Damn, Dr Cliff is in a bad mood...and not because of the vegan tick!

In this conversation, Dr. Cliff Redford discusses two main topics. First, he talks about the trend of regular veterinarians sending all radiographs to specialists for analysis, even when it may not be necessary. He shares his concerns about this practice and emphasizes the importance of veterinarians being able to interpret radiographs themselves. Second, he discusses the Lone Star tick, which can cause an allergy to mammalian meat known as alpha-gal syndrome. He explains the symptoms and implications of this allergy and highlights the need for prompt removal of ticks to prevent diseases like Lyme disease.

First, if you haven't watched my film and live in Canada (or have one of those VPN things), you can watch it here:

https://youtu.be/oMUx3yuyznc?si=oagpg7bGnpbuyXlJ

Be sure to follow me on Instagram @drcliffworldwidevet.com and on Twitter at @drcliff_vet
Listener questions, episode suggestions, or if you have a good idea for a guest, email me at dr.redford@vet905.com
Additional information can be found at drcliff.ca

Transcript

Dr. Cliff Redford (00:09)

I had a new client schedule an appointment for their dog this past Saturday. She'd gone to this emergency hospital the night before because her dog had been vomiting a ton of times during the day. He couldn't keep down any food or water. And basically everyone was worried about an obstruction, right? Like a, like an intestinal obstruction, something was stuck. Now when I got into the clinic Saturday morning, I take a look at the schedule and I see that this new patient is coming in at the end of the day for a follow -up.

So I made the mistake of assuming his situation was stable, that everything was figured out. Well, that assumption was wrong. I realized this when the veterinarian or a veterinarian from the Mercy Hospital called me around midday to discuss the case. They had done radiographs on the abdomen last night and they'd sent the dog home with like supportive symptomatic treatment, things to stop the vomiting, maybe some pain medication, that sort of thing.

and, so they sent the dog home and then they had the radiographs reviewed this morning or that morning, Saturday morning by a board certified radiologist. And the radiologist noted that there was something in the stomach still. And they say still, and this is unusual because the dog had not eaten at the point that with the X -rays were taken, the dog had not eaten for about 12 hours and had vomited over and over again. So.

In theory, the stomach should be empty, right? The emergency veterinarian who had called wanted me to review the radiographs with the owner and take additional images to see if the stomach was still full. So I'm asking this veterinarian, I don't understand. You took the x -rays last night. It's now midday and the dog's coming in at like four, the last appointment of our day. You took the x -rays last night. Why didn't, like, did you not discuss?

the x -rays and they said, well, no, we didn't because we didn't, we didn't fully review them. And there was kind of this back and forth and I kind of realized what had happened. And this is, this is a trend that I'm seeing. So over the last decade or so, I've seen this trend. A lot of other veterinarians talk about it. Let's say, quote unquote, old school veterinarians like myself. and what we're seeing is it seems to be the norm.

or at least very, very common for regular veterinarians. I'm a regular veterinarian, a companion animal or let's say primary practice veterinarian. I'm not a specialist to send all of their radiographs for specialists for analysis. Every single radiograph. Is there a bladder stone? Send it off to the radio for the radiologist. Is the heart enlarged? Send it off to the radiologist. What about hip dysplasia? What about, is there something in the stomach which likely is causing the vomiting?

that this patient was at the emergency clinic for send it to the radiologist. And look, I understand is reasonable occasionally, maybe 10 % of the time to seek the opinion of a board certified specialist, chest x rays, especially I find can be a little tricky. So if you're if you're looking for the tiniest possible tumor on this large chest x ray, I mean, heck,

They're finding now for checking for lung cancer or mammary tumors in people that artificial intelligence are better at picking up these very, very subtle changes. So I get that, that a specialist is needed. But, you know, or maybe I sometimes I recently sent one off to a specialist because there was a lesion in the cortex of a bone, of the femur bone indicating what later on we found out was indicating bone cancer. And so when you're talking about a very serious diagnosis like that,

And in that situation, one that is not urgent right then and there needs to be figured out. A second opinion can be helpful, but every single X -ray at a lot of clinics around my area, and I'm sure it's no different across North America, are routinely sending them to radiologists. And this was an emergency hospital. And the image wasn't very hard to read.

