IVC Journal V10I3 (Summer 2020)

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IVC Summer 2020

IVC Summer 2020


contents FEATURES




By Chris Bessent, DVM, MSOM, DIPL. OM, L.AC. One out of two companion animals is obese. This article explores how obesity, diabetes, and other chronic diseases intersect, and why they are on the rise in cats, dogs — and people.

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Learn how this emerging specialty benefits veterinary teams and the humananimal relationship.


By Nancy Brandt, DVM, CVC, CVA, CVMA

Veterinarians and their staff are at risk of being exposed to viruses and infections, such as COVID-19. Biologically active essential oils are an effective alternative to disinfecting chemicals.





Canine obesity can lead to a range of diseases. Veterinary rehabilitation practices with weight loss programs will help overweight patients shed excess pounds, thereby improving their overall health and longevity.



By Barbara Royal, DVM, CVA


Supporting good cardiovascular health in dogs and cats requires an understanding of the heart’s hemodynamic role in the body, and the factors necessary for its optimal function.



By Megan Kelly, DVM

Most of us suffer self-doubt in the early years of our veterinary practice, and need the reassurance and guidance of an older successful professional — both for clinical skills, and for the critical skills of running a business.


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By Janet Gorden Palm, DVM, CVCP

When horses feel understood, they are more

IVC Summer 2020

at ease with handling. When clients feel they are “heard”, they are more compliant to your recommendations. This model helps you understand the emotional needs of your equine patients and clients.















By Margo Roman, DVM, and Karen Gellman, DVM, PhD

Being able to safely clean our valuable Personal Protective Equipment (PPE) so it can be reused is vital at any time, but especially during the COVID-19 pandemic. Here’s how medical ozone does the job.

By Lori Kogan, PhD

How has COVID-19 changed and impacted the relationship clients have with their dogs? This study explores how the pandemic has impacted human, veterinary and pet relations.


By Caroline Pattie, DVM, CVA

For new veterinary graduates, finding your niche in the profession can be challenging. Use these tips to help navigate your early career.

A UK study has demonstrated that, like human teenagers, dogs go through a moody adolescent stage when they’re in puberty.

By Marian Rowland, CVPM

How practice managers can effectively lead their teams during times of global uncertainty.

By Kathryn Rosalie Dench, DVM

Gaining a better understanding of Brachycephalic Airway Syndrome (BAS) in dogs is key to advising your clients on best management practices.

By Todd Cooney, DVM, CVH

A look at the effectiveness of homeopathy over the last few hundred years, and the methodology for use in epidemics.

advisory board


8 Editorial 12 From the NASC 21 Profitable practice

— Smart.Vet

29 Business profile

— VetBadger

37 IVC Virtual Expo 41 Industry innovations 44 From the IVAS 45 Business profile

— Nature's Logic

53 Profitable practice

— Angel's Animals

57 From the VBMA

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 co-owner of The Healing Oasis Veterinary Hospital, offering massage, rehabilitation, chiropractic and Chinese and Western Herbology. Michelle completed the Chinese Herbal Medicine program from the China Beijing International Acupuncture Training Center, and is certified in Chinese Medicine by the Wisconsin Institute of Chinese Herbology.

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.

65 Marketplace 66 News bites

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 Spring 2020



EDITORIAL DEPARTMENT Editor-in-Chief: Dana Cox Managing Editor: Ann Brightman Associate Editor IVC: Laurin Cooke, DVM Senior Content Editor: Emily Watson Senior Graphic Designer: Dawn Cumby-Dallin Senior Graphic Designer: Alyssa Dow Web Design & Development: Lace Imson Social/Digital Media Specialist: Rebecca Bloom

COLUMNISTS & CONTRIBUTING WRITERS Chris Bessent, DVM, MSOM, Dipl. OM, L.Ac. Bill Bookout Nancy Brandt, DVM, CVC, CVA, CVMA Todd Cooney, DVM, CVH Kathryn Rosalie Dench, DVM Jessica Dreyfuss, DVM, CVA, CCRT, CVFT Karen Gellman, DVM, PhD Janet Gordon Palm, DVM, CVCP Megan Kelly, DVM Lori Kogan, PhD Cynthia Lankenau, DVM Minda Lemmon, PT, CRTS, CKTP, RRCA Running Coach, Bike PT Nell Ostermeier, DVM, CVA, FAAVA Caroline Pattie, DVM, CVA Bethanie Poe, LMSW Margo Roman, DVM Marian Rowland, CVPM Barbara Royal, DVM, CVA

ADMINISTRATION & SALES Publisher: Redstone Media Group President/C.E.O.: Tim Hockley Accounting: Susan Smith Circulation & Office Manager: Libby Sinden

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SUBMISSIONS: Please send all editorial material, photos and correspondence to Dana Cox at Dana@redstonemediagroup.com or IVC Journal, 160 Charlotte St., Suite 202 Peterborough, ON, Canada K9J 2T8. We welcome previously unpublished articles and color pictures either in transparency or disc form at 300 dpi. We cannot guarantee that either articles or pictures will be used or that they will be returned. We reserve the right to publish all letters received. ADVERTISING SALES: Senior Media Specialist/Editorial Associate: Kat Shaw, (866) 764-1212 ext. 315 Katshaw@redstonemediagroup.com Business Development/Editorial Associate: Becky Starr, (866) 764-1212 ext. 221 Becky@redstonemediagroup.com Multimedia Specialist: Drew Beth Noble, (866) 764-1212 ext. 228 Drew@redstonemediagorup.com Multimedia Specialist: Britt Silver, (866) 764-1212 ext. 226 Britt@redstonemediagroup.com Subscription Services Manager: Brittany Silloats, (866) 764-1212 ext. 100 Brittany@redstonemediagroup.com CLASSIFIED ADVERTISING: Libby Sinden classified@IVCJournal.com US MAIL: IVC Journal, 6834 S University Blvd PMB 155 Centennial, CO 80122 CDN MAIL: IVC Journal, 202-160 Charlotte St. Peterborough, ON, Canada K9J 2T8. The opinions expressed in this journal are not necessarily those of the editor, and different views may appear in other issues. Redstone Media Group Inc., publisher of IVC Journal, does not promote any of the products or services advertised by a third party advertiser in this publication, nor does Redstone Media Group Inc. verify the accuracy of any claims made in connection with such advertisers.


IVC Journal (ISSN 2291-9600) is published four times a year by Redstone Media Group Inc. Publications Mail Agreement #40884047. Entire contents copyright© 2020. No part of this publication may be reproduced or transmitted by any means, without prior written permission of the publisher. Publication date: June 2020.

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


IVC Summer 2020

contributors 1









Dr. Chris Bessent has over 30 years of experience in veterinary medicine, and has certificates in veterinary acupuncture, veterinary chiropractic, and veterinary Chinese herbology. She also received her degree in veterinary nutrition and founded The Simple Food Project, formulating freeze-dried raw food diets for cats and dogs using nothing but whole foods. Currently, Dr. Bessent divides her time between The Simple Food Project and Herbsmith, a manufacturer of premium quality supplements for pets. Both are owned and operated out of her facilities in southeastern Wisconsin (simplefoodproject.com, herbsmithinc.com). P 9


Dr. Nancy Brandt graduated from the University of Minnesota College of Veterinary Medicine in 1990, and later began her studies in acupuncture, Chinese medicine, chiropractic medicine, and naturopathic modalities. In 1999, she founded her practice, Natural Care Institute, and in 2017, she founded UnBound Center for Animal Wellness, for special needs pets. Dr. Brandt pioneered the field of Veterinary Medical Aromatherapy® and founded the Veterinary Medical Aromatherapy Association (nancybrandtdvm.com, sparkeducationonline.com). P 18


Dr. Todd Cooney graduated from Purdue University College of Veterinary Medicine. After almost 20 years of conventional practice, he took Dr. Richard Pitcairn’s Professional Course in Veterinary Homeopathy and changed the way he viewed health and disease. He began to use homeopathy in his practice, and now uses it exclusively on all his cases. His practice is located in north-central Indiana. He also does long distance consulting, and serves as an instructor for the Pitcairn Institute of Veterinary Homeopathy. P 60


Dr. Kathryn Rosalie Dench is a veterinary surgeon qualified from Cambridge University. She has over ten years of experience working in a clinic setting, and is passionate about animal health and welfare. P 59


Dr. Jessica Dreyfuss (HolisticVeterinaryInstitute.com) graduated with honors from  Duke University  and received her  veterinary degree with honors from North Carolina State University. Dr. Jessie is a Certified Veterinary Acupuncturist , Certified Canine Rehabilitation Therapist, and a Certified Veterinary Food Therapist. She is a teaching assistant instructor at the prestigious Chi Institute at University of Florida Veterinary School, and is the owner and Medical Director of Healing Paws Center (HealingPawsFL.com). She also offers her own online pet health educational platform with online courses for the public and pet professionals at HolisticVeterinaryInstitute.com. P 22


Dr. Karen Gellman is a graduate of Cornell College of Veterinary Medicine, and has a doctorate in animal locomotion biomechanics. She has advanced training and certification in veterinary acupuncture and veterinary chiropractic, and has practiced these and other modalities since 1995. She has been a speaker for IVAS, IVCA, AVDF, IAED and the Danish Veterinary Chiropractic Association. Dr. Gellman is the educational director and teacher in the Postural Rehabilitation training course for veterinarians, and teaches biomedical research programs for high school students at Cornell. She is Research Director of Maximum Horsepower Research, and principle investigator of a study on equine posture funded by the AHVMA. P 41







Dr. Janet Gordon Palm (KSU ‘81) is a practicing integrative veterinarian. Through the years, her multi-species practice has evolved due to her discovery of ways to activate the body’s inherent pharmacy. This inspired her pursuit of LLLT, VOM, craniosacral and osteopathy through her business, Animobility Integrative Veterinary Services. A Parelli Natural Horsemanship student, Dr. Palm uses concepts of respecting body language in all species she works with, resulting in an enhanced veterinary experience for all. P 32


Dr. Megan Kelly owns and runs onlinepethealth.com, an international continuing education site for veterinary rehabilitation therapists. Every day she pushes the boundaries on what is considered the norm for professional education, creating, innovating and providing online solutions and outstanding customer experiences through webinars and online conferences for vets and veterinary rehabilitation therapists. P 26


Dr. Kogan is a Professor in the Department of Clinical Sciences of Colorado State University Veterinarian Medicine and Biomedical Sciences. She has published numerous journal articles, co-edited several books, and given presentations on topics related to human-animal interactions in both psychology and veterinary medicine venues. Dr. Kogan is currently engaged in several research projects pertaining to the intersection of the human-animal bond and veterinary medicine. In her quest to assess alternatives to traditional medicine for pets, she has published several papers related to the use of CBD in companion animals. P 46


Dr. Caroline Pattie is a 2008 graduate of the Virginia-Maryland Regional College of Veterinary Medicine, and obtained her certification in acupuncture from the Chi Institute in 2009. She is a senior associate at a busy and progressive 24/7 hybrid emergency/general practice in Northern Virginia, with diverse interests in clinical practice, education, industry, and public outreach. Dr. Pattie has been nominated to join the AHVMA Board of Directors in the fall of 2020. P 48


Dr. Bethanie Poe has been involved with the University of Tennessee Veterinary Social Work program for over a decade, first as a graduate student when she helped develop the Veterinary Social Work Certificate Program, and now as an instructor. Dr. Poe is currently the Middle Tennessee Coordinator for UT’s Human-Animal Bond in Tennessee (H.A.B.I.T) program, where she strives to make animal assisted interventions available to victims of crime. P 13


Dr. Margo Roman graduated from the Veterinary College at Tuskegee Institute of Alabama, and was on the faculty of Tufts University, teaching anatomy, physiology and acupuncture. She was the consulting veterinarian in an IACUC for Creature Biomolecule in Hopkinton, Massachusetts, studying osteogenic proteins. Dr. Roman’s integrative practice, Main Street Animal Services of Hopkinton (M.A.S.H.), offers chiropractic, physical therapy, massage, Reiki, acupuncture, herbs, conventional medicine and more. P 41


Marian Rowland has been working in the veterinary industry for 11 years, eight of which have been in practice management. She earned a bachelor’s degree in business management from Clemson University, obtained the designation of Certified Veterinary Practice Manager in 2015, and received the South Carolina Association of Veterinarians Veterinary Hospital Employee of the Year Award in 2016. Her special interests are leadership, practice culture, human resources, staff training, and hospital policies. P 54

IVC Spring 2020



THOUGHTS ON THE PANDEMIC AND OUR VETERINARY PROFESSION This is certainly not the topic I thought I would be writing about for this summer’s Editorial. A global pandemic, along with lockdowns, shuttered schools, face masks, and daily news reports that are often hard to stomach. Email after email with updates about the virus, epidemiology, susceptibility — and how our profession is being affected, as one that is declared essential for both public and animal health. I loved vet school. Yes, there was a lot to study, learn, and process. But I loved the predictable routine. A finite number of classes per semester, and for each, a fresh new syllabus, new notebooks, new texts. Everything neatly organized and divided into subjects. I loved the flow charts and algorithms. A clear set of rules to follow for problem-solving, if meticulously adhered to, would give me logical ways to arrive at diagnoses and treatments. I was committed to perfection, not because I needed the accolades, but because it made me feel safe, as if disease had already been conquered. Sure, there were chronic illnesses whose treatments required some fine-tuning, but for the most part, science had already figured out the answers. All I had to do was learn them. Well… as we all quickly discover, practice is not perfect! Every day, those straight flow chart lines can get squiggly and loopy and sometimes run right off the page. Animals don’t read the textbooks, and neither do clients. And many other variables are thrown into the mix: resources, finances, education, attitudes, and opinions. And global pandemics. We quickly adapt to the futility of perfection and just try to do the best with what we have. This resourcefulness, this flexibility, this thinking-on-your feet mentality all veterinarians develop by necessity are serving our profession well in the time of COVID-19. By adapting almost overnight to curbside check-ins, rationing PPE, navigating supply shortages, protecting staff,


IVC Summer 2020

implementing telemedicine, and reassuring clients, veterinarians are demonstrating what they have been trained to do all along — be calm and collected leaders when many pieces of the puzzle are missing. I hope you find plenty of inspiration, ideas, and innovation in this issue of IVC Journal. Learn how to disinfect valuable PPE with ozone, and implement foot baths with biologically active essential oils. Coronavirus pandemic aside, there is also an epidemic of obesity in our companion animals. Explore the nutrition of weight loss and learn how general practices and rehabilitation clinics can work together to help obese patients. Get informed about the newer field of veterinary social work, as the services of these professionals will most certainly be needed in the coming months and years. And see how identifying the emotional framework of both horse and client can aid in diagnostics and therapy. For our new graduates, everyone at IVC Journal welcomes you to the veterinary profession! Even though your graduation ceremonies had to be virtual, we nevertheless congratulate you on all you have accomplished. Your open hearts, fresh perspectives, and nimble minds will refresh our profession with new energy. Enjoy articles on finding your place in practice and on the value of mentorship! Be well. Stay safe. Continue on.

Laurin Cooke, DVM Associate Editor, drlaurin@ivcjournal.com P.S. We’re so excited to announce the Innovative Veterinary Care Virtual Expo (IVCVX) — the first ever veterinary conference on the moon! See p. 37 for more details or visit IVCVX.vet.

nutrition nook

Obesity and chronic disease in dogs and cats BY CHRIS BESSENT, DVM, MSOM, DIPL. OM, L.AC.

One out of two companion animals is obese. This article explores how obesity, diabetes, and other chronic diseases intersect, and why they are on the rise in cats, dogs — and people.

Obesity and obesity-related diseases such as diabetes run rampant in our society. In 2017 and 2018, 42.4% of Americans were considered obese, a staggering increase from the 30.5% of two decades earlier. During the same time frame, severe obesity rose from 4.7% to 9.2% of the population.1 The numbers are even worse for cats and dogs. As of 2018, according to the Association for Pet Obesity Prevention (APOP), an estimated 56 million cats (58.9%) and 50 million dogs (53.9%) were considered overweight or obese.2 By effectively dealing with obesity in our animal patients, we can help prevent them from developing diabetes and a host of other weight-related problems.

HIGH PROTEIN VS. HIGH CARBOHYDRATE DIETS High protein diets utilize protein for the continual maintenance of body tissues. When there’s more than necessary, the amino acids are used to produce glucose via gluconeogenesis. Gluconeogenesis is an energy-consuming process. Six moles of ATP are required to synthesize one mole of glucose from pyruvate or lactate.7 The additional ATP is needed to dispose of the nitrogen as urea. Cats, as obligate carnivores, are the superstars of gluconeogenesis. This process provides them with a steady low level of glucose.

CARBOHYDRATES AND COMPANION ANIMALS Cats: High carbohydrate diets utilize glucose for energy needs. But when cats consume excess carbohydrates, an unnatural cascade of events occurs. Cats have minimal glucokinase activity, which leads to prolonged hyperglycemia following a high carbohydrate meal, and prolonged hyperglycemia culminates in hyperinsulinemia.8.9 Eventually, insulin receptor resistance occurs as well.10 The scenario repeats with the next meal. This repeated glucose intolerance leads to obesity and inevitably Type 2 diabetes.11,12 High carbohydrate diets truly represent ultimate nutritional abuse for cats. Continued on page 10. IVC Summer 2020


Calorie composition matters There is no question that a high energy intake combined with low activity levels leads to obesity in humans as well as companion animals. But adhering to the notion that all calories are equivalent provides only a surface-level understanding of nutrition. When you look deeper, the composition of calories matters. The way the body metabolizes a calorie plays a crucial role in thermogenesis and the hormonal cascade needed to utilize the consumed energy, as obesity is connected with increased insulin resistance and abnormal glucose homeostasis.

Continued from page 9.

Dogs: Canine pancreatitis is a common condition seen by the practicing veterinarian, and can be attributed to long term, high carbohydrate diets. The average dry dog food contains 41% carbohydrate. These high carbohydrate meals over-stimulate the pancreas to produce immense amounts of amylase. In fact, the amylase activity in the duodenum of a dog fed dry food was 8.5 times higher than in a dog fed a raw meat and lung diet.13 Chronic pancreatic over-stimulation of amylase activity takes its toll.


