V2I4 (Fall 2012) by Redstone Media Group

Integrative PEER REVIEWED

VETERINARY CARE

BENEFITS OF PARTIAL SPAY

HOW SPARING THE OVARIES CAN MINIMIZE CANCER RISK AND OTHER HEALTH ISSUES. Page 16

CHRONIC KIDNEY DISEASE Proper diagnosis and monitoring are important keys to successful treatment.

FALL ISSUE 2012

www.IVCJournal.com

COGNITIVE DISORDER SAMe and choline...two wellstudied therapies for this common geriatric condition.

HERB-DRUG INTERACTIONS How concerned should you be when combining medications and herbal remedies?

GMO PET FOODS Find out how your patients are at risk from genetically modified ingredients.

EQUINE ULCERS Stress reduction and medicinal mushrooms work together to soothe horses’ stomachs.

WHAT’ S NEW • Unlocking the mystery of

Salmonella • Laser therapy symposium • New animal bioscience degree integrative veterinary care

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Integrative VETERINARY CARE

FALL 2012

editorial dePartment

adVertising sales National Sales Manager: Ann Beacom (866) 764-1212 ext. 222 annbeacom@redstonemediagroup.com

Editor-in-Chief: Dana Cox Managing Editor: Ann Brightman Graphic Designer: Dawn Cumby-Dallin Graphic Designer: Kathleen Atkinson Cover Photography: Parsemus Foundation

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colUmnists & contriBUting writers

W. Jean Dodds, DVM Daniel Estep, PhD, CAAB Michael W. Fox, D.Sc, PhD, B. Vet Med, MRCVS Jenna Hahn Suzanne Hetts, PhD, CAAB, CVJ Elaine Lissner Heidi Lobprise, DVM, DAVDC Julie Mayer, DVM, CVA, CVC, CCRP Erin Mayo, DVM Shawn Messonnier, DVM Lucy Postins Deirdre Putman Jochen Schleese, CMS, CEE, CSE Lea Stogdale, DVM, Diplomate ACVIM Small Animals Greg Tilford, Herbalist

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IVC Journal (ISSN 1710-1190) is published four times a year by Redstone Media Group Inc. Publications Mail Agreement #40884047. Entire contents copyright© 2012. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: October 2012.

IMPROVING THE LIVES OF ANIMALS... ONE READER AT A TIME.

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contents FeAtures

ASSESSING AND MONITORING CKD

Because the causes of chronic kidney disease are largely unknown, proper diagnosis and monitoring are keys to controlling this increasingly common condition.

THE PROS OF PARTIAL SPAY

Spay operations that spare the ovaries minimize the cancer risks and other health impacts associated with large breed dogs that undergo the full procedure.

COGNITIVE DISORDER

SAMe and choline are two well-studied therapies that can help treat this common condition in geriatric dogs and cats.

44 48

Integrative Practice HERB-DRUG INTERACTIONS

How concerned should you be when combining medications and herbal remedies?

Case study GETTING GEORGE GOING

How rehabilitation helped a senior cat with chronic lumbosacral disk disease and renal failure regain his mobility and quality of life.

RETHINKING EQUINE VACCINATIONS–PART 2

56 4

integrative veterinary care

Are you giving your patients too many vaccines? As more clients and veterinarians express concerns about the dangers of over-vaccination, it’s a good idea to review your own practice’s protocol.

EQUINE ULCERS

Stress reduction and medicinal mushrooms can work together to treat and prevent this common health issue.

Nutrition nook GMO PET FOODS

Dogs and cats are at risk from genetically modiﬁed ingredients.

THE LATEST ON SEPARATION ANXIETY

Our understanding of what causes this common problem is changing, although behavior modiﬁcation and medication remain the best approaches to treatment.

Tech talk SCRUBS THAT MAKE A STATEMENT

Colorful uniforms with animal-themed designs are more than just a fashion trend. They help put clients at ease and subsequently enhance patient care.

IMMUNOTONIC HERBS

Virtually anyone who delves into the world of natural medicine will quickly learn that “immunotonics”, “immune boosters” or “immune modulators” are the most pervasive terms in the natural supplements industry. They’re also among the most important tools in the holistic practitioner’s tool chest.

advisory board coLuMns & dePArtMents

5 Advisory board 6 What’ s new? 27 Spotlight 33 Industry Innovations 55 Veterinary resource guide

dr. richard Palmquist, DVM, graduated from Colorado State University in 1983. He is chief of integrative health services at Centinela Animal Hospital in Inglewood, California, 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 co-director of the AHVMA 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 co-owner of The Healing Oasis Veterinary Hospital, offering massage, rehabilitation, chiropractic and Chinese and Western Herbology. Michelle completed the Chinese Herbal Medicine program from the China Beijing International Acupuncture Training Center, and is certified in Chinese Medicine by the Wisconsin Institute of Chinese Herbology.

61 Marketplace 62 Events

dr. Joyce harman, DVM, MRCVS, graduated in 1984 from Virginia Maryland Regional College of Veterinary Medicine. She is certified in veterinary acupuncture and chiropractic and has completed advanced training in homeopathy and herbal medicine. Her practice in Virginia uses holistic medicine to treat horses. Her publications include The Horse’s Pain-Free Back and Saddle-Fit Book – the most complete source of information about English saddles.

dr. steve marsden, DVM, ND, lectures for the IVAS, the AHVMA and the AVMA, and is co-founder of the College of Integrative Veterinary Therapies. He is a director of the National College of Natural Medicine, and authored the Manual of Natural Veterinary Medicine. Dr. Marsden is extensively trained in alternative medicine, including Chinese herbology, acupuncture and naturopathic medicine. He has a veterinary and naturopathic practice in Edmonton, Alberta. In 2010, Dr. Marsden was named Teacher of the Year by the AHVMA.

dr. Jean dodds, DVM, received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she moved to Southern California to establish Hemopet, the first non-profit national blood bank program for animals. Dr. Dodds has been a member of many national and international committees on hematology, animal models of human disease, veterinary medicine, and laboratory animal science. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1994.

dr. christina chambreau, DVM, 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. Dr. Chambreau teaches classes in homeopathy for animals, and lectures on many topics. She is co-author of the Homeopathic Repertory: A Tutorial.

Bill Bookout is a founding member of the NASC, serving as president and chairman of the board since 2002. He is founder and president of Genesis Ltd., a company that provides feed and health products for animals. He spent 15 years in the human medical device, drug and animal health industries. Bill received his Bachelor’s degree in physical sciences from the University of Wyoming, and an MBA from Pepperdine University. He has been selected by Health Canada to serve on the Expert Advisory Committee for Veterinary Natural Health Products.

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what’s new Vet swims for charity Veterinarian and athlete extraordinaire Brittany King (right) successfully conquered the English Channel on September 4 to raise funds for two charities that help fund veterinary care. The experienced marathoner and long distance swimmer, who works at Banfield Pet Hospital in Cypress, TX, was motivated chiefly by her love for the animals she sees every day, and for the vital work being done by Pet Peace of Mind and HOPE funds, which provide financial support for those facing veterinary emergencies. She tells the story of a young dog that had broken both his femurs after being hit by a car. Surgery would have cost $1,600, but the charities, both part of the Banfield Charitable Trust, provided funds so the operation could be performed. “She recovered and came back to see me after a month of rehab,” Brittany recalls. “She came running to the back of the clinic on all four legs, as happy as can be.” In addition to completing the “Everest of Swimming”, King, who graduated from Grenada’s St George’s University School of Veterinary Medicine in 2010, has completed an Ironman triathlon and scaled Mount Kilimanjaro.

Of all the household items that might be toxic to dogs, the lowly penny may be something you haven’t considered. According to the ASPCA Poison Control Center, however, American pennies minted after 1981 contain significant quantities of zinc. When ingested, excess zinc is absorbed through the gastrointestinal tract, and causes red blood cells to break apart. The result is anemia. Affected dogs will experience lethargy, vomiting and diarrhea, wine-colored urine and yellowing of the skin and gums.

Unlocking the mystery of Salmonella Scientists at Texas A&M College of Veterinary Medicine & Biomedical Science, working with researchers from the Swedish National Veterinary Institute and the Swedish University of Agricultural Sciences, have examined the intermittent pattern in which pigs shed Salmonella bacteria in their feces. They discovered that Salmonella may lie dormant in the host at an undetectable level as a survival strategy that prolongs the host’s infection. Furthermore, different Salmonella serotypes are shed and go dormant in different frequencies, making detection difficult at best. This “off and on” pattern of pathogen excretion can lead to a host being misdiagnosed as clear of bacteria when it is still infected. In the “on stage”, the host sheds the bacteria in fecal material, while in the “off stage”, the pathogen is still present in the host, but not shed. Therefore, the leading method of detecting infection – fecal shedding – becomes difficult. This study, funded by the National Science Foundation, will become a model for future studies aimed at furthering the detection capabilities and effective control for Salmonella and similar infectious agents in their animal and human host populations. Future research will investigate if the same association between this cyclic behavior and length of infection holds true in other hostpathogen models.

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Image courtesy of Veterinary Pathobiology Department at Texas A&M’s College of Veterinary Medicine and Biomedical Sciences.

Pinching pennies

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Beneficial PartnershiP Photo courtesy of MU News Bureau.

MU students will spay and neuter animals from the Humane Society, gaining valuable surgical experience. “By fixing these animals before they are put up for adoption, it gives them a better chance to actually be adopted,” says Matthew Prator, a clinical instructor of shelter medicine in the MU College of Veterinary Medicine. “Students also will be providing the animals with immunizations to protect them from common diseases.”

A University of Missouri veterinary student examines a shelter animal before surgery. The University of Missouri College of Veterinary Medicine and the Central Missouri Humane Society have begun a program that will give veterinary students hands-on surgical experience with cats and dogs from the Humane Society, allowing animals to receive surgical care free of charge at an MU facility.

soBering statistics

“The program is extremely beneficial for the community,” adds Colin LaVaute, Shelter Relations Coordinator for the Central Missouri Humane Society. “When animals are sent to the Vet School, it frees up our schedule for low cost spays and neuters, and allows us to perform more of these services for those in Columbia that need it the most.” Currently, MU is only working with the Central Missouri Humane Society, but university officials are looking to expand the program to more rural areas throughout Missouri. munews.missouri.edu

Veterinary Professor receiVes fUlBright award S. Mark Tompkins, a University of Georgia associate professor who has been on faculty in the College of Veterinary Medicine’s department of infectious diseases since 2005, has won a Fulbright Award.

It seems the incidence of certain chronic diseases in cats and dogs has risen dramatically during the last five years, according to Banfield Pet Hospital’s State of Pet Health 2012 Report. Here are some key findings: • In the past ﬁve years, obesity has increased 37% in dogs and 90% in cats. • 76% of dog owners and 69% of cat owners believe their pet is just the right weight. • Kidney disease is seven times as common in cats as it is in dogs. • Arthritis has increased dramatically in the past ﬁve years – 38% in dogs and 67% in cats. • 68% of dog owners and 73% of cat owners are not aware that weight gain and arthritis are linked. For the full report, visit stateofpethealth.com

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Tompkins (right) focuses his research on understanding the immune response to respiratory virus infection and developing novel vaccines and treatments for use against human and zoonotic diseases. He will serve six months in Geelong, Australia, where he will work with the Australian Animal Health Labs, a division of the Commonwealth Scientific and Industrial Research Organization, Australia’s national science agency. Specifically, he will focus on collaborative developments of therapeutic drugs for Hendra and Nipah viruses. “This work will not only expand my infectious disease and antiviral drug discovery expertise for the work that is being done in our UGA labs, but will also provide concrete advances in drug development for emerging infectious diseases for which there are no effective treatments or vaccines,” says Tompkins. fulbright.state.gov

new animal Bioscience degree

“Students enrolled in the new animal bioscience degree will have more opportunity to study companion animals, animal behavior, animal and environmental interactions, nutrition, genetics, physiology, toxicology, and health with much less focus on food-animal production offered under the existing program,” says Andrew Van Kessel, department head of Animal and Poultry Science. agbio.usask.ca

Photo courtesy of University of Saskatchewan.

Starting in the fall of 2013, the University of Saskatchewan College of Agriculture and Bioresources in Saskatoon will be offering a degree in animal bioscience (BSc). The new degree program has been Professor Lynn Weber with canine designed to attract students friend Linus. interested in domestic animals, in completing veterinary medicine entrance requirements, or in pursuing careers in a broad range of fields in which knowledge of domestic animal biology is a major asset.

$8 million and coUnting Since 1995, the AKC Canine Health Foundation (CHF) has funded nearly $8.3 million in canine cancer research. This research has provided breakthroughs in treatment options and diagnosis and has helped scientists study cancer at the cellular level, allowing veterinarians to diagnose cancer earlier and treat it more effectively. CHFfunded research has a broad impact, extending beyond dogs to applications in human cancer diagnosis and treatment. Current cancer research projects include “Growth Signaling Pathways in the Pathogenesis and Treatment of Canine Cancer” (University of Wisconsin); “Heritable and Sporadic Genetic Lesions in Canine Osteosarcoma” (University of Minnesota); and “Evaluation of Neutrophil Function in Treated Tumor-Bearing Dogs” (University of Tennessee). akcchf.org/research/funded-research

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Therapeutic Horsemanship Virbac Animal Health has announced the winner of the SCE (Society for Comparative Endocrinology) Resident SOLOXINE Abstract Award. Emily Skovira (left) from Auburn University was chosen for her abstract “The Effect of Surgery on the Pituitary-Adrenal Axis in Dogs”.

“Laparotomy stimulates adrenocortical secretion of cortisol and aldosterone in dogs,” states Ms. Skovira. “In the majority of dogs, pituitary secretion of ACTH rises, but not in all. The lack of correlation between cortisol and ACTH concentrations post-operatively suggest the possibility that ACTH-independent mechanisms are responsible for the increase in post-operative cortisol values, or that an early increase in ACTH caused a sustained release of cortisol. The same mechanism may be at play, however, in causing increases in both cortisol and aldosterone secretion. Further studies are indicated to evaluate the effects of various anesthetic protocols and minimally invasive surgical techniques on the stress response.” The SCE Resident SOLOXINE Abstract Award is based on specific criteria from a distinguished panel of judges compiled of industry experts and academics. Criteria include the clinical relevance of the study, scientific merit, written abstract and the oral presentation of the material.

Laser therapy symposium The American Institute of Medical Laser Applications invites you to attend a Laser Therapy Symposium on November 3 in Lake Buena Vista, Florida. Topics include: • Pushing the Envelope with Laser Therapy • Laser for Pain Management and Physical Rehabilitation in a General Practice • Integrating Laser Therapy with Acupuncture and Eastern Medicine • “Going Wild” with Exotics Applications with the Therapeutic Laser • Integrating Laser Therapy into your General Small Animal Practice • Roundtable Discussion with the Experts Includes seven hours of CE, course notes, continental breakfast and lunch. Course may also be taken online. Register at AIMLA.org or call 937-642-9813.

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Texas A&M University System recently announced the establishment of the Courtney Grimshaw Fowler Equine Therapeutic Program in memory of Courtney Grimshaw Fowler. Made possible through a generous donation from the Grimshaw family, the program will be supported by Texas A&M University, specifically Parson’s Mounted Cavalry, the Texas A&M Department of Animal Sciences, the Corps of Cadets, and with strategic partnerships with the Professional Association of Therapeutic Horsemanship (PATH) and Ride On Center for Kids (R.O.C.K.). The equine therapeutic program will provide teaching experience to Texas A&M undergraduate and graduate students interested in the equine therapy industry and will provide needed assistance to citizens with special needs, including veterans. Grimshaw Fowler, who died in 2010 at age 46, was an internationally ranked dressage competitor, as well as a partner at PricewaterhouseCoopers. “This program embodies so much of Courtney, from her love of horses and their contributions to her wellness, to her desire to help others, said Jim Grimshaw, on behalf of the Grimshaw family.

