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Strategies for managing pancreatitis in small animals

Herbal medicines and low-fat meat and vegetable diets can prevent pancreatitis in dogs and cats, and can also be used to resolve acute and chronic stages of the disease. 

Pancreatitis is commonly diagnosed and treated in small animal veterinary medicine. However, its causes and pathophysiology remain poorly understood, except to say that it is usually a sterile condition. The acute end of the disease spectrum is associated with high mortality, although there is good potential for complete recovery of organ structure and function if the animal survives. At the other end of the spectrum, chronic pancreatitis in either dogs or cats can cause refractory pain and progressive exocrine and endocrine functional impairment.1 Despite the importance of pancreatitis as a clinical syndrome, almost no trials of diets or drugs exist for its treatment and prevention, except for the critically ill patient. The prescription of low-fat kibble and canned foods, although common, is largely untested. Thus, any attempt to formulate an evidence-based approach to pancreatitis, whether using drugs, diet or natural therapies, must begin with a review of the current understanding of the disease’s pathophysiology. There is confusion in the veterinary literature about the definitions of acute and chronic pancreatitis, and there are very few studies on the pathophysiology of naturally-occurring pancreatitis in dogs and cats. But enough laboratory evidence has accumulated to formulate a likely model of pathogenesis.

Pathophysiology of pancreatitis

Part of the confusion surrounding pancreatitis may stem from the fact that the conditions that incite it vanish once the organ has become inflamed. Nitric oxide (NO) and its impact on micro-circulation appear to play a pivotal role in the pathogenesis of the condition.2,3 The onset of pancreatitis is marked by a lack of NO, whereas the acutely inflamed state is marked by an abundance of NO. Preventing and treating pancreatitis thus require almost opposite approaches. The role of the gut is also being explored as a source of oxidative stress which aggravates existing pancreatic inflammation.

Role of nitric oxide and endothelial dysfunction

There are two types of NO germane to the pathogenesis of pancreatitis:4
  • Inducible nitric oxide – of importance in the progression of pancreatitis
  • Endothelial – of relevance in the initiation of pancreatitis
Inducible NO is found in the pancreas parenchyma, where it regulates normal pancreatic exocrine secretion,5 both by boosting pancreatic microvascular blood flow and by directly regulating enzyme secretion. Normally, its presence is key to a properly functioning pancreas. When pancreatitis is in full swing, however, inducible NO levels are high. The pancreas becomes engorged with blood and edematous, enzymes are disgorged, and the pancreas becomes congested. Meanwhile, the strong free radical activity of NO further heightens inflammation, making NO an important target for future pharmaceuticals in the treatment of acute pancreatitis. The heightened levels of NO and blood flow during pancreatitis are in opposition to the state of reduced micro-circulation and NO levels that trigger pancreatitis to begin with.6 Before acute pancreatitis develops, there is:
  • Impairment of pancreatic micro-circulation in the early phase
  • Reduced blood flow
  • Increased platelet adhesion and clot formation.
These events are caused by a reduction of endothelial NO in the vasculature of the pancreas; this is known as endothelial dysfunction (ED). ED promotes the initiation of inflammation because of its associated:
  • Increased vascular permeability
  • Increased leukocyte-endothelial cell adhesion and leukocyte egress.
Experimental evidence supports the notion that a lack of endothelial NO, causing associated ED, is what triggers pancreatitis. Endothelial NO synthase reduces the severity of the initial phase of experimental acute pancreatitis.4 NO synthase inhibition by pharmaceuticals has been shown to trigger acute pancreatitis.7 In short, then, to support endothelial NO levels is to prevent ED; and to prevent ED is to prevent pancreatic inflammation. To resolve chronic pancreatitis, and to prevent its incidence in the first place, clinicians need to focus on the cause of ED. For the most part, ED in small animals is caused by diet.

Diabetes, insulin resistance, and endothelial dysfunction

Veterinarians are used to thinking of pancreatitis as a cause of diabetes mellitus (DM), through the destruction of beta-islet cells. Diabetes mellitus is also an important precursor to pancreatitis, however, and not just a sequela.8 Diabetes often precedes pancreatitis because it is linked to ED. In Type 1 diabetes, ED is consistently found in advanced stages of the disease. For Type II diabetes, ED may even precede it.9 Both types of diabetes are the by-product of insulin resistance. Insulin resistance alters gene expression for a number of pathways known to culminate in ED, including:
  • Increased secretion of pro-inflammatory cytokines
  • Decreased secretion of adiponectin from adipose tissue
  • Increased circulating levels of free fatty acids
  • Post-prandial hyperglycemia.
At the same time, insulin resistance promotes diabetes. Once diabetes is present, increased intracellular concentrations of glucose metabolites in endothelial cells heighten their dysfunction by:
  • Impairing mitochondria function
  • Increasing oxidative stress
  • Activating protein kinase C, causing a halt in endothelial nitric oxide production.
The upshot of chronic insulin resistance is that:
  • Endothelin levels increase
  • Endothelial NO levels drop
  • Vessels constrict
  • White blood cells adhere to and move across blood vessels into the pancreatic interstitium
  • Platelets adhere to endothelial cells to form clots, aggravating any tendencies to hypoxia.
Subclinical pancreatitis can now begin and the animal is also more prone to severe acute episodes. Insulin resistance and subsequent ED are important targets for intervention in resolving chronic pancreatic inflammation, and preventing future episodes. While several herbal formulas can target these self-same pathways, instituting an appropriate diet will help guarantee lasting success in managing these cases.

Preventing pancreatitis with diet

Typically, veterinarians think to limit only fat intake in the animal’s food, but insulin resistance, obesity and a heightened predisposition to pancreatitis are not caused by high fat intake alone. Processed starch-based canned and kibble diets are arguably the most common cause of insulin resistance in veterinary medicine. Pancreatitis becomes a rare event when these diets are avoided. Commercial canned and kibble diets are rapidly absorbed and frequently carbohydrate-based, provoking a surge in post-prandial glucose that leads to chronically high insulin levels and eventually insulin resistance, with its attendant sequelae, including a systemic tendency to inflammation, including in the pancreas. Insulin resistance does not just result in diabetes mellitus, and can be presumed to be present in all overweight animals. In the author’s experience, a minimally processed (raw or homemade) balanced diet of meat and vegetables is of the most benefit in preventing pancreatitis in carnivores. Pancreatitis seldom occurs in animals fed these diets. Once acute pancreatitis is present, however, the familiar recommendation of nothing-per-os (NPO) applies.

Chinese herbs for pancreatic ailments

Targeting insulin resistance – Damp Heat formulas

Three Seeds Combination (San Ren Tang) Three Seeds Combination has a clinical reputation for reversing insulin resistance and Type II diabetes mellitus, particularly in the feline. Coix markedly increases insulin sensitivity and has been shown to reduce adipose tissue weight, leptin and insulin levels.10 The formula is anti-inflammatory, but also reduces predisposition to ED, thus helping to both resolve chronic pancreatitis and reduce the risk of future episodes. Animals needing this formula often have a wet, swollen and lavender tongue, although it can also be a mild red color. The pulse is usually deep and toned. Four Marvels Combination (Si Miao San) This formula is used to manage acute pancreatitis, whether mild or severe. It increases insulin sensitivity and studies have verified its benefits in pancreatitis through its antioxidant effects.11 The patient that benefits from Si Miao San has a tendency towards acute inflammation, oxidation and associated insulin resistance, usually manifesting as inflammation at multiple epithelial surfaces (especially the ears, skin, colon, biliary tree and bladder). Signs of Cushing’s can also occur. The tendency to acute inflammation is marked by a superficial and toneless pulse. The tongue is often red or purple-red.

