Categories
Drugs

Aminocaproic Acid (Amicar)

Fibrinolysis Inhibitor/Antiprotease

Highlights Of Prescribing Information

May be useful for treating degenerative myelopathies in dogs; efficacy not well documented

Treatment may be very expensive, especially with large dogs

Contraindicated in DIC

Infrequently causes GI distress

What Is Aminocaproic Acid Used For?

Aminocaproic acid has been used as a treatment to degenerative myelopathy (seen primarily in German shepherds), but no controlled studies documenting its efficacy were located. There is interest in evaluating aminocaproic acid for adjunctive treatment of thrombocytopenia in dogs, but efficacy and safety for this purpose remains to be investigated. In humans, it is primarily used for treating hyperfibrinolysis-induced hemorrhage.

Pharmacology/Actions

Aminocaproic acid inhibits fibrinolysis via its inhibitory effects on plasminogen activator substances and via some antiplasmin action. Aminocaproic acid is thought to affect degenerative myelopathy by its antiprotease activity thereby reducing the activation of inflammatory enzymes that damage myelin.

Pharmacokinetics

No pharmacokinetic data was located for dogs.

In a study where 70 mg/kg doses were given IV to horses over 20 minutes, the drug was distributed rapidly and plasma levels remained above the proposed therapeutic level of 130 mcg/mL for one hour after the end of the infusion. Elimination half-life was 2.3 hours. The authors proposed that a constant rate infusion of 15 mg/ kg/hr after the original infusion would maintain more prolonged therapeutic levels ().

In humans, the drug is rapidly and completely absorbed after oral administration. The drug is well distributed in both intravascular and extravascular compartments and penetrates cells (including red blood cells). It is unknown if the drug enters maternal milk. It does not bind to plasma proteins. Terminal half-life is about 2 hours in humans and the drug is primarily renally excreted as unchanged drug.

Before you take Aminocaproic Acid

Contraindications / Precautions / Warnings

Aminocaproic acid is contraindicated in patients with active intravascular clotting. It should only be used when the benefits outweigh the risks in patients with preexisting cardiac, renal or hepatic disease.

Adverse Effects

In dogs treated, about 1% exhibit clinical signs of GI irritation. It potentially can cause hyperkalemia particularly in renal impaired patients.

Reproductive / Nursing Safety

Some, but not all, animal studies have demonstrated teratogenicity; use when risk to benefit ratio merits. In humans, the FDA categorizes this drug as category C for use during pregnancy (Animal studies have shown an adverse effect on the fetus, hut there are no adequate studies in humans; or there are no animal reproduction studies and no adequate studies in humans.)

Overdosage / Acute Toxicity

There is very limited information on overdoses with aminocaproic acid. The IV lethal dose in dogs is reportedly 2.3 g/kg. At lower IV overdosages, tonic-clonic seizures were noted in some dogs. There is no known antidote, but the drug is dialyzable.

How to use Aminocaproic Acid

Aminocaproic Acid dosage for dogs:

For adjunctive treatment of degenerative myelopathy (seen primarily in German shepherds):

a) In combination with exercise, vitamin support (vitamin B-complex, vitamin E), and analgesia (if required; using acetaminophen): Aminocaproic acid: 500 mg (regardless of size of animal, approximate dose is 15 mg/kg) PO q8h. Mix 192 mL of the 250 mg/mL injection with 96 mL of hematinic compound (e.g., Lixotinic) producing a 288 mL final volume. Give 3 mL per dose (500 mg). Store solution in refrigerator. Clinical improvement seen within 8 weeks. ()

b) Aminocaproic acid 500 mg/dog PO q8h indefinitely. Used in conjunction with acetylcysteine at 25 mg/kg PO q8h for 2 weeks, then q8h every other day. The 20% solution should be diluted to 5% with chicken broth or suitable diluent. Other treatments may include prednisone (0.25-0.5 mg/kg PO daily for 10 days then every other day), Vitamin C (1000 mg PO q12h) and Vitamin E (1000 Int. Units PO ql2). Note: No treatment has been shown to be effective in published trials. ()

As an antifibrinolytic:

a) No published doses for dogs, but has been used anecdotally at 50-100 mg/kg IV or PO q6h. ()

Client Information

■ Aminocaproic Acid costs to treat a German shepherd-sized dog can be substantial

■ As no well controlled studies have documented that this drug is effective for treating degenerative myelopathy, its use should be considered investigational

Chemistry / Synonyms

An inhibitor of fibrinolysis, aminocaproic acid is a synthetic monamino carboxylic acid occurring as a fine, white crystalline powder. It is slightly soluble in alcohol and freely soluble in water and has pKa’s of 4.43 and 10.75. The injectable product has its pH adjusted to approximately 6.8.

Aminocaproic acid may also be known as: acidum aminocaproicum, CL-10304 CY-116, EACA, epsilon aminocaproic acid, JD-177, NSC-26154, Amicar, Capracid, Capramol, Caproamin, Caprolisin, Epsicaprom, Hemocaprol, Hemocid, Hexalense, or Ipsilon.

Storage / Stability/Compatibility

Products should be stored at room temperature. Avoid freezing liquid preparations. Discoloration will occur if aldehydes or aldehydic sugars are present. When given as an intravenous infusion, normal saline, D5W and Ringer’s Injection have been recommended for use as the infusion diluent.

Dosage Forms / Regulatory Status

Veterinary-Labeled Products: None

The ARCI (Racing Commissioners International) has designated this drug as a class 4 substance. See the appendix for more information.

Human-Labeled Products:

Aminocaproic Acid Tablets: 500 mg & 1000 mg; Amicar (Xanodyne); Aminocaproic Acid (VersaPharm); (Rx)

Aminocaproic Oral Solution: 250 mg/mL in 237 mL & 473 mL; Aminocaproic Acid (VersaPharm); (Rx)

Aminocaproic Syrup: 250 mg/mL in 473 mL; Amicar (Xanodyne); (Rx)

Aminocaproic Acid Injection for Intravenous Infusion: 250 mg/mL in 20 mL vials; generic; (Rx)

Categories
Drugs

Acetylcysteine (N-acetylcysteine, Mucomyst, NAC)

Antidote; Mucolytic

Highlights Of Prescribing Information

Used primarily as a treatment for acetaminophen or phenol toxicity & for its mucolytic effect; used anecdotally for treating degenerative myelopathy

Also used as a topical ophthalmic ()

Has caused hypersensitivity & bronchospasm when used in pulmonary tree

Administer via gastric- or duodenal tube for acetaminophen poisoning in animals

What Is Acetylcysteine Used For?

Acetylcysteine is used in veterinary medicine as both a mucolytic agent in the pulmonary tree and as a treatment for acetaminophen or phenol toxicity in small animals. It has been used anecdotally with aminocaproic acid to treat degenerative myelopathy in dogs.

In horses with strangles, acetylcysteine instilled into the gutteral pouch has been used to help break up chondroids and avoid the need for surgical removal. Acetylcysteine enemas have been used in neonatal foals to break up meconium refractory to repeated enemas.

Before you take Acetylcysteine

Contraindications / Precautions / Warnings

Acetylcysteine is contraindicated (for pulmonary indications) in animals hypersensitive to it. There are no contraindications for its use as an antidote.

Because acetylcysteine may cause bronchospasm in some patients when used in the pulmonary system, animals with bronchospastic diseases should be monitored carefully when using this agent.

Adverse Effects

When given orally for acetaminophen toxicity, acetylcysteine can cause GI effects (nausea, vomiting) and rarely, urticaria. Because the taste of the solution is very bad, use of taste masking agents {e.g., colas, juices) have been used. Since oral dosing of these drugs may be very difficult in animals, gastric or duodenal tubes may be necessary.

Rare adverse effects reported when acetylcysteine is administered into the pulmonary tract, include: hypersensitivity, chest tightness, bronchoconstriction, and bronchial or tracheal irritation.

Overdosage / Acute Toxicity

The LD50 of acetylcysteine in dogs is 1 g/kg (PO) and 700 mg/kg (IV). It is believed that acetylcysteine is quite safe (with the exception of the adverse effects listed above) in most overdose situations.

How to use Acetylcysteine

Acetylcysteine dosage for dogs:

For acetaminophen toxicity:

a) A 2-3 hour wait between activated charcoal and PO administration of acetylcysteine (NAC) is necessary. Give NAC as an initial oral loading dose of 140 mg/kg (dilute to 5% in dextrose or sterile water), followed by 70 mg/kg PO four times daily (q6h) for 7 treatments. With ingestion of massive quantities, some authors suggest using a 280 mg/kg loading dose and continuing treatment for 12-17 doses. May also be given IV after diluting to 5% and given via slow IV over 15-20 minutes. Additional therapy may include IV fluids, blood or Oxyglobin, ascorbic acid and SAMe. ()

b) 150 mg/kg PO or IV initially, then 50 mg/kg q4h for 17 additional doses ()

c) Loading dose of 140 mg/kg PO, then 70 mg/kg PO every 6 hours for 7 treatments ()

For phenol toxicity:

a) 140 mg/kg PO or IV initially, then 50 mg/kg q4h for 3 days. May be partially effective to reduce hepatic and renal injury. Resultant methemoglobinemia should be treated with ascorbic acid or methylene blue. ()

For respiratory use:

a) 50 mL/hr for 30-60 minutes every 12 hours by nebulization ()

For degenerative myelopathy:

a) 25 mg/kg PO q8h for 2 weeks, then q8h every other day. The 20% solution should be diluted to 5% with chicken broth or suitable diluent. Used in conjunction with aminocaproic acid (500 mg per dog PO q8h indefinitely). Other treatments may include prednisone (0.25-0.5 mg/kg PO daily for 10 days then every other day), Vitamin C (1000 mg PO q12h) and Vitamin E (1000 Int. Units PO q12h). Note: No treatment has been shown to be effective in published trials. ()

Acetylcysteine dosage for cats:

For acetaminophen toxicity:

a) A 2-3 hour wait between activated charcoal and PO administration of acetylcysteine (NAC) is necessary. Give NAC as an initial oral loading dose of 140 mg/kg (dilute to 5% in dextrose or sterile water), followed by 70 mg/kg PO four times daily (q6h) for 7 treatments. With ingestion of massive quantities, some authors suggest using a 280 mg/kg loading dose and continuing treatment for 12-17 doses. May also be given IV after diluting to 5% and given via slow IV over 15-20 minutes. Additional therapy may include IV fluids, blood or Oxyglobin9, ascorbic acid and SAMe. ()

b) 150 mg/kg PO or IV initially, then 50 mg/kg q4h for 17 additional doses ()

For phenol toxicity:

a) 140 mg/kg PO or IV initially, then 50 mg/kg q4h for 3 days. May be partially effective to reduce hepatic and renal injury. Resultant methemoglobinemia should be treated with ascorbic acid or methylene blue. ()

For respiratory use:

a) 50 mL/hr for 30-60 minutes every 12 hours by nebulization ()

For adjunctive treatment of hepatic lipidosis (see also Carnitine):

a) Identify underlying cause of anorexia and provide a protein replete feline diet, give acetylcysteine (NAC) at 140 mg/kg IV over 20 minutes, then 70 mg/kg IV q12h; dilute 10% NAC with saline 1:4 and administer IV using a 0.25 micron filter; correct hypokalemia and hypophosphatemia, beware of electrolyte changes with re-feeding phenomenon ()

Acetylcysteine dosage for horses:

To help break up chondroids in the gutteral pouch:

a) Instill 20% solution ()

In neonatal foals to break up meconium refractory to repeated enemas:

a) 8 grams in 20 g sodium bicarbonate in 200 mL water (pH of 7.6), give as enema as needed to effect ()

b) With foal in lateral recumbency, insert a 30 french foley catheter with a 30 cc bulb for a retention enema. Using gravity flow, infuse slowly 100-200 mL of 4% acetylcysteine solution and retain for 30-45 minutes. IV fluids and pain medication should be considered. Monitor for possible bladder distention. ()

Monitoring

When used for acetaminophen poisoning:

■ Hepatic enzymes (particularly in dogs)

■ Acetaminophen level, if available (particularly in dogs)

■ Hemogram, with methemoglobin value (particularly in cats)

■ Serum electrolytes, hydration status

Client Information

■ This agent should be used in a clinically supervised setting only

Chemistry / Synonyms

The N-acetyl derivative of L-cysteine, acetylcysteine occurs as a white, crystalline powder with a slight acetic odor. It is freely soluble in water or alcohol.

Acetylcysteine may also be known as: N-acetylcysteine or N-acetyl-L-cysteine, NAC, 5052 acetylcysteinum, NSC-111180, Acetadote, Mucomyst or ACC.

Storage / Stability/Compatibility

When unopened, vials of sodium acetylcysteine should be stored at room temperature (15-30°C). After opening, vials should be kept refrigerated and used within 96 hours. The product labeled for IV use states to use within 24 hours.

Acetylcysteine is incompatible with oxidizing agents; solutions can become discolored and liberate hydrogen sulfide when exposed to rubber, copper, iron, and during autoclaving. It does not react to aluminum, stainless steel, glass or plastic. If the solution becomes light purple in color, potency is not appreciably affected, but it is best to use non-reactive materials when giving the drug via nebulization. Acetylcysteine solutions are incompatible with amphotericin B, ampicillin sodium, erythromycin lactobionate, tetracycline, oxytetracycline, iodized oil, hydrogen peroxide and trypsin.

Dosage Forms / Regulatory Status

Veterinary-Labeled Products: None

Human-Labeled Products:

Acetylcysteine injection: 20% (200 mg/mL), (0.5 mg/mL EDTA in 30 mL single-dose vials, preservative free; Acetadote (Cumberland); (Rx)

Acetylcysteine Solution: 10% & 20% (as sodium) in 4 mL, 10 mL, 30 mL & 100 mL (20% only) vials; Mucomyst (Apothecon); (Rx) Note: If using this product for dilution and then intravenous dosing, it is preferable to use a 0.2 micron in-line filter.

