Wednesday, January 29, 2020
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CBD for cats and dogs

A look at endocannabinoid support and the tricky therapeutic and regulatory landscape of using CBD for pets.

The cannabidiol (CBD) craze is in full swing all over North America. Recently, it was announced that even gas stations will be selling it, not to mention supermarkets, coffee
shops and health food stores. Big money is being invested in cannabis worldwide, and as with any trade bubble, there are plenty of players trying to get in, get rich, and get out before the bubble bursts — unfortunately, this “get rich quick” scheme has produced a plethora of unreliable products. Even companies specializing in human CBD products are jumping on the bandwagon and offering pet lines as an “extra” — despite lacking knowledge of veterinary applications, dosing or protocols.

But let’s not throw out the baby with the bathwater! This mania would not exist if utilizing CBD didn’t result in remarkable benefits. While most people are familiar with the marijuana plant’s “high” effects, mediated by tetrahydrocannabinol (THC), Cannabis sativa contains
hundreds of compounds, most of which, like CBD, are not psychoactive, and have untapped therapeutic potential. The native cannabis plant has abundant CBD and a small amount of THC; however, high THC strains have been bred for recreational use.

Is CBD legal, and what about my DEA license?

Unfortunately, this is highly variable state by state. To make things even more confusing, while federal law has declared industrial hemp (less than 0.3% CBD) to be lawful, cannabis has not yet been removed from the list of Schedule One drugs, leaving a lot of room for interpretation.

In some states, like California, even though both medical and recreational marijuana products are legal, veterinarians are not allowed to discuss the medical use of cannabinoids with clients. However, all these laws are rapidly changing and adapting to the hemp industry’s exponential growth over the past 18 months. If you don’t like the regulations in your state, wait ten minutes!

Unfortunately, the legal gray area is preventing vets from giving their clients the expertise they need, which leads animal owners to rely on Dr. Google.

How do phytocannabinoids work?

The endocannabinoid system (ECS) helps the nervous system and immune system communicate. The ECS is suspected to be involved in neuroprotection, immunomodulation, the fighting of cancer, pain reduction, metabolic balance and gastrointestinal motility, with effects in and around the synaptic space.1 Phytocannabinoids (cannabinoids derived from hemp and other cannabis species) can act as partial agonists of the ECS, providing pain relief through coactivation with endogenous opioid receptors. They can also reduce excessive inflammatory responses involved in chronic diseases and aging. THC primarily interacts with the CB1 receptors on nerve endings, which function to regulate neurotransmitter turnover. CBD, on the other hand, has indirect effects throughout the body via CB2 receptors, which have widespread distribution in immune cells, muscles, joints, and organs.

Can my dog or cat get high from CBD?

CBD is not a psychoactive drug. However, in a quirk of physiology, dogs have an unusually high number of CB1 receptors in their cerebellum, making them highly susceptible to THC effects — a big health risk for dogs that accidentally ingest their human’s medical or recreational marijuana “edibles” or bud. While THC is not toxic to dogs, subsequent severe ataxia and dissociation make them susceptible to secondary dangers, such as falling or aspiration pneumonia.

Pharmacokinetics of cannabinoids

Preliminary data in dogs indicates that optimal therapeutic levels are most rapidly reached through trans-mucosal 2 dosing, which avoids interaction with the liver CYP450 detoxification system. However, cannabinoids may compete for CYP450 binding sites, possibly altering or affecting drug clearance time for other medications. This list3 of affected drugs includes, but is not limited to, certain anti-seizure medications and several classes of antibiotics and cytotoxic chemotherapy drugs, so it is critically important for people to seek the advice of their human or pet health professional before using these substances on themselves or their animals. Anecdotally, dosing with cannabinoids has not been found to alter phenobarbital serum levels (G. Richter, DVM, personal communication).

Purified cannabinoids have a bell-shaped dose-efficacy curve; clinical effects increase then fall off with doses exceeding the peak efficacy for that individual. For this reason, some trial and adaptation is advisable when adding CBD to a treatment plan, because dosage may increase or decrease. Occasionally, pets receiving micro-doses of CBD for anxiety may become disinhibited — forgetting about their house-training or failing to control their aggressive instincts. This usually resolves with a further reduction of the dose. Best results are achieved when checking the dosage after three to five days for effects. Desired CBD effects, whether for pain mitigation or soothing the nervous system, should be visible within a day or two, unlike many therapeutic regimens which take weeks to load.

Indications for use of exogenous cannabinoids in animals

There are many useful applications for CBD, the non-psychoactive cannabinoid. (THC is mainly used, where legal, for cancer and end-of-life care. CBD is used for reducing anxiety and phobias, treating arthritis pain and inflammation 4 as well as neurogenic pain, mitigating idiopathic and non-drug-responsive seizure activity,5 and regulating diabetes.6 While cannabinoid research is in its infancy in the US, researchers worldwide have speculated that some neurodegenerative conditions, such as Parkinson’s disease in humans and degenerative myelopathy7 in dogs, may have their etiology in dysregulated function of the endocannabinoid system (ECS). For clinicians who have incorporated CBD into their treatment plans, it is proving to be a useful adjunct in managing many common pet ailments, especially in geriatric pets (see CBD case studies at IVCJournal.com/CBD-case-studies).

Though each individual animal’s response may vary, four levels of CBD dosing are generally used in pets:

Dose (per kg body weight) indications

  • Micro (0.1 mg/kg) — anxiety, fear, stress, behavioral issues, mild pain, muscle tension
  • Medium (0.2-0.5 mg/kg) — osteoarthritis, moderate pain, muscle spasms
  • High (0.5-1.0 mg/kg) — moderate to severe pain, neurogenic pain, degenerative myelopathy, tremors, idiopathic epilepsy, diabetes regulation, IBD
  • Ultra (1.0-5.0 mg/kg) — refractory epilepsy, anti-neoplastic, refractory pain, hospice care

In a recent study at Colorado State University College of Veterinary Medicine,8 high dose CBD treatment was associated with mild transitory diarrhea upon initiation of treatment. After long-term high-dose usage, one third of dogs showed elevated alkaline phosphatase. However, this study lacked a control group to compare environmental and stress effects with the CBD-associated effects. It is also essential to note that these results were found at doses of 10 mg/kg to 20 mg/kg, compared with the dose range of 0.1 mg/kg to 1 mg/kg, administered trans-mucosally, recommended by veterinarians with extensive experience in CBD’s clinical applications in pets. (R. Silver, Cornell NYSVMS seminar, 2018; G. Richter, CIVT webinar, 2019).

