Abscesses to Air Sacculitis

Abscesses in Birds


  1. Elevated White Blood Count
  2. Radiographic Evidence of abscesses
  3. Feather plucked bird
  4. Marked weight loss
  5. Abscesses are more common in Amazon parrots and Macaws, but can be in all species of birds
  6. Chronically sick birds, birds that develop one illness after another, never seeming to be able to stay healthy
  7. Obviously sick birds that have not been diagnosed (abscesses are often very hard to diagnose)

Abscesses in Cats


  1. Localized swelling, usually hot to the touch and often feels like there is a fluid filled pocket
  2. Open, bloody, draining hole (this is after the abscess has opened and started draining).
  3. At this point you may be able to treat at home with hot packing and flushing.
  4. People often think their cat has been cut if the abscess is open and bleeding, when in fact, it opened from the inside to allow the pus to drain out.
  5. Fever (100-102.5 °F is normal, 103.5 °F. and higher is a significant fever; fevers over 104.4 °F need to be seen by veterinarian)
  6. Limping, if the abscess is on a leg or foot


Aggression may be caused by behavioral problems, including:

  • Fear based aggression
  • Dominance aggression
  • Breed associated dominance
  • Mistreated and neglected animals
  • Unsocialized and poorly trained animals

Aggression can also be normal in many situations, such as:

  • Dogs protecting their home or people
  • Birds that are protecting their nests or people
  • Animals that feel threatened

Aging: Geriatric Conditions in Cats

In contrast to what pet food manufacturers would have one think, there is no specific age at which your cat suddenly becomes a "senior," and, therefore, requires a "Senior Diet." Senior diets actually decrease the available nutrients, which is just the opposite of what is needed. 

Aging: Geriatric Conditions in Dogs

In contrast to what pet food manufacturers would have one think, there is no specific age at which your dog suddenly requires a "senior" diet. Senior diets are often promoted because they cost less to make, thus the manufacturer has a greater profit margin. Senior diets actually decrease the available nutrients, which is just the opposite of what is needed. 

Air Sacculitis

How would you know if your bird has air sacculitis? This is very hard, actually, since the disease can be quite advanced and the bird will often breathe normally. Any generalized sign of illness might be present. Abnormal breathing, including heavy breathing, accented abdominal breathing and becoming breathless with only a little exercise might indicate air sacculitis. 

Aloe Vera to Combined Approach

Aloe Vera

The active  properties of aloe include barbaloin and isobarbaloin. Aloe has purgative, cholagogue, anti-inflammatory, vulnerary, and anthelmintic effects. Aloe powder is a strong purgative and can be effective with constipation. Scientific studies have shown that aloe is highly effective when applied topically to burns, especially in the early stages following the burn. As a vulnerary, it speeds wound healing and cell growth. 

Arthritis: Degenerative Joint Disease

Signs of Arthritis

  • Limping
  • Stiffness, especially in the morning
  • Decreased exercise tolerance
  • Doesn't want to climb stairs or jump up as much
  • Pain
  • Difficulty rising or sitting or laying down
  • Trouble sleeping through the night
    • As the joint becomes stiffer through the night, it also becomes more painful so the dog, cat or bird will not sleep as well

Bad Breath (Halitosis)

Bad breath becomes more common as dogs and cats age. It is caused by a number of factors, including:

  1. Periodontal disease (bad teeth)
  2. Gingivitis (especially in cats)
  3. Poor digestion
  4. Stomach problems
  5. Chronic small intestinal problems
  6. Poor diet

Canine Liver Disease

The guidelines for a liver diet include:

  1. The liver has a diminished ability to detoxify. Thus, we need to feed adequate, reasonably high levels of easily digested proteins, free of aflatoxins, hormones, herbicides and pesticides.
  2. Limit further damage by limiting copper and, again, pesticides and other toxins.
  3. Support liver regeneration by supplying high levels of antioxidants and free radical scavengers.
  4. Dogs with liver disease are usually suffering from a condition where less protein is being broken down (catabolic) resulting in increased energy needs and therefore the need for more protein.

Chronic Diarrhea in Cats

Chronic diarrhea in cats is often associated with a disease called Inflammatory Bowel Disease (IBD). Other causes include food allergies, chronic bacterial infections, and certain systemic diseases (liver, kidney, and heart diseases, for example).

Because of the serious nature of many cases of diarrhea in cats, all cases of chronicdiarrhea should be examined by a local veterinarian.

Many cases of diarrhea in cats are due to deep seeded, serious conditions of the intestinal tract. This condition is so complex that we believe there are no easy answers. Therefore, we strongly recommend a Phone Consult. We have successfully treated many cats with this debilitating disease.

Combined Approach to the Use of Nutraceuticals, Western Medicine, Herbal Medicine : Liver Disease

The liver is able to regenerate itself completely, even after major damage. For example, two-thirds of the liver can be removed and the organ will regenerate in a few months. Although it can effectively restore itself to normal function, Western medicine has for the most part failed to emphasize liver restorative therapies. In contrast, holistic or integrative medicine (also called functional medicine) does seek to utilize medicinal approaches that are aimed at liver protection and liver restoration. 

Diarrhea to Feeding Your Cat

Diarrhea: Acute/Chronic Diarrhea in Dogs

If your dog has diarrhea and seems to be reasonably strong, happy and active, simply follow these guidelines:

  • Cut the amount of food you are feeding in half
  • Feed home cooked bland diets; they are vastly superior to the commercial bland diets promoted by many veterinarians
  • Bland foods include:
    • 1/3 meat
      • Cooked meats that are very low in fat such as chicken (you can also boil hamburger, which will remove all the fat)
    • 2/3 rice or other bland grain )
      • Cottage Cheese
      • White Rice (some will do better on cooked oatmeal)
    • Do not add any oils or fats to the diet at this point

Essential Fatty Acids

Essential fatty acids are required in the diet, as they cannot be produced in the body. There are two essential fatty acids in people, linoleic acid and alpha-linolenic acid. Dogs and cats can't convert O-3 to O-6 or the opposite. Thus, linoleic acid (O-6) and linolenic acid (O-3) are essential in the dog and cat.

Arachadonic acid is required in the diet of cats, and can only be acquired from animal fat sources (thus, cats can not be vegetarians). Cats do not produce delta_6_dehydrongenase, the enzyme required to convert alpha-linolenic acid to eicosapentaenoic acid (EPA), so if one wishes to increase the amount of EPA, it is best to supplement with omega 3 fatty acids, such as those found in cold water fish oils.

