Ever surf the Web looking for credible information on your pets? If you’re reading this I know you’re working on it. What say you, then, to the research that intends to warn you off blogs like this, lest they be chock-full of “unconstructive” information?
Two recent papers, one of which appeared in this month’s JAVMA (Journal of the American Veterinary Medical Association) effectively urge vets to steer their clients clear of the Internet. Too many of their clients (you), it would seem, are taking to the Web to have your information needs met—and finding “unconstructive” advice instead of the good stuff your vet should be dosing you with regularly.
This latest bit of research revolves around the concept of anesthetic information available online. Authored principally by two boarded veterinary anesthesiologists, it hypothesizes that the Web is an obvious source for poor quality advice on breed-specific anesthesia warnings—as in,
“To the author’s knowledge, there is no scientific basis for any claim that a particular breed of dog is more sensitive to anesthesia than any other, with the exception of sighthound breeds; nevertheless, such claims are prevalent on the World Wide Web.”
Armed with a certain degree of indignation given the fact that their anesthetic knowledge base is being hijacked by breeders (and others) who insist that “the veterinarian is not to be trusted on breed-specific anesthesia risks,” these anesthesiologists used this basic bit of common veterinary knowledge to discredit the Web’s generally erroneous consensus on the issue.
Of the 73 websites this study investigated, one is almost certainly Dolittler, considering that the methodology employed involved an extensive Google search on “anesthesia,” “warning” and “dog.” Nonetheless, it found that even among veterinarian-authored sites, the information on anesthetic risks was more likely to be “unconstructive” than “constructive.”
“Web sites in which information was written by veterinarians were no more accurate or complete than those in which information was written by nonveterinarians.”
Ouch!
In large part I don’t disagree that the preponderance of information on certain pet health subjects is fraught with fallacies, mythology and abundant anecdotism. But it still smarts to be identified as a potential purveyor of “unconstructive” goods. This charge hurts more so considering my outspoken remarks against breed-specific anesthetic fears (I think they’re way overblown and always anecdotal).
You might think I might feel threatened or insulted by my colleagues’ condemnation of Web-based information. Truth be told, I do…but not just for personal reasons. After all, I well understand the frustration of attempting to dissuade a client that their Tibetan spaniel is no more at risk of suffering an adverse anesthetic event due to my inferior knowledge of this breed’s unique and challenging physiology.
But my take is a little different than the study’s authors'. In my view the Web is not the enemy…nor are sites like Dolittler. Rather, the most typical adversary is the dearth of responsible information administered first-hand from those veterinarians among us who need to be more proactive in acquiring our clients’ confidence. We should be more diligently addressing client concerns with the intelligent, science-based knowledge that is our purview. The Web-based findings are a mere symptom of my profession’s failure to properly educate our very own clients.
Admittedly, the enemy is also the lack of responsible sites. Sure, the Web is filled with errors—from Wikipedia’s often-biased “encyclopedic” knowledge to the tiniest blog on Basenji-appropriate anesthetic protocols. We all know it. But does research that harps on the Web do anyone a service beyond scaring the average veterinarians into a fear of everything Internet-related?
Don’t think so. We have seen the enemy—and it is us…not the Internet.
Dolittler
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Here's my post on "Phantom anesthetic sensitivity in purebreeds" for your consideration. Maybe the study's authors can read it again.
Dr. Patty Khuly December 15th, 2008 08:56:30 AM
THANK YOU
miss ksa December 15th, 2008 09:54:34 AM
Maybe I'd be a little more sympathetic to the POV of the article you mention, if more of the vets I've frequented had heard of the MDR1 mutation and its effects on anesthetia protocols. I suppose technically it's not the anesthetic (e.g., isoflurane or similar) that's the problem for the MDR1 mutants, instead it's the PRE-anesthetic Acepromazine, but to moi, it's part of the anesthesia protocol. Therefore, yes, my breed often is more sensitive to anesthesia. And I wouldn't know about it without breed-related websites and lists.
I have seen my dog, at 7yo, have a very long recovery from having X-rays done under anesthesia (approaching 24 hours before she really walked normally), and I've seen her at 12yo move normally a few hours after dental surgery. The difference: I vetoed the first two anesthesia protocols for the surgery as being too high risk for an MDR1 mutant, so my vet went to the VIN and found a protocol geared for MDR1 mutants and used that.
