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Resolving skin inflammation in dogs and cats

The potential for diet, herbs and the microbiome to resolve skin inflammation in small animals.

Dermatological problems in dogs and cats are among the most common and frustrating cases that veterinarians see. Successfully resolving these issues involves understanding new models of skin disease, and the roles that diet, herbs and the microbiome can play in their resolution.

Current conventional treatment approaches

Apart from Omega 3 fatty acids influencing cytokine production, the current use of diet to manage skin inflammation involves the avoidance of antigenic food molecules, particularly proteins. Antigenic proteins are believed to be absorbed intact through the gut mucosa and viewed as foreign by immune cells residing in the lamina propria. Sensitized Helper T cells circulate to the skin, stimulating immune cells residing there to incite inflammation. In short, these animals are understood to be suffering a Type IV hypersensitivity mediated by T cell activation.

Typical strategies to address this problem include suppressing the immune system using pharmaceuticals, and using extruded diets in which molecular sizes are too small to incite a response. Novel protein diets are also used to avoid antigens to which the system has been previously sensitized. No conventional treatments are used to address the increased porosity of the digestive tract that allows entry of antigenic molecules; or the ability of circulating immune cells to enter the interstitium of the skin. Some of the perceived efficacy of natural therapies in dermatitis appears to be due to a targeting of these aspects of pathogenesis.

Despite conventional therapy, success is often inconsistent, even where a link between skin disease and diet appears to be present. In many cases, inflammation continues unabated when the animal is on extruded diets. New food allergies commonly develop, necessitating a parade of diets featuring ever more exotic protein sources. Immune suppression with drugs often has immediate dose-dependent side effects, as well as delayed side effects like predisposition to infections and tumors. It is for these reasons that owners seek out alternative perspectives and treatments for their pets’ skin diseases.

New models of skin disease

Ironically, one can start with current medical research when looking for a new context in which to view small animal dermatitis cases. The knowledge that gave rise to the therapeutic approaches noted above has been added to significantly to create a schema that embraces this pre-existing model; but also goes well beyond this to suggest many new potential avenues for managing dermatitis. These new directions in research provide support for, and help explain the utility of, alternative therapies such as “real food” (e.g. homemade or raw) as well as various supplements and herbs.

Two broad models are emerging of the main mechanisms by which dermatitis arises.

  1. We can call the first model inflammation dysregulation, which appears secondary to the metabolic consequences of feeding processed diets. The high insulin levels that result promote inflammation in and of themselves, but also lead to the accumulation of abdominal fat, often culminating in obesity. The fat accumulations are not inert, but secrete adipokines and cytokines involved in the generation of inflammation. This spawning of inflammation from a state of over-nutrition has long been recognized by Classical Chinese Medicine, which terms the phenomenon “Damp Heat”. Inflammation arising from insulin resistance and obesity can be countered through insulin-sensitizing herbs and the use of less processed diets. It is likely directly aggravated through the use of existing processed diets, including extruded foods.
  2. The second model we can term immune dysregulation and involves the Type IV hypersensitivity reaction veterinarians are familiar with. If a less processed diet does not materially improve the condition, then immune dysregulation is more likely to be present, but instead of managing the condition with just novel protein and extruded diets, practitioners can resolve these conditions through manipulation and deliberate support of the microbiome using various herbs, supplements and food sources. The focus of the diet probably needs to be on fiber, rather than just on novel protein sources.

We’ll now take a closer look at each of these models in turn, outlining the most effective therapies for each.

Inflammation dysregulation

The Damp Heat model

The notion that inflammation is linked to metabolism is an old one, appearing many centuries ago in an albeit more poetic guise, namely the Damp Heat model of Chinese medicine. In that model, the digestive tract (i.e. the Spleen) plays the role of converting raw materials into useful substances that can be used by the body, such as Blood, joint fluid and plasma. If the Spleen is weak due to excessive demands being placed on it, conversion is incomplete, and an unusable fluid known as Dampness accumulates.

Dampness is not used by the body, and goes wherever normal fluids are distributed, to accumulate in joint spaces, urine, and the walls of the blood vessels. Any accumulating unused tissue also qualifies as Dampness, including adipose within the abdomen. Within the vessels, Dampness is imagined to slowly encroach upon and obstruct the flow of Blood, releasing the kinetic energy of flowing Blood as a sort of heat of friction that Chinese medicine terms Damp Heat. If allowed to continue, the Blood stops moving altogether, leading to Blood Stasis and compromised circulation to the associated tissue.

Different treatment approaches are applicable at different stages of the disease’s progression. In the earlier stages, herbs that strengthen the Spleen and drain Damp are more appropriate. As problems progress, cooling and Blood-moving treatments are called for.

If this model were to have any relevance outside of Chinese medicine, there would have to be evidence that inflammation (i.e. Heat) was linked to overconsumption of food and the accumulation of body fat. We’d also want to see a link between chronic inflammation and the disruption of circulation within tissues. Modern nutritional research has confirmed both of these relationships. The disruption of circulation that attends chronic inflammation is termed “endothelial dysfunction” and is beyond the scope of this article, although it should be stated that high insulin levels are a driver of the condition, so dietary recommendations made in this article are as applicable to endothelial dysfunction as the treatment of inflammation and Damp Heat. This article will focus on the link between overconsumption and inflammation, central to which is the phenomenon of insulin resistance.

Insulin, weight gain and inflammation

Veterinarians certainly recognize insulin resistance as occurring in cats, culminating in the development of Type II diabetes. They may not, however, associate it with their canine patients at all. The reality is that both dogs and cats are prone to insulin resistance, which only requires a chronic surfeit of energy within cells to develop. In humans, this is most often due to a surplus of free fatty acids in the diet, but any excess caloric intake can produce the phenomenon, including an excess of carbohydrate intake in dogs.1

The energy surplus ramps up ATP production in the cell’s mitochondria, producing mitochondria over-activation and excesses of ATP. In response, AMPK is up-regulated, triggering pathways that inhibit further lipid and glucose uptake and oxidation by cells.1 Some of this energy glut is stored as fat instead, with circulating insulin levels correlating strongly with the tendency for future weight gains.2,3

Simply gaining some weight might not be a problem in itself, were this anabolic state not associated with inflammation. As body score increases, so do fasting plasma levels of inflammatory mediators like interleukin-6 (IL-6) and monocyte chemoattractant protein-1 (MCP-1). As feeding of energy-rich easily-digested foods continues, dogs enter a state of chronic inflammation.4 The situation only worsens as they eventually become obese.

As in humans, the incidence of obesity in small animals has achieved epidemic proportions. As reviewed by Laflamme,5 obesity in the dog or cat arises from the overconsumption of calories from any source, to the point where accumulated body fat is starting to impair health and body function.

In a human, obesity is achieved when body weight increases to 20% to 25% above the ideal for his/her frame. The same is generally presumed for dogs and cats, and even moderately overweight dogs are at greater risk than their lean-fed siblings for earlier morbidity and necessary medication for chronic health problems. Obese cats likewise face increased health risks, including arthritis, diabetes mellitus, hepatic lipidosis, and early mortality. The risk for developing diabetes increases about two-fold in overweight cats and about four-fold in obese cats.

Decades ago, extra weight was viewed simply and vaguely as producing extra physical strain on the heart and joints. Modern research has clarified that this added health risk is due to the elaboration of inflammatory cytokines and adipokines by body fat stores themselves. Leptin, resistin, tumor necrosis factor-α, IL-1β, IL-6 and C-reactive protein all increase in obese dogs and cats, resulting in a persistent, low-grade inflammatory state. This inflammatory state has been shown to play a causal role in chronic diseases such as osteoarthritis, cardiovascular disease, diabetes mellitus and many others. The oxidative stress that results from chronic inflammatory states serves as an additional aggravating factor, predisposing the animal to tissue damage and tumor formation.5

While weight gain is associated with the development of chronic inflammation in dogs and cats, weight loss produces reductions in circulating inflammatory cytokines. In one study of the effects of weight loss in 26 cases of naturally-occurring obesity in a range of breeds, body fat mass before weight loss was positively correlated with both plasma insulin concentrations and serum insulin to glucose ratios. Both these parameters decreased after weight loss, confirming the presence of insulin resistance. As weight loss progressed, notable decreases in plasma tumor necrosis factor-alpha (TNF-alpha), haptoglobin and C-reactive protein concentrations were observed.7

It’s important to note that in all respects, the link between diet, insulin, body fat and inflammation in dogs and cats is identical to that demonstrated in humans, to the point that dogs and cats have served as the animal models for researching these phenomena in humans. Since obesity with its secondary inflammatory effects in humans has been repeatedly and consistently linked with the consumption of processed foods,6 it is thus entirely reasonable to postulate the same is true for dogs and cats.

The notion of processed foods contributing to small animal disease and fostering an obesity epidemic has been understandably unpopular among veterinarians, given the reliance of the profession on these foods for the management of medical conditions, as well as routine feeding. Also denied in the past was the notion that carbohydrates could produce insulin resistance in dogs and cats, but this has been verified in clinical trials.

A case in point was the analysis offered by a study looking at the efficacy of a high-protein medium-carbohydrate diet for weight loss in dogs that had become obese on a commercial high-carbohydrate medium-protein kibble. Insulin sensitivity and body composition were evaluated before and after weight loss using a euglycaemic-hyperinsulinaemic clamp and the deuterium oxide dilution technique, respectively. Postprandial plasma glucose and insulin concentrations were substantially lower with the high-protein medium-carbohydrate diet than the commercial kibble, which the researchers felt was readily explained by the difference in carbohydrate content between the two diets. 8

Weight loss, real food and the biome

Weight loss is a primary goal in overweight animals suffering chronic inflammation. Weight loss with its attendant reduction in inflammation is achieved in association with, and even because of, shifts in the biome.16 For example, gut flora have been shown to play a crucial role in influencing metabolism, predisposition to weight gain, and blood lipid levels. Changing the microbiota by altering the diet may eliminate its role in creating a pro-inflammatory metabolism.

