Case Studies

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Amadeus is a four-year-old, neutered Cornish Rex, whose owner contacted me for a nutrition consult due to a history of urinary tract and renal disease. 

In our initial consult, I worked on a detailed history of his diet, litter box protocols, and environmental enrichment strategies. Given the owner was a well experienced cat owner, litter box and lifestyle issues did not appear insensitive to Amadeus. His canned food diet seemed appropriate initially, but I was concerned with the limitation. He had been fed one formula of one brand for the last three years. He was fed this as a default because it seemed to reduce his itchy skin and lesions and had been recommended by the breeder. Nonetheless, this limitation gave us an important break: analysis of the formula proved it unfriendly to both the urinary tract and the kidneys.  

Diet changes were implemented to include a rotation of a few well-balanced canned formulas and the addition of some raw meats as a topper to encourage the incorporation of raw food meals over time. An herbal anti-inflammatory urinary formula along with a kidney formula based on Er Xian Tang were introduced, and if he would accept, additional water in his food.

Two months after our initial consult, Amadeus was seen by a feline specialist with significant improvement in his laboratory results. A bonus with the diet change, his skin issues resolved.

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Cassie is a 6 year old, recently spayed Chocolate brown Labrador, with a lovely docile nature. She was rehomed from a breeder and has been with her current owner for approximately six months. Cassie had weighed 37kg/82lbs when she was adopted, but over the six months prior to her presentation, her weight had increased to 41.2kg/91lbs in March 2021.

Cassie’s owners tried a range of diets including home-prepared raw food, raw food with more vegetables added, a popular commercial Labrador dry food and finally a prescription weight loss formula. On the most recent diet, Cassie had stopped gaining further weight, but had reached a plateau, and was currently being fed the ration for a 36kg/80lb dog.

Cassie’s general examination was unremarkable. Her BCS was 7/9, she was calm and well behaved. Moderate back pain was identified, and it was acknowledged that Cassie had a degree of separation anxiety when away from her owner.

Cassie’s owner was reluctant to change her diet away from the weight loss dry food, because her weight had stabilised on this diet.

Assessment of Cassie’s diet indicated that she was eating an appropriate balanced diet based on her required kcal, but there was a block to Cassie losing further weight. Cassie was consuming ~1028kcal/day, the calculated RER for a 36kg/80lbs dog. We decided to remove 1/8 of her kcal (128) and replace this with the following foods:

1 tablespoon of full fat yogurt (15kcal)

½ cup green leafy vegetables (22kcal)

12 pumps PAW Fish Oil (3000mg combined EPA + DHA) (54kcal)

20g food-based micronutrient supplement (93kcal)

Total added kcal = 184kcal/day

This was a net ADDITION of 56kcal/day

Cassie was re-weighed fortnightly for the following eight months without any further change to her diet and she steadily reduced her body weight to 33.4kg/74lbs in December 2021. Since that day, Cassie has varied only slightly in her fortnightly weight checks and currently sits at a comfortable 32.3kg/71lbs in May of 2024.

This case highlights how we can encourage a dog to reach their potential lean body weight by ADDING to their nutrient and caloric intake, once we understand what might be lacking in an individual dog’s diet from a thorough nutritional assessment. Once all of a dog’s nutrient requirements are being met, weight can be released. When experiencing any form of malnourishment, the body aims to preserve energy stores and metabolic rate slows, making weight loss more difficult.

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History

Olive is a 14 year-old, spayed, 41 lbs, female, Australian Blue Heeler. She presented for an integrative consultation to address a recent diagnosis of an inoperable bladder tumor. Olive had a history of years of chronic leukemia with no treatment. Recently she had been examined at her RDVM for frequent urges to go outside to urinate and had been showing blood spots in her urine. UA revealed a UTI, and Olive had been treated for a UTI with two rounds of antibiotics to no avail. An ultrasound showed a mass in her bladder near her urethra. She was also being treated for arthritis.

On a physical exam Olive was overweight and potbellied, scoring 7/9 BCS, and MCS 3 (moderate muscle loss). She appeared somewhat reactive and also depressed. Her popliteal and inguinal lymph nodes were enlarged. She was in an E-collar because she had been frantically licking, chewing and itching the skin around her vulva and abdomen. She presented with severe odor from her rear end, severe inflammation, ulceration and purulent dermal discharge around her vulva, perivulvar, and inguinal folds. She was painful on light touch to any of the affected areas. She had dental tartar, mild lenticular sclerosis OU. Her pulses were deep, slippery and thin with a weight of 41 lbs.

Olive’s diet consisted of a processed dry extruded kibble. The macronutrient content of the kibble consisted of approximately 50% carbohydrates, 38% protein, and 13% fat. Included high in the ingredient list were chickpeas and whole green lentils along with a large amount of supplemental synthetic minerals and vitamins for balance.

Current Medications 

• Phenylpropanolamine 25mg AM/PM for leaking urine
• Gabapentin 100 mg AM/PM
• Rimadyl 75 mg PM
• ReMatrix 1 soft chew AM/PM for joint support - a glucosamine/chondroitin and other joint support ingredients with Glycerine Molasses (dried) as a base
• Purina FortiFlora Pro Probiotic

Antibiotics for suspected UTI:

• Simplicef 200 mg for 6 days
• Switched to Enroquin 136 mg 1/2 tablet once a day for 10 days

Because of Olive’s diagnosis of cancer and other inflammatory conditions (leukemia, severe perivulvar and abdominal dermatitis,and arthritis) it is essential that we address her diet, supplements and medications to decrease inflammation at all levels. A fully integrative approach to her care will likely help her overall health. We recommended Olive transition to a species and moisture appropriate, fresh, balanced, commercial raw diet. We also suggested Olive change her pill vehicle from peanut butter to organic pasture-raised butter (healthier less inflammatory alternative with CLA). Her treats should be well-sourced, freeze-dried meat-based treats. These diet changes will help decrease inflammatory ingredients and the percentage of carbohydrates in her diet.  We will also limit her exposure to unwanted food additives, preservatives, toxins, and high heat by-product carcinogens. 

Additionally we recommended she be offered fresh raw bones to chew for her oral health - to start after she had fully changed diet, and offer frozen for a few minutes a day initially. 

 Treatment Goals

• To introduce a species appropriate diet, treats and bones
• To reduce inflammation and promote the healing of Olive’s vulva and surrounding areas
• Improve her overall health, immune system, weight and biome to promote Olive’s cancer fighting abilities

Treatments

• Discontinue dry/kibble food and transition to a commercially prepared, balanced, fresh, frozen/raw diet - for weight loss, we will aim for about 9 oz of a nutrient dense food per day
• Start to feed her once a day to allow more time for metabolic mitochondrial clean up while the GI tract is empty. Feed at random times to dissociate time with feeding to avoid anticipatory bile production/bilious vomiting. 
• We will be careful with her caloric intake to help her lose weight and become more comfortable, and improve health.
• SQ fluids with Vit B12 periodically for hydration, electrolytes, and urine flow.
• Skin/vulva care
• Gently clean and use topicals and supplements to help her fight her profoundly uncomfortable vulva/abdominal/tail base dermatitis.
• Cool water and dilute Betadine to help keep skin clean - can use squeeze bottle or curved tip syringe to rinse, and/or dab gently on, do not wipe.
• Apply ointment combo: calendula, arnica, aloe, CBD, copaiba to affected areas to soothe & treat for bacteria/yeast infections on the skin.

