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Use of Homotoxicology in treatment of feline hypertrophic Column cardiomyopathy: a clinical case report Summarized from a more complete article cited as: Palmquist R, Broadfoot P, Kari S. Use of homotoxicology and biological therapy in treatment of feline hypertrophic cardiomyopathy: a clinical case report. JAHVMA 2006;25(1):30-7. Introduction determination and thyroid levels. Consultation with a veterinary cardiologist was suggested. Consider q3d aspirin therapy. This paper documents a single case treated utilizing a biological thera- 5. Vital Measurements: these measurements are summarized in Table 1. peutic approach consisting of applied Homotoxicology theories, anti- A work-up consisting of CBC, chemistry panel, T4, Doppler blood homotoxic medications, nutraceutical agents and herbs. The possibility pressure and urinalysis was recommended and performed. The owner of an effective means of early intervention for cats with HCM is highly wished to wait until further tests were completed before starting drug attractive and worthy of examination. therapy. Most veterinarians offer conventional pharmaceutical therapy for these cats. Nutritional and orthomolecular treatments may gain popularity as May 5, 2003 scientific evidence of their usefulness accumulates. Pharmaceutical treat- CBC, chemistry and T4 values were within normal ranges. Systolic blood ment of asymptomatic cats has not been shown to be beneficial and is pressure was determined by Doppler probe and was normal (150 mmHg controversial (Baty, 2004). Other modalities exist that may be helpful determined five times). Mild hematuria was noted and urine specific in management of these patients. , , gravity was 1.055. No other urine chemistries were abnormal. No culture , gemmotherapy, , glandular was obtained. The owner was advised of the cardiac test results and agents, whole food nutrition, flower essences, , and declined therapy. The client was advised that early treatment was not Homotoxicology are some of the commonly used alternative therapies. proven to be beneficial, and she preferred to withhold drug treatment and The complete literature of these modalities can be difficult to locate and to recheck the echocardiogram at a later date. She was further advised that is often not included in larger databases such as PubMed1. sudden deterioration, including sudden death syndrome could occur, and that she should call the office if any signs of heart failure were noted. After Signalment further discussion, the client requested a Homotoxicology approach in Wiley is a neutered-male, domestic short hair cat born in 1998 (eight hopes that early intervention might reduce levels of homotoxins and slow years old). He is grey and white in color, and resides inside a metro- or reverse the disease process. The client was advised that this was theo- 13 politan city apartment. He was vaccinated for unknown agents as a retical and not evidence-based therapy. kitten and had not received any other vaccinations for three years prior Therapy with antihomotoxic medicines and nutritional supplements to presenting to our clinic. There was no known history of prior illness. began according to this initial prescription: He ate a conventional dry cat food. His feline leukemia and feline 1. Cor compositum®, Engystol N®, Ubichinon compositum®, Coenzyme immunodeficiency virus status are unknown. compositum® 0.5 ml of each product given subcutaneously. Presenting Complaint and History 2. Formula CV®2, 0.5 capsule once daily PO. 3. Galium-Heel®, Cralonin®, Berberis-Homaccord® mixed together and April 26, 2003 given at a rate of 5 drops PO BID. Wiley presented for his annual examination. On examination, his pulse, 4. Owner declined other nutraceuticals (vitamin E and coenzyme Q-10), respiration and heart rate were normal. No pulse deficits or arrhythmias as cat was hard to medicate. were noted. No gallop was noted. A heart murmur was present. An elec- 5. A recheck examination was scheduled for three weeks later. trocardigram and echocardiogram were recommended. The owner declined an electrocardiogram, and an echocardiogram was scheduled. May 22, 2003 Wiley’s heart rate had decreased from his prior visit and was 140BPM May 2, 2003 (on entry to the exam room) to 120BPM once he had relaxed. His Echocardiography by an outside echocardiologist revealed the fol- weight was 13.1 lbs. A gallop rhythm was not detectable and his mur- lowing: mur was unchanged. No discharges or other issues indicating regressive 1. 