There’s a storm brewing in Washington D.C., and it’s nothing to do with the hurly-burly town hall meetings on healthcare reform. While the battle rages in congressional circles on the merits and pitfalls of revamping how we bring modern medicine to the masses, legislation to minimize antimicrobial use in industrial animals soldiers on.
Though it’s happening mostly under the average American's radar, veterinarian members of the AVMA are keeping a close eye on the law’s progress...and lobbying HARD against it. This, despite an impressive, two year-long report (PDF) criticizing modern industrial animal agriculture for imposing “unintended” negative environmental, cultural and welfare consequences––while effectively questioning our food supply’s very sustainability.
A slew of recent ads advanced by the authors of the report, the Pew Commission on Industrial Animal Agriculture in cooperation with John Hopkins’ public health department, urges congress to impose strict limits on the use of antimicrobials (antibiotics) for non-therapeutic measures (for prevention and growth promotion) in food animals. The FDA agrees. The AMA agrees. The United Nations agrees. The World Health Organization agrees. And yet the AVMA vociferously disagrees.
Why should YOU care?
Make no mistake, this legislation speaks to the mere tip of the iceberg when it comes to industrial animal agriculture...but it promises to destabilize the whole shebang below the waterline, too. It’s a BIG deal that few outside the relatively small community of ag industry watchers seem to realize.
Predictably, perhaps, food animal veterinarians are enraged over the issue. They believe this legislation is a Trojan horse. Because banning antibiotics (a popular position with the public) threatens the very survival of the current paradigm that allows bigger, better, faster and cheaper animal protein to arrive at a supermarket near you.
Remember Y2K? That’s the argument many food animal veterinarians are advancing––at least the ones at the top level of the AVMA. This should be a non-issue, all this flak and fear over antimicrobial feed additives. After all, these antibiotics are NOT non-therapeutic, they argue––they keep sub-clinical infections at bay.
Further, they claim antibiotic administration in food animal production does NOT affect public health. In fact, banning it would bring more bacteria to the dinner table. It would mean more animal death. So let’s not kneejerk this one––not if you really care about animal welfare.
And the kicker? They claim the report is not science based. Instead, it trades on the romantic notion of small animal farms and the theoretical threat of antibiotic resistance. That’s what they say in this document decrying Pew’s findings. Here’s an excerpt:
“Both in substance and in approach, therefore, the Pew report contains significant flaws and major deviations from both science and reality. These missteps lead to dangerous and under-informed recommendations about the nature of our food system—and shocking recommendations for interventions that are scarcely commensurate with risk. The report is, in many ways, a prolonged narrative designed to romanticize the small, independent farmer, while vilifying larger operations, based simply upon their size.”
To be fair, I can imagine their arguments ring true from an ag industry veterinary perspective. Because when you look at industrial animal agriculture through the prism of, “How much can we produce, how cheaply can we make it, and how quickly can we bring it to market?” the food animal veterinary rebuttal to Pew sounds just about right.
As another industry watcher, Gina Spadafori over at PetConnection commented to me yesterday, the AVMA’s lobbying points are consistent with a point of view that myopically entertains only the economics of their own closed system. “They’re not looking at what’s coming out of the other end of the sewage pipe.” Because it’s not so much about human health or animal health, this food animal veterinary argument. It’s more to do with the money.
Yet much as some of us in veterinary circles might agree with Gina and advance our concerns at a national level, we’re often silenced––especially within the context of our professional organization.
Why? Because small animal practitioners don’t have a dog in this fight, it’s implied. You take care of your side of the industry, we’ll take care of ours. After all, we’re the experts on food production and you’re the experts on the squishy, small animal stuff. So don’t muddy you high heels on this one.
But the AVMA is not monolithic we argue. Veterinarians of all stripes deserve to weigh in––that is, if food animal vets are going to use our AVMA’s clout and coffers to oppose legislation.
Ultimately, the AVMA’s position needs to reflect the larger membership of the AVMA, not just the industrial food animal contingent. If it did, perhaps we’d be moving towards a new, more sustainable agriculture without offering more proof that our professional organization reeks of dinosaurs and grumpy old white men.
Imagine your pet suffers from an insidious disease she’ll have to suffer with for the rest of her life. Next, picture a simple surgery that can fix it. No more drugs. No more side effects. No more constant testing.
Not that you general practitioner or internal medicine specialist doesn’t deserve a shot at treating your pet’s ills. And trust me, you’ll not yet want to go running off to the veterinary surgeon with Dolittler post in hand expecting miracles. Nevertheless, a couple new surgeries may render some hard-to-manage diseases eminently treatable––without the benefit of side effect-ridden drugs.
