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.
Are you saying after the first course of inappropriate ‘remedies’, the client brought the cat to you, you advised and the very next day, the client proceeded to give more inappropriate remedies?
How is the cat now? Did you ask the client where they got the information/ideas for the bogus and very harmful ‘remedies’?
I hope you educated them?
It’s cases like this I wish we could prosecute pet owners for cruelty and neglect. Much it is possible with humans who neglect their children. It just makes me sick when ill-informed humans who have no trouble applying such nonsense to themselves think it’s perfectly ok to apply to their innocent pets.
I’m not sure if I agree with your position that home remedies, if they do no harm, could be appropriate – since suggesting to do so is only placating the client as well as enforcing their misguided beliefs, and it is not teaching them the true benefit of doing nothing at all. Obviously, in this case, calling and getting the cat to you did no further good to the cat since the owner proceeded to ignore your advice and subsequently caused even more harm to the poor cat.
I’m not saying you encouraged the client to do what they did. I guess I’m looking for you to say you did your ultimate best to educate and subliminally made the client feel like the idiot he/she is. (yes, sometimes I’m wicked that way)
Some good questions and complex issues, VT. I didn’t actually see the client when they came in with the cat; that was a different and doubtless less outspoken doctor. I spoke with them on the phone after they had done the enemas and wondered why the cat was still sick.
I certainly did educate in that I informed them that enemas were dangerous and not indicated for diarrhea, and when they defended the practice with the intestinal toxicity nonsense, I told them there was no truth to that idea. However, people as dedicated as this to self-treatment or to avoiding visits to the vet are usually people who have an unrealistic sense of their own knowledge and skills, and often an ideological committment to alternative approaches, so they seldom are willing to consider the idea that I know things they don’t or that what they think they know ain’t necessarily so. Hard core believers are the harrdest to educate.
And as for making people feel like idiots, the only ones who who be susceptible to such an effort would be the very people willing to admit they had made a mistake, so no purpose would be served by allienating them since they might actually be the ones who could learn to do things differently. My only chance to help such people, and theri pets, is to keep them coming to see me, so I have to walk a fine line between honestly and clearly telling the truth about bad ideas, even those they cherish, while still maintaining a rapport that keeps them open to listening to me. Tough sometimes, let me tell you.
As for home remedies, I do see a place for them. If you labrador eats trash regularly and gets mild diarrhea, you don’t need to rush in to see me every time. As long as you understand the signs of something more serious, like a foreign body or obstruction, it’s fine if you want to try a bland diet for 24 hours. Unecessary care doesn’t make patients any better, and it consumes resources that could be used when patients really need it; a lesson we haven’t seemed to be able to learn in human healthcare.
I’m not sure I would consider a bland diet a home remedy, but I get your point.
By subliminal, I didn’t mean confrontational.
The hard core believer/client in this case, is likely to take advantage of your clinic however, in a not so good way. They already took advantage of the vet and staff’s valuable time, took up an appointment that could have best served another pet’s needs, disregarded the vet’s advice and practically slapped the vet in the face by more self-medicating anyway.
I understand how difficult it is to choose between not treading on the client’s belief system and treating the pet, or maintaining a balance, on the odd chance you might be able to get through some day and actually save the pet from the client.
Maybe there should be a whatstheharm? website for pet owners.
“Maybe there should be a whatstheharm? website for pet owners.”
Excellent idea! Anecdotes are always more persuasive than facts, so a collection of them would be a useful resource. Feel like starting one? 🙂
Well, it would be quite the undertaking, wouldn’t it!!
However, how many vets are willing to come forward and tell their horror stories? Where do you find such vets?
I think the British Veterinary Voodoo Society site attempted to post a few cases, but how to go from there and gather data?
My Mom is all over those natural home remedies for herself and the dogs. She is currently attempting to treat a dog ear infection with black walnut extract. I tried to tell her it’s not going to work, but like most subscribers to natural cures, she won’t listen.
I’m amused by the cat enema story. I can’t imagine doing that to a cat that isn’t sedated. I’m sure that the owner got pretty scratched up in the process, but stupid is as stupid does 🙂