Friday, August 14, 2020
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Herb-Drug Interactions

Holistic practitioners are often confronted with difficult decisions regarding which treatments to use for complicated cases. It’s not uncommon to manage a pet taking multiple medications, herbal products and supplements – but how concerned should we be about potential interactions between all these substances?

Unfortunately, the literature can be confusing or even contradictory. This is due to the way adverse interactions are reported. Individual case reports can detail a specific case of suspected interaction. Clinical trials, in which the number of drugs and herbs combined are more closely controlled, may demonstrate adverse interactions. Experimental data and pharmacodynamics studies may also suggest potential interactions, at least theoretically. However, these various sources of information frequently contradict each other and can make it difficult for clinicians to know what is best when treating patients.

Herbal pharmacodynamics
Many drugs are metabolized in the liver and intestines via the cytochrome P450 enzyme pathway. Several enzymes are involved, including CYP2C19 and CYP2E1. Herbs and their metabolites are increasingly being discovered to modulate this pathway.1 Some herbs have also been shown to have different effects depending on the dosage. St. John’s wort can induce CYP2C19 at low concentrations but inhibit it at higher concentrations. Further problems arise with the lack of consistency in the preparation and quantities of active ingredients in herbal products from different vendors. Thus, the pharmacodynamic effect of any given preparation may be difficult to anticipate.

Many physicians and scientists are concerned about the effect herbs may have on drug metabolism and serum levels of certain frequently prescribed drugs. Induction of the cytochrome metabolism system may hasten metabolism and decrease a drug’s efficacy, while inhibition may result in high blood levels and toxicity.

Herbs that have been investigated for their effects on various cytochrome P450 pathway enzymes include Echinacea, garlic, ginkgo, ginseng, St. John’s wort and valerian, all of which have been found to have effects on one or several enzymes.

Garlic (Allium sativum)
This is a commonly used herb for hypercholesterolemia and prevention of arteriosclerosis in humans. In animals, it has been recommended as a treatment for cough, respiratory infections and hyperlipidemia and as an adjunct treatment for cancer for its antitumor and cytotoxic effects.

Many physicians recommend caution when taking this herb because of reports that garlic may infl uence platelet function and blood coagulation. There are also reports of possible interactions with anti-coagulants, especially warfarin. Two trials, however, demonstrated no change in pharmacokinetics or pharmacodynamics when garlic was combined with warfarin, suggesting that adequately monitored patients taking warfarin can safely take garlic.2,3

One case report described a possible interaction with chlorpropamide (sulfonylurea treatment for type 2 diabetes) and garlic in a diabetic patient who ate a curry containing garlic and karela.4 The report documented a decrease in the patient’s blood glucose level after eating the curry, but the hypoglycemic effect may have been the result of the additive effect of the two herbs. Additionally, one report may be insufficient to prove a causal relationship.

Garlic’s demonstrated effects on CYP2E1 do warrant caution when using it in combination with drugs metabolized by this enzyme.5 These drugs include theophylline, isofl urane and sevofl urane. Potential interactions with anti-coagulants remain questionable.

Ginkgo (Ginkgo biloba)
Herbalists commonly prescribe gingko for memory deficits and peripheral vascular disease in people. Indications for animals include treatment for cognitive dysfunction and cardiac disease in which hypercoagulability is a concern. Case reports have previously shown interactions between ginkgo and anticoagulant drugs or those with effects on platelets (such as aspirin and other NSAIDs).5 The patients experienced bleeding while concurrently taking these drugs and gingko. Recent trials have been unable to confi rm these effects when ginkgo was combined with several NSAIDs, thus it is questionable as to whether there is any true risk.5 Ginkgo may interfere with the CYP2C19 dependent pathway, thus altering drug metabolism of CYP2C19 substrates. There is one case report of an epileptic patient who experienced fatal seizures while taking valproic acid and phenytoin as well as several herbal supplements, including ginkgo.6 The patient’s serum concentration was found to be sub-therapeutic for both drugs, and interference of metabolism of the drugs from ginkgo was suspected. Because of this potential alteration of metabolism, care should be taken when combining ginkgo with any CYP2C19 substrate, which includes antidepressants, anticonvulsants (phenobarbital), propranolol and proton pump inhibitors (omeprazole).5 Asian ginseng (Panax ginseng) This is a frequently prescribed herb because it has many indications, including cancer prevention and improved mental and physical performance. Veterinary indications are numerous as well, including immune support, recovery from stress or illness, cancer prevention or adjunct treatment for cancer, and treatment for allergies (allergic skin disease) or brain injury. Ginseng has been shown to inhibit platelet aggregation, though one report demonstrated a patient taking warfarin with ginseng had a lowered international normalized ratio (INR).5 The INR is a measure of coagulation, and in this case, the patient’s lowered number demonstrated interference with anti-coagulation. This patient took several drugs concomitantly with ginseng, therefore, causation was not definitive. Further studies have been unable to confirm any interaction with warfarin. At this time, caution is warranted when combining ginseng with drugs known to have platelet effects, but there is no evidence that precludes the combination.

One report described a patient who co-administered the drug phenelzine (a MAOI class antidepressant) and ginseng.7 This patient experienced insomnia, headache and mania. In this case, causality was established after the patient inadvertently rechallenged herself, resulting in many of the same symptoms. While this may be an isolated case with a patient who has a particular sensitivity, clinicians should still be cautious when considering the combination of MAOIs, specifi cally phenelzine, with ginseng. Licorice (Glycyrrhiza glabra) Licorice is a common ingredient in many Chinese herbal formulas and a popular fl avoring for candy. Indications for humans include treatment for cough, bronchitis and gastric ulceration. Veterinary uses are very similar. Licorice has also been advocated as a treatment for Addison’s disease or to augment steroid treatment. In many Chinese herbal formulas, it is included as a harmonizing herb. A recent study demonstrated that co-administration of licorice with cortisone acetate in patients with Addison’s disease increased the serum levels of cortisol for several hours.8 Another study demonstrated elevated salivary levels of both dehydroepiandrosterone (DHEA) and deoxycorticosterone in healthy subjects given a confectionary containing licorice for one week.9 These reports

demonstrate licorice’s ability to alter circulating levels of several steroid precursors, and substantiate the claims that licorice has steroid-augmenting effects. As a result, licorice should be used judiciously with exogenous steroids. Valerian (Valeriana offi cinalis) People commonly take valerian to help with insomnia and anxiety. Pets with nervous or anxious behaviors are prescribed this herb, and valerian has also been recommended as an adjunct treatment for epilepsy. Valerian metabolites have been shown to modulate gamma-aminobutyric acid (GABA) receptors in rat brain stems.10 While there are no reports of interactions, it is suspected that valerian may potentiate the effect of certain sedatives and anesthetic agents. Benzodiazepines, such as valium and Xanax, are frequently used in veterinary behavior management, and concurrent use with valerian may result in increased sedation. Use before surgical procedures may cause unanticipated complications with anesthetic agents that utilize the GABA-ergic pathway.11 Caution should be used when combining valerian with any sedative or anxiolytic, and valerian usage should be stopped before any anesthetic procedure. More investigation on drug-herb interactions is needed at this time. While pharmacodynamic evidence has shown theoretical interactions, there is little evidence of these interactions occurring at the clinical level. This may be due to a lack of actual interaction or a lack of recognizing or reporting interactions. Case reports detailing potential herb-drug interactions do exist, but it is often diffi cult to fi rmly establish causation of the symptoms with herb-drug interaction.

Cognitive Disorder

Cognitive disorder (dog and cat Alzheimer’s) is the most common chronic degenerative neurological disorder affecting older pets. While the exact incidence is not known, it is estimated that 25% to 30% of dogs and cats begin showing signs of cognitive disorder by age 11 and that 50% to 100% show signs by 15 to 16 years of age. Clearly, regardless of the true incidence, most practitioners will diagnose and treat this problem in a large number of their senior patients. This article will review some of the more commonly recommended natural and conventional therapies for cognitive disorder.

Cause is unknown

As with Alzheimer’s disease, the exact cause of cognitive disorder is unknown. As pets age, their brains may receive less oxygen hypoxic due to decreased cardiac (heart) output, anemia, hypertension (high blood pressure) and arteriosclerosis from fibrosis, endothelial proliferation, mineralization, and amyloid deposition. Decreased levels of neurotransmitters including serotonin and choline, increased levels of monoamine oxidase B (MAOB) which causes decreased dopamine levels, and increased free radicals (oxidizing chemicals that damage and kill cells through inflammation) may also be seen in geriatric pets.

Microscopically, beta amyloid plaques within the brain and its blood vessels are seen in pets with cognitive disorder (as in people with Alzheimer’s). These plaques are a hallmark of the brain damage that occurs in both Alzheimer’s and cognitive disorder.

All these biochemical and pathological changes progress as the pet ages if treatment does not occur. Obviously, early treatment is important and may prevent progression of cognitive disorder.

Clinical signs vary
Clinical signs in dogs and cats can vary between pets and the severity of the disease, but are generally often mistaken for “normal signs of aging” or attributed to the pet “acting senile”. In general, clinical signs include the following:
* Staring at the wall
* Lack of awareness of surroundings
* Occasional lack of recognition of the owner
* Lethargy/lack of energy
* Excess sleep (especially during the day)
* House-training problems (usually urinating inside the house or eliminating outside the litterbox)
* Deafness

Diagnosis based on exclusion
There is no specific diagnostic test (other than postmortem brain biopsy) for cognitive disorder. Diagnosis is based upon clinical signs and laboratory testing to exclude other disorders that might cause similar signs (hypo/hyperthyroidism, adrenal disease, etc.).

Alternative therapies
A number of natural therapies have been recommended for treating cognitive disorder in pets, including Omega-3 fatty acids (fish oil), antioxidants (vitamin C and E, resveratrol), herbs (such as ginkgo biloba) and nutritional supplements (including SAMe, phosphatidylserine and phosphatidylcholine). Since it is beyond the scope of this article to have an in-depth discussion of each therapy, I will focus on two that have been well researched.

1. SAMe (Novifit, Virbac) SAMe is formed in the body (mainly in the liver) through the combination of methionine with adenosyl-triphosphate, and is not supplied in the diet. SAMe functions as a methyl donor in the formation of a variety of compounds (neurotransmitters, proteins, membrane phospholipids, nucleic acids, choline, etc.) and increases levels of serotonin and dopamine metabolites, improves neuron membrane fluidity, and enhances binding of neurotransmitters to receptors.

