Understanding pet digestion
From the outside, pet nutrition seems like an easy subject. Buy a bag of pet food. Feed the same dry food to the pet every day of her life. No fresh food, no variation. As veterinarians, this is typically what we are taught. But is that really the best recipe for pet health? Does it make sense? To find the answer, it is best to shine a light on the inside of a dog (or cat), gain a better understanding of digestion, and examine what they really need from the lens of my 20 years of veterinary practice.

Health is entirely dependent on nutrition

The best way to insure vibrant health and longevity is to provide an excellent and species-appropriate plane of nutrition. Digestion is the product of both the complexity and simplicity of nature. All animals on the planet keep themselves alive and healthy through the actions of finding food and water, ingesting, regulating, digesting, absorbing, rejecting, and defecating. Every aspect of the food our pets eat – moisture, freshness, processing, balance, structure, sourcing, amount, ingredients, frequency of meals, and even how it is served – plays a role for good or ill, in the digestive process. Not being able to find ways to truly heal animals can be frustrating for veterinarians and pet parents who are depending on inappropriate foods for the animals in their care. Why did we ever think that a processed dry food would be better for our beloved animal family members? Why is it so difficult to consider feeding fresh food? If fully changing to a fresh raw food is daunting, it is possible to simply add some fresh food even a few times a week. The health changes can be dramatic. Often, just adding a sardine or two to the food, and using a small amount of fresh meat or pre-prepared raw foods (even lightly cooked) a few days a week can improve health. It is possible (and often a great first step) to mix and match processed and fresh foods. The real first step to creating a healthier animal is to understand digestion. It is clear that food supports the overall development, growth and maintenance of strong bones, muscles, nerves and organs; the regulation of gene expression, the immune system, circulation, and fluid balance; the daily balancing of hormonal/endocrine reactions and behavior; the support of the bacterial biome in the GI tract, skin and throughout the body, and creating an overall happy, healthy and long life. Understanding why and how all these are affected by diet choices is an important and typically absent part of veterinary care. So what is happening in there that we don’t know about?

Who’s on the inside?

Digestive activity is not limited to textbook pictures of the organs and cells of the GI tract. There are many players in digestion besides the animal’s own cells – in fact, nearly 70% of what happens in the GI tract results from other organisms’ actions, production and reactions. The most important component of the digestive process may well be a healthy combination of “good” and “bad” bacteria (a healthy GI biome). There are thousands of species of bacteria that play roles in animal health. In fact, we know that the number of bacteria living in an animal’s body significantly outnumber their own cells. The symbiotic relationship between the body and its GI biome is responsible for a significant portion of the regulation, fermentation, border patrol, absorption and production of nutrients. Healthy animals eating species-appropriate foods are feeding and supporting appropriate GI bacteria. This healthy population of bacteria then keep the animal healthy.  Appropriate bacteria play vital roles in the breakdown of fibers and toxins, vitamin production, protection from pathogenic bacteria, integrity of the GI tract lining, and appropriate absorption. We see dysbiosis and illness when bad bacteria overrun the good. Dysbiosis, GI disorders, absorption problems and other GI related health issues are becoming more prevalent in our pet populations. It is likely that the increase in these disorders is related to bacterial imbalances resulting from increased use of antibiotics, herbicides and pesticides, as well as species-inappropriate, sterile processed foods.

Mythconceptions about bacteria

  • If we get rid of all bacteria, we will be healthier. (Just not true.)
  • If bacteria are resistant to antibiotics, we have no other solutions. (Integrative medicine has many options -- e.g. essential oils, honey, herbs, immune supplements, and excellent foods can all help cure resistant bacterial infections.)
  • If we sterilize surfaces and bathe more, we will be healthier. (The more we rid our environment of good bacteria, which fight bad bacteria, the more likely we will have troublesome problems with bad bacteria, which will multiply unabated and become resistant. Also, sterile environments are implicated in allergy and immune system issues in youngsters.)
  • Plastics are safer than wood surfaces. (Wood has natural antibiotic properties, and what protects trees from bacterial invaders protects wood products from bad bacteria.)
  • All raw meat foods contain harmful bacteria for animals. (While testing is done, healthy dogs and cats are designed to fight many pathogens in their meats, including E.coli and Salmonella. After all, they eat poop, pick up and swallow who-knows-what old meat/animal parts outside, and are fine.)
  • Eating pasteurized, cooked, processed foods is safer for our pets, and for owners and vets. (There are risks and recalls for all meat pet foods. Companies making raw foods are just as concerned about pathogens as processed food makers. Pathogenic bacteria -- more of an issue for humans, and not always a problem for pets -- have been found in all types of pet foods, whether kibble, canned, raw, freeze dried, treats, etc., and no one food is inherently safer than another. The best advice is to be careful with all foods.)
The GI tract functions as an absorptive, protective, motile, interactive immune surface full of live organisms. It protects the body from bad bacteria, disease and toxins, absorbs and creates nutrients, and provides triggers for hormonal, immune and neurologic interactions.

Macronutrients and micronutrients

Nutrients and water are obtained, absorbed and moved through the gastrointestinal (GI) tract to support the many systems of the body. The three generally recognized macronutrients (needed in large amounts) are protein, fat and carbohydrates. Micronutrients are vitamins and minerals that are needed in small amounts. Water is not considered a macronutrient, although it is needed in large amounts for most of the processes, reactions and transportation functions of digestion. It also provides a structural vehicle in which nutrients are presented for use. When we remove water from fresh foods, we create a jumble of dry ingredients that the body needs to untangle. In their original form, fresh foods maintain their cellular integrity and form. The water’s structure creates an appropriate vehicle and an orderly balance for recognition and absorption. Adding or taking away water should not be done lightly.

Cats in troubled waters

Moisture-appropriate foods are even more important for cats. It is possible that cats may be prone to developing kidney problems because we feed them dry foods. They are desert animals and inclined to get their moisture from their prey, as fresh water in the desert is scarce. They will drink to get their moisture, but it will not be a natural activity for them, so they may wait until they are significantly dehydrated before taking a drink. If, for their whole life, for every meal, cats are given dry food that provides little moisture and requires significant moisture from the body just to digest it, we are setting up a situation that causes dehydration and stresses the kidneys. Over time, this can translate into urinary tract disease, stones, infections or kidney disease.

Smell, taste and temperature

Detecting an appetizing smell is essential to start the body’s juices flowing. There are many medications that affect smell and taste, so it is useful to be aware of the side effects of medications. If an animal develops a decrease in olfaction from non-steroidal anti-inflammatory drugs (NSAIDS), it can affect his appetite. This is something known to the owners of dogs who do nose work, so they avoid NSAIDS, especially when the dog is working. Animals will generally also avoid foods that do not smell appetizing, or that smell rotten or toxic (except for some Labradors named Orion, Quincy or Darwin!). This is also true for taste. The ability to detect unhealthy odors or tastes is an important first defense. Temperature and moisture can also play a role in enhancing odors and tastes and stimulating the appetite. Meats would typically be at least at room temperature or even “body temperature” when animals hunt and eat. There is something to be said for trying to mimic what would make a carnivore excited about his food in the wild.

Teeth – not for chewing

The dentition of a carnivore is specifically geared towards tearing off chunks of food and getting them ready to swallow, not for chewing. Dogs and cats have these little pyramids of teeth. Their teeth are sharp, and they interlock to hold and rip flesh. The teeth have done their job if what they have torn off can fit down the esophagus. There are no flat “chewing” teeth. Carnivores can chew, but it is not the “point” of their teeth. We learn in grade school what different teeth do from their shape. There is a difference between large, wide, flat chewing cow teeth and sharp pointy carnivore teeth. Moist meaty foods are easily cleaned off the surfaces of the teeth with a swipe of the tongue. Inappropriate, dry, sticky carbohydrates will stick to the teeth and create tartar. Changing to a fresh, moisture-appropriate food can be one way to improve dentition and mouth biome health.

Saliva, drool, slobber -- lubricant

The carnivore mouth is just a momentary stop for food on the way down. Saliva reflects that purpose. Saliva’s main activity in dogs and cats is to act as a lubricant, although it will mix with bacteria -- both good and bad. It even has a bit of antibacterial capacity to fight pathogens, but its main purpose is to allow easy and quick swallowing.

Wolfing it down -- dogs have the stomach for it

The term “wolf it down” is correct for Canids. This is what they do -- they swallow first and ask questions later. Which is why we have hundreds of radiographs of foreign objects (including a personal favorite – an entire GI Joe) in the stomachs of dogs. But in nature, wild dogs would grab large pieces of meat from their prey, or even the whole prey, and swallow. A dog can eat a huge amount of fresh meat and organs in seconds, and show no ill effects. In fact, their digestive tracts appear to be designed to do just that. Dogs can keep about 70% of their ingesta in the stomach, and only 30% in their intestinal tracts. In humans, those percentages are reversed – 30% in the stomach and 70% in the intestines. So people eat smaller meals, more frequently. We only encounter problems with a dog or cat’s instinctual speed-eating when we feed dry foods, because these foods are not what the body expects. The stomach is made for more moisture-appropriate diet. Animals eating meals of dry processed foods are five times more likely to bloat than animals eating large amounts of fresh moisture-appropriate foods.

The stomach

The stomach creates a very large muscular acid bath for the food. In fact, the stomach acid of a carnivore has a pH of 1 -- extremely acidic. When food arrives in the stomach, it stimulates parietal cells to secrete hydrochloric acid (HCl), which decreases the pH. Eventually, a negative feedback mechanism recognizes there is enough HCl and shuts off production. The acid bath softens foods, kills pathogenic bacteria, breaks bonds, and starts the digestive process. The muscular motion of the stomach wall mechanically mixes the acid with the foods.

Intestines, small and large

As acidic ingesta moves from the stomach into the duodenum, the fats, proteins and lowered pH of the ingesta will stimulate pancreatic and bile secretions, cholecystokynins and digestive enzymes that further digest and neutralize the acid in the food. Proteins are somewhat digested to amino acids, di-peptides, tri-peptides (short-chain polypeptides) by pepsin. Triglyerides (fats) are emulsified, broken down and absorbed. Nutrients are transported across epithelial layers with help from bacteria and the brush border enzymes, pancreatic juices and bile salts. Sugars are fast energy and are absorbed and used quickly (and will affect inflammation and the glycemic index). Note: Production of digestive enzymes depends on appropriate levels of micronutrients and minerals like iron, manganese and selenium .Animals may become deficient in many micronutrients because of an increase in herbicide chemicals like glyphosate in pet foods.  Glyphosate insolubly binds many micronutrients and minerals in foods (specifically metals essential in the production of enzymes), making them unavailable for these metabolic processes. The large intestine is involved in the absorption of water, electrolytes, vitamin production and absorption. Both the small and large intestines contain a great deal of bacteria that serve a number of functions. They are essential for the absorption of vitamins (especially B and K), they produce small fatty acids used as energy by GI epithelial cells, and they are needed to break down indigestible fibers and molecules.

What the poop?                           

Defecation in the carnivore should not involve huge, voluminous soft feces. Normal canines use most of their food, and the resulting poop should be very firm, relatively dry, not horrible-smelling and in a small amount. When carnivores eat healthy, appropriate fresh food, “even the poop is cute”.  Poop odor and flatulence in dogs and cats is related to their biome. Bacteria produce many unpleasant gasses and smells, and an unhealthy biome will smell unhealthy. Pets defecating more than twice a day, and creating soft, odiferous and large feces, reflect the amount of filler and inappropriate ingredients we put in pet food, and is not a normal condition for dogs and cats. A good way to monitor proper feeding amount is by looking at weight and monitoring the frequency of defecation. Dogs and cats normally defecate one to two times a day at a maximum.The stool is small, firm, and doesn’t always look exactly the same. If dogs and cats are pooping more than that, they are either eating too much or ingesting too much filler.

Diarrhea and vomiting

Vomiting or diarrhea can be a reaction to something in the food, or symptoms of a systemic illness. If it is a reaction to food, expelling the food with urgency might be a sensible mechanism. The body is saying “wrong food!” and removes it as quickly as possible. Medical interpretation often describes vomiting and/or diarrhea as a disease process in itself, so medications to stop the expulsion of food are prescribed. These medications can be useful to stop the cycle of GI distress, but they do not solve the problem if the diet is deficient. The answer for many cases of chronic or even sudden GI upsets could be simply to slowly change to a more biologically appropriate, fresh organic food. The natural bacterial biome will be nourished, it will more easily assist in digestion, and the body will be healthier. During diet changes, it can be useful to take a couple weeks to change foods, and consider the need to add an appropriate prebiotic fiber, probiotic bacterial supplement and perhaps even some enzymes for support.

Teamwork in the end

Helpful bacteria, fungi and parasites live in harmony within the body and play an important role in digestion. With the overuse of antibiotics in pets and food animals, and an increase in pesticides/herbicides in many pet foods (like glyphosate, which has known antibiotic properties), we are seeing more problems than solutions to bacterial problems.  As new resistant bacteria become more common, and helpful bacteria diminish, we are upsetting the delicate balance needed for proper digestion. In addition, over-cleaning, over-bathing, sterile foods and lifestyles do not help pets replenish a healthy biome. There are cases in which the only way to fully replenish a damaged bacterial population is to perform a fecal transplant. This procedure involves taking feces from a healthy, fresh food-eating dog or cat, using a special recipe to create a liquid that can be introduced to the unhealthy animal through an enema or capsules. This procedure, while it seems crude, can be tremendously effective in a depleted animal with poor absorption.

Don’t give up, try food!

As we think about all these interactions, and the complicated anatomy and biology of the digestive tract, we may feel overwhelmed by how intricate the system is. There is much to consider: available pet foods, food animal conditions, organic sourcing, pesticides, GMO, costs of various foods, GI bacterial relationships and bacterial species, pH motility, secretions, digestive triggers, external stressors, automatic activity, autonomic nerve reactions, parasympathetic reactions (rest and digest), sympathetic reactions (fight and flight), enteric nervous system intrinsic to the GI tract, histamine releases, HCl secretions, bile flow, absorption, nutrient loss, toxin rejection, defecation issues and more…. The sensible way to maintain health is to be aware of this complexity, and use that understanding to recognize that before we interfere with this naturally balanced system, we should make sure there is really be a good reason. When we tip the balance with a less than optimal food, a gut-changing medication or other intervention, we may see unexpected and unwanted side effects as a result.

Eat less, get healthy, clean up!

Eating once, or at most twice, a day is normal fare for a carnivore. A hunt would provide a meal, they would eat, rest and digest, and maybe not hunt again that day. It may appear that certain dogs or cats are “nibblers” and need/like to eat a little bit all day. This is likely a misunderstanding of what is happening. It is not the ancestral behavior of a carnivore (a dog or cat) to nibble on their prey. It is possible that a bowl of dry kibble left out for free-feeding may be so uninteresting that a pet will only eat a little at a time, hoping for something better. Most animals, when they are changed to a fresh food diet, eat quickly and consume all the food. They don’t need a dry kibble left out all day to snack on if they are eating the wet food well. Cats and small dogs do well on twice-daily feeding, while medium to large dogs may do well on once-a-day feeding. Learning about digestion involves not only learning about how animals process food, but also how they manage when they are hungry. A strong body of evidence suggests that many animals tap into the body’s natural ability to re-invigorate itself when they are hungry. Certain processes that make an animal healthy only turn on when he feels hunger, or when he goes into a fasting, ketogenic state. The animal will switch from the processing food mode to a clean-up mode. This is very different from the type of ketogenic condition we see in a diabetic, where there is a high blood sugar, no insulin, resultant ketones and illness. In a healthy ketogenic condition, the blood sugar is low but not a health threat, and the body is producing ketones to effectively use as energy while it turns on body systems to seek out unhealthy cells, assess mitochondria, DNA and organelles for damage, and repair them. When hungry, the body recognizes the need to hunt more efficiently with a healthy body, so it gets to work on its own cells. Because there is little education about the existence of this health mechanism, we rarely let our pets get hungry. A way to think about this is that the body will be conservative and only do what is necessary. If there’s plenty of food, why clean up? Things must be fine. Or imagine the difference between having a party with plenty of food for everyone, and having the food run out and the kitchen in a huge mess. It’s time to clean the kitchen. If we never let an animal feel hungry, he will never “clean the kitchen”.

GI inflammation

Inflammation in the GI tract, including inflammatory bowel disease (IBD), is often just the body reacting sensibly to “wrong food!” by becoming inflamed for protection and to keep absorption of the wrong food to a minimum. Resolution of signs can often be as easy as supporting the bacterial biome with supplements and changing the food to something appropriate (fresh, organic). Sometimes an animal needs some extra help to re-florinate the population of bacteria. For every case, complicated or obvious, healthcare should always begin by focusing on returning to a natural, biologically sensible dietary balance. It is possible that given the right tools, the body can take care of the rest for us.

References and Bibliography

  • AAFCO Official Publication, 2016 update.
  • Brown, Steve, Unlocking the Canine Ancestral Diet, Dogwise Publishing, 2010; pp 5-10.
  • Becker, Karen Shaw and Taylor, Beth, Dr. Becker’s Real Food for Healthy Dogs and Cats, Natural Pet Productions, U.S., 2009
  • Brown, Steve, Can High-Fat Beef-Based Raw Diets Lead to Behavioral Issues and Aggression in Some Dogs?” Integrative Veterinary Care Journal, winter issue 2014-2015, pps 36-38.
  • Dierenfeld, ES, Alcorn HL, Jacobsen KL, “Nutrient composition of whole vertebrate prey (excluding fish) fed in zoos,” Zoo Biology. 1996; 15:525-537.
  • Federation europeenne de L’industrie des aliments pour animaux familiers (The European Pet Food Association) Nutritional guidelines, 2013.
  • Fox, Michael J., Not Fit for a Dog: The Truth About Manufactured Cat & Dog Foods, Quill Driver Books, Fresno, CA 2009
  • Gross, K.L., Yamka, R.M., Khoo, C., et al. Macronutrients, Micronutrients: Minerals and Vitamins. In: Hand, M.S. ed. Small Animal Clinical Nutrition, 5th Ed. Topeka, Kan.: Mark Morris Institute, 2010
  • Preventing Bloat Naturally, Peter Dobias, DVM. In Dogs Naturally Magazine.
  • Rodney Habib Planet Paws Facebook -- Easy to Make Homemade Dog Food Recipe
  • Harrington, Kohl, Director, Pet Fooled, Documentary, Gravitas, 2016.
  • Martin, Nancy L., Challenging the Pet Food Paradigm, pp 221-230 In: Proceedings of the Annual Conference of the American Holistic Veterinary Medical Association, 2016.
  • Merz, Walter, ed., Trace Elements in Human and Animal Nutrition, 5th Ed., vols.1&2, Academy Press, 1987
  • National Nutrient Database, USDA #05139 and #05144, reference #28.
  • National Research Council of the National Academies, Nutrient Requirements of Dogs and Cats, 2006.
  • Royal, Barbara, The Royal Treatment: A Natural Approach to Wildly Healthy Pets, Simon and Schuster, New York, 2012.
  • Royal, Barbara, The Essential Pocket Guide to Pet Food, Chicago, 2016
  • Stevens, C.E. Physiology implications of microbial digestion in the large intestine of mammals: relation to dietary factors. The American Journal of Clinical Nutrition, 1978; 31: 5161-5168
  • Royal, Barbara; Habib, Rodney; Becker, Karen; Orrego, Daniel; Brown, Steve; Wild Health Nutrition Course #1701, Royal Animal Health University, San Luis Obispo, April 8-9, 2017.
  • Thixton, Susan,, Website
  •, Website

Introducing a holistic approach to conventional medicine – case studies
When you incorporate holistic medicine into a conventional practice, conventional work (spay/neuter, vaccination, specialty referral) is considered “alternative”. Here are a few examples of how holistic medicine can help your clients.

Case study #1 – Roxanne, a 16-year-old SF DSH cat

Roxanne was presented in November of 2014 for a second opinion on treatment for kidney failure. The owner’s conventional veterinarian had recommended urine culture, urine protein, creatinine ratio and blood pressure – all declined due to cost.  Three renal diets were sent home, all of which Roxy refused. The owner gave SQ fluids for a few weeks, but because she’s older, she found it difficult to continue.  She reported that Roxy was lethargic, 70 inappetant, PU/PD and vomiting occasionally. Roxanne’s labs were:
  • BUN 155 mg/dl
  • Creatinine 8.9 mg/dl
  • Phosphorus 10.7 mg/dl
  • USG 1.010
On exam, Roxy was quiet, 6% dehydrated, had a strong rapid pulse, with kidneys bilaterally small and smooth, and loss of spinal muscling. As Roxy only agreed to eat higher-protein canned diet, we continued that diet, but I asked the owner to offer the food lukewarm, with water added to a soupy consistency. I started Roxy on Zhi bai di huang wan tincture at 0.15 ml PO BID, and asked the owner to return for a recheck exam and labs in two weeks. On callback seven days later, the owner reported that Roxy was eating somewhat better (and taking the herbs in food, as the owner could not medicate orally).  After two weeks, the owner reported that Roxy was feeling “much better”, but that she absolutely could not afford a recheck exam and labs. I stressed the importance of doing so, and continued to check in every couple weeks. Ten weeks later, Roxy presented for labs only:
  • BUN 35
  • Creatinine 1.9
  • Phosphorus 2.9
Her owner reported that she was “bossing the other cats around again”, was much more playful, eating well, still PU/PD. She was eating consistently, so we added Standard Process Renafood. I finally saw Roxy for a recheck exam and labs six months after her initial exam with me (I’d long given up hope that the owner would make another appointment, but was happy with heprogress reports). Roxy was still 5% dehydrated, but she had a stable weight and was perky. A mini-screen was normal.  She continued to eat high protein canned diet, with the owner rotating proteins. I learned two things from this kitty. I will never limit protein in any standard chronic renal failure cat. My Chinese training taught me that protein increases renal blood flow. So if there is no sign of renal inflammation (infection, ^UPC, etc.), high protein diets are indicated. I know this topic had been discussed to death on both conventional and alternative forums. There are DVMs far more qualified than myself who can speak to the physiology involved, but I continue to have good success in CRF cats with water-added high protein canned diets, and a proper herb Rx (which is the difficult part sometimes, right?). Secondly, I learned that animals can heal, even under less-than-ideal circumstances.

Case study #2 – Copper, an eight-year-old MN Viszla

Copper presented two weeks post-splenectomy for hemangiosarcoma. On exam, he was shy, had several fatty masses, BCS 6/9, mm slightly pale, pulse deeper and thinnish. He had been very sleepy on Tramadol (a yin tonifier). So he appeared to be blood deficient and damp in TCM terms. I started him on Yunnan bai yao, Dang gui shao yao san, cod liver oil, medicinal mushrooms, IP6. Through the next 15 months of treatment, I tried various additions to the DGSYS, but was never able to quite correct Copper’s thinner pulse. He eventually had an acute bleed and was euthanized. I know there are reports of much longer survival times with HSA patients undergoing herbal care, but with minimal side effects the owner and I were happy to have provided Copper with a period of time well beyond what was expected for splenectomy alone, and even chemo.

Introducing a holistic approach to conventional practice
Many veterinary practitioners who embrace holistic medicine have a personal story. Perhaps conventional medicine failed them, or one of their loved ones, and it was only when they turned to alternative therapies that they saw any true health improvements. These experiences tend to change their outlook on medicine, inspiring them to learn more about holistic treatments and begin introducing them into their own practices. This article follows my own journey towards holistic medicine and how I went about adding it to daily practice.

How I got interested in holistic medicine

My story began with our son, Ben, who suffered for years with headaches, hours-long temper tantrums, skin rashes, night terrors and one ear infection after another. With diet changes and cessation of vaccines, and working with chiropractors, Qigong masters and homeopaths, he started to smile again, and became healthy. Now 18, Ben is a college freshman. He sees an acupuncturist/herbalist to help with anxiety, eats what he wants, and has learned how to keep his moods stable with his own flower essence blend and essential oils.  He’s not perfect, but he’s pretty good. A couple of years into Ben’s treatment, I finally recognized the discordance between what I now believed was “health care” for my family, versus how I had been treating animal patients at the practice for 18 years.

Learning more

At my first AHVMA conference, I met top notch practitioners – specialists in acupuncture, chiropractic, PT, homeopathy, herbs and more. Some practiced out of AAHA-certified hospitals and even referral centers. A few sported braids and sandals! But they all had one thing in common; they had discovered that their Western medical training fell short of their expectations. Soon after the conference, I read an article by Dr. Christina Chambreau about seeking your “right livelihood”, the work that completes you as a person on all levels. This concept really hit home; I wasn’t in my right work anymore. So I gave six months’ notice at my practice and started taking local holistic veterinarians to lunch – acupuncturists, homeopaths, herbalists, chiropractors. They were incredibly helpful in providing some shape to my new business. I wanted to know where they practiced, what modalities they used, where they trained, and the pros and cons of different types of integrative practice approaches.

Offering holistic therapies in a conventional setting

Then I approached the owners of the conventional practice where I’d been an associate for ten years, and we agreed to a shared percentage:
  • 60% (me)/40% (clinic) on exams
  • 25% on radiographs, labs
  • 5% on referred surgery, dentals, specialist consults.
The clinic provides me with an exam room, an assistant/technician when needed, scheduling and diagnostics. The owners have been very understanding of my clients’ choices -- running titers and recommending raw diets, especially since they are a fully Western AAHA-certified hospital. They see a demand for alternative medicine, and know I’ll refer medical and surgical cases to them as needed. Their lawyer and my tax guy strongly suggested the businesses be kept separate – my name is not on the door, the clinic literature or the website. Clients are instructed to contact me at my own Animal Wellness Center and call or email my home office even though pets are seen at the clinic. Most of my supplies, primarily Chinese herbs and Standard Process supplements, are kept at my home. Initial intake exams are 90 minutes. I review records prior to the appointment for the medical history. I typically chat with the owner at length before examining the pet. We discuss medical history; treatments that have worked or failed; their goals (which may not be the same as mine!); vaccines, heartworm, flea and tick prevention and (oh-so-important) diet. Typically, diet is the first change we make, if appropriate. I ask owners to feed a commercial raw or fresh-cooked diet and start whole food supplements while I select the Chinese herbs. Commonly, I hear things like: “She’s so much more energetic!”, “His eyes are brighter”, “No more gas -- thank you!” from the diet change alone. This lays a foundation for healing, the owners are receptive and the herbs will amplify that process. On the flip side, a pet on a fresh diet who isn’t doing well will occasionally show up (e.g. a German shepherd with chronic GI issues who was worse on raw diet). I find that some of these animals do better on hypoallergenic kibble short-term. After a few months of treatment, they can often transition back to raw/cooked diet and do well. Recheck exams are 40 minutes long – I repeat an exam, review treatment success, and make a plan for moving forward. If the client has a conventional veterinarian, I try to keep labs and diagnostics within that clinic as much as possible. Some rechecks are done by phone for clients who live far away, have cats or dogs who are stressed by car rides, or who cannot make my appointment schedule. While not ideal from a TCVM perspective, clients are grateful for this option and will continue with holistic treatments. These cases do move forward. I charge by the minute for calls and extensive emails. I continue to vaccinate younger animals, but using only core vaccines that are given singly. Per Dr. Ron Schultz, I titer puppies after their last DHPP, then typically do not repeat. Rabies is given every three years in healthy pets. I recommend seasonal heartworm preventative and use pyrethrin or essential oil sprays for fleas and ticks. For cats, I give a single FVRCP and one rabies vaccine if they’re kept indoors.

Working with a business coach

After ten years, I finally hired a business coach because managing an integrative practice and generating income was a challenge without typical practice sales. I strongly recommend working with a coach at the beginning of your foray into predominately holistic medicine. We’re making progress on pricing, a new website, and charging for my phone and email time when lengthy (0/hour). My typical clients are middle-aged woman whose beliefs are similar to mine. They are presenting their pets for holistic care, and any conventional work (spay/neuter, vaccination, specialty referral) is considered “alternative”. I love that! Typical cases are chronic medical issues such as IBD, seizures, cancer, atopy and behavior problems. My practice is now aligned with my personal beliefs about wellness, and my patients are benefitting with improved health.

Case study #1 – Roxanne, a 16-year-old SF DSH cat

Roxanne was presented in November of 2014 for a second opinion on treatment for kidney failure. The owner’s conventional veterinarian had recommended urine culture, urine protein, creatinine ratio and blood pressure – all declined due to cost.  Three renal diets were sent home, all of which Roxy refused. The owner gave SQ fluids for a few weeks, but because she’s older, she found it difficult to continue.  She reported that Roxy was lethargic, 70 inappetant, PU/PD and vomiting occasionally. Roxanne’s labs were:
  • BUN 155 mg/dl
  • Creatinine 8.9 mg/dl
  • Phosphorus 10.7 mg/dl
  • USG 1.010
On exam, Roxy was quiet, 6% dehydrated, had a strong rapid pulse, with kidneys bilaterally small and smooth, and loss of spinal muscling. As Roxy only agreed to eat higher-protein canned diet, we continued that diet, but I asked the owner to offer the food lukewarm, with water added to a soupy consistency. I started Roxy on Zhi bai di huang wan tincture at 0.15 ml PO BID, and asked the owner to return for a recheck exam and labs in two weeks. On callback seven days later, the owner reported that Roxy was eating somewhat better (and taking the herbs in food, as the owner could not medicate orally).  After two weeks, the owner reported that Roxy was feeling “much better”, but that she absolutely could not afford a recheck exam and labs. I stressed the importance of doing so, and continued to check in every couple weeks. Ten weeks later, Roxy presented for labs only:
  • BUN 35
  • Creatinine 1.9
  • Phosphorus 2.9
Her owner reported that she was “bossing the other cats around again”, was much more playful, eating well, still PU/PD. She was eating consistently, so we added Standard Process Renafood. I finally saw Roxy for a recheck exam and labs six months after her initial exam with me (I’d long given up hope that the owner would make another appointment, but was happy with heprogress reports). Roxy was still 5% dehydrated, but she had a stable weight and was perky. A mini-screen was normal.  She continued to eat high protein canned diet, with the owner rotating proteins. I learned two things from this kitty. I will never limit protein in any standard chronic renal failure cat. My Chinese training taught me that protein increases renal blood flow. So if there is no sign of renal inflammation (infection, ^UPC, etc.), high protein diets are indicated. I know this topic had been discussed to death on both conventional and alternative forums. There are DVMs far more qualified than myself who can speak to the physiology involved, but I continue to have good success in CRF cats with water-added high protein canned diets, and a proper herb Rx (which is the difficult part sometimes, right?). Secondly, I learned that animals can heal, even under less-than-ideal circumstances.

Case study #2 – Copper, an eight-year-old MN Viszla

Copper presented two weeks post-splenectomy for hemangiosarcoma. On exam, he was shy, had several fatty masses, BCS 6/9, mm slightly pale, pulse deeper and thinnish. He had been very sleepy on Tramadol (a yin tonifier). So he appeared to be blood deficient and damp in TCM terms. I started him on Yunnan bai yao, Dang gui shao yao san, cod liver oil, medicinal mushrooms, IP6. Through the next 15 months of treatment, I tried various additions to the DGSYS, but was never able to quite correct Copper’s thinner pulse. He eventually had an acute bleed and was euthanized. I know there are reports of much longer survival times with HSA patients undergoing herbal care, but with minimal side effects the owner and I were happy to have provided Copper with a period of time well beyond what was expected for splenectomy alone, and even chemo. What to keep in mind
  • In holistic practice, you will see many cases with advanced disease. Some will lose the battle, but when you can extend that pet’s life far beyond conventional predictions, that’s good.
  • Your clients, on average, will be a bit more high-maintenance, so be sure to charge for your time.
  • Soft fleece blankets, extra time and lots of treats make your hospital a fun place (or at least tolerable!). Provide cats with a quiet room, a place to perch or hide, and time to adapt before their exams.
  • These are clients you will typically see more often than in a conventional setting. You’ll get to know them better, and will walk through life’s challenges For me, this has been a great joy.

Holistic management for breeders
Building a better dog begins way before the parents ever meet! Breeders need a thorough understanding of the genetic consequences of their choices. You should coach your breeder clients to understand the strengths and weaknesses of their particular breeds, and to evaluate the conformational and genetic integrity of potential sires and breeding bitches. In the show dog world, there is an unfortunate tendency to “breed to win” by tweaking a line’s morphology to align with popular fads among judges. This practice has been responsible for highly detrimental shifts in breed standards over the past 100 years, creating dogs that have significant health issues bred into them along with the desired looks. [gallery columns="2" size="medium" ids="3718,3717"] Once a well-proportioned, athletic dog, the Bull Terrier has transformed discernibly over time. His thicker abdomen and unnaturally rounded head and snout are a consequence of selective breeding. [gallery columns="2" size="medium" ids="3719,3720"] The Bulldog's ever-increasing size and receding snout has led to numerous health complications. In most cases seen today, medical intervention is required during the birthing of this breed as a result of its large skull. Why does the practice of dog breeding create so many inadvertent health problems?  Through selective breeding, humans have modified size, coat, skull shape, ear type, tail carriage and other traits. But when looking at a variety of wild canids, and interbreeding populations of feral domestic dogs, a genetic blueprint for canids emerges: medium size, medium coat length, long tail, cone-shaped head, and upright ears. (For more information, see “Recovering canine health: the natural dog” by Michael W. Fox, DVM, and Deanna L. Krantz, IVC Journal, Fall 2017) In particular, changes in skull shape toward extreme brachycephalic and dolichocephalic dogs (as well as brachycephalic cats) has destroyed the health and functionality of breeds that were once exceptional working dogs and robust pets.  Some breeds, like English Bulldogs, have such huge heads that they are unable to normally whelp and require a C-section for each litter. his breed is also known for dysfunctional bites, severe dyspnea and cardiac anomalies. Others, like Collies and Shelties, can be expected to have poor dentition and significant eye defects because of their excessively narrow skulls. Vets and breeders need to work together responsibly to prevent these unintentional cruelties. For optimal fertility, the breeding bitch should be in excellent general health, with a solid but lean body score (4 out of 10), and given regular exercise. The diet should be high quality and protein-based. Processed commercial foods are not ideal because many kibbles are found to contain contaminants, which risks teratogenic effects, or even abortion in developing fetuses. Additionally, the high proportion of carbohydrate ingredients in dry dog food has a pro-inflammatory effect in the carnivore body. Many canned foods have a similar nutritional profile by dry weight as their kibble counterparts, so careful label reading is important!

Peri-parturient management

A match has been made, the breeding has “taken”… now what? Prepare, prepare, prepare!  The bitch needs to be in tip-top form for birth and lactation. Body score in the final weeks should be 4 to 5. While extreme roughhousing is not a great idea, normal gentle exercise should be encouraged daily, to help keep the bitch fit and supple for whelping. A prenatal ultrasound evaluation tells how many puppies to expect, and flags skeletal abnormalities or extreme size differences in the puppies. A very large puppy is a risk factor for potential dystocia: it can act as a plug in the birth canal. A prenatal chiropractic adjustment for the mom will normalize and balance muscular tone, reduce stress and may reduce risk of dystocia. During the first half of gestation, the bitch’s nutritional needs are only slightly increased and it is important not to overfeed, as excess weight gain can lead to problems during parturition. If the owner is feeding a homemade diet, it is critical for them to have a proven recipe, a balanced vitamin and mineral supplement designed to provide trace minerals, and an appropriate amount of calcium for this non-lactating adult phase of life. Feeding during pregnancy is a tricky balance. The bitch needs more calories for the developing puppies in the final weeks of gestation, but too much calcium supplementation creates a risk of eclampsia and too little can pull needed minerals from the dog’s bones.  For the first six weeks, the quantity of food provided should not alter from her normal diet.  In the last three weeks of gestation, however, the size of her meals should increase by approximately 25% each week, while keeping the calcium dose the same. In other words, don’t increase calcium intake with the increased ration. If the dog is fed a commercial food, the 25% increase should consist of fresh meat and vegetables; if the dam is fed a fresh food diet (preferred) the breeder may increase the muscle and organ portion of the diet but not add more bones. A baseline mineral ratio should be 0.8% to 1.5% calcium to 0.6% to 1.2% phosphorous.

Whelping concerns

Breeders need to make sure the prepared whelping box is of adequate size to accommodate the size of the dog and the size of the litter. The environmental surface for whelping must have some traction but not snag tiny toenails. Once whelping is in train, make sure the owner knows to document birth order, weight and markings, and to ensure that all puppies are capable of suckling. If this is the dam’s first litter, a lack of adequate mothering skills can endanger the lives of the pups. Recent research has shown that mothering skills are both genetically and epigenetically programmed, with suboptimal nutrition and an experience of poor mothering while the dam was a pup as known risk factors. Homeopathic Sepia (see below) can be a great remedy for rewiring these critical connections if the bitch seems disinterested in her puppies. Puppies that are weak and having trouble getting started often benefit from a dose of homeopathic Thuja (see below). The breeder may need to consider options like a “sow crate” or spacer rails to keep the bitch and pups separated except for nursing. After whelping, lactation demands a higher proportion of calcium and phosphorus: 1% to 1.8% calcium to 0.8% to 1.6% phosphorus. Because of the nutritional demands during this time, it is even more important to feed a high quality, easily digestible and balanced diet.  Most dogs can be fed ad lib until weaning time.

Early management: three to 16 days

Most educated breeders know to weigh puppies daily to monitor weight gain and identify problems, but you may have to coach newbies. It is useful to teach them how to document other significant developmental milestones in each puppy, such as eye opening, visual tracking, tonic neck reflex (ability to hold the head upright) and efforts to stand.  It may be useful to note structural and developmental differences between puppies relative to birth order and size. The early neurologic stimulation program (Bio-Sensor) developed by Dr. Carmen Battaglia is a proven way of jumpstarting the puppies’ neural and immune competence. It starts on the third day of life, and consists of a short daily routine (three to five seconds each) of varied stimuli: tactile stimulation, positioning upright, positioning upside down, positioning on back, and thermal stimulation with a cool towel on the feet. Dogs exposed to this program show numerous benefits: improved cardiovascular performance, stronger heartbeats, stronger adrenal glands, more tolerance to stress, and greater resistance to disease. In learning tests, pups stimulated with the Bio-Sensor program were found to be more active and more exploratory than their non- stimulated littermates (

First adjustment and righting training: 16 to 30 days

[caption id="attachment_3678" align="alignright" width="200"] Positioning puppy upright to challenge extensor reflexes.[/caption] The most important intervention you can make to improve litter quality is to evaluate and correct problems of neural organization before the puppies are fully ambulatory. Ideally the timing for this visit should be somewhere within three to five weeks postpartum, as soon as the pups are able to thermoregulate away from the bitch. First, evaluate the bitch for any residual asymmetry from parturition. This is especially important if there was any dystocia. When the mom and pups come in for exam, carefully observe the puppies in the new environment and document differences among the group in terms of curiosity, gaiting abilities and stress levels. These are toddlers, and while they are funny to watch, they are actually experimenting with different aspects of locomotion. Their primary gaiting patterns and the kind of play they will soon engage in will require movement in multidimensional space. You can assess functional deficits by observing when puppies are unable to do their intended movements: look for the the one who keeps falling over (roll), the one who falls on its face (pitch and tilt), the one who can’t control its direction (yaw), the one who can swim and sit but doesn’t walk (pitch). This will give you clues about what manual therapy needs to be done, and how you can assess your results. Early childhood adjustments have a huge impact, because they can prevent problems before they are ingrained by growth and development. Litters that are given an early childhood intervention, like the one below, tend to yield a higher proportion of show quality dogs. For each puppy, perform an individual examination, including the following:
  • Listen to heart, observe any abnormalities
  • Examine and compare skull and jaw structure and symmetry
  • Look at tonic neck reflexes (can he control his head in space?)
  • Examine visual horizontal tracking (can he direct attention, and track with eyes?)
  • Examine and challenge extensor (standing) reflexes for:
-Strength and symmetry [caption id="attachment_3682" align="alignright" width="273"] Dr. Judith M. Shoemaker demonstrating gentle extension and flexion of the atlanto-occipital joint with Dr. Leslie Woodcock.[/caption] -Equal front and hind competence The following exercises are part of the Canine Posture Rehabilitation protocol, as developed by Dr. Judith Shoemaker, Dr. Karen Gellman and Elizabeth Reese. As you work with the puppy, frequently stand it up on all four feet, “rubber side down”, to reinforce the standing posture reflex. Each time you place the puppy, whether on your lap or the floor, the limb extensor reflex should be triggered by the paws touching a support surface. The primary postural reset for the front end is to gently extend the head and neck downward, and flex at the atlanto-occipital junction by bringing the nose towards the chest with a single finger. Make sure the puppy’s head can turn and rotate in every direction. The postural reset for the hind end is a tug downward on the tarsal bone of each hock. Gently! If you are trained in a specific manual therapy, you can go through your usual manipulation routine, bearing in mind how delicate these juvenile structures are. Be especially careful with any high velocity manipulation. Remember the giant first puppy whose birth was so difficult? These extra large puppies, often the greatest birth weight, can be slower than their littermates to achieve developmental markers, and may appear somewhat dull. The first puppy in a dystocia birth will have spent a long time having his skull squeezed in the birth canal. These slow pups are especially in need of chiropractic, and even cranial-sacral treatment to recover from their difficult parturition. You may need to treat them more frequently in the first six weeks. [caption id="attachment_3680" align="alignright" width="200"] The "righting" exercise, lowering the puppy, head first and supine, with a gentle bend toward one side. The correct response is for the puppy to twist upright and reach out with the near forelimb.[/caption] When your normal manual therapy routine is complete, test the puppy’s righting mechanisms and neural integration. This challenge is achieved by holding the dog supine in your two hands, and lowering it with head down and a slight turn to one side. The righting reflex should trigger the down forelimb to reach to support the body. This should be tested on both sides (see photo at right). In some pups, one side may be slower or they may try to reach with their opposite legs, showing cross signaling. This maneuver should be practiced until both sides react symmetrically. It should take no more than three tries in a pup with a normal nervous system. If one side continues to be slow, practice on the good side, then return to the slow side to see improvement. At the end of all manual therapy and righting challenges, reset the posture again and re-examine symmetry and reflexes. Recheck the heart as well after the procedure -- if there was an abnormality, it may have disappeared with reorganization and posture change. Reassess each puppy’s symmetry, movement, body confidence and curiosity, and document any changes.