2D Echocardiogram: the interventricular septum (IVS) was or progressive vicariation were evident. The decreased heart rate was moderately severely thickened. The left ventricular posterior wall encouraging and further nutraceuticals were prescribed to include: (LVPW) was moderate to moderately severely thickened. The left 1. Coenzyme Q-103, 30 mg per day PO. ventricle was small. The right side of the heart and the other cham- 2. Vitamin E, mixed tocopherols4 100 IU/day PO. bers appeared relatively normal. No masses or effusions were seen. 3. The May 5, 2003 prescription plan was continued unchanged. Mild systolic anterior motion of the mitral valve (SAM) was present. 4. Recheck examination was scheduled for three weeks. 2. Doppler Echocardiogram: pulmonary artery/right ventricular out- flow tract (PA/RVOT) Vmax =1.49 m/s (turbulent). Aorta (Ao) July 27, 2003 Vmax=1.98 m/s (turbulent). Trivial mitral regurgitation was seen Wiley’s heart rate was stable between 140BPM on entry (excited) and with color and spectral Doppler. 120BPM once calm. His weight had increased to 14.0 lbs. It was deter-

3. Interpretation: moderate to moderately severe concentric hyper- mined that the owner had stopped giving our Coenzyme Q-10 and was 2006 Fall trophy. Differential diagnosis included systemic hypertension, hyper- giving 50 mg per day of another brand obtained from a health food thyroidism, and Idiopathic Hypertrophic Cardiomyopathy vs store. No gallop rhythm was noted. The prescriptions were continued infiltrative myocardial disease. The acceleration in LVOT, turbulence and an echocardiogram was scheduled for August. in the pulmonary artery/right ventricular outflow tract and mitral regurgitation were likely responsible for the murmur. Secondary August 27, 2003 changes were moderate to moderately severe at that time. Evidence Echocardiogram repeated by the same outside echocardiologist. for significant diastolic dysfunction was not appreciated. Cats with Findings included: heart disease may be at risk for thrombus formation. 1. 2D Echocardiogram: moderately severe hypertrophy of the LV and

4. Recommendation: consider beta-blocker therapy, blood pressure IVSd had increased from 7.3mm in May, 2003 to 7.8mm today). Therapy Journal of Biomedical 14 Journal of Biomedical Therapy Fall 2006

6. Recheck examinationrecommended in60days. cocktail andgiven orally5drops BID10-20minutesbefore meals. Column VET 5. Galium-Heel 4. Corcompositum capsule BIDPO. 5. 4. 3. 2. scriptions were never filled. continue thehomotoxicology andnutritionalsupport. pre-The drug provided withaprescription foratenololandenalapril,sheoptedto financialrequirements.after accumulatingthenecessary The clientwas recommended andaccepted,buttheclientsaidshewouldreturn later orally. Anelectrocardiogram andconsultationwithacardiologist were Tapeworms were notedand34.5mgofpraziquantelwere administered icate butcontinuedtotakethecoenzymeQ-10intermittently. togive 5dropswith instructions BIDPO. The catwasdifficulttomed- ing ofequalamountsChinaHomaccord The Homotoxicology cocktailwasreformulated anddispensedconsist- pharmaceuticals. regarding medicationensuedandtheowner againdeclinedcardiac showing noexercise intolerancepertheowner. Further discussion pulse ratewasrapid,andmucusmembraneswere normal.He was unchanged andhisweight haddeclinedfrom 14.75lbsto13.7lbs.His had Q-10 Wiley wasrefusing allbuttheHomotoxicology cocktail.Coenzyme December 2,2003 3. Formula CV 2. Vitamin E,mixed tocopherols 50IU/dayPO. 