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Wednesday, September 23, 2020
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The Latest On Separation Anxiety

The term “separation anxiety” likely originated in the mid-1980s with Dr. Victoria Voith, a board-certified veterinary behaviorist and Dr. Peter Borchelt, a Certified Applied Animal Behaviorist. The scientific literature on attachment contains numerous references to separation distress as a normal reaction to separation from individuals with whom an animal has formed a social bond. Puppies for example will whimper and cry if the dam leaves them, even if they are well fed and warm. Separation distress vocalizations begin to decrease around eight to ten weeks of age although they remain higher when puppies are alone in an unfamiliar environment.

Separation anxiety isn’t “over attachment”
The basis for separation anxiety problems has long been thought to be due to an “over attachment” to the owner. But recent research fails to support this interpretation. During an attachment test, dogs with separation anxiety showed no difference in the amount of time they spent in contact with or in proximity to their owners than dogs without separation anxiety. In the same study, 65% of the dogs without separation anxiety were reported to follow their owners from room to room. So these patterns are not reliable diagnostic criteria for separation anxiety.

Most dogs do not engage in the severe destructiveness, vocalizing or elimination as long as they are in the presence of someone. We’ve had cases of anxious dogs that escaped the yard and spent the day comfortably in the companionship of kind neighbors. Separation anxiety dogs that are well socialized with other dogs often do well at daycare as an alternative housing arrangement while a behavior modification plan is being implemented.

A shift in behavioral approaches
An alternative view of the basis for separation anxiety is that dogs with this disorder have difficulty coping with being left alone. This is an important distinction because some behavior modification protocols for separation anxiety recommend owners ignore their dogs and any behaviors from them designed to promote social contact. This is a harmful recommendation because it damages the human-animal bond and produces anxiety and frustration when the dog is powerless to initiate social interaction, and the owner is prevented from doing so. This goes far beyond the typical training advice to not reinforce annoying behaviors with attention, such as barking, jumping up or “stealing” clothing from the laundry.

Rather than focusing on the attention issue, behavior recommendations should help the dog be calm and relaxed, rather than anxious, when left alone. Although this problem is referred to as separation anxiety, a better term might be separation phobia, as many of these dogs are in a complete panic when alone. Not uncommonly, dogs harm themselves by breaking teeth or lacerating their mouths and feet in their attempts to escape the house, yard, or even worse, a crate.

Confining a dog with separation anxiety in a crate in an attempt to prevent further destructiveness or housesoiling is a truly dangerous recommendation. Close confinement seems to increase fear in dogs that are already panicked, particularly when they’ve not been previously accustomed or gradually acclimated to being left alone when confined.

Because this is a fear-related issue, separation anxiety problems respond well to classical counter conditioning and desensitization techniques, at least theoretically. The real difficulty lies in the implementation of these procedures. Regardless of the type of fear, it is well documented in the learning literature that continued exposure to the fear-producing event significantly interferes with the successfulness of these techniques.

Behavior modification works with medication
Because the fear-producing event is being left alone, the trick is preventing the dogs from being in this state, or alternatively preventing the fear response if they are. Veterinarians can help these patients if they can temporarily offer day boards for dogs until behavior modification plans have progressed and/or medication has taken effect.

Reducing the fear response is the reason for prescribing anti-anxiety medications, one of which (Reconcile™) has been FDA approved for separation anxiety problems, although others are commonly used off-label as well. Veterinarians have access to numerous references regarding medication (e.g. Simpson and Papich, 2003). In the authors’ experience, over-the-counter naturopathic remedies are not effective for the high anxiety of separation reactions. Those available by prescription only have a much better success rate.

However, it’s important to note that no medication has been shown to be effective in reducing separation anxiety without concurrent behavior modification. If the dog shows a visible reaction to the owner’s departure routine, classical counter conditioning and desensitization techniques should be created for the discrete events that comprise the routine, as well as for the owner’s absences themselves.

Desensitization is incremental exposure to a fear-producing event, and classical counter conditioning is changing the association between events so that the feared event (previously conditioned stimulus of being left alone) now predicts a pleasant event (a new unconditioned stimulus such as food or toys). The goal of classical conditioning in this context is to change the direction of the emotional arousal from fear to calmness or even pleasant anticipation. A sample desensitization hierarchy for a typical owner departure routine might be separated into the following elements, each of which could be paired with (immediately followed by) tossing a treat to the dog and then resuming regular activities (i.e. not leaving):

• Collecting items owner typically leaves with (purse, briefcase, phone, etc.)
• Triggering the garage door opener
• Picking up keys
• Walking toward the exit door
• Opening the door, then closing it and retreating

In extreme cases, each of these elements may need to be split into even smaller behaviors. Rather than opening the door, just reaching for the door knob may be enough to elicit a reaction in particularly fearful dogs.