 Supplements 

• Mushroom 5 Defenders to help her fight her bladder tumor, provide immune support and healthy fiber for her GI tract
• SAT - Turmeric/Milk Thistle/Artichoke for liver support, GI support, and to help fight cancer
• Cell Forte (Cats Claw, IP6, herbs) herbal/supplement combination to help fight cancer and inflammation
• Astaxanthin antioxidant to help fight cancer
• Vitamin B Complex (Thorne) support to recover from anemia, microbiome and nutritional imbalance
• UT Vibrance to help fight UTIs naturally, and as prevention from urinary tract infections – 
• Ingredients: D-Mannose, Uva-Ursi leaf extract (20% Arbutin), Blueberry whole fruit, Cranberry whole fruit, Dandelion Root, Taraxacum officinale, European Goldenrod (aerial parts), Goldenseal root, Hydrastis canadensis, Parsley (aerial parts)
• Erythropro Herbal to support RBC production in anemia - 
• Ingredients: Iron (naturally occurring) 0.3 mg, Iron EliteTM 656 mg (Pumpkin seed, Organic Oat grass (Avena sativa), Organic Beet root (Beta vulgaris), Blood Advantage 180 mg (Organic Chlorella, whole; broken cell wall, Chlorella sorokiniana), Organic Rice Bran, Organic Tomato fruit, Organic Bilberry fruit (Vaccinium myrtillus), Reishi fruiting body Extract (Ganoderma lucidum). Other Ingredients: Plant-Source Capsules (cellulose, water).
• Yunnan Bai Yao Chinese herbal combination to help decrease bleeding (bladder/infection/cancer)
• NOW GI support 1 tablet daily to help with microbiome/GI health
• Green tea - antioxidant/cancer support.

We may consider additional herbs/supplements

• Vitamin E - helpful for bladder tumors
• Selenium - helpful for bladder tumors
• Additional botanicals as needed

 Urine monitoring

• Check urine with UA for infection every 4-8 weeks
• Also purchase urine strips and dropper to use to check urine at home 1 x week

Discussion 

• Discussed how diet-related issues can develop over time and may be seen as dogs age
• Discussed that we do not know why this cancer occurred, but we will do our best to maximize her overall health to help her fight it
• Discussed inflammatory effects of high carbohydrate, highly processed diets
• Discussed carcinogens as by-products of ultra-processing and also in certain preservatives and medication, pesticides
• Discussed how a fresh raw diet will provide her with the causes of health and is highly unlikely to cause any harm

 Outcome 

Olive’s life improved dramatically by her 2 week recheck. She had lost over 3 pounds, her lymph nodes returned to normal size, her potbelly had decreased, she was less painful on palpation, and was moving better. According to the owner, she seemed happier and better than she had been in a long time with the change to a fresh, balanced raw diet. The perivulvar dermatitis was over 75% healed with the topical medication, and her urgency and urinary signs had disappeared. Ultrasound showed that there was indeed a bladder tumor that was inoperable and was affecting one of her ureters as well. Piroxicam treatment was started and tolerated well. 

At her 6 week recheck exam, Olive’s owners were delighted with her continued body condition improvement, muscle mass improvement, increase in energy, and new interest in play and activity. Her focus and cognitive function had also shown a marked improvement since the addition of integrative treatments and supplements and her transition to a fresh balanced raw diet. Her severe dermatitis was fully healed and she was acting like a healthy dog at home for the first time in a long time. Currently the owners are considering radiation treatment to slow the tumor growth at the ureter. We are excited to keep working with Olive and her family to help manage her bladder tumor while continuing to improve her overall health. 

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Oreo is a seven year old Dalmation, who has faced some unexpected health problems due to his breed. At two and half years of age, Oreo was diagnosed with urate urolithiasis, requiring urgent surgery to remove the stones after he showed signs of blood in his urine and straining to urinate.  Mineral analysis of these stones confirmed the Dalmation-specific difficulty in metabolising purines. After surgery he was put onto a Prescription Dry Food (Hills U/D) that is restricted in protein and purines to prevent this serious problem from recurring.  
 
Oreo has not had any recurrence of bladder stones, however, more recently he has suffered from chronic small intestinal bacterial overgrowth (SIBO) and chronic diarrhoea. He has also been ravenously hungry and scavenging any possible food source, including, to his owner’s horror eating his own and his dog-friend’s poo!! Often as soon as it hits the ground. He lacked energy, was losing muscle tone but putting on weight and generally appeared as an unsettled and anxious little dog.  
 
Oreo's owner sought Dr Kelly Halls out for a second opinion. A thorough nutrition consultation was performed and Oreo was found to be suffering from both protein and micronutrient deficiencies which was responsible for the scavenging and unsettled behaviour. Careful selection of real food ingredients was done and added to Oreo’s dry food ration, replacing 20% of his food intake with fresh foods on rotation.  
 
These foods included egg, zucchini, chicken frames, kefir, smoked oysters, spinach, canola oil, fish oil, psyllium husk, turmeric, spirulina and dried kelp – in careful quantities and on a set rotation over the week. The amounts and rotation of these foods ensured the additives were complete and balanced according to AAFCO guidelines, but necessarily still low in purines. It contained high quality proteins, fats and micronutrients and was fed as only 20% of the total diet with the Hills Prescription U/D dry food the remainder.  
 
A follow up appointment 12 weeks later revealed a very different picture. Repeat urine testing and bladder ultrasound confirmed there is no reappearance of the stones, nor change in the urine pH or concentration and Oreo’s owner described a very much happier little dog. No longer scavenging for food. No longer anxious and unsettled, losing weight around his middle but putting on muscle tone. No more diarrhoea and overall, very much improved. The only down-side – Oreo’s owner now has to pick up much more in the backyard! A further 6-month review showed sustained improvements in his demeanour, behaviour and body condition with no return of urolithiasis. 
 
This is a great example of where the prescription dry food diets can sometimes not quite be right for each individual dog. This dog was being appropriately managed for his urolith problem, but the solution was slowly making him more and more unwell. This combined approach means we will still need to monitor his urine parameters and regularly ultrasound his bladder, but overall, his health and vitality and zest for life are so very much improved. Another example where real foods can heal the gut, the mind and the body and result in better health and vitality all round!  

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History:

Jackson, an 11 year old neutered, 47.2 lb male Labrador mix, presented at 10 months of age with a history of unresolved giardiasis, low Vitamin B12, decreased muscle condition score and body condition score, significant dental tartar, and gastrointestinal disorder including diarrhea, vomiting, and reluctance to eat. Jackson was defecating 4-5 times per day and had chronic diarrhea.  He had been given (Tylosin) Powder for months unsuccessfully to help resolve the diarrhea.