Today’s two ills in question are common. One is considered just plain annoying, and because it’s often unresponsive to medical therapy, the surgical option may provide some very welcome relief. The other falls under the category of “fundamentally difficult to treat” by anyone’s standards. The possibility of a surgical treatment, though admittedly a tricky one, may well save lives for pets who don’t respond well to drug the complex drug therapies involved.
The conditions? The spay-related, hormone-responsive urinary sphincter incontinence and the dreaded Cushings disease.
For dogs who suffer incontinence as a result of hormonal changes, medical management can be fraught with side effects and incomplete remission of symptoms. Then there are dogs whose concurrent conditions and non-urinary drug regimens may make medical treatment not so attemptable. In all these cases, surgery is an option. Here’s what it looks like according to a recent conference proceeding:
“Colposuspension is the most common surgery used to address USMI (urinary sphincter mechanism incompetence) in female dogs. This procedure involves placement of sutures from the cranial vagina to the prepubic tendon on either side of the proximal urethra, thereby positioning the proximal urethra within the abdomen and placing pressure on the urethra as it crosses the pubic brim. Several studies have looked the long-term outcome following colposuspension. One of the most recent studies reported a response rate of 82% with half of those animals completely continent without medication. These results are in contrast to a separate study which reported only a 54% response rate, although a client satisfaction rate of 86% was also found.”
Pretty good stuff, I’d say. And before I read this, I’d never once thought to refer one of my patients to the surgeons across the street for this condition––all of whom can handle this surgery in their sleep (OK, maybe not, but close).
Next up, hypophysectomy. It’s nowhere near so easy as the colposuspension, but medical treatment of pituitary-dependent canine hyperadrenocortisism (Cushings disease) can be so complex, demanding and tricky that euthanasia is often elected in lieu of continued attempts at drug therapy. For this reason, European vets have been treating the source of the problem with brain surgery. Again, according to a conference proceeding from earlier this month:
“Hypophysectomy surgery [removal of the hypophysis (in the brain)] is performed for dogs with pituitary and adrenal-dependent [Cushings] disease. In the United States there is limited experience with hypophysectomy for pituitary tumors but outside the United States this surgery has been performed with good results. The mortality rate can approach 10% but most dogs obtain a complete remission for several years. In addition to perioperative mortality, diabetes insipidus may occur [an easily treated side-effect that results in excessive water drinking] but is usually transient.”
The full range of risks and stats are not immediately at my command, but I’m happy to say I’ll be hearing more now that my intrepid boyfriend-the-vet-surgeon is revving up his CT scanner in anticipation of some cases.
But let’s not get too excited just yet. In the case of both these diseases, it’s clear the old ways still come first. Treating both pituitary-dependent Cushings disease and hormone-responsive urinary incontinence will perhaps always require drugs as a first line of defense, but new treatment options are always welcome for those who can’t be treated the old way.
Pet owners make all kinds of excuses for their fat pets. This especially popular Dolittler entry from a few months back exposes them. Today’s post offers yet another I should have detailed. It's one that gets cited most every time I discuss a canine exercise regimen in any detail: “But she hurts whenever I try to exercise her.”
It’s a conundrum, really. And it's not just to do with overweight dogs. No one wants to begin a much-needed exercise program on a pet whose joint ills or non-specific sluggishness obviously holds him back. Even those who have always exercised their dogs extensively wonder how far to take their walks, whether the swimming is still safe and how much exercise “abuse” it’s fair to inflict. Even these active owners tend to slack off out of humanitarian concerns.
The implication, whether for an able but aging exerciser or a fat newbie needing rehab, is that exercise pushes pets past their comfort zone in ways we humans might be loath to undertake even for ourselves. So how can we possibly subject them to it?
It’s a perfectly legitimate consideration, but one that tends towards the overblown. After all, we humans have always been urged by our physicians and rehab specialists to accept the discomfort of exercise, to push past the initial pain with an eye towards its benefits, and to remain consistent in the application of an exercise regimen––sore muscles, stiffness, joint pain and all.
Too bad too many dog owners just don’t see it that way. Here’s what I hear:
“It’s cruel and inhumane.”
“I can’t stand to watch her suffer.”
“I’d rather have him die in peace.”
“It’s only prolonging her suffering.”
But it doesn’t have to be that way––no more than it is for us. Those who would argue that an exercise regimen for an older, arthritic dog simply prolongs suffering would probably do well to euthanize them immediately. Because exercise doesn’t prolong suffering––life does.
Exercise––done right (and it's easy)––simply offers tiny blips of soreness as it augments muscle tone, enhances coordination and “lubricates” stiff joints.
