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Strategies for managing pancreatitis in small animals

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

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

Pathophysiology of pancreatitis

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

Role of nitric oxide and endothelial dysfunction

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

Diabetes, insulin resistance, and endothelial dysfunction

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

Preventing pancreatitis with diet

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

Chinese herbs for pancreatic ailments

Targeting insulin resistance – Damp Heat formulas

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

Targeting endothelial dysfunction

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

Targeting bacterial causes

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

Using herbs — administration via enema

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

Oral dosing

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

Case example: Falco Teefy

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

Case discussion

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

Conclusion

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




Digestive enzymes in dogs and cats

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

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

Two enzyme categories

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

Normal physiology of digestive enzymes

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

What is an enzyme?

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

Supplemental enzymes

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

Choosing supplements

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

Diseases resulting from enzymatic dysfunction

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

Practical oral supplementation 

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

Specific uses in clinical practice

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

Summary

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




Integrative approaches to megaesophagus – case studies

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

Using acupuncture for congenital megaesophagus

Case #1

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

Case # 2

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

Using homeopathy for megaesophagus

Case #1

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

Case #2

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

Using laser for megaesophagus

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

References

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




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

The 3 pillars of osteopathy

1. Visceral manipulation (visceral osteopathy)

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

2. Joint manipulation

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

3. Craniosacral therapy (CST)

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

Osteopathy in practice – observations related to spay/neuter

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

How spay/neuter adhesions restrict mobility in dogs and cats

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

1. Sacro-iliac fixations

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

2. ACL (CCL) injuries / tears

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

3. Front end lameness

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

Conclusion

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

References

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




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




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.




Homeopathic medicines can alter genetic expression

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

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

Significant studies

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

Homeopathically-prepared DNA

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

References

1Constantin C, Muller C, et al. “Identification of Cav2-PCKβ and Cav2-NOS1complexes as entities for ultrafast electrochemical coupling”. Proceedings of the National Academy of Sciences, 2017. 2Dei A, Bernadini S. “Hormetic effects of extremely diluted solutions on gene expression”. Homeopathy, (2015) 104 3Thangapazaham RL, Gaddipati JP, et al. “Homeopathic medicines do not alter growth and gene expression in prostate and breast cancer cells in vitro”. Integrated  Cancer Therapy (2006), 5. 4Calabrese E. “Hormesis within a mechanistic concept”. Homeopathy (2015) 104 5Bigagli E, Luceri C, et al. “Exploring the effects of homeopathic Apis Mellifica preparations on human gene expression profiles”. Homeopathy (2014) 103. 6Olioso D, Marzotti M, et al. “ Effects of Gelsemium sempervirens L. on pathway-focused gene expression profiling in neuronal cells”. Journal of Ethnopharmacology (2014) 153. 7Ellanghiyil S, Preethi K, et al. “Induction of apoptosis in tumour cells by some potentiated homeopathic drugs: implications of mechanism of action”. Integrated Cancer Therapy (2012) 11. 8Saha S, Khuda-Bukhsh A, et al. “Ultra-highly diluted plant extracts of Hydrastis canadensis and Marsdenia condurango induce epigenetic modifications and alter gene expression profiles in HeLa cells in vitro”. Journal of Integrative Medicine (2015) 13. 9Abha. “Advances in homeopathy: targeting of health promoting genes using sequence specific homeopathic DNA remedies”. Homeopathy 360, bjain.com/homeopathy360-wp/2017/02/18. 10Rosenblatt, Kuro O.“Klotho, an aging suppressor gene”. Horm. res. (2007) 67.




Pet insurance for holistic and integrative practices

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

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

The advantages of pet insurance

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

What to evaluate when looking for pet insurance

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

Comparison between popular pet insurance companies

Graph courtesy of Pet Insurance U (petinsuranceu.com)

A case in point

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

Concluding thoughts

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

References

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




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

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

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

1. Pre-education

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

2. Initial consultation

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

3. Treating and teaching

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

4. Graduation and membership

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

Cost/investment

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

Challenges and wins

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




Recovering canine health: saving indigenous dogs

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

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

Comparing selectively bred dogs with native or pariah dogs

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

A profile of the natural dog

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

Saving indigenous dogs

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

Cloning and gene editing

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

The dark side of the human-animal bond

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

In the West

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




Individualized nutrition based on biomarker testing

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

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

Individualized nutrition

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

Functional superfoods

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

Nutrition, inflammation and oxidative stress

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

Figure 1

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

Figure 2

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

Biomarkers of oxidative stress

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

This article has been peer reviewed.






