​by Dr Chris Piper BVSc MRCVS

​"They are sick that surfeit with too much as they that starve with none." - Shakespeare

This is essentially a discussion on canine dietary requirements although most of it will apply to the cat as well. These two domesticated animals do have very different dietary requirements.

The dog is essentially a carnivore although his association with man over thousands of years has required adaptation to a more omnivorous diet. For a moment consider the diet of the wild African dog. He hunts in a pack and preys on grazing animals - herbivores. The pack competes to eat the most accessible organs - the abdominal contents first, including the stomach and its large quantities of partially digested vegetable matter, then the muscle tissue, and finally the skeleton. They eat the whole animal, which includes a reasonably large proportion of grasses and herbs.

From a holistic perspective it is important that we mimic the "wild" diet using whole foods, unprocessed and unrefined. Organically grown foods are preferable - "Demeter" and "biogro" are symbols of quality certified organic food. Raw fresh food is best, although it is impractical to offer it in quite the same way as in the wild. Prolonged storage, including freezing and refrigeration, will reduce the nutritive value of the food.

If we extend this concept of the "wild" diet it is obvious that cooking is unneccesary. Unfortunately, the idea that cooking is necessary is a myth that persists, encouraged by conflicting opinion amongst veterinarians. However, it is well known that cooking decreases the digestibility (i.e. utilisation) of food by denaturing protein, destroying vitamins, and inactivating enzymes. It is also a major cause of halitosis (bad breath) and flatulence (farting). However, cooking has the advantage of reducing spoilage and therefore extending storage life, and it often improves palatability.

Palatability is the degree of acceptance of a food by the animal, and is improved by the following:

• offering fresh warm food 
• increasing the moisture and fat content
• using animal protein (which is more digestible than vegetable protein),
• using condiments (salt, garlic, onion) 
• ensuring appropriate smell, texture and "mouth feel".

Manufacturers of commercial foods go to great lengths to provide "mouth feel", which can only be described as the sensation which enhances taste and appetite.

It should be clear by now that commercially prepared foods do not meet the requirements of the "wild" diet. Before moving away from cooking, there are two occasions when cooking is useful. It is preferable to cook vegetables and grains as this renders them digestible and mimics the fermentation process which occurs in the multiple stomachs of the herbivore. Alternatively, grains and legumes can be sprouted and fed raw.

As we become more discerning about the food we eat, we should give thought to the food that we provide for our pets. Let's consider the forms of contamination that may affect the food we provide. Generally it is safer to use foods from sources low down in the food chain. Small animals are prey to larger animals. Small animals are lower in the food chain. Large animals will eat large numbers of small animals, thereby concentrating any contaminants in their prey. Concentration of pollutants such as lead, mercury, hormones and antibiotics can occur. Special mention should be made of chlorine and fluorine which are intentional additives to our water supply. I doubt that any consideration was given to our pets when they considered adding these chemicals, especially fluorine. Dogs use panting as a means of heat regulation, and during the hot summer will lose a lot of water from the body through panting. On a comparative body weight basis they drink a lot more water than humans. I am sure this high intake of fluorine affects the health of our animals. By collecting rainwater, allowing animals to drink from natural waterways (preferably running water), and filtering water through reverse osmosis or ion exchange machines, we can help overcome this pollution. Incidentally, the use of aluminium bowls for water or food may lead to excessive intake of aluminium. Stainless steel bowls are recommended.

Commercial foods may contain all or some of the following additives: preservatives, emulsifiers, stabilizers, extenders, humectants, and colourings. How the body battles with this onslaught of chemicals and still remains reasonably healthy is surprising!

Another rule of thumb to remember is that dogs eat to meet their energy needs. If you were to feed a food high in fat, which is a very dense energy food, you would find the animal may not eat very much. In fact, if it is also low in protein your animal may not be ingesting sufficient protein to meet its needs - especially in a growing puppy. Therefore it is important to ensure the balance of protein to energy (fat and carbohydrates) is suited to the particular needs of the animal. A similar problem can arise with bulky foods. Some of these foods which contain a lot of vegetable fibre (which is not very digestible anyway) have a low protein-energy density. The physical size of the dog's stomach is insufficient for the animal to eat enough food to meet its requirements. This arises particularly in the lactating bitch whose demand for food can increase by 300%. During lactation high quality protein, energy dense foods are needed. There are other circumstances when a different balance of protein and energy is required. For growth and late pregnancy a higher proportion of protein is required. The convalescing animal also needs quality protein and readily digestible foods to aid healing. The working dog has obvious needs for extra energy, water and B vitamins.

Sometimes we provide what we think is a very appetizing meal and our pet refuses to eat. Often appetite can be affected by a variety of factors: the surroundings, light, noise, presence or absence of people, or other animals, and the type and cleanliness of food bowls. He may have just returned from scavenging next door and just is not hungry. Hunger is the best stimulant of appetite. Fasting one day each week enables the intestinal tract to rest (and heal) and allows the body to eliminate accumulated wastes/toxins from the body.

Feeding too little will cause a loss of weight but feeding too much will not only cause obesity but may contribute to serious developmental problems as well as diarrhoea. A sudden change in diet may also cause diarrhoea.

Developmental problems in the growing animal are commonly associated with feeding too much protein and mineral/vitamin supplements. The giant breeds are especially vulnerable. Trials using two groups of pups, one group allowed unrestricted food and the other group three quarters of the amount eaten by the first group, showed some interesting differences. The unrestricted group all had bone and joint problems while only 10% of the other group had similar problems. My advice is to keep puppies "lean and hungry looking".

You can also feed too much mineral supplement, or too little depending on the balance of the ingredients of the food used. Perhaps the most important mineral is calcium which is vital for the developments of the skeleton. When the dog eats the whole animal in the wild, the correct balance of bone to meats to organs is achieved. If we feed a high meat diet (which is very common) we need to balance it with additional calcium. There are many calcium supplements on the market to choose from the but the richest source (and cheapest) is calcium carbonate. The best source of course is raw bones. If you are feeding brisket, which includes the bone, it is unnecessary to add extra calcium. There are two occasions when extra calcium is required: firstly, with the all meat diets, and secondly, when you feed cereals and grains, which are high in phytates. Phytates interfere with the uptake of calcium by the body.

Too much calcium will interfere with the absorption of other minerals - iron, copper, zinc and iodine. People who tend to give additional calcium in pregnancy may precipitate birthing problems by inducing a zinc deficiency. Uterine inertia, retained foetus and toxic milk syndrome are thought to be due to zinc deficiency.To confuse things even more, a high protein diet (i.e. all meat) causes a calcium loss through the kidneys. It is important to emphasize again the need for balance, not too little nor too much.

A few comments now on some of the ingredients we consider feeding dogs. Eggs, raw and whole are an excellent source of high quality protein. There is no need to discard or cook the white of egg. There is sufficient biotin in the yolk to saturate the avidin in the white. Some fish contain an enzyme thiaminase which will destroy vitamin B1. Gentle cooking will destroy this enzyme thiaminase. You would need to feed almost exclusively raw fish to induce a B1 deficiency. Milk is considered food for the young although it can remain a valuable supplement for all ages if given in moderate amounts. Too much milk may cause diarrhoea. Some animals are unable to digest lactose in milk, and this may ferment in the lower bowel causing diarrhoea. Watering the milk down 50:50 is often helpful. Too much liver may also lead to diarrhoea. Liver is very "rich" and best given in small amounts.

Although we are almost entirely responsible for providing the food our pets eat I think it is important not to discourage them from foraging for some things themselves. If they chew grass/herbs, let them, providing they are not poisonous. Often they chew grass when unwell. It induces vomiting and helps empty the stomach. If they are garbage gobblers, stealing from neighbours and rubbish bags, they are predisposed to gastrointestinal problems.

If they eat the droppings of other animals (sheep and cattle) it is probably a worthwhile supplement to their diets. When they eat their own it may reflect a behavioural or digestive problem. Incompletely digested food in the droppings may still be palatable.
​
I can hear you say "yuk!" I think it is important not to be anthropomorphic - not to attribute human qualities and tastes to animals. They are "happy" to accept routine feeding and variety is not as important to their appetite as it is to ours. Variety provides the opportunity to provide a wide range of nutrients and reduces the risk of any deficiency. The body is very adaptable and will preferentially absorb nutrients that it is short of.

