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Whoa!  Lay Off the Vitamins!
Posted: 16 June 2013 12:47 PM   [ Ignore ]   [ # 91 ]
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asanta - 16 June 2013 11:45 AM
Mriana - 16 June 2013 08:12 AM

I usually read WebMD or actual medical journals, that are peer reviewed, such as Physician’s First Watch (either the free articles or the abstracts) http://firstwatch.jwatch.org/  I’ve read the recommended limits and avoid going over that.  What about in the foods I eat?  It’s kind of difficult for a vegetarian (almost vegan) homebody to get more than the RDA of vitamin D and calcium.  It’s difficult to get even close to the RDA.

Sorry, I forgot to add in the vegetarians. Yes, you certainly should take supplements.

Of which I think calcium and D are most important, esp since I don’t get out in the sun often, esp in winter.  Vitamin C, not so much because I do eat fruit as a vegetarian.

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Posted: 16 June 2013 12:57 PM   [ Ignore ]   [ # 92 ]
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Lois - 16 June 2013 06:30 AM

You said it Asanta.  Even if someone dropped dead after taking vitamins the alt crowd would say it was aomething else.  Actually I think they should not only keep on taking them, they should double or triple the dose. Eventually they’ll become extinct.

Lois

I don’t think this strategy would work.  Taking ultra megadoses of vitamins is probably not toxic enough to kill off people before they can reproduce.  Also chidren could be born who have an adaptive tolerance (and thus survival advantage) in the ingestion of too much “artificial” vitamins.  So I doubt that they will become extinct.

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Posted: 16 June 2013 01:20 PM   [ Ignore ]   [ # 93 ]
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TimB - 16 June 2013 12:57 PM
Lois - 16 June 2013 06:30 AM

You said it Asanta.  Even if someone dropped dead after taking vitamins the alt crowd would say it was aomething else.  Actually I think they should not only keep on taking them, they should double or triple the dose. Eventually they’ll become extinct.

Lois

I don’t think this strategy would work.  Taking ultra megadoses of vitamins is probably not toxic enough to kill off people before they can reproduce.  Also chidren could be born who have an adaptive tolerance (and thus survival advantage) in the ingestion of too much “artificial” vitamins.  So I doubt that they will become extinct.

The supplements added to food are also artificial too, in that they do not come naturally in that food- such as calcium in orange juice, iron fortified bread, and Vitamin D in milk.  IMHO, it is the same thing that some are saying about vitamin pills.  However, we’ve already been down that road.  It’s still the same thing though and not worth going down a rabbit path again that says it is not.

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Posted: 17 June 2013 11:54 AM   [ Ignore ]   [ # 94 ]
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Mriana,

I have no idea where you got the idea that I was “totally anti-supplement.” I believe I specifically said several times that supplements are inappropriate if not used for a specific proven indication. There absolutely are some clear cases in which supplements are appropriate and effective. The problem is simply the widespread assumption that they are beneficial and safe regardless of any data on the subject.

Unfortunately, your example concenring glucosamine is not a good one since the evidence is very solid that glucosamine and chonroiting are completely useless for treatment or prevention of arthritis. Just last week I wrote about an which re-enforced this conclusion, and I have been covering the subject and the evidence on this one for years (see [url=american-academy-of-orthropaedic-surgeons-evidence-based-review-of-arthritis-treatments]HERE for a summary). This is exactly the kind of widespread misconception that leads to significant waste of money and effort and, in some cases, failure to make use of better validated treatments. Glucosamine supplements are probably harmless, and they are certainly popular, but they almost certainly don’t work. You are free to do whatever you like, and unfortunately there aren’t a lot of good options for older cats with arthritis, but sadly glucosamine is a waste of money.

So I certainly can’t say I never recommend supplements, but that is a straw man that bears no resemblence to what I’ve been saying in this thread. I’m simply talking about the value of relying on good scientific evidence rather than just assuming these things are safe and effective. The reality with supplements is that most of the time we don’t know if they work or not because they haven’t been adequately studies. Sometimes they have been shown to have value, and sometimes they have been shown to be unsafe (HERE is a list of papers and discussions of the risks of various supplements). It’s not a simple matter to decide what one should or shouldn’t take, but if we ignore the evidence when we have it we certainly aren’t going to make the best choices.