Targeting endothelial dysfunction

Minor Bupleurum Minor Bupleurum interferes with the production of cytokines that promote ED.12 It is most helpful in resolving sub-acute to chronic pancreatitis, especially when due to systemic infection or immune dysregulation. These cases will often have inflammation manifesting in other organs, especially the liver and kidneys (as glomerulonephritis), but also including the eyes (glaucoma, uveitis), lungs (pneumonia, pneumonitis), nervous system (disc disease, vestibular disease), and even the skin. Occasionally, the animals have a prior history of cancer. Animals benefiting from Minor Bupleurum almost invariably have deep, toned strong pulses. One or more vagal symptoms are common, including chronic cough, vomiting, bloating and constipation. Glehnia and Rehmannia Glehnia and Rehmannia Combination, known also as Yi Guan Jian, contains two plants, Angelica and Rehmannia, that counter ED to restore normal micro-circulation and actively resolve chronic inflammation in a number of tissues.12 The formula is contraindicated in acute active pancreatitis, since the organ is now severely congested and edematous. It can resolve mild low-grade pancreatitis, and prevent recurrences. Animals that benefit from this formula have reduced circulation to epithelial surfaces, creating dryness, mild gastric inflammation, and irritable bowel syndrome. Animals often display mild to moderate liver enzyme elevations; older animals may have mild to moderate azotemia. Anemia and chronic weight loss may be present, as well as a tendency to timidity or anxiety. The pulse is often thin and the tongue pale, perhaps with a lavender center.

Targeting bacterial causes

Agastache Combination (Huo Xiang Zheng Qi San) Patients often have Damp Heat tendencies, yet do not respond to San Ren Tang and Si Miao San. Huo Xiang Zheng Qi San should be considered next, in case bacteria are inciting the inflammation. Agastache is a strong antimicrobial formula with a broad spectrum of effect against many species of viruses, nematodes, fungi and bacteria.13,14,15 Agastache also interferes with cell adhesion,16 thereby reducing white blood cell ingress into the interstitium, and subsequent inflammation. Consider this formula for chronic pancreatitis in young animals, especially if the disease is, or has been, associated with chronic refractory small bowel diarrhea or suspected small intestinal bacterial overgrowth.

Using herbs — administration via enema

While injectable forms of herbal medicine are not yet available for the NPO patient, quantities of the appropriate formula can be delivered to an acutely ill dog via enema. A patient’s response to an herbal formula delivered by enema is often rapid and dramatic, with enzyme elevations subsiding significantly and the patient stabilizing within a couple of days. Compounds in the formulas are absorbed across the large intestine mucosa into the portal circulation, and from there move rapidly to the systemic circulation, bypassing any gastroparesis. Method
  • Use two to three times the normal dose for the patient (see chart on page xx), and give TID to QID.
  • Suspend each dose in a maximum of 10 ml to 15 ml of warm water.
  • Instill into the transverse colon using a small rubber French feeding tube.
  • Use only granular extracts or crushed tablets, never liquid extracts, for administration via enema.
All the formulas in this article can be obtained in various formats from nphc.ca. Much more detail on veterinary clinical uses of these and other products can be obtained from the College of Integrative Veterinary Therapies, and from the Essential Guide to Chinese Herbal Formulas: Bridging Science and Tradition (S Marsden, 2014, published by CIVT).

Oral dosing

Weight (kg) Weight (lbs) BID dose (mls) BID dose (550 mg tabs) BID dose (tsp granular extracts)
4 10 0.30 1.00 0.25
8 20 0.45 1.50 0.50
12 25 0.60 2.00 0.75
23 50 0.90 3.00 1.00
32 70 1.20 4.00 1.50
/5 150 1.80 6.00 2.00
120 250 2.40 8.00 3.00

Case example: Falco Teefy

Falco is a nine-year-old male neutered Border Collie cross who presented with a chief complaint of pancreatitis. Recent history included removal of an infiltrative lipoma from the caudal thorax, and episodes of a nocturnal hacking cough ending in the vomiting of foamy material. The pancreatitis seemed to gear up over a long period, with nausea, vomiting and pica occurring since the summer of 2016; it did not respond to antacids or anti-emetics. A protocol was eventually settled on, consisting of 0.2 mg/kg prednisone, a round of metronidazole and milk thistle. Two herbal formulas, Yi Guan Jian and San Ren Tang, were also initiated. Falco de-stabilized in October of 2016 when herb use became less consistent. Yi Guan Jian alone was resumed along with metronidazole and continued prednisone use. Although Falco seemed at first to improve again, he had to be hospitalized in November for pancreatitis. Clinical signs at that time included lethargy, fever, diarrhea and abdominal pain. ALP was increased to several times the normal value, and an enlarged liver was seen on ultrasound. A snap test showed a strong positive result for CPL and pancreatitis. Physical examination showed strong-toned mid-depth pulses that responded well to acupuncture of prominent Gall Bladder channel points. In addition to acupuncture, Falco was given anti-emetics, fluid therapy, hydromorphone and the typical low-fat bland processed diet. A derivative of Minor Bupleurum was introduced as the new herbal formula. [caption id="attachment_3848" align="alignleft" width="300"] Response of Falco’s ALP and CPL to Minor Bupleurum[/caption] Falco gradually improved over the next two weeks, but had no appetite for a bland diet, so a low-fat processed kangaroo diet was fed instead. Improvements in laboratory data steadily accrued even as improvements in symptoms were more erratic. Over the long term, prednisone was discontinued, and the combination of Minor Bupleurum and Three Seeds Combination proved sufficient to eradicate all symptoms. This use of herbs continues to date, as does the processed kangaroo diet.

Case discussion

It is common for veterinarians to manage problems in an integrative fashion, using both herbs and drugs together. In Falco’s case, the low doses of prednisone would have favored insulin resistance and ED, but were successfully countered with Yi Guan Jian and San Ren Tang, two formulas for chronic GI inflammation. When first one and then the other of these formulas were discontinued, the negative effects of the prednisone were no longer countered, and the pancreas erupted with inflammation, fueled by a high-fat, albeit raw diet. Minor Bupleurum was the main intervention that arrested symptoms and disease progression in Falco. Its use was indicated by the characteristic pulse, history of cancer, nausea, and the history of a chronic cough that ended in vomiting. Herb use should be continued as long as processed diets are fed, to counter the latter’s tendencies to promote inflammation and ED. The author acknowledges the contributions to this case study of Jana Teefy, AHT, RLAT, and Jennifer Marshall, BSc, DVM, both of Edmonton Holistic Veterinary Clinic.

Conclusion

Pancreatitis can be prevented in carnivores by using herbal medicines and low-fat meat and vegetable diets. Once these therapies are instituted, episodes of pancreatitis consistently cease. Herbal formulas may also be used to resolve acute and chronic stages of the disease, and work along with diet to eliminate the inciting factor of recurrent and chronic pancreatitis -- reduced endothelial nitric oxide. _________________________________________________________________ 1Watson P. “Pancreatitis in dogs and cats: definitions and pathophysiology”. J Small Animal Practice. 2015 Jan; 56(1):3-12. 2Mansfield C. “Acute pancreatitis in dogs: advances in understanding, diagnostics, and treatment”. Top Companion Anim Med. 2012 Aug; 27(3):123-32. 3Mansfield C. “Pathophysiology of acute pancreatitis: potential application from experimental models and human medicine to dogs”. J Vet Intern Med. 2012 Jul-Aug;26(4):875-87. 4DiMagno MJ. “Nitric oxide pathways and evidence-based perturbations in acute pancreatitis”. Pancreatology. 2007;7(5-6):403-8. 5Yago MD, Mañas M, Ember Z, Singh J. “Nitric oxide and the pancreas: morphological base and role in the control of the exocrine pancreatic secretion”. Mol Cell Biochem. 2001 Mar;219(1-2):107-20. 6Sunamura M, Yamauchi J, Shibuya K, Chen HM, Ding L, Takeda K, Kobari M, Matsuno S. “Pancreatic microcirculation in acute pancreatitis”. J Hepatobiliary Pancreat Surg.1998;5(1):62-8. 7Poulson JM, Dewhirst MW, Gaskin AA, Vujaskovic Z, Samulski TV, Prescott DM, Meyer RE, Page RL, Thrall DE. “Acute pancreatitis associated with administration of a nitric oxide synthase inhibitor in tumor-bearing dogs”. In Vivo. 2000 Nov-Dec;14(6):709-14. 8Davison LJ. “Diabetes mellitus and pancreatitis -- cause or effect?” J Small Anim Pract. 2015 Jan;56(1):50-9. 9Rask-Madsen C, King GL. “Mechanisms of Disease: endothelial dysfunction in insulin resistance and diabetes”. Nat Clin Pract Endocrinol Metab. 2007 Jan;3(1):46-56. 10Huang BW, Chiang MT, Yao HT, Chiang W. “The effect of adlay oil on plasma lipids, insulin and leptin in rat”. Phytomedicine. 2005 Jun;12(6-7):433-9. 11Shang SW, Yang JL, Huang F, Liu K, Liu BL. “Modified Si-Miao-San ameliorates pancreatic B cell dysfunction by inhibition of reactive oxygen species-associated inflammation through AMP-kinase activation”. Chin J Nat Med. 2014 May;12(5):351-60. 12Marsden S, Dodds J. “Chinese herbal medicine in autoimmune disease: case reports and speculated mechanisms of action”. JAHVMA, 2015 Winter; 38(31-37). 13Yang JL, Wang JL, Huang F, Liu K, Liu BL. “Modified Si-Miao-San inhibits inflammation and promotes glucose disposal in adipocytes through regulation of AMP-kinase”. Chin J Nat Med. 2014 Dec;12(12):911-9. 14Fan J, Liu K, Zhang Z, Luo T, Xi Z, Song J, Liu B. “Modified Si-Miao-San extract inhibits the release of inflammatory mediators from lipopolysaccharide-stimulated mouse macrophages”. J Ethnopharmacol. 2010 May 4;129(1):5-9. 15Luo TJ, Wang KZ, Zhao WW, Shang SW, Ye LF, Liu K, Liu BL, Huang F, Wang X. “Modified Si-Miao-San regulates adipokine expression and ameliorates insulin resistance by targeting IKKβ/Insulin receptor substrate-1 in mice”. Chin J Integr Med. 2014 Apr 16. 16Zielińska S, Matkowski A. “Phytochemistry and bioactivity of aromatic and medicinal plants from the genus Agastache (Lamiaceae)”. Phytochem Rev. 2014;13:391-416.
 
