Dr. Ron Carsten, DVM, PhD, CVA, CCRT was one of the first veterinarians in Colorado to use the integrative approach, has lectured widely to veterinarians, and has been a pioneer in the therapeutic use of food concentrates to manage clinical problems. In addition to his Doctor of Veterinary Medicine, he holds a PhD in cell and molecular biology and is a certified veterinary acupuncturist and certified canine rehabilitation therapist. He practices integrative veterinary medicine in Glenwood Springs.

Dr. Carsten writes a monthly column for the Glenwood Post Independent.  Links for the articles by  topic are listed below.  The articles can also be found below the links in chronological order.
Dogs
Cats
Dogs and Cats
The wonders of vulnerary herbs for pets
(Dr. Ron Carsten, Glenwood Post 11-2023)
     Vulnerary herbs as a group aid in healing wounds and reducing inflammation. Within this group, vulnerary herbs that work on the skin have been termed emollients. Those that contain mucilaginous substances are considered demulcents when used internally for their healing effects on mucus membranes like the stomach and intestine lining. It is important to note that some herbs work well externally, some internally, and others work well in both areas. The list of vulnerary herbs is long, therefore, a basic recognition of their properties helps in understanding ways to use them. This is important because herbs within this group differ in the substances they contain and the way they work. It is also valuable to know when certain herbs in this category should not be used.
     Herbs in this group often contain substances like tannins that help to bind together tissue proteins which aids in wound closure and tightening. These herbs also facilitate reducing bleeding and decreasing inflammation. This combination of properties contributes to improved wound and tissue healing. Examples of tannin containing herbs commonly used for skin injuries include aloe (Aloe vera), calendula (Calendula officinalis), and plantain (Plantago major L.).
     Other vulnerary herbs like marshmallow root (Althaea officinalis) and slippery elm (Ulmus fulva) contain high concentrations of mucilage substances. These mucilage substances form a coating on the damaged tissue that aids healing and facilitates reducing the inflammation.
     Still other vulnerary herbs contain substances like allantoin. These herbs include comfrey (Symphytum officinale) and aloe. Allantoin helps to stimulate cell growth and division which increases the rate of healing.
     Another interesting herbal action that can be beneficial for protecting injured or damaged tissue is the effect of licorice (Glycyrrhiza glabra) on the stomach mucosal lining. Licorice has the ability to beneficially interfere with a promoter of inflammation in the stomach resulting in increased mucus production and improved blood flow to the stomach lining. These effects help protect and heal the stomach lining.
     Some vulnerary herbs have astringent properties. Astringents like tannic acid cause proteins to precipitate which forms a temporary film of clotted protein over the damaged mucosal surface. This can
protect the area from further damage and can  beneficial effects on sensory nerve endings. Examples of astringent herbs include nettle (Urtica dioica), chamomile (Matricaria recutita), and witch hazel (Hamamelis virginiana L.). Astringent herbs are generally not used for more than two weeks at a time.
     It is important to note that like all herbs, vulnerary herbs contain numerous active substances that have a range of effects. For example, marshmallow root has an important mucilage property that coats but it also contains tannins that can contribute to tissue protein binding that aids protection of the injured surface and facilitates healing. In addition, marshmallow root has been shown to improve blood flow to the stomach lining also promoting improved healing.
     Another important point to recognize is that herbs like marshmallow root and slippery elm have effects beyond the stomach and intestine. They have benefits for reducing inflammation and promoting healing of the mucus membranes (lining) of the respiratory and urinary systems. Individuals with bladder inflammation (cystitis) and coughs can benefit from these demulcent herbs.
     The amazing array of healing properties that herbs have depends on the presence of a variety of substances in the herbs. Each herb has its own combination of substances which means that understanding the use of the herb requires recognition of the functions of its important substances. This herbal understanding should then be paired with understanding of features of each disease process. For example, comfrey has an amazing ability to speed healing. This can be helpful for healing wounds. However, rapid healing of the surface can be problematic if it is used to treat an infected wound because it can heal the surface leaving infection underneath. Another consideration is that comfrey use internally is controversial due to its potential for liver toxicity.
     Combinations of herbs are often the best approach when attempting to use the important properties of each herb to manage a health problem. An example of this approach is the combination of marshmallow root a demulcent with mullein (Verbscum thapsus L.) a stimulating expectorant, ginger (Zingiber officinale) a mucolytic expectorant, and lobelia (Lobelia inflata L. an antispasmodic for certain respiratory problems.
     If you have general questions about pet companion’s health contact your veterinarian. For questions about herbs for your pet, contact a veterinary herbalist.
Skin lumps, bumps, and tags in dogs
(Dr. Ron Carsten Glenwood Post 10-2023)
     A wide variety of skin lumps, bumps, and tags are encountered in dogs, especially as they age. They can arise from many different cells or structures in the skin like the oil glands and hair follicles. These skin changes range from mild concerns like simple skin tags to potentially serious health issues like cancer. Some lumps are more common in young dogs while other lumps are seen more frequently in older dogs. Fortunately benign (non-cancerous) lumps are more common than malignant (cancerous) lumps. When possible, determining the cause of the lump is important.
     The location within the skin and placement on the body plays an important role in guiding decisions regarding steps for testing and diagnosis. For example, a lump on the skin surface of the neck that has a wart-like appearance in an older dog is likely a sebaceous adenoma while a wart-like lump on the lip of young dog is likely a viral papilloma (wart). This is important because they are treated differently and have different implications on how the pet companion is supported. Lumps or swellings that are red, warm, and painful show indications of inflammation and potential infection (abscess). It is important to note that some lumps that appear inflamed are not infected. These include sebaceous cysts and mast cell tumors.
     Microscopic assessment of cells from the lump is important in most situations. This involves collection of cells in the lump using techniques like impression smears (discharges and tissue surface), collection in a needle (fine needle aspirate also known as FNA), and biopsy (lump removed and evaluated). These microscopic evaluations can be essential for determining what is causing the lump and, therefore, critical for identifying the best therapy.
     Treatment and prognosis are based on the diagnosis and how advanced the problem has become. Additional factors include the expected behavior of the lump, location on the body, and overall health of the pet. The expected behavior, for example, involves how aggressive a cancer may grow into the adjacent tissue and complicate removal and healing. It is important to note that behavior of some lumps is to be slow
growing, not body. Abscesses, on the other hand tend to progress from a firm, inflamed tissue to a fluid pocket that drains out through the skin.
     Location can create concerns for the ability to adequately close the surgery site like when the lump is on the lower leg and there is limited extra skin for closure. Other lumps, like on the face, may be caused by an abscessed tooth that requires extraction and antibiotic therapy. Lumps on the eyelid are typically benign and can require special treatment considerations that maintains the shape of the eyelid.
     Overall health can influence the choice of surgery versus more conservative therapies. However, it is important to recognize that even an older pet with health issues can be safely anesthetized and undergo surgery or other procedures that require anesthesia.
     Benign lumps can arise from any structure in the skin and include sebaceous adenomas, papillomas, basal cell tumors, sebaceous cysts, abscesses, histiocytomas, skin tags, cornifying epitheliomas, hair follicle tumors, and apocrine gland cysts. Malignant lumps can also arise from a range of structures in the skin and include mast cell tumors, squamous cell carcinomas, and melanomas. Note that each of these names provides important information about these lumps.
     Prognosis and therapy for each of these conditions depends on the diagnosis and may include approaches like surgery, cyrosurgery, abscess drainage, antibiotics, steroids, chemotherapy, or radiation.         Integrative supportive therapies may include approaches like topical essential oils that have anti-inflammatory or anti-cancer effects (i.e. frankincense), oral herbs that have anti-inflammatory and anti-cancer properties (i.e. boswellia, astragalus), and immune supportive nutrients (i.e. vitamins A, C, D), mushrooms (i.e. turkey tail, reishi), herbs (i.e. echinacea, ashwagandha), probiotics, and glandular extracts.
     Each skin lump, bump, and tag should be evaluated by your veterinarian and choices made about diagnostic procedures, therapy, and supportive care.
     If you have questions about any skin lumps, or even lumps that are under the skin, contact your veterinarian.
Vitamin B12 and our pet companions
(Dr. Ron Carsten Glenwood Post 9-21-23)
     Vitamin B12 plays a critical role in the metabolism of every cell in the body. It is converted into co-factors that aid the function of specific enzymes involved in DNA synthesis and regulation, lipid and protein metabolism and cell energy production. This translates into important roles in formation of red blood cells, function of the brain and nerves and gastrointestinal health.
     Organs or tissues with a high rate of cell turnover like the bone marrow and gastrointestinal tract especially need vitamin B12. Deficiencies can be seen as anemia, digestive disorders like chronic diarrhea, weight loss, poor appetite and neurological problems ranging from minor behavior changes to severe degenerative issues.
     Cobalamins are a group of structurally similar compounds that are collectively referred to as vitamin B12. However, biochemical terminology restricts the name, vitamin B12 to a specific form of cobalamin known as cyanocobalamin. It is a water soluble compound that is not stored in the body and can only be synthesized by microorganisms in the colon. Vitamin B12 is found only in animal sources like meat, fish, and eggs unless the food is fortified (supplemented) with vitamin B12.
     Even though it was isolated almost 60 years ago, vitamin B12 metabolism is not completely understood. It is a complex, multi-step process. Ironically, even though vitamin B12 is produced by microorganisms in the colon, it is not absorbed into the body in the colon. This means it has to be ingested with food.
     There is a complex process for absorption in the body. Initially any free (not bound to protein) vitamin B12 in food is bound by a cobalamin-binding protein found in saliva. As more vitamin B12 is released from food under the influence of digestive processes in the stomach this free vitamin B12 is also bound to the cobalamin-binding protein. In the duodenum (upper small intestine) digestive enzymes release the vitamin
B12 from the cobalamin-binding protein. Once released, vitamin B12 is then bound to intrinsic factor from the exocrine pancreas. The exocrine pancreas is the part of the pancreas that produces digestive enzymes and other factors that are secreted into the intestine during the digestive process. Intrinsic factor is a transport protein that allows for absorption of vitamin B12 in the ileum (end of the small intestines). Once absorbed, vitamin B12 is transported to the liver.
     With this brief overview it is easy to see potential problems with ensuring that there are adequate levels of this important vitamin in the body. For example, if the pancreas cannot produce enough intrinsic factor, vitamin B12 cannot be properly absorbed. The exocrine pancreas is the major source of intrinsic factor in dogs and the only source in cats. This means that proper function of the pancreas is essential for vitamin B12 absorption. Intrinsic factor is species specific so that the use of bovine pancreatic enzyme extracts are not sufficient to restore vitamin B12 absorption. In addition, if the ileum is diseased or has significant enough reduction in ability to absorb vitamin B12, deficiency can occur. Assuming adequate vitamin B12 in the diet, other potential contributors to poor vitamin B12 absorption include chronic pancreatitis, parasitic infections, inflammatory bowel issues and age.
     Measurement of blood levels of vitamin B12 is readily available and can be valuable in a range of health conditions or concerns including chronic digestive problems, weight loss and exocrine pancreas insufficiency (EPI). Supplementation can be done orally with vitamin B12 (cyanocobalamin) or by injection. Oral supplementation may not be as effective for certain problems as the injection is. For example, dogs or cats with disease of the ileum may not be able to absorb adequate amounts of vitamin B12.
     If you have questions about vitamin B12 and your pet companion, contact your veterinarian.
Ashwagandha, how ‘the power of the horse’ can
benefit our pet companions
(Dr. Ron Carsten Glenwood Post 8-27-23)
     Ashwagandha (Withania somnifera), also known as Indian winter cherry or Indian ginseng, is an herb with long use over at least the last 6,000 years. The historical name, ashwagandha, is reportedly descriptive of how the root smells; it smells (“gandha”) like a horse (“ashwa”) and on consuming it, it gives the “power of a horse.”
     With this name and reputation, it is expected to have a wide range of health effects and benefits. These benefits include acting as an adaptogen, nervine, sedative, anti-cancer, and anti-inflammatory agent. In addition, ashwagandha has ability to modulate the immune system, improve the thyroid hormone secretion, has value for the gastrointestinal system, and can benefit the heart and respiratory system.
     An adaptogen is an herb or other natural source like some mushrooms that aids the body to manage stress and restore balance during or after stressful situations. Studies in animals and on isolated nerve cells show that adaptogens have nerve, heart, and liver protective effects. In addition, they have anti-fatigue, antidepressive, anxiolytic, and anti-inflammatory properties.   
     Many adaptogen effects are linked to improved regulation and balancing of the hypothalamic-pituitary-adrenal axis (HPA) and modulation of specific genes associated with stress responses. Keep in mind that the HPA is involved with response to stress and secretion of substances like cortisol (the body’s own steroid) from the adrenal glands. Use of ashwagandha root in dogs undergoing stress has demonstrated a significant decrease in stress related cortisol levels in the urine. At the same time these dogs experienced reduction in their levels of fear and anxiety as measured by the Canine Behavioral Assessment and Research Questionnaire.
     Nervines are substances that affect the nervous system. They are divided into three groups based on their influence on the nervous system: 1) tonic – strengthens and restores, 2) relaxant – reduces the anxiety response and calms, and 3) stimulant – 
increases nerve activity. Ashwagandha is considered by some to have nervine tonic and relaxant properties. Studies have shown significant improvements in mental cognition and memory. These results may be at least partially due to ashwagandha’s ability to reduce inflammation in the nervous system.
     In addition to benefits for the nervous system, ashwagandha can significantly increases muscle strength and muscle mass while resisting the damaging effects of intense exercise. Ashwagandha has also been shown to reduce discomfort in injured knees, improve mobility, and reduce the amount of pain medication needed.
     With this long list of benefits, it is easy to ask how one herb can have all these effects. There are multiple parts to the answer. First, ashwagandha contains a wide range of active substances. Second, the effects are dependent on the dose given which impacts on the concentration of the herb’s active compounds in the tissue of interest (i.e. nervous system, liver, etc). Third, the distribution of the herb in the body after ingestion also influences tissue concentrations. Fourth, the part of the herb that is used and how it is prepared (i.e. dried herb, tincture, decoction, etc.) impacts on the concentration of active constituents in each dose. For ashwagandha, historically all parts of the herb are used, but, certain parts have been described for some clinical applications. Modern health research has generally focused on the root.
     Ashwagandha has benefits for pet companions in a range of situations including anxiety and chronic stress, when adrenal support is needed, low thyroid function (hypothyroid), immune imbalance issues, inflammatory conditions, and patients with cancer. It can also be beneficial in aging pets with cognitive declines, osteoarthritis and other musculoskeletal conditions. An herb with extensive historical use and modern research support, ashwagandha can be an important addition to an integrative support plan for a range of health challenges.
     If you have questions about using this interesting herb with your pet companion, contact a veterinary herbalist.
Age-related sarcopenia and our pet companions      (Dr. Ron Carsten Glenwood Post 7-27-23)
     Sarcopenia affects us all including our pet companions. It is a part of aging that involves loss of muscle mass and strength. It contributes to reduced quality of life with aging, decline in mobility, and lowered activity levels. It can contribute to increased chronic inflammation, obesity, insulin resistance, and heart disease in humans and our pet companions.
     Everyone, including our pet companions, experience aging and it has become clear that they experience aging in similar ways and rates as humans. All body systems undergo changes that result in reduced function. Eye sight diminishes, cognitive functions decline, kidneys and liver have less reserve capacity, heart activity and lungs are less robust, metabolism changes, hormone levels decline, and muscle strength is reduced. These age-related changes result in sleeping more, weight gain or loss from reduced activity or illness, increased joint degeneration, and generalized loss of muscle mass and weakness especially in the back legs.
     Skeletal muscle (muscles of voluntary movement) is composed of multiple muscle fiber (myofiber) types and are organized as a motor unit. The motor unit consists of the myofiber, associated nerve, and supporting cells (satellite cells). During aging, there is a disturbance in muscle metabolism that favors myofiber loss, nerve degeneration occurs, and there is reduced function of the satellite support cells. These events lead to sarcopenia which can be observed as reduced muscle mass (atrophy) and strength.
     This process of muscle loss is a recognized part of aging. However, it can be complicated by the loss of muscle mass and strength caused by inactivity. This inactivity (or relative inactivity) can result from not enough opportunity for physical movement including daily walks and play. Each individual has differing needs for activity. For example, the young dog requires higher levels of activity than an aging dog that may not tolerate long walks or intense play. Cats also need daily physical activity. Limitations that constrain the level of physical activity include degenerative problems like osteoarthritis, injuries like a torn ligament in the knee (ruptured CCL), or health problems like congestive heart disease. Distinguishing between age related sarcopenia and other causes of muscle loss is important when defining a support
plan. Further complicating the challenge is the need to separate other causes of muscle loss (i.e. cachexia) from sarcopenia. Both result in muscle loss (for different reasons) and they can happen at the same time.
     There are multiple contributors to age associated sacropenia. These include molecular signals that start to favor muscle breakdown instead of muscle building, reduced response to essential amino acids, blood flow declines to muscle tissue, less sensitivity to insulin, chronic inflammatory states, hormone changes, and loss of nerve signaling to myofibers.
     Assessment methods for dogs and cats are limited because common human tests like hand grip strength cannot be performed. However, muscle condition scoring in conjunction with body condition scores can be helpful. Other methods like the six minute walk are being evaluated and show promise.
     Basic understanding of the contributors to muscle loss during aging is important for developing a support plan that promotes a graceful aging process. Each individual should be evaluated for their specific needs. Management for health issues like chronic heart disease and kidney disease should be implemented as needed. Effective pain management should be used when appropriate. This may include osteopathic manipulations, laser therapy, acupuncture, and herbs in conjunction with pain medications. Basic daily food needs should be reviewed and tailored for each pet. An individualized exercise program should be developed with the goal of maintaining mobility and quality of life. Keep in mind that cats also need exercise and creative ways to increase their activity can be used.
     Support with nutritional supplements like vitamin D and some B complex vitamins may be valuable along with quality fish oil, and appropriate amino acid supplementation. A wide range of herbs like curcumin (Curcuma longa), ashwagandha (Withania somnifera), and the adaptogens (i.e. Siberian ginseng Eleutherococcus senticosus and golden root Rhodiola rosea) have shown benefits for assisting muscle health and in some situations contributing to increased muscle strength.
     If you have questions about muscle loss and management plans for your pet companion, contact your veterinarian.
Chronic stress and our pet companions
(Dr. Ron Carsten Glenwood Post 6-11-23)
     Everyone, including our pet companions, experiences stress. Sometimes it is minor or brief like when you are dealing with traffic on the way home. Other times it is an ongoing, daily process with tight deadlines, crowded schedules, and unending demands. It is the body’s response to chronic stress that can be damaging. Our pet companions have their own forms of chronic stress. This might include separation anxiety, worry about the daily construction noise and activity next door, or pain from a chronic health problem.
     Indications of chronic stress can be vague and not point to a specific cause. Some pets experience changes in appetite or have diarrhea. Others demonstrate increased vocalization like barking or whining, excess self grooming, destructive behavior, hyperactivity, eating feces, more panting, or frequent hiding or sleeping more. These signs can be associated with other health problems making it challenging to always determine the source of chronic stress.
     Common stress inducers include changes in the household routine, moving to a new home, discord in the home, getting a new pet, or having a family member leave for college. However, the cause of stress may not be so obvious like when a pet is constantly hypervigilant protecting the home. Noises outside that they cannot see the source can heighten their stress. Pain from problems like degenerative joint disease can contribute to chronic stress in dogs and cats.
     The body has a complex process for addressing stress. It is basically regulated through two systems: the sympatho-adreno-medullary (SAM) axis and the hypothalamic-pituitary-adrenal (HPA) axis. That was a hand full to type but boils down to the SAM as the rapid nervous system response that triggers the “fight or flight” reactions. The HPA is a slower response that increases blood cortisol (the body’s steroid).
     When SAM is activated the sympathetic nervous system (part of the autonomic nervous system) triggers release of adrenaline (epinephrine) from nerve terminals and the adrenal medulla (inner part of the adrenal). This prepares the body to respond to the “fight or flight” decision. The heart rate increases, blood pressure increases, and increased blood glucose
is available. In addition, blood flow is increased to the brain and muscles for quick action, but reduced to the digestive tract. This means that the digestive process is slowed which over time can create problems.
     The HPA response happens over minutes to hours after the stress and results in cortisol release from the outer part of the adrenal. Cortisol has many different effects on the body that influence metabolic processes and the immune system. One of the hormones that is part of the HPA also suppresses digestive processes.
The body’s response to stress has survival advantages that benefit the body in the short term. With chronic stress, these beneficial responses can become damaging to health. For example, individuals with chronic stress may have reduced immune responses and be more susceptible to infections, impaired response to vaccination, and slowed wound healing. Interestingly, over time the ability of the body to respond to the stress signals can be reduced. The adrenals can become fatigued, the SAM and HPA coordination can become disconnected, and excess signaling to the adrenal cortex can result in intestinal inflammation and leaky gut type issues. Life span in dogs has been shown to be shortened by chronic stress.
     Reducing or eliminating stress is important but not always easy. There is value to attempting to change the mental/emotional reaction to stressors so that there is less reactivity when the stressors occur. Removing the stress trigger whenever possible is important. This is not always easy but could be straightforward like providing access to a window that allows a view of what is happening outside or a safe way to see through a privacy fence. Getting regular exercise and outings can help. Managing pain and other health challenges that are sources of ongoing stress is beneficial. Integrative support involves the targeted use of anti-anxiety nutraceuticals and pheromones, Bach flower remedies, herbs, food changes, adrenal support, and manual therapies like massage and osteopathy.
     Stress is a common part of our lives. It affects our pet companions. Recognizing the signs of stress and understanding basic ways to support our pets is important. If you have questions about your pet’s health contact your veterinarian.
What is up with CIE in dogs?
(Dr. Ron Carsten Glenwood Post 4-4-23)
     Inflammation in the body is beneficial, but too much of a good thing can be bad. Especially when excess, unregulated inflammation in the intestines leads to chronic diarrhea caused by a condition called chronic inflammatory enteropathy (CIE).
     Diarrhea is considered chronic when it has been present for three weeks or longer. Anyone that has had the experience of helping their dog companion deal with diarrhea knows how stressful it can be. Worry, accidents in the house, frequent trips outside during the night, and occasional vomiting can be a challenge.
     One report estimates that 20-30% of veterinary appointments are related to vomiting and diarrhea in dogs. This is perhaps not surprising because digestion is such a complex process, and there are numerous causes of diarrhea. Intestinal causes include parasites, viral infections, eating inappropriate things, changes in diet, food sensitivities, cancer, and inflammation. Diarrhea caused by problems outside of the intestines include liver or kidney disease, pancreatitis, adrenal dysfunction, and even heart disease. Issues like imbalance in the intestinal flora (microbiota), irregularities in autonomic nervous system control, and stress or anxiety can be contributors.
     In one study of chronic diarrhea in dogs, it was determined that 90% had a problem in the intestines and not outside of the intestines like liver disease. Chronic inflammation in the intestine caused diarrhea in 79% of those dogs. These are the dogs with CIE.
Some dogs and some breeds like German Shepherds and Boxers have a genetic predisposition to an imbalanced immune reaction in the digestive tract. This combined with additional immune stressors like a disrupted intestinal flora, food sensitivities, vitamin deficiencies, and early life exposures can contribute to CIE.
     Diagnosing CIE requires ruling out other causes of chronic diarrhea. This process involves a range of blood tests and stool evaluation. Abdominal ultrasound and even biopsies of the intestines are valuable. Biopsies confirm the diagnosis and provide information about the inflammatory cells. Unfortunately, obtaining intestinal biopsies is invasive and not always done.
     When other causes of chronic diarrhea have been ruled out and the conclusion is that CIE is causing the diarrhea, a support plan should be initiated that
ddresses the contributors to the intestinal inflammation. Studies show that approximately half of dogs with CIE are triggered by food sensitivities that result in intestine inflammation. This means that a critical first step is a therapeutic food trial with a limited ingredient food or preferably a hydrolyzed diet. It can take 8-12 weeks to determine the effect or benefit of the food trial.
     If the food trial does not control the diarrhea, immune suppressive drugs may be used as the next step. After a reasonable course of immune suppressive drugs, antibiotics may be used. However, antibiotic use is being discouraged. Current research indicates that antibiotics have no or minimal impact on shortening the course of the diarrhea. The antibiotics often distort the flora in ways that are difficult to recover from. Dogs that do not respond to the food trial, immune suppressive treatments, or antibiotics (if used) are considered to have idiopathic inflammatory bowel disease. This means that the cause has not been determined. Some dogs have a complicating factor where there is ongoing loss of protein from the blood into the intestine. This is known as a protein losing enteropathy.
     During the feeding trial, other diarrhea contributors should be addressed. Supplementation with cobalamin, folate, and vitamin D may be indicated by test results. Keep in mind that it can take weeks to correct these deficiencies. Addressing issues with the intestinal flora is also fundamental to managing CIE. It can take 6-8 weeks or longer to effect a sustainable shift in the flora. Probiotics and prebiotics are generally necessary. In some situations, fecal transfer may be required. Abnormal intestinal motility can affect the flora in the intestine. Intestinal motility can be influenced by stress and anxiety.
Modulating stress can have important benefits. Regulation of digestion can also be impacted by spinal column alignment issues that influence the autonomic nervous system. Supplements like glutamine and arabinogalactan that support the intestinal lining may be valuable in the early support plan. Inflammation modulating herbs like boswellia and marshmallow root may play an important role in the health of the intestinal lining.
     Managing chronic diarrhea in dogs can be challenging. Providing a comprehensive support plan is based on having a clear understanding of the causes. If you have questions about CIE in your dog, contact your veterinarian.
The dog spleen from a different perspective
(Dr. Ron Carsten Glenwood Post 4-4-23)
     Last month, we reviewed basic information about the dog spleen function and touched on a few disease problems. That information was based on what some call Western medicine which focuses on anatomy, function, and understanding disease pathology. There is another medical approach that is based on centuries of observation of health, disease, and response to treatment. Some refer to this as Eastern medicine. It is a system that evolved to explain and treat symptoms.
     This month, further discussion of the spleen provides an opportunity to explore a portion of Eastern medicine through a Traditional Chinese Veterinary Medicine (TCVM) perspective of the Spleen (capitalized to denote TCVM Spleen).
Keep in mind that Traditional Chinese Medicine is a highly developed and successful medical system for a large population. Its success in managing health and treating disease has stimulated widespread use and increasing amounts of modern medical research in an effort to more fully understand its concepts and how they relate to Western understanding of disease.
     In TCVM, the organs, like the Spleen, are not the anatomy but rather a description of an abstract concept and their dynamic functions based on the anatomy. Organs in TCVM are visualized as webs of energy or systems with defined functions. These organs and systems have interrelated functions with other body organs and systems. Each organ is associated with an element, an emotion, and it opens to the outside of the body. TCVM considers such concepts as Qi and Blood, yin and yang, excesses and deficiencies, and the “six pathogens.”
     Organs in TCVM are paired with another organ in terms of function. The Spleen and Stomach form one of these pairs and are thought to influence digestion, immunity, blood formation, muscle metabolism, body fluids, and more. Working together, the Stomach processes the ingested food into its components which are then transported to the Spleen for transformation and distribution. Substances derived from food are the sources of Qi and Blood. Through these processes, the Spleen is able to govern the transport and metabolism
of water and nutrients in the body, regulate the circulation of blood, and influence immune function.    
     Keep in mind that the discussion here is a relatively
simple description of a complex health care approach. When the Spleen is deficient, digestive disturbances such as poor appetite and abnormal stools can be seen. However, because other organs and systems can be involved, additional signs of deficiency can include muscle atrophy, weak pulse, fatigue, cold limbs, mental fog, anxiety, obesity, and a weakened immune system.
     There are numerous factors not described here that are important to recognize when evaluating a patient. Common contributors of Spleen deficiency include anxiety and worry, eating cold foods, irregular eating patterns, and overexertion. These factors can impact our pet companions.
     Even though TCVM describes a concept, there have been correlations with Western medicine. Interestingly, for centuries, until the recognition of the spleen as part of the lymphoid system, Western medicine also described the spleen as part of digestion. This separation from digestion has shifted in the West again with the realization that there is an interwoven relationship between the stomach and spleen during development in the embryo.
     Further, in the 1970s blood circulation between the stomach and spleen was found to occur through certain arterioles (small arteries) from the spleen to the stomach tissue. Blood was also found to drain in certain veins from the stomach into the spleen. This relationship highlights the potential for secretory and resorptive functions between the spleen and stomach.
     Other modern research has demonstrated correlations between dysfunction of the TCVM Spleen and Stomach and changes in Western anatomy and function. For example, Spleen dysfunction has been associated with muscle metabolism changes, alterations in the stomach lining, suppressed nerve function of the sympathetic nervous system that signals the digestive tract, and reduced immune activity. Gene expression studies of TCVM herbs are supporting physiological observations of functions attributed to the Spleen.
     While it can be challenging to fully understand the principles of TCVM in the context of our Western society, it is fascinating to consider the interface between Western medicine and TCVM observations and descriptions. Recognizing these perspectives and the correlations with current scientific research can facilitate a deeper understanding of supportive care for our pet companions.
The dog spleen
(Dr. Ron Carsten Glenwood Post 2-28-23)
     The dog spleen is an important organ located in the abdomen. Spleens are so important that almost every species of vertebrate animal has one and some species have multiples.
     Depending on the species, the spleen may be used for blood storage and defense as part of the immune system. The spleen in some species like rabbits cannot expand to store blood but has defensive activities. Other species like the dog and cat have spleens that store blood and participate in immune defense.
     The spleen has an extensive network of blood vessels and has the capacity to contain a large volume of blood. In addition, the dog spleen has a significant amount of smooth muscle in the capsule area. This allows, when signaled, for contraction of the spleen and pushing blood into the main bloodstream. It has been estimated that the dog can store one-third of its blood in the spleen at rest.
     Another important function of the spleen is to filter out and remove old, damaged, or abnormal red blood cells from circulation. As part of the body defense, while blood is passing through the spleen, immune cells like lymphocytes and macrophages are able to monitor the blood and react to infection and foreign antigens.
     Like all organs in the body, the spleen is subject to a number of health problems. With its location in the abdomen near the stomach, and its extensive blood supply, the spleen can be injured by blunt trauma like can happen when hit by a car. With severe enough trauma, the spleen can rupture and leak blood into the abdomen. With enough blood leakage the dog can go into shock and collapse. The ability of the body to control the leakage (hemorrhage) depends on many different issues. These situations can be an emergency requiring urgent care.
     Beyond potential issues from trauma, the spleen is also affected by tumors (nodules, swellings, growths) that can range from benign to highly malignant. These growths include hemangioma (benign), blood clots caused by another concurrent disease process like cancer (i.e. lymphoma) or immune-mediated disease (i.e. immune-mediated hemolytic anemia), or hemangiosarcoma (malignant).
     Clearly identifying the cause of the tumor is
important even though some causes are considered benign because they can all result in possible rupture and hemorrhage. The body can usually handle small amounts of hemorrhage but frequent small amounts or sudden large amounts can lead to problems like weakness and collapse. It can be difficult to determine that there is a problem with the spleen because of its location in the abdomen and the body’s ability to adapt and deal with problems. Sometimes the spleen tumor can be large enough that it can be felt by your veterinarian during an examination. Other times it can only be found with a radiograph or ultrasound.
     A dog having an episode of life-threatening bleeding may appear to be suddenly weak, have pale-colored gums, and be cold to the touch. These are indications that the dog is experiencing shock and should be seen immediately by a veterinarian so that appropriate care can be initiated. In some situations the bleeding can stop on its own and the dog can appear back to normal hours or days later. The hemorrhage can lead to anemia because the blood is pooled in the abdomen and not flowing in the blood vessels. Yunnan Biayao is a Chinese herb combination that has shown benefits for helping to reduce bleeding and can be an important part of managing splenic bleeding episodes.
     When masses are found affecting the spleen, evaluation for concurrent disease is important so those contributors can be addressed specifically. However, it may be clear after examination that the spleen should be removed to prevent rupture or to manage ongoing bleeding.
     Once the spleen is removed, the tumor should be evaluated by a pathologist to determine what is happening at the microscopic level. This is important for determining what steps to take for further therapy. For example, often the benign causes can be managed by removing the spleen while the malignant causes like hemangiosarcoma should receive follow-up care like chemotherapy or mushroom extracts which appeared to be an effect alternative in a university based study for this serious problem. Even though the spleen is an important organ, dogs can do well without a spleen.
     If you have concerns about your pet companion’s spleen contact your veterinarian.
Oral health is essential for quality of life for pets
(Dr. Ron Carsten Glenwood Post 1-31-23)
     February has been designated as National Pet Dental Health Month to help draw attention to the importance of dental health care for our pet companions.
     It has long been clear that there is a connection between the health of the mouth and the health of the rest of the body. Dental disease starts early in life for pets with the majority of dogs and cats having some degree of dental disease by the time they are three years old. Ongoing dental disease can contribute to mouth discomfort and stress on organs like the heart, liver and kidneys. This means that dental checkups and care are important important all year. Monitoring and preventive care should start early in life.
     It is often bad breath and build up of hard calculi material on the teeth that brings attention to the mouth. These changes are often just what is seen on the surface with more serious conditions becoming apparent with a deeper look. Indication that there are more problems include a pet with abnormal chewing, food dropping from the mouth when eating, drooling, reduced or no appetite, swelling in the mouth or face, bleeding from the mouth, or pain in or around the mouth.
     One goal of preventive dental care is to avoid more serious problems by addressing issues early. Regular dental exams along with regular dental cleanings are an important part of any preventive program. Ideally, daily teeth brushing with a pet appropriate toothpaste occurs as a way to reduce the plaque on the teeth. Unfortunately not all pets will allow teeth brushing.
     Other options for attempting to reduce plaque accumulation include dental foods, dental treats and chews, oral sprays, and additives in the food or water. Products that have been approved by the Veterinary Oral Health Council (VOHC) can be found on their website. Strategies for reducing plaque and maintaining healthy gums vary by product. Some focus on reducing bacteria levels in the mouth or altering the biofilm on the teeth. Others mechanically “scrape” across the tooth during chewing in a way that helps reduce plaque.
     There are some products that are a combination ofthese approaches. For example, products like soft
rawhide and vegetable based chews containing enzymes, antimicrobials, and antioxidants combined with special shapes to increase plaque reduction when chewed are available. Keep in mind that not all effective products are listed on this VOHC website. For example, a controlled study evaluating a green tea product added to the daily water showed efficacy in reducing plaque.
     Some online sources advocate the use of natural products like deer antlers, rawhide, bones and bully sticks. It is important to recognize that some of these hard products, like bone and antlers, can cause tooth fractures and other trauma to teeth when chewed. Tooth fractures can lead to pain, infections, and often extraction of the tooth. It is important to note that fractured teeth have been reported to occur in nearly 50% of pets at some time in their life. Depending on the extent of damage to the tooth, a root canal and restorative procedures can be done to save the tooth, but not all damaged teeth can be saved. So consider avoiding hard products or at least be aware of the potential problems so that careful monitoring can be regularly done. Concerns with rawhide include how free of contamination the product is and the potential that the pet could swallow pieces of the rawhide leading to digestive distress.
     Regular dental cleanings under anesthesia should be anticipated over the life time of all pets. Some pets like small breed dogs typically require more frequent cleanings than large breed dogs because of the structure of their mouths. Dental x-rays can be essential when assessing the overall health of the mouth. In some studies it has been found that almost 28% of dogs and 42% of cats had diseased teeth seen on x-ray of teeth that appeared normal above the gum line. In pets with teeth that appear abnormal above the gum line there was an additional 50% more teeth in dogs and 53% more teeth in cats that were found to be abnormal with x-ray.
     In addition to regular dental cleanings, daily or every other day brushing is valuable along with the use of products that reduce plaque accumulation and maintain overall oral health. If you have questions about your pet companion’s oral health, contact your veterinarian.
Ginger, a holiday favorite spice with many health benefits
(Dr. Ron Carsten Glenwood Post 12-29-22)
     Ginger (Zingiber officinale) is a fascinating spice long associated with the Christmas holidays. The historical country of origin for its focus as a holiday treat is unclear and may be buried in German folktales or with Queen Elizabeth I.
     Some feel that the focus on using ginger during the holiday season is rooted in the idea that eating a spicy food increases body warmth. Others feel that the aromatic rhizome is part of an enjoyable eating experience. By the 15th century ginger was in wide use in Europe. Its use in gingerbread houses and cookies started in the 16th century. Prior to its popularity in Europe, ginger was prized in ancient times as a spice and medicinal herb contributing to widespread trading beyond its origin in Southeast Asia. Today ginger is found world wide and valued for its unique properties. Ginger can be consumed fresh, dried, as a tea, crystallized and candied.
     Clearly over the millennia, ginger has shown itself to be a valuable medicinal herb and culinary spice. This has created ongoing interest in its use and stimulated efforts to understand how ginger’s health effects are achieved. The ginger rhizome contains over 400 different compounds including numerous volatile and nonvolatile compounds.
     As with all herbs, concentrations of the various compounds are impacted by cultivation conditions, harvesting, processing, and storage. Some of the active compounds of interest include the volatile oils like gingerols and shogaols which contribute to the pungent flavor and medicinal properties. Compounds like zingiberene contribute to the odor. Basic knowledge of the names of the important compounds aids understanding of products labels and research reports.
     Many of the traditional uses for ginger have been verified with modern research including the warming effect, treatment for nausea, vomiting and stomach ulcers, lowering fasting blood glucose, improving cognitive function, blocking bacterial and fungal infections, antitumor effects, and reducing inflammation and pain.
     Ginger has direct effects on the gastrointestinal tract (stomach and intestines) that promote increased motility (i.e. more effective stomach contractions),
improved stomach emptying, and decreased nausea.  Additional studies demonstrated that the anti-nausea effect was equal or better than that provided by some anti-nausea medication. Use against nausea induced by motion sickness and chemotherapy have been beneficial. In addition to effects on motility, ginger has the ability to reduce inflammation in the stomach and reduce or prevent ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs).
     Anti-inflammatory effects of ginger also benefit management of joint degeneration like osteoarthritis. Ginger reduces the joint swelling, damage and pain associated with injury and osteoarthritis. Interestingly, the pain reducing effects may not be as rapid as an NSAID but are slower to manifest. This is important when evaluating response to therapy. Like more recent NSAIDs, ginger has been shown to be a relatively specific inhibitory of COX-2 having minimal effect on COX-1.
     Improvement in cognitive function has been shown in humans and other species. Antioxidant and anti-inflammatory effects of ginger are thought to play a role. But more recent research has identified beneficial effects on secretion of certain brain related signaling compounds and nerve growth factors.
     While it is considered a safe herb, it can induce stomach discomfort when given in high doses and there is concern, in some situations, about its ability to reduce blood platelet function (clotting). Ginger may also increase absorption of certain drugs.
     The appropriate herb dosage varies based on the health problem and the form of herb used (i.e. dried herb vs. an extract). Heating can impact some compounds. For example, within certain parameters, heat decreases gingerols and increases shogaols leading to improved anti-inflammatory effects. It is important to note that the properly processed whole herb contains the entire range of active compounds and is felt by many to be most effective. However, use of the whole herb may not be most convenient for administration.
     Uses in companion pets have focused on gastrointestinal disorders and management of osteoarthritis. However, there may be benefits for cognitive dysfunction.
     If you have questions about ginger for your pet, consult a veterinary herbalist.
Of sweet potatoes and liver...
(Dr. Ron Carsten Glenwood Post 12-2-22)
     Food is an integral part of Thanksgiving. It brings to mind the complexity of food and meal planning. Rightfully, many consider food (nutrition) as the foundation for health. Some feel that illness is often a reflection of nutritional imbalance. Understanding the imbalance can be challenging because the body has an incredible ability to adapt to imbalance and because food has an amazing intricacy.
     This brings us to sweet potatoes and liver. Both are great sources of a wide range of vitamins, minerals, antioxidants and other valuable substances. Both are listed as sources of vitamin A without clearly identifying how different they are as sources of vitamin A. Like other yellow and orange vegetables, sweet potatoes contain high levels of carotenoids. The carotenoids contribute the yellow, orange and red colors. Carotenoids are also found in dark leafy greens like spinach and mustard greens. Over 750 carotenoids have been identified. Many play roles in health and nutrition but not all contribute to increasing vitamin A levels in the body. The carotenoid of particular interest for vitamin A is beta-carotene (b-carotene).
     While often discussed as vitamin A, b-carotene is considered a provitamin A. This means it has to be converted to vitamin A (retinol) before it can be used as vitamin A. Most of the conversion of b-carotene to vitamin A occurs in the cells lining the intestine. Since b-carotene is fat-soluble, getting access to the intestinal cells requires the presence of sufficient fat in the meal. In addition, b-carotene is found in a free form in leaves but in a bound form in vegetables. It has to be released into the free form to be used. Obviously a healthy digestive tract along with a balanced diet are important for the efficient conversion of b-carotene to vitamin A.
     This fascinating process gets more complex when species differences in the ability to convert b-carotene to vitamin A are considered. The most efficient converters are the omnivores (like humans and rats)
and herbivores (like cattle and sheep). This is thought to be related to their basic diets that include many b-carotene sources. Carnivores (like ferrets and cats) are a different story. Cats are considered obligate carnivores which means they require a meat based diet. They do not convert b-carotene into vitamin A. This means they have to have vitamin A (retinol) in their diet to prevent vitamin A deficiency. Even though dogs are considered carnivores, they feed more like omnivores and they have the ability to convert b-carotene to vitamin A enough to generally meet their metabolic needs.
     Species that cannot convert or weakly convert b-carotene require preformed vitamin A in the diet. That brings us back to liver. It is a source of preformed vitamin A meaning it is already in the vitamin A retinol form. This is the form that cats need in their diets. Preformed vitamin A is found in animal source foods like liver, meat, dairy, and fish oils.
Vitamin A is critical for health. It plays a role in growth and development, immune function, and maintenance of the heart, lungs, kidneys, eyes, and mucous membranes. However, excess vitamin A (10 times or more the recommended amount) can be toxic resulting in loss of appetite, nausea, weakness, tremors, and convulsions. Vitamin A is stored in the liver so excess consumption can become a problem over time or with acute very high doses. There is minimal concern with vitamin A toxicity when using b-carotene because it has to be converted to vitamin A and the rate of conversion is reduced when there are adequate vitamin A stores in the liver.
     It is important to recognize that there is individual variation in ability to convert b-carotene to vitamin A. This is in addition to the species variation already mentioned. Not all dogs are efficient converters, especially as they age. Recognizing when a food is providing “vitamin A” as a provitamin or as a preformed vitamin A can be important when considering managing some health conditions.
     If you have questions about your pet companion’s health, contact your veterinarian.
The lowly dandelion and pets
(Dr. Ron Carsten Glenwood Post 10-26-22)
     Love them or hate them, dandelions (Taxacum officinale), the helpful herb or the nuisance weed. Not as prolific now as they are in spring, a few dandelion flowers can be seen emerging from yards around town as they go to seed before winter. It is a reminder of how resilient plants can be and why dandelions thrive around the world.
     Some consider the dandelion the most successful plant that exists. Originally a native plant in Europe and Asia, it can now be found worldwide. This widespread distribution was aided by humans who transported dandelion for both its medicinal and crop uses. All parts of the dandelion are considered safe to eat. They are highly nutritious, providing a range of vitamins (i.e. some B complex, C, E, and K) and minerals (i.e. potassium and calcium) depending on the part of the plant used. Common uses are leaves in salad, roots as a coffee/tea, and the flowers used to make wine or fritters. Medicinal uses include dried leaf, root, or whole plant, teas, and tinctures. A look back at its traditional use is valuable.
     Use of dandelion as an herb has been ongoing for centuries. It was, reportedly, included in the U.S. Pharmacopeia as a tonic and diuretic medicine in 1831 where it remained as a part of the American pharmacy for almost a century. Eventually it was replaced as interest grew in the use of drug therapies. However, in other parts of the world, dandelion remains an important herb.
     Traditional uses were as a digestive tonic, a liver tonic, and a diuretic. These properties contributed benefits for managing stomach and intestinal problems, skin disorders, liver and kidney conditions, and pancreatitis. Understanding the medicinal use of dandelion requires familiarity with the terminology and rational for its use. A tonic is a substance that stimulates well-being by supporting overall health, vitality, and wellness. This occurs because the tonic contributes to improved function by nourishing the tissues and/or stimulating organ function or elimination processes. Some effects of dandelion are
the result of its action as a “bitter tonic.” This property is based on the effect of the bitter taste of the leaves which stimulate secretion of digestive juices (i.e. saliva, gastric secretions, bile) promoting improved digestion, appetite, and adsorption of nutrients.
     Dandelion has anti-inflammatory effects that benefit the liver. In addition, dandelion is able to support the liver by improving the production of bile in the liver and release of bile from the gall bladder. These actions aid the digestive process and absorption of nutrients. Increased release of bile can facilitate some aspects of detoxification. The diuretic effects of dandelion can benefit the kidneys as well as assisting the process of detoxification.
     Dandelion supports healthy gut flora through a number of processes including providing prebiotics like inulin, antimicrobial effects against some bacterial pathogens, and ability to improve the amounts of beneficial gut flora organisms. The anti-inflammatory and immune modulating properties contribute to dandelion’s ability to assist with intestinal ulcers and stomach inflammatory problems.
     With any herb, the benefits and effects are dependent on the amount of the active factors ingested and how long those amounts are maintained in the body tissue of interest. In other words, if inadequate amounts reach the liver, its effectiveness is reduced. Determining the appropriate dose is essential as well as deciding on which part of the plant to use. The intended use will influence the part of the plant chosen. For example, the root is a good source of the prebiotic inulin and fiber while the leaf provides diuretic effects (as well as other important benefits).
     For pets, dandelion is considered a safe herb. However, caution should be exercised when using dandelion in certain situations like when there is bile duct obstruction, diuretic medications are already being used, and when administered at the same time as quinolone antibiotics. Avoid using dandelions that have been treated with herbicides or other chemicals.
     If you have questions about the use of dandelion for your pet companions, contact your veterinary herbalist.
The blood chemistry panel and your pet companion
(Dr. Ron Carsten Glenwood Post 9-29-22)
     The blood-chemistry panel is an essential part of the health assessment for pet companions. It is used in conjunction with the complete blood count (CBC) to form a more complete picture of health status (see the Aug. 30 Glenwood Springs Post Independent article).
     Unlike the CBC, which uses blood that has not clotted, the chemistry panel uses serum. Serum is the fluid that remains after clotting. The serum is removed from the clot before the blood-chemistry panel is performed. Removing the clot also prevents further changes resulting from ongoing contact with the blood cells.
     It is important to remember that the CBC evaluates red blood cell (RBC), white blood cell (WBC), and platelet numbers and other blood-cell measures. This is in contrast to the chemistry profile that includes tests for organs like the kidneys and liver as well as basic tests like glucose, cholesterol and electrolytes like sodium, potassium, and calcium. Commonly available test profiles run from a handful of tests up to almost 30.
     Beyond the basic chemistry profiles, an extensive list of specialized testing is available. Specialized testing would be requested based on the characteristics of the illness and the pattern of results from the CBC and the chemistry profile.
     There are a number of situations where your veterinarian would recommend a chemistry panel (usually in conjunction with a CBC). These include when your pet is ill, when monitoring response to treatment or as part of a wellness evaluation or pre-surgery screening. Individual test results and patterns of results provide guidance for making a diagnosis or determining which drugs to use for anesthesia. For example, it is recognized that kidney tests (like creatinine) are not abnormal until 2/3 to 3/4 of the kidney function is lost. The SDMA is a newer test that provides earlier indications than creatinine about potential kidney concerns. Adding to the challenge of interpreting kidney blood chemistry results, it is important to determine if the pattern of results indicates a problem preventing the kidney from functioning efficiently like low blood flow to the kidney, a primary kidney problem or something impeding the urine flow like kidney stones.
Understanding where the problem is located or what is causing the change in test results related to the kidney is vital for formulating a treatment or support plan.
     Another important consideration is determining if the kidney problem is acute or chronic. Pets with chronic kidney disease have the opportunity to adapt to the worsening kidney function, so they can withstand higher numbers for SDMA, creatinine, and BUN (blood urea nitrogen). However, the chronic change in kidney function can lead to elevated phosphorus, anemia and problems with blood pressure. Each of these patterns of results have impacts on how the pet is managed.
     Blood chemistry results for liver tests can also be assessed for the pattern of values. Unlike the kidney tests, the typical liver tests don’t directly measure function. For example, the ALT is an enzyme released from liver cells as they die. Some amount of cell turnover (death) is normal. When liver cell turnover becomes excessive, the ALT will rise as long as the liver size is normal. On the other hand, liver tests like ALP provide information about the bile system. Complicating interpretation is that elevations in ALP don’t always mean liver. ALP can be induced to increase when there are increased steroids in the blood, either naturally occurring or given as a medication. Sometimes, it is important to perform additional tests like the bile acids panel to assess liver function.
     Other common tests on the blood chemistry panel like the T4 and cholesterol may imply a low functioning thyroid in the dog. However, cholesterol can be elevated when the pet was not fasted prior to obtaining the blood sample. The T4 can be low due to the effect of diseases not directly involving the thyroid or certain medications. Untangling the thyroid results sometimes means performing additional tests like a thyroid panel that includes other tests in addition to the T4.
     This brief discussion gives a glimpse of the power of the blood chemistry panel and how the different tests when interpreted together provide a broader understanding of the health of your pet companion. If you have concerns or questions about your companion’s health, contact your veterinarian. Perhaps a blood chemistry panel and CBC are indicated.
Complete blood count is valuable for pet companions
(Dr. Ron Carsten Glenwood Post 8-30-22)
     Blood cells circulate through the body in the blood vessels. This makes it vital that the number of cells be maintained at appropriate levels. When cell numbers are outside the normal range, they can indicate a health problem. The complete blood count involves counting cell numbers and, for some cells, measuring their size and determining substances like hemoglobin. Cells that are counted include the red blood cell (RBC or erythrocytes), white blood cells (WBC or leukocytes) and platelets (thrombocytes). The end of the names (-cytes) means cells.
     Each cell type responds in characteristic ways to illness. This means information from their evaluation can be used to aid the process of making a diagnosis, determining the need for additional testing and monitoring the response to therapy. For example, a dog that has an increased WBC count may have a bacterial infection (not the only possible reason). Along with physical exam findings, response to antibiotic therapy could be monitored by periodically repeating the WBC counts during therapy.
     The RBC is involved with transport of oxygen and carbon dioxide. When RBCs get too low (anemia), not enough oxygen can be transported. RBCs have to be replaced regularly. They are made in the bone marrow of adults and released into the circulation when signaled by a substance produced mainly by the kidney. Development of RBCs in the bone marrow requires certain nutrients like B vitamins, n3 fatty acids (lipids for the cell membrane) and iron (for hemoglobin).
     Sometimes the bone marrow releases RBCs before they are fully mature. Reticulocytes are RBCs that are one step from being mature RBCs. They are released from the bone marrow to replace the aging RBCs, so low levels are normal. However, in response to anemia, the number of reticulocytes in the blood should increase. A lack of increase shows that the
body is not responding to the anemia. This would suggest the need for additional investigation to identify the cause of anemia. Interestingly, measurement of reticulocyte hemoglobin levels has shown value for recognizing the presence of inflammatory conditions in the body.
The WBC is another important cell type group in blood. They function as part of the immune system and play an important role in defense of the body. WBC is a general term that refers to a group of cells that include the neutrophil, monocyte, lymphocyte, eosinophil and basophil. Each has a unique function and is found in characteristic amounts in the blood normally.
The numbers of each type and the overall WBC count provide information about a range of body conditions. Comparing numbers to normal levels and the overall pattern of numbers is valuable. In our example above, an increased neutrophil count was associated with an infection. This could be supported by seeing an increased monocyte count. The monocyte arrives a few days after an infection to aid in the “clean up.” However, sometimes there can be a temporary neutrophil increase from stress not associated with infection. This would be seen as an increased neutrophil number and a reduced lymphocyte number. It is clear that these patterns of cell numbers can be informative but not always definitive.
Lymphocytes are important cells in the immune response. They respond to viral infections and produce antibodies. Eosinophils and basophils are part of the response to allergies, but they also function as part of the immune response.
Platelets are part of the blood clotting process.
This brief overview gives a glimpse of why the complete blood count is an important part of assessing health and making a diagnosis. There is so much more to the story. Contact your veterinarian if you have questions about the complete blood count.
Calendula and pets
(Dr. Ron Carsten Glenwood Post 7-21-22)
     Calendula (Calendula officinalis) is an herb that has centuries of use for its health benefits and culinary attributes. It is widely distributed worldwide and is commonly referred to as pot marigold (a reference to how easy it is to grow in containers). Keep in mind that there are over 20 different named species in the calendula group (genus), but it is the C. officinalis that is used for medicinal and food purposes. This is not the same as the garden marigold (Tagetes sp.).
     The calendula flowers are used for both medicinal and culinary purposes. From a culinary perspective, the flowers are used to add flavor to foods and yellow to orange color for foods like butter, cheeses, custards and rice dishes.
     It is always interesting to review the historical use of an herb, because this provides insights into its potential benefits. Often modern research techniques validate these uses and identify the important active factors in the herb. For calendula, historical medicinal use has been for both external and internal issues. Common external uses have focused on skin issues like wounds, abrasions, bruises and superficial burns. The properties that make calendula useful for skin issues make it valuable for some internal health problems. Internally, it has been used for issues like stomach ulcers, liver problems and internal inflammatory disorders. It has also been used as a rinse for mouth and throat inflammatory conditions.
     Calendula continues to be used because of the beneficial effects that are observed. Interestingly, modern research is confirming that calendula has a wide range of effects including anti-inflammatory, antimicrobial and astringent properties that contribute to its ability to promote healing. Astringents firm the tissue and reduce excessive discharge, which facilitates healing. Some clinical studies have shown increased healing of experimental excision wounds and skin ulcer reduction almost three times better than control treatments. Certain compounds in calendula, like rutin and quercetin, are thought to stimulate specific cellular targets that increase wound healing activity. Other studies have demonstrated benefits for managing gingivitis
and periodontal disease. Models investigating the effect of calendula on stomach ulcers show a benefit. Calendula appears to have the ability to effect the rate of stomach emptying, lower blood sugar, and protect the liver and kidneys against toxic insults.
     Keep in mind that the effects of herbs, like with medications, is dependent on the dose and contact time with the tissue. The extraction process (i.e. tincture vs infusion) and formulation of the product can influence its effectiveness. Selection of the product depends on the intended use, because there are many ways to use calendula. Available product forms include tinctures, infusions, creams, gels, salves and ointments. Tinctures are made using a described process that involves soaking the dried flowers in alcohol (or glycerine) for a defined period of time, then removing the flower material. The tincture can be administered orally for internal use or used in preparations like creams and ointments. Sometimes it is desirable to avoid alcohol. Alcohol affects the taste of the product, raises concerns about alcohol consumption and can sting when applied topically. Avoiding the alcohol can be done by allowing the alcohol to dissipate before use, using a glycerine based product or using an infusion. Infusions (like making tea) can be made from calendula and applied to injured skin. Infusions using oils like olive oil can also be made.
     Selecting a product involves using a source that is reliable, because it is relatively easy to have adulterated herb products. This makes purchasing from quality sources critical.
     Calendula is considered safe for topical and internal uses for dogs and cats, but it should be avoided during pregnancy. It is also valuable to be aware that calendula is a member of the aster family. Allergy to the aster family is a common concern in humans, but the frequency is unknown in pets. If redness, irritation or itching occur after topical use, the calendula should be discontinued.
     Calendula is an interesting herb with long historical use in a wide range of situations. It appears safe in pets for topical uses. For internal use, consultation with a veterinary herbalist is recommended.
Making the diagnosis is not always simple
(Dr. Ron Carsten Glenwood Post 6-28-22)
     Much of what happens daily while delivering health care revolves around making a diagnosis. The process of arriving at a diagnosis directly impacts our pet companions and their care givers. Understanding what a diagnosis is and how it is obtained can significantly improve communication and understanding of recommended testing and therapy. A diagnosis is, in loose terms, a description of what is wrong. Sometimes arriving at a diagnosis is simple, and other times it is a complicated process filled with challenges.
     An example of a simple diagnosis is a dog with a broken femur after an encounter with a car: The diagnosis is a fractured femur bone. The specific type and location of the fracture will be described as part of the diagnosis (i.e. a comminuted fracture). In this example, arriving at a diagnosis involves a stepwise process beginning with the history (dog was OK before the car), physical exam (swollen, unstable, painful leg) and radiographs of the leg (shows the broken bone). This stepwise assessment is important, because the radiograph shows the fracture but does not tell you that the cranial cruciate ligament (CCL) in the knee is also torn. Assessment of the CCL occurs during the physical exam.
     Making a diagnosis in other situations can be more challenging, requiring more detective work. For example, a cat with chronic diarrhea has a long list of possible causes and diagnoses. Identifying the exact cause provides the diagnosis. The sidewise process again starts with a clear history. This history is important because diarrhea in cats is one of their most common problems and has so many causes. Some causes directly relate to the digestive tract, while others do not.
     The history, including lifestyle (i.e. indoors only, likes to eat house plants, multiple cats in the house, etc.), age (older cats generally have different problems than younger cats), appetite, how long the diarrhea has been occurring and if vomiting is also present. These historical observations help to provide focus for the diagnostic workup and can shorten the list of possible causes. This list can be further narrowed with the findings of the physical exam. For example, a cat with diarrhea that has been drinking lots of water,
urinating frequently, has an increased appetite and weight loss could have a problem with the thyroid or diabetes mellitus (other causes are possible). The physical exam can identify the presence (or absence) of enlarged thyroids, which could point toward a diagnosis of hyperthyroidism. However, the absence of enlarged thyroids in the neck does not rule out hyperthyroidism, because the enlarged glands can slide into the chest.
     Once the history and physical exam are completed, specific testing is often needed to finalize the diagnosis. In our example, a complete blood count, serum chemistry profile, urinalysis and T4 (thyroid test) are important. These tests can show if there is an increased glucose in the blood implying diabetes as the diagnosis. However, cats can increase their blood glucose to high levels when they are stressed (such as a car ride to the veterinarian), giving a false impression of diabetes. An additional test (fructosamine) may be needed, because this gives information on what the glucose was a couple of weeks before. Glucose present in the urine implies diabetes, but there are other causes. Also many diabetic cats have bladder infections, so the urine tests have multiple diagnostic uses.
     What happens if all the initial tests come back in the normal range? Then additional evaluation becomes necessary. For a diarrhea problem, this could include abdominal radiographs and ultrasound, testing of the pancreas, evaluation for infectious causes or food allergies, and assessment for cancer or inflammatory bowel disease.
     The body is a complex group of organs, glands and other tissues that interact to maintain a balance that we interpret as health. There is also a tremendous ability to cover up or compensate for problems. Because the cat is a master at not showing signs of illness, having a complete workup is essential for diagnosis.
     If all this sounds complicated, it can be. This is why so much training is necessary for a veterinarian and why clear communication between the veterinarian and pet care giver is critical. Your veterinarian recommends tests that will guide them to a diagnosis. Without those tests, many problems cannot be adequately assessed or diagnosed.
What’s with my cat’s rodent ulcer?
(Dr. Ron Carsten Glenwood Post 5-31-22)
     Cats can have a variety of inflammatory skin problems. Some can result in ulcers in the lips or feet and nodular lesions in the skin. Rodent ulcer is an old term that has been replaced with indolent (or eosinophilic) ulcer. Today it is known to be part of a group of inflammatory skin disorders called the eosinophilic granuloma complex (EGC). Affected EGC areas may not bother the cat, or they can be very itchy as a result of certain cells (eosinophils) mistakenly releasing inflammatory substances into the tissues. Lesions can start as mild and progress to being ulcerated, discharge can be present, and can they can become infected. The progression can be accelerated and recovery complicated when the cat licks and chews at the inflamed areas. The trigger for the release of inflammatory substances is not always clearly defined but is thought to be part of a poorly regulated allergic reaction.
     The EGC name was developed years ago to refer to a group of skin problems involving the eosinophil. The eosinophil is a white blood cell that is part of the immune system. It is involved with allergic reactions and defense against parasites like roundworms. Eosinophils circulate in the blood, but they also concentrate in the tissues, which is why they play an important role in EGC.
     When activity of the eosinophils becomes excessive or poorly regulated, EGC can appear. These excessive or dysregulated eosinophilic activities have been associated with allergy reactions to food and/or environmental allergies, insect bite allergies (i.e. fleas and mosquito bites),or parasite, bacterial and viral infections. Since there are multiple possible allergens that trigger a reaction, identifying the offending allergen can sometimes be difficult.
     There are three basic forms of EGC: 1) eosinophilic or indolent (rodent) ulcer, 2) eosinophilic plaque and 3) eosinophilic granuloma. Cats can have one or more of these forms at the same time. The eosinophilic granuloma form is the most common. It can be found anywhere on the body, including the tongue, palate, hind legs and foot pads. Affected areas on the legs can have raised, linear or nodular granuloma lesions. The eosinophilic plaque can also appear anywhere on the body but is most commonly seen on the abdomen.
They can appear as red, angry hives. The eosinophilic ulcer is seen on the upper lips.
     Diagnosis involves evaluation of the lesions, review of the medical history, and a thorough physical exam of the cat. This is important because there are other skin problems like bacterial and fungal infections, abscesses and skin or oral tumors that can look like EGC. Laboratory testing including specific blood tests and skin biopsy may be necessary.
     Interestingly, EGC is seen more often in young cats (2-6 years of age) and is observed two-fold more frequently in females. There is speculation that there is a genetic predisposition in some cats. Fortunately, sometimes these lesions will spontaneously disappear. However, some will become progressively worse and require treatment. Typical treatment includes controlling bacterial infections if present, identifying the source of the allergen (and avoiding that allergen), and the use of glucocorticoids (steroids). In some situations, other immunosuppressive drugs may be needed. Food trials to identify food allergies may be helpful for management. In addition, efforts to identify the allergies to environmental allergens may be necessary. This may require keeping the cat indoors to limit exposure to common outdoor allergens or performing intradermal skin or serum testing. However, it is important to note that there are indoor allergens like dust mites that can trigger EGC. Skin parasites like fleas should be treated if present. EGC is a problem that can require lifelong support and management.
      Integrative supportive approaches include evaluation of the intestinal biome (gut flora) for its potential role in immune modulation that may affect the cat’s ability to properly regulate the immune reaction to allergens. Providing probiotics for cats undergoing antibiotic therapy can be beneficial for management of the intestinal biome. While cats are relatively resistant to the side-effects of steroids, it can be helpful to provide support for the adrenal and liver during steroid therapy. Some cats respond to essential fatty acids found in fish oil. These steps can become important for cats with stubborn or difficult to mange EGC lesions.
     If you have questions about EGC in your cat, contact your veterinarian.
 What’s with my sneezing dog?
(Dr. Ron Carsten Glenwood Post 4-26-22)
     Everyone sneezes sometimes, because occasional sneezing is normal. The cause of sneezing in dogs includes normal play-related behavior and reactions to minor irritations to more serious conditions that require therapy. Some dog breeds, like French bulldogs and pugs, are more prone to sneezing because of the shape of their face. Awareness of normal sneeze behaviors and the causes of sneezing can be valuable when deciding about medical attention.
     Sneezing is a forceful expulsion of air through the nose. However, sometimes dogs have a sneeze that involves inhaling air during the sneeze. This is known as a reverse sneeze. Usually sneezing is a reaction to something minor like dust or an irritant. These sneezes are often brief and do not continue once the irritant is gone. With more serious problems, sneezing episodes can be more frequent, last longer and be more distressing to the dog. Nasal discharge can be from one or both nostrils and be purulent, bloody or a combination. The cause of serious problems range from sinus infections, foreign bodies like grass blades or seeds, nasal mites, tooth infections and tumors to nasal trauma. Diagnosis of these problems can sometimes be challenging, so it is important to be observant of your dog’s normal activities, the character of the sneeze, if there is discharge from one nostril or both and the features of the discharge. Social interactions and travel history may become important for chronic or poorly responsive sneezing situations.      
     Allergies can result in sneezing. This is often seasonal when the allergen is present. However, some allergens like dust mites can be present year-round. Nasal discharge associated with allergies is often clear but produced in higher than normal amounts. Nasal foreign bodies can be difficult to diagnose and treat. As with other nasal issues, sneezing, nasal discharge, rubbing or pawing at the muzzle can all be signs of a nasal foreign body. Nasal discharge is from one side of the nose — the side with the foreign body. Keep in mind that the discharge from one side of the nose can be an important clue for focusing diagnostic testing and symptomatic therapy. Problems like an infected tooth, oronasal fistula (abnormal hole between the
mouth and the nasal cavity) and nasal tumors can have nasal discharge from one side.
     Unfortunately, the nasal cavity is the site of a common inflammatory disorder known as idiopathic lymphocytic-plasmacytic rhinitis (LPR). The cause is unknown, but certain cells like lymphocytes and plasmacytes infiltrate into the lining of the nasal cavity resulting in inflammation (rhinitis). LPR is the second-most common chronic problem associated with the nasal cavity in dogs. It is associated with sneezing and the appearance of difficulty inhaling a breath. The nasal discharge varies from bloody to cloudy with a greenish color. Even though LPR generally affects both nasal cavities, it can present with discharge from one or both sides. Diagnosis involves ruling out other causes and obtaining a tissue biopsy from the nasal lining.
     Nasal mites can cause sneezing sometimes. They are transmitted between dogs through contact, but the mites can live in the environment for short periods. Once established in the nasal cavity, the mites can trigger sneezing, reverse sneezing and sometimes a bloody nasal discharge. However, not all dogs sneeze when they have nasal mite infections. This means that some nasal mite infestations remain unrecognized, allowing for continued spreading. The mites are not always visible in the nasal opening, and diagnosis may require examining the nasal cavity under anesthesia with specialized equipment or treating for mites if suspicion is high.
     Obtaining a diagnosis for a sneezing problem can sometimes be challenging. Treatment and supportive care depend on the diagnosis. Unfortunately, some issues, like LPR, are prone to reoccurring. Definitive treatment should always be sought including: foreign body removal, infection treatment, tumor management, dental care, nasal mites treatment and allergy control based on the source of sneezing. Additional supportive care can focus on herbs like marshmallow root that can sooth the membranes lining the nasal cavity and boswellia that has anti-inflammatory properties. Vitamins like A and C can be beneficial for improving function of the nasal cavity lining.
     If your dog is sneezing or has an abnormal discharge, contact your veterinarian.
Marshmallow root herb for dogs and cats                     
(Dr. Ron Carsten Glenwood Post 3-24-22)  
     Marshmallow root (Althaea officinalis) has been used for thousands of years for health care. Its medicinal use was first recorded in the 9th century BC. The scientific name is derived from the Greek altho, meaning to cure, a strong statement for its health benefits. Historically it has been used for health problems related to the mucous membranes. Mucous membranes are the moist, inner lining of some organs and areas of the body like the digestive, respiratory and urinary tissues. This means it has indications for a wide range of problems that include diarrhea, coughs and urinary bladder disorders. Marshmallow root is the focus for use, but, in some situations, the leaf is used. Do not confuse the herb marshmallow root with the sweet marshmallow treat that no longer contains the marshmallow root herb.
     Marshmallow root has many different actions depending on the amount of the herb given, frequency of administration and preparation. These actions include diuretic, antimicrobial, anti-inflammatory, expectorant, blood glucose lowering and immune boosting effects. The way the marshmallow root is processed can have an impact on the amount of the active constituent present. For example, marshmallow root contains a gelatinous material known as mucilage. This mucilage plays an important role in soothing and protecting irritated or inflamed tissue. Making a decoction (heating or boiling) will damage the mucilage, while a cold infusion (soaking in water) is best for the mucilage. This means that the method of preparation should be considered along with its intended use.
     Specific health challenges experienced by dogs and cats that marshmallow root may benefit include problems with diarrhea, nausea and vomiting. These issues may be associated with chronic problems like inflammatory bowel disease or acute issues like stress-related diarrhea or upset from food changes. Marshmallow root also has benefits for urinary tract inflammation and infections as a result of its anti-inflammatory and antimicrobial effects along with its diuretic action. These same effects can be helpful for respiratory issues like bronchitis and laryngitis. In addition to its anti-inflammatory effects and mucous
membrane protective actions, marshmallow root is an antitussive (relieves or prevents coughs). Historically, marshmallow has also been used topically for management of wounds. Marshmallow root is often mixed with other herbs like licorice, mullein leaf or wild cherry bark. The goal is to use herbs that work together to more effectively address the range of symptoms associated with the illness being addressed. Before using these combinations, it is important to understand each of the ingredients and make sure that they are safe for pets.
     Marshmallow root is considered safe to use for dogs and cats. However, it should be avoided in individuals that show sensitivity to marshmallow root. Marshmallow root can also lower blood glucose levels; therefore, use with caution in diabetic pets, especially if they are receiving insulin. Due to the high mucilage content, marshmallow root can potentially interfere with absorption of some medications. Timing of administration can be important.
     As with all health issues for pets, it is essential to get a clear understanding of the illness and diagnosis before starting on any therapy. There are many illnesses that appear similar but have very different therapies. For example, vomiting can indicate that there is simply an upset stomach or intestine that just needs a conservative approach to soothing the inflammation. However, vomiting can indicate many other issues that can be more serious, like liver disease, pancreatitis or a foreign object like a ball in the stomach creating a blockage or severe irritation. Issues like a foreign object may require surgery for removal and cannot effectively be managed by marshmallow alone. In a similar manner, a cough could be caused by irritation in the airways requiring an approach that reduces the inflammation or the cough could be caused by a heart problem that requires management of the heart issue as the primary care. Keep in mind that marshmallow root may play a role in management of a health issue even when it is not the primary focus of therapy. If you have questions about your pet’s health, contact your veterinarian.
     If you have questions about the use of herbs in your pet, contact a veterinary herbalist.
Melatonin is much more than a sleep aid                                 
(Dr. Ron Carsten Glenwood Post 2-22-22)
     Melatonin is a hormone produced in the pineal gland. Interestingly, the pineal gland is a tiny structure in the center of the brain that was described by René Descartes, a French philosopher, mathematician and scientist, as the “seat of the soul” in the early 17th century. He thought of the pineal gland as a place where all our thoughts are formed.
While the pineal gland has an important function, we have a much different understanding of its role today. Its main role is to be responsive to the light-dark cycles (length of the day and night periods). This information is used to determine when melatonin should be secreted. Melatonin is released at night and plays a major role in regulation of the body’s circadian rhythms. Circadian rhythm refers to the physical, mental and behavioral patterns that occur over a 24 hour cycle in response to the light and dark periods. For example, melatonin influences are associated with sleepiness, maximum tiredness and with lowest levels of alertness and performance. While much attention has been focused on melatonin from the pineal gland and its role in sleep and the circadian rhythm, melatonin is also secreted by cells in other parts of the body including the salivary glands, esophagus, stomach lining and intestinal lining. The digestive tract has 100 times more melatonin than that found in blood and 400 times the levels present in the pineal gland. These sources of melatonin contribute to the blood levels especially during the day with release controlled by the periodic intake of food. Importantly, melatonin appears to have direct and indirect effects on the digestive tract, resulting in reduced secretion of stomach acid, promoting regeneration of the digestive lining and stimulation of the gut immune system. Melatonin receptors (binding sites on cells) are found in many parts of the body including the brain, immune system, gonads, kidneys and cardiovascular system. The presence of receptors in these various locations underscores the importance of melatonin in the body and, at least partially, explains why melatonin has such a wide range of potential uses. Melatonin has antihypertensive properties and effects on regulation of heart rate. There is an important role in energy regulation and glucose metabolism.
Antioxidant and anti-cancer properties have also been identified. Melatonin use in pets has focused on its potential benefits as an aid for sleep disorders, anxiety, cognitive dysfunction, adrenal abnormalities (Cushing’s disease), seizure disorders, and problems with nonallergic hair loss. As more is understood about the role of melatonin in the body, the list of health problems that will benefit from melatonin use will continue to grow. It is important to note that melatonin levels in the pineal gland decrease as individuals age. In addition, there are numerous other factors that contribute to depletion or reductions in melatonin levels. These include certain herbicides, EMF (electromagnetic frequencies), electric light exposure (including TV and computers), stress, leaky gut syndrome, and certain drugs. Lack of exposure to sunlight can play a role in melatonin declines. This can be especially important during winter. There are a variety of ways to help maintain or boost melatonin levels. These include using foods that are rich in tryptophan, such as certain meats, like beef, chicken, turkey and fish, peanuts and asparagus. Tryptophan is an essential component of melatonin production. Calcium is also essential, so foods like green leafy vegetables and sardines that increase calcium levels can be valuable. Vitamin D is critical for calcium absorption. Unfortunately, the majority of older pets have low vitamin D levels. Vitamin D is derived from the diet, not from exposure to sunlight, as it is with people. Melatonin can be given as a supplement for health issues like anxiety, noise phobias, insomnia or night restlessness, cognitive dysfunction, digestive health, immune support and nonallergic hair loss. Before starting melatonin supplements, consult with your veterinarian. While melatonin is considered safe, avoid melatonin products that contain ingredients like xylitol, a sugar substitute that can be toxic to dogs. In addition, melatonin should also be avoided in pets that are diabetic, have autoimmune disorders or are receiving certain drugs like anticoagulants. Make sure to discuss your interest in melatonin with your veterinarian before starting melatonin. Also, contact your veterinarian to discuss your pet health concern questions.
 Pet companionship helps with holiday stress management  (Dr. Ron Carsten Glenwood Post 1-4-22)
     Stress, stress everywhere: holidays, holiday travel, family, finances, COVID-19, politics, not enough snow, poor road conditions, days are too short, and the list goes on. We often feel that we are surrounded by stressors. Some are self-imposed and others are not but the bottom line is that this can be a challenging time of year. Now is when I especially appreciate my pet companions. They are always happy to see me no matter how stressful my day. The wag, the wet nose, the lick, the snuggle tells me I am loved and valued. It brings a smile even on the most difficult days.
     Mental health experts recognize that the holidays can be a stressful time. An estimated 75% of Americans have concerns during this holiday season. Underlying these concerns, 37% worry about being able to afford the holiday expenses with travel, gifts, and other holiday associated costs; 30% are concerned about getting sick from COVID-19 or spreading it; 23% are concerned with getting along with loved ones and 21% are worried about loneliness.
     Owning a pet is no guarantee that you won’t experience any stresses, but there is evidence that pet companionship provides positive benefits. Surveys estimate 98% of pet owners consider their pet to be a family member. In addition, 74% of pet owners attribute improved mental health to pet companionship while 75% see improvements in family or friends with pets in their lives. This pet ownership benefit is thought to be the result of increases in secretions like oxytocin that contribute to reduction of feelings like fear and anxiety and promote positive social interactions. Pets provide a feeling of security and daily routine that contributes emotional support. They also facilitate more social interactions that help in forming friendships.
     In practical terms, benefits of pet companionship results in an estimated $11.7 billion in human health care savings. These benefits include positive impacts on the ability to respond to infections, maintain healthy blood pressure, manage stress, reduce
cardiovascular disease, improve weight management, and lessened psychological issues. Overall, pet owners have fewer visits to physicians compared to non-pet owners.
     It is clear that pet companionship provides a valuable contribution to our health and they aid us in coping with holiday stress. However, pet ownership is a serious responsibility. Pets require daily care with fresh food and water, exercise, and regular medical care.
     Like us, pets are also affected by holiday stresses. While our pets help us to cope with stress, they need our help to manage their own response to stresses. As much as possible keep their daily routines the same. Provide a space in the home where the pet feels safe when company comes for the holidays. Be cautious about feeding unusual foods or too many table scraps especially ones that have been sitting out for long periods or are under-cooked. Make the home safe from hazards like small ornaments that can be swallowed and cause digestive problems or electrical cords that can be chewed. Avoid access to items like chocolate that can cause toxicities or products with marijuana that pets can be sensitive to.
     If your pet is having problems with anxiety, fear or other issues, there are a variety of ways to help using herbs, anti-anxiety nutraceutical products, Bach flower remedies, pheromones, and anti-anxiety medications. It is always best to have your veterinarian evaluate your pet to make sure that there are no physical issues like pain from osteoarthritis contributing to the anxiety. For severe anxiety or other behavior concerns, consultation with a behavior specialist may be necessary.
     Take time to celebrate the role that pet companions play in our lives and the positive contributions that they make. Recognize that they are individuals with physical and emotional needs that should be addressed during these stress inducing times. Spend a few moments every day with your special companion. It will help them and it will help you.
​Chamomile is a helpful herb for the holidays
​ (Dr. Ron Carsten Glenwood Post 11-30-21)
     Holidays are a time for celebrating our family and friends by gathering and eating. It is easy to overeat with the abundance of good food and camaraderie. As our companions, our pets can also overeat when we give them special treats or they get into leftovers. This can lead to digestive upset, which is common in pets in the days following holiday gatherings. Chamomile (Matricaria recutita) is an herb often used for digestive issues.
     Chamomile has been used for human health care for at least 5,000 years. Today, chamomile is the most popular herbal tea with an estimated 1 million cups consumed daily. Beyond tea, chamomile dried powder and extracts can be taken internally or used externally as a wash or mixed into a salve or cream. The dried flower and its essential oils have been used widely for a range of health conditions, and the essential oils have been used in cosmetics and for aromatherapy. It is also often used in combination with other herbs.
Interestingly, but not surprisingly, chamomile has also had a long history of use in animals. Descriptions of its use can be found in early veterinary textbooks from the 1850s. Chamomile is considered a very safe herb that is well tolerated by dogs and cats.
     Traditional use has been for conditions affecting the stomach and intestines such as inflammatory bowel disease, diarrhea, vomiting and bacterial infections. It also has topical benefits for assisting healing of inflammatory conditions and bacterial infections of the skin and mouth when used as a wash, salve or cream. Use as a mild sedative and anxiolytic have been reported.
     Current research is exploring and validating many traditional uses and providing insight into new clinical applications. Chamomile has been shown to have anti-inflammatory effects with similar mechanisms like the nonsteroidal anti-inflammatory drugs. In clinical trials, chamomile increases wound strength and the rate of wound healing and reduces bacterial
contamination. Improvements were shown in individuals with generalized anxiety. Chamomile extracts have a benzodiazepine-like activity.
     Chamomile, like all herbs, has a list of clinical benefits, and effects are the result of chamomile’s active constituents and their influence on cell targets. These results are dependent on the dose and length of cell contact of these active constituents. Traditional doses have been described and continue to be used. While chamomile is considered safe, allergic reactions have been described, and excess doses can be a concern for potential impacts on blood clotting. There is potential for increased sedation or depression when used in combination with opioid and benzodiazepine drugs. Chamomile may cause miscarriage and impact on the fetus when used in pregnant animals.
     It is always important when using any herb or supplement that a clear diagnosis is obtained so that appropriate therapy is initiated in a timely way. This is important when using an herb like chamomile for gastrointestinal problems in pets because there are numerous causes for vomiting and diarrhea. Some problems, like a simple upset stomach (i.e. gastritis), are easily managed with an herb while other problems are not well managed by an herb alone. For example, a vomiting cat with a string foreign body in the intestine potentially needs urgent surgery to address the problem. Other issues like a bacterial overgrowth in the intestines from eating too many leftovers, may respond appropriately to the chamomile, but its antimicrobial effect may not be sufficient alone to control an aggressive infection.
     Enjoy the holidays with your pet companions, but remember that they can overeat or get into digestive problems just like a person. Chamomile may be a gentle way to ease them through those issues and help deal with the holiday stress and anxiety. Always seek advice from your veterinarian when you have questions or concerns about your pet.
Cats experience pain​
(Dr. Ron Carsten Glenwood Post 11-3-21)
     Cats have an amazing ability to mask their pain. They commonly do not show easily detectable signs of pain. But this does not mean they do not experience pain. Pain in cats often goes unrecognized. Unmanaged pain can have significant impacts on health and quality of life.
     The experience of pain is a complex combination of sensory stimuli and the mental and emotional perceptions of that sensation. Intensity of pain stimuli depends on the magnitude of the inflammation and the activity of the nerve feedback loops. These factors, along with the perception of pain, make the experience of pain unique to each individual.
     Expression of pain in cats is often subtle; however, there is a range of behaviors that can be present when a cat is experiencing pain. Since these behaviors do not always indicate pain, it is important to investigate and make a clear determination regarding pain. Signs of pain in cats range from the more obvious to the more subtle. The painful cat may have changes in their sleeping habits or social interactions. Appetite may be reduced. They may stop using the litter box or have increased frequency of urination. Grooming may be reduced or become excessive to the point of self mutilation. Previously friendly cats may become aggressive. Cats experiencing pain may become restless or become reluctant to move and withdraw. They may no longer want to jump, and they avoid being handled or petted. Sometimes they won’t bear weight on a limb or have an obvious limp. Use of pain scales for scoring pain and monitoring response to pain management can be important.
     One of the challenges for recognizing pain in cats is the wide range of signs. The interpretation of signs is complicated by the fact that many of the signs of pain are also signs of other problems. For example, cats with kidney disorders can have reduced appetite even without pain. Cats with age-related cognitive dysfunction can have changes in urination and defecation patterns that affect their use of the litter box. Keep in mind that in some situations there is a combination of pain and other health problems.