Essential Oils

In general, omega 3 fatty acids reduce the inflammatory response and omega 6 fatty acids enhance inflammation. Since omega 3 fatty acids are more limited in the diet, it is easier to see beneficial effects from their supplementation. Additionally, desaturase enzymes (which elongate and desaturate fatty acids, thus converting them to different ones) have a greater affinity for omega 3 fatty acids, so increasing the amount of omega 3 fatty acids will decrease the amount of omega 6 fatty acids. Benefits of omega 3 fatty acids include:

  1. Inhibition of tumor development and tumor metastasis
  2. Lowering of cholesterol levels, modifying platelet and vascular function, heart disease therapy
  3. Improving arthritis
  4. Relief of allergic symptoms, eczema and psoriasis
  5. Diminish the inflammatory response

Feather Grooming Disorders

Some avian veterinarians will spend a great deal of time trying to find a physical cause for this problem. This is expensive, invasive to the bird, and not likely to prove beneficial. The vast majority of feather chewing and plucking problems and even self-mutilation (biting or scratching the skin until it bleeds) is based on behavioral, psychological and emotional conditions.

Some birds with dull feathers are hypothyroid and can be treated using our Hypothyroid Chinese Herbal Suppport Formula.Certainly, there are often secondary skin infections or some of the feather follicles will develop infections that may need to be treated. Many birds come from aviaries and pet stores already sick, hide their illnesses, and (amazing but true) can carry these diseases for years before they become outwardly ill. These illnesses need to be treated but just because they are present in a bird that has feather-grooming problems does not mean that the disease is the cause of the problem. But, the underlying reason the problem developed to begin with is emotionally based.

Feeding Your Bird for Health

Since good nutrition is vital, we have a real dilemma in deciding how to feed parrots. Most of how we feed our birds has evolved from years of trial and error. It is more of an art than a science. Since we know so little information from research, it seems likely that studying what the birds eat in the wild will help us decide how to feed in a home situation. Most of the psittacine species can be considered opportunistic omnivores, meaning they eat what is available in their ecosystem, when it is available. Thus, they eat nuts and grains in the fall and winter (for those living in regions that have seasonal changes). They eat fruiting bodies when they are available. They eat greens and sprouts when they are available, and they likely eat insects and other animals or parts of animals that are found during their foraging for food or on the fruits and grains they are eating. Likely, a significant part of their nutrition is what comes from what they consume digging through the soil and mineral deposits near where they live. 

Feeding Your Cat

To understand how to feed a cat, let's first look at some basic aspects of feline nutrition. Cats are strictly carnivores, with essentially no grains required, and only a small amount of vegetables or other food items needed. Cats thrive on diets made up almost entirely of meat, as long as we feed organ meats and bones as well as muscle meats.

Conventional-minded veterinarians often say that commercial diets are superior to home-prepared diets, because the commercial diets are balanced, while home cooking creates nutritional deficiencies and diseases. The reality is just the opposite, as we will see. First, it is really not hard to feed a good, nutritious diet of fresh foods that you prepare. As we will explain, it is actually easy and very rewarding to provide the type of diet that cats love to eat and actually thrive on.

Feeeding Your Dog to Leaky Gut

Feeding Your Dog

To understand how to feed a dog, we first need to understand some basic aspects of canine nutrition. Dogs are almost strictly carnivores. They will eat some grains, fruits and vegetables. Dogs thrive on diets made up almost entirely of meat, as long as we feed some organ meat, bones, grains and vegetables. 

Conventional-minded veterinarians often say that commercial diets are superior to home cooked natural foods because the commercial diets are balanced, while home cooking creates nutritional deficiencies and diseases. The reality is just the opposite, as we will see. First, it is really not hard to feed a good, nutritious diet of fresh foods that you prepare. As we will explain, it is actually easy and very rewarding to provide the type of diet that dogs love to eat and one on which they will thrive. 

Ferrets and Insulinomas

Ferrets commonly develop low blood sugar levels (hypoglycemia) due to a tumor of the pancreas called an insulinoma. The low blood sugar levels can produce signs in ferrets that include:

Muscle weakness


Rubbing or pawing at the face

Loss of appetite (or increased appetite)

Stumbling, drunk appearance

Head thrown over shoulders or sideways

Coma and death

Insulinomas are malignant cancers of the pancreas, specifically involving a cell type in the pancreas called Islet Cells (more specifically, the Beta Cells). They can be seen in ferrets of any adult age, but are most common in ferrets over 3 years of age.

The cause is unknown, but we believe poor diets have a major role in the development of these common cancers. Ferrets are pure carnivores and should be eating meat. Most ferret diets include large amounts of grain, which can not be healthy for the ferret.

Geriatric Case Study

Physical Examination:

1. Trouble rising, partially due to the hips and partially due to mild paresis

2. Dry, dull coat, mildly obese

3. Developing mild posterior cataracts in both eyes

4. The dog has hard stools and tends to fall down when defecating

Blood Test Results:

1. T4 (thyroid): low normal

2. SGPT: mild elevated

Therapeutic plan:

1. Active Bovine Glandular Thyroid, 4 grains twice daily

2. Glucosamine sulfate, 500 mg twice daily

3. DL Phenylalanine, 500 mg twice daily

4. Dimethylglycine, 100 mg twice daily


Over the course of two months, the coat dramatically improved, weight was reduced 10%, and dog seemed much more energetic

The cataracts stopped progressing

The dog started to sleep normally at night

She was able to climb stairs and play again

The owners reported her to be more active than in last 2 years

Hypothyroid Conditions in Dogs

Hypothyroidism implies that there are lower than normal levels of thyroid hormone. This condition is most common in dogs. It is also seen in cats (very rarely) and birds (also rare).

Hypothyroidism is not a specific or well defined disease. It is more accurate to call this disorder a syndrome. A disease has a specific cause and a predictable progression of symptoms. A syndrome is a collection of similar signs of illness, usually having many different underlying causes (some or all of which are unknown), and the progression of signs or symptoms are variable and much less predictable. Hypothyroidism therefore is a syndrome because it has many causes and the progressions of disorders that develop are quite variable. The single common factor is that thyroid gland function is less that optimal OR the various steps in the conversion of thyroid precursor hormones is subnormal OR that their utilization is less than optimal.

