (Eleutherococcus senticosus) Maitake (Grifola frondosa) Cat’s claw (Uncaria tomentosa) Astragalus (Astragalus membranaceus) Asian ginseng (Panax ginseng) Reishi (Ganoderma lucidum) Shitake (Lentinus edodes), Turkey tail (Trametes versicolor) Cordyceps (Cordyceps sinensis) Echinacea (Echinacea purpurea) Xiao Yao San (XYS)
Herbs to address secondary infections and support the liver Echinacea (Echinacea purpurea) Oregon grape (Mahonia aquifolium) Pau d’Arco (Tabebuia spp.) Calendula (Calendula officinalis) Milk thistle (Silybum marianum) Dandelion leaf (Taraxacum officinale) Cleavers (Galium aparine) Gotu kola (Centella asiatica) Cat’s claw (Uncaria tomentosa) Red clover (Trifolium pretense)
Adaptogenic herbs Ashwagandha (Withania somnifera) Korean ginseng (Panax ginseng) Eleuthero root (Eleutherococcus senticosus)
Topical herbs Ginger (Zingiber officinale) (crude extract combined with lemon) Neem (Azadirachta indica) Calendula (Calendula officinalis)
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(Galium aparine), gotu kola (Centella asiatica), cat’s claw (Uncaria tomentosa) and red clover (Trifolium pretense).
of the skin with its vulnerary and antiinflammatory properties, as its flowers are rich in flavonoids and carotenoids.15
Adaptogenic herbs and managing stress
NUTRITION
The author has seen many cases of demodicosis in puppies from stressful housing situations, as well as in older dogs with underlying disease causing emotional and physical strain. Adaptogenic herbs are essential in these cases to address the underlying psychological stress from chronic disease as well as environmental stressors. An adaptogen acts by increasing the animal’s resistance to a broad spectrum of adverse biological, chemical and physical factors, while regulating his organ and system function. Ashwagandha (Withania somnifera), which not only helps modulate the HPA axis, but also has been found to have a strong anti-inflammatory effect, assists in integument healing. Other useful adaptogens include Korean ginseng (Panax ginseng) and eleuthero root (Eleutherococcus senticosus). In cases where the dog has a TCVM diagnosis of Blood deficiency, the formula Xiao Yao San (XYS) is indicated. XYS is a traditional Chinese medicine formulation that relieves depression and nourishes the liver. Its active ingredients can raise the expression of the glucocorticoid receptor and recover the negative feedback of the HPA axis to relieve stress and illness.12
Topical herbal treatments Topical treatment with crude extracts of ginger (Zingiber officinale) and lemon, juiced, mixed, diluted in water and applied to affected areas, resulted in faster recovery when combined with Ivermectin, than when Ivermectin was used alone.4 Topical neem (Azadirachta indica) on affected areas can suppress mite numbers along with diluted essential oils of lavender and eucalyptus.13,14 A rinse of calendula tea improves healing time
Improving the plane of nutrition is another essential step in assisting these cases. A poor quality diet will play a role in the development of disease and the propagation and perpetuation of demodicosis. A fresh food diet, either cooked or raw, is the gold standard; multiple pro-inflammatory factors are associated with kibble diets (including the Maillard reaction).16 The more bioavailable the nutrients are, the better patients are able to absorb and use them in all systems.17 Nutritional supplements such as glutamine will repair and improve intestinal barrier function as well as the immune system and general overall health. Improving gut health also entails microbiome restoration, since 80% of the immune system is in the gut. A non-processed diet will support the gut microbiome as well as the skin microbiome. Probiotic supplementation activates dendritic cells, macrophages and monocytes to provoke specific helper T cell responses that elicit immuno-modulatory effects on not only the intestinal but also the systemic immune system.18 Leaky gut syndrome can be addressed with colostrum, fecal transplants, probiotic supplementation and non-processed diets.
ACUPUNCTURE From a TCVM perspective, acupuncture decreases inflammation and improves the immune system, blood flow to the integument, HPA axis balance, and thyroid and thymus function. Patients with demodicosis are often characterized as Blood deficient, with secondary Wind and accompanying pruritus. A secondary bacterial infection may also lead to Damp Heat. Acupuncture points
should be chosen based on the patient and his tongue and pulse diagnosis. Points that can be helpful for Damp Heat are BL17, ST40 and SP10. Acupuncture up-regulates NK cell activity. Studies have shown that electroacupuncture (EA) stimulation of the acupuncture point ST36 induces secretion of β-endorphins and increases levels of IFN-γ, which enhance splenic NK cell activity. ST36 also suppresses the increase of Th2 cytokines, especially IL-4.19 A number of brain imaging studies in animals have shown that EA treatment activates the hypothalamus, a primary center for neuroendocrine-immune modulation, and regulates activities of the autonomic nervous system. Another point that would be helpful for immune modulation is LI4.
CONCLUSION Demodicosis can be a frustrating condition to treat, but a cohesive integrative approach will help patients heal faster, while also decreasing pharmaceutical side effects and treating underlying predisposing and secondary factors.
1 Kachhawa JP, AP Singh, A Ahuja, A Sharma, S Kachhawaha, M Srivastava. “Clinical Management of Canine Demodicosis with Acaricides and Herbal Immunomodulator”. Intas Polivet 17 (1), 2016:188-190.
Kuznetsova E, Bettenay S, Nikolaeva L, Majzoub M, Mueller R. “Influence of systemic antibiotics on the treatment of dogs with generalized demodicosis”. Vet. Parasitol. 188 (1–2), 2012, 148–155.
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Singh SK, Umesh D. “The immune-pathological conversions of canine demodicosis”. Veterinary Parasitology 203: 1-5, 2014.
3
Roy S, M Roy, T Ottalwar. “Therapeutic Management of Demodicosis in Canines”. Intas Polivet 17, 2016 (1): 186-187.
4
Perego R,. et. al. “Critically appraised topic for the most effective and safe treatment for canine generalized demodicosis”. BMC Veterinary Research; 15-17, 2019. 5
6 Magrone T, et. al. “Olive Leaf Extracts Act as Modulators of the Human Immune Response”. Endocrine, Metabolic & Immune Disorders — Drug Targets, 2018, 18: 85-93.
Bohn B, CT Nebe, C Birr. “Flow-cytometric studies with eleutherococcus senticosus extract as an immunomodulatory agent”. Arzneimittelforschung. Oct;37(10):1193-6, 1987.
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Domingues A, et al. “Uncaria tomentosa Aqueous-ethanol Extract Triggers an Immunomodulation toward a Th2 Cytokine Profile”. Phytother. Res.25: 1229–1235, 2011.
8
Idriss HT, JH Naismith. “TNF alpha and the TNF receptor superfamily: structure-function relationship(s)”. Microsc Res Tech. 2000 Aug 1;50(3):184-95. 9
Wu SJ, Lu TM, et al, “Immunomodulatory Activities of Medicinal Mushroom Grifola frondosa Extract and its Bioactive Constituent”. Am J Chin Med, 2013;41(1):131-44. 10
Kim HW, et al. “Dietary Lutein stimulants immune response in canine”. 2000. Vet Immunol, 74(3-4):315-327.
11
Lu J, Fu L, Qin G, Shi P, Fu W. “The regulatory effect of Xiao Yao San on glucocorticoid receptors under the condition of chronic stress”. Cell Mol Biol (Noisy-le-grand). 2018 May 15;64(6):103-109.
12
Mulla MS, Su T. “Activity and biological effects of neem products against arthropods of medical and veterinary importance”. J Am Mosq Control Assoc 15(2):133-152, 1999.
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14 O’Brien DJ. “Treatment of psoroptic mange with reference to epidemiology and history”. Vet Parasitol 83 (3-4): 177-185, 1999.
Preethi KC, Kuttan R.,” Wound Healing Activity of Flower Extract of Calendula officinalis”. J Basic Clin Physiol Pharmacol., 2009;20(1):73-9. 15
Van Rooijen C, Bosch G, Van Der Poel AFB, Hendriks WH, Wierenga PA. “The Maillard reaction and pet food processing: Effects on nutritive value and pet health”. Nutrition Research Reviews, v26 n2 (2013 01 01): 130-148. 16
Girodon F, et al. “Impact of trace elements and vitamin supplementation on immunity and infections in institutionalized elderly patients”.
17
Fong FL, Shah NP, Kirjavainen P, El-Nezami H. “Mechanism of Action of Probiotic Bacteria on Intestinal and Systemic Immunities and Antigen-Presenting Cells”. Int Rev Immunol. 2016 May 3;35(3):179-88.
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Sun Kwang Kim, Hyunsu Bae. “Acupuncture and immune modulation”. Autonomic Neuroscience: Basic and Clinical 157:38-41, 2010.
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.
HOMEOPATHY FOR HOTSPOTS Hotspots are a hallmark of allergic skin disease. These painful lesions can appear “out of nowhere” and drive dogs mad with itching. Witch hazel, green tea and aloe vera are helpful supportive treatments for topical use. In addition, the following acute homeopathic remedies, with their indications, will help with hotspots:
• Apis — These hotspots are usually swollen, red or white in color, and very sensitive (think bee sting)
• Belladonna — As with other Belladonna conditions, these hotspots appear quickly and are very intense — hot, red and painful. The patient may be more irritable and anxious and is usually thirsty. (Compare this with Apis, which is usually thirstless.)
• Graphites — Indicated for chilly, obese dogs with sores in the bends of their limbs or skin folds, with sticky honey-colored discharge. Skin may be cracked.
• Hepar sulph — Similar to Graphites, but discharge is very foul-smelling; the odor fills the room. These are very painful sores; the dog may be aggressive if the area is touched. Heat is soothing.
• Mercurius solubilis — Sores tend to ulcerate, with greenish discharge or yellowish crust. Pustules or pimples are present and enlarged glands (lymph nodes) may be noticed.
• Rhus toxicodendron — Sores are more itchy than painful and may look similar to poison ivy. The dog may be restless, as motion gives relief, and may also have stiff joints, which improve with motion. After the hotspot storm passes, find the matching chronic remedy to follow up the acute treatment.
