V10I4 (Fall 2020) by Redstone Media Group

Innovative VETERINARY CARE

VOLUME 10 ISSUE 4

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HOW ARTIFICIAL INTELLIGENCE IS IMPROVING PATIENT CARE USING AI WITH RADIOLOGY MEANS YOU CAN RECEIVE CRUCIAL DIAGNOSTIC INFORMATION ALMOST IMMEDIATELY. — P. 14

PBM AND REHAB THERAPY FOR DOGS WITH DM

A retrospective study suggests rehab therapy and photobiomodulation may slow the progress of DM and increase longevity. — P. 10

FALL 2020

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THE NEED FOR RAPID POC DIAGNOSTICS

DIAGNOSING FELINE GI DISEASE

An overview of general diagnostics and specialized tests for cats with GI symptoms. — P. 37

TAKING A MULTIMODAL APPROACH TO CANCER

In-clinic point-of-care tests enhance patient care by delivering rapid lab-quality data. — P. 32

When it comes to cancer, a single solution is rarely effective. A multimodal treatment plan often produces ideal outcomes. — P. 48

BECOME A DIGITAL VETERINARY ENTREPRENEUR

VACCINATING ADULT DOGS AND CATS

Explore ways to digitally reach beyond private practice and diversify your income during the pandemic. — P. 26

Vaccine protocols should consider each animal’s risk of exposure, along with geographical location, and lifestyle factors. — P. 20

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FALL 2020

EDITORIAL DEPARTMENT Editor-in-Chief: Dana Cox Managing Editor: Ann Brightman Associate Editor IVC: Laurin Cooke, DVM Senior Content Editor: Emily Watson Senior Graphic Designer: Dawn Cumby-Dallin Senior Graphic Designer: Alyssa Dow Web Design & Development: Lace Imson Social/Digital Media Specialist: Jamie McClure

COLUMNISTS & CONTRIBUTING WRITERS

Jody Bearman, DVM, CVSMT, CVA, CVCH Nancy Brandt, DVM, CVC, CVA, CVMA Kara M. Burns, MS, MEd, LVT, VTS (Nutrition) Todd Cooney, DVM, CVH Audi Dencklau, CAA, Graduate of Veterinary Medical Aromatherapy (R) W. Jean Dodds, DVM Eric Goldman Hilary Jones, DVM Megan Kelly, DVM Cynthia Lankenau, DVM Lisa A. Miller, DVM, CCRT Randy Ringold, BSc, MT(ASCP), MBA Andrew J. Rosenfeld, DVM, ABVP Barbara Royal, DVM, CVA Judith E Saik, DVM, DACVP, CVA, CVCH, CVFT Samuel D. Stewart, DVM, DACVECC Yu-An Wu, DVM

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SUBMISSIONS: Please send all editorial material, photos and correspondence to Dana Cox at Dana@redstonemediagroup.com or IVC Journal, 160 Charlotte St., Suite 202 Peterborough, ON, Canada K9J 2T8. We welcome previously unpublished articles and color pictures either in transparency or disc form at 300 dpi. We cannot guarantee that either articles or pictures will be used or that they will be returned. We reserve the right to publish all letters received. ADVERTISING SALES: Senior Media Specialist/Editorial Associate: Kat Shaw, (866) 764-1212 ext. 315 Katshaw@redstonemediagroup.com Business Development/Editorial Associate: Becky Starr, (866) 764-1212 ext. 221 Becky@redstonemediagroup.com Multimedia Specialist: Britt Silver, (866) 764-1212 ext. 226 Britt@redstonemediagroup.com Subscription Services Manager: Brittany Silloats, (866) 764-1212 ext. 100 Brittany@redstonemediagroup.com CLASSIFIED ADVERTISING: Libby Sinden classified@IVCJournal.com US MAIL: IVC Journal, 6834 S University Blvd PMB 155 Centennial, CO 80122 CDN MAIL: IVC Journal, 202-160 Charlotte St. Peterborough, ON, Canada K9J 2T8. The opinions expressed in this journal are not necessarily those of the editor, and different views may appear in other issues. Redstone Media Group Inc., publisher of IVC Journal, does not promote any of the products or services advertised by a third party advertiser in this publication, nor does Redstone Media Group Inc. verify the accuracy of any claims made in connection with such advertisers.

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IVC Journal (ISSN 2291-9600) is published four times a year by Redstone Media Group Inc. Publications Mail Agreement #40884047. Entire contents copyrightÂ© 2020. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: October 2020.

improving the lives of animals... one reader at a time.

IVC Fall 2020

contents FEATURES

PBM AND REHAB THERAPY FOR DOGS WITH DM

AI IN VETERINARY RADIOLOGY IMPROVES PATIENT CARE

By Lisa A. Miller, DVM, CCRT

A combination of photobiomodulation and rehabilitation therapy may positively impact symptom progression and survival times in dogs with a presumptive diagnosis of DM.

By Eric Goldman

The implementation of artificial intelligence in the field of veterinary radiology allows doctors to receive crucial diagnostic information almost immediately.

18 20

NANOSHELL TECHNOLOGY AND LASER ABLATION

By Andrew J Rosenfeld, DVM, ABVP

A new treatment for mast cell disease in dogs.

VACCINATION IN ADULT DOGS AND CATS By W. Jean Dodds, DVM

Both the core and non-core revaccination needs of adult dogs and cats should consider the individual’s risk of exposure, along with geographical location, and lifestyle factors.

BUSINESS INNOVATION

THE RISE OF THE DIGITAL VETERINARY ENTREPRENEUR

By Megan Kelly, DVM

Explore ways to reach beyond private practice and diversify your income digitally.

RAPID POC DIAGNOSTICS IN ANIMAL HOSPITALS

By Samuel D. Stewart, DVM, DACVECC

Veterinary medicine has a significant need for in-clinic point-of-care (POC) tests that can deliver rapid, reference lab-quality sensitivity and specificity data.

SCREENING FOR EARLY DETECTION OF OSTEOARTHRITIS

FELINE GI DISEASE: A SYSTEMATIC APPROACH TO DIAGNOSIS

By Randy Ringold, BSc, MT(ASCP), MBA

Screening for OA should start in all dogs over five years of age, and routinely in high risk breeds.

49 4

By Yu-An Wu, DVM

A discussion of the general diagnostic approach to cats with GI symptoms, along with some of the specialized tests available at reference laboratories.

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INTEGRATIVE APPROACHES TO CANINE HEMANGIOSARCOMA

TCVM DIAGNOSTICS FOR THE BEGINNER

TELEMEDICINE AND OTHER ADVANCES ARE HERE TO STAY

HELPING CLIENTS WITH AGING CATS

THE VETERINARY ONCOLOGY TOOLKIT

By Barbara Royal, DVM, CVA

Combining conventional and alternative treatments is the best approach for dogs with HSA.

By Jody Bearman, DVM, CVSMT, CVA, CVCH

A little knowledge about TCVM helps you read the literature more critically. This article gives you a start at understanding this system’s diagnostic approach.

By Hilary Jones, DVM

The changes we've had to make due to the pandemic give us the opportunity to restructure vet med with a focus on innovation and personal wellness.

By Pete Wedderburn, BVM&S CertVR MRCVS

Offer your clients the guidance they need to enhance their cats’ quality of life and longevity throughout the aging process.

By Robert J Silver, DVM, MS

Treating oncology patients is complex, and one solution rarely addresses all dimensions of recovery and well-being. A multimodal approach often produces ideal outcomes.

NUTRITION NOOK

TECHNICIANS AS TEACHERS: EDUCATING CLIENTS ABOUT NUTRITION

By Kara M. Burns, MS, MEd, LVT, VTS (Nutrition)

By initiating discussions about nutrition each time pet parents visit the practice, veterinary technicians can directly impact the lifelong health of their patients.

advisory board Dr. Richard Palmquist, DVM GDipVCHM(CIVT) CVCHM (IVAS), graduated from Colorado State University in 1983. He is chief of integrative health services at Centinela Animal Hospital in Inglewood, California, former president and research chair of the AHVMA, and an international speaker in integrative veterinary medicine. Dr. Palmquist is a consultant for the Veterinary Information Network (VIN) and a past president of the AHVM Foundation. He has published two books, one for conventional veterinarians and a second for clients discussing how integrative thinking works.

COLUMNS & DEPARTMENTS

6 Editorial 13 Business profile — Theralase® 17 From the AVH 24 Industry innovations 31 From the VMAA 36 From the VBMA 53 From the AATCVM 54 News bites

Michelle J. Rivera, MT, VDT, is an instructor at the University of Wisconsin and The Healing Oasis Wellness Center, a post-graduate educational institution offering state-approved programs. She is co-owner of The Healing Oasis Veterinary Hospital, offering massage, rehabilitation, chiropractic and Chinese and Western Herbology. Michelle completed the Chinese Herbal Medicine program from the China Beijing International Acupuncture Training Center, and is certified in Chinese Medicine by the Wisconsin Institute of Chinese Herbology.

Dr. Joyce Harman, DVM, MRCVS, graduated in 1984 from Virginia Maryland Regional College of Veterinary Medicine. Her practice is 100% holistic, using acupuncture, chiropractic, herbal medicine and homeopathy to treat horses to enhance performance and those with a variety of chronic conditions, with an emphasis on Lyme Disease. Her publications include the Pain Free Back and Saddle Fit Books, and numerous articles in lay and professional magazines. She maintains an informative website: www.harmanyequine.com. Dr. Steve Marsden, DVM, ND, MSOM, Lac. Dipl.CH, CVA, AHG lectures for IVAS, the AHVMA, the AVMA, and numerous other organizations. He is co-founder of the College of Integrative Veterinary Therapies and is a director emeritus of the National University of Natural Medicine in Portland OR. He authored the Manual of Natural Veterinary Medicine (Mosby); and Essential Guide to Chinese Herbal Formulas (CIVT). Dr. Marsden is extensively trained in alternative medicine, including Chinese herbology, acupuncture and naturopathic medicine. He has holistic veterinary and naturopathic medical practices in Edmonton, Alberta. In 2010, Dr. Marsden was named Teacher of the Year by the AHVMA; and Small Animal Veterinarian of the year by the CVMA in 2009. Dr. Jean Dodds, DVM, received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she moved to Southern California to establish Hemopet, the first non-profit national blood bank program for animals. Dr. Dodds has been a member of many national and international committees on hematology, animal models of human disease, veterinary medicine, and laboratory animal science. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1994.

Dr. Barbara Fougere, DVM, CVAA graduated in 1986, and was named the American Holistic Veterinary Medical Association Educator for 2011. Dr. Fougere is the principal and one of the founders of the College of Integrative Veterinary Therapies. She has continued studying over the last 26 years, and has three Bachelor degrees, two Masters degrees, three post Graduate Diplomas, several Certifications and numerous other courses under her belt.

Dr. Christina Chambreau, DVM, CVH, graduated from the University of Georgia Veterinary College in 1980. She is a founder of the Academy of Veterinary Homeopathy, was on the faculty of the National Center for Homeopathy Summer School and has been the holistic modality adjunct faculty liaison for the Maryland Veterinary Technician Program and is the former Associate Editor of IVC Journal. Dr. Chambreau teaches classes in homeopathy for animals, lectures on many topics, speaks on Radio and TV, and is the author of the Healthy Animal’s Journal among other titles. She is now on the faculty of the Holistic Actions Academy, which empowers members to keep their animals healthy with weekly live webinars.

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editorial

“THINGS ARE ONLY IMPOSSIBLE UNTIL THEY’RE NOT.” This quote by Captain Jean-Luc Picard from Star Trek: The Next Generation illustrates the essence of innovation. In the 1990s, watching this show was a special treat I gave myself after long hours of studying. I had a secret crush on Data... there was a kind and gentle innocence about him, despite the fact that he was an android devoid of emotion. Are there not days when the sleek technology of the Enterprise sickbay would come in handy? When you could use your nifty tricorder to scan patients for an immediate, organized, and relevant assessment? How much of our science fiction is prescient? Artificial intelligence is already established in both human and veterinary medicine. A device strikingly similar to the tricorder is making its way into human telehealth, so that physicians have the raw physical exam data they need, even in virtual appointments. In veterinary medicine, AI has found traction especially in the imaging field, where computer algorithms are teaching themselves how to read radiographs with precision. The stethoscope hooked around the shoulders of veterinarians and physicians alike has become a meme of medical authority. Not so very long ago, however, even that universal tool was itself a new medical breakthrough. A French physician seeing patients in 1816 decided there must be a better (and less awkward) way of listening to heartbeats than pressing his ear on someone’s chest. The monaural contraption he created began as a simple rolled-up tube of paper. An Irish doctor took the concept a bit further 35 years later, adding a second earpiece to make it binaural.

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With the speed of modern innovation increasing exponentially, Star Trek diagnostic tools don't seem farfetched at all. Will heart sounds soon reach our ears through cyberspace rather than stethoscopes? This is an exciting time to be in medicine, as this issue of IVC Journal demonstrates. Enjoy articles on AI radiology, rapid point-of-care diagnostics, photobiomodulation for degenerative myelopathy, diagnostic tests for evaluating feline GI disease, and innovative ways to expand your digital reach. And while you’re thinking into the future, be sure to join us for IVCVX, launching November 6 and 7. It’s the first virtual veterinary conference and trade show on the moon! Focused on innovative solutions and strategies in veterinary medicine, IVCVX will help you discover the latest trends, technologies, and treatments in a supportive and fun online environment. Find out more in our Conference Guide, which you will find inverted at the back of this Journal. May we all go boldly into the future, with wisdom and compassion.

Laurin Cooke, DVM Associate Editor, drlaurin@ivcjournal.com

Join us for IVCVX Nov 6 & 7

contributors 1

1. JODY BEARMAN, DVM, CVSMT, CVA, CVCH Dr. Jody Bearman graduated from the University of Minnesota College of Veterinary Medicine in 1992. Wanting to help animals that couldn’t be diagnosed or treated with Western medicine, she became a Certified Veterinary Acupuncturist in 2005. She is also a certified Veterinary Chinese Herbalist, practices Tui-na (Chinese massage and physical therapy), and food therapy, and has instructed at the Chi Institute. Dr. Bearman became certified in veterinary spinal manipulation therapy in 2014, and is a member of the College of Animal Chiropractors. She trained in homeopathy and is a member of the AVH. She has a threeveterinarian integrative practice in Madison, WI. p. 42 2. W. JEAN DODDS, DVM Dr. Jean Dodds received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she established Hemopet, the first non-profit national blood bank program for animals. Dr. Dodds has been a member of many committees on hematology, animal models of human disease and veterinary medicine. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1994. p. 20 3. MEGAN KELLY, DVM Dr. Megan Kelly owns and runs onlinepethealth.com, an international continuing education site for veterinary rehabilitation therapists. Every day, she pushes the boundaries on what is considered the norm for professional education, creating, innovating, and providing online solutions and outstanding customer experiences through webinars and online conferences for vets and veterinary rehabilitation therapists. p. 26 4. LISA A. MILLER, DVM, CCRT Dr. Lisa Miller is Vice President of Clinical Veterinary Medicine for Companion Animal Health, and a graduate of the University of Tennessee, College of Veterinary Medicine. She is certified in canine rehabilitation therapy, and practiced rehabilitation, sports medicine, and acupuncture before returning to general practice, and later, joining the animal health industry. Dr. Miller has been working with laser therapy/photobiomodulation (PBM) since 2006, has lectured and written extensively on rehabilitation and laser therapy-related topics, and authored a chapter in Laser Therapy in Veterinary Medicine. Dr. Miller coordinates all veterinary and advanced PBM research involving Companion Animal Health technologies, and is a consultant and reviewer for PBM research worldwide. She is a member of the AVMA, the American Association of Rehabilitation Veterinarians, and the American Society of Laser Medicine & Surgery. p. 10 5. BARBARA ROYAL, DVM, CVA Dr. Barbara Royal is an integrative veterinarian and certified acupuncturist, author and lecturer with extensive experience in veterinary care, including nutrition, acupuncture, emergency medicine, conventional practices, herbal remedies and physical rehabilitation techniques. The author of three books, including The Royal Treatment, A Natural Approach to

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Wildly Healthy Pets, she has also been featured in the film documentary Pet Fooled. She is the founder and owner of The Royal Treatment Veterinary Center in Chicago, and the co-founder of the Royal Animal Health University. Dr. Royal is past president of both the AHVMA and the AHVM Foundation. 6. SAMUEL D. STEWART, DVM, DACVECC Dr. Samuel Stewart graduated from the Ross University School of Veterinary Medicine in 2013. He then completed an Emergency and Critical Care residency at the Massachusetts Veterinary Referral Hospital in Woburn, MA, and was accepted as a Diplomate in the American College of Veterinary Emergency and Critical Care in 2017. Dr. Stewart now does research within Ethos Veterinary Health and the non-profit Ethos Discovery. p. 32 7. YU-AN WU, DVM Dr. Yu-An Wu is originally from Taiwan and received a DVM degree from National Taiwan University. He then joined the Gastrointestinal Laboratory at Texas A&M University. He is currently pursuing his PhD in biomedical sciences with a research focus on pancreatic diseases. p. 37 8. KARA M. BURNS, MS, MED, LVT, VTS (NUTRITION) Kara Burns is a licensed veterinary technician with Masters degrees in physiology and counseling psychology. She is the Founder and President of the Academy of Veterinary Nutrition Technicians, teaches nutrition courses around the world, and is an independent nutritional consultant. Kara has authored many articles and textbooks, has been featured on the cover of Veterinary Technician Journal and NAVTA Journal, and was recently featured in PetVet Magazine. She was named the NAVC Technician Speaker of the Year in 2013 and 2016. Kara was granted an honorary VTS (Internal Medicine) in 2011, and an honorary VTS (Dentistry) in 2012. She was the 2010 NAVTA Veterinary Technician of the Year, and the 2011 Dr. Franklin Loew Lecturer. p. 49 9. RANDY RINGOLD, BSC, MT(ASCP), MBA Randy Ringold is a clinical chemist with over 35 years’ experience in in-vitro diagnostics. He has held senior positions in human healthcare companies like Baxter Healthcare and Quest Diagnostics before founding VDI Laboratory 12 years ago. Randy currently holds over 20 patents in both veterinary and human diagnostics and has peer-reviewed papers in the field of laboratory robotics, vitamin D metabolism, Crohn’s disease and ulcerative colitis, and cancer diagnostics. p. 35 10. ERIC GOLDMAN Eric Goldman is a results-oriented technology leader committed to delivering best-in-class performance. He recognizes that AI is not a complete substitute for radiologists, but can be an essential tool that provides quality and accurate results in a timely manner, directly improving patient care in veterinary medicine. In a rapidly changing environment, Eric is passionate about working with universities, independent radiologists, the AVMA, ACVR, and others to allow for scrutiny in the technology and making sure the algorithms achieve the highest quality of results. He is president of Vetology AI. p. 14.

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How a combination of photobiomodulation and rehabilitation therapy may positively impact symptom progression and survival times in dogs with a presumptive diagnosis of degenerative myelopathy.

PBM AND REHAB THERAPY FOR DOGS WITH DM

BY LISA A. MILLER, DVM, CCRT

— A RETROSPECTIVE STUDY Degenerative myelopathy (DM) is a disease that affects the spinal cord of older dogs, leading to hind limb weakness and paralysis. Most of us are used to seeing DM patients decline from the initial stages of generalized proprioceptive ataxia to non-ambulation within six to nine months, a clinical course consistent with what is reported in the literature.1 This is a grim reality that anyone dealing with DM patients has to come to terms with, as we watch alert, willing, and often otherwise healthy dogs succumb to motor degeneration, incontinence, loss of quality of life, and ultimately, euthanasia. In this paper, we’ll focus on a retrospective study suggesting that a combination of photobiomodulation and intensive rehabilitation therapy may slow the progress of DM and increase longevity.

HOW THE STUDY GOT STARTED “I think I’m seeing a difference in these patients,” said my colleague, Debbie (Gross) Torraca, DPT, MSPT, Diplomat ABPTS, CCRP, referring to her canine patients with DM. As the owner of a referral rehabilitation facility for animals in Connecticut, Debbie has treated many DM cases. She has a large number of very compliant clients whose pets were referred to her for the purposes of palliating their symptoms

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and attempting to slow disease progression as much as possible using intensive rehabilitation therapy.2 As we continued our discussion, it became clear that the results Debbie was seeing in a subset of her patients over the past few years were not typical. Debbie posited that a change in the photobiomodulation (PBM), or laser therapy, protocol she was using was the only difference for the patients in which she was seeing slowed symptom progression and increased survival times. Otherwise, she had utilized the same rehabilitation therapy regimen and home exercise recommendations for pet owners that she had used for years. The results she was seeing were remarkable, but I was admittedly still skeptical. This was, after all, DM we were talking about. But as Debbie shared her data and we started examining it in detail, it became clear that the results were different for this subset of patients treated with a different PBM protocol.

DATA ANALYSIS As this was a retrospective analysis, we were able to gather information on patient demographics, disease progression, and survival in the presumed DM patients treated at the

facility over a nine-year period, and then analyze it to determine if there were any differences in outcomes between the two PBM treated groups, as well as compared to historical data expectations. Twenty dogs ultimately met all the inclusion criteria set forth, and these were sorted into two different groups, labeled PTCL-A and PTCL-B, for analysis based on the PBM protocol used in their treatment. At the time, only three other studies existed in the published literature containing information on the progression of clinical symptoms and/or survival data for larger groups of dogs with DM.2-4 Even though the baseline characteristics of patients from those studies may have been different, along with the treatment interventions applied, we believed they provided a set of historical “expectations” for disease progression and survival information, which was important for comparison purposes. Data analysis revealed statistically significant differences in the mean times between symptom onset or start of treatment, and both non-ambulation and euthanasia, in one treatment group compared to both the other treatment group and the historical published expectations. • The mean time between onset of clinical signs and non-ambulation was significantly longer in the PTCL-B group (31.76 ± 12.53 months) than in the PTCL-A group (8.79 ± 1.60 months) (p < 0.05). • The mean time between onset of clinical signs and time of euthanasia was significantly longer in the PTCL-B group (38.2 ± 14.67 months) than in the PTCL-A group (11.09 ± 2.68 months) (p < 0.05). The data analysis suggested that the combination of PBM consistent with PTCL-B parameters (980 nm wavelength, delivered on contact to the skin surface of the thoracic and lumbar spine at 6 to 12 W power [1.2 to 2.4 w/cm2] with a corresponding energy density of 14 to 21 J/cm2 over the entire treatment area) and intensive rehabilitation therapy delays the progression of clinical signs and extends the survival time of dogs with DM. Continued on page 12.

A laser therapy patient enjoys a treatment at Wizard of Paws Physical Rehabilitation for Animals.

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POSSIBLE EXPLANATIONS FOR THE

EFFICACY OF PBM ON DM

PBM may be exerting an effect on the disease process of DM in one or more of the following ways: • Exerts a protective influence on the motor neurons in the early stages of the disease via a decrease in the invasion of cells involved in secondary damage to the spinal cord, or possible reduction in astrogliosis • Decreases astrocytic nitric oxide production, subsequently influencing the astrocyte glutamate transporter (GLT-1) • Restores healthy cellular energetics in the treated muscles along the spine • Decreases the muscle fatigue experienced by treated patients, aiding their therapeutic exercise program and assisting in recovery after exercise. Continued from page 11.

LIGHT ENERGY DELIVERED TO THE SPINAL CORD In examining possible reasons for response differences between the groups, the most obvious is that the light parameters in one group (PTCL-B), but not the other (PTCL-A), were sufficient to not only reach the tissues of interest in the spinal cord, but to be absorbed there and exert effects. When transcutaneously delivering light to the deep tissues, the light energy is attenuated in the hair coat as well as in the intervening tissues of the skin and muscle. Previous published work5-6 has reported quantitatively the amount of light transmitted to the level of the spinal cord in cadaver dogs under safe, clinically acceptable, skin-applied irradiance, and showed that there is a linear correlation between the irradiance of the light at the skin and that of the light measured at the spinal canal.

GOING FORWARD We acknowledge the retrospective nature of this study, its small sample size, and the dearth of historical data from studies with similar parameters that could be used for comparison. While all these factors suggest caution in drawing conclusions from the results presented, the retrospectively collected data showed that the combination of PTCL-B PBM and intensive rehabilitation therapy had a significant beneficial impact on the clinical symptom progression and survival times of dogs with a presumptive diagnosis of DM. As there are no other effective treatments, we suggest here that this combination should be considered for dogs with a presumptive diagnosis of this disease. Further research on this therapy in a more controlled setting is warranted for dogs, and potentially for humans with ALS. It is our sincere hope that this information will help our colleagues “see a difference” in their patients as well, and give hope for a disease that has long frustrated veterinarians, rehabilitation therapists, and pet owners alike. The complete published Open Access study, including more detailed information on the PBM and rehabilitation protocols, may be viewed here: https://www.liebertpub.com/doi/full/10.1089/ photob.2019.4723. Drs. Lisa Miller and Debbie Torraca have also recorded a webinar presenting the findings from this study and discussing further detailed recommendations for managing patients with DM in practice. This webinar is available on-demand at: https://www.companionanimalhealth.com/webinar/new-degenerativemyelopathy-research-a-review-from-th/true.

Author disclosure statement: Dr. Miller is currently employed by LiteCure and was involved in the collection of data from hospital records, data analysis, and article preparation; however, she was not employed by LiteCure at the time the patients in this study were treated. She declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.

Coates JR, Wininger FA. “Canine degenerative myelopathy”. Vet Clin North Am Small Anim Pract 2010;40:929–950.

Kathmann I, Cizinauskas S, Doherr MG, Steffen F, Jaggy A. “Daily controlled physiotherapy increases survival time in dogs with suspected degenerative myelopathy”. J Vet Intern Med 2006;20:927–932.

Polizopoulou Z, Koutinas A, Patsikas M, Soubasis N. “Evaluation of a proposed therapeutic protocol in 12 dogs with tentative degenerative myelopathy”. Acta Vet Hung 2008;56:293–301.

A large body of evidence in the published literature demonstrates that PBM can effectively modulate the inflammatory response after both peripheral nerve injury and in spinal cord injury (SCI). Many studies provide evidence that light confers specific beneficial effects on the response of cells in the CNS to injury, leading to alteration of the secondary injury response and progression of the injury process.7

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Kanazono S, Pithua P, Johnson GC, et al. “Clinical progression of canine degenerative myelopathy. ACVIM Forum Research Abstracts Program”. J Vet Intern Med 2013;27:673–674.

