Friday, August 15, 2014

Barriers to diagnosis and treatment of infection in veterinary practice

On the whole, human patients don't tend to lick their own wounds...so they can avoid the Elizabethan collar. (For those wanting to know, it was easy to get on and very hard to get off!)

This week I’ve been industriously working on a presentation for infectious disease physicians and scientists at Concord Hospital about infections seen in veterinary general practice. It’s a great reminder of the many similarities between human and animal patients – as well as the differences.

When you look at the barriers to appropriate diagnosis and treatment of infection, there are some interesting comparisons. We have a great human medical system in Australia (under constant threat from politicians), but on the whole it means that many expenses are covered by Medicare.

There is no equivalent system for pets. Thus, unless the owner takes out private pet insurance, they bear the full costs for all diagnostic tests as well as treatment. There are also unique challenges in transporting animals to the vet – getting a cat into a carrier is not the easiest, transporting a vomiting or bleeding animal in a car can be a concern for many people, and carrying large or scared animals with injuries can be hard (though I am sure parents of human offspring struggle with similar challenges!). There is the issue of compliance – not all animals will take their medication readily, especially, it seems, feisty cats and territorial Chihuahuas (I can say this comfortably as Phil is – at last in spirit – a Chihuahua, and is tricky to medicate).

There is a temptation of some owners to attempt self-diagnosis (I’m a big fan of the internet but like any tool it can be used to help or harm) and often some (commonly doctors!) who use human medication on animals without consulting a vet. This can have disastrous results as animals metabolise drugs differently, so even over-the-counter drugs that are relatively safe for humans to take can be highly toxic and potentially fatal to pets.

Other challenges in appropriate diagnosis and treatment of infection in animals are the amount of diagnostic work up people consider reasonable. It costs the same amount of money to culture or biopsy tissue from a budgie or a large dog, but for some people the fact that they paid $5 for the budgie limits their willingness to work up the problem. Often the costs of Government-funded diagnostic tests are not even known by human patients.

In human medicine, because rechecks are often funded by the Government, patients are more likely to return to confirm clearance of infection – whereas this is less common in veterinary patients. And then we have the issue of the vast un-owned animal population – strays, semi-owned pets and wildlife.

Finally, there are some tests available in humans that we don’t yet have validated and available for animals.

Add to that the fact that our patients don’t tend to give verbal histories, spend much of their time un-observed, lick their own wounds, may require general anaesthesia just to get a diagnostic sample, may be asymptomatic carriers of zoonotic diseases, cannot consent to treatment, cannot pay their own vet bills and have no say about their own interests (i.e. a proxy – who cannot speak their language – makes all treatment decisions for them including those regarding euthanasia) – and you see how it can be sometimes tricky.

Nonetheless, overall veterinarians do a pretty good job at diagnosing and treating the majority of infections seen in practice. I am looking forward to hearing more about the challenges human doctors have around infection control and treatment.

For our conservation-minded readers, the Australian Museum is hosting a night talk by Dr Richard Major about efforts to conserve the White-fronted Chat, Epthianura albifrons. This tiny honeyeater was once all over Sydney, but now only found in two isolated patches of saltmarsh – completely surrounded by urban and industrial development. Among other things Dr Major and colleagues have been trialling cages to help protect their nests from predators. For bookings click here.

(On a non-directly animal-related topic, they’re also hosting a fascinating talk on the psychology of aging with Professor Henry Brodaty AO MBBS MD DSc FRACP FRANZCP – a psychogeriatrician whose qualifications and academic posts would take up this whole website. We see dementia-like signs in dogs and cats – although some of these are caused by systemic disease such as kidney failure. What is interesting in the aged-care field is the growing evidence that lifestyle and health activities can reduce the risk of age-related cognitive decline, Alzheimers etc, as well as improve mood, heart function, bones and strength. For more info, click here.

And Mick sent this link to photos of homeless people and their dogs. Don't forget to enter our Shark Girl  DVD giveaway.

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