I'm not upset that I had to advocate for my dog. With more than 150 breeds out there, I don't expect my vet to know everything about all of them. I would be upset, and she would not still be my vet, had she told me there is no substantial difference between breeds in their reactions to anesthesia.
kabbage December 15th, 2008 10:19:05 AM
Wow, Dr K - Let me be the first to say that no one here considers you one of the "enemy."
I am in full agreement that much of the confusion lies with the fact that most vet simply blow over the majority of the information they should be passing on to the client as in "don't worry, I know what I'm doing!"
But I think just as much of the problem lies with those vets who refuse to see the light even after being presented with journal articles and published studies, as per kabbage above.
Some days I don't mind that "I know what I'm doing" mentality, after all I want a vet who's confident in what they do... but it's the "I know everything about what I'm doing" mentality that serves neither client nor patient... nor vet in the long run.
Kim December 15th, 2008 11:09:48 AM
I'm not anti-Internet, or anything. (Heck, I'm here! :-) Although I will say I visit maybe two web sites, regularly...having pretty much "given up on" the usefulness of the old girl.) It's just that I find there are far too many "instant Internet experts" counselling others, when those individuals really have no expertise to speak of. And this is why I, too, tend to steer people away from the Internet for anything but news and humour (okay, and really basic information, or retailer web sites).
There's plenty of interesting stuff to read. Don't get me wrong. But waaaaay too many people read something, then go around preaching it, as though it is "fact"; as though they did the study, the research, or the work, themselves.
It's easy for anyone to see how pervasive this myth-mongering is. Most people have at least one area in which they possess some degree of expertise. Simply by going to web sites related to those fields, one can quickly see how problematic anecdotes, myths, and second-hand information can be. Readers sometimes jump to the exact opposite conclusions than would a real expert...all based on their limited understanding of the subject matter, together with the counselling of equally-inexpert folks. If it's not quite accurate or even useless, it can sometimes be downright dangerous.
Which naturally brings me back to my first thought when reading this post:
"A little knowledge is a dangerous thing."
I've seen the real-world consequences of believing things one has only heard or read written by others. There is no replacement for a proper education coupled with actual, real-life experience.
Marjorie December 15th, 2008 11:10:33 AM
kabbage: The MDR1 mutation does indeed connote certain "sensitivities." But most anesthesiologists consider the dangers overblown, especially when they're extrapolated to include the entire population of affected breeds.
Moreover, acepromazine is not a drug I use often in ANY dog, because of the exact same issues MDR1 mutants face. Opiates also share the same delayed brain-clearing effects of acepromazine in MDR1 mutants, but that doesn't mean we're willing to let them go without appropriate pain relievers--we're simply more careful when we use them.
Sure, it's important to know if we're working with an MDR1 mutant or not, but using safe, reversible drugs (among those with known MDR1 side effects) in all our patients is ideally the protocol all of us should be using on all our patients, IMO, especially since most clients don't OK screening for MDR1.
Dr. Patty Khuly December 15th, 2008 11:40:05 AM
I'm just having trouble understanding why a vet would be upset that they have clients that care enough to do their own research in order to make sure their pets come through various situations as well as possible.
If a client comes with information that isn't correct, is it really THAT HARD to take the time to explain to them why the information isn't right or doesn't apply to their pet? I've always thought that client education is part of the process of being a health care provider, be it for pets or people.
Cindy December 15th, 2008 12:47:52 PM
We all fear what we don't understand, and many veterinarians don't understand how the Internet has helped many people become better care-takers of their pets. Vets hear the nutty stuff off the net and forget the rest.
In any case, the genie ain't going back in the bottle. Veterinarians need to learn how to work with clients who have their pets' best interest at heart -- but may not have found the best information on the web. Use what the client brings in as a starting point for respectful discussion. How can an informed client and good discussion be a bad thing?
And always remember: If it weren't for us crazy Internet types, the pet-food recall would have been swept under the rug.
Gina Spadafori December 15th, 2008 01:28:50 PM
Re: " Veterinarians need to learn how to work with clients who have their pets' best interest at heart -- but may not have found the best information on the web."
And I would add -- Veterinarians need to learn how to work with clients who have their pets' best interest at heart and HAVE found good information on the NET. Specifically, their egos need to learn to deal with it.
I know that some vets react very defensively when confronted with a knowledgeable client who has found GOOD info on the web.
