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The healing power of what?

by
01 February 2015, at 12:00am

Dr DAVID WILLIAMS continues his series with a discussion of some troublesome events and points out that ‘a temporal relationship between treatment and recovery does not necessarily imply a causative one’

’TWAS not a good start to the year. I parked my car in the leafy, treelined overflow car park of St John’s only to return and find it had been broken into.

For the grammar aficionados among you, I really don’t like using the past perfect passive here but you know what I mean! As ever, being a veterinarian’s car it was full of bits and bobs, all of which seemed to have been moved around by the intruders, but with nothing taken.

The copies of the Veterinary Record on the back seat hadn’t even been looked at (surprising, hey?!). None of my in-car CD collection (ranging from Monteverdi to the Black Eyed Peas) had been pilfered, not even my current favourite, Curtis Mayfield’s 1970 debut album with its brilliant extended version of Move On Up (join the nine million plus people who have listened at www.youtube.com/watch?v=6Z66wVo7uNw).

The numerous eyes in pots on the dashboard hadn’t even been touched. Indeed, my friends suggested that they may be the reason the perpetrators left the car without stealing anything! But what the pesky burglars had done was to knacker, if you’ll excuse the phrase, both door locks so I couldn’t secure the car.

I couldn’t find a moment in the next fortnight to get the vehicle into a garage to fit new locks so I removed the CD collection but left the eyes and the Vet Records in place.

Thanks to the thieves?

Maybe then it was not surprising that 10 days later someone had again explored the inside of the car and rearranged the contents, seeing if there was anything worth stealing. There wasn’t. But the kindly thieves seemed to have taken it upon themselves to mend the driver’s side door.

Or maybe the car had healed itself! Now I could lock the car once more! Rather unusual, I hope you’ll agree. Cars don’t generally mend themselves, while animals quite often do.

I offer an ambulatory ophthalmology referral service as well as a clinical service through the vet school at Cambridge. That can have advantages in that it allows a less expensive consultation and some CPD for the referring veterinarian seeing the case with me.

But there are some downsides as well. The operating microscope at the vet school is a great boon although much surgery can be achieved in the practices I visit with a head-mounted loupe.

As a resident at the Animal Health Trust in the 1980s I worked with Dr Keith Barnett who always used a loupe rather than an operating microscope and had excellent results with his surgeries.

Where am I heading, you ask? A recent case has some lessons for us. A dog with a deep corneal ulcer verging on rupturing needed a surgery to move a flap of peripheral cornea into the central visual axis; a corneoconjunctival transposition graft.

It’s one of my favourite surgeries when undertaken using the operating microscope, giving a beautiful, clear central cornea immediately postoperatively.

The trouble in this case was that there wasn’t enough finance to allow a referral to the vet school. So I got my operating loupe out of the car (thankfully the thieves didn’t get into the boot and steal any of my kit) and we proceeded with the surgery.

Half way through the surgery the cornea in the middle of the ulcer decided that it was time to give way. Being a surgeon when things are going well is easy. It’s when there’s a problem that the going gets tough, isn’t it?

Under the operating microscope, such an occurrence is not really an issue – easily modified magnification and excellent lighting ease the situation considerably. But a head loupe doesn’t give you either of these and makes surgery a good deal more difficult.

Battered and bruised

At the end of the surgery the eye had been repaired but it looked rather as if it had been through a couple of rounds with Joe Bugner. Joe, if you didn’t know, was a world-class boxer just when Curtis Mayfield was encouraging us to Move On Up and he used to live just down the road from the practice where this surgery took place. Maybe he still does. A week later I returned, not very hopeful of a passable result but was delighted to find the cat comfortable and seeing through the corneal graft, even though the eye was somewhat inflamed and not perfectly clear.

It was a real surprise to find that the car’s locking mechanism had healed itself, but hardly that amazing to see the eye significantly better than I had left it a week before.

We like to think that we are the healing agency in the animals we treat, don’t we? It’s our surgical skill that has saved the day, our diagnostic expertise and the modern pharmaceuticals we prescribed that led back to complete health.

We need to realise, though, that in many cases we are merely aiding the body in its natural healing processes. I first understood that when working in a small town where another vet, ageing and just about retired, lived just down the road.

People would take their ill pets to the good doctor who would, so they told me, sit them down with a cup of tea, stroke their animal and give it some love and attention before saying that in all probability all would be well.

Don’t worry, he would say, and don’t worry about paying either. And a significant number would get better on their own.

Those that didn’t then came to me, their owners aghast at the prices for the considerable work-up the animals needed for what was now a population of animals with complicated diseases that don’t get better on their own!

Is that how homoeopathy works, I wonder? When Samuel Hahnemann came up with the system of treating like with like if in a crazily diluted form, back in 1796, you have to understand the great advantage of coming under his care.

What was the alternative? The barber surgeons would bleed you to the point of anaemia while the physicians would purge you or administer treatments such as Venice treacle which consisted of a panoply of more than 50 ingredients from opium and myrrh to viper’s flesh.

No wonder giving you the equivalent of water, in true James Bond style shaken not stirred, seemed to have significant benefits in all sorts of conditions compared with standard treatments! The old advert for aspirin said “nothing works better than aspirin” and maybe treatment with nothing is still efficacious.

I must say that a number of animals that come to me have got better by the time they see me. I tell the owners that this is my distance healing ministry: the moment your animal is referred it starts getting better!

Most owners share the joke with me while one did ask how far my powers extended, since his brother had a dog with an eye problem but living in New Zealand.

I took some time to try to explain that my comment was to be taken in jest but eventually I had to tell him that I didn’t think the magic extended much further than my immediate vicinity!

But in effect, the magic is worldwide. For a significant number of animals with a substantial number of diseases will get better by themselves, with a quick shot of vitamin B12 or maybe with a course of homoeopathy.

Not a dog with parvoviral infection, you understand, nor a cat with leukaemia; not a rabbit with myxomatosis for sure unless it’s vaccinated. But an occasional slight diarrhoea, a mild conjunctivitis or a focal dermatitis might well appear to be improved by a non-specific treatment.

Ipso facto?

Just because treatment of a disease is followed by resolution of the condition does not imply a causative relation. Post hoc ergo propter hoc if you want it in Latin which makes it sound much more impressive and with a very long pedigree, although the internet tells me it was first used in 1704 – but not by whom or where. For once Wikipedia has failed me!

But whether in Latin or in English, understanding that a temporal relationship between treatment and recovery does not necessarily imply a causative one is really important for any therapy we give.

And finally, thinking of things that get better on their own, thank you to those who contacted me concerned about my ruptured supraspinatus tendon from months ago or my son Jack and his longboarding injuries from our summer holiday.

Well, as the consultant told me, my shoulder pain resolved spontaneously over six months and Jack was back to his normal self much more quickly than was his ancient dad!

I trust that 2015 doesn’t land you with similar pathology or that if it does, things resolve without the need for surgery, medicine or homoeopathy!