V12I4 (Fall 2022) by Redstone Media Group

Innovative VETERINARY CARE

VOLUME 12 ISSUE 4

IS ADRENAL FATIGUE A TRUE MEDICAL CONDITION? THOUGH THERE’S NO SCIENTIFIC PROOF, MOUNTING EVIDENCE SUGGESTS ADRENAL FATIGUE IN DOGS AND CATS IS REAL — AND WE ARE MISDIAGNOSING IT. — P. 8

HOW THE RIGHT DIET COULD REVERSE FELINE DIABETES _

HAVE YOUR CLIENTS PROVIDED FOR THEIR PETS?

AN INTEGRATIVE APPROACH TO SEIZURES IN DOGS

TREATING CUSHING’ S DISEASE NATURALLY

USING TCVM TO TREAT LIVER DISEASE

DIAGNOSING AND TREATING THYROID DISEASES IN DOGS AND CATS

Feeding diabetic cats a species appropriate diet that’s low in carbs and high in protein may cause the disease to go into remission. — P. 15

www.IV

FALL 2022

C Journal.com

Integrative therapies take time to work when controlling seizures and epilepsy in dogs, but they can be effective and don’t have side effects. — P. 22

How TCVM modalities like nutrition, herbal medicine, Tui_na and acupuncture help treat liver disease in dogs. —P. 32

Would your animal patients have someone to care for them if something happened to their owners? How to start a conversation around this important topic. — P. 38

Find out how nutrition, glandulars, herbs, acupuncture and more can treat your canine Cushing’s patients. — P. 54

Accurate diagnostic testing is vital to successfully managing hypothyroidism and hyperthyroidism. — P. 26

FALL 2022

EDITORIAL DEPARTMENT

Editor-in-Chief: Dana Cox Managing Editor: Ann Brightman Associate Editor IVC: Omer Rashid, DVM Senior Content Editor: Ashley Tonkens Content Editor: Bianca Mazziotti Graphic Design Lead: Ethan Vorstenbosch Graphic Designer: Joy Sunga Junior Graphic Designer: Luke Bakos

COLUMNISTS & CONTRIBUTING WRITERS

Ihor Basko, DVM, CVA Jody Bearman, DVM Chris Bessent, DVM, MSOM, Dipl. OM, L.Ac. Nancy Brandt, DVM, CVC, CVA, CVMA Christina Chambreau, DVM, CVH Todd Cooney, DVM, CVH W. Jean Dodds, DVM Jodie Gruenstern, DVM, CVA Linda S. Jacobson, BVSc, MMedVet (Med), PhD, Toronto Humane Society Melissa Kellagher, AHVMA Director of Operations Cynthia Lankenau, DVM Jaime Pickett, Chief Veterinary Officer, New Day Veterinary Care at Pet Paradise Marlene Siegel, DVM

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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 copyright© 2022. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: September 2022.

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

IVC Fall 2022

contents FEATURES

FATIGUE IN DOGS 8 ADRENAL AND CATS

By Marlene Siegel, DVM

Though there is no scientific proof to say adrenal fatigue is a true medical condition in pets, mounting evidence suggests it’s real, and we are misdiagnosing the symptoms and warning signs.

NUTRITION NOOK DIET AND DIABETES MELLITUS IN CATS

Conventional drugs used to control seizures and epilepsy in dogs can lead to side effects and withdrawal problems. An integrative approach takes time to work but can be an effective way to treat these conditions.

MANAGING AND 26 DIAGNOSING, TREATING THYROID DISEASES IN DOGS AND CATS By W. Jean Dodds, DVM Hypothyroidism and hyperthyroidism are commonly-seen disorders in canine and feline patients. Accurate diagnostic testing and screening are vital to successful treatment and management.

46 26 4

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WHEN THE UNEXPECTED HAPPENS — ENSURING A FUTURE FOR YOUR CLIENTS’PETS

By Christina Chambreau, DVM, CVH Have your clients provided for their pets in the event something happens to them? How to start a conversation around this important topic.

MAKING SENSE OF FELINE PANLEUKOPENIA (FPV) TESTING By Linda S. Jacobson, BVSc, MMedVet (Med) PhD, Toronto Humane Society

How studies on FPV diagnosis and management are helping answer some practical questions important to shelter medicine and beyond.

SEIZURES AND EPILEPSY IN DOGS — HOW TO MINIMIZE SIDE EFFECTS OF PHARMACEUTICALS By Ihor Basko, DVM, CVA

By Jody Bearman, DVM Traditional Chinese Veterinary Medicine (TCVM) includes nutrition, herbal medicine, Tui-na and acupuncture. All these modalities are helpful for treating liver disease in dogs.

By Chris Bessent, DVM, MSOM, Dipl. OM, L.Ac. Many domesticated cats eat kibble diets high in carbohydrates, leading over time to the development of diabetes mellitus. Feeding a species-appropriate diet that’s low in carbs and high in protein creates better health and can even cause diabetes to go into remission.

TCVM FOR LIVER DISEASE IN CANINES

NATURAL APPROACH TO CUSHING'S DISEASE IN DOGS By Jodie Gruenstern, DVM, CVA

A natural approach to Cushing’s disease in dogs includes nutrition, glandulars, herbs, acupuncture and more, addressing all facets of the disease with no side effects.

HOMEOPATHY FOR HYPERTHYROID CATS

By Todd Cooney, DVM, CVH Unknown before the 1970s, hyperthyroidism is now a common ailment in cats. Homeopathy is an effective alternative to conventional treatments.

COLUMNS & DEPARTMENTS

7 Editorial

advisoryboard

19 From the AHVMA 25 From the VMAA 51 From the AAVA 59 Industry innovations 61 From the VBMA 65 From the AVH PROFITABLE PRACTICE

14 ImpriMed 21 VDI Laboratory 31 Alaskan Naturals 43 Infusion Pump Repair (IPR) 53 HempMy Pet™ IN THE NEWS

20 Restoring native predators can

reduce invasive species

44 US govt against concentration of

ownership in vet industry by large players

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.

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 coowner 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.

52 Wildfire-injured cats more prone

to blood clots

60 Can pets get monkeypox? 66 More pets, fewer vets

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.

IVC Fall 2022

1. IHOR BASKO, DVM, CVA

Dr. Ihor Basko has a fully holistic practice with a focus on nutrition, supplementation with vitamins, minerals, nutraceuticals and herbal formulas. Prevention, geriatric medicine, cancer, allergies, chronic digestive problems and skin problems make up a large percentage of his practice. Primary treatments include acupuncture, massage, cold laser, and nutritional counselling as well as herbal therapies. Dr. Basko graduated Michigan State U. Veterinary College in 1971 and was IVAS certified in acupuncture in 1985. Dr. Basko has been formulating pet nutraceuticals for Genesis/Resources, Kemin, and currently for Vet Classics and NaturVet. His current interests include medicinal mushrooms, Hawaiian medicinal plants, and more (www.drbasko.com, drbfree@drbasko.com). p.22

2. JODY BEARMAN, DVM

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 three-veterinarian integrative practice in Madison, WI. p.32

3. CHRIS BESSENT, DVM, MSOM, DIPL. OM, L.AC.

Dr. Chris Bessent has over 30 years of experience in veterinary medicine, and has certificates in veterinary acupuncture, veterinary chiropractic, and veterinary Chinese herbology. She also received her degree in veterinary nutrition and founded The Simple Food Project, formulating freeze-dried raw food diets for cats and dogs using nothing but whole foods. Currently, Dr. Bessent divides her time between The Simple Food Project and Herbsmith, a manufacturer of premium quality supplements for pets. Both are owned and operated out of her facilities in southeastern Wisconsin (simplefoodproject.com, herbsmithinc.com). p.15

4. CHRISTINA CHAMBREAU, DVM, CVH

Dr. Christina Chambreau (ChristinaChambreau.com) has been teaching holistic approaches to health since she began using homeopathy in her practice 36 years ago. She now has a Pet Health Coaching phone consulting practice where you can get help moving down the path to health for your animals. She is also the author of the Healthy Animal’s Journal series, including e-books for cats and dogs. p.38

5. TODD COONEY, DVM, CVH

Dr. Todd Cooney trained at Purdue University. He worked in private mixed practice, served as an officer in the US Air Force and Army, and as a USDA veterinarian. After 22 years of conventional

IVC Fall 2022

practice, he took Dr. Richard Pitcairn’s Professional Course in Veterinary Homeopathy, which changed the way he viewed health and disease. Dr. Cooney began using homeopathy right away, with exciting results (naturalanimalconsulting.com or drtcooney@gmail.com). p.62

6. 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.26

7. JODIE GRUENSTERN, DVM, CVA

Dr. Jodie Gruenstern graduated from UW-Madison in 1987. She is a certified veterinary acupuncturist and food therapist by the Chi Institute; former Vice-President of the Veterinary Medical Aromatherapy Association (VMAA) and a member of the AHVMA and AzVMA. Dr. Jodie is the author of Live with Your Pet in Mind, available on Amazon, and is a nationally-renowned speaker, writer, and pet product formulator. She has provided veterinary supervision for non-anesthesia teeth cleaning throughout Arizona. Dr. Jodie’s Integrative Consulting office is in Fountain Hills (http://docjodie.com, docjodie@ docjodie.com). p.54

8. LINDA S. JACOBSON, BVSC MEDVET (MED) PHD, TORONTO HUMANE SOCIETY

Dr. Linda Jacobson obtained her veterinary degree in Pretoria, South Africa, in 1986 and completed a residency in small animal internal medicine and a PhD on the pathophysiology of virulent canine babesiosis. She completed the University of Florida Online Graduate Certificate in Shelter Medicine in 2015. Dr. Jacobson has served on the College of Veterinarians of Ontario’s Practice Advisory and Standard of Care Panels, and is on the editorial boards of Journal of Feline Medicine and Surgery and Journal of Shelter Medicine and Community Animal Health. She is President and Treasurer of the Ontario Shelter Medicine Association, joined Toronto Humane Society as a staff veterinarian in 2011, and is currently Senior Manager: Shelter Medicine Advancement. p.46

9. MARLENE SIEGEL, DVM

Dr. Marlene Siegel is an international speaker and innovator in integrative veterinary medicine. Her practice, Pasco Veterinary Medical Center, offers the widest array of alternative therapies and detoxification services in the country. She developed her own raw pet food and supplements company, EvoLoveRaw.com. Passionate about education, Dr. Siegel has online integrative veterinary medicine programs for pet parents and veterinarians. This year, she is launching S’Paws Family Wellness, detox centers for pets and their parents. p.8

editorial

focus on

Endocrinology Have you seen Inside Out, the animated movie that personifies five human emotions? If I was to make a similar movie, I would personify the body’s hormones. Endocrinology is a topic I find absolutely fascinating, and it’s what’s this issue of IVC Journal is about. These little glands are just extraordinary, and the way they function is something out of this world. Endocrinology is at the core of physiology. Our glands — and those of our animal patients — pull the strings of a variety of phenomena that take place in the mammalian body. Any problem with the endocrine system is going to badly affect homeostasis and result in ailments. It’s therefore necessary to keep the endocrine system in order so the body can function at its best.

You’ll find two articles about canine hypothyroidism and the various ways it can be treated and managed. We also look at integrative support for Cushing’s disease in dogs (follow the cortisol!). Read up on the connection between food and diabetes mellitus in cats, and why a carnivorous diet is so important to our feline patients. Learn more about adrenal fatigue in dogs and cats, and find out how seizures can be linked to imbalances in the endocrine system. Beyond endocrinology are articles on Traditional Chinese Veterinary Medicine for canine liver disease, and an important study on feline panleukopenia. I hope you enjoy this issue. Have a healthy fall. Warm regards,

The early detection of endocrine disorders is pivotal for keeping damage to a minimum and devising the most effective way forward. An endocrine problem may be a lifelong issue, but with proper management, pets can still thrive and enjoy life. Conventional approaches to treating endocrine malaise can’t be ignored. However, alternative options serve as a backup plan, thanks to experienced complementary and alternative veterinary medicine practitioners. And that’s what this issue is about.

Omer Rashid, DVM, MSc Parasitology Associate Editor, dromer@redstonemediagroup.com

IVC Fall 2022

ADRENAL FATIGUE IN DOGS AND CATS BY MARLENE SIEGEL, DVM

Though there is no scientific proof to say adrenal fatigue is a true medical condition in pets, mounting evidence suggests it’s real, and we are misdiagnosing the symptoms and warning signs.

Adrenal fatigue is not a widely recognized condition in pets, although it affects 10% to 15% of the human population in developed countries.1 Extrapolating information known about adrenal fatigue in humans suggests that veterinarians are probably missing the early warning signs of this condition in pets, consequently misdiagnosing the symptoms as other disorders.

FOLLOW THE CORTISOL Anything that raises cortisol levels, whether as a result of stress or the use of prescription medications, creates a risk for blood sugar imbalances, high inflammation, hormone imbalances, weight gain, low energy and poor vitality. High cortisol contributes to fat breakdown, reduced bone formation, insulin resistance, decreased amino acid uptake by

IVC Fall 2022

the muscles, metabolic acidosis, impaired lymphatic function and the generation of more glucose from the liver. High cortisol also leads to leaky gut, which allows molecules to enter the body through the gastrointestinal tract. These foreign invaders are carried by the blood stream to the liver where they trigger an inflammatory response. The cycle becomes perpetual unless cortisol levels are reduced and the leaky gut is repaired.

CHRONIC INFLAMMATION IS THE ROOT CAUSE OF ALL “DIS-EASE” Early warning signs of adrenal fatigue in pets mimic “allergy” symptoms such as sneezing, itching, excessive eye tearing,

or paw licking. Instead of addressing the root cause of the “allergies”, veterinarians often treat these pets symptomatically with steroids, Apoquil or Cytopoint.2

OUR MODERN WORLD

The brain does not distinguish between real and perceived threats. In today’s modern world, humans experience nonstop “perceived threats”. The “lion” is the S.A.D. Day (Standard American Day), though of course stressors Other symptoms of adrenal fatigue may include waxing don’t just exist in America. People are sleep-deprived, and waning gastrointestinal signs, a finicky appetite, an have financial concerns, eat processed, nutrientinappropriate response to stressors and generalized lethargy. deficient foods, are exposed to thousands of toxins, and are bathed in EMF pollution. Many also live in a state of FEAR (Future Events Appearing Real). Practitioners see these symptoms often, but again, the The S.A.D Day includes the S.A.D. Western practitioner tends to address the symptoms but Diet (Standard American Diet). not the underlying “dis-ease”. The pet improves — until

the next episode. Eventually, the pet relapses or the condition worsens into a chronic degenerative disease or autoimmune condition.3

THE ADRENAL GLANDS

his perpetual state of high alert, T high sympathetic tone, and high cortisol release contributes to adrenal fatigue in people.

The adrenal glands regulate the body’s ability to respond to stress and maintain other essential life functions. Adrenal fatigue, more accurately termed Hypothalamic-PituitaryAdrenal Axis (HPA Axis) dysfunction, is characterized by chronically low cortisol levels. Veterinarians are trained to recognize two major adrenal dysfunctions once they have advanced past the early adrenal dysfunction stage:4 Hyperadrenalcortism (also called Cushing’s disease) results from an excess production of cortisol. This may occur due to a tumor in the pituitary or adrenal gland, or the over usage of exogenous steroids (Iatrogenic). Chronic cortisol

elevation leads to blood sugar imbalances, one of the most insidious robbers of health. Blood sugar imbalance increases inflammation, which puts more stress on the adrenals and begins a vicious cycle as they continue to make each other worse. Whatever the cause of chronically increased cortisol, it marks the start of adrenal dysfunction.5

MEASURING STRESS AND HEART RATE VARIABILITY (HRV) Whether real or perceived, stress increases heart rate, breathing, and blood pressure. When the threat is over, the body relaxes, the heart rate, breathing and blood pressure reduce, and there is a return to a resting state. Heart rate variability (a measure of the variability between heartbeats) is a metric of how the body is recovering from stresses throughout the day, and is an evaluator of overall fitness. Low heart rate variability is considered a sign of current or future health problems because it shows the body is less resilient and struggles to handle changing situations. Low HRV may be an early indicator of adrenal fatigue.8

Adrenal insufficiency6 (also called Addisons disease or Hypoadrenalcortism) is an autoimmune disease in which the body attacks the outer layers of the adrenal glands. This leads to a deficiency in key hormones (e.g. cortisol, which is a glucocorticoid necessary for the stress response; and aldosterone, a mineralocorticoid needed to maintain water and electrolyte balance). Other causes of adrenal tissue destruction include metastatic tumors, hemorrhage, infarctions, granulomatous diseases, and adrenolytic agents like Miototane or Trilostane which inhibit adrenal enzymes. Regardless of the cause, the adrenals have lost the ability to produce the hormones necessary to respond to stress and maintain body functions.7

THE AUTONOMIC NERVOUS SYSTEM (ANS) The ANS has two branches: sympathetic and parasympathetic. As information comes into the brain (through sight, sound, feel, taste and smell), it is processed through the amygdala, an area that contributes to emotional processing. Depending on how the message is received and interpreted, one of the two branches of the autonomic nervous system will be activated. If the message is “danger”, a distress signal is sent to the hypothalamus. This area of the brain functions like a command center, communicating with the rest of the body through the ANS to activate the sympathetic branch for a fight or flight response. When the sympathetic branch is activated, it sends a signal to the adrenal gland.

IVC Fall 2022

Cortisol and adrenaline are released, increased energy and blood supply go to the muscles, stored sugars are released into the blood for immediate energy, and the fight/flight response takes over (run away from the danger or fight to survive). High sympathetic tone shuts down the parasympathetic branch of the ANS. The parasympathetic branch regulates rest, repair, digestion, reproduction and detoxification. As the initial surge of adrenaline (also called epinephrine) subsides, the hypothalamus activates the second component of the stress response system, the HPA axis, which relies on a series of hormonal signals to keep the sympathetic nervous system activated.

THE HPA AXIS The Hypothalamic-Pituitary-Adrenal Axis is a collaboration of the adrenal and pituitary glands, and the hypothalamus. Their joint activities help control the body’s reactions to stress, (physical or psychological). They also help regulate digestion, the immune system, and energy usage. If the brain continues to perceive something as dangerous, the hypothalamus releases corticotropin-releasing hormone (CRH), which travels to the pituitary gland, triggering the release of adrenocorticotropic hormone (ACTH). This hormone travels to the adrenal glands, prompting them to release cortisol. This process allows the body to stay in high alert. Once the danger passes, cortisol levels drop, and the vagus nerve stimulates the parasympathetic branch of the ANS, signaling that rest, repair, digestion and detoxification can begin.

ANS BALANCE IS THE KEY TO THRIVING The ability to appropriately respond to danger and then recover (by moving into a parasympathetic state) through rest, repair and detoxification is imperative for a healthy immune system. Nature demonstrates ANS balance beautifully. A herd of gazelle graze peacefully (but alertly) until chased by a predator (like a lion). They shift immediately into sympathetic tone and run for their lives. The lion (who was in high sympathetic tone while chasing the herd) shifts into parasympathetic while eating his kill. The herd of gazelle settle back down into parasympathetic and return to grazing, even though the lion is still nearby, because the threat has passed.

RISK FACTORS LEADING TO ADRENAL FATIGUE IN PETS

1. 2. 3. 4. 5. 6.

S pecies-inappropriate diets (highly processed, enzymatically dead, nutrient-deficient and loaded with carbohydrates and toxins) contribute to metabolic stress. Non-structured tap water (loaded with heavy metals, insecticides, pesticides, fluoride, pharmaceuticals, glyphosate and more) adds to the toxic burden, plus the body has to re-structure the water in order to absorb it intracellularly. This extra work increases metabolic stress. E nvironmental toxins such as hormone disrupters, mold, volatile organic compounds and electromagnetic pollution (EMF) create massive stress on the body. T he pet’s “stress” can be their own (physiologic or psychological) but can also be entrained from their stressed out owners. Steroids and other drugs used to control symptoms of “dis-ease” are not addressing the root cause of the problem. Their misuse may further suppress the individual, driving the “dis-ease” further into the body. E xogenous steroids are the most overused and abused drugs in the conventional veterinarian’s pharmacy.

The consequences of chronic low-level adrenal stimulation are multifold: •

An increased load on the heart may lead to heart failure.

