Dixie Lynn (formerly Mona Lisa)
In the world of human medicine it’s estimated that 80% of the maladies that prompt physician visits would completely resolve on their own with simple “benign neglect.” In other words, time is all that is needed for a cure. Does this mean that 80% of people are jumping the gun by scheduling a doctor visit? Not at all, because the physician is the one trained to discriminate which 20 percent or so need more than “watchful waiting.”
I suspect that the percentages mentioned above may be comparable in the world of veterinary medicine. Nonetheless, many vets are intent on prescribing, and many of their clients are intent on receiving unnecessary medication for situations in which watchful waiting would suffice. There seems to be a desire to give an injection and/or send home some pills, perhaps to placate the prevailing perception that clients who leave empty-handed will feel under-served.
A classic example of this “gotta do something” philosophy is the dog or cat presented for a couple days’ worth of diarrhea. The patient is completely normal otherwise, and a stool sample check is negative for parasites. In this situation it would be absolutely appropriate to recommend a bland diet, some watchful waiting, and a follow-up phone call or email with a progress report in two to three days. Instead, the client is often sent home with instruction to treat the diarrhea with prescribed medication(s), more often than not, an antibiotic. Please know that cases of canine or feline diarrhea caused by bacterial infection (salmonella, campylobacter, clostridium) are rare at best!
Guess what the number one side effect of most antibiotics happens to be? Diarrhea! (Can you sense that I am cringing as I type this?) Antibiotics are capable of disrupting normal bacterial populations within the intestinal tract which can then turn a simple case of self-resolving diarrhea into an ongoing nightmare. Antibiotics are not unique. Each and every drug a veterinarian can prescribe has the potential to cause adverse side effects. Giving medication when watchful waiting is all that is necessary defies logic as well as the important, universal, medical mantra that states, “First do no harm.”
If my clients absolutely, positively can’t stand the thought of doing nothing, I keep them busy doing something that has zero potential to negatively impact my patient. In the case of diarrhea, this can include preparing a homemade diet, keeping a written log of bowel movements, walking the dog six times daily to observe stool samples, or disinfecting the litter box twice daily. Heck, I’ve even had clients who measure and weigh their pet’s bowel movements – their idea, not mine!
This blog post is my way of encouraging you to be okay with watchful waiting (aka, benign neglect) when this is what the situation calls for. Understand the logic behind any medication your veterinarian prescribes, and avoid pressuring your vet to prescribe “something” for the sake of helping you feel more secure and comfortable. Time is a wonderful cure-all for many maladies.
Have you or your pet ever had a medical issue that benefited from watchful waiting?
If you would like to respond publicly, please visit http://www.speakingforspot.com/blog/?p=4380.
Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
If you’re a dog owner, you probably know that canine parvovirus is a very serious disease seen primarily in unvaccinated puppies and immunocompromised dogs. It is highly contagious and can be fatal. A parvo infection causes hemorrhagic gastroenteritis, which is characterized by vomiting and bloody diarrhea.
The disease is easily transmittable from one dog to another through contact with infected feces. It can also be spread by direct dog-to-dog contact, and contact with contaminated environments or people. Parvo can infect kennels, food and water bowls, collars and leashes, and the hands and clothing of people who handle sick dogs. The virus is highly environmentally stable and can remain infectious in soil for at least a year.
As with most diseases, the sooner a case of parvo is identified, the better the dog’s chances for recovery. In fact, survival can depend on how quickly and accurately the virus is diagnosed.
According to Richard Oberst, professor of diagnostic medicine and director of the Molecular Diagnostic Laboratory in the Kansas State Veterinary Diagnostic Laboratory, many tests currently available can’t detect the newer strains of parvovirus 2c, which has lead to false negative results in infected dogs.
The 2c strain is a newer, emerging strain of canine parvovirus that was first detected in Italy in 2000, and has also been reported in Asia, South America, and Western Europe. It was first reported in the U.S. in 2006, and is now considered the most common strain of the disease. Parvovirus strain 2b is also prevalent in this country; the 2 and 2a strains are very rarely seen.
Fortunately, a new diagnostic test developed by researchers at KSU’s Diagnostic Laboratory can now identify the 2c strain of parvo. It’s a real-time polymerase chain reaction (PCR) test that detects all strains simultaneously and points to which strain or strains might be causing the infection.
Veterinarians can send samples for testing to:
Kansas State Veterinary Diagnostic Laboratory
1800 Denison Ave.
Manhattan, KS 66506
Samples should be shipped in the same manner as all other diagnostic specimens. For more information, DVMs can contact the laboratory at 866-512-5650 or visit www.ksvdl.org.
Parvo causes similar symptoms in all infected puppies and dogs, including vomiting, severe and often bloody diarrhea, lethargy, fever, and loss of appetite. In dogs infected with the virus, dehydration is a constant concern and can occur very quickly as a result of the vomiting and diarrhea. This is especially dangerous in very young puppies.
Most deaths from parvo occur within 48 to 72 hours after the onset of symptoms, which is why it’s critical that you take your dog to a veterinarian or emergency animal hospital immediately if he shows any signs of the infection.
There is no specific anti-viral therapy for parvovirus 2c (or any of the other strains). Treatment of an infected dog consists of immediate delivery of supportive care, including replacing fluids and electrolytes, controlling vomiting and diarrhea, and preventing secondary infections. Since the disease is so contagious, affected dogs should be isolated to minimize spread of infection.
The goal of treatment of parvovirus involves supporting your dog’s organs and body systems until her immune response can conquer the infection. There are some homeopathic and herbal remedies that can be useful in treating the symptoms of parvo. I recommend you work with a holistic veterinarian to determine what natural therapies are advisable for your sick pet, and consider hospitalization until your dog is stable.
I think you’ll agree that the best way to treat a parvo infection is to prevent it from happening in the first place. The parvovirus is nothing to fool around with. It is very much alive and thriving in our environment, and it frequently ends the lives of dogs who become infected.
Over-vaccination is an ongoing problem in the veterinary community, but in my professional opinion, providing baseline protection (two puppy vaccines) against parvo provides your pet with lifetime immunity – and provides you with peace of mind.
The protocol I follow in vaccinating puppies against parvo (the vaccine protects against all strains) is a parvo/distemper shot before 11 weeks of age (ideally at 9 weeks), and a booster at about 14 weeks. I then titer between 2 to 4 weeks after the second shot to insure the puppy was not only vaccinated, but immunized. This is a core vaccine protocol that provides the basic minimum number of vaccines to protect against life threatening illnesses, without over vaccinating.
Since the job of vaccines is to stimulate antibody production, if a puppy is exposed to parvo (or another virus for which he’s been vaccinated), he has some level of circulating protection. Vaccines stimulate antibody production, but it takes 10 to 14 days after the vaccination for adequate protection to occur.
A small percentage of dogs known as “non-responders” will not develop immunity and will remain susceptible to parvo for a lifetime. This is very important information for dog owners to have, which is another reason I titer after the second round of shots.
In addition, some puppies retain a level of immunity from their mother’s milk that interferes with the effectiveness of vaccines. Titering gives us the information we need to be confident the pup has been immunized effectively, or if he hasn’t, to determine why, and what further action should be taken.
I also always provide a homeopathic detox agent for newly vaccinated animals.