A study conducted at Cornell University 4 showed similar elevations of alkaline phosphatase, but also involved dosing at 2 mg/kg to 8 mg/kg orally, rather than the lower doses using trans-mucosal delivery. Neither study showed evidence of hepatocellular damage, so it is difficult to interpret the meaning of the changes mentioned above. It is likely that lower dosing though an appropriate delivery method would prevent them. Preliminary research trials in horses suggest that pain and anxiety reduction can be achieved with as little as 20 mg to 25 mg CBD oil administered trans-mucosally, once or twice a day 9.

Not impressed with CBD results?

Take a closer look at the product quality, administration method and dose amount. Like any therapeutic intervention, details matter!

  1. Is the product you are using reliable? Look for third party lab testing, easy administration, high potency, and companies that stand by their products with a full guarantee. Many new players in the industry are ignorant of cultivars and are putting out inferior products that are poorly extracted with unreliable concentrations. Don’t get fooled by pretty labels and great marketing! Full spectrum CBD oil should have a light herbal bouquet and should not taste like licking a lawnmower, full of grass and solvents.
  2. Is the method of administration correct? It has long been known that oral ingestion of cannabinoids is non-optimal, with estimates that 80% to 90% of CBD/THC is broken down in first pass liver metabolism by the cytochrome P450 system. So avoid any products that have an oral delivery: e.g. treats, biscuits, “chews” or oils that are advertised to go on top of food. In order to be effective, those products must contain five to eight times the dose of CBD that has been shown effective with direct trans-mucosal dosing.
  3. Is the dose correct? High quality CBD, appropriately dosed, should take effect in five to 15 minutes, not weeks to months. Compare the amount of actual CBD in the dose to the chart above, for the indication you are treating. If you know your product is reliable, try a different dose if no results are seen in two to three days. Many pet products have vanishingly small amounts of CBD, like 5 mg/ml, which is great for a Yorkie, but not for a Rottweiler. Know your dosages and use the product that can deliver the right dose in the least amount of oil, so that the pet does not balk at a mouth full of oil.

Full spectrum or isolate?

There is a place for both in your pharmacopeia. Full spectrum advocates like the “entourage effect” of having multiple cannabinoids and terpenes. However, very little is known about the actual benefits of many of the lesser cannabinoids, which occur in much lower amounts. A CBD isolate product can be compounded with other oils, like MCT coconut oil or olive oil, for better palatability, and can be dosed more precisely. Many clients want to use the same products as their pets, for convenience, and some humans need to avoid full spectrum due to the possibility of drug testing at work, which could trigger trace amounts of THC.

How should you choose a CBD product?

When choosing a CBD product to dispense or recommend, it is advisable to consider how “user-friendly” the product is, with doses listed on the label, as well as its reliability. Do not even consider a product that is not made using good manufacturing practices (cGMPs) or does not have third party lab certificates of analysis available for every batch of oil. Better companies will have money-back guarantees on their products, and will be able to answer your questions about the source of their biomass and the overall extraction process. The extraction process can include either ethanol or CO2 extraction. However, beware of poor quality incomplete extraction. In regards to aroma and flavor, full spectrum CBD oil should have a light herbal fragrance without any hint of chemical residues. This is especially important for feline patients — many cats do not appreciate the taste of full spectrum oils, and may do better on an isolate product.

Practical dosing advice

Low potency products (300 mg/oz or less) can be useful for micro-dosing behavioral issues, and for pets under 15 pounds. For anything larger than a toy dog, higher potency products should be utilized, to avoid giving a large mouthful of oil. Additionally, CBD is expensive, and tends to come in small total volume bottles, usually 1 oz (30 ml) in size. It is much easier to achieve excellent compliance from your clients when the total number of CBD mg in the bottle is divisible by 30! It is also useful to remember that oils behave differently than aqueous solutions because of oil’s reduced surface tension compared to water — thus, while eye drops contain about 20 drops per ml, CBD oil has 30 drops per ml, because the drops are smaller. Consider a product that contains 900 mg/oz (30 ml). Each ml will contain 30 mg of CBD, and each drop will contain 1 mg. So for a 55-pound Husky, a dose for anxiety (0.1 mg/kg) will be two to three drops BID; however, for moderate geriatric arthritis (a dose of 0.4 mg/kg), you should start at 10 mg (ten drops or 1/3 ml) and adjust up or down as needed, based on the dog’s response in three to five days.

Cannabidiol can be a useful addition to your clinical pharmacopeia: it is effective at relieving pain and anxiety with little or no side effects, and if administered appropriately, can be a cost-effective way to improve quality of life for aging pets.

Editor’s note: IVC Journal is closely following the advancements in this rapidly-changing industry, and will continue to update readers on the latest research and applications regarding CBD use in animal patients.

* This article is peer reviewed

References

¹Freundt-Revilla J, Kegler K, Baumgärtner W, Tipold A. “Spatial distribution of cannabinoid receptor type 1 (CB1) in normal canine central and peripheral nervous system”. PLoS One. 2017 Jul 10;12(7):e0181064.

²Bartner, McGrath et al. “Pharmacokinetics of cannabidiol administered by three delivery methods at two different dosages to healthy dogs”. Can J Vet Res 2018 82:178-183.

³Zendulka O, Dovrtelova G, Noskova K, et al. “Cannabinoids and Cytochrome P450 Interactions”. Curr Drug Metab. 2016, 17(3):206– 226.

⁴Gamble LJ, Boesch JM, et al. “Pharmacokinetics, Safety,and Clinical Efficacy of Cannabidiol Treatment in Osteoarthritic Dogs”. Front in Vet Sci 2018, 5:165.

⁵Jones NA, Glyn SE, Akiyama S, et al. “Cannabidiol exerts anti- convulsant effects in animal models of temporal lobe and partial seizures”. Seizure. 2012, 21(5):344–352.

⁶Gruden G, Barutta F, Kunos G, Pacher P. “Role of the endocannabinoid system in diabetes and diabetic complications”. Br J Pharmacol. 2016, 173(7):1116-27.

⁷Fernández-Trapero M, Espejo-Porras F, Rodríguez-Cueto C, Coates JR, Pérez-Díaz C, de Lago E, Fernández-Ruiz J. “Upregulation of CB2 receptors in reactive astrocytes in canine degenerative myelopathy, a disease model of amyotrophic lateral sclerosis”. Dis Model Mech. 2017, 10(5):551-558.

