vet-skeptech

[vet-skeptech]

Essential oils are big right now. I’m currently in a FB tech group arguing against the use of diffusers in animal hospitals (no proven benefit, slight but very real proven risk, especially with birds, pocket pets, and cat with respiratory issues).

Somebody brought up the point that essential oil diffusers are often enough to aggravate asthma symptoms in humans, let alone smaller animals!

[vet-skeptech]

Radagast Pet Food (a local Portland company) is shutting down production of their Rad Cat frozen raw cat food due to the financial stress of fees associated with recent recalls- various lots tested by the FDA have come back positive for Listeria monocytogenes, Salmonella enterica, and Escherichia coli. Theoretically this was before any pet/human illnesses were reported, but I’ve seen one or two people online claim that they’ve reported illness and been ignored.

The company sent my store a hilariously unprofessional notice, blaming just about everyone but themselves for the problem and promising to resume production as soon as they get their finances back in order.

Now seems like a great time to remind everybody that while raw meat is the natural diet of wild felines, it can still pose a health risk to domestic cats (and the humans they live with!) Wild cats, as well as feral and indoor/outdoor cats, generally consume their prey immediately after they kill it. The commercial handling, transportation, and long term storage of raw meat greatly increases the risk of contamination. It poses a human health risk as well as a feline one, as bacteria can and will get all over your kitchen if you’re leaving raw meat out for your cats. Even animals who do not become ill can spread the bacteria in their feces.

From a 2011 literature review:

“Clearly, there is some compelling evidence suggesting that raw food diets may be a theoretical risk nutritionally. In addition, raw food poses a substantial risk of infectious disease to the pet, the pet’s environment, and the humans in the household....There is...sufficient evidence available that veterinarians should feel obligated to discuss the human health implications of a client’s decision to use a raw meat-based food for their pet.”

[vet-skeptech]

Regardless of the ongoing research & debate about how useful probiotics are for digestive issues/mood/etc, there’s a more basic issue at play here- making sure that you actually get what you pay for. Probiotics aren’t classified as drugs, but as supplements, which means they aren’t regulated by the FDA. In 2011, a Canadian study evaluating 25 commercial veterinary probiotics found that only 4 of them met or exceeded the claims made on their label about the number of live, viable organisms in the product. Quite a few of them actually contained no live organisms at all. Of the 4 that passed the test, Purina’s FortiFlora is the brand of choice for most veterinarians who recommend or sell probiotics.

(Unfortunately, this particular study didn’t test the probiotic brand that I bought a while ago while dealing with your classic mysterious vomiting cat issue, but I have no real faith in it. Its important to remember that frustration at an intractable problem, and the hope for a miracle cure, can sell almost anyone almost anything, even against their better judgement. Even skeptics.)

[vet-skeptech]

Wikipedia has a short and accurate article about Bach Flower Remedies, which I would recommend reading. You will often run into them in health food stores or other places with an alternative medicine vibe. Rescue Remedy, a blend of five different BFRs, is intended to provide a sense of calm in situations of great fear and stress. Is is often sold in an alcohol-free formula for pets, usually dogs. Although Rescue Remedy is far and away the product I most commonly hear recommended by dog people, the company maintains that all of its products work on nonhuman animals. Here is an excerpt of their claims:

It is worth noting that the phrase “veterinarian recommended” is vague enough that it is not regulated by the Federal Trade Commission and means nothing.

[vet-skeptech]

mom sent me this from Italy today! looks like a coupon for a homeopathic pharmacy that also sells veterinary products. 🙄

[vet-skeptech]

1. not a gerbil

2. my childhood friend lost a significant number of actual gerbils by being this cavalier with rodent/feline interactions

gerbil riding cat

[vet-skeptech]

Alrighty, so I tried something a little different for this video, putting it somewhere between a case study and an explanation of the pathology and treatment. I think it makes it more interesting, even though it makes it a longer video. Tell me what you think of the format.

There’s also some procedure footage in there, but it is very tame and not at all gory, considering the topic.