1. CoenzymeQ-10,30mg/dayPO. The following therapeuticprogram wasprescribed atthistime: andHomotoxicologynutritional support only. cardiomyopathy.hypertrophic The clientunderstoodthisandoptedfor serious andoftenirreversible/progressive/fatal nature ofidiopathic for holisticoptionsthisdisease.Adiscussionensuedregarding the Drug therapywasdiscussedanddeclinedagainby theclient,whoasked minute (BPM). The electrocardiogram showed anormalsinusrhythm. The catfeltfineandwasactive andplayful.Heart ratewas174beatsper The clientreturned fortheelectrocardiogram recommended inAugust. October 31,2003 Table 1. forWiley. data ofechocardiographic Asummary R17171714160 64.3% 94.1% 164 10.2mm 4.5mm 44.2% 9.1mm 79.7% 5.4mm 147 7.2mm 1.32 12.7mm 6.8mm 0.2mm 6.6mm 51.2% 7.9mm 85.9% 4.8mm 13.5mm 7.2mm 10.2mm 11.8mm 197 8.4mm 0.2mm 1.32 4.3mm 64.5% 8.8mm 94.1% 14.4mm 8.1mm 10.9mm 7.0mm 8.8mm 9.4mm 0.2mm 4.9mm 197 1.28mm 1.3 37.0% 12-22-05 14.4mm 72.0% 7.8mm 11.0mm 1.38mm 7.8mm 0.0mm 7.5mm 2-25-05 6.4mm 8.4mm 12.5mm HR 1.47 FS 10.9mm 5.9mm EF 10.2mm 7.3mm 1-22-04 LVPWs 0.4mm LVIDs 13.9mm IVSs LVPWd 10.9mm 8-27-03 LVIDd 1.28 IVSd EPSS ratio LA/AO LA 5-2-03 AO Parameter Vital Measurements: but notelectedby theclient. anelectrocardiogramdiologist andperforming were recommended, adding furosemide andaldactoneasneeded.Consultationwithacar- Recommendation: the increased seen. concentrichypertrophy examination. The decreased LV to chambersize waslikelysecondary Interpretation: were noted. Doppler Echocardiogram: increased. valvular insufficiencieswere appreciated. Cardiac contractilityhad The LV chambersize wasmoderatelydecreased. No significant been given “only afewtimes.” Wiley’s murmurwas ® ® , onehalfcapsuleperdayforweek thenonehalf , Cralonin ® mild progression sincetheprevious ofhypertrophy , 0.5mlvialgiven subcutaneouslyintoBL15. considered beginningenalaprilandatenolol these measurements are summarized in Table 1. ® , andBerberis Homaccord no significantchangesfrom May 2003 ® , Cralonin ® ® combined ina , Aurumheel ® 5. 4. Homotoxicology formulaandrecheck inseveral months. for givingusaccurateinformation,andadvisedtocontinuethe two tothree timessincehislastexamination. The owner wasthanked the cat,ashewasresistive. Wiley hadreceived CoenzymeQ-10only The owner confessedthatshewasnotreally givingCoenzymeQ-10to 3. 2. 1. included: Echocardiogram repeated withthesameoutsideoperator. Findings January 22,2004 1. included: Echocardiogram repeated withthesameoutsideoperator. Findings December 22,2005 3. 2. 1. included: Echocardiogram repeated withthesameoutsideoperator. Findings February 25,2005 4. Vital Measurements: prognosis isfairtoguarded. gram isrecommended in12monthsorasclinicalsignsdictate. The is tion of thecardiac muscle,however myocardial degenerationorinfiltra- muscles lary responsible forthemurmurheard. The changesseeninthepapil- RVOT toconcentricchangeand likely waslikelysecondary 22,2004) 27, 2003to7.0today(January change wasdecreasing, however (7.3onMay 2,2003to7.8onApril Recommendation: Interpretation: No regurgitation wasappreciated. Ao Vmax=1.2m/s (laminar). Doppler Echocardiogram: tricular outflow tract).No massesoreffusionswere seen. transverse views. The anteriorIVSdippedintotheLVOT (leftven- muscleswere thickandhyperechoicpapillary asvisualized inthe 2D Echocardiogram: 2D Echocardiogram: Interpretation: Vmax=1.6m/s (slightlyturbulent).Ao Vmax=1.23m/s (laminar). Doppler Echocardiogram: closer to7.2). gram). No massesoreffusionswere seen.IVSd=5.1-7.2(average were notoverly hyperechoic (relative totheprevious echocardio- muscles was notcompletelyclosedduringsystoleandthepapillary relatively normal. The musclesappearmoderatelythickened. The LV 2D Echocardiogram: sis remains fairtoguarded. Recommendation: diograms. PA/RVOT outflow velocity wasimproved over previous echocar- ance), however overt diastolicfailure wasnotappreciated. relaxation time)suggesteddiastolicdysfunction(decreased compli- Continuewithpresent therapy.dynamics). ly represent subtleimprovement (inbothmusclethicknessandhemo- a consideration. and LVPW likelyrepresent fibrotic/remodeling changes the changes seen in the heart arethe changesseeninheart atleaststatic,but moderate concentrichypertrophy. recheck echoyearly orasindicated. The progno- continue present therapy. Recheck echocardio- these measurements are summarized in Table 1. chamber sizes were relatively normal. The PA chamber sizes, valves andcontractilityappear chamber sizes were relatively normal. The PA/RVOT(turbulent). Vmax=2.89m/s all valves are competent.PA . The turbulenceinthe The IVRT The concentric (isovo lumic like- VET

