If looks could kill....

"How to Say No to Your Vet"

Last week, Slate published an article that ruffled some serious feathers in the vet world. Entitled "How to Say No to Your Vet", Emily Yoffe describes story after story of vets taking advantage of pet owners. Vets are in it for the money, she implies, and not to better the lives of animals and owners. Owners love their pets so much that they just can't help paying for the services that vets offer, whether or not they believe their pets need them.

While she has a point that vets should not take financial advantage of owners during crises (like the guy who brought his dead dog in to the vet) and the need for good, honest communication between vets and their clients, she also seems to imply that vets should not offer the best available care because after all, they are just animals. She writes:

I am grateful to the vets who saved the life of my beagle, Sasha, when she was hit by a car, and I quietly handed over my credit card when the bill for $2,000 came due (although I did manage to decline the offer of the special "orthopedic quality" fix of her injured ligament for an additional $1,500).

I'm impressed that she can be proud of the fact that she declined to get higher-quality care for her dog. She talks about it as though the vet were trying to add on options to a car. More expensive surgery is about providing a better fix, a more comfortable recovery, and a more reliable return to a normal life- not about adding on a deluxe package so you can tell your friends that your dog got human-quality care. By the way, if you get hit by a car, good luck getting out of the hospital only $2000 poorer.

The kicker to the whole article is her support from Dr. James Busby, the kindly old rural vet from Bemidji. Dr. Busby only offers the services his patients need, and says that he'd never enter veterinary medicine today now that it's in such a horrible state with so many money-grubbing vets. What Ms. Yoffe fails to mention is that Dr. Busby is on a limited license since he went before the Minnesota Board of Veterinary Medicine in 2002. Dr. Busby was performing sub-par medicine, including not examining animals before performing surgery on them, re-using dirty needles, sterilizing instruments in a solution that he changed only once a month, and performing surgery on animals using neither gas anesthesia nor oxygen. Ew. Not a great guy to hold up as an example of how vet med should be practiced.

Dr. Busby told Ms. Yoffe what she wanted to hear- that it's okay to only give minimal medical care to your pets. She thinks that vets should only offer the cheapest option, and anything better than that exists simply to line vets' pockets. Of course vets should be sensitive to financial constraints, but not offering high-quality care is just as rotten as not offering anything but the most expensive. I'm glad that vets understand the importance of preventative medicine. The author's daughter's pediatrician doesn't think a heart murmur is worth checking out with an echocardiogram, but her vet thinks the cat's murmur is? Sheesh, lose the pediatrician and start taking the kid to the vet.

Animal myths, part 1

I feel like I've be debunking a lot of animal-related myths lately, or at least encountering enough people who believe in them to make me a little uncomfortable. So, here's my attempt to clear up some confusions about animals.

• Myth #1: Cows always produce milk.

A handful of my classmates experienced the wrath of the public during their volunteer shifts at the Miracle of Birth Center at the state fair this year. Why? They happened to be there after the birth of a calf- and when people discover that calves don't actually get to drink the milk that their moms make (aside from the colostrum), they get really upset. "Why are you taking the baby away from the mom? Doesn't he need to eat?" Well... Cows are mammals, just like humans. Female humans don't make milk until they have a baby. Cows are the same way- they won't make milk until they have calves. If we let the calf drink the milk, then what exactly would end up in the grocery store? After they consume the colostrum, calves get bottle fed a milk replacer, and cows make milk for the human food supply. It isn't healthy to make milk all the time, so after a certain amount of time, the cow gets "dried off" (stops being milked) and gets a vacation before she has her next calf and cycle starts again.

• Myth #2: Since organic farmers can't use antibiotics, organic dairy cows aren't treated when they get sick. They keep getting milked, so the reason that organic milk tastes creamier than conventional milk is due to all the extra pus in it from those sick cows.