Ideally, when a cat is showing behaviors or signs consistent with pain, a complete evaluation should be performed to rule out other diseases. A complete evaluation allows for appropriate focus on pain management along with addressing any additional health issues.
     Options for pain management for cats are much more limited than the options for dogs. Cats are unable to effectively metabolize some medications or have very delayed times for elimination. This means that for some drugs, the doses need to be reduced and there needs to be longer time between doses. Other drugs need to be avoided. Fortunately, there is ongoing research directed at how to improve pain management with pain medications for cats.
     With the limitation in pain management options for cats, it is essential to clearly identify the source of pain. This allows for a focused approach. For example, managing cancer pain can be different than managing myofascial pain or osteoarthritis or dental pain. Common approaches to pain management include nonsteroidal anti-inflammatory drugs like meloxicam, opioids like buprenorphine and other classes of drugs like gabapentin. Each has its benefit and disadvantages. NSAIDs, for example, can create potential problems for the liver and kidneys. Using combinations of drugs may be helpful for keeping individual drug doses lower and reduce the risks of side-effects from higher doses.
     Nondrug options for pain management include acupuncture, manual therapies like osteopathy and massage, herbs, homeopathy and essential oils. Careful selection of the approach or combination of approaches is important and should be based on analysis of the cause of pain. As with drug metabolism, cats also can be slow metabolizing certain herbs and essential oils. This means that some of these products can become toxic if not properly selected and used. Products like glucosamine and chondroitin can be helpful for osteoarthritis issues.
     If you think your cat is experiencing pain, contact your veterinarian. They can provide a complete assessment, diagnosis and pain management plan tailored for your cat.
Dogs experience pain​
(Dr. Ron Carsten Glenwood Post 10-9-21)
     It is clear that animals experience pain. The importance of recognizing the presence of pain and providing pain control have become vital aspects of optimal health.
     Pain is a complex experience that has been divided into two basic components: 1) the sensory part of the pain stimuli and 2) the mental and emotional perception of the unpleasant sensation. This means that pain is not just the sensation you feel but also how it makes you feel and the memories that it evokes. Conditions like the level of inflammation at the site of injury and the activity of the nerve feedback loops impact on the intensity of the pain sensation.
     As a result of the complex nature of pain, the experience of pain is unique to each individual. This can make it challenging to recognize the signs of pain in dogs and to effectively monitor their response to pain management. Signs of pain are sometimes subtle and include reduced activity, reluctance to jump onto the couch or into the car, not going up or down stairs, reduced appetite, episodes of constipation, difficulty lying down or getting up, change in interaction with people or other pets, and excessive grooming or chewing at a specific area. For chronic pain, subtle signs are more common than vocalizations associated with pain. However, some dogs will groan when lying down or growl when touched.
     Chronic pain is often associated with conditions like long-standing injuries, joint degeneration and cancer. Acute pain, on the other hand, is present after surgery or around the time of an injury. Assessment tools (pain scales) have been developed to aid in recognizing and managing pain. Some of these methods of assessment are focused on acute pain, and others are used for chronic pain situations. While some appear to be subjective measures, others use observations of behavior to assess pain levels. Even though not all pain scales have been validated, with regular use, they can still provide consistent information, and they help to increase awareness of pain.
     Once the presence of pain has been recognized, management of the pain is important. There are many approaches to pain management, and the approach depends on a combination of factors including the

source of the pain, the intensity of the pain and the pet’s overall health status. Regardless of the pain management method used, the goals are reduced pain and improved quality of life. General approaches to pain management have been developed. However, it is critical to tailor the approach to the individual pet. This is vital because pain medications have types of pain that they work best on, and they can have side effects that limit the way they can be used.
     Some pain drugs, like the nonsteroidal anti-inflammatory drugs (NSAIDs), opioids and local anesthetics, work at the site of injury. Other drugs work to block the nerve signals that transmit the pain message to the spinal cord. Still other drugs work in the spinal cord to modulate the pain signal or at higher nerve centers to influence the perception of pain. Drugs like the NSAIDs and opioids work at multiple places in the pain pathways. Depending on the cause of the pain and other health-related issues, using a combination of drugs may be valuable for improved pain management. Using multiple drugs at the same time is known as multimodal pain management. This is valuable because drugs with different actions can be combined, which can aid in keeping individual drug doses lower and reduce the potential for side effects.
     While drugs have a valuable role in managing pain, it is critical to recognize that there are other important ways to address pain. Many of these work well alone or in combination with drugs, depending on the cause of the pain. For example, an overweight dog with osteoarthritis can have a significant reduction in joint pain just by losing weight. Manual therapies like chiropractic or osteopathic manipulations, rehabilitation methods like massage, controlled exercise, application of heat or cold and hydrotherapy, and integrative therapies like acupuncture, laser and herbal therapies can be helpful, depending on the cause of the pain.
     If you have concerns that your dog is experiencing pain, contact your veterinarian. They can assist with assessing your dog’s pain and providing an appropriate evaluation for a diagnosis. This information will be valuable for developing a tailored pain management plan.
Urinary tract infections in dogs are common
​ (Dr. Ron Carsten Glenwood Post 9-1-21)
     One of the most common infections in dogs occurs in the urinary tract. An estimated 27% of dogs will have a urinary tract infection at some time in their life. Signs of a UTI include frequent urination, licking genital areas, blood in the urine, painful urination and straining to urinate. It is important to note that these signs do not always indicate that there is a urinary infection. Other disorders that can lead to similar signs include diabetes mellitus and kidney disease, which result in frequent urination because of the large volumes of urine produced, or a urinary bladder tumor, which could bleed into the urine.
     The urinary tract consists of the kidney, ureters (connects the kidney to the urinary bladder), urinary bladder and urethra (connects the urinary bladder to the outside). UTI is typically associated with the urinary bladder and urethra.
     Most UTIs are thought to be the result of bacteria traveling from the external genital areas up the urethra to the urinary bladder. Certain anatomic conditions can predispose to higher levels of bacteria in the genital areas. A small number of UTIs result from infections traveling from the bloodstream. There are numerous protective mechanisms and factors that reduce or prevent urinary infections. These include mechanical flushing action of urine during urination, antimicrobial characteristics of urine, barrier function of the lining of the urinary tract and action of antimicrobial and protective substances produced by the lining of the urethra.
     Some UTIs are sporadic, meaning that there are less than three episodes in a 12-month period. Antibiotics are generally used for these dogs. When there are more than three episodes in 12 months, it is considered a recurrent UTI, and predisposing factors should be investigated. Interestingly, not all dogs with predisposing factors have recurrent UTI.
     There are a number of health problems that predispose to UTIs. These include diabetes, Cushing’s disease (adrenal problem), immune deficiencies, uroliths (bladder stones), tumors, prostate disease
and back pain. The presence of any of these predisposing issues complicates the management of UTIs, and they contribute to recurrent UTI problems. Successfully identifying and addressing these issues can play a significant role in short- and long-term management and control of UTIs.
     The presence of bladder stones adds complexity to managing UTIs. Since there are different types of stones and because they develop for different reasons, they require different therapies. Not all bladder stones are associated with infections, but they can contribute to inflammation and blockage of the urethra. Struvite stones do form along with an infection. The infectious organism becomes part of the stone. Struvite stones can be dissolved with special diets. However, as the stone dissolves it releases the infectious organisms, so protocols generally also recommend antibiotics. Other stones like the calcium oxalates are not associated with infection and have to be surgically removed. Unfortunately, identification of the stone type cannot positively be determined without analyzing the stone. Identification can be essential for long-term management.
     Clearly, it is important to have an appropriate evaluation to determine the presence of a UTI and, in some situations, evaluation for predisposing factors. This may include a complete physical examination, urinalysis, blood tests and X-rays of the abdomen or an ultrasound. While antibiotics can play an important role in management of UTIs, selecting a diet that helps maintain the correct urine conditions can be essential. Addressing any concurrent issues like diabetes or anatomical conditions can aid long-term management. From an integrative approach, providing a probiotic is valuable, along with support for the lining of the urethra and urinary bladder with vitamins like A and C for management of recurrent UTI issues. Certain herbs like cranberry, marshmallow root and uva ursi may be helpful when appropriately selected.
     If you have questions about UTI in your dog, contact your veterinarian.
 Pets coping with heat and the potential after effects
​ (Dr. Ron Carsten Glenwood Post 7-30-21)
     Many people are struggling to cope with the hot summer. Our pet companions also have to cope with the heat. The hot summer and continuing heat has created numerous challenges, including the direct effects of heat on body temperature, activity levels and appetite. In addition, methods used to provide cooling can contribute to unexpected issues including skin infections from chronically wet skin and asthma episodes from exposure to outdoor allergens during the night when windows are open.
     Clearly, hot temperatures can be dangerous for pets. Pets should never be left unattended in a car. The temperature in a car can rise quickly, reaching 120°F and higher even on a mild day. These temperatures are rapidly dangerous for pets, especially those with existing health challenges, like heart disease, or those in vulnerable groups, like the young and geriatric. Street surfaces can become very hot and result in heat damage to foot pads. Caution when walking on these surfaces is important. Hot temperatures also increase the risk of dehydration, so providing plenty of fresh water is essential.
     Pet caregivers have evolved numerous strategies for helping pets to cope with the high temperatures. These include early morning walks when it is cooler and using water for cooling, like wading safely in the river, swimming, sitting in a wading pool, playing in the sprinkler and using a mister. When available, air conditioning can help keep the interior spaces comfortable. For those without air conditioning, using fans and opening windows in the evening helps dissipate the indoor heat.
​     Each of these strategies help to improve coping with the high temperatures, but they can contribute to other problems in susceptible individuals. For example, bacterial or yeast infections can affect the skin when it is wet for extended times. This is a bigger problem with heavy-coated dogs. These infections often occur in areas where there is a skin fold or under the collar, where the skin tends to stay wet longer. Signs of an infection range from minor with small
pustules on the surface to red, inflamed skin with discharge and severe pain. Treatment often includes shaving the affected area, gently cleansing, keeping the area dry and treating with topical medications or shampoos. Sometimes oral antibiotics are indicated if it is a severe bacterial infection. Preventing the skin infections involves completely drying after getting wet.
     Some dogs that swim frequently have more problems with ear infections. This may be in part due to getting moisture in the ear canals. Using strategies to routinely inspect the ears and flush the ear canals can be valuable for preventing ongoing ear infections. Only flush the ears after consultation with your veterinarian.
     Some dogs and cats have reactive airway problems. These pets are generally allergic to an airborne allergen. Exposure to these allergens results in coughing or asthmatic episodes. Increased exposure to allergens often happens at night when the windows are open while cooling the house. This can create a significant challenge while we attempt to balance the need for lowering the home temperatures while avoiding increased stress from allergic reactions. This becomes especially challenging when the reactions become life threatening, like with asthmatic cats.
     It is important to recognize that there are illness problems that can cause a dog or cat to pant, but panting is also response to heat. This makes it important to have an evaluation by a veterinarian to help rule out problems not related to the high temperatures. A loss of appetite or increased drinking can happen with increased temperatures. As with panting, loss of appetite and increased drinking can occur with numerous health problems.
​     Being aware that many of our strategies for managing the heat can contribute to other health challenges is important. This recognition can aid in avoiding unintended consequences and also provide clues for managing these issues. If your pet is experiencing health concerns or you have questions about managing the heat for your pets, contact your veterinarian.
Traveling with the anxious pet
​ (Dr. Ron Carsten Glenwood Post 6-28-21)
     Our pet companions are increasingly spending more time with us. That includes car travel while running errands and going to doggy day care, dog park, walks, and other outings. Many trips are short but some are longer requiring hours or days in the car. This combined with increased interest and plans for travel and vacationing means that being able to comfortably take car trips is important.
     These outings with our pet companions can be fun. Unfortunately some pets get anxious while in the car. Others experience motion sickness resulting in vomiting. Anxiety and motion sickness can certainly complicate car trips and create frustrations. Motion sickness is more common in puppies and young dogs. This is thought to affect younger dogs because the structures in the ears associated with balance are not fully developed. Many dogs will mature out the motion sickness as they complete development. Keep in mind that anxiety can evolve if your puppy’s first car rides make them feel nauseated and result in vomiting. This anxiety can be increased if the puppy is reprimanded for their anxious behavior or vomiting. Also, if the only car travel your puppy experiences is the trip to the veterinarian or other stressful situations, the puppy can associate car trips with anxiety provoking activities.
     Indications that your pet is experiencing motion sickness include whining, uneasiness or inactivity, excessive drooling, licking lips, and vomiting. These are the same type of signs that can be seen with anxiety during car travel. However, some dogs show their anxiety by pacing in the car and barking.
​     Managing car travel with young pets and those that are already sensitized to feeling anxiety and nausea in the car include gradually building your pet’s confidence with car travel. This can be done using a step wise approach by first getting used to approaching the car and spending time outside the vehicle. The next step is getting into the car and spending time without the car running. Once the pet is accustomed to being in the car, take short trips around
the block. Make it fun. Give treats, but not too many at a time. Some pets respond well to having a pet safe toy in the car. Short trips can progress to longer trips. Travel to places your dog enjoys. Keep in mind that changing vehicles can sometimes be helpful if one car is associated with unpleasant experiences.
     Some pets respond well to being confined to a travel crate while in the car. This can help reduce anxiety. Not all dogs respond well to this so base your decisions on how your pet reacts. Keep your car cool inside. Some think that lowering the windows slightly to balance air pressure inside and out may be helpful. Don’t feed a large meal right before travel.
     Additional steps that can be taken to reduce anxiety and nausea during travel include the use of herbs like ginger and essential oils like lavender. Ginger is considered to be a safe herb when used in reasonable amounts and it has anti-nausea effects. This may aid in reducing anxiety. Nutraceutical products designed to reduce anxiety may help. Use of pheromone products in the car like Adaptil (or Feliway for cats) can be useful. Homeopathic preparations like Bach flower Rescue Remedy can helpful in reducing stress but may not be powerful enough on their own to overcome the level of anxiety that your dog is experiencing. So combining it with other approaches can be beneficial. In more severe situations, anti-nausea and anti-anxiety medications may be necessary. Contact your veterinarian for advice on medication use.
     An important reminder during car travel is to keep your pet safe. Explore safety belt options, securing the crate, and other safe travel practices. Also the focus here has been on dogs, but keep in mind that cats can experience anxiety with car travel, some to the point of vomiting and defecating. Working with cats to desensitize and reduce anxiety with car travel can be important.
​     If you have questions about travel anxiety or motion sickness with your pet, contact your veterinarian.
Prepare your pets for your return to work ​
(Dr. Ron Carsten Glenwood Post 5-28-21) 
     COVID-19 cases are declining, mask requirements are being lifted, restrictions on indoor and outdoor gatherings are changing, and people are returning to their workplaces. During the past year, workplace changes associated with COVID-19 prompted many to work from home. This led to record numbers of pet companion adoptions across the country. Many pets, newly adopted or longtime companions, have had a high level of interaction with their caregivers while they worked from home.
     As the workplace opens up, many caregivers will be away from home more. This change may contribute to heightened levels of separation anxiety, boredom, destructive behaviors, elimination problems and other issues associated with this change in household routine. Our pet companions may also develop an awareness of the anxiety and stress that their caregivers are experiencing, adding to their own anxiety.
     It is important to consider the physical and emotional changes that will be affecting our pet companions and make plans for transitioning to a new routine. Preparation and gradual exposure to the anticipated changes in the household can be essential for a stress free transition. Make sure to give yourself and your pet plenty of time to adapt to your new routine.
     Cats are generally more independent than dogs, but cats can still be stressed by the significant changes in routine created by returning to work. Avoid or reduce pet anxiety by creating a routine and practicing longer stays at home alone. Depending on your expected work schedule, you could be away form home for eight to nine hours or more. Start with a routine that will be similar to your anticipated work schedule. For example, go out for a coffee around the time that you would usually leave for work. Keep the initial time out of the house brief and build up. This will condition your pet to being home alone. The gradual process can help to reduce anxiety. Select a time that you can go for a regular daily walk with your dog or have a play session with your cat. Pets learn to anticipate these times and activities. They provide mental stimulation as well as exercise. Provide pet friendly toys that can
help your pet to be distracted while you are out.
Arrange the feeding times so they function around your anticipated work schedule. Some recommend feeding in a room separated from the pet owner. This can help accustom the pet to being away from you and aid in reducing anxiety with separation, especially if your pet is constantly at your side. Food puzzles can be a way to provide distraction and mental stimulation.
     Crate training can be beneficial for some situations. Even though it has advantages it is not the best option for every individual. If you think crate training is appropriate in your situation, start gradually so that your pet becomes accustomed. Make it an enjoyable place for your pet to spend time.
     Pet day care or having someone come to your home for play activity is an option for some. Some people like to leave the television or radio on. Look for pet-friendly content options.
     Watch for signs of anxiety or excess stress. These include destructive behaviors, excess barking, crying, pacing, shaking, and urination or defecation behaviors. Don’t punish for these anxiety behaviors. It is important to reassure your pet. If anxiety or excess stress is observed, back up and slow the transition process.
     Separation anxiety is a complex issue. Sometimes changing the routine gradually and providing the other recommended options can be enough. However, some pets need more than this to manage their anxiety. You can use products that help to reduce anxiety like the calming pheromones in Feliway for cats or Adaptil for dogs, the Bach Flower remedy Rescue Remedy, calming herbs, and nutriceuticals like Composure. Keep in mind that these products can have subtle effects, and the effects are not always immediately observed. For pets with high anxiety, the use of anti-anxiety medications may be needed. Use of anti-anxiety medications should be coordinated with your veterinarian and a behaviorist or trainer.
     Be patient with your pet through this process. If you have questions about this important transition process, contact your veterinarian and trainer.
Essential fatty acids, fatty acids and pets
​ (Dr. Ron Carsten Glenwood Post 4-24-21)
     Fatty acids are lipids (fats). Some fatty acids are considered essential for health because dogs and cats cannot make them. This means that they must be included in the diet. Fats and fatty acids from the diet have important functions that include providing energy (calories), helping intestinal absorption of fat soluble vitamins (like vitamins A and D), increasing (n-6 fatty acid) or reducing inflammation (n-3 fatty acids), aiding formation of cell signaling and hormone-like compounds (prostaglandins), playing a role in the structure of cell membranes, and a host of benefits for the skin, cardiovascular system and brain.
     Dogs require the essential fatty acids LA (linoleic acid), ALA (alpha-linolenic acid), EPA (eicosapentaenoic acid), and DHA (docosahexaenoic acid). Cats require these plus the essential fatty acid AA (arachidonic acid). These essential fatty acids are classified as n-6 or n-3. While food sources contain a variety of fatty acids, it is the inability or limited ability of dogs and cats to convert one fatty acid into another that makes some essential. LA (n-6) and ALA (n-3) can be found in plant oils like corn oil, soybean oil, canola oil, and flaxseed oil. AA (n-6) is found in animal fat. EPA (n-3) and DHA (n-3) are present in fish oils.
     Fatty acids are named based on the length of their carbon chain and the number of single and double bonds they contain. The length of the carbon chain gives short-chain (less than 8 carbons in length), medium-chain (8-12 carbons), and long-chain (more than 12 carbons) categories. Saturated fats contain no double bonds while unsaturated fats can contain one double bond (monounsaturated fat) or two or more double bonds (polyunsaturated fat). They are further described by where the first double bond is found. For example, the n-3 (also known as omega-3) fatty acid in fish oil has it first double bond at the number three position, has more than two double bonds (polyunsaturated), and is more than 12 carbons in length (long-chain).
     The first question to consider is why this mind numbing description is important. Knowing how the 
fatty acids are named and categorized helps with understanding of health claims and information about fatty acid supplements. This also helps to decipher the steps involved with metabolism of the essential fatty acid in the body. For example, LA and AA are both n-6 fatty acids. Dogs are able to convert LA into the longer AA using a specific enzyme reaction. Cats lack this enzyme so cannot make the conversion and need AA in the diet. AA plays an important role in the cell membrane structure, cell signaling, and it is pro-inflammatory.
     Since inflammation has an important role in health and too much inflammation can result in problems, a counterbalance to the n-6 is needed. The n-3 essential fatty acids EPA and DHA provide an anti-inflammatory effect by reducing substances that promote inflammation. It is important that there is an appropriate ratio of n-6 to n-3 in the diet. Fish oil is the main dietary source of EPA and DHA. Krill oil also provides these n-3 essential fatty acids. Research reports are inconsistent in humans regarding whether krill oil is superior to fish oil for providing health benefits. More research will be needed on this topic.
     Coconut oil is a medium-chain fatty acid. It does not contain appreciable amounts of the n-6 or n-3 fatty acids. However, it does contain lauric acid which many believe has anti-inflammatory, anti-fungal, and antibacterial properties. Some feel that coconut oil has been useful for topical applications like wound management. Others feel that coconut oil has been helpful for chronic digestive problems and allergy issues. Research has not substantiated all of its potential uses and some research results are contradictory.
     When selecting an oil or fatty acid supplement, keep in mind the importance of selecting one that is focused on the problem you are supporting and that it is appropriate for the dog or cat. Also remember that some health issues like pancreatitis are typically managed with low fat diets.
​     If you have questions about the use of dietary oils and fatty acid supplements, contact your veterinarian.
 Boswellia has many health benefits
(Dr. Ron Carsten Glenwood Post 4-2-21)
     Boswellia (Boswellia serrata) is an herb that has been used in humans for centuries and is gaining recognition for its health benefits in dogs and cats. Historically it has been used for inflammatory conditions including arthritis, intestinal problems, fevers, bronchitis, cancer, and liver disorders. Modern research methods are further defining its anti-arthritic, anti-inflammatory, anti-cancer, role in diabetes management, action as an analgesic, and liver protective properties. The boswellia resin contains numerous compounds including boswellic acids. Boswellic acids, also found in frankincense, are considered the active factors that are responsible for its health effects. One effect that underlies its many benefits is its ability to reduce inflammation.
     It is important to remember that inflammation is a beneficial response to infection or injury when it is short-lived. It is classically seen as redness, swelling, heat, pain, and loss of function. These changes are caused by a well orchestrated series of cell reactions and responses that rapidly mobilize the appropriate cells and attract them to the problem area. The size of the response is intended to be roughly proportional to the severity of the infection or injury. This means the body has methods for limiting the size of the response and shutting off the inflammatory response once the infection or injury is resolved. Typically inflammation is stopped within hours to a few days when the control mechanisms are working properly.
     When inflammation is allowed to continue and become chronic, it can be damaging and contribute to other health problems. Problems associated with chronic inflammation include osteoarthritis, cancer, heart disease, digestive problems, and liver issues. 
​     Chronic inflammation occurs because the immune system is unable to eliminate the problem or when the body is unable to effectively stop the inflammatory process. There are many reasons why inflammation is not effectively controlled or stopped when it is no longer needed. In these situations, supportive care directed at reducing the inflammation is important. Specific steps for supportive care depend on the location in the body and potential triggers for the
inflammation. In other words, managing inflammation in the intestine will be different from managing osteoarthritis inflammation. However, there are general supportive steps that are valuable.
     A common way to control inflammation is the use of medications with anti-inflammatory effects like the non-steroidal anti-inflammatory drugs (NSAIDs). They can be beneficial for managing pain and degeneration associated with inflammation such as that seen with osteoarthritis. These drugs are clearly helpful, but for some individuals the side-effects can be problematic. For example, in some sensitive individuals certain NSAIDs cause liver and kidney problems and have to be discontinued. In addition, some NSAIDs disrupt GAG (glycosaminoglycans) synthesis. GAGs are important for joint health so inhibited GAG synthesis can accelerate cartilage damage in arthritic joints.
     Fortunately, there are ways to reduce or eliminate inflammation that do not rely on NSAIDs. These options include herbs like boswellia, nutrients like vitamin D, support of the adrenal glands and liver, use of probiotics to restore optimum balance in the digestive tract, and nutriceuticals like glucosamine. Additional supportive options may be used depending on the health problem being addressed.
     Importantly, boswellia is an herb with a wide range of beneficial uses and it is safe for dogs in reasonable doses. In one study of dogs with pain associated with osteoarthritis or spinal disease, 71% of the dogs had reductions in pain, stiffness, and lameness within two weeks and significant reductions within six weeks. In addition to boswellia’s anti-inflammatory effects, it also helps to slow degradation of GAGs which is helpful for joints. Boswellia has also been shown to be of benefit, in conjunction with insulin, for regulating diabetic patients that are difficult to manage with insulin alone. Benefits have also been shown for protecting the liver through its anti-inflammatory and anti-oxidant effects. Its anti-cancer effects have been a valuable part of support for cancer patients.
     If you have questions about the use of boswellia for your pet, contact a veterinary herbalist.