•

Chronic excess blood glucose may lead to diabetes mellitus.

•

Persistent stimulation of the adrenals may lead to adrenal fatigue or ultimately to adrenal failure (Addison’s disease).

IVC Fall 2022

THE CHOICE TO HEAL IS OURS Though there is no scientific proof to support adrenal fatigue as a true medical condition in pets, mounting evidence suggests that it is real, and we are misdiagnosing the symptoms and warning signs.9

https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response

American Holistic Medical Association Conference. https://www.avma.org/Events/Calendar/ Pages/event. aspx?EventID=46482016. 2016. 2

https://my.clevelandclinic.org/health/symptoms/21773-heart-rate-variability-hrv

https://www.merckvetmanual.com/endocrine-system/the-adrenal-glands/overview-of-theadrenal-glands

https://www.merckvetmanual.com/dog-owners/hormonal-disorders-of-dogs/disorders-ofthe-adrenalglands-in-dogs 5

Integrative veterinarians are leading the movement to addressing the root cause of “dis-ease” and support the body’s innate ability to heal. Stress and the ability to adapt are predictors of health and longevity. As we focus more on creating lifestyles that support ANS balance, we will have the greatest impact on our patients.

ADDRESSING THE ROOT CAUSE Because the solutions for pets are intertwined with their owners’ behavior, modifying human behavior as well as the animal’s lifestyle is important. Our modern world has many more stressors than in the past, but our bodies see the stress and respond the same way they did when the lions were in pursuit of us. The goal is to mitigate as many factors as possible that are contributing to high cortisol and a leaky gut.

Husebye, E. S., Allolio, B., Arlt, W., Badenhoop, K., Bensing, S., Betterle, C., … Pearce, S. H. (2014). Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency. Journal of Internal Medicine, 275(2), 104–115. PMID: 24330030 6

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5501750/

https://my.clevelandclinic.org/health/symptoms/21773-heart-rate-variability-hrv

Goldstein M. The Nature of Animal Healing: The Definitive Holistic Medicine Guide to Caring for Your Dog and Cat. Ballantine Books; New York, NY: 2009. 9

8. Mitigate EMF. Hard-wire when possible, increase distance from EMF, turn off routers, avoid smart appliances, and use EMF mitigating products.

9. Create mindfulness practices. Meditate, focus on gratitude, go outside and do grounding exercises with pets.

10. Deep belly breathing puts the body in a parasympathetic state, which pets will entrain to.

11.

12. Detoxify the six organs of elimination (kidneys, colon, lungs, liver, skin and lymphatics).

13. Heal leaky gut. After stopping the behaviors leading to the condition, heal with bone broth, licorice root and humic supplements.

14.

1. Feed a species-appropriate grass fed/finished, free-range balanced raw diet with the appropriate proportions of meat, fat, organs and bone.

intermittent fasting, temperature extremes) to improve HRV and resilience.

3. Provide essential vitamins/minerals and fatty acids 16. 4. Clean with organic products, essential oils or other natural cleaners.

5. Use organic personal body care products. 6.

All laundry and personal care products should be natural and organic.

7. Check indoor air quality for Volatile Organic Compounds (VOCs) and mold.

IVC Fall 2022

Support the microbiome and its diversity with organic, raw fermented foods

15. Incorporate hormetic stressors (rectal ozone,

2. Provide highly filtered structured water. in plant-based bioavailable organic form.

Exercise and move daily for mental and lymphatic health.

Use adaptogenic herbs such as astragalus and ashwaganda.

17. Frequency therapy, using very low frequency in the Pica Tesla ranges, restores normal cellular frequency.

18. Be open to learning. For more info, visit my website (www.DrMarleneSiegel) It has resources and biohacking tools that work with sound, light and vibration to restore balance to the ANS and improve HRV.

HOW TO LOWER THE RISK OF PERIODONTAL DISEASE IN YOUR K9 PATIENTS Periodontal disease is extremely common in dogs and it’s not just older dogs that are being affected. Statistically, 80% of dogs three years of age or older have some form of gum disease, and only 20% of pet parents know about it. A combination of things leads to the high number of dogs with gum disease. For starters, most pet parents don’t think about their dogs’ oral health, especially if the dog is young, and gum disease is often hidden by the dog’s jowls. Other reasons for gum disease include unhealthy, over-processed food, unclean toys and irregular teeth brushing. When pet parents do start thinking about their dogs’ dental care, it’s usually because their veterinarians found an issue, and sometimes by that point, it’s too late. That leads to painful procedures for the patient and an expensive vet bill for the client. Unattended, of course, bacteria will enter via open blood vessels in the bleeding gums and use the circulatory system as a race track to vital organs, where they ravage the organ, and ultimately cause illness or even death to a dog. Preventative measures like getting professional teeth cleanings, having the client brush their dog’s teeth regularly at home, and dental dog treats are the best defense against periodontal disease.

Yummy Combs® has also just earned the coveted VOHC Seal of Acceptance for Tartar! This means that Yummy Combs® is recognized for being an effective dog treat in controlling plaque and tartar, making it an excellent choice for your patients’ daily oral care routine. Yummy Combs is also made with 12 wellness ingredients and 44% superior protein. The PROTEIN IQQ (quantity and quality) of Yummy Combs® was 5 times that of an average of 15 competitive treats. Protein is what professional athletes use to build muscle and vital organs. The other 15 treats had an average of 6.5 times as much starch, which fosters obesity — the #1 nutritional issue of dogs today. Yummy Combs® patented advanced safety technology reduces the risk of choking and intestinal and esophageal blockages with three patented concepts, to provide peace of mind for dog owners. And dogs love the taste, so your clients won’t have to worry about brushing as much. Empower your clients to take care of their dogs’ dental health in between checkups and recommend Yummy Combs® as their daily dog treat for an oral care maintenance program!

However, as veterinarians know, getting clients to brush their dogs’ teeth can be difficult, especially if they have a dog that doesn’t like the experience. The other option for pet parents is to give them a dental dog treat, but a lot of dental treats on the market are made with ingredients that aren’t healthy, especially for a dog to consume every day. Recent third-party research comparing 16 dental dog treats indicated major differences in their effectiveness against harmful oral bacteria, showing that not all dog treats are created equal. One dental treat that is proven to work is Yummy Combs®. With its unique patented honeycomb design, Yummy Combs® flosses 360o around teeth, scrubs away tartar with up to 256 cleaning surfaces, and gets right to the all-important gumline. IVC Fall 2022

profitable practice

How ImpriMed can help increase CANCER REMISSIONS, grow YOUR REPUTATION and level up YOUR REVENUE IMPROVE YOUR CLINICAL SUCCESS RATE One way to increase your practice revenue is to improve clinical success rates. However, cancer is one ailment that can prove to be a nemesis for veterinarians since remission rates are low and prescribed drugs may or may not work. Clients who hope to see their pets recover as soon as possible are disappointed when told the treatment path has to be changed. But what if you could experience a high percentage of clinical remissions and happy clients with the very first treatment? Along with the professional satisfaction that comes with a higher success rate, your reputation will grow, and clients will start referring friends and family with ailing pets to your practice. The inevitable result is increased revenue. By partnering with ImpriMed, you can start overcoming cancer by raising remission rates in your patients. This precision medicine company has developed a state-of-the-art AI platform that uses real-world clinical data to make drug response predictions for each individual patient. ImpriMed is currently offering personalized drug response prediction profiles for both canine lymphoma and leukemia.

DETERMINING THE BEST CANCER DRUGS FOR YOUR PATIENTS ImpriMed’s drug response prediction profile informs you of the most suitable cancer drugs for each patient, along with expected remission times. It’s curated by advanced AI tools that have been trained by chemosensitivity and other patient data. Information from live patient cells is also added

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to the platform to get the best possible individualized drug response predictions. An ingenious robotic machine is used to drop drugs onto the live cancer cells, and the results are recorded. You can expect to have the profile in your hands within seven days of sample collection.

OTHER SERVICES AND TRAINING REQUIREMENTS ImpriMed offers additional services along with their drug response prediction profile. Get reports for immune profiling using flow cytometry and PCR for antigen receptor rearrangements; flow cytometry only; and PCR for antigen receptor rearrangements only. Free immuno-profiles for cats suffering from lymphoma or leukemia are also being offered. All you need is to be familiar with the Fine Needle Aspiration (FNA) method for sample collection. You can easily get a FNA refresher by visiting the FAQ section on ImpriMed’s website. ImpriMedicine.com

nutrition nook

DIET AND DIABETES MELLITUS IN CATS BY CHRIS BESSENT, DVM, MSOM, DIPL. OM, L.AC.

Many domesticated cats eat kibble diets high in carbohydrates, leading over time to the development of diabetes mellitus. Feeding a speciesappropriate diet that’s low in carbs and high in protein creates better health and can even cause diabetes to go into remission.

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The most common form of diabetes in cats is Type 2 diabetes. Also called diabetes mellitus, it results from prolonged inappropriate dietary practices. Chronic improper nutrition (i.e high carbohydrate consumption for a long period) can dramatically change the health of the cat’s body, and there is no more obvious example of this than the high incidence of diabetes mellitus in domesticated cats.

WILD VS. DOMESTICATED FELINE DIETS We need to be providing cats with food that comes as close as possible to the wild or feral feline diet. Recent research involved an analysis of the combined carcasses of wild rodents and small birds, revealing 67% water content, 62% crude protein,

11% crude fat, 14.8% ash, and 2% carbohydrate (nitrogenfree extract). The average energy content of the prey was 3,929 kcal/kg DM.4 Interestingly, a diet of wild rodents and small birds exceeded the recommended allowances provided by the Nutrient Requirements for Dogs and Cats (NRC 2006)5 for fat, crude protein, and essential amino acids. Most importantly, the feral cat diet consisted of only 2% carbohydrates. Many domesticated cats receive standard commercial dry kibble diets. Up to 60% of the energy provided by these diets comes from carbohydrates (mean 41%).6 Compared with dogs and humans, cats have a reduced capacity to metabolize a high glucose load, resulting in higher blood glucose concentrations after a carbohydrate load. Cats also have an extended postprandial period of eight to 15 hours as compared with two to three hours for humans and three to six hours for dogs.2 Glucose metabolism in cats is unique, with limited liver enzyme activity, delayed gastric emptying, reduced small intestinal disaccharidase activity, and reduced and delayed insulin secretion, leading to inherent carbohydrate intolerance.

STUDY SHOWS HIGH RATE OF

DIABETES MELLITUS

In a five-year study of 193,563 cats, the incidence of diabetes mellitus was one in 200 cats, with certain breeds being at higher risk, including Tonkinese, Norwegian Forest and Burmese.1 Although genetic susceptibilities have an influence, obesity is the most important acquired risk factor. In fact, overweight cats have a 4.6 times greater risk of developing diabetes than cats of normal weight.2 Shockingly, approximately 20% of obese cats over eight years of age are prediabetic, with impaired glucose tolerance or impaired fasting glucose.2 With time, obese cats can develop altered expression of several insulin-signaling genes and glucose transporters, and can be leptin-resistant. Diabetic cats also form amyloid deposits within the islets of the pancreas, and develop glucotoxicity when exposed to prolonged hyperglycemia.3

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UNIQUE GLUCOSE BALANCE AND CARBOHYDRATE METABOLISM Healthy cats tend to have consistent blood glucose concentrations because, being carnivores, they are very adept at making glucose from the amino acids they consume in meat-based diets. This happens as a constant process in the carnivore’s body. There are two ways to get glucose into a cat’s body — one is via a dietary source of carbohydrates or sugars, and the other involves a conversion called gluconeogenesis, where the amino acids from protein are converted into glucose. The body has little ability to conserve amino acids, so they need to be used throughout the day, either as a component of protein synthesis or converted to glucose. Carnivores maintain a constant state of gluconeogenesis throughout the day, with a slight increase immediately after eating. Therefore, they can also maintain constant steady blood glucose levels throughout the day. In contrast to omnivores, the gluconeogenesis pathway is always available to carnivores for developing glucose. As mentioned above, the combination of rodents and small birds has a carbohydrate concentration of 2%. Kibble is notoriously high in carbohydrates because it is necessary to form and hold the pieces together during the extrusion process. This means the carbohydrate content of kibble can be as high as 60%. The carbohydrate is broken down into glucose via pancreatic enzymes (e.g. amylase). The glucose is absorbed and transported via the portal vein to the liver.

Within the liver, the glucose is phosphorylated into the active metabolizable glucose-6-phosphate. The phosphorylation process requires two enzymes: •

Glucokinase, which becomes active in high blood glucose levels.

•

Hexokinase, which becomes active in low blood glucose levels.

As carnivores, cats have minimal glucokinase activity and high hexokinase activity rates. Also, glucokinase in the cat cannot be upregulated (i.e. increased during times of high blood glucose). Again, cats have a reduced capacity to metabolize a high glucose load, with an extended postprandial period of eight to 15 hours.7,8,9 All this makes sense because we know that cats are carnivores and should eat high-meat diets, developing glucose via gluconeogenesis (the conversion of excess amino acids into glucose) rather than spikes of glucose from dietary carbohydrates. So what happens when cats eat a high carbohydrate dry kibble diet? The cat’s liver does not have the enzymes to convert high blood glucose into the active metabolic form of glucose (glucose-6-phosphate). Therefore, after a cat eats a kibble meal, the blood glucose remains high for a long time, much higher than an omnivore's. Carnivores cannot rapidly respond to spikes in blood sugars and are subject to longstanding hyperglycemia. Chronic high blood glucose leads to a cascade of physiologic events. High blood glucose signals the release of insulin from the pancreas. Eventually, the losing “blood glucose battle” leads to insensitivity of insulin receptors in the tissue, then the buildup of hyper-produced and released insulin leading to hyperinsulinemia. Hyperinsulinemia and hyperglycemia lead to abnormal fat deposition, obesity and constant unrelenting hunger, nerve damage, kidney and liver issues, nonhealing wounds, cataracts, and repeated urinary tract infections due to excreted glucose in the urine. IVC Fall 2022

CONVERTING

A CAT FROM A HIGH- TO LOW-

CARB DIET

As any pet parent of an obese “carboholic” kitty knows, it is difficult to convert these cats to a species-appropriate, high meat protein, low carbohydrate diet. They refuse to eat. The pancreas is in overdrive, producing insulin, and the tissue that is insulin resistant is screaming for energy. The cat is hungry, doesn’t feel well, and is frankly resistant to all dietary changes. So start slowly, adding small amounts of fresh meat and ground organs to the cat’s kibble. Gradually decrease the carbohydrate-laden kibble and add more and more fresh real meats. As the cat’s metabolism starts to correct, blood sugar decreases and becomes normalized, insulin receptors become more sensitive and provide the tissue with the energy it needs. The cat will become less ravenous, happier and healthier. He will feel better and become more active, and his body weight will normalize.

And the vicious cycle continues. The obese “carboholic” cat is created by feeding a speciesinappropriate diet high in carbohydrates. In 60% of diabetic cats, pancreatitis is present at the time of diagnosis, based on biochemical and imaging findings, though few have clinical signs.9,10,11 Chronic hyperinsulinemia leads to amyloid buildup in the chronically inflamed pancreas, and in turn leads to the loss of insulin production — hence the need for insulin medications.

LOW CARBOHYDRATE DIETS ARE THE ANSWER Feed cats as the carnivorous creatures they are. Cats have a small amount of metabolic flexibility in the utilization of dietary carbohydrates, so diets with less than 12% metabolizable energy are recommended. This is especially important for cats with obesity, as well as older cats, susceptible breeds, and those with chronic corticosteroid needs. The highest remission rates in diabetic cats (>80%) are reported with very low carbohydrate diets (<6% ME) in combination with protocols aimed at achieving normal or near-normal blood glucose concentrations.12 The exciting news is that the goals for managing diabetes mellitus in the cat have changed from attaining glycemic control to achieving diabetic remission. Remission rates of up to 68% have been published. The used of low carbohydrate foods improves the odds of achieving diabetic remission by four times.13 The normalization of blood glucose and body weight, and the remission of diabetes, are linked. This goal can be achieved through slow gradual energy restriction and a suitable weight loss diet with the macronutrient profile shifted from high dietary carbohydrates to low carbohydrates, moderate fat, and high protein. One recommendation is: fat <4 g/100 kcal, carbohydrates <3 g/100 kcal, and protein >10 g/kcal.14 One of the basic premises of integrative medicine is the healing nature of proper nutrition. In cats, returning to a species-appropriate carnivorous diet can not only result in better health and well-being, but even a remission of diabetes mellitus.

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1O’Neill

DG, Gostelow r, Orme C, Church DB, Niessen SJM, Verheven K, and Brodbelt DC. Epidemiology of Diabetes Mellitus among 193,435 Cats Attending Primary-Care Veterinary Practices in England, J Vet Intern Med, 2016 Jul-Aug;30(4):964-972, 2016. 2 Gottlieb

9: 33-42.

S, Rand J. Managing feline diabetes: current perspectives, Vet Med (Auckl) 2018;

3Nelson RW, Reusch C. Classification and etiology of diabetes in dogs and cats. 4Kremen

NA, Calvert CC, Larsen JA, Baldwin RA, Hahn TP, Fascetti AJ. Body composition and amino acid concentrations of select birds and mammals consumed by cats in northern and central California. J Anim Sci. 2013;91(3):1270–1276. 5Nutrient Requirements of Dogs and Cats – Animal Nutrition Series, National Research Council of

the National Academies, 95, 2006. 6Debraekeleer

J. Appendix L: nutrient profiles of commercial dog and cat foods. In: Hand M, Thatcher C, Remillard R, Roudebush P, editors. Small Animal Clinical Nutrition. 4th ed. Topeka, KS: Mark Morris Institute; 2000. pp. 1074–1083. 7American Diabetes Association Diagnosis and classification of diabetes mellitus. Diabetes Care.

2014;37(Suppl 1): S81–S90. 8 Hewson-Hughes

AK, Gilham MS, Upton S, Colyer A, Butterwick R, Miller AT. Post-prandial glucose and insulin profiles following glucose-loaded meal in cats and dogs. Br J Nutr. 2011;106(Suppl 1): S101–S104.

From the AHVMA The mindful leader elevating the veterinary profession through innovation, education and advocacy of integrative medicine.

PLANNING NEXT YEAR’S ANNUAL CONFERENCE Mark your calendars now for the 2023 AHVMA Annual Conference and Exhibition! It’s scheduled to take place October 7 to 20, 2023 at the beautifully remodelled Town and Country Resort in San Diego, California. Expect more than 100 hours of complementary and integrative CE sessions, hands-on labs, and special events. Over the past six years, AHVMA has applied for and received AAVSB RACE approval for over 80 hours of continuing education.

10Appleton

Located on 24 acres, the Town and Country Resort offer lots of amenities for everyone to enjoy, including a new pool complex, 19 fire pits, the Sand Volleyball Court, the threeacre River Park, and a state-of-the-art fitness center.

11Zini

INTERESTED IN SPEAKING OR EXHIBITING?

9 Elliott

KF, Rand J, Fleeman LM, et al. A diet lower in digestible carbohydrate results in lower postprandial glucose concentrations compared with a traditional canine diabetes diet and an adult maintenance diet in healthy dogs. Res Vet Sci. 2012;93(1):288–295. DJ, Rand JS, Sunvold GD. Insulin sensitivity decreases with obesity, and lean cats with low insulin sensitivity are at greatest risk of glucose intolerance with weight gain. J Feline Med Surg. 2001;3(4):211–228. E, Hafner M, Kook P, Lutz TA, Ohlerth S, Reusch CE. Longitudinal evaluation of serum pancreatic enzymes and ultrasonographic findings in diabetic cats without clinically relevant pancreatitis at diagnosis. J Vet Intern Med. 2015;29(2):589–596. 12Marshall

RD, Rand JS, Morton JM. Treatment of newly diagnosed diabetic cats with glargine insulin improves glycemic control and results in higher probability of remission than protamine zinc and lente insulins. J Feline Med Surg. 2009;11(8):683–691. 13Kirk CA. Feline diabetes mellitus: low carbohydrates versus high fiber? J.cvsm. 2006.09.04 14Zoran DL, Rand JS. The role of diet in the prevention and management of feline diabetes. Vet

Clin North Am Small Anim Pract. 2013;43(2):233–243.