Photo Courtesy of Professional Association of Therapeutic Horsemanship International.

SCE award

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Assessing and

monitoring

CKD

Because the causes of chronic kidney disease are LARGELY unknown, PROPER diagnosis and monitoring are KEYS to controlling this INCREASINGLY common condition. by dr. LeA stoGdALe, dVM, diPLoMAte AcViM sMALL AniMALs

hronic kidney disease (CKD) is now the most common problem seen in older feline patients. It is less common in dogs, but we are nevertheless seeing it more often as our patients live longer. The causes are unknown, but some possible contributors include excessive vaccination, chronic infections and/or highly concentrated urine. The early signs of CKD are subtle and rarely noticed by owners. They include slow weight loss with a mild increase in drinking and urine volumes as the serum creatinine climbs above 140 mMol/L = 1.5 mg/dL. Veterinary diagnosis is made when accurate body weight decreases and blood tests are done.

Assessing CKD Assessing this disease includes: • Kidney excretion capacity by measuring Glomerular Filtration Rate (GFR) – serum creatinine • Secondary Renal Hyperparathyroidism – serum calcium (Ca) and phosphorus (P) • Kidney potassium (K) tubular loss – Serum K • Erythropoietin production – Packed Cell Volume (PCV) or hematocrit • Renal protein loss – urine protein:creatinine ratio (UPC) • Hypertension – blood pressure (BP)

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•Thyroid function status in cats – T4 The tests required for adequate assessment of renal function:

1 Thorough

history

(owner

observations)

and

physical

examination

2 Body weight and Body Condition Score – cats and dogs under

10 kg = 22 lb need to be weighed on a paediatric/baby/cat scale, not on adult bathroom scales or walk-on dog scales. Reliable human baby scales are available online for less than $70. All patients should be weighed at every vet visit, and the weight recorded in their files.

3 Complete blood count, CBC 4 Serum chemistry, with T4 in the cat 5 Urinalysis including culture and sensitivity (C&S) and UPC 6 Blood pressure Normal urine results: Urine specific gravity > 1.030 in dogs (first morning sample) Urine specific gravity > 1.030 in cats, if they’re eating canned food without water added Urine protein negative

UPC < 0.2 Urine C&S negative Normal BP arterial/systolic < 160 mm Hg. This includes the “white coat” effect but BP should be done first with the owner present and the patient not “freaking out”.

What happened to urea? Serum urea or nitrogen levels are influenced by many factors, making urea an unreliable indicator of kidney function. Some of these factors include: • Amount of protein eaten (important) • Time since eating • Degree of protein digested to amino acids • Proportion of protein absorbed • Level of intestinal bacteria • Liver function (the most important factor) • Protein loss through the skin, intestines and/or urinary tract • Catabolic processes occurring within the body, such as infection or cancer Urea is non-toxic, water soluble and has a neutral pH. It is a poor indicator of GFR. At best it is a minor indicator of seriously decreased liver function.

IRIS staging Thanks to the International Renal Interest Society (IRIS, iris-kidney. com), we now have better diagnostic and staging information. IRIS is composed of leading international veterinary nephrologists, and has made evaluating, interpreting and monitoring CKD much clearer with their evidence-based stages and recommendations.

Stage and clinical signs

Test results

Stage 1 – Asymptomatic

Creatinine < 140 = 1.5 depending on dog muscle mass; other evidence of kidney disease, e.g. ultrasound

Stage 2 – Mild PU/PD Decreased appetite

Creatinine in dogs 125 – 180 = 1.4 – 2.0 depending on size, diet and muscle mass Creatinine in cats 140 – 250 = 1.5 – 2.8 Potassium 3.5 – 5.0 Phosphorus < 2.0 = 6.0

Stage 3 – PU/PD Dehydration Decreased appetite Weight loss Constipation

Creatinine in dogs 180 – 440 = 2.0 – 5.0 depending on size, diet and muscle mass

Stage 4 Depressed Inappetent Vomiting and/or diarrhea

Creatinine > 440 = 5.0

Creatinine in cats 250 – 440 = 2.8 – 5.0 PCV < 20%

Continued on next page.

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Conversion factors between SI and US units Serum test

US unit

Conversion factor

SI unit

Creatinine

mg/dL

88.4

mMol/L

Potassium

mEq/L

mMol/L

Phosphorus

mg/dL

0.323

mMol/L

Continued from previous page.

Case studies

Monitoring CKD The initial diagnosis of CKD is usually made when the dog or cat is losing weight for no apparent reason, and is based on a thorough history and physical examination. With a diagnosis of “weight loss of unknown cause”, pet owners and I elect to investigate further with CBC, chemistry (plus T4 in cats) and urinalysis. Once the diagnosis is made (Dx CKD Stage 2 with no complications – no urinary tract infection, no proteinuria, no other disorders) we discuss nutrition and the importance of maintaining body weight by getting the animal to eat enough food that he likes. My recommendations for ongoing monitoring, as long as the patient is doing well, is to recheck and run selective blood tests every six months. My experience has pushed me to keep CKD patients eating and drinking with potassium levels above 4.5 mMol/L or mg/dL and phosphorus levels below – 2.0 mMol/L = 6.0 mg/dL. This seems to ensure appetite and activity. Our management and therapeutic aims are to maintain quality of life as well as activity and body weight. Below are the blood levels we aim to maintain:

Blood Test

Dogs

Cats

Hematocrit or PCV

> 39%

> 25%

Creatinine

Stable or only slowly increasing

Potassium

4.0 – 5.0 mMol/L or mg/dL

Phosphorus

0.9 – 1.5 mMol/L 2.8 – 4.7 mg/dL

Cats with CKD should be examined by a veterinarian every six months. Ideally, at that time, the following tests should be done: CBC, serum chemistry, T4, UA and BP. Minimal testing involves PCV and kidney panel (and T4 for cats). The kidney panel is available at some commercial laboratories (I only use commercial laboratories for my patients’ blood tests as I want the most accurate results available and they are quality controlled).

The kidney panel is financially advantageous as it includes urea (useless), creatinine, electrolytes (K is so important in cats), calcium and phosphorus. For my feline patients, I add T4. We do a PCV in clinic. The total price of blood collection, courier, lab fee and my interpretation over the phone is one I find owners are comfortable paying every six months. This is in addition to my half-hour consultation fee. Conversely, the price for the ideal of CBC, serum chemistry, T4 in cats, UA and BP is two-and-ahalf times the kidney panel and is cost restrictive for most of my clients every six months.

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The progression of CKD is completely unpredictable. I used to think, based on my experience, that dogs with CKD died within three months and cats within three months to three years. No longer. Either we diagnose CKD much earlier or we enable them to live much longer. I think the latter is the case. Maintaining body weight is the key.

1 Zoe, a 16-year-old medium-sized border collie/Corgi cross was diagnosed with CKD Stage 2 six years ago. She has maintained her weight and active lifestyle on a home-prepared diet. She has not developed even mild anemia although we are struggling to control her serum phosphorus. She is still going strong.

2 Most of my CKD cats live longer than five years but Tuesday was

an exception. She was ten years old when she was first brought to me. She was already in CKD Stage 2 advanced. My therapeutic approach was to “feed her anything she will eat,” use appetite stimulants, and control her low potassium, high phosphorus, constipation, hyperthyroidism and subcutaneous fluids. She lived happily for another 11 years and died at the ripe old age of 21.

3 Hendrix is a 13-year-old tabby cat in CKD Stage 2. He has always eaten enthusiastically and was maintaining his weight until one month ago. The owner had purchased a home baby

Normal blood results (preferably fasting) Serum test

Dogs

Cats

> 39%

> 25%

Creatinine

< 125 mMol/L < 1.4 mg/dL

< 140 mMol/L < 1.5 mg/dL

Potassium

4.0 – 5.0 mMol/L or mg/dL

Phosphorus

1.0 – 2.0 mMol/L 3.0 – 6.0 mg/dL

Hematocrit or PCV

1.0 – 2.0 mMol/L 2.0 – 6.0 mg/dL

scale and weighs Hendrix weekly. (As a practicing veterinarian in the real world of clients who love their pets but often have financial concerns, I encourage owners to monitor their cats’ progress by weighing them once a week on a baby scale. The cat’s weight and appetite, along with the owner’s assessment of how the pet is doing, are pretty reliable as to the status of the animal.) Four weeks ago, still eating very well, Hendrix’s weight started slowly decreasing. A phone call to us resulted in a simple recommendation: blood tests – CBC, serum chemistry, T4. We found the T4 had increased significantly from previous values; we can control hyperthyroidism.

In summary.... The diagnosis and staging of chronic kidney disease (which is relevant to management) requires a thorough history and physical examination, evaluation of the weight loss and body condition score of the patient, CBC, serum chemistry, urinalysis, blood pressure, and T4 in cats. Ideally, ongoing monitoring would involve repeating these tests at sixmonthly checkup examinations (body weight and condition score, history, physical examination, and discussion as to how the patient and owner are coping). However, depending upon veterinary judgement, a kidney panel and PCV (plus T4 in cats) may provide all the relevant information required for therapeutic advice.

Normal creatinine levels in dogs Serum creatinine mainly comes from the muscles (the steady breakdown of creatine phosphate) with a small amount being contributed by meat in food. Hence, it is preferable to collect a fasting sample especially if a dog is being fed a high protein diet. The muscle mass of the dog influences his serum creatinine level. In humans, women have 10% to 20% lower normal serum creatinine levels than do men, due to their lower muscle mass. Very small dogs with little muscle mass have lower normal serum creatinine levels while large athletic dogs, especially greyhounds, have higher normal serum creatinine levels. Dog size

US unit

SI unit

Miniature (0 – 10 kg)

0.45 – 1.0 mg/dL

40 – 90 mmol/L

Medium to large

0.55 – 1.4 mg/dL

50 – 125 mmol/L

Giant and athletic dogs

1.0 – 2.2 mg/dL

80 – 195 mmol/L

(average) (11 – 45 kg) (>45 kg and greyhounds)

Modified from Dr. David Polzin, University of Minnesota.

Dr. Lea Stogdale, DVM, Diplomate ACVIM, graduated from the Faculty of Veterinary Science, University of Melbourne, Australia in 1970. She worked in general practice in Australia and England before teaching veterinary medicine in South Africa and Saskatoon for eight years. Dr. Stogdale passed the veterinary small animal internal medicine specialty board exams in 1981 to become a Diplomate in the American College of Veterinary Internal Medicine. She has worked in emergency and pet practice for 25 years, taking a special interest in diabetes of dogs and cats, complementary medicine and nutrition (aesopsvetcare.wordpress.com).

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by eLAine Lissner

Spay operations that spare the ovaries minimize the cancer risks and other health impacts associated with large breed dogs that undergo the full procedure.

paying has become such a standard practice that many of us don’t give it a second thought. We know it’s absolutely necessary to help stem pet overpopulation. In fact, spaying has been the key factor in reducing the number of euthanized dogs and cats from 23.4 million in 1970 to just under 3 million now. But what if you could offer your clients a way to maintain that progress, while honoring your commitment to do what is best for each patient’s health? Thought leaders are beginning to accept that spay and neuter have both positive and negative health

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consequences that vary by age, gender and breed. In 2007, veterinarian Dr. Margaret Root Kustritz published a review of the pros and cons of spaying and neutering at different ages (“Determining the optimal age for gonadectomy of dogs and cats”, JAVMA). That same year, a review paper entitled “Long-Term Health Risks and Benefits Associated with Spay/Neuter in Dogs” (Sanborn LJ, available online) gathered the data and summarized it in a comprehensible form.

Implications for large breeds

The conclusion? Mounting evidence indicates that in

large dogs at least, the health benefits of keeping the ovaries may outweigh the health risks, which include mammary tumors and infection of the uterus. For example, removing the ovaries of a Rottweiler quadruples her risk of bone cancer – spayed Rottweilers have a frighteningly high one in four risk of osteosarcoma. Spaying also raises her risk of hemangiosarcoma to 10% to 20%. In addition, traditional spay impacts quality of life issues. The loss of ovarian hormones increases the risk of CCL tears, incontinence, and an obsession with food that can lead to weight gain.

...removing the ovaries of a Rottweiler quadruples her risk of bone cancer spayed Rottweilers have a frighteningly high one in four risk of osteosarcoma. As a result, informed pet owners are beginning to question or resist spay surgery. Those adopting breeds known to have greater risk of certain problems after spay may be in this category (for example, boxers nearly always get incontinence,

A video demonstration The Parsemus Foundation has funded a demonstration of ovary-sparing spay by Dr. Michelle Kutzler, a professor of veterinary medicine at Oregon State University and an acknowledged expert and speaker on dog and cat contraceptive advances and reproduction. In the video on the foundation’s website (parsemusfoundation.org), Dr. Kutzler demonstrates ovary-sparing spay in a sixyear-old mastiff who was finished breeding but whose owner was concerned about her increased risk of bone cancer and cruciate ligament rupture from traditional ovariohysterectomy spay. As Dr. Kutzler demonstrates in the video, the cervix must be ligated precisely – one cannot ligate just anywhere on the uterus as is normally done – to prevent the risk of stump pyometra. This fine point is what has kept ovarysparing spay from being considered a widespread option. Dr. Kutzler points out that the solution lies in taking extra care with ligation placement. Her slightly larger incision allows her to visualize the area and take this extra care. integrative veterinary care

Benefits for veterinary practice • Owners with the economic means may wish to have a mammary-gland ultrasound as part of their dogs’ annual exams once the animals reach middle age; veterinarians who are skilled with ultrasound should be pleased at the opportunity to offer this new service using existing equipment. Meanwhile, population goals are also achieved, because a dog will not be fertile without a uterus.

and giant breeds are prone to bone cancers). This is a distressing development for shelters, which fear a renewed increased in the overpopulation and euthanasia rates formerly curtailed by spay/ neuter operations. The Parsemus Foundation, a non-profit that promotes evidencebased medicine and choice for animal health, is proposing that we all think more creatively about individualizing spay operations. In the situations mentioned previously, veterinarians should be prepared to remove the dog’s uterus and leave the ovaries in a procedure that’s sometimes called “partial spay.”

Remove the uterus, leave the ovaries

• The ovary-sparing procedure takes slightly longer than high-volume spay, because the cervix must be cut and tied off precisely and a larger incision must be made to see what one is doing. More suture time is involved. In compensation, veterinarians offering this option will be able to both meet the needs of a highly-informed group of clients, and distinguish their value-added services from highvolume discount spay.

Removing the uterus eliminates the nuisance of bleeding during heats, along with the risk of infection of the uterus (pyometra), as long as all the uterus is removed. However, precise technique is essential. In traditional spay, there is no need to remove every bit of the uterus, since it will no longer be under stimulation by the ovaries. But in partial spay, also known as ovary-sparing spay, the veterinarian must make a large enough incision to pull the uterus up to the surface, see what he/she is doing, and be able to tie off and cut precisely at the cervix rather than just anywhere on the uterus. Otherwise, it is still possible to have an infection develop in the remaining uterine stump (“stump pyometra”). With this technique, the risk of stump pyometra is eliminated. If the whole uterus is removed, mammary tumors are the only significant health risk remaining from a partial spay. Ovarian cancer is rare enough that the ovaries should not be removed just to try to prevent it. Clients who feel their dogs are likely to live longer or stay healthier by retaining their ovaries can then be informed of the pros and cons, and advised to stay alert to the possibility of mammary tumors as their dogs age.

• Currently, only three veterinarians in the United States are offering ovary-sparing spay. This means that those who learn the procedure will likely be able to command a substantial premium, with new clients willing to travel a significant distance to obtain the procedure for their dogs. • The Parsemus Foundation has begun a list on its website of veterinarians performing hysterectomy (ovary-sparing spay) as an alternative to ovariohysterectomy. Veterinarians who learn the technique from the demonstration video (see additional sidebar on page 17 for more info) and decide to add it to their services can contact the foundation to be included on this list.