I was taking a look at the x -ray sort of just casually kind of seeing what was going on. And one of the technicians I worked with, I work with now I have the greatest technicians, they looked at it, glanced at it without even really knowing the case and said, well, that doesn't look right. And they're referring to the swollen stomach, that something was in the stomach. And they may not have known exactly what was going on, but they knew enough that there was a problem there. And, you know, had they had known the case, certainly if,

themselves and myself had examined the patient and felt the abdomen and checked all the other possibilities and knew that this was a young animal and not likely to have a tumor let's say. They would have said hey this this dog needs an ultrasound or a barium series or even exploratory surgery given the history this dog has probably swallowed something. So our patients depend on us right and our clients expect that if they're paying us

500 bucks for a handful of x -rays and much of that fee involves the cost of our brains the cost of us to interpret the radiograph They rightfully expect that in the vast majority of cases. We should be able to interpret those x -rays That's why we went to school. I vividly remember taking radiology class I'm sure they haven't taken radiology class out of veterinarian school. I Vividly remember having my in -person final exam

final year after a seven day clinical rotation working at the University of Guelph Animal Hospital, a seven day clinical rotation where all we did was take and interpret radiographs. There was a little bit of ultrasound in there. Maybe we were looking at you know, like vertebral disease and things of that nature, myelograms, pardon me, where they put the dye in the in the spinal cord, but 95 % of it was looking at radiographs.

And we were looking at film radiographs, whereas now we have digital radiographs where things are so much more clear and so much more obvious. So, you know, in this, in this final exam, essentially the professor and I sat in his office. He gave me a history of a case, threw up some X -rays and asked me what I thought. I get asked questions about the physical exam findings, about the history and, you know, more questions I may have. And maybe he didn't know, but.

He expected me to say out loud what I saw, the normals and the abnormals and then diagnose the problem. And I'm sure I didn't get every diagnosis 100 % correct. But as long as the diagnosis I made was reasonable, you know, like I could say, Hey, I think there's something in this dog's stomach. We need to do some more imaging or barium series or exploratory surgery. Now, maybe I was leaning towards a foreign body and in the particular case he shows me it's a tumor.

Doesn't matter. Either way, I could see that there was something in the stomach. Now making this up, obviously, I don't remember exactly what the radiographs I saw. This was 27 years ago, probably, either in early 90s or late 97 or early 98. Because I did a clinical rotations for the entire eight months, right? You do it in the fall and then in the spring, and then you graduate as a doctor. So he expects me to say out loud and sort of work through the process, diagnose the problem. And I was only allowed one pass.

You know, there was probably five cases and only one I was able to say, I don't know, can we pass this one? I should be able to do four out of five of these. I wasn't able to call a friend. There were no cheat codes. We were not permitted to say we were too anxious or stressed, and we certainly couldn't hand it over to a specialist for their opinion. This was our job. Even foreign trained veterinarians who want to be licensed here in North America, they have to pass this.

ruling written exam called the NAVLA, North American Veterinary Life Saving Exam, and then they have to pass seven clinical proficiency exams. One of them, this is hands -on stuff, surgery, I think dermatology, but certainly one of them is radiology. They're expected to know this stuff before they become a licensed veterinarian. Now, I would love to learn how universities now are testing.

graduating vets? Is it is it a similar method? Or is it online? It's probably online. They probably look at images and get to select out of multiple choice. And, you know, are they allowed to again, select some cheat codes like they're on who wants to be a millionaire? Can they can they ask the computer to scratch out 50 % of the options? Or instead of like on the TV show where they asked the audience, maybe they can ask the pet owner. Of course not, right? That's not reasonable.