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Submitted by Todd Cooney DVM, CVH IVC Summer 2019
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industry innovations T cell immunotherapy treatment for canine cancer
A patented vaccine-primed T cell immunotherapy treatment is now available in select specialty hospitals. ELIAS Animal Health has launched ECI®, which uses vaccines derived from a dog’s cancer tissue to generate an immune response. T cells stimulated by the vaccines are then obtained from the patient through apheresis and activated to produce a large population of killer T cells that are re-infused into the patient to complete the treatment. Clinical trials are evaluating this treatment as a platform for multiple cancer types. In the ECI-OSA-001 study, researchers found the treatment was safe and tolerable with a median survival time of 415 days. Study results include complete and partial responders and, in some cases, remission or stasis of metastatic disease. eliasanimalhealth.com
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infections and viral ailments. The product is formulated by veterinarians and contains nine active natural ingredients that help maintain your patients’ skin and coat, support hydration, and benefit the immune system and wellness. Available in both oral capsule form and a soothing anti-itch cream. AnimalNecessity.com
For use with dogs and horses during tick season
When a tick bites an animal, the interleukin 2 levels are reduced by components in the tick saliva, which inhibits his TH1 immune response. Spirochetes then colonize the tissues of the weakened system. Ingested daily throughout tick season, Bor-L-Immune® will help support and increase the Interleukin 2, Th1 and Th2 immune response in dogs and horses. It contains five herbs (Japanese knotweed, cat’s claw, astragalus, neem leaf and andrographis) that work in synergy to support a healthy immune response. BLI is active against many gramnegative and gram-positive bacteria, and crosses the blood-brain barrier, protecting the brain specifically against oxidative, bacterial and microbial damage. Some key actions for overall system health include: • Protects heart muscle • Enhances CD-4 white blood cells, raises CD57 and NK cells
• Creates an uninhabitable environment for spirochetes • Enhance normal liver, spleen and thymus function • Antiparasitic, immune potentiator, blood cleanser • Stimulates lymphatic movement, provides vitamin C
sustenanceherbs.com
Unique super premium pet food
Encouraging your clients to feed high quality diets helps your canine and feline patients stay healthier. Made from top quality Canadian-grown protein sources, fruits, vegetables and vitamins, Maples Avenue super premium pet food offers a unique twist — it includes a small amount of Canadian maple syrup, an irresistible naturally-occurring sweetener. This totally balanced and highly palatable food also contains essential DHA and Omega oils and is great for all life stages. maplesavenue.com 38
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Recommending the right supplements to your clients: how the NASC can help The National Animal Supplement Council (NASC) is improving and standardizing the animal supplement industry by awarding their Quality Seal to companies that meet their rigorous standards, and paving the way to better health solutions for your clients. Veterinary clients can walk into almost any pet specialty store, supermarket or vet clinic and find a selection of pet supplements designed to help dogs and cats live their best lives. Whether your clients are looking to help their animals fight discomfort, anxiety, or the ravages of age, they will be faced with an abundance of options and will look to you for guidance in determining what is best for their beloved companions. Today’s pet supplement industry is valued at nearly $2 billion and, often, veterinarians are asked to help navigate this overwhelming landscape. This abundance of options is a far cry from when animal health supplements were once in grave danger of being removed from the marketplace entirely, potentially leaving pet owners unable to obtain the products their pets relied on. The Dietary Supplement Health and Education Act of 1994 (DSHEA) is a statute of US federal legislation that defines and regulates human dietary supplements. But the FDA declared that the DSHEA didn’t apply to
Encourage your clients to look for the NASC Quality Seal when they buy animal health supplements. Doing so will help ensure that your patients’ health is being supported by a responsible supplier who is committed to attaining the highest standards of quality and vigilance.
animal supplements, despite their similarity to human products. Dietary supplements for companion animals weren’t recognized by the FDA as a class of products and instead had to be classified either as food or drugs, depending on their intended use. Products that were improperly marketed as animal food were at risk of being pulled from store shelves. These events led to the creation of a council that can help you steer your patients toward quality choices. Concerned that pet owners would soon lose access to animal health supplements, a group of small business owners in the animal supplement industry banded together in 2001 to form the non-profit National Animal Supplement Council (NASC). The NASC’s mission is to promote the health and well-being of companion animals and horses that are given animal health supplements by their owners, and to protect and enhance the animal health supplement industry. Through close collaboration with federal and state regulators, the NASC successfully achieves self-regulation and provides a complete regulatory roadmap for members. NASC members are responsible suppliers of animal health supplements from around the globe, and are committed to quality, vigilance and Visit animalsupplements.org for a complete list of continuous improvement within NASC members that have earned permission to display the Quality Seal their companies andon their theproducts. industry. The NASC Quality program provides
strict guidelines for product quality assurance, adverse event reporting and labeling standards. Members must earn permission to display the Quality Seal by passing a comprehensive facility audit every two years, maintaining ongoing compliance with rigorous NASC quality standards, and passing random independent testing of their products to help ensure they are meeting label claims.
Look for the quality seal, and find peace of mind. The NASC Quality Seal makes quality visible. When you see the Quality Seal on a product, you can trust it comes from a reputable company that has achieved compliance with our rigorous quality standards. Stringent labeling compliance
Random product testing
Ingredients reviewed by NASC Scientific Advisory Committee
Documented quality control & production procedures
Real-time product monitoring in NASC Adverse Event Reporting Systems (NAERS™)
www.NASC.cc IVC Summer 2019
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Anal sac anal gland adenocarcinoma — how combination therapy impacts outcome Surgery, drugs and nutraceuticals for ASAGACA, from the perspective of the surgeon and oncologist. By Steve J. Mehler, DVM, DACVS and Craig A. Clifford, DVM, MS, DACVIM (Oncology)
Tumors of the anal sac are often thought of as a local disease. But like all malignant conditions, the local development of the primary tumor, the behavior and spread of the tumor (grade and stage, respectively) and the outcome of intervention are all related to the systemic conditions that exist at any point during the disease process. The comprehension of any disease process (not just cancer) at this level provides the veterinarian with a unique opportunity to intervene on many levels â&#x20AC;&#x201D; both providing more options for the pet parent and improving outcomes for the patient. This article will define and describe ASAGACA, and discuss traditional treatment interventions and outcomes as well as adjunct interventions from the perspective of functional food. Tumors of the anal sac are uncommon and represent a small percentage of all skin tumors in dogs (<2%). The most common malignant tumor of the perianal region is the anal sac (gland) carcinoma, accounting for 15% to 20% of all perianal tumors. These tumors are locally invasive and metastasize early in the course of disease. The average age of dogs diagnosed with this disease is ten or 11 years, and there does not appear to be a breed or sex predilection. These tumors are often noted as an incidental finding on a routine rectal examination. If patients present with clinical signs, the most frequently reported are perianal swelling, straining to defecate, licking at the perianal region and bleeding. It is important to measure the size of the tumor because this is prognostic. In some cases, the only presenting signs are polyuria and polydipsia secondary to hypercalcemia, which is the most common paraneoplastic syndrome seen in dogs with ASAGACA, occurring in almost 30% of cases.
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DIAGNOSTICS AND STAGING Standard pre-operative workup includes a CBC and blood chemistry, including an ionized calcium level, as well as urinalysis. Imaging studies are indicated, including threeview thorax radiographs to assess for pulmonary metastasis, and abdominal ultrasound to evaluate the regional lymph nodes, which are the most commonly affected with metastatic spread. Ultrasound is superior to abdominal radiographs for assessing the abdominal lymph nodes, but if ultrasound is not available, enlarged lymph nodes can be identified on radiographs. Computed tomography of the thoracic and abdominal cavities is a superior imaging modality and offers many advantages over radiographs and ultrasound, including cost in some cases. Aspirates/biopsy of the tumor or regional lymph nodes are necessary for clinical staging and therapeutic assessment, when possible. The size of the anal sac tumor does not dictate the presence of metastatic disease. Abdominal ultrasound should be recommended in all anal sac tumor cases to rule out metastatic disease to regional lymph nodes. Up to 50% of patients do have metastasis to the sublumbar nodes at the time of presentation, and 10% to 20% have lung metastasis.
If ionized hypercalcemia is identified on pre-operative blood work, this needs to be corrected before anesthesia and surgery. Diuresis with 0.9% saline, furosemide and possibly prednisone will help normalize ionized calcium concentration prior to surgery.
SURGERY FOR ASAGACA The first stage of treatment for anal gland adenocarcinoma is surgical resection, which in many cases can be curative. The anal sac is located between the external and internal anal sphincters. Malignant tumors commonly invade these muscles. Other regional structures of interest include the pudendal artery, vein and the caudal rectal nerve. Anal sacculectomy is considered a clean-contaminated surgery; antibiotics are given at the time of induction and, depending on the antibiotic, every 90 to 120 minutes during anesthesia. If there is no significant contamination during surgery, antibiotics are not needed in the postoperative period. Pre-operative enemas are not recommended as they will liquefy the feces and contaminate the surgery site. Manual emptying of feces is often required prior to surgical prep of the surrounding skin. In the case of anal sac tumors, a purse
PROGNOSIS IN DOGS WITH ASAGACA Many prognostic factors are established in dogs with ASAGACA. The four worth noting and communicating to the pet owner are:
1 2 3 4
Hypercalcemia at the time of diagnosis or at any time during the disease process The presence of pulmonary metastasis A primary tumor size greater than 10 cm2 Whether surgery is a part of therapy (improved prognosis) or not (poor prognosis).
string is not recommended because access to the anal sac duct opening is often required to obtain surgical margins. In some cases, part of the rectal wall will need to be resected and reconstructed. The patient is placed in the standard perineal position. A rolled towel is placed under the caudal abdomen and the cranial quadriceps muscles are padded against the table to prevent trauma to the femoral nerves. Continued on page 42.
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Continued from page 41. Anal sac tumors are approached with a closed technique. The open technique will lead to contamination of the surrounding tissues with tumor cells and will not provide a clean surgical margin, often leading to local recurrence and providing an ongoing source of metastasis and hypercalcemia. Surgery is approached with an incision directly over the palpable mass, and careful dissection is used to maintain
the integrity of the tumor capsule. Maintaining the capsule is paramount to achieving local tumor control because wide resection in this area is not feasible due to the proximity of surrounding structures, including the rectal nerve, anus, rectum and sciatic nerve. If the tumor has adhered to the dermis or epidermis, it is possible and necessary to obtain a larger skin margin. If using electrosurgery, radiosurgery or carbon dioxide laser for dissection and hemostasis, care must be taken not to damage the caudal rectal nerve, external and internal anal sphincter, and the rectal wall.
Image courtesy of J. Liptak
Monopolar electrosurgery utilizes a grounding plate routinely placed under the patient. The energy source travels from the tip of the instrument through the local tissues, then through the body to the grounding plate, to continue the circuit. Bipolar tip attachments are preferred to minimize thermal damage as the energy only passes between the tips of the instrument.