Cats and digestive disorders​                                                            (Dr. Ron Carsten Glenwood Post 2-28-21)
     Cats are often affected by digestive disorders that result in vomiting, diarrhea and loss of appetite. The cause of the digestive disorder can range from simple to life threatening. Simple problems include temporary stomach irritation caused by something like a hairball. An example of a life-threatening challenge would be a foreign body like string causing damage to the intestine. 
     Not all vomiting or diarrhea is caused by something directly affecting the stomach or intestines. Sometimes digestive problems result from poor liver or kidney function. With such a wide range of causes, selecting appropriate supportive care requires a clear assessment and diagnosis.
     Interestingly, cats can vomit much easier then a person. Anyone that has given a pill to an uncooperative cat and watched them vomit the pill can attest to this. Cats have more voluntary control of vomiting than a person. This is true of many of the carnivores. Therefore, it is important to recognize that the act of vomiting does not give a clear indication of the cause.
     While vomiting is often associated with stomach problems, issues with the small and large intestines can also result in vomiting. Think about the intestine that is having problems. The intestine signals the stomach not to send any food. This stop signal can tell the stomach to empty itself by vomiting. Of course this depends on the severity of the intestinal issue. There are many causes of stomach, small intestine or large intestine dysfunction. These include food allergies, hairballs, bacterial infections, cancer, foreign bodies, viral infections and intestinal parasites. Indirect causes for vomiting could be issues like kidney and liver failure, and pancreatitis.
     Many of these same causes of vomiting can also lead to diarrhea. Consistency of the stools can range from normal firmness and form to liquid. Volume of the stool and urgency can give clues to the area of problem. For example, a large volume of stool without urgency is generally a small intestine problem. The
presence of mucus and fresh blood is usually a large intestine problem. Sometimes the diarrhea is both small and large intestine in origin.
     Many digestive upsets are mild and will sort themselves out with or without any interventions. The more serious problems are the ones that need attention. Recognizing the more serious problem early can be the challenge. Concern increases for the cat that is repeatedly vomiting in a short period of time, has frequent bouts of diarrhea especially when they are liquid or contain fresh blood, is becoming progressively more lethargic, has stopped eating, or is showing signs of abdominal discomfort. Dehydration can become a concern.
     These cats should be seen by your veterinarian so that appropriate diagnostic tests can be run and supportive care can be initiated. In addition to a careful review of the history of the illness and a physical examination, your veterinarian may recommend blood tests to evaluate blood cell counts, kidney, liver and pancreas. Tests for intestinal parasites and viral infections could be considered. X-rays and ultrasound of the abdomen can sometimes be essential.
     Once the assessment is complete and a diagnosis or presumptive diagnosis is made, a support or treatment plan can be implemented. This plan may involve simple steps like giving fluid under the skin and fasting followed by a bland diet, or the plan may be more involved, requiring intravenous fluids, multiple medications or even surgery. The more severe problems require more aggressive care.
     In addition to selected conventional medical care, integrative approaches like slippery elm, which provides soothing effects for the digestive tract, probiotics that aid in restoring balance to the intestinal flora, and acupuncture, which can help improve digestive function, can be implemented. Avoidance of certain food ingredients can be essential for managing food allergy or sensitivity problems.
     If your pet is having digestive problems, contact your veterinarian to discuss ways to diagnose the problem and to implement beneficial care.
Water, an essential nutrient critical for health
(Dr. Ron Carsten Glenwwood Post 1-29-21)
     Water is considered the most important nutrient. Seventy percent of a dog’s or cat’s body is water. All the biochemical processes that are part of metabolism and maintaining a healthy body require water. Water is critical for transport of nutrients and cells in the bloodstream as well as elimination of toxins and metabolic waste through the urine and feces. It is also essential for the digestive process.
     It is critical for life that water be replenished in the body daily. The body has an ongoing need to replace water that is lost through urine and in the feces. Water is also lost as vapor during breathing and as part of the normal metabolic processes. Replenishing the water in the body mostly occurs through drinking but some water ingestion occurs while eating, depending on the moisture content of the food.
     The amount of water required daily depends on a number of factors including body size, environmental temperature, activity levels, age and health status. A healthy cat generally drinks 5-10 ounces of water daily. But this depends somewhat on the type of food eaten. Cats eating dry kibble usually drink closer to the 10 ounces, while cats consuming canned foods tend to consume around 5 ounces daily. Dogs typically consume more water than cats based on their body size. The average dog needs 1 ounce of water for every 1 pound of body weight. That means that a 10 pound dog will need about 10 ounces of water and a 50 pound dog needs 50 ounces. Just as with cats, when a dog is eating canned food, the amount of water needed will be less because of the water that is already in the food. When outdoor temperatures are higher, like in summer, the need for water can be higher. Increased physical activity can also increase the need for water.
     Not having enough water or losing water too rapidly can lead to dehydration. Fresh water should always be available. During the cold season steps should be taken to make sure that the water does not freeze. Some pets will drink too much water too fast if they have not had reasonable access to water for a period of time. Too much water intake can also cause problems.
     In addition to environmental factors and activity
levels, certain health conditions can lead to increased need for water. These conditions include vomiting, diarrhea, diabetes, adrenal problems, liver and kidney disease, where there can be increased water loss. Aging also results in the need for more water ingestion because the body becomes less efficient at conserving water, such as concentrating urine properly. Some medications like diuretics also increase the need to drink more water.
     It is important to monitor your pet’s water intake daily and be aware of their average over time. Increased water consumption can be a sign of a health problem. Your veterinarian may need to know the amount of water being consumed as part of diagnosing and treating the problem. Determining the exact amount of water intake with a dog can sometimes be challenging because they can be sloppy drinkers, spilling water onto the floor or outside the dish. Cats may not be so obvious about their drinking. This means that watching the amount of urine produced can be a valuable indication of increased water consumption. For example, cats passing more urine in the litter box would indicate increased water ingestion. For dogs this could mean that it taking longer to urinate or seeing dilute urine that is very pale in color.
     For acute or sudden conditions like vomiting that can create dehydration, evaluation by your veterinarian is important. Determination of hydration status is valuable so that fluid can be replaced through an IV or by injecting fluid under the skin if needed. A diagnostic workup may be needed to determine additional therapies. For chronic, longstanding situations when increased water consumption or increased urination are observed, contact your veterinarian. A physical exam and diagnostic tests should be considered. Tests that can be important include the basic blood cell count, chemistry panel, thyroid (T4) and urine evaluation. Having a clear diagnosis sets the stage for developing a focused treatment or support plan. Depending on the diagnosis treatment could include changing diet to a specialized food, use of nutritional supplements and herbs, or administration of a specific medication.
COVID-19 and pets, an update
(Dr. Ron Carsten Glenwood Post 12-28-20)
     Contending with COVID-19 continues to be a daily part of our lives and our conversations. While there is still a lot to learn about COVID-19, much has been clarified since we were initially confronted by the pandemic earlier this year. Many questions have been asked regarding how COVID-19 affects our pets and if they can spread the virus to people. According to the Centers for Disease Control and Prevention (CDC), current evidence indicates that there is low risk that animals like dogs and cats spread COVID-19 to humans. However, people can spread the virus to their companion pets.
     Worldwide a small number of animals including dogs and cats have been reported to be infected with the COVID-19 virus. In April the first US positive animal was a tiger at the New York zoo. Other tigers and lions were also found to have clinical signs (coughing) and to be positive at that zoo. Interestingly, one tiger never had clinical signs but tested positive. It was determined that the cats were infected by an asymptomatic COVID-19 infected staff person. Also in April, the first US positive pets were reported. These were two cats in separate households that exhibited respiratory signs. One cat was exposed to a COVID-19 positive person. The other cat was suspected to have been exposed to an asymptomatic infected person. In June the first confirmed US pet dog that tested positive for COVID-19 was reported. This was a German Shepherd with respiratory signs. A second dog in the home that had no clinical signs did have antibodies for COVID-19 indicating a prior exposure. Through the middle of December, the USDA Animal and Plant Health Inspection Service has reported approximately 120 confirmed cases in animals in the US. The majority of these cases have been in cats (54 cases) followed by dogs (38).
     It is important to note that the majority of these confirmed animal cases occurred after close exposure to an infected person. Not all of the animals had clinical signs of being infected. Some animals were tested in an effort to understand virus transmission to animals in households with infected humans. These
reports mean that pets can be infected by the virus. They also raise the question about virus transmission from pets to humans. Based on the current information, the risk of transmission from pets to humans continues to be considered low.
     As a result, the focus is on preventing or reducing exposure of pets to COVID-19. This is best done by avoiding contact between pets and known, infected humans. CDC has recommended that people with COVID-19 that are in home isolating, restrict their interaction with household pets. This means that the infected person should maintain separation from household pets including no petting, hugging, snuggling, sharing food or bedding, or sleeping in the same location. An uninfected household member should take care of the pet. Standard handwashing before and after handling pets should occur. The exception to this restricted interaction is for service dogs that must remain with their owners.
     The possibility of pets being infected with COVID-19 by humans also brings the concern for pets in social settings and interaction with people that are not part of the household. Therefore, walk dogs on a leash and maintain at least the six feet distance from other people and animals. Avoid dog parks or public areas with large numbers of people and animals. Wash hands before and after contact with pets that are not part of your household.
     Keep in mind that human outbreaks are caused by person-to-person transmission, not by pets. The risk of COVID-19 infection in pets is considered low at this time and the signs of infection are vague. This means that the list of possible causes for the signs of illness in pets is long. In other words there are many health issues that can result in sneezing, coughing, nasal discharge, fever, diarrhea, and lethargy. At this time routine COVID-19 testing of pets is not recommended. When making an appointment for your pet’s health care, make sure to inform your veterinarian that your pet has been exposed to a known positive person, if that has occurred.
     If you have questions about COVID-19 and pets, contact your veterinarian.

​Winter conditions and pets require planning​                    (Dr. Ron Carsten Glenwood Post 11-27-20)
     Colorado winters bring cold, snow and ice. Adapting to these conditions for ourselves and our pet companions can sometimes be challenging. This is especially true for older pets that may have osteoarthritis or other age-related diseases like kidney or heart disease. They may be less tolerant of the cold and may not have the muscle strength and coordination to handle unstable footing on ice. Being aware and helping our pet companions address these challenges is important.
     When outside temperatures are cold, outdoor activities should be adjusted to the pet’s health and ability to handle the cold, snow or ice conditions. For some pets this involves shortened walks, using booties to improve traction or wearing a pet coat. Proper fit for the booties and coats are important. Be careful that the pet does not overheat while wearing a coat. This means that selection of the coat should be based on the pet’s overall health like body weight, hair coat and medical issues as well as the weather conditions.
     The optimal amount of exercise is dependent on the dog breed, age and health. Daily 30-minute walks may be sufficient for some, while other dogs need much more. One way to comfortably manage the level of needed activity and weather includes going out during the warmest part of the day. This may be easier this winter with many working from home during the COVID-19 pandemic. Multiple short periods of activity may be best depending colder weather conditions. Some pets benefit from extra support using devices like the Help ’Em Up Harness. This is valuable because these devices can help to prevent or reduce slipping and injury to soft tissues like tendons, muscles and ligaments. Some pets may also benefit from soft support braces for joints like the carpal joints (wrist area). This should be discussed with your veterinarian.
     When walking be aware of conditions like ice and slush since many sidewalks and streets are treated with ice melt products. The ice melt can be irritating
to feet and skin. Some dogs will have immediate reactions like discomfort in the feet after contact with the ice melt, so avoid these areas if possible. If not possible, rinse the feet after walking. This will help to avoid continued damage to the skin and avoid ingestion of the ice melt material while grooming. Depending on the quantity ingested, there may only be irritation in the mouth causing increased salivation. Too much ingestion can cause metabolic issues.
     In addition to minimizing exposure to deicing compounds, it is vital to avoid toxic substances like antifreeze. Antifreeze can be accidentally spilled or left in an unsecured container.
     For days when the weather is severe or getting outside is not feasible, don’t forget indoor activities that can provide exercise and mental stimulation. Simple indoor activities can include hide-n-seek, find the treat, fetch, and practicing tricks and training. Don’t forget that cats enjoy and benefit from indoor activities. Tables, chairs, broom handles and blankets can be used for hide-n-seek or creation of an agility course. It is important to remember that all these activities should be safe and enjoyable for everyone involved.
     During cold weather, it is essential that all pets have access to areas that are sufficiently heated. Pets should not be left outside for extended periods without shelter especially if weather conditions are too severe for that pet. Fresh water that is not frozen should always be available. Enough food to meet calorie needs should be readily available. Calories are important for providing energy and generating body heat. Signs of being too cold include whining, shivering, looking for a sheltered place or stopping play.
     While awareness of potential winter health and safety issues is important, so is recognition of the benefits of daily activity for both exercise and mental stimulation. Contact your veterinarian if you have any questions about your pet companion’s health.
​Autumn is a season of transition that can affect pets​
(Dr. Ron Carsten Glenwood Post 11-2-20)
     Autumn is a season of transition. A transition from the heat of summer to the cold of winter.  Healing methods like traditional Chinese medicine (TCM) describe the potential impacts that temperature changes have on health. They use descriptive terminology to communicate observations of physical changes. These physical changes are indicative of the quality of health and give guidance for supportive and therapeutic care. An example of how cold affects our pet companions is a dog with osteoarthritis. Cold often increases the joint pain. With exposure to cold they may experience generalized weakness and fatigue. In addition, they may be more stiff after lying and attempt to avoid going out into the cold. Interestingly, TCM relates how cold affects the body to how we experience cold. Cold causes contraction and stagnation. Think of how cold affects water changing it from a liquid to a solid (ice) when it becomes cold enough.
     While we cannot control the outside temperature, we can control the home environment, exposure to outside temperatures, and what we feed our pets. Foods are thought to have properties that make them warming, neutral, or cooling. Pets consuming meat daily tend to be less affected by cold because animal protein is overall considered warming. Of course this is a generalization because some meat sources are considered to be more warming or more cooling in relative terms. For example, chicken, lamb, and salmon are considered warming while beef, pork and whitefish are considered neutral.
     Feeding raw foods or adding fresh vegetables and fruit to pet’s meals has become more common. However, raw food that is fed cold is considered potentially a problem because it brings cold into the interior of the body. Warming the food before feeding can be important especially as we enter the cold months of winter. Some foods benefit from lightly steaming while others need more heat to adequately warm them. As with the meat, vegetables and fruits are also considered to have properties of warming,
neutral or cooling. This property is a different issue than the physical temperature of the food. For example, rice, oats, pumpkin, and winter squash are considered warming. Apples, carrots, corn, and green beans are thought to be neutral.
     Herbs are also valuable components of a support plan for managing optimal health. They can be used to warm the body when it is appropriate. Some herbs are warming while others are neutral or cooling. These distinctions can be important from a therapeutic aspect because from a TCM perspective, too much internal heat can be damaging just as too much cold. This makes it critical to have a clear understanding of the pet’s needs and the properties of the herb. Herbs that are often used for their healing benefits that are also considered warming include ginger, turmeric, cayenne, and cinnamon. Ginger and turmeric are known to have anti-inflammatory characteristics that make them valuable for helping with conditions like osteoarthritis.
     A practical approach to helping our pet companions navigate the transition from summer through fall and into winter include providing an appropriately dry, warmed environment. Not spending too much time in the outdoor cold, wet, and wind is also important. Always provide fresh water that is not too cold. Warming foods before feeding is valuable. Selecting herbs that are appropriate for the pet’s condition can add an important component of support.
     Keep in mind that the comments contained here give a very general overview of a TCM concept. TCM can be used as a guide for health assessment and ways to provide health support. This means that it is critical to carefully evaluate the pet’s individual needs so that the proper herb is selected and it is used for the appropriate time at the optimal dose. This is potentially a situation where too much of a good thing is a problem. In other words too much warming can be a problem.
     If you have questions about helping your pet journey through the season changes, contact your veterinarian.
 Pets have to cope with COVID-19 lifestyle changes
(Dr. Ron Carsten Glenwood Post 9-30-20) 
     Companion pets like routine. Our daily routines changed with the onset of COVID-19. Families were together more while they did work or school from home. This meant more contact time with pets, and in some situations, a tremendous change in routine. It has been a wonderful opportunity for interaction and mutual support between pet companions and people. All our changes in routine have given our pets a new daily pattern; a pattern that involves lots of human interaction time. Time with pets is known to have health benefits including reduction of stress and anxiety, improvements in immune function, and enhanced quality of life. Perhaps in recognition of these benefits, there has been an increase in pet adoptions during the COVID-19 pandemic.     
     Fall has always represented a time of transition as the season changes and teachers and students return to school. Pets have had to adapt and cope with these changes. This year has the added stress of even more significant changes in routine as many students resume school and families return to places of work as COVID-19 restrictions are relaxed. Since these changes represent such a large alteration in routine, there is an increased risk of anxiety issues in pets. It can be difficult for dogs to adapt to sudden changes, but cats can also be impacted.
     Separation anxiety can be the result of these sudden alterations in routine. Pets with separation anxiety can panic and show harmful or destructive behaviors when not in contact or proximity to their owners. Signs of separation anxiety include destructive behaviors like chewing and digging, excessive panting, pacing, vocalizations, excessive grooming leading to self harm, changes in elimination behaviors, drooling and escapism. Keep in mind that there are health and training issues that can be part of an anxiety problem. These can sometimes be misinterpreted as separation anxiety. For example, an elderly pet with cognitive dysfunction or a pet experiencing discomfort from a joint problem can exhibit signs of anxiety.
     Recognizing that our changing routines have an
affect on our pet companions is important. It helps inform us about ways to assist our pets with the transition. One of the keys is to provide daily structure, especially during the transition. This can be done by establishing and sticking with a routine that involves quality interactions including daily walks, play time and feeding. Provide an opportunity for your pet to transition to a new work or school schedule if possible by having separate space for your pet for set times during the day. These are times that your pet can start to get used to not being in physical contact with you. Go easy, gradually increase the time, and avoid creating increased anxiety as your pet adjusts. Provide distractions like food puzzles, safe toys and “cat caves.” Consider a pet sitter or dog walker to help fill in the times when you are away.
     Remember that sometimes anxiety issues can result from health problems. Therefore, it is vital to work with your veterinarian to make sure that there are no health problems contributing to the anxiety behaviors. If health problems are identified, they should be appropriately addressed. Then additional supportive approaches including Bach Flower remedies like the Rescue Remedy and nutraceutical products like Composure can be used to reduce anxiety. Pheromone products like Feliway for cats and Adaptil for dogs have also aided in the reduction of anxiety and are easy to use. Some herbs also have anti-anxiety benefits. Depending on the severity of the anxiety or behavior issue, the use of medications combined with interaction with a behavior specialist or trainer may be needed.
     Dealing with the changes in our daily lives created by the COVID-19 pandemic has been challenging. Our pet companions have shared and coped with these changes along with us. While they have been dealing with the stresses of a new routine, they have provided important emotional support and companionship for us.
     If you have questions about the health of your pet or about ways to help make the transition into a new daily routine, contact your veterinarian.
Wildfire smoke affects your pet companion
(Dr. Ron Carsten Glenwood Post 9-1-20)
      What a tremendous relief when the Grizzly Creek fire was finally under control and the wildfire smoke was reduced to a light haze of smoke from the Pine Gulch and California fires. Our area experienced intense concentrations of wildfire smoke. Fortunately there were periods when the smoke lessened to a more tolerable level. Of course this depended on where you were located in the valley. Many are still concerned about the high level of fire danger and the potential for future fires. Be aware of the potential health effects of wildfire smoke and be prepared.
     Wildfire smoke continues to impact air quality in our area. Not only is wildfire smoke a potential problem for humans, it is also a health challenge for our pet companions. Pets with heart and respiratory diseases are at higher risk from exposure to smoke, just like their human companions. Even a healthy pet can be adversely affected by smoke exposure.
     Wildfire smoke contains thousands of compounds. It is a complex mixture of particulates, allergens, carbon dioxide, water vapor, carbon monoxide and hydrocarbon and organic chemicals. The small particulates are considered the major health concern. These small particulates can be inhaled into the lungs and cause damage to the lungs, heart and blood vessels. Damage can start with irritation or direct injury to the cells lining the respiratory passages. This can lead to inflammation and further damage. Expanding inflammatory responses and neurological signaling can impact the function of the heart and blood vessels. With prolonged wildfire smoke contact, the health impact can worsen, especially in sensitive individuals. Larger particulates are often responsible for eye, throat and nose irritation.
     Some of these effects of wildfire smoke occur with short exposure to the smoke while other effects happen with longer smoke exposure. These impacts depend on the concentration of the smoke and the sensitivity of the individual. The closer to the wildfire that you are located the more likely your exposure to higher levels of small particulates, carbon monoxide and other chemicals. In other words, the Grizzly Creek Fire smoke has more potential health impacts than the Pine Gulch Fire and even more than the California fires.
     Indications that the smoke is causing a problem
include coughing or gagging, difficulty breathing with increased noise and open mouth breathing, increased rate of breathing, nasal discharge, eye irritation or excess watering, fatigue or weakness, disorientation and reduced appetite.
Keep in mind that even a healthy individual can have problems with excess or prolonged wildfire smoke exposure. Pet companions with pre-existing respiratory conditions are more susceptible to health problems from the wildfire smoke. This includes cats with feline asthma and dogs with reactive airway disease. Individuals with heart conditions are also at increased risk for complications from smoke exposure.
     The best way to prevent problems from wildfire smoke is to avoid it. Avoidance is not always easy or possible with the fluctuating conditions affecting our area. Pets should not be outdoors for long periods when smoke is visible, especially if the level of smoke is bothering you. Limit outdoor activity until the air clears. Strive to keep the indoor environment as smoke free as possible. Keep windows closed to reduce smoke entering the home. Use an indoor air filter. Recirculate the air and filter when using air conditioning if possible to avoid bringing contaminated air inside. These steps are important because pets will be exposed to this indoor environment for extended periods. If the smoke is severe and cannot be maintained at reasonable levels, the pets should be moved to another location. This is especially important if they have health problems that can be aggravated by exposure to smoke.
     Supportive care for pet companions exposed to wildfire smoke should be based on a complete evaluation of the pet so that specific supplements, herbs and other remedies can be properly selected. Support may include nutritional supplements that support the cells lining the respiratory passages; herbs that have anti-inflammatory effects, like turmeric and licorice root; and herbs that supports the mucous membranes, like marshmallow root. Heart and adrenal support can be important for some pets. Homeopathic medicines like Bryonia may be helpful if properly selected. Bach flower remedies and essential oils may be valuable for reducing anxiety in stressed pet companions.
     Contact your veterinarian if your pet companion is in a crises or if you have questions.
Improving innate immunity can benefit management of chronic disease in pets
(Dr. Ron Carsten Glenwood Post 7-31-20)
      A properly functioning immune system is critical for health. The immune system protects against infection by micro-organisms like viruses and bacteria. We generally think of immunity as a finely orchestrated interaction of immune cells like T cells and B cells along with their signaling molecules. This is the glamorous part of the immune system known as adaptive immunity. Adaptive immunity is able to specifically target identified micro-organisms like the parvovirus that affects dogs.
     The other part of the immune system is known as innate immunity. It involves the physical barriers like the skin and mucous membranes along with effects of urine, mucus and other secretions. Innate immunity also involves white blood cells like neutrophils and macrophages that are involved in inflammation and have nonspecific, destructive effects on micro-organisms. Interestingly, there is a mosaic of micro-organisms that normally inhabit all body surfaces. This normal flora (microbiome) interfaces with innate immunity and adaptive immunity. The microbiome also contributes to protection by suppressing certain pathogens.
     Innate immunity is important and is often neglected when defining an immune support plan. Since it compriseds the barriers like skin, secretions and fluids, and certain white blood cells, support should focus on those areas.
     The barriers are designed to physically prevent micro-organisms from entering deeper and causing infection. Beyond the barrier function, each of these tissues have additional features that improve its protective ability. For example, the skin has antimicrobial secretions, the respiratory tract produces mucus, the digestive tract produces mucus and is bathed at certain points by stomach acid, bile and pancreatic fluid. All of these influence micro-organisms in different ways. Tears help to flush micro-organisms away from the eyes and contain enzymes like lysozyme, IgA antibodies and other substances that kill or reduce the ability of micro-organisms to cause an infection. Urine pH, ribonuclease 7 and other substances contained in urine inhibit bacteria. Mucus from the nose and respiratory tract contain lysozyme and lactoferrin in addition to its ability to trap micro-
organisms that can be removed by sneezing, coughing and the sweeping action of cilia in the trachea. The skin secretes antimicrobial peptides that also trigger wider immune reactions when micro-organisms invade into the skin. Secretions of acid and pepsin in the stomach provide antimicrobial effects. Pancreatic fluid and bile have antimicrobial properties and along with gastric secretions, influence the micro-organism diversity in the digestive tract.
     Immune support has generally focused on support of adaptive immunity. However, some chronic infectious problems can be reduced or controlled by focusing supportive care on the innate immunity. For example, managing urinary tract infections has long been known to benefit by controlling urine pH. Additional urinary tract support would include nutrients like vitamin A and C for support of the tissue lining the urinary bladder and urethra. Nutriceuticals like chondroitin can be used to improve the protective layer inside the urinary bladder. Other support focuses on the kidney as a way to improve urine quality. Use of probiotics has also shown benefits.
     In a similar manner, improving the health and function of the mucous membrane lining the respiratory tract can enhance its barrier function and reduce the ability of micro-organisms to invade or trigger inflammation. Vitamins A and C can be beneficial. Reducing the inflammatory component that contributes to chronic reactive airway disease through adrenal support can play an important role. Control of dental disease and improvements in the oral microbiome can be valuable in certain situations.
     Supporting the digestive tract innate immunity can be accomplished by careful evaluation of the underlying problem and then selecting the appropriate focus. For example, glutamine, an amino acid, is vital for the cells lining the small intestine. Short chain fatty acids are important for the lining of the large intestine. Short chain fatty acids are produced by bacterial fermentation of soluble fiber in the intestine. This process requires appropriate intestinal microbiome and can benefit from probiotic supplementation.
     Innate immunity is an important part of the immune system. Its support can play an important role in managing chronic and stubborn infections. If you have questions about supporting your pet’s innate immunity, contact your veterinarian.
Fireworks, thunderstorms, noise phobias and dogs
(Dr. Ron Carsten Glenwood Post 6-29-20)
     Phobia of loud noises can have major impacts on the quality of life for many pets and their human companions. An estimated 17-49% of dogs show some anxiety, distress and aversion behaviors such as shaking, trembling, hiding, scratching, urinating and defecating when exposed to noises that frighten them. Some dogs may attempt to “escape” from the sound by chewing through walls, jumping through windows and running away. These escape efforts can lead to self harm, property damage and owner distress. Common triggering sounds include fireworks, thunder, gunshots, vacuums, heavy traffic and some loud machinery. Phobia of one noise does not mean that there will be phobia to other noises. Also, not all dogs with noise phobias have anxiety issues such as separation anxiety.
     It is not always clear what initiates phobia reactions to certain noises, but it is likely associated with some type of traumatic or fear-inducing event. The phobia reaction may be reinforced by repeated experiences with the same type of event. This may account for why phobias appear to increase as dogs get older. Some speculate that it is a learned reaction, while others argue that there is a genetic basis. Certain breeds are reported to be predisposed to developing noise phobias. Interestingly stimuli like storms have changes in barometric pressure and cloud cover prior to the storm that can trigger the onset of the phobia. This creates a complex group of stimuli leading up to the storm noise.
     It is important to recognize the difference between phobia and fear. Fear is a learned reaction that can be unlearned through processes like gradual exposure and desensitization. Phobia is a learned fear reaction that persists over time, consistently has the same trigger, is irrational and does not provide an adaptive advantage to the dog.
     There are numerous approaches that have been advocated for supporting the dog with noise phobias. These options range from basic avoidance to herbs to medications. The response to each therapy is variable, and the overall support plan needs to be tailored to
the needs of the individual. Often this means that multiple approaches will need to be used until the right approach or combination is identified.
      When avoidance is not possible, attempts can be made to distract or change focus by adding background music or play activity with a toy. Creating a small, secure space can sometimes be beneficial for reducing the phobia reaction. Dog-appeasing-pheromones may aid in calming. Essential oils like lavender have shown calming effects. Use of a properly fitted, wrap, cape or vest like the Thundershirt or similar product has helped dogs cope with distressing noises. Homeopathic products like Rescue Remedy aid in reducing the reactivity and anxiety associated with noise phobia. Herbs like valerian, chamomile and magnolia can have calming or sedating properties. L-theanine and milk casein containing anti-anxiety products have shown benefits for dogs with noise phobias.
     Some dogs have such a strong phobia reaction that complete control cannot be achieved even with properly administered combinations of the approaches listed above. In those situations, the addition of carefully selected medications may be needed. Medication selection should be done in conjunction with your veterinarian or a behavior specialist. Finding the right medication and dose may require giving the medication and determining if the effect is sufficient to manage the phobia.
     Each individual dog has different levels of sensitivity and reactivity to loud noises. For optimal results, a combination of approaches should be used depending on the intensity of the phobia reaction. Starting prior to the stimulating noise is best whenever possible. Some products like the nutriceuticals can be used on a continuous basis especially during periods with frequent reactive noises.
     If you have a dog with noise phobias, contact your veterinarian for suggestions on how to best support your dog companion during the periods of concern. Start early. Don’t wait until the phobia reaction is so severe that the quality of life is damaged.
Outdoors, springtime and eyes
(Dr. Ron Carsten Glenwood Post 5-28-20)
     With the arrival of warm weather, pet companions are spending more time outdoors and having more opportunity for eye problems. The outer parts of the eye and associated tissues, like the eyelids, are susceptible to injury, inflammation and infections. Since many eye problems, even minor issues, can progress rapidly and can sometimes lead to severe problems, it is valuable to have an understanding of basic characteristics of the eye and the associated tissues. Recognizing the cause and contributing factors for eye issues is essential for effective management.
     Typical dog behaviors like sniffing in the brush and running through the weeds can contribute to eye problems. Pollen counts and dust levels rise leading to increasing exposure to allergens prompting more allergic reactions and more eye irritation. While investigating new smells it is possible to get grass seeds or other foreign bodies between the eyelids and eye or under the third eyelid. Running and playing in the outdoors can also increase the risk of direct injury to the eye from a poke or blow to the eye from a stick or other object.
     The areas of the eye and associated tissues that are easiest to observe include the eyelids, conjunctiva, third eyelid, cornea, sclera and anterior chamber of the eye. Each of these areas has a distinct function, normal appearance and is easily seen. The third eyelid is often seen in the corner of the eye near the muzzle. It may be only slightly up or can completely cover the eye depending on the condition of the eye and excitement of the dog. When the eyelids are gently rolled out, the conjunctiva becomes visible as the pink tissue on the inside of the eyelids. The cornea is the clear, outer part of the eyeball that is in contact with the conjunctiva and/or third eyelid, while the sclera is the white part of the eye. Inside of the eye between the cornea and the iris is the anterior chamber.
     Signs of a problem with the eye include discharge that runs from excess clear to cloudy white, yellow or green discharge. The cloudy discharge implies that a bacterial infection is present. Other signs include squinting or holding the eye partially shut or rubbing the eye. This implies that there is pain in the eye or
surrounding tissue. Redness of the conjunctiva, third eyelid or sclera indicates inflammation and can be a source of discomfort. Damage to the cornea can also be painful. A damaged cornea may be cloudy or gray or have an irregular surface or a defect. Blood vessels can grow across the cornea with chronic problems. The anterior chamber is normally clear. Anything floating in the anterior chamber or discoloration implies a range of issues including anterior uveitis. This could also result in discomfort in the eye.
     Mild discharge or mild conjunctivitis without abnormalities in the cornea can generally be managed conservatively. However, even mild problems can escalate and become bigger problems. Foreign bodies, irregularities and defects in the cornea are urgent problems and sometimes a significant emergency depending on the extent of the corneal damage. With severe injury, the cornea can lose anterior chamber contents and potentially eye function. A blow to the eye may trigger an episode of anterior uveitis without an initial indication of the trauma.
     Evaluation involves observation of each of the important eye structures along with specialized tests like staining the cornea or measuring of tear production. Staining identifies areas of damage that penetrate through the outer layer of the cornea. Low tear production can result in eye problems. Some painful eye problems require a local anesthetic to allow evaluation of the eye.
     Depending on the cause of the problem, treatment may include flushing with artificial tears or administration of topical antibiotics for bacterial infections and topical steroids for inflammation. Controlling infection and inflammation is vital for resolving a many eye problems. Severe inflammatory problems like anterior uveitis can require oral steroids as well as topical treatments. Other medications may be used to assist in management of the anterior uveitis. Lacerations of the eyelids, presence of foreign bodies, and some corneal lesions may require general anesthesia and surgery.
     There are numerous other acute eye problems not described here. If you have questions about an eye problem your pet companion is experiencing, contact your veterinarian for advice.
 How your pet companions are helping with COVID-19
(Dr. Ron Carsten Glenwood Post 4-30-20)    
     As individuals and as a society, we are being challenged in innumerable ways by the COVID-19 pandemic and stay-at-home orders. Financial concerns, health worries regarding potential infection, alterations in work and school schedules, reduced social opportunities, and changes in inter-personal interactions have driven up stress and anxiety levels. High levels of ongoing stress results in increased blood cortisol levels that can impair immune functions and contribute to depression and reduced mental health.
     Immune and mental health status are of particular concern now with the threat of viral infection, especially because COVID-19 can have such an intense and serious effect on immune-compromised individuals. This does not mean that everyone experiencing stress and anxiety are depressed, are immune compromised and will succumb to this infection. These are complex issues with many important, personal components. However, recognition of simple ways to support overall health and manage stress are vital.
     Pet companionship plays an ideal, supporting role during this challenging time. Not only does pet companionship benefit immune function, it improves quality of life, contributes to better cardiovascular health, lowers the risk of obesity, reduces stress and anxiety and decreases depression. Receiving these benefits from pet companionship does not mean that you must have constant contact. Improvement in immune function has been found with brief contact during petting. Even observing fish in an aquarium has documented health benefits. Daily play activity and walks with pet companions can provide physical activities that can be very helpful for both the care provider and the pet companion. While pet companionship provides valuable benefits, it cannot replace appropriate medical care for those affected by COVID-19.
     The stay-at-home restrictions and school closures have been disruptive for children. Pet companionship may be helpful because interaction between pets and children has been shown to reduce stress levels in
children, reduce loneliness and anxiety, provide social support and boost mood. Interestingly, children with pets have fewer respiratory and ear infections in the first year of life. Interaction with pets also contributes to increased physical activity with its many health benefits.
     Keep in mind that even with all these benefits, careful selection of the appropriate pet companion is critical. Having a pet is a long-term responsibility and commitment that requires daily interactions for care. Pet companionship can also create stress especially when the home routines and pet personalities don’t match the owners. For example, a dog that is aggressive to other dogs could be an ongoing challenge in a multiple dog household or a high energy dog in need of multiple, long periods of exercise every day can be difficult for an elderly person with limited mobility. Pet health issues can present financial burdens and issues with administration of medications.
     Remember that many of the health and quality of life benefits that pet companionship provides does not require pet ownership. Just sitting with a friend’s pet for brief periods can have benefits for the immune system and stress relief. Walking the neighbor’s dog provides opportunity for physical activity and exposure to sunlight and increased vitamin D production. Vitamin D is important for the immune system, management of inflammation and mental health.
     An important point to remember is that pet companions are not currently thought to transmit COVID-19. However, it is recommended that individuals ill with COVID-19 restrict contact with pet companions in the same way as restricting contact with other people. Have someone that is not ill care for the pets and follow CDC guidelines.
     Pets play an important role in our daily lives. Now is a time to celebrate their contribution to our lives while striving to optimize the health benefits of the interaction. Take time to focus on their physical and emotional needs. It will directly benefit you.
     If you have questions about pet companionship, contact your veterinarian.
COVID-19 and veterinary medical care
(Dr. Ron Carsten Glenwood Post 3-30-20)
     The COVID-19 pandemic has touched all our lives. Our stress and distress associated with COVID-19 directly affects our pets. They recognize that we are struggling with a difficult situation but they don’t understand the cause. This escalates their stress levels. One stress affecting many pet care givers is the fear that veterinary care for their pet companions will not continue to be available. This is a major concern because many pets have ongoing medical needs and others have urgent needs.Veterinary services are considered essential for animal health. As a result veterinary practices are expected to remain open much longer than other service businesses during this pandemic. To stay open, veterinarians and their staff face a wide range of challenges. They are striving to provide veterinary care for their patients while avoiding their own exposure and preventing spread of COVID-19.
     Veterinary medical facilities are meeting these challenges based on recommendations from resources like the American Veterinary Medical Association (AVMA), Food and Drug Administration (FDA), Centers for Disease Control (CDC), and veterinary experts in infectious diseases. Recommendations are centered around social distancing, avoiding congregation of people, disinfection and use of personal protection equipment (PPE) when applicable. Prioritizing the urgency of the medical issue is being used. This means that elective and noncritical appointments and procedures are being postponed in an effort to reduce veterinary staff exposure to the public and conserve critical medical supplies.
     Understanding of COVID-19 is expanding rapidly, but there is much that needs to be determined. For example, it is not completely clear if pets are naturally infected with COVID-19. Current expert opinion is that dogs and cats are not being infected. This is supported by a recent announcement of laboratory screening of samples from thousands of dogs and cats that were all negative for COVID-19. There is, however, a low level concern that pets can have COVID-19 on their coat and can act as a fomite (object with virus on it) when the pet is in contact with a COVID-19 positive person.
     When requesting an appointment with your
veterinarian, you may find new procedures in place. Veterinary staff will determine the urgency of the medical problem before scheduling the appointment. They may also ask if you have symptoms of a respiratory infection or may have been exposed to anyone that is ill. This will play a role in determining how the appointment is managed. Veterinary facilities are managing social distancing and reducing staff exposure risks by a combination of limited contact with individuals at the reception desk, not allowing clients to congregate in their facility, not allowing anyone except staff into the facility, or offering curbside service. Curbside service may involve a staff member meeting the client in the parking lot so that staff can transport the pet into the facility while the client remains in their car. Discussion about the pet occurs either at a distance or by telephone. These processes limit contact between people while allowing for continuing medical care. Telehealth is getting lots of attention as a way to limit contact between people. While there are certainly benefits and it should be used in some situations, in its current form it cannot meet all needs for pet patients.
     In addition to social distancing efforts, veterinary staff are working to limit staff, client and patient exposure by regular hand washing, judicious use of PPE, and facility disinfection. While navigating all these changes, be patient with the veterinary staff, ask questions if you don’t understand the new procedures, be respectful of social distances, and be sure to inform them if you are ill or have been exposed.
     COVID-19 has created changes in our personal routines and increased stress levels. Our pet companions feel this stress. Focus on keeping your pet companion’s routines as consistent as possible with regular walks and play activity while following appropriate recommendations. Keep regular feeding times. In addition, there are numerous products that can help to reduce pet stress including nutriceuticals like Composure, Bach Flower remedies like Rescue Remedy, essential oils like lavender (be cautious with cats), pheromones, and herbs like valerian. Managing your own stress is valuable.
     Contact your veterinarian if you have questions about how they are addressing the COVID-19 pandemic while continuing to provide quality veterinary care for your pet companions.
Oral health is critical for quality of life
(Dr. Ron Carsten Glenwood Post 2-24-20)
     Oral health is extremely important for everyone including our pet companions. Since oral health is so critical in animals, February has been designated National Pet Dental Health month. Oral health involves all the tissues in the mouth, but the teeth and gums are most commonly affected. It is estimated that 80% of dogs and 70% of cats have oral disease by the age of 3 years and nearly 100% by 5 years. Periodontal disease is thought to be the most common inflammatory disease in dogs and the most common health problem affecting dogs and cats. Oral disease is often a progressive problem involving calculus build up on the teeth, inflammation and infection in the gums (gingivitis and periodontitis), swollen and painful gums, gum recession, tooth root abscesses, and tooth loss. These problems can lead to increased risk of kidney, heart and liver damage.
     Body surfaces like the mouth, intestinal tract and skin have a layer of microorganisms that form a microbial biome. These microbes form a complex community through their microbial interactions, and they are influenced by environmental factors like the types of foods ingested and secretions like saliva and bile. Since bacteria in the mouth interact with food to form plaque that sticks to the tooth surface, the composition of the oral microbial biome has important impacts. Plaque hardens into dental calculus (tartar) in about 48 hours. It is the plaque and calculus that contains bacteria and bacterial toxins that trigger immune reactions in the gum tissue. The sulcus is a shallow fold in the gum tissue where it attaches to the tooth. Buildup in the sulcus is less visible than buildup on the rest of the tooth but can be a bigger problem because of the prolonged contact with the gum tissue.
     Inflammation and infection triggered by the plaque and calculus can cause damage to the attachment of the gum tissue to the tooth and to the attachment of the tooth to the bone of the jaw. These damaging processes lead to periodontal disease, which includes gingivitis (inflammation of the gums) and periodontitis (loss of bone and soft tissue around
tooth). Unfortunately, the damage from periodontal disease is not confined to just loss of teeth. It can progress into formation of a hole between the mouth and the nasal cavity, weakening of bone leading to fractures of the jaw, and bone infection. Bacteria in the mouth can also enter the bloodstream leading to damaging changes in the kidneys, liver and heart. 
     One study estimates that in dogs there is a 1.4 times increased risk of damage to the heart and kidneys, and 1.2 times risk of liver damage for each square centimeter of periodontal disease burden in the mouth. This can be even more significant when the entire mouth is involved. Another study found that the risk of abnormal kidney blood tests increased from 1.6 to 2.7 as the stage of periodontal disease progresses from 1-4.
     It is important to recognize that development of plaque and calculus are inevitable; therefore, efforts to reduce or limit them are important. Teeth brushing is a valuable approach, but it can be challenging to implement. It is reported that less that 1% of pets have regular teeth brushing. Dental chews, dental toys and certain foods are designed to act in a similar way to brushing. Oral flushes and water additives have also been developed. Other approaches include attempts to change the chemistry of the saliva so that the formation of plaque and calculus are reduced. Use of oral probiotics are also showing promise by improving the microbial biome in a beneficial manner.
     For the typical pet, even with regular teeth brushing, regular dental cleaning is important. Some dog breeds, especially small breeds like pugs, Boston terriers, Yorkshire terriers, and Chihuahuas are prone to oral disease and need more frequent care and cleaning. Supportive supplements for the mouth include vitamins A and C for the gum tissue. Adrenal support can be beneficial for modulating inflammation.
     If you have questions about your pet companion’s oral health, contact your veterinarian.
Homeopathy – love it or hate it, but what is it?
(Dr. Ron Carsten Glenwood Post 1-26-20)
     Whether you love homeopathy or view it with skepticism depends on your experience with it and your understanding of its history and how it is thought to work. This discussion will not attempt to defend or degenerate homeopathic medicine but rather to provide background information. The goal is to provide brief information that forms the basis of an informed discussion and deeper exploration.
     Homeopathic medicine has often been confused with holistic or complementary medicine. While homeopathy can be a part of the holistic approach, homeopathy and holistic have different meanings. Homeopathic medicine is a distinct discipline with an interesting history, proposed mechanism of action, and health care application.
     Historically, the concept of homeopathy arose from the work and insights of Dr. Hahnemann, a German physician that lived and worked around 1800. He developed the concepts that would form the basis of homeopathy because of dissatisfaction with the medical approaches in common use at that time. These approaches included the use of arsenic, mercury, purging, bloodletting and administration of stimulants and narcotics. Infectious disease was common and frequently fatal. Surgeries were often fatal and performed without anesthesia.
     The rationale for the homeopathic approach was based on the idea that “like cures like.” In other words Dr. Hahnemann believed that minute concentrations of a toxin could cure the symptoms caused by a much larger dose of that toxin. This theory was similar to the emerging practice of vaccination, where small doses of a germ were given by inoculation to prevent the disease.
     Dr. Hahnemann worked to study and validate the homeopathy by developing a uniform process for creating a homeopathic medicine and then evaluating the effects on people. The preparation process involves dilution and succussion. One interesting component of studying the effect of the homeopathic medicine was to administer homeopathic medicines to healthy volunteers and have them record the details of their experience. This process became known as a proving. Once the pattern of the effects of the homeopathic medicine was recognized, homeopathic
medicines were matched to the illness pattern of the patient with the belief that the homeopathic medicine, when given at the appropriate potency, would move the disease out of the body consistent with the idea that “like cures like.”
     Over time, the observations of patients provided more details about the health effects of individual homeopathic medicines and more homeopathic medicines became available. This growing number of homeopathic medicines combined with an increased understanding of their effects led to the need for a systematic way to select the correct homeopathic medicine. This became known as repertorization.
     The use of homeopathic medicines in patients lead to multiple approaches that include the classical and clinical methods. Classical homeopathy involves the selection of a homeopathic medicine by repertorizing, giving the selected homeopathic medicine, and then monitoring the effect. For some, this approach focuses on giving one homeopathic medicine at a time and monitoring. This process has complications because of the number of homeopathic medicines available and because there are many different potencies (strength) for each. The clinical approach focuses, in part, on selecting homeopathic medicines based on diagnosis of the illness and removal of toxins. Homeopathic medicines are often used in combinations.
     Regardless of the approach, proper selection of the homeopathic medicine(s) is critical along with the appropriate potency. Ideally the potency is chosen based on the severity of the illness, but consideration must also be given to the vitality of the patient. Avoiding a healing crisis in a debilitated patient can be essential. Recognition of the response to homeopathic medicines can be challenging initially because changes can be subtle and evolve over time depending on the potency of the homeopathic medicine and the severity of the problem. Lack of response generally relates to incorrect homeopathic medicine selection, wrong potency, insufficient dosing, and when patients have complex disease patterns that require multiple homeopathic medicines used in a logical sequence.
     Homeopathy can be challenging to use optimally. If you have questions about the use of homeopathic medicines in your pet, contact a veterinary homeopath.
Celebrating the bond we share with our pet companions
(Dr. Ron Carsten Glenwood Post 12-31-19)
     The holiday season represents many things including reconnecting with family and friends. Enjoying time with family and friends is an important part of the holiday season, highlighting their value in our lives. Not surprisingly, our pet companions have become a critical part of our families and our circle of friends. They play an important role, on many levels, in our daily lives. The number of households with pets continues to increase. An estimated 85 million U.S. families have pet companions in 2019. That is 67% of households compared to 56% in 1988 based on American Pet Products Association surveys. There are approximately 90 million dog and 94 million cat companions in the U.S.
     The holidays provide an opportunity to acknowledge and celebrate our bond with our pet companions. Including pets in our holidays continues to increase with an estimated $67 to $185 per pet spent for gifts this year, 54% of pets have a Christmas stocking, 29% will receive a Christmas card, 16% will be featured in their family Christmas card, and 3% of pets will “write” a letter to Santa.
     These statistics are only a superficial reflection of how important our pets are to us individually. Pets provide unconditional love and companionship. They contribute to increased quality of life, reduced rates of cardiovascular disease and obesity, and lower levels of anxiety, depression and loneliness. Pet companionship also improves recovery from illness.
     In addition to these contributions, pet connections have far reaching effects for children including benefits for child development, reduced childhood incidence of certain diseases, and improved response to therapy. Pet companions are great listeners that reduce stress reactions in children performing stressful tasks. Other studies show that classroom pets facilitate learning, respect and empathy. There is also a reduction in aggressive child behaviors.
     The benefits of pet companionship extend beyond
the classroom into the workplace. Pets in the work-place relieve stress, make the work environment more comfortable, facilitate social interaction, increase productivity, and improve interactions with customers. These factors lead to higher job satisfaction, higher employee retention, and a feeling that the workplace supports physical health and mental well-being.
     With all this in mind it is easy to understand that pet companions also contribute to increased quality of life, life satisfaction, and physical and mental health in the elderly. Elderly that have contact with pets are more mobile and have improved social interactions.    
     During the holidays, take time to recognize and celebrate the contribution that pet companions make to all our lives. Don’t forget that they need to be kept safe from holiday hazards like small toys they can ingest, foods that can be toxic to them, under-cooked foods that can lead to food poisoning, houseplants that can be toxic, salt on the sidewalks that can irritate feet, and the cold temperatures that can be problematic. Also remember that pets can become stressed by all the holiday activities that change schedules and bring people into our homes. Dogs need to stay on schedule with their normal exercise routines. Cats also benefit from exercise and play so take time for them. Ultimately these interactions will reduce your own holiday stress and improve the quality of your social interactions.
     For pets that are stressed by the holiday activities, consider the Bach Flower remedies like Rescue Remedy, nutraceutical products designed to reduce anxiety, anti-anxiety herbs, and pheromones like Feliway for cats and Adaptil for dogs. Essential oils like lavender can be calming but be cautious with essential oils around cats because cats are susceptible to toxicity.
     If you have questions about pet safety during the holidays or stress management for your pets, contact your veterinarian. Enjoy the holidays with your pet companions. Happy Holidays.
 Myofascial pain syndrome in dogs
(Dr. Ron Carsten – Glenwood Post 11-23-19)
     Dogs with pain generally do not cry out or vocalize. Instead they often do not want to play as vigorously or walk as far as usual. Lameness may be observed or more mild signs like a shorter stride length or reduced weight loading may occur. The painful dog may avoid being petted or handled and can even become aggressive to others. Some dogs may separate themselves from the family, choosing to spend more time alone.    
     There are many possible sources of pain or discomfort. Sources of pain include some muscle conditions, osteoarthritis and other joint issues, spine alignment challenges, spinal disc disease, ligament and tendon injuries, autoimmune disorders, or even infections like tick borne diseases. Severity of pain and individual sensitivity to that pain can vary.
     Myofascial pain syndrome involves muscle pain. The word myofascial indicates muscle (myo-) and the tissue that connects the muscle fibers (-fascial). It is an often overlooked source of pain and dysfunction in dogs. While it has been recognized as a significant health problem for over 150 years in humans, it is not commonly discussed in dogs.
     Myofascial pain is thought to result from chronic contraction of small muscle groups that evolve into permanent contractions in the affected muscle. This occurs when these small muscle groups are continually asked to contract as a way of responding to lighter loads. These are not the loads that require the entire muscle to contract. Instead these are the small contractions that are involved in adjusting joint and body position as well as some repetitive movements. With these continual contractions, muscle cell energy (ATP) becomes depleted resulting in a permanently contracted muscle fiber. There are also indications that these contractions can alter the way that joint movement occurs and contribute to increased joint degeneration. In addition, discomfort in the affected muscle groups can result in changes in body posture leading to compensatory responses in other muscle groups. Issues affecting nerves can also lead to these muscle contractions.
     Dogs with myofascial pain syndrome can have generalized signs of discomfort but signs can also be more localized. Some dogs show discomfort when they are walking. This may be lameness in the affected leg or reduced flexibility of the back when moving. Other signs can be more subtle like not bearing full weight on one foot or avoiding being touched. Evaluation involves observation of body movements, careful palpation of muscle groups and joints, and radiographs when indicated. Affected muscles have tight bands that are sensitive to touch. Sensitivity can be mild to severe. Radiographs allow evaluation of the joints for presence of osteoarthritis and other bone related issues.
     Treatment involves identifying points of sensitivity in the tight muscle bands and using a variety of modalities including acupuncture, dry needling, manual therapies, homeopathic medicines, and laser. Response to these modalities is generally rapid. However, duration of response is variable because the changes in the muscle fibers that cause pain are considered to be permanent. Initial therapy may require weekly treatments for 3-6 weeks and then periodic re-treatment.
     These modalities are important because muscle response to medications like non-steroidal anti-inflammatory drugs (NSAID) is not completely satisfactory. Since reactivation of the problem is common, identification of and management of contributing factors is important. Contributing factors include joint and spine alignment issues and osteoarthritis.
     Some dogs also benefit from the ongoing use of nutritional supplements. Vitamin D and magnesium may be helpful. Both vitamin D and magnesium have been beneficial for myofascial pain syndrome in humans. Vitamin D is commonly low in dogs. See Understanding the importance of vitamin D for pets, Glenwood Post Independent 3-25-17. Vitamin B complex can be supportive of muscle tissue. Adrenal support and herbal therapies may also be helpful.
     If you have questions or concerns about chronic pain and the myofascial pain syndrome, contact your veterinarian or a canine rehabilitation therapist.