They got to be able to figure it out. But I, I would bet large sums of money with some decent odds that, that they're not doing it in front of a professor where they got to work things out for various reasons. I don't know. Maybe it's too time consuming, maybe too expensive. it was fine when we did it. or maybe they just find that they don't have to deal with sort of the, the uniquenesses of stress or.

anxiety or whoever, whatever the problem is, I don't know. but certainly things have changed in universities these days. Now, look, I understand we all have limitations. I certainly do. I, I screw up. I make wrong choices. in the difficult cases, you know, very rarely, maybe every five years or so I make a mistake and I own up to it and I deal with it. And thank goodness, none of those mistakes I've made have, have caused the, the, the, the patient to pass away.

I've always been able to get the things fixed and maybe call a specialist in to do the surgery or refer the patient, let's say. But once out of every a hundred cases, maybe I need a more expert opinion. But back in the day, when your limitations involve an entire section of being a veterinarian, radiology in this example, we call that a fail. Maybe most of these vets should have like an asterisk beside their degree.

or when they have the little white coats with their names that say Dr. Smith, they have a little asterisks, right? Or do they have to do air quotes on their names whenever they introduce themselves as doctor? Hi, nice to meet you. I'm Dr. Cliff. Of course not. But like, I, you know, is it a reasonable question? Maybe, right? Now there may be some of you, maybe parents of vets, the ones who paid for your kid's education who are saying, well, MDs don't look at radiographs.

And you're right, they don't. Family physicians don't look at radiographs. They just look at the reports, which have probably already been explained to you. They all go to experts or go to a board certified radiologist who look at ultrasounds and MRIs and CTs and all these different imaging techniques. But honestly, that's why I think us vets are better than MDs. Now the brilliant mind of Cosmo Kramer said,

Dr. Cliff Redford (11:43)

No, I'll take a vet over an MD any day. They gotta be able to cure a lizard, a chicken, a pig, a frog all on the same

Dr. Cliff Redford (11:50)

And, but he was right, right? We don't, we do have to know so many animals and so many physiological systems. We also should know how to do mid -level difficult surgeries. We should know how to stabilize an emergency. We should know how to handle average and slightly difficult dermatology cases, behavior cases.

and feel comfortable in interpreting radiographs. Imagine if other professions acted like this. Imagine you pay a lot of money to send your kid to some posh private school and they promise you they will prepare him or her for university, only to find out they don't have a math teacher. Or more specifically, let's say your kid's elementary school teacher, he or she is great at everything they do.

except they don't do story time. They won't help teach your kid how to read. They'll bring in another teacher for that and it'll cost you extra money. That's sort of a similar comparison. You hire a personal trainer and the gym bro you hire with the swollen torso and traps so large he doesn't even really have a neck, doesn't know any leg exercises and pulls some off of YouTube every once in a while and asks you to follow the stuff that you see on YouTube while he's sitting there drinking his

his creatine protein shake. You wouldn't accept that, right? Now I box, I've talked about it a little bit, and I compete at the amateur level. Now imagine if in the middle of a match, my opponent switched to Southpaw, which is left -handed, Orthodox is right -handed, and my coach, Brock, throws in the towel. He says, sorry, Cliff, I don't know how to handle or how to coach you against a lefty. Of course not, right? Like I would, I'd fire him and I'd get my ass

Dr. Cliff Redford (13:37)

Or there's a police officer who can do all of his duties or her duties except doesn't know how to drive the car really fast. I'm sorry, captain. We couldn't catch the robber. He sped off too fast. And well, you know me, I can't drive over 60. We had to pull over so Murphy could take the wheel. And so we lost him. Yes, again. I know, I know. This is the third time this week. It's like the bad guys know I can't drive real good. What are we going to do, cap?

I got the uniform. I want to be a police officer. Can you imagine if that was the case?