Image courtesy of J. Liptak
Dog with right-sided ASAGACA, in sternal recumbency with pelvic limbs hanging over the back edge of the surgery table. Towel pads are placed on the edge of the table supporting the cranial and proximal surface of the pelvic limbs to prevent injury to the femoral nerves. The surgery table is tilted in the Trendelenburg position (head tilted down) to prevent the patient from sliding off of the back end, and to allow the surgeon to comfortably stand during the procedure. A large clip and prep area have been created and the draping margin is wide, allowing for any unexpected alterations in the surgical plan (as commonly occurs with surgical oncology cases). A moistened 4â&#x20AC;?x18â&#x20AC;? laparoromy pad has been gently placed in the rectum (for smaller patients, a tampon works well) to prevent gross fecal contamination of the surgical site. There is ulceration of the skin; the surgical plan should include excision of the skin, using an elliptical incision and with appropriate margins, and include the anal sac and duct in an en bloc excision.
The same dog after an elliptical skin incision was performed to obtain skin margins from an ulcerated ASAGACA. The skin, subcutaneous tissues and anal sac were removed en bloc. 42
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After excision is complete, new gloves and instruments are used for local lavage and closure of the surgical wound to minimize the potential of seeding local tissues with tumor cells. If possible, external skin sutures or staples are avoided as they tend to collect fecal material along the incision in the post-operative period. In the case of gross lymphadenopathy on ultrasound exam or CT, extirpation of the nodes is strongly recommended, especially in the hypercalcemic patient. The medial iliac and hypogastric lymph nodes are located in the region of the distal vena cava and bifurcation of the aorta. With mild levels of lymphadenopathy, removal is straightforward; but as the degree of lymphadenopathy increases, surrounding structures including the distal aorta, ureters and iliac vessels can make removal more challenging. Successful lymph node resection in this location is largely dependent on adequate exposure to the caudal peritoneal cavity and a thorough knowledge of the surrounding structures. The standard celiotomy incision will need to be extended caudally to the pelvic brim to allow for appropriate exposure to the region. Intra-operatively, it may be decided that the affected lymph nodes may not be resectable, and they are therefore biopsied prior to closure of the abdomen. Complications include infection, fecal incontinence and recurrence of local disease. All these are minimized by appropriately prepping and positioning the patient; handling the tissue gently; providing meticulous hemostasis but minimizing the use of electrosurgery or laser; avoiding the use of external sutures or staples; and obtaining tumor-free
margins (if possible). Submit all removed tissues intact; if it is worth removing, it is worth submitting.
ADJUNCT THERAPY Adjunctive intervention with radiation and/or chemotherapy may be recommended based on the pre-surgical staging and the post-operative histopathology report.
Radiation In cases where surgery is not complete, radiation therapy to the primary tumor site and regional lymph nodes will improve local control. Radiation therapy protocols range from 16 to 20 fractions on a Monday-throughFriday schedule. Acute side effects of radiation therapy can be moderate to severe and may result in colitis and rectal mucositis. During this period, an e-collar must be worn to prevent the dog from licking the area. One study found that dogs treated with surgery, radiation therapy (15 treatments) and chemotherapy (mitoxantrone) resulted in an overall survival of >900 days. In non-resectable tumors, hypofractionated radiation therapy has anecdotally been useful in palliation with a relatively high rate of response. Side effects such as rectal stricture may occur with this type of protocol.
Chemotherapy The benefits of chemotherapy for this cancer are not well characterized; however, chemotherapy is often incorporated into treatment protocols. The most commonly used chemotherapy agents include doxorubicin, carboplatin, mitoxantrone, melphalan and gemcitabine. NSAIDs are often utilized for putative anti-cancer effects. In a recent study assessing 42 dogs with ASAGACA treated with surgery +/- chemotherapy, survival time was significantly associated with the presence of sublumbar LN and sublumbar LN extirpation. Median survival time was significantly shorter in dogs with sublumbar than in those without, and in dogs that underwent lymph node extirpation than in those that did not. Disease-free interval was significantly associated with the presence of sublumbar LNs, LN extirpation, and administration of platinumcontaining chemotherapeutic agents. Median disease-free interval was significantly shorter in dogs with sublumbar LN than in those without; in dogs that underwent LN extirpation versus those that didnâ&#x20AC;&#x2122;t; and in dogs that received platinum chemotherapy versus those without. Interestingly, survival time and disease-free interval did not differ among groups when dogs were categorized on IVC Summer 2019
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the basis of histopathologic margins (complete versus marginal versus incomplete excision). One question raised by this study is whether chemotherapy was utilized in the “worst cases”, associating it with an unfavorable outcome to create a study bias. In some cases, all three modalities (surgery, chemotherapy, radiation therapy) are used in the treatment of dogs with ASAGACA.
NON-RESECTABLE/METASTATIC TUMORS No standard of care currently exists for advanced, non-resectable or metastatic tumors. However, several retrospective studies provide some data to help guide clinicians.
Hypofractionated radiation therapy (palliative radiation therapy) One study assessed 77 dogs with measurable ASAGACA; 38% experienced a partial response to RT. For dogs presenting with clinical signs related to the tumor, improvement or resolution of signs was noted in 63%. For dogs presenting with hypercalcemia of malignancy, resolution was noted in 31% with RT alone, and in an additional 46% with radiation, prednisone and/or
A NOVEL THERAPY Recently, unique and novel therapeutic interventions have been developed and their impact on ASAGACA assessed. Toceranib phosphate (Palladia) is an orally bioavailable, multi-targeted receptor tyrosine kinase (RTK) inhibitor that is active against several members of the split-kinase RTK family (VEGFR, PDGFR and Kit). Although approved for use in canine mast cell tumors, due to its mechanism of action in targeting new blood vessel growth, activity in a broad range of tumors might be expected. Following approval in 2009, toceranib was used off label to treat a variety of canine cancers, most often in patients experiencing failed multiple treatment modalities. In a recent retrospective study of 32 dogs with ASAGACA treated with toceranib, eight dogs (25%) experienced partial response (PR) and 20 (62.5%) experienced stable disease (SD) for a clinical benefit (CB) rate of 87.5%. The median duration of treatment for all 32 dogs treated with toceranib was 25 weeks (range: zero to >47 weeks). 44
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bisphosphonates. The median overall survival was 329 days (range: 252 to 448 days) and the median progressionfree survival was 289 days (range: 224 to 469 days). A second study using a protocol of 8 × 3.8 Gy (total dose 30.4 Gy, over 2.5 weeks) was assessed in 28 dogs (15 underwent surgery, 13 underwent RT). At the time of presentation, 21% had a life-threatening obstipation and 25% were hypercalcemic. The progression-free interval and median survival time for surgery cases were 159 days and 182 days, both significantly lower than for radiation therapy cases, which were 347 days and 447 days. Surgery as well as RT led to relief of clinical signs.
INTEGRATIVE AND NUTRITIONAL THERAPY Humans with cancer commonly use physicianrecommended or self-prescribed unconventional but complementary therapies in the form of herbs and nutritional supplements. An interesting insight into the widespread use of nutraceuticals to treat cancer in humans was described in a recent study in which investigators found that only 7% of human cancer patients used unconventional medical therapies when they were asked routine questions by their oncologist; however, when a questionnaire was given to patients across studies, it was revealed that 40% to 80% of cancer patients were actually using nutraceuticals to supplement their chemotherapy or radiation therapy protocols. The high prevalence of nutraceutical use among human cancer patients further suggests that nutraceutical use in pets with cancer is likely to be as frequent, if not more so. There is actually some good science behind the use of certain ocean-sourced natural ingredients, especially purified but not chemically-altered EPA and DHA sourced from fish and the naturally-isolated carbohydrate component of the New Zealand green-lipped mussel. Cachexia (weight loss) in cancer patients, despite adequate nutrient intake, is a devastating consequence of malignancy in both human and veterinary patients. Alterations in resting energy expenditure and derangements in carbohydrate, protein and lipid metabolism have been documented in dogs prior to overt signs of cachexia.
EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) These Omega-3 fatty acids are found in high levels in fish oils. EPA is a potent anti-inflammatory mediator in the body, while DHA has its greatest impact in the brain and
spinal cord. ALA, which is found in some seeds and plants and is marketed as a safe plant source of Omega-3s, requires the enzyme delta-6 desaturase to convert it into EPA and DHA in the body. Unfortunately, humans, dogs and cats have limited ability (dogs and humans) to no ability (cats) to convert ALA to EPA and DHA. In general, the Omega-6 fatty acids, found in vegetable oils, corn oil, grapeseed oil, cottonseed oil, margarine, sesame oil, saturated fats and fast food products are pro-inflammatory. They keep the cells, tissues and body in a state of continued inflammation. The body needs inflammation to heal wounds and fight infection and cancer cells, but too much inflammation over time leads to many systemic health conditions and diseases in dogs and cats. The body constantly strives to be in balance between inflammation and anti-inflammation, between Omega-6 and Omega-3. However, the body canâ&#x20AC;&#x2122;t produce or store Omega-3 or Omega-6 polyunsaturated fatty acids; therefore, it can only use what it is fed.