Jackson’s owner had been switching between a variety of dry/kibble food and bland home-cooked diets for months. He was also consuming a variety of treats: lamb jerky, sweet potato and flavored squeezable pastes. Much of his main diet, regardless of the brand, consisted of oatmeal, rice, hydrolyzed soy protein, and meal by-products. The macronutrient content of these pet food formulas averaged 24% protein (mostly derived from non-meat/legume sources), 10% fat, 10% moisture, 8% ash, 2% fiber and 50% carbohydrates.

We encouraged Jackson’s family to transition to a fresh, species appropriate diet: fresh, balanced, low carb and raw. We also suggested supplements to support the GI tract and biome including probiotics, tripe, coconut oil, and vitamin B-12.

Treatment Goals:

• Introduce a species appropriate diet and nutritional supplements to:
  • Improve gastrointestinal absorption of important nutrients
  • Improve muscle mass and body condition
  • Resolve diarrhea
  • Decrease dental tartar

Treatments:

• Discontinue dry/kibble food and bland diet recipes.
• Slow transition over to a commercially prepared, balanced, fresh, well-sourced raw diet
• Provide fresh, raw meaty bones for dental health - weekly
• Supplements/medications
  • Fenbendazole to treat unresolved chronic giardia
  • Tripe to help repopulate the GI tract with beneficial bacteria
  • Coconut oil to help with GI absorption, fats, skin and haircoat
  • Bacillus coagulans to support microbiome and GI health during diet change
  • Clay as needed to help treat diarrhea
  • Vitamin B-12 injections weekly for vitamin support

Discussion:

The kibble foods and bland diet recipes that Jackson was eating were high-heat processed foods (ultra-processed) containing inappropriately high amounts of inflammatory carbohydrates, inadequate protein sources, and inappropriate moisture content. A growing body requires appropriate, nutrient rich foods for energy, functionality, and development. Medical professionals are aware that food – its sourcing, balance, quantity, and freshness – is very important to health.  It makes sense that pet food would be improved if its freshness and balance more closely mimics the needs of the species we are feeding – in dogs, that is a carnivore/scavenger. The kibble foods provided Jackson with basic nutrients, but not nutrients that would make him thrive.  A significant amount of his protein was from non-meat sources, limiting his full profile of amino acids. The high-heat degradation of his food further added to his nutritional deficiencies and could not support his already struggling immune state. 

It seems that Jackson’s chronic giardia severely debilitated him because his meals provided him with a very poor nutritional plane from which to start.  It is difficult to imagine how to properly support body functions at their most efficient and effective manner while feeding food that begins with inappropriate macronutrient balance (high carb, low protein and fat), and has been rendered, extruded and heated multiple times. This high-heat processing is known to create many troublesome by-products (e.g. advanced glycation end products, heterocyclic amines, acrylamides), and to degrade many needed heat-labile nutrients (thiamine (B1), Panthotenic acid (B5), taurine, omega 3 fatty acids, etc.).

Fresh meat-based protein provides a digestible and complete amino acid profile, unlike protein from legumes (e.g. garbanzo beans, lentils or peas) that are deficient in amino acids like taurine or methionine which are important for immune function and antioxidant activity. In addition, appropriate ratios of animal-based fat with plant-based fats provide a more species appropriate fatty acid profile for a dog.  Improving the macronutrient balance of the food with fewer carbohydrates (sugars) decreases insulin produced by the body and decreases inflammation in the body.

Providing foods/supplements that re-florinate the GI tract’s microbiome (probiotics, fiber, fresh foods) can help the body recover from both microbiota-deficient and macronutrient-deficient foods as well, as these help rebound from GI parasite medications that might alter the microbiome, even as they are needed to manage infection. 

Once more sensible nutrient sources/ingredients and supplements can reinvigorate the body, provide appropriate microbial functionality of the GI tract, the animal can properly grow, develop muscle & body condition, and support a healthy immune system.  

Outcome:

In only a few weeks of eating his fresh species appropriate diet, chewing on raw bones and taking his treatments, Jackson’s gastrointestinal signs were fully resolved, and his body condition steadily improved and his dental tartar resolved completely. His owner noted that in addition to resolving his Gi signs, Jackson’s energy levels and activity were significantly improved as well.  As his body condition score returned to normal so did his muscle condition score.  

While Jackson has remained an overall strong and healthy fellow since he was a one-year-old, he is now 11 years old and the exact effects of his troubled development as a puppy are not clear.  His main health concern over the years has related to periodic joint problems. Currently he is being treated post-op for a ruptured anterior cruciate ligament, but with acupuncture, physical rehabilitation, supplements, and excellent diet, he has recovered well and remains very strong. We will take care to maintain his overall health, microbiome, muscle condition and immune health. We have been delighted to watch Jackson develop and maintain his happy healthy body over the years.

*The image shows Jackson as a thin puppy and an 11 year old, his future's so bright he has to wear shades! 

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History:

Moses is a 9-year-old, 25 lb, neutered, French bulldog. He presented for an integrative consult in August of 2022 to help address a recent diagnosis of splenic hemangiosarcoma. The history of his case began with a morning walk when Moses’ back legs splayed out, and he refused to walk any further. His other symptoms included continued lethargy, regurgitating large amounts of fluid, and sudden overall weakness and dullness. At the ER, he was anemic and radiographs revealed a large abdominal mass. Moses had an emergency celiotomy, and his severely enlarged and diseased spleen was removed. The histopathology diagnosed splenic hemangiosarcoma.  He was given a poor long-term prognosis of three weeks to three months to live. His integrative consult included a recommendation that Moses start on Yunnan Baiyao to help stop bleeding, support his ability to battle the cancer, and promote healing. Moses was put on a fresh, raw diet. He also had a history of vaccine reactions as well as chronic GI distress that resolved with fresh food. 

Treatment Goals:

• Support Moses through his healing post-surgery
• Decrease anemia and support healthy blood production
• Support healthy vascular function to avoid future bleeding
• Support the immune system
• Encourage and enhance his anti-cancer cellular and metabolic functions to overcome any spread of the splenic hemangiosarcoma

Treatments:

• Offer meals at random times once a day, trying to leave at least 18 to 30 hours between meals, mimicking “fasting” between meals to encourage ketone body production which may stimulate a protective adaptive cellular response (a.k.a. “metabolic cellular cleanup mode”) which typically is not employed while a dog is processing a meal. 
• Chronic supplements:
  • Yunnan Baiyao (YBY) is a Chinese herb used specifically in cases of bleeding tumors 
  • ErythroPro Western herbal combination as a blood builder
  • CBD Oil for anti-inflammatory and anti-cancer properties
  • Agaricus Blazei Mushrooms and other mushrooms in broth for immunity support properties
  • Wheat germ oil along Moses’ incision line to promote healing
  • Dehydrated heart treats as a source of natural taurine and cardiovascular support
  • Levothyroxine to treat his thyroid condition

Discussion:

Hemangiosarcoma is an aggressive form of cancer that develops from blood vessels. Clinical signs of this condition vary with the organs involved, however, a common symptom is the ability to bleed profusely. Tumors are invasive at the primary tissue site but as a hematologic cancer, can also aggressively spread to other parts of the body. Moses was diagnosed with splenic hemangiosarcoma which leads to large, blood-filled tumors within the spleen. Although some patients can be asymptomatic, pet parents most often notice clinical signs secondary to a ruptured splenic tumor such as weakness, pale gums, lethargy, decreased appetite, and a distended abdomen. 