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training ViDeo for oVary-Sparing Spay, the founDation iS aLSo working to raiSe the LeVeL of eViDenCe on CaLCiuM ChLoriDe nonSurgiCaL MaLe Dog anD Cat SteriLization, So VeterinarianS Can Make an inforMeD DeCiSion on beSt praCtiCeS anD potentiaL riSkS. in

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integrative veterinary care

by sHAWn Messonnier, dVM

SAMe and choline are two WELLSTUDIED therapies that can HELP treat this COMMON condition in GERIATRIC dogs and cats.

ognitive disorder (dog and cat Alzheimer’s) is the most common chronic degenerative neurological disorder affecting older pets. While the exact incidence is not known, it is estimated that 25% to 30% of dogs and cats begin showing signs of cognitive disorder by age 11 and that 50% to 100% show signs by 15 to 16 years of age. Clearly, regardless of the true incidence, most practitioners will diagnose and treat this problem in a large number of their senior patients. This article will review some of the more commonly recommended natural and conventional therapies for cognitive disorder.

Cause is unknown

As with Alzheimer’s disease, the exact cause of cognitive disorder is unknown. As pets age, their brains may receive less oxygen hypoxic due to decreased cardiac (heart) output, anemia, hypertension (high blood pressure) and arteriosclerosis from fibrosis, endothelial proliferation, mineralization, and amyloid deposition. Decreased levels of neurotransmitters including serotonin and choline, increased levels of monoamine oxidase B (MAOB) which causes decreased dopamine levels, and increased free

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radicals (oxidizing chemicals that damage and kill cells through inflammation) may also be seen in geriatric pets. Microscopically, beta amyloid plaques within the brain and its blood vessels are seen in pets with cognitive disorder (as in people with Alzheimer’s). These plaques are a hallmark of the brain damage that occurs in both Alzheimer’s and cognitive disorder. All these biochemical and pathological changes progress as the pet ages if treatment does not occur. Obviously, early treatment is important and may prevent progression of cognitive disorder.

Clinical signs vary

Clinical signs in dogs and cats can vary between pets and the severity of the disease, but are generally often mistaken for “normal signs of aging” or attributed to the pet “acting senile”. In general, clinical signs include the following: * Staring at the wall * Lack of awareness of surroundings * Occasional lack of recognition of the owner

* Lethargy/lack of energy * Excess sleep (especially during the day) * House-training problems (usually urinating inside the house or eliminating outside the litterbox) * Deafness

Diagnosis based on exclusion

There is no specific diagnostic test (other than postmortem brain biopsy) for cognitive disorder. Diagnosis is based upon clinical signs and laboratory testing to exclude other disorders that might cause similar signs (hypo/hyperthyroidism, adrenal disease, etc.).

Alternative therapies

A number of natural therapies have been recommended for treating cognitive disorder in pets, including Omega-3 fatty acids (fish oil), antioxidants (vitamin C and E, resveratrol), herbs (such as ginkgo biloba) and nutritional supplements (including SAMe, phosphatidylserine and phosphatidylcholine). Since it is beyond the scope of this article to have an in-depth discussion of each therapy, I will focus on two that have been well researched.

Designed specifically for geriatric pets, Cholodin® may help with the following symptoms: Disorientation, confusion • Loss of appetite • Increased sleep time

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SAMe (Novifit, Virbac) SAMe is formed in the body (mainly in the liver) through the combination of methionine with adenosyl-triphosphate, and is not supplied in the diet. SAMe functions as a methyl donor in the formation of a variety of compounds (neurotransmitters, proteins, membrane phospholipids, nucleic acids, choline, etc.) and increases levels of serotonin and dopamine metabolites, improves neuron membrane fluidity, and enhances binding of neurotransmitters to receptors.

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Available through your Veterinary Clinic

Levels of SAMe decline sharply after birth and continue to decline as part of the aging process. While generally safe, SAMe contraindications in people include bipolar disorder, migraine headaches, P a r k i n s o n ’s disease, and active bleeding. Co-administration of SAMe and SSRI medications, MAO inhibitors, 5-HTP and TCAs requires caution or avoidance as some integrative veterinary care

Conventional treatment â&#x20AC;&#x201C; Anipryl

At the conclusion of the study (two months following treatment), owners were asked to evaluate improvement in clinical signs: 82% of dogs showed improvement as did 77% of cats.

Conventional medication (Anipryl [selegiline hydrochloride/L-Deprenyl]) is patients may be at risk for a higher incidence of serotonin syndrome available for the treatment of cognitive and/or synergistic CNS depressant effects. disorder in dogs, but the medication is not approved for cats. It works by inhibiting No direct contraindications are noted in pets but prudence suggests monoamine oxidase-B, preventing the similar caution. destruction of the neurotransmitter dopamine. Since cognitive dysfunction may be associated Recently, a SAMe product (Novifit, Virbac) has been introduced to the with dopamine depletion, Anipryl can allow market as a natural treatment for canine and feline cognitive disorder. increased dopamine levels and reduce the signs Studies in dogs (n=14) and cats (n=16) showed improvement in of cognitive disorder. Additionally, the use of Anipryl reversal learning in treated patients when compared with nonalso helps reduce brain free radicals. Studies using Anipryl have shown that after 30 days, 80% of dogs showed improvement in overall cognitive response compared to pretreatment evaluation. Improvements in individual clinical signs were also observed. After 60 days, 77% of dogs showed improvement in overall cognitive response compared to pretreatment evaluation. In general, it can be expected that approximately 75% of treated dogs will show improvement in at least one clinical sign after one to two months of therapy.

treated patients. Reversal learning is a memory test that measures executive function, which is defined as a set of mental processes that help connect past experience with present action, and is needed for goal-directed behavior. Executive function has been shown to be impaired by age. Researchers concluded that the study supported the use of Novifit to help improve cognitive health in aged dogs and cats, with potential benefits on executive function, especially in the early stages of cognitive dysfunction syndrome.

Phosphatidylcholine (Cholodin, MVP Laboratories) Choline is a component of several major phospholipids (including phosphatidylcholine and sphingomyelin) that are critical for normal cell membrane structure and function. The body uses choline to maintain water balance; as a source of methyl-groups (for methionine formation) to control cell growth and gene expression; as a component of surfactant; and to produce acetylcholine. Supplemental choline may increase the production of acetylcholine and reverse clinical signs of cognitive disorder.

There is a 5% incidence of unacceptable side effects with L-Deprenyl treatment. These include vomiting, diarrhea, appetite loss, itchy skin, tremors, drooling, listlessness, disorientation, diminished hearing or restlessness. Additionally, Anipryl should not be used concurrently with other MAO-B inhibitors (amitraz, i.e. Mitaban dips, Preventic tick collars, ProMeris, ďŹ&#x201A;uoxetine, amitriptyline, clomipramine). It should also not be used with phenylpropanolamine, as Choline supplementation is very safe. In pets, rare instances of hypertension may result. In people, dangerous excitability/nervousness have been reported, but lowering the dosage drug interactions have occurred when resolved this side effect. L-Deprenyl was combined with meperidine. Caution is warranted when combining It has been suggested that aging people and pets begin to lose cholinergic Anipryl with narcotic medications. When administering Anipryl, if no improvement is seen after the first month, the dose is doubled for an additional month.

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receptors and have decreased levels of acetylcholine. Since oral choline administration increases plasma choline levels, and since brain levels of acetylcholine increase as plasma choline levels increase, administering choline may improve neurological disorders that result from decreased acetylcholine.

Choline, specifically the patented product Cholodin (MVP Laboratories), has been shown in studies to reverse clinical signs of cognitive disorder. For the dog study, 21 dogs of various breeds ten years of age and older were enrolled. For the cat study, 21 cats ten

years of age and older were also enrolled. Pets were chosen for the study based on owner observation of clinical signs consistent with cognitive disorder that couldn’t be attributed to other illness after physical examination and laboratory testing. At the conclusion of the study (two months following treatment), owners were asked to evaluate improvement in clinical signs: 82% of dogs showed improvement as did 77% of cats. Regardless of the treatment chosen, early diagnosis and intervention is key to minimizing the incidence of cognitive disorder in pets. Regular “senior pet” checkups that include a full physical examination, blood profile, urinalysis, and microscopic fecal analysis, ideally every six to 12 months for pets five years of age and older, will facilitate communication and allow for early diagnosis.

References and suggested reading Araujo JA, Faubert ML, Brooks ML, Landsberg GM, Lobprise H. NOVIFIT® (NoviSAMe®) Tablets Improve Executive Function in Aged Dogs and Cats: Implications for Treatment of Cognitive Dysfunction Syndrome. Intern J Appl Res Vet Med. 2012.Vol 10(1): 90-98. Fetrow CW, Avila J. Professional’s handbook of complementary and alternative medicines, 3rd ed. St. Philadelphia (PA): Lippincott Williams & Wilkins: 2004:730–58. Goldstein, R, ed. Integrating complementary medicine into veterinary practice. St. Louis (MO): Wiley-Blackwell; 2008:541. Hand M, Thatcher C, Remillard R, et al. Small animal clinical nutrition, 5th ed. Topeka (KS): Mark Morris Publishing; 2010:93–94. Landsberg G, Denenberg S, Araujo J. Cognitive Dysfunction in Cats: A syndrome we used to dismiss as “old age”. 2010 J Fel Med Surg. 12: 837-848. Messonnier SP. The natural health bible for dogs & cats: your A-Z guide to over 200 herbs, vitamins, and supplements, Three Rivers Press, NY, 2001:56–57, 233. Messonnier SP. Natural Care for Aging Pets, Today’s Health and Wellness - July/August 2001 (pgs. 20,21). Pizzorno J, Murray M. Textbook of natural medicine, 3rd ed. St. Louis (MO): Churchill Livingstone; 2005:817, 853, 856, 135-1238, 1603, 1654. Pizzorno J, Murray M, Joiner-Bey H. The clinician’s handbook of natural medicine, 2nd ed. St. Louis (MO): Churchill Livingstone; 2008:17, 20, 559–60. Ruehl WW, Hart BL: Canine Cognitive Dysfunction. In Psychopharmacology of Animal Behavior Disorders (Dodman NH, Schuster L, eds.). Boston: Blackwell Scientific, 1998; pp. 283-304. Stargrove M, Treasure J, McKee D. Herb, nutrient, and drug interactions: clinical implications and therapeutic strategies. St. Louis (MO): Mosby Elsevier; 2008:824–1. Wynn S, Marsden S. Manual of natural veterinary medicine: science and tradition. St. Louis (MO): Mosby; 2003:323.

Veterinarian Dr. Shawn Messonnier authored the Natural Health Bible for Dogs and Cats, The Natural Vet’s Guide to Preventing and Treating Cancer in Dogs, and 8 Weeks to a Healthy Dog. He’s the pet care expert for Martha Stewart Living’s “Dr. Shawn – The Natural Vet” on Sirius Satellite Radio, and creator of Dr. Shawn’s Pet Organics. His practice, Paws & Claws Animal Hospital (petcarenaturally.com), is in Plano, Texas.

PART 1 by Lucy Postins

Gluten has become a “red flag” ingredient in the past few years. Wheat, barley, rye and triticale all contain gluten. Oats, amaranth, buckwheat, millet and quinoa are all free of it. Most modern commercial pet foods contain way too many glutenous carbohydrates, poor quality protein, and insufficient moisture. A highly processed, grain-based diet fed to an animal designed to thrive on a meat-based fresh food diet is very likely to produce symptoms of ill health over time. Diets that address disease most frequently deal with the symptoms that result from a lifetime of inappropriate food, rather than the true cause of the symptoms. The optimal diet for a dog or a cat should closely resemble his natural diet. Genetically modified grains are thought to be especially risky for the gluten intolerant. When butterflies come in contact with pollen from genetically modified crops, they suffer a number of health problems, and genetic mutations eventually occur. It is possible that a similar thing happens in pets – whose systems aren’t designed to cope with a grain overload in the first place – and it’s exacerbated when they’re consuming the same food for many years. There are several ways to pinpoint gluten intolerance. Diagnostic blood tests are not always completely accurate – and can be very costly. Elimination diets can be timeconsuming. A newer alternative is the allergen saliva test available from Nutriscan, which provides specific results about food intolerances and sensitivities.

Lucy Postins is the co-founder and CEO of The Honest Kitchen pet food company, which makes dehydrated natural dog and cat food as well as treats and supplements. Lucy has long been interested in the benefits of home cooked and raw food for pets and started researching healthy nutrition for dogs and cats after adopting a Rhodesian ridgeback puppy in 2000. She began formulating pet food products a year later, and launched The Honest Kitchen in 2002. thehonestkitchen.com

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integrative practice

HERB - DRUG

interactions by erin MAyo, dVM

How concerned should you be when combining medications and herbal remedies?

olistic practitioners are often confronted with difficult decisions regarding which treatments to use for complicated cases. It’s not uncommon to manage a pet taking multiple medications, herbal products and supplements – but how concerned should we be about potential interactions between all these substances?

concentrations but inhibit it at higher concentrations. Further problems arise with the lack of consistency in the preparation and quantities of active ingredients in herbal products from different vendors. Thus, the pharmacodynamic effect of any given preparation may be difficult to anticipate.

Unfortunately, the literature can be confusing or even contradictory. This is due to the way adverse interactions are reported. Individual case reports can detail a specific case of suspected interaction. Clinical trials, in which the number of drugs and herbs combined are more closely controlled, may demonstrate adverse interactions. Experimental data and pharmacodynamics studies may also suggest potential interactions, at least theoretically. However, these various sources of information frequently contradict each other and can make it difficult for clinicians to know what is best when treating patients.

Many physicians and scientists are concerned about the effect herbs may have on drug metabolism and serum levels of certain frequently prescribed drugs. Induction of the cytochrome metabolism system may hasten metabolism and decrease a drug’s efficacy, while inhibition may result in high blood levels and toxicity.

Herbal pharmacodynamics Many drugs are metabolized in the liver and intestines via the cytochrome P450 enzyme pathway. Several enzymes are involved, including CYP2C19 and CYP2E1. Herbs and their metabolites are increasingly being discovered to modulate this pathway.1 Some herbs have also been shown to have different effects depending on the dosage. St. John’s wort can induce CYP2C19 at low

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Herbs that have been investigated for their effects on various cytochrome P450 pathway enzymes include Echinacea, garlic, ginkgo, ginseng, St. John’s wort and valerian, all of which have been found to have effects on one or several enzymes.

Garlic (Allium sativum) This is a commonly used herb for hypercholesterolemia and prevention of arteriosclerosis in humans. In animals, it has been recommended as a treatment for cough, respiratory infections and hyperlipidemia and as an adjunct

treatment for cancer for its antitumor and cytotoxic effects. Many physicians recommend caution when taking this herb because of reports that garlic may influence platelet function and blood coagulation. There are also reports of possible interactions with anti-coagulants, especially warfarin. Two trials, however, demonstrated no change in pharmacokinetics or pharmacodynamics when garlic was combined with warfarin, suggesting that adequately monitored patients taking warfarin can safely take garlic.2,3 One case report described a possible interaction with chlorpropamide (sulfonylurea treatment for type 2 diabetes) and garlic in a diabetic patient who ate a curry containing garlic and karela.4 The report documented a decrease in the patient’s blood glucose level after eating the curry, but the hypoglycemic effect may have been the result of the additive effect of the two herbs. Additionally, one report may be insufficient to prove a causal relationship. Garlic’s demonstrated effects on CYP2E1 do warrant caution when using it in combination with drugs metabolized by this enzyme.5 These drugs include theophylline, isoflurane and sevoflurane. Potential interactions with anti-coagulants remain questionable.

