Saturday, December 13, 2014

Leisure sickness, vultures and dog genetics

dog on beach
Dogs don't seem to suffer from leisure sickness. At least I've never been asked to treat one!
It’s that time of year when everyone goes on holidays. Well, lots of people. Well, possibly many of us are working. But we’re TOLD it’s the holiday season, which can be enough to trigger “leisure sickness” – you know, that awful cold/flu/bug you get when you slow down for a moment and contemplate enjoying an unstructured day.

For those of you staring down the barrel of an xmas/new year break and feeling your blood pressure rise, you aren’t alone. Leisure sickness is a thing, according to James Adonis writing for the Sydney Morning Herald.

You can read the full article here (although a warning, the barbaric – as noted - experiment on monkeys cited in this case doesn’t support the argument at all, and if anything demonstrates how pointless such experiments are. Yes, signs of disease and stress-related illness can have delayed onset – these animals were certainly not subjected to working conditions, nor holiday conditions, and such poor science should not be legitimised with citation).

This vulture, photographed at a zoo overseas, is safe from diclofenac but has to deal with poor husbandry.
Meanwhile the EuropeanMedicines Agency (EMA) has again raised concerns about the use of an anti-inflammatory drug in livestock. Diclofenac, used as an anti-inflammatory and analgesic (and marketed in Australia as voltaren), is used in livestock in many countries. It’s one of a number of drugs that can have adverse effects not just on the animals it is administered to directly, but others as well.

When vultures and other bird species that consume carcases (necrophagous birds – new word for the day) eat carcases containing diclofenac residues, they can die (due to kidney failure).

According to the EMA, the drug is associated with the rapid decline of vulture populations. Veterinary medicines containing diclofenac have been banned in some Southeast Asian countries. The EMA’s Committee for Medicinal Products for Veterinary Use (CVMP) released a report about the problem, which you can read in full here.

Finally, if you’re genetically minded you might enjoy Jessica Hekman’s post on some of the perils of breeding dogs (read here).

She was asked to expand on some comments she made (esp about Golden retrievers) by the Huffington Post (read here).


Enjoy the weekend, folks – and avoid the leisure sickness.

Friday, December 12, 2014

Evidence based medicine and cultural competence in medicine: is there a conflict

Skittles the ferret. She has little to do with today's post but she is absolutely stunning.

Evidence based medicine and cultural competence in medicine are two key concepts most veterinary and medical curricula are trying to accommodate simultaneously. However, there seems to be a fundamental conflict between the two. I finally understood it when I read an editorial in Health Services Research by Romana Hasnain-Wynia, shared by Dr Martin Whiting.

First though, what does each mean on its own?

Evidence-based medicine (EBM to those who know it well) is the “conscientious, explicit and judicious use of current best evidence, primarily from clinical trials, in making decisions about the care of individual patients” (Hasnain-Wynia, 2006).

Skittles looks like she has a Batman mask.
EBM is associated with diagnostic and treatment guidelines, algorithms and protocols. The aim is to standardise patient care. Overall that seems to be a good thing. It means treatment decisions aren’t based on the whims or limitations of one practitioner.

There are a few limitations of this approach. The gold standard of evidence is the randomised controlled trial, but they can be an ethical minefield. For example, subjecting a patient with a particular condition to sham surgery to compare to those receiving a surgical treatment may have an unacceptable welfare cost. So some trials just don’t happen.

ferret walks on lead
Skittles walks on a lead.
EBM is only as strong as its evidence-base, the size of which can be variable. Veterinary trials are relatively thin on the ground, and when they do exist they usually consist of small numbers of animals (with the exception of some large scale, multi-centre studies). Sometimes all we have to go by is a case series or, gulp, a case report. Or extrapolation from first principles. Or asking an expert.

And there are some treatments for which observational studies are convincing enough. Smith (2003) makes this point rather colourfully in a paper suggesting that “the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute” (see the article here).