Yunnan Baiyao is currently one of the most famous and widely used combinations in Chinese traditional medicines. Its ingredients include pseudoginseng, chinese yam, yam rhizome, sweet geranium and galangal root. It has been shown to be useful to stop bleeding, improve blood circulation, disperse clots, and support other possibly anti-cancer cellular functions. Its main active ingredient consists of pseudoginseng root (a.k.a. Panax notoginseng, notoginseng, “tien chi,” or “san qi.”) which contains a high concentration of hemostatic constituents that is more than any of the seven major ginseng types. Uses in cancer treatment may be due to a cytotoxic effect of notoginseng, and possibly its capacity to specifically sensitize tumor cells to ionizing radiation. The small round red “rescue pill” at the center of most bubble pack containers of YBY contains an easy to administer small pill with higher concentration of pseudoginseng to be used in critical bleeding emergencies. Yunnan Baiyao works in two seemingly contradictory ways: it stops bleeding and also acts as an anticoagulant to improve blood circulation and disperse clots. It is prescribed to:

• Stop acute bleeding
• Regenerate new tissue by removing accumulated blood
• Relieve swelling by clearing away toxic materials
• Alleviate pain by promoting circulation
• Accelerate healing of contusions, sprains, fractures, purpura, skin and muscle wounds, penetrating wounds, abdominal enlargement due to internal bleeding, and gastrointestinal, postpartum, and brain bleeds
• Assist in management of immune-mediated thrombocytopenia and blood disorders related to tick-borne diseases

Studies have been done in veterinary medicine about the use of Yunnan Baiyao for hemangiosarcoma in dogs. One study concluded that Yunnan Baiyao initiated hemangiosarcoma cell death at the time of administration and thereafter. These studies as well as the many anecdotal cases of successful use have made YBY a commonly prescribed Chinese herb even in conventional practices and emergency rooms. 

Outcome

Moses is doing so well! His integrative combination of supplements and food seem to have made a difference for him. It has been nine months since his ER visit and his splenic hemangiosarcoma diagnosis. His energy, vibrancy and overall health has dramatically improved, proven by his sprinting around the house and up the stairs! We will continue to work as a team to beat the odds Moses was given. 

Dr Royal is thrilled with Moses's progress and provided this celebratory rhyme from the movie Singing in the Rain....

'Moses supposes his toeses are roses, but Moses supposes erroneously.  

Moses he knowses his toeses aren’t roses, as Moses supposes his toeses to be.'

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History

Rowan is a handsome 12-year-old, neutered, 37lb. Irish terrier. He presented in August of 2022 with suspected spinal arthritis, secondary muscle weakness in his rears, and a history of a sensitive stomach (vomiting). He was eating an ultra-processed dry/kibble food diet high in carbohydrates. Rowan also began to show symptoms of laryngeal paralysis: hoarse barking, spitting up phlegm, and coughing/gagging, especially after getting up from lying down.

We recommended feeding Rowan a balanced, fresh, raw diet and well-sourced probiotics to better support his nutritional health. We also suggested Rowan receive regular acupuncture/aquapuncture treatments and to incorporate supplements to help his arthritis and laryngeal paralysis.

Treatment Goals

• To relieve pain and inflammation stemming from arthritis
• To relieve coughing, gagging, and other symptoms relating to laryngeal paralysis 
• To introduce a species appropriate diet and well-sourced supplements 

Treatment:

• Acupuncture 
• Aquapuncture
• Discontinue dry/kibble food and transition over to a commercially prepared, balanced, fresh, frozen/raw diet
• Supplements:
• Probiotics to support gut health
• Arnica to reduce pain and inflammation 
• Western herbs and Astaxanthin for anti-inflammation, free radical scavenging, and supporting muscle growth

Discussion

Both arthritis and muscle weakness seem to be accepted as normal conditions for older dogs. Instead of accepting that in Rowan’s case, his owners wanted to do more than simply manage the pain that comes with the onset of such diagnoses. In order to decrease systemic inflammation and improve circulation it was necessary to alter his diet to provide him with better tools to help improve and even resolve some of his issues. 

Acupuncture has been developed over thousands of years and can be incorporated in treatment plans to improve and/or resolve almost all medical conditions, including the arthritis, neuromuscular and intestinal conditions Rowan currently had. There are different methods used to employ acupuncture.  In Rowan’s case, in addition to dry needling, we regularly performed aquapuncture with Vitamin B12. Aquapuncture, the injection of liquid substances into acupuncture points to stimulate them instead of needles, has been clinically successful in treating laryngeal paralysis. Laryngeal paralysis can be secondary to neuromuscular degeneration in the larynx making it difficult for the larynx to open & close completely and also to clear saliva/fluid that builds up around the larynx when sleeping. 

We have found that even after just one or two acupuncture treatments many older animals with this condition have a noticeable decrease in their coughing and breathing noise. The treatment frequency at first is at least once a week and typically for a 6 to 12 week duration. After resolution of signs stabilizes, the interval between treatments is increased.  Sometimes treatment intervals can span several months before signs resurface. 

Rowan’s Acupuncture Dry Needle Points

• Governing Vessel (GV) 20, also known as the “permission point”, is located on the highest place of the head where all of the yang meridians meet. 
• Similar points include GV12 and GV14. These points are for neck and upper back pain and stiffness. They are often combined with GV20. 
• Bladder (BL) 40 is useful for all lumbar related issues, such as acute lower back pain.
• BL30 serves as a local point for low back, sacrum, tailbone, and hip pain.
• BL10 is used to relieve stiffness and increase range of motion.
• BL23 is an important energetic point and maximizes Kidney Jing. This is a useful point for Rowan as Kidney Jing is naturally depleted in older animals. 
• Kidney (K) 3 and BL60 are often used in combination and are referred to as the “aspirin point”. These points are useful for pain in the back end and overall inflammation. 
• Gallbladder (GB) 30 helps relieve pain as well as atrophy of the lower back, hip, hind end, and limbs.
• GB2 is used to influence symptoms relating to ear and hearing issues. It also serves as a vestibular point for balance.
• Hip Triangle - local points for arthritis
• HJJx4 Lumbosacral (LS) - local points for circulation and arthritis in the LS spine
• Bai Hui LS (BH) - commonly used for locomotor activity, circulation, inflammation and rear limb weakness
• Located in between BL 35 and BL 27 on the midline
• Interdigital points rears 

Rowan’s Aquapuncture (Vitamin B12) Points

• Equidistant Laryngeal Points (x 6)

Outcome

Rowan’s coughing episodes diminished after only one treatment, after the 3rd treatment his owner reported his mobility had significantly improved and his coughing was rare (1-2 times per week).  The owner comments that the acupuncture was a terrific therapy for Rowan and has improved his quality of life, comfort and overall well being. She is very grateful that he has been responding so well to his acupuncture treatments!