For Hypothyroid dogs consider:

Hypothyroid Chinese Herbal Support (Wellvet.com)

Thyroid Glandular, 2 grain

Six Flavored Teapills

Kidney Disease in Cats

Kidney disease is a very serious disease, and perhaps the most common serious disorder your cat may develop.

Any cat that is suspected of having kidney disease should be seen by a local veterinarian.

Since kidney disease is so common, it is reasonable to ask why so many cats develop this disorder. Although no one knows for sure, we believe the causes include:

  1. Diets
    Commercial dry food diets seem to produce kidney disease, and they certainly produce cystitis
    Cats are 100% carnivores by nature and commercial diets often provide 50-60% of the calories as grains. This alters a cat's normal metabolic processes, changes the cat's pH (acid/base) balance, and creates obesity
    Meat-based diets prevent the development and retard the progression of kidney disease
    We believe that cats fed all-meat diets do not develop as much kidney disease as those fed commercial diets.Meat based diets must be balanced; see our information on how to feed your cat.
  2. Excessive vaccinations

This has not been completely proven, but we do know that vaccines can cause autoimmune diseases. We also know that autoimmune disease can cause a problem in the kidneys called glomerulonephritis. See our recommendations for vaccinations in cats.

  1. Hereditary/Genetic
  2. People that breed cats are rarely motivated by a view toward long-term health and vitality. Over time, poor breeding always develops weaknesses. Kidney disease is a good example
  3. Other Concurrent DiseasesOther conditions, especially Hyperthyroidism (excess thyroid hormone) will commonly lead to kidney disease

Leaky Gut Syndrome and Inflammatory Bowel DIsease

Leaky Gut Syndrome is a condition in which food allergies cause intestinal permeability defects, chronic diarrhea, food sensitivity and generalized allergies.

If your dog, cat or bird has symptoms, we recommend an appointment or a phone consult. Dr. McCluggage has lectured widely on this topic and treated many cases of chronic diarrhea and intestinal permeability defects with good success.


General Products to help your animal with Leaky Gut syndrome (increased intestinal permeability) include:


UltraClear Plus (perhaps the single best product)


Douglas Multi-Probiotic 40-Billion

Omega's EPA/DHA

Licorice to Obesity

Licorice and Deglycrrhizinated Licorice (DGL)


Licorice is an herb that is commonly used by both western herbologists and Traditional Chinese Medicine practitioners. It is likely that licorice is the most common herb used in Botanical medicine.

It has many effects in the body, one of the most important being its powerful anti-inflammatory action which seems to be somewhat similar to cortisol.

Licorice has adrenal gland actions (it is called a glucocorticosteroid and a mineralocorticosteroid effect). These actions can be very powerful and beneficial in healing patients. Some of these effects include:

  1. Licorice seems to enhance desoxycorticosterone, a hormone that affects sodium levels in the body
  2. This causes retention of sodium and water
  3. Excretion of potassium from the body
  4. Licorice will keep the circulating levels of cortisol in the blood steam longer than normal, thus elevating cortisol levels and producing an antiinflammatory effect
  5. This effect is dose related, so one can use appropriate dosages with little risk
    1. Excessive use can lead to a weaknesses in the adrenal gland (called the adrenocortical axis)
    2. This can produce edema (fluid retention)
  6. The mineral/adrenal effects are most common in women
    1. Licorice can be used in women, but with some caution
    2. This sensitivity probably does not extend to spayed dogs and cats


Deglycyrrhizinated (DGL) licorice is a nutraceutical extract of licorice. DGL does not have any of the adrenal gland effects associated with licorice. DGL restores the intestinal lining. It is good for ulcers, stomatitis and inflammatory bowel disease. DGL increases the quantity and quality of mucin, increases the life span of intestinal cells, improves mucosal blood flow and has a prostaglandin-like effect on cytoprotection.

DGL is often used for:

  1. Stomach Ulcers
  2. Stomach Inflammation
  3. Chronically Vomiting Animals
  4. Inflammatory Bowel Disease
  5. Chronic small intestinal Diarrhea

When To use DGL and when to use Licorice?

The whole licorice herb has an adrenal cortical action, as previously mentioned, which may be beneficial in specific situations. Because of this "cortisol-like" effect, it has powerful anti-inflammatory effects that can be very helpful when needed. It should be used in those situations. If you want to have the intestinal protective and mucosal soothing effects on the stomach, then you should consider DGL as it is slightly safer. Ultimately, this is a very hard decision with some cases, and a phone consultation would be appropriate.

Litter Box Action Plan

Rhea Dodd, D.V.M. MA, CVA
Morrison, Colorado (303) 919-1504

If allowed to choose, most cats will naturally pick clean, sandy litter, lots of space, privacy and quiet, no odors (stinky or fragrant), little competition from other cats, and a low stress environment. If your cat is healthy, the next step is to change the environment.

The doctor has diagnosed your cat with a:

  1. Surface Preference For Carpet/(Other)
  2. Litter Type Aversion
  3. Location Preference
  4. Litter Box Aversion
  5. Other

To help create a more naturally attractive and enticing litterbox, please do
the following:

  1. Increase the number of boxes to one more than the number of cats.
  2. If you use a covered box, get an uncovered one; if you use an uncovered box, get a covered one.
  3. Get an extra large box or use an under-bed storage box.
  4. Do not use plastic liners.
  5. Use only UNSCENTED, fine clumping (scoopable) type litter, 2-3 inches deep.
  6. Create a gradient from shallow to deep.
  7. Scoop once or twice daily.
  8. Add litter as needed to keep depth at 2-3 inches.
  9. Dump contents when "crumbs" of broken up urine clumps are visible, there is a noticeable odor, or about once a month.
  10. Clean only with a mild soap, such as Ivory liquid; rinse and dry well.


Place the new boxes where the cat is inappropriately eliminating. Once litter box habits are well established, move box 1-2" a day to a more appropriate location.

Clean soiled areas very thoroughly with "Anti-Icky Poo" (silly name, great product!) or "Nature's Miracle" [or other enzyme product] according to package directions. Very soiled areas may require professional cleaning, carpet replacement, or sealing.

Cover soiled areas with heavy plastic, carpet runners or foil.

Place food and water or toys in the same area.

Place lemon scented glycerin soap bars or lemon scented air deodorizer in the same area, but not so close to the new litter box that it will discourage use.

Place a small square of carpet, bath mat, old T-shirt, fine wedding veil netting, synthetic fleece or hand towel in the empty litter box.