The behavioral starting place for planned absences could be as long as ten minutes, or nothing more than leaving the room for 30 seconds with the dog prevented from following by either a leash or baby gate. The reason to prevent the dog from following is not to “decrease attachment” but instead to create an extremely brief “absence” the dog can experience without panic. Each out-of-sight experience or actual absence should be paired with irresistible treats. Stuffing the treats in a toy designed for that purpose not only holds the dog’s attention but prolongs the duration of treat delivery. The dog’s interest in the treats is also a way to gauge emotional arousal. Refusal to consume what would otherwise be extremely desirable food indicates a persistent high degree of anxiety and the need to further simplify the behavioral start point. Behavior modification for separation anxiety can be tedious and requires a committed owner. If you do not provide in-home follow-up, it’s advisable to work with a competent trainer, behavior consultant or certified behaviorist who can assist clients with implementation. In addition to appropriate partnership referrals, the veterinarian’s most crucial tasks are to educate clients about the nature of separation anxiety and prescribe medication as an adjunct to behavior modification at their discretion.


References
Appleby, D and Pluijmakers, J, 2003. Separation anxiety in dogs: The function of homestasis in its development and treatment. Vet. Clin. North Am. Small Animal Pract. 33 (2): 321-344Borchelt, P and Voith, V, 1982. Diganosis and treatment of separation-related behavior problems in dogs. Vet. Clin. North Am. Small Animal Pract. 182: (12): 625-35. Flannigan, G and Dodman, N, 2001. Risk factors and behaviors associated with separation anxiety in dogs JAVMA 219: 460-6. Parthasarathy, V and Crowell Davis, S, 2006. Relationship between attachment to owners and separation anxiety in pet dogs (Canis lupis familiaris). J. Veterinary Behavior 1: 109-120. Simpson, BS, and Papich, MG, 2003. Pharmacological management in veterinary behavioral medicine. Vet. Clin. North Am. Small Animal Pract. 33 (2): 365-404. Wright, JC, Reid, PJ, and Rozier, Z, 2005. Treatment of emotional distress and disorders – non pharmacologic methods. Pps. In McMillan F. Ed. Mental Health and Well Being in Animals. Blackwell Publishing, Oxford, U.K. More information on separation anxiety is also available from the authors through On Demand webinars at BehaviorEduationNetwork.com and on DVD from HelpingFido.com. Dr. Suzanne Hetts, PhD, CAAB, CVJ and her husband Dr. Daniel Estep, PhD, CAAB are award-winning speakers and authors, having lectured on four continents to animal parents and professionals. Their company, Animal Behavior Associates, Inc., provides pet behavior education to animal professionals at BehaviorEducationNetwork.com and animal parents at HelpingFido.com and HelpingKitty.com. [callout] Rather than focusing on the attention issue, behavior recommendations should help the dog be calm and relaxed, rather than anxious, when left alone.

Dogs & Cats At Risk

Dogs and cats, like the proverbial canaries down the mine shafts, have become our sentinels. They alert us to health hazards in the home-environments we share and in the products and by-products of the same agribusiness food industry that feeds most of us and them. In the mid 1990s I began to suspect diet may play a role in a “cluster” of health problems not seen nearly as often as when dogs and cats were being fed conventional corn and soy. Since that time I have formed the professional opinion that there is sufficient proof from evidence based medicine that dietary ingredients derived from GM crops are not safe for companion animals, and by extension, for human consumers either. Widespread use of GMO crops In the mid 90s, more and more genetically engineered corn and soy were being used in pet foods and fed to farmed animals.

As a nationally syndicated veterinary newspaper columnist, I began to receive an increase in letters from cat and dog owners whose animals were suffering from this cluster of health problems. In the 40 years that I’ve been writing that column, I’ve benefited from a wide-angled and historical perspective that I would never have realized running a conventional veterinary clinic. The thousands of letters that I receive from across the U.S. keep me informed about new and emerging health problems and veterinarians’ responses to the same. During this timeframe in the 90s, people often wrote to report of failed treatments and harmful side effects to prescribed remedies e.g. steroids, as well as problems with various manufactured prescription diets after their attending veterinarians diagnosed their animals with allergies, asthma, atopic dermatitis and other skin problems, irritable bowel syndrome, leaky gut syndrome, inflammatory bowel disease, colitis, recurrent diarrhea, vomiting, indigestion, along with abnormalities in liver, pancreatic and immune system functions.

That animals with these afflictions often recovered completely when I advised that they be taken off all foods containing corn and soy supported the evidence based medical assertion that dietary ingredients were playing a significant, if not sole role in their disease.

A similar picture was developing in human health. It is surely no coincidence that the US Centers for Disease Control and Prevention reported, in Oct. 2008, an 18% increase in allergies in children under the age of 18 years, between 1997-2007. This ties in with the time-frame of when GM ingredients were first introduced into the food chain and then subsequently in greater amounts. Some 3 million children now suffer from food and/or digestive allergies or intolerance. Their symptoms including vomiting, skin rashes, and breathing problems. They take longer to outgrow milk and egg allergies, and show a doubling of adverse reactions to peanuts.

