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Veterinary rehabilitation optimizes clinical outcomes

Rehabilitation therapy for canine patients improves functional outcomes post-operatively, and helps with neurological conditions, intervertebral disc disease and soft tissue injuries.

The goal of veterinary rehabilitation is to provide pain management, promote mobility, and return a patient to the most functional outcome possible. Rehabilitation has become an important part of the treatment plan for animals recovering from orthopedic or neurological surgery and soft tissue injury, as well as for chronic osteoarthritis management, neurological conditions, and obesity management. The purpose of this article is to highlight several conditions in which rehabilitation would play an important part in optimizing a patient’s condition.

Orthopedic surgery

Femoral head ostectomy (FHO) is a surgery for which rehabilitation should be discussed and recommended to the client, preferably prior to the operation, as part of the overall treatment plan. Early postoperative rehabilitation is imperative to optimize range of motion and achieve the most functional outcome for the affected leg. This is especially important in small dogs with an FHO, since it is not uncommon for them to resist using their legs after any orthopedic surgery. In the early postoperative period (before sutures are removed), the focus is on pain management. Traditional pharmaceutical pain therapies are augmented with cryotherapy, gentle passive range of motion, and cold laser therapy. After the initial recovery period, acupuncture and musculoskeletal manipulation can help manage compensatory issues such as back pain and local hip pain. A qualified rehabilitation therapist can assist with incorporating appropriate modalities and progressing therapeutic exercises for optimal outcome. Underwater treadmill therapy is very useful in facilitating use of the limb due to the buoyancy and resistance effect of the water. The underwater treadmill is superior to swimming in recovery, because the patient is more likely to actively stretch the hip when he is walking on the treadmill; many dogs while swimming may “dangle” or not properly extend and use the hip. TPLO and MPL surgeries benefit from rehabilitation to help manage pain and encourage weight-bearing as soon as possible after surgery. Not as beneficial is the approach many clinicians take, which is to recommend rehabilitation for patients experiencing less than optimal outcomes after surgery, including not using the leg after significant time has passed, and encountering significant atrophy and loss of function. This is unfortunate as it is harder to reverse atrophy and preserve range of motion after chronic disuse. In my experience, the best benefit of rehabilitation after stifle surgery is that dogs are less likely to tear the ligament on the nonsurgical leg, which is placed under greater stress during the recovery period. Since recovery is dynamic, it is important that pain is managed thoughout the entire rehabilitation process. A supervised rehabilitation program with controlled return to function optimizes clinical outcomes.

Neurological conditions

Degenerative myelopathy is the disease that prompted me to search for options outside traditional Western medicine, to help patients cope with the devastating decline they endure without intervention. Unfortunately, many patients present after months of being administered a laundry list of medications, dietary recommendations and supplements.  Many of these supplements and dietary interventions should, in theory, prevent progression. In the integrative medicine paradigm, there is no standalone therapy for a degenerative myelopathy patient. This is a disease that truly requires an integrative approach, and early intervention with rehabilitation is critical. A study done in the Journal of Internal Medicine showed that physical rehabilitation kept patients ambulatory on an average of 255 days longer.2 A genetic test offered through the Orthopedic Federation of Animals3 looks for the genetic markers of degenerative myelopathy. If a patient is homozygous recessive, and is exhibiting signs of neurological decline and hind end weakness, it is highly likely he has the disease. If this is the case, it is critical to develop a program to manage other concomitant painful diseases that may cause pain as weak animals compensate for the degenerative myelopathy by placing stress on the spine and front end, which are overworked trying to stay ambulatory. Spinal manipulation is helpful, as is acupuncture, in managing pain for these animals. Dogs with degenerative myelopathy are often deficient from a Chinese Medical perspective, and need a conservative physical therapy program that consists of a shorter and more frequent exercise and treatment regimen. Prolonged exercise and aggressive treatment often depletes these dogs. Therapeutic exercises for proprioception and strength, along with underwater treadmill use, are key in keeping patients with degenerative myelopathy ambulatory. Consider having assistive devices at your clinic for patients with hind end weakness. These can include harnesses that support both the front and rear end (Help ‘Em Up), toe up boots (available through handicappedpets.com), and toe grips (Dr Buzby’s). Clients often struggle with fitting harnesses, and a poorly-fitted sling or harness can rub and cause sores and irritation. Helping clients choose and fit a harness is an important service we can provide.  Also, trimming nails to an appropriate length and applying toe grips is very helpful; clients appreciate assistance with this. Walking clients through recumbent dog care, including how to prevent decubital ulcers and helping with bladder expression and assisting with bowel movements, is not often thought of, but it’s an important part of helping clients cope with the degenerative myelopathy towards the end. Most importantly, despite the plethora of supplements with antioxidant and neuro-protectant qualities that have been recommended for patients with presumptive degenerative myelopathy, the one modality that stands out for making a significant difference is physical rehabilitation.

Intervertebral disc disease

Dogs with intervertebral disc disease come in a diverse variety of presentations:
  1. For the acutely painful dog without proprioceptive deficits, consideration should be given to nonsteroidal anti-inflammatories and gabapentin. Cold laser is helpful in managing both acutely painful dogs and those with chronic pain. Care must be given when one is considering musculoskeletal manipulation at acutely affected sites. Acupuncture and electroacupuncture are helpful in managing the acutely painful patient.
  2. Owners of painful dogs with rapid proprioceptive decline must be aware that surgery is a consideration. Dogs that had surgery and received electroacupuncture and Western medicine recovered faster than those that received electroacupuncture alone.4 Cold laser in the postoperative period is helpful for healing the incision, and for pain management.
  3. It is possible to help a patient with no deep pain to achieve spinal walking, but the majority will not walk again without surgical intervention. These dogs are good candidates for carts. Assisting clients with making measurements and fitting carts is a useful service to offer. As mentioned above, a poorly-fitted cart leads to skin chafing and improper biomechanics that may cause discomfort.
It is also important to address diet in patients with intervertebral disc disease as they are often on restricted activity and more likely to gain weight during this time. Switching from a higher-carbohydrate processed kibble diet to a raw or home-cooked balanced diet is helpful. Consideration should be given to cutting daily calories fed by 25% to 30%. Omega 3 fatty acids should be considered. Along with traditional pain management (gabapentin and nonsteroidal anti-inflammatories), numerous anti-inflammatory herbal formulas contain herbs such as boswellia and curcumin. Traditional Chinese medical formulas include Acute and Chronic Back formulas from Evergreen, and Jingtang Herbs Double P formula. Pulse Magnetic Therapy is being used more and more for patients with intervertebral disc disease.

Soft tissue injuries

Veterinarians and physical therapists trained in animal rehabilitation focus heavily on pinpointing the specific soft tissues involved in an injury, so that a targeted program can be implemented. This contrasts to the old school approach of “cage rest” for a generic diagnosis of soft tissue injury. While cage rest is an important part of rehabilitation, what’s more important is incorporating controlled activity designed to help with healing, pain management and preservation of range of motion. There is a fine balance between encouraging a gradual return to function and offsetting the development of scar tissue, disuse atrophy and compensatory changes as a result of the injury. Often there are subluxations present in the spine as the animal compensates for soft tissue injury.  Weakness or injury to an extremity creates a high likelihood that the animal will sustain an injury to his core trying to compensate for the injury.

Common soft tissue injuries seen in active dogs and canine athletes

Following are some of many soft tissue injuries, along with their most common presentations: Carpal laxity:  Hyperextension at the carpus can present with varying degrees of pain, and dogs that perform in flyball and agility are predisposed. Carpal support wraps help dogs with instability. Bicipital tenosynovitis, supraspinatus tendinopathy and medial shoulder instability: These injuries result from repetitive activities and overuse of the limb. Modalities such as ultrasound, shock wave, cold laser, platelet rich plasma and stem cell therapy are utilized to facilitate healing. Home exercises are designed to challenge the tissues after the acute phase when ice, rest and gentle massage and stretching may be the only things indicated.  Manual therapy encompasses cross friction massage and stretching, home exercises to strengthen the limb, underwater treadmill, progressing to trotting and walking downhill, and wheelbarrowing on the front legs. Iliopsoas strain: Pain occurs on extension of the hip with slight abduction and internal rotation. When one of these strains is suspected, look for other issues such as anterior cruciate ligament disease, meniscal tears, hip issues and lumbosacral disease. After the diagnosis is confirmed and the dog is comfortable with appropriate pain management, a rehabilitation program can begin. Modalities include cold laser and massage. Gentle stretching focusing on hip extension can involve an active hip stretch by having the dogs’ paws up on a surface and luring him forward to open the hip. Core strengthening exercises may also be prescribed. Anterior cruciate ligament tear: Rehabilitation should be considered for dogs with partial tears if surgery is not an option. The best outcome is likely in dogs that weight than 45 pounds. Dogs that are poor surgical candidates may benefit from a custom brace. Trauma to toes: Don’t forget to look at toes as a source of lameness, especially in athletes that turn tight; longer nails can catch on equipment and surfaces when dogs dig in to turn.  Also look at the pads closely for corns.

Learning more about veterinary rehab

As with many areas of integrative medicine, there is no single cookbook protocol to rehabilitating a patient. Veterinarians, veterinary technicians and physical therapists pursue advanced training in rehabilitation to better understand what is appropriate for each individual dog’s situation. For those interested, advanced training may be pursued through the Healing Oasis Wellness Center, the University of Tennessee Northwest Seminars, and the Canine Rehabilitation Institute. In conclusion, rehabilitation therapy has proven to be safe and effective for improving functional outcomes post-operatively, for neurological rehabilitation, and soft tissue injuries. Physical therapy has long been the standard of care for these conditions in human medicine versus the veterinary medicine approach of forced rest. While there is always a place for crate rest, incorporating rehabilitation as a part of our treatment plan speeds healing and provides improved chances for long-term mobility.

References

“Safety and functional outcomes associated with short-term rehabilitation therapy in the post-operative management of tibial plateau leveling osteotomy”. Canadian Veterinary Journal. 2015 Volume 56:942-946. ofa.org/diseases/dna-tested-diseases/dm I Kathmann, S. Cizinauskas, MG Doherr, et.al. “Daily controlled physiotherapy increases survival time in dogs with suspected degenerative myelopathy”. J Vet In Medicine. 2006 July-August;20(4): 927-32.  Jean GF Joaquin, Stelio PL Luna, Juliana T Brondani, et al. “Comparison of decompressive surgery, electroacupuncture and decompressive surgery followed by electroacupuncture for the treatment of dogs with intervertebral dis disease with long-standing severe neurologic deficits”. J Am Vet Med Assoc. June 2010;236:1225-1229.




A successful and healthy veterinary practice using an indigenous healers’ approach

How integrating the idea of Shamanism into veterinary practice addresses the emotional and spiritual aspects of healing.

Most of us will agree that the word “stress” has acquired new meanings that go far beyond what it meant even ten years ago. In veterinary medicine, stress has a major impact, and compassion fatigue and burnout continue to make headlines. Stress is known to lead to a number of chronic illnesses in people. Of course, animals can be affected by stress too, and not just due to their own issues. Because we are so strongly connected to our animals, they can become overwhelmed and even ill because of our stress. Handling this in a positive way is part of the focus of our practice.

Addressing emotional-spiritual health

The emotional-spiritual aspect of health is often neglected, and may cause frustration for both clients and doctors, especially when improvement does not occur as quickly as expected. In our practice -- which is made up in large part of animals with chronic illnesses such as cancer, arthritis, skin issues and allergies of all types – clients come from all over the state. Understandably, they are eager for their companion animals to be healed, but we often see them expressing anger or a lack of understanding regarding the emotional-spiritual components of disease. They don’t yet understand that disease is not just a physical manifestation of symptoms, and that there may be other underlying issues. Our interconnectedness with the wholeness of life is sometimes easy for us to forget in our busy lives. It seems esoteric, but our connection to plants and animals, and to nature, is inherently part of us as a human species. It is in our DNA. Our ancestors did not separate themselves from this wisdom; in fact, the ancient practice of Shamanism, which crossed many cultures, honored this belief system. So how can the idea of Shamanism be integrated into veterinary practice, as a way to address the emotional and spiritual components of healing? Let’s take a closer look at the principles of this ancient practice, and how some are still relevant today.

Principles of Shamanism

Shamanism in indigenous cultures around the world dates back at least 5,000 years, and is universal in its principles. According to Sandra Ingerman, a biologist, shamanic practitioner and teacher, all shamanic practices have several beliefs in common:
  1. Everything is alive and has spirit.
  2. Humans can talk to and communicate with the spirit in all things.
  3. Shamans are able to communicate with plants and animals in diverse ways, which taught early humans about healing and medicine.
  4. There is a relationship between humans and the spirit of all beings.
How does this inform the healing treatments of our primarily dog and cat patients? Animals communicate all the time, with each other, the world, their guardians and with us as healers. Creating a space that emotionally supports and honors an animal’s message is very important, and when clients embrace this, we help them create a space for healing in their own lives, as well as that of their dogs or cats. How does this translate into practice?

Incorporating Shamanism into the exam room

At our hospital, we create a sacred space to give clients and patients a place to breathe, relax and feel safe. Our exam rooms are adorned with photographs and talismans from our ancestral lineages, both Native American and Celtic. Representations of power animals and helping spirits hang on walls. Clients can rest on a carpeted area with their animals, or on cushions and comfortable furniture in all the exam rooms. Gentle music, soothing colors and essential oil diffusers help set the tone for a healing atmosphere.

Using energy work to address emotional healing

In addition to creating healing surroundings, we use energy work, including acupuncture, laser, Healing Touch for Animals™, and Reiki, and/or remedies such as herbs, flower essences, homeopathy and essential oils, to match the energy of the patient. If an animal’s energy is severely depleted, careful steps are taken to not overwhelm his system. Initially, only one or two modalities will be chosen until improvement is seen. A great deal of trust is involved in this approach, and guardians come to understand and build on that relationship of trust -- even if the healing is an honoring of the end of life.

Relationship between pet health and client life changes

When educating our clients about this approach, we teach them to recognize their own part in it, and to view their situation with compassion. The ability to recognize the prevailing energy in our fellow humans, and connect with them as we share a space, is critical. This allows the process of healing to begin. Incorporating some of the principles of indigenous healing into veterinary practice helps open the door to the connection between physical, emotional and spiritual health.

7 things you can do every day for health and well-being

By improving your own health and well-being, you can offer the best to your patients. Here are some tips:
  1. Set boundaries. Take a one- to two-hour lunch and don’t eat at your desk. Take the time to nurture yourself.
  2. Be in nature. Go outside and breathe, feel the grass, listen to the blowing leaves.
  3. Take even a few minutes to close your eyes, breathe deeply, still your thoughts or just notice them like clouds floating by, with no attachment.
  4. Call in your helping spirits, your power animals, your angels, etc. Create a connection to the vast knowledge that is available to us all the time.
  5. Be grateful. Give thanks for the ability to help others.
  6. Forgive yourself for past mistakes.
  7. Listen to your inner voice. We all know how intuition has guided our actions for the better.

References

Polizzi N. The Sacred Science, An Ancient Healing Path for the Modern World, 2018. Ingerman S. Awakening to the Spirit World: The Shamanic Path of Direct Revelation, 2015, sandraingerman.com.




Herbal support for geriatric animals

Health issues, from cognitive to musculoskeletal to cardiovascular, often arise in our geriatric patients. Herbs offer beneficial affects to a variety of body systems to help prevent these problems.

Gerontology is the study of declining function as an individual ages. The big picture approach to geriatric health in veterinary medicine involves supporting the ongoing effort to maintain and repair body tissues as they become more and more inefficient. A variety of herbs can play an important role in the mitigation of aging in veterinary patients.

Causes of age-related illnesses

There are many theories of aging. According to an Anatomy & Physiology textbook1 used to teach OMD (Oriental Medical Doctor) students, aging from a Western perspective may be caused by one or a combination of the following:
  1. Limit on cell reproduction
  2. Nutrition, injury, disease and environmental factors (epigenetics)
  3. Slow-acting “aging” viruses
  4. The “aging” genes that regulate apoptosis or other cell functions (pre-programmed aging)
  5. Autoimmunity, when the immune system attacks its own tissues
  6. Mitochondrial degeneration, which means less ATP and an increase in free radical production.

The prevention of aging

Western and Traditional Chinese herbs have a strong tradition of increasing longevity and preventing aging. For centuries, they have been used as elixirs of longevity. Western herbal supplements are now routinely started in older patients; an example is the use of glucosamine for the prevention and palliation of arthritic symptoms. What more could we start recommending to our animal patients to delay the aging process before symptoms arise? Many body systems will begin to show wear and tear as animals age. The integrative veterinarian can slow this “inevitable” decline by choosing from an herbal smorgasbord of system-supportive ingredients. The primary systems needing support in aging pet include:

Cognition/special senses

Poor cognition in many pets will manifest as abnormal gaits, vocalization or incontinence, and may even be overlooked as a primary cause. Herbal preparations like Ginko biloba, Rhodiola rosea or Bacopa monniera should be part of a preventative program. Special senses like hearing, sight or even smell may diminish and suffer poor repair, declining slowly and unnoticed. Antioxidants play a major role in slowing aging within all tissues, especially the special senses.

Neuroendocrine/adrenal

Neuroendocrine and adrenal support is crucial to a healthily functioning autonomic nervous system. Rhodiola rose, Panex ginseng, Ashwagandha and Eleutherococcous can support the overall system of regulation and control. Use tonic herbal blends for everyday support and repair.

Free radical damage/mitochondrial

Free radical prevention and repair is crucial to the anti-aging process. Mitochondrial support is needed to continue supplying an ample amount of ATP, or “Chi” for the body. Herbs like bilberry, milk thistle, grape seed extract, green tea extract and lycopene taken as prophylactics can both prevent and repair the decline in these aging mechanisms.

Cardiovascular

Support can delay congestive heart disease, even in inherited mitral murmur cases. Feed the organ system vital nutrients in the form of herbs such as lycopene, hawthorn berry, Astragulus and Coleus forskolii.

Immune

The immune system is often treated as overactive, using immunosuppressive drugs. Adaptagenic herbs like green tea extract, Astragalus, Larch arabinogalactian and a variety of medicinal mushrooms can support an often-overloaded immune system.

Hepatic/detoxification management

Support is crucial for keeping waste products from building up in the body. Many pets are subjected to multiple pharmaceutical and chemical products throughout their lifetimes, which stresses these pathways. Gentle herbal tonics like green tea, turmeric, dandelion and milk thistle can repair and keep these systems operational.

Gastrointestinal

The gastrointestinal system is subjected to a variety of foods, often not from the diet of natural selection, so it can become less and less functional as the years pass. Chronic inflammation in the digestive tract can lead to malabsorption, maldigestion, cancer and many other GI mishaps. How many pets are put down because of digestive issues like anorexia and chronic diarrhea? Administration of herbs like marshmallow, rosemary, cinnamon, ginger and slippery elm, along with antioxidants can increase the health of pets significantly. Many other microbiome-supporting supplements can be very beneficial.

Musculoskeletal/connective tissue

Supporting these tissues with herbs like boswellia and turmeric may enhance the properties of glucosamine products and Adequen®.

Renal

The renal system is often neglected, yet in most humans, over 50% of functioning nephrons are lost by the age of 50.2 The kidneys serve as the organ of excretion for the majority of pharmaceuticals used over the lifespan of our patients, aging the nephrons even faster. Supportive herbs include Rheum officinale, Codonopsis and Eleutherococcous.

Top 3 aging issues most likely to lead to euthanasia

  1. Anorexia of aging/wasting disease
  2. Lack of energy/disorientation
  3. Musculoskeletal deterioration

Top 10 herbs for longevity and preventative medicine programs

1. Rosemary

Rosemary has positive effects on appetite, memory and hair growth. Processing meats at high temperatures (especially for dry food) creates HCAs (heterocyclic amines), potent carcinogens implicated in several cancers. HCA levels are significantly reduced when rosemary extract is mixed into beef before cooking, say Kansas State University researchers. "Rosemary contains carnosol and rosemarinic acid, two powerful antioxidants that destroy the HCAs," explains lead researcher J. Scott Smith, PhD.3 Rosemary extract helps prevent carcinogens that enter the body from binding with DNA, the first step in tumor formation, according to several animal studies. “Rosemary has shown a lot of cancer-protective potential,” says study author Keith W. Singletary, PhD.4

2. Turmeric

Turmeric is a strong antioxidant for the GI system and helps prevent gastritis and arthritis symptoms. Turmeric contains curcumin, a powerful anti-inflammatory that works similarly to Cox-2 inhibitors, drugs which reduce the Cox-2 enzyme that causes the pain and swelling of arthritis.5 According to a small clinical trial conducted by the Johns Hopkins University School of Medicine, curcumin can help shrink precancerous lesions known as colon polyps.6 Researchers at UCLA also found that curcumin helps clear the brain of the plaques characteristic of Alzheimer’s disease.7 Both these studies indicate anti-inflammatory properties tissue-wide. More studies need to take place in animals to fully substantiate these correlations.

3. Ginger

Ginger affects metabolic vigor and tonifies digestion. A powerful antioxidant, ginger works by blocking the effects of serotonin, a chemical produced by both the brain and stomach when you're nauseated, and by stopping the production of free radicals, another cause of upset in the stomach.8

4. Rhodiola rosea

Rhodiola rosea is helpful in maintaining muscle mass.9 This herb is also used for fatigue, poor attention span and decreased memory. A review published in the American Botanical Council’s journal reported that numerous studies in humans, animals, and in cells have shown that Rhodiola helps prevent fatigue, stress and the damaging effects of oxygen deprivation. The evidence suggests that Rhodiola has an antioxidant effect and enhances immune system function.10

5. Cordyceps sinensus

According to Andrew Weil, MD,11  Cordyceps sinensus is used as a tonic and restorative. This Chinese fungus can help overcome general weakness and fatigue and increase physical stamina, mental energy, vigor and longevity.

6. Eleutherococcus senticosus

Eleutherococcus senticosuscan help address lethargy, fatigue and low stamina, according to Dr. Weil.12 Both Cordyceps and Eleutherococcus have a long history of use in TCM.

7. Milk thistle

Milk thistle extracts have been used as traditional herbal medicine remedies for almost 2,000 years. Milk thistle contains high levels of bioflavonoids that increase immunity and slow down oxidative stress. The herb is also used for its anti-inflammatory properties. It can aid digestive function, increase bile production, boost skin health, fight the appearance of aging and help detoxify the body. A review of clinical trials evaluating the safety and efficacy of milk thistle found that it has protective effects in certain types of cancer; data shows it can also be used for patients with liver diseases and hepatitis. Milk thistle extracts are known to be safe and well-tolerated.13

8. Green tea extract

Studies have shown that tea polyphenols offer a protective effect against free radicals, cardiovascular damage, some cancers and infections.

9. Boswellia

Boswellia is known to reduce pain and inflammation in both the joints and tendon and ligament attachments. It is also known to strengthen connective tissue resiliency. Boswellia serrata offers many benefits, such as reducing body inflammation and helping to treat conditions like osteoarthritis, rheumatoid arthritisand inflammatory bowel disease. It's also a painkiller, and can help inhibit cartilage l Boswellia can be used to alleviate asthma and may have protective effects against diseases like leukemia and breast cancer.14

10. Ashwagndha and Astragalus

These are adaptogenic herbs. In TCM, Astragalus is used as an immune adaptogen. It is strongly antioxidant, antimicrobial and heart protective. Ashwagandha is used in Ayurvedic medicine for its high antioxidant levels and infection-fighting properties, and is also used to address depression and reduce the effects of stress. In addition to the herbs discussed above, nutritional supplements like CoQ10, probiotics and vitamin D3, as well as TCVM herbal tonics like Liu Wei Di Huang Wan or Sheng Mai San, are routinely used in longevity medicine. The best cure for aging issues is prevention, so offer these herbs and supplements to your clients early on.

Look for quality products

Herbal supplements are classified as dietary supplements by the U.S Dietary Supplement Health and Education Act, which means they’re not tested to prove their safety and efficacy, unlike prescription drugs. Some manufacturers sell herbal products that aren’t completely pure. When buying herbs, investigate the company’s GMP and QC. This ensures you get high quality products that aren’t weakened with less expensive additives, or grown with pesticides or contaminated with heavy metals. Botanical medicine may also cause allergic reactions or interact with conventional drugs.

References

1Patton and Thibodeau. Anatomy & Physiology, 8th edition, Elsevier 2013. Pages 1118-1119. 2Patton and Thibodeau. Anatomy & Physiology, 8th edition, Elsevier 2013. Page 1120. 3Kanithaporn Puangsombat and J. Scott Smith. “Inhibition of Heterocyclic Amine Formation in Beef Patties by Ethanolic Extracts of Rosemary”, Journal of Food Science, 75, 2, (T40). 4Keith W. Singletary, Joan T. Rokusek. “Tissue-specific enhancement of xenobiotic detoxification enzymes in mice by dietary rosemary extract”. Feb 1997, Plant Foods for Human Nutrition. 5Prevention Magazine, June 2007, Page 195. 6“Curcumin in Treating Patients With Familial Adenomatous Polyposis”. National Cancer Institute (NCI), Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, Maryland, United States, 21287, September 2017. 7Prevention Magazine, June 2007, Page 195. 8Suzanna Zick.Can Ginger Ale Really Soothe Nausea?” The Atlantic, October 30, 2016. 9Frank Mayer, et al. “The Intensity and Effects of Strength Training in the Elderly”. Deutsches Aerzteblatt international, May 2011 DOI: 10.3238/arztebl.2011.0359. 10Richard P. Brown, Patricia L. Gerbarg, Zakir Ramazanov.Rhodiola rosea: A Phytomedicinal Overview” HerbalGram. 2002; 56:40-52 American Botanical Council. 11Andrew Weil MD, drweil.com/vitamins-supplements-herbs/herbs/cordyceps/. 12Andrew Weil MD, drweil.com/vitamins-supplements-herbs/herbs/siberian-ginseng/. 13Andrew Weil MD, drweil.com/vitamins-supplements-herbs/herbs/milk-thistle/. 14Dr. Mercola, articles.mercola.com/herbs-spices/boswellia.aspx.




Hospice home care products for pets

From mobility support to hygiene to pain management, these hospice products help improve quality of life for palliative patients at home.

A pet’s end-of-life journey can be extremely taxing for the client, both emotionally and physically. People are concerned about the suffering their pets may experience, and want to extend and improve their quality of life for as long as possible. We often see clients shift their approach from cure to comfort, with a focus on care from the time of a terminal diagnosis until the end of the patient’s life. A growing niche in veterinary medicine focuses on hospice and palliative care within a home-based setting. Clients are asking for a transition to home-based end-of-life (EOL) care – at this point, they no longer want to take their pets to a brick-and-mortar veterinary hospital. They may have already received a terminal diagnosis, or have seen such a decline in their pets’ quality of life that they just want to “keep him home and comfortable”. The growing trend towards in-home hospice and palliative care has generated a surge in products designed to improve a pet’s quality of life and aid in the management of his care.

Benefits of in-home care

There are many benefits to in-home care -- the most significant being a reduction in stress for the patient. A pet is naturally more comfortable in his home environment and, as a veterinarian, I can more accurately assess his comfort or pain without the added stress caused by transport to a veterinary clinic. I can also assess the pet’s environment and make recommendations for improving his comfort, while at the same time helping to ease some of the challenges an owner may face with EOL care.

Mobility support

Mobility issues are among the most common concerns we see in our aging canine population, whether due to osteoarthritis, neurological conditions/degeneration or other disease processes. Any non-carpeted areas in the home can be a challenge to navigate and increase the risk of injury. There are many products on the market to help with mobility – the best will be dependent on the pet’s environment and his tolerance level. For example, dogs who hate having their feet touched may not be candidates for certain footwear or related products. I have found the following to be very helpful:

1. Slip preventives

a) Buzby’s Toe Grips for Dogs – These small, durable rubber rings fit onto a dog’s toenails. The rubber engages with the floor, giving traction for the paw. A small dab of super glue may be applied to the Toe Grips for added security in pups who drag their feet. b) Pawfriction – This non-toxic adhesive is applied to the pads of the feet to prevent slipping on floors. It is easy to apply and well-tolerated by dogs. The frequency of reapplication will depend on the dog’s activity.

2. Harnesses

a) Help ‘Em Up Harness – This harness is not only comfortable for the dog, but is easy and comfortable for the owner to use. Front and back harnesses may be used separately or together. Definitely one of my favorite mobility aids. b) The Walk About Back End Harness — Another tried-and-true harness that’s helpful for dogs with limited hind end mobility. With any harness or sling-type product, care must be used when fitting the dog, and frequent checks made to watch for any rubbing or sores.

3. Wheelchairs/carts

While wheelchairs may not be for everyone, they can provide both physical and mental stimulation for some dogs, which can be invaluable. a) K9 Carts and Eddie’s Wheels – Both these companies offers durable high quality carts and wheelchairs for dogs. b) Handicappedpets.com — For times when a pet is not in a cart or wheelchair, the Drag Bag protects the hind limbs and chest from scraping against the ground. Incidentally, HandicappedPets.com is a wonderful resource for both veterinarians and clients; the website features many products to help pets and owners with a variety of conditions that affect aging animals.

4. Strollers

Mental stimulation is so important for aging pets. For dogs who can no longer go for walks, a stroller-type product can help get them outside for fresh air and mental stimulation. A growing number of products with different features and price ranges are available to dog owners. a) Booyah – This company makes several different types of pet stroller. b) Pet Gear – They also have a variety of strollers, along with other products such as ramps and stairs that may be helpful for dogs with limited mobility.

5. Footwear

For dogs that will tolerate footwear, a number of options may help in a variety of environments. Not only are we concerned with slipping on smooth surfaces, but we also need to protect the feet from dragging wounds or pressure sores. It’s important that clients realize they need to monitor the condition of their pets’ feet and not leave the booties/socks on for extended periods of time. a) Neopaws and Woodrow Wear – Both these companies make reliable products.

6. Mats and rugs

Many homes with geriatric dogs have an assortment of non-slip carpet runners and rugs across the floors to prevent slipping. Interlocking foam squares/tiles may be helpful, since their design allows them to go around corners, down hallways, etc. As a bonus, they are easy to clean. You can find them online or in home improvement box stores. Strategically-placed mats or non-slip rugs are helpful not only for navigating slippery floors, but also for jumping up and off of furniture. A well-placed mat or rug sometimes gives a pet enough confidence to jump on and off his favorite chair.

7. Navigational aids

We often see challenges in patients who are blind and have difficulty navigating their environments. Muffin’s Halo Guide for blind dogs is an aid that helps blind dogs maneuver without risk of injury. Tracerz are scent-based markers used to help a blind dog navigate his surroundings and reduce confusion within the home.

Pain management

While not home hospice products per se, integrative therapies are invaluable when managing palliative care in companion animals.
  • I have found that animals are quicker to relax during acupuncture treatments when they’re at home instead of a brick-and-mortar practice. I try to integrate acupuncture into the majority of my hospice cases.
  • Laser therapy is another valuable tool for managing pain. With proper training, in fact, small handheld laser units may be rented to the owner to allow for more frequent laser therapy sessions.
  • Using pulsed electromagnetic field therapy, the Assisi Loop can also be an important tool in the pain management toolbox. It’s also something that clients can use at home on their own.

Cognitive dysfunction, anxiety and sleep disturbances

These problems affect a large number of our geriatric patients and become a quality of life issue, not only for the pet, but for the human family as well. While many medications and supplements may help manage these issues, some in-home products are also useful. Anxiety may arise from a combination of senility and loss of senses. Any time we see symptoms of anxiety and cognitive dysfunction, it’s also important that we reassess pain management to rule out discomfort as a contribution to the behaviors. Pheromone-containing products such as Feliway for cats and Adaptil for dogs may help ease anxiety and are available in a number of different forms (sprays, diffusers, collars, etc.). As pets age, they may undergo a change in sleeping preferences and habits. Seeing a pet curled up in a cozy bed is very comforting to a client. The choices in bed styles, shapes and price points seem endless, so it’s helpful for us as veterinarians to offer clients guidance in selecting beds based on the needs of their pets. I have seen many situations where an owner is disappointed because their geriatric dog won’t use the fancy 0 orthopedic memory foam dog bed they purchased for him. It may be that the dog finds it difficult to navigate the bed; he doesn’t feel steady walking on it to lie down, so he often lies on the floor instead. A thinner bed may actually be more comfortable for these dogs. Temperature may also dictate where a pet chooses to sleep; many dogs seek heat or coolness and many old kitties prefer warmth. K&H produces a variety of cooling and heated beds for both dogs and cats. Some of the heating beds are pressure sensitive so will only warm up when the animal is on the bed. I love recommending these beds to owners who have thin, geriatric cats.

Hygiene concerns

Hygiene can be an issue in aging pets for a variety of reasons. Fecal and urinary incontinence, inappropriate elimination, pressure sores and tumors may all compromise hygiene. Educating clients on the care of wounds and sores is critical in managing these cases. A variety of diapers and belly bands are available for dogs. When using diapers for fecal incontinence, or for female dogs in general, care must be taken to keep the surrounding hair and skin as clean and dry as possible, to prevent urine scald or infection. HandicappedPets.com has a wide variety of diapers and belly bands to keep pets clean. They also offer the SleepPee bed for incontinent dogs. The design helps keep these dogs clean and dry as they sleep. We may also see inappropriate elimination in feline patients due to disease processes such as kidney failure or diabetes, as well as mobility constraints. The old kitty who has trouble going up and down stairs may need access to a litter box on all levels of the house. Sometimes, cutting down the side of the litter box can make it easier for the cat to get in and out.

Conclusion

I have had general care veterinarians ask me how I deal with compassion fatigue. My honest answer is that I experienced much more compassion fatigue while in general practice. As a mobile hospice/end-of-life care veterinarian, I get to see the best of the human-animal bond every single day, and experiencing it within a home-based setting makes it more intimate. And thanks to the growing number of products designed to help owners maintain and improve their pets’ quality of life, we’re able to make recommendations to sustain the bond we’re so privileged to witness.

Being a mobile hospice veterinarian

One of the biggest challenges I have faced as a mobile hospice/end-of-life care veterinarian is a lack of awareness of our services. Many people do not realize these in-home services are even an option! We have worked hard to cultivate relationships with our local primary care veterinary clinics – we want to work with them, not against them, in order to offer hospice/EOL services to their clients. The mobile hospice practice model is unique because our business needs are somewhat different from those of a general mobile veterinary practitioner. We need to send out notices of euthanasia to primary care veterinarians to let them know we helped their clients say goodbye to their pets. We need to correspond with local crematoriums to arrange aftercare for pets, and complete tasks such as sending off sympathy cards. We need to track our hospice cases based on trajectory of illness. We do not do vaccinations, so don’t need a system to send out reminder notices. A business software program called REX was specifically designed to meet all these needs for the mobile hospice/EOL care veterinarian. Desktop, tablet and iPhone versions all integrate to manage the practice. DVM Center is a specialized client support company that helps end-of-life care veterinarians answer their phones and schedule visits. They also offer social media support and startup services for veterinarians launching their own EOL care practice. The field of hospice/EOL care as a whole is growing and becoming recognized as its own specialty. In 2016, the International Association for Animal Hospice and Palliative Care (IAAHPC) launched a rigorous 16-month certification program, so veterinarians and licensed veterinary technicians may now become certified in Animal Hospice and Palliative Care. I believe this additional education and training is added assurance for primary care veterinarians that our advanced training has value for their clients and pets.




Golden yellow powder for wound healing

How golden yellow powder, an herbal medicine descended from a classical Chinese formula, helped heal a traumatic degloving wound in an Australian Shepherd.

A ten-year-old spayed female Australian Shepherd presented to the Animal Hospital of Dunedin on May 17, 2017 after suffering a traumatic degloving wound on her right rear foot. Deep tissues were exposed. After in-house laboratory values were found to be unremarkable, the dog was sedated with Dexdomitor and received an injection of Ampicillin and Rimadyl. While the dog was under sedation, it was found that a large section of tissue was missing from the site of the injury, and full closure of the wound could not be obtained. The owner declined referral for skin grafts. Lidocaine was used to block the wound site, and the area was thoroughly cleaned and debrided. Fortunately, it appeared that the deeper tissues had been spared from damage. The wound was closed using a simple interrupted suture pattern at the distal and proximal ends, as seen in Photo 1. The center of the wound was left open to heal by second intention, since it could not be closed. Before the dog woke, Golden Yellow Powder was applied to a Telfa Pad which was then bandaged to the wound. The patient was sent home with a seven-day supply of Rimadyl and a 14-day supply of Cephalexin (from a local pharmacy) with the agreement that the bandage should be changed at the hospital at least every three days, with cleaning and application of Golden Yellow Powder, until the wound healed. The first bandage change took place two days later and the wound was reported to be healing nicely. On May 23 (Photo 2), the patient was walking well, a granulation bed was forming and the tissue looked healthy. As the dog was normally highly active, the herbal formula Calm Spirit was started at this visit to quell his anxiety about being on strict rest at home. Bandage changes and applications of Golden Yellow continued on a regular basis, the wound continued to granulate in from the edges, and the dot continued to do well. The last bandage change took place on June 19 (Photo 7), about one month from the initial injury. At this time, it was decided to remove the bandage as the healing process was complete.