Gradually replace it with smaller squares of fabric, while simultaneously adding increasing amounts of litter.

Use an empty litter box, sprinkled with a small amount of litter.

If feasible, simply restrict cat's access to soiled area or preferred surface (e.g. keep bedroom door closed, keep laundry picked up, put 1/2 inch of water in bathtub).

DO NOT punish or scold a cat. It is not effective in correcting soiling problems and may lead to increased stress and further problems.

Correction of litterbox problems is not simple. It takes time, a financial investment, patience, and perseverance. We empathize, and are here to support you. We know if your cat could, he would thank you for having a big heart.

Note: Dr. Dodd is available for phone consults on behavioral problems, please contact her at the above phone number.

Medicinal Mushrooms: Immune Boosters


The Japanese, Chinese, and others have used medicinal mushrooms for centuries. Two good examples are the mushrooms Shiitake and Reishi (Ganoderma).

There are actually dozens of medicinal mushrooms, all possessing some similar characteristics, such as immune enhancement. In addition, each also has its own unique properties. Ganoderma has been shown to regulate immune functions and coronary cerebral blood flow, reduce blood lipid levels, protect the liver from toxicosis and treat liver disease. Shiitake is used to treat cancer. Tremella contains tumor and ulcer inhibiting polysaccharide. Uses might include cancer therapy, following illness to boost strength, and following injury.

Medicinal mushrooms seem to be one of the best methods for long-term immune stimulation.

One can give only one mushroom if you understand which one is best. What is more common is to give a combination of several mushrooms. Neither approach is necessarily better, as it always depends on the animal's condition.

A variety of different medicinal mushrooms are available in combination products, including:


  1. Especially beneficial for cancer therapy
  2. Shown to help fight cancer
  3. Particularly beneficial in countering the side effects of cancer chemotherapy
  4. Has complex mucopolysaccharides that are nonspecific immune boosters.


  1. Anti-tumor activity
  2. Antiviral action
  3. Reduces bronchial inflammation

Ganoderma (Reishi)

  1. Improves cellular immunity
  2. Has antifibrotic or scar decreasing properties, making it beneficial for liver cirrhosis among other disorders
  3. Shown to reduce
    • Aspartate transaminase (AST)
    • Alanine transaminase (ALT)
    • Alkaline phosphatase (ALP)
    • Total bilirubin
    • Collagen content

Tremella fuciformis

  1. Enhances cellular and humoral immunity
  2. Increases interleuken-2
  3. Protects against some of the negative effects of radiation therapy
  4. Is a live protectant (hepatoprotective)
  5. Anticancer
  6. Increases the effectiveness of interferon (antiviral)

Cordyceps sinensis

  1. Enhances red blood cells (erythroid progenitor cells and erythroid colony-forming units in the bone marrow)
  2. Immune stimulation and immune regulation effects
    1. Stimulates phagocytic function and macrophage activity
    2. Thus it is beneficial in cleaning up diseased tissues and restoring health
  3. Anticancer effects
    1. Shown to lengthen the life of lymphoma patients
    2. Counters some of the negative effects of cyclophosphamide (a powerful cancer chemotherapy drug)
  4. Seems to be most effective in treating cellular immunity


Megacolon is a serious disease in older cats. The large intestine becomes dilated and flacid, the passing of stools becomes sluggish, and your cat becomes constipated. Eventually your cat can no longer pass stools, which is, of course, life threatening.

Drug therapy includes the use of Cisapride, a drug that forces the large intestinal muscles to contract harder. This can help pass stools, but over time, this drug will cause more dilation and flacidity of the colon, speading up the disease process.

Before Cisapride is used, we recommend a number of other therapies.

  • Acupuncture and manual therapy (chiropractic adjustments)are often remarkably helpful.
  • Diet modification: feed your cat a raw food diet, or at least a home cooked diet consisting mostly of meat. These diets will produce far less stool, and the colon has far less effort in passing the stool.
  • Supplements:

Appricot Seed and Linum, a Chinese herbal product
Colon Formula, a nutraceutical and herbal supplement that contains herbs to gently encourage the colon to pass stool
Digestive enzyme support, try Similase (Integrative Therapeutics)
Add fiber to the diet, consider MetaFiber (Metagenics)

  • Low Level Laser Therapy
  • Homeopathy
  • Cats with severe constipation and megacolon might benefit from a combined diet and supplement approach that we can offer during a Phone Consult.

Milk Thistle

Silybum marianum (milk thistle) is a flavonoid having an affinity for the liver. Its hepatoprotective and hepatorestorative effects makes silymarin one of the best nutraceutical for many liver disorders. It is primarily used to regenerate hepatocytes, where it improves the flow of bile and fat to and from the liver as well as heal liver cells. Less known, but of equal value, is that it is also an excellent antioxidant. Its antioxidant properties make it valuable in a wide variety of degenerative diseases.

Active ingredients:

The major active ingredient is considered to be the flavonolignan , silybin , a lipid soluble, poorly absorbed compound. Betaine, which has been shown to be a liver protectant, is also found in the plant. There are other flavonolignans in milk thistle, but they appear less significant. Perhaps of more importance are the essential oils and trace minerals found in the herb.

Modes of Action:

As an antioxidant, silymarin inhibits benzoyl peroxide-induced tumor promotion, oxidative stress and inhibits the inflammatory responses with certain types of tumors. Silymarin increases the biliary excretion and the endogenous pool of bile salts by stimulating the synthesis of hepatoprotective bile salts, such as beta- muricholate and ursodeoxycholate.

It enhances Phase II and inhibits Phase I liver detoxification, which can effectively balance detoxification since the by-products of Phase I detoxification are often more toxic than the original products from which they are produced.

Phase I detoxification, the Cytrochrome P450 enzymes, often produce free radicals which must be removed by Phase II detoxification. Silymarin, allowing for greater conjugation of these free radicals, enhances Glucuronic acid, a part of Phase II detoxification. Once conjugated they can be removed from the body through the bile ducts.

Silymarin has been shown to lower elevated levels of bilirubin, aspartate aminotransferase (AST), and alanine amino-transferase (ALT). In part this is due to its ability to stimulate the production of heplatocellular proteins.

Adding to the long list of beneficial effects of this nutraceutical is its anti-lipid peroxidation effect. Silymarin will inhibit the formation of leukotrienes from polyunsaturated fatty acids in the liver, via its inhibition of the enzyme lipoxygenase, stabilized mast cells, modulated immune functions, and is anti-inflammatory.

