V14I3 (Summer 2024) by Redstone Media Group

Innovative VETERINARY CARE

VOLUME 14 ISSUE 3

HOW PBM HELPS WITH NEUROLOGICAL DISORDERS IN DOGS

STUDIES SHOW THAT PHOTOBIOMODULATION MAY BENEFIT DOGS WITH NEUROLOGICAL PROBLEMS SUCH AS SPINAL CORD INJURY, IVDD, AND DEGENERATIVE MYELOPATHY. — P. 8

CAN DIET THERAPY OPTIMIZE INTERNAL ORGAN HEALTH IN DOGS?

ARE THE BRAINS OF NON-HUMAN ANIMALS NEUROPLASTIC?

SUMMER 2024

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A look at how nutrient-rich foods that support a canine patient’s liver, kidneys, heart, digestive and respiratory systems can significantly enhance their quality of life. — p. 18

Evidence suggests that challenging the brains of non-human animals with new experiences demonstrates neural plasticity. — p. 22

TAKING AN INTEGRATIVE APPROACH TO FELINE KIDNEY DISEASE

WHY HERBS CAN BE EFFECTIVE FOR EQUINE COUGHS

A combination of medications, fluid therapy, diet and supplements provide an effective approach to kidney disease in cats. — p. 26

USING ACUPUNCTURE FOR NERVOUS SYSTEM DISORDERS

Acupuncture can improve neurologic disorders in veterinary patients when conventional therapies may not. — p. 50

Whether it’s a simple cough, or a serious chronic disease of which the cough is a symptom, certain herbs can help either cure or alleviate the problem. — p. 46

KEEPING DOGS FIT WITH REHAB THERAPY AND CANINE SPORTS MEDICINE

Used together, canine sports medicine and rehabilitation therapy help keep canine athletes on top of their game. — p. 30

SUMMER 2024 EDITORIAL DEPARTMENT Editor-in-Chief: Dana Cox Managing Editor: Ann Brightman Associate Editor IVC: Omer Rashid, DVM Senior Content Editor: Ashley Tonkens Senior Content Editor: Belinda Rose-Innes Graphic Design Lead: Joy Sunga

COLUMNISTS & CONTRIBUTING WRITERS Nancy Brandt, DVM, MSOM, dip.OM, CVC, CVA, CVMA Todd Cooney, DVM, CVH Donald H. DeForge, VMD W. Jean Dodds, DVM Moira Hechenleitner, DVM, CSAT Cynthia Lankenau, DVM Julie Liu, DVM Bethanie Poe, LMSW Lily Richards, BSc (Hons), BVSc, MRCVS Ruth Roberts, DVM, CVA, CVH, CVFT Margo Roman, DVM, CVA, COT, CPT, FAAO Marlene Siegel, DVM, CNHP, ALT Keith Weingardt, DVM, CVA, CTCVM

ADMINISTRATION & SALES

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COVER Photo courtesy of Lisa A. Miller

IVCJournal.com IVC Journal (ISSN 2291-9600) is published four times a year by Redstone Media Group Inc. Entire contents copyright© 2024. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: July 2024.

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

IVC Summer 2024

contents FEATURES

PHOTOBIOMODULATION 8 USING FOR NEUROLOGICAL DISORDERS IN CANINES

by Lisa A. Miller, CVM, CCRT, CVA Studies are showing that PBM may provide numerous benefits to dogs with neurological problems such as spinal cord injury, IVDD, degenerative myelopathy and more.

26 18

NUTRITION NOOK

USING DIET THERAPY TO OPTIMIZE INTERNAL ORGAN HEALTH IN DOGS by Ruth Roberts, DVM Optimizing a dog’s internal organ health with diet therapy is a proactive and effective way to ensure overall well-being and longevity.

IN NON22 NEUROPLASTICITY HUMAN ANIMALS by Allen Schoen, DVM, MS, PhD (hon.), CVA

This article looks at the evidence of neuroplasticity in non-human animals by showing how challenging their brains with new experiences demonstrates neural plasticity.

AN INTEGRATIVE APPROACH TO

26 FELINE KIDNEY DISEASE

by Angie Krause, DVM, CVA, CCRT

Treating feline kidney disease from an integrative approach includes medications and fluid therapy as well as close attention to diet and the right supplements.

50 4

IVC Summer 2024

REHABILITATION 30 INTEGRATING THERAPY INTO CANINE SPORTS MEDICINE

by Gabriella Varcoe, DVM, DACVSMR, CCRP, CVA, CVPP, IVCA, CVFT, CSMP Used in conjunction, canine sports medicine and rehabilitation therapy help keep canine athletes on top of their game for as long as possible.

TECHNIQUES IN 34 DIAGNOSTIC VETERINARY CHIROPRACTIC NEUROLOGY

by Carl DeStefano, DC, DACNB, FACFN Veterinary chiropractic neurology requires an understanding of the neurophysiological mechanisms of function within the central and peripheral nervous systems.

NEUROIMAGING TO 42 USING MAP ANIMAL BRAINS REVEALS IMPORTANT CONNECTIONS

by W. Jean Dodds, DVM Combining data from the brain atlas and MRI/fMRI neuroimaging can help us understand more about the brains of primates, companion animals, and other non-human species.

APPROACHES TO THE 46 HERBAL EQUINE COUGH by Cindy Lankenau, DVM, RH (AHG), MS (TCVM) Whether an equine has a simple cough, or a serious chronic disease of which the cough is a symptom, certain herbs can help either cure or alleviate the problem.

advisory board FOR NERVOUS 50 ACUPUNCTURE SYSTEM DISORDERS IN VETERINARY PATIENTS

by Narda G. Robinson, DO, DVM, MS, CRPM, FAAMA Acupuncture has been shown to effectively improve neurologic disorders in veterinary patients in ways more “conventional” medical approaches cannot.

COLUMNS & DEPARTMENTS

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.

7 Editorial 21 From the AHVMA 29 From the VBMA 33 From the IVAS 45 From the AVH 53 From the VMAA 54 Industry Innovations IN THE NEWS:

17 UC Davis study revolutionizes canine neutering guidelines

41 New questionnaire empowers horse owners to identify and monitor osteoarthritis pain

55 Groundbreaking research offers new approach to cancer treatment in veterinary patients

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 Summer 2024

contributors

1. CARL J. DESTEFANO, DC, CAC, DACNB, FACFN

Dr. Carl J. DeStefano graduated Cum Laude from the National College of Chiropractic in 1984. He is certified in Animal Chiropractic from the Options for Animals Veterinary Chiropractic Center and the American Veterinary Chiropractic Association (AVCA). He has completed all the educational requirements for the Diplomat program sponsored by the AVCA. Dr. DeStefano is board certified in Chiropractic Neurology through the American Chiropractic Neurology Board, and is a fellow of the American College of Functional Neurology. He is the Founder of the Health Pioneers Institute of Veterinary Chiropractic, and maintains a busy human and animal practice near Chicago p.34

2. W. JEAN DODDS, DVM

Dr. Jean Dodds received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she established Hemopet, the first non-profit national blood bank program for animals. Dr. Dodds has been a member of many committees on hematology, animal models of human disease and veterinary medicine. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1994. p.42

3. 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.26

4. CYNTHIA LANKENAU, DVM

Dr. Cynthia Lankenau received her DVM from Cornell University in 1981 and started studying alternative modalities in 1991. She is certified with the IVAS, AVCA and AHV, and in Chinese Herbal Medicine through the Chi Institute and CIVT. Her western herbal certification is through CIVT's Graduate Western Herbal program and David Winston's professional and graduate level course. She completed her MS(TCVM) at Chi Institute and is a registered herbalist through the American Herbal Guild. Dr. Lankenau is Past President of the VBMA, a board member of ACVBM and NY CAVMA, and owns a private integrative mixed practice. p.46

5. LISA MILLER, CVM, CCRT, CVA Dr. Lisa Miller is VP 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 rehab, 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. 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

IVC Spring 2024

6. RUTH ROBERTS, DVM

Dr. Ruth Roberts has over 30 years’ experience, specializing in integrative pet care. She holds a DVM degree and is certified in Veterinary Chinese Herbology, Veterinary Food Therapy, Veterinary Acupuncturist, and Natural Animal Nutrition (NAN). Dr. Roberts is the creator of the Original CrockPet Diet, a home-cooked meal plan that supports pets' nutritional needs and addresses specific health concerns. Committed to educating pet owners and veterinarians, Dr. Roberts shares her expertise through consultations, webinars, and her popular blog. Her dedication to holistic pet health has earned her a loyal following and numerous accolades. p.18

7. NARDA G. ROBINSON, DO, DVM, MS, CRPM, FAAMA

Dr. Narda Robinson is the CEO and Founder of CuraCore VET and CuraCore MED in Fort Collins, CO. She holds a Doctorate in Osteopathic Medicine from the Texas College of Osteopathic Medicine, and a Master’s degree in biomedical sciences from Colorado State University College of Veterinary Medicine and Biomedical Sciences. Dr. Robinson is a Fellow in the American Academy of Medical Acupuncture and serves on their Board of Directors. She is Vice Chair of the American Board of Medical Acupuncture and heads the Examination Committee for physician board certification. She wrote Canine Medical Massage and Interactive Medical Acupuncture Anatomy. p.50

8. ALLEN M. SCHOEN, DVM, MS, PHD (HON.), CVA

Dr. Allen Schoen received his DVM from Cornell University in 1978. He also holds a Master's Degree in neurophysiology and animal behavior from the University of Illinois. Dr. Schoen has held faculty positions at Colorado State University College of Veterinary Medicine, Tufts University College of Veterinary Medicine and the Chi Institute. He is certified in veterinary acupuncture and veterinary chiropractic and is a past president of the IVAS. In 2010, he received the Lifetime Achievement Award for his contributions to veterinary acupuncture from the American Academy of Veterinary Acupuncture. p.22

9. GABRIELLA VARCOE, DVM, DACVSMR, CCRP, CVA, CVPP, IVCA, CVFT, CSMP

Dr. Gabriella Varcoe graduated from Ross University School of Veterinary Medicine in 2007. In 2010, she studied canine rehabilitation at the University of Tennessee College of Veterinary Medicine and became a Certified Canine Rehabilitation Practitioner. Dr. Varcoe also became certified in Veterinary Acupuncture and Food Therapy through the Chi Institute. In addition, she is certified as a Veterinary Pain Practitioner, Animal Chiropractor and Myofascial Practitioner. In 2017, Dr. Varcoe started a residency program in canine sports medicine and rehabilitation. Her fields of greatest interest include rehabilitation therapy, geriatric and special needs care, pain management, nutrition and the microbiome. p.30

editorial

Milestones in

veterinary neurology Recently, we did a blog post for the IVC Journal website that highlighted an extremely interesting study. It focused on the neural evidence for advanced comprehension in canines. The study revealed that dogs can form mental representations of objects based on the words used to describe them. This fascinating study demonstrated that companion animal brains are capable of a lot more than we realize. Since learning about this study, my interest in veterinary neurology has grown significantly. A diverse array of cutting-edge research and innovative treatment approaches are revolutionizing the way we care for the brains and associated organs of our canine, feline, and equine companions, and that’s what this issue is about. Leading the charge is Dr. Allen Schoen, a renowned expert in the field of neuroplasticity and brain reorganization. In his insightful article, he explores the brain’s remarkable ability to adapt and reorganize itself in response to various stimuli, opening up exciting new avenues for rehabilitation and recovery in veterinary patients. Complementing this groundbreaking work is Dr. Jean Dodds’ exploration of neuroimaging in veterinary neurology. Through the application of advanced imaging techniques, Dr. Dodds and her team are shedding new light on the structures and functions of our four-legged friends’ neural networks, paving the way for more accurate diagnoses and targeted interventions. We are also excited to present Dr. Lisa Miller’s expertise on photobiomodulation (PBM) for neurological disorders in dogs. She explores the potential of light-based therapies to stimulate tissue repair and improve neurological function in our canine patients. Dr. Narda Robinson’s article focuses on how acupuncture can serve as an adjunctive therapy in dogs with neurological disorders. As the field of integrative veterinary medicine continues to evolve, her insights into the synergistic application of acupuncture and conventional treatments offer a promising approach to managing these conditions.

This issue includes additional insightful articles, including Dr. Ruth Roberts’ discussion on how to optimize internal organ function using food options. By explaining the power of nutrient-dense diets, she offers valuable knowledge on how strategic food choices can support essential organs, including the brain and nervous system. Shifting our focus to feline health, be sure to read Dr. Angie Krause’s article on using an integrative approach to kidney disease in cats. Her perspective on combining conventional and alternative therapies promises to enhance the quality of life for our feline kidney patients. Meanwhile, Dr. Cynthia Lankenau’s article on how herbs can help treat equine coughs is a valuable read for those of us with equine patients facing respiratory challenges. Her exploration of herbal remedies offers a natural solution to supporting the well-being of the horses in our practices. Finally, Dr. Gabby Varcoe takes an in-depth look at the crucial role physical rehabilitation plays in canine sports. By highlighting the benefits of strategic rehabilitation interventions, she empowers veterinary professionals to enhance the performance and longevity of athletic canine patients. I hope this Summer issue of Innovative Veterinary Care Journal will inspire you to explore new frontiers in veterinary neurology, and embrace the transformative power of integrative care for the animals we are privileged to serve.

Best regards,

Omer Rashid, DVM, MSc Parasitology Associate Editor, dromer@redstonemediagroup.com IVC Summer 2024

USING PHOTOBIOMODULATION FOR NEUROLOGICAL DISORDERS IN CANINES BY LISA A. MILLER, CVM, CCRT, CVA

Studies are showing that photobiomodulation (PBM) may provide numerous benefits to dogs with neurological problems such as spinal cord injury, IVDD, degenerative myelopathy and more.

Photobiomodulation (PBM) offers a novel and beneficial approach to treating various neurological disorders in the canine. Preclinical studies indicate that PBM reduces oxidative stress and neuroinflammation, and promotes cellular regeneration. It also modulates pain while optimizing mitochondrial function, oxygen consumption, and blood flow in various injuries and diseases of the peripheral and central nervous systems. Tissues rich in mitochondria, such as the brain, spinal cord, and neurons in peripheral nerve ganglia, respond readily to PBM. This is because the principal chromophore for absorbing the wavelengths of light used in this modality is located within the mitochondrial membrane, resulting in repair and regeneration.1 This article looks at a range of neurological conditions in the canine, and how PBM can help with treatment.

PERIPHERAL NERVE AND SPINAL CORD INJURY Peripheral nerve injury results in the loss of associated sensory and motor function. Ensuing degeneration of the axons, and retrograde degeneration of the corresponding neurons of the spinal cord, may be followed by a very slow regeneration. However, total regeneration of the peripheral nerve, even

IVC Summer 2024

when surgically repaired, does not occur, leading to muscle atrophy. The function of the repaired nerve almost never recovers completely. The first pioneering report on the use of light for peripheral nerve repair was published by Rochkind,2 and in the last 20 years, many PBM papers have reported positive effects on peripheral nerve regeneration.3-9 These studies demonstrated that PBM can accelerate functional recovery, and improve the quality of nerve regeneration after autograft repair of severely injured peripheral nerves. • One study on the effects of the transected and end-toend sutured peroneal nerve demonstrated that treatment parameters initially determined using in vitro models should then be translated to in vivo research for clinical practice, taking into account the loss of light as it travels through tissue layers. • As an example, in vivo transmission of the near infrared light measured in anesthetized rabbits showed that, on average, 2.45% of the light applied to the skin reached the depth of the peroneal nerve. This demonstrates that

much higher output powers are needed at the surface to deliver the appropriate therapeutic dose to the depth of the nerve(s) being treated. An in vivo pilot study was performed to determine the optimal parameters for applying PBM to the skin over the injury/repair site. The investigators demonstrated that PBM at various wavelengths with optimized parameters accelerated nerve regeneration and improved functional recovery.9 • Veterinary research offers clinical evidence for the use of PBM in cats, showing that it has analgesic effects on peripheral nerves via the decrease of ascending signals from the spinal cord to the higher central nervous system.10 Other publications have also documented the use of PBM therapy for peripheral nerve injuries in veterinary patients.11 • A study in dogs with severe spinal cord injury (see sidebar on page 12) involved implantation of a segment of peripheral nerve into the injured area, followed by laser irradiation applied to the spinal cord. The results demonstrated diminished glial scar formation, induced axonal sprouting in the injured area, improved weight bearing, and improved locomotion in comparison to transplantation alone.17 Since this publication, several research groups have demonstrated that transcutaneous PBM improves locomotor function in SCI. Transcutaneously applied PBM, used daily for two weeks to treat the transected or contused spinal cords of rats, promoted regeneration and functional recovery, and suppressed immune cell activation (a potential mediator of secondary injury) and cytokine/chemokine expression.18 • Both peripheral nerve and spinal cord injuries can result in neuropathic pain symptoms that may become chronic. Neuropathic pain evolves through various fundamental mechanisms, including abnormal nerve activity, heightened sensitivity in both peripheral nerves and in the central nervous system (CNS), diminished inhibitory control, and abnormal activation of microglia.19 Evidence suggests that PBM can be effective in decreasing neuropathic pain behavior, and altering the inflammatory process associated with peripheral nerve and spinal cord injuries in animals. • Studies focusing on various nerve injury models in rats, and treating them with PBM daily to every other day, demonstrated both decreased mechanical allodynia and improved functional recovery.20-23 One of these studies

also examined the activation of macrophages and microglia along ascending somatosensory pathways related to neuropathic pain. Immunohistochemical analysis of macrophage and microglial inflammatory markers showed a shift towards the M1 (pro-inflammatory) phenotype of microglia in injured spinal cord dorsal horn, though not in the PBM treated group, which received treatment in the hind paw, dorsal root ganglia, and the spinal cord regions. In dorsal root ganglion samples, macrophages expressing M2 markers (anti-inflammatory) were significantly increased in the PBM group, but not in the injury or sham groups, indicating that PBM may contribute to resolution of inflammation.