Herbal discussion

Golden Yellow Powder is an herbal medicine descended from Ru Yi Jin Huang San, a classical Chinese formula. Ru Yi Jin Huang San was first recorded in Wai Ke Zheng Zong, written by Chen Shi Gong during the Ming Dynasty.1 It is meant for topical use in acute inflammatory conditions accompanied by heat, swelling, pain, open wounds, and skin ulcerations, among other things.1 From a TCVM perspective, corresponding patterns are Damp-Heat, Heat Toxin, and Blood Stagnation. It is formulated in both raw powder and salve preparations. Clinical research has shown Ru Yi Jin Huang San can be effective in treating phlebitis, skin ulcers and swelling, and that it has antibacterial activity and can increase the pain threshold.1
  • The ingredient Huang Bai, when administered with Gan Cao, displays a synergistic inhibition of MRSA (Methicillin Resistant Staphylococcus Aureus), while Huang Bai alone has moderate antibacterial effects against bacteria such as Staph aureus, B-hemolytic Strep, Bacillus anthracis, Bacillus dysenteriae and Diplococcus pnuemoniae.1,2
  • Huang Lian also has a broad spectrum of antibacterial activity, against coli, Pseudomonas aeruginosa, Bordatella pertussis, Leptospira, Salmonella typhi and Mycobacterium tuberculosis, among others. It also has been shown to have anti-inflammatory and antipyretic activity.2
  • Jiang Huang addresses the pain and swelling with an injury and has a marked anti-inflammatory effect in rats.2
  • Cang Zhu and Chen Pi have been shown to have anti-inflammatory effects.1
For further ingredients, see the table below. This is an excellent case showing the benefits of using Golden Yellow Powder in the healing of a non-closed wound. The complete healing process was about one month in duration and required dedication and patience from the owner, dog and practitioner. The dog required no pain medication or antibiotic past the first prescriptions, and enjoyed an excellent quality of life during the healing process. Complications such as tissue necrosis, infection and poor healing were absent. Degloving wounds can often be fraught with complications, including delayed necrosis in tissues that may have lost blood supply, requiring repeated debridement.3 This case shows the benefits of using integrative care to achieve a quality outcome for our patients. ___________________________________________________ 1Ma, Aituan. Clinical Manual of Chinese Herbal Medicine, Ancient Art Press, Gaineville, Fl, 2016 300-301. 2Chen, John K, et al. Chinese Medical Herbology and Pharmacology, Art of Medicine Press, City of Industry, CA. 2004. 143,146, 623-624. 3The Merck Veterinary Manual, Ninth Ed, Merck & Co., Inc., Whitehouse Station, N.J., 2005. 1424.




Osteopathic approach to the equine thorax

There are many reasons why a horse may have restrictions in his thorax. As osteopaths, we know that immobility in one area can certainly influence other regions of the body.

There are many reasons why a horse may have restrictions within his thorax. Not the least of these is that the saddle may be resting on his withers. As osteopaths, we know that immobility in one area can certainly influence other regions of the body. Working on the viscera in the thorax is difficult, however, because of the anatomical restrictions. I will first explore the different anatomical features of the thorax and its closely-related structures, then speak about indications for osteopathic treatment.

Basic anatomy of a horse’s thorax

The thorax contains two lungs, separated into left and right lobes by the mediastinum. Many species have two or three lobes on each side, but horses have very small cranial lobes (a little larger on the right than the left), and one accessory lobe that is more connected to the right than the left. The heart sits cranio-ventrally and slightly to the left. It is encased in a firm double parietal pericardial layer and parietal pleural layer called the pericardial sac, which prevents the heart from getting too enlarged. Following are the borders of the thorax:
  • Dorsal: The ventral portion of the vertebrae and hypaxial muscles of the spine
  • Ventral: Sternum, costo-sternal junctions and lower ribs
  • Caudal: Diaphragm (excluding opening for aorta, vena cava and esophagus)
  • Lateral: Rib, parietal pleura and intercostal muscles
  • Cranial: Suspensory ligament of the thoracic dome and all soft tissue connections between the first ribs, pleura, first thoracic vertebrae and surrounding structures.
The heart contains a vast neural network, and secretes neuropeptides and hormones, including oxytocin. It has many more afferent than efferent fibers running to it, and appears to have some function in short and long term memory. Studies in human medicine have shown that the nervous system around the heart can independently influence the brain, and vice versa. Osteopathic approach to the equine thorax

The parietal pleura is tightly attached to the underside of the ribs and intercostal muscles. Anatomy photos courtesy of Paige Poss in conjunction and cooperation with Anatomy of the Equine.

[gallery columns="2" size="medium" ids="3957,3956"]

For the above two pictures:  A view from above plus a close-up the organs in the chest, and how they sit. Note how the diaphragm and liver are as far cranial as the seventh thoracic rib ventrally.

With the right lung removed, you can visualize the azygous vein, cranial and caudal vena cava and its branches. You can also see how the phrenic nerve travels with the mediastinal and pericardial tissues to the diaphragm. The esophagus and aorta lie further to the left and dorsal to the vena cava.

This picture shows the second rib still in place. You can imagine the cervicothoracic and medial thoracic ganglions sitting in between the first and second ribs just below the spine. The cervicothoracic ganglion (or stellate ganglion) is important for regulating blood flow to the pituitary gland and base of the brain. Large lymph nodes and vessels, the brachiocephalic trunk of the aorta, venous trunk, cardiac plexus, brachial plexus, vagus nerve, phrenic nerve and esophagus are all squeezed together in this area and surrounded by fascia that connects the parietal pleura to the scalenus muscle in the neck.

The lungs and heart have autonomic, motor and sensory innervations from the region of T 1-5, the cervical ganglions, cardiac plexus, pulmonary plexus and vagus nerve. The intercostal regions and esophagus are innervated segmentally through the thorax. Lymph vessels drain the pelvic limbs and abdomen by draining into the cisterna chyli and then travelling on the left side of the body, opposite the azygous vein, to empty into the left subclavian venous trunk and travel in to the vascular system. The right side only drains the lymph of the thorax, head and neck on the right. Restrictions affecting the left shoulder may have a greater influence on drainage of lymph from the hind limbs. The forearm covers the thorax. It also is innervated from similar segments of the spine.  The scapula and humerus cover the region of the first four or five ribs and protect the heart. The innervation and blood vessels to the forearm (brachial plexus) leave from the region of the sixth cervical to the second thoracic vertebrae. Problems in one area will affect the other. Each nerve going to the axilla (cranial pectoral, suprascapular, subscapular, thoracodorsal, axillary, musculocutaneous, median, radial and ulnar) and exiting the vertebrae from C6 to T2 has its own group of functions. Because they are so closely connected through the fascia in the brachial plexus, and also from restrictions in movement in the pleural dome,  immobility in one may affect another. Generally, the branches from C6 and C7 go the pectoral muscles, scapula and latissiumus dorsi (area of saddle/girth sensitivity behind the withers). C7 and C8 innervate the forearm and flexors of the forearm. C8 to T1 innervate the radial nerve, which stimulate the extensors of the limb. T1 and 2 is the ulnar nerve, which includes digital flexors of the limb. Many of these nerves move through the area on the forearm with the muscle bellies of these flexors. Opening the space between these muscles using fascial release can improve mobility of the fetlock, carpus, scapula and thoracic vertebrae in the withers, and the temporal mandibular joint. Superficial innervation also interconnects, including an area over the scapula that is innervated from the third and fourth thoracic spinal segments, which may indicate a possible visceral thoracic disorder. Lymphatic flow moves to the medial side of the forearm and continues into the axilla and then the thoracic duct, so it may also be influenced by restrictions in the thorax. The next area that connects with the thorax is the neck, and then the TMJ. From the pectoral region and forelimbs, we see an influence on the subclavius muscle. From the sternum, we see influence on the sternohyoideus, sternothyroideus, sternocephalicus and brachiocephalicus muscles. This will influence mobility in the hyoid, larynx, mandible and temporal bone, as well as the occiput and many others. Sympathetic cervical ganglions will influence blood flow to the head, as well as the function of the many glands in the head, the baroreceptors for the heart and more. Movement restriction in the TMJ may influence the cranial nerves exiting through the jugular foramen (CNN 9, 10, 11) and those leaving through the petrous temporal bone, such as CNN 7 (facial), that innervates the digastricus muscle and also the muscles of facial expression.

Osteopathic diagnosis and treatment

First check for structural immobility in the thoracic vertebrae, ribs, sternum and shoulder girdle. Also check more distally for restrictions in rotational movement in the forelimbs.  Palpate for mobility and motility in the lungs (pleural restrictions). I asked her how to do this. If you find disorders in this region, you may want to treat the thoracic visceral and thorax. Many times, you might find liver or stomach immobility from the restrictions in the thorax, as well as a loss of mobility in the esophagus. Pain or immobility (sometimes even lameness) associated with most caudal cervical vertebrae could be a sign of thoracic visceral involvement. Horner’s syndrome or any other autonomic nervous system signs that could be related to dysfunction of the stellate ganglion could be related. Conditions and situations treated by releasing restrictions in the thorax include:
  1. Horner’s syndrome
  2. Loss of mobility
  3. History of respiratory disease – all such horses could benefit from an examination of the pleura for mobility and motility
  4. Girthiness and resistance to saddling
  5. Resistance to going forward or downhill
  6. Lameness or imbalance in the front limbs.

Methods of treatment

Osteopathic treatment can involve direct or indirect techniques. Often, a combined approach is more effective. Myofascial release is helpful as both a diagnostic aid and therapy adjunct. The photos below show two examples of myofascial releases for the thorax and shoulder girdle: I usually follow up any myofascial releases by the structural release of any further immobilities. Adding flexion of the neck and rotation of the sternum to vertebral manipulations can make them much more effective. I believe this is because these manipulations have an indirect impact on the intrathoracic fascia and mediastinum. In young horses, treatment of the thorax with an eye to its visceral components can be very effective because it can stimulate thymus development. At any age, improving lymphatic flow and function of the organs of the thorax can help mobility and immunity. Movement of the forelimbs, neck and jaw can be improved, and manipulations of the jaw and poll can be more easily perfomed, thereby yielding longer-lasting results when combined with attention to the thorax and thoracic viscera.

References

Visceral Manipulation, Jean-Pierre Barral and Pierre Mercier.  Eastland Press 2005. Rooney’s Guide to the Dissection of the Horse, 7th edition, Orsini and Sack.  Veterinary Textbooks, 2003. Atlas of Equine Anatomy, 3rd Edition, Pasquini.  Sudz Publishing, 1991. Clinical Anatomy of the Horse, Hilary Clayton, Peter Flood and Diana Rosenstein.  Elsevier Limited, 2005. Brain Stars: Glia illuminating craniosacral therapy, Tad Wanveer.  Upledger Productions, 2015. Anatomy of the Horse 6th ed, Klaus-Dieter Budras, W.O. Sach and Sabine Rock. Schlutershe Verlagsgesellschaft, 2011. Champeroux P, Fesler P, et al. “High Frequency Autonomic Modulation:  a new model for analysis of autonomic cardiac control”, Br J of Pharmacology, 2018 May 3. Wetzler G,  Roland M, et al.  “Craniosacral Therapy and Visceral Manipulation: a New Treatment Intervention for Concussion Recovery”, Med Acupuncture. 2017 Aug1: 239-248. Castro-Sanchez AM, Mataran-Penarrocha GA, Sanchez-Labraca N, et al. “A randomized controlled trial investigating the effects of CranioSacral therapy on pain and heart rate variability in fibromyalgia patents”. Clin Rehabili. 2011;25 (1) 25-35. Roger VL. “The heart-brain connection from evidence to action” Eur Heart Journal, 2017 Nov 14;38 (43) 3229-3231. Skalec A, Egerbacher M. “The deep fascia and retinacula of the equine forelimb-structure and innervation”.  Journal of Anatomy, 2017 Sep;231 (3) 405-416.




An integrative approach to chronic kidney disease (CKD) in cats

CKD is a common but manageable condition in feline patients, and responds well to integrative medicine. Herbs and acupuncture are key therapies.

Chronic kidney disease (CKD) is a common problem in cats, and one which all veterinarians encounter in practice. An integrative approach that includes herbs and acupuncture can help treat and even reverse this condition in feline patients. CKD can be detected early through careful monitoring at annual wellness programs. IRIS (International Renal Interest Society) staging allows for the conventional staging of treatment, including any dietary changes. Key treatment strategies for feline CKD include supporting hydration, reducing phosphorus (usually through protein restriction), regulating blood pressure and controlling calcium levels. The intensity of intervention increases with disease progression.

Integrative treatment goals

Using integrative approaches to CKD, we have observed cats moving from IRIS Stages 2 and 3 to Stage 1, and remaining there for years. This reversal implies that nephrons are hypoxic and under-functioning, and that improving their functional capacity is a key goal. See below for integrative treatment goals for CKD. Herbs can optimise kidney cell function by reducing oxidative stress, improving renal blood flow and mitigating fibrosis, thereby maintaining patients in early stages for extended periods. Acupuncture, manipulative therapies and other modalities can also be a part of the integrative approach. With acute renal disease, the goals are modified to regulate/decongest the kidneys by reducing blood flow, and provide anti-inflammatory support to inflamed glomeruli. This may be a starting point with pyelonephritis, for example. Most cats, however, benefit from increased perfusion unless the renal disease is acute in onset (inflammatory).

Dietary considerations

Despite numerous experimental studies and clinical trials, questions about feeding protein to cats with chronic kidney disease (CKD) remain. What is the optimal amount of protein for a cat with CKD? How much restriction is necessary? Do different types of kidney disease require different dietary therapies? At what point in disease progression should protein restriction be implemented? Does the type of protein make a difference? Does every meal have to be restricted? Will a cat in IRIS Stage 3 or 4 benefit if phosphorus is restricted by other means? Might some cats with advanced disease benefit from increased protein levels?1 These concerns remain despite the common practice of prescribing therapeutic renal diets to cats in any stage of CKD. Integrative practitioners provide, or are requested to provide, natural feeding advice to cat owners. Excellent resources include the veterinary Diplomats in Nutrition; Balance It and several software programs that can be used for formulating diets while taking feline preferences into account. See page xx for an example of a low-phosphorus diet for cats with CKD. From an integrative perspective, real food is considered to have many benefits, including palatability for ill cats, and these benefits may outweigh those offered by processed foods. In IRIS Stage 1 and early Stage 2, the diet may not need to be modified, although serum phosphorus and the phosphorus content of the diet should be evaluated. From late Stage 2 onwards, consideration may be given to reducing protein by diluting with fat and carbohydrates.

Herbal help

Herbs can delay the onset and progression of CKD in cats by improving mitochondrial function, and providing antioxidant protection and ACE-inhibiting effects. Many herbs are anti-inflammatory, anti-fibrotic and nephroprotective, and several improve renal blood flow. A principle of herbal medicine is that formulations containing multiple plants can have greater effects than the same herbs taken separately. These synergistic effects enhance the desired action.2 Following are several herbs to be considered and included in formulas for renal treatments.

1. Rehmannia glutinosa

Rehmannia glutinosa occurs in many Chinese herbal formulas, including Rehmannia Eight Combination (Shen Qi Wan, Jin Gui Shen Qi Wan, Ba Wei Di Huang Wan), which is very useful for cats with CKD and weight loss, loss of strength, polyuria, polydipsia, and that are seeking warmth. It is also included in Zhi Bai Di Huang Wan, which is useful in cats with CKD and hyperthyroidism, particularly in those tending towards constipation, agitation and weight loss, along with polydipsia and polyuria. Rehmannia has a long history of research and effective use in CKD. In humans, studies have found that it has a 91% efficacy in reducing renal damage from nephritis, due to the enhancement of renal blood flow and glomerular filtration.3 In a model of renal ischemia, ligated rats that received Rehmannia extract showed improved renal blood flow (to near normal levels) and reduced mortality and hypertension compared to controls, through either ACE inhibition or juxtaglomerular desensitization.4 Rehmannia reduces oxidative stress and can promote red blood cell production through bone marrow stimulation; reduce serum creatinine and urinary protein excretion and glomerulosclerosis in compromised patients; and inhibit the expression of Angiotensin II as well as Type IV collagen in the renal cortex.5, 6 Fresh Rehmannia is utilised in Ba Wei Di Huang Wan and Zhi Bai Di Huang Wan. Interestingly, a recent study supports the use of fresh over prepared Rehmannia; the former acts more powerfully on attenuating interstitial fibrosis by downregulating the expressions of transforming growth factor, a smooth muscle actin, and Type 1 collagen.7

2. Astragalus membranaceus

Astragalus membranaceus is known as a Qi tonic in Chinese medicine, and as a major immune-modulating herb in Western herbal medicine. It should also be known as a major kidney herb. Its major constituent, astragaloside, ameliorates renal interstitial fibrosis in vivo by inhibiting inflammation.8 It has major antioxidant effects.9 Astragalus has been reviewed by Cochrane and was found to offer some promising effects in reducing proteinuria and increasing haemoglobin.10 Its nephroprotective effects against oxidative stress include anti-inflammatory and anti-apoptotic mechanisms.11 In a systematic review of Astragalus on diabetic nephropathy in animal models, this herb was able to reduce blood glucose and albuminuria levels and reverse the glomerular hyperfiltration state, thus ameliorating pathologic changes.12

3. Angelica sinensis

Angelica sinensis contains polysaccharides that inhibit oxidative stress injury in mouse kidneys.13 Like Astragalus, its nephroprotective effects include anti-inflammatory and anti-apoptotic mechanisms.11 Renal microvascular lesions can contribute to the progression of glomerular sclerosis and tubulo-interstitial fibrosis in chronic kidney Both Astragalus and Angelica can improve microvascular lesions by increasing local renal blood flow to lessen hypoxic renal injury, promoting the recovery of renal blood flow and glomerular filtration rate after ischemia-reperfusion; modulating the imbalance of vaso-activators such as nitric oxide and angiotensin; increasing the expression of vascular epithelial growth factor; inhibiting the release of the intracellular calcium ion; and promoting DNA synthesis in endothelial cells to improve the function of endothelial cells. The evidence suggests that both herbs may retard the progress of renal diseases through the above-mentioned mechanisms.14 In one study involving rats with an obstructive uropathy, Astragalus and Angelica were administered with Enalapril and compared to monotherapy. Enalapril with Astragalus and Angelica decreased tubulointerstitial fibrosis to a significantly greater extent than did treatment with Enalapril alone.15

4. Cinnamon

Cinnamon is readily accepted by cats and offers a mono-herbal treatment for fussy felines. It occurs in the Wei Ling Tang formula, which is useful for overweight CKD cats with proteinuria, hematuria, urolithiasis, azotemia, glomerulonephritis and pyelonephritis. Cinnamon can inhibit advanced glycation end products (AGE) and can ameliorate AGE-mediated pathogenesis in diabetic nephropathy.16 Cinnamon is a major antioxidant and anti-inflammatory spice, and has had over 178 papers published on it from 1995 to 2015.17 Cinnamon at a dose of 50 mg/kg for two weeks was given to dogs; the systolic blood pressure and heart rate in the treated dogs was significantly lower than in the normal group.18

5. Silybum marianum

Silybum marianum is one of our preeminent nephron-protective herbs. It should be considered an adjunct to ameliorative potential effects against drug-induced kidney disease, particularly in chemotherapy.19 It is also an herb that could be considered for CKD support. It is a potent antioxidant and free radical scavenger that inhibits lipid peroxidation and stabilizes cell membranes. It also increases intracellular glutathione, which plays a crucial role in the body's antioxidant capacity, and it has anti-inflammatory properties inhibiting T-cell proliferation and cytokine secretion.20 There is also evidence that Silybum has a regenerative effect on renal tissue after injury.21

Mushrooms — Ganoderma and Cordyceps

Mushrooms are well tolerated by cats when given in the form of powders or concentrated tinctures added to food. Ganoderma lucidum is a medicinal mushroom that has been widely used in China and Japan for hundreds of years for its immune-modulating, anti-inflammatory and anti-tumor effects. Ganoderma compounds are renoprotective.22.The active peptide in Ganoderma counteracts oxidative stress from renal ischemia, and in an animal model of diabetic nephropathies has renal protective effects.23 Likewise, Cordyceps sinensis is extensively used by Chinese physicians to treat chronic renal diseases and to stimulate the immune system. It also displays anti-oxidative activities. It is commonly used in renal transplant patients; it has been shown to significantly improve renal fibrosis.24

Acupuncture and moxibustion

A recent single blinded randomized controlled study in patients with CKD showed that acupuncture at bilateral LI4, ST36 and KI3, and electroacupuncture to right ST36 and KI3 and left ST36 and KI3, once a week for 12 weeks, led to reduced creatinine levels and increased glomerular filtration rates.25 Moxibustion at Bl 23 in patients with CKD reduced renal vascular resistance.26 Most of the benefits that acupuncture offers in renal failure are undoubtedly due to the ability of these points to manipulate blood flow. Local blood flow is manipulated using BL23, BL22 and GB25, while systemic blood flow is manipulated with GB34, BL40 and KI3. Systemic blood flow greatly impacts renal function. Peripheral vasoconstriction can be induced to drive more blood to the kidneys. Peripheral vaso-relaxation can be induced to decongest the kidneys. For animals in Stage II renal failure (using the IRIS classification system), and particularly where UPC ratios are greater than 2.5, use GB25, BL22 and GB34. These animals will typically have benefited from hypotensive drugs and low-protein diets, but won’t show an immediate improvement from fluid therapy. For animals in Stage I renal failure, or where UPC ratios are less than 2 to 2.5, use KI3, BL40 and BL23. These animals will typically not benefit from low-protein diets and hypotensive drugs, but will show an overt improvement from fluids.27

Integrative treatment goals for feline CKD

  • Mitigate oxidative stress by using antioxidant herbs
  • Improve renal perfusion (in most cases)
  • Prevent fibrosis, which is a natural consequence of renal disease
  • Optimise systemic health and well-being

Example of a low-phosphorus diet for cats with CKD

  • 50 grams or ¼ cup pearl barley
  • 200 grams raw chicken breast meat
  • 10 grams chicken liver
  • 1 large egg yolk
  • 2 cups raw sweet potato
  • 4 teaspoons salmon oil plus 4 teaspoons flaxseed oil
Cook barley, sweet potato, chicken and liver are on low heat with water. When warm, mix in egg yolk to lightly cook it (and preserve the choline). When cool, the recipe is divided into four meals (average 250 kcals) with the addition of 1 teaspoon of salmon oil and 1 teaspoon of flaxseed oil daily. The meals are divided. The whole recipe provides 1,029 kcal, 36% carb, 40% fat, 24% protein and 724 mg of phosphorus. It needs to be supplemented as it is low in a number of minerals and vitamins, and is still low in choline. Any supplement added should be evaluated for its phosphorus content. This should demonstrate the complexity of balancing diets. Another excellent strategy is to have several recipes and vary the composition of diets over time. More protein can be utilised alongside phosphorus binders in later stages of kidney disease.

Conclusion

Chronic kidney disease in cats is a manageable condition that responds well to integrative medicine. In the author’s experience herbal medicine and acupuncture are key. Many integrative practitioners have reported success with other additional therapies, including homeopathy, cell salts, flower essences and osteopathy.

References

1Larsen JA. “Controversies in Veterinary Nephrology: Differing Viewpoints: Role of Dietary Protein in the Management of Feline Chronic Kidney Disease”. Vet Clin North Am Small Anim Pract. 2016 Nov;46(6):1095-8. 2Bangar OP, Jarald EE, Asghar S, Ahmad S. “Antidiabetic activity of a polyherbal formulation (Karnim Plus)[J]”. Int J Green Pharm, 2009, 3(3) : 211-214. 3Su ZZ, He YY, Chen G. “Clinical and experimental study on effects of man-shen-ling oral liquid in the treatment of 100 cases of chronic nephritis”. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih. 1993;13(5): 259–260,269–272. 4Yi NY, Chu W, Koang NK. “Pharmacologic studies on Liu Wei Di Huang Wan: its action on kidney function and blood pressure of rats with renal hypertension”. Chin Med J-Peking. 1965;84(7):433–436. 5Yuan Y, Hou S, Lian T, Han Y. “Rehmannia glutinosa promotes the recovery of RBC and Hb levels in hemorrhagic anemia by promoting multiplication and differentiation of CFU-S and CFU-E bone marrow cell line”. Chung Kuo Chung Yao Tsa Chih. 1992;17(6):366–368. 6Lee BC, Choi JB, Cho HJ, Kim YS. “Rehmannia glutinosa ameliorates the progressive renal failure induced by 5/6 nephrectomy”. J Ethnopharmacol. 2009;122(1):131–135. 7Liu DG, Zeng M, Gao HY, et al. “Rehmanniae Radix and Rehmanniae Radix Praeparata Ameliorates Renal Interstitial Fibrosis Induced by Unilateral Ureteral Occlusion in Rats and Their Mechanism”. Zhong Yao Cai. 2015 Dec;38(12):2507-10. 8Zhou X1, Sun X1, Gong X1. “Astragaloside IV from Astragalus membranaceus ameliorates renal interstitial fibrosis by inhibiting inflammation via TLR4/NF-кB in vivo and in vitro”. Int Immunopharmacol. 2017 Jan;42:18-24. 9Shahzad M, Shabbir A, Wojcikowski K. “The Antioxidant Effects of Radix Astragali (Astragalus membranaceus and Related Species) in Protecting Tissues from Injury and Disease”. Curr Drug Targets. 2016;17(12):1331-40. 10Zhang HW1, Lin ZX, Xu C, et al. “Astragalus (a traditional Chinese medicine) for treating chronic kidney disease”. Cochrane Database Syst Rev. 2014 Oct 22;(10):CD008369. 11Shahzad M1, Small DM2, Morais C. “Protection against oxidative stress-induced apoptosis in kidney epithelium by Angelica and Astragalus”. J Ethnopharmacol. 2016 Feb 17;179:412-9. 12Zhang J1, Xie X, Li C, et al. “Systematic review of the renal protective effect of Astragalus membranaceus (root) on diabetic nephropathy in animal models”. J Ethnopharmacol. 2009 Nov 12;126(2):189-96. 13Fan YL, Xia JY, Jia DY. “Protective effect of Angelica sinensis polysaccharides on subacute renal damages induced by D-galactose in mice and its mechanism”. Zhongguo Zhong Yao Za Zhi. 2015 Nov;40(21):4229-33. [Article in Chinese]. 14Song JY1, Meng LQ, Li XM. “Therapeutic application and prospect of Astragalus membranaceus and Angelica sinensis in treating renal microvascular lesions”. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2008 Sep;28(9):859-61.[Article in Chinese]. 15Wojcikowski K1, Wohlmuth H, Johnson DW. “Effect of Astragalus membranaceus and Angelica sinensis combined with Enalapril in rats with obstructive uropathy”. Phytother Res. 2010 Jun;24(6):875-84. 16Muthenna P1, Raghu G1, Kumar PA, et al. “Effect of cinnamon and its procyanidin-B2 enriched fraction on diabetic nephropathy in rats”. Chem Biol Interact. 2014 Oct 5;222:68-76. 17Mollazadeh H1, Hosseinzadeh H2. “Cinnamon effects on metabolic syndrome: a review based on its mechanisms”. Iran J Basic Med Sci. 2016 Dec;19(12):1258-1270. 18Kaffash Elahi R. “The effect of the cinnamon on dog’s heart performance by focus on Kortkoff sounds”. J Animal Veterinary. 2012;11:3604–3608. 19Dashti-Khavidaki S1, Shahbazi F, Khalili H, et al. “Potential renoprotective effects of silymarin against nephrotoxic drugs: a review of literature”. J Pharm Pharm Sci. 2012;15(1):112-23. 20Sedighifard Z1, Roghani F1, Bidram P, et al.  “Silymarin for the Prevention of Contrast-Induced Nephropathy: A Placebo-Controlled Clinical Trial”. Int J Prev Med. 2016 Jan 22;7:23. 21Sonnenbichler J, Scalera F, Sonnenbichler I, et al. “Stimulatory effects of silibinin and silicristin from the milk thistle Silybum marianum on kidney cells”. J Pharmacol Exp Ther. 1999 Sep; 290(3):1375-83. 22Wang XL1, Zhou FJ2, Dou M3, et al “Cochlearoids F-K: Phenolic meroterpenoids from the fungus Ganoderma cochlear and their renoprotective activity”. Bioorg Med Chem Lett. 2016 Nov 15;26(22):5507-5512. 23Joob B1, Wiwanitkit V2 Linzhi. “(Ganoderma lucidum); evidence of its clinical usefulness in renal diseases”. J Nephropharmacol. 2015 Dec 27;5(1):9-10. 24Du F1, Li S2, Wang T, et al. “Cordyceps sinensis attenuates renal fibrosis and suppresses BAG3 induction in obstructed rat kidney”. Am J Transl Res. 2015 May 15;7(5):932-40. 25Yu JS1,2,3, Ho CH4,5, Wang HY6,7, et al. “Acupuncture on Renal Function in Patients with Chronic Kidney Disease: A Single-Blinded, Randomized, Preliminary Controlled Study”. J Altern Complement Med. 2017 Apr 19. 26Matsumoto-Miyazaki J1, Miyazaki N1, Murata I, et al “Traditional Thermal Therapy with Indirect Moxibustion Decreases Renal Arterial Resistive Index in Patients with Chronic Kidney Disease”. J Altern Complement Med. 2016 Apr;22(4):306-14. 27Marsden S. “Introduction to veterinary acupuncture course notes’> College Integrative Veterinary Therapies, 2017.




Worried About Grain-Free Diets & Heart Disease? Take Heart!
Grain-free.  These two words are the focus of a recent media storm creating trouble for pet food.  The confusion originates from a July 2018 report by the Federal Food and Drug Administration (FDA) and research conducted by Dr. Joshua Stern, DVM, PhD, DACVIM, Chair of the Department of Veterinary Cardiology at UC-Davis. Dr. Stern is investigating the possible reasons specific “grain-free” dry kibble foods have been implicated in cases of canine Dilated Cardiomyopathy (DCM). Alarmed from media reports, clients feeding grain-free foods to their pets may have serious questions. Let’s get to the heart of the matter and examine the issue more closely.

 What does grain-free really mean?

The term “grain-free’ does not refer to any specific type of food. The grain-free label simply means that the food contains no grains. The term itself does not define anything really important about a pet food.

Why did grain-free foods become popular in the first place?

As veterinarians, most of us were taught that grains are an acceptable, significant part of the canine diet. However, large quantities of grains in dog food were never a good idea. The formulas themselves and the way the food was manufactured and processed have been sources of concern. The market responded to these questions by simply replacing grains with other inappropriate ingredients, and a huge market for grain-free food was born. This strategy assumed that the only complaint about kibble foods was the inclusion of grain, and that by removing the grain, the diet would be healthier. This turned out to be a great marketing strategy, but didn’t necessarily create healthier foods. Instead of creating foods with healthy meats and fresh ingredients, the added niche of “grain-free” only added a new burden to the overload of inappropriate pet food on the market. The market was flooded with foods that were “grain-free” but just as flawed. High heat-processed, nutritionally damaged, industrially sourced pet food too high in carbohydrates and too low in quality proteins and healthy fats is still an unhealthy diet, regardless of the grain-free label on the bag.

Why are grain-free foods being linked to heart disease in dogs?

The new substitutes for grain (potatoes, tapioca, legumes/beans, and many other plant-sourced carbohydrates) may be triggering a worse and more dramatic problem. Because they provide some protein, these plant-based grain substitutes allow manufacturers to lower the amount of meat-based protein in their formulas. But these plant-based proteins do not possess a complete amino acid profile, most notably lacking in taurine, an amino acid required for cardiac health in dogs and cats found in animal-based foods The link between dietary taurine deficiency and heart disease is well described in the cat.  Cats can’t make taurine from other sources and cats deficient in taurine can develop heart disease. In contrast, dogs with the right building blocks can make it themselves. Therefore, taurine is not considered an essential amino acid for dogs. Taurine content was ignored in AAFCO recommendations for dog foods. There is little data and no guidelines about taurine in dogs available from the Association of American Feed Control Officials (AAFCO), FDA, or the U.S. Department of Agriculture. Often these organizations don’t concern themselves with every component of a food. We had not seen significant taurine-related canine heart problems in the past. Until recently, the majority of dog foods were formulated with enough meat-sourced proteins to provide the base amount of taurine needed for most dogs. Now with “grain-free” dry foods, pet food quality has reached a new low. Without minimum recommended levels of taurine for dog foods, companies making these foods have not been held accountable for poorly conceived diets. Other factors also affect the bioavailability of the taurine that is present in the diet.

Additional causes of dietary taurine deficiency

Food Preparation

Cooking meats degrades and drastically reduces the bioavailability of taurine in the food. If meats are cooked in water and the water is discarded, most of the taurine can be lost. Moisture removal to make a dry food further depletes taurine in foods already deficient. Taurine amounts can be diminished somewhat when foods stay frozen for long periods of time as well, but not as much as the loss from cooking.  If there is enough fresh meat, typically there will be enough taurine in a short-term frozen raw food.

Bile Salt Conjugation

Both dogs and cats constantly lose taurine through bile salt conjugation, especially if bile salts are not recycled by the body because they are bound by starchy compounds like rice bran or beet pulp. Both ingredients can be found in grain-free and grained foods. Dogs and cats will have an increased need for taurine if they are eating foods with these components.

Microbiome

Microbiome deficiencies cause the body to absorb taurine and other vital nutrients inadequately. Highly processed, heat-treated, poorly balanced dry foods high in carbohydrates and starch not only overfeed the wrong species of bacteria for a dog’s gut, but also fail to replenish  appropriate bacteria or strengthen the microbiome. Many pet foods source ingredients from industrial farming where antibiotics and chemicals are used. These will be present in the pet food and affect the microbiome of the pet.

Packaging

The diet’s packaging also affects the bioavailability of taurine. Conscientious manufacturers of canned foods for cats typically double the amount of taurine in the food due to concerns that taurine availability may be affected by the canning process.

What does this mean for our patients on grain-free diets?

Pet owners searching for better answers are swayed by marketing, catch phrases, convenience, fancy packaging and perhaps overwhelmed by the glut of good and bad information online. But we all have the same intention. We want to provide our pets and patients with a happy and healthy long life. The circulating news stories suggest that if we all revert to feeding our pets grains in their dry kibble foods, health will return. However, we are not to assume that ALL grain-free food is unhealthy or that ALL grain-free food causes heart disease. Keep the basics in mind about diet. Don’t let clients run back to a diet with grain thinking it is protective to the heart. That is not the answer.  What is in the food matters certainly as much as what is kept out of it. Here are several practical ideas and tips about diets and taurine to help clients avoid more health risks with each new “pet food fad.” I suggest veterinarians strive to provide the building blocks of health, evaluate pet food recipes, and focus on prevention. Look for fresh, balanced, moisture-appropriate food for a carnivore. We can keep animals and their hearts healthy with the foods they are designed to feast upon. Use a fresh, species-specific diet as a sensible starting place to create health. Remember that taurine is nearly non-existent in many plant-based proteins.  We must evaluate ingredients in both dog and cat diets for taurine, regardless of the AAFCO standards. Look for quality, organic, non-GMO meat sources of protein high on the pet food label. Don’t focus on choosing between a dry kibble that has either grains or is grain-free (two bad choices) – choose balance and freshness wherever possible. Add a fresh meat source to pet food — taurine is typically high in many animal-based proteins especially sardines, shrimp, clams, scallops, fresh uncooked dark meat poultry, and heart muscle. Tuna is not a source of taurine. If a fully fresh diet is not possible, try to at least supplement with something fresh. Fresh healthy foods will keep pets healthy!
It is interesting to note that cats who eat mice are not likely to have any taurine deficiency as mouse muscle and particularly a tiny mouse heart contains very high concentrations of taurine.
 Add a probiotic/prebiotic or healthy goat yogurt/milk to help regain a healthy microbiome for better absorption of nutrients. Consider using a well-balanced, well-sourced fresh raw food recipe in your pet’s weekly rations.  Remember that variety helps provide balance too. Many people in the pet food industry are recognizing that the future of pet food is moving towards functional pet food nutrition — ingredients designed and combined for optimizing the individual’s health needs, using software tools like the Animal Diet Formulator™. The data available in the Animal Diet Formulator™ (ADF) software provides a tool used by Royal Animal Health University to teach veterinarians and technicians to evaluate and create recipes and diets. It is an unusually complete and useful tool, in that it includes taurine as well as corrected USDA data on many other ingredients to help us find optimal levels for nutrients and keep up with these health concerns. Hopefully the current research by Dr. Stern will add to our understanding and knowledge about these important micronutrients.