Categories
Horses

Nonneoplastic Sterile Nodules

Single or multiple noninfectious nodules are a common occurrence in horses. Sterile nodules are either immune-mediated or idiopathic in most cases. The two most common presentations are rapid-onset urticarial lesions and more slowly progressive firm nodules.

Urticaria

Collagenolytic Granuloma

Axillary Nodular Necrosis

Clinical Signs

Another less common cause of eosinophilic nodules is axillary nodular necrosis. As the name implies, horses with axillary nodular necrosis present with one or two firm, well-circumscribed 0.5- to 4.0-cm diameter nodules in the subcutaneous tissue of the girth or axillary area. Horses are otherwise healthy, with no clinical signs associated with the condition. The cause of these nodules is unknown.

Diagnosis of Axillary Nodular Necrosis

Diagnosis is made primarily based on history and clinical signs. Cytology will confirm the eosinophilic nature of the disease and be similar to that described for collagenolytic granuloma. Histopathology is distinctive; it shows an eosinophilic granulomatous dermatitis with central foci of coagulation but no collagen degeneration. The histologic picture has led to speculation that the nodules arise from a vascular insult, although vascular lesions have not been observed.

Treatment of Axillary Nodular Necrosis

Treatment is as described for collagenolytic granuloma — that is, intralesional or sublesional corticosteroids or surgical excision. Similar nodules tend to recur in subsequent years.

Unilateral Papular Dermatosis

Unilateral papular dermatosis is a rare idiopathic eosinophilic skin disease of horses. A hypersensitivity reaction is suspected, but the unilateral nature of the disease is puzzling.

Clinical Signs

No apparent age or sex predilection exists. The disease has been described in a number of breeds; however, Quarter Horses appear to be predisposed. Lesions tend to develop in the warm months and consist of multiple (30-300) papules and nodules that are distributed unilaterally over the trunk. No alopecia or ulceration is associated with the lesions, and they are neither pruritic nor painful.

Diagnosis of Unilateral Papular Dermatosis

Histopathology is diagnostic and reveals the eosinophilic folliculitis and furunculosis. Hair follicles are filled with eosinophilic debris.

Treatment of Unilateral Papular Dermatosis

Lesions will spontaneously regress over time; however, systemic corticosteroids will hasten resolution. Lesions may recur in the same or subsequent years.

Sterile Nodular Panniculitis

Another uncommon cause of infiltrative nonneoplastic nodules in horses is sterile nodular panniculitis. Panniculitis has been described as part of a generalized steatitis in association with dietary deficiencies of vitamin E and/or selenium. In addition, sterile panniculitis in horses seems to exist in a form similar to that described in dogs with sterile nodular panniculitis.

Clinical Signs

Horses present with multiple deep subcutaneous nodules over the trunk, neck, and proximal limbs that may become fixed to the overlying dermis. Nodules may be painful on palpation. Lesions may drain to the surface and discharge an oily, sometimes hemorrhagic exudate. Horses may appear systemically ill with fever, anorexia, and weight loss, similar to that in dogs. Anemia has also been seen in association with this disease. Systemic signs may wax and wane with lesion occurrence.

Diagnosis of Sterile Nodular Panniculitis

Cytology of the exudate shows a pyogranulomatous inflammation with no infectious agents seen. Due to the pyogranulomatous nature of the exudate, an exhaustive search to rule out an infectious etiology is indicated. To obtain a definitive diagnosis, wedge biopsy with aseptic technique should be done to ensure that the biopsy sample is deep enough to visualize the lesion. Tissue should be submitted for bacterial, fungal, and mycobacterial cultures and for histopathology. The sterile nature of the lesion can be confirmed by lack of growth on cultures and failure to find infectious organisms by use of special stains. Histologically, lesions are characterized by diffuse pyogranulomatous panniculitis. Fibrosis may be a prominent feature of chronic lesions. Lymphoid nodules may be present within lesional tissue.

Treatment of Sterile Nodular Panniculitis

Treatment of sterile nodular panniculitis consists of immune suppressive doses of prednisolone (2 mg/kg/day) or dexamethasone (0.2 mg/kg/day) for approximately 14 days. Corticosteroids are then tapered to the lowest dose that will control the disease. In some cases, lesions can be controlled with a very low dose of dexamethasone once to twice weekly. Upon withdrawal of the glucocorticoid, many horses will relapse.

Cutaneous Amyloidosis

Cutaneous amyloidosis, a rare cause of nodules in horses, results when amyloid is deposited in the skin and mucosa of the upper respiratory tract. The term amyloid describes a group of unrelated proteins that share certain characteristic properties when stained with Congo red and examined under polarized light.

Clinical Signs

In horses, amyloid may be deposited systemically, thus affecting many organ systems, or in a single organ such as the skin or respiratory tract. Deposition of amyloid in the skin of horses results in the slowly progressive formation of firm, nonpainful cutaneous nodules that range in size from 0.5 to greater than 10 cm in diameter. Nodules occur most often in the skin of the head, neck, and pectoral regions. Occasionally, nodules may initially develop quite rapidly and resemble urticaria. These initial lesions may then regress, to be followed by a more slowly progressive nodule formation. When amyloid is deposited in the nasal mucosa, clinical signs may include respiratory distress and mild epistaxis.

Diagnosis of Cutaneous Amyloidosis

Diagnosis of amyloidosis is confirmed on histopathology of a nodule. Histologically, a nodular to diffuse granulomatous dermatitis with areas of homogeneous, amorphous, eosinophilic material, often surrounding blood vessels, is noted. The presence of amyloid is confirmed by using special stains such as Congo red and by examining the tissue under polarizing light, which demonstrates an apple-green birefringence.

Treatment of Cutaneous Amyloidosis

No effective treatment exists for this disease. Corticosteroids may help reduce the size of the lesions initially, probably by decreasing some of the associated inflammation and edema, but this is only temporary. Amyloidosis is a slowly progressive disease.

Prognosis

The prognosis depends on the degree of respiratory involvement and whether other organs are affected. In humans, some forms of this disease are inherited; therefore, affected horses should not be used for breeding until more is known.

Categories
Horses

Dermatophytosis

Dermatophytosis is a common, contagious, superficial fungal infection of keratinized tissues — including the superficial epidermis, hair, and, less commonly, hooves. Synonyms include ringworm or “girth itch.” Horses of all ages can become infected with dermatophytes, but young horses are more commonly affected. Although multiple fungal genera are capable of producing dermatophytosis, the majority of infections result from infection with either Trichophyton spp. or Microsporum spp. Trichophyton equinum (var. equinum and var. autotrophkum) and Trichopyton mentagrophytes are the species most commonly isolated from equine infections. Trichophyton verrucosum, Microsporum gypseum, M. equinum, and M. canis are potential less common causes of equine dermatophytosis. Most of these fungal species are zoophilic dermatophytes, and transmission requires direct contact with infected animals or contact with infected hair or crusts in the environment. Infected rodents or cats are the most common sources for infection with T. mentagrophytes. Cats are also the typical source for infection with the very contagious species Microsporum canis, whereas cattle are the source for infection with T. verrucosum. Microsporum gypseum is a geophilic fungus that inhabits soil. Consequently, culture and speciation may be beneficial in delineating source of infection.

The prevalence of dermatophytosis increases in hot, humid climates or under conditions of close contact in dark, moist environments. In North America, more cases are seen in the fall and winter months. Young animals with no previous exposure lack immunity and are therefore more vulnerable to dermatophytosis. Horses with poor nutritional status or secondary debilitating diseases can be immunocompromised and more susceptible to dermatophytosis. Not all animals exposed to dermatophytosis develop clinical signs. The incubation period is typically between 1 and 4 weeks, depending on environmental temperature and humidity. Spores in the environment can persist for months to years, and contaminated tack and grooming equipment can be modes of transmission between animals.

Dermatophytosis: Clinical Signs

Hair loss is the most common clinical sign of dermatophytosis. Alopecia results because infected hair shafts are weakened and break more easily and also because hairs within inflamed hair follicles epilate more readily. Lesions are often multifocal, asymmetric, annular areas of alopecia that vary in size from 2 to 4 mm to several centimeters in diameter. Scales and crusts are often associated with the alopecia but inflammation and erythema may be minimal. Papules may be present and are often most noticeable at the advancing edge of lesions. Initial presentation can mimic urticaria with erect hairs in a circular plaque or papular lesion that may exude serum. However, these lesions quickly progress to become well-circumscribed areas of alopecia, scale, and crusting. Once it occurs, hair re-growth starts in the center of the lesion. Areas most commonly affected in the horse include the head, neck, shoulders, and lateral thorax. Skin abrasions or trauma often precede dermatophytosis; lesions consequently are often seen in areas of saddle or girth friction. Horses are only infrequently pruritic with dermatophytosis.

Diagnosis of Dermatophytosis

Dermatophytosis may be overdiagnosed when annular skin lesions are erroneously assumed to result from dermatophyte infection. Differential diagnoses include dermatophilosis, bacterial folliculitis, pemphigus foliaceus, or urticaria due to hypersensitivity reactions. Alopecic lesions with minimal scale or crusting should also have the differential diagnoses of telogen effluvium or demodicosis considered. The flat or plaque sarcoid is a differential diagnosis to consider for solitary lesions. Diagnosis may be suspected based on compatible clinical signs and history, but positive growth on dermatophyte culture medium from samples of hair and/or crusts obtained from representative lesions is necessary for the definitive diagnosis. Fungal culture medium requires vitamin enrichment with nicotinic acid to culture T. equinum, and it requires thiamine and inositol to culture T. verrucosum. Two drops of a commercial multivitamin B complex can be added to a commercial dermatophyte culture medium to provide these additional nutrient requirements. Microscopic examination of hyphae and conidiae allows for species identification.

Treatment of Dermatophytosis

Treatment of dermatophytosis is not always necessary, because cases can be self-limiting and resolve in 1 to 3 months. Based on culture and identification of the species of dermatophyte involved, the source of infection should be identified and eliminated whenever possible. The goals of therapy are to reduce the severity of the skin lesions, prevent transmission to other animals, and reduce environmental contamination. All infected horses should be kept isolated from noninfected horses. The skin around lesions can be clipped, with caution taken to dispose of hair and crusts to minimize contamination of the environment. Those people who handle infected horses also should take care because dermatophytosis is a zoonotic infection that can cause skin lesions in people. All in-contact animals should be treated. Topical fungicidal therapy should be applied daily for 7 to 10 days and then twice weekly until all clinical lesions have resolved.

Therapy may take up to 6 to 8 weeks until all skin lesions resolve. Topical fungicides that can be used to treat dermatophytes in the horse include 3% to 5% lime sulfur, 0.5% to 2.0% chlorhexidine, povidone iodine, 0.5% sodium hypochlorite, and, when available, enilconazole. Lime sulfur is nonirritating and safe, but owners should be forewarned about the strong unpleasant odor and the potential for discoloring the hair coat. Enilconazole is an imidazole that is not available in the United States. It is available in other countries and is reported to have excellent efficacy against dermatophytes. Captan has been listed as a therapy in the past but should not be recommended, as it is a carcinogen and can produce contact skin reactions in people. Whole body treatment with topical fungicides is usually more efficacious than is focal treatment of localized lesions, as many horses can quickly develop generalized dermatophytosis. Systemic therapy with griseofulvin (100 mg/kg daily for 10 days) has been used to treat dermatophytosis, but the ideal therapeutic dose is not known in the horse, and efficacy is difficult to ascertain because many horses will self-cure in 1 to 2 months. Griseofulvin should never be considered in pregnant mares, as it is a teratogen.

The environment also needs to be disinfected. Stalls, tools, tack, blankets, and grooming equipment should be cleaned with a sporicidal antifungal agent. Povidone iodine, 6% sodium hypochlorite, 5% lime sulfur, benzalkonium chloride, enilconazole, natamycin, or 1% lime plus 1.5% copper sulfate can all be used to treat the environment or equipment.

Categories
Complementary Medicine

Mange

Mange (Demodectic / Sarcoptic)

Definition and cause

Demodex is a localized or generalized parasitic disease caused by Demodex spp. mites. The underlying cause is believed to be genetic or related to immune deficiency or imbalance. In cats it is most often associated with other systemic disease such as FIV. Sarcoptic mange is a highly pruritic parasitic disease caused by the mite Sarcoptes scabiei.

Medical therapy rationale, drug(s) of choice, and nutritional recommendations

For demodex the medical therapies of choice are Amitraz, Ivermectin, or Milbemycin, all of which have potential side effects and are potentially toxic. Amitraz is particularly toxic to humans, and proper precautions should be taken to protect humans from exposure to its active ingredient. None of these treatments address the underlying immune imbalance. Therapy for sarcoptic mange involves mitocidal shampoos or dips along with the medications used in demodex, and / or the use of Selamectin. In addition, antipruritic medications such as antihistamines and corticosteroids are often recommended.

Anticipated prognosis

Localized demodectic mange usually carries a good prognosis. Generalized demodecosis in immune-compromised animals often has a more guarded prognosis. Sarcoptic mange has a good prognosis.

Integrative veterinary therapies

Mange is a nondescript term meaning infestation with one of several mite ectoparasites. These ectoparasites cause irritation through their waste products and physical injury to the host (burrowing), and by their physical presence on the host, which triggers various responses directed at elimination of the mites (pruritus, grooming, self destructive behavior). Damage directly from the mite’s activities and or from the host response leads to a worsening condition.

The integrative approach expands the medical therapy to include the immune system. The integrative approach is cellular protective for the potential toxic effects of medication and mitacidal dips, and helps improve immune function and its ability to rid the body or prevent re-infestation of the mites and lessens inflammation, pruritus, and discomfort.

Nutrition

General considerations / rationale

While medical therapy is focused locally upon destruction of the mite and the skin (inflammation and / or pruritus), the nutritional approach adds gland support for the organs of the immune system as well as nutrients to help decrease local inflammation and improve waste elimination. Because mange, especially demodex, can range in severity from local to generalized and can affect other organs, it is recommended that blood be analyzed both medically and physiologically to determine associated organ involvement and disease. This gives clinicians the ability to formulate therapeutic nutritional protocols to address the skin and organ involvement such as liver inflammation secondary to medication or chemical dips (see site, Nutritional Blood Testing, for more information).

