The Team - Summer 2014

Summer 2014 | Vol. 11, No. 3

A WealthEnhancing Resource for Independent Veterinary Practices

DNA Testing for Breed-specific Health 3 | Diagnosis: Suborbital Swelling 7

Decoding Dog Behavior 13 | Benefits of Acupuncture 21

Announcing a Breakthrough in Canine Screening.

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From the Desk of Dennis A. Nelson, dvm MAKING DENTISTRY A PRIORITY Summer 2014 | Vol. 11 | No. 3

A Wealth-Enhancing Resource for Independent Veterinary Practices Your Veterinarian Pet Care News From ®

A WealthEnhanc ing Res for Inde ource penden Veterina ry Practic t es

11, No. 3 SUMMER 2014 | Volume

Summer 2014

| Vol. 11,

No. 3

DecoDe Your Dog Behavior tips from the experts

EyE Spy

What might be causing under-eye swelling

DNA Testing for your pet’s Health Acupuncture as a Healing Therapy

DNA Tes ting

Decodi

for Bre ed-

ng Dog Behavio

specific

Health

r 13 | Benefit

3 | Dia gno

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21

The Team is published to complement Pet Quarterly®, an educational resource for your clients. Look for these articles in the current issue of Pet Quarterly: Decode Your Dog; Suborbital Swelling; DNA Testing for Your Pet’s Health: Acupuncture as a Healing Therapy

Visit us on the web at

www.psi-inc.net

We cover dental topics in every issue of The Team and Pet Quarterly.

Banfield’s newly released State of Pet Health 2014 Report, a survey analyzing medical data from nearly 2.3 million dogs and 470,000 cats, confirms why we do this: Dental tartar and three stages of periodontal disease account for four of the top 20 most common diagnoses among dogs.

Dental problems can surface in surprising ways. In this issue, veterinary dentist Dr. Jan Bellows discusses suborbital swelling— swelling beneath a pet’s eye that clients may think is a result of a bee sting or an eye problem. It’s more likely a result of a tooth fracture, root fragments or jaw cancer. Get his take on diagnoses and treatment on pg. 7.

A lso in this issue: • DNA testing is getting more sophisticated. Royal Canin has expanded the scope of its test to include a breed health analysis. A simple blood test reveals volumes about a pet’s ancestry and provides an analysis of potential health conditions and even nutrition recommendations. Read more on pg. 3.

• Behavior problems are a key reason pets are relinquished to shelters.

A new book from the American College of Veterinary Behaviorists, Decoding Your Dog, sheds light on common behavior problems with great solutions that you might want to share with your clients. We’re featuring an excerpt from the book on pg. 13.

• If you’ve been interested in adding acupuncture to your practice, Dr. Lauren Frank provides an overview and the basics about getting started on pg. 21.

We hope you find this issue wealth-enhancing for your practice.

Sincerely, The Team is an educational resource published by Purchasing Services Inc., St. Petersburg, Fla. Comments are welcome at info@petquarterly.com Visit us on the web at www.psi-inc.net

Dennis A. Nelson, DVM Vice President, Operations Purchasing Services Inc.

© Copyright 2014. All rights reserved.

The Team magazine does not make any representations as to opinions or facts as presented. Reproduction of contents in any form is prohibited without prior written permission of the publisher.

Postmaster: Send address changes to: The Team, 2951 34th Street South St. Petersburg, FL 33711

www.psi-inc.net | the Team | Summer 2014 1

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Breed Health

Ancestry Advances A new DNA blood test can reveal the ancestry of mixed-breed dogs, allowing veterinarians to better tailor their care to these patients.

By Angela M. Hughes, DVM, PhD

Remember Darwin’s Galapagos finches and Mendel’s wrinkled peas? The field of genetics has

progressed far beyond those famous beginnings. In fact, genetics has experienced significant exponential growth in the last few years alone. With many new tools, scientists have learned a tremendous amount about how traits and diseases occur and are inherited.

This knowledge is changing the way that we, as veterinarians, approach our patients. For example, it was only a few decades ago that a serious side effect of ivermectin was identified in some Collies. Now we know that the molecular cause is a small deletion in the multi-drug resistance gene, which can eliminate the function of a very important drug-transport pump in the blood-brain barrier.