On the Feline Diabetes Message Board, it seems daily the owner of a newly-diagnosed diabetic cat comes on and says: "I talked to my vet about home testing kitty's blood sugar values, and he says it's not necessary/will hurt her/is inaccurate . . ." OR: "My vet's never heard of lantus and wants me to use Humulin N." OR: "My vet says to feed kitty this dry prescription food because it's high fiber and that's best for diabetics," or "my vet says kitty can't possibly be experiencing rebound, and she told me to increase her insulin to 6 units" (for a cat who just started treatment recently).
With rare exceptions, all of the above is staggeringly bad advice and is contradicted by much of the more recent research on feline diabetes. But these vets are so threatened, that when the client's come with printouts of Deborah Greco's study on the use of lantus in cats, or some of Dr. Elizabeth Hodgkin's research, etc. they sometimes tell the owner to OBEY THEM OR ELSE find a new vet.
The latter option often being the best advice they've given to date.
I'm in the minority on that list in my reaction to this scenario. Most owners are very patient, and caution newbies to try to "educate" their vets gently keeping their fragile egos in mind.
Now, I don't think there is anything wrong with a vet admitting that they only see a few diabetics a year, and they aren't experts -- as long as they remain open-minded to new information, INCLUDING information brought in by clients from reputable sources.
What I do have a problem with is vets who arrogantly assert that they know best, refuse to consider or review the research of veterinary experts on a topic, and demand compliance with their outmoded approaches. I believe that is flat-out unnacceptable. Makes me very upset. It's dangerous.
Stefani December 15th, 2008 02:53:43 PM
I think it's an issue of trust between veterinarian and client. If there's a good relatioinship there, you should be able to raise your concerns respectfully without insulting your practitioner, i.e., "I read online that sometimes my breed has a sensitivity to acepromazine - could you tell me more about that, as well as your experience with the drug?" Likewise, the veterinarian should respond truthfully and non-condescendingly, perhaps offering to do some further research and to get back with the client in a few days if need be. If you're the kind of client who needs to be able to have these conversations with your veterinarian, but your veterinarian is the type who'd rather tell you what needs to be done and then have you do it, no questions asked, then that's just a bad doctor-client-patient relationship, period. And I don't think veterinary-themed websites are the problem. Rather, I think it's a general lack of critical thinking skills out there that cause the problems. You shouldn't believe everything you read, and you should have the sense to know how to validate what you're reading, IMHO.
anna December 15th, 2008 03:28:35 PM
I totally agree with Gina's comments. Veterinarians should use their client's "research" as a starting point for a healthy dialogue. Dr. Khuly, do you have a direct link to the JAVMA article? I couldn't find it on the AVMA's website. Thanks.
Jason December 15th, 2008 06:45:37 PM
I think the internet anesthesia advice issue is just a symptom of a bigger disease. The problem being veterinarians clearly don't always have time to explain all things in the amount of detail that some people crave. Those owners, striving to be the best advocate they can be for their pet, look to the internet. This is why I think it's so important to have internet sources pre-screened and available to recommend to owners. Then, if they find something on another site, take the time to discuss it reasonably, not in a huff. We should be commending owners for trying to look out for their pet, not making them feel bad for it.
I think that veterinarians, and probably doctors in general, are more afraid of looking dumb than anything. I'll admit this is the first I've heard of MDR1 and I will definitely be looking into what it is and the recommendations for anesthetic protocols. But a fear of being wrong probably stems from trying to gain an owner's confidence. How can they trust you if you don't know everything??? But I would bet that owners who think that way are probably in the minority. If nothing else, if we admit that we don't know something and promise (and follow through!) to look it up and get back to the owner, I think THAT would gain more confidence than getting huffy and blowing off an owner's concerns.
Kelly December 15th, 2008 08:51:32 PM
THAND GOD for the internet! It has made companion guardians smarter and more educated regarding their companions' health problems. Especially websites like this http://www.dcavm.org/05oct.html are a BLESSING! http://www.alabamavetboardwatch.110MB.com
Fotini December 16th, 2008 12:07:36 AM
Kelly, Washington State University has a good website and developed the cheek swab test for the MDR1 mutant gene. See http://www.vetmed.wsu.edu/depts-vcpl/ Although the vets who wrote the article leading to Dr. Khuly's post probably wouldn't approve of this site, I've found it helpful: www.busteralert.com.