First, ew. Second, it's not true. Just because organic farmers can't use antibiotics preventatively doesn't mean they can't use them to treat a sick animal (obviously, it would just be cruelty to leave sick animals untreated). They also have a much longer period after antibiotic treatment before that cow's milk is allowed back into their products. Finally, organic milk has to fit within all the same health criteria as conventional milk, which includes landing within a certain "cell count". A certain number of cells in milk is normal, but elevated levels indicate that there are white blood cells in it, which means the cow has an infection in her udder. Milk with elevated cell counts isn't allowed to be sold, whether it's an organic or a traditional dairy. Milk from grass-fed cows has a different fatty acid ratio than milk from grain-fed cows, which is probably what accounts for the different texture.

• Myth #3: Domestic dogs and wolves have identical digestive tracts.

I don't understand the logic behind this one. The myth usually takes the form of "Our dogs may look different from wolves on the outside, but inside they are indistinguishable. Thus, we should be feeding our dogs the same as we feed wolves." I'm not sure why this is so widely believed. How could you look at a pug, acknowledge its obvious external physical differences from wolves, but believe that selective breeding somehow left the GI tract untouched? One simple example compares large breed dogs to small breed dogs. Large breed dogs have a digestive tract that weighs about 2.7% of their body weight. Small breed dogs have a digestive tract that weighs about 7% of their body weight. That's a big difference! The size of the GI tract is proportionately different in small breed dogs.

If selective breeding could alter the size of the GI tract, I don't see why there couldn't be a ton of differences we simply can't recognize yet. The important thing to pay attention to is what the selective pressures have been on dogs. Early in domestication, the dogs that could survive on human garbage had a selective advantage. More recently, as diets shifted to kibble, dogs that did best on a kibble-based diet had an advantage. Kibble might only be 50 years old, but when you consider how many canine generations that is, that's a lot of time for breeders to be selecting (intentionally or not) for dogs that do well on kibble. A wolf that can't handle the bacterial load of raw meat simply dies. Dogs haven't had the same selective pressure placed on them- when Winnie had awful diarrhea after my attempt at raw feeding, I just put her back on kibble, no (long-term) harm done.

Anyway, my point is, there's almost no way that the GI tract escaped being altered throughout the many many many years of canine domestication. There's nothing wrong with that, and it addresses the important point that while wolves may be well-equipped to deal with raw meat, our dogs aren't always armed with the same protective mechanisms (that's a long way of saying that yes, dogs can get infected with E. coli and Salmonella- and keep in mind that those pathogens exist primarily in our domesticated livestock, and not as often in freshly-killed prey items in the wild...).

• Myth #4: The life span of pets has been decreasing over recent years due to [insert paranoia of choice here].

First, no one collects data on pet life spans, so no one has been tracking this. Second, it anecdotally doesn't appear to be true. Vet clinics today are routinely seeing cats age well into their 20s, something that was remarkable a few decades ago. The same goes for dogs- one of my professors had a 16 year old Boxer (!). So I can't say for sure, since there's no real data, but I think the vast majority of animal professionals would say that pet life expectancy is longer today than ever.

The corollary to this is "Pets are developing more cancer today than 10 years ago due to kibble/flea control products/overvaccination/etc." We are seeing more cancer now than ever, but the vast majority is because pets are now getting old enough to develop cancer- and, as pets are moved out of the backyard and into the house (then the bedroom, then the bed...), owners are far more aware of their pets' health. A lipoma that an owner would never have noticed on the backyard dog is now not only noticed on the 'furkid', but called a "cancer", and results in a trip to the vet.

(still) more thoughts on pet food

*edited to add*: Now Purina is in the game- Alpo Prime Chunks and Gravy recalled late last night (of course).

*edit #2*: Apparently the news is saying everything from "Hills Feline m/d is recalled" (which is true) to "All Hills dry pet foods are recalled" (which is definitely not true). JUST the Feline m/d- no other dry food products- are recalled.