Digestive enzymes in dogs and cats

Supplementing with digestive enzymes can enhance the health and well-being of our canine and feline patients in many crucial ways.

"Man is not nourished by what he swallows, but by what he digests and uses,” wrote Hippocrates. This is true for all creatures, including dogs and cats – and an important part of what determines that nourishment involves digestive enzymes.

Two enzyme categories

1. Metabolic enzymes are present in every cell, tissue and organ in the body, and act as biochemical catalysts in the moment-to-moment function of living cells. They are responsible for keeping the body in proper balance by controlling virtually every chemical reaction associated with metabolism. Because of this, metabolic enzymes are the very basis of the life process. 2. Digestive enzymes, the primary focus of this article, can be separated into intrinsic and extrinsic enzymes. Intrinsic digestive enzymes are those the body manufactures and secretes to break down food. The salivary glands in the mouth, the gastric glands in the stomach, and specific cells in the pancreas secrete the enzymes that work to digest the proteins, fats and sugars in any food. Examples of extrinsic digestive enzymes are protease, which digests protein; amylase, which digests starch; and lipase, which digests fat.

Normal physiology of digestive enzymes

Most fresh-grown food contains enough active enzymes to digest the proteins, starches or fats found in that food. For example, avocados and nuts have naturally-occurring lipase or fat-digesting enzymes, while oats have a high level of amylase, or starch-digesting enzymes. The contribution of food-based enzymes to the digestive process is extremely important and too often overlooked. The food should enter the stomach complete with digestive enzymes, which pre-digest the food. The stomach churns the food, pre-digesting as much as 75% of the meal. This process varies in time with any given species, after which hydrochloric acid, produced by the parietal cells in the stomach wall, is introduced, temporarily inactivating all the food-based enzymes and breaking down what is left of the meal. Then, acid-resistant pepsin is introduced. Enzymes, even though they are proteins, are too big and complex to be destroyed by the acid in the stomach, which means they can't be digested. Most enzymes are rendered temporarily inactive by the high acid environment, then reactivated the moment they enter the more alkaline environment of the intestinal tract. Eventually, the nutrient-rich food concentrate moves into the duodenum, where enzymes produced by the pancreas are responsible for the final digestion of proteins, carbohydrates and fats. Liver secretions neutralize the acidity of the gastric juice and bile emulsifies the fats for better digestion and absorption. Nutrients are absorbed along the surface of the intestine and carried into the blood, which flows to the liver where it is filtered to prevent the circulation of undesirable substances in the body. Nutrients are then delivered to every cell of the body. Finally, waste products, undigested food and bacteria move into the colon to be eliminated.

What is an enzyme?

Enzymes are proteins found either within cells or dissolved in the mesenchyme and body fluids. They serve as biological catalysts, reducing the amount of energy required for chemical reactions, and controlling metabolic reactions that would otherwise either not take place, or occur very slowly, under normal physiological conditions. There are over 80,000 known enzyme systems, each with a specific function. Life would not exist without them, as the body's entire metabolic process is based on the activation, inhibition and control of enzymes.

Supplemental enzymes

Supplemental enzymes are needed to replace those destroyed by cooking and processing food. Processing and cooking  at  any heat of approximately 118°F to 129°F (48°C to 54°C), for as few as three minutes, can destroy virtually all enzymes,1 which results in very little pre-digestion taking place in the stomach. Thus, what's left of the food mass enters the small intestine largely undigested. This puts the pancreas and other organs of the endocrine system under tremendous stress, since they have to draw reserves from the entire body in order to produce massive amounts of the proper enzymes. Supplemental enzymes are often found in combinations:
  • Lipase: Fairly acid stable, digests most fats.
  • Lactase: Digests milk sugar. Most mammals have high intestinal lactase activity at birth, which declines to low levels with age, and causes incomplete digestion of milk and other foods containing lactose. Like humans, some dogs and cats seem more capable of tolerating milk than others; and there is a significant difference in lactose levels between milk products, ranging from zero in cheddar cheese, to 11 grams in a cup of whole milk.2
  • Amylase: Aids the breakdown and assimilation of starches and carbohydrates so they can be converted by other enzymes to glucose.3
  • Glucoamylase: Breaks down maltose into glucose molecules.4
  • Cellulase and hemicellulase: Break down cellulose (fiber), which allows access to key nutrients in fruits and vegetables (e.g. carotenoids in carrots, polyphenols in berries, enzymes, and folate in beans, spinach and broccoli). Cellulase is produced primarily by fungi, bacteria and protozoans.5
  • Maltase: Digests complex and simple sugars, as well as unused glycogen in muscle tissue. Glycogen is converted from sugars and starches and is stored in muscle cells for future use.6
  • Invertase: Breaks down sucrose products like refined sugar, a common food source that can contribute to digestive stress.7
  • Alpha galactosidase: Helps digest carbohydrates found in certain foods, such as beans, that are not readily digestible in the small intestine. Undigested carbohydrates then pass into the large intestine where they are fermented by bacteria and produce gas, bloating, pain and general discomfort.

Choosing supplements

Here are two important points to keep in mind when choosing a food enzyme supplement:
  1. Animal-source enzymes, often called pancreatic enzymes, usually target digestion of protein.
  2. Plant-source enzymes are either derived from actual plants, or cultivated on a plant medium. They are more acid stable than animal-sourced enzymes so are active across the entire pH range in the digestive system, and can digest the full range of food groups. The highest quality digestive enzyme supplements are made by simply inserting the enzyme-rich growing medium into capsules. This means there is no extraction involved, no chemicals, and no drying process to damage the integrity of the enzymes or contaminate the final product. The amount, activity and type of enzymes in the final product depend on the medium used and the length of time the organism is allowed to grow under controlled conditions.
There is an ongoing controversy about whether cultivated or pancreatic enzymes are more suitable for our canine and feline companion animals, but both can be used successfully.

