Drugs
Drugs - or pharmaceuticals; to distinguish them from the illegal, mood altering substances used by humans are viewed with a somewhat paradoxical mixture of fear and necessity by some of the owners of animals that I see. On the one hand antibiotics are requested as if they should be available "off the shelf" and on the other hand long term use of steroids, for example, are viewed with some suspicion.
One of my pharmacology textbooks has a quote at the beginning: "All drugs are poisons". This is an ideal starting point for the Clinician. I think the interpretation is somewhat different "all drugs have an upside and a downside". The secret is to maximise the upside and minimise the downside.
There are many historic examples of drugs side effects, thalidomide is probably the most notorious, although the effects of Viagra were discovered whilst searching for a new heart drug!
Sometimes the side effects are related to the individual rather than the general use of the drug. Steroids are used a great deal in human and animal medicine. (These are the corticosteroids not the anabolics implicated in athletics and bodybuilding). Every now and then an animal given steroids has a marked increase in thirst and appetite despite the normal dose. There is nothing to predict this simply making a note to ensure that a low dose is given in the future. Veterinary Surgeons are taught to use steroids as sparingly as possible. We had a patient "Oscar" a miniature dachshund who suffered from a gastro-intestinal condition that caused chronic intermittent diarrhoea. A great deal of time and money was spent investigating the condition: exclusion diets, blood tests, x-rays and biopsies. The owner tried homeopathy, herbal remedies and ended up spending more time cooking for Oscar than her family. After 9 months and a particularly bad bout of diarrhoea I suggested Oscar had to go onto steroids. We had a long discussion about side-effects but the owner felt Oscar suffered so badly when his tummy was upset that she would try anything. Oscar was cured instantly! Well, I do not think he was cured but at last he had some relief and could eat relatively ordinary prescription diet. We see Oscar every 3 months and adjust his dosage as required. Some weeks he needs the full dose but others he can miss days and only have half doses. Sometimes long-term drug usage is simply the best option.
Arthritis is another condition commonly treated by long-term drug therapy. We sent a Labrador Cross home from the Shelter with advice that he had mild arthritis of one of his elbows. Max only weighed 24kg and was not lame or showing any signs of discomfort. Six months later he came back to the Shelter lame. Now he weighed 32kg - he had 'put on' a stone! After a gentle ticking off and some treatment Max lost weight and his lameness disappeared.
Drugs are vital. We could nor work without them but it is important to remember good management can nearly always modify their use.