The anti- iflammatory effect of silymarin is significant, and has been proven in studies. This allows the practitioner to elect not to use Western antiinflammatories such as prednisone.

Amanita Mushroom Poisoning

Some species of Amanita mushrooms have powerful hepatotoxins, including amanitin and phalloidin. Milk thistle has gained much recognition in its ability to reducing death rates from exposure to Amanita mushrooms up to 100%. Liver enzyme studies and liver biopsies in studies involving dogs shows a significant hepatoprotective effect for silymarin when given toxic doses of Amanita mushrooms.

Other Clinical Uses

Silymarin has been shown to be of some benefit is treatment of liver disease in alcoholics, although it is not as effective as one might expect.

Silymarin is very helpful in the treatment of liver cirrhosis. One study is indicative of this beneficial aspect of the herb. This study, involving 170 patients with liver cirrhosis, were given 420 mg/day of silymarin for an average of 41 months. These patients showed a significant improvement in survival (58% in silymarin-treated patients and 39% in the placebo group). 

In Western medicine, colchicine is often used to inhibit liver fibrosis. This is, however, of questionable value, especially when considering the potential toxicity of colchicine.

In one study the use of silymarin was as effective as colchicine in the treatment of liver disease, and had none of the untoward effects exhibited with colchicine. Silymarin also inhibits fibrosis in lung tissue, kidney tissue, pancreas and other organs throughout the body. 

Being a powerful Antioxidant, it can help improve many degenerative conditions throughout the body, including kidney disease, heart disease, and diabetes. Silymarin is found throughout the entire plant, but is concentrated in the fruit and seeds. Since the seeds have a high content of silymarin, it is an excellent seed to feed birds that have liver disease.

If used in too high a dose, it can cause a loose stool due to the increase in bile it produces.

Obesity and Weight Loss Programs


Diet dog and cat foods are rarely successful. In fact, they MAKE your companion animal want to eat more because they have such poor nutrition that their bodies feel starved for good food.

These diet foods all are designed to decrease calories while increasing indigestible material. One example of a product that is used to add bulk but no calories is peanut hulls. The flawed concept is to make the animal feel fuller after a meal, but not have so many calories per cup of food.

The reason this is flawed is that all animals are driven to eat, not by a feeling of emptiness in the stomach, but by a desire to meet their caloric needs. They are driven to eat by a sense of a lack of calories, not a sense of less food in their stomach. Those of us who have dieted know that the first couple weeks are usually the easiest time to eat less. Then we start having more trouble staying on the diet. Why? The body begins to feel the lack of calories and starts urging us to eat more.

This is also true of animals, they start becoming more persistent in asking us for more food as they start losing weight. The result is that we often start giving them treats between meals, feeding more in the food bowel. Worst of all is the idea that we can feed our obese animals free choice and expect them to lose weight by just moving to a diet dog or cat food. The result of all of this? Our companions just eat more food that is of a poorer quality, leading to malnutrition and disease.

Study after study has shown that diet dog and cat foods never are successful. Animals just don't lose weight on them. The one exception: the caretaker that is willing to limit how much food they feed their dogs and cats.

The basic tenant in a healthy diet plan for people is that we should all eat healthy, freshly prepared foods, adding variety and all the valuable nutrients we need to stay healthy.... but that we should learn to simply eat less. The same is true of animals. The best "diet" plan is simply feeding an excellent diet in the correct portions.

Diet dog foods do just the opposite of this: they provide a poorer quality of nutrition. In our experience, dogs develop unthrifty, dull, and dry looking coats and eventually develop diseases while on diet dog foods. And, they never lose any weight!

Ultimately, the diet dog foods are aimed at the animal caretaker's desire to make their companion happy, and are not made to benefit the animal. We all want to make our companions as happy as possible. We all gain great satisfaction by knowing they are content. One way is to feed a bowl of food that looks like a lot of food. We feel better knowing that our animals get this nice big looking meal once or twice daily.

As we have seen, this is actually the opposite from what we want to do: we want to feed a higher quality diet, and feed much less in the bowl. Your companion animal will feel better for this. They will be healthier and they will feel MORE satisfied with the meal because of the high quality of the food they are eating. And they will feel years younger when they lose the excess weight.

Oxilate Stone Diet to Vomiting

Oxilate Stone Diet


Bladder and especially kidney stones are very serious. You should always have your companion animal seen by your local veterinarian if you suspect bladder or kidney stones. In addition, WellVet.com believes that this is an excellent example of where complementary medicine can offer a great deal of support. Traditional Chinese Medicine seems especially helpful, as does homeopathy.

You will find examples of products that might be beneficial for your animal listed in our diets linked to the button below. However, the exact herbs and supplements will vary by the case. You may wish to individualize therapy for your animal. For phone consult information, please call our office.

The "classic" oxalate-preventing diet is essentially a vegetarian diet, filled with low or moderate oxalate containing foods. At WellVet.com, we believe that only animals that have repeatedly produced oxalate stones, or animals that are strongly genetically predisposed to oxalate stones, should be on a diet devoid of meat. Many animals that develop oxalate stones have been previously placed on diets that artificially lower (acidify) the body's pH because of a prior incident of cystitis (for example, cats with FLUTD also called FUS).

We believe that vegetarian diets will lead to other problems, and that stones can be prevented with moderate amounts of meat, limiting foods that produce oxalates and calcium, and increasing the amount of magnesium in the diet. Magnesium helps stop oxalate stones from developing - even when the pH is incorrect and the calcium levels are excessive. Vitamin D should also be restricted to minimal amounts, as Vitamin D will tend to produce calcium deposits throughout the body, including the kidneys. Even marginally excessive levels of Vitamin D, in animals that tend to produce oxalate stones, can lead to more oxalate crystals that can form into stones in the kidney and bladder.

Vitamin C should not be supplemented in the diet for these animals, as it can be converted to oxalates in the kidneys. Vitamin C will also produce more acidity in the urine, also producing more problems.



Pannus is also called German Shepherd Pannus, but other breeds will also develop the same eye changes (these breeds include Collie, Poodle, Dachshund, Greyhound, mixed breeds). It is a serious disease that can lead to blindness.

The cornea is the outer, clear, portion of the eye. Normally, the cornea has no blood vessels, no pigmentation, and should be smooth and convex shaped.

