Looking for a Place in Oahu

Dear fans on Oahu,

I have been struggling with how best to serve my people and their pets. As you know, travel is very stressful these days. Due to health reasons, I have tried to come to Oahu less, but work more days at one time. Well, this still does not cover all the pets. So I have been looking at how I could best serve and not burn out, burning the candle at both ends.

One way, is to not stay in a hotel environment and energy field. It’s hard to sleep in most places in the city without noise from drunks, motorcycles, ambulances, police, and garbage trucks.

Another way, is to not treat so many animals in the stressful environment that Kapalama Pet Hospital can be. Between the traffic, the parking hassles, and the street people, it’s stressful for people and their pets to see me there.

What I am used to on Kauai, is treating dogs outdoors on a lanai, or under an awning, open to the fresh air. Dogs don’t mind coming to my clinic because they are coming to a “backyard” with tents and chairs under a large tree. The cats get treated in a room that looks like “grandma’s house” with live birds for them to stare at. Everything stays pretty much “mellow”.

Therefore, I am looking for such a place on Oahu, a place I can treat animals (big private yard) and sleep over at night. My wife Jane and I have been looking at places to buy to see if we can afford it, or may have to do something else. The idea is that having a new place from which to work from and treat animals will allow me to come to Oahu twice a month, each time for 4 days.

To accomplish this, I will be scaling down some of my services on Kauai, and increasing phone consultations, and teaching more veterinarians, and animal owners in workshops in Japan, the USA, and on Kauai.

Because I am half-way through writing a book on Dog Nutrition with over 100 recipes for each type of dog and condition, plus moving my clinic on Kauai into my home in May, I may be too busy to start seeing more people on Oahu till the middle of summer.

If you know of a place to rent or buy, a small house with a enclosed lanai, large year, that is private, and would not bother the neighbors…..let me know. We have been looking in Ka a awa, Punaluu (too far….I think?) Maybe….Kaneohe, Waimanalo or Round Top……

I pray that I will find a way to improve my availability to my good clients on Oahu, and Kauai in the coming months with your help.

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Lucky’s Holiday Liver Loaf

This tender morsel of tenderness and juiciness, includes a nutritious blend of vegetables, eggs, liver, and love.

Ingredients:

2 Tablespoons butter

1 cup of water

½ teaspoon of garlic powder (to help repel fleas, and keep cholesterol low and improve taste)

½ tsp salt

1 tsp basil ( prevents gas & aids digestion)

4 Tablespoons of fresh parsley ( cleanses kidneys)

1 tsp of sage powder (blood cleanser )

Put these into a 2 quart sauce pan and heat on medium high

And add the following:

½ cup of chopped broccoli (antioxidants)

½ cup of chopped carrots (fiber & antioxidants)

½ cup of chopped celery (minerals)

½ cup of zucchini squash diced (fiber and antioxidants)

Cover Heat on Medium-Low 20 minutes

Remove from Heat / “Drain soup” and save

Set Aside the cooked veggies

Then prepare the following:

1 cup of chicken liver chopped (Jam packed with vitamins, and minerals)

1 cup of ground beef, chicken or turkey

3 cup of whole wheat bread crumbs (you can make these up from left over bread scrapes)

Add the veggie soup to the bread crumbs / and mix well

Then add 3 scrambled eggs

And a little more water if the bread crumbs are very dry

½ cup of water

Now get a large mixing bowl and mix EVERYTHING TOGETHER WITH YOUR BARE HANDS:

• Liver

• Burger

• Breadcrumbs

• Veggies

Put everything into a casserole dish

Heat the Oven to 350 degrees

Bake for 40 minutes

Turn off Heat and let cool in the oven

Serve room temperature or chilled.

For Parties you can garnish with parsley and cherry tomatoes

You can make little Christmas trees with the parsley

And little red ornaments with the cherry tomatoes

Probably around this time your saying…..why am I doing this?

My house smells like a sausage & hot dog factory

Well, all I can say is… “it’s a very special treat for a very special pet.”

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Holiday Kitty Treats: Fish in Aspic

Fish in aspic is a favorite dish for Christmas Eve supper, but it is much enjoyed at any time of the year. I have modified it….for your cat, but you can eat it too!

