V13I1 (Winter 2022) by Redstone Media Group

Innovative VOLUME 13 ISSUE 1

VETERINARY CARE

USING LASER THERAPY FOR URINARY AND RENAL DISEASE PHOTOBIOMODULATION HELPS REDUCE PAIN AND INFLAMMATION IN DOGS AND CATS WITH URINARY AND RENAL DISEASE. — P. 8

ALTERNATIVE APPROACHES TO RENAL DISEASE

ELECTROACUPUNCTURE FOR CHRONIC LAMENESS

www.IV C Journal.com

WINTER 2023

Ozone therapy and acupuncture are just two modalities that help treat kidney failure and related diseases in canine and feline patients. — P. 12

Chronic lameness in dogs and cats can have a range of causes. Find out how electroacupuncture can help get them moving again. — P. 42

FELINE CARDIOMYOPATHY: CREATING A BETTER OUTCOME FOR PATIENTS

WHY HIP DYSPLASIA BENEFITS FROM INTEGRATIVE APPROACH

Though often seen as hopeless, cats can respond to treatments such as nutritional therapy, herbs, and more. — P. 32

A TREATMENT PLAN FOR FLUTD, USING ESSENTIAL OILS When used safely, pure essential oils are a valuable treatment modality for lower urinary tract disease in cats. — P. 15

An integrative multimodal approach can help manage canine hip dysplasia and the osteoarthritis often arising from it. — P. 38

SUPPLEMENTS THAT SUPPORT DOGS AND CATS WITH CKD

A comprehensive look at the many supplements that can help address chronic kidney disease in dogs and cats. —P. 20

WINTER 2023

EDITORIAL DEPARTMENT

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

COLUMNISTS & CONTRIBUTING WRITERS

Susan Albright, DVM Chris Bessent, DVM, MSOM, Dipl. OM, L.Ac. Todd Cooney, DVM, CVH Cristina Firulete, DVM, CVA Jodie Gruenstern, DVM, CVA Melissa Kellagher, AHVMA Director of Operations Angie Krause, DVM, CVA, CCRT Cynthia Lankenau, DVM Lisa A. Miller, DVM, CCRT Jared Mitchell, DVM, CVMA, CVA, CVFT Margo Roman, DVM, CVA, COT, CPT Nancy Scanlan, DVM, MS, CVA Judith E Saik, DVM, DACVP, CVA, CVCH, CVFT

ADMINISTRATION & SALES

SUBMISSIONS: Please send all editorial material, photos and correspondence to Dana Cox at Dana@redstonemediagroup.com or IVC Journal, 160 Charlotte St., Suite 202 Peterborough, ON, Canada K9J 2T8. We welcome previously unpublished articles and color pictures either in transparency or disc form at 300 dpi. We cannot guarantee that either articles or pictures will be used or that they will be returned. We reserve the right to publish all letters received. ADVERTISING SALES: Senior Media Specialist/Editorial Associate: Kat Shaw, (866) 764-1212 ext. 315 Katshaw@redstonemediagroup.com Business Development/Editorial Associate: Becky Starr, (866) 764-1212 ext. 221 Becky@redstonemediagroup.com Business Development Representative: Luke Pigeon, (866) 764-1212 ext. 228 Luke.pigeon@redstonemediagroup.com SUBSCRIPTION SERVICES MANAGER: Simone Beimbrink, (866) 764-1212 ext. 115 Simone@redstonemediagroup.com CLASSIFIED ADVERTISING: Libby Sinden classified@IVCJournal.com

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IVC Journal (ISSN 2291-9600) is published four times a year by Redstone Media Group Inc. Publications Mail Agreement #40884047. Entire contents copyright© 2023. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: January 2023.

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

IVC Winter 2023

contents FEATURES

THERAPY FOR LOWER 8 LASER URINARY TRACT AND RENAL DISEASE IN PETS

By Lisa A. Miller, DVM, CCRT

By Christ Bessent, DVM, MSOM, DIPL. OM, L.AC

How dogs and cats with urinary and renal disease can benefit from the pain-relieving and inflammation-reducing effects of photobiomodulation or laser therapy.

ALTERNATIVE APPROACHES TO RENAL DISEASES IN VETERINARY PATIENTS

The primary approach to CKD in cats is dietary management to lessen the abnormalities caused by marginal kidney function, and extend the lifespan of felines with this disease.

By Margo Roman, DVM, CVA, COT, CPT

ESSENTIAL OILS FOR FLUTD By Jared Mitchell, DVM, CVMA, CVA, CVFT

By Nancy Scanlan, DVM, MS, CVA

A comprehensive look at the supplements that can help address chronic kidney disease in dogs and cats.

38 32 4

Heart disease in cats is often seen as hopeless, but alternative treatments such as nutritional therapy, herbs, and even medicinal leeches may offer some promise.

When used safely, pure essential oils are a valuable treatment modality for lower urinary tract disease in cats.

OF SUPPLEMENTS FOR 20 APETSSURVEY WITH CKD

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FELINE CARDIOMYOPATHY & THROMBOEMBOLISM — ALTERNATIVE TREATMENTS CAN HELP By Jodie Gruenstern, DVM, CVA

Treatment for kidney failure and other renal diseases in dogs and cats can be supported by a range of alternative modalities, including ozone therapy, acupuncture, and more.

NUTRITIONAL MANAGEMENT OF CHRONIC KIDNEY DISEASE IN FELINES

INTEGRATIVE APPROACH TO CANINE HIP DYSPLASIA By Angie Krause, DVM, CVA, CCRT From physical therapy to acupuncture, an integrative multimodal approach is an effective way to manage canine hip dysplasia and the osteoarthritis that often arises from it.

THE USE OF ELECTROACUPUNCTURE FOR CHRONIC LAMENESS IN SMALL ANIMALS By Cristina Firulete, DVM, CVA Chronic lameness in dogs and cats can have many causes, including osteoarthritis, hip dysplasia and more. Electroacupuncture can be an effective way to help treat the problem.

COLUMNS & DEPARTMENTS

advisoryboard

7 Editorial 19 From the AVH 25 From the VMAA 31 From the AATCVM & WATCVM 41 From the AHVMA 47 Industry innovations

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

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

49 From the VBMA PROFITABLE PRACTICE

48 Profitable practice — Visbiome Vet IN THE NEWS

37 The carbon footprint of veterinary

practices — easy-to-use calculator measures

50 Big data tech being explored to

improve veterinary medicine

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

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

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

IVC Winter 2023

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

Dr. Chris Bessent has over 30 years of experience in veterinary medicine, and has certificates in veterinary acupuncture, veterinary chiropractic, and veterinary Chinese herbology. She also received her degree in veterinary nutrition and founded The Simple Food Project, formulating freeze-dried raw food diets for cats and dogs using nothing but whole foods. Currently, Dr. Bessent divides her time between The Simple Food Project and Herbsmith, a manufacturer of premium quality supplements for pets. Both are owned and operated out of her facilities in southeastern Wisconsin (simplefoodproject.com, herbsmithinc.com). p.27

2. CRISTINA FIRULETE, DVM, CVA

Dr. Cristina Firulete received her DVM from Cluj-Napoca, Romania in 2017. As a student, she worked in practices that offered alternative options such as acupuncture and homeopathy. Upon realizing how important it is to treat every patient with a holistic view, Dr. Firulete enrolled in Chi’s CVA Program in Spain, earning her CVA in 2019, and now continues pursuit of her TCVM education through enrolment in Chi’s Herbal Medicine Course. Dr. Firulete plans to pursue her Master’s Degree in TCVM. She is currently a veterinary surgeon practicing in a holistic clinic in northern England, where she incorporates integrative medicine into the care and treatment plans of her patient. Since 2021, she has been the Chi University UK Director, teaching the onsite acupuncture courses. p.42

3. JODIE GRUENSTERN, DVM, CVA

Dr. Jodie Gruenstern graduated from UW-Madison in 1987. She is a certified veterinary acupuncturist and food therapist by the Chi Institute; former Vice-President of the Veterinary Medical Aromatherapy Association (VMAA) and a member of the AHVMA and AzVMA. Dr. Jodie is the author of Live with Your Pet in Mind, available on Amazon, and is a nationally-renowned speaker, writer, and pet product formulator. She has provided veterinary supervision for non-anesthesia teeth cleaning throughout Arizona. Dr. Jodie’s Integrative Consulting office is in Fountain Hills (http://docjodie.com, docjodie@ docjodie.com). p.32

4. ANGIE KRAUSE, DVM, CVA, CCRT

Dr. Angie Krause graduated from Texas A&M University, College of Veterinary Medicine in 2007. She incorporates many holistic modalities into her practice, has a love for Traditional Chinese Medicine and Physical Medicine, and offers laser therapy, myofascial release, physical therapy, nutrition, and more. Dr. Angie has a house call practice called Boulder Holistic Vet (BoulderHolisticVet.com). p.38

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5. LISA A. MILLER, DVM, CCRT

Dr. Lisa Miller is Vice President of Clinical Veterinary Medicine for Companion Animal Health, and a graduate of the University of Tennessee, College of Veterinary Medicine. She is certified in canine rehabilitation therapy, and practiced rehabilitation, sports medicine, and acupuncture before returning to general practice, and later, joining the animal health industry. Dr. Miller has been working with laser therapy/photobiomodulation (PBM) since 2006, has lectured and written extensively on rehabilitation and laser therapy-related topics, and authored a chapter in Laser Therapy in Veterinary Medicine. She coordinates all veterinary and advanced PBM research involving Companion Animal Health technologies, and is a consultant and reviewer for PBM research worldwide. She is a member of the AVMA, the American Association of Rehabilitation Veterinarians, and the American Society of Laser Medicine & Surgery. p.8

6. JARED MITCHELL, DVM, CVMA, CVA, CVFT

Dr. Jared Mitchell graduated from Mississippi State University’s College of Veterinary Medicine in 2004. He owns Mitchell Animal Clinic in Mobile, Alabama and began incorporating holistic modalities into his practice. Dr. Mitchell has advanced training in essential oils through the VMAA. He has published articles for several peer-reviewed journals and plans to continue contributing articles and educating colleagues on the therapeutic benefits of essential oils. Dr. Mitchell is also certified in veterinary acupuncture and veterinary food therapy through Chi University and is currently enrolled in their Masters of TCVM program. p.15

7. MARGO ROMAN, DVM, CVA, COT, CPT

Dr. Margo Roman graduated from the Veterinary College at Tuskegee Institute of Alabama, and was on the faculty of Tufts University, teaching anatomy, physiology and acupuncture. She was the consulting veterinarian in an IACUC for Creature Biomolecule in Hopkinton, Massachusetts, studying osteogenic proteins. Dr. Roman’s integrative practice, Main Street Animal Services of Hopkinton (M.A.S.H.), offers chiropractic, physical therapy, massage, Reiki, acupuncture, herbs, conventional medicine and more. p.12

8. NANCY SCANLAN, DVM, MS, CVA

Dr. Nancy Scanlan is Executive Director for the AHVM Foundation, a board member of the World Association of Traditional Chinese Veterinary Medicine, and a consultant on the Veterinary Information Network. She has been using complementary health therapies in her veterinary practice since 1970, including nutraceuticals, acupuncture, non-classical homeopathy, and Chinese and Western herbs. Dr. Scanlan was Executive Director of the AHVMA for three years and president of the VBMA for two years. p.20

editorial

Focus on the Urinary System I have a beautiful Angora Rabbit named Tib. My wife, who doesn’t enjoy the company of cats, gets along really well with him. The only problem I had with our new pet was the stinky urine — but that disappeared once I changed Tib’s diet. The lesson here is that dietary modulations have a lot of impact on an animal’s body systems, including the urinary system. Along with diet, a variety of integrative treatment approaches can help us better resolve different urinary problems in our animal patients. As you may have guessed, this issue of IVC Journal is primarily about the urinary system. The renal organs are an important part of the canine and feline body. They are responsible for carrying out the filtration of body fluids, and for the formation and excretion of urine. Veterinarians know that maintaining a healthy urinary system is important for the overall health of an animal. The urinary system plays additional vital functions such as maintaining a constant extracellular environment through the conservation and excretion of electrolytes and water; producing the enzyme renin for regulating blood pressure and sodium reabsorption; producing the hormone erythropoietin, which regulates hematopoiesis; and metabolizing vitamin D. Urinary diseases can occur for different reasons, leading to pathologic processes and malfunction of one or more organs. Appropriate therapies for treating these diseases should be devised according to their causative agents, severity, and location. Diagnostic samples are important because they can help pinpoint the nature of the pathologies. In cases where a specific cause can’t be identified, supportive and non-specific treatment should

be initiated while thoroughly monitoring the animal. Having the knowledge of different treatment approaches is important for increasing the chances of recovery. We present many insightful articles about different approaches to handling urinary problems in our animals. Dr. Nancy Scanlan provides a survey of supplements that can help keep your patients’ kidneys functioning optimally. Useful information about laser therapy for lower urinary tract and renal disease has been curated by Dr. Lisa Miller. You’ll also find an article with a broader scope by Dr. Margo Roman, in which she lists all the possible alternative therapies for renal disease. As well, the use of essential oils for FLUTD is discussed by Dr. Jared Mitchell. Aside from the urinary system, we cover several other fascinating topics that are sure to pique your interest. For example, Dr. Angie Krause discusses an integrative approach to hip dysplasia in dogs. And in Dr. Cristina Firulete's article, you have an opportunity to learn how electroacupuncture can be used to treat chronic lameness. I hope you get the most out of this issue! Warm regards,

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

IVC Winter 2023

How dogs and cats with urinary and renal disease can benefit from the pain-relieving and inflammationreducing effects of photobiomodulation or laser therapy.

FOR LOWER URINARY TRACT AND RENAL DISEASE IN COMPANION ANIMALS BY LISA A. MILLER, DVM, CCRT

The use of photobiomodulation, or laser therapy, as a non-invasive treatment for various injuries and conditions in veterinary medicine continues to expand and generate interest for both practitioners and the research community. Photobiomodulation (PBM) has a beneficial effect on cells and tissues, contributing to a directed modulation of cell behaviors, enhancing tissue repair and cell proliferation while simultaneously reducing inflammation and pain. This article looks at how PBM or laser therapy can help with lower urinary tract and renal disease in dogs and cats.

LOWER URINARY TRACT DISEASE Laser devices emitting light in the visible to far-infrared spectrum have been used in humans to diagnose and/or treat various diseases of the genitourinary tract for nearly 50 years. This has included procedures on both normal and neoplastic tissues, to ablate and/or excise various lesions, and in the management of menometrorrhagia and other conditions.15 Photobiomodulation therapy (PBMT) has been proposed by some in the human medical realm as an alternative for managing genitourinary syndrome of menopause (GSM), stress urinary incontinence (SUI), and interstitial cystitis/bladder pain syndrome (IC/BPS) in women. The biological basis, symptoms, and management of these conditions easily lend themselves to the rationale for using PBMT as a possible treatment, and devices designed for these applications in humans have demonstrated beneficial clinical and histologic changes in recent studies.16-18 One report published on the use of a novel system for the temporary relief of pelvic muscle spasm and pain in

IVC Winter 2023

women showed clinically significant improvement in pelvic pain and pain with urination in 65% of participants, and follow-up data has indicated that the therapeutic effect may last several months.18,19 Based on the non-invasiveness of the modality, and its ease of use for feline patients in particular, PBMT may also be a possible therapeutic intervention for certain lower urinary tract disorders in cats. Feline idiopathic (or interstitial) cystitis (FIC) has also been called idiopathic feline lower urinary tract disease (FLUTD) and feline urologic syndrome.20 While the etiology of FIC is multifactorial and not completely understood, there appears to be a complex interaction between the urinary bladder, nervous system, adrenal glands, and environmental conditions. Affected cats seem to have an excitatory sympathetic nervous system response alongside decreased adrenocortical function in response to stressful episodes or environmental changes, and an associated increase in bladder wall permeability.19,20 This abnormal degree of urothelial permeability, also found in human IC patients, allows increased penetration of protons and potassium ions from urine to the submucosa, which causes irritation and may stimulate sensory neurons.20-23 The positive effects noted in the aforementioned human studies are consistent with the mechanism of action of PBM, and the potential impact on multiple bladder and pelvic pain generators.24

HOW PBM WORKS Using wavelengths in the red and infrared range, PBM activates cytochrome c oxidase and increases mitochondrial electron transport, inducing a cascade of events leading to an increase in adenosine triphosphate (ATP). This produces beneficial reactive oxygen species (ROS), nitric oxide; affects healing and stimulates collagen production via the upregulation of specific substrates and cytokines (including epidermal growth factor and transforming growth factor beta); and downregulates others (e.g. interleukin [IL]-6, IL-8, and IL-1).1-6 Modulating the inflammatory process is a large part of the mechanism by which PBM reduces pain; however, there are other mechanisms involved as well, making it an effective analgesic modality. PBM modulates neuronal activity via the normalization of ion channels, reducing the sensitization of injured or inflamed peripheral neurons, the dorsal root ganglion (DRG) and spinal cord.7-10 In vitro studies in rat dorsal ganglia cultures have demonstrated that PBM can disturb fast axonal transport via perturbation of microtubule arrays by reducing ATP synthesis in axonal mitochondria of small diameter neurons. An in vivo study has shown that PBM utilizing higher irradiances inhibits Aδ and C-fiber transmission, and this mechanism appears to be involved in PBM of the DRG as well.10-13

In addition to effects mediated primarily via the biologically active chromophore mentioned above, there are also lightsensitive ion channels within the cell membrane. These ion As mentioned previously, studies show that channels are gated by light and include "transient receptor PBMT results in analgesia through reduction in potential" (TRP) channels14 which are activated by specific factors, A-delta and C-fiber activity, modification of prosuch as heat or cold, noxious chemicals, and mechanical forces, inflammatory cytokines, growth factors and among others. When activated, TRP channels open, allowing ions such chemokines. C-fiber activation is thought to as sodium to flow into the cell. This results in an action potential, which is realized as a nerve impulse. Mounting evidence suggests that light be a major contributor to the development of mediated activation of TRP is responsible for some of PBM’s mechanisms the allodynia responsible for the symptom of action as well, particularly regarding histamine-dependent wound healing of urinary frequency and bladder pain effects and antinociceptive effects.14 in human patients with IC/BPS.25

Photo courtesy of Black Mountain Animal Hospital, Henderson, NV.

Figure 1. Photobiomodulation being applied to the caudal abdomen of a feline patient.

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C-fiber sensory neurons in the bladder are more sensitive in cats with FIC than in normal cats, contributing to altered activation of neural pathways. Research has also indicated that abnormal transient receptor potential (TRP) vanilloid receptor 1 responses of afferent neurons may contribute to this enhanced bladder sensitivity in FIC.26 The ability to potentially mediate the activation of TRP14 and/or reduce the sensitivity of C-fiber sensory neurons in the bladder of these patients could be a potential target for PBMT to exert antinociceptive effects. Cats with FIC may have a wide range of presentations, including frequent recurrent episodes, chronic persistent signs, or even urethral obstruction.27 PBMT may be of potential benefit in all these situations as part of the multimodal management, decreasing the severity of clinical signs via providing analgesia, and decreasing urethral spasm during episodes of acute pain. When urethral obstruction does occur, many veterinarians, including the author, have also found PBMT helpful for decreasing swelling, spasm, and pain prior to and/or during the placement of a urinary catheter to alleviate any obstruction, and in providing pain management for cats that have been unblocked and/or remain in hospital with indwelling urinary catheters.28 In each of these scenarios, treating the area(s) of the urinary bladder (Figure 1) and the perineum (to target the urethra [and the penis when applicable]) is recommended. Additionally, treating the lumbar and sacral spine could be of added benefit, targeting the sensory neurons innervating the bladder via the pelvic and hypogastric nerves, which originate from the dorsal horn of the sacral and lumbar spinal cord, respectively. A deep tissue dosage of 6-10 J/cm2 is recommended, treating ON contact to minimize light loss(es) from reflection.28 The treatment head/handpiece utilized (and therefore the spot size of the laser beam), and treatment power (in watts) for administering therapy, will determine the irradiance at the skin surface, and subsequently at the level of the urinary bladder.