Somewhere I have mentioned feeding raw bones. Cooked bones are less digestible and often more brittle. Brittle bones may splinters and cause penetration of the bowel. Chop bones and vertebrae are most likely to cause problems. Chicken bones, however, are not the problem they used to be. Today the meat chickens are slaughtered at the tender age of 9 weeks when their bones are still very soft. Old broilers and layers have brittle bones and should be avoided. Bones are not only an excellent source of minerals but they also provide cleaning of the teeth and hours of enjoyable distraction. Cooking fish will cause the flesh to flake from the bones unveiling a sharp and often dangerous weapon.

FOOD PREPARATION
Unless you have the time and motivation to prepare your own balanced diets you could be better off to use commercial foods and supplement these with raw brisket and household scraps.

You can economise by using household scraps (vegetable peelings, cores and left overs) and purchasing ingredients unsuitable for human consumption (bug-infested grain, damaged packets and butcher scraps). Don't use mouldy foods. Buying in bulk is often cheaper although consider the shelf life and possible deterioration of the quality over a long period of time. You can also save time by preparing large quantities which can be stored for a few days in the fridge. Using a pressure cooker (stainless steel) will reduce the cooking time and minimise the damage to the quality of the food.

The protein to energy ration should match the special requirements already mentioned. (growth, lactation, etc.).
Protein : energy (by volume)
75% : 25% - growth, late pregnancy, convalescence
50% : 50% - maintenance
40% : 60% - working

This is a simple guide only and should be discussed with your veterinarian. For simplicity I recommend rotation of the following menu, changing to the next when you have finished your store.

1. Brisket - good for large energetic dogs but may need to have some fat removed for smaller less active dogs. The rib bone is very hard and often is best removed before feeding.
2. Cooked stew
3. Household scraps - add egg or cheese, nuts or tofu to supply the protein. The supplements above can also be added to left over vegetables.
4. Commercial foods - I am reluctant to include this item considering what I have already said about processed foods. However, if you have to compromise it is better to be able to give a balanced diet than not be able to. Try to limit them as much as possible, perhaps to dog biscuits (without colouring). Avoid adding supplements to commercial foods - they already contain them. Don't add rice or other carbohydrates as the protein may not be sufficient.

Meat - beef, mutton (cooked or frozen), fish or chicken. Include small amounts of cooked offal (liver, heart, kidneys, lights, ox cheek, tripe).
Vegs - cereals - brown rice (best), oats, bulgur, millet, potatoes, wholemeal bread or macaroni;
Pumpkin, carrot, peas, beans, garlic and onion as condiments, raw grated carrot and alfalfa sprouts.

Because of the meat (without bone) and cereal content, and additional supplement of calcium is required. The following supplements can be used in this recipe.

​Chris Piper BVSc MRCVS 

SUMMARY 
This paper outlines a holistic treatment for cancer using a whole mistletoe extract (Viscum album L), in combination  with other complementary therapies.

From the holistic perspective, cancer is considered a disease of the whole organism. The integrity of the organism and its homoeostatic mechanism has been overwhelmed by a combination of external insults, deficiency states, disturbances of metabolism, and organ malfunction. The immune system is particularly affected and fails to distinguish between self and non-self  and  cannot differentiate between alien or defective cells and normal cells. The cancerous process is the chaotic and final stage in a progressive sequence of faulty cell development, with neoplasms resulting from reversion to an undifferentiated state, and with progressive liberation from the control mechanisms.

Whole extract of mistletoe counteracts the immunological deficit associated with cancer by enhancing immune function through cytokine-mediated immuno-modulation. Clinical responses to therapy include enhanced well being of patients, slowing down or cessation of tumour growth, regression of tumours, and prolonged survival times.

Helixor® mistletoe preparations are approved for adjunctive treatment of cancer in humans in Germany and in several other countries. The author presents data collected from his experience treating cats and dogs with Helixor® during the last nineteen years.
 
INTRODUCTION 
Biologic therapies, such as mistletoe therapy, are growing in importance for the treatment of humans with cancer, and are used as an adjunct to standard modalities of surgery, radiology and chemotherapy. Paradoxically, conventional therapies are tumour-centred and immunosuppressive, whereas biologic therapies are organism-centred and immunostimulative. However rational and necessary conventional oncological approaches may be, they undeniably impose an additional burden on the already compromised immune system of the cancer patient, thereby exacerbating the existing immunologic deficit. Their benefit is particularly doubtful for patients with metastases or inoperable primary tumours. This paradox imposes a dilemma for the therapist. Conventional therapies such as chemotherapy and radiotherapy may negate the benefits of biologic therapies, however; studies show that biologic therapies can reduce the side effects of these conventional therapies and enhance wellbeing and extend survival time of human patients (1).

Biologic therapies are a rational option in addition to primary oncological therapy to help prevent relapse, metastasis and to support palliative care. The goal of treatment is immuno-modulation, regeneration of healthy tissue, improvement of the quality of life, better tolerance of aggressive conventional therapies, and prolongation of life.

The concept of holistic cancer treatment in humans embraces diet, lifestyle, psychological counselling and biologic therapies. Treatment with whole mistletoe extracts over the last thirty years has developed a reputation as a mainstay in the adjunctive biologic treatment of cancer. Whatever the perspective and approach to cancer treatment is, it is important to be mindful of the insidious nature of cancer and its overt clinical appearance usually months or years after initiation.
 
 CURRENT KNOWLEDGE OF MISTLETOE THERAPY IN HUMAN MEDICINE
 
In 1921 Dr Rudolf Steiner, the founder of anthroposophy and anthroposophic medicine, was the first to give his indications for the use of preparations from the European white-berried mistletoe (Viscum album L) in the treatment of cancer. The efficacy of mistletoe therapy in human medicine is documented in numerous scientific publications and supported by decades of clinical use. A monograph on Viscum album produced by the former Commission C of the German Federal Health Authority (2) summarised its effects as follows:

• Improvement of the general condition and wellbeing in most patients  independent of the effects of the cancer
• inhibition of cancer growth without adverse effects on normal tissues
• Prolongation of survival time. 
• Elevation of body temperature
• Relief of tension and depression
• Mitigation of tumour associated pain

 
HISTORY OF MISTLETOE  (Viscum album, family Loranthacae)
 
The European white-berried mistletoe is one of many plants whose extracts have been used in medicine.  Historically, mistletoe-bearing oaks were holy to the early Germanic tribes.  Their priests, the Druids, wearing white robes, would harvest the mistletoe with a golden sickle, catching it in a white cloth to prevent it touching the earth.  Mistletoe was considered a remedy for all diseases and throughout the Middle Ages was used to treat epilepsy, sterility, high blood pressure and depression.

The extraordinary nature and behaviour of this plant are worthy of mention. The growth of mistletoe defies the expected pattern of plant growth, which, in some ways, is reflected in the unregulated growth of cancer.   It is semi-parasitic, taking only water, mineral salts and traces of organic substances from its host.  Mistletoe cannot grow on the earth nor can it flourish on every tree.  It retains characteristics of both plant and animal, containing the amino acid arginine, which is rarely found in plants, and lacking glutamine and asparagine, which are found in all other plants.  Unlike most plants, it shows no heliotropism or geotropism; that is, it does not grow towards the light nor is there a tendency for the roots to grow towards the centre of the earth. Furthermore, it follows its own seasonal rhythm out of line with other plants, flowering in winter and fruiting in summer.

Other features express its primitive nature. The plant grows by dichotomous branching, does not form bark, the leaves have no upper or lower surface, and do not wither and fall during the first four years.  Chlorophyll is present throughout the plant, even in the areas not exposed to light.  Unlike other plants it germinates in the light and, without displaying a latent period before germination, may begin germinating while still in the berry. It has been described as a survivor of an earlier period (Old Moon Period) in the evolution of the earth when plants, at a stage between our present plants and animals, could live.

Rudolf Steiner, founder of spiritual science in the 1920s, recognised the unusual qualities of this plant. He called it “insane aristocracy”.  He described three formative forces; etheric, astral and ego, which shape the cellular structure of the physical body.  These forces compel the specialisation of cells to constitute the organs of the body, and regulate their functions.  A weakening or disruption of these forces allows cells to escape control and develop “autonomous cellular propagation” (3).  In 1917 Steiner gave an indication for the use of mistletoe in cancer treatment. “The emancipation of the mistletoe from the spatial and chronological order governing its environment can be seen as reflecting the characteristics of tumour cells which rebel against the order governing the function of the organism by liberating themselves from its regulatory processes”.