And again. So its hard to focus on a moving ferret.
Cultural competence in medicine (CCM) is “the delivery of health services that acknowledges and understands cultural diversity in the clinical setting and respects individuals’ health beliefs, values and behaviours” (Hasnain-Wynia, 2006).

It emphasises finding out what is important to the patient. The emphasis is on individualisation, rather than standardisation, of care.

Of course it can be misused, leading to cultural stereotyping, which can be harmful to individual patients and populations. The emphasis of CCM has shifted from providing specific knowledge about certain cultural groups and minorities to promoting humility, communication, understanding patient narrative and so on.

The problem is that EBM and CCM both base recommendations on modal information from studies populations or subgroups – so critics might argue that their recommendations either don’t apply broadly enough or marginalise some individuals. The classic criticism if EBM is that it promotes “cookbook” medicine, a one-size-fits-all approach. The classic criticism of CCM is that, at its worst, is promotes cultural stereotyping.

The real questions are these: can EBM provide patient-centered care? Can CCM demonstrate improved clinical outcomes? And if they do, how can we tell? It can be challenging measuring outcomes for either model (that doesn't mean we shouldn't try).


ferret close up
Skittles held.
Hasnain-Wynia argues that despite the evolution of EBM and CCM, we need to admit that EBM does promote standardisation of care which leads to reduced discretion for clinicians and patients. On the other hand, CCM promotes discretion for clinicians and patients and may leader to greater variability in clinical care. And that is okay. There is a need for both.

Whilst these are exactly the issues that critics target, neither is inherently bad, and neither justifies canning the whole theory (or as philosophers love to say, throwing out the baby with the bathwater).

References
Hasnain-Wynia (2006) Is evidence-based medicine patient-centered and is patient-centered care evidence-based? Health Services Research 41(1): DOI 10.1111/j.1475-6773.2006.00504.x

Smith G (2003) Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ 2003;327:1459

Thursday, December 11, 2014

Call for Pet Santa Photos

Sanchez in his Santa hat. Which he wore for three seconds in exchange for a parsley bribe.

Yesterday we interviewed Nick Baldas, the artist behind the exhibition My Human Family Rescue Dogs Find a Home. Today we’re helping them out by calling animal lovers to submit their pet Christmas photos and help spread the word about rescue pets.

I hope this little dude gets his Elizabethan collar off before Christmas.
If you have a photo of your pet looking festive, you can email them to myhumanfamily@hotmail.com so they can go up on the My Human Family facebook wall.


Wednesday, December 10, 2014

Billy's legacy: My Human Family

Pound dog Billy. Gone, but not forgotten.
Anyone who works with animals knows the experience of tragic and senseless loss. But artist Nick Baldas turned the devastating loss of a pound dog, Billy, into a beautiful legacy. He spoke to SAT about how his pet project, My Human Family Rescue Dogs Find a Home, came to be.

What is your day job?

I am an artist, I work with community groups, councils, galleries and individuals on project that I am passionate about.

Where did the idea for the My Human Family Rescue Dogs Find a Home exhibition come about?

The idea was inspired by Pound Dog Billy, I was sent his tragic story and image and it broke my heart, he was nearly rescued from a pound, his new family were coming to collect him but due to an IT glitch he was euthanised that night, so when the family arrived Billy was dead. I cried and out of my sorrow the exhibition was born - in memory of Pound Dog Billy and all other pound dogs that need a home.

Were you surprised by the number of entries?

No I had no expectations, I would have been happy with 1, 2, 10, 100 entries, the main thing was that we were doing something important for abandoned and neglected dogs. Creating a new opportunity to celebrate the beauty of these dogs and make some noise - BIG WOOFS

How many exhibitions have you had now?

Gee, we have shown in 3 parliament Houses - NSW. QWLD & VIC. 2 galleries. Pine Street Gallery (City of Sydney) and the Margot Hardy Gallery (University of Western Sydney) and 1 library - Campsie Library. So I count 6 showings. 

