Don’t Just Do Something, Stand There

In the world of human medicine it’s estimated that 80% of the maladies that prompt physician visits would completely resolve on their own with simple “benign neglect.” In other words, time is all that is needed for a cure. Does this mean that 80% of people are jumping the gun by scheduling a doctor visit? Not at all, because the physician is the one trained to discriminate which 20 percent or so need more than “watchful waiting.”

I suspect that the percentages mentioned above may be comparable in the world of veterinary medicine. Nonetheless, many vets are intent on prescribing, and many of their clients are intent on receiving unnecessary medication for situations in which watchful waiting would suffice. There seems to be a desire to give an injection and/or send home some pills, perhaps to placate the prevailing perception that clients who leave empty-handed will feel underserved.

A classic example of this “gotta do something” philosophy is the dog or cat presented for a couple days’ worth of diarrhea. The patient is completely normal otherwise, and a stool sample check is negative for parasites. In this situation it would be absolutely appropriate to recommend a bland diet, some watchful waiting, and a followup phone call or email with a progress report in two to three days. Instead, the client is often sent home with instruction to treat the diarrhea with prescribed medication(s), more often than not an antibiotic. Please know that cases of canine or feline diarrhea caused by bacterial infection (salmonella, campylobacter, clostridium) are rare at best!

Guess what the number one side effect of most antibiotics happens to be? Diarrhea! (Can you sense that I am cringing as a type this?) Antibiotics are capable of disrupting normal bacterial populations within the intestinal tract which can then turn a simple case of self-resolving diarrhea into an ongoing nightmare. Antibiotics are not unique. Each and every drug a veterinarian can prescribe has the potential to cause adverse side effects. Giving medication when watchful waiting is all that is necessary defies logic as well as the important, universal, medical mantra that states, “First do no harm.”

If my clients absolutely, positively can’t stand the thought of doing nothing, I keep them busy doing something that has zero potential to negatively impact my patient. In the case of diarrhea, this can include preparing a homemade diet, keeping a written log of bowel movements, walking the dog six times daily to observe stool samples, or disinfecting the litter box twice daily. Heck, I’ve even had clients who measure and weigh their pet’s bowel movements- their idea, not mine!

This blog post is my way of encouraging you to be okay with watchful waiting (aka, benign neglect) when this is what the situation calls for. Understand the logic behind any medication your veterinarian prescribes, and avoid pressuring your vet to prescribe “something” for the sake of helping you feel more secure and comfortable. Time is a wonderful cure-all for many maladies.

Have you or your pet ever had a medical issue that benefited from watchful waiting?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

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13 Responses to “Don’t Just Do Something, Stand There”

  1. Sadie Anne says:

    Oh NO, Dr. Nancy,
    Where was this blog last Monday?
    Our Black and Tan coonhound of unknown age suddenly and for no “apparent” reason started vomiting. He vomited everything he ate for 24 hours. He could keep down all the water he could drink.
    Having raised 2 children my stance was to “watch and wait”.
    My husband, who considers our dogs his “children”, was not about to watch and wait. I knew there was no GDV because there was no bloating and he had an appetite.
    We took Walker to our veterinarian, who suggested watch and wait.
    My husband would not accept that we really should just watch him.
    He agreed to Barium and Xray to determine if things were moving through his system. They were.
    We picked Walker up later in the day with antibiotics and instructions to feed him boiled chicken and white rice is very small amounts.
    The next day my husband remembered feeding Greek pepperoncini to Walker the evening before the vomiting started.
    Hmmm, an upset stomach perhaps?
    $500.00 is the most expensive pepperoncini we’ve ever bought.
    Our Vet is great. My husband is another story.

  2. Carolyn says:

    Once again you’re right on. Over the years I have learned generally, giving it some time is best. The one exception I experienced is when Wally, my cavalier, started experiencing cold/allergy symptoms. I let it go about a week and one morning he just wasn’t himself and, for the first time refused breakfast. I knew immediately something was wrong! I zipped him over to the vet and Dr. Rothe (Disney Pet Hosp/Concord, Ca) said “I think he has pneumonia.” After reviewing the x-ray he confirmed this was the case.