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Extrapolating from computational modeling (COMSOL Multiphysics, Burlington, MA) and previous cadaver work in dogs,29 a treatment spot size of 5 cm2, and a power setting of 5-8 W (1-1.6 W/cm2) at the skin surface means the irradiance at the target tissue should be approximately 155-250 mW/cm2. The author recommends scanning the entire caudal abdomen to treat the urinary bladder, utilizing a similar technique to scanning the area for a diagnostic ultrasound, trying to aim for all aspects of the bladder where it is positioned in the abdomen. Due to the perineum often being contaminated with urine and/or prepped for catheterization, an off-contact treatment technique should be used in this particular area, treating around the entire perineal area and never hovering over one spot, to allow tissues to appropriately thermally relax. Though this discussion has focused primarily on feline patients, the same technique of treating the urinary bladder might also be applied to canine patients experiencing discomfort from cystitis. For acute situations or hospitalized patients, PBMT sessions may be performed daily for pain management, weaning the frequency of treatment sessions as the patient improves, until resolution. For more chronic situations, weaning out to a maintenance schedule of treatments that aid in keeping a patient’s symptoms to a minimum (typically once every two to four weeks) is recommended after initial improvement(s) are clinically noted.

CHRONIC KIDNEY DISEASE Mitochondrial dysfunction, reactive oxidative stress, inflammation, and renal tissue fibrosis are inherent components in chronic kidney disease (CKD), depending on etiology. Studies have investigated PBMT for its potential to aid in the treatment of these patients due to its ability to stimulate repair and attenuate the sequelae of inflammation and fibrosis. Studies examining the mechanisms of PBMT on CKD have described beneficial findings with regards to decreasing inflammatory cytokines,30 decreasing renal hypertension, preserving glomerular filtration rate,31 and decreasing renal fibrosis particularly through affecting TGFβ1 signaling.31,32 One study looking at the effects of PBM in a streptozotocin-induced diabetic kidney model showed that the therapy lowered the values of serum BUN, serum creatinine, and BUN/creatinine ratio in diabetic rats.33 Veterinary colleagues as well as the author have noted anecdotal subjective improvements in their own CKD-PBM treated patients with regards to decreasing azotemia and stimulating appetite and overall well-being.34

To attempt to treat the kidneys, the recommendation is to use a deep tissue dose of 6-10 J/cm2 on contact (scaling up with the size of the patient/depth of the target tissues) and focus on the cranial abdomen, including the area of the kidneys (as though performing a diagnostic ultrasound scan of that area). Approaching from both the ventral aspect of the abdomen and the lateral walls of the abdomen, the left kidney should be easier to localize than the right kidney because of its lateral location along the midabdomen, and may even be palpable. The right kidney, due to its craniodorsal location, may have to be treated based on aiming the treatment beam in that orientation under the rib cage of the abdomen on that side, or even utilizing a lateral approach in large deep-chested dogs through the 11th or 12th intercostal space, making sure to keep the beam scanning and moving at all times.

Karu TI. Primary and secondary mechanisms of action of visible to near-IR radiation on cells. J Photochem Photobiol B. 1998; 49:1–17.

Stadler I, Lanzafame RJ, Evans R, et al. 830-nm irradiation increases the wound tensile strength in a diabetic murine model. Lasers Surg Med. 2001; 28, 220–226.

Hamblin MR, Demidova TN. Mechanisms of low level light therapy. SPIE Proc 2006; 6140:1–12.

Krames ES. The dorsal root ganglion in chronic pain and as a target for neuromodulation: A review. Neuromodulation. 2015; 18:24–32.

de Souza MVP, Ferraresi C, Kawakubo M, et al. Transcranial low-level laser therapy (810 nm) temporarily inhibits peripheral nociception: Photo Neuromodulation of glutamate receptors, prostatic acid phosphatase, and adenosine triphosphate. Neurophotonics. 2016; 3(1):015003.

Wang L, Zhang D, Schwarz W. TRPV channels in mast cells as a target for low-level-laser therapy. Cells 2014;3(3):662–673.

Holanda VM, Chavantes MC, Fatima D, et al. Photobiomodulation of the Dorsal Root Ganglion for the Treatment of Low Back Pain: A Pilot Study. Lasers Surg Med. 2016; 48(7):653-9.

Tsuchiya D, Kawatani M, Takeshige C. Laser irradiation abates neuronal responses to nociceptive stimulation of rat paw skin. Brain Res Bull. 1994; 43:369–374.

Chow RT, Armati PJ. Effects of 830nm laser on cultured rat dorsal root ganglia: Implications for the analgesic effects of laser. Lasers Surg Med. 2004; (Suppl. 6):5.

Holanda VM, Chavantes MC, Wu X, & Anders JJ. The Mechanistic Basis for Photobiomodulation Therapy of Neuropathic Pain by Near Infrared Laser Light. Lasers Surg Med. 2017; 49(5):516-524.

This author as well as other veterinary colleagues34 recommend an initial treatment session frequency of two to three times per week, weaning the frequency of treatment sessions after two weeks, until a maintenance phase treatment session of typically once every two to three weeks is established based on the patient’s response and any improvements noted in labwork. It should be noted that the author is not advocating that PBMT be used in place of traditional CKD management, including nutritional modifications, renoprotective treatments, phosphorus reduction, or the identification and correction of any existing prerenal or postrenal disorders and/or primary disease processes or complicating disorders. As with most complex disease management, a multimodal approach, taking into consideration therapeutic priorities based on the patient’s stage of CKD, is best. In conclusion, a large amount of research has been done over the last 60 years to elucidate the mechanisms behind PBM. Ongoing research is exploring additional molecular mechanisms, biological context, and optimal dosing parameters for various conditions; however, great progress has been made. While further studies in dogs and cats should be performed, this unique, non-invasive modality has the potential to make a significant impact on the overall prognosis and outcome of many veterinary patients being treated for urinary or renal conditions, although this therapy may not always be top of mind when evaluating these cases. PBM should be considered for these patients, as well as to reduce their pain and hasten recovery where possible; and in chronic conditions, to possibly ameliorate other long-term consequences of the dog or cat’s disease.

Freitas and Hamblin. Proposed Mechanisms of Photobiomodulation or Low-Level Light Therapy. IEEE J Sel Top Quantum Electron. 2016; 22(3).

Lanzafame, RJ. The Rationale for Photobiomodulation Therapy of Vaginal Tissue for Treatment of Genitourinary Syndrome of Menopause: An Analysis of Its Mechanism of Action, and Current Clinical Outcomes. Photobiomodulation, Photomed and Laser Surg. 2019; 37(7), 395–407.

de la Torre S, & Miller LE. Multimodal vaginal toning for bladder symptoms and quality of life in stress urinary incontinence. Int Urogynecol J. 2017; 28:1201–1207.

Gaspar A, & Leibaschoff G. Preliminary study using a device for photobiomodulation and controlled exercises in the perineum floor. Presented at: World Society of Cosmetic Gynecology Congress; April 28, 2018; Cartagena, Columbia.

Kohli N, Jarnagin B, Stoehr A, & Lamvu G. An observational cohort study of pelvic floor photobiomodulation for treatment of chronic pelvic pain. J Comp Eff Res. 2021;10(17), 1291–1299.

Zipper R, Pryor B, Lamvu G. Transvaginal photobiomodulation for the treatment of chronic pelvic pain: a pilot study. Womens Health Rep. 2021; 2(1): 518–527.

Forrester SD, & Towell TL. Feline Idiopathic Cystitis. Vet Clin Small Anim. 2015; 783-806.

Westropp JL, Kass PH, Buffington CAT. Evaluation of the effects of stress in cats with idiopathic cystitis. Am J Vet Res. 2006;67(4):731-736.

Lavelle J, Meyers S, Giovani Ruiz W, et al. Urothelial pathophysiological changes in feline interstitial cystitis: a human model. Am J Physiol Renal Physiol. 2000; 278: 540-53.

Parsons CL; The role of the urinary epithelium in the pathogenesis of interstitial cystitis/prostatitis/urethritis. Urology. 2007; 69:9-16.

Cotler HB, Chow RT, Hamblin MR, Carroll J. The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain. MOJ Orthop Rheumatol. 2015;2(5).

Gao Y, Zhang R, Chang HH, Rodriguez LV. The role of C-fibers in the development of chronic psychological stress induced enhanced bladder sensations and nociceptive responses: A multidisciplinary approach to the study of urologic chronic pelvic pain syndrome (MAPP) research network study. Neurourol Urodyn. 2018;37(2):673680.

Sculptoreanu A, de Groat WC, Buffington CA, Birder LA. Protein kinase C contributes to abnormal capsaicin responses in DRG neurons from cats with feline interstitial cystitis. Neurosci Lett. 2005 Jun 10-17;381(1-2):426.

Houston DM, Moore AEP, Favrin MG, et al. Feline urethral plugs and bladder uroliths: a review of 5484 submissions 1998-2003. Can Vet J. 2003; 44(12):974-977.

Lavallee J, and Olson J. Feline-Specific Conditions. In: Eds. Ronald J Riegel and John C Godbold. Laser Therapy in Veterinary Medicine: Photobiomodulation. West Sussex, UK: John Wiley and Sons; 2017: 198-211.

Piao D, Sypniewski L, Bailey D, et al. Flexible nine-channel photodetector probe facilitated intraspinal multisite transcutaneous photobiomodulation therapy dosimetry in cadaver dogs. J Biomed Opt. 2018; 23(1), 010503.

Yamato M, Kaneda A, Kataoka Y. Low-level laser therapy improves crescentic glomerulonephritis in rats. Lasers Med Sci. 2013;28(4):1189-96.

Ucero A, Sabban B, Benito-Martin A, et al. Laser Therapy in Metabolic Syndrome-Related Kidney Injury. Photochem Photobiol. 2013; 89: 953-960.

Oliveira FA, Moraes AC, Paiva AP, et al. Low-level laser therapy decreases renal interstitial fibrosis. Photomed Laser Surg. 2012;30(12):705-13.

Passarella S, Casamassima E, Molinari S, et al. Increase of proton electrochemical potential and ATP synthesis in rat liver mitochondria irradiated in vitro by helium-neon laser. FEBS Lett. 1984; 175, 95–99.

orimoto Y, Arai T, Kikuchi M, et al. Effect of low-intensity argon laser irradiation on mitochondrial respiration. M Lasers Surg Med. 1992; 15, 191–199.

Karu TI. The Science of Low Power Laser Therapy. London, UK: Gordon and Breach Science Publishers; 1998.

Lim J, Sanders RA, Snyder AC, et al. Effects of low-level light therapy on streptozotocin-induced diabetic kidney. J Photochem Photobiol B. 2010;99(2):105-10. Godine, R. Abdominal Conditions. In: Eds. Ronald J Riegel and John C Godbold. Laser Therapy in Veterinary Medicine: Photobiomodulation. West Sussex, UK: John Wiley and Sons; 2017: 169-178.

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Treatment for kidney failure and other renal diseases in dogs and cats can be supported by a range of alternative modalities, including ozone therapy, acupuncture, herbal medicine and more.

Alternative approaches to renal diseases in veterinary patients BY MARGO ROMAN, DVM, CVA, COT, CPT

Chronic and acute renal disease affects many veterinary patients. It is sometimes very hard to control a spiraling of values in a dog or cat, especially in cases of acute toxicity or infections like Leptospirosis. Not everyone has access to or can financially cover kidney dialysis even though it’s sometimes needed. Extreme kidney failure is a scary situation, but having additional alternative tools to support the animal can help make caring for the dog or cat more hopeful for the client. Treating acute injury to the kidneys can also be supported with these therapies. This article features some of the supportive modalities I use for pets with kidney disease.

MEDICAL OZONE AND ULTRAVIOLET BLOOD THERAPY (UVBI) Given the inflammation and occasional infection associated with kidney disease, these therapies should be the first choice. They support the kidneys with their ability to treat bacterial, viral, Lyme, leptospirosis and other infections. Overuse of antibiotics can actually cause kidney damage, so these medications should be avoided, especially when there are other options. Bacterial infections can be resistant to antibiotics; these drugs also have no effect on viruses. However, medical ozone and UVBI have the ability to treat both these issues. Intravenous autohemotherapy with ozone, along with ozonated saline used sub-

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cutaneously over the kidneys, really helps. This approach will potentiate acupuncture, laser, ozonated saline and other therapies as it directly affects the location. The use of photobiomodulation with laser and UVBI as well as Rife frequencies can also help.

ACUPUNCTURE AND AQUAPUNCTURE Standard acupuncture points that support animals in chronic kidney failure have been in use for centuries. They include Bladder BL 23, Kidney KI 3, Spleen SP 6, Stomach ST 36, Pericardium PC 6, Large Intestine LI 11, Governing Vessel GV 14, and Bau Hua. These points are easy to find; even conventional veterinarians not trained in acupuncture can learn how to treat them, and can also inject B12 into them by doing aquapuncture. It would even be helpful to have pet owners massage these points or use a laser pen light on them.

HERBAL MEDICINE Chinese herbal companies offer specific herbal combinations that successfully support the kidneys. Some of these combinations work with the JING of the animal. Young animals with a low JING or weak kidneys need longterm support. Treating kidneys

damaged by old age and injury is different from treating kidneys that have deficiencies from birth. The following Western and Ayurvedic herbs also support animals with kidney issues. Companies offer different combinations of these herbs: uva ursi, stinging nettle, astragalus root extract, N-acetylcysteine, Rehmannia glutinosa extract, rhubarb extract, milk thistle, L-arginine, L-glutamine, asparagus root extract, Dong Quai extract, Szechuan lovage root extract, cordyceps extract, ginkgo biloba extract, green tea extract, hawthorn extract, melatonin, juniper berries, dandelion root, chicory root, Crateva nurvala, marshmallow root, and Punarnava.

Case reports 1. Sultana,

a 15-year-old spayed DMH feline, was diagnosed with

complete kidney failure. Treatment involved ozone therapy, MBRT, acupuncture, hyperbaric chamber, Lactated Ringers, and a senior blend of herbs. Ozone and Lactated Ringers were also given as home care. Within two weeks, Sultana went from kidney failure to complete recovery. Prior to treatment, her creatinine was 15.6 and urea nitrogen was 209. After treatment, creatinine was 2.0 and urea nitrogen was 58. She did well and then the client continued to work with only conventional veterinarians and did not follow up with holistic treatment. Sultana started receiving lots of antibiotics, got kidney failure again, and passed away.

2. Thumper was a two-year-old spayed Corgi with severe uremia. She was diagnosed by another hospital that suspected a possible ruptured ureter or kidney damage and wanted to perform surgery. The client refused and chose to treat Thumper holistically with ozone, acupuncture and herbs, as well as Reiki. All her levels came down and the dog was normal within five days. She did well for years and lived till the age of 13.

3. Blossom, a 17-year-old spayed Russian Blue, was treated in the clinic for complete kidney failure as well as arthritis. Ozone treatment was started, in the office as well as at home. Vitamin C and B injections, aquapuncture, Lactated Ringers SQ, MASH vital mix nutrient supplement and herbal support were given. Blossom’s kidney failure, as well as her other conditions, were well controlled, and she lived to the age of 24. She had a high quality of life for seven years after her initial treatment.

Considerations for frail animals When one is using these modalities with a fragile animal, the dosing should be small and incrementally increased. If the heart is having issues as well, one would want to support it with additional herbs for the heart muscle. When using ozone in a compromised patient, the saline (which has sodium in it) should be limited. Also, ozonated saline is given cool and cannot be warmed to body temperature, so it’s therefore important not to give to much to a hypothermic patient. Instead, give warmed Lactated Ringers on the opposite side of the body from the ozonated saline.

HOMEOPATHY The gentleness of homeopathy works to increase vital force and can prove to be a good option for some very weak individuals. Some remedies can be used acutely but having an in-depth analysis of the patient done by a qualified homeopath can be very helpful. Apis Mellifica, Arsenicum Album, Phosphorus, Aurum Muriaticum, and Cantharis can be useful.

The volume of ozone combined is about 2 cc per pound. So if one is giving ultraviolet blood therapy to a 20-pound dog, they would use 20 cc of ozonated saline with 2 cc of blood and 1 cc of isotonic marine plasma (Biocean). Then add more rectal ozone and less subcutaneous saline due to the sodium. So the volume would be 25 cc of sq O3 and 35 cc rectal O3 gas insufflation. Saline is usually about 37 ug/ml and rectal gas about 24 ug/ml.

Ozone therapy is useful for other conditions as well as kidney disease. At the age of 22, Blossom developed a vestibular issue and ozone gas was administered into her ear canals.

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NUTRITIONAL SUPPORT

Glomerulonephritis in dogs and cats Glomerulonephritis is a renal disease caused by infections (bacterial and viral), autoimmune diseases, cancer and vasculitis. Glomerulonephritis can sometimes

Glandulars like desiccated get better without treatment. For example, if an animal has a bacterial infection kidney, or products that that damaged the glomeruli, it may possibly right itself in time after an antibiotic provide kidney support, treatment if the correct antibiotic is used. are great additions to the nutritional routine. Cutting up a raw organic kidney from a cow, lamb or pig, positive changes to the animal. Appetite improves and freezing it and then giving a piece daily to the animal is another their ability to produce more red blood cells seems to good option for supporting the kidney. Raw organic liver can also be enhanced. In our practice, Microbiome Restorative Therapy (MBRT) from young, vibrant screened donors be helpful. with healthy kidney function has resulted in increased High quality Omega-3 fatty acids bring down inflammation. vitality while lowering certain kidney-related values. Our donors are six generations intact females over 30 years; Dimethylglycine DMG and spirulina are also helpful. an intact urogenital system may have important value for It’s important to prevent further bladder strengthening the urogenital area. inflammation that might proliferate into the kidneys, so keeping the animal Administering both an oral support and rectal Fecal on some bladder anti-inflammatory Microbiota Transplantation is a good strategy. The details of herbs that are also nutritional is a good the procedures we do can be found at www.mashvet.com and idea. Cranberry, marshmallow root, and www.microbiomerestorativetherapy.com. Echinacea can prevent bladder infections from ascending into the kidney. Adding Choosing a screened donor for MBRT is important. There are 500 species and 1,000 subspecies of bacteria that could be viable D-mannose to the diet can help as well. in an animal’s gut. We want a balance to allow for the most efficient absorption of herbal medicines and nutraceuticals. DIGESTIVE HELP Using only a prebiotic, probiotic or postbiotic will provide Probiotic products can help with acute kidney issues. The very important bacterial species, but not the symbiotic and gut is considered to contain 80% of the immune system, so harmonious meshing of hundreds of species. Achieving a full maintaining a healthy microbiome can bring tremendous microbiome seems a more complete way to reboot the gut.

BLOOD PRESSURE CONTROL

Antibiotic use Knowing exactly what antibiotic to use is really important. Just throwing a broad spectrum antibiotic at a kidney problem may cause nephrotoxicity and will most definitely weaken the gut microbiome. Also, antibiotic medications may not be effective due to bacterial resistance. Judicious use of antimicrobials encourages us to look more at alternatives. The best approach is to keep nephrotoxic drugs and antibiotics away from the dog or cat; restrict phosphorus; add antioxidant therapy, along with ozone therapy and support for the gut flora with Microbiome Restorative Therapy; prevent bladder infections; and keep the animal well hydrated and flushed with fluids.

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Diet and nutrition can be used to try keeping the animal’s blood pressure down. Adding natural diuretics such as parsley can help. Reducing sodium intake may also be needed. Encouraging more fluid intake is important for flushing the kidneys. Otherwise, the animal’s blood pressure should be managed by using a medication if and when needed. It can be inconsistent as blood pressure machines are not always repeatable. Certain medicines called angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) can help control blood pressure. Kidney failure and other renal diseases in dogs and cats don’t have to be a death sentence. Adding some or all of these alternative approaches to your toolbox can help give your patients a new lease on life.

ESSENTIAL OILS

FOR FLUTD BY JARED MITCHELL, DVM, CVMA, CVA, CVFT

When used safely, pure essential oils are a valuable treatment modality for lower urinary tract disease in cats.