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Juniper

History

Juniper is an 11-year-old, spayed, shorthair, 10lb gray cat. She presented in 2022 with cerebellar hypoplasia and attendant ataxic/stilted jerky movements, borderline thyroid, constipation, potbelly, dry haircoat and suspected spinal arthritis. Juniper had been slowing down at home for about 2.5 years. She didn’t run or jump anymore and would fall over frequently. Juniper was on an ultra-processed dry/kibble food diet.
We discussed transitioning Juniper to a balanced, fresh raw diet with a combination of well-sourced supplements that support her overall health. We also recommended regular acupuncture treatments for her cerebellar hypoplasia, neurologic function, arthritis, and constipation symptoms.

Treatment Goals:

• To improve fine motor skills, hormone regulation and cognitive acuity including input on muscular function 
• To introduce a species appropriate diet
• To introduce well-sourced supplements for
• Neurological health 
• Resolving constipation
• Joint support and arthritis
• Cardiovascular support

Treatments:

• Acupuncture 
• Supplements: 
• Mushroom powder for inflammation and arthritis, to support neurological function, and as a source of fiber
• Psyllium husk (fiber) and aloe juice (cooling, motility) to help resolve constipation
• Arnica to help with mobility, arthritis, and pain relief
• Cardiovascular supplement along with freeze-dried hearts for added taurine and overall heart support
• Vitamin B12 for overall immune support and possible poor absorption due to GI issues
• Discontinue dry/kibble food and transition over to a commercially prepared, balanced, fresh, frozen/raw diet

Discussion

Acupuncture is an ancient Chinese medical technique used for 3,000 years in China, Japan, and Korea. Techniques have been shown to increase lymphatic flow to tissues, stimulate nerve function, restore neurologic functions, increase the release of neurotransmitters and pain modulators, influence inflammatory responses and help the release of hormones. We have been using a combination of acupuncture points and vitamin B12 in aquapuncture for Juniper’s treatment.

Juniper’s Acupuncture Points:

• Governing Vessel (GV) 16 (Fengfu) & GV20 Points where the sea of marrow and sea of yang enter (GV 16) and exit (GV20) the brain.  GV 20 is located on the highest place of the head where all of the yang meridians meet. These points are important in improving cerebellar neurologic function. They have been shown to improve vertigo and brain blood supply. We use these points on Juniper for cerebellar circulation and clearing, neurological support, grounding, in order to decrease tremors and dizziness. 
• Similar points include GV12 and GV14. These points are traditionally used for neck and upper back pain and stiffness as well as neurologic spinal issues. They are often combined with GV20 in neurologic cases. 
• Gallbladder (GB) 2 is used to influence symptoms relating to inner ear and hearing issues. It also serves as a vestibular point for balance.
• Yin tang, located between the eyebrows, has a mentally stabilizing effect and is commonly used for dizziness, calming and connection to the natural world.
• 2 to 4 Equidistant Dorsal Cervical points (including BL10) create muscular and skeletal release such as muscle spasms and tightness in the neck. They also support clearing, circulation and neurologic activity from the head and neck and possibly cerebral spinal fluid. 
• Bladder (BL) 23 is an important energetic point and maximizes Kidney Jing. This is a useful point for Juniper as Kidney Jing is naturally depleted in older animals. 
• BL26 and 28 are also regularly used for Juniper to help relieve constipation issues, abdominal distention, and to help relieve lower back stiffness, and remove obstructions from the channel. 
• HJJ points over Lumbosacral (LS) and pelvic shelf x 4 were periodically employed similarly, to help relieve constipation issues, abdominal distention, and to help relieve lower back stiffness, and to improve and connect spinal circulation from front to back.
• Large Intestine (LI) 11 targets head and neck is useful in dizziness and cognitive issues and local inflammation. It is useful to clear heat and cool blood, resolve dampness, and regulate Qi and blood.
• Kidney (K) 3 and BL60 are often used in combination and are referred to as the “aspirin point”. These points are useful for inflammation or pain in the lower body and legs, and to reconnect neurologically from the brain to the rear legs and feet. 
• BH is commonly used for locomotor activity, circulation, inflammation and rear limb weakness, and lower GI issues and constipation
• Located in between BL 35 and BL 27 on the midline/GV

Outcome

Juniper’s owner reports she sees significant change in mobility and comfort for Juniper.  She is moving with more ease, even jumping up on the bed, an action that has been absent for several years! Juniper’s additional symptoms such as her constipation, potbelly, and arthritis have also significantly improved in response to her treatments. She defecates regularly and her belly is softer, smaller, and more comfortable.

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History

Lola is a nine-year-old, female, spayed Collie Mix. She presented as a new patient at three-years-old with chronic gastrointestinal issues including recurrent diarrhea and vomiting, as well as significant dental tartar and gingivitis, overweight, and a decreased energy level.

Lola was eating an ultra-processed dry extruded kibble food. The macronutrient content of the kibble food consisted of approximately 50% carbohydrates, 23% protein and 11% fat. Included in the top five ingredients were brown rice, oatmeal, peas, and pearled barley along with a large amount of supplemental minerals and vitamins to balance it. We recommended that Lola transition to a species and moisture appropriate, fresh, balanced, commercial raw diet.

We changed Lola’s treats to meat and organ-based treats instead of peanut butter or baked treats high in carbohydrates. We also encouraged well-sourced supplements including:

• Fish oil for Omega 3 fatty acids
• Prebiotic/probiotic support
• Immune support

Treatment Goals

• Improve GI symptoms
  • Manage GI dysbiosis and microbiome
• Improve dental condition
• Normalize weight and muscle mass
• Raise energy level

Treatment

• Discontinue dry/kibble food and transition over to a commercially prepared, balanced, fresh, frozen/raw diet
• Provide fresh, raw meaty bones for dental health
• Supplements:
  • Vitamin B-12 injections for nutritional support
  • Omega 3 for free radical scavenging, inflammation control, and fatty acid balance
  • Gastrointestinal pre/probiotics to support overall microbial health, improve absorption and GI function, and decrease diarrhea and vomiting
  • Bone broth for electrolytes and GI support

Discussion

Diet-related health issues may not show up immediately but can develop over time as animals age and imbalances magnify. Lola had been on a dry/kibble food diet since she was a puppy and her chronic health signs such as chronic vomiting and diarrhea began to appear as a young adult. Providing a nutritious, balanced, and complete diet with well-sourced protein and fats as the highest macronutrient percentages rather than carbs improved her gastrointestinal function and supported a healthy microbiome. For the first time in years, she was free of GI symptoms and had lost weight.

Fresh, raw bones provide the shearing force on the teeth to remove tartar and provided her with an additional healthy fat source, mental stimulation, and a naturally relaxing activity. While chewing on a bone, animals use muscles meant for this action in the head and neck. Without this satisfying activity, dogs lose those muscles and don’t have the benefit of an activity that is ancestrally practical and beneficial. Most animals in the wild do not require dental tartar removal because of normal chewing activities like this.

Outcome

Lola has been thriving since transitioning to a species appropriate diet and targeted supplements. Lola’s gastrointestinal issues have resolved completely. Her weight has normalized, and her dental tartar and halitosis are also resolved without further intervention. Yay, Lola!

