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“How much of that getting better is us and how much is biology resolving matters on its own?”

01 May 2020, at 8:05am

We do like to think we make a difference, don’t we? The animal comes in ill, we treat it and most of the time it gets better. And there’s the rub… I was going to say “we cure it” but in reality, how much of that getting better is us and how much is biology resolving matters on its own? Or is it just down to the healing power of time?

I did have a period working on my own – vet, nurse and receptionist all rolled into one – in a lovely little town in the middle of Lincolnshire. No names, no pack drill as they used to say but the branch practice I worked in was at one end of the town and at the other end lived the other vet, Dr Mallard (a pseudonym you understand, but as that was 20 years ago I guess he is no longer with us). He must have been 80 and if you took your pet to him he would sit you down, give you a cup of tea and a slice of cake, chat to you about your animal and its problems – and yours too – and then stroke the pet and say “I’m sure everything will be fine… there’s no charge for that.” It gave him a purpose in his retirement and of course maybe about 80 percent of the animals were indeed “cured” by his kindly attention. The 20 percent which didn’t ended up at the door of the practice where I was working and ended up feeling cheated by the prices charged for my services, with the limited arsenal of drugs I had to use. Far fewer than 80 percent resolved under my care, but I like to try and persuade myself that Dr Mallard had creamed off the ones that were on the road to recovery as he petted them and waved them goodbye.

Zip on nearly a quarter of a century and I’m not sure that much has changed. Sure, we have a lot of new wonder drugs to use and new diagnoses. We used to say that elderly ponies with shaggy haircoat had Cushing’s disease and nothing much could be done, or indeed needed to be done. Now they’ve understood the aetiopathogenesis of the condition, renamed it PPID and have a dopamine agonist that solves the problem in up to 80 percent of cases. Interesting – we’re back to four out of five cases cured. Except that with Dr Mallard it was for free while this drug will set you back a fair whack considering you’ll be giving it for the lifetime of your horse.

The main difference is that there is a load of science behind PPID – a quick PubMed search yielded a little shy of a hundred papers on the condition – while there is next to nothing on animals that self-cure. Well, that’s not quite right. Truth be told, back in 1929, Dr Stoll was examining sheep infected with Haemonchus contortus and he found that a second larval challenge to infected animals resulted in a fall in egg production and expulsion of the parasitising worms. Self-cure he named it, and that was way before the development of today’s effective anti-parasiticides. But it’s not the same as pets naturally getting better on their own, is it?

What got me onto this topic in the first place? Well, in these COVID-19 times, there are genuine emergencies for sure. The perforated ulcer won’t generally heal itself (though never say never!) and the thorn stuck through the cornea works its way further in more often than it comes out without surgery. But a lot of other cases that I would have had in within an instant previously do seem to resolve well with some advice over the phone. Oh dear – here I am doing myself out of a job. Maybe I have something to learn from Dr Mallard after all!

Associate Lecturer, Veterinary Ophthalmology at St John's College, University of Cambridge

David Williams, MA, VetMB, PhD, CertVOphthal, CertWEL, FHEA, FRCVS, graduated from Cambridge in 1988 and has worked in veterinary ophthalmology at the Animal Health Trust. He gained his Certificate in Veterinary Ophthalmology before undertaking a PhD at the RVC. David now teaches at St John’s College, Cambridge.

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