Levels of SAMe decline sharply after birth and continue to decline as part of the aging process. While generally safe, SAMe contraindications in people include bipolar disorder, migraine headaches, Parkinson’s disease, and active bleeding.

Co-administration of SAMe and SSRI medications, MAO inhibitors, 5-HTP and TCAs requires caution or avoidance as some patients may be at risk for a higher incidence of serotonin syndrome and/or synergistic CNS depressant effects.

No direct contraindications are noted in pets but prudence suggests similar caution.

Recently, a SAMe product (Novifit, Virbac) has been introduced to the market as a natural treatment for canine and feline cognitive disorder. Studies in dogs (n=14) and cats (n=16) showed improvement in reversal learning in treated patients when compared with non-treated patients. Reversal learning is a memory test that measures executive function, which is defined as a set of mental processes that help connect past experience with present action, and is needed for goal-directed behavior. Executive function has been shown to be impaired by age.

Researchers concluded that the study supported the use of Novifit to help improve cognitive health in aged dogs and cats, with potential benefits on executive function, especially in the early stages of cognitive dysfunction syndrome. 2. Phosphatidylcholine (Cholodin, MVP Laboratories) Choline is a component of several major phospholipids (including phosphatidylcholine and sphingomyelin) that are critical for normal cell membrane structure and function. The body uses choline to maintain water balance; as a source of methyl-groups (for methionine formation) to control cell growth and gene expression; as a component of surfactant; and to produce acetylcholine. Supplemental choline may increase the production of acetylcholine and reverse clinical signs of cognitive disorder.

Choline supplementation is very safe. In pets, rare instances of excitability/nervousness have been reported, but lowering the dosage resolved this side effect.

It has been suggested that aging people and pets begin to lose cholinergic receptors and have decreased levels of acetylcholine. Since oral choline administration increases plasma choline levels, and since brain levels of acetylcholine increase as plasma choline levels increase, administering choline may improve neurological disorders that result from decreased acetylcholine.

Choline, specifically the patented product Cholodin (MVP Laboratories), has been shown in studies to reverse clinical signs of cognitive disorder. For the dog study, 21 dogs of various breeds ten years of age and older were enrolled. For the cat study, 21 cats ten years of age and older were also enrolled. Pets were chosen for the study based on owner observation of clinical signs consistent with cognitive disorder that couldn’t be attributed to other illness after physical examination and laboratory testing. At the conclusion of the study (two months following treatment), owners were asked to evaluate improvement in clinical signs: 82% of dogs showed improvement as did 77% of cats.

Regardless of the treatment chosen, early diagnosis and intervention is key to minimizing the incidence of cognitive disorder in pets. Regular “senior pet” checkups that include a full physical examination, blood profile, urinalysis, and microscopic fecal analysis, ideally every six to 12 months for pets five years of age and older, will facilitate communication and allow for early diagnosis.

References and suggested reading
Araujo JA, Faubert ML, Brooks ML, Landsberg GM, Lobprise H. NOVIFIT® (NoviSAMe®) Tablets Improve Executive Function in Aged Dogs and Cats: Implications for Treatment of Cognitive Dysfunction Syndrome. Intern J Appl Res Vet Med. 2012.Vol 10(1): 90-98. Fetrow CW, Avila J. Professional’s handbook of complementary and alternative medicines, 3rd ed. St. Philadelphia (PA): Lippincott Williams & Wilkins: 2004:730–58.Goldstein, R, ed. Integrating complementary medicine into veterinary practice. St. Louis (MO): Wiley-Blackwell; 2008:541. Hand M, Thatcher C, Remillard R, et al. Small animal clinical nutrition, 5th ed. Topeka (KS): Mark Morris Publishing; 2010:93–94. Landsberg G, Denenberg S, Araujo J. Cognitive Dysfunction in Cats: A syndrome we used to dismiss as “old age”. 2010 J Fel Med Surg. 12: 837-848. Messonnier SP. The natural health bible for dogs & cats: your A-Z guide to over 200 herbs, vitamins, and supplements, Three Rivers Press, NY, 2001:56–57, 233. Messonnier SP. Natural Care for Aging Pets, Today’s Health and Wellness – July/August 2001 (pgs. 20,21). Pizzorno J, Murray M. Textbook of natural medicine, 3rd ed. St. Louis (MO): Churchill Livingstone; 2005:817, 853, 856, 135-1238, 1603, 1654. Pizzorno J, Murray M, Joiner-Bey H. The clinician’s handbook of natural medicine, 2nd ed. St. Louis (MO): Churchill Livingstone; 2008:17, 20, 559–60. Ruehl WW, Hart BL: Canine Cognitive Dysfunction. In Psychopharmacology of Animal Behavior Disorders (Dodman NH, Schuster L, eds.). Boston: Blackwell Scientific, 1998; pp. 283-304. Stargrove M, Treasure J, McKee D. Herb, nutrient, and drug interactions: clinical implications and therapeutic strategies. St. Louis (MO): Mosby Elsevier; 2008:824–1. Wynn S, Marsden S. Manual of natural veterinary medicine: science and tradition. St. Louis (MO): Mosby; 2003:323.

The Pros of Partial Spay

Spaying has become such a standard practice that many of us don’t give it a second thought. We know it’s absolutely necessity to help stem pet overpopulation. In fact, spaying has been the key factor in reducing the number of euthanized dogs and cats from 23.4 million in 1970 to just under 3 million now. But what if you could offer your clients a way to maintain that progress, while honoring your commitment to do what is best for each patient’s health?

Thought leaders are beginning to accept that spay and neuter have both positive and negative health consequences that vary by age, gender and breed. In 2007, veterinarian Dr. Margaret Root Kustritz published a review of the pros and cons of spaying and neutering at different ages (“Determining the optimal age for gonadectomy of dogs and cats”, JAVMA). That same year, a review paper entitled “Long-Term Health Risks and Benefits Associated with Spay/Neuter in Dogs” (Sanborn LJ, available online) gathered the data and summarized it in a comprehensible form.

Implications for large breeds

The conclusion? Mounting evidence indicates that in large dogs at least, the health benefits of keeping the ovaries may outweigh the health risks, which include mammary tumors and infection of the uterus. For example, removing the ovaries of a Rottweiler quadruples her risk of bone cancer — spayed Rottweilers have a frighteningly high one in four risk of osteosarcoma. Spaying also raises her risk of hemangiosarcoma to 10% to 20%. In addition, traditional spay impacts quality of life issues. The loss of ovarian hormones increases the risk of CCL tears, incontinence, and an obsession with food that can lead to weight gain.

As a result, informed pet owners are beginning to question or resist spay surgery. Those adopting breeds known to have greater risk of certain problems after spay may be in this category (for example, boxers nearly always get incontinence, and giant breeds are prone to bone cancers). This is a distressing development for shelters, which fear a renewed increased in the overpopulation and euthanasia rates formerly curtailed by spay/neuter operations.

The Parsemus Foundation, a non-profit that promotes evidence-based medicine and choice for animal health, is proposing that we all think more creatively about individualizing spay operations. In the situations mentioned above, veterinarians should be prepared to remove the dog’s uterus and leave the ovaries in a procedure that’s sometimes called “partial spay.”

Remove the uterus, leave the ovaries

Removing the uterus eliminates the nuisance of bleeding during heats, along with the risk of infection of the uterus (pyometra), as long as all the uterus is removed. However, precise technique is essential. In traditional spay, there is no need to remove every bit of the uterus, since it will no longer be under stimulation by the ovaries. But in partial spay, also known as ovary-sparing spay, the veterinarian must make a large enough incision to pull the uterus up to the surface, see what he/she is doing, and be able to tie off and cut precisely at the cervix rather than just anywhere on the uterus. Otherwise, it is still possible to have an infection develop in the remaining uterine stump (“stump pyometra”). With this technique, the risk of stump pyometra is eliminated.

If the whole uterus is removed, mammary tumors are the only significant health risk remaining from a partial spay. Ovarian cancer is rare enough that the ovaries should not be removed just to try to prevent it. Clients who feel their dogs are likely to live longer or stay healthier by retaining their ovaries can then be informed of the pros and cons, and advised to stay alert to the possibility of mammary tumors as their dogs age.

A video demonstration

The Parsemus Foundation has funded a demonstration of ovary-sparing spay by Dr. Michelle Kutzler, a professor of veterinary medicine at Oregon State University and an acknowledged expert and speaker on dog and cat contraceptive advances and reproduction. In the video on the foundation’s website (parsemusfoundation.org), Dr. Kutzler demonstrates ovary-sparing spay in a six-year-old mastiff who was finished breeding but whose owner was concerned about her increased risk of bone cancer and cruciate ligament rupture from traditional ovariohysterectomy spay.

As Dr. Kutzler demonstrates in the video, the cervix must be ligated precisely — one cannot ligate just anywhere on the uterus as is normally done — to prevent the risk of stump pyometra. This fine point is what has kept ovary-sparing spay from being considered a widespread option. Dr. Kutzler points out that the solution lies in taking extra care with ligation placement. Her slightly larger incision allows her to visualize the area and take this extra care.

Benefits for veterinary practice

  • Owners with the economic means may even wish to have a mammary-gland ultrasound as part of their dogs’ annual exams once the animals reach middle age; veterinarians who are skilled with ultrasound should be pleased at the opportunity to offer this new service using existing equipment. Meanwhile, population goals are also achieved, because a dog will not be fertile without a uterus.
  • The procedure takes slightly longer than high-volume spay, because the cervix must be cut and tied off precisely and a larger incision must be made to see what one is doing. More suture time is involved. In compensation, veterinarians offering this option will be able to both meet the needs of a highly-informed group of clients, and distinguish their value-added services from high-volume discount spay.
  • Currently, only three veterinarians in the United States are offering ovary-sparing spay. This means that those who learn the procedure will likely be able to command a substantial premium, with new clients willing to travel a significant distance to obtain the procedure for their dogs.
  • The Parsemus Foundation has begun a list on its website of veterinarians performing hysterectomy (ovary-sparing spay) as an alternative to ovariohysterectomy. Veterinarians who learn the technique from the demonstration video (see additional sidebar for more info) and decide to add it to their services can contact the foundation to be included on this list [callout] …removing the ovaries of a Rottweiler quadruples her risk of bone cancer — spayed Rottweilers have a frighteningly high one in four risk of osteosarcoma. Elaine Lissner is director of the San Francisco-based Parsemus Foundation, which works to advance innovative and neglected medical research. The foundation’s focus is on supporting small proof-of-concept studies and then pursuing press coverage of the results, so that advances change treatment practice rather than disappearing into the scientific literature. In addition to providing a training video for ovary-sparing spay, the foundation is also working to raise the level of evidence on calcium chloride nonsurgical male dog and cat sterilization, so veterinarians can make an informed decision on best practices and potential risks. The foundation’s work has been featured in WIRED, BBC News, Scientific American, and The Wall Street Journal.

