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When the Patient is an Animal Caregiver

    • 146 posts
    December 16, 2017 12:20 PM EST

    This past week the New York Times featured an article titled "The Patient Was a Veterinarian. Could His Illness Be Related to Animals?" It was written by Lisa Sanders, M.D. who also authored ‘‘Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis.’’

    This article tells the story of a middle-aged veterinarian who developed a prolonged illness. The author writes "he’d been sick for nearly three months. It started with an infected tooth and swollen glands. Two rounds of antibiotics hadn’t helped." The patient ultimately became angry and frustrated and wrote to his doctor stating "he’d been suffering for months, and no one seemed to care." This article sheds light on the fact that veterinarians are at risk for contracting a zoonotic disease and, as importantly, that a patient can have as many diseases as he or she pleases. The patient had an infected tooth that was initially addressed. But he had also contracted an infectious disease in the course of his work with animals, and that was the cause for his protracted illness.

    Last year VetVine hosted a webinar presented by Dr. Ed Breitschwerdt on Tick Borne Infectious Diseases in North America. In that presentation he spoke briefly of the risk of humans to some of these diseases. I had the priviledge of hearing Dr. Breitschwerdt speak again this past summer when he was honored by the AKC Canine Health Foundation for his work in the area of infectious diseases and awarded the 2017 Asa Mays DVM Award for Excellence in Canine Health Research. He was a keynote speaker at this conference and his talk was all about Bartonellosis and "Tumbleweed: The Dog that Changed My Career, Life, and Research Direction." It was an outstanding presentation and highlighted the very real potential for humans to contract disease from the animals they work on, handle, and live with. His talk was not only informative and eye-opening about Bartonella, but it also struck a chord with me. 

    There's a lot of talk these days about the need for collaboration between physicians, veterinarians, and other scientists in order to achieve the best health for people, animals, and our environment.  This has been termed "One Health." The CDC states "the One Health concept recognizes that the health of people is connected to the health of animals and the environment." They go on to say that "6 out of every 10 infectious diseases in humans are spread from animals." That's really quite astounding when you think about it. What's more astounding and disappointing are the numerous stories of patients - like the one told in the New York Times article or the examples cited by Dr. Breitschwerdt of veterinary professionals becoming infected with Bartonellosis. Patients for whom it took months if not years to be correctly diagnosed, all because of the short-sightedness of their treating physicians.  And that - in spite of their patient's "signalment" which included their occupation or history of working or living with animals - an infectious, zoonotic disease was an afterthought or wasn't even on the list of differential diagnoses and explored. In many cases, the honus fell on the patients themselves to keep pushing to find the reason or an explanation for their chronic illness. 

    As one who is a veterinarian and under the care of physicians for a chronic illness, I have certainly encountered similar frustrations. And it's so hard to believe in this day and age of "One Health" talk and all of the information that's out there. I recently made a request of one of my doctors to participate as the requesting physician for a certain blood test - one that was reasonable to request given my health issues and new evidence-based information that supports its utility in my care. I explained what the test was, why I thought I should be tested, and forwarded him information from the testing laboratory and other resources so that he would understand the basis of my request. His response was ... "in the business of medicine it's not the patient who tells the doctor what tests to run ... the doctor decides based on their assessment of the patient." He recommended that I see another doctor. I was shocked by his dismissiveness. But herein is an issue that I believe is way more pervasive than not.