Integrative veterinary care
Laser therapy What’s the buzz? Page10
Profile Dr. Steve Marsden: Meet an award-
tech talk
PREMIERE ISSUE 2011
www.IVCJournal.com
winning veterinarian with a passion for the integrative approach.
Introduction To Reiki: Find out how you can use it to support the animals you care for.
Market Trends Team Effort: 10 tips for building
WHAT’ S NEW Equine veterinarians notice a
Nutrition News Food Labels 101: Making
Horse sense Equine Nutrition: Packing a few
a strong relationship with clients.
sense of ingredient lists on pet food packaging.
drop in patients due to economic challenges being imposed on the horse racing industry.
pounds on an underweight “hard keeper” is easier than you may think. integrative veterinary care
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contents FEATURES
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Class IV laser therapy
It’s the hot technology for 2011 and veterinary medicine is buzzing about it.
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Integrative practice The road to integrative healing
Why a renowned veterinarian changed his definition of healing and began incorporating alternative therapies into his practice.
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Nutrition nook Food labels 101
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Making sense of ingredient lists on pet food packaging.
Back to school Put a pin in it!
What acupuncture can and cannot do.
Antioxidants for ocular health
How these nutrients are proving beneficial for genetic eye disease.
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Tech talk Introduction to Reiki
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Evidence-based medicine for animal supplements – part 1
This safe and effective energetic healing modality is backed up by promising preliminary research. Find out how you can use it to support the animals you care for.
Where is the clinical evidence demonstrating that animal supplements are safe and effective? Here’s a review of the evidence that’s currently available, and the limitations facing the industry.
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Equine nutrition On the skinny side
Once you’ve ruled out health problems, packing a few pounds on an underweight “hard keeper” is easier than you may think.
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Profile Dr. Steve Marsden
Meet an award-winning Canadian veterinarian with a passion for the integrative approach.
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Market trends Team effort
Ten tips for building a strong relationship with clients.
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integrative veterinary care
Integrative research
Testing alternative treatment options for osteoarthritis.
Columns & departments
6 Editorial 8 What’ s new? 27 Industry innovations
Completing Your Approach to Pet Care As the benefits of integrative products are recognized, the need for pet-specific formulations increases. Resources™ is a line of natural supplements specifically developed to support the health and wellness of pets.
37 Veterinary resource guide 42 Events 43 Marketplace
26 uniquely formulated products for dogs and cats Affordable for your clients, profitable for your practice Formulas developed by Ihor Basko, DVM All products provide a synergistic blend of natural ingredients NASC Quality Audited Educational materials and clinical support available Sold exclusively to licensed practicing veterinarians
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feature modality
Class IV laser therapy – the hot technology of 2011
by John C. Godbold, Jr., DVM eterinary medicine is buzzing about the success of Class IV therapy lasers. Over 3,000 practices report clinical and economic success with a technology that was unheard of five years ago. Laser therapy uses electromagnetic energy interacting chemically and biologically with tissue to produce “photo-bio-stimulation” or “photo-biomodulation”. Light interaction with tissue is not a novel concept: electromagnetic energy stimulates photosynthesis, and induces vitamin D formation in human skin cells. The medical use of light – photons, small packets of electromagnetic energy – interacting with
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Light energy can produce a significant healing change in an animal’s tissues.
tissue is also not novel. Ancient Greek physicians noted that some skin conditions responded to exposure to sunlight. Thousands of years later, their observations have been refined; we now more fully understand that photonic energy can produce significant change in tissue. We now appreciate the value of photo-bio-modulation. Since the Federal Drug Administration approved Class IV therapy lasers in the United States in 2005, the science of laser therapy has developed rapidly. Acceptance has been seen on the human side in physical therapy, rehabilitation, wound care and sports medicine programs. In the veterinary profession, Class IV laser therapy use has grown
more rapidly, with practitioners leading the way in testing, protocol development, case reporting, and dissemination of information about the technology.
What can Class IV laser therapy do? It reduces pain and inflammation, and accelerates healing, all in a non-invasive and non-pharmacological way. Symptoms often improve within the first few treatments. Acute conditions are treated until resolution, while chronic conditions are treated until improvement is noted, then treated with reduced frequency to maintain the effect. • Class IV laser therapy works to decrease pain perception through its effect on nerve cells and nociceptors, by increasing stimulation thresholds, reducing neuronal impulses, and increasing the release of tissue endorphins. • Inflammation is reduced by decreasing the release of prostaglandins and inflammatory mediators, increasing macrophage activity and leukocytic phagocytosis, and by reducing edema through dilation of the lymphatic vessels and activation of the lymph drainage system. • Healing is accelerated by increased blood flow from vasodilation, increased angiogenesis and capillary production, increased release of pro-healing cytokines, and the stimulation of fibroblast activity and collagen production. Laser therapy is used as an adjunct to traditional treatment modalities and pharmacological agents, with medications being reduced in many cases. Although not a panacea, and not effective for every patient and condition, most patients with pain, inflammation or healing tissue are candidates for Class IV laser therapy.
Good for acute and chronic conditions Many practices incorporate the use of Class IV laser therapy into routine protocols after surgery and dental procedures to reduce post-procedure pain and inflammation. Single treatments are administered immediately after routine procedures with moderate tissue disruption, like elective surgeries. Procedures resulting in greater tissue disruption, like orthopedic surgeries, are treated immediately post operatively and then every other day for four to six treatments.
components of pain, inflammation and tissue healing. These conditions may be treated only once or multiple times over several days or weeks, depending on the severity of the condition. Examples include wounds, fractures, abscesses, anal sacculitis, acute otitis, hematomas, sprains, strains, muscle discomfort, cystitis, urethritis, injection site soreness, pyotraumatic dermatitis, venomous bites and pododermatitis. • Chronic conditions involving pain, inflammation and healing may also be helped, although treatment has to extend over a longer time, and will be followed by ongoing treatment to maintain effect. Osteoarthritis, elbow hygromas, lick granulomas and neuropathies are examples. Chronic conditions are treated through an initial Induction Phase of treatments until a clinical response is noted. Patients then are treated through a Transition Phase of gradually reduced frequency of treatment, to establish the frequency that will maintain effect. They then enter a Maintenance Phase of treatment every three to six weeks.
How are patients treated? Technician administered treatments take two to ten minutes for each affected area. The laser handpiece is moved in a
Equine applications If you include equine patients in your practice, you know muscle and tendon injuries are common, especially among performance animals. You also know these injuries can end a horse’s career if not treated promptly and properly. Laser therapy is playing a growing role in equine veterinary practice as a way to heal athletic injuries on a cellular level. It can be used for a variety of problems, including muscle soreness and fatigue, navicular disease, bone spurs, ligament injuries and more. Because it hastens healing, patients can often return to competition within a few weeks rather than a few months. Look for more information in a future issue of IVC.