Well, the pet food thing just got a little worse yesterday with a) the FDA's discovering of melamine in the tainted food, and b) Hills' recall of their prescription diet Feline m/d ("metabolic diet", for chubby cats). From what I can tell, melamine doesn't seem particularly toxic. According to VIN, a cat would need to eat about 4 kg of the tainted food to approach a lethal dose. One current theory is that melamine, which is chemically fairly similar to aminopterin, might be converted in the body to aminopterin. That would explain why melamine is present in the affected foods and in the kindeys/urine of animals who ate the foods, but why aminopterin is not necessarily present in all those places.

Anyway. Yesterday afternoon Menu Foods declared the recall a success and stated that all their foods are now safe. Shortly after, Hills announced their recall of m/d when they determined that the source of Menu's wheat gluten (called seitan when you feed it to people) was also the source of their own. Note that the first announcement of a recall was made late on Friday (the 17th), the announcement of the discovery of aminopterin was made last Friday (the 23rd), and the expanded recall and discovery of a new potential toxin was announced yesterday. Chris says this is a common technique in politics, to announce bad news just before the weekend so that people get all mad, then forget about it by the time Monday comes around. If we find out that Hills waited on this recall to make it on a more convenient day, they will have lost the trust of an awful lot of vets. Recalls happen, bad food gets into the food supply, and frankly with the globalization of food production, it's impressive that it doesn't happen more often. But to try to save your company's own skin by delaying the announcement of a recall, while however many pets are eating your (prescription) diet? That's disgusting.

Hills and vets have an interesting relationship. I think their sales line is "The #1 food vets feed their pets," and that's probably true. Some people claim that it's because Hills pays off vets to support their product... I've talked to a lot of people and that's simply not true. Some people say vets recommend it because they sell it, which is true in a lot of cases, but there are only a few companies that make prescription diets (Hills, Purina, and Royal Canin, I think). The main reason vets use and trust it is because vets are all scientists at heart, and Hills has a lot of research on their side. Their prescription diets do a lot of good things, and can replace or at least assist drug therapy in the treatment and control of certain diseases. They clearly spend a lot of time and money formulating their diets, and they get the science to back it up. They also invest a lot of money in vets and vet students. The sponsor a lot of our speakers, both related and unrelated to nutrition, and if we didn't have their funding we'd have a lot fewer opportunities. They even purchased all of us our copy of Small Animal Clinical Nutrition. So why have I still been so skeptical of them?

Maybe it's because I worked for Petco for way too long and have developed a large distrust of all things corporate. Everything in corporate is about CYA (cover your bum) and trying to look good to the public while making as much money as possible. Then don't do anything really beneficial for anyone but the company until you get caught. I'll admit that Petco made some remarkable changes to their animal care policies, but not until their San Francisco store got shut down for animal cruelty. In Hill's case, I think my skepticism came from reassurances that any pet food with a recognizable name (mainly Hills' Science Diet, Purina, or Iams/Eukanuba) is a good food, and what makes them better than the rest is their quality control. Little companies can't afford to be doing chem analyses on each batch of food they produce, while the big guys can. They can afford to make sure the food is safe and contains all the nutrients they say it does. And "pets need nutrients, not ingredients"- meaning that if protein comes from chicken, or soy, or grown in a petri dish, it doesn't matter because your dog's body will process them all the same way. Companies who make dog food using organic free-range chicken are selling more to pet owners than to pets.

I've heard those arguments over and over, and I believe them..... sorta.... I mean, their quality control has to be amazing, considering how many animals eat that food, since recalls like this put a black eye on the companies involved for a long time. And considering "super premium" food companies like Innova or Eagle Pack still only have about 5% of the share of the pet food market, deaths related to a toxin in their foods likely wouldn't even be noticed as being food-related, as it would affect so few pets.

