Evidence, and the RCVS Conference

Sherlock

I just returned from the Evidence-Based Veterinary Medicine Network conference sponsored by the Royal College of Veterinary Surgeons, which was held this past week (October 23 and 24, 2014) in Windsor, Berkshire, UK, outside of London.  I had to opportunity to give two talks – one on ethics, and the other on the true history of acupuncture (CLICK HERE if you want to read it).  But more importantly, I had the opportunity to network with a lot of like-minded people, people who feel that the practice of veterinary medicine is best guided by good scientific evidence.  (If you want to read a good summary about what the conference was, written by Dr. Brennen McKenzie, one of the conference speakers, and former president of the Evidence-Based Veterinary Medical Association, CLICK HERE.)

“Now wait,” you say.  “Isn’t good scientific evidence sort of the standard for veterinary practice?  I mean, what are we paying you for anyway?”

Some people resist listening to evidence

Some people resist listening to evidence

Yes, well, that’s another discussion.

You see, not everyone is convinced of the importance of gathering evidence.  They’ll say things like, “I have all the evidence I need.  I can see it with my own eyes.”  Or, they’ll say, “I can’t wait for the evidence – I have to do something now.”  Stuff like that.

I don’t agree with those positions.  And those are other discussions, too.

What THIS discussion is about is some good, reliable information that was presented on a number of topics that I thought horse owners might find interesting, on a variety of mostly-unrelated topics.  So, here goes.

Itchy1.  If your horse has itchy skin, and you want to shampoo him with something, it probably doesn’t matter that much what shampoo you use.  If you’re treating an itch, the most important thing is skin hygiene, not which shampoo you use.  So, oatmeal, iodine, aloes, etc., don’t make much difference – it’s the keeping skin clean that’s important.  This is information from the treatment guidelines for allergic (atopic) dermatitis in dogs, published by an International Task Force on Canine Atopic dermatitis (CLICK HERE to read all nearly 300 pages of it), and it applies to horses, too.

 

2.  Laminitis is a clinical sign, it’s not a disease.  You probably hadn’t thought of laminitis in that way (to be honest, I really hadn’t either, but it makes a lot of sense).  As Dr. Cathy McGowan, of the University of Liverpool pointed out, not only is laminitis not a disease, it’s not even the same thing in different horses that have the problem.  For example, the laminitis associated with Cushing’s Disease in older horses (PPID – you can CLICK HERE to read my article about it) is not the same thing as the laminitis associated with grain overload.  The changes that occur at the microscopic level in the feet of the two differing forms of laminitis are completely different..

Seriously...  we've come a long way.

Seriously… we’ve come a long way.

Why is this important?  Well, for one thing, if anyone tells you that there is a “cure” for laminitis, you know that that person is off on a limb that is probably not even be attached to a tree.  For another, it tells you that if you’re only treating the signs of laminitis – you know, the sore feet, the bone rotation, etc. – you may not get very far. Ideally, as with any disease, you need to treat the underlying condition.  It also tells you that the key to laminitis management is prevention.  And that opens the door to discussions of all sorts of things, such as weight control, dietary management, pasture management, evaluation of underlying problems (e.g, metabolic disease, or other diseases), or proper management of chronic diseases such as Cushing’s or Equine Metabolic syndrome (CLICK HERE – you just had to know I wrote about that, too).  Speaking of….

Mereworth Castle, around 1930

Mereworth Castle, around 1930

3.  There’s no good evidence that pergolide does anything to control laminitis once it’s started.  Pergolide, the most commonly prescribed drug for equine Cushing’s disease, is about the best choice – heck, it’s really about the only real choice – that helps to modulate the abnormalities in the horse’s body’s hormones that characterize the disease.  The majority of horses over 20 years of age have pituitary gland enlargements, so it’s probably a good idea to get your older horse tested, and especially if he’s showing signs of Cushing’s (like a long, curly hair coat).

That said, from work by Dr. E.J. Knowles of the Bell Equine Clinic in the town of Mereworth, Kent, in southeast England, giving pergolide to a horse with laminitis is unlikely to do anything to relieve or reverse clinical signs of laminitis by itself, and horses on pergolide weren’t any more likely to get better than those on cyproheptadine, and older drug that has fallen out of favor.  Certainly, if you have an older horse that has Cushing’s disease, treating him with pergolide is important.  However, if your horse already has laminitis, pergolide may not help much to control the signs, and especially if there are other problems that are not under control.

4.  Fatty acids may not work very well in cases of allergic skin diseases, but if they do, it could take a couple of months.  And nobody knows what “proper” balance means.  Lots of folks are talking about fatty acids for the treatment of a variety of skin conditions of the horse, as well as many other species.  Flax seed gets mentioned a lot.  But, according to the treatment guidelines mentioned in number 1, right now there are a few things to keep in mind.

  1. Fatty AcidIf they are going to work, it’s going to take a couple of months
  2. Nobody knows what might be optimum types, or balance, or blend
  3. They’re probably not good as primary therapy, that is, you also want to make sure that you’re relying on something that really works.  First choice is to eliminate the problem – but that’s not always possible.  Second choice are corticosteroid drugs (which are not nearly as bad as you may have heard).  Antihistamines – not so much.

Little Engine5.  Fecal occult blood tests aren’t currently useful for, well, for much of anything.  But they’re still trying. There’s a test kit available to check for the presence of blood in the feces of horses.  It’s called Succeed.®.  It’s been promoted as an easy test for gastric ulcers.  It’s not.  Dr. Nicola Kerbyson at the University of Glasgow is doing work to see if the test might be useful to test for parasites, but it’s too early to tell at this point.  Right now, the test seems to be one that’s in search of a disease.  I’d pass on having it performed on your horse, for now.

6.  Still no good evidence for the effectiveness of acupuncture.  Dr. Wesley Rose, and researchers at the University of Guelph, in Canada, have undertaken a scoping review of the evidence available for animal tapping-fingers (1)acupuncture.  In case you don’t know what a scoping review is (I didn’t), it’s a study that tried to accumulate as much evidence as possible for something, and map out the results.  The reviewers looked at as many studies as they could find on cats, dogs and horses.  And what did they find?

Essentially, nothing.  That is, after nearly half a century of what-seems-to-be non-stop promotion and advertisement, there’s still no evidence that it’s clinically useful for, well, anything. (NOTE:  If you think you’ve had good results, or if you’ve actually had good results, that’s great.  But it doesn’t change the fact that there’s still no good evidence).  No surprise actually – I think that if something were going to show up, it would have already shown up.  I mean, it’s only been 50 years (or thousands, if you believe the false advertising).

Horse mouthAND A BONUS BIT OF INFORMATION!!!! Not from the RCVS meeting, but a new study just came out on horse teeth. It was a hospital study, which looked at the teeth, as well as the size of feed particles in the feces (poop) of horses that had been hospitalized for impaction colic.  And the results?  Horses that had impaction colics didn’t have any difference in feed particle size from those non-colic horses used as controls, and they also didn’t have any worse dentition.  CLICK HERE to see the study.

NOTE:  This doesn’t mean that you should never have your horse’s teeth looked at.  It just means that you shouldn’t to lay awake at night worrying that he’s going to get constipated because he hasn’t had his teeth floated in the last several days.  Or weeks.  Or months.  Or probably longer.

It was a such a great, inspiring, and invigorating conference!  I can’t wait until the next one (Edinburgh, Scotland, 2016).  And, of course, I’ll try to keep you up-to-date in the interim.

About Doctor Ramey

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