Appropriate nutrients

Nutritional / gland therapy: Glandular adrenal, thymus and lymph provide intrinsic nutrients and help neutralize cellular immune organ damage and protect organs from ongoing inflammation and eventual degeneration (See site, Gland Therapy, for more information).

Sterols: Plant-derived sterols such as betasitosterol show antiinflammatory properties, which appear to be similar to corticosteriods. A cortisone-like effect without the associated immune suppressing effects is beneficial in inflammatory skin conditions. Bouic (1996) reports on the immune-enhancing and balancing effect that plant sterols have on the body.

Quercetin: Quercetin functions like an antihistamine and an antioxidant, and is beneficial for the skin. In its antihistamine role, quercetin has been shown to inhibit cells from releasing histamines, which makes it helpful in treating inflammatory dermatitis.

Lecithin / phosphatidyl choline: Phosphatidyl choline is a phospholipid that is integral for cellular membranes. It is an essential nutrient required by the skin, which is the body’s largest cellular organ.

Essential fatty acids: Much research has been conducted on the importance of essential fatty acids on the clinical management of allergic dermatitis. In addition, the importance of the ratio between omega-6 and omega-3 fatty acids has been substantiated. Research on the use of poly-unsaturated fatty acids has shown their beneficial and antipruritic effects on skin.

Vitamin C: De la Fuente (1998) and Penn (1991) showed that vitamin C in combination with other vitamins significantly improved immune function as compared with a placebo.

Chinese herbal medicine / acupuncture

General considerations / rationale

Mange is a result of parasites in both Western and traditional Chinese medicine theory. Both modalities have the same treatment objectives: kill the parasite, decrease discomfort, and prevent secondary infections. It may also be prudent in some patients to improve immune function to allow the patient to clear the parasite.

Appropriate Chinese herbs

For topical application:

Alumen (Ming fan): Has been shown to inhibit bacterial growth, which may help to prevent secondary bacterial infections in lesions caused by scratching.

Cnidium (She chuang zi): Has antibiotic properties. It also decreases itching. In a study involving 607 patients with severe pruritis, it stopped itching in 84% of the participants.

Prickly ash (Hua jiao): Possesses antibacterial and antidermatophyte properties. This may help prevent secondary infections.

Realgar (Xiong huang): Has traditionally been used to kill internal and external parasites by traditional Chinese medicine practitioners. It has been shown to treat pinworms and malaria, which are internal parasites. The efficacy shown against internal parasites suggests that it would also be effective topically against external parasites.

Sulfur (Liu huang): Is commonly used topically in Western medicine for mange, often as a lime sulfur dip. It has been used as a component for the treatment of psoriasis. For immunosuppression:

Angelica root (Dang gui): Increases the phagocytic activity of macrophages.

Astragalus (Huang qi): Stimulates the cellular and humoral immune systems. It contains astragalan, which enhances phagocytic activity of macrophages and antibody synthesis.

Codonopsis (Dang shen): Enhances the immune system by increasing the weight of the spleen and thymus and the total number of white blood cells and lymphocytes.

Dioscorea (Shan yao): Enhances both the cellular and humoral immune systems.

Fleece flower root (He shou wu): Increases the total white cell count, especially the T-cells, and increases the phagocytic activity of macrophages.

Licorice (Gan cao): Can enhance the phagocytic activity of macrophages.

Lotus seed (Lian zi): Was shown to increase the number of T cells in the thymuses in mice, which implies that it may be useful in treating immunosuppression.

Poria (Fu ling): Contains pachman, which increases the phagocytic function of macrophage.

Psoralea (Bu gu zhi): Stimulates the phagocytic actions of macrophages.

Rehmannia (Shu di huang): Increases the phagocytic activity of macrophages.

Schizandra (Wu wei zi): Can prevent cyclophosphamide-induced decrease in the white blood count.

White atractylodes (Bai zhu): Increases the TH cell count and the TH / TS ratio. It increases the phagocytic function of macrophages.

Wolfberry (Gou qi zi): Increases the phagocytic activity of macrophage phagocytic and raises the total T cell count.

Zizyphus (Suan zao ren): Enhances cellular and humoral immunity.

Homotoxicology

General considerations / rationale

A genetic predisposition (Degeneration Phase) is involved with demodectic mange, and affected individuals should not be used for breeding.

Palmquist relies on conventional therapy to treat most of these (lyme dip and Ivermectin in breeds which can tolerate the drug), but in certain cases it may prove helpful to support immune function, detoxification, and repair of tissues injured by homotoxins. Antihomotoxic agents may have a place in therapy in such cases. The authors are unaware of any work reporting single use of homo-toxicology in the management of veterinary mange cases.

Appropriate homotoxicology formulas

BHI-Hair and -Skin: May help repair skin and hair in recovery phase and detoxification, provide support in cases of damage from vaccines, and promote vicariation of chronic diseases.

BHI-Skin: Treats eczema on elbows, scaly scratchy dermatitis, ulcerations, and urticarial reactions.

Coenzytne compositum: Contains cis-Aconitum acidum for pruritus, skin diseases, and psoriasis. Several of the active skin catalysts in Coenzytne compositum are common to Cutis compositum.

Cutis compositum: Provides support of all skin conditions. This is a critical skin remedy, named primarily for Cutis suis, and indicated in allergic reactions, dermatoses, eczema, seborrheic conditions, pemphigus, psoriasis, dermatomycoses, neurodermatitis, and other skin conditions, as well as disturbances of renal excretion. Contains Ichthyolum, which has pustular acne and violent pruritus (facial) as its main indications. Ichthyol ointment serves to soften and clear out abscesses and is a stimulative treatment in inflammations. Sulphur is also a critical component (See Sulphur-Heel). The remedy contains Cortisone in homeopathic dilution, which is indicated for diseases manifested in the connective tissue, such as disorders of the skin, blood, and vascular systems. Fumaricum acidum, Alpha ketoglutaricum, and Natrum oxalaceticum included are for pruritus, skin diseases, and psoriasis. These catalysts are also found in Coenzytne compositum. Funiculus umbicalis suis is indicated for rehabilitation of tissue. This is a connective tissue remedy indicated in almost all chronic diseases. It repairs damage to connective tissue, and is used for psoriasis, skin eruptions, and dermatitis.

Echinacea compositum: Used for secondary infections. Arsenicum is indicated for skin eruptions and other symptoms of a stubborn nature that may border on the phase of Degeneration. It also contains Sulphur (see Sulphur Heel) and Cortisonum acidum (see Cutis compositum).

Engystol N: Is immune supportive in allergic and viral cases, and contains sulfur, which is indicated in chronic issues.

Graphites homaccord: Treats pigmented, greasy lesions without hair.

Hepar compositum: Improves detoxification status by its action on the liver.

Psorinoheel: A phase remedy in Excretion and Impregnation cases. Psorinum is an extract of scabies mange excretions and has been used in classical homeopathy for many years. This also contains Sulfur, which is indicated in chronic conditions (see Sulphur-Heel). May be helpful in so-called constitutional cases.

Schwef-Heel: Works through its higher potency of Sulfur.

Solidago compositum: Used in Deposition phases, this remedy assists the skin by its support of the kidney.

Sulphur-Heel: Primarily named for the contained remedy, Sulphur, known for its use in various skin diseases, especially those of chronic nature, and pruritic eczema and suppurative skin diseases. Sulphur is one of the most important components of tissue in the body. Therefore, Sulphur is the major remedy in practically all cellular phases, particularly in the Impregnation Phase, which still displays a tendency to turn regressive. This also contains Mezereum, which is useful for pruritic skin irritations and skin suppuration, and has several other skin-active remedies as components.

Traumeel S: Treats inflammatory lesions with much inflammation.

Authors’ suggested protocols

Nutrition

Skin and immune support formula: 1 tablet for every 25 pounds of body weight BID.

Lymph support formula: One-half tablet for every 25 pounds of body weight BID.

Betathyme: 1 capsule for every 35 pounds of body weight BID. (maximum 2 capsules BID.)

Lecithin / phosphatidyl choline: One-fourth teaspoon for every 25 pounds of body weight BID.

Eskimo fish oil: One-fourth to 1 teaspoon per meal for cats. 1 teaspoon for every 35 pounds of body weight per meal for dogs.

Oil of evening primrose: 1 capsule for every 25 pounds of body weight SID.

Additional vitamin C: 100 mg for every 25 pounds of body weight BID.

Quercetin: 50 mg for every 10 pounds of body weight SID.

Chinese herbal medicine

To kill the mites, the authors use a combination of sulfur (Liu huang), 30g; realgar (Xiong huang), 15g; Alumen dehydratum (Ming fan), 45g; prickly-ash (Hua jiao), 25g; and Cnidium seed (She chuang zi), 25g. Mix well and apply topically daily for 2 to 3 weeks.

The authors also recommended H7 Immune Stimulator for 6 months in conjunction with Mitaban dips, daily Interceptor, Ivermectin, or herbal parasite dips to counteract immunosuppression. The H7 ImmuneStimulator is dosed at 1 capsule for every 10 to 20 pounds twice daily. In addition to the herbs mentioned above, Immune Stimulator contains euryale (Qian shi), longan fruit (Long yan rou), saussurea (Mu xiang), and white peony (Bai shao). These herbs increase the efficacy of the formula.

Homotoxicology

(Dose: 10 drops PO for 50-pound dog; 5 drops PO small dog or cat)

Psorinoheel and Schwef-Heel: Mixed and given twice daily orally.

Cutis compositum: Given initially, and then as needed.

Autosanguis Therapy:

1. Traumeel

2. Hepar compositum

3. Galium-Heel

4. Cutis Heel

5. Ubichinon compositum

Oral cocktail: Schwef homaccord, Psorinoheel, and Lymphomyosot, plus the remains of autosanguis in a syringe, taken orally BID to TID.

Echinacea compositum forte tabs: Use if needed.

Ivermectin: Give PO daily in breeds that can tolerate the drug.

Nutraceuticals: AFA Algae, GlutaDMG, vitamin E, fatty acids.

Product sources

Nutrition

Skin, immune and lymph support formula: Animal Nutrition Technologies. Alternatives: Immune System Support — Standard Process Veterinary Formulas; Immuno Support — Rx Vitamins for Pets; Immugen — Thorne Veterinary Products; Canine Dermal System Support — Standard Process Veterinary Formulas; Derma Strength — Vetri Science Laboratories.

Betathyme: Best for Your Pet. Alternative: Moducare — Thorne Veterinary Products.

Oil of evening primrose: Jarrow Formulas.

Eskimo fish oil: Tyler Encapsulations.

Lecithin / phosphatidyl choline: Designs for Health.

Quercetin: Source Naturals; Quercetone — Thorne Veterinary Products.

Chinese herbal medicine

Formula: H7 Immune Stimulator Natural Solutions, Inc.

Homotoxicology

BHI / Heel Corporation

Categories
Complementary Medicine

Paresis / Paralysis

Intervertebral Disc Disease — Paresis / Paralysis

Definition and cause

Intervertrebal (IV) disc disease is a degeneration of the intervertebral disc, which is characterized by leakage of the disc material, leading to spinal cord compression and neurological deficits. While no proven genetic link has been determined, certain breeds such as dachshunds, beagles, and corgis are more predisposed to the condition. The literature links the cause to aging and degeneration of the disc tissue. The neurological deficits are secondary to compression.

Medical therapy rationale, drug(s) of choice, and nutritional recommendations

The medical or surgical approach to IV disc disease, pain, paresis, and paralysis depends upon the severity of the inflammation and the compression of the cord. Restricted activity or cage rest is recommended in most cases. Corticosteroids are often recommended for their anti-inflammatory effects. Surgical intervention (hemilaminectomy or fenestration) is often necessary because pain or neurological deficits are common. The dietary recommendation focuses on weight reduction in obese animals. Vitamin E is beneficial for cats but has no proven indications for dogs.

Anticipated prognosis

The prognosis depends upon the damage to the cord. Patients with painful episodes generally carry a better prognosis than animals with neurological deficits, paralysis, paresis, and incontinence. The prognosis with surgery is good if the surgery occurs within 48 hours of the rupture.

Integrative veterinary therapies

Paresis refers to weakness of motor function without total paralysis. Paralysis is a lack of motor function. Anything that negatively impacts function of the motor unit can result in signs of paresis or paralysis. Damage to the upper motor neuron or central nervous system can result in paresis due to loss of conscious proprioceptive functions. Nervous tissue is extremely susceptible to a wide variety of injurious processes, and determining the cause of paresis can be challenging. Paresis in this section of text refers to neurological deficits, but the reader should remember that musculoskeletal problems can also lead to gait weaknesses, and that all paresis is not necessarily neurological in origin.

An integrative approach to IV disc-related paresis focuses upon the integrity of the disc itself as well as the secondary compression, inflammation, and resultant cell death. The addition of nutrients, nutraceuticals, medicinal herbs, and combination homeopathics that have anti-inflammatory and potentially regenerative effects on the nerves and IV disc cells can often help improve the clinical signs and the day-to-day level of comfort, and can enhance the healing process. In addition, complementary and alternative veterinary modalities (CAVM) can also strengthen surrounding discs and help prevent recurrences in adjacent locations.

Nutrition

General considerations / rationale

While surgery can help relieve the compression and improve clinical function, nutritional therapies can help improve nerve regeneration and return of function.

Appropriate nutrients

Nutritional / gland therapy: Glandular brain and cartilage supply intrinsic nutrients that help to improve nervous and organ function, reduce cellular inflammation, and strengthen connective tissue (see Gland Therapy in site for a more detailed explanation).

Phospholipids found in glandular brain are a source of unsaturated omega-3 fatty acids, which are now thought to play a vital role in the development and maintenance of the central nervous system. High concentrations of phosphatidyl choline and serine are found in brain tissue. Horrocks (1986) reported on the potential clinical use of these nutrients in chronic neurological conditions.