Fatty liver syndrome in cats
(Dr. Ron Carsten – Glenwood Post 10-25-19)
      Cats can be affected by a variety of liver and gall bladder problems including inflammation, infections, cancer and metabolic and degenerative disorders. Fatty degeneration of the liver (hepatic lipidosis) is one of the most common liver disorders in cats. The cause of fatty liver syndrome is not completely understood, but it is more common in obese cats that stop eating. Rapid identification and aggressive therapy are critical.
     The liver is an incredible organ that is essential for life. It is located in the abdomen and processes blood from the intestine including nutrients, potentially toxic compounds and immune reactive substances before they are carried to other parts of the body. In addition, the liver is responsible for a wide range of other activities such as assisting digestion, synthesis of protein, regulating energy, storing certain vitamins, processing and eliminating toxins and waste products, and it has a role in immunity.
     Cats are unique in many ways. The liver has some unusual aspects such as a low ability, compared to other species like dogs or humans, to perform certain metabolic processes. This results in a reduced metabolism and elimination of drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, certain antibiotics, and opiates like morphine. In addition, cats have less ability to metabolize some phenolic compounds like those found in certain plants and essential oils. Any compounds that are slowly metabolized have higher risk for overexposure and potential toxicity. Interestingly, cats also have faster ability to metabolize other compounds using a different enzyme process in the liver.
     One aspect of the cat liver that can result in problems is the tendency of the liver to undergo fatty infiltration. While the cause for fatty infiltration is not clearly understood, it is thought to occur when the cat is rapidly breaking down body fat to supply energy
while not eating (anorexia). This rapid fat breakdown overwhelms the liver resulting in fat being excessively stored in the liver cells, reducing liver cell function and ultimately overall liver function. Over 90% of affected cats experience fatty liver syndrome secondary to another condition like obesity, diabetes, pancreatitis, hyperthyroidism, kidney disease, cancer and other liver disorders. Regardless of the primary problem, fatty infiltration is always preceded by three to four consecutive days of not eating or two weeks of a 50-75% reduction in eating. Obese cats are at higher risk, but any body composition can be affected.
     Cats that are affected with fatty liver syndrome can have vague signs like lethargy, drooling, constipation, weight loss and weakness. As the problem progresses they can become jaundiced with the white part of the eyes, skin and membranes in the mouth becoming yellow. Once this happens, it is vital to make a clear diagnosis and begin support care without delay. Left untreated, fatty liver syndrome can be fatal. Unfortunately, even with supportive care, some cats are unable to recover. Diagnosis involves a review of the history, a physical examination, blood tests for the liver, and sometimes ultrasound and a needle biopsy. It is also important to determine why the cat stopped eating so that problem can be effectively addressed while working to resolve the fatty liver.
     Treatment for fatty liver syndrome should be started early and involves aggressive feeding with high protein, high energy food. Sometimes this requires surgical placement of a feeding tube so that adequate food volumes can be provided. Intravenous fluids can also be valuable early. Supportive care with herbs like milk thistle and vitamins like the B complex vitamins can be helpful. Therapy can take six weeks or longer.    
     If you have questions about your cat’s liver, contact your veterinarian.
 Aging in cats is similar to aging in humans
(Dr. Ron Carsten  – Glenwood Post 9-27-19)
     Aging is an inevitable part of life. It affects all species of animals. The rate of aging and overall health impact quality of life as cats move into their senior years. Some individuals appear to age at a faster (or slower) pace than the average. Factors like diet and genetics can affect aging. Preventive health care and diet can be controlled while other factors, like genetics cannot be as easily addressed.
     Cats age similarly to humans with changes in kidney and liver function, brain activity, sight and hearing, and muscle strength. There is also an increased occurrence of cancer, dental disease and degenerative diseases like osteoarthritis. Early detection and supportive care is important just as it is for humans.
     The average lifespan for a cat is 12-15 years. Definitions vary, but cats are generally considered as senior at 11-14 years of age and geriatric at 15 years. Comparing cat ages to human ages provides perspective. Aging in the first two years of life for a cat is thought to be comparable to the first 24 years of life for a human. After two years of age, add four years for each cat year to estimate the human comparison. For example, a 15 year-old cat would be equivalent to a 76-year-old human.
     As cats age, their behavior begins to change. The most obvious changes include sleeping more, being less active, grooming less and having a reduced appetite or becoming picky eaters. Hearing loss and declines in vision are frequent.
     Older cats generally want more attention and prefer more holding and petting. However, they do not always like being brushed even though they tend to become matted more often. Dislike of brushing can be the result of the skin becoming thinner, less elastic and having reduced blood circulation. Joint and back discomfort may contribute to resistance to brushing.
     Cats are generally very good at hiding discomfort and may only demonstrate it by protesting against being brushed or having their nails trimmed.
     Other signs of degenerative joint disease and back discomfort include reduced or no jumping up onto the bed or having difficulty getting into the litter box. Some cats with back discomfort become constipated and need emergency care because they have pain
associated with defecation. Problems with constipation can be more challenging because older cats also tend to be chronically dehydrated.
     While constipation can lead to reduced appetite and even episodes of vomiting, other age associated disease problems can affect eating patterns. Dental disease is common in older cats. This can cause discomfort in the mouth and lowered eating. Kidney disease is also common in cats and can lead to poor appetite, excess drinking and, when severe, can result in vomiting and significant decline. Diabetes, on the other hand, causes an increased appetite and increased drinking and urination. Over production of thyroid hormones (hyperthyroidism) also contributes to increased appetite.
     Aging results in changes in the brain that can lead to disorientation, alterations in personality, wandering and excessive meowing. It is important to note that not all behavior changes are the result of the aging brain. Some of the disease problems already mentioned can change behavior.
     Providing good quality food and fresh water are important aspects of maintaining health in cats throughout life. Cats are very good at hiding illness, so it is valuable to monitor your cat closely for any changes that might be related to an illness. Addressing problems early is an important part of preventive health care and managing quality of life later in the aging cat. Common measures of quality of life include assessment of mobility, presence of discomfort or pain, elimination and grooming patterns, appetite and water consumption and sociability.
     Even though certain problems are common and predictable in the aging cat, it is important to have a complete evaluation including blood and urine testing. In some situations X-rays and ultrasound are valuable parts of the assessment. These tests provide the basis for outlining a support plan for the aging cat. This support or therapy plan may include diet changes and alterations in feeding strategies, nutritional supplements, herbs, acupuncture, osteopathic and other manual therapies, and drugs for high blood pressure, thyroid problems and diabetes.
     If you have questions about your aging cat, contact your veterinarian.
Aggressive wasps and wasp stings, a time to be wary (Dr. Ron Carsten – Glenwood Post 8-24-19)    
     As fall and winter approach, the wasps become more aggressive and protective of their nests. They react to any activity near their nests by stinging any individual they encounter. This could be a person or a pet companion unintentionally near the nest. The stings can be painful and evoke severe reactions.
     There are numerous species of wasps in Colorado with different nest types and feeding patterns. The social wasps (yellowjackets, paper wasps, and hornets) all feed on soft-bodied insects. Some like yellowjackets also feed on garbage and carrion. These are the ones that annoy us at picnics. Wasp nests are formed and tended throughout the summer producing more and more young wasps so that there can be a dramatic increase in numbers by fall. Depending on the type of wasp, the nest may be found in rotten wood, underground, under house eaves, or in trees.
     Wasps benefit us by feeding on other insects, but it is the aggressive fall behavior that can be a challenge for our pet companions and us. People and pets are often outdoors in the late summer and early fall.
     Populations of wasps are increased and they are busy searching for food making interactions between pets and wasps likely.
     Wasps sting their insect prey to paralyze them so they can be carried back to the nest.
     Unfortunately, wasps also sting when they feel agitated or threatened. Venom is injected when the sting occurs. Unlike bees that only sting once, wasps can sting multiple times. Inaddition to being designed to paralyze their prey, the venom can induce significant pain in animals and humans. This pain generally causes the individual to leave the area quickly. Pain occurs because components of the venom damage cell membranes and trigger a nerve signal for pain. The pain can be intense and out of proportion to the amount of tissue damage. Other substances in the venom initially reduce blood
flow in the area. This prolongs the time the venom can work at the site of the sting. Still other substances can trigger an inflammatory reaction that results in swelling and redness. These reactions can stay localized, be mild, and resolve in a relatively short time. In sensitive individuals, the reaction can result in severe swelling, prolonged discomfort and take many days to resolve. Severity can be increased when allergic reactions occur.
     If you suspect your pet companion has been stung or bitten by an insect or spider, safely move to another area while quickly scanning for the insect or spider. If it is a spider, safely capture it. If it is a wasp or bee make note. Remove the stinger if it was a bee. The bee stinger has venom glands attached so it is best to scrape the stinger off with something like a credit card or flick it off. This avoids applying pressure to venom glands and injecting more venom. A thick baking soda paste can be applied to the site of the sting and an ice pack can be applied for about 10 minutes. An antihistamine can be given to reduce the reaction. Consult your veterinarian for recommendations and dosage. Homeopathic medicines like Apis mellifica, Ledum, and Hypericum may be useful for reducing the severity of the reaction and shortening the recovery time. Consult a veterinarian familiar with homeopathic medicine for homeopathic selection, proper potency and administration frequency. For mild reactions or a single sting, home care can be sufficient.
     Depending on the site of the sting and the severity of the reaction, urgent medical care may be needed. Signs that urgent medical care is needed include difficulty breathing with or without severe swelling around the head and neck, agitation, excessive drooling, vomiting or diarrhea, disorientation, or seizures. Therapy may involve aggressive shock treatment and supportive care.
     Avoid the wasps as much as possible in the fall. Provide basic home care as needed following a sting. Seek emergency care if there are multiple stings or the reaction becomes severe.
Stress response in dogs can influence behavior and health  (Dr. Ron Carsten – Glenwood Post 7-26-19)     Encountering stressful situations is a normal part of life. Response to stress is key to addressing and managing day-to-day activities.
     Small amounts of short-term stress can be a valuable and inevitable part of life. At the same time it is clear that intense, prolonged and recurring stress is detrimental to health.
     Health issues that can be affected by stress range from digestive disorders, urinary bladder issues, skin problems, mental health, to reduced immune function.
     Defining stress is challenging, because what constitutes a stressful situation or event is based on the perception of the individual that is being affected. In other words an event or stimulus may be interpreted by one dog as not stressful while another dog may react in mild or excessive ways.
     The response is based on prior experiences including events that happen during puppy development (see previous article, Puppies undergo rapid physical and mental development) and conditioning or exposure to the stressful situation. Another important component of how a dog responds to potentially stressful stimuli depends on the presence of certain health challenges.
     Classically, the response to stressful stimuli has been described as a fight-or-flight reaction. This means that the dog either becomes aggressive and fights or the dog flees the situation. However, it is clear that there are other reactions that dogs have to stressful situations.
     These have been termed fidget and freeze reactions. During a fidget response, the dog seems unsure how to react and may have lip licking, lifting a paw, pacing, trembling, and other signs of fear. During the freeze reaction, the dog remains motionless during the stressful situation.
     Obvious health problems that contribute to an individual dog’s stress include reduced mobility and pain from osteoarthritis. Older dogs can become aggressive when handled or approached by other dogs because of their pain. Other sources of pain include problems like the alignment of the spine that can impact nerve roots and contribute to muscle spasms.
     Emerging information also indicates that alignment and positioning issues associated with the first vertebra in the neck can contribute to changes in behavior patterns and ability to successfully respond to and resolve stressful situations.
     During the classic fight-or-flight reactions, the sympathetic nervous system (SNS) is activated. The SNS is part of the unconscious control process managed by the autonomic nervous system. Stress activates nerve and hormone responses including the release of adrenaline, noradrenaline and cortisol.
     When a stress is encountered, nerve signals are sent to a specific part of the brain (hypothalamus). From there, nerves connected to the adrenal glands stimulate the release of adrenaline and noradrenaline, and another brain structure (pituitary) is stimulated to release a chemical messenger that signals the adrenal to release cortisol. Heart rate increases, blood flow to the brain and muscles increase, blood pressure goes up, and the digestive process slows.
     For dogs that have an ongoing stress response, it is important to address the problem by identifying each contributing factor. Issues related to pain are not always easy to identify because many dogs are stoic.
     Other issues related to behavior or anxiety challenges rooted in experiences during puppy development can be difficult to recognize. Regardless of the cause of the stress response, adrenal fatigue and mental reactivity can play a significant role. This means that adrenal support using nutritional supplements, glandular supplements and herbs should be considered.
     Use of nutriceutical products for anxiety, Bach flower remedies, herbs and calming minerals may be helpful for calming the nervous system. In some situations, short courses of antianxiety medications may be needed along with behavior counseling and training.
     Exercise can be beneficial for releasing stress and anxiety. When present, pain should be managed using approaches such as acupuncture, manual therapies, herbs, homeopathic medicines and medications for pain.
     If you have questions about stress management in your dog, contact your veterinarian.
Upset tummies and inflammatory bowel disease in cats    (Dr. Ron Carsten – Glenwood Post 6-28-19)
     Vomiting is a common occurrence in cats. Even healthy cats vomit occasionally. The challenge is deciding when the vomiting is just the periodic hairball or an indication of a more serious problem. There are numerous causes of vomiting in cats including hairballs, intestinal parasites, food allergies, ingesting inappropriate items like string or rubber bands, diabetes, kidney disease, cancer and thyroid disease.
     Vomiting and diarrhea are the most common signs in cats with inflammatory bowel disease (IBD). Loss of appetite and weight loss may occur, but some cats develop a ravenous appetite. IBD is the result of long-term (chronic) inflammation or irritation of the gastrointestinal tract (stomach and intestines). Cats of any age can be affected, but middle age and older cats are more often have IBD. With IBD, inflammatory cells move into the wall of the stomach and/or intestine. Over time this can result in thickening of the wall and reduced ability to properly digest and absorb food.
     The signs of IBD are related to the portion of the digestive tract involved and the severity of the inflammation. If the inflammation is in the stomach or first part of the small intestine, chronic vomiting is the likely sign. Lower small intestine involvement could lead to weight loss, and if the large intestine is affected, diarrhea can occur. Complicating the presentation is the possibility of multiple areas of the digestive tract being affected.
     Currently, IBD is thought to be the result of complex interactions between diet, intestinal bacteria populations (intestinal flora), the immune system, and other environmental factors like stress and anxiety. Some authorities speculate that there may also be genetic abnormalities of the immune system that contribute to IBD in cats.
     Diagnosis generally involves an extensive workup with blood tests, stool examination for parasites and other abnormalities, feline leukemia test, thyroid tests, measurement of blood folate and B12 levels, X-rays and maybe an ultrasound. Trial feeding of a
hypoallergenic diet may be used to rule out food allergies. The extensive workup will either give a clear diagnosis or rule out many of the potential causes of the signs of illness.
     While this workup excludes the other causes of vomiting and diarrhea, conclusive diagnosis of IBD requires obtaining a biopsy of the affected portion of the digestive tract. Obtaining biopsies of the digestive tract is not appealing to everyone because it involves anesthesia and an endoscopic procedure or abdominal surgery. However, many feel that abdominal ultrasound can provide enough supportive evidence to conclude that the problem is IBD.
     Once the conclusion is reached that IBD is present, therapy can be initiated. At this time, there is not a single best treatment, so it is likely that several different therapies or combinations of therapies will be tried before the best treatment for that individual cat is determined.
     Therapies include use of hypoallergenic or novel protein diets, probiotics, and increased soluble fiber. Herbs like slippery elm (see previous article: Slippery elm often used for digestive problems, Sept. 22, 2017) and marshmallow have been used for IBD problems. Amino acids like L-glutamine can be helpful to support the cells lining the small intestine. Vitamin B12 supplementation may be necessary.
     The liver is often overworked in situations where there is inflammation in the intestines making liver support valuable. The herb milk thistle may be of benefit. Use of drugs like the antibiotic metronidazole and prednisolone can be important if there is a poor response to other approaches.
     Management of stress and anxiety can involve changes in the environment such as increased enrichment and activity. Products like Rescue Remedy, the calming pheromone Feliway, or nutriceutical products designed to promote calming can be valuable. Nutritional and glandular support of the adrenal glands aid the cat’s ability to manage stress.
     If you have questions or concerns about your cat and IBD, contact your veterinarian.
The indispensable adrenal glands                                            (Dr. Ron Carsten – Glenwood Post 5-24-19)
     The adrenal glands are vital for survival. An individual cannot live without a properly functioning adrenal. Improperly functioning adrenals can cause severe illness.
     Adrenal secretions help the body respond to and cope with stress. They affect immune responses and inflammation. Body sodium and potassium levels are regulated. Water balance is managed, and metabolism is affected.
     The adrenals in the dog are small and shaped like an unshelled peanut. One adrenal is located near each kidney. Each adrenal has two parts with distinct functions.
     The inner medulla produces substances like adrenaline, which is an important part of the response to stress. These substances cause an increase in heart rate and blood flow to muscles and brain, and help promote glucose production in the liver.
     The outer cortex secretions include steroids like cortisol, regulators of electrolytes and water balance like aldosterone, and low levels of sex hormones.
     Adrenal steroids like cortisol affect the metabolism of proteins, carbohydrates and fats, promotes liver glucose production, and suppresses inflammation and the immune response. They can also be an important part of the reaction to stress. Drugs like prednisone have similar effects.
     Secretions like aldosterone are involved with regulation of electrolytes like sodium and potassium. They also help with body water balance through their effect on the kidney. Sodium and potassium are essential for proper function of cells including the heart.
     With the critical role of adrenal secretions, it is no surprise that there is an intricate regulation process. There are signals from brain areas including the pituitary that trigger secretions from the adrenals. This is based on physiological need and the level of these secretions in the blood allowing for tight control.
     Health problems occur when cortisol levels become too high as with Cushing’s disease or when aldosterone and/or cortisol are too low as with Addison’s disease. Excess cortisol is more common and can be caused by a tumor in the pituitary or in the adrenal. The pituitary tumor signals for too much
cortisol while the adrenal tumor independently produces cortisol in an uncontrolled way.
     Signs of Cushing’s include increased appetite and thirst, increased urination, muscle weakness and wasting, liver problems, pot-bellied appearance and hair loss depending on how high the cortisol becomes and the length of time the problem is present. 
     Diagnosis is based on a combination of the history, clinical signs, routine blood and urine testing, and specialized adrenal testing. Abdominal ultrasound may be of benefit in diagnosis.
     Treatment depends on if the problem is in the adrenal or the pituitary. Side effects of drugs like prednisone and dexamethasone when used in excess can cause the same signs as excess cortisol from the adrenals.
     When adrenal cells die spontaneously or are destroyed by an autoimmune reaction, adrenal function can become dangerously low. This is known as Addison’s disease. Aldosterone levels may drop too low to adequately regulate electrolytes and water balance. Cortisol levels may also be affected.
     Clinical signs are vague and could be attributed to many different diseases making diagnosis challenging. The signs include a waxing and waning weakness, lethargy, vomiting and poor appetite.
     Diagnosis involves history, clinical signs, routine blood testing and specialized adrenal testing. Diseases affecting the pituitary can result in low adrenal activity causing signs that look like Addison’s.
     Treatment depends on the cause of the low adrenal function. If the problem is adrenal in origin, drugs that have aldosterone like activity and cortisol activity (if needed) are used.
     More difficult to recognize are situations where there is adrenal fatigue caused by issues like chronic stress or inflammation. Some dogs with adrenal fatigue have tendencies to be more anxious and are prone to allergies. Adrenal fatigue can be difficult to diagnose.
     Integrative support for adrenal problems depends on the specific issue and can range from support with nutritional supplements and herbs to specific medications.
     If you have questions or concerns about your dog’s adrenals, contact your veterinarian.
The allergic cat
 (Dr. Ron Carsten – Glenwood Post 4-26-19)
     Cats with allergies can scratch and chew themselves to the point of creating open wounds in the skin. They can be miserable, along with their human companions, who are striving to alleviate the itching.
     Allergies are a trigger for itching in the cat just as they are in the dog. However, some cats with allergies have coughing and sneezing but are not itchy. Itching is not always caused by allergies. The presence of skin infections from bacteria, yeast or fungal infections like ringworm can cause itching. Some cats that are not itchy can lick and groom excessively because they have a psychogenic drive created by stress.
     Allergies in cats are not as well understood as allergies in dogs. Since the signs can mimic other diseases, it can be challenging to diagnose and to manage allergies. The most common skin disease in cats in the U.S. is a flea allergic dermatitis (skin inflammation). Cats with a flea infestation are generally scratching and chewing. While elimination of the fleas is the most effective treatment, elimination of fleas is not always easy.
     The relative difficulty depends on the part of the country you reside in and how severe the flea problem is there. Fortunately, fleas are very uncommon in our area, which reduces the likelihood that cats here are itchy because of fleas.
     The second most common allergy problem in cats is an inhalant allergy resulting in feline asthma. These cats exhibit allergic reactions to inhaled allergens. This results in coughing, wheezing, gagging and breathing difficulty that can become an emergency.
     An estimated 5 percent of cats are affected with an average age of onset of 4-5 years. When these cats inhale an allergen to which they are sensitive, the immune system reacts resulting in allergic reactions that can cause swelling of the airway. This reduces the cat’s ability to breath. Mucus accumulation can make the problem worse.
     Diagnosis is based on the health history, physical examination and chest X-rays. Blood tests, allergy testing and evaluation of the airway secretions may also be needed. It is important to rule out other causes of breathing issues such as chronic bronchitis, parasite problems and infections leading
to pneumonia because treatments for asthma may make these problems worse. Unfortunately feline asthma is a progressive problem that can have occasional flare-ups. It is not considered a curable problem, so it has to be managed with the goal of reducing the frequency and the severity of flare-ups.
     Allergy to food ingredients is the third most common allergy problem in cats. Food allergies can result in itching, chewing and scratching, but it can take other forms. Some cats have sores in the lip or along the back of the hind leg. There may be problems with gingivitis and severe oral issues. Other cats have a poor hair coat, hair loss, skin lesions, food avoidance and weight loss.
     Generally, the food allergy problem evolves over an extended time. Only 10-15 percent of cats with food allergies have signs of stomach or intestine reactions like vomiting and diarrhea. Cats of any age can be affected. Ideally, the offending food ingredient would be eliminated from the diet, and the allergy signs resolve. It can be challenging to identify the offending ingredient, and it has been reported that use of foods with limited antigens can give unclear results.
     Some advocate a home-prepared diet so that all ingredients are known. Feeding trials are done for 8–12 weeks to assess the response. The offending ingredient is reintroduced to see if the allergy signs recur. This gives proof that a food allergy is the cause of the allergy signs.
From an integrative management perspective, allergies represent a dysregulated immune reaction. Steps should be taken to avoid the allergen, such as careful food changes or eliminating offending inhaled allergens like dust from cat litter.
     The lining of the respiratory tract and intestinal tract should be supported in an effort to limit allergen entrance into the tissues and contact with the immune cells. Probiotics can be helpful for immune regulation. Addressing the allergic inflammation can also be helpful. In some situations like a severe asthmatic episode, emergency medications are necessary and can be used along with the long-term supportive approaches.
     If you have questions about allergies in cats, contact your veterinarian.
The itchy dog
 (Dr. Ron Carsten – Glenwood Post 3-22-19)
     It’s spring, and you’ve been hiking all weekend with your dog. You are both tired from all the activity, but, your dog is now constantly in motion chewing at its feet, scratching its sides, and rubbing its face on the couch. You are wondering why your dog is so itchy.
     There are many reasons for an itchy dog, making identification of the cause(s) difficult. These reasons include issues like allergies, skin parasites like fleas or lice, yeast or bacterial skin infections, metabolic issues, nutritional factors, and even some types of cancer. Fortunately, fleas are not common in our area.
     Skin problems caused by allergic reactions are one of the most common problems seen in dogs. The allergy reaction in the skin generally appears as itchy, red areas. Dogs can chew and scratch themselves to the point of causing hair loss and skin damage.
     Areas commonly affected include the abdomen, legs, the inside of the ear flap, and regions around the eyes and mouth. An important note is that ear problems are reported in half of dogs with allergies. Skin infections associated with the allergic reaction are common which can complicate the diagnosis of allergies.
      The general term for allergies affecting the skin is allergic dermatitis (AD). Approximately 10-15 percent of dogs are affected by AD from environmental allergens like pollen, mold, or dust mites. The incidence of food allergies in dogs is not clear, but it is estimated that 9-40 percent of dogs that are itchy, and 8-62 percent of dogs with AD are affected by adverse food reactions.
     Adding to the complexity, approximately 30 percent of dogs with AD are affected by reactions to both environmental allergens and food.
Generally, AD associated with environmental allergens is seasonal with peaks in the spring and fall, but it can be year round. Food allergies are year round unless the offending food is eliminated.
     AD has been viewed as a disease caused by immune over reaction to allergens and that these reactions are localized in the affected skin area. The classic description of an allergic reaction involves the allergen, IgE antibody, and mast cells.
     When an IgE binds with its specific allergen and then to the mast cell, the mast cell releases substances like histamine. Histamine triggers the affects commonly seen with allergies including heat, swelling, redness, and itchiness.
     There are other substances released or produced by the mast cell that enhance the allergic reaction. This has lead to the recognition that the allergic process extends beyond the affected skin area, involving other areas of the body and a wide range of immune cell types.
     Local immune cells involved with allergies interact with other immune cells and produce signal chemicals that move into the bloodstream and circulate to other areas of the body including the bone marrow and liver. This results in the wider recruitment of immune cells to the local area and reinforcement of the allergy process.
     Conventional approaches to allergy management generally strive for control of the allergy reaction and reduced itching. This can involve using drugs like prednisone and cyclosporine that suppress the immune system. Other drugs like oclacitinib (Apoquel) inhibit the function of signal chemicals that promote itching and inflammation.
     Additional approaches include allergen avoidance through environmental control or use of special diets, immune therapy focused on desensitization, antihistamine medications to counteract the histamine, and therapeutic shampoos. Infections are treated if present.
     From an integrative approach, management of allergy problems requires a whole body approach. This involves the use of combinations of nutritional supplements, herbs, probiotics, homeopathic remedies, and shampoos with the goal of improving the function of key body systems while avoiding or reducing medication side-effects.
     Regardless of the approach taken, not all allergy problems can be completely controlled without the use of medications and not all itching can be eliminated. The goal is quality of life for both the dog and owner.
     If you have an itchy dog, contact your veterinarian.
Medicinal mushrooms have health benefits for pets
(Dr. Ron Carsten – Glenwood Post 2-22-19)    
     Medicinal mushrooms have been used for centuries for a variety of health problems in humans. Mushrooms have frequently been an important ingredient in herbal mixtures. Interest in their use for dogs and cats has been growing as research that demonstrates their benefits becomes available. Keep in mind that the medicinal mushrooms referred to here are not the psychedelic mushrooms that contain compounds like psilocybin. Psilocybin is a naturally occurring psychedelic compound.
     Medicinal mushrooms that are receiving attention for therapy include turkey tail (Coriolus versicolor), reishi (Ganoderma lucidum), Maitake (Grifolia frondosa), Shiitake (Lentinula edodes) and lion’s mane (Hericium erinaceus). Each species of mushroom has health benefits that are similar to other mushroom species; however, there are unique effects that have been shown.
     Benefits commonly associated with these medicinal mushrooms range from immune support, anti-inflammatory properties, anti-cancer effects, anti-bacterial or viral activity, and kidney, liver and cardiovascular support. Mushrooms contain a range of important compounds. These compounds include polysaccharide-protein complexes like beta-glucans and D-fraction, proteins, vitamins and antioxidants. The presence of and amounts of these compounds depend on the species of mushroom, the growing conditions, stage of development of the mushroom at harvest, and the part of the mushroom used.
     The turkey tail mushroom has been historically used in humans for a variety of cancers, chronic hepatitis and infections in the digestive and upper respiratory systems. More recently, it is being used to stimulate immune function. For humans, turkey tail is being used along with other cancer therapies. Interestingly, cancer survival rate was statistically increased in patients receiving a polysaccharide extract from turkey tail.
     For dogs with hemangiosarcoma, a polysaccharide extract was shown to significantly prolong survival times. Hemangiosarcoma in the spleen of dogs is a difficult cancer with median survival time of 19-86 days with spleen removal only and 141-179 days with the addition of chemotherapy.
     Dogs treated with spleen removal and only the turkey tail polysaccharide had a median survival time of 199 days. This is significant because of the
increased survival time and lack of chemotherapy side effects. Turkey tail extracts have also been advocated for immune support in geriatric dogs and for dogs recovering from surgical procedures.
     The reishi mushroom appears to improve immune function, have anti-cancer effects, reduce inflammation, modulate allergy responses, reduce anxiety and help protect the kidney.
     Maitake mushrooms have been reported to have similar health effects as the other mushrooms but may be more effective. While more research is needed, the D-fraction component has excited interest because of the anti-cancer effects.
     In addition to the immune benefits, anti-cancer effects and anti-viral properties, shiitake mushrooms also appear to improve circulation.
     Lion’s mane mushrooms have beneficial effects on the brain and nervous system. Slowing of aging effects on brain function and improved recovery from nerve injury have been reported. There appears to be benefits for reducing anxiety, healing ulcers in the digestive tract, improving fat metabolism, and enhancing immune responses.
     Unfortunately, a large amount of research on the health benefits of medicinal mushrooms is not available because it appears in foreign language journals. This contributes to challenges when choosing the appropriate mushroom species and determining the optimal amount to administer. The mushrooms discussed here are generally considered safe but there have been some reports of problems. It is not clear if the problems were from the mushroom itself or from the processing required to produce the product.
     While the mushrooms discussed here have many similar health benefits, they also have some distinct properties. This is one of the reasons that multiple mushroom species are often used in combination. When choosing mushroom products, it is also important to consider if the product is an extract, the whole mushroom or a part of the mushroom (i.e., the cap). Since there are advantages for using extracts and advantages for using the whole mushroom, some practitioners use combinations.
     If you have questions about mushroom use for your pet, seek the advice of a veterinary herbalist knowledgeable about mushrooms. For general questions about your pet’s health, contact your veterinarian.
Circadian rhythm and winter activity for dogs
(Dr. Ron Carsten – Glenwood Post 1-25-19)
     Deep winter in our area is marked by long periods of darkness and cold. There is often snow and ice to contend with. These conditions combined with typical work schedules make it difficult to regularly spend time outdoors and exercise our dog companions. It is clear that exercise is valuable for pets just as it is for their human companions.
     Whether you consider the high rate of obesity that contributes to metabolic diseases like diabetes, joint diseases like osteoarthritis, and cancer or the increased rates of behavioral problems associated with inactivity, appropriate exercise is critical for maintaining optimal physical and mental well-being.
     Exercise helps to burn calories and maintain muscle mass. Muscle mass is important for metabolism, mobility and joint health. Exercise is also critical for the health of the heart and circulation of the blood and lymphatic fluid. The mental stimulation gained from being active, even if inside the house, is valuable for reducing boredom and other issues that contribute to behavior problems like excess or inappropriate barking, destructive activities and hyperactivity.
     In addition to the effects of physical activity, health is affected by circadian rhythms. The term circadian rhythm refers to the pattern of physical, mental and behavioral changes that occur over a 24-hour period. Exposure to sunlight and periods of darkness are important for regulating the circadian rhythm of the body. Light wavelengths like those found in daylight result in signals from the eyes that trigger suppression of melatonin production.
     During darkness, melatonin production increases and signals that it is time for sleep. Certain light wavelengths from artificial light can have the same effect on suppressing melatonin production and can disrupt or alter the circadian rhythm and sleep patterns. Sufficient daylight is also thought to be important for maintaining serotonin levels (see “Helping your pet manage winter blues” Nov. 24, 2017).
     Circadian rhythms affect more than just the sleep cycle; they also help regulate activity levels
through influence on brain activity and hormone patterns. This is thought to contribute to why dogs want to be active in the daytime and less active in the nighttime. Aging has an effect on the drive for activity because of changes in the brain. Older dogs have less drive for activity compared to younger dogs. The aging brain is also less sensitive to signals like those from melatonin.
     Physical activity benefits health, is mentally stimulating and offers opportunities to be exposed to daylight. Make sure to get your dog out for a walk and play daily or even multiple times each day. Walks are better for physical activity than just being out in the yard since most dogs will just sit. Avoid the late nights with exposure to artificial light.
     When on walks or playing be cautious with the cold temperatures, especially with dogs that are not adapted to the cold. Footing can be a challenge when ice is present. Slips and falls can result in injury and discomfort. Avoid areas where ice melt has been applied. These compounds can be irritating to dog’s feet. Evening or late day walks can be helpful for burning up accumulated energy from the day and help promote improved sleep patterns.
     If it is too cold outside or it is unsafe due to ice conditions, play indoors. Create games that challenge your dog mentally and physically. These activities can include hiding a favorite toy or food and having your dog find it. Having your dog solve a puzzle to get access to their food can also be fun and stimulating.
     Seek veterinary care if your dog has a physical problem like osteoarthritis or joint injury that makes walking or playing difficult (see “Osteoarthritis” Oct. 10, 2014). Management of pain can significantly improve quality of life and lead to other beneficial changes in activity levels. Pain can be addressed through a variety of methods including supplements, acupuncture, herbs, homeopathy and medications. Melatonin supplementation may have some benefits for night restlessness or anxiety especially in older dogs.
     Enjoy the winter season. Appreciate the health benefits you gain from daily walks with your dog.
Holidays can be stressful for pets
(Dr. Ron Carsten – Glenwood Post 12-21-18)
     Pets are an invaluable part of our families. The benefits of pet companionship are well recognized and include reduced anxiety, depression, and loneliness in humans (see “Owning a pet can improve your health” 12-26-15).
     Pets provide a framework for increased social interactions. Approximately 40 percent of pet owners gain social support from people they met through their pet. Pets help to reduce stress in pet owners and they increase our quality of life and well-being.
     The positive contribution that pets make in our lives has lead to widespread pet companionship. According to the American Pet Products Association 2017-2018 National Pet Owners Survey, 68 percent of U.S. household representing 85 million families, have a pet. Dogs and cats are the most popular. As a reflection of our bond, approximately 48 percent of dogs and 38 percent of cats received gifts for Christmas in 2016. In addition, the number of households having birthday parties for pets continues to increase.
     While it is easy to focus on the benefits of pet companionship, it is important to recognize that our pets depend on humans for their daily physical and emotional health (see Helping your pet manage winter blues 11-24-17). Pets need physical activity and mental stimulation beyond their basic needs for food and water.
     Dogs need daily exercise and time outdoors to walk and play. This can also give them mental stimulation as they explore their surroundings while outdoors. Many dogs benefit from social interactions through dog day care opportunities and dog parks.
     Cats also need exercise and mental stimulation. This can be accomplished through play with the owner and other companion pets, use of safe toys for play, and creative activities such as food “hunting.”
While we recognize the dependency that pets have on humans for their physical needs, it is easy to forget the impact we have on our pet’s emotions. Pets respond to a wide range of cues beyond verbal communication. They are very good at reading emotional messages conveyed in our posture, facial expressions, tone of voice, and even changes in smells related to stress responses.
     Unfortunately, while pets can perceive that we are stressed, they can’t always understand the cause of stress. They just recognize that their human companion has worries. This can create a stress response in pets that can manifest in a variety of ways including destructive behaviors, reduced appetite, restlessness, aggression, and even illness (see “Your dog can experience anxiety, too” 5-26-18).
     During the holiday season there is a great deal of joy as we spend time with friends and family. We enjoy a change of routine, and we experience the fun of giving and receiving gifts. However, the holiday season also brings stress as we prepare for and participate in holiday activities. It also means we generally have less time to care for our pets and ourselves. Pets can become stressed from changes in their routine and when they recognize that their human companions are stressed.
     Make sure to take time for your pets. Try to keep routines as regular as possible. When hosting parties, make sure that your pets have access to a quiet, comfortable place inside. This is especially important if the pet is anxious or is stressed by guests in the home.
     Be cautious with allowing guests to bring their own pets. Not all pets will be comfortable together, especially in a stressful situation. Monitor the doors when guests are arriving or leaving so that your pet does not escape from the house. Pick up all the food leftovers and store them properly. Place the trash in a location that is not accessible to pets. This will avoid temptation and potential illness problems.
     Additional steps that can help to reduce pet stress include the use of pheromones like Feliway, remedies like Rescue Remedy, products like Composure, and nutritional supplements and herbs that reduce anxiety. Essential oils like lavender can be calming but be cautious with essential oils around cats because cats are susceptible to toxicity. Contact a qualified behavior specialist or dog trainer for additional tips. In some situations, the use of anti-anxiety medications may be necessary.
     If you have questions about helping your pet cope with the stress of the holidays, contact your veterinarian.
Holiday spices offer medicinal benefits
(Dr. Ron Carsten – Glenwood Post 11-24-18)
     Many plants have a long and fascinating history of medicinal use. This includes the holiday spices. Cinnamon, ginger, cardamom, nutmeg and cloves are spices commonly used in holiday foods.
     In the past, these spices were highly prized and costly to obtain. For example, cinnamon was more valuable than gold, and one pound of ginger was worth as much as a sheep. Some speculate that this high value may account for why spices became increasingly important during the holiday season, because it was common to include them in lavish parties.
In addition, certain European religious orders also had an interest in the spices that fostered use during special seasons. The inherent appeal of the spices themselves undoubtedly contributed to propagation of their use in holiday baking — especially as they became less costly. Interestingly, in addition to their use in holiday baking, these spices also have medicinal properties that have been recognized and used for centuries. Cinnamon and ginger are the most prominent spices in this holiday group.
Cinnamon is considered to be one of the oldest spices known to man. In ancient Egypt it was highly valued, and in medieval Europe it was the focus of the spice trade. Further, cinnamon is mentioned centuries ago in one of the earliest Chinese botanical medicine texts.
     There are many varieties of cinnamon grown worldwide. The Cinnamomum verum variety is considered the true cinnamon because of its more refined and subtle taste. This is largely due to having less cinnamaldehyde in its essential oil. Cinnamomum cassia is considered the Chinese cinnamon because it is the variety described in the early Chinese herbal texts and is a component of numerous Chinese herbal formulas.
     The cassia variety has more cinnamaldehyde and has a stronger taste. It is cheaper to obtain and widely available making it the variety that is most commonly consumed. In traditional Chinese medicine cinnamon is considered to be a warming herb that counteracts the effects of wind-cold. Both the inner bark and twigs are used. In simple terms, the effects of cinnamon twig include influencing the heart, lung, and bladder acupuncture meridians by warming, acupuncture
meridians by warming, dispersing cold and promoting blood circulation.
     Research has focused on the cinnamaldehyde as the component in cinnamon that provides health benefits. Cinnamon has demonstrated anti-inflammatory effects. See how inflammation affects health in the previous article “Chronic inflammation can harm pets’ health” and see why this anti-inflammatory effect can be valuable. Cinnamon has also been shown to reduce blood pressure, reduce LDL cholesterol, reduce blood glucose, and increase sensitivity to insulin. These benefits can help to lower risk of heart disease and assist management of diabetes.
     Some recommend cinnamon for older dogs to help with joint discomfort associated with inflammation, muscle cramps, for its appetite stimulating property, and its ability to act as an antibiotic. Cinnamon powder is considered safe for cats, but caution should be exercised because toxicity is a concern with the cinnamon essential oil.
     Ginger (Zingiber officinale) root is also used as an enjoyable holiday spice. It is thought to be the most commonly consumed dietary condiment in the world. The Chinese have used ginger for its medicinal benefits for over 5,000 years. Ginger was valued for its medicinal properties during the Roman Empire, and in Europe during the 13th and 14th centuries it was a highly prized part of the spice trade.
     Ginger is considered to be warming, and in traditional Chinese medicine it acts on the lung, spleen and stomach acupuncture meridians. Research has shown a wide range of benefits similar to cinnamon, and ginger has notable anti-nausea and anti-vomiting effects.
     Ginger has also been recommended for older dogs that have digestive problems. It also has benefits for reducing pain and inflammation associated with osteoarthritis. Ginger is felt to be safe for cats.
     As with all herbs, the effects are dependent on the amount of the active component that is ingested, how well it is absorbed and distributed in the body, and how fast it is eliminated. Optimal oral doses have not been established for all of the effects.
     If you have questions about the use of these spices in your pet, contact a veterinary herbalist.
The dog with the crooked head
 (Dr. Ron Carsten – Glenwood Post 10-26-18) 
     When you get home from work you notice that your elderly dog is not at the door to greet you. She is lying half in her dog bed and half out. There is vomit on the floor. Her head is tilted to the right and she seems disoriented. She is unable to stand or walk on her own and her eyes are darting side to side. When you offer her food and water she refuses.
This is an alarming change from her normal playful greeting and how she was in the morning when you last saw her.
     The likely explanation is that your dog is experiencing an episode of old dog vestibular disease (ODV). This has also been referred to as idiopathic vestibular disease because the cause is unknown. It represents about 39 percent of peripheral vestibular disease dog patients. It has a very rapid and often dramatic onset. ODV is generally seen in middle age or older dogs.
     Signs that a dog is experiencing ODV include loss of balance, severe disorientation, staggering walk, head tilt and rapid eye movements. They are often nauseous and experience vomiting in the first 24 hours. Nausea and loss of appetite may continue for several days. Generally, the signs of illness stabilize quickly. The rapid eye movements return to normal after a few days and the staggering gait resolves over three to six weeks; although these times can vary along with the severity. Nursing care is essential, especially early while the dog is adjusting to the changes in signals from the vestibular system. Some dogs may benefit from anti-nausea medications.
     This group of signs makes sense when the function of the vestibular system is considered. The vestibular system provides important information from the inner ear about body position that is used to coordinate position of the head and body relative to gravity so that balance can be maintained.
     Imagine how you feel when you have been on an amusement ride or spun in a circle and you are dizzy, disoriented, having trouble standing, and may even be vomiting. Dogs with ODV look like they are having the same experience because of the vestibular signaling that is similar to what we experience on these amusement rides. This vestibular signaling creates a sensation of disorientation, inability to stand steady, nausea and even vomiting.
     Not all old dogs with a head tilt and unsteady gait have ODV. There are other causes for the signs associated with vestibular disease including middle or inner ear infection, brain tumor, stroke and medication side effects. Diagnosis of ODV will involve a complete history and examination including evaluation of the ear canal.
     Depending on the examination findings and on how the problem resolves over the first few days, additional testing may be needed. Additional evaluation may include blood testing, X-rays of the head and full neurological evaluation. Each of the potential causes for signs associated with the vestibular system has a different treatment and prognosis, which can make this further testing essential in some situations.
     For dogs with ODV, treatment is supportive while the dog adjusts to the initial disorientation. This includes controlling the nausea, assisting with going outside to eliminate, encouraging feeding, and providing a well padded area to lie on until the disorientation begins to resolve and mobility returns. Hospitalization with intravenous fluids may be needed for those that are severely affected and when vomiting continues to occur. The use of anti-inflammatory drugs does not seem to improve the problem. The herb ginger has potential benefits for these dogs because of its ability to reduce nausea and dizziness.
     If you have questions about ODV, please contact your veterinarian.
Grain-free foods, taurine deficiencies and heart disease in dogs
(Dr. Ron Carsten – Glenwood Post 9-29-18)
     Taurine deficiency in dogs eating grain-free foods has received growing attention. This was triggered by an observed correlation between dilated cardiomyopathy (DCM), response to taurine, and feeding grain-free foods. Obviously this raised concerns that these foods were insufficient in taurine to prevent DCM. Keep in mind that this association was noted in a small number of dogs, and the full magnitude of the problem is not yet clear. It has also spurred increased awareness and renewed research to better understand the correlation in affected dogs.
     Cardiomyopathy is a term used to indicate a problem with the heart muscle. Taurine deficiency and cardiomyopathy were clearly demonstrated in cats in the late 1980s but the connection in dogs with cardiomyopathy could not be fully determined. In the 1990s an association between DCM and low taurine levels was found in the American cocker spaniel breed. Since then, other breeds have been identified with low taurine DCM. However, there have been studies showing low taurine levels and no DCM as well as DCM in some breeds even when the taurine level is adequate. These patterns of conflicting results made the role of taurine deficiency and DCM in dogs unclear.
     Taurine is an amino acid. Amino acids are assembled to make proteins. Proteins are vital for basic life functions because they form substances like enzymes, cell membrane receptors, cell structure components, hormones like insulin, and antibodies, and they maintain fluid balances. Some amino acids are considered essential because the body cannot make them and they must be in the diet. There are 10 amino acids that are considered essential in the dog. Note that taurine is considered essential in cats but not in dogs. Other amino acids like glutamine are considered to be conditionally essential. This means that they can be produced in limited amounts in the body but not always in the amounts that are required. In some situations supplementation with the conditionally essential amino acid is beneficial for addressing a health problem. Taurine supplementation in some dogs with DCM has been beneficial.
Taurine has wide distribution in the body and is important for many body systems including the heart, skeletal muscle, central nervous system and retina. It has benefits for heart contractions, synthesis of bile salts, sight, hearing, nerve conduction, movement of calcium across cell membranes and protection of cell integrity. There may also be a role in managing anxiety and calming the sympathetic nervous system.
     Taurine is present in highest amounts in animal tissues like heart, liver, kidney, muscle, fish and poultry. The amount of taurine in these tissues can vary widely. Plants are poor sources of taurine. Methods of ingredient storage and food preparation have significant impacts on the amount of taurine available in the final food product. Since taurine is water soluble, the more water that is used in preparation, the more likely that taurine will be lost in the processing. For example, in order to provide adequate levels of taurine, wet cat food requires twice the amount of taurine added during preparation compared to dry cat food.
     In addition to the effect that ingredients and method of food preparation have on the amount of taurine available in the final food, there is also variation in the amount of taurine that an individual needs. Taurine may be deficient in an individual dog regardless of the amount in the food because there is insufficient taurine synthesis or excess taurine loss in the urine or intestine. These factors together result in variation in the optimal amount of taurine supplementation that is required. It also makes determining if a particular diet is adequate in available taurine challenging.
     While research is ongoing to determine the role of specific food formulations and DCM in dogs, there are a number of approaches that can be taken to support dogs that may be at risk. This includes changing the diet to foods that have traditionally been considered adequate; however, this approach has its own issues of concern. Another approach is to measure the blood levels of taurine and base decisions for supplementation and/or food changes on those levels. Some authorities consider supplemention without knowing the current taurine blood levels to be safe.
     If you have concerns about taurine and the current focus on grain-free diets, contact your veterinarian.
Pets and wildfire smoke exposure
(Dr. Ron Carsten - Glenwood Post 8-24-18)
     This summer of heat, drought and wildfires has created numerous challenges for our pets. One obvious concern has been exposure to wildfire smoke. Depending on how close you are to the wildfire and the prevailing air currents, the concentration of smoke and particulates varies. This means that the risk factors for injury from smoke inhalation also vary, which means that there may be periods when avoiding time outdoors is important.
     Smoke can cause irritation to the eyes, nasal tissues, throat and lungs. In addition, smoke can contain particulates that, depending on size, can compromise the lungs. The tissues around the eyes and lining the sinus, throat and lungs are known as mucous membranes. Properly functioning mucous membranes play a significant role in maintaining health. They are considered the immune system’s first line of defense by forming a barrier that micro-organisms like bacteria are normally unable to penetrate. In addition to this barrier function, some of the mucous membranes, like the lining of the trachea, have specialized microscopic anatomy. Some cells that line the trachea secrete mucus while other cells have cilia that are small projections that have a sweeping action. Mucus traps the inhaled particles and the cilia sweep the material toward the throat area.
In addition to the effects of the mucus trapping and the action of the cilia, the airway size changes from the throat to the lung air sacs significantly limits particles from reaching the air sacs. Since the trachea connects the throat to the lungs and is the way that air is inhaled and exhaled, these activities for limiting potentially damaging substances from reaching the lung is no surprise.
     The function of the lung is to allow oxygen to enter the blood and carbon dioxide to leave. Inhaled oxygen in the lung air sacs has only a thin layer of cells separating it from the red blood cells in the blood stream. Red blood cells carry the oxygen to the body tissues for use and pick the tissue carbon dioxide for removal from the body.
     Even though this is a beautifully designed system, it
is susceptible to injury from inhaled smoke and particles. Contact with smoke and particles can lead to irritation of the mucous membranes. With enough smoke exposure, which depends on the concentration of the smoke and length of exposure, the irritation can lead to swelling of the mucous membranes. This swelling can lead to breathing difficulty and coughing that can get progressively worse during the first 24 hours after exposure. Bacterial pneumonia can be a delayed consequence. Eye, throat and sinus mucous membranes can also be irritated.
Keep in mind that for the average pet in the valley that is not directly in the wildfire areas, the smoke exposure is going to be less damaging. It may only create mild irritation and annoyance. Just like in humans, the most susceptible to the injuring effects of smoke inhalation are the geriatric, puppies and kittens, and those with existing lung problems.
When the smoke builds up, avoid outdoor activities so that exposure can be limited. Be conservative with opening windows or running air conditioners, which can result in more smoke exposure in the indoor spaces. Watch for signs that your pet is experiencing problems from smoke inhalation. These signs include coughing or gagging, difficulty breathing, eye irritation, nasal discharge, weakness, disorientation and loss of appetite. The severity of the signs will determine if your pet requires immediate veterinary care that might include oxygen therapy and other emergency measures. Keep in mind that some of these signs can indicate a heart problem that is separate from a smoke related respiratory issue.
For those pets that may be experiencing low levels of ongoing stress to the respiratory system, the lungs and mucous membranes can be supported with nutrients like vitamin A and vitamin C. Herbs like mullein and licorice have traditional use for respiratory problems because they both have anti-inflammatory properties that can reduce the reaction to the irritating properties of the smoke. Mullein also has expectorant properties.
If you have concerns or questions about your pet contact your veterinarian.
Heat exhaustion in dogs
(Dr. Ron Carsten - Glenwood Post 7-27-18)
     The ongoing heat coupled with the wildfire smoke has created challenges for our pets and us. At one point on Monday, Glenwood Springs was at 95 degrees and reportedly felt like 103 degrees. Outside temperatures are hot, and unless you have air conditioning, inside temperatures are also hot. Cooling homes during the night can be difficult with high evening temperatures and the presence of smoke making it a difficult choice to leave windows open during the night. Cars can heat rapidly. Even on a mild day in the 70s, temperatures inside a car can reach dangerous temperatures of 120 degrees in 30 minutes or less.
     Over time, normal responses to heat include reduced activity, lowered appetite and increased water consumption. These can also be signs of illness, so it is important to monitor your pet and contact your veterinarian if there are other indications of illness or if the problem continues. Individual susceptibility to heat varies with factors like age, health status, acclimation to heat, environmental conditions and activity levels. Obese dogs and those with heart conditions can have increased difficulty with heat. Some breeds of dogs are more prone to heat problems. Dogs like the Alaskan malamute with heavy coats tend to be less tolerant of heat than a short-coated breed like the German shorthaired pointer. Brachycephalic dogs (think of pugs, Boston terriers, boxers and other breeds with the short faces) can be severely affected by heat because they are unable to move air well while panting. Panting is a major way of cooling for dogs. Dogs sweat only through their feet, and cooling by sweating is minimal.
     Avoiding heat exhaustion follows basic safety practices. Limit exercise or outdoor activities on excessively hot days. Especially avoid going out during the hottest part of the day. Provide plenty of drinking water. Seek areas with lots of shade. Swimming, wading or playing in a sprinkler, depending on what works best for your dog, can be helpful for cooling. A cooling pad may be beneficial. Some heavy-coated
dogs benefit from having their coat trimmed shorter during the summer. Keep in mind that sunburn is a risk if the coat is trimmed too short. Don’t walk on the hot pavement or concrete because burns to the feet can occur. When engaged in activities, monitor your dog and take frequent rest breaks.
     Indications that your dog is getting too hot include panting, drooling, reddened gums, rapid heart rate, stumbling gait and changes in mental status. As the heat increases vomiting and bloody diarrhea can occur along with collapse, seizures and breathing distress. These signs occur because too much heat damages the proteins and cells in the body potentially leading to shock and kidney, liver, stomach, intestine and heart damage.
     Rapid response to the overheating is important. Depending on the dog’s condition including core body temperature, acclimation and overall health status and the severity of the clinical signs of overheating, aggressive therapy may be necessary. Heat exhaustion can be difficult to treat. Early intervention has been shown to increase the success of treatment. Basic approaches include cooling the abdomen and feet with cool water from a hose. Don’t cover your dog with a wet towel because this can impair heat loss from the body. Avoid too rapid of cooling because this can create other problems. Medical therapy may include IV fluids to restore hydration and treat shock, water and fans to cool the core temperature, and monitoring for blood coagulation problems.
     Heat exhaustion is a serious problem that is easier to prevent than to treat. During these hot months, monitor your dog carefully during activities, time the activities for the coolest parts of the morning or evening, provide plenty of water, take frequent rests, stay in the shade as much as possible, and never leave your dog confined in a car.
     If you think your dog is showing signs of heat exhaustion, contact your veterinarian immediately and then start the initial cooling process as instructed by your veterinarian.
Astragalus has a wide range of benefits for pets
 (Dr. Ron Carsten – Glenwood Post 6-23-18)
     Astragalus (Astragalus membranaceus) root is considered by many to be one of the most significant herbs. It is an adaptogenic herb that has been used for centuries in traditional Chinese medicine for general debility and chronic illness in humans. Adpatogens are herbs that help the body cope with stress. Astragalus is often combined with other herbs, especially in Chinese herbal formulas. The antiviral and antibacterial effects can work in concert with its other beneficial, body supporting actions. Examples of specific illnesses historically treated with astragalus include diarrhea, poor appetite, nerve disorders, and lung problems. Current research has been focused on its immune stimulating effects, anti-cancer properties, tissue healing, and heart and kidney benefits.
     Astragalus used in supplements is considered to be a safe herb for dogs and cats. No obvious toxicities or side-effects have been noted in published studies investigating the Astragalus membranaceus species. However, it is important to note that some species of astragalus can have toxic effects. This makes selecting the proper species of astragalus critical. Medicinal astragalus should be used with caution in individuals with autoimmune disorders because of its immune stimulating effects.
     Uses for astragalus in dogs and cats include immune deficiency, chronic infections, kidney disease, heart disease, intestinal disorders, cancer, and general support for geriatric pets. This is a wide range of conditions, especially for an herb that, like many others, is not considered to be well absorbed after oral administration. The effect of herbs, like drugs, is dependent on the distribution in the body. In other words, what organs the active components concentrate in. Additionally, the tissue concentration, rate of elimination, and frequency of administration play an important role in the therapeutic effect.
     Interestingly, the active components of astragalus are relatively widely distributed in the body including the heart, stomach and areas of the small intestine,
kidneys, lungs, liver, spleen, skeletal muscle, and fat following injection. This provides opportunity for beneficial effects in numerous parts of the body. The mechanism of action (the way it affects the body cells) also plays a critical role in the benefits of astragalus.
     Astragalus has a number of direct effects on body cells. These include improved function of mitochondria (responsible for producing energy in cells), protect DNA from certain types of damage and slow some DNA aging processes, and anti-oxidant properties. In addition to these cell effects, astragalus has been shown to have anti-inflammatory benefits, improves coronary blood flow, helps to relax and dilate arteries, reduces excess blood pressure, lowers cholesterol, and improves glucose metabolism. Astragalus can affect certain enzyme systems in the liver resulting in changes in the rate that certain drugs are eliminated. In some types of cancer, astragalus has been shown to suppress the cell cycle (rate of cell replication) and induce cancer cell death.
     One of astragalus’ best-recognized features is its ability to stimulate immune system responses. This occurs through a variety of means including direct effects on a wide range of white blood cells that function in immune processes. Astragalus also has a beneficial effect on the thymus and spleen, both are directly involved with the immune system. Interestingly, the beneficial effects of astragalus on immune cell function have been shown to continue for a period of time even after the astragalus is no longer administered.
     The use of astragalus for dogs and cats can play an important role in supporting management of diseases of the immune system, kidneys, cardiovascular system, digestive tract, and cancer. Quality of astragalus products can vary so selection of a high quality product is critical. In addition, use of the whole root instead of an extract may be important. Combination with other herbs is common and may enhance the benefits of astragalus.
     If you have questions about the use of astragalus in your pet, consult a veterinary herbalist.
Your dog can experience anxiety, too                                 
(Dr. Ron Carsten – Glenwood Post 5-26-18)
     Anxiety is the most frequent behavior problem seen in dogs. It is estimated that some form of anxiety affects 30 percent of dogs. The common anxieties include separation anxiety, noise sensitivity and general fearfulness. Affected dogs may show their anxiety by hiding, through self-trauma, escape attempts, restlessness, destructiveness, inappropriate defecation or urination, excessive barking or even aggression.
     Dogs of all breeds and ages can experience anxiety; however, small breed dogs such as the chihuahua, dachshund, maltese and toy poodle have been shown to be more likely to have anxiety behaviors. Large breeds like the golden retriever, Labrador retriever and rottweiler and brachycephalic (shortened head) breeds like the Boston terriers, bulldogs and pugs are least likely. Interestingly, in some breeds like the Siberian husky, German shorthaired pointer, border collie and greyhound, a profound fear reaction of unknown cause has been noted that is thought to, at least in part, have a genetic influence.
     It is important to recognize that not every small breed dog will have an anxiety problem and that anxiety can occur in dogs of any breed, including the large breeds. Many fears and anxieties are thought to develop at 12-36 months of age when dogs are becoming socially mature. However, dogs with profound fear from unknown causes can develop at 8-10 months of age. While there may be a genetic component to the anxiety, there are prenatal and neonatal stresses such as maternal separation and lack of socialization that contribute to developing anxiety. In elderly dogs, development of separation anxiety may be related to cognitive dysfunction including declines in memory and thinking. Development of anxiety and fear may be the result of stressful experiences such as being exposed to loud noises at critical times during the process of maturing.
     Other triggers include a painful experience, changes in work schedules, relocating to a new residence, or being surrendered to a shelter.
     Once anxiety behaviors are recognized, a thorough evaluation should be performed to rule out medical problems that can lead to or contribute to those behaviors. For example, an elderly dog that is restless, withdrawn and exhibiting aggression may be responding to joint pain associated with osteoarthritis. After the pain is controlled the dog's behavior may become normal. When medical causes have been ruled out, working with a qualified trainer or behaviorist is important so that controlled desensitization and other behavior modification can be initiated. During this process, changes in the household routine may be needed along with supplements, herbs and/or medications. Use of products that reduce anxiety play an important role because reducing the over-response to the stimulating event aids in the process of desensitization.
     Anxious dogs often have exhausted adrenal glands because they are in a continuous state of stress. Providing nutritional supplements and herbal support for the adrenal glands can be an important component of the support plan. Supplements that contain milk casein have been shown to reduce anxiety. The amino acid L-theanine has an effect on brain serotonin and dopamine levels that contribute to increased calming. Herbs like valerian root are thought to act in a similar way as the drugs Valium and Xanax. Essential oils like lavender have been shown to reduce anxiety in dogs while riding in a vehicle. Products that diffuse pheromones may be beneficial in some situations. Pheromones are chemical signals released by the mother dog to calm the puppies.
     Anti-anxiety medications may be necessary to fully control the anxiety. The goal with the use of the medications is to use them short term while working on desensitization and retraining. When the desensitization has been completed, the medication can be withdrawn.
     Treatment should be individualized for each dog and may require multiple or combination approaches.
     If you are concerned with anxiety in your dog, contact your veterinarian.
Stress causes behavior and health problems in cats
 (Dr. Ron Carsten – Glenwood Post 4-28-18)
     Long-term stress can have detrimental effects on health and quality of life because stress affects almost every part of the body. Short periods of a stress response, on the other hand, can be beneficial for dealing with a crisis.
     Hormones released from the adrenal gland and stimulation of parts of the nervous system are responsible for responses like an increased heart rate, improved blood flow to muscles, and increased breathing. The stress response is intended to be short-term so the individual can quickly manage challenges then recover.
     Long-term or chronic stress has detrimental effects that can lead to behavioral problems and stress-related diseases. Numerous factors play a role in an individual's ability to cope with stress, including both genetic and environmental factors.
Development of the stress response starts before the kitten is born and can be affected by the mother's quality of nutrition and amount of stress that occurs during pregnancy. Kittens born to a stressed mother with poor nutrition are prone to developing stress and have poor coping abilities that lead to common behavior problems. This can be compounded if there is a lack of proper socialization to the household environment and contact with people and other animals at an early stage of life.
     Indications that a cat is stressed include hiding, elimination issues like not using the litter box, loss of appetite or overeating, vomiting hair and/or bile, low activity, aggression, or overgrooming. While there may be medical problems underlying these behavior changes, chronic stress can be the initiating cause, and addressing stress inducers can be an important part of successful management. For example, a cat that eliminates outside the litter box could have an infection in the urinary bladder or could have osteoarthritis pain that prevents appropriate use of the litter box. However, chronic stress from any source, including pain, can lead to inflammatory conditions in the urinary bladder by weakening the protective glycosaminoglycan (GAG) layer. The GAG layer protects the lining of the urinary bladder from the irritating effects of urine. A weakened GAG layer is associated with release of substance P, which is associated with pain, anxiety and depression in
     humans.
     Stress impacts the digestive system, resulting in slowing of contractions in the stomach and small intestine while stimulating contractions of the colon. Individuals that are sensitive to stress have an exaggerated response that can lead to a host of digestive problems including inflammatory bowel disease.
     Chronic stress can disrupt the normal immune response leading to inability to effectively mount an appropriate immune response, allowing latent infections to activate (see "The sneezing cat," Post Independent March 23, 2018). This disruption can also result in ongoing inflammation (see "Chronic inflammation can negatively impact health," Post Independent September 25, 2016). Adrenal gland response to inflammation is important for controlling inflammation. Interestingly, cats with chronic urinary bladder disorders have been shown to have weak adrenal responses and smaller than normal adrenal gland size.
     Management of disease problems associated with chronic stress in cats requires not only dealing directly with the disease itself, but also managing the factors that contribute to chronic stress.
     Assessment of the home environment for stressors and ways to avoid the stressors is important. Cats should be provided unrestricted access to resting areas that are free from other cats, dogs, small children or loud noises. Food should be high quality, competition between cats should be avoided, and simulation of predatory behaviors using food puzzle toys can be helpful. Litter boxes with appropriate litter should be large enough to easily accommodate the cat and should be located in a location that feels safe to the cat. Cleaning should be done daily. Opportunities to scratch and have play behaviors are important.
     Some foods and supplements containing L-tryptophan and milk casein can be beneficial. Probiotics can play a role in normalizing the stress response. Products like Rescue Remedy and Feliway may reduce the reactivity to stress. Adaptogen herbs and supplements that support improved adrenal function can assist in achieving appropriate stress responses.
     Contact your veterinarian if you have questions regarding stress in your cat.
The sneezing cat  
(Dr. Ron Carsten – Glenwood Post 3-24-18)
     Upper respiratory infections (URI) are common in cats worldwide with an average of 25-35 percent of cats being affected in some shelter studies. Owned cats have a lower incidence than shelter cats. URI in cats can be caused by a variety of viruses and bacteria. Signs of infection include eye discharge, nasal discharge, sneezing, oral ulcers and eye ulcers. Many cats can effectively clear the infection, while others become carriers or have latent infections.
Younger cats and older cats are thought to be at higher risk for developing URI because their immune systems cannot effectively prevent the infection. Older cats with health concerns or increased stress levels may have further impairment of their immune system. Vaccination history can have an impact on preventing infection, but vaccines are not available for all organisms.
     URI in cats is complex because multiple organisms can be involved. These organisms include feline herpesvirus-1 (FHV), feline calicivirus (FCV), Chlamydophila felis (C. felis), Bordetella bronchiseptica (B. bronchiseptica), and Mycoplasma felis (M. felis). While some authorities estimate that 90 percent of infections are caused by FHV or FCV, one organism or a combination of organisms at the same time can cause URI. This complexity can create challenges for initial treatment and long-term management, especially because each of the infectious organisms has unique disease patterns in the cat and susceptibility to environment conditions.
     FHV and FCV are viruses. C. felis and B. bronchiseptica are bacteria, while M. felis is an unusual type of bacteria. Cats infected with any of these organisms will typically have sneezing and nasal discharge as a sign of infection. Some infections with FHV and FCV can result in ulcers in the mouth and eyes. B. bronchiseptica can cause coughing. Interestingly, infections with FCV and M. felis can result in lameness from joint pain and osteoarthritis.
     Diagnosis is based on the signs, but there are tests
that can be performed to confirm the diagnosis. In severely affected cats additional tests like blood counts and X-rays may be necessary for full patient evaluation.
     Generally, the infections run their course in 7-21 days but this can be complicated by secondary bacterial infections and the ability of the immune system to respond adequately. Viruses like FCV have multiple strains. Some strains are very aggressive at causing disease and can be so severe that they can cause death. Other organisms like FHV infection can lead to latent infections, and C. felis can have a chronic carrier state. These infections can re-emerge following stress or other events that can suppress the immune response.
     Infections are spread through sneezing and direct contact with infected cats or organisms in the environment. The organisms can survive in the environment for variable times. For example, FHV and C. felis do not live long in the environment, while FCV can survive over a month.
     Treatment depends on the organism(s) causing the URI and the severity of the infections. Antibiotics may be needed for organisms like C. felis and B. bronchiseptica or for secondary bacterial infections. Use of anti-viral drugs is becoming more common for FHV and FCV infections. Severely affected cats may have to be hospitalized for treatment to help maintain hydration and assist with eating. Many cats stop eating because of the mouth ulcers and nasal discharge. Supportive care for the lining of the respiratory tract and immune system using vitamins like A and C can be important. Probiotics have been shown to increase immune activity. Mushrooms and certain herbs may be beneficial for boosting the immune system. The amino acid lysine has been advocated for helping to manage the viral infections.
     If you have questions about your sneezing cat, contact your veterinarian. Keep in mind that not all sneezing is caused by a respiratory infection. There are other causes.
There are many causes for coughing in the dog              (Dr. Ron Carsten – Glenwood Post 2-23-18)
     Coughing is a normal process designed to rid the body of irritants, mucus or foreign particles from the throat, upper airways and lungs. A cough is triggered by receptors in the airway and controlled by cough centers in the brain.
     Occasional coughing in dogs is not a cause for concern. However, ongoing, repetitive coughing can be. The duration and severity of the cough is important to recognize along with determining whether the cough is productive. These characteristics play a role in diagnosing the cause of the cough and outlining the therapy plan.
There are numerous causes or triggers for coughing. Some triggers are minor problems while others are the result of severe health concerns. Common causes of coughing include infections like kennel cough or canine influenza, collapsing trachea, reactive airway disease, heart disease, heartworms, pneumonia and cancer. Clearly, this list represents a wide range of problems that require different treatments.
     Dogs affected by kennel cough and canine influenza can have a goose honk or gagging type of cough that occurs after exposure to other coughing dogs. These infections may be self-limiting and resolve on their own in 7-14 days.
     Even though these infections are viral, antibiotics can be important for controlling the secondary bacterial component in severely affected dogs. Support of the immune system and tissue lining the respiratory tract can be important for rapid recovery. Some dogs need cough suppressants to break the cough cycle because coughing causes irritation in the trachea.
     Dogs can have a cough associated with allergy reactions in the airways. These allergic reactions are to an inhaled substance that is often undetermined. Examples of potential airborne allergens include dust, mold, smoke or pollens. Avoidance of the triggering allergen is of obvious benefit. Steroids are often used to control the allergic reaction.
     Some parasites migrate through the lung tissue as part of their life cycle so administering routine
deworming medications can be important for controlling the allergic reaction. Nutritional support of the lung tissue can also be beneficial for long-term management.
     The problem of collapsing trachea tends to occur in middle-aged and older small breed dogs like the Pomeranian, toy poodle and Maltese. In affected dogs, the cartilage in the trachea gets soft and is unable to effectively hold the trachea open during breathing. In some cases the collapse can be severe enough that the dog is in significant distress. Interestingly, many of the affected dogs also end up with abnormal liver tests. The correlation between the trachea and liver is unclear. Supportive care includes supplements to support the cartilage and liver. Cough suppressants may be used depending on the severity. Drugs or herbs to reduce anxiety may be beneficial for long-term management.
     Coughing can also result from heart disease when the heart is in failure and fluid is building up in the lung tissue or when the heart is enlarged and pressing on the trachea. Pressure on the trachea gives the sensation of something in the airway which triggers the cough reaction. Managing a failing heart often requires urgent care with multiple drugs to improve the heart contractions, modify the blood pressure and clear excess fluid. Herbs like hawthorn berry may be of benefit (see previous article "Valve disease common cause of canine heart murmurs").
     It is clear from the wide range of problems that can result in coughing that it is essential to obtain a clear diagnosis. This allows treatment to be directed at the source of the cough. Supportive care may also involve using vitamins like A and C to improve the lining of the airways. Herbs like andrographis and mushrooms like coriolus may improve the immune response. Herbs like slippery elm may be helpful as an expectorant. The cough may need to be suppressed in order to break the cough cycle. However, the cough is an important defensive reaction and caution is needed when suppressing the cough.
     If you have questions about your coughing dog, contact your veterinarian.
Oral probiotics and periodontal disease                                (Dr. Ron Carsten – Glenwood Post 1-27-18)
     February has been designated National Pet Health Month for good reason. Periodontal disease is the most common health problem affecting dogs and cats. Over 80 percent of dogs and 70 percent of cats over 2 years of age have periodontal disease. Almost all dogs and cats by 5 years of age are affected. Untreated periodontal disease can lead to multiple problems in the mouth including bad breath, pain and tooth loss and problems in the body such as damage to the heart, kidneys and liver as they age. These issues are alarming from a health perspective but also because periodontal disease is thought to be preventable through regular home and professional care.
     In the mouth, bacteria form plaque that sticks to the surface of the tooth. This plaque hardens into dental calculus (tartar). As a cause of periodontal disease, plaque and calculus that is below the gum line is a bigger problem than the more visible buildup that you can see on the teeth. The plaque and calculi below the gum line, in the small groove where the gum attaches to the tooth (sulcus), can incite inflammation and infection. This inflammatory process can cause damage to the attachment of the gum tissue to the tooth and to the attachment of the tooth to the bone of the jaw. Bacteria can secrete toxins that also contribute to the damage.
These damaging processes lead to periodontal disease, which includes gingivitis (inflammation of the gums) and periodontitis (loss of bone and soft tissue around the tooth). Unfortunately, the damage from periodontal disease is not confined to just loss of teeth. It can progress into formation of a hole between the mouth and the nasal cavity, weakening of bone leading to fractures of the jaw, and bone infection. Bacteria in the mouth can also enter the bloodstream leading to damaging changes in the kidneys, liver and heart.
     When you consider the cause of periodontal disease it becomes clear that the methods for preventing or
controlling it are focused on reduction or control of the undesirable bacteria in the mouth. These approaches include brushing, wipes, hard dental chews and rinses. Other approaches include the administration of seaweed products that are thought to change the chemistry of the saliva, which contributes to reduced plaque and calculi formation.
     Another tool that is gaining widespread attention is the use of oral probiotics. Oral probiotics are showing potential for preventing and treating periodontal disease. They appear to improve the overall health of the mouth, as well as improving the healing of the diseased areas in the mouth. The mouth has a biofilm or microbiome much like what exists in the digestive tract. A healthy microbiome equals a healthy digestive tract and immune system just like a healthy biofilm in the mouth equals a healthy mouth. Probiotics for the mouth act in a similar fashion as probiotics for the intestinal tract. They can prevent adhesion of the undesirable bacteria to mouth surfaces, produce substances that inhibit the undesirable organisms, compete for nutrients against undesirable organisms, and can lead to less inflammation and less overall damage.
     Even with regular teeth brushing and other at-home oral care approaches, periodic teeth cleaning is an important part of oral health care just as it is for humans. In dogs and cats, a thorough teeth cleaning can only be accomplished while under anesthesia. While teeth cleanings that do not use anesthesia have their benefits, they cannot do as effective of a cleaning of the sulcus area, which is where periodontal disease is thought to start.
     Periodontal disease is considered a preventable problem. An effective program requires both at-home care and professional cleanings. Some individuals and some breeds are prone to periodontal disease and require more intensive support programs.
     If you have questions about your pet's oral health, contact your veterinarian.
Frankincense and myrrh have health benefits for pets (Dr. Ron Carsten – Glenwood Post 12-23-17)
     Historical patterns of herb use, their medicinal applications, and their impact on society can be fascinating and informative. Frankincense and myrrh are part of the Christmas tradition, but they have historical roots extending into ancient times long before becoming gifts for the Christ child. Along with gold, they were considered gifts fit for kings in the ancient world. In addition to their symbolic and religious significance, frankincense and myrrh were valued for their medicinal properties. There is evidence that frankincense and myrrh were used and traded over 5,000 years ago. The Babylonians and Assyrians may have burned them as incense during religious ceremonies. Ancient Egyptians used them in incense, perfumes and salves for wounds. In part, because of its antiseptic properties, myrrh was an ingredient used for embalming the bodies of pharaohs. The ancient Romans and Greeks used frankincense and myrrh in religious ceremonies and recognized a wide range of medicinal effects. Traditional Chinese medicine has used these resins for improving blood circulation, treating traumatic injuries and masses, arthritis and other health problems.
     Frankincense and myrrh are resins collected from trees. Trees providing the frankincense and myrrh are related and grouped in the same plant family classification. They are found growing in the harsh environment of the Somalia and Arabian Peninsula. Resin is collected when it oozes from cuts in the tree bark. The resin can be used in multiple ways including burning as incense, inclusion in herbal formulas, or extracted as an essential oil.
     While the history and symbolism of frankincense and myrrh are interesting, their medicinal benefits are being explored. One fascinating study found that frankincense has anti-depression and anti-anxiety effects in mice, giving rise to speculation that there may be more than symbolism involved with the use of frankincense in religious ceremonies. In other studies frankincense has shown clear benefits for managing osteoarthritis pain and may be more effective than
use of a NSAID for some patients. Myrrh has also been shown to reduce pain. Frankincense and myrrh both have benefits for inflammatory problems like irritable bowel disease and asthma. In addition, they have anticancer effects and aid wound healing.
     Herbs have been an increasingly important part of health care over the last decade (see "Properly selected herbs provide effective therapies," April 28, 2017). For example, it is now estimated that 91 percent of human cancer patients worldwide use some form of complementary and alternative medicine with the focus on herbs and nutritional supplements. The use of herbs and nutritional supplements has also played an important role for pet health care. Frankincense has received attention for its medicinal effects in dogs and cats. Less attention has been given to myrrh even though it clearly has potential for a wide variety of conditions.
     Use of frankincense for dogs and cats has focused on the essential oil and on the resin in boswellia herbal products. Benefits were found for reducing pain, stiffness and lameness in dogs with osteoarthritis. Clinical observations support the use of boswellia for inflammatory diseases of the digestive tract. These observations are consistent with results of clinical studies in humans. Myrrh has also been shown to have anti-inflammatory effects, pain modulating benefits, antibacterial properties and anticancer attributes. Some advocate the use of frankincense and myrrh together with the thought that there is a synergistic effect. This has not been evaluated in the dog and cat. While frankincense and myrrh essential oils are considered safe in cats (see "Essential oils can be toxic to cats," March 26, 2016) caution should always be exercised.
     The holiday season reminds us of the rich history of use of frankincense and myrrh in ceremony and for their health benefits. Growing use in dogs and cats highlights their medicinal properties. If you have questions about the use of these herbs, contact a veterinary herbalist.
     Enjoy the holiday season with your furry companions.
Helping your pet manage winter blues
(Dr. Ron Carsten – Glenwood Post 11-24-17)
     The holidays — what a wonderful opportunity to share time with family and friends. Pets have become such an important part of our daily life that many consider these furry companions as part of their families. While our pets provide us with innumerable health benefits and companionship, they also provide an invaluable opportunity to study the aging process. Dogs are receiving widespread interest for human aging studies because they age rapidly compared to humans and in very similar ways. Aging is the result of multiple processes that result in decline of organ and tissue function. These changes include heart disease, liver and kidney problems, cognitive declines, nerve and muscle degeneration, and increased risk for osteoarthritis and cancer (see previous article Teaching About Old Dogs). In addition to these changes, dogs share their environment with humans which means that they are exposed to similar environmental conditions as humans.
     With this information in mind, it is not surprising that pet companions are thought to also experience seasonal affective disorder (SAD) like humans. Affected humans experience feelings of sadness and loss of energy around the times of the year when the days are the shortest, typically December through February. These individuals have difficulty regulating serotonin and melatonin. They also tend to have low levels of vitamin D. Serotonin is a substance that is responsible for helping to balance mood. During summer, exposure to sunlight aids in maintaining normal serotonin activity. When sunlight decreases in winter, serotonin activity decreases. In addition, affected individuals experience increased production of melatonin. Melatonin is produced in a part of the brain (pineal gland). It is produced in response to darkness and helps to promote sleepiness. As the winter nights become longer, there is an increased production of melatonin and a corresponding increase in sleepiness and lethargy.
     While dogs have similar brain chemistry to humans, it has not been clearly established that dogs and cats experience SAD. A small survey in Britain provided some answers but the study relied on owner perceptions of their pet companion without supporting scientific documentation. In this study it was determined that 40 percent of dog owners reported a decline in their dog's mood, 50 percent thought their dogs slept longer, and 40 percent thought their dogs were less active. Interestingly, over 30 percent thought their cats seemed "sadder" and less playful. For both dogs and cats, 25 percent of owners thought their pet's appetite increased during the winter.
     One criticism of this survey is that pets are very good at mirroring the emotions of humans. The ability of dogs to recognize emotions in humans was shown in a study that evaluated the how well dogs can pair facial patterns with verbal cues. This ability to recognize emotions has only been previously shown in primates and the additional ability to recognize emotions across species has only been shown in humans. Obviously this complicates interpretation of owner observations of pet's emotional states.
     Regardless of whether companion pets experience SAD, there is an important message regarding the close relationship that humans have with companion pets. Take time to walk your dog regularly, especially in the winter. The exercise is invaluable and will provide opportunities for more exposure to sunlight during the daylight hours. Keep in mind that dogs do not produce vitamin D from sunlight. Consider testing for vitamin D levels and supplementing as needed (see previous article Understanding the Importance of Vitamin D for Pets). Play with your dog and cat indoors. Find activities that are stimulating for them and get them moving regularly. Provide appropriate toys. Increase the full spectrum light in your home during the winter. Take care of yourself because your health and emotional well-being can affect your pet companions. Enjoy the holiday season and include your companion pet whenever possible.
Your dog and the risk of lymphoma
(Dr. Ron Carsten – Glenwood Post 10-27-17)
     Lymphoma is the one of the most common cancers diagnosed, accounting for up to 24 percent of cancer cases seen in dogs. Multiple types of lymphoma can strike dogs, and the behavior of the cancer is extremely variable.
     Some types of lymphoma have rapid progress that can quickly become life-threatening. Other forms can be very slow in their progression.
     The cancer is usually seen in middle age to older dogs with an average age of 6-9 years. Certain breeds are more commonly affected like the Golden Retrievers, Boxers, Scottish Terriers and Basset Hounds. Interestingly, some breeds like the Dachshunds and Pomeranians appear to have a lower risk.
     Lymphoma is a cancer of lymphocytes. Lymphocytes are cells that are part of the immune system. They are found throughout the body. As a result, lymphoma can be found in many different locations in the body including the lymph nodes, liver, spleen, bone marrow and intestinal tract. Signs of illness vary with the location of the lymphoma. They can be mild, with loss of appetite and lethargy, or more severe, with vomiting, diarrhea and weakness. Lymph node involvement is the most common form and is identified by lymph node enlargement.
    The cause of lymphoma is unknown. However, exposure to certain lawn herbicides may increase the risk, while some chemicals like paint and solvents may predispose to developing lymphoma. Chromosome studies have shown that some dogs with lymphoma have had changes that result in abnormal chromosome structure.
     Diagnosis of lymphoma depends on the location of the cancer. A biopsy is needed for an accurate diagnosis. When the lymph node is affected, collecting lymph node cells through a needle may be sufficient for making the diagnosis. However, in about 10 percent of dogs, the biopsy may require surgery to remove a portion or the entire lymph node.
     Special staining methods can help to further define the lymphoma. Once there is a diagnosis of lymphoma, the dog should be evaluated to determine the stage of the disease. Determining the stage will identify the extent of the problem and help to define
treatment options. Staging is generally done with blood tests, chest X-rays and ultrasounds of the abdomen.
     Length of life from diagnosis time depends on the stage of the cancer, location and therapy chosen. With no therapy, lymphoma can be fatal in 1-3 months after diagnosis. When steroids alone are used, survival time is about 2-4 months. The currently accepted best course of conventional therapy is a combination of chemotherapy agents given over a period of 25 weeks. Seventy to 90 percent of dogs receiving this chemotherapy combination have complete or partial remission with an average survival time of 6-12 months. Less than 10 percent of lymphoma patients are cured.
     Supportive care for dogs with lymphoma needs to be coordinated with the decisions about chemotherapy and includes supplements that support the adrenal glands and liver, herbs that reduce inflammation, and herbs that have anti-cancer effects.
     Herbs like turmeric and boswellia have anti-inflammatory and anti-cancer effects. The coriolus mushroom has been shown to have anti-cancer effects for lymphoma cells. Dogs with lymphoma commonly have reduced levels of vitamin D. Supplementation with vitamin D3 may be beneficial for lymphoma patients.
     There is concern that carbohydrates in food (i.e. grains) help to "feed" the cancer cells; therefore, these cancer patients may benefit from a high-protein diet. The protein may aid in slowing the cancer cell growth. Fish oil is also a beneficial addition to the diet.
     Keep in mind that some forms of lymphoma advance so rapidly that herbs and supplements alone cannot slow or stop the cancer cells rapidly enough. In those situations, chemotherapy may be a critical part of treatment. Supportive care like that briefly touched on above may have benefits for improving remission times.
     Unfortunately, there is a lack of studies outlining how the supportive therapies can extend life. It is also important to recognize the need for a coordinated therapy plan so that all the treatments and supportive care work properly together.
     If you have questions about lymphoma, contact your veterinarian. For questions about herbal therapies, contact a veterinary herbalist.