⁸McGrath, Bartner et al. “A Report of Adverse Effects Associated with the Administration of Cannabidiol in Healthy Dogs”. JAHVMA 2018, 52:34-38.

⁹Silver, R. Chief Medical Officer for RxVitamins, White paper: “Equine Phytocannabinoid Dosing Study”, 2018.

New interactive rabies map

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An online interactive map that shows the areas within the United States that have pre-exposure rabies vaccination laws for domesticated small animals

As of March 9, 2018, 36 states and the District of Columbia had pre-exposure rabies vaccination laws for domestic dogs and cats.

Earlier this year, LawAtlas.org launched a comprehensive interactive map that provides information on state rabies vaccination laws for dogs and cats. Using the online map, you can explore:

  • which states have a pre-exposure rabies vaccination law
  • which animals those laws apply to
  • the age for primary vaccination and booster vaccination
  • whether a certificate or proof of inoculation is issued and whether a tag or tag number is issued after inoculation
  • whether rabies vaccination is required to obtain a license or registration for the animal, and any exemptions to this law
  • details about vaccination requirements for dogs and cats entering a state.

Compiled by a team from the CDC Public Health Law Program and researchers at Temple University, the data includes the laws from all 50 states and Washington, DC that were in effect as of March 9, 2018. lawatlas.org/datasets/rabies-vaccination-laws.

Work-life balance: not the only answers for veterinarians

When taking steps to maintain your mental health and energy levels as a busy veterinary practitioner, you need to do more than achieve work-life balance.

Veterinary professionals today must protect their mental health and energy. Recent studies show that as many as 85% are experiencing depression and burnout,1 while a study done in 2012 found that 19% had considered suicide.2 In fact, almost every veterinary professional with whom I have spoken has a personal connection to someone who decided to end their life. The good news is that veterinary professionals are waking up to the issue and becoming more proactive about solutions. Work-life balance is a commonly discussed topic — but I do not believe this is sufficient to solve the problem and turn the field around.

What does “work-life balance” mean?

I run a coaching business for veterinary women. Whenever new clients come into my coaching community, I ask them where they want to be in five years. “I want to have more work-life balance,” is one of the most common answers I hear. Yet when I ask them what that means in their lives, most don’t know.

What they do know is that they’re miserable in their jobs. They know they’re tired and exhausted, and feel they never have enough time to relax and recharge. They know something needs to change. Many of these women are looking for new jobs when they find me. And I fully admit that for some of them, that’s the right solution at the moment. But I’m going to tell you a story.

Back in 2013, I was a weekend emergency doctor. I worked days and was on call at night. I often worked from one day all through the night, and then the whole next day as well, with no additional compensation. On paper, that job was horrible. But I was actually happy.

I left for various reasons and took a job in a small town at a small animal day practice. I went from working four days a week (including both weekend days) and two nights a week on call, to a four-and-a-half-day schedule with no nights on call. On paper, this clinic looked ideal, but I was miserable. I hated the job, and I hated where we were living. I had a great work-life balance yet I burned out quickly and felt completely trapped, unsure where to turn next.

I’ve seen similar situations with several of my clients.

Work-life balance is a worthwhile goal — if it is part of the big picture. We also have to work on ourselves so we can be happier at work. If we are unhappy in our jobs because of poor boundaries or mindsets, that unhappiness will overflow into our home life (which is why work-life balance isn’t enough) and is likely to follow us to the next job!

If we instead prioritize working on ourselves, on our mindsets and self care, we can improve our quality of life even while at a job that may not be ideal anymore. It’s then possible to be happier at that job, which cascades into improved overall happiness and an ability to find a better situation in the future.

So how do we improve our mindset and self care within the realms of any work situation?

1. Allow yourself to dream

The first activity I assign to anyone who comes into my coaching community is to dream. I believe one of the biggest problems faced by professionals in our field who feel trapped is simply that we don’t dream anymore. We decided we wanted to be veterinarians when we were so young that we knew what our path was for years, and we stayed on it, through high school, college and vet school, then our first job. It was straightforward and we never stopped to think what else we wanted out of life.

We fell into a pattern. And then, when we began to feel stuck, it never occurred to us that we could break the pattern just by remembering we have other goals and ambitions. I also find that many of my clients struggle to dream because it’s very hard to admit that the goal they worked towards for so long — becoming a veterinarian — isn’t always what they expected it to be. However, just because you’re allowing yourself to start dreaming again, and setting new goals, does not mean you have to leave the field, or that you made the wrong choice by going into it in the first place. It just means you’re looking towards the next steps.

Allowing ourselves to dream is a baby step. It doesn’t require any commitment, and nothing is set in stone. We’re dreaming about how we would like our life to look.

That simple act often creates excitement in our lives again. We become clearer on our goals and excited about our destination, which decreases the trapped feelings and creates more hope for the possibilities.3 Just this one step alone can start to change your mindset, which can dramatically change your life and level of happiness.

2. Look for the roadblocks

Once we’ve allowed ourselves to dream of where we want to be, we have to address those inevitable thoughts of “that’s not possible!” If we don’t address them, they remain obstacles and hinder progress towards our goals.The most common obstacle I see is fear. Everyone has it, but unless we address it, we may either not see our next steps or choose not to take them! I see three common types of fear in my work.

a) Fear of failure4,5 — We’re afraid to try anything new because we may not succeed. That’s a hard pill to swallow for most veterinarians! Additionally, many of us hesitate to proceed if we don’t know exactly how our goals are going to come about because we can’t see every step. Yet we have to take action despite the fear My clients often say, “I haven’t updated my resume to apply for jobs, because what if I don’t get any of them?” “Okay,” I respond. “How many jobs are you getting when you aren’t updating and submitting your resume?” It’s a simplistic example, but this type of thought reversal can be used for almost any situation in which you fear failure. We can never succeed at something if we don’t try!

b) Fear of success6 — “Well, if I’m successful, and I make a lot of money, then everyone is always going to be asking me for money and thinking I’m greedy, and I don’t want that!” Other versions are similar, but you get the point. More importantly, we worry that when we succeed, we may not be able to sustain that success. This almost feels worse than failing in the first place! Simply recognizing that you have these fears is often all it takes to move past them and take action. You can also look for people in your world who have achieved what you want to achieve, without experiencing the things you’re worried might happen. Look for stories that prove your fears wrong!

c) Fear of judgment — Put simply, we put too much thought and energy into worrying about what other people will think. What will they think if we fail? What will they think if we’re successful? The reality is that their opinions don’t matter. I realize that’s easier said than accepted, but the only person whose opinion matters is your own. Obviously, depending on the situation, I’m not telling you to ignore your boss! But when we’re talking about our dreams, what we want out of life, or what we want our lives to look like, so many people hold themselves back because of what other people think. It’s time to stop caring about this so much and live the life you want.