Research Evidence of Harms

In the creation of GM crops like corn and soy bean, novel proteins are created that can cause allergies and assault the immune system. This in turn creates illness, especially in the offspring of mothers fed such foods, and to their young fed diets containing GM ingredients. The genetic modification of such food crops can also lower their nutrient content, elevate potential toxins, and also create novel RNA variations. The latter are not destroyed by digestion, and so called micro RNA has been found in mammalian tissues where they can exert influences on gene expression and therefore affect health across generations, (Zhang et al, 2011). These kinds of problems are in part due to the inherent genetic instability of GM plants that can result in spontaneous and unpredictable mutations, (Wilson et al 2006).

In their detailed review of animal safety studies of GM foods, Dona & Arvanitoyannis (2009) conclude that “The results of most of the rather few studies conducted with GM foods indicate that they may cause hepatic, pancreatic, renal, and reproductive effects and may alter hematological, biochemical, and immunologic parameters the significance of which remains unknown.” Altered DNA from GM foods can be incorporated by gut bacteria and may alter their behavior and ecology in the digestive tract. Likewise the bacterial incorporation of genetic material from antibiotic resistance genes used to identify some varieties of GM food crops could have serious health implications, (see Smith 2007 and Traavik & Heinemann, 2007).

Three varieties of Monsanto’s GM corn, approved for consumption by US, European and several other national food safety authorities, caused liver, kidney and other internal organ damage when fed to rats, ( J.S.de Vendomois et al 2009). A subsequent 2-year feeding trial by Seralini et al (2012) reported that rats fed on a diet containing NK603 Roundup tolerant GM corn or given water containing Roundup, at levels permitted in drinking water and GM crops in the US, developed cancers faster and died earlier than rats fed on a standard diet. Females developed significant and numerous mammary tumors, pituitary and kidney problems. Males died mostly from severe liver and kidney chronic deficiencies.

The insecticide Bt (from the inserted genes of Bacillus thuringiensis) produced by several varieties of GM corn may create allergies and illness. Bt-toxin from genetically engineered corn sources has been found in the blood of pregnant women and their babies, as well as in non-pregnant women. Bt-toxins, which have been shown to damage human kidney cells, may cause leaky gut syndrome in newborns, the passage of undigested foods and toxins into the blood from the intestines leading to food allergies and autoimmune diseases. Also, since the blood-brain barrier is not developed in newborns, toxins may enter the brain and cause serious cognitive problems. Some health care practitioners and scientists are convinced that this is the apparent mechanism for autism.

Where does that leave us? Genetically engineered foods, derived from GM crops, have never been proven safe for human consumption but have been on the market for the last two decades. You can find a list of hidden GMO ingredients, as well as tips for avoiding GMOs, visit www.NonGMOShoppingGuide.com

There are GM corn and soy-free, and organically certified pet foods now available on the market, and websites providing recipes for home-prepared diets for companion animals (www.drfoxvet.com , www.dogcathomeprepareddiet.com and www.feline-nutrition.org) which many informed cat and dog care givers are now providing for their animals. This enlightened consumer action is an integral part of the long overdue revolution in agriculture to promote more ecologically sound, sustainable and humane farming practices, a healthier environment, and more healthful, wholesome and affordable food for all.

Pet food manufacturers that have USDA Certified Organic ingredients, and especially those that use no corn, soy, canola, cotton by-products (oil & cake) or sugar beet, — which could be genetically engineered, or imported rice (which can be contaminated with GM rice) could legitimately claim “No GMO Ingredients” on their packaging. I feel very strongly that this is a pivotal issue in the health/ food revolution, where there is no place for GM food ingredients in what we consume and feed to companion, and also to farmed -food animals. I have communicated these concerns to several responsible pet food manufacturers who are not unaware of what Hippocrates advised, — to let our food be our medicine and our medicine our food.

* The author is an Honor Roll Member of the American Veterinary Medical Association, website www.drxoxvet.com. His most recent books are Healing Animals & the Vision of One Health, and Animals & Nature First. He is co-author of Not Fit for a Dog: The Truth About Manufactured cat & Dog Food.

For further reading see: Fox, M.W. Healing Animals and the Vision of One Health. Tallevast, FL One Health Vision Press/Amazon.com 2011 and Fox, M.W., Hodgkins E., and Smart M. Not Fit for a Dog: The Truth About Manufactured Dog and Cat Food Sanger CA Quill Driver Books 2012. Smith, J.M. Genetic Roulette: The Documented Health Risks of Genetically Engineered Foods Fairfield. Iowa Yes! Books 2007.

For Supportive References: See detailed review on this topic at www.drfoxvet.com

Equine Ulcers

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When faced with a diagnosis of ulcers in their horses, many clients are shocked. “My horse could not possibly be stressed. I give him a great life.” Sound familiar? Many people think they are doing what’s best for their horses, but despite their good intentions they’re often working with the wrong information.

Stomach linings x 2

Horses are meant to graze all day, which means they produce stomach acid 24/7. They can produce up to 16 gallons of acidic fluid every day. Horses’ stomachs also have two different linings:

1. The glandular mucosa is a stronger protected lining at the bottom of the stomach where the acid sits. The glandular mucosa is where you will see ulcers from NSAID use/overuse due to decreased blood flow to the stomach lining.

