Integrative PEER REVIEWED
VETERINARY CARE
BENEFITS OF PARTIAL SPAY
HOW SPARING THE OVARIES CAN MINIMIZE CANCER RISK AND OTHER HEALTH ISSUES. Page 16
CHRONIC KIDNEY DISEASE Proper diagnosis and monitoring are important keys to successful treatment.
FALL ISSUE 2012
www.IVCJournal.com
COGNITIVE DISORDER SAMe and choline...two wellstudied therapies for this common geriatric condition.
HERB-DRUG INTERACTIONS How concerned should you be when combining medications and herbal remedies?
GMO PET FOODS Find out how your patients are at risk from genetically modified ingredients.
EQUINE ULCERS Stress reduction and medicinal mushrooms work together to soothe horses’ stomachs.
WHAT’ S NEW • Unlocking the mystery of
Salmonella • Laser therapy symposium • New animal bioscience degree integrative veterinary care
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contents FeAtures
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ASSESSING AND MONITORING CKD
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Because the causes of chronic kidney disease are largely unknown, proper diagnosis and monitoring are keys to controlling this increasingly common condition.
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THE PROS OF PARTIAL SPAY
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Spay operations that spare the ovaries minimize the cancer risks and other health impacts associated with large breed dogs that undergo the full procedure.
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COGNITIVE DISORDER
SAMe and choline are two well-studied therapies that can help treat this common condition in geriatric dogs and cats.
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Integrative Practice HERB-DRUG INTERACTIONS
How concerned should you be when combining medications and herbal remedies?
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Case study GETTING GEORGE GOING
How rehabilitation helped a senior cat with chronic lumbosacral disk disease and renal failure regain his mobility and quality of life.
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RETHINKING EQUINE VACCINATIONS–PART 2
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Are you giving your patients too many vaccines? As more clients and veterinarians express concerns about the dangers of over-vaccination, it’s a good idea to review your own practice’s protocol.
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EQUINE ULCERS
Stress reduction and medicinal mushrooms can work together to treat and prevent this common health issue.
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Nutrition nook GMO PET FOODS
Dogs and cats are at risk from genetically modified ingredients.
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THE LATEST ON SEPARATION ANXIETY
Our understanding of what causes this common problem is changing, although behavior modification and medication remain the best approaches to treatment.
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Tech talk SCRUBS THAT MAKE A STATEMENT
Colorful uniforms with animal-themed designs are more than just a fashion trend. They help put clients at ease and subsequently enhance patient care.
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IMMUNOTONIC HERBS
Virtually anyone who delves into the world of natural medicine will quickly learn that “immunotonics”, “immune boosters” or “immune modulators” are the most pervasive terms in the natural supplements industry. They’re also among the most important tools in the holistic practitioner’s tool chest.
advisory board coLuMns & dePArtMents
5 Advisory board 6 What’ s new? 27 Spotlight 33 Industry Innovations 55 Veterinary resource guide
dr. richard Palmquist, DVM, graduated from Colorado State University in 1983. He is chief of integrative health services at Centinela Animal Hospital in Inglewood, California, president and research chair of the AHVMA, and an international speaker in integrative veterinary medicine. Dr. Palmquist is a consultant for the Veterinary Information Network (VIN) and co-director of the AHVMA Foundation. He has published two books, one for conventional veterinarians and a second for clients discussing how integrative thinking works.
michelle J. rivera, MT, VDT, is an instructor at the University of Wisconsin and The Healing Oasis Wellness Center, a post-graduate educational institution offering state-approved programs. She is co-owner of The Healing Oasis Veterinary Hospital, offering massage, rehabilitation, chiropractic and Chinese and Western Herbology. Michelle completed the Chinese Herbal Medicine program from the China Beijing International Acupuncture Training Center, and is certified in Chinese Medicine by the Wisconsin Institute of Chinese Herbology.
61 Marketplace 62 Events
dr. Joyce harman, DVM, MRCVS, graduated in 1984 from Virginia Maryland Regional College of Veterinary Medicine. She is certified in veterinary acupuncture and chiropractic and has completed advanced training in homeopathy and herbal medicine. Her practice in Virginia uses holistic medicine to treat horses. Her publications include The Horse’s Pain-Free Back and Saddle-Fit Book – the most complete source of information about English saddles.
dr. steve marsden, DVM, ND, lectures for the IVAS, the AHVMA and the AVMA, and is co-founder of the College of Integrative Veterinary Therapies. He is a director of the National College of Natural Medicine, and authored the Manual of Natural Veterinary Medicine. Dr. Marsden is extensively trained in alternative medicine, including Chinese herbology, acupuncture and naturopathic medicine. He has a veterinary and naturopathic practice in Edmonton, Alberta. In 2010, Dr. Marsden was named Teacher of the Year by the AHVMA.
dr. Jean dodds, DVM, received her veterinary degree in 1964 from the Ontario Veterinary College. In 1986, she moved to Southern California to establish Hemopet, the first non-profit national blood bank program for animals. Dr. Dodds has been a member of many national and international committees on hematology, animal models of human disease, veterinary medicine, and laboratory animal science. She received the Holistic Veterinarian of the Year Award from the AHVMA in 1994.
dr. christina chambreau, DVM, graduated from the University of Georgia Veterinary College in 1980. She is a founder of the Academy Of Veterinary Homeopathy, was on the faculty of the National Center for Homeopathy Summer School and has been the holistic modality adjunct faculty liaison for the Maryland Veterinary Technician Program. Dr. Chambreau teaches classes in homeopathy for animals, and lectures on many topics. She is co-author of the Homeopathic Repertory: A Tutorial.