Ingredients :

1 whole snapper fillet (cut into 1”x1 inch pieces

¼ cup of shrimp (washed & chopped up….with shells)

½ tsp salt

4 tablespoons of grated carrot

1 tablespoon of powdered catnip ( or 2 tablespoons of fresh)

Optional….if you cats like catnip / or

Use chopped up broccoli

1 tablespoon of Knox Gelatine

¼ cup of cold water

Directions:

In a sauce pan place fish and shrimp on the bottom

Boil 2 cups of water, and pour over the shrimp and fish

Add salt, carrots, catnip, broccoli

Turn heat onto low….and simmer 30 minutes with a cover on the pan
- Do Not Boil

Remove fish and shrimp

And place them into ice cube trays…… about 1 tablespoon in each

Boil fish shrimp liquid down to about ½

Mix ¼ cup of cold water and 1 tablespoon of Gelatine together

Then add it to the boiled fish/shrimp water.

Pour this liquid into each of the ice cube trays (with the fish & shrimp)…..then either freeze for long term storage or refrigerate it & it will turn into Fish Jello.

You can also get fancy molds and make little balls, or mouses.

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Pain Remedies and Safety Issues

With the news that Cox -2 inhibitors used for pain control in dogs and humans are creating severe and sometimes fatal side-effects, its time to look at safer alternatives for pain control. Here’s an article that I wrote for veterinarians. Please read it and make a copy for your veterinarian.

Can Pain Management Be Safe & Effective?

It’s time to take another look at pain control options
by Ihor Basko, DVM

Has the news of cardiovascular risks in humans associated with the chronic use of Cox-2 inhibitors affected the way you now prescribe pain relief medications to your animal patients?

Are you seeing more clients asking for safety re-assurances on the use of Cox -2 inhibitors in their pets?

• Do you mention the potential for gastritis, ulceration, intestinal bleeding, diarrhea, liver damage and death with their use?

• Can you win a law suit in which a client looses a dog to an NSAID reaction because you told them they were safe?

The latest news regarding the severe side-effects of heart attacks and strokes in humans coupled with the FDA’s slam of Novartis for not reporting deaths associated with Deramaxx has “sensitized” millions of people nation–wide to the short comings of these pain relieving drugs, and has created an atmosphere of distrust of drug companies and their “scientific safety” studies. As a result, people are looking for alternatives. This is a wake up call for all veterinarians.

As more and more clients become aware of the potential side-effects of NSAID drugs, they will turn to their veterinarians and ask for alternatives. How many choices have you to offer them?

Pain & Perception

What an animal is really feeling can only be extrapolated and imagined. One can appreciate pain more completely by experiencing different kinds of pain from different causes personally. Having experienced pain yourself, you know that quelling pain is more complicated than just taking a pill and hoping for relief.

Perception of pain can be different than the feeling of pain. How the owner “perceives” pain in their pet is important to consider. They will be the final judge of whether or not your treatments are successful. If an animal is limping, cries out or whimpers, the owner concludes there is pain. What occurs when you administer an NSAID or steroid mollifying the whimpering but the dog is still limping? How will you assess that? How will the owner?

It is imperative to understand the causes, contributing factors, the degree and characteristics of the pain an animal is experiencing before a successful treatment plan can be initiated.

Mechanisms of Pain

Pain often arises from intense stimuli that cause tissue damage. It is believed that this tissue damage leads to an accumulation of certain chemicals such as:

• histamines

• prostaglandin E

• bradykinins

• serotonin

• leukotrienes (from arachidonic acid metabolism, cyclooxgenase, lipoxgenase)

The release of leukotrienes will result in chemotaxis, chemokinesis, synthesis of superoxide radicals (ROS) and release of lysosomal enzymes by phagocytes. This sets up a process of cyclic pain starting at the sensory nerves through the spinal chord pathways to the brain, and is difficult to stop unless all the contributing factors are mollified. No one drug or botanical can completely stop the process. (See Table 1).

Most NSAIDS are designed to control the release of prostaglandins, but therapeutic Inhibition of the 5-lipoxygenase pathway is rare. Boswellia is a botanical analgesic that inhibits this pathway thus reducing the release of leukotrienes. ( Resources: Extra Strength Pain Support)

Review of Musculo-Skeletal Pain

Pain is not a “bad reaction” but a signal to the living being that there is tissue damage and it’s time to stop and access the situation. Tissue damage to muscles, tendons, ligaments, articular surfaces and bone can result from mechanical, chemical, thermal, viral, bacterial, or parasitic trauma, and the accumulation of biological wastes.