was lightly dilated. The papillary muscles were large, irregular and Homotoxicology. Modern medicine is just awakening to the possi- Column hyperechoic as seen on previous scans. There is a small portion of the bilities inherent in mitochondrial therapies. LVPW, which was thin (infarction). Contractility was good. The • Galium-Heel®9 is a broad usage preparation which promotes detoxi- IVS was the same thickness (7.2 mm) as the previous study. No cation of the cellular milieu. masses or effusions were seen. The right side of the heart appeared • Cralonin®10 contains Craetaegus (Hawthorne) and is indicated in cases relatively normal. The valves appeared normal. of decreased cardiac output, strict affectation and tropism of cardiac 2. Doppler Echocardiogram: IVRT=60ms. Mitral inflow=0.69m/s tissues, for cardiac decompensation, and serves as a “heart tonic”. with E/A superimposition. Pa Vmax=1.95m/s (moderately turbu- • Berberis-Homaccord®11 for cardiovascular collapse and fainting lent) Ao Vmax= 0.82m/s (moderately turbulent). attacks, thready pulse, and asthmatic constriction of the chest, which 3. Interpretation: the hemodynamics were relatively normal and are characteristic of the Veratrum fraction, as well as support of the unchanged from previous studies. There was a small area of renal system, and adrenal function (Reckeweg, 2002). infarction in the LVPW. Cardiac muscle remodeling/fibrosis was • Aurumheel®12 for vegetative-functional coronary and circulatory evident as before. Significant diastolic dysfunction was not appreci- disorders, hypotension, disturbance of the rhythm of the heart ated. Advised to maintain same treatment regime. (package insert). 4. Recommendation: continue present therapy. Recheck echocardio- • China-Homaccord®13 for exhaustion and debility (package insert). gram was recommended in 12 months or as clinical signs dictated. It is the authors’ sincere hope that research into antihomotoxic medi- The prognosis remained fair to guarded, however the disease did cines and the application of Phase Theory as created by the founder of not appear to be significantly progressing. The infarct was cause for Homotoxicology, Dr. Hans-Heinrich Reckeweg, will lead veterinarians concern. toward more effective therapies for their cardiac patients. Broadfoot, Palmquist, and Demers currently have many cardiac patients that are August 31, 2006 responding well to treatment programs utilizing an integrative Wiley continues to do well in his new home. Follow-up echocardio- approach, and some of these have been presented in Homotoxicology grams are scheduled for six months. training opportunities, but such cases do not appear in journals read by the majority of the members of the veterinary profession. Currently Discussion Palmquist has three other feline idiopathic HCM cases, which have Biological therapy utilizing antihomotoxic medicines in manage- shown marked clinical improvement and one demonstrating ventricu- ment of cardiac disease in veterinary patients has been reported lar thinning in less than six weeks of therapy. It is likely that other cli- anecdotally (Broadfoot, 2005), (Demers, 2005), (Palmquist, 2005). nicians utilizing Homotoxicology have successful case outcomes but Homotoxicology formulas are well established for cardiac and vascular they are not published or accessible for examination at this time. diseases in humans and are frequently used in European countries Homotoxicologists must take responsibility for our individual case (Schroder, 2003). successes and see that the results are published and shared with others. 15 The exploration of biological therapies in veterinary medicine is just While single case reports do not carry much evidentiary weight, they beginning in earnest. Interest in veterinary Homotoxicology is rela- are of value, because from these successful outcomes it may become tively new in the United States and many cases are treated without possible to greatly improve treatment outcomes for our patients. undergoing full diagnostics making documentation difficult. Researchers interested in biological therapies can use these case studies Clinicians have observed clinical improvement in these patients, but it to embark on more detailed studies and ultimately on