Unless we're a specialist, then we could consider ourselves a master of no trades. But we are a jack of all of them. Now, some of you may think I'm being a jackass, but if you bring your pet to me and I recommend radiographs, I'm going to be the one interpreting them. There's no asterisks on my degree, no air quotes when I introduce myself as doctor. Plain and simple. I'll take a look at the x -rays. I'll do as best I can for your pet. No call of friends.

Dr. Cliff Redford (14:45)

you can tell, this was my random rant for today. I appreciate you guys being my therapist.

and invoice me for the hour, even though it didn't take that long.

Let's talk

this tick out of Texas that infects the people at bites with veganism. I think this is a hilarious story. This is a true story, though I am embellishing it a tiny bit, not much, a tiny bit. And I think, think about this as I'm going through the story. This is the Lone Star's tick. It's called that because it has the females have this very prominent white star shaped.

A pattern, a single star on its let's call it's back. It's like a shield. And so it's like a lone star. It also is often seen or most often seen in Texas, which is the lone star state based on their flag. It is also known as I think the turkey tick because they're they're they the immature ticks are found on turkeys. And then I think it's seen in Australia and some other countries and it's.

It's got other names, but I think it's hilarious that it's coming out of one of the primary states that creates meat, right? Like beef farming, cattle ranching is huge all in that Southern region of the United States. I wonder if they're going to have a, cold air version here, up in Alberta. so this, this Lone Star tick sorta does infect you with being a vegan.

It is it gives you a condition called the alpha gal syndrome or AGS. It's also known as the alpha gal allergy or the mammalian meat allergy MMA. And it's a it's a type of acquired meat allergy characterized by a delay of onset. Typically, it's like three to eight hours after you ingest mammalian meat. Now, this is pretty much all mammals except for primates. So don't worry.

You're not a real vegan. You can still eat little monkeys and lemurs and things of that nature But not your typical mammals, right? And it does occur due to a previous exposure to this tick bite It was first reported in 2002 and the symptoms of the allergy vary. They vary greatly between individuals they can be rash hives nausea or vomiting difficulty breathing

drop in blood pressure, maybe fainting and dizziness, diarrhea, severe stomach pain, possible anaphylactic reaction, and like any true vegan, it probably increases your risk of dying your hair blue or neon pink. Now what this alpha -gal allergy is, is it's a reaction to a carbohydrate called the galactose alpha -13 galactose or alpha -gal, galactose alpha -13.

Galactose alpha -gal and what happens is the body becomes overloaded with a Immunoglobulin E what we call IgE antibody upon exposure to this specific carbohydrate and basically these these Carbohydrate molecules this alpha -gal molecule. It's found in mammals except again apes and old -world monkeys

And and it's also not found in humans. So don't worry the the cannibals are okay These ticks aren't going to take away their protein source. Well, what ends up happening is I'm just kind of scanning through a little bit here is Once this this carbohydrate is sort of transferred to this victim and and and creates this abundance of IGE You become allergic

So essentially red meat, healthcare providers basically say you gotta avoid food products that contain beef, pork, lamb, venison, rabbit. And in some individuals, if they're super hypersensitive, they can't even have dairy products. So it's very, very close to being a vegetarian. You're basically other than, you know, the jokes about primates and humans.

You basically are stuck with eating seafood and chicken. so not a vegan, you can still have your honey, but it does severely reduce. It's like basically a vegetarian. You're like a pesco vegetarian. and the other issue too, is there are certain mammalian gelatin products, basically like gel caps that a lot of drugs come into that also have this alpha gal protein or this alpha gal.