Although we have many terms and names for pain syndromes such as: myalgia, myositis, rheumatism, fibrositis, myofasciitis, interstitial myofibrositis, bursitis, osteoarthritis, etc. these terms do not describe the characteristics of the pain experienced. The same condition can result in pain that is experienced differently from one individual to the next.

Depending upon location, function, and innervation, musculo-skeletal pain can have the following characteristics and patterns:

• burning-hot/ intermittent or constant / radiating

• sharp - stabbing / intermittent

• dull aching / intermittent or cyclic

• burning-cold / intermittent or cyclic / radiating

• stiffness / intermittent or constant

These differences are due to the different kinds of afferent sensory fibers (A-delta, C-delta, etc.) present at the site of tissue damage, and the different pathways these fibers are connected through the spino-thalamic tract to communicate pain to the brain.

Other of characteristics of Paincan be:

• Radiates from one area to another (referred pain)

• Cycles from one joint or muscle to another

• Anemia, hypothyroidism, stress, fatigue, nutritional deficiencies (B12, B6, B1) can contribute to or aggravate existing pain. 1

• Aggravated by climatic changes (rain/ wind/cold)

• Acute Trigger Point pain in muscles, ligaments, and tendons can be “triggered” by stress, anemia, viruses, hypothyroidism, and climatic changes 1

• Aggravated with movement

• Improved with movement

• Acute pain can be mollified by cold & ice

• Chronic pain can be assuaged by heat & water

The patient should be thoroughly examined moving, and at rest. Besides palpating the lame leg, adjacent structures supporting the joints, the spine, and the contra-lateral limb muscles can be examined for evidence of pain.

Radiographs, thermographs, ultrasounds, blood chemistry analysis (SGOT & CK, T4,), CBC as well as the patient’s past history of response to analgesics may assist the veterinarian in discovering the reasons for a reoccurring or chronic problem and what to do about it.

For Example

The condition commonly known as hip dysplasia is very complex and can have many sources of pain besides the affected hip joints. Many times clinicians will remark after looking at x-rays, that the side with the most pathology radiagraphically is not the side the dog is limping on.

This condition can be complicated by:

• referred pain to the hind legs (aka “sciatica”) from a lower back problems such as spondolysis, spondolosis, or chronic disc disease.

• acute trigger point muscle pain may be present and located in the anterior-cranial portions of the quadriceps muscle, the contra-lateral triceps muscle, mid lumbar area, and most commonly the pectineus muscle and tendon

• shortening or atrophy of the biceps femoris

• atrophy of the spinalis longitudinus & longisimus dorsi muscles

• osteoarthritis of the carpal bones

• acquired osteoarthritis in the opposite stifle joint

• stiffness and loss of range of motion in the cervical vertebra and lumbar vertebra, stifle joint, and occipital-cervical areas

Treating Hip Dysplasia and any chronic or reoccurring condition requires a “broad spectrum” approach for best results.

The Broad Spectrum Plan of Action

No one drug, product, herb, surgical procedure, or treatment modality will give complete and lasting pain relief. Due to the complexities of osteoarthritis and the different kinds of degenerative & inflammatory processes occurring, the plan of action for pain management must be “broad spectrum”:

I. Nutrition

• Many commercial diets will contribute to the creation of ROS (reactive oxidizing species) or “free radicals” which damage the DNA of cartilage and related tissues. The practitioner should investigate diets that include more antioxidant and omega-3 content, and protein sources with higher biologic values and less biologic waste and residue.

• Antioxidant supplements will assist in “blocking” the ROS from damaging cells and will diminish the rate of decline: Vitamins C & E, Mn, Se, Omega-3 EPA,Methylsulfonylmethane (MSM), SOD, procyanidins, S-adenosyl-methionine (SAMe) ( Resources: Canine Antioxidant Support, Joint Support Plus)

In a recent study, Finnish researchers have discovered that the compounds that act like antioxidants contained in Scotch Pine Bark (christmas trees) show promising anti-inflammatory action that can help arthritis pain.

