Archives for posts with tag: parasite

As House M.D. ends its eighth and final season I wanted to say thank you to the show for a number of things as they relate to my professional world and give it a (little) bit of a hard time for couple of others. I should make perfectly clear that I am a huge fan and that apart from a couple of minor missteps the show has been amazing television. I apologize for any spoilers!

Parasites and Zoonosis

I freely admit that I do not watch a lot of hospital shows. Apart from the odd episode of ER, House is really the only medical show I have had much time for. But House, as far as I’m aware, has had more than its fair share of parasites. From a veterinary perspective this is amazingly refreshing. As someone who seems to spend their life talking about zooanosis to doctors, staff, and the public, it is great to see some worse case scenarios played out in fiction, with a grounding in scientific fact.

Any one remember the episode with the giant tapeworm? I bet if you’ve seen the episode and your pet(s) have ever had tapeworms you won’t soon forget it. Or there is the episode autistic boy with roundworms, the team members infected with Naegleria fowleri, the homeless woman with Rabies, or the woman who catches Bubonic Plauge from her pet dog. Admittedly these are all extreme cases, but the mere fact that they are on television in some ways is a minor miracle considering that most people do not even want to talk about parasites and zoonosis.

So thank you Dr. House for spreading the word about zoonosis and parasites. Every little helps!

The Diagnostic Process

One of the great gifts that House M.D. gave the veterinary, and probably the wider medical community at large, was giving the public a greater understanding of the diagnostic process. Admittedly, House’s methods are often very unsound, but that fact the he and his team regularly are a loss for what is going on is extremely refreshing. We all in the veterinary profession have heard the complaints:

“Why do you have to do that Parvo test?”
“Why do you need that bloodwork?”
“You did that expensive bloodwork and there is nothing wrong!”

Even a casual viewing of House M.D. shows what is supposed to be one of the world’s foremost diagnosticians performing tests that come out negative and going down blind alleys searching for an elusive diagnosis. By bring the diagnostic process into the living room, House has helped acquaint the public with the idea that a certain level of trial and error are to be expected in any evidence based search for answers.

On more than one occasion I have used the show to help explain to a frustrated client why it took three separate diagnostic tools or lab tests to get diagnosis and why we couldn’t just immediately go to the correct one. So thank you Dr. House for helping to shed light on the diagnostic process!

Superstar Bad Behavior

I went into at some length in a post a couple of months back about what I call “The Steve Jobs Effect.” This is this the phenomena of some doctors, and other professionals, feeling that because they are so good at what they do, it excuses almost any level of behavior. Now House M.D. is very much fiction and levels to which the character of House delves would lead to his dismissal by pretty much any employer – never mind at a medical facility. The sarcasm, plain offensive behavior, and even harrasment, does make for great television, but, although it rarely reaches the epic proportions of House – it does happen in real world.

So not so much thanks, Dr. House, for reenforcing the stereo type that great skill can excuse bad behavior!

The Cuddy Episode

Every now and again on a long running T.V. show the writers shake things up by imagining the world they have created from a different perspective. On the show House M.D. this took the form of a very underrated episode from the perspective of Dr. Lisa Cuddy, the Dean of Medicine (Hospital Administrator to you and I).

The episode (5 – 9), shows the administrator doing very administrator type things – facing off with a vendor, placating the Board, dealing with major H.R. headaches (being short staffed and theft). The episode also deals with the thorny issue of billing and a patient who does not feel they should pay their bill (sound familiar). It is great to see these challenges, admittedly extremely exaggerated for added drama, and that these types of issues as just as much the part of running a medical facility as what the viewers watch Dr. House do every week.

I do have a problem with the episode however. After doing a great job of explaining to a patient why their bill is fair, the episode ends with Dr. Cuddy ripping up the patient’s check. I understand that it is supposed to show how kind-hearted the star of the episode is, but it undermines everything she states earlier in the episode. I also don’t buy that the character would do this.

So thank you Dr. House, sort of, for a great episode showing the role of administrators everywhere.

I, like a lot of people, am going to miss House M.D. But I am grateful that we’ve been able to have eight great seasons of television, and even more grateful that an intelligent show has shown some of the issues that I personally and professionally care about. So long Dr. House, for all your faults, we’ll still really miss you.

Since it seems like everyone wants to talk about heartworms in an effort to sell you something, but is rare to hear anything new, it was really refreshing to really be scared by some of the statistics and language being used by the experts.

I was recently the guest of Novartis, the makers of Interceptor Heartworm prevention, at a small two day meeting in Tucson, on parasite control. Speaking were Dr. Noble Jackson from the University of Arizona (U of A) and Dr. Bowman of the Companion Animal Parasite Council (CAP-C).

Dr. Jackson has been looking at heartworm levels in the Coyote population in Arizona and the data is quite startling for those who believe that heartworm does not exist in Arizona. In Pinal County, which Includes Casa Grande where I live, the infection rate Dr. Jackson has seen is 34%. In Cochise county, that includes Sierra Vista where I used to live, the infection rate is 11%.

Now Dr. Jackson’s work is not finished or published yet, and the sample sizes are relatively small – 160 Coyotes for the whole state. But even allowing for statistical anomalies these results make you sit up and take notice.

Dr. Bowman, however, had the most disturbing news to my ears, in that there have been two confirmed cases of heartworms in humans. Heartworm infection in humans is extremely difficult to detect, since it looks a lot like lung cancer (infection shows up as coin sized lesions in the lungs that can only be definitively diagnosed by thoracotamy) and so the actual rate of infection is sure to be significantly higher.

There is currently mandatory reporting of heartworm positive cases in three states, and significant restrictions on exporting positive dogs.

Heartworms are not that scary for dogs, cat or humans compared to a lot of other parasites, the issue is that prevention is so easy and so successful that makes the current epidemic so sad.

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