2. The squamous mucosa makes up the top half of the stomach and is a non-protected lining.

These two types of stomach lining meet at the margo plicatus. This is where you most often see the beginnings of stress ulcers; as they get more severe, they can cover the whole squamous mucosa.

EGUS in horses

Equine Gastric Ulcer Syndrome (EGUS) is a very common disease. As many as 93% of racehorses , 63% of competitive horses , 51% of foals and 71% of broodmares can have them. Some of the stressors causing ulcers are competition, travel, training, trailering, limited turnout or grazing, lay up, changes in routine, and changes in herd dynamics or facility.

Symptoms you will see in EGUS horses include changes in eating and drinking behavior, weight loss and poor hair coat (usually seen in long term cases), a change in attitude, recurrent colic, and decreased or poor performance. Foals will grind their teeth or lie on their backs. Stomach pain, back pain and cinchiness are also signs.

Two types of “ulcer horses”

1. High energy and outwardly nervous horses tend to show their stress, whether through behavior, sweat, poor performance or other signs. 2. The silent sufferer is what is called the “internalizer”. These horses do not show signs or symptoms. They may simply have a poor hair coat, an inability to put on weight, or display a slight change in behavior.

Educating the client

The first step in treating stomach ulcers is helping your client understand what EGUS is. Most clients are horrified and feel a lot of guilt when they find out their horse has stomach ulcers. They feel responsible and can take it very personally. Once you start to explain how a horse’s stomach works and how it is different from a human’s, they will start to open up to the conversation .

Find the source of stress

The next step to treating stomach ulcers is finding the source of stress and helping the horse cope with whatever he is being faced with. For example, an old retired horse was moved into a new pasture and started to go downhill quickly. He lost weight rapidly and his coat became dull. After a scope, he was diagnosed with severe ulcers. All it took for him to recover was a change in pasture with other horses that let him eat and were nice to him.

In another case, a horse was kicking at his sides and biting the air when he ate his grain every night. The grain turned out to be acidic and was producing excess stomach acid, which was irritating his stomach. By changing his feed, the kicking and biting went away.

Sometimes you cannot avoid the stress that causes ulcers, as in the case of performance horses. “I believe it is difficult, if not impossible, to ask elite equine athletes to perform at their optimum level when they are suffering from EGUS,” says Dr. Wayne Browning of Bayhill Equine Clinic. For these horses, you will need to find a way to help them cope with the stress and treat the ulcers.

Treatment choices

There are many treatment options available for ulcers. Some are efficacious and some are not.

• The first option is rest. A horse’s stomach can heal itself. If he is removed from the stressful situation, he will usually heal within a month. The problem with this method is that most people do not want to turn their horses out for a month and lose that time for training or showing while they wait for the ulcers to heal.

• Many medications treat ulcers, including acid pump inhibitors, H2-antagonists, and antacids. They work to varying degrees, but the most important thing when using them is knowing how long the drug works in the system and remembering that a horse’s stomach produces acid 24 hours a day.

• There are also many natural approaches: slippery elm, aloe vera juice, licorice, papaya and more. Very little or no research has been done on the effectiveness of these treatments. Most of the information has been anecdotal.

Look at medicinal mushrooms

Mushrooms have a number of modes of action for both preventing and treating EGUS. Reishi has been shown to balance adrenal function – reducing adrenalin response to stress from travel, separation anxiety, modifications to training schedules, etc. Medicinal mushrooms contain a prebiotic platform for probiotic development and healthy mucosal flora. Powerful beta glucans unique to medicinal mushrooms activate the immune system to be “battle ready” for exposure to bacteria, viruses and contaminants.

Recent research on the super antioxidant l’ergothioneine derived from medicinal mushrooms has established that it is the only antioxidant with a cellular transport mechanism. This mechanism senses inflammation and transports l’ergothioneine into the cell to reduce free radical activity.

Medicinal mushrooms also contain high levels of B vitamins, vitamin D, digestive enzymes and proteins. Finally, Reishi is highly regarded as an adaptogen to balance behavior, promote focus and reduce hyperactivity.

As a natural whole food, dehydrated medicinal mushrooms can help treat and prevent ulcers with no potential side effects.

Prevention tactics

The last step to treating stomach ulcers is preventing them. This is a step most people forget or ignore. Just because the ulcers have been treated and healed, it doesn’t mean they won’t come back as soon as the horse is reintroduced to the stress that caused them in the first place. “In our experience, a horse that is stressed for any reason (prolonged transport, systemic illness, major husbandry change, etc.), particularly one that is inappetant, is an ulcerated stomach waiting to happen,” says Dr. Jill Higgins of Loomis Basin Equine Medical Center. “Keeping these horses eating, decreasing stress as much as possible, and being proactive in prevention are key.”

Reducing stress and using natural solutions like medicinal mushrooms will provide the horse with a well rounded prevention plan. Other ways to help prevent stomach ulcers include having a full hay net available to the horse at all times, to promote “grazing”, or feeding him more frequently during the day. If you have an easy keeper and feeding hay all day is not an option, try soaking the hay in water prior to putting it in a hay net. This will help decrease the calories.