Ginkgo ( Ginkgo biloba ) Herbalists commonly prescribe gingko for memory deficits and peripheral vascular disease in people. Indications for animals include treatment for cognitive dysfunction and cardiac disease in which hypercoagulability is a concern. Case reports have previously shown interactions between ginkgo and anticoagulant drugs or those with effects

on platelets (such as aspirin and other NSAIDs).5 The patients experienced bleeding while concurrently taking these drugs and gingko. Recent trials have been unable to confirm these effects when ginkgo was combined with several NSAIDs, thus it is questionable as to whether there is any true risk.5 Ginkgo may interfere with the CYP2C19 dependent pathway, thus altering drug metabolism of CYP2C19 substrates. There is one case report of an epileptic patient who experienced fatal seizures while taking valproic acid and phenytoin as well as several herbal supplements, including ginkgo.6 The patient’s serum concentration was found to be sub-therapeutic for both drugs, and interference of metabolism of the drugs from ginkgo was suspected. Because of this potential alteration of metabolism, care should be taken when combining ginkgo with any CYP2C19 substrate, which includes antidepressants, anticonvulsants (phenobarbital), propranolol and proton pump inhibitors (omeprazole).5

Communication is key How can practitioners ensure safety when prescribing herbal products? The best defense is having open communication with clients. Among human patients, approximately 19% of the population takes herbs or other supplements, but only one-third of these patients disclose this information to their physician.11 Additionally, many over-thecounter pet herbal products contain several herbs, and owners may be inadvertently double-dosing. Having open and honest communication with clients and frequent reviews of all medications, herbs and supplements will help protect patients from potential adverse interactions.

Asian ginseng (Panax ginseng) This is a frequently prescribed herb because it has many indications, including cancer prevention and improved mental and physical performance. Veterinary indications are numerous as well, including immune support, recovery from stress or illness, cancer prevention or adjunct treatment for cancer, and treatment for allergies (allergic skin disease) or brain injury. Ginseng has been shown to inhibit platelet aggregation, though one report demonstrated a patient taking warfarin with ginseng had a lowered international normalized ratio (INR).5 The INR is a measure of coagulation, and in this case, the patient’s lowered number demonstrated interference with antiintegrative veterinary care

Drugs that may be at risk for

interaction Macrolide antibiotics

demonstrate licorice’s ability to alter circulating levels of several steroid precursors, and substantiate the claims that licorice has steroid-augmenting effects. As a result, licorice should be used judiciously with exogenous steroids.

Proton pump inhibitors Selective serotonin reuptake inhibitors Benzodiazepines Drugs that have a narrow therapeutic range, such as warfarin, can be highly sensitive to alterations in metabolism

coagulation. This patient took several drugs concomitantly with ginseng, therefore, causation was not definitive. Further studies have been unable to confirm any interaction with warfarin.5 At this time, caution is warranted when combining ginseng with drugs known to have platelet effects, but there is no evidence that precludes the combination. One report described a patient who co-administered the drug phenelzine (a MAOI class antidepressant) and ginseng.7 This patient experienced insomnia, headache and mania. In this case, causality was established after the patient inadvertently rechallenged herself, resulting in many of the same symptoms. While this may be an isolated case with a patient who has a particular sensitivity, clinicians should still be cautious when considering the combination of MAOIs, specifically phenelzine, with ginseng.

Licorice (Glycyrrhiza glabra) Licorice is a common ingredient in many Chinese herbal formulas and a popular flavoring for candy. Indications for humans include treatment for cough, bronchitis and gastric ulceration. Veterinary uses are very similar. Licorice has also been advocated as a treatment for Addison’s disease or to augment steroid treatment. In many Chinese herbal formulas, it is included as a harmonizing herb. A recent study demonstrated that co-administration of licorice with cortisone acetate in patients with Addison’s disease increased the serum levels of cortisol for several hours.8 Another study demonstrated elevated salivary levels of both dehydroepiandrosterone (DHEA) and deoxycorticosterone in healthy subjects given a confectionary containing licorice for one week.9 These reports

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Valerian (Valeriana officinalis) People commonly take valerian to help with insomnia and anxiety. Pets with nervous or anxious behaviors are prescribed this herb, and valerian has also been recommended as an adjunct treatment for epilepsy. Valerian metabolites have been shown to modulate gamma-aminobutyric acid (GABA) receptors in rat brain stems.10 While there are no reports of interactions, it is suspected that valerian may potentiate the effect of certain sedatives and anesthetic agents. Benzodiazepines, such as valium and Xanax, are frequently used in veterinary behavior management, and concurrent use with valerian may result in increased sedation. Use before surgical procedures may cause unanticipated complications with anesthetic agents that utilize the GABA-ergic pathway.11 Caution should be used when combining valerian with any sedative or anxiolytic, and valerian usage should be stopped before any anesthetic procedure. More investigation on drug-herb interactions is needed at this time. While pharmacodynamic evidence has shown theoretical interactions, there is little evidence of these interactions occurring at the clinical level. This may be due to a lack of actual interaction or a lack of recognizing or reporting interactions. Case reports detailing potential herb-drug interactions do exist, but it is often difficult to firmly establish causation of the symptoms with herb-drug interaction.

References

Laird J. Interactions between supplements and drugs: deciphering the evidence. JAAPA 2011; 24(12): 44-6, 48-9. Macan H, Uykimpang R, Alconcel M, et al. Aged garlic extract may be safe for patients on warfarin therapy. J Nutr 2006; 136: 793S-5S. 3 Mohammed Abdul M, Jiang X, Williams K, et al. Pharmacodymanic interaction of warfarin with cranberry but not with garlic in healthy subjects. Br J Pharmacol 2008; 154:1691-700. 4 Aslam M, Stockley IH. Interaction between curry ingredient (karela) and drug (chlorpropamide) [letter]. Lancet 1979; I:607. 5 Izzo A, Ernst E. Interactions between herbal medicines and prescribed drugs. Drugs 2009; 69(13): 1777-1798. 6 Kupiec T, Raj V. Fatal seizures due to potential herb-drug interactions with Ginkgo biloba. J Anal Toxicol 2005; 29:755-8. 7 Jones BD, Runikis AM. Interactions of ginseng with phenelzine. J Clin Psychopharmacol 1987; 7: 201-2. 8 Methlie P, Husebye EE, Hustad S, et al. Grapefruit juice and licorice increase cortisol availability in patients with Addison’s disease. Eur J Endocrinol 2011; 165(5): 761-9. 9 Al-Dujaili EA, Kenyon CJ, Nicol M, Mason J. Licorice and glycyrrhetinic acid increase DHEA and deoxycorticosterone levels in vivo and in vitro by inhibiting adrenal SULT2A1 activity. Mo Cell Endocrinol 2011; 336(1-2): 102-9. 10 Yuan C, Mehendale S, Xiao Y, et al. The gamma-aminobutyric acidergic effects of valerian and valerenic acid on rat brainstem neuronal activity. Anesth Analg 2004; 98(2): 353-8. 11 Kennedy J, Wang CC, Wu CH. Patient disclosure about herb and supplement use among adults in the US. Evid Based Complement Alternat Med 2008; 5: 451-6. 1

Dr. erin Mayo, DVM, graDuateD froM the north CaroLina State uniVerSity CoLLege of Veterinary MeDiCine in 2002. She reCeiVeD her Veterinary aCupunCture anD ChineSe herbaL CertifiCation froM the internationaL Veterinary aCupunCture SoCiety, anD proViDeS hoLiStiC anD tCVM SerViCeS for CoMpanion aniMaLS in CentraL new JerSey.

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Goodwinol Shampoo is made up of all natural ingredients. This one of a kind, all purpose, medicated Shampoo is gentle enough for kittens and puppies. We have combined Lanolin and Benzocaine in a remarkably effective Cedar Oil base. Goodwinol Shampoo helps relieve itching, ﬂaking and scratching. It leaves coats lustrous and imparts a glowing natural shine without the use of conditioners.

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Perfect form Perfect Form™ is The Honest Kitchen’s best-selling supplement, designed to support the normal healthy functioning of a dog or cat’s digestive tract. This supplement combats gas, facilitates regularity, firms up loose stools, soothes and protects the GI Tract. Perfect Form is ideal for pets with Irritable Bowel Syndrome (IBS), Colitis or occasional digestive upset (diarrhea or vomiting). Perfect Form can also be used when transitioning to a new food. To try a canister for free, vets can email info@thehonestktichen.com 1-866-437-9729 thehonestkitchen.com

Med Vet International is proud to announce our newly redesigned sterile Oasis Skin Stapler. The new lever action design allows it to fit comfortably in your hand to enhance control and reduce surgery time. The angled head and arrow indicator allow visibility for precise staple placement, while the staple count indicator gives you an accurate count of remaining staples. It comes with 35 pre-loaded staples that are available in two styles, wide and regular. This skin stapler is manufactured with quality construction in a simple design that provides consistent reliable performance and is affordable for any budget.

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nUVifleX NuviFlex is the most effective for pets suffering from joint disease. It also has preventative uses that may reduce or eliminate the need for joint injections or other procedures that may have unpleasant side effects. Safe alternative to Rymadyl, Deramaxx & other prescribed medications without long term side effects.

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ZymoX formUlas Antibiotic alternatives with broad spectrum effectiveness. The ZYMOX® line of topicals utilizes the patented LP3 Enzyme System with demonstrated antibacterial, antifungal and anti-yeast properties for the management of infections, irritations and allergic symptoms. Now featuring the Advanced Formula ZYMOX® Otic with biofilm dissolving enzymes for resistant microbes such as pseudomonas.

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art for yoUr clinic Enhance your clinic setting with animal-themed art from Vet Med Art. These beautiful pieces created by Dr. Donna Ragona, DVM, CVA, feature dogs, cats and other animals, and many also include insightful quotes. Dr. Ragona custom designs artwork for veterinary clinics across the country. Note cards and prints are also available.

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Feline Medical Chart

Getting George GOING

How rehabilitation helped a senior cat with chronic lumbosacral disk disease and renal failure regain his mobility and quality of life.

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eorge is a 16-year-old neutered male cat. He was generally healthy until three years ago when he was diagnosed with chronic renal failure. He is on a low protein diet, and currently taking Buprenorphine as needed for his back pain, and daily lactulose for constipation.

Medical history

About a year ago, his owner noticed George was not jumping up on the furniture as much. Approximately six months prior to his renal disease diagnosis, she noticed he was hesitating before jumping. And approximately two months prior, she noticed constipation and occasional slipping on the hind end. Lactulose improved the constipation but the slipping in the rear progressed to left rear limb paresis with decreased range of motion and muscle atrophy. He also lost one pound. At home he was slightly ataxic in the rear and falling down on smooth surfaces, but was still jumping on the couch. George would fall on the hardwood floors while playing but would slowly get up on his own. Recently, George had a dental with his primary care veterinarian. Shortly thereafter, he started dragging his left rear leg and limping. The veterinarian took x-rays then referred him to a neurologist. The neurologist found gluteal atrophy, plantigrade stance of the left hind limb, decreased hemihopping and hemistanding on the pelvic limbs, decreased cranial tibial reflex on the left and right hind limb, decreased patellar reflex on the left rear. An MRI scan of thoracolumbar and lumbosacral spine revealed Type II disk protrusion at L7-S1 disk space with moderate midline sacral nerve root compression. The diagnosis was chronic lumbosacral disk disease. Nerve conduction testing was done and there were some changes that were most likely secondary to chronic renal disease and age. The options given to treat George were surgery with post op rehab versus long term prescription pain management. The kidney specialist was consulted and concluded that George was an anesthetic risk due to the renal pathology, so medical management was pursued with Buprenorphine on a regular basis. The owner was instructed to discourage jumping at home, carry him up and down the stairs, and give him three weeks of semi-confinement.

Evaluating George

Observation: Lying on the exam table, George was alert and nervous but did not appear to be distraught. He had visible bilateral muscle atrophy of the pelvic limbs. His Body Condition Score was 4/9. His right thigh was 19.5 cm and left thigh 19 cm; integrative veterinary care

1 2

Goals for George The client’s goals were to manage pain and improve George’s quality of life. The rehab goals were to decrease pain and inflammation, increase muscle mass/strength of the pelvic limbs (taking into consideration his debilitating kidneys disease), increase range of motion, tonify the nervous system, improve and restore functional daily activities, and resolve any compensatory issues.

these measurements were taken while the cat was standing with minimal support and somewhat crouched.

Multifaceted treatment plan

A six-week rehab treatment plan was designed, which consisted of the following: • Low Level Laser therapy – icing the areas pre and post

treatment to his lumbar vertebrae, lumbosacral joint, coxofemoral joints and proximal sciatic nerve routes.

George received Lo w Level Laser ther

apy as part of his re

hab regime.

Gait assessment: It was hard to assess his gait because he was timid and unwilling to move around the exam room. He had a crouched gait in the rear with no obvious knuckling/dragging. The tail was in a neutral position and not limp. Passive range of motion: George had normal range of motion of the pectoral limbs. He was guarding extension of his right coxofemoral joint and seemed uncomfortable with manipulation of this limb. He also seemed uncomfortable and moved away at end extension of the left coxofemoral joint. His hocks and stifles had normal range of motion. His lower lumbar vertebrae were less mobile. The lumbosacral region was sensitive to dorsoventral digital pressure and George would try to sink/collapse underneath the pressure.

ding pulse

fort by sen

nd discom lieve pain a

re py can help Laser thera . e u tiss of light into

Neurological testing: Postural reflexes were hard to assess since the cat was uncooperative. He had normal pain withdraw in the pelvic limbs. The cranial tibial and patellar reflex were a little decreased on the right rear compared to the left. He was reactive to palpation of the proximal aspect of the left sciatic nerve cranial to the ischiatic tuberosity. Bilaterally, he had slow CPs of the pelvic limbs with the left worse than the right.

• Acupuncture twice a week for three weeks, then once a

Pain Assessment: Overall I rated George 6 out of 10 using the pain assessment scale from Mathews, K.A., “Pain assessment and general approach to management”, Management of Pain, The Veterinary Clinics of North America, Small Animal Practice, July 2000, p. 729-755. The left rear sciatic nerve and sacrum were reactive to palpation and I rated these areas 8 out of 10 on the same pain scale.

• Home therapeutic exercises during week three. The exercises

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week during weeks four, five and six. • Veterinary chiropractic once during weeks three and six. • Underwater treadmill twice a week starting on the

third week.

chosen would focus on balance and coordination such as Cavalettis, figure eights, balance board or disk, weight shifts and diagonal leg lifts, standing and walking on foam blocks or cushions/mattress, and peanut physioball therapies. A combination of these exercises was recommended for five

minutes once or twice a day, four to five time per week, then working slowly up to ten-minute sessions. The owner was instructed to finish with ice on George’s lower back for ten to 15 minutes. George’s cooperation dictated the techniques chosen. • A treatment plan progress exam with the prescriber during

weeks three and six to re-assess and re-evaluate.

py George was given hydrothera

ater treadmill. twice a week on an underw

Positive outcome

George tolerated the first three weeks of his therapy and was more tolerant with digital pressure at the lumbosacral region. He allowed gentle palpation, manipulation, and some range of motion of both rear limbs. According to the owner, he became more mobile around the house. He was more willing to walk around the exam room but still had a slightly crouched stance. His CPs in the rear were still slow but equal timing. He was defecating more regularly. On the fourth week, we added hydrotherapy and home therapeutic exercises while tapering off the laser and acupuncture treatments. George went into the underwater treadmill with a veterinary technician certified in rehabilitation. The technician sat on a bench in the tank while guiding George, who was donned with a life vest, to walk through 6” water. George was very nervous at first, but once he was surrounded by water and the treadmill was turned on, he started walking immediately. There was no dragging of the rear limbs at all. In general, his gait was stilted on the right rear and he placed his left rear lighter and leaned off the left rear more. The client was instructed to start some home therapeutic exercises with leg lifts, weight shifts, and walking on foam, pillows and couch cushions, along with post exercise icing on the days that he did not have hydrotherapy.

On the fourth week, we added hydrotherapy and home therapeutic exercises while tapering off the laser and acupuncture treatments. Continued on page 32.

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Another happy patient post rehabilitation therapy.