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




Prolotherapy in practice

Prolotherapy is used to increase tendon and ligament strength and relieve arthritis changes. In veterinary medicine, it can treat lameness and other conditions.

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

Technique is paramount

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

Examples of use in practice

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

Caution

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

Ingredients to make a 15% solution

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

Where to get supplies

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

Case Report – treating seizures with prolotherapy

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




Integrative treatment for inherited diseases in dogs

Because inherited diseases are chronic conditions, integrative medicine has many contributions to make that can help support the canine patient’s health.

An “inherited disease” is officially defined as a condition that has been proven to be inherited, or to be statistically higher in one or more specific breeds than in others.1 Inherited diseases range from mild to life-threatening. Integrative medicine has quite a bit to offer in the treatment and management of these conditions.

Inherited diseases explained

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

Breed considerations

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

The role of integrative medicine

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

Online lists of inherited diseases in dogs

Dodds, WJ. 2011. Guide to Congenital and Heritable Disorders in Dogs (Includes Genetic Predisposition to Diseases). Humane Society Veterinary Medical Association, 2011. Available as a download at hsvma.org/assets/pdfs/guide-to-congenital-and-heritable-disorders.pdf vet.cam.ac.uk/idid/howto, IDID list of inherited diseases, including photos. instituteofcaninebiology.org/genetic-disorders-by-breed.html discoveryspace.upei.ca/cidd/, Canine Inherited Disorders Database ncbi.nlm.nih.gov/omim, Human genetic disorders database of over 2,000 diseases. informatics.jax.org/mgihome/homepages/stats/all_stats.shtml#allstats_snp, Mice strains including 1,372 human diseases with one or more mouse models.

Labs that test for genetic diseases in dogs, including PRA

ofa.org/dnatesting/rcd4.html optigen.com/opt9_test_prcd_pra.html animalnetwork.com.au/dnatesting/benefits.php

References

1“Selection of Diseases”, vet.cam.ac.uk/idid/selection. 2Dodds, WJ. Guide to Congenital and Heritable Disorders in Dogs (Includes Genetic Predisposition to Diseases). Humane Society Veterinary Medical Association, 2011. 3ncbi.nlm.nih.gov/omim 4“How are Defects Inherited”, discoveryspace.upei.ca/cidd/how-are-defects-inherited. 5Riehl J1, Okura M, Mignot E, Nishino S. “Inheritance of von Willebrand's disease in a colony of Doberman Pinschers”. Am J Vet Res. 2000 Feb;61(2):115-20. 6“Progressive Retinal Atropy – PRCD, animalnetwork.com.au/tests/index.php?testid=20. 7Dostal J, Hrdlicova A, Horak P. “Progressive rod-cone degeneration (PRCD) in selected dog breeds and variability in its phenotypic expression”. Veterinarni Medicina. 2011 Jun; 56(5):243-47. 8Clements PJ, Gregory CY, Peterson-Jones SM, Sargan DR, Bhattacharya SS. “Confirmation of the rod cGMP phosphodiesterase beta subunit (PDE beta) nonsense mutation in affected rcd-1 Irish setters in the UK and development of a diagnostic test”. Curr Eye Res. 1993 Sep;12(9):861-6. 9Kohyama M, Tada N, Mitsui H, Tomioka H, Tsutsui T, Yabuki A, Rahman MM, Kushida K, Mizukami K, Yamato O. “Real-time PCR genotyping assay for canine progressive rod-cone degeneration and mutant allele frequency in Toy Poodles, Chihuahuas and Miniature Dachshunds in Japan”. J Vet Med Sci. 2015 Nov 6. [PubMed: 26549343] 10Moody JA, Famula TR, Sampson RC, Murphy KE. “Identification of microsatellite markers linked progressive retinal atrophy in American Eskimo Dogs”. Am J Vet Res. 2005 Nov;66(11):1900-2. [PubMed: 16334947] 11Zangerl B, Goldstein O, Philp AR, Lindauer SJ, Pearce-Kelling SE, Mullins RF, Graphodatsky AS, Ripoll D, Felix JS, Stone EM, Acland GM, Aguirre GD. “Identical mutation in a novel retinal gene causes progressive rod-cone degeneration in dogs and retinitis pigmentosa in humans”. Genomics. 2006 Nov; 88(5):551-63. [PubMed: 16938425] 12Bellumori TP, Famula TR, Bannasch DL, Belanger JM, Oberbauer, AM. “Prevalence of inherited disorders among mixed-breed and purebred dogs: 27,254 cases (1995-2010)”.  J Am Vet Med Assoc 2013 242: 1549-1555. 13Bonnett BN, A Egenvall, A Hedhammar & P Olson  Mortality in over 350,000 insured Swedish dogs from 1995-2000: breed-, gender-, age-, and cause-specific rates.  Acta Vet Scand 2005 46 : 105-120. 14IDID: inherited diseases in dogs: web-based information for canine inherited disease genetics. Mamm Genome. 2004 Jun;15(6):503-6. This article has been peer reviewed.