Decrease energy per meal by increasing fiber levels

The literature features mixed reviews about the concept of bulk-induced satiety in pets. And unfortunately, most of these diets are still high in soluble carbohydrates, leading to the abnormal cascade of hormonal events. Even diets with reduced energy content due to fiber dilution may not provide all the needed nutrients, especially protein.14


Change the macronutrient proportions

Adjust the diet’s proportions from commercial dry pet food with its low protein, moderate-to-high carbohydrate content, to meals that are high in protein and low in carbohydrates. Much of this research focuses on the effects on postprandial glucose and insulin levels, as well as the sensitivity of insulin receptors. After a high protein/low carbohydrate meal, both blood glucose and insulin levels stabilize throughout the day. Though weight loss is more gradual, there is also a recovery of insulin receptor sensitivity with fewer spikes in glycemia.15 Weight loss diets with high protein/low carbohydrate content have also been shown to preserve muscle mass during weight loss. The amount of fat reserves is diminished as muscle mass is conserved.16

REDUCING THOSE NUMBERS ON THE SCALE Obesity can be addressed in several ways, though some of these methods are more effective than others.


Decrease energy per meal and increase activity

This absolutely works to reduce body weight. But pets hate it. And then their owners hate it even more, eventually giving in to the dog or cat’s begging. Plus, diets with reduced energy content may provide suboptimal levels of muchneeded nutrients, especially protein.

Thin dogs have low leptins and high adiponectin. Obese dogs have high leptins and low adiponectin.


IVC Summer 2020

Further, an increase in postprandial thermogenesis occurs with high protein/low carbohydrate meals. This effect is most likely due to the energy-consuming process of gluconeogenesis. The increased thermogenesis is also associated with weight loss.

THE ROLES OF LEPTIN AND ADIPONECTIN Leptin and adiponectin also play essential roles in obesityrelated inflammation. • Leptins are satiety hormones that communicate how much fat is stored in the body and signal the dog’s brain to stop eating. Higher levels indicate the body has adequate fat stored; lower levels signify the need to eat.

• Adiponectin exerts anti-inflammatory properties on cells lining blood vessels; higher numbers are beneficial. Low levels of adiponectin (as found in obesity) are associated with inflammation, lipid abnormalities, insulin resistance, and increased risk of diabetes in humans. In a recent study evaluating high protein diets in obese dogs, the leptin and adiponectin levels showed that these diets are associated with low postprandial peak leptin concentrations and the smallest decrease in adiponectin release.17 This research suggests that a higher protein diet may improve immune metabolic health and satiety in overweight dogs.

GLYCEMIC INDEX OF CARBOHYDRATES There is a strong association between low glycemic index foods and weight loss in humans, dogs, and cats.18 The highest glycemic food is sugar; rated at 100, sugar causes the highest rise in blood sugar two hours after eating. Potato and brown rice are high glycemic foods; corn and sweet potato are moderate glycemic foods; and grains such as sorghum and barley are low glycemic foods. The low glycemic foods provide a level of satiety by minimizing postprandial insulin rise and preserving the sensitivity of insulin receptors.19,20 Interestingly, according to APOP, of the 1,156 pet owners and 574 veterinary professionals surveyed, only 28% of pet owners and 20% of veterinary professionals felt that a low glycemic diet is healthier for dogs. Conversely, 62% of pet owners and 41% of veterinary professionals “did not know” whether it was healthier.

Human obesity trends People have been fed the dogma that high fat diets are the source of most of our chronic diseases, especially obesity. Given the poor longterm success rates of low fat/high carbohydrate diets, however, this idea is being reconsidered. 3 Carbohydrate consumption is now in question because of its connection to obesity and Type 2 diabetes; obesity is one of the strongest risk factors for developing the disease.4 And obesity is second only to hypertension in risk factors for cardiovascular disease. 5 Evidence suggests that obesity also correlates with a higher risk of several specific cancers, including pancreatic and thyroid cancers.6 These widespread issues are intrinsically related to consuming a high carbohydrate diet and the hormonal cascade of events that follow.

Whether dog, cat, or human, obesity and obesity-related chronic diseases are on the rise, and bordering on epidemic levels. Abundant research in dogs and cats supports that hormonal imbalance is associated with chronic highcarbohydrate consumption.21,22 The content of calories is important (see sidebar at left), and without also evaluating the hormonal regulation of catabolism, thermogenesis, and macronutrient balance in the diet, we aren’t adequately serving the companion animals in our care. Feeding high protein/low glycemic index carbohydrate diets can promote and maintain weight loss, control obesity, and curb their preventable related diseases.

“Obesity is a Common, Serious, and Costly Disease”. Centers for Disease Control and Prevention. https:// www.cdc.gov/obesity/data/adult.html. Published 2020. Accessed May 14, 2020. 2 Association for Pet Obesity Prevention. https://petobesityprevention.org/. Published 2020. Accessed May 14, 2020. 3 Camacho Salvador, Ruppel Andreas. “Is the Calorie Concept a real solution to the obesity epidemic?” Global Health Action. 2017;10(1):1289650. 4 Wu Y, Ding Y, Tanaka Y, Zhang W. “Risk factors contributing to type 2 diabetes and recent advances in the treatment and preventio”. Int J Med Sci. 2014;11(11):1185–1200. 5 Benjamin E, Muntner P, Alonso A, et al. “AHA 2019 Heart Disease and Stroke Statistics — American College of Cardiology”. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2019/02/15/14/39/ aha-2019-heart-disease-and-stroke-statistics. Published 2020. Accessed May 14, 2020. 6 “Obesity and Cancer Fact Sheet”. National Cancer Institute. https://www.cancer.gov/about-cancer/ causes-prevention/risk/obesity/obesity-fact-sheet. Published 2020. Accessed May 14, 2020. 7 Manninen AH. “Is a Calorie Really a Calorie? Metabolic Advantage of Low-Carbohydrate Diets”. J Int Soc Sports Nutr. 2004; 1, 21. 8 Hewson-Hughes AK, Gilham MS, Upton S, Colyer A, Butterwick R, Miller AT. “Postprandial glucose and insulin profiles following a glucose-loaded meal in cats and dogs”. Br J Nutr. 2011;106. 9 Hewson-Hughes AK, Gilham MS, Upton S, Colyer A, Butterwick R, Miller AT. “The effect of dietary starch level on postprandial glucose and insulin concentrations in cats and dogs”. Br J Nutr. 2011;106. 10 Bierer T, Bui L. “High-Protein Low-Carbohydrate Diets Enhance Weight Loss in Dogs”. J Nutr. 2004;134(8):2087S-2089S. 11 Nelson R, Reusch C. “Animal Modes of Disease: Classification and etiology of diabetes in dogs and cats”. J of Endocrinology. 2014;222(3):T1-T9. 12 Farrow HA, Rand JS, Morton JM, O'Leary CA, Sunvold GD. “Effect of dietary carbohydrate, fat, and protein on postprandial glycemia and energy intake in cats”. J Vet Intern Med. 2013;27(5):1121–1135. 13 National Research Council, et al. Nutrient Requirements of Dogs and Cats. National Academies Press, 2006, p. 57. 14 Diez M, Nguyen P, Jeusette I, Devois C, Istasse L, Biourge V. “Weight loss in obese dogs: evaluation of a high-protein, low-carbohydrate diet”. J Nutr. 2002;132(6 Suppl 2):1685S–7S. 15 André A, Leriche I, Chaix G, Thorin C, Burger M, Nguyen P. “Recovery of insulin sensitivity and optimal body composition after rapid weight loss in obese dogs fed a high-protein medium-carbohydrate diet”. J Anim Physiol Anim Nutr (Berl). 2017;101 Suppl 1:21–30. 16 Bierer T, Bui L. “High-Protein Low-Carbohydrate Diets Enhance Weight Loss in Dogs”. J Nutr. 2004;134(8):2087S-2089S. 17 Blees NR, Wolfswinkel J, Kooistra HS, Corbee RJ. “Influence of macronutrient composition of commercial diets on circulating leptin and adiponectin concentrations in overweight dogs”. J Anim Physiol Anim Nutr (Berl). 2020;104(2):698–706. 18 Mitsuhashi Y, Nagaoka D, Ishioka K, et al. “Postprandial lipid-related metabolites are altered in dogs fed dietary diacylglycerol and low glycemic index starch during weight loss”. J Nutr. 2010;140(10):1815–1823. 19 Mitsuhashi Y, Nagaoka D, Bigley KE, Umeda T, Otsuji K, Bauer JE. “Metabolic and Hormonal Alterations with Diacylglycerol and Low Glycemic Index Starch during Canine Weight Loss”. ISRN Vet Sci. 2012;2012:750593. Published 2012 Dec 19. 20 Brand-Miller JC, Holt SH, Pawlak DB, McMillan J. “Glycemic index and obesity”. Am J Clin Nutr. 2002;76(1):281S–5S. 21 Kimura T. “The regulatory effects of resistant starch on glycaemic response in obese dogs”. Arch Anim Nutr. 2013;67(6):503–509. 22 Brunetto MA, Sá FC, Nogueira SP, et al. “The intravenous glucose tolerance and postprandial glucose tests may present different responses in the evaluation of obese dogs”. Br J Nutr. 2011;106 Suppl 1:S194–S197. 1

IVC Summer 2020


From the NASC Scrutinize product claims when choosing supplements to sell or recommend BY BILL BOOKOUT

When reviewing health and nutritional supplements to carry in your practice or recommend to clients, it’s very important to pay close attention to product claims on packaging and marketing materials. Marketers know you’re busy, and that they have very little time to capture your attention and convince you to take a closer look. The language they use can make all the difference. Unfortunately, some brands take a “say anything” approach to selling that misleads buyers and casts a negative shadow on the entire supplement industry. The U.S. Food & Drug Administration’s Center for Veterinary Medicine regulates animal health and nutritional supplements, and follows the law established in the Federal Food Drug & Cosmetic Act regarding product claims, in order to protect consumers and animals. The good news is the majority of pet supplement suppliers understand and follow these rules and are careful to make credible claims allowable by law. Many of these suppliers are members of the National Animal Supplement Council and have access to succinct labeling guidance to help them follow the law and avoid making errant or egregious claims. Keep a careful eye out for suppliers that disregard the rules for product claims.


IVC Summer 2020

They are fairly easy to spot when you know what to look for: • Words that state or imply the product will treat, prevent, cure or mitigate a disease. Example: “Aids against UTIs and bladder infections”. • Use of any disease name or reference to a disease. Example: “Fights gingivitis and periodontal disease”. • A ny stated or implied comparison to, or replacement for, pharmaceuticals. Example: “Reduces the need for prescription pain medication”.

concise. They communicate that the product helps support the normal structure and function of a dog or cat’s body rather than trying to correct an abnormal condition or disease. And perhaps most importantly, allowable claims don’t rely on absolutes or language that over-promises outcomes. Allowable product claims include: • “Contains ingredients to support a healthy urinary tract” • “ Promotes normal periodontal health” • “Maintains healthy liver function”

• A ny reference to a chronic condition. Example: “Protects against chronic pain and inflammation”.

• “Supports a healthy inflammatory response”.

• Claims disguised as product names. Example: “Inflamm-Relief”.

Supplements are not a magic bullet. If a claim sounds too good to be true, it probably is. Selecting products with the NASC Quality Seal will help ensure you are dealing with suppliers that responsibly produce and market their products within the bounds of the law, rather than preying on consumer vulnerabilities in the name of profit.

Keep in mind that product and brand marketing are an extension of the label, and are therefore subject to the same rules. Apply the same cautious scrutiny when visiting a company website as you would when looking at the product package. This also applies to internet advertising, trade show materials, social media posts, blogs, e-newsletters and YouTube channels, as well as more traditional advertising like radio, TV and print ads. Allowable or “good” claims on supplements are typically simple and

Bill Bookout is president and founder of the National Animal Supplement Council. He has more than 30 years’ experience in the animal health industry and holds a bachelor’s degree in physical sciences from the University of Wyoming, and a master’s degree from the Pepperdine University Presidents and Key Executives MBA program.



Learn how this emerging specialty benefits veterinary teams and the human-animal relationship.

If you ask veterinarians why they chose their profession, a love of animals typically tops the list. However, the animals don’t bring themselves to the veterinary hospital; they all come in the company of at least one person with whom the veterinary team must interact, whether it’s an owner, animal control officer, rescue volunteer, or even a zookeeper. And while the medicine may be straightforward, interactions with people — particularly in high anxiety situations such as when an animal is injured, sick, or dying — can be complicated. In addition to doing the best for animals, veterinarians often find themselves wading through intense emotions, financial worries, conflicts, and high levels of stress. Wouldn’t it be great if there was someone who understood the importance of the human-animal relationship, and how to navigate the issues that come up for people in a veterinary setting? Good news — there is! They’re called veterinary social workers. Veterinary social work practice (see sidebar on page 15) is generally broken down into four major categories:

Animal-related grief and bereavement If you have ever lost a pet you were deeply attached to, you know what a heart-wrenching experience it can be. In studies, pet owners often identify their animals as friends, companions, their babies or children. Unlike our relationships with other people, our relationships with animals are uncomplicated. For many, animals are a source of companionship, protection, emotional support, and unconditional love. Companion animals are often with their caregivers many hours a day over many years. A pet may set the routine for a person’s day, with walks, feeding, and playtime, all of which can vanish when the animal passes away. When we take all this into consideration, it’s no wonder that the loss of a pet can cause intense feelings of grief. While pet ownership is common, pet loss is still a form of disenfranchised grief, meaning that the loss is not readily recognized by society in general. Statements such as “it was just a cat” or “you can get another dog” from seemingly well-intentioned friends and family members IVC Summer 2020


can leave the grieving person feeling misunderstood, isolated, and confused about the intensity of their feelings. In a veterinary setting, a social worker can be of assistance before as well as after the death of a pet. For clients who are coping with an animal’s illness or injury, or trying to decide about euthanasia, the social worker can provide emotional support, facilitate communication, and provide tools to help with decision making. A veterinary social worker can be present to support the client during euthanasia, so the veterinarian is able to focus on the animal. After the loss of a pet, a veterinary social worker can help normalize what the grieving person is experiencing and help them move through the mourning process via one-on-one counseling, pet loss support groups, memorial events, or a combination of these.

The link between human and animal violence Called “the Link” for short, the link between human and animal violence refers to the correlations between animal abuse and other types of violence, such as intimate partner violence, child abuse, and elder abuse. Animal fighting, such as dog fights or cockfighting, as well as


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animal hoarding, fall under this umbrella term as well. For hundreds of years, people have acknowledged that when someone is violent towards animals, they are often also violent towards people and display other types of antisocial behavior. Research in this field began in the 1970s and continues today. Based on those results, animal abuse that may once have been dismissed as “only a cat” or “boys being boys” is today recognized as a red flag for other problems. By being aware of the Link, veterinary social workers can help in a variety of ways, such as developing services for pet-owner domestic violence survivors; including questions about animal abuse in child abuse assessments; and treating children and adults who abuse animals.

Animal assisted interventions (AAIs) In contrast to pet loss and the Link, animal assisted interventions could be considered the lighter side of veterinary social work. While animal assisted interactions is the all-encompassing term for all kinds of human-animal encounters, animal assisted interventions refers to instances in which an animal is deliberately used for some therapeutic purpose. While dogs and horses are some of the most commonly-used animals in AAI, a wide variety of others can be used, including other common companion animals such as cats, rabbits, and birds, as well as livestock like goats, llamas, donkeys and other equines. While bringing an animal into a person’s treatment regime might sound like fun, there are a lot of things to consider. First, what is the purpose of bringing in the animal? Service animals can provide tremendous support to clients living with various types of disabilities. In other cases, the use of an animal in therapy might help a client stay calm and

Defining focused when talking about difficult subjects. Animals can be incorporated into physical and occupational therapy, as clients improve muscle strength and balance by learning to ride a horse or improve their grip by throwing a ball for a dog. Visiting therapy animals may be used to brighten a person’s day in a variety of settings, including mental health clinics, hospitals, schools, residential facilities, courtrooms — even some accountants’ offices during tax season! Animals to be used in AAIs must receive appropriate training and have a temperament suitable for the tasks they will be asked to do. Just like us, animals vary in their skills and preferences, so some will do better in some situations than others, even if they all pass their evaluations. Most importantly, the welfare of the animal must be top priority. Only animals who have been evaluated by reputable AAI organizations should be used. Handlers should be in tune with their animals and intervene if the animals seem stressed or uncomfortable. Animals used in AAIs need breaks and time to rest. Lastly, we must also recognize that there are situations in which AAIs are not appropriate; for example, if the client has allergies, an intense fear of animals, or is violent.

Compassion fatigue and conflict management While the other areas of veterinary social work often focus on animal owners, the last area is centered on animal-related professionals. Compassion fatigue, or secondary traumatic stress, is a form of burnout that shows up as physical, emotional, and spiritual exhaustion. It can also be described as the result of working very hard, and caring very much, while not recognizing and caring for one’s own personal needs. The symptoms of compassion fatigue show in myriad ways, including PTSD, or abuse of drugs, alcohol or food. Physical symptoms include headaches, gastrointestinal problems, exhaustion, and sleep disturbances, as well


Social workers are professionals whose main mission is to “enhance human well-being and help meet the basic human needs of all people” (NASW). The profession of social work is title protected, meaning that in order to be a social worker a person must hold at least a bachelor’s degree in social work from an accredited university; many social workers go on to earn their master’s degrees in order to become licensed clinicians. In addition to earning a college degree, social workers must pass state licensing exams and complete a period of supervised practice over several years before being allowed to work independently. The term “veterinary social work” was coined in 2002 by Dr. Elizabeth Strand, MSSW, PhD at the University of Tennessee. Veterinary social work is a specialized area in which social workers are educated on how to address challenges that can arise for people when dealing with the human-animal relationship. Veterinary social workers may work with people on a one-to-one basis, or on a bigger scale such as working with communities or influencing local, state, or national policies. When people hear the term “veterinary social work”, the first question that often comes to mind is: “So, you do therapy on pets?” Not exactly! As with people working in veterinary medicine, many veterinary social workers are first attracted to the field because they are animal lovers. However, veterinary social workers stick to the ethical code, practice standards, and paradigm of all social work, which means they focus on meeting human needs and well-being and leave animal welfare in the skilled hands of the veterinary profession. A veterinary social worker is someone who can work to facilitate problem solving, decision making, and psychoeducation about issues that involve animals. The hope is that by improving circumstances for the people involved, the animals will benefit as well.