• The addition of chondroprotective glycoaminoglycans into a supplementation program will improve the longevity of the articulating surfaces by enhancing regeneration and repair, Glucosamine: HCl or SO4; chondroitins: chondroitin sulfate A & C; Hyauronic acid; Perna mussel, Sea cucumber

(Resources: Canine Joint Support Plus & Bone & Joint Support)

Glucosamine’s effectiveness in controlling long term arthritis pain has made it a very popular supplement for animals and humans. Unfortunately, the law of “supply and demand” has caused the prices to rise again. Expect higher prices of about 20-30% beginning this spring. It may be time to stock up on products containing glucosamine and chondroitin now.

II. Exercise

• Programs should be designed to fit the individual patient’s condition and needs. Exercise will improve stamina, flexibility, muscle strength, range of motion, circulation and in the long term, prevent more pain. Regular schedules of swimming, walking, and light running on grass or soft dirt can improve the quality of a dog’s life.

III. Rehabilitative Physical Therapy

These modalities are becoming more and more popular because done properly, they work so very well. They are beneficial in the restoration of the loss in range of motion, alleviating muscle pain, reducing stiffness, and blocking “trigger point” pain.

• Hydrotherapy / Magnesium salts / Alternating Warm/Cold/Warm

• Massage / / Manipulation

• Topical pain control

• (massage aromatic medicated oils containing arnica, frankensence, wintergreen, peppermint, noni, kava kava)

• transdermals (myristin, glucosamine, hyaulronic acid, SAMe

IV. Other Complimentary Modalities of Treatment

As more research and time goes by the value of these modalities will become more evident.

• Acupuncture / Moxibustion

• Chiropractic

• Trigger Point Therapy

• Soft Laser Therapy

• Infra-red Heat Therapy

• Prolotherapy

• Neural Therapy

V. Oral Pain Control

Medication should provide safe and sustained pain relief. Duration of treatment with NSAIDS should be long enough to quell the inflammatory cascade 3-7 days, with repeated doses on “as needed” basis. Long-term daily use of NSAIDS will suppress other enzyme systems that maybe beneficial to the patient and produce unwanted side-effects with long-term use.

Veterinarians have to remind their clients that there really are no guarantees for safety, only probabilities of safety. Once the clients understand the probabilities of safety in regards to a particular pain medication, they can make better choices for the treatment of their pets.

• Botanicals : Higher probability of safety than NSAIDS

Boswellia / Yucca/Meadowsweet/Ginger

(Resources: Extra Strength Pain Support)  

• NSAIDs: give clients pros and cons / sign release agreement

Increase antioxidants ( Resources: Canine Antioxidant Support ) & chondro- protective agents to decrease the probability of side-effects.

• Aspirin: offers good pain control by may cause gastric irritation and bleeding with chronic use.

Avoid using in dogs who have clotting disorders (Bearded Collies, Dobermans, Rottweilers, etc).

• Muscle Relaxants

• Valium / chronic use may cause liver damage

• Magnesium citrate / only side-effect is diarrhea or loose stools

• Botanicals with NSAIDS.

With serious pain conditions such as bone cancers, severe osteo-proliferative arthritis, and acute disc disease, broad spectrum pain relief can be achieved by combining low doses of NSAIDS and high doses of (safer) botanical extracts for more sustained pain control. Because individual animals differ in pain thresholds doses will have to be monitored and triturated down or up for best results.

The dose of the NSAID drug is lowered by 50-70% and is used in combination with a safe botanical pain formulation.

Lowering the dose of the NSAID will lower the probability of an “adverse event”. The botanicals will diminish pain through different pathways.

Botanical plant extracts such as licorice, ginger, yucca, boswellia, and meadowsweet can be added to eliminate some of the side-effects of long term NSAID use which manifest as ulcerations of the stomach and intestinal tract, or diarrhea,

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Alternatives to NSAIDs? Botanicals: The Gentle Analgesics

Boswellia / Boswellia serrata /Frankincense tree gum

Dried extracts of the resin of the Boswellia serrata tree have been used since antiquity in India to treat inflammatory conditions. Boswellia plant contains anti-inflammatory triterpenoids called boswellic acids and has been in use for many centuries in Ayurvedic medicine.