Without prevention or removing horses from stressors, the patients you have treated will get ulcers again. This is an important message to stress to clients. It will keep your patients ulcer-free and their owners happy.

Kitchen DL, Merritt AM, Burrow JA. Histamine-induced gastric acid secretion in horses. AJVR 1998; 59(10): 1303-1306. Murray MJ, Schusser GF, Pipers FS, Gross SJ. Factors associated with gastric lesions in thoroughbred racehorses. Equine Vet J 1996; 28:368-374. Mitchell RD, Prevalence of gastric ulcers in hunter/jumper and dressage horses evaluated for poor performance. Association for Equine Sports Medicine, September 2001. Murray MJ, Endoscopic appearance of gastric lesions in foals; 94 cases (1987-1988). JAVMA 1989;195(8): 1135-1141. Le Jeune SS, Nieto JE, Dechant JE, Snyder JR. Prevalance of thoroughbred broodmares in a pasture: A preliminary report. The Veterinary Journal September 2009;181(3):251-255.

A demonstration they’ll remember

One trick to use when explaining stomach ulcers to clients is a plastic Ziploc bag. Draw a line 2” from the bottom of the bag. Explain the two types of stomach lining.

Then pour a liquid in the bag to just below the line you have drawn. When a horse is in training, his stomach shrinks: grab the bottom of the bag so the liquid rises above the line or “margo plicatus” into the “squamous mucosa”.

Then show what happens during times of stress by simply adding more liquid to the bag — when horses are stressed they produce more stomach acid.

Lastly, show what eating roughage does to help the situation: pour a bunch of shavings from the stall into the bag and watch the liquid be absorbed back down below the line. This is a very visual way to teach your clients about the equine stomach and how it works.

Jenna Hahn is Director of Marketing and Animal Health Sales for Matrix Healthwerks. Her professional experience includes the pharmaceutical industry, veterinary practice outreach, small start-up animal health companies, on-line equine development, work with competition managers, horse trainers and more. After graduating from University of CA, Davis with a double major in economics and organizational sociology, Jenna worked for Hill’s Science and Prescription Diets. She is very active in the veterinary industry where she has spent most of her career working with veterinarians and their staff to help improve the quality of life for animals. Jenna has been an avid show jumper her whole life.

Rethinking Equine Vaccinations – Part 2

In the first part of this series, we discussed the benefits and potential side effects of vaccinations, which provide an important means of protecting animals and people from clinically important infectious diseases. We also introduced the changing paradigm of vaccination in veterinary medicine. What impact has this change had over last decade on the way we approach this preventive health measure?

A recent survey of the profession indicated that some veterinarians were initially apprehensive about the recommendation to extend the timeframe for boosters from one to every three years or even less frequently. While clinicians wanted to offer what was best for the animals, they were concerned about the lost incentive for clients to visit them annually when vaccinations were not needed. However, partly because of the emerging documentation about adverse reactions associated with routine vaccinations, veterinarians accepted that they needed to address these concerns with their clients. Today, a decade later, the public has generally embraced the concept of having their animals seen annually for wellness examinations as well as during periods of illness.

But while this paradigm shift has been well accepted in small animal practice, relatively little emphasis has been directed towards horses. Hopefully, increased efforts will be made to incorporate the newer science and concepts about vaccination into equine medicine. But in the meantime, it’s more important than ever for us to become as informed as possible about our equine patients’ vaccine requirements. Let’s take a closer look at what clinical studies say about equine herpes, influenza and encephalitis viruses, keeping in mind that very little research has been done on the effectiveness of titers to help prevent over-vaccination.

1. Equine herpes viruses

Five distinct herpes viruses (EHV) are known to infect horses. Two of them, EHV-1 (also known as equine abortion virus) and EHV-4 (also known as equine rhinopneumonitis virus), are major causes of abortion and respiratory disease. Recent outbreaks of EHV-1 infection have caused neurological disease at raceways, horse shows, farms and clinics in several areas of North America, with many cases of illness and a few deaths.

In addition to abortion in infected mares, EHV-1 strains can cause respiratory disease, although many times horses incubating the virus will only exhibit fever. The virus can be shed from nasal secretions, and stress can precipitate illness. That’s why it’s not unusual to see outbreaks where horses feel stressed, such as at racetracks. Horses exhibiting neurological signs often harbor high viral loads in their blood and nasal secretions, and can transmit the disease to other exposed horses. To control the disease, it’s crucial to separate and isolate the sick animal from the rest of the herd. Diagnostic testing for EHV-1 using the PCR (polymerase chain reaction) is useful to establish exposure in the presence of clinically relevant disease.

The vaccines

Both activated (killed) and modified-live (MLV) herpes virus vaccines are available, as single or combination (EHV-1 + EHV-4) vaccines. As mentioned in Part 1 of this series, a recent comparison of killed and MLV EHV-1 vaccines found the latter offered superior protection when tested in an aerosol challenge.