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as feelings of hopelessness, anger, depression, and a decreased sense of personal accomplishment. In some cases, these symptoms may lead to suicidal thoughts or actions. Communication challenges such as giving bad news, coping with difficult clients, and effectively working in teams are often cited as major stressors for veterinarians. Veterinary social workers can help mitigate some of this stress in a few different ways. In some situations, they function as a liaison between clients and the veterinary team, making the communication process smoother and clearer. In other situations, a veterinary social worker might serve in a coaching capacity, providing the veterinary team with feedback on how to approach a difficult topic or client, along with communication tactics and opportunities for the team to practice. In some veterinary colleges today, like the University of Tennessee, students receive communications training as a part of their curriculum in order to better prepare them for their future practice. In addition to working on communication skills, veterinary social workers can also help veterinary professionals develop healthy stress management techniques. Equipped with the advocacy, communication expertise, and skills of a social work education, along with specialized training related to human-animal relationships, veterinary social workers are a useful ally for veterinary professionals who are working toward bettering the lives of people and animals. To learn more about this specialty, and how to access a veterinary social worker in your area, as well as educational opportunities for veterinary professionals, visit the University of Tennessee Veterinary Social Work program’s website at vetsocialwork.utk.edu.

NASW: Read the Code of Ethics. (n.d.). Retrieved April 6, 2020, from https://www.socialworkers.org/About/Ethics/Code-of-Ethics/ Code-of-Ethics-English. National Link Coalition. (n.d.). Retrieved April 6, 2020, from http://nationallinkcoalition.org/. Veterinary Social Work. (n.d.). Retrieved April 6, 2020, from https://vetsocialwork.utk.edu/. Strand EB, Poe BA, Lyall S, Yorke J, Nimer J, Allen E, Nolen-Pratt T. (2012). “Veterinary Social Work Practice”. In Social work fields of practice historical trends, professional issues, and future opportunities (pp. 245–271). Hoboken, NJ: Wiley.


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Meeting the physical and emotional needs

of senior animals through grooming Age can present a number of challenges for animals — decreased mobility, loss of appetite, labored breathing, mood changes, and a general lack of “zest” for life. Though aging affects every animal differently, it’s the job of the caregiver to make their animals’ golden years as comfortable as possible, physically and emotionally. To help clients support their aging animals, the benefits of therapeutic grooming should not be overlooked.

Therapeutic grooming — the benefits are numerous One of the most effective ways to improve the comfort and overall health of a senior animal is through grooming with the intention of providing a massage. Grooming in this manner will increase circulation to oxygenate the blood, reduce inflammation, relieve arthritic pain, muscle tension, soreness and weakness, improve flexibility and mobility, reduce anxiety and stress, improve mood and provide comfort. The correct grooming tool is essential. Because the skin of many older pets becomes fragile and can develop tags, lumps and bumps, grooming with traditional tools can be a painful experience as most are not typically designed to mimic a massage. An ideal alternative to suggest to clients is the StripHair ® Gentle Groomer. The soft and flexible structure easily conforms to the body, and because it does not rely on bristles or a blade, there is no risk of causing discomfort or injury. The Gentle Groomer ® does more than just alleviate the anticipatory fear of discomfort from having the skin scratched or the coat tugged — it provides a relaxing experience for both the senior pet and the caregiver. This comfortable form of grooming

becomes a mutually beneficial activity that enhances the human-animal bond, rather than a rushed, “just get it done,” experience. Odor is another common problem for senior dogs. If all internal causes have been ruled out, The Gentle Groomer ® can help address foul smells by distributing the skin’s natural oils to clear the dried pungent sebum formations from the hair follicles and remove dander along with the shedding hair. The result is a healthy looking coat without the “old dog smell”. Other useful products to encourage your clients to keep on hand are Betty’s Best Skin & Coat Grooming Cloth Wipes — saturated with high quality plant-based oils and extracts designed to keep the coat and skin clean and fresh without regular baths, which can be difficult to administer once dogs reach a certain age. For minor skin issues, Betty’s Best Healthy Skin Spray, also made from plant-based oils and extracts, is formulated as a spot treatment to address issues such as dry skin, hot spots, and inflammation, and can also be applied to the underbelly and legs before going outside to ward off fleas, ticks and biting insects.

A loving presence: your best prescription Above all, encourage your clients and their families to be present, mindfully, with their senior animals each day. Whether through therapeutic grooming, leisurely outings, fun games, or gentle exercise, taking the time to just be with senior pets strengthens the bond and keeps them engaged well into their twilight years. IVC Summer 2020


Harnessing the


Veterinarians and their staff are at risk of being exposed to viruses and infections, such as COVID-19. Biologically active essential oils are an effective alternative to disinfecting chemicals.

As veterinarians and essential businesses, we and our staff are at increased risk for coming in contact with novel viruses or infections. In veterinary medicine, we often become a bit lax when it comes to protection. However, because our patients are in direct contact with their families through hugs, cuddles, pets and kisses, their coats can become exposed to human-sourced pathogens, and as such we must consider pets as potential fomites. What should we do? Should we be spraying down or bathing pets in disinfecting chemicals? Are there alternatives? The answer to the last question is yes. Essential oils can offer a safe and effective alternative to chemical disinfectants.


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ESSENTIAL OIL PRODUCTS MUST BE BIOLOGICALLY ACTIVE Much research has been done on the antimicrobial nature of essential oils; many are known to be effective for MRSA infections in addition to having antiviral properties. In our practice, they are the first go-to for viral infections. The caveat to using essential oils safely and effectively is determining whether they are biologically active. Essential oils can cause harm if they are just as adulterated as other chemical products. There are many poorly-produced products out there that your clients are reaching for. Your

job is to educate yourself on what constitutes a safe and effective essential oil. All essential oils are not the same; however, they are often all lumped together as ineffective and even dangerous. As an analogy, life-giving water can sustain us or kill us, depending on how clean it is. Likewise, you can drink water or drown in it. The same goes for essential oils. Adulterated, contaminated oils are not medicinal, biologically active ones. They can be ineffective at best, and dangerous at worst. Conversely, biologically active oils have powerful healing qualities. What follows is a brief overview of the biologically active essential oils I have found to be safe and effective for antimicrobial use, through my practice and from clinical studies since 1997. Numerous culture results taken in the practice have confirmed the effectiveness of their use in bacterial infections.

PROTECTION FOR PATIENTS AND STAFF During the COVID-19 pandemic, my practice instituted an essential oil disinfection protocol for all animals and staff. • First, videos and letters were sent to all clients so they were informed about what to expect upon arrival at our clinic. • A ll animals were sprayed down thoroughly with a diluted, safe, effective, biologically active essential oil disinfectant blend on the way in and on the way out. • Footbaths were also used for employees and pets as they entered and exited the building. • A ll surfaces were constantly sprayed down as well.

Fourteen-year-old Kirby stands in a footbath containing a pad saturated with essential oil solution. The client or technician offers each patient a treat to encourage cooperation. All humans entering and exiting the building must also use a footbath.

make the host stronger. Many essential oils can increase cellular regeneration and tissue repair, thereby increasing the integrity of the immune system’s barrier function. In contrast, through the inhalation or ingestion of many commercial cleaning products, protective mucous membranes can be burned or compromised, rendering the individual more susceptible to infections by allowing microbes to penetrate more deeply into the body. We need to consider the use of toxic products as contributing factors to respiratory malfunction and inflammation. Continued on page 20.

Our practice used products that animals could safely lick and therefore ingest (we have been using these for over 20 years) at a concentration known to not cause sensitivities. We avoid spraying animals or surfaces with harsh chemicals such as bleach, or any other product that humans themselves cannot ingest.

ESSENTIAL OIL MECHANISMS FOR ENVIRONMENTAL CLEANING Essential oils are lipid in nature and therefore able to break down the lipid coating of viruses, similar to what soap does. They can also dessicate viruses, bacteria, and fungi. When essential oils are sprayed on surfaces, they remain in place rather than evaporating, and therefore increase the barrier function of the surface. Many of the essential oils with strong antimicrobial properties are also safe for ingestion. In addition, essential oils have chemical constituents that support the cellular activities of the host cell and IVC Summer 2020


Continued from page 19.

Essential oils known to have



In addition to external decontamination, essential oils can be used medicinally for respiratory health. They may be diffused into the air or applied rectally to gain higher blood levels in respiratory emergencies. Rectal application is well tolerated by the patient and easy for clients to learn.

Scotch pine (Pinus sylvestris) Hyssop (Hyssopus officinalis var decumbens) Spike lavender (Lavandula latifolia) Narrow-leaved peppermint (Eucalyptus radiata) Tea tree (Melaleuca alternifolia) Oregano (Origanum compactum) Blue-leaved mallee (Eucalyptus polybractea cryptonifera) Peppermint (Mentha x piperita) Ceylon cinnamon tree (Cinnamomum verum) Thyme (Thymus vulgaris thymoliferum) Lemon balm (Melissa officinalis)

Essential oil blend for

FOOTBATHS Clove bud (Syzygium aromaticum) Lemon peel (Citrus limon) Ceylon cinnamon tree (Cinnamomum verum) Eucalyptus leaf (Eucalyptus radiata) Rosemary leaf (Rosmarinus officinalis) Use one drop of this blend for every four ounces of water. Use 100% pure, therapeutic grade essential oils only.

Essential oil blend for

DISINFECTANT SPRAY Citronella (Cymbopogon nardus) Rosemary (Rosmarinus officinalis) Lemongrass (Cymbopogon flexuosus) Tea tree leaf (Melaleuca alternifolia) Lavandin (Lavandula hybrida) Myrtle (Myrtus communis) Use one drop of this blend per one ounce of water in a spray bottle. Use 100% pure, therapeuticgrade essential oils only.


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In my practice, for viral infections such as canine distemper, I will use intense deep inhalation. The eyes must be lubricated during these treatments. They are best performed in the clinic setting where the practitioner can monitor vital signs and watch for a Jarisch–Herxheimer reaction as bacterial microbes from secondary infections begin to die off. During the first few treatments, patients are put on oxygen and coupage is performed to move the mucus being broken up by the essential oils. Combining this treatment with ozone therapy is beneficial, with no side effects observed. The best essential oils for the respiratory tract, according to French medical literature, is a combination of thyme, hyssop and eucalyptus, applied through diffusion or rectal administration. Other oils supportive to the respiratory tract are tree oils, such as pine. For cats, avoid long-term use of essential oils that are more irritating in nature, including oregano, thyme, cinnamon and melaleuca. Instead, a good choice for felines is lemon balm (Melissa officinalis), an essential oil with strong antiviral properties but minimal tissue irritation. In my practice, it is my go-to choice for treating FIP, FIV and FeLV positive cats, with noticeable viral load reduction and no side effects.

EDUCATION IS VITAL WHEN IT COMES TO ESSENTIAL OILS One of our jobs as veterinarians is to educate the public. Pet guardians should not be educated solely by the companies selling essential oil products, by the internet, or by well-meaning professionals who have not been trained in essential oil use. Practitioners can join unbiased, non-partisan professional organizations such as the Veterinary Medical Aromatherapy Association for education and support. Astani A, Reichling J, Schnitzler P. “Comparative study on the antiviral activity of selected monoterpenes derived from essential oils”. Phytother Res. 2010;24(5):673–679. Brandt N. Chemical Free Pets. Spark Education LLC; 2016. Brandt N. The Dig Deep Method. Spark Education LLC; 2018. Brochot A, Guilbot A, Haddioui L, Roques C. “Antibacterial, antifungal, and antiviral effects of three essential oil blends”. Microbiologyopen. 2017;6(4). Choi HJ. “Chemical Constituents of Essential Oils Possessing Anti-Influenza A/WS/33 Virus Activity”. Osong Public Health Res Perspect. 2018;9(6):348–353. Franchomme P, Pénoël D, Jollois R. L’aromatherapie exactement; 2001.

Saika T, Saira W, Waseem R, et al. “A comprehensive review of the antibacterial, antifungal and antiviral potential of essential oils and their chemical constituents against drug-resistant microbial pathogens”. Microbial Pathogenesis.2019;134. Sharifi-Rad J, Sureda A, Tenore GC, et al. “Biological Activities of Essential Oils: From Plant Chemoecology to Traditional Healing Systems”. Molecules. 2017;22(1):70. Swamy MK, Akhtar MS, Sinniah UR. “Antimicrobial Properties of Plant Essential Oils against Human Pathogens and Their Mode of Action: An Updated Review”. Evid Based Complement Alternat Med. 2016;2016:3012462. VMAA.vet Wińska K, Mączka W, Łyczko J, et al. “Essential Oils as Antimicrobial Agents-Myth or Real Alternative?” Molecules. 2019;24(11):2130.


BECOME A PET TELEHEALTH PROVIDER IN 24 HOURS! The unique Smart.Vet platform is 100% customized to your brand. smart.vet/veterinarian

ABOUT THIS SERVICE Smart.Vet is a telehealth platform designed by practicing veterinarian Dr. Sharon Quinn. Smart.Vet allows vets to seamlessly navigate the logistic and financial changes that have resulted due to the COVID-19 pandemic. The Smart.Vet interface has a built-in e-commerce engine that allows you to charge for your consultations. Not only does it take the work out of appointment-setting, the inexpensive fees make it profitable with some clinics realizing a Return on Investment (ROI) of 500%-1000% or more.

WHY PRACTICE OWNERS LOVE IT The Smart.Vet platform has the ability to be custom branded to every clinic. The telehealth platform promotes your clinic branding rather than a third party’s, so the Smart.Vet brand is hidden from clients. The telehealth platform is designed to look like a part of your website as a simple extension of your clinic’s services. Clients can reach out through text, phone or the platform’s own proprietary peer-to-peer video hosting option. This private one-onone interaction is kept on record so clients can refer to it later. INCOME POTENTIAL • Return on Investment (ROI) averages 500%-1000% with clients that are actively using the platform. COST: •S mart.Vet has no upfront costs! •C linics can set up telehealth for a low monthly cost starting at $99, with no transaction or per consult fees. TRAINING REQUIREMENTS: • The creation of the telehealth system is done completely through Smart.Vet technologists! You don’t have to worry about the set up or interface implementation. • Initial hands-on training may be required with clinic staff members to familiarize them with the platform. TIME TO IMPLEMENT: Start scheduling clients in less than 24 to 48 hours, through the Smart.Vet secure, web-based telehealth system.

Telehealth offers veterinary clinics a number of advantages, including continuity of care when clients can’t bring patients into the clinic, more flexible hours for better work-life balance, and a way to improve client communications. Smart. Vet’s technology has been reviewed by the College of Veterinarians of Ontario (Canada) and currently serves clients in a variety of countries, including the U.S., Canada, Australia and the U.K. Smart.Vet provides clinics with an easy-to-navigate formal framework that ensures you can interact professionally, be attentive to your clients, and get paid. IVC Summer 2020




Canine obesity is not just one disease — it represents a major risk factor for a plethora of serious yet preventable health problems. That fat, adorable, jiggly Labrador in your exam room is at risk for developing diabetes mellitus, urinary incontinence, osteoarthritis, and pulmonary diseases, as well as many other life-threatening conditions,1 and is also at risk for a shortened life span.2 Veterinary rehabilitation practices offer you the opportunity to recommend safe and successful weight loss programs that will assist clients with obese dogs. Each patient will most likely present with a significant number of comorbidities (such as marked osteoarthritis) that must be carefully managed to ensure his safety. Trained veterinary rehabilitation therapists are perfectly positioned to help these dogs.

START WITH AN IN-DEPTH CLIENT INTERVIEW Studies have indicated that 34% to 59% of dogs are obese or overweight.1,3,4,5 In order to tackle this heavy problem (no pun intended), a number of investigations must begin. An in-depth interview surrounding the dog’s lifestyle should be conducted, including but not limited to: • Daily routine: A rundown of a typical day for the client’s dog. • Current activity level: This includes walks, runs, play, etc. • Quality of life: How does the client feel the dog is dealing with his weight? • Complete calorie count, including treats and table scraps: Don’t forget to ask how the client is measuring the dog’s food — do they use a common cup or a standard measuring cup? • Previous medical history, including recent bloodwork: It is absolutely essential to rule out any underlying metabolic conditions that will dampen weight loss efforts, such as hypothyroidism or hyperadrenocorticism.1


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Charlie enjoys a veterinary acupuncture session as part of his weight loss and conditioning program for shoulder osteoarthritis and a partial cranial cruciate ligament rupture.

SET MUTUAL AND OBTAINABLE GOALS WITH THE CLIENT It is also necessary to establish realistic expectations with the client. Every client’s lifestyle is unique, and weekly rehabilitation or underwater treadmill visits may not be reasonable or realistic to him or her. The client may not agree that the dog’s weight represents a major issue or hindrance to overall well-being. For these hesitant clients, the author provides research studies2 while also highlighting the fact that physically fit dogs, just like humans, are likely to live longer than overweight ones. It may be necessary to discuss the high probability of chronic diseases, such as diabetes and arthritis, and their associated financial costs. By setting mutually agreed-upon and obtainable goals, you will find clients are more compliant and honest, leading to more successful outcomes for weight loss programs.

WEIGHT LOSS PROGRAM BASICS IN VETERINARY REHABILITATION PRACTICE Controlling the calories: food intake Counting all the calories coming into the dog before initiating the weight loss program will make it easier to control the calories coming in after the program starts. As a trained veterinary canine rehabilitation therapist, this author prefers to have clients complete a “daily food diary” of everything and anything that enters the dog’s mouth. In more cases than not, one family member is the predominant “treat-giver” (or “calorie-provider”). Explaining to clients how to read the kilocalorie count on a treat or food bag will help them realize just how many kilocalories they are feeding their furry kids every day. It is strongly recommended that this food diary be kept up throughout the weight loss program in order to keep clients accountable for their dogs’ daily food intake.