Feline lower urinary tract disease (FLUTD) is a term many cat owners are familiar with because they’ve heard it from their veterinarians. It doesn’t refer to a single syndrome or specific diagnosis, but is a general term used to describe conditions affecting the feline bladder or urethra.1 Both physical and behavioral causes have been reported (Figure 1). Clinical studies, along with epidemiological surveys, indicate that approximately 4.5% to 8% of cats presenting to veterinary practices or teaching hospitals have FLUTD.2 In this article, the author will focus on how essential oils can become an effective part of the treatment protocol for these cats.

TREATMENT PLAN FOR FLUTD Once a diagnosis has been made (see sidebar on page 17), a treatment plan can be implemented. Many options are available to the clinician. Some can be used alone while others may be combined. Fluid therapy, diet, and conventional pharmaceutical medications have long been the mainstay of FLUTD treatment, although more interest and research into integrative and holistic options, including essential oils, means these approaches are becoming more widely utilized.

EFFECTS OF ESSENTIAL OILS ON THE BLADDER Conditions affecting the urinary tract have plagued humans and animals for millennia. Throughout that time, various treatment modalities were developed. With the advent of modern medicine came pharmaceutical medications that offered convenience and fast relief from symptoms, thus replacing a lot of traditional therapies. As time passed, however, bacterial resistance began to occur.3 In an effort to find effective alternatives, human physicians and veterinarians revisited traditional therapies. Acupuncture, laser therapy, and botanical medicine became popular modalities used as standalone treatments or combined with standard medical treatments.4,5 In the veterinary profession, many pet owners began to utilize essential oils to help maintain the optimal balance of health as well as treat certain medical conditions, including urinary tract issues. As the popularity of essential oils, and their medicinal qualities, became known within the mainstream, scientific evaluation and clinical studies were performed to evaluate IVC Winter 2023

Figure 1: Causes of feline lower urinary tract disease

Feline Lower Urinary Tract Disease (FLUTD)

Stress

Physical Causes

Non-Obstructive

Feline idiopathic cystitis

Neoplasia

Congenital anatomical defects

Obstructive

Addition or death of a house mate

Urethral plugs Urinary tract infection

New food

Any sudden or abrupt change: - Owners work schedule changes

Urolithiasis

their reported medicinal attributes. Results demonstrated antiinflammatory, antibiotic, anti-tumoral, and relaxing effects on urinary tract issues.6,7,8,9

SELECTING ESSENTIAL OILS: PURITY AND SAFETY When using essential oils in any situation, it is crucial to understand the importance of selecting the purist quality oils and using them correctly and safely. This cannot be stressed enough when using essential oils with cats. The feline species has evolved with many unique characteristics. Cats lack the CP450 enzyme and have developed other enzymatic pathways.10,11 A knowledge of which essential oils are safe for cats, and how they can affect physiological body systems, is necessary to properly utilize them. Essential oils with high level of phenols should not be used, or if needed, used with extreme caution and under the guidance of a veterinary aromatherapist. Table 1 lists some of the most common essential oils with a high phenol content. Purity and safety go far beyond just selecting the proper oil to treat a medical condition. They begin before the oil is even produced. They start with proper land and seed selection and continue throughout the growing and harvesting stages. IVC Winter 2023

New litter

- New home Neurologic disorders Trauma

Behavioral Causes

Table 1: Common essential oils containing high levels of phenols Wintergreen

Thyme

Basil

Tea tree

Clove

Laurus nobilis

Oregano

Cinnamon bark

Maintaining the proper techniques to ensure the most organic and holistically produced essential oil is paramount to creating pure products that can be used safely.

COMMON OILS TO USE WITH FLUTD Lavender (Lavandula angustifolia) Lavender is probably one of the most well-known essential oils on the market today. Everyone in the mainstream is familiar with its amazing calming and relaxing abilities. Clinical research has demonstrated that lavender has a multitude of medicinal properties as well.12 As a result, it’s considered the “Swiss Army Knife” of essential oils.

Lavender can help with urinary disorders such as FLUTD in several ways. • T he

anxiolytic effects can help calm and relax the cat, creating a relaxing environment.13,14 This can help with behavioral issues, which can be a cause of inappropriate urination and FLUTD.

• L avender

can be utilized for its anti-inflammatory effects,15 which can help reduce inflammation within the bladder and urinary tract that could be causing FLUTD.6

• L avender

has been shown to be powerfully antiinfective and can help fight the bacteria that can be another cause of FLUTD.16

Frankincense (Boswellia carterii) Frankincense essential oil is considered a must-have for many veterinary aromatherapists. It has been utilized with most species and is considered incredibly safe, well tolerated, versatile, and effective.18 It possesses wonderful antiseptic and anti-inflammatory properties.19 In the mainstream, frankincense is probably best known for its anti-tumoral properties.In clinical studies, it has shown promise in targeting cancer cells, including those in the bladder.20

Copaiba (Copaifera officinalis) Copaiba is a wonderful essential oil to use with urinary tract issues, including FLUTD. Its constituents make it a very powerful anti-inflammatory. It acts much like an NSAID by blocking the oxidation of 5-lipoxygenace, a major player in the inflammatory cascade, thus reducing pain and inflammation. 17 Because copaiba is both a pain reliever and an anti-inflammatory, it’s very important for conditions such as FLUTD.

Helichrysum (Helichrysum italicum) Helichrysum is an essential oil renowned for its anti-inflammatory effects.21 It is also known to chelate chemicals and toxins, and helps with circulation and circulatory disorders. This oil is often included in pain recipes and is most often combined with copaiba and/or myrrh, where there seems to be an enormous synergistic effect for pain management.22

Geranium (Pelargonium graveolens) Geranium essential oil can have many beneficial uses for cats suffering with FLUTD. This oil’s medical properties are extensive, and it can be a great antispasmodic, antiinflammatory, and antimicrobial. From an emotional and behavioral standpoint, geranium can help balance the cat’s emotional state by releasing negative memories and easing nervous tension.23

FLUTD — clinical signs and diagnosis The clinical signs of FLUTD are numerous and depend on the exact etiologic cause or combination of said causes. In general, lower urinary tract disease can be grouped into non-obstructive or obstructive causes, each having distinguishing characteristics and clinical signs as well as varying degrees of severity.1 Pollakiuria, hematuria, stranguria, anuria, and vomiting are just some of the clinical signs noted. With such a wide variety of signs, proper diagnosis is key in helping to choose the appropriate treatment protocols.

A thorough evaluation and diagnostic workup is needed and should involve a thorough and complete patient history, including environmental and dietary questions as well as the progression and duration of the condition. A physical exam should be performed. At a minimum, diagnostic testing should include a urinalysis and two view radiographs. The more detailed and complete the diagnostics, the more tailored the treatment will be for that patient. Complete blood counts, biochemical profiles, urine culture, and ultrasounds are other tests that should be considered.

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Juniper (Juniperus osteosperma) Juniper has been used for centuries as a diuretic, and in the treatment of urinary tract infections. It has antiseptic and anti-infective attributes. It is also known to help increase circulation through the kidneys, and can assist with the excretion of toxins.24 Reported adverse issues with juniper may be related to its more harmful oxidized form. Only fresh and well-stored juniper essential oil should be used.25

applied over the lower abdomen two to three times daily30 (Table 2). The author personally begins with twice-daily applications and generally continues these treatments for five days, then re-evaluates the patient. If long-term therapy is required, the author continues with five days of consecutive treatments followed by two days without treatment. This cycle is then repeated as needed. It allows the body to recognize what it needs and try to reach a homeostatic state. It also allows for frequent re-evaluation of the cat, and their condition and response to therapy.

Lemongrass (Cymbopogon flexuosus) Lemongrass has very powerful antifungal, antibacterial, and anti-inflammatory properties. In one study from 2008, it was shown to inhibit Methicillin-resistant Staphylococcus aureus (MRSA).26 It has also been demonstrated to dilate blood vessels and improve circulation.27 Lemongrass is especially useful for bladder infections and other urinary tract issues that can lead to FLUTD. It is considered one of the “hot” oils for topical use in animals. It’s very important to dilute lemongrass with a carrier oil.28

USING ESSENTIAL OILS FOR FLUTD Essential oils can be used singly or combined with other oils to work in a synergistic fashion. For example, lavender could be utilized for its calming attributes and combined with juniper for its ability to increase circulation through the kidneys, while both could also provide anti-inflammatory and anti-infective properties. Essential oils can be used as a primary treatment option, or integrated into an already established treatment protocol. As discussed, FLUTD can have many underlying causes. Conventional medications and treatments should not be overlooked and may be needed to provide proper care. Essential oils, however, can be a welcome addition to the treatment protocol, and may lessen the potential side effects of long-term medications.29 Topical application, diffusion, and oral administration have all been used to treat medical conditions in veterinary aromatherapy. With FLUTD, the most common techniques are diffusion and topical application. When using essential oils topically, they should be in a 50% to 75% dilution and

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Table 2: General dilution guidelines for essential oil use in cats Percent dilution

Number of drops of essential oil

Number of drops of carrier oil

50%

70%

FINAL THOUGHTS Feline lower urinary tract disease (FLUTD) is a collective term used to describe multiple disease processes affecting a cat’s bladder and lower urinary tract. Over the years, many treatment options have been developed, and while they have been a mainstay, increases in antibiotic resistance and concerns about side effects have led to the research and use of alternative treatment modalities. Essential oils are one of these options and have shown great promise both in clinical settings and research studies. 1Heseltine J. Diagnosing and Managing Feline Lower Urinary Tract Disease. Today’s Veterinary Practice

September / October 2019. 42-53.

2Lekcharoensuk C, Osborne CA, Lulich JP. Epidemiologic study of risk factors for lower urinary tract

diseases in cats. JAVMA 2001;218(9):1429-1435. 3Waller

TA, Pantin SAL, Yenior AL, Pujalte GGA. Urinary Tract Infection Antibiotic Resistance in the United States. Primary Care: Clinics in Office Practice. Volume 45, Issue 3, p455-466, September 01, 2018. DOI:https://doi.org/10.1016/j.pop.2018.05.005. 4Raditic DM. Complementary and integrative therapies for lower urinary tract diseases. Vet Clin North

Am Small Anim Pract. 2015;45(4):857-878. doi:10.1016/j.cvsm.2015.02.009. 5Das

S. Natural therapeutics for urinary tract infections-a review. Futur J Pharm Sci. 2020;6(1):64. doi:10.1186/s43094-020-00086-2. 6Horváth A, Pandur E, Sipos K, et al. Anti-inflammatory effects of lavender and eucalyptus essential

oils on the in vitro cell culture model of bladder pain syndrome using T24 cells. BMC Complement Med Ther. 2022;22(1):119. Published 2022 Apr 30. doi:10.1186/s12906-022-03604-2. 7Ebani

VV, Nardoni S, Bertelloni F, Pistelli L, Mancianti F. Antimicrobial Activity of Five Essential Oils against Bacteria and Fungi Responsible for Urinary Tract Infections. Molecules. 2018; 23(7):1668. https://doi.org/10.3390/molecules23071668.

8 Ebani VV, Mancianti F. Use of Essential Oils in Veterinary Medicine to Combat Bacterial and Fungal

Infections. Vet Sci. 2020;7(4):193. Published 2020 Nov 30. doi:10.3390/vetsci7040193. 9 Frank

MB, Yang Q, Osban J, et al. Frankincense oil derived from Boswellia carteri induces tumor cell specific cytotoxicity. BMC Complement Altern Med. 2009;9:6. Published 2009 Mar 18. doi:10.1186/1472-6882-9-6. 10 Fink-Gremmels

J. Implications of hepatic cytochrome P450-related biotransformation processes in veterinary sciences. Eur J Pharmacol. 2008;585(2-3):502-509. doi:10.1016/j.ejphar.2008.03.013. 11Lautz

LS, Jeddi MZ, Girolami F, Nebbia C, Dorne JLCM. Metabolism and pharmacokinetics of pharmaceuticals in cats (Felix sylvestris catus) and implications for the risk assessment of feed additives and contaminants. Toxicol Lett. 2021;338:114-127. doi:10.1016/j.toxlet.2020.11.014. 12Cavanagh

HM, Wilkinson JM. Biological activities of lavender essential oil. Phytother Res. 2002;16(4):301-308. doi:10.1002/ptr.1103. 13Malcolm

BJ, Tallian K. Essential oil of lavender in anxiety disorders: Ready for prime time?. Ment Health Clin. 2018;7(4):147-155. Published 2018 Mar 26. doi:10.9740/mhc.2017.07.147. 14Komiya

M, Sugiyama A, Tanabe K, Uchino T, Takeuchi T. Evaluation of the effect of topical application of lavender oil on autonomic nerve activity in dogs. Am J Vet Res. 2009;70(6):764-769. doi:10.2460/ajvr.70.6.764. 15Silva GL, Luft C, Lunardelli A, et al. Antioxidant, analgesic and anti-inflammatory effects of lavender

essential oil. An Acad Bras Cienc. 2015;87(2 Suppl):1397-1408. doi:10.1590/0001-3765201520150056. 16Wińska

K, Mączka W, Łyczko J, Grabarczyk M, Czubaszek A, Szumny A. Essential Oils as Antimicrobial Agents-Myth or Real Alternative? Molecules. 2019;24(11):2130. Published 2019 Jun 5. doi:10.3390/molecules24112130. 17Baylac

S, Racine p. Inhibition of 5-lipoxygenase by essential oils and other natural fragrant extracts. Int J Aromather. 2003;13: 138-142. 18Shelton M. Essential Oil Singles:

Frankincense. The Animal Desk Reference, 2nd ed. 2018. 256-261.

19Siddiqui

MZ. Boswellia serrata, a potential anti-inflammatory agent: an overview. Indian J Pharm Sci. 2011;73(3):255-261. doi:10.4103/0250-474X.93507. 20 Frank

Viegas D, Palmeira-de-Oliveira A, Salgueiro L, Martinez-de-Oliveira J, Palmeira de-Oliveira R. Helichrysum italicum: from traditional use to scientific data. J Ethnopharmacol. 2014;151(1):54-65. doi:10.1016/j.jep.2013.11.005. 22 Shelton M. Essential Oil Singles:

Helichrysum. The Animal Desk Reference, 2nd ed. 2018. 267-269.

23The

essential Oils Animal Desk Reference. Single Essential Oils: Geranium. Life Science Publishing, May 2017. 54.

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

HOMEOPATHY AND THE ANIMAL’S URINARY SYSTEM The urinary system is one of the most important systems in animals. Its main function is waste elimination — not very glamorous, but critical. Kidneys perform secretion and filtration, water regulation, and help maintain normal blood pressure. All blood in the body is filtered about 60 times daily. Urinary disease has serious effects on the animal’s body, and indicates a deep imbalance of vital force. After a good homeopathic prescription, it’s common to see increased urine output, and even more debris and inorganic matter, such as crystals. The urinary tract is one of the main systems impacted by the sycotic miasms, and suppression of superficial sycotic disease can result in urinary symptoms. One of the major triggers of sycosis is vaccination, and many “bladder infections” will occur shortly after vaccination. Repeated suppression of cystitis with steroids and antibiotics will lead to renal failure. Conventional medicine sees this as a “natural progression” of disease, or the “side effects” of drugs, but homeopathy sees it as a natural result of suppression. Urinary disease at any level can progress to kidney disease if treated improperly — that is, by suppression. Veterinary homeopaths usually link calculus/crystal formation to hepatic dysfunction, and improving diet quality by decreasing animal protein is one of the most important steps. Bladder disease is much more treatable than kidney disease, and proper homeopathic treatment can help slow or prevent the progression of illness. A few helpful remedies for urinary disease include:

24 Raina

R, Verma PK, Peshin R, Kour H. Potential of Juniperus communis L as a nutraceutical in human and veterinary medicine. Heliyon. 2019;5(8):e02376. Published 2019 Aug 31. doi:10.1016/j.heliyon.2019.e02376. 25Shelton M. Essential Oil Singles: Juniper.

The Animal Desk Reference, 2nd ed. 2018. 272.

26 Chao, S., Young, G., Oberg, C. and Nakaoka, K. Inhibition of methicillin-resistant Staphylococcus

aureus (MRSA) by essential oils. Flavour Fragr. J., 2008. 23: 444-449. https://doi.org/10.1002/ ffj.1904. 27The

essential Oils Animal Desk Reference. Single Essential Oils: Lemongrass. Life Science Publishing, May 2017. 63 28 Shelton M. Essential Oil Singles: Lemongrass. The Animal Desk Reference, 2nd ed. 2018. 280-281. 29 Langeveld

WT, Veldhuizen EJ, Burt SA. Synergy between essential oil components and antibiotics: a review. Crit Rev Microbiol. 2014;40(1):76-94. doi:10.3109/1040841X.2013.763219. Essential Oils Animal Desk Reference. Chapter 10: Cats (Felines). Urinary Tract Conditions. Life Science Publishing, May 2017. 174-175. 30The

•A rsenicum album — often thirsty for small amounts; vomits right after eating. •C antharis — frequent straining with or without blood; very little urine output. •M ercurius solubilis — cystitis and diarrhea; irritable temperament change. • Nux vomica — straining and frequent attempts with decreased urine; history of conventional drug treatments. •N atrum muriaticum — extreme thirst for large amounts, and often; weight loss and huge appetite; ascites/fluid retention; “egg white” discharges. •P hosphorus — thirsty for large amounts of cold water; tries to drink from any source (puddles, sinks, toilets); vomits five to ten minutes after eating; bloody urine. •S taphysagria — bloody, scant urine; worse at night; resentment and anger; post-urinary catheterization. •T huja — relation of vaccination and bladder inflammation; suspect vaccinosis.

Submitted by Todd Cooney, DVM, CVH IVC Winter 2023

A comprehensive look at the supplements that can help address chronic kidney disease in dogs and cats.

A SURVEY OF SUPPLEMENTS FOR PETS WITH CKD BY NANCY SCANLAN, DVM, MS, CVA

Kidney disease is a common condition in dogs and cats, especially as they get older. Controlling the inflammatory reactions and oxidative stress that contribute to chronic kidney disease can be done with the help of a variety of supplements. This article discusses the pathology of CKD (see sidebar on page 22), and how supplements, including antioxidants, can address the inflammatory factors associated with this prevalent disease.

THE DIFFERENCE BETWEEN DRUGS AND SUPPLEMENTS Drugs with antioxidant effects, developed to try to deal with many of these problems, have “minor” side effects — such as the muscle spasms, nausea, and cardiotoxicity seen with bardoxolone use — restricting their status to investigational drugs only.6 In contrast, most nutraceuticals have few to no side effects, although some must be used in a narrow dose spectrum so enough is administered to be beneficial without the effects of overdose.7 Nutritional supplements can help address all the factors mentioned above, and increase the longevity of pets with CKD. Antioxidants are the primary way that oxidative stress can be combated naturally. Most kidney supplements have at least some antioxidant effects. When individual supplements are used one at a time, the evidence for their benefits can be slight or even conflicting. When looking at complete diets, or combinations of nutrients

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as nutritional interventions in healthy aging trials, additive or multiplicative effects are striking for both humans and animals.8,9,10 Commercial products for kidney support recognize this, and the best recommendations for pet owners would be to follow that tendency.

NUTRITIONAL KIDNEY SUPPLEMENTS ANTIOXIDANTS Reviews of research using a single antioxidant at a time often show mixed or no effects, and doses that are too low. The strongest research support comes from studies that showed the effects of two or more antioxidants used together. Some natural substances, such as vitamins C and E, CoQ10 and N-acetyl-cysteine, already exist in the body as part of the inflammation-limiting effect. In CKD patients, however, they tend to be depleted. Supplementation can help by restoring these antioxidants to a level that can once again fight inflammation from the disease.11

VITAMIN E A human study showed that vitamin E alleviates renal injury by mediating the inactivation of nitric oxide (NO), but that it has no effect on hypertension.12 Other studies showed a cardioprotective effect as CKD advanced.13,14 A study of vitamin E

supplementation in cats showed no difference in oxidative stress.15 In this author’s opinion, however, the dose used was too low, and no vitamin C was administered as a cofactor. So it is possible that the end result was an increase in the pro-oxidant form of vitamin E, which cannot act to reduce oxidative stress.