Because of the severity and endemic spread of EHV, many equine veterinary groups recommend serial vaccination for EHV in pregnant mares, and booster vaccinations every six to 12 months. I would recommend weighing a mare’s risk of exposure and serious disease during a viral outbreak before following this course of action. However, many show horses and some racehorses are vaccinated every two to three months, even though there is no evidence that this prevents the disease. There is no immunologic reason to vaccinate this frequently and there is compelling anecdotal evidence that horses on this heavy a vaccine schedule have weakened immune systems.

The titers

Vaccine titers for EHV-1 and EHV-4 are available. Existing data indicates that serum antibody levels in vaccinated horses can last six to 12 months, especially if an MLV product is used. A serologic titer can assess levels of residual antibody if the horse recovered from a natural case of EHV infection.

2. Equine influenza virus

They are two types of equine influenza virus (EIV): H7N7 (subtype 1) and H3N8 (subtype 2). The horse influenza viruses evolved from avian influenza viruses, and the recent appearance of clinically significant canine influenza apparently resulted from a mutation of the equine H3N8 virus.

Equine influenza is endemic throughout North and South America and Europe, and is considered the most important viral respiratory disease of horses. Disease is characterized by fever, depression, coughing, and a nasal discharge, which develop one to five days after infection, and is occasionally complicated by secondary bacterial infections that may lead to pneumonia and death. Due to the short incubation period and resulting persistent cough, the disease can spread rapidly. In the past two decades, all major outbreaks of EIV have involved the H3N8 subtype.

The vaccines

Continually mutating influenza viruses in people and animals, including horses, means we need to regularly update the vaccines in order to maintain their efficacy. Researchers say this “antigenic drift” is partially responsible for the previous failures of equine influenza vaccines to protect horses. So what’s changed to improve the efficacy of the vaccine?

Until recently, influenza vaccines were the inactivated type. These produce relatively short-lived immunity and poor protection rarely lasting beyond six months. As well, a critical lag time (immunity gap) between the completion of the initial two doses of vaccine and the recommended booster at 12 months resulted in vaccine failure.

Newer approaches to vaccination were obviously needed and resulted in the development of the MLV intranasal and recombinant viral vectored and naked DNA vaccines. The advertised intranasal MLV vaccines state efficacy for up to six months or a year, with a decrease in the severity of disease after challenge at one year. Studies with recombinant canarypox vectored (rCP-EIV) vaccine showed that two boosters protected ponies from viral challenge and that a third booster dose provided immunity for at least one year thereafter. Thus, rCP-EIV vaccine effectively closes the immunity gap between the initial and one-year booster timeframe.

Once again, you need to consider the horse’s exposure to this serious disease. Performance horses will undoubtedly be more at risk, while “backyard” horses with strong immune systems will most likely be better equipped to recover naturally, especially if no secondary infection develops.

Influenza vaccines are available as single vaccines or in combination with herpes virus, encephalitis, and/or tetanus vaccines. While some manufacturers state that these polyvalent vaccines are safe for horses, ponies, pregnant mares, sucklings, weanlings and yearlings, vaccination of pregnant and very young animals should be done with caution and preferably only in the case of disease outbreaks. Clinically, the injectable vaccines produce significantly more immediate vaccine reactions than the intranasal, though some horses appear to become headshakers following the intranasal.

The prevalence and severity of equine influenza has prompted many vets to routinely vaccinate. Show and racehorses are frequently done on the same two- to three-month schedule as EHV. However, in older horses, vaccination has been associated with vasculitis and purpura (bruising), as well as dysbiosis (disruption of normal body functions leading to colic, laminitis and founder) so it’s important to carefully consider the pros and cons of vaccinating an older horse. Heavily vaccinated horses appear more likely to develop a chronic cough after an EIV infection (which can still occur in frequently vaccinated horses).

The titers

While serum titers for EIV are available, the short-lived duration of immunity from vaccination or natural disease makes their measurement of little use. Experience with rechecking titers over many years of practice indicates that the titer levels, though low, are persistent, which may indicate there is more residual duration of immunity than is shown by the limited available research

3. Equine encephalitis viruses

Eastern encephalitis virus (EEE), Western encephalitis virus (WEE), and Venezuelan encephalitis virus (VEE) are all mosquito-transmitted viruses that occur in North and South America. They spread rapidly and cause epidemics of neurological disease that require effective prevention and control strategies.

The vaccines

Available vaccines are of the inactivated killed virus type, as well as more recently developed MLV vectored vaccines. General recommendations are to give two doses of combination encephalitis vaccine 30 days apart followed by annual or biannual boosters. One of the newest vaccines uses recombinant canarypox-vectored vaccine technology. Dr. Madalyn Ward, a holistic equine veterinarian, recommends giving the two combination encephalitis/tetanus vaccinations at five to six months of age followed by a booster every three years, or sooner in the face of an outbreak. Dr. Ward also recommends using caution when vaccinating older horses, in particular those over 15 years of age. Dr. Joyce Harman recommends checking the prevalence of WNV in your state or area and making a decision based on need, as many states have very few or no cases, while certain localities continue to have cases each year.