Continued from page 31. George continued to slowly improve. His owner reported he would be somewhat tired after longer hydrotherapy sessions, but was much more active once he recovered. Less and less pain medication was required. The more advanced home therapeutic exercises, like Cavalettis and the physioball, were not all that successful because George is a cat and not very motivated about being told what to do. His owner would compromise and play with him by getting him to chase string and a laser light. Also, with our advice, she assisted him slowly up and down the stairs once a day. He was defecating regularly without difficulties so the lactulose was discontinued. At the six-week recheck, George looked and felt a lot better. He was walking tall and proud around the exam room with the tail up. He still had a stilted gait in the rear but was definitely less ataxic and more coordinated. His thigh measurements were 20 cm on both the left and right. There was no more pain at the L-S junction. He had better overall range of motion of his coxofemoral joints but was still tight on end extension of his left hip. His CPs in the rear were not as slow and more even. The sciatic nerves on both sides were calm when palpated. His pain score was 2 out of 10, and he had gained two pounds since the initial visit.

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At the end, the client, my staff and I were very happy, and so was George. Unfortunately, his kidney values continue to increase and he will eventually succumb to the chronic disease. But at present, his quality of life is great for an old man!

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Feeding formulations the U-Balance™ Product Line recently introduced by Uckele Health & nutrition is a streamlined system designed to take the guesswork out of choosing which feeding formulations are most appropriate for your equine patients. these scientifically-based formulas start with a foundation vitamin-mineral supplement containing essential ingredients as a fundamental starting point for all horses. From there, U-Balance™ offers specialty formulas that target specific health considerations for each individual horse, including support for the immune system, metabolic function, joint health, and brain and nervous system health. The formulas come in palatable pellets that can be easily incorporated into the horse’s feeding program without added fillers or sweeteners. uckeleequine.com

Detecting equine lameness Veterinarian Dr. Kevin Keegan, professor of equine surgery in the college of veterinary Medicine at the University of Missouri, has developed a way to detect lameness in horses using a motion detection system called the “Lameness Locator”. it places small sensors on the horse’s head, right front limb and croup. the sensors monitor and record the horse’s torso movement while he is trotting. the recorded information is then transferred to a computer or mobile device and compared against databases recorded from the movement of healthy horses and other lame horses. The computer is then able to diagnose whether or not the horse is lame. In a study, Keegan put special adjustable shoes on horses that temporarily induced symptoms of lameness. The horses were monitored by the Lameness Locator as well as veterinarians using any lameness testing methods they wished. the Lameness Locator was able to correctly identify lameness earlier than veterinarians more than 58% of the time. munews.missouri.edu

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virbac animal Health announces the indexing of Suprelorin F Implant, a new non-surgical treatment for ferrets suffering from adrenal gland cortical disease, delivered via a dissolvable, controlled-release implant. Published studies have shown it effectively manages the clinical signs of adrenal gland cortical disease in ferrets, and remains effective for up to one year. A return to normalcy was reported at eight weeks for hair loss, at six weeks for vulvar swelling, and at two weeks for skin disorders and sexual behavior. The product was also shown to suppress key hormones (estradiol, hydroxyprogesterone and androstenedione). The 4.7-mg dose has been shown to be safe in domestic ferrets when combined with clinical monitoring by the veterinarian. VirbacFerretsUSA.com

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e’ve all seen it – a dog that is overly shy among strangers, is afraid of loud noises, or turns into a quivering mass when he comes through the door of your clinic. While caution and moderate fear of unknown things are means of self-protection, true anxiety and phobias can exist in some pets that are not actually in danger. Adequate exposure to new and potentially scary things during the pet’s socialization phase can help minimize some of these anxieties. However, a single intense or traumatic experience can result in one “trial learning” that may impact the animal for the rest of his life. The pet owner may think the person, noise or experience poses no threat, but to the animal, his perception is his reality. Common behaviors may include fleeing, fidgeting, freezing or fighting. Any other stressful stimulus during the time of anxiety, such as punishment or owner excitement, can exacerbate the problem. Veterinary behaviorists often work with pet owners and their dogs or cats to understand what is triggering the actual behavior and the extent of the response, as well as make recommendations for behavior modification. It is important for owners to address two critical issues: first, to consider if the pet could cause injury to himself or others, and second, to realize that the pet owner’s response should lead to calming and settling the dog or cat. If aggression becomes part of the pet’s response, the owner should seek professional help from a veterinarian or behavior specialist at once. With milder forms of anxiety, identifying the source or stressor is the first step. In order to teach calming and settling techniques,

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by Heidi LoPrise, dVM, dAVdc

the owner must provide a feeling of security so she will be able to control and communicate with the pet. Counter-conditioning and desensitization can then work with re-exposure to the stimulus along a gradient from low to high, using calming techniques and rewards. The intensity of the stimulus can slowly increase as the pet experiences the event without showing signs of fear. During this period, avoiding the stimulus at other times may be necessary when training is not active. Some pets have challenges reducing their stress response, and in severe cases, pharmaceuticals may be needed. In lieu of using anxiolytic or psychotropic drugs, other choices can sometimes reduce anxiety in pets. These include pheromone therapy and supplements. One such supplement, Anxitane® (L-Theanine®) Chewable Tablets, contains an amino acid proven to help reduce signs of fear and anxiety. This compound, found in green tea, can help pets stay calm and relaxed, which can help them in the learning process of behavior modification. Owners who have concerns about potential side effects of pharmaceutical drugs may prefer a supplement such as this. And with proven palatability, dogs and cats seem to like it as well. By combining this supplement, that can be given daily for as long as necessary, with behavioral modification, many pets can enjoy reduced stress in their lives.

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eQUINe VAccINAtIONS

PART 2 by W. JeAn dodds, dVM

Are you giving your patients too many vaccines? As more clients and veterinarians express concerns about the dangers of over-vaccination, it’s a good idea to review your own practice’s protocol. n the first part of this series, we discussed the benefits and potential side effects of vaccinations, which provide an important means of protecting animals and people from clinically important infectious diseases. We also introduced the changing paradigm of vaccination in veterinary medicine. What impact has this change had over last decade on the way we approach this preventive health measure? A recent survey of the profession indicated that some veterinarians were initially apprehensive about the recommendation to extend the timeframe for boosters from one to every three years or even less frequently. While clinicians wanted to offer what was best for the animals, they were concerned about the lost incentive for clients to visit them annually when vaccinations were not needed. However, partly because of the emerging documentation about adverse reactions associated with routine vaccinations, veterinarians accepted that they needed to address these concerns with their clients. Today, a decade later, the public has generally embraced the concept of having their animals seen annually for wellness examinations as well as during periods of illness. But while this paradigm shift has been well accepted in small animal practice, relatively little emphasis has been directed towards horses. Hopefully, increased efforts will be made to

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incorporate the newer science and concepts about vaccination into equine medicine. But in the meantime, it’s more important than ever for us to become as informed as possible about our equine patients’ vaccine requirements. Let’s take a closer look at what clinical studies say about equine herpes, influenza and encephalitis viruses, keeping in mind that very little research has been done on the effectiveness of titers to help prevent over-vaccination.

1 EquinE hErpEs virusEs Five distinct herpes viruses (EHV) are known to infect horses. Two of them, EHV-1 (also known as equine abortion virus) and EHV-4 (also known as equine rhinopneumonitis virus), are major causes of abortion and respiratory disease. Recent outbreaks of EHV-1 infection have caused neurological disease at raceways, horse shows, farms and clinics in several areas of North America, with many cases of illness and a few deaths. In addition to abortion in infected mares, EHV-1 strains can cause respiratory disease, although many times horses incubating the virus will only exhibit fever. The virus can be shed from nasal secretions, and stress can precipitate illness. That’s why it’s not unusual to see outbreaks where horses feel stressed, such as at racetracks. Horses exhibiting neurological signs often harbor high viral loads in their blood and nasal secretions, and can transmit the

disease to other exposed horses. To control the disease, it’s crucial to separate and isolate the sick animal from the rest of the herd. Diagnostic testing for EHV-1 using the PCR (polymerase chain reaction) is useful to establish exposure in the presence of clinically relevant disease.

The vaccines Both activated (killed) and modified-live (MLV) herpes virus vaccines are available, as single or combination (EHV-1 + EHV-4) vaccines. As mentioned in Part 1 of this series, a recent comparison of killed and MLV EHV-1 vaccines found the latter offered superior protection when tested in an aerosol challenge. Because of the severity and endemic spread of EHV, many equine veterinary groups recommend serial vaccination for EHV in pregnant mares, and booster vaccinations every six to 12 months. I would recommend weighing a mare’s risk of exposure and serious disease during a viral outbreak before following this course of action. However, many show horses and some racehorses are vaccinated every two to three months, even though there is no evidence that this prevents the disease. There is no immunologic reason to vaccinate this frequently and there is compelling anecdotal evidence that horses on this heavy a vaccine schedule have weakened immune systems.

The titers Vaccine titers for EHV-1 and EHV-4 are available. Existing data indicates that serum antibody levels in vaccinated horses can last six to 12 months, especially if an MLV product is used. A serologic titer can assess levels of residual antibody if the horse recovered from a natural case of EHV infection.

2 EquinE inFluEnZa virus There are two types of equine influenza virus (EIV): H7N7 (subtype 1) and H3N8 (subtype 2). The horse influenza viruses evolved from avian influenza viruses, and the recent appearance of clinically significant canine influenza apparently resulted from a mutation of the equine H3N8 virus. Equine influenza is endemic throughout North and South America and Europe, and is considered the most important viral respiratory disease of horses. Disease is characterized by fever, depression, coughing, and a nasal discharge, which develop one to five days after infection, and is occasionally complicated by secondary bacterial infections that may lead to pneumonia and death. Due to the short incubation period and resulting persistent cough, the disease can spread rapidly. In the past two decades, all major outbreaks of EIV have involved the H3N8 subtype.

The vaccines Continually mutating influenza viruses in people and animals, including horses, means we need to regularly update the vaccines in order to maintain their efficacy. Researchers say this “antigenic drift” is partially responsible for the previous failures of equine influenza vaccines to protect horses. So what’s changed to improve the efficacy of the vaccine? Continued on page 38. integrative veterinary care

lameness

Symptomatic

part 1

by JocHen scHLeese, cMs, cee, cse

If you have an equine patient whose lameness isn’t responding well to treatment, consider how the ﬁt of his saddle might be contributing to the problem. With complex physiological issues, veterinarians may recommend treatments to alleviate symptoms. The horse benefits greatly when the health care team works together, combining knowledge to understand underlying factors. This series discusses concepts to assist professionals in the diagnostic process. When issues of symptomatic lameness are addressed (often in the right hind leg), and logical treatments no longer work, then injections, antiinflammatory creams, or chiropractic adjustments at the SI joint are often selected. Observations of horse and rider in various gaits reveal many other causes of lameness – including saddle fit. We have found that horses with symptomatic lameness in the right hind leg fall into the majority of horses (70%) that are muscled stronger on the left shoulder. This unevenness can be easily seen by viewing the horse over his rump. This has implications for saddle fit. The average fitted saddle appears to fit well while the horse is in the crossties. But a chain reaction starts when the horse moves, beginning with a scapular rotation upwards and backwards. Saddles that are not adjusted properly to fit the larger shoulder will be tight and put more pressure on it. Additionally, the larger shoulder will push and therefore twist the saddle to the right. This causes the left panel to impinge against the left side of the horse’s spine, reducing proper function with resulting inflammation over the sacroiliac. To compensate for the saddle twisting to the right against the spine, the rider leans to the left to maintain balance, causing increased pressure on the left side of the horse’s back. This may result in a subluxation at the sacroiliac joint and pelvic intersection, causing a misalignment of the horse’s back. JoChen SChLeeSe

iS a CertifieD MaSter SaDDLer who paSSier, anD CaMe to CanaDa aS offiCiaL SaDDLer at the 1986 worLD DreSSage ChaMpionShipS. he regiStereD the traDe of SaDDLery in north aMeriCa in 1990. JoChen’S LifeLong StuDy of equine DeVeLopMent, SaDDLe DeSign, the bio-MeChaniCS of horSe anD riDer in Motion, anD the effeCtS of iLL-fitting SaDDLeS, LeD to the eStabLiShMent of SaDDLefit 4 Life in 2005 (saddlefit4life.com), a gLobaL network of equine profeSSionaLS DeDiCateD to proteCting horSe anD riDer froM Long terM DaMage. graDuateD froM

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Continued from page 37. Until recently, influenza vaccines were the inactivated type. These produce relatively short-lived immunity and poor protection rarely lasting beyond six months. As well, a critical lag time (immunity gap) between the completion of the initial two doses of vaccine and the recommended booster at 12 months resulted in vaccine failure. Newer approaches to vaccination were obviously needed and resulted in the development of the MLV intranasal and recombinant viral vectored and naked DNA vaccines. The advertised intranasal MLV vaccines state efficacy for up to six months or a year, with a decrease in the severity of disease after challenge at one year. Studies with recombinant canarypox vectored (rCP-EIV) vaccine showed that two boosters protected ponies from viral challenge and that a third booster dose provided immunity for at least one year thereafter. Thus, rCP-EIV vaccine effectively closes the immunity gap between the initial and one-year booster timeframe. Once again, you need to consider the horse’s exposure to this serious disease. Performance horses will undoubtedly be more at risk, while “backyard” horses with strong immune systems will most likely be better equipped to recover naturally, especially if no secondary infection develops. Influenza vaccines are available as single vaccines or in combination with herpes virus, encephalitis, and/or tetanus vaccines. While some manufacturers state that these polyvalent vaccines are safe for horses, ponies, pregnant mares, sucklings, weanlings and yearlings, vaccination of pregnant and very young animals should be done with caution and preferably only in the case of disease outbreaks. Clinically, the injectable vaccines produce significantly more immediate vaccine reactions than the intranasal, though some horses appear to become headshakers following the intranasal. The prevalence and severity of equine influenza has prompted many vets to routinely vaccinate. Show and racehorses are frequently done on the same two- to three-month schedule as EHV. However, in older horses, vaccination has been associated with vasculitis and purpura (bruising), as well as dysbiosis (disruption of normal body functions leading to colic, laminitis and founder) so it’s important to carefully consider the pros and cons of vaccinating an older horse. Heavily vaccinated horses appear more likely to develop a chronic cough after an EIV infection (which can still occur in frequently vaccinated horses).

The titers While serum titers for EIV are available, the short-lived duration of immunity from vaccination or natural disease makes their measurement of little use. Experience with rechecking titers

over many years of practice indicates that the titer levels, though low, are persistent, which may indicate there is more residual duration of immunity than is shown by the limited available research.

3 Equine encephalitis viruses Eastern encephalitis virus (EEE), Western encephalitis virus (WEE), and Venezuelan encephalitis virus (VEE) are all mosquito-transmitted viruses that occur in North and South America. They spread rapidly and cause epidemics of neurological disease that require effective prevention and control strategies.

The vaccines Available vaccines are of the inactivated killed virus type, as well as more recently developed MLV vectored vaccines. General recommendations are to give two doses of combination encephalitis vaccine 30 days apart followed by annual or biannual boosters. One of the newest vaccines uses recombinant canarypoxvectored vaccine technology. Dr. Madalyn Ward, a holistic equine veterinarian, recommends giving the two combination encephalitis/tetanus vaccinations at five to six months of age followed by a booster every three years, or sooner in the face of an outbreak. Dr. Ward also recommends using caution when vaccinating older horses, in particular those over 15 years of age. Dr. Joyce Harman recommends checking the prevalence of WNV in your state or area and making a decision based on need, as many states have very few or no cases, while certain localities continue to have cases each year.

Factors that may affect

vaccination Ask yourself these questions before finalizing a vaccination program for a patient. He may need fewer vaccines than you think. 1. Is he a performance horse that attends a lot of shows/ events, or more the stay-at-home type? 2. Does the client have her own acreage or is the horse boarded at a big facility where there’s more risk of exposure? 3. Does the client support the horse with a natural diet and supplements so he has a better chance of fighting off infection? 4. What is the horse’s age? 5. How is his overall health? 6. Which diseases are prevalent in your area?