Slippery elm often used for digestive problems
(Dr. Ron Carsten – Glenwood Post 9-22-17)
     Many authorities consider the inner bark of the slippery elm (Ulmus rubra) to be an herb with excellent healing properties. It can be used internally and externally. This herb is also thought to have a wide safety margin.
     Slippery elm is native to North America with a range from Canada to Florida and Texas. Historically, slippery elm was widely respected by indigenous peoples for its healing qualities and was used for treating wounds, skin problems, digestive disorders, urinary issues, respiratory conditions, eye conditions and childbirth.
     Slippery elm products are made from the soft, stringy inner bark. This inner bark contains large amounts of mucilage. Mucilage is a substance that swells, becomes slippery and does not dissolve when mixed with fluids.
     The mucilage, when ingested, coats the throat, esophagus and remainder of the digestive tract. It stimulates nerve endings in the digestive tract that result in increased mucus production, which adds additional protection for the lining of the digestive tract. The mucilage also has anti-inflammatory and antioxidant properties. Slippery elm contains nutrients including vitamin C, beta-carotene, calcium and trace minerals that may provide benefits.
     There have been a small number of studies showing benefits of slippery elm for inflammatory bowel diseases in humans. These limited studies support the historic use of slippery elm for inflammatory bowel disease. Historical use has shown benefits for other inflammatory conditions including those affecting the stomach, small intestines, colon, throat, urinary bladder and respiratory tract. The anti-cough effect of slippery elm has benefits for respiratory problems like bronchitis and asthma. Slippery elm also exhibits
diuretic effects that may aid in management of urinary bladder disorders.
     Uses in dogs and cats have focused on the treatment of digestive tract problems like inflammatory bowel disease, ulcers, colitis, diarrhea, constipation and nausea. Other uses when ingested have been for inflammatory conditions outside the digestive tract including urinary bladder (cystitis) and respiratory tract problems. There may also be a benefit for reducing urinary bladder pain, which can be a common issue for cats.
     When using slippery elm long term, keep in mind that it coats the walls of the digestive tract and may interfere with absorption of some drugs, supplements or herbs.
     Before starting treatment with slippery elm, it is important to have a clear diagnosis. There are conditions that present as a digestive disorder that are not directly caused by an intestinal problem. For example, liver disease can present with diarrhea, vomiting and weight loss. Relying on slippery elm as the treatment for the diarrhea may result in delays of diagnosis and appropriate treatment. Keep in mind that slippery elm may be a component of the treatment plan once the diagnosis is obtained.
     Slippery elm is widely available in a powdered form. The powder can be mixed with water to the consistency of gruel. The slippery elm absorbs many times its weight in water so you may be surprised how much water is needed. Treatments are typically given between meals and separated from other medications.
     For skin problems, mix slippery elm with water to make a paste. This can be smeared onto the affected area and allowed to dry. It may stay in place for a few hours if the pet will allow it.
     If you have questions about any problems with your pet, contact your veterinarian. For questions about slippery elm and its use, contact a veterinary herbalist.
Valve disease common cause of canine heart murmurs
(Dr. Ron Carsten – Glenwood Post 8-25-17)
     Heart disease affects about 10 percent of dogs. Insufficiency of the mitral valve is the most common cause, accounting for 75-80 percent of heart disease cases. Mitral valve disease is more common in small dogs such as the Cavalier King Charles Spaniel, Toy Poodles and Pomeranians.
     A degenerative process affecting the mitral valve is thought to be genetic. The first sign of mitral valve disease is a murmur that begins between 6-10 years of age. When the murmur is low grade, there may not be any other signs. However, as the murmur (insufficiency) progresses, signs can include coughing, increased breathing rates or effort, exercise intolerance and even fainting.
     The mitral valve is located in the left side of the heart between the left ventricle and left atrium. It provides a vital function by preventing blood from moving backward during heart contraction. Insufficiency means that the valve is not functioning properly allowing blood to leak backward past the valve when the heart contracts.
     Understanding how mitral insufficiency affects the body requires further discussion about heart anatomy and function.
     The heart is divided into two sides. Each side has two chambers — the atrium and the ventricle. The right side of the heart pumps blood to the lungs so that carbon dioxide (CO2) can be released and oxygen (O2) picked up for delivery to the body. Blood with oxygen returning from the lungs to the left side of the heart is pumped to the rest of the body.
     When degeneration affects the mitral valve, the edges of the valves become rough and no longer completely close. This allows blood to move backward with each heart contraction. This leaked blood must be pumped again by the heart, resulting in increasing work and inefficiency.
     The increased volume of blood in the heart
chamber, also results in increased stretching of the heart muscle. This stretching can reduce the efficiency of the heart muscle contractions. When enough blood has leaked backward, it can start backing up into the blood veins leading from the lungs to the heart, causing problems with blood circulation in the lungs.
     Mitral insufficiency can be detected by hearing a murmur over the mitral valve. However, it is important to have a full work-up completed to determine how severe the problem is. Tests often include chest X-rays to determine the heart size and changes in lung blood vessels, ECG to determine the presence of abnormal heart rhythms, blood pressure, and liver and kidney test values. Echocardiogram (ultrasound) of the heart provides an assessment of heart structure and function; however, it is not generally needed for mild mitral insufficiency.    
     Treatment and supportive care depend on the severity of the heart condition. Generally, medications that improve heart contraction, reduce blood pressure and remove excess fluid are used to manage the effects of mitral insufficiency. Reduced sodium diets are considered to be important. Fish oil, vitamins E, C, and B complex, L-carnitine and trace minerals may be of benefit. Herbs such as hawthorn berry (Crataegus oxyacantha) have a wide range of benefits, including safety, improved blood flow to the heart muscle, enhanced strength of the heart contraction, and removal of excess fluid.     
     When considering supportive care for dogs with mitral insufficiency, it is important to recognize that other parts of the body are indirectly affected. For example, many dogs with heart problems are in a chronic stress mode as the body tries to cope. This ongoing stress can lead to reduced adrenal function. The kidneys can also be affected and may need supportive care.
     If you have questions about mitral insufficiency in your dog, contact your veterinarian.
Hot weather can be a health risk for pets
(Dr. Ron Carsten – Glenwood Post 8-5-17)
     Hot summertime temperatures bring lots of opportunity for outdoor activities. But these temperatures also bring increased health risks for pets. Car temperatures can rise quickly into dangerous ranges, pavement can be extremely hot and dehydration can become a problem. As a result, it is critical to think ahead when taking your pet on trips around town or on extended travel.
     The normal body temperature of dogs and cats is 100.5-102.5 F. It is critical to normal body function that temperature is maintained in this range. When the body temperature gets too high, heatstroke can occur. Heatstroke can cause serious damage to the body and even result in death.
     When environmental temperatures rise above about 80 F, dogs pant, which promotes evaporative cooling as moisture on the mucous membranes evaporates and by moving more blood to the skin to promote heat transfer out of the body. Moving more blood to the skin involves dilating blood vessels and moving more blood with the heart.
     However, this works only in the dog in places where the hair is thin like the ears and tongue. Sweat glands in the dog and cat are only found in the feet so sweating is not effective for cooling. Contact with a cool surface or with moving air can also help to promote heat loss from the body.
     When the environmental temperature rises above what is considered a neutral temperature (~80 F), the body has to work harder to release heat. Depending on the health condition of the pet, there can be significant stress on the body and variation in the ability to release the heat. For example, a dog or cat with heart problems can have difficulty responding with increased heart rate and blood flow. A dehydrated dog or cat will have reduced ability to use evaporative cooling through panting.
     Dogs with short muzzles and elongated soft palates (extra tissue in the throat) have more difficulty dissipating heat through panting. Obesity predisposes to over heating. These health and conformation
 factors mean that these individuals will be less tolerant of high environmental temperature.
     If left in the sun and especially if left in an enclosed space like a car, a pet can rapidly overheat because the body cannot response well enough to keep body temperature normal. Once the body temperature reaches 106 F, irreversible organ damage can occur. Multiple body systems fail at temperatures above 109 F. The severity of the damage caused by excess heat depends on the health status of the pet and the duration of the increased body temperature. Getting the body cooled has a significant benefit for recovery.
     Heatstroke is such a serious health problem that Colorado has a new law that goes into effect Aug. 9 that allows a person to break the window of a car to rescue a dog if they think there is danger that the dog might die if left in the car. The law requires reasonable efforts to contact the owner and police before breaking into the car.
     Signs that heat stress is becoming a problem include restlessness and anxiety, excessive or heavy panting, weakness and confusion. As the body struggles and the heat worsens, the gums may become pale or gray, breathing becomes shallow and can eventually become slow or absent. Collapse, seizures, coma and death can occur if the excess heat is not released.
     The best ways to prevent heatstroke and complications from excess heat is to plan. Avoid placing your pet in a compromising situation. Air temperature in a car can rise rapidly into the 140 F range. Temperature in a car can be excessive even when parked in the shade. Make sure that your pet has plenty of fresh cool water. Provide a cool area that is easily accessed by the pet. Be aware of health problems that can compromise your pet's ability to regulate temperature.
     If you have concerns about your pet's health that could compromise your pet's ability to handle heat, contact your veterinarian. A veterinarian should be contacted immediately for pets that are suffering from heatstroke. Early and aggressive therapy is essential.
The potential benefits of curcumin for pets
(Dr. Ron Carsten - Glenwood Post 6-30-17)
     Along with the growing interest in the therapeutic use of herbs (see "Properly selected herbs provide effective therapies," April 28, 2017), an increasing amount of research identifies many of the ways that herbs work at the cell level and outlines their health benefits. Turmeric (Curcuma longa) is one of those herbs that has an extensive list of health benefits and has been a focus of intense research.
     Turmeric has been used for over 5,000 years as a food spice and as a medicine. This is the herb that gives curry its golden color. In both Ayurvedic and traditional Chinese medicine, turmeric has been used to treat inflammatory disorders, digestive problems, liver issues, skin diseases and wounds.
     The turmeric root is the part of the plant that is used. Curcumin is the compound in turmeric that gives it the yellow color. It was first identified two centuries ago and the chemical structure was defined in 1910. Curcumin is also the compound that has received so much interest for its health benefits. Turmeric root contains a wide range of compounds.
     It is estimated that only 2-5 percent of turmeric root is curcumin. This means that it requires large volumes of the root powder to obtain recommended doses of curcumin. In addition, curcumin is poorly absorbed from the intestines and is rapidly eliminated by the liver. This adds to the challenge of achieving and maintaining beneficial levels of curcumin in the body.
     A number of approaches have been used to improve the ability to get higher blood and tissue concentrations of curcumin and to maintain those levels long enough to have benefits. First, some curcumin preparations have over 75 percent curcumin. Second, there are products that contain curcumin bound to another compound making a phytosome. Phytosomes can increase the absorption of curcumin 6-10 times over the root or standard, non-bound curcumin. A third strategy is to make turmeric paste, which is a mixture of turmeric, ground black
pepper, and coconut or olive oil. The oil may improve the absorption of curcumin and a compound in pepper (piperine) slows the metabolism of curcumin in the liver resulting in an up to 2,000 percent increase in the curcumin in the body.  
  Curcumin has anti-inflammatory properties that have shown promise for activity against inflammatory diseases, including osteoarthritis, inflammatory bowel disease, colitis and pancreatitis. This anti-inflammatory property is valuable because the source of many chronic diseases is unresolved inflammation (see Chronic inflammation can harm pets' health, Sept. 25, 2016).
     Interestingly, in addition to being valuable for management of inflammatory disease, there appear to be benefits for reducing muscle inflammation caused by exercise. This reduced muscle inflammation can lead to improved range of motion and better muscle function.
     Since inflammation plays a role in the development of cancer, curcumin can play a role for cancer patients, especially since curcumin has been shown to have anti-cancer effects in addition to its anti-inflammatory effects. Numerous studies using cell culture show a reduction in cancer cells and also show how the curcumin affects cancer cells. In human clinical trials, curcumin has demonstrated benefits for a range of cancers including colorectal, pancreatic, breast, and lung.
     Curcumin products are being used for dogs and cats for management of problems like osteoarthritis, back pain, inflammatory bowel disease, immune disorders, liver and kidney problems and cancer. A number of curcumin products are available for pets, including some phytosome-based products.
     While curcumin has been considered safe, even at high doses, there are some cautions. It's important to closely monitor blood glucose levels in diabetic patients and to consider discontinuing curcumin prior to surgery because of the potential for reduced blood clotting.
     If you have questions about curcumin for your pet, contact your veterinary herbalist.
How to help pets cope with tick season
(Dr. Ron Carsten - Glenwood Post 5-28-17)   
     Tick season in Colorado is early spring to early summer. These unsettling little creatures are often found in the woods, in grassy, brushy areas on the edge of fields and along commonly used trails.
According to Colorado State University Extension, more than 30 tick species live in Colorado. The Rocky Mountain wood tick (Dermacentor andersoni) is most common in our area. These ticks have four stages in their life cycle – egg, larva, nymph and adult. Completion of the life cycle requires that ticks feed on a mammal host at each of the three mobile stages.
     The ticks drop off following a blood meal and mature to the next stage. In the early stages, they generally feed on small mammals like rodents. As they mature, they feed on larger mammals, and eventually as adults, encounter humans and their pets. It is during these feeding periods when the ticks can become infected with diseases like Colorado Tick Fever or ehrlichiosis.
     In addition to the unpleasant prospects of finding ticks crawling on your pet or yourself, there is concern for transmission of certain diseases if the tick has been able to burrow into the skin and start feeding. Risk of disease is unclear because of difficulty in diagnosis and vague symptoms, but it appears that the risk is generally low in this region based on current data.
     The Companion Animal Parasite Council (CAPC) provides forecast information by region based on ongoing studies of prevalence. However, it is important to note that the incidence is likely to increase as awareness and reporting improve. Toward this goal, Gov. John Hickenlooper recently proclaimed May 2017 to be Lyme and Tick-Borne Disease Awareness month in Colorado.
     During tick season, exposure to ticks can be minimized by avoiding areas that are likely to contain ticks, checking your pets for ticks after each outing and, in high-risk settings,
using tick repellent products. When using tick repellents, make sure they are safe for your pet.
     It takes approximately 12-24 hours after the tick is on your pet before feeding begins. This should give adequate time to look for ticks and remove them from your pet before they begin feeding. If the tick becomes attached, the best way to remove them is to grasp the tick firmly with blunt tweezers as close to the skin as possible and pull slowly. Once the tick has been removed, wash and disinfect the area as you would any wound. Wash your own hands thoroughly. Note that covering ticks with petroleum jelly or touching them with a match are not considered effective removal methods.
     Diseases of concern for your pet according to CAPC include Lyme (Borrelia burgdorferi), ehrlichiosis and anaplasmosis. Some controversy exists regarding diseases like Lyme in Colorado because of the tick species implicated in its transmission. However, it is still valuable to minimize tick exposure and increase knowledge of these diseases.
     The good news is that more than 90 percent of dogs exposed to Lyme do not become ill. Their immune systems appear to be able to successfully clear the infection. For those dogs that become ill, signs of illness may not develop until months after the tick bite. Signs of illness include fever, lameness that shifts between legs, swollen lymph nodes and joints, lethargy and loss of appetite. Signs of ehrlichiosis are also vague, and include fever, swollen lymph nodes, weight loss and bleeding disorders that can last two-four weeks.
     It is important to keep in mind that information about the incidence of these diseases in Colorado continues to evolve and the true risk of infection is unknown. Therefore the best approach is to avoid areas that are common habitat for ticks, check your pet regularly for ticks during tick season and remove the ticks as soon as they are found.
     Keep your pet's immune system in optimal health by maintaining overall health especially with the digestive system. For example, a balanced intestinal microbiome has beneficial impact on the immune system (see previous article, Probiotics provide important benefits, Glenwood Post Independent 8-27-16).
     If you have questions about ticks and tick-borne diseases in your pets, contact your veterinarian.
Properly selected herbs provide effective therapies
 (Dr. Ron Carsten – Glenwood Post 4-28-17)
     Herbs have been used for their health benefits in humans and animals for thousands of years. In the past, eclectic physicians and veterinarians in the U.S. made extensive use of herbs. However, with the increased availability of effective drugs, the use of herbs significantly declined.
     Now, there is a resurgence of interest in the use of herbs for therapy. In a 2016 report from the American Botanical Council, U.S. consumer spending for herbs was estimated to be $6.92 billion in 2015. This represents a 7.5 percent increase over the previous year. Importantly, this is part of a continuous trend of increased sales over the last 12 years.
     With the millennia of use, extensive folklore surrounds the therapeutic use of herbs. While this folklore use has provided guidance for herb selection, current clinical application relies on a growing body of scientific research. For an herb to be beneficial, it must be safe for use, the active compounds must be effective for the intended purpose, be sufficiently absorbed after ingestion, be distributed to the target tissue, reach therapeutic levels in that tissue and remain in that tissue for an appropriate amount of time.
     An additional layer of complexity involves the fact that plants contain a wide variety of compounds. For example, Boswellia, popular for its anti-inflammatory effects, contains more than 340 different compounds. Defining the therapeutically active compound(s) in plants can be challenging. Further, it is becoming increasingly clear that combinations of plant compounds work in a synergistic way which makes them more effective therapeutically at lower doses.
     Many plant compounds are formed as part of the normal processes of life for the plant. Other compounds are formed by the plant for protection. For example, grapes produce resveratrol to protect the grape from fungal infections. This means that some plants will have higher concentrations of these active compounds depending on the level of need for protection.
     Certain growing conditions can create stresses for plants resulting in higher or lower levels of key compounds.

