Letter Home (to WAH): The First Update

Catherine is an employee at WAH and a third year veterinary student. We love her emails to us and wanted to share one with you.

Hello WAH Family!
While my parents text me with updates about how unseasonably warm it is back in Delaware, I donned a wool coat in the first week of September. Though Sebastian is rejoicing in the crispness of this autumn weather, I am refusing to accept autumn weather before it is actually autumn on the calendar.

Speaking of the animals, the new little kitten, Jalapeno, is settling in very well. He and Dory would play all day long if they didn't have to eat or sleep. Essie tolerates him enough to let him sleep next to her. Jalapeno is infatuated with Sebastian. He splits his time at night between our bed and Sebastian's (which Sebby is only okay with because he sleeps so soundly that he doesn't notice the kitten trying to be his little spoon).

And now for classes this year. The only way you can fully appreciate this is if I list them: Cardiorespiratory Diseases of Small Animals, Musculoskeletal Diseases of Small Animals, Neurology & Ophthalmology for Small Animals, Small Animal Medical Exercises, Large Animal Clinical Techniques, Food Animal Medicine, Equine Medicine, Exotic Pet Medicine, Principles of Integrative Medicine, and Small Animal Radiology I. For those of you that went to the trouble to count the total was TEN. I am taking TEN classes. Because I didn't think a full vet school curriculum was enough, I am voluntarily taking an online course through the University of Florida on Shelter Animal Disease.

Occasionally I sleep and eat, but mostly I just sit in class and listen to lectures about eye balls and dairy cow mastitis. In fact, tomorrow I have a lecture in Food Animal Medicine entitled, "The Teat." That's right, all this money I am spending on vet school tuition and tomorrow afternoon I will be sitting through a 50 minute lecture on a cow's nipple. Mentally invigorating. On the bright side, last week I got to draw blood from a dog! It was sooooooo cool. I wish I had a job where I could do stuff like blood draws all day long! :)  [Note: Catherine DID have a job in which she drew blood all day long- at WAH!]

Hope all is well! Another update to come again soon!

-Catherine

Antibiotics: Too Much of a Good Thing?

I recently read a number of different articles that all came to the same conclusion: Antibiotics can be lifesaving but their overuse can have deleterious consequences.

We’re hearing some good stories in the media recently about the role that bacteria play in our bodies. A recent New York Times article by Michael Pollan entitled, “Some of My Best Friends are Germs” highlighted the fact that we are only 10% human- the other 90% of us are bacteria. And the most important bacteria are those that live in our guts.

This means that every time we swallow an antibiotic, we are killing some of the good bacteria that are living within us and performing important functions like helping us utilize food that we eat, making important vitamins like the B’s and fighting off bad-guy bacteria. And this antibiotic ingestion is not always intentional. Think of all the antibiotics used in the meats we eat!

Mitochondria are little mini-organs, or organelles, that exist within our cells. They have many important responsibilities to keep us alive and healthy. Among their many roles are the production of energy for cells and their antioxidant action. The intriguing thing about mitochondria is that it is believed that they are descended from bacteria that somehow found their way into cells and decided to remain there.

What does this mean? Well, it turns out that the mitochondria share a lot in common structurally with bacteria, and every time we take an antibiotic we are actually damaging our mitochondria! This effect is seen with many other types of drugs as well, and is likely one of the reasons we see so many pets with liver problems. We are still uncovering the vast array of diseases that result from mitochondrial damage.

In 2008, the International Journal of Cancer published a paper showing an increased risk of cancer proportional to antibiotic use in people. They found that in people who have taken 2-5 prescriptions of antibiotics, their risk of cancer was increased by 27%, and greater than 6 prescriptions led to an increased risk of 37%.

An earlier study (2004) showed that antibiotic use was associated with an increased risk of breast cancer. For those taking antibiotics for more than 500 cumulative days, the risk of breast cancer doubled. The antibiotics included the fluoroquinolones (known to be carcinogenic) as well as tetracycline, erythromycin, penicillin VK and cephalexin. We use all of these in veterinary medicine.

How can we avoid these problems with antibiotics?

First of all, keep your gut as happy as possible. A happy gut leads to a healthy immune system which leads to less need for fighting infections. For pets, feeding as close to an archetypal diet as possible (raw is the closest way) should help to grow the healthiest colonies of bacteria. Consider giving your dogs raw green tripe 2-3 times a week to help achieve this goal.