INTERVERTEBRAL DISC DISEASE One of the most common causes of neuropathic pain and SCI in veterinary medicine is intervertebral disc disease (IVDD). Most of us are familiar with the differences and pathophysiology of Type I versus Type II IVDD; however, either disc extrusion or protrusion can cause varying degrees of SCI and pain. After initial injury, pathologic changes progress, and the ensuing neurodegenerative process contributes to the development of inflammation. This occurs along with a complex cascade of vascular and biochemical events that contribute to secondary SCI and neuronal damage. Even after any sources of spinal cord compression may have been surgically removed, it is important to remember that decreased perfusion and ischemia, as well as secondary oxidative damage, will contribute to the severity of spinal cord injury in these patients. Modalities that promote tissue perfusion24 are of upmost importance in patients with these injuries. • Canine models have shown that PBM improved neurologic function after experimentally-induced disc disease, with treated dogs being able to walk within nine to 12 weeks after spinal cord transection and sciatic nerve autograft insertion, compared to a still-paralyzed untreated control group. Histologic analysis of treated dogs revealed that new axons and blood vessels had migrated into the graft.17 • Another study examined the use of PBM therapy in non‐ ambulatory dogs with thoracolumbar IVDD following decompressive surgery, compared to a control group that received hemilaminectomy alone. A significant difference in the median time to ambulation was observed between the two groups.25 Even though this study demonstrated a positive effect, more information needs to be gathered to optimize the parameters used to treat this condition. IVC Summer 2024

TREATING PERIPHERAL NERVE CONDITIONS AND SPINAL CORD INJURY/IVDD Recommended parameters for PBM in peripheral nerve injuries and spinal cord injury/IVDD are comparable to those recommended for deep-tissue musculoskeletal dosing (10-20 J/cm2), scaling up with the size of the patient and depth of target tissues/nerves. Treatment surface areas used for calculating dose should encompass the suspected site(s) of injury as well as the entire nerve tract(s) of the traumatized nerve(s), along with adjacent muscles experiencing associated myofascial pain or spasms. For the spinal cord specifically, treatment surface areas used for calculating dose should take into consideration a few spinal segments both cranial and caudal to the suspected area of intervertebral disc extrusion or protrusion. If neurological deficits are present in the limbs, treating the remainder of the spine caudally, as well as the descending nerve tracts, is recommended. For lesions in the thoracic or lumbar spine, treatment should be applied on contact directly over the spine, as well as a few inches to either side, aiming toward the spine through the paraspinal musculature. In the neck area, a lateral and ventral approach is recommended to effectively treat the caudal cervical area (Figure 1).

is a long, slow process, and treatment with PBM should continue until acceptable function has returned. For patients with IVDD in which conservative management has been elected, PBM therapy should begin immediately and continue daily, if possible, until significant improvement is seen. At that time, weaning to a transition phase of less-frequent treatment sessions is recommended, to continue until clinical signs resolve. Some patients with chronic IVDD may benefit from continued maintenance therapy once every two to four weeks, as in patients with osteoarthritis. For patients that have undergone surgery for IVDD, PBM therapy should be started immediately afterwards. Ideally, it should be performed daily for three to five days, if possible, then continued at least two to three times weekly until significant improvement is seen, when the frequency of treatment can be reduced as described previously. As always, an excellent physical rehabilitation program and other supportive care is recommended for neurologic patients.

Power settings of 3-7W for small to medium patients, 5-11W for medium to large patients, and 7-15W for large to extra-large patients are likely appropriate for most neurological applications involving the peripheral nerves and spinal cord. These doses should be effective and safe for most commercially available laser units, but the practitioner should always confirm the safety specifications with the manufacturer, depending on the optics of their handpiece and the power output of the laser device. For peripheral nerve injury, treatment should be administered daily for three to five days and then two to three times weekly, if possible, until resolution. Recovery from peripheral nerve injuries

IVC Summer 2024

Photo courtesy of Lisa A. Miller

FIGURE 1 : Applying PBM to the neck area of a canine patient.

• Two more recent studies showed contrasting results. One found no difference in recovery-related variables among dogs that received PBM and physical rehabilitation, compared to those receiving physical rehabilitation with sham PBM.26 The second report described how including PBM in the rehabilitation protocol during the post-operative period improved patients’ neurological status; there was also a shorter mean time to the return of ambulatory ability.27

the CNS, leading to alteration of both the progression of the injury process and the secondary injury response(s). Numerous studies have suggested that astrocytes and the astrocyte glutamate transporter (GLT-1) may play a role in modifying disease progression and motor neuron (MN) loss in neurodegenerative disease progression.28-32 Astrocytes can induce MN degeneration through secretion of inflammatory mediators, including nitric oxide and prostaglandin E2.33-34

• The three studies above used vastly different parameters, and some were incorrectly or incompletely reported, emphasizing the importance of these factors in the design and interpretation of clinical research involving PBM. While there is a need for further studies in veterinary patients, in both conservative‐management and post‐ surgical‐application models, there is certainly enough evidence in the present body of literature to support the use of PBM as an adjunct to current treatment plans for patients with IVDD. It should be noted that whether or not PBM is available, current best practices for both surgical and conservative management should be communicated to owners after examination of the patient.

• One published study specifically examined the use of PBM in an SOD1 transgenic mouse model of ALS.35 This study reported a statistically significant yet short-lived improvement in the group that received laser therapy, suggesting a delay in the onset of motor deficits. However, this beneficial effect was seen in only the early stage of the disease. Other study findings contributed to the authors’ conclusion that PBM may have conferred a protective effect by suppressing astrocytes surrounding MNs in the spinal cord.

DEGENERATIVE MYELOPATHY Canine degenerative myelopathy (DM) shares similarities in cause, clinical signs, and disease progression to some forms of ALS in humans. It is characterized by progressive generalized proprioceptive ataxia of the pelvic limbs, asymmetric upper motor neuron (UMN) paraparesis (Stage I disease), and a lack of paraspinal hyperesthesia. This progresses to lower motor neuron (LMN) and paralysis of the pelvic limbs (Stage II), and eventually the thoracic limbs (Stage III) and brain stem (Stage IV).36-37 As DM is progressive, incurable, and fatal, the veterinary community looks to novel clinical interventions to improve the overall quality of life of affected patients. Dogs with DM are usually euthanized when they become non-ambulatory and/ or incontinent, both of which present challenges to pet owners. Time of progression from Stage I to Stage II is generally six to nine months.37 Various therapeutic protocols attempt to slow DM’s clinical symptom progression, but none have been significantly successful.38-39 Only daily intensive physiotherapy has demonstrated some benefit as a supportive therapy for DM.40 The literature discussed above provides evidence that light can confer specific beneficial effects on the response of cells in

• Recently, a retrospective study was published that examined the impact on the pathology of canine DM by adding two different doses of PBM to rehabilitation therapy.41 The authors examined the records of dogs referred for presumed DM to a specialty rehabilitation facility, and screened for patients meeting the study criteria. Qualifying patients were divided into two groups: a lowerdose group and a higher-dose group, based on the PBM protocol used. The time between symptom onset and non-ambulatory paresis or paralysis of dogs in the higherdose group (31.76±12.53 months) was significantly longer than those of dogs in the lower-dose group (8.79±1.60 months). Similar findings were reported relative to the time between symptom onset and euthanasia. The data showed significantly slower disease progression and longer survival times for patients in the higher-dose group than those in the lower-dose group, or for dogs in published historical data.38 The authors suggested that the potential beneficial mechanisms of PBM observed in these findings might include a protective effect on the MNs in the spinal cord through astrocyte-neuronal interactions, similar to the studies mentioned above. In addition, they suggested that PBM may act as an aid to therapeutic exercise and the prevention of exercise-induced muscle fatigue and/or damage. When treating DM, the author strongly recommends all dogs receive weekly to twice-weekly in-clinic rehabilitation therapy, including PBM and other therapeutic exercises as outlined

IVC Summer 2024

THE PATHOLOGY

OF SPINAL CORD INJURY

The spinal cord’s role is to conduct information between the peripheral nervous system and the brain via spinal nerves and ascending and descending tracts within the spinal cord. Spinal cord injury (SCI) causes damage to the cells within the cord and severs the ascending and descending nerve tracts, disrupting the flow of sensory and motor information between the body and brain, and resulting in loss of sensation, movement, and autonomic regulation.12 SCI can result in serious debilitation and neurological deficits as well as chronic pain. Damaged axons fail to regenerate following SCI in adult mammals. After SCI, a secondary injury mediated in part by the immune response occurs13 and causes further impairment.14-15 Therefore, alteration of cell invasion/activation after SCI can help improve functional recovery. PBM has been shown to be effective in reducing pro-inflammatory cytokines and reactive oxygen species (ROS) that infiltrate the spinal cord following injury.16

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by a rehabilitation therapist or practitioner. Supportive care, including the use of assistive devices (such as slings for walking support, and protective foot coverings) are also strongly recommended. If in-clinic rehabilitation is not possible, the primary veterinarian should consult with a rehabilitationcertified practitioner, since DM dogs have extremely finite exercise tolerance. If this tolerance is exceeded, it may take several days to recover and/or the dog may become temporarily worse. Similarly, a rehabilitation practitioner may outline a suitable home exercise program for pet owners. PBM treatment should be applied with the laser treatment head in contact with the dog’s skin, directly over the spinal column, as well as several inches lateral to the right and left sides of the spinal column in the paraspinal musculature, thereby treating the entire thoracic and lumbar spine. For dosimetry consistent with the higher-dose group in the aforementioned retrospective study, the area to be treated as described above should be measured in square centimeters, calculating a target energy density of 15-25 J/cm2 to obtain the total dose (in Joules) desired (e.g. 500 cm2 x 20 J/cm2= 10,000 total Joules). Once the total dose is calculated for the patient, an appropriate treatment power in watts (W) may be selected based on the size of the patient, and the corresponding depth of tissue, scaling up with the patient’s body mass. Power should always be adjusted down if the patient is uncomfortable, or if the laser operator feels any excessive thermal buildup in the dog’s coat or on the skin. For any chronic degenerative condition such as DM, treatment should begin with an “induction phase” of initial, more frequent treatment sessions (as described for IVDD). The author recognizes that colleagues will be presented with patients in various stages of disease progression. Subjectively, better results are seen in dogs whose intervention starts earlier. Each patient must be evaluated and treated as an individual. The practitioner is encouraged to set expectations with pet owners that immediate results may not be appreciated, and that a cure is not possible. Once improvement in clinical signs is noted, a “transition phase” of treatment sessions is initiated in which they are decreased to twice weekly, then once weekly, at which a “maintenance phase” is established. These maintenance sessions are more frequent than for pain-related chronic conditions due to the neurodegenerative nature of the disease.

TRANSCRANIAL PBM AND CANINE COGNITIVE DYSFUNCTION SYNDROME (CCDS) In 2004, PBM was first applied to the human brain to treat acute ischemic stroke using transcranial near-infrared light (Oron et al, 2006). In the last 20 years, transcranial PBM (tPBM) has undergone extensive trials as a therapeutic intervention for various neurological conditions, and has been found to be safe. More recently, with an improved understanding of dosing, several recent tPBM trials have demonstrated both safety and efficacy in treating Alzheimer’s disease (AD)42 and Parkinson’s disease,43 traumatic brain injuries,44 and in improving cognitive performance in healthy young adults.45 Canine cognitive dysfunction syndrome (CCDS) is becoming more common in veterinary practice as we lengthen pets’ lives through better nutrition and medical care. It is a naturallyoccurring degenerative brain disorder with gradual onset and insidious progression,46-47 analogous to human Alzheimer’s disease.46,48 CCDS is often characterized by confusion, disorientation, excessive panting, pacing, agitation, separation anxiety, and other clinical signs. The pathophysiology of AD and CCDS is multifactorial, involving vascular compromise, neuronal mitochondrial dysfunction, inflammation, oxidative brain damage, and deposition of β-amyloid (Aβ ) around blood vessels and neurons. Over time, these factors lead to progressive loss of dendrites, synapses, and neurons, followed by cognitive decline.48-50 There is no cure, although a variety of supplements, pharmacological agents, special diets, and environmental strategies have been used to treat CCDS.46 Compromised blood flow, mitochondrial dysfunction, and subsequent oxidative stress and inflammation are at the core of this disease process, and these all happen to be where PBM may be especially helpful as a treatment modality. • Studies have demonstrated the ability of tPBM to cause disaggregation of Aβ via suppression of β-secretase activity and the stimulation of enzymes responsible for degrading Aβ peptides.51-55 • Rodent studies have shown that tPBM decreased brain levels of Aβ, improved cognitive test scores, and increased cerebral vascular density.56,53

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• While no veterinary studies have been published on the efficacy of tPBMT for treating CCDS, one publication discussed the pathophysiology and previously mentioned mechanisms by which PBMT may be beneficial.57

the patient. When treating with a higher-power laser (or at the higher end of the irradiance range discussed below), the laser operator is encouraged to keep the treatment head in continuous motion at all times.

The ideal parameters for the use of tPBMT for CCDS are not well established. However, data extrapolated from rodent and human studies involving AD45 58-62 may be used as a basis of where to start. Different pulse structures have also been examined in some of these studies. The potential reasoning behind the use of pulsed delivery is that neural oscillations measured by electroencephalography recordings have been linked to different mental processes.63 Some authors suggest that pulsing with certain frequencies might add extra benefit to tPBM against AD.64 While it has been demonstrated that pulsing affects the biology of the brain differently than continuous wave (CW), the true benefits remain to be elucidated and should be investigated further.

An irradiance between 250 mW/cm2 and 1.5 W/cm2 at the skin surface is recommended. The resultant irradiances at the cortical surface in dogs should replicate dosing shown to be safe and effective in humans,65 and tested in other species. Therefore, the laser operator must know the spot area of their laser handpiece, as well as the power setting and duty cycle (if pulsed) for the laser to adequately calculate dose. As an example, a 50% duty cycle when pulsing would necessitate a doubling of the calculated treatment time to achieve the same dose as with CW light.

FIGURE 2: Using PBM to treat canine cognitive dysfunction syndrome.

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Photo courtesy of Lisa A. Miller

For treating CCDS, the authors recommend the handpiece be held in contact with the dorsal surface of the skull, treating both hemispheres (Figure 2). As with any treatment on the head and neck area, laser-safe eyewear is recommended for

For a medium to large dog being treated over the dorsal calvarium, the size of the area may be between 50-70 cm2, which would result in a total dose of 1,000-1,400 Joules delivered over the entire area if using a fluence of 20 J/cm2. As with most chronic degenerative conditions, PBM therapy should be started with two to three sessions the first week, if possible, weaning to a transition phase of less-frequent treatments

(twice weekly, then once weekly), and continued once every two to three weeks as needed to keep clinical signs at a minimum. The author and colleagues have observed that, in most cases, the use of transcranial PBM therapy seems very effective for improving the symptoms of CCDS within four to six weeks.

Acknowledgements

The author wishes to acknowledge the contributions of Drs. Juanita Anders and Ann Kobiela Ketz in the preparation of this article.

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In the news

UC Davis study revolutionizes

canine neutering guidelines In a landmark development, researchers at the University of California, Davis (UC Davis) have made a comprehensive update to their guidelines on the optimal age to neuter 40 of the most popular dog breeds. The study, published in the prestigious Frontiers of Veterinary Science, looked into the correlation between early neutering (before one year of age) and the potential health risks that can manifest in different breeds, including joint disorders and certain types of cancer. “This is a shift from a long-standing model of early spay/neuter practices in the U.S. and much of Europe to neuter by six months of age, but it’s important to consider as we see the connections between gonadal hormone withdrawal from early spay/ neuter and potential health concerns,” explained Professor Lynette Hart, lead author of the study. Building on the team’s previous work that began in 2013 with a study of Golden Retrievers, the latest iteration of the research focused on an

additional five breeds — German Short/ Wirehaired Pointer, Mastiff, Newfoundland, Rhodesian Ridgeback, and Siberian Husky. The findings revealed significant breed-specific variations in the health risks associated with early neutering, underscoring the need for a more personalized approach to this crucial decision. “It’s always complicated to consider an alternate paradigm, but this guidance provides information and options for veterinarians to give to pet owners, who should have the final decision-making role for the health and well-being of their animal,” said Professor Benjamin Hart, the study’s co-author. For instance, the research showed that male and female Pointer breeds had elevated risks of joint disorders and increased cancer incidence when neutered early, while male Mastiff breeds experienced heightened cranial cruciate ligament tears and lymphoma. In contrast, Siberian Huskies showed no significant effects on joint disorders or cancers.

“We’re invested in making contributions to people’s relationship with their animals,” Professor Hart continued. “This is about empowering veterinarians and pet owners to make informed decisions that prioritize the long-term health and well-being of their canine companions.” The updated guidelines, which will soon be available as a free e-book called Effective Options Regarding Spay or Neuter of Dogs, aim to provide the veterinary community with a comprehensive, evidence-based resource to handle this complex issue. As the industry embraces this paradigm shift, the future of canine healthcare is poised to enter a new era of personalized, breed-specific approaches to neutering, ultimately leading to improved outcomes and enhanced quality of life for dogs around the globe. www.ucdavis.edu/health/news/whenshould-you-neuter-or-spay-your-dog

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nutrition nook USING DIET THERAPY TO OPTIMIZE INTERNAL ORGAN HEALTH IN DOGS BY RUTH ROBERTS, DVM

Optimizing a dog’s internal organ health with diet therapy is a proactive and effective way to ensure overall well-being and longevity. By incorporating nutrient-rich foods to support the liver, kidneys, heart, digestive and respiratory systems, you can significantly enhance your canine patients’ quality of life.

Ensuring the health of your canine patients’ internal organs is crucial for their overall well-being and longevity. These vital organs perform essential functions that keep dogs healthy and active. One of the most effective ways to support internal organs is through nutrition, specifically diet therapy. In this article, we’ll explore how diet therapy can enhance the functioning of canine vital organs, including the liver, kidneys, heart, and digestive system.

7 KEY REASONS FOR SUPPORTING ORGAN HEALTH Each organ plays a vital role in maintaining a dog’s health, and optimizing its function can significantly improve the patient’s well-being. Here are the primary reasons why supporting internal organ health is so important:

activities. Healthy organs ensure a dog has the energy and vitality to run, play, and enjoy life to the fullest.

Overall well-being: A dog with healthy internal organs will generally feel better and exhibit more positive behaviors. They will have better appetite, more energy, and healthier coat and skin, indicating overall wellness.

5 Prevention of secondary health issues: When internal

organs are not functioning properly, secondary health problems can arise. For example, kidney dysfunction can cause hypertension, and liver issues can lead to toxin buildup in the body. Maintaining organ health helps prevent these cascading health problems.

6 Efficient metabolism and waste removal: Internal or-

tial for a longer, happier life. When organs function optimally, a dog is less likely to suffer from chronic illnesses that can reduce their lifespan and quality of life.

gans such as the liver and kidneys are responsible for metabolizing nutrients and removing waste products from the body. Optimizing their health ensures these processes run smoothly, preventing toxin buildup and other metabolic disorders.

2 Disease prevention: Proper nutrition and care can help

7 Immune system support: Healthy organs, particularly

Optimal performance: Just like humans, dogs need their organs functioning well in order to perform everyday

By focusing on diet therapy and including a variety of nutrientrich foods in a dog’s diet, you can support the efficient functioning of their internal organs.

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1 Longevity and quality of life: Healthy organs are essen-

prevent diseases that affect vital organs. For instance, a balanced diet can prevent conditions such as kidney, liver, and heart disease, reducing the risk of serious health issues.

the liver and kidneys, play a role in supporting the immune system. A well-functioning immune system is crucial for protecting a dog against infections and diseases.

HOW ORGAN HEALTH CAN BENEFIT FROM THE RIGHT FOOD OPTIONS By carefully selecting the right foods and incorporating them into a dog’s diet, you can significantly support the health and function of their internal organs.