Lecithin / phosphatidyl choline: Phosphatidyl choline is a phospholipid that is integral to cellular membranes, particularly those of nerve and brain cells. It helps to move fats into the cells and is involved in acetylcholine uptake, neurotransmission, and cellular integrity. As part of the cell membranes, lecithin is an essential nutrient that is required by cells for general health and wellness.

Coenzyme Q10: Coenzyme Q10 (ubiquinone) is found in the mitochondria and is involved in the cells’ energy production that is required for the daily functioning of the body. It is essential in the manufacture of ATP, the energy source for all of the body’s cells and tissues. CoQ10 is also a potent antioxidant that helps to neutralize free radicals and protect cells.

Chinese herbal medicine / acupuncture

General considerations / rationale

Intervertebral disc disease may be a result of trauma, as in Western theory. It may also result from Wind, Damp, and Cold invading the Kidneys, which leads to Qi and Yang deficiency.

Trauma is self-explanatory. It was also thought that Wind could blow Cold into the body, where it could attack the Joints. Application of Heat often relieves the signs in these patients. Damp tends to make things tight and sticky, which explains the stiffness many patients feel in damaged Joints. The Kidneys control the Bones, so Kidney pathology can cause Osseous and Joint lesions. When there is Qi and Yang deficiency, the patient has little energy to move and too little warmth to warm his body and Joints.

Treatment is aimed at decreasing the inflammation associated with injuries, increasing mobility, and decreasing pain.

Appropriate Chinese herbs

Atractylodes (Cang zu): Increases the pain threshold. In addition, it can counteract xylene-induced ear swelling and carrageenin-induced foot swelling. This indicates that it may be useful in decreasing inflammation at the site of disc disease.

Aconite root (Fu zi): Reduces swelling and inflammation in joints. It has been shown to have analgesic properties.

Angelica (Bai zhi): Has been shown to have anti-inflammatory and analgesic effects in mice.

Angelica root (Dang gui): Is as strong as aspirin at decreasing inflammation and is 1.7 times as strong as aspirin for pain relief.

Astragalus (Huang qi): Has demonstrated mild analgesic effects in mice.

Cinnamon twig (Gui zhi): Has analgesic properties. It was part of a formula used in 30 patients with arthritis; 50% recovered completely, 20% showed marked improvement, 17% showed some improvement, and 13% did not respond.

Coix (Yi yi ren): Has analgesic and anti-inflammatory effects. It suppresses dimethylbenzene-induced auricular swelling and carrageenin-induced foot swelling in mice. It was shown to help women with severe menstrual cramps, which may indicate that it would be useful in treating the pain associated with intervertebral disc disease.

Earthworm (Di long): Has a significant analgesic effect.

Jujube fruit (Da zao): Decreases inflammation. Jujube fruit was shown to reduce dimethylbenzene-induced auricular inflammation in mice and egg-white-induced toe swelling in rats, which implies that it may be useful for decreasing the inflammation involved with intervertebral disc disease.

Licorice (Gan cao): Contains glycyrrhizin and glycyrrhetinic acid, which have anti-inflammatory effects. They have approximately 10% of the corticosteroid activity of cortisone. They decrease edema and have anti-arthritic effects. Licorice has demonstrated analgesic effects in mice, especially when combined with white peony (Bai shao).

Notopterygium root (Qiang huo): Has anti-inflammatory and analgesic effects. In mice, it was shown to decrease xylol-induced ear lobe swelling and carragenin-induced foot pad edema, and increase the thermal pain threshold.

Sichuan aconite (Chuan wu): Seems to have a centrally mediated analgesic effect. In mice, it was shown to be effective for decreasing inflammation and pain. It is stronger than aspirin at reducing inflammation. It controlled the signs in 92% of 150 human patients with arthritis when given in combination with Cao wu, Qiang huo, Du hua, Fu zi, Mo yao, Ru xiang, Dang gui, Chuan niu xi, Ma huang, Gui zhi, Wu gong, Chuan xiong, and Ma qian zi.

White peony (Bai shao): Contains paeoniflorin, which is a strong anti-inflammatory. It has demonstrated specific effects on pain in the lower back.

Acupuncture

The World Health Organization lists lower back pain as one of the indications for acupuncture (World Health Organization 2006). One study looked at the use of abdominal acupuncture and electroacupuncture for treatment of prolapsed lumber intervertebral discs. In this study there was complete relief from symptoms in 35% of the patients, significant improvement in 45% of the participants, slight improvement in 16%, and no response in 4%.

Homotoxicology

General considerations / rationale

It is beyond the scope of this text to fully deal with all causes of paralysis and paresis. This section primarily addresses fibrocartilagenous embolic and intervertebral disease, which represents Impregnation or Degeneration phase homotoxicoses.

Appropriate homotoxicology formulas

Aesculus compositum: Treats post-embolic circulatory disorders such as infarct and stroke. It is worthy of evaluation in fibrocartilagenous embolic disease, but no studies exist. Supportive of circulation (Aesculus hippocastanum, Secale cornutum, Tabacum, Solanum nigrum, Arnica Montana, Barium iodatum, Hamamelis virginiana, Arteria suis, and Rhuta graveolens). Cuprum assists with spasm. Aesculus has specific antiCOX-1 and COX-2 inhibitory effects; other agents also affect vascular structures. It is supportive of joints and muscles and is useful for sharp pains and counteracting the effects of cold, wet weather (Solanum dulcamara). Apis helps reduce swelling and pain.

Atropinum compositum: The oral and injectable vials are currently off the market in the United States, but oral tablets are available. This agent is highly effective for spasm and pain associated with diseases of the spine and back. If this remedy is not available consider Spascupreel in its place.

Barijodeel: Treats paresis post stroke.

BHI-Inflammation: Rhus toxicodendron assists in cases of paresis. Cases may be aggravated after lying in wet grass. Patients may have pustular, pruritic skin conditions, joint pain, myelitis, vertigo / dizziness, intercostal pain, and other types of neuralgia. Commonly used in combination with other antihomotoxic agents.

Cerebrum compositum: Used in the recovery phase. Placenta suis assists in peripheral circulation while improving vitality and awareness, particularly in aged patients.

Cimcifuga homaccord: Has regional affinity for cervical spine neuralgia and pain originating in the sacral area and passing cranially. Treats cervical spine spasm.

Coenzytne compositum: Supports energy production through enzyme induction and repair. Useful in repairing damage to enzyme systems of metabolism and following administration of drugs injurious to metabolism. Phase remedy in the Degeneration and Dedifferentiation phases.

Colocynthis homaccord: Regional remedy for pain in the sacral and lumbar region. Useful in colitis cases and for sciatica.

Discus compositum: The principal antihomotoxic medication for intervertebral disc disease. Discus compositum contains 37 ingredients, making it a balanced agent that helps a wide variety of spinal and matrix-clearing issues. Signs of homotoxin off-load is common following use of Discus compositum.

This compositae class agent combines animal, mineral, and plant agents to assist in healing, drainage, and detoxification. Tissue receives direct support through Discus intervertebralis suis (intervertebral disc), Funiculus umbilicus suis (umbilical cord, which supports vascular and stem cell tissues), Cartilago suis (cartilage), Medulla ossis suis (bone marrow), Embryo suis (embryo), and Glandula suprarenalis suis (adrenal gland). It is useful in all cases of intervertebral or degenerative spinal disease. This remedy treats sciatica and sciatic neuralgia (Citrullus colocynthis, Cimcifiga racemosa, Picric acid, Ammonium chloride). It also supports energy metabolism and tissue repair (vitamin C, vitamin Bl5 vitamin B2, vitamin B6, Nicotinamide, Coenzyme A, Nicotinamide Adenine Dinu-cleatide, Sodium osalacetate, Thioctic acid, Calcium phosphate, Silicic acid, and Sulphur). Zincum metallicum is a strong nerve remedy that is included for peripheral symptoms in the nervous system, with numbness of the soles of the feet and cutting pains in the heel, which may proceed to the point of complete paralysis or hemiparesis with twitching, tremors and weakness.

Engystol N: Creates a “channeling effect” in the mesenchymal tissues and lymphatic system.

Galium-Heel: This phase remedy in matrix and cellular phases provides powerful support of the immune system (Echinacea augustifolia). Assists in drainage of cell and matrix, supports renal tubular function, and decreases swelling and edema (Apis mellifica, Galium aparine, and Galium mollugo). It is a critical component in the deep detoxification formula. Dosing should be done with regard to clinical condition and response, with the dose reduced if strong reactions are noted.

Gastricumeel: Useful in supporting gastric and duodenal function following spinal pathology.

Gelsemium homaccord: Used for headache, depression, posterior weakness, and fear of open spaces. Main formula for paresis. Gelsemium semperervi-rens has long been used in herbal medicine because it has an affinity for nervous tissues. Strong neuroprotection results from low-dose use of Gelsemium.

Glyoxal compositum: Used to unblock cellular receptors and provides mitochondrial repair of damaged enzyme systems in Degeneration and Dedifferentiation phase disorders.

Lymphomyosot: Used after cortisone therapy and mesenchymal purging in chronic disease states. Reduces swelling and pressure. Contains Aranea diadema for periodic neuralgia, spinal nerve irritation, paralgesia, and painful articular disease. Calcium phosphoricum is indicated for calcium deficiency and spinal affections. Fumaria officinalis has indications for tightness in the back over the right kidney. Treats back pain and cutting pain on the right side, along with lumbar pain or sudden weakness in the lumbar region and cervical tension on the right side. Myosotis arvensis is used for conditions that include left-sided cervical pain or constriction in the cervical region. This also treats pressing pain in the lumbar region and right-side scapular pain that is stabbing.

Nux vomica homaccord: Provides enteric protection following spinal injury.

Ovarium compositum: Supports gonadal tissue in geriatric patients.

Placenta compositum: Supports hypophysis after cortisone therapy. Contains sulfur to support enzyme and metabolic repair. Regenerative of hypophyseal-adrenal axis and vascular stem cells. Repairs vascular structures and is used intermittently in endocrine disorders.

Khododendroneel S: Treats paresis of the radial nerve.

Solidago compositum: Deposition Phase remedy needed to remove debris from the matrix after regressive vicariation begins.

Spascupreel: Treats stabbing pains, muscle spasm, and neuralgia. Very useful in managing spasmodic pain. It is an alternative for Atropinum compositum.

Testes compositum: Supports connective tissue.

Thalamus compositum: Supports thalamus, pineal gland, adrenal gland, and cellular regulation through glandular content and homeopathically diluted cyclic adenonsine monophosphate (cAMP). Assists in establishing autoregulation of pyschoneuroendocrine-immune functions. Assists in resetting pain thresholds.

Thyroidea compositum: Used for matrix drainage and repair of autoregulation. Contains low levels of thyroid, pineal, spleen, bone marrow, umbilical cord, and liver to support glandular function and repair. Galium aparine drains matrix and cellular components. Cortisonum aceticum in low potency assists in repairing damage from excess levels of cortisone. Precursors and Krebs cycle constituents promote energy metabolism through the Michaelis-Menten law of enzyme activity. Pulsatilla and Sulfur assist in regulation rigidity-type situations. Part of the deep detoxification formula.

Traumeel S: Has nonsteroidal anti-inflammatory effects. Useful in acute intervertebral disc herniation to reduce swelling (Apis) and pain, and activates blocked enzymes. Listed in the Physician’s Desk Reference.

Ubichinon compositum: Provides mitochondrial repair of energy production mechanisms. Used in chronic diseases, iatrogenic injury to mitochondria from antibiotic therapy, and is part of the deep detoxification formula.

Zeel : Useful for its anti-inflammatory effects and supportive qualities for chronic arthritis.

Authors’ suggested protocols

Nutrition

Brain / nerve and cartilage / ligament / muscle / skeletal support formulas: 1 tablet for each 25 pounds of body weight BID.

Coenzyme Q10: 25 mgs for every 10 pounds of body weight daily.

Lecithin / phosphatidyl choline: One-fourth teaspoon for each 25 pounds of body weight BID.

Chinese herbal medicine / acupuncture

Formula H39 BackRelief: 1 capsule per 10 to 20 pounds twice daily. If necessary it can be combined with steroids, nonsteroidal anti-inflammatory drugs, and nutraceuticals. (NOTE: it is never recommended to combine NSAIDS and steroids). In addition to the herbs listed above, Back-Relief also contains aconite / cao (Cao wu), allium (Cong bai), carthamus (Hong hua), papaya (Mu gua), poria (Fu ling), and siler (Fang feng). These herbs increase the efficacy of the formula.

Recommended acupuncture points are “AShi” points, BL23,BL25, BL57, BL40, Baihui, ST36, and GB30 (Handbook of traditional Chinese medicine Practitioner 1987).

Homotoxicology (dose: 10 drops PO for 50-pound dog; 5 drops PO for small dog or cat)

Symptom formula: Traumeel S and Discus compositum given initially by injection, preferably into applicable acupoints. Traumeel Gel and Lymphomyosot Gel mixed together and massaged into the affected areas BID to TID. Spascupreel, Aesculus compositum, Lymphomyosot, and Traumeel S combined and given orally BID to TID. Add Cimicifuga homaccord (cervical disc or pain), Gelsemium homaccord (posterior weakness), Colocynthis homaccord (lumbosacral disease or sciatica). Zeel and Discus compositum orally twice per week and Cerebrum compositum weekly.

Deep detoxification formula: Galium-Heel, Hepar compositum, Solidago compositum, Thyroidea compositum, Coenzyme compositum, Ubichinon compositum mixed together and given orally twice weekly to every other day.

Product sources

Nutrition

Brain / nerve and cartilage / ligament / muscle / skeletal formulas: Animal Nutrition Technologies. Alternatives: Cosequin — Nutramax Labs; Glycoflex — Vetri Science; Musculoskeletal Support — Standard Process Veterinary Formulas; Nutriflex — Vet Rx Vitamins for Pets; Arthra-gen — Thorne Veterinary Products.

Coenzyme Q10: Vetri Science, Thorne Veterinary Products.

Lecithin / phosphatidyl choline: Designs for Health.

Chinese herbal medicine

Formula H39 BackRelief: Natural Solutions, Inc.