3. Establish strong self care

Self care is often discussed as a way to increase happiness in our lives. However, the concept includes a myriad of pieces. We often hear about self care practices that promote health and help us feel better. Certainly exercising and eating right, in addition to scheduling fun and relaxing activities such as pedicures and massages, can all be part of a self care program. But I believe very strongly that the most important aspect of self care is respecting our own boundaries.7 What are we willing to tolerate in our lives, and what are we no longer willing to tolerate?

This facet of self care is the biggest reason why just finding a new job isn’t the solution. If you don’t set good boundaries at one job, you’re not going to set them at another. If you don’t know where your boundaries are when it comes to what you will tolerate in your life, then you’re likely putting up with lots of situations that increase your stress.

Sometimes the most difficult part involves boundaries with ourselves. Boundaries such as: “I won’t go on social media every time I have a down minute at work today” or “I’m going to make sure I get eight hours of sleep tonight, no compromising.”

We have to figure out what our own bodies and minds need, and then we have to set and maintain boundaries to protect those needs!8

Self care isn’t just spa days and exercise. It’s also figuring out what we’re willing to allow into our lives, and what we’re no longer willing to tolerate, not only from our jobs, families, and friends, but also from ourselves!

Conclusion

Work-life balance is a worthy goal. But it can’t be the only focus. If your goal is to have more of the “life” part, but you’re still miserable while at work, then your overall happiness will be severely affected and you’ll still find yourself drained. If you work on your mindset and self care, however, then you can improve almost any job, which is automatically going to improve your quality of life. And when your mindset and self care improve, it will be easier to not only achieve the life you want, and obtain that work-life balance you’ve been striving for, but to also enjoy your whole day, not just the “life” part.

References

1americanveterinarian.com/news/recognizing-and-remedying-staff-brownoutburnout

²ncbi.nlm.nih.gov/pmc/articles/PMC4266064/

³psycnet.apa.org/record/2006-11798-011

⁴psychologytoday.com/us/blog/the-squeaky-wheel/201306/10-signs-you-might-have-fear-failure

⁵talkspace.com/blog/5-signs-fear-failure-keeping-best-life/

⁶forbes.com/sites/jackkelly/2018/10/04/how-to-overcome-your-crippling-fear-of-success/#3382ca976970

⁷thriveglobal.com/stories/3-reasons-boundaries-are-the-foundation-for-happiness/

⁸ forbes.com/sites/kathycaprino/2017/05/21/3-steps-to-strengthening-your-boundaries-to-build-a-happier-life-and-career/#62a4c2ca48e6

A holistic approach to self care for veterinarians

Implementing key strategies such as nutrition and exercise into your self care regime supports your current and future well-being as a veterinary practitioner, and diminishes your susceptibility to “dis-ease”.

As veterinary practitioners, we are well-versed in the importance of good nutrition, sufficient rest, exercise and lifestyle for our veterinary patients. But in regards of self care, do we walk our talk by taking as much care of ourselves? Sometimes we’re so busy looking after others that we don’t make the time or effort to do the same for ourselves. This article looks at current research that tells us what we already know intuitively, but probably don’t pay enough attention to in our busy, sometimes hectic, daily lives as veterinary practitioners. Self care is important. Let’s take some time to holistically assess our own health, and look at some efficient practices to improve our own well-being.

Reality Check

First, rate yourself subjectively on a scale of 1 to 10 (10 being the best). Remember, no one sees this but you!

Is there room for improvement – and what should we take notice?

Avoiding death, disability, dementia and cognitive dysfunction are high priorities as we age. Evidence is mounting that these conditions are associated with impaired glycemic control,1 and that a healthy dietary pattern reduces the risk of common diseases such as cardiovascular disease, diabetes and dementia.2 Maintaining your physical health is an important part of self care.

Self care and the importance of body condition

Increased BMI (see image below) and body fat content, especially central obesity, have been associated with endothelial dysfunction.3 The endothelium is a complex organ with endocrine functions, and endothelial dysfunction is considered a key process in atherogenesis, a risk factor for heart disease, and is also linked to Alzheimer’s disease.4 Endothelial dysfunction has also been shown to be directly involved in peripheral vascular disease, stroke, diabetes, insulin resistance, chronic kidney failure, tumor growth, metastasis, venous thrombosis, and severe viral infectious diseases.5 Dysfunction of the vascular endothelium is thus a hallmark of human diseases, including chronic inflammation. The pathogenesis is still not completely understood but is linked to tumor necrosis factor (and reduced nitric oxide production), oxidative stress, dyslipidemia (and insulin resistance) and autoantibodies.6

Dyslipidemia is additionally associated with excess visceral fat, the metabolically most active adipose tissue that causes increased insulin resistance, high triglyceride concentrations, changes in the size of low-density lipoprotein (LDL) particles, and low concentrations of high-density lipoproteins.6

Skeletal muscle comprises approximately 40% of total body mass and is the primary tissue contributing to insulin-mediated glucose uptake and fatty acid oxidation. Mounting evidence suggests that skeletal muscle is also an endocrine organ capable of secreting a variety of factors that act on peripheral tissues to alter metabolic function. Myokines are skeletal muscle specific-secreted factors able to exert humoral effects in vivo and may underlie the health benefits associated with daily physical exercise.

Assessing your cardiorespiratory fitness through peak oxygen uptake

Many studies suggest that cardiorespiratory fitness, measured as peak oxygen uptake (VO2 peak), may be the single best predictor of future health, cardiovascular morbidity, and premature cardiovascular mortality. Recently, a cross-sectional study of over 4,600 men and women (20 to 90 years old) showed that even in people considered to be fit, VO2 — the maximal oxygen uptake (fitness) — was clearly associated with cardiovascular risk factors.7

The same study proposed a model that can provide a rough tool for assessment of cardiovascular fitness.8 The researchers observed that the mean maximal oxygen uptake in women and men were 35 and 44 mL/kg/min, respectively. The material suggested a ~7% decline in maximal oxygen uptake with every ten-year age increase in both genders. Women and men below the gender-specific mean were four to eight times more likely to have a combination of more than three conventional cardiovascular risk factors (i.e. metabolic syndrome) compared to the most fit quartile of subjects. The researchers also observed that maximal oxygen uptake may represent a continuum from health to disease, and that a general 5 mL/kg/min lower maximal oxygen consumption was associated with ~56% higher odds of having metabolic syndrome. The study indicates that cardiovascular fitness may be even more important for cardiac health than previously thought.