We also learned that this mutation is found in many pure and mixed-breed dogs besides the Collie and that it involves many drugs beyond ivermectin. This type of knowledge makes us better clinicians and leads to better care of our patients. >> the Team | Summer 2014 3

The Process Behind Genetic Health Analysis

™

The process starts when a veterinarian sends a whole blood sample to the laboratory, where the dog’s DNA is extracted from the white blood cells and examined at the 321 genetic markers used for the breed analysis and the 13 disease mutations.

A proprietary computer algorithm evaluates the dog’s DNA data and performs more than 7 million calculations as it considers all of the pedigree trees that are possible in the last three generations. The trees considered include a simple pedigree with a single breed (likely a purebred dog), two different breeds at the parental level (a first-generation cross), continuing all the way up to a complex tree with eight different great-grandparent breeds allowed.

The algorithm works with breed signatures for more than 250 breeds, types and varieties to fill these potential pedigrees and gives each ancestry tree a score representing how well that selected combination of breeds matches to the dog’s DNA data. The pedigree with the overall best score is the one selected, and only breeds that reach the confidence threshold for reporting are included.

A health pre-screening considers which breeds are identified on each chromosome tested to determine if a breed at risk for a specific genetic condition likely contributed that chromosome and thus whether the dog may be genetically predisposed to the condition with further testing recommended. The veterinarian receives a report with the results of the 13 disease mutations and any health pre-screens performed.

Identify breed-specific risks and customize patient care based on breed background to allow for earlier diagnosis and medical intervention.

Understanding and utilizing genetic advances such as these enable us to provide even more comprehensive care for our patients and increase client awareness of the value of that care. It enables us to provide individual care plans for our patients.

By the Breed Our clients may choose to own a Dachshund or a Boxer, and we can distinguish ourselves as clinicians by looking at each breed’s unique medical concerns, thereby practicing “Dachshund medicine” or “Boxer medicine.” Identifying breed-specific risks and customizing patient care based on breed background allows for earlier diagnosis and medical intervention and improves the client’s relationship with the veterinary practice.

As a veterinary professional, you likely already take some breed differences into account when making medical decisions or speaking with clients. You should develop a consistent message that your entire team can relay for each breed. Discuss any breed-specific concerns with your clients early and often, so they can be prepared and you can create the best possible wellness plan for their dogs. Wellinformed clients are likely to visit your hospital more often for routine care, perform the recommended preventive care, and recognize sooner when their pets are ill.

Mixed-Breed Messages Obviously, this type of breed-specific health care is easily applied to the approximately half of your patients that are purebred dogs. But now you can extend this benefit to your mixed-breed patients as well. Royal Canin® Genetic Health Analysis™, which is powered by Wisdom Panel® DNA-testing technology, can evaluate the pure-breed ancestors within the last three generations of the dog’s ancestry (parent, grandparent and great-grandparent) with an accuracy of approximately 90 percent when tested against mixed-breed dogs of known ancestry.

Genetic Health Analysis™ can presently identify more than 250 breeds, types and varieties, including all fully recognized American Kennel Club breeds. Based on the test results, you can help your clients better understand 4 Summer 2014 | the Team | www.psi-inc.net

Breed Health their dogs and create individualized wellness plans specifically for them.

Sample Case As an example of the importance of the need for proper breed identification, my own mixed-breed dog was initially mislabeled a Papillon cross. At five years old, he had an episode of scratching at his face that looked like a choking event, but no cause could be identified. Six months later, he began having grand mal seizures and was diagnosed with epilepsy. The first event was then recognized as a likely focal facial seizure.

Based on the presumption of Papillon, epilepsy was not initially on our differential diagnosis list; however, through DNA testing, he was later found to have some Cocker Spaniel and Maltese in his ancestry. If we had known this up front, we could have treated him properly sooner, since Cocker Spaniels have a breed predisposition to epilepsy.

As in this case, it is very important to understand your patient’s breed history and treat the dog appropriately. Visual identification of breeds can be incomplete and/or misleading, with an accuracy of only about 25 percent per breed, and thus should not be relied on solely when making important medical decisions.

Diseases and Nutrition In addition to breed identification, Genetic Health Analysis™ provides the veterinarian with disease predisposition information for each patient tested. This information comes in two forms:

GENETIC HEALTH ANALYSIS™ can identify more than 250 breeds, types and varieties of dogs.