Homotoxicology

BHI / Heel Corporation

Categories
Complementary Medicine

Epilepsy

Definition and cause

Epilepsy is defined as a seizuring condition in which there are no physical conditions or lesion in the brain. While the mechanism that incites epilepsy and convulsions is not known, it is believed that there is an underlying biochemical imbalance. Epilepsy is more common in Golden and Labrador retrievers, St. Bernards, Springer spaniels, Shetland sheepdogs, and Corgis. It is rare in cats.

Seizures can originate from a wide variety of causes. Anything that interferes with the complex and delicate neurophysiological, autoregulatory system may trigger seizure activity, and a partial list of precipitating causes includes acute trauma, hypoxia, infectious agents, parasites, brain swelling, scar tissue, impregnation of viral particles or toxins, metabolic disturbances, adverse reactions to medications, allergies, psychosomatic stressors, organ diseases (cardiovascular, hepatic, endocrine), electromagnetic disturbances, radiation damage, genetic factors, enzyme deficiencies or damage, and neoplasia. The presence of seizures alone is not sufficient to diagnose epilepsy.

Medical therapy rationale, drug(s) of choice, and nutritional recommendations

The most popular therapy is a combination of phenobarbital and potassium bromide. Other therapies that are often recommended include dilantin, diazapam, and primadone. There is little evidence to support diet in the control of seizures; however, several reports point to food allergies as the source of the seizures via an immune-mediated process. These studies indicate that a restricted diet was responsible for the resolution of the seizures. In people, studies have indicated that seizures can be controlled with a hypoallergenic type of diet; they showed that the seizures began again when other foods were reintroduced. Despite the little amount of evidence, many veterinarians recommend a hypoallergenic type of diet when managing dogs and cats with epilepsy, often with surprisingly good results.

Anticipated prognosis

While control of seizures is possible with combinations of drugs such as phenobarbital and potassium bromide, complete control is often difficult. Side effects of medications that are refractory to chronic medications and the potential for status epilepticus lessen the course and prognosis.

Integrative veterinary therapies

Epilepsy is a chemical and electrical imbalance in the brain. Medical therapies are prescribed to stop seizures; however, they do not address the underlying cause or inciting factors leading to this imbalance. When approaching epilepsy from an integrative viewpoint, a double phase approach must be taken. First, the diagnosis must be confirmed and the proper medical or alternative therapies that control the convulsions implemented. Second, if possible, the approach should include a determination of the cause and the necessary steps to eliminate inciting factors. Assessing the animal’s internal and external environments is important. In addition, the diet should be thoroughly examined; all chemical additives, preservatives, environmental toxins, and other potential seizure-causing substances should be eliminated; side effects of medications should be considered; and prior and future vaccinations should be evaluated for the long-term control of seizures.

General considerations / rationale

Epilepsy has been linked to allergic food reactions. One report showed that there was significantly more biological evidence to an allergy component to epileptic people than non-epileptic people.

Appropriate nutrients

Nutritional / gland therapy: Glandular brain, pituitary, hypothalamus, pineal, liver, and adrenal glands supply the intrinsic nutrients that help to reduce cellular inflammation and improve the function of the brain and nerves, liver, and adrenal glands (see Gland Therapy in site for a more detailed explanation).

Note: Epilepsy can have multiple causes, and therefore a medical and physiological blood evaluation is recommended to assess general glandular health. This helps clinicians to formulate therapeutic nutritional protocols that address the central nervous system as well as other organ weaknesses (see site, Nutritional Blood Testing, for additional information).

Vitamin E: Research has found that adding vitamin E to medical therapy reduced the frequency of seizures.

Fatty acids: In preliminary studies it was found that omega-3 fatty acids significantly reduced the frequency of seizures in human patients.

Phosphatidyl serine (PS): Phosphatidyl serine is a phospholipid that is essential in cellular membranes, particularly those of brain cells. It has been studied in people with mental functioning and degeneration with positive results.

Lecithin / phosphatidyl choline: Phosphatidyl choline is a phospholipid that is integral to cellular membranes, particularly those of nerve and brain cells. It helps to move fats into the cells and is involved in acetylcholine uptake, neurotransmission, and cellular integrity. As part of the cell membranes, lecithin is an essential nutrient required by all the cells of the body for general health and wellness.

Magnesium: Physiologically, magnesium activates adenosine triphosphatase, which is required for the proper functioning of the nerve cell membranes and fuels the sodium potassium pump. Magnesium has also been associated with neuromuscular function and conditions such as muscle cramping, weakness, and neuromuscular dysfunction. Magnesium is recommended for therapy for epilepsy and weakening muscle function.

Chinese herbal medicine

General considerations / rationale

According to Traditional Chinese Medicine, epilepsy is caused by Wind and Phlegm obstructing the Mind. There is also Liver Qi stagnation.

Author’s interpretation

In Western terms, wind is motion. Epilepsy is a form of motion (wind) that is manifested by tonic / clonic muscular activity. Wind also refers to a condition that comes and goes suddenly, just as a gust of wind may do. Seizures tend to have this pattern. The patient is normal between episodes.

According to TCM, the Liver controls the Tendons and Ligaments. Therefore, smooth flow of Liver Qi is needed to keep the Limbs supple. When the suppleness is lost, movement becomes spastic.

The loss of consciousness experienced during a seizure is defined as interference with the functioning of the Mind (phlegm obscuring the Mind). When the Mind does not function properly, the patient is unable to interact normally with the environment (in other words, the patient loses consciousness).

The central nervous system must be sedated to prevent wind from creating the excess nerve activity that leads to seizures.

Appropriate Chinese herbs

In cases of active seizing, valium, barbiturates or inhalant anesthetics should be administered as required. Herbal therapy is helpful in decreasing the frequency, severity, or duration of seizures. The following herbs have demonstrated anti-epileptic effects:

Scorpion (Quan xie): Decreased the severity, duration, and frequency of seizures when administered to rats with induced epilepsy.

Silkworm (Jiang can): Reduces the frequency of seizures in humans.

Grass-leaf sweet-flag (Shi chang pu): Decreases seizure activity in humans.

Polygala root (Yuan zhi): Can help decrease seizure frequency.

Uncaria (Gou teng): Contains rhynchophilline, a chemical that has been shown to decrease spontaneous activity and strengthen phenobarbital-induced sedation in mice. It has been proven to prevent seizures in animals.

In addition to herbal therapy, acupuncture may be considered to decrease the duration or frequency of the seizures. The efficacy of acupuncture reported in the literature varies greatly. Some researchers find that it has no effect, while others are more positive. In one study, 5 dogs with intractable epilepsy were treated with gold bead implants in acupuncture points. Three dogs responded but 2 dogs relapsed after 5 months. Reports of 2 other dogs treated with acupuncture in the ear (Shenmen point) demonstrated that acupuncture was able to decrease seizure episodes by 80%.

Homotoxicology

General considerations / rationale

Seizuring cases may represent Inflammation to Dedifferentiation phase homotoxicoses. For that reason, and because selection of correct antihomotoxic medicines depends upon proper identification of phase, the clinician must properly diagnose the condition and identify any extrinsic factors associated with the onset of seizures. Typically, idiopathic epilepsy is thought to represent a Degeneration Phase disorder.

In cases in which other causes of seizure activity have been eliminated and the signs and history indicate idiopathic epilepsy, homotoxicology therapy can decrease seizure activity and reduce dependency upon pharmaceutical agents, and may help improve other pathological processes in a patient’s condition. Antihomotoxic medicants are appropriate and can be used in conjunction with a wide variety of other supportive and pharmaceutical agents to manage seizures. Drugs are necessary and recommended for patients that have severe, life-threatening seizures, or when seizure intervals are too short.

Patients so treated often undergo regressive vicariation and it should be noted that in some instances, the seizure activity might worsen as neurological tissues become inflamed, swell, and discharge homotoxins. Many of these patients recover from their disease signs following such responses. Canine distemper virus signs, including mentation changes (with or without misemotional states), fever, tonic-clonic tics, oculonasal mucoid discharge, and coughing, can occur. Such biological responses are predicted by Hering’s Law and are necessary for healing; however, clients may not accept them readily, and they should be well informed before beginning such treatment.

Appropriate homotoxicology formulas

Autosanguis therapy may be needed to shift the organism’s position to the left on the Six-Phase Table. A large number of homeopathic remedies are indicated for seizures, and a complete listing is not practical in such a text. The following list covers major antihomotoxic formulas; others may be indicated depending upon the entire case’s manifestations:

Aconitum homaccord: Treats seizures aggravated by or associated with fear, fever, or red skin. Use early in the history because this is an Inflammation Phase remedy.

Apis homaccord: Reduces swelling.

Atropinum compositum: Treats convulsions and muscle spasms. Argentum nitricum is indicated in epilepsy when the pupils are enlarged for hours or days before the attack. It seldom produces a full and final cure; however, distinct improvements can often be achieved, e.g. in the frequency and violence of the attacks. Also note that it is absolutely necessary (for humans) to maintain a diet that is strictly free of pork toxins. The remedy also contains Atropinum sulphuricum, which acts like Belladonna but is to be preferred in neuralgias, painful states, biliary colic, and epilepsy. It should be used if Belladonna fails. This remedy is also found in Spascupreel. Cuprum aceticum is considered in diseases accompanied by a tendency to spasmodic conditions, such as cerebral seizure disorders.

Belladonna homaccord: Used in Inflammation Phase disorders and in acute seizures to reduce severity and length. It is the agent of first choice for acute seizure.

BHI-Body-Pure: Treats environmental toxicity issues, especially petroleum products, tobacco, drug exposure, and emotional upset.

BHI-Calming: Used for stress-induced issues.

Cerebrum compositum: Supports cerebral tissues with the help of Hyoscyamus. The indications include states of excitement with great restlessness, mobility, depression to the point of melancholia, dull apathy, delirium, weakness of thinking and memory, and a dulling of the powers of comprehension. Attacks of epileptic spasms with tetany, convulsions, trismus, congestion of blood in the head, and headaches are also typical. The eyes have a glazed stare and an unusual sheen, and there may be protrusion, distortion, and spasms of the eye muscles. Further indications are conjunctival discharge, marked pupil enlargement, dullness of vision, weakness of vision, and myopia (these are also indications for Belladonna).

A summary of the main Hyoscyamus symptoms presents the following remedy picture: symptoms of cerebral irritation with convulsions, muscle twitching, catalepsy, and epileptiform spasms. Another contributing note comes from Ignatia, which should also be borne in mind in numerous retoxic phases. The irritability of the nervous system may provide a clue (effects of strychnine and brucine), because this is characteristic of Ignatia and constitutes the organic foundation for the changing symptoms that occur in Impregnation Phases. It is a nerve remedy above all, suited to hypersensitivity of the sensory organs, including the skin, nasal organs, and taste. This remedy also treats trembling and twitching. It is used for Sydenham’s chorea and epileptiform attacks.

Coenzytne compositum: Provides catalyst support of the metabolism. Important in nearly all cases.

Galium-Heel: Use in most epilepsy cases. It is a Deposition, Impregnation, Degeneration, and Dedifferentiation phase remedy that is very important in cellular detoxification and matrix drainage and cellular repair. It contains a wide variety of agents, especially Apis, which reduces swelling.

Hepar compositum: Provides liver detoxification and support.

Solidago compositum: Provides kidney support and detoxification.

Hepeel: Detoxifies and supports the liver.

Lymphomyosot: Used for lymph drainage and swelling reduction, especially when combined with Apis homaccord and / or Traumeel.

Lyssinum-Injeel: Not available in the United States but can be useful in cases of seizures associated with rabies vaccination reactions.

Molybdan compositum: Treats trace mineral disorders and chronic diseases.

Nux vomica homaccord: Treats gastrointestinal issues, food allergy, adverse reactions to food or food additives, emotional upsets, and anger.

Psorinoheel: Deep acting remedy that contain Bufo (toad venom), which is useful in Inflammation and Degeneration phase homotoxicoses. Signs may include alternating torpor and convulsions, and epileptiform attacks occur. A peculiar state of agitation is noticed before these symptoms appear, and deep sleep may be seen after the convulsions.

Also found is Cicuta virosa. The main indications include pica appetite, convulsions with worm infestation, epileptiform attacks, and meningitis with hypersensitivity and attacks. It is a complementary remedy in tubercular meningitis, and is indicated in a wide variety of psychoses and conditions of the brain and spinal cord that include cramps that may be caused by worms. There also may be stomach cramps with hematemesis, paralysis of the bladder, and skin diseases with simultaneous disturbances of the peripheral nervous system.

Spascupreel: Treats convulsions and muscle spasm. Agaricus muscarius is included for Sydenham’s chorea, tics, states of agitation, epileptiform attacks, itching, crawling sensations, burning pains, sensations of numbness, general restlessness of the muscles with a compulsion to move in unusual ways (cf. Stramonium). The symptoms may change to tetany, stupor, conditions of excessive excitement, reduction of excitability of the nervous system, sequelae of drug and medication abuse, state of confusion, and cerebral seizure disorders.

Schwef-Heel: Sulfur-containing enzyme that is used for reactivation and detoxification. Dosing is intermediate.

Strophanthus compositum: Contains Aesthusa cyna-pium for convulsions associated with vomiting. The tincture of Fool’s Parsley produces considerable toxic effects that are particularly noticeable in disturbances of the nervous system: various kinds of spasms, dulling of faculties, loss of consciousness, oppressed mood with anxiety, restlessness, irritability, possibly hallucinations, delirium, and sleepiness, sometimes to the point of unconsciousness. Epileptiform spasms also may occur, along with dilated pupils and particularly great weakness of the lower limbs.

Thyroidea compositum: Provides hormonal support and matrix drainage. Corpus Pineale Suis exhibits certain counterpoint actions to the pituitary. May be tried experimentally as a supporting or intercurrent remedy in epilepsy, Sydenham’s chorea, and Degeneration Phases generally.

Traumeel: Reduces inflammation in traumatic or inflammatory issues.

