I'm complaining a little and, for those in the medical field who practice good quality medicine, this is not directed at you. We had it pounded into our heads about the importance of not creating resistance in bacteria by overuse or injudicious use of antibiotics. There are several issues in veterinary medicine regarding whether we should be allowed to use particular antibiotics in specific instances or, sometimes, if we should have access to the medications at all. It scares me that the people who are attempting to make these decisions are often not even medically trained...
There I go on a bit of a tangent again but it is necessary for the story I'm about to relate so that y'all understand why I'm frustrated. It was thrown in our face (and continues to be) that veterinarians are the reason for bacterial resistance to antibiotics. Of course the human medical field has no hand in the problem; it is all our fault.
Yesterday, I had a dog come back in that I had performed an enucleation on last week due to a tumor of its globe. A portion of the lid had dehisced and I was concerned about lacrimal / secretory tissue maybe having been missed because that particular enucleation is currently in my chronicles as the bloodiest I have as yet performed (and I've done quite a few!) I'm sure it was because of the tumor but I was concerned at the time about remaining tissue simply because of the sheer volume of hemorrhage. I explored the socket and determined there was no remaining tissue that shouldn't be there but that the dog likely had an allergic reaction to the suture I had used, based on the tissue appearance. I re-sutured the eye with a different suture type and called the owner after the dog was awake to let them know what I had found. That was when the owner started complaining because "he had spoken with a human doctor friend who said that we should have put the dog on antibiotics because they always did."
Just to compare notes: when y'all go to the doctor for a mild cold, do they always run a CBC? How often do they perform a culture and sensitivity? And how often do you go home with a Z-pack regardless if it is really needed? Except in the case where the globe is abscessed or the animal has evidence of a systemic infection, why would you place an enucleation on antibiotics? For crying out loud, the eye (face) has such a wonderful blood supply it just begs to heal itself; almost as much as the mouth or the rear end or the bladder...
But, don't forget, veterinarians alone are responsible for multi-drug resistance in bacteria.
No, I did not put the dog on antibiotics. And yes, I do readily admit that some of our older colleagues who have not stayed on top of newer information do overuse antibiotics. I just find it frustrating that we get that bum rap then get advice from a human doctor on how to manage our cases. I don't even know if the human doctor he spoke with is an ophthalmologist. Maybe next time I go to the doctor I'll suggest how they should handle my case based on my experiences with multi-species...
4 years ago
3 comments:
Remember, it's way easier getting into med school than vet school.
If you perform a sterile surgery, no antibiotics should be needed until the animal or the owner is an idiot and causes the incision site to become contaminated (ie: no e-collar so the dog licks the incision to pieces). I, truthfully, really try to fight giving antibiotics to herpes cats who only have a mild sneeze and clear ocular discharge with no ulcers and no nasal drainage or sinus congestion. Give the owners lysine if they want something to do. I've had cats that get over that nonsense in a day or two without complication. If it worsens, they can call and I'll call them in a script somewhere. Kinda flies in the face of the z-pack for a cold, doesn't it? A lot of the time I think people just want something to do. Other than an e-collar, of course.
On the other side of the coin, though, I routinely prescribe antibiotics to cats with suspected UTIs. Now, of course we all know, not all of them are truly infections. But how do you weed out which are and which aren't when the owner's refuse to culture? And it's the cat that suffers, unfortunately. Same for skin issues: I don't routinely culture until 2 of my top choice antibiotics have failed. In these cases, yes I add to mdr but I doubt it's any worse than most MDs.
One of my human physician friends once explained, earnestly, to my husband that horses have a high rate of MRSA infection as a result of horses' exposure to cattle and other food animals, because veterinarians overuse antibiotics in food animals. That's when I pointed out that most of the horses in my practice have never in their lives seen a cow, or any other food animal. Then my husband changed the topic.
Breathtaking arrogance and ignorance - that's human medicine.
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