Raw and real food diets are being fed on an increasing basis to reduce body weight and tendencies to inflammation. Commercial high protein and high fiber diets produce weight loss with associated characteristic shifts in the microbiome that are identical to what real food diets achieve, suggesting they may work in a similar manner.9,14

The lower glycemic index of real food diets that stems from their higher protein and lower carbohydrate contents seems to promote a metabolism conducive to weight loss and an anti-inflammatory effect in many dogs and cats. A crossover study was performed to examine the effect of raw diets and their functional opposites (namely, highly processed extruded diets) on the microbiome. Raw diet effects included:

  • Reduced fatty acid synthesis
  • Increased balance and diversity of the micrbiome
  • A shift in microbiome metabolites towards those associated with a healthy gut
  • Increased lactic acid and pH of the stoll

The results of extruded diets on skin inflammation are commonly disappointing, but are perhaps explicable since in the above the study, they had a deleterious and opposite effect on the microbiome.14

Beneficial effects on the microbiome were also seen in dogs fed a minced beef diet, and these changes were reversed when the diet was replaced with commercial kibble. 15

Additional prospective research is needed to confirm whether raw and real food diets may promote weight loss and reduce systemic inflammation in overweight animals.

Herbal approaches

While real food diets are employed to induce weight loss and favorable shifts in the microbiome, Damp Heat formulas can be used to reduce excess insulin levels and counter inflammation.

San Ren Tang (Three Seeds Decoction) and Si Miao San (Four Marvels Powder) are both Damp Heat formulas used for the management of dermatitis (see Tables 1 and 2). Si Miao San, by some estimates, is the most widely used herbal formula in veterinary medicine, testifying to its utility in managing inflammation. Si Miao San is used more for acute inflammation, where a decongesting effect is needed on the body periphery; San Ren Tang is used for more chronic inflammation, where a return of blood supply is required to help actively resolve chronic lower-grade inflammation.

Si Miao San and San Ren Tang are not the only two Damp Heat formulas used in the management of skin disease, and the differences in their indications are more numerous and nuanced than is represented here. The reader is referred to professional reference texts38 for more information on how to use these two formulas safely and effectively. Both formulas exemplify, however, the strategy of combining insulin-sensitizing and anti-inflammatory herbs within the same formula. This innate synergy is likely what has driven their popularity, and provides corroboration for the role of insulin resistance in driving the development of inflammation. Since the ingredient list of both formulas reflects several centuries of refinement to achieve maximum efficacy, we can conclude that insulin as a driver of inflammation is not strictly a phenomenon of modern society but has been a problem throughout human history. It is only our awareness of the problem that is recent. To act on the knowledge requires us to overcome the inertia produced by standard industry practices.

Both Si Miao San and San Ren Tang contain Coix, an anti-inflammatory herb.39 The effects of this herb stem from its ability to inhibit nitric oxide synthesis, as well as superoxide production and release by macrophages. Coix also contributes to insulin sensitization. It has been shown to reduce adipose tissue weight, leptin and insulin levels in rat models of metabolic syndrome.40

Si Miao San is a more potent anti-inflammatory insulin-sensitizing formula, and is also antioxidant due to its Phellodendron content. Phellodendron has demonstrated antioxidant activity in numerous studies41 and also has an anti-inflammatory effect through its inhibition of the production of inflammatory cytokines and nitric oxide. It also inhibits expression of the gene for iNOS, as well as tumor necrosis factor (TNF-alpha).42

Si Miao San improves insulin sensitivity by protecting and enhancing insulin signalling.35.36 Berberine, a plant compound extracted from Phellodendron in Si Miao San, has been shown through a systematic review of clinical trials to improve multiple aspects of Type II diabetes and insulin resistance, including blood glucose markers such as HbA1c, hyperlipidemia and hypertension.34 Phellodendron as a whole has been shown to directly combat the central mechanism by which insulin resistance is generated, by reversing the inhibition by AMPK of glucose and lipid oxidation,37 facilitating the removal of adipose stored in hepatocytes.43

Si Miao San also contains Atractylodes, which has been shown to improve several metrics in diabetic patients.37

Immune dysregulation

The connection between the gut and skin

While the microbiome likely plays a key role in inflammation due to weight gain, its role in immune dysregulation is probably even more central. Gut microflora are important drivers of host immunity, help protect against invading enteropathogens, and provide nutritional benefits to the host. Their role when things go awry is still being unraveled, but so far, the discoveries for dogs and cats parallel what has been discovered for humans.

Specifically, shifts in the microbiome can:

  • Cause synthesis of metabolites that have an epigenetic role in immune dysregulation
  • Increase gut permeability, causing sensitization to antigens within the gut lumen that then propagates to the skin
  • Stimulate ongoing inflammation in the gut wall (i.e. inflammatory bowel disease or IBD) which propagates to the skin.

Cell-mediated immune reactions are important in the latter two mechanisms. Helper T cells stimulated into action at gut level through excess exposure to microflora then circulate, eventually prompting Effector T cells in the skin to secrete interleukins that prod macrophages and neutrophils to ramp up their inflammatory response to local skin irritants. In other words, inflammation from one cause in the gut ramps up the inflammatory response to antigens from other sources in the skin. Since exposure to the inciting antigen or pathogen is ongoing, inflammatory responses in the skin persist or continue to grow.18,19 Conventional treatment with anti-inflammatory and immune-suppressive therapies often provides only temporary relief but may potentiate increased permeability and dysbiosis, ironically resulting in inflammation becoming perpetuated.16 Reducing background inflammation produced by gut dysbiosis may be the primary consideration for allowing skin inflammation to subside.

Stress can amplify the role of the gut in inducing skin inflammation. Itacts through the “brain-gut-skin axis” to suppress gut immunity through increased secretion of cortisol, promoting dysbiosis. Only after enteropathogens have proliferated is the immune system once again incited into activity, producing a cell-mediated inflammatory response that damages the gut wall and leads to secondary skin inflammation.

Restoring a healthy biome

Determining all the immune mechanisms that might be involved within a given patient may be difficult, but significant improvement can be achieved by simply following the central tenet of naturopathic medicine to “restore the causes of health” by:

  • Promoting species diversification within the microflora while controlling pathogens
  • Reducing gut permeability
  • Minimizing stress to avoid immune suppression and overgrowth of pathogens.

As reviewed by Craig,16 a healthy microbiome can be supported by feeding a species-appropriate diet using real foods wherever possible.

As a highly adaptive species, dogs (like humans) can thrive on a great variety of foods, at least in the short term, allowing debate among veterinarians and consumers of just what the ideal diet is for a dog. From the perspective of gut microflora, however, the definition of the ideal diet becomes narrower. In carnivores, use of higher-protein diets promotes greater stomach acidity, reducing the predisposition to small intestinal bacterial overgrowth and deleterious shifts in the biome. Craig notes that “animal-sourced roughage” such as scales, skin, hair, teeth, tendon, bone and cartilage from real food diets may have a prebiotic effect even if not digested.

Craig also states that “low carbohydrate cereal-free diets should be considered in the investigation of any chronic skin disorder [in dogs], whether or not there is evidence of gastrointestinal disease”. His concerns extend from the presence of gluten and fermentable carbohydrates within cereal grains. Fermentable carbohydrates lead to dysbiosis and secondary impairment of the GI barrier. Gut bacteria species have been shown to create metabolites from gluten that increase gut permeability, prompting immune dysregulation.

While fermentable carbohydrates can increase gut permeability, foods containing soluble fiber can help strengthen the GI barrier by having a prebiotic effect. Short-chain fatty acids, such as butyrate, produced by gut flora from these fiber sources tighten the junctions between gut mucosal epithelial cells, thereby reducing the priming of the immune system by lumen contents. Fecal IgA is also increased, helping to bind and inhibit the activities of enteropathogens.20 Example fiber sources include those from beans and potatoes.20, 21

Note that overweight inflamed animals do not apparently experience the same boost in fatty acid synthesis from high protein high fiber diets that immune dysregulation dogs do.13 Indeed, their fatty acid synthesis may drop. Fiber supplementation thus appears a much more important consideration for the immune dysregulation animal.

Other prebiotics exist besides fiber, including inulin and oligosaccharides, which are resistant to host digestion, allowing them to be fermented in the colon, producing beneficial metabolites. They are widely used in pet foods, although their efficacy in animals has not been researched.

Also commonly used are probiotics, which help change flora composition and activity to improve host health. Probiotic benefits include:

  • Inhibition of pathogen adherence
  • Sealing of the intestinal barrier
  • Killing pathogens through bacteriocins produced by commensal flora
  • Increasing immunity and the intestinal barrier by stimulating IgA production
  • Downregulation of cytokine secretion.

Craig states that probiotics have been effective in clinical trials of human atopy, and early exposure to probiotics reduces the intensity of symptoms in models of canine atopy. As reviewed by Miraglia del Guidice and De Luca, many clinical trials have shown that probiotics have the ability to alleviate allergic inflammation, as evidenced by both the control of clinical symptoms and a reduction of local and systemic inflammatory markers.17

When the microbiome is suspected as being operative in an animal’s inflammatory condition, certain pharmaceuticals, including antacids and antimicrobials, should be used only with great care to avoid perpetuating or worsening the problem.

At times, antimicrobials may be necessary to correct a dysbiosis, though efficacy is inconsistent. More popular among veterinarians recently has been the use of fecal microbiota transplantation (FMT) to restore normal gut flora populations.

Herbal approaches

Based on the foregoing, there are three main ways an herbal medicine can address immune dysregulation manifesting as immune-mediated dermatitis.

  1. Support a normal local immune response within the gut to correct dysbiosis
  2. Modulate the cell-mediated immune reaction being propagated to the skin
  3. Reduce stress as a cause of immune suppression and secondary enteropathogen proliferation.