The titers Vaccine titers for all three types of equine encephalitis are available and offer a good indication of the immune status of the horse. Being aware of the common infectious diseases that affect horses, and what your patients’ risk factors and options are, is your best line of defense against unnecessary over-vaccination.

What about

Lyme

disease? Currently, there are no approved equine Lyme vaccines, although some veterinarians are using canine vaccines. The new Lyme multiplex blood test from Cornell may be able to differentiate between horses that have had a Lyme vaccine and ones that have been naturally exposed. However, Lyme tests are still open for interpretation and the vaccines may or may not work or be safe.

Boone TJ. “Respecting equine herpes virus-1”. Calif Vet 61(2):18-19, 2007. Desmettre P. “Diagnoses and prevention of equine infectious diseases: present status, potential, and challenges for the future”. Adv Vet Med 41:359-375, 1999. Goodman LB, Wagner B, Flaminio MJ et al. “Comparison of the efficacy of inactivated combination and modified-live virus vaccines against challenge infection with neuropathogenic equine herpesvirus type 1 (EHV-1)”. Vaccine 24:3636-3645, 2006. Minke JM, Toulemonde CE, Coupier H, et al. “Efficacy of a canarypoxvectored recombinant vaccine expressing the hemagglutinin gene of equine influenza H3N8 virus in the protection of ponies from viral challenge”. Am J Vet Res 68:213-219, 2007. Rosenthal M. “Practitioners concerned about safety, embracing new vaccine recommendations”. Product Forum & Market News, Spring 2007 Tizard I, Ni Y. “Use of serologic testing to assess immune status of companion animals”. J Am Vet Med Assoc 213: 54-60, 1998. Townsend HG, Penner SJ, Watts TC, et al. “Efficacy of a cold-adapted, intranasal, equine influenza vaccine: challenge trials”. Equine Vet J 33:637643, 2001.

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 research. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1984.

integrative veterinary care

by JennA HAHn

How stress reduction and medicinal mushrooms can work together to treat and prevent this common health issue.

hen faced with a diagnosis of ulcers in their horses, many clients are shocked. “My horse could not possibly be stressed. I give him a great life.” Sound familiar? Many people think they are doing what’s best for their horses, but despite their good intentions they’re often working with the wrong information.

Stomach linings x 2

Horses are meant to graze all day, which means they produce stomach acid 24/7. They can produce up to 16 gallons of acidic fluid every day.1 Horses’ stomachs also have two different linings:

The glandular mucosa is a stronger protected lining at the bottom of the stomach where the acid sits. The glandular mucosa is where you will see ulcers from NSAID use/overuse due to decreased blood flow to the stomach lining.

The squamous mucosa makes up the top half of the stomach and is a non-protected lining.

These two types of stomach lining meet at the margo plicatus. This is where you most often see the beginnings of stress ulcers; as they get more severe, they can cover the whole squamous mucosa.

EGUS in horses

Equine Gastric Ulcer Syndrome (EGUS) is a very common disease.

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As many as 93% of racehorses2, 63% of competitive horses3, 51% of foals4 and 71% of broodmares5 can have them. Some of the stressors causing ulcers are competition, travel, training, trailering, limited turnout or grazing, lay up, changes in routine, and changes in herd dynamics or facility. Symptoms you will see in EGUS horses include changes in eating and drinking behavior, weight loss and poor hair coat (usually seen in long term cases), a change in attitude, recurrent colic, and decreased or poor performance. Foals will grind their teeth or lie on their backs. Stomach pain, back pain and cinchiness are also signs.

Two types of “ulcer horses”

1 2

High energy and outwardly nervous horses tend to show their stress, whether through behavior, sweat, poor performance or other signs.

The silent sufferer is what is called the “internalizer”. These horses do not show signs or symptoms. They may simply have a poor hair coat, an inability to put on weight, or display a slight change in behavior.

Educating the client

The first step in treating stomach ulcers is helping your client understand what EGUS is. Most clients are horrified and feel a lot of guilt when they find out their horse has stomach ulcers. They

feel responsible and can take it very personally. Once you start to explain how a horse’s stomach works and how it is different from a human’s, they will start to open up to the conversation (see sidebar on page 42).

Find the source of stress

The next step to treating stomach ulcers is finding the source of stress and helping the horse cope with whatever he is being faced with. For example, an old retired horse was moved into a new pasture and started to go downhill quickly. He lost weight rapidly and his coat became dull. After a scope, he was diagnosed with severe ulcers. All it took for him to recover was a change in pasture with other horses that let him eat and were nice to him. In another case, a horse was kicking at his sides and biting the air when he ate his grain every night. The grain turned out to be acidic and was producing excess stomach acid, which was irritating his stomach. By changing his feed, the kicking and biting went away. Sometimes you cannot avoid the stress that causes ulcers, as in the case of performance horses. “I believe it is difficult, if not impossible, to ask elite equine athletes to perform at their optimum level when they are suffering from EGUS,” says Dr. Wayne Browning of Bayhill Equine Clinic. For these horses, you will need to find a way to help them cope with the stress and treat the ulcers.

Treatment choices

There are many treatment options available for ulcers. Some are efficacious and some are not. • The ﬁrst option is rest. A horse’s stomach can heal itself. If he is removed from the stressful situation, he will usually heal within a month. The problem with this method is that most people do not want to turn their horses out for a month and lose that time for training or showing while they wait for the ulcers to heal. Continued on page 42.

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Saddle If the

fits...

Jochen Schleese draws on a lifetime of experience to teach professionals and riders about the complexities of saddle fit. Jochen Schleese knows a thing or two about horses and saddles. The former three-day event rider and graduate of Passier is a Certified Master Saddler who came to Canada from Germany in 1986 as Official Saddler at the World Dressage Championships. Four years later, Jochen founded Schleese Saddlery Service (saddlesforwomen.com), registering the trade of saddlery in North America, and in 2005 he established Saddlefit 4 Life® (saddlefit4life.com).

Signs of poor saddle fit in a rider • Back, hip pain • Pelvic discomfort • Struggling to maintain correct position • Feeling pulled apart • Fighting the saddle • Falling in front or behind the motion

To protect horses and riders from long term damage, Jochen helps professionals and riders find answers to the tough questions and issues they are experiencing with horses. The goal of his Saddlefit 4 Life diagnostic system is to identify signs of poor saddle fit. The evaluation and analysis looks at equine issues and rider concerns, and suggests solutions for improved fit, comfort and performance. Jochen also teaches through lectures and professional seminars. He offers expertise on saddle fit and design as well as male and female anatomy, the bio-mechanics of motion, equine development and more.

Equine problems caused by ill-fitting saddles • Undiagnosed lameness requiring repeated injections • Gait abnormalities • 4-beat canter • Toe dragging • Head nodding • Tail swishing • Poor work attitude • Sore, sensitive back • Behavioral issues • Resistance • Lacking engagement • Muscle atrophy

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A demonstration they’ll remember One trick to use when explaining stomach ulcers to clients is a plastic Ziploc bag. Draw a line 2” from the bottom of the bag. Explain the two types of stomach lining. Then pour a liquid in the bag to just below the line you have drawn. When a horse is in training, his stomach shrinks: grab the bottom of the bag so the liquid rises above the line or “margo plicatus” into the “squamous mucosa”. Then show what happens during times of stress by simply adding more liquid to the bag – when horses are stressed they produce more stomach acid. Lastly, show what eating roughage does to help the situation: pour a bunch of shavings from the stall into the bag and watch the liquid be absorbed back down below the line. This is a very visual way to teach your clients about the equine stomach and how it works.

Continued from page 41. • Many medications treat ulcers, including acid pump inhibitors, H2-antagonists, and antacids. They work to varying degrees, but the most important thing when using them is knowing how long the drug works in the system and remembering that a horse’s stomach produces acid 24 hours a day. • There are also many natural approaches: slippery elm, aloe vera juice, licorice, papaya and more. Very little or no research has been done on the effectiveness of these treatments. Most of the information has been anecdotal.

Look at medicinal mushrooms

Mushrooms have a number of modes of action for both preventing and treating EGUS. Reishi has been shown to balance adrenal function – reducing adrenalin response to stress from travel, separation anxiety, modifications to training schedules, etc. Medicinal mushrooms contain a prebiotic platform for probiotic development and healthy mucosal flora. Powerful beta glucans unique to medicinal mushrooms activate the immune system to be “battle ready” for exposure to bacteria, viruses and contaminants. Recent research on the super antioxidant l’ergothioneine derived from medicinal mushrooms has established that it is the only antioxidant with a cellular transport mechanism. This mechanism senses inflammation and transports l’ergothioneine into the cell to reduce free radical activity.

Medicinal mushrooms also contain high levels of B vitamins, vitamin D, digestive enzymes and proteins. Finally, Reishi is highly regarded as an adaptogen to balance behavior, promote focus and reduce hyperactivity. As a natural whole food, dehydrated medicinal mushrooms can help treat and prevent ulcers with no potential side effects.

all day is not an option, try soaking the hay in water prior to putting it in a hay net. This will help decrease the calories. Without prevention or removing horses from stressors, the patients you have treated will get ulcers again. This is an important message to stress to clients. It will keep your patients ulcer-free and their owners happy. Kitchen DL, Merritt AM, Burrow JA. Histamine-induced gastric acid secretion in horses. AJVR 1998; 59(10): 1303-1306. 2 Murray MJ, Schusser GF, Pipers FS, Gross SJ. Factors associated with gastric lesions in thoroughbred racehorses. Equine Vet J 1996; 28:368-374. 3 Mitchell RD, Prevalence of gastric ulcers in hunter/jumper and dressage horses evaluated for poor performance. Association for Equine Sports Medicine, September 2001. 4 Murray MJ, Endoscopic appearance of gastric lesions in foals; 94 cases (1987-1988). JAVMA 1989;195(8): 1135-1141. 5 Le Jeune SS, Nieto JE, Dechant JE, Snyder JR. Prevalance of thoroughbred broodmares in a pasture: A preliminary report. The Veterinary Journal September 2009;181(3):251-255. 1

Prevention tactics

The last step to treating stomach ulcers is preventing them. This is a step most people forget or ignore. Just because the ulcers have been treated and healed, it doesn’t mean they won’t come back as soon as the horse is reintroduced to the stress that caused them in the first place. “In our experience, a horse that is stressed for any reason (prolonged transport, systemic illness, major husbandry change, etc.), particularly one that is inappetant, is an ulcerated stomach waiting to happen,” says Dr. Jill Higgins of Loomis Basin Equine Medical Center. “Keeping these horses eating, decreasing stress as much as possible, and being proactive in prevention are key.” Reducing stress and using natural solutions like medicinal mushrooms will provide the horse with a well rounded prevention plan. Other ways to help prevent stomach ulcers include having a full hay net available to the horse at all times, to promote “grazing”, or feeding him more frequently during the day. If you have an easy keeper and feeding hay

organizational

Diets. She

Jenna Hahn is Director of Marketing and Animal Health Sales for Matrix Healthwerks. Her professional experience includes the pharmaceutical industry, veterinary practice outreach, small start-up animal health companies, on-line equine development, work with competition managers, horse trainers and more. After graduating from University of CA, Davis with a double major in economics and sociology, Jenna worked for Hill’s Science and Prescription

is very active in the veterinary industry where she has spent most

of her career working with veterinarians and their staff to help improve the quality of life for animals. Jenna has been an avid show jumper her whole life.

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nutrition nook Genetically modiﬁed (GM)

INGREDIENTS IN PET FOODS:

&ATCATS RISK

DOGS

by dr. MicHAeL W. FoX, d.sc, Phd, b. Vet Med, MrcVs

ogs and cats, like the proverbial canaries down the mine shafts, have become our sentinels. They alert us to health hazards in the home environments we share and in the products and by-products of the same agribusiness food industry that feeds most of us and them. In the mid 1990s I began to suspect diet may play a role in a “cluster” of health problems not seen nearly as often as when dogs and cats were being fed conventional corn and soy. Since that time I have formed the professional opinion that there is sufficient proof from evidence based medicine that dietary ingredients derived from GM crops are not safe for companion animals, and by extension, for human consumers either.

Widespread use of GMO crops In the mid 90s, more and more genetically engineered corn and soy were being used in pet foods and fed to farmed animals. As a

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nationally syndicated veterinary newspaper columnist, I began to receive an increase in letters from cat and dog owners whose animals were suffering from this cluster of health problems. In the 40 years that I’ve been writing that column, I’ve benefited from a wide-angled and historical perspective that I would never have realized running a conventional veterinary clinic. The thousands of letters that I receive from across the U.S. keep me informed about new and emerging health problems and veterinarians’ responses to the same. During this timeframe in the 90s, people often wrote to report of failed treatments and harmful side effects to prescribed remedies, e.g. steroids, as well as problems with various manufactured prescription diets after their attending veterinarians diagnosed their animals with allergies, asthma, atopic dermatitis and other skin problems, irritable bowel syndrome, leaky gut syndrome, inflammatory bowel disease, colitis, recurrent diarrhea, vomiting, indigestion, along with abnormalities in liver, pancreatic and immune system functions. That animals with these afflictions often recovered completely when I advised that they be taken off all foods containing corn and soy supported the evidence based medical assertion that dietary ingredients were playing a significant, if not sole role in their disease. A similar picture was developing in human health. It is surely no coincidence that the US Centers for Disease Control and Prevention reported, in Oct. 2008, an 18% increase in allergies in children under the age of 18 years, between 1997 and 2007. This ties in with the time frame of when GM ingredients were first introduced into the food chain and then subsequently in greater amounts. Some three million children now suffer from food and/or digestive allergies or intolerance. Their symptoms including vomiting, skin rashes, and breathing problems. They take longer to outgrow milk and egg allergies, and show a doubling of adverse reactions to peanuts.

Research evidence of harms In the creation of GM crops like corn and soy bean novel proteins are generated that can cause allergies and assault the immune system. This in turn creates illness, especially in the offspring of mothers fed such foods, and to their young fed diets containing GM ingredients. The genetic modification of such food crops can also lower their nutrient content, elevate potential toxins, and also create novel RNA variations. The latter are not destroyed by digestion, and so called micro RNA has been found in mammalian tissues where they can exert influences on gene expression and therefore affect health across generations (Zhang et al, 2011). These kinds of problems are in part due to the inherent genetic instability of GM plants that can result in spontaneous and unpredictable mutations (Wilson et al 2006). In their detailed review of animal safety studies of GM foods, Dona & Arvanitoyannis (2009) conclude that â&#x20AC;&#x153;The results of most of the rather few studies conducted with GM foods indicate that they may cause hepatic, pancreatic, renal, and reproductive effects and may alter hematological, biochemical, and immunologic parameters the significance of which remains unknown.â&#x20AC;? Altered DNA from GM foods can be incorporated by gut bacteria and may alter their behavior and ecology in the digestive tract. Likewise the bacterial incorporation of genetic material from antibiotic resistance genes used to identify some varieties of GM food crops could

have serious health implications (see Smith 2007 and Traavik & Heinemann, 2007). Three varieties of Monsantoâ&#x20AC;&#x2122;s GM corn, approved for consumption by US, European and several other national food safety authorities, caused liver, kidney and other internal organ damage when fed to rats ( J.S.de Vendomois et al 2009). A subsequent two-year feeding trial by Seralini et al (2012) reported that rats fed on a diet containing NK603 Roundup tolerant GM corn or given water containing Roundup, at levels permitted in drinking water and GM crops in the US, developed cancers faster and died earlier than rats fed on a standard diet. Females developed significant and numerous mammary tumors, pituitary and kidney problems. Males died mostly from severe liver and kidney chronic deficiencies. The insecticide Bt (from the inserted genes of Bacillus thuringiensis) produced by several varieties of GM corn may create allergies and illness. Bt-toxin from genetically engineered corn sources has been found in the blood of pregnant women and their babies, as

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well as in non-pregnant women. Bt-toxins, which have been shown to damage human kidney cells, may cause leaky gut syndrome in newborns, the passage of undigested foods and toxins into the blood from the intestines leading to food allergies and autoimmune diseases. Also, since the blood-brain barrier is not developed in newborns, toxins may enter the brain and cause serious cognitive problems. Some health care practitioners and scientists are convinced that this is the apparent mechanism for autism.