Cat penises, folks. The topic is cat penises and what happens when they get blocked.

[vet-skeptech]

this product is so patently absurd that I’m just gonna let RationalWiki take it

[vet-skeptech]

a vet I was talking to today told me that she was trained (on the job) in holistic veterinary medicine as a technician. she never questioned any of the complementary therapies they used until after she graduated from vet school and went back to the same practice to work there as a doctor. 

in her words: “and it wasn’t until then that I realized oh, this is all pretend!”

[vet-skeptech]

2 bloggers discuss the issues

Me: I’m a vet tech student just starting my first clinical, and the hospital I’ve been placed at uses a low level laser on every incision, to “reduce pain and inflammation and speed up healing”. I’m skeptical, but certain that as a student being given a month-long learning opportunity, it would not be appropriate for me to bring up my concerns. (They already have a robust pain management protocol in place, so I’m not sure why additional therapies would even be necessary, but its not harming anyone.) The doctor claims that there is solid scientific evidence supporting its efficacy, but she also does acupuncture, so who knows. I feel like an idiot wearing goggles and waving a laser around, but writing off the whole thing as fake (or even just unproven) threatens my ability to trust what I’m learning from these people. They’re a long-established, well-respected, busy clinic with devoted clients. How does one separate the wheat from the chaff?

The SkepVet: Unfortunately, the way our human brains work, confidence in nonsense is not incompatible with being smart, competent, and well-meaning. Perfectly rational, excellent doctors who practice fundamentally sound medicine often throw in a little nonsense that they have great faith in. At its core, this faith usually comes from anecdotal evidence, their own or someone else's, which we know is unreliable. However, cognitive dissonance and confirmation bias, among other cognitive quirks, lead us to seek support for whatever we believe, regardless of where that belief comes from. Therefore, such folks often skim the scientific literature and unconsciously cherry pick from it, ignoring the flaws in studies that support their beliefs and exaggerating the limitations of research that doesn't. The end result is the absolute confidence that science supports whatever they happen to believe in, even when it really doesn't. As you can see from my articles on the subject, there is not robust scientific evidence to support clinical uses of laser in small animal medicine. The evidence in favor is weak, and there are at least two clinical trials in dogs at this point showing no benefit. This will almost certainly not convince your mentors, who will either reinterpret the evidence in a way that agrees with their belief or fall back on the "well, I've seen it work for my patients" line, which of course can be used to support anything from lasers and stem cells to homeopathy and faith healing. This doesn't mean your teachers aren’t smart or right about other things, only that they share the same cognitive biases that lead all of us astray from time to time, particularly the trust in one's personal experiences regardless of contradictions in controlled research evidence. My advice is to always ask for specific evidence for anything you wonder about, and to learn how to find and evaluate this evidence for yourself. That's what evidence-based medicine is all about, and you don't have to be a vet or an academic to utilize it. There probably is no value to challenging specific beliefs held by people you work with until you have an established relationship and they know you and the consistency of your scientific approach, not just to new or "alternative" therapies but to everything. I think I have changed minds about some things, but I have been in the same practice for almost 15 years, and I have aged into a position where people respect my knowledge and experience even when they disagree with me, so it's an easier place to raise controversial issues from than where you are. Take this experience as an opportunity to learn what you can, without giving up your own ability to think critically about what other folks claim, and also a chance to see how such dubious therapies take hold, and in the future this knowledge will help you to influence others as you progress in your career.

[vet-skeptech]

me: so, you know how we all use fluoridated mouthwash because [city] is too full of hippies to put it in the water supply?

professor: yeah?

me: ...should I be fluoridating my cat’s water fountain?

professor: ...don’t worry about it

[vet-skeptech]

I had a small convo with a customer at work today who was looking for over-the-counter kennel cough remedies. It started with “no, we don’t have any, I’m sorry” and then I shyly added “but I don’t really think they’ll help”, and he took the bait!