The titers

Vaccine titers for all three types of equine encephalitis are available and offer a good indication of the immune status of the horse.

Being aware of the common infectious diseases that affect horses, and what your patients’ risk factors and options are, is your best line of defense against unnecessary over-vaccination.

What about Lyme disease?

Currently, there are no approved equine Lyme vaccines, although some veterinarians are using canine vaccines. The new Lyme multiplex blood test from Cornell may be able to differentiate between horses that have had a Lyme vaccine and ones that have been naturally exposed. However, Lyme tests are still open for interpretation and the vaccines may or may not work or be safe.

Factors that may affect vaccination

Ask yourself these questions before finalizing a vaccination program for a patient. He may need fewer vaccines than you think. 1. Is he a performance horse that attends a lot of shows/events, or more the stay-at-home type? 2. Does the client have her own acreage or is the horse boarded at a big facility where there’s more risk of exposure? 3. Does the client support the horse with a natural diet and supplements so he has a better chance of fighting off infection? 4. What is the horse’s age? 5. How is his overall health? 6. Which diseases are prevalent in your area?


References

Boone TJ. “Respecting equine herpes virus-1”. Calif Vet 61(2):18-19, 2007.

Desmettre P. “Diagnoses and prevention of equine infectious diseases: present status, potential, and challenges for the future”. Adv Vet Med 41:359-375, 1999.

Goodman LB, Wagner B, Flaminio MJ et al. “Comparison of the efficacy of inactivated combination and modified-live virus vaccines against challenge infection with neuropathogenic equine herpesvirus type 1 (EHV-1)”. Vaccine 24:3636-3645, 2006.

Minke JM, Toulemonde CE, Coupier H, et al. “Efficacy of a canarypox-vectored recombinant vaccine expressing the hemagglutinin gene of equine influenza H3N8 virus in the protection of ponies from viral challenge”. Am J Vet Res 68:213-219, 2007.

Rosenthal M. “Practitioners concerned about safety, embracing new vaccine recommendations”. Product Forum & Market News, Spring 2007

Tizard I, Ni Y. “Use of serologic testing to assess immune status of companion animals”. J Am Vet Med Assoc 213: 54-60, 1998.

Townsend HG, Penner SJ, Watts TC, et al. “Efficacy of a cold-adapted, intranasal, equine influenza vaccine: challenge trials”. Equine Vet J 33:637-643, 2001.

Dr. Jean Dodds, DVM, received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she moved to southern California to establish Hemopet, the first non-profit national blood bank program for animals. Dr. Dodds has been a member of many national and international committees on hematology, animal models of human disease, veterinary medicine and laboratory animal research. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1984.

Rehabilitation for senior cat diagnosed with chronic lubosacral disk disease

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SIGNALMENT: “George” Meyer
16 years
Domestic long hair
Male
neutered
Life style: House cat

HISTORY: George was adopted at 4-6 weeks of age. He needed to be hand fed kitten milk replacer. He has been generally healthy until three years ago when he was diagnosed by a kidney specialist with chronic renal failure. He is on a prescription low protein diet. He is currently taking Buprenorphine as needed for his back pain and daily lactulose for constipation.

The owner noticed about 1 year ago that George was not jumping up on the furniture as much. Approximately six months prior to the diagnosis, the owner noticed that George was hesitating before jumping. And approximately 2 months prior, the owner noticed constipation and occasional slipping on the hind end. Lactulose improved the constipation but the slipping in the rear progressed to left rear limb paresis with decreased range of motion and muscle atrophy. He also lost one pound. At home he was slightly ataxic in the rear and falling down on smooth surfaces but was still jumping on the couch. George would fall onto the hardwood floors while playing but would slowly get up on his own. Recently, George had a dental with his primary care veterinarian. Shortly thereafter, he started dragging his left rear leg and limping. The veterinarian took x-rays and then referred him to a neurologist. The neurologist diagnosed George with L7-S1 disc protrusion and sacral nerve root compression with rear limb neuropathy. They found gluteal atrophy, plantigrade stance of the left hind limb, decreased hemihopping and hemistanding on the pelvic limbs, decreased cranial tibial reflex on the left and right hind limb, decreased patellar reflex on the left rear. MRI scan of thoracolumbar and lumbosacral spine revealed Type II disk protrusion at L7-S1 disk space with moderate midline sacral nerve root compression. Their diagnosis was chronic lumbosacral disk disease. Nerve conduction testing was done and there were some changes which were most likely secondary to chronic renal disease and age. The options given to treat George were surgery with post op rehab versus long term prescription pain management. The kidney specialist was consulted and concluded that George was an anesthetic risk due to the renal pathology; so medical management was pursued with Buprenorphine on a regular basis. The owner was instructed to discourage jumping at home, carry him up/down the stairs, and 3 weeks of semi-confinement .