Astragalus-based formulas such as Ginseng and Astragalus Combination (Bu Zhong Yi Qi Tang) are used to support or restore normal and local immunity within the gut, while Minor Bupleurum (Xiao Chai Hu Tang) derivatives work through all three pathways (see Tables 3 and 4).

Astragalus

Several studies illuminate the role of astragalus (A. membranaceus) in the correction of dysbiosis. Polysaccharide extracts from the plant have been shown to alter gut microbiota and the SCFAs they synthesize in diabetic mice.22 Another study in broiler chickens showed a reduction of pathogenic gut flora and a concomitant increase in commensal and symbiotic species.23

Indeed, astragalus (Huang Qi) is much studied for its ability to improve productivity in farm animals by correcting the microbiome. The plant was shown in pigs to reduce diarrhea secondary to dysbiosis, leading to enhanced growth rates and improved digestibility of food. Improved microbiota health was also indicated by an increase in species diversity and was likely due to an improved immune response against enteropathogens, as evidenced by increases in IL-2 and TNF-alpha.24 The same general impact was seen in a study on chicks, where the plant extract was used in tandem with probiotics to successfully combat pathogenic strains of E.coli.25

Minor Bupleurum

Minor Bupleurum consists of three key herbs: bupleurum (Chai Hu), scutellaria (Huang Qin) and panax ginseng (Ren Shen). It is an herbal powerhouse for the management of immune dysregulation caused by “leaky gut”, with all three plants showing efficacy independent of each other in all three areas of correcting dysbiosis:

  1. Reducing predisposition to, and the adverse effects from, stress on microflora
  2. Modulating the immune system to support local immunity or reducing the intensity of cell-mediated immune reactions

Dysbiosis

With respect to dysbiosis, bupleurum was shown in the context of another formula, Bupleurum Soothe the Liver Combination (Chai Hu Shu Gan San), to protect microflora from pathogenic overgrowth.26 Scutellaria (in the formula Huang Lian Jie Du Tang) has been shown to help restore normal gut flora in rats by reducing pathogens and increasing the presence of bacteria that do not incite inflammatory responses. SCFA synthesis increased accordingly.27 Many studies support the use of ginseng for the correction of dysbiosis secondary to antibiotic use.28

Brain-gut-skin axis

Ginseng is widely known as an adaptogenic herb that can normalize and optimize adrenal gland output of cortisol, lessening its secretion in times of repetitive stress, but increasing it when increased alertness is required. Normalization of cortisol secretion reduces immune suppression allowing enteropathogenic bacteria overgrowth. Scutellaria species likewise have research support for their long history of use in treating anxiety and other CNS organic and mood disorders.29 Bupleurum has likewise been shown to reduce depression and anxiety in animal models of repetitive stress.30

Immune dysregulation

Wogonin, found in scutellaria, has been analyzed for its ability to support normal immunity and reduce inflammatory bowel changes in colitis in rats. Levels of protective IgA were increased, while IgE levels associated with hypersensitivity were maintained at low levels. The ability to induce local immunity in the gut was increased in rats given wogonin, but the intensity of the inflammatory response during colitis was reduced, making scutellaria a true immune modulator.31

A decrease in bowel wall integrity can increase exposure of the immune system to endotoxins (LPS), sparking an inflammatory response that can propagate to the skin. Administration of bupleurum tempers the pro-inflammatory effects of LPS exposure, while supporting phagocytosis and removal of the offending antigens.32 Bupleurum’s tempering effect of an immune response has been widely studied and demonstrated at other mucosal surfaces as well, including for the reduction of allergic responses at respiratory epithelia.33

Conclusions

On a fundamental basis, the typical strategies in small animal dermatitis have changed very little over the last several decades and are still centered around the feeding of extruded or novel protein processed diets; and/or the use of immune suppressant medications.

Research into the role of diet in dermatitis has progressed, however, illuminating the primary role that metabolism and the microbiome play in driving skin inflammation. Use of unprocessed diets and herbs undermines the role of insulin and weight gain as drivers of inflammation; while manipulation of the microbiome using diet, herbs, prebiotics and probiotics holds significant promise for the relief of immune-mediated skin disease. These strategies are deserving of much more research attention, and appear to offer significant hope of advancing the veterinary profession in an arena that it has historically found highly frustrating.

You can view Dr Marsden’s webinar series on “Dermatological Dilemmas” by visiting civtedu.org/steve-marsden-skin-diseases-webinar-series/.

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New data on the health impacts of gonadectomy in dogs

How connections between obesity, nontraumatic orthopedic injuries and gonadectomy in large-breed dogs can impact conversations between you and your clients

For decades, gonadectomy has been promoted to both pet owners and veterinarians in North America for its various health benefits, and as a critical tool for combating pet overpopulation. It’s widely seen as an important component of responsible pet ownership.

Gonadectomy, though, is receiving increased scrutiny as veterinary medicine continues to embrace evidence-based recommendations. Over the last 10 years, researchers have attempted to find answers regarding the optimal timing of sterilization of dogs, while balancing the positive and negative health outcomes of gonadectomy with the very real problem of pet overpopulation. Study results have been inconsistent, with some studies in conflict with current recommendations and other studies in conflict with each other. While the science is far from settled, there are still takeaways that can inform the conversation veterinarians have with owners around the timing of gonadectomy for their dogs.

Obesity has become a major health issue in dogs, with estimates of up to 60% of dogs in the United States either overweight or obese. The list of diseases associated with obesity in dogs is legion and recent data suggests overweight, gonadectomized dogs have shorter life spans. Although gonadectomy has been associated with the development of overweight or obesity, the association between age at gonadectomy on overweight or obesity has produced conflicting results.

Questions surrounding gonadectomy and nontraumatic orthopedic injuries likewise have produced similarly conflicting results. Many veterinarians now recommend delaying gonadectomy in large-breed dogs, with these recommendations often based on personal experience and anecdotal evidence. While many plausible causal mechanisms exist to explain why gonadectomy may be associated with joint injury and disease, the scientific literature provides conflicting results.

The evidence surrounding cancer risk and gonadectomy is even more tangled. Although the link between early spaying and the development of mammary cancer is well known, other studies point to conflicting results when it comes to reproductive hormones and cancer.

A large Australian study published in 2018 showed that gonadectomized dogs (of both sexes) were at a higher risk for lymphoma compared to their intact counterparts. Another study looking at golden retrievers in California, also published in 2018, did not find a difference between gonadectomized and intact males in regard to cancer-related mortality, but did demonstrate a difference between intact and spayed females with more spayed females dying of cancer than males. An earlier study looking at a population of golden retrievers in California found that gonadectomy in either males or females increased the risk of several different types of cancers when compared to intact dogs. Lastly, a paper published in 2014 demonstrated that gonadectomized vizslas had increased odds of developing cancer than their intact counterparts.

Morris Animal Foundation recently published a study on the effect of gonadectomy on the incidence of obesity and overweight, and nontraumatic orthopedic injury using data from their Golden Retriever Lifetime Study. This longitudinal study is collecting data on more than 3,000 dogs as they mature from puppyhood through adulthood to better understand the risk factors for cancer and other diseases in dogs.

For the spay/neuter study, the team divided their cohort into four age groups: dogs under 6 months of age at gonadectomy; dogs 6 months to 12 months of age at gonadectomy; dogs over 1 year of age at gonadectomy; and intact dogs. Results showed that gonadectomized dogs in all categories had an increased risk of obesity and overweight compared to the intact group. For nontraumatic orthopedic injuries (in this study cranial cruciate ligament rupture and arthritis), only dogs gonadectomized under 6 months of age had an increased risk of these conditions.

“These findings emphasize that the timing of gonadectomy may impact future health outcomes, both in positive and negative ways.” said Dr. Missy Simpson, lead author of the paper and Staff Epidemiologist for the Golden Retriever Lifetime Study. “These results are especially powerful because we were able to verify that gonadectomy preceded overweight/obesity and orthopedic injury. Establishing the order of events is important because we can rule out reverse causality as an explanation for our findings. In other words, owners’ decision to spay or neuter their dogs was not a result of the outcomes we studied.”

Recommendations about the timing of gonadectomy represent one facet of a trend toward personalized medicine in both veterinary and human health care. As we learn more about the effect of reproductive hormones on health, we’ll be better able to guide our clients and improve health and longevity in our patients.

Learn more about the Golden Retriever Lifetime Study at morrisanimalfoundation.org or listen to a podcast about the spay/neuter study.

 

 

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Integrated approaches to canine cancer: augmentative treatment strategies

Three integrative treatment modalities that, when used in conjunction with chemo and radiation, can increase the longevity and life quality of canine cancer patients.

Conventional treatments for canine cancer include surgery, chemotherapy and radiation.  In recent years, however, evidence has been mounting that additional treatment modalities can increase patient longevity and life quality. Including other modalities can also increase owner acceptance of the proposed clinical plan. This article focuses on three additional functional treatment categories — immune support; apoptosis (cancer cell suicide); and extracellular matrix therapies – that can be used alongside conventional cancer treatments.

1. Immune support

“…treatment with combination chemotherapy caused a significant and persistent decrease in B cell numbers (in dogs).” — Journal of Veterinary Internal Medicine, 2006

Compromised immunity is common in cancer patients, and a strong oncological research trend is underway to deliver immune-targeted therapies.

Cancer itself is known to be immuno-suppressive. It has been shown that dogs with cancer (lymphosarcoma and osteosarcoma) experience reductions in circulating T cells. This not only promotes the development and progression of cancer itself, but also increases the risk of infection.

Neoplasia may be immune-compromising, but it is also immune-deranging. Abnormal circulating immune complexes seem to impede effective immune responses in dogs with mammary carcinomas.