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Sammy is a handsome 15-year-old, neutered, standard poodle who presented with seizures, mild/moderate ataxia/balance issues, laryngeal paralysis, AU yeast otitis, multiple skin masses and lipomas, generalized muscle weakness and decreased muscle mass, dry haircoat, 4/4 dental tartar, halitosis and gingivitis. He had a history of benign splenic tumors (splenectomy), liver cancer (suspect hepatic carcinoma), neurological issues, decreased stamina, and a “sensitive stomach” with daily diarrhea episodes. His owner was interested in dietary and nutrition recommendations to improve overall health.

Sammy was eating an ultra-processed dry extruded kibble food. The macronutrient content of the kibble food included nearly 50% carbohydrates, 26% protein (much from non-meat legume sources) and 15% fat. Ingredients included garbanzo beans, lentils, beet pulp, pea proteins, and pea flour. We encouraged Sammy’s family to transition Sammy to a species appropriate, fresh, balanced, commercial raw diet. We also recommended well-sourced supplements including anti-inflammatory herbs, probiotic/prebiotic support, and Omega 3 fatty acids. Further, we recommended feeding Sammy once a day and at random times.

Sammy was also diagnosed with significant dental tartar and gingivitis. We recommended offering fresh, raw meaty bones to improve dental health, oral health, and jaw/head/ears/neck musculoskeletal condition.

Treatment Goals

• To introduce a species appropriate diet and nutritional supplements that improve:
  • Overall health, skin/ear condition, biome
  • The oral biome and decrease dental tartar
  • Laryngeal function
  • Neurological function
  • Seizure prevention
  • Neuromuscular function and stability
  • Immune system functions in preventing further tumors/skin growths

Treatments

• Discontinue dry/kibble food and transition over to a commercially prepared, balanced fresh, frozen/raw diet
• Fresh, raw meaty bones
• Acupuncture
• Supplements:
  • CBD Oil for anti-inflammation and seizure control
  • Omega 3 for overall health, inflammation control, seizure support, free radical scavenging
  • Gastrointestinal supplements/probiotics to support overall microbiome health, absorption and improve GI function, decrease diarrhea
  • Anti-inflammatory herbal combination – musculoskeletal support –turmeric, Boswellia, corydalis, marine extract, hyaluronic acid, glucosamine, MSM

Discussion

Geriatric dogs have been shown to need more protein than younger dogs to avoid sarcopenia (muscle loss/atrophy) typically associated with age. They can require up to three times as much protein to maintain proper muscle mass. Providing a nutritious balanced and complete diet with protein and fats as the highest macronutrient percentages rather than carbs can improve muscle mass in a geriatric dog with sarcopenia. The protein from excellent meat sources will provide a digestible and complete amino acid profile, unlike protein from legumes like garbanzo beans, lentils or peas which will be deficient in amino acids like taurine or methionine.

Feeding once a day helps the body maintain condition and health by allowing more time for mitochondrial cleanup mode. While the body processes food, it shuts down its mitochondrial cleanup mode as it needs to instead assimilate nutrients into cells. When digestion is finished, it will then turn to “cleanup mode” and start repairing and healing body areas with inflammation, unusual cells, cancer cells, or damaged cells. This is the idea behind “intermittent fasting” as a helpful tool to improve health and longevity. More time “cleaning up” will mean healthier bodies. Feeding once a day provides this “clean up time.” In addition, a dog’s stomach is 70% of their GI tract (humans’ are 30%) and ancestrally they should really only expect one large meal per day. Feeding them half portions or even feeding smaller amounts more frequently can be unsatisfying to a dog. Once they get used to eating once a day again, their GI functionality improves, overall health improves, and they are very satisfied by their meals.

Feeding at random times prevented Sammy from developing a hyper acidic response from anticipating a meal. Feeding at random times will mean that the dog will not know when mealtime is. We understand that would be unusual for a dog/canine in the wild to know exactly when they might catch and eat a rabbit every day. Being on a schedule is relatively unnatural for them although they get used to it and certainly can tell time. When a dog is used to a fixed schedule of eating, there are other health concerns. They will start anticipatory bile production in the stomach sometimes 30-60 minutes before a meal. A random amount of bile and saliva and enzymes will be produced and is waiting in the stomach for the food. The food amount will not be necessarily what the canine expects (especially if the meals are being split and fed two times a day or more) and the acid may be too much for that meal, creating possible vomiting, diarrhea and at best a strange over-acidic pH for the GI tract to deal with. Sometimes if an animal that expects a meal at a certain time is not fed on time, they will vomit the bile that has been waiting in the stomach for the meal. The best way to avoid this bilious vomiting syndrome is not to feed acid reducing medication, or feed earlier. It is best to simply avoid feeding at a specific time. Then the dog can return to a more natural state of not knowing when mealtime is, not overproducing acids/bile, and the GI tract can function more normally.

Bone Chewing

Fresh, raw bones provide the shearing force on the teeth to remove tartar, and provided him with an additional healthy fat source, mental stimulation and a naturally relaxing activity. While chewing on a bone, animals use muscles meant for this action in the head and neck. Without this satisfying activity, dogs lose those muscles and don’t have the benefit of an activity that is ancestrally practical and beneficial. Most animals in the wild do not require dental tartar removal under anesthesia.

Outcome

Since transitioning to a species appropriate diet and targeted supplements, Sammy is a healthy, happy dog. Sammy’s seizures have subsided, and his stamina has drastically improved as evidenced by daily two plus mile walks (a distance he was previously unable to accomplish – he would barely go around the block). Sammy’s tartar and gingivitis were resolved with fresh raw bones. We have loved watching Sammy rediscover his vitality!

Words from Sammy’s Owner

“It’s unreal. Sometimes we look at him and wonder how he is 15 years old with liver cancer and a history of seizures. His stamina is great. He’s even jumping on the bed again! That was the most notable change when switching to raw food. Feeding him one big meal a day really helped with his digestion; we were able to discontinue medications such as famotidine. The low keto diet helped him neurologically too. Sammy’s absolute best prognosis in October 2021 was that he would get seven months. We’re thrilled and amazed to have such quality of life for him after twice that many months – and counting!”

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PoPo is a Japanese Spitz currently aged 10 years and 7 months. Popo first came to see me in November 2017 (at 5 years of age) as her owner had always fed her a home cooked diet and was prompted to seek my advice on ensuring this was complete and balanced for her. After analysing her diet of cooked meat, rice and green vegetables, a nutritional balancer was added to her diet to approach a nutritionally complete recipe. PoPo’s owner was very averse to feeding any commercially prepared diets. Baseline blood and urine testing at the time returned normal results.

In October 2018, PoPo returned to see me as she had been urinating indoors which was very unusual for her. Blood and urine testing was performed and it became evident that PoPo had developed early chronic renal disease. Her diet was again analysed and recalculated to provide a diet with moderate protein, moderate carbohydrates and a reasonable amount of fat.