Diseases resulting from enzymatic dysfunction

Diseases that disrupt the synthesis or secretion of digestive pancreatic enzymes cause mal-digestion with subsequent malabsorption.
  • Exocrine pancreatic insufficiency (EPI) occurs when there is a loss of 85% to 90% of exocrine pancreatic mass. Without the pancreatic enzymes, severe mal-digestion and malabsorption of starch, protein and most notably fat will occur. EPI in dogs is often complicated by secondary bowel pathogen overgrowth and antibiotic-responsive diarrhea, which further disrupts nutrient digestion and absorption. EPI is relatively uncommon in cats and is most frequently due to chronic pancreatitis.
  • Lactase deficiency from a brush border enzyme deficiency may cause milk intolerance in adult dogs and cats.
  • Amylase deficiency from acquired brush border defects may be seen in the course of generalized small intestinal disease. Carnivores are not suited to high carbohydrate diets, as they cannot maintain long term production of the quantity of amylase enzymes necessary to properly digest and utilize them. Proteins in grains are also less easily digested than animal proteins. Allergies and other chronic immune problems may develop, as noted in the subsequent section on CIC issues.8
  • Allergies and food sensitivities are common. Allergens are almost always proteinaceous, and undigested particles of food may cross the intestinal barrier into the bloodstream, where they are identified as foreign substances by the immune system. This wastes precious defense resources on a "false alarm" rather than defending the body from true hazards, and is referred to as food leucocytosis (a food-driven increase in white blood cells). CICs (circulating immune complexes) start out as undigested large protein molecules (primarily from wheat, corn, dairy and soy) that can be absorbed into the bloodstream. Antibodies couple with these foreign protein invaders to form CICs. At first, these CICs may be neutralized by the immune system, then eliminated through the lymphatic system and kidneys. A glut of CICs can overwhelm the body's ability to eliminate them, so the body is forced to "store" them in its own soft tissues, resulting in an ongoing allergic immune response that leads to inflammation9 and, ultimately, autoimmune disorders.10 In fact, studies have shown that diseases that present high CIC levels can be improved or even cured by eliminating the excess CICs.11 Furthermore, putrefaction in the gut caused by undigested food may jeopardize the integrity of the intestinal wall, allowing various environmental toxins in the food to find their way into the blood and body.
There is strong evidence that glyphosate can poison the microbiomes leading to a host of other health problems, including systemic illness, digestive issues, malnourishment and fatigue, which all symptoms considered triggered by gluten sensitivity or intolerance. Some research shows that glyphosate inhibits a type of digestive enzyme that helps process and activate vitamins A and D3, along with detoxifying pollutants.12 Based on this research, some scientists have concluded that it’s not the gluten in wheat that’s the problem. It’s the glyphosate, or even both. [caption id="attachment_3843" align="aligncenter" width="2550"] Image courtesy of Carola Schleuss, CNC, CMP.[/caption]

Practical oral supplementation 

There are many digestive enzyme products on the market, often combined with probiotics. When enzymes are fed with meals, they aid in digestion. When you feed the exact same enzymes at other times, they work systemically for metabolic purposes. If the intent is pre-digestion, non-enteric coated products are best. Their presence in the upper stomach normalizes the signaling mechanisms that govern the release of stomach acid or the production of bicarbonate and enzymes by the pancreas. Given between meals, non-animal-derived enzymes, such as microbial or fungal enzymes, can be used as anti-inflammatories.13 Research has now shown that proteolytic enzymes can increase the permeability of the mucosal epithelium and facilitate bioavailability by a mechanism of self-enhanced paracellular diffusion.14 They are best given between meals for allergies, as they help to remove or digest circulating proteins that can cause reactivity. As an added bonus effect, proteolytic enzymes have the ability to digest and destroy the protein-based defense shield of every pathogen, allergen and rogue cell, thereby leading to their ultimate elimination. Enteric pathogens often gain access to the body by altering the structure and function of tight junctions to increase permeability of the barrier via the secretion of proteases, which can cleave tight junction proteins, or by altering the cytoskeleton.15

Specific uses in clinical practice

Though animals being fed a raw meat diet (frozen or home-prepared) rarely need digestive enzyme supplements, they may be needed during diet transitions, or when part of the diet is plant-based; in the wild, most plant materials would be “pre-digested” in the ingesta of the intestinal tract. Any animal whose diet is predominately processed will greatly benefit from digestive enzymes, as processed foods are enzymatically dead. Animals with digestive upsets (gas, diarrhea, vomiting), yeast overgrowth and sluggish metabolism clearly benefit while deeper cures are attained. Many animals undergoing stress (travel, anxiety, fear of things like thunder or fireworks) benefit, as do aged animals, since their enzyme systems are probably depleted. Antibiotics or other medications may interfere with the microbiome and enzyme function, so both digestive enzymes and probiotics are routinely indicated.

Summary

Recently, research scientists have found evidence that impaired digestion, as well as decreased enzyme activity in the blood, are directly related to the aging process and many of the illnesses and chronic degenerative conditions so prevalent in modern society. These studies suggest that as we and our animals age, the number of enzymes and their activity levels decrease in our bodies. As Dr. Howell said in his book on enzyme nutrition, "A person's life span is directly related to the exhaustion of their enzyme potential. And the use of food enzymes decreases that rate of exhaustion, and thus, results in a longer, healthier and more vital life."16 We can certainly enhance the life of our dog and cat patients by considering the contribution of enzymes to their wellness. ___________________________________________________ 1rawfoodlife.com/cooking-creates-toxins-that-causes-disease/ 2dogfoodadvisor.com/dog-feeding-tips/dogs-milk-dairy-products/ 3Singh S, Guruprasad L. "Structure and sequence based analysis of alpha-amylase evolution." Protein Pept Lett. 2014;21(9):948-56. ncbi.nlm.nih.gov/pubmed/25034346 4Kelly JJ and Alpers DH. “Properties of human intestinal glucoamylase". Biochim. Biophys. Acta 315: 113--122. 1973. ncbi.nlm.nih.gov/pubmed/4743896 5Parada J, Aguilera JM. "Food microstructure affects the bioavailability of several nutrients." J Food Sci 2007, 72:R21-32. ncbi.nlm.nih.gov/pubmed/17995848 6Weinik M, Campagnolo D. "Acid Maltase Deficiency Myopathy." Medscape 25 Mar 2014. (Accessed 21 Jul 2014.) emedicine.medscape.com/article/313724-overview 7Lieberman, P. "Is allergy or intolerance to sweet or sugar exist, and how to manage or treat it?" AAAA. (Accessed 21 Jul 2014.) aaaai.org/ask-the-expert/allergy-intolerance-sugar.aspx 8Malabsorption Syndromes in Small Animals, merckvetmanual.com/digestive-system/diseases-of-the-stomach-and-intestines-in-small-animals/malabsorption-syndromes-in-small-animals 9Arazi A, Neumann AU. "Modeling immune complex-mediated autoimmune inflammation." J Theor Biol. 2010 Dec 7;267(3):426-36. ncbi.nlm.nih.gov/pubmed/20832412 10Cano PO, Jerry LM, et.al. "Circulating immune complexes in systemic lupus erythematosus."Clin Exp Immunol. Aug 1977; 29(2): 197--204. ncbi.nlm.nih.gov/pmc/articles/PMC1541106/pdf/clinexpimmunol00234-0013.pdf 11Stauder G, Ransberger K, Streichhan P, Van Schaik W, Pollinger W. "The use of hydrolytic enzymes as adjuvant therapy in AIDS/ARC/LAS patients." Biomed Pharmacother. 1988;42(1):31-4. ncbi.nlm.nih.gov/pubmed/3408806 12Samsel A, and Seneff S. “Glyphosate, pathways to modern diseases II: Celiac sprue and gluten intolerance.” (2013 December) NCBIInterdiscip Toxicol. 2013 Dec; 6(4): 159–184. Retrieved from ncbi.nlm.nih.gov/pmc/articles/PMC3945755/ 13Rachman B. "Unique Features and Application of Non-Animal Derived Enzymes." Clinical Nutrition Insights. 510 8/97 Vol. 5, No. 10. (Accessed 24 Jun 2014.) cudoc.com/Digestive%20Enzymes.PDF 14Kolac C, Streichhan P, Lehr C-M. "Oral bioavailability of proteolytic enzymes." European journal of pharmaceutics and biopharmaceutics. 1996, vol. 42, no4, pp. 222-232 (68 ref.) cat.inist.fr/?aModele=afficheN&cpsidt=3191444 15Berkes J, Viswanathan VK, Savkovic SD, Hecht G. “Intestinal epithelial responses to enteric pathogens: effects on the tight junction barrier, ion transport, and inflammation”. Gut 2003, 52:439–451. 16Howell E. Enzyme Nutrition: The Food Enzyme Concept  New Jersey: Avery Publishing Group, 1985. *This article has been peer reviewed.
 