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Posted: 17 June 2013 11:59 AM   [ Ignore ]   [ # 95 ]
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Asanta,

Just wanted to point out that I wouldn’t recommend ibuprofen for your dog. It has a VERY narrow safety margin in dogs (much more so than in humans) because they don’t detoxify it effectively, and both GI ulcers and renal failure can easily occur with use of this one. Acetominophen is also not very safe. Aspirin (about 10mg/kg) is best tolerated of the over-the-counter drugs, though some dogs do show sensitivity to it and have vomiting. If your dog really has significant discomfort or disability due to arthritis, a prescription NSAID labeled for dogs with regular bloodwork monitoring is best. And, as you say, there is no reason to think glucosamine is worthwhile.

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Posted: 17 June 2013 03:00 PM   [ Ignore ]   [ # 96 ]
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TimB - 16 June 2013 12:57 PM
Lois - 16 June 2013 06:30 AM

You said it Asanta.  Even if someone dropped dead after taking vitamins the alt crowd would say it was aomething else.  Actually I think they should not only keep on taking them, they should double or triple the dose. Eventually they’ll become extinct.

Lois

I don’t think this strategy would work.  Taking ultra megadoses of vitamins is probably not toxic enough to kill off people before they can reproduce.  Also chidren could be born who have an adaptive tolerance (and thus survival advantage) in the ingestion of too much “artificial” vitamins.  So I doubt that they will become extinct.

Oh, well, I tried! wink

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Posted: 17 June 2013 05:18 PM   [ Ignore ]   [ # 97 ]
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mckenzievmd - 17 June 2013 11:54 AM

Mriana,

I have no idea where you got the idea that I was “totally anti-supplement.” I believe I specifically said several times that supplements are inappropriate if not used for a specific proven indication. There absolutely are some clear cases in which supplements are appropriate and effective. The problem is simply the widespread assumption that they are beneficial and safe regardless of any data on the subject.

Yes.  Now that I can agree with.

Unfortunately, your example concenring glucosamine is not a good one since the evidence is very solid that glucosamine and chonroiting are completely useless for treatment or prevention of arthritis. Just last week I wrote about an which re-enforced this conclusion, and I have been covering the subject and the evidence on this one for years (see [url=american-academy-of-orthropaedic-surgeons-evidence-based-review-of-arthritis-treatments]HERE for a summary). This is exactly the kind of widespread misconception that leads to significant waste of money and effort and, in some cases, failure to make use of better validated treatments. Glucosamine supplements are probably harmless, and they are certainly popular, but they almost certainly don’t work. You are free to do whatever you like, and unfortunately there aren’t a lot of good options for older cats with arthritis, but sadly glucosamine is a waste of money.

I was skeptical too, until I saw my 14 y.o. cat hobbling around less, is playing again, and eating more.  Not sure what is happening, but he seems to be doing better and putting his weight back on again.  Another man I met said it helped his cat or dog (I forget which it was).  I don’t know why he stopped hobbling and eating more after the med was started, but he has.  If it wasn’t the glucosamine what was it?  I seriously doubt it was changing his diet from dry to moist foods.  The only relationship that has would be for his mouth and stomach, which ironically has improved (not his mouth, but his stomach).  Whatever the case, the dr is going to do some blood work on the old man as fast as I can pay for it.  Almost $200 for blood work.  Seems outrageous to me, but I know that will tell us a lot more than the appearance of the glucosamine helping him.  Then again, Amber took it for arthritis, before she ended up with organ failure at the age of 12.  :( However, she didn’t show any improvement before she took sick.  She just went from hobbling around to laying in her waste without caring, and then eventually looked like an anorexic on death door before they confirmed what I already know and had to let her go.  She was the first cat I ever gave or rather permitted via the vet’s recommendation, euthanasia at the end.  So, I don’t think this is the same thing and sometimes I think he’s going to make it at least until he’s 20.  He’s just that stubborn, which is good, I think.

[ Edited: 17 June 2013 05:24 PM by Mriana ]
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Posted: 19 June 2013 04:07 AM   [ Ignore ]   [ # 98 ]
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Coldheart Tucker - 07 June 2013 05:51 PM

People taking vitamin supplements can have a dramatically increased risk of death.

In October 2011, researchers from the University of Minnesota found that women who took supplemental multivitamins died at rates higher than those who didn’t. Two days later, researchers from the Cleveland Clinic found that men who took vitamin E had an increased risk of prostate cancer.

These findings weren’t new. Seven previous studies had already shown that, for certain groups, some vitamins increased the risk of cancer and heart disease, and shortened lives.

Much more at the link.  In short, unless you’re taking vitamins for a few specific conditions, you’re screwing yourself.  Possibly fatally.