He said that he had found all sorts of remedies on Amazon which had five-star reviews, but that he was trying to shop locally. I explained that as a self-limiting disease, kennel cough is one of those things that amasses long lists of home remedies- because whatever people try right before it goes away on its own appears to have worked. I told him that if he took the dog to the vet they would almost certainly prescribe antibiotics if he asked (which would help shorten the course of the illness) but that many vets consider it unnecessary in mild cases, and try to avoid overusing the antibiotics due to the risk of creating new drug-resistant strains. He liked that.

Turns out a friend had told him that antibiotics didn’t work because the disease was caused by a virus. I completely fumbled the explanation that while Bordetella is a genus of bacteria (with many different species and strains), there are other pathogenic agents which can cause identical symptoms in dogs, including viruses. To be fair, it’s just fundamentally confusing, and also at that point we were holding up the line, and he was starting to scrape the bottom of the barrel of what I remembered from my Small Animal Diseases class. I’ll do better next time. Finally I told him that he could probably get a prescription antitussive if the coughing was as severe as he said it was becoming, but that if he chose to wait it out the (young, healthy) dog would almost certainly be fine. And not to be surprised if the symptoms lasted up to 3 weeks. He was reluctant to go to the vet, but I reiterated my skepticism about the random stuff on Amazon. If I had thought to mention it, I might have told him that if the vet had physically examined his dog within the last year (and liked/trusted him as a client) they might be willing to write the necessary script/s based on a video of the cough- its very distinctive, and if there’s no reason to suspect other potential causes...well, nobody wants a contagious animal in a hospital lobby if they don’t absolutely have to be there. But on the other hand, a lot of veterinary antitussives are technically opioids, and therefore controlled substances. So probably it was good not to put the idea in his head. Just because I’ve seen it done doesn’t make it best practices, and it doesn’t mean that his vet would be comfortable doing it.

I only just barely managed not to reply to his final, barked question- “what about the antibacterial properties of coconut oil?”- with “there aren’t any”, instead simply saying “uhhhh” as he was swept away by the crowd of people impatient to buy dog food. I think it went pretty ok, overall. I remembered most of what I needed to remember, and he was happy to have someone to talk to about his poor, coughing dog. And he wasn’t mad at me or insulted, which means that I got my tone and phrasing right. Hope he listened to some of it.

A brief Amazon survey reveals...HomeoPet again, no surprises there. (God I hate those people!) A couple general herbal ‘immune support’ things (usually containing mushrooms because people are big into mushrooms these days for some reason), and...big jars of honey. Which is fine. You can give your dog any of that. Nothing will happen. That’s the problem. Nothing...will happen.

[vet-skeptech]

I’m so new to this field that every day people ask my opinion about remedies I’ve never heard about before and don’t have the time to do serious research  on. The day before yesterday, it was ‘knuckle bones contain enzymes in the  bone marrow that can stop the progression of periodontal disease if they are fed to dogs’.

Immediate thoughts:

1. This customer bought cooked bones. Enzymes denature at high temperatures, rendering them ineffective. The person who gave her this advice (a veterinary assistant, which means it could be either a 17 year old kid with no formal schooling or a 60 year old dog breeder who took a 9-month online assistant’s course and has been working in veterinary medicine for their whole life) actually suggested raw bones. Customer stated she did not buy the raw bones because they were ‘messy’. I did not mention the heat issue, but simply recommended that she double check the advice with her vet. 

2. I really have no idea what enzymes she might be talking about. There are so many damn enzymes, and I don’t have the time or ability to memorize all of them. Could she actually mean hematopoietic stem cells?

3. Why knucklebones, specifically? What are knucklebones? In this case, the products labeled as ‘knucklebones’ were slices of the head of a bovine femur, not an ankle bone as you might expect. So that’s mostly red marrow, which is another clue that she might have been thinking about stem cells.

4. There actually have been multiple studies (in dogs, even!) suggesting that stem cells derived from bone marrow can help regenerate tissue lost to periodontal disease. Cool. But that was with careful transplantation of living cells, not just...a dog chewing on a bone. Can those results be assumed to transfer over in this situation? I’m also fairly sure that the cooking and preservation process these commercial bone chews go through will kill all living animal cells. So...???