Ubichinon compositum: Provides catalyst support of the metabolism in later cases. Naphthoquinone is also indicated in epilepsy with a brief aura, traumatic epilepsy, shock following serious head injury, and threatened vaccinial encephalitis from which seizures may result.

Valerianaheel: Mildly neurotonic and tranquilizing for stress-induced issues or difficulty sleeping. Contains Kali Bromatum (potassium bromide). The main indications are: restlessness, always busy and occupied, trembling hands, nervousness, conditions of excessive excitement associated with the central nervous system, cerebral seizure disorders, nightmares, sleepwalking, insomnia, reduced cerebral emotivity as with paralysis, and sequelae of cerebrovascular accidents. This component is also found in Nervobeel.

Viscutn compositum: Used in Dedifferentiation Phase cases.

Authors’ suggested protocols

Nutrition

Brain / nerve support formula: 1 tablet for each 25 pounds of body weight BID.

Pituitary / hypothalamus / pineal and immune support formulas: One-half tablet for each 25 pounds of body weight SID.

Lecithin / phosphatidyl choline: One-fourth teaspoon for each 25 pounds of body weight BID.

Phosphatidyl serine: 25 mgs for each 25 pounds of body weight BID.

Omega-3 fatty acids: Eskimo fish oil — one-half to 1 teaspoon per meal for cats, 1 teaspoon for each 35 pounds of body weight for dogs; hemp or flax oil — 1 teaspoon for every 25 pounds of body weight with food.

Additional vitamin E: 50 IU for each 25 pounds of body weight.

Magnesium: 10 mgs for every 10 pounds of body weight SID.

Chinese herbal medicine

Epitrol (White Crane Herbs): 1 capsule per 10 to 20 pounds BID to effect.

Important note: The Epitrol formulation also contains the following herbs: Abalone shell (Shi jue ming), snake skin slough (She tui), typhonium gigantium rhizome (Bai fu zi), arisaema pulvis (Dan nan xing), bamboo shavings (Zhu ru), red tangerine peel (Ju hong), gentiana root (Long dan cao), scutellaria (Huang qin), forsythia (Lian qiao), gypsum / raw (Shi gao), and hoelen spirit (Fu shen). These herbs help to balance the formula and increase the efficacy of the herbs mentioned above. They also help to increase the antiseizure activity of the formula.

The authors occasionally use the following acupuncture points for treatment of active seizing or to prevent future seizures; they are generally used in conjunction with herbal or Western therapy: GB20, Bai hui, PC6, St36, B115, and B118.

Homotoxicology (Dose: 10 drops PO for 50-pound dog; 5 drops PO for small dog or cat)

Symptom formula: Start cases on the following mixture for 8 to 12 weeks: Galium-Heel, Spascupreel, Belladonna homaccord, Atropinum compositum BID to TID PO as needed. In acute seizures this mixture can be given several times in close succession. Adjust this mixture as the case dictates. In cases in which constitutional seizures are suspected, consider Psorinoheel if no or poor response is obtained.

Deep detoxification formula: Thyroidea compositum, Hepar compositum, Solidago compositum, Coenzyme compositum every 3 days for several months. Handle regressive vicariation as needed during this process.

Note: After several months attempt to reduce anticon-vulsant dosage slowly.

Product sources

Nutrition

Brain / nerve, pituitary / hypothalmus / pineal, and immune support formulas: Animal Nutrition Technologies. Alternatives: Immune System Support — Standard Process Veterinary Formulas; Immuno Support — Rx Vitamins for Pets; Immugen — Thorne Veterinary Products.

Lecithin / phosphatidyl choline: Designs for Health.

Phosphatidyl serine: Integrative Therapuetics.

Eskimo fish oil: Tyler Encapsulations.

Alternatives: Flax oil — Barlean’s Organic Oils; Hemp oil — Nature’s Perfect Oil; Ultra EFA — Rx Vitamins for Pets; Omega-3,6,9 — Vetri Science.

Chinese herbal medicine

Epitrol: White Crane Herbs.

Homotoxicology

BHI / Heel Corporation

Categories
Complementary Medicine

Degenerative myelopathy

Definition and cause

Degenerative myelopathy is a slow, progressive degeneration of the spinal cord, which often leads to loss of motor control of the hind legs. While no proven cause is known, it is believed that an autoaggressive process may be involved with the observed degeneration of the spinal cord. Although it is most commonly found in German Shepherds, degenerative myelopathy has also been seen in other breeds such as old English Sheepdogs, Belgium Shepherds, and Weimaraners.

Medical therapy rationale, drug(s) of choice, and nutritional recommendations

Once diagnosed, there is no proven therapy for degenerative myelopathy. Clemmons (1989) states that “the current treatment of degenerative myelopathy is designed to suppress the immune disease, but does nothing to correct the immune alterations which led to the disease state.” Clemmons has proposed an immune-mediated cause in German Shepherds, and as such recommends a combination of controlled exercise to improve tone and circulation, vitamins and other supplements, n-acetyl-cysteine, and aminocaproic acid (EACA), which have shown an improvement or stabilization of the condition in more than 50% of the animals with degenerative myelopathy. No controlled trials have been reported, however.

Anticipated prognosis

Most animals diagnosed with degenerative myelopathy slowly lose nervous control and become non-ambulatory within 1 to 2 years of diagnosis. Late-stage degenerative myelopathy is often complicated with both fecal and urinary incontinence. Clemmons (1989) offers a better prognosis (see medical therapy above).

Integrative veterinary therapies

The authors recommend an augmented version of Dr. Roger Clemmons’ protocol for the treatment of degenerative myelopathy in dogs. The enhancements to Dr. Clemmons’ program include adding the authors’ specific glandular, Chinese herbal, acupuncture, and homotoxicology remedies to his published protocol.

Nutrition

Gland therapy: Glandular brain, adrenal, thymus, and spleen supply the intrinsic nutrients that help reduce autoimmuine cellular inflammation, neutralize free radicals, and improve organ and nerve function. This helps to slow and spare the nerves from progressive degeneration (see Gland Therapy in Chapter 2 for a more detailed explanation).

Phospholipids found in glandular brain are a source of unsaturated omega-3 fatty acids, which are now believed to play a vital role in the development and maintenance of the central nervous system. High concentrations of phosphatidyl choline and serine are found in brain tissue. Horrocks (1986) reported on the potential clinical use of these nutrients in chronic neurological conditions.

General considerations / rationale

Many of the following considerations and recommendations are taken from the web site of Clemmons (2002): http: / / neuro.vetmed.ufl.edu.

“Diet may have a powerful influence on the development of chronic degenerative diseases. New information suggests a significant connection between dietary regulation and the progression and development of diseases such as multiple sclerosis. Eliminating toxins from processed food may help prevent a number of immune-related disorders. The current treatment of degenerative myelopathy is designed to suppress the immune disease, but does nothing to correct the immune alterations which led to the disease state.

Diet might help to correct this defect and allow the immune system in degenerative myelopathy dogs to stabilize. The principles of dietary therapy, including a homemade diet, are outlined here. For those who cannot cook for their dog, the basic diet should be supplemented with the additional ingredients listed below. It is best to choose a dog food that is close in protein content and is as natural as possible. Wild dogs were not meat eaters. They ate bodies, including intestinal contents that were often laden with plants and plant materials. Dogs have evolved so that eating animal fats and protein do not cause them to suffer the same problems as humans when eating these sources of saturated fats. Even so, dogs probably suffer from the same causes of dietary and environmental intoxication that affect humans.

Basic diet (1 serving for 30 to 50 pounds body weight)

2 oz. boneless pork center loin chop (boiled, baked, or fried in olive oil)

4 oz. tofu

8 oz. long grain brown rice (3 oz. cooked in 6 oz. water)

2 teaspoons extra virgin olive oil

1 / 4 cup molasses

2 carrots (boiled and then chopped) 1 cup spinach (cooked)

4 tablespoons green bell pepper (chopped and steamed)

4 broccoli spears (boiled and chopped)

This diet provides approximately 1,160 to 1,460 calories per serving. Poultry meat, beef, and lamb can be substituted for the pork chop. This alters the composition slightly, mainly by adding fat. The weight of the meat is based upon boneless weight. Most of the items can be prepared in a microwave.

Based upon the dog’s body weight, more or less will need to be prepared. For example, multiply all the ingredients by 1.5 times to 2.5 times for dogs weighing 80 pounds (daily caloric requirements may vary by dog).

This recipe can be made in advance, divided into appropriate quantities, and frozen. Just before feeding, thaw in hot or boiling water or defrost in the microwave.

To complete the diet, add the following combination before serving (recipe makes 1 serving; multiply or divide as needed):

1 teaspoon dry ground ginger

2 raw garlic cloves (crushed)

1 / 2 teaspoon dry mustard

1 teaspoon bone meal

Approximately 1 serving of the above diet equals 1 can of commercial dog food. The exact requirements for a dog can be approximated by substituting the diet on that basis. The dog should be weighed each week, and the amount of the diet increased if it is losing weight (or decreased if the dog is gaining weight). Eventually, the correct amount will be clear.

Many German Shepherds have sensitive stomachs; therefore, it may be wise to phase in the new diet by mixing it with existing food until the dog adapts. Start by mixing the diet with existing food in equal amounts. After 1 week increase the diet to replace 75% of the original food. After another week, switch completely to the new diet. This diet is balanced and high in most of the vitamins and minerals that dogs need. Any shortcomings can be corrected with the supplements given below.”

Appropriate nutrients

B-complex: B vitamins are water-soluble, and any excess amount is eliminated through the urine. They may help in neural regeneration and should be given to dogs. No dog should die while having cheap urine. There is altered absorption of some B vitamins in degenerative myelopathy, and supplementation can correct this.

Vitamin E: Vitamin E is an important nutrient that has been shown to have a number of physiologic and pharmacologic effects. It is a potent antioxidant that reduces fat oxidation and increases the production of HDL cholesterol. At higher doses it also reduces cyclooxygenase and lipooxygenases activities, decreasing production of prostaglandins and leukotreines. As such, it is a potent anti-inflammatory drug. It reduces platelet function and prolongs the bleeding time slightly in healthy individuals. There are no known side effects to vitamin E at levels less than 4,000 to 6,000 IU per day (except in cats, where levels over 400 IU / day might create hepatolipidosis). This drug slows the progression of degenerative myelopathy and corrects for low serum and tissue levels. In degenerative myelopathy, there appears to be a deficient absorption and tissue-binding protein which accounts for the low serum and tissue concentrations of vitamin E.

Vitamin C: Vitamin C works with vitamin E and helps with its regeneration, potentiating its antioxidant effect. Vitamin C supplementation does no harm, because the excess is excreted through the kidney. While dogs produce vitamin C in their bodies (unlike humans, pigs, and guinea pigs, who must obtain it from their diet), they may need vitamin C in excess of their manufacturing capacity when they are suffering from stress or disease.

Selenium: Selenium is an important mineral that has antioxidant properties similar to vitamin E. Vitamin E can replace the requirement for selenium in the body, but selenium cannot substitute for vitamin E. In addition, selenium does not cross the blood-brain barrier like vitamin E. On the other hand, selenium may help vitamin E to be more effective. Many plant sources are low in selenium and supplementation may be important.

Omega-3 fatty acids: Omega-3 fatty acids such as EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are the constituents of fish oils that act as anti-inflammatory agents. They may be worth trying in dogs with autoimmune disorders or arthritis.

Gammalinolenic acid: Borage oil, evening primrose oil, and black currant oil are natural sources of gammalinolenic acid, a fatty acid that is hard to get in the diet. GLA is an effective anti-inflammatory agent with none of the side effects of anti-inflammatory drugs. It also promotes healthy growth of skin, hair, and nails. It may be good for skin conditions, arthritis, and autoimmune disorders. It takes 6 to 8 weeks to see changes after adding GLA to the diet.

Soybean lecithin: Lecithin is a fat-like substance found in the cells of the body. It may combat atherosclerosis, improve memory, and fight Alzheimer’s disease in people. However, there is no scientific evidence to support these claims. On the other hand, lecithin is harmless. It is not necessary as a supplement unless a dog has degenerative myelopathy and the client elects not to use the diet outlined above (tofu contains plenty of soybean lecithin).

Coenzyme Q: Coenzyme Q, also called CoQ10, is a natural substance that assists in oxidative metabolism. It may improve the use of oxygen at the cellular level, and patients with heart, muscle, and nerve problems may find it worth trying in doses of 30 to 100 mg per day. Some people report that it increases their aerobic endurance.

Medication: The following medications are recommended by Clemmons:

Over the last 2 decades, we have found 2 medications which appear to prevent progression or result in clinical remission of degenerative myelopathy in many (up to 80%) of patients: aminocaproic acid (EACA) and n-acetylcysteine (NAC). Clemmons recommends giving EACA as a solution, using the generic product. This product, while designed for injection, can be mixed with chicken broth to provide a palatable solution for oral usage. Clemmons recommends mixing 2 parts of aminocaproic acid solution (250 mg / ml) with 1 part chicken broth and giving 3 ml of this mixture orally every 8 hours. In his experience, this mixture has been equally, if not more, effective to the tablet form of aminocaproic acid. Furthermore, the solution is much less expensive than the tablets. The generic form of aminocaproic acid solution can be obtained from American Regent,1l-(800) 645-1706 (outside of New York). The generic drug from American Regent may be obtained through prescription with the help from a local pharmacy.

An alternative source for aminocaproic acid is to have a compounding pharmacy make the solution from chemical grade EACA. WestLab Pharmacy in Gainesville, Florida, can be reached at 1-800-4WESTLA (1-352-373-8111) and can mail the medication and bill the client directly. Occasional gastrointestinal irritation is the only side effect that has been attributed to aminocaproic acid. This only presents a problem in a few patients, usually those who have pre-existing GI problems that the medication might exaggerate. A local pharmacist can help determine whether any additional drugs might be contraindicated or lead to possible drug interactions with the recommended therapy. The only known interaction is with estrogen compounds, and only in high doses.