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Shockwave therapy

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

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

Shockwave use in equine practice

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

Treatment protocol in equines

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

Equine case report   

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

Shockwave use in small animal practice

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

Treatment protocol in small animals

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

Small animal case report

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

Selecting your shockwave machine

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

Mechanism of action

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

Summary

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




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

Skin problems in pets

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

Traditional Chinese Veterinary Medicine (TCVM)

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

Acupuncture

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

Herbals

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

1. Wind-Heat

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

2. Damp-Heat

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

3. Blood Heat

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

4. Liver and Kidney Yin deficiency

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

5. Liver Blood deficiency

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

Other integrative therapies

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




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

Common symptoms of EPM

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

How EPM develops

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

Is environmental prevention possible?

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

Conventional treatments

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

Integrative diagnosis

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

Treatment schedule

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

Concurrent parasitism

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

Prevent EPM with a strong immune system

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




Maximizing the role of veterinary technicians in integrative practice

Technicians are vital for creating more effective and efficient use of DVM time, and in reducing expenses by managing inventory, improving profits, and improving client communication.

The support roles veterinary technicians fill in both traditional and integrative veterinary practice settings are as varied as the practices themselves. Technicians are vital for creating more effective and efficient use of DVM time, and in reducing expenses by managing inventory, improving profits, bonding with clients and improving client communication. The aim of this article is to help DVMs and technicians create an effective dialog surrounding shared goals of professional, practice and personal growth, while improving income for the practice and its staff. Sharing insights can help generate efficient systems and procedures, which ultimately improve service delivery, patient care, work-life balance and revenue generation, while achieving a more cohesive team effort. Connie has been an LVT with Dr. Maro’s practice for 19 years. We co-authored this article to present the perspectives of both owner and technician when it comes to successful actions that can enhance operations in integrative practice. In our daily work, we can make many assumptions and take much for granted. As veterinarian and technician, we have worked together a long time, but while preparing this article we learned a great deal about each other’s independent and mutual goals and objectives. These are not often discussed in our daily work with patients and clients. Practitioners need to be cognizant of the fact that technicians have insights that may not always be expressed, since technicians tend to assume a role of deference to veterinarians. Asking for technician input, and having bi-annual meetings with technicians, along with surveys of their views and practice goals, can enhance employment satisfaction. A 360° evaluation of management and ownership also improves staff communication and operations.

Surveying veterinary technicians for their insights

Practitioners can survey LVTs with questions like these, while technicians can use surveys to reflect and create a dialog with ownership/management:
  1. What do you enjoy about your current position?
  2. What one change would make your job more rewarding?
  3. What services/roles can you provide to free up the DVM or make her more efficient and productive?
  4. Which modalities do you enjoy, and are there any in which you would like to pursue advanced training?
  5. What do you least enjoy about your job?
  6. List a talent we have overlooked or underutilized.
  7. How do you see yourself most significantly enhancing revenue generation?
  8. What suggestions would you give each DVM to enhance his/ her effectiveness/skills in benefiting the practice and patients?
After reviewing the technician’s answers, ownership should schedule a prompt meeting (within two weeks) to discuss changes that mutually benefit the practice and LVT.

