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The BBC is wrong to allow an unqualified person to recommend unproven treatments to animals

The Hay Festival is not a place where you might expect to learn about the treatment of animals: it's an annual literature festival held in Hay-on-Wye, Powys, Wales, for ten days at the end of May every year. Caroline Ingraham has written an interesting book - "How animals heal themselves" -  which is presumably the reason she was given the opportunity to give an account of her subject at the Hay Festival last week. The BBC have created a podcast from her talk,  but I believe that the editors were wrong to give her this uncritical forum to propagate her views. Caroline has a controversial belief in the ability of animals to choose their own medicine. There's nothing wrong with her having these beliefs, but there is a problem when her views are broadcast without any "public health warning". There is a serious risk that animals could suffer unnecessarily if members of the public follow her advice to the letter. In her talk, Caroline recounts entertaining anecdotes of animals (including elephants, horses, dogs and cats) that have recovered following her approach of allowing them to choose their own treatment from vegetation and other substances in their natural environment, or from herbal products offered to them by Caroline. In her words, the animals "guide her to help them make a full recovery". Caroline stresses the importance of "letting animals lead the way" for behavioural and physical problems. As a vet in practice, I know that 70% of the animals brought to see me will recover by themselves, with no intervention or medication. Animals have evolved with strong internal natural healing capacity (it's called homoeostasis) Our aim as vets is to assist the healing process using scientific methods. There are many reasons why animals may fail to heal themselves, and science can often help. Serious bacterial infections are cured by giving antibiotics that kill the bacteria. Coughing caused by a failing heart is stopped by giving diuretics that remove the fluid gathering in the lungs. Cancer can be cured by surgical excision, followed sometimes by drugs to slow the regrowth of cancer cells. These are all treatments that are scientifically proven: in trials, it has been shown that if some animals are given the treatment, and some are not, a significantly greater number of animals improve. Caroline offers no such evidence: her treatments are all anecdotal. My concern is that she may be witnessing the "regression towards the mean"  i.e. the ability of animals to heal themselves without human intervention. Since around 70% of animals may recover naturally, if you believe that any recovery that you witness was caused by your intervention, you will believe that your treatment "works" 70% of the time. While this may sound impressive, the truth is that your intervention is having zero effect. If Caroline wants to clearly demonstrate the efficacy of her methods, she needs to do what pharmaceutical companies are obliged to do: carry out trials that compare animals receiving her treatment with animals that receive no treatment (a so-called control group). If she does this, she will be able to say without question that any extra improvement in the treated group is due to her treatment. Without doing this, her claims have no scientific validation, and it's hard for objective observers to take them seriously. At the end of the talk, the presenter did ask Caroline if she was a scientist, and if her work was "evidence based research". She replied "I am not a scientist but the subject of zoopharmacognacy is an academic science". Caroline says that in trying to develop her work, "resistance came in from a variety of different establishments that tried to make it really very difficult for me to continue this work." There is a simple reason for this resistance: there is strong legislation in the UK to protect animals. Only vets are allowed to diagnose and treat animals. The law is there to stop (often well-meaning) unqualified people who may not be aware of their own ignorance  from accidentally harming animals because of their lack of knowledge. There may be some truth in Caroline's claims: animals may be able to choose certain forms of self treatment for some physical and behavioural issues. But this has not been proven, and it is wrong to state it as fact. It just does not seem right when an unqualified person suggests that pets should be allowed to choose their own "pain relieving herbal remedies" rather than the safe proven methods of pharmaceutical pain relief recommended by the vet attending the animal. And it does not seem right that the BBC should