What about supplementation?

If an animal has a heart condition and taurine might be a factor, consider suggesting a taurine supplement to a diet. For cats the literature suggests about 75-100 mg of taurine daily. For dogs, the levels are typically extrapolated, but it is difficult to overdose (it is excreted rather than stored in the body). Literature references about 500 mg for a 30lb dog up to three times a day as a good place to start. It can take several months to see cardiac improvement, but if a taurine deficiency was at the heart of the problem, it may fully resolve with supplementation. Use organic and well-known sources. Certainly breeds predisposed to Dilated Cardiomyopathy (DCM) that can be more strongly affected by taurine deficiency might benefit from added taurine – either in foods or supplements. These breeds include Golden Retrievers, Doberman Pinschers, Great Danes, American Cocker Spaniels, Boxers, and other large breed dogs.
Consider using freeze dried heart treats to help increase amino acids, including taurine.
Dogs with urate or cystine stones should consider taurine supplementation because the body uses these as building blocks for taurine synthesis. Finally, we must remember that food is medicine. While a good diet cannot cure all ills, a poor diet will always create problems. With proper nutrition, there is a strong tendency for health.

Additional information

To test a pet’s amino acids/taurine levels: University of California Davis Amino Acid Laboratory Diet and Taurine Research: Wójcik OP, Koenig KL, Zeleniuch-Jacquotte A, Costa M, Chen Y. “The potential protective effects of taurine on coronary heart disease”. Atherosclerosis. 2010 Jan; 208(1):19-25. doi: 10.1016/j.atherosclerosis.2009.06.002. Epub 2009 Jun 11. Ko KS, Fascetti AJ. “Dietary beet pulp decreases taurine status in dogs fed low protein diet”. J Anim Sci Technol. 2016 Aug 2;58:29. doi: 10.1186/s40781-016-0112-6. eCollection 2016. Backus RC, Cohen G, Pion PD, Good KL, Rogers QR, Fascetti A.J. Taurine deficiency in Newfoundlands fed commercially available complete and balanced diets. J Am Vet Med Assoc. 2003 Oct 15;223 (8):1130-6. Fascetti AJ, Reed JR, Rogers QR, Backus RC. Taurine deficiency in dogs with dilated cardiomyopathy: 12 cases (1997-2001). J Am Vet Med Assoc. 2003 Oct 15;223(8):1137-41. Torres CL, Backus RC, Fascetti AJ, Rogers QR. Taurine status in normal dogs fed a commercial diet associated with taurine deficiency and dilated cardiomyopathy. J Anim Physiol Anim Nutr (Berl). 2003 Oct;87(9-10):359-72 Belanger MC, Ouellet M, Queney G, Moreau M. Taurine-deficient dilated cardiomyopathy in a family of Golden Retrievers. J Am Anim Hosp Assoc. 2005 Sep-Oct;41(5):284-91. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4971673/ Journal of Animal Physiology and Animal Nutrition.  87(7-8):251-62,  September, 2003 https://www.petfoodindustry.com/articles/7473-the-next-big-thing-in-pet-food-functional-ingredients?v=preview Microbiome Research: https://www.aaas.org/news/missing-gut-bacteria-raises-infants-asthma-risk https://www.cmaj.ca/content/190/37/E1097 https://health.ucsd.edu/news/releases/Pages/2018-05-15-big-data-from-worlds-largest-citizen-science-microbiome-project-serves-food-for-thought.aspx https://americangut.org/ https://americangut.org/ppublications/ Mitochondria + Microbiome: https://drive.google.com/open?id=0B9c8LZOhi7gFQzBaNXBORG1vQkdsdXVSc25mM3VoVmdVcEhJ




Omega fatty acids for dogs and cats

A comprehensive look at Omega fatty acid sources for canine and feline patients, and the pros and cons of each.

Omega fatty acids are vital for health in our animal patients. The most-studied Omega-3s are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Both EPA and DHA have strong antioxidant and anti-inflammatory properties; cell membranes also need DHA to stay sufficiently fluid for optimal function. This article looks at the main sources of Omega-3s on the market, from the bottom of the food chain, and the pros and cons of each when it comes to dogs and cats.

Algal oil

Oil made from certain species of algae has a high DHA content. But natural algae contain little to no EPA. To achieve a better EPA content, certain species have been genetically selected for this ability. But the ratio of DHA to EPA is still upside down compared to most OMEGA-3 supplements; there is more DHA than the stronger anti-inflammatory EPA. While algal oil is a valid choice for vegan humans, dogs and cats are best served by getting their Omega-3s from an animal source.

Phytoplankton

A relative newcomer to the Omega scene, phytoplankton forms the basis of the marine food ecosystem. A whole food supplement, it offers a beneficial array of vitamins, minerals, amino acids and fatty acids, including EPA. Freshwater phytoplankton does not produce EPA. A proprietary combination of freshwater and marine phytoplankton does, but in only miniscule amounts. Neither is a sufficient source of Omega-3s.

Flaxseed/nut/vegetable oils

Plant oils contain several fat types. Coconut and palm oil are high in saturated fat. Most other common cooking oils, like corn, sunflower and safflower oils, are more unsaturated. They contain mostly Omega-6. Flaxseeds and a few other seeds and nuts also contain the Omega-3 ALA, which has beneficial effects of its own, particularly on skin and coat health.

Coconut oil

Many people are confused about this product, but there are no Omega fats in coconut oil. It is almost entirely saturated fat, with very small amounts of oleic and linoleic acids.

Krill oil

Krill oil is a popular non-fish Omega-3 alternative that is heavily promoted by some of its sellers. Krill are tiny, pinkish shrimp-like crustaceans that are said to comprise the largest biomass on earth. They are a keystone species, and a major food source for multiple species of fish, whales, seals, squid and birds. Krill are harvested for many purposes, but increasingly for Omega-3 oil supplements. However, even though there are lots of krill in the ocean, warming temperatures and decreasing sea ice pose a dire threat to them. Krill feed on phytoplankton under the sea ice, so less ice means fewer krill. Moreover, krill are often harvested in and around critical feeding grounds for the animals that eat them. These factors are already causing krill depletion in local areas, threatening dozens of species of fish, seabirds and mammals, including whales. Populations of Chinstrap and Adélie penguins in Antarctica have been declining since the 1980s due to the decimated krill population, and that trend is accelerating.

Greenlip mussel oil

New Zealand greenlip mussels (Perna canaliculus, GLM) are grown in the Marlborough Sound under a Sustainable Farming Program. This ensures the long-term viability of the greenlip mussel industry, with minimum impact on the environment. GLM are bivalve mollusks that provide a rich source of 33 fatty acids, including all 18 known forms of Omega-3s (including EPA, DHA and ALA). Among the GLM’s unique array of Omegas is ETA (eicosatetraenoic acid). ETA -- which is not found anywhere else to any measurable degree -- has extremely powerful anti-inflammatory properties. GLM oil has less saturated fat and more mono- and polyunsaturated fat, than fish or cod liver oils. When cold-pressed and packaged at the source, GLM oil appears to be more bioavailable than fish oil, so a smaller amount can be used to get the same benefits. MOXXOR is a good source of greenlip mussels (using the coupon code DRJEAN will get you a good discount).

Calamari oil

This is another new kid on the block. Calamari is a marine animal, and a close relative of the clever octopus. They are abundant, and their population is growing. Like algae, calamari are much higher in DHA than EPA. As the more powerful anti-inflammatory, EPA is probably more suited to most dogs than DHA, which is important primarily during fetal development, and again later as the aging brain starts to decline. Squid live in a variety of water temperatures and conditions. Cold water dwellers have much more Omega fatty acids than those in warmer waters, where the temperature allows for more fluid membranes. Therefore squid from northern and extreme southern waters are likely more beneficial. There is always the potential for over-harvesting, but at this time the population is robust.

Fish-based oils

Fish body oil and cod liver oil are the most common sources of EPA and DHA. Small fish get it from eating algae, plankton and aquatic plants; predatory fish eat small fish and accumulate it. The advantage of fish oil is that species at the top of the food chain have a higher concentration, so it takes less fish oil to get the same quantity of Omega-3. Most salmon oil (especially from Canada and the Atlantic Ocean, Scotland and Norway) comes from farm-raised salmon. These factory-farmed fish are grown in polluted, overcrowded pens; they are heavily vaccinated, are fed dyes, antifungals, parasiticides and antibiotics, and contain up to ten times more mercury, dioxins, PCBs and other toxins than wild fish. Farmed salmon also pose a serious threat to wild species in both Atlantic and Pacific oceans due to the interbreeding of escaped fish, parasites and infectious diseases. Farmed salmon are extremely fatty due to their diet and lack of free movement. Oil from farmed fish contains about the same amount of Omega-3s as wild fish -- but far more Omega-6s, thanks to the unnatural corn, soy and trash fish they are fed. Even salmon labeled “Alaska”, “wild” or “wild-caught” may not be truly wild. About a third of both Pacific and Atlantic salmon are bred and raised in hatcheries. Their release into the ocean is threatening both wild salmon and other fish. Cod liver oil is a good choice when properly produced. But cod liver oil for humans is commonly supplemented with vitamins A and D at levels that could easily become toxic in cats and dogs. Moreover, a loophole in the law allows non-cod species to be labeled as cod. Inexpensive mass-produced fish oils usually contain filler oils (such as sunflower, safflower, canola and olive oil), which add undesirable Omega-6s. They may also be processed with harsh chemicals because of cost considerations. It may make sense to stay away from top-level predatory fish to avoid the pollutants that accumulate in their fat. Menhaden is the source of most “fish oil” not identified by species. Unfortunately, it is also a threatened keystone species. Sardine, herring and anchovy oils are more sustainable and cleaner than most other fish oils. While a product made specifically for pets may not have the additives found in human products, many are quite low in potency, and may not be sufficient for your patients’ needs. Processing is the final wild card in the game. Make sure the fish oil products you choose are safely extracted without high heat or solvents, and are tested by an independent laboratory for PCBs, mercury and other pollutants. One company I recommend for quality fish oil is Nordic Naturals.

Requirements for dogs and cats

Adult dogs and cats require linoleic acid (LA, an Omega-6), and alpha linolenic acid (ALA, an Omega-3) in their diets. Cats also need arachidonic acid, an Omega-6. Both EPA and DHA are considered essential for young puppies and kittens. It's not that adult dogs and cats don't also need EPA and DHA for good health. It's just that the National Research Council, upon whose work the AAFCO pet food nutritional standards are based, couldn't agree on a necessary minimum level, so they just left them out of the recommendations. Still, we know that providing these nutrients provides many health benefits, so it's wise to supplement them to animal patients.

Omega-3s – plant or animal?

Perhaps the most common point of confusion about Omega-3s is the difference between plant and animal sources. Many plants are a good source of LA; some, like flaxseed, hemp, walnuts, canola and soybeans also contain ALA. Hemp also contains gamma-linoleic acid (GLA), an anti-inflammatory Omega-6. It’s important to know that adult dogs and cats can’t readily convert ALA into EPA and DHA. Very young puppies can manufacture DHA, but they lose that ability at weaning. At best, dogs can convert only 1% to 2% of ALA to EPA, and they convert virtually no ALA to DHA. Cats are even more limited. When recommending Omega-3 oils for canine and feline patients, it’s important to be aware of your sources, and to do some research to ensure you’re suggesting the healthiest possible choices.

References

Boelen P, van Dijk R, Sinninghe Damsté JS, et al. “On the potential application of polar and temperate marine microalgae for EPA and DHA production”. AMB Express. 2013, 3:26. Hinke JT, Cossio AM, Goebel, et al. “Identifying Risk: Concurrent Overlap of the Antarctic Krill Fishery with Krill-Dependent Predators in the Scotia Sea”. PLoS One. 2017; 12(1): e0170132. Pawlosky R, Barnes A, Salem Jr N. “Essential fatty acid metabolism in the feline: relationship between liver and brain production of long-chain polyunsaturated fatty acids”. J Lipid Res. 1994; 35:2032-2040. Rule DC, Broughton KS, Shellito SM, Maiorano G. “Comparison of muscle fatty acid profiles and cholesterol concentrations of bison, beef cattle, elk, and chicken”. J Anim Sci. 2002 May;80(5):1202-11.




Programs and apps that improve your practice

Is technology the answer to providing more detailed care to your clients and patients? New programs and apps that digitize records, notes and follow ups mean that you can spend more time educating and caring.

The shift towards relying on practice management programs started as a simple debate over whether or not to switch from paper to electronic medical records. In just a short time, it developed into a new and well-populated market, offering everything from Electronic Medical Records to personalized and branded apps for client download. As more programs develop, it becomes easier to transition to a more efficient way of managing the hustle and bustle of your practice. The opportunity to spend a little extra time answering questions, training with your staff or expanding your own knowledge will help create a better client experience overall – so why not give it a try? Here’s a quick look at some of the efficiency tools available to adventurous veterinarians.

Electronic records and the cloud

A good first step to improving your management system is to make the change from paper to Electronic Medical Records (EMRs). This digitization of records gives your team members direct access to a patient’s entire record at the tips of his or her fingers. EMRs can be updated immediately, and be seen by the whole team – an important stepping stone toward improved communication and efficiency. Making the switch can feel intimidating, so try balancing both systems for the first little while. Enter all new information in your electronic records and keep the paper only for reference. Another advantage to embracing EMRs is the ability to store them safely within your own system or in the cloud. Cloud based management systems mean records are not subject to the same risk of misplacement as physical records; there is always a back-up. Using the cloud allows for protection from any system troubles or disasters, and lets you access files from home – a convenient perk that many veterinarians find very useful.

There’s an app for that

These days, you can access almost anything with the touch of a phone screen. So why not offer veterinary care that way? New programs have been developed that help you organize client communication through an app that can be branded for your practice. This means appointments, reminders, and follow ups all go through one direct channel. Some apps even have options that allow you to schedule and send out communications automatically. Nothing gets overlooked, and your time is free for face to face interactions.

Talk-to-text technology

A successful veterinary practice is a high-paced environment which makes sitting down to document notes from an appointment, referral or client call nearly impossible. Incorporating talk-to-text technology into your everyday routine can allow you to record appointments and ideas as they happen. Dragon Veterinary Software, for instance, has a curated veterinary vocabulary system that allows you to record, then transfers those recordings automatically to your files. Inspired by busy veterinarians who work to do a thorough job for every patient, this technology keeps track of every detail so you don’t have to waste your time scribbling down notes and trying to remember what transpired. Our dependence on technology grows every day. In some cases, this dependence is dangerous. But in a veterinary clinic setting, it allows us to be more efficient and more connected to what we do. By freeing up time from administrative duties, you can make yourself more available to clients, which gives them the sense of trust they need to ask more questions, absorb more information, and help their pets live long, healthy lives.




Alternatives to traditional spay and neuter – evolving best practices in dog sterilization

Standard spay and neuter surgery can have negative impacts on a dog’s health. What are some alternatives options?

In the United States, broad scale pet sterilization has been advocated to decrease pet overpopulation and euthanasia rates at shelters. This practice has become standard, with shelter animals being sterilized before adoption and most pet owners spaying or neutering their animals even if not adopted from a shelter. The decrease in the number of pets entering shelters (estimated at six to eight million currently, down from 13 million in 1973), and the resulting decrease in euthanasia rates, are cited as successful outcomes of spay/neuter programs.1,2 However, removing an animal’s reproductive organs can have adverse effects as well as benefits. This article looks at some alternatives to spay and neuter surgery.

Pros and cons of gonadectomy

In the US, sterilization involves removal of the reproductive organs (gonadectomy), usually through ovariohysterectomy (spay) of females and orchiectomy (castration) of males. These procedures eliminate the hormones produced by these organs. While gonadectomy makes it impossible for the pet to reproduce, what other impacts does a lack of sex hormones have on the pet? Research projects to answer this question first evaluated the difference between early and later gonadectomy, usually supporting the early sterilization practice of sheltered pets.3,4 More recently, research has broadened to compare large numbers of gonadectomized dogs with intact dogs.5,6 This area of study is relatively new, but the research indicates that gonadectomy confers a mixture of benefits and adverse effects, depending on age at neutering, breed and sex.7 Eliminating sex hormones has the positive effect of reducing mammary, ovarian and testicular cancers, pyometra, perineal and inguinal hernias, prostatitis, benign prostatic hyperplasia, prostatic cysts and squamous metaplasia of the prostate. Intact dogs have a higher incidence of infectious disease and sterilized dogs have higher cancer rates, with the latter often reported as having longer lifespans.8 On the other hand, gonadectomized dogs have been reported to have a higher incidence of obesity, urinary incontinence, urinary calculi, atopic dermatitis, autoimmune hemolytic anemia, hypoadrenocorticism, diabetes mellitus, hypothyroidism, immune-mediated thrombocytopenia, inflammatory bowel disease, hip dysplasia, cranial cruciate ligament rupture, aggressive and fearful behavior, cognitive dysfunction syndrome, prostate adenocarcinoma and transitional cell adenocarcinoma.6,9-12 Musculoskeletal issues may be especially significant for large breed dogs gonadectomized before they have finished growing, as bone physeal closure is delayed. A significant contributor to the negative health impacts of removing the gonads in dogs is that the natural hormone feedback mechanisms become unregulated. Normally, the pituitary gland releases luteinizing hormone (LH), which then stimulates the production of steroid hormones from the gonads. Without the gonads, there is no feedback signal to reduce production so LH concentrations remain very high for the remainder of the dog’s life. Receptors for LH are present in the urinary tract, skin, thyroid, blood vessels, ligaments, bone, synovium, immune cells and brain.12 Elevated LH concentrations resulting in activation of these receptors may predispose gonadectomized dogs to developing the health problems listed previously.

Alternative options to traditional spay/neuter

Responsible pet ownership
It is interesting to note that while gonadectomy is viewed as the standard in the US, it is relatively uncommon in other regions of the world. In Norway and Sweden, for example, there are virtually no stray dogs and neutering is very uncommon, usually only allowable due to health concerns.13 To avoid unwanted pregnancies, responsible pet owners of intact dogs must take special precautions. Females go into heat for a few days once or twice a year and need to be confined in an area without access to intact males. Male dogs should not be allowed to roam freely, as they are incredibly persistent in reaching a female in heat. Other issues to consider include females bleeding while in heat; behavior changes that may be triggered by changing hormones; the logistics of having both male and female intact dogs in the same house; and health monitoring for diseases of the reproductive organs. Responsible dog owners are expected to manage these issues.
Hormone-sparing sterilization
Not all pet owners are ready to keep an intact dog and guarantee that no unwanted pregnancies will occur. Luckily, there are options that will ensure a dog is incapable of reproducing while keeping his/her natural gonadal hormones to protect his/her health. Females: A hormone-sparing option that sterilizes a female dog involves conducting a hysterectomy (also called ovary-sparing spay or partial spay) by removing the uterus and leaving the ovaries intact. It is important to remove all the uterus to ensure that stump pyometra does not occur. After the procedure, the female dog is sterile and bleeding is eliminated. The female will still go into heat due to the influence of hormones produced by her ovaries, possibly showing behavioral changes around this time. Ovarian cancer is often cited as an argument for removing ovaries -- but ovarian cancer is rare, and the small risk does not outweigh the health benefits of preserving hormones. However, the dog should be monitored for mammary tumors after middle age. An owner can do this when he/she rubs the dog’s tummy. These tumors are usually benign but should be removed promptly. Veterinarians may wish to establish/offer mammary examination as part of annual wellness checkups for senior dogs. Tubal ligation has also been practiced in dogs, but pyometra remains an issue, as well as bleeding during heat, making ovary-sparing spay a better option. Males: For male dogs, a vasectomy sterilizes while sparing testosterone. The procedure involves severing or ligating the vas deferens, the duct that transports sperm. The procedure is quick, less invasive than castration, and not difficult for veterinarians to master. What are the downsides of testicular preservation? Leaving the testicles and hormones intact means that testicular cancer, perianal gland tumor, and enlarged prostate may occur -- but if they arise later in life, they are typically treated via castration. In such a case, the dog’s health still benefitted from years of natural hormones prior to castration. Also, prostate enlargement can now be treated non-invasively with finasteride (Proscar®, Merck) or by using pulsed electromagnetic therapy.14 Hormones will also influence the male dog’s behavior and interest in females in heat, a complex issue discussed below. Other experimental approaches: The epididymis is the sperm maturation and storage area, making it an ideal target for hormone-sparing sterilization procedures. Injection of a necrotizing agent, such as calcium chloride in alcohol, can effectively disrupt the ability to produce sperm. Leoci and colleagues reported success with this non-surgical approach using ultrasound guidance (personal communication, 2018). The dogs retained normal hormone profiles, yet were sterile. Other options, such as epididymal ligation15 or therapeutic ultrasound,16 are promising approaches that require more refinement for use in companion animals.
Parsemus.org offers information on hormone-sparing options, including extensive online training material for veterinarians on ovary-sparing spay.

An ethical dilemma

Questioning whether gonadectomy is really in the best interest of the dog has raised the hackles of many veterinarians and organizations who work hard to sterilize animals in the US to reduce pet overpopulation. Interpretation of research results has been hotly debated, with many arguing that differences in the long-term health of gonadectomized dogs are negligible, and others arguing that they are serious enough to reconsider the wisdom of widespread spay/neuter programs. The issue represents a common ethical dilemma – is the welfare of the population more important than the welfare of the individual? In other words, is the positive impact of gonadectomy on reducing pet overpopulation more important than the possible negative impact on an individual dog’s long-term health and welfare? Stepping back from the debate, it is not surprising that the loss of natural gonadal hormones has significant health implications for the dog. As veterinary practitioners, it makes sense for us to understand and discuss the pros and cons of gonadectomy with clients when decisions about sterilization are made. This individualized approach is supported by the American College of Theriogenologists.10 This doesn't require locking into adversarial positions or giving up spay/neuter. Fortunately, there are a number of alternative methodologies to consider, including methods for sterilizing dogs while maintaining hormone levels. The next step is to evaluate the different options available to the dog owner or adopter, and determine the best option for the particular dog and situation.

A note on behavior

Gonadal hormones can have behavioral effects, and hormone-sparing options are appealing to dog owners who do not want changes in behavior (e.g., for performance or hunting dogs). On the other hand, many express the concern that leaving dogs with natural hormone levels will produce undesirable behaviors. This sentiment is common in animal welfare and rescue/shelter communities, with the rationale that dogs may display more inter-male aggression, urine marking, mounting and roaming, which may result in owners abandoning or returning their pets and thus increasing shelter populations. We are beginning to understand that behavior is under the influence of a number of psychological and physical stimuli, and that no simple straight-line relationship between hormones and undesirable behaviors exists. For example, eliminating testosterone may not make a dog less aggressive. In fact, a recent large survey reported that gonadectomized dogs did not differ from intact dogs in terms of aggression directed toward familiar people or pets, and they actually showed higher levels of aggression toward strangers.5 Dog aggression is a main reason for relinquishment to shelters17 and neutered male dogs were more often surrendered for such behavioral reasons.18 Gonadectomized dogs may also develop more anxiety and fear, and show more cognitive decline than intact dogs.19,20 The dog’s age, breed, personality and environment will impact his/her behavior. When choosing a hormone-sparing method, if a dog evidences behavioral issues later, traditional spay or neuter can then be considered. Keep in mind that castration of adult male dogs may decrease reproductive-related behaviors (urine marking, mounting and roaming) but impacts on other behaviors are variable.21

Moving forward

As our understanding of the long-term health consequences of gonadectomy in dogs grows, the demand for alternative options increases. Unfortunately, the supply of practitioners experienced in alternatives has not met the demand. In most veterinary schools in the US, students are not taught how to do hysterectomy or vasectomy, and the number of veterinarians making these options available is small. At the 2017 AVMA conference, 81 veterinarians were surveyed about the use of nontraditional sterilization methods. Only 7.4% percent reported performing hysterectomies or vasectomies in dogs, whereas 73.4% reported discussing long-term health risks of traditional spay and neuter with dog owners prior to surgery. Parsemus Foundation is doing its part to encourage education, dialogue and communication with pet owners and practitioners. Their website offers information on hormone-sparing options, including extensive online training material for veterinarians on ovary-sparing spay. They also maintain a list of veterinarians who offer alternatives to traditional spay/neuter; many have reported receiving referrals from this service. Parsemus Foundation envisions a win-win future, when veterinarians offering choices are sought out by dog owners and adopters who want the most appropriate method of sterilization for their individual pets. More vets are needed to turn this innovative trend into an impactful movement. To join the growing list of clinics that offer safer alternatives to traditional spay and neuter, contact info@parsemusfoundation.org.

Acknowledgements

The authors thank Elaine Lissner, founder and trustee of Parsemus Foundation, for her review of an earlier version of this paper, and advocacy for innovative and alternative methods of pet sterilization. Ovary-Sparing Spay from Parsemus Foundation on Vimeo.

References

1Humane Society of the United States. “Pets by the numbers”. No date ; downloaded 6/27/18 from: humanesociety.org/issues/pet_overpopulation/facts/pet_ownership_statistics.html. 2Marsh P. “Replacing myth with math: Using evidence-based programs to eradicate shelter overpopulation”. 2010; Town and Country Reprographics, Inc., Concord, New Hampshire. 3Howe LM1, Slater MR, Boothe HW, Hobson HP, Holcom JL, Spann AC. “Long-term outcome of gonadectomy performed at an early age or traditional age in dogs”. JAVMA 2001;218:217-21. 4Spain CV, Scarlett JM, Houpt KA. “Long-term risks and benefits of early-age gonadectomy in dogs”. J Am Vet Med Assoc 2004;224:380-7. 5Farhoody P, Mallawaarachchi I, Tarwater PM, Serpell JA, Duffy DL, Zink C. “Aggression toward familiar people, strangers, and conspecifics in gonadectomized and intact dogs”. Front Vet Sci 2018;5:1-13. 6Sundburg CR, Belanger JM, Bannasch DL, Famula TR, Oberbauer AM. “Gonadectomy effects on the risk of immune disorders in the dog: a retrospective study”. BMC Vet Res 2016;12:278. 7Kustritz MVR. “Determining the optimal age for gonadectomy of dogs and cats”. J Am Vet Med Assoc 2007;231:1665-1675. 8Hoffman JM, Creevy KE, Promislow DE. “Reproductive capability is associated with lifespan and cause of death in companion dogs”. PLoS One 2013;8(4):e61082. 9Reichler IM. “Gonadectomy in cats and dogs: a review of risks and benefits”. Reprod Domest Anim 2007;44(Suppl. 2):29-35. 10Society for Theriogenology, Board of Directors, and the American College of Theriogenology. “Basis for Position on Mandatory Spay-Neuter in the Canine and Feline”. 2013; downloaded 6/27/18 from: c.ymcdn.com/sites/www.therio.org/resource/resmgr/docs/spay-neuter_basis.pdf. 11 Zink, C. “Spay neuter considerations to maximize health”. IVC Journal 2017;Feb. 6, 2017. 12Zwida K, Kutzler MA. “Non-reproductive long-term health complications of gonad removal in dogs as well as possible causal relationships with post-gonadectomy elevated luteinizing hormone (LH) concentrations”. J Etiol Anim Health 2016;1(1):1-11, article number JEAH-1-002. 13Sallander M, Hedhammar Å, Rundgren M, Lindber JE. “Demographic data of a population of insured Swedish dogs measured in a questionnaire study”. Acta Vet Scand 2001;42:71-80. 14Leoci R, Aiudi G, Silvestre F, Lissner E, Lacalandra GM. “Effect of pulsed electromagnetic field therapy on prostate volume and vascularity in the treatment of benign prostatic hyperplasia: a pilot study in a canine model”. Prostate 2014;74:1132-41. 15Tamadon A, Nikahval B, Sepehrimanesh M, Mansourian M, Naeini AT, Nazifi S. “Epididymis ligation: a minimally invasive technique for preparation of teaser rams”. Vet Surg 2010;39:121-7 16Leoci R, Aiudi G, Silvestre F, Lissner EA, Marino F, Lacalandra GM. “Therapeutic ultrasound as a potential male dog contraceptive: Determination of the most effective application protocol”. Reprod Dom Anim 2015;50:712–718. 17Weiss E, Gramann S, Spain CV, Slater S. “Goodbye to a good friend: An exploration of the re-homing of cats and dogs in the US”. Open J Anim Sci 2015;5:435-456. 18Salman MD, Hutchison J, Ruch-Gallie R. “Behavioral reasons for relinquishment of dogs and cats to 12 shelters”. J Appl Anim Welfare Sci 2000;3:93–106. 19Hart BL. “Effect of gonadectomy on subsequent development of age-related cognitive impairment in dogs”. J Am Vet Med Assoc 2001;219:51-6. 20Kim HH, Yeon SC, Houpt KA, Lee HC, Chang HH, Lee HJ. “Effects of ovariohysterectomy on reactivity in German Shepherd dogs”. Vet J. 2006;172:154-9. 21Neilson JC, Eckstein RA, Hart BL. “Effects of castration on problem behaviors in male dogs with reference to age and duration of behavior”. J Am Vet Med Assoc 1997;211:180-2.




Evaluating the effects of electropollution on human and animal health

Studies reveal that the homeostasis within all living bodies is dramatically affected by the rise of electropollution (electromagnetic radiation levels), with negative consequences on health.

Within the last two decades, wireless technology has exploded onto the global scene. This means most people and their companion animals are now living in a dense sea of electromagnetic energy waves, termed electromagnetic radiation (EMR). Current EMR levels are estimated to be 100 to 200 million times greater than they were a century ago.  Numerous studies reveal that the homeostasis within all living bodies is dramatically affected by these increasing EMR levels, with negative consequences on health.

Defining electric and magnetic fields

Electric and magnetic fields (also called radiation) are invisible areas of energy produced by electricity; i.e. the movement of electrons, or current, through a wire. An electric field is produced by voltage, and as voltage increases, the strength of the electric field increases. A magnetic field results from the flow of current through wires or electrical devices, and this energy field increases in strength as the current increases. Electric fields are produced whether or not a device is on, but magnetic fields are produced only when current is flowing, which usually requires a device to be turned on. However, power lines produce magnetic fields continuously because current is always flowing through them. Electric fields are easily blocked or weakened by walls and other objects, but magnetic fields can pass through buildings, living things, and most other materials. It is important to note that the strength of a magnetic field decreases rapidly as the distance from its source increases. There are two main categories of electromagnetic fields (EMFs):
  • Higher-frequency EMFs include x-rays and gamma rays. These EMFs are in the ionizing radiation part of the electromagnetic spectrum.
  • Low- to mid-frequency EMFs include magnetic fields from electric power lines and appliances, radio waves, microwaves, infrared radiation and visible light. These EMFs are in the non-ionizing radiation part of the electromagnetic spectrum.

Common sources of non-ionizing EMFs

Sources of non-ionizing EMFs can be either natural or manmade. The earth’s magnetic field is an example of a naturally-occurring EMF. Human-made EMFs fall into both the ELF (extremely low frequency EMFs) and radio frequency categories of the non-ionizing electromagnetic spectrum, and can come from a number of sources -- power lines, electrical wiring, and appliances such as shavers, hair dryers and electric blankets. Common sources of radio frequency radiation are wireless telecommunication devices such as cell phones, tablets and laptop computers; they also include Wi-Fi, cell phone towers, radio and TV signals, satellite stations, MRI devices, microwave ovens, and digital electric and gas meters (“smart meters”).

Effects of electropollution

Ionizing EMFs are known to cause direct damage to cells and DNA. Although non-ionizing low frequency EMFs have not yet been “definitely proven” to directly damage DNA or cells, an increasing and overwhelming amount of data suggests they do. Although the wireless industry and the US government claim controversy despite mounting data and research, current evidence is prompting many countries outside the US to issue public health risks regarding mobile devices, and to decrease the number of cell phone towers. They are especially curbing the advertising of wireless devices to adolescents and children, and are outlawing mobile devices and Wi-Fi in classrooms for young children. As an important reminder, magnetic field levels are highest near the radiation source, and decrease rapidly the farther away you get from the source. It has been shown that magnetic fields are significantly decreased at a distance of about 12” from most appliances. For computer screens, a distance of 12” to 20” offers a dramatically lowered magnetic field. The World Health Organization International Agency for Research on Cancer classified radio frequency radiation as a possible carcinogen in 2011, and as a probable carcinogen in 2013. Many experts report that electropollution-induced biological stress profoundly compromises normal physiology and intercellular communication, leading to the breakdown of healthy cellular processes. Specifically, cell function deteriorates, cell membranes harden, free radical damage occurs, nutrients cannot enter the cell, and toxins cannot be excreted. Numerous studies have shown the harmful effects of EMR on the immune system, enzyme syntheses and nervous system,1,2 as well as on learning, moods and behavioral patterns. All aspects of physiology at molecular, cellular and biochemical levels can potentially be damaged by EMR exposure.

Expanding knowledge regarding EMR toxicity

In the early days of radiation technology, it was believed the only risk associated with EMR came from a thermal effect (i.e. the heating of tissues, as in a microwave oven). Since cell phones do not produce enough power to heat tissue, the US government did not require any studies to investigate potential health problems caused by these devices. However, emerging science has found that the problem with cell phones does not come from their power output (thermal effect) but rather from the information in the carrier waves. These information-carrying radio waves (ICRW) use frequency to convey specific packets of information that allow for the transmission of voice, text, graphics, etc.3 This is what creates the problem. ICRW is a frequency that has never before existed in nature. The cells of an animal or human body are totally unfamiliar with it and perceive it as a dangerous foreign invader. The latest research has clearly identified the biological mechanisms of harm caused by ICRWs. Cells have special receptor sites that sense frequencies and perform signal transduction, converting extracellular signals into intracellular signals. Because cell receptors interpret ICRWs as an unknown “threatening” energy, the cell membrane quickly goes into protective lockdown mode. This means nutrients cannot get into the cell, and toxins and waste products cannot get out. This induced protective mode also prevents vital cell-to-cell communication.4 The effects are immediate and last as long as the cells are exposed to ICRWs. The longer the exposure persists, the greater the biological damage, leading to a loss of cellular energy as well as free radical damage, genetic mutation, premature aging and degenerative disease. In fact, specific studies have identified that information-carrying radio waves trigger protein membrane responses at the cell membrane level, leading to disruption of intercellular communication and the build-up of free radicals inside the cell.5
  • Endocrine function appears particularly harmed by the effects of EMR. And we have seen a marked increase in endocrine diseases in pets over the last 20 years.
  • Electromagnetic radiation is a known to act as a hormone disrupter and specific studies have shown that EMR has a direct effect on melatonin production. In 2001, a Japanese study showed that breast cancer cells treated with melatonin resumed growing when exposed to power-frequency EMR.6 The results demonstrated that magnetic fields disrupt the cells’ signaling system, which explains why reduced melatonin levels from EMR exposure have been shown to cause a number of cancers including breast, prostate and colorectal as well as melanoma, ovarian malignancies and childhood leukemia.
Although melatonin is well known for its association with regulating the circadian rhythms governing the sleep/wake cycle, this hormone also happens to be one of the most efficient destroyers of free radicals. Through various mechanisms, melatonin supports the immune system and counteracts stress-induced immune suppression. Melatonin not only inhibits the release of estrogen and suppresses the development of breast cancer, it has the ability to increase the cytotoxicity of the immune system’s killer lymphocytes and enhances the ability of vitamin D to inhibit tumor growth.
  • Neurotransmitters such as serotonin and dopamine play a major role in moods, and decreased serotonin levels are associated with depression. One study that examined the brain function of monkeys exposed to magnetic fields found that serotonin and dopamine levels were significantly depressed immediately following exposure, and only dopamine returned to normal levels several months later. 7
  • Numerous studies have found that EMR affects both sperm health and prenatal fetal health. One study involving prenatal mice exposed to cell phones showed that the offspring had higher levels of hyperactivity, decreased memory and less fear. These results point to concerning risks for pregnant women and animals exposed to EMR, as well as for young children and animals.
Many studies are also reporting the effects of EMR on wildlife, and their impact on entire ecosystems. A well-known study reported on CNN in 2010 found EMR exposure to be associated with a dramatic decline in honey bee populations. Another study found that within ten days of mobile phones being placed inside hives, worker bees stopped returning. Researchers in northern India performed an additional study in which cell phones were fitted to bee hives and powered up for two 15-minute periods each day. After three months, the bees stopped producing honey, the queen’s egg production fell by half, and the population of the hive dramatically decreased. As early as 2007, the U.S. Fish & Wildlife Service was reporting on concerns about the potential radiation impacts of cellular communication towers on migratory birds and other wildlife. Companion animals are also facing exponentially increasing exposure rates to EMR toxicity, since they (via their human counterparts) are surrounded with multiple devices much of the time. This scenario includes horses too, as many riders and owners are carrying personal devices, even attaching them to saddles or leg holsters as they ride. Animals and people who live in (or near) densely-populated cities are exposed to dramatically higher EMR, since there are many more towers and electric systems in these regions as compared to rural areas. As an additional note, veterinary practices using lasers should consider locating the control unit and power source away from people and animals.