• Patients with a wide variety of acute problems can benefit. Common among these problems are the integrative veterinary care
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What are practitioners reporting? With so many practices using Class IV therapy lasers, the volume of reports is substantial. The growing list of conditions being treated with success results from practitioners applying the simple concept of reducing pain and inflammation and accelerating healing. With a good understanding of the etiology of health conditions, and of the effects of laser therapy, practitioners are demonstrating that a wide diversity of problems respond to laser therapy. While the treatments are not hot – again, patients experience only a pleasant, gentle warming sensation in their tissues – the technology certainly is. As more and more practices begin enjoying the patient benefits and financial success of Class IV laser therapy, it will surely continue as the hot technology of the decade!
scanning motion, either close to or in light contact with the tissue. Patients tolerate treatments well, often relaxing as the therapy is administered. Human patients report a gentle warming sensation in the area being treated. (An increase in local tissue temperature is not considered a therapeutic benefit, but it is comfortable!) Studies demonstrate tissue endorphins are released during laser therapy treatment. Whether the released endorphins have a systemic effect has not been documented. Regardless, a common observation is that veterinary patients, even fractious ones, tend to relax and become calmer during treatment. Treatments are designed to deliver a specific dose of energy. The dose is a measure of the amount of energy delivered to an area of tissue, expressed in Joules per square centimeter (J/cm2). Established target doses are three to four J/cm2 for superficial tissues (those that can be seen), and eight to ten J/cm2 for deeper tissues (those that cannot be seen). Target doses have been developed through numerous studies determining the optimal dose for tissue response, and the use of tissue power meters measuring the percentage of penetrating photons reaching target tissue.
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Dr. John C. Godbold, Jr., DVM, graduated from Auburn University School of Veterinary Medicine in 1978. In 1980, he established Stonehaven Park Veterinary Hospital in Jackson, Tennessee where he practices full time as a small animal practitioner. Since 1999, Dr. Godbold has pursued a special interest in surgical lasers and the use of other laser modalities in small animal practice. He has extensive experience with surgical and therapeutic lasers, has developed new surgical and therapeutic techniques, and assists equipment manufacturers with the development of new laser and laser associated technologies. Dr. Godbold is a member of the Medical Advisory Board of the American Institute of Medical Laser Applications and published the Atlas of CO2 Laser Surgery Procedures and the Atlas of Class IV Laser Therapy – Small Animal. References and Further Reading Helina Moges, Xingjia Wu, Brian Pryor, Jason Smith, Juanita Anders. 980nm LASER IRRADIATION IMPROVED FUNCTIONAL RECOVERY AFTER PERONEAL NERVE INJURY IN RABBITS. Lasers in Surgery and Medicine Supplement (2011). Delia Roberts, Roger Kruse, Matthew Petznick, Jacklyn Kiefer, Peter Alaskym, Stephen Stoll. A Randomized Controlled Trial for the Efficacy of Therapeutic Class IV Laser Treatment for Tendinosis. Procedings of the International Association for the Study of Pain (2010). Kristen Williams, Reed Mathis, J. Derek Kingsley, Emily Simonavice, Francesca Charles, Chris Mojock, Jeong-Su Kim, Victor McMillan, Lynn Panton. Effects of Class IV Laser Therapy on Disease Impact and Function in Women with Fibromyalgia. Proceedings of the American College of Sports Medicine (2010). L.D. Morries. Class IV Laser Therapy: Effective for Back and Neck/ Shoulder Pain. Proceedings of the American Chiropractic Board of Sports Physicians (2010). M Naeser. Photobiomodulation of pain in Carpal Tunnel Syndrome: A review of seven laser therapy studies. Photomedicine and Laser Surgery. V24 N2 101-110 (2006). Roberta T Chow, Mark I Johnson, Rodrigo A B Lopes-Martins, Jan M Bjordal . Efficacy of lowlevel laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials. Lancet V374: 1897–908 (2009). CHRISTOPHER R. CARCIA, ROBROY L. MARTIN, JEFF HOUCK, DANE K. WUKICH, Achilles Pain, Stiffness, and Muscle Power Deficits: Achilles Tendinitis Journal of Orthopedic Sports and Physical Therapy.40(9):A1-A26 (2010). Scott Haldeman, Linda Carroll, J. David Cassidy, Jon Schubert and Åke Nygren. The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders. SPINE Volume 33, Number 4S, pp S5–S7 (2008).
For further reading, visit ivcjournal.com/LLLTstudies
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back to school
Put a pin in it! What acupuncture can and cannot do.
A
cupuncture has been practiced in China for over 2,000 years, and spread to other Asian countries such as Japan and Korea about 1,500 years ago. During the past 25 to 30 years there has been tremendous growth and development of the use of acupuncture in animals in the United States, Canada and Europe.
What acupuncture can do Acupuncture has been used to treat a variety of diseases in horses, dogs, cats and other animals, and many clinical studies have documented its therapeutic benefits. It is generally safe and effective and can be used to treat conditions such as pain, arthritis, muscle spasms, injured tendons or ligaments, abdominal pain, immunodeficiency, autoimmune disease, intervertebral disc disease, seizures, Wobbler’s syndrome, nerve paralysis, behavioral disorders, infertility, skin disease and for improving the overall quality of life in chronic diseases. Acupuncture is defined as the stimulation of a specific point on the body, referred to as an “acupoint.” Physiological changes in response to acupoint stimulation are the basis of clinical treatment. Some of these changes include release of endogenous opioids, immune system stimulation and blood pressure regulation. Stimulation of an acupoint causes activation of Aα and Aβ nerve fibers to conduct electrical signals through the spinothalamic tract to the hypothamalus and cause release of β-endorphins. Acupuncture also activates the descending
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by Carolina Medina, DVM, CVA, CVCH, CCRT
pain inhibitory pathway which in turn activates the periaqueductal gray matter to release more β-endorphins and the nucleus raphe magnus to release serotonin. Therefore, pain is blocked with the release of these endogenous opioids and neurotransmitters. Acupuncture can also activate T-cell lymphocytes and increase the number of white blood cells which is beneficial in the treatment of immunodeficiency. Additionally, acupuncture can affect the blood pressure receptors and can either increase or decrease blood pressure.
Acupoints and techniques There are approximately 361 acupoints located throughout the body. There are four types of acupoints.
1. Motor points – make up about 70% of the total acupoints and are located in areas where a nerve enters a muscle
2. Midline points – located on dorsal and ventral midlines where the superficial nerves meet
3. Nerves or nerve plexus points 4. Muscle-tendon junction points. The three most common techniques use to stimulate acupoints include dry needle, electro-acupuncture and aqua-acupuncture. • Dry needle is the insertion of an acupuncture needle
into an acupoint. These needles are filiform, sterile and of varying widths and lengths. Dry needle is the most common treatment modality used in veterinary medicine. • Electro-acupuncture is the attachment of electrical leads to dry needles and connection to an electro-acupuncture machine. The purpose of using the electro-acupuncture machine is to control the frequency and amplitude applied to each point. This allows for more effective stimulation than dry needle alone. • Aqua-acupuncture is the injection of a soluble, sterile medium such as saline or vitamin B12 into acupoints. The purpose of aqua-acupuncture is to provide a constant stimulation by means of the pressure induced by the liquid injected into the acupoint.
Studies and what they have shown
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Studies have found that electro-acupuncture produced a significant analgesic effect on inflammatory pain in rats with collagen-induced arthritis.
