Harriett Hall, The SkepDoc from whom I cribbed my moniker, recently wrote on the science-Based Medicine blog about the new Mayo Clinic guide to home remedies, which sounds like a sensible guide to appropriate kinds of self-treatment for minor medical problems. Despite the accusations of the fringes of the alternative medicine movement, that doctors are driven by greed and love to provide unnecessary treatment for minor ailments, the reality is that doctors prefer to treat the truly ill, not those with problems that will resolve themselves. People who go to the doctor with self-limiting viral infections for which there is no effective treatment are accomplishing nothing other than sharing their virus with their healthcare providers, so if they could treat their own symptoms at home I’m sure their doctors would be thrilled. And I frequently discuss with my clients both indications that a pet needs to come in to see me and indications that they don’t and can be managed by their owners at home.
The thing is, most mild ailments do get better all by themselves. This is one of the reasons nonsense therapies often seem to work. If you have a common cold, a headache, an upset tummy from too much spicy chili, and so on, you are likely to feel better pretty soon no matter what you do. So home remedies are fine if they make you feel better (by placebo or real effects), or if they just give you something to do while waiting to get better.
The key, though, is that while it isn’t so important if home remedies are effective, since they are only appropriate for mild, self-limiting illnesses, it is critical that they be benign. Any remedy that does harm for a mild disease that’s going to get better on its own is automatically doing more harm than good, unlike a medication which may cause harm that is worth tolerating in order to treat a more serious disease.
I had a case the other day which exemplifies the problem with home remedies: ineffective and potentially harmful treatments applied with no understanding of medicine or even common sense. An otherwise healthy cat had developed some patches of hair loss which the owner self-diagnosed as ringworm (a fungal infection). The owner attempted to treat this with a commonly recommended remedy of vinegar and grapefruit seed extract. There is no good quality evidence this mixture is effective even if ringworm is present, though some laboratory research suggests grapefruit seed extract may have little effect on this particular kind of fungus, and like many “natural” remedies may have contaminates that can present a health hazard.
The cat developed vomiting, diarrhea, and a loss of appetite after licking itself where the remedy was applied. The owner attempted to treat this with activated charcoal and probiotics. I’ve written about probiotics in general (as well as about specific uses and studies and some of the more egregiously fraudulent marketing of them), and there is some plausibility to the idea they may be useful for some kinds of diarrhea, though this is not at all proven in dogs and cats. And activated charcoal is an appropriate agent to give animals suspected of ingesting poison, since it can reduce absorption of the toxins. However, a cardinal rule of treating toxin exposures is never give oral medications, especially charcoal, to an animal that is vomiting. Not only will these likely incite more vomiting, but there is a great risk of aspirating the charcoal into the lungs, which can cause a serious pneumonia. This was clearly a case where a home remedy was not indicated.
The client brought the pet in and was given some suggestions about medications and feeding, with the main suggestion being to let the cat alone. The hardest thing for any pet owner to do when their companion is sick is nothing, even when that’s the best thing to do. Like many people who feel they need little or no veterinary advice to treat their own pets, the owner had a stock of left over medications previously prescribed for other pets which the person was eager to use. And in the absence of being told to use them, the client was eager to apply home remedies rather than simply give the cat time to recover naturally.
The next day, the cat was no longer vomiting but didn’t want to eat and still had soft stools. In addition to giving the cat a variety of foods, including some clearly inappropriate for a patient with a gastrointestinal problem, such as egg yolks, the owner then attempted to treat the diarrhea by giving the cat two enemas, one with aloe vera and another with flax seed oil. Apart from the lack of any evidence to suggest either of these substances have benefit for GI upset, and the utter ridiculousness of the colon cleansing and intestinal toxicity ideas, the notion of treating diarrhea by giving enemas is every bit as stupid as it sounds. Such treatment is not only going to further aggravate the original problem but can potentially cause serious injury, especially performed by someone without proper training in an inadequately controlled environment.
The clearest evidence of this person’s complete lack of not only medical knowledge but even common sense was when they seemed both worried and puzzled by the fact that the cat was reluctant to be picked up or touched near the hind end by the owner!
Home remedies are perfectly appropriate for mild, self-limiting conditions, as long as the remedies themselves do no harm. But as this case illustrates, determining when it makes sense to use such remedies, and what kinds of treatments are appropriate for what conditions, is not apparently as straightforward as proponents of treating your own pets at home would have you believe. No doubt most pet owners are sensible enough, and have enough understanding of the limitations in their own knowledge and skill, to be trusted to recognize when their pets need professional care and when they can try using simple home remedies themselves. However, in my years of practicing I have seen many, many cases of unbelievably inappropriate treatments and horrible neglect due to a complete lack of any understanding by owners of what is mild and what is serious disease and what remedies they can reasonably apply on their own, so I believe we must be very cautious when telling pet owners they don’t necessarily need to seek veterinary care when their pets are sick.
The most important part of any guide to home remedies should not be the treatments themselves, those these should of course at least be safe. The most important thing such a guide should emphasize is that owners must recognize the limitations of their own medical knowledge and understanding and know when to call their vet. Ultimately, home remedies may or may not effectively treat symptoms, but they are only appropriate if they do no harm and if they are used for conditions that are going to get better on their own regardless of whether we do anything at all.