Piao D, Sypniewski LA, Bartels KE. “Challenges of transcutaneous laser application for the potential of photobiomodulation of the spinal cord at the scale of a large companion animal”. Proc SPIE 2017;10048:8–10.

Piao D, Sypniewski LA, Dugat D, Bailey C, Burba D, De Taboada L. “Transcutaneous transmission of photobiomodulation light to the spinal canal of dog as measured from cadaver dogs using a multi-channel intra-spinal probe”. Lasers Med Sci 2019;34:1645–1654.

Anders JJ. “The potential of light therapy for central nervous system injury and disease”. Photomed Laser Surg 2009;27:379–380.

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In the late 1960s, in the era of Martians and ray guns, laser therapy was touted as a futuristic treatment that was just beginning to make its way into mainstream medicine. Surgical lasers made their debut first, since it was easier to witness their effects on tissue; however, therapeutic lasers came soon after, as further research demonstrated their healing effects. Therapeutic lasers soon attracted the attention of healthcare practitioners, but options were limited, as few companies had the knowhow on how to develop high quality products at affordable price points.

LASER THERAPY MADE ACCESSIBLE In 1994, Theralase® came onto the scene, dedicated to designing, manufacturing, and distributing high quality, cutting-edge therapeutic laser systems at an affordable price. Their Cool Laser Therapy (CLT) systems were embraced by healthcare practitioners, who utilized them to eliminate pain in their patients, starting with knee conditions and then advancing to reducing inflammation and accelerating tissue healing for numerous nerve, muscle, and joint conditions, in off-label use. Twenty-five years later, Theralase® is a leader in the CLT field and has expanded into the research and development of anticancer treatments. In fact, the company’s motto is “Healing at the Speed of Light®”. In 2004, Theralase® began in-licensing, researching and developing Photo Dynamic Compounds (PDCs). PDCs are light-sensitive molecules that have the ability to localize to cancer cells, bypassing healthy cells, and when light-activated, produce destructive forms of oxygen within the cancer cells to destroy them. The PDCs induce oxidative stress within the

cancer cell and hence elegantly destroy it from the inside out. Theralase® is now actively researching and developing safe and effective ways to destroy various forms of cancer.

RESEARCH AND PRODUCTS Theralase® executes on the company’s mandate through scientific, preclinical and clinical research in each of their two divisions — Anti-Cancer Therapy (ACT) and Medical Laser Technology (MLT). Theralase® CLT exposes tissue to laser energy at two different wavelengths, within the visible and near infrared spectrums, triggering a chain of biochemical reactions within the cells to induce tissue healing and pain reduction. Using laser diodes to deliver up to 100,000 mW of power deep into injured tissue, these systems offer a highly effective, noninvasive, and pain-free treatment alternative for a wide range of nerve, muscle, and joint conditions.

LOOKING TO THE FUTURE Theralase®, in both the ACT and MLT divisions, plans to launch new, innovative pain and oncology solutions in 2021. They have also demonstrated that their lead PDC is able to destroy a variety of viruses, including H1N1 Influenza and Zika. Next in the research phase is whether or not it is able to destroy coronaviruses, including COVID-19. If successful through a Phase III clinical study, and with the regulatory approval of Health Canada, the Theralase® COVID-19 vaccine could be commercialized across the world. (Note: the company does not claim or profess that they have the ability to treat, cure, or prevent contraction of the COVID-19 coronavirus.)

theralase.com/companionanimal/ IVC Fall 2020

Innovations in veterinary radiology:

using AI to improve patient care BY ERIC GOLDMAN

The implementation of artificial intelligence in the field of veterinary radiology allows doctors to receive crucial diagnostic information almost immediately. The world of medicine is constantly changing, and the veterinary medical field is no different. Technology is advancing rapidly, and the rule is to adapt to these changes or succumb to the consequences. The use of artificial intelligence (AI) in veterinary radiology is a relatively new area. Leaders in this field are ethically responsible for providing correct product knowledge to the veterinary community, and should follow the principles of transparency, honesty, and integrity. At the same time, veterinary professionals eager to use this new technology must understand that the field is ever-evolving. As such, offered products will be in different development stages. Good Machine Learning Practices (GMLP) should be adhered to and documented.1

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AI IN VETERINARY MEDICINE â&#x20AC;&#x201D; POTENTIAL AREAS OF IMPACT Implementing an artificial intelligence strategy is a must for veterinary practices moving into the future. Access to specialists is not always available to hospitals or clients, and AI offers an attractive solution. However, experts believe that depending solely on AI can be detrimental. A strategic combination of both human competency and AI technology is important to drive the best care. Some of the products related to AI in veterinary practice have already been in the marketplace for years. These are expected to gain immense popularity in the near future. The

global market for wearable devices for the remote monitoring of pet health and activity is forecast to reach over $8 billion by the year 2025. When it comes to the human health market, similar products have gained in popularity. These are known for measuring simple parameters such as movement, heart rate, and body temperature. In addition, these devices keep tabs on food intake. They will make recommendations based on appropriate behavioral responses. For instance, these devices will inform diabetic patients about requirements for glucose or insulin. New devices with the capability of measuring other important parameters will soon be available. In the veterinary field, cattle can be fitted with movement sensors to identify the onset of estrus. Similar technology will no doubt become available for other species, including pigs. At present, these sensors are quite expensive, especially for routine usage. Special efforts are being made to produce low-cost versions of the technology that would make them more accessible to farming operations. This process will emulate the rapid decrease in the cost of genome analysis, resulting in possible developments of custom-made medicines in animals and human patients. Apart from identifying individuals with genotypes that may make them more or less vulnerable to the effects of specific drugs, professionals will also carry out genomic analyses on microbiome samples from the skin, gut, and other sites to evaluate which disease-causing organisms may exist in the patientâ&#x20AC;&#x2122;s body. There have been speculations on whether these approaches will ultimately lead to a reduction in the demand for antibiotics. Advancements in monitoring technologies will similarly lead to challenges in processing and applying the available IVC Fall 2020

FAST, AUTOMATED ANALYSIS

One example of software that evaluates veterinary radiographs using artificial intelligence is Vetology AI. This program gives an automated analysis within five minutes or less for cases involving abnormalities related to heart size, heart failure, lung disease, pulmonary nodules, and pleural effusion. Vetology AI functions independently and will automatically upload x-rays to secure servers from clinics. One of the star functions of this AI is the automated heart evaluation, which works without any input from a human. The software is capable of notifying veterinarians about a serious enlarged heart condition called cardiomegaly. This is a revolutionary technology that uses the AIâ&#x20AC;&#x2122;s neural networks. As primary care veterinarians gain more experience with the output and limitations, the technology will continue to improve with self-evaluation and self-teaching. The software also compares heart size with respect to the vertebral body size of the patient (vertebral heart score); the entire process results in a heart evaluation report, with the vertebral heart score being delivered to the veterinarian through email/fax within two minutes of uploading the x-rays. The ability of this innovative software to provide the veterinarian with an immediate heart analysis, before a manual or machine-based evaluation of a patientâ&#x20AC;&#x2122;s radiograph, is instrumental. For cases not involving the canine, the platform provides a like-for-like comparison of the x-ray with an image library numbering in the hundreds of thousands. Once a user agrees with the match, they can bring up a corresponding radiology report from this vast library.

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data. It is believed that doctors will have access to 200 times more data than the human mind can process. Consequently, another priority is the development of artificial intelligence software that analyzes this mass of information and draws precise conclusions about its meaning. Google and Apple have special teams working on these issues. Significant development has already been seen; a team has produced diagnostic software that can easily identify human patients with early indications of diabetes. It is based on constant measurements of heart rate variation. This technology and others will change the way clinical practice operates.

CURRENT APPLICATIONS 1. Medical imaging processing and assessment The use of AI in this area includes quick yet precise and sensitive interpretations of radiographs, MRI images, CT scans, ultrasound images, and cytology assessments. At present, all aspects of AI are progressing exponentially, from computer processing power, speed, and affordability, to the development of machine vision reference directories. Hence, it is expected that most standard tasks involving clinical interpretation in veterinary practice will be allotted to AI. This will help veterinarians obtain quick, accurate, and detailed reports as well as consistency in interpretation, a factor that currently depends on the experience and skill level of the individual practitioner.

Examples of AI-generated findings in medical imaging. Left: Severe cardiomegaly has been detected but heart failure is not suspected. Right: A soft tissue pulmonary nodule/mass lesion is present.

2. First-line primary consultations This is another area where AI shows enormous potential. For human patients, smart kiosks are available that cut down on wait times, a major source of dissatisfaction among patients and stress for physicians. However, a combination of AI and detailed AR (augmented reality) instructions ensures a consistent, accurate, and detailed collection of crucial patient history and physical examination data. This is provided and collected by the patients themselves while they are guided through the entire procedure. After collecting the relevant data (usually completed in under 15 minutes), the doctor is sent a detailed patient work-up that includes a proper breakdown of predicted illnesses and treatment options. The medical practitioner then conducts a video consultation in order to confirm the authenticity of the AI-collected information, verify the diagnosis, and approve or alter the treatment plan. AI will also help maintain detailed and accurate healthcare records, and will automatically follow up with patients within a few days of the consultation. Special efforts are being made to roll out veterinaryrelated versions of this system. Experts in the field believe that this technology will significantly augment the experience of clients and their pets. Implementation of this technology will also improve the professional lives of veterinarians, who face similar issues of stress and overload as their human physician counterparts. Using artificial intelligence software provides an attractive option for all doctors, allowing them to receive crucial diagnostic information almost immediately. Author disclosure statement: Eric Goldman is President of Vetology AI, a company that designs and delivers service innovation for the veterinary industry. He has a financial interest in Vetology Innovations LLC. For more information visit vetology.ai.

A merican Association of Veterinary Radiologists guidelines, submission and review process for Veterinary Radiology Artificial Intelligence (AI) AAVR GMLP SaMD Product Certification — American Association of Veterinary Radiologists. Available at: http://www.aavr.org/index.php?option=com_content&view=a rticle&id=99&Itemid=263.

From the AVH

The Academy of Veterinary Homeopathy is comprised of veterinarians who share a common desire to restore true health to their patients through the use of homeopathic treatment. Members of the Academy are dedicated to understanding and preserving the principles of Classical Homeopathy.

IMAGING, DIAGNOSTICS, AND HOMEOPATHY Would Dr. Hahnemann use imaging and diagnostics if he were here today? Some say yes, others no or maybe. He instructed that all we need to know about a disease is available to our senses, and that there is nothing mysteriously hidden from our observations. The totality of symptoms helps with the selection of a homeopathic medicine, to move our patients in a curative direction. As a homeopathic veterinarian, imaging and diagnostics help supplement information I am getting from an animal patient (and their human companion), and often add to the overall understanding of the disease process. But remedy selection is possible without advanced imaging and diagnostics. The information obtained from a detailed case intake goes a long way to identifying the homeopathic medicine needed to solve the case. A common veterinary example is the animal with polyuria/polydipsia. We know from conventional training the differential of possibilities — kidney, liver, endocrine disease, or psychogenic causes. Bloodwork can help rule these in or out, but in my experience, quite a few of these animals have “normal” lab values. So as a homeopath, I factor in other things — when is the animal thirsty, and does he want large or small quantities of water? Does he have a temperature preference? Are there any behavior changes in general, or towards people or other animals? How is the appetite, and are there any abnormal cravings or pica? Unless an animal has a very imbalanced immune system, a close-fitting homeopathic medicine can move things in a positive direction.

Submitted by Todd Cooney, DVM, CVH

IVC Fall 2020

NANOSHELL

TECHNOLOGY AND

L ASER ABL ATION — A NEW TREATMENT FOR MAST CELL DISEASE IN DOGS

BY ANDREW J ROSENFELD, DVM, ABVP

Mast cell tumors account for 17.8% of all canine skin tumors diagnosed.1 The majority of these tumors reside in the skin or subcutaneous tissue.2 Overall, breeds with the greatest risk of high grade mast cell tumors are the Shar-Pei, Weimaraner, and Boxer.1 Treatment commonly involves surgical excision, with the goal of obtaining microscopically tumor-free surgical margins.3 Prognosis can be poor and controversial, and depends on the tumor’s location. Certain veterinarians feel that the poor prognosis comes with diagnosis of a poorly-differentiated tumor, whereas others associate it with difficulties in performing surgery.1 Thus, the poor prognosis may be associated with the difficulty of applying an appropriate surgical procedure, and incomplete tumor resection.1 However, a new treatment involving nanoparticles and laser therapy is showing promise for better outcomes.

NANOPARTICLES AND LASER LIGHT THERAPY Laser light therapy (photobiomodulation) with specific lightsensitive dyes has been used for decades to treat specific types of tumor. Nanoparticles, made from noble elements such as gold, are a new discovery, and have an increased sensitivity

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to visible and near-infrared light absorption as compared to conventional laser phototherapy agents. The mechanism of action for these new particles, as they enter the body by intravenous administration, is to concentrate in tissue with altered vascular permeability, such as tumor masses. When the nanoparticles are then irradiated with laser light, electrons within them enter an excited state, releasing energy through heat production, and causing an overheating of the regional tissue, along with local cell death and destruction. Gold nanospheres, nanorods, and nanocages are commonlyused gold nanoparticles, and all have demonstrated an increased ability to absorb visual and near infrared light. The size and shape of the particles allow for vibration and spinning excitation, which produces heat and tissue necrosis when focused laser light is applied to these areas.4

NANOTHERAPY — PILOT STUDY AND CLINICAL TRIALS Companion Animal Health is conducting clinical trials utilizing nanotherapy for several tumor types, and has completed a pilot

Initial data from this study was presented at the ACVIM in 2018 and revealed that all patients responded to Companion Nanotherapy, with 67% maintaining remission. The procedure was completed as a single treatment with a very low rate of toxicity (See Figures 1 to 8).5 Currently, more formal study groups are in progress at multiple trial sites, looking at Companion Nanotherapy’s use in oral squamous cell carcinoma (cats), oral and cutaneous melanomas (dogs), and soft tissue sarcomas (dogs). To date, this treatment modality has been used on more than 130 dogs and cats with various types of tumor. All patients have shown a very low rate of toxiciy and complications, thus far.

Figure 1

Figure 2

Administration of nanoparticles.

Patient is prepared for light irradiation.

Figure 3

Mass evident prior to treatment.

Figure 5

Figure 4

Mass right after initial treatment.

Figure 6

Given the current treatment options for low-grade cutaneous mast cell tumors, nanoshell therapy and photothermal ablation may offer patients a non-surgical, one-time treatment option with few to no complications. This treatment modality may allow veterinarians to shrink and stop tumor growth in patients that have masses in regions where surgery may not be as successful, and where limited surgical margins may affect prognosis. Andrew J. Rosenfeld served as the veterinary lead to the International/National Productive Management Team for Zoetis, and was the Medical Director of Abaxis Global Diagnostics. He has been medical director of many facilities, most recently for VCA Boston Road Animal Hospital. He was Director of Technical Education for the Pet’s Choice family of veterinary hospitals and specialty practices, and has practiced small animal critical care and emergency medicine for 29 years. Dr. Rosenfeld is a member of the American Board of Veterinary Practitioners. He authored The Veterinary Team Handbook, and co-authored Clinical Pathology for the Veterinary Team.

Mass as it appears one week after treatment.

Figure 7

Three weeks after treatment.

Figure 8

Śmiech A , Ślaska B, Łopuszyński W, Jasik A, Bochyńska, D, Dąbrowski, R. “Epidemiological assessment of the risk of canine mast cell tumors based on the Kiupel two‑grade malignancy classification”. Acta Vet Scand (2018) 60:70.

Thompson JJ, Pearl DL, Yager JA, Best SJ, Coomber BL, Foster RA. “Canine Subcutaneous Mast Cell Tumor: Characterization and Prognostic Indices”. Veterinary Pathology 48(1) 156-168.

Milovancev M, Townsend KL, Tuohy JL, et al. “Long-term outcomes of dogs undergoing surgical resection of mast cell tumors and soft tissue sarcomas: A prospective 2-year-long study”. 2019 The American College of Veterinary Surgeons, Veterinary Surgery. 2020;49:96–105.

Huang X, Jain PK, El-Sayed IH, El-Sayed MA. “Plasmonic photothermal therapy (PPTT) using gold nanoparticles”. Lasers Med Sci (2008) 23:217–228.

Parshley L. “Nanoparticle and laser thermal ablation in canine low-grade mast cell tumor”. Proceedings, ACVIM Forum, 2018. Olympia Veterinary Cancer Center, Olympia, WA, 2020.

Ten weeks after treatment.

32 weeks after treatment.

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Photos courtesy of Olympia Veterinary Specialists: The Cancer Center and Bridge Animal Referral Center

study with small mast cell tumors. These nanoparticles are made with a gold shell and nonconducting silica core. Their average size is 150 nanometers in diameter. The particles target cancerous tissue, including low grade mast cell tumors due to alterations in the endothelium of the blood supply of these masses, and are then irradiated with focused infrared laser energy.

BY W. JEAN DODDS, DVM

VACCINATION IN ADULT DOGS AND CATS: what do we need to consider?

Vaccines should be thought of as any other medication, and used as necessary to address the true health needs of each canine and feline patient, especially when they become adults. Both the core and noncore revaccination needs of adult dogs and cats should take into account the individualâ&#x20AC;&#x2122;s risk of exposure, along with geographical location, and lifestyle factors. A more proactive approach is still needed to both standardize the production and individualize the use of veterinary vaccines to ensure their safety and efficacy. This is especially relevant for dogs and cats who have been properly vaccinated and immunized as youngsters. This article explores factors to consider when creating vaccination strategies for adult animals.

WHY A NEW APPROACH? Controversies and misunderstandings around the principles of immune memory and protection are ongoing. In addition, compliance failure with current national vaccine policies and guidelines, resistance to change, and denial of the potential for adverse events within the general veterinary community and society as a whole complicate thoughtful vaccine decisions for adult companion animals. The solution depends upon more focused educational efforts within academic veterinary medicine, clinical practice, and companion animal owner communities. Vaccines are not innocuous products; the benefit/risk equation needs to be assessed before vaccination and booster vaccination.

NO PANACEA There is little doubt that the application of modern vaccine technology has permitted us to effectively protect companion animals (and people) against serious infectious diseases.1-5 However, vaccinations are increasingly recognized (albeit still rarely) as contributors to immune-mediated blood, skin, bowel, bone, and joint diseases, bone marrow and organ failure, central nervous system excitation, and behavioral aberrations.3,6 Genetic predisposition to these adverse events (termed vaccinosis) has been documented. It must be recognized, however, that we have the luxury of expressing these concerns today only because the risk of disease has been effectively reduced by the widespread use of vaccination programs. Nevertheless, the accumulated evidence

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indicates that vaccination protocols should no longer be considered a “one size fits all” program.1-3,7,8 In cats, while adverse vaccine reactions may be less commonly seen, aggressive tumors (fibrosarcomas) can occasionally arise at the site of vaccination, as they can in dogs.8,9 Other cancers, such as leukemia, have also been associated with vaccines.9 In the ensuing 20 years since vaccineassociated sarcomas were recognized in cats, the prevalence has not decreased nor has the age of affected cats increased, despite changes in vaccine formulations and worldwide protocol guidelines.9 Even today, it is estimated that only 40% of veterinarians are following the current World Small Animal Veterinary Association, American Veterinary Medical Association, American Animal Hospital Association, and British Veterinary Association vaccine policy guidelines.3 There is no such thing as an “up to date” or “due” vaccination. Enlightened veterinarians can now offer a package of separated vaccine components, when available, rather than administer them together, since the published data show more adverse reactions when multiple vaccines are administered concurrently.

VACCINE DOSAGE Dogs are currently vaccinated with the same quantity of vaccine, independent of size or breed.1,2 Why do very small and very large dogs need the same dose of vaccines, when clinical trials by vaccine manufacturers are typically performed on laboratory beagles and with minimal field testing in different breeds prior to licensing?3 More vaccine adverse events have been documented in smaller dogs.2 Toy and small dogs logically should require less vaccine than giant and large dogs in order to be fully immunized. Similarly, puppies and kittens should require less vaccine volume to immunize than adults do.1 Continued on page 22. IVC Fall 2020

Continued from page 21.

ALTERNATIVES TO CURRENT PET

VACCINE

PRACTICES3

• Measuring serum antibody titers • Avoiding unnecessary vaccines or over-vaccinating • Deferring vaccination of sick or febrile individuals • Tailoring specific minimal vaccination protocols for dogs of breed types or families known to be at increased risk for vaccinosis, such as Weimaraners, Great Danes (especially Harlequins), Akitas, Standard Poodles, Vizslas, Old English Sheepdogs, and any white or light-colored dogs, including mixed breeds (except in virulent disease outbreaks, orphans, or those deprived of colostrum) • Starting vaccination series later, such as at nine to ten weeks of age when the immune system is more robust • Alerting caregivers to watch their pets’ behavior and overall health after boosters • Avoiding revaccination of individuals already experiencing a significant adverse event •A voiding revaccination of vaccinated, immunized geriatrics

Treatment of

VACCINOSIS

The diagnosis of vaccinosis is an exclusionary one, as typically nothing will be found to explain the presenting symptoms.6 Our experience indicates that the animal should be given the oral homeopathic medicine, Thuja occidentalis (for all vaccines other than rabies), and homeopathic Lyssin, to alleviate the symptoms of vaccine-induced rabies miasm. Therapy often includes modest doses of steroids, initially for five to seven days and, if needed, in tapering doses over four to six weeks, to stop the inflammatory process and clinical symptoms.6 These patients should not receive further vaccine boosters; in the case of rabies vaccine, exemption should be sought on a case-by-case basis but may not be granted in some locales.11

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In support of the size hypothesis, this author studied healthy, adult, small breed dogs who had not been vaccinated for at least three years.10 The dogs were given a half-dose of bivalent distemper and parvovirus vaccine, whereby all of them developed increased and sustained serum vaccine antibody titers.10 Presumably, this approach would apply also to puppies, and further research is needed.

VACCINATE WISELY, ONLY WHEN NEEDED When an adequate immune memory has already been established, there is little reason to administer booster vaccines, and it would be unwise to introduce unnecessary antigen, adjuvant, and other excipients, as well as preservatives, by doing so.3-5 Serum antibody titers can be measured triennially or more often if needed, to assess whether a given animal’s humoral immune response has fallen below levels of adequate immune memory. In that event, an appropriate vaccine booster can be administered. For legally required rabies vaccines, these alternative options are often limited by necessity, given the exposure risk to this fatal disease.11 Importantly, pet caregivers should understand that the act of giving a vaccine may not equate to immunization. Vaccines may not always produce the needed or desired immune protective response. This can occur if the vaccine itself was inadequately prepared (very rare) but also if the pet is a genetic low- or non-responder to that vaccine (quite common in certain breeds of dogs and their families, such as Akitas, Greyhounds, and Labrador Retrievers, especially black Labs). In the latter case, that pet will be susceptible lifelong to the disease of concern and revaccination will not help and could even be harmful.3,7 Vaccination can provide an immune response that is similar in duration to that which follows a natural infection. In general, adaptive immunity to viruses develops earliest and is highly effective. Such antiviral immune responses often result in the development of sterile immunity and the duration of immunity (DOI) is often lifelong.3,7,10 In contrast, adaptive immunity to bacteria, fungi, or parasites develops more slowly. The DOI is generally short compared with most systemic viral infections. Sterile immunity to these infectious agents is less commonly engendered. Old dogs and cats rarely die from vaccine-preventable infectious disease, especially when they have been vaccinated and immunized as young adults (i.e. between 16 weeks and one year of age).7,10 However, young animals do die, often because vaccines were either not given or not given at an appropriate age (e.g. too early in life in the presence of maternally-derived antibody).1-3

More animals need to be vaccinated to achieve the 70% or more needed to increase herd (population) immunity to protect the unvaccinated against these diseases.2,8 Titers do not distinguish between immunity generated by vaccination and/ or exposure to the disease, although the magnitude of immunity produced just by vaccination is usually lower. Core vaccines should be given to all adults, but not more often than every three years, and we prefer to measure serum antibody titers instead.1-3,7 Serological and challenge studies actually indicate that protection is likely much longer, ranging from seven to nine years.7

OTHER ISSUES WITH OVER-VACCINATION Increased costs in time and dollars need to be considered, despite the well-intentioned solicitation of clients for pets to receive their wellness examinations.1,3 Giving unnecessary annual boosters has the client paying for services that are likely of little benefit to the pet’s existing level of protection against these infectious diseases. It also increases the risk of adverse reactions from the repeated exposure to foreign substances.1-4

COMPLIANCE OR RESISTANCE TO CURRENT VACCINE GUIDELINES The issues discussed above have been legitimately raised for over two decades, but why is this knowledge still considered controversial?1-3,8 Have veterinarians embraced the national and international policies on vaccination guidelines? Does the public trust veterinarians to be up-to-date on these issues? Do they believe veterinarians have a conflict of interest if they derive income from annual booster vaccinations? While some veterinarians still tell their clients there is no scientific evidence linking vaccinations with adverse effects and serious illness, this fallacy confuses an impressionable client.3 On the other hand, vaccine and anti-vaccine zealots abound with hysteria and misinformation. Neither of these polarized views is helpful.

to understand the principles of vaccinal immunity, it is not surprising that attempts to change vaccines and vaccination programs have created significant controversy. As stated by the American Animal Hospital Association’s 2003 guidelines: “No vaccine is always safe, no vaccine is always protective, and no vaccine is always indicated. Misunderstanding, misinformation, and the conservative nature of our profession have largely slowed adoption of protocols advocating decreased frequency of vaccination. Immunological memory provides durations of immunity for core infectious diseases that far exceed the traditional recommendations for annual vaccination. This is supported by a growing body of veterinary information as well as welldeveloped epidemiological vigilance in human medicine that indicates immunity induced by vaccination is extremely long lasting and, in most cases, lifelong.”1-3 These statements were groundbreaking at the time, and still apply today.3

VACCINES SHOULD BE INDIVIDUALIZED TO EACH PATIENT “Vaccination should be just one part of a holistic preventive healthcare program for pets that is most simply delivered within the framework of an annual health check consultation,” said the late Professor Michael J. Day. “Vaccination is an act of veterinary science that should be considered as individualized medicine, tailored for the needs of the individual pet, and delivered as one part of a preventive medicine program in an annual health check visit.”1

Day M J, Horzinek MC, Schultz R D, Squires R. “WSAVA Guidelines for the vaccination of dogs and cats”. J Sm Anim Pract 2016; 57: E1-E45.