I dunno. This is one of those ideas that I suspect really does have some validity. Certainly, scraping the teeth on bone while chewing has a mechanical cleaning effect. And with a fresh, recent kill? There would be all sorts of good stuff in that organ meat and bones. And periodontal disease is so epidemic among dogs and cats these days, and my old outdoor hunting kitties never had a tooth problem in their lives...but that’s anecdata. The large raw bones given to dogs can be hard enough to fracture teeth, and cooked bones can splinter into pieces which can choke the dog or perforate their GI tract. So there’s a lot of cost-benefit analysis left to do here. I haven’t finished thinking and reading about it yet. I’ve really only just started. And nobody likes to hear that.

[vet-skeptech]

Allergies suck. Allergy testing sucks. Wouldn’t it be nice if there was a simple, relatively inexpensive, at-home kit that would let you take a DNA sample from your dog and send it in to a laboratory, which would analyze it and send you a list of everything your pup was allergic to?

Yup, that would be awesome, simplifying the diagnostic process immeasurably,  saving clients money, patients suffering, and veterinarians precious time. In 2012, Immune IQ was launched, a product which promised to do just that. Unfortunately, it didn’t work. A study a few years back done by a team of skeptical veterinary dermatologists, found that “ImmuneIQ test results given for multiple submissions of samples from two dogs were no different from results that would occur by random chance”. In addition, they failed to distinguish between dog fur and fake fur, or between saliva and water, and sent back full allergen reports for the fake samples. The company refused to give any information about their ‘proprietary’ testing process.

In June of 2017, the Colorado Board of Veterinary Medicine issued cease and desist orders to the company’s owners, and their website is now offline. Be on the lookout for knockoff brands- they seem to be popping up and getting shut down fairly quickly, but you never know.

[vet-skeptech]

I loathe the way that the anti-vaccine people have put us in the ridiculous position of being “pro-vaccine”, as if both human and veterinary doctors weren’t already engaged in the daily risk/benefit analysis of vaccination for every patient they see.

Vets write rabies waivers for dogs who have had previous anaphylactic vaccine reactions, if the state allows them to do so. If not, they have a plan in place beforehand- usually Benadryl for the dog. After the nightmare of Feline Injection Site Fibrosarcomas (which one of my childhood cats was euthanized for), PureVax was developed as an option to provide immunity without the risk factor of aluminum adjuvants, and vaccine protocols were changed so that certain vaccines are only given to high-risk cats, and given in locations where a tumor could safely and easily be removed. Vaccines which prove to be less effective than their manufacturer claimed are abandoned en masse by the profession.

Literally no one on Earth pays more attention to which vaccines are safest and most effective than medical personnel, but somehow we’ve rhetorically become these naive puppets thoughtlessly injecting random stuff into people.

[vet-skeptech]

I can’t complain about homeopathy forever without boring everyone, so with a brief Amazon search, the major brands you need to watch out for when it comes to pet homeopathy seem to be:

Natural Pet Pharmaceuticals by King Bio- (which has the distinction of being the company on this list to most recently get a warning letter from the FDA for making unverified claims about their remedies), HomeoPet, PetAlive, Newton Homeopathics, Smarthealth Naturopathics, Dr. Goodpet, Only Natural Pet, VETiONX, BestLife4Pets, and Natural K-10

(Rescue Remedy is going to get its own post because its such a phenomenon)

[vet-skeptech]

Ok, I’ll admit it- I’m starting with homeopathy because its an easy target. There’s tons of this stuff on the market, and its all the exact same tube of water. Lots of the same ‘ingredients’, too. Bee venom, any plant with any amount of strychnine in it, anything in the nightshade family, poison ivy...just any toxin, really. And just diluted to hell and back- this remedy starts at 12x, which is something like 1 part tincture in 1 million parts water. So, nothing. Absolutely nothing. It costs $14.99.