Immune support can be found in several forms:

  • One existing immune therapy for canine cancer is the plasmid DNA melanoma vaccine; several other anti-cancer vaccines in development have also shown promise.
  • COX-2 inhibitors currently used in metronomic protocols, whether pharmaceutical or botanical, reduce immuno-suppressive prostaglandins.
  • The use of immune-stimulating modified bacteria has shown to be beneficial in increasing remissions and durability of stable disease in a research setting.
  • Finally, low-dose chemotherapy and local radiation can increase immune destruction of cancers without systemic immune compromise.
  • Beta glucans are another tool the clinician can use for immune support (see below).

Beta glucans for additional immune support

Beta glucans are a group of D-glucose monomers linked by a β-glycosidic bond, found in fungal and plant cell walls. Common sources are extracts derived from various mushrooms, oats and yeast. These compounds have demonstrated strong immuno-modulatory activities based on animal and human-based research.

“β-glucans are known to exhibit direct anticancer effects and can suppress cancer proliferation through immuno-modulatory pathways.” — Investigational New Drugs, 2017

Immune-supporting beta glucans have been shown to bind to pattern recognition receptors (PARRs) on a variety of immune cells. In this way, they activate an array of immune pathways.

In humans, these compounds have been shown to increase adaptive and innate immune responses, as well as decrease cancer metastasis.  As immune-stimulating molecules, they activate macrophages, granulocytes, dendritic cells — and of particular interest in cancer immunity, natural killer cells. This leads to downstream stimulation of both T and B cells.

Beta glucans (β-1,3/1,6) extracted from yeast and administered orally to dogs elicited an immune response (and competency) similar to that of a kennel cough vaccination. Beta glucans from oat were shown to balance canine vaccination immune response by maintaining cellular immunity alongside humoral immunity. (Cellular immunity is in general the main effector branch of anti-cancer immune responses.)

It was previously assumed that oral delivery of these compounds did not yield appreciable results. However, it is now known that pinocyte microfold (M) cells, located in the small intestine, actively transport beta glucans to the Peyer’s patches.

“Glucan effects on cancer inhibition are well established.” — Anti Cancer Research, 2018

In clinical practice, the author uses both K-9 Immunity® as well as Im-Yunity® as beta glucan sources. K-9 Immunity contains a spectrum of beta glucans from a variety of medicinal fungal sources. The encapsulated formulation is preferred. Im-Yunity® contains various glucans along with a protein component, which together comprise the active ingredient, PSP.

Cases of canine hemangiosarcoma deserve special mention. At 100 mg/kg PO daily, Im-Yunity® was shown to increase median survival times to 199 days in a small cohort of dogs with splenic hemangiosarcoma. To the author’s knowledge, this is the highest median survival time reported for splenic hemangiosarcoma treatment.

Transfer factors found in low molecular weight lymphocyte extracts are thought to enhance the binding of beta glucans to immune system cells, particularly T cells, which are active in cell-mediated immunity. Transfer Factor is available commercially and the author uses it concurrently with beta glucans.

The beta glucans as a group have a high safety margin, with only rare cases of digestive upset that can be minimized by administration with food. The same can be said for Transfer Factor. However, the author avoids these immune therapies in cases of historical or active immune-mediated disease.

 2. Apoptosis: cancer cell suicide induction

“One of the few areas in the cell death field that everyone does agree upon is that having cancer cells undergo apoptosis would be a good thing.” — Carcinogenesis, 2005

Cancers uniformly lack the normal cell suicide response (apoptosis) seen in damaged, aged, infected or otherwise deranged cells. Triggering normal apoptosis in these deficient cells is a targeted approach to decreasing cancer cell burden. In fact, traditional oncologic therapies for canine cancer, such as chemotherapy and radiation, trigger apoptosis or programmed cell death of neoplastic cells.

“Owing to the fact that apoptosis causes minimal inflammation and damage to the tissue, apoptotic cell death-based therapy has been the centre of attraction for the development of anticancer drugs.” — Cell Death and Disease, 2016

However, both chemotherapy and radiation have additional effects that are not specific to neoplastic cells. The resulting toxicity leads to dose limitations.

Other compounds, called apoptogens, are capable of inducing apoptosis. An array of naturally-occurring, low-toxicity, phytochemical apoptogens selectively induce cancer cell suicide. In general, they are limited by oral bioavailability, which should be enhanced to obtain a therapeutic effect.

Common phytochemical apoptogens include curcumin, silymarin, EGCG, luteolin, lycopene, capsaicin, resveratrol and many others. Interestingly, these and other apoptogens can be extracted from dietary sources. These naturally-occurring dietary apoptogens act at multiple sites in the intracellular cascades involved in activating normal apoptosis.

“A long list of such dietary constituents is known to induce apoptosis of cancer cells without affecting normal cells.” — Biochemical Pharmacology, 2008

Additionally, several dietary apoptogens are chemo- and radio-sensitizers, enhancing the effects of chemotherapy and radiation when used concurrently. These include curcumin, silymarin and luteolin, among others.

The author uses Apocaps® as a combination source of bioavailability-enhanced dietary apoptogens. This formula may also be used alongside conventional therapies such as surgery and chemotherapy.

The author typically discontinues most therapeutic supplements, including Apocaps®, at least four days prior to surgery until ten to 14 days post-operatively. When anti-inflammatory treatments such as corticosteroids or NSAIDS are used, the author will reduce the labeled Apocaps® dose by approximately half, since Apocaps® constituents have mild to moderate COX-2 inhibiting effects.

Apocaps® has a high safety margin in clinical practice, with rare cases of digestive upset, usually loose stool. This can often be minimized by administration with food.

3. Extracellular matrix therapies

Reducing cancer spread is central to mitigating mortality and morbidity. Cancer spread occurs through a complex series of events, including mutation, loss of cancer stem cell anchoring points, migration, vascular invasion, immune dysfunction, alterations in the extracellular matrix (ECM), adhesion, and proliferation of distant tumor cells.

One possible reason for loss of remission after chemotherapy or radiation is an altered microenvironment that results from these conventional treatments. This altered matrix actually favors metastasis. In particular, the injury of cancerous tissues seems to favor conditions for regenerative responses, including aberrant neoplastic cell migration.

“Several studies demonstrated that ionizing radiation might promote migration and invasion of tumor cells” — Critical Reviews in Oncology/Hematology, 2016

“Chemotherapy by itself can instigate metastatic spread while simultaneously restraining growth of the primary tumor.” — Cancer Research, 2015

It is the author’s opinion that substantially increased attention should be placed on this subject in veterinary cancer patients.

Modified citrus pectin

The use of modified citrus pectin is one way to address this problem. Modified citrus pectin (MCP) is a complex water-soluble indigestible polysaccharide obtained from the peel and pulp of citrus fruits. To increase oral bioavailability, the citrus pectin has been modified by means of high pH and temperature treatments.

“Modified citrus pectin (MCP), a complex water-soluble indigestible polysaccharide…has emerged as one of the most promising anti-metastatic drugs.” — Carbohydrate Research, 2009

MCP has anti-adhesive properties relative to metastatic mobile cancer cell attachment. After neoplastic cell detachment and vascular invasion, endothelial attachment and neoplastic accumulation is mediated by galectin-3. MCP appears to antagonize galectin-3 adhesion. Galectin-3 also mediates mobile neoplastic cell extravasation from blood vessel to adjacent tissue extracellular matrix, where MCP appears to be active as well. Finally, MCP has the potential for increasing apoptotic responses of tumor cells to various events such as loss of anchoring, chemotherapy and radiation. Inducing normal apoptosis of cancer cells by MCP is also mediated, at least in part, by inhibiting galectin-3 anti-apoptotic function.

It has been shown in humans that high doses of MCP over one to three weeks, or modest doses long-term, increase urinary excretion of the toxic heavy metals lead, arsenic and cadmium, without increased excretion of normal dietary mineral elements.

MCP is exceptionally safe, with few to no clinical side effects. Digestive upset or allergic response is possible, but the author has not seen adverse effects clinically. The author uses approximately two to three times the human adult labeled doses pound for pound, mixed in food. Bear in mind that MCP is a pectin, so it can form a clear gelatinous substance in the presence of moisture, including dog rations.

Summary

When it comes to cancer, relative to other disease states, dog owners are often concerned about adverse survival metrics and life quality concerns. This can lead to dissatisfaction with canine cancer management, and treatment refusal. By practicing cancer care that includes immune support, cancer cell suicide induction, and extracellular matrix therapies, the clinician may experience increased opportunity for more favorable treatments.

References

Immune support

Walter CU, Biller BJ, Lana SE, Bachand AM, Dow SW. “Effects of chemotherapy on

immune responses in dogs with cancer”. J Vet Intern Med. 2006 Mar-Apr;20(2):342-7.

Rutten VP, Misdorp W, Gauthier A, Estrada M, Mialot JP, Parodi AL, Rutteman

GR, Weyer K. “Immunological aspects of mammary tumors in dogs and cats: a survey. including own studies and pertinent literature”. Vet Immunol Immunopathol. 1990. Nov;26(3):211-25. Review.

Klingemann H. “Immunotherapy for Dogs: Running Behind Humans”. Front Immunol. 2018;9:133. Published 2018 Feb 5.

Stuyven E, Verdonck F, Van Hoek I, et al. “Oral administration of beta-1,3/1,6-glucan to dogs temporally changes total and antigen-specific IgA and IgM”. Clin Vaccine Immunol. 2009;17(2):281-5.

Ferreira LG, Endrighi M, Lisenko KG, et al. “Oat beta-glucan as a dietary supplement for dogs”. PLoS One. 2018;13(7):e0201133. Published 2018 Jul 31

Bashir KMI, Choi JS. “Clinical and Physiological Perspectives of β-Glucans: The Past, Present, and Future”. Int J Mol Sci. 2017;18(9):1906.

Brown DC, Reetz J. “Single agent polysaccharopeptide delays metastases and improves survival in naturally occurring hemangiosarcoma”. Evid Based Complement Alternat Med. 2012;2012:384301.