The Conference Program Committee is still taking speaker submissions for next year’s conference. For consideration, submit your proposal(s) via the online call-for-papers portal no later than the October 15, 2022 deadline (www.ahvma. org/call-for-papers/ ). Those selected will be contacted by the AHVMA CPC. If you’re a current exhibitor, be on the lookout for 2023 exhibitor information coming to you via email later this year. Sponsors and Associate Members will receive advance access to booth selection and sponsorship opportunities. AHVMA will open registration to all other exhibitors beginning in February 2023. Submitted by Melissa Kellagher, AHVMA Director of Operations

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newsbite

Restoring native predators can reduce invasive species Can re-introducing native animal predators to a habitat put a check on invasive species? A new study by Queen University Belfast and Cornell University suggests the answer is “yes”!

unpreparedness of invasive species to native predators, along with the lack of spatial refuge, puts them at a disadvantage. This holds true for a wide variety of invasive species in different parts of the world.

One of the greatest threats that biodiversity faces comes from invasive species. Such species are the main cause behind the extinction of many animals over the last century, which in turn harms the functioning of the ecosystem. These problems come with a price tag, too. Experts believe that issues caused by invasive species cost an estimated $162 billion a year.

For instance, the reintroduction of the native pine marten in the UK and Ireland resulted in a reduction in the overabundant numbers of gray squirrels. Other reintroductions include the Eurasian lynx to help reduce the population of Ireland’s sika deer, a species that harms trees and contributes to spreading bacterial diseases; and the Florida panther, to control the invasive and destructive feral pig population in that state. https://onlinelibrary.wiley.com/doi/10.1111/gcb.16w236

The Queen University study found that restoring the population of native predators can balance the equation and decrease numbers of invasive species. How? The evolutionary

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profitable practice

Advanced GI panels from VDI Lab increase the profitability of diagnostic workups in patients with gastrointestinal signs THE GI PATIENT

WHAT CLIENTS LOVE

Patients presenting with gastrointestinal signs can pose a challenging workup becuase the pathology of these disorders can be multi-factorial. Diseases such as IBD, pancreatitis, PLE, LSA, SIBO, Addison’s, and allergies may exist concurrently, so multiple tests, imaging, and other workups are needed to guide the differential diagnosis. A comprehensive analysis of GI disease facilitates a quicker diagnosis, reduces tech time and hospital visits, and limits resource use. This is where the Advanced GI Panel from VDI Laboratory can assist.

More than numbers on a page, VDI test reports provide detailed, visual, and intuitive information that helps make sense of what all those numbers mean. Their contextsensitive approach to reporting results gives you the most case-specific, patient-centric information, helping you to make important decisions for your clients. VDI Lab’s dedication to answers, not numbers, makes them a true diagnostic partner, and is what makes the Advanced GI Panel a new standard for GI workup.

INCREASE DIAGNOSTIC EFFICIENCY

INCOME POTENTIAL

VDI Lab has assembled and integrated a unique array of tests to improve diagnostic efficiency for your GI patients. The Advanced GI Panel is a 12-parameter test that examines a range of GI diseases commonly present in cats and dogs. With optional integrations for Addison’s, cholangitis, and allergies, this single blood panel can simplify the differential process.

GI workup doesn’t necessarily have to be a step-by-step approach. With a dedicated array of tests looking specifically at gastrointestinal diseases, the Advanced GI Panel is well suited for quickly ruling in or out a number of common diseases in any GI patient. When used in conjunction with ultrasound, your diagnostic pathway becomes simpler and more profitable.

TRAINING REQUIREMENTS Minimum training is required. However, it’s recommended that vets and staff attend a live webinar with VDI Lab to acquire basic technical understanding and to review case studies on how to interpret and implement the Advanced GI Panel. VDI Lab is available for case-by-case consultations at any time. https://vdilab.com/advanced-gi-panel/ IVC Fall 2022

Seizures and Epilepsy in dogs —

how to minimize side effects of pharmaceuticals Conventional drugs used to control seizures and epilepsy in dogs can lead to side effects and withdrawal problems. An integrative approach takes time to work but can be an effective way to treat these conditions. BY IHOR BASKO, DVM, CVA

Seeing a dog suffering from seizures or epilepsy is a frightening experience for clients. Diagnosing the problem by trying to get to the root cause, and taking an integrative approach to treatment, can help manage the problem while minimizing the issues arising from long-term drug use.

EPILEPSY AND SEIZURES — WHAT’S THE DIFFERENCE? The disease of “epilepsy” is not very well understood by Western conventional veterinary medicine, especially in dogs and cats. There is no cure, and treatments are designed to suppress biochemical reactions and “slow the excitability” of the neurons. Dogs who have “seizures” might not have true epilepsy but are responding to physical, environmental, or emotional stress while experiencing compromised brain function due to lack of proper nutrition, aging, hereditary reasons, or a buildup of heavy metals in the brain from food and water. A “stroke” can be classified as a type of seizure, and can reoccur, causing progressive signs such as permanent head tilt, deafness, blindness, and vertigo.

CONDITIONS THAT CAN LEAD TO SEIZURES Many conditions can result in seizure activity in dogs. If we want to affect a cure for the problem, it’s important to track back and see if we can identify any “triggers” that may have been overlooked. Some of these include: • Chronic exposure to pesticides and toxins •D rug reactions (Proin, Heartguard/Invermectin, Fipronil, etc.) • Food allergy reaction • Tramatic brain injuries • Brain tumors • Genetic predisposition • Cervical vertebral luxation • Kidney disease • Eclampsia/milk fever • Hepatitis/liver disease/metabolic syndrome • Idiopathic

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• Low blood glucose to the brain can be another factor. A condition that seems to be common in certain breeds with seizures (Labs, Golden Retrievers, Dobermans, German Shepherds, Rhodesian Ridgebacks, etc.) is hypothyroidism. • With the onset of “rat lung/brain worms” in humans living in some areas of Hawaii, parasites in the brain might be another cause. A spinal tap might help diagnose the problem. Also, dogs eating raw meat, especially lamb, may have a tapeworm called Echinococcus that may be associated with seizures. • More recently, veterinarians in the US are reporting seizures after multiple vaccinations, especially rabies. •S eizures in geriatric dogs (eight years and older) can result from metabolic biochemical disturbances in the brain. These can be due to poor circulation, vitamin or mineral deficiencies, fatty infiltration, chronic infections, liver dysfunction, a deficiency in the heart, and a buildup of heavy metals and pesticides. Different dogs may react in a variety of similar and different ways during a seizure, and there are many kinds of seizures.

CONVENTIONAL VETERINARY MEDICINE FOCUSES ON DRUGS Conventional medicine goes for drugs rather than real solutions, because the causative factors are not well investigated, and most practices do not have the ability to do tests such as CT scans and MRIs, nor can most clients afford these procedures. Although the drugs used for these conditions can improve the quality of life in the short term, dependency becomes a problem. This is because they’re addictive substances that may cause “withdrawal” problems that in turn could cause seizures when dosages are reduced or stopped. Commonly-used drugs include barbiturates such as Phenobarbital, and muscle relaxants such as Diazepam; other drugs (potassium bromide, Gabapentin) can cause damage to the liver when used for long periods.

Encourage clients to do the following if seizures occur: • Calm yourself first, by taking five, deep, slow breaths. • I f necessary, move your dog to a safer area, such as a carpet without nearby furniture, lamps, glass, and other hazards. • Place your hands on the dog’s chest (while calming yourself with deep breaths) and gently massage his/ her neck and head in circular motions. • Be with your dog until he/she gets through it. • Crushed ice bags on the belly and neck, or ice water on ears and face, can help reduce the seizure’s duration. • If the dog suffers from frequent and severe seizures, keep valium on hand (clients can learn to inject it without a needle into the rectum). As an alternative to valium, CBD can be administered under the tongue. • Discontinue: — Heartworm preventative (for two consecutive months), then resume monthly treatment. — Flea and tick medications. — All vaccines. • Keep a diary to record observations, along with what is working and what is not. On the days a “seizure” occurs,

note the symptoms, duration, intensity and what worked to bring your dog out of it, what was eaten that day, and what emotions or stimuli were present. • Note the color of the dog’s tongue: — Pale pink = lack of blood flow. — Pale pink purple = poor blood flow with stagnation (somewhere in the body’s blood stream. — Purple = stagnation and lack of oxygen. — Bluish = lack of oxygen — check breathing and do “mouth to mouth” resuscitation. • Take the dog’s temperature (using a rectal thermometer) right after the seizure. This will show how serious it was and if there could be more brain damage.4 • Listing all the contributing stress factors present in the dog’s environment, if possible, will give us clues as how to mollify the situation by avoiding or eliminating them. • Vagal Nerve Stimulation might be a good way to control the severity and length of seizures. The dog owner could employ this technique before the dog has a seizure, during one of the prior behaviors that seem to occur each time. IVC Fall 2022

TAKING AN INTEGRATIVE APPROACH TO TREATMENT Treatment with integrative medicine focuses on the cause of the problem, revitalizes the nervous system, repairs damage, controls symptoms, and improves quality of life without the use of harmful drugs. Treating epilepsy and seizures from an integrative standpoint might take several months and includes understanding the dog and how he/she reacts to the environment. • Acupuncture will help a dog experience less stress from any chemical imbalance in the brain, and will stimulate healthy endorphins that counterbalance the brain after seizures. •C hinese herbs are prescribed to assist the detoxification of the dog’s liver and nervous system, and help control seizures. Nutraceuticals, antioxidants, and vitamins may be prescribed to aid in repair. See chart below right for a list of ingredients featured in many products formulated for anxiety. Other considerations to support drug or Chinese herbal therapy include DHA (Pure Encapsulations EPA/DHA) and Phosphatidylcholine, and possibly more magnesium (Pure Encapsulations) (avoid using any herbal calming formula containing tryptophan with SSRI antianxiety drugs).

Reducing Drug Dosages You need to guide the process of withdrawing a client’s dog from medication. If the dog is on Phenobarbital, and you want to begin to reduce the dose, do so gradually if it has been more than a month. I would recommend waiting three weeks after beginning the above supplements, unless the dog has high liver enzymes and is showing signs of phenobarbital toxicity. In case of toxicity, decrease phenobarbital (after three weeks on the above supplements) by 25% and re-evaluate. If seizures don’t occur or are greatly reduced, continue another three weeks, decrease the drug by another 25% (this should be now half the original dose) and re-evaluate. Keep in mind that it’s not possible to do this with every situation and every dog. It's important to note that seizures may occur as you reduce medications that the dog’s body has become dependent on. 24

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Most drug doses can begin to be reduced after three to six weeks when using the above supplements. In some cases, the severity of the seizures can be lifethreatening and drugs should be given. Adding antioxidants such as milk thistle (silymarin), turmeric, and vitamin C will help prevent the side effects of the drug(s). In my experience, most dogs I see respond to non-drug treatments except those that: • Have a brain tumor (very rare) • Had a series of strokes, causing paralysis •H ave excessive heavy metal or pesticide poisoning of the sympathetic nervous system.

GENERAL TREATMENT PLAN FOR SEIZURES AND EPILEPSY I. Improve nutrition to the brain •P hosphatidylcholine supplement)

(eggs,

liver,

broccoli,

kale,

• DHA (Omega-3 fish oils) • Antioxidants (alpha-lipoic acid) • B-complex vitamins II. Support detoxification and improve liver function •A ntioxidants to support liver function (milk thistle, dandelion root, alpha-lipoic acid) • Avoid drugs and chemicals • Chinese herbal formula (based on the patient’s constitution • Turmeric • Coenzyme Q10 •A ntioxidant-rich vegetables (kale, chard, broccoli, green papaya [needs to be cooked], red cabbage, carrots, parsley, alfalfa sprouts, etc.) III. I mprove blood flow dynamics (to brain, heart and liver) • Omega-3 EPA • Gingko, Dan Shen, Uncaria • Acupuncture IV. Support the calming circuits in the brain with herbs and supplements

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 auxiliary 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.

AROMATHERAPY CASE STUDIES A two-year-old spayed female Bichon was suffering from urinary incontinence three months after her OVH surgery. She would leak urine in her sleep in the guardian’s bed. We used a blend of biologically active essential oils over the sacrum three times a day. Blend: 25 drops Clary Sage, 15 drops Peppermint, 25 drops Spanish Sage, and 10 drops Fennel essential oils in 15ml of fractionated coconut oil. Two to three drops of this blend were placed on the dog’s sacrum every eight hours. The incontinence resolved within two weeks without any other therapy. A five-year-old male neutered mix breed dog presented for collapse. The diagnosis was Addison’s disease. Conventional treatment was started but the dog continued to have severe stress episodes. We used a blend of biologically active essential oils over the kidney/adrenal area three times a day. Blend: 20 drops Spearmint, 8 drops Sage, 12 drops Geranium, 10 drops Myrtle, 5 drops Nutmeg and 8 drops Chamomile in 15ml of fractionated coconut oil. Two to three drops of this blend were placed over the L1-2 area of the back. After three days of application, there were no more stress episodes. The owners were to use this blend four times a week and twice a day if stress is anticipated. Overall, biologically active essential oils can mimic neurocrines or hormones and naturally balance the system.

• Passion flower, chamomile, valerian, kava kava, CBD (hemp) • Melatonin • B complex • Magnesium, oyster shell • Acupuncture V. Support hearth health/decrease stress with adaptogens •Z izyphus, Dan Shen, licorice, Siberian ginseng, ashwagandha, medicinal mushrooms (Reishi) Treating seizures and epilepsy integratively requires time and effort, but it can be an effective way to manage the problem while reducing the use of conventional medications and their side effects.

Submitted by Nancy M. Brandt, DVM, CVC, CVA, CVMA IVC Fall 2022

Diagnosing, managing and treating thyroid diseases in dogs and cats BY W. JEAN DODDS, DVM

IVC Fall 2022

Hypothyroidism and hyperthyroidism are commonly-seen disorders in canine and feline patients. Accurate diagnostic testing and screening are vital to successful treatment and management.

Like humans, dogs and cats can be affected by diseases of the thyroid. This article provides a comprehensive discussion of the diagnosis, treatment and management of these frequentlyseen disorders.

THYROID DISEASES AND THEIR CAUSES Hypothyroidism is the most common endocrine disorder in dogs, and the second most common in older cats, after diabetes. At least 80% of canine cases result from heritable autoimmune (lymphocytic) thyroiditis. Because the heritable nature of this disorder poses significant genetic and health implications for breeding stock, accurate diagnosis of the early compensatory stages of canine autoimmune thyroiditis that lead up to clinical hypothyroidism affords important genetic and clinical options for prompt intervention and case management. In cats, hyperthyroidism is readily induced, especially in geriatrics, by feeding commercial pet foods, treats and snacks containing excessive amounts of iodine. Since this discovery, major changes have been made to the iodine content of commercial cat foods.

DIETARY-INDUCED HYPERTHYROIDISM IN DOGS AND CATS Studies have documented iatrogenic hyperthyroidism in pets fed the gullet or throat portion of raw red meat (usually beef or lamb), if it contains the thyroid gland. The patient may be relatively asymptomatic, with the diagnosis made upon finding significantly high thyroid basal levels without clinical evidence of a thyroid mass in the neck or chest. Questioning the pet owner then reveals the raw meat diet (clients may not be aware that the gullet or throat portion of the carcass is included in the product). Removing the meat from the diet resolves the hyperthyroidism in about four to six weeks, at which time retesting the thyroid levels should show they have returned to normal.

IODINE CONTENT IN COMMERCIAL PET FOODS An excess of iodine causes alterations in thyroid activity, blocking both its characteristic functions and cell proliferation. Feeding excessive amounts of iodine in foods and supplements (kelp, seaweed) reduces thyroid function in dogs and increases thyroid activity in older cats.

BASELINE CANINE THYROID PROFILES A complete baseline thyroid profile is measured in dogs, and typically includes total T4, total T3, free T4, free T3, and TgAA (thyroglobulin autoantibody). It can also include circulating T3 and T4 autoantibodies (T3AA and T4AA), and the canine-specific thyroid stimulating hormone (cTSH). The TgAA assay is an especially important component for screening breeding stock for heritable autoimmune thyroid disease.

GENETIC SCREENING AND DIAGNOSTIC TESTING FOR CANINE THYROID DISEASE Nearly all cases of canine thyroiditis have elevated serum TgAA levels, whereas only about 20% to 40% of cases have elevated circulating T3AA and/or T4AA. Thus, while the presence of elevated T3AA and/or T4AA also confirms a diagnosis of autoimmune thyroiditis, it underestimates the prevalence, since a negative (non-elevated) level of these circulating autoantibodies does not rule out the presence of thyroiditis. Measuring TgAA levels also permits early recognition of the disorder, and facilitates genetic counselling since affected dogs should not be used for breeding.

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OTHER ASSOCIATED DISORDERS POLYGLANDULAR AUTOIMMUNITY Human and canine individuals who are genetically susceptible to autoimmune thyroid disease may also become more susceptible to immune-mediated diseases affecting other target tissues and organs. Multiple endocrine glands and non-endocrine systems become involved in a systemic immune-mediated process. The most common associated disorders are Addison’s disease, diabetes and reproductive failure. Common associated non-endocrinologic autoimmune disorders include autoimmune/immunemediated hemolytic anemia (AIHA/IMHA), idiopathic thrombocytopenic purpura (ITP), chronic active hepatitis, and immune-complex glomerulonephritis (systemic lupus erythematosus; SLE).

ABERRANT BEHAVIOR AND THYROID DYSFUNCTION The principal reason for pet euthanasia stems not from disease, but undesirable behavior, which can reflect underlying problems of a psychological nature. An association between behavioral and psychological changes and thyroid dysfunction has been recognized in humans since the 19th century. A parallel association has been established between aberrant behavior and thyroid dysfunction in the dog, and can occur in cats with hyperthyroidism. Typical clinical signs include unprovoked aggression towards other animals and/or people, sudden onset of seizure disorder in adulthood, disorientation, moodiness, erratic temperament, periods of hyperactivity, hypoattentiveness, depression, fearfulness and phobias, anxiety, submissiveness, passivity, compulsiveness, and irrita-bility. After episodes, most of the animals appeared to come out of a trance-like state, and were unaware of their bizarre behavior.

sex hormones on baseline thyroid function should be minimized.

Cumulative data show that females are significantly more likely to have thyroid autoantibodies than males.

Canine autoimmune thyroid disease has been documented to be similar to Hashimoto’s lymphocytic thyroiditis in humans. These diseases are associated with a handful of genes from the major histocompatibility complex (MHC) tissue types in people, and in more than a dozen dog breeds and hybrid breeds. Several detailed publications have studied the parallel genes that convey predisposition to, and increased risk for, heritable thyroiditis in dogs.

Thyroid testing for genetic screening purposes is

DIAGNOSTIC TESTING FOR FELINE THYROID DISEASE

less likely to be meaningful before puberty. Screening is initiated, therefore, once healthy dogs and bitches have reached sexual maturity (between ten and 14 months in males and during the first anestrous period for females following their maiden heat — i.e. at 12 to 16 weeks from its onset). As the female sexual cycle is quiescent during anestrus, any influence of

Free T4 is the non-protein-bound, physiologically-active form of T4 and therefore the best marker of thyroid status in dogs and cats. Indeed, in cats with overt hyperthyroidism (consistent clinical signs and high T4), the free T4 measured by equilibrium dialysis (ED) is elevated. In cats with early or mild hyperthyroidism

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(more mild signs of disease and T4 in the upper half of the normal reference range), the FT4ED is often elevated. However, in 5% to 10% of cats with non-thyroidal illness (e.g., chronic renal failure, IBD, liver disease, neoplasia), FT4ED can be elevated for reasons that are unclear. These cats may have signs consistent with hyperthyroidism, (e.g. weight loss, vomiting) but there is typically no palpable thyroid nodule(s), and T4 values are usually within normal limits.

THYROID DYSFUNCTION IN DOGS — IMPORTANT FACTS Thyroid dysfunction can affect any dog breed, hybrid/ cross-breed, and mixed breed. Thyroid dysfunction is a heritable and familial trait in many breed types. Accurate diagnosis can be difficult.