What is it about these images that touches people?

I think it’s the stories, people love the images because the dogs and families in them are cute, but I think people are really touched by the stories. Most start in really tragic places and end up in LOVE. I think people are surprised at the horror some of these dogs have been through. They are then rescued and loved. I also think the exhibition is successful because we focus on the LOVE, we keep positive.

This exhibition can save lives: how?

I hope the exhibition can save lives through open and honest sharing of photos and stories via social media and via holding the exhibitions in high profile venues, which hopefully will gain the exhibition free editorial. I hope it will stop people buying from breeders and pet shops and visit a pound for their next dog. 

Have you always been a dog person or was there a transformative moment?

I was never allowed to have a dog when I was young, so when I turned 30 I drove out to the RSPCA in Yagoona to find my first dog. Her name was Daisy and she was a white staffy cross puppy.

Daisy passed away 2 years ago - old age, she was 16, she was a great dog and I still miss her every day. Yes I have always been a dog person.

My transformative moments and a blessing to my life is to have been able to share it with Daisy. I was very lucky to have found her. RIP Daisy. 

Do you live with any non-human companions?

Not at the moment, my partner and I have decided to travel for 1 year so we can't adopt a new non-human companion until we return. When we return I intend to adopt 2 dogs and a cat. All from rescue shelters.

How do you think we can make the world better for companion animals?

I honestly don't know, humans and not very nice to each other and we can communicate. We have to try, we have to use our voices, stories and photos for our companion animals. Through LOVE create understanding. 

Thanks Nick. To keep up with My Human Family click here.


Tuesday, December 9, 2014

What doctors can learn from vets, and what on earth is zoobiquity

mccaws
Can doctors learn about managing self-harm in humans from vets who manage feather-plucking?
When I went through vet school our vet society proclaimed a t-shirt that shouted “real doctors treat more than one species.” Now the term “one health” has become such a buzz-word people are taking the claim seriously. Doctors and veterinarians have more in common than the use of the honorary term “doctor” (a REAL doctor actually has a PhD – but that’s another can of worms).

Cardiologist Barbara Natterson-Horowitz gave this fantastic talk on TedMED about medicine’s blind spot about the commonalities between animals and humans. You can watch the video by clicking this link or see below.



Dr Natterson-Horowitz dealt exclusively with human patients until she was contacted by a zoo to check out a chimp with a suspected stroke. One animal consult lead to another and she was checking out gorillas, lions, exotic birds.
She realised that she had had, until then, a hidden bias in her thinking: “……I feel that tug of human exceptionalism even as I recognise the scientifically isolating cost of seeing ourselves as a superior species apart.”

She began to ask herself “might I be taking better care of my patient if I saw them as a human-animal patient?”

For example, in 2000 doctors believed they “discovered” emotionally induced heart failure. It was reported in a gambler who lost his life savings in one hit, and a bride who was dumped at the altar. But this wasn’t new, nor was it uniquely human. Veterinarians had recognised fear induced heart failure for some time.

Doctors, she argues, could learn much from veterinary management of self-harm, post-partum depression and psychosis, separation anxiety and various cancers.

To take full advantage of these commonalities, UCLA embeds animal experts and evolutionary biologists in its medical rounds. Similarly, zoobiquity conferences facilitate collaboration disorders that human and animal patients have in common.

The Centre for Veterinary Education is running its first zoobiquity conference in Sydney.
I hadn’t heard the term zoobiquity til recently. The word, used by Natterson-Horowitz and colleague Kathryn Bowers in their book of the same name, refers to the link between human and animal health. (I'm still not quite clear on how or why zoobiquity is different to One Health but that will come I am sure).