give such a person an uncritical platform to disseminate her viewpoint. Update 25th November - Caroline has forwarded this response to the original blog: I believe that your post undervalued the importance of case reports (referred to as anecdotes) that can provide important, detailed information about individual cases that can be very valuable, and it is much better to gather this information than do nothing at all, especially as cases typically come to us after other options have been tried. In fact some successful clinical trials have been started principally because of the promising findings of a collection of related interesting case reports; a topical example is in the human medicine world where the recent FDA approval of a new viral therapy against melanoma, which was inspired by case reports of some patients with cancer going into remission after a viral infection: (of course in this case viral therapy would have to be under the control of a qualified specialist with an appropriately modified virus!). Other observational, non-experimental approaches have also been fruitful, such as with the work by Jane Goodall, among others.  As for Applied Zoopharmacognosy itself, after my lecture to veterinary students at Bristol University yesterday, many came up to me inspired by these case reports and want to explore setting up research projects, and possibly even small scale clinical trials, investigating self-medicative behaviours. I take your point about regression to the mean, but I understand this likely applies more to certain, short term conditions such acute pain, acute infections, slight anxiety etc. that in many cases would be expected to resolve spontaneously. Many of the individuals that I have worked with have long term conditions, most commonly with long standing behavioural issues but also other symptoms as well. The responses can be dramatic and remarkably fast, and so regression to the mean is a less plausible explanation in these cases. It is it important to note that we do not make medical diagnoses, and I advocate self-medicative approaches as complimentary to veterinary treatment not as a replacement; veterinarians are highly trained and highly skilled individuals and their input is typically invaluable. It would be fantastic if veterinarians were to add Applied Zoopharmacognosy as part of their skill set. Finally, I read with great concern in several veterinary blogs (though not this one) and tweets that I have been suggesting to pet owners to offer onions to dogs as a wormer. I would like to clarify that I have never offered, nor recommended giving an onion to a dog. It was merely an observation of an event that I found fascinating since it paralleled other documented occurrences of sick animals selecting typically poisonous plants including: Michael Huffman when he witnessed chimpanzees selecting Vernonia amydalina (locally known as 'Goat killer'), to rid themselves of nematodes (Huffman and Feifu, 1989; Jisaka, et al 1993), and in a study by Singer, et al. 2009, when caterpillars with parasitoid wasp larvae infestations changed their foraging on (normally) poisonous alkaloids such to rid themselves of parasites. The relationship between self-medicative behaviour and plant poisons is a complicated topic, which would take a lot of words to cover adequately. In brief, the most common plant poisons are due to certain chemicals called alkaloids and the reasons for why animals may poison themselves on these are not incompatible with self-medication (possible reasons include evolutionary separation of poisonous plants and companion animals, degradation of bitter warning compounds during drying such as with ragwort, reduced alternative foraging options etc.). Applied zoopharmacognosists typically work with extracts high in other compounds such as terpenoids, not alkaloids. My observations have been presented at a scientific conference in South Korea last year following an invitation by my colleague Michael Huffman, Associate Professor, Kyoto University as well as at Bristol university. I would be more than happy to open dialogue on the subject with any interested parties. Challenges to consider with self-medictaion and clinical trials: I would fully support clinical trials that look into the efficacy of self-medicative approaches. However, clinical trials are often prohibitively expensive and time intensive. The difficulty would also be that it is not immediately obvious how a trial that focuses on two different approaches to animal health could be set up without having to split it up into multiple, equally expensive trials that each focus on particular conditions. It is also important to remember that clinical trials are not completely fail-safe either.  