Dr. Khuly, maybe it's just because my breed has a pretty high number of affected individuals, but I think it makes more sense to assume "affected" in an affected breed if the DNA test hasn't been done. I haven't actually done the test on my dog (she's altered, no offspring, and of unknown parentage, so no one gains anything if her mutant status is confirmed), but I think her reactions to anesthesia indicate that treating her as a mutant is the way to go. Your comment on Ace and recovery is the first I've heard of it being a widespread problem outside the MDR1 mutant population. Thanks for the heads up.
kabbage December 16th, 2008 01:36:00 AM
Jason: JAVMA doesn't have the abstract up yet--They're always about a week or two off of their pub dates with the online stuff. Unfortunately you have to subscribe ($) to JAVMA to read the entire paper but that shouldn't be a problem for you. ;-)
kabbage: I'm with you...safer's better. I'd rather assume "sensitivity," no matter how rare we're told it is than to get caught out with a serious problem. After all, it's not hard to adjust protocols with all the drugs we've got in our arsenals.
Dr. Patty Khuly December 16th, 2008 07:19:08 AM
If websites authored by veterinarians suck just as bad as sites authored by the hoi polloi, then on what basis do they recommend that clients get their information from their veterinarians?
Sounds like a damned if you do, damned if you don't kinda thing.
As for MDR1 mutation, I'm personally getting rather cross about vets who:
a) Still equate breed with sensitivity. (No Doc, this dog has been DNA tested. She is normal/normal. Let's move on already.)
b) Get the affected breeds wrong anyway.
c) Think that ivermectin is the only problem, and that any dose of ivermectin is a problem
H. Houlahan December 16th, 2008 08:58:39 AM
H Houlahan: Great point...damned if you do, damned if you don't. Sounds like all of us just got a stern rap on the knuckles, don't it?
Dr. Patty Khuly December 16th, 2008 02:18:36 PM
As a client that just requested a procedure that my vet was unfamiliar with, it would have been nice to have some reasonable behaviour displayed. I was treated quite poorly, and as a result, I think my dog probably didn't receive the best of care either. I requested this procedure as an alternative to surgery (which I just paid for 6 weeks ago) that she wanted to repeat. Yes $$$ was a factor. I would have loved it if my vet had of asked where I got my information and offered to look at/consider this procedure rather than performing it blindly (as I'm pretty sure she did), and very rudely suggesting techniques that had almost no success rate. I haven't removed the bandages from my dog yet to see what was performed, nor did I receive any explanations or aftercare suggestions.
Amanda December 17th, 2008 02:20:11 PM
Amanda: You have a right to this information (explanations and aftercare suggestions). Sometimes things happen and we slip up but your vet should always follow up. Some clients actually prefer that we don't but it's the vast minority who'd rather remain in the dark and have us do "all the work."
If it happens again find another vet who will take your concerns and information needs seriously. After all, anyone who wants to know more should be considered a dream client.
Dr. Patty Khuly December 17th, 2008 02:38:47 PM
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I’m fortunate that my veterinarians are willing to look at info as long as I come in with information from a reputable source – if I suspect a certain ailment or want a treatment I research and find studies which are relevant and reputable. It is also important to point out that in many cases anecdotal reports which become common lead to research and in some cases that anecdotal information becomes fact :) Many breed club health committees get research funded to investigate these “anecdotal” reports and what do you know it sometimes is true. I think anecdotal information should be taken into consideration as one of the many factors…There is no research (yet) in my breed about anesthetic sensitivity just my 20 years of breeding experience and many other long term breeders who can say wow we have lost a lot of dogs under anesthetic and we are asking why and we are reporting that to our vets, and looking into different research opportunities. In addition, shouldn’t I as a client give full disclosure (even if anecdotal) to my vet, if I take my dog in and I know there are hundreds of reported deaths while under and I don’t tell him/her that ? that doesn’t seem right either…hmmm.....