LIVER • Detoxification: The liver detoxifies harmful substances in the body. Foods rich in antioxidants, such as blueberries and spinach, help neutralize toxins and support liver detoxification processes. •P rotein management: High quality, easily digestible proteins reduce the liver’s workload, which is beneficial for dogs with liver conditions. Lean meats and fish are excellent sources. •E ssential nutrients: Supplementing with essential nutrients like B-complex vitamins and digestible starches supports liver function and regeneration.

KIDNEY • Reduced protein load: A diet low in protein helps minimize the production of nitrogenous waste, which is filtered out by the kidneys. This reduces the workload on these organs, and helps manage kidney disease. •P hosphorus and sodium control: Lowering phosphorus and sodium intake prevents further kidney damage and helps maintain electrolyte balance. Foods like fish oil, flaxseed, and low-phosphorus vegetables such as cabbage and cauliflower are beneficial. •H ydration: Adequate hydration is crucial for kidney function, so incorporating moisture-rich foods and ensuring constant access to fresh water is important.

HEART •O mega-3 fatty acids: Foods high in Omega-3 fatty acids, such as salmon and tuna, help reduce inflammation and support heart health.

WHAT RESEARCH TELLS US ABOUT DIET THERAPY Diet therapy, also known as nutritional therapy, involves the use of specific dietary interventions to support various health conditions. It is a fundamental aspect of holistic healthcare, emphasizing the role of nutrition in promoting overall wellbeing and helping manage disease. This approach applies not only to humans but also to animals, including our pets and patients. A study by Qunli Wu and Xiaochun Liang explains how diet therapy in Traditional Chinese Medicine (TCM) aims to maintain balanced nutrition and achieve Yin-Yang balance through dietary interventions. Diet therapy emphasizes the principle that food can act as medicine, supporting health, preventing disease, alleviating illness, and slowing aging. Another study by Sahoo and Singh (2006) explores the significant role of therapeutic diets in the clinical nutrition of pets, emphasizing how dietary interventions can effectively support animals suffering from various health conditions. Therapeutic diets are specifically designed to provide tailored nutritional support for clinically ill pets, assist animals during recovery, and help prevent the onset of clinical illnesses. These specialized diets play a crucial role in maintaining the overall health and performance of animals by ensuring they receive a balanced diet, which is essential in avoiding nutrient deficiencies or toxicities. Nutritional deficiencies can have severe consequences, as they can exacerbate infections and impair immune function, leading to an increased severity of disease and higher medical costs. Proper nutrition is fundamental in replenishing tissue stores, improving immune function, and supporting recovery from illness. This is especially important in pets with chronic conditions, or those recovering from surgery or illness, as their nutritional needs may be higher or more specific than those of healthy animals. These studies underscore how by providing the right balance of nutrients, therapeutic diets can help manage and even mitigate the progression of disease. They can improve the quality of life for pets, reduce the need for medications, and lower veterinary costs in the long term. The integration of therapeutic diets into veterinary care highlights the importance of nutrition in the overall treatment and management of pet health, reinforcing the idea that food can indeed act as medicine.

• Taurine and potassium: These nutrients are vital for proper heart function. Including taurine-rich foods like lean

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meats, and potassium-rich foods such as sweet potatoes and bananas, can support cardiovascular health. • Low sodium and saturated fat: A diet low in sodium and saturated fat helps maintain healthy blood pressure and reduces the risk of heart disease.

DIGESTIVE •F iber and probiotics: Fiber-rich foods like pumpkin and sweet potatoes aid in digestion and help prevent constipation. Probiotics from yogurt with live cultures promote a healthy gut microbiome. •H ypoallergenic proteins: Along with easily digestible foods, these minimize the risk of gastrointestinal upset and food allergies. Ingredients such as turkey and rice are often well tolerated. •O mega-3 and Omega-6 fatty acids: These fatty acids help reduce inflammation in the digestive tract, and support overall gut health.

RESPIRATORY •A ntioxidant vitamins: Foods rich in vitamins A, C, and E, such as blueberries and broccoli, help reduce oxidative stress and support respiratory function. •E xpectorants: Natural expectorants like honey can soothe the respiratory tract and assist in clearing mucus

HOMEMADE DIETS Diet therapy can be effectively implemented at home by preparing meals tailored to the dog's specific health needs using high quality, fresh ingredients. Homemade diet therapy allows pet owners to have complete control over what goes into their dogs’ food, ensuring it meets all their nutritional requirements without any unnecessary additives or preservatives. By incorporating a variety of nutrient-rich foods, such as lean meats, fresh vegetables, and whole grains, pet owners can create balanced meals that support the optimal function of their dogs’ internal organs. Recipes can be customized based on veterinary recommendations to address specific health issues such as liver or kidney disease, heart conditions, or digestive problems. Diets like The Original CrockPet Diet are also tailored for a pet’s specific organ health issues. Homemade diet therapy not only caters to the individual needs of each dog, but also strengthens the bond between pet and owner through the care and attention given to meal preparation.

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DIETARY RECOMMENDATIONS FOR OPTIMAL ORGAN HEALTH Diet therapy involves utilizing the therapeutic properties of food through specific dietary interventions to support and optimize internal organ health. The key components of diet therapy for dogs include a comprehensive assessment of the patient’s health status, dietary habits, and nutritional needs, which may involve veterinary consultations and diagnostic tests. Based on this assessment, a customized dietary plan is developed that includes specific foods and nutrients to address the dog’s health condition and promote overall well-being. Implementing this diet involves incorporating the tailored meal plan into the dog’s daily routine, often with guidance from veterinarians or animal nutritionists. Regular monitoring and adjustments are crucial to ensure the diet remains effective and meets the dog’s evolving health needs, thereby ensuring a balanced intake of nutrients to avoid deficiencies or toxicities and support optimal organ function and overall health. Here are the key dietary recommendations for supporting the cardiovascular, respiratory, liver, kidney, and gastrointestinal health of a dog, ensuring they stay active and healthy for years to come. •C ardiovascular: Diets should be low in sodium and saturated fat, and include extra potassium, B-complex vitamins, and taurine. Suggested Foods: Meat (beef, chicken), fish (tuna, salmon), berries (blueberries, strawberries), leafy greens (kale, spinach)

•R espiratory: Diets should be palatable and balanced with added antioxidant vitamins and expectorants. Suggested Foods: Blueberries, pumpkin, broccoli, honey

• Liver: Diets should be low in fat and protein with high biological value, and include digestible starch, supplemental enzymes, and B-complex vitamins. Suggested Foods: Blueberries, spinach, lean meats (chicken, turkey), fish (salmon, sardines)

• Gastrointestinal: Diets should be highly digestible, low in fiber and lactose, and include hypoallergenic proteins, medium chain triglycerides, Omega-3 and Omega-6 fatty acids, and probiotics.

From the AHVMA

Suggested Foods: Pumpkin, sweet potatoes, yogurt (with live cultures), oats

•K idney: Diets should be low in protein, phosphorus, and sodium, and include non-protein calorie sources and added water-soluble vitamins to support kidney function and reduce strain on the kidneys. Suggested Foods: Fish oil, flaxseed, lowphosphorus vegetables (cabbage, cauliflower), fresh water (ensure hydration)

CONCLUSION Optimizing a dog’s internal organ health through the right dietary choices is a proactive and effective way to ensure their overall well-being and longevity. By focusing on diet therapy and incorporating nutrient-rich foods tailored to support the liver, kidneys, heart, digestive and respiratory systems, you can significantly enhance a dog’s quality of life. Veterinarians should develop a personalized dietary plan that meets each dog’s specific health needs, and monitor their progress regularly. A well-balanced diet not only supports optimal organ function but also plays a crucial role in disease prevention, recovery, and overall vitality, proving that indeed, food can act as medicine.

References Daina S, Macri A. The benefits of unconventional (homemade) food administered to dogs with digestive disorders. Lucr Stiint Ser Med Vet. 2023;66(2). Hall JA, Fritsch DA, Yerramilli M, Obare E, Yerramilli M, Jewell DE. A longitudinal study on the acceptance and effects of a therapeutic renal food in pet dogs with IRIS-stage 1 chronic kidney disease. J Anim Physiol Anim Nutr (Berl). 2018;102(1):297-307. doi:10.1111/jpn.12735. Mchiza ZJ. Diet Therapy and Public Health. Int J Environ Res Public Health. 2022; 19(14):8312. Published 2022 Jul 7. doi:10.3390/ijerph19148312. Richter G. The Ultimate Pet Health Guide: Breakthrough Nutrition and Integrative Care for Dogs and Cats. Hay House, Inc.; 2017. Sahoo A. Therapeutic Diets in Clinical and Pet Nutrition. Published online November 3, 2006.

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

ANNUAL CONFERENCE REMINDER Reserve the dates of September 28 through October 1 for the 2024 AHVMA Annual Conference and Exhibition in Reno, Nevada. It features over 100 hours of complementary and integrative CE sessions, hands-on labs, and special events. Over the past seven years, AHVMA has applied for and received AAVSB RACE approval for over 80 hours of continuing education. This year’s keynote address, “The Changing Landscape of Veterinary Medicine” by Madeline Yamate, will have us looking at the positive ways holistic veterinarians can help change veterinary medicine. This year’s conference includes lectures on photobiomodulation, ozone, homeopathy, botanical medicine, TCVM, homotoxicology, aromatherapy, and so much more! Look for our introductory talks on various holistic modalities. Not only will you be exposed to a wealth of knowledge, but you will also acquire information on how to integrate these modalities into your practice.

AHVMA RETREAT HOSTED BY COUNCIL OF ELDERS The Annual AHVMA Retreat, hosted by the Council of Elders, immediately follows the conference from October 1 through 3, at Camp Richardson on Lake Tahoe. More details regarding lodging and registration for the retreat will be updated on the AHVMA website (ahvma.org).

INTERESTED IN SPEAKING AT THE 2025 CONFERENCE?

Wu Q, Liang X. Food Therapy and Medical Diet Therapy of Traditional Chinese Medicine. Clin Nutr Exp. 2018;18. doi:10.1016/j.yclnex.2018.01.001.

The Call for Papers portal is now open for the 2025 AHVMA Conference, which will take place in West Palm Beach, Florida.

Resources

OFFICE MOVE

https://drruthroberts.com/ https://drruthroberts.com/collections/crockpet-diet https://www.avma.org/

The AHVMA office has moved to Tennessee. The new address is PO Box 803, Fayetteville, TN 37334. The phone number remains the same at 410-569-0795, and fax 931433-6289. IVC Summer 2024

NEUROPLASTICITY

in non-human animals BY ALLEN SCHOEN, DVM, MS, PHD (HON.), CVA

While neuroplasticity is an established and well-studied phenomenon in human brains, less is known about if or how it applies to animals. This article looks at the evidence, and shows how challenging our animals’ brains with new experiences demonstrates neural plasticity.

Neuroplasticity, or brain plasticity, has varied definitions when it comes to humans. Essentially, it describes the brain’s ability to change in structure or function in response to experience, how it rewires to integrate new information. Simply put, neuroplasticity is an internal rewiring process that allows the mind to grow and meet new, increased demands. The ability of neural networks to change through growth and reorganization has been acknowledged and taught in numerous medical schools. I took my first course relating to the subject decades ago through Harvard Medical School’s Department of Mind/Body Medicine. There were 1,000 MDs in the audience, but I was the only veterinarian. However, I don’t feel it is unreasonable to accept that most, if not all, vertebrate brains (perhaps non-vertebrate too) are neuroplastic. This article, perhaps the first or among the first on this topic, focuses on the potential ability of non-human animal brains to build mental muscle when their minds are challenged and given new experiences.

NEUROPLASTICITY STARTS AT BIRTH Newborn babies look to their parents to learn how to survive outside the womb. This behavior is also evident in puppies, kittens, foals, etc. It is their first exercise in neural plasticity. Parents continue to train their offspring in the ways that helped them survive when they were young. One of the

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papers I published for my master’s degree in animal behavior focused on the development of play behavior in foals. Play is an easy, early form of learning and is directly related to the mothers’ dominance order in a herd.

BRAINS ADAPT AND REMAIN FLEXIBLE THROUGHOUT LIFE Neuroplasticity results in both functional and physical changes inside the cranium. New synaptic connections form between billions of neurons as the brain takes in novel information. The brain continuously undergoes rewiring from learning new experiences.

NEUROPLASTICITY ISN’T JUST ABOUT LEARNING NEW TRICKS The brain’s ability to constantly update and reprogram can also power relearning, a critical need after a cervical vertebral injury, stroke, or traumatic head injury. These types of injuries interrupt blood flow and can cause the death of neuronal pathways. Neuroplasticity makes it possible for your brain to bypass damaged areas. Those synaptic connections essentially create new pathways to work around injuries.

For example, as animals meet another of their own species, they mentally adjust to communicating with them vocally and physically. A submissive dog may roll over to expose their belly as they confront a more dominant dog. Cats may hiss at each other until they acknowledge their dominance order.

TEN PRINCIPLES OF NEUROPLASTICITY

Agility training is another classic example of neuroplasticity in animals. Two of my staff members routinely took their adult dogs to an agility course, offering them new tricks, going through variously-sized tunnels, and leaping over increasingly high jumps. The dogs’ excitement about learning new tricks was quite evident.

In 2008, researchers A. Klein and A. Jones proposed ten principles of neuroplasticity they feel optimize brain function, especially after brain damage.

REPETITION IS IMPORTANT FOR NEURAL PLASTICITY

it or lose it. Learning something once 1 Use doesn’t mean you’ll know it forever. If you don’t

Dr. Richie Davidson from the University of Wisconsin’s Department of Investigating Healthy Minds shared a mind/ body medicine adage with me: “You fire what you wire and you wire what you fire.” This saying addresses the importance of repetition regarding neural plasticity. Glial cells make up the connective tissue that surrounds nerves in the brain. The more you repeat something, the more glial cells surround the nerve that fires. This is why you fire pathways for things you do continuously and often, including both positive and negative patterns. Repetition is the mother of memory. For example, the more you play a musical instrument, the better you get. This is also why riding the same trails helps make horses more comfortable with them, and why dogs feel increasingly comfortable on routine walks. In addition, it helps mynah birds and parrots learn repeatedly-heard human phrases. Two mynah birds bequeathed by an elderly client would make me belly laugh at the words they would say.

APPLYING NEUROPLASTICITY TO ANIMAL PATIENTS Just like other muscles in the body, keeping mental muscles fit and powerful requires work. Approaches to improving neuroplasticity in humans can also be applied to animals. Research shows that novelty and challenge can enhance the cognitive function of dogs, cats, horses, birds etc. Here are some ideas you can suggest to clients:

How would you apply these principles to your animal patients and companions?

use a skill, odds are it will deteriorate and weaken over time.

it and improve it. To use an old phrase, 2 Use “practice makes perfect.” Be tactical in your approach. Focus 3 Specificity. on the exact skill you want to learn, Doing a task repeatedly can even4 Repetition. tually make it feel like second nature. “Repetition is extra practice for your brain,” says psychologist Dr. Grace Tworek.

matters. Go all-in. A half-hearted effort 5 Intensity often brings mediocre results. matters. If you have a brain injury, don’t 6 Timing delay on trying to rebuild pathways. Early action typically brings better results.

matters. You’ll do better at something 7 Salience if it’s truly meaningful to you. Commit yourself to the effort.

matters. Anybody at any age can benefit 8 Age from neuroplasticity, but the process is a bit

easier when you’re younger. “If you’re older, it may take a bit more time and patience,” says Dr. Tworek.

Everyone likes a 2-for-1 deal, right? 9 Transference. Well, practicing one skill can bring side benefits

when you do related tasks (e.g. retraining stroke victims to use a spoon after improving other motor skills).

Conversely, something you learn 10 Interference. may interfere with the next thing you have to

learn. This is especially true if you take shortcuts and must undo bad habits.

• Challenge the animal’s brain regularly with new activities and experiences. In the case of horses, this could include different riding trails or a new style of riding. I have IVC Summer 2024

seen racehorses adapt quite well to becoming hunter/ jumpers or trail riding horses. Agility dogs enjoy learning new courses, while cats love new and novel toys. • Build the concept of “new experiences” into the animal’s day-to-day life with some simple acts. The idea is to break their routine, even just slightly. Einstein said that imagination is more important than knowledge. What might imagination include when it comes to new experiences in your animal friends’ lives? • Add something different to the animal’s exercise routine. Taking dogs on new walking routes to various stores, hiking trails or neighborhoods is good for their brains. • Consider travelling with dogs, even short distances. Travel to novel places stimulates new neural pathways. Brains are forced to stop auto-piloting in unfamiliar environments. Dogs also love looking out car windows, especially while you’re exploring new areas. • Periodically place bird cages in new, safe environments with novel views to stimulate their brains. The same goes for any caged animal, whether winged, scaled, etc. • Play varied music — it’s good for animal brains. I have seen parakeets and parrots start flapping their wings and singing voraciously to new music they resonate with. • Teach parrots and parakeets new words. They seem to love it (positive words are better, in my opinion).

• Ensure the animal also gets sufficient rest. This is important for neuroplasticity; the brain needs time to incorporate the day’s activities, especially new ones. There is a balance — too much rest and the animal becomes a couch potato, but too little and they are exhausted. The old dog I was treating for brain abnormalities (see sidebar below) would be taken for walks in novel areas, go into a deep, restful sleep for a while, then wake up re-energized. Every time an animal learns or does something new, the brain creates a new connection. As stated previously, repeating that action reinforces this connection. See what works for you and your patients and keep me posted — if you’re interested in more concepts to enhance neuroplasticity in your animal companions and patients, contact me through IVC Journal’s Associate Editor at dromer@ivcjournal. com.

CASE IN POINT: Novelty is key to brain plasticity

A client brought me a ten-year-old dog

that two board certified neurologists recommended be euthanized, based on

physical exams, MRIs, prognosis and

age. They were correct — based on conventional medicine. I used an integrative approach that helped

that dog reach her 17th birthday and beyond. Part of that approach

included recommending that the

client take her on numerous and

varied walks throughout the day. In

addition to providing exercise, these varied

walks kept the dog’s brain and senses

stimulated with novelty, and she loved every minute of her extended life.

IVC Summer 2024

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AN INTEGRATIVE APPROACH TO FELINE KIDNEY DISEASE BY ANGIE KRAUSE, DVM, CVA, CCRT

Treating feline kidney disease from an integrative approach includes medications and fluid therapy as well as close attention to diet and the right supplements.

As the most common metabolic disease in cats, feline kidney disease is a regular part of a small animal practitioner’s daily caseload. While it most commonly affects geriatric cats over the age of 12, renal insufficiency can also affect younger felines. This article will outline an integrative approach to managing kidney disease in cats, no matter the pathogenesis and age of the patient.