Pannus is a disorder that affects the cornea of the eye. It is not painful, causes no eye discharge in its early stages and, most concerning, it is insidiously progressive. It is thought to be an autoimmune disorder, worsened by exposure to ultraviolet radiation (sunlight).

For reasons unknown, the body's own immune system reacts to the cornea producing neovascularity (blood vessels grow onto the cornea), pigment deposition into the cornea and eventually enough scar tissue to completely block all vision.

It is considered by many to be a disease that can not be cured and even with continual treatment can lead to blindness in many of the affected dogs.

Traditional Western therapy for Pannus includes the use of eye drops or ointments containing steroids (prednisone, dexamethasone) and/or cyclosporine ointments. In the most advanced cases, surgery is performed to remove the outer layers of the cornea, allowing for some vision to return.

In our experience, when seen early enough some cases are curable and many more easily maintained so that your dog never goes blind. If seen early, I suspect we can either cure or provide excellent life-long palliation in 90% of the cases.

What Causes Pannus from a Holistic View

From a Traditional Chinese Medical perspective, these animals are Yin deficient and often Blood deficient.

I have the most success with Chinese herbal remedies, combined with nutraceuticals.

My favorite formula is Ming Mu Di Huang Wan. I also have good success with Qi Ju Di Huang Wan (Lycii, Chrysanthemum and Rehmannia Teapills). One of these formulas forms the basis of therapy.

I then will often add Reconciling Tablets, a formula that treats autoimmune diseases.

A few cases seem to respond well when I add Tang Kwei; some seemed to need Aloe vera (using a fresh plant, not any extract).

All are placed on diets rich in carotinoids (usually sweet potato, kale, etc.), along with my typical diet recommendations.

Acupuncture seems to help all cases (don't rely on the GB, ST, BL eye points; use points for Blood (ST 36), Yin (CV 4, LU 7), and Spleen Qi (SP 3). Of course the point selection always varies by the animal, most have other issues that need addressing.

Environment is critical, especially early on, meaning they must be kept out of the sun until the Yin is replenished.

I always work with constitutional homeopathy as time goes by, and how much that helps is always hard to say. Homeopathy is powerful but slow to act in chronic miasms making it hard at times to know what good I do with it. There is a wealth of rubrics to look in, and the entire Repertorium Generale is needed to select the appropriate remedy.

To prevent permanent corneal changes, steroid eye drops are used at the start, but these are usually stopped after a while. I used to think the dogs always needed ocular steroids, but found out that over time people stopped using the eye treatments because it was inconvenient and things went along just fine. And, I used to think I needed to keep up some therapy or another, but again I kept seeing dogs 2-3 years later doing well with no therapy... same reason, the owners just stopped everything on their own. Again, the eyes stayed normal.

The most frustrating aspect of Pannus is that I see far too many cases when they have been on steroids and cyclosporine for years and the eyes are now a mess. Those cases are not curable, not easily treated, and at best only suppressed.. meaning they need to stay on steroids and I can barely arrest the advancement of the corneal dystrophy.

Therapies to consider:

  1. Ming Mu Di Huang Wan
  2. EPA/DHA
  3. Reconciling Tabs
  4. Small Animal Antioxidants
  5. Arthroplex
  6. Immuplex

Struvite Stone Diet


Bladder and especially kidney stones are very serious. They can be very hard to treat and eliminate. This diet plan can help our animal with this issue, but you should always continue to work with your local veterinarian.

Traditional Chinese Medicine also seems especially helpful, as does homeopathy. Recommended herbs and supplements will vary by case, and the products listed below are included as guidelines only. Other products may be better indicated to help heal your animal.

Portions can be made up daily then added together at mealtime.

All portions are in a rough volume percent of the total amount fed. This allows for variation by size without worrying about cups, teaspoons, and other measuring devices.

  • 50% of each meal is meat. The type of meat should be varied from time to time. For example, some meats to include:


Lean ground beef


  • The meats should be cooked right before being fed and the portion adjusted to accommodate for the animal's size (equaling 50% of the total amount of food in the bowl). Cook the meat to a medium point. Do not overcook it. While cooking, add extra water. Stir enough of the extra water into the meal once all ingredients have been added to make a stew-like consistency.
  • 25% of the meal should be a carbohydrate

Sweet potato

White potato

White rice

These should be cooked fairly well done, and the skin removed, for the first 60 days following the stone removal, or until the stone has been dissolved. The skin has extra minerals that will contribute to the next stone's formation, if one is going to form.

  • 25% of the diet should be varied, almost daily, and include:



Carrots (peeled early on, as the skin has more minerals that contribute to stone formation. later on the carrot can be fed whole and raw)


Beets (cooked)

Squash (cooked)

To the above, at each meal add:

  • One high quality multivitamin per meal (consider Rx Vitamins: Rx Essentials for Dogs, and for cats, Rx Vitamins Rx Essentials for Cats).
  • 1/2 to 3 capsules of a Calcium Citramate supplement (cats and small dogs get 1/2 capsule; increase the dose for dogs from there based on the dog's size, where the largest of dogs would get 3 capsules per meal.
  • A small pinch of a "salt substitute" which is actually potassium chloride
  • 1/4 to 2 tablespoons of olive oil or coconut oil (again, cats and small dogs receive the smallest dose and large dogs the maximum dose)

In addition, WellVet.com recommends that the urine is routinely checked to make sure it stays in an acid pH and that a urine culture be performed every 1-3 months for the first year to make sure there is no bacterial cystitis developing.

WellVet.com also recommends our proprietary Chinese herbal formula by Wellvet: Cystitis and Dissolve Crystals Formula.

If the pH does not stay acidic, we recommend adding L-Methionine (not DL-Methionine, the synthetic compound).