Effects and Properties

Boswellic acid and its derivatives have the following observed effects:

• anti-inflammatory 5,6

• anti-carcinogenic

• blood lipid lowering

Mechanism of Action

Boswellia reduces inflammation by the inhibition of pro-inflammatory

5-lipoxygenase chemicals therefore decreasing leukotriene synthesis. 2,3,4 Leukotrienes cause pain in the body through chemotaxis, chemokinesis, and the synthesis of superoxide radicals (ROS) and release of lysosomal enzymes by phagocytes (creating more inflammation).

Uses and Indications

Clinical studies have shown effectiveness in the treatment of osteoarthritis 5 asthma 6 and colitis 7. In one study a statistically significant reduction of severity and resolution of typical clinical signs in individual animals, such as intermittent lameness, local pain and stiff gait, were reported after 6 weeks. Boswellia was administered with the regular food at a dose of 400mg/10 kg body weight once daily for 6 weeks. Significant pain reduction was noticed by owners after just 2 weeks of treatment 8.

Mechanism of Action

The anti-inflammatory effects of this plant are due to the presence of salicylaldehyde and methylsalicylates that suppress prostaglandin synthesis. These act synergistically with flavonoids rutin (which inhibits 9-keto-reductase and reduces the pro-inflammatory prostaglandins, 10 and quercitin which inhibits histamine release.

Uses and Indications

Meadowsweet can be an effective botanical in the control of osteoarthritic pain alone, or in conjunction with other botanicals or drugs.

Because of its protective and soothing nature on the mucousal membranes of the digestive tract, meadowsweet can prevent or support the healing of ulcers generated by the use of drugs such as, NSAIDS, phenylbutazone, aspirin, and reserpine. 11

Toxicology

Animal studies on the flowers and the alcoholic and aqueous extracts have suggested that meadowsweet is without toxic effects. 12

Care should be taken when concurrently administering anti-clotting drugs or herbs such as heparin, garlic and high doses of aspirin or phenybutazone.

Dogs with auto-immune disease, Von Willibrands disease and other platelet or clotting disorders should be monitored carefully.

Yucca / Spanish Bayonet / Yucca schidigera, glauca, spp.

Yucca is found commonly in the North American deserts and Western mountain regions of US and Mexico on sandy or limestone hillsides. It has been used for centuries by Native Americans for food, to make soap, and medicine. Internally the roots were used to treat digestive ailments, and arthritis.

Effects & Properties

• Anti-inflammatory 15

• Anti-rheumatic

• Laxative

• Alterative 14

Mechanism of Actions

The active ingredients in yucca are the saponins which are noted for their anti-inflammatory and anti-rheumatic effects. 15

Its beneficial properties may be due to the presence of phytosterols and their influence on corticosteroid hormone metabolism. 16

Saponin’s “detergent effect” helps to increase the solubility of lipophilic molecules via micelle formation. Early research suggests that these saponins will cause the intestinal cell membranes to be more permeable and increase the uptake and assimilation of poorly absorbable nutrients. Yucca has been used in commercial dog foods to improve absorption of nutrients, and as a stool de-odorizer.

Uses and Indications

Yucca is commonly used by herbalists as an anti-inflammatory medicine to treat joint injuries and rheumatoid conditions. 17 When yucca is combined with other herbs such as boswellia and meadowsweet, its synergistic properties provide broad spectrum pain relief.

Toxicology

In high doses may cause intestinal irritation and diarrhea.

Long term feeding of saponins to animals did not demonstrate any signs of toxicity. 18

Ginger / Zingiber officinale

Effects & Properties

• Anti-emetic

• Anti-inflammatory

• Peripheral circulatory stimulant

• Enhances bioavailability

• Anti-spasmodic

• Antixoidant 24,25,26,27,

Mechanism of Actions

Ginger’s anti-inflammatory actions are due to its inhibition of arachidonic acid and the subsequent decreased synthesis of cyclooxygenase and lipoxygenase enzymes of the prostaglandin and leukotriene pathways. 19,20,21

The active gingerols were shown in clinical studies to be more potent prostaglandin inhibitors than indomethacin. 22

Uses and Indications

Ginger was demonstrated to share a prostaglandin synthetase promoting activity with a number of NSAIDs 23 and is an effective anti-inflammatory for the treatment of arthritic conditions.