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Another study proved that electro-acupuncture is more effective than dry needle acupuncture and that electroacupuncture at acupoint ST-36 (local stifle point) may have anti-inflammatory, anti-arthritic and immune-regulatory effects on collagen-induced arthritis in mice.
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Several studies have revealed that visceral pain associated with rat irritable bowel syndrome can be effectively treated with electro-acupuncture.
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One study showed that electro-acupuncture at ST-36 enhances natural killer cell activity and complement activity which indicates the usefulness of ST-36 in immune system activation.
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Another demonstrated that electro-acupuncture combined with standard Western medical treatment was effective and resulted in shorter time to recover ambulation and deep pain perception than did the use of Western treatment alone in dogs with signs of thoracolumbar intervertebral disc disease.
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Numerous studies have shown that acupuncture has anti-depressive effects in both humans and rats.
The results of yet another study indicated that acupuncture is an effective treatment for pruritis and that this effect is due to the anti-pruritic effect of kappa-opioid receptor activation induced by acupuncture stimulation.
Cautions and contraindications There are certain cautions and contraindications one must be aware of when using acupuncture as a treatment option. • Care must be taken when treating weak or debilitated patients. Typically, fewer acupoints are stimulated in weak or geriatric animals. • When treating agility or other performance dogs, wait a couple of hours after training or competing before starting an acupuncture treatment. • Acupoints around the thoracic cavity require a more shallow insertion than other acupoints located on large muscle groups such as the gluteals. • One must be cautious when using acupoints around the eyes so as to not puncture the globe. • It is contraindicated to insert a needle directly into a mass, tumor, open wound, umbilicus or scar tissue. • Specific points, especially those around the lower abdomen and lower lumbar spine, are contraindicated during pregnancy. • Electro-acupuncture is contraindicated in patients with a pacemaker or a history of seizures, and should be used with caution in patients with congestive heart failure. In summary, acupuncture can be used to treat a variety of diseases including pain, neurological dysfunction, gastrointestinal disorders, dermatological conditions and anxiety. Different acupoints and different methods of stimulation can be employed to treat specific diseases. Although few, there are some cautions and contraindications to using acupuncture therapy. Therefore, it is highly recommended that a licensed veterinarian take a course certifying him or her in veterinary acupuncture before implementing it as part of his/her practice. With the increasing amount of clinical trials and research being performed on acupuncture therapy, we have a better understanding of its mechanisms of action and therapeutic benefits. Dr. Carolina Medina received a Doctor of Veterinary Medicine degree from St. George’s University School of Veterinary Medicine in 2005. After graduating veterinary school, she completed a 14month clinical internship in Acupuncture at the University of Florida College of Veterinary Medicine, and the Chi Institute and China’s National Society of Traditional Chinese Veterinary Medicine granted her certification in Veterinary Acupuncture, Herbology, Tui Na Massage Therapy and Food Therapy. Dr. Medina was one of the founders of the American Association of Traditional Chinese Veterinary Medicine and has been an Associate Editor for the American Journal of Traditional Chinese Veterinary Medicine since its inception in 2006. Last year, she became certified in canine rehabilitation therapy through the Canine Rehabilitation Institute. Currently, she works as a clinical assistant professor and service chief of the Acupuncture and Rehabilitation Service at the University of Florida College of Veterinary Medicine.
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Antioxidants for
ocular health How these nutrients are proving beneficial for genetic eye disease. by Dr. Carmen Colitz, DVM, DACVO, PhD and Dr. Terri McCalla, DVM, DACVO
T
oday’s dogs seem far more predisposed to cancer and other immune-mediated diseases than dogs in decades past. Conditions like these result from an excess of oxidative stress that cannot be counteracted by the endogenous antioxidant systems of the cells, or by the typical diet. The causes are likely numerous but certainly the quest for the perfect dog in a specific breed has led to many of the genetic diseases we see in veterinary medicine – and ophthalmology. The hybrid or designer breeds now popular are not immune even though the intent was to diminish the genetic issues; unfortunately, this did not entirely happen.
The most common genetic diseases we see in veterinary ophthalmology practice include cataracts, retinal degenerations and glaucoma.1-3 Each breed or group of breeds likely have various mutation(s) that predispose that dog to one or more of these diseases. And unfortunately, you cannot change your genes. Thanks to the Dog Genome Project, the mutations for these diseases are already identified for some breeds, and many more will continue to be identified. The new disciplines of nutrigenomics and nutrigenetics have helped cement nutrients as ways in which to modulate health. Nutrigenomics refers to genetic variation and its dietary response.1 Nutrigenetics refers to the evolutionary aspects of diet and the role of nutrients in gene expression.1 While the impact of diet and nutritional supplementation may not appear to affect inherited ophthalmic diseases in dogs, we might learn that genes that become involved in any of these diseases may be affected by what a dog eats. Likewise, this same concept of genetic variation and genenutrient interaction is important in drug metabolism and adverse reactions to drugs.1 That said, an intake of certain nutrients may directly or indirectly modulate genes, including those that affect eye diseases.
Cataracts While inherited cataracts in dogs are unlikely to be prevented or inhibited by nutriceutical supplementation, antioxidants will improve the environment of the lens cells and possibly reduce secondary sequellae to the
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ensuing oxidative stress caused by cataractogenesis. Some examples of nutrients shown to have aprotective effect on lens epithelial cells and/or cataract development include grapeseed extract, lutein/zeaxanthin, lycopene, zinc and coenzyme Q10. Proanthocyanidins are powerful antioxidants found in grapeseeds, tea, nuts, pine bark and other plant extracts. They have a variety of effects, including free radical scavenging and anti-inflammatory, anti-viral and antimicrobial activities. They also potentiate the function of vitamins C and E.5-7 A strain of rats (ICR/f) predisposed to hereditary cataracts due to lipid peroxidation were fed a diet containing grapeseed extract (GSE). Cataracts were slowed in progression and active glutathione (GSH) was higher in GSE-fed rats as compared to unsupplemented control rats.2 Selenite-induced cataracts, a form of toxininduced cataract, were also significantly slowed or prevented by GSE.3 In vitro studies on lens epithelial cells found that GSE reduced oxidative stress-induced reactive oxygen species production and attenuated stress-induced cell-signaling markers and NF-kB.4, 5 Lutein and its coexistent isomer, zeaxanthin, are oxycarotenoids with two hydroxyl groups on either side of the molecule. They protect ocular tissues against photooxidative stress, quench and scavenge ultraviolet radiation-induced reactive oxygen species, inhibit lipid peroxidation, and filter blue light.6 They are the only continued on page 24
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Other plant extracts with protective effects against cataracts include lycopene and curcumin. Lycopene is a potent carotenoid found in tomatoes. Lycopene protects against selenite-induced cataracts as well as galactosemia-induced cataracts.12, 13 In vitro, lens epithelial cells exposed to selenite improved antioxidant activity and glutathione levels when supplemented with lycopene, compared to unsupplemented control cells. Curcumin is the chief phenolic compound found in turmeric (Curcuma longa).14 Curcumin’s anti-inflammatory and antioxidant effects are due to its ability to induce antioxidant enzymes, decrease production of pro-inflammatory cytokines, sequester free radicals, inhibit neutrophil and macrophage function, and inhibit lipid peroxidation.15-20 All cataractogenic processes have an imbalance in calcium, and curcumin may have anticataractogenic effects by preventing free radical-mediated accumulation of calcium in the lens.21 Calcium (Ca2+) is elevated in cortical, but not nuclear cataracts,22 and excessive Ca2+can be detrimental to lens cells. Calcium is tightly regulated in the lens and its imbalance is associated with changes occurring during cataractogenesis.23
carotenoids found in the retina and lens (Bomser, unpublished results in dogs).7 Lutein and zeaxanthin are potent antioxidants that inhibit lipid peroxidation. Though the literature strongly supports their role in protection against age-related cataracts in humans, there are no published reports investigating their inhibition of specific inherited or toxic cataracts in rodent models or other species. However, lutein and zeaxanthin may improve the lens environment during cataractogenesis through their antiinflammatory activity.8 Cataractogenesis, regardless of the stage in dogs, causes inflammation9, 10 and chronic uveitis can cause cataractogenesis.11 Therefore, one can exacerbate the other.
