Mrs. Smith called about Smoky. She said Smoky’s ears started acting up again like they did in 2008, and since it was the same thing she used his old medicine to start treating them again. But they aren’t getting better and she wanted to know if Smoky could be seen today. I asked when she had last put medicine in, and she told us ten days ago, then she ran out of the old drops. We scheduled Smoky for the same day.
The above is a scenario that is repeated almost daily at most veterinary clinics. It’s just human nature to see something that LOOKS the same to a pet owner, and want to treat it with the same medicine “as last time.” Of course, the approach is not limited to veterinary practices. Parents do the same thing with their children, and even themselves.
IF the condition being treated happens to actually be the same as last time, and the treatment is used appropriately, it will probably get better.
Sadly, as in Smoky’s case, having the same (or similar) appearance to the naked eye is no guarantee that the condition is actually the same. Or that the previous medication is proper.
At Smoky’s afternoon visit we performed cytology and found the reason the ears had failed to respond: the ear infection had a different cause compared to the infection five years previously.
You might be wondering why I asked the question about when medicine was last put in. With recent administration of drops the cytology might have told us nothing. Medicine has a way of masking what is seen on the microscope in cytology.
Recent medicine administration would have put us at a crossroads. In cases where the patient is not uncomfortable we might have instructed Mrs. Smith to use no medication and perform no cleanings for 7 to 10 days, then perform cytology and dispense the correct pharmaceutical.
On the other hand, if Smoky’s ears hurt, we cannot expect him to suffer for a week! We would have dispensed medicine based on the examination and on medical experience, albeit without the benefit of cytology, and we would have treated for a full therapeutic session.
Full therapeutic session is the major message in today’s post. If you feel you cannot take your pet to the veterinarian because of time restrictions, work schedule or shortage of funds, and you want to “try the same medicine again,” we simply ask that you follow the label instructions for a full course of therapy. If the label calls for twice daily treatment for three weeks, please don’t put medicine in for ten days and stop. Doing so “teaches” the infectious organisms the patient is suffering from how to outsmart the active ingredient and become resistant to it.
When resistance happens, that particular medication won’t work against that infection anymore.
The same thing occurs when we don’t give all of the oral antibiotics we were dispensed for an ailment, then use the leftovers for a subtherapeutic time period. We (or our pet) may be sick again because we didn’t kill all of the infection the first time, yet the medicine may not work when we take the “leftovers.” Even if it does, we probably don’t have enough “left over” for a full term of treatment.
See you next week, Dr. Randolph.