Feed organic or at least antibiotic-free meats. This is a challenge, but I’m throwing this in here so that maybe you will at least consider eating this way for yourselves. For people, diets high in fruits and vegetables also help. Organic, of course.

Recognize that your health is intertwined with your pet’s health. Research shows that people who own pets have different bacteria in their systems than non-pet-owning people. Likewise,  if you ask for antibiotics every time you visit the doctor for a head cold or sore throat, problems that are likely viral anyway, you are exposing your pet to potentially resistant bacteria.

Correct imbalances in your pet’s body that may have occurred as a result of prior antibiotic therapy. Your pet may need probiotics to restore the good bacteria, or prebiotics that provide the food for good bacteria to grow. Your pet may need antioxidants or CoEnzyme Q10 to repair mitochondrial damage and resultant organ damage.

Look for alternatives to antibiotic therapy. Is the bacteria really the problem or is something not right in your pet that is allowing the bacteria to infect your pet? You may achieve longer-lasting results by addressing the underlying problems and strengthening your pet’s immune system.

At WAH, we offer many alternatives to antibiotics, including homeopathy, acupuncture, ozone therapy and a wide array of supplements to boost the immune system. You can read more at: http://wilmingtonanimalhospital.com/services_holistic.php

New Scientific Findings in Homeopathy

 Our April 28, 2013 Facebook post (https://www.facebook.com/WilmingtonAnimalHospital?ref=hl#_=_)  showed me in a very brief video lecturing at the Academy of Veterinary Homeopathy (AVH) Annual Conference on updates in research in veterinary homeopathy. We had over 5500 views and numerous requests to learn more. As one who spends many hours each week reading (and enjoying this reading!) about the research findings, I am thrilled that the interest is so great!

My main concern about sharing the entire 20-page paper is that it is very technical, especially the basic science part which is the bulk of it. Many of my colleagues who practice homeopathy day in and day out commented about how they are glad that someone has gone to the trouble of understanding the research and taken the time to present it in a manner that they could somewhat comprehend. This stuff turns out to be based on physics, biology, pharmacology, physiology, nanoscience, neurology, immunology…and fields that combine a lot of these words like psychoneuroimmunology, nanopharmology and nanophysics.

So…I thought it would be kindest to present this material in two parts. The first is a very brief summary that follows immediately. The second is actually a summary written by my colleague Dr. Lisa Brienan. You can skip right to it, but it starts to get a bit technical so you may want to read the brief summary first. The original 20-page manuscript is the property of the AVH and is only available to veterinarians who are AVH members.

If you are interested in reading veterinary studies, you can visit my British colleague Mark Elliot’s website:

http://homeopathicvet.org/Veterinary_Research_into_Homeopathy/Welcome.html

Here it goes:

1. Homeopathic remedies are made by a process of dilution and succussion, or rigorous pounding/shaking. Widespread belief holds that homeopathy is no more than placebo effect because many remedies that are used are too diluted to have an effect. The assumption is based on the belief that there is no physical material that could provide a medicinal effect in high homeopathic dilutions.

2. However, there are many physicochemical studies on ultra-diluted and serially succussed solutions that have shown properties different from plain water.

3. With improvements in technology, researchers can now view nanoparticles (NP) of the starting bulk substance as well as glass-derived silicates in these solutions. High-speed videography has enabled visualization of these NPs as they are transferred from one container to the next in the dilution process.

4. Nanochemistry/physics has shown different physical properties of NPs compared to those of their starting bulk substance.

5. NPs, unlike larger pharmacologically-active substances, penetrate through the body’s usual barriers, like skin, the blood-brain barrier, the lining of the gut and airways.

6. Meanwhile, hormesis is a field of toxicology in which a low dose stressor- chemical, toxin, physical exposure like heat, etc.- stimulates the organism while a higher dose is toxic to it.

7. Homeopathic remedies may act via hormesis, specifically as post-exposure stressors.  In other words, homeopathic remedies may be hormetins. In other words, only small doses are actually needed to stimulate a healing response!

That’s the very brief version! Now for slightly more details, complements of Dr. Brienan:

Dr. Shelley Epstein shared the latest, cutting edge research related to homeopathy in Updates in Research in Veterinary Homeopathy.  This lecture was presented in two parts.  Part one detailed updates in basic science and part two outlined veterinary clinical trials.