Energy within cells

All cells communicate with each other via subtle electromagnetic signals and biochemical reactions. In fact, most biochemical mechanisms, from digestion to brain activities, are powered by the rearrangement of charged particles. Signal pathways carry energetic information that is translated into physiologic processes in the body. Problems arise with continuous exposure to manmade (unnatural) EMR, which distorts and disrupts normal cellular communications, resulting in abnormal cellular metabolism, and ultimately disease. Electromagnetic energy within cells can be described by the term “biofield”. Western science has developed several tools that can demonstrate and even measure the bioenergetic emanation of living cells, tissues and bodies. Science has proven that upon death of cells (or the body), the DNA content remains and can continue to be extracted and evaluated later. In contrast, the energy emanating from the cells is immediately gone once the body or tissue dies, and can no longer be demonstrated or measured. Other cultures in the world use different terms to describe the phenomena of living energy: Qi in China, and Prana in India.

Addressing solutions to the electropollution problem

Leading authorities in the fields of hormone health and EMR safety are recommending three levels of intervention in order to adequately protect against electropollution.
  1. Primary intervention involves reducing exposure as much as possible. This can be done by tactics such as avoiding constant proximity to EMFs, using headsets for mobile phones, keeping phones in airplane mode as often as possible, etc.
  2. Secondary intervention focuses on minimizing the effects of radiation. Specific options include subtle energy technologies, diodes and pendants. These tools are designed to “harmonize” the stressful EMFs. Many of these devices are created by reputable energy design companies. They can be used in offices and homes, attached to mobile phones and other personal devices, and/or placed on animal collars or worn as pendants.
  3. The third level of intervention is directed at strengthening the body’s metabolic systems to support correction of cell damage. This is done through a healthy diet and lifestyle. As always, the value of a nutrient-rich diet containing foods and/or supplements that either deliver or promote antioxidant activity are beneficial. Some of the most effective antioxidants include melatonin, N-acetylcysteine, SAMe, lipoic acid, green tea, CoQ10, selenium, and vitamins A,C and E. Interestingly, gingko biloba is the first herbal supplement to be tested against cell phone radiation. Pre-treatment with this brain-protective herb reversed cell phone-induced oxidative stress and depletion of antioxidant enzymes in rodents.8 Resveratrol and grape seed extract are also reported to protect against the oxidative stress induced by cellphones.
In conclusion, electropollution is a very real threat to both present and future generations of animals and people. Companion animals and pets can be expected to have very high exposure rates due to often constant proximity to their human caretakers’ multiple EMR-emitting devices. As animal health advocates and leaders in the integrative veterinary health field, we should be seeking effective interventions to protect animals, while educating pet owners about this topic of growing concern.

References

1Saunders RD, Kowalczuk CI, Sienkiewicz ZJ. (1991) “Biological Effects of Exposure to Non-ionizing Electromagnetic Fields and Radiation III. Radiofrequency and Microwave Radiation”, NRPB Report R 240, National Radiological Protection Board, Chilton. 2ortho.lsuhsc.edu/Faculty/Marino/EL/EL5/Summary5.html. 3Carlo, George. Cell Phones: Invisible Hazards in the Wireless Age. An Insider’s Alarming Discoveries About Cancer and Genetic Damage. 4Bioenergetics Institute, Energy Resonance Technology (ERT): A Targeted Intervention For Electro-Magnetic Radiation (EMR) Induced Biological Effect. 5omega.today.net/20070223. 6Masami Ishido, Hiroshi Nitta and Michinori Kabuto. “Magnetic fields (MF) of 50 Hz at 1.2 T as well as 100 T cause uncoupling of inhibitory pathways of adenylyl cyclase mediated by melatonin 1a receptor in MF-sensitive MCF-7 cells”. Carcinogenesis, Vol. 22, No. 7, 1043-1048, July 2001. 7”Serotonin, Suicidal Behaviour, and Impulsivity", The Lancet p. 949-950, 24 Oct. 1987. 8Ilhan A(1), Gurel A, Armutcu F, Kamisli S, Iraz M, Akyol O, Ozen S. “Ginkgo biloba prevents mobile phone-induced oxidative stress in rat brain”. Clin Chim Acta. 2004 Feb;340(1-2):153-6.




Probiotics, the missing nutrients — part 2

A balanced intestinal microbiome is crucial to good health in dogs and cats, as well as in humans. Probiotics can play an important role in maintaining this balance.

In Part 1 of this series (IVC Journal, Spring 2018), we looked at the discovery of probiotics along with research documenting the importance of a balanced intestinal microbiome. We discovered how many modern medical practices can disturb the balance of gut bacteria in an unhealthy way, and the role probiotics play in mitigating dysbiosis and maintaining intestinal lining integrity. In Part 2, we will explore more detailed research on the health benefits of probiotics.

Probiotic effects on healthy pets

Probiotic supplementation can have beneficial effects on healthy animals. In one study, dogs were given probiotics for seven days. Even though the administered strains disappeared within a week after discontinuation, there was a sustained change in the population of indigenous lactic acid–producing bacteria in jejunal contents, with native L. acidophilus strains predominating.1 In another study where dogs were supplemented with L. acidophilus, an associated increase in the numbers of fecal lactobacilli, along with a decrease in clostridial organisms, was observed. Furthermore, there were significant increases in RBCs, HCT, hemoglobin concentration, neutrophils, monocytes and serum IgG,  and reductions in RBC fragility and serum NO2Supplementation of puppies with Lactobacillus caused an increase in appetite and food intake, which led to higher daily weight gain.3 When 15 healthy cats were supplemented with L. acidophilus, populations of fecal bifidobacteria, Clostridium spp and Enterococcus faecalis, decreased. Granulocyte phagocytic activity and eosinophil numbers increased, while erythrocyte fragility and plasma endotoxin concentrations decreased.4 Other researchers found that “Feeding studies with a Lactobacillus acidophilus probiotic have shown positive effects on carriage of Clostridium spp. in canines and on recovery from Campylobacter spp. infection in felines. Immune function was improved in both species.”5]

Probiotics and GI disease

Studies show that chronic GI issues, such as inflammatory bowel disease (IBD), are associated with alterations in the microbiome. There are consistent decreases in Firmicutes and Bacteroidetes and increases in Proteobacteria species. These changes lead to susceptibilities in the innate immune system of dogs and cats with IBD.6 Other research confirms there is a predictable pattern of dysbiosis in dogs with various GI diseases, and that the bacterial groups commonly decreased are those considered to be important short-chain fatty acid producers.7 This is important because short-chain fatty acids are needed to maintain the health of enterocytes.

Probiotics and the immune system

The gut associated lymphoid tissue (GALT) makes up 70% to 80% of the body’s immune system. This means the GI tract is the largest organ of the immune system. Multiple studies show that probiotic supplementation can affect the systemic immune system in many ways. When puppies were given the probiotic E. faecium SF68 from weaning to one year of age, their serum IgA concentrations were higher, they had a greater proportion of mature B cells, and they had higher titers after distemper vaccination than control puppies.8 Also, several studies in humans show that probiotics can prevent and/or treat food and atopic allergies.9,10 A study in dogs found that when puppies were given a probiotic supplement before the age of six months, they had decreased allergen-specific IgE and reduced development of atopic dermatitis in the first six months. A three-year follow-up with an allergen challenge demonstrated a low IL-10 for all allergens in probiotics-exposed dogs.11 Other researchers concluded: “Many studies have found that gut microbes are involved in the immunopathogenesis of Diabetes Mellitus. Probiotics strengthen the host's intestinal barrier and modulate the immune system….”12

The microbiota-gut-brain axis

An aspect of the microbiome that is often overlooked is its effect on the brain. One study found that the microbiomes of patients with major depressive disorder (MDD) differed significantly from those in healthy controls. When the microbiomes of MDD patients were transplanted into germ-free mice, the mice displayed depression-like behaviors. To the contrary, when germ-free mice were transplanted with microbiomes from healthy patients, there was no behavior change. “The gut microbiome is an increasingly recognized environmental factor that can shape the brain through the microbiota-gut-brain axis.…” concluded the researchers. “This study demonstrates that dysbiosis of the gut microbiome may have a causal role in the development of depressive-like behaviors, in a pathway that is mediated through the host's metabolism.”13 No doubt, dysbiosis plays a role in canine and feline behavioral issues. One way the microbiome affects the brain is the fact that certain intestinal bacteria produce and deliver neuroactive substances such as serotonin and gamma-aminobutyric acid (GABA). “Preclinical research in rodents suggested that certain probiotics have antidepressant and anxiolytic activities.”14 In addition, three double-blind, placebo-controlled trials studied the effect of probiotics on the stress responses in healthy medical students before exams. They found that probiotics may reduce stress reactivity in the paraventricular nucleus through vagal afferent signaling.15 Another study found that chronic administration of probiotic L. rhamnosus (JB-1) to mice caused a reduced level of anxiety and depression-like behavior. The probiotics induced changes in the GABAergic system in regions of the brain known to involve these behaviors. The researchers further found that a vagotomy prevented the effects of the probiotic, confirming the vagal signaling theory.16

Probiotics and the urinary tract

In a recent study, five lactobacillus strains (L. gasseri, L. rhamnosus, L. acidophilus, L. plantarum, L. paracasei,) were tested in vitro against four uropathogens common in infantile urinary tract infections. All the Lactobacillus strains showed moderate antimicrobial activities against the uropathogens.21 An intriguing case-controlled study involved the ingestion of fermented milk products in Japan. The researchers concluded: It was strongly suggested that the habitual intake of lactic acid bacteria reduces the risk of bladder cancer.”22

Probiotics and mutagen detoxification

In an early study of fermented milk products, 11 healthy subjects were put on a standardized diet that included consuming fried beef patties twice daily. For the first three days (Phase 1), the subjects were given Lactococcus (non-probiotic) fermented milk. During Phase 2, the subjects drank L. acidophilus fermented milk. The total fecal and urinary mutagen excretion (a cancer-causing chemical that is, or has been, excreted in the urine) on Day 3 during Phase 2 was 47% lower compared to Day 3 of Phase 1, indicating the possible role of probiotics in preventing cancer.23

Probiotics as nutrients

According to Stedman’s Medical Dictionary24 a nutrient is “a constituent of food necessary for normal physiologic function.” The term “essential nutrients” refers to “nutritional substances required for optimal health. These must be in the diet, because they are not formed metabolically within the body.” In my opinion, given the research explored in this article, probiotics meet these definitions. I am not alone in my assertion. “The health and well-being of companion animals, just as their owners, depends on the gut microbes…. Specific probiotic strains and/or their defined combinations may be useful in canine and feline nutrition, therapy, and care.”25 Probiotics are essential nutrients for dogs and cats that are not contained in conventional diets, and must be supplemented regularly throughout life in order to maintain or regain health.

Microbiome and obesity

The metabolic activity of the microbiome is especially demonstrated by its effect on fat accumulation in the body. One study utilized four sets of human twins, one of whom was obese and the other lean. When a fecal transplant of the “lean” bacteria was made into germ-free mice, the mice remained thin. However, a fecal transplant of the “obese” bacteria into germ-free mice resulted in obese mice. Moreover, obese mice became thin when housed with thin mice apparently due to coprophagia.17 Another interesting study found that fecal transplants from conventionally raised mice into germ-free mice resulted in a 60% increase in body fat content and insulin resistance within 14 days despite reduced food intake. According to the researchers, “Our findings suggest that the gut microbiota is an important environmental factor that affects energy harvest from the diet and energy storage in the host.”18

Probiotics and pancreatitis

A randomized, double-blind, placebo controlled trial in human patients with acute pancreatitis found that “Supplementary L. plantarum 299 was effective in reducing pancreatic sepsis and the number of surgical interventions.”19 A similar study in dogs looked at experimentally-induced severe pancreatitis and compared ecoimmunonutrition, parenteral nutrition, and elemental enteral nutrition. (Ecoimmunonutrition refers to the feeding of L. plantarum-containing formula.) The probiotic treated dogs experienced lower levels of increase in serum amylase, ALT, AST, and plasma concentrations of endotoxin. They also had suppressed pancreatic and ileal histopathologic changes. Bacterial translocation was also decreased in the probiotic treated dogs.20

Conclusion

We have seen that a well-balanced microbiome with numerous, diverse bacteria is important to an animal’s health. We have also explored the many commonly-used modern medications that can disrupt a pet’s GI bacterial equilibrium, leading to dysbiosis and leaky gut. And now we know how the use of probiotics can improve the health of well animals and effectively address a multitude of diseases. Probiotics truly are the missing nutrients in the diets of our dogs and cats. 1Manninen TJK, et al. “Alteration of the canine small-intestinal lactic acid bacterium microbiota by feeding of potential probiotics”. Appl Environ Microbiol. 2006;72(10):6539-6543. 2Baillon M-LA, Marshall-Jones ZV, Butterwick RF. “Effects of probiotic Lactobacillus acidophilus strain DSM13241 in healthy adult dogs”. Am J Vet Res. 2004;65.3:338-343. 3Pasupathy K, Sahoo A, Pathak NN. “Effect of lactobacillus supplementation on growth and nutrient utilization in mongrel pups”. Archiv für Tierernaehrung. 2001;55(3):243-253. 4Marshall-Jones ZV, Baillon ML, Croft JM, et al. “Effects of Lactobacillus acidophilus DSM13241 as a probiotic in healthy adult cats”. Am J Vet Res. 2006;67:1005–1012. 5Rastall RA. “Bacteria in the gut: friends and foes and how to alter the balance”. J. Nutr. 2004;134:2022S-2026S. 6Honneffer JB, Minamoto Y, Suchodolski JS. “Microbiota alterations in acute and chronic gastrointestinal inflammation of cats and dogs” World J Gastroenterol. 2014;20(44):16489-97. 7Suchodolski JS, et al. “The fecal microbiome in dogs with acute diarrhea and idiopathic inflammatory bowel disease”. PLoS One. 2012;7(12):e51907. 8Benyacoub J, Czarnecki-Maulden GL, Cavadini C, et al. “Supplementation of food with Enterococcus faecium (SF68) stimulates immune functions in young dogs”. J Nutr 2003;133:1158–1162. 9Majamaa H, Isolauri E. “Probiotics: a novel approach in the management of food allergy”. J Allergy Clin Immunol. 1997;99(2):179-185. 10Kalliomäki M, et al. “Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial”. Lancet. 2003;361(9372):1869-1871. 11Marsella 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;2:185–189. 12Wang F, Zhang C, Zeng Q. “Gut microbiota and immunopathogenesis of diabetes mellitus type 1 and 2”. Front Biosci (Landmark Ed). 2016;21:900-6. 13Zheng P, et al. “Gut microbiome remodeling induces depressive-like behaviors through a pathway mediated by the host's metabolism”. Mol Psychiatry. 2016 Jun;21(6):786-96. 14Evrensel A, Ceylan ME. “The Gut-Brain Axis: The Missing Link in Depression”. Clin Psychopharmacol Neurosci. 2015;13(3):239–244. 15Takada M, et al. “Probiotic Lactobacillus casei strain Shirota relieves stress‐associated symptoms by modulating the gut–brain interaction in human and animal models”. Neurogastroenterol Motil. 2016 Jul;28(7):1027-36. 16Bravo JA, et al. “Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve”. Proc Natl Acad Sci U S A. 2011;108(38):16050-16055. 17Ridaura F, et al. “Gut microbiota from twins discordant for obesity modulate metabolism in mice”. Science, 2013; 341(6150):1241214. 18Bäckhed F, et al. “The gut microbiota as an environmental factor that regulates fat storage”. Proc Natl Acad of Sci U.S.A., 2004; 101(440;15718-15723. 19Olah A, Belagyi T, Issekutz A, et al. “Randomized clinical trial of specific lactobacillus and fibre supplement to early enteral nutrition in patients with acute pancreatitis”. Br J Surg. 2002; 89:1103-1107. 20Xu GF, Lu Z, Gao J, et al. “Effect of ecoimmunonutrition support on maintenance of integrity of intestinal mucosal barrier in severe acute pancreatitis in dogs”. Chin Med J. 2006; 119:656-661. 21Shim YU, Lee SJ, Lee JW. “Antimicrobial activities of Lactobacillus strains against uropathogens”. Pediatr Int, 2016; Feb 10. Doi: 10.1111/pet.12949. 22Ohashi Y, et al. “Habitual intake of lactic acid bacteria and risk reduction of bladder cancer”. Urologia internationalis, 2002; 68(4):273-280. 23Lidbeck A, et al. “Effect of lactobacillus acidophilus supplements on mutagen excretion in faeces and urine in humans”. Microbial Ecology in Health and Disease, 1992;5(1):59-68. 24Stedman’s Medical Dictionary (27th ed). 2000, Baltimore, MD; Lippincott Williams & Wilkins. 25Grześkowiak L, Endo A, Beasley S, Salminen S. “Microbiota and probiotics in canine and feline welfare”. Anaerobe. 2015;34:14-23. This article has been peer reviewed.




Integrative approaches to megaesophagus

Several alternative therapies are attracting attention for successfully treating megaesophagus, either as a sole therapy or part of a larger treatment approach.

Megaesophagus is a disorder of the esophagus in mammals. It’s characterized by esophageal dilatation and an inability of the esophagus to effectively transport food from the throat to the stomach. Megaesophagus occurs predominately in humans and dogs, and is the most common cause of canine regurgitation. Any dog breed can be affected, but certain underlying conditions have breed predilections.1 Experts in general agree that dogs with megaesophagus carry a poor prognosis as they typically die of malnutrition, aspiration pneumonia, or are euthanized because the owners are told there is no hope.2

Pathophysiology of the esophagus

Dysphagia, or disorder of swallowing, is a major sign of esophageal disease. Swallowing is a complex and highly coordinated physical act that can be divided into three phases: oral, pharyngeal and esophageal.3 The oral phase is usually associated with lesions of the oral cavity and tongue, while the pharyngeal phase is associated with pharyngitis and tonsillitis. When considering the esophageal phase, the first and last part may be impeded by failure of the cricopharyngeus muscle to relax during swallowing (achalasia), or increased tension at the lower esophageal sphincter which impedes the flow of food into the stomach.1,3 Segmental or diffuse dysfunction of the body of the esophagus is classified as megaesophagus. It results from atony of the esophageal muscle and is characterized by flaccidity and luminal dilatation. The esophagus is innervated by the vagus nerve; afferent vagal receptors are stimulated by the presence of food and liquid in the pharynx and upper esophagus, causing a swallow reflex and the esophagus to contract.1 The functional lesion may reside in the upper motor neurons of the central swallowing center or in the afferent sensory arm of the reflex controlling peristalsis, which arises in the esophagus.3 Whatever the etiology, the result is failure of the peristaltic propulsion of the food bolus through the lower esophageal sphincter. Retention of food in the esophagus leads to putrefaction and esophagitis in dilated/dependent areas. The volume of the dilated thoracic and cervical esophagus may greatly exceed that of the stomach, with displacement of the intrathoracic trachea and heart ventrally. Common signs animals may present include malnutrition, dehydration, rhinitis and aspiration pneumonia.1,3,4,5

Clinical aspects of megaesophagus

There are two primary categories of megaesophagus -- congenital and acquired. Congenital megaesophagus: In the congenital form of the disease, swallowing dysfunction and regurgitation becomes especially evident with the introduction of solid food.1,3,4 A puppy with congenital megaesophagus characteristically begins to regurgitate at weaning (eight to 12 weeks old) when he is consistently consuming solid food.4 Initially, the puppy regurgitates immediately after food consumption, but as the esophagus dilates, food is held for longer periods before regurgitation. Commonly, the puppy will present with fever, cough and nasal discharge along with poor weight gain as the syndrome becomes complicated by aspiration pneumonia.4 Congenital megaesophagus is primarily associated with heritable anomalies in either neuromuscular innervation or vascular ring anomalies that entrap the esophagus near the heart base. Prognosis for the resolution of congenital megaesophagus in puppies is only 20% to 40%, although there is potential for improvement up to one year of age.1,6 Acquired megaesophagus: Gastrointestinal, endocrine, immune-mediated, neuromuscular, paraneoplastic and toxic disorders have been associated with acquired megaesophagus, with myasthenia gravis being the most common etiology in 25% to 30% of cases.1,5 Affected animals regurgitate (lack of vigorous abdominal contractions, vomitus with PH>5, lacks bilirubin) and have generally lost weight.6 Respiratory signs may predominate with little or no history of regurgitation. Thoracic radiographs reveal air, fluid or food in a dilated esophagus.1,4 Typical treatment involves medical management directed at the etiology, or surgery for vascular ring anomalies. This includes finding a diet that best prevents regurgitation, and this varies between individuals (slurry to more solid). A feeding schedule of small frequent meals from an elevated dish, where the forelimbs are higher than the hindlimbs, along with keeping the dog in this upright position ten to 15 minutes after eating, works best to prevent postprandial regurgitation. The overall prognosis is poor if the underlying etiology cannot be corrected, and many affected animals die from aspiration pneumonia.4

Alternative approaches to megaesophagus

The morbidity and mortality of dogs affected with megaesophagus depends on the degree and nature of the underlying disease (if known), as well as client compliance. Medical management in general is aimed at relieving clinical signs, such as weight loss and respiratory infections secondary to food aspiration. Alternative therapies are increasingly being used to stimulate the esophagus to move more effectively, either as a sole therapy in mild cases or as an adjunct to Western therapeutic management.7-10 Some promising evidence-based clinical studies demonstrate the efficacy of acupoint stimulation on gastrointestinal motility. Studies have focused on two key acupuncture points -- PC-6 and ST-36. Research on PC-6 includes 33 controlled trials (published worldwide as of 1996) for its use for nausea and vomiting, with 27/29 trials showing statistically significant positive results. Stimulating Pericardium 6 (PC-6) in clinical trials produced a significant reduction of perioperative emetic sequelae. ST-36 has been found to have analgesic and spasmolytic effects on the GI tract; it also regulates gastric acidity and has a homeostatic effect in endocrine and metabolic disorders.9,10  Other studies have demonstrated that transcutaneous electrical stimulation (TENS) at LI-4 and SI-3/HT-7 significantly decreased lower esophageal sphincter pressure in humans with achalasia, by creating an increased plasma vasoactive intestinal peptide release. This inhibitory neuropeptide is associated with the relaxation of lower esophageal sphincters.9 Other alternative approaches used successfully in treating megaesophagus include Traditional Chinese Veterinary Medicine (TCVM), homeopathy and laser therapy.

TCVM and acupuncture

In TCVM, megaesophagus is considered a Qi Deficiency, due to the inhibition of directional movement of a tubular organ. It can be also be associated with concurrent Blood or Yin Deficiency with subsequent dryness that fails to lubricate the ingesta. With acquired megaesophagus, an exogenous (i.e. distemper virus, trauma, toxins) or endogenous (i.e. hypothyroidism, hypoadrenocorticism, myasthenia gravis) pernicious influence leading to a localized Wei syndrome (weakness without pain) needs to be considered, and the pattern of imbalance addressed. The primary treatment principles are to tonify global and local Qi, assist directional Qi flow, increase body moisture/fluids, tonify Yin, and nourish and invigorate blood.8 Various acupoint prescriptions for this condition have been presented depending on the TCVM pattern diagnosis as well as results from evidence-based studies. Acupuncture has demonstrated efficacy in the control of vomiting (Stomach Qi rebelling) associated with megaesophagus. In one study on five dogs with idiopathic megaesophagus, a 70% resolution of regurgitation along with increased weight gain was observed when using points PC-6, PC-9, HT-9, ST-36, LI-4, LI-11 and ST-40 with dry needles for ten minutes twice a week for four weeks.8,9,10 Other experts have provided acupoint prescriptions such as LI-4/11, ST-36/41, BL-13/23, PC-6 and HT-9 as beneficial for treating megaesophagus.11 Acupoint selection can also be based on treatment principles and TCVM patterns with Local Points (GB 20/21, TH-17/16, ST-9/10, LI-17/18, CV-22/23) along with Distal Points (LI-4/11, SI-3, LU-7, LIV-3) and Qi Tonifying Points (BL-20/21, BL 23/26, Shen-shu, ST-36, SP-9). Electro-acupuncture is also used with success in this condition, with treatments combining CV-23+CV-22, LI-17+GB-21, BL-14 bilateral, BL-20 bilateral, BL-23 bilateral (20Hz/10 min + 80/120 Hz 10 min).12 Chinese herbal medicine as a component of traditional Chinese Veterinary Medicine is used to address the root of the megaesophagus disease syndrome, Qi deficiency, as well as other imbalances such as Yin and Blood Deficiency. Chinese herbal formulas such as Four Gentlemena (modified Si Jun Zi Tang) for Qi deficiency and/or Happy Eartha (modified Wei Chang He) for rebellious Stomach Qi (regurgitation) in combination with acupuncture can be used successfully to treat megaesophagus. Pharmaceutical studies demonstrating improved gastric emptying and small intestinal motility by inhibiting the dopamine D receptor and 5-HT receptor as well as improvement in overall health in animal subjects has been demonstrated for Si Jun Zi Tang.13, 14, 15 Components of the herbal formula Happy Earth have demonstrated specific and significant effects on the gastrointestinal tract such as inhibition of the vomiting center in the brain and anti-spasmodic effects of the small intestine through modulation of the central nervous system.15, 16, 17

Homeopathy

Homeopathy is an individualized therapeutic approach based on the principles that the same illness creates a different set of clinical signs in different individuals.18 Selection of homeopathic remedies follows the medical principles first espoused by Hippocrates – “Like cures like”, known as the “Law of Similars”. Homeopathic medicine has no formal experimental studies on efficacy associated with treatment of megaesophagus. Clinical evidence shows good results using classical homeopathy to find the “similimum” – the homeopathic medicine that matches the individual animal’s clinical signs associated with the disease condition as well as with general characteristics.

Laser

Low-level laser therapy (LLLT) is a therapeutic modality of photobiostimulation that uses the emission of red and near infrared light wavelengths between 400 nm and 905 nm that are optimally absorbed by mitochondrial chromophores (cytochrome C oxidase). This sets up a cascade of events, including upregulated oxidative phosphorylation and increased ATP production, that modulates the activity of a number of cell types and biological mechanisms. In addition to wavelength and power (measured in watts or miliwatts), various frequencies (ranging from 4 Hz to over 10,000 Hz) are used depending on the tissue type and disease condition being treated. It is imperative to know the power (watts) and wavelength (nm) of the laser device being used in order to apply it appropriately to tissues and not cause harm. Some lasers (Class 4) generate thermal changes to tissues that can be tolerated in musculoskeletal issues, but are contraindicated over endocrine and gonads. The laser system used in the case report on page xx was a Class 2 visible light wavelength (635 nm, 405 nm) frequency specific low power (5 mW, 7.5 mW) laser. The end result is that laser therapy, when used appropriately, with an understanding of the specifications and applications, can provide a non-invasive, pain-free, drug-free and non-surgical treatment for a variety of conditions.

Conclusion

Megaesophagus is a debilitating condition that carries a poor prognosis, whether present congenitally or as an acquired condition in adult dogs. Chronic regurgitation accompanied by aspiration pneumonia leaves an affected animal malnourished and in neverending cycles of severe respiratory distress. Several alternative therapies are beginning to attract attention for successfully treating this condition, either as a sole therapy or a part of a larger integrative medicine approach. As these therapies become more mainstream for the approach of megaesophagus treatment, there is cautious optimism that in some cases the condition could be successfully managed with a good quality of life for the affected animal.

Using acupuncture for megaesophagus

Case #1

A four-month-old intact female five-pound Bichon Frise/Havanese crossbreed was presented to the Integrative Medicine Service with a diagnosis of megaesophagus. The puppy had a history of chronic vomiting after eating (one to two times a day) and a failure to gain weight since weaning. Conventional treatment resulted in no improvement. TCVM with needles and the Chinese herb Happy Earth (modified Wei Chang He) was started. The one-week recheck showed significant clinical improvement, and after three needle treatments and after nine months of Happy Earth, the pup was at a normal weight and asymptomatic. She was still fine at four years of age.

Case #2

A two-year-old male neutered Siberian Husky crossbreed was presented to the emergency and critical care clinic at the Veterinary Teaching Hospital, with a several-week history of vomiting and gagging along with rapidly deteriorating locomotor activity. The dog had been normal prior to a vaccination one week before. With conventional treatment, the dog then developed severe hindquarter weakness and was diagnosed with lower motor neuron disease and referred to the teaching hospital. A diagnosis of presumptive acquired myasthenia gravis of undetermined etiology was made. The dog responded to treatment with a gradual improvement of weakness and decreased regurgitation. Three weeks after the diagnosis, the owner presented her dog to the Integrative Medicine Service for assessment; the goal was to decrease Western medications, which were creating side effects such as ravenous appetite, diarrhea and lethargy, and possible improvement of the megaesophagus. Treatment included dry needle acupuncture and two herbal formulas, Four Gentlemen (to tonify Qi) and concentrated Hindquarter Weakness (to address Qi and Yin Deficiency), with no change in Western drug doses and continued feeding in the Bailey chair. The protein in the dog’s diet was changed from chicken (Hot) to beef (Slight Warm) for a slightly Cooler diet. Two weeks later, at recheck, there was significant improvement with a good appetite, no regurgitation and conscious proprioception normal in one hind leg. Over the next two months, with acupuncture treatment monthly, all Western medications were tapered and then stopped while the dog returned to a normal neurological status and energy level with no regurgitation. He continues to do well at seven months past initial clinical signs.

Using homeopathy for megaesophagus

From Ed DeBeukelaer, MVRCS, author of Homeopathy: What to Expect, Including 101 Cured Cases (12edb3@gmail.com) Two Dalmatian puppies were seen at three weeks of age for milk regurgitation, but were otherwise clinically normal. By five weeks of age, a full diagnostic workup was performed due to increasing dyspnea, yielding a diagnosis of megaesophagus with copious aspiration of milk into the lungs. Phosphorus 30c (tid drops) was started while the owner contemplated whether to continue clinical treatment or euthanize the puppies. The following day, there was a steady improvement in their breathing, accompanied by decreased regurgitation; therefore, treatment was continued. At eight months old, one of the puppies was euthanized due to continued clinical complications. The second puppy is now 2.5 years old, has steadily grown and is taller than her normal littermates. She still regurgitates small amounts of smelly mucus every day but is able to maintain normal nutritional status, with only minor intermittent loss of small amounts of ingesta. She has responded well to the homeopathic medicine Falcon Peregrine (made from Peregrine Falcon) for abdominal enlargement after eating. A year later Ara macau (made from Scarlet Macaw) was prescribed because of her character, mild regurgitation and mild otitis. The ear problem resolved, and she has since taken this remedy every few months in a 30c preparation when the regurgitation increases.

Using laser for megaesophagus

From Janet Gordon Palm, DVM, CVCP (animobilityvet.com) An 11-year-old male neutered Collie presented at New Hope Animal Hospital with evidence of aspiration pneumonia secondary to megaesophagus. The dog had a history of regurgitation and retching multiple times as day for months, and now presented with worsening pneumonia, which had been present for over one week. Radiographs were taken, and a broad-spectrum antibiotic therapy, which included Clavamox and Baytril, was initiated. One week later, the dog presented for recheck. He had not significantly improved and the owner had to go on an international trip. Due to the dog’s deteriorating condition, he was boarded at the veterinary clinic. While at the clinic, the megaesophagus was treated with laser therapy twice daily for two days. On the second day of treatment, the dog was brighter and eating without retching. A total of six treatments were performed over a one-week period. The pneumonia resolved quickly once laser therapy was started, and the dog was relatively cough- and regurgitation-free during the rest of the time he was boarded. The owner was unable to afford the remainder of the recommended 12 total treatments (twice a week for two weeks, followed by once a week for eight sessions). The dog was discharged, and was symptom-free for over five weeks. He then presented with a recurrence of occasional regurgitation, but no further aspiration. Laser treatment was reinstated and the dog was successfully managed with this therapy until euthanasia seven years later, due to unassociated age-related quality of life issues. ______________________________________________________________________

Footnotes

a Veterinary specific patented herbal formula; Jing Tang Herbal, Reddick, FL. USA

References

1KuKanich K. Diagnosis and management of megaesophagus in dogs. In: CVC in Kansas City Proceedings, Aug 01, 2011, Kansas City, Missouri. 2Schachtel, J. Swallowing protocol and early identification of LES achalasia. Abstract; Annual Conference of American College of Veterinary Radiation, Oct 19-22, 2016, Orlando, FL. 3Barker I, Van Dreumel A. The alimentary system. In: Pathology of Domestic Animals 3rd Ed, Jubb K, Kennedy P and Palmer N (eds). Orlando, F; Academic Press 1985:26-27. 4Merck- Aiello S, Mays A (eds).  Anomalies of the Digestive System and Diseases of the Esophagus in Small Animals. In: The Merck Veterinary Manual 8th Ed, Whitehouse Station, NJ; Merck & Co Inc 1998:128, 276-278. 5Mace S, Shelton G, Eddlestone S. Megaesophagus. Web accessed 15Jan2018. Compend Contin Educ Vet 2012 Feb;34(2):E1-E8. 6Willard M. Recognizing and treating esophageal disorders in dogs and cats. Veterinary Medicine 2004, http://veterinarymedicine.dvm360.com/recognizing-and-treating-esophageal-disorders-dogs-and-cats; 15Jan2018 Web access. 7Dodd J. Megaesophagus. Web accessed 15Jan2018; https://drjeandoddspethealthresource.Tumbir 8Clemmons R. Megaesophagus and megacolon. Web access 15Jan2018; dog2doc.com/chi-files/TCVM_Herbs/August_Chi/Megaesophagus_Megacolon.ppt 9Schoen A. Veterinary medical acupuncture for gastrointestinal conditions. In: CVC in San Diego Proceedings, Nov 01, 2009, San Diego, CA. 10Dill S, Bierman N. Acupuncture for Gastrointestinal Disorders. In: Veterinary Acupuncture, Ancient Art to Modern Medicine, Schoen, A (ed). St Louis, MO; Mosby 2001:239-260 11Looney A. Acupuncture and canine disc disease, points for treatment of megaesophagus. Atlantic Veterinary Conference 2001. https://www.vin.com/VINDBPub/SearchPB/Proceedings/PR05000/P00271_IMCO3306.htm; Web access 15Jan2018. 12Xie H, Wedemeyer L, Chrisman C, et al. Practical Guide to Traditional Chinese Veterinary Medicine Small Animal Practice. Chi Institute Press, Reddick, FL, 2014. 13Ye F et al. Pharmacological study of Si Jun Zi decoction of gastrointestinal tract. Shi Zhen Guo Yi Guo Yao. 2005, 16(1):61. (in Chinese) 14Kimura Y et al. Effects of an Atractylodes lancea rhizome extract and a volatile component B-eudesmol on gastrointestinal motility in mice. J Ethnopharacol. 2012, 141(1): 530-536. 15Ma A. Clinical Manual of Chinese Veterinary Herbal Medicine. Gainesville, FL.: Ancient Art Press 2016: 101-102, 208-210. 16Zhao, YJ et al. Effect of rhizome pinelliae on vomiting in minks. Zhongguo Zhong Yao Za Zhi, 205, 30:227-229. 17Watanabe K et al, Pharmacological properties of magnolol and honokiol extracted from magnolia officinalis: central depressant effects. Planta Med. 1983, 49:103-108. 18Khalsa D. Dr Khalsa’s Natural Dog. Irvine, CA: i-5 Press 2015: 115-122.




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Integrative ways to optimize mobility in older animals

Integrative medicine has earned a place as first-line treatment for veterinary patients, especially older animals with pain, neurological compromise or debilitating arthritis.

When clients complain that their older animals are refusing to go on walks, that they sleep all the time or have even become aggressive, we need to think about problems centering on mobility and pain. In so doing, however, we should reconsider the “easy fix” of gabapentin, tramadol or non-steroidal anti-inflammatories, and seek to do more to help these patients. Each of the aforementioned medications can cause its own set of problems, such as oversedation, inappetance and organ injury.  Furthermore, they do little to directly treat the causes of mobility impairment, whether due to osteoarthritis, chronic spinal cord injury, myofascial dysfunction or pain.