There are GM corn and soy-free, and organically certified pet foods now available on the market, and websites provide recipes for home-prepared diets for companion animals (drfoxvet.com, dogcathomeprepareddiet.com and felinenutrition.org) which many informed cat and dog care givers are now providing for their animals. This enlightened consumer action is an integral part of the long overdue revolution in agriculture to promote more ecologically sound, sustainable and humane farming practices, a healthier environment, and more healthful, wholesome and affordable food for all.

GMO

Where does that leave us? Genetically engineered foods, derived from GM crops, have never been proven safe for human consumption but have been on the market for the last two decades. You can find a list of hidden GMO ingredients, as well as tips for avoiding GMOs, at NonGMOShoppingGuide.com.

Pet food manufacturers that have USDA Certified Organic ingredients, and especially those that use no corn, soy, canola, cotton by-products (oil and cake) or sugar beet, which could be genetically engineered, or imported rice (which can be contaminated with GM rice) could legitimately claim “No GMO Ingredients” on their packaging. I feel very strongly that this is a pivotal issue in the health/food revolution, where there is no place for GM food ingredients in what we consume and feed to companion, and also to farmed food animals. I have communicated these concerns to several responsible pet food manufacturers who are not unaware of what Hippocrates advised – to let our food be our medicine and our medicine our food.

Further reading Fox, M.W. Healing Animals and the Vision of One Health. Tallevast, FL One Health Vision Press/ Amazon.com 2011 and Fox, M.W., Hodgkins E., and Smart M. Not Fit for a Dog: The Truth About Manufactured Dog and Cat Food Sanger CA Quill Driver Books 2012. Smith, J.M. Genetic Roulette: The Documented Health Risks of Genetically Engineered Foods Fairﬁeld. Iowa Yes! Books 2007. For Supportive References: See detailed review on this topic at drfoxvet.com.

Dr. MiChaeL w. fox iS an honor roLL MeMber of the aMeriCan Veterinary MeDiCaL aSSoCiation, (drfoXvet.com). hiS MoSt reCent bookS are HealiNg aNimals & tHe visioN of oNe HealtH, anD aNimals & Nature first. he iS Co-author of Not fit for a dog: tHe trutH aBout maNufactured cat & dog food.

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Encourage

home dental care

by Heidi Lobprise, DVM, DAVDC

In the Summer issue of IVC, we discussed how a complete dental care program includes regular oral examinations, professional dental care, and daily home care. There are still some who may scoff at the idea of home dental care for pets, but it’s more accepted now than it was 25 years ago, when the concept was first introduced. Effective daily tooth brushing will always be the gold standard, since both the mechanical removal of soft plaque from the tooth surface as well as chemical or enzymatic action help keep bacteria away from the teeth. Many animals, particularly dogs, may actually like the flavor of pet toothpaste. When a pet is in the exam room, conduct a “taste test” to see if he has a preference for a particular flavor, such as C.E.T.® Enzymatic Toothpaste choices of VanillaMint, Malt or Poultry. To encourage clients to brush their pets’ teeth, advise them to start by simply letting the pet lick the toothpaste off the brush. Then suggest they gradually increase the amount of contact the brush has with tooth surfaces. Eventually, many pets will allow their owners to move the brush across their teeth. For pets that won’t allow brushing, appropriate dental chewing devices can be helpful. Hard objects should never be used, as they can break the teeth. Some devices will provide mechanical disruption of plaque while others may add an antiseptic, such as chlorhexidine, or a dentifrice to enhance the cleansing action.

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separation anxiety

THE LATEST ON

seParation anXietY isn’t “over attachment” The basis for separation anxiety problems has long been thought to be due to an “over attachment” to the owner. But recent research fails to support this interpretation. During an attachment test, dogs with separation anxiety showed no difference in the amount of time they spent in contact with or in proximity to their owners than dogs without separation anxiety. In the same study, 65% of the dogs without separation anxiety were reported to follow their owners from room to room. So these patterns are not reliable diagnostic criteria for separation anxiety. Most dogs do not engage in the severe destructiveness, vocalizing or elimination as long as they are in the presence of someone. We’ve had cases of anxious dogs that escaped the yard and spent the day comfortably in the companionship of kind neighbors. Separation anxiety dogs that are well socialized with other dogs often do well at daycare as an alternative housing arrangement while a behavior modification plan is being implemented.

a shift in BehavioraL aPProaches

by suZAnne Hetts, PHd, cAAb, cVJ And dAnieL esteP, PHd, cAAb

UR UNDERSTANDING OF WHAT CAUSES THIS COMMON PROBLEM IS CHANGING, ALTHOUGH BEHAVIOR MODIFICATION AND MEDICATION REMAIN THE BEST APPROACHES TO TREATMENT. The term “separation anxiety” likely originated in the mid-1980s with Dr. Victoria Voith, a boardcertified veterinary behaviorist and Dr. Peter Borchelt, a Certified Applied Animal Behaviorist. The scientific literature on attachment contains numerous references to separation distress as a normal reaction to separation from individuals with whom an animal has formed a social bond. Puppies for example will whimper and cry if the dam leaves them, even if they are well fed and warm. Separation distress vocalizations begin to decrease around eight to ten weeks of age although they remain higher when puppies are alone in an unfamiliar environment.

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An alternative view of the basis for separation anxiety is that dogs with this disorder have difficulty coping with being left alone. This is an important distinction because some behavior modification protocols for separation anxiety recommend owners ignore their dogs and any behaviors from them designed to promote social contact. This is a harmful recommendation because it damages the human-animal bond and produces anxiety and frustration when the dog is powerless to initiate social interaction, and the owner is prevented from doing so. This goes far beyond the typical training advice to not reinforce annoying behaviors with attention, such as barking, jumping up or “stealing” clothing from the laundry. Rather than focusing on the attention issue, behavior recommendations should help the dog be calm and relaxed, rather than anxious, when left alone. Although this problem is referred to as separation anxiety, a better term might be separation phobia, as many of these dogs are in a complete panic when alone. Not uncommonly, dogs harm themselves by breaking teeth or lacerating their mouths and feet in their attempts to escape the house, yard, or even worse, a crate. Confining a dog with separation anxiety in a crate in an attempt to prevent further destructiveness or housesoiling is a truly dangerous recommendation. Close confinement seems to increase fear in dogs that are already panicked, particularly

when they’ve not been previously accustomed or gradually acclimated to being left alone when confined. Because this is a fear-related issue, separation anxiety problems respond well to classical counter conditioning and desensitization techniques, at least theoretically. The real difficulty lies in the implementation of these procedures. Regardless of the type of fear, it is well documented in the learning literature that continued exposure to the fearproducing event significantly interferes with the successfulness of these techniques.

Behavior modification works with medication Because the fear-producing event is being left alone, the trick is preventing the dogs from being in this state, or alternatively preventing the fear response if they are. Veterinarians can help these patients if they can temporarily offer day boards for dogs until behavior modification plans have progressed and/or medication has taken effect. Reducing the fear response is the reason for prescribing antianxiety medications, one of which (Reconcile™) has been FDA approved for separation anxiety problems, although others are commonly used off-label as well. Veterinarians have access to numerous references regarding medication (e.g. Simpson and

Papich, 2003). In the authors’ experience, over-the-counter naturopathic remedies are not effective for the high anxiety of separation reactions. Those available by prescription only have a much better success rate.

Rather than focusing on the attention issue, behavior recommendations should help the dog be calm and relaxed, rather than anxious, when left alone. However, it’s important to note that no medication has been shown to be effective in reducing separation anxiety without concurrent behavior modification. If the dog shows a visible reaction to the owner’s departure routine, classical counter conditioning and desensitization techniques should be created for the discrete events that comprise the routine, as well as for the owner’s absences themselves. Desensitization is incremental exposure to a fear-producing event, and classical counter conditioning is changing the association between events so that the feared event (previously conditioned stimulus of being left alone) now predicts a pleasant event (a new unconditioned stimulus such as food or toys). The goal of classical conditioning in this context is to change the

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Many behaviors too mild to be presented No research has been done to determine how the typical companion dog reacts to regularly being left alone for most of a normal workday. It would be tempting to assume that most dogs are not bothered by this, because they are not presented to behaviorists, veterinarians or trainers with separation anxiety problems, even though such cases do represent a goodly portion of the case load for these individuals. Separation reactions only become problems when the behaviors displayed are issues for owners. The big three are destructive behaviors, house soiling, and excessive, prolonged vocalizations. An unknown percentage of dogs react more passively, and tend to show behavioral depression including reduced activity levels, and not eating or drinking when alone. Upon their return home, many owners report their dogs will drink for prolonged periods. Our own dog Coral will accept a biscuit from us as we walk out the door, only to drop it and not eat it until we return home. Because these behaviors do not present problems, owners rarely if ever report them to veterinary or behavior experts. Yet these dogs are displaying what could be called mild separation anxiety.

be as long as ten minutes, or nothing more than leaving the room for 30 seconds with the dog prevented from following by either a leash or baby gate. The reason for preventing the dog from following is not to “decrease attachment” but instead to create an extremely brief “absence” the dog can experience without panic. Each out-of-sight experience or actual absence should be paired with irresistible treats. Stuffing the treats in a toy designed for that purpose not only holds the dog’s attention but prolongs the duration of treat delivery. The dog’s interest in the treats is also a way to gauge emotional arousal. Refusal to consume what would otherwise be extremely desirable food indicates a persistent high degree of anxiety and the need to further simplify the behavioral start point. Behavior modification for separation anxiety can be tedious and requires a committed owner. If you do not provide inhome follow-up, it’s advisable to work with a competent trainer, behavior consultant or certified behaviorist who can assist clients with implementation. In addition to appropriate partnership referrals, the veterinarian’s most crucial tasks are to educate clients about the nature of separation anxiety and prescribe medication as an adjunct to behavior modification at their discretion.

References direction of the emotional arousal from fear to calmness or even pleasant anticipation.

Appleby, D and Pluijmakers, J, 2003. Separation anxiety in dogs: The function of homestasis in its development and treatment. Vet. Clin. North Am. Small Animal Pract. 33 (2): 321-344 Borchelt, P and Voith, V, 1982. Diganosis and treatment of separation-related behavior problems in dogs. Vet. Clin. North Am. Small Animal Pract. 182: (12): 625-35.

A sample desensitization hierarchy for a typical owner departure routine might be separated into the following elements, each of which could be paired with (immediately followed by) tossing a treat to the dog and then resuming regular activities (i.e. not leaving): • Collecting items owner typically leaves with (purse, briefcase, phone, etc.) • Triggering the garage door opener • Picking up keys • Walking toward the exit door • Opening the door, then closing it and retreating

Flannigan, G and Dodman, N, 2001. Risk factors and behaviors associated with separation anxiety in dogs JAVMA 219: 460-6.

In extreme cases, each of these elements may need to be split into even smaller behaviors. Rather than opening the door, just reaching for the door knob may be enough to elicit a reaction in particularly fearful dogs.

Dr. Suzanne Hetts, PhD, CAAB, CVJ (left) and her husband Dr. Daniel Estep, PhD, CAAB are awardwinning speakers and authors, having lectured on four continents to animal parents and professionals. Their company, Animal Behavior Associates, Inc., provides pet behavior education to animal professionals at BehaviorEducationNetwork.com and animal parents at HelpingFido.com and HelpingKitty.com.

The behavioral starting place for planned absences could

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Parthasarathy, V and Crowell Davis, S, 2006. Relationship between attachment to owners and separation anxiety in pet dogs (Canis lupis familiaris). J. Veterinary Behavior 1: 109-120. Simpson, BS, and Papich, MG, 2003. Pharmacological management in veterinary behavioral medicine. Vet. Clin. North Am. Small Animal Pract. 33 (2): 365-404. Wright, JC, Reid, PJ, and Rozier, Z, 2005. Treatment of emotional distress and disorders – non pharmacologic methods. Pps. In McMillan F. Ed. Mental Health and Well Being in Animals. Blackwell Publishing, Oxford, U.K. More information on separation anxiety is also available from the authors through On Demand webinars at BehaviorEduationNetwork.com and on DVD from HelpingFido.com.

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Scrubs that make a STATEMENT by Ann briGHtMAn

Colorful uniforms with animal-themed designs are more than just a fashion trend. They help put clients at ease and subsequently enhance patient care.

hen a client step into your clinic with her pet, the surroundings will have a profound effect on how comfortable she feels. Color schemes, lighting, even the quality of the chairs in the waiting room all work together to enhance – or detract from – her levels of ease. The scrubs you wear also play a role in creating a welcoming ambience. While there’s nothing wrong with the traditional white coat, many veterinarians, vet techs and their staff are turning to colorful animal-themed scrubs. These fun patterns can help “break the ice”, put a smile on people’s faces, and consequently

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encourage them to relax a little more. A relaxed client will communicate more effectively and that in turn will help you do the best for his or her pet.

Helping clients relax fosters trust Michelle Rivera, MT, VDT, agrees. “In my office, we like to ‘honor’ all the types of animals we see, such as dogs, cats, horses, reptiles and birds,” she says. “I have found the colors on the scrubs really influence other staff members in their attitudes toward their jobs,

Photos courtesy of Uniform Country.

tech talk

Consider

and they definitely affect the clients. When we wear very bright and cheerful colors, I find the clients seem to feel more at ease around us, making their anxiety wane, and they are more trusting of us and our suggestions. I have always felt that when you wear solid colored scrubs, it makes us feel as if the treatments, environment, and attitudes of the medical professionals are very ‘sterile’ and almost ominous and frightening.”

quality too

When ordering scrubs, adds Michelle, it’s important not to overlook quality in favor of colors and patterns. She says she most often uses Scrubs.com and VAC (Veterinary Apparel Company). “I have, on occasion, gone on the internet, looked up an animal of my choice and purchased from an unknown company, but I found that doing this sometimes does not Thanks to the wide variety of scrub colors and patterns ensure that the sizes are consistent with the tag. They tend available nowadays, there’s something to suit every taste. to generally run smaller. I have also sometimes found the You can choose from cheery dog and cat designs to bright material used to be inferior, which truly cuts the life of the tropical birds, zebra stripes or other animal prints, safari garment considerably. As in all uniforms (team, medical and patterns, cartoons, or cool, calm oceanic scenes. Some are workout) we want them to last with frequent washings cute and amusing, while others are classy and stylized. “In my and to hold their shape and color. Throughout the personal practice, I have found that if our intention, as the medical years, we also tend to stay clear of the light practitioner, is pure, the animals will respond positively to us no or white background scrubs, for obvious reasons. Ours is not always the matter what we wear,” says Michelle. “It is the client we must put at cleanest of jobs!” ease and make happy, because if we can make a client trusting, calm and receptive to us and our treatments, it will in turn allow their pets to follow their lead. How many times have we seen anxious owners and equally anxious pets? By the colors we choose in our facilities to the scents we have lingering about, to the choice of scrubs we wear, all these factors influence the client which in turn will influence the pets and ultimately lead to a very positive experience for all.”