Once clients understand the number of kilocalories their dogs should be consuming, it is then a matter of adjusting their daily kilocalorie intake. The veterinary market offers numerous weight loss diets that target satiety with increased fiber content. Alternatively, you may find that simply cutting out all high-calorie (and heavily-laden fat content) treats is a far more effective method. Safely increasing activity levels Just as in human medicine, increased activity levels can help burn fat and preserve joint function. For obese dogs, however, a veterinary rehabilitation weight loss program tailors the program to each patient’s current ability. Overweight or obese dogs are at increased risk for musculoskeletal injuries; concurrent diseases, such as tracheal collapse or painful osteoarthritis, can affect the safety of prolonged exercise. Land-based exercises, joint manipulation, land dog treadmills, acupuncture, and hydrotherapy (underwater treadmill therapy — UWTM) can be utilized to provide a safe, pain-free weight loss plan for any obese or overweight dog. • Land-based exercises consist of personalized exercises targeting core muscle groups, as well as exercises to increase endurance without placing excessive pressure on the joints. A major benefit of land-based exercises is that they can be taught to the client and continued in the home setting for the rest of the dog’s life. Once your patient has lost the excess weight, the next step is to maintain that lower weight! Veterinary rehabilitation therapists are trained in these exact areas. •U nderwater treadmill therapy safely increases the obese/ overweight patient’s endurance level via a reduced weightbearing and buoyant environment. The warm water environment can aid in muscle relaxation and facilitate the

For veterinary rehab practices — ­ marketing

your weight loss program

If you have a veterinary rehabilitation practice, marketing your weight loss program to local animal hospitals can involve a variety of techniques. These may include social media tactics showcasing “before” and “after” pictures/videos, as well as discounts for weight loss-only programs. A coupon offering discounted consultations can be a popular conduit for spreading the word. Flyers can be created that highlight the benefits of the program, while also stating the requirements. As well, referring hospitals should be informed that your rehabilitation practice will require bloodwork to rule out underlying conditions, and that you will recommend to clients that these laboratory services be performed by the referring hospitals.

With underwater treadmill therapy, Roxy is able to increase her endurance without putting excessive strain on her arthritic joints.

Offering daycare at a minimal cost, or even at no cost, for the weight loss program could persuade more clients to opt for your program over a doggie daycare-only plan.

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Sample weight loss program at a veterinary rehabilitation practice Service



Tech/ Dr.

Week 1 Hydrotherapy (UWTM)


Rehabilitation/Land Exercises


Veterinary Acupuncture


Week 2 Hydrotherapy (UWTM)


Rehabilitation/Land Exercises


NOTES Track weight every week. Email daily food diary with kilocalorie calculation every week.

Week 3 Hydrotherapy (UWTM)


Rehabilitation/Land Exercises

/ Re-assess patient at this time

motivation to walk. Turbulence and depth can all be controlled for a more individualized workout. Weaker patients will reap more benefits from the safety and control of an underwater treadmill than in open swimming pools. Research has demonstrated that raising the water level to hip height reduces the total body weight to about 38%.6 Swimming pools also offer these benefits, but in a more uncontrolled setting. Managing pain in patients with concurrent osteoarthritis For obese dogs that also have advanced osteoarthritis, veterinary rehabilitation therapists offer non-invasive pain management techniques, including veterinary acupuncture and veterinary therapeutic laser therapy. These methods can be incorporated easily into any weight loss program. See the table above for an example of a weight loss program within a veterinary rehabilitation practice.

ANALYZING WEIGHT LOSS SUCCESS Weight loss success can be measured in a number of ways; most often, of course, the measurement of true success is seeing numbers decrease on the electronic scale. While your clients may wish to quantify success this way, the author believes that a number of other factors should also be included when analyzing the success of a weight loss program. Every week, the following should be gauged: • Stance • Energy levels • Stamina • Quality of life • Decrease or elimination of comorbidity signs (such as coughing from tracheal collapse or limping from arthritis) Stance analysis can include weekly or bi-weekly standing photographs — body changes may appear very small from week to week, but an initial photograph or “before” video versus the end photograph or “after” video can speak volumes!

German AJ. “Concurrent Symposia 2: Pet nutrition and chronic disease; outcomes of weight management in obese pet dogs: what can we do better?” Proceedings of the Nutrition Society. 2016 Aug; 75(3):398-404.


Underwater treadmill therapy offers all dogs the opportunity to safely and effectively achieve their weight loss (and maintenance) goals.


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K ealy RD, Lawler DF, Ballam JM, et al. “Effects of diet restriction on life span and age-related changes in dogs”. J Am Vet Med Assoc. 2002 May 1; 220(9): 1315-20.


cGreevy PD, Thomson PC, Pride C et al. “Prevalence of obesity in dogs examined by Australian veterinary M practices and risk factors involved”. Vet Rec. 2005 May 28;156(22):695-702.


L und EM, Armstrong PJ, Kirk CA, et al. “Prevalence and risk factors for obesity in adult dogs from private US veterinary practices”. Int J Appl Res Vet Med. 2006;4(2):177-186.


C olliard L, Ancel J, Benet JJ, et al. “Risk factors for obesity in dogs in France”. J Nutr. 2006 July;136:1951S – 1954S.


Owen, MR. “Rehabilitation Therapies for musculoskeletal and spinal disease in small animal practice”. The European Journal: companion animal practice. 2006;16 (2):137-148.


for canine and feline heart health


Supporting good cardiovascular health in dogs and cats requires an understanding of the heart’s hemodynamic role in the body, and the factors necessary for its optimal function. The heart isn’t just a muscle; it’s a complex pumping system involving electrical impulses, individual contractions, valve closures, and precise volumes of blood circling the vasculature. The heart’s condition depends on patient activity levels, size, body condition, genetics and of course, its ability to repair itself. Thinking of all the things that can go wrong for the heart may be overwhelming. So let’s first consider what needs to go right. What is necessary for cardiac wellness?

THE HEART IS A SPECIALIZED MUSCLE The heart muscle requires amino acids in the diet to build proteins and maintain the constant muscular beats. Appropriate levels of essential amino acids — ten are required for a dog, and eleven for a cat — must be in the diet. The recent study linking cardiac disease and grain-free dry foods (which utilize legumes/potatoes instead of grains for consistency) has led people to incorrectly assume grains are somehow cardioprotective. This study does not support the conclusion that the grains are beneficial to the heart. In fact, other studies clearly show a strong direct link between increased carbohydrate levels in food and increased cardiovascular disease.1,2 The legume proteins used in grain-free diets lack certain amino acids like taurine, which is essential to the heart and its function. Taurine may already be low in processed foods because it is destroyed by heat. 3 Although taurine is not considered an essential amino acid for dogs as it is for cats, supplementing with taurine helps support heart function in many species.

THE HEART IS AN ELECTRICALLY STIMULATED MUSCULAR PUMP The heart’s function is affected by muscle integrity, clarity of its nerve signals and vascular elasticity. There are many useful herbs historically known to support normal cardiac contractility, nerve signal transmission, and vascular elasticity. Hawthorn berry, effectively used to support cardiac function on several fronts, has beneficial free radical scavengers, bioflavonoids, and compounds like proanthocyanidins. This herb can influence the strength of the heart’s contractions, act as a vasorelaxant and enhance transmission of nerve signals. Claims that hawthorn berry is not safe to use are not substantiated by current research.4 Other diuretic herbs, like dandelion, may be supportive as they gently decrease the volume of blood passing through the heart pump.

CARDIAC FUNCTION IS ALSO AFFECTED BY WEIGHT Maintaining appropriate weight and exercise can support cardiac health. Weight gain and cardiac disease are likely associated with a high carbohydrate diet rather than one high in fat. Feeding an ancestrally appropriate diet (e.g. low carb, fresh balanced meat diets) can help animals maintain heart-healthy weight. Planning for excellent cardiovascular health is not complicated when we know the heart’s hemodynamic role in the body. If we focus on factors necessary to support the elegant systems nature has provided, we can protect and enrich the quality of our patients’ lives.

Dr. Barbara Royal is an integrative veterinarian and IVAS-certified acupuncturist. The author of three books, including The Royal Treatment, A Natural Approach to Wildly Healthy Pets, she has also been featured in the documentary Pet Fooled. Dr. Royal is the founder and owner of The Royal Treatment Veterinary Center in Chicago and co-founder of the Royal Animal Health University, and is the past president of both the AHVMA and AHVM Foundation.

Heart tissues periodically need repair Antioxidants and antiinflammatory compounds from fresh unprocessed foods can help the heart heal from damage. • Vitamin E helps maintain heart health and supports normal healing after an injury.5,6 • Coenzyme Q10 (a cofactor in the generation of energy) can optimize the efficiency of muscle and valve function. 7 • Magnesium is important for hemodynamics and electrophysiologic functioning. Its deficiency is associated with complications in heart failure.8,9,10 Animals with chronic absorption issues, kidney disease, or who eat processed pet foods can develop magnesium and electrolyte deficiencies, compromising heart function. Safely supplementing electrolytes such as magnesium can help maintain healthy cardiac function over time. References available at ivcjournal.com IVC Summer 2020


Young veterinarians can benefit from

great mentors BY MEGAN KELLY, DVM

Most of us suffer self-doubt in the early years of our veterinary practice, and need the reassurance and guidance of an older successful professional — both for clinical skills, and for the critical skills of running a business. 26

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Whether you’re just opening your first veterinary clinic, or have been in practice for many years, you can probably remember the uncertainty and self-doubt you felt on your very first day as a veterinarian. For any young vet just starting out, those early days become much easier to navigate if they have a mentor to guide them on their way, not only in terms of clinical skills but also in the skills of running a successful business. In this article, I’ll look at the relationship between mentor and mentee, and how it can help you grow into a successful veterinary professional. A PERSONAL STORY It was my first day at my first job after qualifying as a vet. I was an hour early, sitting in my car in the practice parking lot, and I was already thinking about retiring. Like most of my colleagues, I naively thought six years of study had adequately prepared me for this day. But it hadn’t. I felt I knew nothing, a feeling exacerbated by my first client’s comment: “Aren’t you too young to be a vet?” I spent a long time hanging around the dispensary that first day, hoping to bump into one of the other vets as they emerged from their rooms to collect prescriptions. I needed reassurance that I was on the right path. I was fortunate that the vets in this mixed animal practice in Ryde on the Isle of Wight had ridden this rodeo before! I latched onto one of the female vets, Jill, and she became my first mentor. Little by little, Jill’s words of encouragement and reassurance transformed my personal doubt into courage and self-belief, and I became motivated to push myself to achieve

more and more. The more I achieved, the more I believed in myself, and of course my mentor’s belief in me fuelled me still further. Over the years, I met many veterinarians and veterinary nurses who would shape me into the vet I am today. Finding clinical mentors always seemed to happen quite organically. I don’t remember ever actively seeking a mentor until I opened my own practice. That’s when I realized I needed a quite different sort of mentor — a business mentor. I needed to learn some very specific skills, fast, and was fortunate enough to find someone willing to coach and guide me through this second phase of intense learning. FROM MENTEE TO MENTOR Fast forward to today, and I find myself mentoring young veterinary rehabilitation therapists in business skills — a much-neglected area for most vets and veterinary rehab therapists, and one which gives me immense satisfaction. In the 20 years since I was first mentored, I have made many mistakes and endured failures of all kinds, but have always regarded them as opportunities to learn and improve my skills. Both failure and success have created a bank of experience that I can now tap into any time I need to make a decision. This bank of experience is what I use as a guide for those whom I mentor. I see my younger self in each and every one of my mentees in some way. My hope for them is that they learn through my mistakes; if I can save them a few years of struggle or prevent them from losing money, then I am doing my job. IMPOSTER SYNDROME Many professionals suffer from imposter syndrome in the years after they first graduate — the feeling that they don’t really belong where they are; that they haven’t got the skills people think they have; and that they’re only hanging on by the skin of their teeth! It’s just not true, but it’s what we believe. Having someone to back us up, to reassure us that our training and knowledge are sufficient for the task at hand, and to guide us when we’re really unsure, gives us an incredible sense of security in those early years. It can make the difference between floundering or giving up completely — or persevering, while also gaining skills and developing confidence. MENTORING FOR BUSINESS As we grow and branch out into running our own practices, our needs change, and we begin to need mentors of a different kind — business mentors. As veterinary professionals, we are disadvantaged from the start when it comes to business. First, we are generally not taught any business skills in veterinary school; and second, for most of us, the business side of things is just not a priority. We want to do what we were trained to do — treat animals. So although we know we should be improving our business skills and marketing our practices, this side of things gets pushed down the list because teaching that paralyzed dog to walk or giving that dehydrated cat intravenous fluids is just more important. My husband Graeme was my own business mentor. He was a successful entrepreneur who was running two businesses at the time we met, and I naturally IVC Summer 2020


What to look for in a



A good mentor is someone you look up to and admire, who exhibits the qualities that make for success. They’re hardworking, enthusiastic and self-disciplined.


They have the qualities of a good teacher: they’re knowledgeable, compassionate, patient, encouraging, and good communicators.


They may have already shown an interest in you. You should feel you can trust them, that they have your interests at heart, and that there is a bond between you.


A good mentor is interested in their field, and learning all the time. They’re aware of new developments, and are eager to learn. They read journals, attend conferences, are willing to try new practices, and love passing on what they learn.


They take the mentoring relationship seriously, and are committed to your success. They’re confident enough in their own success not to be threatened by yours.


Although encouraging and patient, a good mentor will also challenge you, pushing you to be the person you are too scared to become.


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Continued from page 27. sought his advice when it came to the business side of my practice. It was great to have someone supporting and encouraging me, sharing my highs, and holding me up during my lows. I am not sure if this is only a “woman thing”, but some of us tend to make decisions with our hearts. I did, and it was not good for business! Graeme set me straight during these times and helped me remove emotion from my decisions. He showed me how to think and act tactically. Would I have eventually arrived at the same place on my own? Probably. But it would have taken years to become successful if I’d had to learn through experience alone. What I love about mentoring is that, although I am the one who initially offers the guidance, as my vet rehab mentees gain confidence, they grow so rapidly that I end up learning from them. Without exception, they have all made huge strides in their businesses and are reaping rewards as they go. I believe that sound mentoring makes the difference. HOW DO YOU FIND A MENTOR? • Professional business coaches charge for their services, but have experience with lots of small businesses along with a wealth of knowledge and insight. The challenge is they don’t usually understand the veterinary field — but then it’s your job to educate them. • Most cities also have business centers that offer support to small businesses. Do a Google search for your own area. • You might also identify a successful veterinarian in your area whom you think you could learn from, and reach out to them. You could ask them straight away to be your mentor, or you might prefer to build a relationship with them which grows over time into a mentoring one. These kinds of relationships are usually built on friendship foundations, so don’t see them as a business transaction only. Think of ways you can give back for your mentor’s time. You might volunteer to assist them on cases or projects, share their Facebook posts, or just be there for them when they need it. • Conferences are great places to meet mentors. Get out there, meet people and talk to them. Be clear about what type of mentor you’re looking for. A clinical mentor, for instance, might not be the best person to help you with your business. You might find two mentors — one for your business and one for your cases. The point is, we all need someone. Mentoring is a very special kind of relationship where both parties have your personal and business growth at heart — and where sound, practical advice backs up that care and commitment. We really cannot do without it. You may feel that the advice of friends and family is enough, but my advice is to find a mentor who is not quite so personally connected (unless he or she has the professional experience you're looking for, as with Graeme). A good mentor will understand your challenges and enable you to see things you cannot currently see. Good mentoring really does make a difference!

VetBadger’s management software streamlines client communication


Top left: Dr. Alexandra with Lilli. Above: VetBadger's patient dashboard allows medical exam information to be entered with ease.

Like all practicing veterinarians, Dr. Alexandra McLaughry has always spent a lot of time communicating with her clients. But something wasn’t adding up for her. Technology was advancing, yet connecting with and supporting pet parents wasn’t getting any easier. She became frustrated with the features and functionality — or lack thereof — of existing practice management systems. Dr. Alexandra wanted software that offered client communication as a primary feature, but it didn’t exist. So in 2016, she enlisted her software engineer husband, Stephen McLaughry, and one of his colleagues, Phil Craven, to design it, and VetBadger was born. Right from the start, VetBadger’s mission has been to help their customers provide high quality personalized medical service to their clients. Within a short period of time, Stephen and Phil realized that a cloud-based solution would provide many additional benefits that server-based systems would never be able to match. “As we continue to add features in response to our customers’ needs, we follow the philosophy that software should make the user’s life easier and simpler, instead of adding complexity,” says Dr. Alexandra. “We want our customers to have clients who love coming to the vet, and who would never consider going to another clinic. At the same time, we want our users to go home at the end of the day feeling their software has made them more efficient and effective medical providers.” With their integrated telemedicine platform, two-way integrated email and text messaging, and client messages that go straight into the medical chart, the company is accomplishing everything they set out to do — and more.

A new feature allows for “tele-visit” video appointments to take place between you and your clients — fully integrated with the patients’ medical records — and something that will help clinics run more smoothly and safely during and in the aftermath of COVID-19. “Our ability to constantly adjust and improve the system gives us the flexibility to match our users’ needs and expectations as the world changes and technology evolves,” says Dr. Alexandra. The team at VetBadger is motivated by the knowledge that the success of a veterinary practice hinges on client communication. Dr. Alexandra says that one of the biggest problems with owner compliance is confusion, uncertainty and misunderstanding, which underscores the need for better explanations regarding diagnoses and treatment. And of course, the less time spent organizing day-to-day operations, the more time there is to dedicate to what matters most — the patients. “We are continually working to make it easier for clinics to be more successful with less effort,” says Dr. Alexandra. “Better communication leads to better business and medical outcomes (80% better according to one study). VetBadger provides clinics with the ability to simply and easily provide this enhanced level of service.” vetbadger.com Below: Telemedicine in action.

So what sets VetBadger apart from other practice management programs? Besides keeping your team on the same page throughout the workday, QuickBooks integration keeps inventory and financials up-to-date in real time. IVC Summer 2020



FOR DIABETIC PETS! This innovative easy-to-use device will deliver pain-free injections to dogs and cats with diabetes. Here’s how you can invest in this game-changing new technology.