Traditional Chinese Medicine and the Liver


Specific Patterns of Liver Disease

Stagnated Liver Qi

  • Invading the Stomach, causing slow digestion, poor crop emptying, vomiting and nausea
  • Invading the Spleen, causing diarrhea
  • Invading the Small intestine, causing constipation
  • Impaired movement of Blood
  • Decreased fertility, causing vaginal and uterine problems, impeded flow of Qi to other organs and the movement of blood, both will negatively affect the function of the "western" immune system
  • This will have the potential to lead to chronic infections, especially those of the liver and respiratory system

Liver Fire Blazing Upwards

  • From the Invasion of Wind Heat or from Stagnation of Liver Qi
  • Produces red swollen eyes ("conjunctivitis")
  • Also seen with certain viral infections and chlamydial infections

Stasis of Liver Blood

  • Produces infertility in hensCan produce vomiting of blood and nose bleeds
  • Dries out the nasal and sinus passages, predisposing birds to infections

Vaccine Protocol


We recommend vaccine protocols that are created specifically for each animal. Animals that are living indoors are less likely to need certain vaccines. Animals that have had repeated vaccines are less likely to need certain vaccines. ALL animals that have acute or chronic diseases should not be vaccinated. This includes animals with disorders such as food allergies, skin allergies, chronic bouts of diarrhea, chronic eye and ear infections, and any immune or autoimmune associated disorder.

Do not vaccinate any animal with any acute or chronic disease! Vaccines can cause great harm in sick animals. Even animals with "minor" issues such as diarrhea should never be vaccinated during the illness. No pregnant or lactating bitch should receive vaccinations

NOTE: While this schedule is the one I recommend, there is considerable controversy within this evolving field of vaccinology. Until we have more information, vaccine protocols will remain a matter of professional judgment and choice.

General Vaccine Guidelines For All Animals:

  1. When possible, give individual vaccines, not combinations (some vaccines only come as combinations, and there is no option to give separately)
  2. Never give a vaccination while other procedures are being performed, such as dentistries, surgery, grooming and boarding (these situations are already creating stress to the immune system)
  3. Never vaccinate a sick animal, no matter how mild the illness
  4. Never vaccinate a pregnant animal
  5. Do not vaccinate at too young an age as they still have maternal immunity which prevents the vaccine from working


Rabies vaccine is licensed by the Federal Government to be effective for at least three years. We recommend that you always keep your animal's rabies vaccine current as required by law. In most states, rabies vaccines are required in dogs and cats. The first vaccine should be given after twelve weeks of age and before six months of age. One year after the first rabies vaccine is given, a second rabies vaccine is required. Thereafter, rabies vaccines should be given as required by the laws in the state in which you reside (generally every three years).


Rabies vaccine as required by law

Feline Panleukopenia vaccine (Feline Distemper)

Although somewhat controversial among conventional doctors, a considerable body of evidence has led researchers to believe that feline distemper vaccine, once given as a kitten, provides lifelong protection in almost all cats.

We recommend a series of two shots. The first vaccine is at 8-9 weeks of age, and the second is given at 12-13 weeks of age.

We do not recommend yearly Feline Distemper vaccines. The Association of Feline Practitioners recommends Panleukopenia every three years. For cats in high-risk situations, we recommend a Blood Titer Test to check levels of immunity every three years.

Feline Leukemia Virus (FeLV)

Feline Leukemia Vaccine is controversial in that the vaccine is extremely ineffective, especially when compared to the effectiveness of other vaccines. Kittens are at greatest risk, and the best protection you can give a kitten is to keep the kitten indoors for the first year of its life.

The reported vaccine effective rate varies from 0% of vaccinated cats protected to 67%. One of the more interesting studies involving natural infection (as compared to a lab setting) showed no protection.

Feline Leukemia was first recognized as a disease in the late 1970's. It was not around before then. Since then, the incidence of Leukemia in cats has rapidly decreased. Today, the disease can be considered to be rare. What is the reason? Naturally acquired immunity! It is well known that almost all cats that are immune competent (their immune system is working at normal levels) and are over 10 months of age, once exposed to the Feline Leukemia Virus, develop resistance, remove the virus from their body, and become immune to future infection. Since the vaccine has such a poor rate of success, and since natural immunity protects almost all cats, there are few cats with leukemia now, entirely due to natural immunity.

Other than a few instances where the risk of contracting feline leukemia is at a very high level, we do not recommend leukemia vaccines.

The reasons are:

  1. The vaccine does not protect cats well
  2. Repeated vaccines do not improve its effectiveness
  3. The vaccine causes incurable cancers (fibrosarcoma) in roughly 1 in every 2,000 - 5,000 cats
  4. The vaccine can cause vaccinosis (a homeopathic term that means the animal develops a relatively permanent degradation of their vital health)
  5. All vaccines can degrade health, so any vaccine is a risk vs. benefit assessment
  6. Use of the vaccine gives the caretaker a false sense of security, when the caretaker should instead be aware of the more important methods they can employ to protect their cats (keeping the kitten indoors for the first year of life)


  1. Rabies
    Rabies vaccine last for several years, certainly more than the three years it is licensed for. However, you should keep your dogs current with state requirements
  2. Canine Distemper/Parvo Vaccines
    For most animals, we recommend vaccinating for the two most serious diseases, Distemper and Parvovirus. Most vaccines come in combinations of several diseases in the same shot. If you select a combination vaccine, we recommend the one with the least number of diseases in the vaccine; that would include Distemper and Parvovirus

9 weeks: MLV Distemper/Parvovirus only

Less than 12 weeks: MLV Distemper/Parvovirus only

16-20 weeks: MLV Distemper/Parvovirus only

  1. From then on, we do not believe dogs need further Distemper/Parvovirus Vaccines; however, high-risk animals could have titer checked. If a titer ever shows a protective level, these vaccines are certainly good for life; no new titers need be taken.
  2. We do NOT recommend Bordetella, Corona virus, Leptospirosis or Lyme vaccines. In rare situations, one or more of these vaccines might provide limited benefits.
  3. Giardia Vaccine
    Studies show that their mother and/or the kennel environment have exposed essentially 100% of all dogs to Giardia, almost always from birth.

    It makes no sense to use a vaccine when the primary infectious agent has already been seen by the dog's immune system (the Giardia).

    Thus, we never use this vaccine


In short, there are NO vaccines that are appropriate for psittacine (parrot type) birds.

Let's look at the vaccines that are available:

  1. Polyoma Virus Vaccine
    One vaccine that is rarely recommended as a routine vaccine in pet birds is thePolyoma Virus vaccine.

The Myth: In reading about Polyoma virus, some fear-based articles discuss how so many species are susceptible to the disease, and how the number one symptom that your bird might develop is sudden death; they simply look fine one day and die the next with no warning.

What they fail to mention is that these birds that die suddenly are nestlings, or, more rarely, fledglings. By the time they have fledged and developed into young birds suitable to leave the aviary, they are no longer at risk for the virus.