Resources

Scrubs.com SmartScrubs, smartscrubs.com Uniform Country, uniformcountry.com VAC (Veterinary Apparel Company), veterinaryapparel.com

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Product Profile

enzymes Bio-active

beneﬁt xerostomia

by Ann briGHtMAn WitH deirdre PutMAn

ry mouth or xerostomia is characterized by an insufficiency of saliva or a change in the chemical makeup of the saliva. It can have a profoundly negative effect on the oral and general health of a dog or cat, causing a range of symptoms such as gum disease and tooth decay as well as ulcers, sores and other types of inflammation, bad breath, thick saliva, and difficulty eating and drinking. It can deeply impact a pet’s quality of life and general well being. Unfortunately, xerostomia often goes undiagnosed and untreated. Many people find it hard to believe a dog can have dry mouth because they seem to drool so much, but xerostomia is more than dry mouth or the absence of saliva – it’s insufficient or inadequate quality of saliva. Without sufficient or adequate quality saliva, serious decay can set in. It’s also important to note that the first sign of dry mouth – in pets or people – is bad breath. Xerostomia can be caused by certain medications as well as a wide variety of health conditions, including diabetes, dehydration, renal failure, chronic liver disease, aging, FIV in cats, pancreatitis, thyroid dysfunction, nutritional deficiencies and many others. According to The Merck Veterinary Manual, radiation treatment, drugs such as atropine, and immune-mediated issues can also cause the condition. Managing xerostomia involves managing the underlying problem. In the meantime, however, there are ways to relieve and alleviate the symptoms of dry mouth by encouraging the production of quality saliva without excess salivation. “Physiologically balanced mouthwashes relieve the discomfort that results from xerostomia,” offers The Merck Veterinary Manual. “Fluids may be administered to correct dehydration, if present. Immunosuppressive therapy is indicated if immune-mediated disease is suspected.”

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Management also includes restoring the quality and balance of beneficial bacteria in the mouth. The patented LP3 Enzyme System from Pet King Brands (petkingbrands.com) contains lactoperoxidase, lactoferrin and lysozyme, bio-active enzymes that inhibit harmful bacteria without damaging the beneficial strains. This enzyme technology is in all the company’s products, including the Brushless Oral Care line, marketed under the brand name Biotene Veterinarian. The latter also features the enzymes mutanase and dextranase, which work together to make plaque biofilm water soluble and help prevent it from adhering to tooth surfaces. These products improve the quality of the pet’s saliva, reduce plaque, and hinder diseasecausing bacteria as well as fungus and some viruses, through the following specific actions: Lactoperoxidase: An antibacterial agent created from a known milk peroxidise. Lactoferrin: An enzyme found in milk, tears, saliva and some white blood cells. It kills bad bacteria by depriving them of iron. Lysozyme: An enzyme found in milk and egg whites. It splits the cell walls of harmful bacteria by disrupting the formation of a glycosidic bond between the two components of peptidoglycan. Mutanase and dextranase: Disrupts glycan bonds in plaque. Managing the underlying cause/s of xerostomia, along with using products to alleviate dry mouth symptoms and restore bacterial balance, can effectively correct the problem.

Veterinary Resource Guide ASSISTIVE DEVICES HandicappedPet.com Amherst, NH USA Phone: (603) 577-8858 Website: www.handicappedpets.com

Tallgrass Animal Acupressure Institute Castle Pines, CO USA Phone: (303) 681-3033 Email: nancy@animalacupressure.com Website: www.animalacupressure.com

Best Friend Mobility Myrtle Beach, SC USA Phone: (503) 575-9407 Email: sylvan@sylvancompany.com Website: www.bestfriendmobility.org

Traditional Chinese Veterinary Medicine TCVM Reddick, FL USA Phone: (352) 591-5385 Email: register@tcvm.com Website: www.tcvm.com

Animal Orthocare Arlington, VA USA Phone: (703) 474-6204 Email: animalorthocare@hotmail.com Website: www.animalorthocare.com

Veterinary Botanical Medicine Association VBMA Acworth, GA USA Email: ofﬁce@vbma.org Website: www.vbma.org

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Immunotonic

herbs

by GreG tiLFord, HerbAList

egardless of the natural practitioner’s chosen modality – whether it’s Western herbal medicine, traditional Chinese Medicine, Ayurveda or even homeopathy – the goal of improving the body’s protective and corrective abilities is at the center of the therapeutic effort. For example, in the case of a viral infection that is producing fever, the goal of a Western herbalist is not to simply squelch the heat as conventional analgesics might do, but to honor the fever as part of what the body is trying to do for itself, and to optimize the immune functions that are at work.

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Although uncomfortable to the sufferer, fever is seen as part of an immune response to an invading pathogen that needs to be removed from the body system. Rather than trying to attack the invading entity directly with drug interventions that might inhibit the body’s immune responses, the herbalist will work toward improving the body’s efforts by supporting or “boosting” the immune system in ways that will allow the body to heal more quickly and efficiently. To accomplish this, the practitioner can choose from a wide variety of immune system “tonics” – natural substances that are known to strengthen immune activities.

Not all immunotonics are created equal

Some immunotonics, like the venerable Echinacea, are best used for strengthening immune defenses at the earliest onset of infection, and reducing the severity and duration of viral respiratory tract infections, but do not serve well as a prophylactic agent.1, 2. In fact, Echinacea has been shown to have little or no effect upon the immune systems of healthy men who took the herb for preventative purposes.3

â&#x20AC;Śthe hardest part of my job is convincing people that immunotonics seldom work well in the absence of good nutrition. Many other immunotonics, however, do appear to boost immune functions prophylactically and serve as powerful antioxidants that can be used as part of a daily supplement regimen to reduce the risk of tumor development or other forms of immune-mediated disease in susceptible individuals.

A closer look at Reishi

One example is Reishi mushroom (Ganoderma lucidum). Reishi extracts are safe to use, palatable and easy to feed, and can be used to add a unique mix of beta-glucans, triterpenes and other polysaccharides to the diet that have direct antioxidant and cytotoxic activity against hepatoma, cervix uteri tumor, mouse and murine sarcoma, and other forms of cancer, 4,5 perhaps even before the cancer can develop. At the same time, the polysaccharides in reishi may also help stimulate glutathione S-transferase activity, meaning that it could have a potential role in detoxification reactions.6 Reishi also appears to positively effect insulin and blood glucose levels. Animal studies show that ganoderan B, a reishi mushroom glycan, seems to decrease plasma insulin levels and glycogen liver content. It also seems to increase the activity of glucokinase, phosphofructokinase, and glucose-6-phosphate dehydrogenase, while decreasing glucose-6-phosphate and glycogen synthetase activity. 7 What this all means is that reishi, as well as other medicinal mushrooms like maitake (Grifola integrative veterinary care

In vitro studies indicate that the polysaccharides of astragalus appear to bind and activate B cells and macrophages, but not T cells. frondosa) or cordyceps (Cordyceps sinensis) may benefit an immune compromised body in a variety of ways that conventional drugs and basic nutrition cannot.

Astragalus as an immune tonic

While each immuntonic herb or mushroom may differ in how they specifically affect systems that support natural immunity, a few stand out as “general purpose” immune tonics. One such herb is Astragalus (A. membranaceus), a member of the legume family that has been used in Chinese medicine for thousands of years to promote strong immunity and boost “vital life energy”. From Western scientific accounts, astragalus seems to improve the immune response. In vitro studies indicate that the polysaccharides of astragalus appear to bind and activate B cells and macrophages, but not T cells.8 Astragalus potentiates the effects of interferon, increases antibody levels of IgA and IgG in nasal secretions, and increases interleukin-2 levels (IL-2).9,10 It also seems to improve the response of mononuclear cells and stimulate lymphocyte production.11 Astragalus contains astragalans, polysaccharide constituents that stimulate white blood cell production, T-cells, killer cells and antibodies in a fashion that helps maintain and restore the immune system. Although very few animal studies have been conducted, a human study conducted in China tested over 1,000 people and found that those taking astragalus had fewer colds – and those who did get a cold had a much quicker recovery time.12 From my perspective, it is among the best tonics for daily support of elderly or otherwise debilitated animals, especially those with depressed heart or renal function,13,14 where part of its effectiveness may be attributable to diuretic and natriuretic effects. Best of all, like most immunotonic herbs, astragalus is very safe. A daily dose is as simple as a sprinkle of the ground root on food. A typical dose for dogs would be the range of 4g to 6g daily, and cats 2g to 3g daily. A low alcohol glycerin tincture can also be employed, adding the advantage of delivering higher concentrations of active constituents in much smaller, sweeter-tasting doses. The exact dose will vary according to the nuances of the formulation, so follow the manufacturer’s recommendations.

Feed the body ﬁrst

Now comes the most important part of this article: the subject of diet and acceptance of the unknown. As an herbalist who travels many thousands of miles per year to speak with audiences ranging from first time pet owners to experienced veterinarians and academics, I have to tell you that the hardest part of my job is convincing people that immunotonics seldom work well in the absence of good nutrition. Year after year, I receive conflicting reports and read negative studies about how Echinacea and other immunotonic herbs and mushrooms really aren’t effective – but the biggest flaw in all of them is that nutrition and quality of life are never taken into account. As mentioned at the beginning of this article, the primary goal of holistic medicine is to support the body in what it is designed to do best: stay healthy. To accomplish this goal, the practitioner needs to keep two golden rules in the front of his or her mind at all times:

1 2

We are trying to support or stimulate a very complex system of organs, microbes and chemistries that still baffle our greatest scientists.

In order for any system of the body to operate at optimum levels, it must be well fed and in balance with other systems that support it.

A big part in the success of any holistic course of healing requires that we let go of our inherent desire to understand how everything in nature works. In the case of the immune system, there are many “how” and “why” questions that science may never be able to answer. They include the triggering mechanism of cytokines, and the innate yet selective abilities of the body to produce its own medicinal mix of disease fighting chemicals. We don’t know all the answers, but we cannot deny that the body can do things we don’t understand. At the core of successful holistic medicine is a requirement to let go of scientific validation long enough to simply let the body do its work. We also have to take into account that the body, as amazing as its healing abilities may be and regardless of whether it belongs to a human or a Guinea pig, needs to be properly nourished before it can be expected to work properly. The immune system must be afforded the right tools to do its job, in the form of good food that is appropriate for the species (another article, indeed!), healthy Continued on page 60.

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Continued from page 58.

More noteworthy

immunotonic herbs Eleuthero (E. senticosis) – Formerly known as “Siberian ginseng”. Contains eleutherosides that are antioxidant and anti-tumor. Olive leaf (Olea europaea) – Immune boosting herb that also has broad spectrum antibacterial, antifungal and antiviral properties. Ashwaganda (Withania somnifera) – Contains withanolides and sitoindosides that may stimulate macrophages, phagocytosis, and lysosomal enzymes. Thought to improve immune system functions while the body is undergoing physical or emotional stress. Garlic (Allium sativum) – Antitumor, antioxidant with strong antimicrobial and liver support attributes. Safe when used in moderation. Just a pinch a day on the food! Schisandra (Schisandra chinensis) – Referred to as an adaptogen, schisandra seems to increase concentration, coordination, and endurance as it boosts the immune system at various levels of activity. It supports healthy liver function at the same time. 60

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exercise, and a clean, happy living environment. Likewise, if the body is polluted with toxic waste because it cannot effectively eliminate the byproducts of digestion, the immune system’s capacity to protect against pathogens or carcinogenesis will be significantly diminished. Before immunotonic herbs can be used to their full potential, one must learn to see immunity from a much broader perspective – one that regards the immune system as an amazing, integral part of a delicately balanced, interdependent body system; a complex arrangement of organs, chemistries and life energy, all of which must be honored as a whole. 1

Brinkeborn RM, Shah DV, Degenring FH. Echinaforce and other Echinacea fresh plant preparations in the treatment of the common cold. A randomized, placebo controlled, double-blind clinical trial. Pytomedicine 1000;6:1-6.

Melchart D, Walther E, Linde K, et al. Echinacea root extracts for the prevention of upper respiratory tract infections: a double-blind, placebo-controlled randomized trial. Arch Fam Med 1008;7:541-5.

Schwarz E, Metzler J, Diedrich JP, et al. Oral administration of freshly expressed juice of Echinacea purpurea herbs fails to stimulate the nonspecific immune response in healthy young men: results of a double-blind, placebo-controlled crossover study. J Immunother 2002;25:413-20.

Wasser SP, Weis AL. Therapeutic effects of substances occurring in higher Basidiomycetes mushrooms: a modern perspective. Crit Rev Immunol 1999;19:65-96.

Yuen JW, Gohel MD. Anticancer effects of Ganoderma lucidum: a review of scientiﬁc evidence. Nutr Cancer 2005;53:11-7

Kim HS, Kacew S, Lee BM. In vitro chemopreventive effects of plant polysaccharides Aloe barbadensis miller, Lentinus edodes, Ganoderma lucidum and Coriolus versicolor). Carcinogenesis 1999;20:1637-40.

Hikino H, Ishiyama M, Suzuki Y, et al. Mechanisms of hypoglycemic activity of ganoderan B: a glycan of Ganoderma lucidum fruit bodies. Planta Med 1989;55:423-8.

Shao BM, Xu W, Dai H, et al. A study on the immune receptors for polysaccharides from the roots of Astragalus membranaceus, a Chinese medicinal herb. Biochem Biophys Res Commun 2004;320:1103-11.

Hou YD, Ma GL, Wu SH, et al. Effect of Radix Astragali seu Hedysari on the interferon system. Chin Med J (Engl) 1981;94:35-40.

Upton R, ed. Astragalus Root: Analytical, quality control, and therapeutic monograph. Santa Cruz, CA, American Herbal Pharmacopoeia. 1999:1-25.

Sun Y, Hersh EM, Lee SL, et al. Preliminary observations on the effects of the Chinese medicinal herbs Astragalus membranaceus and Ligustrum lucidum on lymphocyte blastogenic responses. J Biol Response Mod 1983;2:227-37.

Chang, H, Pharmacology and applications of Chinese material medica, World Science 1987

Ma J, Peng A, Lin S. Mechanisms of the therapeutic effect of astragalus membranaceus on sodium and water retention in experimental heart failure.

Yang YZ, Jin PY, Guo Q, et al. Treatment of experimental Coxsackie B-3 viral myocarditis with Astragalus membranaceus in mice. Chin Med J (Engl) 1990;103:14-8.

greg tiLforD iS Co-author of all you ever waNted to kNow aBout HerBs for pets. he iS an internationaLLy renowneD herbaLiSt, author anD Co-DeVeLoper of aniMaLS’ apawtheCary, a Line of herb tinCtureS DeSigneD for DogS anD CatS. he iS a LeaDing expert in the fieLD of Veterinary herbaLiSM anD SerVeS aS a profeSSionaL ConSuLtant, CuStoM forMuLator, anD eDuCator for Many VeterinarianS, ManufaCturerS, anD pubLiSherS throughout

north aMeriCa. greg iS weLL known for hiS unpreCeDenteD work in the fieLD of earth-ConSCiouS herbaL MeDiCine anD haS written three bookS on the SubJeCt: tHe ecoHerBalists fieldBook, ediBle & mediciNal plaNts of tHe west anD from eartH to HerBalist.

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events 2012 Veterinary Cancer Society Annual Conference October 18-21, 2012 – Las Vegas, NV The 2012 Annual Conference will be quite a conference for both VCS and ACVR. We’re expecting nearly 900 participants to join us for this four day conference. The M Resort is SOLD OUT but in Las Vegas, there are lots of other choices! Chaired by Dr. Andrew Vaughan and co-chair Dr. Pam Jones, plans are well underway for THREE excellent keynote speakers, a Resident Review Workshop, outstanding oral and poster presentations, a Technician workshop and so much more. The Awards Reception on Saturday evening at the Palms Resort will be like none other and we hope that you will mark your calendar and plan to join us in Vegas in October. For more information: Sandy Strother (573) 823-8497 Vetcancersociety@yahoo.com www.vetcancersociety.org

American College of Veterinary Surgeons Symposium November 1-3, 2012 – National Harbor, MD The ACVS Veterinary Symposium offers the most advanced information on a wide range of surgical procedures as well as pre-operative patient care, post-operative complications and advanced diagnostic techniques. With over 200 speakers including guest lecturers, scientific abstracts and posters you will come away with new information that will improve your veterinary surgical practice and there will be plenty of opportunity to visit the Exhibit Hall with over 100 exhibitors for one-stop shopping for veterinary supplies, equipment and architectural needs. For more information: Sue Nocitra (301) 916-0200 acvs@acvs.org www.acvs.org

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