VITAMIN C In un-supplemented human CKD patients, renal dysfunction is associated with decreased plasma vitamin C levels, which may cause endothelial dysfunction via an increase in oxidative stress.16 In humans with CKD, the administration of vitamin C may prevent progression to end stage kidney disease (requiring dialysis and/or a kidney transplant).17 The majority of studies investigating antioxidant treatments in CKD patients show a reduction in oxidative stress, and many show improved renal function.11,18 It is possible that vitamin C levels could also be depleted in canine and feline patients. Vitamin C’s beneficial effects in human studies suggest that animals could benefit from its use as well, especially if vitamin E is part of the treatment. A study involving the use of vitamin E in combination with vitamin C and beta carotene showed significantly reduced DNA damage in cats with renal insufficiency.3 Another study using fish oil, antioxidants (lipoic acid, vitamins C and E), L-carnitine, and botanicals (fruits and vegetables) for six months showed no progression of CKD versus controls.10

VITAMIN A (NOT BETA CAROTENE) All-Trans Retinoic Acid (ATRA), a metabolite of retinol, is required for the production of erythropoietin by both the kidneys and liver. As CKD advances, urinary retinol excretion increases and the body’s supply of retinol decreases. Eventually, erythropoietin production is affected.19 In mice, renal-associated anemia has been reversed by vitamin A. In humans, clinical improvement has been seen in CKD patients treated with retinoids.20 This approach holds promise as a way to maintain the body’s ability to produce erythropoietin in the face of CKD, but research is needed to establish safe doses without causing toxicity.

THIAMIN (B-1) In humans, functional thiamin deficiency is common in patients with Type II diabetes. Normal top high plasma levels of thiamine are usually found, but are negated by the anti-metabolite oxythiamine. This contributes to microvascular endothelial dysfunction, a part of CKD. Daily thiamin supplements are often recommended for humans on dialysis, and this should be considered for CKD patients being treated with fluid therapy.1

VITAMIN D

(IN THE FORM OF CALCITRIOL)

Calcitriol is the final form of vitamin D used in the body, and is converted from vitamin D by 1-alpha-hydroxylase. Activity of this enzyme is reduced in CKD, so calcitriol is preferred over vitamin D supplementation. The goal of using calcitriol along with phosphorus binders is to restore, as much as possible, the normal balance between calcium and phosphorus in the body. Calcitriol’s primary use is to control renal secondary hyperparathyroidism. It slows both the loss of podocytes and the progression of fibrosis in the kidney, resulting in increased appetite and longer survival times. Calcitriol should be monitored to prevent hypercalcemia, the primary problem seen with vitamin D toxicity.21

PHOSPHORUS BINDERS Calcium carbonate is an inexpensive, over-the-counter agent that is widely used as a phosphorus binder. It also has the benefit of being an antacid, which helps address the problem of metabolic acidosis. Calcium acetate costs a little more but binds twice as much phosphorus per dose. 22 Chitosan is another phosphorus binder that boosts the effect of calcium compounds. At least one supplement on the market combines chitosan and calcium carbonate, and is palatable for cats. This combination has been shown to significantly decrease plasma phosphorus levels and the urinary excretion of phosphorus.23

A LIST OF KIDNEY SUPPLEMENTS •

Fat-soluble vitamins A, C, D, E

•

Water-soluble vitamin B1 (Thiamin)

•

The minerals calcium acetate, and selenium

•

CoQ10

•

L-carnitine

•

Omega-3 fatty acids

•

Curcumin

•

Sulforaphane

•

Quercetin

•

Resveratrol

•

EGCG

•

Ursolic acid

•

Prebiotics and probiotics

•

Chitosan

carbonate,

calcium

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Chitosan also adsorbs uremic products and lowers BUN and creatinine levels in humans with CKD.23

OMEGA-3 FATTY ACIDS “Adequate” (according to the NRC) levels of Omega-3 fatty acids can decrease proteinuria, kidney fibrosis, tissue calcification, inflammatory cytokines and inflammation in dogs and cats.4,25,26 “Higher than adequate” levels (more than twice the NRC “safe” limit) can also protect against malnutrition-inflammation syndrome in cats with CKD.27 Prolonged coagulation time has been reported as a side effect, but primarily at doses higher than the “higher than adequate dose,” so it may be worth trying this dose level in uremic cats who are losing weight. Nausea is a side effect, so it is advisable to start with a low dose and work up to whatever may be tolerated by the cat.

CURCUMIN Curcumin acts as an antioxidant by reacting directly with free radicals such as superoxide and NO, due to the presence of phenolic groups in its chemical structure.28, 29 Curcumin protects against kidney fibrosis by downregulating factors, including profibrotic cytokines, vascular endothelial growth factor (VEGF), TGF-β, and connective tissue growth factor (CTGF), among others, and decreasing extracellular matrix proteins such as fibronectin.30 Curcumin also upregulates enzymes and cytoprotective and antioxidant proteins such as superoxide dismutase, due to its ability to upregulate enzymes and cytoprotective and antioxidant proteins such as SOD.31,32,33

SULFORAPHANE Nuclear factor erythroid 2 (Nrf-2) is a transcription factor that activates genes containing a DNA sequence known as the antioxidant response element (ARE). AREs are present in the promoter regions of genes, which promote the production of natural antioxidants such as SOD. When active, genes containing AREs promote increased levels of natural antioxidants. These genes stimulate the production of antioxidant proteins, phase I oxidation, reduction, and hydrolysis genes, phase II detoxifying enzymes such as glutathione s-transferases (GSTs), NADPH-generating enzymes, drug transporters, and stress proteins involved in heme and metal metabolism, such as heme oxygenase 1 (HO-1). In a normal body, a protein (Kelch-like ECH-associated protein 1 known as KEAP 1) keeps Nrf-2 production at low levels as part of the homeostatic pro-oxidant-antioxidant balance. In CKD, there’s a decrease in natural antioxidants but no decrease in KEAP 1 and no increased ARE activity. Sulforaphane, an isothiocyanate found in cruciferous plants, has a potent Nrf-2 activating effect, which helps restore the body’s own normal levels of antioxidants.34

COQ10 The features of mitochondrial dysfunction seen in CKD include changes in mitochondrial morphology, increased oxidative stress, and significant decrease in ATP production and mitochondrial biogenesis. Mitochondria constantly change their shape and size through fission and fusion processes. Normal shapes range from spherical to hyperfused

THE PATHOLOGY OF CKD For decades, chronic kidney disease (CKD) in humans has been linked to hypertension, diabetes, and advanced age. But the current emphasis on the need to control inflammation and oxidative stress has gained traction in the last ten years. In CKD, pro-inflammatory reactions, needed to fight infection, and anti-inflammatory reactions, needed to limit the celldamaging effects of prolonged inflammation, are out of balance. Oxidative stress and inflammation are hallmarks of kidney disease, and the increasing severity of CKD is marked by increasing levels of pro-inflammatory markers in humans as well as dogs and cats.1,2,3,4 Chronic inflammation leads to the overproduction of inflammatory cytokines, impaired antioxidative systems, and kidney fibrosis. Telomeres are

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shorter in cats with CKD, leading to premature senescence that contributes to kidney fibrosis.5 Accumulating metabolic end-products act as uremic toxins, leading to complications such as high (or higher) blood pressure, metabolic acidosis, altered immune response, and calcium-phosphorus imbalance leading to mineral/ bone disturbances. Dysbiosis and altered adipose tissue metabolism eventually come into play. Inflammatory cytokines Interleukin-1 and -6, associated with anorexia, and increased levels of the inflammatory markers C-reactive protein, Interleukin-1, and Tumor Necrosis Factor alpha, are associated with the severity of CKD and are predictive of mortality.1,6

reticular networks. Normally, there is a balance between fission and fusion, depending on metabolic and signaling cues in the cell.35 Excessive fission activity and increased mitochondrial fragmentation have been seen with increased ROS in CKD.36 This leads to mitochondrial dysfunction and can result in cell death.37 Kidneys have the highest levels of CoQ9 and CoQ10 as compared to all other organs in the body. CoQ10 is required for normal health and functioning of the mitochondria, and is directly involved in ATP generation. It also acts as an antioxidant in preventing lipid peroxidation, and interacts with alpha-tocopherol. CoQ10 supplementation is needed in CKD to ensure mitochondrial health.11

SELENIUM Selenium is involved with selenoproteins, most importantly (for CKD) glutathione peroxidase and phospholipid hydroperoxide glutathione peroxidase (PLGSH-Px), which play an important part in ROS metabolism and prolonged telomere length.38 They inhibit ferroptosis, a non-apoptotic form of cell death seen in cancer, hippocampal, and renal cells.39 They also prevent lipid peroxidation, as long as a normal amount of vitamin E is present in the membranes, and decrease the total amount of vitamin E necessary for this purpose.40 Homemade diets may be deficient in selenium, but care must be taken when adding it since an excess amount is toxic.

PREBIOTICS AND PROBIOTICS Animals with CKD have an imbalance of bacteria in the microbiome: an increase in bacteria such as Clostridium and Bacteroides and a decrease in Lactobacilli and Bifidobacteria.41 Administration of Lactobacillus acidophilus improves this balance and limits adhesions of pathogens, strengthening the gut barrier.42 Probiotics also reduce blood urea and serum phosphate concentration. Adding prebiotics such as psyllium to probiotics increases the numbers of Bifidobacteria and Lactobacillus, decreases formation of the uremic toxin p-cresol and its plasma levels, decreases blood urea nitrogen, and reduces inflammation and oxidative stress.43 In addition, studies indicate that a diet supplemented with specific antioxidants (e.g. European olea, vitamin E, IVC Winter 2023

carotenoids, polyphenols, and flavonoids) is important for limiting renal oxidative stress and the progression of CKD.2

L CARNITINE L carnitine is associated with improved nitrogen balance, inhibits apoptosis, and has anti-inflammatory and antioxidant effects. Dietary supplementation with L-carnitine is associated with improved nitrogen balance, the inhibition of apoptosis, and improved mitochondrial function. It is needed to transport long-chain FA from the cytosol to sites of FA β-oxidation in the mitochondria.10

QUERCETIN Quercetin is a flavonoid with antioxidant and anti-inflammatory properties. It can reduce levels of inorganic phosphate, blood urea nitrogen and creatinine, and increase total antioxidant activity. In one study, rats with CKD were treated with quercetin and showed fewer histopathic renal abnormalities, including fewer signs of chronic interstitial inflammation.1

RESVERATROL Resveratrol is a polyphenol that is safe to administer to dogs, and has immunomodulating, anti-inflammatory, antioxidant, and vaso-protective properties. It enhances the production of antioxidant enzymes44 and inhibits oxidative stress and renal interstitial fibrosis.45 It also decreases muscle atrophy from CKD.46

URSOLIC ACID

EGCG Present in green tea, EGCG neutralizes free radicals, acts as a ROS scavenger, and chelates metal ions. It inhibits oxidative stress in the kidney and decreases the levels of uremic toxins such as methylguanidine, slowing the progression of kidney disease.49

Rapa SF, Di Iorio BR, Campiglia P, Heidland A, Marzocco S. Inflammation and Oxidative Stress in Chronic Kidney Disease-Potential Therapeutic Role of Minerals, Vitamins and Plant-Derived Metabolites. Int J Mol Sci. 2019 Dec 30;21(1):263.

Halfen DP, Caragelasco DS, Nogueira JPS, Jeremias JT, Pedrinelli V, Oba PM, Ruberti B, Pontieri CFF, Kogika MM, Brunetto MA. Evaluation of Electrolyte Concentration and Pro-Inflammatory and Oxidative Status in Dogs with Advanced Chronic Kidney Disease under Dietary Treatment. Toxins (Basel). 2019 Dec 19;12(1):3.

Y u S, Paetau-Robinson I. Dietary supplements of vitamins E and C and beta-carotene reduce oxidative stress in cats with renal insufficiency. Vet Res Commun. 2006 May;30(4):403-13.

Brown SA, Brown CA, Crowell WA, et al. Beneficial effects of chronic administration of dietary omega-3 polyunsaturated fatty acids in dogs with renal insufficiency. J Lab Clin Med. 1998;131:447–455.

Quimby J, Erickson A, Mcleland S, Cianciolo R, Maranon D, Lunn K, Elliott J, Lawson J, Hess A, Paschall R, Bailey S. Renal Senescence, Telomere Shortening and Nitrosative Stress in Feline Chronic Kidney Disease. Vet Sci. 2021 Dec 8;8(12):314.

Rayego-Mateos S, Valdivielso JM. New therapeutic targets in chronic kidney disease progression and renal fibrosis. Expert Opin Ther Targets. 2020 Jul;24(7):655-670.

Padayatty SJ, Levine M. Vitamin C: the known and the unknown and Goldilocks. Oral Dis. 2016 Sep;22(6):46393.

Lin JL, Fung TT, Hu FB, Curhan GC. Association of dietary patterns with albuminuria and kidney function decline in older white women: A subgroup analysis from the Nurses' Health Study. Am J Kidney Dis. 2011;57(2):245– 54. 10.1053

(3)Hall JA, MacLeay J, Yerramilli M, Obare E, Yerramilli M, Schiefelbein H, Paetau-Robinson I, Jewell DE. Positive Impact of Nutritional Interventions on Serum Symmetric Dimethylarginine and Creatinine Concentrations in Client-Owned Geriatric Dogs. PLoS One. 2016 Ap

(4) Hall JA, Jewell DE. Feeding healthy beagles medium-chain triglycerides, fish oil, and carnitine offsets agerelated changes in serum fatty acids and carnitine metabolites. PLoS One. 2012;7(11):e49510

Small DM, Coombes JS, Bennett N, Johnson DW, Gobe GC. Oxidative stress, antioxidant therapies and chronic kidney disease. Nephrology (Carlton). 2012 May;17(4):311-21.

Tamay-Cach F, Quintana-Pérez JC, Trujillo-Ferrara JG, Cuevas-Hernández RI, Del Valle-Mondragón L, GarcíaTrejo EM, Arellano-Mendoza MG. A review of the impact of oxidative stress and some antioxidant therapies on renal damage. Ren Fail. 2016;38(2):171-5.

Boaz M, Smetana S, Weinstein T, Matas Z, Gafter U, Iaina A, Knecht A, Weissgarten Y, Brunner D, Fainaru M, Green MS. Secondary prevention with antioxidants of cardiovascular disease in end stage renal disease (SPACE): randomized placebo-controlled trial. Lancet. 2000 Oct 7;356(9237):1213-8.

This supplement is widely found in fruit peels, and in herbs such as rosemary and thyme. It is anti-inflammatory and protects against CKD and renal fibrosis. It inhibits proinflammatory cytokines in muscles, which slows the decline of muscle mass associated with the progressive loss of protein in CKD.47 Interestingly, ursolic acid has been shown to directly inhibit the expression of pro-inflammatory cytokines in the muscles of mice with CKD.48

Meagher EA. Treatment of atherosclerosis in the new millennium: is there a role for vitamin E? Prev Cardiol. 2003 Spring;6(2):85-90.

Timmons RM, Webb CB. Vitamin E supplementation fails to impact measures of oxidative stress or the anemia of feline chronic kidney disease: a randomized, double-blinded placebo control study. Vet Med Sci. 2016 Jan 22;2(2):117-124.

Takahashi, N.; Morimoto, S.; Okigaki, M.; Seo, M.; Someya, K.; Morita, T.; Matsubara, H.; Sugiura, T.; Iwasaka, T. Decreased plasma level of vitamin C in chronic kidney disease: Comparison between diabetic and non-diabetic patients. Nephrol. Dial. Transpl. 2011, 26, 1252–1257

Jun M, Venkataraman V, Razavian M, Cooper B, Zoungas S, Ninomiya T, Webster AC, Perkovic V. Antioxidants for chronic kidney disease. Cochrane Database Syst Rev. 2012 Oct 17;10(10):CD008176.

S ung CC, Hsu YC, Chen CC, Lin YF, Wu CC. Oxidative stress and nucleic acid oxidation in patients with chronic kidney disease. Oxid Med Cell Longev. 2013;2013:301982

Rojo-Trejo MH, Robles-Osorio ML, Sabath E. Liposoluble vitamins A and E in kidney disease. World J Nephrol. 2022 May 25;11(3):96-104.

Kinoshita K, Kishimoto K, Shimazu H, Nozaki Y, Sugiyama M, Ikoma S, Funauchi M. Successful treatment with retinoids in patients with lupus nephritis. Am J Kidney Dis. 2010;55:344–347

Corbee R. J. Vitamin D in Health and Disease in Dogs and Cats Advances in Small Animal Care 1 (2020) 265–277

Emmett, M. A Comparison of Calcium-Based Phosphorus Binders for Patients with Chronic Kidney Disease Dialysis & Transplantation May 2006

Wagner E, Schwendenwein I, Zentek J. Effects of a dietary chitosan and calcium supplement on Ca and P metabolism in cats. Berl Munch Tierarztl Wochenschr. 2004 Jul-Aug;117(7-8):310-5. PMID: 15298059.

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Jing SB, Li L, Ji D, Takiguchi Y, Yamaguchi T. Effect of chitosan on renal function in patients with chronic renal failure. J Pharm Pharmacol. 1997 Jul;49(7):721-3.

From the VMAA

Roudebush P, Polzin DJ, Adams LG, Towell TL, Forrester SD. An evidence-based review of therapies for canine chronic kidney disease. J Small Anim Pract 2010; 51(5): 244–52.

Maniaki E, Finch N Chronic Kidney Disease in cats and Dogs, managing proteinuria In Practice London Vol. 40, Iss. 7, (Sep 2018): 266.

Harris M, Lunn K, Quimby J, etal Omega 3 fatty acids mitigate inflammation in felines with chronic kidney disease FASEB April 2012 Vol 26 Iss 51

Pan, Y.; Zhu, G.; Wang, Y.; Cai, L.; Cai, Y.; Hu, J.; Li, Y.; Yan, Y.; Wang, Z.; Li, X.; et al. Inhibition of high glucoseinduced inflammatory response and macrophage infiltration by a novel curcumin derivative prevents renal injury in diabetic rats. Br. J. Pharm. 2012, 166, 1169–1182

Barzegar, A.; Moosavi-Movahedi, A.A. Intracellular ROS protection efficiency and free radical-scavenging activity of curcumin. PLoS ONE 2011, 6, e26012.

Soetikno, V.; Watanabe, K.; Sari, F.R.; Harima, M.; Thandavarayan, R.A.; Veeraveedu, P.T.; Arozal, W.; Sukumaran, V.; Lakshmanan, A.P.; Arumugam, S.; et al. Curcumin attenuates diabetic nephropathy by inhibiting PKC-α and PKC-β1 activity in streptozotocin-induced type I diabetic rats. Mol. Nutr. Food Res. 2011, 55, 1655–1665.

Leong, G.S.; Oh, G.S.; Pae, H.O.; Jeong, S.O.; Kim, Y.C.; Shin, M.K.; Seo, B.Y.; Han, S.Y.; Lee, H.S.; Jeong, J.G.; et al. Comparative effects of curcuminoids on endothelial heme oxygenase-1 expression: Orthomethoxy groups are essential to enhance heme oxygenase activity and protection. Exp. Mol. Med. 2006, 38, 393–400

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

ESSENTIAL OILS FOR THE PET’S URINARY SYSTEM

Ye, S.F.; Hou, Z.Q.; Zhong, L.M.; Zhang, Q.Q. Effect of curcumin on the induction of glutathione S-transferases and NADP(H): Quinone oxidoreductase and its possible mechanism of action. Yao Xue Xue Bao 2007, 42, 376–380.

Rushworth, S.A.; Ogborne, R.M.; Charalambos, C.A.; O’Connell, M.A. Role of protein kinase C delta in curcumin-induced antioxidant response element-mediated gene expression in human monocytes. Biochem. Biophys. Res. Commun. 2006, 341, 1007–1016.

Liebman SE, Le TH. Eat Your Broccoli: Oxidative Stress, NRF2, and Sulforaphane in Chronic Kidney Disease. Nutrients. 2021 Jan 18;13(1):266.

Essential oils have adaptogenic properties that make them useful in veterinary medicine. One oil may be used for different diagnosed conditions while several oils may be appropriate for the same condition. Chronic kidney disease (CKD) is a challenge in older pets. Along with dietary considerations and medication options, essential oils may be useful when combined with acupuncture/acupressure points. These three essential oils can be beneficial for kidney/bladder issues: 1.