You can use an online fitness calculator (ntnu.edu/cerg/vo2max) that asks a series of questions to calculate your VO2 and expected fitness level, as well as your actual fitness level or fitness age.

VO2 max =15.3 x HR Max / HR Rest (or see Table 2)

Your HR Rest is your pulse at rest ________

Your HR Max = 205.8 – (0.685 x age) (Run or cycle as fast as you can for three minutes, take a rest for two minutes and repeat. Your heart rate will peak during the second burst — it’s best not to do this if you haven’t been exercising!)

Your HR max = ________ Your VO2 max = ________

Data from the study mentioned above helps you gauge your fitness by age. Middle age (defined as 35 to 58 years old) is associated with a loss of aerobic capacity, as evidenced by a decline in VO2 max of approximately 8% per decade and an associated functional decline of 15% between young and middle age. The loss of skeletal muscle performance/skeletal muscle endurance capacity is associated with a loss of mitochondrial enzyme activity and impaired mitochondrial protein synthesis at rest. Further, there’s a loss of insulin sensitivity of 8% per decade in both males and females. Together, the loss of skeletal muscle performance is associated with an increased risk of lifestyle diseases such as Type 2 diabetes (T2D) and cardiovascular disease during middle age.9

After your self-assessment, now what?

What holistic self care options do you have to improve your cardiovascular fitness and reduce BMI?

1. High Intensity Interval Training (HIIT)

You could start running one hour per day, three to four times per week, join a gym, or even walk daily for 30 minutes. The belief is that that the more time you spend exercising, the better. You will be pleased to know that High Intensity Interval Training is another option. HIIT has caused a stir because studies over the last decade demonstrate that a few minutes of intense exercise a day can make a significant difference to your metabolism and VO2; it can get you fitter faster than standard exercise, improve your insulin sensitivity, build muscle tone, and reduce fat in the most time-efficient manner. There is evidence that just 40 seconds of intense activity can make a difference. Researchers have recently reported improved insulin sensitivity in young men following six weeks of HIIT training involving three sessions per week of two 20-second sprints against 7.5% of bodyweight — a total of ten minutes exercise over six weeks.10 A study also demonstrated the benefits of HIIT in untrained middle-aged adults, three males and 11 females. Over eight weeks, with twice-weekly training consisting of ten six-second sprints with one minute of recovery between each, there was significant improvement in aerobic capacity (8% increase in VO2 peak), physical function (11% to 27%), and a 6% reduction in blood glucose.9

Another study showed that three minutes of intense intermittent exercise each week, with a total time commitment of 30 minutes, including warm-up and cool-down, increased skeletal muscle oxidative capacity and markers of health status in overweight/obese but otherwise healthy men and women. Each session began with a two-minute warm-up, followed by three 20-second all-out sprints interspersed with two minutes of recovery followed by a three-minute cool-down. Peak oxygen uptake increased by 12% after training (32.6 ± 4.5 vs. 29.1 ± 4.2 ml/kg/min), and resting mean arterial pressure decreased by 7%.11

So even implementing just two short 11-minute sessions per week into your self care routine can make a significant difference, and have the potential to improve and maintain physical function and reduce the risk of disease. While time is a major barrier for all of us, can you afford not to invest 11 minutes twice a week for your health? Alternatives to sprinting include hurtling on a stationary bike with resistance, squatting, rowing, lunging, planks, skipping, pushups, step-ups, boxing, or anything that makes you open-mouth breathe and raises your heart rate! If you can’t engage in HIIT, then consider aerobic and/or resistance training.

2. Nutrition

Nutrition is a key pillar to self care. We all know what good nutrition is, but do we eat well to optimize health and well-being? Metabolic syndrome, dysglycemia and insulin resistance are insidious and silent. Between 32% and 34% of all adults (31% to 34% of men and 33% to 35% of women) in the United States have metabolic syndrome. Over 50% of people with hypertension have dysglycemia,12and both are components of metabolic syndrome. Although only more recently defined and investigated, metabolic syndrome epitomizes the integrative nature of modern chronic disease, given its endocrine, metabolic and cardiovascular underpinnings.

The most important causes of insulin resistance are a high-fat refined-carbohydrate diet and physical inactivity.13 In 2006, the Harvard School of Nutrition hosted a conference called Metabolic Syndrome and the Onset of Cancer, during which several papers were presented showing that hyper-insulinemia was related to breast, prostate and colon cancers. It has been known for over a decade that adipose tissue dysfunction is a central underpinning link to obesity in the pathogenesis of metabolic syndrome and Type 2 diabetes, and we now know that adipose tissue is a dynamic, metabolic endocrine organ, secreting various cytokines, chemokines and adipokines.

Table sugar (sucrose) is a disaccharide composed of two monosaccharides: glucose and fructose. Sucrose is a common ingredient in industrially-processed foods, but not as common as high-fructose corn syrup (HFCS). Whereas sucrose is equal parts fructose and glucose, HFCS has more fructose (usually 55%) than glucose (the remaining 45%) and is the most frequently-used sweetener in processed foods, particularly in fruit drinks and sodas. Feeding sucrose to rats stimulates the sympathetic nervous system (SNS), and increases heart rate, renin secretion, renal sodium retention and vascular resistance. These interact to elevate blood pressure; sucrose-fed rats have increased blood pressure. Sucrose feeding also induces insulin resistance, as part of a broader metabolic dysfunction. People who consume 10% to 24.9% of their calories from added sugars have a 30% increased risk of mortality from cardiovascular disease compared to those who consume less than 10% of their calories from added sugars. Worse, those who consume 25% or more calories from added sugars have an almost threefold increased risk.14

It’s time to take a stock of sugar consumption in the foods you eat on a regular basis. Around 300 years ago, humans consumed a few pounds of sugar per year — now, Americans consume anywhere from 77 to 152 pounds of sugar per year, with 13% consuming at least 25% of their total caloric intake as added sugars. This equates to an intake of added sugars of 24 to 47 teaspoons (about 100 g to 200 g) per day, with an average daily fructose consumption of 83.1 g (about 16 teaspoons)!