Some tumor cells have difficulty using lipids as a fuel source, although host tissues continue to oxidize lipids for energy. This finding led to the hypothesis that foods moderately high in certain fats may benefit animals with cancer, as compared with foods relatively high in carbohydrates. Pets in North America receive most of their nutrient intake from commercial dry pet foods. In general, these
foods are usually high in soluble carbohydrate and relatively low in fat. These characteristics may make some commercial kibble-based foods less optimal for the nutritional management of animals with cancer. High levels of EPA and DHA, as found in the triglyceride form of fish oil, are probably the most important nutraceutical to consider for animals
Studies of polyunsaturated fatty acids (PUFAs), especially the Omega-3 eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids, have demonstrated prevention of carcinogen-induced tumors, the growth of solid tumors, and the occurrence of cachexia and metastatic disease in experimental tumor models. The proposed mechanisms in which these fatty acids elicit their effects may be related to the inhibition of cell proliferation and induction of apoptosis. In contrast, PUFAs of the Omega-6 series appear to enhance tumor development and metastases and are considered to be inflammatory in the tissues of the body. There is also epidemiologic evidence of an inverse relation between dietary Omega-3 fatty acid intake and the incidence of some cancers. IVC Summer 2019
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with cancer. Several human epidemiologic studies have suggested that consumption of the correct form, source and dose of EPA and DHA is a beneficial adjunct to treating many cancers. The recommendation for feeding high levels of EPA and DHA to pets with cancer is based on in vitro cell culture studies; studies in rodent models evaluating different types of cancer; clinical trials in human patients with solitary and metastatic forms of cancer; and clinical trials in dogs treated for lymphoma and carcinoma. Several hundred studies using laboratory models have evaluated the effects of EPA and DHA on tumorigenesis, tumor growth, metastasis and chemotherapy. EPA and DHA administration reduces the cancerous transformation of irradiated fibroblasts and inhibits proliferation and metabolism in various cancer cell lines; inhibits growth of aberrant cells; increases radiation sensitivity of cancer cells; inhibits growth of primary and metastatic tumors; demonstrates an enhanced effect of chemotherapeutic agents on cancer cells; decreases angiogenesis; reduces radiation damage to normal tissues; increases survival time when used with chemotherapy; increases disease-free interval when used with chemotherapy; and increases quality of life when used with chemotherapy. Several well-controlled clinical trials have evaluated the use of a fish oil-supplemented food in normal dogs and those undergoing chemotherapy for lymphoma, and in a study of dogs being treated for carcinoma. EPA and DHA supplementation were found to decrease or eliminate the metabolic alterations seen in dogs with stage IIIa and IVa lymphoma treated concurrently with doxorubicin chemotherapy, providing a significantly longer disease-free interval, longer survival times, and improved quality of life. It is extremely important to note that specifically increasing the serum DHA content was associated with longer disease-free intervals and survival times in dogs with stage III lymphoma. This is key because only the triglyceride form of fish oil provides superior absorption, bioavailability and cell membrane saturation of DHA. Another controlled and randomized clinical trial evaluated the effect of fish oil supplementation on the acute effects of radiation injury in dogs with nasal tumors. Dogs fed the supplemented food had higher serum concentrations of EPA and DHA compared with control dogs. Higher serum levels of EPA and DHA were associated with lower plasma
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lactic acid concentrations, lower tissue concentrations of inflammatory mediators, improved quality of life scores, and a lower degree of histologic damage to normal tissues from radiation therapy.
MATRIX METALLOPROTEINASES (MMPS) MMPs are a family of zinc-dependent enzymes that play a key role in degrading basement membrane components and extracellular matrix. MMPs are pro-inflammatory, tissue-destructive, and thought to be involved in chronic inflammation and some neoplastic conditions. MMP activity is detectable in canine and feline neoplastic tissue and in the serum of tumor-bearing animals. MMP activity is higher in tumor tissue than in unaffected stromal tissue, indicating that MMPs may be involved in the pathogenesis of angiogenesis, tumor growth and metastasis. MMPs have been found to be significantly higher in naturallydeveloping malignant mammary gland tumors in dogs and most carcinomas compared with activities in normal tissues, and activities of tissue inhibitors of MMPs were lower in tumor tissue. MMPs also play a significant role in the early and late inflammatory destruction of irradiated tissues. A study of dogs with osteosarcoma found that patients with activated levels of plasma MMPs had a significantly shorter survival time than dogs without. New Zealand green-lipped mussels (GLM) that are harvested as adults from the ocean, and immediately processed by cold live extraction methods, maintain their glycoprolex (glycogen-protein complex) component, which contains the active ingredient necessary for significant inhibition of MMP activation. Together, these studies suggest that feeding a diet supplemented with a natural triglyceride (chemically unaltered) form of EPA and DHA, and the appropriate form (isolated carbohydrate) of a GLM extract, increases survival time of dogs undergoing single-agent cancer chemotherapy; increases the survival time of a subset of dogs undergoing single-agent cancer chemotherapy by more than 30% compared with similar dogs consuming an unsupplemented food; reduces the severity of some acute phases of radiation therapy, thereby improving quality of life; suppresses the clinical signs of cancer for longer intervals; and counteracts persistent metabolic changes found in many canine cancer patients. References available at IVCJournal.com
MORRIS ANIMAL FOUNDATION — GOLDEN RETRIEVER LIFETIME STUDY
WHAT 3,000 GOLDEN RETRIEVERS CAN TELL US ABOUT
CANCER By Kelly Diehl, DVM, MS, Dipl. ACVIM As most practitioners know, cancer is a top health concern among dog owners, and for good reason. Cancer is the most common cause of disease-related death in dogs over ten years old, and statistics suggest one in four dogs will develop cancer in their lifetimes. Despite significant advances made in the diagnosis and treatment of canine cancer, long-term survival has plateaued for many of the most important and deadly forms of the disease, including lymphoma, hemangiosarcoma and osteosarcoma. Identifying the risk factors for cancer development would help in the struggle against the disease, but finding these factors is challenging due to the complexity of the disease process and its typically prolonged clinical course. It can take weeks or months for cancers to be detected in our veterinary patients. Retrospective studies can help guide us toward risk factors, but they are often skewed due to recall and selection bias. Longitudinal studies that follow subjects over time, with the intention of gaining insight into the development of disease outcomes, are particularly useful for investigating chronic diseases since exposures are collected before the condition manifests. The Morris Animal Foundation Golden Retriever Lifetime Study was launched in 2012 to investigate the incidence of
and risk factors for cancer. Owners of 3,044 golden retrievers in the US have volunteered their dogs for this observational cohort. Both owners and their family veterinarians complete annual online questionnaires about the health status and lifestyle of each dog. Participants must undergo a yearly physical examination and collection of biological samples. We determined that at least 500 cancer diagnoses are required to make valid associations between an environmental risk factor and cancer. Based on current estimates, it will take approximately five more years to reach this goal. Almost half a million biological specimens have been collected and banked, and we have thousands of owner- and veterinarian-reported data points, documenting everything from diet to environment. By the study’s completion, based on our current accumulation of data, we’ll have more than five million data points and biological samples, all catalogued and stored for current and future research. In 2017, we opened our data and samples to the research community. We have three active studies in progress, ranging from characterizing the gut microbiome in obese and lean dogs to evaluating the genetics behind litter size. These projects are nearing
completion and we expect publications out within the next year. Closer to home, our staff epidemiologist, Dr. Missy Simpson, has also started to analyze the data. Dr. Simpson’s current project looks at how age at spay/neuter affects the development of non-traumatic orthopedic injury. Her results are scheduled for publication in July of this year. The Golden Retriever Lifetime Study, with an estimated budget of $32 million, is a one-of-a-kind project that will provide data and samples, as well as guide cancer research funding, for generations to come. It will lead to advances in understanding the risk factors for cancer and other diseases, and help all dogs lead happier healthier lives. IVC Summer 2019
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PEER-REVIEWED
AN INNOVATIVE APPROACH TO
SEPARATION ANXIETY IN DOGS By Moira Hechenleitner, DVM, CSAT
How using a Certified Separation Anxiety Trainer (CSAT) in your practice can help you successfully alleviate this common canine behavior problem.
Statistics tell us that over 17% of dogs in the US suffer from separation anxiety. In fact, this condition is one of the primary reasons for surrender, abandonment and euthanasia — not only here, but worldwide. As a veterinarian, you most likely have clients whose dogs have separation anxiety, and know that it can be challenging to overcome. In this article, we’ll look at how a Certified Separation Anxiety Trainer (CSAT) can help your practice successfully solve this common behavior disorder.
A BIT OF PERSONAL BACKGROUND After becoming a veterinarian and working for many years as a behavior consultant and Bach Flower therapist, I had the opportunity to specialize in canine separation anxiety. Through a Separation Anxiety Certification Program designed by Malena DeMartini, I became a CSAT (Certified Separation Anxiety Trainer), forming part of an amazing group of behavior consultants who work to help dogs and their families overcome this condition. In becoming part of a league of healers who work to mend the emotional aspect of separation anxiety, I also became a healer of their guardians’ spirits, thereby achieving my inner purpose of bringing hope to them.
SEPARATION ANXIETY IS A FRUSTRATING PROBLEM When dog guardians reach out to us for help, they feel they have already tried everything. They have read all the information they can find on separation anxiety, and are almost at the point of giving up. They are confused because different specialists from different fields have given them different explanations and different advice, and in their despair they have tried it all, making the problem worse in the process. Furthermore, they have limited their social lives in
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CSATs (Certifi ed Separation Anxiety Trainers) are a group of experienced behavior consultants who work to help dogs and their families overcome separation anxiety.
order to avoid leaving their dogs alone, and many times have lost the support of their families and friends. Common in all these cases is the dog’s irrational fear of being left alone.
STEPS FOR SUCCESS: TEAMWORK As a veterinarian, behavior consultant, and CSAT, I have been privileged to see how truly beneficial an integrated holistic approach to healing can be. We know there are many parts to a dog (or family) that might need healing. In response, our society has created a diverse range of professions to accomplish this, including veterinary medicine, dog training, behavior consulting, and dog walking, among others. Additionally, we have created further divisions of focus within each of these categories.
Working as a team is the key to success. It allows us to utilize the best of each field to help dogs and their guardians overcome separation anxiety successfully. A problem arises when we, as healers, who seek the best for our patients and clients, have to make the decision of asking someone else to help us. We often don’t want to share our patients, and we act as if we are afraid that something bad could happen to them if someone else touches them or adds his or her expertise. In treating canine separation anxiety from both veterinary medical and behavioral perspectives, I have observed that veterinarians often don’t trust behavior consultants, and vice
versa; and although everyone tries on their own to do their best for the dog, they fail in navigating the problem as a whole. This isn’t only an issue in the US. The country I come from, and many others I have had the opportunity to visit, suffer from this same dynamic. Maybe we should take a step back and remember why we are here, why we are doing this, and trust in one another’s skills and fields, in order to provide dogs with the best opportunity for healing and enhanced quality of life. We need different specialists and skills to successfully treat separation anxiety as a whole: • A veterinarian, who can help rule out any physical problems the dog might be suffering from, and whose field of expertise includes knowledge of behavior pharmacology, and/or holistic medicine and therapy.
• A specialist in separation anxiety behavior modification, who puts a behavior program into practice to help the dog overcome that part of the issue.
• Additionally,
we may need another dog trainer or behavior consultant who can focus on other behavior problems the dog might be showing.
CLEAR COMMUNICATION AMONG TEAM MEMBERS IS VITAL Treating canine separation anxiety is a straightforward process, but not a particularly easy or rapid one. As such, it is imperative that all team members communicate clearly with one another, and offer support and guidance from their own areas of expertise for the benefit of the dog. When we start working with a separation An open communication channel among team members working to help a dog overcome separation anxiety will optimize results and increase the likelihood of a better prognosis.
anxiety dog and her guardian, we offer to get in touch with their vet, dog walker, trainer, daycare, etc., so everybody knows what’s going on and what each person can do to support recovery. We emphasize that everyone’s efforts are valuable and essential pieces of the puzzle.