Testing older cats Basal thyroid levels in older cats should be lower than in adults. Other illnesses often lower T4, masking hyperthyroidism. Minimum testing needed is T4, free T and cTSH. FT4ED is usually high in hyperthyroidism but can also be high in inflammatory bowel disease, renal and liver diseases, and neoplasia

MANAGEMENT AND THERAPY Dogs Dogs testing positive for heritable autoimmune thyroiditis should be treated immediately with thyroxine twice daily, even if their basal thyroid levels are still normal (i.e. in the state of “compensative autoimmune thyroiditis”). This is because feedback inhibition of TSH output from the pituitary gland shuts off stimulation of thyroid gland receptors, and thus slows or stops thyroid autoantibody production. Thyroxine therapy typically takes around five to seven months or longer, during which thyroid autoantibody levels should gradually decline until they are lower or normal (negative). Regardless, therapy with thyroxine is needed lifelong to prevent the reoccurrence of the genetically controlled autoantibody production. Keep in mind that thyroxine binds to calcium and soy, so this drug should be given apart from meals (e.g. one hour before in the morning, and three hours after in the evening), regardless of what the product label says. While physicians are taught about the binding behavior of this drug in order to alert their patients, veterinarians traditionally have not been told about it.

• Puppies have higher basal thyroid levels than adults. • Geriatrics and large/giant breeds have lower basal thyroid levels. • Sighthounds have much lower basal thyroid levels.

Classical clinical hypothyroidism occurs once the thyroid has undergone 70%+ damage; early signs include weight gain and behavior issues. T4 alone gives misleading results, despite its common use on health profiles at veterinary reference laboratories; it inaccurately assesses thyroxine therapy, especially in the face of concurrent non-thyroidal illness, and fails to detect autoimmune thyroiditis. Even T4 plus free T4 and TSH is inadequate for diagnosing heritable thyroiditis.

Canine TSH is poorly predictive of thyroid function (30%), unlike the human test (95%). In-clinic commercial tests for T4 and even cTSH are inadequate for accurate diagnosis. Age- and breed-specific norms are essential for accurate diagnosis; Hemopet provides “Case Specific Ranges” on each pet report. Hemopet thyroid tests are unique, non-RIA and patented. Thyroxine binds to calcium and soy, so must be given apart from meals. Twice-daily therapy is preferred, as thyroxine’s halflife is 12 to 16 hours in pets. Stopping thyroxine to retest the pet’s basal thyroid capacity requires six weeks or more. Thyroid support/thytrophin supplements are inadequate on their own, and natural glandulars are more costly and contain T3.

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Because of the heritable nature of this disorder, as discussed above, dogs affected with thyroiditis, even if still asymptomatic, should not be used for breeding purposes.

Cats After diagnosis, hyperthyroid cats are typically treated with oral (tablet or compounded liquid) or transdermal ear tip applications of methimazole, radioactive iodine-131 therapy to ablate the thyroid acinar cells, or with surgical removal of the thyroid adenoma(s). Six to eight weeks after this therapy, these cats should be retested with at least the T4, T3 and cTSH assays.

References Aronson LP, Dodds WJ. The effect of hypothyroid function on canine behavior. Proc Int Vet Beh Med 2005. Baral RM, Peterson ME. Thyroid gland disorders In: Little SE, ed. The Cat: Clinical Medicine and Management. St. Louis: Elsevier Saunders, 571-592, 2012. Beaver BV and Haug LI. Canine behaviors associated with hypothyroidism. J Am An Hosp Assoc 39: 431-434, 2003. Bianchi M, Dahlgren S, Massey J, et al. A multi-breed genome-wide association analysis for canine hypothyroidism identifies a shared major risk locus on CFA12. PLoS ONE, 10(8): e013472, 2015. doi:10.1371/journal.pone.0134720 Broome MR. Thyroid scintigraphy in hyperthyroidism. Clin Tech Sm An Pract 21:10-16, 2006. Cameron DL, Crocker AD. The hypothyroid rat as a model of increased sensitivity to dopamine receptor agonists. Pharm Biochem Behav 37:627-632, 1990. Denicoff KD, Joffe RT, Lakschmanan MC, Robbins J, Rubinow DR. Neuropsychiatric manifestations of altered thyroid state. Am J Psych 147:94-99, 1990. Dewey CW, Shelton GD, Bailey, CS. Neuromuscular dysfunction in five dogs with acquired myasthenia gravis and presumptive hypothyroidism. Prog Vet Neurol 6: 117-123, 1995. Diaz Espineira MM, Mol JA, Peeters ME, et al. Assessment of thyroid function in dogs with low plasma thyroxine concentration. J Vet Intern Med 21:25–32, 2007. Dixon RM, Mooney CT. Evaluation of serum free thyroxine and thyrotropin concentrations in the diagnosis of canine hypothyroidism. J Sm An Pract 40:72-78,1999. Dodds WJ. Thyroid can alter behavior. Dog World 1992, 77(10); 40-42. Dodds WJ. Estimating disease prevalence with health surveys and genetic screening. Adv Vet Sci Comp Med, 39: 29-96, 1995. Dodds WJ. Autoimmune thyroiditis and polyglandular autoimmunity of purebred dogs. Can Pract 22 (1): 18-19, 1997. Dodds WJ. What’s new in thyroid disease ? Proc Am Hol Vet Med Assoc 1997; pp 82-95. Dodds WJ. Behavioral changes associated with thyroid dysfunction in dogs. Proc Am Hol Vet Med Assoc, 80-82, 1999. Dodds W J and LaVerdure D.R. “The Canine Thyroid Epidemic”, Dog Wise Publ, Wenatchee, WA, 2011. Dodman NH, Mertens PA, Aronson, LP. Aggression in two hypothyroid dogs, behavior case of the month. J Am Vet Med Assoc 207:1168-1171, 1995. Dodman NH, Aronson A., Cottam N., Dodds WJ. The effect of thyroid replacement in dogs with suboptimal thyroid function on owner-directed aggression: A randomized, double-blind, placebo-controlled clinical trial. J Vet Behav 8: 225–230, 2013. Feldman EC, Nelson RW. Canine and Feline Endocrinology and Reproduction. Second Edition. Philadelphia: WB Saunders Co, 1996. Ferguson DC, Caaffall Z, Hoenig M. Obesity increases free thyroxine proportionally to nonesterified fatty acid concentrations in adult neutered female cats. J Endocrinol 194:267-273, 2007. Frank LA. Comparison of thyrotropin-releasing hormone (TRH) to thyrotropin (TSH) stimulation for evaluating thyroid function in dogs. J Am An Hosp Assoc 32: 481- 487, 1996. Gori E, Pierini A, Bartolomeo E, et al. Serum total thyroxine evaluation in critically ill feline patients. Ve. Sci, 8, 21, 2021. doi.org/10.3390/vetsci8020021 Greco DS. Diagnosis of congenital and adult-onset hypothyroidism in cats. Clin Tech Sm An Pract ;21:40-44, 2006 Hall IA, Campbell KC, Chambers MD, et al. Effect of trimethoprim-sulfamethoxazole on thyroid function in dogs with pyoderma. J Am Vet Med Assoc 202:1959-1962, 1993. Happ GM. Thyroiditis - A model canine autoimmune disease. Adv Vet Sci Comp Med 39: 97-139, 1995. Happ GM, Ollier W, Kennedy LJ. Genetic determinants of susceptibility to hypothyroid disease in dogs. AKC Research Foundation Report, Sept 2005. Hauser P, Zametkin AJ, Martinez, P et al. Attention deficit-hyperactivity disorder in people with generalized resistence to thyroid hormone. N Eng J Med 328:997-1001, 1993. Henley WN, Chen X, Klettner C. Bellush LL, Notestine MA. Hypothyroidism increases serotonin turnover and sympathetic activity in the adult rat. Can J Physiol Pharmacol 69:205-210, 1991. International Symposium on Canine Hypothyroidism, University of California, Davis. Can Pract 22 (1) : 4-62, 1997. Iverson L, Jensen AL, Høier R, et al. Biological variation of canine serum thyrotropin (TSH) concentration. Vet Clin

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Pathol 28:16-19, 1999. Jensen AL, Iversen L, Høier R, et al. Evaluation of an immunoradiometric assay for thyrotropin in serum and plasma samples of dogs with primary hypothyroidism. J Comp Pathol 114: 339-346, 1996. Kaptein EM. Thyroid hormone metabolism and thyroid diseases in chronic renal failure. End Rev 17:45-63, 1996. Kennedy LJ, Quarmby S, Happ GM, Barnes A et al. Association of canine hypothyroid disease with a common major histocompatibility complex DLA class II allele. Tissue Antigens 68:82-86, 2006. Kennedy LJ, Hudson HJ, Leonard J, Angles JM, et al. Association of hypothyroid disease in Doberman pinscher dogs with a rare major histocompatibility complex DLA class II haplotype. Tissue Antigens 67:53-56, 2005. Köhler BC, Stengel C, Neiger R. Dietary hyperthyroidism in dogs. J Sm An Pract 53:182-184, 2012. McGregor AM. Autoimmunity in the thyroid - Can the molecular revolution contribute to our understanding? Quart J Med 82 (297): 1-13, 1992. Mooney CT, Peterson ME. Feline hyperthyroidism In: Mooney CT, Peterson ME, eds. BSAVA Manual of Canine and Feline Endocrinology. Fourth ed. Quedgeley, Gloucester: Briti Sm An Vet Assoc 92-110, 2012. Nachreiner RF, Refsal KR. Radioimmunoassay monitoring of thyroid hormone concentrations in dogs on thyroid replacement therapy: 2,674 cases (1985-1987). J Am Vet Med Assoc 201: 623-629, 1992. Nachreiner RF, Refsal KR, Davis WR, et al. Pharmacokinetics of L-thyroxine after its oral administration in dogs. Am J Vet Res 54: 2091-2098, 1993. Nachreiner RF, Refsal KR, Graham PA, et al. Prevalence of autoantibodies to thyroglobulin in dogs with nonthyroidal illness. Am J Vet Res 59:951-955, 1998. Nachreiner RF, Refsal KR, Graham PA, Bowman MM. Prevalence of serum thyroid hormone autoantibodies in dogs with clinical signs of hypothyroidism. J Am Vet Med Assoc 220:466-471, 2002. Overall KL. Clinical Behavioral Medicine for the Small Animal. St. Louis, Mosby, 1998 Panciera DL, Johnson GS. Hypothyroidism and von Willebrand factor. J Am Vet Med Assoc 206: 595-596, 1995. Panciera DL. Clinical manifestations of canine hypothyroidism. Vet Med 92: 44-49, 1997. Panciera DL. Thyroid-function testing: Is the future here? Vet Med 92: 50-57, 1997. Panciera DL. Treating hypothyroidism. Vet Med 92: 58-68, 1997. Panciera DL. Hypothyroidism in dogs: 66 cases (1987-1992). J Am Vet Med Assoc 204: 761-767, 1994. Paradis M, Pagé N, Larivière N, et al. Serum-free thyroxine concentrations, measured by chemiluminescence assay before and after thyrotropin administration in healthy dogs, hypothyroid dogs, and euthyroid dogs with dermatopathies. Can Vet J 37: 289-294, 1996. Peterson ME, Graves TK, Gamble DA: Triiodothyronine (T3) suppression test: An aid in the diagnosis of mild hyperthyroidism in cats. J Vet Intern Med 4:233-238, 1990. Peterson ME, Melian C, Nichols R. Measurement of serum total thyroxine, triiodothyronine, free thyroxine, and thyrotropin concentrations for diagnosis of hypothyroidism in dogs. J Am Vet Med Assoc 211:1396-1402, 1997. Peterson ME, Melian C, Nichols R. Measurement of serum concentrations of free thyroxine, total thyroxine, and total triiodothyronine in cats with hyperthyroidism and cats with nonthyroidal disease. J Am Vet Med Assoc 218:529-536, 2001. Peterson ME. Diagnostic tests for hyperthyroidism in cats. Clin Tech Sm An Pract 21:2-9, 2006. Peterson M. Hyperthyroidism in cats: What's causing this epidemic of thyroid disease and can we prevent it? J Feline Med Surg 14:804-818, 2012. Peterson ME. Hyperthyroidism in cats In: Rand JS, Behrend E, Gunn-Moore D, et al., eds. Clinical Endocrinology of Companion Animals. Ames, Iowa Wiley-Blackwell, 295-310, 2013. Pyzik A, Grywalska E, Matyjaszek-Matuszek B et al. Review Article: Immune disorders in Hashimoto’s thyroiditis: What do we know so far? J Immunol Res, 2015 Article ID 979167. doi.org/10.1155/2015/979167 Schmidt MA, Bland JS. Thyroid gland as sentinel: Interface between internal and external environment. Altern Ther 3: 78-81, 1997. Scott-Moncrieff JCR, Nelson RW. Change in serum thyroid stimulating hormone concentration in response to administration of thyrotropin-releasing hormone to healthy dogs, hypothyroid dogs, and euthyroid dogs with concurrent disease. J Am Vet Med Assoc 213:1435-1438, 1998. Scott-Moncrieff JCR, Nelson RW, Bruner JM, et al. Comparison of thyroid-stimulating hormone in healthy dogs, hypothyroid dogs, and euthyroid dogs with concurrent disease. J Am Vet Med Assoc 212:387-391, 1998. Scott-Moncrieff JC, Azcona-Olivera J, Glickman NW, Glickman LT, HogenEsch H. Evaluation of antithyroglobulin antibodies after routine vaccination in pet and research dogs. J Am Vet Med Assoc 221: 515-521, 2002. Sontas BH, Schwendenwein I, Schäfer-Somi S. Primary anestrus due to dietary hyperthyroidism in a miniature pincher bitch. Can Vet J 55:781-785, 2014. Surks MI, Sievert R. Drugs and thyroid function. N Eng J Med 333: 1688-1694, 1995. Thacker EL, Refsal KR, Bull RW. Prevalence of autoantibodies to thyroglobulin, thyroxine, or triiodothronine and relationship of autoantibodies and serum concentration of iodothyronines in dogs. Am J Vet Res 53: 449-453, 1992. Thacker EL, Davis JM, Refsal KR, et al. Isolation of thyroid peroxidase and lack of antibodies to the enzyme in dogs with autoimmune thyroid disease. Am J Vet Res 56: 34-38, 1995. Tomer Y, Davies TF. Infection, thyroid disease, and autoimmunity. End Rev 14: 107-120, 1993. Uchida Y, Dodman NH, DeNapoli J, Aronson LP. Characterization and treatment of 20 canine dominance aggression cases. J Vet Med Sci 59:397-399. 1997. Vajner L. Lymphocytic thyroiditis in beagle dogs in a breeding colony: findings of serum autoantibodies. Vet Med Czech 11:333-338, 1997. Wakeling J. Use of thyroid stimulating hormone (TSH) in cats. Can Vet J 51:33-34, 2010. Wakeling J, Moore K, Elliott J, et al. Diagnosis of hyperthyroidism in cats with mild chronic kidney disease. J Sml An Pract 49:287-294, 2008. Williams DA, Scott-Moncrieff C, Bruner J, et al. Validation of an immunoassay for canine thyroid-stimulating hormone and changes in serum concentration following induction of hypothyroidism in dogs. J Am Vet Med Assoc 209: 1730-1732, 1996.

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TCVM FOR LIVER DISEASE IN CANINES BY JODY BEARMAN, DVM

Traditional Chinese Veterinary Medicine (TCVM) includes nutrition, herbal medicine, Tui-na and acupuncture. All these modalities are helpful for treating liver disease in dogs.

The canine liver is a vital organ with several functions. It produces bile, which aids in excreting material and absorbing and digesting fats. The liver also stores and metabolizes fat-soluble vitamins such as D and K, and metabolizes and detoxifies drugs. Diseases of the liver interfere with these functions, affecting overall health and quality of life, but the various modalities offered by Traditional Chinese Veterinary Medicine (TCVM) can help.

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CAUSES OF LIVER DISEASE Injury to the liver can be caused by many factors, such as some medications and foods, viruses (e.g. infectious canine hepatitis), bacteria (e.g. leptospirosis), fungal organisms (e.g. histoplasmosis and coccidiodomycosis), parasites (e.g. Toxoplasma gondii and Leishmania) and congenital and genetic diseases (e.g. microvascular dysplasia and copper storage

disease). Liver damage can also occur secondary to endocrine diseases such as diabetes mellitus, hyperadrenocorticism and hyperthyroidism. Cancers of the liver can be primary, especially in older dogs, while secondary metastases can arise from lymphoma and many other metastatic neoplasias.

TCVM DIAGNOSIS OF LIVER DISEASE If the TCVM diagnosis is liver heat, liver yin deficiency, liver damp heat or liver qi stagnation, you may see red, swollen, painful dry eyes, hot feet possibly with lesions, and damp hot ear inflammation along with the typical anorexia and vomiting, and possible jaundice. Liver blood deficiency can affect the tendons and ligaments, leading to cruciate ruptures; and the eyes, leading to dryness.

NUTRITION IS KEY TO TCVM TREATMENT Nutrition is important in the TCVM treatment of liver disease. Many dogs with liver disease have poor appetites, which is attributed to liver spleen disharmony. If there is no free flow of Qi in the liver, the gut is affected.

• Celery is an excellent Yin tonifier and damp drainer. Cooking and pureeing is the best way to add celery to the dog’s diet. • Any edible mushroom drains damp. In liver disease, damp is seen as jaundice, hot feet, skin or mucous membrane lesions, and damp ear discharge. Mushrooms can be added as powdered supplements or chopped and added to food. • Feeding liver, such as freeze-dried liver treats, tonifies liver blood deficiency. • If a dog has liver heat or liver damp heat, as described above, avoid heating foods such as lamb and venison.

TCVM CAN HELP WITH EARLIER DIAGNOSIS

• Along with milk thistle, which is not only a supplement but a food, dark leafy green vegetables are very helpful in relieving liver Qi stagnation.

In TCVM, the liver is regarded as a blood

• Dandelions, as long as they are not sprayed, can be pureed and mixed with canned dog food. If the dog is weak, the greens can be steamed or boiled, since Qi-deficient dogs digest cooked vegetables more easily than raw.

tendons and ligaments, peripheral nerves

storage container. It allows the free flow of Qi (life force) through the body, controls and gut function, and opens to the eyes. These functions let us see liver disease earlier than may be found with Western examination

• Other dark leafy greens that help relieve Qi stagnation and tonify Yin (increase cooling in the body) are kale, collards, mustard greens, spinach, broccoli and chard. Be careful in dogs who are prone to calcium oxalate uroliths, as some of these vegetables contain oxalates.

and blood work.

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• Liver cold damp is rarely seen, but a dog with this problem would be cold rather than hot, with cold ears and feet, no redness, and a desire for warmth, along with slippery pulses. These dogs will prefer more warming foods, including chicken, which has a warming quality.

THE SIGNIFICANCE OF WIRY PULSES TCVM tells us that liver is associated

CHINESE HERBS Chinese herbal medicine is very specific and depends on the TCVM diagnosis. Chai Hu Shu Gan is a main formula for liver Qi stagnation, diagnosed by a wiry pulse, purple tongue, irritability or aggression. Liver Happy is for treating liver Qi stagnation with heat, but not for Yin deficiency. Heat has an excess pulse, while Yin deficiency has a weaker left pulse. Yin deficiency is often seen in older or less chronically healthy dogs. Many other herbal formulas are used, depending on the specific TCVM diagnosis, and some will be mentioned in the cases on the next page.

TUI-NA AND ACUPUNCTURE

with wiry pulses, especially at the liver location, which is the middle left femoral

Tui-na uses Chinese massage techniques and is helpful in

pulse on the dog. Wiry pulses can

moving Qi in a dog with liver Qi stagnation, as long as the dog allows it. One technique called Nie-fa involves rolling the skin to the sides of the spine (not on the spine) from head to tail. This tonifies all organs as well as moving Qi and loosening fascia, which also helps the immune system. It should be started gradually with one to three rolls per day; more than that may be detrimental.

manifest as a purple tongue, aggressive or irritable behavior, and red eyes. Some or all of these may be found on examining a dog with liver disease.

Acupuncture

is very helpful in healing liver disease. Excellent points for liver Qi stagnation are LIV3, on the dorsal hind foot between metatarsals 1 and 2, and BL18. LIV3 can be very tender in a dog with liver issues, so the use of calming points such as AnShen or GV20 is recommended first. If the dog has liver Yin deficiency, SP6 may be needed; and if liver damp heat is present, GB34 is an excellent choice. Clients can be shown how to perform daily acupressure on these points, in addition to acupuncture.