Management after initial adjustment

Adjust and perform righting challenges (Postural Rehabilitation) again before weaning.  In cases of asymmetry, adjust frequently (every one to three weeks) during rapid growth to allow symmetrical growth. Document and address, if possible, abnormalities in dentition every time, along with listings and asymmetries. Dental problems are best addressed in the juvenile teeth, before the adult bite is formed. All carnivores are born with an underbite to facilitate nursing. There is normally a growth spurt in the mandible as the first teeth erupt. If a puppy has teeth that are slow to erupt, a dose of homeopathic Silica (or its constitutional remedy) may correct the problem. Growth asymmetries are usually addressed by removing the baby teeth on the slow side. It is best to consult a board-certified veterinary dentist at the appropriate time. Teaching puppies to chew appropriately by giving them raw chicken necks to learn on is a great way to build good behaviors and even intelligence. Dogs who learn to gnaw the meat off the bone, and grip the bone in their paws, have greater dexterity and problem-solving skills. Getting puppies straight and symmetrical in the beginning will save the owner much time, money and worry. Many puppies raised like this are self-maintaining -- needing only six-month or once-yearly checkups unless they experience trauma, toxins or stress. When animals start life with a solid grounding in their relationship with gravity, they can often withstand and heal from severe illness and injury.

Acute Peri-parturient homeopathic remedies  (“first aid”)

Classical homeopathy can be a quick and effective way to treat emerging conditions pre- and post-partum. You may want to put together a homeopathic emergency kit for breeder clients who will use it responsibly. It is best to use lower potencies when treating acute problems at home (30c and 6c by Boiron are often available in health food and even grocery stores). The remedies usually come as BB-sized pellets, packaged in small, lip balm-sized tubes. They can be administered either as one to two pellets given orally; or for tiny pups, dissolved in a small amount of water then dripped into the mouth with an eyedropper. Dosing is usually done one or two times, and not repeated until after consulting a homeopathic veterinarian. Please also consult a homeopathic veterinarian for directions using higher potency remedies. Apis mellifica: Mastitis with red, edematous mammary tissue (and lack of thirst) Arnica: Good to give to dam after whelping to promote quick healing of bruised tissues; also good for newborn puppies that seem slow in starting to nurse/move around. Arsenicum: For the puppy that has trouble getting started breathing, is cyanotic Belladonna: Mastitis with redness and heat, bitch is irritable Carbo vegetabilis: For weak, cold puppies Gelsemium: For the bitch that is extremely weak and exhausted during labor Phosphorus: Good for stopping bleeding Phytolacca: For mastitis when glands become indurated and painful, milk is stringy or chunky Pulsatilla: For stalled labor, a dam that seems to have trouble bonding with puppies, or puppies that are weak and cry constantly Sepia: For a dam that is not bonding with her pups at all Silica: For puppies whose teeth are slow in coming, who seem weak and may have large heads Thuja: Helps to stimulate puppies that are weak For a larger and more detailed list of remedies, Homeopathic Care for Cats & Dogs: Small Doses for Small Animals by Don Hamilton is a good beginning resource. The Pitcairn Institute of Veterinary Homeopathy offers a year-long veterinary training program and Dr. Christina Chambreau offers three- to six-day introduction to veterinary homeopathy classes.  

TCVM – preventive seasonal medicine for pets
In Chinese medicine, the seasons are associated with different bodily organs, ages and personalities. Encouraging your clients to come in for a seasonal “tune-up” is a good way to prevent future illness in their pets. Sending out wellness reminders with tips regarding seasonal medicine can help clients realize that you are committed to their animals’ health, and not merely treating ailments. Discussing the foods that correspond with each season is another way to promote your patients’ health, while encouraging clients to feed a variety of fresh foods.


Winter, the coldest season, is associated with the kidneys, bladder, hearing, water and old age. The water personality is careful, curious, self-contained, meditative, slow, consistent, and has a tendency to hide. Those who are old, cold and have a Water personality will benefit from eating warming foods such as lamb, venison, chicken, garlic, buckwheat, eggs, ginger and cinnamon. Warming all food to room temperature or warmer is helpful for Water personality animals in the winter, as well as for most older or cold animals even at other times of the year. Kidney yang deficient animals, who may have a cold back, possibly early morning diarrhea and a sinking hind end, benefit from cooked food rather than raw, as raw feeding requires more energy to digest. Eggs contain qi (strengthening) and yin (cooling). Since eggs are the beginning of life, they also strengthen kidney jing, or life force, which comes from egg and sperm, and decreases with age. It is important to also nourish kidney yin, as all animals need the balance of yin and yang (qi plus warmth). Animals with kidney disease or bladder damp heat (blood, crystals or bacteria in the urine) are often very thirsty, may seek cool areas and may have a red dry tongue, often indicating yin deficiency. Some foods that nourish kidney yin are duck, pork, kidney, tofu, eggs, asparagus, cabbage, apples, barley, black beans and honey. Even if an animal is not old or a water personality, all animals can benefit from slight feeding changes in winter. For an animal with a cold back or cold hind end, moxa treatment can be very helpful. Moxa, or compressed mugwort, is lit and moved over the cold areas (but not touched to the skin). Smokeless moxa keeps odor away, but regular moxa seems stronger in my experience. If you are using this in a clinical setting, be sure to warn those around that it smells a bit like marijuana. This video provides a demonstration: Massage can also strengthen the back and organs. Nie-fa, or skin rolling, can be done on the sides of the spine from head to tail. This loosens the fascia, allowing more free movement of the spine and supporting the immune system. Watch this video for a demonstration:


Springtime is wood season, and associated with youth, the liver and gallbladder (even in those animals without a gallbladder). The Wood personality is decisive, assertive, confident, athletic and wants to be alpha. These animals can be prone to irritability, ear problems, conjunctivitis, a purple color to the tongue (excluding Chows and Chow mixes of course), nail and foot problems; and tendon and ligament issues. To prevent these problems in young Wood personality animals (and all animals in the springtime), feeding cooked or pureed dark leafy greens such as kale, collards, turnip greens, beet greens, mustard greens, chard, spinach or broccoli is very helpful. Older animals or those with weak intestinal tracts do better with cooked greens, whereas young strong animals can handle pureed raw greens. Mixing greens with scrambled eggs or meat or onion-free broth can make them very palatable for finicky pets. Carnivores also benefit from eating liver. Those with sensitive gastrointestinal tracts can handle freeze-dried liver better than freshly cooked. Animals who run warm should have beef or bison liver, while heat seeking animals can handle chicken liver. Wood animals like to work hard and need both mental and physical exercise. Food dispensing toys can help when weather is too hot for physical exertion. Wood animals enjoy difficult competitive exercise, such as agility, lure coursing, endurance competition and racing, and tend to do well as they have the will to succeed. Springtime is also the time of “wind”, which can be internal or external. Internal wind manifests in the form of seizures, and external wind as itchiness. Dark green vegetables help decrease the risk of both ailments. Acupuncture or acupressure of liver points such as liver 3 (on top of the hind foot between the second and third metatarsal bones) and blood points can help decrease “wind” issues. The empty cases of cicadas can also help. Children often love searching for these and adding them to their dog’s food.


Summer is associated with the Fire personality, adolescence, the tongue, the heart and pericardium, small intestine and the Triple Heater, which doesn’t fit an exact anatomical organ but is somewhat similar to the thyroid. The Fire personality is outgoing, talkative, friendly and likes to be the center of attention. In the heat of summer, Fire problems such as shen disturbance, which can be seen as noise phobia or other abnormal behaviors, are more likely to occur. To cool Fire animals or any other hot animals in summer, feed cooling foods such as watermelon, celery (which also drains damp, helping hot animals with diarrhea or moist dermatitis), greens as mentioned above, brown rice, millet, turkey, rabbit (which is also strengthening), clams, cod and other whitefish. Feeding heart is also helpful. A cooling bed or fan is a great adjunct in hot weather. Since the tongue is the sense organ of the fire element, heart disease and shen disturbance can sometimes be suspected by a red and/or bell shaped tip to the tongue. Determine diagnostics needed (such as an echocardiogram) with a Chinese pulse examination and a very thorough physical. Treatment with food therapy, acupuncture and herbal medicine, along with any conventional medicine needed, can also help. It may give a clue to which cats may have a propensity to hypertrophic cardiomyopathy before saddle thrombus or sudden death occur, so prevention can begin. To correctly assess the tongue, the animal must show it freely, without having the mouth opened externally. Often when a person sticks out their tongue, the animal will do the same. Watching closely to catch a glimpse can be done but it can be tricky! If necessary, peek through the lips between the teeth to see the general tongue color, shape and moisture. Shen disturbance can be helped with Chinese herbal medicine (often a heart yin tonic) and non-Chinese medicine adjuncts such as Rescue Remedy for pets given orally or rubbed on the hairless parts of ears several times a day. This is especially important in the instance of fireworks and thunderstorms.

Late summer

Late summer is associated with the Earth personality, adulthood, Damp Heat and the gastrointestinal system, called the Spleen and Stomach in Chinese medicine. Earth personality animals are laid back, mellow, round and large, sociable and sympathetic. To help a weak gastrointestinal system in an Earth personality animal, well-cooked quinoa, sweet potato, pumpkin or squash are strengthening, along with beef, bison, rabbit and tripe. Damp-draining foods for those with loose stool or moist dermatitis include celery (which is also cooling), mushrooms and turnips. Avoid dampening foods such as watermelon, pork and salmon, as these worsen moist dermatitis and diarrhea. Hot spices such as garlic and ginger can help prevent Dampness and are good as long as the animal is not too hot. Limbs should be cool from the carpus distal and the tibiotarsal joint distal in all animals, the ears should be warm towards the head and cool at the tips, the nose should be cool and moist in dogs and cats and the paw pads should be soft and pliable in a healthy animal. If these areas are hot, too moist or dry, use foods to correct the imbalance. The tongue in an animal with Damp may be thick and even have tooth impressions, giving another clue as to which foods to feed. Earth personalities are prone to worry, so Rescue Remedy for pets, pheromone-based products such as Dog Appeasing Pheromone, and Feliway can be helpful. Strengthening the gastrointestinal tract with Chinese herbal medicine (spleen qi tonics) and probiotics can also help ease worry.


Autumn, with its cool and often dry weather, is associated with middle age, Metal personalities, and the lung and large intestine, which are prone to drying out and causing cough and constipation. The skin and haircoat may also be dry and coarse. Metal personalities are aloof, love order and obey the rules. To moisten the respiratory tract and prevent cough, pears and honey are excellent foods, especially local honey as it contains small amounts of local allergens, helping prevent respiratory allergies. Yin deficient (or hot dry) coughs are more common at night, and the animal may have a red tongue and warm dry nose.  If the cough is weak or in the daytime, walnuts can help strengthen lung qi. Sardines help prevent constipation with their unique blend of yin and blood, which are, respectively, Cool and Moist, and Warm and Moist. Feeding lung also helps the lung, and if the large intestine is weak, such as in constipation, strengthening foods such as pumpkin, sweet potato and winter squash are helpful. Other moistening foods that help the lung, large intestine, skin and coat are eggs, duck, barley, tofu and rice. Understanding the seasonality of Chinese medicine, the personalities that go with the seasons and seasonal foods that are helpful to add can help animals be healthier all year long. Of course, each individual animal can be much more complicated. Traditional Chinese Veterinary Medicine Volume 1 by Huisheng Xie and Vanessa Preast is a good place to start for a more thorough understanding of this ancient medicine.

Homeopathic medicines can alter genetic expression

Studies are showing that homeopathic medicines have an effect at the level of genetic expression, thereby giving the homeopath another tool for understanding the potential uses of remedies in their patients.

Over the course of more than 30 years as a practising veterinary surgeon, veterinary homeopath and human homeopath, I have witnessed the mainstream conventional scientific world slowly changing its perspective. Science is realizing that life is much more complex than the largely mechanistic models that assumed everything was merely a series of chemical reactions, where proteins act in a series of physical lock and key interactions, and DNA is believed to be housed in the nucleus of the cell with the genes simply coded for the chemicals of life. We now know that if genes are present and have not been irrevocably damaged, they are capable of being switched on and off according to interactions with a multitude of factors, including diet and environmental changes. We also know that different arrays of over 25,000 genes code for the more than 100,000 proteins that make up the material of life. We’re now beginning to understand how the interface works whereby electrical signals are transformed into chemical ones.1 Researchers are currently able to measure changes occurring at the level of genetic switching. Homeopaths may now be able to measure and, in effect, “observe” the action of a dynamic medicine generating a change in the living body that then becomes material. Molecular biological tools, such as DNA-microarrays and the ability to utilise specific cell line cultures, are making these studies possible, and the limited numbers of studies to date are providing some positive results.2 A significant number of studies have shown a positive response, while some have not. It is important to critically evaluate the positive and negative results in studies within the context of the remedy and potencies used, the cell lines, etc.3 While beyond the scope of this article, there is another important aspect of many of these and related studies. A greater understanding of the hormesis concept (dose-response relationship that shows how substances can be either inhibitory or stimulatory at different dose rates) challenges the way conventional pharmacology has evaluated drug dose rates.4 Even before homeopathic medicine becomes mainstream, we will begin to see the use of therapeutic microdoses, and the use of the same substance given to inhibit or stimulate a body response according to dose, and perhaps according to the genetic makeup of the individual receiving the dose.

Significant studies

  • One study5 looked at the gene expression of RWPE-1 cells (prostate epithelial cells) when exposed to Apis mellifica mother tincture -- 3C, 5C and 7C potencies for 24 hours.2 Apis mellifica is a very well-known remedy to homeopaths and is made from the honey bee, including the venom. This remedy is commonly used for many different presentations of allergy - edema, redness, pain and inflammation. The researchers looked at the expression of genes involved in cytokine expression, inflammatory processes, anti-oxidative responses and protease degradation. Not only did they find clear effects, but they also saw different effects from the mother tincture versus potentised dilutions. For instance, the mother tincture increased expression of the IL1b gene, which codes for a potent pro-inflammatory cytokine, whereas the potentised remedies reduced expression of the same gene.
  • A number of studies have looked at Gelsemium sempervirens and gene expression.6 Bellavite et al exposed human SH-SY5Y cells (neuroblastoma cells) to potentised dilutions of Gelsemium (2C, 3C, 4C, 5C, 9C and 30C) for 24 hours and found that the expression of 56 genes was significantly changed (49 down-regulated and seven up-regulated). Gelsemium sempervirens has long been recognised by homeopaths as having its centre of action on the nervous system and muscles. The plant from which the remedy is derived contains strychnine-like alkaloids, such as gelsemine, that act within this sphere. The study authors suggest that the pain-relieving and anti-anxiety effects associated with the remedy may be attributed to the negative modulation of some neuronal excitatory signalling pathways.
  • Using micro-array and RT-PCR techniques, Preethi et al investigated the expression of genes associated with cytotoxicity and apoptosis (programmed cell death) in Dalton’s lymphoma tumor cells and other tumor cell lines.7 They exposed the cells to ten different potentised medicines, including Ruta 200C, Carcinosinum 200C, Hydrastis 200C, Conium 200C, Podophyllum 200C and Thuja 200C. They found different effects in different remedies and with different potencies. Conium 200C was more cytotoxic than its mother tincture; Carcinosinum was more cytotoxic at 200C than at 30C. The researchers were able to demonstrate clear gene induction in some cases -- Carcinosinum 200C significantly induced p53 gene expression (pro-apoptotic gene).
  • Khuda-Bukhsh et al used HeLA cells (HPV18 positive cells) to test the effects of the ultra-high dilutions Condurango 30C and Hydrastis canadensis 30C on gene expression when compared to controls.8 They were able to demonstrate significantly different gene expression patterns of genes associated with carcinogenesis for the ultra-high dilutions, when compared to controls. Hydrastis canadensis and Condurango are both commonly used as homeopathic medicines in cancer cases. Classical homeopathic forefathers such as Clarke cited Hydrastis as the remedy that has cured more cases of cancer than any other single remedy.
Although homeopaths (in the UK at least) can make no claims of efficacy for homeopathic treatment, we are beginning to see the evidence in a form that is acceptable to the scientific world, thereby beginning to confirm what homeopaths have known for centuries. These studies not only show the effects homeopathic medicines have at the level of genetic expression, but they can also give the homeopath another tool for understanding the potential use of a remedy in a patient, in addition to traditional provings, cured case reports and toxicology studies. The results to date align with what we already know regarding which systems and processes homeopathic remedies can affect. Now we may begin to understand a little more of how they are doing it. Through this understanding of switching genes on and off, conventional medical and homeopathic communities may have found a mutual ground for further consideration and comprehension.

Homeopathically-prepared DNA

DNA taken from a variety of sources (e.g. fish and cattle) has had a number of provings over the years (e.g. Julian, Jenaer and Robbins). Not surprisingly, homoeopathically-prepared DNA has been found to have affinities with the mind, nerves, endocrine and reproductive systems.9  Recently, there has been a lot of interest in Sequence Specific Homeopathic DNA medicines, which use specific DNA sequences (300 to 400 base pairs in length) potentised to 6C and aimed at targeting genes known to have sub-optimal expression in certain disease states or processes. For instance, the KL gene is recorded to have reduced expression with age, and is associated with impaired immunity, signs of aging and increased susceptibility to autoimmune disease.10   While these medicines are not being used in the classical homeopathic tradition, it will be interesting to follow published results of their use.


1Constantin C, Muller C, et al. “Identification of Cav2-PCKβ and Cav2-NOS1complexes as entities for ultrafast electrochemical coupling”. Proceedings of the National Academy of Sciences, 2017. 2Dei A, Bernadini S. “Hormetic effects of extremely diluted solutions on gene expression”. Homeopathy, (2015) 104 3Thangapazaham RL, Gaddipati JP, et al. “Homeopathic medicines do not alter growth and gene expression in prostate and breast cancer cells in vitro”. Integrated  Cancer Therapy (2006), 5. 4Calabrese E. “Hormesis within a mechanistic concept”. Homeopathy (2015) 104 5Bigagli E, Luceri C, et al. “Exploring the effects of homeopathic Apis Mellifica preparations on human gene expression profiles”. Homeopathy (2014) 103. 6Olioso D, Marzotti M, et al. “ Effects of Gelsemium sempervirens L. on pathway-focused gene expression profiling in neuronal cells”. Journal of Ethnopharmacology (2014) 153. 7Ellanghiyil S, Preethi K, et al. “Induction of apoptosis in tumour cells by some potentiated homeopathic drugs: implications of mechanism of action”. Integrated Cancer Therapy (2012) 11. 8Saha S, Khuda-Bukhsh A, et al. “Ultra-highly diluted plant extracts of Hydrastis canadensis and Marsdenia condurango induce epigenetic modifications and alter gene expression profiles in HeLa cells in vitro”. Journal of Integrative Medicine (2015) 13. 9Abha. “Advances in homeopathy: targeting of health promoting genes using sequence specific homeopathic DNA remedies”. Homeopathy 360, 10Rosenblatt, Kuro O.“Klotho, an aging suppressor gene”. Horm. res. (2007) 67.  

Pet insurance for holistic and integrative practices

Find out how pet health insurance helps clients and patients while benefiting the veterinary practice.

As a veterinarian, I always believed that if I set aside a certain amount of money for my pets, I would be able to afford whatever was thrown my way in terms of their care. Why would I need to spend extra money each month on pet insurance? However, my latest job over the past nine months has shown me how important it is to carry pet insurance, not only for maintaining my own pets’ health, but also for benefiting our practice financially and providing our clients with gold standard care. Our integrative small animal clinic in Fort Collins, Colorado, pays towards our pet insurance policies as an employee benefit; this allows the entire staff to see the true advantages of having pet insurance and how it can help our clients and patients. Many pet insurance companies offer some coverage for alternative medicine. The challenge is to evaluate the different companies in every area of their plan coverage.

The advantages of pet insurance

According to the NAPHI State of Industry Report 2017,1 close to 1.8 million pets were insured at the end of 2016. This translates to an average annual growth rate of 11.5% from 2015.  DVM360 recently posted an article titled “The changing pet owner: 5 trends driving change in veterinary practice”2 which places financial stress at the top of the list. Pet insurance is the number one way we can help our clients and patients and benefit everyone. About 50% of clients stated they would purchase pet insurance if veterinary clinic staff discussed it with them during an appointment! A veterinary clinic needs to decide which insurance plan or plans to recommend. Technicians can do the research, compiling information so the hospital manager or owners can make the final decision. The technicians in our own clinic play a large role in informing and enrolling our clients in pet insurance. During every appointment, the technicians discuss how pet insurance can help people’s animals and make it easier for them to afford the best care. Having pet insurance also allows clients to do more with preventative medicine – for example, seasonal acupuncture tune-ups and regular chiropractic/osteopathic before and after agility. Our technicians know the benefit of pet insurance first hand because their own animals are on it. We have technicians who would have spent over ,000 on surgeries and medical treatment out of pocket if they had not had pet insurance. As it was, they spent only 10% of that amount, thanks to their insurance plans!

What to evaluate when looking for pet insurance

  1. Make sure alternative medicine is covered if you offer these services at your practice. The level of compliance for the integrative services I offer increases exponentially when clients have pet insurance. With some companies, you don’t have to pay for alternative services separately, but it’s an important factor to be aware of when delving into the pet insurance world. Trupanion requires an alternative rider, and additional cost, for alternative services. Similarly, PetPremium’s Level 3 plan covers alternative therapies. Embrace covers the greatest number of alternative therapy types. PetsBest, PetPlan, HealthyPaws, Nationwide and Embrace all include alternative therapies in their routine plans.
  2. Check if there are annual deductibles, per incident deductibles and/or lifetime limits. If there is a yearly cap on a plan, the amount a client can spend that would be covered could be severely limited. Also, a plan can have a per incident deductible, which can add up. Numerous companies will have annual deductibles. Most will allow you to pick the deductible amount. Usually, a higher deductible will come with a lower monthly premium.
  3. Read the fine print for any exclusions or to see if there are time periods mentioned before certain conditions will be covered. Numerous companies, such as PetPlan and PetFirst, have a time delay of six to 12 months before a cruciate tear or disc disease will be covered if it occurs after a pet is on the insurance plan. Some of these plans allow that exclusion to go away, however, if the pet is examined within 30 days of starting an insurance plan. For example, PetPlan will remove the time exclusion if the pet is deemed to have healthy knees by a veterinarian within 30 days of starting a plan. Numerous companies will exclude nutritional supplements and vitamins although they will cover alternative treatments such as acupuncture.
  4. Be sure to check if there may be price changes during the year. With Trupanion, the plans are on a monthly contract and can thus increase. Other companies, such as Embrace and PetPlan, cannot change the rates for a year’s contract. Also, confirm how clients are paid. The easier it is to be reimbursed, the happier the client will be. Trupanion has an Expresspay option by which the clinic submits the charges directly to Trupanion and the client only pays the co-pay. Other companies, like HealthyPaws, have mobile apps that allow clients to submit their bills easily and quickly via their phones.
  5. Finally, check customer reviews on different pet insurance companies. You want to be comfortable with who you are using. There are many great insurance companies out there. It is a matter of finding what works best for what you are looking for in a pet insurance plan.
The graph below compares the main pet insurance companies. It was made by an independent reviewer ( to limit bias towards any one company. Companies will compare themselves to others, but be wary of any bias that may skew one to look better than another. It is important to always call the insurance company to clarify all details once a plan has been chosen, to confirm everything that is included and the actual cost. The average rating includes Yelp, BBB and consumer reviews to determine that number. The differences between basic and best coverage refer to the different plans the companies offer, and can vary greatly for the services and amounts that are covered. The independent reviewer for the graph found HealthyPaws to be the best, but this will vary for everyone; this is why it’s so important for technicians to research all the information to figure out what is best for their clinics to recommend to clients.

Comparison between popular pet insurance companies

Graph courtesy of Pet Insurance U (

A case in point

My nine-year-old German shepherd, Finn, showed me why it is very helpful to have pet insurance. About three months into my job, I noticed Finn was limping on his rear leg.  Because he was covered by insurance with no pre-existing conditions, I did not have to worry financially about doing radiographs to rule out hip, spine and knee issues. Finn does have a partial cruciate tear which may need surgery in the future, but I am able to afford rehabilitation, acupuncture, laser therapy, herbal medicine, supplements -- and eventually the surgery if it’s needed -- all because the treatments are covered!

Concluding thoughts

Our overall success rate of enrolling clients in pet insurance is due to our technicians. They are able to showcase how beneficial pet insurance is to our clients, and because they have it for their own animals, they are able to share success stories on how it helped them. Our accounts receivable are very minimal because our clients can follow our gold standard recommendations for their pets and not worry about paying for it, while their pets get the best treatment possible. As a clinic, it is important to research a company that everyone feels passionate about, and then dive in. Your profits will rise, anxiety over collecting payments will decrease, and you will be able to practice the way you want, whether your focus is alternative, integrative or conventional medicine!


1State of the Industry Report. North American Pet Health Insurance Association, 2017. Retrieved from 2“The changing pet owner: 5 trends driving change in veterinary practice”. DVM360 Magazine, May 20, 2017. Retrieved from

A new business model for integrative veterinary practice – focusing on education

This new model of integrative veterinary practice combines treating patients with providing a wealth of education to clients.

Many integrative and holistic veterinary practitioners share similar frustrations. Even though we provide as much education and explanation as we can for the reasons behind holistic and proactive care, clients still often look for a quick fix. Many come to us with limited funds, having already spent hundreds on diagnostics and failed treatments. Even clients with young animals wait until an obvious illness occurs rather than following our guidelines for building health and preventing problems. The more I learned about true healing and what it really takes to achieve it, the more frustrated I became with what I offered my clients and what they were willing to do. I felt as if I was working with both hands tied behind my back, unable to help my animal patients the way I’d be able to if their guardians would only let me. Attempting to educate clients during the short time they spent in my office yielded limited results, because despite my efforts to emphasize prevention, I often wouldn’t see them again until something else went wrong with their pets. One experience gave me a new perspective on running my practice. I had been talking repeatedly to one of my clients about the importance of proper dental work for her horse, but on some level she still didn’t understand how crucial it was to work with an equine dentist who knew how to balance teeth properly. It wasn’t until she heard me speak at a lecture that addressed teeth, the TMJ and hyoid apparatus that the coin finally dropped. That’s when I realized clients don’t hear half of what I explain to them when their animals are present. Maybe they are worried, the material is too new to them, or they’re too emotional, so the knowledge doesn’t stick? In addition, I kept meeting animals in their eleventh hour when their people were distraught and financially drained. These frustrations didn’t really change when I opened my own practice, because now I also had to face my lack of business skills. In search of better ways to practice, I asked myself: “What if I could train people so their animals stayed healthy until they die of old age, just like my grandparents did?” Luckily, that’s when I came across an opportunity to learn about an entirely different business model that has changed the way I work. My new model of integrative veterinary practice combines treating my patients with educating my clients. I still mostly see patients in desperate need of healing, with the occasional holistically-minded client who already cares for his/her animals in proactive ways. The difference is that I now train clients in the art of health and prevention. This benefits their sick pets while building health for any other animals they have or will share their life with in the future. The format of my treatment and teaching practice has five distinct parts:
  1. Pre-education
  2. Initial consultation
  3. Treating and teaching
  4. Graduation
  5. Membership

1. Pre-education

When potential clients call my office, I briefly explain that I work differently than most veterinarians. Currently, I have no staff. I ask them to watch a video lecture or invite them to one of my in-person talks so they better understand what I do and why I do it. During this pre-education, I take them step by step from the “quick fix” belief to knowing what it will really take to truly turn their animals’ health around. By the end, they know the true meaning of symptoms and that to restore their animals’ health they need to address the root cause of problems. I explain some basic physiologic needs to point out that everything is connected and that the body needs to be taken care of as a whole. I also go through the six pillars of health with them: nutrition, GI tract, detox, hormones, nervous system and fitness and exercise. This helps them recognize that if they address all these aspects of healing together, they will get much better and faster improvement than if they only work with one body part at a time. This approach was key to my own personal healing from auto-immune disease. This pre-education process prepares potential clients for understanding the need to invest time and money into their animals’ healing and future health-building. Pre-education also helps me weed out people who are looking for something else, and saves me time during consultations. At the end of a live talk, potential clients get the option to sign up for an initial consultation. Those who watch the video at home are usually already scheduled for an appointment.

2. Initial consultation

In preparation for our first consultation, I email the client a questionnaire to send back to me along with veterinary records and lab results. This allows me to prepare for the consultation with a plan of action for his or her animal. The purpose of this first meeting is to go over the questionnaire, explain the treatment plan I envision for the patient, and talk about the program I recommend for the animal depending on age and level of health. In a way, it is a bit like an interview for both parties. The investment for the program is explained. If the client decides this is the path she wants to take, we get started with lab work. The physical exam is usually done once the lab results are in and we meet again. I offer three different programs, each of which includes an education component.
  • “Jump Start to a Healthy Life” is for puppies, kittens and foals. Depending on how old the animal is, the duration of this program can be as long as 12 to 15 months. Initially, the animal gets a little more attention just to get him or her on a good diet, detox some of the vaccines he might have received, and assure that his nervous system is innervating all parts of the body properly so he can grow up with good alignment and decreased risk of injury. Follow-up visits take place about every other month depending on need. This program allows me to help prevent over-vaccination and the application of other toxic substances, and to be sure the client is continuing to take steps to maximize his/her animal’s health.
  • The “Optimizing Health” program is for adult animals with no health issues and a guardian who wants to prevent illness from arising down the road. The duration is 16 weeks and includes approximately four visits, during which I walk the client through nutrition, GI health, detox and the rest of the six pillars, all individualized for his/her animal.
  • The “Wellness Program” is for animals with more significant health issues. Its duration is six months and includes more visits, treatments and supplements.

3. Treating and teaching

The goal here is to restore and maximize a patient’s health while the client goes through an educational series of classes. By the time he/she graduates from this program, he/she understands what is required to create and maintain health.
  • The treatment part always starts out with a physical exam and a review of lab results. The client receives a binder containing important information, as well as the initial supplements included in his/her program fee. Optimizing nutrition and healing the gastrointestinal system is the first step for all programs. Once a good degree of stability is achieved, most patients go through a detox program. From the first visit, to support bodily healing, patients receive a variety of treatments such as chiropractic care, acupuncture, microbiome restorative therapy, NAET treatments, ozone therapy, and hormonal support.
In the first half of the program, I see patients approximately every two weeks, more often if necessary. After that, the consults usually spread out to every three to four weeks.
  • The education part is key to my success. While patients are receiving treatment, their guardians go through a series of eight classes. The sessions take place at a local juicery every other week in the evenings for about one to one-and-a-half hours. These classes also introduce people to some healthy support for themselves. Alternately, clients can also choose the online option and watch the classes in the comfort of their own homes. This series of videos is also available to other holistic veterinarians to incorporate into their own practices.
The classes include:
  • Nutrition Basics
  • Nutrition Application
  • GI Health
  • Detox
  • Nervous System
  • Hormones
  • Heartworm
  • Vaccines
  • Fitness/Exercise with an outside trainer specializing in balance and correct muscle development to enhance performance and avoid injuries

4. Graduation and membership

Once they complete the program, most people will continue on for maintenance or further healing if necessary. At that point, I offer three membership options including four to 12 visits per year and different discount levels for labs and supplements, depending on the plan they choose.


All my program costs are bundled. This allows me to offer outside financing and also takes money off the table to focus on healing rather than the cost of supplements, etc. As a result, I can give patients what I deem most helpful without their guardians having to worry about expenses every time I see them. The investment can range anywhere from ,500 to ,000+ depending on the size of the animal and the duration of the program. Three payment options are available:
  1. One time investment at initial visit; clients receive an extra 5% off.
  2. Three monthly payments with the first due at the time of initial visit.
  3. Outside financing for up to 60 months.
This fee covers the following:
  • Individualized program design, including any research I need to do
  • Initial lab work
  • Supplements and neutraceuticals
  • All treatments and consults
  • One-on-one mentoring and support outside of appointments
  • Educational materials
  • Eight classes
Additional lab work necessary to re-check progress is charged extra. Supplements usually last at least three months. There might be extra cost depending on what the animal needs. To offset any interest clients might incur from outside financing, I deduct 10% from the total program investment for everyone.

Challenges and wins

Of course difficulties are never lacking. This method of practicing comes with its own set of challenges, depending mostly on the practitioner’s strengths and weaknesses. For me, marketing and getting people to sign up for the program is the most challenging part. I’ve had to make many adjustments to find a way that suits me best. On the bright side, it has pushed me to learn about many business-related considerations I had no clue about. As with any patient’s care, I have to be very creative and flexible and find ways to think outside the box. It is an ongoing process, for sure, and as they say: “no pain, no gain”. When I first switched over to this approach, I was only offering the programs. Realizing that I was turning away too many patients who either couldn’t afford the whole package, or still needed a little more time to get on board, I now recommend the program as a starting point of the financial discussion, and then work with people at the level they’re comfortable with. All in all, it is exciting to try on a new business model. I’ve been much happier with the results I see in my patients, and feel more fulfilled practicing this way, because I can give everything I have. It’s heartwarming to see how my clients change as they learn. Many have even applied the education they receive to their own health. In addition, getting paid for all the hours I spend researching and teaching is certainly nice!

Recovering canine health: saving indigenous dogs

Genetic abnormalities caused by extreme dog breeding are on the rise, while natural indigenous dogs with robust health are in danger of extinction. 

The burden of genetic abnormalities in Canis familiaris, the first animal species that humans domesticated, has reached a critical state. Selective breeding for extreme abnormal traits, along with subsequent inbreeding, are to blame. “An associated cost of selection for specific traits in breed dogs is an enhanced likelihood of (inherited) disease,” states a study published in December of 2015 in the Proceedings of the National Academy of Science. UCLA geneticist Clare Marsden and her colleagues examined the genomes of 46 dogs from 34 distinct breeds, and compared them with the genomes of 19 wolves, 25 village dogs and one golden jackal (a more distant relative of wolves and dogs). They found that, compared to wolves, breed dogs had 22% more cases of genes that had not one, but two, copies of a harmful mutation, because it was inherited from both parents. Compared with wolves, breed dogs averaged around 115 more mutations that posed some risk to their well-being. The researchers concluded that their results “highlight the costs associated with selective breeding, and question the practice [of] favoring the breeding of individuals that best fit breed standards…. Considering that many modern breeds have been selected for unusual appearance and size, which reflects fashion more than function, our results raise ethical concerns about the creation of fancy breeds.” The growing popularity of “designer dogs”, cross-breeds of two or more pure breeds, is in part generated by consumer demand for certain traits such as non-shedding and small or large size. The probability that such mixed breeds may have fewer inherited disorders than pure breeds because of “hybrid vigor” is undermined by the possibility that both parental lineages from two separate breeds carry similar recessive harmful genetic mutations. It is advisable for people purchasing a pure breed or designer dog to receive assurances of progeny testing for hereditary diseases from the breeder/supplier; and when purchasing either very small or large breeds, or those with extreme body conformation and skull shapes, to purchase a veterinary health insurance policy that covers pre-existing conditions of hereditary origin. [caption id="attachment_3542" align="alignleft" width="300"] Bingo is a prototypical Nilgiris aboriginal “country” dog.[/caption]

Comparing selectively bred dogs with native or pariah dogs

Veterinarian Dr. Wayne H. Riser was one of the first to identify health problems arising from selective breeding for sizes and shapes that did not conform to what he saw as the ancestral aboriginal/pariah dog. (See his monograph “The Dog: His Varied Biological Makeup and Its Relationship to Orthopaedic Diseases”, American Animal Hospital Association, 1985. For further details, see M.W. Fox, The Dog: Its Domestication & Behavior, Dogwise Publications). This article will focus on my experience with the native dogs of the Nilgiris, South India, which I became familiar with while running an animal shelter and providing community veterinary services for a decade, starting in the late 1990s.

A profile of the natural dog

Natural, aboriginal dogs can still be found in many developing countries, especially in rural communities, as well as in the US, as detailed in my books Dog Body, Dog Mind and The Dog, Its Domestication and Behavior. One example is the so-called Carolina dog or American dingo, originally a landrace or naturally selected type of dog that was discovered living as a wild or free roaming dog by Dr. I. Lehr Brisbin. A breed standard has been developed by the United Kennel Club that now specifies the appearance of these dogs, which could be their undoing if genetic diversity declines. We have met very similar dogs from some of the Native American Indian reservations in Minnesota and the Dakotas. In appearance, these dogs vary in size from 25 to 50 pounds, with many adults being undersized and underweight due to chronic malnutrition. They are long of limb, with usually erect or semi-erect ears. Tails are normally long and straight and are curled upward or downward in display, though some dogs have more permanently up-and-curled “Spitz” tails. [caption id="attachment_3543" align="alignright" width="300"] Indian villager feeding community dogs, some of which have homes/owners: Note coat color diversity but similar size and conformation.[/caption] Normally, all these dogs are protective and very faithful to their owners. They have good musculature, and the males are clearly more robust and have more powerful jaws than the females. All have characteristically small paws relative to their size, as compared to most modern breeds. The females are more protective towards theirs puppies than non-native breeds; they will choose to whelp in a secluded place and may sometimes burrow a den. They will often nurse their pups for several weeks longer than other dogs do -- pups may continue to be accepted as old as four to five months of age. The native dog’s sense of smell and tracking abilities is considered superior to that of most imported European breeds. They are skilled hunters, and tribal people rear these dogs to guide them in the forest and to hunt smaller animals. These dogs also instinctively alert to the scent tracks of potentially dangerous panthers, tigers, wild boar and cobras, and are especially on the alert after dark. They are noted for their courage and tenacity, and will defend their owners from wild boar and sloth bear attacks. Around other domestic animals, such as chickens, calves and goats, with which they normally live in villages and tribal settlements, they are gentle and even protective, most probably as a result of selective breeding and training. These dogs have great stamina and better resistance to many diseases when compared to imported breeds and cross-breeds. They are able to sustain themselves as scavengers, often existing on a subsistence diet that for other dogs would frequently mean rickets, stunted growth and other deficiency diseases. They show innate nutritional wisdom, and have often been seen eating mineral-rich dirt, and the feces of suckling calves, which are rich in enzymes, bacteria and protein. The native dogs’ vocal repertoire varies considerably, and is generally rich and subtle in terms of sound combinations (like growl-whines, yelp-barks and pant-huffs), giving a clear indication of an animal’s emotional state and intentions. Some emit low “huffs” and growls when sensing danger, while others give full voice (not preferred when in the potentially dangerous jungle). They will give different barks when alerting to wild boar in the bush versus monkeys in trees, and will engage in coyote-like yip-yap howls when they sing in horal groups. One distinctive sound some of these dogs make in greeting is a coo-like twitter with high notes that sound like whistling, much like the whistle-call of the Dhole or Asiatic Wild dog. [caption id="attachment_3545" align="alignright" width="300"] A typical Nilgiris red dog.[/caption] The Nilgiris native dogs’ coat colors include black, red, tan, white, piebald and brindle. The most characteristic coat color is red (or ruddy tan), possibly a parallel or convergent adaptive coloration seen in the indigenous wild dog (Cuon alpinus), also known as the Dhole or Chennai, one of the few wild canid species that hunts in packs. (For more details, see India’s Animals: Helping the Sacred & the Suffering by D. L. Krantz and M.W. Fox, Createspace Books,, 2016).

Saving indigenous dogs

The Nilgiris native dogs, like other indigenous dogs around much of the world, are in a state of potential extinction due to breeders introducing foreign “exotic” European breeds that are seen as a status symbol. Many of these purebreds are deliberately crossed with the Nilgiris native dog, in part to help them adapt better to local conditions, which further dilutes and “contaminates” the genetic lineage of the indigenous dogs. Spay/neuter “birth control” programs have further reduced their numbers. Outside breeds contaminating the gene pool of this native lineage in the Nilgiris include the German shepherd (Alsatian), Doberman, Labrador retriever, Rottweiler, terriers and hounds brought in decades ago by British people, and more recently by affluent Indian citizens. A policy decision to not neuter classic phenotypes of this now-threatened domestic dog variety would be a wise move in this and other bioregions where there are viable populations of relatively “pure” indigenous aboriginal dogs. This would allow the conservation of an ancient lineage, and preserve the beauty and temperament of the Nilgiris native dog (and other indigenous dogs), which some believe is the classic prototype of the earliest domesticated dog.

Cloning and gene editing

Like it or not, the age of bioengineering cybergenetics is upon us. Chinese biotechnology firm Boyalife and South Korea's Sooam Biotech are building what will be the world's largest animal cloning facility in China. But genetically engineered/edited and cloned animals often have genetic and developmental abnormalities and new diseases that cannot be justified for the novel pet trade. Dogs have joined the list of species that have been genetically edited; that list includes pigs, goats, monkeys, rabbits and rats. In December of 2015, Laura Jacques and Richard Remde of Yorkshire, England, received two new puppies, Chance and Shadow, who were cloned using their deceased dog Dylan's DNA. The couple paid roughly 0,000 to have Dylan cloned at the Sooam Biotech Research Foundation in South Korea. Meanwhile, in another cloning project, scientists in China used what is called CRISPR/Cas9 gene editing technology, which enables multiple genes to be simultaneously altered to create two beagles that lack some or all of the muscle-inhibiting protein, myostatin, resulting in dogs with larger-than-normal muscles. These activities raise profound ethical concerns. For more info, see my article “Don’t clone your dog”, as well as my DVD concerning earlier developments, at

The dark side of the human-animal bond

In a conference on the human-animal bond (Veterinary Record, December 5, 2015 p 558-559), University of Copenhagen bioethics professor Peter Sandoe observed that some people are attracted to and exhibit higher attachment to breeds with extreme (inherited) health problems requiring a higher level of care than healthy dogs. This observation implies there may be a Munchausen-by-proxy dynamic in some peoples’ choice of particular pure breeds and that “an owner’s love towards an animal does not necessarily translate into good welfare for that animal.” Sandoe concluded: “There is a dark side to human attachment to companion animals, alongside some of the benefits of ownership.”  One favored dog gene has a human counterpart that has been implicated in Williams-Beuren syndrome, where it causes exceptional gregariousness and friendliness toward strangers.

In the West

Concerted efforts in the West to reduce the number of aboriginal/ indigenous dogs by various means (both humane and inhumane) for public health reasons (especially rabies control) may actually lead to the disappearance of landraces and the loss of genetic diversity in regional canine populations.

Individualized nutrition based on biomarker testing

Understanding the relationship between nutrition and gene expression enables one to design an optimal diet based on an individual animal’s genotype.