On a Dry Matter basis, the diet was formulated to provide 30% protein, 25% fat, 35% carbohydrates (7% fibre and 3% ash). Proteins were chosen to be white meat only (chicken, turkey, pork and fish), avoiding the extra DNA breakdown products from lean, red meats. The Ca:P ratio was adjusted to be higher (2:1) and the B group vitamins, and other micronutrients were increased by adding a micronutrient supplement, to help cope with her metabolic stress. A calculated omega 3 fatty acid supplement was added, as was a TCM Rehmannia 8 herbal formula. Silymarin was also later introduced.

During the almost four years since her diagnosis, PoPo has progressed from IRIS Stage 1, normotensive, normo-proteinuric to now being IRIS Stage 2 (SDMA of 34 and Creatinine of 200 in July 2022). Her blood pressure and urine protein remain normal. Ipakitine was introduced in November 2021 as her blood phosphate levels increased but ground eggshells were also introduced to her diet to increase the calcium further and the Ipakitine was later discontinued as PoPo refused her food with this added. Her blood phosphate levels have since remained near the upper end of normal.

Earlier this year CBD oil was introduced to manage back pain related to osteoarthritis and her mobility and general demeanour have improved with this addition. PoPo has required yearly dental treatments under general anaesthesia, sometimes requiring dental extractions. Analgesia during these times were with carefully calculated non-steroidal medications, as well as opioids and paracetamol. A combination Silymarin, SAMe and Vitamin E preparation was used to support PoPo in the peri-anaesthesia period.

Sadly (for us), PoPo’s family will be returning to Korea in early 2023 and PoPo’s ongoing care may be lost to us as she will migrate with her family. Her back pain will be managed with palmitoylethanolamide and a concentrated green lipped mussel extract due to concern over the different prescribing laws for CBD oil in that country. This case is a good example of how a combination of tailored nutrition and herbal supplementation can be used to manage a case of chronic ill health for many years.

PoPo is now four years into her diagnosis and remains a bright and alert and very happy little dog. Whilst many practitioners and owners may baulk at performing general anaesthesia and dental treatments for a dog with a diagnosis of kidney disease, we feel this has enabled PoPo to remain well over the past four years. We are constantly amazed at the care and dedication her owner provides her, her compliance and her gratitude for our care. She has been a darling little dog to know and to care for. We wish both her and her owners the best of luck for their move to another country.

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Crystal is a 2 year old spayed/vaccinated all white cat.  She was in foster care for more than 12 months because nobody wanted to adopt her due to her skin issues.  She was losing fur and had dry, bumpy skin with bleeding sores. She also had pockets of swelling all over her body, as well as a yeasty discoloured coat. Her diet while in foster care consisted of two commercial food products. During that time she was administered an allergy injection, topical steroids and steroidal shampoo baths with no visible change reported. After 12 months the foster carer could no longer afford Crystal’s vet care. Fortunately, she was adopted by an owner who had a sound knowledge of natural nutrition and therapies. She immediately set about switching the cat to a more natural diet. It took only a week to transition Crystal to a raw food diet with the help of some added 100% natural canned cat food. Raw goat’s milk was also gradually added to the diet for its naturally occurring probiotic properties to support a healthy gut and immune function. Over the next few weeks Crystal was moved onto two all natural food products – one frozen and one freeze dried – as well as fish oil and CBD oil. In less than a month her coat was dramatically improved as seen in the photos.

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Sebastian is a 10 month old Blue Point Birman kitten with dysuria - straining to urinate and frequent urination - over several days. He was examined by his vet and a urine test showed no infection, but quite a lot of blood and inflammatory white blood cells in the urine, and a urine pH of 7.

Often in such a case, ongoing anxiety or a recent stress event can cause a dysuria or cystitis, but Sebastian’s owner said that there had been no stress and that he was a very relaxed character. However, she was feeling guilty that he was eating mainly dried kibbled food, and that she was concerned this could be the problem. He was a fussy eater, who would only eat other fresher foods for one day, then would refuse them the next, so it was easier for the owner to just leave the dried food out all the time.

I suggested not giving any dried food, so he would actually be hungry! Then I asked her to list the foods he did like for a day – raw lamb, cooked lamb, egg, cheese, canned sardines, canned salmon, one flavour of a good quality sachet food and a good quality freeze died raw complete diet for cats.

We drew up a calendar so that he had one of these foods in rotation at each meal, so would only have each food for about two meals a week, and they added up to a complete and balanced diet over one week.

We were able to get Sebastian to eat the raw lamb several times a week, which was important as raw meat is nature’s urinary acidifier, and if we could keep his urine at pH 6, it would be near impossible for him to get cystitis again.

A follow up urine test a month later showed healthy urine, and he had no more symptoms of dysuria. Sebastian has now been well for over 6 months on his frequently changing natural diet.

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Mr Brownie, an eleven-year-old, 2.27 kg, Chihuahua, was diagnosed in December 2021 with Laryngeal Paralysis and Renal Disease. He also suffers with severe food allergies and as his owner shared, he would go through bouts of inappetence due to coughing and resulting regurgitation. His treatments began with the transition to a kidney-friendly homemade diet incorporating food therapy principles to support healthy lungs, increase kidney yin, and strengthen Spleen Qi. His favorite recipe includes cooling pungent aromatic peppermint to stimulate circulation and move energy up and out; sweet and sour properties of apples to moisten dryness and cool heat of the lungs; sweet, neutral flavors of green beans to strengthen digestion and increase yin fluids; cooling and sweet flavors of Napa cabbage for inflammation and qi deficiency; with warming energetics of turkey to balance the overall cooling nature of the recipe; and blueberries, not only for kidney yin but the added benefits of antioxidants and phytochemicals. Food texture was also adjusted for his preferences, and he now dances in anticipation of his meals. Additionally, Xiao Chai Hu Tang was introduced to address the collapsing trachea, along with Yi Guan Jian for the renal disease. Recent blood test results reveal his renal functions have improved significantly. And while he’s still challenged with Laryngeal Paralysis, coughing is minimal, vomiting of meals has been eliminated, and he can sleep through the night with the support of hydrocodone. With a goal of removing this last medication, we are adjusting the herbal therapies and adding aromatherapy.

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Oreo, an anxious six year old male neutered Chihuahua, presented with a long history of recurrent anal gland abscessation and a more recent history of unusual neurologic episodes that appeared to be triggered by stressful events and exposure to certain foods and toxins. Bloodwork and urinalysis were unremarkable. Further diagnostics were declined and the owner sought an integrative medicine consultation. Oreo’s diet was changed from kibble-based to a balanced lightly cooked novel protein homemade diet supplemented with fibre and probiotics, and a western herbal tincture containing Passionflower, Bacopa, Chamomile, Baical skullcap, Burdock and Milk Thistle. This was implemented alongside behavioural modification strategies and a consistent home environment. Oreo’s stool bulk improved and his anal gland disease resolved. Neurologic episodes became very rare and only mild when they did occur, and his anxiety was well managed. He is now a very happy and healthy nine year old and the owners are delighted with his quality of life!