Integrative approaches to megaesophagus – case studies

Below are details of the summarized case studies featured in the article “Integrative Approaches to Megaesophagus” by Dr. Judith Saik, IVC Journal Volume 8, Issue 3.

Using acupuncture for congenital megaesophagus

Case #1

A four-month-old intact female five-pound Bichon Frise/Havenese crossbreed was presented to the Integrative Medicine Service with a diagnosis of megaesophagus that had not responded to conventional treatment. The puppy had a history of chronic vomiting after eating (one to two times a day) and a failure to gain weight since weaning. Radiographs (no contrast study) assessed by a cardiologist showed idiopathic megaesophagus not associated with vascular ring obstruction. Treatment for the megaesophagus by the referring veterinarian included Reglan (0.1mg -0.2mg/lb BID), probiotics and small amounts of canned food (Blue Buffalo) three to four time a day.  There was no noticeable improvement with this therapy. The TCVM examination included a dark pink-purple tongue (Stagnation, Heat), neutral body and paw temperature, sensitivity at CV-12 (Stomach alarm point) and decreased femoral pulse on the right side (Qi Deficiency). Although the puppy had slightly harsh lung sounds, there was no respiratory distress, coughing or nasal discharge. TCVM pattern diagnosis included Spleen Qi Deficiency, Kidney Jing Deficiency (congenital presentation) with Rebellious Stomach Qi (chronic regurgitation). The puppy was resistant to the application of acupuncture needles, so only five dry needle acupoints placed bilaterally were used: BL-20/21, Shen shu, ST-36 and CV-22. The puppy was started on the Chinese herbal medicine, Happy Earth (modified Wei Chang He), dosed at 0.25g BID to address Stomach Qi Stagnation. At recheck one week later, the puppy was doing well on the herbal formula and regurgitation was significantly decreased to only several times that week. An exam still found a dark pink-purple tongue with a decreased pulse on the right side, but there was no reaction at CV-12. Only four dry needle acupoints (BL-20/23, ST-36, CV-12), placed bilaterally, were used. A second herbal formula, Four Gentlemen (Si Jun Zi Tang), was dispensed to tonify Qi and to be given along with the other herbal formula at the same dose. Two days after starting the second formula, the puppy had a decreased appetite, so the herbal was stopped and the puppy was maintained on Happy Earth only. Over two months (with acupuncture treatment once a month), the puppy improved to the point where regurgitation after meals had ceased, with only one severe episode when the owner forgot to give the herbal medicine the day before. Once back on Happy Earth, there were no more episodes. Acupuncture sessions were discontinued after the third session, but the Chinese herbal medicine was continued for six more months, at which time the dose was tapered and then stopped. The dog has continued to do well for four years, with no regurgitation at the time of this publication.

Case # 2

A two-year-old male neutered Siberian Husky crossbreed was presented to the emergency and critical care clinic at the Veterinary Teaching Hospital with a several-week history of vomiting and gagging, along with rapidly deteriorating locomotor activity. The dog had been normal prior to the present clinical signs. He was vaccinated one week prior to the current episode. The primary veterinarian treated him with metronidazole (10mg/kg BID for five days) and Cerenia (1mg/kg SID as needed) with intravenous fluids. The dog improved initially then began vomiting ten days later.  He was switched to a hypoallergenic diet, but two days after the food change, he developed severe hindquarter weakness and was diagnosed with lower motor neuron disease. He was referred to the teaching hospital. When presented to the referral facility, the dog was transferred to the neurology service where diagnostic tests (radiographs, neurology work-up, CBC, clinical chemistry) diagnosed ambulatory tetraparesis (localization as diffuse neuromuscular), reduced gag reflex, leukocytosis with aspiration pneumonia and megaesophagus. A Tensilon test and AChRab titer (acetylcholine receptor antibody) were both positive. A presumptive diagnosis of acquired myasthenia gravis2 of undetermined etiology was made. Treatment was started, and included pyridostigmine (90 mg TID), mycophenolate (250mg BID), hyoscyamine (0.125mg TID), prednisone (30 mg given over 24 hours) and Clavamox (500mg BID) given orally. The dog responded to treatment with gradual improvement of weakness and decreased regurgitation. The owner was instructed at hospital discharge that while this was a treatable condition, most patients require long-term medications and special feeding (upright/vertical in a Bailey chair with food in small meatballs). Three weeks after the diagnosis, the owner presented her dog to the Integrative Medicine Service for assessment with the goal of decreasing Western medications – which were creating side effects such as ravenous appetite, diarrhea and lethargy – and possibly to improve the megaesophagus. Clinical and TCVM assessment on presentation revealed a lethargic dog with dry mucous membranes, medium pink tongue, severe constant panting, reddened sclera, hot ears/feet, dry warm nose, rough foot pads, muscle wasting along the topline, neutral to slightly cool back, and a forceful pulse that was decreased on the right side, particularly at the Spleen location. There were no positive Back-shu or Front-mu points. Auscultation of the chest revealed harsh lung sounds and there was a decreased gag reflex along with conscious proprioception deficits of both hind legs. The TCVM pattern diagnosis was Qi and Yin Deficiency with Liver Qi Stagnation. Treatment included dry needle acupuncture at BL-17/18, ST-36, LI-10, BL-20/21, Bai-hui and GV-14 with aqua-acupuncture (B12 vitamin, 0.2cc) at CV-12, CV-17/22/23 and LI-4. Two herbal formulas, Four Gentlemen (to tonify Qi) and concentrated Hindquarter Weakness (to address Qi and Yin deficiency) were prescribed at one gram each twice daily with no change in Western drug doses and continued feeding in the Bailey chair. The protein in the dog’s diet was changed from chicken (Hot) to beef (slight Warm) for a slightly Cooler diet. Two weeks later at recheck, the lethargy had improved, lungs sounded clear, mucous membranes were moist, ears/feet were neutral to slight warm, the back was slight cool, the pulse was decreased on the right (but improved) and there was a slight deficit at the Lung position. The dog’s appetite was good, there was no regurgitation, and conscious proprioception was now normal in one of the hind legs. TCVM pattern diagnosis was Spleen Qi Deficiency and Wei Syndrome. Acupuncture points included dry needle at Bai-hui, LI-10, CV-12, ST-36/37 and KID-1 and electro-acupuncture at BL-20/21 bilateral (5 min 20Hz, 5 min 80Hz-120Hz). The herbal formulas were continued, the antibiotic was to be finished and stopped, and the prednisone was decreased to 15 mg SID in the morning. Daily massage therapy (Tui-na) and acupressure protocols were started, and the owner was trained how to apply the therapy. Over the next two months, with acupuncture treatment monthly, all Western medications were tapered and then stopped while the dog returned to normal neurological status and energy levels with no regurgitation. The AChRab titer (acetylcholine receptor antibody) was repeated one month after all Western medications were ceased, and the titer result was negative (normal). One herbal formula (Four Gentlemen) was discontinued at month three, and replaced with Bu Zhong Yi Qi herbal formula (to tonify the Middle and Augment the Qi Decoction). This Chinese herbal medicine has veterinary applications for megaesophagus and myasthenia gravis. In a study involving 100 human patients with myasthenia gravis, there was an efficacy rate of 86% when using this formula with general Kidney tonics.1  The dog continues to do well as of the writing of this paper, seven months since initial clinical signs.

Using homeopathy for megaesophagus

Case #1

From Veterinarian Jimena Beltran de Heredia, Mobile practice, Granada, Spain (jimenavetintegrativa@gmail.es) A four-year-old female English Setter mix presented for chronic vomiting. She had a history of vomiting either immediately or within minutes of food consumpion since she was eight weeks of age. The vomitus contained undigested food without an acid smell. She was in poor body condition (BCS=3/10). The submaxillary glands were slightly enlarged and she had an inducible cough.  A clinical diagnosis of regurgitation – not vomiting – was made based on undigested food in tubular form which did not have a normal low pH consistent with stomach contents. Based on this, megaesophagus was assumed (the owners refused further disgnostic tests).  Homeopathically significant symptoms included weakness after parturition of the dog’s only litter. She was very emotional, empathetic, and demanded the company of her owner and resident cat. She was worse when left alone or with other people, and displayed a strong fear of fireworks and barking dogs. She was also anxious in the car, very loquacious, and drank a lot of water at home and even more from ditches while on walks. On August 25, 2015, the owners elevated her feeding platform. She started taking homeopathic Phosphorus 30c, diluted and succussed, 2ml per night for five nights. She had an aggravation (a good sign that the vital force is responding) of urinating copiously the second night, then less and less for the next three nights. At the same time, she felt better and drank much less. On days 30 and 31, there was no regurgitation. The diluted Phosphorus 30c was given every 15 days, then occasionally as needed.   Six months later, the owners moved to Portugal as the dog was feeling better. She still regurgitated from time to time but had gained weight and was happy.  She rarely needed more Phosphorus.