Unless you are taking vitamins because of a genuine medical need as prescribed my an MD all you re doing is making your urine expensive for no good reason.

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Posted: 21 June 2013 02:33 AM   [ Ignore ]   [ # 99 ]
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mckenzievmd - 17 June 2013 11:59 AM

Asanta,

Just wanted to point out that I wouldn’t recommend ibuprofen for your dog. It has a VERY narrow safety margin in dogs (much more so than in humans) because they don’t detoxify it effectively, and both GI ulcers and renal failure can easily occur with use of this one. Acetominophen is also not very safe. Aspirin (about 10mg/kg) is best tolerated of the over-the-counter drugs, though some dogs do show sensitivity to it and have vomiting. If your dog really has significant discomfort or disability due to arthritis, a prescription NSAID labeled for dogs with regular bloodwork monitoring is best. And, as you say, there is no reason to think glucosamine is worthwhile.

Thanks, the motrin was recommended by the vet. I’ll ask for something else. I spend a fortune already on his anti-seizure meds, may as well add another to the mix prn, of course. He’s been a stable 29.5 kg for the 5 years I’ve had him (he’s a Lab). I’ll pick up some aspirin and probably decrease the dose a bit. I get another med when I visit the vet again to refill his other med. Thanks again.

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Posted: 21 June 2013 02:07 PM   [ Ignore ]   [ # 100 ]
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Asanta, since I have no expertise in dog biology, I certainly wouldn’t recommend it, but it would be interesting to get McKenzie’s take on the use of quinine as an analgesic.  It’s old fashioned, but I believe it was once and possibly is still used as a cattle analgesic. 

Occam

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Posted: 22 June 2013 09:57 PM   [ Ignore ]   [ # 101 ]
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Occam. - 21 June 2013 02:07 PM

Asanta, since I have no expertise in dog biology, I certainly wouldn’t recommend it, but it would be interesting to get McKenzie’s take on the use of quinine as an analgesic.  It’s old fashioned, but I believe it was once and possibly is still used as a cattle analgesic. 

Occam

This particular dog spends time at the vet every few months. I can ask her then. There are probably more effective pain killers for dogs. He just needs an occasional mild NSAID for the times he refuses to accept that he is old… Lol! Like the rest of us!

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Posted: 24 June 2013 01:52 PM   [ Ignore ]   [ # 102 ]
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I have looked into it, but I can’t find any reference to use of quinine as an analgesic other than the PubChem statement that it has been so used. Nothing on PubMed or any of the veterinary drug compendia. Never heard of it.

There are many analgesics that have been tried in dogs. The main problem is that it is difficult to objectively determine the amount of pain a dog feels or how much improvement there is with a particlar drug. Clients almost always report subjective improvement with almost every therapy they try, and there is good documentation of a “caregiver placebo effect” that leads owners and vets to see improvment in clinical trials where none can be measured objectively (through, for example, analysis of the weight bearing on a particular limb). Without controlled trials, we’re just guessing, and there aren’t many trials for most of the agents in use. NSAIDs, though, are well studied, so they are the first choice in many cases.

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Posted: 24 June 2013 04:42 PM   [ Ignore ]   [ # 103 ]
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mckenzievmd - 24 June 2013 01:52 PM

I have looked into it, but I can’t find any reference to use of quinine as an analgesic other than the PubChem statement that it has been so used. Nothing on PubMed or any of the veterinary drug compendia. Never heard of it.

There are many analgesics that have been tried in dogs. The main problem is that it is difficult to objectively determine the amount of pain a dog feels or how much improvement there is with a particlar drug. Clients almost always report subjective improvement with almost every therapy they try, and there is good documentation of a “caregiver placebo effect” that leads owners and vets to see improvment in clinical trials where none can be measured objectively (through, for example, analysis of the weight bearing on a particular limb). Without controlled trials, we’re just guessing, and there aren’t many trials for most of the agents in use. NSAIDs, though, are well studied, so they are the first choice in many cases.

If a dog cries and whimpers in supposed pain, even when asleep, then rests quietly for several hours after taking a medication, isn’t that objective evidence that the medication is effective against the pain? Isn’t it further evidence of effectiveness when the dog begins to whimper again several hours after the medication is administered? Is it any different than when a small child receives pain medication and can’t put into words how s/he feels?