Yoon TJ, Koppula S, Lee KH. “The effects of β-glucans on cancer metastasis”. Anticancer Agents Med Chem. 2013 Jun;13(5):699-708. Review.

Stier H, Ebbeskotte V, Gruenwald J. “Immune-modulatory effects of dietary Yeast Beta-1,3/1,6-D-glucan”. Nutr J. 2014;13:38. Published 2014 Apr 28.

Vetvicka V, Vetvickova J. “Glucans and Cancer: Comparison of Commercially Available β-glucans — Part IV”. Anticancer Res. 2018 Mar;38(3):1327-1333.

Berrón-Pérez R, et al. “Indications, usage, and dosage of the transfer factor”. Rev Alerg Mex. 2007. Jul-Aug;54(4):134-9. Review.

Apoptosis

Kaufmann SH, Earnshaw WC. “Induction of apoptosis by cancer chemotherapy”. Exp Cell Res. 2000 Apr 10;256(1):42-9. Review.

Eriksson D, Stigbrand T. “Radiation-induced cell death mechanisms”. Tumour Biol. 2010 Aug;31(4):363-72.

Baig S, Seevasant I, Mohamad J, Mukheem A, Huri HZ, Kamarul T. “Potential of apoptotic pathway-targeted cancer therapeutic research: Where do we stand?” Cell Death Dis. 2016;7(1):e2058.

Khan N, Afaq F, Mukhtar H. “Apoptosis by dietary factors: the suicide solution for delaying cancer growth”. Carcinogenesis. 2007 Feb;28(2):233-9.

Khan N, Adhami VM, Mukhtar H. “Apoptosis by dietary agents for prevention and treatment of cancer”. Biochem Pharmacol. 2008;76(11):1333-9.

Limtrakul P. “Curcumin as chemosensitizer”. Adv Exp Med Biol. 2007;595:269-300. Review.

Garg AK, Buchholz TA, Aggarwal BB. “Chemosensitization and radiosensitization of tumors by plant polyphenols”. Antioxid Redox Signal. 2005 Nov-Dec;7(11-12):1630-47. Review.

Prasad NR, Muthusamy G, Shanmugam M, Ambudkar SV. “South Asian Medicinal Compounds as Modulators of Resistance to Chemotherapy and Radiotherapy”. Cancers (Basel). 2016;8(3):32. Published 2016 Mar 5.

Fantini M, Benvenuto M, Masuelli L, et al. “In vitro and in vivo antitumoral effects of combinations of polyphenols, or polyphenols and anticancer drugs: perspectives on cancer treatment”. Int J Mol Sci. 2015;16(5):9236-82. Published 2015 Apr 24.

Extracellular matrix therapies

Moncharmont C, et al. “Radiation-enhanced cell migration/invasion process: a review”. Crit Rev Oncol Hematol. 2014 Nov;92(2):133-42.

Vilalta M, Rafat M, Graves EE. “Effects of radiation on metastasis and tumor cell migration”. Cell Mol Life Sci. 2016;73(16):2999-3007.

Karagiannis GS, Condeelis JS, Oktay MH. “Chemotherapy-induced metastasis: mechanisms and translational opportunities”. Clin Exp Metastasis. 2018. Apr;35(4):269-284.

Ran S. “The Role of TLR4 in Chemotherapy-Driven Metastasis”. Cancer Res. 2015;75(12):2405-10.

Glinsky VV, Raz A. “Modified citrus pectin anti-metastatic properties: one bullet, multiple targets”. Carbohydr Res. 2009 Sep 28;344(14):1788-91.

Tehranian N, et al. “Combination effect of PectaSol and Doxorubicin on viability, cell cycle arrest and apoptosis in DU-145 and LNCaP prostate cancer cell lines”. Cell Biol Int. 2012 Jul;36(7):601-10.

Eliaz I, Hotchkiss AT, Fishman ML, Rode D. “The effect of modified citrus pectin on urinary excretion of toxic elements”. Phytother Res. 2006 Oct;20(10):859-64.

Zhao ZY, et al. “The role of modified citrus pectin as an effective chelator of lead in children hospitalized with toxic lead levels”. Altern Ther Health Med. 2008 Jul-Aug;14(4):34-8.

Editor’s noteIf you are interested in learning more about Dr. Dressler’s approach to managing canine cancer, he has created a private video training series, sponsored by Functional Nutriments, that is free to veterinarians. You can find it at FunctionalNutriments.com/IVC.

Disclosure Statement

The author of this publication developed the Apocaps® formula and is a paid consultant for Functional Nutriments, LLC. He has no equity interest in either Functional Nutriments, LLC or Apocaps®.

Homeopathic approach to cancer in companion animals

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

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

Beginning a cancer case

When cancer cases are presented at our surgery, they have commonly just finished an intensive diagnostic or surgical regime. Often, they are still in the process of receiving chemotherapy. For each animal that presents to our surgery with a cancer diagnosis, we begin by addressing the following general aims:

  1. To slow tumor growth
  2. To address pain and discomfort
  3. To strengthen the body so it can begin to heal
  4. To improve the patient’s overall mental and physical well-being
  5. To gently lead the body to cure, if it is able.

As we work towards each of these goals, while the patient is on homeopathic treatment, we observe several different outcomes. Some will hold a cancer in a steady state, unchanged, for many years. Some will experience a slowdown in the growth of their cancer. And still others will be led to cure, with a complete shrinking of their cancers.

Miss Kitty – case study

August 2012

Miss Kitty first presented at our surgery at ten years of age. She had recently become quite breathless with any exertion. Her usual vet recommended euthanasia because thoracic radiographs revealed large growths on her lungs. Miss Kitty’s heart had been pushed sideways and could only be auscultated on the right side of her chest dorsally. An exact histopathological diagnosis was not pursued by the owners; however, homeopathic treatment was begun using her history, presenting symptoms, physical exam, and preliminary diagnostics.

 

Treatment began with two homeopathic medicines, Lycopodium Clavatum 200c and Carcinosin 200c. These two medicines were used in alternation, one for three days, then the other, using the methods devised for human cancer treatment by A.U. Ramakrishnan and Catherine Coulter and outlined in their book A Homeopathic Approach to Cancer,  a distillation of Dr. Ramakrishnan’s  treatment of over 10,000 people.1 The Ramakrishnan approach uses an organ-specific remedy that has an affinity for cancer in that area, alternating with a more general cancer homeopathic medicine like Carcinosin or Scirrhinum. Dr. Ramakrishnan uses the remedies in 200c potency as he has found it matches the energy of the cancer in most cases. The potency is then increased as the being heals.

Several other homeopathic medicines were used with Miss Kitty over the following year. They were prescribed depending on the presenting symptoms at her monthly visits. During one visit, she became quite cyanotic during handling and was treated with a homeopathic medicine called Carbo vegetabilis in a 1M potency; this helped with her general breathing for many months.

April 2014

After almost two years of homeopathic treatment, a new growth the size of a lemon was palpated in Miss Kitty’s abdomen behind the liver. It was not causing any symptoms but had grown rapidly over the past month. Her owners declined further diagnostic work. Her breathing was now quite stable, but there was no great change in chest auscultation, with the heart only audible on the right dorsal side.

Based on the location of the new mass, Miss Kitty’s homeopathic protocol was changed to homeopathic Phosphorus 200c and Tuberculin 200c, to be given in three-day alternation. Often, a change of remedy in a chronic case will stimulate the healing mechanisms again, as opposed to using the same medicine at the same strength. Miss Kitty’s case was re-analyzed with the new symptom of the liver tumor, allowing determination of a new homeopathic prescription.

June 2014

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

Mammary growth in June of 2014.

March 2016

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

Mammary growths in November of 2016.

 

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

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

These repertory databases hold all the information that has been obtained from either provings (data obtained from the intentional taking of a substance by healthy persons to observe the symptoms), accidental poisonings, or the clinical use of potentised medicines, collected over the past 200 years. In this case, it was observed that, at least in humans, a huge desire for cream is a symptom experienced many times in patients who have benefited from a homeopathic medicine called Lac humanum, derived from human breast milk.

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

June 2016

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

February 2017

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

Conclusion

In Miss Kitty’s case, homeopathic treatment followed Hering’s Law of cure (see sidebar above), gradually shifting her disease from deep within vital organs to more external locations. As aspects of her illness resolved, other symptoms surfaced, allowing us to individualize her homeopathic prescriptions further, improving her vitality and physical and mental well-being. A homeopathic approach to Miss Kitty’s care allowed her to live a long and full life with her family.

1Ramakrishnan AU, Coulter, Catherine R. A Homeopathic Approach to Cancer. Berkeley Springs, West Virginia: Ninth House Publishing, 2001.

2MacRepertory (Computer Software), 2017.

This article has been peer reviewed.

CBD case studies: anxiety and epilepsy

The following case studies demonstrate how CBD can be used in the treatment of anxiety and epilepsy in dogs and cats.

In this author’s clinical experience, full spectrum CBD products have been most effective in cases of anxiety, osteoarthritis and seizure disorders in both dogs and cats. For the purposes of these case studies, HempRx Forte was used.

Anxiety

CBD-rich cannabis is the most effective natural method for treating anxiety in both dogs and cats, in this author’s practice. Start at a dose of 0.5 mg/kg by mouth every 12 hours with food, and increase every three days to the desired effect. Most guardians notice improvement within 12 to 24 hours. In refractory cases, this author has administered CBD with SSRIs. However, there are no studies proving their combined safety.

Pugsley’s anxiety and dog aggression improved dramatically with the use of CBD. Photo courtesy of Angie Krause.

Anxiety case study

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

Epilepsy

CBD-rich hemp extracts have gained popularity for treating children’s seizure disorders. Due to the lack of THC, these children can enjoy life without the sedative effects of traditional anticonvulsants. Many pet guardians are hesitant to use drugs like potassium bromide and phenobarbital long-term due to their undesirable side effects. Other drugs like levetiracetam have questionable efficacy and dosing schedules that make compliance difficult. CBD may provide a safe and efficacious alternative for some animals. It may also help reduce dosage in conventional pharmaceuticals.