For individuals seeking a veterinarian to perform procedures beyond surgical spay or neuter, view a list of providers here.

Parsemus Foundation (Bottom Banner)

Assessing and Monitoring CKD

Chronic kidney disease (CKD) is now the most common problem seen in older feline patients. It is less common in dogs, but we are nevertheless seeing it more often as our patients live longer. The causes are unknown, but some possible contributors include excessive vaccination, chronic infections and/or highly concentrated urine.

The early signs of CKD are subtle and rarely noticed by owners. They include slow weight loss with a mild increase in drinking and urine volumes as the serum creatinine climbs above 140 mMol/L = 1.5 mg/dL. Veterinary diagnosis is made when accurate body weight decreases and blood tests are done.

Assessing CKD

Assessing this disease includes:

• Kidney excretion capacity by measuring Glomerular Filtration Rate (GFR) — serum creatinine
• Secondary Renal Hyperparathyroidism — serum calcium (Ca) and phosphorus (P)
• Kidney potassium (K) tubular loss — Serum K
• Erythropoietin production — Packed Cell Volume (PCV) or hematocrit
• Renal protein loss — urine protein:creatinine ratio (UPC)
• Hypertension — blood pressure (BP)
• Thyroid function status in cats – T4

The tests required for adequate assessment of renal function:

1. Thorough history (owner observations) and physical examination 2. Body weight and Body Condition Score — cats and dogs under 10 kg = 22 lb need to be weighed on a paediatric/baby/cat scale, not on adult bathroom scales or walk-on dog scales. Reliable human baby scales are available online for less than $70. All patients should be weighed at every vet visit, and the weight recorded in their files. 3. Complete blood count, CBC 4. Serum chemistry, with T4 in the cat 5. Urinalysis including culture and sensitivity (C&S) and UPC 6. Blood pressure

Normal urine results: Urine specific gravity > 1.030 in dogs (first morning sample) Urine specific gravity > 1.030 in cats, if their eating canned food without water added Urine protein negative UPC < 0.2 Urine C&S negative

Normal BP arterial/systolic < 160 mm Hg. This includes the “white coat” effect but BP should be done first with the owner present and the patient not “freaking out”.

What happened to urea?

Serum urea or nitrogen levels are influenced by many factors, making urea an unreliable indicator of kidney function. Some of these factors include:

• Amount of protein eaten (important)
• Time since eating
• Degree of protein digested to amino acids
• Proportion of protein absorbed
• Level of intestinal bacteria
• Liver function (the most important factor)
• Protein loss through the skin, intestines and/or urinary tract
• Catabolic processes occurring within the body, such as infection or cancer

Urea is non-toxic, water soluble and has a neutral pH. It is a poor indicator of GFR. At best it is a minor indicator of seriously decreased liver function.

IRIS staging

Thanks to the International Renal Interest Society (IRIS, iris-kidney.com), we now have better diagnostic and staging information. IRIS is composed of leading international veterinary nephrologists, and has made evaluating, interpreting and monitoring CKD much clearer with their evidence-based stages and recommendations.

Stage and clinical signs Test results Stage 1 — Asymptomatic Creatinine < 140 = 1.5 depending on dog muscle mass; other evidence of kidney disease, e.g. ultrasound Stage 2 — Mild PU/PD Decreased appetite Creatinine in dogs 125 – 180 = 1.4 – 2.0 depending on size, diet and muscle mass Creatinine in cats 140 – 250 = 1.5 – 2.8 Potassium 3.5 – 5.0 Phosphorus < 2.0 = 6.0 Stage 3 — PU/PD Dehydration Decreased appetite Weight loss Constipation Creatinine in dogs 180 – 440 = 2.0 – 5.0 depending on size, diet and muscle mass Creatinine in cats 250 – 440 = 2.8 – 5.0 PCV < 20% Stage 4 Depressed Inappetent Vomiting and/or diarrhea Creatinine > 440 = 5.0

Monitoring CKD

The initial diagnosis of CKD is usually made when the dog or cat is losing weight for no apparent reason, and is based on a thorough history and physical examination. With a diagnosis of “weight loss of unknown cause”, pet owners and I elect to investigate further with CBC, chemistry (plus T4 in cats) and urinalysis.

Once the diagnosis is made (Dx CKD Stage 2 with no complications — no urinary tract infection, no proteinuria, no other disorders) we discuss nutrition and the importance of maintaining body weight by getting the animal to eat enough food that he likes. My recommendations for ongoing monitoring, as long as the patient is doing well, is to recheck and run selective blood tests every six months. My experience has pushed me to keep CKD patients eating and drinking with potassium levels above 4.5 mMol/L or mg/dL and phosphorus levels below – 2.0 mMol/L = 6.0 mg/dL. This seems to ensure appetite and activity. Our management and therapeutic aims are to maintain quality of life as well as activity and body weight. Below are the blood levels we aim to maintain:

Blood Test Dogs Cats Hematocrit or PCV > 39% > 25% Creatinine Stable or only slowly increasing Stable or only slowly increasing Potassium 4.0 – 5.0 mMol/L or mg/dL 4.0 – 5.0 mMol/L or mg/dL Phosphorus 0.9 – 1.5 mMol/L 2.8 – 4.7 mg/dL 0.9 – 1.5 mMol/L 2.8 – 4.7 mg/dL

Cats with CKD should be examined by a veterinarian every six months. Ideally, at that time, the following tests should be done: CBC, serum chemistry, T4, UA and BP. Minimal testing involves PCV and kidney panel (and T4 for cats). The kidney panel is available at some commercial laboratories (I only use commercial laboratories for my patients’ blood tests as I want the most accurate results available and they are quality controlled).

The kidney panel is financially advantageous as it includes urea (useless), creatinine, electrolytes (K is so important in cats), calcium and phosphorus. For my feline patients, I add T4. We do a PCV in clinic. The total price of blood collection, courier, lab fee and my interpretation over the phone is one I find owners are comfortable paying every six months. This is in addition to my half-hour consultation fee. Conversely, the price for the ideal of CBC, serum chemistry, T4 in cats, UA and BP is two-and-a-half times the kidney panel and is cost restrictive for most of my clients every six months.

Case studies

The progression of CKD is completely unpredictable. I used to think, based on my experience, that dogs with CKD died within three months and cats within three months to three years. No longer. Either we diagnose CKD much earlier or we enable them to live much longer. I think the latter is the case. Maintaining body weight is the key.

1. Zoe, a 16-year-old medium-sized border collie/Corgi cross was diagnosed with CKD Stage 2 six years ago. She has maintained her weight and active lifestyle on a home-prepared diet. She has not developed even mild anaemia although we are struggling to control her serum phosphorus. She is still going strong.

2. Most of my CKD cats live longer than five years but Tuesday was an exception. She was ten years old when she was first brought to me. She was already in CKD Stage 2 advanced. My therapeutic approach was to “feed her anything she will eat” use appetite stimulants, and control her low potassium, high phosphorus, constipation, hyperthyroidism and subcutaneous fluids. She lived happily for another 11 years and died at the ripe old age of 21.

3. Hendrix is a 13-year-old tabby cat in CKD Stage 2. He has always eaten enthusiastically and was maintaining his weight until one month ago. The owner had purchased a home baby scale and weighs Hendrix weekly. (As a practicing veterinarian in the real world of clients who love their pets but often have financial concerns, I encourage owners to monitor their cats’ progress by weighing them once a week on a baby scale. The cat’s weight and appetite, along with the owner’s assessment of how the pet is doing, are pretty reliable as to the status of the animal.) Four weeks ago, still eating very well, Hendrix’s weight started slowly decreasing. A phone call to us resulted in a simple recommendation: blood tests – CBC, serum chemistry, T4. We found the T4 had increased significantly from previous values; we can control hyperthyroidism.

In summary….

The diagnosis and staging of chronic kidney disease (which is relevant to management) requires a thorough history and physical examination, evaluation of the weight loss and body condition score of the patient, CBC, serum chemistry, urinalysis, blood pressure, and T4 in cats. Ideally, ongoing monitoring would involve repeating these tests at six-monthly checkup examinations (body weight and condition score, history, physical examination, and discussion as to how the patient and owner are coping). However, depending upon veterinary judgement, a kidney panel and PCV (plus T4 in cats) may provide all the relevant information required for therapeutic advice.

Dr. Lea Stogdale, DVM, Diplomate ACVIM, graduated from the Faculty of Veterinary Science, University of Melbourne, Australia in 1970. She worked in general practice in Australia and England before teaching veterinary medicine in South Africa and Saskatoon for eight years. Dr. Stogdale passed the veterinary small animal internal medicine specialty board exams in 1981 to become a Diplomate in the American College of Veterinary Internal Medicine. She has worked in emergency and pet practice for 25 years, taking a special interest in diabetes of dogs and cats, complementary medicine and nutrition (aesopsvetcare.wordpress.com).

Normal creatinine levels in dogs

Serum creatinine mainly comes from the muscles (the steady breakdown of creatine phosphate) with a small amount being contributed by meat in food. Hence, it is preferable to collect a fasting sample especially if a dog is being fed a high protein diet. The muscle mass of the dog influences his serum creatinine level. In humans, women have 10% to 20% lower normal serum creatinine levels than do men, due to their lower muscle mass. Very small dogs with little muscle mass have lower normal serum creatinine levels while large athletic dogs, especially greyhounds, have higher normal serum creatinine levels.

Dog size SI units US units Miniature (0 – 10 kg) 40 – 90 mmol/L 0.45 – 1.0 mg/dL Medium to large (average) (11 – 45 kg) 50 – 125 mmol/L 0.55 – 1.4 mg/dL Giant and athletic dogs (>45 kg and greyhounds) 80 – 195 mmol/L 1.0 – 2.2 mg/dL Modified from Dr David Polzin, University of Minnesota

Feng Shui in the clinic setting

Feng Shui is an ancient art of placement that can help you and your colleagues maintain wellbeing and harmony in the workplace.