    Wally has been to several vets, had a complete exam with CT scan, more radiographs, nasal exams, cultures (SAGE clinic/Concord, CA) and no cause was found for this condition. No foreign objects. Dr. Erin Troy (Mueller Vet/Walnut Creek, CA) spoke with a specialist at UC Davis and they had no answers. So I didn’t take him to Davis.

    He has been on Baytril and Doxycycline for over two years now. Fortunately, he doesn’t have a problem with diarrhea but I do worry about him taking these drugs indefinitely. I friend suggested I give him probiotics. when I asked Dr. Rothe about it he said “If the antibiotics kill the good bacteria what makes you thing they won’t kill the probiotics?” good point.

    Anyway, in this case I might have avoided the penumonia had I taken him in sooner but I can’t say for sure. I have only heard of this allergy (?)/respiratory condition in one other dog, a Beagle, and he is being treated the same way.

  3. Miriam Yarden, B.Sc.,MS,APDT says:

    Unfortunately, most owners don’t realize that dogs and cats puppies and kttens have temporary bouts of diarrhea and vomiting, just like human babies. A call to my vet who recommends boiled chicken and rice usually takes care of these. Waiting and watching pariod: 2-3 days. Sudden lamenes in large breed pups is very often panosteitis which also disappears in a day or two. Wait and watch! Again, time limit is 2-3 days. I refuse antibiotics unless there is a bacterial infection present and he is OK with that.
    I did have a client once who was instructed to bring in the dog in seven days to review his stool and this lady kept a daily sample, packaged them and dated each one and presented them in a shoebox to her vet. He and I excused ourselves for a moment, went into his office and literally collapsed with laughter. After that we dealt with her courteously and tactfully and explained that ONE sample was all that was needed. Fortunately, she also almost collapsed with laughter…..

    Watch and wait is sensible as long as it is not protracted. If the stool or vomitus show traces of blood, infected eyes, itchy, red and swollen ears, etc., then there is no watch-and-wait. You don’t go, you RUN to your vet.
    Worked for me for the last 40 years and all my dogs (you can imagine how many I’ve had in all that time) have lived to ripe old ages except one who had a ruptured vertebrae and there was no help for him being rendered paralized in all four legs. Broke my heart….

  4. Tripawds says:

    Thank you SO MUCH! Yep Dr. Kay, you answered it brilliantly. I’ll be sure to share this in our Forums.

    P.S. Why can’t ALL vets be as awesome as you?!

  5. speakingforspot says:

    You’ve posed a great question. Depending on the underlying issue, I would typically recommend “watchful waiting” for no more than 2-7 days. If things have not improved, back to the veterinarian you go. People who seek out Tripawds are often folks whose dogs have undergone an amputation because of bone cancer. This typically shows up as a lameness issue that can have an fairly abrupt onset. If one opts for “watchful waiting” in this situation, I would recommend doing so for no more than 3-5 days before pursuing further diagnostics if no improvement has occurred. Certainly, one’s decision-making is swayed by the age and breed of the dog. My own son’s large breed elderly dog (a Hurricane Katrina rescue) had an abrupt onset of lameness and I recommended radiographs right from the get-go. Age and breed wise, he is far more likely to develop bone cancer than a two year old dog or small breed dog. Thankfully, the radiographs revealed no bone cancer. Does this help address your very good question?

  6. Tripawds says:

    Dr. Kay, you always give us something to think about.

    I’m going to play devil’s advocate here because all too often we see Tripawds community members whose vets suggested watching and waiting, which led to an unnecessarily prolonged bone cancer or soft tissue sarcoma diagnosis.

    SO, how do you draw the line between being OK with watchful waiting and taking further steps to diagnose the issue?

    Is there a reasonable time limit for watching and waiting, depending on the symptoms? Which symptoms are OK to practice “benign neglect” and which ones aren’t?