Do vets charge too much for bitch spays?

As part of my work as a "media vet", I'm a strong advocate for spaying and neutering pets as the best way to control the problem of pet overpopulation. Accidental pregnancies still account for a high number of unwanted puppies and kittens, and routine spaying/neutering of young adult pets is the best way to prevent these. This doesn't meant that every pet needs to be spayed/neutered when young (there are some good reasons to delay or even not to do the operation for some individual animals), but it does mean that every pet owner should at least discuss the options with their vet around the time of puberty.

Why do people refuse to have their pets spayed?

People have a variety of reasons for not having the operations done on their pets, and the cost is a major factor. In a recent social media discussion, the following comment came in. "Vets should reduce their fee to £120 for a female dog. A lot of people genuinely just can't afford it."

Why don't vets reduce their fees?

This is a good point. Why don't vets reduce the price of spaying? Let's look at how this could be done: what makes up the cost of an operation, and how can those items be reduced? To put this in perspective, what are the typical fees for spaying? The recent SPVS survey found that the median fee nationwide for an adult bitch spay was £204. There is significant regional variation on this, but the figure acts as a reasonable starting point for discussion. How could it be reduced to £120? If you look at the pie chart at the foot of this page, you can see that over half of the costs of vets' fees are made up of overheads that are difficult to reduce: rent, heat, light, phone, drugs, surgical supplies, cleaning, nurses' wages and administration costs. Vets already do as much as they can to keep these costs down: it's in their own interests to do so. So let's leave these alone for the sake of this discussion. So what about the obvious "top item" on the cost list for most people: the money that goes to the vet. Surely vets can manage with less? For every £10 you give the vet, typically only £2 to £2.50 goes to the vet. If a vet gives you a 20 to 25% discount, they are working for nothing. Vets are well enough paid, but their salaries are lower than most people expect. A typical new graduate vet earns around £30000, and a vet qualified for 20 years might earn £50000. Should vets work for less than that, with five years of tough training and high costs in getting through college? For the sake of this discussion, let's say yes, and agree that vets will operate for free on bitch spays: take 25% off £204, and you're left with £153. What next? What about VAT? The government charges 20% on all vet fees, making up £34 of the £204. If this was not charged, £153 minus £34 = £119. Bingo: it's less than £120. So if vets work for nothing, and the government agrees to stop charging VAT, the cost of a bitch spay would reach the desired target. Is this going to happen? Of course not.

In the real world, how can pet owners pay as little as possible for bitch spays?

So what can impoverished pet owners do? Here are three tips. First, plan in advance. You should budget for the spay/neuter surgery when you get a pet, just as you should think about how much it will cost you to feed your new animal. If you genuinely can't afford it, perhaps you should not get a pet. For the financially disadvantaged, there are some subsidised schemes to help, but charity resources are limited, and most of the working population will not qualify for these. Second, shop around, but don't do this on price alone. You should physically visit at least three vets, eyeballing the premises (are they clean?), talking to staff (do they seem to care?) and asking some specific questions: • Do they have qualified veterinary nurses? • Do they use up-to-date anaesthetic, pain relief and monitoring equipment? • Does they monitor all pets after anaesthesia until they are awake? You may not be fully aware of the "right answers" to these questions, but even just by asking the questions and judging the tone of the response, you will learn a lot about the practice. Third, ask for a discount. Some vets may just say "no" ( this is understandable - it directly eats into the 20 - 25% that they are paid), but as in any other consumer transaction, there is no harm in asking the question. If you think a bitch spay is expensive at £200, remember that it would cost around £5000 to have a similar operation carried out on a human. And if you want to help with the pet overpopulation problem, as well as benefitting your own pet's health, it's a price that's well worth paying.

Elizabethan Collars – a necessary evil?

  [caption id="attachment_4253" align="alignleft" width="768"]Elizabethan collars are named after clothing worn in the time of Queen Elizabeth I Elizabethan collars are named after clothing worn in the time of Queen Elizabeth I[/caption] One of my clients was talking about his recently neutered bitch today. "She needs one of those Victorian Buckets" he said. I knew what he was talking about, but his terminology was not quite correct. The problem was that his bitch had been licking her operation wound, and he wanted to stop her. The item he was describing is an important tool to assist the healing of animals' wounds. It is more correctly called an 'Elizabethan Collar', because it resembles the white starched lace collars that Queen Elizabeth I and her subjects used to wear. Most people have seen animals wearing these large, lampshade-shaped cones, fastened around their necks and extending up around their heads. Animals have a strong instinct to lick their wounds. In moderation, such licking can be cleansing and beneficial. The problem is that animals do not know when to stop. Excessive licking causes redness, soreness and itchiness, and this makes an animal want to lick a wound more and more. It is a vicious circle - the more licking , the more sore a wound becomes, and the more the animal wants to lick it. In the worst cases, a wound can be completely prevented from healing. Animals have even been known to cause themselves serious open wounds by biting and chewing itchy areas. Drugs can be used to ease the itchiness, but they are seldom adequate alone. The only sure answer is the Elizabethan collar. These were originally home-made by vets, using pieces of cardboard, or by cutting the bottoms out of buckets. However, it was not always easy to create a finished product which was effective. Modern pet Elizabethan collars are custom-made from shiny lightweight plastic. They are manufactured in different sizes, to suit anything from a kitten to a Great Dane. They have become more sophisticated as time has passed, and there is now a range of different products available. The traditional collars are made from white plastic, but these restrict an animal's vision, causing animals to crash blindly around the house, bumping into people and furniture. Some modern collars are semi-transparent, to allow animals to see where they are going. We often advise people to line the outer edge of the collar with elastoplast, to blunten the sharp plastic edge which can otherwise cause painful scratches on an owner's legs as an excited animal barges past. Attaching the collar to the animal can be a fiddle - buckles and slots are fitted into place and the whole construction is strung onto the animals normal leather collar. Owners sometimes feel that it is unfair to inflict these collars on their animals, but you only need to see one example of the serious damage which self mutilation can cause to realise how important it is to stop some animals from reaching their wounds. Animals cope with the imposition of an Elizabethan collar in different ways. Most accept their fate sadly but in a quietly resigned fashion. Some Labrador-types seem to enjoy their new 'hats', and they dash around the room enthusiastically causing chaos as they bounce off walls, people and objects. Some cats do what I call an 'Elizabethan Dance', when they twist, leap and pirouette in an effort to escape the collar. After an initial uneasy settling in period, most pets do not mind this odd looking, but very effective structure. There are, of course, a number of modern alternatives, from inflatable life-ring type products to neck braces to soft floppy collars. Some of them are definitely worth trying, but as is often the case in life, I suspect that the reason there are so many alternatives is that nobody has yet found the perfect way of preventing pets from interfering with their own wounds.
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Antifreeze, the killer chemical of pets – don’t let yours be a victim.

