Why don’t you DO something?

You’re familiar with the phrase, "a double-edged sword", as in something that cuts both ways.  That sounds like a good thing, but is usually used to indicate something whose desirable effects may be offset by other effects you don’t want.  Somehow "double-edged sword" has edged out "back-firing blunderbuss" (which I believe more accurately conveys the intended idea).  I guess "double-edged sword"  doesn’t sound as dumb as "back-firing blunderbuss".

When one of my clients is super-observant of their pet’s behavior, it’s a double-edged sword.  On the one hand, they pick up problems very early in the course of the disease.  This should make it easier to effect a cure, as the animal has suffered minimal damage and his body will be better able to respond to treatment.  On the other hand, these people notice when the dog "just isn’t right" but doesn’t yet have any specific signs and symptoms.   You really want to pat them on the back for being so attuned to their pet’s health.  On the other hand, "just isn’t right" doesn’t narrow the problem down much.  When you can’t tell what’s wrong with the pet, what do you do?

This evening we looked at Radar, the Boston Terrier.  He’s still eating, looks great, no fever, absolutely nothing out of the ordinary on his physical examination.  He’s not vomiting, stools are okay, no straining, no sensitivity or other indication of pain.  He’s just "not right".  So, whaddayagonnado?

For me, that depends on several things. First of all, how "not right" is he?  If his problem is virtually undetectable, then I have no rational basis for giving him any medicine.  What about diagnostic tests?  With no specific signs of disease, there’s no way to narrow it down, so you’d just be running a huge battery of tests hoping to find something.  Again, hard to justify with somebody who may just be having a bad day because of a change in the weather.  In a case like this, if the owner doesn’t have to drive too far, I feel the best course is to just observe him overnight.

If the pet is really pretty sluggish and depressed, I’d push harder for some diagnostic testing, at least a complete blood count and blood chemistry panel.  With the pet whose condition is more subtle, there may not even be measurable changes in the blood yet.

Many of my clients have a thirty-minute drive or longer.  It’s not so easy for them to take off work again tomorrow or the next day if the pet needs to be re-evaluated.   If he’s better in the morning, it’s a non-issue.  If he’s worse, that’s a problem, particularly if his signs are still non-specific.

I believe that this is why veterinarians (and M.D.s) over-prescribe antibiotics.  The client wants you to "do something" and, hey, it might be an infection, and the antibiotics are unlikely to make him worse.  Unfortunately, if it is an infection, and the antibiotic is not appropriate, it may give you spurious results should you need to culture the problem (culture = take  a sample from the problem area and try to grow the bacteria living there.  If successful, you grow them again and test their ability to survive various antibiotics.  It’s how you pick the right drug for sure, instead of just hoping you get lucky.)

Your dilemma is that you know you should wait and avoid subjecting the animal to unnecessary (or inappropriate) treatment.  BUT if you wait and he’s worse, why didn’t you do something?

That’s where the art of practicing medicine comes in.  More importantly, it’s why your relationship with the client requires good communication and trust.  "Doing something" too soon is not always the best thing to do.

Leave a Reply

Your email address will not be published.