Weekend Beef: Don’t Trust Google More Than Your Vet
In the age where any Joe can have a blog, website, or informational page, pet owners need to practice extreme caution when gleaning information about their pet’s health. I think most people realize the internet is full of misinformation. That’s why most pet owners who’ve done their research online bring a pile of it to their appointment. I help them sort through the facts and fiction and in due time we come to a conclusion together. While “I read on the internet” can sometimes make my eyes roll, I do enjoy a pet owner who is well informed. I do not, however, enjoy a pet owner who has been handed a bunch of opinions disguised as facts and, despite an education from yours truly, still trusts her online support group more than her veterinarian.
Such was the case I was presented with this week. A senior cat was diagnosed with end stage kidney failure. I was the third veterinarian to see him at our practice and the also the third veterinarian to explain chronic renal failure, treatment options, and quality of life issues. At this stage in my career, I think I have renal failure down pat, but my friend Justine Denial had lessons for me to learn. I walked into my appointment and encountered what I like to refer to as “The Scroll”.
The Scroll is the sheet of paper that has every question, topic, and reference the owner found on infallible sites like Wikipedia, Ms. Kitty Purrfect’s Blog, and Josey Magoo’s facebook page. The Scroll, mind you, is very different from the list of questions many responsible pet owner’s bring to their appointment. The Scroll, on the surface, seems to have been derived from willingness to learn. Explore deeper, however, and I realize it’s a trap. It’s an amalgam of misinformation that challenges the very education I’ve had as a veterinarian.
Ms. Denial informed me she had joined an online renal failure support group and they recommended “slippery elm” supplements for the cat’s constipation. While I am not adverse to herbal therapy, I know nothing about this slippery supplement and let her know I would look into it. I also discussed the constipation issue is due to the chronic state of dehydration and will be something we would battle continually as the cat deteriorates. I was met with a blank stare. I suppose the support group hadn’t told her that. We talked more about quality of life and what to expect as her cat became sicker. Another blank stare. Hmm, perhaps she wasn’t understanding this is a progressive, always fatal condition? One more try and I realized she just wanted to stick with the scroll.
We charged forward into a headache-inducing discussion about SQ fluid choices because she heard from her support group that the cat should be getting one specific type of fluids. Trying to explain acid-base balance and electrolyte abnormalities to a lay person who didn’t want to hear what I had to say was maddening and a monumental waste of time. I recommended a fluid and we settled on it.
Finally, Ms. Denial rattled off a list of parameters she’d liked checked, including creatinine, potassium, calcium, “anemia”, magnesium, and vitamin B12. When I offered explanations that most of these parameters were included in labwork from several days ago and were normal, she still wanted them checked because her support group said she should have it done. I offered Ms. Denial a renal panel, at the cost of $80, that would allow me to check many of her required values. “Well, I don’t have THAT kind of money.” I could feel the aneurysm bulging behind my eyes. We finished and I decided I’d rather shove a pencil through my nose than sit through an appointment like that again. Two hours later Ms. Denial called asking to exchange her fluids.
Side Note: Slippery Elm is a safe fiber supplement for cats with questionable efficacy for constipated cats with renal failure.
This is kinda off topic, but I seem to recall that people also suggest slippery elm for horses with anhidrosis. I guess it’s supposed to help with dehydration somehow (a common theory for anhidrotic horses is that they’re dehydrated, tho this hasn’t been shown in research). I just did a quick web search and couldn’t come up with anything besides vague claims with no backing (shrug).
1Dr. K.. – I am a member of one of one of those dreaded online support groups. Let me say this though, not all online support groups are created equal. I have a wonderful vet who I think very highly of and trust completely.
I also have a labrador who was diagnosed with Primary Addison’s and I quickly realized that if my boy was going to live a long and healthy life I would need to educate myself. I read everything I could get my hands on from legitimate veterinary sources. He was started on florinef and did not do well and his dose was constantly being increased until he was taking 2.2mg a day and his lytes were still not under control. The research I did led me to Percorten V which at the time was not available in Canada and my Vet had never heard of it.
I decided I needed to find a way to convince my Vet to try the drug if I could get it into Canada. I printed out as much info as I could find on using percorten, the product insert etc and met with my Vet and asked her to read through it when she had a chance and tell me what she thought and did it look like a viable treatment option for my boy. I don’t think she was really interested in it but she did read it, checked out my info on VIN and was really quite excited to try it..
