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Vet Talk

Along the Treatment Highway
November 13, 2017 (published)

Treatment Highway

Art by Tamara Rees of VIN

The notion of a “cure” is frequently overrated and often over-anticipated considering how few cures actually exist. It’s no one’s fault. Headlines - both legitimate and click-bait - are full of “cures for cancer,” “cures for autism,” “cures for Alzheimers” and more…

More often than not, if you read the article you’ll find that the author is really talking about a treatment for a disease rather than a cure. Well, except for those articles that think random spices fix everything.

So what’s the difference? Let’s think of the progression of life with a disease as a journey.

The Cure Expressway is the highway detour that's just a hop off and then back on the same highway. You may have to run on the outer road for a bit while (laid up with a broken leg) or you may just go down the off ramp and right back up the on ramp (eye drops for pinkeye); you probably don't even lose sight of the highway before you're cruising along again.

Treat and Manage Highway is the detour that takes you way off the highway, often on slower back roads that add miles to your trip and are full of potholes and extra stop lights. Some treatments are better at paving over potholes than others. You may or may not make it to your destination before you run completely out of gas, but you never make it back to the original highway.

You’re more likely to get a pass for the Cure Expressway if you have a bacterial disease like strep throat, or something surgically fixable like a cut or broken bone or appendicitis.

For most other conditions, you’re diverted onto the Treat and Manage Highway. This is a much longer road, and it never brings you back to the original route. Once on the Treat and Manage highway, you’re on a different journey altogether.

I think it’s human nature to want the Cure Expressway for everything. After all, who doesn’t want the scenic, smooth, hassle-free route through life? But expecting a cure from every medication or surgery is a fast-set up for disappointment and miscommunication.

Think of arthritis. Both humans and animals get it; many of us (furry and non) take medications for it. If we look at the summer-Frisbee-by-the-lake/ frolicking-through flowers advertisements on television, we’d assume that 1) You can use the same medication for arthritis, depression, ulcers, and sexual dysfunction (seriously, have you noticed how all pharmaceutical ads have the same people and same backdrops?) and 2) that you pop a pill and life is back to normal – All Fixed! Cured!

But arthritis (inflammation of the joints) is called something else in the medical world – degenerative joint disease (DJD). Notice the first word. Degenerative. As in, it degenerates. As in it’s bad and it’s gonna get worse. Is there anything in the word “degenerative” that makes you think that you or your pet can take a month’s worth of pills and be an adolescent again? I hope not.

We don’t cure arthritis. We treat and manage it. We use medications to reduce pain and inflammation. We may do surgery to remove bone spurs and damaged cartilage. We recommend exercise to promote circulation and increase the quality of the joint fluid as well as to enhance weight loss. We inject joints with steroids or proteins that increase joint fluid (lubrication) quality. But arthritic joints will never again be young and shiny. And over time, they will get worse. Treatments aren’t aimed so much at making it all better as they are at reducing pain and slowing damage, regardless of what the TV ads are trying to tell you.

Allergies are another area where we all really want an on-ramp to the Cure Expressway.

I’m always surprised at how many humans, sniffling and sneezing their way through spring, expect a single shot to cure their dog’s itchy butt or horse’s hives. Most people have learned to accept human allergies as an ongoing thing. Those who suffer stand by every season with inhalers, antihistamines, and air purifiers at the ready, as well as avoiding long walks in the knee deep grass growing along the Road of Life.

Yet weirdly (at least to me), this knowledge doesn’t translate to our expectations for animal allergies. People who are allergic to ragweed or mold know that no pill in the world is strong enough overcome a romp through the field or trek through a humid cave. And most people seem to grasp that it only takes one bee sting to be a problem for someone who is allergic to bees and that bee avoidance is the key. But it’s surprisingly hard to understand when these same people do not grasp why flea control is critical to managing a dog’s flea allergy, or why the horse with fly allergies is *still* itchy in the summer.

Allergies, while common, are a long, winding journey down the Treat and Manage Highway. An animal with allergies is typically allergic to more than one thing. We can treat the body’s whacked out immune response to the allergen with medications that lower the effects of the immunological freak out, and we can occasionally train the immune system not to panic by slowly desensitizing it to the allergens (e.g. allergy shots). We can also manage the animal by keeping away from the allergens (think flea prevention). But for the most part, the immune system isn’t any more likely to quit declaring pollen or fleas to be dangerous invaders than your dog is to spontaneously quit barking at squirrels. Unfortunately for all allergy sufferers, the on-ramp from allergies to the Cure Expressway is perpetually under construction!

As you walk down the Road of Life, enjoying the sunrises and sunsets, keep in mind that when your veterinarian sends you home with pain pills for your dog’s arthritis or gives you a list of things to help your itchy horse, know that you’re likely to be doing these things for a long time to come, that your pet is now on the Treat and Manage Highway and you are there driving him.

As a medical practitioner and fellow allergy sufferer with creaky knees, I can tell you, no one likes the Cure Expressway more than medical practitioners. It’s easy, straightforward, and everyone is happy at the end. We will continue to look for those on-ramps to the Cure Expressway, but know that we aren’t hiding them from you. Honest.


 
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