Bill Bookout is a founding member of the NASC, serving as president and chairman of the board since 2002. He is founder and president of Genesis Ltd., a company that provides feed and health products for animals. He spent 15 years in the human medical device, drug and animal health industries. Bill received his Bachelor’s degree in physical sciences from the University of Wyoming, and an MBA from Pepperdine University. He has been selected by Health Canada to serve on the Expert Advisory Committee for Veterinary Natural Health Products.
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Assessing and
monitoring
CKD
Because the causes of chronic kidney disease are LARGELY unknown, PROPER diagnosis and monitoring are KEYS to controlling this INCREASINGLY common condition. by dr. LeA stoGdALe, dVM, diPLoMAte AcViM sMALL AniMALs
C
hronic kidney disease (CKD) is now the most common problem seen in older feline patients. It is less common in dogs, but we are nevertheless seeing it more often as our patients live longer. The causes are unknown, but some possible contributors include excessive vaccination, chronic infections and/or highly concentrated urine. The early signs of CKD are subtle and rarely noticed by owners. They include slow weight loss with a mild increase in drinking and urine volumes as the serum creatinine climbs above 140 mMol/L = 1.5 mg/dL. Veterinary diagnosis is made when accurate body weight decreases and blood tests are done.
Assessing CKD Assessing this disease includes: • Kidney excretion capacity by measuring Glomerular Filtration Rate (GFR) – serum creatinine • Secondary Renal Hyperparathyroidism – serum calcium (Ca) and phosphorus (P) • Kidney potassium (K) tubular loss – Serum K • Erythropoietin production – Packed Cell Volume (PCV) or hematocrit • Renal protein loss – urine protein:creatinine ratio (UPC) • Hypertension – blood pressure (BP)
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•Thyroid function status in cats – T4 The tests required for adequate assessment of renal function:
1 Thorough
history
(owner
observations)
and
physical
examination
2 Body weight and Body Condition Score – cats and dogs under
10 kg = 22 lb need to be weighed on a paediatric/baby/cat scale, not on adult bathroom scales or walk-on dog scales. Reliable human baby scales are available online for less than $70. All patients should be weighed at every vet visit, and the weight recorded in their files.
3 Complete blood count, CBC 4 Serum chemistry, with T4 in the cat 5 Urinalysis including culture and sensitivity (C&S) and UPC 6 Blood pressure Normal urine results: Urine specific gravity > 1.030 in dogs (first morning sample) Urine specific gravity > 1.030 in cats, if they’re eating canned food without water added Urine protein negative
UPC < 0.2 Urine C&S negative Normal BP arterial/systolic < 160 mm Hg. This includes the “white coat” effect but BP should be done first with the owner present and the patient not “freaking out”.
What happened to urea? Serum urea or nitrogen levels are influenced by many factors, making urea an unreliable indicator of kidney function. Some of these factors include: • Amount of protein eaten (important) • Time since eating • Degree of protein digested to amino acids • Proportion of protein absorbed • Level of intestinal bacteria • Liver function (the most important factor) • Protein loss through the skin, intestines and/or urinary tract • Catabolic processes occurring within the body, such as infection or cancer Urea is non-toxic, water soluble and has a neutral pH. It is a poor indicator of GFR. At best it is a minor indicator of seriously decreased liver function.
IRIS staging Thanks to the International Renal Interest Society (IRIS, iris-kidney. com), we now have better diagnostic and staging information. IRIS is composed of leading international veterinary nephrologists, and has made evaluating, interpreting and monitoring CKD much clearer with their evidence-based stages and recommendations.
Stage and clinical signs
Test results
Stage 1 – Asymptomatic
Creatinine < 140 = 1.5 depending on dog muscle mass; other evidence of kidney disease, e.g. ultrasound
Stage 2 – Mild PU/PD Decreased appetite
Creatinine in dogs 125 – 180 = 1.4 – 2.0 depending on size, diet and muscle mass Creatinine in cats 140 – 250 = 1.5 – 2.8 Potassium 3.5 – 5.0 Phosphorus < 2.0 = 6.0
Stage 3 – PU/PD Dehydration Decreased appetite Weight loss Constipation
Creatinine in dogs 180 – 440 = 2.0 – 5.0 depending on size, diet and muscle mass
Stage 4 Depressed Inappetent Vomiting and/or diarrhea
Creatinine > 440 = 5.0
Creatinine in cats 250 – 440 = 2.8 – 5.0 PCV < 20%
Continued on next page.
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