DIETARY CONSIDERATIONS This may be the most controversial and complicated aspect of treating cats with kidney disease using an integrative approach. There are many competing needs between the nutritional philosophies of cat guardians and veterinarians, data from clinical studies, and what cats find acceptable and palatable. Prescription diets formulated for cats in renal failure are lower in phosphorus and protein compared with maintenance diets. They are often higher in Omega fatty acids and fiber. While most scientific literature supports the efficacy of lowering phosphorus levels in renal diets, the degree and timing of protein restriction continues to be debated. Feeding a species appropriate diet is a hallmark of an integrative or holistic approach to feline health among both veterinarians and cat guardians. Cats are obligate carnivores, and most

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integrative practitioners will recommend feeding a balanced diet high in protein and moisture, and low in carbohydrates. Feeding a protein restricted diet is in direct opposition to this philosophy. However, increased longevity and quality of life has been proven among cats fed diets with restricted protein and phosphorus; most of these benefits are likely due to phosphorus restriction.5 This author recommends taking a moderate approach to balance the nutritional philosophies of practitioners and guardians with the existing literature and available commercial diets. Client education should aid cat guardians in making decisions around therapeutic diets. Discussing the data and benefits of phosphorus restriction while acknowledging the controversy around protein restriction empowers cat guardians to make more informed decisions. Many feline guardians who have chosen a holistic or integrative approach will be reluctant to feed diets produced by major prescription food manufacturers. Further, some of the ingredients listed on labels may be unacceptable to the guardian. A market of phosphorus and moderate protein restricted diets is emerging thanks to other companies such as Blue Buffalo and Medicus. These manufacturers use ingredients that may be more attractive to cat guardians wishing to take an integrative approach. Meanwhile, many traditional prescription diet

manufacturers are taking steps to improve the ingredient decks and palatability of their foods to benefit both the patient and the guardian. No matter which diet is selected, a moisture-rich canned or pouched food is beneficial for hydration.

SUPPLEMENTS FOR KIDNEY DISEASE Caution should be used when adding supplements to the food of a cat suffering from renal disease. Cats are very sensitive to the texture and flavor of their diet, and anything added to it. Cats with advanced renal disease may also suffer from anorexia and gastric disease, increasing their sensitivity to any changes in their food. Encourage cat guardians to use only supplements their cats accept, and that have the most efficacy, to avoid the risk of food aversion. 1. Rehmannia glutinosa: This herb has been used in Asian cultures to treat renal disease. In rat models, it has been shown to be renoprotective.6 One proposed mechanism for how it does this is by increasing perfusion to the kidneys. This herb can be found in several classic Chinese herbal formulas, including Ba Wei Di Huang Wan (Rehmannia Eight Combination). These formulas come in extracts and granules. Most cats tolerate small amounts of these granules in their food. This herb can also be found in an easy-to-administer supplement by Rx Vitamins for Pets (Rx Renal Feline Beadlets). 2. O mega-3 fatty acids: These are often found in higher levels in prescription renal diets. Most renal disease is inflammatory in pathogenesis, and increasing levels of an antiinflammatory fatty acid may be beneficial. Many cats find fish oils palatable and accept them on their food. 3. C annabidiol and other phytocannabinoids: These hemp extract compounds may be beneficial for cats with renal disease. While preliminary pharmacokinetic and safety studies are emerging, there have been no studies to investigate the anti-inflammatory effects of phytocannabinoids on feline kidneys. However, this is also the case for Omega fatty acids. CBD and other phytocannabinoids can help reduce pain and inflammation associated with arthritis and may increase a cat’s overall sense of well-being. While CBD isolates have been proven safe for long term use in cats, the author finds most cats show a positive clinical response at 0.5-1 mg/kg CBD twice daily, given with food.7

DIAGNOSING RENAL DISEASE IN CATS Screening for renal disease as cats enter their senior years can greatly impact the efficacy of treatment and improve quality of life. Regular diagnostics should include a complete blood count, chemistry panel, and total T4. This screening should be performed yearly after the age of ten, and more frequently if kidney disease is detected. The International Renal Interest Society has created guidelines to classify the progression of kidney disease into stages. This can aid practitioners in selecting stage-appropriate therapies, and may give both the practitioner and cat guardian a general idea of longterm prognosis.

TREATING COMPLICATIONS OF KIDNEY DISEASE Hypertension Secondary hypertension is often overlooked by practitioners after the diagnosis of kidney disease has been established. A small study reported that 17 of 26 cats with glomerular disease also had systemic hypertension.1 Unfortunately, most cats with hypertension are asymptomatic until the disease state progresses to retinal detachment and acute vision loss. Untreated hypertension may worsen the progression of kidney disease.3 After feline patients have been diagnosed with kidney disease of any stage, it is imperative to monitor blood pressure every six months. If hypertension is detected, immediate treatment and control can help slow the progression of kidney disease and maintain the patient’s quality of life. Amlodipine is the most commonly used calcium channel blocker to treat cats with hypertension. A starting dose of 0.625 mg once daily can be increased to twice daily if blood pressure is not lowered adequately. Some cats will require 1.25 mg twice daily to gain

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control of the hypertension. A new angiotensin II receptor blocker, Telmisartan, has shown promise in effectively treating cats with hypertension.5

Bacterial urinary tract infections While bacterial infections of the urinary tract are uncommon in cats, the presence of kidney disease increases susceptibility to these ascending infections. While urinalysis is usually an accurate tool to screen for bacterial cystitis, it becomes less useful as cats lose their ability to concentrate urine. Sudden increases in creatinine, along with clinical signs of pyelonephritis, should warrant further investigation with ultrasound and possible empirical treatment of infection.

Hyperphosphatemia The kidneys are the primary route for phosphorus excretion, and as renal function declines, serum phosphorus levels rise. Increased serum phosphorus levels cause cats to feel poorly, and may hasten the progression of renal disease by many mechanisms. Several studies have shown that rising phosphorus levels are correlated with an increased risk of death.2,4 For severe hyperphosphatemia, IV fluid therapy should be used to rapidly lower serum phosphorus levels. Phosphorus restricted diets should be considered as a first line therapy for a mild increase in serum phosphorus levels. For patients that refuse low phosphorus diets, or have moderate to severe increases in serum phosphorus, binders such as aluminum hydroxide should be added to meals. Sevelamer hydrochloride, lanthanum carbonate, and calcium acetate are phosphorus binders that could also be considered.

Hypokalemia Low serum potassium can occur in cats with renal failure due to low appetite, cellular translocation secondary to acidosis, and urinary or fecal loss. Supplementing with potassium gluconate or citrate is an easy and straightforward way to combat these losses.5

A dynamic and individualized therapeutic plan for managing renal disease in cats is imperative for creating maximum benefits for the patient. Therapies consistent with the guardian’s philosophical views on health may lead to a higher level of compliance. Protocols must also be accepted by the feline patient for optimal outcomes.

Rayhel LH, Quimby JM, Cianciolo RE, et al: Clinicopathologic and pathologic characteristics of feline proteinuric kidney disease. J Feline Med Surg. 2020 Vol 22 (12) pp. 1219-1229. 1

Chew D: Artificial Intelligence Takes the Surprise Out of Chronic Kidney Disease. AAFP 2019

Grauer GF: Protein-Losing Nephropathy. Western Veterinary Conference Proceedings 2005.

Boyd LM, Langston C, Thompson K, et al: Survival in cats with naturally occurring chronic kidney disease (2000-2002). J Vet Intern Med 2008 Vol 22 (5) pp. 1111-17. 4

Acierno MJ, Brown S, Coleman AE, et al: ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats. J Vet Intern Med 2018 Vol 32 (6) pp. 1803-22. 5

Lee BC, Choi JB, Cho HJ, Kim YS. Rehmannia glutinosa ameliorates the progressive renal failure induced by 5/6 nephrectomy. J Ethnopharmacol. 2009 Feb 25;122(1):131-5. 6

Coltherd JC, Bednall R, Bakke AM, Ellerby Z, Newman C, Watson P, Logan DW, Holcombe LJ. Healthy cats tolerate long-term daily feeding of Cannabidiol. Front Vet Sci. 2024 Jan 24;10:1324622. 7

KEEPING FELINE PATIENTS HYDRATED WITH FLUID THERAPY Intravenous and subcutaneous fluid therapy are effective tools for hydrating and correcting electrolyte imbalances in cats with kidney disease. Intravenous therapy is primarily used for acute or chronic episodes of azotemia. Subcutaneous (SC) fluid therapy is done at home using a balanced fluid such as lactated Ringers solution. SC fluid therapy is generally used for cats with IRIS Stage 3-4 kidney disease. Fluid is administered every one to three days. When prescribing the volume of fluid to be administered, it is important to keep in mind the cardiovascular function of each patient. Most cats are prescribed and tolerate anywhere between 75-150ml of fluid. Educating cat guardians about techniques to help minimize stress while administering fluids at home can help improve patient outcome and quality of life.

IVC Summer 2024

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? St. John’s Wort (Hypericum perforatum) has a long history of use as a nervine tonic. It is best for hepatic depression. It is very effective for relieving nerve pain or hypersensitivity, and treating nerve injuries to the spinal cord. St. John’s Wort is useful for treating sciatic pain, facial nerve pain, peripheral neuropathies, intercostal neuralgia, head trauma injuries, and painful urinary conditions.

CASE REPORT Nyia, an eight-year-old spayed female DLH cat, suffered with herpes lesions in her eyes as a kitten and had now developed a sterile cystitis characterized by frequent urination with straining. Her urine showed traces of blood and protein; the pH was 6. Nyia was placed on a Chinese formula called Ba Zheng San along with Hypericum at seven drops twice a day of a 1:5 tincture. Over the next two weeks, her urgency to urinate decreased, and within three weeks, her clinical symptoms had resolved.

RECENT WEBINARS The VBMA held a membership special for renewing and first time members, as well as a greatly discounted webinar on January 30 focusing on respiratory issues. On June 26, VBMA president Marge Lewter, DMV, presented a webinar entitled “Turn Over a New Leaf — Get Started with Veterinary Botanical Medicine.” Dr. Lewter featured practical tips on how to incorporate botanicals into veterinary practice to improve patient care.

herbal oncology. Chanchal’s expertise lies in bridging the gap between traditional herbal knowledge and modern scientific understanding. She interned with Donnie Yance and brings his wealth of knowledge to us along with her clinical experiences.

ECO-TOUR DETAILS We’ll arrive in Eugene, Oregon on October 26 and attend the Mushroom Festival at Pisgah Arboretum on the 27th. After the festival, we'll travel to the Belknap Hot Springs on October 28 for hiking, mushroom foraging, and lectures on how to connect with the spirit of plants. Our speakers will be Ihor Basko, DVM and Scott Kloos of the School of Forest Medicine. Enjoy the hot springs and hike among the trees while you connect with your surroundings and your colleagues on this healing retreat.

VIRTUAL CONFERENCE IN NOVEMBER The ACVBM and VBMA are holding a joint conference on November 9 and 10. It features Jody Noe, ND, speaking on Cherokee medicine and the gut-brain connection; and Brendan Kelly, LAc, who will talk about the School of Cold/Shang Han Lun and the Five Phases/Wu Xing, Wen Bing Xue/School of Heat. Brendan will also present case studies from his experience treating cases of active COVID-19 and long COVID, and his clinical experience integrating Western herbs with Chinese herbal medicine. Register for all events and webinars at vbma.org. Submitted by Cynthia Lankenau, DVM

GUESS THIS HERB!

VBMA TRACK AT AHVMA CONFERENCE This year’s VBMA track at the AHVMA Annual Conference will feature Chanchal Cabrera, a renowned herbalist, author, and educator. With over 40 years’ experience in the field of herbal medicine, she is recognized as a leading authority in

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

IVC Summer 2024

Integrating REHABILITATION THERAPY into CANINE SPORTS MEDICINE BY GABRIELLA VARCOE, DVM, DACVSMR, CCRP, CVA, CVPP, IVCA, CVFT, CSMP Canine sports medicine promotes the health, wellbeing, and performance of athletic and working dogs, while rehabilitation therapy helps minimize injury risk and offers treatments for acquired injuries. Together, they help keep these dogs on top of their game for as long as possible.

eterinary sports medicine and rehabilitation (VSMR) is a growing field that addresses the unique demands of working or performance animals. It includes prevention as well as diagnosis and treatment following injury, surgery, and illness. More specifically, canine sports medicine, when integrated with rehabilitation therapy, offers a multidisciplinary team approach to optimizing the health, performance, and longevity of dogs in various roles, including military and police dogs, search and rescue dogs, service dogs, and various companion athletes. Many companion dogs and geriatric canines can also benefit from rehabilitation therapy.

REHABILITATION THERAPY REQUIRES A WHOLE-BODY APPROACH Rehabilitation therapy for dogs is similar to human physical therapy in that it uses a whole-body approach to assess and treat the animal. It focuses on the restoration, maintenance, and promotion of physical function, and plays a vital role in the treatment of multiple conditions. Rehabilitation encompasses various therapies, such as hydrotherapy, therapeutic exercises, manual therapies, and other modalities to treat injuries, improve mobility, and enhance performance while preventing future injuries. Rehabilitation therapy is also used to manage chronic conditions, such as degenerative joint disease, to keep dogs comfortable and maintain mobility. With various studies looking at the incidence of injury in various canine sporting events, and in the working dog population, rehabilitation therapy has been recommended by many to help dogs regain function and return to sport or work. There are many things to take into consideration when establishing an appropriate return to work, or a sports retraining regimen, and this requires an understanding of various fields of veterinary medicine, including neurology, orthopedics, biomechanics, exercise physiology, and internal medicine.

A rehab session can include manual therapies such as massage.

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Rehabilitation therapy involves a tailored approach to return the dog to a safe and functional level, and prevent future injuries with proper conditioning exercises. This is done by focusing on general strength and stability, including core strength, and proprioception. These dogs require a higher level of fitness and conditioning to meet the demands of their jobs or sports.

REHABILITATION PROGRAM STARTS WITH THOROUGH EVALUATION A comprehensive program begins with proper evaluation, including a detailed history of the dog’s training schedule, nutrition, previous injuries, and performed activities. A working dog experiences different physical and mental demands than a companion dog, and thus requires a different approach to treatment and return to function. Overall, evaluation and rehabilitation therapy for both groups of dogs have many similarities. A full physical exam, which includes a thorough orthopedic and neurologic evaluation, is performed to identify the underlying problem and localize the injury. Specific tests are performed at the initial exam and repeated at various time points during rehabilitation to evaluate theprogression of recovery. These tests may include goniometry to evaluate joint range of motion, muscle mass circumference, posture evaluation and strength tests. Gait analysis, both subjective and objective (when available), should be performed at the initial and subsequent evaluations. Following the examination, further diagnostics, such as baseline radiographs, are routinely performed. Additional diagnostics, such as musculoskeletal ultrasound or advanced imaging, may be required.

NUTRITION AND WEIGHT PLAY IMPORTANT ROLES

REHABILITATION TREATMENT PLANS ADDRESS THE DOG’S INDIVIDUAL NEEDS Once the dog is evaluated and their deficits identified, a treatment plan is created based on the findings. The plan has both short- and long-term goals, to be updated at re-evaluations. Rehabilitation protocols are somewhat dependent on whether or not the dog undergoes surgical repair of an injury, or is able to be treated with rehabilitation therapy on its own. A tailored rehabilitation program is developed to address the specific needs of the dog. Treatment plans may include a combination of therapeutic modalities and exercises designed to manage pain, provide support during the healing phase, and improve flexibility, strength, and endurance while addressing any underlying musculoskeletal or neurological issues. Regular monitoring and follow-up are conducted throughout the process as the dog is gradually returned to activity. Without a proper guided transition back to unrestricted activity, there’s a risk for re-injury or new injury. Similar to physical therapy for humans, canine rehabilitation uses specific techniques and assistive devices to help support patients through their recovery.

A nutritional assessment is a very important part of the rehabilitation program, and helps ensure the dog is receiving an adequate diet for recovery and performance. Nutraceuticals are often incorporated as part of a comprehensive rehabilitation program to support the dog’s body. Rehabilitation therapy is a great tool to help overweight dogs reach, and maintain, a lean body composition. Dogs should maintain a body condition score (BCS) of 4-5/9. This has been shown to not only improve mobility but also lifespan. Leaner dogs generally live longer than their overweight cohorts. This is especially important for working dogs or athletes who use their entire bodies to perform their jobs, and often need to jump, turn, and run regularly.

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TYPES OF INJURY AND TREATMENT

Hydrotherapy can help with pain relief, muscle strength, and range of motion.

Laser therapy is often used in conjunction with manual therapies and exercises.

THERAPIES AND EXERCISES TO DO AT HOME A home therapy program involving specific manual therapies and a progressive exercise plan is also prescribed for the dog’s owner or handler to do at home. This not only helps with the recovery process but also further strengthens the bond between the owner/handler and the dog. The exercises are modified based on the dog’s level of functionality to help them gain strength and get back to full activity. Often, a home maintenance plan is continued after full recovery to aid in maintaininng performance. This can include preparation and recovery exercises, and a warm up and cool down plan, to help prevent future injury.

The injuries seen in a rehabilitation setting depend on the dog’s sport or job, and can involve a variety of tissues, including bone, tendon, ligament, and muscle. Fractures, sprains, and strains are common and can be treated with rehabilitation therapy following surgical repair, if the latter is indicated. A definitive diagnosis is required for an appropriate recovery plan that follows general healing principles of the underlying condition. A well-rounded rehabilitation program generally includes proprioceptive exercises, strength training, skills training, and endurance exercises that are similar to the dog’s demands when working or participating in athletic events. This is often done with a team of professionals trained in rehabilitation, and may include the dog’s veterinarian, a physical therapist, technicians and fitness trainers. Everyone on the team brings valuable skills and knowledge that will help the dog recover, and will also help maintain a training program moving forward.

A TYPICAL REHABILITATION SESSION A standard rehab session can include manual therapies, such as soft tissue massage, joint mobilizations, stretching, and myofascial trigger point therapy. Practitioners with advanced training in other fields, such as veterinary spinal manipulation therapy (VSMT) or osteopathy, may also incorporate these skills into the treatment plan. Mobilization and other manipulation techniques are often used for pain relief, improving muscle extensibility, and enhancing healing. They can also help dogs recover after activity, and if performed routinely, can be used as a monitoring technique to pick up on early changes in tissue tone and flexibility. Dogs are generally seen one or more times a week in the clinic or rehabilitation center and are progressed based on their abilities and response to therapy. This allows for adequate loading of the tissues, as well as for recovery and strength-building.

THERAPEUTIC EXERCISE — THE FOUNDATION OF REHABILITATION THERAPY Therapeutic exercise can be done as single exercises or as an obstacle course. Targeted, specific therapeutic exercises improve balance, proprioception and flexibility, and promote a return to functional independence. These exercises are often used for improving strength and endurance and for general conditioning. Therapeutic exercises improve balance, strength, and proprioception.

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At each appointment, the therapeutic exercise plan will be assessed and adapted to reflect the dog’s stage of healing and improve functionality. • Specific equipment is used to work on these goals, and can include balance discs, Cavaletti poles, physioballs, various platforms and other obstacles.