Veterinary medicine is an amazing field to be in. Those of us who get to work with animals and their owners are truly blessed. But it can also be frustrating and overwhelming at times. Many things are beyond our control — from not-so-easy-to-handle patients to concerned and sometimes angry caretakers. We may also have difficult employers or staff members to work with, and long grueling hours to put in.

Feng Shui can help with these problems. This ancient Chinese art (pronounced “fung schway”) involves making physical changes to your working environment to help your practice run more smoothly and bring harmony to everyone. It aims to improve every aspect of your life using the principles of harmony and energy flow.

The literal meaning of Feng Shui is “wind and water”. These are the two natural elements in nature that flow, move and circulate everywhere on Earth. Our lives should also flow even though we have occasional ups and downs, similar to the way water gently flows around a rock and meets on the other side to move smoothly along again. Many times in our environment “the rock” is our employers, co-workers, the design and layout of the facility, our clients, and our relationships with other people. Feng Shui helps us subtly fix things in our environment that we do not have direct control over.

Feng Shui is also sometimes known as “the ancient art of placement”.  They way you place your furniture, color your walls and position your décor can influence the movement (flow) of energy to bring good health and harmony into your life and workplace. For example, if you find your clients have a tendency to “linger” around the reception desk talking about their lives, hanging a crystal in an appropriate place above the desk will help move the energy along, thus moving clients along. If a crystal is not available, a decorative bowl filled with water and colorful rocks will also move the energy. After all, in order for a practice to flow smoothly, we would ideally like our clients to come into the waiting room for a short time, have their scheduled appointments, see the receptionist on the way out to pay their bills and get their prescribed supplements, then happily leave. Any “stagnation” or stopping at any point in this flow will directly affect the health of the practice and staff. When there is a smooth flow of energy (also called Qi), there will be a steady flow of money to the practice and good health to the staff.

Five basic principles

Adhering to these basic principles before making any Feng Shui changes will improve your success and happiness.

1. Intention

Intention is the true power behind Feng Shui. Two things contribute to success in Feng Shui – the visible factors consisting of walls, doors, streets and various other tangible elements; and the invisible factors consisting of energy and the strong desire and visualization of what you want a Feng Shui “cure” to produce. This is intention. Without a pure intention, Feng Shui will not work for you.

A healthy practice encompasses a compassionate well-educated staff, doctors on the cutting edge of medicine with their fingers on the pulse of the newest advances in integrative therapies, happy and satisfied clients, and most of all, happy and healthy patients. To achieve this clean intention, your clinic needs to retain staff and keep them happy and motivated.

Feng Shui can assist with this. Simply putting large stones in your cabinets will “anchor” the practice, keeping staff turnover to a minimum. In addition, allowing staff to bring in decorative items from their own lives will keep them comfortable in the environment and lessen the sometimes negative thoughts and actions of certain staff members. Too often, the décor of a facility is determined by the owners and the staff is not consulted on color choices and furnishings, so adding each employee’s personal touch can be critical. Intention is what you want to happen and how clearly and purely you want it. If you can see and feel the result before it happens, then expect the result to happen.

2. Mantra

Mantra is the sacred words of power. Many people omit this when attempting to use Feng Shui cures, greatly lessening the chances of obtaining what they want. First visualize what you want (intention), then decide what you need to add or move to obtain this want (e.g. add a mirror, move a table, etc.). Then say the Mantra nine times either aloud or silently and the Feng Shui cure will be set.

There are many mantras, but for basic purposes The Six True Words are the sacred speech that can be utilized for your Feng Shui cures. The Six True Words are Om Ma Ni Pad Me Hum (pronounced ohm-mah-nee-pahd-mee-hum). This mantra has the power to improve your luck, uplift your mind, correct negative thought, enhance your wealth and prosperity, and help you better perform in your daily life.

3. Mudra

Mudra is equally important in obtaining what you want when using Feng Shui. This spiritual hand gesture, position, or action aligns the energy of your body to help create the desired energetic value. For basic purposes, the Expelling or Ousting Mudrais most often recommended, especially when using The Six True Words. This Mudra is performed by pointing the first and pinky fingers straight up and then holding the middle and the ring fingers out from the palm with your thumb. You then repeatedly “flick” the middle and ring fingers out from the palm. Women should use their right hands for this Mudra and men their left hands, and you should repeat this flicking motion nine times.

4. Nine

Nine is the most powerful and auspicious number in Feng Shui, symbolizing power and completion. It is for this reason we say the Mantra and perform the Mudra nine times for each Feng Shui cure. In addition, if you hang or place anything in a Feng Shui cure it should be done in increments of nine. For example, when hanging a crystal above a desk to bring harmony and peace, make the length of the string in 9” increments (9”, 18”, 27”, etc., depending on how you want it to look).

5. Red

This is Feng Shui’s power color. For adjustments and cures, use red above all others to get the most out of your intentions. The color yellow, although powerful as well, was traditionally held for emperors and other high-powered religious figures, and is not the hue of choice when adding a Feng Shui cure. In the next article, we will address different colors and how to use them, and you will learn that yellow can be used to feed and nurture our health and is traditionally put in spaces used for eating – e.g. lunch rooms, kitchens or break rooms.

Because life moves and flows, Feng Shui should not be done only once and then forgotten. Once there is a positive shift in the practice, the art should be revisited, the practice re-evaluated and the cures done according to the new energy.

Positive effects

The use of Feng Shui in veterinary clinics is becoming more and more common. Traditionally, veterinary medicine was notorious for having a high employee turnover, but in practices that employ Feng Shui cures, turnover has decreased. Client compliance with recommended services can also be greatly increased by utilizing the principles of Feng Shui. Many practice owners hire Feng Shui consultants to prepare their hospital blueprints and landscaping before they build their dream facility, as well using the art in the interior design.

Feng Shui can also help you personally, immediately and at any moment in the day. If you feel overwhelmed or unclear about what to do in any situation, start by stating a clear intention of how you want your day to go – e.g. getting out on time, getting along with co-workers, hoping surgery goes smoothly, etc. State or even write down your intention and solidify it by saying Mantra and executing Mudra nine times.

…if you find your clients have a tendency to “linger” around the reception desk talking about their lives, hanging a crystal in an appropriate place above the desk will help move the energy along, thus moving the clients along.

…yellow can be used to feed and nurture our health and is traditionally put in spaces used for eating – e.g. lunch rooms, kitchens or break rooms.

What is a “cure”?

A Feng Shui cure is an adjustment you can make that positively shifts the energy of your home, property or workplace. When you change the energy of your environment with a cure, you can experience new, positive influences from that environment. Cures put the power of Feng Shui in your hands, and by applying them you can change your life in any area you wish.

There are many “schools” of Feng Shui and this ancient art also can encompass oral traditions. For the purpose of this article, and to simplify the enormous array of cures, we will limit our discussion to reliable and simple methods that can be brought into any veterinary practice.


Mirrors are known as “the aspirin of Feng Shui”. They can be used to draw in as well as reflect energy. When in doubt about which cure to use, the mirror will serve you well.

The mirror can be any shape — square, rectangular, round or octagonal. Octagonal mirrors tend to have the most powerful and positive symbology, and if possible should be the first choice. Square and rectangular mirrors symbolize balance, and round mirrors symbolize oneness and unity.

A mirror can add light or brightness, attract new energy to your space, repel harmful or negative Qi, redirect energy flow, restore a missing space in a room or building, and expand an area to energetically create more space.

An example of where you might use a mirror would be on the front door of your practice. The front door is considered “the mouth of Qi” and sets the tone for the whole practice. If the front door faces an unsightly or negative structure, the mirror will redirect the energy away from your facility when it’s placed using the Mudra, Mantra and intention discussed above. If the front door faces something beautiful, peaceful or auspicious, the mirror will bring in that positive energy and allow it to flow smoothly into the practice.

Mirrors may also be placed above desks. This allows for clear and accurate thought, which in the case of receptionists can enhance accuracy. If receptionists are reviewing the charges incurred and prescriptions dispensed, mirrors will greatly eradicate mistakes in these areas. Mirrors above the doctors’ desks help encourage a clear and uninterrupted train of thought when deciding treatment protocols, options and plans. They can help keep doctors on track with appointments and restore calmness between patient visits. Remember, you must put in the intention of what you would like to happen when you place the mirror, and say the Mantra nine times.

If your office is set up with long corridors, and/or if clients tend to come in and walk past the reception desk without checking in, this is usually due to Qi whisking them through, causing confusion and chaos. By placing a mirror at the end of the hall, or on the wall beyond the reception desk, the Qi will be slowed down and allow clients to walk in and see where they need to be, helping to ensure smooth movement through the practice.

Chimes and bells

Sound is very effective for clearing out old and negative energy and bringing in new and positive energy. The most powerful sound cure would be one with a ringing quality such as chimes, bells and gongs. Sound can awaken and alert, stimulate new energy, provide protection, and create harmony, peace and balance.

Wind chimes can be used for a multitude of curing purposes, inside and out. Metal chimes tend to be best because they emit a clear tone, and brass is the most favored metal. However, the beauty of Feng Shui is that what resonates with you is what will work, so if you favor the sound of something other than metal, feel free to use it. If over time you do not gain the result you were looking for, then you may need to re-evaluate your choice. When hanging chimes, the use of a red ribbon/string/thread will give the best results.

Hanging a wind chime outside the front door of your practice will enliven and enhance the energy coming into the facility. The gentle sound of the chimes will help calm an upset client, which in turn calms a patient in distress. The energy of an outside wind chime also brings prosperity into the practice, which can mean payments made at the time services are rendered. Many large animal facilities have trouble collecting payment; putting wind chimes outside the facility can greatly reduce the number of receivable accounts.

Hanging chimes or bells on doors inside the practice will awaken energy and make the staff work optimally even in the most chaotic circumstances. This is particularly important in treatment rooms and pharmacies where we must perform without mistakes.

Brass bells placed on the reception desk and rung after each client leaves can ensure a cleansing of possible negativity as well as a clearing for the next transaction and client when they come through.

Plants and animals

A living cure can be utilized anywhere in a space. This particular cure actually uses the energy or vitality of the living plant, fish, bird, etc.