Issues in aging animals

The problem may extend beyond musculoskeletal and neurologic systems, so a whole patient examination and lifestyle analysis is indicated. Taking the time to gently palpate the myofascia and examine neurologic status yields vital differential diagnostic information about the nature and location of discomfort and/or compromise, without having to force the neck or back into extreme and unnatural ranges of motion. Geriatric animals may need more readily digestible food, anti-aging nutrients, and caloric intake adjustment. Overweight animals are at greater risk of joint disease and inflammation, while underweight individuals may have difficulty procuring, chewing or digesting food. Both states can cause muscles to weaken and strength to further decline. Time may also rob our patients of vision, audition and overall vitality. Perceived cognitive changes such as disorientation, diminished activity, reduced social interactions, behavioral shifts and incontinence may actually stem from undiagnosed pain and neuromuscular impairment. Furthermore, many common geriatric afflictions, such as neoplasia, infections, immune-mediated illness, organ dysfunction and endocrinopathy can also change the way a dog or cat behaves.

Science-based integrative medicine supports movement and reduces pain

After appropriately assessing an animal and identifying the source of his reluctance to rise, walk or otherwise engage in the activities he used to enjoy, the next step is to discuss with the client the pros and cons of conventional and integrative treatment. The latter may involve medical acupuncture, massage, photomedicine (i.e. therapy with laser or light-emitting diodes) or even the cautious inclusion of botanical agents. Each of these techniques, when performed safely and correctly, allows for non-drug and non-surgical options that work on several levels to improve health and restore function.  The aforementioned physical medicine approaches yield overlapping benefits through unique mechanisms of action. Despite their differences, laser, acupuncture and massage all share the common mechanism of neuromodulation. That is, each activates somatic afferent fibers in the periphery; peripheral nerves then deliver impulses to the spinal cord and brain to help normalize central, autonomic and peripheral nervous system function. All three also have the capacity to beneficially impact local tissue, promoting blood flow, reducing pain and working in an anti-inflammatory manner. The versatility and acceptability of these approaches to patients make them suitable for both in-hospital and outpatient care. Healthcare providers can introduce short, supportive treatments throughout the day to help in-patients relax and recover. Motivated clients can learn easy and safe home care techniques involving touch and light-emitting diodes that aid in keeping their animals active and healthy.

1. Acupuncture

Acupuncture incites its somatic afferent stimulation by inducing slight mechanical traction on the tissues near the needle shaft. The metal needle engages with muscle and collagen fibers, leading to a small amount of local tissue deformation capable of causing wide-ranging results. Fascia extending out from the needle begins to relax, and blood flow within the muscle normalizes. Nerve endings and axons in the vicinity issue action potentials and reflexes that cause re-regulation of firing patterns in peripheral, autonomic and central nervous system pathways.

2. Photomedicine

Photomedicine provokes alterations in cellular physiology and neural activity through photonic means. Photoacceptor enzymes within the mitochondria, such as cytochrome c oxidase, absorb photons which then alter the enzyme’s binding patterns with nitric oxide and oxygen. Mitochondrial metabolism increases, as does ATP synthesis. The cavalcade of photochemical events that ensue benefit cellular physiology, intercellular signaling, and tissue repair. What makes laser therapy stand out is this capacity to “kickstart” cellular energy production needed for tissue cleanup and repair.

3. Massage

The mechanical effects of massage activate pressure-sensitive mechanoreceptors in the skin and subcutaneous tissue. Massage can calm or stimulate the nervous system depending on techniques, and it facilitates fluid flow through the interstitium. Signals from treated tissue travel to the spinal cord and brain to normalize nervous system balance within central, peripheral and autonomic networks. The movements of massage encourage the flow of fluids (lymphatic, arterial, venous and interstitial) through the body. This improves the health of not only somatic structures but also visceral function.

The problem of intervertebral disc disease (IVDD)

A common condition affecting older dogs is intervertebral disk disease (IVDD). It causes pain, weakness, muscle tension, inflammation, circulatory compromise and even paralysis.    Clients facing the expense, fear and psychological trauma of having their dogs undergo surgery need to be educated on what non-surgical alternatives can offer based on science and research, along with appropriate anti-inflammatory pharmaceuticals and analgesics, if indicated. In contrast, weeks-long cage confinement, which is a commonly-recommended mandate, has no supportive scientific research and can lead to negative long-term neurologic and orthopedic consequences. Even if a client seeks surgery for a dog with IVDD, the process of removing extruded disc material does little to directly address changes that take place within the spinal cord in the secondary injury phase, which occurs in the days after injury takes place. It may even worsen the inflammatory cytokine responses in the cord and surrounding tissue, and precipitate biochemically-mediated neuronal death and spinal cord inflammation. In contrast, modalities such as photomedicine and acupuncture stimulate recovery by controlling pain, inflammation and edema. They work to promote neural regrowth and functional restoration through stem cell activation and the encouragement of more normalized neural firing patterns. Massage aids the myofascia in relaxing and provides its own form of neuromodulation.

How do you know the treatment is working?

Acupuncture and massage provide immediate feedback through the delivery device; laser does not. A skillful practitioner inserting an acupuncture needle gauges the amount of resistance the needle encounters as it penetrates one or more layers of muscle. This mechanical information conducted through the needle informs the acupuncturist about the state of tone, tension and tenderness in a muscle. Reactions from the patient further advise the acupuncturist about the degree of stimulation taking place within the patient’s nervous system. An experienced massage therapist develops palpatory techniques that convey other types of information. Feeling the tissues respond to touch and the myofascia melt under one’s palms during indirect release techniques provide moment-to-moment messages about how the patient’s body and mind are responding. Laser, like other instrument-driven methods such as ultrasound therapy, limits the amount of tissue engagement by the practitioner unless s/he makes a point of palpating the patient during or soon after treatment. Despite this limitation, all three modalities can fit seamlessly into integrative pain medicine treatment plans. Blending them maximizes the benefits to the patient by multiplying the mechanisms of action at play.

How does the safety of each modality compare?

When practiced by a medical/veterinary professional, acupuncture is one of the safest interventional techniques available. As long as one uses sterile needles and avoids inserting a needle into an organ, the spinal cord, a joint or a major vessel, complications are mild and resolve quickly. Similarly, properly-performed massage is relatively non-injurious as long as pressure is kept reasonable and the practitioner remains cognizant of any patient behavior that indicates discomfort or stress. However, photomedicine with lasers, in contrast to LEDs, may cause problems. Higher-powered laser therapy devices (i.e those in the Class IV category, which deliver >500 mW of power) may cause retinal damage with direct ocular exposure (hence the need for protective and specifically designed laser goggles). Furthermore, the race to produce higher-powered devices in the Class IV category is elevating the number of anecdotal reports of thermal burns and patient pain during the procedure. Clearly, more caution is required for veterinary patients than is often recognized, and geriatric animals with impaired ability to escape a painful treatment, or even sense a thermal burn if they have nerve injury, warrant even more caution and care.

Conclusion

Scientific integrative medicine has earned a place as first-line treatment for veterinary patients across the board, especially for older animals with pain, neurologic compromise or debilitating arthritis. It is time for veterinary medicine to move from a disease-based to a health-supporting paradigm of treatment, and address dysfunction well before it manifests as illness. Performing quick neurologic and gentle myofascial palpation evaluations on patients at every visit will indicate whether and where the animal is developing dysfunction in myofascia, joints or other tissues. We need to stop relying on artificial chemicals to keep animals moving, because their effects are limited and sometimes engender costly and damaging side effects. By working instead through neuromodulation, connective tissue remodeling and photobiomodulation (i.e. acupuncture, massage and photomedicine), the body’s endogenous self-healing mechanisms are engaged, and the patient regains the ability to recover from injury more fully and quickly.

10 homecare tips for clients

  1. Ensure adequate traction in the home (area rugs, carpet runners, non-slip stair treads); consider toe grips or high traction socks or booties for dogs.
  2. Keep nails well-trimmed and delicately trim matted or soiled fur.
  3. Give the animal access to warm or cool surfaces based on his individual needs and preferences; ensure access to fresh, clean air and exercise while avoiding exposure to taxing weather conditions.
  4. Provide clean and appropriately-cushioned surfaces for sleeping and relaxing. Many animals with mobility challenges may prefer firmer bedding that offers much-needed structural support.
  5. Keep animals with elimination problems clean and ensure they have dry bedding.
  6. Help severely impaired animals maintain adequate hydration and nutrition by ensuring they have ready access to food and water.
  7. Consider purchasing a light-emitting diode (LED) device for home treatment of pain and neurologic challenges. Longer exposure to the less intense light offered by LEDs may be safer and more beneficial for some animals than the short bursts of high-powered laser treatments that have become popular in many veterinary practices. Reports of thermal burns and discomfort during treatment are increasing as the hype around high-powered laser units grows.
  8. Encourage daily, appropriate exercise and environmental enrichment. Think about an assistive harness for animals that need help with rising and walking. Purchase a ramp for dogs who enjoy car travel.
  9. Learn simple, safe and supportive massage techniques to improve circulation, digestion, nerve health and pain control.
  10. Examine the pros and cons of botanical medicines such as boswellia, turmeric and cannabidiol to help with pain and inflammation. Consult a veterinarian educated in science-based integrative medicine about options based on facts and research.





Digital Infrared Thermal Imaging — Case Studies

These case studies demonstrate how digital infrared thermal imaging can provide an objective assessment of feline and canine patients.

Case study #1

Presentation: Feline patient with a history of a gradual reduction in activity. A physical examination did not localize any sites of discomfort.  Digital infrared thermal images were captured utilizing a Digatherm 640 unit.

Interpretation of the thermal images

Both hind limbs (Figures 1 and 2) exhibited increases within the thermal gradients associated with the stifle joints. The left stifle revealed an increased hyperthermic asymmetry when compared to the right.  Interpretation indicates inflammation within both stifle joints. [gallery columns="2" ids="4042,4043"]   In the right hind limb increases in thermal gradients were noted within the soft tissues radiating out from the stifle joint, particularly over the sartorius and biceps femoralis muscles (Figure 1). Indication of not only an inflammatory process within the joint but an illustration of the strain on the surrounding compensatory soft tissue structures. In the left hind limb areas of hyperthermia were noted directly over the stifle joint and decreased in intensity as they radiate to surrounding soft tissues (Figure 2). Interpretation suggests a lesser amount of inflammation within this joint as the compensatory soft tissue structures surrounding the joint are exhibiting reduced areas of hyperthermic activity when compared to contralateral structures on the right. After this visual representation of their pet’s physiological state to the client, permission was granted to do a radiographic study of both stifles.  This lead to a diagnosis of osteoarthritis. tPEMF therapy was prescribed using the Assisi Loop.  This was done three times per day for one week, once per day the second week, and every other day the third week.

Digital thermal image re-evaluation:

Interpretation of thermal images: After an interpretative analysis of the images: The right stifle experienced a 91% decrease in the hyperthermic activity. Also, there was an increase within the thermal gradients throughout the distal limb. Interpretation: a decrease in inflammation within the original hyperthermic areas and a re-establishment of normal circulation throughout the distal limb. [gallery columns="2" ids="4036,4037"]   The left stifle underwent a 96% decrease within all of the hyperthermic areas observed originally. There was also an increase within the thermal gradients associated within the phalangeal structures. Interpretation: a decrease within the inflammatory state of the stifle joint and the surrounding structures and a re-establishment of the circulatory pattern within the distal limb.

Summary

The treatment plan successfully reduced the inflammatory response within all of the hyperthermic regions and objective measurements are recorded to monitor this patient again in thirty days. Clinically, the patient has regained movement that has not been observed in years.

Case study #2

Presentation: hind limb paralysis. Case contributed by Dominic Gucciardo DVM, CVA; Integrative Veterinary Therapies; Ridge, NY. The initial dorsal thermal image (Figure 1) of the thoracolumbar area showed symmetrical and asymmetrical hypothermic activity throughout numerous vertebral and paravertebral segments. Thermal window of 73-92°F. Interpretation: this correlates to an asymmetrical irritation to the nerve supply to the vasculature in each anatomical region of interest. Electroacupuncture of Bai hui, GV14, GV4, ST36, and BL23 was administered. [gallery ids="4038,4039,4040"]   Eighteen minutes after electroacupuncture. Thermal window of 73-92°F.  Evidence of increases within all thermal gradients throughout image.  This is a visualization and a quantitative measurement of the re-establishment of the circulation within the regions of interest. Twenty-eight minutes after electroacupuncture. The monitoring images (Figures 2 and 3) show progressive increases within the thermal gradients in the areas initially identified as hypothermic.  This indicates a normalization in circulation from re-establishment of neurological function following electroacupuncture.




Digital infrared thermal imaging

Digital infrared thermal imaging provides an objective assessment of any integrated treatment plan.

Disclaimer: Dr. Ronald Riegel is a co-founder of Digatherm, a company that offers technologically advanced IR systems to the veterinary medical field. The practice of integrated medicine focuses on the healing of the entire patient through multimodal therapeutic approaches. Digital infrared thermal imaging (DITI) provides an objective measurement, visually and numerically, of the progress, or lack of, at any point in the treatment plan.

What is Digital infrared thermal imaging?

Traditionally, subjective assessments are made that don’t provide a comprehensive evaluation of the patient. Phrases like: “He is now able to walk up the back steps.” “Today he is using his leg more than he has in quite some time.”  “I am palpating less swelling within the left stifle joint.”  These subjective observations are useful but don’t offer an accurate status of the patient’s whole well-being. DITI provides non-invasive, objective, quantitative, and qualitative visual and numerical measurement of the physiological status of the entire patient irrespective of the multimodal therapeutic plan. In a matter of a few minutes, images can be captured that represent the physiological state of the patient at that exact moment. This is what is physiologically happening to the patient right now! This is in contrast to radiographic, ultrasonic, and MRI studies which tell us what has already happened to the patient. These images not only monitor and quantify the efficacy of the treatment plan, but will also detect any other areas in need of further diagnostics, serve as visual proof to the client the current status of the patient, and provide baseline data for future reference. This visualization of the physiological state of the patient provides you with a “roadmap” to maximize your therapeutic plan and provides proof to the client of the efficacy of your treatment.  An educated client will be more compliant to further diagnostics, multimodal treatment approaches, and even more frequent visits. Interpretation of the thermal images is not difficult. Any increase or decrease of  >1.0°C within the thermal symmetry of contralateral anatomical areas is significant. Areas depicting an increase (hyperthermic) or decrease (hypothermic) in thermal asymmetry require further evaluation and possibly further diagnostics. Areas of hyperthermic activity correlate to an inflammatory process, resulting in an increase in blood flow, whereas areas of hypothermic activity correlate to a vasoconstrictive state usually in response to a dysfunction within the sympathetic nerve pathway to the vasculature. Digital infrared thermal imaging provides an accurate visual assessment and objective quantification of the clinical response of the patient. When clients are provided with a visualization of the progress of their pets, they have a better understanding and are more compliant to the individualized treatment plans.

Case study #1

Presentation: Feline patient with a history of a gradual reduction in activity. A physical examination did not localize any sites of discomfort.  Digital infrared thermal images were captured utilizing a Digatherm 640 unit.

Interpretation of the thermal images

Both hind limbs (Figures 1 and 2) exhibited increases within the thermal gradients associated with the stifle joints. The left stifle revealed an increased hyperthermic asymmetry when compared to the right.  Interpretation indicates inflammation within both stifle joints. [gallery columns="2" ids="4042,4043"]   In the right hind limb increases in thermal gradients were noted within the soft tissues radiating out from the stifle joint, particularly over the sartorius and biceps femoralis muscles (Figure 1). Indication of not only an inflammatory process within the joint but an illustration of the strain on the surrounding compensatory soft tissue structures. In the left hind limb areas of hyperthermia were noted directly over the stifle joint and decreased in intensity as they radiate to surrounding soft tissues (Figure 2). Interpretation suggests a lesser amount of inflammation within this joint as the compensatory soft tissue structures surrounding the joint are exhibiting reduced areas of hyperthermic activity when compared to contralateral structures on the right. After this visual representation of their pet’s physiological state to the client, permission was granted to do a radiographic study of both stifles.  This lead to a diagnosis of osteoarthritis. tPEMF therapy was prescribed using the Assisi Loop.  This was done three times per day for one week, once per day the second week, and every other day the third week.

Digital thermal image re-evaluation:

Interpretation of thermal images: After an interpretative analysis of the images: The right stifle experienced a 91% decrease in the hyperthermic activity. Also, there was an increase within the thermal gradients throughout the distal limb. Interpretation: a decrease in inflammation within the original hyperthermic areas and a re-establishment of normal circulation throughout the distal limb. [gallery columns="2" ids="4036,4037"]   The left stifle underwent a 96% decrease within all of the hyperthermic areas observed originally. There was also an increase within the thermal gradients associated within the phalangeal structures. Interpretation: a decrease within the inflammatory state of the stifle joint and the surrounding structures and a re-establishment of the circulatory pattern within the distal limb.

Summary

The treatment plan successfully reduced the inflammatory response within all of the hyperthermic regions and objective measurements are recorded to monitor this patient again in thirty days. Clinically, the patient has regained movement that has not been observed in years.

Case study #2

Presentation: hind limb paralysis. Case contributed by Dominic Gucciardo DVM, CVA; Integrative Veterinary Therapies; Ridge, NY. The initial dorsal thermal image (Figure 1) of the thoracolumbar area showed symmetrical and asymmetrical hypothermic activity throughout numerous vertebral and paravertebral segments. Thermal window of 73-92°F. Interpretation: this correlates to an asymmetrical irritation to the nerve supply to the vasculature in each anatomical region of interest. Electroacupuncture of Bai hui, GV14, GV4, ST36, and BL23 was administered. [gallery ids="4038,4039,4040"]   Eighteen minutes after electroacupuncture. Thermal window of 73-92°F.  Evidence of increases within all thermal gradients throughout image.  This is a visualization and a quantitative measurement of the re-establishment of the circulation within the regions of interest. Twenty-eight minutes after electroacupuncture. The monitoring images (Figures 2 and 3) show progressive increases within the thermal gradients in the areas initially identified as hypothermic.  This indicates a normalization in circulation from re-establishment of neurological function following electroacupuncture.




Selecting physical rehab products for your canine patients

The vast number of rehab products on today’s market can make it difficult for pet owners to know what to purchase. Helping clients make well-informed product decisions is not only beneficial to patients, but also prevents costly or damaging mistakes.

Over 85 million families have a pet, according to the 2017-2018 National Pet Owners Survey from the American Pet Products Association. The number of working dogs, or those in canine sports, has also grown. These dogs are involved in everything from hunting and gathering livestock, to patrolling with soldiers, detecting explosives, searching for missing people, providing assistance for the disabled, and competing in dozens of canine sports. Injuries often occur in these dogs, and rehabilitation is needed to bring them back to health, which means the rehab products industry has also grown exponentially. The thousands of rehab products on today’s market may lead to overspending, and/or inappropriate product choices. This means dog owners often look to assistance from veterinary professionals to help make well-informed product decisions based on fit, activity goals, or in many cases, injury prevention or recovery. You can help guide your clients through the marketplace, avoid costly overstocking, and provide for your patients’ needs by considering the following points:
  • Intended use of assistive product
  • Sizing and style availability
  • Breed-related structural differences
  • Behavioral differences between animals
  • Ease of equipment modification
  • Common orthopedic conditions (e.g. cranial cruciate ligament insufficiency, osteoarthritis, congenital disorders)
  • Common neurological conditions (e.g. intervertebral disc disease, degenerative spinal conditions)
  • Common musculoskeletal conditions (e.g. tendonitis, muscle sprains and strains)

Recommended equipment for a rehab facility

[caption id="attachment_4019" align="alignleft" width="300"] Figure 1: Cavaletti rail equipment helps improve overall joint range of motion and proprioception during movement. Image courtesy of Kristen Hagler.[/caption] While the surrounding environment can often provide basic needs for therapeutic exercise through the use of hills, slopes, short flights of stairs, varied terrains and curbs, equipment (Figure 1) that specific for the individual’s exercise goals, and is of the appropriate size for the animal, improves overall efficiency and effectiveness. What follows is a list of recommended essential items for a rehabilitation facility treating animals of various sizes recovering from injury, in addition to those participating in canine performance sports. Practitioners are encouraged to review the most common conditions seen at their facilities to determine the needs of the surrounding pet population. For example, big cities tend to have larger populations of small breed dogs compared to large or giant breeds, so keeping high numbers of inventory items for larger animals is not wise.
  • Thermal therapy (cryotherapy and heat therapy) to treat multiple sized joints
  • 12” road cones with holes drilled at varying heights
  • Wooden dowels 2’ to 3’ in length, or agility poles for use with road cones
  • Balance cushions or discs of at least two sizes (large and small)
  • Physioballs or peanut-shaped inflated therapy balls of various sizes
  • Training platforms or exercise steps of varying heights
  • Foam wedges
  • Balance boards
  • Balance pods or wedges (air-filled)
  • Balance beam rail or walkway

“Wardrobe essentials” -- structural assessment and fit

Structure and function are intimately linked. The recognition of abnormal structural components during rehabilitation therapy or early risk assessment for athletic performance activities may help reduce risk of injury based on structural predispositions. Understanding basic canine anatomy and structural components helps guide treatment for injury or injury prevention, in addition to helping guide selection of equipment based on the animal’s conformation. [caption id="attachment_4020" align="alignright" width="300"] Figure 2[/caption] The forelimbs bear 60% and the pelvic limbs bear 40% of the total body weight in the dog. As seen in Figure 2, the thoracic limbs are constructed as such to permit significant range of motion, provide lift when jumping and directional changes when running. If problems occur in the spine or pelvic limbs, weight bearing on joints increases due to compensation and, over time, the abnormal postural changes give rise to secondary conditions (Saunders DG. 2005). Structural variation in the thoracic limbs occurs between breeds, with differences in the degree of shoulder layback, length of the humerus, and ratio of humerus to scapula length affecting forelimb structure and ultimate functional capabilities. [caption id="attachment_4021" align="alignleft" width="300"] Figure 3[/caption] The perfectly built dog should have an ulna and scapula of equal length and 30 degrees of shoulder layback. Shoulder layback is measured from a line drawn perpendicular to the ground through the point of shoulder and another line drawn to follow the scapular spine (Zink CM. 2008) (Figure 3). The pelvic limbs of the dog are designed to provide propulsion and directional changes while on level surfaces and “drive” the cranial portions of the body forward during activity (Gross D). Variations in pelvic limb angulation can be measured between animals by drawing two perpendicular lines from the ground; one from the ischeal tuberosity of the pelvis and the other from the tarsi perpendicular to the ground then drawing a line along the caudal aspect of the tarsi (Zink CM. 2013). The distance between the two lines is then compared. [caption id="attachment_4023" align="alignright" width="300"] Figure 4[/caption] Ideally the dog will have an evenly balanced distance between the two perpendicular lines, allowing for larger bony areas available for muscle attachment (Figure 4). In reality however, dogs are not evenly balanced and have either too much or too little rear angulation. There are advantages and disadvantages to having abundant rear angulation. Those with a lot of rear angulation are able to take longer strides and expend less energy, but often are less stable in the rear as it takes tremendous muscular strength and coordination to stabilize the overly angulated rear. As a result, dogs with straighter pelvic limbs tend to be able to turn more sharply than dogs with overly angulated pelvic limbs (Zink CM. 2013). For humans, our general body shape remains relatively constant and finding the correct fit for an article of clothing is not an insurmountable task. However, for a quadruped animal, getting the right fit for a harness can be challenging. Taking into account basic structural needs, practitioners can help pet owners navigate products such a body harnesses, protective footwear, footing or traction aides and even mobility carts. Assistive technology is an umbrella term that includes assistive, adaptive, and rehabilitative devices for individuals with disabilities and also includes the process used in selecting, locating and using them. Assistive technology can be defined as “any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities” (Nicolson et al., 2012). Determining what a patient needs is determined by the type of injury, the chronic condition being treated, level of independence or need for assistance, prevention of further injury based on environment, and therapeutic or activity goals.

Protective footwear

Protective footwear for animals may serve multiple purposes, including traction for slippery surfaces, and protection from environmental abrasions, such as in the case of neurological injury or a working dog conditions on glass, chemicals or sharp surfaces. Depending on the animal’s level of strength, footwear can help or hinder ambulation. When used for protection against the environment during work, uninjured animals easily accommodate to wearing it. [caption id="attachment_4024" align="alignleft" width="235"] Figure 5: Balloon type booties may help pets gain traction on slippery flooring and lower injury risk. Image courtesy of Sticky Paws.[/caption] Using protective footwear for animals with disability presents challenges in movement, as well as obstruction of proprioception through the foot pads, and general poor fit due to the the patient’s disability. Booties tend to twist, slip distally, or are cumbersome, causing frustration for all involved. Most have Velcro straps at the top and rubberized soles to prevent slipping, and are machine washable (Figure 5). Customized grip socks are also available and have rubberized tread under the paw surface. These may serve the patient better when on surfaces where traction only is desired. In addition to protective footwear, rubberized coatings are available to increase the nails’ “grip”. It is essential that these items to fit correctly, and that owners are instructed on care and use to prevent the development of sores or ineffective utilization. All protective footwear should be removed several times daily to assess the skin condition and, if possible, during therapeutic exercise to increase proprioception through the bottom of the pads. The following features are recommended in protective shoes for dogs:
  • Flexible sole
  • Fabric breathability
  • Grip “zone” for the paws or nails
  • Overall weight (this is especially important for animals with weakness or incoordination)
  • Overall length, and ability to adhere to either the hock or metatarsals
  • Ease of use for caretaker
  • Overall purchase on the plantar/palmar aspect of the paws
At least three different footwear examples should be recommended for dog owners to evaluate. If using a rubberized nail covering, it’s advisable to keep at least one of each available size on hand. Recommended footwear and traction product companies include:
  • PawzTM
  • Cushy-Paw SlippersTM
  • Ruffwear bootsTM and Bark’N Boot linerTM
  • Lewis Brand Vented Rubber Dog BootsTM
  • FoufoudogTM
  • Dr Buzby’s ToeGripsTM
  • MediPawTM
  • Handicapped PetsTM
  • TheraPawTM
  • DogLeggsTM
  • Sticky PawsTM
  • Woodrow WearTM Power Paws

Assistive harnesses

Animals may require the aid of an assistive device for a variety of reasons, such as temporary post-surgical recovery, weakness secondary to age, or for activities carrying certain physical risk (e.g. hiking or swimming). Length of use, the handler’s ability to put on the harness, and the animal’s life stage should all be taken into consideration when choosing an appropriate assistive device. Post-operative patients require assistance getting in and out of enclosures or cars, or geriatric patients requiring assistance getting up and down off the floor, each require a different harness style. The post-operative patient will likely only require a harness for several weeks until the surgical area is healed and there’s a lower risk of surgical failure from slipping or falling; therefore, a lightweight, simply-designed abdomen sling-style harness is most appropriate for short periods of use. [caption id="attachment_4025" align="alignright" width="300"] Figure 6: The Ruffwear™ Webmaster™ is a harness with the handle in the middle of the animals back — ideal for providing assistance during movement. Image courtesy of Kristen Hagler.[/caption] Geriatric patients require significantly more physical assistance for essential daily activities and will likely continue to use the harness throughout the remainder of their lives. When choosing a harness for patients with disability, professionals should consider harness handle placement and patient needs. The most ideal location for a handle is near the thoraco-lumbar junction just behind a dog’s center of gravity, behind the shoulder blades. This location helps handlers guide animals into a standing position from lying down by providing forward momentum and preventing overcompensation in the thoracic limbs (Figure 6). Animals with an even higher degree of disability, low strength in the pelvic limbs or amputation of a limb, may require assistance from two lift points over the shoulders and hips. While abdominal sling-style harnesses are useful, they produce vertical lift against the abdominal region, including the bladder, and lumbar spine (Figure 7). A more ideal lift location point is directly under the pelvic region, because the sacrum helps distribute pressure points. [caption id="attachment_4026" align="alignleft" width="229"] Figure 7: The HelpEm UP Harness™ provides assistance through the sternum and underneath the pelvis, so less strength is needed by a handler. Image courtesy of Blue Dog Designs. HelpEm Up Harness™[/caption] Using a supportive harness will also help patients with motor function keep from falling, as well as providing the benefits of gait repatterning and strengthening. In addition to handle locations, slings and harnesses may be fitted for the forelimbs, hindlimbs, or both (Figure 8). They should have long, hand-held straps attached to allow proper body mechanics for the handler, thereby avoiding personal injury when supporting the pet. Assistive harnesses should not obstruct movement, or protraction or retraction of a limb. They should allow voiding and have a soft lining against the animal’s skin to avoid sore development. Most importantly, they should be washable, and animals should be given periods throughout the day when they’re not wearing them. Having a variety of assistive devices in a clinical setting is advisable to help owners decide what will work for their needs, in addition to their dogs’. The following are recommended as essential items for the clinical setting:
  • GingerLead SlingTM (Abdomen slings)
  • [caption id="attachment_4027" align="alignright" width="300"] Figure 8: The HelpEm Up Harness™ provides assistance to both the front and rear legs for pets with higher levels of disability or weakness. Image courtesy of Kristen Hagler.[/caption] FourFlags Quick LIftTM (Abdomen slings)
  • RuffWearTM Webmaster or Front Range (Thoracic harness)
  • HelpEm UpTM harness (Two lift point harness system)
  • Walkabout harnessTM and Handicapped PetsTM (Forelimb support, hindlimb and abdomen support harnesses)

Mobility carts

While mobility carts serve a smaller population of animals, in a clinical setting they are extremely useful for multiple reasons. They provide alternative options for clients with severely disabled dogs, act as therapeutic aids when performing therapeutic modalities, allow functional independence for impaired animals, and aid in ambulation (Figure 9). They are normally suggested for paretic or paralyzed animals, those with severe arthritis or obesity, and may be used with other devices such as protective shoes and assistive harnesses. Some animals with long-term balance issues may also benefit from a mobility cart. [caption id="attachment_4028" align="alignleft" width="300"] Figure 9: Mobility carts are use for animals with severe disabilities which make movement with a harness assistive device extremely difficult. Image courtesy of Kristen Hagler.[/caption] Cart fitting can be challenging and time-consuming, but this improves with equipment familiarity. Mobility carts can be either completely custom made for the animal, requiring multiple measurements and custom fabrication, or semi-custom made, where equipment parts can be interchanged to generally fit the animal’s needs. It’s also necessary to consider the overall weight of the equipment, its ease of transportation in vehicles or within the household, the overall wheel base if the cart is to be used in the home, and the handler’s ability to place the animal properly in the cart. For most practitioners, it is not extremely beneficial to keep a wide variety of mobility carts in the clinical setting because properly fitting dogs to the carts is extremely important, and storage takes up critical space. It is, however, recommended that you offer at least two manufacturer examples (e.g. semi-custom and custom) and two size options (e.g. small and large) to help clients visualize using the equipment. While several companies manufacture mobility carts, the following are listed based on the author’s experience:
  • Doggon’ WheelsTM
  • Eddie’s Wheels for PetsTM
  • K9 cartsTM
  • Walkn’ WheelsTM

Fitness vs. function

Therapeutic exercise involves specific movement patterns prescribed for a patient with the goals of injury recovery and/or preventing further injury. They are performed gradually to return a patient to the highest level of function possible. Physical rehabilitation reverses various physical conditions associated with injury or dysfunction. Activity is generally performed in a controlled stepwise manner with regular assessment intervals to ensure that functional progress and therapeutic goals are being met, and the animal is being restored to a desired level of physical function. Body systems respond to physical stress by undergoing adaptations that ultimately improve their functioning. Rehabilitation is the process of applying stress to healing tissue in accordance with specific stresses that the tissue will face on return to a particular activity. Although rehabilitation exercise may appear similar to conditioning, it’s not the same. When exercises are performed to enhance an already learned skill or activity, or to improve performance during activity, they are considered fitness training or conditioning exercises. Activity increases occur as soon as the animal demonstrates proficiency, and successes are measured during competition or performance of the sport. Exercises are typically performed at home in between skill training classes. In contrast, therapeutic exercises are done in a clinical setting with a trained professional, and are for patients recovering from injury.

Conclusion

By understanding basic canine anatomy and structural components, as well as the needs of your practice’s population, you can help guide your clients through the assistive technology marketplace, provide for your patients’ needs, and avoid costly overstocking.

References

Dale RB. Physical Rehabilitation of the Injured Athlete, 4th Edition. Edited by James R. Andrews, Gary L. Harrelson, Kevin E. Published 2012 by Elsevier-Saunders, 42. Goldberg ME, Tomlinson JE. The Disabled Patient 1: Assistive Devices and Technology.  Physical Rehabilitation for Veterinary Technicians and Nurses, 1st Edition. Edited by Mary Ellen Goldberg, Julia E. Tomlinson. Published 2018 by John Wiley & Sons, Inc. 148-150. Gross, DM. “Introduction to Small Animal Physical Therapy”. In Woodman, RM ed. Canine physical therapy – orthopedic physical therapy. Connecticut: Wizard of Paws, 2002, 8. McDonald JW, Sadowsky C “Spinal‐cord injury”. Lancet 359, 2002, 417–425. Nicolson A, Moir L, Millsteed J. “Impact of assistive technology on family caregivers of children with physical disabilities: a systematic review”. Disabil Rehabil Assist Technol, 2012, 7(5):345–349. Rafferty A. Davidson JR. Home Exercises. Physical Rehabilitation for Veterinary Technicians and Nurses, 1st Edition. Edited by Mary Ellen Goldberg, Julia E. Tomlinson. Published 2018 by John Wiley & Sons, Inc. 83. Saunders DG, Walker JR, Levine D. “Joint Mobilization In Vet Clinics of North America”. Small An Practice, 2005, 1295. Zink CM. Introduction to the Agility Dog. The Agility Advantage – Health and Fitness for Canine Athletes. Clean Run Productions, LLC. South Hadley, MA. 2008; 6-11. Zink MC. “What Is a Canine Athlete?” In Zink CM, Van Dyk JB, eds. Canine Sports Medicine and Rehabilitation. Wiley-Blackwell, 2013.




Treating chronic bowel problems in dogs with homeopathy and integrative medicine

Diarrhea and other bowel problems are common among canine patients. Homeopathy along with other therapies, such as probiotics and herbs, may effectively resolve these issues.

Chronic bowel problems are very prevalent in the canine population, and a cause for great anxiety and stress among many clients. These clients have to face not only the inconvenience of diarrhea in the home, but also the worry that their dogs are potentially malnourished, may lose weight and are clearly not in optimum health. Beyond these concerns, financial commitments can be heavy. Often, clients come to us looking for alternative treatments after having tried a long string of medications, including antibiotics.

General points about the canine bowel

It is difficult to provide a general overview of the issues facing the holistic veterinarian in such cases, as there is a wide spectrum of presentations and one attempt at description cannot cover all. However, we can make several general points. The lining of the bowel serves a similar immune function to that of the skin -- i.e. keeping the inside in and the outside out. It is part of the immune fortress’s ramparts. In addition, it has a digestive and absorptive duty that requires it to act as gatekeeper of the fortress, allowing the “good guys” in and keeping the “bad guys” out. The mucosal lining is furnished with myriad villi, massively increasing the surface area exposed to ingesta. In addition to those structural and functional considerations, we have the population of microscopic organisms that necessarily populate the bowel, in a symbiotic or commensal relationship with the body. These serve digestive, immune, synthesising and regulatory functions. It is only relatively recently that the absolute vital necessity of a healthy biome to the host’s health and well-being has been widely recognised. Gut flora represents the vast majority of this biome.

What happens in chronic bowel disease?

There are three main categories of local damage we have to face in patients with chronic bowel disease:
  1. The result of inflammatory processes in the mucosal lining and bowel structure
  2. Destruction or withering of the villa
  3. Changes to the biome.
These factors give focus to some of the adjunctive treatments we have to consider. They present a challenge to both our therapeutic skills and communication skills; we need to bring the client alongside the need for overcoming the structural results of long-term damage, which does not necessarily respond immediately to treatments.

Causes of chronic bowel disease in dogs

Chronic bowel disease can result from a failure to overcome an acute infection caused by a bowel pathogen, such as Salmonella, Giardia, Parvovirus, Distemper or Campylobacter. Since the bowel is such an integral and large part of immune “system”, bowel disease can result from any stimulus that damages the immune system and bodily balance in general. Under this heading, we would have to consider such disturbing influences as systemic viral or bacterial infection and adverse vaccination reaction. Problems can result from an unhealthy and unsuitable diet, or even be triggered by a failure to recover properly from a one-off dietary indiscretion or toxic event. There is also much evidence, particularly in the case of colitis, IBD or IBS, that Mycobacterium avium (subspecies paratuberculosis) infection is responsible, possibly arising from dairy products or meat

Homeopathic treatment

In homeopathy, we have over 4,000 described medicines, and the prescriber can make further special medicines as required or indicated. This presents a challenge in prescription selection in our quest to stimulate full recovery from chronic bowel disorders in canine patients. Herbs, auto-nosodes, bowel nosodes, probiotics and prebiotics, along with diet, also aid in management. For the homeopathic intervention, we have to use a selection process that suits our way of working. The correct prescription will be the homeopathic medicine that best fits the whole symptom picture. The patient’s own individual characteristics are very important in developing a prescription for chronic disease. The “picture” of the homeopathic medicines, which has to be matched to that of the patient, is recorded in the Homeopathic Materia Medica. Many remedies are available, with dissertations on the individual medicines varying in depth and detail. The most obvious technique for medicine selection, and one that can be taught relatively easily, is that of repertorisation. This involves the use of a repertory, or index of symptoms. There are several such works available; one of the most commonly used is Synthesis. It relies heavily on the accurate definition of symptomatology. Accurate symptom identification is important, both of “local” signs and of patient characteristics and mental indicators. If the information fed into a computer program is incorrect, then the answer is likely to be incorrect.