Proper nutrition plays a key role in maintaining the health and longevity of human and animal populations and their resistance to disease.1-3 In addition to providing an energy source, food and diet directly influence the expression of our genetic potential. In the last 15 years, medical, veterinary and nutritional scientists have begun applying genomics to the field of nutrition. Nutritional genomics (nutrigenomics) is playing an essential role in assuring the quality and safety of human, livestock and pet foods.4-6 In this regard, foods are evaluated for their functional ingredients. Different diets can alter gene expression, resulting in changes in the production of specific proteins and metabolites. Understanding the relationship between nutrition and gene expression enables one to design an optimal diet based on an individual genotype, which can ultimately have a profound effect on the phenotype and observable traits of the person or animal.1-4 Food constituents can act by “up- or down-regulating” target genes, thereby altering their expression. Thus, diets for animals should ideally be tailored to the genome or genomic profile of individuals or breeds in order to optimize physiological homeostasis, disease prevention and treatment, growth, reproduction, and athletic and obedience performances. Nutrigenomics can individualize dietary intervention to prevent, mitigate or cure chronic diseases.1-6

Individualized nutrition

The foundation for achieving individualized nutrition starts by feeding wholesome, fresh and nutrient-dense foods that are selected and optimized based on an individual’s genomic profile.1,5,6

Functional superfoods

Foods that promote the expression of “healthy” genes are often called “functional superfoods”,1-6 and include certain botanicals, amino acids, vitamins and phytochemicals. All individuals can receive health and longevity benefits from functional superfoods to help prevent or mitigate chronic lifestyle-related diseases, and thus promote a state of optimum health and well-being.2,7,8 Examples of functional superfoods include berries (e.g. blueberries, cranberries), coconut oil, curcumin (turmeric), dark green leafy and yellow orange vegetables, fruits like apples, pears and bananas, medicinal mushrooms, milk thistle, Omega 3 fatty acids, pomegranates, prebiotics (spirulina and soluble and insoluble fiber) and probiotics. Further, to help pets avoid developing intolerances/sensitivities, rotate foods every one to two months using “novel” animal proteins and gluten-free foods.2 Proteins commonly considered “novel” are bison, buffalo, duck, fish, goat, lamb, pork, turkey and venison. While this approach may seem logical, many people don’t realize that an animal protein source that’s “novel” for one dog or cat won’t necessarily be so for another, unless he has never eaten it before. This is because, unlike a food allergy (which is an immediate reaction), intolerances/sensitivities can build due to prolonged consistent exposure to a particular ingredient. For example, kangaroo, emu and ostrich meats contain proteins that are novel for most dogs in the United States, yet are routinely available in countries like Australia. Similarly, lamb, turkey and venison were once considered novel proteins in the United States but now that they are more mainstream, dogs are beginning to manifest food intolerances/sensitivities to them.1,2 Food intolerances cause a delayed-type immune sensitivity reaction that often begin in the gut, but the antibodies involved are also released in secretions of saliva, tears and sweat, as well as from the nasal passages and ear canals, and the mucosal surfaces of the entire GI and urogenital tracts.1,2 Food intolerance is the third most common condition seen in animals, after flea bite sensitivity and atopy (inhalant allergy). Food intolerance is also the cause of 20% of all allergic skin disease.1

Nutrition, inflammation and oxidative stress

Oxygen is required to produce the high-energy compound ATP coupled to the breakdown of fats, carbohydrates, etc. This process is not 100% efficient, and a lot of O2 is converted to “reactive oxygen species” (ROS), including hydroxyl and superoxide radicals (see Figure 1). ROS quickly react with biomolecules, including lipids, proteins and DNA. Although several protective mechanisms have evolved, an excess of ROS (a condition called oxidative stress) is a primary risk factor for a wide variety of diseases. Oxidative stress, in turn, typically promotes chronic inflammation in which tissues or organs receive inflammatory “mediator” messages that cause them to react as though the “trigger” or pathogen was still present. Rather than repairing themselves, these cells remain in an ongoing state of inflammation that can wax and wane for an entire lifetime. Antioxidants are now considered vital for inclusion in diets for humans and pets, and are often heavily promoted. Indeed, antioxidants are used in pet foods with higher fat and oil content in an effort to reduce lipid oxidation and the resultant rancid, unhealthy lipid oxidation products.9,10 Many antioxidants in pet foods are oxygen scavengers (see Figure 2) and neutralize ROS in 1:1 reactions. However, some functional foods act at the genomic level, especially via the Nrf2 transcription factor, to stimulate production of antioxidant enzymes. The flavonoids, a large family of polyphenolic compounds synthesized by plants, play a pivotal role in the Nrf2 regulatory pathway of oxidative stress. Dietary flavonoids provide multiple health benefits. In addition to being ROS scavengers, they mainly act as activators of the Nrf2 pathways -- stimulating the body’s own defensive systems. Flavonoids comprise the following subclasses: anthocyanidins (pigmented vegetables and berries), flavanols (tea, berries, apples), flavanones (citrus fruits), flavonols (quercetin; tea, onions, kale, broccoli, apples and berries), flavones (parsley, thyme, celery), and isoflavones (genistein; soybeans, legumes).11,12

Figure 1

Oxidative stress due to reactions of superoxide anion radical, hydrogen peroxide and the hydroxide ion with cellular components is mitigated by the actions of superoxide dismutase and catalase.

Figure 2

Many substances have beneficial antioxidant effects. Several small molecules are ROS scavengers, reacting 1:1 with a single ROS. Hence, large quantities are needed to combat oxidative stress. Other components of the diet, including several carotenoids, activate the expression of Nrf2-regulated genes, increasing the levels of several protective enzymes, including catalase and superoxide dismutase (SOD), with each enzyme capable of inactivating huge numbers of ROS for prolonged periods.

Biomarkers of oxidative stress

Measuring the beneficial or harmful effects of food ingredients in an individual can be accomplished by monitoring certain biomarkers, including levels of ROS scavengers, antioxidant enzymes, and/or byproducts of ROS damage.9-12 Recent human and veterinary research literature has assessed the effects of various factors, including diet, exercise and disease, on the cellular biomarkers of oxidative stress, including antioxidants and chronic inflammation. However, applying this research in practical clinical settings has been hampered by the instability of most relevant biomarkers in blood, tissues and other body fluids. Once the specimens contact air, additional reactions occur that obfuscate the in vivo status of the subject, even if samples are stored frozen at -80°C. Sophisticated laboratory equipment and assays have also been required. Standard oxidative stress and antioxidant biomarkers9-12 include glutathione (GSH), a measure of Nrf2 (nuclear factor-erythroid-2-related factor 2) activation11,12; total antioxidant capacity (TAC), the sum of low molecular weight scavengers of reactive oxygen species; malondialdehyde (MDA), a by-product of lipid peroxidations, tumor necrosis factor-alpha (TNF-α) a key inflammatory mediator; and antioxidant enzymes including SOD (superoxide dismutase) and catalase. Recent improvements in biomarker assays are allowing their increased use in developing optimized diets for us and our pets. 1Dodds WJ. “Functional foods: the new paradigm based upon nutrigenomics”. J Am Hol Vet Med Assoc 2014; 36: 26-35. 2Dodds WJ, Laverdure DR. Canine Nutrigenomics: The New Science of Feeding Your Dog for Optimum Health. 2015. DogWise Publishing, Wenatchee, WA, pp. 323. 3Essa MM, Memon MA. Food as medicine. New York: Nova Biological, 2013. 4Fekete SG, Brown DL. “Veterinary aspects and perspectives of nutrigenomics: A critical review”. Acta Vet Hung 2007; 55(2): 229-239. 5Kaput J, Rodriguez RL. Nutritional genomics: Discovering the path to personalized nutrition. Somerset, NJ: John Wiley & Sons, 2006. 6Swanson KS, Schook LB, Fahey GC. “Nutritional genomics: Implications for companion animals”. J Nutr 2003;133(10): 3033-3040. 7Laflamme DP. “Nutritional care for aging cats and dogs”. Vet Clin N Am: Sm An Pract 2012; 42(4): 769-791. 8German JB, Roberts MA, Fay L, Watkins SM. “Metabolomics and individual metabolic assessment: the next great challenge for nutrition”.  J Nutr, 2002; 132: 2486-2487. 9McMichael M. “Timely topics in nutrition. Oxidative stress, antioxidants, and assessment of oxidative stress in dogs and cats”. J Am Vet Med Assoc. 2007; 231: 714-720. 10Wang J, Schipper HM, Velly AM, et al. “Salivary markers of oxidative stress: a critical review”. Free Rad Biol Med 2015; 85: 95-104. 11Dodds WJ, Callewaert DM. “Novel biomarkers for oxidative stress for veterinary medicine, Parts 1 and 2”. Proceedings AHVMA, Columbus. OH; Sept 2016. 12Kangas K. “A review of oxidative stress and the Nrf2 pathway”. J Am Hol Vet Med Assoc 2016; 44: 8-13.

This article has been peer reviewed.

Treating seizures with prolotherapy
In February of 2016, I was presented with Tanner, a 97.6-pound six-year-old M/N German shepherd with a history of seizures. His owner, John, was referred to me by his human chiropractor. Tanner was experiencing full and often severe epileptic-type seizures approximately every three to five weeks since September of 2014. The primary clinic exam found no musculoskeletal or neurological abnormalities. Bloodwork showed a mildly elevated ALP. Tanner had been put on phenobarbital, potassium chloride and Keppa with no relief. Since the current medication regime did not affect the severity or frequency of Tanner’s seizures, John had removed him from all medications by the end of December. The seizures continued every two to four weeks when I met Tanner and John in February. On exam, Tanner’s lumbar muscles from T10 to L3 were very tight. The nuchal ligament was also tight. He had normal biceps abduction angles, and thin and tight patellar ligaments. Dry needle acupuncture was initiated relative to the initial exam findings. I prescribed a Chinese formula for the seizures. We continued acupuncture and herbal formulas every month. While talking to John, I learned that three or four years prior to our meeting, Tanner had run into and flipped over a retaining wall, but little was thought of it since any obvious soreness was gone within a few days. The severity of Tanner’s seizures lessened over the next three months, but they continued to occur. A radiograph showed a mild and quiet greenstick fracture line on the axis wing, mild occipital arthritic changes and inflammation. Tanner was anesthetized with a combination of ketamine and diazepam i.v. A solution of 15% dextrose was prepared, using 1cc of 2% lidocaine, 3cc of 50% dextrose, and 6cc of sterile water into solution. A 25ge x 1.5” sterile needle was put out for use. We also collected 3cc of plasma from Tanner. The dextrose solution was used in multiple taps at the nuchal ligament attachments on C2, along the nuchal ligament and its insertion, and the cervical vertebral ligament attachments. The plasma solution was used on the occipital protuberances where the arthritic changes were more evident, most cranial vertebral ligaments, and the C1 wings – especially noting the area of the greenstick fracture line to facilitate stem cell healing. Here I chose to use plasma in areas that not only needed more healing than strengthening, but also where I was working closely to the brain stem and spinal cord. Tanner was sent home with instructions for no collar, no neck pulls and neck ROM exercises using treats several times daily. Tanner had a very minimal seizure two days post-procedure, but none at the normal three-week mark. Three months later, his owner reported there had been no seizures from May until August – a period of three months! Tanner had another mild seizure the end of August, so another prolotherapy session using the same protocol was set up for September 1. Tanner was again seizure-free until late November 2016 – almost another three months. John had the carpets cleaned and that night Tanner seized. He was put on 97.2 mg of phenobarbital daily by his primary veterinarian, which has kept the seizures under control.  As of July 2017, Tanner was seizure-free on a minimal dose of phenobarbital.

Prolotherapy in practice
Prolotherapy is a non-surgical treatment used to increase tendon and ligament strength and relieve arthritic changes. In humans, it is commonly used in Olympic sports medicine, as well as for the non-surgical treatment of rotator cuff injury, knee problems, and degenerative back and arthritic diseases. Prolotherapy is also becoming a more common practice in veterinary medicine for treating lameness.  However, I have found it to be useful in a variety of other cases. I have been using dextrose prolotherapy in my practice since it was introduced to me by Dr. Carvel Tiekart at the AHVMA conference in 2006.1 Regenerative injection therapy is a newer name that reflects the most common theory as to the treatment’s effects. The injection of a substance into a joint or at ligament/tendon attachments causes a controlled injury with a subsequent healing cascade. This results in the production of new collagen, thus tightening the joint and decreasing pain. I believe that each component of the dextrose solution carries with it specific properties that come together in a healing we are only just learning the intricacies of. This healing process continues over a course of six to eight weeks, so if another treatment is needed, I wait until after the six-week recheck to decide. Recently, I have also incorporated plasma therapy, using the same technique, for intervertebral and arthritic joints. The platelets in the plasma contain stem cells that can differentiate to create a healing cascade in degenerative joints. For chronic or specialized cases, I use a combination of dextrose and plasma techniques on the same patient, often using the dextrose for torn knee ligament injuries, and plasma to relieve the associated lower back and/or hip arthritis that often accompanies the degenerative knee problem. I have also found success in using the dextrose solution for the tendons and ligaments of a weak knee with a mild-moderate drawer sign, and using the plasma solution on the arthritic cartilaginous bone surfaces. I also used a combination of therapies in a case of refractive seizures. I tend to use the dextrose solution for primary tendon/ligament issues, and the plasma in areas of arthritic change.

Technique is paramount

Knowing your anatomy is critical for needle placement. The needle and solution must come in contact with the origin, and I often also tag the insertion, of the tendon or ligament where it connects to the bone, and follow the tendon to the muscle body and the ligament to its attachments. Always pull back on the syringe when you are working near blood vessels. Often, the tendon or ligament will give a very quiet, but palpable and audible, pop sound as you penetrate it. This is my indication that I am in the right spot; then I follow it to its insertion, injecting multiple drops of solution as I go. Once I have found my point of contact, I will walk the needle, injecting as I go, as far as possible before retracting and starting a new puncture. Plasma injections are not walked through like dextrose injections, but are rather given in several small injections onto cartilage surfaces and into joints. I treat the main tendons (patellar in the knee, biceps in the shoulder/elbow, brachiocephalic in the neck and shoulder) and also the respective surrounding collateral ligaments. I finish with local corresponding acupuncture points – for example, GB34 at the knee; TH14, LI15, SI9 at the shoulder; SI8 at the elbow; sometimes TH5 and TH4 for foreleg lameness completion; and GB29, GB30, and BL54 at the hip. I have used 25ge x 1.5” needles in very large dogs, but a 28ge x 1.5” needle for medium and large dogs, and a 30ge x 1” needle for small dogs and cats gives me a better outcome with less pain and more rapid improvement post-procedure. In my opinion, it is worth finding the right-sized needle. My basic solution is made up of 50% dextrose, sterile water, and 2% lidocaine (without epinephrine). I have used procaine in the past, with the goal of better breaking down scar tissue, but it needs to be compounded, has a shorter shelf life, and doesn’t seem to really make a difference. I use a short-acting injectable anesthetic. The procedure itself tends to only take ten to 20 minutes. For a large dog, I will often use 15cc to 20cc of dextrose solution, for a medium dog 10cc to 15 cc, and for a small dog or cat 5cc to 10cc. The quantity of plasma I use often depends on how much I get from the patient. I aim for 1cc to 3cc for a medium dog with one joint to treat, and 6cc for a large dog with multiple joints needing treatment (each vertebra is a joint). I prefer to draw fresh whole blood into a red top tube, let it clot, spin down and separate. In our area, we are endemic for Lyme disease and anaplasmosis. I always test for these tick-borne diseases prior to the procedure. Previously undiagnosed anaplasma has led to severe bruising in the area post-procedure.

Examples of use in practice

Shortly after Dr. Tiekart’s lecture, I was working with a three-year-old Shiba Inu named Tiko who was starting to fail at the pole weaves as he advanced in agility. That summer, I attended a rehabilitation conference at which Dr. Christine Zink discussed how to recognize tendon laxity, primarily in the biceps. Tiko was being seen by a veterinary rehabilitator and was prescribed hobbles, much to my client’s dismay. Putting the two conference ideas together, I called the client and asked if we could try prolotherapy on Tiko’s shoulders.  We did all four joints -- shoulders and knees. Tiko went on and won his grand champion Mach title in agility that fall. I was impressed and motivated. Since then, I have used the dextrose technique on a large number of agility, sporting and pet dogs, ranging from five to 150 pounds. Most pets and owners were happy with the results after just one treatment, though a number of the agility and sporting dogs were given two treatments (“just to make sure they are as strong as possible”). In all cases, the increased thickness and spring of the patellar ligament was palpable at the six-week visit. I have also used this technique to tighten luxating patellae; however, unless it is a traumatic luxation, I haven’t seen prolotherapy alone eliminate it beyond a Grade 1 after four treatments. I have used dextrose prolotherapy treatments in two dogs with fixed knees, one congenital and one on an older rescue dog and with no clear cause. The young dog (20 weeks) had a full recovery. The rescue adult experienced what I see as an 80% recovery -- still a little stiff, but almost fully flexible.


Movement post-procedure is imperative. For at least the first 48 hours, clients are instructed not to let the animal stay in one position for longer than two hours without a minimal 15-minute walk. They can sleep a full night. One of my few failures with prolotherapy involved a patient that traveled 2.5 hours for a treatment. The client was given direction to stop halfway home to walk the dog, which she did not do. When she got home, the dog was kenneled for the next eight hours with no walks. Although most dogs (and the couple of cats I have treated for low lumbar arthritis) respond to one or at most two treatments, one case took almost six weeks to show improvement, though it finally did. The more cases I see, and the more I treat that are longstanding rural cases rather than on-the-spot agility cases, the more rounded my success curve becomes. Prolotherapy is still a vital part of my practice. It would benefit every practice, especially those with a large caseload of agility or performance dogs.

Ingredients to make a 15% solution

In a 10cc to 12cc syringe, draw up 1cc of 2% lidocaine (without epinephrine). Fill to 4cc with 50% dextrose, and to 10cc with sterile water (saline does not give the same results, in my experience). This is equivalent to 1cc lidocaine, 3cc 50%dextrose, and 6cc sterile water.

Where to get supplies

Plasma: from the animal you are treating – spin, separate, and draw up into a syringe. Dextrose solution: veterinary supply distributors Needles:  we found 28ge x 1.5”, and 30ge x 1” at Air-Tite Products Co., Inc.

Case Report – treating seizures with prolotherapy

In February of 2016, I was presented with Tanner, a 97.6-pound six-year-old M/N German shepherd with a history of seizures. His owner, John, was referred to me by his human chiropractor. Tanner was experiencing full and often severe epileptic-type seizures approximately every three to five weeks since September of 2014. The primary clinic exam found no musculoskeletal or neurological abnormalities. Bloodwork showed a mildly elevated ALP. Tanner had been put on phenobarbital, potassium chloride and Keppa with no relief. Since the current medication regime did not affect the severity or frequency of Tanner’s seizures, John had removed him from all medications by the end of December. The seizures continued every two to four weeks when I met Tanner and John in February. On exam, Tanner’s lumbar muscles from T10 to L3 were very tight. The nuchal ligament was also tight. He had normal biceps abduction angles, and thin and tight patellar ligaments. Dry needle acupuncture was initiated relative to the initial exam findings. I prescribed a Chinese formula for the seizures. We continued acupuncture and herbal formulas every month. While talking to John, I learned that three or four years prior to our meeting, Tanner had run into and flipped over a retaining wall, but little was thought of it since any obvious soreness was gone within a few days. The severity of Tanner’s seizures lessened over the next three months, but they continued to occur. A radiograph showed a mild and quiet greenstick fracture line on the axis wing, mild occipital arthritic changes and inflammation. Tanner was anesthetized with a combination of ketamine and diazepam i.v. A solution of 15% dextrose was prepared, using 1cc of 2% lidocaine, 3cc of 50% dextrose, and 6cc of sterile water into solution. A 25ge x 1.5” sterile needle was put out for use. We also collected 3cc of plasma from Tanner. The dextrose solution was used in multiple taps at the nuchal ligament attachments on C2, along the nuchal ligament and its insertion, and the cervical vertebral ligament attachments. The plasma solution was used on the occipital protuberances where the arthritic changes were more evident, most cranial vertebral ligaments, and the C1 wings – especially noting the area of the greenstick fracture line to facilitate stem cell healing. Here I chose to use plasma in areas that not only needed more healing than strengthening, but also where I was working closely to the brain stem and spinal cord. Tanner was sent home with instructions for no collar, no neck pulls and neck ROM exercises using treats several times daily. Tanner had a very minimal seizure two days post-procedure, but none at the normal three-week mark. Three months later, his owner reported there had been no seizures from May until August – a period of three months! Tanner had another mild seizure the end of August, so another prolotherapy session using the same protocol was set up for September 1. Tanner was again seizure-free until late November 2016 – almost another three months. John had the carpets cleaned and that night Tanner seized. He was put on 97.2 mg of phenobarbital daily by his primary veterinarian, which has kept the seizures under control.  As of July 2017, Tanner was seizure-free on a minimal dose of phenobarbital. 1Tiekert, Carvel G, DVM. “Prolotherapy treats pain by stimulating the body to repair damaged/loose ligaments”. IVC Journal, Summer 2015.

Integrative treatment for inherited diseases in dogs
Because inherited diseases are chronic conditions, integrative medicine has many contributions to make that can help support the canine patient’s health. Nancy Scanlan, DVM, MS, CVA An “inherited disease” is officially defined as a condition that has been proven to be inherited, or to be statistically higher in one or more specific breeds than in others.1 Inherited diseases range from mild to life-threatening. Integrative medicine has quite a bit to offer in the treatment and management of these conditions.

Inherited diseases explained

Over 300 canine diseases are officially proven to be inherited.2 This number is probably low, especially when compared to humans and mice. In humans, over 2,000 genetic diseases have been identified; there are over 1,300 mouse models for human diseases (which means over 1,300 mutations).3 The study of affected animals in pedigrees is the first step to show inheritance of a particular disease. This is followed in a number of cases by identifying the specific genes involved and, ideally, developing a test for those genes. Another method is to review prevalence of a disease in a specific breed and to compare it to the prevalence of the disease in the rest of the canine population, but this is less scientifically predictive.4
  • A disease caused by the single mutation of a dominant gene is easiest to spot. Any animal with a single copy of that gene will have that disease. Genes that are dominant but with incomplete penetrance may have variable expression, so symptoms of the disease can be anywhere from mild to severe, depending on the degree of gene expression. Type 1 Von Willebrand disease (vWD) in Dobermans is such a disease. Because the variability means many afflicted Dobermans may not show severe signs of excessive bleeding, it has been difficult to get breeders to remove affected animals from the gene pool. In such cases, this type of problem can become widespread throughout a breed.5 
  • On the other hand, diseases may be caused by a single recessive mutation, which means that until a test is developed to determine carriers, and until a breed association becomes resolved to eradicate that trait from the breed, the trait may become widespread. This is especially true when a popular sire is also a carrier for the disease. Type 3 vWD in Scottish terriers is a classic example as it has autosomal recessive inheritance whereby two obligate carrier heterozygotes can produce clinically affected homozygous offspring that express a severe bleeding tendency. The affected gene has been identified and extensive carrier testing has virtually eliminated most of this problem from the breed.4 All but one type of progressive retinal atrophy (PRA) is another autosomal recessive example. To further complicate matters, this disease can be caused by at least six different mutations.6-11 There are six different DNA tests available. Fortunately, most breeds affected by PRA have the same type: PRCD (Progressive Cone/Rod Degeneration).4 Conscientious breeders involved with breeds afflicted with this problem are actively testing and removing carriers from the breeding pool.
  • The hardest diseases to control with conventional medicine are those with multiple genes involved; other factors include conformation, nutrition, breed, rate of growth, amount of exercise and others. Hip dysplasia is an example. This type of problem is one where intervention with integrative veterinary medicine can help the most, especially when it’s started at an early age.

Breed considerations

Purebred dogs are more likely to have certain specific inherited diseases than dogs whose ancestors come from two or more breeds. But this does not mean all non-purebred dogs are healthier. They may inherit problems from all their ancestors. In addition, certain body shapes (as in the case of brachycephalic dogs) are associated with specific disease syndromes, regardless of whether a dog is purebred or crossbred. A survey at UC Davis involving dogs affected with 24 of the most common genetic diseases with major health consequences showed that for about half of them, there was no difference in occurrence between purebred versus mixed breed dogs.12,13 Popular breeds are more likely to have a longer list of inherited diseases than less popular breeds. There are a larger number of dogs among the popular breeds, so there will be more individuals with some of the less common forms of the disease, allowing more opportunities for the disease to continue within that breed. In addition, owners of popular breeds may be more likely to breed their dogs with the nearest dogs of the same breed without any genetic screening, increasing the chances of spreading undetected problems.14 One should not rely solely on official surveys of the incidence of inherited diseases. A breed that’s new to a country may not have been present long enough for any problems to become obvious. A rare breed may not have enough members to enable a good statistical sampling, or to show signs of the problem so it can be recognized as being breed-related.2 Pet owners may purchase a dog based on an internet search for “healthiest dog breed” and end up with a rare breed that has a number of unexpected problems.

The role of integrative medicine

Because these are inherited genetic defects, often associated with anatomical changes, integrative medicine is not going to prevent most of them, unlike diseases associated with the environment or nutrition. However, because the cause (genetic) is present over an animal’s entire lifespan, inherited diseases are chronic conditions. For chronic diseases and those with multiple causes, integrative medicine has many contributions to offer that can help support the patient’s health. Chronic conditions often respond better to integrative medicine than to conventional medicine alone. For some genetic diseases, such as vitamin A-responsive dermatosis and zinc-responsive dermatosis, the conventionally recognized treatment is already essentially an integrative one involving a single nutraceutical (a vitamin or mineral used in a higher dose than is present in conventional pet food and supplements). Obviously, some dysfunctions and diseases are associated with body structure. Dogs with pendulous ears are much more likely to have chronic otitis than dogs with erect ears. Chondrodysplastic breeds with short legs are more likely to have Type I intervertebral disc disease (IVDD) than breeds with a more wolf-like conformation. In the case of pendulous ears, integrative treatment will not change the shape of the ears but neither will conventional treatment. But often, an integrative treatment can be used to prevent the otitis associated with pendulous ears, with longer-lasting results than conventional treatment. In the case of IVDD, prevention is harder to accomplish, but treatments such as acupuncture can have analgesic effects equal to or even surpassing those of conventional medicine. The same is true of most polygenic conditions that can cause pain, such as hip dysplasia. When the problem is related to conformation or body structure, the pet owner’s idea of “cure” may not be realistic. Dangling dewclaws on the hind legs, with nails that grow and curve around into the tissue, are not going to fall off or allow the nails to wear down normally, no matter what treatment is used. This is where an “integrative” approach applies: the ideal treatment is either regularly trimming the nails or removing any excess toes. In contrast, other diseases with multiple contributing factors, such as hip dysplasia, can be improved or even in some cases cured, if proper nutrition and other treatment are started early enough. Inherited skin diseases in general are especially amenable to integrative treatments, including almost half of those identified as being inherited. Some immune disorders also can respond dramatically to integrative treatments. In such cases, a spectrum of treatments is most effective, often involving a combination of nutrition, nutraceuticals, herbal therapy, and/or homeopathy as well as other modalities. In short, integrative medicine can help alleviate the issues caused by or associated with many inherited diseases in dogs.

Online lists of inherited diseases in dogs

Dodds, WJ. 2011. Guide to Congenital and Heritable Disorders in Dogs (Includes Genetic Predisposition to Diseases). Humane Society Veterinary Medical Association, 2011. Available as a download at, IDID list of inherited diseases, including photos., Canine Inherited Disorders Database, Human genetic disorders database of over 2,000 diseases., Mice strains including 1,372 human diseases with one or more mouse models.

Labs that test for genetic diseases in dogs, including PRA


1“Selection of Diseases”, 2Dodds, WJ. Guide to Congenital and Heritable Disorders in Dogs (Includes Genetic Predisposition to Diseases). Humane Society Veterinary Medical Association, 2011. 4“How are Defects Inherited”, 5Riehl J1, Okura M, Mignot E, Nishino S. “Inheritance of von Willebrand's disease in a colony of Doberman Pinschers”. Am J Vet Res. 2000 Feb;61(2):115-20. 6“Progressive Retinal Atropy – PRCD, 7Dostal J, Hrdlicova A, Horak P. “Progressive rod-cone degeneration (PRCD) in selected dog breeds and variability in its phenotypic expression”. Veterinarni Medicina. 2011 Jun; 56(5):243-47. 8Clements PJ, Gregory CY, Peterson-Jones SM, Sargan DR, Bhattacharya SS. “Confirmation of the rod cGMP phosphodiesterase beta subunit (PDE beta) nonsense mutation in affected rcd-1 Irish setters in the UK and development of a diagnostic test”. Curr Eye Res. 1993 Sep;12(9):861-6. 9Kohyama M, Tada N, Mitsui H, Tomioka H, Tsutsui T, Yabuki A, Rahman MM, Kushida K, Mizukami K, Yamato O. “Real-time PCR genotyping assay for canine progressive rod-cone degeneration and mutant allele frequency in Toy Poodles, Chihuahuas and Miniature Dachshunds in Japan”. J Vet Med Sci. 2015 Nov 6. [PubMed: 26549343] 10Moody JA, Famula TR, Sampson RC, Murphy KE. “Identification of microsatellite markers linked progressive retinal atrophy in American Eskimo Dogs”. Am J Vet Res. 2005 Nov;66(11):1900-2. [PubMed: 16334947] 11Zangerl B, Goldstein O, Philp AR, Lindauer SJ, Pearce-Kelling SE, Mullins RF, Graphodatsky AS, Ripoll D, Felix JS, Stone EM, Acland GM, Aguirre GD. “Identical mutation in a novel retinal gene causes progressive rod-cone degeneration in dogs and retinitis pigmentosa in humans”. Genomics. 2006 Nov; 88(5):551-63. [PubMed: 16938425] 12Bellumori TP, Famula TR, Bannasch DL, Belanger JM, Oberbauer, AM. “Prevalence of inherited disorders among mixed-breed and purebred dogs: 27,254 cases (1995-2010)”.  J Am Vet Med Assoc 2013 242: 1549-1555. 13Bonnett BN, A Egenvall, A Hedhammar & P Olson  Mortality in over 350,000 insured Swedish dogs from 1995-2000: breed-, gender-, age-, and cause-specific rates.  Acta Vet Scand 2005 46 : 105-120. 14IDID: inherited diseases in dogs: web-based information for canine inherited disease genetics. Mamm Genome. 2004 Jun;15(6):503-6.  

This article has been peer reviewed.

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Shockwave therapy

This non-invasive modality can successfully treat a range of orthopedic and soft tissue problems in animals. Though most commonly used for horses, shockwave therapy also has many applications in small animal practice.  

Shockwave therapy is a non-invasive treatment that can speed the healing of many types of orthopedic and soft tissue injuries and conditions. It has been used in Europe in human medicine to treat tennis elbow, plantar fasciitis, rotator cuff injuries, calcifying tendonitis of the shoulder, femoral head necrosis, non-union fractures, wounds, burns, osteomyelitis with draining tracts, myofascial pain and more. New research has shown potential applications in treating periodontal disease, infected wounds, and to help speed fracture healing and reduce the incidence of non-union fractures. In the United States, shockwave therapy has been successfully used for many years in veterinary medicine to treat animals with both acute and chronic soft tissue injuries, bone and joint disease, and back pain. It is also used to aid in wound healing, with and without infection, and to stimulate bone healing, particularly in the case of non-union fracture cases. Shockwave therapy is widely accepted in equine practice and is commonly used to treat many orthopedic conditions, both bony and soft tissue. While its use is less common in small animal practice, the applications are still numerous. One key to success is an accurate diagnosis and a clearly defined area of injury so you can direct the shockwave to the appropriate area.

Shockwave use in equine practice

In my practice, shockwave therapy is most often used for suspensory ligament injuries, even with avulsion fractures. It can be used on its own for acute injuries or in conjunction with stem cell therapy, PRP injections, or IRAP. It can also be very effective in managing chronic suspensory inflammation of either the body or the branches of the suspensory ligament. It can be a key component in the therapy and rehabilitation of hind limb suspensory ligament injuries, which present a challenging diagnosis at best. In addition to the initial series of treatments in the case of an acute injury, I will also often periodically use shockwave therapy as the horse comes back into work, in an effort to continue to help stimulate healing and remodeling of the injured area. Good response is also seen in horses with sore backs, including those with muscular pain and pain related to kissing spines. It may be used on its own or in combination with other therapies such as corticosteroid injection of the back musculature, or of the interspinous spaces in the case of kissing spines. I also frequently use shockwave therapy to treat horses with neck pain, including in the upper cervical region and at the poll. I often combine shockwave therapy with chiropractic care in horses with neck, poll or back pain; I find that this combination of therapies can be very effective in managing and relieving pain in these areas. Other uses include:
  • Tendon tears and strains
  • Osteoarthritis
  • Collateral ligament injuries
  • Navicular syndrome • Ringbone • Joint inflammation and pain • Neck pain
  • Muscle tears and strains
  • Infected or large wounds
  • Burns

Treatment protocol in equines

The precise treatment protocol depends on the diagnosis of each individual patient. Treatment varies in the number of shockwaves administered and the energy of those shockwaves. Most acute soft tissue injuries are treated a total of three times spaced at two to three week intervals. I typically recommend a re-check exam at three to four weeks after the third treatment to assess the healing that has taken place. In some cases, additional treatments are needed. If shockwave therapy is being used in conjunction with a regenerative therapy such as stem cell or PRP, I would ideally complete one shockwave treatment prior to the regenerative therapy and then would do the second shockwave at three to four weeks after the regenerative treatment, then the third shockwave three weeks after the second treatment. In cases of osteoarthritis, the protocol is similar, depending on the severity of the degenerative changes. Typically, I would recommend a series of three treatments, spaced at three-week intervals. However, if I don’t see at least a modest improvement by three weeks after the second treatment, I would not do a third. In cases of osteoarthritis that respond well to shockwave therapy, I frequently find it useful to do single “booster” treatments at intervals ranging from three to six months, depending on the individual, his or her workload, and overall response to treatment. In some cases of ringbone, I have had a response lasting up to two years from the initial series alone, and have then come back and done a second series of three, also with positive results. More commonly, I recommend re-treating the horse at a shorter interval in an effort to stay ahead of any decline in comfort. In cases of navicular disease, I also typically recommend a series of three treatments done at shoeing intervals (the frog needs to be pared down and the foot soaked overnight prior to treatment), with “booster” treatments done at three to six month intervals. The treatments are easily performed at the horse’s home barn, typically with the horse under mild sedation. Sedation may not be necessary, such as when shockwaving the back, neck, or chronic suspensory branches.  In cases of acute or recent injuries, sedation is almost always required. Typically, the horse will start to experience some reduction in pain and/or swelling within hours. This relief will generally last two to four days, then the horse will return to almost his original status. Over the next two to three weeks, however, actual healing will take place. The early response or improvement in comfort is seen both in horses with recent injuries and those with more chronic problems. Major medical insurance policies for equines will reimburse owners for the cost of focused shockwave therapy.  Each policy differs in the coverage offered.

Equine case report   

Mary was an 18-year-old Welsh Cob mare used in competitive trail riding (mountainous terrain). She had ringbone RF and was approximately +2 of 5 lame, despite treatment involving corrective shoeing and NSAID therapy. I treated Mary with a series of three shockwave therapy sessions and she was able to return to her previous level of performance for a period of two years, with only intermittent NSAID use. Two years after her initial shockwave therapy series, I did a second series of three treatments and Mary was able to continue competing for one additional year. At that point, the owner opted to retire her. Ringbone is a particularly challenging diagnosis, with limited therapeutic options, so an additional three years of competing thrilled Mary’s owner.

Shockwave use in small animal practice

Shockwave therapy has been successfully used to treat many soft tissue and bony problems, both acute and chronic, in small animals. These include, but are not limited to:
  • Hip dysplasia
  • Non-union fractures
  • Degenerative joint disease
  • Spondylosis
  • Lumbosacral pain
  • Osteoarthritis
  • Tendon and ligament injuries
  • Bursitis
  • Muscle tears and strains
  • Wounds
  • Lick granulomas

Treatment protocol in small animals

As with horses, the precise treatment protocol depends on the diagnosis of each individual patient. I work with several small animal practices in my area and have helped educate the clinicians about cases that may benefit from a referral for shockwave therapy. If, after learning the details of the case, I think it may be useful, I will then speak with the pet’s owner by phone to discuss the therapy and the expected results, as well as protocol and cost. Some pet insurance companies will cover shockwave therapy for small animals; this is frequently a determining factor in whether or not the owner will opt for it. If the owner decides to proceed with shockwave therapy, I schedule an appointment at their regular veterinarian’s clinic, and request that the pet come prepared for anesthesia (eight-hour fast). I will then examine the animal and finalize discussions with the owner.  We proceed with anesthesia and the treatment is carried out. For follow-up, I request that the owner keep the pet quiet, with leash walks only, for three days after the treatment, then gradually (over a week) return to a normal level of activity. I typically will re-check at ten days and three weeks. At the three-week visit, I again ask that the pet come in fasted and prepped for anesthesia. If, at the three-week exam, the pet has achieved an excellent result, I will opt not to do an additional treatment. If the pet has not achieved the desired improvement, then I will do a second treatment with the same follow-up schedule. It is rare that I would do more than two treatments. The results are typically quite long-lasting, with a range of six to 18 months of pain relief in most cases. As with horses, some pets/cases will benefit from a schedule of “booster” treatments at six-month intervals. Multiple areas can be treated at one time. As with equines, many pets almost immediately experience a remarkable reduction in pain. Typically, the animal will start feeling a reduction of pain and/or swelling within hours. This will generally last two to four days before the animal returns to nearly the original status. Then, over the next two to three weeks, actual healing takes place.

Small animal case report

Ginger was a 12-year-old mixed breed spayed female dog, weighing approximately 40 pounds, that I saw on a monthly basis for chiropractic care. She had severe degenerative joint disease in both hips and became increasingly uncomfortable. I had discussed shockwave therapy for Ginger’s hips with the owners on multiple occasions, and when Ginger presented +4 of 5 lame on the RH, they finally approved it. On the day Ginger was brought in for shockwave therapy, she was non-weight bearing on her RH. I had some reservation about proceeding with the treatment, but felt that any improvement in comfort would be a success. When Ginger was discharged several hours after waking up from the anesthesia, she was able to walk out of the clinic. At the ten-day re-check, she was bearing 50% weight on her RH, and at the three week re-check, she was bearing 75% of normal weight. I did a second shockwave treatment, and at the three-week check after that, Ginger was bearing 85% to 90% of her full weight on her RH. This improvement in comfort is not attainable with conventional medications. Ginger passed away several months later due to unrelated causes, but remained comfortable on her RH until the end. This case demonstrates the rather dramatic improvement that can be achieved with shockwave therapy.

Selecting your shockwave machine

In this article, I have focused on shockwave therapy, rather than radial shockwave. The physics of the radial wave are completely different. Equine major medical insurance coverage typically will cover only focused shockwave therapy. Some focused shockwave machines on the market advertise a deeper penetration of the shockwave into the tissue. Considerations here include whether the focal point for the release of the shockwave is so concentrated that there is potential for tissue damage, or a greater likelihood of missing the desired target tissue or injury.

Mechanism of action

A shockwave is a pressure wave – it displaces its surrounding medium. The ripple created when a stone is thrown into a pond is a shockwave. Shockwaves used in veterinary medicine are generated in a fluid medium inside a transducer head, and are then transmitted readily through skin, fat and muscle. The high-energy waves are focused within the transducer head so that the shockwave can be directed to the precise area of an injury. When shockwaves hit an area of higher acoustic impedance, such as bone, they slow dramatically and a large amount of energy is released into the surrounding tissue. Shockwaves are modified or focused for medical/veterinary use so that their energy is released at a specific distance from the point of origin. Typical characteristics of a shockwave include a short rise time; within nanoseconds, the wave reaches a peak pressure of up to 1,000 times atmospheric pressure. This is followed by a longer period of decreasing pressure, and a return to negative pressure – 10% of the maximum positive pressure – the hallmark of a true shockwave.*


Shockwave therapy is well-accepted in equine practice as a treatment modality for soft tissue injuries, as well as for a variety of degenerative bony conditions, and neck and back pain. In small animal medicine, there are many indications for which shockwave therapy is very effective, but there is some resistance to it due to the fairly standard requirement for general anesthesia. Shockwave therapy is an excellent option for animals that can’t tolerate daily anti-inflammatory medication, or are difficult to treat on a daily basis. My practice is currently comprised of approximately 40% shockwave therapy and 60% chiropractic work, and is approximately 85% equine overall. As a veterinarian who does not compete with local colleagues in the traditional care market, I have been able to develop a very effective working relationship with the other veterinarians in my area.  The shockwave portion of my practice originally began solely on a referral basis from other veterinarians. As I have become known in my area for both shockwave therapy and chiropractic care, my shockwave caseload is made up of a mixture of cases referred to me by other veterinarians; cases in which the owner or trainer contacts me directly; and cases that I identify while doing chiropractic work that I feel may benefit from shockwave therapy. In each case, I make a substantial effort to keep the owner’s regular veterinarian “in the loop” about the shockwave therapy I have done, as well as any findings I think may benefit from his/her attention. In that way, I help the animal, the owner and the veterinarian by being an “extra set of eyes” on the patient. Through this consistent effort and respect for practice boundaries, I have been able to establish an excellent working relationship with the other veterinarians in my area. Shockwave therapy is one of the most exciting therapies to become available to veterinary medicine in quite some time. *McClure and Dorfmuller. Clinical Techniques in Equine Practice, Dec, 2003.

Integrative approach to skin problems in pets
Integrative therapies for skin disorders in pets encompass many treatment modalities. These include, but are not limited to, Traditional Chinese Veterinary Medicine (acupuncture, Chinese herbs and food therapy), laser, homeopathy, Western herbs, nutraceuticals, essential oils, and hyperbaric oxygen therapy. In general, it may take a combination of treatments to manage a patient’s skin disorders. It is important to have patience when treating skin problems, especially if the condition is chronic and severe. This article reviews common integrative modalities with a focus on Traditional Chinese Veterinary Medicine for treating inflammation and pruritus of the skin in pets.