But despite that, I still have a hard time buying the "nutrients, not ingredients" line. I understand it scientifically- your gut could care less what the source of those proteins are, it just wants to digest and absorb them. But at the same time, I can't believe I'd be just as healthy consuming a powder that contains all necessary nutrients as I would be eating a well-balanced diet that includes fresh foods (to quote Michael Pollan, "Eat food. Not too much. Mostly plants."). Okay, so the body utilizes nutrients rather than ingredients, but ingredient type and source and quality all have to factor in to how well our body can extract nutrients from it, right?

My nutrition text states that to meet a dog's daily protein requirements, a kibble should have about 20% protein. Beyond that, protein is utilized not to build other proteins, but to provide energy. Carbs provide energy too, so most dog food companies use 20% protein and make up the rest of the energy needs with carbs, because protein is expensive while carbs are not. But who says that carbs are the best choice here? Cheaper yes, but would dogs do better with more protein? Does a high-carb kibble have any unintended side-effects? The Hills guy told us at a lunch talk the other day that n/d, their prescription cancer diet, is low carb because cancer feeds off of carbs. Lower the carbs, starve the cancer. So why not just use a low-carb diet all the time? It won't keep cancer from occurring, but if you never give it carbs to grow on in the first place.... But oh, carbs are cheap, protein is expensive.

This is my last point, I swear. This recall is coming from a breakdown in quality control somewhere. Perhaps not in the manufacturing plant, as they clearly didn't know to be testing for this toxin since they didn't even know what the toxin was. The breakdown came early on, when someone decided that importing pet food ingredients from China was safe, despite the fact the both of the toxins they've found are illegal for use in U.S. food production. Pets need nutrients, not ingredients.... but some ingredients have toxins from fertilizers and pesticides... Maybe Winnie doesn't need organic chicken, and maybe I'm buying her food for my own piece of mind. But at the beginning of all this, Hills' and IAMS' defenders kept insisting that this sort of thing could happen to any company, big or small. Now that they know what this is, I can say that it couldn't have happened to those companies who practice their quality control at the beginning of production- utilizing pesticide-free grains grown in the U.S.

another quick food update

Here's a good list of all the food brands NOT involved in the food recall:

http://petsitusa.com/blog/?p=210

Also, I want to remind everyone to stay smart about all this. I'm seeing a lot of messages like, "My 12 year old dog ate Newmann's Own canned food and died of renal failure in December, so thus that food must have been contaminated." Kidney failure is not super common, but also not unheard of- having a pet go into kidney failure does NOT mean they had to have eaten a tainted food, or that the brand of food they ate caused it. That would be like saying that anyone who came down with vomiting and diarrhea during the E. coli spinach recall must have contracted E. coli.

Second, I see a lot of people vowing to never buy food from any company that has ever associated itself with Menu. Keep in mind that pet food companies determine the recipe of their foods. Natura (the Innova people) uses Menu, but they only use ingredients that came from within the U.S. I find it difficult to believe that the affected companies weren't aware that Menu was finding the cheapest possible ingredients to use in their foods. I also wonder why those companies didn't ask the same question so many are asking now: how cheap must Chinese wheat be to make it economical to import wheat into Kansas?

another food update

The toxin has been identified- aminopterin, a component of rat poison. It's not legal for use in the U.S., and is thought to have come in on wheat imported from China.

I don't think IAMS and Eukanuba are ever going to recover from this.

Food recall information

We are getting a few hits from people searching for information about the pet food recall, so here's a little more information that I've collected (with lots more available at vetcetera)...

The Animal Medical Center of New York offers the following information about cases they've had:

Owners of pets with azotemia [an excess of urea or other nitrogenous wastes in the blood as a result of kidney insufficiency] have been contacted to determine if the pets had eaten the recalled foods. During this time period 143 chemistry profiles were performed and 5% of pets who had a chemistry profile obtained in that time period have been determined to have food-related acute renal failure. At this time, AMC has identified 12 cases of food-related acute renal failure, 8 cats and 4 dogs. Age range was 2-14 years with a mean age of 7.4 years.