EVALUATION: Observation: Lying on the exam table, George was alert and nervous but he did not appear to be distraught. He had visible bilateral muscle atrophy of the pelvic limbs. His Body Condition Score was 4/9. Girth measurements: right thigh 19.5 cm and left thigh 19 cm taken while cat was standing with minimal support and somewhat crouched. Gait Assessment: hard to assess gait because pet is timid and unwilling to move around the exam room. He had a crouched gait in the rear. No obvious knuckling/dragging. The tail was in a neutral position and not limp. Passive Range Of Motion: George had normal range of motion of the pectoral limbs. He was guarding extension of his right coxofemoral joint and seemed uncomfortable with manipulation of this limb. He seemed uncomfortable and moved away at end extension of the left coxofemoral joint. His hocks and stifles had normal range of motion. His lower lumbar vertebrae were less mobile. The lumbosacral region was sensitive to dorsoventral digital pressure and the cat would try to sink/collapse underneath the pressure. Neurological Testing: postural reflexes were hard to assess since the cat was uncooperative. He had normal pain withdraw in the pelvic limbs. The cranial tibial and patellar reflex were a little decreased on the right rear compared to the left. He was reactive to palpation of the proximal aspect of the left sciatic nerve cranial to the ischiatic tuberosity. Bilaterally he had slow CPs of the pelvic limbs with the left worse than the right. Pain Assessment: Overall I rated George at a 6 out of 10 using the pain assessment scale from Mathews, K.A., Pain assessment and general approach to management, Management of Pain, The Veterinary Clinics of North America, Small Animal Practice, July 2000, p. 729-755. The left rear sciatic nerve and sacrum were reactive to palpation and I rated these areas 8 out of 10 on the same pain scale.

GOALS : The client goals were to manage pain and improve the quality of life. The rehab goals were to decrease pain and inflammation, increase muscle mass/strength of the pelvic limbs (taking into consideration his debilitating kidneys disease), increase range of motion, tonify the nervous system, improve and restore functional daily activities, and resolve any compensatory issues.

TREATMENT PLAN: A 6 week rehab treatment plan was designed which consisted of Low Level Laser therapy (icing the areas pre and post treatment to his lumbar vertebrae, lumbosacral joint, coxofemoral joints and proximal sciatic nerve routes along with acupuncture twice a week for 3 weeks, then once a week during week 4,5, and 6. Veterinary Chiropractic once during week 3 and 6. Underwater Treadmill twice a week starting on the third week. Home Therapeutic Exercises during week 3. The exercises chosen would focus on balance and coordination such as Cavalettis, figure 8s, balance board or disk, weight shifts and diagonal leg lifts, standing and walking on foam blocks or cushions/mattress, and peanut physioball therapies. A combination of the above exercises for 5 minutes 1-2 times a day 4-5 times per week and then slowly work up to 10 minute sessions. The owner was instructed to finish with ice on lower back for 10-15 minutes. The pet’s cooperation dictates the techniques chosen. Treatment Plan Progress Exam with the prescriber during week 3 and 6 to re-assess and re-evaluate.

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OUTCOME: George tolerated the first three weeks of his therapies and was more tolerant with digital pressure at the lumbosacral region. He allowed gentle palpation, manipulation, and some range of motion of both rear limbs. According to the owner, he became more mobile around the house. He was more willing to walk around the exam room but still had a slightly crouched stance. His CPs in the rear were still slow but equal timing. He was defecating more regularly. On the fourth week of therapies we added hydrotherapy and home therapeutic exercises while tapering off the laser and acupuncture treatments. George went into the underwater treadmill with a veterinary technician certified in rehabilitation. The technician sat on a bench in the tank while guiding the cat donned with a life vest to walk through the six inch water. George was very nervous at first in the UWTM but once he was surrounded by water and the treadmill was turned on he started walking immediately. No dragging of the rear limbs at all. In general his gait was stilted on the right rear and he placed his left rear lighter and leaned off the left rear more. The client was instructed to start some home therapeutic exercises with leg lifts, weight shifts, and walking on foam, pillows, couch cushions, along with post exercise icing on the days that he did not have hydrotherapy.

George continued to slowly improve. The owner reported that he would be somewhat tired after longer hydrotherapy sessions but was much more active once he recovered. Less and less pain medication was required. The more advanced home therapeutic exercises like cavalettis and the physioball were not all that successful because George was a cat and not very motivated to be told what to do. The owner would compromise and play with him by chasing string and a laser light. Also, with our advice she assisted him to go slow up and down the stairs once a day. He was defecating regularly without difficulties so the lactulose was discontinued.

At the 6 week recheck George looked and felt a lot better. He was walking around the exam room tall and proud with the tail up. He still had a stilted gait in the rear but he was definitely less ataxic and more coordinated. His thigh measurements were 20cm on the left and 20cm on the right. No more pain at the L-S junction. He had better overall range of motion of his coxofemoral joints but was still tight on end extension of his left hip. His CPs in the rear were not as slow and more even. The sciatic nerves on both sides were calm when palpated. His pain score was 2 out of 10. He had gained two pounds since the initial visit.

At the end the client, my staff, George, and I were very happy. Unfortunately, George’s kidney values continue to increase and he will eventually succumb to the chronic disease. But, at present his quality of life is great for an old man!

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

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.

Water

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

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

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

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

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

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.