From the IVAS The mission of the International Veterinary Acupuncture Society (IVAS) is to provide, promote and support veterinary acupuncture and related treatment modalities through quality basic, advanced and continuing education, internationally recognized certification for veterinarians, and responsible research.

• Canine-specific land treadmills can be useful for cross training and conditioning. • Hydrotherapy involves the use of water-based exercises. It is beneficial for dogs recovering from surgery or injury, and can be used for conditioning during the return to work or sport phase. The benefits of hydrotherapy include pain relief, improved range of motion, and muscle strengthening. A common type of hydrotherapy involves walking the dog on an underwater treadmill; this allows the therapist to control the water level, speed, and intensity of the exercise by adding in trotting intervals, jets, or inclines as indicated. • Other modalities often used during the rehabilitation program include thermal therapies, photobiomodulation (also known as laser therapy), extracorporeal shockwave therapy (ESWT), therapeutic ultrasound, TENS (Transcutaneous Electrical Nerve Stimulation), and pulsed electromagnetic field therapy (PEMF). These modalities are often used in combination with manual therapies and therapeutic exercises to enhance recovery. • Further therapies frequently incorporated into rehabilitation include acupuncture, kinesiology tape for improving comfort or proprioceptive awareness, or more invasive procedures such as intra-articular therapies, include orthobiologics. Overall, canine sports medicine plays a crucial role in promoting the health, well-being, and performance of athletic and working dogs. Rehabilitation therapy helps minimize the risk of injury, offers treatments for acquired injuries, and maximizes longevity in those activities. It can be used to either aid in recovery or maintain general fitness and body composition. Used in conjunction with one another, canine sports medicine and rehabilitation therapy are an effective way to return canine athletes and working dogs back to the activities they do and love best.

ACUPUNCTURE FOR NEUROLOGIC CONDITIONS Certain neurologic conditions that afflict canines are incurable or do not have a definitive diagnosis. This is a challenge for veterinarians because options to help these patients using a conventional medicine approach are limited. As an adjunctive or stand-alone therapy, acupuncture can improve neurologic symptoms and quality of life for these dogs. From a Traditional Chinese Medicine (TCM) standpoint, nearly all neurologic conditions have a pathologic Wind component. Wind can cause abnormal movement, paralysis, vestibular syndrome, and seizures. Wind is also a component in cases of degenerative myelopathy (DM). These neurologic cases are complicated and multi-factorial, but one can always start with resolving Wind and supporting the fundamental substance or organs that are most obviously out of balance. Acupuncture points commonly used to resolve Wind include: GB 20, GV 14, BL 12, GB 31, and LI 4. One organ that is often out of balance in patients suffering from Internal Wind syndromes, such as epilepsy or vestibular disease, is the Liver. Points to support the Liver include: LIV 3, LIV 13, LIV 14, GB 21, and GB 34. In senior patients, Blood and/or Kidney Yin Deficiency are common. Acupoints BL 17, SP 6, and SP 10 support Blood while acupoints BL 23, KID 3, KID 6 and Lumbar BH are helpful for the Kidney and Yin. The patient’s overall well-being is also important, and utilizing acupoints PC 6, HT 7 and An Willa receives acupuncture Shen can help support emotreatment for DM tional balance. For more information on becoming IVAS Certified, visit ivas.org. Submitted by Nell Ostermeier, DVM, CVA, FAAVA

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DIAGNOSTIC TECHNIQUES IN VETERINARY CHIROPRACTIC NEUROLOGY BY CARL DESTEFANO, DC, DACNB, FACFN

When it comes to diagnosis and treatment of our animal patients, veterinary chiropractic neurology requires an understanding of the neurophysiological mechanisms of function within the central and peripheral nervous systems.

What can veterinary chiropractic neurology contribute to the diagnosis and treatment of many presenting animal complaints? The answer is simple yet complex. It is simple in that a chiropractic neurological evaluation considers functional as well as pathological origins. But it is also complex because an understanding of neurophysiological mechanisms of function within the central and peripheral nervous system is required. This differentiates a disease process (pathology) from aberrancies in the frequency of firing (FOF) of neuron pools presynaptic to an end-organ (functional). Functional neurologic evaluation does not replace traditional veterinary neurological exam procedures, but instead expands the clinician’s perspective on causation, and often on treatment.

THE NEUROLOGICAL EXAM Veterinarians and chiropractors study neurology in school and should have a basic understanding of how to perform a neurological exam. For those of us engaged in animal chiropractic, performing a good neurological exam is critical. A well-trained animal chiropractor is a functional neurologist who understands the pertinent neuroanatomy and neurophysiology needed to interpret patient history and objective findings. Where we differ from our traditionally trained brethren is in our ability to appreciate the subtleties of a multi-modal integrated nervous system. A traditional approach to the neurological exam provides a simple yes or no answer evaluating

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for disease. However, the chiropractic neurologist is sensitive to degrees of function. We understand that the nervous system can work less than optimally without being diseased. With this distinction in mind, we can utilize different windows into the nervous system that evaluate the frequencies of firing of pools of neurons. Our goal is to return the nervous system to the highest degree of function allowed by the animal’s genetic potential. Certainly, the diagnosis of neurological pathology is an important goal of any neurological exam. Yet the presence of functional neurological deficiencies is much more common and thus much more likely to be of benefit to the majority of our patients. A veterinary chiropractic neurological approach includes those aspects of the neurological exam that can be used to evaluate the functional integrity of neuronal pools. Treatment can then be aimed specifically at those areas of the neuro-axis either compromised by pathology or a decreased FOF of a pre-synaptic pool. Since animal chiropractors use receptor-based therapies as their therapeutic tool, we are unique in our abilities to specifically reach pools of neurons by modulating receptor potentials. This of course implies necessary training in the area of functional neurology in order to determine the longitudinal level of the neurologic lesion, so a targeted receptor-based therapy can be employed. Before we consider the neurological exam from this new perspective, an understanding of certain neurophysiological concepts is necessary.

THE CENTRAL INTEGRATIVE STATE AND ANIMAL HEALTH There is probably very little argument that the central nervous system (brain and cord) runs things; at least in the physical body. The nervous system directs healing and maintains health. Nothing is beyond the awareness of the nervous system. Information is received and transmitted throughout the neuro-axis by chemical and electrical means. The synaptic transmission of information is well understood and the sensitivity of neurons can be modulated by chemical and electrical factors. A total of all excitatory and inhibitory influences from temporal and spatial pre-synaptic effects defines the central integrative state (CIS) of a neuron or pools of neurons. A good chiropractic neurological exam seeks to define the central integrative state at the differing longitudinal levels of the neuro-axis. If the central nervous system (CNS) drives all aspects of biology, what drives the central nervous system? The answer is critical because it explains why our therapies are so effective. The central nervous system is driven by the environment! The greatest and only constant environmental stressor is gravity. The forces of gravity are transduced into electrical signals by mechanoreceptors. These include muscle spindle cells, golgi tendon organs, and other proprioceptors. Gravity’s influence on the CNS via mechanoreceptors is responsible for the majority of the baseline activity of the neurons of the CNS. In other words, in the absence of normal gravitational forces, all neuronal function would be severely hindered, making neuronal death highly probable over time. A very high percentage of mechanoreceptor populations lie in close proximity to the spine in the form of joint mechanoreceptors in the ligaments and joint capsules of the spinal segments. The muscle spindle cells (MSC) and golgi tendon organs (GTO) of the intrinsic muscles of the spine have a significant influence on the CIS of the central nervous system. This is due to their sheer numbers, as well as the fact that as midline structures they were phylogenetically responsible for the evolution of the structures that developed more laterally. Loss of intersegmental motion (fixation) or aberrant motion (subluxation) reduces the FOF (temporal summation) and the numbers of mechanoreceptors firing (spatial summation) into the central nervous system. Since incoming sensory information is divergent in nature, loss of firing of only a few receptors can have tremendous consequences on the central nervous system.

THE ROLE OF RECEPTORS Receptors are neural structures that transduce an environmental stimulus to an electrical message. Different receptors transduce different types of environmental stimuli. The retinal receptors transduce light, and the auditory receptors transduce sound. Mechanoreceptors transduce joint position sense, and vestibular receptors transduce movement of the head. These are examples of receptors that perceive the external environment. There are also receptors that perceive the internal environment of the animal, such as temperature, pH, hormone levels etc.

KINESIOLOGICAL TESTING Kinesiological testing is an accepted, necessary component of the neurological exam in humans. Every text on the human neurological exam contains muscle testing procedures to evaluate for segmental and central lesions. In animal medicine, pupillary responses, gag responses, panniculus responses, postural reflexes and more are utilized as muscle tests. Adding applied kinesiological testing to the animal neurologic exam helps acquire much additional valuable information. Muscle testing on an animal requires surrogate testing, but because of a lack of understanding of the mechanisms involved in surrogate testing, applied kinesiological evaluation of the animal patient remains controversial. I have been involved in the study of applied kinesiology for many years, and although I feel muscle testing is an invaluable diagnostic tool, we understand the problems inherent in its application. Whether muscle testing humans without a surrogate, as in the standard neurological exam, or with a surrogate in the case of animals, accurate testing is a skill learned with much practice and time. This being said, we believe an attempt to include some simple muscle testing procedures in the neurological exam is of great diagnostic benefit to animal patients.

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As sensory information enters the cord and brainstem via a sensory neuron, it diverges via collateralization. In other words, one sensory neuron will synapse with many postsynaptic neurons that will in turn synapse with many other post-synaptic neurons that will in turn modulate the central integrated state of each neuron in its path. The central integrated state of a neuron can be defined as the sum total of all the excitatory and inhibitory influences on the neuron. The central integrated state of a neuron will determine its probability of firing. If any sensory receptor undergoes a decrease in FOF, the postsynaptic pool of neurons will at some point begin to undergo some aspect of trans-neural degeneration.

TRANS-NEURAL DEGENERATION All neural tissue needs oxygen, glucose, and active electrical stimulation to remain healthy. When a neuron is fired, second messengers activate genetic material in the mitochondria and nucleus. These immediate early gene responses direct the production of more mitochondria and new protein within the

cytoplasm. This protein is used for structural purposes, as in the production of organelles and microfilaments, as well as enzyme production. The mitochondria are the site of oxidative phosphorylation where glucose is metabolized to produce ATP. This ATP is used in part to run ion pumps that maintain the electrical and chemical gradients of the cell. Protein is also greatly responsible for the negative charge within the cell. With decreased frequencies of firing, secondary to loss of receptor stimulation, protein production is slowed or stopped and the numbers of mitochondria within the cell decrease. Energy for cellular function is more likely derived from the anaerobic pathway of glycolysis. Lactic acid levels rise, creating ferrous iron free radicals, which are poisons to the neuron. With less mitochondria there is less ATP produced to power the ion pumps. Hydrated Na+ ions now accumulate within the cell and the neuron swells. Less protein means less structural integrity and less negativity within the neuron. As the equilibrium potential of the cell is slowly lost, the neuron begins to swell. This process of degeneration is known as trans-neural degeneration. The mechanism described above may occur to some degree in all neurons in a particular pathway. The probability that a

THE BRAIN HAS TWO OUTPUT SYSTEMS Sensory information diverges all the way to the cortex. It is at the cortex where a response to the incoming sensory information is initiated. The cortex fires back down through motor pathways to converge on two motor output systems. There are only two motor output systems from the brain. One is to somatic muscle via the ventral horn and the other is to the autonomics via the intermedial lateral cell column. This makes great sense. As the animal moves in response to environmental stimuli, concurrent activation of the autonomic system occurs to support that movement by shunting blood to the appropriate muscles, releasing glucose stores, increasing cardiac output, etc. Sensory information from the environment is transduced to an electrical message that diverges to many postsynaptic neurons and allows integration as well as health maintenance of those cells. At the cortex, a motor response is sent through a converging system to affect somatic muscle and the autonomics.

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The central nervous system receives and integrates sensory data from the internal and external environment, integrates with memory data, and responds via the motor systems of somatic muscle and the autonomic nervous system.

particular neuron will be affected by a pre-synaptic decreased FOF from a receptor field depends on the pre-existing health of the neuron (i.e. central integrated state), and other collateral influences on that neuron from homologous pathways. In other words, maintaining adequate frequencies of firing to neuronal pools via prophylactic receptor stimulation can protect these cells in times of injury or disease when receptor stimulation is reduced. Driving frequencies of firing via exercise and specific treatment modalities leads to long-term potentiation, a phenomenon where increased frequencies of firing are maintained in a cell long after the original stimulus has ceased. This increased drive to the genetic machinery of the cell causes positive cell growth. More mitochondria and other organelles increase the stability of the neuron. Budding or dendritic spur formation occurs, increasing the surface area for synaptic communication with other neurons and allowing for more efficient exchange of information (neuroplasticity). This explains the general clinical observation that animals who are regularly exercised and/or receiving prophylactic chiropractic care have an easier time recovering from injury and illness.

DESCENDING SUPRASEGMENTAL AND SEGMENTAL INFLUENCES AFFECT MUSCLE SPINDLE CELL SENSITIVITY In the absence of trauma, most injuries are a failure of somatic muscle to fire at the right time and at the right amplitude to support a joint against the forces of movement and gravity. Decreased cortico-ponto-medullary influences on alpha and gamma motor neurons cause muscle paresis and a decreased reflexogenic response to stretch. Decreased sensitivity of muscle spindle cells (MSC) means a greater environmental message (stretch) is needed to cause the monosynaptic and polysynaptic firing of homonymous and synergist muscles that support the loaded joint. The reduced sensitivity of the MSC is caused by decreased FOF of the gamma motor neuron that innervates this receptor. Its FOF is determined by its pre-synaptic pool of neurons from local cord reflexes and descending suprasegmental pathways from the brain as stated above. The pre-synaptic pool to both the cord and brain comes ultimately from receptor transduction of environmental forces.

INTERMEDIAL LATERAL CELL COLUMN (IML) AND AUTONOMIC FUNCTION Veterinarians and chiropractors study neurology in school and should have a basic understanding of how to perform a neurological exam. For those of us engaged in animal chiropractic, performing a good neurological exam is critical. A well-trained animal chiropractor is a functional neurologist who understands the pertinent neuroanatomy and neurophysiology needed to interpret patient history and objective findings. All incoming sensory input (including mechanoreceptor input) to the dorsal horn sends a collateral to the intermedial lateral cell column (IML), the output nuclei for all autonomic function. In other words, it is impossible to perceive your environment without simultaneously affecting the autonomic system. This input to the IML from all receptors is excitatory. Excitatory influences on the IML also come from descending mesencephalic reticulospinal pathways. In the thoracic and lumbar output of sympathetics, therefore, increased blood pressure, vasoconstriction, sweating, pilo-erection, etc. will occur. All mechanoreceptor input fires to the cerebral cortex. The cortex then fires back down (via the ponto-medullary reticular formation) to inhibit the ipsilateral IML. This would cause a reduction in blood pressure, vasoconstriction, sweating, and pilo-erection. Since every environmental potential has a collateral that excites the IML, there needs to be a system that dampens the IML, keeping it in balance. Cortical stimulation of ponto-medullary reticular formation is necessary to inhibit IML output. Since cortical integrity is determined largely by mechanoreceptor input, its ability to dampen IML output depends on proper joint motion. If there were cortical deficits secondary to the loss of joint motion, incoming sensory input to the IML would not be sufficiently dampened by suprasegmental influences, leading to increased blood pressure, vasoconstriction, hypoxia, etc. Hypoxia causes cell damage and the release of noxious chemicals that irritate nociceptors, causing pain that fires back to the cord and fires the IML even more. At this point in our discussion, we recognize that the nervous system expresses itself in several ways: through the ventral horn cells and muscles and through the IML and the autonomics. This fact provides “windows” for diagnosing functional neurologic deficits.

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Manual muscle testing (MMT) is a valuable diagnostic tool utilized in human neurology, chiropractic and physical therapy as a window to CNS integrity. It is extremely important to recognize that muscle strength is a function of fitness and, most critically, the FOF of the integrated presynaptic influences on ventral horn cells. These are the alpha and gamma motor neurons that fire directly to the muscle and muscle spindle cells, respectively. Increased or decreased frequencies of firing of these ventral horn cells can cause muscle hypertonicity or paresis, increasing the probability of joint instability with breakdown and injury. Restoring an appropriate FOF to these ventral horn cells should be the goal of receptor based targeted therapy. The central integrated state (CIS) of ventral horn cells is influenced by the 10,000 to 12,000 presynaptic neurons that fire to them from many areas of the neuroaxis.

The central integrative state of ventral horn cells is determined by converging pre-synaptic input from suprasegmental and segmental integers.

With this understanding, neurological exam procedures can be utilized with the goal of diagnosing the longitudinal lesion of functional as well as pathological lesions. In animals, direct muscle testing is not an available tool, yet muscle tone palpation, posture and gait provide an indirect method for estimating the likelihood of aberrant firing frequencies of ventral horn cells from a specific longitudinal level

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of the cord or brainstem. For example, cranial cruciate ligament sprain is a common canine injury. A chiropractic neurologic approach would involve evaluating all the muscles that cross the joint. This is based on the knowledge that, to a large degree, the stability of a joint is determined by the FOF of the muscle/tendons that cross the joint. Their FOF is determined by the FOF of the alpha and gamma motor neurons that innervate those individual muscles. It then follows that the FOF of these ventral horn cells depends on the FOF of converging neurons from throughout the nervous system. Where is the problem? This is where a combined cranial nerve exam, postural exam, etc. are viewed in a broader perspective. In other words, using our example, we begin to appreciate that functional lesions, almost anywhere in the nervous system, can influence the central integrative state of ventral horn cells and their muscle end-organs, contributing to stifle instability and injury. The veterinary chiropractic neurologic exam aspires to diagnosing the specific longitudinal level of the functional or pathologic lesion. Through our knowledge of neuroanatomy, we can then implement a plan of therapy that specifically addresses the pool or pools of neurons in question with targeted receptor based therapies. In tandem with more traditional veterinary rehabilitation therapies that address end organ injury, this should lead to quicker recovery and less recidivism. End-organ dysfunction of the autonomic nervous system is more greatly appreciated by veterinarians as coming from anatomical structures far removed from the end organ. As examples, thyroid disease implies involvement of the pituitary, and Cushing’s disease may involve the pituitary or hypothalamus. In this discussion, we expand our view of autonomic function as a consequence of the central integrative state of the intermediate lateral cell column (IML). As in our discussion of the ventral horn cells, we can acknowledge that organs, glands, blood vessels, and other end-organs of the autonomic system are subject to the central integrative state of the IML. The CIS of the IML is a consequence of the thousands of presynaptic integers synapsing on the IML from suprasegmental and segmental pools of neurons. As in evaluating muscle dysfunction, the veterinary chiropractic neurological exam endeavors to locate the presynaptic pool of neurons contributing to localized IML aberrancy and resulting end-organ dysfunction.

