Thursday, March 5, 2009

Treasure Hunts in Alternative Medicine Land

Teaching gives me a chance to get a new perspective on a problem every time. I love it.

So I have a favorite teaching device or two when it comes to educating veterinary students on what their clients will face out there in alternative medicine land. It’s called a treasure hunt, and it puts them face to face with the best and the worst of holistic capitalism…. er….. healing.

Today, I sent two students to a local feed store that apparently concentrates its inventory on the natural/holistic diets. What is a natural/holistic diet, you might ask? Actually, you would only be asking that if you are a veterinarian, nutritionist or a skeptic, because people interested in holistic medicine seem to understand it on an intuitive level, and for everyone else, there is no regulatory definition.

I know what *I* think a holistic diet is. And I plan to talk about that one day, but I’d be more interested in what YOU think it is. Of course, you’ll have to post to start that discussion, and I hope you will.

But back to the treasure hunt. I ask my students to pose as typical pet owners who are interested in natural and do-it-yourself cures for a chronic and frustrating problem. Not actually all that hard for them to do, because many are faced with the same problems you are – not much money and a long term veterinary expense.

So one goes to a feed store and asks about her cat who has a history of lower urinary tract disease (LUTD). This is a painful and potentially deadly set of diseases – one version is severe inflammation of the bladder, not due to infection and not well understood which, like the similar condition in women, can lead to a serious diminishment in quality of life because the patient lives in constant pain. Another version of LUTD is due to the accumulation of mucus and mineral crystals that form an uncomfortable sludge in the bladder, in some cases blocking the urethra which requires emergency treatment to prevent death.

Veterinarians need a good history and some labwork to decide which of these disorders afflicts your cat. But that doesn’t stop the holistic food manufacturers….no….they simply propose to treat your cat without this information.

Let’s look at the treatment for interstitial cystitis, the horribly painful, bloody cystitis that has nothing to do with a urinary tract infection. Veterinarians doing research in the field believe that this disorder is associated with stress, and some are investigating the theory that an underlying viral infection or other pathology may make it re-activate when the cat is stressed. Recommendations are to dilute the urine by feeding food that has more water in it (i.e. canned or fresh/homemade food) and possibly to treat with glycosaminoglycans (like glucosamine) that are thought to protect the bladder wall. Stress reduction is a vital part of treatment of this disease.

On the other hand, if your cat forms crystals and mucus plugs, the treatment is mostly to dilute the urine so that those crystals are less likely to form. To a lesser extent, we try to manage the acidity of the urine, but on a long term basis this is fraught with danger as preventing one type of stone (struvite) by urine acidification can predispose to another type (calcium oxalate) which gives us a completely different set of management problems.

The newest thinking is that it’s best to manage cats with these problems by making sure they are getting plenty of water in their diets – and this isn’t gonna happen if they eat dry food, unless it’s a prescription diet. Although we used to talk about management of mineral concentrations in the urine by limiting ‘ash’ and then magnesium in the diet, we realized sometime in the last decade or two that this wasn’t really the right target.

And since these problems are sterile (at least initially) – that is – they are not urinary tract infections – no antibiotic therapy is needed at all.

So back to the treasure hunt – here is what the holistic pet food store employee recommended:

1. a low ash diet
2. a diet that contained cranberry (cranberry being for urinary tract infections and to acidify the diet).
3. Not a word about avoiding dry food.

Sigh. Disappointing not only that they are giving out inaccurate information, but that the information is at least 10 years out of date! And this store actually holds ‘nutrition seminars’ given by a local dog trainer!

OK, I’m a fan of holistic diets too, but friends, please ASK about the medical training of a person making recommendations for your sick pet. There are veterinarians out there who can help you with holistic diet and other therapeutic choices. My students now better understand why they need to help their clients find reasonable holistic options rather than leaving it up to chance.

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