Which homeopathic medicines to use?

The correct homeopathic prescription needs to be selected on the basis of the patient’s individual expression of the disease, rather than for a specific syndrome. The following are a few commonly applicable medicines used in cases of chronic bowel disease, along with some of their individual characteristics to help guide your study.1,2,3
  • Arsenicum album – Stools profuse, watery, bloody, excoriating, painful, fetid odor and mucus. Unhealthy appearance, dejected, restless especially at night, seeming near to death, fearful. Frequently thirsty for small sips of water.
  • Bryonia – Very thirsty for large amounts of water. Worse from being jostled, or from any movement -- even the motion of the stool coming out can be painful. These dogs cannot tolerate heat. Stools are large, dry and even burnt-looking. The dog can have chronic diarrhea as well, and may be irritable.
  • Lycopodium -- Constipation or diarrhea. Flatulence common, loud and smelly. Dog is fear aggressive, yet acts guilty. Wants to be near owner but not petted that much. Often has a history of or concurrent urinary tract problems. Associated with liver disease.
  • Mercurius solubilis – Straining, never feels done so the dog squats continuously in the yard or on a walk. Mucus and blood. Does not want to be too hot or too cold.
  • Natrum sulphuricum -- Diarrhea occurs on rising, and is worse in cold, wet weather. Concurrent asthma or liver disease. Sadness.
  • Nux vomica – Diarrhea or constipation with frequent, ineffective urging. Normally sweet animals, these dogs become very irritable when ill, so as the chronicity of the GIT illness progresses they become grumpier. Desire for heat.
  • Phosphorus -- Seeks company, outgoing, vocal. Startles to noises. Thirsty for cold water. Can vomit after water or food warms a bit in the stomach. Blood is common in any discharge. Open, protruding anus.
  • Pulsatilla – Sweet, affectionate, likes cuddles and feels better from attention. Prefers cold and open air, has very little thirst and discharges, even stools are bland with little odor, and change a lot. Constipation may alternate with diarrhea. Worse after eating or at night.
  • Silicea -- Often used for a longer duration of problem. These dogs prefer heat. It’s hard to push out the stool so they often feel constant urging. Sensitive animals.
  • Sulphur -- Worse in the morning. As with Arsenicum, the stool can be excoriating with itching or pain. Dog is very thirsty. Prefers cold. Looks messy and unkempt.

Nosodes and tautodes

A Nosode is a medicine made by the homeopathic dilution/succession process, from diseased material, in this case from the bowel. A Tautode is made the same way but from a substance considered to be part of the cause, such as a toxin, dietary ingredient or vaccine. In stubborn cases, I have sometimes resorted to making an Auto-Nosode (in which a medicine is made from the diseased material of the ill individual).

Additional management therapies

If the bowel is structurally damaged, which is highly likely in such a chronic condition, homeopathy alone may not be sufficient to bring about a cure. While searching for the remedy that will help healing, other management tools should be considered. An inflamed and sore bowel lining may be soothed by herbs such as slippery elm or marshmallow. Another herb that serves to soothe the bowel, firm the stool and act as a valuable prebiotic is psyllium husk. A vicious spiral occurs in chronic diarrhea problems. When inflammation damages the digestion process, more higher quality nutrients progress to the lower parts of the bowel. This results in increased populations of bacteria in those lower regions; owing to population expansion, the bacteria begin to migrate further up the bowel than normal. The products of their fermentation are alien to those higher portions of the bowel and inflict damage on the villi and mucosa. This results in a further failure of digestion and even more higher quality nutrients escaping the attentions of the proximal bowel, leading to further population growth and migration of flora from lower portions of the bowel. The process is self-aggravating, and if it has persisted for a considerable time, presents a challenge to the veterinarian who has to try to achieve restoration of more normal microbial distribution and function, and restore structural normality to the bowel lining. Large doses of high quality probiotic are possibly the best ally in this endeavor. Large numbers of microorganisms and a wide spread of species are needed. Just giving the dog live yoghurt, kefir or sauerkraut is unlikely to be sufficient. The client must understand that this restorative process will not be instant. (Micro Biome Restorative Therapy can often help restore normal gut flora.) If modern pharmaceuticals have already been tried without success, then they probably have no further part to play. Antibiotics, of course, are deadly to the friendly biome and present a risk of generating dangerous antibiotic-resistant strains (AMR). One should be very cautious with their usage. In chronic cases, the use of pharmaceuticals in the past may have resulted in the suppression of symptoms/signs, thereby increasing the risk of the disease becoming chronic. There is also the risk of “side effects” which have to be considered against the possible benefits (e.g. sulphur drugs and kerato-conjunctivitis sicca). Anti-diarrheals, such as Kaolin, may prevent or delay the necessary elimination of toxic and damaging material. Allergy testing may help find foods that irritate the bowel further. However, allergy is a fundamental immune malfunction and triggers can alter from time to time. This means that relying on the results of allergy testing may be an unproductive route to follow. Likewise, desensitising treatments may not get to the source of the problem.  Generally speaking, a dog should be able to eat a species-suitable fresh diet, with no chemical additives, without it leading to diarrhea. If he can’t, then there is an immune problem and bowel microflora balance issue that need to be corrected.

Case reports

Case 1: Daisie, an 11-month-old female boxer with chronic diarrhea

First seen on July 13, 2006, with colitis and chronic diarrhea of a variable nature, with very poor condition (bony appearance). The problem had started on May 26, and there had been problems ever since. Daisie was ravenous and flatulent. She had been vaccinated in October of 2005, was spayed before her first season, and had been fed a fresh organic diet. Daisie visibly liked cuddles and warmth, had little thirst, a ravenous appetite, few fears, barked at animals on television and was quite excitable. Her left ear was crusty but not smelly. She had right pelvic misalignment (lumbo-sacral distortion). Prescription: Homeopathic Pulsatilla and Mutabile. Chiropractic-type manipulation. Probiotic. Both Pulsatilla and the Bowel Nosode Mutabile suited the patient’s changeability and symptomatology. Pulsatilla also suited Daisie’s character to a tee. Each was given one time, orally. July 17, 2006: A fecal sample revealed possible E. coli. July 19: Daisie is so much better it’s amazing – no diarrhea since 24 hours after being seen. Different dog, energy levels brilliant, gaining weight, symptom-free. July 21: Slight “blip” – asked to go out twice in night, with normal motion each time. In the morning, the motion was a bit soft and contained mucus (she’d been given two lamb bones the day before). July 24: Stools either 100% or just tiny bit soft, much better in herself, vomited a tiny bit of potato and chicken bone on the Sunday morning. July 27: Daisie doing really well. Every now and then, she passes a very firm stool with a bit of mucus/slime coating – otherwise all normal. She is great in herself, energy like you wouldn’t believe, even in very hot weather. She has definitely put on weight, so will carry on and keep in touch. May 14, 2007: Daisie is seen for residual skin problems (recurrent eruptions, non-severe, with rumbling ear problems). Prescribed homeopathic Thuja. Her owner is nonetheless delighted, as Daisie is so well, in such good condition and has no problems with bowels/digestion. This case illustrates “Hering’s Order of Cure”, in that the skin problem was almost certainly related to the diarrhea and was a more “superficial” expression of the health disturbance. This progression from “internal” to “external” signs was very encouraging for the prospects of a long-term cure. In fact, Daisie’s “skin problem” resolved uneventfully and she had no further GIT problems.

Case 2: Harvey, a 10½-month-old Weimaraner with chronic diarrhoea and digestive problems

Harvey was first presented on February 23, 2006. He had suffered from chronic diarrhea since September of 2005. He was in extremely poor condition, and his coat was dull. The diarrhea persisted despite dietary changes. He was passing profuse watery stools with blood and mucus, likely indicating colitis. He had a sad, dejected and unhealthy appearance. He could be described as “hang-dog”. His family was close to considering euthanasia. He had been vaccinated in July of 2005. Harvey was given homeopathic Arsenicum and Gaertner (Bowel Nosode, selected in view of his severe malnutrition), supported by probiotic and followed by E. coli Nosode. The Arsenicum was prescribed on the basis of his condition, his appearance and the apparent lack of hope among all concerned, including the patient. Harvey failed to respond fully until after the Nosode. March 3, 2006: Much perkier and happier, bouncing when on walks -- had diarrhea today. March 7: Absolutely great. Hungry all the time. Passed a proper motion today. On a natural diet. March 10: Doing really well. Back to normal self and eating well. Eats everything but won't touch scrambled egg. March 13: Small amount of diarrhea at the weekend -- ate some treats given by a family member. March 15: Everything settled well again. April 20: Bowels normal. Harvey is a much more cheerful and happy dog who enjoys life. No remedies since the beginning of April. July 20: Doing really well -- brilliant – a different dog. Enjoying natural diet and bowels fine. March 28, 2007: Has been brilliant but diarrhea again this week. Repeated medication. June 29, 2009: Owners reported that Harvey is doing brilliantly. “Thanks for saving his life.” As we all know, case anecdotes prove nothing individually. However, the weight of multiple cases can begin to add up to a pattern.

Summary

In acute disease, attending to symptoms/signs alone may reduce owner anxiety and increase patient welfare (as long as no adverse event follows), while the body sets about healing. However, this amounts to suppression and can lead to a chronic condition. Once the chronic situation sets in, little more than temporary palliation can be offered by pharmaceuticals that target symptoms/signs. The aim must be to stimulate a true healing process within the body, so that a real cure may be achieved. This appears to be the role that homeopathy plays in so many cases of chronic disease. However, it is also important to attend to potential “obstacles to cure”, such as diet, over-vaccination, environment, management, disturbed bowel flora etc., in order to enable healing. _______________________________________________________________ 1Day, Christopher. Homeopathic Treatment of Small Animals. 2Hamilton, Don. Homeopathic Care of Cats and Dogs. North Atlantic Books, 1999. 3Clarke, J.H. Dictionary of Practical Materia Medica. B. Jain Publishers, 1990.




Integrative training for technicians

Credentialed veterinary technicians are in short supply. Integrative training helps empower vet techs and strengthens the field overall.

Technicians are leaving the veterinary field in alarming numbers. According to a 2016 survey by the National Association of Veterinary Technicians in America (NAVTA), the industry is dealing with a shortage of credentialed veterinary technicians. A major complaint among veterinary practices is the difficulty in finding new qualified personnel. This trend is apparent in the integrative veterinary practice as well.1

Why are technicians leaving?

Wages are a big factor. Under-utilization is also a common complaint.2 It is my experience that both these issues can be overcome through proper training and a team effort. In a nutshell, none of us will succeed unless all of us succeed. I have found that the practices which embrace this concept are successful. There is more satisfaction among the staff, and everybody benefits. Clients are happier and the bottom line financially is sound. The practice manager or veterinarian/owner would benefit by recognizing the long-term beneficial effects of training technicians, thereby empowering them in the practice, having them continuously learning new skills, and thereby increasing their desire to stay.

Certification and training programs for vet techs

Nutrition

There’s a revolution happening in the pet food industry, and it’s being driven mostly by millennials.3  This generation is starting to question how we have been feeding pets for the past 50+ years, and are not as willing to blindly accept what veterinarians tell them is best for their animals’ nutrition. They are making more of their own decisions about how to feed their pets, which leads to some good decisions as well as some very bad ones. Raw pet food is currently the fastest growing market in the pet food industry.4 Given the popularity of PetFooled, a documentary that came out early in 2017, I suspect this trend will continue. In general, interest in integrative veterinary options continues to grow at a rapid pace.5 Join any Facebook raw feeding group and you will see the good, the bad and the ugly of this movement. Many are doing it right, but even more are doing it wrong. Regardless of how you feel about this type of diet, it is imperative that we stay on top of this as veterinary professionals, and be able to offer healthy, balanced ways to feed raw and fresh food. The extreme need for proper nutritional education opens a gaping hole that can be filled by technicians. A nutrition technician, expertly trained in how to properly balance a diet, can be invaluable, not only in an integrative practice, but also in a conventional practice that is trying to retain millennial clients who don't want to feed their pets out of a bag or can. A number of certification programs can address this need:
  • Royal Animal Health University (RAHU): Founded by Drs. Barbara Royal and Natasha Lilly, this university launched in April of 2017. It plans to offer modules covering many aspects of integrative medicine, including nutrition, restraint, herbal medicine and more. Classes will be offered both online and in classroom format throughout the year. There will be certification offered for RVTs, DVMs and pet parents.
  • Companion Animal Nutrition and Wellness Institute (CANWI): Founded by Drs. Karen Becker and Donna Raditic, this organization will be offering a certification program in nutrition for RVTs, DVMs and pet parents. CANWI is also doing clinical studies on pet food.
  • The College of Integrative Veterinary Therapies (CIVT): This international university offers a Natural Nutrition Program, which can be taken by DVMs, technicians and receptionists. This is not a certification program. Susan Wynn’s recent lectures will soon be available as webinars/podcasts, along with a course on the east coast next year. A number of webinars on real food nutrition, nutrigenomics, etc. are available for purchase from their library.

Herbalism

Herbs can be incredibly beneficial for dogs, cats, horses and other animals. Whether Chinese, Western or Ayurvedic, education in this area can create great opportunities for technicians.
  • The Chi Institute: This prestigious school of Chinese Medicine has been around since 1998. Founded by Dr. Huisheng Xie, it offers a certification course in TCVM for veterinary technicians. This class is offered once a year and fills up quickly. Classes are both online and onsite. Technicians can also take courses in business management.
  • College of Integrative Veterinary Therapies (CIVT): This college is government-accredited and offers opportunities to learn a number of different integrative therapies, including Western herbs, environmental animal health, nutrition, anatomy, physiology and professional communications. The courses are accredited and some are at the post-graduate level. Classes are offered both online and onsite. This school offers an excellent curriculum and world-renowned teachers.

Rehabilitation

Technicians drawn to this path do well if they like lots of interaction with clients. Unlike some other technician roles, the rehabilitation tech spends a lot of time not only with the patient, but also with the pet parent. Sometimes you are seeing these patients multiple times a week. This sets up wonderful continuity and the opportunity to really bond with the patient. It is also important to understand that there is a lot of hospice-type work that comes with rehabilitation. A good strong back is a plus! Here are some certification programs for canine and equine rehabilitation:
  • University of Tennessee Certification Program: This program has many opportunities for veterinary technicians to excel. There are also certification courses in pain management, nutrition, rock taping, business management and more. Technicians work side by side with DVMs and physical therapists in these classes. Technicians need to be licensed to take these courses, but in rare cases, exceptions can be made.
  • The Healing Oasis Wellness Center LLC: An educational institution located in Sturtevant, Wisconsin dedicated to the advancement of Veterinary Spinal Manipulative Therapy (VSMT), Veterinary Massage and Rehabilitation Therapy (VMRT), clinical & functional neurology as they apply to above programs  with related Cont. Education.
  • Canine Rehabilitation Institute (CRI): Full disclosure – this is the certification course I took and I absolutely loved it! It was an incredibly positive experience for me, and set me up very well for my career in canine rehabilitation. Technicians work alongside DVMs and physical therapists. This class is very popular and sells out quickly. Following the coursework, technicians do a 40-hour internship with a CRI-approved rehab facility.
  • Full Spectrum Canine Therapy: Physical therapist Patricia Kortekaas has been teaching these wonderful classes since 2006. She has a passion for helping technicians understand the importance of proper handling techniques for pets under anesthesia, having blood draws, or undergoing dental work. A technician properly trained by Patricia would be a great asset to any veterinary practice. This school offers osteopathy as well as craniosacral therapy.

Homeopathy

Created by Dr. Samuel Hahnemann in the late 1700s, homeopathy is a safe and effective form of alternative medicine for animals. It can be incredibly rewarding to observe an animal’s response to the correct homeopathic remedy. Technicians working in a clinic can actually manage cases even if the veterinarian is not trained in homeopathy. More and more clients are requesting this deep healing modality. Professional Course in Veterinary Homeopathy: The veterinary world is blessed with an amazing classical homeopathic teacher, Dr. Richard Pitcairn. He created this year-long (five weekends) training course for DVMs, vet techs and a few other professionals.

Muscle testing/applied kinesiology

Muscle testing, also known as applied kinesiology, is based on the concept that the body's energy field will be strong in the presence of something that is good for it, and weak in the presence of something that is not. This modality is gaining ground in the veterinary world. I have seen some excellent results and know of some veterinarians who use muscle testing almost exclusively. I also know of technicians who are getting into this unregulated area. A good muscle-testing technician could be priceless in the right practice.
  • Morphogenic Field Technique (MFT): This technique was developed by Frank Springob, DC. He travels around the country giving seminars and offering certification courses.
  • Nutrition Response Testing (NRT): Developed by chiropractor Freddie Ulan, NRT teaches a 13-step process of muscle testing. Classes are taught at locations around the country.

Acupressure

  • The Tallgrass Institute: Founded by Amy Snow and Nancy Zidonis, Tallgrass offers a 300-hour certification program in acupressure.

Massage

  • The Lang Institute for Massage: Canine and equine massage courses are offered here. Located in Lovelend, Colorado, it’s the only state-approved training program offering veterinary medical massage. There is a 663-hour class requirement -- four days are hands-on and the rest is done through videos, books and DVDs. Students study at their own pace.
  • Canineology and Equinology: This school offers four different progressive levels of Equinology Equine Body Worker certification. It also has two Caninology Canine Body Worker certification programs. The school offers both onsite and distance programs.
  • Equissage: Students who successfully complete this program will receive 50 CE hours through The National Certification Board for Therapeutic Massage and Bodywork. (Note -- this is not veterinary CE.)

Reiki

Reiki classes are available in most communities and online. This therapy is used in many human shock trauma centers and hospitals and is practical for pain relief and emotional support. Many shelters have increased adoption rates through the use of Reiki – find out more at ShelterAnimalReikiAssociation.org. Meanwhile, a new research project will study pre- and post-op use of Reiki on animals (visit AnimalReikiAlliance.com).
  • Animal Reiki Source: A pioneer in Animal Reiki, Kathleen Prasad offers training, classes, workshops and more.

Healing Touch

Investing in your technician

My own experience is a great example of how investing in your technician will yield great results. In 2005, I was offered a job at a veterinary practice with a canine rehabilitation component. I had only recently graduated from RVT school and had student loans to pay. The DVM owner I worked for had the foresight to see my potential and made an agreement with me. The practice would pay for half my education to become a CCRA plus the airfare to attend school. I had to complete my certification within a specific period of time. If I left the practice within 12 months of completing my certification, I would be responsible for paying back a portion of the tuition. I stayed at the practice for six years and it was a win for all of us. There is a veterinary practice in Northern California that I greatly admire. It consists of an integrative veterinarian and her assistant. The practice always has a waiting list, and is very well-respected in the community. The veterinarian/owner realized early on the importance of having a well-trained assistant, and has supported continuing education for the six years that the assistant has been there. This assistant now has certification and/or skills in craniosacral therapy, massage, Tui na, acupressure, osteopathy, Reiki, and animal communication. The veterinarian in this practice feels supported, and says it has taken a lot of pressure off to have such a knowledgeable assistant who can step in and provide these valuable treatments. The assistant feels empowered, is making more money, and has a sense of ownership. The clients feel safe and taken care of, and trust the assistant to understand the details of their pets’ issues. A continuity of care resonates through the entire practice. Both of the above examples are easily achievable. There are plenty of technicians, assistants, receptionists, etc. who would jump at the chance to be trained. It's important to think outside the box when looking for staff. Some of the finest integrative staff I have seen are career change individuals. I was 43 years old when I went to school to become an RVT and truly feel my maturity gave me an extra advantage with working in veterinary practice. Wisdom and compassion grow with age and life experience.

Summary

Poll your clients and staff to see which of these many modalities are most desired, and create incentive programs for carefully-selected technicians/receptionists. Because integrative medicine is still a fairly new area for technicians (the Maryland Technician program has been teaching an integrative required class for over a decade), I have started a Facebook page called “TheTribe – A Community of Integrative Veterinary Technicians”. There are currently 421 members, all technicians who either work in integrative veterinary medicine or have an interest in it. This is a much-needed forum on which you can safely discuss any holistic issues. _________________________________________________ 1“Why Vet Techs are the Veterinary Profession’s Backbone”. Veterinary Practice News. veterinarypracticenews.com/why-vet-techs-are-the-veterinary-professions-backbone/ Oct 11, 2016. 2Velasquez LVT J, 2016, Nov 27. “Four Reasons Techs Leave the Field”. drandyroark.com/four-reasons-techs-leave-the-field/. 3Wall T, 2017, Apr 27. #tbt “Raw pet food growth continues despite concerns” petfoodindustry.com/articles/6431-tbt-raw-pet-food-growth-continues-despite-concerns. 4“PetLife: Millennial Pet Owners Leading Charge in Rapid Growth of Holistic Pet Care”. Business Wire. businesswire.com/news/home/20170324005105/en/PetLife-Millennial-Pet-Owners-Leading-Charge-Rapid, Mar 24, 2017. 5”PetLife: Holistic Pet Health is Next Big Trend in Veterinary Medicine”. Business Wire.  businesswire.com/news/home/20170412005301/en/PetLife-Holistic-Pet-Health-Big-Trend-Veterinary, Apr 12, 2017.




Microbiome Restorative Therapy in companion animals

A procedure in which fecal material is transferred from a healthy individual to the gastrointestinal tract of an ailing individual, MBRT helps balance the microbiome and treat digestive issues.

The microbiome is a characteristic community of microorganisms (bacteria, fungi, viruses and other microbes) occupying a well-defined habitat, such as in or on an animal’s body.1 Mammals are exposed to their first microbes during birth and through breastfeeding.2 These early life events contribute to each animal having a unique gut microbiome signature. The microbes that are first to arrive in a particular habitat can affect which new species will be able to colonize later on. In other words, these early life events are foundational and will influence a cat or dog’s health for the rest of his life. Research on the gut microbiome suggests it plays essential roles in host digestion, immunity, the central nervous system, behavior (including anxiety and depression), skin health, obesity and other metabolic disorders.3

The missing microbes

A young animal may fail to get the full complement of beneficial microbes if the mother is missing them herself, or if the young animal is orphaned or weaned too early. Even if a healthy microbiome is established early in life, microbes in the gut will change with age, diet and lifestyle. The gut microbiome may also be depleted or harmed by exposure to broad spectrum antibiotics that kill both harmful and beneficial microbes. The widespread use of antibiotics and antimicrobials may be contributing to increased incidences of conditions such as inflammatory bowel disease (including Crohn’s disease and ulcerative colitis), esophageal reflux, Type 1 diabetes, asthma, and food allergies in human populations.4 Food additives and non-steroidal anti-inflammatory drugs (NSAIDs) have also been shown to alter the composition of the gut microbiome,5 and may further contribute to the development of chronic digestive conditions in companion animals. The widespread use of antibiotics and other medications may also contribute to why digestive issues are a top reason for veterinary visits in both cats and dogs.

Do feral cats have healthier microbiomes?

In a citizen science project called KittyBiome,6 microbiome samples were collected from domestic cats living in shelters, households (both indoor and outdoor cats), and outside (feral). Samples from wild cats, including black-footed cats, cheetahs, lions and leopards, were also collected. Many house cats had depleted microbiomes with low bacterial diversity when compared to adult feral cats and their wild cousins, and 20% suffered from a chronic digestive condition. The research showed that diet played a large role in the composition and diversity of gut bacteria. Cats fed a raw diet tended to have greater bacterial diversity and increased representation of bacteria associated with the production of the short chain fatty acid, butyrate (AnimalBiome unpublished data).7 Butyrate is produced by bacterial fermentation of dietary fiber and is a critical mediator of the inflammatory response in the gut microbiome. Participants in the study wanted to know how to restore their cats’ health. Many had already tried using antibiotics, steroids and dietary modifications, including prescription diets, and were looking for other solutions.

MBRT can replace missing microbes

One approach to rebuilding the gut microbiome is Microbiome Restorative Therapy (MBRT), a procedure in which fecal material is transferred from a healthy individual to the gastrointestinal tract of an ailing individual. Although its use in human medicine has only begun to increase in recent years, MBRT (also known as transfaunation or fecal microbiota transplantation [FMT]) has been used in veterinary practice since at least the 18th century for cattle, horses, sheep and other animals suffering from rumination disorders, indigestion and colitis.8,9,10 Interest in the application of MBRT in small animal practice is growing, particularly for digestive disorders. Despite pioneering integrative veterinarians like Dr.Margo Roman (mashvet.com), who has performed >2,000 MBRT procedures in the past ten years, MBRT is still not widely used at this point in conventional practice11 (see Dr. Roman’s article on MBRT in IVC Journal, Volume 4, Issue 4, or at ivcjournal.com/mbrt-immune-system). In contrast, there has been tremendous interest in the application of FMTs in human medicine, particularly in the treatment of Clostridium difficile infections that are not responsive to antibiotics, as well as Crohn’s disease, ulcerative colitis, constipation and enterocolitis. Studies have shown that it is possible to introduce microbes from a donor into the microbiome of a recipient, where they are maintained, at least for a period of time. A growing number of integrative veterinarians offer MBRT as a way to provide microbial supplementation to patients from a healthy live donor of the same species. One factor restricting the growth of MBRT in practice is the availability of screened fecal material from healthy donors. To create a bank of carefully-screened fecal material from healthy donors, a variety of factors must be considered. In addition to standard pathogen and parasite screening, donors must have no current or past health concerns, whether physical or behavioral; and they must have no history of systemic antibiotic use. These “golden-poo pets” must also be old enough to have developed a sufficiently diverse microbiome, but young enough for that diversity to still be intact. Fecal transplants may be administered in three ways, often depending on the severity of the ailment:
  • Rectally, via enema and colonoscopy (typically uses fresh or frozen material). This method may be needed in more critical cases.
  • Orally, via nasoduodenal intubation and enteroscopy (typically uses fresh or frozen material).
  • Orally, via enteric-coated capsules sold only to veterinarians. The capsules contain pre-screened material prepared with all-natural ingredients that remain stable at room temperature while retaining high viability. Enteric coatings are made of long-chain carbohydrates that prevent capsule contents from being destroyed by stomach acid.

Why MBRT?

Scientists haven’t even begun describing many of the common organisms living in the microbiomes of healthy dogs and cats. For example, recent research identified more than 20 bacterial strains that are new to science, in a single sample of cat poop. This makes it difficult to develop a supplement that contains the full spectrum of genera found in healthy dogs and cats. Probiotic strains that are not cat- or dog-specific may be helpful for controlling clinical signs of disease, but will not typically colonize the host. This means they must be given continuously in order to see an effect. MBRT provides a “complete package” because it reflects the abundance of bacteria, fungi and bacteriophages in the relative ratios found in a healthy cat or dog.

Top ten uses for MBRT

  1. Chronic diarrhea
  2. Chronic vomiting
  3. Recovery from antibiotic treatment
  4. Constipation
  5. Inappetence and poor body condition
  6. Food sensitivities
  7. Hemorrhagic gastroenteritis
  8. Skin conditions, including atopic dermatitis
  9. Decreased gut motility and difficulty passing hairballs
  10.  Fecal incontinence
For more information visit AnimalBiome.com, mashvet.com, and read Dr. Roman’s article on MBRT.

Case report – an application of MBRT for IBD

Laila, an active boxer mix, was the picture of health until she turned five. Over the course of just a few months, she developed severe diarrhea and vomiting. She was given antibiotics, antacids, probiotics and prescription diets, but nothing seemed to alleviate her symptoms and she continued to worsen. After an official IBD diagnosis, she began a high daily dose of prednisone in addition to her other medications. Her diarrhea temporarily resolved, but after lowering the prednisone dosage to minimize side effects, Laila relapsed. She once again developed watery diarrhea, and it was not alleviated even after significantly increasing the prednisone dosage. Instead of resolving her digestive issues, in fact, the prednisone increase prompted an onset of medication-induced Cushing’s disease, turning this once energetic muscular dog into a frail low-energy one. Despite the steroid, her digestive issues persisted. Finally, Laila was tried on oral Gut Restoration capsules for MBRT. Slowly, the consistency of her feces changed from a yellowish liquid to a healthy brown solid, and she has since been tapered off all prescription medications. Most importantly, her health and happiness have improved beyond measure. The chart shows Laila’s gut microbiome prior to taking the capsules, compared with that of a healthy dog. Her sample indicated an absence of bacteria commonly found in dogs, including Prevotella, Fusobacterium, Bacteroides and Megamonas, which are found in 84%, 95%, 97% and 93% of healthy dogs, respectively. ______________________________________ 1Whipps JM, Lewis K, Cooke, RC. 1988. “Mycoparasitism and plant disease control” 161-87.in NM Burge Editor, Fungi in Biological Control Systems. Manchester University Press. 2Pannaraj PS, Li F, Cerini C, Bender JM, Yang S, Rollie A, Adisetiyo H, Zabih S, Lincez PJ, Bittinger K, Bailey A. 2017. “Association Between Breast Milk Bacterial Communities and Establishment and Development of the Infant Gut Microbiome”. JAMA pediatrics. 3Yong E. 2016. I Contain Multitudes: The microbes within us and a grander view of life. Random House. 4Blaser MJ. 2014. Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues, Macmillan. 5Igarashi H, Maeda S, Ohno K, Horigome A, Odamaki T, Tsujimoto, H. 2014. “Effect of oral administration of metronidazole or prednisolone on fecal microbiota in dogs”. PloS one, 9(9), p.e107909. 6Dahlhausen K, Krebs BL, Watters JV, Ganz, HH. 2016. “Crowdfunding campaigns help researchers launch projects and generate outreach”. Journal of microbiology & biology education, 17(1), p.32. 7AnimalBiome – unpublished data –CHRISTINA TO PROVIDE REST OF REFERNCE 8Brag S, Hansen HJ. 1994. “Treatment of ruminal indigestion according to popular belief in Sweden”. Revue scientifique et technique (International Office of Epizootics), 13(2), pp.529-535. 9Rager KD, George LW, House JK, DePeters EJ. 2004. “Evaluation of rumen transfaunation after surgical correction of left-sided displacement of the abomasum in cows”. Journal of the American Veterinary Medical Association, 225(6), pp.915-920. 10DePeters EJ, George LW. 2014. “Rumen transfaunation”. Immunology Letters, 162(2), pp.69-76. 11Chaitman J, Jergens AE, Gaschen F, Garcia-Mazcorro JF, Marks SL, Marroquin-Cardona AG, Richter K, Rossi G, Suchodolski JS, Weese JS. 2016. “Commentary on key aspects of fecal microbiota transplantation in small animal practice”. Veterinary Medicine: Research & Reports, 7, pp.71-74.




Integrative approach to diarrhea in the equine

Diarrhea is common in horses, and can be stubborn to treat. Alternative therapies offer a safe and effective way to resolve the problem.

The horse’s digestive tract is very complex, sensitive to its environment, and prone to complications. It is also abused with an overabundance of antibiotics, non-steroidal anti-inflammatories, de-wormers and many other drugs. Additionally, horses are often under stress, either for performance or in the way they are housed and handled. One of the common signs of an imbalanced digestive tract is diarrhea. An integrative approach to treatment is the most effective way to manage most cases.

Diarrhea symptoms

A horse’s manure can vary significantly though the year, depending on the main roughage source. Hay-fed horses can have very dry fecal balls, while fresh spring grass-fed horses almost always have loose wet stool. Alfalfa hay-fed horses may have naturally loose manure. If you are unsure about the effects of the feed on a patient, check the other horses on the same roughage regime. From a holistic perspective, it is important to ask and observe the details of the stool condition -- odor, frequency and consistency. Ask about signs of discomfort before, during and after the stool passes. This could be seen as restlessness, moving around quickly as the stool ends, circling the stall before defecating, or making grimacing faces during the passing. It is helpful to observe the color and moisture of the tongue and gums. TCVM practitioners are trained to incorporate that information, but all practitioners can benefit from this information. As treatment progresses, how does the tongue color and moisture change? Clients can be taught to observe these details and report changes.

Acute diarrhea

Diarrhea diseases in the horse can be life-threatening and are most often treated in hospital settings. The most serious are Salmonella, Clostridium difficile and Potomac Horse Fever. Coronavirus is being recognized as not just an opportunist, but an actual pathogenic cause of diarrhea. Parts of the country with sandy soil also see diarrhea associated with sand ingestion and accumulation. Antibiotics have been shown to be one of the most important causes of serious colitis in horses.1

Chronic diarrhea

The symptoms of chronic diarrhea in horses range from watery fluid passing with formed feces to projectile diarrhea. The majority of cases seen by integrative practitioners are chronic and non-life threatening, with some being very long-standing and unresponsive to conventional treatment. Ulcers are commonly associated with loose stool in some horses. These are usually hind-gut ulcers, but can occur anywhere in the digestive tract. Testing with the Succeed Fecal Blood Test is a non-invasive, low-stress method to determine if ulcers could be the cause. Endoscopy can also be performed. One of the most common complaints is stool that is partially formed, but accompanied by a significant amount of acrid, brown watery fluid that can build up in the tail and is difficult to remove in the winter. This is most common in the cooler seasons of the year. Some horses seem to be triggered by eating hay, and are non-symptomatic on grass. Older horses, especially those in their 20s and above, may have poorly-formed stool or the above symptoms of partially formed combined with watery fluid. These horses may have an aging digestive tract, with a weaker microbiome, or a poorly-functioning enzyme system. Horses fed a wet diet due to a lack of teeth may be getting more water than they can process, with diarrhea as the result.

The horse’s microbiome

The genetic makeup of the microbiota is called the microbiome.2 The microbiota grow on prebiotics, not on the intestinal wall. Populations of microbiota are quite variable between horses, even among those kept on similar feeding programs.3,4 There is a great deal of variation throughout the digestive tract of each horse. Because they reproduce rapidly, microbial populations are susceptible to changes in diet and environment. Research into equine microbial populations using DNA testing is just beginning, as it the understanding of how the balance of microbes relates to health and disease.5,6,7 The normal pH of the intestinal tract changes from acidic in the stomach and upper small intestine, to alkaline in the large intestine. The microbial balance helps keep the pH in the correct range, and and pH keeps the microbes in balance. When microbial populations move to incorrect locations in the gut, the tissue may become inflamed, leading to diarrhea.

An organic garden for your horse

A new idea I have for restoring the natural soil-based microbiome in horses is to plant a corner of the property as a high quality organic garden, using grasses and herbs that horses naturally will eat. Allow ten minutes of grazing per day to provide natural microbe populations that cannot be supplied from a package.

Causes of diarrhea

Many factors can lead to loose stools or diarrhea in horses.
  1. Feeds, feed changes and variations in forage have been shown to change the microbiota significantly.8 Some horses adapt well, while others develop wetter-than-normal manure. Excessive grain affects the microbiota and can lead to changes in stool consistency. Food allergies or intolerances to common feed ingredients, especially alfalfa, can lead to inflammation and diarrhea.
  2. Glyphosate, the herbicide used in genetically modified organism (GMO) feeds has been shown to increase ulceration of the intestinal tracts of pigs.9 Diarrhea was not one of the symptoms in the pigs; however, inflammation of the intestinal tract in the equine can lead to loose stool.
  3. Drugs, especially NSAIDs, can lead to diarrhea in sensitive individuals. Along with antibiotics, these drugs are implicated in inflammatory lesions throughout the digestive tract, and changes in the microbiota.1
  4. Weather changes, especially cold and damp conditions, lead to stool changes. TCVM pays particular attention to weather effects, and clinically this author sees many more cases of diarrhea during such conditions. Large swings in temperature and barometric pressure are also a factor.

General review of TCVM and digestion

A useful way to understand the workings of the gut is to take a Traditional Chinese Veterinary Medicine (TCVM) perspective. The treatment choices do not need to be Chinese. It is beyond the scope of this article to give a complete lesson in Chinese Medicine, but here is a summary.
  • The Stomach (ST) receives and ripens incoming food and drink. The pure or clear part descends to the Spleen (SP) while the turbid part goes to the small intestine. The energy of the ST needs to move in a downward direction to accomplish this.
  • The SP is responsible for generating and containing the Blood and keeping fluids in the proper place. A SP Qi deficiency can allow too much fluid to escape through the digestive tract, leading to diarrhea.
  • The Kidney (KI) Yang provides Fire for digestion and vaporizes the water in the lungs, allowing it to descend and dispersing the fluids in a downward direction (the natural direction of the lungs). The KI Yang also assists the SP Yang in vaporizing the fluids. If the Yang is deficient, the fluids escape downwards.
  • The Liver (LV) governs the smooth movement of Qi through the vessels and organs and also stores the Blood. The SP has a close relationship with the LV. The LV maintains an upward Qi flow and releases bile to help digestion. When the LV Qi stagnates (a common occurrence in the equine) it over-controls the SP and damages it. This can lead to ulcers, and loose stool. The LV is the Chinese organ most affected by stress, hence the prevalence of ulcers in modern horse-keeping.
  • The Large Intestine (LI) reclaims and excretes downward the more solid parts of the food and drink, and reabsorbs water from the waste material.