Plants and flowers are used in Feng Shui to bring color into a space as well as symbolize new life and growth. Rounded leaves are generally best as opposed to pointed leaves. Sick and dying plants should never be used. The most powerful plants and flowers are live ones, and the second best is silk. Dried arrangements are “dead” Qi and should really not be used because they can negatively influence your environment and the people in it. If you must use a dried flower arrangement, just be sure it is not placed on the front door; as we stated earlier, this is the mouth of Qi.

Outside landscaping should incorporate plants and herbs that can help heal ourselves and our patients. Generally, what grows abundantly in the landscape is what we need, so it is not uncommon for catnip to grow well for veterinary practices, dandelions to be prolific for detoxification and lavender to flourish for its healing and calming properties.

Fish are very auspicious and can bring prosperity into the practice. Traditionally, nine goldfish in total – eight gold and one black — will bring the most prosperity. The fish and environment must be healthy and aesthetically pleasing for this cure to be effective. The water must be clear and not murky, and algae levels must be adequate for the tank and not take over and become unsightly. If any fish die, replace them at once.

Birds and other in-clinic animals are also very important and give vitality and energy to the practice. Again, they should be happy and healthy; any signs they are not need to be addressed as soon as possible or negative energy will impact the clinic environment.


The final cure we will touch on is water, which in veterinary practices is sorely lacking. Fountains and waterfalls create new energy flow in the environment. Moving water creates sound and instigates a healthy refreshing release of negative ions. This provides a sense of well-being and makes breathing a bit easier.

Flowing water means flowing money; a fountain placed by the front entryway will allow money to come into your practice. The best fountains are ones in which you can see the flow of water, and the water pools rather than disappearing immediately. Another powerful fountain is one that works like a turning water wheel. Having a small motion-activated fountain in your exam room and reception area will ensure timely movement with appointments.

All these cures will work providing you add your Mantra and Mudra nine times, include your positive intention, and re-evaluate your environment periodically. You may need to adjust and re-adjust your cures as you see and feel the changes in your workplace.

Color cures

Color can affect every area of our lives, and opportunities for using it to improve the environment are innumerable. Color can adjust the energy of an entire room, change a mood or activate an emotion and the subconscious mind for success. Color can be used by painting a room or just adding a hint of a particular hue in an object such as a flower, book or painting. When we talk of color, we can use shaded variations to soften, evoke intensity, or add subtly to our lives. In veterinary medicine, there are many important colors you can incorporate into the practice so you may work in harmony with others and help heal your patients.


Green signifies new life, new beginnings, growth, vitality, energy and hope. It is the color of spring and can be used in waiting rooms. Clients come to us for a variety of reasons, ranging from treatment for their animals and education for their care, to emergences and surgery. All these situations need hope and vitality.


Purple is the color of wealth and royalty. It’s the extreme value of red — the Chinese saying “it’s so red it’s purple” means great energy and power. This is an excellent color to put in areas of power such as doctor’s offices, treatment areas and the pharmacy. Purple has a calming and clearing effect. It help keep thinking uncluttered and maintain balance in our thoughts.


Blue signifies knowledge, the sky, life and hope and is a very good color to put in exam rooms. Blue promotes the healing process both physically and mentally.


Yellow and earth tones are the colors of health, the earth, grounding and connection. They can be used in areas where we gain nourishment, such as kitchens and break rooms. Yellow is also good for the reception area because it keeps our first line of defense grounded, uplifted and connected. Many transaction mistakes can be alleviated if yellow is in place to keep reception staff alert and thinking clearly.


Red is a very powerful color and offers protection, energy and activity. Too much red can make us ill, so it is best to use it as an accent in areas such as surgery and rehabilitation rooms. If your practice has a space for training or lectures, red will help keep attendees awake, engaged and able to hear the power of whatever is being demonstrated in this room. Generally, red is used on the front door as strong protection from negative influences.

Incorporating some of these Feng Shui cures into your facility will help with all aspects of the veterinary practice, from attracting clients and patients to collecting fees and having a healthier, happier workplace with less employee turnover.

Bowen Therapy – Does It Work?

Can a hands-on technique really help laminitis pain, musculoskeletal problems (mild, severe/acute and chronic) TMJ and digestive issues, as well as reduce anxiety and an inability to focus? Touch Balancing/Animal Bowen™ (TB/AB) is a gentle, hands-on therapy based on the human Bowen Technique developed by the late Thomas Bowen of Geelong, Australia. The technique consists of a series of gentle rolling moves on the skin performed with fingers and thumbs or an open palm, using minimal pressure. The moves are done at specific locations in specific sequences, with brief pauses in between that allow time for the nervous system to respond. Touch Balancing/Animal Bowen is an adaptation of the Bowen Technique for use in animals. It was developed by Carol Bennett of Durango, Colorado in the mid 1990s.

How it was developed

TB/AB came about as a result of a disabling auto accident that left Bennett with chronic neck, back, shoulder and arm pain. Her discomfort was only partially responsive to chiropractic, acupuncture, myofascial release, Western medical interventions and other therapies. A physician friend urged her to attend a Bowen course being given in the United States. The first treatments left Bennett virtually pain-free, and also resolved several structural problems remaining from the accident.

Realizing that this modality would be highly beneficial for animals, Bennett spent the next two years studying human Bowen Technique and becoming a certified practitioner, adapting the moves to animal anatomy with input from several veterinarians, and finally writing a manual. Her work was recognized in 1997 by the Bowen Academy of Australia and was approved as the recognized Bowen for small animals. Since then, TB/AB has been used with success on a wide variety of animal species, large and small, and is being taught across the United States.1

The technique

The basic technique consist of sets of small, gentle, precise moves performed using the thumbs, fingers or palms. Each move starts with a preparatory action called “taking slack”, in which a small “reserve” of loose tissue is created.

  1. This is done by first moving the skin overlying a specific muscle or tendon to the edge of the structure, in the direction opposite to which the move will be performed.
  2. Gentle pressure is applied and held against the edge of the muscle or structure, so as to stretch and displace it slightly from its normal shape and position. This is called the “challenge” (Figure 1a).
  3. A slow rolling move is made back over the muscle or structure while maintaining the light pressure. The muscle or tendon springs back to its original shape and position as the thumb or fingers pass over it (Figure 1b). This is a dynamic event, similar to plucking a string on an instrument.
  4. Finally, a two-minute “hands-off” wait ensues to allow time for the nervous system to respond.  Changes in tissue tension, mental/emotional state, and energy/activity are seen to occur during this waiting period.

The most basic sequence of moves is performed along the spine, and is aimed at balancing/releasing tissue tension from the cervical vertebrae to the sacrum and coccyx. During the course of a treatment, some moves may be repeated or augmented with additional procedures to address other areas or organs. The moves are usually done only once or twice over an area, the pauses observed, then the next region addressed.

Physiological basis and theory

There is no clear consensus as to how the Bowen moves work. Anatomically, the various moves are made over sites of acupuncture points and meridians, trigger points, neurolymphatic reflex points, and proprioceptors of the joints. Alpha motor neurons, which directly initiate skeletal muscle contraction, receive both inhibitory input from the Golgi tendon organs and excitatory input from muscle spindle fibers that are activated by the stretching action of the challenge.2 Skin pressure and vibration from the “plucking” effect of the moves also stimulate somatic sensory pathways which convey information to the alpha motor neuron and by various spinal tracts to the thalamus, then the somatosensory cortex, prefrontal cortex, and limbic system. The latter includes areas associated with behavior and emotion, conditioned fear and anxiety, memory, sympathetic inhibition, and the fight or flight response.3

The author proposes a mechanism based on the following observation of George Goodheart, a neuromuscular clinical researcher. When a muscle is neurologically inhibited or weak due to aberrant signaling of the cutaneous receptors, stretching the skin over the weak muscle causes the muscle to become immediately facilitated or temporarily strong again. Vibrating the skin simultaneously with the stretching activates specific receptor types and makes the correction long-lasting or even permanent.4 Both stretch and vibration are elements of the Bowen moves. Since an inhibititory muscle dysfunction usually results in the antagonist muscle(s) becoming hyperfacilitated (staying in a prolonged state of excessive tone), “turning on” or facilitating the inhibited muscle also has the effect of normalizing the antagonist muscle(s) tone and, presumably, alpha motor neuron function as well as the associated cortical and cerebellar pathways involving higher brain centers, leading to autonomic nervous system modulation.

Two particular effects have been observed in human studies that support this concept. The first is that the Bowen Technique can modulate the balance between the sympathetic and parasympathetic nervous systems as evaluated by Heart Rate Variability (HRV) studies, and so is able to shift the highly stressed/painful body out of a sympathetic (fight or flight) dominant state into a more parasympathetic (rest and digest) state, which supports healing and more normal function.

People undergoing Bowen therapy report a deep sense of overall relaxation following a treatment, which may persist for days to weeks afterwards. Pain – both acute and chronic – will often disappear after even a single move or session. For example, in one pilot study, human subjects with fibromyalgia reported pain relief of up to six weeks following a single Bowen treatment.5 In animals, significant shifts towards calmer behavior are usually observed (Figure 2). Rapid Eye Movement sleep often occurs in small animals during a treatment. The beneficial effects appear to be cumulative, resulting in long-lasting improvement, even when chronic patterns of physical dysfunction have been present.

The second observation is that the technique can balance muscle tension between the left and right sides of the body or across a joint.6 According to a model of neuropathic pain proposed by Dr. C. Chan Gunn, unequal muscle tension along the spine or across joints can produce abnormal pressure distribution which affects the surrounding nerves and tissues, blocking the flow of motor impulses, and sensitizing the nerve and associated skeletal or smooth muscle (Figure 3). This sensitization can further cause sustained muscle shortening or spasms in a self-perpetuating cycle, leading in many cases to chronic pain and eventually osteoarthritis. Restoring symmetry of muscle tension by releasing/relaxing the shortened muscle(s) was found to bring long-term pain relief to many of Dr. Gunn’s patients.7

Veterinary clinical applications

TB/AB is a good first line therapy for any condition in which physical or emotional stress is a factor. In any emergency or acute condition, one or two specific moves can be employed to help reduce shock and pain.