The LVT’s role in client communications

An LVT with experience and an understanding of conventional practice can help clients who may have fears about what to expect when seeking integrative care for their pets. This type of communication is a vital part of a technician’s duties. Dr. Maro says her most valuable daily client interactions result from Connie’s exam room preparation with new and existing clients. “Before walking into the exam, I receive concise information regarding both the owner’s and the animal’s medical, emotional and mental state, financial expectations and limitations, scheduling abilities, and attitudes towards conventional and holistic care,” says Dr. Maro. “This preparation helps prevent surprises and allows me to budget my time from the moment I enter the room.” To prepare a thorough briefing of relevant information, an LVT should:
  1. Become well-versed in practice philosophies, modalities and client expectations. Teach clients how to be compliant; when and how to communicate between visits; and to understand the quantity of DVM time the schedule entitles them to.
  2. Develop, along with the DVM, efficient and relevant history and intake questions.
  3. Obtain and read prior records, highlighting illnesses, vaccines and medications.
  4. Introduce clients to the practice, policies, and DVM’s goals for the animals.
  5. Interview clients about their expectations and goals for their animals’ health.
  6. Discover what prior knowledge and exposure first-time clients have had to alternative care. If a client has had a bad experience with a personal chiropractic adjustment, or lacks familiarity with Applied Kinesiology, and the DVM starts performing an adjustment or muscle testing his or her animals, the visit can become complicated and dissatisfying for all.
  7. Explain what will happen during the exam, highlighting the value of the practice’s services. For example, a DVM who performs an Eastern and Western exam, along with spinal evaluation, may be assessing a great deal about the patient, while the client may simply see it as “petting the dog”. An LVT can introduce these valuable assessments before the DVM enters.
  8. Develop proficiency in discussing finances, estimates and expectations regarding frequency and duration of care for chronic and terminal cases.

Maintain statistics/results of patient care

Technicians who maintain logs of patient diagnoses, treatments and follow-up results create valuable information for DVMs tracking responses to integrative care. This information improves credibility for your practice when clients ask, “How many cases have you treated this way and what was the average survival time after diagnosis?” The LVT can also enter this information into the database at CuredCases.com, beginning with the very first client visit. This database is available to all veterinarians for help with cases or research purposes.

Delivering service with joy

Match passion and purpose with the roles each technician fills in the practice. If you are regularly doing the survey mentioned earlier, technicians can ponder what brings them the most joy in the practice. For example, if you are a technician who loves hands-on work with patients, rather than running anesthesia, speak with your practice owner about attending rehabilitative therapy certification classes. Depending on the size of your practice, you may still be running anesthesia as needed, but developing a new skill and revenue center will improve profits and job satisfaction.

Inventory and financial management

Inventory management can make or break cash flow in a practice. Though many practices have computer systems that track inventory, the nature of prescribing in integrative practices makes it difficult to quantify every acupuncture needle and homeopathic pellet. Assigning a primary technician to each DVM helps the LVT keep mental track of ordering. In our practice, three different technicians are assigned to maintaining inventory supplies:
  1. One maintains and orders TCVM supplies, homeopathics and essential oils.
  2. One maintains conventional drugs.
  3. One maintains laboratory and surgical supplies and reagents.
Between these three technicians, we seldom have excess inventory or outdated items. Technicians often facilitate “closing the deal” for cases requiring involved and chronic care. Train technicians to become comfortable with discussing the need for care, as well as the costs involved. Teaching support staff to address concerns with specific positive language saves the DVMs time, and determines the central issue for clients who are hesitant about proceeding with services. For example, after the DVM discusses a diagnostic and treatment plan, the technician can review a cost estimate with the client. When the client indicates uncertainty, the LVT can ask specifically what is causing the hesitation. If it’s about understanding the tests and treatments involved, the discussion can proceed. When clients still won’t commit, the technician can ask if they are concerned about the time or cost involved. This direct question often gets to the central issue more quickly.