Percorten was a miracle drug for my boy. To look at him you would never know he has a disease. My vet has told me that although she learned about Addison’s in school, I educated her on Addison’s.
A great deal of the info I got was from the yahoo support group Addison Dogs, and the website they maintain http://www.addisondogs.com
Some of these groups are excellent, people need to look carefully for disease specific, breed specific, large groups with moderators, the info presented should be backed up by Published articles. The better groups also have websites with links to good quality veterinary Info on the specfic disease it covers.
A good group always suggests that people talk to their Vets, that they need to be a partner in their dogs health care especially when it comes to chronic disease.
We try to get people to present an idea and then ask their Vets opinion on that idea..
You have had a bad experience with a member of a support group but please do not let it colour your view of all support groups.
I can only speak for the group I belong too but we do good work.
We see people join our list who have wonderful experienced Vets and their dogs get great care and we also see the other end of the spectrum.
Dogs diagnosed with Primary Addisons and put on percorten with completely normal electolytes prior to treatment when they only needed the steroid replaced and didn’t ever require percorten. We see newly diagnosed dogs who were taking prednisone before the ACTH test and when they are weaned from the prednisone and retested they didn’t have Addison’s. All because the Vet did not know that steroids other than dexamethasone can cause a false positive for Addison’s.
We see dogs who have had Addison’s for several years when suddenly the percorten does not seem to be working and so the dose is increased and the time between injections is shortened. We encourage the owners to see a specialist to get another set of eyes on it and it turns out to be Kidney failure or something else unrelated to Addison’s. When a dog has a disease like Addison’s sometimes a vet seems to have blinders on to other things.
I am not knocking vets at all please do not think that. I just want to point out that there are good and bad support groups, just as there are good and bad vets and more experienced and less experienced vets..
I really believe that there is a place for online support groups.
Sorry this was so long, I bet you can’t tell I am passionate about good online support groups and Addison’s
Addison Dogs Rock!!
Elizabeth and Raider ( my ADog )
2Elizabeth,
I appreciate your response. For the record, I am not adverse to responsible support groups. In fact, I promote my friends at Tripawds.com to my canine amputees. I am also very open to outside ideas. I will definitely take a look at your support group and won’t hesitate to share it.
My bigger issue was this particular client adhered to every opinion held by her probably well-intentioned support group and refused to listen to me when I offered the truth. It’s so important to follow facts, especially in cases where realistic expectations are critical.
At the risk of sounding whiny, we vets take a lot of grief from owners. From struggles with finances to the stress of end of life decisions, we take the brunt of misguided stress. I tolerate that with a “grin and bear it” mentality. My breaking point comes from folks who seem to lack respect for my education and knowledge base. I don’t know everything, but I like to think most times I know more than a pet owner. When I don’t know something well, I research it like a mad woman until I have a grasp.
PS – All we use for Addison’s dogs is Percorten V. You’ll be happy to know the last dog I diagnosed was on Friday, no steroids pre-ACTH stim. Na:K of 20!
3Dr K,
Tripawds.com is awesome! I sent my friend there when her dog lost a leg to cancer..
I know Vets take a lot of grief, ( you do not sound whiny btw) I unfortunately hear it on our group as well, but I also hear about all the great things Vets do.
Please know there are many of us who do appreciate all you do for our beloved family members. I always make every efford to show my Vet I appreciate what she does. I hope in some small way it makes up for the grief she has to take from people like the one you wrote about.
It’s too bad we always seem to hear that voice of complaint in our head more often then the ones of praise and thanks.
I think the owner of the Addison’s dog you just diagnosed doesn’t know how lucky she is to have you.. Send her along to Addison dogs and we will remind her hehehe…
hey how do you feel about low dose percorten treatment? Raider weighs 75lbs and now takes 1ml of percorten Q 28 days, his Na:K was 15.3 when diagnosed just in case you might think that percorten dose is too low for him to really have Addison’s..
E
4Elizabeth,
Thank you for your kind words.
Percorten dosing to effect. If it’s keeping him controlled, then it’s the right dose even if it seems low! We should always strive to use the lowest doses of medications possible.
5“Percorten dosing to effect”, how I love those words! That dog is truly in good hands..
Elizabeth
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