THE VETERINARY CHIROPRACTIC NEUROLOGICAL EXAM It is outside the scope of this article to teach the neurological exam. It is assumed that as a veterinarian or animal chiropractor, you have been trained to utilize the tools of the cranial nerve exam, postural exam, reflex testing, withdrawal testing, and gait analysis, and are skilled in their application. I remind you that the neurological exam begins when first seeing the animal. Everything you observe, hear, and touch is important. The chiropractic neurology practitioner sees everything as a clue to a functional or pathologic lesion! The veterinary chiropractic neurological exam considers windows to central nervous system output, ventral horn cells and IML, as opposed to positive and negative neurological testing. For example, in a cranial nerve exam, deficits may imply peripheral or central pathological lesions of the cranial nerve, its nucleus, or surrounding brain tissue. In addition, consider the central integrative state of regional areas of the brain: olfactory nerve (cortex), optic nerve (thalamus), oculomotor and trochlear nerves (mesencephalon), abducens, trigeminal, and facial nerves (pons), vestibulocochlear nerve, (pontomedullary junction), glossopharyngeal, vagus, and hypoglossal nerves (medulla). For segmental evaluation, in addition to pathological peripheral or segmental, consider the consequences of aberrant CIS of specific levels of spinal segments on muscle tone, joint stability, and autonomic tone. This is the veterinary chiropractic neurological exam! It is no different than the classic veterinary neurological exam except that we now appreciate the multimodal influences on neurological function.

fire with a given stimulation of a pre-synaptic pool so that their time to summation will be less. Due to the inefficiency of cellular energetic processes. there will also be an increased probability that the cells will fatigue at a faster rate with a given stimulation. Examining an end-organ’s time to summation and fatiguability can give evidence of TND somewhere in the system. By integrating information from a complete history and examination, an accurate assumption on the longitudinal level of pathology or TND can be determined. From this information, a therapeutic plan can be developed that is aimed at increasing the FOF of the involved neurons when appropriate.

CONSIDERATIONS FOR BROADENING THE USEFULNESS OF THE NEUROLOGICAL EXAM 1

An exam procedure performed in isolation tells you nothing. Only by integrating all aspects of the history and exam can any diagnostic conclusions be reached.

hen performing a test procedure, always compare one W side to the other when appropriate. Is one side firing too much, or is the other side firing too little?

he purpose of each test is to ultimately find the longiT tudinal level of the pathologic or functional lesion.

I t is natural for the chiropractor to think in terms of segmental (spinal) affects on end-organ response. Now consider the effects of central integration on end-organ response.

onsider using receptor challenges as a diagnostic winC dow. For example: does slow stretching a muscle cause a change in your neurological test? Is the change ipsilateral or contralateral? Is the end-organ response inhibited or facilitated? Not only will asking these questions help you localize the level of the lesion, but they may also aid you in choosing the most effective treatment approach.

eep in mind that a test procedure may appear normal K when first applied, but may quickly turn abnormal with repeated application of the test secondary to TND and fatigue.

As we perform our neurological exam, we will be more sensitive and attentive to the subtleties of the patient’s response. Two important factors that are windows into the central integrative state of a neuron or pool of neurons are:

1 Time to summation 2 Fatiguability of end organ response. Neuronal pools that are undergoing trans-neural degeneration will be sitting closer to threshold by the mechanisms described earlier. There’s an increased probability that these neurons will

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Some test results may actually improve with repeated testing secondary to immediate early gene responses, long- term potentiation, and neuroplastic change. ost neurological testing involves a sensory input and a M motor output. In animal patients, it is difficult to quantify sensory loss. In the presence of some motoric response to our testing, we can only say that some aspect of the sensory pathway would have to be intact. In the case of an absent or decreased motoric response to our testing, we don’t know the cause so must consider the following: a. The receptor potential was not of sufficient amplitude to fire the second order neuron. b. Central integration at some level of the neuro-axis caused insufficient facilitation or too much inhibition on the cell bodies of the motor neurons.

FACTORS TO CONSIDER IN A VETERINARY NEUROLOGICAL EXAM

response to testing, so need to consider the following:

a. The receptor potential was of increased amplitude because of an increased environmental input (from the tester), or from an increase in receptor sensitivity (as in nociceptor sensitization and gamma simulation of muscle spindle cells). b. The central integrative state of the central neurons are over-exciting or under-inhibiting the cell bodies of the motor neurons. An understanding and appreciation of the mechanisms described in his paper should lead the veterinary chiropractor to a better understanding of the neurologic significance of correcting mechanical faults in the system in general. Receptorbased therapy directed to specific pools of neurons contributing to joint instability and autonomic dysfunction should be our goal. I hope this article provides some motivation for reviewing neuroanatomy. The more we know, the better questions we can ask.

References Back W, Clayton HM. Equine Locomotion, W.B. Saunders. 2001. Beck RW. Functional Neurology for Practitioners of Manual Therapy, Churchill-Livingstone, 2008.

1 Pathological, functional or both

Binder MD, editor. Progress in Brain Research, Vol.123, Peripheral and Spinal Mechanisms in the Neural Control of Movement. Elselvier, 1999.

2 Peripheral or central

Guyton and Hall Textbook of Medical Physiology, 14th Edition.

3 The longitudinal level of the lesion or lesions

Haines DE, editor. Fundamental Neuroscience for Basic and Clinical Applications, 3rd Edition ChurchillLivingstone, 2006.

a. F or peripheral: i. E nd-organ disease ii. N euromuscular junction disease iii. P eripheral nerve iv. Plexus v. S pinal nerve vi. S pinal rootlets vii. V entral horn b. For central:

i. S pinal cord ii. B rain stem ii. Cerebellar iv. Thalamic v. B asal ganglion vi. C erebral cortex

4 Right or left or bilateral

10 We also don’t know the cause with an increased motoric

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Henneman K. Recognizing Soft Tissue Injuries in the Dog from and Integrative Perspective, Part 1, Innovative Veterinary Care, Vol.8, Issue 4, 2018. Kandel ER, Schwartz JH, Jessell TM, Siegelbaum SA, Hudspeth AJ. Principles of Neural Science, 5th edition, McGraw-Hill. 2013. Latash ML, Zatsiorsky VM. Biomechanics and Motor Control. Elselvier. 2016. Purves D, Augustine GJ, Fitzpatrick D, Hall WC, LaMantia A, McNamara JO, Williams SM. Neuroscience, Sinauer Associates. 2004.

In the news NEW QUESTIONNAIRE EMPOWERS HORSE OWNERS TO IDENTIFY AND MONITOR OSTEOARTHRITIS PAIN

Researchers at the Morris Animal Foundation have introduced a revolutionary questionnaire designed to help horse owners detect and track the signs of osteoarthritis in their equines. Developed by a team of experts, including Dr. Janny de Grauw from The Royal Veterinary College in the United Kingdom, and Dr. Diane Howard, the new assessment tool is modeled after the Brief Pain Inventory — a widely used instrument in human pain evaluation. This innovative approach aims to bridge the gap between owners’ observations and veterinarians’ clinical assessments, ultimately facilitating earlier intervention and more effective treatment. “Horses are another long-lived athletic species, and there is some thought that arthritis studies in horses may also apply to people, so having a similar instrument could help with that research,” said Dr. Howard.

A preliminary trial of the questionnaire, involving 25 owners and caretakers of horses diagnosed with arthritis, has yielded promising results. An overwhelming 88% of participants found the questionnaire to be beneficial, while 84% praised its simplicity and ease of use. One particularly poignant insight from the study highlights a common misconception among horse owners. “Many horse owners blame themselves for their horse’s arthritis or believe it to be a natural occurrence beyond treatment,”explained Dr. Howard. “In general, it’s not the owner’s or trainer’s fault, and once they realize that, they could be more willing to think, ‘Maybe my horse is hurting a bit, and maybe it’s arthritis,’” she continued. “There are currently no ways of curing it, but there are certainly ways of controlling the pain and slowing the progress of the disease.”

The development of this groundbreaking questionnaire represents a significant stride in empowering horse owners to play a more active role in their animals’ healthcare. By facilitating earlier detection and enabling more effective monitoring of osteoarthritis, this initiative has the potential to vastly improve the quality of life for countless equine companions. As the veterinary community eagerly embraces this innovative tool, the future of equine healthcare looks brighter than ever, with a renewed focus on collaborative efforts between owners and practitioners to combat the debilitating effects of osteoarthritis.

www.morrisanimalfoundation.org/article/ Morris-Animal-Foundation-horses-osteoarthritisdetection-tool

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USING DATA AND NEUROIMAGING TO HELP UNDERSTAND THE BRAINS OF ANIMALS BY W. JEAN DODDS, DVM

When it comes to understanding the brain — and its structural, physiological, and behavioral functions — neuroimaging techniques such as magnetic resonance imaging (MRI) and functional MRI (fMRI) play a major role.1,2,3,4 These advances help both veterinary researchers and clinicians understand how different areas of the brain communicate and integrate.7 This article combines data from the brain atlas (see sidebar on page xx) and MRI/fMRI neuroimaging of companion animal species, horses, and pigs,3,4,6,7-9 to help advance our understanding of their brains, and the differences and similarities between them.

EXPLORING THE BRAINS OF DOGS The canine brain is gyrencephalic (having cortical folds), making it more like the human brain than rodent and avian models, which are lissencephalic (without cortical folds).5 Let’s take a closer look at what we’ve learned about the canine brain: a. The role of the cingulate cortex and lateral frontal lobes Resting (task-free) fMRI investigations of brain activity have identified the important role of the cingulate cortex in the evolution of the mammalian brain.

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Combining data from the brain atlas and MRI/ fMRI neuroimaging can help shed light about the brains of companion animals, horses, and pigs.

The cingulate cortex is a bilateral structure located deep within the brain’s cerebral cortex. Over many centuries, its central role and function have been partly taken over by the lateral frontal lobes, which control problem-solving, taskswitching, and include word detection and odor distinction. Therefore, brain areas function in synchrony to form taskspecific networks. It is interesting to note that these networks have a smaller role in dogs than in humans, despite the proportionately larger canine brain. The use of fMRI can help analyze diseases characterized by dysfunctional integration and communication between brain areas. It also can determine which areas of the canine brain are active when the dog reacts to external stimuli. b. T he functional brain Dogs are strongly motivated to learn tasks by mimicking the work of another already trained dog because of the praise they receive.3,4 This is evident during testing. During MRI or fMRI, they can lie still without moving for eight minutes when expecting the petting and treats observed with other dogs. Sounds also are played to study which brain areas are activated by various sounds. But functional brain activities

are irregular and may not follow any anatomical regular boundaries. Parts of the brain act in synchrony to form a functional brain network.4 c. The connection between human and canine brains Aging studies in dogs, like those in humans, have revealed increased framewise displacement (i.e. head motion) within the MRI scanner.3,4 A recent task-free large study involved 33 family trained dogs (1 to 14 years of age, 17 females, 16 males, and various breeds including nine Border Collies, seven Golden Retrievers, five mongrels, two Australian Shepherds, and one each of several other breeds). The older dogs were somewhat less able to maintain their initial position as shown by head displacement. Similar findings are seen in older people, as normal aging results in increased head motion.4

THE BRAIN ATLAS AND ITS CONTRIBUTIONS The brain atlas provides us with a valuable understanding of the relationships between the anatomical structures of the brain. It contains pictures of brain sections from different orientations (three-dimensional space, and coronal, sagittal, and axial planes).5,6,12-14 This gives us the coordinates of relevant brain structures and defines their outlines or volumes.6 Various stereotaxic procedures can then be calculated to identify coordinates for accurately recording or locating lesions in deep brain structures. The functional activity in brain networks across species is achieved by combining the brain atlas with electrophysiological data.5,6 Most of these data have been derived from studies of human, non-human primate, and rodent brains, although studies have also involved domestic livestock and companion animals.1,5,6,10-12,14-15

These family dogs were studied as a population group not bred or reared under laboratory research and testing conditions. They lived in their natural social environments, which provided useful data for awake fMRI assessments.

THE EFFECTS OF HUMAN INTERVENTION ON THE CANINE BRAIN Significant neuroanatomical variation has been documented among a variety of dog breeds based on how they were bred — i.e. for specific tasks such as hunting, herding, guarding, or companionship10 Has this purpose-bred approach altered the gross anatomical organization of the canine brain? The reported variation in the study was distributed nonrandomly across the brain and was plainly visible on stereotactic analysis. Specific regional sub-networks co-varied significantly, and not merely because of variations in total brain or body size, or skull shape. The behavioral specialization selected for within the four functional dog groups (hunting, herding, guarding, companionship) significantly correlated with their anatomy, and most changes occurred in the terminal branches of the phylogenetic tree, indicating a strong recent selection in these individual breeds. Thus, through selective breeding, humans have differentially altered the brains of various lines of domestic dogs.10 Interestingly, the authors indicated that based on their published findings, studies involving domesticated animals should not lump them together as a species but should consider breed types, structure, and function.

WHAT RESEARCH TELLS US ABOUT FELINE BRAINS As brain atrophy increases with aging, studies of older cats documented behavioral changes with more cognitive dysfunction.1 The changes in behavior include excessive vocalization, spatial and/or temporal disorientation, alterations in interactions with owners or other pets, shifts in the sleep-wake cycle, house soiling, changed activity levels, anxiety, and/or learning and memory deficits. Other concurrent disorders include hypertension, hyperthyroidism, pain, and separation anxiety. Atrophy of regional brain structures such as the hippocampus can be viewed with MRI, but the assessment of global atrophy remains difficult, especially because cats are often very stressed during veterinary clinic visits. In humans, global and regional brain abnormalities can be assessed with Voxelbased morphometry (VBM). A study looking at the use of this technology in cats without neurological or behavioral signs (65 cats, aged 17 to 200 months) showed a significant decrease with aging in the gray matter within the brain’s bilateral parietal lobes. The white matter did not show any size reduction, nor was there a significant age-related reduction in inter-thalamic adhesion.1 Aging feline brains have shown neuronal loss and atrophy, amyloid-β deposition, and tau phosphorylation. Amyloid-β IVC Summer 2024

deposition and tau phosphorylation have been seen not only in the brain’s parietal cortex, but also in the para-hippocampal cortex and occipital cortex.1

THE USE OF NEUROIMAGING IN HORSES Large animal veterinary neuroimaging has become increasingly important, especially in the horse.11 Intracranial diseases in horses with neurological signs are now more often studied by MRI.11,12 High magnetic field strengths (3Tesla) are now available in veterinary medicine; images collected with 3Tesla give

TRANSLATIONAL RESEARCH Advances in the fields of neurology and neurosurgery have aided translational neuroscience research. 2,15,16 Studies on dogs have thus enhanced our knowledge of the evolutionary steps that led to the development of primate, and then human, brain function.1,3,4 The domestic canine offers multiple advantages for studying brain function and behavior as compared to the more standard rodent and primate models, so the use of dogs as a model in neurocognitive, aging, and clinical research is growing.5 Ethology is a branch of zoology that studies the behavior of non-human animals. Research in this field has revealed that training can be socially motivated. Dogs are more highly trainable than rodents and non-human primates, and can undergo non-invasive experimental procedures without restraint, including fMRI. In cats, the pathological changes within the parietal lobes are called neurofibrillary tangles, which form thick bundles near the cell surface of affected neurons, and are among the changes seen in humans with Alzheimer’s disease. Cats can be an effective animal model for this disease, as opposed to dogs and monkeys, which apparently do not produce neurofibrillary tangles. Pigs are increasingly used in biomedical research, including neuroscience and neurotransmitter studies, because their brains are like those of humans.8 The subthalamic nucleus of pigs is like that of humans as well as non-human primates, rats, and cats. This nucleus is important for the surgical treatment of advanced Parkinson’s disease, which means the pig could become an alternative model to primates and rats when studying this disorder.

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improved image clarity and detail. However, even with progress in the technical adaptations of scanners and detection coils used in equine medicine, the description of brain morphology in horses has lagged behind that of other species.1 Completed studies have mostly examined the brains of foals. The characteristics of the ungulate (hoofed animal) brain include a readily seen expanded neocortex and intensive gyrification by MRI. Equine gyri and sulci display a more complex pattern than in carnivores and other ungulates, a finding asso-ciated with their increased body mass, and special senses. Sensory information conveyed from the lips is important, and is processed in the cortex surrounding the diagonal gyrus. The nostrils and tongue are represented in the area behind the supra-sylvian sulcus.11,12 The temporal lobe in horses is expanded in such a way that the insular cortex is deeply hidden in the depths of the sylvian and oblique sulcus, and thus is no longer visible from the outer surface The horse is a macrosmatic mammal (highly developed) when it comes to olfactory function. They have a relatively large rhinencephalon and rather small olfactory bulbs. In other ungulates, like the pig and cow, the linkage between these two structures is stronger.11,12 The hippocampus and para-hippocampal gyrus also appear small in relation to the very large rhinencephalon (olfactory brain). The horse’s comparatively underdeveloped efferent system, which carries motor signals away from the brain to the rest of the body, could explain the animal’s minimal motor control of the distal limbs. A characteristic feature of the equine cerebellum is the deviation of the vermis, which controls body posture and locomotion, although the cerebellar shape is characteristic of that seen in ungulates. Some of these published differences may be artefacts.12

THE ANATOMY OF PIG BRAINS IS SIMILAR TO HUMANS The digitalized brain atlas, along with MRI and fMRI, and histological resources have contributed to recent porcine research. The pig brain is large, with cerebral structures common to other mammals, and appears comparable to the human brain in its anatomy, histology, myelination, growth and development, and vascularization (e.g. humans and pigs share a similar cerebrovascular anatomy of the circle of Willis).8 Further, the pig brain more closely resembles that of primates rather than rats in terms of cortical convolutions, shape and number of neocortical neurons.

The pig brain, like that of the human and dog, is gyrencephalic with a folded brain cortical surface and welldefined circumvolutions, while the rat and avian brain are lissencephalic with a smooth-surfaced cerebral cortex.8 The primate brain has a more pronounced curvature of the telencephalon and more developed anterior pole, although the pig brain has a more developed olfactory system that fills a large portion of the anterior brain. The large rostral snout of the pig likely developed for its tactile ability to explore the environment (think searching for truffles).8 Studying the brains of various species through neuroimaging and data related to the brain atlas reveals interesting differences and similarities, and will hopefully lead to beneficial outcomes in the future.

Hamamoto Y, Yu Y, Asada R, Mizuno S, Hasegawa D. Age-related brain atrophy in cats without apparent neurological and behavioral signs using voxel-based morphometry. Front. Vet. Sci. 2022, 9:1071002. doi: 10.3389/ fvets.2022.1071002. 1

Radhakrishnan H, Ubele MF, Krumholz SM, Boaz K, Mefford JL, Jones ED, Meacham B, Smiley J, et al. Tacrolimus protects against age-associated microstructural changes in the beagle brain. J. Neurosci. 2021, 41 (23):5124–5133.doi.org/10.1523/JNEUROSCI.0361-21.2021.

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.