There are a number of other symptoms attributed to this virus, including the nebulous concepts of "chronic subclinical illness", and "carrier birds". Again, lets look at the facts. If a bird is a carrier, then no vaccine will change that, and the bird will, in all likelyhood, remain healthy for life. And since adult birds almost always develop immunity, the rest of your flock is safe from the carrier.

The vaccine is claimed to be "95%" effective (a figure that is pulled out of thin air, by the way). So, why not vaccinate your birds on a yearly basis?

The Fact: Polyoma is entirely a disease of immature birds (nestlings; before they have grown out their feathers). Adult birds are completely resistant to the disease, and don't benefit from the vaccine. Self-protection, being nearly 100%, is far better than anything the vaccine can offer.

The Polyoma "epidemic" has come and gone entirely on its own. Improved sanitation and breeding techniques have produced healthier birds. These birds don't ever develop overt disease if exposed to Polyoma Virus. As an Epidemiologist by training, I can assure you that there have never been enough birds vaccinated for Polyoma virus to even slightly dent the incidence of Polyoma virus disease. The disease, like most diseases, is simply going away due to a bird's natural ability to develop self-immunity.

The rare case where an adult bird might develop this disease would be in a bird already immunologically compromised to the point that the vaccine would not alter the course of the disease. Even in aviaries, the vaccine is extremely questionable since very young birds (the most susceptible to the disease) can't respond to the vaccine. By the time these fledglings can respond to the vaccine, they likely can or have developed natural immunity! The window of opportunity that the vaccine might help is so small as to make it impractical in most aviaries.

In over 20 years of practice and far more years as a bird owner, I have never seen an adult bird develop Polyoma Virus. Any reasonable analysis would decide that the risk of adverse effects from the vaccine far outweigh any potential benefit.

Finally, lets look at the concept of yearly vaccination for Polyoma virus. Leaving aside the fact that the vaccine has no place in medicine (again, adult birds are completely resistant on their own to the disease), IF the vaccine was so effective, then after being given once, there would be no reason to continue to vaccinate a bird. Effective viral vaccines provide protection that lasts a lifetime.

  1. Pacheco Virus Vaccine

A second vaccine that is rarely used is the Pacheco Disease, also called Herpes Inclusion Body Hepatitis vaccine. Herpes viruses are known to be exceedingly difficult to vaccinate for. Genital herpes in people, for example, has proven completely resistant to the development of an effective vaccine. It is highly unlikely, therefore, that the Pacheco Virus vaccine provides any significant protection. This vaccine has shown a high rate of mortality immediately after the vaccine is given. We do not recommend its use.

  1. Pox Virus Vaccine

A final vaccine to consider is Pox Virus vaccine. While there is no Pox Virus vaccine available for parrot-type birds (hookbills), several species of birds do have Pox Virus vaccines available for use. In species for which there are vaccines available, the protection is poor following vaccination, but may be warranted in limited situations.

Vomiting and Regurgitation in Dogs and Cats



Dogs and cats commonly vomit and/or regurgitate food or stomach contents. Vomiting can be a normal and even healthy event for dogs and cats. Dogs will often eat things that do not agree with them. Cats might need to eliminate hair balls. The purging action of vomiting brings the body back to health. It will eliminate toxins in the stomach.

There is no cause for alarm if your dog or cat vomits once or twice a month. However, frequent episodes of vomiting or regurgitation is not normal. The animal the vomits regularly has a problem and should be treated.

Causes of vomiting animals:

  1. Foreign Bodies (hair balls, plastic, bones, dogs that eat anything they find)
  2. Poor digestion in the small intestine (this slows stomach emptying, the food that remains in the stomach too long becomes acidic the animal feels bloated)
  3. Gastric Ulcers
  4. Cancers (very uncommon)
  5. A side effect of many medications (pain relief drugs, such as Rimadyl, aspirin, predisone, cortisone, and many others)
  6. Lack of digestive enzymes
  7. Inflammatory Bowel Disease (IBD)

What to do?

Acute Vomiting

This is a common event in dogs and cats. It is not common in birds, unless it is behavioral or sexual regurgitation, and should be treated in birds as a serious condition. An avian veterinarian should be consulted.

Dogs and cats that are vomiting should be assessed at home: are they acting reasonably fine, even thought they are vomiting? If so, treat at home by following these guidelines.

  1. Feed a bland diet, consisting of 2/3 rice, sweet potato and oatmeal and 1/3 of the meal should be well cooked non-fatty meats. These include fish, chicken and buffalo.
  2. Feed only 1/2 of the normal amount of food at a time. Even better, feed several small meals until the vomiting has subsided.
  3. Support your animal with herbal products that soothe the stomach. One such herb is aloe vera. One of our favorite products is a Chinese combination herbal product called Calm Stomach

Monitor these milder cases, for several days. If your companion has not stopped vomiting after a 3-5 days, we are now dealing with chronic vomiting.

Chronic Vomiting

More serious cases, especially if the dog, cat or bird clearly does not feel well, need a routine exam and work-up that will include radiographs, blood tests, and maybe ultrasound. If you find an underlying disease, treat for that.

Western medicine traditionally uses products that stop the production of acid in the stomach (e.g.. Tagamet Pepcid. This is not a good idea in most cases, since the stomach acid is present to improve digestion. Lowering the stomach acid can lead to dysbiosis, bacterial infections, chronic ulceration, and candida (yeast) overgrowth. It is also common to use motility modifiers that pass the food through the stomach more rapidly than normal (e.g. Reglan). Before using these products, try using the rest of the ideas we have on this page for vomiting and diarrhea.

If the underlying cause can not be cured, (for example, stopping a dog from drinking contaminated water or eating indigestible foods), then we recommend that herbs and nutraceuticals be used to enhance digestion, heal the stomach and intestinal lining cells, and bring the body back into health.

What NOT to do:

  1. Don't feed blander and blander commercial diets, you are simply feeding food devoid of any true nutrition and not addressing the real problem
  2. Don't feed hypoallergenic diets. The vomiting is almost never due to allergies and these diets really work by being over-processed to the point that you are really feeding a soup based diet (put a piece of the dog food in water and watch it dissolve to nothing).
  3. Don't feed commercial diets, they are not as wholesome as home cooked foods.

Finally, a chronic vomiting animal is sick, and the the problem needs to be corrected, not masked using drugs that decrease acid production and increase stomach emptying (metoclopromide). If the therapies we suggest do not work and you live too far away to get to our clinic we recommend you call for a Phone Consult appointment.