  • For chronic musculoskeletal conditions including back pain, sacroiliac pain, or cervical problems, a TB/AB treatment can immediately begin to address compensation patterns of movement or muscle use that may be contributing to overall painfulness, and improve freedom of movement.
  • Specific procedures for respiratory and digestive issues can help correct a variety of problems in these systems, and support homeostasis.
  • There are even instances of this technique being instrumental in restoring normal blood glucose values in a diabetic animal.
  • TB/AB can often address emotional/behavioral issues associated with fear, physical trauma or abuse. Dr. Peck (co-author of this article) has had very good success treating thunderstorm phobia and separation anxiety in dogs using only this technique.

TB/AB is a versatile, wide-ranging and effective therapy that has many uses in equine and small animal veterinary practice. Because it is very non-invasive, most animals will accept treatment with minimum restraint and quickly come to enjoy it. It is particularly valuable for subtle or difficult to diagnose problems, for rehabilitation after injury, and to improve or maintain performance in show or sport horses; but it also can help chronic gastrointestinal, respiratory or behavioral problems.


2Denoix, J-M and Pailloux, J-P. Physical Therapy and Massage for the Horse, pp 7-13. Translated by Jonathon Lewis. Trafalgar Square Publishing, North Pomfret, VT, 2001.

3Price, D.D. and Bushnell, M.C. “Overview of Pain Dimensions and Their Psychological Modulation”, Psychological Methods of Pain Control, pp 3-17. IASP Press, Seattle, WA, 2004.

4Walther, David S. “Applied Kinesiology: Synopsis”,  2nd edition, pp. 66-67. Systems DC, Pueblo, CO, 2000.

5Whitaker, J, Gillam P, Seba D. “The Bowen Technique: A Gentle Hands-On Healing Method that Affects the Autonomic Nervous System as Measured by Heart Rate Variability and Clinical Assessment”. Presented at the American Academy of Environmental Medicine Annual Meeting, December 1997, La Jolla, CA.

6Bennett C. A research project on the application of the Bowen Technique on TMJ abnormality was started in Durango, CO by Dr. John Bauman, DDS. Assessments of left and right masseter muscle tension by biofeedback, measurement of bite and subjective symptoms were compared before and after treatment. Immediately after the first treatment, 20 out of 22 patients showed significant reduction in left-right masseter muscle tension differences and approximately one out of three patients felt dramatic relief in some of their symptoms.

7Gunn, C. Chan. “An Introduction to Radiculopathic Pain”, The Gunn Approach to the Treatment of Chronic Pain, 2nd edition, pp. 3-10. Churchill Livingstone, New York.

Winter Feeding For Horses


As nature slips toward dormancy in winter, hay becomes the forage of choice for most horses. Once fresh grass is cut, dried and stored as hay, however, its vitamin content, along with valuable Omega 3 fatty acids, dramatically decline, making supplementation necessary to fill in the nutritional gaps. Hay also has very little moisture compared to fresh pasture.

In other words, it takes more than hay to keep horses healthy during the colder months.  Even horses living in a milder southern climate without the blizzards of the north are impacted by weather changes in a variety of ways. Optimal nutritional planning will help your equine patients enjoy the season and emerge in good condition when spring arrives.

Shift slowly and check teeth

Any time the diet changes, it should be done gradually to allow the hindgut microbial population to adjust. This is also a great time to have your patients’ teeth checked for points that can make chewing painful. Hay is more difficult to chew and teeth need to be in top shape.

Vitamin D is key

Hay cannot compare to fresh grass when it comes to nutritive value. Once grass is cut, dried and stored, it begins to lose vitamins C, D and E, beta carotene (for vitamin A production), and Omega 3 fatty acids.

Normally, a horse produces vitamin D when exposed to sunlight. But spending more time indoors, combined with shorter daylight hours, can induce a vitamin D3 deficiency, leaving bones, joints and muscles unprotected. When exposed to sunshine, 7-dehydrocholesterol in skin oils is converted to cholecalciferol, which is then converted in the liver and kidneys to vitamin D, known as 25-hydroxy-cholecalciferol, or D3 for short. It’s a hormone, since it is produced in the kidneys, yet it has effects in the small intestine and bones. D3 is critical for maintaining blood calcium, so the horse’s bones, joints and muscles function optimally.

  • D3 helps calcium absorption in the gut.
  • If there is not enough calcium in the diet, D3 triggers the bones to release calcium into the blood.
  • D3 prevents loss of calcium in the kidneys.

A half-hour to 90 minutes in the sun will give the average person all the daily vitamin D he/she needs. But it typically takes five to eight hours of exposure to ultraviolet light (which is still present, though to a lesser degree, on cloudy days) for horses to produce enough vitamin D. This increased time is due to many barriers including hair, blankets, fly sprays, coat conditioners and reduced body oils (if recently bathed).

Winter (with its blanketing and less sunlight), frequent bathing and an indoor lifestyle cause vitamin D deficiency, leading to reduced appetite, slowed growth, bone demineralization (leading to stress fractures and bone deformities), and poor muscle contraction. Therefore, a vitamin supplement, along with flaxseed meal or chia seeds (to provide Omega 3s), will fill in the nutritional gaps created by hay-only diets.

Consider alfalfa

Contrary to popular opinion, alfalfa it is not higher in sugar than grass hay. It is high in protein, but this is a good thing. At a moderate intake (approximately 10% to 30% of the total hay ration), it boosts the overall protein quality of the diet to keep a horse’s muscles, joints, feet, skin, hair and bones fed, as well as protect her blood and immune function. Alfalfa also serves as a stomach buffer against developing an ulcer, a common occurrence when a horse is stalled during the winter after being accustomed to fulltime turnout.

Hay should be offered free-choice

Cold weather increases the metabolic rate, which means horses need to burn more calories to maintain a normal internal body temperature and consistent weight. When hay is provided free-choice day and night, it simulates the horse’s natural need to graze. It allows her to consume the increased amounts she needs to help stay warm and account for this higher energy requirement. Free-choice is always best (regardless of the season or condition) because it allows the horse to self-regulate her intake and eat only what her body needs. Horses that experience an empty stomach between hay “meals” will eat their hay very quickly. Horses offered hay free-choice will learn there is always hay available, and will therefore eat more slowly and self-regulate their intake to eat only what they need to maintain condition. This lowers the risk of colic.

Concentrates for more calories

For many horses, hay will not provide enough calories to maintain normal body condition. A high-fat commercial feed is fine for healthy horses. For the easy keeper or insulin-resistant horse, avoid sweet feeds and those that contain oats or corn. Beet pulp, alfalfa pellets, or low starch commercial feeds are excellent alternatives. Fatty feeds such as rice bran, flaxseed meal, or chia seeds offer the most concentrated source of calories. Avoid corn or soybean oils, since they promote inflammation due to their high Omega 6 fatty acid content. When clients feed bran mashes, or any added feed, they should give it every day. Consistency will prevent colic. Keep in mind, however, that bran (rice or wheat are most common) is very high in phosphorus in relation to calcium. Therefore, advise clients to use a commercial product with added calcium, or to feed alfalfa to counteract the elevated phosphorus content.

Older horses need special attention

The older horse may need a joint supplement along with vitamin C for collagen production (the protein found in bones and joints), since less vitamin C is produced as horses age. For the hard keeper, clients should make sure there is no competition from younger, more aggressive horses for hay. Older horses should receive a senior feed, along with added flaxseed meal.

Other winter tips

  • Water consumption needs to stay at optimal levels. Since most horses do not drink enough water when it is icy cold, it is best to use a heated water bucket to bring the water temperature up to 50ºF. Dehydration due to decreased water consumption is the main cause of colic during the winter. Snow is not a substitute for water.
  • Use a prebiotic (fermentation product, not live microbes) or a potent probiotic (one that contains billions — 109 — colony forming units) to keep the hindgut microbial population healthy. Boosting the health of bacterial flora living in the hindgut eases the transition from one form of forage (pasture) to another (hay).
  • Don’t forget salt. Salt blocks, free-choice granulated salt, or two tablespoons of table salt added to the horse’s meals per day (divided between meals), will keep his body in proper water balance. Salt blocks are made for cattle with their scratchy tongues; horses’ tongues are smooth so they may avoid salt blocks because they can cause irritation. Clients can offer granulated salt, free-choice. They should start out with a small amount so the horse’s curiosity won’t result in him eating a big mouthful of salt. Once the horse sees it’s salt, the client can fill the container with enough to last a few days. A full-sized horse requires approximately two tablespoons (one ounce or 28 grams) of table salt per day, divided between meals.
  • Clients should avoid blanketing their horses if at all possible. The winter coat is designed to keep the horse warm and regulate his internal body temperature. However, horses should have access to a shelter to get out of the wind, rain and heavy snow so their skin remains dry. Blankets flatten the coat, making it unable to protect the horse against extreme cold. If the horse is very thin, or clipped, and the client finds a blanket is necessary, have her check his condition each day to make certain he is not sweating.

Preventing colic when transitioning to hay

Because of the nutrient differences from grass, and because hay has very little moisture compared to fresh pasture, colic risk significantly increases in the winter months.

Colic is the number two killer of horses, number one being old age! Colic isn’t actually a disease; it’s a symptom of another problem. With increased hay consumption, impactions and excess gas production are the most common causes. Enteroliths (stones) are often seen in high alfalfa hay diets. And ulcers often develop when a horse is transferred from day-long turnout to longer periods of time in the stall. Following the feeding guidelines in this article will significantly lower the risk of colic.

Special keys to prevent colic:

  • The client should offer hay 24/7 to keep the intestinal motility normal, prevent acid buildup, and protect the vital forage-digesting hindgut microbes.
  • Make diet changes slowly.
  • Offer a pre-biotic.
  • Provide plenty of tepid water.
  • Provide salt, which encourages drinking to prevent impactions.
  • Limit winter stalling.
  • Float teeth to prevent partially chewed hay, which can cause impactions throughout the digestive tract.
  • Allow the horse to be a horse just as much during the winter as the rest of the year.
  • Consider an intestinal soothing supplement, typically containing herbs such as chamomile and slippery elm, to ease digestive distress.

Quality of hay

Not all hay is alike. If clients have two months’ supply or more, it is worthwhile for them to have the hay analyzed for its sugar and starch content, as well as protein, minerals and selenium levels. Equi-Analytical Labs will offer a complete analysis at a nominal fee: visit http://www.equi-analytical.com to learn more.

…it typically takes five to eight hours of exposure to ultraviolet light…for horses to produce enough vitamin D.