Patient scheduling

Ideally, every veterinarian should have every appointment filled, with a lunch break in the middle of the day. Unfortunately, gaps in schedules, late appointments, nervous animals and long problem lists can keep the schedule from flowing well. LVTs can add value to their roles by reviewing the next several days’ schedules and looking for potential problems, such as patients requiring consultations on grave diagnostic results. Here are some technician tips for improving schedules during their review of upcoming days:
  1. Call clients during one of the lighter days/times preceding their appointments to get an update or thorough history, thereby reducing interview times in exam rooms.
  2. If a particular case sounds complicated during one of these calls, suggest the client schedule a more extended appointment time (with an increased fee) or break the appointment into two visits a few days apart.
  3. Encourage clients to visit during non-peak times by offering slightly longer appointment times or shorter wait times.
  4. When demand is high, give feedback to the DVM about scheduling, which can then be modified to better fit client demands.
  5. Consider increasing office visit fees for peak times, and keep fees stable for non-peak times.
  6. If your DVM has openings and gaps in the schedule, call clients who have not recently received services. Gaps will often be filled once animal chiropractic and rehabilitative clients are reminded of the need for maintenance care.
  7. Create workshops and educational events, both in the clinic and at animal venues, such as 4-H clubs and pet stores. Education and awareness draw clients to integrative practices to fill schedule gaps.

Matters of compensation

When a technician approaches a manager looking for reviews and raises, he or she should take specific and measurable information into the meeting. This information should detail how revenue and operations have been directly enhanced by the technician’s actions since the prior review:
  1. Keep metrics regarding client contact, enhanced sales and client feedback.
  2. Detail how a scheduling activity, service or promotion of service has directly impacted the practice with client numbers, client satisfaction and revenue increases.
  3. If you would like the practice to pay for a course of study, research how you could add a new service and how much money would be generated by this service. For example, let’s say you take a course in nutrition and begin calling clients for 30 minutes daily to tell them about your DVM’s new information regarding supplements. You can document the clients called and the resulting sales.
If you have begun taking action to improve schedule flow and history taking, resulting in decreased staff overtime, document those numbers for your next review.

Considerations for practice owners

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

In conclusion

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

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

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





Integrating essential oils for skin care

The natural chemistry of these 12 essential oils makes them ideal for use in the management of healthy skin for our animal patients.

Most abnormal skin conditions include some amount of inflammation or infection. As allopathic veterinarians, we were trained to utilize anti-inflammatory drugs such as prednisone, immunosuppressives such as cyclosporine, antibiotics such as cephalosporins, or parasiticides such as ivermectin to manage these conditions. We have watched our cases become more difficult to manage due to medication side effects and the development of drug resistance. This has caused a resurgence of treatments which were used in the “olden days”.  Some view this as a fad, but essential oils, some of which have been revered since biblical times, can be very effective and safe if selected and utilized properly. Essential oil usage is often the modality of choice now requested by many natural-minded pet parents!

What is an essential oil?

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

Do they work?

