British Columbia Medical Journal, January/February 2010 issue Please download or visit this entire issue online at http://bcmj.org/january-february-2010

1. bc centre for
disease control
Why you should get to know your local veterinarian
Sue L. Pollock, MD, FRCPC, owners from harm. The risks are pri- ing in your patients’ charts whether
Craig Stephen, DVM, PhD marily related to pet-associated infec- they are pet owners, and periodically
tions.3 These risks may be elevated ask about the health of their pets. If a
ur health is inextricably linked when children, pregnant women, and patient has an unusual clinical presen-
O to our environment through
the air we breathe, the food
we eat, and the water we drink. Ani-
immunocompromised individuals live
in the home. Other health concerns
include allergens and trauma.
tation and is a pet owner, a phone call
to a veterinary colleague could prove
invaluable. Veterinary resources with-
mals are an integral part of this envi- in BC include local and provincial
ronment, and our lives are increasing- veterinarians and the BC Veterinary
ly intertwined with theirs. The recent Our patient may be Medical Association web site: www
H1N1 pandemic (swine flu) and an out- willing to increase his .bcvma.org. The veterinarian might
break of E. coli 0157:H7 associated or her medications to provide information on the potential
with farm animals in BC have high- zoonotic diseases associated with that
lighted the importance of this close
control asthma, but not animal species and on the prevalence
relationship. be willing to find a new and distribution of the disease. For
Almost everyone has some daily home for the dog. example, if you care for an immuno-
interaction with animals, whether compromised child, the veterinarian
through food animals and animal could advise on pet species your
products, wildlife, or household pets. For the primary care physician, it patient should avoid (e.g., reptiles due
In particular, pet ownership, including is important to remember that pets are to the high risk of salmonellosis).4
exotic animals such as reptiles and part of the family. An assessment of Such interdisciplinary collaboration
birds, is increasingly widespread in the risk-benefit ratio of keeping pets is intended to better understand the dis-
Canadian households. It is estimated important in the overall care of the ease within the animal health context
that more than 50% of Canadian patient. Communicating this risk to may also expedite your patient’s diag-
households have at least one cat or dog your patient can be challenging. Rec- nosis and treatment. The veterinarian
in their home,1 which speaks to the ommending outright that susceptible may be able to provide recommenda-
importance of pets within the family patients get rid of their pets may not tions on how to minimize the risk of
structure. be the solution, especially if they disease transmission, which you can
There are benefits and risks asso- cherish their companion animal. The then relay to your patient. Examples
ciated with pet ownership. Examples patient may not agree with your rec- of recommendations that would bene-
of benefits include companionship, ommendation and insist on keeping fit both your patient and his or her
improvement in mood (e.g., through the pet. Consider whether the risk is pet may include vaccinating the pet
animal-assisted therapy), increased short-term or long-term to guide your against rabies or treating a suspected
physical activity,2 and protection of advice. If short-term (e.g., pregnant Campylobacter infection in the animal.
woman susceptible to toxoplasmosis Close interaction of humans with
Dr Pollock is a field epidemiologist with the from cat feces), the solution may be to companion animals is here to stay, and
Canadian Field Epidemiology Program, designate another member of the there are many good reasons to pro-
Public Health Agency of Canada. She is cur- household the task of waste disposal. mote this relationship. For the physi-
rently placed at the National Collaborating If long-term (e.g., allergy to dog dan- cian caring for the health of a family,
Centre for Environmental Heath within the der triggering severe asthma attacks), it is imperative to remember that pets
BCCDC Environmental Health Services negotiate with your patient an accept- are family too. In addition to recom-
Division and at the Centre for Coastal able threshold for taking action. For mending that your patients take pre-
Health. Dr Stephen is a veterinarian epi- example, your patient may be willing cautions such as hand washing after
demiologist and director of the Centre for to increase his or her medications to contact with pets and proper disposal
Coastal Health. He is an associate profes- control asthma, but not be willing to of their waste, communication with a
sor in the Department of Ecosystem and find a new home for the dog. veterinarian can aid in disease pre-
Public Health, Faculty of Veterinary Medi- A thorough history is an essential vention, diagnosis, and treatment.