Products for diagnosing and treating equine diarrhea

Succeed Fecal Blood Test, succeedfbt.com Spore Probiotics, microbiomelabs.com/products/megasporebiotic/ Minerals for bacterial communication -- Restore, restore4life.com Western herbal formula -- Digest Support, hiltonherbsusa.com/us-horse-supplements-es/digestion-supplements-for-horses-es/digest-support-for-optimum-digestive-health Psyllium-based product -- Assure Plus, arenus.com/assure-plus/ Organic enzyme product, abcplus.biz/Organic_Equine_Digestion_Enzyme_Product

Treating equine diarrhea

Acute, severe cases are best treated in a hospital setting with access to intravenous fluids, along with acupuncture, probiotics, fecal transplants and antibiotics if needed. In some cases, the antibiotics are the cause of severe diarrhea and the treatment needs to be done without them. Replenishing the microbiome is perhaps the most important aspect of treatment, since the microbial population has been compromised.

Acupuncture

Acupuncture has been clinically shown to be an effective adjunct to treating acute diarrhea, and is used at several universities with trained clinicians.10 Acupuncture can also be a first-line treatment for many chronic cases, and may be all that is needed. To be effective, an accurate TCVM diagnosis is made and points are selected based on the diagnosis. Several universally useful points include ST 36, BL 20 and 21, SP 6 and 9, LI 10 and GV 1.

Probiotics

The most important GI supplement is a good probiotic formula. Horses in general are treated with antibiotics for every little cut and scrape, not to mention every upper respiratory infection. In many cases, supplementation with a probiotic will be the key to repairing gut function and may be the only extra supplement needed. Any horse showing signs of ill health would do well with at least two months of probiotic treatment. Useful probiotics usually contain some or all of these beneficial bacteria: Lactobacillus acidophilus, L. plantarum, L. casei, Enterococcus faecium, Bifidobacterium thermophilum and B. longum. A Lactobacillus Acidophilus fermentation product can also be used to stimulate bacteria growth. Many probiotics are poorly-made and unstable, so by the time they are purchased and used, they may or may not contain active ingredients. Beware of heavily-preserved formulas and those with artificial flavorings and sweeteners.

Prebiotics

Prebiotics are usually short-chain fructo-oligosaccharides that support the growth of probiotic bacteria. They can be quite beneficial in a formula. The microbiome is often best supported with some of the newer products that include soil organisms, the spores of the microbes or the minerals that form the communication network for the bacteria.

Fecal transplantation

Fecal transplantation has been performed for many years in equine practice.11 Most of the research and clinical papers have focused on severe, acute cases, or antibiotic-induced colitis. As microbiota DNA analysis becomes more available, it will be possible to accurately select healthy donor horses, and potentially commercialize a fecal microbiota for easy administration.

Herbal supplementation

Herbs from many traditions can be used to treat diarrhea. Horses are easy to feed with herbs since they are capable of digesting raw plant material. In many cases, horses will selectively choose the herbs they need and reject those they don’t. Some horses are quite picky and will not eat any form of the herb, but they are usually the exception rather than the rule. A horse that eats herbs well, then refuses them, likely does not need that formula anymore. Dosing is generally two to four times the human dose, whether the herbs are raw or in tincture form. Horses are quite sensitive to the energy of herbs, and in many cases will respond to even lower doses. Herbs can be mixed with palatable feeds or mixed with liquid and syringed into the mouth. Western herbal mixes can contain herbs such as yarrow, mullein, hops, marshmallow, meadowsweet or cinnamon if a warming herb is needed. Formulations prepared with the knowledge of the energetics of herbs are usually more effective than just symptomatically using them. High cannabinoid-containing hemp has anti-inflammatory action in the gut, and early usage in the equine shows promise as an herbal support to the gut. Chinese formulas are selected based on the TCVM diagnosis, which can be SP Qi Deficiency, SP Yang Deficiency, or a formula to clear Heat in an infectious cause of diarrhea.

Additional supplements

Simple nutritional supplements can be very effective depending on the clinical presentation. Psyllium and probiotics can help not only with sand accumulation, but also with soothing and healing the gut wall.12 Enzymes can be useful especially for older horses whose overall body functions are failing, or those that have long-standing absorption problems.

Homeopathy

Homeopathy can be very useful in the treatment of diarrhea. Simple cases can be treated with remedies such Arsenicum Alb, Sulphur, Veratrum Alb and Lycopodium. There are many choices in the Materia Medica, so it is important to use the details of the condition to pick the remedy. For example, Arsenicum Alb works very well with projectile diarrhea in Potomac Fever, or in horses that are restless and thirstless, while Sulphur works with cases that have extremely offensive-smelling diarrhea, that may or may not be profuse.

Chiropractic

Chiropractic is not often thought of as a treatment for diarrhea, but itshould be considered in chronic situations. A horse that is not responding well to other treatment, should be checked to ensure his spine has normal motion throughout, especially in areas from the sixth thoracic vertebra and down, where various spinal nerve roots affect the digestive tract.

Conclusion

Diarrhea in the equine is a common, and at times, challenging condition. Daily assaults on the digestive tract through extensive use of drugs, poor feeding regimes and stress affects the microbiome in a negative manner. Natural approaches to treatment are more cost-effective, successful and healthier for the horse than the typical drug regimen. Many horses need ongoing support, since the conditions surrounding the diarrhea are often unavoidable, and a natural approach offers safe and effective therapies. ________________________________________________________ 1Gustafsson, Agneta. “Antibiotic associated diarrhea in horses”. Acta Universitatis agriculturae Sueciae. Veterinaria, 1401-6257; 166 (2004). 2Costa MC, Weese JS. “The equine intestinal microbiome”. Animal Health Research Reviews 13(1); 121–128. 3Al Jassim RAM, Andrews FM (2009). “The bacterial community of the horse gastrointestinal tract and its relation to fermentative acidosis, laminitis, colic, and stomach ulcers”. Veterinary Clinics of North America: Equine Practice 25: 199–215. 4Perkins et al. “Equine Stomachs Harbor an Abundant and Diverse Mucosal Microbiota”. ncbi.nlm.nih.gov/pmc/articles/PMC3318809/. 5Ericsson AC et al. “A Microbiological Map of the Healthy Equine Gastrointestinal Tract”. journals.plos.org/plosone/article?id=10.1371/journal.pone.0166523. 6Venable EB. “Role of the gut microbiota in equine health and disease”. animalsciencepublications.org/publications/af/articles/6/3/43. 7Proudman CJ et al. “Characterization of the faecal metabolome and microbiome of Thoroughbred racehorses”. Equine Vet J. 2015 Sep;47(5):580-6. Epub 2014 Sep 29. ncbi.nlm.nih.gov/pubmed/25041526. 8Respondek F, Goachet AG, Julliand V. (2008) “Effects of dietary short-chain fructooligosaccharides on the intestinal microflora of horses subjected to a sudden change in diet”. J Anim Sci 86, 316–323. 9Carman JA et al. “A long-term toxicology study on pigs fed a combined genetically modified (GM) soy and GM maize diet”. Journal of Organic Systems, 8(1), 2013. 10Xie H. 2010. “Treatment of Diarrhea in hospital settings”. Personal communication. 11Mullen KR, Yasuda K, Divers TJ, Weese JS. (2016). “Equine faecal microbiota transplant: Current knowledge, proposed guidelines and future directions”. Equine Vet Educ. doi:10.1111/eve.12559. 12Sahagun AM, Vaquera J, Garcia JJ, Calle AP, Diez M, Fernandez N, Loro JF, Portilla HO, Sierra M. “Study of the protective effect on intestinal mucosa of the hydrosoluble fiber Plantago ovata husk”. BMC Complement Altern Med. 2015; 15: 298.   *This article has been peer reviewed.




A shared space practice model

It takes time to develop a veterinary practice based on a shared space model, but it has many benefits, including a decrease in overhead and an increase in offered services.

Most veterinary practices have owners and associates. New services can only be offered if someone at the practice learns them, or patients are referred out. If clients are looking for services that the existing staff cannot offer, a shared space practice model can help solve the problem. For many years, I ran the Holistic Medicine “department” at a large specialty hospital in the Northern Virginia area. While the public saw the facility as one practice with one name, the group was actually a collection of separate practices working out of a shared space. The proximity to other service providers can offer a variety of treatment options to clients, and also lets them know about your own services for future use. [caption id="attachment_3860" align="alignright" width="300"] Dr. Kocen treating a dog with acupuncture. Rooms are designed to be comfortable for the animals so they are easier to treat.[/caption] At the specialty hospital, our practice offered acupuncture, homeopathy and Chinese herbal medicine. There was another practice offering rehab, but if I thought patients would benefit from therapeutic massage or chiropractic, for example, I had to refer them to someone outside the practice. This wasn’t a problem, but I didn’t know the hours, fees or areas of service of these mostly house-call practitioners. And I frequently ran out of their cards to give to clients.

Reaching out to other practitioners

While the arrangement I had was working, the limitation to offering additional services prompted me to think about opening my own practice. I wasn’t in a positon to hire practitioners to provide other services. So I thought about developing my own holistic practice based on the shared space model. I called some of the practitioners I was already referring clients to, and asked if they would interested in using my proposed new facility a day or two per week. Several of these practitioners worked with horses as well as small animals, so they were based away from areas of denser population; this reduced their ability to work with small animals, required lots of driving, and limited the number of clients they could see in a day. The advantage of sharing a space meant they would be able to use an existing small animal facility without having to build and maintain one themselves, or pay full time rent for a space they would use only part time. I explained that a shared space facility would also increase exposure to their services among clients coming in to see someone else. Those clients might consider using their services or inform friends that these services were available. In turn, those referrals would be exposed to our other services. The advantage to the practice owner is that fees from the associates help defray expenses. In our case, the expenses were to be used to build out and maintain a clinic. We would all benefit from the clients of other practitioners seeing the services we offer, and they referrals they would send. As you may imagine, the prospective associates had many questions: they wanted to know what limitations there might be on the services they could offer, what services they could get for their fees, what access they could have when we weren’t there, and how much it would cost.

Protocols in a shared space practice

Coming from the world of the “referral hospital”, I was used to clients having diagnostics done before they arrived for initial consultations. I also recommended that they have their regular vet do any follow-up diagnostics. We also did not do annual exams, nor dispensed conventional medications. Since clients returned to their “regular vets” for these services, it let the conventional veterinarians follow the progression of holistically-treated cases and see the pets getting better. Since I was not competing with them for the services they offer, they were more likely to refer cases to me. [caption id="attachment_3858" align="alignleft" width="300"] In a shared office space, rooms can be chosen that are appropriate for the modality. This room is often used for chiropractic (Dr. Bierly) and physical therapy.[/caption] In our current shared space practice, practitioners are allowed to offer any treatment options they think the patient needs, apart from conventional therapies. They may do diagnostics but we are not staffed to provide conventional medicine assistance. The two associates who offer chiropractic are also certified in acupuncture, so even though my own practice already offers acupuncture, the associates are not limited to offering just the therapy they list as their primary therapy. It is also understood that no one has an exclusive right to any therapy. We have two chiropractors and two massage therapists, but they come in on different days. We have another practitioner who offers acupuncture and Chinese Herbal Medicine, as does my practice. She has a strong interest in cancer treatment so we are happy to refer cases to her. I don’t see any of this as competition, but as providing a wider array of services. Ultimately, it would be great to have all therapies available every day. Each associate makes his/her own appointments and takes his/her own fees. We list all the practitioners on our website, with links to their own websites, so clients can learn more about them and what services they offer. We all try to mention the other practices in our space whenever we are at promotional events, so that everyone benefits.

Building a group takes time

Over time, I have found that each associate views the arrangement differently. Some have complained about slow growth of their clientele. For each individual practice to grow, however, the practitioners should ideally reach out to the public, to human practitioners in their fields, and to the general veterinary community. It is unrealistic to think that increased clients will come entirely from internal referrals. Not working to grow an individual practice can have a negative impact on the other practices in the shared space. Therefore, even though each practice is separate, there should be an understanding that supporting the facility as a whole will help everyone. We have had a few practitioners start and leave, but most have stayed. A few I spoke to decided that what we had was not for them. In time, however, I think the “right” group of people will find us, and help us develop this practice to reach its full potential.




Building good behavior in your patients – strategies for stocking your pharmacy
Most animals are relinquished to shelters because of behavioral issues. Many clients simply tolerate unwanted behaviors in their pets, while you and your staff are often stressed by poor patient behavior in the clinic. And it doesn’t stop there. Studies have documented the impact of emotional and mental health in animals on physical ailments. Addressing these issues can provide a major income source for your practice, and also increase client retention. The key is to create a receptionist-technician-veterinarian team to identify problem animals, treat them, then follow up on a regular basis. Starting conversations with clients when they first acquire young animals or adopt older ones is mandatory if your goal is to maximize patient health in your practice. You probably already suggest basic training classes, or perhaps offer them at your clinic. You also suggest treatments for animals with specific behavior problems or refer them to specialists. Three approaches can improve your success in this area:
  1. Therapeutic product sales
  2. Classes and associated services – Reiki, Tellington T-Touch, massage, basic training, “handle me”
  3. Treatment with holistic modalities.

1. Therapeutic products that help with emotional and behavioral issues

Create a sales strategy based on the behavior problems you see in your clinic. Start with “Build Good Behavior”, then move to treatment of specific behavior problems. I’ll cover a few common conditions and some products that would help. Companies will be mentioned below, and you will discover more as you read and learn about different modalities. Articles in IVC journal, Animal Wellness, Equine Wellness and JAHVMA, along with speakers at the annual AHVMA conference address in more detail the different modalities for treating training and behavior issues. Begin by looking at the companies you already order from. They may have behavior products you have not considered. For example, you may be using VeteriScience’s Glycoflex, but have never ordered Composure (for calming, barking, help with training). Next, pick one of the following categories and explore the different companies whose products address that approach

Flower essences

I would suggest starting with these since there are never any side effects and the products are labeled for their use (e.g. Scaredy Cat, Training, Anxiety, Aggression, etc.).Flower essences: There are many companies that offer flower essences, including Bach, Living Tree Orchid Essences, Perelandra and the Flower Essence Society (for training). If you’re looking for essences labeled for specific animal problems you can check out Jackson Galaxy Essences, Green Hope Essences, Anaflora (the formulator is also an animal intuitive), Pet Essences and Alaskan Essences.

Essential oils

These are excellent for emotional problems and can facilitate learning as well. Good quality is essential, even within reputable companies. Some study is needed to learn how to select oils, how to use them with cats, and their multiple uses for physical and behavioral issues. You can find out more from the Veterinary Medical Aromatherapy Association, Dr. Melissa Shelton (animalEO) and Doterra. Oils can be administered multiple ways, including orally, on collars or crates, or through petting and diffusion. One good source of these support products is Blue Sky Textiles. Mellow Dog Essential Oil Spray and Blend by LifeFORCE Pet Health are formulated to soothe dogs in times of stress. Its counterpart, Mellow Cat, has been safely tested on felines.

Cannabis

It’s proving to offer amazing results for anxiety and stress problems, along with its many physical benefits. Check out books and products by Dr. Robert Silver at Well Pet Dispensary, or look into Therabis’ Calm and Quiet, or oils from the Medicinal Cannabis Dispensary.

Western herbs

They can be used in two main ways: individual herbs chosen from your studies, and combinations labeled for specific behavior problems. Again, quality is critical. Are the herbs raised organically and sustainably? If wild-crafted (harvested from the wild), is it being done in a sustainable way? Many courses are available, on-ine and onsite, from the Veterinary Botanical Medical Association (VBMA), the College of Veterinary Botanical Medicine and the College of Integrative Veterinary Therapies. When purchasing herbal combinations, be sure ask about sourcing. Greg Tilford of Animals’ Apawthecary is a leader in the herbal field for animals, and his combination herbal products are labeled for specific conditions; he has also authored an excellent book, Herbs for Pets. Herbalist & Alchemist has high quality single herbs and has been a regular vendor for decades at the AHVMA conferences. Other companies to check out include Veterinary Botanicals and Pet Wellness Blends.

Nutritional supplements

These are often needed, especially when pets are on a commercial diet. Again, quality is critical, as is palatability. Herbs or oils are often included in nutritional supplements. VetzLife, Rx Vitamins (products include vitamins and herbs, including hemp), Nutramax, Vet Classics and VetriScience are some examples of quality supplement companies.

2. Building basic good behavior with training and education

Our clients and staff often struggle because many dogs and cats are fearful or aggressive in the clinic, or will not let their feet, ears, mouth, belly, etc. be examined or treated, often even at home. They may have trouble riding in the car to and from the clinic (or anywhere else). Addressing this during every visit with every client – whether it’s a new puppy/kitten, a new adult, or a current patient -- until you have a super well-behaved animal, is well worth it. Step one: Have a staff member in charge of a program to train clients in helping their animals actually enjoy being handled by anyone, including themselves.  This includes handling for nail trims and dental checks. This program could include selling products to calm pets, increase trainability and break bad behaviors. Step two: Set up a system to identify each client who has not yet been through the program, and to follow up on progress. This is best done by the receptionist, who can also recognize training issues in the waiting room. Include a check box on the client’s file, or a tag in the digital records, so reminders can be easily sent. Step three: Encourage this training at every wellness exam, in blog posts, with annual exam cards, or on social media. It can be offered as a free clinic benefit, or charged for minimally, as it will make your job easier and increase client retention. This would be a job for all members of your team. The receptionist may have photos and testimonials in the office (on a bulletin board or in a scrapbook) and add them to the website as well. Classes and products
  • Offer classes in Reiki, animal communication, Tellington T Touch, massage and basic behavior training.
  • Have staff make videos of the classes or stage ones that demonstrate how to trim nails, take an animal’s temperature, brush teeth, clean the ears, hot pack and express the anal glands, examine the lymph nodes and extremities and maybe even take the pulse and palpate the abdomen. These videos can be sold or used as a practice promotion. Include transcripts of the videos for those who learn best from the written word.
  • Choose what therapies and companies you want to work with:
    • Flower essences: Remind people that some animals respond well while others seem unaffected. Flower essences are 100% safe and can be used frequently. You may decide to stock a few essences for basic good behavior that can be sold OTC at the front of the clinic. Since clients can usually buy them cheaper on the internet, you may opt to not carry them and provide websites in your handout. Some companies have affiliate programs so you can still monetize client purchases (usually only 5% to 20%). Administering flower essences one to five times a day for three weeks is a good trial; if those from one company do not seem as effective, try essences from another.
Bach Rescue Remedy (or emergency essences from other companies) can be used as follows -- put four drops in one ounce of water (you could also sell empty dropper bottles) and administer in water (but not the water bowl), in food, per os, or topically (especially for itchy skin and other skin and ear lesions). This can decrease anxiety in any situation, including at veterinary visits. To help pets learn faster, other flower essence combinations and single remedies can be tried by you or your clients. Have them keep good notes, maybe in a journal that you can sell, and schedule consults to evaluate the patient’s changes. Too often, the client focuses merely on the main complaint, so you or your staff can keep them looking at the whole animal in context. Some products to try include Training Formula (Jackson Galaxy Essences), Good Dog, Happy Feet, for nail trimming training and problems (Anaflora), Courage (Anaflora), Anxiety, Neediness (Green Hope Essences), Calm My Focus (Calm My Pet Inc.), Easy Learning (Alaska Essences), Best Behavior (Blackwing Farm)
  • Essential oils can also decrease anxiety and increase learning ability. Until you have studied with, or spoken to, experts in the field, use hydrosols in cats.
Lavender is great to decrease anxiety, while lemon is used to increase cognitive awareness. You can also try Focus (for dog and trainer) from Dr. Shelton, or LifeFORCE’s Good Dog Essential Oil Blend, which promotes mental balance and function.
  • Herbs to try include the Tranquility Blend by Animals’ Apawthecary; it’s useful for training problems caused by anxiety. Also consider Cognitive Function from Pet Wellness Blends.
  • Encourage the best possible diet (fresh ingredients are ideal) with minimal chemicals, GMOS or glyphosates, and consider selling general health supplements. Mental and emotional health need a good basic set of amino acids; Steve Brown reminds us that low tryptophan from too much fat in the diet could increase aggression in genetically inclined dogs. (com/can-high-fat-beef-based-raw-diets-lead-to-behavioral-issues-and-aggression-in-some-dogs/?hilite=%22steve%22%2C%22brown%22). There are many wonderful sources to boost the nutrition of a fresh food diet, including:
    • Herbal Multivitamin: Animal Essentials -- Green Alternative
    • Blue Green Algae – The Edge Up
    • Mushrooms – Mushroom Wisdom
    • CAS Options – Vet Classics: mushrooms and more
    • Kelp: Thorvin
    • Daily defense powder for cats and dogs: Glacier Peak Holistics

3. Treating Behavioral Problems

Some animals present for behavior problems so severe that there is no time for the above training approach. You need to have products on hand to temporarily address these issues while more individualized treatments are begun (homeopathy, TCVM, osteopathy, chiropractic, client training, referral to a behavioral specialist, etc.). Quantify each symptom along with the trigger and duration. Your intake needs to probe. The patient may present as aggressive, yet your questioning reveals timidity, fear biting, protective growling but no real anger. You would make different choices based on your assessment. One joy of prescribing the following is that they offer broad emotional support, so they don’t have to be as precise as the more curative modalities. Have clients keep a daily record of changes in all symptoms, not merely those that are of concern. Selling a journal or giving one to new clients can encourage record-keeping. Aggression -- can have many triggers, including reactions to rabies vaccination. Regardless of the cause, any of the following can be helpful for fear or aggression.
  • Flower essences
    • Bully, Scaredy Cat, Safe Space, Self-Esteem, Grouch, Nervous Nelly -- Jackson Galaxy Essences
    • Anxiety, Jealousy, Outburst -- Green Hope Essences
    • Aggression, Buddha Nature, Courage, Calm Kitty -- Anaflora
    • Out of Control, Anxiety and Fear, Calming Solution, Emotional Stability -- Pet Essences
    • Calm My Dog, Calm My Cat -- Dr. Pam Fisher’s Calm My Pet
    • Fruits of Courage -- Living Tree Orchid Essences
    • Drama Trauma, Confidence -- Blackwing Farms
  • Essential oils, single or in combination:
    • Calm-a-mile – Dr. Melissa Shelton
    • Chill-Out – Silk Road Oils
  • Herbs
    • Hemp, Tranquility Blend -- Animal Essentials
    • Pet Calming – Pet Wellness Blends
    • Calm and Quiet (hemp with nutritional additions) – Therabis
  • Nutritional supplements can be offered singly, or in combinations:
    • NutriCalm, NutriCalm for dogs, Rx B12 – Rx Vitamins
    • Soliquin (a combination many trainers find useful for helping anxious dogs and cats) -- Nutramax
    • @Eaze calming gel (herbs, oil and nutrients) -- VetzLife
  • Sound therapy can also help.
    • Sound and Beginning -- Silk Road Oils
    • Calm my Pet CD -- Calm My Pet
Separation anxiety – many of the above products will work, but also try:
  • Flower essences
    • Separation Anxiety -- Jackson Galaxy
    • Drama Trauma, Home Alone! -- Blackwing Farms
    • Loneliness/Home Alone -- Pet Essences
  • Music, EMF protection, hydrosols, and flower essences are also effective for separation anxiety.
Becoming certified in a deep healing modality will help you resolve most behavioral problems. While you are studying homeopathy, TCVM, chiropractic, botanical medicine or osteopathy, the gentle therapies highlighted in this article can help your patients much more safely than most drugs. They are also a great addition to conventional practices whose clients may be asking for alternatives to drug treatments for behavior problems.




Probiotics, the missing nutrients -- Part 1

A balanced intestinal microbiome is crucial to good health in dogs and cats, as well as in humans. Probiotics can play an important role in maintaining this balance.

Maintaining a healthy and balanced intestinal microbiome in our patients (and in ourselves) is becoming increasingly difficult. This can lead to a multitude of health issues, in which probiotics can be of significant assistance. In the first of this two-part article, we’ll look at the discovery of probiotics (see sidebar on page xx) and how they can alleviate microbial imbalance in the gut and support the integrity of the intestinal lining.

The microbiome

“The intestinal microbiota is the collection of the living microorganisms (bacteria, fungi, protozoa, and viruses) inhabiting the gastrointestinal tract.”1 The term “microbiome” includes the organisms, their interactions and their environment. Microbiomes are extremely unique between even closely-related individuals. Each gut hosts thousands of bacterial species and strains. There are between 100 and 150 times more bacterial genes than human genes in our bodies. And there is an intricate interaction between the host and both the intestinal bacteria and their genes. About 500 cultivable species of bacteria exist in the gut. An additional 1,000 species have been identified by modern molecular techniques (specifically ribosomal RNA sequencing, known as metagenomics). “This microbial community…varies quantitatively and qualitatively along with the different environments from the stomach, small and large intestines…. This complex community is metabolically active and contributes to homeostasis.”2 A functional microbiome breaks down foods to liberate more nutrients, manufactures several vitamins, inhibits disease-causing bacteria, and nourishes the enterocytes by producing the short-chain fatty acids used for fuel. Thus, the intestinal microflora maintains the integrity of the intestinal lining that protects the entire body from the inflammation associated with leaky gut syndrome.3 Furthermore, the microbiome acts as a detoxification organ; an imbalance in the bacteria can stress the liver. Gut bacteria influence the systemic immune system. They also affect brain chemistry and structure. Animals have co-evolved with their microbiomes, and so they have developed a symbiotic relationship with them.4 In fact, some researchers assert that the microbiome should be considered an organ of the body5 – an organ as vital as the kidneys or liver. At a phylogenetic level, the gastrointestinal microbiomes of humans, dogs and mice are similar.6 This indicates that microbiome research from one of these species applies to the others. In dogs and cats, more than ten bacterial phyla have been identified, with Firmicutes, Bacteroidetes, Proteobacteria, Fusobacteria and Actinobacteria constituting more than 99% of all gut microbiota.7 Some of the gut bacteria that are beneficial for people are also helpful for dogs. In one study, Lactobacilli were isolated from the jejunal chyme of five fistulated beagles. They found that Lactobacillus acidophilus was dominant.8 According to recent research, “The symbiotic relationship that exists between GI microbes and the host is critical for proper function of nutritional, developmental, immunological, and physiologic processes in animals, and thus contributes to host health… Decreased GI pH also results in decreased solubility of bile acids, thus decreased reabsorption and enterohepatic circulation of bile acids, increased absorption of minerals, and reduced absorption of ammonia.”9

The discovery of probiotics

The story of probiotics begins with Elie Metchnikoff (1845-1916). This Russian-born biologist was the first to understand the importance of white blood cells for immunity, which earned him the Nobel Prize in medicine in 1908. In fact, Metchnikoff is considered the “Father of Natural Immunity”. He noticed that Bulgarian peasant farmers were healthier, more robust, and lived longer than their city-dwelling countrymen. He insightfully realized their consumption of fermented foods, more specifically the bacteria those foods contained, was responsible for the farmers’ good health. Metchnikoff coined the word “probiotics” (literally “for life”) for the beneficial bacteria in fermented foods. He reasoned that for health, the intestines must harbor more “good” than “bad” bacteria. He said that “Death begins in the colon.” This statement echoes that of Hippocrates who said: “All disease begins in the gut.” The fermentation of food dates back 6,000 years when the Chinese began fermenting cabbage. A critical component of food safety, fermentation has been embraced by almost every culture around the globe. From Korean kimchi and Indian chutney to African garri and European pickled vegetables, to Hawaiian poi and the ubiquitous yogurt and sauerkraut, fermented foods are utilized worldwide. In some countries, the fermentation process involves burying the food, reminiscent of carnivores that bury their uneaten prey. When you think about it, it seems obvious that any other carnivore that wandered past a shallow grave would smell, exhume and consume its contents. So if predators don’t bury their leftovers to hide them, then why do they do it? Perhaps it’s to support fermentation, so the carnivores can benefit from probiotic bacteria. At the very least, it must be acknowledged that our pets’ ancestors of did not eat sterile food. Fermenting food involves creating an environment that promotes the growth of acid-forming bacteria. These microbes convert sugars into organic acids. The low pH that is created inhibits the growth of pathogenic bacteria, and thus keeps the food from spoiling. The formation of acid is also responsible for the ability of probiotics to kill off pathogenic bacteria in the gut. The balance of intestinal microflora has broad effects on an animal’s health, and on ours. There are 100 trillion microbial cells in our bodies. In fact, we consist of ten times more bacterial cells than human cells. So, at the cellular level, we are more bacterial than we are human! The same is no doubt true for pets.

Dysbiosis and leaky gut

The term “dysbiosis” is used to indicate a state of gastrointestinal microbial imbalance or maladaptation. Another common factor of dysbiosis is a serious decrease in microbiota diversity. According to recent research, molecular interactions link the gut microbiota with host energy metabolism, lipid accumulation and immunity. These researchers go on to state: “Altered gut microbial ecosystems have been associated with increased metabolic and immune disorders in animals and humans.”10 Unbalanced gut microbiota is associated with disorders such as obesity, diabetes mellitus, schizophrenia, autistic disorders, anxiety disorders, and major depressive disorders.11 Many GI diseases linked to dysbiosis lead to an increase in intestinal permeability, a condition commonly known as “leaky gut syndrome”. Certain pathogenic bacteria damage tight junctions and produce toxins that then pass into the systemic circulation. According to research, leaky gut may allow the passage of toxins, antigens or bacteria into the portal circulation and may play a pathogenic role in advanced liver cirrhosis and its complications. Furthermore, translocated bacterial antigens can result in a cross-reaction with the self-antigens and the induction of autoimmunity. A growing number of diseases have been shown to involve an increase in intestinal permeability related to changes in tight junction competency.12 In fact, when translocated bacterial antigens affect metabolically-active tissues, it may result in a chronic inflammatory state and impaired metabolic function.13 The solution to this problem is probiotics. Multiple studies show that probiotics decrease intestinal permeability.14,15

Messing with the microbiome

Modern medicine has found many ways to disturb the delicate balance of the microbiome. Obviously, antibiotic therapy of any kind indiscriminately kills the “good” bacteria along with the “bad”.   Other drugs also cause a deleterious change in the gut bacteria – these include NSAIDs, proton-pump inhibitors, antidepressants and laxatives. Researchers have concluded that, “Bacteria in the gastrointestinal tract reflect the combinations of medications that people ingest.”  Just about any pharmaceutical can lead to a state of intestinal dysbiosis.

Health benefits of probiotics

Probiotics are defined as “live microorganisms, which when administered in adequate amounts confer a health benefit on the host.”16 The most commonly-used probiotic bacteria are species belonging to the genera Lactobacillus and Bifidobacterium for humans and Aspergillus, Bacillus, Enterococcus, Lactobacillus and Saccharomyces for animals.17 One key to the efficacy of a probiotic supplement is that it must provide an adequate number of bacteria. For people, the agreed upon range is 5-10 X 109 Colony Forming Units (CFUs), while pets need at least 1 X 108 CFUs. An ideal probiotic should have microbes that originate in the species being treated, and should also be nonpathogenic, resistant to digestion by gastric acid and intestinal enzymes, able to adhere to the intestinal epithelium, and capable of influencing host immune responses.18

Conclusion

In this article, we have reviewed the discovery of probiotics, as well as research documenting the importance to health of a balanced intestinal microbiome. We have seen how modern medical practices can disturb the microbiome, and looked at the role that probiotics play in mitigating dysbiosis and maintaining the integrity of the intestinal lining. In Part 2 of this series (IVC Journal, Summer 2018), we will delve more deeply into the research on probiotics and how they affect the immune system, microbiota-gut-brain axis, and systemic detoxification. We will further explore the influence of probiotics on such diverse conditions as chronic gastrointestinal disease, mood disorders/behavior, obesity, pancreatitis, diabetes mellitus and cancer. The sum of this research will allow the conclusion that probiotics are essential nutrients that are missing from modern conventional diets in both humans and pets. 1Honneffer JB, Minamoto Y, Suchodolski JS. “Microbiota alterations in acute and chronic gastrointestinal inflammation of cats and dogs”. World J Gastroenterol. 2014;20(44):16489-97. 2Ferreira CL, et al. "Terminology concepts of probiotic and prebiotic and their role in human and animal health." Rev Salud Anim. 2011;33(3):137-139. 3Suchodolski JS. “Companion animals symposium: microbes and gastrointestinal health of dogs and cats”. J Anim Sci. 2011;89(5):1520-30. 4Hooda S, Minamoto Y, Suchodolski JS. “Current state of knowledge: the canine gastrointestinal microbiome”. Anim Health Res Rev. 2012:13(1);78–88. 5O'Hara AM, Fergus S. “The gut flora as a forgotten organ”. EMBO reports. 2006;7(7):688-693. 6Swanson KS, et al. “Phylogenetic and gene-centric metagenomics of the canine intestinal microbiome reveals similarities with humans and mice”. ISME J. 2011;5(4):639-649. 7Suchodolski JS. “Companion animals symposium: microbes and gastrointestinal health of dogs and cats”. J Anim Sci. 2011;89(5):1520-30. 8Tang Y, Manninen TJ, Saris PE. “Dominance of Lactobacillus acidophilus in the Facultative Jejunal Lactobacillus Microbiota of Fistulated Beagles”. Appl Environ Microbiol. 2012;78(19):7156–7159. 9Hooda S, Minamoto Y, Suchodolski JS. “Current state of knowledge: the canine gastrointestinal microbiome”. Anim Health Res Rev. 2012:13(1);78–88. 10Boulangé CL, Neves AL, Chilloux J, Nicholson JK, Dumas ME. “Impact of the gut microbiota on inflammation, obesity, and metabolic disease”. Genome Med. 2016 Apr 20;8(1):42. 11Evrensel A, Ceylan ME. “The Gut-Brain Axis: The Missing Link in Depression”. Clin Psychopharmacol Neurosci. 2015;13(3): 239–244. 12Fasano, Alessio. "Leaky gut and autoimmune diseases." Clin Rev Allergy Immunol. 2012;42(1):71-78. 13Brown K, et al. “Diet-induced dysbiosis of the intestinal microbiota and the effects on immunity and disease”. Nutrients. 2012;4(8):1095-1119. 14Rosenfeldt V, et al. “Effect of probiotics on gastrointestinal symptoms and small intestinal permeability in children with atopic dermatitis”. J Pediatr. 2004;145(5):612-616. 15Madsen K, et al. “Probiotic bacteria enhance murine and human intestinal epithelial barrier function”. Gastroenterology. 2001;121(3):580-91. 16Nomoto K. “Prevention of infections by probiotics”. J Biosci Bioeng. 2005;100:583–592. 17Ferreira CL, et al. “Terminology concepts of probiotic and prebiotic and their role in human and animal health”. Rev Salud Anim. 2011;33(3):137-139. 18Dotan I, Rachmilewitz D. “Probiotics in inflammatory bowel disease: possible mechanisms of action”. Curr Opin Gastroenterol. 2005;21:426–430. *This article has been peer reviewed.




Strategies for managing pancreatitis in small animals

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

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

Pathophysiology of pancreatitis

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

Role of nitric oxide and endothelial dysfunction

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

Diabetes, insulin resistance, and endothelial dysfunction

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

Preventing pancreatitis with diet

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

Chinese herbs for pancreatic ailments

Targeting insulin resistance – Damp Heat formulas

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

Targeting endothelial dysfunction

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

Targeting bacterial causes

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

Using herbs — administration via enema

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

Oral dosing

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

Case example: Falco Teefy

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

Case discussion

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

Conclusion

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




Digestive enzymes in dogs and cats

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

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

Two enzyme categories

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

Normal physiology of digestive enzymes

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

What is an enzyme?

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

Supplemental enzymes

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

Choosing supplements

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

Diseases resulting from enzymatic dysfunction

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

Practical oral supplementation 

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

Specific uses in clinical practice

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

Summary

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




Integrative approaches to megaesophagus – case studies

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

Using acupuncture for congenital megaesophagus

Case #1

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

Case # 2

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

Using homeopathy for megaesophagus

Case #1

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

Case #2

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

Using laser for megaesophagus

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

References

1Clemmons R. Megaesophagus and megacolon. Web access 15Jan2018; dog2doc.com/chi-files/TCVM_Herbs/August_Chi/Megaesophagus_Megacolon.ppt 2Beebe S, Salewski M, Chen J et al. Tonic Formulas. In: Chinese Herbal Formulas For Veterinarians, City of Industry, CA; Art of Medicine Press Inc 2012:423-431.