Helixor® is a non-fermented, whole liquid extract produced from blending four seasonal harvests of mistletoe.  It is unprocessed, and undergoes micro-filtration to achieve sterility.  The four seasonal extracts are blended in an egg-shaped vessel where a vortex has been created by an impeller.  The special whirling process enhances the potency of the extract and is reminiscent of the stirring method used in the preparation of the biodynamic preparations 500 and 501 used in biodynamic farming. There are three kinds of Helixor® corresponding to the three different botanic subspecies of Viscum Album L:

• Helixor® M   from the apple tree, 
• Helixor® A   from the fir tree,                    
• Helixor® P   from the pine tree.

 
The three preparations show some differences in their therapeutic effects as well as their biochemical profiles. Helixor® M induces the greatest reaction (fever and local swelling) and causes the greatest tumour inhibition and inflammatory stimulant effects. Helixor® A shows the  least reaction and is the best tolerated and has the most potent immunoprotective and roborant effect.  Helixor® P comes somewhere in between these two, and is the one preferred by the author. Helixor® is provided in glass ampoules of varying concentrations from HELIXOR Heilmittel GmbH & Co. KG, Germany. There are several other commercial preparations of mistletoe available.
 
BIOLOGIC THERAPY 
Biologic therapy is now regarded by oncologists as the fourth modality after surgery, radiation and chemotherapy.  It refers to those cancer treatments that produce anti-tumour effects by stimulating host defences.  Activation of the host’s reponses occurs through modulation, augmentation and restoration of immune function as well as direct anti-tumour activity. There is also a protective effect on normal cells against the adverse effects of other cancer therapies.

Biologic therapies trigger the immune cascade.  This immune cascade is instigated through phagocytes, natural killer cells, and T and B lymphocytes.  In addition to these cells, a number of lymphokines play an important part in immune activity.  Cytokines such as tumour necrosis factor (TNF α), colony-stimulating factors (G-CSF and GM-CSF), and interleukin-2 (IL2) have all been studied in veterinary oncology (4).

Helixor® has been shown to have an immuno-modulating, anti-mutagenic and immuno-protective action.  Specifically it increases the number and activity of natural killer cells and neutrophils; it induces cytokine release (TNFα, IL1, 2 and 6) (5,6,7); it increases γ interferon (8); it is cytotoxic (in vitro); it has a DNA stabilising effect; it stimulates T cells and the production of GM-CSF (9); it enhances new collagen formation and inhibits collagenase activity of cancer cells; it increases fibroblastic activity which restores matrix (10);  and it protects peripheral blood lymphocytes against chemotherapy-induced mutagenicity and immunosuppression (11).These effects explain many of Helixor’s clinically established effects of fever, leucocytosis, release of CRP and other acute phase proteins, and stimulation of medullary haematopoeisis.  These tumour growth inhibiting effects result in a slowing down or cessation of tumour growth.

A number of biologically active substances in Viscum album have been described (12,13). The predominant constituents are carbohydrates (oligosaccharides and polysaccharides), proteins (lectins), amino acids (especially arginine), and flavenoids. Some constituents have specific effects; however, the whole extract has been shown to be the most effective formulation for cancer therapy.

A combination of mistletoe therapy with radiotherapy or chemotherapy is beneficial. It has been shown that the side effects of nausea, vomiting, bone marrow suppression, and immunosuppression can be reduced by concurrent mistletoe therapy. Moreover, there is less need to interrupt antineoplastic therapy because of bone marrow depression. Studies also show an improvement of quality of life and survival times for human patients treated with a combination of chemotherapy and helixor compared to chemotherapy alone (1).  An increasing number of clinical trials on mistletoe therapy are available to support the efficacy of this cancer treatment. Kienes`s critical analysis showed that four out of six studies confirmed statistically significant results when groups of patients were compared with their respective control groups (14).
 
INDICATIONS  FOR  HELIXOR (in humans) 
Helixor® is indicated in humans for the following situations :

• As an adjunctive and palliative therapy for inoperable solid tumours (carcinoma, sarcoma, melanoma) and systemic malignancies (lymphoma, leukaemia).
• As a preoperative or postoperative therapy to help prevent relapse and metastases.
• Precancerous conditions (cervical intraepithelial myoplasias,chronic hepatitis B and C, ulcerative colitis, intestinal polyps)
• Treatment induced myelosuppression (aplastic anaemia)

 
Contraindications for use are allergic reactions to Helixor® are persistent high fever, severe inflammatory disease, pregnancy, and severe hyperthyroidism. Pronounced allergic reactions are very rare.
 
 
MISTLETOE THERAPY IN CATS AND DOGS
The author has used Helixor® extracts since 1984 for treating cancer in cats and dogs. He has modified the human protocols to suit veterinary medicine and provide ease of use for clients who are responsible for implementing the treatment. Clients give the injections and record daily temperatures at home.
 
CASE SELECTION 
Effective treatment requires a dedicated commitment from veterinarian and client. Careful observation, high motivation, compliance, and willing co-operation from the client are essential to the effectiveness of therapy.  Patients should be selected carefully using the following criteria:

• The general health of the patient and the presence of concurrent debilitating disease and/or paraneoplastic complications.
• The duration of  the cancer prior to presentation.
• Tumour type. Hard tumours appear less responsive and fast growing  anaplastic tumours are often very responsive to treatment.
• Previous treatments such as surgery, radiation, and immunosuppressive drug therapy. The ability of the animal to respond may be compromised by age, immune competence and general debility.
• The site and the size of the tumour.  Large tumours may be less responsive and the site of the tumour may cause physical obstruction or interfere with organ function and mobility.

 
A realistic appraisal should be given at the outset along with any ethical requirement to inform the client of the unorthodox nature of the treatment. The veterinarian should provide caring support, an honest assessment of treatment, and be accessible to the client at all times especially during the first three weeks of treatment. Because it is difficult to predict the progression of this disease and the individual’s response to treatment, it is important to maintain close communication with the client and provide frequent assessment of the patient to ensure that the quality of life of the patient is protected.
 
 
TREATMENT PROTOCOL 
Treatment commences with daily subcutaneous injections starting with 1.25mg and increasing in 1.25-2.5mg increments until a reaction occurs. The author uses either 50 unit (0.5cc) or 100 unit (1cc) insulin syringes to aspirate the contents of a 100mg ampoule (2cc) of Helixor® P. Alternatively, the contents of an ampoule can be transferred to a 3cc vaccutainer without additive (yellow top) or an empty vaccine diluent vial, which must then be stored in the fridge. The daily dose can be aspirated from the vial. The appearance of flocculent material is indicative of fungal contamination and the contents should be discarded.

Injections are given subcutaneously on both sides of the body between the neck and costal arch. Injection sites are rotated to avoid giving injections in the same place twice. These sites are chosen for ease of administration; however, it is often preferable to inject as close as possible to the tumour and may, in some cases, be more beneficial to inject into the tumour. Marking the site of injection by marking the fur with a felt-tipped pen helps identify where injections have been given.

The reaction manifests as a fever and/or a localised swelling at the site of injection, and the animal may also show malaise and inappetence.  At the onset of these symptoms, assuming that they are related to the therapy and are not paraneoplastic in origin, the dose is kept the same as the previous one until these signs abate.  If the fever is marked (>39.5°C) or lethargy persists, no further injections are given until the fever abates and demeanour improves. By constantly measuring rectal temperature in the morning and evening and recording it graphically, a pattern of response can be observed.  The fever response can be detected several hours after injection and usually peaks around eight hours after the injection, but may persist for more than twelve hours.

If the temperature in the evening is elevated (>39°C), the dose the following morning remains the same as the previous morning. If the temperature in the evening is normal, then the dose the next morning is increased. If the temperature on the following morning, twenty four hours after the injection, remains elevated (>39°C), then no injection should be given that day. The peak fever can vary by several hours for individual animals.  This fever response normally occurs at a dose of 2.5mg-5mg and may persist for two weeks until the dose has reached 10-15mg. The degree and duration of the fever, in association with the clinical demeanour of the patient, are the main parameters used to determine the progression of treatment. A persistent fever may reflect another cause, either a paraneoplastic condition, tumour necrosis or some other concurrent disease. During the reactive phase some loss of body weight may occur. Appetite and demeanour may be significantly enhanced following this phase.  Once the reaction to injections has ceased, the dose is then increased by 5mg increments until a dose of 50mg has been achieved. The reactive phase seldom lasts longer than 2-3 weeks and it is during this time (a window of opportunity) that the immune cascade is best stimulated.