Skin problems in pets

The skin is the largest body organ and serves as a protective barrier against harmful effects from the environment. Many internal imbalances manifest in the skin. When a pet’s skin is healthy, the client rarely thinks about it, but when problems occur, they can take a serious toll on the animal’s health. In veterinary practice, skin diseases, including food allergies, atopy, ear infection, and auto-immune dermatitis, are the most challenging problems to treat. Pruritus (itching of the skin) is the most common clinical sign associated with skin disease, and it can cause serious disruptions to the pet’s well-being. It can also cause significant distress in the owner.1 Although Western medication will help relieve skin itch and inflammation, effective long-term control of pruritus is often not achieved.2 As well, some medications could potentially cause undesirable adverse effects.3 Both pet owners and veterinarians recognize a need for additional safe and efficacious therapeutic options to treat skin disease – especially complementary and integrative therapies.

Traditional Chinese Veterinary Medicine (TCVM)

TCVM, which uses acupuncture combined with herbal medicine and food therapy, seems to be effective for treating various skin disorders in animal patients. It stresses the importance of catering therapy to the needs of each individual, unlike Western therapeutic approaches that are standardized for all patients. In TCVM, external pathological factors such as Wind, Dampness, Dryness or Heat can invade the body and cause skin disorders. Internal imbalances are differentiated into patterns such as Blood Stagnation, Disharmony of Liver and Kidney, or Blood Deficiency, and are often reflected in skin disorders. When skin problems are generated by internal imbalance, the underlying problem must be addressed in order to clear up the surface manifestation and prevent future problems. The pattern diagnosed will determine the best mode of treatment using herbs, acupuncture and diet therapy.


Acupuncture includes dry needling, aquapuncture, electro-acupuncture, acupressure, moxibustion, and laser application) aims to restore the body's natural balance by stimulating homeostasis. In humans, the meta-analysis demonstrates acupuncture’s potential for the treatment of dermatological conditions in achieving positive patient outcomes, including dermatitis, urticaria, chloasma, pruritus and hyperhidrosis, compared with placebo acupuncture, alternative treatment options, and no intervention.4 In dogs, acupuncture has been shown to enhance the efficacy of antibiotics treatment for otitis.5 At one-year follow-up, 93% of the dogs that received acupuncture did not have recurrent disease, compared with the 50% that received placebo acupuncture.5 While the exact mechanism remains unclear, studies have shown that acupuncture can exert anti-inflammatory effects through a complex neuro-endocrino-immunological network of actions, including inhibition of histamines and down-regulation of pro-inflammatory cytokines, neuropeptides and neurotrophins that enhance and prolong inflammatory response in the body. Acupuncture is well tolerated by most animals and is generally safe with no to mild side effects when performed by a certified veterinary acupuncturist. Typically, six to ten acupuncture treatments are needed in a short period, initially, after which the spacing of sessions may be lengthened once the skin condition has improved. Some patients may require long-term therapy with acupuncture.


Herbals are a rich source of active ingredients and can be effective for the treatment for different skin diseases. Recent research indicates that some herbs offer considerable medicinal benefits. Herbal substances can possess an anti-inflammatory action by inhibiting the formation of cytokines and eicosanoids, and inflammatory reaction cascade.7 A few randomized, controlled trials have demonstrated significant results in the use of herbal therapies for the treatment of dermatologic disorders in humans and dogs.8-11 While most herbs are generally considered safe, many can be quite toxic if taken incorrectly. It is recommended that herbs only be used under the direct recommendation and supervision of a certified veterinary herbalist. Followings are some acupuncture and Chinese herbal medicine treatment methods for skin problems:12-15

1. Wind-Heat

Patients with a Wind-Heat pattern tend to be worse in the spring and summer, have dry hair coat and skin, and are often thirsty and cool-seeking. Most often, these are young to middle-aged individuals with allergic hypersensitivities and atopic dermatitis. Violent scratching may cause oozing blood and crust formation. The tongue is red and dry, and the pulse is superficial, wiry and rapid. Treatment principle: Clear Heat, cool Blood, eliminate Wind to stop itching. Acupoints: LI-4, LI-11, TH-5, GB-20, GV-14, SP-10, Er-jian. Formula: Xiao Feng San or Wind Toxin. Dose at 0.5 gm per ten pounds orally twice daily. Food therapy:* Cooling foods such as duck, rabbit, turkey, white fish, broccoli, celery, cucumbers, kelp, spinach, watermelon, bananas, blueberries, brown rice and tofu. Avoid warm and hot foods such as chicken, lamb, venison, ginger, pumpkin, oats and white rice.

2. Damp-Heat

The Damp-Heat pattern is commonly seen in warm humid climates and is often exacerbated during periods of high humidity. Patients often have greasy, malodorous, sebaceous or waxy exudates from the skin or ears. Most often, these cases have localized or generalized skin papules/pustules, pyodermatitis, wet hot spots, or chronic otitis. They are also cool-seeking, restless, have a red tongue with a yellow greasy coating, and a fast and forceful pulse. Treatment principle: Clear Heat, eliminate Damp, and stop itching. Acupoints: LI-4, LI-11, GB-34, GB-41, SP-6, SP-9, ST-40. Formula: Long Dan Xie Gan Tang, Qing Shi Re Tang or Damp Heat Skin for generalized skin lesions; Si Miao San or Lower Jiao Damp Heat for lesions around lower jiao, flank and genitals; Four Paws Damp Heat for lesions on paws; Qing Er Tang or Ear Damp Heat for otitis. Dose at 0.5 gm per ten pounds orally twice daily. Food therapy:* Cooling foods as mentioned above; also add foods that eliminate Dampness such as barley, celery, kidney beans, mushrooms and turnip. Avoid fatty, oily, sweet, high carbohydrate and dairy foods because they can lead to Damp.

3. Blood Heat

Blood Heat is often due to chronic Blood Stagnation in chronic skin disease. Heat is accumulated when Blood becomes stagnant and results in abnormal skin manifestations, such as red spots, ulcerations, crusting, erythema, depigmentation, bruising or blood spots under the skin without an obvious reason. This pattern is often seen in patients with immune-mediated dermatologic disorders. The tongue is red or purple, or has red or purple spots on it, sublingual veins may tend to be purple, and the pulse is rapid and surging. Treatment principles: Clear Heat and invigorate Blood to expel Stagnation. Acupoints: SP-6, SP-10, PC-4, LI-4, LIV-3, BL-17. Formula: Liang Xue Jie Du or Blood Heat Formula. Add Mu Dan Pi if Blood stagnation is severe. Dose at 0.5 gm per ten pounds orally twice daily. Food therapy:* Cooling foods as mentioned above; also add foods that help resolve Stagnation, such as ginger, vinegar, turmeric, celery, eggplant, shiitake, hawthorn berry, and pepper. Avoid cold and raw foods as they would stagnate circulation.

4. Liver and Kidney Yin deficiency

Yin deficiency in the Kidney and Liver is commonly seen in chronic skin disorders, especially in geriatric animals. It is often characterized by itching that’s worse at night and in the summer, dry skin with small dandruff, alopecia, excessive panting, cool-seeking behavior, anxiety and restlessness, especially at night. The tongue is red, dry with a thin or no coating, and the pulse is deep, thready, and rapid (weaker on the left side). Treatment principles: Nourish Yin, Kidney and Liver. Acupoints: KID-3, SP-6, LIV-8, BL-18, BL-23. Formula: Yang Yin Zhi Yang or Zhi Bai Di Huang. Dose at 0.5 gm per ten pounds orally twice daily. Food therapy:* Cooling foods as mentioned above; add Yin tonic foods, such as tofu, black beans, kidney beans, honey, asparagus, spinach and tomato. Avoid warm and hot foods such as chicken, lamb, venison, ginger, pumpkin, oats and white rice.

5. Liver Blood deficiency

Liver Blood nourishes and moistens the skin and a deficiency is often at the root of many skin diseases. Liver Blood deficiency is also commonly a result of deficient Liver and/or Kidney Yin. When Liver Blood is deficient, “Wind” can form in the skin, resulting in itching and skin lesions that suddenly appear or disappear or that move from place to place. It also causes a dry brittle hair coat and skin with dandruff, alopecia, and cracked nails or hooves. The patient has a pale dry tongue and a pulse that is deep, thready and weak (weaker on the left side). Treatment principles: Nourish Blood and Liver. Acupoints: SP-10, BL-17, ST-36, BL-18, LIV-8. Formula: Si Wu Xiao Feng or Yang Xue Qu Feng Tang. Dose at 0.5 gm per ten pounds orally twice daily. Food therapy:* Blood tonic foods such as beef, liver, heart, pork skin, sardines, salmon, eggs, carrots, kidney beans, black beans, beets, parsley, dates. Avoid cooling and raw foods. *All food therapy must be formulated by a veterinarian or veterinary nutritionist to meet the individual patient’s nutritional needs.

Other integrative therapies

a) Laser therapy, with 630nm (red) and 830nm (near infrared) wavelengths, appears to have a wide range of applications for skin conditions, especially where the stimulation of healing, reduction of inflammation and cell death, and skin rejuvenation are required.16 Laser therapy at 808nm once a day for five days significantly improved pyogranulomatous pododermatitis in dogs even at two months of follow-up.17 b) Homeopathy may offer an effective and side effect-free treatment for various skin conditions, especially seborrheic, atopic and auto-immune dermatitis. It may help reduce pruritus, and in some cases showed complete resolution of the skin condition, allowing for the discontinuation of conventional treatments.18 c) Topical administration of essential oils and fatty acids, either as a daily spray (Dermoscent Atop 7) or a weekly spot-on (Dermoscent Essential 6) has shown to decrease pruritus in canine atopic dermatitis.19 d) Hyperbaric Oxygen Therapy was reported to successfully treat some inflammatory diseases, including atopic dermatitis, implying that HBOT may exert immune-regulatory effects in skin diseases (for general discussion of HBOT, see the Winter 2015 issue of IVC Journal).20 e) Omega 3 fatty acids have anti-inflammatory effects and are shown to have beneficial effects in various skin diseases. DHA and EPA inhibit the activation of pro-inflammatory cell signals, and reduce the leukotrienes and prostaglandins that play a role in dermatitis.21 f) Probiotic supplementation (bifidobacteria and lactobacillus) could be considered an integral part of the multimodal therapy for the long-term efficient management of canine atopic dermatitis22 by modulating the immune response and mitigating allergic reactions.23 g) Antioxidants and flavonoids, found in dark berries and some plants, protect against free radical damage, have anti-inflammatory properties, strengthen connective tissue, and may help reduce allergic reactions.23 Antioxidant agents to be considered include melatonin and vitamins A, C, D and E.23 Melatonin can be used to facilitate a better night’s sleep and to reduce skin inflammation. Vitamin A is involved in the growth and repair of epithelial cells. Vitamin C is vital for the production of collagen and can act as an antihistamine. Vitamin D helps boost immunity and heal damaged tissues. Vitamin E removes free radicals and helps ease dryness. Quercetin, a naturally-occurring polyphenol, shows antioxidant, anti-inflammatory and anti-allergic activities for atopic dermatitis.24 h) Bovine colostrum, rich in immunoglobulins, growth factors and other active compounds that stimulate the immune system, has been used anecdotally to successfully treat various skin conditions in animals. In summary, integrative medicine can be an excellent adjunctive or primary therapy for dermatologic disease, especially in chronic cases unresponsive to conventional therapy. In addition, integrative modalities such as TCVM can also help restore the body’s balance, offering a more permanent resolution to chronic cases. Nevertheless, there is a need for more research to evaluate and confirm the efficiency and safety of various integrative therapies. References 1Halliwell RE, Schwartzman RM. “Atopic disease in the dog”. Vet Rec 1971;89: 209–14. 2Scott DW, Miller WH, Griffin CE. “Skin immune system and allergic skin disease”. In: Muller and Kirk’s Small Animal Dermatology. Philadelphia: WB Saunders; 2001. p. 543–666. 3Paradis M, Scott DW, Giroux D. “Further investigations on the use of nonsteroidal and steroidal anti-inflammatory agents in the management of canine pruritus”. J Am Anim Hosp Assoc 1991;27:44–8. 4Ma C, Sivamani RK. “Acupuncture as a Treatment Modality in Dermatology: A Systematic Review”. J Altern Complement Med. 2015 Sep;21(9):520-9. 5Sa ́nchez-Araujo M, Puchi A. “Acupuncture prevents relapses of recurrent otitis in dogs: a 1-year follow-up of a randomised controlled trial”. Acupunct Med 2011; 29:21–6. 6McDonald JL, Cripps AW, Smith PK, Smith CA, Xue CC, Golianu B. “The anti-inflammatory effects of acupuncture and their relevance to allergic rhinitis: a narrative review and proposed model”. Evid Based Complement Alternat Med. 2013;2013:591796. 7Xu XJ, Banerjee P, Rustin MH, Poulter LW. “Modulation by Chinese herbal therapy of immune mechanisms in the skin of patients with atopic eczema”. Br J Dermatol. 1997 Jan;136(1):54-9. 8Sheehan MP, Atherton DJ. “A controlled trial of traditional Chinese medicinal plants in widespread non-exudative atopic eczema. Br J Dermatol 1992;126: 179–84. 9Sheehan MP, Rustin MH, Atherton DJ, et al. “Efficacy of a traditional Chinese herbal therapy in adult atopic dermatitis”. Lancet 1992;340:13–7. 10Nagel TM, Torres SM, Horne KL, et al. “A randomized, double-blind, placebo- controlled trial to investigate the efficacy and safety of a Chinese herbal product (P07P) for the treatment of canine atopic dermatitis”. Vet Dermatol 2001;12: 265–74. 11Ferguson EA, Littlewood JD, Carlotti DN, et al. “Management of canine atopic dermatitis using the plant extract PYM00217: a randomized, double-blind, placebo-controlled clinical study”. Vet Dermatol 2006;17:236–43. 12De-Hui S, Xiu-Fen W, Wang N. Manual of Dermatology in Chinese Medicine. Seattle, WA. Eastland Press 1995:1-50. 13Yan Zhou-Ping, Liu Dai-Hong. Zhong Yi Pi Fu Bing Zhi Liao Xue. Chinese Medicine for Dermatology. Beijing, China. China Traditional China Medicine Publisher 2011:18-42. 14Huisheng Xie. Chinese Veterinary Herbal Handbook (2nd edition). Reddick, FL. Jing Tang Publishing 2008:36-7. 15Xie H, Priest V. Xie’s Veterinary Acupuncture. Ames, Iowa: Blackwell Publishing 2007:316-8. 16Avci P, Gupta A, Sadasivam M, Vecchio D, Pam Z, Pam N, Hamblin MR. “Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring”. Semin Cutan Med Surg. 2013 Mar;32(1):41-52. 17Perego R, Proverbio D, Zuccaro A, Spada E. Low-level laser therapy: Case-control study in dogs with sterile pyogranulomatous pododermatitis. Vet World. 2016 Aug;9(8):882-7. 18Hill PB, Hoare J, Lau-Gillard P, et al. “Pilot study of the effect of individualized homeopathy on the pruritus associated with atopic dermatitis in dogs”. Vet Rec 2009;164:364–70. 19Tretter S, Mueller RS. “The influence of topical unsaturated fatty acids and essential oils on normal and atopic dogs”. J Am Anim Hosp Assoc. 2011 Jul-Aug;47(4):236-40. 20Kim HR, Kim JH, Choi EJ, et al. “Hyperoxygenation attenuated a murine model of atopic dermatitis through raising skin level of ROS”. PLoS One. 2014 Oct 2;9(10):e109297. 21Mueller RS, Fieseler KV, Fettman MJ, et al. “Effect of omega-3 fatty acids on canine atopic dermatitis”. J Small Anim Pract. 2004 Jun;45(6):293-7. 22Marsella R, Santoro D, Ahrens K. “Early exposure to probiotics in a canine model of atopic dermatitis has long-term clinical and immunological effects”. Vet Immunol Immunopathol. 2012 Apr 15;146(2):185-9. 23“A double-blind, placebo controlled-trial of a probiotic strain Lactobacillus sakei Probio-65 for the prevention of canine atopic dermatitis”. J Microbiol Biotechnol. 2015 Nov;25(11):1966-9. 24Ji H, Li XK. “Oxidative Stress in Atopic Dermatitis”. Oxid Med Cell Longev. 2016;2016:2721469. Dr. Ronald Koh is an assistant professor and section chief of the Integrative Medicine & Rehabilitation Department at the Louisiana State University School of Veterinary Medicine. He received his veterinary degree in Taiwan and completed a specialty internship and Master’s program at University of Florida College of Veterinary Medicine. He is certified in acupuncture (CVA), Chinese herbal medicine (CVCH), food therapy (CVFT), and canine rehabilitation (CCRP). Dr. Koh is currently working toward the board certification of American College of Veterinary Sports Medicine and Rehabilitation (DACVSMR). His interests include using acupuncture, Chinese medicine and rehabilitation for pain management, neurological disorders, geriatric conditions, and hospice.

Treatment protocol for Equine Protozoal Myelitis (EPM)
Equine Protozoal Myelitis (EPM) has been around since the 1960s in the US. It’s caused by two protozoal parasites.
  1. Sarcocystis neurona is the most common, and causes multiple symptoms.
  2. Sarcocystis hughesi affects less than 1% of horses. It invades the central nervous system.
Horses in the US seem to have developed some immunity to EPM, since fewer than 1% of exposed horses develop a clinical disease. The horses I see with severe symptoms are usually very weak, stressed or old.

Common symptoms of EPM

The symptoms I see with my equine patients in Texas include:
  • hind limb weakness
  • problems with proprioception
  • performance problems
  • gait abnormalities
  • un-coordination
  • stiffness
  • head tilt
  • general ataxia
  • extreme irritability for no reason.
My differential diagnosis includes wobbler syndrome, trauma, equine herpesvirus myeloencephalopathy, equine degenerative myelopathy, and West Nile Encephalomyelitis. Over 85% of the horses test positive for antibodies to EPM, but many do not show any symptoms, or at least none recognized by their owners. Perhaps some were a little “off” for a week or two while their immune systems produced antibodies; or perhaps they were strong enough to mount an immediate response when the protozoa were introduced into their bodies.

How EPM develops

The life cycle of the sporocyst is complicated. Briefly, it involves many intermediate hosts (domestic cat, raccoon, skunk, armadillo, other mammals, and maybe even passerine birds and sea otters) who are then ingested, often as “road kill”, by opossums. The opossum is the definitive host (reservoir) in which the sporocyst develops. This animal excretes both oocysts and sporocysts (environmentally resistant stage) in its feces. Horses are subsequently infected when they eat feed or water contaminated with sporocysts from opossum feces. The horse itself is a dead-end host, and does not pass sporocysts in his manure. The sporocysts in his body migrate from the GI tract into the bloodstream, where they can cross the blood/brain barrier into the CSF. This means that an infected horse cannot infect another horse. The infected horse can show symptoms immediately after exposure, or can harbor the organism for months and develop signs at a later date, often during periods of stress.

Is environmental prevention possible?

Except for the horse, most of the animals involved in the life cycle of EPM are scavengers, and will eat any dead animal. One way for owners to protect their horses is to keep feed locked up in a manner that prevents feces from getting into it. Cats see stalls as giant litter boxes, so this poses the question about whether or not to keep barn cats to control mouse populations. There is really no reasonable way to protect pastures from the feces of these animals. I have heard of giant vacuum cleaners being used in pastures, but this is not very practical for most horse owners. One thing horse owners can and should do is pick up any dead animals they find in their pastures.

Conventional treatments

There is no vaccine for EPM. Conventionally, horses are treated with Ponazuril (Marquis), Pyrimethamine-Sulfadiazine products, and Diclazuril. Like me, many of you probably remember treating horses 20 years ago with Diclazuril bagged up to be added to chicken feed. It now comes in many new packages, with many new names, but it is the same ingredient. I have not had much luck with any of these treatments lasting more than about four months without a relapse. Some farms use these products as a preventative, but what is this long-term treatment doing to the horses? I am certain it creates gastrointestinal imbalances over time, thus weakening the animals’ immune systems.

Integrative diagnosis

Diagnosing EPM early, and then improving the immune system, is the best way to prevent serious symptoms. Treating EPM when it’s first entering the horse, before the protozoa can damage the neurological system, is preferable. I diagnose EPM using osteopathy. A horse with EPM will first present with performance problems, such as not getting to the bottom of their stops, not sitting at their barrels, being clumsy or irritable, hitting jumps, showing hind limb instability, difficulty with proprioception, or an inability to engage their backs, etc. When I examine the spines of these horses in an osteopathic manner, one side will be very flexible, actually too flexible, and the other side very stiff. If I find this on an osteopathic exam, I put EPM in my differential diagnosis. Horses suffering from an inflammation of the spinal cord associated with EPM will be painful between CO and C1. If I squeeze that area with my hand, the horse will duck his head and twist it to one side. These horses are often positive on a tail pull, giving to one or both sides. Additionally, I almost always see atrophy of the postural muscles. These horses appear thin at first, but when you evaluate them, you find an atrophy of the postural muscles (often the gluteals and quadriceps). To confirm my preliminary diagnosis, I prefer to use the Indirect Fluorescent Antibody test (IFAT), offered at UC Davis. Some clinics prefer to submit both blood and CSF, measuring the ratio of antibody in the blood to that in the CSF. Using this osteopathic preliminary diagnosis, and a positive IFAT test, I can be relatively certain that the horse has EPM. I have treated over 300 cases of EPM in this manner, mostly diagnosing them with my osteopathic techniques.

Treatment schedule

I begin treating a horse with EPM and L4 larvae at the anterior mesenteric artery (see sidebar on page xx) with a commercial de-wormer. If he does not have a history of de-worming within the past four months, my recommendation is to begin with a dose of Ivermectin. Because Ivermectin causes a slow kill, it will prevent a worm impaction if the horse has a large number of worms. Three weeks later, I move forward with the rest of my L4 larvae protocol:
  1. Because of the EPM, I also immediately start the horse on an immune system booster called Karbo Pellets, and another called Epic Liquid (from Gomer’s Inc). They feature some components that help with the digestive system as well.
  2. I use a Panacur Powerpak with sufficient dosage for the horse’s weight. Ideally, this paralyzes the L4 larvae but does not kill them. This is a daily double dose of fenbendazole for five days in a row.
  3. Next, I wait ten days to allow the horse to recover from the Panacur. Then I administer Quest Plus in an amount equal to the horse’s weight. Quest Plus enters the bloodstream and kills the L4 larvae that are already paralyzed and unable to move away from the blood vessels carrying the chemical.
  4. After waiting ten more days, a regular Quest is administered to ensure as many L4 larvae as possible are eliminated.
  5. After the last dose of de-wormer, I recommend waiting at least five days before starting Sefacon, an equine herbal health supplement that actually kills the protozoa (Endocrine Technologies).
When a horse presents with a mild case of EPM, is not in a stressful situation, and has a history of regular de-worming, I begin with Karbo Pellets and Epic Liquid. I feed two scoops of the pellets and 60cc of the liquid two times a day for three months. If the horse is in a stressful situation, or the EPM is coming in fast and strong, I will add a product called Sefacon for ten days. The horse is usually very improved by the end of three weeks. It is very important to treat the horse with sufficient Sefacon for his weight. I will use double doses in a large horse (over 1,200lb). If the horse is already very ataxic and wobbly, I begin with Marquis to kill off some of the protozoa as quickly as possible before I start my regular treatment. I have not seen much true cure with Marquis. Often, the horse will get better for around four months, then relapse, or never return to his previous level of performance. My method of treatment allows for early diagnosis, so the horses return to their previous levels of performance.

Concurrent parasitism

Most horses who come down with EPM have weakened immune systems. This allows the protozoa to enter the CNS and cause inflammation. In Texas, one condition that weakens the immune system involves an abundance of L4 strongyle larvae at the anterior mesenteric artery. Our Texas climate does not desiccate the eggs with heat, nor freeze them with cold, and this results in a huge parasite problem. On osteopathic diagnosis, these horses will be stiffer on the right side of their spines, moreso than a horse with just EPM. They will still have the same reaction to a hand squeeze across the front of the atlas, dropping the head ventrally and rotating to the side. I always question owners about the de-worming status of their horses. It is my belief that Texas and Florida cannot follow AAEP guidelines for using fecal egg counts to determine which horses need a de-wormer. In Texas, many horses are kept on small pastures where strongyle eggs could be high in number. Since it can take six to seven months for the eggs to develop into egg-laying worms, the L4 larvae have plenty of time to accumulate and do damage to the tissue around the anterior mesenteric artery while the horses maintain a low egg count in their feces.

Prevent EPM with a strong immune system

A strong, healthy immune system will help protect horses from contracting EPM. Keeping my client horses’ on Chlorella (species vulgaris, broken cell wall) helps remove heavy metals from their systems and provides them with a healthy food source. The more stress a horse is under, the more likely he is to have a weakened immune system. I see more cases of EPM in young horses who are just going into training and dealing with the stress of leaving home and being trained; and in performance horses that travel a lot. I like to keep these horses on the immune and digestive health booster, Karbo Combo. It comes as a small pellet that is fed in small amounts every day. All methods that maximize health will decrease the risk of neurological EPM – a high quality diet, fewer chemicals, stress management with appropriate time outdoors or a decreased show schedule, regular osteopathic treatments, etc. For those interested in pursuing osteopathy (which I highly recommend as it’s the best tool in my toolbox) visit Janek Vluggen teaches equine osteopathy at my clinic in San Marcos, Texas. Dr. Lu Ann Groves graduated in 1981 from Colorado State University College of Veterinary Medicine. She opened a mobile equine clinic in 1982, then opened The Whole Horse Veterinary Clinic (thewholehorse. com) in San Marcos, Texas in 2004. She offers osteopathy, acupuncture, chiropractic, craniosacral therapy and ozone therapy along with conventional diagnostics and therapies. Dr. Groves teaches basic classes at The Vluggen Institute of Equine Osteopathy, also in San Marcos, Texas.

Maximizing the role of veterinary technicians in integrative practice

The support roles veterinary technicians fill in both traditional and integrative veterinary practice settings are as varied as the practices themselves. Technicians are vital for creating more effective and efficient use of DVM time, and in reducing expenses by managing inventory, improving profits, bonding with clients and improving client communication. 

The aim of this article is to help DVMs and technicians create an effective dialog surrounding shared goals of professional, practice and personal growth, while improving income for the practice and its staff. Sharing insights can help generate efficient systems and procedures, which ultimately improve service delivery, patient care, work-life balance and revenue generation, while achieving a more cohesive team effort.

Connie has been an LVT with Dr. Maro’s practice for 19 years. We co-authored this article to present the perspectives of both owner and technician when it comes to successful actions that can enhance operations in integrative practice.

In our daily work, we can make many assumptions and take much for granted. As veterinarian and technician, we have worked together a long time, but while preparing this article we learned a great deal about each other’s independent and mutual goals and objectives. These are not often discussed in our daily work with patients and clients.

Practitioners need to be cognizant of the fact that technicians have insights that may not always be expressed, since technicians tend to assume a role of deference to veterinarians. Asking for technician input, and having bi-annual meetings with technicians, along with surveys of their views and practice goals, can enhance employment satisfaction. A 360° evaluation of management and ownership also improves staff communication and operations.

Surveying veterinary technicians for their insights

Practitioners can survey LVTs with questions like these, while technicians can use surveys to reflect and create a dialog with ownership/management:

  1. What do you enjoy about your current position?
  2. What one change would make your job more rewarding?
  3. What services/roles can you provide to free up the DVM or make her more efficient and productive?
  4. Which modalities do you enjoy, and are there any in which you would like to pursue advanced training?
  5. What do you least enjoy about your job?
  6. List a talent we have overlooked or underutilized.
  7. How do you see yourself most significantly enhancing revenue generation?
  8. What suggestions would you give each DVM to enhance his/ her effectiveness/skills in benefiting the practice and patients?

After reviewing the technician’s answers, ownership should schedule a prompt meeting (within two weeks) to discuss changes that mutually benefit the practice and LVT.

The LVT’s role in client communications

An LVT with experience and an understanding of conventional practice can help clients who may have fears about what to expect when seeking integrative care for their pets. This type of communication is a vital part of a technician’s duties.

Dr. Maro says her most valuable daily client interactions result from Connie’s exam room preparation with new and existing clients. “Before walking into the exam, I receive concise information regarding both the owner’s and the animal’s medical, emotional and mental state, financial expectations and limitations, scheduling abilities, and attitudes towards conventional and holistic care,” says Dr. Maro. “This preparation helps prevent surprises and allows me to budget my time from the moment I enter the room.”

To prepare a thorough briefing of relevant information, an LVT should:

  1. Become well-versed in practice philosophies, modalities and client expectations. Teach clients how to be compliant; when and how to communicate between visits; and to understand the quantity of DVM time the schedule entitles them to.
  2. Develop, along with the DVM, efficient and relevant history and intake questions.
  3. Obtain and read prior records, highlighting illnesses, vaccines and medications.
  4. Introduce clients to the practice, policies, and DVM’s goals for the animals.
  5. Interview clients about their expectations and goals for their animals’ health.
  6. Discover what prior knowledge and exposure first-time clients have had to alternative care. If a client has had a bad experience with a personal chiropractic adjustment, or lacks familiarity with Applied Kinesiology, and the DVM starts performing an adjustment or muscle testing his or her animals, the visit can become complicated and dissatisfying for all.
  7. Explain what will happen during the exam, highlighting the value of the practice’s services. For example, a DVM who performs an Eastern and Western exam, along with spinal evaluation, may be assessing a great deal about the patient, while the client may simply see it as “petting the dog”. An LVT can introduce these valuable assessments before the DVM enters.
  8. Develop proficiency in discussing finances, estimates and expectations regarding frequency and duration of care for chronic and terminal cases.

Maintain statistics/results of patient care

Technicians who maintain logs of patient diagnoses, treatments and follow-up results create valuable information for DVMs tracking responses to integrative care. This information improves credibility for your practice when clients ask, “How many cases have you treated this way and what was the average survival time after diagnosis?”

The LVT can also enter this information into the database at, beginning with the very first client visit. This database is available to all veterinarians for help with cases or research purposes.

Delivering service with joy

Match passion and purpose with the roles each technician fills in the practice. If you are regularly doing the survey mentioned earlier, technicians can ponder what brings them the most joy in the practice.

For example, if you are a technician who loves hands-on work with patients, rather than running anesthesia, speak with your practice owner about attending rehabilitative therapy certification classes. Depending on the size of your practice, you may still be running anesthesia as needed, but developing a new skill and revenue center will improve profits and job satisfaction.

Inventory and financial management

Inventory management can make or break cash flow in a practice. Though many practices have computer systems that track inventory, the nature of prescribing in integrative practices makes it difficult to quantify every acupuncture needle and homeopathic pellet. Assigning a primary technician to each DVM helps the LVT keep mental track of ordering. In our practice, three different technicians are assigned to maintaining inventory supplies:

  1. One maintains and orders TCVM supplies, homeopathics and essential oils.
  2. One maintains conventional drugs.
  3. One maintains laboratory and surgical supplies and reagents.

Between these three technicians, we seldom have excess inventory or outdated items.

Technicians often facilitate “closing the deal” for cases requiring involved and chronic care. Train technicians to become comfortable with discussing the need for care, as well as the costs involved. Teaching support staff to address concerns with specific positive language saves the DVMs time, and determines the central issue for clients who are hesitant about proceeding with services. 

For example, after the DVM discusses a diagnostic and treatment plan, the technician can review a cost estimate with the client. When the client indicates uncertainty, the LVT can ask specifically what is causing the hesitation. If it’s about understanding the tests and treatments involved, the discussion can proceed. When clients still won’t commit, the technician can ask if they are concerned about the time or cost involved. This direct question often gets to the central issue more quickly.

Patient scheduling

Ideally, every veterinarian should have every appointment filled, with a lunch break in the middle of the day. Unfortunately, gaps in schedules, late appointments, nervous animals and long problem lists can keep the schedule from flowing well. LVTs can add value to their roles by reviewing the next several days’ schedules and looking for potential problems, such as patients requiring consultations on grave diagnostic results.

Here are some technician tips for improving schedules during their review of upcoming days:

  1. Call clients during one of the lighter days/times preceding their appointments to get an update or thorough history, thereby reducing interview times in exam rooms.
  2. If a particular case sounds complicated during one of these calls, suggest the client schedule a more extended appointment time (with an increased fee) or break the appointment into two visits a few days apart.
  3. Encourage clients to visit during non-peak times by offering slightly longer appointment times or shorter wait times.
  4. When demand is high, give feedback to the DVM about scheduling, which can then be modified to better fit client demands.
  5. Consider increasing office visit fees for peak times, and keep fees stable for non-peak times.
  6. If your DVM has openings and gaps in the schedule, call clients who have not recently received services. Gaps will often be filled once animal chiropractic and rehabilitative clients are reminded of the need for maintenance care.
  7. Create workshops and educational events, both in the clinic and at animal venues, such as 4-H clubs and pet stores. Education and awareness draw clients to integrative practices to fill schedule gaps.

Matters of compensation

When a technician approaches a manager looking for reviews and raises, he or she should take specific and measurable information into the meeting. This information should detail how revenue and operations have been directly enhanced by the technician’s actions since the prior review:

  1. Keep metrics regarding client contact, enhanced sales and client feedback.
  2. Detail how a scheduling activity, service or promotion of service has directly impacted the practice with client numbers, client satisfaction and revenue increases.
  3. If you would like the practice to pay for a course of study, research how you could add a new service and how much money would be generated by this service. For example, let’s say you take a course in nutrition and begin calling clients for 30 minutes daily to tell them about your DVM’s new information regarding supplements. You can document the clients called and the resulting sales.

If you have begun taking action to improve schedule flow and history taking, resulting in decreased staff overtime, document those numbers for your next review.

Considerations for practice owners

If you would like to spend more time with your family, and have more revenue so you can enjoy your hobbies, find a technician who shares your vision and goals, communicates well, and has the desire to learn and the ability to heal. Help him or her explore the many facets of integrative practice and allow his or her skills to grow.

In conclusion

Remember that the most valued technicians seek the highest level of action they can take, relative to their abilities, during both busy and slow clinic times. This means action that will generate the most return for their efforts, while delegating cleaning tasks to less highly-trained assistants. This action leads to more efficiency and revenue generation, resulting in clear justification for salary enhancements.

For technicians curious about alternative therapies, and desiring to learn more

  1. Find an alternative practice where you can shadow or work.
  2. Read IVC Journal, and publications like Animal Wellness.
  3. Join the AHVMA and attend conferences and CE events.
  4. Explore books available through the AHVMA bookstore.
  5. Become certified in an alternative modality, physical therapy, Reiki or other energy medicine.
  6. Take courses in herbology, massage, or courses for technicians through the Chi Institute or online with CIVT.
  7. Work with the practice owner to learn how you can utilize your skills, with considerations for legality and your state’s practice act, in the best way possible for the practice.

Connie Glavan is a veterinary technician at Ellwood Animal Hospital, Inc. ( She works in integrative veterinary medicine at all three Ellwood Animal Hospital locations in the Pittsburgh area. Connie had years of experience working in veterinary clinics before attending the Median School of Allied Health Careers, where she earned her degree in Veterinary Technology. Her interest in and understanding of energy medicine have made her a valuable asset in the practices she supports.

Dr. Cynthia Maro owns Ellwood Animal Hospital, Chippewa Animal Hospital and Cranberry Holistic Pet Care, which incorporates acupuncture, animal chiropractic, rehabilitation, myofascial and physical therapies, veterinary NAET, animal massage, herbology, homeopathy, Bach Flowers and essential oils. She graduated from Ohio State University College of Veterinary Medicine in 1987, is a member of the AVMA, AHVMA, AAVA, IVAS and AVCA, and served on the AVCA Board from 2002 through 2007. She mentors veterinary students and speaks to several colleges’ integrative veterinary medicine organizations (

Integrating essential oils for skin care

Most abnormal skin conditions include some amount of inflammation or infection. As allopathic veterinarians, we were trained to utilize anti-inflammatory drugs such as prednisone, immunosuppressives such as cyclosporine, antibiotics such as cephalosporins, or parasiticides such as ivermectin to manage these conditions.

We have watched our cases become more difficult to manage due to medication side effects and the development of drug resistance. This has caused a resurgence of treatments which were used in the “olden days”.  Some view this as a fad, but essential oils, some of which have been revered since biblical times, can be very effective and safe if selected and utilized properly. Essential oil usage is often the modality of choice now requested by many natural-minded pet parents!

What is an essential oil?

These oils are not the lipid or fatty oils from the plant, but rather the life blood of the plant. An essential oil is a concentrated hydrophobic liquid which contains the volatile aromatic compounds from the plant. Using oils to manage skin conditions is where essential oils shine the most! Many skin conditions produce an odor, so what could be better than using a treatment that smells good too? It is the volatility of the essential oils which makes them aromatic. The aromatic oil carries the components which protect the plant from adversaries. A natural chemical might repel an insect or kill a fungus. These same plant constituents can be used protect us or our animal patients. It is also these same constituents that can be analyzed with tools such as gas chromatography to identify the specific “finger print” of an essential oil. The combination of these natural chemical constituents is what gives particular oils their unique properties for use, effectiveness, safety or danger.

Do they work?

Natural product producers cannot make claims that their products are used to prevent, manage or cure disease. The FDA only allows that these claims be made by drug manufacturers. But, as a holistic veterinarian, I can tell you that my experience using essential oils has been so positive, I would never want to go back to practicing without them! Additionally, there are many testimonials and studies which support efficacy or safety of essential oils.

Top 12 essential oils for skin

There are a dozen top oils that I use to support healthy skin. Each oil possesses different percentages of natural chemical constituents. These chemical constituents have been found in research to have anti-inflammatory, antimicrobial, or immune supportive properties. Indeed, pharmaceutical companies have isolated some of these constituents in order to manufacture drugs. Further study of each chemical constituent can guide you toward additional uses of the oil. For this, Google is your friend; also some of the oldest oils reference books are the most useful.

1. Lavender

Almost every essential oil discussion begins with lavender because its applications are so universal. It is soothing emotionally and physically. It does not burn irritated skin when applied topically, even if the skin is burned, chafed or rashy. It can help to relax a pet that is frenzied due to chronic itching. It has been used internally, but make sure that it is pure and not perfume grade. Lavender may refer to Lavandula angustifolia or the hybrid lavandin. Their chemical constitution is similar but different. Both are high in linalyl acetate and linalool. Lavandin contains camphor which differentiates it from the original Lavandula.

Methods of application

When applied “neat” (undiluted) to the skin, the smell and the taste of lavender can deter licking. Clients love this feature as they may not need to use an E-collar. Lavender on a pet might help an exhausted pet parent get some rest, as both can benefit from the aroma. Lavender not only penetrates the skin but also the nasal passages and the blood brain barrier. Fur is a wick, not a deterrent to effectiveness. This oil can be diffused actively with a cold-air diffuser, or passively through the air even when only applied topically. Never use heat with quality essential oils. This will damage the natural chemistry. Sometimes lavender is diluted to disperse it or to dilute the potency. An essential oil may be diluted with a fatty vegetable oil such as coconut oil, olive oil, almond oil, grapeseed oil, wheat germ oil, sesame seed oil or even avocado oil. (These are called carrier oils.) You can also dilute essential oils with water if you add some healthy soap to emulsify. Remember, water and oil don’t mix. So the oil will float on top of the water. If you are using a mister, don’t forget to add soap to the water and oil, and shake before spraying. This is a great way to cover a larger body surface area. My favorite method to apply essential oils for overall body care is with soaks. I do not call this a bath, as you do not lather, spray or rinse! It is a peaceful procedure. Fill the tub or basin with warm water, add a ‘healthy’ soap, and add the selected essential oils. I use a toxin-free soap which contains coconut oil. The soap allows for the dispersion of the essential oils. This soap does not need to be rinsed off. It is ideal because then the coconut oil and essential oil residue remains on the pet. This can be soothing and provide immediate relief. It is not drying, so this procedure can be performed daily if needed and desired, or weekly as maintenance. The skin is a huge surface area which allows for the transfer of chemical constituents into the body and toxins out of the body. All of the oils discussed in this article can be utilized in a soak, separately or in various combinations depending on the goal.

2. Frankincense

Frankincense is distilled from resin and includes several varieties such as Boswellia carteri or Boswellia sacra. It is high in alpha-pinene and limonene. This has been used for centuries to support healthy skin and immune systems.

3. Copaiba

Copaiba is sold as an essential oil, but is essentially a sap from a tree in an Amazonian culture where this is their antiinflammatory medicine. It is very high in beta-caryophyllene.

4. Chamomile (Roman)

Chamomile is ideally steam distilled from its flowers. Roman chamomile is very high in isobutyl angelate and isoamyl methacrylate. These have anti-inflammatory, anti-parasitic and skin regenerative properties in addition to being calming.

5. Citronella

Citronella is also steam distilled, but from its leaves. It is high in geraniol and limonene. Citronella is antibacterial, antifungal, anti-inflammatory, an insect repellent and a deodorant.

6. Tea tree

Also called, Melaleuca alternifolia, this oil is commonly used and commonly feared. It is very high in terpinene and terpinenol. It is antimicrobial, anti-inflammatory, antiparasitic, immunostimulant, analgesic, a neurotonic and protects against radiation. Fears may be unfounded and due to negative experiences with contaminated or poorly distilled product.

7-11. A Blend of Clove, Lemon, Cinnamon, Eucalyptus radiata, and Rosemary

This popular combination contains oils which are antiseptic, anti-inflammatory and can numb tissues on contact. Clove can be as high as 87% eugenol. Cinnamon is also high in eugenol, but approximately 50% trans-cinnamaldehyde. These natural chemicals make this a “hot” oil, which can burn skin, but at the same time be antimicrobial and increase blood flow. It is best used diluted or within a blend. Eucalyptus radiata, also distilled from leaves, is up to 75% eucalyptol, making it antiinfectious and anti-inflammatory. Rosemary is Rosmarinus officinalis 1,8 cineol or vervenon. The former contains a much greater concentration of 1,8 cineol which is a eucalyptol, again, making this antimicrobial. The verbenon variety is much higher in alpha-pinene. Both can help decrease hair loss. Avoid using if a pet is epileptic. Lemon oil is cold-pressed from rinds and is up to 73% limonene, a most common terpene. Limonene has been shown to be safe and multipurpose for the body due to the nature of terpenes. I have used this blend dozens of times to soak a paw in need. Mix a few drops in warm water with a healthy soap.