1. Direct mutation testing for 13 health conditions, including hyperuricosuria, myotonia congenita, cystinuria and primary lens luxation.

2. Health pre-screening based on the breeds identified in the dog’s ancestry for nearly 30 more patented disease mutations that the dog may be at risk of carrying, including ivermectin sensitivity, exercise-induced collapse, Boxer cardiomyopathy and >>

EYES

Identifying Tula’s Health Concerns Sara fell in love with Tula’s fuzzy face and adopted her from the local shelter. She was curious about Tula’s ancestry and wanted to work with her veterinarian to create the best possible care plan. Genetic Health Analysis™ identified that one of Tula’s parents was a purebred Golden Retriever, while the other was half Labrador Retriever and half Standard Poodle, also known as a Labradoodle.

This made a lot of sense with Tula’s physical and behavioral traits such as intelligence, treat motivation and love of the water and outdoors. Sara and her veterinarian plan to pay particular attention to Tula’s skin, joints, eyes and heart health, as these breed ancestors can predispose her to heath concerns in these areas in particular.

SKIN

HEART HEALTH JOINTS

www.psi-inc.net | the Team | Summer 2014 5

Breed Health degenerative myelopathy.

Royal Canin® has also incorporated its research into canine nutrition to provide nutritional recommendations based on each dog’s unique genetics and predicted adult weight range. You can incorporate this information into discussions with your clients about their pet’s proper diet choices, caloric needs and

Sample Report To view a Genetic Health Analysis™ sample report, visit www.RoyalCaninGHA.com. maintenance of a healthy weight and body condition through each life stage.

With the breed detection, disease predisposition and nutritional information obtained through the use of the Royal Canin® Genetic Health Analysis™ test, veterinarians now have a tool to provide both our pure-breed and mixed-breed canine patients with the most informed care possible, leading to better medicine for our patients and happier clients. n Angela M. Hughes, DVM, PhD, is a veterinary geneticist with Mars Veterinary.

Online Genetic Resources n R oyal

Canin® Genetic Health Analysis™: www.RoyalCaninGHA.com

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Dental Health

Diagnosis: Suborbital Swelling Swelling below the eye can be a sign of severe dental disease that requires surgical treatment.

By Jan Bellows, DVM; Diplomate, American Veterinary Dental College; Diplomate American Board of Veterinary Practitioners

If swelling appears under the eye of a dog or a cat, your

clients may think their furry friend has suffered a bee sting or a bump from a side table. If the swelling doesn’t resolve on its own or returns after an antibiotic injection, you are probably looking at a much more serious condition. With suborbital swelling, the root of the problem may lie not in the eye, but in your patient’s teeth or gums.

What is suborbital swelling?

Suborbital (“below the eye”) swelling is an enlargement of the tissue below the eye (photo 1). It affects dogs more commonly than cats.

What causes suborbital swelling?

The most common cause is a complicated fracture of one more cheek teeth—usually the

1 >>

Swelling under the left eye in a Labrador.

www.psi-inc.net | the Team | Summer 2014 7

Dental Health upper third or fourth premolars and/or first molars—allowing oral bacteria and debris to travel through the tooth to the bones and soft tissues below the eye.

Tooth fractures are classified as uncomplicated when the pulp (internal nerve and blood vessels) is not exposed to the oral environment but remains protected by enamel or dentin; those where the pulp is exposed are called complicated fractures.

Once the pulp is exposed, oral bacteria soon invade, often causing an infection that may result in swelling beneath the

TOP CAUSE

A fracture of a cheek tooth commonly causes suborbital swelling. eye (photos 2a and 2b). If the underlying cause is not treated, the swelling often enlarges until an abscess ruptures, leading to a bloody or pustular discharge below the eye (photo 3).

Other causes of swelling below the eye include trauma from insect bites to the area; fractured roots due to trauma or inadvertently left

The Team Approach Receptionists It’s you who will field the phone call from the client who queries why the bug bite below the dog or cat’s eye seems to be getting bigger rather than smaller, or why it went away after the doctor gave an antibiotic injection but then came back. Know that a swelling below the eye that doesn’t go away with minimal care is a potentially painful and serious situation. Let clients know that an immediate visit to the office for a veterinary exam is in order.