LC December 17th, 2008 06:39:19 PM
sorry for the wierd stuff above my post..yikes :(
LC December 17th, 2008 07:38:06 PM
There's a big difference between 1)a client that brings in a few pages from a reputable pet health website and politely asks for more information or clarification 2) a client that self diagnoses by the internet then brings in 20 pages from joe blow's website (who has no credendtials) and quite rudely announces that this is what their pet has and the papers will 'explain' it to the vet how to treat it. Obviously client #1 is going to have a far better, more infomative and productive convo with the vet. Client #2 is going to probably be met with a fair bit of hostility. After all the client is basically saying that they don't need the vet for the years of schooling or clinical experience, they just need a prescription and can't get it themselves. Even if client #2 ends up being correct by chance, that's certainly a rude and uncalled for way to address a licensed professional. If a vet has to deal with very many clients like this on a daily basis it's going to increase the amount of time that they have to spend debunking bad advice before they can even get to the current problem and treatment options. This will translate into higher costs for everyone somewhere down the line. Well informed clients that care about their pets is one thing, and can be a very good thing. Self diagnosing and basically telling a vet his schooling was unnecessary after the invention of the internet is just plain wrong.
Cl December 18th, 2008 11:47:35 PM
As a dog owner, I will admit that I no longer trust everything that a vet will say or do. I remember being told by my vet to never let my pups out of my house and yard until ALL of their puppy vaccinations were completed. I trusted and followed that advice, but this amounted to no outside socialization for an Akita-like breed until they were 6 months old. I learned online, after it was too late, that this was poor advice. I remember being told to vaccinate every year by the veterinarians. My sister followed that advice, and her dog developed autoimmune hemolytic anemia after given the cocktail of annual booster shots. After two blood transfusions, medications, and $6000 later, the dog still died and the vet denied any connection between vaccinations and the anemia. I found out online that the U of Colorado vet school had already changed their vaccination protocol because of this very thing. There are vets that are not aware that some Asian breeds will give false positives for high potassium if their blood sample is not prepared with care. Pet owners are being told that their dog is suffering from Addison's disease when they are not. Fortunately, there was a single Korean veterinary article that I was able to request via interlibrary loan because I was a grad student, and I was able to distribute the abstract online. I know as an ex-grad, I wouldn't of had any access to this information and neither would have the average pet owner.
Ann December 20th, 2008 08:07:12 AM
Boy , oh boy, this is very, very sad. There are enough reputable-based information on college-sponsored web sites to sift through articles that will inform the average pet-owner to educate themselves, much to many vet's dismay.
And being involbed in a purebred club to inform yourself of the particular inherent problems is invaluable.
I, too, have a comment regarding anesthesia protocol. Years ago, only ONE of my bitches needed 3 days of staggering to recover from her spay. What was the difference? I'd have to look it up, but was honestly informed that an "older protocol" was used on her. Did it cause irreparable harm? No, it didn't---she went on to live a good 15 1/2 years.
Ann, your post brought back a distinct memory. I think it is called "not separating the serum from the cells in the blood tube---for HOURS. This creates the appearance for Addison's. Been there, done that. (as a client/patient)--also lowers the glucose level.
Marjorie, "A little knowledge is a dangerous thing." Yikes, I had that quoted to me verbatim, not many weeks ago. What the heck is that supposed to mean? This degreed un-named professional was insisting my "Pocket" had a chance to recover at the age of 11 1/2, low hematocrit, and uncorrected phosphorus of 18 after 18 hors of 2x fluid administration!! Was I supposed to "buy" that?? Do I have some dangerous knowledge?? Finally, when pegged down for a figure, it was a 50/50 chance of recovery......hmmm, but YOU always know it is the 50% that LOSES!!
Too insulting, that either veterinarians fear client education, or that it is impossible for the client to do so without them. Barbara A. Albright
Pocket's Story from NH December 20th, 2008 11:43:39 PM
I think that often times that anecdotal evidence coming from breeders and the 'net have some value. I also have a breed affected by the MDR1 mutation. For years, we were told it was all our imagination that these dogs were having problems. In fact, even after the gene was found, but before I had my dogs tested, I had a vet fuss at me when I refused Heartguard and wanted a different heartworm med. "Oh, there is not a problem with Aussies and Heartguard. It's an old wive's tale." I had to print out info on the MDR1 mutation to take to him. Shouldn't it have been his job to know that, not mine to inform him?
My three Aussies have all been tested now. Two are normal/normal. One is mutant/normal. But one vet's ignorance and poo-pooing the "old wives tale" could have injured my dog. Sometimes we laymen and our old wive's tales are accurate!
Nita January 3rd, 2009 10:36:03 PM
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