12. Neem

Because neem oil is highly revered as a natural skin care product, I will mention it here to clear up any confusion. It is not an essential oil. It is a cold pressed vegetable oil which contains essential fatty acids (EFAs), triglycerides, vitamin E, calcium, steroids and some essential oil constituents. Because of its EFAs and vitamin E, neem oil penetrates deep into the skin to moisturize and heal. The primary essential oil constituents are terpenoids. The EPA explains that in cold-pressed neem oil the most common terpenoid, azadirachtin, is now a federally registered active ingredient pesticide. You can see how the natural chemistry of this dermal dozen make them ideal for utilization in the management of healthy skin for our animal patients.


The amount of water and the number of drops of oil will depend on the species, size and age of the pet, and the oil. Certainly it would be difficult to do a full body soak on a horse or a mastiff; but surely you can soak a hoof or a paw. Horses respond fabulously to essential oils. On the other spectrum, we can soak a small dog or even a cat, but we must be cognizant of a potential sensitivity to an oil, and treat small animals as we would an infant. One drop of oil can go a long way! Sometimes we use the ‘tooth pick method’. A toothpick is placed into the center hole of your oils bottle in order to dispense less than a drop. The oil on the tip is then delivered to the area of concern or even blended with a carrier oil to dilute further. Roughly, I would suggest beginning with one drop per 10 pounds into the soak water. Multiple oils can be combined.


The Chemistry of Essential Oils Made Simple. David Stewart, PhD, D.N.M. Essential Oils Integrative Medical Guide. D. Gary Young, ND Linalyl acetate as a major ingredient of lavender essential oil relaxes the rabbit vascular smooth muscle through dephosphorylation of myosin light chain. J. Cardiovasc Pharmacol, 2006 Jul;48(1):850-6. Anti-inflammatory activity of linalool and linalyl acetate constituents of essential oils Phytomedicine, 2002 Dec;9(8):721-6. Composition and antibacterial activity of the essential oils of four commercial grades of Omani luban, the oleo-gum resin of Boswellia sacra FLUECK. Chem Biodivers., 2012 Mar;9(3):615-24. doi: 10.1002/cbdv.201100189. Copaiba Oil-Resin Treatment Is Neuroprotective and Reduces Neutrophil Recruitment and Microglia Activation after Motor Cortex Excitotoxic Injury. Evid Based Complement Alternat Med. 2012; 2012: 918174. Published online 2012 Feb 19. doi: 10.1155/2012/918174 Bioactive Products in Chamomile. chamaemelum-nobile.html. Efficacy of citronella and cinnamon essential oils on Candida albicans biofilms. Acta Odontol Scand. 2016 Jul;74(5):393-8. doi: 10.3109/00016357.2016.1166261. Epub 2016 Apr 21. Antimicrobial activity of the major components of the essential oil of Melaleuca alternifolia. J. Appl Bacteriol, 1995 Mar;78(3):264-9. Clove (Syzygium aromaticum): a precious spice. Asian Pac J Trop Biomed, 2014 Feb; 4(2): 90-96. D-Limonene: safety and clinical applications. Altern Med Rev, 2007 Sep;12(3):259-64. Antimicrobial efficacy of eucalyptus oil and 1,8-cineole alone and in combination with chlorhexidine digluconate against microorganisms grown in planktonic and biofilm cultures. J Antimicrob Chemother, 2009 Dec;64(6):1219-25. doi: 10.1093/jac/dkp362. Epub 2009 Oct 16. Chemical composition and antifungal activity of rosemary (Rosmarinus officinalis L.) oil from Turkey. Int J Food Sci Nutr, 2008 Nov-Dec;59(7-8):691-8. doi: 10.1080/09637480701777944. Cold Pressed Neem Oil Fact Sheet. registration/fs_PC-025006_07-Apr-10.pdf National Pesticide Information Center Fact Sheet. Chemical Characteristics of Toilet Soap Prepared from Neem. articles/chemical-characteristics-of-toilet-soap-prepared-from-neemazadirachta-indica-ajuss-seed-oil.pdf. Dr. Jodie Gruenstern has been practicing veterinary medicine in Muskego, Wisconsin since 1987. She is a UW-Madison graduate and has been a Chi Institute-certified veterinary acupuncturist and food therapist since 2008. Dr. Jodie is the owner of the Animal Doctor Holistic Veterinary Complex, an integrated, fullservice small animal practice. She is an avid writer, speaker and local radio personality. For more info, healthy products or an educational DVD, visit

The practice of mindfulness in veterinary medicine

Mindfulness is not only a gift to ourselves. It’s a way of being that can have far-reaching, positive effects for our patients and clients.  Mindfulness is a practice that truly “pays itself forward”; it has been shown to not only decrease professional burnout and compassion fatigue, and raise distress tolerance, but it actually improve patient outcomes.1 

The four attributes of mindfulness

I consider mindful practice to be based on four attributes: attending, listening, empathy and self-compassion.  Each attribute by itself helps us to be present professionally and personally; together, they are a powerful quartet that allows us to be engaged with those we meet wherever we are, in the consultation room or elsewhere.

1. Attending allows us to “check in” with our own mental processes as we observe what is before us. Self-observation and self-reflection are the fruits of attentiveness.  When we give attention to another, we suspend our initial judgments, hold them in abeyance, and see with what can be called “beginner’s mind”.  This is a mind that is engaged, curious and open to possibilities; it lacks the often very narrow constraints of “expert’s mind”.

The attentive mind is a courageous one that is not afraid to challenge what we thought we knew, and replace it with what we now see with new clarity. It allows us to respond to things that may be missed with an “automatic” approach; it helps us resolve to consider anew each patient and client before us, regardless of the number of times we have seen them. When we choose to pay attention to someone, we imbue them with importance. Attending allows us to make each patient and client important; no one’s concerns or suffering matters more than another’s. Attending allows us to be engaged with another in equanimity so we are attuned to but not engulfed by their needs.

2. Listening mindfully allows us to hear the concerns of another without using the lens of our own personal bias as a filter. It is common for clinicians to “hear” a client concern against a backdrop of algorithms, whether we practice from a single theoretical basis or utilize several modalities. When we listen with intention, we are able to construct a narrative of the patient and client that is rich and meaningful. We can be present to the cadence of a client’s report, and hear undercurrents of anxiety, resignation and hope; these are all helpful in meeting the client where he or she is and ultimately being of greater service to the patient.

Listening removes us from judging a client who may not be completely adherent to our recommendations, and encourages us to consider that he or she, due to personal circumstances, is doing the best they can. When we listen with intention, we give another that which we all yearn for -- the opportunity to be heard deeply without judgment or suggestion.

This type of deep listening is only possible when our own minds are clear enough to hear only what is before us. In our contemporary world where so few are actually listened to, having our words truly heard by another is a particularly welcome gift. Listening also makes room for silence, which allows another to speak his or her mind and heart unencumbered by the listener’s filter. This feeling of being completely held, and of mattering to another, can be transformative.

3. Empathy is an attribute many of us wish to demonstrate. However, much professional burnout and compassion fatigue can be traced to a misunderstanding of what it means to be empathic. We may think we are being empathic when we are merely resonating with another’s emotions. This is not empathy; rather, it involves oscillating with another in a way that is not helpful and may even be detrimental.

Empathy can be defined as understanding another, even when our life journeys vary. With empathy, we can imagine what another is feeling and experiencing. It does not require that we have experienced the same things; it only requires that we be open to another’s experience and search our own for a feeling or thought that resonates with it. To be truly empathic, we need to have one foot firmly entrenched in our own reality, with one immersed in the other’s. When we enthusiastically jump into another’s situation with both feet, we lose the connection to ourselves from which empathy springs. Empathy requires an “I-thou” relationship of two forging a connection based on understanding.

4. Self-compassion means treating ourselves during times of stress as a good friend would. It is one of the most difficult aspects of mindful practice for many veterinarians, due to our innate perfectionism. Perfectionism is considered a maladaptive schema, one of many unhelpful ways of thinking that are learned and introjected (taken in) at an early age (typically before we are five years old).

Perfectionism develops either from a feeling of defectiveness, so that we continually strive harder and harder to prove our self-worth, or from being validated for having been good, so that we continually work to attain that external validation. Although perfectionism carries some benefits, including the academic achievement necessary to attend veterinary school, perfectionists are not only intensely vulnerable to external criticism but are also beholden to a particularly vicious internal critic. The truth is that we can only do what time and resources allow. While many times we turn our attention (and blame) to external factors that limit our ability to practice in accordance with our wishes, self-compassion allows us to see that we are sometimes the limiting factor, perhaps because of a deficient knowledge base, the limitations of what our hospitals can offer patients and clients, etc. 

Perfectionists typically believe that self-compassion reduces motivation for excellence or is a sign of weakness. However, research done by Dr. Kristin Neff2 and others has shown that treating ourselves with kindness does not diminish a desire to perform to the best of our ability and actually helps build courage and resilience.  When we are self-compassionate, we are more willing to think “outside the box”; and errors (while they are to be avoided as much as possible) are not personally destructive.

Sitting practice for mindfulness

A daily sitting practice is the cornerstone of this intentional lifestyle. Western culture typically involves and rewards constant activity and multi-tasking, so the very act of devoting time each day to simply being with our breath and allowing thoughts to come and go without grasping at them is a counter-cultural and revolutionary way of being.

Most of us wish to be mindful as we go about our daily lives so we seek to walk, cook, eat and work with intention. While we might be able to incorporate mindful practice into all these activities in time, sitting practice allows us to begin the hard work of tolerating a wide range of emotions, including boredom, anger, frustration, happiness and contentment, without escaping from them.

Time spent watching the breath is a laboratory of sorts, in which we practice for life beyond the cushion or chair. Sitting practice allows us to observe whatever comes up, reflect on it and let it go. In the process, we become increasingly able to tolerate thoughts and emotions without needing to escape from them or hold onto them.

Ultimately, mindful practice is a continual journey. We only fail at mindfulness if we assume there is a goal to be achieved, and that at some time in the future we will have fully attained it.

Mindful veterinary practice involves each of us living moment to moment, trying to be an attentive listener who practices empathy for others, and holding oneself gently and with self-compassion. If we come up short one moment, we have the opportunity to try again in the very next moment.


1Krasner MS, Epstein RM, et al. “Association of an education program in mindful education with burnout, empathy and attitudes among primary care physicians”. JAMA 2009. Sep 23;(302), 12; 1284-93. doi 10.1001/jama.2009.1384


Seaweeds for animal health

Seaweeds and kelps are proving to be powerful tools for skin, hoof and coat health, digestive improvements, and more.

Seaweeds have been an important component of mammalian diets throughout evolutionary history. They provided the one sure way for humans to avoid the goiter and cretinism caused by iodine deficiency – and they have proven useful for companion animal health as well. Knowing why, when and how to use quality seaweeds can you help best deliver the benefits of the powerful nutrients they contain. “Seaweed” is a general term for marine macro-algae. Most of the earth’s oxygen comes from seaweeds.1 Phycologists, the scientists who study macro-algae, divide them into three groups: brown algae, red algae and green algae, which together comprise over 20,000 different seaweeds. Names for marine ocean macro-algae mentioned in recent IVC Journal articles include “sea vegetable”, “kelp”, “bladderwrack” and “fucus”. Most of the seaweed used in pet foods and supplements are brown algae from the Laminaria and Fucus families.

How seaweeds differ from land plants

Land plants draw only on the limited resources of the footprint of soil in which they are growing. In contrast, seaweeds collect nutrients through their fronds from the abundant resources in circulating seawater. The fronds of seaweeds are like plant leaves and the holdfasts are like the roots of terrestrial plants. While land plants use roots to absorb nutrients, sea plants use their fronds. This absorption method gives seaweeds a nutrient profile advantage because they are such powerful collectors of the minerals and phytonutrients in the areas where they grow. Ocean water is literally the lifeblood of the planet, containing all essential nutrients in similar ratios to those in the mammalian bloodstream.2 Thus, seaweeds can deliver a very consistent and powerful mineral profile. In turn, there are vast differences in the minerals and biochemicals each species of seaweed collects and stores. The difference between land and sea plants makes seaweeds a more powerful source of micronutrients and phytonutrients, providing they are properly selected, harvested and processed to retain the targeted nutrient profile. Knowing the genus and species of the “kelp” or “seaweed” you are using can guide you to its nutrient content. However, feed labeling laws do not require species identification and allow broad terms like “seaweed” and “kelp” in ingredient panels. The term “seaweed” can refer to any marine macro-algae, while the term “kelp” is permitted to include any Laminaria or Fucus species, according to feed control officials.

Evaluating quality

What about ocean pollution, radiation, heavy metals, sustainability and quality? How do you know what you are getting? Look for sources harvested from clean waters in remote locations, and that are quickly processed and dried. USDA Organic certification is one way to assure site and processing have been inspected for cleanliness and sustainability.  Kosher certification of the original harvest is another way to assure third party inspection for purity. Some harvest sites are richer in baseline nutrients; these include bays with geothermal vents and mineral-rich estuaries or rivers. This converts to higher nutrients in the harvestable seaweed. Rapid collection and drying are important because many of the minerals, including iodine, are freshwater soluble and can be washed away if improperly handled.3 Carefully reducing the moisture content to less than 10% helps assure stability and deliverability to animals. Ascophylum nodosum, a brown Fucus seaweed growing in the tidal zones of the North Atlantic from New England to Canada, Iceland and northern Europe, is the most common species harvested for animal nutrition. Harvest methods range from hand-cutting with a seaweed knife, to custom vacuum cutters, to mowing (like cutting hay) at mid-tide.  Thousands of tons of wet wild harvested Ascophylum are dried using methods such as outdoor windrowing (similar to drying hay in the field), high-temperature drum drying, and lower temperature conveyor belt drying using geothermal heated air. The highest quality, most consistent, effective and sustainable products rely on mapping the beds, mowing on a four to five-year cycle, and converting geothermal energy to hot air for controlled drying.

What’s in seaweed?

Interestingly, macro-algae or seaweeds are most notable as a source of micro-nutrients, including over 60 mineral elements. Iodine: Seaweeds are historically known as a rich source of iodine, an essential nutrient for thyroid and metabolic health. Iodine content can range from 50 ppm in some of the fast-growing seaweeds, such as red algae of the genus Pyropia (used for sushi nori), to 7,500 ppm in true deep-water kelps like Laminaria digitata. The range for Ascophylum is 300 to 1,200 ppm. Consistent and reliable delivery of a uniform quantity of iodine depends on careful harvest and post-harvest handling and drying. Some suppliers provide detailed specifications and analysis as well as custom blending and formulations to uniformly target iodine delivery levels. Iodine in kelp is present as iodide,4,5 which is easily absorbed. Too much or too little iodine in the diet can cause a range of problems, including goiter, hyperthyroidism and hypothyroidism, infertility, and cognitive dysfunction.6 Iodine is an essential nutritional element required in very small amounts by animals. It is a constituent of the thyroid hormones thyroxine (T4) and tri-iodothyronine (T3), which play a major role in cell differentiation, growth and development in growing animals and in the regulation of metabolic rates in adult animals. Clinical signs of iodine deficiency include goiter (enlargement of the thyroid gland), alopecia (hair loss), dry sparse hair coat, and weight gain. An all-meat diet can produce iodine deficiency.7 Too much iodine can be toxic. Clinical signs may include excessive lacrimation, salivation, nasal discharge, and a flaky dry skin. Paradoxically, goiter can be a sign of iodine excess as well as deficiency. High plasma concentrations of iodine can inhibit the production of thyroid hormones by the thyroid gland. Seaweed supplements should be correctly dosed to obtain the most benefits from their nutrient content (see below). Routine inclusion of seaweed is easiest when it is used as an ingredient in a reliable prepared food. But it can also be added, top-dressed, or in limited cases, provided as a free-choice supplement. Assuming a guaranteed and consistent analysis of 750 ppm, kelp should make up a very small amount of the total dry ration. For dogs and cats, we are talking about 0.25% of their dry matter intake, 0.1% for horses, and 0.5% for goats and chickens. Eggs from chickens fed kelp show darker yolks and higher nutrition including iodine.8 Rabbits are special, with a minimum iodine requirement of only 0.2 ppm of diet.9 The iodine requirement for any animal will be higher if the diet includes substantial amounts of cabbage or other Brassica species, which contain natural goitrogens and increase the need for iodine.10 Trace minerals and complex phytonutrients: The vast array of 60 other trace minerals and complex phytonutrients found in seaweeds is incredibly valuable to animal health. Complex bioactive compounds such as polysaccharides promote digestive activity and immune function. Trace levels of vitamin E have been attributed to improved conception rates. Along with iodine, seaweeds can help with subtle dietary deficiencies, providing very trace quantities of a range of micronutrients. Consider selenium. Kelp accumulates selenium from seawater, and converts as much as 85% of it into organic selenium species11 of high biological activity. In animal studies, kelp has been found to protect against the mammary carcinogenic effect of dimethylbenz[a]anthracene (DMBA).12 These findings suggest that selenium may be responsible for the low incidence of breast cancer in Japanese women, who consume a diet containing iodine-rich and selenium-containing seaweed.13,14 Seaweed is most useful as a baseline preventative nutrient source in the diet. In some cases, it is also an effective treatment when specific problems indicate thyroid iodine deficiency.

Reports from clinical practice15

Kelp, specifically A. nodosum, is recommended by leading holistic veterinarians as a supplement in homemade diets for dogs and cats, and by large animal vets as a nutritional supplement for poultry, cattle, goats, alpacas and horses.  It is one of the few dietary ingredients that contains essential iodine for the thyroid gland and immune system. Many commercial and raw food diets, including The Honest Kitchen, Sojos, and Fresh Pet, use kelp as a source of natural iodine rather than the synthetic sources such as calcium iodate or potassium iodide found in commercial kibble. Many practitioners realize that seaweeds are different than other green supplements because they deliver different nutrients from land vegetation and microalgae grown in fresh water. Because of their concentrated trace minerals, only a small quantity is needed, and seaweeds are appropriate for daily use. Freshwater microalgae and land plants like alfalfa have their own health benefits and can be used along with seaweed species for veterinary patients.
  • Most practitioners recognize that low thyroid function is rampant in our canine population. Many of the problems we see daily, such as skin conditions, allergies, obesity and even seizures, are related to low thyroid function. The usual blood tests are poor at detecting early thyroid dysfunction. Dr. Jean Dodds notes that kelp can be used to aid in correcting hypothyroidism. Providing the essential nutrients of iodine and selenium for optimal thyroid gland function is critical for returning the animal to health before irreversible changes occur.
  • Practitioners also recognize that along with the benefits seaweed offers in the daily diet as a source of iodine and trace minerals, it can additionally be used to help treat disease conditions in veterinary patients. The salty taste is valued in Chinese Food Therapy for therapeutic support. For example, Dr. Connie Dinatale has used red algae seaweed yezoensis L (nori) to shrink lipomas in her food therapy practice. The salty taste of seaweed enhances palatability and is well accepted by patients of all species.
  • Cynthia Lankenau states that kelp is a balanced supplement with a strong Yin quality, but also a strong Qi moving ability. In particular, it is a Kidney Qi mover with a Spleen Qi mover, and cleanses lymphatics. She finds it beneficial for dogs with lymphoma, congestive heart failure, diabetes, renal dropsy and poor coats. Horses with founder benefit from an improvement in the lamina of the hoof. Dr. Lankenau’s alpaca clients have stated that kelp species such as Ascophyllum nodosum improves the fiber quality of the alpaca diet.
  • Other practitioners like kelp because of its benefits to cancer patients. As holistic practitioners, we know that giving patients the fuel they need for a fully functioning immune system is critical to managing every disease, including cancer.
  • Rick Palmquist shares the case of an aged dog that was mauled by a coyote. After a protracted recovery, the dog’s coat was poor and his hair did not grow back. His thyroid tests were below normal. When a small amount of kelp was added to the dog’s diet, his hair began growing back darker and thicker, within two weeks.
  • Barbara Royal finds kelp especially useful in younger patients that tend to be overweight after spaying or neutering. She feels that removing the gonads, which are important endocrine organs, leads to a system-wide imbalance of many other organs and endocrine tissues, which must compensate for the rest of the patient’s life.
Holistic veterinarians want the purest available source of kelp for their patients. Kelp that is certified organic and carefully harvested from colder ocean waters is more likely to be a reliable product that does not vary in quality. All in all, seaweeds and kelps are proving to be powerful and useful tools for skin, hoof and coat health, digestive improvements, and even improved conception rates. Supporting the thyroid gland with quality kelp allows the endocrine and immune systems to function at their best to maintain wellness and resist disease.


1Hall J. "The Most Important Organism?" 2011 [cited 2017 4 August]; Available from 2Thompson DJ. "Seawater: A blood plasma substitute?" Nexus Magazine, 2006. 13(6). 3Teas J, et al, "Variability of iodine content in common commercially available edible seaweeds". Thyroid, 2004. 14(10): p. 836-41. 4Kupper FC, et al. "Iodide accumulation provides kelp with an inorganic antioxidant impacting atmospheric chemistry". Proc Natl Acad Sci U S A, 2008. 105(19): p. 6954-8. 5Lin L, Chen G, Chen Y, "Determination of iodine and its species in plant samples using ion chromatography-inductively coupled plasma mass spectrometry" Se Pu, 2011. 29(7): p. 662-6. 6Office of Dietary Supplements National Institutes of Health. "Iodine -- Fact Sheet for Health Professionals". June 24, 2011 [cited 2017 August 3]; Available from 7National Research Council, Nutrient Requirements of Dogs and Cats. 2006, Washington, DC: The National Academies Press. 8Jacob J. "Seaweed in Poultry Diets" 2015  [cited 2017 4 August]; Available from: 9National Research Council Committee on Animal Nutrition, "Nutrient Requirements of Rabbits", 1977, National Academy Press. 10Chesney AM, Clawson TA, Webster B. "Endemic goitre in rabbits. I. Incidence and characteristics". Bull Johns Hopkins Hosp, 1928. 43: p. 261-277. 11Yan X, et al. "Enriched accumulation and biotransformation of selenium in the edible seaweed Laminaria japonica". J Agric Food Chem, 2004. 52(21): p. 6460-4. 12Maruyama H, Watanabe K, Yamamoto I. "Effect of dietary kelp on lipid peroxidation and glutathione peroxidase activity in livers of rats given breast carcinogen DMBA". Nutr Cancer, 1991. 15(3-4): p. 221-8. 13Smyth PP. "The thyroid, iodine and breast cancer". Breast Cancer Res, 2003. 5(5): p. 235-8. 14Cann SA, van Netten JP, van Netten C. "Hypothesis: iodine, selenium and the development of breast cancer". Cancer Causes Control, 2000. 11(2): p. 121-7. 15Clinical Practice Interviews: Dr. Constance Dinatale, Veterinary Acupuncture and Complementary Therapy, Winter Park, FL; Dr. Cynthia Lankenau, Holistic Center for Veterinary Care, Coldon, NY; Dr. Rick Palmquist, Centinela Animal Hospital, Inc., Inglewood, CA; Dr. Barbara Royal, The Royal Treatment Veterinary Center, Chicago, IL; Dr. Jean Dodds, Hemopet, Garden Grove, CA.

Kelp feed rates for companion animals

Based on a kelp product with an iodine content of 750 ppm

Ideal application is by inclusion in formulation, but controlled dosing is acceptable.

*⅛ oz = ¾ tsp; ¼ oz = 1½ tsp; ½ oz. = 1 tbspNational Research Council recommended iodine daily allowance range. Generally not recommended for nursing young when the mother is already on kelp. Dogs: Add kelp at 0.25% of Dry Matter Intake (DMI), sprinkle on or mix into food daily. Cats: Add kelp at 0.25% DMI, or sprinkle a pinch of kelp on food daily. Reduce rates if the food or supplement already meets iodine requirements. Horses: Mix in feed at 0.1% of Dry Matter Intake (DMI). Feed ¼ oz of kelp per 500 lbs of body weight, generally not to exceed ½ oz per head per day. Mix into grain ration or apply as top dressing. Reduce rates if your feed or feed supplement already meets iodine requirements. Goats: Mix in feed at 0.5% of Dry Matter Intake (DMI). Feed 1/4 oz of kelp per 50 lbs of body weight. Kelp can also be fed free choice, alone or with salt. Chickens: Mix in feed at 0.5% of Dry Matter Intake (DMI) or mix 4 oz of kelp into 25 lbs of grain ration, or apply as top dressing.

Case studies: chiropractic problems and treatments in cats

For those not familiar with the notations used for recording chiropractic findings and treatments, here are a few hints. It all started with human anatomical terminology and is now a blend of human and animal terminology since we veterinarians have been taught chiropractic by human chiropractors. The notations indicate the location and direction of correction of a subluxation complex.


C1PL = C1 posterior (dorsal) on the left side

C1SR = C1 superior (cranial) on the right.

C1 = Atlas

C2 =Axis

P = posterior = dorsal

A = anterior = ventral

S = superior = cranial

I = inferior = caudal

L = left

R = right

PI and AS refer to Iliac spine


Gillyweed, a female DSH, was first seen at eight weeks of age (4/2013) at her post adoption exam by one veterinarian at the practice. She was found to have a congenital deformity of her left front leg, including a missing radius, a short and twisted ulna, and a few missing carpals. She was spayed at 11 months (1/2014) with no complications.

When seen at 16 months (6/2014) for her annual exam, she was referred for chiropractic treatment. Two weeks prior to the chiropractic appointment, she stopped climbing on her cat tree and seemed painful when picked up.

At her conventional exam (7/2014), Gillyweed was found to be depressed and dehydrated with a moderately painful abdomen, an arched back and tight spinal muscles. IV fluids overnight improved her attitude and hydration, but she was still resistant to being handled. Permission for a chiropractic exam and treatment was obtained. Subluxations were found and treated with manual adjustments at C7BR, C6BL, T1PR, T8PL, T12P, L1PL, L2P, L6PL, Sternum R, and R femoral head cranial.

At Gillyweed’s check two weeks later (8/2014), her owner reported improvement in her activity level and attitude and that she was using her left elbow when she ran. At her chiropractic exam, she was stiff in both extension/flexion and lateral/flexion mid-back with a stiff and high right pelvis. TX: T6P, T8PL, T12P, T13PR, L1PL, RPI.

Two weeks later (9/2014), her owner reported that Gillyweed was better overall, but starting to seem stiff again. She was found to be stiff with motion palpation in all three main areas: cervical/thoracic/lumbar-pelvis. TX: C7BR, T1PL, T8PL, T11PR, T12P, T13PL, L4PL, RPI, Sternum L.

Two weeks later, Gillyweed was improved in attitude and behavior. A chiropractic exam showed VSC cervical/thoracic/lumbar-pelvis (VSC=vertebral sub-luxation complex). TX: C5BR, T5PR, T12P, L1PL, L2PR, SAR, SBPL (SA=sacral apex, SB=sacral base).

At another recheck in two weeks, she was much improved, purring again and sociable with all family members. The exam showed VSC cervical/mid-back .TX: C1PR, C2P, C6BL, T5PL, T13PR, L4PL.

She was rechecked again in two weeks (10/2014) at which she was reported to be more active and social. During the exam, her back was found to be flat — for the first time since was first seen for abdominal pain. VSC was found in cervical/mid-back areas. TX: C7BR, T1PL, T6P, T12PL, L1PR, L5PL.

Another recheck in three weeks (11/2014) found Gillyweed doing well. TX: T2PL, T4PL, L3P, L6P, RPI (PI= sacral-iliac joint stuck in flexion, AS=sacral- iliac joint stuck in extension).

Gillyweed continues to be a long-term patient and is comfortable and active with maintenance chiropractic treatments three or four times a year. Her main trouble areas have stayed consistent, probably due to her compensations for her deformed left front leg. So far, her follow-up radiographs have not shown any signs of arthritic changes.


Harry Pawter, a neutered male Maine Coon born in 2000, was first referred for chiropractic care at his annual exam on 7/11/2014. His owner reported that he was arthritic and he was found to have tense back muscles and pain with palpation. Other findings included being overweight, a benign mass on his ventral abdomen, and early stage renal disease.

A later chiropractic exam found that Harry had decreased lateral/flexion cervical and thoracic and decreased extension/flexion in his lumbar segments.

Manual adjustments were performed at the following segments: C1PR, C7BL, T1PR, T4PL, T12 and T13PR, L1PR, L4P, L6PL, SAL, Sternum L, left ribs 11 and12 P, R rib 9 dorsal/caudal.

A recheck was suggested in two weeks; the appointment made was for three weeks later (9/23/2014). Harry’s neck was stiff to the left, and he had decreased lateral/flexion mid-back, stiff ribs on the L, and decreased motion in his pelvis. TX: C7BL, T1PR, T6PL, T12PR, L2PL, L6PR, R SA, caudal sternum L, Right rib10 P.

On 5/1/15, Harry’s owner reported that was lying down slowly and carefully, and had been chewing at his mid-back area a few days earlier. A chiropractic exam found a slightly oily area dorsal mid-back with a strong panniculus response at T10-L1, stiff ribs on the L, sternum shifted L, L pelvis high, decreased lateral/flexion cranial lumbar through mid-thorax, and decreased motion L and R cervical. TX: C1PR, C2P, C3BR, C7BL, T4PR, T6PL, T9PR, T11PL, T13PR, L1P, L3PR, L PI, SA L, sternum L. RX:

Dasuquin Cats #60 1 SID on food. A recheck with bloodwork was suggested for seven to ten days later.

Harry was seen again on 7/28/15; his owner reported that he had been doing well up until a couple of weeks prior. The exam showed decreased lateral/flexion and extension/flexion mid-back and lumbar with a strong panniculus response mid-back, and a pain response with palpation over his pelvis and hip joints. Harry’s coat was thin and oily along his dorsal midline and pelvis. He had an increased heart rate with normal rhythm along with weight loss. Bloodwork showed a slight decrease in WBC and an increased T4. RX: Methimazole transdermal gel 5mg SID, and a continuation of Dasuquin. TX: C2P, C6BR, T1PL, T6P, sternum R, T11PL, T12P, L1PL, L3PL, L5PR, R SA. We discussed adding low dose Meloxicam when traveling and/or Body Sore (Chinese herb mixture). A chiropractic recheck and a check for T4 was recommended in a month’s time.  

Harry was seen a month later for a T4 re-check only. The Methimazole was increased to BID.

He was next seen for chiropractic care on 7/7/16. He was found to have back muscles and a painful back. A chiropractic exam revealed even ribs, decreased lateral/flexion mid-back and lumbar, and a neck stiff to the L. TX: C7BL, T1PL, T5PR, T6PR, T8PL, T10P, T12PL, T13PR, L2PR, L3PL, L5PR, L6PL, R rib 7P, R radial head lateral, L femoral head caudal.

I continue to see Harry Pawter once or twice a year as needed. Unfortunately, this isn’t often enough to help increase the stability of his back, but it does seem to keep him comfortable for significant periods of time. His symptoms are interesting because the first thing his owner noticed were the changes in his coat and grooming behavior.

Chiropractic problems and treatments in domestic cats

Chiropractic problems are often found as the underlying reason feline patients are presented. If more veterinarians were trained to recognize this component of cat health in physical exams, and to realize the wide variety of conditions chiropractic can help, we would be able to assist in many cases.

Very few studies relate to chiropractic issues in cats. Anecdotally, we see and treat them frequently, so this article shows both the incidence of these problems in cats, and some of the treatment approaches we use.

Background information

A search of the literature revealed no published data relating specifically to chiropractic issues in domestic cats, but it did offer a body of information on arthritis/DJD/spondylosis. The first, in 1964, was a radiographic presentation of spondylosis. The next grouping of reports ranged from the late 1990s to a 2001 study looking at the efficacy of Meloxicam in pain control for arthritic cats. There have been other reports of arthritis pain management since, but nothing relating to chiropractic problems or treatment (that we could find). The general conclusion of these studies was that cats get radiographically visible arthritis by the age ten to 12 on average, with some as young as six, and that more joints are affected as they get older.

Our incidence study


Using some of these arthritis studies as a model, I (Dr. Thompson) evaluated the next 200 cats that came into the hospital for any reason, sick or well, indoor and/or outdoor, and of any age, from eight weeks to 20 years old. These cats included hospital patients, vaccination clinic animals, and barn cats seen on equine ambulatory calls. Each was palpated for both static mal-alignments and changes in motion at the same locations as in the arthritis studies, namely along the entire spine, elbows, shoulders and hips. I added the sternum, as I have found in clinical practice that this is a common and significant site for arthritic changes, and is not looked at by radiologists.


  1. I found one eight-week-old kitten with no discernable subluxation complexes. A subluxation complex refers to a joint with abnormal or restricted motion and all of its surrounding soft tissue support structures. This would include the muscles, their attachments, tendons, ligaments, blood vessels, lymphatics, nerves, joint capsule, etc.
  2. Subluxation complexes were more common with age.
  3. These complexes were present at younger ages than at which arthritis was found in previous studies.
  4. 5% of cats had sternum involvement; those cats alsohad a statistically significant increase in subluxation complexes than those of the same age without sternum involvement.
  5. This increase is seen in both spinal segments and extremities.


As the sole practitioner gathering data, there should be consistency in the data from animal to animal. It would have been beneficial to have multiple practitioners gathering data in additional locations to get a better variety of cat populations and a larger number of participating cats. This would require that we all agreed on and practiced our protocol before collecting data. The information we gathered sparks a number of additional questions to be answered:
  1. Is there a difference between indoor and outdoor kept cats?
  2. Can we effect a change in the development of arthritis in older cats by keeping them regularly adjusted with chiropractic from a young age?
  3. If yes, what is the optimal maintenance protocol?
  4. Do these trends hold true in other species?
As chiropractic practitioners, we know our treatments can have an important impact on the lives of our patients, and their owners. It is my hope that this basic information provides a starting point for further research that will help all of us educate and encourage our colleagues, co-workers and owners about the benefits of early chiropractic treatment and continued preventative maintenance in our feline patients.


Most of my patients are referred in-hospital to me by the other practitioners, while some come from other practices. Colleagues who have utilized my suggestions for incorporating a few easy additions to their physical exam routines often find muscular/skeletal problems. I offer free chiropractic exams to any puppy or kitten I see and check all litters and their moms during wellness appointments. This allows us to start the conversation about lifetime preventative chiropractic maintenance. Once existing problems are resolved, we evaluate maintenance needs for the animal. Often, twice yearly chiropractic treatments keep them comfortable. I see active working or competitive animals more frequently, once every four to six weeks as needed, depending on their workloads or show schedules. As the case studies below will show, many chiropractic problems are a part of (or the only) reason some of our patients are presented. So if more veterinarians were trained to recognize this component in physical exams, and to realize the wide variety of conditions that chiropractic can help, we would be able to assist in many cases. Chiropractic is a wonderful addition to any practitioner’s treatment options.

Case studies

For those not familiar with the notations used for recording chiropractic findings and treatments, here are a few hints. It all started with human anatomical terminology and is now a blend of human and animal terminology since we veterinarians have been taught chiropractic by human chiropractors. The notations indicate the location and direction of correction of a subluxation complex. Examples: C1PL = C1 posterior (dorsal) on the left side C1SR = C1 superior (cranial) on the right. C1 = Atlas C2 =Axis P = posterior = dorsal A = anterior = ventral S = superior = cranial I = inferior = caudal L = left R = right PI and AS refer to Iliac spine

1. Gillyweed

Gillyweed, a female DSH, was first seen at eight weeks of age (4/2013) at her post adoption exam by one veterinarian at the practice. She was found to have a congenital deformity of her left front leg, including a missing radius, a short and twisted ulna, and a few missing carpals. She was spayed at 11 months (1/2014) with no complications. When seen at 16 months (6/2014) for her annual exam, she was referred for chiropractic treatment. Two weeks prior to the chiropractic appointment, she stopped climbing on her cat tree and seemed painful when picked up. At her conventional exam (7/2014), Gillyweed was found to be depressed and dehydrated with a moderately painful abdomen, an arched back and tight spinal muscles. IV fluids overnight improved her attitude and hydration, but she was still resistant to being handled. Permission for a chiropractic exam and treatment was obtained. Subluxations were found and treated with manual adjustments at C7BR, C6BL, T1PR, T8PL, T12P, L1PL, L2P, L6PL, Sternum R, and R femoral head cranial. At Gillyweed’s check two weeks later (8/2014), her owner reported improvement in her activity level and attitude and that she was using her left elbow when she ran. At her chiropractic exam, she was stiff in both extension/flexion and lateral/flexion mid-back with a stiff and high right pelvis. TX: T6P, T8PL, T12P, T13PR, L1PL, RPI. Two weeks later (9/2014), her owner reported that Gillyweed was better overall, but starting to seem stiff again. She was found to be stiff with motion palpation in all three main areas: cervical/thoracic/lumbar-pelvis. TX: C7BR, T1PL, T8PL, T11PR, T12P, T13PL, L4PL, RPI, Sternum L. Two weeks later, Gillyweed was improved in attitude and behavior. A chiropractic exam showed VSC cervical/thoracic/lumbar-pelvis (VSC=vertebral sub-luxation complex). TX: C5BR, T5PR, T12P, L1PL, L2PR, SAR, SBPL (SA=sacral apex, SB=sacral base). At another recheck in two weeks, she was much improved, purring again and sociable with all family members. The exam showed VSC cervical/mid-back .TX: C1PR, C2P, C6BL, T5PL, T13PR, L4PL. She was rechecked again in two weeks (10/2014) at which she was reported to be more active and social. During the exam, her back was found to be flat -- for the first time since was first seen for abdominal pain. VSC was found in cervical/mid-back areas. TX: C7BR, T1PL, T6P, T12PL, L1PR, L5PL. Another recheck in three weeks (11/2014) found Gillyweed doing well. TX: T2PL, T4PL, L3P, L6P, RPI (PI= sacral-iliac joint stuck in flexion, AS=sacral- iliac joint stuck in extension). Gillyweed continues to be a long-term patient and is comfortable and active with maintenance chiropractic treatments three or four times a year. Her main trouble areas have stayed consistent, probably due to her compensations for her deformed left front leg. So far, her follow-up radiographs have not shown any signs of arthritic changes.

2. Harry Pawter

Harry Pawter, a neutered male Maine Coon born in 2000, was first referred for chiropractic care at his annual exam on 7/11/2014. His owner reported that he was arthritic and he was found to have tense back muscles and pain with palpation. Other findings included being overweight, a benign mass on his ventral abdomen, and early stage renal disease. A later chiropractic exam found that Harry had decreased lateral/flexion cervical and thoracic and decreased extension/flexion in his lumbar segments. Manual adjustments were performed at the following segments: C1PR, C7BL, T1PR, T4PL, T12 and T13PR, L1PR, L4P, L6PL, SAL, Sternum L, left ribs 11 and12 P, R rib 9 dorsal/caudal. A recheck was suggested in two weeks; the appointment made was for three weeks later (9/23/2014). Harry’s neck was stiff to the left, and he had decreased lateral/flexion mid-back, stiff ribs on the L, and decreased motion in his pelvis. TX: C7BL, T1PR, T6PL, T12PR, L2PL, L6PR, R SA, caudal sternum L, Right rib10 P. On 5/1/15, Harry’s owner reported that was lying down slowly and carefully, and had been chewing at his mid-back area a few days earlier. A chiropractic exam found a slightly oily area dorsal mid-back with a strong panniculus response at T10-L1, stiff ribs on the L, sternum shifted L, L pelvis high, decreased lateral/flexion cranial lumbar through mid-thorax, and decreased motion L and R cervical. TX: C1PR, C2P, C3BR, C7BL, T4PR, T6PL, T9PR, T11PL, T13PR, L1P, L3PR, L PI, SA L, sternum L. RX: Dasuquin Cats #60 1 SID on food. A recheck with bloodwork was suggested for seven to ten days later. Harry was seen again on 7/28/15; his owner reported that he had been doing well up until a couple of weeks prior. The exam showed decreased lateral/flexion and extension/flexion mid-back and lumbar with a strong panniculus response mid-back, and a pain response with palpation over his pelvis and hip joints. Harry’s coat was thin and oily along his dorsal midline and pelvis. He had an increased heart rate with normal rhythm along with weight loss. Bloodwork showed a slight decrease in WBC and an increased T4. RX: Methimazole transdermal gel 5mg SID, and a continuation of Dasuquin. TX: C2P, C6BR, T1PL, T6P, sternum R, T11PL, T12P, L1PL, L3PL, L5PR, R SA. We discussed adding low dose Meloxicam when traveling and/or Body Sore (Chinese herb mixture). A chiropractic recheck and a check for T4 was recommended in a month’s time. Harry was seen a month later for a T4 re-check only. The Methimazole was increased to BID. He was next seen for chiropractic care on 7/7/16. He was found to have back muscles and a painful back. A chiropractic exam revealed even ribs, decreased lateral/flexion mid-back and lumbar, and a neck stiff to the L. TX: C7BL, T1PL, T5PR, T6PR, T8PL, T10P, T12PL, T13PR, L2PR, L3PL, L5PR, L6PL, R rib 7P, R radial head lateral, L femoral head caudal. I continue to see Harry Pawter once or twice a year as needed. Unfortunately, this isn’t often enough to help increase the stability of his back, but it does seem to keep him comfortable for significant periods of time. His symptoms are interesting because the first thing his owner noticed were the changes in his coat and grooming behavior.

Nutritional approaches to dermatology cases

Basic nutritional guidelines for improving the overall health of patients and lessening the chance of illness – including dermatology cases.