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

Oliver’s seizures decreased from one to two seizures a month to less than one every 6 months on CBD. Photo courtesy of Angie Krause.

Epilepsy case study

Oliver is an eight-year-old MN DSH cat weighing 11 lbs. He presented after having one or two seizures a month for five months. His guardian was reluctant to start anticonvulsants due to the possible side effects. Bloodwork and physical examination were within normal limits and imaging was not performed. Oliver was started on 0.2 mls of HempRx containing 3 mg of CBD, twice daily with food.

After starting CBD, Oliver stayed seizure-free for six months. At that time he had one seizure. His current seizure frequency is approximately twice yearly.

Click here to read more about incorporating medical cannabis into your practice.

TCVM: An integrative approach to treating cancer

TCVM may be a stand-alone or adjunctive treatment for animal cancer patients. It not only treats cancer, but can potentially prevent recurrence and metastasis. 

Cancer is one of the most despised and feared words in the medical vocabulary. It’s also one of the biggest health concerns facing not only humans, but also our canine and feline patients. Cancer afflicts one in every three1 to one in every four dogs2, with incidence increasing to almost 50% in dogs over the age of ten years2. In fact, it is the leading cause of death in dogs and cats in the United States; as many as 50% of our companion canines and felines die from cancer.

Conventional medicine seeks to kill cancer cells by utilizing surgery, chemotherapy, radiation therapy and immunotherapy. Treatment is based on the particular type of cancer a patient has, and focuses more on the disease itself than on the overall health of the individual patient. Conventional treatments often cause collateral damage to the body, with impacts ranging from mild to severe.

In contrast, Traditional Chinese Veterinary Medicine (TCVM) treats the disease pattern identified in an individual patient (irrespective of the conventional biomedical diagnosis), taking into consideration the overall condition of the patient at that time. TCVM treatments work with the body rather than against it, and the side effects, if any, are typically mild. TCVM may be used as a stand-alone treatment or an adjunctive treatment for cancer patients. It provides the veterinary practitioner the ability to not only treat active cancer, but to potentially prevent recurrence and metastasis.

Traditional Chinese Medicine etiology of cancer

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

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

2. Endogenous factors include internal organ (Zang-fu) disharmony(ies), an imbalance of Yin/Yang and Qi, and Blood deficiency (weak constitution).

3. Emotional factors result in emotional stress or heightened emotions (e.g. lack of exercise or social interaction, changes in household schedule or members, etc.). Any of these factors, singly or in combination, may cause stagnation of Qi/Blood, Phlegm, Dampness or Toxicity, which may then develop into cancer. Often, a root deficiency of Qi, Qi/Yang, Blood or Yin have enabled the external factors to have a strong impact, or are the actual cause of Zang-fu

In veterinary medicine, some of the most common TCM etiologies of neoplasia include:

  • Trauma and/or Cold-Damp, leading to Blood Stasis
  • Inappropriate diet, which may result in Food Stagnation, leading to Accumulation of Phlegm and/or Heat Toxin
  • Environmental changes (household changes, boarding, travel, etc.), leading to Qi Stagnation
  • Invasion of the six Pathogenic Factors, leading to Stagnation of Blood/Qi, accumulation of Phlegm, Heat, Heat Toxin, and/or Damp
  • Disharmony of Zang-fu (internal) organs, leading to Zheng Qi deficiency, which then leads to Stagnation of Blood/Qi, accumulation of Phlegm, Heat, Heat Toxin, and/or Damp
  • Note: Vaccines and chemicals are Toxins/Heat Toxins. Their administration may bypass the normal route of TCM pathogenic invasion; thus, the body is unable to “fight” these pathogens, and they can have a strong negative impact on the body . Additionally, as these exogenous toxins may be introduced to the body at the deepest (Xue) level, they may remain latent as a pathogenic factor, only to emerge in the future when the body’s Zheng Qi is weakened.

Strategies for treating cancer with TCM

1. Tonify Zheng Qi

If Zheng Qi is deficient, the body’s resistance to pathogenic factors is weak. Zheng Qi deficiency is ultimately the root cause of cancer.

  • Tonify Qi
  • Tonify Spleen
  • Nourish Blood
  • Nourish Yin

 2. Move Qi and Blood

Stagnation of Qi and Blood is the basic pathologic change seen in the development of cancer.

3. Clear internal Heat and toxins

Infection and chronic inflammation are predisposing factors in the development of cancer.  In TCM, Heat-toxin is a major cause of cancer.

4. Dispel Phlegm and Dampness

Damp obstructs the smooth flow of Spleen Qi. This means the Spleen’s ability to transform food into Food Qi (Gu Qi) and transport Gu Qi to the Upper jiao (Lungs for distribution to the rest of the body, and Heart where the transformation into Blood occurs) is impaired.  The Spleen hates Damp; when there is Damp, the Spleen must work extra hard to eliminate the pathogen. Damp is the origin of Phlegm, and when Phlegm accumulates, masses develop.

  • Support Spleen to drain Damp
  • Drain Damp
  • Transform Phlegm

5. Bring the body back to balance

The fundamental basis of TCM is balance and harmony.  When the body is out of balance, disharmony occurs and disease is manifested. Treatment therefore seeks to help the body come back into balance, eliminating excesses and supplementing deficiencies.

 The five main branches of TCM

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

1. Acupuncture

To date, the full effects of acupuncture are not completely understood. Its physiological effects cannot be explained by a single mechanism; however, there is evidence that acupuncture stimulates a series of interactions among the nervous system, endocrine system and immune system, resulting in somato-somatic, somato-visceral and somato-autonomic reflexes. Acupoints and needling technique should address the TCM pattern of disharmony as well as the side effects from current treatment protocols, such as chemotherapy-associated nausea and diarrhea, or pain secondary to the cancer or subsequent to the treatment modality. Insertion of a needle at or very close to a known malignant mass is contraindicated, as is electro-acupuncture across a neoplastic mass.

 2. Chinese herbal medicine

Herbal formulas may be used separately or in tandem with conventional therapies. Strategies to employ prior to and after conventional therapies should focus on supplementing Qi, nourishing Blood, and tonifying the Spleen, Liver and Kidneys. During conventional therapies, herbal formulas may be utilized to mitigate negative side effects. When used as the primary therapy, formulas to dispel pathogenic factors to directly address the tumor should be used in tandem with formulas that supplement Qi, nourish Blood and tonify Spleen, Liver, Kidneys and other affected Zang-fu. In this author’s experience, as the TCM patterns change with the disease state, formulas are typically modified or changed altogether.

3. Dietary or food therapy

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

In this author’s opinion, fresh foods, either home-cooked or from a gently-cooked, commercially-prepared, frozen raw diet, are critical to the treatment of cancer in our companion animals. Historically, we have designed TCM diets utilizing 60% to 70% high quality protein, 10% to 20% primarily low-glycemic index carbohydrates, and 20% to 30% lightly-cooked vegetables in tandem with nutraceuticals such as digestive enzymes, pre- and probiotics, fish oil or algae-based EPA/DHA, microalgae, medicinal mushrooms, and whole food vitamin-mineral supplements. Current research utilizing a ketogenic diet is promising, and when combined with the tenets of TCM may yield the best results yet.3

4. Tui-na

Other veterinary substitutions for Tui-na include body work such as massage, chiropractic, and craniosacral therapy.

5. Tai-chi/Qi-gong

Daily exercise, ideally in environments with minimal chemicals and electromagnetic fields, is recommended as a “substitute” for Tai-chi/Qi-gong.

Cancer case studies illustrating the principles of TCVM

Amynta

Amynta, a 4½-year-old spayed female Rhodesian ridgeback, was presented for TCM treatment following exploratory surgery with resection and anastomosis for an ileal intussusception. Histopathology of the resected small intestine and cytology of an abdominal lymph node were consistent with high grade lymphoma.

One month post-surgery, the patient was started on CHOP-based chemotherapy with a board-certified oncologist, as well as Chinese herbal medicine, nutraceuticals, and a home-cooked diet for support during chemotherapy. Amynta’s owner also started her on alkalinized water. The patient received dry needle and aqua-acupuncture with vitamin B12 and lyophilized thymus extract on a regular basis, but after four months, her owner discontinued chemotherapy due to the negative side effects.

Since then, Amynta has been maintained on regular dry needle and aqua-acupuncture, Chinese herbal medicines, nutraceuticals, daily oral thymus extract with colostrum, DLLV (lily extract), and a primarily home-cooked diet to address her TCM patterns of disharmony. After the owner moved out of town, she and her local veterinarian added rectal ozone therapy with microbiome restorative therapy to address Amynta’s chronic intermittent diarrhea (often secondary to dietary indiscretion). Chinese herbal medicines and nutraceuticals have been changed over time to address her changing TCM patterns of disharmony.

To date, two years and two months since initial presentation, Amynta is doing extremely well, and is lively and active, with no evidence of recurring disease.

Treatment strategies utilized: Tonify Spleen Qi and drain Damp, nourish Blood and Yin, move Qi and Blood, and support Kidney Jing.

Camille

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

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

Treatment strategies utilized: Tonify Spleen Qi, nourish Blood, move Qi and Blood, tonify Kidney Qi.

Magnus

Magnus, a 4½-year-old neutered male boxer, was presented to the emergency service for hemoabdomen. The day before, an approximately 8cm complex mass was seen on abdominal ultrasound. No metastasis was appreciated on thoracic radiographs, and biopsy of the spleen and liver revealed splenic hemangiosarcoma but no apparent hepatic involvement.

The owner opted for follow-up TCM treatment only and presented with Magnus one month after surgery.  The patient was prescribed two Chinese herbal medications, coriolus mushroom extract, and a home-cooked diet to address his TCM diagnosis. He was also treated twice with aqua-acupuncture using vitamin B12, bioregulatory medicine, and lyophilized thymus extract.