Concurrent drug treatment may affect the development of a fever response. Non steroidal anti-inflammatory drugs are effective anti-pyretics and corticosteroids may also interfere with the therapeutic benefit. It is advisable to stop this medication if possible, at least for the first 2-3 weeks during the reactive phase.

Once a dose of 50mg has been achieved a rhythmic dose sequence is instituted.   The frequency of injections is reduced to every two or three days, and the dose is rotated from 50mg to 75mg to 100mg and repeated. Following several cycles, and depending on the response to therapy and the malignancy of the tumour/s, the frequency of injections is reduced to weekly, then to monthly, with the dose being maintained between 50mg and 100mg.
                                                                                                                                                        
ADJUNCTIVE SUPPORT
It is helpful to provide additional support for the body, especially during the reactive phase, as this protects against free radical damage and encourages immune modulation. This is particularly important when concurrent chemotherapy is used. The author uses a comprehensive antioxidant formula, high levels of vitamin C, and a mushroom extract.

Dietary advice includes the use of a high protein, high fat and low carbohydrate foods preferably prepared at home from fresh raw meat and cooked or raw coloured vegetables (carrot, beetroot, broccoli, beans, pumpkin). Cold pressed oil can be used to increase the fat content of food (flax oil 5cc/10kg). Other modalities such as homoeopathy, acupuncture, herbal remedies and nutraceuticals can also be used.
 
MONITORING  TREATMENT
In addition to measuring daily rectal temperature, local skin reaction and general demeanour, the monitoring of haematological indices is valuable. A complete blood count will often show a moderate leucocytosis with a left shift.

The rate at which the dose can be increased and the frequency at which injections can be given is determined by;

• The degree of fever and local reaction
• The tumour size; the rate of tumour growth and tumour malignancy
• The animal’s health; any debilitating, paraneoplastic or concurrent disease.

 
A local swelling greater than 4cm in diameter or a fever over 39.5°C is excessive. Where there are prolonged and debilitating reactions and/or large local swellings over the injection sites, the following options can be considered:

• Reduce the incremental dose from 2.5mg to 1.25mg
• Miss a day or give injections every second or third day
• Change from Helixor® P to Helixor® A. Once the reactive phase is over Helixor® P can then be substituted.

 
These side effects of Helixor® treatment constitute an excessive manifestation of the desired inflammatory and immunostimulatory effect, and can be controlled by adjusting the dose and frequency of injections. Local subcutaneous swelling is indicative of delayed cellular responses and shows that the immune system is responding. A fever is an indirect indication of the release of interleukin-1 from macrophages, marking the start of the immune cascade. Occasionally there may be regional lymph node enlargement. Clients may regard these local reactions as debilitating for their animal; however, if they are made aware of what to expect, that the response to treatment is evidence of efficacy, and that the reaction is transient and should not last longer than 2-3 weeks, then most are willing to persevere.
The response to Helixor® therapy is primarily dependent on the patient’s capacity for mustering an immune response. While there may be some direct effect on the tumour it is the stimulation of immunological, regulatory and regenerative processes that constitutes the main benefit of therapy. Significant individual differences in response and course of disease necessitate individualised treatment regimens.

Where an allergic reaction occurs, seen as generalised urticaria or persistent swelling at the injection site for more than two weeks, then desensitisation should be instituted. Desensitisation using Helixor® A in minute doses of 0.1mg should be given twice weekly until there is no appreciable skin swelling. To date the author has not seen any allergic reactions. Surveillance using radiography, sonography and digital palpation are useful for monitoring response to treatment. Where appropriate, callipers can be used to directly measure the size of superficial tumours.

The duration of treatment is variable and depends on:

• Other concurrent therapy being used
• The presence of secondaries
• The prior use of surgery and whether it was successful
  
• The malignancy of the tumour
• The degree of tumour reduction seen since treatment commenced

                                               
Where surgery has succeeded in complete removal of the tumour or tumours and there has been no recurrence, treatment may stop after twelve months. Where there has been incomplete surgical excision, tumour recurrence or continued growth, high malignancy or the presence of secondaries, then Helixor® treatment should be maintained indefinitely.

As well as the effect Helixor® has on the tumour it is important to recognise the benefits of enhanced well being. Patients often show improved appetite and demeanour and take up activities that they have not displayed for some time, such as chasing the ball or barking at visitors. Amelioration of the symptoms of concurrent diseases such as arthritis and dermatitis may also occur.
 
CASE REPORT  - LIVER CARCINOMA IN A CAT
On the 16th October 1985 a 3cm diameter palpable liver tumour was diagnosed in Candy, a 13 year old cat. Candy’s liver enzymes were elevated and weight loss and polydypsia were evident. Treatment with Helixor® A began on the 16th October 1985 commencing with a dose of 2.5mg and increased daily by increments of 2.5mg. When a dose of 50mg was reached the frequency of injections was reduced to every second or third day. Concurrent supportive treatment with the antioxidant selenium ACE and the homoeopathic remedy lycopodium was given. The owner administered a fresh extract of aloe vera regularly.  After 2 weeks the cat’s appetite was good and no increase in tumour size was palpable.

On the 13th November 1985, one month after commencing treatment, no hepatic mass could be palpated. The dose at this stage was 12.5mg. The tumour was again palpable on the 16th December 1985 but despite this Candy was in good health. On the 30th December 1985, the cat was operated on for the removal of a gastric furball. Observation of the tumour at surgery determined that it was inoperable and the prognosis was poor. The tumour continued to grow over the following four months reaching 4cm in diameter.

A year later in December 1986 Candy was again operated on to remove a gastric furball. A cystic 6cm mass was removed from the liver at the same time and was confirmed histologically as a hepatocellular carcinoma. Histologically there was extensive necrosis, vacuolation and degeneration with a mild to moderate host immune response.  Multiple liver secondaries were also observed at this time.  Extensive invasion of the portal fissure was observed and an extremely poor    prognosis given.  Helixor® was maintained at 50mg fortnightly and Candy`s condition remained surprisingly stable.  No tumour was palpated in October 1988 but by February 1990 the tumour had regrown. The tumour continued to grow slowly over the following eight months during which time Candy received 50mg Helixor® every month. The frequency was increased to weekly but by the end of January 1991 the tumour had increased further in size. Candy died peacefully at home on the 10th February 1991 at the age of 18½ years of age, five and a half years after the diagnosis and commencement of Helixor® therapy.                                                   
 
 REFERENCES
1.         Grossarth-Maticek,R.: Use of Iscador, an Extract of European Mistletoe, in Cancer Treatment: Prospective Non Randomised and Randomised Matched-Pair studies nested within a Cohort Study. Alternative Therapies, May/June 2001. vol. 7, No.3 57-74
 
2.         Drugs Review Committee C of the German Federal Health Office 04.06 1986: Monograph Viscum Album. Bundesanzeiger Nr. 99a, 38
 
3.         Leroi,R.  MD.: ‘An Anthroposophical Approach to Cancer’.  Mercury Press, Spring Valley, NY.
 
4.         MacEwen,E.,  Helfand,S: Recent Advances in the biologic therapy of cancer. Compend Contin Educ Pract Vet vol.15, No. 7 July 1993, 909-918
 
5.         Franz,H.: Further biological activities of ML and its isolated chains. Advances in Lectin Research Vol.2, 1989, 48-59
 
6.         Hajto,T.et al.: Increased secretion of tumour necrosis factor alpha, interleukin 1, and interleukin 6 by human mononuclear cells exposed to beta-galactoside.specific lectin from clinically applied mistletoe extract. Cancer Research 50, 1990, 3322-23326
 
7.         Männel,D. et al.: Cancer Immunology. Immunotherapy.33, 1991
 
8.         Muller,E.A., Anderer,F.A.:  A Viscum album oligosaccharide activating human natural cytotoxicity is an interferon-gamma-inducer. Cancer  Immunologyl. Immunotherapy.32, 1990, 221-227
 