Case #2

From Ed DeBeukelaer, MVRCS. Author of Homeopathy: What to Expect, including 101 Cured Cases (12edb3@gmail.com) Two Dalmatian puppies were seen at three weeks of age for milk regurgitation, but were otherwise clinically normal. Since the owner was feeding a lot of milk to the mother, we advised stopping this to see what would happen. The regurgitation continued and at five weeks it became clear that these two pups (out of five) were not growing as much as the others and had started showing respiratory issues. Conscious chest X-rays of both pups showed bronchia which appeared filled. A diagnosis of megaoesophagus was made carrying an uncertain prognosis suggesting copious aspiration of milk. At the time of the x-rays, the pups were both dyspneic. The gestation had been normal but delivery had been slow: the mother did not seem to push much and the owner had given a few doses of calcium orally. The two affected pups were very lively and hungry, pushing the others out of the way to get to the nipples to drink. I started with a quick prescription of Phosphorus 30c in liquid TID while the owner contemplated whether to treat the puppies or put them to sleep. Their breathing improved the next day and treatment was continued. The regurgitation also reduced. A follow up x-ray three weeks later of the worst of the two pups showed a complete clearing of the bronchia. The owner had started feeding solids while holding the puppies upright and they were doing reasonably well. One pup made it to the age of eight months, but because of an aggravating situation was then put to sleep. The other one is now two-and-a-half years old and is even taller than the rest of his litter. She does regurgitate small amounts of smelly mucus daily but keeps all her food down most of the time. Both puppies had received several follow-up prescriptions: the one that was eventually put to sleep only partially responded to further prescriptions. The one that is still alive responded well to Falcon peregrine first, then Ara macau later. Falcon peregrine (10M) was prescribed based on the fact that this pup was the brightest and fastest of all the pups (at the age of three months). I was told she was fearless. The owner also noticed her abdomen enlarged substantially after each meal. A key to the Falcon prescription was combining the rubrics “fearless” and “abdomen enlarged after eating”.  The dilation of the abdomen stopped and she did well for a year. One year later, more help was needed: her character had become more pronounced. She turned out to be a naughty but funny pup, smiling at her owners, stealing things for fun, and jumping over any gate or fence. She could jump from a standing position – there was no effort involved. She would not run off but could not be contained. None of the other seven dogs in the house jumped the barriers; they were all well-behaved. This one got away with everything.  She was always on the go – restless, the owners told me. She was also very much a family dog in relation to her attitude to the other dogs and owners. There was a greyish discharge coming from her ears but she did not like them being touched. Closer examination (which proved very difficult) revealed a very mild ear canal irritation. The Falcon peregrine remedy did not help any further, so Ara Macau was prescribed based on the dog’s conflict with being a well-behaved family member and wanting to keep her freedom. I had another case of the same remedy of laryngeal paralysis which had a very similar dynamic. The ear problem settled and she has since taken this remedy every few months in a 30c upon worsening of the regurgitating.

Using laser for megaesophagus

From Janet Gordon Palm, DVM, CVCP (animobilityvet.com) An 11-year-old male neutered Collie presented at New Hope Animal Hospital with evidence of aspiration pneumonia secondary to megaesophagus. He had a history of regurgitation and retching multiple times a day for months. The pneumonia had been present for over one week prior to presentation, and was getting worse. Radiographs were taken, and the patient was given appropriate dosing of Clavamox and Baytril upon presentation. One week later, the owner presented the dog again for a recheck. He had not significantly improved. The owner had an emergency in his home country of Russia where he would be staying for three weeks. His dog sitter refused to take on the dog’s care and the owner was facing a decision to euthanize, or to board him with us for the duration of his trip. I had actually suggested euthanasia as there had been little improvement during the dog’s week on antibiotics, and there was no ICU option for ideal care. After a conversation about  risks, and a discussion of our right to make an executive decision if suffering progressed, it was agreed that we would take on the dog’s care. The next day, seeing the dog deteriorating, I decided to try my new-found complementary therapy in the form of VOM neuronal adjustment, and Erchonia Freqiency Specific Low Power Laser (VOMtech.com, Wm Inman, DVM). I performed three passes using a human Chiropractic Activator starting at the right and left Atlanta-occipital area, and proceeding along the dorsal spinous processes from C1 to S3, on each side of the sacrum, as well as both ischiums. There were "reads" along C2-T2; T8-S3. A Somato-Visceral Release was performed afterwards using the same Activator along the Paralumbar muscles from T1-L4. I followed this with LLLT using the Erchonia PL5 (5mW; 635nm) There are two heads each with diodes per head. Line generated beams allow a larger surface area to be treated. Frequency specificity allows for programming specific frequencies obtained from Rife, Nogier, and others to fine tune specific treatment areas. The Preset Head has frequency settings of 4/9/33/60. This was placed at the Foramen Magnum for all of the following treatment modules.
  1. The Programmable Head was placed over the entire dorsal spine, in particular, T1-L4 where the sympathetic ganglia are located. A Sympathetic Overstimulation was performed. These settings were 216/16/83/66. The time of this simultaneous stimulation of the brain and nervous system was 180 seconds. The concept is that once the absorption and ultimate stimulation of the light energy from the cell to cell response subsides as stimulation has stopped, the sympathetic tone plummets, and the parasympathetics can now rise. This was followed by a treatment further enhancing the parasympathetics.
  2. This time, the Programmable is set for the parasympathetic, colon, endocrine 240/20/73/147. The beam is shone over the cranial and sacral areas, stimulating the Vagus nerve and colon. This is also for 180 seconds.
  3. Following that was Pain/Inflammation/Lymphatic drainage/circulation/liver 9/16/42/53 and this was shone over the entire spine, neck, chest, abdomen
  4. Settings 2949/676/690/728 and 465/72/9/53 was shone sequentially over the entire dorsal spine and abdomen using the Programmable head. Preset was at the Thoracic Inlet for the first set, and at the Foramen Magnum for the second set. Again 180 seconds each.
  5. Lastly, Immune System settings with Preset at the Thoracic Inlet, and the Programmable over the chest and abdomen (especially over the spleen). 10,000/5000/777/240. This is intended to increase lymphatic production of macrophages, Killer T lymphocytes.
Two sessions each day at a minimum of two hours apart for three days were performed. The Sympathetic and Parasympathetic treatments only needed to be performed once each day as the effects last several hours. After the second day of the two treatments a day, the kennel assistant ran out to meet me coming in from the parking lot exclaiming that he was jumping up on things, which he had never done before. He was more vibrant and happy, had eaten his food without retching, and seemed overall brighter. I performed another two treatments separated by one to two days for a total of six treatments within a one week time period. The pneumonia resolved quickly once the LLLT started. A second VOM treatment was performed one week after the initial treatment. He was relatively cough- and regurgitation-free through the rest of the time he was boarding. Since we could not reach the owner by phone to obtain approval, I chose not to charge him for what was performed. He was appreciative, but could not invest in the remainder of my recommended 12 total treatments (continuing with two a week for two weeks, then one per week for the remainder. He decided to monitor for recurrence of symptoms. The dog was discharged, and was symptom-free for over five weeks. He then presented with a recurrence of occasional regurgitation, but no further aspiration. We began treatments as he could afford them and were able to manage him until his eventual euthanasia from age-related quality of life issues. That was over seven years ago. I have had several Laryngeal Paralysis dogs and two other megaesophagus dogs that have responded favorably, as well as feline and canine constipations, equine colics, etc. The key is re-establishing nerve communication and circulation to the area. You cannot use a heat producing laser as it has been found that over 15mW/cm2 can alter osteoblast function, and I would be concerned about other cells, as well as DNA impact. The ability to vary the vibration of the light energy in frequencies found by Rife, Nogier, etc. to correspond with different tissue resonance is also key.