We have moved well beyond whether homeopathy can be measured into being able to measure nanoparticle quality control issues among the starting homeopathic products; measure specific frequency differences between remedies and their potencies; measure variation in particle and aggregate size and shape; and measure elemental composition of the homeopathic particles.  Studies are finding out how nanoparticles remain dispersed in solution via the hypotheses that trituration generates nanofraction formation, lactose acts as stabilizer to prevent aggregation, dilution allows larger raw particles to settle out and nano-clusters to disperse freely in the medium.  Other research involves remedies as nanomedicines and how their dissolved silicate structures carry remedy information into the body.

She moved on to a discussion of hormesis and the stress response.  In hormesis, a phenomenon in the field of toxicology, there is an initial dose dependent toxicity response followed by a compensatory rebound response.  In this context homeopathy is a low dose stress (an initial action on the life force) which enhances repair and recovery (counteraction).  When a low dose stress is administered, the resulting compensatory biologic process also confers a protective effect against exposure to a subsequent more severe stress.

Dr. Epstein detailed the multiple pathways the body uses to respond to stressors and the resulting multi-factorial repair and return to function.  A balanced stress response network keeps the body functioning normally; however when there is an overwhelming accumulation of stressors, there is dysregulation in the stress response network and the body becomes stuck in chronic disease.

Back to the concept of homeopathy as nanoparticles; because of their properties of increased bioactivity and bioavailability, only a small quantity of remedy is needed to produce an effect.  This small quantity (low dose stressor) that causes a reparative response means that homeopathic remedies are hormetins. Also recall that the resulting compensatory response to a low dose stressor confers protection to future exposure of more severe stress…and may confer future protection to an unrelated stressor (cross-adaptation).

Further research by Bell and Koithan¹ has led to the model of Time Dependent Sensitization (TDS) – exposure to a hormetic agent (homeopathic remedy) initiates compensatory changes that amplify over time, do not require the continued presence of the initiating agent and are independent of specific pharmacological action on receptors.  In observing homeopathic treatment of fibromyalgia in people, repeated intermittent doses of individualized remedies amplified electroencephalographic alpha activity, reduced local pain and improved overall health.

In the discussion of veterinary clinical trials, Dr. Epstein outlined the challenges: how to demonstrate efficacy while following the principles of classical homeopathy (individualization of remedy prescription); prescriber skill; and the difficulty of the randomized clinical trial model (RCT) of one medicine for one diagnostic condition without consideration for comorbidities.  She outlined the ideal RCT for homeopathy including: “randomization and placebo or drug controlled; adequate number of test subjects to provide statistically meaningful results; individualization of prescription and ability to select from all available homeopathic remedies; adequate screening time to determine a similimum and medicine adjustment; adequate follow up to monitor decreased symptoms, remission and collateral health benefits.”  She finished with a series of clinical trials in different animal species in which remedy effects were clearly demonstrated and quantified.

¹Bell IR, Koithan M. A model for homeopathic remedy effects: low dose nanoparticles, allostatic cross-adaptation, and time-dependent sensitization in a complex adaptive system. BMC Complement Altern Med 2012;12(1):191 (Epub ahead of print] 

Things that go BOOM! in the Summertime: Thunderstorms and Fireworks

Summertime can really push the limits for many dogs with noise fears. Thunderstorms and fireworks alike can cause these dogs to shake, hide in bathtubs and closets, destroy things in the house, and in the worst cases, jump out of windows. Many of us just want to cuddle with our petrified buddy, although this is not possible when the thunderstorms occur while we’re at work.

We have many tricks up our sleeves for ameliorating dogs’ fears during these events. Here are some of them:

1. Composure by VetriScience. This is a natural and safe calming supplement that comes in a chewable form that dogs like. Its active ingredient is L-theanine, which is found in green tea and is what gives you that calm feeling after drinking it.  We carry this supplement at WAH.
2. Tight wraps like ThunderShirts. These take about 10 minutes to calm your dog. The ThunderShirt company claims a “dramatic calming effect for over 80% of dogs.” You can order this on-line.
3. Melatonin. This is a hormone that some people with insomnia take. It appears to have a beneficial effect in calming dogs with thunderstorm phobias. It is recommended to give it one hour before a storm for the most benefit. This is generally available at most stores that sell nutritional supplements.
4. Adaptil collar, diffuser, and spray. This is a product that mimics the natural pheromones that a bitch produces when she is nursing her pups. This hormone has a calming effect. The company is marketing it with thunderstorms and fireworks as indications for its use. We carry this product at WAH.
5. Addendum 6/26/13:  We've just learned of a product out of the U.K. called "de-stress and calming" by Pet Remedy.  Its active ingredient is valerian in a low concentration and it works via aromatherapy.  Anecdotally, many of Dr. Epstein's U.K. colleagues rave about this product.  It is available as a plug-in diffuser as well as in spray mist form.  You can order it on line but be sure you get the plug-in prongs that fit U.S. outlets!    
6. Addendum 8/20/13: We have the product and the preliminary reviews are very favorable! We are now carrying the aerosol plug-ins, a large spray bottle, and a tiny spray bottle.