A merican Animal Hospital Association (AAHA). Canine Vaccination Task Force: Ford RB, Larson LJ, Schultz RD, Welborn LV. “2017 AAHA canine vaccination guidelines”. J Am Anim Hosp Assoc 2017; October: 26-35.

D odds WJ. “Vaccine issues and the World Small Animal Veterinary Association (WSAVA) Guidelines (20152017).” Israel J Vet Med 2018; 73 (2): 3-10.

Dodds WJ, Herman K. “Heavy Metals in vaccines”. J Am Hol Vet Med Assoc 2019; 57: Winter 16-18.

Dodds WJ. “Adjuvants and additives in human and animal vaccines”. Med Res Arch. 2016; 2(5): 1-8.

Dodds WJ. “Rabies virus protection issues and therapy”. Global Vaccines Immunol. 2016; 1: 51-54.

S chultz RD, Thiel B, Mukhtar E, Sharp P, Larson LJ. “Age and long-term protective immunity in dogs and cats”. J Comp Pathol. 2010; Jan;142 Suppl 1: S102-8.

Veterinary practitioners may simply believe what they originally learned about vaccines and are therefore less inclined to change or “fix” what is perceived to be unbroken.1-3,8 Annual vaccination has been the single most important reason why the majority of people bring their dogs and cats for an annual check-up or “wellness visit”. When combined with a failure

Scherk MA (Chair), et al. 2013 AAFP Feline Vaccination Advisory Panel Report. J Fel Med Surg 2013; 15:785-808.

Wilcock B, Wilcock A, Bottoms K. Brief communication. Feline postvaccinal sarcoma: 20 years later. Can Vet J 2012; 53: 430-434.

D odds WJ. Efficacy of a half-dose canine parvovirus and distemper vaccine in small adult dogs: a pilot study. J Am Hol Vet Med Assoc 2015; 41:12-21.

D odds WJ, Larson LJ, Christin, KL, Schultz RD. Duration of immunity after rabies vaccination in dogs: The Rabies Challenge Fund research study. Can J Vet Res 2020; 84:153–158.

IVC Fall 2020

industry innovations Trusted support for your patients’ kidneys

Add animal bodywork to your practice

Increase revenue by offering massage and/or other bodywork modalities to your patients. Holistic Animal Studies’ online courses can be started anytime and have no deadlines — your staff can work at their own pace. Certification courses are available in Massage Therapy, Kinesiology Taping, Craniosacral Therapy, Body Alignment, Cold Laser Therapy, and more. Use the coupon code WELLNESS when you enrol, to get 20% off! HolisticAnimalStudies.org

Support normal kidney function and health, and help enhance renal function, with NOW® Pets Kidney Support. It’s made with botanicals, antioxidants, arginine, and taurine. Chicken bone broth is added for flavor — it’s sourced from the US, and is free of both growth hormones and steroids. All the company’s pet supplements are formulated by Dr. Barbara Royal, DVM, CVA, founder of the Royal Treatment Veterinary Center. They also carry the National Animal Supplement Council (NASC) seal. NowFoods.com/pet-health

Telemedicine at its finest

Looking for a revolutionary cloud-based practice management software that blends power and simplicity? Turn to VetBadger. Thanks to its integrated video telemedicine platform with two-way email and text messaging, client communication never gets missed. Exam data entry is quick and easy; integrations with reference and in-house lab systems and payment processors appear where you need them. Role-based task management keeps your team working efficiently throughout the day. Real-time integration with QuickBooks always keeps your inventory and financials up-to-date. VetBadger.com

New non-invasive test for GI LSA in cats

A new serum test released by VDI Laboratory will complement your current toolset. The Feline GI Lymphoma Panel improves the sensitivity and specificity of diagnosing LSA in the GI cat, with better detection of small cell LSA — a challenging differential diagnosis. This panel is an extension of the general VDI Cancer Panel and includes four biomarkers: thymidine kinase type 1, haptoglobin, cobalamin, and folate. A non-invasive test for feline GI LSA. VDILab.com 24

IVC Fall 2020

Compact laser therapy

Perfect for the modern veterinarian, Pegasus’ premium PTX therapy laser has been engineered to produce optimal outcomes while supporting both new and experienced staff with real-time guidance. Key features include: • Exclusive SmartCoat technology that enables accurate dosing based on patient absorption characteristics • Application specific treatment heads that deliver efficient, consistent outcomes for both deep and superficial conditions • Empower IQ handpiece with visual and haptic feedback to provide the most accurate dosing ever • Individual patient tracker • Battery operation. PegasusTherapy.com

Safe oral speculum for dentistry and endoscopy

For a safe alternative to spring-loaded gags or cut syringe caps, consider the Smart Gag Set. Each set comes with six different sizes, so your patient is not overextending his jaw, causing trauma. Our red and green mouth gags are safe to use on feline patients and do not cause the circulatory or neurological deficits seen with spring-loaded gags. The simple and robust design allows for multiple uses without failure and can be sterilized by ethylene oxide gas or steam autoclave —10% off with code IVC10. BellaVMS.com

Healthy balance for healthier pets

The endocannabinoid system (ECS) governs a number of critical functions in the body, including the neuronal, gastrointestinal, endocrine, immune, bone, and muscular systems. VF Hemp Oil from Standard Process helps support the ECS in dogs and cats. It comes in liquid form, which provides convenient, flexible dosing with a graduated dropper. It’s also gluten-free, and contains non-GMO hemp. StandardProcess.com/Veterinary-Formulas

IVC Fall 2020

business innovation THE RISE OF THE

digital veterinary entrepreneur BY MEGAN KELLY, DVM

IVC Fall 2020

Explore ways to reach beyond private practice and diversify your income digitally. We are experiencing unprecedented times. No one could have planned for a global pandemic (it’s not something that happens in most people’s lifetimes), and it is forcing us to do a lot of re-evaluation — including a re-evaluation of our income sources. For many veterinarians, although they have had to implement new rules and restrictions, work has carried on as usual. For others, the circumstances of COVID-19 have precipitated a sudden drying up of income. Whether practice hours have been significantly reduced or completely eliminated, the question facing many veterinary professionals has become: “How can I use my professional medical expertise to generate income that doesn't involve practicing?” Thinking entrepreneurially is not something most of us have much training in. I recall a single lecture at my university called “Vets in Industry”, and to be honest, I didn’t concentrate very much during that class! I mean, when you are studying to be a vet, who wants to think about anything other than being a vet? In truth, however, our veterinary degrees open many doors for us that we have not learned to recognize and exploit. In addition to academia, public health, and industry settings where we can work — including pharmaceutical and nutrition companies, and diagnostic services — we are now also seeing the rise of the veterinary entrepreneur. I have always had an entrepreneurial mindset, and I believe this sense of being both a vet and an innovator has contributed to the enjoyment, excitement, and passion I derive from my career. Diversifying has also brought financial rewards. From the time I qualified as a veterinarian, I have always been thinking of other avenues I could explore, in addition to direct patient care.

LIMITATIONS OF CONSULTING We all love what we do, but we have to acknowledge some limitations in the way we do it. Face-to-face consulting is time bound. We can only see a certain number of clients in a certain length of time, and for that reason, there is a ceiling to our daily earning potential. Even if we throw teleconsulting into the mix, we are still limited by our time. Continued on page 28. IVC Fall 2020

Continued from page 27. In my first years of running my vet rehab clinic, Holisticvet, this limitation became very apparent. I was nearly fully booked but not really making much money. So I started to think about ways I could serve my clients that were not restricted by time. I did what many of us do — I opened a shop in my practice and started selling products that my clients and patients needed, such as Sticky Paws, harnesses, life jackets, joint supplements, and holistic dog food. Soon, almost every client coming in for their pet’s acupuncture or underwater treadmill therapy was walking out with something they’d bought. The added income to my practice was noticeable, and I opened a profit account for the first time. Yay! I was finally making a profit. But I didn’t stop there. A lot of these products were unavailable at veterinary practices and through local distributors, so I had to import many of the hard-to-obtain items directly from manufacturers into South Africa where I live, which presented a steep learning curve. Since I was the only person importing these goods regularly, I began ordering more and distributing them to vets and other vet rehabilitation therapists. I created an online shop and sold the products there as well, posting or couriering items to buyers. This became a business within a business, and brought an immediate boost to my income. That was just the beginning of becoming a veterinary entrepreneur.

SOLVING A PROBLEM Every good business solves a problem. If you can think of a group of people who have a problem, and you can find a way to solve it, chances are you have the seeds of a business idea. Consumers will pay for a product or service that solves their problem. I am a problem-solving kind of person, and got into product manufacturing through a specific problem I wanted to solve. When a patient needed a product that we didn’t have and I couldn’t source, I made it myself. The product was a brace for a dog with an angular limb deformity. Nothing existed that would fit, so I spent many hours

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with a needle and thread, thermoplastic, Velcro, and neoprene trying to get this product right. Eventually, I created what today is known as a thermomould — a brace that, when immersed in warm water, becomes malleable, and then cools and hardens around the dog’s leg. Other products followed, and I was soon into fullscale product manufacturing and distributing. I loved everything about it — except that the perfectionist and control freak in me was a little obsessed with quality control. A good thing, I suppose, because quality is always a challenge in manufacturing. I continued thinking of ways to diversify. Part of the impetus was my desire to do more to help more animals. Owners in far-flung places would phone, desperately seeking rehabilitative help for their pets. I knew exactly what exercises the animal needed, but could not get to the patient. I hated the fact that I could not get to a dog in a small town ten hours away, when I knew just what the dog needed! At first I’d try to find a therapist close by, but in those days veterinary rehabilitation was still new in South Africa, and very few were available. So I started helping owners by explaining exercises via Skype and emailing PDFs of exercises to the owners. Sending videos was not yet a readily available tool. The increasing number of faraway people seeking help opened my eyes to a business opportunity; clients needed easy-tofollow demonstrations of rehabilitative and preventative exercises for their dogs, packaged in an inexpensive way. I needed to create something online that would help all pet owners. I started with e-books and eventually developed three online courses. I developed three popular courses: a 12-week strengthening program, a massage course, and my “7-minute doggie workout”. These were all programs I had used successfully in my clinic. Each one of these projects became an additional source of income. Continued on page 31.

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11 ideas to inspire your own entrepreneurial spirit Here are some basic ways to use the technology at our disposal to create something new, exciting, and helpful — and generate more income! •

Create an online course

C ourses can be delivered in short videos using sites such as udemy.com, or you can host your own using software such as teachable.com. Alternatively, you can hire a developer to build a site for you. Most of us have so much we can teach others, but we just don’t realize it. Snoutschool, founded by Danielle Lambert, is a group of female pet professionals doing just that. The #snoutsquad, as they are called, work together, empowering one another to generate incomes online.

• Create a membership-only platform Membership sites are subscription-based learning platforms where you continually develop content for an audience. This content is accessible on a website which only your members can access with a specific login and password. You could create a membership site for a specific audience of pet owners — for example, “Managing your arthritic pet”. See my own subscription service as an example: https://onlinepethealth-info.com/. • Write a book Publishing a book used to be difficult. You needed an approved publisher, and it could take years before someone accepted your manuscript. Nowadays, anyone can selfpublish through Amazon on Kindle, and you can even have a paperback version published as well. I believe we all have unique knowledge and insight, and there is a book inside each of us. Share your genius! Once in book form, your knowledge can benefit generations to come. Veterinarian Dr. Dave Nicol wrote a book to help new veterinary graduates by sharing the lessons he learned over the years that he was not taught in vet school. His book is called So you're a vet...now what? • Write e-books Veterinary rehab therapist Carolyn Mcintyre created her own e-book, entitled Warm up and Cool down of the Canine Athlete. She sells it on her website shop for $28.

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• Create an app Guavavet is a recruitment app that uses artificial intelligence to link employees with the right veterinary practice. It was developed by veterinarian Dr. Aubrey Kumm. • Create software Veterinarians (and clients) involved in software development are usually pushed into the field by frustration with the software that they are currently using. They get to the point where they say, “I am just going to make my own!” Some examples include VetBadger (https://vetbadger.com), Teletails (https://www.teletails.com), and Televet. • Invent and manufacture a product Integrative veterinarian Dr. Julie Buzby invented Dr. Buzby’s ToeGrips, small rubber rings that slide onto the nails of dogs to increase their grip zone and help prevent slipping. • Start a podcast Veterinarians Hubert Hiemstra and Gerardo Poli started “The Vet Vault”, a podcast dedicated to helping vets find a worklife balance. Once a podcast develops a following with enough downloads, it can usually be monetized through sponsors. • Create a blog with affiliate links C reate links to products on your blog that allow your readers to purchase recommended products. Amazon has an affiliate system that tracks the origin of referrals, and you can receive a commission of up to 10% for every sale you refer. If customers purchase other products at the same time, you earn a commission on those products, too. Consider establishing this affiliate referral system with other companies, especially if there are certain products you recommend regularly. •

Start a YouTube channel

r Evan Antin created a channel for pet owners and has D nearly 40,000 subscribers. With enough views, your channel can be monetized. Advertisers pay Dr. Antin every time someone watches one of his videos, with their advert preceding each of his.

• Become Instafamous With over 1.3 million followers on Instagram, Dr Antin used this popular platform to launch his own brand of wellness products called Happy Pet.

From the VMAA The Veterinary Medical Aromatherapy® Association (VMAA) is an organization of veterinarians and veterinary technicians dedicated to the responsible use of aromatherapy in animal practices. Their mission is to promote standards of excellence in animal aromatherapy, to provide outreach and education to veterinarians and axillary animal practices, and to promote continual improvements in Veterinary Medical Aromatherapy®. The VMAA is elevating the veterinary profession through innovation, education, and advocacy of integrative medicine.

CORNEAL ULCER RESPONDS TO ESSENTIAL OIL THERAPY Continued from page 28. Gradually I added pet owner workshops, lecturing, TV presenting, and brand consulting to the pie. And so when pregnant with my second child in 2014, I was able to take a sabbatical from practice, relying on all the additional sources of income I had created.

THE DIGITAL VET During this period at home, I started a new project called Onlinepethealth.com. It is a subscription-based, online learning platform for veterinary rehabilitation therapists. Everything I do now is online and from my home office. I have a hand in helping animals all over the world through serving the vet rehab therapists in the online community I’ve created. I’m often asked if I miss practicing. And yes, while there are certain aspects I do miss, I get the same emotional reward from helping the people who help animals. I know I am positively affecting many young vet rehab therapists and far more animals this way. The one thing I love about working online is that geographics are never a limitation. I have members in 52 different countries; we even have a rehab therapist in Iceland. I may well go back to practicing when my children are older. For now, though, I am bursting with ideas on using the digital space to generate income (see sidebar at left for 11 ideas you can implement yourself). Having and loving pets is never going to go out of fashion, and veterinary professionals will always have a role to play, as long as we read the signs of the times, think creatively, and use our entrepreneurial muscles. You might just have the next big idea to further help animals, pet owners, and other veterinary professionals worldwide.

Elsie, a spayed ten-year-old miniature Australian Shepherd, presented for a corneal ulceration of her left eye. She had been placed on two different antibiotic eye drops that failed to improve her condition. She had redness in her eye along with cloudiness and oozing. On February 26, 2020, Elsie was seen by an eye specialist who suggested laser surgery to repair the ulcer and remove tissues that were growing over the third eyelid. Optixcare was prescribed to keep the eye moist until the time of surgery. While awaiting surgery, Elsie’s owner sought natural alternatives. Along with continued use of Optixcare, she was directed to place one drop (neat) of each of the following oils in sequence into the orbital socket of the affected eye, three to four times each day: Lavender (Lavandula angustifolia), Cypress (Cupressus sempervirens), Helichrysum (Helichrysum italicum), and Copaiba (Copaifera officinalis). Because corneal ulcers are open sores, these four essential oils were selected for their monoterpenes, offering antiseptic and anti-inflammatory properties. Helichrysum is also known to detoxify the liver.

Elsie prior to essential oil optical therapy (February 26, 2020)

Elsie after essential oil optical therapy (March 22, 2020)

By March 12, Elsie’s eye had improved considerably. The cloudiness was gone, and the oozing had stopped. We opted to continue treatment once daily for an additional ten days until her appointment with the ophthalmologist. Elsie had no adverse reactions and recovered completely — without the need for surgical repair. Contact a VMAA member for guidance on the safe and effective usage of essential oils for your patients — visit www.vmaa.vet. Submitted by Andi Dencklau, CAA, Graduate of Veterinary Medical Aromatherapy (R), with Nancy Brandt. DVM, CVC, CVA, CVMA.

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Photo courtesy of Lexagene

Veterinary medicine has a significant signifi cant need for inclinic point-of-care (POC) tests that can deliver rapid, reference labquality sensitivity and specificity specifi city data.

By Samuel D. Stewart, DVM, DACVECC

RAPID POINT-OFCARE DIAGNOSTICS

IN ANIMAL HOSPITALS In the veterinary clinic setting, rapid point-of-care tests allow for accurate insights to be derived from the results, so clinicians have more confi confidence dence in their prescribed treatment plans. Furthermore, the rapid nature of this type of testing lends itself to producing results in real time, possibly while the patient is still in the hospital, removing the impact of time delays experienced with traditional reference laboratory testing methods. These innovations are on the cutting edge of both veterinary and human diagnostics.

THE NEED FOR FASTER RESULTS In veterinary medicine, clinicians rely on available diagnostic technologies to confi confirm rm diagnoses and provide clinical insight into patient care. In the case of suspected bacterial infections, culture and susceptibility (C&S) tests are routinely ordered to provide defi definitive nitive insight into the causative pathogens, and to determine whether

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antimicrobial resistance is present. Commonly, however, the need to make treatment decisions often precedes obtainment of the C&S results, requiring antibiotics to be prescribed empirically in order to address the suspected infection, improve the patientâ&#x20AC;&#x2122;s symptoms, and to give the client peace of mind that their pet has been offered solutions-focused patient care. Once the C&S results are received, the empiric antibiotic selection is either confi confirmed rmed as effective, or if resistance is demonstrated, the antibiotic is changed. When culture testing is ordered, the collected samples are typically shipped to centralized reference laboratories for C&S testing. The downside of these current testing methods is the time delay involved in shipping samples offsite, in addition to laboratory processing times. The standard turnaround time for C&S testing is three to fi five ve days, with some cases taking up

to one week or longer for certain infection types, or in the case of practices located in rural areas that may be some distance away from testing facilities. Urinary symptoms, such as straining to urinate and blood in the urine, are common reasons for dogs and cats to be taken to the emergency room, with urinary tract infections (UTIs) often being one of the top differentials. A previous study evaluating the prevalence of UTIs diagnosed via C&S demonstrated that 17.5% of cases were positive for at least one bacterial isolate.1 Some of these results could be false negatives; however, the negative samples could also indicate an underlying non-infectious pathology, such as bladder stones or cancer. For some of these disease conditions, the long turnaround time for C&S testing could potentially delay the pursuit of further diagnostics, and achieving a definitive diagnosis, thereby delaying the start of effective treatment for the patient.

PROMISING RESULTS FROM EARLY CLINICAL TRIALS Ethos Veterinary Health is a network of 25 emergency and specialty hospitals located across the US, with significant experience in conducting veterinary clinical trials. Ethos has been working with the molecular diagnostics provider LexaGene to help quickly advance this emerging technology through the development of an in-house PCR analyzer capable of providing accurate infectious disease testing with a rapid turnaround time. In June 2019, Ethos launched the first beta trial of LexaGene's automated PCR analyzer for the detection of urinary tract infections. This trial demonstrated 98.2% concordance between the analyzer results and standard C&S testing. LexaGene and Ethos now seek to conduct further clinical trials for other disease indications, including infectious disease, inflammatory disease, and cancer.

ANTIMICROBIAL STEWARDSHIP

FINANCIAL BENEFITS FOR CLIENTS AND CLINICS Rapid POC testing has the potential benefit of reducing the overall cost of care for the pet owner. If a definitive diagnosis is reached earlier, the need for further diagnostics may be reduced and a more focused treatment plan can be made. The course of an empirically prescribed antibiotic can represent an initially reasonable cost to owners; however, for patients that are found to have complicated infections or antibiotic resistance, there can be further costs associated with multiple hospital visits, diagnostic tests, and adjustments to the treatment plan. The potential cost to the client for rapid POC testing is in line with the cost of prolonged antibiotic treatment, and if used as a first line diagnostic could reduce the overall cost of care to owners whose pets have complicated or resistant infections. The revenue potential represented by POC testing for veterinary practices can complement prescribing revenue, and shift the expense of laboratory services to an incremental revenue stream opportunity for in-clinic testing.

The use of POC molecular testing allows for the improved implementation of antimicrobial stewardship programs that encourage the judicious use of antimicrobials to reduce antimicrobial resistance rates. The focus on antimicrobial resistance to date has been predominantly to measure its impact on human health; however, there is now an increasing focus on veterinarians to adopt a One Health2 approach in veterinary medicine in an effort to curb the development of antimicrobial resistant bacteria. Studies in human healthcare have shown that antimicrobial resistance, especially multidrug resistant infections, significantly impact the ability of practitioners to properly treat infections â&#x20AC;&#x201D; a risk that has been described as one of the greatest threats to human health worldwide.3 Antimicrobial resistance in veterinary patients presents similar treatment challenges for veterinarians and has the potential to transfer this bacterial resistance to humans, which is of particular concern to government, industry, academia, and veterinary organizations who play an active role in the stewardship of antimicrobials used in animals.4 By providing insight into causative pathogens and antibiotic resistance factors, PCR testing can facilitate the use of first-line antibiotics that will reasonably treat the infection and mitigate the temptation for veterinary practitioners to prescribe higher tier antibiotics in treatment, which would represent a divergence from good antibiotic stewardship practices. Continued on page 34.

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Continued from page 33.

DRAWBACKS OF POC ANTIBODY TESTS When in-clinic point-of-care (POC) testing for infectious diseases is available, it can provide clinicians with a greater level of confidence in the therapies they are prescribing. However, in-house POC antibody tests have been shown to lack the sensitivity and specificity that is achieved with laboratory testing utilizing polymerase chain reaction (PCR), which is deemed a gold-standard chemistry used in diagnostics. Also, most antibody tests screen for just one to three pathogens. The one-pathogen tests (singleplex test) are the hardest to support as they often generate false negative results, since many infections can be caused by numerous organisms. This drawback supports the use of more highly multiplexed syndromic testing panels. For example, many POC tick-borne disease tests typically consist of only two or three disease targets, and therefore don’t represent the full spectrum of possible tick-borne infections that can be seen in veterinary patients. This can create the potential for misdiagnosis, and possibly the prescribing of ineffective treatments. Another disadvantage of antibody tests is that they do not provide information on the presence of antibiotic resistance. In contrast, genetic-based tests such as PCR can not only identify the pathogen that causes the symptoms, but can also be used to identify gene sequences

IMPROVED CARE FOR COMPLEX INFECTIONS In addition to antimicrobial stewardship, POC molecular diagnostics could also improve the diagnostic and treatment process in patients with chronic, recurrent, or complicated infections. These patients can often have more complex infections with multiple pathogens, each potentially with a different antimicrobial susceptibility profile. Furthermore, traditional culturing techniques might not always be representative of the full spectrum of pathogens that are present at the site of infection. With these patients being at a higher risk for multidrug resistant infections, there is a higher possibility that they could be started on an ineffective antibiotic pending their C&S testing results. These patients, even more so than those with simple infections, would likely benefit the most from a rapid POC test, especially in the setting of severe infections where a delay in effective treatment could result in progression to sepsis and a significantly higher mortality risk.

TRANSITIONING TO MOLECULAR-BASED POC TESTING The use of molecular-based POC tests is a novel diagnostic approach in veterinary medicine and is not a typical component of the standard diagnostic workflow. Since the empirical prescription of antibiotic treatment is so prevalent in the face of long turnaround times for test results, there may be a reluctance among practitioners to depart from a known treatment practice and financial model. However, as the development of molecular diagnostics progresses in veterinary medicine, and they are demonstrated to have acceptable accuracy, it is expected that their use will eventually become more commonplace. Furthermore, there is significant ongoing research in molecular diagnostics in both human and veterinary medicine, opening the door for a wide range of disease applications that this technology can be used for. Ethos Veterinary Health plans to incorporate molecular-based POC testing at its locations to rapidly triage infections as an innovative approach to patient care and adoption of cutting-edge veterinary medicine technology. LexaGene plans to launch its MiQLab™ system — an automated, easy-to-use PCR analyzer for point-of-care testing — this fall. For further information, visit https://www.ethosvet.com and https://lexagene.com.

that confer resistance to antibiotics. The advantage of highly multiplexed

Author disclosure statement:

syndromic testing panels is that they allow

The work expressed in this article is from Dr. Stewart’s research experience with LexaGene and the MiQLab through his role at Ethos Veterinary Health.

for the screening of multiple pathogen targets at the same time, in addition to antibiotic resistance markers. This method is highly desirable for syndromic

Hall JL, Holmes MA, Baines SJ. “Prevalence and antimicrobial resistance of canine urinary tract pathogens”. Vet Rec. 2013;173(22):549.

One Health-AVMA. Available at: https://www.avma.org/resources-tools/one-health.

testing, reducing the need for numerous

diagnostic tests to obtain a diagnosis,

and increasing the chances of a positive, informative result the first time.

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Llor C, Bjerrum L. “Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem”. Ther Adv Drug Saf. 2014;5(6):229-241. “Supporting antimicrobial stewardship in veterinary settings: goals for fiscal years 2019-2023 — FDA Center for Veterinary Medicine”. Available at: https://www.fda.gov/media/115776/download.

Screening for the early detection of osteoarthritis BY RANDY RINGOLD, BSC, MT(ASCP), MBA

Osteoarthritis (OA) is the most commonly diagnosed joint disease in both human and veterinary medicine. It affects 20% of dogs older than one year and a stunning 80% of dogs over eight.1 Certain breeds are predisposed to OA, with males having higher incidence than females, especially when neutered.2,3 Examples of higher risk breeds include Golden Retrievers, Labrador Retrievers, German Shepherds, Rottweilers, Great Danes, Doberman Pinschers, Mastiffs, St. Bernards, Huskies and Newfoundlands. Many dogs succumb to the crippling effects of OA with most not being diagnosed until it reaches an advanced stage and clinical signs are obvious.4 While NSAIDs remain the mainstay therapy, other modalities such as mesenchymal stem cell (MSC) therapy or plasma rich growth factors (PRGF) are gaining acceptance when NSAIDs fail to provide the relief needed. Regardless, like many diseases, when OA is caught early, more can be done to slow its progression. While the pathophysiology of OA is very complex, aging and inflammation play an important role. As disease progresses, synovitis occurs, allowing Hyaluronic Acid (HA) to leak into the peripheral bloodstream. In the early to advanced stages of OA, serum concentration of HA (sHA) increases as the chondrocytes continue to replace the HA leaking into the bloodstream.1,5 An increasing concentration of sHA correlates with disease severity.6 In patients with late stage OA, there is a decline in

sHA as the chondrocytes have diminished capacity to produce HA; however, with successful treatment using MSC or PRGF, increased concentrations of sHA occur as chondrocytes are reactivated.7 This allows the use of HA for the early detection of OA, and the monitoring of therapeutic intervention.