cine, the University of Calgary. diagnostic tool. Consider document- Continued on page 18
www.bcmj.org VOL. 52 NO. 1, JANUARY/FEBRUARY 2010 BC MEDICAL JOURNAL 15

2. college library icbc
Learning at your convenience Continued from page 17
must be promptly notified of a trial
ccess to clinical information College Library subscribes to these date and whether they may be re-
A is often best used when the
physician is at the point of
care. But what about the kind of learn-
lectures in CD format and makes them
available for loan. Furthermore, since
2006, the files have been available in
quired to attend at trial for cross-
examination. Objections to any
expert opinion must be raised no
ing that requires quiet contemplation? MP3 format. Through the Library’s less than 21 days before trial or
Continuing medical education at account at Audio-Digest, College they will not be permitted at trial.
the point of convenience, when the members may download hundreds of An expert is not permitted to
learner has the time to focus and con- files and listen to them on their com- give evidence at trial unless a
centrate, is clearly ideal. This can be puters or mobile devices for free. report has been prepared and serv-
achieved by listening to audio files on Instructions for access are on the ed in accordance with the rules. If
portable CD or MP3 players, or even library’s web site at the Audiovisual a party wishes to cross-examine an
on smartphones. Audio-Digest Foun- & PDA page, www.cpsbc.ca/library/ expert, they must give notice to the
dation, an affiliate of the California pda-video-audio. A limited number of party tendering the report within
Medical Association, has been offer- these files have been made publically 21 days after the report is served. If
ing recordings of lectures of CME available by Audio-Digest on the an expert has been requested for
meetings from across the USA for iTunes web site, but access using the cross-examination, the report will
more than 50 years. The lectures cover College’s web site offers a much larg- not be admitted unless the expert is
a wide range of specialties including er selection by virtue of the Library’s present at trial. If an expert is not
anesthesiology, emergency medicine, subscription. called for the purpose of cross-
family practice, gastroenterology, —Karen MacDonell examination, the scope of the evi-
general surgery, internal medicine, —Robert Melrose dence he or she can give is limited
obstetrics and gynecology, ophthal- —Judy Neill to clarifying terminology in the
mology, orthopaedics, otolaryngolo- College Librarians report or otherwise making the
gy, pediatrics, and psychiatry. The report more understandable.
In anticipation of the new rules
coming into force, medical experts
will likely soon be asked to change
bcmd2b Continued from page 11 cdc Continued from page 15 the format of the reports to reflect
injected with a saline solution so that the new rules, particularly for any
the surgeon can see where micro holes References matter which has a trial date after 1
exist and close them with a small sta- 1. Ipsos Reid. Paws and claws: A syndi- July 2010.
pling device. This prevents the graft cated study on canadian pet owner- Medical experts will continue
from leaking. Unfortunately, I had ship 2001. www.ctv.ca/generic/Web to play an important role in
understood Bitte Ziehen (please pull). Specials/pdf/Paws_and_Claws.pdf personal injury litigation in the
Like a good surgical clerk I followed (accessed 14 December 2009). province. The new rules should
instructions and started tugging on the 2. Barker SB, Wolen AR. The benefits of serve to clarify the role of experts
vein that the technician had so care- human–companion animal interaction: in civil litigation and provide
fully removed. A review. Veterinary Med Educ 2008; greater certainty for both parties
“What are you doing?” the surgeon 35:487-495. and the experts who are retained.
screamed. “This is cardiac surgery!” I 3. Rabinowitz PM, Gordon Z, Odofin L. —Tanya Heuchert, BA, LLB
was not sure what was happening as I Pet-related infections. Am Fam Phys Counsel, ICBC Claims Legal
had done everything that was asked of 2007;76:1314-1322. Services
me. I stopped pulling the blood vessel. 4. Hemsworth S, Pizer B. Pet ownership
Thankfully it was not harmed in the in immunocompromised children—a If you have any suggestions for
ordeal and the patient successfully review of the literature and survey of future articles, please contact
received a new graft. Surprisingly, existing guidelines. Eur J Oncol Nurs DrLaura.Jensen@icbc.com.
though, the telephone in my pocket 2006;10:117-127.
did not ring on Friday.
18 BC MEDICAL JOURNAL VOL. 52 NO. 1, JANUARY/FEBRUARY 2010 www.bcmj.org