ADDRESSING PHYSICAL HEALTH AND ENVIRONMENTAL FACTORS In order to maximize chances for a successful outcome, it’s important to identify and address any physical problems with the dog’s health that could be influencing his behavior. Any necessary environmental adjustments need to be explored as well. Research has shown a high correlation between general anxiety, noise sensitivity and separation anxiety, and as such, there may be a genetic predisposition to the condition. This suggests these dogs may be suffering from a chemical imbalance in which hormones and/or neurotransmitters aren’t working as they should, either due to a pathophysiological issue, a threshold alteration at the nervous system level, or over/under production. Environmental factors such as stressful changes, new noises or traumatizing events might trigger the onset of separation anxiety at any age. Once these factors are addressed, our task as CSATs is to start the behavior modification program.
THE CSAT BEHAVIOR MODIFICATION PROGRAM The program is designed to guide and coach the guardian through daily training sessions that seek to desensitize the dog to his person’s departure and absence. They include several strategic steps that help the dog adjust to his guardian approaching
A single training task Focusing on only one training task during the behavior program is essential. Assigning a long list of daily tasks for guardians to accomplish in order to help their dogs, even if the tasks are appropriate, won’t sustain their participation and involvement. Sooner or later, they will get tired and stop performing all the tasks, likely quitting after a short period. Teaching guardians to do only one thing, consistently and on a daily basis, will promote faster results in terms of behavior modification, and will keep motivation, compliance and hope high.
Benefit s of a remote behav ior program • Daily support for dog and guardian, permitting a proactive rather than a reactive approach.
• Avoidance of mistakes when selecting the next session’s training criteria.
• More accurate assessment of the problem, without adding other influencing factors such as the presence of a consultant when leaving the house.
• Real time reading of the dog’s body language. IVC Summer 2019
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Considering the condition’s genetic predisposition, many cases benefit from a medical approach in conjunction with a behavior modification program.
SEPARATION ANXIETY TRAINING SESSION Walk to door, jiggle door handle, come back Walk to door, open/close door, come back Grab keys, walk to door, jiggle door handle, come back Exit and close door, immediately return Walk to door, open/close door, come back Exit and close door, wait five seconds, immediately return Grab keys, walk to door, open/close door, come back Exit and close door, wait five seconds, immediately return Exit and close door, wait 20 seconds, return
the door, leaving for a few seconds, and using some of the objects she would normally bring with her when leaving (keys, purse, coat, etc.). The next session is created based on the dog’s performance during his last rehearsal. Learning to read and interpret a dog’s body language is essential. The dog’s reaction to each session’s steps will help us create the next one and strategically vary our criteria. In time the dog learns to trust and adjust to departures, giving us the chance to increase the duration of the guardian’s absences, so she can finally leave the dog alone without triggering panic.
DESENSITIZATION AND RESPECTING THE THRESHOLD Reward-based training is a very successful tool for navigating many behavior problems. Counterconditioning (or classical conditioning) and operant conditioning are great for speeding the learning process and more quickly elicit the behavior change. However, when working with separation anxiety, we seek relaxation from the dog, not the alertness that reward-based training would trigger. Besides, having the guardian reward the dog with a treat when she returns, to reinforce the dog’s behavior for not reacting when alone, will be insufficient once the absences become longer.
Body language will tell us if a dog is reaching his threshold — the moment when the stimuli he is being exposed to becomes aversive and he won’t be able to recover from it.
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Instead, by gradually increasing the intensity of the stimuli while always staying under threshold, desensitization allows us to teach the dog he has nothing to fear when left alone. In time, the dog will begin to relax and adjust to the stimuli, which will allow us to progressively increase the intensity until we accomplish our absence duration goal. The concept of threshold is an important one, because it tells us when the dog is no longer able to adapt to change and is about to enter survival mode, from which the panic response arises. In order for the desensitization program to work, we have to find, through reading the dog’s body language, where his threshold is. In other words, we have to find how long the dog can stay alone before the situation becomes aversive. Once the threshold is identified, we must always stay under it when designing training sessions. In time, the dog’s threshold will change, and that will allow us to get closer to our goal.
REMOTE OBSERVATION: AN INNOVATION CRITICAL TO SUCCESS My mentor, Malena DeMartini, once shared this quote from Rear Admiral Grace Hopper: “The most dangerous phrase in our language is ‘we have always done it this way’.” We can apply this wisdom to treating separation anxiety. Utilizing technology as our 21st century helper, we use remote viewing to observe dogs and their guardians so we can create customized therapy plans that allow us to daily guide and coach these families. Yes, our whole program is done remotely! Technology optimizes our chances of success while allowing families to access help regardless of locale. I have clients who live in Chile, called the “last place in the world” by some, along with clients who live in the nearest town. Many conditions need to be addressed in person, and many fields of work require physical presence, but the opposite is true when treating separation anxiety. We need to observe the dog’s
body language when the guardian leaves, or when she is rehearsing a training session, and in order to do that without becoming a disruption, we need to be “ghosts” or “spies” who can see every detail without the dog noticing. We need to teach the dog that it is okay for his guardian to leave every morning or every afternoon, and this wouldn’t be realistic if she had to practice with us in the same room; she doesn’t leave for work every morning with us by her side.
A remote viewing approach allows us to design a customized training session every day, based on the results of the previous session, without risking mistakes due to lack of guidance and support, or bad results that weren’t immediately identified and corrected. Personally, I have found the remote viewing work to be richly rewarding. I love connecting with people this way by helping them with their dogs. When I came onto this path, I was scared it wasn’t going to suit me, and that I was going to miss the dynamic of seeing my clients and their dogs in person. I was wrong. I have never connected so much with my clients, their dogs and families as I am doing now. Before treating separation anxiety this way, I never felt as if I was really bringing people hope. Now I do.
CONCLUSION If we open ourselves to the amazing results that can arise from working as a team of different types of healers, we will understand the meaning and importance of synergy. Being a veterinarian, but also a dog trainer who currently works exclusively on separation anxiety cases, I feel very eager to bring vets, trainers and behavior consultants together, so dogs with separation anxiety can benefit from a holistic approach — one that includes the best of each area of expertise, and helps dogs and their families succeed.
References and resources Crowell-Davis, Sharon L and Murray, Thomas. Veterinary Psychopharmacology, Blackwell Publishing, 2006. DeMartini, Malena. Treating Separation Anxiety in Dogs, Dog Wise Publishing, 2014. Overall, Karen L. Manual of Clinical Behavioral Medicine for Dogs and Cats, Elsevier Inc. Mosby, 2013. Sherman et al. “Effects of Reconcile (Fluoxetine) Chewable Tablets Plus Behavior Management for Canine Separation Anxiety”, Veterinary Therapeutics, Vol.8, Nº1, 2007. Tiira, Katrina et al. “Prevalence, Comorbidity, and Behavioral Variation in Canine Anxiety”, Journal of Veterinary Behavior, Elsevier Inc., 2016. Wilde, Nicole. Don't leave me!, Phantom Publishing, 2010. malenademartini.com moirahechenleitner.com/en
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From the AHVMA
The mindful leader elevating the veterinary profession through innovation, education and advocacy of integrative medicine.
THIS YEAR’S ANNUAL CONFERENCE
Save the dates! The 2019 AHVMA Annual Conference runs September 7 to 10 at the Gaylord Opryland Resort and Convention Center in Nashville, Tennessee. It will offer over 100 hours of lectures on topics ranging from integrative cancer treatments and herbal medicine to mindfulness and self-care. This year’s keynote address, “Earth, Herbs and Animal Wellness — Where We’ve Been and a Prelude to What’s Next”, is presented by herbalist Greg Tilford, who will explain why holistic veterinary medicine is not only about maintaining the health of animals, but also about healing ourselves and celebrating the interconnectedness of all living things. Attendees will walk away with a strong sense of motivation to advance holistic veterinary medicine to the next level. The AHVMA would like to extend thanks to the VBMA for their generous support of this year’s keynote address. Also look for our introductory talks on various holistic modalities. Not only will you be exposed to a wealth of knowledge; you’ll also acquire information on how to integrate these modalities into your practice. We encourage students from AVMA Accredited Veterinary Schools to attend these lectures as a way to broaden their veterinary education.
AHVMF SILENT AUCTION
The future of holistic medicine depends on today’s veterinary students. The Silent Auction will be held on Monday, September 9, and all proceeds will benefit students interested in integrative medicine. Please consider donating a product or service; all donations are greatly appreciated and tax deductible. Auction items include jewelry, books, art and vacation getaways (just to name a few). Visit AHVMF.org for donation details.
STUDENT AHVMA — SPEAKERS NEEDED
The AHVMA is seeking member veterinarians willing to donate their time to speak to Student AHVMA (SAHVMA) Chapters. Modality interests and requests may vary by
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chapter. Members interested in sharing their knowledge may send a brief statement to office@ahvma.org for consideration. Please include which vet school(s) you are nearest to, and which modalities you would like to help the students learn about.
CONTINUED GROWTH
We are pleased to announce that the AHVMA continues to grow. Thanks to the commitment of our members, we proudly maintain our seat in the AVMA House of Delegates. Although exciting, growth forces change and brings new challenges. We are now too large for all but a handful of hotels, but are not yet large enough to be able to afford large convention centers. We have made the difficult transition to a larger “conference hotel” that includes enough accommodations for our group, as well as enough meeting space for all our programs. Increasing attendance from veterinary students at AHVMA Conferences means we need to ask for your help to continue providing students with these unique educational opportunities. We would like to extend our gratitude to the sponsors who have already given directly to our student fund. The AHVMA would not be able to meet these ongoing challenges without the dedication of our members, exhibitors and sponsors. Thank you for your continued support!
Save the date! Join us for this year’s AHVMA Annual Conference in Nashville, Tennessee!
September 7–10, 2019
PEER-REVIEWED
Equine skin disease A complementary medical approach for 5 common skin conditions in horses. By Joyce Harman, DVM, MRCVS Veterinary clients and conventional practitioners often think of the horse’s skin as easy to heal since it’s on the outside of the body. However, skin is often the hardest organ to heal, and reflects internal as well as external health. In fact, most equine skin diseases need to be approached from a deep level of healing, and may take a long time to completely resolve. In this article, we’ll look at five common skin conditions in horses, and how a complementary medical approach can tackle them successfully. Summer usually brings equine skin diseases to the surface, though some conditions are actually present year-round.
