Remote diagnosis and prescription is rarely helpful

Many readers are familiar with the response they usually get from medical doctors if they try to engage a doctor in a phone conversation about their illness and possible treatment. The answer is almost always, “You will need to come to the clinic.”

The statement is delivered with finality and calmness that discourages any further prodding of the professional. I have heard people complain that the practice is rude. Really, it is not, rather, underlines the sensitivity of health matters.

Medical training inculcates the ethos in doctors that you treat what you have personally seen, examined and made a diagnosis that you can successfully defend in case of treatment failure, deterioration of the condition or undesirable reaction to the treatment.

The doctor can advise on first aid to be given to a patient even by non-medical people where the life or quality of life of a patient is threatened; but the action advised is only to prevent rapid deterioration and give time for the arrival of medical personnel or moving the patient to a medical facility.

The ethos of medical practice in veterinary and human medicine are basically the same since in both cases animals with life and feelings are involved. However, there are many people who believe veterinary doctors should just give their diagnosis from history and photos shared with them on the phone by the animal owners.

During my practice, farmers have claimed that my insistence to visit their sick animals on their farms is motivated by earnings rather than medical treatment. The truth is far from that.

Last week a number of farmers from various parts of the country presented me with cases of their cattle, sheep and goats on phone and WhatsApp. Each requested me to make a diagnosis and advise them on treatment and provide prescriptions.

One farmer suggested that if I prescribed medicine that needed injection by a doctor or a paravet, then she would look for the service provider to do the administration. Of all the cases I got, only one was appropriate for me to give a diagnosis and treatment remotely.

The cow in the case had drastically dropped milk production but appeared normal. Detailed discussions with the farmer revealed the animal had inadvertently been denied sufficient drinking water. The video the farmer presented and his account of how the milk dropped was sufficient evidence for me to determine that the issue was denial of water.

The other cases were complex and required actual examination by a veterinary doctor. The first one was really dramatic. The cow had been eating and behaving normally but suddenly it coughed violently for some minutes.

The animal appeared to be running out of breath and kept raising the head up against the direction of the wind. Suddenly it coughed out blood through the nose and mouth. From the video provided, the blood was bright coloured as though an artery had been broken.

It is easy to differentiate blood from an artery and a vein. Arterial blood is bright red as it contains a lot of oxygen. All blood returning from body tissues back to the heart is returned by the blood vessels called veins.

It enters the right large chamber of the heart called the left ventricle. The heart then pumps it into the small right chamber called the right auricle which squeezes the blood into the lungs.

Venous blood is dark red as it contains very little oxygen and a lot of carbon dioxide because the oxygen it had as arterial blood was used up in the tissues and exchanged with carbon dioxide. In the lungs, the carbon dioxide is removed and replaced with oxygen.

The blood is renewed to its bright red colour. It now changes into arterial blood as it flows into the pulmonary artery.

The cleaned blood moves into the left auricle and onward into the left ventricle. From the ventricle, it is pumped into the great aortic artery that distributes the oxygen-rich blood to the whole body through a network of smaller arteries.

The left ventricle is a powerful pump that ensures the blood moves with sufficient force to reach all the tissues of the body. When an artery breaks, there is heavy flow of bright red blood that comes out in spurts in rhythm with the pumping of the heart.

The colour of the blood being discharged by the cow, the volume and the rapid rate of flow was sufficient evidence for me to conclude the cow had broken a major internal artery. The difficulties in breathing indicated it would have to be a branch of the pulmonary artery.

I advised the farmer that the case was an emergency and she needed to contact her veterinary doctor immediately. The last such case I handled physically died on my hands soon after my arrival on the farm due to excessive blood loss. At postmortem, I found a major branch of the pulmonary artery had been damaged by an abscess and burst when the cow choked on water and coughed violently.

Another farmer called from Garissa and sent me a video of sick sheep and goats. He had brought them from Wajir a week earlier. The animals showed difficulties in breathing and reluctance to lie down.

Again, such cases require physical examination by a doctor to pick up a sufficient number of disease signs to enable her make an accurate diagnosis or recommend further testing.

I encourage farmers to understand the complexity of diseases and their diagnosis and the need for physical examination of patients for the doctor to arrive at a reasonably accurate diagnosis. In medicine we say prescription or treatment for a wrong diagnosis is useless to the patient.

[email protected]