Serum HA in healthy controls compared to patients with OA.

Screening for OA should start in all dogs over five years of age, and routinely in high risk breeds. The half-life of sHA within blood is less than five minutes, as it is rapidly cleared by the liver. While it is common practice to provide HA as a supplement, manufacturers modify it to delay clearance for 24 hours, to prevent its rapid destruction. To avoid the detection of supplemental HA when testing, stop providing the supplements 48 hours prior to testing. Serum HA testing is currently available through VDI Laboratory, LLC.

vdilab.com Anderson KL, O'Neill DG, Brodbelt DC, et al. “Prevalence, duration and risk factors for appendicular osteoarthritis in a UK dog population under primary veterinary care”. Sci Rep. 2018.

Hart BL, Hart LA, Thigpen AP, Willits NH. “Long-term health effects of neutering dogs: comparison of Labrador Retrievers with Golden Retrievers”. PLoS One. 2014.

Hays L, Zhang Z, Mateescu RG, Lust G, Burton-Wurster NI, Todhunter RJ. “Quantitative genetics of secondary hip joint osteoarthritis in a Labrador Retriever-Greyhound pedigree”. Am J Vet Res. 2007.

Pettitt RA, German AJ. “Investigation and management of canine osteoarthritis”. In Practice. 2015

Hyaluronic acid (HA) is a glycosaminoglycan found in the skin, synovial fluid, and other tissues. It has a unique capacity to bind and retain water molecules, achieving excellent viscoelasticity. These properties mean HA acts as a lubricant and shock absorber, and it is therefore extremely useful in joints.3 Chondrocytes, cells within the articular cartridge, are responsible for the synthesis of synovial fluid, including HA.1

⁵ Thonar EJ, Masuda K, Lenz ME, Hauselmann HJ, Kuettner KE, Manicourt DH. “Serum markers of systemic disease processes in osteoarthritis”. J Rheumatol Suppl. 1995. ⁶ Sasaki E, Tsuda E, Yamamoto Y, et al. “Serum hyaluronic acid concentration predicts the progression of joint space narrowing in normal knees and established knee osteoarthritis — a five-year prospective cohort study”. Arthritis Res Ther. 2015. ⁷ Vilar JM, Rubio M, Spinella G, et al. “Serum Collagen Type II Cleavage Epitope and Serum Hyaluronic Acid as Biomarkers for Treatment Monitoring of Dogs with Hip Osteoarthritis”. PLoS One. 2016.

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From the VBMA

The Veterinary Botanical Medicine Association is a group of veterinarians and herbalists dedicated to developing responsible herbal practice by encouraging research and education, strengthening industry relations, keeping herbal tradition alive as a valid information source, and increasing professional acceptance of herbal medicine for animals. Submitted by Cynthia Lankenau, DVM

The VBMA hopes everyone is safe and healthy. The use of botanical medicines can be very advantageous during these times.

DID YOU GUESS LAST ISSUE’S MEDICINAL HERB? Ramps, Allium tricoccum, is a wild onion species that is native to the Eastern North American forest. Ramps are an endangered herb, so for anyone who plans to go “ramping” next spring, please harvest responsibly. The Native American tribes and inhabitants of Appalachia have long celebrated spring with the arrival of the ramp, believing it to be a tonic capable of warding off many winter ailments. Indeed, ramp’s vitamin and mineral content did bolster the health of people who went without many green vegetables during the winter. The warm juice can be used for earaches. Some Native Americans also used juice from the crushed bulbs to treat insect stings. In humans, all the onion species are diaphoretic herbs that “open the pores” to allow the expulsion of toxins. However, our feline friends have a problem with any significant dose of any of the Allium species, and they can be potentially toxic to dogs as well. Allium species toxicosis typically ensues after consumption of a single large quantity of the material, or repeated small amounts. Dogs and cats are both susceptible to onion toxicosis: consumption of 5 g/kg of onions in cats or 15 to 30 g/kg in dogs has resulted in clinically important hematologic changes. Onion toxicosis is consistently noted in animals that ingest more than 0.5% of their body weight in onions at one time. For anyone who knows how finicky cats can be, that would be eating several grams. In short, do not feed these animals ramps or other Allium species!

TOXICOLOGIC MECHANISM OF RAMPS AND OTHER ALLIUMS The primary toxicologic mechanism of Allium speciesderived organosulfur compounds is oxidative hemolysis,

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which occurs when the concentration of oxidants in the erythrocyte exceeds the capacity of the antioxidant metabolic pathways. Catalase antioxidant activity in erythrocytes is low in dogs, and even lower in cats. Oxidation of the exposed beta-93 cysteine residues present in hemoglobin results in the formation of sulfhemoglobin. Being less soluble than hemoglobin, it precipitates, aggregates, binds to the cell membrane and forms Heinz bodies. Oxidation of hemoglobin globin chains can also result in membrane cross-linking reactions and eccentrocyte formation. The formation of Heinz bodies and eccentrocytes increases erythrocyte fragility and extravascular hemolysis. Direct oxidative damage to the erythrocyte cell membrane and its sodium-potassium pump or the oxidative production of hemin also contributes to cell lysis. The end result is RBC cell death and less oxygen getting to the tissue.

UPCOMING EVENTS Attend the VBMA/ACVBM Virtual 2020 Annual Conference on October 24 and 25, live online! Visit vbma. org for information on purchasing conference notes, or for past webinars. We hope all are staying safe and well in these interesting times!

GUESS THIS HERB!

Join the VBMA at vbma.org to find out. The answer will also be published in the next issue of IVC Journal.

PEER-REVIEWED A discussion of the general diagnostic approach to cats with GI symptoms, along with some of the specialized tests available at reference laboratories. BY YU-AN WU, DVM

FELINE GASTROINTESTINAL DISEASE: A SYSTEMATIC APPROACH TO DIAGNOSIS

Gastrointestinal (GI) disease is common in cats but can often be accompanied by nonspecific clinical signs. Cats tend to hide discomfort well and can present with a different spectrum of clinical signs than dogs or humans. Recognizing feline GI disease thus poses a diagnostic challenge. In this article, we will discuss the general approach to cats with GI signs and review some current specialized tests available at reference laboratories.

WHAT TEST SHOULD I USE FOR A FELINE PATIENT WITH GI SIGNS? The chronicity and severity of clinical signs often dictate which specific laboratory tests should be considered. The diagnostic plan can be complemented by a general guideline in order to approach each patient systematically. For example, in cats with acute diarrhea, the clinician can consider parasitic and enteropathogen testing or empirical anthelmintic therapy. In cases with chronic GI signs (more than three weeks), a broader diagnostic approach may be needed, including evaluation for systemic (minimum database and serum total thyroxine, with added free thyroxine and cTSH for older cats with occult hyperthyroidism) and gastrointestinal causes of the signs (see sidebars on page 38).

TESTING FOR ENTEROPATHOGENS AND PARASITES PCR-based testing is available as a panel to screen for multiple bacterial and protozoal organisms. Indications for performing the panel include: • Diarrhea that is severe (especially in young or immunocompromised animals) • Cases where multiple animals are affected • Screening donors prior to collection for fecal microbiota transplantation. In general, PCR testing has a high sensitivity, so it is important to remember that several of the bacterial organisms and toxins tested are frequently found in healthy animals without diarrhea. Therefore, PCR testing might be useful when initial diagnostics (e.g. fecal exam, ELISA, cytology, or culture) are inconclusive. However, a positive result does not prove causation. The management of uncomplicated cases of diarrhea is nonspecific and supportive. Only animals that are systemically ill (e.g. with evidence of sepsis) should receive antimicrobial therapy. Continued on page 38. IVC Fall 2020

COMPLETE BLOOD COUNT, SERUM CHEMISTRY PROFILE, URINALYSIS A minimum database may not provide a definitive diagnosis and is often unremarkable in cats with primary GI disease. However, it is essential, especially in the older animal with insidious signs, since it enables us to: • Evaluate disease severity (e.g. hydration status, electrolyte balance, blood loss, inflammation) • Evaluate for systemic diseases causing GI signs (e.g., endocrinopathies) • To plan more specialized and potentially more invasive tests or procedures.

COBALAMIN DEFICIENCY LEADS TO MMA ACCUMULATION Cobalamin deficiency leads to accumulation of serum or urine methylmalonic acid (MMA). MMA concentration is often increased in cats with cobalamin deficiency and has been shown to decrease with cobalamin supplementation.17 Some patients with low normal serum cobalamin concentrations have increased MMA concentrations, indicating cobalamin deficiency on a cellular level.17 The MMA assay is not widely commercially available for cats; thus, our current recommendation is to supplement cobalamin in cats with low normal serum cobalamin concentrations.

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Continued from page 37. When diarrhea is suspected to be associated with protozoa, direct fecal or wet mount smears can be performed to detect motile protozoa, such as Giardia and Tritrichomonas foetus. The protozoa trophozoites can be differentiated by their characteristic motion and morphology. Giardia cysts can be detected by fecal flotation with centrifugation techniques. Since false negatives are common, feces from multiple time points should be evaluated. If cytology is inconclusive, further testing such as fecal culture and/or PCR assay for T. foetus, fecal antigen ELISA assays, immunofluorescence assays (IFA), and PCR assays for Giardia spp. are recommended. For cases in which T. foetus is strongly suspected based on cytology or clinical signs, fecal culture of T. foetus can be performed using a commercially available culture system, InPouch TF (BioMed Diagnostics, White City, OR).1,2 This test has an approximately 50% sensitivity, whereas PCR, the gold standard for diagnosis of T. foetus, has a sensitivity of approximately 90%.3 For symptomatic animals suspected of having Giardia spp. infection, it is recommended to perform a fecal antigen ELISA assay in combination with fecal flotation. IFA is recognized as the gold standard for diagnosing Giardia spp. infection, and allows for the concurrent detection of Cryptosporidium spp.4,5 PCR assays for Giardia spp. and Cryptosporidium spp. are generally not indicated unless the animal is known to be positive and the genotype of the organisms is of interest. Further information regarding diagnosis and treatment of parasites can be found on the Companion Animal Parasite Council website (https://capcvet.org/).

MEASURING SERUM FTLI, FPLI, COBALAMIN, AND FOLATE CONCENTRATIONS For cats with chronic GI signs, especially those for which a systemic cause cannot be identified or initial therapies (e.g. diet, anthelmintic therapy) have not resulted in improvement, consider the measurement of serum fTLI, fPLI, cobalamin, and folate concentrations. • Feline trypsin-like immunoreactivity (fTLI) Cats with exocrine pancreatic insufficiency (EPI) often do not display the classic clinical signs described for dogs (polyphagia, weight loss, and unformed feces).6 Indeed, weight loss can be a lone clinical sign in cats with EPI. It is therefore suggested that in cats with unexplained weight loss or chronic diarrhea, serum fTLI should be measured to evaluate for EPI. Although fTLI is highly sensitive and specific for the diagnosis of EPI, it might be increased in cats with renal failure. Also, serum fTLI concentrations can be slightly increased after feeding. Therefore, at least eight hours of fasting is recommended before collecting a blood sample. Both the canine and the feline TLI assays are species-specific, and thus are not affected by pancreatic enzyme supplementation. Serum fTLI concentrations increase in approximately 30% of cats with pancreatitis.7-9 Therefore, in cases of suspected pancreatitis, serum fPLI

measurements are needed. If a high fTLI concentration with a normal Spec fPLI is obtained, intestinal disease should be suspected, as pancreatitis is unlikely. â&#x20AC;˘ Feline pancreatic lipase immunoreactivity (fPLI) Serum fPLI is the current diagnostic test of choice for pancreatitis. In clinical settings, when pancreatitis is suspected, it is recommended to first screen with SNAP fPL (IDEXX Laboratories, Westbrook, ME), for convenience. SNAP fPL is a semi-quantitative test. A negative result helps rule out pancreatitis; a positive result correlates with the serum fPLI >3.5 Âľg/L, and further confirmation is needed. This can be done by performing an abdominal ultrasound or ideally by measuring Spec fPL.10 The latter can serve for evaluating therapeutic efficacy and future monitoring. An increase or decrease by two to three times the previous value may indicate a more significant change in disease state; an increased serum fPLI concentration in a clinically normal cat may suggest subclinical pancreatic acinar cell damage. The influence of renal disease on serum fPLI concentrations is controversial. Serum fPLI concentration was not found to be significantly increased in cats with experimentally induced chronic kidney disease.11 In contrast, another study found that renal insufficiency, but not prerenal azotemia, can result in an increase of Spec fPL.12 However, this study did not report how many cats had other evidence compatible with pancreatitis (e.g. clinical signs, ultrasonography). Therefore, Spec fPL concentration is still considered specific and can be used to diagnose pancreatitis in cats with renal failure. Questions have been raised as to whether feline pancreatitis has been overdiagnosed.13 To avoid over-diagnosis, one should also evaluate other concurrent diseases and diagnose pancreatitis only with a combination of history, physical examination, ultrasonography (where available), and laboratory tests. â&#x20AC;˘ Cobalamin and folate Dietary insufficiency is unlikely to contribute to hypocobalaminemia or hypofolatemia since commercial diets are replete in these water-soluble vitamins. However, animals that are fed exclusively a non-fortified vegetarian diet for prolonged periods without proper supplementation might develop cobalamin deficiency. Measurement of serum cobalamin and folate concentrations can help identify the presence of GI disease associated with malabsorption, since their uptake occurs at specific sites and IVC Fall 2020

not necessarily prompt any therapeutic intervention (e.g., antibiotic administration). However, it is important to note that a normal serum cobalamin and folate concentration does not rule out the presence of intestinal dysbiosis. Historically, hyperthyroidism has been associated with low serum cobalamin, low serum folate, or both. However, in one study of cats with hyperthyroidism, hypocobalaminemia was uncommon.16 Low serum folate concentration might occur with hyperthyroidism in cats but concentrations tend to normalize following establishment of euthyroidism.16 Therefore, if small intestinal disease is suspected in a cat with hyperthyroidism, cobalamin and folate concentrations should be measured, when possible, once the cat is euthyroid.

CONCLUSION depends on several factors. When inflammatory disorders (e.g. IBD, lymphoma, fungal disease) are severe and chronic, intestinal receptor damage can occur. Depending on the affected location, the damage can result in subnormal concentrations of these vitamins.14 A low serum folate concentration suggests proximal intestinal (duodenal, jejunal) disease, while a low serum cobalamin concentration suggests ileal disease; decreased concentrations of both vitamins indicate a diffuse and potentially severe process.

In this article, we have reviewed some routinely available specialized assays for use in cats with GI signs. Many other tests, for example for intestinal permeability and inflammation markers, are being studied. Although most are currently of limited availability and for research use only, more tools are expected to become available to help us evaluate and manage feline patients with GI disease.

G ookin JL, Foster DM, Poore MF, Stebbins ME, Levy MG. “Use of a commercially available culture system for diagnosis of Tritrichomonas foetus infection in cats”. J Am Vet Med Assoc. 2003;222(10):1376-1379.

C eplecha V, Svoboda M, Cepička I, Husník R, Horáčková K, Svobodová V. “InPouch™ TF-Feline medium is not specific for Tritrichomonas foetus”. Vet Parasitol. 2013;196(3-4):503-505.

Serum cobalamin and folate concentrations are often abnormal in cats with EPI, as the exocrine pancreas appears to be the exclusive source of intrinsic factor in cats.15 Serum cobalamin must bind to intrinsic factor in order to be absorbed in the distal ileum. Therefore, cats with EPI almost always have subnormal serum cobalamin concentrations. Also, whereas dogs with EPI often have increased serum folate concentrations due to decreased pancreatic secretion, cats with EPI often have concurrent intestinal disease that may damage folate receptors and thus often have decreased serum folate concentrations. When fTLI is normal, serum cobalamin and folate abnormalities are highly suggestive of intestinal disease.

G ookin JL, Stebbins ME, Hunt E, et al. “Prevalence of and risk factors for feline Tritrichomonas foetus and Giardia infection”. J Clin Microbiol. 2004;42(6):2707-2710.

Rishniw M, Liotta J, Bellosa M, Bowman D, Simpson KW. “Comparison of 4 Giardia diagnostic tests in diagnosis of naturally acquired canine chronic subclinical giardiasis”. J Vet Intern Med. 2010;24(2):293-297.

Vasilopulos RJ, Rickard LG, Mackin AJ, Pharr GT, Huston CL.“Genotypic analysis of Giardia duodenalis in domestic cats”. J Vet Intern Med. 2007;21(2):352-355.

Xenoulis PG, Zoran DL, Fosgate GT, Suchodolski JS, Steiner JM. “Feline exocrine pancreatic insufficiency: a retrospective study of 150 cases”. J Vet Intern Med. 2016;30(6):1790-1797.

Swift NC, Marks SL, MacLachlan NJ, Norris CR. “Evaluation of serum feline trypsin-like immunoreactivity for the diagnosis of pancreatitis in cats”. J Am Vet Med Assoc. 2000;217(1):37-42.

G erhardt A, Steiner JM, Williams DA, et al. “Comparison of the sensitivity of different diagnostic tests for pancreatitis in cats”. J Vet Intern Med. 2001;15(4):329-333.

Steiner JM, Williams DA. “Disagrees with criteria for diagnosing pancreatitis in cats”. J Am Vet Med Assoc. 2000;217(6):816-818.

Schnauß F, Hanisch F, Burgener IA. “Diagnosis of feline pancreatitis with SNAP fPL and Spec fPL”. J Feline Med Surg. 2019;21(8):700-707.

X enoulis PG, Finco DR, Suchodolski JS, Steiner JM. “Serum fPLI and Spec fPL concentrations in cats with experimentally induced chronic renal failure [JVIM abstract 250]”. J Vet Intern Med. 2009;23(3):758.

Folate is absorbed as folate monoglutamate in the proximal small intestine after dietary folate polyglutamate is deconjugated by brush border enzymes located in the jejunum. If folate-producing bacteria proliferate in the proximal small intestine, the bacteria can increase serum folate concentrations by producing folate available for host absorption and/or decrease serum cobalamin concentrations by consuming luminal cobalamin. The finding of hyperfolatemia should be considered in conjunction with other clinical data and should

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Jensch S. “The effect of naturally occurring renal insufficiency on serum pancreatic-specific lipase in cats”. Comp Clin Path. 2013;22(5):801-803.

Bazelle J, Watson P. “Is it being overdiagnosed? feline pancreatitis”. Vet Clin North Am Small Anim Pract. 2020.

Simpson KW, Fyfe J, Cornetta A, et al. “Subnormal concentrations of serum cobalamin (vitamin B12) in cats with gastrointestinal disease”. J Vet Intern Med. 2001;15(1):26-32.4

F yfe J. “Feline intrinsic factor (IF) is pancreatic in origin and mediates ileal cobalamin (CBL) absorption”. J Vet Intern Med. 1993;7:133.

G eesaman BM, Whitehouse WH, Viviano KR. “Serum cobalamin and methylmalonic acid concentrations in hyperthyroid cats before and after radioiodine treatment”. J Vet Intern Med. 2016;30(2):560-565.

Ruaux CG, Steiner JM, Williams DA. “Relationships between low serum cobalamin concentrations and methylmalonic acidemia in cats”. J Vet Intern Med. 2009;23(3):472-475.

INTEGRATIVE APPROACHES TO

CANINE HEMANGIOSARCOMA BY BARBARA ROYAL, DVM, CVA

Combining conventional and alternative treatments is the best approach for dogs with HSA.

Hemangiosarcoma (HSA) is a relatively common and devastating tumor often found in the spleen, skin, heart, or liver. It accounts for approximately 7% of all cancers in dogs. The prognosis depends on many factors, including location/ size of the tumor and the overall health of the patient. Current research does not describe chemotherapy or other conventional approaches to be truly effective for HSA. With pharmaceutical and/or surgical intervention, the conventional prognosis remains similar — less than 10% of HSA patients survive a year. But a multi-pronged approach can improve outcomes.

SURGERY

(e.g. BHA, BHT), pesticides (e.g. glyphosate/Roundup), and byproducts of processing/storage (e.g. high heat in kibble foods, BPA lining in cans). These toxic compounds are absorbed into the vasculature during digestion. Fresh, balanced, and wellsourced (organic) foods are best.

SUPPLEMENTS • Yunnan Baiyao is a well-researched, effective Chinese herbal used to decrease bleeding and support patients with HSA. • Mushrooms, with a plethora of useful bioactive compounds, are essential. Research has shown that mushrooms like Turkey Tail improve cell growth inhibition by inducing apoptosis, and have immunotherapeutic effects.

Is the tumor resectable and is the patient healthy enough to withstand surgery?

• Milk thistle has been shown to prevent oxidative stress damage within the arteries, and to protect against environmental toxins/injury to liver and spleen.

Do it, if possible. Once the troublesome and likely bleeding tumor is removed, nutrition and supplements can help the body fight any other circulating tumor cells.

• Turmeric improves vascular health with its effects on inflammation, oxidative stress, and structural proteins of the artery.

WEIGHT AND DIET

•R ed clover has traditional applications for anemia.

• Assess the dog’s Body Condition Score. Thinner is better. Extra “padding” to fight cachexia won’t increase longevity as much as an overall healthy body will.

• Burdock root is a powerful herbal remedy used to fight cancer.

• Avoid foods and treats with high carbs that can cause inflammation or cancer. Of the three components in food — protein, fat, and carbohydrates — decreased carbohydrates (max 10% to 20% of diet) should be a feature of cancer diets. Avoid dry kibble foods which typically contain 40% to 50% carbs.

• NOW Pets has an Immune Support combination that includes these and a few other helpful supplements for a cancer diagnosis.

• Consider ketogenic diets. Fresh, balanced, raw foods and homemade balanced diets can help. Use the Animal Diet Formulator program (www.animaldietformulator.com) to find cancer support recipes, ketogenic diets, and/or to formulate your own recipes.

• A good probiotic or unpasteurized goat milk also offers benefits.

• Reduce exposure to carcinogens. Sadly, many unhealthy ingredients/carcinogens are found in pet foods — preservatives

•S elenium has been shown to provide long-term vascular protection.

• Daily Omega-3 fatty acids from well-sourced fish oil can be helpful for free radical scavenging.

When we combine the best of conventional medicine with the best of integrative nutrition and supplements, the prognosis for HSA in dogs need not be measured in weeks; we can even see an improvement in overall health. IVC Fall 2020

PEER-REVIEWED

Tongues, pulses, and points:

TCVM DIAGNOSTICS FOR THE BEGINNER BY JODY BEARMAN, DVM, CVSMT, CVA, CVCH

Traditional Chinese Veterinary Medicine, like Western medicine, is an extremely broad subject that can be studied for years. As with any medical system, a little knowledge helps you read the literature more critically and whets your appetite to learn more. This article gives you a start at understanding the TCVM diagnostic approach.

Comprehending the depth and breadth of Traditional Chinese Veterinary Medicine diagnoses requires specialized training. Understanding the origin of the five elements of Wood, Fire, Earth, Metal, and Water, and how each is associated with the organs, is essential. Also imperative is recognizing the tension between the two forces of Yin and Yang, and how it produces harmony, deficiency or excess. This is the basis of disease in Traditional Chinese Medicine/Traditional Chinese Veterinary Medicine. However, you can begin to understand articles written about TCVM by learning what some of the diagnostic information means. In particular, tongue and pulse information forms the backbone of physical diagnostics in TCVM.

TCVM TAKES A DIFFERENT APPROACH THAN WESTERN MEDICINE Traditional Chinese Veterinary Medicine looks at health from a different perspective than Western medicine does. In TCVM,

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health is regarded as the free flow of Qi and Blood without any blockages (Stagnation) along the channels of energy (meridians) in the body. Qi is the life force that animates a being. Without Qi, one is dead. With reduced, deficient, or stagnant Qi, the being (or part of the being) is weakened. Qi is carried in the Blood along meridians in the body, to animate the entire being. When Blood is Stagnant, pain occurs along with a lack of free-flowing Qi. The body needs the correct amount of both Blood and Qi, along with open channels, for optimal function and energy without pain.

TONGUE DIAGNOSIS In TCVM, the tongue is assessed for color, moisture, coating, and shape, and specific locations along the tongue are examined. Tongue color is easily changed by eating (think clover with horses) and forcing the mouth open, so it is best assessed by watching the animal carefully, or if necessary, peeking between the lips to see the tongue without the use of force.

Begin to look at tongue colors in different animals; notice the qualities of your patients’ tongues whenever they show you on their own during examinations, such as when they yawn or stick out their tongues.

occurs with Qi Deficiency, which is often seen in chronic disease or weakness of the whole body or organ system.

Each animal species has a normal tongue color, and in dogs, this can vary by breed, such as the black tongue seen in the Chow Chow. The normal equine tongue color is pale pink, while carnivores have a darker pink color. Young and healthy animals can provide good examples of normal tongue colors. Just as in veterinary school, it is best to learn the normal first, so abnormal can be recognized. Abnormal tongue colors include paleness, red and deep red, shades of purple or lavender, yellow and black (when not physiologically normal).

Tongues also have coatings. A normal tongue coating is thin and usually white, but can be other colors depending on the species and food in the mouth. A thin coating can be normal, whereas a thick coating tends to be seen with deeper or more chronic disease. Heat is indicated with a yellow coating, with deeper coloration indicating a more severe issue.