Therefore, it is important to recognize that there are variations in amounts of plant compounds based on the plant strain, part of the plant (i.e. leaf, flower, or root), seasonal growing conditions and storage after harvest. For example, a study on turmeric (Curcuma longa) showed a 10-fold difference in curcumin content between turmeric strains and variation in the same strain by year of production.
     Hawthorn (Crataegus laevigata) is an example of an herb that has clinical effects documented with current research that is consistent with traditional use. Hawthorn leaves and flowers have long been used for heart problems. It is now known that the active compounds in hawthorn increase the force of the heart contraction, improves blood flow to the heart muscle and reduces the heart muscle oxygen demand. Clearly, for these effects to be documented in human and animal studies the active compounds must reach the heart after ingestion, and elimination must be slow enough to maintain therapeutic levels between doses.
     Not all herbs are effectively absorbed. Herbs such as turmeric are felt to be poorly absorbed and do not maintain significant levels in the body for long periods of time. These factors have a direct effect on the dose of the herb, how frequently the herb is ingested, and even the combination or form used. For other herbs the method of elimination is important. For example, cranberry (Vaccinium macrocarpon) has been shown to be beneficial in certain urinary conditions. Efficacy of these compounds relies on their presence in urine. More than 40 different cranberry related compounds have been found in urine following ingestion and metabolism.
     A wide variety of herbs are available with varying amounts of supportive research documenting their efficacy in patients. Properly selected herbal therapies can be effective alone or when integrated with other supportive methods. While successful use of herbs depends on appropriate selection, it also involves the use of high quality herbs and herb products that are true to label claims.
     If you have questions about the use of herbs for your pet companions, contact a knowledgeable veterinary herbalist.
Understanding the importance of vitamin D for pets
 (Dr. Ron Carsten – Glenwood Post 3-25-17)
     Vitamin D has been emerging as a very interesting substance. In some respects it acts as a hormone, while in other aspects as a vitamin. Its wide range of actions in the body underscore both the importance of vitamin D for health and the complexity of its role in the body. Vitamin D in this article refers generically to vitamin D and its metabolites in the body.
     Vitamin D from cod liver oil was first shown to prevent rickets in dogs in 1914. Rickets is a disease of the growing bone in young animals. Following this discovery, the role of vitamin D in absorption of calcium and phosphorous from the small intestine was determined. Additional work showed that vitamin D also played an important role in maintaining blood calcium levels by regulating mobilization of calcium from bone.
     Over time it has become increasingly clear that vitamin D has an essential role in maintaining health beyond its function for healthy bones and calcium metabolism. It is estimated that vitamin D controls up to 5 percent of the human genome. One study of white blood cells showed that nearly 300 genes were influenced by vitamin D. This effect on the genes results in a wide-ranging impact on cell and organ function. For example, vitamin D has an effect on insulin production, inflammation reduction, and heart and immune function.
     In humans, sunlight exposure is a primary source of vitamin D. This is not the case for dogs and cats. They are not able to produce significant vitamin D through exposure to sunlight. Vitamin D must be included in their diet. Since vitamin D is a fat-soluble (dissolves in fat instead of water) vitamin, it is stored in the fat tissue of the body.
     Before commercial dog foods, dogs obtained their vitamin D from eating the fat of their prey. Commercial pet foods have added vitamin D in amounts that are sufficient to prevent rickets. However, these amounts do not appear to be sufficient to meet all the vitamin D needs. This is complicated by variation in the ability to absorb vitamin D from the diet. Once in the body, vitamin D must undergo processing in the liver and then the kidney to become the active form.
     A study published in 2015 found a wide variation in the

vitamin D levels in the blood of dogs. Interestingly, although the study groups were small, there was a significant difference in vitamin D levels between breeds. For example, the German Shepherds had significantly higher levels than Golden Retrievers. The authors note implies breed differences in ability to absorb vitamin D from the intestines. Another interesting observation was a difference in vitamin D levels between male and female dogs and if they were spayed or neutered, implying some sex hormone influence on vitamin D absorption.
     These findings are important because there has been an association between low vitamin D levels and cancers including lymphoma and hemangiosarcoma, and health problems including infections, inflammatory bowel disease, and heart and kidney disease in dogs. Another study from 2014 determined that the vitamin D blood level needed to prevent abnormal bone development (20-25 ng/ml) was not sufficient to prevent or reduce risk of other diseases. As a result, experts now recommend levels of 100-120 ng/ml. Based on this new recommended value, 85 percent of dogs in the 2015 study were in the insufficient range.
     Our own observations are consistent with these studies. The majority (more than 95 percent) of our tested patients fall into the insufficient range. These are patients with a variety of problems ranging from osteoarthritis to cancer. One observation has been the overall improvement in joint comfort once the vitamin D blood levels reach the sufficient range. Many of these patients become more active and initiate more play behaviors.
     Since vitamin D is fat soluble and stored in the body, there is concern for toxicity when over-supplemented. Therefore, it is always best to test blood levels before starting vitamin D supplements and to periodically retest because of the variability of absorption.
     Contact your veterinarian if you have questions about vitamin D or would like to have vitamin D testing performed.
A common cause of lameness in dogs
(Dr. Ron Carsten – Glenwood Post 3-4-17)
    The most common hind leg injuries in the dog are cranial cruciate ligament (CCL) insufficiency and iliopsoas muscle strain. CCL disease was previously discussed in this column; therefore, the focus here will be on the iliopsoas.
    Interestingly, iliopsoas injuries are common in humans. While the spelling of iliopsoas looks intimidating, just ignore the “p” when pronouncing (il-e-o-so-as). The name is based on the fact that two muscles (the psoas major and iliacus) join to form the iliopsoas. These two muscles together move the leg forward at the hip and when standing, aid bending the lower back to the side.
    Injuries to the iliopsoas result from excessive force on the muscle. This can occur in dogs competing in athletic activities where the muscle is contracting while it is stretched. However, iliopsoas injury can also occur when a dog slips into a splay-legged position, during rough play with other dogs, or when jumping out of a vehicle.
    Dogs with iliopsoas strains can have variable amounts of lameness ranging from subtle, intermittent reduced weight bearing on the affected side to a significant lameness that worsens with activity. Affected dogs will have discomfort and spasms when the muscle is touched during examination. Pain may be accentuated by stretching the muscle while examining.
    X-rays are generally not useful in the early phases but may reveal mineralization where the muscle attaches to the femur in longstanding cases. The use of CT scans, MRI, and ultrasound may be used to identify iliopsoas injury. However, the history, physical exam, and response to treatment can provide evidence to support the presumptive diagnosis of iliopsoas injury.  
    Treatment depends on severity and how longstanding the problem is. For acute (recently started) injuries, treatment generally includes controlled activity, cryotherapy (ice packs), and non-steroidal anti-inflammatory drugs (NSAID) such as carprofen. Herbs like boswellia, turmeric, and ginger have anti-inflammatory effects that can be helpful. In severe cases, muscle relaxants may be used to reduce pain and muscle spasms.
    Rehabilitation techniques including laser therapy can be beneficial for reducing pain and improving healing. Acupuncture can also be valuable for promoting healing and pain management. Additionally, proper alignment of the sacroiliac joints, lumbar spine, and front part of the pelvis are critical. It is important to note that it can take 4-6 weeks or longer to recover from an iliopsoas injury.
    For chronic (longstanding) injuries, supportive care and management are similar to the acute injuries except there is a need to reinitiate the inflammatory process to assist in remodeling and healing of the tendon fibers. Maintaining proper alignment and mechanics of movement are essential to avoid ongoing strain to the muscle. Laser therapy, acupuncture, massage, stretching and heat can benefit healing a chronic iliopsoas injury.
    Iliopsoas injuries can be slow to heal and are prone to reinjury. Some performance dogs can never return to competition. Household companions may also be limited in their ability to hike as much as they did prior to the injury.
    Ongoing osteopathic or chiropractic care is valuable along with regular laser therapy sessions, massage, and core strengthening programs. Core strengthening activities focused on the gluteal, hamstring and iliopsoas muscles include controlled, slow walking up and down gradual hills, use of cavaletti poles, and standing with the front paws on an elevated surface. Keep in mind that it is important to gradually increase the activity to avoid reinjury. Chronic iliopsoas problems can take longer to heal than the acute injury.
    Regenerative medicine treatments with stem cell injections can be used for patients that do not response to conservative therapy and rehabilitation management. Surgery may be an option when the iliopsoas strain occurs at regular intervals.
    Nutritional supplements and other products that may be of benefit during the recovery process include glucosamine, vitamins C, D, and B complex, and manganese. Each of these has some value in supporting the connective tissues and tendons.
    If you suspect that your dog has an iliopsoas injury, contact your veterinarian for an evaluation and therapy plan.
Dental health essential for pets’ quality of life
(Dr. Ron Carsten – Glenwood Post 1-28-17)
    February has been designated as National Pet Dental Health Month because pet dental care is fundamental for overall good health. While poor dental health can result in bad breath and pain associated with dental disease, poor oral health also has been linked to increased risk of heart, liver, and kidney problems.
    More than 80 percent of dogs and 70 percent of cats older than 2 years have periodontal disease. Periodontal disease is an inflammatory condition affecting the tissues of the mouth that support the teeth. With aging, the frequency of periodontal disease increases. Almost all dogs and cats by 5 years of age are affected, making periodontal disease the most common health problem seen in dogs and cats.
    Good oral health for dogs and cats, just as for humans, requires eating good quality food, daily teeth brushing, regular dental checkups, and periodic dental cleanings. Ideally, plaque is removed daily by brushing. Plaque is a sticky combination of food particles, saliva and bacteria. When not removed, plaque hardens into tartar. Tartar is more difficult to remove.
    Since plaque and tartar contain large amounts of bacteria and can build up along the gum line, the gums can become inflamed with long contact. Inflamed gum tissue appears red and swollen. Over time, the bacteria multiply and the inflammation can widen. Breakdown of the gum tissue from the inflammation and infection can progress to periodontal disease that includes damage to the periodontal ligament and even bone loss around the tooth. Further progression can result in infections affecting the root of the tooth. While there is some individual variability in susceptibility, some dog breeds like the pug, Yorkshire terrier, and Chihuahua are prone to periodontal disease.
    Ideally, pets should be trained as puppies and kittens to allow their teeth to be brushed, but older pets can also be trained. Start simple by getting the pet accustomed to lifting their lip then gradually touching the teeth and gums. Placing a small amount of a food item like peanut butter on the finger can act as a reward to help the process of training.
    The next step is to gently introduce the toothbrush. Use a toothbrush designed for pets. Some pets respond better to finger brushes or pads. Don’t rush the process — make it fun
and give plenty of reward treats. Be cautious if your pet tends to bite. Toothpaste for dogs and cats can have appealing flavors like poultry or seafood and they are safe to swallow. Daily brushing is a lifelong health benefit and worth the effort.
    If brushing just is not possible, many products are designed to remove or reduce plaque. These products can physically rub or scrape off the plaque when chewed. Some products add enzymes or other ingredients that can reduce the amount of bacteria and plaque formation.
    The Veterinary Oral Health Council has developed criteria for accepting products that have been shown to reduce plaque. Look for their acceptance.
    Keep in mind that not all available products have been reviewed by this group, so some basic guidelines for selecting chewable products is important. Avoid hard products like cooked bones or nylon. Chewing on these items can result in broken teeth. Depending on the personality of your pet, avoid products like rawhide chews or dried pig ears that can be partially chewed and swallowed in large pieces. The large pieces can cause chocking or even intestinal blockage. Choosing softer items that are flexible and have an irregular surface may fill the need for something to chew that can help to reduce the plaque. Crunchy foods and chew treats can also be helpful.
    Nutritional support for the tissues in the mouth can help to reduce periodontal disease. Nutrients of interest include vitamin A for healthy mucous membranes and saliva flow; vitamin B12 for its ability to reduce periodontal disease progression; vitamin C for connective tissue repair and reduction in inflammation; vitamin D for calcium absorption, benefits for bones and growing teeth, and anti-inflammatory effects; and vitamin E for reducing inflammation in the mouth tissues.
    It is not possible to keep the mouth completely clear of any plaque or tartar so periodic dental cleanings under anesthesia are necessary. The timing of these cleanings is based on recommendations from your veterinarian following an examination of your pet’s mouth.
    Good oral care is essential for quality health. Contact your veterinarian if you have questions about your pet’s dental health and care.

Celebrating pet companionship
(Dr. Ron Carsten – Glenwood Post 12-24-16)
    Recently, someone told me that they adopted a dog a number of years ago to “replace her son that left home for college.” Of course she told me she was kidding because no one could replace her son, however, she felt the dog did significantly fill the void by giving her companionship.
    It is widely known and accepted that pet companionship improves people’s lives. Benefits that have been documented include improved heart health, lowered blood pressure, slower heart rates, reduced stress and anxiety, fewer doctor visits, enhanced and increased social interactions with people, and reduced levels of depression.
    While current scientific research has identified and continues to define health benefits of pet companionship, appeal of animal companionship has deep historical roots. It is estimated that the domestication of the ancestor of modern dogs occurred 12,000-14,000 years ago. Cats are thought to have begun living with humans about 8,000 years ago. The common assumption has been that domestication of dogs and cats occurred because they performed useful functions such as assisting with hunting, guarding, herding and elimination of mice and other small prey that were considered pests. However, there is archaeological evidence from 12,000 years ago that implies that even in the beginning the human-animal bond was more than just a working relationship.
    The nobility and ruling classes of many societies are known for their pet ownership. For example, the Egyptian pharaohs are frequently shown in murals with pet companions. Chinese emperors and Greek and Roman nobility are also known to have kept pet companions. During the classical Greek period, dog breeding flourished.
    Puppy selection, naming and training were of significant importance. Dogs of young Greek aristocrats are shown wearing collars attached to leashes and accompanying their owners. In Athens, children were given small dogs as pets. Other types of pets including birds, roosters, ducks, geese, hares, goats and fawns were also kept as pets in ancient civilizations.
    During the Middle Ages in Europe, pets were popular among the aristocracy. Noble ladies kept lap dogs while the noble men focused on hunting hounds and falcons. Hunting
with hounds was considered important as a symbol of power and status. This led to the development of dog breeds specifically for pursuing quarry.
    Unfortunately, during the Middle Ages, there was a growing movement against pet ownership. There was fear that pet ownership was associated with pagan worship. This reached a peak during the Inquisition. The witch trials of the 16th and 17th centuries also focused on associations with animals. Ironically, the accused tended to be elderly and socially isolated women who kept animals for companionship. As fears of witchcraft declined, interest in pets regained popularity.
    Pet ownership was not generally accepted until the end of the 17th century; becoming common in the middle classes at the end of the 18th century. Our current pattern of pet ownership is likely derived from the Victorian era.
    While our relationship to animals as companions has evolved and shifted over time, it appears that we again recognize the enjoyable and beneficial aspects of pet companionship. An estimated 62 percent of U.S. households (71 million) own pets. Most people now consider their pets a member of the family. More than 60 percent of households with pets have a Christmas stocking for their pets and give them gifts.
    Ancient Greeks kept dogs in their healing temples because they were thought to cure illness. We now know many of the healing benefits of pet companionship that the Greeks recognized. Dogs again assist with therapy by reducing levels of pain and anxiety among hospitalized children and adults. In assisted living facilities, interaction with dogs leads to more social interactions among residents and less loneliness.
    Pets uplift our lives in innumerable ways. They provide us with unconditional love and nonjudgmental companionship. They raise our spirits when we are down. They ease our anxieties. They improve our health — even watching fish has health benefits. They improve our social life and benefit our human interactions. They provide therapy for the elderly and housebound.
    As you reflect on the holidays, family, friends and pets, take a moment to thank your veterinary health care team. They are a hardworking, compassionate group that strives to care for the needs of your companions. Happy Holidays.
Exercise for dogs is important - especially in winter
(Dr. Ron Carsten – Glenwood Post 11-25-16)
    It is widely recognized that regular exercise is valuable for maintaining good mental and physical health regardless of whether you are a human, dog, cat or any other species of animal. For dogs, exercise is especially important for maintaining heart health, mobility, muscle tone and strength, and controlling weight. Obesity is considered the No. 1 preventable disease in dogs in the U.S. It affects more than 25 percent of dogs. Interestingly, weight reduction in obese dogs is a critical component for managing osteoarthritis (OA). Osteoarthritis is a degenerative process that affects joints. It is considered to be the most common joint disease and the most common cause of chronic pain in dogs. Since obesity worsens OA and makes pain management for OA more difficult, the winter weight gain many dogs experience can be a bigger problem than many recognize. Many dogs gain weight in the winter because they are less active. Not only can increased activity in winter help with weight management, consistent exercise can have beneficial effects on reduction or elimination of behavior problems related to boredom, anxiety and destructive behaviors.
    Winter in western Colorado creates a number of challenges for maintaining an effective exercise routine. The short days with darkness at the beginning and end of the workday, cold temperatures, snow and ice affecting safe footing and busy family schedules related to the holidays contribute to less opportunity for exercise. This often results in a pattern of winter weight gain that is not completely lost during the spring and summer.
     Optimal amounts of exercise are dependent on the dog breed, age and health status. Daily walks provide needed physical activity while providing mental stimulus and opportunity to eliminate. Walking for 30 minutes each day can be sufficient for some dogs, but others may need much more. Some authorities recommend two hours or more of activity per day depending on the breed, age and overall
health. That can be quite a challenge when the outside
temperature is too cold and the footing too unsure because of ice.
    Indoor exercise can range from simple activities that do not require purchasing equipment to the more elaborate that involves specialized equipment like treadmills designed for dogs. Simple activities include games of fetch, hide-n-seek, find the treat, scent work and practicing tricks and training commands. For all of these activities, make sure the activity is safe for the pet. Slipping and falling on slick floors or stairs can result in medical problems. More elaborate activities requiring equipment or rearranging the house involve an indoor agility course or conditioning equipment. Chairs, tables, broom handles and blankets can be used to create an agility course. Couch cushions can be used to create conditioning opportunities. Other activities to consider include play dates with other dogs, doggy day care and dog parks. All dogs should get along so that the interaction is positive while providing quality physical and mental stimulation.
    Keep in mind that any activities you share with your dog should be safe, fun and stimulating for both of you. Involve the whole family whenever possible. However, it is important to consider your dog’s health status when deciding on the activity. For example, don’t expect a dog with a heart condition or one with OA and unmanaged pain to fully participate in an indoor agility course. The proper activity may simply be gentle passive range of motion exercise, three legged stands and standing on the couch cushion. It is also important to strive for optimal pain management or heart support. Be cautious of playing hard all weekend and being relatively inactive during the week. Warm up by walking before intense activity. Maintaining muscle tone with at least 20 minutes of activity three times per week may be beneficial for avoiding injuries like torn cranial cruciate ligaments (ACL).
    If you have questions about what activities are appropriate for your dog, contact your veterinarian.
Feline asthma is a common, serious problem  
(Dr. Ron Carsten – Glenwood Post 10-22-16)
     Feline asthma, also known as allergic airway disease, is the most common respiratory disorder in cats. It is estimated that 1-5% of cats are affected. This means that over 800,000 cats are affected by acute or chronic asthma in the US. Affected cats are often chronically affected and it is thought to be a lifelong problem. The average cat is diagnosed between 4-5 years of age, although it is believed that a low grade inflammatory process starts at a much younger age. Most agree that feline asthma is caused by an allergic reaction to inhaled allergens. This allergic reaction results in inflammation (see last month’s inflammation article) in the small airways of the lungs resulting in swelling that constricts the airway. In addition, mucus accumulation can cause further complications.  
     The intensity of the signs associated with feline asthma can range from mild to severe. Some authorities classify feline asthma into four categories: 1) mild - intermittent signs that do not interfere with normal activity, 2) moderate - signs occur daily but do not interfere with regular activities, 3) severe - debilitating signs that occur daily, and 4) life-threatening - airway constriction so severe that oxygen deprivation occurs and emergency treatment is needed. Difficult breathing may appear as rapid breathing that may include open mouth breathing with the head extended. Wheezing, coughing or hacking may also occur. Episodes often begin suddenly. Severely affected cats focus on trying to “catch their breath” and, in addition to the signs already described, often have excessive breathing effort with the chest and abdominal muscles.
    Diagnosis of feline asthma involves gathering a complete history of the problem, a physical examination, blood tests that include a complete blood count, serum chemistries, and tests for feline leukemia virus, and chest x-rays. Additional tests may include bronchoscopy, culture of airway secretions, feline heartworm tests, and stool exam for parasites. These tests are important because feline asthma is one of a group of lung diseases that can affect cats. A full evaluation is important so that therapy can be focused appropriately on
reducing the airway inflammation and constriction.     
    Effective management of feline asthma requires a range of approaches that are somewhat dependent on the severity. Basic care involves avoidance of the allergen triggers and substances that can affect the airways. This includes avoidance of cigarette smoke (second hand smoke is a major trigger for sensitive cats) and wood smoke especially in the winter. Gradually changing litter to an unscented, dust free or low dust cat litter is important. Use dish soap or vinegar to clean the litter box and rinse well. Avoid chemical sprays, aroma therapies, and scented products. Consider an air purifier. Minimize stress for affected cats. Feed a high quality food and be aware of potential allergic reactions to foods that can complicate the management of the feline asthma problem. 
     The choice of medication for treatment depends on the severity and occurrence of acute episodes. In an acute episode with severe respiratory difficulty, tranquilizers, airway dilators, and oxygen may be needed. While steroids and airway dilators are the central focus of conventional therapy for chronic management of feline asthma, there is concern for increased risk of diabetes and pancreatitis with steroids. It is important to make sure that each cat has been adequately treated for roundworms. Integrative support care also involves reducing the inflammatory reaction in the airways and improving the overall health of the lung tissue. This can help to reduce the need for ongoing or high levels of steroids. Use of vitamins A and C can be supportive of the respiratory lining. Vitamin A must be in the retinoid form found in foods like liver or cod liver oil. Vitamin D plays a role in controlling inflammation. Be cautious to avoid toxicities from too much vitamin A or D. Improved adrenal function and fish oil can aid in reducing inflammation. Probiotic support of the intestinal flora can be beneficial in supporting the immune system. Essential oils should be avoided because they may aggravate feline asthma and because cats are more sensitive to potentially toxic effects of the compounds found in some essential oils.
     Contact your veterinarian if you have questions about feline asthma.
Chronic inflammation can negatively impact health
(Dr. Ron Carsten – Glenwood Post 9-24-16)   
    Inflammation is a process that is critical for good health, but too much inflammation can cause damage.
     Our understanding of inflammation has grown significantly since the ancient physicians described it as redness, swelling, heat, pain and loss of function. We now know that these ancient observations are the result of a complex sequence of cell and chemical reactions that leads to increased blood flow to the affected area (redness and heat), increased leakage of fluid and cells from blood vessels (swelling), tissue damage from the initial insult or from the inflammatory response (pain) and reduced mobility from swelling or loss of cells to injury (loss of function).
     The ancient physicians saw inflammation as a beneficial part of the healing process. In contrast, during the last century, many viewed inflammation as an undesirable process that had damaging effects. Modern understanding of inflammation now recognizes that inflammation has both good and bad aspects.
     The good aspect of inflammation is that it is an essential part of the body’s normal defense and repair processes. Inflammation is triggered whenever tissues are damaged. Damage can be caused by insults like trauma or infections.
     Since the majority of the defense cells and defense chemicals are found in the bloodstream, an important sequence of events is initiated when injury occurs. These events allow the blood vessels to dilate and become leaky so that defensive cells and substances begin to arrive at the site of injury quickly. The focus of this process is to limit the spread of damaging organisms, dispose of dead and damaged cells, eliminate any bacteria that are present, and facilitate tissue repair and restoration of function.
     Without the inflammation, the immune system would not be able to respond properly and the body would not be able to effectively heal after injury. From this perspective, inflammation is clearly essential for health.
     The beneficial events of inflammation occur rapidly following an injury, and once the problem is resolved, the process of inflammation should stop. When it becomes an ongoing or chronic process, the bad aspects of inflammation can occur.
     In some conditions, the process of inflammation does not resolve and can become a long-term or even a lifelong
problem. Examples of problems where chronic inflammation can play a role include inflammatory bowel disease, osteoarthritis, heart disease, kidney disease, cranial crucial ligament injury and cancer.
     In some situations the injury or infection is ongoing, preventing resolution of the inflammation. For example, a disrupted intestinal microbiome (see last month’s probiotic article), can lead to a chronic inflammatory condition in the intestinal wall leading to inflammatory bowel disease. In other situations, the processes that turn off the inflammation fail to effectively stop the inflammatory process. For example, poor adrenal gland function can contribute to low cortisol production and ineffective dampening of the inflammation. Deficiency of certain nutrients including vitamin D can also result in inadequate control of inflammation.
     Clearly, addressing the source of the inflammation is critical for effective control. This could involve the use of antibiotics for a bacterial infection if an infection was the source of inflammation. Unfortunately it is not always possible to identify the source of inflammation, making it essential to support the normal processes that help to control the inflammatory process. Important areas of the body to support include the intestinal tract, intestinal microbiome, adrenal glands and liver. Each of these areas of the body has a direct or indirect influence on the inflammatory process. Nutrients of importance include vitamins A, C, and D, glutamine, and n3 fatty acids like fish oil.
     Nonsteroidal anti-inflammatory drugs like carprofen (Rimadyl) are commonly used for osteoarthritis in the dog. They are anti-inflammatory and help reduce pain. Steroid drugs like prednisone are also commonly used to control inflammatory conditions. Numerous herbs and spices have anti-inflammatory properties. Some like boswellia and turmeric have gained widespread use for inflammatory joint conditions like osteoarthritis. In addition, certain herbs are showing benefits for inflammatory bowel disease and other generalized inflammatory conditions. Each herb or drug has advantages and disadvantages. Unfortunately, the doses and tissue distribution of most herbs has not been adequately determined.
     If you have questions or concerns about inflammatory conditions in your pet, contact your veterinarian.
Probiotics provide important benefits 
(Dr. Ron Carsten – Glenwood Post 8-27-16)
    How likely would you be to give a pill to your pet that could speed up the recovery from episodes of diarrhea, help with allergic skin problems, assist the body to deal with stressful situations, support the immune system and improve the immune response to vaccinations? This sounds like a tale that is unbelievable, but, it is true.
    A growing number of studies have shown that probiotics can deliver these beneficial effects in humans and animals. Probiotics are living organisms that confer health benefits in addition to their basic nutritional value.
     Probiotics contribute to improvements in intestinal and immune function because they can exert positive effects on the gut microbiome. The gut microbiome is a collection of living microorganisms such as bacteria, fungi, archaea and protozoa. It is estimated that there are 10 times more microorganisms in the gut than there are cells in the entire animal body. Bacteria are a significant part of the microbiome of the gut, and it is no surprise that there is an incredible variety of bacteria types.
    This vast variety of microorganisms results in a complex interaction between the microorganisms in the microbiome. Some of these interactions have been determined but many remain to be identified and understood. In addition, the microorganisms can form a defensive barrier against bad bacteria such as E. coli and salmonella, help to breakdown nutrients in the diet, provide important nutrients for intestinal cells and the body, and regulate the immune system.
    The balance of the microbiome is constantly being impacted by factors like stress, altered secretions and motility of the gut, antibiotic use, consumption of certain foods or diet changes, and colonization with bad bacteria. Changes in the microbiome can result in alterations in the intestinal barrier, absorption of nutrients and vitamins, and proper metabolism of bile acids and soluble fiber. In addition, an altered microbiome can result in toxic substances passed in the bile being absorbed back into the body.
    Interestingly, dogs with chronic intestinal problems have been shown to have changes in the microbiome. Some of the bacterial groups that are significantly reduced are ones that produce short-chain fatty acids which play an important role in the health of the large intestine. Other bacterial groups that secrete metabolites with anti-inflammatory properties
 have also been shown to be reduced in individuals with inflammatory bowel disease.
    With the increased understanding of the importance of the gut microbiome and the realization that many disease processes can result from an abnormal microbiome, the use of probiotic products to support the microbiome has dramatically expanded. Numerous probiotic products are available, making selection of the appropriate product difficult.
    General guidelines for probiotic selection includes 1) ability of the microorganism to survive passage through the stomach, 2) ability of the microorganism to establish itself on the lining of the intestine, 3) number of strains of microorganisms in the product, 4) number of viable microorganisms in each product dose, and 5) does the product contain a prebiotic.
    Ability of the microorganisms to survive passage through the stomach and establish colonies on the intestinal lining is critical. Not all microorganisms can survive the acid in the stomach. For example, microorganisms in yogurt, unless specifically included as a probiotic microorganism, are generally not considered likely to be able to establish in the intestines. Some probiotics products contain one or a handful of microorganism strains while others contain 10-14 strains.
    The argument is that products with lots of strains are better. However, this has not been uniformly accepted as an important criterion. Successful therapy with products with a small number of strains has been shown. An additional consideration is the number of microorganisms in each dose of the probiotic. A common recommendation is 3-4 billion microorganisms per dose. Prebiotics are substances that feed the good bacteria and help them to establish. Some prebiotics like FOS (fructooligosaccharides) can also have suppressive effects on bad bacteria.
    Another consideration focuses on the question of giving animals probiotics that are intended for humans. Some have argued that these products are not effective in animals, but, research and clinical experience show that these products can be effective in animals. Products intended for animal use have not always performed better.
    As the understanding of the gut microbiome increases, the selection of microorganism strains for specific health problems will become possible. This will result in more effective therapeutic use of probiotic products for health maintenance.
Back problems in cats can significantly reduce their quality of life (Dr. Ron Carsten – Glenwood Post 8-2-16)    
    Intervertebral disc disease (IVDD) in dogs is well recognized with an estimated 2.3 percent of dogs affected. In cats, the incidence is generally considered to be low with an estimated 0.02-0.12 percent of cats. These low estimates are likely a reflection of how good cats are at hiding the disability and pain caused by IVDD. With the increasing awareness of chronic pain in cats, there is a growing recognition of the prevalence of conditions like degenerative joint disease and spinal disorders in cats leading many authorities to believe that IVDD is much more common in cats than earlier estimates. This is supported by autopsy evaluations that show disc rupture and herniation are common and generally found in middle-age to older cats. The discs in the spine of the chest (thorax) and lower back (lumbar) are most often affected. Disc degeneration generally leads to degeneration of the small joints of the spine and formation of bone spurs that can, when severe, bridge between vertebrae.
    In one study, the most severely affected area for IVDD was the lumbosacral (LS) disc. The LS disc lies between the last lumbar vertebra and the sacrum. This is the area at the front of the pelvis. Disease of the LS area is complex and can involve disc protrusion, degeneration of the articular areas of the vertebra, and thickening of the associated soft tissues. Some of the associated soft tissues are inside the spinal canal, and the thickening results in narrowing of the spinal canal. Problems with the disc and instability of this area of the spine can result in pain from degeneration and nerve impingement.
    By some estimates, cats with LS disease are generally 8 years of age and older. Affected cats compensate for weakness and pain in the rear limbs by reducing their activity, discontinuing jumping, and by pulling themselves up onto furniture using their front limbs. This effort to compensate often leads to overuse of muscles associated 
with the front limbs, which can cause some amount of discomfort. Depending on the level of discomfort and dysfunction with the LS area, these cats may have difficulty even getting into the litter box to defecate and urinate, especially if the box has high sides. In addition, they often have difficulty posturing to eliminate. As a result, many affected cats will eliminate outside of the litter box.
    Cats with these signs should have a full evaluation, because there are other problems that can affect this part of the spine and result in a pattern of dysfunction similar to LS disease. These problems include infectious disease, inflammatory problems, injuries, vascular problems and cancer. Evaluation should include a complete history of the problem, physical examination, neurological examination, blood and urine testing, and X-rays. These tests are a valuable part of the evaluation, but definitive diagnosis typically involves MRI studies.
    Treatment recommendations for cats with LS disease generally involve pain management medications, control of inflammation, weight reduction as needed, and possibly surgery to remove herniated disc material and stabilize the affected vertebra. While the number of medications available for pain management is growing for the cat, options for long-term management are still limited. Integrative supportive care involves the use of osteopathic or chiropractic manipulations, acupuncture, laser therapy, rehabilitation therapies, homeopathic remedies and nutritional supplements. Supplements that may be beneficial include glucosamine, fish oil (n-3 fatty acids), vitamins C, E and A, and minerals like manganese. Since this is a degenerative problem, ongoing supportive therapy and pain management are needed with the goal of maintaining quality of life.
    If you have questions or concerns about back pain and dysfunction in your cat, contact your veterinarian.
Cause of dog seizures can be hard to determine
(Ron Carsten – Glenwood Post 6-25-16)       
    The most common neurological condition in dogs is the seizure, which affects approximately 1 percent of dogs. A seizure is caused by abnormal electrical discharges from brain cells that result in uncontrolled muscle activity seen as involuntary jerking movements of the head and limbs. Excessive drooling can occur, along with voiding urine or stool.
    Seizures generally start and stop suddenly and last a few minutes or less. Immediately after a seizure, the dog may be uncoordinated, temporarily blind, appear confused or disoriented, restless or even aggressive. This can last for minutes to hours. Affected dogs can seem completely normal between seizures.
    Often the cause of seizures can be challenging to determine because numerous abnormalities in the body can trigger seizures. These include abnormal organ function, environmental toxins or abnormalities in the brain itself. Examples of organ dysfunction that can lead to seizures include liver disease, kidney disease, low blood glucose levels or heart disease. Problems with the brain itself include infections and tumors.
    Brain tumors are not uncommon in older dogs. Unfortunately, growing numbers of young dogs have brain tumors. Certain breeds like the Boxer, Boston Terriers and English Bulldogs are predisposed to developing brain tumors. While the neurological signs of a brain tumor vary considerably, seizures can be one of the signs.
    With the wide range of causes for seizures, a complete work-up including physical examination, neurological examination, blood tests and urinalysis should be performed. Based on the results of these tests, additional testing may be recommended. This might include evaluation of the heart, if indicated, or specialized imaging like MRI or CT scans of the brain.
    Ideal management of seizures depends on a clear diagnosis; however, this is not always possible even with extensive evaluation.
    Once other possible causes are eliminated, a diagnosis of idiopathic epilepsy is often made. Idiopathic epilepsy is the
most common cause of seizures, affecting 80 percent of dogs with seizures. Idiopathic means that the cause cannot be determined. Some authorities feel that there may be an inherited aspect to idiopathic epilepsy with beagles, collies, Labrador Retrievers and Golden Retrievers commonly affected, but it can occur in any breed.
    When a seizure occurs, remain calm and note the time that the seizure started. Make sure the pet is on the floor and away from water, stairs, other pets and children. Pets are not at risk of swallowing their tongue, so do not reach into their mouth during a seizure. If the seizure lasts longer than 5 minutes or there are multiple seizures in a day, contact your veterinarian. A single seizure that lasts only a few minutes is generally not dangerous. There is more concern when there are multiple seizures within a short period or if the seizures continue for longer than a few minutes. Prolonged seizures can result in elevated body temperature, which can lead to other problems.
    Therapy should be directed at the cause of the seizure. For example, if the primary problem is low blood glucose, this should be corrected.
    Deciding when to start anticonvulsant treatment depends on the frequency, severity and diagnosis. The goal of anticonvulsant drug therapy is to reduce seizure frequency to an acceptable level because it is not always possible to completely prevent all seizures. About 30 percent of dogs with idiopathic epilepsy do not respond to anticonvulsant therapy.
    There are a number of commonly used anticonvulsants and combinations of anticonvulsants. Each has advantages and disadvantages including cost and side-effects. Integrative support for the seizure patient includes supplements and herbs for organs that are impacted by the side-effects of anticonvulsants. For example, phenobarbital can cause liver problems and herbs like milk thistle may be beneficial for supporting the liver. Other supportive care for seizure patients includes evaluating alignment of the neck, nutritional supplements, acupuncture and Chinese herbs.
    Contact your veterinarian if you have questions about seizures in dogs.