Retinal diseases Inherited degenerative or dystrophic retinal diseases have been a focus of research beginning in 1955. This research evaluated red Irish setters using the electroretinogram,24 and was followed in 1965 by the description of a photoreceptor abiotrophy in the elkhound.25 Since then, hundreds of publications have characterized and described the various forms of retinal dystrophy and degenerations in numerous breeds of dogs. With our improved understanding of gene cloning and the establishment of the Dog Genome Project, mutational analysis has identified specific mutations for these diseases in many breeds. As a result of this research, DNA testing is now available for 67 breeds so far. Lutein and zeaxanthin selectively accumulate in the retina and lens.3-5 Recovery of electroretinographic function in dogs with Progressive Retinal Atrophy (PRA) has been demonstrated following nutritional supplementation; these findings suggest the progression of canine PRA is inhibited by antioxidant supplementation, including lutein and zeaxanthin.26 Regardless of the mutation causing retinal dystrophy or degeneration, there is cell death and oxidative stress. Since rods are the major source of oxygen utilization in the retina, their death results in deleterious oxygen levels and photoreceptor damage.27, 28 Once the rods die, the cones gradually follow. It is hypothesized that cone death is due to oxidative damage possibly secondary to increased oxygen levels in the outer retina.27, 28 A combination of antioxidants including alpha-tocopherol, ascorbic acid and alpha lipoic acid, reduced oxidative stress. Individually, alpha-tocopherol and alpha lipoic acid, both lipid soluble antioxidants, showed significant increases in cone numbers compared with the other groups.27 Therefore, as long as enough cones survive in retinas with degenerative or dystrophic diseases, vision may be maintained or prolonged by the use of antioxidants.
Glaucoma Oxidative stress is an important part of glaucoma.29, 30 One
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theory is that an unstable ocular blood flow leads to repeated mild reperfusion events.31 Elevations in intraocular pressure (IOP) damage retinal ganglion cells with secondary excitotoxicity and free radical generation.32 Coenzyme Q10 has been shown to delay apoptosis in retinal ganglion cells resulting from high IOP.33 Much of the information, thus far, pertains to humans with open angle glaucoma, and rodent models; therefore, confirmation of oxidative stress events and evaluation of the effects of antioxidants in canine glaucoma are warranted. Other antioxidants, including polyphenols (grapeseed extract) and EGCG (green tea extract), may help slow the progression of the damage occurring in glaucoma.31
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In summary, all diseases – including inherited ophthalmological conditions – have oxidative stress in their pathogenesis. The body’s numerous endogenous antioxidant systems fight the daily free radical damage that occurs with normal body functions, including digestion and metabolism and growth in young animals. However, an excess of oxidative stress, occurring with chronic lifelong situations such as inherited ophthalmic disease, depletes the endogenous antioxidant systems, and any antioxidants available from the diet. This likely exacerbates the progression of these diseases. Therefore, the use of antioxidant supplements as a complement to traditional therapy is likely beneficial. Dr. Carmen Colitz is a board certified veterinary ophthalmologist with a PhD in Comparative and Experimental Medicine. She has extensive research experience involving antioxidants and
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integrative veterinary care
how they affect eye health, particularly the lens. In addition, Dr Colitz discovered telomerase activity in cataracts and has over ten years research experience working in this field. Dr. Terri McCalla is a board certified veterinary ophthalmologist and owner of Animal Eye Care in Bellingham, Washington. Her research interest is in retinal pathology, and she has been in private specialty practice for over 20 years. References: 1. Simopoulous AP. Nutrigenetics/Nutrigenomics. Ann Review Pub Health. 2010;31:53-68. 2. Yamakoshi J, Saito M, Kataoka S, Tokutake S. Procyanidin-rich extract from grape seeds prevents cataract formation in hereditary cataractous (ICR/f) rats. J Agric Food Chem. 2002;50:4983-4988. 3. Durukan AH, Everklioglu C, Hurmeric V, et al. Ingestion of IH636 grape seed proanthocyanidin extract to prevent selenite-induced oxidative stress in experimental cataract. J Cataract Refract Surg. 2006;32(6):1041-1045. 4. Barden CA, Chandler HL, Lu P, Bomser JA, Colitz CMH. The effect of grape polyphenols on oxidative stress in canine lens epithelial cells. Am J Vet Res. 2008;69:94-100. 5. Jia Z, Song Z, Zhao Y, Wang X, Liu P. Grape seed proanthocyanidin extract protects human lens epithelial cells from oxidative stress via reducing NF-ะบB and MAPK protein expression. Mol Vis. 2011;17:210-217. 6. Lutein and zeaxanthin. Alternative Medicine Review. 2005;10(2):128-135. 7. Yeum KJ, Taylor a, Tang G, Russell RM. Measurement of carotenoids, retinoids, and tocopherols in human lenses. Invest Ophthalmol Vis Sci. 1995;36:2756-2761. 8. Jin X-H, Ohgami K, Shiratory K, et al. Inhibitory effects of lutein on endotoxin-induced uveitis in Lewis rats. Invest Ophthalmol Vis Sci. 2006;47:2562-2568. 9. Gelatt KN, MacKay EO. Secondary glaucoma in the dog in North America. Vet Ophthalmol. 2004;7(4):245-259. 10. Leasure J, Gelatt KN, MacKay EO. The relationship of cataract maturity to intraocular pressure in dogs. Vet Ophthalmol. 2001;4(4):273-276. 11. Davidson MG, Nelms SR. Diseases of the Canine Lens and Cataract Formation. In: Gelatt KN, ed. Veterinary Ophthalmology. Vol 2. 4 ed. Ames: Blackwell; 2007:859-887. 12. Gupta SK, Trivedi D, Srivastava S, Joshi S, Halder N, Verma SD. Lycopene attenuates oxidative stress induced experimental cataract development: an in vitro and in vivo study. Nutrition. 2003;19(9):794-799. 13. Pollack A, Oren P, Stark AH, Eisner Z, Nyska A, Madar Z. Cataract development in sand and galactosemic rats fed a natural tomato extract. J Agric Food Chem. 1999;47:5122-5126. 14. Manikandan R, Thiagarajan R, Beulaja S, Sudhandiran G, Arumugam M. Effect of curcumin on selenite-induced cataractogenesis in Wistar rat pups. Curr Eye Res. 2010;35(2):122-129. 