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

Top 12 essential oils for skin

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

1. Lavender

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

Methods of application

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

2. Frankincense

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

3. Copaiba

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

4. Chamomile (Roman)

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

5. Citronella

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

6. Tea tree

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

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

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

12. Neem

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

Dosing

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

References

The Chemistry of Essential Oils Made Simple. David Stewart, PhD, D.N.M. Essential Oils Integrative Medical Guide. D. Gary Young, ND Linalyl acetate as a major ingredient of lavender essential oil relaxes the rabbit vascular smooth muscle through dephosphorylation of myosin light chain. J. Cardiovasc Pharmacol, 2006 Jul;48(1):850-6. Anti-inflammatory activity of linalool and linalyl acetate constituents of essential oils Phytomedicine, 2002 Dec;9(8):721-6. Composition and antibacterial activity of the essential oils of four commercial grades of Omani luban, the oleo-gum resin of Boswellia sacra FLUECK. Chem Biodivers., 2012 Mar;9(3):615-24. doi: 10.1002/cbdv.201100189. Copaiba Oil-Resin Treatment Is Neuroprotective and Reduces Neutrophil Recruitment and Microglia Activation after Motor Cortex Excitotoxic Injury. Evid Based Complement Alternat Med. 2012; 2012: 918174. Published online 2012 Feb 19. doi: 10.1155/2012/918174 Bioactive Products in Chamomile. sigmaaldrich.com/life-science/nutrition-research/learning-center/plant-profiler/ chamaemelum-nobile.html. Efficacy of citronella and cinnamon essential oils on Candida albicans biofilms. Acta Odontol Scand. 2016 Jul;74(5):393-8. doi: 10.3109/00016357.2016.1166261. Epub 2016 Apr 21. Antimicrobial activity of the major components of the essential oil of Melaleuca alternifolia. J. Appl Bacteriol, 1995 Mar;78(3):264-9. Clove (Syzygium aromaticum): a precious spice. Asian Pac J Trop Biomed, 2014 Feb; 4(2): 90-96. D-Limonene: safety and clinical applications. Altern Med Rev, 2007 Sep;12(3):259-64. Antimicrobial efficacy of eucalyptus oil and 1,8-cineole alone and in combination with chlorhexidine digluconate against microorganisms grown in planktonic and biofilm cultures. J Antimicrob Chemother, 2009 Dec;64(6):1219-25. doi: 10.1093/jac/dkp362. Epub 2009 Oct 16. Chemical composition and antifungal activity of rosemary (Rosmarinus officinalis L.) oil from Turkey. Int J Food Sci Nutr, 2008 Nov-Dec;59(7-8):691-8. doi: 10.1080/09637480701777944. Cold Pressed Neem Oil Fact Sheet. www3.epa.gov/pesticides/chem_search/reg_actions/ registration/fs_PC-025006_07-Apr-10.pdf National Pesticide Information Center Fact Sheet. http://npic.orst.edu/factsheets/neemgen.html Chemical Characteristics of Toilet Soap Prepared from Neem. http://www.imedpub.com/ articles/chemical-characteristics-of-toilet-soap-prepared-from-neemazadirachta-indica-ajuss-seed-oil.pdf.




The practice of mindfulness in veterinary medicine

Mindfulness has been shown not only to decrease professional burnout and compassion fatigue, and raise distress tolerance, but it actually improves patient outcomes.