Based on this survey, we can provide the following limited information about food-related acute renal failure. All pets had at least one clinical sign of acute renal failure: 75% had anorexia, 50% had polyuria and polydipsia, 50% had vomiting and 50% lethargy. The course of the disease before presentation to AMC ranged from 1 to 60 days. Mean creatinine was 7 mg/dl with a range of 2.1-14.8 mg/dl. Mean BUN was 110 mg/dl with a range of 33-210 mg/dl. Three pets were diagnosed on an out-patient basis. Nine animals were hospitalized of which 3 (2 dogs, 1 cat) died or were euthanized despite treatment. Six were discharged from the hospital. Four of these were discharged with persistent azotemia. Our follow-up time is short and the long-term prognosis is unknown.

Cornell's diagnostic lab is still working on figuring out what the toxin is that's causing this... They posted this a couple of days ago with information for pet owners and vets.

There are still no dry foods included in this recall. If the brand you feed is not on Menu's recall list but you want to be sure they aren't in the recall, check their website. I know that Natura (who makes Innova and California Naturals), Nature's Variety, Timberwolf Organics, Eagle Pack, and Wysong all have statements that they are not involved in the recall.

The extent of the problem still isn't clear...

Pet food recall

The veterinary community has been all over the big pet food recall announced a few days ago. Menu Foods, a manufacturer of about 50 brands of dog food and 40 brands of cat food, recalled about 60 million cans of wet food and pouches. Some ingredient, possibly wheat gluten used in the gravy of "chunks and gravy"-type foods, may be causing pets to go into acute kidney failure. The problem has the potential to be quite devastating... So far there are 10 confirmed cases, but they were all animals involved in a feeding study. 10 out of 50 animals in the study died- a 20% mortality rate. Yikes. Hopefully this isn't as bad as it sounds like it could be... I would be so sick with guilt if something I fed Winnie killed her. The companies (Iams, Petsmart, etc) seem to be on top of things, paying for treatment of any pets that became ill after eating the recalled food. If you think your pet ate recalled food, CALL YOUR VET to see what he/she recommends, and SAVE THE PACKAGE... Without it, you have no proof your pet ate recalled food, and the food companies may not reimburse you for treatment. It's going to take Nutro and Iams years to recover from this, if they ever do...

What does this say about the pet food industry? I don't really know yet. I choose not to feed Win one of the "big name" foods (Science Diet, Eukanuba, Iams, Purina) mainly because I think they are overpriced for what you get. Corn is definitely digestible, but it's also a really cheap carb source- why would I pay the same price for a corn-based food as for a rice-based food when a) rice is a more expensive carb source and b) rice is more digestible? I honestly just like how Winnie does on Eagle Pack, and if it ain't broke, don't fix it. She has a nice coat, good energy, good poops, and she enjoys the food. The main benefit of feeding a big name brand is that their quality control is ridiculously good because when things like this happen, it costs the company a bundle to clean up. But alas, quality control doesn't catch everything I guess. I don't think it says anything about the quality of food these guys make, or that something like this could never happen to super premium brands like Innova, Eagle Pack, etc. I think it's just pure bad luck, like the spinach E. coli outbreak, or the salmonella in peanut butter. It will be interesting to see how it all pans out. Pray for any sick critters who are in the hospital tonight trying to recover from whatever this is.

Totally unrelated to the food recall, this is a fun little toy... The Baby Name Wizard can show you how popular your name has been over the years. "Megan" hit its peak popularity in the 1980's/1990's (thank you The Thorn Birds), while "Chris" was most popular in the early 1960's 1970's 1980's and 1990's. "Winnie" was most popular in the 1890's. "Bjorn", however, has never been among the most popular 1000 names (sorry Bjorn).

(and no, I am not looking at baby names... someone just linked to it on a rabbit forum, I swear!)