9.         Schultze,J.L. et al.: Demonstration of specifically sensitized lymphocytes in patient treated with an aqueous mistletoe extract (Viscum Album L). Klinische Wochenschrift 69, 1991, 397-403
 
10.        Heine,H.: Mistletoe preparations (Viscum Album L). Effects on human  tumour tissue in vitro. Zeitschrift fur Phytotherapie 3, 1985, 67-72
 
11.        Bussing,A. et al.: Viscum album L . Extracts reduce sister chromatid exchanges in cultured peripheral blood mononuclear cells.  European Journal of Cancer 30A (12), 1994, 1836-1841
 
12.        Ribéreau-Gayon,G. et al.: The proteins,alkaloids and polysaccharides of mistletoe (Viscum album).Therapeutikon 3, 1989, 22-26
 
13.        Franz,H.: Ingredients of mistletoe as potential drugs.Pharmazie 40(2), 1985, 97-104
 
14         Kiene,H.: Clinical Studies on Mistletoe Therapy of Carcinomatous Diseases. Therapeutikon 3 (6), 1989, 347-353

by Dr Chris Piper

Arthritis is a very common and often progressive disease of companion animals, especially of dogs. While arthritis is strictly a degenerative and often inflammatory disease of joints, the clinical syndrome is, from my perspective, a disease of the whole body, and affecting part or the whole of the locomotory system. Systemic disease will often impact on the locomotory apparatus. When viewed this way, an integrated approach, which considers the broadest picture, becomes relevant. If we can understand the way arthritis is emerging as a clinical entity, and further elucidate its pathogenesis, we may provide more opportunities to prevent or slow down the progression of this disease. This is an outline of a comprehensive approach to locomotor disease.

INTEGRATIVE MEDICINE is a development of medicine using the widest holistic perspective for the diagnosis, prevention, and treatment of disease. This approach is currently limited by the skills and knowledge of individual practitioners, and the willingness of owners to use this approach. Holism is defined as the integration of the parts for the benefit of the whole - a synergistic effect. It acknowledges the whole organism as an integrated unit. Historically the development of alternative medicine implied something other than the conventional. Integrative medicine acknowledges the use of conventional medicine as part of the approach. The gap between the two has been narrowing slowly over the last 20 years.

OSTEOARTHRITIS (DJD) is a degenerative disorder of moveable joints, especially the weight-bearing joints, characterised by destruction of the articular cartilage and by formation of new bone at the articular margins. This is a narrow definition describing only the physical changes. In my view, it is a complex clinical entity requiring a comprehensive approach. It may affect all or part of the locomotory system and may be discrete or generalised, affecting one or more joints. It may be the result of anatomical, biochemical, metabolic, or physiological factors, or a combination of some or all of these factors. It is a slowly progressive disease amenable to preventive and therapeutic intervention.

The LOCOMOTORY SYSTEM (musculoskeletal system) is composed of bone, ligament, tendon, capsule, cartilage, synovia, and muscle. The performance of this system is dependent on the proper anatomy and functioning of all of these structures. Stress on one or more of these structures will impact on the rest, leading to the development of disease. In addition to joint disease there may also be bursitis, tendinitis, spondylitis, muscle wasting and weakness, and stretching and thickening of joint capsule. In my opinion, ankylosing spondylitis plays a significant part in the clinical syndrome seen in old dogs. The locomotory system is highly integrated with the cardiovascular, respiratory, neurologic, haemolymphatic, endocrine, and digestive systems. Primary disorders of any of these interrelated systems may produce symptoms directly related to the musculoskeletal system.

The SYNOVIAL JOINT is composed of two opposing articular surfaces lined with cartilage, which is attached to the underlying trabecular bone, and held in correct alignment by ligaments and capsule. The joint capsule envelops the joint and produces and contains the joint fluid, which lubricates the joint, and provides nutrition to the cartilage.

CARTILAGE is an avascular connective tissue composed of two elements - chondrocytes (5%) and extracellular matrix (95%). The chondrocytes produce and maintain the matrix and in turn the matrix provides support and nutrition for the chondrocytes. The matrix is composed of proteoglycan aggregates woven with collagen to form an elastic and compressible structure. The proteoglycans are composed of glycosaminoglycans (GAGs) attached to a core protein, forming a bottlebrush structure. The GAGs are mostly chondroitin-4-sulphate, and lesser amounts of chondroitin-6-sulphate and keratan sulphate. The chondroitins are long chain mucopolysaccharides built from repeating disaccharide units of glucuronic acid and galactosamine sulphate. The precusor for these disaccharides is glucosamine, an amino-monosaccharide, formed from glucose and an amino acid.

The PATHOGENESIS of DJD appears to be associated with a multitude of factors including abnormal loading forces on the joint, trauma, instability, degradation and loss of the cartilage matrix, nutritional imbalances, aging, and predisposing genetic and developmental (dysplastic) factors.

At the anatomical level there is initially a softening (chondromalacia) of cartilage, a loss of elasticity, and roughening of the surface. Later on there is loss of cartilage with fibrillation, cracking, and erosion. The underlying subchondral bone becomes sclerotic from mechanical pressure or the reaction to leakage of synovial fluid. The joint capsule thickens and the synovial surface develops a granular surface resulting in changes to the synovial fluid. Early on there is osteophyte development at the articular margins. The degree of synovial inflammation is variable. This may help explain the poor correlation between anatomical changes and the degree of immobility observed clinically.

At the biochemical level there is a normal turnover of cartilage with a fine balance between the degradation and production of cartilage matrix. If this balance is upset there is an overall loss of cartilage. It appears that chondrocytes release a cascade of catabolic cytokines, leukotrienes, and prostaglandin derivatives which trigger an inflammatory response. In addition, these cytokins induce the release of lytic enzymes, including metalloproteinases, which degrade collagen and proteoglycans. Simultaneously, normal matrix synthesis is inhibited. These events result in a reduced amount of GAGs and collagen, a loss of binding between them, and as a result there is an increase in the amount of water in the matrix. These biochemical changes decrease the tensile strength and resilience of the matrix, and prevent it from functioning normally in transmitting forces, supporting chondrocytes, and protecting the subchondral bone. As a result there is further damage to chondrocytes and a vicious circle ensues. The disease progresses inexorably with the sloughing of cartilage, proliferation and micro-fractures of subchondral bone, formation of bone cysts and osteophytes, fibrosis of the capsule, joint effusion (loss of viscosity of the fluid and nutrient carrying capacity), and the production of joint mice. The clinical result is pain, deformity, swelling and reduced mobility.

At the metabolic level there are many nutritional factors which affect the biochemical processes described above. Since articular cartilage is avascular, it depends upon synovial fluid as a source of nutrition, and for the disposal of metabolic wastes. Nutritional excesses or deficiencies will affect the normal development and maintenance of the locomotor system. The provision of nutrients to the joint may be influenced by other organ function:

• Liver - carbohydrate metabolism and detoxification
  
• Circulation - perfusion of nutrients to the synovia and subchondral bone
  
• Pancreas - digestion and glucose metabolism
  
• Gut - absorption of nutrients (lectins)

The production of free oxygen radicals(FOS) causes tissue damage, reduces synovial fluid viscosity, and promotes inflammation. There is damage to proteins, lipids, GAGs, and proteoglycans. The provision of adequate anti-oxidants will minimise this damage.


CHONDROPROTECTIVE AGENTS have the following attributes:

• Support chondrocyte synthesis of collagen and proteoglycans in matrix
• Support production of hyaluronans in joint fluid
• Inhibit cartilage degradation enzymes
• Prevent fibrin formation in synovial fluid and plaque formation in subchondral blood vessels.

Compounds that exhibit some of these characteristics are the endogenous components of articular cartilage - hyaluronic acid, glucosamine, and chondroitin sulphate.

EXAMINATION AND DIAGNOSIS are best helped by observing the animal walking, trotting, and running, and provides information on gait and visible lameness. Turning in decreasing circles and climbing steps may accentuate abnormalities. Simply watching the animal sit and stand can provide useful information. Stiffness upon rising appears to be due to changes in elasticity of peri-articular structures.

A good history will reveal how the lameness is affected by exercise, rest, the conditions where it is better or worse, time of day, changes in weather, the activities the patient is unwilling to do (climbing stairs, jumping into the car), and whether it is acute or chronic in onset.