Technicians/Dental Assistants In most practices, you spend more time in the patient’s mouth then anyone. Be aware of any swellings on the face or in the oral cavity and bring them to the attention of the veterinarian. It’s also your role to provide diagnostic X-ray imaging for the veterinarian to

examine. Appreciate that 60 percent of the tooth is located under the gum line and that, in most cases, examination of intraoral films reveals the cause of the oral swelling and provides direction for therapy.

behind after surgical extraction (photo 4); foreign penetrating objects; and nasal or upper jaw cancer, especially in older patients.

Why are immediate diagnosis and treatment important?

By the time the painful swelling is noted, the infection or tumor causing it has festered for weeks or months. Fortunately, most of these swellings can be cured once the proper diagnosis is made.

“Wait and see” after administration of antimicrobial and/ or anti-inflammatory medication

Suborbital sweeling in dogs can be difficult to diagnose and requires immediate treatment.

Practice Administrators/ Office Managers Realize that suborbital swellings in dogs can be difficult to diagnose. Equip the office with intraoral dental imaging and a high-speed dental delivery system for extractions. This will improve overall success in dental diagnosis and care.

Veterinarians Suborbital swellings can be diagnostic challenges, especially in cases where there is no obvious fracture of the cheek teeth. Understand that often the swelling is secondary to persistent infection and

8 Summer 2014 | the Team | www.psi-inc.net

that antimicrobials will not give long-term positive results until the cause is removed.

To evaluate suborbital swellings, use general anesthesia with intubation, intraoral images and fineneedle aspiration cytology.

Treatment involves surgery

to either remove the tooth or retained root fragments, root-canal therapy to save the tooth, or tumor excision.

Due to the syndrome’s complexity, consider referral to a veterinary dentist (avdc. org) based on your available equipment and expertise.

is not indicated for patients with suborbital swelling. The first step should be a thorough professional oral examination with special attention focused on the cheek teeth. >>

2a

Swelling under a Maltese’s left eye.

2b

Crown root complicated (slab) fracture of the maxillary fourth premolar, causing the swelling seen in photo 2a.

3 Hemorrhagic pustular discharge under the left eye, caused by pulp exposure from a fractured tooth.

4

Intraoral draining of fistula in the area of root fragments.

8

8

www.psi-inc.net | the Team | Summer 2014 9

Dental Health

Are X-rays and biopsy needed?

The key diagnostic step is to take an X-ray of the area while the patient is anesthetized.

X-ray imaging of the swollen area usually shows a significant cause of pathology (photos 5-7).

Additionally, you may also place a small needle into the area of swelling under local anesthesia to aspirate cells and examine for infection or cancer.

What are the treatment options?

The most common causes of suborbital swelling include a fractured tooth with pulp exposure, root fragments that became infected, or cancer. Treatment involves surgery to remove the cause if possible. Antibiotics, no matter how powerful, will not permanently cure the swelling and

5

6

Periapical lucency around the distal root of the left fourth premolar from the dog in photos 2a and 2b.

Root fragments causing the fistula in photo 4.

8

7

Marked lucency surrounding the tooth roots of the dog in photo 1, typical of neoplasia.

Root-canal therapy for treatment of periapical disease.

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9

Left-sided suborbital swelling secondary to root fragments after extractions.

10

should not be used as the primary treatment. n For a fractured tooth with pulp exposure, the tooth may be repaired through root canal therapy or removed surgically. n For swellings caused by infected root fragments, surgical exploration below the gum line is needed to find and remove the fragments to affect a cure. n For swellings caused by cancer, surgery and radiation therapy are often helpful.

How is the prognosis?

Once surgery is performed, the prognosis for resolution of nonmalignant suborbital swelling is generally excellent (photos 9 and 10). n

Resolution of swelling in photo 9 after extraction of the root fragments.

Dr. Jan Bellows specializes in veterinary dentistry at All Pets Dental in Weston, Fla.

Tough Talk How to deliver bad news in cases of malignancy.

To prepare your client for the possibility of bad news, your initial exam-room conversation should bring up the possibility of malignancy as one of the potential causes of suborbital swelling. Often, fine-needle aspiration under local anesthesia and examination of the cells can give you a tentative diagnosis to share with the owner, with a final diagnosis made after histopathological confirmation.

If the news is bad, let the client know that surgery often provides a favorable prognosis. Share success stories and photos of patients treated for a similar condition.