Lemongrass (Cymbopogon flexuosus) has been studied for its antibacterial, anti-inflammatory and pain-relieving effects. In vitro research demonstrated inhibition of several urinary tract pathogens, including E. coli.* Another study suggested that lemongrass prevents edema* — a concern in animals with CKD. Dilution is recommended for topical use.

Geranium (Pelargonium graveolens) is another essential oil with research on its antioxidant, anti-inflammatory and antibacterial actions. In vitro studies show inhibition for some of the same urinary tract pathogens as lemongrass. Geranium improved the effectiveness of ciprofloxacin in treating UTIs.* Citronellol, a primary constituent of this oil, has been studied for its effects on lowering blood pressure by increasing vasodilation.*

Juniper ( Juniperus osteosperma) essential oil has been traditionally used to support urinary tract health. It’s considered to be a diuretic and can reduce fluid retention in the body. Antioxidant and antibacterial actions similar to lemongrass and geranium make this essential oil another good choice.*

Mishra P, Chan DC. Mitochondrial dynamics and inheritance during cell division, development and disease. Nat Rev Mol Cell Biol. 2014; 15:634–646.

Brooks C, Wei Q, Cho SG, et al. Regulation of mitochondrial dynamics in acute kidney injury in cell culture and rodent models. J Clin Invest. 2009; 119:1275–1285.

Galvan DL, Green NH, Danesh FR. The hallmarks of mitochondrial dysfunction in chronic kidney disease. Kidney Int. 2017 Nov;92(5):1051-1057.

Cai Z, Zhang J, Li H. Selenium, aging and aging-related diseases. Aging Clin Exp Res. 2019 Aug;31(8):1035-1047.

Cardoso BR, Hare DJ, Bush AI, Roberts BR. Glutathione peroxidase 4: a new player in neurodegeneration? Mol Psychiatry. 2017 Mar;22(3):328-335.

Ursini F, Bindoli A. The role of selenium peroxidases in the protection against oxidative damage of membranes. Chem Phys Lipids. 1987 Jul-Sep;44(2-4):255-76.

Nallu A, Sharma S, Ramezani A, Muralidharan J, Raj D, 2017. Gut microbiome in chronic kidney disease: challenges and opportunities. Transl Res. 179:24–37.

Hall JA, MacLeay J, Yerramilli M, Obare E, Yerramilli M, Schiefelbein H, Paetau-Robinson I, Jewell DE, 2016. Positive impact of nutritional interventions on serum symmetric dimethylarginine and creatinine concentrations in client-owned geriatric dogs. PLoS One. 11(4):e0153653.

Lopes RCSO, Balbino KP, Jorge MP, Ribeiro AQ, Martino HSD, Alfenas RCG. Modulation of intestinal microbiota, control of nitrogen products and inflammation by pre/probiotics in chronic kidney disease: a systematic review. Nutr Hosp. 2018 Apr 27;35(3):722-730.

Saldanha, J.F.; Leal, V.O.; Rizzetto, F.; Grimmer, G.H.; Ribeiro-Alves, M.; Daleprane, J.B.; Carraro-Eduardo, J.C.; Mafra, D. Effects of Resveratrol Supplementation in Nrf2 and NF-κB Expressions in Nondialyzed Chronic Kidney Disease Patients: A Randomized, Double-Blind, Placebo-Controlled, Crossover Clinical Trial. J. Ren. Nutr. 2016, 26, 401–406

Liang, J.; Tian, S.; Han, J.; Xiong, P. Resveratrol as a therapeutic agent for renal fibrosis induced by unilateral ureteral obstruction. Ren. Fail. 2014, 36, 285–291. [146].

Topical application of these oils (singly or in a layering fashion) several times daily at BL23 (an easy point to teach owners) can be incorporated into existing protocols for CKD and UTI patients.

*Johnson, Scott A. Medicinal Essential Oils, 2017.

Sun, L.J.; Sun, Y.N.; Chen, S.J.; Liu, S.; Jiang, G.R. Resveratrol attenuates skeletal muscle atrophy induced by chronic kidney disease via MuRF1 signaling pathway. Biochem. Biophys. Res. Commun. 2017, 487, 83–89.

Kunkel, S.D.; Suneja, M.; Ebert, S.M.; Bongers, K.S.; Fox, D.K.; Malmberg, S.E. mRNA expression signatures of human skeletal muscle atrophy identify a natural compound that increases muscle mass. Cell Metab. 2011, 13, 627–638.

Stenvinkel, P.; Ketteler, M.; Johnson, R.J.; Lindholm, B.; Pecoits-Filho, R.; Riella, M. IL-10, IL-6 and TNFalpha: Central factors in the altered cytokine network of uremia–the good, the bad and the ugly. Kidney Int. 2005, 67, 1216–1233.

Yamabe, N.; Yokozawa, T.; Oya, T.; Kim, M. Therapeutic potential of (-)-epigallocatechin 3-O-gallate on renal damage in diabetic nephropathy model rats. J. Pharmacol. Exp. Ther. 2006, 319, 228–236.

Submitted by Susan Albright, DVM IVC Winter 2023

HOW TO DIAGNOSE YOUR PATIENTS’ GI ISSUES FAST! Figuring out the root cause of your canine and feline patients’ GI issues can be a long and complex process. Common GI symptoms have a number of possible causes, and multiple tests usually need to be issued, including blood, fecal and urine tests, along with abdominal ultrasounds, to really understand what’s going on. This process can take months, leaving the patient in GI distress for longer than necessary.

THE #1 SOLUTION TO GI SYMPTOM DIAGNOSIS Diseases such as IBD, pancreatitis, PLE, LSA, and SIBO may exist concurrently, so no one test can do it all. This means diagnostic tests are often done by several different laboratories, leaving vets with a lot of information that takes time to connect the dots. Why not simplify the GI diagnostic process and use the top system that connects the dots for you? VDI Lab’s Advanced GI Panel is the best solution for identifying the exact cause of a patient’s GI distress. This is done by bringing together common diagnostic tests and combining them with VDI’s specialty diagnostics into

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a single blood panel for diagnosing the patient with GI signs. The panel uses a single blood test and artificial intelligence that utilizes pattern recognition to quickly provide the right diagnosis for your patients’ GI symptoms. The Advanced GI Panel is also cost-effective, non-invasive, and useful for the initial workup and for therapeutic monitoring, making it a leader in GI diagnostics. With VDI Lab’s Advanced GI Panel, you can get insights on:

• M alabsorption and SIBO • F ood and environmental allergens • A ddison’s disease • C holangitis Along with the proper diagnosis, you also get context aware interpretation, a clinical case review, patient-specific dosing guidelines for vitamin deficiencies, and repeat tests for equivocal results. VDI Lab’s Advanced GI Panel will make you feel confident that you’re giving your canine and feline patients the right diagnosis for their GI symptoms.

• P rotein losing enteropathy

Take the guessing out of your patients’ GI issues and start using VDI’s Advanced GI Panel today! Now available for $160 with test code: 260.

• N utritional deficiencies

https://vdilab.com/

• L ymphoma vs. IBD • P ancreatitis

The primary approach to CKD in cats is dietary management to lessen the abnormalities caused by marginal kidney function. These nutritional measures have been proven to reduce uremia and extend the lifespan of cats with this common disease.

Nutritional management

of chronic kidney disease in felines BY CHRIS BESSENT, DVM, MSOM, DIPL. OM, L.AC

The incidence of chronic kidney disease (CKD) in cats is shockingly high. Reported ranges of CKD in young cats (< four years) are between 13% to 37.5%, depending on the specificity of testing. In middle-aged cats (four to ten years), CKD was diagnosed at 24% to 40.9%. CKD is especially prevalent in older cats (> 15 years), at 32% to 80%. Nutrition is key to managing feline CKD, and is the focus of this article. Before we jump into the details of diet, let’s step back a moment. The nutritional management of CKD in cats is contingent on the fact that felines are obligate carnivores with unique nutritional needs, processes, and physiology. The overall basis of a veterinary diet for an obligate carnivore must include, if not have, a foundation of animal-based protein, meat and organs. It can be challenging to balance the needs of the carnivore and the nutrient restrictions of the renallychallenged using a whole food, species-appropriate diet, but to do so, the following areas must be focal points.

PHOSPHORUS There is no question that blood phosphorus levels are a prognostic indicator, and that dietary levels of phosphorus affect the blood levels in a direct relationship. But cats are obligate carnivores, and as such, have a biological and physiological need for meat or animal-based proteins. Meat has the highest levels of phosphorus and protein, yet dietary restriction of phosphorus is necessary and effective for controlling hyperphosphatemia. However, some whole food choices reduce dietary phosphorus consumption. Beef, for example, has some of the lowest phosphorus levels of all meats, and eggs are an easily digested animalbased protein source. Phosphorus binders, such as chitosan and calcium carbonate, even out the phosphorus load. Chitosan is the exoskeleton of a crustacean, and will bind the consumed phosphorus in the gut. This combination is then passed out of the body via stool. Calcium carbonate, the major mineral in eggshells, also acts as a phosphorus binder in IVC Winter 2023

the gut. For obligate carnivores, restricting dietary phosphorus in combination with appropriate phosphorus binders has been shown to manage serum phosphorus levels.

PROTEIN

Cause of CKD is

challenging to determine The actual cause of kidney damage is seldom identified since cats can very often have it at an early age and with minimal signs. Weight loss may be common, and although this is one of the primary indicators of early kidney damage, it is often overlooked and not identified. By the time kidney damage is diagnosed, fibrosis to the kidney “muddies the water” as to the cause. Once identified, the primary approach is dietary management to lessen the abnormalities occurring due to marginal kidney function. These abnormalities include imbalanced mineral levels, restriction and compensation, acid base problems, hypertensive issues, oxidative stress, vitamin and mineral washout, uremic toxin challenges, and impairment of the gut-kidney axis.

Another balancing act in the dietary needs of the obligate carnivore is protein consumption. As in all things nutritional, too much or too little can cause issues. Too much protein increases the formation of urea, the by-products of protein catabolism. Urea excretion is restricted by the marginal kidney and therefore accumulates in the blood, increases metabolic pressure on the kidneys, and leads to the clinical signs of vomiting, diarrhea, lethargy, anorexia, polyuria and polydipsia, and proteinuria. On the other hand, cats have a physiologic need for the amino acids abundant in meat. Too little protein in a cat’s diet can contribute to catabolism of their own tissue to meet their nutritional needs, leading to muscle loss, cachexia, and malaise. Most importantly, low dietary protein levels do not slow the progression of CKD in most cats. Current research suggests that moderate levels of high quality digestible meats can meet a cat’s protein needs and avoid cachexia.

POTASSIUM Supporting potassium levels in the cat with CKD is important due to the connection between hypokalemia and CRF. This does not seem to be the case with dogs. Hypokalemia has been shown to negatively affect the glomerular filtration rate (GFR), and supplementation with potassium can reverse this decline. Hypokalemia is also seen in cats with excessive urinary potassium loss. Potassium levels may be depleted in cats with CKD for several reasons: decreased appetite and therefore decreased food consumption; diets with low potassium levels; changes in gastrointestinal absorption or excretion; and increased kaliuresis. It is generally thought that decreased intake and increased urinary losses represent the change in potassium levels. Dietary potassium supplementation such as potassium chloride or “lite salt” will improve renal function in cats.

SODIUM LEVELS AND HYPERTENSION The percentage of CKD patients with concurrent hypertension is high — 60% of cats and 93% of dogs with CKD

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have hypertension. Suggested underlying mechanisms include sodium retention, activation of the renin-angiotensin system, and sympathetic nerve stimulation. The relationship between dietary sodium or salt concentration and hypertension has not been established in cats or dogs; this notion is extrapolated from human data. However, caution should be used with high levels of sodium intake in patients with renal disease, as levels above AAFCO’s dietary recommendations may have a negative effect on the kidneys independent of any effect on blood pressure. And vice versa: low sodium levels may lead to a decrease in the volume of extracellular fluids, and prerenal azotemia. And certainly, low sodium levels in food negatively affect palatability and diet acceptance.

METABOLIC ACIDOSIS AND ALKALIZING DIETS Acid-base imbalance due to damaged kidneys not excreting hydrogen ions and retaining bicarbonate can lead to metabolic acidosis. In a study of cats with CKD, approximately 80% had metabolic acidosis. Combined with the fact that most commercial cat foods tend to be acidifying only exacerbates the pH imbalance. This is the one instance where alkalizing the diet can be beneficial. Sodium bicarbonate or potassium citrate can help alkalize the blood.

OXIDATIVE STRESS AND ANTIOXIDANTS Renal oxidative stress is unquestionably a component of CKD. Oxidative stress has recently been shown to be most prevalent in the early stages of feline kidney disease. It is not associated with increasing disease progression as it is in humans. Researchers measured urinary F2‐isoprostanes, an indicator of oxidative stress in cats with CKD. The hypothesis was that this marker of oxidative stress would increase by IRIS stage in cats as it does in humans. They found that urinary F2‐isoprostanes were highest in early (Stage 1) CKD in cats, compared to Stage 2 where they were significantly decreased with progressive IRIS stage. Interestingly, decreased indicators of oxidative stress were strongly and inversely correlated with increased serum creatinine concentration. This data suggests that adding dietary antioxidants to a feline CKD patient’s diet would be most helpful in the early stages of disease.

Dietary antioxidants can come from many superfood fruits, vegetables, and herbs. Superfoods are defined as plant-based materials that are uniquely dense in phytonutrients and antioxidants. These are particularly important in a carnivore’s diet due to the lower percentage of predigested plant material consumed in a species-appropriate diet.

OMEGA-3 FATTY ACIDS Omega-3 polyunsaturated fatty acids (PUFAs) in the active forms of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) competitively inhibit the formation of proinflammatory leukotrienes and prostaglandins from Omega-6 fatty acids. High dietary levels of Omega-3 fatty acids have been shown to be reno-protective by reducing glomerular capillary pressure and proteinuria, abating the decline of GFR, and decreasing the progression of renal disease in dogs. A retrospective study in 2005 found that cats fed a therapeutic kidney diet with a higher concentration of EPA had longer survival times compared to cats eating other therapeutic kidney diets. A dosage of 40 mg/kg body weight EPA combined with 25 mg/kg body weight DHA per day has been recommended for cats with CKD. The cleanest whole food sources of EPA/DHA are algae, krill and anchovies, then larger fish species. Where higher concentrations of the Omega-3 fatty acids EPA and DHA have shown to be reno-protective, increased dietary IVC Winter 2023

Omega-6 fatty acids had a negative effect on kidney function. The differences seem to be in the process of lipid metabolism, glomerular hypertension and hypertrophy, and urinary eicosanoid metabolism, with supplementation of Omega-6 PUFAs enhancing kidney decline and supplementation of Omega-3 PUFAs having reno-protective actions.

Probiotics have also been shown to improve the levels of uremic toxins in blood. Streptococcus thermophilus, Lactobacillus acidophilus and Bifidobacterium longum have been shown to utilize urea, uric acid, and creatinine as a food source, therefore leading to lower uremia levels. These bacteria are then passed in the stool as an “enteric dialysis”.

GUT-KIDNEY AXIS, PROBIOTICS IN SUMMARY AND PREBIOTICS Cats with CKD have concurrent intestinal dysbiosis. A recent study (2019) showed that the microbiome of cats with CKD was less rich and diverse as compared with healthy cats. Although there is no proven link between the gut microbiome, diet, and kidney disease in cats, there are plenty of indications of an association — for instance, the correlation between high uremia levels, increases in ureaseproducing bacterial growth in the gut, and an increase in uremic toxin concentrations, such as ammonia, in the gut. Urease breaks urea down into ammonia. These uremic toxins negatively change the environment within the gut, including pH levels and microbial populations. Furthermore, recent research has associated gut-derived uremic toxins with the progression of CKD, cardiovascular disease, and mortality in humans. In fact, higher numbers of ureaseproducing bacteria are found in subjects with end-stage renal disease. CKD affects the gut microbiome, and the disrupted gut microbiome worsens CKD. Furthermore, several recently-published studies demonstrate that feeding diets high in fermentable fibers (prebiotics) decreased the absorption of uremic toxins and reduced the concentration of bacterial produced uremic toxins within the gut of both dogs and cats. As well, an improvement in various markers of kidney health, including creatinine and urea, were observed in cats consuming a food high in fermentable fibers versus controls.

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Veterinary diets for feline patients with CKD should be made of whole food ingredients, including moderate levels of high quality clean protein, low phosphorus, moderate sodium, moderately high potassium, and high levels of EPA/DHA. These recommendations should be paired with additional supplementation of fermentable fiber, prebiotics, and select probiotics to balance the gut-kidney axis. These nutritional measures have withstood the test of time and have been proven to reduce uremia and extend the lifespan of cats with CKD.

References Marino CL, Lascelles BDX, Vaden SL, Gruen ME, Marks SL. Prevalence and classification of chronic kidney disease in cats randomly selected from four age groups and in cat recruited for degenerative joint disease studies. Journal of Feline Medicine and Surgery 2014;16: 465-472. Lulich JP, O'Brien TD, Osborne CA, et al. Feline renal failure: questions, answers, questions. Compend Educ Pract Vet. 1992; 14:127–152. Geddes R.F., Finch N.C., Syme H.M., Elliott J. The role of phosphorus in the pathophysiology of chronic kidney disease. J. Vet. Emerg. Crit. Care. 2013;23:122–133 doi: 10.1111/vec.12032. Polzin D.J. Chronic kidney disease in small animals. Vet. Clin. N. Am. Small Anim. Pract. 2011;41:15–30. doi: 10.1016/j.cvsm.2010.09.004. Freeman, DVM, PhD, DACVIM, L. M. (2022, June 27). Test your Nutrition Know-How for Cats with Kidney Disease. Pet Foodology. https://vetnutrition.tufts.edu/2022/06/test-yournutritionknow-how-for-cats-with-kidneydisease/?utm_source=feedburner&utm_medium=email. Martello E, Perondi F, Capucchio MT, Biasato I, Biasibetti E, Cocca T, Bruni N, Lippi I. Efficacy of a new dietary supplement in dogs with advanced chronic kidney disease. Peer J. 2020 Aug 14;8:e9663. doi: 10.7717/peerj.9663. PMID: 32864210; PMCID: PMC7430264. Finco DR, Brown SA, Brown CA, Crowell WA, Sunvold G, Cooper TL. Protein and calorie effects on progression of induced chronic renal failure in cats. Am J Vet Res. 1998 May;59(5):575-82. PMID: 9582959. Dow SW, Fettman MJ, LeCouteur RA, Hamar DW. Potassium depletion in cats: renal and dietary influences. J Am Vet Med Assoc. 1987 Dec 15;191(12):1569-75. PMID: 3693010. Syme H. Hypertension in small animal kidney disease. Vet Clin North Am Small Anim Pract. 2011 Jan;41(1):63-89. doi: 10.1016/j.cvsm.2010.11.002. PMID: 21251511. Chandler ML. Pet food safety: sodium in pet foods. Top Companion Anim Med. 2008 Aug;23(3):148-53. doi: 10.1053/j.tcam.2008.04.008. PMID: 18656843.