References Xie H. Chinese Veterinary Herbal Handbook 2nd ed. Reddick, FL: Chi Institute of Chinese Medicine; 2008. Xie H., Preast V. Traditional Chinese Veterinary Medicine Volume 1: Fundamental Principles Reddick, FL: Jing Tang; 2005. Center S. Disorders of the Liver and Gallbladder in Dogs Merck Manual Veterinary Manual www.merckvetmanual.com/dog-owners/digestive-disorders-of-dogs/disorders-of-the-liver-andgallbladder-in-dogs 2020.

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CASE STUDIES SCOUT An 11-year-old 17 kg poodle/Lab mix named Scout presented on July 30, 2015 with a history of seizures every three to four months for a year. He had been treated with phenobarbital and potassium bromide, which the client discontinued at an unknown date. Scout’s last seizure occurred in the spring of 2015. He also suffered a fracture of the right forelimb proximal to the carpus at three months of age, with chronic limping of the right front limb. Abnormalities on his examination included a dry, warm nose, warm paws, crepitus of right carpus with warmth and thickening, wiry pulses, weaker spleen pulse and purple tongue.

The herbal medicine Di Gu Pi1 was dispensed to help relieve pain and tonify Yin in the carpus. At this time, the client declined herbs to move liver Qi and tonify Yin. It was recommended that dark leafy greens and liver (as freeze-dried treats) be added to the diet to relieve liver Qi stagnation and tonify Yin. Nie-fa was demonstrated for the client to perform once daily to keep Scout more comfortable.

Blood work from May 19 showed a normal CBC with ALT high at 371 U/L (reference range 10-118 U/L), and elevated total bilirubin 0.7 mg/dl (reference range 0.1-0.6 mg/dl). Free catch UA showed well concentrated urine with heavy triple phosphate crystals on microscopic exam in clinic. Scout’s TCVM diagnosis was liver Qi stagnation with Yin deficiency, stagnation (pain) of right carpus, and internal wind, which is one TCVM designation for seizures. His treatment began with acupuncture, using small 38 gauge needles as he was very nervous and a bit irritable, designated a Wood/Fire constitution which is associated with the liver and heart. The acupuncture point AnShen, located behind the ears, is not only calming but moves internal wind to help prevent seizures, so his treatment began there. LIV3, SP6, BL60/KID3 and LI4 on the right were added to relieve liver Qi stagnation, tonify liver Yin, relieve pain, help the bone and locally help the carpus.

Scout in April 2022, at 18 years of age.

At Scout's next appointment on August 15, his exam was similar, and the client said he was much better after his first treatment, had no seizures but had just begun limping again. Herbs for liver Qi stagnation and Yin tonification were recommended but declined. Shorter walks were recommended but were also declined. By Scout’s third treatment, his nose was cold and wet. The client was away in October and Scout refused to eat. His ALT increased to 1559 U/L and preprandial bile acids were 52 umol/L (reference range 0-12 umol/L), with postprandial 178 umol/L (reference range 5-25 umol/L), indicating a significant

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decrease in liver function. Stress strongly affects the liver in a dog with a Wood personality. Scout was started on the herbal formulas Liver Happy (for liver Qi stagnation with heat) and Yi Guan Jian (to tonify liver Yin). By January 2016, he was acting like a puppy and playing a a lot, according to the client, which was a significant change. By August of that year, the client had run out of the herbs for a month and the family had gone on vacation without Scout. When they returned, Scout was anorexic and his ALT was >2000 U/L, so the client re-ordered the herbs. Scout was icteric on examination and acupuncture was repeated, adding GB34 and SP9 to drain damp and LIV13 for liver/spleen disharmony. Within a day, Scout’s normal energy and appetite returned. He continued to do well, walking at least half a mile daily with one to three acupuncture treatments per year, along with herbal medicine and daily Nie-fa until July 2022, seven years later, when he was euthanized at 18 years of age.

LOKI Loki, a ten-year-old neutered male Australian shepherd, presented in 2008 with a history of severe liver disease, hepatocutaneous syndrome, and diabetes mellitus. He was receiving 20 units of NPH insulin twice daily. He had been unable to stand or walk for a week, and needed to be carried, held up to urinate and defecate, and be hand fed. On examination, he was obtunded, hot to the touch but also with damp heat rising off his body. His pulses were thin and wiry, his tongue was red with a yellow coat. All four of his feet had thick yellowish crusts on the pads and appeared ulcerated under the crusts. His coat was dry, brittle and discolored. He had thick red elbow calluses. Mucous membranes appeared red but on depression appeared slightly icteric. Loki’s TCVM diagnosis was liver damp heat with Yin deficiency. He received acupuncture to drain damp (SP9), cool (GB34), tonify Yin (SP6), relieve pain (LIV3, BL60/ KID3), and strengthen (ST36). Herbs were ordered to help drain damp and clear heat, beginning with Artemisia Combination. Cooked dark leafy greens, celery and button mushrooms were added to his diet to cool and clear liver Qi stagnation, along with cooked beef liver. To help strengthen Loki, Nie-fa was demonstrated to the client to be done once a day. Within three days, Loki was able to stand on his own. In addition to Artemisia Combination, the herbal formula Jiang Tang Cha was added to tonify Qi and Yin, and clear heat to help regulate Loki’s diabetes mellitus. Acupuncture was done every week for several weeks, then de-creased to monthly, then even less frequently as he became more energetic. Loki began to play ball again within a month, and continued to do well with a good quality of life until 2010, at the age of nearly 13.

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5 reasons why more veterinarians are choosing a career with Pet Paradise

BY DR. JAIME PICKETT, CHIEF VETERINARY OFFICER & SENIOR VICE PRESIDENT, NEW DAY VETERINARY CARE AT PET PARADISE

For pet lovers, a career in veterinary medicine can be incredibly fulfilling. But it also has become increasingly demanding as a surge in pet ownership during the pandemic has professionals working harder than ever to provide quality care for millions of new pet owners. Research from the American Veterinary Medical Association found that 92% of respondents ranked increasing levels of stress among their top mental health challenges, with 88% of respondents citing student debt and depressive thoughts as leading stressors. The increase in pet adoption has added to the many stressors veterinarians face, such as: • Emotional and physical stress: In addition to caring for pets, veterinarians experience high emotional stress from having difficult conversations about unfortunate health outcomes and diagnoses. • Administrative burdens: The tight labor market has made it difficult for veterinary practices to recruit and retain support staff. The high employee turnover disrupts workflows, increases operational inefficiencies and decreases productivity. • Financial pressures: New veterinarians graduate with sizable student loans. The average veterinary-school debt in 2020 for borrowers was $188,853, according to the American Veterinary Medical Association. At Pet Paradise and New Day Veterinary Care, we are dedicated to creating a vibrant, healthy culture to remove the pain points that lead to career burnout in our industry. Each day, we strive to bring about change by providing an environment that recognizes the importance of work-life balance, empowers veterinarians to provide the best care possible (no minimum visits per day), and encourages teamwork and a sense of community. Here are a handful of ways we are doing that:

our full-service clinics so they can spend more time with their clients and their pets.

Our pet perk means less stress: Our veterinarians and support staff are encouraged to bring their pets to work so they can visit them in the play yards during the day (where they get exercise and fresh air).

We offer generous benefits and perks: In addition to a competitive salary, we provide top-tier benefits, including a generous student loan repayment assistance program and quarterly profit-sharing opportunities.

We are growing: The 25th New Day location opened in the Summer of 2022 and, with more locations on the horizon, we will continue to provide superior pet care from Phoenix, Arizona, to Fort Lauderdale, Florida, and beyond. Our mission at Pet Paradise and New Day Veterinary Care is to enhance the quality of life for pets, our customers and team members by providing exceptional pet care, outstanding customer experience, and a fulfilling work environment. If you are in search of a meaningful career with a healthy work-life balance, explore our career offerings at https://newdayvetcareers.com/. We look forward to hearing from you.

We are flexible and listen to our veterinarians: Listening helps us understand what our veterinarians need to succeed. We pivot quickly to provide resources or enhance policies and procedures so they can continue to provide superior care.

We leverage new technology: Maximizing the use of innovative new technology improves pet diagnoses, enhances patient communication and increases productivity. Our veterinarians have access to best-in-class technology at IVC Fall 2022

When the Unexpected Happens —

Ensuring a Future for your Clients’ Pets Have your clients provided for their pets in the event something happens to them? How to start a conversation around this important topic. BY CHRISTINA CHAMBREAU, DVM, CVH

Your clients look to you for much more than health advice, especially if you’re an integrative veterinarian. They want to know how to build vitality and well-being for a long and happy life in their pets. In addition, they often need to understand and discuss family dynamics as part of your integrative treatment plan. One area that is still not adequately covered in many of our client conversations is ensuring that if something happens to the client, or the client is no longer able to look after the animal, his or her cherished companions will be cared for. Natural disasters are becoming ever more frequent; financial stresses are escalating; a growing number of people who live alone and

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work at home have adopted animals; and many elderly people with pets often live alone as well. And people do die. The AVMA, ASPCA and many legal websites frequently address how to provide for pets once a person dies, and some also address incapacitation. A few help people recognize when they may not be properly caring for their pets, especially as they age.1 Suggestions for preparing for natural disasters can also be found on many websites. Insurance partially addresses the financial stress that pet healthcare can bring, but less frequently discussed are strategies for how you can help clients who truly cannot afford your fees.

LIVING ALONE WITH COMPANION ANIMALS The area that’s least addressed is what may happen to animals if a person living alone dies or becomes physically or mentally incapacitated, and no one knows there are pets in the home who now have no food or water, and may suffer and die. I have been unable to find anything on the internet about this issue, yet in 2019, an estimated 34.75 million Americans were living in single-person households.2 There has been a huge increase of people working from home during the pandemic. How many have bosses, co-workers, friends or relatives who know they share their homes with pets? There is plenty of information online about how to live safely when alone, 3 some of which includes a discussion of daily caretaking needs for pets — but none of this info mentions how to plan for the animals when/if the owner is no longer present. An individual living alone who does not work, or who works virtually, may fall and lie seriously injured or dead for days to weeks before being found. These people may also be injured or taken ill away from home, and perhaps wind up in a coma or be otherwise unable to communicate about their pets waiting for them at home.

TWO EXAMPLES OF WHAT CAN HAPPEN A few personal experiences have made me very aware of this potential for animal distress. The 50-year-old daughter of a friend of mine lived alone with five dogs. Her mother tended to stop by daily — which was a good thing because one day she walked in to find that her daughter had tragically fallen down the steps and broken her neck. Of course, the mom took responsibility for the dogs by taking them in personally or finding them good homes. In another incident, a relative of mine who was very active on social media, spending many hours a day describing how her dogs were doing, and supporting friends with their families and dogs, went silent for two days. The friends nearest her went to her home to find that she was in need of hospitalization, and looked after the dogs until she came home.

EDUCATING YOUR CLIENTS How you educate your clients about this issue will depend on your clientele. First of all, do you know how many of them live alone? That may be an important metric for your health care recommendations, in addition to safety issues. Next, are you already educating them about pet trust planning? How do you regularly communicate with your clients — by blog, newsletter, online or mailed reminders, waiting room notice boards or flyers? Even those who don’t live alone may share your recommendations with people they know who do.

You may want to have your technicians initiate this conversation, and note the client’s response in the record, and if they need a follow-up conversation. You could create a packet of support materials, or a page on your website with live links that direct people to more information on these different areas of pet support. Because this issue has not yet been fully addressed, the following is merely a beginning set of guidelines.

Disaster planning We all need reminders to plan for natural disasters. Multiple websites address what is required in order to be prepared. Suggested items that aren’t readily available could be sold by your clinic. Important issues include:

Being prepared to find a pet lost in a disaster — microch ipping, tattoos, ID tags and new technology using GPS, Bluetooth technology and more; once lost, social media and internet sites, flyers and animal communicators can be useful

A few basics to remind your clients to have on hand:5,6,7

• Sturdy leashes, harnesses and/or transport carriers • Food, drinking water, bowls, cat litter/pan and a manual can opener • Pet bed, favorite toy and blankets if possible • Pet first aid kit.

Attach a waterproof container to the pet’s carrier with the following up-to-date information and items: • Medications and copies of medical records • Caretaker contact info • Contact info of people living far away from the disaster site •C urrent pictures and details on personality, favorite toys, games, foods, feeding and other daily schedules. IVC Fall 2022

Each of you will think of more ways to help ensure the safety and well-being of patients living in different circumstances. Encourage your clients to be creative and find ways that work for them, so it doesn’t feel like an intrusive or onerous task. You could have them share what works on your bulletin board, in your blogs, or on your Facebook page.

QUESTIONS TO ASK CLIENTS • W ho knows you live with animal companions? The more there are, the better. • Family, friends • People you work with/for • Neighbors • People your dog plays with • Mail or food delivery persons • Do these people interact with you on a daily basis, or every other day? Would they know that something may have happened if they don’t hear from you for two or three days? Do they know you live with pets?

Resources Financial Help https://cofundmypet.com/ www.waggle.org/ https://vetbilling.com/meet-vetbillings-board-of-advisors/ www.browndogfoundation.org/ www.rescuewell.org/ https://rockykanaka.com/money/ www.fetchpet.com/aarp

Pet Trusts www.aspc a .org /pet-c are /pet-planning /infor mal-vs-for malarrangements www.aspca.org/pet-care/pet-planning/funding-dos-and-donts www.aspca.org/pet-care/pet-planning/pet-trust-prim www.avma.org /javma-news/2001-12-01/pet-estate-planningpreparing-your-pets-future-without-you www.nolo.com/legal-encyclopedia/pet-trusts.html www.petsbest.com/blog/what-happens-if-you-pass-away/ https://ez-probate.com/learn/blog/what-happens-dog-owner-dies/

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• If you do not routinely communicate with anyone, daily or every other day, set up a regular checkin with a friend. Examples include a smiley face text every AM or PM, a call, or an email to let them know you’re fine. • Pick a few people to be your pet partners, and be sure to keep them updated on changes in your life and the lives of your animals. • Have someone nearby with a key to your home, who is willing to be called by others if they are concerned about you.

• Some people have a routine that their neighbors know — if the shades do not rise in the morning, the neighbors check on them. • Have a sign on the door with the number and species of animals inside. Many people already do this in case of fire or other disaster. (Your clinic could provide these signs, which are often free from the local fire department.) • Carry a card with your driver’s license/personal ID (maybe your clinic could design a practical card with its logo and contacts) with upto-date information about who to contact about your pets if something happens to you. This would be very useful if you were in an accident and unconscious for a few days. • Keep a notebook (maybe accessible online) with details about each animal: photos if there’s more than one pet; personality (are they shy, skittish, etc.); favorite toys, games, foods; care providers, and if possible, a running note on what needs to be done and when — update this regularly. This is also required for pet trusts and disaster preparedness.

INABILITY TO PROPERLY CARE FOR A PET A related issue necessitating the support of friends, relatives and the community is briefly addressed on websites for seniors, though it’s not just an aging issue.4 Pet parents of any age may develop health issues, and may not initially recognize that they are no longer able to give their pets the attention they need. Examples include: • Forgetting to feed the animal regularly • A n inability to exercise the pet • A nimals that are defecating or urinating around the house • A n inability to keep the pet groomed sufficiently.

Educate your staff to watch for hints that this may be happening, and bring it to your attention. Having a staff person or volunteer who’s interested in helping people find solutions could be beneficial. Create a handout or blog on the topic. IVC Fall 2022

PET TRUSTS

Several points to share with clients:

In the last several decades, much has been written about planning ahead for an animal’s care after the guardian dies or is incapacitated.

• Have money allocated over time, not in one lump sum

Most importantly, educate your clients to use a trust, not a will to enforce their wishes. Why? A will has to be probated, any and all conflicts resolved, and the estate closed before the wishes and any money in the will can be accessed and followed. This means the animals will be in limbo during that period. In 1990, a section was added to probate code saying that "a trust for the care of a designated domestic or pet animal and the animal's offspring” was valid. The trustee must follow the owner’s instructions and use the allocated money only for the care of the pet. To best serve your clients, check out your state or provincial pet trust regulations, and which lawyers are familiar with this work.

Financial Issues These days, clients struggle to pay for well- being checkups, and grieve over refusing care because they can’t afford it. Not enough practitioners are researching insurance and suggesting the options and companies that are most fitting for their clientele. New pet insurance companies appear frequently, as do annual reviews of what’s available.

• Frequently review who will be taking responsibility for the animals • Have the trustee verify identification of the pets and how often to check on them • I nclude detailed instructions — favorite games, toys, food, medical conditions as well as preference for final disposition when the pet dies • Review and update when the guardian’s death is pending. If no one is willing to be responsible for the pet, local shelters and branches of the SPCA, and even some veterinary colleges, will take responsibility for the animal, placing him with a family and monitoring him with a specific amount donated.

CONCLUSION Strategizing and staying updated on these areas of your patients’ lives, from birth to death, is well worth the investment of time. We all need reminders to be prepared. Your clients are more likely to take the above prevention steps when given resources and specific actions with instructions. As veterinarians, we can lessen the chance of hearing tragic stories of needless animal suffering. Start with your clinic staff so their pets are protected and they can see if instructions are clear and easy to follow.

www.safewise.com/blog/9-safety-guidelines-for-living-alone/

Statista, “Percentage of Single-Person Households in the United States in 2019, By State,” September 2020. Accessed October 20, 2021. 2

Every veterinarian has donated or discounted services when they can. How else can you help clients who truly cannot afford your fees? Decide if you want to create support in your practice community. Many practices have funds people contribute to that can be used as loans or gifts when needed. Often, these are instituted by people in honor of their own pets; other times, the clinic promotes it. Internet sites offer fundraising options, often through social media. Various groups and charities offer financial support for local pets, specific breeds or conditions. Your state or local veterinary organization could be nudged to provide educational resource materials for their members’ clients. 42

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www.apartmentguide.com/blog/living-alone/

www.caringseniorservice.com/blog/take-care-of-pets

https://animalwellnessmagazine.com/tracking-lost-animals/

www.redcross.org/get-help/how-to-prepare-for-emergencies/pet-disaster-preparedness.html

www.ready.gov/pets

profitable practice

CUT MEDICAL EQUIPMENT COSTS AND SAVE TIME WITH INFUSION PUMP REPAIR Infusion Pump Repair has made it their mission to reduce equipment costs for veterinary practices by providing new, refurbished, and repaired infusion pumps that are affordable and accessible. infusionpumprepair.com

COST-SAVING PRODUCTS FOR YOUR PRACTICE IPR has a newly released line of infusion pumps that are specially designed and calibrated for veterinary practices. Here are the most accessible and affordable infusion pumps on the market for your clinic: The PETite IV infusion pump is lightweight, portable, and easy to use, with a dynamic touchscreen display. The PETfusion veterinary syringe infusion pump has a long battery life, can be calibrated to any syringe set, and has a dynamic touchscreen display. The SnipPET IV infusion pump has great features like a multi-functional interface, dynamic pressure slow, and selectable occlusion levels.

5 WAYS IPR CAN LOWER YOUR MEDICAL EQUIPMENT EXPENSES 1. They’ll find you the most affordable solutions, whether you want to repair or replace. 2. You get free incoming shipping. 3. Evaluations are free. 4. Prevent costly repairs and get more life out of your infusion pumps with annual preventative maintenance and calibration. 5. Upgrade for less with trade-in discounts.