References

1Clemmons R. Megaesophagus and megacolon. Web access 15Jan2018; dog2doc.com/chi-files/TCVM_Herbs/August_Chi/Megaesophagus_Megacolon.ppt 2Beebe S, Salewski M, Chen J et al. Tonic Formulas. In: Chinese Herbal Formulas For Veterinarians, City of Industry, CA; Art of Medicine Press Inc 2012:423-431.
 
Osteopathy to improve mobility after routine surgeries
Osteopathy is a system of medicine based on manual manipulation. It alleviates pain, restores freedom of movement and enhances the body’s innate healing abilities. Though people often assume osteopathy is similar to chiropractic, it’s actually a whole body approach that considers fascia, viscera, vascular and lymphatic flow, and is not exclusively focused on the spine and joints. While it is a newer modality in the world of integrative and holistic veterinary treatments, osteopathy has, for me, been revolutionary in getting to the “why” of many musculoskeletal conditions, and has resolved many mobility issues in dogs, cats and horses. I became certified in veterinary chiropractic in the mid-1990s, and over the following 15 years my small animal and equine practice consisted of 100% chiropractic and acupuncture. The majority of my cases then and now have been neurologic/musculoskeletal conditions. Over the years, I began studying osteopathy in the form of human craniosacral therapy and human visceral manipulation, and later took extensive training in equine osteopathy. I adapted what I learned on other species to treat dogs and cats. Along the way, I made some remarkable discoveries of my own concerning the deep underlying causes of certain mobility issues in small animals. Conditions commonly treated by osteopathy include lameness, back or neck pain, arthritis, ACL (CCL) injuries, prevention of ACL tears, lumbar/thoracolumbar disc disease, iliopsoas muscle strain, spondylosis, lumbosacral stenosis, Wobbler syndrome, urinary incontinence, lick granulomas and common mobility issues in older dogs/cats (stiffness, hind end weakness, loss of normal physical activity). I also see canine athletes to improve their performance and prevent injuries, as well as puppies and litters of puppies to address alignment and joint freedom very early on.

The 3 pillars of osteopathy

1. Visceral manipulation (visceral osteopathy)

Fascia, including the ligaments that tether organs to other internal structures, can become excessively tight from trauma, surgery or inflammation. An adhesion is tissue that has lost its normal gliding movement with any surrounding tissue. This form of excessive tension can change autonomic nerve flow back to the spine (via gamma interneurons), which causes rotation and reduced mobility in the sacrum (if pelvic viscera is involved) and can also cause two to three vertebrae to fixate as a group. When the tight fascia is released, these previously restricted bones automatically become free on their own without direct intervention. This leads to a longer-term correction than a manipulation of these particular joints. In addition to “tight” organs, organ dysfunction or pathology can also have an influence on altered autonomic nerve flow back to the spine. When health returns to the affected organ, the altered autonomic nerve flow will return to normal and will be reflected in restored normal range of motion in the affected joints. Osteopathic principles regard the importance of the afferent nerve flow (from the organ back to the spinal vertebrae and cord) as well as the influence of the efferent autonomic nerve flow (nerve flow going from the spinal cord to the organs). The goal of visceral manipulation is to release excessive mechanical tension around any organ, thus improving mobility, nerve function and blood/lymph flow in the area. Techniques include direct, gentle mobilization and more passive “listen and follow” fascial releases. [caption id="attachment_3711" align="aligncenter" width="300"] Visceral manipulation of the bladder ligaments to release the spay surgery adhesion (normalizes autonomic nerve tone to the sacrum and upper lumbar vertebrae).[/caption] While chiropractic and other manipulative techniques can help when joint restriction is truly local, at least 50% of joint restrictions in the spine, pelvis and shoulders can originate from organ issues (too tightly attached or not working at 100%). If a bone (sacrum, vertebra, scapula) has lost its normal motion from a visceral cause, addressing the internal visceral issue will lead to automatic release of the joint restriction without the need for any local treatment.

2. Joint manipulation

The purpose of an adjustment/manipulation is to restore normal range of motion to the joint (spinal, extremity or rib) through normalizing local neurologic reflex loops (by interrupting irritated gamma and alpha motor neurons and restoring normal afferent stimuli). This inhibits local spinal muscle spasms that are maintaining the restriction in the joint. Other benefits include the release of local adhesions in the joint, restoring local circulation, and decreasing local or referred pain. Two techniques are used:
  • Direct techniques These go into the direction of the barrier or “stuck-ness” and include osteopathic slow, long lever manipulations or short lever, high velocity, low amplitude thrusts (HVLA) (similar to some chiropractic techniques).
  • Indirect techniques or functional indirect techniques These techniques move away from the restriction barrier to the “side of ease”. This is a more individualized way to release a joint; it involves “listening” to where all the tissues want to go in three dimensions, and then slowly following these unique unwinding movements until there is a complete release of the entire joint, including all surrounding soft tissues.
[caption id="attachment_3712" align="aligncenter" width="300"] Checking sacro-pelvic symmetry/balance.[/caption] Joint restrictions are “neurologically mediated” from two different causes. The first cause is local to the joint itself (from trauma, repetitive strain, stress) and is resolved via a direct manipulation (chiropractic, osteopathic, etc.). The second cause occurs via altered autonomic nerve flow from an organ issue. Resolving the organ issue (adhesion, dysfunction) will cause the joint(s) to automatically normalize on its/their own.

3. Craniosacral therapy (CST)

CST addresses not only increased mechanical tensions in the dural tissues of the central nervous system, but also fascial strain patterns anywhere in the body, including the thoracic and abdominal cavities, visceral ligaments, and fascia around joints. Intense physical activity and trauma (slips, falls, extreme play) can cause increased tensions in internal fascial tissue, and the respiratory diaphragm, etc., that can be released via CST. An indirect light touch technique (5 grams of pressure, or the weight of a nickel) encourages the self-correcting mechanisms of the body to release abnormal tensions.

Osteopathy in practice – observations related to spay/neuter

Over the last decade, I have made three significant observations – all related to routine spay/neuter: 1:  Routine spay/neuter surgeries cause a sacro-iliac (SI) fixation in all dogs, cats and horses. This reduces normal motion and power in the hind end, setting them up for future mobility problems. Quadrupeds are “rear wheel drive” creatures so it is all about maintaining full power in the hind end for as long as possible. Mechanical issues (non-visceral) can also be going on in the sacro-pelvic region (which is why chiropractic can help with hind end issues); however, the spay/neuter influence will always have more significant impact due to the young age at which these surgeries are done. This loss of symmetrical freedom and mobility in the hind end is not noticed at this age, and many animals adapt to it for several years until they no longer can. 2:  ACL (CCL) injuries/tears can be potentially prevented if early treatment of spay/neuter adhesions are addressed to normalize SI movement. The fibula is involved in this pattern of susceptibility. 3:  Front end lameness is often directly related to an SI fixation in the pelvis on the same side, and can be a stubborn problem to treat. We truly need to look at the whole dog/cat in these cases.

