Patient vs The Disease

For the majority of my professional career as a veterinarian, I have treated the disease that presents to me instead of the patient. Not only is this philosophy drilled into our heads as students of medicine, but it is also presented to us at educational courses that we may pursue. Let me explain a little further. Let's say we have a patient present with chronic ear infections or maybe even recurrent urinary tract infections. The majority of practitioners would elect to treat the problem at hand using topical antibiotic solutions in the ears or oral antibiotics for the case of a urinary tract infection. This is all good and the proper thing to do but we have to also ask ourselves as to why this problem keeps recurring. What is it in the patient that makes them susceptible to these problems? Is is an immune based problem? Is it a malformation or defect of some sort that is predisposing the patient to these problems? The bottom line is that there has to be a variable somewhere that is contributing to the problem. Take for instance a day care full of toddlers. What makes some of them more prone to ear infections and upper respiratory problems while others are rarely affected? Is it the diet, something in the environment, a toxin? What is it? That is the ultimate question and one that in many instances is never answered, but none the less a question that needs to be asked in any instance of a recurring health condition. This question needs to be asked as well of the more serious medical conditions such as diabetes, arthritis, back issues and even cancer. I have to applaud the human medical community lately as there is more information regarding proper diet and the impact on health, but that information is not enough. We, as medical professionals, need to enforce this information and educate our patients. Diabetes is not cured by the administration of insulin...it is controlled. Cancer is not cured by radiation or chemotherapy...it is controlled. The problems do not go away and in many instances continue to burn like small embers in the background, waiting for an opportunity to flare back up. Only by finding the flaw, per se, that allowed the disease to get a foot hold, will we then be able to "cure" the disease. A simple story that will convey this message is as follows. As a veterinary student on a farm call with a local practitioner, we were called to examine a colicky horse. The veterinarian examined the animal and was unable to find a cause of the pain. He then administered a pain medication called Banamine. The horse responded and resumed eating. I inquired as to what the problem was with the horse and the veterinarian responded that he had a Banamine deficiency. I honestly think he believed this to be true. The medication resolved the acute problem at hand, but we didn't dig deeper to find the cause, which might have been able to be corrected to prevent future problems.

Food for thought from Nouvelle Veterinary

Tom Schell, D.V.M.