Antifreeze, which often contains ethylene glycol, is very good at doing what it says on the bottle.  If you have ice on your windscreen or want to keep various pipes and water features from freezing up, then adding antifreeze will do the job.  What the bottle DOESN’T always say, however, is that antifreeze is so toxic to cats, dogs and other small mammals and that it takes only about a teaspoon in a cat or a tablespoon in a dog of the substance to bring about a rapid and unpleasant death.  In fact, a recent news article has highlighted the fact that around 50 cats a month in the UK are killed by antifreeze poisoning.

Why is it such a big problem?

Antifreeze is a commonly used chemical, especially in the winter months, but many people are unaware of the danger it poses to animals.  Even small children are at risk, because ethylene glycol has a sweet taste that most mammals wouldn’t think twice about consuming.  It can leak out of damaged car pipes and onto the drive where cats then lick it up, or perhaps a small amount of the substance was left in the bottle and left open after use.  Ethylene glycol can be found in radiator coolant, windscreen de-icing agents, motor oils, hydraulic brake fluid, paints, photographic chemicals and various solvents.  A worrying new trend is for people to use it in their garden water features to keep them from freezing – an extremely dangerous action as many cats and also wildlife use these features to drink from.  Unfortunately, some heartless people also use the substance to intentionally poison cats that get into their garden, and there are several cases of this under investigation at the moment.

How does it affect cats?

Initial signs include behavioural changes, such as looking groggy or ‘drunk’, which makes sense because the chemical binds to the same receptors as alcohol in the body.  These initial signs may only last for 1-6 hours, then they seem to recover but although they may appear to temporarily feel better, the real damage has already begun.  Ethylene glycol causes crystals of calcium oxalate to form within the kidneys and because these crystals cannot be dissolved once formed, the damage is irreversible and rapid kidney failure results.  Within hours to days the cat may start urinating more, then not at all as the kidneys shut down.  This results in a build-up of toxins within the blood causing severe lethargy and lack of appetite, panting, vomiting, oral or gastric ulceration and sometimes coma or seizures.  Death almost always occurs within a few days.

Is there any treatment?

If you are lucky enough to see your cat or dog ingest antifreeze and can get them to the vet within about 3 hours before the product has a chance to be metabolised, then treatment is possible though the recommended treatment is very expensive and most vets aren’t able to stock it.  Interestingly, one of the treatments for antifreeze toxicity is ethanol (aka the ‘vodka drip’ you may have heard about), as the alcohol prevents the ethylene glycol from binding to receptors in the body.  This treatment is dangerous in itself however, so the prognosis for recovery is still guarded.  If treatment is successful, affected animals will likely have to stay in hospital for several days on a drip to flush out any remaining toxins from the body and some degree of permanent kidney damage is likely.

What can we do to cut down on antifreeze poisonings?