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Behavior

DECODING YOUR DOG Tips for helping your clients communicate with their pets and solve common behavior issues.

By Jeannine Berger, DVM, DACVB, and Lore I. Haug, MS, DVM, DACVB

Every night it’s the same: Anna comes home after eight grueling hours at the office, and Rowdy, her happy-go-lucky Labrador Retriever mix, jumps on her. Scratch that—he barrels into her. At 60 pounds and with all the exuberance of his two years, Rowdy has almost toppled his petite owner on several occasions. Anna has lost some of her best outfits this way and often ends up with paw scratches

on her stomach. She doesn’t mind the jumping so much on weekends when she’s in jeans and a T-shirt and the two of them wrestle on the lawn. But on a weekday in the evening, she’s exhausted and wearing heels. No matter how many times she shouts “No!” and pushes him off, Rowdy still treats her like a trampoline every night. She has even tried spraying water in his face—to no avail.

Anna is certain Rowdy acts this way to dominate her. After all, he spends more time at home than she does. He also steals stuff from the kitchen counter if she leaves anything out, and he spreads the trash all over the floor if he can get to it. Clearly, he thinks he owns the place.

So many of our dogs’ behaviors are normal and have evolved because of their close relationship >>

www.psi-inc.net | the Team | Summer 2014 13

Behavior to humans. Nonetheless, some of these behaviors can annoy us to the point of damaging our relationship with our dogs. It is sometimes difficult to see how to change course and get back on track to a loving bond with our dogs if they steal our favorite shoes or tear into the expensive new couch.

We emphasize improving your communication and training skills

14 Summer 2014 | the Team | www.psi-inc.net

so you can implement suggested plans to improve your dog’s behavior, leading to a tighter bond and a longer-lasting relationship with your canine buddy.

Facts, Not Fiction Let’s stay with jumping. Biologists tell us dogs have evolved a greeting ritual specifically to interact with humans. Jumping and grinning are

innate to dogs, but dogs developed a greeting style just for us probably because we are missing some of the physical attributes they rely on for social interactions with other dogs: ears that move, tails, and certain glands that send olfactory signals.

They use ritualized “I’m meeting a person” greetings to communicate varying degrees of recognition and attachment. Hence the difference between a modest tail wag when a dog meets a stranger and the dance of joy he breaks into when he greets his owner.

Jumping up, therefore, is not a bid for dominance but a normal canine greeting behavior. Rowdy has no idea how Anna would prefer to be greeted. Not only that, but Anna has inadvertently strengthened the jumping by reinforcing it some of the time— which is called “intermittent reinforcement”—when she welcomes Rowdy’s jumping up on weekends. The pushing and scolding don’t change Rowdy’s behavior because that’s attention, and attention is precisely what Rowdy craves after many hours without his best friend.

Don’t forget, dogs are intensely social creatures. They therefore do many things to get and hold our attention. Our response often determines how persistent they might be and what they do next.

They might jump on us, hump our legs, or steal the remote control— obviously a high-value object, given how much people clutch it. Dogs who hunger for our attention are “people dogs,” that is, they’re highly motivated by interactions with us. It then is up to us to give that attention only when they perform the behavior we are looking for (sitting, lying relaxed, or dropping the ball). A highly attentionmotivated dog will often work for praise, and a pat on the head might trump food.

Rowdy gets a good amount of exercise, which is great and an absolute must for a young and

reinforcement (rewarding every time the desired behavior occurs).

But reinforcement can also haunt you if you inadvertently reward your dog intermittently by periodically giving attention for jumping up, by sometimes leaving food out on counters, or by occasionally feeding him from the dinner table.

Is That Really True?

energetic dog, but he still spends at least eight hours alone with no company and nothing to do except trash diving and counter surfing.

This is fun entertainment for many dogs because, again, the intermittent reinforcement—sometimes finding something—is very rewarding.

Intermittent reinforcement is a powerfully motivating force to all animals, including humans. Think of it as the Las Vegas effect: the

anticipation of a periodic jackpot keeps us dropping coins into a slot machine, even though we only occasionally win. Dogs are no different. Sometimes there is a loaf of bread left on the counter, so it makes it worthwhile to keep looking.