Acetylcysteine is a potent antioxidant that has powerful neuroprotective effects. Clemmons gives 75 mg / kg divided in 3 doses a day for 2 weeks. After that, give the 3 doses every other day. The N-acetylcysteine comes as a 20% solution and must be diluted with chicken broth (or other compatible substitute) to 5% to prevent stomach upset. This new treatment is expensive unless purchased through compounding pharmacies. Again, WestLab Pharmacy has this product and can send it to clients upon veterinary prescription. Using N-acetylcysteine at the above dose does not appear to have side effects. It can produce vomiting and may increase the bleeding time. The GI upset is likely due to the sodium content of the pharmaceutical product, which requires high concentration of base to buffer to pH 7.4. WestLab’s product does not have as many side effects because the pH is reduced during preparation. Giving fresh ginger 30 minutes before and giving the NAC with food (or on a full stomach) often reduces this effect.

The combination of aminocaproic acid, N-acetylcysteine, dietary supplements, and exercise is the best treatment we have discovered. It corrects those aspects of the immune dysfunction, which we can treat, based upon our belief that degenerative myelopathy is an immune-mediated inflammatory disease. We always hope that all patients will respond to our treatment protocol. Although it does not work in all cases, this combined treatment has been up to 80% effective in patients diagnosed at the University of Florida. The chances of successful treatment are improved if the therapy is begun early in the course of degenerative myelopathy rather than later. A response to the drugs should be evident within the first 7 to 10 days. There are no other medications that Clemmons has found to provide any real benefits in the long-term treatment of degenerative myelopathy.

Chinese herbal medicine / acupuncture

General considerations / rationale

Degenerative myelopathy is due to Qi, Blood, Yin, and Essence deficiency in the Kidney, Liver, Spleen, and Stomach. The Spleen and Stomach produce the nutrients that in turn nourish the Muscles and Nerves and support the Kidney. Therefore, deficiencies in these organs lead to deficiencies it those structures. The Liver controls ligaments and the Spleen controls Muscles, so Blood and Yin deficiency in these organs leads to weakness and atrophy. The Kidneys control the Marrow or interior of Bones. The Spinal Cord is inside the Vertebrae, so this structure falls under the auspices of the Kidney. Qi deficiency in these organs defines the weakness seen in the condition. The Stomach also suffers from deficiency of Qi, preventing it from extracting enough Blood and fluids from food to reverse the pathology. There seems to be a genetic predisposition to development of degenerative myelopathy. It is most often seen in German shepherds. This suggests a deficiency of Essence, or genetic predisposition in Western terms.

Appropriate Chinese herbs

Achyranthes (Niu xi): Has anti-inflammatory effects. It can ameliorate egg white-induced foot swelling in rats, which may make it efficacious in decreasing inflammation in the spinal cord.

Licorice (Gan cao): Contains glycyrrhizin and glycyrrhetinic acid. These compounds have 10% of the corticosteroid activity of cortisone. If an autoimmune etiology is truly the cause, this property could be quite beneficial.

Milletia (Ji xue teng): May modify the immune system. It has an inhibitory effect on cellular immunity. It may decrease immune-mediated destruction of the nervous system.

Rehmannia / cooked (Shu di huang): Has anti-inflammatory properties and has been used for nervous system inflammation. It was one component of a supplement that also contained Rou cong rong, Lu han cao, Gu sui bu, Yin yang huo, Ji xue teng, and Lai fu zi that was used in 1,100 patients with myelitis. Seventy-three percent had significant improvement in clinical signs, and another 13% had moderate improvement.

Sichuan aconite (Chuan wu): Decreases inflammation.

Acupuncture

Degenerative myelopathy is similar to multiple sclerosis in people. Acupuncture has been shown to help decrease symptoms in affected humans. Naeser (1996) reviewed studies in human medicine related to spinal cord disorders and multiple sclerosis. A total of 42 people participated in the various studies. Acupuncture was shown to improve incontinence and muscle spasms. One woman who had been unable to walk without assistance was able to walk short distances after 1 year of treatment. Clemmons (2006) has found that acupuncture therapy slows the rate of progression of the degenerative myelopathy in dogs.

Homotoxicology

General considerations / rationale

Degenerative myelopathy is a progressive Degeneration Phase disease with no known cure. Practitioners are unable to address such homotoxicoses until too late in the pathophysiology for cure. This condition may represent a genetic deterioration involving only a few breeds. Autoimmune disease is another possible cause. Theoretical approaches to such conditions involve draining the matrix, supporting organelle repair, and supporting energy metabolism.

The authors have not used homotoxicology as a sole agent to treat any patients with confirmed diagnosis of degenerative myelopathy, and are unaware of any published cases that have responded favorably in a measurable way. Success in assisting these patients has been reported by Wynn and Marsden using acupuncture, herbs, and nutriceuticals.

Clemmons feels there may be similarities to multiple sclerosis in humans, a homotoxicosis that has some history of therapy in homotoxicology. Unfortunately, many of the constituents of this experience are not available in the United States.

Classical homeopathic doctors have reported success in individual cases. While no controlled studies on homeopathy for degenerative myelopathy exist, further research may reveal useful information based upon known data on the use of aminocaproic acid and n-acetylcysteine (NAC) in conjunction with antioxidant therapy, Chinese herbs, and acupuncture as the desired foundational therapy.

Appropriate homotoxicology formulas

Aesculus compositum: Supports vascular tissues.

Arsuraneel: Useful when the patient feels there is no hope. Symptoms include weakness, exhaustion, disability, and polyneuritis. Contains Curare (also contained in Circulo-Injeel, Syzygium compositum, and Testis compositum).

BHI-Recuperation: Contains Causticum, Gelsemium sempervirens, and Plumbum metalicum, which are commonly indicated for weakness and paralysis.

Causticum compositum: Usually indicated for burns, radiation injuries, and other sharp burning pains, Causticum is useful for weakness of the rear legs and paralysis of single parts. Unsteady walking is a symptom. It is also contained in Barijodeel, Husteel, Neuralgo-Rheum-Injeel, Reneel, Rbeuma-Heel, BHI-Arthritis, BHI-Bladder, BHI-Recuperation, BHI-Tbroat, and BHI-Uricontrol. The ingredient Embryo suis has been used for muscular dystrophy. Other ingredients support chronic degenerative conditions.

Circulo-Injeel: Contains Curare for weakness and paralysis, as well as polyneuritis.

Coenzyme compositum: Supports metabolism.

Discus compositum: Combination remedy that supports connective tissue.

Echinacea compositum: May normalize inflammatory reactions.

Galium-Heel: Treats cellular diseases and provides matrix drainage. Contains Galium mollugo for detoxification. Also treats precancerous conditions. Echinacea augustifolia strengthens immunity and is used in inflammatory conditions. Useful in autoimmune conditions.

Gelsemium homaccord: Main remedy for rear leg weakness; trembling is common. Gelsemium is also contained in BHI-Back, BHI-Headacbe, BHI-Heart RX, BHI-Neuralgia, BHI-Recovery, BHI-Recuperation, BHI-Sciatic, Cerebrum compositum, Echinacea compositum, Spascupreel, and Spigelon.

Ginseng compositum: Treats weakness and exhaustion.

Glyoxal compositum: Depolymerizes homotoxins from receptors and enzymes and assists in energy production and receptor activation.

Graphites homaccord: Treats weakness in the lower back in overweight patients with history of skin affectations and constipation. Patients are easily chilled.

Lymphomyosot: Provides lymph drainage and immune support.

Lyssin-Injeel: Not available in the United States, but is included because this is homeopathically prepared rabies virus. Due to the possibility of progressive vicariation reactions resulting from vaccination, this remedy may prove helpful in some cases.

Medulla spinalis suis-Injeel: Nosode therapy for the spinal cord.

Neuralgo-Rheum-Injeel: Contains Silicea, and is a major remedy for vaccinosis. Also contained in BHI-Alertness, BHI-Migraine, BHI-Neuralgia, Cruroheel, Discus compositum, Spigelon, Strumeel, and Zeel.

Phosphor homaccord: Supports spinal weakness in thin animals that are prone to hemorrhage. Constitutional remedy.

Psorinoheel: Miasmic medicine that reaches deep homotoxicoses for all chronic diseases. Also act as an Excretion Phase remedy.

Schwef-Heel: Contains homeopathic dilutions of Sulfur, which activate blocked enzyme systems, assist in construction of structural substances of the matrix, activate blocked or stalled cases, and treat heaviness or paretic limbs.

Selenium homaccord: Treats weakness and exhaustion.

Testes compositum: Provides strengthening and drainage of the matrix in male patients with weakness. Contains Conium maculatum for ascending hindlimb ataxia, weakness, and hemiplegia. This also may be helpful for older dogs. Also found in Cerebrum compositum, Coc-culus compositum, Ginseng compositum, Rauwolfia compositum, Thyreoidea compositum, Tonsilla compositum, Ubicbinon compositum, Vertigoheel, BHI-Circulation, BHI-Dizziness, BHI-Ligbtheaded, and BHI-Stramonium Complex.

Traumeel S: Anti-inflammatory agent which activates blocked enzyme systems. Treats regulation rigidity.

Ubichinon compositum: Supportive of metabolism in cellular diseases and Degeneration Phase diseases.

Authors’ suggested protocols

Nutrition

Brain / nerve and immune support formulas: 1 tablet for each 25 pounds of body weight BID. These formulations contain glandular brain, adrenal, lymph, thymus, spleen, alpha-lipoic acid, L-carnitine, N-acetyl cysteine, phosphatidyl choline, and phosphatidyl serine.

The combination of these brain / nerve and immune support formulas contains the following nutrients per serving for a 75-pound dog:

Vitamin A — 3,750 IU

Vitamin E — 525 IU

Vitamin C — 750 mg

N-Acetyl Cysteine — 75 mg

Selenium — 105 meg

Lecithin — 300 mg

Phosphatidyl serine — 75 mg

In addition to the above 2 formulations which add multiple glandular support, Clemmons recommends adding the following nutrients and additional vitamins and minerals to those listed above to achieve his recommended, target dosage schedule of:

Vitamin C — 1,000 mg BID

Vitamin E — 2000 IU daily

Selenium — 200 meg daily

Vitamin B complex: Give high potency B-complex (with approximately 50 mg of most of the B components) to healthy dogs. Dogs with degenerative myelopathy should receive stress formula B-complex with 100 mg of most of the B components.

Coenzyme Q10: 100 mgs daily.

Fatty acids: Many versions of these substances are on the shelves of health food stores, from salmon oil to capsules of concentrated EPA. However, eating some cooked salmon or sardines may have benefits over capsular forms of the fish oils. Alternatively, dogs can be given ground flax seeds, flax oil, or hemp oil as a dietary supplement instead of fish oils. These materials reduce platelet function for a brief period in dogs, but it seems that dogs compensate for this within about 8 weeks. Omega-3 fatty acids replace the 2-series fatty acids over time. As such, cellular stimulation produces 3-series prostaglandins and thromboxanes. The latter does not cause inflammation nor does it reduce blood flow like the 2-series thromboxanes do. All dogs should receive 1,000 mg of fish oil capsule, 1 tablespoon ground flax seeds, or 2 sardines every day.

Gamma-linolenic acid: 500 mgs BID.

Lecithin / phosphatidyl choline: One-fourth teaspoon for each 25 pounds of body weight BID.

Oil of evening primrose: 1 capsule for every 25 pounds of body weight SID.

Blue-green algae: One-fourth teaspoon for each 25 pounds of body weight daily.

Chinese herbal medicine / acupuncture

The authors use a formula called Degenerative Myelopathy at a dose of 1 capsule per 10-20 pounds twice daily to effect. In addition to the herbs discussed above, Degenerative Myelopathy also contains Antler gelatin (Lu jiao shuang), arisaema / bile (Dan nan xing), astragalus (Huang qi), bamboo silicea (Tian zhu huang), centipede (Wu gong), citrus (Chen pi), dragon’s blood (Xue jie), earthworm (Di long), ginger (Ren shen), salvia (Dan shen), silkworm (Jiang can), and uncaria (Gou teng). These herbs help increase the efficacy of the formula.

The authors recommend the following acupuncture points: B118, BL23, BL30, BL60, ST36, Baihui, and GV4.

Homotoxicology (Dose.10 drops PO for 50-pound dog; 5 drops PO for small dog or cat)

The two protocols below are strictly experimental. The first is based upon current protocols used by Broadfoot; the second is based upon Reckeweg’s protocol for multiple sclerosis. Results, positive or negative, should be reported for further evaluation.

Broadfoot’s protocol for neurological degeneration:

Autosanguis Therapy (for the full procedure, see Advanced Homotoxicology: Autosanguis Therapy, chapter 33): (give half of each injection subcutaneously to patient and place the remainder in the symptom cocktail formula which follows below): Traumeel S, Galium-Heel plus Neuralgo Rheum, Circulo Injeel plus Engystol N, Discus Compositum, and Coenzyme compositum plus.

Ubichinon compositum. Give half of each injection subcutaneously to the patient and place the remainder in the following symptom cocktail:

Symptom cocktail: Phosphor homaccord, Gelsemium homaccord, Aesculus compositum, Ginseng compositum, and autosanguis (above) mixed together and given orally BID. Arsuraneel at 1 tablet BID orally.

Glyoxal compositum: 1 vial weekly. Circulo-Heel at 1 vial weekly.

Multiple sclerosis per Reckeweg:

Psorinoheel, Galium-Heel, Schwef-Heel, Graphites homaccord, Lymphomyosot mixed together and given 2 to 6 times daily. Injection therapy using Echinacea compositum (forte) and Cerebrum compositum every 2 to 4 days. Ubichinon compositum and Coenzyme compositum at intervals. Glyoxal compositum given once and repeated once change ceases. Medulla spinalis-Injeel (if available) given once weekly IM. Autosanguis therapy using the above-mentioned injections are recommended.

Product sources

Nutrition

Brain / nerve and immune support formulas: Animal Nutrition Technologies. Alternatives: Immune System Support — Standard Process Veterinary Formulas; Immuno Support — Rx Vitamins for Pets; Immugen — Thorne Veterinary Products.

Coenzyme Q10: Vetri Science; Rx Vitamins for Pets; Integrative Therapeutics.