Whitehouse W, Quimby J, Wan S, Monaghan K, Robbins R, Trepanier LA. Urinary F2 -Isoprostanes in Cats with International Renal Interest Society Stage 1-4 Chronic Kidney Disease. J Vet Intern Med. 2017 Mar;31(2):449-456. doi: 10.1111/jvim.14634. Epub 2017 Feb 4. PMID: 28160524; PMCID: PMC5354001. Brown SA. Oxidative stress and chronic kidney disease. Vet Clin North Am Small Anim Pract. 2008 Jan;38(1):157-66, vi. doi: 10.1016/j.cvsm.2007.11.001. PMID: 18249247. Martello E, Perondi F, Bruni N, Bisanzio D, Meineri G, Lippi I. Chronic Kidney Disease and Dietary Supplementation: Effects on Inflammation and Oxidative Stress. Veterinary Sciences. 2021; 8(11):277. https://doi.org/10.3390/vetsci8110277 Brown SA, Brown CA, Crowell WA, Barsanti JA, Kang CW, Allen T, et al. Effects of dietary polyunsaturated fatty acid supplementation in early renal insufficiency in dogs. J Lab Clin Med. 2000;135(3):275-86. Brown SA, Brown CA, Crowell WA, Barsanti JA, Allen T, Cowell C, Finco DR. Beneficial effects of chronic administration of dietary omega-3 polyunsaturated fatty acids in dogs with renal insufficiency. J Lab Clin Med. 1998 May;131(5):447-55. doi: 10.1016/s0022-2143(98)90146-9. PMID: 9605110. Plantinga EA, Everts H, Kastelein AM, Beynen AC. Retrospective study of the survival of cats with acquired chronic renal insufficiency offered different commercial diets. Vet Rec. 2005 Aug 13;157(7):185-7. doi: 10.1136/vr.157.7.185. PMID: 16100367. Summers S. C., Quimby J. M., Isaiah A., Suchodolski J. S., Lunghofer P. J., Gustafson D. L. (2019). The fecal microbiome and serum concentrations of indoxyl sulfate and p-cresol sulfate in cats with chronic kidney disease. J. Vet. Intern. Med. 33 662–669. 10.1111/jvim.15389. Stavropoulou E, Kantartzi K, Tsigalou C, Konstantinidis T, Romanidou G, Voidarou C, Bezirtzoglou E. Focus on the Gut-Kidney Axis in Health and Disease. Front Med (Lausanne). 2021 Jan 21;7:620102. doi: 10.3389/fmed.2020.620102. PMID: 33553216; PMCID: PMC7859267. Pan W, Kang Y. Gut microbiota and chronic kidney disease: implications for novel mechanistic insights and therapeutic strategies. Int Urol Nephrol. 2018 Feb;50(2):289-299. doi: 10.1007/s11255017-1689-5. Epub 2017 Aug 28. PMID: 28849345. Krishnamurthy V. M., Wei G., Baird B. C., Murtaugh M., Chonchol M. B., et al. (2012). High dietary fiber intake is associated with decreased inflammation and all-cause mortality in patients with chronic kidney disease. Kidney Int. 81 300–306. 10.1038/ki.2011.355 Ephraim-Gebreselassie E., Jackson M. I., Jewell D. E. (2017). “Fermentable fibers influence markers of aging in senior dogs and cats,” in Poster presented at the 2017 Meeting of the International Scientific Association for Probiotics and Prebiotics (Chicago, IL:), 39. Wang IK, Yen TH, Hsieh PS, Ho HH, Kuo YW, Huang YY, Kuo YL, Li CY, Lin HC, Wang JY. Effect of a Probiotic Combination in an Experimental Mouse Model and Clinical Patients With Chronic Kidney Disease: A Pilot Study. Front Nutr. 2021 May 31;8:661794. doi: 10.3389/fnut.2021.661794. PMID: 34136518; PMCID: PMC8200566 Ranganathan N, Patel BG, Ranganathan P, Marczely J, Dheer R, Pechenyak B, Dunn SR, Verstraete W, Decroos K, Mehta R, Friedman EA. In vitro and in vivo assessment of intraintestinal bacteriotherapy in chronic kidney disease. ASAIO J. 2006 Jan-Feb;52(1):70-9. doi: 10.1097/01. mat.0000191345.45735.00. PMID: 16436893. Wernimont SM, Radosevich J, Jackson MI, Ephraim E, Badri DV, MacLeay JM, Jewell DE, Suchodolski JS. The Effects of Nutrition on the Gastrointestinal Microbiome of Cats and Dogs: Impact on Health and Disease. Front Microbiol. 2020 Jun 25;11:1266. doi: 10.3389/fmicb.2020.01266. PMID: 32670224; PMCID: PMC7329990. Stavropoulou E, Kantartzi K, Tsigalou C, Konstantinidis T, Romanidou G, Voidarou C, Bezirtzoglou E. Focus on the Gut-Kidney Axis in Health and Disease. Front Med (Lausanne). 2021 Jan 21;7:620102. doi: 10.3389/fmed.2020.620102. PMID: 33553216; PMCID: PMC7859267. Hall JA, MacLeay J, Yerramilli M, Obare E, Yerramilli M, Schiefelbein H, Paetau-Robinson I, Jewell DE. Positive Impact of Nutritional Interventions on Serum Symmetric Dimethylarginine and Creatinine Concentrations in Client-Owned Geriatric Cats. PLoS One. 2016 Apr 14;11(4):e0153654. doi: 10.1371/journal.pone.0153654. PMID: 27078852; PMCID: PMC4831797.

From the AATCVM & WATCVM The American Association of Traditional Chinese Veterinary Medicine (AATCVM) is a non-profit organization founded in 2006 to support practitioners of Traditional Chinese Veterinary Medicine (TCVM) and promote high quality research in all aspects of TCVM, including acupuncture, Chinese herbal medicine, Tui-na and food therapy. Members of AATCVM also enjoy dual membership with the World Association of Traditional Chinese Veterinary Medicine (WATCVM).

MEMBERSHIP BENEFITS One of the benefits of being an AATCVM/WATCVM member is access to the AJTCVM, which publishes clinical research studies and continuing education articles. Some of the articles in the most recent issue (August 2022) included: a scientific report on the efficacy of Tui-na for arthritis in dogs; acupuncture and Chinese herbal medicine for neck pain in dogs; osteoarthritis in penguins; and Balance Method acupuncture treatment for gastrointestinal disease in animals. For WATCVM members, new benefits are coming in 2023! These encompass updated and new scientific abstracts and articles; Dr. Huntingford ’s Canine Weight Loss Calculator; a veterinary wellness support group and resources; case publishing opportunities via blog, newsletter and social media; the chance to register to be a TCVM webinar lecturer; and a new e-book. The WATCVM also maintains its current member benefits, including the biannual TCVM Journal (AJTCVM-Digital); a case consultation forum; educational resources; an herbal handbook (e-book); a discount for the annual TCVM conference; a discount for monthly TCVM webinars; TCVM clinical PDF forms; an “Introduction to TCVM” PowerPoint you can download and use for lectures; and a practitioner directory.

CASE REPORT SUMMARY — FROM WATCVM’S QUARTERLY MEMBER NEWSLETTER Basic Acupuncture Strategy for Feline Inflammatory Cystitis by Nell Ostermeier, DVM, Certified Veterinary Acupuncturist, FAAVA Harper is a three-year-old neutered male Siberian cat who was given a traditional Western treatment plan for urinary symptoms. However, three weeks after discontinuing the medications, his symptoms recurred. Harper was placed on the same treatment plan, and again the symptoms returned, so his owner contacted the author for an acupuncture consult. When Harper came for his first acupuncture visit, he was still taking prazosin and gabapentin daily. He weighed approximately 8.5 kg with a body condition score of 7/9, so he was overweight. His tongue was pink and moist, with a mild lavender hue. His pulses were even and fairly normal, but felt most forceful at the deep level and seemed choppy. He was sensitive at the Bladder Channel acupoints BL-25 and BL-28. The TCVM diagnosis was Liver Qi Stagnation leading to Damp Heat in the Bladder. TCVM treatment principles included moving Liver Qi, calming the Spirit, resolving Damp Heat in the Lower Jiao (Bladder), and resolving discomfort/Channel Stagnation. Harper’s acupuncture point prescription included GV-20, GV-14, BL-23, BL-25, BL-28, LIV-13, ST-36, SP-9. Harper has been returning for acupuncture approximately once every four weeks for five months, and is completely off his Western medications. He has had no return of symptoms during this time.

Submitted by Judith E Saik, DVM, DACVP, CVA, CVCH, CVFT

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FELINE CARDIOMYOPATHY & THROMBOEMBOLISM – creating a better outlook for veterinary patients BY JODIE GRUENSTERN, DVM, CVA

Heart disease in cats is often seen as hopeless, but alternative treatments such as nutritional therapy, herbs, and even medicinal leeches may offer some promise. Heart disease and blood clots in cats are often regarded as hopeless disorders for which little or nothing can be done. With some proactive thinking, however, and the integration of a variety of alternative therapies, cats prone to cardiomyopathy and thromboembolic disease may have a better outlook.

TYPES AND CAUSES OF CARDIOMYOPATHY There are several cardiomyopathies, but the two seen most often in practice are the dilated and hypertrophic forms.

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Dilated cardiomyopathy has all but disappeared with the recognition of taurine deficiency as the cause, and the subsequent required addition of this important amino acid to all processed cat foods. Hypertrophic cardiomyopathy persists as the most diagnosed form, especially secondary to feline hyperthyroidism. A common sequela to this is the all-too-familiar sudden onset IVC Winter 2023

of “saddle” thrombus or aortic thromboembolism, which can be excruciatingly painful and paralyze a kitty in one day. Client education and proactive care are critical to preventing or at least delaying the onset of these disorders. Cat parents have become increasingly wary of processed cat foods, given all the recalls and social media shares about inadequate nutrition and potentially toxic ingredients in many commercial brands. This has led to a resurgence of home cooking. It is important that veterinarians question what a client is feeding their cat and counsel them regarding balance and adequate amounts of necessary nutrients. Many cat parents may not realize that cooking meat destroys taurine, and that its deficiency is a cause of dilated cardiomyopathy. Those who home prepare their cats’ food must give them complete, raw, species-appropriate diets; if they are heating the meat, they must add taurine and other missing nutrients. Today’s post-COVID veterinarians must regain the trust of pet parents who have become reluctant to seek timely veterinary

care. We must also shift focus away from over-vaccinating and instead emphasize the importance of annual wellness exams and bloodwork, especially in our aging cat population.

A proBNP is a great screening tool. If it is negative, it provides peace of mind. If it is positive, it creates the impetus to recommend an echocardiogram. Don’t let one of your feline patients succumb to sudden death due to undetected cardiomyopathy!

CARDIOMYOPATHY MANAGEMENT

DIAGNOSING CARDIOMYOPATHY Cats eight years or older should receive annual blood work screening that includes a TT4 and a proBNP. Explain to clients that cats who are eating great but losing weight are at risk for feline hyperthyroidism. Diagnosis can be delayed when a chubby cat who is dieting and losing weight has concurrent thyroid disease. When a cat’s thyroid disease goes undetected, they can develop secondary hypertrophic cardiomyopathy (HCM). Veterinarians must explain to cat parents that not hearing a murmur with a stethoscope does not mean heart function is okay.

Felines with elevated TT4 and/or proBNP need follow-ups and monitoring. Many of these cats also have hidden kidney disease, which becomes unmasked with the treatment of hyperthyroidism. Balancing TT4 with BUN/creatinine/SDMA using methimazole can be like walking a tightrope. Not enough methimazole to bring down TT4 causes secondary heart disease; too much allows kidney tests to elevate and leads to decreased appetite. Where there are thyroid, heart, and kidney issues, there may also be blood pressure problems. So don’t forget to check that too! Undetected blood pressure problems can exacerbate kidney and heart issues; hypertension can also cause blindness in cats. If you are having trouble regulating a cat’s TT4, or they are experiencing methimazole side effects of facial pruritus or bone marrow suppression, consider changing the type of

thyroid medication you are using. In my hands, the Felimazole brand rarely causes side effects and is easy to administer. I have found compounded ear gel formulations to be extremely inconsistent in efficacy. Of course, inform cat owners that thyroidectomy and radioiodide treatment options also exist, but each has its pros and cons. I have not seen herbals used alone to be effective as a sole treatment for full-blown hyperthyroidism; as an adjunct or for early intervention, however, they can be very helpful. Several commercial feline nutritional supplements combine glandular and herbal ingredients to support thyroid, kidney, liver, and cardiovascular health. Combination products can be great for kitties who do not appreciate a boatload of supplements added to their food or syringed into their mouths. Products that contain the organ of interest can be most beneficial and palatable.

GLANDULAR/ORGAN THERAPY — BEEF HEART •

Heart muscle is high in taurine, and should be fed as part of a commonsense prevention strategy for a cat’s entire life. Fresh organs can be presented in raw meals, or freeze-dried versions can be fed as meal toppers or treats. Cooking heart muscle destroys the taurine.

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Beef heart contains complete protein with nine essential amino acids. It also contains peptides, which may improve heart contraction strength. I still get chills when I think about how much sense it makes to feed a fresh, preyconcept diet that includes organs to prevent and manage organ dysfunction in our carnivorous pets!

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Beef heart is loaded with B vitamins. Excess B vitamins are expelled in the urine. Many veterinarians prescribe B12 injections for their aging feline patients. Obtaining these vitamins naturally in food can boost energy, and improve mentation, immune function, and normal cell division. B vitamins help maintain healthy blood pressure, and aid with the enzymatic reactions that keep a carnivore’s brain and heart clear of homocysteine, a potentially harmful by-product of protein metabolism.

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The selenium in beef heart is critical for thyroid and immune function, and is preferable to the synthetic

IMPORTANT REMINDERS Consider these reminders regarding feline patients at risk of cardiovascular disease or receiving treatment: M onitor for excessive appetite, weight loss, TT4, blood pressure, proBNP. H ave client observe the cat for lethargy, bruising, or vomiting, and report to veterinarian. D iscontinue blood-thinning drugs or herbals prior to surgical interventions or dental extractions.

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C onsider useful herbs such as angelica, clove, danshen, garlic, ginger, ginkgo, panax ginseng, poplar, red clover, or willow.

THE PROBLEM WITH MINERAL PROTEINATES

sodium selenite in most processed pet foods. Selenium helps in the cascade of nutrients that repair DNA. •

Beef heart contains large quantities of the antioxidant coenzyme Q10. Antioxidants slow the aging process. This nutrient is commonly “prescribed” for heart and oral health.

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Cats can also obtain antiviral immune-supportive zinc from eating heart muscle. Zinc impacts the destruction of damaged cells and protects the respiratory tract. The zinc from heart muscle is preferable to the laboratoryderived zinc proteinate, which is typically made from GMO soy and is a hidden source of glyphosate in processed pet foods.

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Heart is loaded with iron, a building block of red blood cells that help deliver oxygen to the body’s tissues. A kitty low in iron will feel very tired. Again, a natural source is preferable to iron proteinate, the chelated iron found in kibble and canned foods (see sidebar on page 33). Even worse is the iron oxide used in super cheap animal feed.

Mineral proteinates are often viewed as good because the chelation enhances absorption. However, the protein chelation is commonly derived from soy, which is a common allergen and is genetically modified. Six years ago, the FDA showed that in 264 soybean samples, 66% were positive for glyphosate. Research published in Food Chemistry also showed that glyphosate-tolerant genetically-modified soybeans contain high residues of glyphosate, also known as Roundup, which causes gut dysbiosis and contributes to diabetes, obesity, food allergies, heart disease, antibiotic-resistant infections, cancer, inflammatory bowel disease, and more.

supplements. Scientists say this Crataegus spp. has multiple effects on the cardiovascular system, including hypotensive activity via vasorelaxation from nitrous oxide stimulation; significant antioxidant activity; and tonic action on cardiac myocytes. Studies show that the whole herb is greater than the sum of its parts, and that it is very safe and can be combined with other cardiac medications. Standard Process Feline Cardiac Support contains bovine heart, hawthorn berry and more. Thorne Bio-Cardio contains taurine, CoQ10, hawthorn, etc.

Try to source heart muscle from organic, pasture-raised animals. Pasture-raised livestock is higher in healthy fats and many micronutrients. It’s also possible that the heart of a stressed animal is less desirable for consumption than the heart of a happy one.

HERBAL TREATMENTS FOR THE HEART •

Hawthorn berry is a well-known Western herbal that is nutritive to the heart and helps balance blood pressure. Like taurine and CoQ10, it is used in many feline heart

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Zhi Bai Di Huang Wan is a Chinese herbal with a positive reputation among TCVM practitioners as a formula for early intervention in hyperthyroid cats, and especially those with elevated kidney indicators.

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Jing Tang Heart Qi Tonic can be used with early onset heart issues. It also seems to reduce the need for diuretics, and can improve quality of life and increase longevity even in cats developing pleural effusion associated with HCM. This can be very important for practitioners trying to avoid diuretics in cats with concurrent kidney issues. Heart failure is a Qi deficiency. The ingredients in Heart Qi Tonic possess TCVM properties and their physiologic effects on cardiovascular function have been validated by many studies.

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Astragalus root tonifies Qi. It may decrease calcium overloadinduced myocardial damage and improve heart function.

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Codonopsis root also tonifies Qi. It can activate the GS-βARcAMP-PKA signaling pathway and improve morphology of the heart muscle.

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Poria sclerotium drains damp and strengthens the spleen.

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Cassia bark warms Yang.

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Schisandra fruit was shown in a human study to reduce blood pressure by inhibiting sympathetic nerves, leading to a decrease of heart preload and a reduction of myocyte ischemia.

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Polygala root tonifies the heart.

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Oriental arborvitae seed/Biota/Bai Zi Ren also tonifies the heart.

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Sichuan lovage rhizome/Ligusticum/Chuan Xiong moves the blood. Lovage is a cousin to parsley, tastes like celery, and has diuretic effects. It is also a digestive aid.

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Dong quai root nourishes the blood. Also called angelica, this herb contains coumarins, which cause blood thinning.

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Chinese licorice cured root and rhizome tonifies Qi, harmonizes the formula and tastes good.

REFERENCES The Feline Cardiomyopathies: 3. Cardiomyopathies Other Than HCM https://pubmed.ncbi.nlm.nih.gov/34693805/ Genetics of Feline Hypertrophic Cardiomyopathy https://pubmed.ncbi. nlm.nih.gov/32215921/ The Feline Cardiomyopathies: 2. Hypertrophic Cardiomyopathy https://pubmed.ncbi.nlm.nih.gov/34693811/ Thromboembolic Therapies in Dogs and Cats: an Evidence-based Approach https://pubmed.ncbi.nlm.nih.gov/17466757/

THROMBOEMBOLIC COMPLICATIONS Due to the grave prognosis for feline aortic thromboembolism (FATE) or saddle thrombus, euthanasia without attempting treatment is chosen by cat owners 50% to 75% of the time. Cats with concurrent heart disease typically survive less than three months, and those without heart failure less than eight months. Practitioners treat these patients with anticoagulant and antithrombotic medications, but the hind limb paralysis can be persistent and painful, and the clot can cause permanent tissue damage. A more useful, novel approach does exist but is rarely used because it involves maintaining a leech colony.

HEMOACUPUNCTURE FOR FATE Hirudo medicinalis, or medicinal leeches, can be used to relieve the TCVM diagnosis of blood stagnation by moving blood. They are FDA approved as a medical device and have bacteriostatic and anesthetic properties. The protocol for saddle thrombus treatment includes shaving and wetting the fur on the medial thighs and applying the leeches at LIV-10 and SP-11. When a leech bites, hyaluronidase and collagenase enzymes digest the tissues and access the blood vessels. Dilation of vessels occurs by the action of histaminelike molecules. Platelet functions and coagulation decrease, and inflammatory reactions are suppressed. Practitioners use this method successfully in the human plastic surgery field, and leeches have also been used to manage ear hematomas in dogs. Exploring the alternative approaches discussed in this article may help improve the prognosis of cats diagnosed with cardiomyopathy.

