Answers From A Place Of Authority



Have you ever heard one of the following authoritative statements?

1. “I will never use [drug X] again. I lost a patient because of it.” (Recent examples include buprenorphine and some NSAIDs.)
2. “More and more pets are overweight/obese/diabetic because evil pet food companies use more and more fillers/carbs/corn.”
3. “The increasing frequency of immune-mediated diseases is clearly due to overvaccination programs.”
4. “Cancer in pets is clearly due to X, Y, Z.”
5. “We should ban pit bulls.”
6. “We should ban declawing.”
7.  “TPLO [tibial plateau leveling osteotomy] is the devil.” 
8.  “Amputation/subtotal colectomy/ chemotherapy/ radiation therapy is inhumane.”
9. “Spaying/neutering is unnatural.”
10. “Spayed/neutered pets become fat.”
11. “Females should have one heat cycle to achieve ideal growth/behavior/happiness.”
12. “This pet is too old for this procedure.”

As my English teacher used to say, “Generalizations are risky.”

Clearly, the world would be simpler if life’s little problems had easy answers. However, answers are rarely black and white. They come in shades of gray.

Let’s review these 12 statements.

1. “I will never use [drug X] again. I lost a patient because of it.”
Was the drug truly the culprit, or was some kind of human error involved? And how do we know that drug X killed the patient rather than drug Z? And why does everybody else in the world seem to use the drug with few complications?

2. “More and more pets are overweight/obese/diabetic because evil pet food companies use more and more fillers/carbs/corn.”
A more balanced realization may be that in the vast majority of cases, pets gain weight because they eat too many calories or because they don’t exercise enough.

3. “The increasing frequency of immune mediated diseases is clearly due to overvaccination programs.”
Don’t take that answer from a surgeon who doesn’t vaccinate (besides his own pets). 

Alice Wolf, a board-certified veterinary internist from the Texas A&M vet school and a Veterinary Information Network consultant, says: “Vaccines rarely induce immune-mediated [IM] diseases such as IM hemolytic anemia, IM thrombocytopenia, IM polyarthritis, etc. But most occurrences of IM disease are spontaneous and the triggering event is not known.”

Based on some top secret information obtained for Veterinary Practice News readers, we are able to say that more specific recommendations will be made in the upcoming 2010 American Animal Hospital Association vaccination guidelines. 

Richard Ford, a board-certified internist at the North Carolina State vet school, suggests: “If a patient has a history of having a known or suspected immune-mediated disease, booster vaccination is generally not recommended. That said, this belief has yet to be objectively documented or confirmed in the scientific literature.”

4. “Cancer in pets is clearly due to X, Y, Z.”
Sadly, in the vast majority of cases we don’t know the cause of cancer.

5. “We should ban pit bulls.”
Whether breed bans actually work remains to be proven. In my limited experience at one practice, banning “aggressive breeds” led to the sudden proliferation of mixed-breed dogs: a pit bull suddenly became a boxer mix and an American Staffordshire terrier magically became a Rottie mix.

6. “We should ban declawing.”
 No comment.

7.  “TPLO is the devil.”
Well, that one is silly. As a TPLO surgeon, I would say: “TPLO rocks!”

8. “Amputation/subtotal colectomy/chemotherapy/radiation therapy is inhumane.”
Just one comment: Lack of sufficient pain management is inhumane.

9. “Spaying/neutering is unnatural.”
No comment.

10. “Spayed/neutered pets become fat.”
Removing gonads increases the risk of weight gain because of an increased appetite or decreased metabolism (by 20 to 25 percent). If more of us routinely recommended switching to a light diet after sterilization of cats and dogs, fewer pets would be overweight.

11. “Females should have one heat cycle to achieve ideal growth/behavior/happiness.”
This is a rather stubborn urban legend. The main reason to spay females before the first heat is to virtually eliminate the risk of mammary cancer. Some studies may suggest possible orthopedic consequences, but they are non-life-threatening and curable. So it’s a matter of weighing the pros and the cons of each procedure.

12. “This pet is too old for this procedure.”
My standard reply to this is: “Age is not a disease.” We often do tie-backs in dogs with laryngeal paralysis. Most are older Labs: 10-, 12-, 14-year-olds. A frequent comment I hear after surgery is: “He acts like a puppy again.”

There are, of course, many similar situations. Rather than a discussion about age, the practitioner and client should discuss differential diagnosis, prognosis, cost and other factors. 

Age is a very relative factor, in my mind. Is it worth removing a benign splenic/hepatic/skin tumor in a 14-year-old patient? It shouldn’t be up to us veterinarians. Because no matter how knowledgeable we think we are, we don’t know whether that particular pet is going to live to be 15 or 16.

Personal conviction, anecdotal information and verbal abuse are unfortunately widespread. Because of dogma, countless pets do not receive the treatment that could cure their disease, improve their quality of life or prolong their lives (of course with respect, dignity and adequate pain control).

So here is another “authoritative statement” for you: Dogma sucks.

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