Transitioning an animal with skin problems to a fresh food diet can sometimes bring about a rapid improvement in itchiness. More commonly, however, the inflammation reduces slowly and gradually, which over time lessens the need for conventional medication. If a pet is itchy year-round, then a diet change might bring about a gradual resolution; if a pet is seasonally itchy, then altering the diet may reduce the level of allergens in the body, necessitating less medication when that season arrives. We have seen some skin cases completely clear up with diet changes. In the first month, most itchy animals show a 30% to 50% improvement, which can still leave enough itchiness to require additional alternative treatment. In our office, this treatment might include homeopathy, Traditional Chinese Veterinary Medicine, chiropractic or Nutrition Response Testing. Some skin problems are related to internal problems other than food or environmental sensitivities, so a full diagnostic laboratory workup is always important. This allows the client to make an informed choice from conventional and/or alternative therapies. The purpose of this article is to provide some basic nutritional guidelines to improving the overall health of patients and lessening the chance of illness, including dermatological conditions. Each animal is unique and may require additional nutritional supplementation in the long run, but the basic food changes covered in this article can be a good start for many. Exceptions to these guidelines must always be considered depending on the severity of clinical pathology that may exist when the case is presented to you. Skin conditions in conjunction with advanced kidney, cardiac or liver disease, for example, may require further conventional and/or alternative treatments to initially stabilize the case, and may require particular considerations for nutritional supplements. Above all, it is important to keep the basic food changes and preparation simple enough so that clients can and will continue to comply over the long-term. Keys to getting clients started 1. Food quality is very important. a) Fresh: We discuss with clients the incredibly improved nutrition of fresh food over processed foods.1,2,3,4 We also provide a one-page synopsis of the book Pottenger’s Cats, which helps clients understand the value of raw diets.5 You can request a copy of this synopsis page by emailing our office. b) Clean: Many chemicals are used in animal and plant farming.6,7,3 The term “natural meat” is defined as containing no antibiotics or hormones, but it will still have pesticides, herbicides and fungicides in it. c) Cost: The client’s financial situation will determine if organic or natural meats are affordable. d) Availability: The Weston A Price Foundation8 produces a compact paperback Shopping Guide, updated each year, that lists reliable meat sources around the country. You or your clients may know of local community-supported farms with organic or minimally chemically-treated meat and produce. There may also be local pet food co-ops that your clients can join to purchase meats less expensively. 2. The basic diet for dogs is 50% to 75% meat and 25% to 50% high calorie cooked vegetables. a) Protein: This makes the diet about 17% to 25% animal protein, a minimal amount and also suitable if the pet has renal disease. We can increase the percentage of meat for growing, athletic, cachectic and pregnant or nursing animals. b) Vegetables: Fresh food contains approximately 75% water, whereas dry foods are without moisture. So we need high calorie vegetables along with the meat. The harder the vegetable is, the more calories it contains. Examples would be potatoes, sweet potatoes, cauliflower, beets, winter squashes, turnips and parsnips. If a dog has arthritis, we stay away from nightshade vegetables in case he has a sensitivity to glycoalkaloids or steroid alkaloids. Nightshade vegetables include white potatoes, all types of tomatoes and peppers, and eggplants. The basic diet for cats is 100% meat. One can add some well-cooked vegetables for variety if the cat likes them. Some cats are so conditioned to the taste, texture and smell of dry foods that it can take time – sometimes months – to change their diet. If a cat will not eat any type of fresh meat at all, the client is advised to ever so gradually add water to the dry food. Once the dry food is soft enough, we start adding minute amounts of cooked minced meat, gradually increasing the amount of meat and decreasing the dry food. Then over time, the client can cook the meat less and less. Some cats will eat canned or cooked minced food when the dry food is powdered and “salted” over the top. 3. We usually start with cooked meat since the pet’s intestinal microflora have been conditioned to processed food and might not easily digest raw meat at first. This can result in loose and frequent stools. We gradually cook the meat less and less until it’s being served raw. Not every pet can eat every kind of meat protein. We tell clients that if any observable problems occur after their pets eat a particular type of meat, not to feed that meat. If a pet cannot digest any meat, we recommend alternative treatment to correct that problem. 4. We provide very basic supplements for most pets. We use reliable whole food product companies such as Standard Process9 and Animal Essentials6 for nutritional supplementation. Their quality controls are excellent and Standard Process’ facilities and products are annually FDA inspected at the company’s request. a) Calcium is needed to balance the high phosphorus content of meat. Animal Essentials’ Natural Calcium comes from seaweed; a heaping half-teaspoon provides 600mg calcium to balance the phosphorus in each cup of meat. The high sodium in seaweed may be contraindicated. Standard Process has many concentrated beet calcium products for specific health issues. Processed bone meal and other calcium carbonate products may be indigestible for some animals and the company should ensure the bone meal is clear of heavy metals. I have seen two dogs that were fed meat with bone diets whose incisors looked like glass, with a line of pink pulp inside clearly visible. The teeth became white again after some months of providing a more bioavailable calcium supplement for each dog (Standard Process). b) For vitamins and minerals, we advise whole food products in which you will see only food names listed in the ingredient list – not chemical names for vitamin fractions. Daily doses vary with the size of the animal and consultants with whole food vitamin companies can advise you. Most commercial diets have artificial fractions of vitamins and non-chelated minerals added after cooking. These are not usable by the body unless it adds the missing phytonutrients to create the complete biologically-active vitamins we get in fresh foods.1,2 And in some cases, these artificial fractions can be toxic to the body.1,4 c) Omega 3 fatty acids are very important for itchy dogs as they are needed to modulate inflammatory conditions. If the client can afford to feed pasture-raised animal products, there may be sufficient Omega 3 in the food and additional supplementation won’t be needed. 5. The water we provide should be filtered through activated charcoal, at the very least. Pitcher-type filters can be found in many department stores. Tap water contains many chemicals, metals and unhealthy organic compounds.8,6,10,11 Helpful information about different water filtration systems can be found at and 6. We ask the client to keep a log of weekly body weights and to call us if there is any weight loss. We then increase the food volume. It is also a great idea to keep a record of the pet’s clinical illness signs. For example, the client can rate the animal’s itchiness on a scale of 0-10 (none to horrible) on a weekly or bi-weekly basis. This is very useful for deciding when to add alternative therapies and for tracking progress. One useful resource for keeping such records is the Healthy Pet Journal.9 7. One more very important point. The doses of products chosen for basic support or for specific medical conditions may need to be reduced over time. Comparing excellent whole food nutrition support products containing concentrated vitamins and minerals with non-whole food supplements, is like comparing espresso coffee to decaf. For example, if a person who needs espresso each morning to get going began a health improvement program, that caffeine pick-me-up would eventually no longer be necessary. At that stage, drinking a morning espresso might cause shaking and other side effects of too much caffeine. Similarly, once the pet’s body is in a healthier condition and builds up reserves, the concentrated nutrient product seems to overstimulate the system, so a dose reduction may be required. We are not yet aware of the mechanism for this phenomenon.

Whole Food Diets

Pet supply stores now carry many frozen meat, meat/ vegetable or meat/vegetable/bone diets. Varying the nutrients is more difficult, though one could rotate different frozen diets. The amount of each nutrient required by a given animal is determined by many factors, including whatever inflammatory or disease processes the pet is experiencing; the lifestyle and financial capability of the client; the animal’s genetic predispositions; the microbiome of his intestinal tract; and any stressors in the household.


Consuming adequate protein and healthy fats with a variety of fruits and vegetables, while staying away from processed foods and refined sugar, is still the healthiest way for both animals and people to eat. Fresh diets help maintain great health. They can heal skin conditions on their own, or become a key part of an integrative approach. Over the past 15 years, we have had success in our clinic using the strategies discussed in this article.

Case Studies

  1. Maggie is a ten-year-old spayed Labrador retriever. For most of the previous three to five years, she had been on antibiotics and anti-inflammatory medications for interdigital cysts and inflammation of the feet and ventral abdomen. After a month of eating a fresh food diet and taking basic calcium, vitamin/ mineral and Omega-3 supplements, Maggie’s itchiness had decreased by about 50%. More recent biopsies showed yeast in the tissues of the feet, so we started her on two products from Standard Process – Zymex capsules and Lact Enz. The swelling in Maggie’s toes gradually reduced and the licking and itchiness lessened. However, after some weeks, the licking increased again. It is standard practice in our office to be sure the client knows to stop the adjunct treatment products if they see an increase in physical or mental signs, and to let us know. Maggie’s owner stopped the Zymex and Lact Enz, and in two days the licking subsided again. She is off all conventional medications and her owner does not feel additional alternative therapy is needed as yet.
  2. Duke, a neutered male boxer, came to us at six years of age with chronic diarrhea and constant scratching of the ears, neck and chest. Two weeks into the diet transition, his diarrhea resolved and the itchiness reduced to the point where he could sleep through the night. The client saw this as a 50% decrease in itchiness. However, Duke was still so itchy during the day that his owner wished to hurry up the process. So we gave him Nutrition Response Testing and found he had mercury poisoning. Mercury, arsenic and aluminum toxicity commonly underlie skin conditions in Massachusetts, where Duke lives. We gave him concentrated cilantro (Nature’s Balance), and the mercury in Duke’s body’s gradually decreased over the next six weeks; as well, his itchiness gradually subsided and has not returned over the past three months. Duke’s owner will monitor him over the next year for any seasonal return of itchiness.
  3. Oliver, a male neutered seven-year-old Bichon/ Shihtzu cross, presented with a diagnosis of atopy and recurrent ear inflammations that started when he was 1½ years old. Spring and fall brought on more itchiness. By the third week of diet transition, Oliver no longer needed Benadryl, and the client reported an itchiness rating of 2/10 to 3/10 compared to the initial 10/10. Two weeks later, the itchiness increased to 6/10 and Nutrition Response Testing showed his medications to be a problem. Solidago (Marco Pharma) was used to start the detoxification process. Six weeks later, Oliver’s itchiness had reduced to 2/10 to 3/10 again – this was significant as the fall had been particularly problematic for him in previous years. A few weeks later, the itchiness increased so the Solidago was discontinued and the itchiness subsided over the next two days. Currently, the owner feels Oliver does not need any alternative treatment. His itchiness is still 3/10 but she feels this is tolerable. We will continue to monitor him.

Additional Resources


1DeCava, J. The Real Truth About Vitamins & Anti-Oxidants, Selene River Press, Inc., 2006. 2Medford, L. Why Do I Need Whole Food Supplements? LDN Publishing, 2002. 3Pitcairn, RH.  and Pitcairn, SH. Pitcairn’s Complete Guide to Natural Health for Dogs and Cats, Holtzhrinck Publishers, 2005. 4Shayne, V. Whole Food Nutrition – The Missing Link in Vitamin Therapy,, Inc., 2000. 5Pottenger, FM. Pottenger’s Cats:  A Study in Nutrition 6Cimperman, S. “Environmental Toxins and PreDiabetes”, Well Being Journal, March/April 2014. 7Jensen, B.  Empty Harvest, Avery, 1990. 8Bryson, C.  The Fluoride Deception, Seven Stories Press, 2004. 9Chambreau, C. Healthy Animal’s Journal, TRO Productions, 2003. 10Moody, J. Water, Water Everywhere But Is It Safe to Drink? Wise Traditions, Spring, 2014. 11Teller, M. Lead in the Water:  Flint’s Cautionary Tale, Wise Traditions, Spring, 2016.

Western botanicals for treating otitis media in animals

Unlike conventional drugs, herbs and other botanicals make resistance nearly impossible for even the nastiest pathogens, and are effective weapons against the bacteria and fungi associated with otitis media in dogs, cats and horses.

Otitis refers to dermal or epidermal inflammation of the ear. Otitis externa or media are not diseases in themselves, but are symptoms of one or more preexisting conditions – and like dermatitis that occurs elsewhere on the body, the causes are rarely just skin deep. The primary difference between otitis and any other skin condition involves the unique environment in which inflammation and infection occur. The ear canal is like a fermentation vessel for pathogenic bacteria and fungi, especially if copious ear wax, dirt or other debris is present. This article looks at the herbs and other botanicals that can effectively treat otitis media in dogs, cats and horses.

Topical Interventions

Begin by cleaning the ears with a rinse solution that serves a dual purpose of removing dirt while inhibiting pathogenic bacteria and fungi residing in the ear canal. I prefer a base of cider vinegar, aloe vera juice and distilled water, to which a variety of essentials oils and herb extracts can be added. The overall solution should be fairly dilute, especially in the case of essential oils, which can otherwise be irritating to the point of aggravating rather than relieving inflammation. To prevent this and to assure optimal effectiveness of the formula, I recommend limiting essential oil components of any formula to ≤3% of total volume of the formula. Most herb extracts (tinctures) can be used more liberally, depending of course on the choice of herbs. “Hot” herbs, such as garlic or peppermint, should not be used in concentrations exceeding 5%. Calendula on the other hand is quite forgiving, especially if used as a glycerite – my preferred form of any herb extract used in or on the ears. Glycerin lends its own healing benefits to a formula. Both antimicrobial and humectant, glycerin serves to absorb drainage and prevent pooling of exudate in dermal tissues.

Botanicals for an ear rinse

All of the botanicals presented in this article are best used as components of the aforementioned ear rinse, twice a day. Here are some of my favorites, and how they work.

1. Cider Vinegar

Well known for its yeast-fighting antifungal and antibacterial actions,1 it’s an excellent cleanser that cuts through ear wax while inhibiting yeast and bacterial reproduction. Vinegar containing 5% acetic acid, in a concentration of ≤20% of the total formula, can be safely used with minimal risk of increased irritation.

2. Calendula Extract (Calendula officinalis)

The activities of Calendula extract have been compared to those of Fluconazole, a drug commonly used to combat blastomycosis, histoplasmosis and various other fungal infections.2,3 It is also antibacterial and serves as an excellent vulnerary agent, bringing soothing relief and accelerating cell reproduction and granuloma at the site of open sores, insect bites and other minor injuries.

3. Tea Tree Oil (Melaleuca alternafolia)

Tea tree oil is especially useful in the ears, and has strong activity against a broad variety of pathogenic fungi and bacteria.4,5 It can be safely used in concentrations of ≤3% on dogs, horses and most other animals; however, in my opinion, tea tree oil should not be applied consecutively for more than three days in cats, who tend to be hypersensitive to tea tree oil, especially when they lick it from their fur. Although I have yet to see any actual adverse events from the use of tea tree oil, a number of reports warn of acute hepatotoxicity, neurotoxicity and nephritic events when the oil is ingested in higher concentrations over non-specific periods of time. More is not better, and caution always rules – use this one sparingly on felines, and try to avoid direct ingestion of whatever formulation you use.

4. Lavender Oil (Lavendula off.)

This oil has been shown to be effective against at least 120 strains of pathogenic bacteria,6 and is among the safest essential oils for use in animals. It is also a remarkable healing agent and “carrier” for other botanical medicines; it serves as a quick-acting vasodilator that quickly increases blood circulation into the dermis. Lavender oil also lends a much welcomed calming effect, often to both the patient and practitioner!

5. Thyme Oil (Thymus off.)

Thyme oil is stronger and more reliable than lavender as a broad spectrum antimicrobial agent6 in solutions below 0.5%. This is due to its high concentrations of highly active thymol and carvacrol. As an example of how “less is sometimes better”, pick up a bottle of Listerine mouthwash and read the label. Thymol is a primary active ingredient – at a concentration of just 0.064%. Being an herbalist who believes that “the whole plant is greater than the sum of its parts”, I prefer to use thyme in the form of a whole leaf ethanol tincture. To use thyme in the ears, simply dilute 5ml of the 1:2 alcohol based oil into 250ml of a distilled water solution containing 20% cider vinegar. Rinse the ear liberally with the solution, twice daily.

6. Goldenseal (Hydrastis canadensis), Oregon Grape (Mahonia spp.) and Coptis Species

The roots of these plants are rich with berberine, a bright yellow, protoberberine-type isoquinoline alkaloid. Berberine offers a very broad spectrum of antibacterial, antifungal and antiviral activity. Several studies support this claim. In one, berberine was shown to be highly active against Fluconazole-resistant yeasts.7 It is also effective against a wide variety of pathogenic bacteria, including drug resistant staphylococcus aureus. Although most of these studies are in vitro, the usefulness of berberine stems from its ability to strongly inhibit, if not completely kill, pathogenic microbes on contact. This puts goldenseal and other berberine-bearing plants at the top of my list of resources for direct application. They also make a beautiful yellow dye – a feature that may be scorned by pet owners who don’t like temporarily stained fur, but welcomed by the herbalist who sees the staining as assurance that active principles of the plant remain present at the site of application.

7. Olive leaf (olea europaea)

Perhaps the “king” of antimicrobial herbs, olive leaf is simply amazing. Its healing powers have been known for a very long time. In the early to mid-1800s, olive leaf was found to be a very effective febrifuge remedy, and was seen as much more effective than quinine in the treatment of malaria. In 1962, Italian researchers recorded that oleuropein, one of several active components in olive leaf, could reduce blood pressure in both humans and animals. In 1969, the Upjohn Company, in recognition of a growing body of evidence illuminating not only the broad-spectrum antibacterial and antifungal properties of the plant, but also its remarkable activity against numerous protozoa and viruses, went to work to develop a new antiviral drug. As pharmaceutical research often goes, Upjohn focused on isolating a single component of olive leaf (oleuropein) in hopes of creating a new, patentable antimicrobial/antiviral super drug. They realized that olive simply does not work in the absence of a more complete representation of the plant’s chemistry. Hence, “the whole plant is greater the sum of its parts”. Like all herbs, the “entourage effect” of multiple chemical components, including (among others) coffee acid, verbascoside, luteolin 7-O-glucoside, rutin, apigenin 7-O-glucoside, luteolin 4’-O-glucoside, maslinic acid, hydroxutyrosol and oleocantha, all contribute to the wonders of this amazing botanical. Upjohn abandoned its pursuit, leaving behind a very impressive list of in-vitro activities. In fact, every germ that was inoculated in their studies was killed by olive leaf extract, including but not limited to multiple strains of Herpes virus, Candida yeast, and dozens of pathogenic bacteria. In a more recent invitro study, a scant 0.6% (v/v) dilution of olive leaf tea was shown to kill E coli within three hours. Candida albicans was completely killed by a 15% (v/v) extract.8 Olive leaf is effective in many forms (aqueous, ethanol or glycerin extracts) and is very safe. For applications against Otitis media, I recommend a 1:4 glycerite, diluted to concentrations between 10% to 20% in distilled water and up to 20% cider vinegar.

8. Rosemary Oil (Rosmarinus off. L.)

No article on Western botanical interventions against Otitis media would be complete without a strong mention of rosemary oil. There is good reason why this oil is used as a natural preservative in hundreds of natural foods and medicines. It can be applied safely and is very effective at inhibiting reproduction or killing (depending on concentration) an impressive variety of troublesome bacteria. In a 2003 study published in The Brazilian Journal of Biosciences, rosemary oil was found to be effective against 18 isolates of Staphylococcus pseudintermedius isolated from dogs.9 In another study, the oil was shown to be effective against six microbial species, including gram-positive bacteria (Staphylococcus aureus and Bacillus subtilis), gram-negative bacteria (Escherichia coli and Pseudomonas aeruginosa), a yeast (Candida albicans), and a fungus (Aspergillus niger). Rosemary oil can be used with a broad margin of safety in dilutions of ≤3%. Like lavender, it may impart a calming effect upon an otherwise pain-tormented animal – or a nervous veterinarian. However, I find that stronger dilutions will sometimes result in an opposite, energizing effect.

Dietary Changes

Many cases of otitis media are influenced by food allergies, so any holistic approach will require a critical assessment of diet. • Begin by removing all the “usual suspects” from the diet: wheat, soy, corn and their by-products. • Meat by-products (leftovers from the human food slaughterhouse) and meat meal (parts of virtually any animal, from virtually anywhere but a human food process) should also be avoided in favor of whole, human-grade meats (e.g. turkey, fish, beef, chicken, lamb, duck, etc.). • Artificial dyes or preservatives should also be eliminated. Instead, opt for foods that are preserved with natural vitamin E, rosemary oil, or other natural antioxidants. • Supplementation should include immunotonics, such as Echinacea, to help boost the body’s fight against infection, and antimicrobials. Both can be used topically for direct intervention at surface tissues, and systemically to chase and inhibit pathogens from the inside out. As many strains of pathogenic bacteria and fungi become increasingly resistant to our antibiotic arsenal, what may once have been a “simple case” of Otitis media can now become an all-out battle against infection. Fortunately, we have herbs to turn to. Unlike conventional antimicrobial drugs, herbs present complex chemistries that make adaptation and resistance nearly impossible for even the nastiest pathogens. Best of all, these herbs are easy to access and very safe to use. 1Aminifarshidmehr N. “The management of chronic suppurative otitis media with acid media solution”. Am J Otol. 1996;17:24–25. 2Preeti KC, Kulttan R. “Wound Healing activity of flower extract of Calendula officinalis”. J Basic Clin Physiol Pharmacol. 2009:20(1): 73-9. 3Efstratiou E, Hussain AI, Nigam PS, Moore JE, Ayub MA, Rao JR. “Antimicrobial activity of Calendula officinalis petal extracts against fungi, as well as Gram-negative and Gram-positive clinical pathogens”. Complement Ther Clin Pract. 2012 Aug;18(3):173-6. doi: 10.1016/j.ctcp.2012.02.003. Epub 2012 Apr 25. 4Nenoff P, Haustein UF, Brandt W. “Antifungal activity of the essential oil of Melaleuca alternifolia against pathogenic fungi in vitro”. Skin Pharmacol 9 (6):388-394, 1996. 5Reichling J, Fitzi J, Hellmann K, Wegener T, Bucher S, Saller R. “Topical tea tree oil effective in canine localised pruritic dermatitis -- a multi-centre randomised double-blind controlled clinical trial in the veterinary practice”. Dtsch Tierarztl Wochenschr. 2004;111(10):408–414. 6Sienkiewicz M, Lysakowska M, Ciećwierz J, Denys P, Kowalczyk E. “Antibacterial activity of thyme and lavender essential oils”. Med Chem. 2011 Nov;7(6):674-89. 7Anderson Ramos da Silva,  João Batista de Andrade Neto, Cecília Rocha da Silva, Rosana de Sousa Campos, Rose Anny Costa Silva, Daniel Domingues Freitas, Francisca Bruna Stefany Aires do Nascimento, Larissa Nara Dantas de Andrade, Letícia Serpa Sampaio, Thalles Barbosa Grangeiro, Hemerson Iury Ferreira Magalhães, Bruno Coêlho Cavalcanti, Manoel Odorico de Moraes, and Hélio Vitoriano Nobre Júnior. “Berberine Antifungal Activity in Fluconazole-Resistant Pathogenic Yeasts: Action Mechanism Evaluated by Flow Cytometry and Biofilm Growth Inhibition in Candida spp”. Antimicrob Agents Chemother. 2016 Jun; 60(6): 3551–3557.Published online 2016 May 23. Antimicrob Agents Chemother. 2016 Jun; 60(6): 3551–3557. 8Markin D, Duek L, Berdicevsky I. “In vitro antimicrobial activity of olive leaves”. Mycoses. 2003 Apr;46(3-4):132-6. 9Catiana Oliveira Lima , Humberto Medeiros Barreto , Edeltrudes de Oliveira Lima , Evandro Leite de Souzaand José Pinto de Siqueira Júnior. “Antimicrobial effect of the essential oil from Rosmarinus officinalis L. against Staphylococcus pseudintermedius isolated from dogs”. Brazilian Journal of Biosciences. August 19, 2013.

An integrative approach to Equine Herpes Myeloencephalopathy (EHM)

A look at what is currently known about EHM – a neurologic manifestation of the EHV-1 virus – along with integrative therapies for its prevention and treatment.

Integrative therapies aren’t often considered for the treatment of infectious disease. However, many integrative modalities can integrate smoothly and beneficially into established treatment protocols. In the face of a disease outbreak, where the best that conventional medicine can do is provide physical support, many nutritional and integrative modalities such as acupuncture, herbal medicine and homeopathy could possibly assist with prevention, acute disease treatment and recovery. One such disease facing equine practitioners is Equine Herpes Virus-1 (EHV-1), especially in its neurologic form of Equine Herpes Myeloencephalopathy (EHM). This article will provide a brief review of what is currently known about the EHV-1 virus and its neurologic manifestation, along with possible integrative intervention strategies that can be added for prevention and treatment. What is EHM (neurologic EHV-1)? The neurologic variant of EHV-1 was first officially identified in the US during a serious outbreak at a college in Ohio in 2003 (although potential outbreaks may have occurred in Kentucky in the 1970s). Of the 135 affected horses, 86% showed clinical signs and 39% showed neurologic signs. Twelve horses died or were euthanized. Since then, there have been numerous outbreaks, especially in California, Florida, Connecticut and Utah. This rise in reported outbreak incidence of the formerly uncommon EHV-1 and even rarer EHM could represent a concerning change in virus virulence and host susceptibility. To date, while no increased virulence has yet been demonstrated, the genomic areas of variation (the variants are now identified as D752 and N752) have been identified. While each can cause both illness and neurologic symptoms, the D752 variant has a higher correlation with clinical EHM symptom onset. Horses can be infected and become carriers of both variants at the same time, thus a latent infection with one does not prevent infection with the other. Most importantly, EHV-1, like all other herpes viruses, has a strong ability to lie latent in the body until stress stimulates reactivation. It tends to hide in both the lymphoreticular system and the trigeminal ganglion. Latency studies show viral presence in up to 66% of horses with an unknown exposure history, and 54% of Thoroughbred broodmares. Once activated in neurologic disease, the spinal cord gray and white matter are most commonly affected, resulting in ischemic necrosis. (The author wonders if there is a link between trigeminal neuralgia syndrome [head shakers] and latent EHV-1.) EHV-1 is transmitted via shedding from the nose (or infected fetal membranes); via fomites such as hands, brushes, blankets, feed or water buckets; or via aerosol. The virus can survive in the environment for several days up to a couple of weeks, depending on conditions. Subclinical shedding is not considered a factor in the development of clinical outbreaks – rather, this type of exposure probably leads to latent infection in exposed animals. Both the abortive and neurologic manifestations are thought to occur only when latent disease is activated to full clinical disease, or there is exposure to a clinically sick animal. Protection from reinfection after recovery is thought to last only three to six months. The development of clinical neurologic disease in any individual horse seems to be linked to the level of viremia (a prerequisite for the development of both neurologic and abortive clinical signs), the degree of pyrexia, the length of time since vaccination (see more in vaccine section) and stress. The incubation period is approximately three to seven days. The viremia can last as long as 14 days, peaking approximately five to nine days after intranasal exposure. A high fever (>103.5°F) that recurs several days after the initial onset of fever is thought to be predictive for the onset of EHM. Risk factors for EHM appear to be different from those associated with EHV-1 respiratory illness. Older and larger horses are more susceptible (ponies, of course, seem to be particularly resistant). Mares, especially pregnant ones, are also more likely to be affected. Abortion symptoms are more likely to occur in the last trimester. Symptoms of EHM Initial symptoms may be vague – fever, lack of appetite and lethargy – and can progress rapidly to the neurologic form. Neurological symptoms include incoordination, leaning against walls for stability, urinary incontinence or dribbling, loss of tail tone, paralysis, and eventually an inability to stand. To vaccinate or not to vaccinate? In general, vaccinating in the face of an outbreak is always controversial. In some situations, when there is enough time for the occurrence of an immune response to the vaccine stimulus, vaccination might provide for enough antibody response. However, it has been demonstrated that many vaccinations can cause a transitory period of immune-suppression, so an animal could be at greater risk if exposed during that period. Currently, the standard EHV-1 vaccine for the respiratory or abortive infection is not thought to stimulate cross-protection to the EHM variant. There is some controversy as to whether or not increasing the presence of Killer T lymphocytes at the nasal mucosal boundary by performing parenteral EHV-1 vaccination may prevent the viremia that is a critical step in the development of EHM. The following excerpts were taken from a presentation given by Dr. Julie Watson (Internal Medicine) at an American Association of Equine Practitioners meeting in December of 2005: “Conventional IM (intramuscular) vaccines usually require at least one week for measurable humoral responses to a booster or a second dose and similar time period in naive animals. This time lag has discouraged the use of vaccines in exposed animals, yet vaccination has been successful in protecting adjacent groups not yet exposed. “In a California outbreak of neurologic EHV-1 infection, horses vaccinated with either type of vaccine within the previous year were nine to 14 times more likely to develop neurologic signs than non-vaccinated horses. Because the vasculitis associated with the neurologic form is immune-mediated, vaccination after exposure raises concerns of producing a more severe disease. Consequently, vaccination in the face of a confirmed outbreak of EHV-1 neurologic disease has been controversial.”  (Wilson, 2005) In the 2003 Finley University (Ohio) outbreak, Dr. Stephen Reed (an equine neurologist) discovered that animals vaccinated against EHV-1/4 had both higher morbidity and mortality rates than horses that had received no parenteral vaccinations at all. To be fair to all perspectives, some argue that this is because older animals are more susceptible, but no one has argued that perhaps older animals are more susceptible because they have had more vaccinations. Because EHV-1 viremia is mononuclear cell-associated, and EHM is associated with a significant inflammatory and immunemodulatory vasculitis, integrative practitioners, especially those who might be new to the various modalities, might want to delay vaccination in the face of exposure and resort to therapies that can boost activity of immune cells, especially lymphocytes and modulate inflammation. (Note: when dealing with competitive horses in which EHV-1 vaccination is mandatory, the author recommends using an intranasal vaccination.) Steps to take during an EHV-1 outbreak Whether a veterinarian primarily uses conventional or integrative therapies, one thing common to both approaches is basic infectious disease management. First and foremost, clients should avoid transporting horses to areas where the transmission of active virus could occur. If the horse has already been exposed, then he should be isolated and quarantined from contact with other horses, and strict disinfection protocols should be started (biosecurity). A clinically ill animal can continue to shed the virus for 21 days (possibly longer) after initial infection. New PCR tests (especially live time) are now available to help identify potentially exposed individuals early on, allowing for both conventional and integrative interventions that can help lower viremia and boost immune function. Second, remember that the animal’s own immune system is still the best protection. In the face of environmental or performance stresses, immune support may delay, decrease or prevent clinical signs. There are a variety of ways an integrative veterinarian can support immune function:
  • Manage and try to avoid things that can suppress the immune system, such as stress (travel, strange places, separation from herd buddies), alterations to gut microbiome (antibiotics, NSAIDs), and suppressive medication (hormones, steroids for skin problems, sedatives or tranquilizers, over-vaccination before travel).
  • Stimulate and support immune function with nutrition, acupuncture and herbs. For example, moxibustion has been shown to increase the activity of cytotoxic T-lymphocytes and promote the production of anti-inflammatory cytokines (Takayama, 2010).
Integrative medicine for prevention and treatment The difference in infectious disease perspective between conventional medical practitioners and more integrative ones is the emphasis on the body’s role in preventing disease. Conventional medicine often has to rely on either vaccinations (which may worsen the EHM) or a more wait-and-see approach in the face of possible exposure. Integrative medicine has many nutritional, herbal and homeopathic options to help prevent and also treat symptoms that may appear. There are many ways to stimulate the immune system. While there are products on the market that are advertised to boost the immune system, they are very general and coarse ways of stimulating a system that is so complex and specifically fine-tuned. In the author’s experience of treating chronic immune deficiencies, these products can cause chronic health problems and immune sensitivities that can last long past the initial need. It is much like an usher getting a smoker to put out his cigarette by yelling “FIRE” in a theater. The smoker has put out the offending burning object, but there are also people screaming and causing undirected havoc all around him. In other words, significant collateral damage can occur, with hypersensitization in some areas and deficiencies in others. The best way to boost the immune system is by doing it from the ground floor, through nutrition. After addressing diet, acupuncture and herbs can be used to increase immunity. Using nutrition to boost immunity Feeding whole, clean, quality grains is important – be cautious using overly processed feeds with ingredients made from by-products, since these actually increase oxidative stress in the body. In addition, I recommend the following supplements:
  • Vitamin C: double the dose if there has been a recent potential exposure.
  • Vitamin E: give a minimum of 4,000 IU/day. Vitamin E is a potent fat-soluble antioxidant and has been shown to act as an anti-inflammatory in nerve tissue.
  • Omega 3 fatty acids: numerous studies show the anti-inflammatory and neurologic protective effects of Omega 3s.
  • Zinc: found in supportive levels in hoof and skin supplements.
  • Caretenoids: the precursor to vitamin A, which boosts activity of virus-fighting killer T cells.
  • Probiotics: a plethora of research in just the past few years shows links between healthy gut bacteria, lymphatic cell, body cytokine (inflammatory and anti-inflammatory) production, and total body immune function. This indicates probiotics should be among the first things an integrative practitioner thinks of.
Immune-boosting herbs (Western and Chinese)
  • Ginseng (Korean or Siberian): both types (American ginseng is weaker) support the adrenal glands, which when stressed or exhausted are unable to support the body’s stress functions. For a practitioner trained in Traditional Chinese Medicine, many immune-supporting Chinese herbal formulas contain ginseng (Panax or Eleuthro) and can be custom blended at a Chinese herbal pharmacy (the author uses either Mayway or Jing Tang).
  • Echinacea: needs to be on-board at the time of exposure. Also, to be effective, it needs to be given at least three times a day. Human research has shown that Echinacea is more effective if given as a water extract (tea).
  • Goldenseal: has antiviral activity, but can only be used short-term.
  • Astragalus: this Chinese herb is extremely effective as an immune booster, especially when combined with Ligustrum. An Astragalus and Ligustrum formula has been used in Chinese Medicine for almost 1,000 years. Today, it has been shown to be very effective in treating HIV and Epstein-Barr virus.
  • Gan Mao Ling: a traditional Chinese formula that’s effective in preventing or reducing the symptoms of rhino virus in humans.
  • Garlic: has been shown in several studies to increase the activity of virus-fighting lymphocytes. If you use garlic in your horse, since it is a “warm” herb in the Chinese pharmacy, make sure you combine it with other herbs that are a bit more cooling, such as mint, elderberry or lemon balm.
  • Turmeric (curcumin): from the ginger family, this Asian herb is backed by strong data demonstrating its antimicrobial and anti-inflammatory properties (in humans it has been shown to reduce C-reactive protein).
Managing stress Managing stressors that can affect emotional, mental and immunologic health is where integrative therapies shine. Most competitive horses have probably been exposed to natural EHV-1. If a horse is stressed by trailering, travel or leaving his/her herd, try to scale back if there has been a potential exposure or cases reported in the area. Be aware of a horse’s training schedule and counsel clients when their horses might need a break. In the world of sports medicine, rest is considered as important as exercise in the overall picture of conditioning and fitness, but with high drive clients or with a big show in the works, it can be easily overlooked or skipped. Remember that horses younger than five may be more susceptible to training stress than seasoned campaigners. Also be cautious of overusing non-steroidal anti-inflammatories (Bute, Banamine) as well as steroidal medications such as prednisone and dexamethasone. These medications can affect immune cell function or cause additional inflammation and stress in the digestive system (the location of 80% of the body’s immune cells). Vaccinations can create a transient drop in immunity within three to ten days afterwards. The more viruses combined into one vaccine, the greater the transient drop. Many labs now run antibody titers so it’s easier to determine if an animal even needs to be vaccinated (because, isn’t the point of a vaccination to create immunization?). There are now accurate and cost-effective tests for EEE, WEE, WNV and rabies. Homeopathy for EHV-1 While homeopathy doesn’t work well as a preventive, it might be extremely effective in treating the initial stages of disease, especially when combined with conventional supportive care. During the cholera epidemic of WWI, homeopathic hospitals in Philadelphia had a16% mortality rate versus 60% for the general hospital population. OTC remedies can be purchased online from homeopathic pharmacies or from most health food stores. Remedy potencies are 6C or 30C.
  • Belladonna: the best remedy for sudden onset of high fevers with neurologic symptoms.
  • Aconitum: sudden, vague fevers with lethargy.
  • Gelsemium: initial stages of viral infection with neurologic symptoms and fatigue.
  • Oscillococcinum from Boiron: specifically for human flu symptoms such as lethargy and fever – symptoms very similar to the early signs of EHV-1. The author has used this OTC remedy (or had clients use it) with excellent outcomes in horses with these symptoms.
Smokejumpers have a saying: “Every fire starts small.” The best way to avoid having to treat a horse seriously ill with EHM is to prevent the disease in the first place. Many of the therapies we can use to support an animal exposed to EHV-1 can also be used in more general and preventive circumstances in competitive and traveling equine athletes. All it takes is for the integrative veterinarian to start a dialogue for educating horse caretakers.
 References Allen GP. “Risk factors for development of neurologic disease after experimental exposure to equine herpesvirus-1 in horses”. American Journal of Veterinary Research, 2008. Goehring LS, Brandes K, Ashton LV, et al. “Anti-inflammatory drugs decrease infection of endothelial cells with EHV-1 in vitro”. Equine Veterinary Journal, 2016. Henninger RW. “Proceedings of the equine herpesvirus-1 Havermeyer workshop 2004”. Veterinary Immunology & Immunopathology, 2006. Henninger RW, Reed SM, Saville WJ, et al. “Outbreak of a neurologoic disease caused by equine herpesvirus-1 at a university equestrian center”. Journal of Veterinary Internal Medicine, 2007. Kydd JH, Townsend HG, Hannant D. “The equine immune response to equine herpesvirus-1: the virus and its vaccines”. Veterinary Immunology and Immunopathology, 2006. Kydd JH, Slater J, et al. “Third International Havemeyer Workshop on equine herpesvirus type 1”. Equine Veterinary Journal, 2012. Lee MJ, Jang M, Choi J, et al. “Bee venom acupuncture alleviates experimental autoimmune encephalogmyelitis by upregulating regulatory T cells and suppressing Th1 and Th17 responses”. Molecular Neurobiology, 2016. Lunn DP, Davis-Poynter N, Flaminion MJBF, et al. “Equine herpesvirus-1 consensus statement”. Journal of Veterinary Internal Medicine, 2009. Lunn DP, Morley P. EHV-1 Information. Colorado State University, Dept Clinical Sciences, 2011. Muller N. “Essay on protecting your horse for EHV-1”, Los Caballos Equine Practice (Galt, CA). ePub. Takayama Y, Itoi M, Hamahashi T, et al. “Moxibustion activates host defense against herpes simplex virus type 1 through augmentation of cytokine production”. Microbiology and Immunology, 2010. Traub-Dargatz JL, Pelzel-McCluskey AM, et al. “Case-control study of a multistate equine herpesvirus-1 myeloencephalopathy outbreak”. Journal of Veterinary Internal Medicine, 2013. Walter J, Seeh C, Fey K, et al. “Prevention of equine herpesvirus myeloenceophathy - is heparin a novel option?” Tierärztliche Praxis Großtiere, 2016. Williams JE. “Review of antiviral and immunomodulating properties of plants of the Peruvian rainforest with particular emphasis on Uña de Gato & Sangre de Grado”. Alternative Medicine Review, 2001. Reed S. “Data on Finley EHV1 Outbreak”, personal communication with Dr. Julie Wilson, 2004. Wilson J. “Vaccine Efficacy and Controversies”. AAEP Annual Proceedings, 51: 409-420. 2005.

Taking an integrative perspective with laminitis

Understanding how an integrative approach can be used to diagnose and successfully treat laminitis.

Laminitis is a frustrating disease commonly encountered by equine practitioners. In a 2000 USDA-NAHMS study, laminitis was noted on 13% of horse operations.  Fortunately, integrative methods such as acupuncture and related techniques can help treat this difficult disease.

Laminitis explained

Laminitis is defined by Gary M. Baxter, VMD, MS in Adams and Stashak's Lameness in Horses, 6th Edition (Wiley-Blackwell, 2011) as “a disease in which failure of the soft tissue structures that suspend the distal phalanx within the hoof wall, the interdigitation between the dermal and epidermal laminae of the digit, commonly results in a crippling lameness due to displacement of the distal phalanx within the hoof capsule.” There are several important structures within the equine limb. The equine digit is composed of four main bones: the navicular bone (distal sesamoid) and the first (proximal), second (middle) and third (distal) phalanges. The primary nerve that innervates the distal thoracic limb is the median nerve, which arises from C6-T2, and splits into the median and lateral palmar nerves just distal to the carpus. Once the nerves reach the metacarpophalangeal joint, they’re termed the palmar digital nerves. There is also some contribution from the ulnar and musculocutaneous nerves. The equine foot has no motor nerves, but it does have significant input from autonomic, sensory and autonomic vasomotor nerve fibers. An understanding of the anatomical structure of the hoof, nerves and neurovascular bundles is imperative when performing acupuncture on a laminitic equine patient. The majority of laminitic episodes originate in the thoracic limb. During a laminitic episode, the distal phalanx can be displaced and/or rotated due to lamellar separation or failure. I explain this concept to horse owners using a trampoline analogy. I describe the outer support structure of the trampoline as similar to the hoof wall; the springs equating to the lamina; and the black center of the trampoline as the coffin bone. Once inflammation occurs, fibrosis, or a metabolic event that causes the lamina (springs) to lose their ability to function properly, the coffin bone will begin to rotate or displace.

Causes of laminitis

Laminitis is commonly a consequence of five primary clinical events. These include:
  1. Disease associated with sepsis and/or endotoxemia
  2. Excessive weight placement on a limb
  3. Cushing’s disease
  4. Equine Metabolic Syndrome (EMS)
  5. Ingestion of black walnut bedding.
Cushing’s disease and EMS can be difficult to differentiate, but they contribute to laminitis with equal intensity. Hyperadrenocorticism, Cushing’s disease, causes excessive glucocorticoid production, as well as vascular changes within the body. The most notable outward signs associated with Cushing’s disease is a long curly coat, cresty neck, and polyuria/polydipsia. Equine Metabolic Syndrome is an insulin resistant disease predisposing horses to laminitis through vasoregulatory processes that insulin helps to regulate. EMS horses are typically obese and middle-aged.

Three stages of laminitis progression

  1. The first stage is developmental, in which the horse is undergoing one of the aforementioned primary diseases processes, but is considered “at risk” and has not developed clinical symptoms.
  2. The condition then progresses to the acute phase, where there is no radiographic evidence of changes to the coffin bone. The acute phase is considered to last 72 hours.
  3. Finally comes the chronic stage. At this point, radiographic evidence of coffin bone displacement can be seen. Patients in the chronic stage of laminitis can be extremely frustrating and difficult to maintain with conventional medicine. These horses tend to have ongoing structural and hoof problems that can change the shape of the hoof, cause chronic pain, or generate visible rings. Horses with chronic laminitis should be managed with a combination of medical, dietary, exercise and holistic approaches.

Conventional treatment for laminitis

Conventional approaches for laminate include analgesics, vasodilators, hypertensive agents, cryotherapy, and a reduction of mechanical forces on the lamellae. Monitoring total protein intake is important when giving analgesics such as phenylbutazone and flunixin meglamine. Both these analgesics, when used for long-term pain management, can lead to edema and colitis.