Influence of the Chelation Process on the Stability of Organic Trace Mineral Supplements Used in Animal Nutrition www.ncbi.nlm.nih.gov/pmc/articles/PMC8227544/

Analysis of Effect of Schisandra in the Treatment of Myocardial Infarction Based on Three-Mode Gene Ontology Network www.ncbi.nlm.nih.gov/pmc/articles/PMC6435518/

Monsanto’s Round-up (Glyphosate) Exposed www.beyondpesticides.org/assets/media/documents/journal/bp-37.2su17%20Glysophate-final.pdf

Dong Quai (Angelica sinensis, Chinese Angelica) www.medicinenet.com/dong_quai_angelica_sinensis-oral/article. htm#what_is_dong_quai_angelica_sinensis_what_is_dong_quai_ used_for

Hawthorn (Crataegus spp.) in the Treatment of Cardiovascular Disease www.ncbi.nlm.nih.gov/pmc/articles/PMC3249900/

The Use of Antithrombotics in Critical Illness www.sciencedirect.com/science/article/abs/pii/S0195561620300784

Effects of Astragalus on Cardiac Function and Serum Tumor Necrosis Factor-alpha Level in Patients with Chronic Heart Failure https://pubmed.ncbi.nlm.nih.gov/20929124/

Feline Aortic Thromboembolism: Presentation, Diagnosis, and Treatment Outcomes of 15 Cats https://pubmed.ncbi.nlm.nih.gov/33282706/

Investigating the Mechanism of Shengmaiyin (Codonopsis pilosula) in the Treatment of Heart Failure Based on Network Pharmacology https://pubmed.ncbi.nlm.nih.gov/35189795/

Beef Heart Nutrition and Benefits www.doctorkiltz.com/beef-heart/

Benefits Of Lovage Herb: What To Do With Lovage Plants www.gardeningknowhow.com/edible/herbs/lovage/what-to-do-withlovage-plants.htm

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Feline Aortic Thromboembolism (FATE or Saddle Thrombus) https://veterinarypartner.vin.com/default.

aspx?pid=19239&id=5307199

Leech Power Point www.siav-itvas.org/wp/wp-content/uploads/2019/02/proceedings_ vam2011_5-7-1.pdf Medicinal Leech Therapy -- an Overall Perspective www.ncbi.nlm.nih.gov/pmc/articles/PMC5741396/

Inthenews

O-U

-T

EAS

RES

ICES

THE C

ACT

ARB

T OF VETERI N I R P NAR T O O Y NF

SE C ALCULATOR

he veterinary industry has a considerable carbon footprint. This includes the carbon emitted during the running of a veterinary practice, and that emitted as pet owners provide care for their animals. The way to control this carbon footprint is to first have the capability to accurately gauge how much carbon we are emitting. Recently, veterinarians in the UK introduced a carbon footprint calculator that can be used to measure the environmental impact of activities carried out at veterinary practices.

made public at the London Vet Show where it received a very good response. The calculator has been endorsed by many of the UK’s professional associations, and the British Veterinary Association has also given it a nod.

The calculator was developed by Vet Sustain, a volunteer organization founded by environmentallyconscious professionals, and was

Currently, the calculator is only optimized for use in the UK, although Vet Sustain hopes to make it go international. They are hoping to

Using the calculator involves feeding it data such as energy usage, amount of waste, and information related to transport. It then gives you a figure representing the amount of carbon dioxide in metric tons produced by your practice.

A E M

collaborate with international organizations that can adopt the core functionality of the tool and benefit from the information it offers. Calculators that measure carbon footprints are not new. Several are already on the market, and there are others that can be used for free. In addition to the simpler carbon footprint calculators, more advanced ones are used by larger organizations. This newly-launched calculator is different because it is a lot cheaper to use and is user-friendly. https://news.vin.com/default.aspx?pid=2 10&catId=611&Id=11244883

BY ANGIE KRAUSE, DVM, CVA, CCRT

INTEGRATIVE

APPROACH TO

CANINE HIP DYSPLASIA From physical therapy to acupuncture, an integrative multimodal approach is an effective way to manage canine hip dysplasia and the osteoarthritis that often arises from it.

Canine hip dysplasia is the most common congenital joint condition in dogs. It affects several breeds, with a higher prevalence in the larger ones.1 Some dogs with dysplastic hips will never show signs of disease, while others may be debilitated by severe osteoarthritis as a result of the condition. In either scenario, managing hip dysplasia is a lifelong endeavor. This article discusses an integrative multimodal approach to managing hip dysplasia, including the management of osteoarthritis.

TREATMENT AND MANAGEMENT 1.

Surgery

• F HO

may be preferred if the dysplasia is unilateral, and is a more affordable surgery that can be successfully performed by many general practitioners.2

The other two surgeries for correcting hip dysplasia include triple pelvic osteotomies (TPO) and juvenile pubic symphysiodesis (JPS). • T riple

pelvic osteotomies are performed in dogs who are diagnosed with hip dysplasia and are less than 20 weeks of age, with the aim of reducing the future development of osteoarthritis. The goal of this surgery is to increase the coverage of the femoral head by the acetabulum and decrease ligamentous laxity in the joint.3

• J uvenile

Four surgical procedures are used for treating dogs with hip dysplasia. Two are complete salvage procedures used when medical management has failed; these include total hip replacement and femoral head/neck osteotomy (FHO). • T otal

hip replacements can be performed on dogs only after the growth plate of the greater trochanter has closed. Cemented and uncemented implants are available and may be used in combination. Total hip replacements may be financially inaccessible for many guardians.

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pubic symphysiodesis (JPS) is also performed on young puppies by using electrocautery to fuse the pubic symphyseal growth plate. Like TPO, this causes more of the femoral head to be covered by the acetabulum.4

Physical therapy

Physical therapy is an underutilized tool in veterinary medicine for supporting canine patients with hip dysplasia and osteoarthritis. It aims to relieve pain by strengthening the tendons and muscles around a joint, increasing circulation and mobility, and decreasing pain caused by compensatory movement. Hydrotherapy, such as underwater treadmills and current pools, create resistance while providing buoyancy. Fascial release can relieve adhesions from the compensatory movement patterns that cause pain. Massage done both by a practitioner and guardian can help improve mobility and circulation, while decreasing pain. Exercises done regularly at home can help improve stability of the coxofemoral joint. This may also help reduce the onset and severity of arthritis; however, more studies are needed.

Acupuncture

Research that investigates the efficacy of acupuncture to treat hip dysplasia in dogs is lacking, but an abundance of anecdotal evidence from general practitioners supports its use. For the practitioner who uses acupuncture in private practice, hip dysplasia and osteoarthritis are often the most rewarding cases to treat. Most patients start with acupuncture once to twice weekly and decrease to every other week or monthly, depending on how long symptom relief is experienced. Three points are commonly used to treat hip dysplasia: GB 29, GB 30 and BL 54. These are often the same points practitioners use to implant gold beads in an effort to permanently stimulate the points. The small and limited studies that have investigated gold bead implants yielded mixed results.

Chiropractic care

Adjustments of the spine and other joints may provide relief from pain in other areas of the body caused by compensatory movement. Dogs with hip dysplasia anecdotally have an increase in SI joint dysfunction and paraspinal lumbar pain. Regular chiropractic adjustments may improve the health of surrounding structures as well as alleviate pain. While this modality will likely not decrease osteoarthritis in the coxofemoral joint, it may reduce overall pain and improve quality of life for patients with mild to moderate hip dysplasia and osteoarthritis.

Nutraceuticals

While most supplements have mixed data to support their use, they can be part of an integrative plan to help dogs with dysplastic hips. Most of these supplements do not have published dosing, leaving practitioners guessing and using medical grade products in hopes of reaching a therapeutic dose. • G lucosamine,

chondroitin sulfate and MSM can all support joint integrity and may reduce inflammation. These supplements are thought to be more effective when started at a young age. Starting high-risk breeds on jointsupportive blends containing glucosamine, chondroitin sulfate and MSM may help delay or reduce the severity of osteoarthritis. More studies are needed to determine their efficacy in dogs with hip dysplasia, as well as therapeutic dosing regimens.

• T here

is some evidence to support the use of Omega fatty acids in dogs with hip dysplasia and osteoarthritis. One study of 77 dogs with osteoarthritis showed a small improvement over several scores of assessment for the dogs supplemented with fish oil. These improvements did not reach significance, but were enough to encourage the use of fish oil in dogs with osteoarthritis as a part of a multimodal approach to management.5

• A nother

study investigating a diet enriched with green lipped mussel (GLM) fed to 30 dogs found a significant improvement in clinical signs of hip dysplasia as compared to dogs fed a control diet.6 This study also investigated the plasma levels of the different components of GLM.6

NSAIDs

For many practitioners, this class of drug is a first line choice to provide relief for the pain associated with inflammation and joint degeneration resulting from hip dysplasia. These medications can be helpful for keeping dogs active and moving to maintain strength and weight control. They are also effective for controlling pain to improve quality of life. Some dogs may not tolerate their deleterious effects on the gastrointestinal lining, while others may have concurrent IVC Winter 2023

conditions such as kidney or liver disease that limit the long term use of NSAIDs. In these cases, other therapies outlined in this article should be considered.

CBD

Cannabis extract may be included in a multimodal approach to decreasing inflammation and controlling pain in dogs with osteoarthritis from hip dysplasia. One study showed a significant improvement in dogs with osteoarthritis when treated with 2 mg/kg of CBD twice daily.7 Practitioners should counsel clients on product selection to ensure they are purchasing hemp extracts instead of marijuana. Hemp extracts have less than 0.3% THC and will not cause a “high” like marijuana extracts do. Hemp products

Preventing hip dysplasia Hip dysplasia is a congenital disease caused by a delay in the endochondral ossification of the coxofemoral

may help lessen the amount and frequency of other pain medications such as tramadol and NSAIDs. CBD-rich hemp extracts are also reported to have anxiolytic effects that may benefit many dogs.

joint.13

This results in laxity of the

hip joint, and subsequently, the development of osteoarthritis.13 Breeding programs that

Weight management

This is perhaps the most critical and impactful aspect of managing the clinical signs associated with the osteoarthritis arising from hip dysplasia. Lifelong caloric restriction has been demonstrated to delay the onset and prevalence of hip osteoarthritis in Labrador Retrievers.8 This emphasizes the importance of educating guardians of medium to large-breed dogs during puppy visits, and supporting lean weights throughout life. The use of calorie calculators, diet management, regular weight checks and body condition charts becomes critical for the health and longevity of patients that are more susceptible to osteoarthritis.

Regenerative medicine

Therapies focused on regenerating joint cartilage and decreasing inflammation have gained popularity. Two primary types of regenerative therapy are available in veterinary medicine: stem cell therapy and platelet rich plasma therapy. • S tem cell therapy utilizes mesenchymal cells from adipose

tissue or bone marrow either from the patient or a donor. These are then administered by intra-articular injection, either once or in a series. This therapy helps regenerate cartilage and modulate inflammation in the joint.9

attempt to eliminate this congenital disease have mixed results due to the polygenic nature of its heredity.14 The correlation between hip dysplasia and spaying/neutering dogs before puberty has been a topic of discussion for the past 15 years. One study found that intact male dogs had a lower incidence of hip dysplasia,

• P latelet

rich plasma is less expensive and less invasive than stem cell therapy. Growth factors associated with the platelets decrease inflammation and promote healing.10 A recent study that compared the effectiveness of platelet rich plasma and adipose derived stem cells found that both were significantly effective at reducing pain. The stem cell therapy was slightly more effective.11

as compared to both female and male dogs altered before one year of age.15 Another study found an increase in joint disease (including hip dysplasia) among Golden Retrievers and Labrador Retrievers altered before six months of age.16

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A nother study published in 2020 demonstrated that the addition of physical therapy prolonged the positive effects of platelet rich plasma therapy in dogs with osteoarthritis resulting from hip dysplasia.12

Using an integrative approach when managing canine patients with hip dysplasia and osteoarthritis can be rewarding. Each patient requires an individually tailored treatment plan, as there is great variation in disease severity, lifestyle, athletic goals, personality and genetic expression. The guardian’s financial, emotional and time resources must also be considered when creating a plan for the dog. 1Smith G.K., Lawler D.F., Biery D.N., Powers M.Y., Shofer F., Gregor T.P., Karbe G.T., McDonald-

Lynch M.B., Evans R.H., Kealy R.D. Chronology of hip dysplasia development in a cohort of 48 labrador retrievers followed for life. Vet. Surg. 2012;41:20–33. doi: 10.1111/j.1532950X.2011.00935.x. 2 Shell

L, Harasen G. Hip Dysplasia (Canine). Veterinary Information Network, VINcyclopedia of Disease. 2022. 3Guevara

F, Franklin SP. Triple Pelvic Osteotomy and Double Pelvic Osteotomy. Vet Clin North Am Small Anim Pract. 2017 Jul;47(4):865-884. doi: 10.1016/j.cvsm.2017.02.005. Epub 2017 Apr 28. PMID: 28460693. 4Dunlap AE, Mathews KG, Walters BL, Bruner KA, Ru H, Marcellin-Little DJ. Three-dimensional

assessment of the influence of juvenile pubic symphysiodesis on the pelvic geometry of dogs. Am J Vet Res. 2018 Nov;79(11):1217-1225. doi: 10.2460/ajvr.79.11.1217. PMID: 30372155. A, Roine J, Elo K, Lappalainen A, Junnila J, Laitinen-Vapaavuori O. An un-commissioned randomized, placebo-controlled double-blind study to test the effect of deep sea fish oil as a pain reliever for dogs suffering from canine OA. BMC Vet Res. 2012 Sep 6;8:157. doi: 10.1186/1746-6148-8-157. PMID: 22950577; PMCID: PMC3514349. Was 7.

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

NEXT YEAR’S ANNUAL CONFERENCE Save the dates for the 2023 AHVMA Annual Conference and Exhibition! It takes place in San Diego, California from October 7 to 10. Expect over 80 hours of complementary and integrative CE sessions, hands-on labs, and special events. Over the past six years, AHVMA has applied for and received AAVSB RACE approval for over 80 hours of continuing education.

5Hielm-Björkman

6Rialland

P, Bichot S, Lussier B, Moreau M, Beaudry F, del Castillo JR, Gauvin D, Troncy E. Effect of a diet enriched with green-lipped mussel on pain behavior and functioning in dogs with clinical osteoarthritis. Can J Vet Res. 2013 Jan;77(1):66-74. PMID: 23814358; PMCID: PMC3525174. 7 Gamble

LJ, Boesch JM, Frye CW, Schwark WS, Mann S, Wolfe L, Brown H, Berthelsen ES, Wakshlag JJ. Pharmacokinetics, Safety, and Clinical Efficacy of Cannabidiol Treatment in Osteoarthritic Dogs. Front Vet Sci. 2018 Jul 23;5:165. doi: 10.3389/fvets.2018.00165. PMID: 30083539; PMCID: PMC6065210. GK, Paster ER, Powers MY, Lawler DF, Biery DN, Shofer FS, McKelvie PJ, Kealy RD. Lifelong diet restriction and radiographic evidence of osteoarthritis of the hip joint in dogs. J Am Vet Med Assoc. 2006 Sep 1;229(5):690-3. doi: 10.2460/javma.229.5.690. PMID: 16948575.

The conference will be held at the beautifully remodeled Town and Country Resort and Convention Center in San Diego. When AHVMA was last in San Diego back in 2017, we had our largest attendance ever! It’s the perfect place to see and connect with everyone in person. Located on 24 acres, Town and Country offer a wide range of amenities for everyone to enjoy. Don’t want to leave the hotel? Visit the new pool complex! Want a quieter pool experience? Check out the Regency Pool near Regency Tower.

8Smith

9 Mason,

David. 2017. An Introduction And Overview of Stem Cell Therapies. Wild West Veterinary Conference. 10 Franklin,

Samuel. 2015. Regenerative Medicine in Dogs: PRP and Stem Cells. Wild West Veterinary Conference. CE, Cassu RN, Joaquim JGF, Reis Mesquita LD, Rahal SC, Oliveira HSS, Takahira R, Arruda I, Maia L, Cruz Landim FD, Luna SPL. Chronic pain and gait analysis in dogs with degenerative hip joint disease treated with repeated intra-articular injections of plateletrich plasma or allogeneic adipose-derived stem cells. J Vet Med Sci. 2021 Jun 2;83(5):881-888. doi: 10.1292/jvms.20-0730. Epub 2021 Apr 5. PMID: 33814521; PMCID: PMC8182309.

Conference attendees will also love the additional amenities that focus on health and wellness! Do your workout in the new state-of-the-art fitness center, or participate in a game at the Sand Volleyball Court. For those who just want to relax, take advantage of the beautiful three-acre River Park, or grab a seat by one of the 19 fire pits!

11Okamoto-Okubo

12Cuervo B, Rubio M, Chicharro D, Damiá E, Santana A, Carrillo JM, Romero AD, Vilar JM, Cerón

JJ, Sopena JJ. Objective Comparison between Platelet Rich Plasma Alone and in Combination with Physical Therapy in Dogs with Osteoarthritis Caused by Hip Dysplasia. Animals (Basel). 2020 Jan 21;10(2):175. doi: 10.3390/ani10020175. PMID: 31972961; PMCID: PMC7070503.

13Schachner ER, Lopez MJ. Diagnosis, prevention, and management of canine hip dysplasia: a

review. Vet Med (Auckl). 2015 May 19;6:181-192. doi: 10.2147/VMRR.S53266. PMID: 30101105; PMCID: PMC6070021.

INTERESTED IN EXHIBITING? Current exhibitors and sponsors should now have received a copy of the 2023 exhibitor prospectus — please contact the AHVMA office if you have not. For all other exhibitors, be on the lookout for registration at the beginning of 2023. Based on AHVMA’s history in San Diego, we expect another large attendee turnout! ahvma.org Submitted by Melissa Kellagher, AHVMA Director of Operations

14King MD. Etiopathogenesis of Canine Hip Dysplasia, Prevalence, and Genetics. Vet Clin North

Am Small Anim Pract. 2017 Jul;47(4):753-767. doi: 10.1016/j.cvsm.2017.03.001. Epub 2017 Apr 28. PMID: 28460694. 15Witsberger TH, Villamil JA, Schultz LG, Hahn AW, Cook JL. Prevalence of and risk factors for

hip dysplasia and cranial cruciate ligament deficiency in dogs. J Am Vet Med Assoc. 2008 Jun 15;232(12):1818-24. doi: 10.2460/javma.232.12.1818. PMID: 18598150. 16Hart

BL, Hart LA, Thigpen AP, Willits NH. Long-term health effects of neutering dogs: comparison of Labrador Retrievers with Golden Retrievers. PLoS One. 2014 Jul 14;9(7):e102241. doi: 10.1371/journal.pone.0102241. PMID: 25020045; PMCID: PMC4096726. IVC Winter 2023

A closer look at the use of

Electroacupuncture for Chronic Lameness Monty happily coming into the practice for his electroacupuncture session.

in Small Animals BY CRISTINA FIRULETE, DVM, CVA

Chronic lameness in dogs and cats can have many causes, including osteoarthritis, hip dysplasia and more. Electroacupuncture can be an effective way to help treat the problem.

ameness in dogs and cats is a sign of illness, not a specific disease, and refers to the inability to use one or more limbs properly. It is associated with pain or injury in soft tissues, joints or bones. Nerve and muscle function may be impaired due to changes to neuromuscular tissues. Muscle and skeletal problems may affect other organ systems, including the urinary, digestive, and circulatory systems. Chronic lameness may be caused by osteoarthritis. Lameness can affect pets of any age, from growing to senior animals. This article discusses how electroacupuncture can be used to effectively treat chronic lameness in dogs and cats.

The level of needle stimulation can be accurately measured by known frequencies, amplitudes, and duration of treatment. This enables the acupuncturist to rigorously assess a treatment session and replicate effective treatments in the future.

EA allows the acupuncturist to deliver a higher and more continuous level of needle stimulation than by hand, thus facilitating unique treatments for pain and neurodegenerative disorders (Shanghai College of Traditional Chinese Medicine, 1981).

A MULTIMODAL APPROACH IS PREFERRED

The dorsal horn gray matter of the spinal cord, the periaqueductal gray matter, the pons, medulla, limbic system, cerebral cortex and autonomic system are generally influenced by EA.

Some forms of lameness, such as that caused by osteoarthritis, require lifelong medical treatment, while others require surgical repair. Alongside the general nonsteroidal drugs and pain relief medications, more and more alternative options are being used, such as acupuncture, electroacupuncture (EA), laser treatment, chiropractic adjustment and physiotherapy. These days, a multimodal approach is preferred over “one treatment fits all”.

WHAT IS ELECTROACUPUNCTURE? Electroacupuncture involves passing an electrical current through acupuncture needles that have already been inserted into acupoints on the animal’s body. EA provides more robust stimulation and more predictable effects.

