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| 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.