The patient moved out of state one month after presentation, but was continued on herbal medication for one year.

Three years and five months after initial presentation, the owner informed us that Magnus was still alive and thriving. She ran out of herbs but continued the TCM diet and added colloidal silver and several drops of food grade hydrogen peroxide to his drinking water.

Treatment strategies utilized: Tonify Qi, tonify Spleen, nourish Blood, move Qi and Blood, support Kidney Jing.

Conclusion

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

1wearethecure.org/

2vetcancersociety.org/pet-owners/faqs/

3ketopetsanctuary.com/

This article has been peer reviewed.

Non-surgical treatment for feline resorptive lesions and chronic periodontal disease in a cat with chronic kidney disease

This layperson’s case study demonstrates how a patented blend of natural oils helped a high-risk feline overcome chronic periodontal disease.

Synopsis

Patient: Yochabel (feline)

Weight: 11.0 pounds
Age: 18 years old
Diet: Not kibble. Homemade species specific diet and wet food.

Diagnosis:

  1. Periodontal disease: Dental calculus and gingivitis. COHAT and frm to stage and treat. Possible underlying TR
  2. Tooth resorption: COHAT and frm, probing to rule out TR. 409 has retained root(s), rule out other lesions. Extraction is indicated
  3. Renal insufficiency-elevated BUN, Creatinine.
  4. Periodontal disease stage 2
  5. Retained root fragment

Ramifications of Diagnosis: Inability to eat food
Other Medical Issues: Chronic kidney disease
Treatment: 1/4 of a capsule of DentaPet rubbed on Yochabel’s gums/ twice daily
Outcome: Improved gum health and return to regular diet

____________________________________

My 18 year old cat, Yochabel, was a “foodie”, her passion in life was eating. When the day came that she didn’t knock over her food bowl trying to devour the last morsel, I knew something was wrong. After a consultation with her veterinarian followed by a referral to a veterinarian dental specialist, Yochabel was diagnosed with chronic periodontal disease and feline resorptive lesions. During her oral exam, it was found that Yochabel had several broken teeth and exposed nerve roots, making eating painful. After Yochabel was diagnosed with resorptive lesions, I pureed and warmed all of her food to make eating more comfortable. The specialist stated that the solution was surgical teeth extractions, which required anesthesia. However, we were faced with a dilemma: Yochabel had chronic kidney disease, which, combined with her age, made surgery high risk.

I was reluctant to proceed with surgery, and set upon researching more innovative, non-surgical treatment options. This is when I discovered Hope Science Vet DentaPet: a patented blend of natural food oils targeting periodontal disease and gum inflammation, created to naturally support oral health. The directions recommended rubbing Yochabel’s gums with the ointment and/or placing it on her paws so she would lick the ointment onto her own gums. As I slowly introduced her to the ointment, first through smell, then taste, she seemed receptive. Gradually I approached her from behind her head and stroked her as I gently introduced the ointment into her mouth. In no time at all, she let me rub her gums. This became part of our daily routine and the results were astonishing. After three months of consistent Dentapet application twice daily, Yochabel’s gum health markedly improved. Within four months she no longer required pureed food and was able to resume her regular diet with ease. Her normal diet wasn’t kibble because I know that she would not have been able to crunch down on hard food. She could however chew chicken and turkey breast, ground beef, etc. comfortably after healing took place. I continued to apply Dentalpet once per day for maintenance.

This non-surgical, alternative treatment improved Yochabel’s quality of life, a decision that was in the best interest of her care. After her diagnosis, Yochabel continued to have a great life until she passed away at the age of 20.

Cranial sacral osteopathy

Why CST is a valuable tool for the equine cancer patient.

Cranial sacral therapy (CST) has shown efficacy in treating inflammatory bowel disease, migraines, post-traumatic stress disorder, cranial skeletal trauma, concussion, and psychological disorders such as depression in humans. It is also an effective tool to use in conjunction with other modalities during cancer treatment.

In veterinary applications, CST offers a way to decrease the side effects associated with chemotherapy or radiation. And following surgical interventions, especially in the equine where induction, movement and recovery are not without physical and structural risks, CST and osteopathic manual manipulation can be especially beneficial.

History of osteopathy and cranial sacral therapy

Osteopathy began in the 1850s when Dr. Andrew Taylor Still observed how the motion of the body’s structures correlated with overall health. He proposed that by manipulating the structures of the body to create optimal motion, the overall autonomic function of the body could be improved, and the body could be supported to correct itself and heal.

Dr. Still introduced the concept of “terrain”,  an area of the body adversely affected by immobility in bones that border the blood supply, lymphatics and nervous structures to a particular area. This can result in congested capillary beds, increased contraction in muscles, decreased viscosity in the serum surrounding the fascia, and/or hypersensitization of the nerves — all of which have an effect on overall tissue vitality in an area and can lead to degeneration, injury and illness.

Osteopathy is divided into three major areas: structural manipulation, visceral manipulation, and cranial sacral manipulation. An osteopathic manual manipulation treatment (OMM) that includes all three of these pillars of therapy is considered the most effective.

In cancer patients, structural and visceral manipulation may be limited because of risks associated with metastasis. Many cancer patients (animal and human) suffer side effects associated with cancer therapies while also requiring the best functioning immune system possible. CST can be a great tool to both reduce the side effects of conventional therapies and support the overall health of the immune system. Studies have shown that even a single osteopathic session can dampen the acute stress response in healthy individuals by affecting the autonomic and neuroendocrine response, lowering cortisol and decreasing the sympathetic response. CST can result in less muscle contraction and cramping, reduced drying out of fascia, and less congestion in the periphery, allowing the body’s responses to be directed more towards digestion and healing.

A retrospective look at the use of OMM for inflammatory bowel disease in 2014 showed positive outcomes in treating irritable bowel syndrome, another common sequelae to many cancer treatments. Other research has shown a direct effect on cerebral tissue oxygenation and on migraine headaches thanks to cranial sacral osteopathic techniques. Applying this research to animals demonstrates how we can provide optimal palliative care, minimizing side effects and pain and boosting overall immunity, with the help of osteopathic therapies, including cranial sacral techniques.

Cranial sacral therapy was first discussed by Dr. William Sutherland in the early 1900s. He published the first explanation of his theories during the 1940s in The Cranial Bowl, in which he explained the anatomy of the human skull. He felt a palpable “filling” and “emptying” motion of the skull that seemed to occur regularly, eight to 12 times per minute, in human beings. He was able to use light manual therapeutic techniques to influence and decrease asymmetries in this movement. Since then, John Upledger, John Martin Littlejohn, and recently, Tad Wanveer in his book Brain Stars, have added to our understanding of cranial sacral therapy.

The motion that can be felt in the skull has been called the Primary Respiratory Mechanism (PRM) or the Cranial Rhythmic Impulse (CRI). Using Doppler, a measurement was made to compare CRI to the Traube-Hering-Mayer oscillation, the cyclical change in arterial blood pressure, and it appears to be measurable and similar. Further study using Doppler flow was able to show a statistically significant lowering of frequency following cranial sacral manipulation. The authors of the research proposed that cranial sacral therapy affected the autonomic nervous system and lowered blood flow, since the low frequency oscillations associated with the Traube Hering Mayer oscillation appear to be associated with the autonomic nervous system as well. A recent study in veterans showed that osteopathic therapy consisting of visceral, neural and cranial manipulation improved visual and motor accuracy, increased range of motion, decreased pain and improved sleep patterns.

Treating the horse with cranial sacral osteopathy

As an equine veterinarian, I am keen to apply the same principles to my patients. I see many horses presenting with traumatic injuries affecting the head, jaw or first few cervical vertebrae. I am sure the same can be seen in small animal practice. Cranial sacral therapy in these cases may help decrease pain, improve overall range of motion, and possibly change the behavior of the animal when responding to requests from his owner or trainer. In addition, CST may decrease terrain and improve vitality of the overall body.

In equine practice, our exposure to cancer is somewhat minimal, primarily involving skin tumors, benign hypoplasia of the pituitary gland, and occasionally lymphoma. Treating these would include minimal structural work near the tumor, along with CST.

A review of anatomy: paired, unpaired and sutures

The equine skull is made up of paired (parietal, temporal, frontal) and unpaired (occipital, sphenoid, ethmoid) bones; paired bones should move together in synchrony. The portion of the skull surrounding the brain is the the most important, but all the bones will be mobile, and a restriction in a suture between any two bones can cause asymmetry. The smallest restriction is often the one causing the largest problem. The most important of these for motion is the joint between the occipital bone and sphenoid bone on the base of the skull, the spheno-basilar synchondrosis, or SSB. There are many other bones in the skull that can indirectly affect the mobility of the brain case: the unpaired vomer bone at the level of the nasal septum, and the paired maxillary, incisive, pterygoid, palatine, lacrimal, zygomatic, and nasal bones and mandibles. The hyoid cartilages also play a role in the mobility of the skull and cervical spine.

The most common areas affected in horses are the temporal bones, occipital bones, parietal bones and mandibles. When a restriction is found in a suture between two bones, it is usually corrected using a distraction or spread technique to open up the area and decrease tension at the level of the suture line. Depending on the angle of the suture, this can be directly or indirectly applied, possibly in one to two different directions.

An example of an easy one-direction suture that can be manipulated would be the lacrimal suture between the lacrimal bone and maxillary bone. If a horse has mild ocular discharge that necessitates flushing of the lacrimal duct, a distraction of the lacrimal suture could help to open up the duct within the sinus cavity, yielding improved drainage from the eye into the lacrimal duct, and through the duct to the nasal opening at the level of the nostril.

A more complicated suture to release is the squamous suture, lying between the parietal and temporal bone. This suture has a slanted joint. In order to mobilize it, the parietal bone must be manipulated medially and then dorsally to release it, using a squeezing and lifting motion instead of a simple spreading of the suture.