How spay/neuter adhesions restrict mobility in dogs and cats

As I summarized above, spay/neuter can affect mobility in three ways:

1. Sacro-iliac fixations

The mild fascial adhesion created subsequent to routine spay/neuter surgery causes a subtle loss of normal mobility at the level of the distal bladder (ligaments of the bladder lose their full motion by only a few millimetres). This changes afferent autonomic nerve flow (sympathetic and parasympathetic) to the sacrum and to the first and second lumbar vertebrae, causing them to rotate/lose normal mobility. The sacro-iliac joint restriction (sacral rotation and ilium rotation) involves loss of normal SI motion on one side only. In osteopathic language, this is often referred to as a “dorsal inflair” of the ilium (same as “PI” – Posterior Inferior ilium in chiropractic terminology). For my clients, I call it “Crooked Butt Syndrome” to relay the idea that there is no longer symmetry in how the animals use their bodies.  This pelvic crookedness is the basis of the commonly-noticed “side winding” or “crabbing” gait. There are both short lever (chiropractic) and long lever motion tests to find which SI joint is affected, but I find the long lever (hind limb abduction or “pee on a tree”) test more accurate. Lumbar 1 and 2 restrictions are in a lateral side-bending pattern and both to the same side. This restriction pattern is often in extension and feels “softer” than a typical vertebra restricted in flexion that is easy to palpate and release with chiropractic manipulation (like a lower thoracic vertebra).  Lumbars 1 and 2 lose their mobility due to direct ANS influence (afferent sympathetic flow) and automatically return to normal motion when the adhesion around the bladder is released. Improving the motion of Lumbars 1 and 2 by treating spay/neuter adhesions can significantly help dogs with thoracolumbar disc disease and back pain, and probably prevent some cases as well. Direct, gentle mobilization and release of the spay/neuter adhesion will resolve the rotated sacrum/ilium and lumbar restrictions immediately, without actually having to go to those osseous structures directly. It takes one to three treatments (a week or more apart) to permanently resolve spay/neuter adhesions. I am a strong advocate for spaying/neutering (although not pre-pubertal); however, in an “ideal” world, veterinarians would know to treat these adhesions soon after surgery. Other visceral causes of sacropelvic/lumbar restrictions include congestion of the prostate in intact male dogs. and adhesions from severe cystitis, cystotomy, C-section, and hormonal imbalance in some bitches.

2. ACL (CCL) injuries / tears

At any given time, 30% or more of my patients are dogs with ACL issues. I discovered that the side of surgical repair (in the first knee) and the side of SI restriction from the earlier spay/neuter surgery were correlated almost 100% of the time. The early SI restriction causes a subtle loss of motion at the area of the distal fibula/calcaneal-tarsal joint on the same limb. This leads to a loss of subtle motion at the proximal fibula near the stifle and an early mild laxity of the ACL. No lameness occurs with this very mild laxity. It is like a “pre-pre” positive drawer sign -- in a joint that has had no damage. Yet this laxity is reversible to 100% tightness when the normal motion of the fibula is restored. It is an immediate change mediated by what I think is some local neurological reflex between the fibula and the stifle joint. It is my belief that this treatment could be highly preventive of future ACL injuries since the early, reversible laxity can be a form of weakness in the ligament, which sets it up for a potential future tear. In dogs that already have a partial ACL tear, treating the fibula/tarsus still addresses some laxity and can help joint stability. Restoring normal SI motion strengthens the hind end with or without surgical repair of the ACL. By restoring power to the hind end in dogs that have an ACL issue in the first knee, it’s possible to prevent the second knee from getting a future ACL injury. My clients who have “ACL-prone” breeds bring in their young dogs for early treatment of the spay/neuter adhesion and to normalize the biomechanics of the affected limb. The potential is always there to actively prevent a devastating ACL problem. I agree with recent epidemiologic research that there is a greater incidence of ACL issues in spayed/neutered dogs, but I believe the true cause has more to do with this abnormal mechanical influence of the SI joint to the fibula rather than to the loss of hormones from surgery.

3. Front end lameness

The dura mater around the brain and spinal cord are firmly attached at only the pelvis and skull, so excessive tension at one end is relayed directly to the other end on the same side. When the SI joint gets restricted (from either a mechanical or visceral cause), there is a corresponding reciprocal restriction in the temporal bone on the same side. Along with that comes an upslip (dorsal/ventral) restriction in the scapula (via the brachycephalicus muscle connecting the skull to the humerus). I see an almost 100% correlation between the side of front end lameness and SI restriction from earlier spay/neuter adhesion. When the SI restriction is resolved (via treating either the visceral or local mechanical cause), normal mobility automatically returns to the scapula. This truly shows the fascial continuity of the body. In the front-end lameness cases that do not respond to other approaches (conventional, chiropractic, acupuncture, physio/rehab) I have had excellent results in many patients by directly restoring normal scapular movement via the treatment of pelvic viscera. Once the scapula is moving normally up and down, the previous soft tissue lesion causing the pain/lameness can actually heal. All spayed/neutered dogs and cats have a scapular upslip on one side, but not all become lame in that limb. The susceptibility for future pain/lameness will always exist on that side since the loss of ideal scapular motion is a set-up for potential soft tissue strain in the shoulder area. These local soft tissue pathologies are commonly found by rehab/physio/orthopedic-oriented vets but often these practitioners do not find the underlying reason for the strain pattern since it often exists at the other end of the body (SI joint, viscera). Also, since quadrupeds do not have a clavicle when the scapula loses its normal dorsal-ventral motion, the lower cervical vertebrae are directly affected, which sets up animals for neck issues (stiffness, lameness, referred nerve issues such as lick granulomas, etc.).

Conclusion

Visceral osteopathy seems magical at times. Treating spay/neuter adhesions has literally revolutionized my practice. It is very empowering to get at the root of mobility issues very quickly in dogs and cats, and see long-lasting, efficient responses in just a few treatments, often leading to a permanent cure of lameness or musculoskeletal pain. Having treated older dogs and cats for 20 years, I know what I am also preventing if I see them when they’re younger and get the chance to restore symmetry and balanced mobility early on. Videos of the osteopathic exam and treatment of the spay/neuter issue can be viewed at TaylorHolisticVet.ca/video.

References

Barral, Jean-Pierre. Visceral Manipulation (revised ed). Seattle: Eastland Press, 2007. Barral, Jean-Pierre. Visceral Manipulation II. Seattle: Eastland Press, 1989 Barral, Jean-Pierre, Croibier, Alain. Trauma: An Osteopathic Approach. Seattle: Eastland Press, 1997. Becker, Rollin. The Stillness of Life. Portland: Stillness Press, 2000. Becker, Rollin.  Life in Motion. Portland: Stillness Press, 1997. Budras, Klaus-Dieter.  Anatomy of the Dog. Hannover: Schlutersche, 2007. Chaitow, Leon. Fascial Dysfunction: Manual Therapy Approaches. Edinburgh: Handspring Publishing, 2014. Felten, David, Jozefowicz, Ralph. Netter’s Atlas of Human Neuroscience. Teterboro Icon Learning Systems, 2003. Kern, Michael. Wisdom in the Body. The Craniosacral Approach to Essential Health, Berkeley: North Atlantic Books, 2005. Paoletti, Serge. The Fasciae: Anatomy, Dysfunction and Treatment. Seattle: Eastland Press, 2006. Schleip, Robert et al. Fascia: The Tensional Network of the Human Body. Churchill Livingstone Elsevier, 2012. Schwind, Peter. Fascial and Membrane Technique. Churchill Livingstone Elsevier, 2006. Stone, Caroline. Visceral and Obstetric Osteopathy. Churchill Livingstone Elsevier, 2007.
 
Advice on how to buy lower-cost equipment
When a veterinarian is opening a practice, there’s usually a sense of “sticker shock” when the total cost of outfitting the new clinic comes in. Often, buying new equipment is just too expensive. Wouldn’t it be wonderful if you could buy the entire contents of a closing clinic for the fraction of the cost? Alternatively, if you have extra equipment you no longer need, wouldn’t it be great to sell it? But it’s not always that easy, for various reasons. Some of the barriers that arise when sales are conducted between veterinary clinics include:
  1. The seller doesn’t know how much equipment should be listed for, and the buyer doesn’t know how much to pay.
  2. Neither party knows how to repair equipment that’s not working, so it makes for a very confusing transaction.
  3. Unclear contracts and transaction dealings (i.e. should I collect the money before or after they get the product?)
  4. Lack of knowledge regarding shipping and packaging, especially where larger items, such as cages, are concerned.
  5. Veterinarians are typically very busy – especially if they don’t have a business manager. They often have little time to sell surplus assets or acquire used product from each other.
Not surprisingly, veterinarians typically have reservations about buying technical equipment from other veterinarians because of the risk involved. At the end of the day, it’s usually easier just to buy from dealers because of the assurance of assistance in such cases – but again, this gets pricey. A used equipment broker or exchange network can help you overcome all the aforementioned obstacles. These options can help find a buyer if you’re selling, and a seller if you’re looking to buy. They also provide valuable services such as repairs, warranties, shipping and escrow type services, making buying and selling used equipment a low risk, stress-free experience.