15. Kunchandy E, Rao MNA. Oxygen radical scavenging activity of curcumin. Int J Pharmaceut. 1990;58:237-240. 16. Sreejayan M, Rao N. Nitric oxide scavanging by curcuminoids. J Pharm Pharmcol. 1997;49:105-107. 17. Srivastava R. Inhibition of neutrophil response by curcumin. Agents Actions. 1989;28:298-303. 18. Joe B, Lokesh BR. Role of capsaicin, curcumin and dietary n-3 fatty acids in lowering the generation of reactive oxygen species in rat peritoneal macrophages. Biochim Biophys Acta. 1994;1224:255-263. 19. Chan MMY, H.I. H, Fenton MR, Fong D. In Vivo inhibition of nitric oxide synthase gene expression by curcumin, a cancer preventive natural product with anti-inflammatory properties. Biochem Pharmacol. 1998;55:1955-1962. 20. Reddy AC, Lokesh BR. Effect of dietary turmeric (Curcuma longa) on iron-induced lipid peroxidation in the rat liver. Food Chem Toxicol. 1994;32:279-283. 21. Manikandan R, Thiagarajan R, Beulaja S, Sudhandiran G, Arumugam M. Curcumin prevents free radical-mediated cataractogenesis through modulations in lens calcium. Free Radic Biol Med. 2010;48(4):483-492. 22. Duncan G, Bushnell AR. Ion analyses of human catractous lenses. Eye Research. 1975;20:223-230. 23. Rhodes JD, Sanderson J. The mechanisms of calcium homeostasis and signalling in the lens. Exp Eye Res. 2008;88:226-234. 24. Parry HB, Tansley K, Thomson LC. Electroretinogram during development of hereditary retinal degeneration in the dog. Br J Ophthalmol. 1966;39(6):349-352. 25. Cogan DG, Kuwabara T. PHOTORECEPTIVE ABIOTROPHY OF THE RETINA IN THE ELKHOUND. Pathol Vet. 1965;106:101-128. 26. Umeda Y, Maehara S, Wakaiki S, et al. Electroretinographic, evaluation of supplementation including lutein for canine progressive retinal atrophy. Paper presented at: Annual Meeting of the American College of Veterinary Ophthalmologists, 2004. 27. Komeima K, Rogers BS, Lu L, Campochiaro PA. Antioxidants reduce cone cell death in a model of retinitis pigmentosa. Proc Natl Acad Sci USA. 2006;103(30):11300-11305. 28. Shen J, Yang X, Dong A, et al. Oxidative damage is a potential cause of cone cell death in retinitis pigmentosa. J Cell Physiol. 2005;203(3):457-464. 29. Zanon-Moreno V, Garcia-Medina JJ, Gallego-Pinazo R, Vinuesa-Silva I, Moreno-Nadal MA, Pinazo D, M.D. Antioxidant status modifications by topical administration of dorzolamide in primary open-angle glaucoma. Eur J Ophthalmol. 2009;19(4):565-571. 30. Izzotti A, Sacca SC, Longobardi M, Cartiglia C. Sensitivity of ocular anterior-chamber tissues to oxidative damage and its relevance to glaucoma pathogenesis. Invest Ophthalmol Vis Sci. 2009;Epub ahead of print. 31. Mozaffarieh M, Grieshaber MC, Orgul S, Flammer J. The potential value of natural antioxidative treatment in glaucoma. Surv Ophthalmol. 2008;53:479-505. 32. Russo R, Cavaliere F, Rombola L, et al. Rational basis for the development of coenzyme Q10 as a neurotherapeutic agent for retinal protection. Prog Brain Res. 2008;173:575-582. 33. Nucci C, Tartaglione R, Cerulli A, et al. Retinal damage caused by high intraocular pressure-induced transient ischemia is prevented by coenzyme Q10 in rat. Int Rev Neurobiol. 2007;82:397-406.
industry innovations Tools for rehab As a veterinarian, you’ve probably seen more than a few injured dogs come through your doors – dogs that may need surgery and/ or rehabilitation to get them back on track. FitPAWS® Canine Conditioning Equipment is used by animal rehabilitation professionals, veterinarians, sport dog enthusiasts and professional dog trainers for core strengthening, increased range of motion and flexibility, neuromuscular facilitation, sensory and perceptual stimulation, joint alignment, and balance control. dogtreader.com
They know SAMe Presenting Nutralife, the innovators who introduced the top-selling supplement, SAMe, to the United States. SAMe has been studied in numerous clinical trials involving thousands of patients over the last three decades. It is used to promote healthy liver function and joint mobility, and to maintain mood and cognitive function. Many veterinarians have already prescribed Nutralife’s Original SAMeTM for their patients. Nutralife now introduces the NutralifePet line of SAMe, tailor made in multiple doses and sizes to meet the unique needs of the veterinary market. NutralifePet aims to make quality supplements affordable to all pet owners. See the NutralifePet ad in this issue. nutralife.com
Learning opportunity If you’re interested in adding massage and bodywork to your practice, check out Integrated Touch Therapy, Inc. President and primary instructor Patricia Whalen-Shaw is a licensed massage therapist in Ohio and nationally certified by the NCBTMB. She has been teaching equine, canine and feline massage to practitioners for 20 years. Classes are small with hands-on practice and hundreds of hours of schooling. Massage and bodywork can be used to generate additional income for your practice; it can help older dogs move more freely, can be used in the prevention and early detection of disease, especially masses, may speed hair growth by increasing circulation, and keep animals calm during office visits. integratedtouchtherapy.com
For patient anxiety Examining a tense or frightened animal can be challenging. Rescue Remedy Pet is an all-natural stress reliever that can help calm pets in any stressful situation, including vet visits. It contains the same five Bach Flower Remedies used in the original formula created for humans over 75 years ago, but in an alcoholfree, glycerin-based preservative ideal for sensitive animal patients. Rescue Remedy Pet is available in 10ml or 20ml drops and is suitable for all animals including dogs, cats, horses, birds and rabbits. nelsonsnaturalworld.com
Two new supplements
Rx for renal failure
Omega Alpha Pharmaceuticals Inc. has developed two new products to round out their line of herbal-based liquid nutraceutical formulations for cats, dogs and small animals. The new products address common pet needs such as respiratory health with Lung Tone™, and pain and inflammation with E-Z Mobility™. Omega Alpha Pharmaceuticals has been GMP certified for manufacturing to pharmaceutical standards since its inception in 1992, and is site licensed for manufacturing nutraceuticals by the Natural Health Products Directorate (NHPD), a division of Health Canada. OmegaAlpha.ca.