Intermittent reinforcement is an important aspect of training, because it helps solidify new behaviors once they are learned using continuous

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We tend to assign human motivations to dog behavior—and particularly nuisance behaviors, such as pulling on leash walks. Not only is that unfair to dogs, but it also sets up a power struggle. If we believe the dog is acting out of spite or is trying to dominate us, we start looking for ways to put him in his place without considering other explanations for his behavior. From this springs such unfortunate strategies as stepping on a dog’s toes or kneeing him in the chest to stop him from jumping, which amounts to punishing the dog

>>

Behavior

Behavior Management Techniques

To Prevent This

Do This

Jumping on visitors to the home

Put the dog in another room when the doorbell rings

Jumping on you when you come home

Throw treats on the ground or a ball to retrieve

Barking at passersby outside

Draw the curtains or restrict the dog’s access to the windows

Pulling on the leash

Use an anti-pull head halter or harness

Attacking the water hose

Put the dog inside while you are watering

Chewing on the furniture

Don’t allow access; use a baby gate or crate

Training Alternate Behaviors

To Replace

Train To

Door dashing

“Sit” or “down” before opening the door

Eating trash off the ground

Carry a toy or keep eye contact with you

Barking at the doorbell

Get a toy

Digging up the roses

Fetch or hide-and-seek with dog toys

Pawing at you

Put pawing on a cue—so he uses his paw for a “high five” or “wave” when asked

16 Summer 2014 | the Team | www.psi-inc.net

for being happy to see you.

A much better approach is to focus on helping our dogs learn what we would like them to do instead—for example, greet us politely by sitting in front of us or barking on cue when asked to “speak.”

Management Techniques Many annoying behaviors can be prevented or managed to a point where they no longer present a problem. Keep in mind that management isn’t training. The dog isn’t learning how we would prefer him to behave; he is simply prevented from behaving in an unwanted way in a situation because we control the options and outcomes. But management is a great short-term measure for getting relief, especially for young animals with nuisance behaviors, and it often works well enough to satisfy many people in the long term too.

Management techniques might include setting up barriers such as baby gates and exercise pens, using humane anti-pull devices such as head halters or harnesses, and simply dog-proofing the house, stowing away food, and placing desirable things out of reach.

Substitute sitting for jumping on you by rewarding your puppy only when he is sitting. No punishment is needed, because he learns very quickly that when he sits, he gets what he wants. This allows him to explore different behaviors and make the correct decision.

The puppy will very likely offer this sitting behavior again. If you are consistent in your reactions, soon he will default into a sit position for greetings.

door just because the dog paws at it; don’t throw the ball just because he barks at you. For those and countless other privileges, ask the dog to say “please” first by doing something like sitting quietly.

The benefits of this approach are many. For one thing, good manners become part of everyday routines rather than something the dog is asked to do only in special training situations. Your dog also learns

a degree of impulse control. He realizes that not immediately acting on impulse, but rather stopping to consider alternative options, can be rewarding. Training also becomes linked in the dog’s mind to all his favorite activities—he will sit for having his leash put on for a walk, he will comply with a request before being invited onto the couch, he will look at you before getting his breakfast or a chew toy, and he will release the >>

Training Consistent Interactions This means using everyday situations to train and continually strengthen good manners—without spending a lot of time on dedicated dogtraining sessions. It boils down to this: Whatever the dog wants, don’t give it away for free. Don’t open the www.psi-inc.net | the Team | Summer 2014 17

Behavior ball before tossing it again and playing fetch with you. When all good things must be preceded by responding to a cue that you give, your dog quickly learns to behave politely.

The goal isn’t to seek the perfect obedient response to “sit” or “stay”; it simply teaches your dog to say “please.” If the dog puts his bottom to the floor, the item or attention will be provided. Soon it becomes second nature, and your dog might default into a “sit” behavior instead of jumping or pawing at you.

Training Solutions The trick with all nuisance behaviors is to train and reward an opposite or competing behavior.

For example, Rowdy can’t jump on Anna if he’s sitting to greet her. He can’t bark at visitors if he has a toy in his mouth, or beg at the dinner table if he is in a down-stay on his bed, or pull on his leash if he’s by

18 Summer 2014 | the Team | www.psi-inc.net

Anna’s side making eye contact every five seconds. Whatever bothersome behavior the dog is engaging in, think of something that would preclude it, and train that behavior consistently.