All those free radicals and muscle acids that speak in painful tones when we work out? We’re finding they’re every bit as essential to pets when it comes to mental health, immune system function and even in such seemingly unrelated areas as digestion, skin condition and––here’s a shocker––overall quality of life.
But what’s enough? And how much is too much?
Dosing exercise is the hardest part for me, the healthcare provider, to determine. A prescription for exercise must be precise enough for my clients to follow and doable enough to yield habit-forming stability, but not so rigid and rapidly soreness-inducing to elicit non-compliance after the first couple of walks around the block.
Moreover, exercise must often be accompanied by a dietary plan for my fatties (the bulk of them) and a pain-relieving regimen that usually involves a round-robin of supplements and drugs to limit the discomfort inherent to the flexion and extension of muscles attached to painful joints.
Curious about what a detailed prescription might look like?
Feed 1/3 cup X food twice daily Offer up to 5 baby carrots or apple slices per day as treats Glucosamine once daily Fatty acids once daily Adequan injection twice weekly for four weeks 5 minutes exercise AM and PM daily (swimming, walking, ball-throwing, etc.) Twice weekly, two 30 minute outings Offer Metacam one hour before each longer outing or whenever extra soreness results after daily exercise Increase daily exercise by five minutes every two weeks until 30 minutes achieved Increase intensity level of daily exercise every second week after increased duration Consider hiring a dog walker/runner for exercise assistance Consider massage therapy and acupuncture
It’s a complex bit of calculus, this recipe, because it’s different for all pets and always requires tweaking and revisiting on all points, not just when it comes to the duration and intensity of the exercise. And for many pet owners, hand-holding is an inevitable bit of the equation, too.
Luckily, common sense and maybe a phone call or two is usually enough to help dedicated pet owners power through the rough spots inherent to such a regimen. But then, we can all guess at the stats on the prevalence of common sense.
Hence my frustration when, six months later, my daily schedule includes Fluffy at 3 PM for “can’t get up” because her owner couldn’t bear to “force her to walk when she didn’t want to.” Which means the regimen was over before it started. So it is that when I evaluate Fluffy’s legs at 3 PM, they’ll probably be the last she'll ever walk on, too far gone to heal and too painful to allow her to live with.
That moment is inevitable for all of us, including our pets. It's just sad to see that for some, I've failed to bring them another six months, a year, or maybe many more, because I couldn't get out there and do the work their owners couldn't do. Because I couldn't convince their humans that those last months or years were likely to have been comfortable, happy ones...as long as exercise had played a basic role.
If you’re a great client and you ask, I’ll sell you a vaccine to administer at home to your pets––for your convenience––as long as you’re willing to listen to my speal on the subject of proper vaccine storage, handling and administration. But that doesn’t mean I support the extra-veterinary sales of biologicals like vaccines––not by a long shot.
This week on Dolittler has been lousy with talk of counterfeits, recalls and gray market veterinary product sales. We’ve seen what can happen to perfectly good products when they’re handled haphazardly by byzantine, deregulated systems of distribution.
Given that we’re so worried about flea and tick product safety as they navigate the murky waters of the gray markets, it behooves us to think on the “lowly” vaccine and wonder how many of these sensitive biologicals are rendered useless or worse as they’re handled by feed stores and shipped by online merchants of dubious repute.
After all, hardy Frontline and Advantage ship like a dream when you compare them to the temp-sensitive vaccines we work with.
Still, I know lots of you do it. You order the vaccines from Drs. Foster and Smith (excuse me if i don't provide a direct link) and you give your own shots like the pros do. I don’t blame you for wanting your continued access to inexpensive vaccines. (Yes, vaccines are easily ten times cheaper when you buy them online.) But you should at least consider the risks you undertake when you do so:
Counterfeits (a distinct possibility when dispensed by feed stores from multi-use vials), poorly stored and shipped products (do you know where your vaccines have been?) and inappropriate administration are all big issues. (On this latter point: Vaccination is not just a point and shoot flick of the wrist. In fact, for cats, it would be unfair to call me alarmist when I explain that the exact location of a vaccine can even make the difference between life and death.)
By contrast: Should you buy a vaccine from me, I don’t just hand you a bag and a syringe, collect my cash and send you on your merry way. Should you trust me for your pets’ other healthcare needs, you’ll know my vaccines have been carefully selected for your pets’ individual needs, safely sourced and well stored. You get detailed instructions on transportation, home handling and proper administration. And, best of all (from my POV), if I think you’re incapable of doing a good job, I don’t have to sell it to you.