NEUROLOGY AND HOMEOPATHY Any dynamic insult can unbalance the vital force of the human or animal body, leading to symptoms. The nervous system is affected by disorders in other systems, as well as direct injury to nervous tissue by any sort of trauma. According to embryology, nervous tissue develops from primordial skin tissue, and there is a strong tendency for the suppression of psora to manifest as a nervous disorder. For example, a young dog with pyoderma develops epilepsy after the vet “clears up” the skin with suppressive drugs. Psora manifests as a deficiency, or decreased function, so paralysis or muscular weakness are common signs.

Saccà V, Sarica A, Quattrone A, Rocca F, Quattrone A, Novellino F. Aging effect on head motion: a machine learning study on resting state fMRI data. J. Neurosci. Methods 2021, 15;352:109084. doi:10.1016/j.jneumeth. 2021.109084 Epub 2021 Jan 25. PMID: 33508406. 3

Szabó D, Janosov M, Czeibert K, Gácsi M, Kubinyi E. Central nodes of canine functional brain networks are concentrated in the cingulate gyrus. Brain Struct. Funct. 2023, 228:831–843. doi.org/10.1007/s00429-02302625-y. 4

Johnson PJ, Luh W-M, Rivard BC, Graham KL, White A, FitzMaurice M, Loftus JP, Barry EF. Stereotactic cortical atlas of the domestic canine brain. Sci. Rep. 2020, 10:4781. doi.org/10.1038/s41598-020-61665-0. 5

Banstola A, Reynolds JNJ. Mapping sheep to human brain: The need for a sheep brain atlas. Front. Vet. Sci. 2022, 9:961413. doi: 10.3389/fvets.2022.961413. 6

Ella A, Barrière DA, Adriaensen H, Palmer DN, Melzer TR, et al. The development of brain magnetic resonance approaches in large animal models for preclinical research. Animal Front. 2019, 9(3): 44-51. doi: 10.1093/ af/vfz024. 7

Sauleau P, Lapouble E, Val-Laillet D, Malbert C-H. The pig model in brain imaging and neurosurgery. Animal 2009, 3(8):1138–1151. doi:10.1017/S1751731109004649. 8

Buxton DF, Compton RW (1986).The canine brain: Basic atlas for an autotutorial approach to the central nervous system. S.I. 34. 9

Hecht EE, Smaers JB, Dunn WD, Kent M, Preuss TM, Gutman DA. Significant neuroanatomical variation among domestic dog breeds. J. Neurosci. 2019, 39(39):7748-7758. doi.org/10.1523/JNEUROSCI.0303-19.2019.

Vaccination is a major factor in epilepsy (which is usually called idiopathic), and seizures often occur within several months of the last vaccine. However, vaccine damage can be inherited, so symptoms can appear in animals that were never vaccinated. Vaccinosis is a form of sycosis miasm, and antisycotic remedies can help in cases of epilepsy, along with good constitutional prescribing. Major nervous system symptoms to consider for homeopathy include: • Behavior changes • Postural or gait changes • Convulsions/seizures • Decreased muscle function • Decreased or increased sensitivity to all impressions • Altered mental status. Many remedies might be helpful, based on similarity, but following are a few commonly needed for neurologic problems:

Schmidt MJ, Knemeyer C, Heinsen H. Neuroanatomy of the equine brain as revealed by high-field (3Tesla) magneticresonance-imaging. PLoS ONE 2019, 14(4): e0213814. doi.org/10.1371/journal.pone.0213814. 11

Arencibia A, Vazquez JM, Ramirez JA, Ramirez G, Vilar JM, Rivero MA, Alayon S, Gil F. Magnetic resonance imaging of the normal equine brain. Vet. Radiol. 2001, 42(5):405-408. doi.org/10.1111/j.1740-8261.2001. tb00959.x. 12

Kraft SL, Gavin PR, Wendling LR, Reddy VK. Canine brain anatomy on magnetic resonance images. Vet. Radiol. 1989, 30(4): 1740-8261. doi.org/10.1111/j.1740-8261.1989.tb00767.x. 13

Datta R, Lee J, Duda J, Avants BB, Vite CH, et al. A digital atlas of the dog brain. PLoS ONE 2012, 7(12): e52140. doi:10.1371/journal.pone.0052140. 14

Hudson LC, Cauzinille L, Kornegay JN, Tompkins MB. Magnetic resonance imaging of the normal feline brain. Vet. Radiol. 1995, 36(4):267-275. doi.org/10.1111/j.1740-8261.1995.tb00261.x 15

Salazar I. The brain of the dog in section: a comprehensive view for veterinary students. Anatomia, Histologia, Embryologia 2005, 34(S1):44. doi.org/10.1111/j.1439-0264.2005.00669-100.x 16

De Sousa AA, Dames BAR, Graff EC, Mohamedelhassan R, Vassilopoulos T, Charvet CJ. Going beyond established model systems of Alzheimer’s disease: companion animals provide novel insights into the neurobiology of aging. Comm. Biol. Perspective 2023, 6 (655): 1-16. doi.org/10.1038/s42003-023-05034-3 17

Tannenbaum J, Bennett BT. Russell and Burch's 3Rs then and now: the need for clarity in definition and purpose. J. Am. Assoc. Lab. Anim. Sci. 2015, 54(2):120-132. PMID: 25836957; PMCID: PMC4382615. 18

1. Belladonna — nervous signs with hyperthermia/fever; sudden onset; for convulsions or seizures, give during or shortly after an episode (if possible and safe to do so). Animals may become vocal, restless, aggressive, with dilated pupils. 2. Conium — ascending paralysis is a keynote, with more weakness in hindlegs and trembling forelegs; suspected spinal trauma. 3. Hypericum — great remedy for nerve damage, both peripheral and CNS; more pain than weakness is present, and is worse with motion; good for post-op pain; use with Arnica for injuries, and with Ledum for puncture wounds or bites. 4. Lachesis — seizures that begin while sleeping; history of symptoms starting after rabies vaccination; increased aggression and barking. Find a homeopathic vet at theAVH.org.

Submitted by Todd Cooney, DVM, CVH IVC Summer 2024

HERBAL APPROACHES

TO THE EQUINE COUGH BY CINDY LANKENAU, DVM, RH (AHG), MS (TCVM)

Whether an equine has a simple cough, or a serious chronic disease of which the cough is a symptom, certain herbs can help either cure or alleviate the problem.

The equine cough may be a simple symptom to deal with — or it may reflect deep and entrenched chronic disease. A horse can develop a simple cough in response to an invading pathogen (i.e. bacteria, virus, fungi, dust), but is very susceptible to retaining that pathogenic material. This can result in severe and complicated chronic disease, of which the cough is a symptom, such as chronic obstructive pulmonary disease (COPD). Either way, easily-obtained herbal medicines can either cure a horse’s cough, or help alleviate the symptom as part of a more complex treatment plan. This article will focus on the principle or leading herbs that can give symptom relief from an equine cough.

CONSIDERATIONS WHEN USING HERBS FOR A COUGH IN HORSES • In general, the main leading herb will have the highest proportion in a formula, with the assisting herbs present in a lower percentage. A typical formula would address

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the specific energetics of the individual horse (see sidebar on page 49), with an expectorant, antispasmodic effect to relax the spasms of the cough. • The approach utilized by some Western herbalists is to use herbs based on their pharmacologic effects — that is, expectorant, anti-spasmodic, diaphoretic, or mucolytic. This approach is effective, but the practitioner still needs to pay attention to the temperature effects of the herb. Cold herbs must be balanced with a warming herb if the horse is cold. Likewise, if the animal is showing signs of a heat excess, one must use great caution with hot or warming herbs. • A quick note about dosing: in general, an adult 1,000pound horse requires only two to three times the human dose of a formula, usually 1-2 tbsp of a ground dried herb, or 80 drops of a tincture. Most horses love the taste of herbs and readily eat them in a bran mash. They can also be mixed with some applesauce. In an acute critical situation, higher doses, such as triple the regular dose, are

often needed in the short term. Care must be taken with any drop dose herbs when formulating a prescription. In other words, botanical medicines are powerful and should never be used without a firm foundation of knowledge.

IS THE HORSE’S COUGH WET OR DRY? The first differentiation is if the cough is wet or dry. A wet cough sounds heavy and rattly. The horse is expectorating mucus and is seen to be swallowing after coughing. The tongue is wet, probably swollen, with teeth imprints on its edge. The pulse could be full and “slippery”. A dry cough, conversely, would be deep and harsh. There is no excessive moisture in the mouth, and the tongue would be dry, often with cracks. If heat is present, the pulse will be fast; if the animal is more “cold”, the pulse will be deep and slow. A dry disease state has a dry tongue, while a wet disease would have a wet tongue.

Herbs for the dry cough From a Western pharmacological view, if the cough is dry, one would look for herbal medicines with expectorate, mucolytic, and mucus membrane protectant effects. While the horse’s tongue would be dry, it could be either pale or red. If red, there is heat trapped in the body and a cooling herb is indicated. Conversely, if the tongue is pale, a more warming herb is indicated. ullein leaf (Verbascum thapsus) is one of the most 1. Mversatile herbs for dry coughs. It is slightly cool to neu-

tral, so can be used in cold or hot conditions. Mullein is considered high in mineral salts and releases a salty mucilage, which is very helpful for dry coughs, especially when the horse is unable to expectorate “stuck phlegm”. This mucilage acts as an emollient to bring water into hardened, closed places, such as dried-out tissues, causing the release of secretions from those tissues. Mullein is indicated when tissues are dry or when water is caught in isolated pockets. It is particularly useful for dry, irritable, tickly coughs. It opens the lungs, reduces coughing and tightness, lubricates the mucosa, relaxes the larynx, opens the sinuses, and causes a more open feeling in the head and brain.

THE ENERGETIC DIAGNOSIS When developing an herbal strategy for any condition, an energetic diagnosis is first needed so you can fine-tune your prescription for the specific equine. The energetic state of a horse can be determined by symptoms, tongue appearance (i.e. color, moisture, or cracks), and pulse quality. With a cough, the most common pattern diagnosis would be hot or cold; wet or damp; if the disease has progressed deeper into the body or is an excessive or deficient condition. The herbal prescription is used to balance this state of disharmony. The clinician needs to use a principal herb for the leading action (i.e. hot or cold, damp or dry, antibacterial, antiviral, antiinflammatory, expectorant, diaphoretic). Along with this are supporting and assisting herbs (i.e. to clear wind, move Qi, antispasmodic, antiasthma) that can treat secondary patterns and act as harmonizers (e.g. Licorice, Glycyrrhiza uralensis) and envoys (e.g. Playtocodon, Platycodon grandiflorum). Chinese Medicine will often include a suspected etiology. If the horse was out in cold, windy conditions and developed a cough, your diagnosis would be an invasion of wind/damp or wind/cold. Specific formulas are used for treating an invaded pathogen with relation to the depth of the disease invasion, whether it’s a superficial infection in the Tai Yang layer, or has gone deeper into the lungs (a Shao Yin invasion).

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Mullein has a mild analgesic, antibacterial, anti-inflammatory, antispasmodic, and expectorant pharmacologic effect. It is a soothing expectorant useful for irritative coughs, upper respiratory tract congestion, and laryngitis. It can also be used as part of a formula for more severe respiratory illness, such as bronchitis and asthma. The fresh leaves decocted in milk were used in England and Ireland as a folk remedy for treating or preventing tuberculosis. Mullein also has an influence on the nerves and mind. It is a great painkiller and helps induce sleep. It has a calming effect on all inflamed and irritated nerves, which is why it works so well for controlling coughs, cramps, and spasms. It can loosen mucus and move it out of the body. Mullein is valuable for all lung problems because it nourishes as well as strengthens. This herb has a long history of use, as reported in the 1800s: “Husbandmen of Kent do give it their cattle against the cough of the lungs.”

root (Althaea officinalis) is another very 2. Marshmallow effective botanical medicine for dry coughs. It has a long traditional use as an emollient, and is specific for hot, dry inflamed mucous membrane tissues in the throat.

3. Horehound (Marrubium vulgar) has long been used as a

respiratory remedy. Because it is energetically almost neutral, it can be used in hot or cold, dry or damp lung conditions. It is especially indicated for non-productive coughs with a feeling of constriction in the chest due to bronchitis or damp asthma. It can also be used for upper respiratory conditions, bronchiectasis (for enhancing fluid drainage), laryngitis, post-nasal drip, and pneumonia. Culpeper, a 1600s herbalist, stated that horehound is helpful for those who are short of breath, asthmatic, or have a cough, to clear cold “rheums” from the lungs of older people, and to expectorate tough phlegm from the chest.

Herbs for the wet cough A wet cough is softer and moist, and a nasal discharge is seen. A white or clear nasal discharge is classified as cold, while a yellow or green discharge is classified as hot. A horse with a hot condition has a faster pulse with a reddish tongue; a cold pulse is slower.

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The tongue of a damp horse would be swollen with lots of moisture in the mouth. The main herb needs to be warming and act as a stimulant to move and resolve the damp accumulation. (Zingiber officinale) can assist in treating a 1. Ginger damp/cold cough. Dried ginger warms the center and

expels cold, as it is a warming circulatory stimulant. It is also an expectorant for cold/damp lung conditions (profuse clear or white mucus). Ginger works synergistically with cinnamon, thyme, and/or citrus peel.

(Gui zhi) is a diaphoretic and circulatory 2. Cinnamon tonic. It is warm, dry, sweet and pungent, and is specific for wind/damp or wind/cold conditions.

(Thymus vulgaris) is classified as antitussive, 3. Thyme expectorant, alterative and immunoregulatory, with anti-

microbial, antispasmodic, antioxidant, antiallergic, antiinflammatory, and anti-catarrhal effects. It also acts as a carminative digestive tonic. This herb has been used for thousands of years.“Thymos” means “strength” in Greek. Dioscorides, a Greek physician in the first century AD, stated that thyme “expels dampness, expels viscous phlegm from the chest and helps difficult breathing and wheezing; and expels ‘worms.’” It is suited for cold, inactive conditions, where there are chills, putrefaction, with stagnant stuck mucus. Hildegard von Bingen stated that thyme’s heat and strength carries off the putrid matter caused by ailments, and will diminish rotten matter and bad humors. Thyme is a dry herb, with both a hot and warm-cool temperature. While it is very warming and stimulating, it does exert a slightly cooling effect as it moves blood, which means it can be used for horses with a sub-normal to slightly elevated temperature, though not those with high fevers. Thyme is an aromatic, acrid, and slightly bitter herb high in phenolic monoterpenoids with a strong antibacterial/antifungal effect. It is among the herbs that are very effective against mycoplasma infections. Thyme leaf stimulates immunity and has a broncholytic and secretomotor agent. It doubles the rate of ciliary clearance.

leaf (Eucalyptus globulus) works synergis4. Eucalyptus tically with thyme. It has expectorant, antitussive, anti-

microbial, antispasmodic, and antibacterial effects along with a bronchodilating sedative action. Eucalyptus leaf treats stagnant, depressed, and constricted tissue.

peel (Citrus aurantium) is a useful expectorant 5. Citrus and flavoring agent in cough syrups. It is a warming

antibacterial, and most effective for cold/damp coughs. Citrus peel also has the ability to decrease pathogenic biofilms. Biofilms can prevent the body’s immune system from fully expelling pathogenic material, thereby setting the stage for the development of deeper pathologic conditions.

ADDITIONAL HERBS FOR EQUINE COUGHS • When dealing with a “hot” condition, cooling to cold herbs with strong antimicrobial effects are needed. Honeysuckle, Jin Yin Hua (Lonicera japonica) is an analgesic, antibacterial, antifungal, anti-inflammatory, antioxidant, antiviral, diaphoretic, diuretic, expectorant febrifuge that clears blood heat, fire poison, pathogenic fire and/or wind/heat. In China, the barefoot doctors used a combination of Lonicera and Chinese Coptis as a pill. This antibiotic-like medicine was known as poor man’s penicillin. • When a cough is the leading presenting symptom, antispasmodic (clear wind) herbs are of prime importance. Khella seed (Ammi visnaga) is cold, slightly drying, bitter, acrid, and dispersing. It is a leading respiratory spasmolytic, and can prevent bronchial asthma attacks. Khella seed calms liver wind, acting as an antispasmodic. • Elecampane root (Inula helenium) is a superb respiratory remedy for ticklish, persistent coughs with pain in the ribs and chest.

Following is a preparation of wild cherry bark syrup from the 1890 7th U. S. Pharmacopoeia: “Wild Cherry, in No. 20 powder, one hundred and fifty grams; sugar, seven hundred grams; glycerin, one hundred and fifty cubic centimeters; water, a sufficient quantity to make one thousand cubic centimeters. Mix the glycerin with three hundred (300) cubic centimeters of water. Moisten the Wild Cherry with a sufficient quantity of the liquid, and macerate for 24 hours in a closed vessel; then pack it firmly in a cylindrical percolator and pour on the remainder of the menstruum. When the liquid has disappeared from the surface, follow it by water, until the percolate measures 450 cubic centimeters. Dissolve the sugar in the percolate by agitation, without heat, strain and pass enough water through the strainer to make the product measure 1,000 cubic centimeters. Mix thoroughly.” • A final thought for a post Strep equi. infection cough that might be due to a deeper abscess: if this is suspected, one very useful herb to use in your formula is Japanese Knotweed root (Fallopia japonica). It is very high in resveratrol and specific for abscesses of internal organs and coughs with yellow phlegm. These are just a few herbal medicines that can not only help resolve equine coughs but, more importantly, address the root cause of the cough. It is important to use sustainably grown herbs from reputable growers. For further information, contact United Plant Savers (unitedplantsavers.org) and the VBMA (vbma.org).

References Bensky D, Barolet R. Chinese Herbal Medicine, Formulas & Strategies; United States; 1992. Chen J and T, Beebe S, Salewski M. Chinese Herbal Formulas for Veterinarians; Art of Medical Press; City of Industry; 2012 Fruehauf, Heiner. Lecture on Gu Syndrome; Daoist Arts College, Oct 10, 2020. Liu G. Warm Pathogen Diseases: Clinical Guide, Seattle, Eastland Press, 2005, pp 3-37, 261-263 Ni M. The Yellow Emperor’s Classic of Medicine, Boston, MA, Shambhala, 1995.

• Wild cherry bark (Prunus virginiana, P. serotina) has a long history of use as a cough suppressant. It is specific for spasmodic hacking coughs with excess mucus and dyspnea. The Eclectics felt it was most effective for chronic respiratory irritation accompanied by a feeble but rapid pulse. The fresh bark, twigs, and leaves of the cherry tree contain cyanide; dry the bark thoroughly before using it.

Winston, David. Two year Professional Herbal Class, 2018-2020. Wood, Matthew. The Earthwise Herbal: A complete Guide to Old World Medicinal Plants, North Atlantic Books, 2008.

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ACUPUNCTURE FOR NERVOUS SYSTEM DISORDERS IN VETERINARY PATIENTS BY NARDA G. ROBINSON, DO, DVM, MS, CRPM, FAAMA

Acupuncture has been shown to effectively improve neurologic disorders in veterinary patients in ways more “conventional” medical approaches cannot.