Spend some time analysing your own diet using nutritiondata.com(also a useful tool for looking at animal diets).

We all know that the cornerstones of self care and good health — good nutrition, exercise, and taking care of our emotional health — apply to ourselves as well as our animal patients. We must commit to walking our talk and practicing what we preach, so we may achieve the vibrant health and well-being we strive for so diligently in our patients.

References

1Cukierman-Yaffe T, Anderson C, Teo K. “Dysglycemia & cognitive dysfunction & ill-health in people with high CV risk: results from the ONTARGET/TRANSCEND studies Unsuccessful Aging & Dysglycemia”. Am Soc Clin Oncol Educ Book. 2015;35:e66-73.

² Harvie M, Howell A, Evans DG. “Can diet and lifestyle prevent breast cancer: what is the evidence?” BMC Geriatr. 2015; 14: 36. Mar 21.

³ Sundell J, Laine H, Luotolahti M et al. “Obesity affects myocardial vasoreactivity and coronary flow response to insulin”. Obes Res. 2002; 10:617-24.

⁴ Lathe R, Sapronova A, Kotelevtsev Y. “Atherosclerosis and Alzheimer – diseases with a common cause? Inflammation, oxysterols, vasculature”. BMC Geriatr. 2014 Mar 21;14:36.

⁵ Rajendran P, Rengarajan T, Thangavel J. “The Vascular Endothelium and Human Diseases”. Int J Biol Sci. 2013; 9(10): 1057–1069.

⁶ Steyers C, Miller F. “Endothelial Dysfunction in Chronic Inflammatory Diseases”. Int J Mol Sci. 2014 Jul; 15(7): 11324–11349.

⁷ Aspenes S, Nilsen T, Skaug E et al. “Peak oxygen uptake and cardiovascular risk factors in 4,631 healthy women and men”. Med Sci Sports Exerc. 2011 Aug;43(8):1465-73.

⁸ Nes B, Janszky I, Vatten L et al. “Estimating VO2 peak from a non-exercise prediction model: the HUNT Study”. Norway Med Sci Sports Exerc. 2011 Nov;43(11):2024-30.

⁹ Adamson S, Lorimer R, Cobley J. “High Intensity Training Improves Health and Physical Function in Middle Aged Adults” Biology (Basel). 2014 Jun; 3(2): 333–344.

10 Metcalfe RS, Babraj JA, Fawkner SG, Vollaard NBJ. “Towards the minimal amount of exercise for improving metabolic health: Beneficial effects of reduced exertion high intensity interval training”. Eur. J. Appl. Physiol. 2012;112:2767–2775.

11 Gillen J, Percival M, Skelly L et al. “Three Minutes of All-Out Intermittent Exercise per Week Increases Skeletal Muscle Oxidative Capacity and Improves Cardiometabolic Health”. PLoS One. 2014; 9(11): e111489.

12 Cheung B, Wat N, Tso A et al. “Association Between Raised Blood Pressure and Dysglycemia in Hong Kong”. Chinese Diabetes Care. 2008 Sep; 31(9): 1889–1891.

13 Roberts C, Hevener A, Barnard J. “Metabolic Syndrome and Insulin Resistance: Underlying Causes and Modification by Exercise Training Compr Physiol”. 2013 Jan; 3(1): 1–58.

14 DiNicolantonio J, Lucan S. “The wrong white crystals: not salt but sugar as aetiological in hypertension and cardiometabolic disease” Open Heart. 2014; 1(1): e000167.

 

Juvenile hip dysplasia in the canine

A case study of canine juvenile hip dysplasia involving the use of digital thermal imaging. How this tool can enhance patient analysis and treatment.

Gloria, an 11-month-old intact female Rottweiler, was presented for evaluation after a history

Figure 1: Gloria’s radiography at ten months of age

of rear limb lameness. Radiography at ten months of age (Figure 1) demonstrated signs of juvenile hip dysplasia: 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.

Physical exam — The exam confirmed pain and decreased range of motion in the coxofemoral joints, and offloading on the right side.

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 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.

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).

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

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.

Hypertrophic cardiomyopathy in cats – a silent killer

Hypertrophic cardiomyopathy (HCM) often goes undiagnosed until a cat is in heart failure. Understanding HCM can help early disease detection and client education.

Photo courtesy of Morris Animal Foundation

Hypertrophic cardiomyopathy (HCM) is by far the most common type of heart disease diagnosed in cats. The disease is difficult to detect when a cat has no obvious clinical signs. That means most cats are diagnosed when they have signs of congestive heart failure, arterial thromboembolism or even sudden death.

 

 

Despite the prevalence of hypertrophic cardiomyopathy, we’re still learning more about the disease, how to treat it and how to accurately diagnose it before the condition becomes life-threatening. Results from a study funded by Morris Animal Foundation offer new hope that a simple screening to detect HCM early can improve treatment and outcomes.

Cat’s heart showing HCM are courtesy of Dr. Kate Meurs, researcher at North Carolina State University.

Thorough physical examinations are the cornerstone of veterinary appointments, but several studies have shown that few cats with subclinical heart disease have telltale physical exam abnormalities. For example, most practitioners know the presence or absence of a heart murmur doesn’t mean a cat has or doesn’t have hypertrophic cardiomyopathy. While the presence of a heart murmur typically triggers further testing, such as echocardiography, detecting occult heart disease remains difficult.

Cat’s heart showing HCM are courtesy of Dr. Kate Meurs, researcher at North Carolina State University.

Echocardiography is the gold standard for diagnosing hypertrophic cardiomyopathy in cats. Elizabeth Rozanski, DVM, ACVIM, ACVECC, and colleagues at Tufts University knew that several barriers to this test exist including cost, proximity to a boarded cardiologist, and the skillset and equipment required to perform a full echocardiogram. They were also aware that focused cardiac ultrasound (FCU) was gaining popularity in human hospital emergency rooms as a quick way to assess patients for serious cardiac conditions. Dr. Rozanski wanted to determine if a non-specialist practitioner (NSP) could be trained to perform FCU to increase detection of occult heart disease in cats.

 

NSP Training and Results

Dr. Rozanski and her team developed an FCU protocol and trained 22 NSPs to perform the procedure. The NSPs screened 289 cats without signs of heart disease. All patients had follow-up echocardiograms by a board-certified cardiologist.