Diabetes affects nearly one million dogs and cats in OLD TECHNOLOGY VS. PKA SOFTTOUCH North America, and these animals require an average of As every veterinarian knows, using a traditional syringe is two injections a day. Compliance from clients is crucial a multi-step process requiring two hands. First, the correct so diabetic pets stay healthy, but many clients face dosage must be pulled from the vial of medication. Then the emotional and physical difficulties giving a dog or cat practitioner or client must find an area with loose skin on painful injections with the dog or cat, and, after pulling common syringes — syringes that section of skin between This microneedle penetrates only which really haven’t altered their fingers, they insert insert 1.5 mm into the skin layer, and significantly in nearly 170 years. the needle, taking care to not

injects the medication into the interstitial fluid; it never reaches the nerves, so it causes no pain.

Now all that is about to change. PKA SoftTouch Inc. has been working on an innovative painfree, pre-filled insulin injection device that will deliver virtually pain-free injections. With your help, the company is advancing towards veterinary clinical trials and the device is expected to be on the market by the end of 2020.


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inject it through their own skin and into their fingers. Next, the plunger is pulled back slightly; if blood is seen, the needle must be removed and re-inserted. Finally, once the injection process is finished, the cat or dog must be checked to ensure there is no blood or medication leaking from the injection site.


The Crowdfunding Campaign will allow PKA SoftTouch to raise funds and bring their new device to the market — the investor also gets shares and becomes a part owner. Using the pre-filled needle is as easy as removing the cap, placing it against the skin, and pressing the plunger.

Now imagine a process that allows a client to pet the dog or cat with one hand, while giving him an injection he doesn’t even notice with the other hand. That would never happen with an outmoded syringe! Here’s why:

HOW TO USE THE PKA SOFTTOUCH ALTERNATIVE 1. Remove the prefilled device from the sterile package. 2. Detach the safety cap that prevents accidental actuation. 3. Place the device against any area where there’s skin, like a tummy that’s being rubbed.

4. Press the plunger – the medication is delivered painlessly in 1 to 1.5 seconds while your dog or cat continues to enjoy his belly rubs.

5. Replace the safety cap and toss the device in any trash receptacle — no sharps disposal required!

WHY IS PKA SOFTTOUCH PAIN-FREE? How does the PKA SoftTouch work without causing pain? Unlike a traditional needle that reaches the nerves (Figure 1), this microneedle penetrates only 1.5 mm into the skin layer (see Figure 2), and injects the medication Figure 1

The needle in a traditional syringe penetrates into the nerves, causing pain.

into the interstitial fluid, so it causes no pain. In addition, the drug reaches its therapeutic level twice as fast as when injected by a syringe (see Figure 3). After the injection, the needle automatically retracts back inside the device, and with a pull of the plunger, locks safely in place inside the microneedle device. As PKA SoftTouch moves into its veterinary clinical trials, the company is currently running an “Equity Crowdfunding Campaign”. This campaign will allow the company to raise funds in order to move forward — the investor also gets shares and becomes a part owner in the program. To find out more, visit the equity campaign page at https://frontfundr.com/company/pka or the company website at www.pkasofttouch.com. Once veterinary trials are completed, PKA SoftTouch will move on to human clinical trials, and then the worldwide market. The company strongly believes their device would also be the perfect vehicle to deliver the COVID-19 vaccine once it’s developed; since it’s pre-filled, pain-free and easy to use, with no need for sharps disposal. The PKA SoftTouch technology will be a real disrupter in the syringe market. Don’t miss your chance to get on board!

Figure 2

The PKA SoftTouch needle penetrates only 1.5 mm into the dermal layer and is virtually pain-free.

Figure 3

Because the needle releases the medication into the interstitual fluid, it reaches its therapeutic level twice as fast.

IVC Summer 2020


Recognizing and managing equine (and client!) emotional states

for a more harmonious diagnostic and treatment experience


When horses feel understood, they are more at ease with handling. And when clients feel they are “heard”, they are more compliant to your recommendations. This model helps you understand the emotional needs of your equine patients and clients.

Natural horsemanship is a global movement that is revolutionizing the equine industry. Many excellent clinicians have contributed to this noble cause. Pat and Linda Parelli have pioneered the long overdue awareness that horses perform more efficiently when a willing partnership is developed from “love, language, and leadership in equal doses”, rather than from dominance and forced submission. Learning how horses communicate through body language, and understanding their point of view, enhances the humananimal bond as well as the veterinary diagnostics and treatment experience. The Parellis recognized that horses have very distinct personality traits that cause them to react differently to stimuli. Motivating each individual involves understanding the primary needs of each personality. Personalities vary due to innate or genetic characteristics, learned behaviors,


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environmental stimuli, and spirit level. In conjunction with psychologist Patrick Handley, PhD, the Parellis developed Horsenality™ and Humanality™, a personality assessment for horses and their riders, and their emotional states.1,2,3,4

HORSENALITY ™/ANEMOTIONALITY ™ The primary need of an animal at any given moment can vary, depending on whether they are a prey or predator species, and in a confident/rational (left brain) state or an insecure/emotional (right brain) one. Extroversion and introversion of either state will add another layer to the personality (see sidebar at right). Low, medium or high spirit levels will exacerbate particular personality traits, acting as a “volume control”. The equine species is generally considered a prey species, but even within that grouping, there can be differing levels of confidence, as well as emotional and security-related responses.

Definitions These emotional states are dynamic and can change in an instant, depending on environmental stimuli. The author has extrapolated this model to include other species as well, and has termed it AnEmotionality. 5,6 Traditional Chinese Medicine practitioners will see similarities between this model and the Five Elements Theory of Fire, Earth, Metal, Water and Wind. The tendency to be an introvert or extrovert, as well as rightor left-brained, affects learning and attention span. Although an animal may possess one or two primary traits, different situations and environments can allow other traits to show up. It is not surprising that the veterinary environment can bring out previously unseen behaviors. Addressing the primary needs of each personality will help manage the emotions and result in a more productive outcome.

CLINICAL EXAMPLES OF EQUINE PATIENTS AND CLIENTS RBE horses (Safety): These horses are not motivated by treats until they can be encouraged to access left-brain thinking. Decreasing pressure by incorporating approach-and-retreat (with lots of retreat), and little to no eye contact, is beneficial. A highenergy extroverted horse will need to move his feet so as not to feel trapped. Allowing this to occur within limits by directing where the horse is moving allows him to release stress while also respecting your leadership.

RIGHT BRAIN: Unconfident, fearful, insecure, searching for safety and leadership, avoids eye contact. LEFT BRAIN: Confident, dominant, brave, looking to challenge your leadership or place in the herd order, makes own rules if none are perceived.

INTROVERT: Inactive, conserves energy, needs to think before reacting or fleeing.

EXTROVERT: Active, energetic, needs to move feet or react before thinking. RIGHT BRAIN EXTROVERT (RBE): The sky is falling!! Needs focus; primary need is safety.

RIGHT BRAIN INTROVERT (RBI): Slow down, give them time to think, and be gentle; primary need is comfort.

LEFT BRAIN EXTROVERT (LBE): Life’s a game! Play with me! Primary need is play!

LEFT BRAIN INTROVERT (LBI): What’s in it for me? Primary need is incentive.

Continued on page 34.

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Hierarchy of needs PLAY Horses have primary needs that must be met in order to ensure their survival. These needs are safety, comfort, food and play. The motivation for a horse depends on his emotional state that day. A horse that is fearful may not be inclined to accept a treat reward until he feels safe or comfortable. A confident horse is not worried about safety, so will be motivated by food or play.


Continued from page 33. Repetition and patterns work well with unconfident rightbrain horses. Falling into a routine of movement can be comforting. If anxiety is high, interrupting the pattern by redirecting movement can also be beneficial. For some anxious horses, it may be helpful to approach the evaluation in stages. RBE clients: These people can be anxious and exuberant fast talkers, who offer way too much information. Redirecting the conversation to include the patient while matching the client’s energy, helps that person feel heard without being offended. Offering a task that he/she can handle, can help them feel valued. RBI horses (Comfort): They appear calm and quiet, but can explode unpredictably. In life, they can be the silent sufferers who hate conflict, become catatonic, hide, and allow their stress cortisol levels to wreak havoc. Take your time with the exam and proceed slowly and gently. Incorporate lots of approach-and-retreat, even with eye contact. Discussing management options with the client to reduce stress in the environment can be productive; and postponing the hands-on portion of the exam while discussing your intentions can allow time for the horse to relax. Since he’s being ignored during the discussion, he may become curious and offer you his eye. This is his permission for you to proceed with the exam. Glancing and looking away while discussing history or management with the client can work wonders in helping the horse gain confidence. It is this author’s opinion that at least 30% of the physical exam involves visual observation. A lot can be assessed about the horse’s general health, well-being, and state


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of mind while not handling him. This is especially true with right-brain introverts. The stress hormone, cortisol, triggers cascades of deleterious effects. A suitable analogy for comprehending this concept is to think about what happens to us when flashing lights from an advancing police car are seen in the rearview mirror, and the rush of relief we feel when we see the car pass us and continue to the intended target. For an RBI, the “release” of pressure is what teaches and/or brings confidence for survival. RBI clients: These clients have difficulty making and keeping eye contact, are quiet and shy, and need time to process what has been said. They can seem calm, but as stress increases, they may explode. It helps if you bring your energy down and ask if they are clear on a topic before proceeding. This is especially true when presenting an estimate for services. LBE horses (Play): Such horses are playful, energetic and naughty! Think of the mouthy and pushy horse who won’t leave you alone. These are the “in your pocket” animals. They are outgoing, very treat-motivated, love to run, and have a difficult time staying still. If they are unable to move their feet, they will move their mouths. These horses are very easily trained, since it is simple to motivate them. They tend to get bored easily and will need you to be more interesting than their surroundings. LBE clients: They’re confident, outgoing, active, and may be controlling and dominating. They have take-charge personalities, prefer order, and like to get in and out, although they will want to tell you the latest joke before they do. Matching their energy and getting to the point will result in a winning formula. Be attentive to their need to “cut to the chase” when presenting an estimate.

LBI horses (Incentive): Horses that are stubborn, argumentative, and refuse to budge fall into this category. They can also be bullies. These horses often refuse to come when called, unless treats are involved, and may also turn their butts to you in disrespect. They have a tendency to get angry when things don’t go their way. Or they may refuse to move forward under saddle. These animals can usually be motivated with treat rewards. Try to make your idea become their idea, and avoid the argument. LBI clients: These clients are skeptical and will likely respond to your history questions by saying: “You tell me, you’re the doctor!” Arms are often folded across the chest. These people want you to “prove it”. They can also feign disinterest. It is important not to fall into the trap of talking too fast, especially over an estimate. Calm your energy, keep appropriate eye contact, and offer an incentive. It may be in the form of acknowledging their

Dr. Gordon Palm performs low level laser therapy on a left-brain introvert horse with laminitis. Prior to treatment, she utilized techniques to shift the horse’s emotions from a high sympathetic tone to a calm parasympathetic state.

relationship with their equine partner; their intelligence in recognizing the need to seek medical attention for their horse; or the fact that they’re a great storyteller!

IN SUMMARY Veterinary exams can be stressful. Animals don’t understand that our intentions for preventative health and maintenance are for their own well-being. And clients are not always on their best behavior either. Understanding the state of mind of our patients and clients, identifying what motivates them, and attending to their primary needs results in a more positive experience for them and the practitioner. The Parelli Horsenality™ and Humanality™ models extrapolate effectively to other species; the author terms this extrapolation to the emotional states of all animals AnEmotionality™. Maintaining the relationship with the animal is of utmost importance. Recognizing and managing “who shows up that day”, rather than using preconceived judgments, allows for a more rewarding outcome. Offering strategies to manage clients in their different emotional states allows us to be stewards of the gift of relating. The relationship becomes a more nuanced “dance” in order to help another sentient being feel heard and understood. This is more effective than the opposite approach of sticking completely to your own direct line of thought, which can monopolize the agenda. Offering the emotional currency that each animal and client requires to feel validated and confident in your intentions decreases stress, preserves the dignity of the animal, and increases client compliance while accomplishing the necessary veterinary procedures.6

Parelli. Natural Horsemanship, Pagosa Springs, Colo, 81147.

1 2

Parelli L. “The Parelli Horsenality Profile Issue”, Savvy Times 16: Aug 2007.

McFarland C, Parelli L, Pat Parelli. “Secrets for success, introverts and extroverts: opposite education”, Horse Illustrated, March 2008. 3


Parelli L, Handley P. Horsenality/ Humanality Workshop, Ocala Florida, 1/31/2014- 2/5/2014.

Gordon Palm, Janet. AnEmotionality; Understanding Animal Emotional States Allows for Harmonious Relationships, 2015. 5


Gordon Palm, Janet. “Stress Free Animal Relationships, Keys to That Kingdom”, AHVMA 2016.

IVC Summer 2020



Therapeutic taping helps a dog recover from a severe bite wound BY MINDA LEMMON, PT, CRTS, CKTP, RRCA RUNNING COACH, BIKE PT

During Easter of 2019, my husband and I were out walking our golden doodle, Caicos. We were almost home when a neighbor’s dog darted into the street and abruptly bit into our dog’s leg. Caicos was dragged several feet. She ended up with a huge laceration along her left hind leg.

interstitial lymphatic fluid flow and facilitate fluid exchange between tissue layers. So once the staples were removed from Caicos’ wound, I began using canine-specific tape on her, following the standard method for edema control, and to promote healing.

Caicos had surgery that evening and a drain was put in. She subsequently had more surgery the following Friday; there was so much damage to her hind leg tissue and muscle that the first surgery didn’t work as well as was hoped, and the tissue died. The doctors had to then debride and remove the dead tissue.

As Caicos’ incision healed, I then applied canine tape to the incision to assist with decreasing the scar tissue. I also continued the canine taping method for edema every other day. As her hair started to grow back, each taping application would last about 24 hours. Even though Caicos wasn’t able to tell me where it hurt or how it felt, I knew she was benefiting from the common effects of therapeutic taping: in addition to relieving her pain, the taping visibly worked to reduce the swelling, equalize temperature around the injury, and create channels of low pressure beneath the skin.

The biggest concern was that the tissue wouldn’t hold the second time because so much was removed. The veterinarian had to hold it together extremely tightly, but the incision did gap open. Thanks to my experience with human patients, I am familiar with the positive effects of therapeutic tape on superficial lymphatic drainage. For years, I’ve seen success in using elastic tape to increase

I continued to perform this taping strategy for three weeks. At that point, I started using canine taping to address scar tissue for an additional two to three weeks. Applications would typically last about 24 hours, mostly because Caicos tried to remove the tape; for this reason it was applied in the evening. Now, Caicos’ scar is very flat and her tissue has healed extremely well. I believe canine taping helped improve her overall inflammation, enhanced the healing process, and minimized scar tissue. Caicos has resumed all her running activities and we are very thankful to all who assisted in her recovery! Minda Lemmon deals with many different patients and conditions as a physical therapist with Steppin’ Up Physical Therapy in Fort Wayne, Indiana. Her specialized qualifications range from CKTP (Certified Kinesio Taping Practitioner) to RRCA Running Coach and Bike PT. She has an active personal life as well. Minda has become a go-to taping expert in her community and among her friends and family.


IVC Summer 2020

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STRAP IN FOR — a state-of-the-art, solutions-based conference designed with your practice in mind! Interested in the latest veterinary strategies and techniques? Want to add new tools to your tool kit? Join us for the Innovative Veterinary Care Virtual Expo — the world’s first veterinary conference on the moon (it’s virtual, after all)! Our Dream Team of speakers — the leading experts in their fields — will help you discover the latest trends, technologies, and treatments in a supportive and fun environment. And you experience it all from the comfort of your own home, office or mountain top!

JOIN US FOR IVCVX… IT’S WHERE INNOVATIVE MINDS MEET! MOST INNOVATIVE CE We have assembled an incredible team of the best and most innovative veterinary professionals ever.

INNOVATIVE EXHIBITORS Visit our Exhibitor Hall for an experience that’s truly out of this world! Watch short product or service videos, and collect information. You can even online chat/video live to get answers to your questions.

EXCLUSIVE SPECIAL DEALS For a limited time, save money and stock up on great products for your practice with exclusive IVCVX Exhibitor Deals available only at the Expo.

FUN AND EASY TO NAVIGATE With the click of a mouse you can go from a lecture to an exhibitor booth and then to the lounge for a “cocktail”. The easy-to-use layout is intuitive and fun to explore. Use your intergalactic ID to participate in ‘off-world’ games and earn lunar points for amazing prizes!


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IVCVX DELIVERS THE MOST INNOVATIVE SOLUTIONS AND STRATEGIES FROM THE TOP EXPERTS IN VETERINARY MEDICINE TODAY. EARN CE FROM THE BEST Register to learn from highly specialized Innovative Veterinary Leaders who will help your practice thrive well into the future. After each lecture enjoy a live Q&A period.


LE C T U R E S !

KEYNOTE SPEAKER Dr. Ernie Ward, DVM, CVFT Dr. Ernie Ward is an internationally recognized award-winning veterinarian known for his work in the areas of general small animal practice, pet obesity and nutrition, life extension and longevity, practice management and leadership, and the special needs of senior dogs and cats. Lowell Ackerman DVM, DACVD, MBA, MPA, CVA, MRCVS

Jennifer Adolphe PhD

Bill Bookout BSc, MBA

Paul Camilo CVPM


Carmen Colitz DVM, MS, DACVO

Sarah Dodd BVSc, MSc, PhD Candidate, ECVCN Resident

Holly Ganz PhD

Karen Gellman DVM, PhD

Nadine Hamilton BSc (Psych), PGDip.Psych, MTrain&Dev, EdD

Hilary Jones DVM

Dawn Kingsbury DVM, PhD, DACVIM

Michelle Kutzler DVM, PhD, DACT

Terri McCalla DVM, MS, DACVO

Lisa Miller DVM, CCRT

Mike Petty DVM

Kendra Pope DVM, DACVIM (Oncology), TCVMP, CVFT

Donna M. Raditic DVM, CVA, DACVN

Lisa Radosta DVM, DACVB

Barbara Royal DVM, CVA

Marlene Siegel DVM, CNHP

Robert Silver DVM, MS, CVA

Odette Suter DVM, CVA, CVSMT, MA

Valerie Tynes DVM, DACVB, DACAW



IVC Summer 2020




1. Nutrition: • Pet Food Facts and Fallacies • Proactive Nutrition for the At-risk Canine • Fresh Food: A closer look at the Health, Safety and Convenience of this growing trend • Managing Macronutrients, Micronutrients, Microbiome & Mitochondria • Nutritional Support for the Canine Brain • Antioxidants and Ocular Health: A Closer Look at Nuclear Sclerosis, Cataract, and Lens Luxation in the Aging Eye

2. Scientific Advancements: • Chronic Enteropathy, Leaky Gut Syndrome and Mechanisms • How to incorporate Regenerative Medicine into your practice • Laser: Pain Management in the busy practice • EMFs: Why exposure is a big deal & advice on protection • The Aging Eye: Degenerative Retinal Diseases — Inherited, Age-related and Acquired

3. Innovative Techniques: • Long-term Adverse Health Effects of Desexing



FREE All Access Pass Attend the “live” event on Nov 6-7, interact with innovative exhibitors, get IVCVX Special deals on products AND play games to win or earn prizes!