Lois

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Posted: 24 June 2013 05:13 PM   [ Ignore ]   [ # 104 ]
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Lois - 24 June 2013 04:42 PM
mckenzievmd - 24 June 2013 01:52 PM

I have looked into it, but I can’t find any reference to use of quinine as an analgesic other than the PubChem statement that it has been so used. Nothing on PubMed or any of the veterinary drug compendia. Never heard of it.

There are many analgesics that have been tried in dogs. The main problem is that it is difficult to objectively determine the amount of pain a dog feels or how much improvement there is with a particlar drug. Clients almost always report subjective improvement with almost every therapy they try, and there is good documentation of a “caregiver placebo effect” that leads owners and vets to see improvment in clinical trials where none can be measured objectively (through, for example, analysis of the weight bearing on a particular limb). Without controlled trials, we’re just guessing, and there aren’t many trials for most of the agents in use. NSAIDs, though, are well studied, so they are the first choice in many cases.

If a dog cries and whimpers in supposed pain, even when asleep, then rests quietly for several hours after taking a medication, isn’t that objective evidence that the medication is effective against the pain? Isn’t it further evidence of effectiveness when the dog begins to whimper again several hours after the medication is administered? Is it any different than when a small child receives pain medication and can’t put into words how s/he feels?

Lois

Its not any different but in both cases care giver placebo effect is a big issue. Mckenzie did a very good job of going over caregiver placebo affect in an earlier post so maybe he will elaborate further here but when trying to assign cause and effect we must remember that just because events unfold in a given sequence does not prove that the first event ( giving the medication) caused the second ( the apparent relief of pain). Obviously the more times the sequence is observed the greater the probability that the first caused the second but even then there is no certainty.

Imagine a situation where you get up every morning and notice your dog is stiff. You give him a remedy and an hour later he appears to be more mobile. You do this same thing for weeks on end and the same pattern continues. Did the medication help the dog? It sure seems to but there are other possible and even probable explanations. Arthritis is a disease where the symptoms fluctuate naturally and sometimes in a regular pattern. Arthritic patients often describe pain that is worse after a period of inactivity and which improves with movement. The dog might be stiff every morning because he hasn’t moved all night and get better after rising and moving about, and it all may have nothing to do with the medication despite the illusion created by the sequence of events.

Confirmation bias is also an issue. Few pet owners ( or parent for that matter) are keeping an objective journal with notes about the response to every dose of medication given. Its very possible that the dog or child might appear to feel better one day after a med is given and anther day there is no change in their condition but wanting to believe we are helping the patient in our charge we remember the times the med worked and forget the times it didn’t.

Keep in mind also that what we are measuring here is very subjective. How active or mobile an animal is can vary in degree, speed and type. How are we gauging all of these things. Its not something you can easily put a numerical value on. Sampling error can be an issue too, especially if you are not observing the animal all day. You may have observed him during his least active 10 minute period on Monday. He may have done nothing during that period but ran around like crazy the rest of the day. You may then have seen him during his most active period on Tuesday but he was a total slug the rest of the afternoon when you weren’t watching. If you didnt observe the full 24 hour period both days you would get the wrong impression. Another problem is that you are using movement as a proxy for pain but the two may correlate poorly or not at all sometimes.

I’ve left out a lot here but suffice it to say, there are plenty of reasons not to use personal observations an anecdotes as evidence of efficacy.

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Posted: 25 June 2013 07:49 AM   [ Ignore ]   [ # 105 ]
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Lois,

Macgyver is correct. One of the most challenging things about evaluating medical therapies is that the way things seem is often not the way they actually are. Placebo effects are powerful and emotionally compelling, and they come with a sense of rightness or certainty that is difficult to shake even when objective evaluation shows we are being fooled. People with asthma who get acupuntcure, for example, report a significant iporvement in their breathing when treated. What could be more objective than the cessation of an asthma attack? Yet when you do objective measures of lung function, there is no improvement with acupuncture, while there is measurable change with drug therapy even though it doesn’t feel any different to the patient. Such placebo effects have been reported consistently in studies of therapies given to pets as well, and they occur because for many reasons, those cited by Macgyver and others, things often look better to us after we’ve given a treatment even when they aren’t actually better.

HERE is a link to an article I wrote discussing a recent study of arthritis treatments in dogs. Almost half of the veterinarians, and over half of the owners, reported an improvement in the dogs getting the placebo therapy even though the objective measure (the amount of weight the dogs could carry on the affected leg) did not change. Unfortunately, this effect makes it very easy for us to give our pets a treatment and think it is working when they are actually getting no releif, which is why objective controlled studies of pain medication in animals are so important.

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