Careful manipulation may elicit areas of tenderness within muscle, ligaments, bones, tendons and joints. Rotating joints through their full range of movements helps determine joint function and the presence of pain. Loss of joint range of motion may be due to joint surface incongruity, muscle spasm and contracture, capsular contraction, or mechanical block from osteophytes or joint mice. The presence of bilateral or multi-joint disease is suggestive of a more systemic problem.

Palpation will reveal joint changes (effusion, capsule thickening), conformation, crepitus, muscle wasting, instability (luxation, ligament rupture), and deformity. 

A neurological examination may be warranted. Further diagnostic tests may include radiology, joint fluid cytology, and blood analysis. There is a poor correlation between the degree of lameness and radiographic changes.The older, large breed dogs, are those most commonly affected.

THERAPEUTIC OPTIONS
The main objectives of therapy are relief of pain, restoration of joint function, correction of any underlying structural problem, prevention of avoidable disability or progression of the disease, and attention to any systemic disease. From the discussion on pathogenesis the focus on treatment is the restoration of balance. Prevention may prove to be the best management tool we have.
The use of several of the options below provides the basis for an integrated approach.

* provision of essential nutrients - diet - balance (Ca and protein)

• supplements (chondroprotectives)
• phytonutrients(herbs) - lectins
• anti-oxidants (free radical scavengers)

* lifestyle management - weight control exercise - swimming

• rest support - strapping/immobilisation
• heat or cold compresses

*manipulative therapy - physiotherapy osteopathy - craniosacral manipulation

• chiropractic

*drugs - anti-inflammatory - steroidal/ non-steroidal (destroy cartilage, loss of proteoglycans, inhibit

• hondroitins, gut erosion)
• inhibitors of MMPs
  
• analgesics
  
• slow acting drugs (SAARDS) - injectable/oral
  
• polysulphated GAGs
  
• sodium hyaluronate

* holistic - acupuncture

• homoeopathy
  
• organ support - liver detoxification/bowel cleansing/insulin balance

*surgery - joint irrigation/ ligament repair/ correction of deformity/ debridement of osteophytes and removal of joint mice/prostheses/ muscle release (pectinectomy)/ arthrodesis/ arthroplasty/ wedge osteotomy/ amputation/ neurectomy

PERSONAL APPROACH

• natural diet - mimic the wild diet - fresh/raw/balance/prevention white meats-minced bone/cartilage
• homoeopathy/acupuncture
• supplements - supply nutrients, anti-oxidants, and anti-inflammatory agents
• EFAs and herbs
• judicious use of drugs – steroids/NSAIDs
• surgery
• treatment of concurrent disease - eg diabetes, Addisons, SLE, hypercalcaemia, hypothyroidism.
• Nutraceuticals. A nutraceutical source of type II collagen, hydroxyappatite, fatty acids, botanicals, amino acids, GAGs (chondroitins), glucosamine, trace elements, minerals, and vitamins. These nutrients are best sourced from whole animal extracts which have been carefully processed by freeze drying to minimise nutrient damage. This combination provides a broad range of nutrients with inherent natural balance.

Shark cartilage provides 7-12% GAGs and bovine tracheal cartilage 20-28% GAGs. Contrary to popular opinion green lipped muscle only contributes 2-3% of GAGs. The variation in GAGs depends on the age and species used.

There appears to be a link between angiogenesis and the progression of OA. The anti-angiogenetic effect of shark cartilage may prevent the vascularisation and degradation of cartilage and block the progression of disease. Much of the effect of green lipped mussel may be due to a glycogen component.

​CONCLUSION
This approach addresses the whole locomotor system and considers the impact of systemic disease. Treatment is primarily focused on prevention - mostly through sound nutrition. Where there is significant pathology, the aim is to supply additional nutrients including chondroprotective, anti-inflammatory, and anti-oxidant agents.


REFERENCES
​Recent Advances in Non-Steroidal Anti-Inflammatory Therapy in Small Animals. Paris, June 11-13 1999.
Clinical Review, Vol 1. No 1. September 1998
Complementary and Alternative Veterinary Medicine - Principles and Practice. Schoen & Wynn.
Oral Chondroprotective Agents. Parts I & II. Compendium Vol. 21, No. 9 July & September 1999.
Glucosamine Salts and Chondroitin Sulfates. Luke R. Bucci, Townsend Letter for Doctors, January 1994.
Treating Osteoarthritis with Chondroprotective Agents. David S. Hungerford, MD. Professor, Orthopaedic Surgery, John Hopkins University, Baltimore.
Current Concepts in the Treatment of Degenerative Joint Disease. The Compendium Vol. 13, No. 9, North American Edition, September 1991
Handbook of Small Animal Orthopedics and Fracture Repair. Brinker et al.
The Merck Veterinary Manual.Handbook of Small Animal Practice. Second Edition.
Morgan.Joint Relief Handbook. Great & Small - Animal Health Limited.

by Chris Piper BVSc MRCVS
GENERAL INSTRUCTIONS
tbsp = tablespoon
C = cup
tsp = teaspoon
RICE - Use wholegrain rice (brown). One cup dry rice will make 3 cups cooked rice. To cook, mix 1 cup dry rice with 2-2½ cups water, bring to boil and turn down to barely simmer with the lid on. After 20-30 minutes the water should be absorbed completely by the swollen grain.
VEGETABLES - Where a recipe calls for vegetables use a combination of seasonal vegetables - carrots, broccoli, pumpkin, peas, beans. Don't use leafy vegetables like cabbage. Cook quickly until tender, preferably by steaming, to retain goodness and improve digestibility. Use the liquid they are cooked in.
COOKING - There is no law requiring offal to be cooked. We recommend cooking minced chicken. Cooking vegetables improves digestibility, although small amounts of raw grated or pureed vegetables can be used. Try to feed most other food raw.
SUPPLEMENTS - KY supplement, available from the clinic, contains yeast, kelp, alfalfa, calcium, flax seed fibre and liver powders and is added roughly 1 tsp per 10 kg bodyweight just before feeding. Growth supplement contains calcium, hydroxyapatite, yeast, alfalfa, liver and kelp and is added 1 tsp per 10 kg body weight (or per 200 g meat).
OIL - use cold pressed oil (flax, sunflower, safflower) at a rate of 1 tsp per 5-10 kg bodyweight.
QUANTITIES - Most recipes are balanced to meet the needs of your average animal unless otherwise stated.
The following table gives a rough guide:
Cat's weight (kg)       quantity         Dog's weight (kg)       quantity
2-3                             2/3 cup                     2.5                        1/4 cup
3-4                             3/4                               5                           1/2
4-5                              1                                 10                           1
>5                                1                                 20                         1 1/2
                                                                      25                            2
                                                                      30                            3
                                                                      40                            4
                                                                      50                            5
   
Remember animals eat to satisfy their energy needs, so if you give lots of vegetables without sufficient protein (meat, eggs, cheese) then they may lose muscle weight. The more active your pet is, the more you need to feed.

BASIC RECIPE - Below are three protein/energy combinations to meet the different needs of dogs. Select your animal's needs from the following list: Feed roughly 1 cup/10kg body weight.
Basic - Inactive adults
Meaty - growing puppies, late pregnancy, convalescence, cats
Reducing - Overweight, constipation.

INGREDIENTS                                    BASIC                                    MEATY                                       REDUCING
Rice and Veg (cooked)                     2 C (2/3 C uncooked)            1 C (1/3 C uncooked)                 1 C (1/3 C uncooked)
Meat                                                  1/2 C (125gm)                          3/4 C (200gm)                            1/2 C or 1 egg
Offal (liver)                                       1/4 C (75gm)                            1/4 C                                             1/4 C
Oil                                                      2 tsp                                        2 tsp                                              1 tsp
Supplement (KY or Growth)           2 tsp                                        2 tsp                                             1 tsp + 1 C bran or broccoli

CAT RECIPES
DAIRY DELIGHT
1 tsp oil1 medium egg
1/3 C cooked brown rice
1/2 C cottage cheese
1 tsp grated/chopped veg
1 tsp KY/growth supplement
Add oil to warm pan. Scramble egg and supplements lightly, then mix in the rest of the ingredients. Warm slightly. Serve.