Dr. Rozanski found that the NSPs were very good at detecting moderate and severe heart disease in the study population. They were less skilled at detecting mild disease, but Dr. Rozanski was encouraged by the results and hopes more practitioners can learn FCU and incorporate it into their practice. Dr. Rozanski published her results in the Journal of Veterinary Internal Medicine.

Further research into HCM

Another important project funded by Morris Animal Foundation centered on hypertrophic cardiomyopathy was the REVEAL study. Published in 2018, the study was a collaborative effort among veterinary cardiologists at 50 veterinary hospitals located in 21 countries. In total, 1,730 cats were examined over a 10-year period. Philip Fox, DVM, MS, DACVIM/ECVIM (cardiology), DACVECC, the lead author of the study and a Foundation-funded grantee, was curious to learn more about the natural history of occult hypertrophic cardiomyopathy. He felt that because prior studies often were located at one referral facility and generally focused on cats with severe disease, results were skewed toward adverse outcomes and short survival. Dr. Fox wanted to learn more about the outcomes for cats who had HCM but were preclinical.

Dr. Fox, who is Head of Cardiology at the Animal Medical Center in New York City, and colleagues compared cats with asymptomatic hypertrophic cardiomyopathy to apparently healthy cats. The cats with hypertrophic cardiomyopathy were further divided into cats with nonobstructive or obstructive forms of hypertrophic cardiomyopathy. The study found that during the study period, congestive heart failure or arterial thromboembolism (or both) occurred in 30.5% of cats with either form of HCM. The study also noted that cardiovascular death occurred in 27.9% of cats with either form of hypertrophic cardiomyopathy. His conclusion was that cats with HCM had a high risk of morbidity and mortality. Interestingly, the study did not find a significant difference in morbidity or morality between cats with nonobstructive and those with obstructive forms of hypertrophic cardiomyopathy. Dr. Fox published his findings in the Journal of Veterinary Internal Medicine.

Concluding thoughts

Although we’re making progress, we still have a lot to learn about hypertrophic cardiomyopathy in cats. Early detection is important for long-term monitoring of patients and for client education. Unfortunately, there remains a significant knowledge gap in understanding which preventive measures, if any, can delay onset of clinical signs or improve long-term survival. Morris Animal Foundation continues to support research in this important area of feline medicine. Our hope is that we can fill this knowledge gap and improve the lives of cats everywhere.

 

 

Morris Animal 3 Bottom

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

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?

So what are essential oils? Simply put, they 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, 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:

  1. 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.
  2. Essential oils give clients an easy and fun way to interact with their pets, allowing them to become more involved in the overall wellness of their companions.
  3. Essential oils require minimal financial investment.
  4. They are versatile. Essential oils can be used as standalone 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 sifting through mountains of this information can be challenging to say the least. While a great deal of positive information can be found, an equal quantity of misinformation is also circulating around the Internet. 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.

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 to help soothe sore muscles and release stress and tension. A quick Google search provides insight into how 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.

References

1Young, D. Gary. “Chapter 1: Essential Oils: The Missing Link in Modern Medicine”. Essential Oils Integrative Medical Guide, Life Science Publishing, 2003.

2Yuen, Jeffrey C. “The use of Essential Oils in Accordance with Chinese Medicine Part 1”. AHVMA Conference Proceedings, 2014, pages 604-608.

3Yip,Y.B., Tse, S.H.M. “An Experimental Study on the Effectiveness of Acupressure with Aromatic Lavender Essential Oil for Sub-acute, Non-specific Neck Pain in Hong Kong”. Complementary Therapies in Clinical Practice, Volume 12, Issue 1, February 2006, pages 18-26.

4Yip,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.

5Options 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.

This article has been peer reviewed.

Herbs for Life, Inc. supports animal health with unique botanical medicinals

How Herbs for Life Inc. is a brand striving to sustain the best quality of life for animals through unique and organic botanical formulas

Over ten years ago, Joyce Belcher decided to turn her passion for holistic health into a business. She expanded her studies to focus on herbs and, launched Herbs for Life, Inc. in 2008. Belcher worked with several holistic and integrative veterinarians, creating custom formulas for various illnesses by learning what needed to happen in the animal body with respect to specific plant medicines and how they could heal. Offering a unique line of organic pet supplements as well as herbal medicinals, Belcher’s new company quickly began to thrive…and so did her customers.

From the start, Herbs for Life, Inc. has been dedicated to quality. Every product is made using non-GMO, certified organic or wild-harvested ingredients, and no chemicals are added or used in the manufacturing process. Belcher prides herself on safety and efficacy and plans to continue growing without losing focus of her mission. “Our mission and passion is, and has always been, to help pets get healthy and stay healthy as nature intended,” she says. Whether an animal needs a daily supplement to balance his immune system, or a botanical medicinal to address a more serious issue, Herbs for Life, Inc. is a go-to brand veterinarians can count on.

Adaptogens and tonic herbs form the basis of Belcher’s products. Boasting herbal and superfood formulas for dogs, cats and horses, these wellness blends are created with optimal synergy for optimal results. Her Detox Liver Cleanse, for instance, has been a game-changer for the health of many animals. It works to remove heavy metals, restore normal healthy function of the eliminatory organs (liver, kidneys, lymphatic system, blood and neurological systems), and like all her products, contains no inactive ingredients.

Because there are no fillers, the dosage is significantly smaller than with most other supplements. This means you get more bang for your buck, and the animal’s body doesn’t have to work as hard to reap the benefits. “Fillers have to be processed out of the body,” says Belcher. “Many companies use fillers to make their products less costly, but the animal has to consume a much larger dose and the kidneys and liver then have to work hard to rid the body of what it has no use for, taxing these organs of elimination.” Fillers also reduce the amount of nutrients the body absorbs. Because most herbs are water-soluble, they will pass through the kidneys quickly, and are 100% absorbable. This also makes them safe to take on an ongoing basis.

Given that Belcher’s primary goal has always been to help animals, it’s not surprising that she supports several rescue organizations by donating products, funds and consulting time when there’s a need. She also regularly contributes to several animal health publications. Recently, however, she felt the name of her supplement line, Pet Wellness Blends, didn’t fully encompass the values she so strongly upholds, so she rebranded. This line can now be found under the name Sustenance Herbs, a title that better reflects its ability to support and maintain health. “Sustenance refers to something consumed that sustains life or health,” says Belcher. “And the happiness that pet owners express when their dogs, cats or horses are healthy, happy and feeling great is what keeps me going! SustanenceHerbs.com

Equine skin disease

A complementary medical approach for 5 common skin conditions in horses.