Horses living in climates with warm humid summers often present with the most difficult skin diseases; these can continue through the winter months among many equines living in southern regions. In contrast, those living in more northern climates often have skin diseases related to the cold and damp conditions of winter. Treatment can be frustrating from a conventional perspective, as drug selection is limited, but complementary medicine offers the practitioner many options. However, some cases can be very refractory to treatment, regardless of approach. Continued on page 54. IVC Summer 2019
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Complementary treatment for sarcoids • Homeopathic medicines are usually prescribed according to the appearance of the tumor along with any other symptoms the horse has. Remedies such as Thuja occidentalis, Causticum, Sulphur, Lycopodium clavatum, Nitric Acid or Graphites are commonly prescribed, but there are many more that could be indicated, giving the homeopath multiple choices. • Topical applications called escharotics or Black Salves, made with the herb bloodroot (Sanguinaria canadensis), have been in use for many years. Tumor tissue is selectively destroyed by the salve, though it can leave a large wound that will heal slowly, but usually without incidence. This treatment is best used in the cooler months when the fly population is lower. A less aggressive topical option can be made with Thuja in ointment form. It takes longer to reduce the size of the tumor, but causes much less irritation. • Both Chinese and Western herbal formulas can be used to help support the immune system and aid in the removal of large masses through the apoptosis of tumor cells. The more that is known about the Chinese TCVM pattern, the more accurate the Chinese formula prescription will be. • An extract of mistletoe (Viscum album), ), Iscador P, has been shown to reduce or eliminate sarcoids in 41% of cases treated.1 This extract has been safely used for many years in Germany as a part of cancer treatment in humans. There are no side effects, but a small injection needs to be directed into the lesion several times a week until it has healed. Despite the published study, this treatment has failed to become popular, yet it remains promising.
Continued from page 53.
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SARCOIDS
Sarcoids are generally benign tumors that appear on the skin, sometimes at the site of a previous injury. They may have a bovine papilloma virus origin. Only locally invasive as a rule, they often will not spread or cause problems. In some cases, however, due to location or excessive growth, sarcoids need to be treated. Horse owners may find them unsightly or worry about them getting worse, and many sarcoids do progressively enlarge. Aggressive sarcoids can be bloody, have an odor, and behave like a cancerous tumor, although they seldom metastasize. Those in areas where tack can rub against them require treatment, as do those that are encroaching on the eyelids. Conventional treatment includes surgical removal or cryosurgery, but both of these techniques often lead to recurrence, which can often be more aggressive than the original tumor. Several chemotherapeutic agents are used, again with variable results. Complementary treatments include homeopathic medicine, herbal formulas, and topical applications of herbal preparations — see sidebar above. Some sarcoids appear to be aggravated in the first few weeks after vaccination, so it is helpful to reduce vaccinations and check titers so that only critical vaccines are given.
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HIVES
Hives are common in the equine world. Horses lie on the ground in places where plants with strong oils may grow, causing an allergic reaction in the skin. Many individuals — especially, but not limited to, light-colored chestnut or white-skinned horses — are sensitive to a range of potential allergens in the environment, and react by producing hives. Chronic hives are infrequent but can be difficult to treat conventionally. Treatment for hives is often similar to that for pruritic skin conditions. Essential fatty acids, immune system support (but not stimulation), and appropriate herbal formulas will generally work well. Homeopathic medicines are also effective for acute and chronic hives. An important key to arriving at a remedy is to ascertain the horse’s preference for either warm or cold compresses. For simple acute hives, if warm compresses ameliorate, Rhus toxicodendron can often be helpful; horses that prefer cool or cold water do well with Apis mellifica. Chronic cases require a complete history in order to be treated well with constitutional homeopathy.
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PRURITIC SKIN REACTIONS
The most common equine skin cases that present to the veterinarian during the summer are allergic pruritic horses. Allergic reactions can be mild to severe, and range from itching without eruptions, to raw bloody eruptions. Many factors can be involved, including pollens, foods, Culicoides mites, topical reactions to weeds, reactions to shampoos and detergents in saddle pads, as well as dust, molds and more. Allergy testing can be done, using skin tests for inhalant allergens, saliva tests for food allergens, and blood tests for both. However, with equine patients, it is impossible to remove many airborne allergens from their environments. It is much easier to change the terrain (i.e. the horseâ&#x20AC;&#x2122;s immune system) than to change the environment. A good history, with information about the onset of symptoms, can help determine the basic class of allergen (examples include tree pollens in the early spring, and ragweed in late summer). Complementary medicine offers many possible solutions to treating allergic skin disease â&#x20AC;&#x201D; see sidebar on page 56. Simple cases may respond quickly to a single modality, but refractory or longstanding cases may require the treating veterinarian to have extensive training in homeopathy or herbal medicine. Most allergic skin cases will benefit significantly from high levels of Omega 3 fatty acids, in the form of flax, hemp or chia seeds, either as oil or in seed form. Omega 3 fatty acids support and regulate the immune system. Flax and hemp oil or chia seeds can be supplemented at a rate of 2oz to 4oz per day, or whole seeds fed at 4oz twice per day. Naturallystabilized ground seeds can be used; if the seeds are not stabilized, they will oxidize as soon as they are ground. Additionally, most equine skin cases will respond best if prebiotics and probiotics are used to restore the microbiome, since the skin and gut are actually continuous structures that have a significant influence on one another. The horseâ&#x20AC;&#x2122;s history may reveal that he was on a course of antibiotics in the few years before the skin disease became a concern.
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RAIN ROT
Rain rot (dermatophilosis), mud rash, and many other regional names are given to lesions on the back and lower legs. These are often seen in wet conditions, and frequently in colder climates and seasons. Continued on page 56. IVC Summer 2019
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Continued from page 55.
Pruritic skin reactions respond well to homeopathy and herbs Homeopathic medicine
Homeopathy is one of the most powerful systems for treating skin diseases. However, since most pruritic skin conditions arise from deep imbalances in the body, it is important to approach most cases constitutionally. This will take into account the individual’s history, season of the year, and the symptoms with aggravating and ameliorating factors.
Herbal formulas
Both Chinese and Western herbal formulas can provide the tools to help heal these cases. In Western medicine, pruritus is usually considered a single condition, with many possible allergic triggers. In Chinese medicine, many different patterns may be seen with this one condition. (There isn’t the space to discuss each pattern and formula here, but they may be addressed in a future article.) An example of a Chinese formula for treating itchy, raw, oozing skin would be Long Dan Xie Gan Tang, a classical formula that clears the Chinese condition of Damp Heat. It’s effective during the hot humid summers of the East Coast and South. In dry western areas, Yin deficiency formulas may be of more use. Western herbal formulas often include soothing herbs such buckwheat (Fagopyrum esculentum), nettle (Urtica dioica), chamomile (Matricaria recutita), garlic (Allium sativum), and calendula. Western herbs are easy to feed horses, as they usually like the flavors and are able to digest the herbs with minimal processing on the manufacturer’s part.
Topical treatments
Most of the healing that needs to be done is accomplished by internal means. Some topical relief is often desired and useful. Strong black tea can act as an astringent and is easy to apply over a large portion of the skin, for some relief. Herbal preparations of Calendula officinalis, noni (Morinda citrifolia), aloe vera and plantain leaves (Plantago officinalis) all help relieve the itch until internal treatment restores the immune system. Gentle water-based essential oil preparations can be useful, if the horse does not react to the oils. Some horses are very sensitive to essential oils, so test the formula on a small area before covering the skin.
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Conventional treatment usually requires baths in an antimicrobial shampoo, and picking off the scabs that form. This can be problematic in cold wet conditions, as horses do not dry well and may become chilled. It also can be very painful to keep picking the scabs. More severe cases are usually treated with antibiotics, which affect the beneficial bacteria in the gut. Homeopathics offer a simple solution that does not require bathing. For lesions on the back, oral remedies such as Tellurium, Sepia, Thuja, and occasionally Sulphur usually stop the infection in a week or so, then the scabs become dry and naturally fall off during grooming. For lesions on the legs, the more common remedies are Antimonium crudum, Graphites and Sulphur. For horses, homeopathic remedies are dosed at about six to eight pellets of a 30C or 200C potency (strength), given once a day for three to seven days. In many cases, three days at a time is enough for the response to begin; if there are still signs of tenderness at the lesions in two weeks, a second round of three days can be administered. Topically, salves can help lessen soreness and promote tissue healing, but they are usually not the primary factor in curing the condition. Gentle topical essential oils in a water-based solution can also be soothing and help keep inflammation down, as well as treat secondary infections.
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SCRATCHES
Scratches are chronic lesions on the lower legs of horses. They’re most commonly seen in the winter, but different versions occur all year around and in different parts of the country. Scratches is known by local names such as greasy heel or mud fever. If the legs are white, the lesions may be from photosensitization, so be careful not to use herbs such as St. John’s Wort (Hypericum perforatum), which may aggravate the problem. Topical ointments of many different herbs are routinely used, but the most effective treatment strategy is to use an internal herbal formula to support
immune function, along with high levels of Omega 3 fatty acids (flax, hemp, chia seeds) or homeopathic medicines. It is best not to wash the lesions with soap every day, and pick the scabs off, as most clients are instructed to do. The skin needs to be allowed to heal, and scrubbing it does not allow that. Water-based gels and creams or honey are better than lanolin or petroleum-based ointments because they allow the skin to breathe better. Ointments may help keep some moisture off horses turned out on damp pastures. A dilute solution of apple cider vinegar can be used to lower the pH, limiting the growth of bacterial or fungal infections secondary to the inflammation. Effective ingredients for topicals include chaparral (Larrea tridentata), calendula, Pau d’arco (Tabebuia avellanedae), aloe vera, vitamin E (a natural source is best), comfrey (Symphytum officinale), lavender (Lavandula angustifolia), yarrow (Achillea millefolium), diluted tea tree oil (Melaleuca linariifolia), Echinacea, noni (Morinda citrifolia) and St John’s Wort (Hypericum perforatum). Other topical herbal salves can also be useful.
Homeopathics are especially effective in treating scratches, though a topical to keep the skin softer and more pliable while healing takes place is useful. Some of the most common remedies are Antimonium crud, Sulphur and Causticum, usually beginning with a 30C potency and repeating the remedy daily for a week to ten days.