• Paleness can indicate a Qi or Blood Deficiency. A Qi-deficient tongue tends to be wet, often with teeth marks on the lateral edges due to swelling. Blood Deficiency is always associated with dryness and may or may not be associated with anemia. Often, a pale tongue associated with anemia is seen earlier than the condition is indicated by laboratory values. A Blood-deficient tongue tends to be dry as well as pale. • Red or deep red can indicate excess Heat in the body or Yin Deficiency (broken air conditioner of the body). Yin Deficiency is a lack of coolness and is frequently seen in older animals or those with chronic disease, but it can also be seen in some young animals. For example, patients with diabetes mellitus can have a red tongue without a coating due to a lack of coolness and moisture. On the other hand, a red or deep red tongue due to excess Heat will have a coating, as seen in animals with heat stroke. • Purple or lavender indicates Stagnation, which can be due to pain (Qi and or Blood Stagnation). It can also be due to Stagnation of Qi associated with an organ. An example is Liver Qi Stagnation, which can have varied causes, including the animal’s personality (decisive, assertive, competitive); external factors that affect the liver, such as medications or toxic substances; stressors in an animal with the aforementioned liver (Wood) personality; or liver/spleen disharmony, in which a gut issue affects the liver and/or gallbladder (e.g. triaditis in cats). • Yellow indicates Damp in the liver, or icterus. Tongues can be dry or wet. A dry tongue will be seen in excess Heat conditions such as acute pneumonia or heat stroke, since the Heat is so extreme and/or quick that it dries up the Yin. Dryness will also be seen with a Deficiency of Yin, which is cool and wet; or Blood, which is warm and wet. A wet tongue

YIN and

YANG These are opposite and controlling forces of one another: • Yin is cool, quiet, restful and predominates at night. • Yang is active, hot, and predominates during the day.

A swollen tongue, as mentioned earlier, can indicate Qi deficiency, but in some cases can also indicate a Heat pattern, so both color and coating must be considered. A thin tongue can indicate Blood or Qi deficiency. The tongue also has a “map” of the organs, with the tip of the tongue indicating the Heart element. Just caudal to the Heart element is the Lung element. The lateral edges of the tongue caudal to the Lung element contain the Liver and Gallbladder, while the Kidney element is on the caudal aspect of the tongue. Depending on where a coating, shape change, or crack in the tongue is located, issues with the corresponding organ system can be identified. One example is a deep red color or cleft at the tongue tip, which can indicate diseases of the Heart element.

PULSE DIAGNOSIS As with the tongue, the pulses are a window into imbalances in the body and are important for determining a TCVM Pattern diagnosis. The pulse is assessed in various locations, depending on species. Cats, dogs, goats, and sheep have their femoral pulses checked. Equine pulses are palpated using the common carotid at the base of the neck or external maxillary artery, while the ventral tail (median caudal artery) is assessed in the bovine. Pressing on the artery determines its strength/character on the surface (superficial), or with increased pressure, at a middle and deep location. Pulses on the left side, when weak, indicate Blood or Yin Deficiency. Weakness in the right-sided pulses indicate Qi IVC Fall 2020

MERIDIANS AND POINTS Meridians, the channels of energy that carry Blood and Qi from the organs to the entire body, are an important concept in TCVM. Acupuncture and acupressure points are often located on these channels of energy, which vary somewhat by species. Acupuncture points are denoted by the meridian, such as BL for Urinary Bladder Meridian, and a number, such as 67, which is the last point on the BL meridian, located on the lateral hind foot. Meridian maps for dogs and horses are easily accessible. Acupuncture points can have local and systemic effects on the body. Each point is decided on by knowing the correct TCVM Pattern diagnosis. If the diagnosis is Spleen Qi Deficiency, points are chosen that strengthen the Spleen (gastrointestinal tract). If the diagnosis is Liver Qi Stagnation, points to relieve Stagnation of the Liver are treated. Yin Deficiency is treated by tonifying or strengthening the Yin, and Blood Deficiency is likewise treated with Blood tonification. Excess Heat requires draining the Heat, and Phlegm can be reduced by specific Phlegm reduction points. Other techniques can be used on acupuncture points. These include aquapuncture, which involves the injection of various sterile substances at a point to prolong its stimulation; electroacupuncture, to give a very strong long-lasting stimulus between acupoints; and moxibustion, the burning of mugwort at a point to warm and strengthen it.

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FIRE

WOOD

The five elements and associated organs • Wood (Liver, Gall Bladder) • Fire (Heart, Small Intestine) • Earth (Spleen, Stomach) • Metal (Lung, Large Intestine) • Water (Kidney, Bladder)

WATER

EARTH

METAL

Deficiency. Left-sided locations include the Heart, Liver and Kidney Yin, while right-sided locations include the Lung, Spleen (gastrointestinal), and Kidney Yang (Qi plus Heat). • A strong and forceful pulse indicates an Excess pattern, while a weak pulse indicates Deficiency. • Slow pulse indicates Cold, while a fast pulse indicates Heat. • Slippery pulse is palpated in pregnant animals, and can indicate Excess Phlegm (something not normally in the body or mind of healthy animals, other than pregnant ones). • Wiry pulse feels like a tight violin string, and most frequently indicates Stagnation. Pulse diagnosis is a great skill to develop, and whole book chapters are written on the variety of pulses and their association with different disease syndromes. When a clinician starts this process, however, it is important to remember the basics of determining pulse strength (strong or weak), the character of the pulse at organ spots and levels (superficial, middle, deep), and any unique quality it may possess (wiry). Pulse and tongue diagnostics, combined with a medical history and the rest of the physical exam, form the basis of a TCVM Pattern diagnosis, which is then used to determine the best course of treatment, including acupuncture, Chinese herbal medicine, food therapy, and Tui-na (Chinese massage techniques) to help bring the body back into balance. Traditional Chinese Veterinary Medicine (TCVM) is very different from Western veterinary medicine in diagnostics and treatment. Both systems, however, have the same goal — to achieve health for our animal patients. Knowing something about tongue and pulse diagnostics is a good first step toward understanding the TCVM approach.

MAINTAINING MOMENTUM:

TELEMEDICINE AND OTHER TECHNOLOGY ADVANCES ARE HERE TO STAY

BY HILARY JONES, DVM

The changes we've had to make due to the pandemic give us the opportunity to restructure vet med with a focus on innovation and personal wellness. Prior to the pandemic, veterinary medicine was already changing, but the challenges brought forth by the outbreak have quickened its evolution. The growth of telemedicine and the development of curbside service have transformed where and how we offer care to our patients. As the profession moves forward, some old routines will return, some new ones will be created, but we can and should use this opportunity to push for positive changes. In this new world, telemedicine is going to be integral to how care is delivered. Pet owners have enthusiastically adopted it and are not going to give it up willingly. In 2018, JAVMA published a study on digital post-surgical rechecks which showed that “owner-reported satisfaction with the recheck examination did not differ substantially between the telemedicine group and control group” and that pet owners would preferentially pick digital appointments in the future.1 Many veterinarians discovered the benefits of telemedicine during COVID, but the advantages were present before, and still extend into post-pandemic practice. As Tim Atkinson, Executive Director of the New York State Veterinary Medical Society puts it: “If you think of being able to charge someone for a consultation — the alternative was by phone. You didn’t make any money and you didn’t manage to see the pet. Now you can actually see the pet and earn a fee. So, I think people will find this valuable and will carry on.” As we envision the future, we have the opportunity to realign practice values. The status quo of previous generations may not reflect the vision of a more diverse field of veterinarians. Recently, personal and mental health has started to achieve the attention it deserves. With only 24% of veterinarians under 34

recommending their job to friends, it’s time to make a change.2 Technology, like telemedicine, can set boundaries for when and how vets interact with clients, allow flexibility around where care is provided, and reduce workplace stress through tools for improved time management and communication. Clearly, not everything can or should be done remotely, but we’ve learned the definition of an exam room is more fluid than we previously thought. By being able to charge appropriately for our time and expertise, we are reinforcing our value, not only within our practices, but to our communities as well. Now is not the time to return to the way things were out of habit. It’s time to lean into new technology as we did with electronic medical records, digital radiography, and the other tools that each, in turn, revolutionized the practice of medicine. Veterinary medicine started as equine practitioners for the cavalry. We are now honorary members of many families and have vital roles in industry, policy, and on the One Health stage. The adoption of new technology, like telemedicine, wearables, and the integration of large scale data analytics, is necessary for the evolution of the field as a whole. Our next challenge is to help our profession recover and find its way “for the benefit of society”, our colleagues, and our patients.

B ishop G, Evans B, Kyle K, and Kogan L. “Owner satisfaction with use of videoconferencing for recheck examinations following routine surgical sterilization in dogs”. J Am Vet Med Assoc 2018;253(9):1151–1157.

L au E. “Survey: Majority of veterinarians don’t recommend the profession”. VIN News 2018; Feb. 6. Accessed at: https://news.vin.com/VINNews.aspx?articleId=47603.

Dr. Hilary Jones graduated from Tufts Cummings School of Veterinary Medicine and completed a small animal rotating internship at Fifth Avenue Veterinary Specialist, now BluePearl Downtown. During her time as a primary care and emergency clinician in New York City, she developed TeleTails to better connect with her clients and their pets. Since its launch, Dr. Jones has been working with veterinary teams across the country to help veterinary medicine safely evolve digitally. IVC Fall 2020

Aging problems in cats: helping clients through the golden years Offer your clients the guidance they need to enhance their cats’ quality of life and longevity throughout the aging process. BY PETE WEDDERBURN, BVM&S CERTVR MRCVS

As cats grow older, their ability to function can decline — sometimes significantly. Clients become understandably concerned, hoping to keep their cats comfortable and healthy as long as possible. As veterinarians, we can make life easier for aging cats and their owners by offering practical takehome advice.

LET CLIENTS KNOW THAT A CERTAIN LEVEL OF DECLINE IS NORMAL A little bit of reassurance can go a long way toward giving clients peace of mind. Help them understand that cats can suffer from age-related feline cognitive dysfunction (FCD) that can contribute to a variety of issues, including: • Anxiety • Aggressive reactions • Changed Changed social behavior with the people and other pets in the home

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• Altered sleeping patterns • Forgetting where food is or eating less • Grooming less • Forgetting where the litter box is located • Eliminating near eating or sleeping areas • Appearing A ppearing lost in familiar locations, or wandering aimlessly • Appearing Appearing uninterested in interactions, or suddenly seeming clingy and over-dependent. If cognitive dysfunction is present, you can explain that medication might help. Selegiline hydrochloride (Anipryl®) is used to treat cognitive dysfunction in dogs, but there is anecdotal evidence from vets and behaviorists concerning its ability to improve functioning in cats with FCD.

ENCOURAGE CLIENTS TO KEEP CATS COMFORTABLE AT HOME

particularly if these supplements are added before time takes too much of a physical toll on the cat’s body.

Even when cognitive functioning seems normal, vision changes, hearing changes, and mobility challenges call for special accommodations. Geriatric cats might appreciate:

STRESS THE IMPORTANCE OF REGULAR VISITS

• Night lights in important areas such as near the litter box, food bowls, and frequently-traveled routes throughout the house • Area rugs or yoga mats placed on slippery sections of floor • Stick-on scent markers such as Tracerz® can help blind cats find their way around • Warming beds to comfort aging, achy joints • Litter boxes with low sides for easier access • Additional litter boxes placed where they are easy to find and access • Pheromone therapy to help with anxiety • Anti-anxiety medications to ease worries and help reduce the loud, repetitive vocalizations that can accompany cognitive and physical decline • Ramps to access favorite resting spots such as the sofa or a window seat.

ENCOURAGE PROPER NUTRITION Some clients might not realize that the right food can help cats stay healthy and comfortable as they age, so be sure to mention therapeutic diets if they are warranted. Mention the increased importance of hydration for stable kidney functioning, and recommend switching to wet food from dry when cats might not be drinking quite enough.

Clients can help their cats stay comfortable and healthy by taking them for more frequent check-ups — every six months or so instead of just once a year. Regular bloodwork, urine testing, and physical examinations often catch problems in their early stages when they’re easier to control and less costly to treat. Finding and correcting problems early means less stress for cats and their owners alike, as well as improving the quality and length of cats’ lives.

CONCLUSION With compassionate guidance from veterinarians, clients can face aging issues from a well-informed place. Knowing what to expect and how to approach problems empowers clients and makes it easier for them to give their geriatric cats a better quality of life. Pete Wedderburn, BVM&S CertVR MRCVS, is well known as a media veterinarian with regular national TV, radio, and newspaper slots, including a weekly column in the Sunday Telegraph since 2007. Pete is known as "Pete the Vet" on his busy Facebook, Instagram, and Twitter pages, regularly posting information on topical subjects and real-life cases from his clinic. He also writes a regular blog at petethevet.com and allaboutcats.com His latest book, Pet Subjects, was published by Aurum Press in 2017.

In addition, you can explain that supplementing with glucosamine and chondroitin can help improve joint comfort,

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Treating a veterinary oncology patient is complex, and it’s rare to find a single solution that addresses all dimensions of recovery. A multimodal approach often produces ideal outcomes.

BY ROBERT J. SILVER, DVM, MS

THE VETERINARY ONCOLOGY TOOLKIT: TAKING A MULTIMODAL APPROACH Multimodal approaches to animal oncology are a growing field of study. Immunonutrition and chemoprevention are acknowledged as ancillary treatments that may benefit cancer patients on chemotherapy. They have been shown to reduce the severity and occurrence of adverse events and infections, thus improving quality of life and survival times. By incorporating a range of complementary solutions into an individualized care plan, veterinarians can help increase comfort while improving outcomes.

WEAKENED IMMUNE SYSTEM AND CHRONIC INFLAMMATION Without a strong immune system, cancer can grow unchecked. Further, while immunosuppressive side effects from chemotherapy are rare in animals, they still sometimes occur, making immune adjuvants doubly important for recovering and fighting off secondary infection.

LOW VITAMIN D LEVELS Cancer occurs when cells don’t mature, replicate, or die in a healthy way. Recent research indicates there is a correlation between vitamin D deficiency and the incidence of certain cancers in dogs and cats.

• Beta glucans — Blending beta glucans with immune-modulating herbs such as astragalus and licorice root have been shown to improve cell-mediated and humoral immunity over betaglucans used alone. • Curcumin — Curcuminoids have been found to provide health benefits to the immune system through both upstream and downstream cell signaling molecules. • L-glutamine — Glutamine has been shown to reduce the development of mucositis from chemotherapy drugs in the gastrointestinal tract. • Omega-3 fatty acids (EPA and DHA) — In addition to numerous other benefits, Omega-3 fatty acids can help create a healthy response to inflammation. Studies indicate that EPA

Animals mainly obtain vitamin D from their diets. When this isn’t sufficient, vitamin D supplements can help encourage healthy cell lifecycles and reduce chronic inflammation. The best supplements contain cholecalciferol, a precursor to vitamin D3 in animals. To get an accurate idea of vitamin D levels, regular testing is recommended. Accurate, simple, and convenient vitamin D test kits are now available to veterinarians.

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There are several natural options for immune system modulation. It is important to research each active ingredient to ensure it is right for the patient.

and DHA can also sensitize cancer cells to the cytotoxic effects of chemo and radiation therapies without harming healthy cells. DIARRHEA AND NAUSEA As a side effect of chemotherapy, some animals may experience gastrointestinal problems. Cannabinoids and terpenes found in extracts of cannabis reduce nausea by binding to receptor sites in the brain stem that control nausea. Hemp oil extracts, with their naturally low, nonintoxicating levels of THC, are safe and effective tools to help restore quality of life. The secondary metabolites of chemotherapy eliminated through the bowel cause chemo-related diarrhea. Calcium aluminosilicate clay can adsorb these metabolic by-products, thus reducing the incidence of diarrhea post-chemotherapy. These clays have also been found to bind to bacterial toxins and inflammatory cytokines in the gastrointestinal tract, without interfering with nutrient or pharmaceutical absorption.

Dr. Robert J. Silver is a 1982 graduate of Colorado State University’s College of Veterinary Medicine. He serves as Chief Medical Officer of RxVitamins, and authored the book, Medical Marijuana and Your Pet. Dr. Silver is vice president of the American College of Veterinary Botanical Medicine, past president of the Veterinary Botanical Medicine Association, and was on the board of directors for the American Holistic Veterinary Medical Association.

nutrition nook

By initiating discussions about nutrition each time pet parents visit the practice, veterinary technicians can directly impact the lifelong health of their patients.

BY KARA M. BURNS, MS, MED, LVT, VTS (NUTRITION)

Technicians as teachers:

tapping their expertise to educate clients about nutrition Nutrition applies to every patient of a veterinary practice. Out of three primary components affecting the life of an animal — genetics, nutrition, and environment — nutrition is the one factor the veterinary healthcare team can impact.1 Proper nutrition and feeding management is the foundation upon which healing and the maintenance of health rests.

diseases and assist in the management of other conditions. Incorporating nutritional assessments into each appointment is key; each assessment should consider the animal’s health, current diet, feeding practices, and environment. Nutritional assessments are iterative; each factor affecting the animal’s nutritional status is assessed and reassessed, as often as needed.

The positive impact of proper nutrition on health and disease is well established in all animals. Appropriate feeding during each life stage helps maintain health and support healing from disease and injury, as well as prevent diet-associated

THE TEAM APPROACH TO NUTRITIONAL EDUCATION The American Animal Hospital Association (AAHA) recommends five vital assessments of patient health at every IVC Fall 2020

CLIENT COMMUNICATION Education, patience, and support are important keys to communicating with pet owners about nutrition.

q Take the time to educate — it will help increase compliance and provide the patient with the best care.

w Remember to include why a specific food is being recommended. Clients want to know how specific recommendations help their animals stay healthy or manage a disease condition.

e Calculate the initial feeding amount. Introduce the concept of using an 8oz measuring cup for feeding.

examination to ensure the highest standard of care.2 These five vital asssessments are: temperature (T), pulse (P), respiration (R), pain, and nutrition. Thanks to the nutritional assessment guidelines from both AAHA and WSAVA, the initiative to consider nutrition the fifth vital assessment helps promote it as a standard of care. Veterinary technicians are already responsible for TPR and pain recognition; adding nutrition to their essential task list adds a new challenge, along with enhanced job satisfaction, increased client compliance, and most importantly, patient health. Nutritional assessments and client education should be veterinary technician-driven.

r Emphasize the total energy intake, and stress that the patient should be fed only what has been recommended. Consistency in feeding is critical, and that includes feeding only from a designated dish.

t Allow for treats. Snacks and treats are important to the human–

animal bond and should not be eliminated. It is important, however, to account for the calories contributed by treats. As with all life stages, treats and snacks should never make up more than 10% of the animal’s daily calorie intake.6 If veterinary technicians do not allow for treats, the owner will still treat — and not share it with the veterinary team. This can have significant consequences on the patient’s weight, nutrient intake, and disease condition management. By allowing the owner to provide veterinary teamapproved treats and quantities, the patient will be better managed.

y Allow time for the client to ask questions. u Ensure the recommendation and plan is written down for the client and is included in the pet’s medical record.

i Explain how to transition if a diet change has been recommended.

If a change in diet causes the animal to have diarrhea, the client will switch back to the original diet and dismiss all the information you worked so hard to provide.

o Follow up with the client to successfully implement the nutrition

plan. Evaluate, adjust, communicate, and encourage on a consistent basis. It is important to call owners the next day to ensure their understanding of your nutritional recommendations and to answer any questions they may have considered since discharge. Another follow-up in two weeks and then two months (if the patient does not have a re-check scheduled) is important so the patient and the owner do not get “lost” in the business of the hospital. Email and texting (if client permission is received) are all quick and simple ways to follow up as well. Prior to discharge, make sure the owner is given a business card with the name of the technician, along with his/her contact information, and hours available.

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Integrating preventive healthcare into a practice requires commitment and engagement by the entire veterinary team. A strong preventive program will promote practice success by optimizing pet health, enhancing the client-pet relationship, and building long-term client relationships with the practice. Nutrition is a key component of any preventive health care program, and client interest in learning about the best nutrition for their pets is growing. Pet parents look to their veterinary team as experts in healthcare, as well as for nutritional advice. In an AAHA study, 90% of clients wanted nutritional recommendations, yet only 15% perceived they were given any.3 The AAHA compliance study revealed that only 7% of the pets that could potentially benefit from therapeutic foods were actually receiving that therapy.3 There is tremendous opportunity for veterinary technicians to fulfill this role rather than allow clients to gain nutritional information from nonveterinary personnel or the internet.

THE NUTRITIONAL ASSESSMENT Every animal that presents to the hospital, and every time they present, should have a nutritional assessment. Feeding goals, determined by the pet’s physiology and/ or disease condition, should be created. The role of the veterinary technician is to establish patient history, score the

An example of a Nutritional History Questionnaire created by the author. patient’s body condition, work with the veterinarian to determine the proper nutritional recommendation for the patient, Nutritional History Questionnaire and communicate this information to the Date______________________ Pet’s name ________________________ pet owner. Species _________________ Breed___________________________________ Date of Birth_________________________________ Gender___________________________ Neutered/Spayed___No____ Yes The first step in evaluating a pet and • Tell me about your pet’s living environment determining the nutritional status is to take Indoors Outdoors Both • Do you have other pets? No Yes a thorough history, including signalment If yes, list here____________________________________________________ (i.e. species, breed, age, gender, reproductive • Are pets fed separately? No Yes If yes, please describe______________________________________________ status, activity level, and environment). • Tell me about your pet’s appetite. ________________________________________________________________ Next, a nutritional history should be taken • Who feeds your pet? to determine the quality and adequacy of ________________________________________________________________ • What changes have been made to your pet’s diet in the past 30 days? the food being fed to the pet; the feeding ________________________________________________________________ protocol (e.g. whether the pet is fed at designated meals or has free choice, the Food/Treat Form Amount/How Often/Date Started amount of food given, the family member ● Please list the brands and product names (if applicable) and amounts of ALL responsible for feeding the pet); and the foods, treats, snacks, dental hygiene products, rawhides, and any other foods that type or types of food given to the animal. your pet is currently eating. _________________________________________________________________ The technician should ask the owner open● Tell me what supplements your pet receives. ended questions (see sidebar on page 52). _________________________________________________________________ What medications is your pet taking and how is each administered? This type of questioning helps uncover more _________________________________________________________________ • Tell me about the toys your pet enjoys. information, as it gets the owner talking; _________________________________________________________________ closed-ended questions typically end in • Tell me about food or treats not formulated for pets that your pet receives. _________________________________________________________________ one-word answers, thus potentially not • Tell me what foods/treats are NOT tolerated by your pet. _________________________________________________________________ uncovering everything the patient eats in a • If you are going on vacation and I am your pet sitter, tell me everything I need to day. It also has the potential to put the pet do for your pet while you are gone. _________________________________________________________________ owner on the defensive, thus sabotaging ____________________________________________________________________________________________________________________ any relationship the veterinary technician ©Kara M. Burns is trying to build with her — especially when it comes to nutrition. The technician should also ask the owner about the animal’s access to foods, person in the household feeding the pet, is the animal supplements, and medications, and how much of each the pet getting more calories than recommended, etc.) and begin to consumes each day. Pets also may be fed by more than one establish a feeding protocol to insure the patient’s proper family member or receive numerous treats throughout the calorie consumption (see an example of a Nutritional History day. All these factors play a role in proper nutrition. Questionnaire above).

All members of the healthcare team should be familiar with taking a nutritional history, so that the team can pinpoint a breakdown in owner compliance (e.g. is more than one

NUTRITIONAL CALCULATIONS Veterinary technicians should be comfortable with calculating the amount of food needed to meet the appropriate energy

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EXAMPLES OF

OPEN-ENDED QUESTIONS

• What does your animal eat over the course of a day? • What other pets and family members are in your household? • What is your pet’s appetite like? • How about any changes in elimination habits? • Which supplements does your pet receive, if any? • Which medications is your animal on?

needs of each patient. The pet’s daily energy requirement (DER) reflects his activity level, and is a calculation based on his resting energy requirement (RER). Veterinary technicians should have these calculations memorized or on laminated note cards in every exam room (along with a calculator) for easy access! The most accurate formula for determining the RER for a cat or a dog, regardless of the breed, is: RER kcal/day = 70(ideal body weight in kg)0.75 or RER kcal/day = (kg x kg x kg, √, √) x 70 Once RER is determined, DER may be calculated by multiplying RER by a standard factor specific to the life stage and body condition of the animal.

BODY CONDITION SCORING The healthcare team should document the pet’s body condition score (BCS) and weight at every visit, as part of the physical examination. Body condition scoring is a subjective assessment that is important when determining whether a dog or cat is at a healthy weight, and when substantiating a diagnosis of obesity. It allows healthcare team members to assess a patient’s fat stores and muscle mass, helps in evaluating weight changes, and provides a value that can be used in team communication.

whereas the nine-point scale is scored to the whole point.4 It is important for all members of the healthcare team to use the same scoring system from the outset so as not to confuse or miscalculate the patient’s score. Body condition is assessed by beginning at the head of the pet and working toward the tail. Fat cover is evaluated over the ribs, down the topline, around the tail base, and ventrally along the abdomen. On the five-point scale, a score of 1 represents “too thin” and 5 represents “obese”; a score of 3 means “ideal.” According to body composition studies in cats and dogs, a body condition of 15% to 25% fat is optimal; therefore, a pet with an ideal BCS has 15% to 25% body fat. A pet with a BCS indicating he’s overweight has 26% to 35% body fat, and a pet with a BCS indicating obesity has more than 40% body fat.5 BCS is a tool that owners can use at home to monitor their pets. Veterinary technicians should demonstrate how to assess body condition on the animal while in the exam room and have the client perform one as well. Doing this together helps ensure understanding and proper scoring. Have the client perform a BCS monthly at home and forward the results to the clinic to have it added to the patient’s medical record! A veterinary technician’s goal is to help patients live a long, happy, and healthy life, and proper nutrition is the cornerstone of that goal. Therefore, it is imperative that veterinary technicians play an active and leading role in educating clients about proper nutrition for their pets. Even animals that are not sick may not have optimum wellness. Pet parents who understand that nutrition preserves and lengthens their relationship with their animals are much more likely to become regular consumers of veterinary medical services, regardless of economic conditions. The veterinary healthcare team should focus on proper nutrition for every animal that presents to their hospital. To do this, veterinary technicians should be responsible for performing complete nutritional histories and patient assessments, as well as for educating pet parents about proper nutrition for their beloved animals.

Burns KM. “Proper Nutrition: Is the New Emphasis a Fad?” Veterinary Team Brief. June, 2014:8-9.

Baldwin K, Bartges J, Buffington T, et al. “AAHA Nutritional Assessment Guidelines for Dogs and Cats”. JAAHA. 2010;46:285-296.

“The path to high quality care: practical tips for improving compliance”. American Animal Hospital Association, Lakewood, CO:AAHA Press;2003.

Burns KM. “Why is Rocky so Stocky? Obesity is a disease”. NAVTA Journal Convention Issue. 2013:16-19.