WHY VETERINARIANS LOVE IPR PRODUCTS AND SERVICES IPR is the country’s largest infusion pump specialist, and veterinarians know they can rely on IPR for infusion pump services. Their PM and calibration services keep your pumps operating properly and calibrated for your practice so that you can focus on helping patients. They also have a quicker turnaround time than original equipment manufacturers and offer rush services when you’re facing an emergency. Once more, they provide free evaluations with fair, transparent quotes so you can make informed decisions and budget wisely. IPR offers unparalleled customer support, exceptional quality, and timely delivery, and all at reasonable prices that will help your practice reduce costs. IVC Fall 2022

needtoknow US GOVERNMENT

AGAINST

CONCENTRATION OF OWNERSHIP IN VET INDUSTRY BY

LARGE PLAYERS The US government continues to exhibit concerns about concentrated ownership in the veterinary industry, especially by the larger players such as National Veterinary Associates and Mars Inc. Big corporations own a sizable chunk of the industry, and the Federal Trade Commission (FTC) is trying to put a check on that. A few months back, the FTC ordered National Veterinary Associates (NVA) to sell six such hospitals, three in Texas and three in California. This order was a wake-up call for NVA. The corporation had acquired ownership of 16 hospitals from Sage Veterinary Centers through a $1.1 billion acquisition last year. The FTC’s order, however, means that NVA will lose one-third of the assets it wanted to obtain from the agreement. And there’s more. The FTC subsequently ordered NVA to sell still more hospitals in the US. This shows that the regulators are increasingly uncomfortable with the concentration of veterinary ownership, particularly in specialty practice and emergency. Putting a check on the monopoly of these big dogs is opening the door for smaller competitors to bid more effectively for veterinary hospitals and accrue higher market shares. Speculation is mounting that the FTC will also look at deals involving general practices. Alarms have already been raised regarding the increasing power of private equity firms in the profession. https://news.vin.com/default.aspx?pid=210&Id=11062289

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Data science can markedly improve cancer treatment outcomes —

ImpriMed shows you how Cancer treatment in companion animals can have unpredictable results. Different breeds have different genetic makeups — leading to different drug responses. Veterinarians often have to alter a treatment path because drugs for a particular patient stop working, while the cancer invasion lingers on. The good news is that data science can significantly improve cancer treatment outcomes in your patients. Data science is changing the world we live in. It is not only helping businesses reap revenues, but is also helping medical science evolve. The advent of precision medicine along with data science has the potential to increase recovery rates. Genomic data is a pivotal pillar of precision medicine. This data can help bring wonderful advancements in veterinary medicine by leveraging the right tools. In fact, veterinary cancer treatments can now readily profit from the technologybased drug response predictions made available by ImpriMed. ImpriMed is a precision medicine company focused on countering cancer. They have started their cancer war by helping animals, and are currently offering canine lymphoma and leukemia drug response prediction profiles by using data science and AI. They are also conducting an ongoing study on feline neoplasia.

IMPRIMED’S FIRST PUBLISHED STUDY ON CANINE LYMPHOMA This study involved a combination of ex vivo and immunophenotyping assays with computational modeling. Published in Veterinary and Comparative Oncology in October 2020, it involved 261 canine lymphoma patients who were given at least one of the five common chemotherapy agents (doxorubicin, vincristine, cyclophosphamide, lomustine, and rabacfosadine). Canine lymph node cells were collected through fine needle aspiration, and the post-treatment clinical response was recorded. Flow cytometry was applied for immunophenotyping and ex vivo chemosensitivity testing. The acquired data was then used to train computational models. These machine learning models enabled the transfer of ex vivo chemosensitivity assay results into a predicted probability of in vivo drug efficacy. The results clearly show that this method can improve treatment outcomes by establishing predictive estimates.

WHAT DOES IMPRIMED OFFER VETERINARIANS? ImpriMed offers a drug response prediction profile based on its novel AI platform. The company’s AI has been trained by varied sets of exclusive real-world clinical data, which translates into remarkable results. Veterinarians can now send fine needle aspirates of their canine patients to ImpriMed and get a highly advanced drug response prediction profile within seven days. This allows you to carefully select a treatment regimen that is most likely to bring remission. ImpriMed also provides other services, including immune profiling using flow cytometry and PCR for antigen receptor rearrangements, flow cytometry only, and PCR for antigen receptor rearrangements only. Another way that you could help ImpriMed in their feline neoplasia study by sending samples of suspected neoplasia cases for free flow cytometry and PARR. ImpriMed offers virtual educational meetings regarding feline immunophenotyping for each sample. www.imprimedicine.com IVC Fall 2022

Making sense of feline panleukopenia (FPV) testing How studies on FPV diagnosis and management are helping answer some practical questions important to shelter medicine and beyond.

BY LINDA S. JACOBSON, BVSC, MMEDVET(MED) PHD, TORONTO HUMANE SOCIETY

Feline panleukopenia virus (FPV), or feline parvovirus, is an important cause of disease in cats, particularly kittens.1 It is frequently seen in animal shelters, which house a mixed and ever-changing population of animals, including kittens that are too young to be reliably protected by routine vaccination.2,3 In puppies with the closely-related canine parvovirus (CPV) infection, clinical signs are often classic, with vomiting and bloody diarrhea being quite consistent. In cats, however, vomiting and diarrhea are not always seen, particularly early in the disease course. Bloody diarrhea is relatively uncommon, and the disease may manifest non-specifically as sudden death or acute signs of septic shock. In our experience, severity can also range from mild to severe, even within the same litter.

CPV RAPID ANTIGEN TESTS HAVE MIXED RESULTS Practical point-of-care (POC) diagnostic testing has been largely limited to CPV rapid antigen tests, which are not optimized or labeled for FPV, and have yielded mixed results

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in studies.4,5 Highly sensitive quantitative PCR tests can detect small amounts of virus DNA, but this may lead to false positive results, particularly after modified live virus (MLV) vaccination.6 It may also extend isolation times by detecting DNA from non-viable virus. Our studies7–9 focused on several practical questions regarding FPV diagnosis and management: •

How does POC testing compare with quantitative PCR?

•

Can rectal swabs or vomit samples be tested if diarrhea is not present?

•

What does a weak positive POC test result mean?

•

When do infected kittens stop shedding virus and when can they be released from isolation?

•

How are test results affected by modified live vaccination?

We utilized and compared a rapid antigen POC test for CPV (IDEXX SNAP Canine Parvo ELISA; SNAP) and a real-time, quantitative PCR test for FPV.

WHAT DO RAPID ANTIGEN AND PCR TEST RESULTS MEAN? In cats suspected of having clinical panleukopenia infection, sensitivity and specificity for the SNAP test, compared with PCR, were as follows: •

Fecal samples: 55% sensitivity and 99% specificity (n=102)

•

Anal swabs: 30% sensitivity and 96% specificity (n=55)

•

Vomit: 100% sensitivity and 100% specificity (n=17)

When fecal PCR was compared with anal swab PCR, the sensitivity was relatively low, at 77%. The lower sensitivity for anal swabs was most likely due to small sample volumes. The results for vomit should be considered preliminary, because only 17 samples were tested, and only two were positive. This author had previously understood that our observed low sensitivity for the SNAP test arose from the fact that FPV must differ quite markedly from CPV. This is not, in fact, the case. The feline virus is genetically very stable,10 and differs from CPV by only six amino acid residues.4,11 The low SNAP sensitivity compared with PCR is, in fact, a “tip of the iceberg” phenomenon. Many feline stool samples contain relatively low concentrations of virus, which are below the detection limit of the antigen test. Virus load can be expected to differ between groups and individuals, depending on factors like vaccination, husbandry, previous maternal exposure, and individual immunity.

We concluded that, like the SARS-CoV-2 rapid tests, the FPV POC antigen test is a useful screening test, but a negative result in a clinically suspicious patient is not reliable. In these cases, the SNAP can be repeated on a subsequent stool sample, or a sample can be submitted for PCR. Vomit samples can be attempted if no stool is available. Through this study, we also gained a clearer understanding of what routine FPV PCR results mean. Results are currently reported by the diagnostic laboratory as “positive” or “negative”, with no quantitation reported. DNA quantitation is, however, part of the test methodology, and was provided for the study. Many “negative” samples contained some panleukopenia DNA. Small quantities of parvoviruses (which could be field virus and/or vaccine virus) can be detected in stool from many healthy dogs and cats.14,15 Consequently, diagnostic laboratories set a technical cut-off value, in this case ≥1.6 x 106 viral DNA copies per gram.16 Virus concentrations above the cut-off are reported as “positive”, and those below are “negative”. In cases where test interpretation is difficult, quantitative results can be obtained from the laboratory.

HOW LONG SHOULD INFECTED CATS BE KEPT IN ISOLATION? A follow-up study tested stool samples from naturally infected shelter kittens on Days 0 (day of diagnosis), 3, 7, 14 and 21. The goal was to optimize isolation times. Both FPV and CPV viral loads typically peak within the first few days, then rapidly decline.15,18 However, older literature stating that FPV can be shed for up to six weeks17 continues to be quoted in reviews and book chapters. Panleukopenia can be successfully treated. Intravenous fluids are essential for many patients.

In the short period since this study was conducted, this “tip of the iceberg” phenomenon has become familiar around the world thanks to the COVID-19 pandemic. By now, we are all aware that rapid antigen tests for the SARSCoV-2 virus are positive when virus loads are high, but are negative for lower virus loads that still produce positive PCR results.12 The study confirmed previous findings that, in a symptomatic cat, any positive SNAP test, no matter how faint the positive color change, should be viewed as a true positive.4,5 This is consistent with the manufacturer’s recommendations for CPV results.13 IVC Fall 2022

Summary of study findings Diagnostic testing7 •

Stool samples remain the sample of choice for diagnosing feline panleukopenia, but vomit has potential for early diagnosis.

•

Any positive SNAP result in a sick kitten should be considered a true positive, but a negative test is unreliable.

•

PCR can be used to confirm the diagnosis where needed.

Viral shedding after clinical infection8 •

The SNAP test has little utility for postdiagnosis confirmation that viral shedding has ceased.

•

Our findings supported release from isolation >14 days after diagnosis; future virus isolation research might support even earlier release. Additional precautions must be in place after release from isolation.

Post-vaccinal positive tests9 •

Post-vaccinal SNAP tests were rare, but positive PCRs were quite common, and typically occurred on Day 7 following the initial MLV vaccination.

•

Judicious test submission and careful assessment are needed to avoid false positive diagnoses.

Panleukopenia is treatable in shelters if adequate resources are available, with 80% survival in our study. 48

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Samples were available from 16/40 cats with clinical FPV, confirmed by PCR. SNAP tests were positive for 12/16 cats on Day 0, and 3/16 on Day 3. The SNAP was negative for all kittens on Day 7, and positive for one on Day 14 (a presumed false positive). In contrast, the PCR test remained positive for 13/16 on Day 3, 6/16 on Day 7 and 1/16 on Day 14. It was negative for 12/12 on Day 21, as was the SNAP. We concluded that the SNAP test is not reliable for detecting ongoing virus shedding. As a result of this study, we have removed our shelter’s previous requirement for a negative SNAP test after two weeks. The study did not support using clinical measures as a proxy for virus shedding, with diarrhea and systemic signs (pyrexia, lethargy, inappetance, weight loss) all being unreliable indicators of likely PCR status. A negative PCR test was not accompanied by a resolution of diarrhea in many cases. This is unsurprising, given the severe intestinal damage caused by FPV,1 and the potential for secondary infections and dysbiosis. Although we used PCR to determine shedding, it is important to note that this modality does not distinguish between nucleic acid from live and dead viruses. Virus isolation studies of SARS-CoV-2 showed that positive PCR results persisted well beyond the point that virus could be cultured.19,20 In dogs with CPV, viable virus was shed for a maximum of eight to 14 days post-infection.18,21 Virus isolation is the true test of virus viability and potential infectivity, and a follow-up study comparing PCR and virus isolation during recovery from FPV would be very useful.

Previous shelter recommendations were to hold recovered cats for three weeks after recovery, while more recent recommendations were to isolate them for five weeks after diagnosis.22,23 Based on our findings, and previous research, we recommended that infected cats can be released from isolation >14 days after diagnosis. Follow-up PCR tests are not routinely required to determine the timing of release from isolation. After considering multiple factors, and our own context and risk management, our current shelter protocol was adjusted to allow release from isolation from seven days after diagnosis, so long as the animal is bright, eating well and gaining weight. Biological variation being a given, additional measures must be in place. These include vaccination upon intake, robust cleaning and sanitation, stress reduction, and housing recovered cats in areas containing only vaccinated adults. A distinctly positive parvo SNAP test (blue circle on right).

Of interest in this study was that 80% of the initial group of 40 panleukopenia-positive cats and kittens survived, compared with previously reported mortality of 50% to 90%.24–26 No referral treatment was required. Of paramount importance was the ability to provide intravenous fluid support, when needed.

DO VACCINES RESULT IN FALSE POSITIVE RESULTS? After MLV vaccination, vaccine parvovirus replicates in the intestine, and post-vaccinal shedding has been demonstrated in both dogs and cats.27,28 Cats entering a shelter might experience poor appetite, vomiting and diarrhea for many reasons, such as stress, diet change, parasites or other infections. A false positive diagnosis of FPV in such animals could lead to unnecessary isolation, outbreak measures, or even euthanasia. Shelter guidelines recommend frequent vaccination of kittens to try to hit the “sweet spot”

between vaccine interference by maternal antibodies and the time of maximum susceptibility to infection,29 meaning that there could be more than one risk period for vaccine-related false positive PCR results. The study above tested stool samples from healthy shelter cats and kittens, starting before or within 24 hours of FVRCP vaccination (Felocell 3, Zoetis). Cats with any previous vaccination history were excluded. Thirtyseven cats were followed to Day 14, and 17 to Day 21. There was one positive SNAP test on Day 7, confirming previous findings that vaccine-positive SNAP results are uncommon.30 (In the previous study, the frequency of postvaccinal positive results differed for different vaccines and point-of-care tests.30) Eight cats had nine positive PCR results, one on Day 3 and eight on Day 7. This is consistent with peak viral loads for

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To avoid false positive results in the initial period following vaccination, FPV PCR testing should be limited to cats with a high index of suspicion for FPV infection, and/or if there is high outbreak potential. History, vaccination dates, and clinical status should be taken into account when interpreting the results. Other supporting factors, such as neutropenia and quantitative DNA results (available from the reference laboratory), should also be assessed. If the diagnosis remains in doubt, shelters should manage the animal as a positive case.

Barrs VR. Feline panleukopenia: a re-emergent disease. Vet Clin North Am Small Anim Pract. 2019;49(4):651 670. doi:10.1016/j.cvsm.2019.02.006.

Jakel V, Cussler K, Hanschmann KM, et al. Vaccination against feline panleukopenia: implications from a field study in kittens. BMC Vet Res. 2012;8(May). doi:10.1186/1746-6148-8-62.

DiGangi BA, Levy JK, Reese MJ, Dingman PA, Tucker SJ, Dubovi EJ. Effects of maternally-derived antibodies on serologic responses to vaccination in kittens. J Feline Med Surg. 2012;14(2):118-123. doi:10.1177/1098612X11432239.

Abd-Eldaim M, Beall MJ, Kennedy MA. Detection of feline panleukopenia virus using a commercial ELISA for canine parvovirus. Vet Ther. 2009;10(4):E1-6. www.ncbi.nlm.nih.gov/pubmed/20425728.

A faint blue reaction on a parvo SNAP test (blue circle on right) should be considered a true positive in a symptomatic kitten.

both vaccine virus and natural infections.6,15,18,28 The amount of viral shedding was significantly lower in the vaccine-positive samples, compared to cats with confirmed clinical infections. All the cats with positive results postPCR were ≤6 months old, and most were from higher-risk environments, namely hoarding settings or community cat colonies. This could suggest subclinical shedding of field virus and/or lack of neutralizing antibodies to reduce vaccine virus concentrations, as might have occurred in older and previously exposed or vaccinated cats. No positives occurred seven days after the second vaccine in the 11 cats that had a second vaccine on Day 14.

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Neuerer FF, Horlacher K, Truyen U, Hartmann K. Comparison of different in-house test systems to detect parvovirus in faeces of cats. J Feline Med Surg. 2008;10(3):247-251. doi:10.1016/j.jfms.2007.12.001.

Bergmann M, Schwertler S, Reese S, Speck S, Truyen U, Hartmann K. Antibody response to feline panleukopenia virus vaccination in healthy adult cats. J Feline Med Surg. 2018;20(12):1087-1093. https://doi. org/10.1177/1098612X17747740.

Jacobson LS, Janke KJ, Giacinti J, Weese JS. Diagnostic testing for feline panleukopenia in a shelter setting: a prospective, observational study. J Feline Med Surg. 2021;23(12):1192-1199. doi:10.1177/1098612x211005301.

Janke KJ, Jacobson LS, Giacinti JA, Weese JS. Fecal viral DNA shedding following clinical panleukopenia infection in shelter kittens: a prospective, observational study. J Feline Med Surg. 2021;Epub ahead(June). doi: 10.1177/1098612X211023056.

Jacobson L, Janke K, Ha K, Giacinti J, Weese J. Feline panleukopenia virus DNA shedding following modified live virus vaccination in a shelter setting. 2022. doi: https://doi.org/10.1016/j.tvjl.2021.105783.

Wang X, Carrai M, Van Brussel K, et al. Low intrahost and interhost genetic diversity of Carnivore protoparvovirus 1 in domestic cats during a feline panleukopenia outbreak. 2022. doi:10.3390/v14071412.

Hueffer K, Parker JSL, Weichert WS, Geisel RE, Sgro J-Y, Parrish CR. The natural host range shift and subsequent evolution of canine parvovirus resulted from virus-specific binding to the canine transferrin receptor. J Virol. 2003;77(3):1718-1726. doi:10.1128/jvi.77.3.1718-1726.2003.

Brümmer LE, Katzenschlager S, Gaeddert M, et al. Accuracy of novel antigen rapid diagnostics for SARSCoV-2: a living systematic review and meta-analysis. Vol 18.; 2021. doi:10.1371/journal.pmed.1003735.

IDEXX Reference Laboratories. Frequently asked questions about SNAP parvo test. 2017. https://idexxcomlive-b02da1e51e754c9cb292133b-9c56c33.aldryn-media.com/filer_public/94/bb/94bb23b2-7d3a4d40-a119-1b82cc0f145e/snap-parvo-test-faqs.pdf.

Meggiolaro MN, Ly A, Rysnik-Steck B, et al. MT-PCR panel detection of canine parvovirus (CPV-2): vaccine and wild-type CPV-2 can be difficult to differentiate in canine diagnostic fecal samples. Mol Cell Probes. 2017;33:20-23. doi:10.1016/j.mcp.2017.02.007.

Jas D, Aeberlé C, Lacombe V, Guiot AL, Poulet H. Onset of immunity in kittens after vaccination with a non-adjuvanted vaccine against feline panleukopenia, feline calicivirus and feline herpesvirus. Vet J. 2009;182(1):86-93. doi:10.1016/j.tvjl.2008.05.025.

Gizzi ABDR, Oliveira ST, Leutenegger CM, et al. Presence of infectious agents and co-infections in diarrheic dogs determined with a real-time polymerase chain reaction-based panel. BMC Vet Res. 2014;10:1-8. doi:10.1186/1746-6148-10-23.

Csiza CK, Scott FW, de Lahunta A, Gillespie VMD. Immune carrier state of feline panleukopenia virus-infected cats. Am J Vet Res. 1971;32(3):419-426.

Decaro N, Desario C, Campolo M, et al. Clinical and virological findings in pups naturally infected by canine parvovirus type 2 Glu-426 mutant. J Vet Diagnostic Investig. 2005;17(2):133-138. doi:10.1177/104063870501700206

Ben-Shmuel A, Brosh-Nissimov T, Glinert I, et al. Detection and infectivity potential of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) environmental contamination in isolation units and quarantine facilities. Clin Microbiol Infect. 2020;26(12):1658-1662. doi:10.1016/j.cmi.2020.09.004.

Mondelli MU, Colaneri M, Seminari EM, Baldanti F, Bruno R. Low risk of SARS-CoV-2 transmission by fomites in real-life conditions. Lancet Infect Dis. 2020. doi:10.1016/S1473-3099(20)30678-2.

Proksch AL, Unterer S, Speck S, Truyen U, Hartmann K. Influence of clinical and laboratory variables on faecal antigen ELISA results in dogs with canine parvovirus infection. Vet J. 2015;204(3):304-308. doi:10.1016/j. tvjl.2015.03.009.

From the AAVA The American Academy of Veterinary Acupuncture (AAVA) is committed to improving animal healthcare through the advancement of veterinary acupuncture. The AAVA’s seat within the American Veterinary Medical Association’s (AVMA) House of Delegates (HOD) gives us multiple opportunities to represent veterinary acupuncture. The AAVA strives to bring veterinary acupuncture practitioners together to promote acupuncture to veterinarians and the public. The AAVA is also committed to providing quality CE with live and on-demand online CE options for their members. Non-members are required to pay $150 but will be awarded a one-year free membership, giving them access to all member benefits. Each year, there will be at least one small animal as well as one large animal webinar hosted by AAVA. All live and on-demand webinars are IVAS and RACE approved. Register now for AAVA’s October 18 webinar, Treating the Competing Sport Horse, by Dr. Lori Bidwell.

