My last patient today, presented with such impact. I suppose my intolerance is showing. I found this circumstance so incredible, so sophomoric (sophomore means wise fool), that I confess I'm having great difficulty attempting to articulate the circumstance. If you might appreciate that I find explaining the obvious far more difficult that explaining the complex. But, yet, even though expreience tells me otherwise, I wish to attempt to save the world from itself.
This patient presented with a complaint that the dog, a young eighteen month old, had been having accidents in the house. Urinating and lately deficating with mucous on the stools on the rug. Giving credit where credit is due, this is a concerned pet owner. They have pet insurance. They adore their animals. They noticed that this particular dog had not "blown it's coat" as it should have in the fall. They noticed that this dog has a dry lack-luster hair coat that paradoxically feels somewhat greasy. Being intelligent intellectual people the wife gets on the internet and as I understand it, finds a site of a highly recommended "holistic", certified (by somebody}, highly thought of (by some other folks) Canadian expert who, over the internet diagnoses the problem and recommends three different drugs. Addmittedly, the diagnosis was tentative, i.e. it might be an allergy, or it might be skin irritation, that's the best the husband could remember. He's obviously doing a "honey do",bringing the dog to me. He's trying hard to be a man, but the little girl is very much in control.
They're pretty good patients. A urine sample has been presented along with a fecal sample. This kind of awareness is unusual. They're pretty "with it" pet owners. Careful scrutiny of the history (see Uncle Doc) reveals that this Canadian expert has prescribed a Tibitian Allergy formula, Xanthium and cortisone (but appreciate that it's natural cortisone). I have no idea what is in a Tibitian Allergy concoction or even if Tibitians, at their high altitude, even suffer allergies. I did look up Xantium, which turns out to be a Chinese herbal medicine thing that cures everything from sinus problems to poverty. But by golly, I do know about cortisone. Cortisone, in the anti-aging world, is known as the "death hormone". Don't get me wrong, I love cortisone. It is probably one of the most valuable drugs I have. But, as good as it is, you need to know that cortisone doesn't cure anything, it merely makes you feel better while you're dying and in many cases post pones your death. More to the point with this patient, patients on cortisone will want to eat a great deal more (I didn't mention that this dog had increased his body weight by almost 20%, up 14 lbs. in six months-basically gotten to be an axe handle wide), patients on cortisone will want to drink a lot more water. This "expert", had prescribed a prescription drug (natural cortisone [prednisone]) three times a day without ever seeing the patient, talking to the owner or knowing the true history. The urinanalysis on the patient revealed a specific gravity of the uring of 1.005. Almost water. This poor dog's bladder filled to over capacity with urine (water) in less than an hour because it was driven to drink bunchs of water by a pretty high dose of cortisone. With nobody home to let it out is it any surprise that she urinates on the rug? Hello!
I want to make a couple of points
1. Natural. If you made your living on Madison avenue could there possibly be a better word for you to be able to utilize and marketa product than Natural? Might you please explain to me what un-natural cortisone is? Does that mean we people made it in our laboratory? Would that suggest that instead of squeezing it out of some plant or crushing some animal's pituitary and harvesting the wet stuff from the press and that we instead discretely made a very pure chemical molecule of exactly what we desired, not having all the other plant juice or animal by-product in our final product? Does having a pure molecule make it un-natural? I guess you have to be the judge. You can tell that I'm totally underwhelmed by the natural hype. The frightening thing is the obvious perception that the word natural imparts to too many people that something is safe. This just isn't true. Nor is it true that products made or altered by man are not safe. If you're overcome by the feeling that because it is natural it has to be safe, remember that mercury is natural. Arsenic is natural. Lead is natural, an on it goes. A lot of real bad stuff is natural. Natural isn't necessarily better, nor is natural necessarily worse, but natural may have a whole lot of stuff in it that you don't want. If natrual was so good and perfect, smart people would have no reason to have messed around in their laboratories trying to make an imporvement over that natural thing.
2. Hurt I suppose this whole soliloquy is generated by sense of hurt and failure. I just quite can't understand why this owner wouldn't have called me (I don't charge for telelphone consultations) and simply asked, like one friend to another, what do you think? Why did she feel it necessary to seek "free" advice on the internet, when basically, free advice was available right here. Why was she so fool-hardy, giving her best friend a drug that would kill it, when a simple phone call would have avoided the entire risk. The sense of failure obviously stems from my career long goal of wanting my patients and owners to know, that my primary interest, my only quest is to care for the well being of their friends. Just call me. If I need to see the pet, fine, but so many issues can be simply resolved with some heart to heart talk.
3. The internet is terrific, I love it. So often I only now need to give a loving owner the name of a problem and they'll do all the research. I don't have to spend hours trying to explain it anymore. But, like all things in life, there is a down side. There is a lot of crap on the internet, too. As far as serious things go, especially medical things, you're best to only believe the stuff that comes from web sites with suffixes like xxxx.edu. (and I suppose that includes this one.)