Can acupuncture help veterinary patients with paralysis from disc disease, peripheral nerve injury, and even incontinence? Often, yes! Some of the most rewarding outcomes in veterinary acupuncture result from treating animals who have lost the ability to stand or bear weight on a limb. Examples include dogs paralyzed in the hind end from intervertebral disc disease (IVDD) or traumatic injury to the spinal cord,1 and horses with radial nerve injury2. Any of these conditions could lead to euthanasia if the individuals are unable to recover, so an effective and safe integrative medical approach such as acupuncture can be key to keeping them alive and restoring functional mobility.3

WHERE’S THE SCIENCE BEHIND ACUPUNCTURE? Acupuncture has the most well-researched substantiation of any integrative therapy approach. Consequently, we no longer need to guess at how it works or attribute its actions to mythical, mystical processes. For example, acupuncture reduces hyperactivity in the sympathetic, or fight-or-flight, portion of the nervous system. This leads to less anxiety, inflammation, and cardiovascular arousal, and paves the way for a calmer, recuperative inner state. Alternatively, when nerves fail to fire sufficiently, as in the case of CNS or peripheral nerve injury, acupuncture can induce changes that encourage neural pathways to heal and participate more fully in neural networks that control whole-body function. Acupuncture also controls pain, which for nervous system problems may arise from impaired circulation, damage to nerves in the CNS or the periphery (e.g. the limbs), or from compression of nerve branches due to constrictive soft tissues.4 For these conditions, medications may fail to control pain or adequately resolve the issue, whereas acupuncture

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may be able to.5,6 Furthermore, acupuncture reduces inflammation,7 facilitates tissue repair,8-10 improves circulation,11 and strengthens the patient’s overall health.12

DOES ACUPUNCTURE NEED TO INVOLVE NEEDLING? Creating a relaxing and comfortable atmosphere and treatment technique is paramount to producing a fear-free, comforting session. As such, needle number, gauge, location, depth, and method of stimulation depend on the patient. The canine patient shown in Figure 1 is relaxing during his acupuncture treatment for neck tension. Ideally, acupuncture patients require little to no restraint during treatment and are allowed to rest in a recumbent position on a soft and padded surface. Sometimes, veterinary patients tolerate only a few extremely thin needles. In cases where they are just too sensitive, the practitioner can substitute acupressure or laser to activate the points. Figure 1

Several acupuncture needles in the dorsal cervical region address neck pain and tension in this Corgi, who dozed comfortably during the session.

WHAT IS ELECTROACUPUNCTURE ABOUT? Electroacupuncture (EA), depicted in Figure 2, enhances the effects of needling through a variety of mechanisms. EA blocks pain by modifying the release of various bioactive chemicals in the central, peripheral, and autonomic nervous systems. It accentuates the release of opioidergic neurotransmitters in the periphery; these, in turn, desensitize peripheral nociceptors and reduce levels of pro-inflammatory cytokines in both peripheral nerves and the spinal cord. Other neurotransmitters involved in EA-induced analgesia include norepinephrine and serotonin as well as the endogenous cannabinoid, anandamide.

Figure 2

WHAT WOULD AN ACUPUNCTURE TREATMENT LOOK LIKE FOR A DOG WITH DISC DISEASE? Figure 3 describes an anatomically based treatment protocol for a dog with hind limb paralysis from TL IVDD. It includes acupuncture points in the paraspinal region that would assist with recovery of compromised spinal cord segments and aid in protecting and regaining neuromotor function. Adding the acupuncture point Stomach 36 (ST 36) at the motor point of the cranial tibialis muscle fosters the promulgation of signals that participate in long-loop reflexes from the crus to the nucleus tractus solitarius (NTS) in the brainstem. The NTS cross-talks with the dorsal motor nucleus of the vagus nerve; in so doing, it supports parasympathetic function. This assists with immune system and digestive autoregulation. The point protocol includes patient-specific sites where the practitioner identifies myofascial dysfunction, typically denoted as “local” points on the record. Figure 3

As with “dry needling”, dogs receiving gentle electroacupuncture treatment should be able to rest in a comfortable position with minimal or no restraint. This image shows the veterinary acupuncturist adjusting levels on an electroacupuncture device. The alligator clips are attached to local points addressing lumbosacral dysfunction and elbow pain.

EA has notable anti-inflammatory effects. It induces the release of endogenous opioids from macrophages and monocytes, lymphocytes, and granulocytes in inflamed tissue. EA may also enhance the migration of opioid-containing cells to an inflamed region, elevating the local concentration of opioids. These substances then activate receptors in peripheral nerve terminals to suppress nociceptive signaling. Moreover, EA elevates the amount of endocannabinoid receptors (CB2) in immune cells as well as the endocannabinoid ligand, anandamide, in inflamed tissue. For tissue regeneration, EA enhances endogenous stem cell proliferation and differentiation, adding to the beneficial effects of mesenchymal stem cell administration.

This diagram shows typical acupuncture needle placement for a dog with thoracolumbar intervertebral disk disease (TL IVDD). Points in the thoracolumbar region address the injured spinal cord segment and related soft tissues. Points on the pelvic limb (ST 34, ST 36, BL 60, and Bafeng) activate peripheral nerves to address paraparesis or paraplegia. The point just distal to the stifle (ST 36) serves as a parasympathomimetic point to restore balance in the autonomic nervous system. Local points in the neck would alleviate tension in the myofascia that may accrue secondary to biomechanical disarray and weight-shifting.

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NEUROLOGIC CONDITIONS ARE A “NATURAL” FOR ACUPUNCTURE Acupuncture works, in large part, through the nervous system. Stimulating acupuncture points by needling or other means initiates action potentials that begin at or near the point and ultimately travel to the spinal cord and brain (together, these structures comprise the central nervous system or CNS). This then allows the outgoing signals to reconnect with parts of the body that had essentially gone “off-line”. Normalizing nerve function has other benefits, too. For example, the interruption of neural signaling between pelvic organs and the CNS may lead to urinary or fecal incontinence, as sometimes occurs with IVDD or problems in the lumbosacral region. Acupuncture treatment based on a neuroanatomic approach promotes communication between the brain and pelvic sphincters to relay information about the “need to go” or the “need to wait,” and activates local functions accordingly.

A LOOK AT LASER ACUPUNCTURE Laser acupuncture combines the analgesic, neuromodulatory, tissue-supporting, and circulation-increasing effects of laser therapy with the multi-point paradigm of acupuncture. Frequently, acupuncturists include multiple acupoint stimulation techniques in a single session. That is, they may needle sites that require more of a mechanical engagement with the tissue, and apply photonic stimulation in areas too sensitive to needle. Following a session, they may perform medical massage over the entire patient or preferentially at the regions receiving other forms of activation. This not only soothes the patient, but provides an opportunity for the practitioner to re-assess the status of the myofascia and provide any last-minute treatment deemed necessary before the session ends.

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CLINICAL RESEARCH ON ACUPUNCTURE A growing number of publications detail the mechanisms of acupuncture and summarize scientific evidence of its effectiveness for neurologic problems. With reference to IVDD specifically, studies involving acupuncture, electroacupuncture, and aquapuncture highlight the effectiveness of this modality in restoring function and providing pain relief.13-19 For dogs with thoracolumbar disc disease, acupuncture has a strong track record, making the case for its inclusion in the routine approach to this relatively common condition. Recent research has further elucidated acupuncture’s underlying mechanism of action for fostering nerve repair via nervous system remodeling. Acupuncture encourages neural regeneration and axonal sprouting by activating the retrograde transport of neurotrophins. Nerve growth factor, brain-derived neurotrophic factor, glial cell-derived neurotrophic factor, N-cadherin, and microRNAs represent some of the most significant substances affected by acupuncture. To quote a recent study: “Acupuncture not only reverses the poor remodeling of the nervous system (in response to injury) but also stimulates the release of neurotrophic substances such as nerve growth factors in the nervous system to ameliorate pain and promote the regeneration and repair of nerve fibers. In conclusion, the neurologic remodeling at the peripheral and central levels in the process of acupuncture treatment accelerates nerve regeneration and repair. These findings provide novel insights enabling the clinical application of acupuncture in the treatment of PNI (peripheral nerve injury).” 20

CONCLUSION Acupuncture effectively improves a gamut of neurologic disorders in veterinary patients, and in ways more “conventional” medical approaches simply cannot. Mounting evidence for its use, along with clear, scientifically-based mechanisms of action, qualify acupuncture as a first-line consideration early in the treatment process to optimize outcomes and maximize the chances of full recovery.

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

ESSENTIAL OILS TO HELP OFFSET NEURODEGENERATION IN DOGS

CuraCore VET YouTube Channel. Successful Treatment of Intervertebral Disk Disease in a 3-Year-Old Dachshund with Acupuncture. Accessed on May 28, 2024 at www.youtube.com/watch?v=tvlp3EFuZn4. 1

CuraCore VET YouTube Channel. CuraCore VET Case Report: Medical Acupuncture for Radial Nerve Injury in an 8-Week-Old Filly. Accessed on May 28, 2024 at www.youtube.com/watch?v=lZ4Fo2PYcx0. 2

Frank LR, Roynard PFP. Veterinary neurologic rehabilitation: The rationale for a comprehensive approach, Top Companion Anim Med 33(2):49-57, 2018. 3

Huntingford JL, Petty MC. Evidence-based application of acupuncture for pain management in companion animal medicine, Vet Sci. 2022,9,252. https://doi.org/ 10.3390/vetsci9060252. 4

Dewey CW, Xie H. The scientific basis of acupuncture for veterinary pain management: a review based on relevant literatures from the last two decades, Open Veterinary Journal 11(2):203-209, 2021. 5

Dunning J, Butts R, Mourad F, et al. Dry needling: a literature review with implications for clinical practice guidelines, Physical Therapy Reviews 19(4):252-265, 2014.

Canine neurodegenerative disorders include conditions such as canine cognitive dysfunction (CCD), degenerative myelopathy, idiopathic epilepsy, and encephalomyelitis, to name a few of the more common syndromes. It is estimated that 14% to 35% of dogs eight years or older will develop CCD, with dogs aged 15 and older having a 68% chance of exhibiting symptoms.1

Oh J-E, Kim S-M, Anti-inflammatory effects of acupuncture at ST36 point: a literature review in animal studies, Front Immunol 12:813748. doi: 10.3389/fimmu.2021.813748. 7

Dubrovsky G, Ha D, Thomas A-L, et al. Electroacupuncture to increase neuronal stem cell growth. Med Acupunct. 2020;32(1):16-23. 8

Deng Q, Ma L, Yang Y, et al. Effect of electroacupuncture stimulation on proliferation and differentiation of endogenous neural stem cells in rats with spinal cord injury, Mol Neurobiol. 2023 Aug 31. doi: 10.1007/s12035-023-03577-4. Online ahead of print. 9

Chen Y, Pan Z, Meng F, et al. Magnetic resonance imaging assessment of the therapeutic effect of combined electroacupuncture and stem cells in acute peripheral nerve injury, Front Cell Neurosci. Volume 16 - 2022 | https://doi.org/10.3389/fncel.2022.1065557. 10

Kubo K, Yasuda A, Yajima H, et al. Effects of acupuncture and acupressure of the acupoint compared to the tendon on the blood circulation of human tendon in vivo, European Journal of Applied Physiology 124:269-279, 2024. 11

Birch S. Treating the patient not the symptoms: Acupuncture to improve overall health — evidence, acceptance and strategies, Integr Med Res 8(1):33-41, 2019. 12

Hayashi AM, Matera JM, Pinto ACBdC. Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disk disease in dogs, J Am Vet Med Assoc 231(6):913-918, 2007. 13

Joaquim JG, Luna SP, Brondani J, et al. Comparison of decompressive surgery, electroacupuncture, and decompressive surgery followed by electroacupuncture for the treatment of dogs with intervertebral disk disease with long-standing neurologic deficits, J Am Vet Med Assoc 236(11):1225-1229, 2010. 14

Laim A, Jaggy A, Forterre F, et al: Effects of adjunct electroacupuncture on severity of postoperative pain in dogs undergoing hemilaminectomy because of acute thoracolumbar intervertebral disk disease, J Am Vet Med Assoc 234(9):1141-1146, 2009. 15

Sawamura M, Arai T, Kawasum K. Effect of acupuncture on the energy metabolism of dogs with intervertebral disk disease and cervical disk herniation: A pilot study, Veterinary Research Communications 47:879-884, 2023. 16

Sedlacek J, Rychel J, Giuffrida M, et al. Nonsurgical rehabilitation in Dachshunds with T3-L3 myelopathy: Prognosis and rates of recurrence, Front Vet Sci 2022 Jul 19;9:934789. doi: 10.3389/fvets.2022.934789. eCollection 2022. 17

Sumida JM, Matera JM, Hayashi AM. Randomized single-blinded prospective comparison between ozone therapy and electroacupuncture for canine thoracolumbar disk disease, Res Vet Sci 161: 173-179, 2023.

Essential oils, due to their minute molecular size, can pass through the blood-brain barrier, which many pharmaceutical agents cannot. Therapeutic-grade essential oils such as rosemary have pharmacological effects, including antioxidant, metal chelation, and anti-inflammatory properties.2 Essential oils that are high in sesquiterpenes, such as cedarwood, black pepper, blue cypress, ginger, myrrh, patchouli, sandalwood, spikenard and vetiver, act as powerful antiinflammatory and antimicrobial agents. Sesquiterpene-rich essential oils are also known for their calming and soothing properties. Dogs and cats suffering from nervous system dysfunction can benefit from essential oils administered via direct inhalation, or through diffusion using a water-based diffuser. Topical application can also be performed, although discretion is advised with feline patients due to their affinity for self-grooming and inadvertent ingestion of the oils. Direct inhalation is non-invasive, and allows molecules of the essential oils to be delivered within seconds to the limbic area of the brain, giving the practitioner a rapid, effective therapy for a patient needing urgent care. VMAA.vet

Tsai LC, Lin YW, Hsieh CL. Effects of bee venom injections at acupoints on neurologic dysfunction induced by thoracolumbar intervertebral disc disorders in canines: A randomized controlled prospective study, Biomed Res Int 2015; 2015:363801. doi: 10.1155/2015/363801. 19

Yang UY, Rao C, Yin T, et al. Application and underlying mechanism of acupuncture for the nerve repair after peripheral nerve injury: remodeling of nerve system. Frontiers in Cellular Neuroscience. October 2023, 17.1253438. 20

Colorado State University. Could treatment for doggie dementia yield clues for Alzheimer’s disease in humans? CSU clinical trial aims to find out. SOURCE Contributor. Feb.24, 2022. https://cvmbs.source.colostate.edu/could-treatment-for-doggie-dementia-yield-clues-foralzheimers-disease-in-humans-csu-clinical-trial-aims-to-find-out/#:~:text. 1

NIH. National Library of Medicine. 2016: 2680409. Journal List Evid Based Complement Alternat Med v.2016; 2016 PMC4749867. 2

Submitted by Barbara A. Fox, DVM

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Natural calming “releaf” CBD is a cannabinoid found in the hemp plant. When it enters a mammal’s body, it activates a system called the endocannabinoid system (ECS), triggering receptors from the nervous system to the digestive system and activating the self-healing process. Stress Releaf 300 CBD Oil from Pet Releaf is made from organic full-spectrum hemp extract to help reduce stress and promote calmness in dogs and cats. Great for vet visits, and helps with noise phobias, separation anxiety and more. www.petreleaf.com/collections/calming

Skin cream with nanosilver As far back as ancient Greece, silver was used to treat stomach aches and wounds. It was largely swept aside by the advent of antibiotics in the 20th century, but a small group of researchers in California continued studying silver’s medicinal potential. After decades of research into nanosilver, the result is ClearFur Skin Cream for pets. This potent blend combines silver's unique properties with carefully selected plants, to gently and safely soothe problems such as itchy, dry, inflamed, irritated skin and open wounds. www.clearfur.co

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In the news

GROUNDBREAKING RESEARCH OFFERS NEW APPROACH TO CANCER TREATMENT IN VETERINARY PATIENTS In a major scientific breakthrough, researchers at the University of Guelph’s Ontario Veterinary College (OVC) have uncovered a novel strategy to enhance the body’s immune response against cancer. This discovery offers hope for safer and more effective cancer treatments for our canine and feline patients. Led by Dr. Sam Workenhe, a professor in OVC’s Department of Pathobiology, the study focused on a unique form of cell death known as pyroptosis. Unlike the more commonly studied apoptosis, pyroptosis has been shown to elicit a potent immune response, prompting the body’s defense mechanisms to recognize and attack cancer cells. “Killing tumors is the ultimate goal of radiation and chemotherapy, but these traditional cancer treatments are not 100% effective,” explained Dr. Workenhe. “Our research suggests that harnessing the power of pyroptosis may be the key to unlocking a more robust and sustained immune response against even the most resistant forms of cancer.” In their experiments, the researchers developed two genetic models to induce different types of cell death in tumors. While apoptosis, a non-inflammatory form of cell death, did not significantly

impact tumor growth or survival, the team found that triggering pyroptosis in cancer cells led to a remarkable slowing of tumor progression and prolonged survival in the animal models. The reason for this stark difference lies in the unique properties of pyroptosis. This “explosive” form of cell death not only releases pro-inflammatory signals but also activates dendritic cells, a critical component of the immune system. These dendritic cells then go on to “educate” the body’s cytotoxic T cells, equipping them with the necessary information to recognize and eliminate cancer cells. “Dendritic cells have a fascinating ability to engage T cells in fighting cancer,” said Jordon Inkol, a PhD candidate and the study’s first author. “By stimulating pyroptosis in the tumor, we’re able to harness this powerful immune-activating mechanism and direct it towards the cancer cells.” The implications of this research are particularly exciting for veterinary oncologists, as it offers a potential solution to the challenge of treatment-resistant cancers in our animal patients. Tumors such as those found in brain and pancreatic cancer are often refractory to conventional immunotherapies, but may respond better to

therapies that leverage the body’s own defense systems through the induction of pyroptosis. “Our aim is that by activating this kind of cell death in brain and pancreatic cancer cells, we can perhaps recruit the body’s immune cells to fight these tumors,” said Dr. Workenhe. “Many cancers are skilled at evading the immune system, but by restoring the pyroptosis pathway, we may be able to overcome this barrier and develop more effective treatments.” As the research team continues to explore the mechanisms behind pyroptosismediated immune activation, they are also investigating ways to stimulate tumor pyroptosis without causing unwanted inflammation in healthy tissues. This delicate balance will be crucial in translating these findings into safe and reliable cancer therapies for our veterinary patients. “This groundbreaking work at the University of Guelph presents a novel and promising approach to cancer treatment,” concluded Dr. Workenhe. “We are excited to see how this research can be further developed and applied in the veterinary field, offering new hope for our furry companions fighting this devastating disease.” https://ovc.uoguelph.ca/news/node/3062

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