In fact, I really don’t like sending vaccines home at all, even under these circumstances (only the best, most knowledgeable clients get my vote). Consider that should I elect to do so and your pet experiences a reaction, I may well be as liable as the manufacturer. So if you do take a vax home from your vet, don’t be offended if we make you sign on a dotted line. (FYI: I’ve never required this, but veterinary practice legal consultants strongly recommend that I do so.)
Then there’s the fact that when I administer a vaccine (or a member of my staff does), not only does the patient receive the benefits of our experience when it comes to how its best administered (which includes not administering it at all when appropriate) there’s a legal document of its administration––a start-to-finish paper trail documenting where and when the vaccine was made, who shipped it and how it was given.
That’s more than I can say for the woman whose rabies-vaccinated German shepherd bit me when I was a child. Even thirty years ago, receipts from her mail-order source somehow weren’t good enough for my doctors. Imagine that! (That’s why according to more recent laws, canine and feline rabies vaccines are not to be administered except under the direct supervision of a veterinarian.)
So when it comes to supporting feed stores, Drs. Foster and Smith and other online retailers, you should know that veterinarians may have other reasons for urging you to eschew them (beyond gray market sales of flea and tick products and basic loss of extra income).
For my part, I’ll still defend your right to buy these products elsewhere if the manufacturer is willing to sell them and back them up. Just don't fool yourself: It’s buyer beware all the way. I don’t know about you, but when it comes to something as crucial and safety-fraught as a vaccine, I just can’t imagine how the savings could be worth it.
Can you think of a scenario more nostalgic than one in which you’re forced to undertake a picture-by-picture, letter-by-letter purge of your personal life?
Long-departed pets shoulder their way back in as their images proliferate on your bedspread. Their old tags tinkle alongside Canine Good Citizen certificates as a ream of ancient adoption paperwork flutters to the floor.
Spring cleaning is underway in spectacular fashion in the Khuly household. Yes, I know it’s not spring. In my defense, I did start in spring. It just so happens this year’s been a long, slow burn kind of “clean.”
Remember the last time you moved and all the crap that went out the window? This go-round is perhaps even more thorough than that. (Case in point: over a thousand old books have already been adopted into good homes or donated to the library in advance of my new Kindle.)
But it’s not just about upending boxes of old photos and digging up glorious animal treasures. Aided by this summer’s failure of hot water heaters (plural), a well pump, and my electrical panel (you should see last month’s electricity bill) along with a mold problem and an exterior rotting wood scenario, this year’s spring fling won’t likely be complete ‘till Christmastime.
You know how it is. Whether it’s time to move or just time to sit down and mindfully organize your life’s possessions, it’s always frustrating to sort through the chaff...but immensely rewarding to rediscover the wheat along the way. And sometimes, if you can get past the tears, it’s cathartic to revisit the times and places that have defined your life.
Among the glories: Embarrassing pics from my first college road trip (that hair!). Graduation snapshots from high school (God, I hated that place). Black and whites of two boxers playing in the Philadelphia snow (color shots would have been a travesty for that foul neighborhood). Newborn portraits from my son’s first day home from the hospital. All the long-gone cats, dogs, birds and the one pretty pony from my tween years.
And then there was the piece de resistance: A patient’s cage card I’d saved from my very first euthanasia.
Kato was a young boxer whose undefinable autoimmune joint disorder had led to high fevers and debilitating pain. Despite what must have been agony (if what humans describe for similar situations is any measure), Kato never lost his drive to lick your hand, wiggle his stumpy tail in a perpetual windshield-wiper motion or give a happy-ear look whenever you peeked in on him. All this from a prone position atop his orthopedic mattress in the hospital ward where he lived for a week amid a blur of potent pain meds and a scrub-clad crowd of soon-to-be-vets.
After a week and a series of immunocompromising drugs had failed to bring him any relief, his kidneys rebelled and Kato declined. That’s when I was handed the syringe and asked to participate––if I could––in his euthanasia.
Afterwards, as I wheeled him to the necropsy room behind a veil of tears, a wise vet hospital worker spoke to me: "Remember how you feel right now and keep it with you for your whole career. If you can do that you’ll be a great vet, no matter what else happens."
It’s only a 1.5 x 3-inch sliver of blue molded plastic. But it looks kind of odd amid all the kooky costume jewelry I used to wear in vet school. That’s why after this weekend’s box-raiding session it’s time to give it a proper place. It’s own frame, perhaps? In a stately spot in my home office?
Maybe it’s a morbid thought, but sometimes resurrecting the dead is doable after revisiting a pile of ragtag ruins––even when they happen to come from a moldy closet alongside a leaky water heater. Luckily, some things can be repaired. And when they can’t, at least they can be well-remembered.