Kidney issues are common in cats. Rx Renal Feline is a complex formulation of multiple botanical extracts and nutraceuticals that has shown efficacy in normalizing renal blood values in patient trials. Each ingredient is supported by scientific evidence that shows its usefulness in effectively addressing elevated renal values. This formula is well tolerated in cats, and positive clinical results can be achieved in as little as two weeks. For more information, Rx Vitamins offers a comprehensive Technical Report. rxvitamins.com integrative veterinary care
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tech talk
Introduction to Reiki This safe and effective energetic healing modality is backed up by promising preliminary research. Find out how you can use it to support the animals you care for. by Kathleen Prasad
Because it is holistic in nature, Reiki can address both physical and emotional issues. It supports healing on all levels. It is an ideal therapy to use with animals because it is gentle, painless and stress-free, does not require direct physical contact in order to be effective, and allows animals to choose their own level of participation and acceptance of the energy.
ast year, Dr. Oz declared Reiki his No. 1 alternative medicine secret. With 40% of Americans having tried alternative medicine – and 60% of US households home to at least one pet – many people are increasingly turning to Reiki and other holistic therapies to help their animals. Thanks to Reiki’s increasing popularity, many integrative veterinarians now offer it and other energy healing options in the clinic environment. Many conventional veterinarians are also learning more about Reiki as a holistic option, at the request of their human clients. Reiki literally means “spiritual energy” and refers to a Japanese healing system that uses specific meditative, breathing and other practices to support energetic rebalancing and the self-healing process.
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Maybe you work in an integrative clinic where Reiki is already part of the healing program. Or perhaps you work for a veterinarian who is at present unaware of how Reiki can help the animals in her care. In either case, there are many benefits to learning Reiki.
Benefit 1: Reiki is easy to use and will not take away from your regular duties. Reiki is something you can use any time during the day whenever an animal might need some extra support. Although longer and more focused treatments are extremely helpful, you can also use Reiki quickly and easily with some simple focus and breathing techniques. This particular benefit has already been documented for nurses in “Effects of Reiki on Autonomic Activity Early After Acute Coronary Syndrome” a study that appeared in the Journal of the American College of Cardiology (2010;56;995-
995). In this study, Reiki-trained nurses provided this therapy to patients on cardiac units. The study showed they were able to incorporate these treatments (and their therapeutic benefits) into the standard care protocol without disruption or additional cost.
Support of Cancer Patients” by Pamela Miles in Advances (Fall, 2007, Vol. 22, No. 2). This human study showed how Reiki relieves symptoms such as anxiety and pain, helping patients feel better, “frequently within minutes.”
Benefit 4: Reiki self-care can reduce stress at work.
Benefit 2: Reiki can calm animals before and during exams and procedures. As care providers for animals in a clinic environment, veterinary technicians are in a unique position to provide Reiki when animals might become stressed: before and during exams and procedures, for example. According to the study “Reiki Improves Heart Rate Homeostasis in Laboratory Rats” in the Journal of Alternative and Complementary Medicine (14(4): 417-422, 2008), Reiki significantly reduced a rise in heart rate produced by exposure to noise. Extrapolating these results to the clinic environment, veterinary technicians can use Reiki to help animals remain calm and relaxed during their visits.
Benefit 3: Reiki provides post-surgery comfort and recovery support. A valuable time to offer Reiki to animals is immediately after surgery, or after treatment before they go home. By offering Reiki at this time, you can support a quick recovery. The benefits of Reiki for pain management and recovery have been documented in “Reiki for Mind, Body and Spirit
Last but far from least, Reiki can offer you self care and stress reduction. Reiki teaches that all healing begins within the individual, and that it’s through our own spiritual development and self-healing that we can deepen our ability to help others. In the study “Nurses’ Lived Experience of Reiki for Self Care” in Holistic Nursing Practice, (23(3): 129-145, 2009), nurses were able to reduce on-the-job stress by doing Reiki self treatments. Reducing stress can also help support veterinary technicians in their interaction with co-workers, human clients and animals. There are many more benefits to Reiki, and it’s a perfect complementary modality for veterinary technicians to learn. Reiki is taught by a growing number of practitioners, so it’s easy to find courses. Give it a chance, and see how Reiki can help you be the best professional you can be. Kathleen Prasad is co-author of Animal Reiki and The Animal Reiki Handbook. She is also an animal Reiki teacher, founder of Animal Reiki Source and President of the Shelter Animal Reiki Association. Find out more about energy healing and Reiki for animals through her website animalreikisource.com.
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Evidence-based medicine for animal supplements – part 1 – Where is the clinical evidence demonstrating that animal supplements are safe and effective? Here’s a review of the evidence that’s currently available, and the limitations facing the industry.
yadda, yaddy, yadda... incredible! yadda, yaddy, yadda... the best!
by William Bookout, BS, MBA
hen United States Congress passed the Dietary Supplement Health Education Act (DSHEA) in 1994, they failed to consider the potential application and benefits of supplements for animals. The Food and Drug Administration, Center for Veterinary Medicine (FDACVM) published a notice in the Federal Register stating that due to the lack of specific references to animals, DSHEA did not apply to products for animals1. Consequently, there are only two categories under existing US law for these types of products, determined by their intended use:
or any function of the body of man or other animals; and (D) articles intended for use as a component of any article specified in clause A, B, or C.”
“SEC. 201. [21 U.S.C. 321] Definitions; generally for the purposes of this Act2
Economic considerations
“Food (Animal Food/Feed) – (f)(1) The term ‘food’ means (1) articles used for food or drink for man or other animals, (2) chewing gum, and (3) articles used for components of any such article. “Drug (Animal Drugs) – (g)(1) The term ‘drug’ means (A) articles recognized in the official United States Pharmacopoeia, official Homoeopathic Pharmacopoeia of the United States, or official National Formulary, or any supplement to any of them; and (B) articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or other animals; and (C) articles (other than food) intended to affect the structure
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This means that animal supplements, if they are not intended to provide nutrition to animals, are considered by the FDA to be unapproved drugs; therefore, safety and effectiveness for their intended use in specific species has not been evaluated by the agency. For a product to be an “approved” drug, a company must submit a New Animal Drug Application (NADA) with safety, efficacy and quality data that are then evaluated by the agency.
Meeting this burden of proof is impossible for animal supplements. The time required to develop a new animal drug can be between six to eight years with an investment of approximately $100 million, so submitting the data and information required to receive approval is both time consuming and very costly. For a company to afford it, it must accomplish at least two things: 1) recover its investment, which is reflected in the price it charges for the products, and 2) try to protect the business opportunity by patenting the product as a barrier to competitors.
Allowable product claims Labeling claims are probably the most misunderstood and misused aspect of animal supplement regulation. Under current US law, products marketed for animals that are similar to human dietary supplements have
only two legal categories: animal food/feed or animal drugs. Depending on their intended use, products may be considered unapproved animal drugs that may be marketed under enforcement discretion. Examples are supplements with ingredients supporting joint function, or herbal ingredients with a functional supportive purpose other than flavoring. Labeling generally includes, but may not be limited to, product labels, product literature, websites, advertising and trade show materials, such as booth graphics. The accompanying table illustrates both violative claims and claims that may not be objected to by regulatory agencies. Claims for natural health products for animals may be allowed by FDA-CVM if they are not in violation of those associated with approved animal drugs, and are limited to supporting the normal, healthy structure and/or function of the animal. Further information on labeling claims can be found in Labeling Claims, General Information on the FDA website; however, this guidance applies to nutritional products and human dietary supplements, and should only be viewed as general claims guidance. Claims that sound too good to be true probably are. Any company that makes claims for natural products and mentions disease is an egregious violator, unless the company can provide a letter of non-objection from FDA-CVM.