    And where do you draw the line between smart “benign neglect” and recognizing an incompetent vet who can’t seem to diagnose the issue yet won’t offer up a second opinion referral?

    I’d love to share your answer with our members. Thanks for your valuable insight!

  7. Jane Eagle says:

    As a rescuer, many dogs pass through my home, in addition to those who refuse to leave :-). Several years ago, my local pound called right before christmas to ask me to take in 4 huskies. I cannot say no to a dog in need, so they came home with me, bringing clostridium (highly contaigous)…so in addition to 4 sick dogs, of course my 4 plus another foster all got sick. 9 large dogs with diarrhea a week before christmas: THAT was a holiday to remember! And of course, since they were contaigous, they could not go to new homes where they might infect other dogs. They all found homes after they recovered, but since then my pack gets clostridium every couple of years. My favorite vet tech once told me “You’ve GOT to clean up your yard more often.” I informed him that I clean my large yard at LEAST 3X daily, more when someone is sick.
    My motto is: when in doubt, go to the vet. But I often call first to ask if it might be a wait and see. When we do need antibiotics, treatment is followed by a few weeks of probiotics to regrow their lost intestinal fauna.
    Bland diets, ear cleaning, and watchfulness really do take care of most situations.
    I am really blessed to have a vet who is brilliant, open minded, and down to earth.

  8. Jane says:

    I find I need to continually reassure doctors of all sorts that I am FINE with being told “No need to do anything. Go home, and come back if it gets worse.”

    Otherwise I find way too much eagerness to offer meds, which, as you say, have side effects. I have a dog who was rendered deaf by #(*$(*#^ triotic. She prescribed it for him despite telling me “there is nothing wrong with his ears; he’s just very itchy”…………………… Still kicking myself for not reminding her that I do not EVER want him to get drugs simply because I note anomalous behavior and bring him in to get looked at!

    ps — love your suggestion for 6x daily walks to keep them busy

  9. DAN says:

    I have a 3 year old, male Leonberger,. Shortly after we got him as a 9 week old puppy I started to give him a very high, active bacteria Pro-Biotic.
    I can honestly say during the past 3 years he has not had stomach or bowel problems to speak of.
    Thru the years of owning several Giant breed male dogs I’ve learned to observe our dogs eyes. When he is feeling good his eyes seem to sparkle and when he’s not his eyes lack this sparkle,
    So far this has worked out very well for our boys and us.

  10. KT says:

    I have paid for a lot of “watchful wait” outcomes.

    I’m ok with that. I like the peace of mind from knowing an issue was checked out by a qualified vet and nothing is seriously wrong. That’s a good enough outcome for me and I don’t need pills to walk away happy. It’s a much better outcome than living with regret of a missed serious problem

    Endosorb is a nice choice for diarrhea that needs watchful waiting :)

  11. Jana Rade says:

    What an awesome article!

    I am always wanting to do SOMETHING but I’m also always trying to stay away from medications. I completely agree that medicating left and right doesn’t do anybody any good.

    Weighing the stool? That one actually never occurred even to me! ;-)

  12. Amy says:

    When I have a geriatric I do rush to the vet. A seemingly normal cough or vomiting episode has turned out to be the end stage of something fatal for four of my geriatric dogs.

    My current dogs are younger. One of them mysteriously started limping so I put him on crate rest for a couple of days. Then it started again. It turned out he was slipping on the ice outside when he went potty in what is apparently his favorite part of the yard despite the ice. I put him on crate rest again and fortunately the ice melted at about the time he was feeling better.

    I did have my vet check him out later, though, in case he had a kneecap that was slipping in and out.

  13. Lisa H.-Smith says:

    This is so timely. Last week: My dog Ditto had 4 days of diarrhea. I phoned my vet. NO other symptoms…active…eating…no vomiting…no abdominal tenderness, etc. She suggested a few days of only rice and chicken. Good digestive re-set and now she’s back on her normal diet and everything is fine. No vet bill. No meds. What more could I wish? I love my vet.