Kittens need nurturing during development
(Ron Carsten – Glenwood Post 5-28-16)   
    Kittens, like puppies, need to be nurtured in specific ways during their development to avoid behavior challenges later in life. Some authorities believe that kittens learn to become cats from their mothers and siblings before they are 8 weeks old.
    Further, behavior lessons not learned during this time may never be learned. The socialization period occurs when kittens are very young. This period can have a significant impact on later life experiences.
    Kittens are born completely dependent; they cannot regulate their own body temperature, they cannot see or hear, and they cannot move more than a few inches without assistance. They progress from this beginning to become incredibly athletic individuals that have sensitive hearing, ability to see in very low light conditions and have a heightened sense of smell.
    The foundation for this transformation occurs in a few short weeks. Tactile sensitivity and sense of smell are present at birth and are important for locating the nipple during nursing. Purring begins on day two. Eyelids open by two weeks. Smell becomes well developed by three weeks. Teeth erupt during week four, and kittens can orientate to sounds. Walking and running skills improve during weeks four and five, and kittens can begin to stalk and pounce. Weaning is completed by weeks six to eight. Motor skills continue to improve and reach maturation at about weeks 10-11.
    The period for socialization in cats is much earlier than dogs. This period starts in week two when eyes and ears open and are functioning. Some advocate handling kittens gently for a few minutes several times per day starting in the second week and gradually increasing the time as the kittens continue to age.
    Make sure that the mother is accepting of this handling. Handling kittens for only 15 minutes per day from birth to 12-14 weeks of age produces kittens that are more interested
in people. Interestingly, in one study, handling kittens for 40 minutes per day resulted in kittens that would more enthusiastically approach people and stay in their laps longer than kittens handled for 15 minutes per day.
    Another benefit of handling kittens regularly from birth to 45 days is that they appear to be more confident later in life. They will approach unfamiliar objects rapidly and spend more time with the objects when they are four to seven months of age. Kittens handled by numerous people from five and a half to nine and a half weeks show less fear and more interest in people later.
    Ideally, kittens should be handled by men, women and children so that they form a general picture of the human race. Kittens exposed to only one gender have a tendency to be fearful of the other gender.
    It is essential to recognize the importance of the mother cat in the socialization process. Studies show that kittens separated from the mother at two weeks are fearful and aggressive to other cats and humans. They also appear to learn poorly. Social play between kittens is also critical and begins during weeks three and four. A well-socialized kitten should also be exposed safely to other species. Kittens exposed safely to another species, such as a dog, at four weeks, will show no fear of the other species when the kitten reaches 12 weeks.
    It is clear from the research that gentle handling of kittens early in life is important for later quality of life. In addition, with the rapid growth and developmental changes that occur with kittens, quality, balanced nutrition is essential. Foods that contain nutrients that benefit brain development and function may provide added benefits. For example, fish oil and B complex vitamins have been shown to support brain development. Preventive health care for intestinal parasites and vaccinations should be used to avoid periods of illness during these important growth and development stages.
    If you have questions about your kitten, contact your veterinarian.
Puppies undergo fast physical, mental development
(Ron Carsten – Glenwood Post 4-23-16)
    Nurturing a puppy into a healthy and happy adult requires basic understanding of puppy development. Raising a well-socialized and content dog avoids problems associated with a fearful or aggressive dog.  During certain phases of puppy development, puppies are prone to fear reactions that can imprint for life.  At other phases, they are learning and are very receptive to training. Since experiences in the early part of a puppy’s life can have significant impacts on later quality of life and health, understanding puppy development during the first months of life is critical.
    Puppies are born relatively helpless, unable to see or hear, unable to control their own body temperature, and barely able to move on their own.  They progress from this dependency to eating softened food, responding to taste and smell, and beginning to explore their environment during the first month of life.  Their learning and awareness changes rapidly and, by some estimates, a 5 month old puppy is equivalent to a 10 year old child.  It is clear that there is a tremendous rate of change in a relatively short time.
    During the 3rd week of life, puppies begin to learn and remember what they have learned.  Since they are becoming aware of their environment, they can startle easily with loud sounds and sudden movements.  Startling events at this stage can be imprinted and affect a puppy lifelong.  Social bonding begins to occur.  Orientation to visual and auditory stimuli occurs and they begin to recognize familiar stimuli. Puppies begin to eliminate in a group elimination area.  From week 3-7, puppies begin to learn dog behaviors like chasing, barking, biting, and body postures.  They are gaining co-ordination skills, problem solving, bite inhibition, and important socialization skills.  In addition, they are learning and accepting discipline from mom and learning submissive body postures.  These skills are critical for later life because they set the foundation for interacting with other dogs and for accepting training from humans. 
    The amount and complexity of appropriate stimulus in a puppy’s environment can have an affect on their rate of development.  Providing safe exposure to other people, pets, and new situations that require problem solving are important during the socialization 
period that can last into week 12.  Lack of appropriate socialization can lead to difficult fear and/or aggressive behaviors later in life.  During this time, a puppy’s mental abilities are fully formed and they are learning fast.  Behaviors can be shaped and modified. Training helps increase mental capacity by stimulating brain cells in important brain regions.  However, it is vital to recognize that puppies also have a heightened susceptibility to fear during weeks 8-10.  This means that emotionally and physically traumatic situations should be avoided.  Learning at this age is considered permanent.  Training should be short sessions that are kept positive.  Necessary medical care should be turned into fun visits.
     From 3-4 months, puppies are becoming more independent and trying to figure out who is in charge.  This makes it important to continue to provide a safe, structured environment as your puppy works through this transition period.  By 16 weeks, it is thought that a puppy’s brain is 80% developed but their emotional development is completed.
     During the 4-8 month period, puppies become more independent, act out, and can be more stubborn.  They seem to forget all their previous training and act like “rebellious teenagers.”  Understanding that this stage will occur, helps with the transition through it.  Continuing to have a calm and safe environment while gently reinforcing training will reduce frustrations during this time.
    As you can see, there are significant changes that happen in puppy development over a very short period of time.  Recognizing the developmental phases provides an opportunity to help puppy grow into a well-adjusted, well-socialized adult dog.  Training requires a gentle persistence.  Keep in mind that medical issues such as teething can be a distraction from learning. 
    Puppies are lots of fun and a big responsibility.  During this early part of life, proper veterinary care is important.  Veterinary care can be facilitated with home training that includes examining the teeth, ears, and eyes as well as handling the paws.  Brushing the teeth daily is also an important part of training.  Quality nutrition is essential for body growth and support of the developing puppy brain.  Contact your veterinarian if you have questions about your puppy.
Essential oils can be toxic to cats
(Ron Carsten – Glenwood Post 3-26-16)
    Essential oils are be coming increasingly popular for medicinal uses. They have a long history of use in humans and are now gaining widening acceptance as a therapeutic approach in animals.
     There is a long list of proposed therapeutic uses ranging from treating bacterial and viral infections to reducing nausea, controlling inflammatory conditions and managing pain. There are approximately 400 aromatic plants that are processed for commercial use. The essential oils derived from these plants contain a mixture of volatile organic compounds that contribute to the flavor and fragrance of the plant. Additionally, many of these compounds have therapeutic value.
    Extraction of essential oils includes steam distillation, solvent extraction and, more recently, CO2 extraction. Each of these methods has advantages and disadvantages that can affect on the quality of the essential oil, especially if it is intended for therapeutic use. Therapeutic essential oils should be free of contaminants, including solvents and pesticide residues.
     Therapy can be performed through inhalation with a diffuser, through the skin with topical application and/or by mouth in animals. While many of the compounds in essential oils have been shown to have effects in cell culture, therapeutic effects in people and animals have not been completely studied. However, it is important to note that clinical experiences, in combination with mechanism of action studies, have provided valuable insights into the potential for therapeutic benefits.
     With the growing interest in essential oil therapy for animals, it is important to consider the potential benefits and problems for a species like the cat. Cats are considered strict carnivores and have evolved differently than dogs and humans in regard to how efficiently they metabolize chemicals like phenols and terpenes found in certain foods and certain drugs.
    The enzyme glucuronyl transferase, which is critical for efficient elimination of these chemicals, is deficient in cats. Toxicology studies have shown that it can take 48 hours for the liver to process these compounds using other enzymes. This means that cats are slow at removing drugs like aspirin, acetaminophen and certain compounds found in essential
oils. As a result, cats are more susceptible to becoming toxic from these compounds than other animals like the dog.
    Since essential oils contain a wide range of chemical compounds, it is important to understand the chemistry of each essential oil to determine the potential for toxicity, the therapeutic use, and the optimal dose and method of treatment. While some essential oils appear to be relatively safe for cats, the use of essential oils in cats has become controversial.
    Some advocate the use of any essential oil with the idea that it is natural and therefore safe, especially if it is highly diluted. This is an erroneous assumption. Others recommend using only very small doses of very diluted essential oils in cats in an attempt to avoid toxicity. Still others are adamantly opposed to using any essential oils in cats.
    The most rational approach centers on understanding the compounds found in each oil and determining which essential oils represent small or limited risk for toxicity in cats. These essential oils can be diluted and in some cases given infrequently enough to allow appropriate elimination from the body.
    This approach allows for the careful use of essential oils in cats to achieve therapeutic goals while striving for safety. Examples of essential oils that are considered relatively safe in cats include frankincense, clary sage and helichrysum. However, it is important to use caution when using even the essential oils considered safe, especially in a cat that may have an illness that further inhibits the ability to process the essential oil.
    Examples of essential oils that are considered unsafe for cats include citronella, tea tree, clove, pennyroyal, oregano, pine and wintergreen. Keep in mind that this is only a short list of essential oils that are not considered safe. There are many others. General signs of a possible toxicity in cats can include lethargy, loss of appetite, vomiting and diarrhea.
    Once all the factors are considered regarding the ability of cats to detoxify and the chemistry of the essential oils, caution should be used when choosing essential oil therapy for cats. Careful selection of essential oils, small doses, large dilutions and infrequent applications may reduce some of the potential risk. Before initiating the use of essential oils in cats, seek the advice of someone experienced in their use.

Pets grieve for their companions
(Ron Carsten – Glenwood Post 2-28-16)
     In her book, “How Animals Grieve,” Barbara J. King describes grief behaviors in a variety of animal species ranging from cats and dogs to chimpanzees.  She uses observations of animal behaviors to illuminate their capacity to grieve.  From her descriptions, it is clear that there are variations in the expression of grief between species and even among individuals of the same species; however, there are some common patterns.    
    Grief is a firmly accepted response to loss in humans.  It is the result of the emotional suffering experienced when someone or something you love is taken away.  The intensity of the grief is related to the significance of the loss.  Death of a loved one is often the cause of the most intense grief, however, there are many causes of grief, including loss of health, retirement, and selling a home.  While grief has been divided into 5 stages, not everyone experiences all stages and there is no defined time line for grief.  Grieving for humans is an individual process just as it is for animals.
    While it is clear that humans grieve, the recognition that animals grieve has not always been accepted.  There have been concerns about inappropriately attributing human emotions to animals.  This concern, in conjunction with challenges in defining what grief looks like in animals, has slowed acceptance that animals grieve.
    The American Society for the Prevention of Cruelty to Animals (ASPCA) completed a study in 1996 investigating the expression of grief in dogs and cats.  This study was prompted by calls to the Companion Animal Services’ Behavior Helpline seeking guidance for pets exhibiting grieving behaviors over the loss of another household pet. The Companion Animal Mourning Project evaluated the response of surviving dogs and cats after the loss of another pet in the household.  Over 65% of pets showed 4 or more behavioral changes.  Identified behavior changes included reduced or loss of appetite, seeking more attention from
owners, increased or decreased vocalization, and changes in sleeping places and habits. Other authorities also discuss lack of interest in everyday activities, searching for the deceased pet, and loss of interest in play behaviors.  In the ASPCA study, 63% of dogs changed vocalization patterns, over 50% of dogs and cats were more affectionate, and 36% of dogs and 46% of cats ate less food with 11% of dogs and 8% of cats completely stopped eating.  Since grief is a manifestation of distress associated with loss of a loved one, the length of time that grieving occurs varied from weeks to over 6 months.        
     Common recommendations for helping a pet with their grieving include monitoring them closely for changes, maintaining normal daily routines, providing more attention to the grieving pet if the pet is seeking more attention, encouraging more exercise and play, rewarding calm and relaxed behaviors, and keeping your own anxiety and stress in balance.  Keep in mind that these are general recommendations, and the best approach is to tailor the interactions to the needs of each pet.  For example, some pets do not want more affection or attention and forcing unwelcome attention can cause unnecessary distress.  Avoid getting a new pet until the grieving process is completed.
     Since common medical problems can lead to behavior changes, seek veterinary care if behaviors seem extreme or continue for an unreasonable period of time.  It is important to identify and initiate treatment for any underlying medical conditions.  Prolonged periods of not eating in cats can be a serious problem and may require medical intervention.  Other recommendations for support for the grieving process include the use of Bach Flower Remedies, pheromone containing products, nutritional supplements that support the adrenal glands, carefully selected herbs, and in some cases appropriate drug therapy may be indicated.
     If you have questions or concerns about your pet, contact your veterinarian for additional information.  

Intervertebral disc disease a threat to dogs
(Ron Carsten – Glenwood Post 1-22-16)
     Intervertebral disc disease (IVDD) is the most common neurological problem in dogs. It can result in problems ranging from pain and mild nerve dysfunction to complete paralysis. In addition, the onset can range from very rapid or more gradual, occurring over a longer period of time.
    The pain can result in a reluctance to move, loss of appetite, or vocalizing when touched or moved. Nerve damage can result in weakness, loss of urine and bowel control, and if severe enough, an inability to walk. Clearly IVDD can be a very serious problem.
     Intervertebral discs are positioned between the vertebrae (bones of the spine) of the back and neck. They stabilize and act as a cushion between the vertebrae. Each disc has an outer fibrous layer and a gel-like center. As dogs age, discs undergo a process of degeneration where the central gel loses its fluid and is less able to recover or withstand normal mechanical stresses. The outer, fibrous portion also weakens and becomes stiffer.
     As the degenerative changes advance in dogs with IVDD, the central gel part can bulge into or rupture through the outer layer. This more severe manifestation of degeneration and can lead to disc material pressing against the spinal cord or the adjacent nerve roots, causing pain and nerve damage. Bulging or rupture can sometimes occur slowly, often leading to milder problems. Other times the disc bulge or rupture can occur rapidly, causing more severe signs.
     It is generally difficult to identify a single event such as jumping or aggressive play that results in a bulging or ruptured disc. This is because the problem is thought to be caused by a combination of normal activity and normal mechanical stresses on a weakened, degenerated disc. It is also interesting to note that the majority of dogs will experience a progressive deterioration over a few hours or days rather than sudden paralysis. Some dogs experience recurrent episodes of pain or nerve deficits over months or even years.
     Some dog breeds are predisposed to IVDD. The chondrodystrophic dog breeds — those with the short legs with angular deformities like the dachshund, bulldog, basset hounds, corgis, and shih tzus are genetically programmed to undergo disc degeneration starting at an early age. Generally, these breeds are affected in middle age (4-8 years)
but it is not uncommon for 2- to 3-year-old dogs to have disc problems.
     Episodes in the chondrodystrophic breeds tend to be an acute, explosive rupture of the disc leading to neck or back pain, depending on which disc is involved. Severity of the injury to the spinal cord and location of the affected disc dictates the type of nerve dysfunction seen. In dog breeds that are not chondrodystrophic, such as German shepherds, Labrador retrievers and Dobermans, the IVDD involves a gradual herniation of the disc material in older dogs (8-10 years of age). The most common area of the spine that is affected is near the last rib. Other areas that are less commonly affected include the middle of the neck and the spine near the pelvis.
     A grading system for severity has been developed to help in making diagnostic and treatment decisions. Grades run from painful with no neurological deficits to complete paralysis and loss of bowel and urine control. Diagnosis is based on the history, physical examination and neurological examination, along with some combination of imaging techniques like X-rays, myelograms, CT scans or MRI. The thoroughness of evaluation for diagnosis depends on a number of factors including the severity and treatment decisions like surgery.
     Treatment depends on severity and can range from conservative treatment that includes confinement, anti-inflammatory drugs and pain medications as needed, manual therapies, acupuncture and therapeutic laser to emergency surgery to remove the problem disc material. Some studies are showing that electroacupuncture alone or in combination with surgery has been more effective than surgery alone in severely affected dogs. Electroacupuncture in conjunction with corticosteroids appears to improve the speed of recovery. Therapeutic laser can improve nerve regeneration and tissue healing along with benefiting pain management. Herbs and nutritional supplements that support healing and the adrenal glands can be an important part of the recovery process. Rehabilitation therapies can also facilitate recovery.
     IVDD in the dog can be a challenging and catastrophic problem to address. Early supportive care is important. If you have questions about IVDD, contact your veterinarian for additional discussion.

Owning a pet can improve your health
(Ron Carsten – Glenwood Post 12-26-15)
    The holidays are a time for family and friends to share food, gifts and companionship. It is also a time to acknowledge the pets that are part of our families.
     A growing body of scientific evidence supports the long-held belief that pet companions benefit human health. These health benefits include improved quality of life, better cardiovascular health, lowered risk of obesity, reduced stress and anxiety, and less depression. Nothing compares to the unconditional love that pets offer.
     The number of pet dogs and cats in the U.S. has risen from an estimated 40 million in 1967 to more than 160 million in 2006. Approximately two-thirds of U.S. households own at least one pet.
     Archeological evidence indicates that this relationship between humans and pets has existed for at least 12,000 years. These numbers tell a significant story about the human-animal bond. Research has shown that human-dog interactions create the same oxytocin feedback loop seen between mothers and their infants. While this oxytocin-fueled bond has contributed to the enduring relationship between humans and pets, pet companions offer many beneficial effects on humans. Recognition and understanding of these benefits continues to increase as more research is completed. It is important to note that dogs and cats are not the only pets that contribute health benefits through their companionship and interaction with humans.
     Results of a recently released study by the Human Animal Bond Research Institute estimates that $11.7 billion is saved on U.S. health care annually as a result of pet companionship. The largest amount of saving comes from fewer physician visits by pet owners compared to non-pet owners. This equates to an estimated saving of $11.37 billion in health-care costs. In addition, dog owners that walk their dogs five or more times per week have a lower incidence of obesity, saving an estimated $419 million in health-care costs.
     A study paid for by the National Institute of Health found that adults suffering from heart attacks, regardless of the severity, were more likely to be alive a year later if they owned a dog compared with those not owning a dog. In another study, married couples with pets were found to have
lower heart rates and blood pressure at rest and when undergoing stress tests. Interestingly, pet owners had milder reactions and recovered faster from stress when they were with their pets than when they were with their spouse or a friend.
     Dog owners typically get more exercise, are less likely to be obese, and tend to walk further and faster than those who did not walk regularly. Elderly dog walkers tended to be more mobile in their homes. In addition, dog walking leads to increased conversation and social interaction with others. People with more social relationships generally live longer and have less physical and mental declines as they age.
     Children also benefit from pet companionship. They generally have improved immunity, are less likely to have allergies, and have increased empathy for others. Also, children who are emotionally attached to their pets are better at building relationships with other people. From a therapeutic perspective, dogs can help calm hyperactive or overly aggressive children; of course supervision and proper training should be a component.
     Animal-assisted therapy programs are becoming more widely available as the benefits of the human-animal bond are increasingly recognized. These programs have provided an important function for children in K-12 programs, college students, and for patients in hospitals and nursing homes. At-risk children, those in need of improvements in areas like self-confidence, self-esteem, motivation, empathy and behavior control have benefited. For individuals hospitalized or in nursing homes, animal-assisted therapy has improved patient moods and reduced anxiety.
    As scientific investigation into the health benefits of pet companionship increases, new information will continue to emerge that further defines the essential role that these companions play in our daily lives. However, it is critical to understand that pet ownership is a long-term commitment that requires diligence, motivation and careful thought. Pets need fresh food and water daily, exercise, training, routine veterinary care and, as their lives progress, geriatric health care similar to humans.
     In this season of sharing, take a moment to hug that pet that provides unconditional love. You will get back so much in return.
Holidays can be hazardous for your pets
(Ron Carsten – Glenwood Post 11-28-15)
     The holidays are a time of excitement and fun as family and friends gather for season’s greetings, meals and gifts. Unfortunately, it can also be a time of stress for many family pets when their daily routines change, holiday decorations alter the home, visitors arrive and unfamiliar activities occur. Added to this is the fact that some holiday decorations, ornaments, plants and foods can be health hazards for pets. Understanding some of the common holiday risks and taking steps to avoid problems can help to ensure pet safety and happiness during this busy time.
    When decorating your home, take steps that ensure pet safety by preventing access to electrical cords, ribbons, strings, tinsel and small ornaments. Chewing a plugged-in electrical cord could result in electrical burns, shock or even death; ingesting parts of an electrical cord, ribbons, tinsel or ornaments could result in stomach or intestinal problems. Once ingested, the problem may be minor, resulting in irritation and limited vomiting followed by a rapid recovery — or the problem could be major, requiring surgery to remove the ingested object. In addition to potential digestive tract injury, some ornaments contain toxic materials.
    Toxicity can also occur from ingestion of certain holiday-season plants. These plants include the poinsettia, lilies, holly and mistletoe. Poinsettia is now considered to be only mildly toxic; therefore, it is much less of a concern than other common holiday season plants. One or two bites of lily, often used in holiday bouquets, can result in kidney failure in cats. Some authorities even feel that the water in the flower vase containing lilies can be toxic. Christmas and English holly have spiny leaves that can upset the digestive tract and they contain potentially toxic compounds. The Japanese Yew, used for wreaths, contains a toxic compound that can cause dizziness, abnormal heart rate, coma and even death.
    While not a holiday-season plant, pet exposure to marijuana has also increased. Dogs and cats can be intoxicated through ingestion of marijuana, marijuana-containing products or by secondhand smoke. Signs of intoxication are generally seen within three hours and can include an unsteady gait, severe depression, coma, low heart rate, hyperactivity and seizures. The effects on pets are not fully understood, but they appear to be more sensitive
to the effects of tetrahydrocannabinol, marijuana’s active ingredient. Since emergency room visits for intoxicated pets have been rising, caution should be used to prevent accidental exposure or ingestion.
    Keep in mind that some holiday foods can cause a simple digestive upset because the pet is not used to them. Other foods are not safe for pets. Avoid chocolate and cocoa. They contain a chemical that is considered to be highly toxic to dogs and cats. Sugarless gums and candies that contain the sweetener xylitol should be avoided. Xylitol can cause a life-threatening drop in blood sugar and liver failure.
    Fatty leftovers may increase the potential for developing pancreatitis leading to abdominal pain, vomitin, and diarrhea. Undercooked foods or foods that have been allowed to sit for extended periods may provide the opportunity for bacteria like Salmonella or E. coli to grow. These organisms have the potential to cause food poisoning or bacterial contamination resulting in severe intestinal problems and illness.
    According to Colorado State University Extension, when the room temperature is less than 90 degrees Fahrenheit, food should not be left out for more than two hours and cooked leftovers should be used within four days. Onions and garlic pose a danger. Cats are more sensitive than dogs, and depending on the amount ingested and the sensitivity of the individual, damage to red blood cells can occur along with nausea, vomiting and diarrhea. It is best to be cautious and keep your pets on their regular foods even though it is tempting to give them treats.
    Ice-melt products can cause contact skin irritation and digestive upset when small amounts are ingested. Ingesting larger amounts may lead to salt poisoning, vomiting and seizures.
     It is important to recognize that this season can be stressful to pets. Take time to maintain their normal routines. Spend as much time with them as possible. Consider using stress-relieving products like Rescue Remedy for dogs and cats or products containing appeasing pheromones like Feliway for cats or Adaptil for dogs.
     Have an enjoyable holiday season. Spend quality time with your pets and make your holidays pet safe. Contact your veterinarian if you have any concerns about your pet.

  Thyroid disease epidemic in cats                            
(Ron Carsten - Glenwood Post Independent 10-24-15)
    The thyroid gland is the most commonly diseased gland in cats. It is almost always overactive (hyper-), so the condition has been referred to as hyperthyroidism. Unfortunately, hyperthyroidism in cats is so common today that it is being described as an epidemic.
     Feline hyperthyroidism was first reported in 1979. Prior to that, enlarged or abnormal thyroid glands and signs of thyroid illness were rarely observed. Since then, there has been a steady and dramatic increase in the number of cats affected. Along with this increase in incidence, it has become a major cause of death in cats.
     In spite of numerous theories for the cause of hyperthyroidism in cats, sadly, the cause is unknown and there is no clear recommendation for prevention. The two main areas of focus are nutritional factors including excesses or deficiencies in cat food and thyroid-disrupting compounds present in the environment, drinking water or food.
     In more than 95 percent of the hyperthyroid cats, the glands have benign (not cancer) changes and are overproducing hormones. In 70 percent of affected cats, both glands are involved. Less than 5 percent of hyperthyroid cats have cancer in the thyroid glands. The average age of affected cats is 13 years, but 5 percent are younger than 10.
     The thyroid is a paired hormone-producing gland that is located on each side of the trachea near the throat. Hormones produced by the thyroid, mainly T4 and T3, affect nearly all organs in the body. As a result, when elevated, they can cause other problems including an elevated heart rate and heart enlargement. Over time this can lead to compromised heart function and even heart failure. Elevated blood pressure can also occur. This hypertension can cause damage to the eyes, kidneys, brain, and heart.
     Indications that a cat is affected by hyperthyroidism can be mild initially and progress to severe over time. These signs include weight loss, increased appetite, increased thirst, urination, hyperactivity, diarrhea and vomiting. Often the hair coat is matted and unkempt. The heart rate may be increased and the cat may be depressed or have aggressive
behavior. Some cats are restless, mentally confused and may yowl at night.
    Diagnosis of hyperthyroidism typically involves measurement of the T4 hormone in the blood. However, since there are other diseases with the same signs, such as diabetes, chronic kidney failure and intestinal disease, it is valuable to perform a complete blood count, serum chemistry profile, and urinalysis. A thorough physical exam is important along with palpation for enlarged thyroid glands.
    While most cats with hyperthyroidism have an elevated T4, 2-10 percent will have a normal T4, making the diagnosis more complicated. These normal T4 values in a hyperthyroid cat may be the result of mild hyperthyroidism or a concurrent illness that is suppressing the T4 levels so that they appear normal.
     There are basically three accepted therapies for hyperthyroidism: oral treatment with methimazole, surgery to remove the thyroid glands or treatment with radioactive iodine. While radioactive iodine is currently considered the treatment of choice, each approach has advantages and disadvantages. These should be discussed with your veterinarian so that the appropriate therapy can be planned. The pet food manufacturer Hills has developed a Prescription Diet, y/d that has been beneficial for some cats with hyperthyroidism. Regardless of the therapy chosen, once the thyroid hormones are returned to a normal range, underlying kidney or heart disease may become apparent. The high blood flow caused by the hyperthyroidism, can mask these underlying problems.
    From an integrative perspective, the organs that are stressed by the hyperthyroidism should be supported using appropriate nutritional supplements and herbs. These organs include the kidneys, heart and liver. If high blood pressure is present, supportive care for the eyes may also be beneficial in addition to controlling the blood pressure.
     If you have questions about hyperthyroidism or suspect your cat may be hyperthyroid, contact your veterinarian for further information.
'Twisted stomach' in dogs is a serious problem
(Ron Carsten - Glenwood Post Independent 9-26-15)
     Gastric-dilatation-volvulus looks like a convoluted and complex name. This name however, gives a clear description of a serious, life-threatening problem that occurs in dogs. The condition affects the stomach (gastric), involves bloating of the stomach (dilatation), and finally, twisting or rotating of the stomach (volvulus). It is often abbreviated as GDV.
     While the cause of GDV is unclear, it has often been associated with older, large-breed, deep-chested dogs that are fed one large meal a day and are related to other dogs that have experienced GDV. Any dog can be affected, but the most common breeds are Great Danes, Weimaraners, St. Bernards, Irish setters, and Gordon setters. Interestingly, aggressive dogs seem to be at higher risk. There also appears to be an increased risk if a susceptible dog is fed primarily dry kibble dog food in one or two large portions each day, compared with those that are allowed to eat smaller meals throughout the day or are fed canned foods. In addition, high fat content in foods has been associated with increased risk.
     Many of the initial signs associated with GDV are general and do not conclusively indicate GDV. These signs include an anxious look, looking at the abdomen, standing and stretching, panting and drooling. As the GDV progresses, signs become more focused on the bloated stomach and include distended abdomen, retching, unproductive vomiting and difficulty breathing. With continued progression, the dog can collapse from poor blood circulation and difficulty breathing.
     These later signs reflect the fact that GDV is a serious problem that affects the whole body. The bloating stomach puts pressure on the blood vessels, reducing the ability of the blood to properly circulate. Pressure on the diaphragm makes breathing difficult. When the stomach rotates, the blood circulation in the body and stomach is further compromised. Toxins begin to be released. Irregular heartbeats can occur. These events can lead to shock, collapse, coma and even death if not treated. GDV is an emergency and should be treated immediately. The sooner it is aggressively treated the better the outcome.
    Diagnosis of GDV relies on a characteristic gas pattern in the stomach seen on X-rays. Initial treatment is focused on stabilizing with IV fluids and oxygen, and getting the gas and fluid out of the stomach. Once the dog is sufficiently stabilized, anesthesia and surgery will be performed. The surgery is intended to untwist the stomach and tack the stomach to the inside of the abdomen wall (gastropexy) to prevent reoccurrence of GDV. In addition, the stomach will be inspected for areas that have to be removed as a result of damage from poor blood flow during the GDV. If the spleen has also twisted, it must be untwisted. The spleen may also be removed if it has become too damaged. Antibiotics will be needed because bacteria can leak into the bloodstream from the compromised intestine. There may also be disturbances in the blood pH and electrolytes like potassium that need to be addressed. Irregularities in the heart rhythm can occur. These irregularities, if unmanaged, can sometimes be life-threatening.
    After surgery, monitoring of the heart is important for the first 24 hours. Exercise restrictions will also be recommended for the first one to two weeks while the surgery site is healing. Frequent small meals of bland food are often advocated along with frequent small amounts of water. Monitoring of the kidneys may be important initially depending on the severity of poor blood circulation during the GDV.
    Since GDV is an emergency that is best handled by stabilizing with decompression of the stomach, intravenous fluid therapy and surgical intervention, integrative approaches are best used to support the stabilization process and surgical recovery. These therapies may include acupuncture to help manage pain and promote return of normal stomach and intestine contractions after surgery, laser therapy may facilitate healing and reducing pain in the incision, probiotics help replace beneficial bacteria in the digestive tract, and nutritional supplements and herbs may be supportive of a compromised kidney.
    GDV is a life-threatening emergency. Contact your veterinarian or veterinary emergency facility if you suspect your dog is experiencing GDV.
  An overview of heart disease in cats    
(Ron Carsten - Glenwood Post Independent 8-22-15)
    The heart is a marvel of engineering and function. In the resting cat, it is a muscle that contracts on average almost 190,000 times per day (130-140 times per minute) only resting briefly between contractions. In addition, the heart has the ability to increase its rate to meet the needs of the exercising body.
    The heart is designed to force blood to move forward with each contraction for efficient movement throughout the body and lungs. This forward movement of the blood is made possible because of the valves in the heart and in the large arteries leaving the heart along with the elastic fibers in the major arteries. Valves in the veins prevent blood from moving backward while muscle contraction acts to squeeze blood forward toward the heart.
    In order to efficiently circulate blood to all parts of the body, the heart is divided into two sides. Each side has its own circulation path — the right side pumps to the lungs and left side pumps to the rest of the body. Oxygenated blood from the lungs returns to the left side of the heart to be pumped to the rest of the body. Deoxygenated blood from the body moves into the lung circulation through the right side of the heart.
    The general term for heart muscle problems in cats is cardiomyopathy. This means heart (cardio-) muscle (myo-) disease (pathy). These diseases can be categorized as primary or secondary. Primary cardiomyopathy is a problem specific to the heart muscle, while secondary cardiomyopathies are caused by another health issue, such as an overactive thyroid.
    Primary cardiomyopathies include: 1) hypertrophic, 2) restrictive and 3) dilated.
    Hypertrophic cardiomyopathy (HCM) is the most common, accounting for 85-90 percent of primary patients. HCM is a condition where the heart muscle becomes abnormally thickened. This thickening reduces the volume of blood filling the heart chamber and prevents the heart muscle from relaxing between contractions. It mainly affects the left side of the heart. There is no clear explanation for its cause, but a genetic component is likely.
    In the restrictive cardiomyopathy (RCM), the heart muscle has increased amounts of fibrosis (scar type tissue), making the heart walls stiff so the chambers cannot fill with blood properly or empty completely with a contraction. RCM occurs in about 10 percent of primary cardiomyopathy
patients and mainly affects geriatric cats.
    Dilated cardiomyopathy (DCM) is just as it sounds. The heart muscle is thinner than normal and cannot contract properly. DCM is relatively uncommon, accounting for about 1-2 percent of the patients. DCM was once more common until it was determined that the cause was a taurine deficiency. Pet foods generally contain appropriate levels of taurine now.
    Secondary cardiomyopathies occur when the heart is affected by a problem that exists in another part of the body. These include nutritional imbalances, hyperthyroidism, cancer, infections, immune reactions and toxicities.
    Indications that a cat is affected by cardiomyopathy include difficult or rapid breathing, general weakness, lethargy, poor appetite, and sudden weakness or paralysis in the back legs. Gallop sounds or abnormal rhythm may be heard when listening to the heart. Lung sounds may be muffled or harsh. Body temperature may be low due to poor blood circulation.
    Evaluation for a diagnosis generally includes blood tests, chest X-rays, ultrasound of the heart and electrical recordings of the heart. Treatment recommendations depend on the diagnosis and how advanced the problem is. For example, in life-threatening congestive heart failure, a rapid response is indicated and may include the use of diuretic drugs, oxygen therapy, blood pressure medication and drugs to improve heart contractions. Treatment for blood clots may be important. Factors contributing to the heart problem, like an overactive thyroid or an infection should be addressed.
    Cats that are in early stages of cardiomyopathy or not in a life-threatening situation may benefit from long-term support in addition to any medications that are necessary. Supportive care may include nutrients that are beneficial for the heart muscle like vitamins E and C, taurine, L-carnitine, and appropriate levels of minerals including magnesium and calcium. Herbal therapies like hawthorn may be helpful for improving blood flow to the heart muscle and increasing the strength of contraction.
    With reduced heart function, the kidneys may be compromised. In addition, ongoing stress places more demands on the adrenal glands. Support for both the kidneys and adrenal glands should be considered as part of an overall care plan.
    If you have questions about heart disease in cats, contact your veterinarian.

Teaching about old dogs
(Ron Carsten - Glenwood Post Independent 7-25-15)
    It is hard to imagine that puppy with boundless energy or that young adult with the fluid grace of an athlete, becoming, in what feels like a few short years, an individual that sleeps longer, has diminished eyesight and hearing, and has discomfort associated with osteoarthritis. Dogs progress through the same aging changes as humans. In fact, the similarities have lead to development of university based aging studies in the dog as a way to better understand human aging.
     The average lifespan of a dog is 12-15 years. Unfortunately, the aging process occurs much more rapidly in giant-breed dogs than in small-breed dogs. This means that small and medium size dogs (less than 50 pounds) would be considered senior at 7 years of age, large breed dogs (51-90 pounds) at 6 years, and giant breeds (over 91 pounds) at 5 years. In general, a dog is considered elderly when it is in the last 25 percent of its lifespan.
     Aging changes happen gradually, making them less obvious in daily interactions. Common signs of aging include gray hair, grayish lenses and reduced vision, less acute hearing, sleeping more and more deeply, development of osteoarthritis, weakness and difficulty getting up from laying or sitting, reduced ability to exercise, alterations in intestinal function, and changes in cognitive behavior. The speed and severity of the changes, in conjunction with your pet’s normal lifestyle, dictate how impactful these age-related changes are. For example, a dog that hikes regularly can be significantly impaired by osteoarthritis while a small dog that spends the majority of time indoors generally is not.
     The above changes can be observed through daily interaction. Many other changes are found with a physical examination and routine blood and urine testing. The physical examination can identify irregularities with the heart such as a murmur or changes in lung sounds. Early evaluation of lumps and bumps can make management easier. Monitoring oral health becomes increasingly important because dental disease can compromise the heart and kidneys. Aside from the effects of poor oral health, liver and kidney function are known to decline with age, making regular testing important. Thyroid function can also be impaired, complicating the aging process. This makes early identification of health problems essential for optimal care.
    While the normal loss of function associated with aging cannot be stopped, there are approaches that may slow the decline. For example, keeping a dog active will help to maintain muscle strength and muscle tone longer. Unfortunately, dogs with unmanaged osteoarthritis are less active and can lose strength rapidly. One of the keys to improving activity levels, and by extension muscle strength, is to address joint pain. Depending on the intensity of the joint pain, supportive care may involve weight loss, use of glucosamine, herbs like boswellia, nutritional supplements, vitamin D supplementation, and nonsteroidal anti-inflammatory drugs.
     Joint discomfort is not the only reason for decline in muscle strength. There is an age-related, progressive decline in the ability of muscle cells to produce work and there is a loss of muscle fibers. In addition, nerve function also declines. These factors can result in weakness and an unsteady gait. While these changes relate directly to the ability of muscles to perform work, other issues that affect muscle include diminished heart and lung function resulting in reduced oxygen and blood flow to muscles. Exercise is an important way to maintain muscle strength. However, activity levels must be tailored to the dog’s ability. This often means giving up strenuous hikes and instead using multiple short walks daily.
     Cognitive dysfunction in older dogs can also be challenging. Some dogs experience degeneration of nerves in the brain that affects behavior and cognitive ability. These dogs may have decreased awareness, confusion, vocalization, altered sleep cycles and loss of house training. Increasing the levels of antioxidant vitamins has been advocated to reduce declining brain function. Interestingly, providing whole food, rich in antioxidants has been more successful than the use of isolated vitamins. Providing more B vitamins and fatty acids in the form of fish oil may also be beneficial.
     Aging happens to everyone, including our pets. The process is complex and each individual experiences aging in different ways. Support for the aging dog should focus on quality nutrition, appropriate levels of exercise, mental stimulation, the use of targeted nutritional supplements and herbs, and regular veterinary exams to detect emerging age related diseases.
     If you have questions about your aging dog, contact your veterinarian to discuss these important issues.
Pancreatitis in cats surprisingly common
(Ron Carsten – Glenwood Post Independent 6-28-15)
    Studies indicate that feline pancreatitis is surprisingly common, with 67 percent of cats having microscopic changes in the pancreas that indicate inflammation. It is the most common problem affecting the enzyme-producing part of the pancreas. Interestingly, 45 percent of cats that appeared healthy had microscopic changes consistent with pancreatitis.
     The pancreas, a gland found in the abdomen, is associated with the first part of the small intestine, weights about 6-8 ounces, and is vital for digestion and glucose regulation. One part of the pancreas produces hormones such as insulin, which is critical for controlling blood glucose and preventing diabetes mellitus. The other part of the pancreas is responsible for producing digestive enzymes. These digestive enzymes break down the ingested food so nutrients can be absorbed from the intestine.
     To protect the pancreas from digesting itself, the digestive enzymes are in an inactive form while in the pancreas. Once secreted into the intestine, the enzymes are activated so they can begin digestion of the food. Premature enzyme activation in the pancreas is often the initiating event for an episode of pancreatitis.
    Pancreatitis can be acute (sudden onset), recurrent acute (repeat acute episodes) and/or chronic. Acute episodes are often more severe than the chronic problem. Unfortunately, signs of pancreatitis in cats are not very specific. The majority of cats with pancreatitis are lethargic, not eating, and are dehydrated. Vomiting is seen in less than half of the affected cats. Pain and diarrhea are not prominent in cats. Since loss of appetite and lethargy are common with many cat diseases, these signs do not automatically point to pancreatitis.
     While the causes of acute pancreatitis are not fully understood, a number of issues may contribute to development of pancreatitis. These include bile tract disease, inflammatory bowel disease, pancreatic duct blockage, certain drugs, ingestion of toxins or insecticides, infections like toxoplasmosis or feline infectious peritonitis, and trauma. These conditions can also contribute to chronic pancreatitis. Intermittent episodes of pancreatitis can occur over time gradually leading to scar tissue in the pancreas. Scar tissue reduces the ability of the pancreas to function
properly.
    Since the list of diseases that can look like pancreatitisis long and we have lacked a specific test for pancreatitis, effective evaluation of the ill cat has often required extensive testing to rule out the other diseases. Typical evaluations have included a complete blood count, chemistry profile (includes testing for liver, kidneys, and glucose), X-rays and ultrasound. Biopsy of the pancreas is considered the most informative, but because surgery is required in an ill cat, biopsy is not frequently used. Fortunately, newer tests specific for cats have become available, making it easier to diagnose pancreatic problems.
    Therapy for pancreatitis is based on severity. Supportive care like IV fluids, use of medications to prevent vomiting and antibiotics are often indicated for acute pancreatitis. Even though pain is not a common observation with cats with pancreatitis, there does seem to be improvement when pain management is initiated. Some cats with acute pancreatitis develop a transient diabetes mellitus that may need to be treated short term with insulin. Whenever possible, contributing problems like inflammatory bowel disease and bile duct disease should be treated. It is important to keep cats eating whenever possible to avoid a problem with fatty liver. For cats with chronic pancreatitis, management of the contributing factors is important.
    Integrative support care includes the use of nutritional supplements and herbs to manage inflammatory bowel disease and bile duct inflammation, if present. Since pancreatitis can contribute to liver dysfunction, liver support can be important. Beneficial herbs for the liver and intestines include milk thistle, boswellia and slippery elm. Glutamine is important for the cells lining the small intestine. Vitamin B12 is often deficient and should be considered as a component of supportive care. Probiotic therapy can be beneficial for improved intestinal health and immune function, especially if there is ongoing antibiotic therapy. Acupuncture can be used to improve comfort and function. Avoid foods to which the cat may be sensitive or may contribute to inflammation in the intestine. Easily digestible foods may be beneficial along with the addition of digestive enzymes.
    If you suspect your cat has pancreatitis or you have questions, contact your veterinarian.
Cruciate ligament injuries often cause lameness in dogs 
(Ron Carsten – Glenwood Post Independent 5-22-15)
    One of the most common causes of lameness and pain in the hind leg of the dog is a torn cruciate ligament. Cruciate ligaments in the dog knee have a similar but more complex function than those in the human knee. Basically, cruciate ligaments provide important knee support. The ACL (anterior cruciate ligament), or more correctly termed the CCL (cranial cruciate ligament) in the dog, prevents forward motion of the tibia (bone below the knee) with respect to the femur (bone above the knee). In addition, the CCL limits over straightening of the knee and rotation of the tibia.
     In the dog, the CCL can be partially torn or completely torn resulting in partial or complete instability. CCL damage can occur from trauma like an acute injury or long-term or chronic degeneration. A partially torn CCL occurs in 25-30 percent of dogs. Frequently the partial tear progresses to a full tear. A damaged CCL leads to instability and degenerative changes within a few weeks of injury. Degeneration can progress to severe within a few months. Over 50 percent of dogs with a torn CCL will also experience a torn or damaged meniscus, the fibrocartilage pad in the knee.
        Traumatic tearing of the normal CCL occurs in only about 20 percent of dogs. Interestingly, it has been estimated that in a normal CCL, it requires a force 4 times the body weight of the dog to cause a tear. In the remaining 80 percent of dogs, tears occur with much less force in a CCL that has undergone long-term chronic degeneration. Unfortunately, because degeneration plays a role in a large number of dogs, 40-60 percent of dogs will eventually experience a torn CCL in the other leg.
     Factors that contribute or predispose to ligament degeneration include aging, obesity, poor physical condition, abnormal confirmation, disuse, immune mediated damage, and genetics factors. Degeneration related to aging is more significant in dogs over 30 pounds and over 5 years of age. Abnormal confirmation such as bowlegged, knock-kneed, or having straight knees and hocks predisposes to CCL rupture. Some dog breeds like the Rottweiler, Newfoundland, Staffordshire Terrier, Mastiff, Akita, Saint Bernard, Chesapeake Bay Retriever, and Labrador Retriever are more commonly affected. A genetic mode of inheritance has been
 identified in the Labrador Retriever.    
    The signs of CCL injury include difficulty rising from sitting, reduced activity, varying severity of lameness, loss of muscle mass, thick area on the inside of the knee, pain, and stiffness. Keep in mind that these signs are not specific to CCL injury and can be caused by other problems. Therefore, it is important to have a thorough examination that may include X-rays. Complete tears are generally straightforward to diagnosis while the partial tears can be more challenging. An increased cranial draw motion (tibia slides forward abnormally) is consistent with CCL tear. In addition, there is often increased fluid in the joint.
     Optimal treatment of the torn CCL depends on the dog’s activity level, size, age, knee conformation, and amount of knee instability. Surgical stabilization is generally thought to be the best approach. There are a number of surgical techniques that are commonly used and are generally selected based on the size of the dog and the surgeon’s preference. The goal for surgery is to stabilize the knee so that degeneration is eliminated or its rate of progression significantly slowed. However, surgery is not practical for all dogs due to health concerns associated with anesthesia risk or financial reasons. When surgery is not practical, some dogs can be kept comfortable using a custom made knee brace. These are designed to provide support during activity, but are not intended to be worn continuously. Partial tears may benefit from prolotherapy.
     In addition to surgery or a knee brace, there are a variety of nutriceutical products, supplements, and herbs that can be used to help manage inflammation, pain, and reduce degeneration of the joint. For example, glucosamine and chondroitin products reduce the damaging effects of inflammation on the cartilage surface in the joint. Fish oil and herbs like boswellia help to reduce inflammation. Manual therapies may be indicated to help maintain appropriate alignment of the back and pelvis because there is additional stress in these areas during times of lameness. Non-steroidal anti-inflammatory drugs like Rimadyl help to reduce inflammation and pain. Acupuncture and therapeutic laser can be used to reduce pain and improve healing after surgery. A rehabilitation program can be beneficial after surgery.
     If you have concerns or questions about your dog, contact your veterinarian for further information.
Obesity and your cat
(Ron Carsten - Glenwood Post Independent 4-25-15)
     It has been estimated that 36 percent of American adults are obese. Ironically, more than 50 percent of cats are overweight and 25 percent are considered obese. This is a trend that has increased over the last 30 years in a similar to the increase in diabetes. Obesity in cats has increased health risks similar to those experienced by humans, including heart disease, diabetes, respiratory compromise, certain liver diseases, urinary tract disease, ligament injury and osteoarthritis. More common in older, less active cats, obesity is also often seen in cats fed free choice, and spayed or neutered cats that do not have their food intake managed. Interestingly, a neutered male cat requires 28 percent fewer calories.
     The simplest explanation for obesity is that it is the result of excess energy intake and insufficient energy use. Unfortunately, the development of obesity is often complex with multiple contributors. In addition to excess energy intake, other contributors include genetic factors, food preferences developed as kittens, excess carbohydrate-containing foods and some metabolic issues. A further complication is that white adipose functions as an endocrine (hormone) gland by secreting a wide range of hormones called adipokines and obesity is associated with chronic, low-grade inflammation.
     These factors mean that obesity prevention and management is not always simple. Health issues such as heart disease or osteoarthritis may prevent adequate exercise. Cats may refuse to eat the diet food selected by the owner. Managing effective volume control for feeding can be especially difficult if there are multiple cats in a household.
     Since there are numerous body types and cats come in many sizes, it is important to be able to recognize when a cat is becoming obese. The first step for assessing obesity is to feel both sides of the chest with your fingers. With ideal weight you should be able to feel the ribs with a thin layer of fat under the skin. In a severely obese cat, it may not be possible to feel the ribs through the fat layer. The second step is to view the cat from the side. An obese cat may have a layer of fat hanging below the abdomen. The third step is to view the cat from above. Cats that are obese will not have a waistline because it is hidden below a layer of fat. Body
condition charts are also available for comparison.  Ask your veterinarian for assistance if you have questions.
     As with many diseases, prevention of obesity is easier than the treatment. Avoiding obesity includes increasing activity. It is estimated that the typical cat needs 15-30 minutes of activity each day. Access to a variety of toys can help. In addition, managing energy (calories) intake is critical. This can involve both the amount of food given and the type of food offered. The growing consensus is that cats should not be fed free choice. In addition, they should be fed a high-quality canned food. Canned foods generally have higher protein, lower carbohydrates and are high in water content. Keep in mind that carbohydrates that are not being used are being stored as fat. There should be distinct feeding times and no treats or snacks in between. Making changes gradually can be important for many cats because some cats are stressed by change and may not tolerate or accept rapid diet changes.
     For cats that are already obese, increasing activity, if not limited by a health problem, is important. Check the food manufacturer’s recommendation for the amount of food daily. Carefully measure the food when feeding. If the amount fed is consistent with the manufacturer’s recommendation, some veterinarians recommend reducing the amount of food by 25 percent and then another 10 percent every two-three weeks until 1 percent of the starting body weight has been lost. This will give you an amount to feed until the desired weight is lost. Consult with your veterinarian before starting a weight-loss program. There may be health issues that contribute to obesity or require close monitoring. Also, too drastic food or weight reductions can create problems.
     In addition to exercise and diet management, some cats benefit from support for organs and glands that are stressed in the obese cat. These include the adrenal glands and liver. Any existing health problems should also be supported. For example, cats with osteoarthritis should have appropriate pain management, such as acupuncture, for improved quality of life and to encourage more activity.
     If you have questions about obesity in cats and need assistance for developing a weight management plan, consult your veterinarian.