Allergen in it so you have to avoid certain over -the -counter and prescription Medications and again, you're pretty much stuck with eating poultry seafood And I guess if you're down south you can have gator you can have reptile meat snake meat Frogs, you know you on my last episode I talked about the American bullfrog the surgery that I had if I had this disease I could have eaten that frog if it

If it had a croaked in the end, which it did not. So what ends up happening is this again, this lone star tick, the saliva from this lone star tick contains this alpha gal. Now the ticks bite is painless and they're quite small initially and they can attach to you for up to seven days and you don't even notice it half the time. And they basically slowly get engorged in blood before they fall off. So a bunch of saliva can be.

administered or leaked. It's called leaked spit. It spits into your body, this saliva. It results in this simple allergy. Now recovery can take up to five years. It can be as short as eight months. There is a cure and the cure is basically a tincture of time. But there's no real

medication you can treat it symptomatically with sort of antihistamines and steroids if it's the anaphylactic reaction but basically for up to five years you're not eating you're not eating steak you're not eating pork chops you're not eating venison you're not eating rabbits you're not eating would it be kangaroo I mean they're marsupials so probably not

And I did read about this tick being in Australia and I didn't see anything about kangaroo. They eat a lot of kangaroo down there. So it becomes a problem. Now all joking aside, I mean, it is obviously tragic is not the right word. It's unfortunate. I don't eat those meats. So it's not really an issue for me, but it is unfortunate if you do eat those meats and you all of a sudden can't. But here's the real scary thing.

And this is including the anaphylactic reaction. That's quite scary, but you can avoid that, right? A lot of heart valves and a lot of like stents, like basically a vascular surgery implants. They're made from pig valves and pig protein and pig body parts. The pig heart is very, very similar to ours. So imagine if you all of a sudden become allergic to.

Pig protein, let's call it that for lack of a better term. Because you got bit by this tick and you have a pig valve keeping your heart functioning. That's when things get really, really scary. I joked in my trailer that Mother Nature is fighting back and obviously I don't think she has enough time in her hands. She's not bothered by us petty little humans. She's got the entire cosmos to look over. But...

Like you do wonder if there's some sort of evolutionary adaptive process through sort of just the natural environment that are we eating too much meat? I don't know. I'm not trying to get into a philosophical conversation here, but are we eating too much meat that our bodies can't handle it? And somehow therefore we create this IgE alpha -gal antibody. And then it's only that these ticks.

in one of the states that have the largest meat production and therefore probably consumption ever exists. Is there some sort of connection? I don't know. The mathematics behind it is too complicated for me. I should ask my master's degree, Master Redford, my brother Tim. So that is my story about the tick that sort of turns you into a vegan or let's say a quasi vegetarian and

Maybe it will allow you to be a better person. I don't know how to end this story but it's a fascinating one about this tick. If you guys do see any ticks on you, get them off as soon as possible. I would honestly talk to your doctor right away because of Lyme disease. I can't talk about the prevalence of this alpha -gal mammalian meat.

Allergy how prevalent it is that disease the Lyme disease is super prevalent I think they've said recently in Canada this year and I'm sure it's similar in the US that the reported numbers of Lyme disease and people have gone up by a Thousand percent. So what is that ten times? It's gone up ten times more frequently and Lyme disease is scary as heck and people So if you ever get a tick on you

and you don't get it off right away. If you're not sure, talk to your doctor. All of these diseases are pretty easily prevented very, very quickly with antibiotics except for this MMA mammalian meat allergy because it is not a autoimmune condition like Lyme disease is not due to a bacteria like Lyme disease is. So antibiotics are not going to help. All you can do is be a better person and stop eating meat.

Okay, that was a little bit of a poke. So obviously on this podcast, the opinion here is mine. It is not meant to replace the advice of your veterinarian or since I mostly spoke about human diseases, it certainly is not here to replace the advice of your physician. Although according to Cosmo Kramer, veterinarians are way better than doctors and I will leave it at that. Thanks for listening.

Stay tuned for more episodes of Vet Life with Dr. Cliff. Please send in your comments. I'll probably get some that are going to be a little bit more spicy and with attitude. That's fine. Bring it on. I don't care. I'll read them on the next episode. And of course, as always, be kind to animals, be kind to others, and be kind to yourself. Take care.