When training any new behavior, especially to replace a well-established nuisance behavior, patience and consistency are key.

It can take a while for the dog to give up strategies that have worked for him consistently, but if he is no longer rewarded for them and is instead consistently reinforced for an alternative behavior, he will soon choose that new response every time. Stick with it. Because the unwanted behavior worked in the past, your dog will most likely try it again, but harder, before he will give it up. This is called an “extinction burst.” It’s a sudden display of a behavior that was diminishing after you stopped rewarding it. It’s sort of like your

dog saying, “Was she really serious about that?” Don’t give up; stick with your plan and you will be rewarded. n Excerpted from Decoding Your Dog, American College of Veterinary Behaviorists, Edited by Debra F. Horwitz, DVM, DACVM, and John Ciribassi, DVM, DACB, with Steve Dale; Houghton Mifflin Harcourt, 2014.

www.psi-inc.net | the Team | Summer 2014 19

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General Wellness

Acupuncture Assets From helping alleviate chronic pain to calming anxiety before procedures, acupuncture offers many benefits to your patients and your practice.

By Lauren R. Frank, DVM, CVA, CCRT, CVCH

Western medicine provides of tools for addressing acute disease, but the lack of options in treating chronic disease can be frustrating to both veterinarians and clients. In recent years, more people are realizing that acupuncture can provide relief and benefits to animals as well as people.

Acupuncture stimulates the body’s pain-relieving pathways. In addition, it helps the body to heal itself. It can be used as an alternative or adjunct to many Western medications. It also promotes an overall sense of well-being and can boost quality of life in many individuals. Acupuncture can easily be integrated into any traditional veterinary practice with training, limited supplies and selection of the right cases. plenty

Acupuncture can be integrated into any traditional veterinary practice with training and limited supplies.

Common Uses Acupuncture can treat a vast number of pathologies, although pain, nausea and neurologic conditions are the most studied indications.

In veterinary medicine, acupuncture is commonly used for osteoarthrosis/osteoarthritis (OA), Intervertebral Disc Disease (IVDD), lumbosacral (LS) disease, vomiting, diarrhea, constipation, anxiety, kidney and liver problems, pancreatitis, immune-mediated diseases, asthma, inflammatory bowel disease and cancer, as well as many other conditions.

Acupuncture can rejuvenate energy and immunity and can act as a powerful appetite stimulant.

As a veterinary acupuncturist, there are few things more gratifying than stimulating an anorexic animal >> www.psi-inc.net | the Team | Summer 2014 21

General Wellness to eat just after an acupuncture treatment. Another indication for acupuncture is to help calm nervous or anxious patients, especially cats, prior to routine procedures. Surprisingly, one of my best acupuncture patients is a fractious Bengal cat. Prior to having acupuncture treatments, he would consistently defecate and urinate during his examinations. Now we do

acupuncture first, and he becomes quiet and cooperative with any procedures that follow, including blood draws and cystocentesis.

Getting Certified Certification in veterinary acupuncture (CVA) is available to veterinarians through three continuing education programs in the United States: Chi

Institute of Chinese Veterinary Medicine, International Veterinary Acupuncture Society, and the Colorado Veterinary Medical Association.

Generally, an acupuncture training program requires about 130 to 140 hours of lectures and laboratories, with rigorous written and oral examinations. Some courses offer introductory classes and some training

The Team Approach The whole team can work together to identify cases that would benefit from acupuncture, promote treatment in ideal patients, and lure clients who are seeking alternative options.

Receptionists Ask clients about their interest in acupuncture. Be aware of potential cases that would benefit from acupuncture.

Remember that acupuncture can also act as a sedative in many patients prior to routine medical procedures and grooming. Encourage clients to consider acupuncture as a potential therapy for their pet’s condition.

Veterinary Assistants/ Technicians Although only veterinarians can give pets acupuncture with needles, you can practice the theory of acupuncture by using acupressure (applying pressure at particular points). Gently stroking the area between the eyes in cats stimulates a relaxation acupoint; in addition, rubbing the base of the ears is calming to many small animals. Use these techniques to promote relaxation during medical procedures or prior to acupuncture, and teach them to clients with anxious animals.

Consider taking courses for technicians to help promote understanding and awareness of veterinary acupuncture (such courses are available at the Chi Institute).

