Monday, June 18, 2018

Dogs Getting High


Ralph was certainly not himself. It was hard to tell how he actually felt, but the old shepherd was barely able to walk, stumbling and swaying each time he tried to take a step. And his eyes had a glassy far-away look.

"His arthritis is so much worse today!" Mrs Sorensen said, clearly upset and worried.
Although he was obviously having trouble getting up and walking, this did not look at all like arthritis symptoms.

"Have you been giving him anything for the arthritis?" I asked, a suspicion beginning to form.

"He gets his glucosamine and fish oil and then recently I started to give him a little CBD oil. Just a little doctor."

Suspicion confirmed - Ralph was stoned.

In theory this shouldn't happen with CBD, also called cannabidiol, because, in theory, it should not contain any THC, the psychoactive component of cannabis. But that's just in theory.

In one year CBD has gone from a "what's that" obscurity to an every day conversation with pet owners. Quite literally every day. I have been in practice long enough to have seen this phenomenon before. Just in recent memory vitamin E, eichinacea, grain-free diets and coconut oil have all had their moment in the sun as potential panaceas. The internet age spreads the word so much faster while amplifying the most improbable stories. In each case these remedies did not end up curing cancer, reversing kidney disease or noticeably "boosting the immune system", but each did end up finding a place in the array of options for some specific conditions in some specific patients. It's just a much smaller place than the enthusiasts had hoped for. If medicine were only so simple!

And so it will be for CBD oil. The range of disorders that people want to try it on their pets for is breathtaking, but the best evidence we have is that it might be useful for three things: epilepsy, nausea and, yes, arthritic pain. There are some problems though.

The first problem is that the research is lacking. There is a lot of work being done right now though, so hopefully we'll have some more clarity soon, but for the time being everything we know is based on anecdote and extrapolation from humans. There are plenty of examples in other areas of medicine where anecdotes and extrapolations have misled us, so some caution is warranted.

The second problem, as illustrated by Ralph's experience, is that quality control and regulation are also lacking. Contamination with THC is not that rare. I haven't seen numbers on that, but I did see another stoned dog with the same story soon after Ralph. Also, some reports indicate that the majority of commercially available CBD oil is contaminated with pesticides and other troubling substances. Google "contaminated CBD" if you're in the mood to be alarmed. Also, when tested, some of the products contain either very little or even no CBD oil at all. Moreover, all of this can vary from batch to batch, so just because Aunt Marge's corgi is like a pup again after three drops of "Doctor Good Earth's All Natural Holistic Small-Batch Artisanal CBD Oil", doesn't mean that your dog will have the same experience.

Patience people. My own dog is epileptic and I'll probably try CBD, but only once the science is in and the quality is truly assured (i.e. not just by the dude at the health food store). If your dog suffers from epilepsy, chronic nausea or arthritic pain and you feel like you can't be patient because nothing else has worked, please check with your vet first before winging it with CBD. New information is coming out regularly.

Ralph was better after about a day. Mrs Sorensen is going to be patient now.

Monday, June 4, 2018

The Shoemaker's Children


A few months ago my wife, who is also a veterinarian, and I began noticing that Gabi, our 11 year old little black and white cat, was becoming even more aggressive about stealing food. I say "even more" because our three cats and one dog are an unruly, barely trained lot who climb on tables and surf counter-tops with impunity. Ok, impunity is an exaggeration because we do shout at them, but this is apparently just a bunch of monkey noise as far as they're concerned. It is, of course, entirely our fault and we have more or less made peace with the situation, but Gabi had become so much worse that it got our attention. She was also yelling more and beginning to look a bit skinny, despite her impressive appetite.

Now those of you with some knowledge of cat diseases are beginning to go, "hmm..." However, Lorraine and I, despite having considerably more than "some" knowledge of cat diseases did not go, "hmm..." We just shrugged and didn't make much of the changes. She seemed fine otherwise.

Fortunately Gabi was due to have some dental work done, so I took her into the clinic for that. I was ordering routine pre-anesthetic bloodwork for her when the penny finally dropped. Seeing her in a clinical setting caused a sudden shift in my perspective. I asked them to run a thyroid level as well. Yup. Our cat was hyperthyroid and had probably been hyperthyroid for several months, displaying textbook symptoms right under our noses.

Most of you have heard the proverb regarding the shoemaker's children. The shoemaker is so focused on making beautiful shoes for his customers that he doesn't notice that his own family is shoe-less. It's not anywhere that extreme for most veterinarians most of the time, but at times the shoemaker's children phenomenon is quite real and it is downright embarrassing.

This is an interesting subject (I hope...) because many clients when faced with a difficult decision will ask us what we would do for our own pets. This is a fair question. In fact, when I first started out in practice I didn't have any pets of my own, but in giving advice I had "if this was my mother's pet" as a mantra to guide me. I can obviously only speak for myself  and I may well be a freakish outlier, but despite that mantra I have to confess that I do sometimes treat my own pets differently than my clients' pets. Often worse, as in Gabi's story, but sometimes better too. Maybe it's instructive to see where I deviate, so I've made a list:

- I never stop vaccinating due to age, because immune function can decline, and I never worry about reactions because they are so very rare, but I am not good at keeping to an exact vaccine schedule. A three year vaccine might sometimes be done in four years when I finally remember. I'm not recommending this slack approach, but it does illustrate that there is some flexibility. Thorough annual exams are important though as pets age five to seven human-equivalent years for every calendar year. If the experience with Gabi has taught me anything it's that I need to do this religiously for my own pets and not rely on those casual assessments that occur because I happen to live with them.

- The moment I finally recognize that something is wrong with one of my animals, I run every test that might conceivably be helpful. With clients we're often concerned about the cost of running lots of tests, but we should give them the option of doing more than the minimum if they can afford it and want the peace of mind.

- When one of my pets is deathly ill I am tempted to try heroics, and have in at least one case done more than was in retrospect sensible to do. I think we do a better job counselling our clients on end of life decisions than we do for ourselves.

- My family feeds more treats and "people food" than I recommend, so I understand what those soft brown eyes and purring leg rubs can do to a person's willpower. This is not an excuse though - you can and should be stronger willed than me (or my family)!

- Ditto for brushing their teeth. We don't do it and I really do know we should and I really do believe in the benefits of it. But it's supposed to be my kids' job. That's my excuse and I'm sticking to it.

Gabi is on medication now for her hyperthyroidism and is doing well, so no harm done. But it was valuable lesson and one that I hope I will actually remember this time!