Lecithin / phosphatidyl choline: Designs for Health.

N-acetyl cysteine: Pure Encapsulations.

Blue-green algae: Simplexity.

Beyond essential fats: Natura Health Products.

Alternatives: Hemp oil — Nature’s Perfect Oil; Flax oil — Barlean’s Organic Oils; Eskimo fish oil — Tyler Encapsulations; Ultra EFA — Rx Vitamins for Pets; Omega-3,6,9 — Vetri Science; Evening primrose oil — Jarrows Formulas.

Chinese herbal medicine

Natural Solutions, Inc.

Homotoxicology

BHI / Heel Corporation

Categories
Diseases

Heart Diseases

As in man, heart troubles are very much more common in old age. However, even young animals may suffer from faulty heart action due to congenital defects.

Signs

Irregularity in the heartbeat, some difficulty in breathing without obvious changes in the lungs or pleura, breathlessness when the animals are compelled to exert themselves, a tendency to swelling of the dependent parts of the body (e.g. along the lower line of the chest and abdomen and ‘filling’ of the limbs), are among the signs. A cough is sometimes a symptom of valvular disease.

Congestive heart failure

Disease of the right side of the heart often gives rise to ascites, sometimes to swelling of one or more limbs due to oedema. Engorgement of the veins often occurs, with enlargement of the liver. The animal becomes easily tired and may lose weight. Ultimately congestive heart failure is likely to occur. This may also result from left-sided failure due to myocarditis or mitral valve incompetence. In small animals, treatment consists in reducing exercise and giving diuretics.

A common cause of heart failure in dogs is degeneration of a MITRAL VALVE.

Pericarditis

Pericarditis is an inflammation of the membrane covering the exterior of the heart. It may be ‘idiopathic’, when its cause is not known; it may be ‘traumatic’, when it is due to a wound; or it may follow a general infection (e.g. ‘heart-water’) or a local infection (e.g. pleurisy) or an abscess in a remote part of the body. Pericarditis may be ‘dry’, in which case the 2 opposing surfaces of the membrane are covered by a layer of fibrin; or oedema may accompany this condition, in which case fluid fills up the pericardial sac and, when no more distension of the sac can occur, presses upon the outside of the heart itself. Pericarditis has been reported in very young pigs at grass. The piglet, often in good condition and not anaemic, dies suddenly at about 2 to 3 weeks of age. (See also ‘MULBERRY HEART’.)

Tamponade

A rapid accumulation of blood in the pericardium, suddenly arresting heart function.

Acute or chronic tamponade was the presenting sign in 42 cases of pericardial effusion in a series of large dogs with an average age of 9 years. Twenty-four of the cases were associated with neoplasia, 8 with benign idiopathic effusions, 6 with primary heart disease, and 2 with trauma.

Echocardiography was found to be the best way of detecting pericardial effusion; and the idiopathic effusions responded well to pericardiectomy.

Congenital heart disease in dogs and cats

Congenital heart disease in dogs and cats is usually indicated by a cardiac murmur, the site and nature of which shows whether a valve or a shunt is involved.

Shunts include ‘holes’ in the heart, and patent ductus arteriosus.

Radiography and Doppler ultrasound are helpful in diagnosis.

Surveys of a total of 580 dogs with congenital heart disease showed that 28 per cent had patent ductus arteriosus; 16 per cent had pulmonary stenosis; 9 per cent had persistent right aortic arch; over 7 per cent had a ventricular septal defect; and over 7 per cent had stenosis of the aorta. (See also HEARTWORMS.)

Deficiency of vitamin E

Deficiency of vitamin E is one cause of sudden cardiac arrest in cattle.

Signs

These are not always characteristic, but they include breathlessness, pain on pressure of the left side of the chest, a jugular pulse (seen along the jugular furrow with each heartbeat), and oedema. On listening to the heart a variation in the normal sounds may be heard, or they may be altogether masked by the presence of the fluid. A tinkle is sometimes audible over the region of the heart; friction sounds indicate the presence of dry pericarditis; and irregularity or even palpitation may be noticed.

Traumatic pericarditis of cattle

Sometimes when the animal is thought to be suffering from simple digestive disturbance, it is found that a nail or piece of wire has been swallowed and arrives in the reticulum.

A distance of about only 5 cm separates the heart from the reticulum, so that the foreign body is liable to penetrate the pericardium.

Attacks of pain may occur, the appetite is irregular, but after a time the animal regains its normal health, since an adhesion has occurred around the hole in the reticulum wall, and the inflammation subsides. A cow may die suddenly before symptoms of pericarditis appear, or soon afterwards.

Treatment

Treatment is sometimes feasible by surgically opening the rumen and removing the piece of metal.

Prevention

In Switzerland the percentage of cows slaughtered on account of traumatic pericarditis was reduced following the use of magnets for the treatment of traumatic reticulitis. Magnets weighing 114 g, 90 mm long and 15 mm in diameter were used orally 10 minutes after a subcutaneous injection of atropine sulphate. Without this it was found that only 53 per cent of the magnets dropped at once into the reticulum. The correct siting of the magnets was checked with a compass.

Myocarditis

Myocarditis is inflammation of the heart muscle. In the pig it is seen in HERZTOD disease, for example; in cattle, in MUSCULAR DYSTROPHY. (See also CANINE PARVOVTRUS; MYOCARDIUM.)

Endocarditis

Endocarditis is an inflammation of the membrane lining the heart. It frequently leads to the development of nodules on the valves.

The nodules result in an incomplete closing of the valves, and since the fibrin deposited upon them tends to become converted into fibrous tissue (‘organised’), the growths slowly increase in size. They are seen in chronic erysipelas of pigs. (See SWINE ERYSIPELAS.)

The valvular insufficiency can be diagnosed by auscultation. Congestive heart failure may be the outcome (sometimes embolism); but compensation takes place, and the animal may live a long time with faulty valves.

Bacterial endocarditis is a cause of death in cattle, especially in South Wales. (See HEARTWORMS for another cause of endocarditis in the dog.)

Valvular diseases

Valvular diseases form a most important and common group of heart disorders, and although the power of compensation already referred to may so neutralise the ill-effects of a narrowed valve, or one which leaks, severe strains or exertion — or even trying conditions such as parturition — may precipitate ill-effects. Very often when an animal ‘drops dead’, perhaps after running a race or while undergoing some departure from its normal mode of life, the actual cause is afterwards found to be a diseased heart valve. Fainting fits are not by any means rare in incompetence of the tricuspid valves. Congestion of the lungs may be brought about by incompetence of the auriculo-ventric-ular valve on the left side of the heart (mitral insufficiency); this same condition may lead to a chronic asthmatical cough in old dogs, which is occasionally mistaken for bronchitis.

Canine heart repair

Skeletal muscle transplants were used to replace or repair defects in the left ventricle of dogs, some of which were kept alive for over a year. At autopsy the transplants were found to be in good condition, according to a report in Circulation.

Hypertrophy

Hypertrophy, or enlargement of the heart, takes place as the result of some constant simple strain, such as occurs in racehorses, hunters, and sporting dogs; or as the result of backward pressure from a diseased valve, and which entails the heart muscle ‘compensating’ for the effects of valvular disease. Alternatively it may be due to resistance to the flow of blood in some diseased organ or tissue which results in high blood pressure. (See COMPENSATION.)

Hypertrophy of the left ventricle, leading to heart failure, may in the dog follow Leptospira canicola infection.

Dilatation of the heart may precede hypertrophy, i.e. when it occurs before the heart muscle has had an opportunity to increase to meet the extra demands upon it; and it very frequently follows hypertrophy, especially when there is some disease process at work which hinders the proper nutrition of the heart muscle.

Hypertrophy may be a beneficial condition in any animal, and, except when it is due to valvular trouble, need not cause any worry to the owner. It is sometimes excessive in horses; in some instances the heart may weigh as much as 11 kg (25 lb) instead of the 3 or 3.5 kg (7 or 8 lb) of the normal. Degenerative changes may follow hypertrophy when the animal becomes less active during later life.

Congenital defects

These include a patent ductus arteriosus. (See diagram of fetal circulation undtr CIRCULATION OF BLOOD; also LIGAMENTUM ARTERIOSUM; ECTOPIA CORDIS.) Tetralogy of Fallot consists of: (1) stenosis of the pulmonary valve; (2) a defect in the septum which separates the 2 ventricles; (3) the aorta over-riding both ventricles; (4) marked hypertrophy of the right ventricle.

The signs are often vague: in kittens, for example, these may be a failure to thrive, and inability to cope with exercise. More serious defects result in the death of newborn kittens.

Functional disorders

Palpitation is a condition in which the heart beats fast and strongly, due to fright, for example(see tachycardia, below).

Bradycardia is a condition of unusually slow action of the heart. Intermittency or irregularity is an exceedingly common condition among animals, and as a rule appears to cause them no inconvenience whatever. In some horses at rest in the stable the heart constantly misses every 3rd, 4th, or 5th beat, a long pause taking the place of the pulsation, but when at exercise or work the normal rhythm is restored.

Heart-block is a condition in which the conducting mechanism between atrium and ventricle (atrio-ventricular bundle of His) is damaged in whole or part, so that the two beat independently of each other.

Rapid heart action (tachycardia) may have a number of causes including exertion or excitement. It is normally harmless in such cases. It is also seen in diseases which affect the transmission of the heartbeat stimulus.

Cardiac flutter and fibrillation are conditions of great irregularity in the pulse, due to the atria emptying themselves, not by a series of regular waves, but by an irregular series of flutters or twitches instead, which fail to stimulate the ventricles properly.

Five cases of atrial fibrillation were described in horses after racing. In 4 of them, which had performed poorly during their races, the arrhythmias disappeared spontaneously within 24 hours; these cases were regarded as paroxysmal. In the 5th horse, which won its race, the arrhythmia persisted for at least 45 hours after the race and it was regarded as an example of persistent atrial fibrillation. Treatment with quinidine sulphate restored the sinus rhythm. Paroxysmal atrial fibrillation may cause a sudden decrease in racing performance.

Diagnosis of heart disease

Diagnosis of heart disease is based largely on the character of the pulse and heart sounds. Murmurs, for example, indicate valvular incompetence, cardiac dilatation, or congenital lesions. Muffled sounds may indicate fluid in the pericardium (or pleurisy).

Additionally radiography and cardiography are used in diagnosis. (See PACEMAKERS as a possible treatment of some canine patients.)

Heart Stimulants

Drugs used as cardiac stimulants include theophylline, adrenaline, isoprenaline and dobutamine.

Categories
Veterinary Drugs

AMINOCAPROIC ACID

Chemistry

An inhibitor of fibrinolysis, aminocaproic acid is a synthetic monamino carboxylic acid occurring as a fine, white crystalline powder. It is slightly soluble in alcohol and freely soluble in water and has pKa’s of 4.43 and 10.75. The injectable product has its pH adjusted to approximately 6.8. Aminocaproic acid may also be known by the acronym EACA.

Storage – Stability – Compatibility

Products should be stored at room temperature. Avoid freezing liquid preparations. Discoloration will occur if aldehydes or aldehydic sugars are present. When given as an intravenous infusion, normal saline, D5W and Ringer’s Injection have been recommended to be used as the infusion diluent.

Pharmacology

Aminocaproic acid inhibits fibrinolysis via its inhibitory effects on plasminogen activator substances and also via some antiplasmin action.

Aminocaproic acid is thought to affect degenerative myelopathy by its antiprotease activity, thereby reducing the activation of inflammatory enzymes that damage myelin.

Uses – Indications

Aminocaproic acid has been used as a treatment to degenerative myelopathy (seen primarily in German shepherds). In humans, it is primarily used for treating hyperfibrinoly-sis-induced hemorrhage.

Pharmacokinetics

In humans, the drug is rapidly and completely absorbed after oral administration. The drug is well distributed in both intravascular and extravascular compartments and penetrates cells (including red blood cells). It unknown if the drug enters maternal milk. It does not bind to plasma proteins. Terminal half life is about 2 hours in humans and the drug is primarily renally excreted as unchanged drug.

Contraindications – Precautions – Reproductive Safety

Aminocaproic acid is contraindicated in patients with active intravascular clotting. It should be used when the benefits outweigh the risks in patients with preexisting cardiac, renal or hepatic disease. Some, but not all, animal studies have demonstrated teratogenicity; use when risk to benefit ratio merits.

Adverse Effects – Warnings

In dogs treated, about 1% exhibit symptoms of GI irritation.

Overdosage

Acute Toxicity

There is very limited information on overdoses with aminocaproic acid. The IV lethal dose in dogs is reportedly 2.3 g/kg. At lower IV overdosages, tonic-clonic seizures were noted in some dogs. There is no known antidote, but the drug is dialyzable.

Drug Interactions

Hypercoagulation states may occur in patients receiving estrogens.

Laboratory Considerations

Serum potassium may be elevated by aminocaproic acid especially in patients with preexisting renal failure.

Doses

Doses for dogs:

For adjunctive treatment of degenerative myelopathy (seen primarily in German shepherds): a) In combination with exercise, vitamin support (vitamin B-complex, vitamin E), and analgesia (if required; using acetaminophen): Aminocaproic acid: 500 mg (regardless of size of animal, approximate dose is 15 mg/kg) PO q8h. Mix 192 ml of the 250 mg/ml injection with 96 ml of hematinic compound (e.g. Lixotinic®) producing a 288 ml final volume. Give 3 ml per dose (500 mg). Store solution in refrigerator. Clinical improvement seen within 8 weeks. (Clemmons 1991)

Client Information

Drug costs to treat a German shepherd-sized dog can be substantial.

Dosage Forms – Preparations – FDA Approval Status – Withholding Times

Veterinary-Approved Products:

None

Human-Approved Products:

Aminocaproic Acid Tablets 500 mg; Aminocaproic Oral Solution 250 mg/ml; Amicar® (Immunex); (Rx)

Aminocaproic Acid Injection for Intravenous Infusion 250 mg/ml (5 gram); Amicar® Intravenous (Immunex); Generic; (Rx)