Visiting Veterinarian

Medication debate

By Michele Gerhard Jasny V.M.D. - November 21, 2007

I went to the doctor the other day. After discussing my various aches and pains, my physician made a few suggestions, including some medication - a medication I didn't want to take. We batted it around. She felt it could improve my quality of life and address several issues simultaneously. I felt... well, I felt like I didn't want to take it. I had my reasons, some rational, some not. I could see my doc's frustration as she accepted my reluctance but frankly pronounced my objections to be "Victorian." Her training tells her she can help me. My experience tells me conventional medicine can do amazing things, but it doesn't have all the answers. My mind trusts my doctor and appreciates her advice. My gut repeats a litany of scary side effects and bad outcomes. I told her I would think about it.

Going back to my own office, I went about seeing appointments. The first patient was a black lab puppy introductory examination. She was healthy, cuddly, and full of fun. She was also full of fleas and ticks. "We should start a monthly total-body flea and tick control product, like Frontline Plus or K9 Advantix," I advised casually. "We could apply a dose right now." Living in tick heaven, most of my clients routinely use these products, grateful to have a safer and more effective treatment than in the old days when we dunked our dogs every ten days in stinky insecticide dips. I expected the owner to jump at the offer. Instead I saw a look cross her face. A remarkably familiar look. Like the look I had earlier at my physician's office. I knew what was coming next.

"I don't think I want to use those poisons on my dog," she said. Ah. I nodded silently as I continued my examination and considered my response. Flea and tick control wasn't the only point of discussion. The owner also declined heartworm preventative. And she wasn't my only reluctant client that day.

Another dog presented with a fever and loss of appetite. I couldn't immediately locate the source of the infection, but I suggested starting antibiotics while waiting for test results. Her owner was hesitant. I wholeheartedly support avoiding overuse of antibiotics, but I thought in this particular case it made sense to give them. I reluctantly agreed to wait for test results before prescribing medication, and wondered idly if the universe was taunting me for rejecting my physician's advice.

Then a third woman arrived. She, too, didn't want to use flea and tick products, nor did she want a Lyme vaccine. "I've read a number of things about it," she said, almost apologetically. "One article even said that if your veterinarian advised Lyme vaccination, you should change veterinarians." Ah.

When I first started practice, despite my counterculture tendencies, I took my responsibility as enforcer of traditional veterinary guidelines very seriously. Perhaps it was the years of veterinary school indoctrination, or the fear of making a mistake, or the possibility of a liability suit. Maybe it was just my Good Girl habit of following the rules. All these may lead to a certain rigidity in how one practices medicine.

Now, after 25 years, I still strongly believe in good flea and tick control, in heartworm preventative, in antibiotics. I also understand and respect my clients' urge to question. People have a right to their own philosophies about medicine and about pet ownership, as long as they are not harming their pets. But there's the rub.

The first rule of medicine is "Do No Harm," but how do we define harm? I believe the flea-infested puppy is being harmed. Fleas suck blood. They can transmit diseases. They make the animal uncomfortable. But her owner believes the flea products I am advising are harmful. I believe that a Lyme vaccination can protect a dog from a potentially life-threatening infection that is rampant here on the Vineyard. I believe the side effects are rare enough and the efficacy adequate to warrant vaccinating all Vineyard dogs. Some owners (and veterinarians) believe otherwise. How do we come to an understanding about what to do in such circumstances?

My advice

I used to try yelling at people. Funny, but that didn't work too well. Then I tried expressing my opinion without raising my voice but being clearly judgmental. For a while, I thought this was effective until I noticed some owners had simply stopped bringing pets in for routine health care. Hhmmm. That wasn't really helping my patients, was it? Yet I continue to feel compelled to offer my opinion, my professional opinion, the one that comes with 25 years of veterinary experience behind it. The best solution I have come up with is to assure my clients that I respect their right to make choices, invite them to explain their reservations, encourage them to think scientifically, then let it go. So here goes.

People often suggest that flea and tick control products and heartworm preventative are somehow responsible for animals getting cancer. They say things like "I knew someone who used FleandTickStuff every month and their dog died of a tumor," or "Why do so many animals get cancer? It must be the heartworm pills or all those vaccinations." I don't deny we should keep an open mind about long-term effects of products. It took the scientific community too long to acknowledge the adverse effects of substances ranging from DDT to Vioxx.

But let's not throw the puppy out with the bath water. The reality is that, in general, dogs (like people) are living longer than ever before thanks to things like... well, things like heartworm pills and all those vaccinations. The longer Fido lives, the greater the odds are he may eventually develop cancer, and dogs got plenty of cancer before the advent of any of these medications. There is no scientific evidence to support the idea that if used properly these products increase their risk. There is plenty of evidence to show that eliminating parasites improves Fido's health and quality of life.

What about that controversial Lyme vaccination? Honestly, if we lived in Denver, or New York City, or any place where there were fewer ticks and a lower incidence of reported Lyme disease, I would happily skip this vaccination, but I have seen way more Vineyard dogs harmed by Lyme disease than by Lyme vaccine.

What I want is for you to talk to me about your rationale for declining my advice. I'll do my best to bring you around to my way of thinking. If I fail, so be it. I wish you'd take my counsel, but I accept that we have differing ideas. Don't eschew veterinary visits just because we disagree. Instead, let's discuss other ways to protect your pooch.

Don't like heartworm preventative? Then avoid mosquito exposure. Don't take him out at dusk or dawn or to marshy skeeter-ridden locales. Remove standing water from your property. Have him tested yearly so if he does get infected, we can treat him quickly.

No Lyme vaccine? Use total body tick control year-round. Ask your vet about screening annually for sub clinical Lyme infection.

As for the dog with the fever of unknown origin, we quickly tracked the source to a serious kidney infection requiring hospitalization, intravenous fluids, and, no debate about it, antibiotics. Her owner willingly complied and the dog is on the mend.

Have other points you want to debate? I'll do my best to hear you out. Then you do the same for me.

Meanwhile, I'm still on the fence about my physician's recommendation..., but I'm thinking about it.