FISHY CAT MEAL
500g lightly poached fish (or 425g tin mackerel)
¼ C cooked mashed veges
1-1 ½ C cooked brown rice (kittens 1 C)
1 tsp cold pressed oil
2 tsp supplement (adults KY, kittens growth supplement)
Mix, warm and serve. Makes 3 meals.

CHICKEN COMBO
1 whole chicken
1 C chopped pumpkin
1 to 1 1/2 C uncooked brown rice
Place rice and pumpkin in pressure cooker or pot and add 3-4 ½ C water. Place chicken on top and cook. Allow to cool and remove meat from chicken and mix into rice/pumpkin. Add KY/growth supplement to each serving.

FELINE FATTY MEAT MENU
¼ C cooked brown rice
1/3 C raw beef/mutton mince
2 tbsp grated/chopped veges
1/3 C cottage cheese
1 tsp oil1 tsp KY/growth supplement
Warm up the rice in a saucepan, adding the meat and vegetables if they are to be cooked. Mix in the cottage cheese and supplements and serve. Yield: about 1 cup.

LEAN MEAT 'N' EGGS FOR CATS
2 medium eggs
¼ C organ or lean meat
½ C cooked brown rice
1 tbsp grated or chopped veges
1 tsp KY/growth supplement
If you cook the eggs, scramble them first with the supplements (and meat, if you cook it). Add the other ingredients and serve.

KIDNEY DIETS

FELINE KIDNEY DIET NO. 1
1 large egg
¼ C lean or organ meat
½ C cooked brown rice
1 tbsp grated veges
1 tsp oil
 tsp KY supplement
Simply combine the ingredients and serve.

CANINE KIDNEY DIET NO. 1
2 medium eggs
½ C lean or organ meat
2 C cooked barley or brown rice
1 tsp KY supplement
2 tbsp parsnip or other veg1 tbsp honey vegetable, grated
Mix the first four ingredients as the main ration. Roll the parsnip and honey into balls and feed as a treat. Yield: about 2 ½ cups

FELINE KIDNEY DIET No. 2
¼ C beef mince
¼ C cooked barley or brown rice
¼ C kidney/azuki beans
2 tbsp cottage cheese
½ tsp KY supplement
1 tbsp chopped parsley or other veg
Combine the ingredients and serve. Yield: about 1 cup.

CANINE KIDNEY DIET NO. 2
1/3C beef or mutton mince
1/3C cooked kidney/azuki beans
1 ¾ C cooked barley or brown rice
1 tbsp non-fat powdered milk
¼ C chopped vegetables (or 1/3C skim milk)
1 tsp KY supplement
Combine the ingredients and serve. Yield: about 3 cups.

WEIGHT PROBLEM DIETS
WEIGHT LOSS DIET FOR CATS
½ C lean meat
1/3 C cooked oatmeal
2 tbsp grated/chopped veges
2 tbsp bran
½ tsp KY supplement
Mix ingredients together and serve slightly warm. Yield: about I cup.

WEIGHT LOSS DIET FOR DOGS
½ C lean meat
¼ C cottage cheese
1 C cooked oatmeal
½ C grated/chopped veges
½ C bran 1 tsp KY supplement
Mix ingredients together and serve slightly warm. Yield: about 2 ¾ cups



DOG RECIPES
VAL'S LOAF
1 C beef mince
1 C cooked veges
2 C cooked rice
1 C rolled oats
1 C rye flakes
3 raw eggs1 tsp KY/growth supplement
Mix all ingredients and store in frig.
WOFFAL
1 C beef mince
½ C liver or kidneys
4 C cooked rice
1 tsp KY/growth supplement
Cook meat and rice. Cool, and add supplement.
LENTIL LOAF
3 C water/stock
1 C lentils2 C rolled oats
¼ C soy flour
¼ C oil
1-2 beaten eggs
1 clove garlic, minced
1 small onion, chopped
1 tsp KY/growth supplement
¼ C tomato sauce
Slowly add lentils to boiling water/stock and simmer 20 mins. Add oats and soy floor and let soak 10 mins. Mix in rest of ingredients and turn into loaf pan. Bake at 350 F for 30 mins.

CANINE DELIGHT
1 C chicken mince, cooked
¼ C cooked mashed veges (pumpkin, kumara, peas, carrots, beans)
2 C cooked brown rice/potatoes/wholemeal bread
1 tsp cold pressed oil
¼ C cooked ox liver
2 tsp KY/growth supplement
Mix ingredients together. (Sufficient for large dog - 30Kg.)

FAST FISH
425g can mackerel or sardines
1/2 C raw sprouts2 carrots, raw, grated
3 C cooked rice or wholemeal bread
1 tsp KY/growth supplement
Mix together and serve.

DAILY DUO FOR DOGS
1 ½ C cooked oatmeal
1 C whole milk1 tsp honey
Morning: serve as a hot cereal.
1 C chopped cooked potatoes
2 ½ C lean beef
1 tsp oil1 tbsp grated/chopped veges
1 tsp KY/growth supplement
Evening: Combine and serve warm. Yield: about 4 cups.

CANINE MEAT 'N' GRAIN BULK MENU
12 C cooked brown rice
2 C mutton flap
2 C lean meat
1 ½ C grated/chopped veges
6 tsp KY/growth supplement
Mix and serve warm. Suitable for freezing. Yield: about 18 cups.

POTATOES AU CANINE
3 C boiled, sliced potatoes
½ C cottage cheese
1 tbsp food yeast
¼ C whole milk
¼ C grated cheese
2 tsp KY/growth supplement
2 tsp grated/chopped veges
Layer together the potatoes cottage cheese, yeast and supplements in a casserole dish. Pour milk over them and top with grated cheese. Broil or bake until cheese is melted and slightly brown (about 15 mins at 350°F). Let cool. Mix veges in or serve on side.

PUPPY CEREAL AND EGGS
1 C cooked oatmeal
1 tbsp soy protein isolate
1 C whole milk
2 tsp honey
Morning: serve as a hot cereal.
4 medium eggs
¼ C grated/chopped veges
1 tsp growth supplement
Evening: Scramble together and serve.

BRISKET FEAST
5OOg raw fresh brisket.
Serves a large dog. This is the quickest and easiest balanced meal to serve. Bone provides chewing exercise - it is best to remove the rib bone as it is very hard.

VEGETARIAN TWO-MEAL PLAN
1 ½ C cooked oatmeal
1 C whole milk
1 tsp honey
Morning: serve as a hot cereal.
2 medium eggs
1/2 C tofu1 tsp KY/growth supplement
2 tbsp grated/chopped veges
1 1/2 C cooked brown rice
Evening: scramble together the eggs and tofu. Add the rest of the ingredients and serve. Yield: about 2¾ cups.

MILK REPLACEMENT FORMULA (for young puppies)
1 C homogenised milk (or goats milk)
1 egg yolk1 tsp milk powder
1 tsp food yeast
Blend together and store in fridge. Warm to blood temperature (37°C) before feeding. Give 1 ml per 30g bodyweight every 2-3 hours.

CONVALESCENCE, MALNOURISHMENT, YOUNG PUPPIES, NURSING BITCHES, OLD AGE
HEARTY CANINE COMBO
4 medium eggs
½ C beef/mutton (or 8 oz tofu and 2/3C cottage cheese)
1 C cooked brown rice
¼ C grated/chopped veges
1 tsp KY/growth supplement
Scramble eggs lightly with supplements and meat. Mix together and serve warm. Add rice and veges and serve.

DOG'S DELlGHT
¾ C mutton flap (Or 5 medium eggs, and 1 tsp oil)
¾ C cooked brown rice
¼ C cottage cheese
¼ C grated/chopped veges
2 tsp marmite1 tsp KY/growth supplement
Scramble eggs lightly with supplements and meat. Mix together and serve warm. Add the rice and vegetables and serve.

BISCUITS
WHEAT OR RYE CRISPS
1 C whole wheat or rye flour
¼ C rice flour3 tbsp oil or lard
1/3C water
½ tsp growth supplement
Mix flours. Mix oil/lard with water. Add liquid to lard and mix well. Roll out on oven tray and cook until golden brown at 350°F. Break into bite-size chunks.