Ginger may enhance the bioavailability of other medications and is commonly used in combination with other herbs in Traditional Chinese Medicine.

It has anti-emetic properties and can be used instead of drugs such as cimetidine long term without side-effects.

Toxicology

In moderate doses there are no known side-effects. 27 In high doses, ginger should be avoided in obstructive biliary disease.

Licorice Glycyrrhiza glabra

Licorice has been an important member of traditional Chinese herbal pharmacopoeia for 1,000’s of years. This herb was in use in ancient Egypt, Greece, and India. Considered a digestive “tonic”, this root has been also popular in the treatment of respiratory diseases and arthritis.

Effects & Properties

• Anti-inflammatory

• Influences Steroid metabolism

• Antioxidant

• Anti-ulcerogenic/Mucoprotective

• Expectorant

• Immunostimulating

Mechanism of Actions

Key constituents include triterpenoid saponins,glycyrrhetinic acid, sterols and a wide range of flavonoids.

Anti-inflammatory effects were demonstrated in a number of animal models. 29,30,31.

Licorice was found to have similar anti-inflammatory activity to hydrocortisone in experimental arthritis in rat studies. 30

Licorice inhibits corticoid, progesterone, and prostaglandin dehydrogenases. 32.

Potentiates the anti-inflammatory effect of glucocorticoids

Antioxidant effects may be due to the high amount of flavanoids.

Uses and Indications  

• Digestive aid: eases inflammation and tissue damage in the upper digestive tract

• Anti-inflammatory and gastric protectant in combination with aspirin, NSAIDS or potentially irritating botanicals or supplements..

• Cough medicines: facilitates movement of mucus from the respiratory tract

Toxicology

When used in accordance with proper herbal prescribing licorice rarely causes side-effects. Toxicity has been common in humans who over consume licorice candy. Symptoms include peripheral and pulmonary edema, pseudoaldosteronism, hypokalemia and myopathy. Should not be used in pregnancy or lactation.

Conclusions

If clients ask for alternatives, the veterinarian can offer them a safe and effective formulation.

Resources Extra Strength Pain Support helps reduce pain in the joints, muscles, and tendons without fear of serious side-effects. Besides its inflammatory affects inhibiting prostaglandin, leucotriene, 5-lipoxygenase synthesis, and the reduction of Reactive Oxidative Species (free-radicals) it contains ingredients to protect the digestive tract against ulceration that may have occurred with chronic NSAID or aspirin use.

Resources Extra Pain Support is indicated for the pain management of the following conditions:

• Hip and Elbow dysplasia

• Generalized osteo-arthritis

• Spondylosis & back pain

• Chronic disc disease

• Post-operative orthopedic surgery

• Dental pain

• Autoimmune inflammatory joint disease

If animals are currently using NSAIDS, aspirin, or steroids, Resources Extra Pain Support can help reduce the dosage to 30-50% and eventually help you wean animals off the drug medications.

For best results treating chronic osteo-arthritic pain, the addition of antioxidants (Resources: Canine or Feline Antioxidant Support) and sources of glycol-amino-glycans ( Canine Joint Support Plus) will support the repair and regeneration of joint surfaces.

Because botanicals take longer to accumulate in the body and affect the physiology In some cases expect sustained pain relief to occur within 2 weeks. Initially, a higher dose can be initiated which can be reduced to a maintenance level when pain relief is evident.

For best results in pain control for your pets, find a veterinarian experienced in the treatment of arthritis pain who does not depend solely on drugs for pain relief but includes: supplementation, natural diets, exercise, hydro-therapy, and appropriate wholistic treatments such as acupuncture and massage therapy.

Remember:

Pain medications should NOT be used everyday for weeks and weeks. Most safety studies on animals concluded after only 6 weeks. Use drug pain medications only when necessary usually 3 -7 days at a time.

Side-effects of Cox-2 inhibitors (Rimadyl, Deramaxx, Ibuprophen) in animals include: ulcers in the stomach or intestinal lining, vomiting, diarrhea, liver disease, and death.

When in doubt use Boswellia for arthritis pain, or a combination product such as Resources: Extra Strength Pain Support (www.genesispets.com)

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All Creatures Great & Small, Inc.
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©2003 Ihor Basko, DVM

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