The two most common BCS systems are the five-point scale and the nine-point scale. Both rating scales use nine points, but the five-point scale is scored to the nearest half-point,

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Brooks D, Churchill J, Fein K, et al. “AAHA weight management guidelines for dogs and cats”. J Am Anim Hosp Assoc. 2014;50(1):1-11.

Fascetti AJ, Delaney SJ. “Feeding the healthy dog and cat”. Applied Veterinary Clinical Nutrition. Ames, IA: Wiley Blackwell; 2012: 75-94.

From the

AATCVM The American Association of Traditional Chinese Veterinary Medicine (AATCVM) is a non-profit organization founded in 2006 to support practitioners of Traditional Chinese Veterinary Medicine (TCVM) and promote high quality research in all aspects of TCVM, including acupuncture, Chinese herbal medicine, Tui-na and food therapy. The AATCVM promotes the practice of evidence-based TCVM by funding high quality studies of the basic science and mechanisms of action of treatments and randomized clinical trials of the efficacy of treatments.

THE WATCVM NEWSLETTER Membership with AATCVM (publisher of the American Journal of Traditional Chinese Veterinary Medicine) is combined with the World Association of Traditional Chinese Veterinary Medicine (WATCVM), which publishes a quarterly TCVM newsletter, an excellent resource for continued education and TCVM news updates. For example, the 41st issue of the WATCVM newsletter features a dive into the historical viewpoint of TCM/TCVM on the concept of infectious diseases. In addition, the bulletin always carries interesting case reports showcasing the clinical benefits of TCVM for a variety of species. In this same issue, for instance: • Dr. Seungchul Lee presents the case of an eight-year-old Shih Tzu with difficulty walking and cold extremities. A TCVM pattern diagnosis of Spinal Cord Qi-BL Stagnation with Kidney Yang Deficiency was made, based on neurological deficits, symptoms of Cold, and deficient pulses. Successful

resolution of this Bony Bi Syndrome was achieved with dry needle and electro-acupuncture, moxibustion and Chinese herbal medicine. • Dr. Lauren Javernick reports on the treatment of a nonhealing leg wound in a three-year-old thoroughbred mare diagnosed with hemangiosarcoma with metastasis to the lungs. After a poor prognosis for treatment with conventional medical therapy, Dr. Javernick treated the case with acupuncture and Chinese herbal medicine, both topically and systemically. The leg mass resolved, and the mare has successfully produced two normal foals.

JOIN US FOR THE 22ND ANNUAL TCVM CONFERENCE We invite you to attend this year’s Annual International Conference on TCVM — an exciting learning and networking opportunity for veterinarians and TCVM experts. Cosponsored by Chi Institute and WATCVM, this year’s event will focus on gastrointestinal and hepatobiliary diseases in dogs, cats, and horses. Hosted at the Chi Institute campus in Reddick, FL, the conference (32 CE hours pending RACE approval) will span four days from November 19 to 22. Enjoy two days of lectures from world-renowned TCVM experts, and two days of rotating, hands-on workshops. Due to COVID-19, the conference will also have a virtual attendance option, with all lectures and workshops live-streamed via Zoom and recorded for three months of convenient online access. SUBMITTED BY JUDITH E SAIK, DVM, DACVP, CVA, CVCH, CVFT

IVC Fall 2020

news bites STUDY SHOWS KIDS WITH DOGS FARE BETTER THAN THOSE WITHOUT The results of a recently-published study led by researchers at The University of Western Australia, and funded by the Human Animal Bond Research Institute (HABRI), demonstrate that young children from dog-owning households are less likely to experience difficulties with their emotions and social interactions compared to children without dogs. The study was published in the journal Pediatric Research. The team of researchers, led by Dr. Hayley Christian, Associate Professor at The University of Western Australia, collected survey data from 1,646 households, taking into account the children’s ages, biological sex, sleep habits, screen time, and parents’ education levels.

PRP LYSATE CAN HELP WITH EQUINE JOINT INFECTIONS Researchers at North Carolina State University have developed a platelet-rich plasma (PRP) lysate that, when teamed with antibiotics, can eradicate bacterial biofilms common in persistent equine joint infections. To create the lysate, the research team took blood from horses and isolated the platelets. They then packed 50 times the number of platelets that would be found in an equal amount of blood into their product, and lysed the platelets to release antimicrobial peptides — proteins that attack bacteria. The team separated out the antimicrobial peptides, then after testing them against common bacteria, all the horses’ peptides were pooled together for one lysate product. Synovial fluid from the horses’ knees was collected with taps, and the fluid was seeded with bacteria in the laboratory and allowed to grow biofilms. Finally, researchers tested three methods to attack the biofilms; antibiotics alone, lysate alone, and a combination of antibiotics and lysate. The researchers found that antibiotics alone were completely ineffective. The lysate alone significantly decreased the bacterial load. The antibiotic and lysate combination, however, completely eradicated the biofilms and bacteria. onlinelibrary.wiley.com/doi/ abs/10.1002/jor.24584

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Findings indicate that dog ownership is associated with improvements in well-being and social-emotional development in children. Specifically, children in dog-owning households were 23% less likely to have difficulties with their emotions and social interactions than children who did not own a dog. They were also 30% less likely to engage in antisocial behaviors; 40% less likely to have problems interacting with other children; and 34% more likely to engage in considerate behaviors, such as sharing. habri.org

NEW FELINE VACCINE GUIDELINES The American Animal Hospital Association (AAHA) and the American Association of Feline Practitioners (AAFP) recently released the 2020 AAHA/AAFP Feline Vaccination Guidelines, which provide updated recommendations and the most current information for feline vaccinations. The new guidelines stress the need for an expanded understanding by veterinary professionals of individualized feline risk factors to determine a proper preventive healthcare plan. Practitioners are encouraged to gain better insight into feline patients’ risk factors, which may include life stage, environment, and lifestyle. The guidelines provide resources for the entire veterinary team, including: • A lifestyle-based feline vaccine calculator • FAQs and tips for client and staff education • Recommendations for core and non-core vaccines for pet and shelter-housed cats • A webinar summarizing the must-see and clinically important sections of the guidelines (available in October). With these new guidelines, the veterinary team can educate pet owners about vaccination protocols, provide proper vaccine recommendations for pet and shelter cats, and have open conversations to address clients’ questions or concerns. Learn more at aaha.org/felinevaccination and catvets.com/vaccinations.

A AVS B

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CONFERENCE GUIDE

IVCVX launches November 6/7 90 DAYS

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ON - DE MAN D LE C TU R E S

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Attend one of 3 ways:

Join us for our live two-day event where you can audit your choice of any lecture

Pay $29.95 and audit live lectures PLUS any lectures “on demand” until February 6, 2021

Pay only $149 and earn CE credits on the lectures of your choice — we offer 48 AAVSB RACE-approved CE lectures. You’ll have access to the live event plus any lecture until February 6, 2021.

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56 IVCVX 2 IVC Fall 2020 2020

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Earn CE Credits in 2020 & 2021! In addition to our “live” conference on November 6 & 7, you can access our on-demand content after the conference until Feb. 6, 2021. So you can earn CE over two calendar years! This IVCVX program #44156 is approved by AAVSB RACE to offer a total of 48.00 CE Credits. Method of Delivery: Non-Interactive-Distance. This RACE approval is for the categories of Medical & non-Medical.

WE’RE SO PROUD TO WELCOME OUR KEYNOTE SPEAKER DR. ERNIE WARD, DVM, CVFT Join us for Dr. Ward’s keynote address Nov. 6th — 12:00 PM EST

This approval is valid in jurisdictions which recognize AAVSB RACE; however, participants are responsible for determining each board’s CE requirements. RACE does not “accredit” or “endorse” or “certify” any program or person, nor does approval validate the content of the program. While in many cases there will be live Q&A after the lectures, you will be asked to answer 5 questions post-course to evaluate participation. To facilitate this, the answers will be prominently displayed in the lecture. Certificates of attendance will be presented to participants receiving a 70% grade or higher on the post-course test.

Lectures and CE credits available until Feb. 6, 2021 at IVCVX.vet. Only registered veterinarians and veterinary technicians will receive CE credits and a certificate of attendance.

Have Questions? T: (705) 741-0817 xt 225 9am-5pm Mon-Fri EST E: info@ivcvx.vet

Dr. Ernie Ward is an internationally recognized award-winning veterinarian known for his work in the areas of general small animal practice, pet obesity and nutrition, life extension and longevity, practice management and leadership, and the special needs of senior dogs and cats. He has authored three books, including The Clean Pet Food Revolution: How Better Pet Food Will Change the World, Better You, Better Dog, Better Life: 30 Days to Happiness with Your Best Friend, Chow Hounds: Why Our Dogs Are Getting Fatter. Dr. Ward has been a frequent guest on television programs and served as the resident veterinarian for the Rachael Ray Show from 2007 until 2014. Dr. Ward has authored and been featured in more than 100 practice management and peer-reviewed medical journal articles in 11 countries, co-authored the American Animal Hospital Association (AAHA) Weight Management Guidelines, co-authored the peer-reviewed Veterinary Clinics of North America Small Animal Obesity textbook, and is a 1992 graduate of the University of Georgia College of Veterinary Medicine. He is also a certiﬁed veterinary food therapist (CVFT), dedicated to preserving health, extending longevity, and improving quality of life through better nutrition.

Keynote: Our Passion, Our Profession, Our Gift. How to Open Your Mind and Live Up to Your Highest Potential.

Table of Contents 4 IVCVX Schedule

22 Show specials

6 Speakers & Lectures

25 Exhibitors

Animal lover...veterinarian...healer — our passion, our profession, and our gift.These three distinct journeys come with unique challenges and opportunities that intersect in personal fulfillment and professional success. Today, the most innovative vets are embracing creative opportunities in addition to integrating a variety of healing modalities that best resonate with their path. So why do so many veterinarians struggle to fi nd their way during the course of their careers? Why do our passion, profession, and desire to heal seem in conflict at times? Dr. Ernie Ward shares his experiences, observations, and insights from his own evolution over the past 30 years.

21 Event details IVC IVCVX IVC Fall 2020 2020 57 3

IVC Fall 2020 Dr. Michelle Kutzler 9:00-9:50

Dr. Mike Petty 9:00-9:50

9:30

11:00

6:00

5:30

5:00

4:30

4:00

Dr. Marlene Siegel 4:00-4:50

Photobiomodulation: How LLRT Lights the Way for Healing

Dr. Dawn Kingsbury 2:30-3:20

3:00

3:30

Chronic Enteropathy, Leaky Gut Syndrome and Mechanisms

Dr. Sherman Canapp 1:00-1:50

2:30

2:00

1:00

12:30

12:00

How to Incorporate Regenerative Medicine Into Your Practice

Dr. Dawn Kingsbury & Dr. Holly Ganz 10:30-11:20

10:30

11:30

Using Microbiome Testing to Guide Manipulation of the Gut Microbiome in Clinical Practice

The Health, Safety and Convenience of Fresh Food Dr. Barbara Royal 9:00-9:50

Dr. Marlene Siegel 9:00-9:50

Nutrition & Supplements

Adding New Tools to the Toolkit

Integrative Solutions

Dr. Marlene Siegel 10:30-11:20

Adding New Tools to the Toolkit Part 2

Dr. Robert Silver 2:30-3:20

Cannabis and The Big Three – How to Manage Pain, Cancer, and GI issues

Dr. Robert Silver 4:00-4:50

Cannabis in Practice: Cases, Applications, and Tips on Product Tests and Dosing

Imposter Syndrome in the Veterinary Profession Dr. Nadine Hamilton 4:00-4:50

Dr. Jennifer Adolphe & Sarah Dodd 4:00-4:50

Cocktail Hour / Entertainment

Paul Camilo 2:30-3:20

Creating a Culture of Fun

Dr. Lowell Ackerman 1:00-1:50

Problem-free patients – How to Promote a Lifetime of Care

Paul Camilo 10:30-11:20

How To Make Best medicine The Best Option for clients

Dr. Hilary Jones 9:00-9:50

Telemedicine: Extending Care Beyond Your Walls

Wellness for You & Your Practice

Plant Based Nutrition for Dogs

Live Q&A / Check Out Our Great Exhibitors!

Fear Free Dentistry

Dr. Tom Cameron 2:30-3:20

Pet Nutrition in Flux – Why Whole Food Still Makes the Most Sense

Dr. Valarie Tynes 1:00-1:50

Nutritional Support for the Canine Brain

Live Q&A / Check Out Our Great Exhibitors!

Dr. Michelle Kutzler 2:30-3:20

Non-Surgical Alternatives to Spaying and Neutering

Paul Camilo 4:00-4:50

Dr. Robert Silver 1:00-1:50

Intro to Cannabis: What’s the truth & what’s trending

Live Q&A / Check Out Our Great Exhibitors!

Dr. Michelle Kutzler 1:00-1:50

Surgical Alternatives to Spaying and Neutering

Lunch Time

Dr. Ernie Ward 12:00-12:30

Our Passion, Our Profession, Our Gift. How to Open Your Mind and Live Up to Your Highest Potential

Dr. Barbara Royal 10:30-11:20

Managing Macronutrients, Micronutrients, Microbiome & Mitochondria: Practical Solutions to Biome Problems

Live Q&A / Check Out Our Great Exhibitors!

Dr. Michelle Kutzler 10:30-11:20

Long-term Adverse Health Effects of Desexing: Neoplastic Diseases

Live Q&A / Check Out Our Great Exhibitors!

Long-term Adverse Health Effects of Desexing: nonneoplastic diseases

Laser Pain Management in the busy practice: Yes, you do have time!

9:00

10:00

Innovative Techniques

Diagnostics & Scientific Advancements

Time

IVCVX Day 1 – Friday, November 6, 2020

CONFERENCE SCHEDULE

IVC Fall 2020

6:00

5:30

5:00

4:30

4:00

3:30

3:00

2:30

2:00

1:30

1:00

12:30

12:00

11:30

11:00

10:30

10:00

9:30

9:00

Time

Dr. Robert Silver 9:00-9:50

Dr. Ernie Ward 9:00-9:50

Dr. Lisa Radosta 10:30-11:20

Dr. Karen Gellman 10:30-11:20

Dr. Marlene Siegel 1:00-1:50

Dr. Odette Suter 1:00-1:50

Dr. Lisa Radosta 2:30-3:20

Dr. Odette Suter 2:30-3:20

Dr. Robert Silver 2:30-3:20

Integrative Oncology: What You Can Do as an Integral Part of Your Patient’s Super Team

When it Comes to CBD Pet Supplements, Know the Law and Prioritize Quality Bill Bookout 4:00-4:50

The Oncology Toolbox: From Integrative Therapies to Cancer-busting Supplements Dr. Kendra Pope 4:00-4:50

Dr. Carmen Colitz 2:30-3:20

Antioxidants and The Aging Eye: A Closer Look at Nuclear Sclerosis, Cataract, and Lens Luxation

Cocktail Hour / Entertainment

Live Q&A / Check Out Our Great Exhibitors!

Increasing success of Microbiome Restorative Therapy (MBRT) by treating biofilm Dr. Margo Roman 4:00-4:50

Lucas Pantaleon 1:00-1:50

Dr. Carmen Colitz 1:00-1:50

Dr. Nadine Hamilton 4:00-4:50

Change and Uncertainty – Coping in Difficult Times

Check out our lunar scavenger hunt!

Biosecurity in practice: working together to prevent infectious disease

Check out our lunar scavenger hunt!

Bill Bookout 9:00-9:50

What You Need to Know About How Supplements are Regulated, and How to Help Your Clients Select Quality Products

Wellness for You & Your Practice

The Aging Eye: Degenerative Retinal Diseases — Inherited, Age-related and Acquired

Live Q&A / Check Out Our Great Exhibitors!

Foundations for Fear Free Feline Restraint

EMFs – Protection & Remediation

Dr. Lisa Miller 4:00-4:50

Dr. Bill Ormston 1:00-1:50

How chiropractic helps the body heal itself

Lunch Time

Dr. Donna Raditic 10:30-11:20

Proactive Nutrition

Live Q&A / Check Out Our Great Exhibitors!

Introduction to Ozone Therapy

EMFs – Is EMF Exposure Really a Big Deal?

Shining a Light in the Dark: Dosing Laser Therapy for Osteoarthritis and Degenerative Myelopathy

Dr. Terri McCalla 10:30-11:20

The Squinting Cat: Strategies for Feline Herpetic Ocular Disease

Live Q&A / Check Out Our Great Exhibitors!

Step into the Matrix. Feline communication for the veterinary team

Dr. Donna Raditic 9:00-9:50

Pet Food Facts and Fallacies

Nutrition & Supplements

Live Q&A / Check Out Our Great Exhibitors!

Chronic Kidney Disease: There’s More You Can Do!

Integrative Solutions

The Evolution of the Innovative Veterinary Healer

Innovative Techniques

Why Abnormal Compensatory Posture is So Common in Domestic Animals

Dr. Karen Gellman 9:00-9:50

Why Posture Matters

Diagnostics & Scientific Advancements

IVCVX Day 2 – Saturday, November 7, 2020

CONFERENCE SCHEDULE

SPEAKERS & LECTURES LOWELL ACKERMAN, DVM, DACVD, MBA, MPA, CVA, MRCVS Dr. Ackerman received his veterinary degree from the Ontario Veterinary College (Canada), and board certification from the American College of Veterinary Dermatology. In addition to his veterinary credentials, Dr. Ackerman holds a Masters in Public Administration from Harvard University, a Masters in Business Administration from the University of Phoenix, a Certificate in Veterinary Practice Administration from Purdue University, and he is a Certified Valuation Analyst (CVA) through the National Association of Certified Valuators and Analysts (NACVA). Currently, Dr. Ackerman is an independent consultant, author and lecturer, is on the Fear-Free Advisory Board, is a Fear-Free Certified Professional, is a founding member of the Global Veterinary Dermatology Education Group (GVDEG) and is on the Continuing Education Committee of the World Small Animal Veterinary Association. He has authored or co-authored several books, and has lectured extensively on a global basis, on topics in both medicine and management.

LECTURE:

SARAH DODD, BVSC, MSC, PHD CANDIDATE, ECVCN RESIDENT Dr. Sarah Dodd graduated with her veterinary degree from Massey University in New Zealand. She has a Master of Science degree from the Ontario Veterinary College, University of Guelph, where she is currently completing her PhD in Population Medicine. In addition to her PhD research, she is a resident of the European College of Veterinary and Comparative Nutrition and is the owner-operator of Dodd Veterinary Services, oﬀering veterinary medicine and consultancy in Ontario, Canada.

LECTURE: Plant-Based Nutrition for Dogs

Problem-free patients — How to Promote a Lifetime of Care Pet owners and their pets beneﬁt from active, ongoing veterinary care throughout a pet’s life as a continuum of care, rather than just a passive transaction-based process. The strategy for providing a lifetime of care depends on three main areas of engagement — prevention, early detection, and treatment with facilitated compliance — preventing problems consistently in practice; detecting problems earlier, preferably when they are still subclinical and when there are typically the most options for intervention; and managing problems appropriately given their anticipated treatment course.

JENNIFER ADOLPHE, PHD Dr. Jennifer Adolphe graduated with her PhD in companion animal nutrition from the Western College of Veterinary Medicine at the University of Saskatchewan. She has a Master of Science degree in human nutrition

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and previously worked as a registered dietitian. She is the recipient of over 20 awards and scholarships for her academic work and has numerous peer-reviewed publications. She is currently the Nutrition Manager at Petcurean Pet Nutrition, a Canadian company committed to oﬀering superior quality pet foods.

Plant-based diets for dogs can be a great option, not only for them but for their humans and the environment. People choose to follow a plant-based diet for a variety of reasons, including ethical, environmental and health benefits. More and more people want their pets’ food to have these same advantages. For dogs, in addition to the environmental benefits, plant-based diets may offer health benefits, particularly for dogs with sensitivities to animal proteins or with liver disease. However, it can be challenging to formulate a plant-based diet that meets all nutrient requirements. This presentation will provide an overview of the nutrients that need special attention when formulating a plant-based diet and how to overcome these challenges. We will also discuss how protein is a metabolically and environmentally expensive ingredient and how a plant-based diet can address this issue. Lastly, we will review the research about plantbased nutrition in dogs and share information about the current research being performed on this topic at the University of Guelph.

BILL BOOKOUT, BSC, MBA Bill Bookout is president, board chairman, and a founding member of the National Animal Supplement Council, the world s leading trade association representing manufacturers and suppliers of supplements for dogs, cats, and horses. Mr. Bookout was selected to serve on the Health Canada Expert Advisory Committee for Veterinary Natural Health Products and has been an ambassador for the industry for over 20 years. He is recognized as a leading expert on regulatory issues surrounding animal health and nutritional supplements, has testiďŹ ed on behalf of the industry at FDA public meetings, and has participated in countless educational programs, legal forums, regulatory trainings, trade events and other professional meetings. Mr. Bookout received his bachelor s degree in physical sciences from the University of Wyoming and his MBA from the Pepperdine University Presidents and Key Executives program.

LECTURES: What You Need to Know About How Supplements are Regulated, and How to Help Your Clients Select Quality Products Veterinary clients can walk into almost any pet retailer, supermarket or vet clinic and ďŹ nd a selection of supplements designed to help pets live their best lives. Faced with abundant options, they will look to you for guidance in selecting the best products for their pets. Are you prepared to help them navigate this overwhelming landscape? In this session, you will learn how animal health and nutritional supplements are regulated; why improving and standardizing the pet supplement industry is so important; how successful self-regulation within the pet supplement industry has been achieved through close collaboration between federal and state regulators and the National Animal Supplement Council (NASC); and which crucial questions you should ask when evaluating supplements to sell or recommend to your clients. When it Comes to CBD Pet Supplements, Know the Law and Prioritize Quality Many veterinary clients who have used cannabidiol (CBD) themselves are now choosing it for their dogs and cats in the hopes of helping their animal companions feel their very best. Chances are youâ&#x20AC;&#x2122;re asked about CBD at least a few times a month, which is good because you want your clients to rely on you for information, not â&#x20AC;&#x153;Dr. Google.â&#x20AC;? If you are a veterinarian who views CBD as a beneďŹ cial option for your clients, it is important to understand your risk for exposure when recommending or prescribing these types of products. In this session, you will learn how

the hemp/CBD landscape has changed since the passing of the 2018 Farm Bill, get a status update on this dynamic and inconsistent regulatory environment, and learn how to minimize risk through excellent record keeping and careful scrutiny of products to recommend or carry in your practice.

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LECTURE: Pet Nutrition in Flux â&#x20AC;&#x201D; Why Whole Food Still Makes the Most Sense The pet food industry today is full of confusion, both for veterinarians and pet owners, with conďŹ&#x201A;icting viewpoints on the best way to feed our pets. Pet owners donâ&#x20AC;&#x2122;t know who to trust and are looking for guidance. Grainbased, grain-free, raw, fresh frozen, freeze-dried, canned, vegetarian/plant-based â&#x20AC;&#x201D; all have been touted as the best (and sometimes the most dangerous) pet diets. This is a â&#x20AC;&#x153;kitchen tableâ&#x20AC;? discussion on why whole foods are so important, with feeding strategies for modern times.

PAUL CAMILO, CVPM Paul Camilo is a CertiďŹ ed Veterinary Practice Manager (CVPM) with a degree in Business Administration. He is the founder of Veterinary Consultation Services, LLC, where he advises companies, practice owners and managers on business development matters. He has a strong focus on technology, communication, and dentistry. Paul serves as the Veterinary Dental Forum s Management and Marketing program Track Coordinator, VetPartner s Webinar Committee Chairperson, an Advisory Board member for Vets First Choice, and an Advisory Board member for ePethealth. Paul is currently a Podium Speaker for Zoetis, Fear Free Speakers Bureau, on the

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VetSOAP advisory board, and VetPartners program committee. For 14 years Paul was the practice administrator of Hometown Animal Hospital, All Pets Dental & 10 Lives Cat Clinic in South Florida. Paul has presented at many national conferences including American Animal Hospital Association conference, the Veterinary Dental Forum, Western Veterinary Conference, VMX, AVMA conference, and many state VMAs.

LECTURES: Creating a culture of fun Many kids dream about working with animals from a very early age. What they don’t know is that the veterinary profession has a systemic problem of high turnover. Unfortunately, animal hospitals have some of the highest turnover and suicide rates for professional workplaces. This presentation addresses the issue and provides solutions. We will discuss hiring the right people, providing them with great benefits and setting up a cool workplace for fun and success. In this lecture, you will learn: • how your mission statement affects culture • how to hire the right team member • what unique nomenclature you can use to create the culture • which benefits you should use to attract top talent • Ideas on how to make the workplace fun. Fear Free Dentistry Historically, dentistry has the biggest opportunity in animal hospital yet produces very little because of compliance. Fear Free techniques are starting to bridge the gap. In this lecture, you will learn: • the principles of Fear Free • how to use communication technology to adopt a more fear free process • 10 fear free techniques that are applicable to veterinary dentistry to increase treatment compliance and improve the service experience.

How to make best medicine the best option for clients Veterinary medicine is more advanced today than ever before. Practitioners have access to great innovative diagnostic testing and treatments. Specialty medicine

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continues to grow year over year. However, with better veterinary care come higher expenses. With higher expenses comes more fees to the clients. This leaves veterinarians in a difficult position — having the ability to help pets with advanced medical services but having a hard time keeping it affordable for the average person. This talk will cover how to create an ecosystem in an animal hospital where compliance comes easy. In this lecture, you will: • see how to best leverage pet insurance and the factors that make a good pet insurance plan • learn how to use wellness plans in order to create great wellness compliance • address how to successfully use financing to reduce the burden to clients, and allow the doctors to practice high quality medicine, while stimulating growth.

SHERMAN CANAPP, DVM, MS, CCRT, DACVS, DACVSMR Dr. Canapp is a Diplomate of the American College of Veterinary Surgeons, and Charter Diplomate of the American College of Veterinary Sports Medicine and Rehabilitation, of which he is also Past President. Dr. Canapp serves as the National Director of Sports Medicine, Rehabilitation and Regenerative Medicine for Pathway Vet Alliance. He is co-founder of the Veterinary Orthopedic & Sports Medicine Group (VOSM) in Annapolis Junction, MD, where he routinely receives referrals for sports-related injuries, arthroscopic procedures and regenerative medicine treatments from domestic and international sources. He also created the VOSM Academy, LLC. As president and CEO of Orthobiologic Innovations LLC, Dr. Canapp is actively engaged in concept and product design and development for orthopedic and arthroscopic devices, instrumentations, medical systems, biologics and regenerative medicine technologies. He established Project GO (Global Orthopedics for Animals), a non-proﬁt foundation (501c3), to help animals with musculoskeletal injuries.