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

The four attributes of mindfulness

I consider mindful practice to be based on four attributes: attending, listening, empathy and self-compassion.  Each attribute by itself helps us to be present professionally and personally; together, they are a powerful quartet that allows us to be engaged with those we meet wherever we are, in the consultation room or elsewhere. 1. Attending allows us to “check in” with our own mental processes as we observe what is before us. Self-observation and self-reflection are the fruits of attentiveness.  When we give attention to another, we suspend our initial judgments, hold them in abeyance, and see with what can be called “beginner’s mind”.  This is a mind that is engaged, curious and open to possibilities; it lacks the often very narrow constraints of “expert’s mind”. The attentive mind is a courageous one that is not afraid to challenge what we thought we knew, and replace it with what we now see with new clarity. It allows us to respond to things that may be missed with an “automatic” approach; it helps us resolve to consider anew each patient and client before us, regardless of the number of times we have seen them. When we choose to pay attention to someone, we imbue them with importance. Attending allows us to make each patient and client important; no one’s concerns or suffering matters more than another’s. Attending allows us to be engaged with another in equanimity so we are attuned to but not engulfed by their needs. 2. Listening mindfully allows us to hear the concerns of another without using the lens of our own personal bias as a filter. It is common for clinicians to “hear” a client concern against a backdrop of algorithms, whether we practice from a single theoretical basis or utilize several modalities. When we listen with intention, we are able to construct a narrative of the patient and client that is rich and meaningful. We can be present to the cadence of a client’s report, and hear undercurrents of anxiety, resignation and hope; these are all helpful in meeting the client where he or she is and ultimately being of greater service to the patient. Listening removes us from judging a client who may not be completely adherent to our recommendations, and encourages us to consider that he or she, due to personal circumstances, is doing the best they can. When we listen with intention, we give another that which we all yearn for -- the opportunity to be heard deeply without judgment or suggestion. This type of deep listening is only possible when our own minds are clear enough to hear only what is before us. In our contemporary world where so few are actually listened to, having our words truly heard by another is a particularly welcome gift. Listening also makes room for silence, which allows another to speak his or her mind and heart unencumbered by the listener’s filter. This feeling of being completely held, and of mattering to another, can be transformative. 3. Empathy is an attribute many of us wish to demonstrate. However, much professional burnout and compassion fatigue can be traced to a misunderstanding of what it means to be empathic. We may think we are being empathic when we are merely resonating with another’s emotions. This is not empathy; rather, it involves oscillating with another in a way that is not helpful and may even be detrimental. Empathy can be defined as understanding another, even when our life journeys vary. With empathy, we can imagine what another is feeling and experiencing. It does not require that we have experienced the same things; it only requires that we be open to another’s experience and search our own for a feeling or thought that resonates with it. To be truly empathic, we need to have one foot firmly entrenched in our own reality, with one immersed in the other’s. When we enthusiastically jump into another’s situation with both feet, we lose the connection to ourselves from which empathy springs. Empathy requires an “I-thou” relationship of two forging a connection based on understanding. 4. Self-compassion means treating ourselves during times of stress as a good friend would. It is one of the most difficult aspects of mindful practice for many veterinarians, due to our innate perfectionism. Perfectionism is considered a maladaptive schema, one of many unhelpful ways of thinking that are learned and introjected (taken in) at an early age (typically before we are five years old). Perfectionism develops either from a feeling of defectiveness, so that we continually strive harder and harder to prove our self-worth, or from being validated for having been good, so that we continually work to attain that external validation. Although perfectionism carries some benefits, including the academic achievement necessary to attend veterinary school, perfectionists are not only intensely vulnerable to external criticism but are also beholden to a particularly vicious internal critic. The truth is that we can only do what time and resources allow. While many times we turn our attention (and blame) to external factors that limit our ability to practice in accordance with our wishes, self-compassion allows us to see that we are sometimes the limiting factor, perhaps because of a deficient knowledge base, the limitations of what our hospitals can offer patients and clients, etc. Perfectionists typically believe that self-compassion reduces motivation for excellence or is a sign of weakness. However, research done by Dr. Kristin Neff2 and others has shown that treating ourselves with kindness does not diminish a desire to perform to the best of our ability and actually helps build courage and resilience.  When we are self-compassionate, we are more willing to think “outside the box”; and errors (while they are to be avoided as much as possible) are not personally destructive.

Sitting practice for mindfulness

A daily sitting practice is the cornerstone of this intentional lifestyle. Western culture typically involves and rewards constant activity and multi-tasking, so the very act of devoting time each day to simply being with our breath and allowing thoughts to come and go without grasping at them is a counter-cultural and revolutionary way of being. Most of us wish to be mindful as we go about our daily lives so we seek to walk, cook, eat and work with intention. While we might be able to incorporate mindful practice into all these activities in time, sitting practice allows us to begin the hard work of tolerating a wide range of emotions, including boredom, anger, frustration, happiness and contentment, without escaping from them. Time spent watching the breath is a laboratory of sorts, in which we practice for life beyond the cushion or chair. Sitting practice allows us to observe whatever comes up, reflect on it and let it go. In the process, we become increasingly able to tolerate thoughts and emotions without needing to escape from them or hold onto them. Ultimately, mindful practice is a continual journey. We only fail at mindfulness if we assume there is a goal to be achieved, and that at some time in the future we will have fully attained it. Mindful veterinary practice involves each of us living moment to moment, trying to be an attentive listener who practices empathy for others, and holding oneself gently and with self-compassion. If we come up short one moment, we have the opportunity to try again in the very next moment.

References

1Krasner MS, Epstein RM, et al. “Association of an education program in mindful education with burnout, empathy and attitudes among primary care physicians”. JAMA 2009. Sep 23;(302), 12; 1284-93. doi 10.1001/jama.2009.1384 2self-compassion.org




Seaweeds for animal health

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

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

How seaweeds differ from land plants

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

Evaluating quality

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

What’s in seaweed?