CE Credits Package – Available for 90 days! Attend our “live” event PLUS earn credits on your choice of the 40+ lectures

*This program has been submitted (but is not yet approved) for 44 hours of continuing education credit in jurisdictions which recognize RACE approval

The lectures will be available for 90 days on-demand so you can complete at your convenience!

ONLY $ 199


• Surgical Alternatives to Spaying and Neutering • Fear Free Dentistry — how to grow this side of your business • Introduction to Ozone Therapy • Step into the matrix: Feline communication for the veterinary team • Learning the foundations of Fear Free restraint

4. Integrative Solutions: • C annabis and The Big Three — How to Manage Pain, Cancer, and GI issues • C annabis in Practice: Cases, Applications, and Tips on Product Tests and Dosing



SAVE $50!

EXCITING LECTURE TRACKS • Nutrition & Supplements • Scientific Advancements • Innovative Techniques • Integrative Solutions • Wellness for You & Your Practice

• Integrative Oncology: What You Can Do as an Integral Part of Your Patient’s Super Team • The Oncology Toolbox: From Integrative Therapies to Cancer-busting Supplements • Postural Rehab: Why Posture Matters • Adding New Tools to your Toolkit: Cases

5. Wellness: • Telemedicine: Extending Care Beyond Your Walls • Dealing with Imposter Syndrome • Problem-free patients — How to Promote a LIfetime of Care • Coping with Change and Uncertainty


IVC Summer 2020



industry innovations

Thermal imaging in the palm of your hand

Thermal imaging can tell you a lot about a patient’s health. Digatherm’s veterinary-specific thermal imaging system takes patient exams to a new level. The handheld system allows you to image your patients’ real-time physiology, providing important information that creates a roadmap for further diagnostics and treatment. You can capture and store images, and share them with clients on their own devices, so they can view, understand, and become more involved in and compliant with their animals’ care. digatherm.com

Healthy treats — and a pouch to carry them in Providing dogs with healthy rewards just got a lot easier. New Blue-9 Inspire dog treats deliver all the taste, smell and inspiration a dog needs while moving through his everyday tasks. And for something to carry those treats, Blue-9 has created the Inspire dog treat pouch, the ultimate in convenience and comfort. This slim and simple solution makes it easy to carry treats and personal essentials for a walk or run. This lightweight treat pouch uses a proprietary snap-back access system that securely closes the pouch without the use of zippers or hinges. blue-9.com

Raising the bar for veterinary mats

This long-lasting mat will provide a secure space for the animal patient during exams, treatment and recovery. The Bella Bed is a waterproof veterinary mat designed to reduce laundry and increase patient safety and comfort. It is made from a durable material that’s scratch- and punctureresistant, and can hold up to regular disinfectant use. As a bonus, the seams are welded, so all surfaces of the mat can be thoroughly disinfected. 10% off when you use code IVC10 BellaVMS.com

Clinically-studied hemp oil products

If your clients are buying hemp oil for their pets, it’s important they look for high quality products backed by science. HempMy Pet makes organic hemp oil products for pets. The company grows its own hemp, using a cultivar-specific type known for its medicinal purposes, and handles the entire production process from seed to sale at their farm in Colorado. Their products are fullspectrum, which means they possess the full complement of CBD compounds, plus beneficial terpenes and even trace amounts of THC to offer an “entourage effect” of maximum effectiveness. HempMy Pet is veterinarian-recommended and has been clinically studied for its beneficial effects on the pain and inflammation associated with arthritis and other issues. hempmypet.com IVC Summer 2020



Being able to safely clean our valuable Personal Protective Equipment (PPE) so it can be reused is vital at any time, but especially during the COVID-19 pandemic. Here’s how medical ozone does the job. The following is excerpted from Dr. Margo Roman’s instructional video for first responders and other medical workers on how to safely clean Personal Protective Equipment (PPE) using ozone, so the equipment can be reused. Medical ozone is a treatment modality that has been around globally, used by doctors and dentists, for over 30 years. Not only can it be used to combat infection and chronic disease in humans, but I have [also] used medical ozone in my veterinary practice since 2003. Our team has [performed] over 70,000 treatments in that time, and we are using it for all types of medical conditions, including severe viral and bacterial infections as well as for sterilizing our own Personal Protective Equipment, our masks and our gowns.


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Medical ozone means utilizing the power of oxygen radicals to disrupt biological organisms like bacteria and viruses. Oxidizing is the primary way our bodies break down toxins and invaders. The oxygen we breathe, the O2, is very stable and safe. Oxygen is needed for our survival. Ozone molecules have an extra oxygen atom which makes them very unstable. They can quickly break down into stable O2 and an active oxygen molecule. We can create ozone molecules by using electricity to stimulate pure surgical oxygen. This is done in a simple apparatus called an ozone generator. The ozone gas created in the generator can now be used in medical applications. The protective gear [that] medical staff need is in short supply. Gowns, masks, helmets, and gloves can be all sterilized quickly by bathing them in a high concentration

of ozone. For most of these procedures, we use gaseous ozone at a concentration of 75 micrograms per milliliter. The concentration of ozone is a product of setting your generator and your speed of airflow. The slower the oxygen flow, the more concentrated the ozone. For this reason, we typically use a pediatric regulator on the oxygen tank so we can get the flows as low as 1/32 liter per minute. The ozone gas created in the generator can now be used in medical applications, [such as] disinfecting water and Personal Protective Equipment, and even treating infectious disease directly. The key to successful disinfection is not mixing up the contaminated and clean gear equipment. I recommend that you wear gloves and wash and disinfect the gloves after handling the contaminated PPE. The simplest ozone system is a tank of medical oxygen, a pediatric regulator valve, a tube between the oxygen source and the generator, and an outflow tube from the generator carrying ozone. It is important that the ozone carrying

tube be made of silicon because a standard plastic or rubber tube will degrade from contact with the ozone. Line a bin with a plastic garbage bag, making sure you have a generous cuff around the outside. This will enable you to not touch the contaminated [interior] of the bag when you close it up later. Load all your gowns, helmets, and visors into the bags. The smaller PPE, such as personal masks, can be put in a smaller bag and marked with the owner’s name. We recommend disinfecting your gear with at least 70 micrograms per milliliter of ozone. On this unit we need a flow of 1/8 liter of oxygen per minute to get that strength. Wash and disinfect your hands after loading your PPE and before handling your ozone generator and oxygen tank. When you are ready to begin, open the valve on your oxygen tank, set your regulator to the desired flow rate, in this case 1/8 of a liter per minute. Be sure you have good ventilation in the room [where] you are



1. A simple ozone system consisting of a medical oxygen tank, a pediatric regulator valve, a tube between the oxygen source and the generator, and an outflow tube carrying ozone. 2. Ozone system for disinfecting personal PPE. 3. Set-up for loading the larger gear bag. 4. A zip tie holds the ozone tube securely within the bag.


3 IVC Summer 2020


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.

CASE REPORT — ACUPUNCTURE HELPS A RABBIT WITH EAR IRRITATION Stuart is a seven-year-old bunny who had been shaking his head and scratching his ears for two years. On the exterior, his ears looked normal. However, an otoscopic exam found thick, sticky exudate deep within the canal. Ear cytology revealed occasional yeast and a lot of debris. Stuart had visited the vet several times, but none of the typical treatments helped. Other than being a bit overweight, the rest of his physical exam was normal. His energy level was good for his age, and his digestion was solid. He has a laidback Earth constitution and worries when left alone for too long. His pulses and tongue color were normal.

TCM Diagnosis Wind Damp Heat in the ear/GB Channel Earth Constitution prone to Damp Kidney Essence declining with age

Treatment Principles Clear Wind and drain Damp Heat from the ear/GB Channel, support Spleen, and prevent Dampness

Acupuncture Rx GV 20, SI 19, GB 2, GB 20, GV 14, BL 20 9 (vitamin B12 aquapressure), ST 36, GB 41, BL 23 (to support kidneys)

Other treatments and recommendations Pellets were reduced to one tablespoon per day to decrease Damp and support weight loss. Stuart was also given an herbal formula, Damp Heat Derma Relief tincture by Kan Herb, at ten drops twice per day. Ear cleansing was done daily for one month.

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Leave the bag for one hour. It’s best to open bags outdoors or in an area with an effective outflow fan. Ozone in this state should not be breathed directly as it’s irritating to the lungs. Once your bag is opened, fluff it several times to disperse the remaining gas. Now your gear is clean and ready for reuse. Medical ozone is a powerful virucide that can protect first responders and health care providers as well as dramatically improve patient outcomes during this pandemic and beyond. View the video at www.youtube.com/watch?v=PiZv9pLbW6g.

Stuart receiving acupuncture.

Submitted by Nell Ostermeier, DVM, CVA, FAAVA


When there is visible air in your bag, remove the ozone tube, seal the bag, and place it into a larger gear bag. In this way, both the inside and outside of your personal gear bag will be disinfected. Remove the larger gear bag from the bin, handling only the outside of the bag. Insert your ozone tube into the end of the bag. Use a zip tie to hold your ozone tube tightly within the bag so no ozone will escape while filling. Once there is a visible fill in the bag, carefully remove the tube and reseal your bag, fluffing the contents so that the surfaces are in contact with the ozone, and set aside. Since the outside of your ozone tube may be contaminated from contact with the inside of the bag, disinfect it right away with alcohol or disinfectant wipes.

LINKS TO US AND INTERNATIONAL MEDICAL OXIDATIVE THERAPY GROUPS www.ozonewithoutborders.ngo www.aaot.us/default.aspx www.ozonetherapiesgroup.com www.sopmed.org

Outcome At Stuart’s follow-up visit, he had no more itchy, gooey ears!

working and don’t breathe the ozone gas directly. Insert the ozone tube into your personal PPE bag, flatten out the excess room air and zip the bag closely around the tube. Now turn the ozone generator on and you are making an ozone/oxygen mixture.

Illustrations by Michael A. Simmons, MFA, and licensed under Creative Commons.


is committed to being

100% natural What started as a simple idea has grown into an industry-changing pet food company with a commitment to using only natural ingredients. Back in 2006, Nature’s Logic ® founder Scott Freeman asked a pivotal question — is it possible to create a complete animal diet, with all the essential nutrients, from only whole foods? He discovered it was, and became devoted to reshaping the pet food industry around this concept. At the time, pet foods without artificial ingredients were still an innovative idea. “Being 100% natural is our hallmark,” says CEO David Yaskulka. “All the vitamins and minerals in our recipes come from food ingredients, not synthetics, which often come in packets made in China.” By avoiding the latter, Nature’s Logic prevents problems such as vitamin toxicity — a common issue that led to a 2019 FDA warning and recall on many pet food brands. It also means that dogs and cats receive all the nutrients they need from their meals, without requiring additional supplementation in most cases. Relying on natural ingredients continues to guide the company’s decisions, especially when it comes to keeping up with today’s pet food trends. Nature’s Logic recently launched a grain-free kibble for dogs — a food category that is beneficial for many animals despite recent controversy. “We know some pets truly do require a grainfree diet,” says David. The key, of course, is feeding a high quality brand that doesn’t just swap grains with legumes and other cheap ingredients in order to lower costs. “Our grain-free diet is, like all our diets, high in animal protein, so it’s rich in natural taurine and methionine-cystine,” he adds. “And we don’t replace grains with high-glycemic

substitutes like potatoes, peas, or other legumes like chickpeas or soybeans.” While making high quality pet food has always been top priority at Nature’s Logic, the company also dedicates time and resources to championing other areas of sustainability. They are an active member of the Pet Sustainability Council (PSC), and their headquarters, as well as their kibble and bag manufacturing facilities, are powered by 100% renewable electricity. For every pound of food sold, they purchase one kilowatt hour of renewable electricity. Their latest goal is to help some of their partners also become powered by renewable electricity. “We continue to explore as many ways as possible to make our carbon footprint smaller,” explains David, adding that Nature’s Logic is the first pet company to become certified plastic-neutral. This means their packaging balances the quantity of produced plastic with an equivalent quantity of recycled plastic, to offset their carbon footprint. Nature’s Logic was built on the idea that pet food should contain all natural ingredients with no synthetic vitamins or other additives. This goal has continued to serve the company well in product development, customer retention and more — and has led them to make conscious, sustainable choices for the sake of their customers and the planet. “Staying true to our roots allows us to look with confidence to the future,” says David. “We’re excited for what’s to come.” natureslogic .com IVC Summer 2020



How has COVID-19 changed and impacted the relationship clients have with their dogs? This study explores how the pandemic has impacted human, veterinary and pet relations.

The COVID-19 pandemic has brought countless changes to how we live our lives, creating an uncomfortable level of uncertainty, altering our daily routines, adding financial stressors, and increasing social isolation. How have these changes impacted the relationship veterinary clients have with their dogs? What COVID-related concerns do people have regarding the care of their canine companions? This author and four other researchers from Colorado State University, Washington State University, Palo Alto University and the University of San Francisco set out to answer these questions by distributing an online anonymous survey via social media to current dog owners (there’s a separate survey for cat owners). The survey asked respondents to share their thoughts, experiences and concerns during the pandemic.

Lifestyle changes Over



of people report that their dogs help reduce their feelings of anxiety, depression, isolation and loneliness.


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One of the first things we want to explore is how COVID-19 and the related schedule/lifestyle changes have impacted the amount of time people spend with their dogs. The results suggest there are many happy dogs — 72% of people report spending more time overall with their dogs, with most par ticipants reporting that this increased time strengthened the bond they feel with their canines. Given that 29% of respondents reported feeling they have minimal social support now (compared to only 8% who felt that way before COVID-19), this human/ canine bond is more important than ever. In addition, dogs appear to help people cope with

Dog owner concerns surrounding the ability to afford and access veterinary care during the COVID-19 pandemic NO CONCERN





Ability to afford emergency veterinary care now

1,183 (29.6%)

931 (23.3%)

1,153 (28.9%)

521 (13.0%)

208 (5.2%)

Ability to afford emergency veterinary care in the future

1,051 (26.3%)

975 (24.4%)

1,231 (30.8%)

569 (14.2%)

170 (4.3%)

Ability to afford non-emergency veterinary care now

1,629 (40.8%)

1,117 (28.0%)

807 (20.2%)

245 (6.1%)

198 (5.0%)

Ability to afford non-emergency veterinary care in the future

1,516 (37.9%)

1,094 (27.4%)

939 (23.5%)

279 (7.0%)

168 (4.2%)

Concern that my vet will not be open/ available if I need them for emergencies

598 (15.0%)

860 (21.5%)

1544 (38.9%)

898 (22.5%)

96 (2.4%)

Concern that my vet will not be open/available if I need them for non-emergencies

683 (17.1%)

1,103 (27.6%)

1,434 (35.9%)

672 (16.8%)

104 (2.6%)

Concern about having to leave the house if my dog gets injured or sick

1,078 (27.0%)

1,140 (28.5%)

1,076 (26.9%)

552 (13.8%)

150 (3.8%)

many of the negative emotions that can accompany the changes created by the pandemic. Over 50% of people report that their dogs help reduce their feelings of anxiety, depression, isolation and loneliness.

Access to veterinary care Because the study indicates dogs are playing a critical role for many people during these stressful times, it’s not surprising that many owners are concerned about being able to provide and care for their dogs. This includes the ability to afford and access veterinary care as well as dog food and other supplies. For example, when asked about their concerns around their ability to afford emergency veterinary care, 42% of respondents expressed concern about meeting current needs, while 45% expressed concern around meeting future needs. Perhaps even more alarming is that 61% of respondents reported concern that their veterinarians would not be there in the case of an emergency, while 53% indicated similar concerns when asked about veterinarian availability for non-emergencies. While it would appear that most people are appropriately unconcerned about giving COVID-19 to their dogs, or contracting it from them, 60% did report concern about their ability to care for their dogs if they become ill themselves. At the same time, only 60% of respondents reported that they have identified someone to care for their dogs if they become ill.



of respondents reported concern that their veterinarians would not be there in the case of an emergency.

How these findings can assist veterinarians Capitalizing on these results, veterinarians have the opportunity to better address their clients’ concerns. Help your clients understand that your veterinary hospital will work with them to meet their pets’ needs, and proactively reach out to them to explain your new (and changing) protocols. You may want to offer guidance to your clients in determining an appropriate designated caretaker if they should become ill. And most importantly, as we all transition into this new reality, reassure your clients that your medical team will continue to be there for them in times of need. To learn more about this study, you can access the full preliminary report at FidoFortCollins.org. IVC Summer 2020


innovative practice



WORLD For new veterinary graduates, finding your niche in the profession can be challenging. Use these tips to help navigate your early career.

Early in my veterinary medical career, I had to reconcile my new role as a veterinarian with my simultaneous desire to explore other more integrative and innovative treatment options. I felt somehow set apart from my mainstream colleagues. I envisioned a medical metaphor — a mountainous horizon, with the peaks of the mountain range representing the traditional paradigm, and the sky in between holding other healing interventions. Though the mountain peaks and sky were distinctly different, by viewing them together you could grasp the full picture of what medicine could offer. The original veterinary profession was founded on mentorship and apprenticeship. Years of on-the-job training, often from a younger age and with a committed teacher, guided a fledgling healer on the professional path to self-sufficiency. Since then, various economic, sociocultural, and corporatization factors have evolved,


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sadly dashing that dream for countless aspiring young veterinarians. There is so much value in new and recent graduates: they have drive, passion, and have generally anticipated the harsh learning curve of real-world medicine “where the cases don’t read the book”. Today, for a young veterinarian with no place to roost, it can be terrifying trying to find the right fit. But there are guideposts you can follow.