LECTURE: How to Incorporate Regenerative Medicine into Your Practice This lecture covers how to incorporate platelet rich plasma (PRP) and stem cell therapy into your practice for the treatment of various orthopedic conditions in dogs. Participants will learn about adipose and bone marrow

collection, PRP collection, processing, and injection techniques. Indications for use, including osteoarthritis, tendon, and ligament injuries will be discussed. Participants will also learn PRP and stem cell treatment protocols and post-injection rehab programs for the various conditions and treatments.

CARMEN COLITZ, DVM, PHD, DACVO Dr. Carmen Colitz earned her Doctorate of Veterinary Medicine and a Ph.D. in Comparative and Experimental Medicine from the University of Tennessee in 1993 and 1996, respectively. Her research involved the study of ocular embryology and molecular biology of cancer. She became a board-certified veterinary ophthalmologist in 1999. During her residency training, Dr. Colitz completed a one-year post-doctoral research project and successfully competed for a five-year grant from the National Institutes of Health Eye Institute. Dr Colitz has written or co-written over 60 peer reviewed publications and 19 book chapters and is Past-President of the American College of Veterinary Ophthalmologists. In 2009, she founded Aquatic Animal Eye Care, LLC. Aquatic Animal Eye Care s mission was to understand and improve the ocular diseases that affect marine mammals, penguins and fi shes both under human care and in the wild. Dr. Colitz was also a founding member of Animal HealthQuest, LLC, and is currently a Consulting Veterinarian for Animal Necessity, LLC.

LECTURES: Antioxidants and Ocular Health: A Closer Look at Nuclear Sclerosis, Cataract, and Lens Luxation in the Aging Eye This lecture will review the role of oxidative stress in ocular disease, and general antioxidant therapeutic strategies to support ocular health. It will take a closer look at lens physiology and how aging and oxidative stress aﬀects lens cellular functions, resulting in nuclear sclerosis, cataract, and lens luxation. Through the lecture, you will: • gain an understanding of the basic concepts of oxidative stress related to ocular physiology and pathophysiology • learn about the construct and function of the lens, and how it can be damaged by age-related oxidative stress mechanisms. • learn how speciﬁc antioxidants support key aspects of ocular health

• learn strategies for protection of the lens and preservation of vision as pets age and in geriatric patients. The Aging Eye: Degenerative Retinal Diseases — Inherited, Age-related and Acquired In this lecture, we will look at the presentation of retinal physiology and how aging and oxidative stress aﬀects retinal cellular functions both in the normal aging animal, and animals with common retinal diseases. Strategies to support retinal health in all stages of life and disease will be presented. In this lecture, you will gain an understanding of the physiology of the aging retina, and the pathophysiology of how oxidative damage associated with aging and common retinal diseases aﬀects retinal health and vision. You’ll also discover strategies for protection of the retina and preservation of vision in all stages of life and disease.

HOLLY GANZ, PHD Dr. Holly Ganz is Chief Science Officer and co-founder of AnimalBiome, a biotech company that provides microbiome assessments and oral fecal transplant capsules to restore key beneficial microbes in cats and dogs. Dr. Ganz received her PhD from the University of California, Davis and was a postdoctoral scholar at UC Berkeley. Her efforts to translate academic research into solutions for companion animals began five years ago when she launched KittyBiome, a citizen science project, which revealed that imbalances in the gut microbiome are common in pets and there is a pressing need for better approaches to maintain and restore gut health.

LECTURE: Microbiome Testing to Guide Manipulation of the Gut Microbiome in Clinical Practice The presence of a taxonomically deﬁned core fecal microbiome in healthy cats and dogs is supported by comparative studies, using humans as animal models. Through examples, this lecture will demonstrate that microbiome composition has the potential to identify individuals who are at risk for developing certain chronic health conditions. Microbiome analysis provides the opportunity for disease prevention, therapeutic intervention, as well as longitudinal monitoring of treatment response. Current medical and dietary

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interventions manipulating microbiome composition are also discussed in this case series. In this lecture, we will: • review support for a core healthy microbiome in cats and dogs. • deﬁne the microbiome and describe the roles it can play in animal health • demonstrate how the microbiome is altered in association with chronic and infectious diseases, with individual case examples • explore the current medical and dietary interventions to manipulate microbiome composition

KAREN GELLMAN, DVM, PHD Dr. Karen Gellman holds DVM and PhD degrees from Cornell University in animal locomotion biomechanics. She has advanced training and certiﬁcation in veterinary acupuncture and veterinary chiropractic, and has practiced these and other holistic modalities since 1995. She teaches about posture, biomechanics and holistic therapies to veterinarians worldwide, is research director of Maximum Horsepower Research and practices holistic veterinary medicine in New York State, and on a consulting basis. In 2019, Dr. Gellman founded Plena Curae Botanical Solutions, a company making novel botanical pain solutions for pets and horses.

LECTURES: Why Abnormal Compensatory Posture is So Common Standing posture is a window into the function and integration of animals’ complex neuro-musculoskeletal system, and aﬀects athletic performance, sympathetic tone and overall well-being. For dogs, especially larger breeds, maintaining a neutral standing posture can minimize risks for musculoskeletal injury. In Part One, we will learn about how standing posture is generated and maintained, and what are its structural and functional components.

Why Posture Matters: the profound eﬀects on pets of standing around (and what you can do) Standing posture is a window into the function and integration of animals’ complex neuro-musculoskeletal system, and aﬀects athletic performance, sympathetic tone and overall well-being. For dogs, especially larger breeds, maintaining a neutral standing posture can minimize risks for musculoskeletal injury.

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In Part Two, we will learn why domestic animals often have abnormal compensatory posture, the clinical consequences, and how veterinarians can help horses and dogs achieve neutral posture.

NADINE HAMILTON, BSC (PSYCH), PGDIP.PSYCH, MTRAIN&DEV, EDD Dr. Nadine Hamilton is the proud founder of the Love Your Pet Love Your Vet charity, which is now a leading charity in the area of veterinary wellbeing. Nadine founded the charity following the completion of her doctorate in 2016. Dr. Hamilton continues to help veterinary professionals get on top of stress and conﬂ ict to avoid burnout and suicide, and also works with practice managers and owners to increase well-being, productivity, and retention in the workplace. Dr. Hamilton is the author of Coping with Stress and Burnout as a Veterinarian , published by Australian Academic Press and released in February 2019, and is the 2020 winner of the Blackmores Mercie Whellan Women+Wellbeing Award in 2020.

LECTURES: Change and Uncertainty — Coping in Difficult Times This presentation discusses current and topical issues around change and uncertainty, and how we can cope with these more effectively. It outlines some of the more common symptoms of someone who may not be coping, as well as a variety of key concepts to address these symptoms and effectively help participants to cope in uncertain times. It is expected that participants will be able to assist themselves and others in identifying signs of an inability to cope with change or uncertainty, as well as practical skills in addressing these symptoms. Imposter Syndrome in the Veterinary Profession This presentation will provide information about imposter syndrome — what imposter syndrome is, who it affects, the symptoms, and also things that can be done to address it. By the end of the lecture, it is expected that participants will be able to identify the concepts of imposter syndrome either in themselves and/or others, and be able to implement some key skills and strategies as an initial way of addressing the symptoms.

EARN POINTS TOWARDS AMAZING PRIZES! — See pg 29

HILARY JONES, DVM Dr. Hilary Jones graduated from Tufts Cummings School of Veterinary Medicine and completed a small animal rotating internship at Fifth Avenue Veterinary Specialist, now BluePearl Downtown. During her time as a primary care and emergency clinician in New York City she was inspired to look for a better way to connect with her clients and their pets leading to the development of TeleTails. Since its launch, Dr. Jones has been working daily with veterinary teams across the country and thought leaders such as the AVMA, AAVSB, and state associations to help veterinary medicine safely evolve digitally. She speaks on the beneﬁts, opportunities, and economics of implementing telemedicine in veterinary practice.

LECTURE: Telemedicine: Extending Care Beyond Your Walls Veterinary medicine today is changing rapidly. Pet owners are expecting more and more from their veterinarians. These growing expectations, combined with changing consumer habits, can put new strains on hospitals and their bottom line. Adding a flexible telehealth platform as an additional tool to deliver care can help veterinary teams adapt to the new demands through improved communication and client engagement, streamlined team-based workflows, and the creation of new revenue opportunities. To fully realize the benefits of telehealth, veterinarians must understand best practices, legal and regulatory implications, and how to adopt them in their own offices. This lecture will use real-world data and case examples to demonstrate how virtual care can be used to improve practice efficiency and productivity and deepen client relationships. Through this lecture, you will: • develop an understanding for the differences between telehealth, telemedicine, and the role of the VCPR • be able to identify how to apply video-based telehealth tools to improve workplace efficiency and flexibility • understand how incorporating a telemedicine platform can generate new revenue streams for the practice • discover how telehealth can drive continued client engagement and help improve client retention • be able to use lessons learned from human telehealth adoption to avoid common implementation pitfalls

DAWN KINGSBURY, DVM, PHD, DACVIM Trained at UF (BS), NCSU (DVM), Tufts (internship) and ISU (Small Animal Internal Medicine residency), Dawn Kingsbury has worked in general, as well as specialty, practice settings. Her wanderlust saw her working in academic settings at Massey University, New Zealand; University College Dublin, Ireland; and U-Vet Werribee, Melbourne, Australia. She has experience in stem cell research. Her PhD in integrative pathobiology was at the University of California at Davis, looking at the role of neutrophils in murine Salmonella typhimurium colitis. Her current position, as chief veterinary oﬃcer at AnimalBiome, aligns with her research interests: hostmicrobe interactions, comparative medicine, precision regenerative medicine and One Health, while allowing her to promote fecal microbiome analysis as a non-invasive clinically actionable tool and to cultivate evolving microbiome restoration strategies.

LECTURES: Chronic Enteropathy, Leaky Gut Syndrome and Mechanisms CE just doesn’t stand for Continuing Education; it also stands for Chronic Enteropathy (CE). Chronic enteropathy may be an ideal term to describe gastrointestinal (GI) disease that lasts longer than three weeks in cats and dogs and lacks a more specific diagnosis. In this lecture, a useful framework is provided that can be carried through the diagnostic journey without overstatement. Further refinement can be defined by response to treatment, including discussion on disease mechanisms such as leaky gut. In this lecture, you will learn to: • implement a classification scheme for chronic gastrointestinal patients that recognizes the challenges of the varying ability to obtain definitive diagnoses in the real world and focuses on treating the treatable. • anticipate how the words we and our clients use to describe chronic gastrointestinal disease can play a role in successfully completing our diagnostic and therapeutic algorithm. • formulate personalized plans for chronic gastrointestinal patients, incorporating pet, owner and best medical practice preferences.

LECTURE: Microbiome Testing to Guide Manipulation of the Gut Microbiome in Clinical Practice Presented with Holly Ganz — see page 9.

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MICHELLE KUTZLER, DVM, PHD, DACT Dr. Michelle Kutzler graduated from Washington State University and worked in private practice in Minnesota for four years before going to Cornell University to pursue a theriogenology residency. She stayed on at Cornell University to complete a PhD in Physiology. Since 2002, she has been at Oregon State University in Corvallis, Oregon. She has published widely in the area of non-surgical sterilization as well as the long-term adverse health effects of spaying and neutering. She is an active member of the American College of Theriogenologists, serves on the Scientific Advisory Committee for the Alliance for Contraception in Cats and Dogs, and is the Chair of Scientific Committee for the 2021 International Symposium on Canine and Feline Reproduction. She is also an AKC Breeder of Merit.

LECTURES: Long-term adverse health eﬀects of desexing: neoplastic diseases Practitioners are hearing more and more about the longterm health consequences of desexing dogs from journals, their clients, and of course, the internet. This lecture will summarize over 100 articles discussing the relationship between these conditions and gonad removal so that you can discuss with your clients which sterilization option is best for their pets. This two-part lecture will focus on the neoplastic consequences. Attendees will learn about several cancers that occur with higher incidence in desexed dogs. In addition, attendees will learn about some alternative complementary treatments for these cancers that may increase remission times.

Long-term Adverse Health Eﬀects of Desexing: nonneoplastic diseases Practitioners are hearing more and more about the longterm health consequences of desexing dogs from journals, their clients, and of course, the internet. This lecture will summarize over 100 articles discussing the relationship between these conditions and gonad removal so that you can discuss with your clients which sterilization option is best for their pets. This two-part lecture will focus on the non-neoplastic health consequences. Attendees will learn about the endocrinologic, metabolic, urinary and renal, musculoskeletal, and integumentary consequences of desexing.

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Non-Surgical Alternatives to Spaying and Neutering Nonsurgical methods of contraception and sterilization can be safe, reliable and in some cases, irreversible. Hormonal treatments using progestins, androgens, or gonadotropin releasing hormone (GnRH) analogs act to either directly block reproductive hormone receptormediated events, or indirectly block conception via negative feedback mechanisms. Immunocontraception, via vaccination against GnRH, the luteinizing hormone receptor or zona pellucida proteins, is also possible. Intratesticular or intraepididymal injections provide a method for non-surgical sterilization of the male dog and cat. Additional methods for mechanical disruption of fertility including intravaginal and intrauterine devices and ultrasound testicular ablation will be reviewed.

Surgical Alternatives to Spaying and Neutering There are many surgical procedures not taught in the veterinary curriculum, including gonad sparing sterilization. Gonad sparing sterilization is supported by the American Veterinary Medical Association as an alternative to routine ovariohysterectomy or castration. The surgical approaches for ovary-sparing hysterectomies and vasectomies are similar to traditional methods and easy to master. Attendees will learn how to perform an ovary-sparing hysterectomy and vasectomy. In addition, attendees will learn about the health risks and beneﬁts of gonad-sparing surgical sterilization surgeries.

TERRI MCCALLA, DVM, MS, DACVO Terri McCalla is a board-certiﬁed veterinary ophthalmologist. She obtained her DVM degree from Oregon State University and Washington State University (combined program) in 1984. After completing a residency in comparative ophthalmology from the University of Missouri in 1989, she became a Diplomate of the American College of Veterinary Ophthalmologists in 1989 and received her MS in Veterinary Pathology in 1990. Dr. McCalla created her solo referral practice, Animal Eye Care LLC in Bellingham, Washington, in 2001. Because she is passionate about helping animals live their best lives, in 2006 she co-created a veterinary supplement research and development company (Animal HealthQuest Solutions LLC) and co-invented the veterinary vision supplement Ocu-GLO™. Dr. McCalla retired from active practice in 2019 to focus on her other interests, which include: the role of complementary and alternative medicine

in animal vision health; veterinary ophthalmology education; feline herpesvirus; and empowering adults with autism to live meaningful lives.

LECTURE: The Squinting Cat: Strategies for Feline Herpetic Ocular Disease In this lecture, we will look at the presentation of feline herpesvirus (FHV), and the role of stress in the pathophysiology of the clinical manifestations of herpetic disease. Strategies for pain management, and for protection and support of ocular health and general wellbeing will be presented. Through this lecture, you will gain an understanding of the pathophysiologic mechanisms in which feline herpesvirus manifests, as well as the management of acute and chronic herpetic ocular disease.

LISA MILLER, DVM, CCRT, CVA Dr. Lisa Miller is the Vice President of Clinical Veterinary Medicine for Companion Animal Health and is a graduate of the University of Tennessee, College of Veterinary Medicine. After graduation, Dr. Miller completed an internship in internal medicine and then became certiﬁed in canine rehabilitation therapy. Working in a large referral hospital, she practiced rehabilitation, sports medicine, and acupuncture for several years before returning to general practice and later, joining the animal health industry. Dr. Miller has been working with laser therapy/photobiomodulation (PBM) since 2006 and has lectured worldwide on rehabilitation and laser therapy related topics. Additionally, she has authored numerous articles on laser therapy in veterinary publications, a chapter in the textbook Laser Therapy in Veterinary Medicine , and peer reviewed research for publication. In her current role, she coordinates all veterinary and advanced PBM research involving Companion Animal Health technologies and is a consultant and reviewer for PBM research worldwide.

LECTURE: Shining a Light in the Dark: Dosing Laser Therapy for Osteoarthritis and Degenerative Myelopathy

In this lecture, you will: • gain an understanding of basic light-tissue interaction and how PBM is dosed in order to achieve consistent results in deep tissue conditions. • learn the best way to apply PBM for results in treating patients with OA and potentially other chronic deep tissue conditions, such as DM in clinical practice.

BILL ORMSTON, DVM, CAC, DVETHOM Dr. Bill Ormston received a BS in animal science in 1982 and a veterinary degree in 1988, both from Iowa State University. Since graduation, Dr. Ormston has worked in or owned mixed animal practices. In 1998 he attended Options For Animals and became certified in animal chiropractic care by the American Veterinary Chiropractic Assoc. In 2002 he hosted the AVCA conference in Dallas, Texas at Parker Chiropractic College and then was asked to help start an Animal Chiropractic program at the College. In 2012, Dr. O, along with Dr. Amy Hayek, decided that for busy professionals to become certified Animal Chiropractors, the program needed more flexibility, and Animal Chiropractic Education Source (A.C.E.S.) was formed. They moved to the ranch in 2016 so that students could be immersed in the philosophy while learning with hands on live animals every day they are in class. Dr. Bill is also a professional public speaker and sees animals at All Creatures Every Spine.

LECTURE: How chiropractic helps the body heal itself Veterinary medicine today is changing rapidly and pet owners are expecting more and more from their veterinarian. These growing expectations, combined with changing consumer habits, can put new strains on hospitals and their bottom line. Adding chiropractic to the tool box will beneﬁt every animal that walks through the door. Chiropractic is aimed at maintaining the health of the nervous system by using the bony prominences on the spine surrounding it to remove interferences. This lecture will utilize case studies and basic sciences to allow the attendee to understand how to better utilize the chiropractic adjustment. Through this lecture, you will:

Evidence based science on the use of photobiomodulation (PBM, previously referred to as laser therapy) will be reviewed, speciﬁcally as it relates to new research examining the use of PBM in treating both osteoarthritis and potential Degenerative Myelopathy in dogs.

• develop an understanding for the power of the chiropractic adjustment

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• be able to identify how and why every patient will beneﬁt from some form of chiropractic adjustment • understand how incorporating chiropractic care can generate new revenue streams for the practice • discover how chiropractic care can drive continued client engagement and help improve client retention • be able to use lessons learned in basic biology to explain to clients why the chiropractic adjustment is a needed and valid treatment

LUCAS PANTALEON, DVM, DACVIM, MBA Dr Lucas Pantaleon is a Board Certiﬁed Internal Medicine Veterinarian and holds an MBA. He has been working on topics related to infection prevention and One Health for 15 years. Through his company, DVM One Health and Ogena Solutions, he advises clients in diﬀerent sectors of animal health with the ultimate aim of improving health of animals, people and the environment. He has given presentations nationally and internationally as well as published many articles on topics related to infection prevention and biosecurity. Dr Pantaleon is involved in volunteer activities such as Co-Chair of the Membership and Communications Committee for the ACVIM and member of the Board of Directors for the NIAA.

LECTURE:

MIKE PETTY, DVM Dr. Michael Petty, DVM, is a 1980 graduate of the veterinary school at Michigan State University. As the owner of Arbor Pointe Veterinary Hospital and the Animal Pain Center in Canton, Michigan, he has devoted his professional life to the care and well-being of animals, especially in the area of pain management. Dr. Petty is the past president of the International Veterinary Academy of Pain Management. A frequent speaker and consultant, he has published articles in veterinary journals and serves in an advisory capacity to several pharmaceutical companies on topics of pain management. He was also an ELITE speaker for Pﬁ zer Animal Health during the life of that program. He has been the Investigator/Veterinarian in over 12 FDA pilot and pivotal studies for pain management. He has lectured both nationally and internationally on pain management topics.

LECTURE: Laser Pain management in the busy practice: Yes, you do have time! When confronted with a chronic pain issue during a routine exam on a busy day, it is often too easy to send home an NSAID and hope it works. Unfortunately, that is often not enough and either the animal is going to continue to suﬀer from pain, or the owner will go elsewhere. This session discusses how to approach and manage chronic pain patients, get a proper diagnosis, set up a treatment plan, and enlist the owner as part of the patient care team.

Biosecurity in practice: working together to prevent infectious disease One Health aims to understand and address health and disease arising from the intricate relationship between human, animal and environment through multidisciplinary collaboration. Today more than ever, veterinarians must play a key role in preventing infectious diseases not just in animals but the animal care team as well. This talk will focus on approaching infection prevention through the One Health lens and will expand on examples of human and animal health that can be applied to small animal practice. The importance of vaccination, antibiotic stewardship and their role in One Health will be discussed.

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KENDRA POPE, DVM, DACVIM (ONCOLOGY), TCVMP, CVFT Dr. Pope received her veterinary degree from the University of Florida in 2011, and certiﬁcations in veterinary acupuncture, Chinese herbal therapy, food therapy and Tui-na at the Chi Institute of Traditional Chinese Veterinary Medicine in Reddick, Florida. She went on to complete a rotating internship and residency in medical oncology at the University of Pennsylvania. She is currently studying at David Winston s Center for Herbal Studies and will be applying for certiﬁcation as a Registered Herbalist through the American Herbalist Guild. Dr. Pope opened her Integrative Oncology & Veterinary Wellness center in 2017, where she practices integrative medicine and oncology and has an active role in clinical research. Dr. Pope serves as a visiting clinician in Integrative Oncology at the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania and serves as

President-Elect for the American College of Veterinary Botanical Medicine.

LECTURE: The Oncology Toolbox: From Integrative Therapies to Cancer-busting Supplements When cancer strikes the beloved family pet it can have far-reaching consequences on family emotions, family bank accounts and family time commitments. Cancer is such a multifactorial disease that it needs to be approached in a multifactorial, integrative fashion. Developing a team approach to supporting both the patient and their family is at the core of this integrative approach. Blending the best evidence-based integrative therapies with the appropriate conventional therapeutics will have the best outcomes. In this lecture, you will learn about the evidence-based modalities an integrative oncologist employs most often in her oncology practice. Mechanisms of action and cases will help to illustrate these unique and eﬀective tools. This class will discuss team building and some of the more important cancer-busting supplements.

DONNA M. RADITIC, DVM, CVA, DACVN Donna M. Raditic is a Diplomat of the American College of Veterinary Nutrition and was a Professor for both the Nutrition and the Integrative Medicine Services at the University of Tennessee College of Veterinary Medicine. Currently she is a member of East Coast Think Tank (https://www.vetnutrition.com/research-of-petfoods/) established by Veterinary Nutritional Consultations, Inc. which oﬀers independent information and consulting about companion animal nutrition and supplements. With a career that includes being a general practitioner, veterinary nutritionist, academician, and consultant, she oﬀers unique perspectives on the role of nutrition, supplements and integrative veterinary care for companion animals.

LECTURES: Pet Food Facts & Fallacies Veterinarians, veterinary technicians, and the general public are inundated with information — some accurate and some not — on pet nutrition. Put in “dog nutrition”

or “cat nutrition” in Google, for example, and you get 1317,000,000 hits. Discussing pet nutrition is sometimes akin to discussing religion or politics: people are passionate, with strong beliefs and opinions. In this lecture, we will discuss the more common facts and fallacies related to pet food, including the latest information on pet food and canine dilated cardiomyopathy. “Nutritional landmines” are not always straightforward, but educating yourself and applying the principles of evidence-based medicine enables you to provide balanced information and sound nutritional recommendations. In this lecture, you will learn to: • know and understand how to use evidence-based medicine to resolve pet nutrition controversies • learn the latest update on pet food and canine dilated cardiomyopathy • understand the positives and negatives of pet food processing Proactive Nutrition Today there are many dog breeds known to be “at risk” for chronic disease states such as overweight/obesity, developmental orthopedic disease, canine atopic disease, and chronic enteropathy. Understanding the role of speciﬁc nutrients and/or dietary factors in the etiopathology of these diseases allows the practitioner to prescribe appropriate diets to best manage these “at risk” canine patients. In this nutritionist’s clinical experience, earliest nutritional interventions using what is termed “proactive nutrition” can prevent these chronic disease states. Using proactive nutrition is rewarding and is often less expensive than long term conventional or integrative medical management of a patient with these types of chronic diseases. Cases examples will be discussed. You will learn to: • Recognize the known dog breeds “at risk” for overweight/obese, developmental orthopedic disease (DOD), canine atopic disease (CAD), and chronic enteropathies (CE) • Understand the role of speciﬁ c nutrients and/or dietary factors in the etiopathology of these chronic disease states • How to use appropriate diets proactively to prevent and/ or best manage the “at risk” canine patient

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LISA RADOSTA, DVM, DACVB Dr. Radosta is a board-certiﬁed veterinary behaviorist and the owner of Florida Veterinary Behavior Service since 2006. She is a well-known national and international speaker, and has written for the Handbook of Behavior Problems of the Dog and Cat; Blackwell s Five-Minute Veterinary Consult , Canine and Feline and Small Animal Pediatrics , and Decoding Your Cat . She is the coauthor of From Fearful to Fear Free . In addition to publishing scientiﬁc research and review articles, Dr. Radosta is the Behavior section editor for Advances in Small Animal Medicine and Surgery , and serves on the Purina Institute Advisor Council. She also served on the inaugural Fear Free Executive Council and the AAHA Behavior Management Task Force. Dr. Radosta has been interviewed by many media outlets, including animal and veterinary publications and news and television shows.

LECTURES: Foundations of Fear Free Feline Restraint Cat restraint doesn’t have to include scrubbing and stretching. Veterinary team members can gain confidence and lower stress in cats with some foundational concepts. Low stress restraint doesn’t mean that restraint has to be unsafe! Attendees will learn key concepts supported by videos which can be used the next day in practice. Step into the Matrix: Feline communication for the veterinary team. Understanding cats is like being in the Matrix. What is real? Are they scared? Are you going to get bitten? Veterinary team members often express uncertainty about handling cats. Understanding how cats communicate with us, when they are happy, sad, angry, fearful and distressed is the first step to Fear Free restraint and confident, safe veterinary team members. Attendees will review videos of cat behavior and body language throughout this lecture to better understand cat communication and body language signaling.

www.mashvet.com. Dr. Roman has used Medical Ozone Therapy for 17 years, and Micro Biome Restorative Therapy ( MBRT ) for eight years, creating the ﬁ rst fecal bank for dogs and cats. Her 42 years of practicing conventional and alternative modalities, (acupuncture, homeopathy, herbs, nutrition, hyperbaric oxygen, UVBI) have given her more tools to enhance health and well-being of patients. With over 16,000 MBRT, the results have been amazing. Her dogs have been studied by MIT for their microbiomes.

