Just what was I suffering from? - Veterinary Practice
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Just what was I suffering from?

Dr David Williams, having experienced some sharp pain recently explains that much of the joy of practice is dealing with different species, recognising what is wrong and then responding to it.

I’VE done something to my right shoulder. Well to be more specific I’ve given myself a partial rupture of my supraspinatus tendon.

It’s amazing how a tiny lesion in a small tendon can give such widespread results. I woke one morning with pain all across my upper chest even down to my fingertips.

Not cardiac in origin I reasoned; I was able to get up and move around and it resolved somewhat with an oral non-steroidal. But maybe it was a connective tissue disorder like rheumatoid arthritis or Wegener’s granulomatosis?

I had been dealing with a cat with toxoplasmosis the week before. Perhaps I had toxoplasmosis? Maybe I was having an acute attack of hypochrondriasis?!

I had an appointment with my GP some days later. Simon knows me well so he asked me for my differential diagnosis list and then sent me straight downstairs to the vampire nurse. Before taking any blood she asked me whether I was pregnant! I wasn’t expecting that but she explained that only expectant mums get toxo screens in her experience.

Everything came back negative (even the pregnancy test!) but I still had the pain. A referral to the local hospital would have taken weeks but luckily in the same village where I live the rheumatologist for the UK Olympics team has a private clinic.

Politically I’m generally against private health care but when the pain is that bad even my strongest views tend to wane somewhat! A consultation was arranged for later in the week.

A minute or two with wonderful Professor Speed (what a great name for a top sports doctor, hey?!) and a quick swipe of her ultrasound probe showed that the problems all resulted from this obvious tendon rupture.

Maybe the wrestling match I had trying to examine a French Mastiff the day before was to blame?

So what was the plan of action? I could have some physio; I could have a steroid injection; I could leave it to resolve itself in a few months. But could I stand a few months with that pain?

Actually, most of the pain had gone the moment I knew what the problem was. Once I realised it was not a long-term systemic disease I was quite happy to cope with a twinge of discomfort. The level of pain had gone down from maybe a 7-8 out of 10 to a 3-4. All in the space of one 20-minute consultation. That was worth the £250 for sure!

Pain on both hands

Here was a good example of how pain is on the one hand a physiological reaction to a nociceptive stimulus but on the other hand an emotional response to that issue.

As the International Association for the Study of Pain notes, pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. Sensory and emotional indeed.

For me, much of the pain was the worry that it signalled a major systemic disease. Once it was only a local musculoskeletal strain, all the concern had gone even if the ache was still there. Some of you may have chronic aches which are life-changing and of course I don’t want to suggest that physical pain is always only a minor inconvenience. And if a year down the line I’m still having grumbling aches or sharp stabbing pains I may have quite a different view of things.

But being a painful patient started me thinking of my own patients and their pain. How does what we feel as humans in pain fit in with something like lameness in cattle?

A dairy cow may hobble along with an arched back but is she actually emotionally affected?

A fish caught on a line writhes and thrashes before it is unhooked and thrown back into the river but is it emotionally scarred?

How much does pain in a dog with hip arthritis actually mean to the animal?

The fact that lameness in cattle reduces milk production and fertility suggests that it is having a significant effect and careful work by Lynn Sneddon and Victoria Braithwaite showed that pain changed fish behaviour.

James Rose from the University of Wyoming criticised their studies saying that without a neocortex fish cannot have an emotional response to pain. But Professor Nicky  Clayton’s work on cognitive skills in birds  has shown that an apparent difference in neuroanatomy does not have to signal a corresponding deficit in cognition. The same may well be true in fish.

Now we might find it difficult to empathise with a cow or a fish, but  as Professor Pat Bateson noted in his report following the Pedigree Dogs Exposed TV programme, “Many people simply know what it is like to be a dog.”

Animal empathy

Dog owners who have for years worked and played with their canine companion know instinctively what he means. We know when our pet is happy or sad or tired or ready for a walk: it’s a case of learning to read the signs for us just as it is for them. But many scientists would beg to differ: how can one know what it is to be a completely different species?

The philosopher Thomas Nagel’s 1974 paper “What is it like to be a bat?” argues that conscious experience is a brain function that is widespread across animal species, particularly in mammals even when sensory input may be quite different. Descartes, centuries before, had disagreed in the strongest terms.

The only thing one can be sure of, he said, is one’s own thoughts: Cogito ergo sum, or if you prefer it in Descartes’ native French (which I certainly do!) Je pense, donc je suis – “I think therefore I am.”

The only problem with that is if you consider that animals don’t think – don’t have the same cognitive abilities as we do – then philosophically they don’t exist as meaningful players in an ethical framework: “I don’t think,  therefore I am not!”

Perhaps that is what allowed Descartes to experiment on live dogs, considering that their howls were the grinding of the cogs in the machine. Descartes was a dyed-in-the-wool subjectivist. Objectivism on the other hand would say that we can indeed have some idea of what it might be like to be another individual, even another species.

We can attempt to lay our thoughts onto those of another. It takes a bit of communication, whether between husband and wife or sheepdog and shepherd, and while neither can know the other’s mind completely, they can have at least a working understanding of how the other is functioning.

One would have to be remarkably callous not to be able to empathise with a dog howling in agony caught in a gin trap, or so you might think.

But these two disparate ideas are theories, not really based on hard-core evidence.

Bateson has had a lifetime not just of studying animal behaviour academically, ending up as the professor of ethology at Cambridge, but also in keeping and breeding animals. Living with an individual, even of another species, living alongside them, sharing time together, does give an instinctive understanding of how that animal responds to events and interacts with others.

Different responses

The trouble is that different species do respond quite differently: a rabbit in pain acts in a diametrically opposed way to a dog in pain but let us not think that one species feels pain while another does not. We just have to be aware of how these different pain responses manifest.

Professor Paul Flecknell and colleagues have shown that rabbits have facial features of pain – a grimace score – just in the same way that years ago neonates, who were thought not to experience pain as adults do, were shown to have subtle, or not so subtle, facial features of pain.

The more species that are investigated, from sheep to sh, the more are found to have these pain-related changes in appearance quite as much as behaviour.

Part of the joy of veterinary medicine is working with all these diverse species and learning to deal with each of them whether in pleasure (that’s a subject for a whole column on its own) or in pain, recognise that emotion and respond to it.

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