MAINTAIN YOUR NETWORK Believe me when I say I had no idea what I was looking for, other than “a job”. The position I filled was never even advertised. During my senior year of veterinary school, a recent graduate emailed our class to recruit for an opening at her clinic, located where I was planning to move. While I was rejected for that position, she afterwards informed me that the owner of the clinic

work environment. I had a bad gut feeling during that particular interview, but I was so desperate for a job at the time that I would have signed up anyway. When I look back on all the job interviews/initial job experiences I’ve had in my life, I can trace back a consistent “gut feeling” about my potential happiness there. Those feelings have generally proven to be accurate.

MAINTAIN LOYALTY, COMMITMENT, AND QUALITY I have been working at my current job for almost 12 years. I know a good thing when I have it. The hours are long, the workload can get crushing, frustrations and miscommunications can be found everywhere, but we are humans in the real world and this should hardly be surprising. Outside of that are many bonuses. The feeling of a work family is strong. We have a diverse and engaged team — people with diverse prior lives, careers, and means. Despite the variety of backgrounds, they are all folks who decided they love working with animals for a living. All these people should be made to feel welcome in your chosen work family, too. We hold our clients to a very high standard. It’s not easy to always stick to recommending the gold standard every time, when it feels as if we spend so many of our days “wheeling and dealing”, but it’s the right way to practice and we strive as a group to show clients the value of our services. where she had done her preceptorship was seeking another associate. I went for an interview and got the position — all thanks to this person maintaining her network! Even now, as I meet veterinarians at educational events, social functions, and conferences, I try to present my best self and keep their contacts, because ultimately we are a small and tight-knit tribe, and we are in the position to help each other out tremendously.

TRUST YOUR GUT The interview for my current job lasted almost three hours, with a somewhat unstructured yet easily-flowing conversation. I felt free to ask any questions I wanted, and felt like I was getting honest answers. Incidentally, I later learned through the grapevine that the place where I had first applied was quite a toxic

The staff is highly trained as we delegate as much as possible to technicians and assistants for increased clinic efficiency. We take the time to educate them with skills and procedures, and we hold them accountable. We have a progressive administration that communicates well. I have watched my clinic evolve from a 2,300 sq ft strip mall unit to a 12,000 sq ft freestanding building. I have seen many managers come and go over the years as our practice identity and culture has evolved to incorporate growth. Change is very difficult, and over time we have assembled an incredible team running behind the scenes. Looping in a cloud-based communications platform was a crucial part of this evolution. The COVID-19 pandemic was peaking at the time of this writing, and our clinic’s size may not have survived as successfully without a coordinated effort from each individual staff member’s participation within this portal. Continued on page 50. IVC Summer 2020




I knew I had found my dream job when my boss practically kicked me right back out the door within that first year of practice, providing tuition and time off so I could obtain my certification in veterinary acupuncture. "Take advantage of your brain, it is still fresh from vet school,” he said. I was encouraged to bring my training back to the clinic and have been actively incorporating it in our regular appointment system for over a decade. I am free to use my CE allowance for my choice of annual conferences. I am also marketed on the clinic's outreach materials and available to see referrals from other clinics for just the integrative services, if a client is looking for them.

Continued from page 49. None of this would be possible without a practice owner with sound business sense and a talent for medicine and surgery alike, which my boss surely is. He is a rare combination of superhuman and human being who embodies what this profession was founded upon. This owner respects me, protects me, has observed my development, and trained me to protect myself from liability. He has been generous with benefits and has shown integrity in the community.

DON'T HANG ON TO DEAD WEIGHT One of the primary reasons I like my job is that we do not hang on to dead weight, whether it involves outright termination, documentation of policy violations, or dealing with people just not in step with the group. People are in our profession to do great work; they are there because they want to be. General practice is not for everyone, and nor is emergency/critical care. Regardless, it is imperative to have an administration that will prevent toxic, disengaged employees from hanging on, and that will keep the liabilities out. I have worked in practices that drag on for years staffed with the worst kind of people. I have heard countless stories of utter shock and horror from all my colleagues and classmates. I once worked in a place that caught an employee stealing controlled substances, and instead of firing and reporting them, the practice allowed them to stay on — a huge red flag! Working for animal health and shouldering the humans attached to them is a hard enough job as it is. The rates of suicide and other mental health issues among veterinarians are top-priority issues. Veterinary employers who prioritize standards and integrity are essential.

MARKET YOURSELF “You know, acupuncture would help that.” “Please have your family contact me with any questions they may have about this modality.” “I would like to apply this great treatment to your pet.” Yes, you will say the same things over and over again; yes, you will get some


IVC Spring 2020

as comfortable with it as he initially let on. He just trusted me enough to realize that if it was something I felt I needed to do, then he would let me do it.

painfully polite declines; and yes, you won't always get the results you want. But we do this every day in regular veterinary medicine anyhow. It’s just another tool in the kit, as we like to say. That doesn't make it any less potent or applicable, so keep putting it out there!

Provide clear instructions to your associates about what makes a good referral case. Be patient, treat hospitalized cases, practice interpreting these complicated paradigms to the captive audience of your staff so that your clients understand it better when you talk with them. Document your successes; I have a case I like to show of a dog’s vertebral heart score reducing over time with just acupuncture. The fireworks will occur eventually for those who “need proof”, but over time your work even on basic cases will build up enough magic to open the eyes of your coworkers and clients.



Perhaps your boss heard one too many stories about that quack down the road. Perhaps they put their reputation on something that didn’t succeed. Perhaps they have lost associates to something they didn’t understand.

The entire veterinary industry is creeping closer to the table as One Health initiatives progress. Veterinary associations have been keen to keep the profession’s future in mind as we pass through a critical time of legislative, commercial, and educational growth. Hopefully, there will also come a point where the word “medicine” will conjure more in the minds of the general population than just drugs and hospitals.

Even though my boss encouraged me to pursue acupuncture, I realized over the following few years that he was not

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“adolescent” phase A recent study has demonstrated that, like human teenagers, dogs go through a moody adolescent stage when they’re in puberty. Published in Biology Letters, the study — “Teenage dogs? Evidence for adolescent-phase conflict behavior and an association between attachment to humans and pubertal timing in the domestic dog” — found that dogs in puberty (at eight months of age) are more likely to ignore commands given by their caregivers, and are also harder to train. This behavior is more pronounced in dogs with an insecure attachment to their owners. “This is a very important time in a dog’s life,” says study leader Dr. Lucy Asher, the Senior Lecturer in Precision Animal Science at Newcastle University’s School of Natural and Environmental Sciences. “It’s when dogs are often re-homed because they are no longer cute little puppies, and suddenly, their owners find they are more challenging and can no longer control or train them. But as with human teenage children, owners need to be aware that their dogs are going through a phase and that it will pass.” Dr. Asher and other researchers from Nottingham and Edinburgh Universities monitored a group of 69 Labradors, golden retrievers, and crossbreeds of the two for obedience at the ages of five months — before adolescence — and eight months — during adolescence. The team found that the dogs took longer to respond to the “sit” command during adolescence, as opposed to before adolescence. Additionally, the dogs were less likely to respond when the command was given by their caretakers as opposed to strangers. Further supporting evidence was found when the team next looked at a larger group of 285 Labradors, golden retrievers, German shepherds and their crossbreeds. Their owners, along with trainers less familiar with each dog, filled in


IVC Summer 2020

questionnaires looking at the dogs’ “trainability”. It asked them to rate statements such as: “Refuses to obey commands, which in the past he has learned” and “Responds immediately to the recall command when off lead”. Caregivers gave lower scores of “trainability” to dogs around adolescence, compared to when they were five or 12 months old. The trainers reported that they found the dogs more trainable during adolescence than the owners did. The experts also found that, in common with humans, female dogs with insecure attachments to their caregivers (characterised by higher levels of attention-seeking and separation anxiety) were more likely to reach puberty early. This data provides the first cross-species evidence of the impact relationship quality has on reproductive timing, highlighting another parallel with parent-child relationships. “Our results show that the behavior changes seen in dogs closely parallel that of parent-child relationships…and that just as with human teenagers, it’s a passing phase,” says Dr Naomi Harvey, co-author of the research from the University of Nottingham’s School of Veterinary Medicine and Science. “It’s very important that owners don’t punish their dogs for disobedience, or start to pull away from them emotionally at this time,” adds Dr Asher. “This would likely make any problem behavior worse, as it does in human teens.” ncl.ac.uk/press/articles/latest/2020/05/teenagedogs/


INCOME POTENTIAL • $50-$100 per 20-min session, depending on the techniques & location. Administered by veterinarian, veterinary technician or other trained employee. TRAINING REQUIREMENTS: Angel’s Animals certifications timelines: • Massage program — 100 hours • Reiki course — 14 hours • Other certifications — approx. 10 hours each • Every certification requires students to submit case studies & videos, and take an online exam

Dr. Sarina Barbara, DVM, offers an Animal NeuroMyofascial Release (ANMR) technique to one of her patients.

INCREASE REVENUE THROUGH BODYWORK! The state-of-the-art learning platform from Angel’s Animals, LLC makes it easy!

TIME TO IMPLEMENT: Start seeing clients immediately, once: • Certification is obtained • Essential supplies are purchased • Appropriate space is designated TYPICAL SESSIONS: • Massage — 20 min • Body alignment — 10 min • Other techniques — 10-20 min




Angel’s Animals, LLC. offers online certification courses in animal massage, craniosacral therapy, kinesiology taping, Reiki and body alignment. Their courses can be started at any time and never expire, so you can work at your own pace and will always have access to the material. Their state-of-the-art learning platform allows students to effectively learn the techniques and successfully incorporate them into their practice. The instructors assess their students through online exams, case studies and video submissions, and strive to ensure that all graduates feel confident in their abilities at the completion of the course. The techniques taught by Angel’s Animals are all very safe to perform and do not require direct veterinary supervision.

More and more animal owners are looking for less invasive and medication-free options to treat their animals’ pain. Adding animal bodywork services to your practice will allow you to incorporate techniques such as massage and body alignment into treatment programs and generate an additional revenue for your practice. Many animal caretakers have personal experience receiving various forms of bodywork and are often eager to purchase these services for their pets as well.

IVC Summer 2020





— the importance of leadership during a crisis

How practice managers can effectively lead their teams during times of global uncertainty.

Leadership has a direct correlation with the efficiency, productivity and success of your veterinary business. When utilized effectively, leadership helps a practice thrive; on the other hand, a lack of leadership can cause its demise. Earlier this year, I read a book called Great By Choice by Jim Collins, and was struck by this quote: “Throw leaders into an extreme environment and it will separate the stark difference between greatness and mediocrity.” (Jim Collins and Morten T. Hansen. Great by Choice. Random House Business Book, 2011.) It is easy to focus on improving your leadership skills as they relate to your normal day-to-day business activities. But do you have the leadership skills your team will need when you are presented with a crisis or “extreme environment”?

crisis for you, requiring good leadership. However, the truth is, you’ve experienced crises before. Think about past experiences in which your team was presented with significant difficulties or hardships. Personally, I’m recalling hurricanes, internet outages, power outages and IT issues. Unfortunately, these situations create a negative shift at their onset. Client service, patient care, and team attitude can all decline, adding fuel to the fire of compassion fatigue. It is your job as a leader to put a halt to that negative shift in your practice, and do what you can to lead your team through it.

We are all still recovering from the shock and impact of the COVID-19 pandemic. No doubt, it has been an unprecedented

• Admit to what you can’t control and commit to what you can During any kind of crisis, there will be things you cannot


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What follows is a recipe I’ve put together for great leadership during a crisis.

control. As frustrating as this is, you must take a moment to admit it. Spending your time and energy on things you have no control over is a waste, and does not help your team. Rather, make a list of things you can do to alleviate stress despite the barrier that’s in your way, and throw all of your energy into those! The fall of 2016 presented our own practice with the threat of Hurricane Matthew. It was the first time in our years of business that we found ourselves navigating our community’s reaction to an approaching hurricane. I could not change the fact that all our clients simultaneously realized they had a short window of time to get what they needed from us. For 48 hours, our phones rang nonstop. Appointments were being cancelled and prescription and food requests were coming in faster than we could fill them. We quickly realized we needed to redistribute our staff to accommodate this unprecedented demand. We moved tech staff to help our client care coordinators handle incoming phone calls; we pulled one doctor away from appointments to weed through and approve all the prescription requests; we increased the number of technicians filling the prescription labels that were printing; and we changed our voicemail and auto email responses so our clients were aware we were working as hard and as fast as we could.

If we hadn’t promptly identified and changed what we were capable of changing to alleviate the stress of the situation, our staff morale would have been diminished, our clients could have turned to another vet practice, and our patients could have been without important medications. I’m grateful that our team quickly jumped to resolution mode, and by the time the storm came, every client and patient had their needs met. • Over-communicate Now is not the time to be worried about annoying anyone. Your staff members are probably scared, even if they seem fine. Hearing from the leaders in your practice will empower them to stay the course. Communicate with them via email or in person two to three times a week. For shorter crises that last only a few days to a week, communicate daily. Feelings of uncertainty create anxiety and fear. Do not leave staff wondering what is happening or what to expect. Your team will be much better prepared to withstand the crisis if they are informed, feel supported, and know what to do. Staff communications should identify what you know about the situation, what you are doing to help, what they should be doing, and your projected thoughts about the foreseeable future. I also recommend devoting one communication each

IVC Summer 2020


week (or at the end of a short crisis) on self-care. Remind and encourage your team to care for themselves. Showering them with tools and resources is a great way to do this. Don’t forget about communicating with your clients! With COVID-19 specifically, we have found our weekly client updates to be very beneficial. We include any new information we have to share, what is still the same regarding process and client/pet safety, and what our team is doing to help. The response from our clients has been overwhelmingly positive. We’ve taken out the guesswork for them. If their pets need us while they’re sheltering in place, they know what to do and don’t panic. Regardless of what you will face as a practice, your patients are still going to need you. Make sure your clients are informed and prepared! • Be present, be positive, and be real Your office desk is not the place to be right now. Get out there and be with your team. Endure the struggle with them. Let them see that you are in it, too. If you can do it, they can do

it. Ask them questions. What do they think would help? Do they have any great ideas they are holding back? Utilize them as your greatest resource for what is working and what is not. Make yourself available to their concerns. Perform routine one-on-one check-ins to ensure they are doing well. They need that. They need you. Stressful times create dark clouds. Be the light in the darkness. Work against it with calmness and positivity. If you are calm, your staff will be calm. If you are positive, they will be positive. What fun can you create to fight off negativity? During COVID-19, we took an hour-long break on one day, closing the practice, and had lunch delivered for everyone. We sat outside in the beautiful weather and “social distanced” in the daycare yard. Then, our two owners reminisced about their younger gymnastics days and had hand-walking and back-handspring competitions before we returned to finish the rest of our day. It was refreshing and just what our staff needed during the stress of a global pandemic. We didn’t weigh them down with staff meetings on process or new training. We chose something light and beneficial to rejuvenate them and keep them going during this time. Be real. You may be worried or scared too. It’s okay to show your staff that you are human. Covering up your feelings with excessive optimism isn’t going to help anyone. It may actually make your staff feel they’re doing something wrong if you seem to feel good about things when they don’t. However, they will feel inspired if you are real with your stance on the situation, while maintaining a positive attitude that you are all in this together and will endure. Jim Collins refers to this as the Stockdale Paradox, in which successful outcomes are more likely when optimism and positivity are balanced with acknowledgement of the reality of a situation. Ultimately, leadership skills are not about how you lead when things are easy and all seems to be going right. It is about how you lead when circumstances are challenging and you are thrown that curve ball you never expected. Life is uncertain, this we know. You can’t predict the next obstacle you will face. But what you can do is prepare yourself and strengthen your leadership ability for the next crisis, whatever it may be.


IVC Summer 2020

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. Submitted by Cynthia Lankenau, DVM

The VBMA hopes everyone is safe and healthy. The use of botanical medicines can be very advantageous during these times.

DID YOU GUESS LAST ISSUE’S MEDICINAL HERB? Hen-of-the-woods, also known as Maitake (Grifola frondosa), is a polypore mushroom that grows in clusters at the base of trees, particularly oaks. It is typically found in late summer to early autumn. Maitake is a truly amazing mushroom; it is safe to eat and very tasty. But to extract all the medicinally-active beta glucans from the mushroom, it needs to be gently decocted for hours. This mushroom is an immune amphoteric, which means it is equally indicated in cases of over or underactive immune systems. It is effective for hypo-immune diseases such as cancer, or hyper-immune conditions (e.g. autoimmune diseases) as well as frustrating illnesses like FIP. This mushroom also has hepatoprotective activity.

CASE REPORT Sam is a six-year-old spayed female domestic shorthair cat. She suffered through at least three bouts of FIP. Her owner does rescue feral cat work, and with every exposure to new cats, Sam had a recurrence. All bouts were successfully treated with herbal medicine, but the recurrences were draining to Sam. Since starting a preventative decoction of 60% Maitake, 10%, thyme, 10% Angelica archangelia, and 20% cinnamon twig, Sam has experienced no further recurrence of FIP, despite many new exposures.

• With the COVID-19 crisis, the VBMA has been hard at work on its listserv to provide herbal information. For example, the Daoist Traditions College has published several formulas, including one for prevention: Huang Qi (Radix Astragali) 15g; Bai Zhu (Rhizoma Atractylodis Macrocephalae) dry fried 10g; Fang Feng (Radix Saposhnikoviae) 10g; Mian Ma Guan Zhong (Rhizoma Dryopteridis Crassirhizomatis) 10g; Jin Yin Hua (Flos Lonicerae Japonicae) 10g; Chen Pi (Pericarpium Citri Reticulatae) 6g; and Pei Lan (Herba Eupatorii) 10g. There are many potential influenza and pneumonia formulas, and each depends on specific individual signs and symptoms. By joining the VBMA you will be part of this informative listserv. • T his year’s joint conference with the ACVBM takes place in Eugene, Oregon. Book accommodations at Graduate Eugene Hotel for $139 per night (graduatehotels.com/eugene). » October 26: VBMA will host lectures featuring Kevin Spelman, RH (AHG) and Subhuti Dharmananda, PhD, director of the Institute for Traditional Medicine (ITM). » October 27: ACVBM will host lectures by Chanchal Cabrera, MSc, FNIMH, RH (AHG), Medical Herbalist. » October 28-30: VBMA Domestic Ecotour at Belknap Hot Springs, Lodge and Gardens, McKenzie Bridge, OR. You can sign up for just the lectures, the ecotour, or both. This will be a small conference and very socially safe! For registration information, visit acvbm.org.