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Chronic lameness, caused by the following issues, is the most popular reason for using EA: •

Osteoarthritis

•

Hip or elbow dysplasia

•

Patellar luxation

•

Ligament disease

•

Intervertebral disk disease

•

Osteochondritis dissecans

Case Example Monty, a ten-year-old male neutered Clumber spaniel, presented for acupuncture due to chronic lameness and inflammatory bowel disease for the past four years. At age six, he was diagnosed

GV 14

with bilateral hip dysplasia, severe subluxation of both femoral heads, and spondylosis on L7-S1 with a mild displacement of the L7 nerve but no compression. Monty responded very well to initial acupuncture sessions using dry needles only. Electroacupuncture was then started to reduce the frequency of sessions and achieve better results.

BL 20

His Traditional Chinese Veterinary Medicine pattern was Kidney Qi and Yang deficiency plus Spleen Qi deficiency. The treatment plan was to tonify Qi

Shen shu

and warm Yang to improve Monty's pain level and quality of life.

(both red leads)

Depending on results and re-evaluation, distal and local points were selected at each visit. Main points used:

•

Distal points: Electroacupuncture at ST 36 + LI 11 (He-sea points) at 80-120 Hz for 20 to 40 min — for Spleen deficiency pattern, boosting energy level, and immunostimulatory effect.

•

Local points: Bai Hui to GV 14 — Bai Hui (Yang deficiency, diarrhea, pelvic limb paresis or paralysis); GV 14 (crossing point of the GV with the Six Yang Channels).

Bai Hui In addition, dry needles were used at:

•

BL 40 (master point for caudal back/hips)

•

BL 11 (influential for bones, intervertebral disk disease, degenerative joint disease)

BL 54: Master point for the pelvic limbs, coxofemoral joint pain

•

BL 23 (back-shu association point for Kidney)

and osteoarthritis, pelvic limb paresis or paralysis, lameness and

•

BL 25 (back-shu association point for large intestine)

•

ST 36 (master point for gastrointestinal tract and abdomen; general Qi tonic)

osteoarthritis of the coxofemoral joint, pelvic limb paresis or

•

Sp 6 (master point for caudal abdomen)

paralysis, gluteal muscle pain

•

Ki 3 (Yuan point for Kidney)

GB 30: Crossing point of the GB and BL Channels; osteoarthritis

•

LI 4 (Yuan point for the large intestine; general Qi tonic)

of the coxofemoral joint, pelvic limb paresis or paralysis, gluteal

•

GV 3 + GV 4 (to warm Yang).

muscle atrophy, perianal disorders, dysuria GB 29: Crossing point of the GB and Yang Qiao Channels;

muscle pain Shen shu, Shen jiao, Shen peng: tonify kidney, warming Yang

An herbal formula was also introduced based on the TCVM pattern: Loranthus formula 0.5 g per 10 pounds twice a day.

Monty had no adverse reaction to electroacupuncture and

Monty continued to have electroacupuncture sessions every four to

tolerated it very well; 0.25 mm x 25 mm needles were used.

six weeks for 2½ years. Later on, he developed severe osteoarthritis

EA settings were 30-40 Hz for 20 to 40 minutes, with a gradual

in his right elbow, which was controlled with EA as well using local

increase of amplitude every five to ten minutes.

points like LI 11, TH 10, SI 8, LU 5, PC 3, HT 3 and Zhou-shu.

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Examples of frequencies •

Low-frequency: F1 = 20-30 Hz, F2 = 0 Hz — provides good analgesia

•

Dense and disperse (DD): F1 = 80 Hz, F2 = 120 Hz — used more for paralysis, intervertebral disk disease and internal medicine cases

•

Intermittent wave: F1 = 0, F2 = 50-200 Hz — used for muscular atrophy

The Jing Tang Electroacupuncture unit has seven leads and is a 2-in-1 machine, which allows the practitioner to use two different settings at the same time.

ELECTROACUPUNCTURE UNITS Electroacupuncture units are very similar, and are pretty easy to use. First, all leads should be turned to zero amplitude and completely turned off before being connected to the needles. Stimulation should always start at the lowest amplitude, be gradually increased until there is an apparent deQi response, then lowered slightly from that amplitude. The voltage must be high enough to overcome the resistance of the tissue being treated, and the current must be enough to depolarize nerves. Since tolerance and habituation to the stimulus will occur, the amplitude or frequency may be slightly increased or changed every five to ten minutes. Stimulating a patient with a wide range of frequencies will provide a broader range of neurotransmitter release. Dense and disperse EA units alternate low and high frequencies every few seconds. The alternation allows for nerve fibers to accommodate stimulation, and for the optimum release of neurotransmitters.

How to use the unit The two buttons connected to the leads are named F1 and F2 (these are the ones that set the frequency). F1 sets the constant frequency, which should always be connected. F2 produces an intermittent frequency (comes and disappears). •

If F1 > F2, only a constant frequency will be administered to the patient, based on the F1’s level.

•

If F2 > F1, a frequency between F1 and F2 will be administered (dense and disperse)

•

The average frequency (about 100 Hz) produces rapid analgesia through the local production of dynorphins via the spinal cord or nuclei of the brainstem. This analgesia is rapid and dissipates quickly when EA stops. This frequency is mainly used for surgical cases. When patients are under the effects of opiates, EA is administered at frequencies near 200Hz — this will favor the release of local and systemic dynorphins and serotonin.

ELECTROACUPUNCTURE SESSIONS The first session: Should be around five to 20 mins using a maximum of three pairs (six) needles where F1 = 20 Hz and F2 = 0 Hz The second session: If no side effects were noticed, then EA duration can increase to 20 to 45 mins using seven pairs (14) EA 14 needles and a combination of frequencies — F1 = 80 Hz, F2 = 120 Hz; F1 = 0 Hz, F2 = 50 Hz, depending on the case. As a general rule, we match the points bilaterally. Cassu et al found in their study that bilateral EA produced a shorter latency period, a greater intensity, and a longer duration of analgesia than unilateral stimulation, without creating a stress response. Therefore, bilateral electroacupuncture produces a better analgesic effect than unilateral stimulation.

How to pair the points •

Points on the same meridian: ST 36 + ST 41, GV 14 + Bai Hui

•

Points with similar energy function: ST 36 + GB 34

If F1 = 0, then the unit will provide an intermittent output provided by F2.

In most cases, we start by using a constant low-frequency stimulation, about 4-40 Hz (usually 20 Hz), which primarily results in a release of endorphins and enkephalins.

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Local points should be connected bilaterally so that electric current flows through the stagnation area. Examples: GB 21 + SI 9 for shoulder pain, GB 34 + ST 35 of the same limb for knee pain, Huatuo-Jia-Ji crossed for IVDD, GB 20 + GB 21 or Jing-Jia-Ji for Wobbler syndrome. •

Proximal to distal points: BL 23 + Liu Feng for paralysis of a posterior limb, GV 14 + PC 9 in paralysis of the forehand

Healthy area to be paired with the affected area — for example, in right facial paralysis, bilateral ST 5 + ST 4 + ST 7 As the case example shows (see sidebar on page 43), dogs and cats with chronic lameness often respond very well to electroacupuncture. Because lameness is a common symptom in small animals, this modality is certainly worth your consideration.

WHEN NOT TO USE

ELECTROACUPUNCTURE Electroacupuncture is contraindicated in: •

Very weak or old patients, at least during the first session; EA can be used carefully once you know the patient's reaction to dry needling

•

Pregnant females

•

Near or crossing a tumor mass

•

Epileptic animals

•

On the chest for cardiac patients

•

Very Yang Fire animals (not well tolerated)

•

Vervous, agitated patients

•

Windy conditions, e.g. Heat Excess Yang.

A ten-year-old Labrador receiving EA for weakness in the hind legs. TCVM pattern: Kidney Qi and Spleen Qi deficiency

References U lett GA, Han S, Han JS. Electroacupuncture: mechanisms and clinical application. Biol Psychiatry. 1998; 44: 129-138 C assu RN Luna SP, Clark RM, Kronka SN Electroacupuncture analgesia in dogs: is there a difference between uni- and bi-lateral stimulation? Vet Anaesth Analg. 2008 Jan;35(1):52-61. doi: 10.1111/j.1467-2995.2007.00347. F ukazawa Y, Maeda T, Kishiokia S. The pharmacological mechanisms of electroacupuncture. Curr Opin Investig Drugs. 2009; 10: 62-69. H uisheng Xie Dr., Vanessa Preast Dr. (BX12) -Traditional Chinese Veterinary Medicine: Fundamental Principles 2nd Edition. H uisheng Xie Dr, Vanessa Preast Dr. XIE’S VETERINARY ACUPUNCTURE. B asic Principles for Electroacupuncture, Dr.Lorena Lloret Nadal, Chi University lecture. A nalgesia and Anesthesia with Electro-Acupuncture, Dr.Lorena Lloret Nadal, Chi University lecture. Electroacupuncture: A practical manual and resource, Edited by David F. Mayor, Churchill- Livingstone Elsevier. Monty falling asleep during his treatment

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BRINGS EMPLOYEE OWNERSHIP TO THE INDUSTRY An enduring love of animals draws people to the veterinary industry, but financial constraints and lack of work-life balance also drive them away. Whether your passion brings you to an exam room, an ER, the front desk, or an office, you deserve proper compensation for your hard work. Many veterinarians are practice owners and work hard to build their businesses, but don’t get the kind of deal they expect when looking to sell them. Over the past year, practice valuation multiples dropped from a generous 18-23x to 8-11x. Meanwhile, veterinary professionals who are employees often struggle to live up to work demands — and building a balanced life often becomes a far-fetched proposition. Galaxy Vets brings solutions to these problems with a long-term sustainable strategy.

A WIN-WIN SCENARIO Galaxy Vets is a veterinary healthcare system that aspires to democratize wealth in veterinary medicine, and bring ownership back to veterinary professionals in a manner that creates a win-win scenario. It leverages an ESOP (employee stock ownership plan) to provide equity and a retirement benefit at no cost to all its employees — veterinarians, technicians, assistants, administrative staff, and even relief workers. Galaxy Vets aims to create hubs in dense areas that will include general practices with a specialty and emergency hospital in the center, enhanced by membershipdriven telehealth services and a network of retail diagnostic centers. By augmenting

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brick-and-mortar hospitals with telehealth, they aim to change the entire veterinary healthcare delivery model to improve access to care and fight burnout in veterinary teams.

As Galaxy Vets’ purpose is to eliminate burnout in the industry, they take a systemic approach to employee satisfaction and well-being.

Benefits for practice owners According to recent VIS research, around 50 veterinary consolidators, mostly privateequity-backed, currently operate in the U.S., acquiring veterinary practices and hiring veterinary professionals. However, they are not the same as Galaxy Vets. Founded and run by veterinarians, Galaxy Vets focuses on giving veterinary professionals a stake in growth and providing improved work conditions by eliminating key causes of burnout.

TWO MAIN PATHS Galaxy Vets offers two main paths by which you can become a part of their veterinary healthcare system. 1. P ractice owners can partner with Galaxy Vets and continue growing their hospitals with rollover equity in the entire system. Their staff will also receive equity in the entire organization. Galaxy Vets offers a part-cash, part-equity roll-over mechanism designed to outperform any valuation offered by other buyers. They are looking for likeminded practice owners interested in staying with the company and driving innovations together. 2. V eterinary professionals can join any Galaxy Vets hospital with the opportunity to participate in the group’s ownership and build wealth as their shares appreciate over time.

• Y ou’ll keep your business in the hands of veterinarians who prioritize employee well-being. • Y ou’ll have an ownership stake in the entire veterinary healthcare system and continue growing your wealth. • Y our team will be rewarded with equity in the whole organization.

Benefits for employees • Y ou become an equity shareholder in the entire healthcare system and accumulate a significant and free retirement benefit starting with working as few as 20 hours per week. • N o non-competes, a generous PTO policy, and CE and licensure allowances with a focus on continuous improvement. • O ngoing feedback loops ensure employee satisfaction and autonomy with a strong focus on burnout prevention. • Y ou can build a meaningful career while enjoying a healthy work-life balance. Galaxy Vets plans to provide options for remote work in telehealth to ensure flexibility and task variety.

https://galaxyvets.com

industry innovations

Working together to change lives Good nutrition can change the lives of your patients. Standard Process® creates high quality, whole food-based supplements, including their Veterinary Formulas™, to support the health of pets and people. The company believes that whole foods deliver complex nutrients the way nature intended. That’s why their holistic approach to farming, manufacturing, and formulation is intended to preserve the efficacy of their ingredients. By combining innovative nutrition research with regenerative farming practices, Standard Process is able to enhance wellness for the entire family, both animal and human. www.standardprocess.com

Effective allergen immunotherapy Identifying the specific environmental allergen triggers of atopic dermatitis is imperfect at best. Published studies on the reliability of serum, hair, and saliva “allergy tests” show poor agreement, as well as frequent false positive and negative readings. RESPIT® allergenic extracts enable you to prescribe effective, prescription-strength allergen immunotherapy without depending on unreliable allergy testing. Important allergens for your geographic region, selected by a board-certified veterinary dermatologist, are included in oral or injectable versions of RESPIT. www.vetrespit.com

Raising the bar on nutrition Side by Side raises the bar nutritionally with its small-batch, minimallyprocessed, raw freeze-dried clean whole food formulas that are nutritionally balanced without the need for any added vitamins or minerals. Plus, they are the only food program that empowers pet parents to be able to determine not only what food is best for their dogs, but which one is actually the right food for their "temperature". Learn about their Veterinary Affiliate Program today — contact Crystal@SideBySidePet.com. www.sidebysidepet.com

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profitable practice

THIS EFFECTIVE PROBIOTIC FROM VISBIOME VET TRANSLATES TO HEALTHY PETS AND HAPPY CLIENTS https://visbiomevet.com

The concentration of gut microbiota in our canine and feline patients can be disturbed by different factors, leading to issues that are detrimental to the animal’s health. Recommending the regular use of an effective probiotic is a good strategy for avoiding an altered gut microbiota and the resulting adverse effects. Many veterinary probiotics are available in the market, but Visbiome Vet has an edge thanks to its formulation.

WHY VISBIOME VET? For the normalization and maintenance of gut health in dogs and cats, Visbiome Vet is your go-to choice. It features the De Simone Formulation, which encompasses a blend of eight different bacterial strains. Studies have shown that using different bacterial strains in a probiotic formulation yields superior efficacy. Visbiome Vet also has a higher potency level compared to other probiotics because it has higher concentrations of bacterial strains. It contains 225 CFU live bacteria per packet, and 112.5 billion CFU live bacteria per capsule, making it one of the most potent probiotics on the market. Its efficacy has been validated by different placebo-controlled studies in dogs with GI disorders and kidney dysfunction.

CLIENT SATISFACTION AND INCOME POTENTIAL Visbiome Vet is the most studied probiotic on the market. Along with having the highest potency, the product is kept refrigerated from production to distribution. It is shipped in insulated containers with ice packs and a sensor that monitors the temperature to ensure product efficacy and safety. All these features ensure your clients get an effective probiotic to help keep their furry companions healthy and playful. A regular daily intake of Visbiome Vet means your patients will experience a reduction in loose stools caused by environ-

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mental stress or dietary change. The probiotic also supports the protective layers of the bowel, maintains proper gut flora, and helps with normal kidney function. The Visbiome Vet website hosts more than 800 five-star reviews from clients — a good measure of client satisfaction. Recommending a veterinary product with proven effectiveness is a win-win for both vets and clients. A high-potency probiotic that helps animals achieve and sustain normal gut microbiota is going to result in healthy pets and happy clients. And client happiness translates to client retention, which means more revenue for your practice.

WEIGHT-BASED DOSING AND EASY-TO-USE PACKAGING Visbiome Vet has devised daily intake recommendations based on the individual requirements of pets, and has already charted out dosage recommendations for dogs and cats belonging to different weight brackets. The product comes in convenient packaging for easy veterinary application.

From the VBMA

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

DID YOU GUESS LAST ISSUE’S MEDICINAL HERB? An herbal tea made from the leaves of Labrador Tea (Rhododendron tomentosum, previously Ledum palustre) was a favorite beverage for treating flus and colds among Athabaskan First Nations and Inuit. Today, the herb’s use has shifted to preventing and treating Lyme Disease. “It affects especially the rheumatic diathesis, going through all the changes, from functional pains to altered secretions and deposits of solid, earthy matter in the tissues,” notes William Boeicke, MD. “The Ledum rheumatism begins in the feet and travels upward. Indicated for any puncture wounds, produced by sharp-pointed instruments or bites.”

CASE REPORT Zahra, a four-year-old Scottish Deerhound, received innumerable tick bites this year. She was periodically treated with homeopathic Ledum 30 C after these bites, and never developed Lyme disease.

AT THE AHVMA CONFERENCE The VBMA presented a track at the AHVMA conference, which ran from September 10 to 13 in West Palm Beach, Florida. We enjoyed a wonderful start to the conference with our pre-day herb walk. This year, we went on an urban “survival” walk to see what was available within the block around the hotel. It was amazing what we found! A tangerine tree (Citrus tangerina), a well-used herbal medicinal for GI food stagnation, was in the hotel lobby along with Pothos (Epipremnum aureum), a plant known to improve air quality. Agave (Agave americana), a natural sweetener and base for tequila, and Hibiscus (Hibiscus spp.), an anti-hypertensive metabolic herb, were both seen on the outside walkway. We found only a few “weeds”, but among those was a prime lymphatic and artillery plant (Pilea microphylla). Artillery plant has been used medicinally around the world: in China for fluid retention, in Jamaica for asthma, and in Barbados for bowel disorders.

Pilea microphylla

Several trees also grabbed our attention, including Loquat (Eriobotrya japonica), whose fruit is a wonderful cough treatment, and Senna (Senna alexandrina), whose fruit (pods) and leaves have a laxative effect and are used to treat constipation. All of this within sight of the hotel lobby! Our conference speaker track featured Renee Crozier, RH (AHG), a clinical practicing herbalist who spoke for five hours. She mostly focused on the use of adaptogens, nootropics, like Bacopa (Bacopa momnieri) and Gotu Kola (Centella asiatica), and nervines, like Blue Vervain (Verbena hastada) and Hawthorn (Crataegus oxyacantha). Renee is a big supporter of making your own flower essences and gave in-depth directions. A couple of herbal tidbits: Andrographis (Andrographis paniculate) can help dissolve biofilm and can also flush the gallbladder, while Agrimony is specific for a Heart/Kidney disconnect. It was nice to have a new face lecturing for the VBMA!

UPCOMING EVENTS Future events include an urban herb walk presented by Rona Sherebrin, DVM, and a panel discussion on feline URD. Visit vbma.org for details. Submitted by Cynthia Lankenau, DVM

GUESS THIS HERB!

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

IVC Winter 2023

Inthenews

BIG DATA TECH BEING EXPLORED TO IMPROVE VETERINARY PROFESSION The use of big data has brought many advancements to different industries. As far as healthcare is concerned, it has a lot to offer. Thanks to big data, many organizations working in the area of human healthcare are already reaping the benefits by better understanding diseases and remedies, and by using insights to develop the best possible prevention strategies. Now, veterinary healthcare organizations are also stepping up to the plate. Companion Animal Veterinary Surveillance Network (CAVSNET) and University of Minnesota College of Veterinary Medicine have teamed up to collect data from electronic veterinary health records and create a substantial database for veterinarians. The

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insights gathered from this extensive database will help veterinarians make more efficient clinical decisions. The focus of this project is currently limited to antibiotic use data. CAVSNET has two mechanisms in place for data collections. One is the transfer of clinical and diagnostic laboratory data in real time to the CAVSNET database. The other, which is a rather low-tech path, involves the point prevalence survey in which data from a single time point (e.g, one clinic workday) is collected from several clinics. In addition to antimicrobial usage and resistance trends, the CAVSNET database will be a rich source of information regarding animal health, disease, and veterinary practice.

All data collected by CAVSNET is de-identified and analyzed by approved researchers. The researchers will provide scientific papers for veterinary professionals, the wider scientific community, and the general public. Important information will be communicated through publications, webinars, conferences and social media, along with other media as deemed fit. CAVSNET is also looking to generate revenue through the program to ensure the longevity of the project, which in turn will result in improvements in pet care and the veterinary profession as a whole. https://cavsnet.umn.edu/sites/cavsnet.umn.edu/ files/2019-11/CAVSNET_Measurement%20 and%20Benchmarking%20of%20AU%20 and%20AR_15July2019_Final.pdf