KITTY & DOGGIE CRUNCHIES - VEGETARIAN
2 C whole grains (oatmeal, millet, cracked wheat, corn, barley etc.)
2 ½ litres water
1 C rice flour
1 C bran
1 tsp sea salt
½ C wheatgerm
¾ C skim milk powder
½ C KY supplement
½ C food yeast
400 i.u. vitamin E
½ C oil1 tsp cod liver oil
Slowly stir grains, rice flour and salt into the water which is boiling. Cover and simmer 15 mins or until done. Add more water if too dry. Cool slightly. Add remaining ingredients, stirring rapidly and thoroughly. Spread thinly on an oven tray. Dry in the oven at 150-200°F until crisp. Break in pieces. Supplement with a little extra protein food, such as meat, tofu, eggs or cottage cheese if fed regularly to a cat.

DOG BISCUITS
2 C wholemeal flour
½ C rice floor
½ C wheatgerm or millet
¼ C sunflower seeds
¼ C milk powder
2 tsp oil
2 tbsp honey
1 tsp salt (optional)
2 eggs, beaten
¼ C KY supplement
Mix ingredients with sufficient water to make a dough. Roll out on floured surface to ½" thickness and cut into squares. Bake at 200°C for 20-25 mins. Best stored in frig.

KITTY & DOGGIE CRUNCHIES WITH MEAT
500g ground chicken necks and gizzards (or other meat
)½ C food yeast
1 can mackerel
2 C rice flour
2 C wheat floor
1 C rye floor
1 C cornmeal
1 C wheatgerm
1 C non-fat milk powder
¼ C KY supplement
1 tbsp cod liver oil
4 tbsp oil or fat
400 i.u. vitamin E
3 cloves garlic, minced
2 ½ L water
½ chopped onion (optional)
Mix all ingredients to make firm dough. Spread flat on oven trays and roll to ¼ - ½" thickness. Bake at 350°F for 30-45 mins. Cool, break into bite-size chunks, and store in airtight containers. Keeps 2-3 days without refrigeration, longer with it. Supplement with a bit of fresh food if fed on a regular basis.

MEALTIME TIPS
1. Serve the food lukewarm or at room temperature, neither too hot nor too cold.
2. Keep the bowl clean. Don 't let uneaten food particles accumulate. Avoid using a harsh or strong smelling cleanser.
3. Give each animal its own bowl and keep the feeding routine regular and reliable. In most instances feed 1 or 2 meals a day, taking up and refrigerating any uneaten food after about half an hour. Cats may sometimes refuse food because it is natural for them to eat less often.
4. Provide a place to feed that is reasonably quiet and pleasant and protected from intrusions by toddlers, other animals or strangers.

INGREDIENT SUBSTITUTES
1 C cooked rice = 1 C cooked barley, bulgur, millet or potatoes or oatmeal or 3 slices of wholemeal bread
1 C fatty meat (250 g) = 4 large eggs or 1C cottage cheese or 1 C lean meat plus 1 tsp oil

 by Dr. Chris Piper
 
The role of nutrition is vital to the proper development and maintenance of joints. Chondroprotective agents (CPAs) have been shown to promote normalisation of cartilage and synovial fluid, and also slow down the degeneration of cartilage.

Considerable confusion exists regarding the therapeutic value of different CPAs and the most appropriate sources of these nutrients. This article attempts to clarify these issues. CPAs have the following attributes:

• support chondrocyte synthesis of collagen and proteoglycans in the matrix
• support the production of hyaluronans in joint fluid
• inhibit cartilage degradation enzymes
• prevent fibrin formation in synovial fluid and plaque formation in subchondral vessels

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Examples of compounds which exhibit these characteristics are glucosamine, chondroitins, and hyaluronic acid.

Cartilage is a very complex connective tissue composed of two elements; the cellular component, the chondrocytes (5%), and the extracellular component, the matrix (95%). The matrix (see fig.1) is composed of water (70%), collagen, and proteoglycan aggregates. The proteoglycan aggregates are composed of numerous proteoglycan monomers attached end on end to hyaluronic acid. Each proteoglycan is composed of numerous glycosaminoglycans attached to a core protein which in turn is joined to the hyaluronic acid molecule by a link protein. The predominant glycosaminoglycans (GAGs) of cartilage are chondroitin-4-sulphate, chondroitin-6-sulphate, hyaluronic acid, and keratan sulphate. Chondroitin sulphate is composed of repeating disaccharide units of glucosamine and galactosamine. Glucosamine is either preformed from nutritional supplementation or synthesised from glucose and amino acids, and galactosamine is formed from glucosamine by changing one of the hydroxyl groups. Galactosamine cannot be used as a nutritional supplement as it causes liver damage.

To summarise:
Glucose + amine => glucosamine + glactosamine => disaccharide + disaccharides => glycosaminoglycan + glycosaminoglycans + core protein => proteoglycan monomer + proteoglycan monomers + hyaluronic acid => proteoglycan aggregates + collagen => matrix + chondrocytes => cartilage

The integrity of cartilage is dependent on adequate structural support from the underlying subchondral bone, the joint capsule and its supply of synovial fluid., and proper support from the ligaments and muscles which maintain alignment of the opposing surfaces of the joint.

Many of the nutraceuticals available contain sources of chondroitins and glucosamine and often contain other cofactors (minerals and vitamins) as well. Some CPAs are provided in purified forms and others as animal extracts. Whatever the form, it is important to know what a product contains, and sufficient information should be present on the label or available from the manufacturer, to enable you to identify levels of specific ingredients. Many of the whole animal extracts will contain valuable nutrients apart from the chondroitins and glucosamine. In addition to chondroitins and glucosamine there is a need for collagen, hyaluronic acid, proteins, and sufficient cofactors to enable the body to synthesise the matrix.
There are several rich sources of these nutrients.

Glucosamine is extracted from chitin, the exoskeleton of crabs, shrimps, and lobsters. The preferred form is glucosamine hydrochloride, and it is readily absorbed from the gut - up to 98%. It also provides significantly more glucosamine than glucosamine sulphate and is much more stable.

Chondroitin sulphate is the most abundant GAG of cartilage although keratan sulphate, dermatan sulphate, and heparan sulphate are also present. Chondroitin 4 sulphate and chondroitin 6 sulphate are sourced from bovine, shark, and poultry tissues. Another marine source, green lipped muscle, is a poor source of GAGs (2-3%) despite appearing in the literature as a rich source of GAGs. Bovine tracheal cartilage contains 20-28% GAGs as chondroitin 4 sulphate and chondroitin 6 sulphate as well as 23% collagen and a source of calcium. Shark cartilage contains 7-25% GAGs mainly as chondroitin 6 sulphate (15% is keratan sulphate), 20% collagen, and 50% calcium hydroxyapatite. Hydroxyapatite is an essential ingredient of bone matrix.

A combination of glucosamine and chondroitin sulphate has been shown to be more effective than either agent alone.

Hyaluronic acid is poorly absorbed, however, up to 70% of chondroitin sulphate is absorbed, mostly as shorter chain polysaccharides. Partial or complete digestion may improve the availability of these nutrients. Whole extracts are likely to contain other important cofactors and will be less likely to have been damaged during extraction than those that have been purified. Freeze-drying is the best extraction process as it is a low temperature operation. Air drying and roller drying may cause heat damage.

Cofactors play a significant role in the production of cartilage including Vitamins E and C, and minerals/trace elements boron, zinc, copper, selenium, magnesium, and manganese. Trace elements, bound in chelated form, are more readily available to the body and less likely to interact and interfere with each other during absorption. Rich sources of amino acids, especially the sulphur containing ones (methyl sulphonyl methane) are important in the manufacture of cartilage matrix.
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Apart from the provision of nutrients and chondroprotective agents for cartilage maintenance and repair, there is an additional requirement for anti-inflammatory and anti-oxidant agents for the management of degenerative joint disease (arthritis). As the cartilage degenerates there is an increase in free radical damage and subsequent inflammation. While the CPAs have been shown to exert some anti-inflammatory effect there are other agents which are more effective. Vitamin A and E, green lipped mussel and some herbs are able to provide significant effects on joint function. It is likely that these agents will slow down the progression of disease and if used early enough, may prevent the development and progression of arthritis. Much work is still required to determine if this is possible. It is the author's opinion that the use of sufficient raw bone, cartilage and connective tissues in the diet, especially in the growth phase, are essential to the proper development and maintenance of cartilage.