Ear problems in dogs — common challenge   
(Ron Carsten - Glenwood Post Independent 3-27-15)
    Ear problems are reported to be the second most common reason for taking a dog to a veterinarian. These veterinary visits cover a broad range of ear problems that include issues with the earflap (pinna), ear canal, middle ear and inner ear. Of all the ear problems, inflammation of the ear canal (otits externa) is seen most frequently.
     Dogs with otitis externa will generally have some combination of head shaking, ear scratching, redness, pain, discharge or odor. Since there are numerous causes of otitis and because of the complex nature of ear disease in dogs, otitis is often challenging to treat.
     It is well known that dog hearing is more acute than that of humans. They can hear about four times the distance of humans and hear high-pitched sounds. Dogs have 18 muscles that allow them to move their ears in the direction of the sound. The dog pinna comes in many sizes and shapes; some ears are erect, others are folded and hang down. Unlike humans, the dog ear canal is a very long 2 inches with a vertical portion then a horizontal portion.
     It is the size, shape and length of the dog ear canal, along with the type of pinna, that can predispose dogs to otitis, can make diagnosis difficult and can make management challenging. Otitis generally starts with inflammation. Inflammation left untreated can lead to bacterial or yeast infections. With chronic otitis, the lining of the ear canal can undergo changes that are often permanent. These changes can make the otitis worse, more difficult to treat and contribute to future problems.
     Issues related to otitis can be divided into groups in an effort to better understand the problem. These groups are predisposing factors, primary causes, secondary causes and perpetuating factors. Predisposing factors for otitis include a narrow ear canal, hair in the canals, pendulous pinnae, excessive cerumen production and debilitated health.
     Primary causes that stimulate inflammation include allergies to food ingredients, environmental allergens (inhaled and contact), parasites, foreign bodies, thyroid dysfunction and autoimmune disease. Secondary causes include bacterial and yeast infections. They contribute to ear problems only in the abnormal ears or in combination with other issues.
     Finally, perpetuating factors can prevent resolution of the
otitis and are a major reason for poor response to therapy. Perpetuating factors include microscopic changes in the lining of the ear canal caused by chronic inflammation. These changes reduce the ability of the ear canal to maintain a healthy ear environment. Over time, ongoing otitis and the chronic inflammation can lead to narrowing of the ear canal and even calcification of the canal cartilage.
    Treatment and management of otitis includes identification and management of the primary cause, treating secondary causes like bacterial and yeast infections and addressing perpetuating factors. How each of these factors is dealt with depends on the primary cause and severity. Once a diagnosis is made, treatment may be as simple as removing the foreign body (i.e. grass awn) or more complex if the primary cause is an issue like allergies. The ear canal should be cleaned. Use an appropriate ear cleaning solution. Never push Q-tips into the ear canal. Sometimes cleaning requires sedation or anesthesia. For bacterial infections, antibiotics placed into the ear canal may be sufficient. However, some severe situations require the use of oral antibiotics. A number of herbal and enzyme ear products are now available that may offer some therapy advantages for bacterial and yeast infections. Control of any ongoing inflammation is important.
     It is noteworthy that allergies to food ingredients and/or environmental allergens like pollen are the most common predisposing factor for otitis. It is estimated that 83 percent of dogs with allergies have otitis. In some dogs the only indication of allergies is the otitis. For the dogs with allergies, avoidance of allergens is important. Food changes may be critical. Avoiding environmental triggers and/or desensitization guided by allergy testing may be necessary. Numerous nutritional supplements and herbal remedies have been advocated for managing allergy problems. While results have been variable, some products can contribute to improved management of otitis.
     For dogs with poor thyroid function (hypothyroidism), thyroid therapy should be initiated. Dogs that are susceptible to otitis after swimming should avoid getting water in the ears or use a “swimmer’s solution” regularly.
     Acupuncture and laser therapy provide benefits for making management of otitis easier when used in conjunction with other therapies that address the primary cause.
     If you have concerns about your dog’s ears, contact your veterinarian for a consultation.
Diabetes in cats, a growing problem 
(Ron Carsten - Glenwood Post Independent 2-20-15)
    As with dogs and humans, diabetes mellitus in cats is a common problem. The incidence has been increasing over the last 30 years. With an estimated seven of every 1,000 cats affected with diabetes, there are approximately 800,000 diabetic cats in the U.S. While all cats can be affected, diabetes is seen most often in middle-aged and older cats. Risk factors include obesity, genetics, dental disease, certain drugs and inactivity, especially with indoor cats.
     Diabetes in cats shares similarities with diabetes in dogs, but has some notable differences. These differences are important because unlike diabetes in dogs, which is almost always type 1, 80-95 percent of diabetic cats have type 2. Type 2 diabetes occurs because insulin secretion from the pancreas is impaired. At the same time cell response to insulin becomes reduced (increasing resistance or lowered sensitivity).
     Insulin is critical for control of the glucose level in blood by signaling cells to take in glucose where it is used for energy. In addition, when energy levels are sufficient, insulin signals the liver to take in glucose and store it. With type 2 diabetes, the insulin levels are low, often 80-90 percent below normal, and body cells become less responsive or insensitive to the insulin. This results in cells not being able to effectively take in glucose and liver production of glucose is not switched off contributing to the increased blood glucose. The body starts using fat as an energy source. Altered metabolism of carbohydrates, fats, and proteins occurs.
     The altered carbohydrate metabolism contributes to elevated blood glucose and to glucose in the urine once the blood glucose rises high enough. It is this elevated glucose that results in increased urination and drinking. Altered fat metabolism can result in increased fat in the blood and liver changes. Cats with a reduced ability to use glucose, proteins and fats can become lethargic, lose weight, are hungrier, have a poor hair coat, experience reduced immunity and can have recurrent infections when the diabetes is not treated.
     Diagnosis of diabetes in cats is based on a combination of the signs of excessive drinking, excessive urination, increased appetite and weight loss combined with persistently elevated blood glucose and glucose in urine. The presence of a persistent glucose elevation is important because cats have the ability to significantly increase their
blood glucose in response to persistent glucose elevation is important because cats have the ability to significantly increase their blood glucose in response to stress. Since this rise is temporary, it does not reflect the daily ongoing blood glucose levels. For some cats, repeating the blood glucose measurement is important to document a continuing high level. Another valuable test measures blood fructosamine. This provides information about what the blood glucose levels were two-four weeks before.
     Diabetes in cats is treatable. The typical approach for treating diabetic cats is to rule out and treat diseases, such as an over-active thyroid, that can complicate management of diabetes. Drugs, like methylprednisolone, that have been linked to increased risk of diabetes should be eliminated if possible.
     In the early stages of diabetes where the problem is subclinical, oral hypoglycemic drugs may be beneficial along with control of obesity and use of high protein, low carbohydrate canned foods. When the diabetes is more advanced and clinically evident, the administration of insulin is essential. Your veterinarian can provide guidance on the best approach for each individual cat. Monitoring of the blood glucose is important especially early in treatment. As the diabetes becomes controlled, some cats can have reduced need for insulin injections over time and some can go into remission. This makes ongoing monitoring vital for effective management.
     In addition to oral hypoglycemic drugs and insulin, supportive care for the liver, pancreas and immune system using nutritional supplements may be beneficial. There are a number of herbs advocated for use in diabetic cats to aid in reduction of blood glucose levels. These include gymnema leaf, dandelion root, and burdock root. However, it is important to note that these herbs have not been fully evaluated to demonstrate their real value for diabetes management in cats. As a result, caution should be used to avoid potential negative complications including lowering the blood glucose too much. In addition, cats are less able to metabolize many substances compared to dogs and people, making them more susceptible to potential toxic reactions.
     If you have concerns about your cat and diabetes, contact your veterinarian for guidance. Diabetes can be a complex problem to manage making regular interaction with your veterinarian valuable as you assist your cat companion with this common disease.
Diabetes affects 1 percent of dogs  
(Ron Carsten - Glenwood Post Independent 1-23-15)
    Diabetes mellitus is a common disease in dogs. It affects an estimated 1 in 100 dogs, and the incidence has tripled over the last 30 years. While the exact causes of diabetes are not known, there is speculation that autoimmune disease, genetics, obesity and chronic pancreatitis could be important predisposing factors.
     Certain dog breeds like Australian terriers, standard and miniature schnauzers, dachshunds, poodles, keeshonds and samoyeds are more commonly affected. Occurrence in female dogs is twice that in males. The peak age for onset of diabetes is 6-9 years in dogs. Fortunately, diabetic dogs that receive treatment, and have their blood glucose controlled, have the same average lifespan as dogs of the same age and gender that are not diabetic.
     There are two types of diabetes. In the dog, almost all diabetic patients are type 1; type 2 rarely occurs. Type 1 diabetes requires insulin administration and occurs because the pancreas does not produce enough insulin. Lack of insulin is a significant problem because insulin plays a critical role in controlling blood glucose. Insulin signals cells to take in glucose to be used for energy, and when there is sufficient energy, insulin signals the liver to take in glucose and store it. When blood insulin is low or absent, as with diabetes, glucose is not taken up by most body cells. When this happens, the body uses fat as a source of energy. In addition, blood glucose increases because liver production is not switched off. Altered metabolism of carbohydrates, fats and proteins occurs.
     Without enough insulin, the altered carbohydrate metabolism leads to elevated blood glucose and glucose in the urine once the blood glucose rises high enough. This elevated glucose results in increased urination and drinking. Cataracts can also form. Alterations in fat metabolism can lead to increased fat in the blood and liver changes. Reduced ability to use glucose, proteins and fats can lead to lethargy, weight loss, hunger, poor hair coat, reduced immunity and recurrent infections when the diabetes is not treated.
     Diagnosis of diabetes is based on elevated levels of glucose in the blood. This is important because the signs associated with diabetes — increased or excessive drinking, increased urination, weight loss, increased appetite and recurrent infections — can be caused by other health problems. A thorough history, physical examination, and blood and urine
testing are all important parts of a complete evaluation.
    Diabetic dogs that receive treatment, and have their blood glucose controlled, have the same average lifespan as dogs of the same age and gender that are not diabetic.
     In uncomplicated diabetes, treatment involves injection of insulin along with careful regulation of feeding time and use of specific diets. Consistent amounts and frequency of exercise are also important. Therapy is lifelong and tailored for each individual dog. There are a number of different types of insulin grouped by how long they work in the body. There are also individual responses to the insulin. Your veterinarian will provide advice on the proper selection of insulin.
     Some dogs are more sensitive to insulin and will need less for optimal control of the blood glucose. These factors make monitoring of the blood glucose a critical component of establishing the optimal insulin dose initially. Periodic blood glucose measurement can be valuable to ensure that the correct insulin dose is continuing to be given. For some dogs this is a relatively straightforward process, while for other dogs, it is very challenging and sometimes frustrating. Management of diabetes can be complicated when there are concurrent disorders such as those that involve the adrenal or thyroid glands, when infections are present, when poor kidney, liver, or heart function occurs, with obesity, or if there is cancer. Urinary tract infections are common in diabetic dogs. In addition, diabetic dogs are also more susceptible to developing infections in the mouth.
    Integrative care involves, in addition to insulin, nutritional or herbal support of organs that have reduced function such as the liver or kidneys. Probiotics can be used to improve the intestinal flora and have a beneficial impact on the immune system. This is especially important if antibiotics are being used to treat infections. Opinions vary on the best commercial or prepared foods to use. For example, many advocate the use of high-fiber diets while others argue that many dogs do well on moderate fiber diets.
     Successful management of diabetes in dogs is based on consistency. This includes consistency with monitoring, dosing of insulin, types and amounts of food, the amount of daily exercise, and control of any concurrent problems. If you have concerns that your pet may have diabetes, contact your veterinarian for a complete discussion of this important issue.
Urinary problems are common issues for cats 
(Ron Carsten - Glenwood Post Independent 11-14-14)
    Feline urinary problems are the most common health issue in cats. Affected cats often have bloody urine, urinate frequently, urinate in unusual places and may strain to urinate. These signs associated with the lower urinary system have been described in cats for at least 90 years, yet the causes are still not fully understood. Currently these urinary problems are grouped together and called feline lower urinary tract disease (FLUTD). Inflammation in the urinary bladder appears to play a significant role.
    Unfortunately, there are numerous causes of bladder inflammation, making diagnosis and management challenging. Sources of the inflammation include bladder stones, infections, urinary tract cancer, trauma, or a combination of stones and infections. No cause for inflammation can be identified in at least two-thirds of the cats with FLUTD, even after extensive testing. These cats fall into a classification called feline idiopathic cystitis (FIC); idiopathic meaning the cause of the bladder inflammation (cystitis) is unknown.
    Cats showing signs of FLUTD should be evaluated to rule out life-threatening issues like a urethral blockage and to determine a cause if possible. Evaluation generally includes a physical examination and a urinalysis. Depending on those findings, your veterinarian may order blood work and X-rays or ultrasound.
    The most common causes of FLUTD are urinary stone, urethral blockage and, mostly FIC. Interestingly, FIC shares many similarities with human interstitial cystitis. FIC cats may have blood and inflammatory cells in their urine with no recognizable cause such as stones or infection.
    Crystals are often found in the urine, but are no longer felt to be the cause of the cystitis but rather the result of cats producing very concentrated urine. Cats with FIC tend to have a group of abnormalities in common, including a defective urinary bladder glycosaminoglycan (GAG) layer, neurogenic inflammation, stress and abnormal responses to stress. The GAG layer protects the bladder wall cells against damaging substances found in urine. In FIC, this GAG layer is insufficient, allowing damage and irritation to occur, leading to inflammation.
    Neurogenic inflammation can occur when nerves in the
bladder wall are stimulated by local irritation or sometimes stimulation by the brain as part of a stress response. This nerve stimulation can result in release of neurotransmitters that can worsen local inflammation and pain. Stress can initiate FIC episodes. Affected cats have an adrenal gland and brain response to stress that is abnormal.
    Since FLUTD issues can be complex, it is important to use a variety of therapeutic and supportive approaches. These approaches include dietary management, modifications to the environment, supplements, herbs and drugs including antibiotics, anti-inflammatories and pain medications as indicated.
    The main goal of dietary management is to encourage more drinking and urination by feeding canned foods. More water intake contributes to more dilute urine and more frequent urination. Special diets are indicated for cats with specific problems such as bladder stones. Offering fresh water in multiple locations, using bowls that cats often prefer (i.e. shallow), or offering running water (a pet fountain) can also have a beneficial impact on water consumption and frequency of urination. Using multiple litter boxes placed in quiet, strategic locations can help promote more frequent urination.
    Identifying stresses and striving to eliminate them or reduce them can be important. Enriching the environment with cat toys, hiding place, and scratching posts can be helpful. Managing issues like osteoarthritis can be important for improving litter box use, increasing activity and reducing stress.
    Antibiotics are important for bladder infections. Chinese herbs, cranberry and marshmallow, for example, have been used to manage FLUTD problems. Products like Feliway and Rescue Remedy can help reduce stress. Improvements in adrenal gland function using herbs and supplements may help with stress responses and inflammation. Nutrients like vitamin A can be beneficial for the urinary bladder lining cells (be cautious to not over supplement). Injectable and oral glucosamine products may offer benefits for the bladder GAG layer and help arthritic joints.
     If your cat is showing any signs of urinary problems such as frequent urination, straining to urinate, not using the litter box properly or blood in the urine, a visit to your veterinarian is important.
Osteoarthritis, a common problem that is not just for old dogs
(Ron Carsten - Glenwood Post Independent 10-10-14)
    Osteoarthritis is the most common joint disease and the most common cause of chronic pain in dogs. It is a degenerative process that involves loss of joint cartilage, local tissue damage, ongoing inflammation and formation of new bone at joint surfaces and margins.
     OA is often associated with large dogs, but all sizes and all ages of dogs can be affected. The typical age of onset varies by dog breed and contributing factors like malformations, traumatic injuries or obesity.
     While the initiating causes of OA are not always clearly defined, one fundamental component is damaged joint cartilage. This damage can be caused by excessive forces on normal cartilage or even with normal forces if the cartilage is abnormal or defective. Conditions that result in excessive forces on normal cartilage include defective joint development, limb deformities, cranial cruciate disease or incorrect joint alignment.
     Certain breeds are predisposed to joint disease; genetic factors can play a role in defective joint development as seen with hip dysplasia. Environmental factors like the amount of exercise, body weight and diet can affect the onset, severity and rate of progression. Overfeeding growing puppies can result in rapid growth that increases bone length and body weight. In addition, excess weight predisposes the aging dog to OA.
     Generally, dogs with OA appear to be suddenly lame following episodes of minor trauma or excess exercise on an already-diseased joint. Stiffness after rest is often seen before obvious lameness. The stiffness typically resolves in just a few minutes after rising from rest. Lameness, stiffness, and pain may be worsened by long periods of exercise, cold conditions and obesity.
     Some dogs may experience depression, loss of appetite or become aggressive as a result of their discomfort. Affected joints may be swollen, normal joint movement may be restricted, and pain may be detected at the limits of extension and flexion. Heat and redness are usually not seen unless there has been trauma or an infection is present. Diagnosis is often based on history, examination and X-rays.
    OA is a progressive problem with no cure. The goal of therapy is to manage the OA in a way that maintains quality of life and slows progression. Early intervention is important. Therapy can be divided into broad areas including lifestyle changes, nutritional supplements, herbs, acupuncture, medical treatments and rehabilitation techniques. Many obese dogs no longer have signs of OA or can be more easily managed once they reach their ideal body weight. Appropriate levels of exercise are important. Inactivity can lead to tissue and muscle weakness along with joint stiffness that makes therapy more complicated. In contrast, overexercise can make the OA condition worse by accelerating the degenerative process.
    A range of nutritional supplements, nutraceuticals and herbs are available. The focus is to facilitate improved tissue health and function even in the face of the ongoing degeneration. Nutritional supplements and tissue extracts that can support the ligaments and joint capsule can contribute to improved stability. Some products like glucosamine and chondroitin have been shown to be anti-inflammatory and reduce cartilage damage. Essential fatty acids found in fish oil prevent inflammation and reduce degradation of the cartilage. Herbs like Boswellia serrata improve lameness and reduce pain. Acupuncture can be useful, especially if pain is present.
    Dogs experiencing pain are often given nonsteroidal anti-inflammatory drugs. However, other pain medications can be combined with the NSAIDs for a multimodal drug therapy. The value of this multimodal approach is that the dose of individual drugs can often be reduced while improving pain management.
    A key to effective management of OA in the dog is early recognition. Combining nutritional supplements with lifestyle changes (including obesity management) should be part of the initial approach. Manual therapies like massage, passive range of motion exercises and other rehabilitation approaches can help to maintain improved joint fitness and comfort. Intervention with NSAIDs and other pain medications along with acupuncture can be layered on the foundation created by the above supportive methods.
    If you feel that your dog has OA or you have questions, please contact your veterinarian.
Cognitive dysfunction in aging cats is a common problem
(Ron Carsten - Glenwood Post Independent 5-16-14)
    It is estimated that there are more than 82 millions cats in the United States. In the last 20 years there has been a 40 percent increase in cats older than 7 years of age and a 15 percent increase in those older than 10 years. More than 10 percent of cats are greater than 10 years of age. Clearly cats are living longer. As with humans, aging cats are increasingly impacted by age related problems like cognitive dysfunction, osteoarthritis, chronic kidney disease, systemic hypertension, reduced vision and hearing loss. At least 28 percent of cats 11-14 years of age develop at least 1 age-related behavior issue that reflects decline in mental functioning. By 15 years and older, 50 percent of cats exhibit behaviors like aimless wandering and vocalizations. These declines in mental functioning have been collectively referred to as cognitive dysfunction syndrome (CDS).
     Signs of CDS include changes in behavior, inappropriate elimination, altered interaction with family, inappropriate vocalizations, and changes in sleep/wake cycles and activity. It is important to determine that these behavioral changes are not caused by other medical conditions. For example a cat with osteoarthritis may have inappropriate eliminations outside the litter box because they have difficulty stepping into a box with high sides. In addition, a cat with osteoarthritis may avoid interaction with family members because of discomfort. Dental problems can result in reduced appetite. Vision changes can be caused by systemic hypertension impacting on the retina. Uncontrolled diabetes can cause increased urine and often urination outside the litter box.
     Since there are numerous medical problems that can appear like CDS, it is critical to have a complete evaluation by your veterinarian before deciding that your cat has age-related CDS. This evaluation will include a full history, complete physical examination including blood pressure measurements and mobility assessment, blood testing (including a complete blood count, chemistry profile and thyroid), and urine evaluation. These results can lead to a recommendation of further testing which may include X-rays, ultrasound, ECG, biopsies, or feline leukemia testing.
     The causes of CDS in cats are not yet fully understood, but it is likely that a combination of factors leads to brain dysfunction. These factors include decreases in blood flow to the brain resulting from changes in the brain blood vessels, reduced output of blood from the heart, and altered blood
viscosity. This diminished blood flow to the brain can cause lowered oxygenation of the brain and reduced delivery of nutritive substances and removal of cell metabolism products. Excess levels of free radical compounds can lead to cell damage. In addition, age-related loss of nerves and nerve connections in the brain can occur.
     Cats with CDS can appear to be disoriented or confused; they can get trapped in corners or forget where their litter box is located. Behavioral responses change; they can be more irritable, have increased anxiety, or have reduced responses to stimuli. There may be changes in sleep/awake cycles with a tendency to sleep during the day and be awake at night. They may vocalize inappropriately, especially loud crying at night. Many cats will aimlessly wander or pace. Eating patterns can change with either an increased or, more commonly, a decreased appetite. There may be a reduction in grooming. Memory loss may occur.
    Cats with CDS can appear to be disoriented or confused; they can get trapped in corners or forget where their litter box is located.
     Although there are no published studies documenting effective therapy in cats, studies have been published in other species and form the basis for current recommendations. Treatment and supportive care include diet changes, environmental management, and possible drug treatments. Dietary changes are focused on supplying foods (vegetables and fruits) with increased levels of antioxidants to reduce damage caused by the free radicals. Increased levels of vitamins C and E, essential fatty acids, beta-carotene, and L-carnitine may be beneficial. Environmental enrichment can lead to an increase in cognitive function especially in conjunction with dietary changes. However, once cats have significant CDS signs, changing the environment may actually lead to increased stress and negative effects because these cats may be unable to adapt to these changes. A number of drugs have been used in cats including selegiline, buspirone and fluoxetine with varying success; however, studies in cats are lacking.
     If you suspect your cat has CDS, contact your veterinarian for an evaluation to make sure there are no other age-related diseases that mimic CDS signs or are contributing to declining cognitive function. Since many older cats have multiple problems, a complete evaluation is essential for diagnosis and planning. Early supportive care for CDS appears to slow progress of dysfunction and helps to maintain quality of life.
Heartworm infection in dogs   
(Ron Carsten - Glenwood Post Independent 4-29-14)
    Heartworm (Dirofilaria immitis) infection in dogs has been reported in all U.S. states. The highest numbers are in the Southeast and Mississippi River Valley with infection rates in some areas as high as 45 percent. In 2001, approximately 240,000 cases were diagnosed in the U.S. The mosquito is an essential part of the heartworm life cycle. This means that the incidence of heartworm varies between regions and climates relative to the mosquito populations. In Colorado, the regions of most concern are Grand Junction and Front Range areas. Dogs living in or traveling to these areas, especially during the mosquito season are at higher risk. Fortunately there is a simple blood test to detect heartworm infection and there are effective preventive drugs.
     The life cycle of the heartworm is interesting and complex. In a dog infected with heartworms, adult heartworms live in the pulmonary (lung) arteries and to a lesser extent in the right ventricle of the heart. After mating, the adult heartworm releases microfilaria (baby heartworms) into the blood. Female mosquitoes ingest these microfilaria while feeding. Then the microfilaria undergo two molts over 8-17 days in the mosquito. At this stage, they can be injected back into a dog at another feeding where a third molt occurs over 1-12 days. A final molt occurs over 50-68 days to become an immature adult. Immature adults enter the bloodstream and migrate to the heart and lungs where they mature. Amazingly, male heartworms grow to about 15-18 cm and the female to 25-30 cm. Mating occurs and production of microfilaria begins. The complete life cycle takes about 184-210 days with microfilaria found in the circulating blood at 7-9 months. Adult heartworms are known to live 5-7 years and microfilaria up to 30 months. Interestingly, heartworm molting and maturation are dependent on the presence of a symbiotic bacterium.
     Signs seen in dogs with heartworm infection range from no signs (majority of dogs) to weight loss, reduced ability to exercise, cough, difficulty breathing, and formation of abdominal fluid. Heart murmurs and arrhythmias may occur. The severity of signs depends on the number of worms, length of infection, and the dog’s reaction to the heartworms. Heartworm numbers have been reported to range from 1 to over 250. The worms can produce a toxic substance, induce an immune reaction, cause damage to
the lining of the blood vessels, and in severe cases create blockage of blood vessels. Dead heartworms can block arteries and form emboli.
    Diagnosis is made using blood to test for adult heartworm antigens. Dogs with a positive antigen test generally have a second confirming test performed followed by a test to look for the presence of microfilaria. Additional evaluation includes other blood tests and chest X-rays. This information is important for planning treatment. Depending on the severity of infection and clinical signs, complications associated with treatment can be challenging. Melarsomine has been approved for treatment of adult heartworms but it is in critically short supply. The American Heartworm Society has developed guidelines for treatment and care when melarsomine is unavailable.
     It is clear that heartworm infection can cause serious problems and be challenging to treat. However, preventive steps can be taken, including monthly administration of a preventive product such as Heartgard, Interceptor, or Revolution.
     Our region does not yet have an endemic heartworm problem even though we live in a river valley. However, common recommendations for reducing the individual risk here include annual testing for heartworms even when your dog never leaves the valley, use of the monthly preventive year round or at least during mosquito season, and not traveling with your dog to a heartworm area during mosquito season. Annual testing can be important to make sure that infections are identified and treated early especially because a small number of dogs become positive even while taking the preventive.
     Alternatives to the monthly preventive drugs have been proposed including the use of herbs like walnut and wormwood, and homeopathic remedies. Unfortunately, none of these proposed approaches have been adequately evaluated to determine their efficacy. In addition, there is concern about toxicity with the use of wormwood-containing products. Therefore, it is important to be fully informed before using these products.
     Heartworm infection is a serious problem that is preventable. Even though we live in an area that is relatively free of heartworm problems, it is still valuable to discuss this issue with your veterinarian and establish a proactive approach for protecting your dog companion.
Osteoarthritis, an under-recognized problem in cats
(Ron Carsten - Glenwood Post Independent 3-26-14)
    The U.S. cat population is aging. In the last 10 years, the percentage of cats over 6 years of age has grown from 24 percent to 47 percent, the percentage over 10 years of age has grown 15 percent, and the percentage over 15 years of age from 5 percent to 14 percent.
     As the cat population ages, there is an increasing awareness that they are affected by osteoarthritis (OA) just like dogs and other species. This recognition is important because traditionally it has been assumed that cats do not suffer from OA, mainly because cats generally don’t show lameness like dogs. However, it is now clear that cats are affected by OA.
     Over 90 percent of cats over 12 years of age are reportedly affected. Instead of lameness, affected cats show their chronic pain through changes in lifestyle and behavior, including loss of appetite, weight loss, poor grooming habits, urination or defecation outside the litter box, reluctance or inability to jump on or off objects, change in attitude, irritability when handled and prolonged sleeping.
     OA is a progressive, degenerative condition affecting joints. The cause and contributing factors in cats are poorly understood. Over time, the normal cartilage in the joints breaks down; pain results from inflammation, bone on bone contact, formation of bone spurs, and other degenerative changes affecting the joints and surrounding tissues. The most commonly affected joints are the elbows and hips; however, shoulders and hocks are also reported. Significant numbers of cats have OA involving the spine and sternum. Since OA is a progressive problem, it should be actively managed with the goal of slowing progression, preserving remaining joint function, and maintaining quality of life.
     Interestingly, OA in cats can be difficult to diagnose even for experienced veterinarians. Cats appear to be very tolerant of severe joint disease because of their small body size and normal agility. Diagnosis is complicated by the fact that most cats do not like to be examined and generally do not walk around the veterinarian’s examination room. In addition, the degenerative changes associated with OA in cats are subtle. Obvious reduced joint range of motion and crepitus (grinding or crunching) are uncommon in the cat. Thickening of the tissue around the joints is common in cats, but the extent is not always easy to completely appreciate.
X-rays can be valuable, but a large number of cats with OA associated pain do not show OA changes on X-rays. As a result of these challenges, the owner observations at home are essential for alerting the veterinarian that there is a potential OA problem.
     Treatment options have been limited, due primarily to a lack of research focused on cat OA. Information from dogs and other species cannot be easily or reliable extrapolated to cats because cats metabolize drugs differently and the causative factors leading to OA are unclear. Management methods include using litter boxes with lower sides for ease of entry and exit, elevating the food and water bowls to reduce the amount of bending during feeding, providing soft bedding to increase comfort, reducing or eliminating the need to jump up on the sofa, windowsill or other favored location through the use of a ramp or series of small steps, and spending time grooming the cat.
     Some authorities recommend the long term use of specific non-steroidal anti-inflammatory drugs (NSAID) based on their use outside the U.S. As with all NSAID drugs, there is the potential for side-effects that may involve the stomach and intestines, kidneys, heart, or liver, especially in cats. A complete evaluation and discussion with a veterinarian should occur before initiating any NSAID therapy. Supportive therapies that have been shown to increase activity of cats with OA include diets high in glucosamine/chondroitin, green-lipped mussel extract, and fish oil. Acupuncture can be a valuable addition to the support plan. For pain not effectively managed by these options, drugs like buprenorphine, gabapentin, tramadol, and amantadine have been advocated.
     Since pain is difficult to assess in cats, determination of response to therapy is based on owner observations, such as increased mobility, increased activity levels, improvements in appetite and return to previously normal behaviors. Therefore, close communication between the veterinarian and the cat owner is essential for optimal management of OA in cats.
     If you suspect your cat has OA, contact your veterinarian so that a complete discussion, evaluation, and comprehensive plan for therapy can be developed. Slowing the progression of OA and managing any associated pain can improve the quality of life for your cat companion.
Liver disease affects many dogs but is hard to diagnose
(Ron Carsten - Glenwood Post Independent 2-21-14)
    Liver disease is a leading cause of death in dogs. Unfortunately, signs of liver disease in dogs are generally vague and indistinct, making it difficult to recognize early. The term liver disease describes a wide range of liver problems that includes infectious diseases, inflammatory problems, toxicities, genetic issues, and cancer.
     The liver is a large organ found in the abdomen next to the diaphragm. It is predominantly composed of liver cells, bile ducts, and blood vessels. Bile ducts connect to the gall bladder. Incredibly, the liver has tremendous functional reserves: three-quarters of the liver can be removed and still maintain appropriate function while regenerating. This reserve plays an important role in maintaining liver function.
     The liver is responsible for maintaining optimal health through an incredible range of metabolic activities including carbohydrate, protein and fat metabolism; detoxification; vitamin, trace mineral, and glycogen storage; and bile production. The liver is intimately associated with the digestive tract with blood from almost the entire digestive tract entering the liver for processing before moving to the rest of the body. This is important for removing toxic substances from the blood before they can harm the rest of the body. In addition, the liver is in a prime location for dealing with bacteria that have inappropriately passed through the intestinal wall. These bacteria are attacked by white blood cells that are specifically maintained in the liver for that purpose. This also means that good intestinal function is critical for a healthy liver. Like all other organs, the liver relies on a steady blood flow from the heart to deliver oxygen and important nutrients and to remove cellular waste products. Clearly good heart function and blood flow are important for proper liver activity.
     With its central role in maintaining health through its vast metabolic activities, the liver can be affected by a range of problems. Some problems like bacterial infections, inflammatory conditions of the liver (hepatitis) and bile ducts, or abnormal liver cell function directly involve the liver. Other problems are caused by disease in other organs or glands such as intestinal wall dysfunction, excess production of steroid (cortisol) by the adrenal glands, inadequate blood flow to the liver, or pancreatitis.    
Signs of liver disease are typically vague and can range from “just not doing right” to vomiting, diarrhea, increased thirst and urination, or even seizures. From a diagnostic perspective these signs do not clearly focus on the liver. Adding to the diagnostic complication is that some problems like ingestion of a poison can cause damage very quickly while others like a chronic hepatitis can occur slowly over time. Diagnosing liver disease involves a number of steps starting with blood tests for liver enzymes like ALT (alanine aminotransferase) and ALP (alkaline phosphatase) that are released into the blood. A healthy liver releases these enzymes at a relatively constant rate while an unhealthy liver or a liver being damaged by indirect causes will typically have an increased release of these enzymes.
     Unfortunately, these enzymes do not evaluate function since they leak from liver cells (ALT) or can be induced by poor bile flow (ALP). In addition, these enzymes can be increased by drugs like phenobarbital, NSAID, and steroids; muscle damage; or congestive heart failure. Measurement of bile acids before and after a meal can provide information about liver function. Levels of albumin, coagulation proteins, and bilirubin also provide insight into liver function but generally change only late in the course of disease. X-rays, ultrasound, and liver biopsies may be required to obtain a final diagnosis.
     Treatment of liver disease depends on the cause and severity. Addressing the initial insult is essential if it can be determined, however, it is not always possible to identify. In most situations, regardless of the initial cause, it is important to provide supportive therapy for the liver itself. This can be done by diet changes and using products that support liver cell function including SAMe, herbs like milk thistle and schisandra, vitamins C and E, and bile acid products. Intravenous fluids and antibiotics may be required initially in some situations. Additional support of the intestinal tract with probiotics and glutamine may be beneficial as well as herbs that help move bile like dandelion.
     Liver disease is a significant problem in dogs. It has a wide range of causes. Unfortunately, signs of liver disease are ambiguous and similar to many other problems. If you have concerns about your dog, contact your veterinarian and discuss blood testing for liver problems and supportive care if needed.
Marijuana intoxication can harm your pets
(Ron Carsten - Glenwood Post Independent 1-18-14)
    With the increasing availability of marijuana (Cannabis sativa) in Colorado, pet exposure to marijuana has been on the rise. Dr. Meola et.al. reported in 2012 that there was a 146-fold increase in registered medical marijuana users in Colorado, and a 4-fold increase in dogs presented for marijuana toxicosis from 2005-2010 in two large Colorado Front Range veterinary emergency centers. There were two deaths out of 125 marijuana intoxicated dogs. The deaths were likely from ingestion of highly concentrated medicinal products. Pet Poison Helpline, an animal poison control center has also experienced a 200-percent increase in pet marijuana cases over the last 5 years. Significantly more dogs than cats appear to be involved.
    Pet exposure occurs through secondhand smoke and direct ingestion of marijuana or foods containing marijuana. Most exposure appears to be unintentional but there is increasing interest in the use of marijuana for pain management, appetite stimulation, and prevention of vomiting in pets with cancer. Unfortunately, there currently is little research documenting the benefits of marijuana consumption, the optimal dosages, or details of how marijuana works in pets. With concerns about potential toxicity and lack of scientific documentation, a cautious approach is recommended until more research can be completed and standardized marijuana preparations become available.
    More than 400 chemicals have been identified in marijuana; over 60 of these are cannabinoids including the major psychoactive compound cannabinoid δ-9-tetrahydrocannabinol (THC). Whole marijuana has not been approved by the FDA for medical use, however, cannabinoid-based drugs like Nabilone and Dronabinol (synthetic cannabinoids) are available by prescription in the United States. An extracted cannabinoid, available in Europe, is currently undergoing clinical trials in the United States. In humans, indications include pain, loss of appetite, and control of vomiting in cancer and AIDS patients.
    The amount of marijuana required to cause a toxicosis in dogs or cats is dependent on the THC concentration. THC concentration is variable between plant varieties, plant part used, and growing and storage conditions. The minimum lethal dose of THC for dogs is considered to be 3g/kg of body weight. Effects of intoxication are seen 30-90 minutes after ingestion and most resolve over a period of 3-12 hours.
However, effects can last up to 4 days while the body is detoxifying. Signs of intoxication can include severe depression, walking as if drunk, lethargy, and even coma. Some pets have low heart rates, low blood pressure, depressed respiration, diarrhea, and dilated pupils. Others can be hyperactive, vocalize, and even have seizures. Vomiting is often seen with dogs even though THC has anti-vomiting properties. Intoxicated pets may lack the coordination necessary to consume food and water and may be prone to dehydration and injuries related to falling.
    Use of the human urine test for dogs to detect THC has been controversial. Recent studies show inconsistent ability to detect THC in dog urine resulting in false negative results. This creates a problem for diagnosis because even though serious long-term health issues and fatality from marijuana intoxication have been extremely rare, the newer, highly concentrated medical strains of marijuana and synthetic cannabinoids have more potential for serious problems. A further concern is that marijuana toxicosis appears similar to other serious poisonings like antifreeze and other drug intoxications. Toxicity in pets can also occur from chocolate and xylitol which may be ingredients in foods mixed with marijuana.
    While most pets with marijuana toxicosis recover with no problems, caution is warranted. Vomiting can be induced by your veterinarian to reduce the potential for toxicity if you discover the marijuana ingestion within 30 minutes and your pet has no signs. Some authorities also recommend giving activated charcoal after marijuana ingestion in an attempt to reduce the absorption in the digestive tract. Supportive treatments include keeping the pet warm and minimizing sensory stimuli. Pets with severe agitation may require sedation. Intravenous fluids may become necessary if prolonged vomiting has occurred or if the pet is unable to drink for an extended period.
    Significant optimism exists about the potential benefits of marijuana for pets. However, a great deal of research still needs to be completed, especially with the newer, high THC concentration products. Therefore, even though serious health problems have been rarely reported in pets, a cautious approach is important. Marijuana toxicosis can also mimic other more serious poisonings. Contact your veterinarian if you have questions about marijuana toxicosis in pets or if you suspect your pet has ingested marijuana.
Keeping the holidays safe for your pets
(Ron Carsten - Glenwood Post Independent 12-19-13)
    Holidays are a time of joy and sharing with family and friends. Pets are an important part of our families, so it is essential to consider their safety needs during the holiday season.
    Many common holiday items can pose dangers for our pets, especially because pets often do not understand the consequences of their own actions. Potential dangers include chewing and swallowing holiday items like ornaments, decorations, electrical cords, toxic plants, foods and toys. Results can range from mild harm to the mouth to severe life-threatening emergency situations.
    When decorating your home for the holidays, keep in mind that decorations can be intriguing for pets and invite play. This play can involve chewing and sometimes ingestion. Some chewed items like glass ornaments or light bulbs can injure the mouth and, if swallowed, can injure the esophagus, stomach or intestines. Chewed electrical cords can cause electrical burns and electrocution resulting in damage to the mouth and even death. Swallowing tinsel, strings, small ornaments and hooks can cause serious injury to the stomach and intestines requiring surgery to remove or repair. In addition, holiday decorations can contain heavy metals that can be toxic when ingested.
    Avoid these hazards by pet proofing your holiday home. Keep tinsel and popcorn strings out of reach of your pets. Don’t leave your Christmas lights plugged in when you are not able to monitor your pet. Food should not be placed into wrapped packages that pets have access to. Toys should be designed for pets; be aware that small eyes and squeakers can be swallowed, stuffing can be eaten, and threads can be interesting to pull on and swallow. Treats should be pet-friendly and avoid ingredients that can be harmful and food should be fresh so that food poisoning does not occur. Holiday plants should be placed so that pets cannot chew or ingest them.
    Foods and food ingredients to avoid include chocolate, onions and garlic, candy and sugarless gum with xylitol, bones, leftover fatty meat scraps and foods that have been left out for long periods of time. Chocolate toxicity depends on the amount of chocolate ingested and the type. Small
amounts  of chocolate may only cause a mild upset withsome vomiting and diarrhea, while larger amounts may result in agitation, elevated heart rate, abnormal heart rhythms, seizures and collapse. Cats are more sensitive than dogs to the effects of onion and garlic. Depending on the amount ingested and the sensitivity of the individual, damage to the red blood cells can occur along with nausea, vomiting and diarrhea. Xylitol can cause low blood glucose and liver problems in dogs. As with chocolate, the severity of toxicity is dose dependent – only one piece of chewing gum may be enough to cause problems in a 10 pound dog.
    Bones can become lodged in the stomach or intestines and result in mild (digestive upset) to severe problems (blockage) that require surgery. Leftover fatty meat scraps can potentially lead to severe inflammation of the pancreas (pancreatitis) resulting in abdominal pain, vomiting and bloody diarrhea. Foods left sitting for long periods of time can give the opportunity for bacteria like Salmonella or E. coli to grow. These organisms have the potential to cause food poisoning or bacterial contamination. Severe intestinal problems and illness can result from this food contamination. According to Colorado State University Extension, when the room temperature is less than 90 degrees, food should not be left out for more than 2 hours and cooked leftovers should be used within 4 days.
    Common holiday plants include the poinsettia, mistletoe, lilies, and holly. Poinsettias are no longer considered to be highly toxic to pets. The milky white sap of the poinsettia can cause a mild self-limiting oral irritation, salivation and vomiting. Mistletoe is also currently considered to be less toxic than thought in the past. Ingestion of the American mistletoe leaves or berries may result in some vomiting and lethargy. Lilies like the tiger, Asiatic, Easter and day lilies are dangerous for cats. Ingestion of 1-2 leaves or flower petals can result in sudden kidney failure. Holly leaves are considered to be more of an irritation to the mouth from the spiny leaves while the berries can cause stomach and intestinal upset.
    The best policy is to make your holiday home pet safe and monitor your pets so that you can have a quiet and enjoyable holiday season. Contact your veterinarian if you have any concerns about your pet.
What you should know about kidney disease in cats
(Ron Carsten - Glenwood Post Independent 11-17-13)
    Chances are if you have a cat or know someone with a cat, you have encountered feline kidney disease. Kidney disease is one of the most common problems in cats.
    Cats older than 7 are most at risk, and nearly 30 percent of cats older than 10 are affected. This is a concern because proper kidney function is vital to life. These incredible organs do more than just filter blood to form urine and eliminate metabolic waste. They also play an important role in blood pressure regulation, vitamin D activation, blood electrolyte and acid-base regulation and fluid balance, and they produce a hormone signal that is critical for red blood cell production and prevention of anemia.
    These functions are continuously performed by a pair of kidneys that are normally only 2-1/2 inches long in the cat. Despite their small size at only 0.5 percent of the total body weight, they receive 25 percent of the blood pumped by the heart. At the microscopic level, it is the nearly 200,000 nephrons that are responsible for important functions of the kidney, and it is the loss of functioning nephrons that results in kidney failure.
    There are many causes of kidney failure in cats. Some damaging insults cause sudden kidney failure (also known as acute renal failure or ARF). These insults include antifreeze poisoning, urinary obstruction, plant toxins, certain drugs like the non-steroidal anti-inflammatory drugs (NSAID) or certain antibiotics, heart failure, and bacterial infections of the kidney. Generally, if these problems are appropriately treated, kidney function can be restored.
    Chronic kidney disease (CKD), on the other hand, generally evolves over time. Diseases that contribute to CKD include bacterial infections of the kidneys, ongoing inflammatory conditions, cancer, immune disorders and exposure to toxins and certain drugs. Since CKD is typically a slowly progressing problem and the kidney has tremendous ability to compensate and continue to perform its vital tasks, affected cats generally don’t show illness until the disease is advanced. Underscoring this point is the recognition that the ability of the kidney to concentrate urine does not start to decline until 2/3 of kidney function has been lost, and the
creatinine blood value does not rise until approximately 3/4 of kidney function has been compromised.  Diagnosis of kidney failure is made by blood tests measuring the blood urea nitrogen (BUN) and creatinine. Analysis of urine and other evaluations like abdominal X-rays and ultrasound can provide valuable information. Early indications of kidney problems can be subtle and may only be seen as increased water drinking and increased urination. As the kidney function continues to decline and the cat becomes increasingly unable to effectively detoxify, they can become depressed, lose their appetite, experience vomiting, and if the toxicity is severe enough, ulcers in the mouth may develop. Since the kidney has many more functions than just detoxification, the cat may also experience high blood pressure that can contribute to injury to the retinas of the eye, become anemic, become continuously dehydrated, and have problems regulating potassium and phosphorus.
    Once kidney disease is diagnosed and contributing causes identified, treatment can be initiated. For ARF, the main goals are to restore hydration, work to flush out the toxins, address contributing factors, control any nausea and vomiting, and maintain food consumption. For CKD, treatments are based on the stage of severity. Generally for cats that are ill, efforts are focused on stabilizing the cat, slowing progression of the deterioration of the kidney, and maintaining quality of life. Unfortunately, in most cases of CKD it is not possible to return the kidney to normal function. Treatment and supportive approaches depend on severity and may include fluid injections, special diets, phosphorus binders, blood pressure medications, stomach acid blockers, and steps to combat anemia. Affected cats are monitored carefully for progression and support therapy modified accordingly. The integrative approach may include the addition of acupuncture, omega-3 fatty acids, herbs and supplements. While specific studies are not always available for every supportive approach, numerous clinical observations indicate that these supportive methods can be beneficial for the long-term care and comfort of affected cats.
    Contact your veterinarian if you suspect your feline companion is showing any signs of kidney problems. It is always best to start supportive care early.
Nearly every dog and cat is affected by this disease
(Ron Carsten - Glenwood Post Independent 10-26-13)
    When was the last time you looked at your dog’s or cat’s teeth and gums? You might be surprised by what you see.
    Periodontal disease affects almost all dogs and cats at some point in their lives and contributes to increased risk of heart, kidney, and liver disease similar to humans. Understanding periodontal disease is the first step toward recognition and successful management. Over 80 percent of dogs and 70 percent of cats over 2 years of age are affected. The frequency of disease increases with age and affects almost all dogs by 5 years of age. This makes periodontal disease the most common health problem seen in dogs and cats.
    Periodontal disease involves two distinct inflammatory conditions. The first inflammatory condition affects the gums and is called gingivitis. The second inflammatory condition is called periodontitis because the gums, tooth attachment tissues, and the associated bone are affected. Any dog or cat can be affected, but, periodontal disease is most common in small and toy breeds such as the toy poodle, Yorkshire terrier, and Maltese. There are a number of factors that contribute to periodontal disease including small mouth size with crowded teeth and a genetic predisposition. In addition to bad breath, periodontal disease can result in mouth pain, difficulty eating, and tooth loss. Also a big concern is that bacteria and bacterial toxins from the mouth can be shed into the bloodstream. This means that the larger the amount of bacteria and bacterial toxins in the mouth the greater the risk of heart, kidney, and liver disease.
    Periodontal disease starts out as gingivitis. This inflammation in the gum tissue is a reaction to the soft food particles and bacteria (plaque) accumulating in the area where the gum tissue attaches to the tooth. In addition to bad breath, swollen and bright red gums, minor bleeding may occur when toys or rawhides are chewed. Gingivitis is the initial stage of periodontal disease. It is considered reversible with appropriate care involving removal of the plaque and calculus and daily teeth brushing. Regular daily brushing is recommended because, when plaque is mixed with saliva and minerals in saliva, it quickly hardens into calculus.
    While teeth brushing is considered the best home care, not all dogs and cats allow their teeth to be brushed. Other care
options include dental diets, special chews, water additives, and certain toys. Some dental diets work by mechanically breaking up the plaque and binding calcium in the saliva to reduce calculi formation. Chlorohexidine-based oral products and zinc ascorbate gels have been shown to reduce plaque accumulation and can reduce the bacteria that cause periodontitis. Unfortunately, these approaches may not completely control the problem, therefore, it is important to be aware that a dental cleaning and polishing under general anesthesia may be recommended by your veterinarian. General anesthesia is important because it allows the veterinarian to carefully clean the plaque and calculi in the gum sulcus and between the teeth that may not be visible without a thorough inspection. Also, overgrown inflammatory gum tissue can be removed, and a search for periodontal pockets can be completed.
    Gingivitis can progress into periodontitis where the gums and the tissues that attach the tooth to the jaw bone become inflamed and the tooth attachments can breakdown. Periodontitis can fluctuate between periods of active inflammation and no inflammation. Therefore, there are periods of time where the mouth looks stable and periods of rapid decline. The severity of the periodontitis is graded based on the depth of periodontal pockets, the amount of gum tissue destruction, and the amount of bone loss around the tooth root. In some cases, the complete extent of the periodontal disease can only be determined with an X-ray.
    Diseases such as diabetes, feline leukemia virus, and anemias can play a role in progression of periodontal disease. Treatment of periodontitis requires antibiotics, general anesthesia, a complete dental cleaning, and surgical correction of periodontal pockets. In addition to daily teeth brushing, use of dental diets, and appropriate oral rinses, long term management may be improved with the addition of foods that provide increased vitamins such as vitamin A and C that are supportive for the gums and connective tissues and immune system. Oral probiotics have potential benefits. Additionally, probiotics can be supportive of a healthy immune system and have benefits following antibiotic use.
    Since your pet is likely affected, contact your veterinarian to discuss periodontal disease. Prompt treatment is essential for long term health in the mouth and the entire body.