LECTURE: Increasing success of Microbiome Restorative Therapy (MBRT) by treating biofilm A well-functioning microbiome can make up 80% of the immune system. Microbiome Restorative Therapy (MBRT) can be an important treatment for animals with compromised immune systems and issues including IBD, allergies, pancreatitis, EPI, hepatic and kidney disease, autoimmune disease, cancer and behavioral problems. Developing the terrain of the recipient’s GI tract is the key to successful MBRT. In this lecture, we will discuss the use of medical ozone as an important factor in reducing the biofilm of the colon and mouth, in order to achieve a better outcome. Through research and challenging case studies, you will learn: • how medical ozone reduces biofilm and increases mitochondria function, hence increasing the stem cells of the colon columnar cells. • how the MBRT process with ozone is done, including how to easily place the catheter to allow the spreading of ozone into the colon. • how the microbiome replacement products are made, and how microbiome “mixology” is an option for some patients • the qualities we look for in MBRT donors in order to improve success • how a damaged biofilm can be improved with nutrition and some nutraceuticals • how to maintain MBRT and continue to support patients

MARGO ROMAN, DVM, CVA, COT, CPT Dr. Margo Roman graduated from Tuskegee University Veterinary School in 1978. After completing an internship at Angell Memorial Animal Hospital, she served on the Faculty of Tufts University School of Veterinary Medicine from 1979-87. Dr. Roman is the owner of M.A.S.H. ̶ Main Street Animal Services of Hopkinton, a cuttingedge integrative practice in Massachusetts (since 1983).

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BARBARA ROYAL, DVM, CVA Dr. Barbara Royal is a Chicago integrative veterinarian, IVAS certiﬁed acupuncturist, author and lecturer with extensive experience in veterinary care, including zoo, marine and wildlife animals, nutrition, acupuncture, emergency medicine, pathology, conventional practices, herbal remedies, physical rehabilitation techniques and

alternative treatments. The author of three books, including The Royal Treatment, A Natural Approach to Wildly Healthy Pets , she has been featured in the ﬁlm documentary Pet Fooled , and in other ﬁlms, books, television, print and online media publications. She is the founder and owner of The Royal Treatment Veterinary Center in Chicago and co-founder of the Royal Animal Health University and is also an adjunct professor at Cal Poly State University in San Luis Obispo. She is the past-president of both the American Holistic Veterinary Medical Association (ahvma.org) and the AHVM Foundation (ahvmf.org), and a Board Member of PAWS Chicago, a nationally-renowned no-kill humane animal shelter.

LECTURES: Managing Macronutrients, Micronutrients, Microbiome & Mitochondria Practical Solutions to Biome Problems What is the difference between a balanced diet and a perfect diet? In this lecture, we will discuss the physiologic response to different macronutrients in carnivores (from muscles to mitochondria) and the reason we use different macronutrients and food-based micronutrient balance in a pet food recipe. We will look at what science and clinical data say about fasting and random feeding, and its effects on mitochondrial function and overall health. Details on diversity and variety, ingredients, moisture appropriateness, variety for “sensitive stomach pets”, sourcing, freshness, texture, amount, timing, and ancestral satisfaction will be addressed. Finally, attendees will learn how to recognize and support the healthy and essential variations in microbe populations and protective skin and GI substances, and to recognize excesses and deficiencies that cause issues. Practical tips on how to keep the biome healthy will also be discussed.

MARLENE SIEGEL, DVM, CNHP After becoming Florida s fi rst female paramedic in 1977, Dr. Siegel fulfi lled her life s passion to become a veterinarian, graduating from the University of Florida College of Veterinary Medicine in 1985. After a few years of relief work and emergency care, Dr. Siegel opened her own small animal and exotic practice (Pasco Veterinary Medical Center) in 1987 where she continues to practice full time. Dr. Siegel s determination to heal her horse after a near-fatal accident led her to the world of integrated medicine because her traditional equine vets had nothing more to offer besides retirement or euthanasia. Dr. Siegel continues to be an innovator in integrative medicine, offering the widest array of alternative therapies and detoxification services in the country. She is an avid speaker on many topics, and has been featured in several documentaries, TV shows and webinars, and contributes to several magazines regarding integrative veterinary care.

LECTURES: Adding New Tools to the Toolkit Never again say “there is nothing more we can do.” This presentation will present a blueprint six-step system for health and healing that may be applied to a wide variety of the chronic, relapsing, day to day cases seen in private practice. Part one of this lecture will explore innovative and cutting edge diagnostic tools that are proving valuable in the animal industry. We will cover the mechanisms and implementation, along with demonstrating them on clinical cases. Through the lecture, you will:

The Health, Safety and Convenience of Fresh Food In this lecture, we discuss the concept that, while an excellent diet alone will not cure all conditions, a poor diet will always cause health issues. It will cover the basic truths about the physiologic health benefits of a fresh diet and specifics on how it supports health on many levels. It will include a brief description of relevant nutrition terminology, tips on how to minimize diet-related health problems, and a cost analysis discussion about financial costs and the cost and causes of health. You may also be surprised to learn new and current information on: • pet food ingredients, sourcing, food animal practices and product storage • research about pathogenic bacteria and other health risks from the different options in pet food,

• gain an appreciation for why new diagnostic tools are needed with the advancing complex diseases in this modern world. • gain an understanding how the tests work and their beneﬁt in diagnosing patients. • gain value in seeing the tools used in practical clinical cases.

Adding New Tools to the Toolkit — Part 2 Never again say “there is nothing more we can do.” Part two of this lecture explores cutting edge and innovative treatments, procedures and products being used to eﬀectively reverse chronic degenerative disease. The mechanism of action is explained along with demonstration with clinical cases.

• why people may choose diﬀerent options for pet food

Continued on page 18.

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Through the lecture, attendees will: • gain an appreciation for why new treatments, procedures and products are needed with the advancing complex diseases in this modern world. • gain an understanding how the treatments benefit patients. • gain value in seeing the application and outcome of clinical cases common to veterinary practice. Introduction to Ozone Therapy Safe, effective, affordable, fun. This presentation discusses the science behind how ozone works and demonstrates the various applications in clinical practice through case presentations. Through the lecture, you will: • gain an appreciation for what ozone is and the pathophysiology effect it has on the body. • gain an understanding of practical application methods in veterinary medicine. • gain value in seeing the application and outcome of clinical cases common to veterinary practice. Photobiomodulation: How LLRT Lights the Way for Healing This presentation will cover the science behind low level light therapy and demonstrate the versatility of use in day to day practice.

chapters in two Springer publications on veterinary cannabis. Dr. Silver published a peer-reviewed review article in the online journal Animals , entitled: The Endocannabinoid System of Animals. Dr. Silver contributes to the blog: www. NurseYourPet.com Dr. Silver is currently vice-president of the American College of Veterinary Botanical Medicine and PastPresident of the Veterinary Botanical Medicine Association. He was formerly on the board of directors of the American Holistic Veterinary Medical Association.

LECTURES: Cannabis and The Big Three — How to Manage Pain, Cancer, and GI issues This lecture will present the scientific data that supports that cannabis can improve outcomes for the several conditions commonly seen in veterinary practice, including neoplasia, the management of pain and mobility and addressing the inflammatory diseases of the digestive system. The endocannabinoid system will be discussed in greater detail so as to provide an in-depth explanation of the mechanisms of action whereby cannabis and CBD can provide support for these conditions. The endocannabinoid system is present in all animals from primitive Cnidarians to primates, except for insects. It was undiscovered until 1990 when the easing of restrictions into research into THC determined there are membrane receptors and endogenous molecules that the plant molecules from cannabis interact with to create its medical benefits. This class will explain how this works. Intro to Cannabis: What’s the truth & what’s trending

This lecture will help you: • gain an appreciation for the pathophysiology eﬀect of low level light therapy on the body. • gain an understanding of practical application in veterinary medicine. • gain value in seeing the application and outcome of clinical cases common to veterinary practice.

ROBERT SILVER, DVM, MS, CVA Dr. Robert J. Silver is a 1982 graduate of Colorado State University s College of Veterinary Medicine. Dr Silver received his MS in 1976, and his BS in Animal Science from CSU in 1974, with honors. Dr. Silver serves as Chief Medical Oﬃcer of RxVitamins, and has authored the book: Medical Marijuana and Your Pet . He has contributed 4 textbook

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This talk provides entry level learning about veterinary medical cannabis, its use, its safety, the studies supporting its application in veterinary medicine, and the regulatory environment for veterinarians in the US and Canada. With the passage of the 2018 Farm Bill, hemp and CBD are no longer Schedule One drugs, and as unscheduled agricultural products from the legally grown hemp plant, veterinarians are able to now recommend and dispense this important emerging therapy. Come learn about the plant molecules that have created this green revolution, CBD and THC and others, and learn about how the body receives these exogenous ligands into its own endocannabinoid system of receptors. Learn about the new university studies and what they tell us about the safety and eﬃcacy of CBD in dogs, horses and cats, and learn about products, how to determine the quality of a product, and dosing strategies from a vet who has been involved with cannabis in Colorado since 2009.

Cannabis in Practice: Cases, Applications, and Tips on Product Tests and Dosing Product selection of a legal cannabis remedy can be complicated by product adulteration and poor laboratory analyses. This lecture will help you to define the parameters needed to be understood for product selection and dosing. Case illustration will help to understand the flexible dosing strategies found with medical cannabis. Integrative Oncology: What You Can Do as an Integral Part of Your Patient’s Super Team Veterinarians are the first responders when a pet gets cancer. It’s not enough to refer your patient to an oncologist, it’s important to create a team approach to support your client and their pet with cancer. In addition to referral to an oncologist, consultation with a nutritionist and an integrative vet to provide supportive evidencebased nutritional and nutraceutical therapies can help to improve outcomes. Anticipatory grief counseling, and goal setting, as well as learning how to assess Quality of Life will also be discussed in this class. Some of the more commonly used supplements for cancer will be explained. Chronic Kidney Disease: There’s More You Can Do!

and Nutrition. Dr. Suter owns Peak Animal Health Center where she oﬀers intensive training programs, combining holistic treatment and teaching to educate clients on creating longevity for their animals. Her passion for teaching lead her to write her international best- selling book What Your Vet Never Told You ̶ Secrets to Supporting Peak Health for Your Animal and create her in-depth video training course called Animal Longevity Secrets Revealed.

LECTURES: EMFs — Is EMF Exposure Really a Big Deal? Due to rapid progress and invention, animal and human bodies are now exposed to unprecedented levels of manmade electromagnetic radiation (EMR) from various sources. As a result, all of our health is affected. This lecture will present basic theory of EMFs and research evidence of the effects of EMFs on the body, as well as provide information on future technologic advances and their influence on health. It will also look at mitigation measures, including reducing electro “smog” to safer levels and increasing distances from emissions sources. In this lecture, you will: • learn about the origins of EMFs and their effects on the body and the world • find out where EMF “progress” is headed

This lecture will review the conventional approaches for patients diagnosed with chronic kidney disease (CKD); the IRIS system will be used as a guide for the introduction of additional therapeutics with the inevitable progression of this disease that aﬀects more cats than dogs.

• learn how to shield our animals from EMFs through remediation (lowering EMF exposure) and by strengthening the body.

Integrative approaches for CKD patients will be discussed and the scientiﬁc evidence for their use will be presented. An integrative protocol that blends these two approaches for the management of CKD will conclude this vitallyimportant-for-you-to-attend class.

In our current world, it is impossible to entirely avoid electromagnetic radiation (EMR). Thus, the goal of any mitigation is to reduce electro smog to a safer level. There are many easy ways to decrease EMR including increasing distance from emitting sources. Simply moving a bed a few inches, for example, can make a huge diﬀerence. In many cases though, proper remediation isanything but straightforward. In fact, employing a building biologist trained in this ﬁeld is highly recommended because there are many pitfalls that can be avoided, such as worsening EMF exposure through improper shielding and grounding.

ODETTE SUTER, DVM, CVA, CVSMT, MA Dr. Odette Suter graduated from veterinary school in Switzerland in 1994. Early on, she recognized the limitations of conventional medicine. Her unconventional upbringing, combined with her own healing journey, has led her to explore many avenues to discover and treat the underlying cause of disease in her animal patients. Her research has included Chinese Medicine, Veterinary Spinal Manipulation and Chiropractic Neurology, Applied Kinesiology, NAET, Animal Communication,

EMFs — Protection and Remediation

This lecture will help you: • understand how to shield our animals from EMFs through remediation (lowering EMF exposure) • gain knowledge on ways to protect our animals from EMFs through strengthening the body.

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VALARIE TYNES, DVM, DACVB, DACAW Dr. Valarie Tynes is a native Texan and received her DVM from Texas A&M University. She worked in private practice for 14 years before returning to academia to pursue a residency in clinical animal behavior at the University of California at Davis in 2000. She has been a diplomate of the American College of Veterinary Behaviorists since 2003 and is also Board Certiﬁed in Animal Welfare. Her special interests are the behavior and welfare of pet pigs, exotic pets and zoo animals. She has been actively involved in the Fear Free initiative since its inception and serves on the Fear Free Speakers Bureau. She is a frequent speaker at veterinary meetings around the world and author of numerous articles and textbook chapters. She joined Ceva Animal Health in October of 2014 as a veterinary services specialist but continues to provide consulting services to zoos.

LECTURE: Nutritional Support for the Canine Brain As medical technology and knowledge improve our ability to help our pets live longer lives, also improves. Canine cognitive dysfunction syndrome, a progressive, irreversible, degenerative brain condition aﬀects a large percentage of aging dogs and has the potential to greatly decrease the quality of their latter years. Some medications may be helpful in slowing the progression of the disease but there are also numerous supplements and other nutritional strategies that can help reduce the risk factors associated with cognitive decline and support brain health. Nutritional support can be used with less risk of contraindications associated with other medical conditions and medications that are also common in the aging pet. Through this lecture you will: • gain a superﬁcial understanding of the causes of canine cognitive decline as we currently understand them • learn some easy tips for recognizing cognitive decline in dogs • learn about the currently available neuroprotective supplements and the research that supports their use • learn some additional tips for behavioral enrichment for the senior pet.

ERNIE WARD, DVM, CVFT Dr. Ernie Ward is an internationally recognized award-winning veterinarian known for his work in the areas of general small animal practice, pet obesity and nutrition, life extension and longevity, practice management and leadership, and the special needs of senior dogs and cats. He has authored three books; The Clean Pet Food Revolution: How Better Pet Food Will Change the World, Better You, Better Dog, Better Life: 30 Days to Happiness with Your Best Friend, Chow Hounds: Why Our Dogs Are Getting Fatter. Dr. Ward has been a frequent guest on television programs and served as the resident veterinarian for the Rachael Ray Show from 2007 until 2014. Dr. Ward has authored and been featured in more than 100 practice management and peer-reviewed medical journal articles in 11 countries, co-authored the American Animal Hospital Association (AAHA) Weight Management Guidelines , co-authored the peer-reviewed Veterinary Clinics of North America Small Animal Obesity textbook, and is a 1992 graduate of the University of Georgia College of Veterinary Medicine. He is also a certiﬁed veterinary food therapist (CVFT), dedicated to preserving health, extending longevity, and improving quality of life through better nutrition.

LECTURE: The Evolution of the Innovative Veterinary Healer Maintaining curiosity, fostering creativity, and keeping an open mind are the foundations for becoming the best healer you can be. In this practical and motivational session, Dr. Ward discusses why becoming a “specialized generalist” is great vocational advice, shares techniques on how to help accelerate professional and personal evolution, and offers tips on how to bridge the chasm between the financial pressures of veterinary practice and the profession’s altruistic leanings. Through this lecture, you will learn: • why it is essential for veterinarians to remain openminded and analytical when making diagnostic and treatment decisions. • how becoming a “generalized specialist” can improve your veterinary patient care, professional success, and personal career satisfaction. • daily practices and techniques to accelerate learning, creativity, and personal growth. • how to create realistic financial expectations and develop coping mechanisms to manage client complaints about fees.

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IVCVX may be virtual but the FUN is REAL!

Thanks

TO OUR GREAT SPONSORS FOR MAKING THIS ALL POSSIBLE. Please make sure to visit their booths.

Experience all the great opportunities that you would expect at an inperson event. We have created an experience that delivers innovative lectures AND a roster of outstanding exhibitors PLUS lots of chances to win prizes and have fun. World Class Speakers IVCVX has assembled the most amazing list of professional veterinary speakers — all experts in their fields covering leading edge topics. All lectures are free to attend, with AAVSB RACE-approved CE credits available when you purchase the unlimited CE Credit Package.

Most Innovative Products Visit our Exhibitor Hall for an experience that’s truly out of this world! Go at your own pace, watch short product or service video demos, and collect information. Exhibitors are available through live online chat to answer any questions you may have.

Win Great Prizes Earn points towards winning prizes every time you click on something as you navigate IVCVX. Every action has a different points value ranging from 100 points for registration up to 500 points for connecting by live chat with an exhibitor through their booth. And keep an eye out for our Space Pup who will pop up all over the event — he’s worth 200 points if you click on him!

Cocktails, Music & Mingling Going to the moon can’t be all about work. Come to the Lunar Lounge and have some fun. Chat with your fellow colleagues, listen to your favorite song or grab a cocktail. IVC IVCVX IVC Fall 2020

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SHOW INNOVATIONS FOR YOUR PRACTICE To be a great veterinarian you need eï¬&#x20AC;ective tools. Take advantage of these amazing show specials from our list of innovative vendors covering a wide range of products and services perfect for your practice. Also, make sure to visit these vendor booths in the Exhibit Hall and connect via live chat, text or email to ask any questions you may have.

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IVC IVCVX IVC Fall2020 2020

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For Veterinarians seeking a quality hemp oil for their patients we are offering Two Free Bottles of our 1,000 mg Hemp Seed Oil formula, the same as used in the Study, for your own evaluation. Contact us at sales@hempmypet.com, 720-452-2588.

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Get a sample of our Pet liniment 10%. This topical is an ozone infused cream used to treat infections, hot spots, granulomas, wounds and more through the power of ozone! Order a sample at our booth and give it a try.

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IVC IVCVX IVC Fall2020 2020

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EXHIBITORS PROUDLY PRESENTING THE MOST INNOVATIVE PRODUCTS Visit our Exhibitor Hall for an experience that’s truly out of this world! Go at your own pace, watch short product or service video demos, and collect information. Exhibitors are available through live online chat to answer any questions you may have.

ANGEL'S ANIMALS LLC

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The Angel’s Animals Holistic Seminars were developed by Dr. Angelique Barbara and are currently oﬀered on-line to health care and animal professionals, as well as animal owners all over the world. We oﬀer online courses in animal massage, cranoisacral therapy, kinesiology taping, body alignment, Reiki and cold laser therapy.

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DYNAMITE / ANIMALANDHUMAN NUTRITION101.COM Animal and Human Nutrition 101 is an Independent Distributor for Dynamite Specialty Products — manufacturer of all-natural nutritional supplements and feed for all living things. Animal and Human Nutrition 101 is dedicated to teaching the public and their animal caregivers how to live a healthier lifestyle using Dynamite Specialty Products.

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Iceland Pure LLC is the only US company oﬀering several pharmaceutical human-grade ﬁsh oils for animals, as well as USA-grown CBD tinctures with up to 2,000mg potency. Iceland Pure is an importer of unscented human-grade Salmon Oil, Shark Liver oil, and a next level blend of CBD infused Sardine Anchovy Oil.

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HEMP MY PET HempMy Pet™. Your trusted source for hemp-infused pet products. Our Hemp is bred and grown by us on our Colorado farm. All products are formulated and produced by us, using only organic carrier-oils and our full-spectrum, cultivar-speciﬁc hemp extract. Clinically studied and Veterinarian recommended. Wholesale, Dropship, and Aﬃliate options available.

IVC Fall 2020

ION* Gut Health for Pets. By fortifying their gut lining, ION*Gut Health For Pets diversiﬁes your pet’s microbiome the natural way. How? It acts as a catalyst for redox signaling which maintains tight junction integrity in the epithelial layer of their gut lining. • Strengthens Digestion • Supports Kidney Function • Promotes Healthy Skin • Enhances Vitality • Shield Against Toxins

KRUUSE

NASC

KRUUSE is a Danish company driven by a passion for supporting veterinarians and the well-being of animals. Founded in 1896, KRUUSE supplies leading technologies and best-in-class products in postoperative care, wound care, urology, and much more. KRUUSE oﬀers more than 5,000 branded products to veterinarians and pet owners in over 100 countries.

Not all supplements are created equal. Look for the yellow NASC Quality Seal on supplements for dogs, cats and horses to know the products come from responsible suppliers that have passed a comprehensive facility audit and maintain ongoing compliance with rigorous NASC quality requirements. View member list at www.animalsupplements.org/members.

MASH MicroBiome Restorative Therapy (MBRT) is a practice of restoring the gut bacteria through a single or many fecal transplants. Our transplants come in easy, ready to use enemas (slurries), oral capsules, oral raw nuggets, oral whole raw, and unﬁltered raw product for your own preparation.

NATURE’S LOGIC Nature’s Logic’s goal is to provide the safest and most nutritious 100% all-natural products. We are a line of premium quality pet food and treats focusing on the beneﬁts of natural whole food nutrition. Nature’s Logic uses only 100% natural ingredients, and NO synthetic vitamins and minerals — The Way Pet Food Should Be ®.

NOW HEALTH GROUP NOW® Pets is an NASC-certiﬁed pet supplement line formulated exclusively for dogs and cats. As one of the natural product industry’s leading manufacturers, NOW® Pets products are made with the same premium ingredients as NOW’s supplement line for people, specially formulated to meet the unique needs and health conditions of pets.

O3 VETS We equip veterinarians to treat tough cases by providing one of the most important tools you will ever put into your toolbox. Ozone therapy is a safe, technician-driven treatment with high ROI that will treat root causes and allow you to focus on building your business the right way.

OGENA SOLUTIONS WELCOME TO

Bio-security, green technologies, and leading-edge bathing systems are central to Ogena’s product focus. Not only is Ogena the exclusive master distributor for Virox Technologies Accelerated Hydrogen Peroxide® products in the Canadian Companion Animal Health sector, but their own products and usage protocols are respected as being some of the best and most eﬃcient available.

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PARSEMUS FOUNDATION The Parsemus Foundation works to create meaningful improvements in human and animal health and welfare by advancing innovative and neglected medical research. The foundation’s focus is on supporting small proof-ofconcept studies and then pursuing press coverage of the results, so that the advances change treatment practice rather than disappearing into the scientific literature.

RX VITAMINS Rx Vitamins for Pets is an innovative nutraceutical company providing veterinarians with nutritional formulations designed to enhance patient outcomes. Since 1998, Rx Vitamins has set the standard in the development of safe, well-researched, condition-specifi c formulas that provide the veterinarian with a wide choice of treatment options to complement the conventional care of companion animals.

PETCUREAN PET NUTRITION

TEEF FOR LIFE

Petcurean Pet Nutrition is a Canadian company that creates carefully formulated premium quality recipes for each and every pet. Our GATHER producer partners meet our strict criteria of following human animal welfare practices, protecting water supplies, farmer, rancher and producer livelihoods, and ensuring preservation of natural resources.

TEEF for life’s mission is to eliminate dental disease and all the problems that come with it. The patented prebiotic technology in Protektin42™, the product of microbiology and immunology expertise, works to strengthen the oral microbiome for natural dental health.

PLEANA CURAE

TELETAILS

Plena Curae makes novel botanical pain solutions for pets and horses, sold only to veterinary medical professionals. Our products have superb ingredient quality and formulations that are the most bioavailable of any on the market.

TeleTails is a veterinarianfounded digital pet care platform that allows veterinarians and behaviorists to connect with clients when and where they need help the most. The company’s digital care software provides teams with tools to offer live video consultations, flexible messaging, cross-team communication, and payment capabilities to securely and easily connect with pet owners digitally.

RESPOND SYSTEMS Respond Systems, Inc. (RSI) has been manufacturing both cold laser and PEMF therapy in the USA for over 30 years. As a leader in development and research, RSI’s mission is to improve the lives of animals through two of the most effective, versatile, and non-invasive therapy modalities on the market today.

IVC Fall 2020

THERALASE For the past 25+ years Theralase® Technologies Inc. has been manufacturing patented Cool laser therapy systems used in a wide range of bio-stimulative and bio-destructive clinical applications. Fast, effective and with one touch, Theralase can reach up to 5” in depth of penetration while activating all three known cellular pathways.

IVCVX CLICK & WIN Win great prizes just for going through the normal

VDI LABORATORY VDI Laboratory is the leading veterinary blood diagnostics provider in the fi elds of cancer, infl ammation, osteoarthritis, sepsis, wellness, and nutrition focused on Test & Treat solutions. VDI is advancing diagnostic interpretation using computer algorithms, termed Intelligent Diagnostics, to provide veterinarians specifi c diseases associated with test results.

motions of exploring the Expo. We have designed the event so there are lots of ways to collect points, from just the click of a mouse or touch pad. Winners will be able to choose from a selection of amazing swag as well as other great items provided by our vendors. Attendees that are in the top 50 points earners will win a prize.

HOW YOU COLLECT POINTS VETRISCIENCE LABORATORIES VetriScience® Laboratories offers clinical strength and condition-specific formulas to support the health of your patients. For over 40 years, VetriScience® has led the way in the animal health industry with the formulation of nutritional supplements for companion animals, consistently setting new standards of quality, safety, and efficacy in the field.

POINTS SYSTEM EARN ACTION 500

Have a live exhibitor chat

400

Visit exhibitor booth

300

Open exhibitor document

300

Watch exhibitor video

300

Click on the Space Dog

200

Click any banner sign

200

Click any top navigation menu item

200

Open the Lunar Lounge chat room

200

Complete survey

100

Pre-register for IVCVX

100

Watch webinar

100

Download signature expo cocktail recipe

100

Watch a music video in the Lunar Lounge

100

Click IVC Journal landing page button

100

Click IVC Facebook link button

100

Click IVC LinkedIn link button

Game starts November 6, 2020 and will end February 6, 2021 at 11:59pm EST.

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IVC Fall 2020