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Kyser, a 7 year old male Rhodesian Ridgeback, presented with a history of reoccurring Mast Cell Tumours, chronic anal gland infections, conjunctivitis, dermatitis and hindleg discomfort. He had received many courses of antibiotics, non-steroidal anti-inflammatories, skin supportive medication, antioxidants and Vitamin C. The aim was to support Kyser’s immune system, reduce the inflammation, detoxify the body, address any food intolerances, possible gut imbalances and possible nutritional deficiencies. He was treated with herbal tinctures, a course of stem cell treatments and his diet was changed from processed foods to a raw diet. Probiotics and further supplements were also introduced. Two years later Kyser’s mast cell tumours have been managed, the anal gland infections, dermatitis and conjunctivitis have resolved and he is maintaining a good quality of life. His owners feel that he is a happier dog, often walking up to one hour a day.

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Mindy, a 9yo Maltese cross, presented with a history of frequent recurrent urinary tract infections and two surgeries for struvite bladder stones. Her dedicated owners were finding it challenging to tablet her, collect repeat urine samples and feed her a prescription diet. They were also highly motivated to implement a more natural preventative strategy. Her treatment approach involved a high moisture containing homemade diet supplemented with probiotics and Cranberry extract, as well as the administration of a twice daily Western herbal tincture based on Crataeva, Astragalus, Marshmallow Root, Withania and Chamomile. She has had no further urinary tract infections since commencement of this regime over a year ago and is a very happy little dog who willingly takes her food and supplements!

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Integrative treatment of hip and stifle pain in a dog with lymphangiectasia.

Samwise is a 7 year old MN German Shepherd dog, who presented for TCM evaluation for treatment of hip and stifle pain. At 10 weeks of age he was surrendered with a dislocated, broken mandible. He additionally suffered from giardiasis and parvovirus. Despite this, he was adopted by the current owner, a veterinarian. At two years of age he was diagnosed with bilateral hip dysplasia, and a cranial cruciate rupture of the left stifle, at which time he underwent a tibial plateau leveling osteotomy (TPLO). With this history, he had been administered chronic pharmaceutical regimens of antibiotics and analgesics.

One year later, he developed a reaction to the TPLO implant which required removal of the implant. Around the same time he was diagnosed with lymphangiectasia and was prescribed steroid therapy. If the steroids are tapered or discontinued, overt severe foul-smelling diarrhea occurs. The diet must be strictly controlled with prescription low-fat kibble, and the only treats he tolerates are carrots and watermelon. The dog can no longer take conventional analgesics without a severe exacerbation of diarrhea and associated abdominal pain.

The owner sought integrative therapy for progressive musculoskeletal pain, with the goal of allowing the dog to comfortably enjoy weekend hiking and camping.A TCM diagnosis of Spleen Qi deficiency with Damp Heat was made based on poor muscle condition, maldigestion and lymphangiectasia with foul-smelling diarrhea. Kidney Jing deficiency was assigned due to the presence of hip dysplasia. Pain that was not severe and migratory between stifles and hips indicated Qi stagnation. Chronic medication with antibiotics and steroids exacerbated the Spleen Qi deficiency and Damp. The TCM treatment principle was to tonify Spleen and Kidney Qi, drain Damp and clear Heat (resolve inflammation), and invigorate Qi to relieve pain.

Biweekly acupuncture was performed, timed around Platelet-Rich Plasma (PRP) treatment of the hips and stifles. The addition of a whole food nutritionally complete diet was prescribed to supplement, if not replace, the processed kibble. The combination of acupuncture and food therapy has successfully allowed the dog to continue to participate on hikes, sometimes many miles in mountainous terrain, comfortably without pharmaceutical intervention for pain.

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Winston is a five year old male neutered Border Collie owned by a local harbor master in Chicago, USA. 

History and PE 

Winston was being fed a half cup of a dry kibble food twice a day and was significantly overweight. His owners considered the dry kibble food to be a "high-quality'' food. He was also given baked treats and occasionally raw bones to chew on, but not recently. He was given plenty of exercise and was able to go to work with his owner. He has a history of a hypothyroid condition managed by 0.8mg Levothyroxine with food, his levels had been tested three months prior to presentation. Overall, he was described as having decreased energy at home, decreased appetite and not playing anymore.

On presentation he weighed 92 pounds, his coat was dry with significant dandruff and his body condition score was 8/9. He had difficulty and was slow to get up from lying down and slow to go up and down stairs. He had 0-2/4 dental tartar and mild gingivitis and halitosis, a heart rate of 80 bpm and deep, slippery pulses. 

After His Integrative Veterinary Consultation

Winston’s diet was changed to a high quality fresh raw food. It was recommended that he be fed once a day but his owner wanted to wait a few weeks before starting once a day feeding. They transitioned him over ten days to 8 ounces of fresh complete and balanced raw food twice a day. The raw food was low carbohydrate, with fat and protein percentages almost equal. Fresh raw bones to chew on were again provided. His dose of Levothyroxine was decreased to 0.4mg and given on an empty stomach twice daily. He was also given a quarter cup of fermented goat milk three times a week to improve his gut biome, sustainably sourced fish oil from pelagic fish (mackerel, sardines, anchovy) for omega 3 and a half teaspoon of sunflower oil twice a week for linolenic acid.

At a three week physical examination he had already lost 10 pounds. The owners commented that his energy, appetite, cheerfulness and interaction had improved dramatically, and he was "a different dog." His heart rate was 96 bpm, he was energetic, engaged, not slow to get up or down and he moved with alacrity in the room. His coat was shiny and lustrous with no dandruff. His eyes were bright, his teeth and gum condition had already improved significantly. The owners and many people at the harbor club commented that he seemed like a much older dog before the dietary changes. After his transition they stated that he seemed to be younger and more engaged. He is overwhelmingly excited by his food, eating enthusiastically. In addition, his stools and intestinal gas were significantly improved as well – smaller, firmer and easier to pick up faeces, and less frequent defecation (once a day, normal for a canine) and much less flatulence.

The short turnaround in his condition was noted by all who know Winston and his improvements continue at the time of this writing (four weeks after initial consult) and are impressive. His thyroid regulation will be checked in two weeks. It is anticipated that it all will be well as his physical condition is so good.

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Amadeus is a 4-year-old, neutered Cornish Rex, whose owner contacted me for a nutrition consult due to a history of urinary tract and renal disease. 

In our initial consult, I worked on a detailed history of his diet, litter box protocols, and environmental enrichment strategies. Given the owner was a well experienced cat owner, litter box and lifestyle issues did not appear insensitive to Amadeus. His canned food diet seemed appropriate initially, but I was concerned with the limitation. He had been fed one formula of one brand for the last three years. He was fed this as a default because it seemed to reduce his itchy skin and lesions and had been recommended by the breeder. Nonetheless, this limitation gave us an important break: analysis of the formula proved it unfriendly to both the urinary tract and the kidneys.  

Diet changes were implemented to include a rotation of a few well-balanced canned formulas and the addition of some raw meats as a topper to encourage the incorporation of raw food meals over time. An herbal anti-inflammatory urinary formula along with a kidney formula based on Er Xian Tang were introduced, and if he would accept, additional water in his food.

Two months after our initial consult, Amadeus was seen by a feline specialist with significant improvement in his laboratory results. A bonus with the diet change, his skin issues resolved.