Many drugs and medical devices are not approved for animals When discussing supplements for animals, it is worthwhile to compare products and equipment used without question every day by veterinarians. Drugs – How many drugs on pharmacy shelves in every veterinary clinic and hospital are specifically approved for use in animals? An estimated 50% to 70% of drugs used every day by veterinarians are off-label or extralabel use, and have not met the criteria for safety and efficacy for animals. Why are these drugs allowed to be sold by the FDA? The Code of Federal Regulations states: “530.30 Extralabel drug use in nonfood animals. (a) Because extralabel use of animal and human drugs in nonfood-producing animals does not ordinarily pose a threat to the public health, extralabel use of animal and human drugs is permitted
in nonfood-producing animal practice except when the public health is threatened.” It is a risk-versus-benefit analysys; if extralabel drug use was not allowed, veterinarians would have far fewer drugs to choose from in treating their patients and veterinary medicine would not have made the advances it has. If safety and efficacy data were required for all current drugs used to treat animals, veterinarians simply could not treat patients effectively. Medical devices – In human medicine, there is an “approval” process for medical devices, typically referred to as the 510K process. Depending on the class of device, the requirements may be more or less rigorous. When a company wants to market a medical device for human use, it typically submits a documentation packet to FDA; when successful, it receives a letter granting permission to market the product. The FDA states the company has satisfied the requirements and they have no further questions. Human devices, or drugs for that matter, are not technically “approved” by FDA; the agency essentially grants permission to market products. integrative veterinary care
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Supplement
Violative claims, whether specifically stated or implied
Claims that may not be objected to
Animal supplement containing glucosamine, chondroitin sulfate and MSM
• Benefits animals with osteoarthritis, degenerative joint disease
• Supports normal healthy joint function
• Any claim linked to treating and/or preventing a disease
• Helps maintain healthy joint function
Supplement containing ingredients like coenzyme Q10
• Benefits animals with cancer, autoimmune disease, congestive heart failure
• Supports normal healthy immune function
• Any claim linked to treating and/or preventing a disease
• Helps maintain healthy immune function
• Any mention of a specific disease or implied reference to a disease
• Any mention of a specific disease or implied reference to a disease
Supplement containing ingredients such as fish oil, omega-3 or omega-6 fatty acids
• Benefits animals with dermatitis, chronic allergies, chronic skin conditions • Any claim linked to treating and/or preventing a disease • Claims to reduce excessive shedding • Any mention of a specific disease or implied reference to a disease
What products would require 510K submissions evaluating safety and effectiveness? Anesthesia machines/vaporizers, pulse oximeters, CO2 monitors, endotracheal tubes, IV pumps, IV tubing, anesthesia circuits…almost every medical device in a human hospital or clinic requires some type of evaluation by FDA prior to being legally marketed. The FDA-approval process and requirements for animal medical devices are virtually non-existent in comparison to human medicine. If all animal medical devices used by veterinarians were eliminated in cases where safety and efficacy have not been evaluated, almost all of them would no longer be available. If the majority of drugs for animals have not been evaluated for safety and efficacy, and there is no approval process for animal medical devices, why don’t thousands of animals die? The reasons are:
1 2
The products have been used by people without causing significant “harm to public health”.
Regulatory agencies utilize risk-based approaches to allocate resources that serve the best interests of public safety and health. The products are allowed to be marketed under FDA enforcement discretion, provided the industry is acting responsibly. In Part 2 of this article, which will appear in the next issue of IVC, I’ll look at how the animal supplement industry is working with regulatory agencies, and the important role the National Animal Supplement Council (NASC) plays in regulating natural health products for animals.
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• Supports healthy skin and coat • Essential fatty acids help your pet maintain a glossy, shiny coat • Salmon oil helps maintain normal shedding
Bill Bookout is a founding member of the National Animal Supplement Council, serving as president and chairman of the board of the nonprofit organization since early 2002. Bill is also president of Genesis Ltd., a company he founded in 1999 that provides both feed products and health products for companion animals. Prior to founding Genesis, he spent 15 years in the human medical device, drug and animal health industries, including executive positions with Medex Medical, the All-Care Animal Referral Center and AnaMed International, and director of sales and marketing for Marquest Medical Products. Bill received his bachelor’s degree in physical sciences from the University of Wyoming, and an MBA from Pepperdine University, Presidents and Key Executives Program. He has been selected by Health Canada to serve on the Expert Advisory Committee for Veterinary Natural Health Products. He serves on the Board of Directors of the University of Wyoming’s National Ambassadors as a student mentor for the university. Bill and his wife, Mary are involved in Akita Rescue and have four rescue Akitas: Yin, Yang, Akiko and Hana. References FDA Veterinarian – May / June 2002. Animal Dietary Supplements – A US Update www.fda.gov/cvm/4410.htm Federal Food Drug & Cosmetic Act, SEC. 201. [21 U.S.C. 321], CHAPTER II—DEFINITIONS, SEC. 201. [21 U.S.C. 321] Definitions; generally For the purposes of this Act. www.fda.gov/RegulatoryInformation/Legislation/FederalFoodDrugandCosmeticActFDCAct/ FDCActChaptersIandIIShortTitleandDefinitions/ucm086297.htm Requirements for New Animal Drug Applications. www.fda.gov/AnimalVeterinary/DevelopmentApprovalProcess/NewAnimalDrugApplications/default.htm Small Animal Clinical Pharmacology, Jill E. Maddison, Stephen W. Page, pp. 20-22. National Animal Supplement Council, FAQs. nasc.cc/index.php?option=com_content&task=view&id=29&Itemid=38 FDA, Labeling Claims, General Information. www.fda.gov/Food/LabelingNutrition/LabelClaims/default.htm Extralabel drug use in animals. www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=530 www.fda.gov/iceci/enforcementactions/warningletters/2008/ucm1048139.htm www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm162121.htm www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm165062.htm www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm208978.htm www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm212363.htm www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm215443.htm
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profile Dr. Steve Marsden
start, he was dissatisfied with this approach. “There were so many conditions I couldn’t seem to treat effectively, and many more that resisted diagnosis. For other conditions, the treatment seemed worse than the cure.”
Photo courtesy of the Canadian Veterinary Medical Association.
DVM, ND, MSOM Lac Dipl.CH CVA
Dr. Steve Marsden (right) receives the 2009 Small Animal Practitioner Award from the Canadian Veterinary Medical Association. The award was presented by Dr. Lynn Webster of Petsecure Pet Health Insurance, who sponsored the award.