Animal-specific considerations

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

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

In conclusion, cranial sacral therapy can be a relaxing and easy way to start your therapy on any animal, and can be helpful in cases where structural or visceral work could be dangerous (in the case of metastasis) or too intense (in the older, debilitated patient). It can also be a great way to help with very young animals, in whom light touch is likely to be safer. It can be effective in cases of trauma to the head, including concussive force injuries.  More research needs to be done in humans to assess efficacy for other symptoms and diseases, and since very little research in clinical veterinary medicine has been published, similar studies need to be conducted in veterinary circles.

References

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

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

Wanveer, Tad, “Brain Stars: Glia illuminating craniosacral therapy”.  Upledger Productions, 2015.

Sergueef N, Nelson, KE, Glonek T. “The effect of cranial manipulation on the Traube-Hering-Mayer oscillation as measured by laser-Doppler flowmetry.” Altern Ther Health Med, 2002 Nov-Dec;8 (6); 74-76.

Nelson KE, Sergueef N. Lipinski CM. Chapman AR, T. Glonek. “Cranial rhythmic impulse related to the Traube-Hering-Mayer oscillation: comparing laser-Doppler flowmetry and palpation.” JAOA, 2001 mar;101 (3); 163 -173.

Shi X. Rehrer S, Prajapati P, Stoll ST, Gamber RG, HF Downey. “Effect of cranial osteopathic manipulative medicine on cerebral tissue oxygenation.”  JAOA, 2011;111 (12); 660-666.

Christine DC. “Temporal bone misalignment and motion asymmetry as a cause of vertigo: the craniosacral model.” Altern Ther Health Med, 2009 Nov-Dec;15 (6); 38-42.

Downey Pa, Barbano T,  Kapur-Wadhwa R, Sciote JJ, Siegel MI, MP Mooney.  “Craniosacral therapy: the effects of cranial manipulation on intracranial pressure and cranial bone movement.” J Orthop Sports Phys Ther. 2006 Nov;36(11); 845-853.

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

Vluggen, Janek, DO, MRO-EU, EDO. Cranial Sacral Osteopathy. November 2010.

Budras, Klaus-Dieter, WO Sack, Sabine Rock.  Anatomy of the Horse, Schlutersche Verlagsgesellschaft mbH and Co. 2009.

Herbs and superfoods: a way to naturally detox the body

An increase in toxins within the body can weaken immune systems in animals, so providing them with naturally occurring vitamins and minerals is an important step in ensuring their health and longevity.

Dogs and cats are susceptible to hidden (or visible) toxins that can build up over time to create an overburdening for the eliminatory organs.  When the organs become overburdened and are no longer able to function efficiently, the skin – being the largest organ of elimination – can become a sign of a deeper issue and a need to detox the body.

How toxins affect overall health

As we know, homeostasis is the ability of the body to maintain balance.  Toxins disturb the natural flow of homeostasis forcing the immune system to defend against them, creating imbalance and dis-ease while damaging the microbiome.

A healthy immune system that is not overloaded with toxins can fight this off at first sign, but a weakened immune system due to a heavy load of toxins cannot eliminate them as nature intends, therefore, presenting varying symptoms.

When the body receives the right balance of minerals, trace minerals and vitamins to nourish the liver enzymes, it functions well and is able to eliminate or process the toxins.  Unfortunately, much of the pet food available, some vaccines, and chemicals contain heavy metals like mercury, creating an environment that hinders the normal structure and function of the liver and kidneys. Older animals are more susceptible to the burden of toxins and heavy metals but their overall health can benefit greatly by cleansing the blood, organs, lymphatic, and neurological systems, giving them a new lease on life.

There are many other toxins that wreak havoc on the neurological and lymphatic systems that can be safely removed with organic herbs and superfoods in a short period of time.

Protect and rebuild

Below is a list of herbs and superfoods that are game-changers for pet health and longevity.  They nourish the body with minerals, trace minerals and vitamins for optimal function by, naturally detoxifying and strengthening the organs, blood, GI tract, lymphatic and neurological systems, creating homeostasis.

Bladderwrack

Bladderwrack cleanses the digestive tract. A primary source of alginic acid, it binds with heavy metals that may be found in the intestines, such as barium, cadmium, lead, mercury, zinc, and even radioactive strontium. These metals will not be absorbed by the body when alginic acid is present, thus helping to bind and draw out toxins stored in the body.

Schisandra Berry

Schisandra Berry contains about 40 lignans and enhances glutathione production in the liver, a very important cellular antioxidant that helps rid the body of heavy metals and other toxins. This very unique adaptogen has an affinity not only for cleansing, protecting and strengthening the liver but also the central nervous system which is vital when neurotoxins are present.

Broccoli Sprouts

Broccoli Sprouts support all phases of detox including activating, neutralizing, and eliminating contaminants. They are high in vitamin C and antioxidants that help detox enzymes in the GI tract, and support all detox processes, i.e., activation, neutralization and elimination of contaminants.

Dandelion

Dandelion (leaf & root) is a powerhouse of essential nutrients. It contains manganese, vitamins A, C, K, E, folate, zinc, potassium and selenium, along with antioxidants for cleansing the digestive tract, urinary tract, and the kidneys.

Calcium Bentonite

Calcium Bentonite performs like a magnet in the body by absorbing and pulling toxins from the digestive tract out of the intestines, stomach, and colon. Important minerals in Calcium Bentonite include copper, iron, magnesium, silica, and potassium.

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Kiiko Matsuomoto Style – a unique approach to back pain in dogs and cats

Persistent back pain in your patient? Try Kiiko Matsuomoto Style, a modern twist on an ancient Japanese technique.

Often in an initial appointment, new clients recount how their companion responded well to treatment for a specific problem (ranging from osteoarthritis to bladder stones), but they still seem “off”. Clinical parameters like range of motion are improved, but elusive discomfort lingers. Often I’ll note an exaggerated Panniculus reflex (especially over the mid-back), regional or multiple sights of tight skin that is uncomfortable when touched down the spine, and tension, taught bands, and spasm in grouped muscles. If the problem is hard to localize and patients are too uncomfortable to examine without creating terror (or in cats, fury) what’s one to do?  I’ve found an incredibly well-tolerated and effective approach for this clinical presentation to try – Kiiko Matsuomoto Style.

Kiiko Matsuomoto Style (or KMS) is a palpation-based acupuncture system developed by Kiiko Matsumoto that draws on her training with Japanese Masters and incorporates other systems. Japan, Korea, Taiwan, and China each have unique acupuncture styles that originated from Chinese Medicine but evolved into distinct forms, reflecting the culture and history of the region. Japanese style relies heavily on palpation, prioritizes patient comfort, and utilizes fine needles with a shallow insertion. The needle guide tube commonly used today was invented in Japan during the Edo Period (17th–19th Centuries). With the emphasis on tactile skills, blind students were encouraged to become acupuncturists, and many of the great Japanese masters of acupuncture were blind. In fact, it’s estimated that 20–40% of acupuncturists in contemporary Japan are blind.

In Kiiko Matsuomoto Style, the order of examination and treatment are precise and begins with abdominal palpation (Hara Diagnosis) and then to other regions. In each area, specific acupuncture points called “reflex zones” are palpated in sequence and when any abnormality (pressure, pain, taut bands, etc.) is felt, digital pressure is applied to a specific acupuncture release point(s) using the practitioner’s other hand. The finger pressing the release point is moved very slightly in different orientations until the abnormality disappears. There is great overlap with many of the KMS concepts and current research on the connection of myofascial planes.

I frequently use the “I-Hi-Kon” treatment from this system, named for the abbreviated first letters of the Japanese acupoints used. Singly, each point serves as a release for a specific location on the spine, and together they can treat the entire back (see image below):

  1. Bladder 40 (BL40 “I-Chu”) is in the center of the popliteal crease behind the stifle (red circle). It is the release point for the spine at the level of the L2-3 intervertebral space (red circle).
  2. Bladder 60 (BL60 “Kon-Ron”) is in the depression between the lateral malleolus and calcaneous, level with the tip of the lateral malleolus (blue circle). It is the release point for the occiput (blue circle).
  3. Bladder 58 (BL58 “Hi-Yo”) is found halfway between a line drawn between BL40 and BL60 (green circle). It is a release for the T7-8 intervertebral space (green circle).

The I-Hi-Kon treatment can be applied in many ways. If there is discomfort or twitching along the back and the patient is reluctant to let you work on the area directly, you can use acupuncture, LASER, moxibustion, or massage to release discomfort. In Kiiko style, palpate along the back and when an area of pain or dysfunction is found, use the other hand to apply digital pressure on the ipsilateral I-Hi-Kon point with the closest reflection to the abnormal area. Continue palpation of the back as you slightly change the finger orientation on the release point until palpation changes noted resolve. Needle, LASER, or moxibustion the location on the I-Hi-Kon line that normalizes palpation, and then treat the back using your preferred modality. If the abnormal area on palpation is caudal to L2-3, walk your digital pressure along that same Bladder line dorsally (nestled between the hamstring muscles) until you find the point that normalizes palpation. Treat the release point on the limb first and then treat the back.

There are myriad releases for other regions of the body in this system. It is well-tolerated, provides immediate feedback, and is supported by cutting edge science while maintaining its traditional roots.

Select References

Kobayashi A. et al. History and progress of Japanese acupuncture. Evid Based Complement Alternat Med. 2010;7(3):359–365.

Krause F et al. Intermuscular force transmission along myofascial chains: a systematic review. J Anat  2016; 228(6):910-8.

Matsumoto K and Euler D. Kiiko Matsumoto’s Clinical Strategies: In the Spirit of Master Nagano, Vols. 1 and 2. Massachusetts: Kiiko Matsumoto International, 2008.

Wilke J et al. What Is Evidence-Based About Myofascial Chains: A Systematic Review. Arch Phys Med Rehabil. 2016 Mar;97(3):454-61.

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