The Case For Whole Foods

For decades, clinical nutrition was used supportively for common diseases, but in recent years our viewpoint has changed. “[Nutrition] has emerged as a cornerstone of treatment based on the principles of grade 1 evidence-based medicine,” report Drs. Kirk and Bartges in Veterinary Clinics of North America: Small Animal Practice. “No longer are nutrients simple building blocks, co-factors, or enzymes, but instead regulators of cellular metabolism, gene transcription, or translation.”1

The “NEW NORMAL” misses the mark
While we all now agree on the importance of nutrition, there is debate over what constitutes the ideal diet for small animals, as the popularity of raw meat, fresh homemade raw or cooked, raw dehydrated, grain-free and other diets are on the rise. Since different individuals thrive on different diets we have an opportunity to help our clients fi nd the optimal choice for their animals. Our fi rst task is to help our clients choose foods by understanding the differences between food preparations.

The conventional view, presented to us in school and through clinics, is based on information and research provided by the pet food industry. It focuses on the nutrient content and perceived balance of canine and feline foods, and sees the actual ingredients as less important. Today’s pet diets contain ingredients such as starch and grain-based proteins, which dogs and cats were not meant to eat in abundance. The food is then processed at high temperatures and pressures, denaturing it to a form that our pets’ ancestors and their current wild counterparts have never experienced. Finally, minerals, amino acids and synthetic vitamins are added to attempt to balance the diet, at least to our current, incomplete level of understanding. This approach seems to be keeping many veterinarians from looking at fresh food diets.

Challenging flawed assumptions
An alternative view of pet nutrition looks for guidance to the sciences of comparative anatomy and evolution. For example, we are told dogs are omnivores, and in our society that is certainly true. But since our pets have no choice over what they eat, how can we be sure the diets we force on them are ideal? A 1979 study reviewed wildlife literature that seems to provide an answer.2 “[A] good deal of disagreement exists within the veterinary profession about the proper diet for dogs…” The study inventoried the stomach contents of coyote, fox, wolf, bobcat, cougar and lynx. Their justifi cation for the comparison is that anatomically, the digestive tracts of these wild carnivores are similar to that of the domestic dog. The study concluded that “… the staple diet of carnivores living in a natural setting includes other animals, carrion, and occasionally fruits and grasses…carnivores IVC Winter 2012/13 63 in their natural environments consume diets high in animal protein, bulk, and roughage from indigestible parts of animal carcasses and low in carbohydrates, and caloric density.” This nutrient profi le does not match that of our current, conventional diets. The idea that we can formulate the ideal diet for pets from processed, inappropriate ingredients is based on fl awed assumptions. Cooking at high heat and pressure processing reduces the potency of almost all nutrients, including L-carnitine3 and completely destroys others such as thiamine, folic acid, vitamin C, vitamin A, niacin, pantothetic acid.4 Can this nutrient depletion be easily remedied with synthetic vitamins? Are they identical to the vitamins, amino acids and nutrients in whole foods?

An incomplete understanding of nutrition
You don’t have to look too far back in history to see demonstrations of our nutritional ignorance. In the early 1980s, cats were going blind and dying from dilated cardiomyopathy (DCM). Initially, the cause of the problem was considered idiopathic. No one thought cat food that was “complete and balanced” could be the cause. In 1987, it was discovered that DCM was caused by a taurine deficiency. Looking at the research of the day is enlightening. They found that canned cat foods (cooked) required extra taurine supplementation.5 “We have found that these same canned diets, if fed in an uncooked form, do not cause clinically significant taurine deficiency.”6 This seems to indicate that cats were meant to eat raw food. “Taurine deficiency alone is not suffi cient to cause myocardial failure or central retinal degeneration in all cats…most likely in our opinion, these conditions may be caused by taurine deficiency and other, currently unidentified, cofactor or cofactors.”7 It appears our understanding of nutrition is incomplete. “When you look at the classic example of taurine defi ciency, many [diets] were deficient. The cats that didn’t become ill were those that were going outside and catching mice.”8 It seems when we try to improve on nature, we often get it wrong. How many other current idiopathic diseases may be related to nutritional issues?

Nutrition is complicated
A truly balanced diet must consist of many more micronutrients than the 30 or so included in the AAFCO recommendations. Human nutrition experts are starting to realize the importance of whole, unprocessed foods. One article points out that there are 8,000 phytochemicals present in whole foods, and that there is a synergistic health-benefitting effect from the complex mixture of these compounds in whole foods.10 Another points out that it is not a single component but rather the interaction of complex mixtures of natural chemicals found in whole foods that help prevent and treat many chronic human diseases.11 Animal-based as well as plant-based foods are functional because they provide biologically active nutrients besides vitamins and minerals that are not produced by human biological systems and that could be deemed equally essential for life.12 Although the studies cited above are related to human nutrition, the basic tenets of whole food nutrition translate to all species.

• One recent study found that the consumption of any type of vegetable at least three times per week was associated with a 70% to 90% risk reduction in the development of transitional cell carcinoma in Scottish terriers.13 If adding some vegetables to the diet of Scotties can have this effect, other breeds are also likely to benefit from whole food supplementation of processed diets.

• Another study compared the cognitive ability of older dogs on different diets.14 The control group was fed a processed senior diet. The test group’s food was enriched with vitamins E and C, mitochondrial co-factors (L-carnitine and DL-alpha-lipoic acid), and a mixture of fruits and vegetables. The dogs receiving the enriched diet performed significantly better than controls.

Whole food raw diets are beneficial
From my research and clinical experience, I have concluded that many pets benefit from being fed raw, evolution-based diets, since dogs and cats evolved over millions of years eating such diets. Simply looking at a pet’s teeth indicates they are carnivores in every sense of the word. If they had evolved significantly from their wild roots, and now required processed foods, their teeth and jaws would reflect that change. There are many ways to provide a whole foods diet.

1. The “Bones and Raw Food” (BARF) movement has been gaining in popularity over the past 15 years. This philosophy provides “meaty bones” (raw chicken necks and backs) as part of the diet as well as shredded vegetables and organs. The bones help maintain the calcium-to-phosphorus ratio and keep the teeth clean. We have been taught that bones are dangerous for pets to eat and that certainly is the case for cooked bones. However, small raw bones like chicken necks and backs are much safer. Having said that, it is not impossible for raw bones to be a choking hazard, as are sticks, stones and toys.

2. Another whole food option is using a commercial supplement to balance a diet made with meat from the grocery store, health food store or local farm. These commercial mixes contain calcium and other essential nutrients that can be mixed with meat (and vegetables) to create a balanced diet. This alternative allows the pet owner to control the meat source, and eliminates the need for bones. One concern often cited with the above two methods is the possible contamination of the food with pathogenic bacteria and/or parasites. Raw meat products for human or animal consumption are loaded with pathogenic bacteria that are killed when the meat is cooked. Serving these meats raw would appear to pose a danger to pets and their human companions. In my opinion, this danger is overblown. In one recent study, 33% of dry dog food samples and 8% of canned dog food samples tested positive for non-type specific E. coli, and 4% of canned food samples tested positive for cryptosporidium.15 Another report found up to 36% of healthy dogs and up to 18 % of healthy cats shed salmonella in their stool.16 Decades of feeding raw meat diets shows fewer problems than commercial foods with their frequent recalls.

Encouragement for clients
My preferred method of providing pets with raw diets is to refer clients to one of the many premade raw foods commercially available. Research into the companies is needed to find one whose formulation expertise and nutrient philosophy matches yours. For example some have higher vegetable percentages than others. Another consideration is the method the company uses to mitigate pathogens. Many have turned to high-pressure pasteurization, which makes one wonder how raw the food really is. I do not believe there is any one diet type ideal for every patient and every client. I am also pragmatic and realize that not all my clients are willing or able to provide the nutrition I think is best. Some real food is better than none at all, so I always encourage my clients to at least enhance their animals’ diet with raw or lightly cooked meats and vegetables, or whole food supplements. I am always impressed by the amazing health benefits of whole foods.


1 Kirk CA, Bartges JW. “Dietary management and nutrition, preface”. Veterinary Clinics of North America Small Animal Practice, 2006; 36(6):xi-xii.

2 Landry SM, Van Kruiningen HJ. “Food Habits of Feral Carnivores: A Review of Stomach Content Analysis”. J Am An Hosp Assn, 1979; Vol 15:775-782.

3 Phillips T. “L-carnitine, Evidence indicates it may accelerate weight loss and increase lean body mass”. Pet Food Industry, May 2002; 24.

4 Schroeder HA. “Losses of vitamins and trace minerals resulting from processing and preservation of foods”. Am J Clin Nut, 1971; 24(5):562-573.

5 Hayes KC. “Taurine Status in Cats Fed Canned and Dry Diets”. Alpo Viewpoints in Veterinary Medicine, 1995.

6 Pion PD, Kittleson MD, Thomas WP, Skiles MI, Rogers QR. “Clinical findings in cats with dilated cardiomyopathy and relationship of findings to taurine deficiency”. J Am Vet Med Assoc, 1992; 201(2):267-274.


8 Smith CA. “Changes and Challenges in Feline Nutrition”. J Am Vet Med Assoc, 1993;203(10):1395-1400.

9 Iams Partners for Health, Ground breaking study links diet and learning, Aug. 2004, Vol 2, No. 8 p.1-3.

10 Liu HR. “Health benefits of fruit and vegetables are from additive and synergistic combinations of Phytochemicals”. Am J Clin Nut, 2003; 78(3):517S-520S.

11 Lila, MA. “From beans to berries and beyond: teamwork between plant chemicals for protection of optimal human health”. Ann N Y Acad Sci, 2007; 1114:372-80.

12 Jacobs DR Jr, Tapsell LC. “Food, not nutrients, is the fundamental unit in nutrition”. Nutr Rev, 2007; 65(10):439-50.

13 Raghavan M, et al. “Evaluation of the effect of dietary vegetable consumption on reducing risk of transitional cell carcinoma of the urinary bladder in Scottish Terriers”. J Am Vet Med Assoc, 2005;227: 94-100.

14 Milgram NW, Head E, Zicker SC, et al. “Learning ability in aged beagle dogs is preserved by behavioral enrichment and dietary fortification: a two-year longitudinal study”. Neurobiol Aging, 2005; 26:77–90.

15 Strohmever, Racheal A., DVM et al. “Evaluation of bacterial and protozoal contamination of commercially available raw meat diets for dogs”, JAVMA, 2006, 228: 537-542.