CONCLUSION
Many equine skin conditions can be treated effectively with the use of complementary modalities. Consider complementary medicine for these cases, especially the refractory ones. “Treatment of clinically diagnosed equine sarcoid with a mistletoe extract (Viscum album austriacu)”. J Vet Intern Med. 2010 Nov-Dec;24(6):1483-9. doi: 10.1111/j.1939-1676.2010.0597.x. Epub 2010 Oct 12.
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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.
ESSENTIAL OILS TIP FOR THE SEASON Summer skin needs extra care and protection! Pet parents can dilute a high quality myrrh essential oil with coconut oil and apply it to their own skin before enjoying the sunshine. However, applying a carrier oil to dog hair will make it sticky, and since it tastes delicious, will encourage licking, so this type of dilution is often not recommended for dogs. Two essential oils that are calming and soothing to our canine patients’ skin are lavender and copaiba. They can be used neat (or straight) if they are high quality ingestible oils. Counsel your clients to apply these oils directly on dogs with irritated areas, or between the toes. Remember, one drop goes a long way and will help deter licking! You can also make a mist to repel pests by combining healthy water, citronella, lemongrass, cedarwood, eucalyptus and thyme essential oils. Five drops of each in a 16oz spray bottle is sufficient. Be sure to add some healthy soap for emulsification. Do not use essential oils as “spot-ons” — repetitive use in one location can cause the skin to “scurf”. A light mist providing a full body shield works best. Use essential oil brands you know are safe. Tell clients to spray the blend into their palms, and then apply it to their pets’ faces — while avoiding the eyes! Always use extra caution with cats. These tips will help you become a resource for clients who want to care for themselves and their pets naturally. You will also be a hero who provides toxin-free alternatives to the many commercial products that are harming pet and human health, and contaminating our environment. Contact a VMAA member for guidance on the safe and effective use of essential oils for your patients and your own pets. Visit vmaa.vet to learn more. Submitted by Jodie Gruenstern, DVM, CVA, and VP of VMAA IVC Summer 2019
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Physical exam — The exam confirmed pain and decreased range of motion in the coxofemoral joints, and offloading on the right side.
CASE STUDY
Physiological screen with digital thermal imaging — The patient was acclimated to room temperature, was not handled during acclimation, and remained calm during image capture. Three digital thermal images were taken with a Digatherm IR 640 unit.
Analysis of the thermal images — Marked thermal
Juvenile hip dysplasia in the canine
asymmetry was evident between the lateral images of the rear limbs. The RH lateral image showed hyperthermia from the hip extending distally, becoming more pronounced over the lateral aspect of the tibia.
A case study involving the use of digital thermal imaging. By Trisha Allie, BSc, RVT Gloria, an 11-month-old intact female Rottweiler, was presented for evaluation after a history of rear limb lameness. Radiography at ten months of age (Figure 1) demonstrated significant abnormalities of the coxofemoral joints with flattening and remodeling of the femoral heads bilaterally, which was more pronounced on the right side along with right coxofemoral subluxation.
(Above) Figure 1: Gloria’s radiography at ten months of age. (Below, from left to right) Figure 2: Digital thermal image right hip, lateral view; Figure 3: Digital thermal image left hip, lateral view; Figure 4: Digital thermal image lumbar and sacral spine, dorsal view.
The average temperature in Zone 1R, over the right hip, was 85.1°F (29.5°C) (Figure 2). The LH lateral image showed hypothermia radiating cranioventrally from the sacral area. The average temperature in Zone 1L, over the left hip, was 79.5°F (26.4°C) (Figure 3). The average temperature difference (∆T) was 37.6°F (3.1°C). This marked difference in temperature represents a physiological hyperthermia on the right side and a physiological hypothermia on the left side. A dorsal thermal image of the lumbar and sacral area showed patchy asymmetrical hypothermia over the right lumbosacral junction and throughout the left caudolateral sacral area (Figure 4).
Interpretation of the thermal images — The thermal images are consistent with radiographic evidence of juvenile hip dysplasia and the symptoms of rear limb lameness. They support the physical exam findings of pain and decreased range of motion in the coxofemoral joints along with offloading on the right side. Areas of hyperthermia are noted throughout the thermal image of the right rear leg, which radiographically shows the most severe coxofemoral joint changes. The areas of hypothermia noted in the left lateral and dorsal images are consistent with pain activation of the sympathetic nervous system, which can lead to peripheral vasoconstriction.
THE IMPORTANT ROLE OF DIGITAL THERMAL IMAGING
Infrared digital thermal imaging supported Gloria’s assessment and treatment plan by providing:
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Physiological evidence to accompany the history, radiographic and physical examination findings.
Evidence of physiological compensatory involvement throughout the lumbosacral area.
A roadmap for medical and physical therapy.
Baseline images and temperature analysis for monitoring response to therapy through subsequent thermal images.
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BUSINESS PROFILE
Why Golden Needle is many veterinarians’
“BEST KEPT SECRET”
It’s not easy to earn respect in the veterinary industry. But over the last two decades, product distributor Golden Needle has done just that. With its reputation for superior quality products and personalized service, the company has earned its place as a trusted source. Still, founder Barry Thorne says new customers are often surprised to discover the comprehensive list of products that Golden Needle carries — roughly 300 brands to date. “Some people think we offer only Traditional Chinese Veterinary Medical products,” explains Thorne, a trained practitioner in TCM and Shiatsu therapy. “Then they visit our website and see more than 20,000 products from a range of complementary modalities.” Of course, Golden Needle does carry a complete array of TCVM products, from acupuncture supplies to herbs to high quality foods — it’s a convenient, one-stop shop. But integrative practitioners can also find pet nutraceuticals through its fully stocked online pharmacy, as well as pet care accessories, odor eliminators and even elk antler chews, all with fast delivery and drop ship service.
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With such a variety of products, Thorne believes personalized service and a family atmosphere is what keeps his customers coming back. “We are a family here,” says Thorne, “and we treat all our customers like a second family.” This close-knit connection helps Golden Needle choose the most relevant high quality products, and design services that better meet the needs of busy integrative veterinarians. In addition to their focus on service, the company offers convenient options such as a “favorites list”, which makes re-ordering a breeze. And their clean concise website makes finding products easier too. “Exceeding expectations is our mantra,” says Thorne. “It’s what we strive for every day.” GoldenNeedleOnline.com
Essential oils in your practice
PEER-REVIEWED
Effective modern tools with ancient origins, essential oils are an accessible starting point for adding integrative modalities to veterinary practice. By Jared Mitchell, DVM Essential oils and aromatic therapy are among nature’s most ancient and best-kept secrets. In recent years, however, these modes of healing have returned to the forefront of both traditional and holistic medical discussions. Leading the charge is the amazing versatility these oils exhibit in their ability to improve and maintain health. This is one of the major reasons I chose essential oils as the starting point for incorporating integrative modalities into my practice.
WHAT ARE ESSENTIAL OILS AND HOW DO YOU GET STARTED?
Simply put, essential oils result from the metabolic processes of plants. They are aromatic volatile liquids distilled from many parts of plants and shrubs, including flowers, leaves, roots and seeds, with the exception of citrus oils, which are cold-pressed from the rinds of the fruit.1 However, a simple definition of essential oils belies their elegance. In fact, the chemical nature of each oil is a very complex synergistic mixture of hundreds of compounds.2 This is why purity and proper training are two of the most important factors to consider when selecting essential oils for use in our veterinary patients. How did I get started with essential oils? As with most people, my journey began with a personal experience. In July of 2013, my wife sustained an injury which tore a tendon in her foot. We sought the medical advice of physicians, podiatrists and orthopedic specialists, and my wife followed their instructions to the letter. She ran the gauntlet of treatments, including bed rest, casts, steroid injections, and
ESSENTIAL OIL EDUCATIONAL RESOURCES FOR VETERINARIANS
Organizations: Veterinary Medical Aromatherapy Association (VMAA), vmaa.vet; American Holistic Veterinary Medical Association (AHVMA), ahvma.org
pain medications. Surgery was also mentioned, although it carried only a 50% success rate. While many of these treatments helped, none gave my wife the relief and healing she needed. All that changed, however, when she was introduced to essential oils. After seeing my wife’s results firsthand, I decided to research as much as I could about essential oils. I was amazed at the versatility of these aromatic compounds. I also learned how beneficial they could be in every aspect of veterinary medicine. There are oils to help clients and their pets heal their physical bodies; some to help clear the mind; and others to bring peace and balance to the spirit.
AN EASILY-INTEGRATED THERAPEUTIC MODALITY
Essential oils offer a practical starting point for introducing integrative services to a veterinary practice: Many clients are familiar with essential oils and already incorporate them into their own healthcare. With proper training, they enthusiastically embrace the use of essential oils in their pets’ healthcare, enhancing treatment compliance.
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Essential oils give clients an easy and fun way to become more involved in the overall wellness of their companions.
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Essential oils require minimal financial investment. Continued on page 62.
Books and journals: American Journal of Essential Oils and Natural Products; Books by Dr. Kurt Schnaubelt; IVC Journal; Journal of Essential Oil Research; Journal of the American Holistic Veterinary Medical Association; The Essential Oils Animal Desk Reference, 1st ed. by Life Science Publishing; Veterinary Aromatherapy by Nelly Grosjean IVC Summer 2019
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GUIDELINES FOR ASSESSING ESSENTIAL OIL PURITY Purity and quality are two of the most important considerations when purchasing essential oils, and there are numerous companies and brands to choose from. Select the safest and highest quality oils that fit your needs. A poor quality oil will not provide therapeutic benefits and could actually harm pets and their guardians.
Questions to ask the company* If you ask a company these questions and they can confidently answer “yes” to all of them, you may feel confident that their oils are pure. 1 Do they grow their own plants? Do they use outside suppliers? 2 Are the techniques and procedures used at all their suppliers’ farms uniform and consistent? 3 Is the company checking each step of the process to make sure no synthetic chemicals are being used? 4 Do they visit their suppliers’ farms? 5 Can you visit their farms? 6 Do they know the complexity of harvesting at peak times, and how to distill the oils properly with the use of low pressures and temperatures? 7 Are the distillation cookers made of the correct material to prevent chemical reactivity between the oils and the metal? 8 Is each batch tested with five different chemical analyses? 9 Are the oils tested by outside/ independent labs? 10 Do the oils smell and feel like true essential oils, or do they feel synthetic or chemical in nature? 11 Is the botanical info provided by the company listed correctly on the bottle? In other words, does it list the complete scientific name down to chemotype?
Continued from page 61. They are versatile. Essential oils can be used as standalone 4 treatment options for many routine aliments, from behavior problems and dermatologic conditions to pain control. They can also interact synergistically with other holistic modalities.