PAST ACTIVITIES AND UPCOMING EVENTS • T he VBMA’s first webinar program of the year focused on the natural treatment and prevention of heartworms. On May 14, the VBMA held a webinar on hip and knee disorders, with a favorite speaker, Dr. Steve Marsden. All webinars are available for purchase at vbma.org.

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

IVC Summer 2020


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IVC 10:3





BAS IN THEIR DOGS Gaining a better understanding of Brachycephalic Airway Syndrome (BAS) in dogs is key to advising your clients on best management practices.

The selective breeding that has given brachycephalic breeds such as Chihuahuas, Pugs and French Bulldogs their distinctively flat faces has concurrently led to a compression of their upper respiratory anatomy. The extent of these anatomical differences and the degree to which they cause airway obstruction is variable between breeds and individuals. Here, we’ll look at how to identify Brachycephalic Airway Syndrome (BAS) and the recommendations for management.

Brachycephalic Airway Syndrome BAS is defined as airway obstruction caused by primary characteristics such as stenotic nares, soft palate elongation and hyperplasia, and tracheal hypoplasia. The resultant air turbulence in the upper respiratory tract can lead to secondary abnormalities, including everted laryngeal saccules and laryngeal or tracheal collapse.1,2 Patients often present with a combination of stridor, inspiratory dyspnea and exercise intolerance; in severe

cases, heat stroke and episodes of cyanosis or syncope may occur, and the airway obstruction may be life-threatening.

Diagnosing BAS is based on an assessment of the dog’s respiratory anatomy in relation to published criteria in order to identify abnormalities; as such, the diagnosis is made by laryngoscopy and/or tracheoscopy. Surgical techniques have been developed to address several of the abnormalities associated with BAS, with the aim of reducing upper airway obstruction; these include rhinoplasty, soft palate resection and removal of everted laryngeal saccules. 3 There is evidence that early intervention leads to a better prognosis, since secondary laryngeal changes can be present in puppies as young as six months old.4 However, some abnormalities such as tracheal hypoplasia cannot be treated surgically, and correct management will continue to be important in these BAS patients. Continued on page 60. IVC Summer 2020


Continued from page 59.


Management recommendations SAFE EXERCISE It is important to provide advice to clients for safe exercise management in dogs suffering from BAS. Overexertion and overheating can precipitate breathing problems; conversely, obesity arising from lack of exercise exacerbates airway obstruction. These dogs should not undertake strenuous outdoor exercise in hot or humid weather; owners should be encouraged to provide their dogs with alternative opportunities for moderate exercise in cool air-conditioned environments.4,5


USE OF A HARNESS A standard collar and lead can put intense pressure on the trachea and exacerbate symptoms of BAS, sometimes triggering tracheal collapse. A low-front harness is recommended for these breeds, even if they are not showing symptoms of BAS.6


HYPERTHERMIA AWARENESS Owners of brachycephalic breeds need to understand that their dogs may not be able to cool down by panting as effectively as other breeds do, so they should take preventive measures to protect their dogs from overheating. Advice includes avoiding outdoor activity in hot weather, checking that pavement or asphalt is not too hot for walking barefoot, and maintaining a cool temperature within the home. Owners should also be made aware of the signs of heat stroke. and the importance of acting quickly if they notice these symptoms in their dogs.

“Brachycephalic Airway Syndrome” from PetMD, petmd.com/dog/conditions/respiratory/c_multi_ brachycephalic_airway_syndrome.


Lodato DL, Hedlund CS (2012). “Brachycephalic airway syndrome: pathophysiology and diagnosis”. Compend Contin Educ Vet, 34 7, E3.


The degree of airway obstruction experienced by brachycephalic dogs varies widely, and not all meet the criteria for a diagnosis of BAS. As clinicians, therefore, it is important that we educate our clients on the early signs of BAS and make timely surgical and management recommendations.


IVC Summer 2020

3 Lodato DL, Hedlund CS. (2012). “Brachycephalic airway syndrome: management”. Compend Contin Educ Vet, 34 8, E4.

Pink JJ, et al. “Laryngeal collapse in seven brachycephalic puppies”. J. Small Animal Practice 47.3 (2006): 131-135; and “Brachycephalic-friendly exercise ideas” from American Kennel Club, akc.org/expertadvice/dog-breeds/sports-snouts-and-extreme-weather-workout-safety-for-flat-faced-dogs/


“Harnesses for brachycephalic breeds from WileyPup”. wileypup.com/best-harness-for-french-bulldog/




A look at the effectiveness of homeopathy over the last few hundred years, and the methodology for use in epidemics.

“Since every case of disease in a given epidemic has the same origin, the disease puts all those who have fallen ill into the same kind of disease process.” – Dr. Samuel Hahnemann, “The Organon of the Medical Art”, Aphorism 737 As I write this in late April 2020, most of the world is under mandatory lockdown due to the COVID-19 pandemic, and our conventional medicinal approach to really help with epidemic disease is being challenged. The daily news only brings an updated scoreboard of the spread of disease and death, and dire warnings of things getting worse. There is another approach. Over 200 years ago, Dr. Samuel Hahnemann provided very clear instructions on dealing with epidemic diseases. Homeopathic approaches have been very successful during the greatest disease outbreaks of the last few centuries. While the focus is on recent human health issues, these are very relevant to our veterinary world as well, and the same principles of homeopathy apply.1,2

Homeopathy does not need weeks, months or years to develop remedies or prophylactics for facing newly-emerging epidemics. The medicine chest is already completely stocked with potential cures waiting to be applied. Homeopathy is a pure method of science, the result of careful observation of phenomena, rigorous experimentation, and repeatable verifications. Anyone practicing genuine homeopathy is always ready to face any new epidemic disease, because the Law of Similars can be applied to any sick patient at any given time. Homeopathic literature is full of effectiveness studies, controlled cohort studies, observational studies, and outcome studies from official reports of hospitals, boards of health, insurance companies, and state institutions. Continued on page 62. IVC Summer 2020


Continued from page 61. Homeopathy is safe and cost effective, with very consistently strong therapeutic and prophylactic effects, and real-world long-term efficacy. It can be applied to treatment plans for many common veterinary epidemic diseases, such as canine parvovirus, kennel cough and influenza, not to mention devastating livestock ailments like shipping fever, mastitis, and bird flu.

HISTORICAL REFERENCES TO HOMEOPATHY AND EPIDEMICS Homeopathic literature abounds with volumes, references, books and pamphlets on the treatment of epidemics with homeopathy. Mortality rates are consistently much lower with homeopathic treatment, regardless of physician, time, place or disease. This includes diseases with known high mortality rates, like cholera, smallpox, diphtheria, typhoid fever, yellow fever, and pneumonia. Homeopathy is used both to treat and protect large numbers of people or animals during epidemics. The results cannot be explained by placebo effect. Consider pneumonia alone as a good example, and one that’s very relevant to the COVID-19 situation (see sidebar on page 64).


IVC Summer 2020

From scarlet fever in Germany in 1796, to leptospirosis in Cuba in 2008, homeopathy has succeeded in easing the effects of epidemics when allowed to be used. The most consistent, predictable, and impressive results were, and still are, obtained by those practicing genuine classical homeopathy.5 • In 1813, homeopathy was effective for typhus fever. After Napoleon’s army moved through Germany to attack Russia, they retreated back through Germany. Along the way, they traveled through the town of Leipzig, spreading lice-born typhus to the area. Dr. Hahnemann happened to be in the area at the time, and treated 180 cases with only two deaths (1.1%). Conventional mortality for typhus around that time was approximately 20% (e.g. 536 deaths in 2,742 cases in Vienna, Austria between 1850 and 1852, about 40 years after Dr. Hahnemann’s success in Leipzig).4,6 • In 1830, a cholera epidemic was reported coming from the East. Dr. Hahnemann considered the symptoms of the disease after reading newspaper accounts, and published an article on which medicines might be helpful. When cholera eventually struck Europe in 1831, the conventional treatment led to 40% to 80% mortality, while homeopathic treatment saw only 9% mortality. For example, in 21 hospitals in Europe, there were 63 deaths per 100 patients. In Vienna alone, 1,360 of 4,500 patients treated allopathically died (30%). However, three homeopaths in Vienna reported treating 309 cases with only 18 deaths (6%).6 • Similar successful results were reported for diphtheria, a disease with over 50% mortality under conventional treatment, yet with only about 16% deaths when homeopathic methods were used. Statistics compiled from Broome County, New York from 1862 to 1864 showed

84 deaths per 100 cases for allopathy (84%), and only 20 deaths per 125 cases for homeopathy (16.4%).4 • In 1900, Thomas Lindsley Bradford, MD, wrote The Logic of Figures, a book describing the success of homeopathy in treating epidemic diseases. Here is a brief quote from the book: “Homeopathy had become very popular in North America during its early years due to its amazing successes obtained by the ‘old guard’ during the epidemics — epidemics of diphtheria, scarlet fever, cholera, malaria, yellow fever — especially yellow fever; the death rate for that was 55% when allopathic treatment was used, but less than 5% in cases with homeopathic treatment; and it was the same for cholera. It is here with the ‘old guard’ that homeopathy obtained its golden letters.”6 • The most severe epidemic of all time was the influenza pandemic of 1918 to 1919. Twenty percent of the entire world population was infected, and nearly 50 million people died. In the US, this epidemic was so devastating that the average lifespan decreased by ten years. Homeopathic medicines were used widely both for treatment and prophylaxis. The average mortality under standard treatment ranged from 2.5% to 10%, while 1% or fewer patients died under homeopathic treatment.4 Dr. T.A. McCann of Dayton, Ohio reported that 24,000 cases of flu treated with allopathy had a mortality rate of 28.2%, while 26,000 cases treated with homeopathy had a mortality rate of just 1.05%. This last figure was supported by Dean W.A. Pearson of Philadelphia (Hahnemann College), who collected 26,795 cases of flu treated with homeopathy with the above results. Dr. Herbert A. Roberts from Derby, Connecticut said that 30 homeopathic physicians in his state responded to a request for data. They reported 6,602 cases with 55 deaths, which is less than 1%.9 There are great advantages to treating epidemics with homeopathy, and these contribute to its amazing success. First, patient individuality is not such an issue as when prescribing for chronic disease. Consequently, the skill of individual prescribers is not a critical issue, because each homeopath can choose from a small group of closely matching medicines for the particular epidemic, using the genus epidemicus approach.

METHODOLOGY OF GENUS EPIDEMICUS The term genus epidemicus refers to the combined symptoms of a large group of individuals afflicted with the same disease or epidemic. This symptom list is used to choose the medicine best suited to treating those IVC Summer 2020



Most deaths from flu or flu-like illnesses are from pneumonia (98%). Pneumonia is the leading cause of death in children worldwide, killing more than AIDS, malaria, and TB combined, according to the WHO. In the US, pneumonia is the leading cause of death from infectious causes, hospitalizes over 1.2 million Americans per year, and costs $40.2 billion. The age-adjusted mortality rate of pneumonia has been increasing over the last few decades, from 11.2 per 100,000 in 1979, to 15.7 per 100,000 in 2011. One in 25 of all Americans will die of pneumonia. Dr. Andre Saine, ND, a prominent homeopath from Canada, reported interesting figures on the results of various treatments for pneumonia over the past 100 years, using large numbers of cases. On the conventional side, preantibiotic allopathy had the highest mortality of 24.3%, while contemporary allopathy had a lower rate of 13.7%. However, the mortality rate of general homeopathic treatment was just 3.4%, while the mortality rate under the care of Hahnemannian homeopaths (those strictly following Hahnemann’s principles) was even lower at just 0.4%.3 Morbidity and mortality from pneumonia could be greatly reduced by the simple application of homeopathy.

affected without having to consider each individually. This could also be thought of as an “epidemic simillimum” or ideal medicine for the epidemic. 7 Dr. Hahnemann addressed the concept of genus epidemicus in Aphorisms 101–102 of the Organon, 6th edition, and first mentioned the term in Aphorism 241: “Each epidemic has its own self-same character which is common to all of the individuals who are taken ill. If the character of the epidemic disease is discovered according to the symptom complex common to all the patients (i.e. the genus epidemicus), this will point to the homeopathically fitting (specific) remedy for the totality of the cases.”8 Recently, the genus epidemicus approach was used for the canine influenza outbreak. Using characteristic signs exhibited by many dogs with that diagnostic label, veterinary homeopath Dr. Will Falconer proposed the use of two homeopathic medicines as the most useful for treatment and prevention in exposed dogs showing similar signs —Phosphorus and Nux vomica. Using one of these two remedies to prevent the disease is different from the homeopathic practice of using a nosode (a specialized medicine made from the product of disease) to prevent an illness. The genus epidemicus method is considered by most homeopaths to be more effective at prevention than the use of nosodes.10

also been effective at preventing canine parvo in my own practice, proven over the last decade.1

CONCLUSION Homeopathy has proven successful in treating epidemic diseases. This is obvious from the historical record, as well as from more recent outbreaks. Yet results obtained by homeopaths during epidemics are almost completely ignored by medical historians. And despite homeopathy’s great efficacy, low cost, and safety in protecting against disease, only a few governments have promoted its use. Epidemic diseases will continue to plague humans and animals, as they have throughout recorded history. The genus epidemicus approach offers a safe, gentle way of restoring health.

Cooney T. “Homeopathic Treatment for Epidemic Diseases: Parvo and Distemper”. Integr Vet Care J. 2015;5(4):54-58.



Cooney T. “Epidemics and Genius of Homeopathy”. JAHVMA. 2018;51:22-25.

Saine A. “Case Management of the Influenza and Pneumonia Patient with Homeopathy During the COVID-19 Pandemic”. AIH Webinar, http://www.homeopathyusa.org; Accessed April 4, 2020. 3

Winston J. “Treatment of Epidemics with Homeopathy — A History”. http://www.homeopathycenter.org/treatment-epidemics-homeopathy-history. Accessed Feb. 17, 2020.



Saine A. http://www.homeopathy.ca/research-development. Accessed March 21, 2018.

Bradford TL. The Logic of Figures; Boericke and Tafel, Philadelphia, first pub. 1900. Reprinted by Trieste Pub. Pty Ltd; Collingwood, Victoria, Australia; 2017. 6

7 Yasgur’s Homeopathic Dictionary and Holistic Health Reference, 4th ed. Van Hoy Pub. PO Box 636, Greenville PA 16125; 2007.

Hahnemann SH. “Organon of the Medical Art”. O’Reilly, ed. Adapted from the 6th edition of Organon Der Heilkunst, 1842. Birdcage Books, Palo Alto CA, 2013.


However, health officials in Cuba recently used a leptospirosis nosode with great success to reduce the incidence of this horrible seasonal epidemic by more than 85% in over 2.4 million people, whereas vaccination programs in place for years failed to help.11 Nosodes have


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Hoover T. “Epidemic Diseases and Homeoprophylaxis: Fact or Fiction?” http://toddhoovermd.com/ articles/epidemic-diseases-and-homeopathic-prophylaxis.html. Accessed Feb. 7, 2018.



Falconer W. http://www.vitalanimal.com. April 26, 2015. Accessed Feb. 3, 2020.

Bracho G., et al. “Large-scale Application of Highly Diluted Bacteria for Leptospirosis Epidemic Control”. Homeopathy, July 2010; 99 (3): 156-66.



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news bites


Researchers have discovered the canine nose has the ability to detect weak thermal radiation. A team of scientists at Lund University (Sweden) and Eötvös Loránd University (Hungary), recently conducted a study to test their hypothesis that dogs’ noses are particularly sensitive to radiating heat. To test their theory, they trained three dogs to choose between a warm (88°F or 31°C) and ambient-temperature object, each placed 5.25’ (1.6m) away. The dogs weren’t able to see or smell the difference between these objects, but after training they were all able to detect the object emitting weak thermal radiation. The team then used functional magnetic resonance imaging to look at the brains of 13 different dogs as they sniffed two objects: one neutral and one warm. They discovered that a region in the left somatosensory cortex — the part of the nervous system connected to senses such as temperature and smell — was more responsive to the warm object. nature.com/articles/s41598-020-60439-y

Infrared imaging shows how cold the canine nose is compared to the rest of the body, making it more sensitive to radiating heat.

DOCUMENTARY FOCUSES ON INTEGRATIVE MEDICINE Earlier this year, veterinarian Dr. Marty Goldstein and director Cindy Meehl (Buck) released their documentary film, The Dog Doc. Exploring the question of whether we are overmedicating our animals (and ourselves), the film features real life interviews along with scientific findings that show the healing powers of integrative medicine. As a pioneer in the field of merging conventional medicine and alternative treatments, Dr. Goldstein looks forward to using The Dog Doc to share the power of integrative medicine with more health care professionals and animal parents. To learn more, watch the documentary at dogdocthefilm.com.

ANESTHESIOLOGIST DISCOVERS NEW WAY TO SEDATE HORSES Detomidine, a commonly-used sedative typically given to horses as a gel beneath the tongue, can be difficult to administer. Veterinarian Dr. Reza Seddighi at the University of Tennessee’s Department of Large Animal Clinical Sciences has discovered an alternative way to sedate female horses — intravaginally. Vaginal tissue is thin, permeable, and highly vascularized — similar to mucosal membranes in the mouth — making it a fast and effective way of getting Detomidine into the bloodstream. It also means the sedative doesn’t have to pass through the GI tract. In a study to test this method of administration, Dr. Seddighi and his team sedated and observed six mares for four hours, scoring them every 15 minutes for ataxia, behavioral changes, appearance, muzzleto-floor distance, and heart rate. They also had blood samples analyzed by the University of California, Davis. While the study confirmed that the drug takes effect most rapidly when given intravenously, intravaginal administration worked twice as fast as sublingual administration. As well, sedation was deeper and longer-lasting in the intravaginallyadministered gel group than in the IV group. ncbi.nlm.nih.gov/pubmed/31474339


IVC Summer 2020

IVC Summer 2020



IVC Summer 2020

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