Boarding Managers and Animal Caretakers Be alert for patients that appear to be 22 Summer 2014 | the Team | www.psi-inc.net

sore, painful, anorexic or depressed, or that have vomiting or diarrhea. Be aware that acupuncture is an excellent way to address these signs without adding medications or masking problems, and promote this possibility to clients. Many clients welcome the idea of their pet being treated with acupuncture, not only to help with stress, but also to improve their overall quality of life. Knowing that their animal is going to get a “spa treatment”—including something as relaxing as acupuncture—can help alleviate some of the guilt of boarding.

Practice Managers Include acupuncture on your practice protocols for the treatment of pain, neurologic signs and gastro-intestinal issues. In your marketing, stress that acupuncture can help calm pets and promote the overall quality life. Offer this extra service to patients, boarders and grooming candidates, and

encourage a pre-signed consent for acupuncture prior to any issues that may arise. Make sure a supply of acupuncture needles is available in your practice— they are inexpensive, easily purchased and represent low overhead. Encourage veterinarians in training to practice acupuncture; this will help accelerate its popularity and use.

Veterinarians Start with learning one or two acupoints and concentrate on cases that would benefit from these points. Many veterinarians use Governing Vessel-26 (GV-26) for resuscitation after shock, Caesarian section and anesthesia, as it stimulates respiration and cardiac output.

Acupuncture is generally safe; regardless, be careful placing needles in areas over the lungs or peritoneum.

Encourage your practice manager to stock acupuncture needles. Start practicing— you’ll find that acupuncture quickly sells itself.

Treatment with a dry needle technique called “circle the dragon” for a hotspot related to a tick bite.

online. In addition, around 40 hours of internship training under a certified acupuncturist and several written case reports are required in order to receive a Certified Veterinary Acupuncturist (CVA) certificate.

Expand Your Toolbox Acupuncture can be an innovative therapy to add to a veterinary practice. Once you become skilled in acupuncture, it has very little overhead costs associated with it. It can be an effective, safe and noninvasive addition to your “toolbox” of therapies to offer and can be something else to offer patients when there are no other Western options.

In this regard, acupuncture can be a great asset, not only as a practice builder, but also as a morale booster, because it is a therapy that can produce astounding results. n Dr. Lauren Frank practices Physical Rehabilitation and Integrative Medicine at University of California, Davis Veterinary Medical Teaching Hospital.

She received her Certification in Veterinary Acupuncture (CVA) and Certification as a Veterinary Chinese Herbalist (CVCH) through the Chi Institute of Chinese Veterinary Medicine. Dr. Frank is also a Certified Canine Rehabilitation Therapist (CCRT).

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Quiz TEST YOUR KNOWLEDGE Quiz questions are based on articles in the current issues of The Team and Pet Quarterly ®

1 What are two key dental causes of suborbital swelling?

A. Tooth fracture B. Retained teeth C. Periodontal disease D. Jaw cancer 2 What is NOT a typical de ntal treatment option for suborbital swelling?

A. Root canal B. Extraction C. Antibiotics D. Radiation therapy 3 What method of acupunc ture for cases of marked pain? is typically used A. Dry-needle acupuncture B. Aqua-acupuncture C. Electro-acupuncture D. Laser acupuncture 4 True of false: Acupunctu re can act as an appetite stimulant.

A. True B. False

5 Why do dogs jump on pe

8 Which are common healt h concerns for Cocker Spaniels?

A. Hypothyroidism B. Autoimmune hemolytic anemia C. Ear infections D. Aortic stenosis 9 Genetic Health Analysis™ analyzes _____ breeds, types and varieties of do gs.

A. 150 C. 225 B. 175 D. 250

10 V isual identification of a dog’s breed has an accuracy rate of about __ ___ percent.

A. 15 C. 35 B. 25 D. 40

1-A,D, 2-C, 3-C, 4-A, 5-B,

A. To show dominance B. To greet C. To play D. None of the above

ople?

6 When a dog’s ears are in a for pricked position, it can me ward and an _____.

A. Alertness B. Attentiveness C. Aggressiveness D. All of the above 7 True or false: Certain car diac medications may increase and blood-pressure a pet’s risk of overheating.

A. True B. False

www.psi-inc.net | the Team | Summer 2014 25

B

6-D, 7-A, 8-A,B,C, 9-D, 10-

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