An integrative physical exam

  • To perform an integrative physical exam, practitioners must obtain a thorough history of the horse. As veterinarians, we must ask for information regarding illnesses, diet changes, management changes, ande prior treatment for similar events, as well as the clinical signs the owner is noticing. Historically, one of the first signs most owners mention is that their horses are “walking on egg shells”.
  • Once a thorough history is obtained and the traditional PE is performed, we assess the horse using integrative medicine and a DAPE examination. A DAPE examination is derived from a traditional Japanese approach to acupuncture by means of palpation; it’s used to assess the whole body for noted trigger points, regions of pain, loss of sensations, change in range of motion, areas of heat, and general pathologies. When performing a DAPE examination, it is important not to use more than three pounds of pressure to find reactive or painful areas. Palpation of the myofascial planes, bony insertions and trigger points will guide the practitioner in an assessment of the horse. According to Traditional Chinese Medicine, we want to achieve uninterrupted “Qi” with our patients.
  • Using TCM, we must also assess the patient based on the Five Elements -- Wood, Fire, Earth, Metal and Water. These elements help the practitioner pick up on individual characteristics as well as the horse’s personality, and can guide him or her in an appropriate assessment for treatment.
  • Many laminitic patients will need their Qi-Blood to move in order to resolve stasis/stagnation. If the flow of Qi is interrupted, there is noted insult or disease within the body. Qi is the energy that flows through the body’s meridians. These 12-paired meridians connect and unify the internal organs with the external body, allowing the body to experience harmony. Significant scientific support emphasizes the connection between meridians and peripheral nerve pathways. According to TCM, it is also important to check the pulse and tongue appearance to see if there is any excess Heat, Qi deficiency, Blood deficiencies, stagnation, etc. associated with different organs in the body. These portions of the integrative physical examination are important to helping assess the patient for whole body wellness and deficits.
  • Finally, radiographs are highly recommended for any horse with laminitis, or suspected laminitis, in order to help assess the staging and rotation/displacement angles.

Acupuncture for laminitis

Acupuncture can help achieve whole-body wellness, provide better control of chronic disease processes, aid in healing and manage pain. It has been of great benefit to our laminitic patients. Originally, acupuncture points were based on a human model. These ting points have been modified to fit our equine counterparts, who have single digits as opposed to five phalanges. Around the horse’s digit, there are six ting points. These points are located around the coronary band in a rich web of joint, ligament, tendon and neurovascular input. As previously stated, the meridians are in direct correlation with peripheral nerve pathways. When assessing the equine thoracic limb, the LU meridian is correlated to the musculocutaneous nerve; PC is correlated with the median nerve; and HT is associated with the ulnar nerve. The ting points for the front limb are: HT 9, LU 11, SI 1, LI 1, TH 1 and PC 9. The ting points for the pelvic limb are: ST 45, SP 1, GB 44, BL 67, KI 1, LR 1. Laminitis treatment is based on local as well as systemic pain, myofascial dysfunction, and the need for inflammation management. This can all be achieved through dry needling and electric stimulation. Taking into consideration that forelimb laminitis is most common, it is also important to assess the thoracic limb, shoulders and cervical spine for point selection. Additionally, one should take into consideration any myofascial tension and windup that can occur, especially over the bladder meridian.

Additional treatment

The goal of all laminitis treatment methods is to make our patients comfortable, halt disease progression, and stabilize the horse.
  • Horses suffering from laminitis should always have deep bedding in their stalls to give them as much support as possible.
  • The team of horse owner, veterinarian and farrier should all be in contact.
  • Dietary management is a key topic to discuss with clients. Horses going through a laminitic episode should not be fed high concentrate feeds or lush pasture. Devices such as grazing muzzles, in cases where horses lives outside on pasture, may be a suitable recommendation to offer owners. Forage is a great alternative for feed concentrates, and monitoring hydration status should be a priority since most patients are reluctant to move during agonizing laminitic episodes.
  • Chiropractic care works well in conjunction with acupuncture, primarily when focusing on the spinal column to decrease joint dysfunction and help the animal find homeostasis. It has been noted that when animals have a misalignment, they enter a state of stress that can lead to a metabolic decline. Equine metabolism is directly associated with laminitis, which it why it is important to keep our equine patients well-balanced, both physically and physiologically.
  • Moxibustion involves burning an herb called mugwort. It can be used on or over an acupuncture point. The heat from the herb helps modulate pain and loosen muscle tension.
  • Additional herbal supplements that can aid in treating laminitis include Move Freely and Four Marvels Combination. Four Marvels is a combination of Atractylodes rhizome, Achryanthes root, Coix seed and Phellodendron bark. It should only be used in acute cases of laminitis. Move Freely is a combination of Cyathula root, Chinese angelica root, safflower, tumeric rhizome, Corydalis tuber, Persica seed, Ligusticum rhizome, licorice root, myrrh, and Sappan wood. This combination is beneficial for chronic inflammation and increasing peripheral circulation, but should not be used in pregnant mares. When using herbal supplements, it is very important to first assess what stage the laminitis is at.
  • Cold laser therapy or low-level laser therapy (LLLT) has recently gained popularity in the equine community. LLLT can aid in sole and heel growth during laminitis episodes, as well as cause autonomic nervous system stimulation. LLLT is based on photochemical and bio-stimulation, without the generation of heat.
As outlined in this article, acupuncture is not just a supplemental tool for treating equine laminitis; it is also a way to achieve whole body wellness in horses. In addition to acupuncture, several other holistic modalities that go beyond Western medicine can be used for treating laminitis. Laminitis is a difficult disease process to treat and requires teamwork by the owner, veterinarian and farrier. By integrating Western with holistic medicine, and working as a team, we can give our equine patients long and healthy lives.


Baxter GM, Adams OR. Adams and Stashak's Lameness in Horses (6th ed). Oxford: Wiley-Blackwell, 2011. Boldt Jr., Ed. “Veterinary Acupuncture and Chiropractic: What, When, Who?” Am Assoc Equine Pract, 2016. Crisman, Mark V., DVM, MS, CVA, DAVVIM. “Equine Acupuncture -- Beyond the Qi Concept”. Proc. of ABVP 2012, Blacksburg, Virginia. n.d. Web. 1 Feb. 2017. Haussler K. “Equine chiropractic: general principles and clinical applications”. Proceedings Am Assoc Equine Pract. 2000;46:84–93. Holt, Tim, DVM. “Implementing Equine Manual Therapy”. Western Veterinary Conference 2008. Fort Colling, CO. n.d. Web 1 Feb. 2017. Lancaster, Lisa S, Bowker, Robert M. “Acupuncture Points of the Horse’s Distal Thoracic Limb: A Neuroanatomic Approach to the Transposition of Traditional Points”. Animals : an Open Access Journal from MDPI 2.3 (2012): 455–471. PMC. Web. 18 Mar. 2017. Palm, Janet Gordon, DVM, CVCP. “LLLT in the Management of Laminitis, and Inflammatory Equine Conditions”. Proc. of Wild West Veterinary Conference 2015, Animobility, Minneapolis, MN. n.d. Web. 1 Feb. 2017. Parks, Andrew Hugh, MA, Vet MB, MRCVS, DACVS. “Acute and Chronic Laminitis -- An Overview”. Proc. of 64th Convention of the Canadian Veterinary Medical Association, Athens, GA.  n.d. Web. 1 Feb. 2017. Schoen A. Veterinary Acupuncture: Ancient Art to Modern Medicine. 2nd ed. Mosby; St. Louis, MO: 2001. Schott, Hal, DVM, PhD, DACVIM “Fat, Foundered Horses: Equine Metabolic Syndrome and Laminitis”. Proc. of Pacific Veterinary Conference 2015, East Lansing, MI. n.d. Web. 1 Feb. 2017. Dr Megan McCorkel is a practicing veterinarian with a mobile acupuncture practice in Denver, Colorado. She is interested in both large and small animal medicine, alternative therapies, HVHQ surgery, and sports medicine. She graduated from the Western University of Health Sciences with her DVM, and completed her acupuncture certification through One Health SIM, formerly known as MAV, in Fort Collins, Colorado.

Homeopathic treatment of Primary or Idiopathic Seizures

Primary or idiopathic seizures are commonly lumped under the diagnosis of “epilepsy”. Secondary seizures linked to various other pathologies are entirely different, and require different approaches based on treatment of the primary condition. The conventional approach of anti-convulsant drugs may provide a quick solution in that fits are controlled (and clients are happy). However, such treatment can never amount to more than symptomatic control. These drugs must be given for life, with their attendant costs, monitoring requirements and often side effects for the animal. In addition, there are many animals in which, for a variety of reasons, complete control cannot be achieved.


Homeopathy, on the other hand, offers the possibility of a genuine cure in the majority of cases, and in certain circumstances it can be combined with conventional methodology. There are, however, important differences between these two approaches, and these must be appreciated for the best results.

The first thing to remember is that in homeopathy, there is no such thing as one remedy indicated for every case. Each prescription is individual, and is selected using criteria involving the general characteristics of the patient and the modalities (factors that modify the intensity) of the symptoms not usually considered by the orthodox world. We must also appreciate that from a homeopathic approach, seizures are the acute manifestation of an underlying chronic condition, and the latter must be addressed if there is to be a successful cure.

Even with accurate details of the fi t, it must be remembered that these are essentially local symptoms and must be considered as such. They represent the means whereby the body exteriorises the underlying condition. Too much concentration preventing that manifestation, whether by purely locally-acting remedies or conventional medication, results in suppression of the external symptom, which leads to the disease process either finding another external outlet, or involving the deeper organs of the body.

Controlling seizures may lead to the animal developing chronic skin problems, diarrhea, or in time, an apparently unconnected, deeper and possibly life-threatening condition. Successful homeopathic treatment addresses the underlying chronic condition without merely suppressing external symptoms. The patient will then be free of seizures and healthier overall, with the chance of a longer life. Often, he will not need to stay on medications; conventional drugs can usually be stopped or the dosages dramatically reduced.


The first big problem with epilepsy is that animals have fits. The often spontaneous and violent nature of a seizure can lead to outright panic on the part of the animal’s owner. Even without such an extreme reaction, the owner may demand that “something must be done immediately to ensure a fit never happens again”. Unless care is taken, this demand can lead to a concentration on the presenting symptom when selecting treatment. At the same time, amid the general upset and confusion, useful information relating to the nature of the seizure may be missed by the attendants.

The second problem is that most cases of idiopathic epilepsy fall into the homeopathic category of “one-sided diseases”, in which only one symptom presents, or one symptom is so dominant that it overshadows any others that may be present. Homeopathically, this presents a challenge, so different strategies are needed to select the curative remedy.         

Taking the case includes the symptoms of the convulsions, possible causes in the individual, and any concomitant symptoms.


Trauma, infection, toxins and hereditary factors are all recognized and easily-understandable causes of epilepsy, but two other causes account for many cases. The first is vaccination, which can cause neurological problems shortly after the vaccine is given. Homeopathic veterinarians recognize seizures as one possible manifestation of this chronic condition, known as vaccinosis. Since over-vaccination can lead to the condition, booster vaccines should not be given unnecessarily. Under no circumstances should a booster be given to an animal with a history of fits from any cause. Primary vaccines given too early, while the animal’s immune system is still extremely immature, can lead to vaccinosis and seizures. The condition can also be triggered by the suppression of a normal acute reaction to the challenge of vaccination, such as a sore ear, patch of eczema or attack of diarrhea appearing shortly after vaccination.

Mental factors such as fright, and particularly grief, can also be significant in triggering fits. It is easy to understand bereavement arising from a death, but it must also be remembered that a separation that’s explicable in human terms may well seem like a bereavement to an animal. The departure of a child to college, for example, while producing a sense of temporary loss in the parents, can produce grief-induced fits in a closely-attached animal who cannot understand what is happening.

Additionally, a history of any skin disease that quickly responded to drug therapy (or even to holistic treatments) can be a clue. When the vital force expresses its imbalance with skin symptoms which are then quickly stopped (suppressed), more serious problems like epilepsy may result.                 


The goal is to use the collected symptoms to select from over 4,000 homeopathic medicines the one that best matches all the symptoms of the individual animal. Sometimes there will be one clear-cut unique symptom (e.g. seizures only occur at the full moon and/or at night), or else all the symptoms clearly point to one remedy (the similimum). A repertory is used; this is an index of all symptoms of each medicine derived from both testing and clinical practice (a rubric is a list of medicines showing a particular symptom listed under the name of that symptom).

At other times, the homeopathic technique known as “Never Well Since” (NWS) is needed. In these cases, a clear connection between the onset of fits and a particular event can be established; this event must form part of the totality of the case and should be included in the repertorisation (rubrics under “Ailments from” in the repertory). For example, Arnica, Natrum Sulphuricum, Helliborus or Opium may be indicated in cases associated with head trauma; Ignatia or Natrum Muriaticum when there is grief; or Thuja or Silica to counter a vaccinosis (each of these rubrics has a much longer list of possible homeopathic medicines). 

If the appropriate remedy is a polycrests (a remedy with a broad symptom picture, multiple indications and deep action), then that single remedy may be all that’s required since it will address both the local and constitutional levels of the case.

Cases in which anti-convulsive drugs have completely or partially controlled the fits pose particular problems because the symptom picture has been supressed or modified, and restoring the genuine picture causes considerable case/client management challenges. NWS can be useful in these situations to select remedies that can influence the cycle before the control provided by drugs is lifted.

Acute-acting remedies (i.e. Belladonna or Aconite) can replace anti-convulsants and gain time in which to address the deeper aspects of a case. The bowel nosode Proteus can be of particular use because its theme of sudden nervous involvement mirrors the broad epilepsy picture; its use will often prevent the seizures and lead to a change in the symptom picture that will indicate a clear choice of a further remedy.


Although the energy of a fit is high, care must be taken with potency selection since an aggravation can trigger a stasis epilepticus situation. Once trained in homeopathy, people develop a preference for administering single doses only, perhaps repeated for a few days to stimulate the curative effect, or repeated liquid dilutions. Since the goal of homeopathy is to stimulate the body to heal itself, to rebalance, remedies should not need to be given for life. If the animal is not getting healthier in addition to not having fits, then any new symptoms should be added to the list and a new similimum selected.

Seizure Case Reports


Rosie was a four-year-old spayed female Labrador who had been living with a couple and their two teenage sons since she was eight weeks old. She was vaccinated and wormed annually. Her first convulsion happened unexpectedly one afternoon, shortly after a walk. Thereafter, they occurred every three to four weeks. They were single fits lasting around three to four minutes, always during the day but with no time pattern. Stimulus from light or noise would trigger further fits. Rosie exhibited spasms and a lot of muscle twitching but no vocalization or incontinence. Recovery was followed by deep sleep if she was left quietly. On two occasions, she vomited while recovering. Her appetite and thirst were average and not affected by the fits. The only other medical history involved occasional patches of eczema (no laterality) during the previous year that responded to local treatment with a steroid/antibiotic cream. Rosie’s seizures were being conventionally treated with phenobarbitone BID for 48 hours following each fit. Homeopathic treatment was sought after the fourth episode.

Rosie was initially treated with Belladonna 200c, to be administered immediately when a fit started. With this, her fifth attack settled in around 1½ minutes. Further investigation revealed a pattern in which the fits occurred on or around the full moon. Rosie was a friendly animal who became nervous in new situations but was upset by nothing when at home. Two weeks after her fifth fit, she was prescribed Calcarea carbornicum 30c BID. A short mild fit occurred day days later (no Belladonna was needed). One week after this short sixth attack, Rosie was given Calcarea carbonicum 30c twice in one day. This resolved the fits; and her eczema, which was not present once the fits started, did not return. 

Belladonna: Single fits. Great sensitivity to external stimuli. Heartbeat strong and rapid.

Calcarea carbonicum: The “chronic remedy” to Belladonna. Aggravation at full moon. Love of home. Anxiety in new situations and a need for security.


Smudge was a seven-year-old neutered male domestic shorthaired cat. He lived with a single lady in a small semi-detached house in the suburb of a large city. A cat flap gave him free access to a small garden. His semi-feral mother had given birth in an animal shelter and Smudge had been adopted into his current home at nine weeks of age. He was vaccinated at eight and 11 weeks old, and was regularly boosted and wormed since then. There was no history of major health problems. Smudge had a close bond with the woman, sleeping on her bed and enjoying being fussed over. Around two years before his seizures began, the lady formed a relationship with a man who became an increasingly regular visitor to the house. Smudge seemed quite happy to see him and would accept food and some stroking from him, but he was never as affectionate as he was with the woman. He even seemed indifferent when the man occasionally spent the night.

Smudge’s fits began suddenly about two months after the man moved into the woman’s home. Although he at first occasionally urinated on the man’s possessions, he otherwise appeared unmoved and this behavior ceased after a few weeks. The fits consisted of a cluster of three or four closely-spaced episodes that would occur at any time. Smudge screamed during the seizures, though there was no incontinence. Attempts to comfort him were difficult and to no avail, but did not appear to aggravate the situation. Several clusters could occur over a day, and then none for a week or more.

Staphysagria 200c BID was administered for three days. The pattern of Smudge’s fits changed, becoming single fits at seven- to ten-day intervals. He also developed a distinct facial twitch. He resumed urinating on the man’s possessions, but would now also urinate, in full view, directly on the man. Smudge was prescribed Hyoscyamus 1M, three doses in 24 hours. The fits ceased and so did the direct urination, but the twitch and surreptitious urination continued. Hyoscyamus was repeated after three weeks, and all symptoms resolved over the next month. No further treatment was needed.   

Staphysigria: Ailments from anger and humiliation. Sexual passion. Nervous excitability. Sensitivity to insults.

Hoscyamus: Lewd behavior in public. Jealousy. Muscle twitches, especially of face.


Blasig T and Vint P. Remedy relationships. Hahnemann Institut, 2001.

Saxton J. “Do we truly understand vaccine reactions and vaccinosis?” Homeopathy 94, 200-201 2005.

Saxton J. Bowel nosodes in homeopathic practice, 2nd ed. Saltire Books, 2012.

Saxton J and Gregory P. Textbook of veterinary homeopathy. Beaconsfield Publishers, 2005.

Swayne J (ed). International dictionary of homeopathy. Churchill Livingstone, 2000.

How to Create a Holistically-Managed Practice
Like many veterinarians, I derive energy from learning, healing and integrating multiple modalities into my practice. It is significantly more challenging to find the energy for managing office problems. Daily pressures and interruptions related to the business aspects of our profession can negatively impact work-life balance, detracting from the joys of client interactions and patient healing. After 30 years in practice, I own three practices all within 16 miles of one another. My practices are financially successful and show consistent growth. I have arrived at a place where I accept that serenity and peace in daily practice must be cultivated from within. I recognize that systems like the ones detailed in this article help create more predictability and order amid the chaos that can accompany veterinary practice. My definition and view of success is constantly changing as I examine the quality of my personal and family time, and the many facets of practice and home life from varying perspectives. I believe that continued success requires regular analysis, and ongoing learning. We must all keep refining our systems to keep pace with evolving needs and our individual development. Having a trusted MBA practice manager and a separate hiring/ training manager, who take care of the big picture, allows me to practice more efficiently. I have more personal time to travel for pleasure, take weekends off and spend more time with my family. My schedule includes three short days of office hours, two longer days with evening hours each week, and a half day three Saturdays per month. My practices employ a core nucleus of 11 team members who have been with the clinics from anywhere between six and 20 years, and they provide consistent and committed staffing. They also train and support the hires who have quicker turnover, including the many pre-vet and veterinary students we mentor and those assistants and receptionists who decide to raise families after a shorter time working with the practice. There are 30 team members who are cross-trained in all positions, and in all offices. This allows flexible positioning for vacations and illness. This is in sharp contrast to my first years of practice ownership, when I worked approximately 90 hours a week and had difficulty hiring and retaining staff. There was no time for family and every seven days spilled into the next seven without end. The worst part was that I saw little financial gain for all my efforts. Unfortunately, veterinary education provides minimal business training, even though our profession requires us to develop business acumen, salesmanship and client hospitality protocols. Our combined roles of salesperson, business manager (even associates need to manage caseloads, payment considerations and staff) and medical professional can overwhelm us with challenges, including:
  1. Overtime, causing conflicts with personal and family life
  2. Inconsistent client numbers/revenue to support the employment of additional staff
  3. High staff turnover or difficulty hiring/training or retaining qualified team members
  4. Client communications interrupting office hours
  5. Staff training communication problems
  6. High debt or unpaid client accounts
  7. Low client numbers or difficulty obtaining new clients
  8. Poor cash flow
  9. Overwhelming paperwork, regulatory and HR demands on the business side of the practice
  10. Feelings of burnout and/or compassion fatigue
  11. Competition with online pharmacies, corporate clinics and low cost clinics that impact revenue
  12. Inventory management headaches.
Veterinary conferences offer management tracks that address these problems, while the American Animal Hospital Association, AVMA, Veterinary Information Network, and online publications like DVM360 provide professional resources for dealing with business issues. Increasing numbers of practice management consultants offer services to help us define and create successful practices. Over the past 30 years as a veterinarian, I’ve built five practices and worked in large and small animal medicine, emergency and shelter medicine and integrative veterinary medicine. The practice of medicine has been rewarding, but until I gained a recognition of and solutions for business conundrums, there was little time or money to enjoy life outside the clinic. Over the years, the diagnostician in me had to seek solutions to these problems, which changed depending on the economy and availability of human and other resources. Cash flow, rapid growth followed by recessions (three times), employee theft, staffing (both associate and support staff), attracting new clients, team training, marketing through social media, and identifying with/motivating employed younger generations (including millennials), are just a few of the issues that have required creative problem solving. We all need to find personal motivators for tackling problems and my early ones were:
  1. Financial necessity (my first employer had been embezzled from, requiring me to start my own practice sooner than planned)
  2. Desire to provide for clients, patients and a financially burdened community.
My mentors imparted lessons that illuminated the need for a holistic approach to the business of veterinary medicine, beyond simply treating patients. I learned from their examples that clients want to be heard and have someone to identify with. Understanding the range and expression of human emotion, developing empathy, and communicating well creates a strong foundation for bonding clients and establishing a thriving practice. I developed a clear vision of my life and practice goals from working with others. PROFESSIONAL AND PERSONAL PLAN Many factors are required in creating a thriving business that supports the emotional and financial abundance necessary for long term practice, as well as mental and emotional health. Providing for patients, our communities, staff, families, and ourselves as veterinary professionals requires a well thought out and written plan. I suggest writing out both a personal and professional plan, complete with your vision, mission statement, financial plan and budget, and then scheduling frequent reviews of those plans. The hard part is scheduling time to create these plans. My advice is to just block out the time and lock your office door. Not doing this will be more devastating to your practice evolution and success than skipping CE attendance. The good news is that many of us have family, friends and clients with business training. They can help guide us through the creation of these plans once we get through the initial stages of writing out our goals for both our lives and practices. After roughing out what you want to create in life, you can move on to writing a mission statement. Your mission statement can be modified at any time, so feel free to refi ne it as needed. MISSION STATEMENTS Mission statements include the healing you are bringing to patients, the financial exchange you require between yourself and your clients, your role in the community, and the involvement of your staff. Here’s an example of my mission statement: “Our exemplary staff offer more options for health, happiness and hope to pet owners for the enjoyment of their companions through integrative veterinary medicine. We provide enrichment for our community through education, and develop loyal clientele who refer others and pay their bills on time. We strive to improve our practice with medical advancements and the development of an enthusiastic staff team.” As you plan for more enjoyment of your practice, along with increased prosperity, write your own mission statement including your vision for your clients and patients, as well as for your staff. Include this information in employee manuals and at the staff entrance to your practice, so everyone in your clinic will be reminded of your joint goals. Staff will shift from merely wanting to help animals to understanding their roles as part of a larger vision. An abbreviated mission statement could be shared with the public in your client education materials, interviews, waiting room and more. BUSINESS MODEL The next step to solving practice headaches is to think about your practice as a business entity, with only one part being your treatment of patients. Regardless of the size of your practice, you can create a better business model simply by identifying which areas of your practice are in need of attention/modification. Consider your practice as you would a sick patient. The first thing you need before diagnosing problems and creating a treatment plan is a clear understanding of the fundamental elements of business structure – this is the anatomy of the business. During early years in practice, I rated my practice’s success based on the number of happy clients and patients I was seeing. This rather narrow view did not produce a healthy lifestyle, nor did it support me financially. After two years of working seven days a week with little time off, a lack of funds for adequate staffing, and no savings, I began taking business courses. Those courses helped me shift my views about my role as a practice owner. I began recognizing that many of my business problems resulted from unidentified and unfilled positions in the company. After I began looking at business models in successful corporations, I saw how far my practice was from being run as a real business. My solution was to copy these models and mimic organizational charts in my own office. This approach really helped me shift and expand my thinking about the clinic, the role it played in the community and how important it was for everyone to create expectations for clients and staff. Problems decreased as we became proactive. Within a year of creating organizational changes, revenue for practice growth and additional staff became available, and I had more time for professional growth courses and for my family. My clearer vision also meant I no longer experienced guilt when clients wanted to shift their lack of compliance or their financial irresponsibility onto me and the practice. In order to create a more holistic system of managing your practice, my suggestion is to identify and break down all jobs into separate departments, represented by pages or poster boards, vital to a well-run business. The following examples are not all-inclusive in the business area. You will also want to create a similar list of all medical and healing-related job duties. Maro practice chart-3 Maro practice chart-2 Maro practice chart-1
  1. Human resources and internal communications a) Hiring, recruiting, staff training, reviews b) IT, communications and all communications equipment c) IT consultants d) Scheduling staff e) Scheduling clients
  2. Marketing a) Internal marketing programs b) External marketing c) Social media integration d) Website development and maintenance
  3. Finance department a) Accounts payable b) Accounts receivable c) Payroll d) Accounting e) Budget creation f) Tax filing g) Bookkeeping
  4. Veterinary medicine: service delivery/pharmacy and product sales a) DVMs and their duties b) Technicians, assistants, kennel staff and their duties c) Energy workers and subcontractors who work within your clinic d) Consultants (veterinary, such as traveling radiologists and off-site consultants) e) Equipment and building maintenance f) Inventory control, ordering g) Controlled substances control and record keeping h) Safety and OSHA
  5. Public Relations/community work (these efforts raise awareness of your presence and are not designed to produce a high financial return on investment) a) Adult community civic presentations b) Schools c) Shelter support
  6. Patient retention and follow-up (quality control) a) Check out questions at the desk b) Follow-up calls and surveys
  7. Planning and executive board (creation of short term and long term business goals, budgets, policies and procedures) a) Ownership and executive board (if you are a sole owner, this is you) b) Consultants c) Attorneys d) Accountants e) Banking/bankers
Take time to list each job; this is needed to create a fully-functioning department. In small practices with five or fewer employees, you may have as many as 40 individual jobs in each department with names repeated many times. I suggest creating an electronic file, so you can keep modifying as your business grows and adds staff. Ask your practice manager and staff members to list every job they do. Most practitioners who use this organizational chart will end up adding staff after they realize how many duties a few team members are being burdened with. Often, this recognition leads to fee analysis and adjustments, so the practice can budget for additional team members. Improving organization, filling important roles and acknowledging the value of team members brings esteem to the entire practice and will aid your ability to charge competitive fees for your services. These steps will increase prosperity for your entire team. Preventing burnout and compassion fatigue
  1. Identify what is causing feelings of stress/fatigue.
  2. Target the causes by seeking support and outside motivation.
  3. Make policy/procedural changes.
  4. Get staff on board to change situations causing energy depletion. If they won’t change, then change staff.
  5. Know you are not alone; every practitioner goes through emotional ups and downs. Use wisdom/advice from colleagues.
  6. Find ways to recharge on a daily basis: family, humor, meditation, motivational recordings. They are all around us and easily available. Build breaks into your schedule. If you’re too busy to take a break, review your fees and your timewasters.
If practice is not bringing joy to you, your clients, patients, staff and/or family, adjust the demographic you are attracting, eliminate the people who drag you down, and find time for family, travel and hobbies to bring more happiness and abundance into your life.


A novel and integrative nutritional approach to neurologic disorders and autoimmunity

Last year, funding for four grants was approved by the AKC Canine Health Foundation as part of an Epilepsy Research Initiative. This initiative is designed “to provide the veterinary community and dog owners with improved methods for preventing and treating epilepsy in dogs”.1 One of the grants will look at the effects of nutrition (ketogenic diet) on the reduction of seizure frequency and/or the severity of seizures in drug-resistant dogs.2 It is exciting that research is starting to focus on nutritional solutions to optimize the health of our pet patients.

Functional nutrition through the use of tissue-specific protein extracts (Protomorphogens™) should also be explored as an integrative nutritional approach to neurologic challenges. Cells need food to function. To function optimally, nerve cells need to be exposed to the right quality and quantity of a variety of nutrients. These nutrients should ideally come from the food an animal eats. Every part of the animal is important to the health and wellness of the predator: “A victim to a carnivore’s table is frequently eaten entirely.”3 Organ and glandular tissue is especially essential; it has more DNA per gram than skeletal muscle, and it contains protein, vitamin and mineral profiles unique to that organ.4 When an animal consumes the brain and nervous tissue of its prey, that meal will uniquely nourish the brain and nervous tissue of the predator.


Organotherapy, the treatment of disease with organs and glands, was studied by human endocrinologists in the early part of the 20th century. Dr. Royal Lee, DDS, an early pioneer in human nutrition, proposed that glands and organ tissue could be effective beyond their unique vitamin and mineral content. He believed that animal extracts supported cellular health at the level of the nucleus, and in an unbalanced system these extracts could activate cells to repair. In 1947, six years before Watson and Crick defined DNA and the double helix, Dr. Lee proposed his theory of Protomorphology.5

Dr. Lee described Protomorphogens as “cell determinants” from organ or glandular tissue (“proto” = primary or original; “morphogen” = that which organizes form). He believed them to be the smallest functional units of the chromosome – cell-specific nucleoproteins that provided the blueprint and framework upon which a cell was constructed: “Suppose you have a building that is deteriorating. The manager will call in the repair crew. If the crew doesn’t have a blueprint, the repair won’t be adequate.” According to Dr. Lee, Protomorphogens (PMGs) served the cell like the seeds of a plant by helping with normal tissue function and catalyzing cell repair.4,6


In Dr. Lee’s opinion, it wasn’t that there were so many autoimmune conditions; it was that so many chronic health challenges reached the autoimmune phase. Autoimmunity is inevitable in chronic disease as tissues became necrotic and decayed. Autoimmunity is the result of a failure to heal.

Dr. Lee theorized that when tissue was damaged – as is in the case of a coronary occlusion – nucleoproteins from the necrotic tissue would leak into the bloodstream. Antibodies would respond to these “foreign” antigens and the patient would essentially become “allergic” to his own heart. The patient’s bloodstream would begin to carry antibodies to the heart, impairing the repair of the heart itself.6 This is autoimmunity. Dr. Lee envisioned the autoimmune cascade as the body’s attempt to preserve itself, even though its effects could be more deadly than the disease itself.

Dr. Lee saw the solution to autoimmunity in the nucleoproteins of the cell. He hypothesized that a heartspecific protein (Cardiotrophin PMG®) could be given orally to lower circulating antibodies to the heart tissue. Once in the gastrointestinal tract, the PMG would act as a decoy to the immune system, drawing cardiac auto-antibodies away from the heart, thus relieving the autoimmune attack on the heart, and giving the heart the opportunity to heal as therapeutic nutritional support is introduced.6


Dr. Lee’s theory is strikingly similar to research that is being conducted today in the field of Oral Tolerance. Defined in 1977,7 Oral Tolerance is a state of non-responsiveness to an antigen.8 According to Oral Tolerance, when an antigenic protein is ingested orally, it is taken up by the Peyer’s patches in the ileum and presented to the bloodstream via dendritic cells. The body’s natural immune response is then used to induce regulatory cells directed at that antigen.9 Oral Tolerance works by one of three mechanisms:

  1. activating regulatory cells, which suppresses symptoms;
  2. rebooting the immune system so it doesn’t react to the antigen (anergy); and
  3. deleting reaction to the antigen altogether (clonal deletion).

Results are dose dependent. Higher doses lead to anergy or deletion, and low doses support suppression of symptoms.8 Continuous administration enhances the effect significantly by upregulating IL-10 and TGF-β.10

Oral Tolerance has been used in animal models to block the development of disease. It has been found to have beneficial effects in animal models of arthritis, colitis, diabetes, uveitis, myasthenia gravis, thyroiditis and EAN (Experimental Allergic Neuritis).

In inflammatory conditions that have not yet reached the autoimmune phase, Oral Tolerance can protect the body against the self-antigen produced in response to inflammation.10


Nervous system trauma induces auto-antibody production as part of the natural healing process. Research has shown that anti-brain antibodies are produced following traumatic brain injury and spinal cord trauma. They have been found to be big players in neurologic disorders like SLE and MS.11 Patients with CNS paraneoplastic syndromes, kids with autism, and people exposed to environmental toxins have been found to have these antibodies in their serum. Some antibodies can be traced back to tissue injury occurring years before the onset of disease. Brain autoantibodies are also a produced as part of the natural aging process.11,12

Oral Tolerance can be used to treat some forms of neuro-inflammation. Tissue-specific antigens like oral MBP (myelin basic protein) given orally to rats with induced strokes were shown to decrease stroke size, most likely because of the downregulation of inflammation. Both small and large doses of MBP have been shown respectively to suppress EAE (Experimental Allergic Encephalomyelitis) and be protective, non-detrimental and beneficial in EAE animal models. Findings from these studies indicate that:

  1. the effect of Oral Tolerance is dose-dependent;
  2. purified proteins are most effective;
  3. the more frequently and consistently an oral antigen is given, the more effective it is;
  4. early therapy yields better results; and
  5. combination therapy with medications may provide better results.11


Protomorphogens are cell-specific proteins. One of the ways they may work in the body is through Oral Tolerance. Unlike Oral Tolerance, Protomorphology was outcome-based. Patients who took PMGs experienced symptom relief. Dr. Lee did not have today’s science to prove his theory, but he was able to trace heart sounds before and after the administration of a heart PMG. He found the sounds amplified shortly after oral administration of the PMG, which he theorized was due to increased pressure and better cardiac contractility. As with a heart PMG, patients with chronic coughs or TB could take a lung PMG; patients with digestive issues could take a pituitary PMG; and patients with nervous disorders could take a nervous system PMG to support healing.


It is not difficult to integrate PMGs into a patient care plan. They come in tablet form, are palatable, and for most animals (even cats) they can be given as treats. Animals with seizure disorders, neuritis, degenerative myelopathy, nerve trauma, head injury and other nervous system-related injuries or conditions are excellent candidates for this type of targeted nutritional therapy. In our experience, and in the experience of other practitioners, PMGs have supported animals dealing with any type of acute tissue injury, toxin exposure, or chronic condition. Many patients see symptomatic improvement when a PMG is added to their nutritional plan.

The following is a guideline for PMG use in veterinary patients:

  1. PMGs should be given on an empty stomach if possible. It’s important for the PMG to reach the Peyers patches in the ileum in order for the immune system to recognize it.
  2. PMGs can be given in twice daily or single daily doses. Oral tolerance suggests a higher single dose will help not only with symptoms, but may affect anergy or clonal deletion.
  3. The general dosage is as follows, but should be tailored to the individual:
  • Large (>50#) 4/day
  • Medium (20-50#) 3/day
  • Small dog or cat (<20#) 2/day
  1. Start the PMG at half the recommended dose for the first seven to ten days, then increase to full dose (as tolerated). Histamine response (itch, digestive upset) is uncommon but can happen. If histamine response occurs, antihistamines or a beef liver fat extract (VF Antronex®) can help detoxify histamine from the liver; the PMG may be continued at a reduced dose.
  2. Duration of treatment depends on the individual. In the case of chronic conditions, PMGs may be given long term (years). In acute situations, the treatment course may be shorter (several months to a year).

While PMGs contain minerals, nucleotides (the components of nucleic acids like RNA and DNA), and peptides (short chains of amino acids), they don’t provide the complex nutritional tools the body needs for full function.4 Their job is to help maintain normal cell metabolism and cell cycling, and to potentially enable tissue-specific immune downregulation. It’s important that other whole functional foods are provided along with a PMG to promote full healing and repair to damaged tissues.


Protomorphogens are proprietary glandular extracts (Standard Process) that offer a novel and safe approach to supporting nervous system health. As a form of Oral Tolerance therapy, they lack toxicity, are easy to administer, and are antigen-specific; current medical therapies for people and animals with autoimmune and inflammatory conditions often depend on non-specific immune-suppression with medications – some of which can have undesirable effects.10 In practice, Protomorphogens can profoundly support patients with nerve-related and other conditions by encouraging healing over time, especially if they are used as an integrative approach to overall patient care.

Case Studies

  1. George the cat was ten months old when he presented in March of 2016 for a nutritional consult due to acute (over the last three weeks) and progressive neurologic symptoms including an inability to jump, weakness, a choppy gait in the rear, and mental dullness. He was an indoor cat who had been adopted from a shelter several months prior. He had been to a veterinary neurologist with no definitive diagnosis despite extensive testing. He tested positive on an FIP blood test, but results were inconclusive for active disease. George was very quiet, subdued and non-painful upon examination.

Nutrition Response Testing® (NRT) revealed blocked autonomic nervous system regulation and a PNS switch associated with environmental EMFs (electromagnetic fields) and heavy metal/ petrochemical challenges. A biologically-appropriate, meatbased low-carbohydrate diet was recommended. George was also started on a whole food-based mineral supplement (Organically Bound Minerals®), a supplement to support toxin binding (Cholacol II®), and a salivary Protomorphogen (Parotid PMG®) to support detoxification of heavy metals and chemicals.

Within a month of initiating nutritional therapy, George’s gait began to improve. He was starting to jump onto low furniture and was more interactive. At his two-month recheck he tested for additional cardiovascular and neuromuscular nutritional support (Feline Cardiac Support), and at his 12-week recheck he was mentally engaged, and able to jump from floor to countertop. After six months of nutritional therapy, his gait was visibly normal and he was back to regular activity, jumping up to multiple levels on his cat tree. Supplements were incrementally decreased. One year later, George remains fully recovered.

  1. Miller, an eight-year-old M/N Sealyham terrier, was diagnosed with GME (Granulomatous meningoencephalomyelitis) in late 2008. He was placed on cyclosporine, prednisone and gabapentin and made a full symptomatic recovery. Within a month of treatment, he experienced gingival hyperplasia and the cyclosporine was discontinued. He then experienced relapses at several-month intervals. Euthanasia was recommended during one episode, though Miller experienced intermittent improvements on drug therapy, which included azathioprine and procarbazine.

During his current remission, his owners became concerned with the long-term effects of the drugs on his immune system, and sought nutritional consult. Nutritional recommendations for Miller included: grain-free diet, whole food-based nutritional supplements (Canine Immune Support, Canine Hepatic Support, Canine Whole Body Support) and a nervous system Protomorphogen (Neurotrophin PMG).

One year later, Miller was reported as active, happy, pain-free and thriving. He was eating a home-cooked diet, was off all medication and continued on his supplement protocol. The supplements were to be decreased to the lowest effective dose, but because GME is a chronic condition, his nutritional therapy and support were recommended to continue lifelong.

  1. Gabbe was a 3 year old F/S Golden Retriever who was referred for a nutritional supplement consult on February 14, 2014. She had a history of hot spots and a 4 month history of idiopathic epileptic seizures. She would experience grand-mal seizures 2-4 times a day every 10 to 14 days. Her owners were unwilling to place her on a recommended pharmaceutical protocol and were looking for alternative nutrition based therapies. Though this isn’t an ideal situation, nutritional therapy was started and the owners were cautioned to seek medical treatment for the dog should the seizures continue in frequency and/or severity.

Gabbe was started on a nervous system Protomorphogen™ (Neurotrophin PMG® –Standard Process) and was also started on a whole food based supplement to support healthy liver function (Livaplex® - Standard Process). She was also prescribed a fish oil supplement (Tuna Omega 3® – Standard Process).

Gabbe remained seizure-free for 8 weeks following the initiation of nutritional therapy and was reported to be much calmer in her temperament and behavior.  Her owners commented that stress levels for the entire family had significantly reduced as a result.  Her hot spots were also reported to be resolved. Gabbe was lost to follow-up, and the length of time that she remained seizure-free is unknown.

  1. Marshall was a 1 ½ year old M/N Springer Spaniel who had a history of grand-mal seizures every 2 weeks for several months. His diet consisted of Purina Dog Chow, Gravy Train, and Milk bone treats. He had normal CBC and chemistry panel results and was diagnosed with idiopathic epilepsy. Medication was recommended to address the seizures but Marshall’s owner declined medical therapy. On June 3, 2013 Marshall was evaluated for nutritional recommendations. The owner declined further diagnostics which included a comprehensive thyroid panel. The following recommendations were made: his food was changed to a grain-free, complete and balanced moistened diet: he was started on a Protomorphogen™ (Neurotrophin PMG® – Standard Process), and whole food based supplements to support healthy liver function (Livaplex® – Standard Process) and general body system/endocrine support (Catalyn®- Standard Process).

Marshall became seizure free following the initiation of nutritional therapy and at the 5 month mark in October 2013, the owner reported that she had discontinued the supplements due to cost. The dog continued to be healthy, happy and seizure-free until August 2014 when the owner reported that Marshall had a round of cluster seizures, was hospitalized and placed on Phenobarbital to manage the seizures. Marshall experienced side effects on the medication:  drooling, whining and delirious behavior. Despite recommendation to continue medical therapy along with restarting nutritional supplementation, the owner stopped the medication and just started nutritional therapy but the dog’s quality of life declined rapidly and he was subsequently euthanized.


1JAVMA, Sept 1 2014, Vol 245, Number 5:478.

2"Canine Health Foundation Awards Six New Grants to Study Epilepsy and Reproductive Diseases in Dogs”. AKC 5/9/2016,

3Patton, Richard. Ruined by Excess, Perfected by Lack: The paradox of pet nutrition. Nottingham University Press, 2011.

4"Protomorphogen™ Extracts Fact Sheet”.

5Royal Lee and William A. Hanson. Protomorphology: The Principles of Cell Auto-Regulation. Lee Foundation for Nutritional Research, Milwaukee WI 1947.

6“Dr. Royal Lee on Protomorphogens”. Digital re-recording from source tapes recorded in September 1957. Applied Nutritional Services.

7Vaz NM, Maia LC, Hanson DG, Lynch JM. 1977. “Inhibition of homocytotrophic antibody responses in adult inbred mice by previous feeding of the specific antigen”. J. Allergy Clin Immunol, 1977, 60(2):110-115.

8“Food for Thought: Can Immunological Tolerance Be Induced to Treat Asthma?” Lauren Cohn Department of Internal Medicine, Section of Pulmonary and Critical Care, Yale University School of Medicine, New Haven, CT Am. J. Respir. Cell Mol. Biol. Vol. 24, pp. 509–512, 2001.