By Ann Brightman ome people know from a very young age what they want to be when they grow up. Veterinarian Dr. Steve Marsden is one of them. “I was seven years old and accompanying my mother as she took our cat to the veterinarian,” he recalls. “I remember being struck by the way our veterinarian simply ran his hands over her body and was able to tell us instantly what was wrong with her. I’d been raised to respect and admire animals, so the concept of being able to tell so much about them just by touching them was stunning to me. Right then and there, I resolved that I had to be just like that vet.” As with most other veterinarians, Dr. Marsden was trained in conventional medicine. “Part of my training was to inherit an unhealthy disrespect and disregard for all things holistic as unproven and unscientific.” But right from the
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At one point, Dr. Marsden considered leaving the veterinary field, but an incident with one of his patients turned his life around. “A client came in to have her dog vaccinated. She said, ‘I believe in preventive medicine for my kids, too. I give them arsenic every morning.’ I looked at her with horror and alarm. ‘Well, it’s homeopathic,’ she replied defensively.” Intrigued but still sceptical, Dr. Marsden started researching homeopathy and was amazed to learn that vets in Europe regularly use it with their patients. “They use it for just about every condition I was frustrated by. What followed was two years of experimentation, aided tremendously by Christopher Day of the UK. It took awhile, but eventually I was successfully treating even devastating problems with homeopathy. After one particularly stunning success, when the owner assured me her dog was now perfectly normal, I became aware of a vast hole in my training.” Dr. Marsden decided to become a naturopathic physician and has never looked back. He practices in Edmonton, Alberta. Along with homeopathy, his treatment method of choice is Chinese medicine. “It has several different modalities that can all be understood according to the same medical theory, and thus applied simultaneously and synergistically to a patient,” he explains. “With any patient, you can do something physical immediately – such as acupuncture, acupressure or massage – even as you’re waiting for herbs and a diet change to kick in. You end up with a protocol that works both immediately and over the long term, while fighting a problem on multiple levels. That being said, I now understand how homeopathy, Western herbal medicine, and
chiropractic integrate with Chinese medicine, such that I can make a Chinese diagnosis, but then elect to treat it with a homeopathic remedy or Western herb. “Chinese medical theory sounds arcane but it was created by empiricists, just like medical science,” he adds. “Two disciplines based so much on observation and interpretation can’t be that far off from each other, and I’m now in a place where I can see they often are both saying the same thing, despite their apparent differences. In short, I’ve come to a place in my career where I practice only one medicine, and can select from various traditions, and even conventional medicine itself, a group of treatments that will work well in both the short and long term.” In 2009, Dr. Marsden was named Veterinarian of the Year by the Canadian Veterinary Medical Association. “At the time, I was advising Health Canada and the Veterinary Drug Directorate on new regulations on the safe use of alternative medicine in animals.” He has also written several textbooks, including the Manual of Natural Veterinary Medicine – Science and Tradition, co-authored with Dr. Susan Wynn, and lectures to veterinarians around the world about the practice of alternative medicine. He founded the Natural Path Herb Company, which
provides high quality organic herbs for veterinary use, and co-founded the Australia-based College of Integrative Veterinary Therapies, a leading distance education college for veterinarians interested in alternative therapies. “Last year, I received the Teacher of the Year award from the American Holistic Veterinary Medical Association. It came chiefly from my being asked to present at their annual conferences for the past 12 years.” It’s a busy life for one man, but Dr. Marsden has no regrets and believes passionately in what he does. “I do it strictly to effect some kind of change,” he says. “I’ve felt for myself how alternative medicine can revolutionize a veterinarian’s life and practice, bringing enormous gratification as he or she sees their efficacy skyrocket while becoming liberated from the practice of sending every second patient home on prednisone. “We are approaching a time when veterinarians can offer ‘the best of all possible worlds’, without straying from their comfort zones,” Dr. Marsden concludes. “With that in mind, I think the next couple of decades will see a revolution in veterinary practice, at least in North America. There will never have been a better time to be a doctor.”
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market trends Ten tips for building a strong relationship with clients
Today’s pet owners are more educated about animal care and view their dogs and cats as family members. Meeting their expectations includes making them part of your healthcare team. by charlotte walker esponsible pet owners are a savvy bunch these days. That was the consensus after speaking with a number of pet owners and several veterinarians about the client/veterinarian relationship. Pet owners seem to know a lot more about animal healthcare than they did decades ago, thanks to the many pet publications out there and the advent of the internet. More than ever, they want to be regarded as proactive partners in their animals’ care, rather than just being told what to do. This is perhaps even truer of those who favor the integrative approach to their animals’ care. These people have done their homework, which is why they are looking for alternative healthcare options in the first place. Here’s a checklist of things your clients might ask or expect of you and your clinic and staff. By being prepared and open to their expectations, you will build up good working relationships with clients that will endure for years – and consolidate and enhance the reputation of your practice. ONE Today’s pet owners want a clinic environment that’s comfortable, friendly and
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unintimidating, just as they would at their own doctors’ offices. Waiting rooms should be bright, spacious, clean and welcoming, furnished with comfortable chairs and decorated with calming color schemes. Depending on how much space you have, you might even consider separate waiting rooms for dogs and cats. TWO Clients will want to know that both they and their animals will be treated with kindness and respect. All staff, including front desk personnel, should be compassionate, patient and warmnatured. Good communication skills are a must. THREE You want your clients to respect you as well as trust you. Always present a professional appearance and demeanour. FOUR Listen to your client’s concerns and opinions, even if you don’t particularly agree with them. If you feel a client is wrong about something, explain it to him/her in a courteous manner. Honest and open dialogue is important, as it also builds client trust and respect. Offer clients as many options as you can for their animals’ care, and help them choose the best ones.
FIVE Courteously provide advice to clients when you feel they need it. For example, not everything they read online about a particular condition or treatment will be true. Guide them to reputable literature or websites if they want to learn more, or have printed information available.
Pet Safety Mat by
SIX Ensure your clients understand what you are telling them, especially when it comes to diagnoses and the available forms of treatment. This is another time when good communication skills come into play. Although many pet owners are well educated, don’t assume they understand technical or clinical terms. Explain disease processes and treatment procedures in a way that laypeople can understand, and answer any questions clients may have. SEVEN Don’t discredit any type of treatment. “It’s not about ‘leaving your Western mind at the door,’” says Dr. Narda Robinson, director of the Center for Comparative and Integrative Pain Medicine and Natural Healing at Colorado State University. “I still vaccinate and use antibiotics when there’s a need,” adds Dr. Mark Newkirk of Margate Animal Hospital and Alternative Care Center. “Traditional methods like ultrasound and steroids help with acute problems; holistic methods help when there’s a chronic condition and vitamins or amino acids are healthier long-term than steroids.”
[A] vet should be able to lay out the treatment plan. What are the expected outcomes? Exactly what does he plan to do, in what order? He should give [clients] materials to read so [they] can learn more and know what to ask. Dr. Mark Newkirk, BS, MS, VMD
EIGHT Don’t rush clients into making decisions. Unless it’s an emergency situation, give them time to think about how they want to proceed with their animals’ care. NINE If a client chooses a treatment you don’t offer, be willing and able to refer him or her to someone who does. “[You] may not want to do acupuncture or herbal care, but [you] should be able to refer [the client] to someone who does,” says Dr. Paul McCutcheon of the East York Animal Clinic in Toronto. “I don’t do dental surgery, but I refer patients to traditional surgeons.” TEN Make it clear to clients that the health of your animal patients is your top priority. Those who get the impression that money comes first will lose their trust in your clinic and start looking for another veterinarian. In summary, try to treat your clients like collaborative partners in their animals’ care. While your knowledge and experience are vital to ensuring they don’t make poor or ill-informed decisions, today’s pet owners want to feel they are taking a proactive role in how their companion animals will be cared for.
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