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.

1. 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 below. 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.

2. 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.

3. 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 horse’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 – see sidebar below. 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. Naturally-stabilized 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 horse’s history may reveal that he was on a course of antibiotics in the few years before the skin disease became a concern.

4. 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.

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.

5. 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 the 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.

1“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.

This article has been peer reviewed.

The role of immunotherapy in veterinary practice

Immunotherapy offers a new approach to cancer, and involves re-educating the patient’s immune system to combat the disease

Cancer is a devastating disease resulting from mutations that lead to uncontrolled cell growth, which also changes the local microenvironment. Cancer is not only mutated cells, but also a complex tissue composed of cancer cells with an underlying matrix, all promoting tumor growth and metastasis. Immunotherapy offers a new approach to cancer, and involves re-educating the patient’s immune system to combat the disease. Immunostimulation against specific tumor-associated antigens (TAAs) can result in tumor and metastatic disease destruction. Because tumors are complex tissues, an immune response to a wide array of tumor-specific antigenic targets increases the odds of destroying a tumor.

Torigen is a team of veterinarians and cancer researchers who are building a research company that is able to evaluate emerging therapies for humans and adapt them for veterinary medicine. The company’s first product is a whole-cell tissue vaccine — a personalized cancer immunotherapy created from a patient’s resected tumor that has been used in over 600 veterinary cancer patients. The vaccine includes an enormous menu of patient-specific antigen targets. This article reviews Torigen’s autologous approach and product development of monoclonal antibody and targeted neoantigen vaccine strategies.

Whole-cell tissue vaccines

The goal at Torigen is to make personalized cancer immunotherapy accessible to veterinary patients. Our whole-cell tissue vaccine is considered by the USDA Center of Veterinary Biologics to be an experimental product until conditional or full licensure is approved. However, it is available now for use under the supervision and prescription of a licensed veterinarian.

The vaccine is custom-produced using patient tumor material (~5 g). The whole-cell tissue vaccine results in immune presentation of a vast menu of antigenic targets such as those offered by neoplastic cells, tumor extracellular matrix, and tumor-associated fibroblasts. Each of these latter components helps promote tumor growth, metastasis and immuno-tolerance, and can be directly targeted by the immune system when a patient is treated with a tissue-based vaccine. The more tumor-associated antigens presented, the greater likelihood of a successful immune response. The initial research on this approach was conducted in rodent models using prostate, ovarian and melanoma tumors.

This response was further improved by the addition of a novel adjuvant designed to enhance the cellular immune response. This adjuvant, Matrix Immune Modulator (MIM), consists of “sticky” proteins that allow antigens to bind and be processed by macrophages, promoting an anti-cancer immune response.

The combination of tumor tissue with MIM leads to increased concentrations of specific cytokines that stimulate cytotoxic CD8+ T cells – cells which lead to a directed immune-mediated anticancer response.

Sources: “Prevention of denovo prostate cancer by immunivation with tumor-derived vaccines”. MA Suckow et al. Cancer Immunology, Immunotherapy 2007. 56(8)1275-1283. “Prevention of human PC-346C prostate cancer growth in mice by a xenogenic tissue vaccine”. MA Suckow et al. Cancer Immunology, Immunotherapy, 2007. 56(8) 1275-1283. “Inhibition of prostate cancer by administration of a tissue vaccine”. MA Suckow et al. Clinical and Experimental Metastasis, 2008: 2005(8)913-918. “Use of an extracellular matrix material as a vaccine carrier and adjuvant”. MA Suckow et al. Anticancer Research, 2008: 28:2529-2534.

Veterinarians are invited to contact the Torigen team (which includes a cancer biologist, veterinarian oncologist and veterinarian surgeon) to discuss upcoming tumor removal cases, in order to better understand how to apply this technology to a specific case. A free tumor collection kit with a prepaid overnight express shipping label for tissue submission will be provided. To request a kit, visit torigen.com.

This photomicrograph shows MIM uptake by macrophages. DyLight 594-labeled MIM was exposed to THP-1 cells activated with PMA (to promote macrophage phenotype). After five hours of exposure to the labeled MIM, the cells were fixed.

The tissue collection process is simple. After tumor excision, a portion of unfixed tissue is submitted to the Torigen laboratory. It is important that the submitted tissue not be placed in formalin. Formalin strongly cross-links tumor-associated antigens, rendering them less effective in stimulating a targeted and specific response.

The product is returned to the veterinary practice in as few as three days from initial surgery — this is important since Torigen’s process “captures” currently-expressed TAAs, providing a contemporary immune stimulation without days or weeks of tumor cell culture or T cell expansion. Since tumors can mutate rapidly, we believe timely and specific immunostimulation is critical. The product is administered subcutaneously (1 mL) once weekly for three weeks.

The company can provide tumor-specific data on many tumor types based on a database of over 600 patients treated to date — contact 860-519-9956 or info@torigen.com for information.

Future directions

Torigen strives to be the leader in veterinary cancer immunotherapy. To succeed, the company is investigating ways to further improve vaccine approaches to cancer, for example:

  • Immune checkpoint inhibitors will further promote immune-mediated cancer attack. Specific monoclonal antibody therapies, PD-1, PD-L1 and CTLA-4, block the downregulation of T-cells within the tumor microenvironment. When the tumor is “inflamed” or has many T-cells, these therapies can ensure the T-cells remain active in the microenvironment and attack the tumor. The pairing of tissue vaccines with checkpoint inhibitors offers a novel way to fight cancer.
  • Another approach under investigation is the development of innovative neoantigen vaccines. While tissue vaccines offer a wide array of TAAs, Torigen will also create neoantigen vaccines based on identifying the important antigen targets specific to each patient’s tumor (neoantigens), and add additional doses of those neoantigens to the tissue vaccine as a way to magnify anti-tumor immunity. This requires technically-complex full genome and exome sequencing between tumor and normal tissue, and exploiting discovered differences to establish important neoantigens for inclusion in each patient’s vaccine.

Providing effective and affordable cancer immunotherapy to veterinary patients is the goal at Torigen. To that end, the company is committed to educating veterinarians about cancer immunotherapy and further emerging tools in cancer treatment. Our team of experts is available for a consult — contact us to learn more.

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