9“Antigen-Specific Strategies for Auto-Immune Disease Treatment: Oral Tolerance, ImmuneWorks”, uploaded February 2012,

10Ana M, C. Faria1 and Howard L. Weiner2. “Oral tolerance: Therapeutic implications for autoimmune diseases”. Departamento de Bioquı´mica e Imunologia, Instituto de Cieˆncias Biolo´gicas, Universidade Federal de Minas Gerais, Av. 1Departamento de Bioquı´mica e Imunologia, Instituto de Cieˆncias Biolo´gicas, Universidade Federal de Minas Gerais, Av.Antonio Carlos, 6627, Belo Horizonte,MG 31270-901, Brazil, and 2Harvard Medical School, Center for Neurologic Diseases, Brigham and Women’s Hospital, 77 Avenue Louis Pasteur, Boston, MA 02115, USA ISSN 1740-2522 print/ISSN 1740-2530 online q 2006 Taylor & Francis.

11Kobeissy FH. “Autoantibodies in CNS Trauma and Neuropsychiatric Disorders: A New Generation of Biomarkers”. Brain Neurotrauma: Molecular, Neuropsychological, and Rehabilitation Aspects. Ch. 29 editor. Boca Raton (FL): CRC Press/Taylor & Francis; 2015.

12Elamin NE1, Al-Ayadhi LY. “Brain autoantibodies in autism spectrum disorder”. Biomark Med., 2014; 8(3):345-52. doi: 10.2217/bmm.14.1.

Ingredient sourcing for optimal nutrition in dogs and cats

Why fresh organic food is the healthiest choice for your patients

Many holistic or alternative veterinarians still express some angst regarding their recommendations on the type of food clients should feed their pets. Confusion about what constitutes the appropriate diet for dogs and cats comes from an interesting convergence of food production and labeling politics; marketing strategies in OTC pet foods and veterinary prescription diets; food journalism as it applies to animal and human health; and the science of nutrition. The science of nutrition, rather than adding clarity to the discussion, has obscured our understanding of food with its emphasis on the material contents of food and the internal metabolic machinery of each species.1,2


The missing link in our education involves what exactly happens to food as it passes through our patients’ guts. We are only now beginning to understand that the miraculous transformation of food into tissue could not take place without the contribution of an enriched broth of bacteria and fungi we call the intestinal microbiome (each individual’s microbiome outnumbers their own cells by ten to one). Only a few pathogens negatively impact animal health.3 All plants and animals share their functional life with a nurturing and supportive microbiome from birth (or sprout) to decomposition.4 Likewise, the earth could not support plant or animal life if not for the rich mat of organic material that inhabits its crust.5

The TCVM concept of Qi, the vital life force that encompasses all living things, is remarkably similar to our current understanding of the planet’s robust biosphere, and its continuous cycle of promotion and decay – a cycle that has been taking place in the deepest, farthest, and most extreme places on the planet for billions of years.6

Veterinarians learn that healthy ruminant digestion relies on a partnership with microbial inhabitants. A similar discussion of the microbiome in dogs and cats was largely overlooked in small animal nutritional textbooks, as if it was only marginally involved in digestion and overall health.1,2 In fact, each pet’s microbiome is establishing residence within one hour after birth, and hastily begins directing the development of the structure of the host’s intestines, immune system and neurologic system.4,7 The resident microbiome, in concert with the host’s cells, is responsible for an elaborate communication system that influences nutrient assimilation, tissue growth and repair, body composition, inflammation, neurological development and mental health. At weaning, the microbiome population alters as the food substrate changes. In carnivores, this means that microbes and enzymes associated with carbohydrate digestion begin to naturally diminish, while microbes, intestinal cells, and organs that assist in amino acid and fat digestion flourish and develop.7 The host’s hormonal state during puberty, estrus, pregnancy and lactation influences the bacterial population in the intestines by promoting a shift towards microbes that are more efficient at harvesting energy from the diet.

The external environment also influences the microbiome. Research shows that animals and people who spend time outdoors have more robust microbiomes, as do humans that live in multi-generational households, or share their living space with pets.8


What is it about the overcooked dry extruded diets, fed to pets since the 1950s, that are contributing to the marginal health and diminished lifespan of dogs and cats? Perhaps an example concerning the discovery in the 1980s that taurine was deficient in commercial cat foods answers that question (clinical symptoms cats presented with were CHF and blindness). It seems taurine was present in the cat food (according to the guaranteed analysis), but the high cooking temperatures made this essential amino acid unavailable to feline intestinal microbes. This interesting finding illustrates how dynamic the science of nutrition is as it applies to industrialized pet foods. The paradigm of essential nutrients depends on the recognition that a particular disease can be associated with a specific nutrient. As more diseases or clinical conditions are reported and investigated, more nutrients may be defined as essential.2

The paradigm of bio-availability currently compares the concentration of a nutrient or drug before it is ingested, to the blood levels achieved at post-ingestion intervals. We now know that the health and composition of the microbiome influences what crosses from the lumen of the gut into the bloodstream and impacts the analysis of the bio-availability. Currently, fresh food diets (commercial or home-prepared) are being scrutinized by veterinary nutritionists as they compare their guaranteed analyses to industrial processed preparations. This work ignores the concept of microbial-assisted bioavailability which favors amino acids, fats and minerals from fresh uncooked meat, fat and bone diets for carnivores. It is true that processing and cooking improves the digestibility of plants (by making their contents more bio-available to microbial digestion), but one could argue that amplifying the energy content of pet food will not benefit the health of our largely overweight and obese pets. Dry extruded diets (even grain-free) are deficient in essential amino acids and fatty acids, and excess in plant sugars, because of the high temperatures associated with their cooking and composition.

High-fiber, plant-based processed diets designed to reduce a pet’s energy harvest from food (and theoretically help reduce weight) further amplify these deficiencies. These diets increase the volume of indigestible fiber and dilute not only the caloric content of the food, but also its essential amino acid and fatty acid content, leaving pets extremely deficient in both.


The current trend towards “ancestral diets” represents an effort to correctly feed the ancestral microbiome of our carnivorous pets. This is not an attempt to take our canine pets back to wolves, or turn apartment-dwelling felines into lynx. It recognizes that the evolution of domestic dogs and cats from carnivorous hunting partners, varmint managers and scavengers to house-dwelling couch potatoes spans just 150 years – a short period when compared to the approximately 20,000 years of domestication. Many variations of ancestral diets are now commercially available, and most are approximately 75% to 80% meat, fat and bone with variable plant material and supplements added. Most are designed to be fed raw or gently cooked; either is biologically appropriate.

Many animal owners, with little support from their veterinarians, use the information from books, other publications and the internet to feed their pets combinations of raw meat by-products from human food distributors, such as chicken backs and necks, tripe and various organ meats. Typically, some type of vegetable material is added along with many variations of commercially available supplements. These animal owners are motivated to improve their pets’ health and longevity with fresh species-appropriate food, and most report favorable results. But are these industrially-produced food animals and plants really “ancestral”?

After WWII, agriculture used scientific innovations to develop a war on insects, weeds and plant pathogens. The war on famine justified the overproduction of cereal grains, and government subsidies for politically-important crops influenced the development and use of agro-chemicals to maximize production. This focus on the health benefits to plants of being grown in a world free of pathogenic bacteria, fungi and insects now seems unrealistic and short-sighted. The increased yields and profits realized through these farming methods are celebrated, while the costs to beneficial microbes and the environment are largely ignored. The non-target effects of agricultural technological development continue to be realized only as they play out in the laboratory of our world, our pets’ health and our own lives.

Authors David Montgomery and Anne Bikle (The Hidden Half of Nature) write about the remarkable similarity between the relationships human and animal hosts develop with their microbiome, and the relationships plants develop with the earth’s biosphere. They note the functional similarities between the roots of plants and the cells of our gut as they interact with a healthy, robust microbiome. These beneficial soil microbes function much like the microbiome of our colons, enhancing the plant’s ability to uptake minerals and additional nutrients. Plants evolved by providing exudates to soil bacteria and fungi through their roots, in exchange for nitrogen the microbes fix from the soil and atmosphere and make available to the plant.

The theoretically-benign herbicide glyphosate is toxic to these critical nitrogen-fixing bacteria and mycorrhizal fungi in the soil. Additional chemical fertilizers are needed to supply nitrogen, phosphorous and potassium to enhance plant growth. Chemically-fertilized plants get lazy and fail to develop robust root systems, which starves soil microbes. The result of 70+ years of chemical fertilization and soil microbe starvation is a substantial decrease in the plant content of most soil micronutrients (vitamins and minerals). One study that looked at changes in the micronutrient content of fruits and vegetables from 1940 to 1992 documented decreases in all micronutrients, with the exception of phosphorous. These decreases ranged from 2% to 97%, depending on the plant type. 

Studies have shown that magnesium, for example, is necessary for the development of several digestive enzymes. A dietary deficiency of magnesium is related to many human health problems such as ADHD, schizophrenia, bipolar disorder, depression, and not surprisingly, chronic gut inflammation. It is estimated that most Americans now only get 10% to 20% of the magnesium they need through their diets. Many GMO plants (corn, soybeans) were genetically designed to resist the effects of glyphosate, which means they can be exposed to and uptake this chemical without dying. The toxicity of glyphosate residues to the beneficial microbiota of animals and humans is currently being explored. Researchers have found alterations in the beneficial gut microbiome of poultry and cattle fed GMO corn and soybeans, which leaves the animals vulnerable to pathogenic bacteria.

Industrialized agriculture and the use of glyphosate create the same deficiencies in the plants and animals it produces and in the soil that contributes to their growth. Humans and pets, as predators, are at the top of this deficient food chain. The health of our pets is definitely improved when fresh food is substituted for dry extruded diets, but “ancestral” diets can only begin to restore integrity and balance to the system when the meat, plants and supplements included in these diets are derived from organically-farmed sources. 

Veterinarians interested in finding a path to health for their clients’ pets can also promote a path to health for the planet when they advocate fresh organic diets for animals. When consumers pay for the actual environmental costs associated with production of the food we and our pets consume, we begin to bring balance to our relationship with the planet.

Veterinarians are trained to provide clients with a risk benefit analysis for each medical directive or treatment protocol that we recommend. Informed veterinarians can now give clients a risk benefit analysis for organic and fresh food diets versus industrially farmed processed kibble diets by also encouraging them to consider the costs to the health of the planet.


  1. Always get a complete health history (TCVM or CWM) and perform any necessary diagnostics (CBC, chemistry, U/A) on new patients before you start them on a fresh diet, to avoid the potential that chronic health problems (pancreatitis, food allergies, IBD) may cause a healing crisis.

  2. Discuss stool quality and its relationship to digestion so that clients realize how important it is to daily monitor their pets’ stools.

  3. Discuss food prep and storage hygiene as well as kitchen management to educate clients on the risks of handling raw meat. Due to enzymatic activity in raw meat, amino acids can be lost during prolonged storage in refrigerators.

  4. Raw meat should not be fed to animals that have recently been on courses of antibiotics; the disruption this causes to their beneficial microbes leaves them susceptible to pathogenic bacterial invasion. A one- to four-month waiting period on gently-cooked food should be protective.

  5. Senior patients with compromised GI function may never be able to properly digest raw food.

  6. All pets on fresh food diets should receive animal-sourced Omega 3 fatty acid supplementation; even grass-fed and free-range livestock aren’t able to consume the variety of plants necessary to ensure they are incorporating these fatty acids into their own fat.

  7. All pets should be on a well-rounded mineral supplement to compensate for deficiencies in soil and harvested plants. (Even organic farms are still in the process of building good soil, and mineral deficiencies occur across the US).

  8. All pets should be on a daily pre- and probiotic to provide a source of beneficial bacteria and stabilize and promote GI function and motility.

  9. Whenever possible, clients should purchase pet foods or ingredients that are organic, non-GMO, free-range or grass-fed, and free of hormones and antibiotics.

  10. Clients should also be encouraged to establish relationships with local food producers. As more farmers become aware that consumers are willing to pay more for healthy organic food, more will begin farming that way.


1Schenk PA and Strombeck DR. Home-prepared dog and cat diets, 2nd Ed. Ames, Iowa: Wiley-Blackwell, 2010.

2Gross KL, Yamka RM, Khoo C, Freisen KG, Jewell DE, Schoener WD, Debraekeleer J, Zicker SC. “Macronutrients, micronutrients: minerals and vitamins”. In: Hand MS, ed. Small Animal Clinical Nutrition, 5th Ed. Topeka, Kan: Mark Morris Institute, 2010. 49-148.

3Freeman L, Chandler M, Hamper B, Weeth L. “Current knowledge about the risks and benefits of raw meat-based diets for dogs and cats”. JAVMA 2013; 243: 1549-1558.

4Buddington R. “Postnatal changes in bacterial populations in the gastrointestinal tract of dogs”. AJVR 2003; 64:646-51.

5Montgomery, David R and Bikle, Anne. The hidden half of nature, the microbial roots of life and health. New York: W.W. Norton & Company, Inc., 2016.

6Legget D. Helping ourselves, our guide to traditional Chinese food energetics, 2nd Ed. Devon, England: Meridian Press, 2005.

7Hamper BA. “Nutritional adequacy and performance of raw food diets in kittens”. Doctoral Dissertation, University of Tennessee (2012):14-24.

8Blaser, Martin J. Missing microbes: How the overuse of antibiotics is fueling our modern plagues. New York: Henry Holt and Co., 2014.

Integrative Treatment of Spinal Dysfunction

How acupuncture, homeopathy and other therapies can help in the treatment of intervertebral disc disease (IVDD) and spondylosis in pets.

I have seen it time and again: a client brings in a sweet beloved pet that cannot use his hind legs. Depending on which segment of the spinal cord is affected, the animal may also be unable to urinate or defecate with control. The client is understandably upset but still holding out hope that something can be done about her pet’s spinal dysfunction, which may signify IVDD, spondylosis, or other conditions.

Many pet owners today are asking for an integrative approach to treating spinal dysfunction, in addition to conventional pain management, after learning about successful outcomes through word of mouth, the Internet and social media. It seems the high cost of surgery, plus the time and pain involved in what is called conservative therapy (total cage rest, pain medications, anti-inflammatories) is leading owners to look for alternatives. Even some conventional experts are questioning conservative therapy. In a recent textbook, Curtis Dewey, DVM, MS, states that one study found “no association between duration of cage confinement and success of medical therapy”.1

In my integrative practice, I treat many species with neurological conditions, including intervertebral disc disease (IVDD) and spondylosis deformans. In my experience, localization of the spinal lesion can best be done by combining conventional exam and diagnostics, and holistic techniques.


The integrative veterinarian may be presented with anything from lameness, organ dysfunction, proprioceptive loss and ataxia, to paresis and paralysis. The first step in diagnosing the condition is a physical exam. This typically means repeating the tests made by any conventional veterinarian with the goal of locating the lesion and delineating the cause.


Most of the time, pain will impede many normal responses, and muscle stenting and compensatory changes in joint movement are also present, so while examining the dog, avoid anything but gentle palpation in the area. Evaluate the nervous system from head to toe:

  • Check for cranial nerve deficits.
  • Palpate to test for painful areas along the vertebrae. Are they lumbar, thoracic or cervical?
  • Determine if the lesion is Upper Motor Neuron or Lower Motor Neuron. Are the leg reflexes hyper- or hypo-reflexive? Is there a panniculus response?
  • Test the integrity of the proprioceptive pathway. Does the brain respond to the foot being turned over?2


The TCVM practitioner interviews the client, observes the patient, takes the history and evaluates the tongue and pulse as part of the exam to determine:

  • Preferences to hot or cold
  • Pain behaviors – is the animal in pain or is there weakness without pain?
  • Wet or dry presentation
  • Which acupoints are sensitive and what portion of the nervous system are we trying to modulate by stimulating the nerves and the local humoral response?

From these points, the practitioner can differentiate between spondylosis and IVDD to select the most appropriate treatment. IVDD will generally present with a stagnation pattern of pain (in muscles or joints, and/or stiffness in the joints), and also present with the Bi syndrome. (Table 1)

Spondylosis is more chronic and slow to progress since it can develop as generalized Bi syndrome over a long period, reflecting spinal instability. Most commonly, the patient presents with ataxia but he/she may present acutely, showing weakness without pain due to loss of neurological function. This pattern is the Wei syndrome. (Table 2)

Table 1 – Bi Syndrome Pattern3

Bi syndrome patterns



Clinical findings/grade of deficit

Wind-Cold-Damp invasion with external Qi/Blood stagnation


Superficial, strong, slow, wiry

Grade 1 acute neck or back pain. No paresis or paralysis.

Kidney Yin deficiency with external Qi Blood stagnation

Reddish purple, dry

Deep, weak, worse on left, rapid, thready or wiry

Grade 1 acute neck or back pain. No paresis or paralysis. Panting, cool-seeking, warm ears, back, feet, dry skin.

Kidney Yang deficiency with external Qi Blood stagnation



Deep, weak, worse on right or wiry

Grade 1 acute neck or back pain. No paresis or paralysis. Heat-seeking, cold ears, back, feet.

Spinal cord Qi/Blood stagnation with Kidney Qi deficiency


Pale purple, wet

Deep, weak, worse on right or wiry

Grades 2-5 deficits acute or chronic. Paresis or paralysis (+/=) neck or back pain.

Spinal cord Qi/Blood stagnation with Kidney Yang deficiency


Pale purple, wet

Deep, weak (weaker on right), slow, may be wiry

Grades 2-5 deficits acute or chronic. Paresis or paralysis (=/+) neck or back pain. Heat-seeking, cold ears, back, feet.

Spinal cord Qi/Blood stagnation with Kidney Yin and Qi deficiencies


Pale or red, purple, wet or dry, cracked, chronic

Deep, weak, may be on both sides, rapid, thready, may be wiry

Grades 2-5 deficits acute or chronic. Paresis or paralysis (=/+) neck or back pain. Panting, cool-seeking, warm ears, back, feet, dry skin

Spinal cord Qi/Blood with Kidney Yin and Yang deficiencies


Pale, red or purple, wet or dry

Deep, weak pulses on both sides, may be rapid or slow or wiry

Grades 2-5 deficits acute or chronic. Paresis or paralysis (=/+) neck or back pain. Seeks heat or cold, may or may not pant, warm or cold ears, back, feet. May be warm in front and cold in back.


Table 2 – Wei Syndrome Pattern4

Wei syndrome patterns



Critical signs

Damp Heat

Greasy, moist

Rapid, slippery

Obesity, chronic skin problems, edema, weakness in back legs, no paralysis.

Spleen Qi deficiency

Pale, swollen

Deep, weak

Weak limbs, flaccid loose stools, weakness in rear legs.

Kidney Qi and/or Yang deficiency

Pale, moist

Very deep, weak

Weak and cold lumbus and hind end, difficulty rising. Weakness to immobile rear legs.

Qi and Yin dual deficiency

Pale or red and dry

Weak, thin

Emaciation, weak hind end, dry skin, false heat, cool-seeking, weakness to immobile rear legs.


Differentiating Bi and Wei syndromes facilitates choosing the correct acupuncture points, Chinese herbal formulas, Tui Na massage plans, and food therapy for each animal.


The homeopathic veterinarian looks for idiosyncratic reactions that indicate the best remedy. Signs to consider:

  • A fear of being touched
  • Temperature of the paws
  • Condition of the hair coat
  • Vaccination history
  • Reaction to stimuli
  • Past medical history.5


After localizing the lesion area with a physical examination, the integrative veterinarian moves to the next phase of diagnostics, which is radiography. The newer digitized radiographs allow us to see late stage inflammatory changes, but not always all the pathology. If Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) is going to be pursued, generally, surgery will be planned.  


Following case intake, physical exam and diagnostics, a treatment plan is formulated using the appropriate modalities. Different approaches are needed for IVDD and spondylosis.

Treatment options for IVDD

Before discussing treatment options, let’s review IVDD pathology. Spinal vertebrae surround the spinal cord. Between the vertebrae sit eight joints, including an intervertebral joint, which contains the nucleus pulposus. This acts like a malleable ball bearing to equalize stress on the disc. With IVDD, calcification of the nucleus pulposus occurs (this can happen as young as three years of age). Quadrupeds have shear force along the spinal canal versus compressive force in the human species. Enough shear force can cause the nucleus pulposus to rupture up through the layers of annulus fibrosus lamina and into or around the spinal canal. Type I Hanson’s IVDD occurs acutely, most commonly in short-legged long-bodied dogs. Type II is more degenerative than explosive, often occurring in older dogs and larger breeds. 

The conventional veterinarian will suggest surgery, anti-inflammatories and cage rest for IVDD. However, in his book, A Practical Guide to Canine & Feline Neurology, Dr. Dewey says that in studies, the “glucocorticoid therapy in treating spinal injury is questionable at best, with no beneficial effect”, although NSAIDs in the acute phase have been shown to have an anti-inflammatory effect.6

On the other hand, the integrative veterinarian has many tools available to treat IVDD. Dr. Narda Robinson of Colorado State University states the following in her request for a re-evaluation of the Standard of Care for IVDD:

“The old mindset that nothing can cure a dog but surgery and strict cage confinement (with minimal to no analgesia) remains widely held in some circles, even academia…. Acupuncture reduces the extent of damage by helping keep neurons and oligodendrocytes alive. In comparison, what does cage confinement without physical medicine do to a dog with disk disease and back pain? It risks further degrading the disks, increasing muscle tension, and inducing long-term maladaptive gait patterns.”7

Other experts agree with Dr. Robinson. Joaquim et al show that acupuncture has been demonstrated to aid in recovery from IVDD.8 

Acupuncture point selection is based on a pattern diagnosis to improve and modulate the nervous system. In addition, TCVM practitioners include Chinese herbal medical formulations for anti-inflammatory and healing effects, as well as Tui-Na massage. A prescription of physical rehabilitation passive exercise during exercise restriction can improve proprioception, motor pattern generators and reduce pain.

Spinal manipulation and stretching

Careful consideration is needed before using adjustments on a dog with IVDD. Is there movement in the intervertebral area, or is it too dangerous to gauge movement in the event of a possible nucleus pulposus rupture? We can use spinal manipulations to add movement to other joints around the area, and use stretching to relax spasmodic muscles.9


Outcomes with a conventional-only approach are often limited. At the least, a patient may experience loss of muscle mass. At the worst, a paralyzed patient can die from the inability of his organs to function due to poor innervation of the sympathetic and parasympathetic nervous systems. An integrative treatment plan (with consultation from experts, if needed) can improve the return to function and keep the neurological status of the patient healthier.


When the homeopathic medicine matching the individual dog is administered, the vital force begins a self-healing. First the dog will have improved mentation, appetite and energy. Then, even with total paralysis, he will begin to show a return of normal neurological function. Several weeks may be needed if treatment is begun shortly after diagnosis; several months if paralysis has not responded to surgery and drugs. Hypericum and Nux vomica are frequently indicated remedies. One eight-year-old Dachshund presented with a flaccid tail, stool falling out, urine retention and no deep pain. Five doses of Hypericum 12c over a two-week period were needed for full recovery.5


What about the pathology of spondylosis? The ligaments of the spine allow it to move within an acceptable range of motion. One of these ligaments – the ventral longitudinal ligament (VLL) – runs beneath the spinal cord and prevents hyperextension of the spine. The VLL can become stretched and unable to support the vertebral joints and spinal cord if the intervertebral joints move too far in any direction and/or the abdominal muscles are consistently weak. This chronic instability of the joints leads to inflammation and, finally, calcification of the ligament. Calcification causes a decrease in nerve health due to:

  1. Fewer nutrients, resulting from impeded blood flow;
  2. Decreased firing from lack of movement, which is the body’s attempt to keep the spine from moving abnormally (from compromised muscle support, arthritis in the joints and ligaments, and tendons becoming stressed and then fibrotic). Early fibrotic changes will appear on the radiograph as rounding, due to loss of calcification of the bone at those attachments.

The conventional approach of using anti-inflammatories and joint modifiers (glucosamine, chondroitin, milk proteins, hyaluronic acid) may not be enough to avoid spondylosis.

Occasionally, surgery can fail and owners will seek other options. These cases are by far the more difficult to treat due to the loss of muscle tissue from the surgery and the time lag from recommendations that delay follow-up care with the integrative practitioner.

On the other hand, an integrative veterinarian has a number of techniques available to help reverse or stabilize the changes in the ligament that lead to this condition.10 Sometimes, even the entire mass of accumulated calcium can be dissolved.5 Since inflammation triggers the production of calcium deposits, multiple modalities can both prevent and possibly resolve spondylosis, by ensuring movement and healthy blood flow to intrinsic muscles, tendons and ligaments. Remember, when the joints move freely, the nerves can fi re adequately. Proper ROM also keeps the intrinsic and paravertebral muscles healthy so they in turn can maintain postural input to the sympathetic and parasympathetic nervous systems. Successful approaches include:

  1. Regular animal chiropractic work
  2. Spinal manipulation and adjustments
  3. Stretching, balancing and flexion/extension exercises
  4. TCVM – Chinese herbs, acupuncture and Tui-na
  5. Homeopathy – individualized selection of remedies.

In conclusion, integrative care – joint modification therapeutics, Chinese herbal formulas, and homeopathic remedies, combined with conventional medications in the acute phase – can improve the outcome of IVDD and spondylosis. Many more spinal conditions can also be treated with these integrative modalities. At our clinic, we also use laser therapy, an underwater treadmill, and PEMf therapy with TCVM modalities. By using these integrative modalities, successful return to function without surgery, or post-surgical rehabilitation for muscle, neurological and gait deficiencies, is often achieved


Daisy is a 12-year-old FS Border Collie who moved slowly and loved to lie under the car. On New Year’s Eve, her owner did not know she was there, and she sustained fractures in the skull, mandible and foot; a large de-gloving area; and a painful back.  With chiropractic adjustments, Chinese herbal formulations, laser, and great nursing care, she became pain-free and even more mobile than she was prior to the accident, once her wounds were completely healed.

Captain is a ten-year-old Jack Russell terrier who presented in extreme pain due to IVDD. Five years ago, his referral veterinarian gave a poor prognosis after incorrectly diagnosing him with Granulomatous Meningeal Encephalitis (GME). Peripheral nociception (part of the pain response sensation) and LMN disease affected his CNS, causing disorientation. Acupuncture, laser, chiropractic and Chinese herbal formulations alone have been able to keep his mentation and spinal nerves healthy, in spite of two more episodes of IVDD.

Over the years, Captain’s owners have been willing to treat him only two times at each episode. On the referring veterinarian’s insistence, they stopped all Chinese herbal formulations for Bi syndrome, except the formulation for neck pain. As a veterinarian, I treat what I have at the moment. Each time, “moving the stagnation” and treatment has him back acting as Jack Russells do. Owner compliance with rehabilitation, acupuncture, laser and Chinese herbal formulations are a challenge, as this real case demonstrates.


1Eschbach, Dennis. “Thoracolumbar Pathology: Based on notes by Sharon Willoughby”, Basic Chiropractic Course, 2007.  P.371-37.

2Dewey, Curtis W. “Chapter 10: Myelopathies:  Disorders of the Spinal Cord”, A Practical Guide to Canine & Feline Neurology, 2008, p. 332.

3Chrisman, Cheryl L. “Spinal Cord Disorders”, Traditional Chinese Veterinary Medicine for Neurological Diseases, 2011. 13th Annual TCVM Convention, pp. 225-266.

4Ferguson, Bruce and Boggie, Linda. “How I Treat Wei Syndrome”, Traditional Chinese Veterinary Medicine for Neurological Diseases, 2011. 13th Annual TCVM Convention, pp. 455-465.

5Personal communication with Drs. Pantzer and Chambreau.

6Jurek, Christine. “The Role of Physical Manipulation (Chiropractic) in Canine Rehabilitation”, Canine Sports Medicine and Rehabilitation, 2013. p. 431.

7Joaquim JG, Luna SP, Brondani JT, et al. “Comparison of decompressive surgery, electroacupuncture, and decompressive surgery followed by electroacupuncture for the treatment of dogs with intervertebral disk disease with long-standing severe neurologic defi cits”. J Am Vet Med Assoc, 2010.  pp. 1225-1229.

8Robinson, Narda. “An Emerging Standard of Care for Thoracolumbar Intervertebral Disk Disease in Dogs”, CuraCore,, Sept. 12, 2015.

9Dewey, Curtis W. “Chaper 3:  Performing the Neurologic Examination”, A Practical Guide to Canine & Feline Neurology, 2008, pp. 53-74.

10Dewey, Curtis W. “Chapter 10: Myelopathies:  Disorders of the Spinal Cord”, A Practical Guide to Canine & Feline Neurology, 2008, p. 332.

Integrative Tools for Treating Neurologic and Other Disease Conditions

Neurological ailments can result from various disturbances in the body that ultimately affect different parts of the neurological system. Irritation from a physical, chemical or biological event can result in chemical reactions with inflammatory, infectious or degenerative consequences. Examples include seizures, cerebral vascular accident, encephalomyelitis, intervertebral disc disease (IVDD), degenerative myelopathy, diabetic neuropathy, amputations and sciatica, among others. I have had success managing these conditions using a combination of approaches for patient evaluation and the modalities further explained in this article. The intention here is to inspire the practitioner with the concepts of energy medicine, and its bearing on ultimate treatment success. 


“If you want to understand the secrets of the universe, think in terms of energy, frequency, and vibration.” (Nikola Tesla)

Conventional medicine is based in Newtonian science, in which the body is a veritable solid object surrounded by space. Current quantum physics shows that the body is more space than solid matter. Your choice of science will influence your treatment plans and outcomes. The conventional approach is to focus on treating physical symptoms (or organs) rather than the energetic root causes (which will then heal the physical symptoms, often permanently).

We are primarily energetic electromagnetic beings, and secondarily physical beings. Consider the following:

  • Cell division is stimulated by a resonance event. Russian research has demonstrated the presence of photon emission (biophotons) in almost every tested living organism, from bacteria and yeast to plants and vertebrates. This photon emission was dependent on physiologic conditions.1
  • Studies document energy auras radiating from us.
  • Memory is said to be stored in much of this outer energy field. A true connection to the universe as well as to each other helps explain telepathy, a sixth sense, animal communication, and out of body experiences.
  • Nikola Tesla, Royal Raymond Rife and Paul Nogier were pioneers who laid the groundwork for discovering that our bodies are in a constant state of vibration, the “language of the universe”. Different organs and tissues vibrate at different resonance frequencies, thereby explaining the benefits of pulse electromagnetic frequency (PEMF) on healing, and a subsequent increase in ATP production.2
  • Laser light energy has been well documented for increasing ATP.
  • No matter the energy form used (micro-electric current, sound waves or light energy), healing is enhanced as a harmony of resonance frequencies is encouraged. Tuning forks have shown benefits, and even a cat’s purring has been found to be therapeutic.


Environmental and ingested pollutants, electromagnetic field radiation (EMFs), genetically modified organism (GMO) grains, and stress all set up systemic inflammation that can affect the gut microbiome, and disturb the normal resonance frequencies of healthy tissues. Vibrational frequencies are altered by the effects of chronic inflammation.3 Inflammation causes increased free radical oxygen and nitrogen species. Mitochondrial dysfunction is the by-product of chronic reactive oxygen species (ROS), and is ultimately an end result of inadequate ATP production.3

Based on the awareness that disease conditions result from impaired mitochondria, it would make sense to supply building blocks for healing, along with tools that can repair this dysfunction. Although numerous alternative modalities can and have been used with success, for the purposes of this article we will focus on some of the modalities I have trained in.


The healing power of intention

Regardless of a patient’s primary complaint, all enlightened veterinarians would agree that the most important tool we can apply to affect outcome and healing success is the power of our intention. Literally falling in love with the animal can be transformative. He receives our positive vibrations through our body language and the relaxation of our energy. Being aware of the animal’s body language and emotional state furthers our goal of decreasing the deleterious effects of the stress hormone, cortisol.

Body language is universal in all species. An extrapolation of Natural Horsemanship principles inspired my own animal and owner personality assessment, called AnEmotionalityTM.4, 5 Reading cues and developing an awareness of the emotional state of the animal and owner during a visit creates an ability to minister to the primary need of the patient. Emotional states vary from day to day, as well as moment to moment, possibly due to changing environmental triggers. Learning to “key in” to the emotional currency the individual needs at the time can lower stress; this is important since stress can be an obstacle to the healing benefits of any future modality we attempt to incorporate.

  • An animal showing fear and insecurity may require that his/ her safety and comfort be managed before he accepts a treat reward, after which play can seem interesting. Offering less eye contact, making postural changes, postponing the hands-on exam, calming our energy and slowing down before proceeding can be rewarding.
  • Animals that are in a confident, dominant, playful state may welcome treat rewards, and/or an opportunity to show off their trick repertoire.

Demonstrating frequency specific LLLT and simultaneous communication of nerve root as well as area of involvement.

  • Allowing extroverts to move their feet, and introverts to remain stationary, further establishes this relationship “dance”.

The desired outcome is an animal that feels more confident, cared for and understood, allowing for an easier examination. Likewise, the owner feels that he or she is being heard, and will be amazingly present to our diagnostic and treatment plans. The reward is the recipient’s further confidence in our intention, as well as decreased stress for all involved.

Using all our senses

In addition to a complete signalment, medical history and neurologic exam to assess cranial nerve signs, as well as to distinguish UMN from LMN disease, a holistic exam incorporates the following senses:

  1. Vision – needed for most of the conventional exam.
  2. Smell – of a patient’s coat, feet, mouth, excretions and secretions.
  3. Hearing – auditory cues from the heart and lung fields, gut sounds, mentation, footfalls for rhythm changes and lameness evaluation, vocalizations and purring. Any environmental contributor is especially important in house call practice.
  4. Touch – in the form of offering comfort, sometimes requested by the patient prior to evaluation, running your hand over the patient to feel heat patterns, feeling integument, muscle tone and symmetry, trigger points, texture changes, and observing response to pressure variations.
  5. Taste – can also play a role in evaluating feed, hay, certain medications, presence of essential oils, etc.
  6. Intuition – or our sixth sense, must not be minimized, and can overrule our subjective observations in some cases. We can generally sense when an animal “just ain’t doin’ right”, well before we have enough evidence to validate that insight.

Incorporating our sensory observations with a thorough history and signalment will provide many of the puzzle pieces. I use the analogy that the patient presents as a puzzle to be put together. The more we can learn from the edge pieces of the patient’s history, aided by our subjective and objective information, the less the owner may need to invest in diagnostic testing. This encourages a wealth of data that the owner may have otherwise been too sheepish to admit to.


The practitioner’s choice of tools allows for individualized medicine. Without a doubt, the most important tool for benefiting health and minimizing inflammation is the adoption of good nutritional practices, including a quality organic non-processed diet, with appropriate supplementation when indicated. Also, improving the gut microbiome, fecal transfers when indicated, the use of ozonated fluids, essential oils, tuning forks for balancing chakras, PEMF, LED red light therapy, and homeopathic remedies have all been used with great success by complementary therapists. For this article, I focus on tools I have used successfully for neurological conditions.

  1. a) Neuronal adjustment: Everything originates from the nervous system, which is the first system to form embryonically.6 Rehabilitating the CNS, where the insult most likely originates, would be key. There are basically two forms of neuronal adjustment – “direct” and “indirect”.
  2. i) Direct includes chiropractic, involving a high velocity thrust to musculoskeletal tissues; acupuncture, which involves the insertion of needles into soft tissue; and Veterinary Orthopedic Manipulation7 (VOM), involving the use of a human chiropractic activator to affect a high velocity low thrust impact to spinous processes.
  3. ii) Indirect includes functional indirect osteopathy techniques. This form of manipulation relies heavily on subtle energetic forces to relieve soft tissue, as well as vascular and lymphatic restrictions, and also includes cranial sacral manipulations.
  4. b) Myofascial release: There are numerous effective myofascial release techniques. As long as principles of circulatory blood flow, lymphatic drainage and thermal criteria are followed, and the animal’s acceptance and response to this tactile therapy is carefully monitored, this rehabilitation of the muscles and fascia (living matrix) is vital to optimal healing.
  5. c) Frequency specific low level laser therapy (FSLLLT): There are numerous therapy lasers on the market. The low power laser chosen by myself allows for long-term cellular enhancement without the inherent risks of occult thermal damage. It is a non-heat producing visible light wavelength Class 2 laser, with a power output of 5mW and 7.5mW, depending on the device. This is nearly 100 times less power than that of a Class 4 laser at 500mW. Class 3b lasers are generally 60mW to 200mW. The wavelength provided by FSLLLT is in the visible light spectrum of 635nm (red) or 405nm (violet). No eye protection is needed due to the visible light wavelengths and inherent blink response. This allows for decreased pain and inflammation, as well as increased circulation and lymphatic drainage, without the risk of thermal damage or retinal scarring. The beam is line generated and can affect a larger area by increasing its distance from the patient. The ability to vary the pulsations of the laser beam by programming in different frequencies brings current the science of Tesla, Rife and Nogier. The focused, coherent (in sync) wavelengths of this true laser allow for little energy lost within the ideal treatment range of up to 12”. Another feature of this laser is its ability to affect the autonomic nervous system. It has been used to decrease sympathetic tone to calm fractious or painful animals, as well as increase the parasympathetic tone to promote increased appetite, gut motility, and an increase in homeostasis.7

The ability to treat the nerve root as well as the area of involvement aids in the management of sciatica, IVDD, degenerative myelopathy, amputation and traumatic induced neuropathies. Low power lasers have been found to stimulate stem cells, which can aid in regeneration of nerve and other tissues.8, 9 Since the ultimate end result of laser therapy is to increase ATP production and repair mitochondrial DNA and messenger RNA, it is quite obvious that this tool may be one of the most beneficial in repairing the damage of mitochondrial dysfunction, impacting multiple disease conditions.


Many neurologic conditions can be a symptom of a systemic dysfunction. The new paradigm for healing requires that both an awareness of the universe within our cells and the ultimate connections beyond our physical bodies be taken into consideration for optimal treatment success. Recognizing and managing the emotional state of the animal, his/her owner, and his/her environmental relationships can contribute to our success in forming an optimal diagnostic and treatment plan. Along with mindful practices and genuine intention, alternative modalities are being successfully used to guide the cells in our bodies back to optimal health. With this in mind, non-invasive modalities that would manage the consequences of cellular irritants, psychological stress, and mitochondrial dysfunction could all be used with varying success to return the body to a state of harmonic resonance.

Case Reports

Skippy – a “fractious” 16-year-old male neutered dachshund with a one-week history of posterior paresis secondary to IVDD. He was referred for integrative care because he was currently overdosed on Rimadyl. With little improvement of symptoms, and an inability to safely administer steroids, a guarded prognosis was made. FSLLLT was performed starting with a sympathetic/parasympathetic balance, followed by modules including management of pain, inflammation, circulation, lymphatic drainage, scar tissue, connective tissue, liver, and immune system balance. These were coordinated into four modules that were three minutes long and considered one “treatment”. An accelerated protocol of two treatments per day for three days, then one treatment daily for three days, then one treatment every other day was performed. Skippy immediately calmed and within two days began to walk with minimal CP deficits. After two weeks, he was able to trot. He was weaned off the Rimadyl, as his owner requested more natural ways to manage him.

Sugar – an adult mixed breed spayed female found in an abandoned sugar mill in Kauai. She had been lame on her left front leg since admission to the Kauai Humane Society three weeks previously with a diagnosis of cervical disc disease. Her primary need was safety, so a relationship with her was established by implementing approach and retreat concepts. VOM adjustment was performed using the chiropractic activator. FSLLLT was used over the cervical vertebrae as well as the entire dorsal spine. Two separate three-minute treatment modules were used. The first module used frequency settings specific for decreased pain, inflammation, increased circulation and lymphatic drainage. The second was for scar tissue, chronic inflammation, connective tissue and nerves. She was clinically improved upon completion of the treatment.

Archimedes – a canary with a history of being down on his hocks for several days, and an inability to perch that indicated lumbosacral disease. Mild tassel foot was present, but not considered to be the cause. No obvious trauma was apparent, but a night fright episode was suspected. A presumptive diagnosis of spinal insult was made. FSLLLT was applied to the entire spine, using settings similar to those used on Sugar. Two 60-second treatments were performed on days one and two, at least two hours apart. By the evening of the second day, Archimedes was able to stand up off his hocks and perch.

Skye – an eight-year-old husky with Cushing’s hypertension. His response to treatment demonstrated the benefits of performing FSLLLT over the sympathetic ganglion between T1 and L4. Once the laser beam turns off at three minutes, the sympathetic tone decreases and the parasympathetic tone increases. Skye calmed, and his blood pressure went from 220/110 to 148/72 within 25 minutes, even with an attempt at placing an in-dwelling catheter (which is not a calming procedure).

Blue – A young adult intact female DMH was thrown from a moving vehicle, resulting in a severe de-gloving injury. Safety was her primary need and much of the treatments were performed with approach and retreat concepts, as well as sedation for bandage changes. A VOM adjustment was initially performed, along with myofascial release in the form of manual massage, and FSLLLT using the red/violet laser. She received twice weekly laser treatments. MRSA was cultured during the course of healing; however, healing was not set back due in part to the bactericidal benefits of the 405nm violet wavelength. The entire paw regenerated with complete hair growth and minimal scarring within 16 weeks. There was no skin grafting.

1Van Wijk, Roeland. Light in Shaping Life -- Biophotons in Biology and Medicine, Melina, Geldermalsen, The Netherlands, 2014, p 295-375.

2Meyers, Bryant, BS, MS. PEMF The 5th Element of Health, 2014, p. ix-209.

3Perlmutter, D., MD. “The Role of Inflammation in Neurodegenerative Disorders: Integrative Approaches to Challenging Neurological Disorders”, FACN, Director, Perlmutter Health Center.

4Gordon J. “Enhancing the Veterinary Exam Using Natural Horsemanship Principles”, AAV 2013; “Stress Free Small Animal and Equine Communication”, AHVMA 2016.

5Parelli, Linda, Pat and Handley, Patrick, PhD. Horsenality, Humanality, Pagosa Springs, CO, 2009-2016.

6DeLahunta. Veterinary neuroanatomy and clinical neurology, 3rd edition, Saunders, Elsevier, 2009, p 23-37.

7Inman, William, DVM, VOM. Technology, Couer de Alene, Idaho.

8Tuner, J and Hode, L. Laser Photo Therapy Clinical Practice and Scientific Background, Prima Books, 2014.

9Yang, C and Wang, J. “Synergistic effects of low-level laser and mesenchymal stem cells on functional recovering rats with crushed sciatic nerves”, J Tissue Eng Regen Med, 2013, 10:120-131.

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