double-blind, can be challenging to prove their precise effects in a clinical setting. placebo-controlled studies capable of satisfying demands for evidence- This case clearly demonstrates the potential value of these products in based therapies in our profession. This move is underway in Europe a single case. This case presentation will not answer the question as to and is overdue here in the United States. Such studies are important to which component of the therapeutic plan was responsible for the the preservation of our profession’s ability to obtain satisfactory results improvement. Further studies will be needed to assess whether all parts in the management of our patients. are necessary to the successful outcome observed here. It may well be FOOTNOTES that other agents may be added to improve the rate and degree of 1. PubMed. www.pubmed.gov. 2. Formula CV. Rx Vitamins for Pets: Professional Veterinary Formula, Hawthorn recovery. The field is ripe for research for those with inquiring minds. Berry (standardized 3.2% vitexin)100mg, L-Carnitine (pharmaceutical grade A brief review of the Homotoxicology medications used may give some amino acid)100mg, L- Taurine (pharmaceutical grade amino acid)50mg, Vitamin E (d-alpha tocopherol succinate) 75 IU, Dimethylglycine (DMG) 10 mg, insights as to their value in these cases: Magnesium (citrate) 10 mg, Potassium (citrate) 10 mg, Coleus Forskolii 10 mg, ® 5 Selenium (selenomethionine) 5 mcg. • Cor compositum is indicated for thickening of the walls of the ven- 3. Co Q10-30 softgel caps. Rx Vitamins for Pets: Professional Veterinary Formula. tricles with an associated increase in systolic pressure and decreased 4. Vitamin E Mixed Tocopherols, unknown brand, which client purchased from arterial flexibility. It has a wide range of action, with benefits as a health food store. 5. Cor compositum®, Heel. stimulator of cardiac muscle compromised by fatigue and metabolic 6. Engystol N®, Heel. or toxic issues, particularly in geriatrics. It is useful in myocardial 7. Ubichinon compositum®, Heel. diseases with hypertrophy and/or cellular storage pathologies 8. Coenzyme compositum®, Heel. 9. Galium-Heel®, Heel. ®6 • Engystol N , though primarily considered a medication for viral 10. Cralonin®, Heel. disease which may in fact, be an underlying issue in some cardiac 11. Berberis-Homaccord®, Heel. 12. Aurumheel®, Heel. diseases, (much like Rheumatic fever in humans), has other tissue 13. China-Homaccord®, Heel. effects, and has been used in a variety of mesenchymal diseases. It REFERENCES owes much of its activity to Sulphur, which is the major ingredient Baty C. 2004. Feline hypertrophic cardiomyopathy: an update. Vet Clin North Am in practically all cellular phases, and particularly in impregnation Small Anim Pract. Spe;34(5): 1227-34. Fall 2006 Fall phases. Therefore, those cases that are unresponsive to the proper Broadfoot, P. 2005. Heart Happy Homotoxicology, in proceedings of antihomotoxic medication should have Sulphur intermittently. AHVMA/Heel Homotoxicology Seminar, Denver, CO., pp 71-98. ®7 ®8 Demers J. 2005. Cardiovascular Disease (Homotoxicology and TCM), in pro- • Ubichinon compositum and Coenzyme compositum . These ceedings of AHVMA/Heel Homotoxicology Seminar, Denver, CO., pp 98-104. products are critical catalysts for the mitochondrial respiration chain Palmquist R. 2005. Clinical Case Presentation, in proceedings AHVMA/Heel and the citric acid cycle. The need for agents that enable the body to Homotoxicology Seminar (Cardiology), Denver, CO., pp 106-108. “jump start” the systems that provide for the cellular functions Reckeweg H. 2002. Homeopathica Antihomotoxica Materia Medica, 4th ed. Aurelia- cannot be overstressed. Both of these preparations have far reaching Verlag, Baden-Baden, Germany, p 196, 260-262. Schroder D, Weiser, M, and P Klein. 2003. Efficacy of a homeopathic Crataegus implications for body organs that are as energy consumptive as the preparation compared with usual therapy for mild (NYHA II) cardiac insufficiency; cardiac system. Their action is truly unique to the field of results of an observational cohort study. Eur J Heart Fail. Jun; 5(3): 319-26. Journal of Biomedical Therapy Journal of Biomedical