16 Sanchez, S, Hofacre, CL, Lee, MD, Maurer, JJ Doyle, MP. “Animal Sources of Salmonellosis in Humans”. JAVMA, 2002, 221:492-497.

Management Of Feline Chronic Gingivostomatitis of Suspected Viral Origin With A Thymic Extract


Richard E. Palmquist, DVM. Centinela Animal Hospital, Inc. 721 Centinela Avenue, Inglewood, CA. 90302. cahdogcat@aol.com


A thymic extract, Kyosenex1, was used in management of a protracted case of feline gingivostomatitis. The patient responded dramatically, especially in the caudal portion of the oral cavity. The condition recurred upon stopping therapy and improved again on reinstituting the agent. This indicates causation, a lack of cure. Since quality of life was greatly improved further research is indicated.


Veterinarians are well acquainted with feline stomatitis, a syndrome of inflammation that can be frustrating to address. (Healey, et al 2007) The condition and its conventional diagnosis and management have been reviewed elsewhere. (Lommer, Verstraete 2003; Belgard, et al 2010; Dowers, et al 2010; Lee, et al 2010; Bhella , Corbee 2011; Goodfellow, et al 2011; Hennet, et al 2011; Krishnan, et al 2011) L-lysine may contribute to inflammation from viral issues in the caudal oral cavity. (Drazenovich, et al. 2009) Thymus extracts can contain many biologically active compounds and may have usefulness in a wide variety of chronic disease states including viral infections and cancer. (Ioannou, et al 2012)

In cases where conventional therapies fail it is appropriate to seek out and try novel therapies and there are many such routes available to those veterinarians with training and interest in complementary and alternative medicine (CAVM) (Goldstein 2008). When these therapies gain research and validation they are integrated into the body of conventional medicine. The purpose of this paper is not to review the condition and its known therapies, but to present a case report involving use of a novel product which provides an interesting option for further research and development.

Case Report:

A thirteen-year old, spayed female, domestic short haired cat presented for a chronic history of hyperthyroidism managed with methimazole. A complete blood count, urinalysis, FeLV, FIV, and T-4 were normal. The cat’s chronically recurring rhinitis and sinusitis had been medically managed using a wide variety of medical therapies including antibiotics (selected empirically and via culture and sensitivity and used for extensive periods of time), antihomotoxic and homeopathic agents, nutritional therapies including L-lysine and medical mushrooms, novel antigen diets, herbal agents, acupuncture, and essential oils.

A few months before the cat had presented with difficulty eating and was diagnosed with chronic stomatitis. At the recommendation of the general practice veterinarian the cat was seen and treated by a boarded veterinary dentist with dental radiographs, dental prophylaxis, multiple extractions and antibiotics. The cat did improve for a short period of time following therapy, but oral cavity pain and inflammation returned shortly after its therapy. The owner’s declined immunosuppressive therapies as their prior cat had died of cancer and they wished to preserve the cat’s immune integrity. Since their other cat had been treated successfully by integrative methods, they sought CAVM to see what assistance could be offered.

A discussion of the condition, its recurring nature and frustrating recurrence rates ensued. The owners were informed that all such therapies were experimental and could not be supported by research. Herpes or other viral infections were strongly suspected as inciting cause in this cat and the owners understood that cure was unlikely. The author had just returned from a holistic conference where he had met with representatives of a company that was seeking research on their novel thymic extract. The owners were interested and agreed to allow its use in their cat. The product was made for oral use but since this cat was so hard to medicate we evaluated sterility and opted to give it by injection subcutaneously. One vial of lyophylized thymic extract was hydrated with 2.0 cc of the recommended diluent. The cat was given a five day cycling dosing pattern that consisted of giving 0.2cc of this mixture by subcutaneous injection daily for three days and skipping two days before repeating the cycle again. During this time the cat received acupuncture weekly for three total treatments. After a month the dose was reduced to 0.1cc daily for three days, off for two days and repeated in five day cycles.

Patient comfort improved rapidly. Nine days after beginning injections the cat was able to open her mouth and began eating. Her owners reported she began playing and purring again. Erythema and pain were both reduced and continued to improve for two months. Her sinusitis would flare but her oral cavity did well until she developed an invasive nasal mass. The owners declined biopsy but CT revealed a mass eroding into the skull from the nasal passage. Carcinoma was suspected by the internist.

The owners continued to manage her condition with multi-modal CAVM therapies and the cat did well until her euthanasia eight months later. Her owners were very happy with her therapy.

The following pictures demonstrate her condition and progress:

Figure 1. Day one of therapy. Note multiple extractions and excellent healing from prior dental care. At this time the patient objected strongly to opening her mouth. Figure 1-Stomatitis Day 1-300
Figure 2. Thirty days of therapy (6 x 5 day cycles). Inflammation still present but mouth is far less red and far more comfortable. Cat was eating well and playing at this exam. She did not object to opening her mouth. Figure 2-Stomatitis-30days-150
Figure 3. Sixty days of therapy (12 x 5 day cycles). Inflammation still present, particularly in the incisor and canine tooth regions, but the pharyngeal area is nearly normal. Figure 3-Stomatitis-60days-300


This case demonstrates an interesting response to a novel thymic extract. The treatment is not curative but did seem to greatly reduce patient discomfort as evidenced by the cat’s behavior, appetite and activity levels. The owners reported she felt five years younger while on this treatment. She received the injections off and on for a year with no sign of adverse effects. The author has subsequently treated several more cases of chronic gingivostomatitis in cats using this agent and multi-modal integrative therapies with good results.

In the author’s experience this condition should be addressed in a systematic and thorough manner with the aid of a qualified, preferably board-certified veterinary dentist. In the event of poor outcome, it seems appropriate to seek out further ways to relieve suffering and assist these patients and their owners. Integrative medicine may well have many new options for such cats and the entire profession will benefit as we gain more research and understanding of these therapies.


1. Kyosenex. ULR Laboratories LLC, 5333 Likini Street 1510, Honolulu, HI 96818.


Belgard S, Truyen U, Thibault JC, Sauter-Louis C, Hartmann K. Relevance of feline calicivirus, feline immunodeficiency virus, feline leukemia virus, feline herpesvirus and Bartonella henselae in cats with chronic gingivostomatitis. Berl Munch Tierarztl Wochenschr. 2010 Sep-Oct;123(9-10):369-76.

Bhella D, Goodfellow IG. The cryo-electron microscopy structure of feline calicivirus bound to junctional adhesion molecule A at 9-angstrom resolution reveals receptor-induced flexibility and two distinct conformational changes in the capsid protein VP1. J Virol. 2011 Nov;85(21):11381-90.

Corbee RJ, Booij-Vrieling HE, van de Lest CH, Penning LC, Tryfonidou MA, Riemers FM, Hazewinkel HA. Inflammation and wound healing in cats with chronic gingivitis/stomatitis after extraction of all premolars and molars were not affected by feeding of two diets with different omega-6/omega-3 polyunsaturated fatty acid ratios. J Anim Physiol Anim Nutr (Berl). 2011 Jul 18. doi: 10.1111/j.1439-0396.2011.01195.x

Dolieslager SM, Riggio MP, Lennon A, Lappin DF, Johnston N, Taylor D, Bennett D. Identification of bacteria associated with feline chronic gingivostomatitis using culture-dependent and culture-independent methods. Vet Microbiol. 2011 Feb 24;148(1):93-8.

Dowers KL, Hawley JR, Brewer MM, Morris AK, Radecki SV, Lappin MR. Association of Bartonella species, feline calicivirus, and feline herpesvirus 1 infection with gingivostomatitis in cats. J Feline Med Surg. 2010 Apr;12(4):314-21.

Drazenovich TL, Fascetti AJ, Westermeyer HD, Sykes JE, Bannasch MJ, Kass PH, Hurley KF, Maggs DJ. Effects of dietary lysine supplementation on upper respiratory and ocular disease and detection of infectious organisms in cats within an animal shelter. Am J Vet Res. 2009 Nov;70(11):1391-400.

Goldstein R, editor. 2008. Integrating Complementary Medicine into Veterinary Practice, Wiley-Blackwell Publishing. pp 277-91, 669.

Hargis AM, Ginn PE. Feline herpesvirus 1-associated facial and nasal dermatitis and stomatitis in domestic cats. Vet Clin North Am Small Anim Pract. 1999 Nov;29(6):1281-90.

Healey KA, Dawson S, Burrow R, Cripps P, Gaskell CJ, Hart CA, Pinchbeck GL, Radford AD, Gaskell RM. Prevalence of feline chronic gingivo-stomatitis in first opinion veterinary practice. J Feline Med Surg. 2007 Oct;9(5):373-81.

Hennet PR, Camy GA, McGahie DM, Albouy MV. Comparative efficacy of a recombinant feline interferon omega in refractory cases of calicivirus-positive cats with caudal stomatitis: a randomised, multi-centre, controlled, double-blind study in 39 cats. J Feline Med Surg. 2011 Aug;13(8):577-87.

Ioannou K, Samara P, Livaniou E, Derhovanessian E, Tsitsilonis OE. Prothymosin alpha: a ubiquitous polypeptide with potential use in cancer diagnosis and therapy. Cancer Immunol Immunother. 2012 May;61(5):599-614.

Krishnan SK, Ganguly S, Veerasamy R, Jan B. Synthesis, antiviral and cytotoxic investigation of 2-phenyl-3-substituted quinazolin-4(3H)-ones. Eur Rev Med Pharmacol Sci. 2011 Jun;15(6):673-81.

Lee M, Bosward KL, Norris JM. Immunohistological evaluation of feline herpesvirus-1 infection in feline eosinophilic dermatoses or stomatitis. J Feline Med Surg. 2010 Feb;12(2):72-9.

Lommer MJ, Verstraete FJ. Concurrent oral shedding of feline calicivirus and feline herpesvirus 1 in cats with chronic gingivostomatitis. Oral Microbiol Immunol. 2003 Apr;18(2):131-4.

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Dr. Christina Chambreau, DVM, CHC


Graduated from the University of Georgia Veterinary College in 1980. She is a founder of the Academy Of Veterinary Homeopathy, was on the faculty of the National Center for Homeopathy Summer School and has been the holistic modality adjunct faculty liaison for the Maryland Veterinary Technician Program. Dr. Chambreau teaches classes in homeopathy for animals, and lectures on many topics. She is the author of the Healthy Animal’s Journal and the co-author of the Homeopathic Repertory: A Tutorial.