As it happens, the Centre for Veterinary Education has just announced its first zoobiquity conference in February, around the important theme of nutrition:
Animals and humans get many of the same diseases yet human physicians and veterinarians rarely share their knowledge. Zoobiquity explores how the commonality of animals and humans can be used to diagnose, treat, and heal patients of all species. Drawing on the latest insights from both medical and veterinary science – as well as evolutionary biology and molecular genetics – Zoobiquity proposes an integrated, interdisciplinary approach to physiological, nutritional and behavioural health.
The Centre for Veterinary Education, the Sydney Medical School and the Charles Perkins Centre from the University of Sydney are thrilled to be hosting the first Australian Zoobiquity Conference in Sydney in 2015, the first such conference to be held outside North America. The theme is nutrition and disease in man and companion animals. Given that our companion animals share every aspect of our modern lifestyle, it is not surprising that, along with humans, our dogs and cats are suffering an obesity epidemic. What may not be obvious is our companion animals have encountered changes to their diet like our own – an increased intake of highly refined, calorie dense, nutritionally questionable foods.  
Our multidisciplinary program will go back to basics. What is the epidemiology of adiposity in Australia? What are the macronutrients we need for good nutritional health? What drives the desire for these macronutrients? How much salt do we need, how much water should we drink, and how much exercise should we get commensurate with our lifestyle? Dogs are obligate carnivores – should we forget the packaged food and return their diet in part to raw meaty bones? How does diet impact periodontal disease and how does periodontal disease impact health?
We have an outstanding line up of speakers who include zoologists, nutritional ecologists, microbiologists, molecular biologists, veterinary dentists, dietitians and human and veterinary physicians. We expect an invaluable cross-pollination of ideas as well as discussion and controversy. An unlikely debate may ensue with industry representatives from pet food companies.
What better theme to kick off with. With more animals and humans suffering from nutrition related diseases, including diabetes and obesity, than ever, its about time doctors and vets put their heads together. For further info, download the brochure here.

Monday, December 8, 2014

A Girl's Best Friend

My BFF with "A Girl's Best Friend" by David Darcy. The book is almost as tall as him!
Imagine undertaking a project that enables you to drive right around Australia, stopping to meet some remarkable dogs (and people) on the way.

Photographer and author David Darcy, known for his books EveryMan and His Dog and Australian Mongrel, among others, did just that. The result is AGirl’s Best Friend, a collection of photos and stories documenting the bond between women and their dogs.

In order to find these women, Darcy went on a road trip right around Australia – visiting places like Epping Forest in Tasmania, Yuendumu in the Northern Territory (where he interviewed one of the most remarkable women I’ve ever met, Gloria Morales), Melbourne, Sydney, Cottesloe Beach WA, Coober Pedy in SA, Far North Queensland…really, it sounds idyllic although I am sure he was glad to get back to his own dogs at the end of it all.

The women tell, in their own words, how they met their dog and the dramas they’ve been through – whether it’s a dog drama (being run over by a tractor – twice, being abdandoned after a hunt, or extensive veterinary treatment for cancer) or a human drama (being treated for aggressive ovarian cancer, buying a vet clinic, running a business, going through a divorce, living remotely, losing family members). It’s a potent reminder that everyone with a dog has a story. We don’t always hear them in consults but these narratives are a powerful force.



Darcy boldly attempted to photograph women the way dogs see them, i.e. without hair and make-up. After all, he says, “its common knowledge that dogs don’t judge.” He mostly succeeds although some lipstick and styling sneaks in occasionally (and fair enough – dogs don’t judge – or at least if they do, they keep it to themselves – but people do).

He argues that “dogs are a great leveller” – whether you are rich and famous, like Rose Hancock, or neither, like most of the interviewees – the thing that these women have in common is a strong bond with their dog.

The photos are beautiful and they capture the bond between women and dogs beautifully. And the interviews give insight into those relationships. You can read a condensed version of the interview with Gloria Morales here.

It’s a beautiful, beautiful book that will appeal to any dog lover. But beyond that I think it’s a fantastic read for anyone interested in the human-animal bond. You can read more and order a copy here.

RRP $29.95


Disclosure: I received a review copy of this book.