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

Reports from clinical practice15

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

References

1Hall J. "The Most Important Organism?" 2011 [cited 2017 4 August]; Available from ecology.com/2011/09/12/important-organism/. 2Thompson DJ. "Seawater: A blood plasma substitute?" Nexus Magazine, 2006. 13(6). 3Teas J, et al, "Variability of iodine content in common commercially available edible seaweeds". Thyroid, 2004. 14(10): p. 836-41. 4Kupper FC, et al. "Iodide accumulation provides kelp with an inorganic antioxidant impacting atmospheric chemistry". Proc Natl Acad Sci U S A, 2008. 105(19): p. 6954-8. 5Lin L, Chen G, Chen Y, "Determination of iodine and its species in plant samples using ion chromatography-inductively coupled plasma mass spectrometry" Se Pu, 2011. 29(7): p. 662-6. 6Office of Dietary Supplements National Institutes of Health. "Iodine -- Fact Sheet for Health Professionals". June 24, 2011 [cited 2017 August 3]; Available from ods.od.nih.gov/factsheets/Iodine-HealthProfessional/. 7National Research Council, Nutrient Requirements of Dogs and Cats. 2006, Washington, DC: The National Academies Press. 8Jacob J. "Seaweed in Poultry Diets" 2015  [cited 2017 4 August]; Available from: articles.extension.org/pages/65717/seaweed-in-poultry-diets. 9National Research Council Committee on Animal Nutrition, "Nutrient Requirements of Rabbits", 1977, National Academy Press. 10Chesney AM, Clawson TA, Webster B. "Endemic goitre in rabbits. I. Incidence and characteristics". Bull Johns Hopkins Hosp, 1928. 43: p. 261-277. 11Yan X, et al. "Enriched accumulation and biotransformation of selenium in the edible seaweed Laminaria japonica". J Agric Food Chem, 2004. 52(21): p. 6460-4. 12Maruyama H, Watanabe K, Yamamoto I. "Effect of dietary kelp on lipid peroxidation and glutathione peroxidase activity in livers of rats given breast carcinogen DMBA". Nutr Cancer, 1991. 15(3-4): p. 221-8. 13Smyth PP. "The thyroid, iodine and breast cancer". Breast Cancer Res, 2003. 5(5): p. 235-8. 14Cann SA, van Netten JP, van Netten C. "Hypothesis: iodine, selenium and the development of breast cancer". Cancer Causes Control, 2000. 11(2): p. 121-7. 15Clinical Practice Interviews: Dr. Constance Dinatale, Veterinary Acupuncture and Complementary Therapy, Winter Park, FL; Dr. Cynthia Lankenau, Holistic Center for Veterinary Care, Coldon, NY; Dr. Rick Palmquist, Centinela Animal Hospital, Inc., Inglewood, CA; Dr. Barbara Royal, The Royal Treatment Veterinary Center, Chicago, IL; Dr. Jean Dodds, Hemopet, Garden Grove, CA.

Kelp feed rates for companion animals

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

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

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




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

1. Gillyweed

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

2. Harry Pawter

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




Chiropractic problems and treatments in domestic cats

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

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

Background information

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

Our incidence study

Methods

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

Findings

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

Discussion

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

Treatment

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




Nutritional approaches to dermatology cases

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

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

Whole Food Diets

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

Conclusion

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

Case Studies

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

Additional Resources

Animalessentials.com marcopharma.com natures-balance.com Standardprocess.com WestonAPrice.org

References

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




Western botanicals for treating otitis media in animals

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

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

Topical Interventions

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

Botanicals for an ear rinse

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

1. Cider Vinegar

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

2. Calendula Extract (Calendula officinalis)

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

3. Tea Tree Oil (Melaleuca alternafolia)

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

4. Lavender Oil (Lavendula off.)

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

5. Thyme Oil (Thymus off.)

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

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

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

7. Olive leaf (olea europaea)

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

8. Rosemary Oil (Rosmarinus off. L.)

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

Dietary Changes

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