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

The 3 pillars of osteopathy

1. Visceral manipulation (visceral osteopathy)

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

2. Joint manipulation

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

3. Craniosacral therapy (CST)

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

Osteopathy in practice – observations related to spay/neuter

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

How spay/neuter adhesions restrict mobility in dogs and cats

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

1. Sacro-iliac fixations

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

2. ACL (CCL) injuries / tears

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

3. Front end lameness

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

Conclusion

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

References

Barral, Jean-Pierre. Visceral Manipulation (revised ed). Seattle: Eastland Press, 2007. Barral, Jean-Pierre. Visceral Manipulation II. Seattle: Eastland Press, 1989 Barral, Jean-Pierre, Croibier, Alain. Trauma: An Osteopathic Approach. Seattle: Eastland Press, 1997. Becker, Rollin. The Stillness of Life. Portland: Stillness Press, 2000. Becker, Rollin.  Life in Motion. Portland: Stillness Press, 1997. Budras, Klaus-Dieter.  Anatomy of the Dog. Hannover: Schlutersche, 2007. Chaitow, Leon. Fascial Dysfunction: Manual Therapy Approaches. Edinburgh: Handspring Publishing, 2014. Felten, David, Jozefowicz, Ralph. Netter’s Atlas of Human Neuroscience. Teterboro Icon Learning Systems, 2003. Kern, Michael. Wisdom in the Body. The Craniosacral Approach to Essential Health, Berkeley: North Atlantic Books, 2005. Paoletti, Serge. The Fasciae: Anatomy, Dysfunction and Treatment. Seattle: Eastland Press, 2006. Schleip, Robert et al. Fascia: The Tensional Network of the Human Body. Churchill Livingstone Elsevier, 2012. Schwind, Peter. Fascial and Membrane Technique. Churchill Livingstone Elsevier, 2006. Stone, Caroline. Visceral and Obstetric Osteopathy. Churchill Livingstone Elsevier, 2007.




Advice on how to buy lower-cost equipment
When a veterinarian is opening a practice, there’s usually a sense of “sticker shock” when the total cost of outfitting the new clinic comes in. Often, buying new equipment is just too expensive. Wouldn’t it be wonderful if you could buy the entire contents of a closing clinic for the fraction of the cost? Alternatively, if you have extra equipment you no longer need, wouldn’t it be great to sell it? But it’s not always that easy, for various reasons. Some of the barriers that arise when sales are conducted between veterinary clinics include:
  1. The seller doesn’t know how much equipment should be listed for, and the buyer doesn’t know how much to pay.
  2. Neither party knows how to repair equipment that’s not working, so it makes for a very confusing transaction.
  3. Unclear contracts and transaction dealings (i.e. should I collect the money before or after they get the product?)
  4. Lack of knowledge regarding shipping and packaging, especially where larger items, such as cages, are concerned.
  5. Veterinarians are typically very busy – especially if they don’t have a business manager. They often have little time to sell surplus assets or acquire used product from each other.
Not surprisingly, veterinarians typically have reservations about buying technical equipment from other veterinarians because of the risk involved. At the end of the day, it’s usually easier just to buy from dealers because of the assurance of assistance in such cases – but again, this gets pricey. A used equipment broker or exchange network can help you overcome all the aforementioned obstacles. These options can help find a buyer if you’re selling, and a seller if you’re looking to buy. They also provide valuable services such as repairs, warranties, shipping and escrow type services, making buying and selling used equipment a low risk, stress-free experience.




Preventing injuries in canine athletes

Many dogs engage in regular physical activity and can be considered athletes even when not competing or on active duty. Here’s how to help prevent injuries.

The focus of modern healthcare is to prevent injuries and disease. Dogs, like humans, are enjoying longer active lives and many people are looking for progressive medicine that integrates a variety of care approaches for their pets throughout each stage of life.   Many dogs engage in regular physical activity and can be considered athletes even if they are not competitive champions or on active duty in the military or police force. An athlete is defined as an individual who is trained or skilled in exercises, sports or games requiring physical strength, agility or stamina.1 As with humans, there are different types and ages of canine athletes participating in work, sports, competition and play. Canine athletes can be found in the military, police departments, on search and rescue teams, or working as service dogs. Many pet dogs can also be considered athletes when they engage in regular physical activity with their owners. According to the AKC, in agility alone, 1,223,660 entries for competitions were recorded in 2016.1

Key components

There are many opportunities for veterinary teams to integrate injury prevention into general or holistic practices. Key components of injury prevention include client/handler education, age appropriate conditioning, nutrition, and early recognition of warning signs.  Expanded general health assessments and a knowledge of the sport or pet’s activity and associated risks will further assist the veterinary team in prevention and early recognition of injury. Veterinary technicians and assistants can be instrumental in empowering handlers and dog owners to take a proactive role in maintaining a healthy lifestyle with their canines. Many different preventive programs can be implemented to educate pet owners and handlers, beginning with puppies, or at any age. Although most agility and canine sports have minimum age requirements of 12 to 14 months, owners may start at any age. They may be exercising or conditioning dogs with little or no professional guidance.

Age appropriate conditioning: puppies and adolescents

Recently, I was asked to review age appropriate exercise with an owner after a puppy exam due to “joint stiffness and pain”. The owner was jogging with the 12-week-old puppy to help “work off puppy energy”.  This notion can lead people to push puppies into inappropriate levels of exercise in an effort to solve behavior problems. But puppies are prone to injuries that may affect them for the rest of their lives. Growth plates dictate safe activity levels for a growing puppy. These soft areas at the ends of long bones are vulnerable to injury until closed, which may occur from 12 to 18 months of age, depending on breed and individual. If a dog has been spayed or neutered prior to that time, a more conservative approach of waiting until 20 months may be indicated for heavier impact activities.2 Puppies also have softer bones and are at a higher risk for fractures caused by falling off furniture, accidental dropping, having their limbs or feet stepped on, or rough play with other dogs. Mind-body awareness is a good focal point for both puppies and adolescent dogs. Slowing down movements, promoting hind end awareness, and promoting a sense of balance help build confidence and prevent injury. Exercise guidelines for puppy owners should be reviewed by the veterinary team. Educational tools can range from a simple handout, guidelines listed on the clinic website, or integrated into a puppy preschool or socialization program. Some clinics or rehabilitation practices also offer individual sessions to review and practice appropriate puppy exercises, in addition to providing training resources. This is a good opportunity to create educational programs to review safe exercises and provide socialization.

Basic exercise guidelines for puppies

  • Allow self-directed play on varied moderately soft ground such as yards or gardens.
  • Avoid repetitive exercise such as long hikes or long walks, especially on hard surfaces.
  • Avoid going up and down stairs until the puppy is three months of age or older.
  • Don’t allow jumping or jump downs higher than “wrist” height until the pup is six months of age; and no higher than elbow height until 18 to 20 months old.4
  • Avoid pulling during tug games.
  • Allow short training periods for learning commands.
In preparation for work or sport, certain baseline health screenings are recommended, usually between nine and 12 months of age, or prior to beginning a sport in older adults.
  • Physical exam, including lab work (CBC, Serum chemistry).
  • Radiographs for hips, elbows, check patellas.
  • Consider referrals to check eyesight and/or heart as needed.
  • Gait and postural assessments: stance, sitting, walk, and trot.
  • Fitness level and conformation assessment (evaluate risks for injury).
  • Consider referral to sports medicine or rehabilitation professional.
Once baseline health has been established, determine what type of conditioning is required.  Conditioning programs take into account the types of activity to be performed and their frequency, and the overall health of the canine. “Weekend warrior” activity should be discouraged and replaced by consistent, appropriate exercise and play.

Senior athletes

As we already know, old age is not a disease and aging athletes will continue to benefit from exercise. Many working dogs reach age ten or older before retiring. However, seniors may develop other health conditions, including arthritis, heart disease or diabetes, which may require adjustments in their exercise program or activity. Sporting events often offer different levels of competition to allow seniors to participate at lower levels of stress or impact. Osteoarthritis management programs designed to treat the condition in the early stages will help pets remain active longer. Pain scoring as a vital sign is also an essential aspect of monitoring any veterinary patient, especially the aging canine athlete.

Disability in working dogs

The veterinary team can help keep older working dogs moving, even with a disability. Many working dogs retire following a back injury and surgery. A common recommendation is to never allow the canine to jump down again. Although ideal, not many dogs I know will heed this recommendation. The rehabilitation professional can help develop exercises to keep such dogs active and to minimize risks of future injury. A variety of holistic health approaches can be taken in the clinic or by the client at home. TCVM, homeopathy, chiropractic, osteopathic, massage, Reiki and more can keep these older dogs as active as they wish. There are also increasing numbers of assistive devices available, such as carts or braces, to help keep canines active. Disabled pets require a higher level of nursing care from owners, who look to the veterinary team for guidance and education.

Components of a conditioning program

  • Warm up: athletes have improved performance with warm ups.A warm up may include walks of five to ten minutes, and activities to encourage active range of motion or movements to be performed during the sport or activity.
  • Exercises: strength (core strength, front limb, hind limb), endurance, flexibility, skill training, balance and proprioception. Careful attention to form is essential!
  • Cool down: a slow trot or walk for five to ten minutes, active stretching exercises.
  • Periods of rest: one month off from competition, and jumping at full height only a percentage of the time during training, to help avoid repetitive injury.
  • Environment: surfaces should ideally be non-slip and compressive during training.
  • Therapies: massage, acupuncture, chiropractic
  • Caution: to avoid overheating and dehydration.

Nutrition and supplements

Obesity is considered an epidemic and is so common that owners may not recognize their dogs are overweight. Avoiding excess calories and calcium intake is also important for growing dogs. Along with nutritional counseling, maintaining objective measurements such as body condition scores and weight:height ratios will help owners and handlers better understand how weight might contribute to injury. The weight:height ratio can be obtained by dividing the dog’s weight by his height (measured at the withers or top of shoulder blades to the floor). “Dogs with ratios higher than 2.5 experience greater amounts of stress on the musculoskeletal system during running, jumping, and turning.”4 Nutritional counseling programs provide further details to help dog owners calculate energy requirements and percentage of fat and protein recommendations for high energy sports. Supplements such as Omega-3 fatty acids and chondroprotectants may also be helpful for long term joint health.6 Dogs should also avoid large meals prior to activity.  A light meal with access to water is recommended.6

Knowledge of the sport or work, its risks and associated common injuries

A wide variety of activities are available beyond the dog park. A basic knowledge of what is expected of the dog during such events will help the veterinary team prevent and recognize injury. The once popular method of treating injury with rest and Rimadyl often leads to a recurrence of the injury once the dog returns to activity. An understanding of common sporting injuries will lead to earlier diagnosis and improved outcomes. Sporting injuries often initially present as performance issues, such as decreased run times, “knocking poles” in agility, or a new reluctance to perform a specific duty. Working dogs are often stoic and may work through pain, only showing obvious signs once the condition has progressed. A survey of agility handlers revealed that the most common injuries incurred during the sport were soft tissue injuries such as sprains and strains. The same survey cited shoulders as the most common location of injury.7 Unfortunately, many cases of strains or sprains are not presented to a veterinarian for early diagnosis, and therefore become chronic conditions.

Common sporting injuries

  • Biceps brachii tenosynovitis
  • Supraspinatous insertionopathy
  • Medial shoulder instability
  • Teres minor strain
  • Lumbosacral disease
  • Iliopsoas strain
  • Stress injuries to carpus or tarsus
  • Superficial digital flexor tendon injury
  • Achilles tendon injury
  • Gracilis myopathy
  • Foot pad injuries
  • Partial or complete cruciate ligament rupture

Canine sporting events: (non inclusive)

  • Agility
  • Flyball, disc dog, Triebball
  • Dock diving
  • Schutzhund
  • Field trials, retrieving trials, tracking
  • Nosework, barn hunt, earth dog
  • Bikejoring, mushing, carting, scootering, skijoring
  • Conformation showing, junior showmanship
  • Dog parkour (urban agility)
  • Dog hiking, pack hiking, trail running
  • Hare coursing, lure coursing, herding
  • Musical canine freestyle, trick dog
  • Obedience, rally obedience

Conclusion

There are many opportunities for the veterinary team to further their education in providing quality care for canine athlete of all ages. Many therapies, including massage, also offer diagnostic benefits such as picking up on vague lameness, structural imbalances, or myofascial trigger points. Start asking your clients about activities their dogs participate in, and attend local events.  Obtain pain scores as part of the medical history to help monitor trends. Develop educational programs to assess fitness and develop exercise programs, manage nutrition and weight, monitor for pain and osteoarthritis, or offer rehabilitation therapies. Learn about and practice fear-free handling, because sporting dog handlers expect it and all pets deserve it. Your patients will love you for it.

Suggested Resources

  • IVAPM: become a CVPP, learn more about pain scoring
  • North East Seminars/University of Tennessee: Canine Rehabilitation, Massage, Fitness, Nutrition, Osteoarthritis management Courses
  • fourleg.com : Learn more about puppy programs, senior programs and anything related to rehabilitation
  • PennVet Working dog Center
  • CRI: Canine Rehabilitation Institute

References

1) http://images.akc.org/pdf/events/agility/MACH_EndYear2016.pdf?_ga=2.248095552.676954721.1508876515-1754799958.1507561129 2) Stubbs, Salmeri and Bloomberg. 1995. Early neutering of the dog and cat by In: Bonagura (ed), Kirk's Current Veterinary Therapy, XII, Philadelphia WB Saunders & Co., pp.1037-1040. 3) http://www.latrobe.edu.au/news/articles/2012/article/warm-up-to-increase-athletic-performance 4) C. Zink, J. Van Dyke, Canine Sports Medicine and Rehabilitation, Wiley-Blackwell, 2013, pp. 9-10. 5) https://www.researchgate.net/profile/Wendy_Baltzer/publication/271206936_Sporting_dog_injuries/links/54c1956c0cf25b4b80728148/Sporting-dog-injuries.pdf 6)  https://www.cleanrun.com/index.cfm/feature/65/a-survey-of-injuries-occuring-in-dogs-participating-in-agility.htm




Ozone Therapy:  a way to build and maintain health
Aging and degenerative diseases are caused by a decrease of oxygen utilization that can affect many of our organs and their functions. If we keep oxygen levels high using ozone therapy, cells and organs can function at peak levels, causing the body to operate more efficiently. Young animals may even age more slowly. Frank Shallenberger, MD, says: “Every single aspect of healthy living exerts its effects by improving oxygen utilization. … The reason taking that vitamin or doing that exercise, or whatever it is we’re talking about, makes you better and healthier is because it’s improving your oxygen utilization. They’re all doing the same thing. So when you measure oxygen utilization, you’re measuring the sum totality of everything you can possibly do that is working in your body.”1 Oxygen is utilized in many parts of the body, including mitochondria and red blood cells.

Oxygen for mitochondrial health

In our current environment, air quality is poor, oxygen has been reduced, and our patients are increasingly exposed to more pollution and chemicals. Not surprisingly, immune systems are at risk. As we additionally undermine the internal microbiome within gastrointestinal tracts with antibiotics and other medications, the body’s defenses are further damaged. The work of Nobel Prize winner Dr. Otto Warburg showed that decreased oxygen utilization caused by decreased mitochondrial function is the underlying factor in the development and progression of all disease processes.  This is partly due to the fact that detoxification is so mitochondrial-dependent. In order for an animal’s body to function at peak efficiency, its mitochondria, which make up 10% of the body weight, need to be operating at their highest potential. They are the batteries of the body’s cells (some individual cells may contain thousands of mitochondria) and they require oxygen to convert sugars, fats and other chemical fuels into ATP. Ozone Therapy can increase mitochondrial function, thereby helping the animal’s body to operate optimally and heal more effectively (micro.magnet.fsu.edu/cells/mitochondria/mitochondria.html).

Oxygen for the circulatory system

Healthy blood flows to the tissues via the circulatory system. For good health in any individual, it is essential that this system operates optimally. With adequate oxygenation, red blood cells clump less and have more flexibility to pass through the vessels, which allows more oxygen to flow into the tissues via the microcapillaries.

How Ozone Therapy works

Ozone (O3) is an activated, trivalent (three atoms) form of oxygen (O2). It easily breaks down into an oxygen molecule (O2) and a singlet oxygen atom. This singlet oxygen atom has unpaired electrons, making it unstable, so it is sometimes referred to as an “oxygen free radical”. Though free radicals are considered damaging to health, this oxygen atom behaves as an ion (O2-), at normal physiological blood pH, and creates lipid peroxides. It is these peroxides that mediate the many positive effects of ozone therapy in biological systems.

The benefits of ozone

Ozone offers many benefits to the body, including:
  • Killing bacteria, viruses and fungi. Healthy cells are well protected by antioxidant enzyme systems (glutathione peroxidase, catalase, glutathione reductase and superoxide dismutase). Cancer cells, compromised cells and microbes of all kinds do not have this protection, and are thus destroyed by the oxidative stress provided by ozone therapy.
  • Optimizing cellular function. Ozone peroxides improve oxygen delivery, endothelial function, nitric oxide formation and oxygen utilization.
  • Activating the immune system by stimulating production of cytokines, including interferons, interleukins, tumor necrosis factor, etc.
  • Decreasing damage from harmful free radicals, and stimulating the body’s protective NRF2-activated enzyme systems helps protect healthy cells from injury.
  • Increasing energy production. Ozone accelerates the Kreb’s Cycle in the mitochondria, increasing the amount of ATP produced. Providing more efficient overall metabolism thus increases energy production. This decreases the number of toxic byproducts used to produce energy in the body.

Uses of Ozone Therapy

Ozone Therapy can help treat:
  • wounds, hot spots, abscesses, allergic dermatitis, etc.
  • infections: chronic ear, stomatitis, gingivitis, viral and bacterial diarrhea
  • chronic and acute Lyme and other tick borne co-infections
  • acute and chronic liver, kidney, pancreatic and Cushing’s disease
  • heart disease and circulation problems.
It can also be used:
  • as an adjunctive cancer therapy, and for seizures and autoimmune reactions
  • to decrease the amount of drugs needed. Concurrent use of ozone dramatically increases the effects of most hormones, drugs, vitamins, and herbs, by facilitating more complete oxidation reactions.

Ozone delivery systems

Ozone Therapy requires the following equipment:
  1. Ozone generator -- look at the American Academy of Ozonotherapy website (aaot.us), for the criteria for an acceptable clinical generator. Select a company that offers good training and support. The price can range from ,000 to ,000, depending on the different attachments and additional functions selected. Under ,000 should be sufficient for most practices.
  2. Pure surgical oxygen, at least 99% pure
  3. Ozone saline maker
  4. Syringes, catheters, and IV tubes, which you already stock in your clinic
[caption id="attachment_3726" align="aligncenter" width="300"] Injecting a mandibular abscess with ozone gas in Baxter, a 15-year-old dog. This healed with no antibiotics or other drugs.[/caption]

Methods of administration

Ozone is not stable, so several methods are used to ensure the efficacy of increasing oxygen into the mitochondria:
  1. Auto-hemo therapy (frequently used). A percentage volume of blood by weight is removed and mixed with ozone or ozonated saline, then reintroduced to the body.
  2. Ozonated saline. Ozone is bubbled through the saline in the “Saline Maker” to saturate the saline with O2 and O3. It’s best used immediately (chilled on ice in glass, it only lasts 30 hours). Given as Sub Q or IV fluids, the ozone quickly works in all parts of the body. Ears, skin, wounds, hot spots and any infected area can be flushed with ozonated saline in the clinic.
  3. Rectal insufflation. Unhealthy biofilms interfere with a balanced microbiome diversity, thereby weakening the immune system. When ozone is rectally insufflated, it kills bacteria (more likely anaerobic than aerobic), fungi and yeast -- even the potentially good ones. When this procedure is done higher in the colon, it enhances Microbiome Replacement Therapy (MBRT). When it is done in the distal rectum, it is absorbed into the caudal rectal vein and goes via the portal system into the liver where it works on the millions of mitochondria in the hepatic cells. Ozone optimizes the function of the stem cells of the colon. Because stem cells have more mitochondria than mature cells, they have a more critical need for oxygen.
  4. Ozonated olive oil. Available in oil, cream, suppositories and toothpaste, products can be made in the clinic or purchased. In the fridge, products stay therapeutic for years and can be used topically for ears, wounds, hot spots, etc., to speed healing. Ozonated olive oil suppositories can be given rectally for colon problems, like tumors, or put in the vulva for vaginitis. Ozonated toothpaste can be used for gingivitis, stomatitis or preventative dental care. Some of these products can be sold to clients for home use.
Important note: Ozone gas itself is very irritating to the lungs, so it should never be breathed directly. [caption id="attachment_3725" align="aligncenter" width="225"] Administering prolozone — ozone with prolotherapy — for cruciate repair. It helps bring more oxygen to the location, increases stem cell production, and prevents infection. Consider as an option for cruciate and other musculoskeletal issues.[/caption]

Ozone Therapy use is expanding

Ozone Therapy for veterinary use has seen dramatic growth in the last several years. There are now three US organizations promoting veterinary medical ozone, and over 800 veterinarians in Brazil and 300 in Japan using ozone. (Brazil and Japan have also formed organizations.) Dr. Zullyt Zamaro, veterinarian and PhD, has written the first veterinary textbook on ozone therapy, including double placebo blind studies and clinical applications. The state of Massachusetts has added Ozone Therapy to the practice act.

Building health strategies

A key to health and longevity is good nutrition. By regularly stimulating the mitochondria to provide more efficient oxygen utilization, cells can better metabolize nutrients. While there are many ways to do this -- improved nutrition, nutraceuticals, vitamins and exercise – Ozone Therapy can further improve the process, especially if the animal is not thriving. The bottom line is that no matter what treatment you are giving your patient, the results will be better when adding in Ozone Therapy.

Conclusion

As oxygen uitilization loses efficiency, the rate of free radical damage escalates and ultimately leads to mitochondrial decay. The benefits of increased mitochondrial biogenesis and ATP through Ozone Therapy include increases in metabolic function, energy level, exercise performance, cognitive function and lifespan. Helping young animals heal rapidly from any infections, injuries and surgical procedures can speed their return to normal growth functions. No matter what course of treatment is being used, the addition of Ozone Therapy will provide for better results. This article has been peer reviewed. 1Shallenberger, Frank, MD, HMD, ABAAM. The Principles and Applications of Ozone Therapy, John Cole, 2011.  

For further learning

  • Read The Principles and Applications of Ozone Therapy by Dr. Frank Shallenberger, MD, available on Amazon.
  • Published literature -- nearly 3,000 different indexed articles -- many of them authored by veterinarians, can be accessed through the “Library” portal on the American Academy of Ozonotherapy website at aaot.us.
  • Ozone certification courses and videos of conferences are available through: -American Academy of Ozonetherapy (aaot.us) -Society of Progressive Medical Education (sopmed.org) -Ozone Therapies Group (ozonetherapiesgroup.com)
  • Just published -- Ozone Therapy in Veterinary Medicine by Zullyt Gamora, veterinarian and PhD. It will be available at Ozone Therapies Group.
  • Madrid Declaration 2015 – purchase online. Report from 20 countries on Ozone Therapy. International Scientific Committee of Ozone Therapy (isco3.org)





Strategies for building and maintaining equine health
The practice of veterinary medicine has changed dramatically in the 35 years since I graduated from veterinary school. Today, clients seek information from all kinds of sources -- the internet, their extension agents, or even worse, chain farm supply store sales agents and promotional signage. In this climate, we veterinarians need to use our unique knowledge to stand back and get the big picture on equine health. And we need to be proactive in promoting and “selling” this service. Below are a few areas equine veterinarians can consider.

1. Vaccines and antibiotics

Vaccinations and antibiotics are available at every farm store, even though recent regulations require a prescription for stores to dispense antibiotics, which implies a valid CPV relationship. As equine veterinarians, we need to learn how to advise our clients on the proper time to vaccinate for each disease, and which vaccines are necessary, based on the susceptibility of each horse. Not every horse needs every vaccine. Holistic veterinarians are aware of the problems associated with over-vaccination. Even though there are multiple holistic treatments for these ailments (vaccinosis), the horse is often left more susceptible. Careful vaccine recommendations can improve longevity and health.

2. Emerging diseases

Get current on emerging infectious diseases, and re-learn obscure diseases. The relocation of animals after the recent spate of natural disasters will result in previously unseen diseases in your area due to transfer by animals or fomites, or by insect vectors. Climate change has also resulted in shifts in insect populations and the timing of their lifecycles. We may see Tabenid flies and noseeums earlier; or cayenne ticks, which transmit spiroplasmosis, farther north.

3. De-worming

In the past, equine practitioners in Lexington, Kentucky would deworm 250 head of horses before lunch. Today, tube deworming has been largely replaced with paste deworming done by the owner, often too frequently and with limited efficacy. We need to help our clients develop strategic deworming protocols because many of the anthelmintics are no longer effective (see sidebar on page xx). Even the need for anthelmintics can be questioned. A herd of horses on the research farm at the University of Kentucky in Lexington, for instance, has not been dewormed in 35 years. They provide untreated helminthes for research. The horses maintain good weight and show no external signs of parasitism.

4. Colic

Colic is a big issue today, mainly because of parasitism and incorrect feeds. Every horse and owner combination should learn and be comfortable with proper handling so that in a colic crisis, a veterinarian can easily and safely pass a nasogastric tube. Show the owner how to auscult normal gut sounds. Owners can also be trained in acute TCVM and homeopathic treatments, which may quickly resolve most colics.

5. Farm visits

Equine veterinarians should schedule twice-yearly farm visits to review management, and perform wellness exams. These farm visits, which are billed for based on time, give the practitioner the opportunity to review the housing situation, including companionship for each horse, and the horse’s level of boredom or over-stimulation. Natural light exposure and potential EMF or microcurrent exposures should be evaluated. It is important to do a pasture walk with the owners to assess safety factors such as inadequate fencing or proximity of toxic plants. These pasture walks should be repeated at different seasons because there are different toxic plants present at different times of the year. Most horses will avoid toxic plants if there is good forage present, so the forage should also be evaluated. It is important that the pasture not be a monoculture; it should include trees and shrubs for browse as well as forbs, which have deeper root systems and may bring nutrients to the surface. While at the farm, veterinarians should also inspect the feed room. Open the feed bins and see if there is contamination with rodent feces, especially opossums (whose feces may have protozoa for EPM). Look for ventilation to help assess the potential for mold in the feed. Find out how often the owner buys feed and how long it is stored on site. This gives the veterinarian a chance to discuss the ration formulation as well as make recommendations on feeding whole grains. Highly processed grains are digested too quickly and can change the population of gut bacteria. Horses need to be able to munch on forage all day long to decrease acid production in the stomach and to relieve boredom. Horses with a tendency to gain weight can wear a muzzle, while those not on pasture can use slow feeders. Remember to also inspect and discuss the mineral source at the farm. White salt blocks have a very little nutritional value for horses. Combination salt/mineral blocks force a horse to eat too much salt or too many minerals. Loose minerals are much easier for horses to lick, and different free choice minerals can allow them to self-medicate. Know the mineral deficiencies and excesses specific to your region’s soil so you know what to recommend. Establish a relationship with a PhD nutritionist in your area who can help you analyze the hay fed on a farm and match that to the correct grain and mineral combination. We must also be aware that animal feed may no longer contain all the nutrients listed in every table since so much farmland soil has been depleted.

6. Physical exams

A physical exam of each horse is important during every visit. This can be as complicated as a full physical exam or as brief as looking at the horse move in a pasture. The condition of the feet and teeth should be noted. Watch how the horses interact in the field and observe how the owners handle them, especially as they saddle and mount the animals. This is also a good time to discuss deworming and vaccination protocols.

Decreasing a horse’s parasite load

When horses are kept in rotated pastures, with ample space and access to non-grass plants, they may have few to no worms. The addition of other species, like goats or chickens, which are not hosts, will decrease egg and larval loads. We do not need to deworm unless there is a heavy parasite load. A few adult worms in the lumen prevent maturation of larvae, so this host/parasite interaction improves, rather than lessens, health. The various pieces of the veterinary care pie are divided among many sources these days. It is important that, as veterinarians, we develop relationships with the nutritionist, farrier and “tooth fairy” so that we may work with them to develop a treatment plan for a horse or for a farm. Learn equine massage, chiropractic, osteopathy or other modalities so you can add to your bottom line, or partner with other practitioners for modalities you do not want to learn. Stay current on infectious diseases. Understand the effects of feed on the gut microbiome. Do regular proactive farm visits. Gain knowledge so you can be a more effective leader in the health care of your equine patients.




Integrative medicine in veterinary curriculum

Many private veterinary practices and some teaching hospitals now offer integrative veterinary medicine modalities as an adjunct to conventional therapies.

There’s an increasing interest in integrative therapies within human medicine, and animal owners are seeking similar therapies for their pets. Many private veterinary practices and some teaching hospitals are now offering integrative veterinary medicine (IVM) modalities as an adjunct to conventional therapies.

A revealing study

The results of a recently published1 retrospective analysis of 5,195 integrative patient treatment sessions suggest that acupuncture, laser therapy and hydrotherapy were utilized in more than 50% of the patients. Medical records from a mixed animal IVM service at an academic teaching hospital over a 400-day period were collected. The multiple modality treatment sessions were most commonly utilized for patients (n=274) with neurological (50.7%) and orthopedic (49.6%) conditions in dogs (95.6%), cats (3.0%) and horses (0.8%). Acupuncture treatments included dry needle acupuncture, which was used in most patients (81.5%), followed by electro-acupuncture (60.5%) and aqua-puncture (9.8%). Next most frequently used were laser (66.3%), hydrotherapy (51.8%), therapeutic exercises (37%), and conventional drugs (37%). Other modalities included ultrasound, TENS/NMDS, nutrition, herbal and massage. The data support the fact that IVM can be successfully incorporated into conventional veterinary practices.

Integrative veterinary medical modalities in veterinary curriculum

To understand the need for IVM to be taught at veterinary colleges, 32 veterinary specialists have agreed on an IVM curriculum. Guidelines recognizing the important modalities to be taught to veterinary students as an introduction to IVM were recently published in Open Veterinary Journal.2 Veterinary students should receive adequate exposure to the principles, theories and current knowledge supporting or refuting these therapies. A proposed IVM course guideline would broadly introduce students to these veterinary treatments while increasing their ability to respond to questions from clients from a position of knowledge about IVM in clinical practice. Such a course should be evidence-based, unbiased, and unaffiliated with any particular IVM advocacy or training group.  Training future veterinary professionals in IVM may produce an openness to new ideas about scientific methods and a willingness to pursue and incorporate evidence-based therapies in clinical practice, including those presently regarded as integrative, or complementary. A survey of AVMA-accredited colleges indicated that students should be aware of IVM modalities because of strong public interest.3 Nearly 25% of recent Washington State University graduates reported facing questions about IVM on a weekly or daily basis, and polled veterinary students had a positive outlook towards IVM education. These findings prompted the formation of a national curriculum committee, supported by the American Academy of Veterinary Acupuncture (AAVA), tasked with developing a model curriculum for veterinary students. Committee members met during the AAVA annual conference in May of 2013, and agreed that IVM should be the focus and title of a model training course. The course outline was discussed, and consensus was established that the following IVM modalities commonly used in veterinary practices should be included in the curriculum: acupuncture, veterinary manipulative therapy, integrative nutrition, physical rehabilitation/sports medicine and herbal therapy (see Table 1).

Joint education efforts between IVM organizations

Non-profit organizations and one institution are assisting in accomplishing two goals -- IVM education offered as a part of veterinary curriculum, and having IVM modalities become a part of veterinary practice. Joint efforts between IVM-related organizations are needed to assist veterinary students in learning IVM, helping veterinary faculty to become certified in IVM modalities, and increasing public awareness of the IVM benefits. A. World Association of Traditional Chinese Veterinary Medicine (WATCVM, watcvm.org) -- This non-profit organization was founded in Spain on Sept 14, 2013 by 45 TCVM practitioners from 25 countries, with the mission to:
  • unite the global TCVM community through prom­­­otion and publication of research on all aspects of TCVM
  • develop guidelines for TCVM practice (standardize acupuncture points, channels, and herbal medicines -- dosage and usage, etc.)
  • raise funds to support research and scholarship for veterinary students/faculty
  • to help establish TCVM curriculums for veterinary colleges globally.
  1. The Stuart Rosenburg International Scholarship -- This scholarship is designed to support veterinary school faculty in developing countries with a per capita annual income less than US ,000. Veterinarians from Bangladesh and Ecuador have received the Rosenburg Scholarship in 2015 and 2016, respectively, to support their veterinary acupuncture education to become Certified Veterinary Acupuncturists.
  2. Veterinary student support -- In addition to other student membership benefits, WATCVM provides speakers to give presentations and demo acupuncture labs to veterinary students, meet veterinary college faculty/administrators to seek support for IVM, and assist in development and support of TCVM student clubs. Since its inception in 2013, WATCVM representatives have assisted various AVMA-accredited veterinary colleges including Iowa, Ohio, St. George’s, Oregon, Ross, Tuskegee, North Carolina, Colorado and Washington. TCVM is also promoted by WATCVM-BODs in their native counties or regions on the world, including China, Costa Rica, India, Indonesia and Japan.
  B. Chi CVM Scholarships -- These scholarships are offered by the Chi Institute of Traditional Chinese Veterinary Medicine. Founded in 1998, Chi Institute offers educational programs in TCVM modalities, including acupuncture, Chinese herbal and food therapy, and Tui-na. Promoting TCVM in veterinary colleges is the main purpose of the Chi CVM Scholarships. Chi grants, a total of ,000, are awarded to veterinary students, veterinary college faculty, residents and graduate students (com/Resources/CVMScholarships.aspx). C. IVAS Scholarships – The International Veterinary Acupuncture Society (IVAS, org) is one of the first international organizations (it was started in 1974) to offer veterinary acupuncture certification. Currently, IVAS offers a 50% tuition scholarship to fourth-year veterinary students for its acupuncture course. IVAS has been working on scholarship fundraising; it has also awarded one full tuition scholarship to a veterinary faculty member in the past (personal communications). The promotion of IVM education as a part of veterinary curriculum is a promising trend and one that should result in more conventional practices offering integrative therapies.

References

1Shmalberg J, Memon MA.A retrospective analysis of 5,195 patient treatment sessions in an integrative veterinary medicine service: Patient characteristics, presenting complaints, and therapeutic interventions”. Veterinary Medicine International, (open access journal), Volume 2015 (2015), Article ID 983621, 11 pages, hindawi.com/journals/vmi/2015/983621/. 2Memon MA, Shmalberg J, et al (18 additional authors). “Integrative Veterinary Medical Education and Consensus Guidelines for an Integrative Veterinary Medicine Curriculum within Veterinary Colleges”. Open Veterinary Journal 6:41-56, 2016, openveterinaryjournal.com/2016/Volume%206%20(1)/OVJ-169-12-15%20M.A.%20Memon%20et%20al.pdf. 3Memon MA, Sprunger LK. “Survey of colleges and schools of veterinary medicine regarding education in complementary and alternative veterinary medicine”. J Am Vet Med Assoc. 239: 619-623, 2011. Prof Emeritus, Dept of Vet Clinical Sci., Washington State University, Pullman, Washignton Integrative Reproduction Consultatnt, Loving Touch Animal Center, St Mountain, Georgia Executive Director, World Association of Traditional Chinese Vet Med, Gainesville, Florida What is this section referring to? Acknowledgments: The information in this article is adopted from manuscripts authored or co-authored by the author and are cited as references, and were presented at the annual AHVMA Conference in October. The author is grateful for the encouragement and assistance provided by Dr. Christina Chambreau, Associate Editor for IVC Journal.




Understanding pet digestion

Providing optimal nutrition to your four-legged patients includes understanding how digestion works in dogs and cats, from one end of the body to the other.

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. http://www.dogsnaturallymagazine.com/preventing-bloat
  • 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, TheTruthAboutPetFood.com, Website
  • http://www.petfoodindustry.com/Petfood-Industry-Knowledge-Center, 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

Tips and suggestions for understanding the journey from conventional to holistic veterinary medicine within the practice setting.

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

How to help your breeders understand the strengths and weaknesses of their particular breeds, and aid in ensuring healthy litters of puppies.

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 (breedingbetterdogs.com/article/early-neurological-stimulation).

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

Understand seasonal medicine according to TCVM, the personalities that go with the seasons, and the which foods to add to patient diets during these times.

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 

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: https://youtu.be/bb7aQTibVTQ 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: https://youtu.be/qs4_z7BBwIg.

Spring

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

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

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.