Some dogs will do well with just one of the above measures, while others may require two or more. All are compatible with one another.

We do not generally recommend reaching for sedatives like acepromazine first, unless there is a real concern that the dog will harm himself or be destructive to your house. Most sedatives do nothing to relieve the fear, but they instead make the dog so drowsy that he will not be able to express his reaction as effectively.

At Wilmington Animal Hospital, we see many patients that suffer from noise fears and phobias. We are happy to discuss management of your dog’s specific thunderstorm, fireworks, and noise phobias. Please visit our website for more information on how to reach us: WilmingtonAnimalHospital.com.

Kennel Cough

 We’ve recently been experiencing a little uptick in the number of canine patients with kennel cough. This is a relatively benign cough, but it’s a major nuisance for the dog and its people.

“Kennel cough” is actually a catch-all term for any infectious cough that dogs get. Many organisms are known to cause it, ranging from viruses to bacteria. The affected dog has a cough that typically sounds like something is caught in his throat, and this cough usually ends with the dog gagging.  The dog usually feels fine and has good energy levels and appetite, but just suffers from this highly annoying cough. And the owners may be kept up at night listening to this cough!

Since this is spread from one dog to another when an infected dog coughs or sneezes on a susceptible dog, kennels are ideal environments for transmission. Of course, wherever dogs meet up with each other, kennel cough can be spread. While we see cases all year round from dogs that have boarded at kennels or spent time in daycare centers, many of our recent cases have come from dogs that play in the area’s dog parks. Less frequently, dogs can pick up kennel cough at the groomer’s.

It’s not easy to prevent kennel cough. It’s just like the common cold: you can eat right, exercise, and seem like the healthiest person around…until someone coughs or sneezes on you and you get sick. There are vaccines for kennel cough, but these are not always effective. At least ten or more organisms are known to cause kennel cough, and most vaccines only contain two to three of these agents.

The vaccine is most commonly given in the nose (“intranasally”) where it creates a low-grade infection that the immune system should, in theory, respond to. It can take at least a few days if not longer for the immune system to build up adequate resistance to these few germs. The most common problem we see is that owners get this vaccine last-minute- the same day the dog is due to enter a boarding kennel- and the dog has not had time to develop immunity before being exposed. In addition, this dog, when placed in a kennel without the rest of its pack (of humans), is stressed. Stress causes release of the hormone cortisol, which suppresses the immune system, which can make the dog get kennel cough from the vaccine! It’s not surprising that kennels that require this vaccine still experience many cases of kennel cough.

What can you do to try to prevent or treat kennel cough? Probiotics may help. These healthy bacteria can stimulate the production of the type of antibody that guards the respiratory tract. Studies in humans have shown that people who take probiotics at the onset of the common cold get over the cold much faster than those who do not take probiotics. It’s not a bad idea to put your dog on probiotics if you are going to board her, take her to daycare, or just socialize her frequently.

Homeopathic remedies can help sometimes. When the correct remedy is given, the coughing dog may return to normal within hours to a day.

Cough suppressants help in many cases. The over-the-counter versions tend to not be as effective as the prescription ones. Drowsiness is the major side effect, but sleep is restorative! We rarely prescribe antibiotics as these may actually prolong the course of the illness. We reserve antibiotics for dogs that are not in good health or have other problems that put them at higher risk for pneumonia.

Can I still board my dog if she has kennel cough? Sorry, no. The goal of every kennel is to prevent the appearance of this nuisance illness. If you know that your dog has kennel cough, you should not board your dog or take her to daycare or parks until she has been better for at least a week. Normal otherwise-healthy dogs who contract kennel cough typically get over it in 7-10 days. New dogs in the house may take up to a month to stop coughing. You will have to rearrange your plans, enlisting friends and family or hiring a professional pet sitter.

Kennel cough is an annoyance but rarely becomes serious in the healthy dog. If your dog shows signs of kennel cough, keep him away from other dogs and give him lots of TLC to speed the recovery.