Tuzio H. Feline panleukopenia. In: Hurley KF, Miller L, eds. Infectious Disease Management in Animal Shelters. Ames, Iowa, USA: Wiley-Blackwell; 2009:183-196.

Guidebook: Feline panleukopenia. Koret Shelter Medicine Program 2017. https://www.sheltermedicine. com/library/guidebooks/?r=feline-panleukopenia.

Kruse BD, Unterer S, Horlacher K, Sauter-Louis C, Hartmann K. Prognostic factors in cats with feline panleukopenia. J Vet Intern Med. 2010;24(6):1271-1276. doi:10.1111/j.1939-1676.2010.0604.x.

Litster A, Benjanirut C. Case series of feline panleukopenia virus in an animal shelter. J Feline Med Surg. 2014;16(4):346-353. doi:10.1177/1098612X13497738.

If you were not able to join us in Memphis, TN for our 17th Annual Meeting, and enjoy completing CE from the comfort of your home or office, we have great news for you. AAVA will be providing ten hours of virtual CE in January 2023! These ten hours will consist of some of the most popular CE offered in Memphis, alongside a few new topics. Both member and non-member pricing options will be available. More information to come soon! Our next in-person event will be a joint conference with IVAS in August 2023, to be held in Alexandria, VA.

Porporato F, Horzinek MC, Hofmann-Lehmann R, et al. Survival estimates and outcome predictors for shelter cats with feline panleukopenia virus infection. J Am Vet Med Assoc. 2018;253(2):188-195. doi:10.2460/ javma.253.2.188.

Bergmann M, Schwertler S, Speck S, Truyen U, Reese S, Hartmann K. Faecal shedding of parvovirus deoxyribonucleic acid following modified live feline panleucopenia virus vaccination in healthy cats. Vet Rec. 2019:doi 10.1136/vr.104661. doi:10.1136/vr.104661.

Visit aava.org to learn more.

Freisl M, Speck S, Truyen U, Reese S, Proksch AL, Hartmann K. Faecal shedding of canine parvovirus after modified-live vaccination in healthy adult dogs. Vet J. 2017;219:15-21.

Stone AES, Brummet GO, Carozza EM, et al. 2020 AAHA/AAFP feline vaccination guidelines. J Am Anim Hosp Assoc. 2020;56(5):249-265. doi:10.5326/jaaha-ms-7123.

Patterson E V., Reese MJ, Tucker SJ, Dubovi EJ, Crawford PC, Levy JK. Effect of vaccination on parvovirus antigen testing in kittens. J Am Vet Med Assoc. 2007;230(3):359-363. doi:10.2460/javma.230.3.359.

IVC Fall 2022

Inthenews

Wildfire-injured cats more prone to blood clots Cats that suffer from smoke inhalation and burns are likely to have blood clots, according to a study by the University of California, Davis Veterinary Medical Teaching Hospital. The study, which looked at feline patients treated after the 2018 Camp Fire in Paradise, CA, concludes that felines injured in urban wildfires have a high incidence of developing potentially fatal heart problems. Compared to healthy cats, or those with subclinical hypertrophic cardiomyopathy (HCM), the felines who sustained injuries in wildfires had overactive platelets and were even more likely to throw clots than the cats with HCM. The platelets of wildfire-injured cats also released high amounts of microvesicles — microscopic membranous bubble-like structures filled with proteins — which are associated with cardiovascular disease and an elevated risk of clotting. Platelets are not only behind clot formation, but are involved in overall cardiovascular health and diseases as

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well. The study also aided in finding a new receptor for feline platelets, which may aid in clotting and could be considered for the development of future treatments. In addition, the results signify the role of platelets in linking inflammation with coagulation. This and future studies may also have implications for humans, since wildfires increase health risks for people too, including heart attacks and strokes after exposure. www.ucdavis.edu/health/news/cats-injured-wildfires-riskdeadly-blood-clots

profitable practice THE VETERINARY ADVANTAGE PROGRAM FROM HEMPMY PET™ GIVES YOU A FLEXIBLE WAY TO OFFER THE HIGHEST QUALITY HEMP OIL All veterinary practices have patients that could experience a significant reduction in their symptoms if they were prescribed hemp oil. HempMy Pet’s high quality range of hemp products meets a unique set of criteria:

Full-spectrum, strain-specific hemp extract — This form has the greatest medicinal value, the highest number of compounds (offering more benefits), and is the least processed CBD oil.

2 3

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Organic, human grade — Products are gluten-free, GMO-free, pesticide-free, cruelty-free, and vegan (except their Pumpkin Harvest biscuits, which contain eggs). HempMy Pet never uses any fillers, flavors, synthetic or unnecessary additives. All ingredients and formulations are 100% human grade.

ALLOWS YOU TO TARGET A RANGE OF HEALTH ISSUES HempMy Pet’s products target a number of both physical and mental health-related issues in pets, including: Canine osteoarthritic-related pain: HempMy Pet’s CBD Oil Formula is clinically proven to effectively treat pain in osteoarthritic dogs. Anxiety/mood: HempMy Pet’s second clinical study showed that their hemp oil reduced anxiety in horses while travelling. Epileptic seizures: Studies have shown that CBD products can help reduce the frequency of seizures in dogs.* Mobility problems: CBD products can help with mobility issues in dogs because they target pain and reduce inflammation, making it easier for dogs to move effectively. Inappetence: CBD is clinically proven to increase appetite and prevent nausea in dogs, making it a great option for cancer patients undergoing chemotherapy.

INCOME POTENTIAL AND TRAINING REQUIREMENTS Now more than ever, clients are looking for natural products to ease their pets’ symptoms. Hemp products can be a great tool in conjunction with other remedies to help patients that are experiencing a variety of ailments. Minimum training is required when it comes to hemp products. HempMy Pet makes the transition easier by having a Head of Research, Toxicologist, who can help guide you on the pharmacodynamics and pharmacokinetics of hemp in animals.

VETERINARY ADVANTAGE PROGRAM HempMy Pet knows that the rules and regulations around CBD change depending on location. That’s why they offer three distribution options — Wholesale, Dropship, and Affiliate — so you can find the distribution option that works best for your practice and level of comfort with hemp products.

*Colorado State University. "CBD clinical trial results on seizure frequency in dogs 'encouraging'." ScienceDaily, 21 May 2019. www.sciencedaily.com/ releases/2019/05/190521101450.htm.

IVC Fall 2022

A natural approach to Cushing’s disease in dogs includes nutrition, glandulars, herbs, acupuncture and more, addressing all facets of the disease with no side effects.

NATURAL APPROACH TO HYPERADRENOCORTICISM (Cushing's disease) IN DOGS BY JODIE GRUENSTERN, DVM, CVA

Today’s dog parents go online to search for the safest and most effective therapies for their canine companions. However, hyperadrenocorticism or Cushing’s disease is among those common disorders that must be explained thoroughly to dog owners who wish to make informed decisions on how to best treat their four-legged family members. This article looks at why a natural approach is an effective option for dogs with hyperadrenocorticism.

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THE CONVENTIONAL APPROACH TO CUSHING’S Although often helpful, today’s conventional option for hyperadrenocorticism comes with side effects that can be complicated to manage, and even deadly. Trilostane is currently the most used pharmaceutical for this condition. It acts by blocking receptor sites to decrease cortisol in the dog’s body.

The side effects of inadequate cortisol can include vomiting, diarrhea, weakness, and even collapse. This means a fair amount of monitoring is required when using this treatment protocol. Patients on Trilostane typically survive less than two years. Before using this treatment, the attending veterinarian must confirm a Cushing’s diagnosis. Sometimes the diagnostics are difficult to implement. The Cortrosyn gel used to perform the one-hour ACTH stimulation test is expensive, difficult to handle and store, and sometimes not available. The eighthour low dose dexamethasone suppression test utilizes readily available medication but is difficult to use in dogs with severe anxiety or aggression issues, or at veterinary facilities with inadequate kennels. Add to this the likelihood of false negative testing.

Case report Molly was a 12-year-old poodle who was dumped at the local shelter after “mom” died and “dad” didn’t want to wipe up her urine puddles anymore. A holistic vet rescued Molly and began a healing journey for her. Initially, she wore a pink coat to hide her bald, hyperpigmented body, but daily detox soaks and fresh food like raw bones helped make her happy and beautiful again. Molly lived to be almost 18 years old!

Most, but not all, dogs with Cushing’s have an elevated SAP/alkaline phosphatase level. Veterinarians commonly “chase” this test result, trying to figure out why it is elevated in an otherwise normal dog, or a dog with Cushing’s signs but normal follow-up testing. For these individuals, early intervention with a natural approach is ideal.

NATURAL APPROACH PHILOSOPHY The natural approach addresses all facets of Cushing’s, including the entire Hypothalamic-Pituitary-Adrenal (HPA) dysregulation. It also has no side effects. Many canine patients have signs consistent with HPA dysfunction long before Cushing’s testing becomes positive. Wouldn’t it be nice to implement a treatment strategy at the early onset of this insidious disorder, even before testing becomes confirmatory?

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GLANDULAR THEORY Glandular therapies are supplements made from the glands, organs, or tissues of healthy animals, and administered in tablet, capsule, or powder form. The purpose is to maintain or repair the corresponding tissue or organ in the patient’s body. •

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Pituitary-dependent hyperadrenocorticism begins in the pituitary gland with the overproduction of ACTH. Trilostane does not address this, but the natural approach utilizes the glandular theory and adds supplements that contain pituitary. The overabundant ACTH tells the adrenal to overproduce cortisol. This is what causes the excessive thirst and urine volume, sometimes ravenous appetite, pot belly, thin coat and skin seen in Cushing’s patients. Providing the body with adrenal gland in the diet directly addresses the adrenal imbalance. Elevated cortisol adversely affects the liver. The natural approach uses liver-supportive glandular, super foods and herbals.

EMOTIONAL BALANCE — CORTISOL IS A STRESS HORMONE We should consider the deepest level of “dis-ease”, including the contribution made by emotional imbalance. After all, cortisol is a stress hormone. When I inquire about the history of my Cushing’s patients, I find that an unusually large number suffered a grief incident prior to the onset of their disease, such as the death of their person or another pet in the home. For this situation, I use essential oils because of their multi-purpose natural chemistry. Aromatherapy affects the amygdala, the memory center of the brain, and hormonal physiology. Select oils can calm the mind, lower cortisol, and detoxify the liver!

Tell the client to avoid activities, medications, and products that can adversely affect their dog’s emotions, adrenals, and liver, including toxic household cleaners and lawn care products. Many products are endocrine (hormone) disruptors, such as plastics, pesticides, and herbicides. Keep this in mind when determining if a heartworm, flea, or tick preventative is necessary. Common endocrine disruptors include DDT, BPA, PCBs, herbicides, cadmium, lead, triclosan, phthalates, arsenic, and even de-sexing. The best natural approach is prevention. Keeping dogs intact or providing natural hormone replacements should be considered. Spayed females are at greatest risk for developing hypercortisolism. Avoiding stress and toxins is difficult, but at least an awareness of the importance of doing so can be beneficial.

NATURAL NUTRITION-FRESH FOOD Natural nutrition is vital to the successful management of a Cushing’s patient. Conventional processed foods contain excessive starch, sodium, and even hidden endocrine disruptors. Starch breaks down into glucose. The more glucose, the more insulin is needed. Cortisol suppresses insulin and may cause insulin resistance. Eliminate processed food and sugars from the dog’s diet, and feed a species-appropriate, fresh, preyconcept menu. In addition to pituitary dependent hyperadrenocorticism, as well as primary adrenal tumors that can overproduce cortisol and cause Cushing’s signs, a food-induced hyperadrenocorticism condition can also occur. In some dogs, glucagon inhibitory peptide (GIP) receptors may be found on the adrenal glands. When stimulated by GIP, these adrenal gland receptors produce cortisol. GIP release is stimulated by glucose (starch/ sugar) ingestion in the stomach with every meal.

Central Nervous System Stress + Hypothalamus

LIFESTYLE IS IMPORTANT The dog’s lifestyle should not exacerbate his or her Cushing’s. Daily exercise and play are mandatory to alleviate stress and provide ample opportunity for urine elimination. Exercise also promotes the release of endorphins, the feel-good hormones! Cushing’s dogs should never be water restricted, and need to urinate frequently. Providing a doggy door, a diaper or belly wrap, or potty pads may become necessary for longevity and the dog parent’s quality of life. Although diapers can increase the incidence of urinary tract infection, they can also minimize caging and decrease everyone’s stress.

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CRH

Shortloop Feedback

Pituitary ACTH

Adrenal Glands

Cortisol

Implementing

A NATURAL APPROACH TO

Cushing’s

Diet

• Start with a fresh, raw, species-appropriate diet based on local access, or a freeze-dried food. Many companies ship frozen food on dry ice. Emphasize the addition of blended, dark leafy greens, especially cruciferous vegetables for “liver-cleansing”. Studies show that orally-ingested sulforaphane from broccoli extracts induces Phase II detoxification enzymes.

2. Glandulars • Standard Process (SP) Canine Adrenal Support or Adrenal Complex • SP Pituitrophin PMG • SP Canine Hepatic Support or Livaplex (both contain milk thistle) • SP Symplex M or Symplex F-replaces missing gonadal influence with orchic or ovarian extract

3. Essential oils*/detox soaks • This is my favorite tool. I use Revii Moisturizing Mineral Soap with any of the following oils. It is safe to use as a daily soak if needed, and helps manage secondarily-infected skin, detoxify, and regrow hair by stimulating circulation. Soaking is emotionally soothing for most dogs. • Lavender angustifolia lowers cortisol and has antimicrobial properties. • Copaiba is high in beta-caryophyllene, which is anti-inflammatory. • Nutmeg contains myristicin, which is antioxidant, antimicrobial and more. Use caution as high doses can be psychoactive. One drop diluted in a soak once per week is adequate. • A blend of blue tansy, fennel, geranium, helichrysum, roman chamomile and rosemary is good for calming, liver detoxification, and improving circulation.

*Note: A ll my safety and efficacy experience with essential oils usage is exclusively with Young Living.

4. Chinese herbals • To appropriately address underlying Qi/energy imbalance, consider Jing Tang Ophiopogon Powder, Natural Path Si Maio San, or Wei Ling Tang. TCVM practitioners can choose the appropriate formulation based on the dog’s constitution and tongue and pulse diagnosis, as well as colleagues’ experiences.

5. Acupuncture • In TCVM, hyperadrenocorticism is most commonly a pattern of Yin deficiency or Qi-Yin deficiency. In the case of excessive appetite, thirst, urine volume, dry coat, thin hair to baldness, and

excessive panting with a dry red tongue and thready rapid pulse, needles can be used for Yin Deficiency. Common points used are BL-23/52, KID-3/6/7, SP-6/8/9. A useful herbal formulation is Mai Men Dong, also known as Ophiopogon Powder. • A Qi-Yin deficiency also includes a pendulous abdomen which may be due to an enlarged liver, uneven fat distribution, or even fluid related to heart failure. Pulmonary edema may occur, with excessive panting especially at night. The tongue may be paler and the pulse weaker. Common points used are BL-23/26, KID-3/7, HT-7, LIV-3, SP-6, CV-4/6, ST-36. A useful herbal formulation is Rehmannia 11.

6. Hemp • Hemp products can be beneficial, but purchasing the right product can be confusing. I trust and use SP Canine Hemp Complex (gel cap) or Animal Essentials Super Hemp (liquid). These are full-spectrum hemp products, not CBD specific.

7. Omega-3 fatty acids • Fish oil, algae oil, or krill oil supplementation can help lower circulating triglycerides. An appropriate Omega-3-6-9 balance may also help improve dry skin, dull coat, excessive shedding, and inflammatory skin conditions that may accompany hyperadrenocorticism.

8. O ther

adaptogenic or calming herbals and nutrients

• Lion’s mane mushroom • Reishi mushroom • L-theanine • L-tryptophan-amino acid (found in high levels in turkey; can be a good protein choice for many anxious dogs) • Catnip • Valerian • Passionflower • Lemon balm • SP Bacopa Complex has been shown to lower cortisol levels

9. Melatonin promotes sleep, lowers cortisol. 10. L ignins

are found in flax hulls and sprouts; they lower cortisol and estradiol.

11. H omeopathics

should be used with the help of an experienced classical homeopath to help “peel the onion”; Cushing’s is a complicated disorder to manage.

Many natural approach ingredients work synergistically and can be used in combination if finances permit and the dog will consume them. You can use the alkaline phosphatase (SAP) level as a monitoring tool if it’s elevated. The dog owner should keep a journal to monitor thirst and urine volume as well as appetite and energy. IVC Fall 2022

Elevated cortisol and blood sugar levels create anxiety and panting, classic and annoying Cushing’s signs. •

Weight loss usually occurs easily on a low-carb diet, which helps reset hormonal imbalances.

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Hypertension can resolve when excessive salt is avoided. Blood pressure should be measured regularly. Run a blood proBNP to monitor heart health in Cushing’s patients. Hawthorn berry, taurine, coQ10, l-carnitine and more can be added to a fresh diet to support a healthy heart and circulatory system.

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Hyperpermeability or “leaky gut” often heals with a fresh diet that includes a variety of pro/prebiotics and absorbable minerals from foods like bone broth. Many believe there is an autoimmune component to adrenal disease and a correlation between leaky gut and immune dysfunction. SARDS-sudden acquired retinal degeneration syndrome is often associated with Cushing’s and may be immune-mediated.

I start my clients with a commercial, balanced raw diet for their dogs, and help them graduate to a home-prepared diet, if desired. I recommend avoiding synthetic vitamins and minerals and HPP (High Pressure Pasteurized), although I make an exception if I feel a dog is significantly immune-suppressed or if there are food-safety concerns in the household. All commercial raw diets are a huge step up the nutritional ladder from the processed kibble that exacerbates this disorder. Remember, no starchy biscuit-style treats either! Use freezedried organs as functional treats.

Avoid oxalates and calcium supplementation. Cortisol increases calcium excretion and many of these dogs develop calcium deposits in their skin, as well as calcium oxalate urolithiasis. Choose low oxalate veggies. If, during a veterinary client discussion, it is deemed necessary to manage a patient’s Cushing’s with conventional medication, keep in mind that the natural approach can be combined with it. Great nutrition, appropriate supplements, and improved lifestyle can minimize the amount of medication needed, and keep the dog on the healthiest track possible.