The best thing you can do at home is to not use antifreeze that contains ethylene glycol.  Many newer products now contain propylene glycol, which isn’t nearly as toxic.  Have your car serviced regularly to ensure there are no leaks onto the drive, and if you do spot a leak, clean it up immediately and dispose of all waste or empty containers properly.  Many suppliers put bright fluorescent green dye into their products so it’s easy to spot in a puddle on the drive.  Most vets stock a UV or black light which makes this dye glow brightly and finding the dye on the cat’s paws or muzzle can be a good way to confirm exposure.  If your neighbour has a water feature in their garden, it might be wise to confirm that they are not using antifreeze and to inform them of the dangers if they are not already aware.  Another recommendation that has been suggested is to put a bitter-tasting substance (Bitrex) in the antifreeze so that any sensible animal or child would spit it out as soon as they tasted it, but not all companies regularly do this.  This would also cut down on intentional poisonings.  At the very least, all products containing ethylene glycol should be clearly labelled as being fatal to animals.

Spread the word – antifreeze kills! Amy Bergs DVM MRCVS  - Visit The Cat Doctor website by clicking HERE

Ask a vet online-‘treatment for feline herpes virus’

Question from Carmen James: Best treatment for feline herpes virus flare ups? Answer from Shanika Winters: Hi Carmen and thank you for your question regarding feline herpes virus, I will discuss what the virus is, the disease process and possible treatment options. So what is feline herpes virus? Herpes is a virus that we are familiar with in people as it is associated with cold sores, herpes viruses are specific to a species that means human herpes viruses only affect people and feline herpes virus only affects cats. Feline Herpes Virus (FHV) can affect any cat, it is spread in discharges from eyes, nose and mouth. FHV is usually associated with cold like symptoms which include runny eyes, sneezing, coughing, corneal ulcers (ulcers on the surface of the eye) and general signs of illness such as increased temperature, weakness and appetite loss. How do I know if my cat has FHV? If your cat seems unwell and is showing any of the signs listed above then it is important to take him to your vet for a full examination. A combination of the signs listed and blood tests or PCR test (tests done on discharge samples from your cat at a laboratory) can confirm that your cat is likely to be suffering from FHV. Herpes viruses can remain in your cat even when they seem well and this means that your cat could spread the disease (your vet may refer to the virus as being latent). At times of stress the virus can be shed by your cat and this may also mean signs of illness appear. The severity of the signs of illness will depend on your cats level of stress and how strong its immune system is (that is its body’s natural defence against diseases) Can my cat be vaccinated against FHV? Routine cat vaccines offer protection against cat flu and FHV is one of the components of the cat flu part of the vaccine. Vaccinations give your pet protection against disease but this cannot account for factors such as your cat already being exposed to the virus before vaccinations. Why do cat with FHV get flare ups? The reason for flare ups in cases of FHV is due to the nature of herpes viruses, they remain in the cats body and when your pet is well the virus is ‘latent’. At times of stress however the virus is shed(released again) and this can lead to signs of disease again or a ‘flare up’. How can the flare ups be treated? Firstly it is really important to try and avoid flare ups of FHV by ensuring your cat is well, calm and up to date with his or her vaccines. However even with the best possible cat care flare ups will still occur. There is no licenced antiviral treatment available for cats with FHV, there are a few human antiviral medicines in the form of tablets, creams and ointments which have been tried on cats with some success. Most commonly it is antibiotics which are used to treat FHV signs, this is because when your cat has a viral infection they are more prone to bacterial infections on top of the viral infection. Antibiotics are effective against the bacterial part of the infection, and once this is cleared your cat will hopefully feel better, have less discharge from its eyes /nose and feel like eating and drinking. If it is only the eyes that are affected then treatment can be focused on the eyes alone, this avoids giving medications that may have side effects on the whole of your cat. How to minimise flare ups? Prevention of flare ups can be helped by keeping your pets environment calm, having a regular daily routine, strict hygiene when it comes to food dishes/water dishes and the litter tray. Isolate cats showing signs from other cats. Keeping your cat’s the eyes and nose clean and clear of discharges. The correct use of antiviral and or antibiotic drugs can also help keep flare ups to a minimum and shorten the lent hog episodes. I hope that my answer has helped you to understand how FHV works and that in order to keep flare up under control there are things you can do at home as well as with the help of your vet. Shanika Winters MRCVS (online vet) If you have any worries about your pet, please make an appointment with your vet, or try our Symptom Guide.
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