INITIAL STEPS: PURE INVENTORY AND QUALITY EDUCATION
While the upfront costs of adding essential oil therapy to a practice are low compared to other holistic or traditional modalities and equipment, investing in high quality, pure grade brands and choosing quality education and training is priceless. A seemingly unlimited supply of information on the use of essential oils is available online, and while a great deal of positive information can be found, an equal quantity of misinformation is also circulating. This is why I advocate for non-branded certification in essential oils; it helps add credibility to the field of essential oil study, and shows clients that the veterinarian has specialized training in the use of these oils. Most certification classes are online, giving busy practitioners the ability to learn and become certified without leaving the clinic, and without loss in revenue — a win-win for veterinarians and their patients.
USING ESSENTIAL OILS WITH OTHER MODALITIES Essential oils and laser therapy
We know the amazing benefits photobiomodulation produces in relation to wound healing and pain control. Now imagine combining it with an essential oil, such as Balsam Fir (Abies balsamea), which has strong anti-inflammatory properties. Applying the properly-diluted oil before routine laser therapy pushes the oil deeper into the tissues, creating a synergistic effect for greater healing and a faster return to function. Note: Although some aromatherapists advocate this approach, others exercise some caution. It is possible that the combination of an essential oil (especially citrus) with laser light may create a skin photosensitivity irritation. Veterinarians should become familiar with their laser devices before implementing essential oils. What class of laser is used? What are its safety features? Does it produce heat or pigment changes in the skin? Lasers and essential oils can be used safely, but knowing your equipment and practicing sound and safe techniques are paramount.
While purity is the key, dilution is important, too. With time and training, you will develop a sense of when and how much to dilute, if at all. Finally, less is always more with essential oils!
*Questions developed and interpreted from material learned at the Veterinary Medical Aromatherapy Association course with Dr. Nancy Brandt. 62
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The author uses essential oils and laser therapy to help treat a cat that sustained back injuries as a result of trauma.
Even wildlife and exotic species can benefit from essential oils combined with laser therapy.
Essential oils and acupuncture
Essential oils can also be incorporated into TCVM practices. They can be classified using criteria similar to that of Chinese herbal medicine, via the law of signatures, five elemental associations, nature or temperature, taste as well as aroma, and channel affiliation.2 Acupuncturists have combined essential oils with traditional techniques in the treatment of certain conditions. Needles can be dipped into the prescribed oil, then used in the traditional manner, or the essential oil can be applied directly to specific acupressure points and meridians on the body to help enhance the desired effects. Often, channels are chosen based on their resonance with certain oils.2 Studies published in 2004 and 2006 demonstrated the positive benefits of acupoint stimulation using acupressure with Lavender (Lavandula angustifolia) essential oil to provide an increase in short-term pain relief in humans with back and neck pain. 3,4
Essential oils and massage/chiropractic
Animal massage therapists and veterinary chiropractors are well-poised to reap the benefits of combining essential oils with their treatment techniques. Essential oils have been used in massage therapy for years and many veterinary chiropractors are already incorporating essential oils into their everyday adjustments. In a March 2018 educational conference, Options for Animals College of Animal Chiropractic, an institution accredited by the American Veterinary Chiropractic Association to teach animal adjusting, devoted an entire day to the topic of incorporating essential oils into veterinary chiropractic medicine. 5 Integrating essential oil therapy with veterinary massage and chiropractic adjustments results in more relaxed animals and increased efficacy of treatment outcomes. While further research into essential oils should continue, they have proven to be a versatile tool in the holistic toolbox of an integrative practitioner. Their ability to help with conditions of the mind, body and spirit, along with their ability to synergistically work with other holistic modalities, make pure grade essential oils an excellent starting point for veterinarians looking to become integrated practitioners.
Young, D. Gary. "Chapter 1: Essential Oils: The Missing Link in Modern Medicine". Essential Oils Integrative Medical Guide, Life Science Publishing, 2003.
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Yuen, Jeffrey C. "The use of Essential Oils in Accordance with Chinese Medicine Part 1". AHVMA Conference Proceedings, 2014, pages 604-608.
Yip,Y.B., Tse, S.H.M. "An Experimental Study on the Effectiveness of Acupressure with Aromatic Lavender Essential Oil for Sub-acute, Nonspecific Neck Pain in Hong Kong". Complementary Therapies in Clinical Practice, Volume 12, Issue 1, February 2006, pages 18-26.
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Yip,Y.B., Tse, S.H.M. "The Effectiveness of Relaxation Acupoint Stimulation and Acupressure with Aromatic Lavender Essential Oil for Non-specific Low Back Pain in Hong Kong: A Randomised Controlled Trial". Complementary Therapies in Medicine, Volume 12, Issue 1, March 2004, pages 28-37.
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Options for Animals College of Animal Chiropractic. "4th Annual Animal Chiropractic Olympics and Essential Oils for the Animal Chiropractic Patient", 4267 Virginia Road, Wellsville, Kansas, March 8-11, 2018.
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From the VBMA
The Veterinary Botanical Medicine Association is a group of veterinarians and herbalists dedicated to developing responsible herbal practice by encouraging research and education, strengthening industry relations, keeping herbal tradition alive as a valid information source, and increasing professional acceptance of herbal medicine for animals.
DID YOU GUESS LAST ISSUE’S MEDICINAL HERB? Turkey Tail (Trametes versicolor) is a mushroom in the Polypore family. It has strong anti-tumor, anti-viral and immuno-modulating actions. Turkey Tail dispels Dampness, transforms Phlegm and clears Heat while acting as a Liver and Kidney tonic. It stimulates the immune system, and promotes the regeneration of muscle. It can also invigorate the Shen and tonify Qi and Blood. This mushroom is currently indicated for a wide variety of conditions, including multiple types of cancer. It is especially known for its effects on hemangiosarcoma. It reduces the toxic effects of chemotherapy and radiation, increases the effectiveness of chemotherapy, and treats the side effects of cortisone and Cushing’s disease. Turkey Tail serves as a general tonic for the immune system and supports healthy liver function. It is useful for treating infections, including from URS, infections of the urinary and GIT, and immune deficiency diseases.
intensely and use it as a foundation in their professional work. Their knowledge of the topic was impressive. A second webinar, presented by Dr. Cindy Lankenau, highlighted Western herbs in the treatment of respiratory conditions, a timely topic for those in the unstable northern hemisphere. Most recently, Dr. Janice Huntingford gave a webinar on herbs used in post-surgical rehab and recovery. This was a very informative session.
UPCOMING EVENTS From June 7 to 9, the VBMA held its speaker track at the International Herb Symposium (IHS) at Wheaton College in Norton, Massachusetts. The IHS is one of the foremost herbal symposiums in the country. It is the “baby” of renowned herbalist Rosemary Gladstar and was originally established as support for United Plant Savers. And don’t forget that from June 29 to July 6, the VBMA is going to Scotland on an international eco-tour. A few spots are still available! Join us for an unforgettable experience with like-minded colleagues.
CASE REPORT Casey was a spayed Golden Retriever diagnosed with splenic hemangiosarcoma at eight years of age. Her owner declined surgical options, and Casey was given a six-month prognosis. Casey was placed on several Chinese herbal formulas, based on her pattern of disharmony of a Triple Heater dysfunction, along with Turkey Tail. She lived another six years, passing away peacefully at 14 from old age. Although Turkey Tail was only part of Casey’s treatment, it was strongly felt that it provided significant immune support throughout her treatment.
To register for upcoming events, or purchase webinars, visit vbma.org. Submitted by Cynthia Lankenau, DVM
NAME THIS HERB!
PAST ACTIVITIES The VBMA continues with a strong webinar series, including a recent presentation by Drs. Ihor Basko and Constance DiNatale on utilizing the taste of foods to develop food therapy ideas. Both lecturers have studied food therapy
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Join the VBMA at vbma.org to find out. The answer will also be published in the next issue of IVC Journal.
marketplace
Advertise Here! 866.764.1212, IVCJournal.com
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news bites CENTER FOR VETERINARY BUSINESS AND ENTREPRENEURSHIP
From left to right: Dr. Kevin Hallock, dean of the SC Johnson College of Business; Jodi Korich, DVM, associate dean for education; and Lorin D. Warnick, DVM, PhD, the Austin O. Hooey Dean of Veterinary Medicine. All three are involved in the launch of Cornell’s new Center for Veterinary Business and Entrepreneurship.
Dogs that receive Omega-3 fatty acid supplements, or have hypothyroidism, may be less likely to develop T-zone lymphoma (TZL), a slowly-progressive disease with a high incidence in older Golden Retrievers. These findings were recently announced by Morris Animal Foundation-funded researchers at Colorado State University, and were published in the Journal of Veterinary Internal Medicine. To reach their conclusions, the researchers studied detailed health questionnaires as well as blood or biological samples from more than 350 Golden Retrievers recruited through Morris Animal Foundation’s Canine Lifetime Health Project. morrisanimalfoundation.org/golden-retriever-lifetime-study
Photo courtesy of Sustenance Herbs
Photo courtesy of Rachel Philipson
KEY FINDINGS ABOUT T-ZONE LYMPHOMA
Veterinary academia has largely ignored the business of veterinary medicine as a subject for teaching and research — until now. The Cornell University College of Veterinary Medicine is launching the Center for Veterinary Business and Entrepreneurship (CVBE), a new inter-disciplinary program intended to spur research, training and outreach in veterinary business, thereby improving animal healthcare. The CVBE focuses on four programmatic pillars: education, economics research, entrepreneurship and intrapreneurship. It will offer a variety of educational programs including a new DVM certificate program, as well as post-graduate executive education. The center will also establish a veterinary economics research program. As part of the launch, Cornell now offers two new business courses for veterinary students: Veterinary Practice Management and Agile Innovation, an experiential course that teaches students creative problem-solving skills that can be applied to animal health challenges. More courses are to come. vet.cornell.edu
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NEW NAME, SAME DEDICATION TO HEALTH Sustaining health is as important as gaining it. Herbs for Life, Inc. is reintroducing its Pet Wellness Blends and Veterinary Botanicals product lines as Sustenance Herbs. The company’s non-GMO certified organic or wild-harvested ingredients will remain the same; only the name is changing. Those who regularly use their adaptogens and tonic herbs can still reach for the same products they have come to depend on. Sustenance Herbs’ new name reflects their decade-long dedication to not only helping pets regain health — but to sustain that health for the rest of their lives. sustenanceherbs.com
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