References Cushing’s syndrome—an epidemiological study based on a canine population of 21,281 dogs, www.ncbi. nlm.nih.gov/pmc/articles/PMC6500859/#:~:text=In%20the%20United%20States%2C%20the,et%20 al.%2C%202015. Survival analysis of 219 dogs with hyperadrenocorticism attending primary care practice in England, www.ncbi. nlm.nih.gov/pmc/articles/PMC7146928/. Fructose-induced inflammation and increased cortisol: A new mechanism for how sugar induces visceral adiposity, https://pubmed.ncbi.nlm.nih.gov/29225114/. Hypothalamic-pituitary-adrenal axis dysregulation and cortisol activity in obesity: A systematic review, https:// pubmed.ncbi.nlm.nih.gov/26356039/. Modifying influence of dietary sugar in the relationship between cortisol and visceral adipose tissue in minority youth, https://pubmed.ncbi.nlm.nih.gov/23929660/. Glucose ingestion selectively amplifies ACTH and cortisol secretory-burst mass and enhances their joint synchrony in healthy men, https://pubmed.ncbi.nlm.nih.gov/21752898/. Stress Recovery Program Part II: The Cortisol-Glucose Connection, www.stmoritzmedical.com/blog/2020/5/12/ stress-recovery-program-part-2-the-cortisol-glucose-connection. The Interaction of Insulin and Pituitary Hormone Syndrome, www.frontiersin.org/articles/10.3389/ fendo.2021.626427/full. Galac S, Kars VJ, Voorhout G, et al. ACTH-independent hyperadrenocorticism due to food-dependent hypercortisolemia in a dog: a case report. Vet J 2007;177(1):141-143. N'Diaye N, Tremblay J, Hamet P, et al. Adrenocortical overexpression of gastric inhibitory polypeptide receptor underlies food-dependent Cushing's syndrome. J Clin Endocrinol Metab 1998;83(8):2781-2785. Supplements - Whole Food Supplements, https://vcahospitals.com/know-your-pet/supplements---wholefood-supplements. Sudden Acquired Retinal Degeneration Syndrome (SARDS) and Immune Mediated Retinitis (IMR), https:// animal-eye-iowa.com/sardsimr/. Changes in systolic blood pressure in dogs with pituitary dependent hyperadrenocorticism during the first year of trilostane treatment, www.ncbi.nlm.nih.gov/pmc/articles/PMC7848348/. Broccoli sprout extract induces detoxification-related gene expression and attenuates acute liver injury, www. ncbi.nlm.nih.gov/pmc/articles/PMC4572790/. What Are Adaptogenic Mushrooms? Benefits, Risks, and Types, www.healthline.com/nutrition/adaptogenicmushrooms#types-potential-benefits. An acute, double-blind, placebo-controlled cross-over study of 320 mg and 640 mg doses of Bacopa monnieri (CDRI 08) on multitasking stress reactivity and mood, https://pubmed.ncbi.nlm.nih.gov/23788517/. Omega’s, www.petmd.com/dog/nutrition/whats-vet-recommended-diet-canine-cushings-disease. Treatment Option Considerations for Hyperadrenocorticism in Dogs, https://vetmedsp.tennessee.edu/vmc/dls/ Endocrinology/Documents/Treatment%20Considerations.pdf. Pharmacological and Therapeutic Potential of Myristicin: A Literature Review, www.ncbi.nlm.nih.gov/pmc/ articles/PMC8512857/. Xie H. Preast V. Xie’s Veterinary Acupuncture Ch.9 p. 304. Marsden, S. Essential Guide to Chinese Herbal Formulas.

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industry innovations

Get them off on the right paw For young dogs and cats, the early days are a critical time for development. Help your patients build lifelong wellness, starting with the Puppy Pack and Kitten Kit from Standard Process®. They’re effective ways to distinguish your client offerings, improve satisfaction, and help pet parents support the newest members of their families. Each contains two veterinariandeveloped Standard Process nutritional supplements, and a free gift for pet parents. www.standardprocess.com

New treatment for your canine patients Approximately 25% of all dogs in the US are spayed or neutered. While these procedures help with population control, they can also have detrimental health effects. Dogosterone™ Therapy is safe and effective, and can improve the quality of life and longevity of spayed and neutered dogs via veterinary-administered treatments using testosterone injections. Learn how to provide this therapy to your canine patients by taking the online course, which includes two hours of video instruction, phone support and downloadable materials. The course is AAVSB RACE approved for 1.25 CEUs. www.dogosterone.com

95% Success Rate With No Side Effects Over 200 Dogs Treated

Simplify GI diagnostics Gastrointestinal issues can be challenging to diagnose. Veterinary Diagnostics Institute (VDI) streamlines the process by combining a unique array of tests that help pinpoint the exact problem using a single blood panel. VDI’s Advanced GI Panel entails a simple blood draw, so it’s non-invasive, cost-efficient, and effective for initial workup and therapeutic monitoring. VDI’s GI Lymphoma Panel integrates multiple tests and provides diagnostic insight into lymphoma vs IBD vs food-related issues; pancreatitis; protein losing enteropathy; nutritional deficiencies; malabsorption and SIBO. https://vdilab.com/VDI Labs

Your source for infusion pumps Infusion pumps are vital to both human and veterinary medicine. IPR is a nationally trusted depot for infusion pumps. They work on over 100 different models and have over 1,000 syringe and IV pumps in stock, including a newly-released brand that allows them to specify settings and calibrate for their customers’ use, including veterinarians. Additional features include touchscreens, lightweight/ portable capabilities, and a two-year warranty. Servicing clinics, hospitals and more, the company troubleshoots everything down to the component level of the mainboards. Get 10% off during October by using code IVIPR. https://infusionpumprepair.com/ IVC Fall 2022

newsflash

CAN PETS GET MONKEYPOX? A recent case involving a dog indicates they can. Here’s what one expert advises. You may have heard the news that an Italian Greyhound in France contracted monkeypox from its owners, showing that the virus can jump from people to pets. Dr. Scott Weese, the chief of infection control at the Ontario Veterinary College, and director of the University of Guelph’s Centre for Public Health and Zoonoses, says that while this is cause for concern, it’s not a reason for panic.

a mask isn’t a bad idea. Hand hygiene is vital, especially before touching the animal or handling his food or water bowls.

In his blog, Worms and Germs, Dr. Weese explains that information about monkeypox should be treated the same as COVID-19, and that it’s important “to assume that a virus can infect a range of species until we know that it can’t.” At the present time, it’s not known whether dogs can transmit monkeypox to other animals, or to humans.

• An infected pet should not be exposed to others. Grooming appointments should be postponed, as should veterinary appointments (unless it’s an emergency). Dogs can be walked as long as they aren’t going to come into contact with other dogs.

While there’s still much we need to learn about monkeypox in pets, Dr. Weese provides some guidelines on what to do in the event a monkeypox infection occurs in a household with pets. • While some advise removing the pet from the household, this raises the risk of a potentiallyinfected animal spreading the virus to other households or facilities. Dr. Weese recommends keeping the pet at home, if possible, and using isolation methods to prevent transmission; or at the very least, limiting contact between the pet and any infected individuals.

• Make sure the house has good ventilation. A HEPA filter running in the room/s being used by the infected person is helpful.

• A person with monkeypox can remain infectious for up to 21 days. Potentially-exposed pets should ideally be kept away from veterinary offices, grooming salons and off-leash areas for another 21 days after that. • Dr. Weese acknowledges that not all owners will be happy about isolating their pets from the human household, as this is stressful for both the animals and the people who rely on them for companionship and comfort. However, he emphasizes that following some of the guidelines above is better than doing nothing. www.wormsandgermsblog.com

• Monkeypox skin lesions should be covered, when possible, and the pet not allowed to have any direct contact with them. While the jury is still out on whether or not monkeypox can be transmitted via aerosol droplets as well as direct contact, wearing

IVC Fall 2022

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.

DID YOU GUESS LAST ISSUE’S MEDICINAL HERB? Coltsfoot (Tussilago farfara) is a common weedy plant that grows in ditches and by streams and roadsides. The dandelion-like flower appears early in the spring, with the leaves maturing after the flower has bloomed. Both the early leaves and flowers are used medicinally. Coltsfoot has a long history of use as a medicine in Europe, Russia, and China. In medieval France, a Coltsfoot leaf painted on a door was the “sign” of an herbalist. The tea is used for irritation of the upper respiratory tract with a ticklish cough, as an expectorant and antitussive for chronic coughs, hemoptysis, and bronchial spasms. Coltsfoot is also occasionally used for inflammation of the GI tract, urethra, bladder, or urinary passages, as it will help soothe the tissue and relieve irritation. A poultice of the fresh leaves has been used for bruises, boils, and rashes.

CASE REPORT Handsome, a 15-year-old Arabian gelding, developed a ticklish cough in the early spring that was presumed to be from a load of dusty hay. Coltsfoot was growing in his pasture, and he was seen seeking out this spring herb and eating it greedily. Once he started self-medicating with coltsfoot, Handsome’s cough disappeared. Interestingly, once the dusty hay was eliminated, he stopped eating the coltsfoot.

Participants at Matthew Wood's Seminar in Catskill Mountains

Our Alaskan ecotour ran August 4 to 10 at Twin Bear campground, north of Fairbanks, Alaska, with a wide diversity of activities and lecturers. Are Thoresen, DVM, the main speaker, is a unique practitioner using many principles of anthroposophical medicine. The event also included a geothermal tour, and some time in the hot springs. Kathleen Hildebrand Meckel, a native who teaches at Fairbanks University, spent two days with us, teaching us about the local herbs and their medicinal and native uses. Finally, we enjoyed a tour of the Muskox center at the University of Fairbanks.

COMING EVENTS The VBMA had a speaker track at the AHVMA conference from September 10 to 13. Featured was Renee Prince, RH (AHG), a clinician, educator and ecologist, for five hours of lectures on skin topics, intestinal and blood parasites, formulations, and flower essences. An herb walk took place in the late afternoon of September 8, as a nice pre-conference get-together. Submitted by Cynthia Lankenau, DVM

GUESS THIS HERB!

RECENT EVENTS Matthew Wood, RH (AHG), recently led an amazing seminar at a small Buddhist retreat in the Catskill Mountains. He spoke on many of our current health problems, including autoimmune diseases, Lyme disease, and cancer, in his 3½ days lecturing on Animal Medicine. The entire seminar was videoed and is available for purchase through the NY CAVMA (www.nycavma.org).

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

IVC Fall 2022

Homeopathy BY TODD COONEY, DVM, CVH

FOR HYPERTHYROID CATS

Unknown before the 1970s, hyperthyroidism is now a common ailment in cats. Homeopathy is an effective alternative to conventional treatments.

Hyperthyroidism is the most commonly diagnosed endocrine disorder of cats, mostly in those over eight years old. Also called thyrotoxicosis, it was first reported in 1979, and not recognized as a clinical entity before that time. In fact, hyperthyroidism was totally unknown in the 1960s, although it is now one of the most common ailments in older cats. The condition is usually due to a benign tumor of the thyroid gland (adenoma), and is rarely a malignant carcinoma. Vaccines and toxins are potential causes/ triggers. Vaccines produce immune dysfunction or confusion, with tumor growth as a possible outcome, while toxins such as mercury in the food chain, as well as fire retardant chemicals, are known to affect the thyroid gland.

SYMPTOMS OF HYPERTHYROIDISM

THE THYROID GLAND

Early in the disease process, the thyroid hormone level may be normal, and an enlarged thyroid gland may not yet be palpable. It’s usually the increased appetite, weight loss, and increased energy or hyperactivity that make us suspect hyperthyroidism.

The thyroid is a butterfly-shaped, bilobed gland situated behind the trachea at variable distances from the larynx. It produces thyroid hormone, a major regulatory hormone involved in metabolism.

IVC Fall 2022

Hyperthyroid cats tend to be thin and losing weight, despite a ravenous appetite. Many times, people notice their cats seem to have “kitten-like” energy again, something they haven’t seen for years. As the disease progresses, the cat’s appetite can vary, and vomiting and/or diarrhea may occur, similar to irritable bowel syndrome (IBS). The cat may seem jittery and hyperactive, with a rapid heart rate often over 180 beats per minute, along with increased thirst and urination. Panting and fever can appear in some cats.

WHY CATS AND NOT DOGS?

DIET AND SUPPLEMENTS

Hyperthyroidism rarely occurs in dogs. In fact, the most common problem in canines is the opposite condition — hypothyroidism, which is mostly due to autoimmune thyroiditis. In cats, the thyroid gland produces excess hormone. It appears to be an immune-mediated disorder (think vaccinosis), resulting in a benign productive thyroid tumor, which is often unilateral. It is most common in mature cats.

Good food is a key aspect in dealing with any chronic disease, as are minimal vaccines. (All vets should heed the advice of drug inserts included with each container of vaccine, stating “only use in healthy animals.” This statement alone disqualifies many animals from ever getting another vaccine!)

No one is really sure why cats are more prone to hyperthyroidism and dogs to low thyroid function, but from a homeopathic perspective, it probably comes down to susceptibility and miasmatic disease patterns.

• A fresh, minimally processed diet is ideal.

In one study of 270 senior cats (over eight years old), the most common health complaints were kidney disease, hyperthyroidism, arthritis, and overgrooming. Interesting note — all these problems can be attributed to immune dysfunction (vaccinosis again!). In this study group, the majority of cats responded to homeopathic treatment, with almost 67% of the hyperthyroid cats showing positive responses to various remedies.

• Enzymes added to the food are helpful. • Kelp and seaweed tend to normalize thyroid function. • V egetables in the Brassica family help slow thyroid function (broccoli, cabbage, cauliflower, Brussels sprouts, kale, turnips). These are also available in dehydrated capsule form to mix with food.

TREATMENT OPTIONS In any discussion of hyperthyroid treatment for cats, conventional options are usually presented: medicine (methimazole), surgery (thyroidectomy), or radioactive Iodine treatment (I-131). •

Methimazole blocks the production of thyroid hormone, with common side effects in most cats, so is not a desirable option in my opinion.

•

Surgery can be an excellent option, in my experience. The disease is often unilateral, so partial thyroidectomy can be followed with homeopathic treatment to address the underlying imbalance. The surgery is minimally invasive, quickly performed with practice, and fairly atraumatic to the cat. I’ve performed many of these surgeries with good outcomes on cats as old as 19 years. So age is not always a limiting factor in determining the surgical risk for these cats.

•

I-131 is very expensive, and the cat becomes temporarily radioactive and must be quarantined for seven to ten days in a radiation-approved facility (stressful for both the cat and the client).

IVC Fall 2022

As with any other type of therapy, each individual must consider the pros and cons. Some have great success and satisfaction with medical and radioactive iodine treatments. But as an integrative practitioner, I urge you to consider alternative options to treat this disorder — especially homeopathy, my favorite.

HOMEOPATHY FOR HYPERTHYROIDISM Homeopathy can help restore health in a gentle way, and the literature offers many suggested remedies. Hyperthyroidism is a complex chronic disease, and an experienced homeopathic veterinarian should be consulted for guidance. Different authors and practitioners list various remedies as being helpful.

CASE EXAMPLE Dr. Don Hamilton gives this case example in his book, Homeopathy for Dogs & Cats: Sheba was a nine-year-old female Siamese mixed cat. One week after receiving vaccine boosters at her regular vet, she stopped eating and developed a rapid heart rate. The vet suspected hyperthyroidism, but Sheba’s bloodwork was normal. Dr Hamilton gave her one dose of Thuja (a key vaccinosis remedy), which reversed her appetite and heartbeat problems. In fact, her health was better than before she became ill. learly the vaccines were a factor here, C though it is not always so obvious. The damage often appears long after the vaccine.

Dr. Richard Pitcairn lists the following in his well-known book, Dr. Pitcairn’s Complete Guide to Natural Health for Dogs & Cats. With each of the following remedies, he recommends trying one dose and waiting a month.

Iodium 30c (or higher) — cats needing this remedy have big appetites, but still lose weight and become very thin. They tend to be hypersensitive or restless. Chronic diarrhea and/or kidney disease often occur at the same time.

Lycopodium 30c (or higher) — these cats are not big eaters, and seem to eat small amounts at a time, or hover over the food dish as if thinking about eating. There is a tendency to cystitis, with crystals, sand or stones forming in the urine. Most tend to be thin with a dry coat that stands up, and they seek warmth. They’re weaker in the morning.

Phosphorus 30c (or higher) — cats needing this remedy tend to be thin and anxious, but become more mellow as they get sicker. They sleep more, and don’t seem as interested in their surroundings as before. They tend to vomit easily, often five to ten minutes after eating or drinking. They’re usually more sensitive to noise or movement, sometimes becoming hard of hearing or deaf as they age.

British homeopathic vets Peter Gregory and John Saxton list the following remedies in their book Textbook of Veterinary Homeopathy. They typically recommend 30c or 200c twice weekly with most remedies.

Spongia — useful for a combination of respiratory symptoms and glandular swellings (thyroid).

Natrum phos (sodium phosphate) — falls between the two extremes of Natrum muriaticum (emotionally closed) and Phosphorus (affection/closeness). Could be helpful in some cats showing these mental/ emotional signs.

Iodium (again) — the cat tends to be heat intolerant, worse in damp conditions, and is active and on the go. May be anxious. Marked emaciation with good/ ravenous appetite is evident, as are muscle weakness and poor coat quality.

Natrum muriaticum — weight loss is an aspect of this remedy picture, with increased thirst, urination, and an emotionally closed personality.

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3 4 5

Dr. Peter Dobias reported positive results in eight of 13 cats using single doses of Natrum muriaticum 200c, so this is a very good potential remedy (Homeopathy 2011; 100(04): 270-274).

Dr. Sara Fox Chapman reported symptom resolution in four out of four cats using individual homeopathic remedy prescribing. The nosode Thyroidinum helped one of the four cats.

Other remedies used successfully for feline hyperthyroidism include:

Silicea 30c (or higher) – this remedy is listed under “External throat; goiter” in Kent’s repertory (“goiter” being the older term for “enlarged thyroid gland”). Calcarea carbonica and Spongia are also listed in higher grade under this rubric.

Lachesis — helpful in cases of left-sided thyroid enlargement.

Any of these remedies could be tried, based on the symptom totality. Give the cat a single dose and wait at least a month to gauge the response, before switching remedies.

CONCLUSION Hyperthyroidism is a relatively recent disease of cats — not just previously misdiagnosed, but nonexistent prior to the 1970s. It is a dangerous illness, and hard to treat. Conventional treatment options are potentially harmful, often with long-term repercussions. Homeopathy is a better alternative to conventional treatment. To learn more, find a homeopathic veterinarian at www.theAVH.org.

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.

ENDOCRINE PROBLEMS AND HOMEOPATHY The endocrine system consists mainly of the pituitary, thyroid, pancreas, adrenals, and gonads (testes, ovaries). It is the system most closely linked to homeostatic functions, and the primary way the vital force manifests itself. Endocrine organs control most functions of the body. Weakness/deficiency or function failure are key features induced by toxins, the influence of which is often a major factor in endocrine malfunctions. The extra burden that toxins place on the body is thought to be the most important cause of chronic disease in pets today. Immune dysfunction can be a direct result of these toxins, or can be related to vaccination (a potent cause of autoimmunity). Effects of endocrine imbalance are widespread in the body, but polycrest remedies (homeopathic remedies with many uses) tend to be very useful in treating these conditions. Many endocrine disorders are helped by the correct constitutional remedy, and the major polycrest remedies can be part of this approach: •C alcarea carbonica has many similarities to hypothyroidism, and can be useful in dogs with this disorder. • I odium has strong connections to the thyroid gland, and cases of deficient or excess thyroid function may benefit. • N atrum muriaticum is often useful for feline hyperthyroidism, a condition involving a productive thyroid tumor. • S epia can be helpful for conditions following the neutering of mature animals of either sex, if general lethargy and weight gain are part of the picture. •E ndocrine diseases are complex, but many animals can benefit from good nutritional support and correct homeopathic prescribing, resulting in partial or complete restoration of health.

Submitted by Todd Cooney, DVM, CVH

IVC Fall 2022

newsworthy

More Pets, Fewer Vets

A recently-released report shows that while more households have pets than ever before, the shortage of small animal veterinarians is growing. Did you know that more than half the global population has pets? The US alone is home to around 150 million pet dogs and cats, according to the Global State of Pet Care report, published by HealthforAnimals, a non-profit animal health association. Yet there is a growing shortage of small animal veterinarians in an already overstretched workforce. Here are some highlights from the report: • T he life expectancy of pets is increasing by up to 230%. Between 2002 and 2016, the average life expectancy of US-owned dogs went from 10.5 years to 11.8 years — an increase of 11.4%. One estimate found that the life expectancy of dogs has doubled in the last 40 years.

• Innovation is needed to deal with the problem, and how veterinarians deliver care for their patients is rapidly changing. — Artificial intelligence and machine learning are powering tools that help veterinarians deliver increasingly rapid and accurate diagnoses, and allow for earlier treatment, offering a greater chance of success and lower impact on animal welfare. — “Big data” tools can leverage the accumulated diagnostic profiles of countless animals to pinpoint new risk factors for illnesses like cancer, and facilitate better preventative action.

• Over 100,000 veterinarians are practicing in the US. Given the actual number of pets in the country, this works out to 0.79 veterinarians per 1,000 pets. In addition, the US is facing an estimated shortfall of 15,000 veterinarians by 2030.

— A s pet populations age, they’re facing new challenges, but new technologies and treatments can help veterinarians and pet owners adapt. For example, cutting-edge gene therapy treatments could allow vets to address cancers that are common in older pets.

• R ates of burnout among veterinary professionals increased substantially from 2020 and 2021, thanks to the COVID-19 pandemic and the subsequent pet adoption boom.

To read the entire report, visit: www.healthforanimals.org/reports/pet-care-report/global-trends-inthe-pet-population/.

IVC Fall 2022