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Thursday, July 16, 2009

A Problem With Royal Pains

Yes, I know I already blogged for today, but I really need to get this off my chest. So forgive the rant.

Tonight I watched an episode of the new USA Network series, Royal Pains (it comes on right after Burn Notice which is my current favorite show). In the episode the main character, a doctor named Hank, is dealing with a mysterious respiratory infection causing pneumonia among members of a household and then party. As he's working on one patient, he picks up her dog and notices that the dog is warm. He then touches the dog's chest and notes a "dull spot". His immediate conclusion is that the dog is the source of the infection, especially once the owner says that her vet has had him on medications for kennel cough. My interest (and skepticism) perked up at that, and I paid closer attention. Unfortunately, the episode became completely unrealistic from that point on. Let me point out the problems that are driving me crazy and would be missed by the average public.

1. Hank barely touched the dog and noticed that he was warm. A dog's normal temperature is 101-102F, several degrees warmer than a human. Unless he had extensive experience with pets, how would he notice an even warmer temperature?

2. Hank noted a "dull spot" when he touched the dog's chest. The writers probably intended this to be evidence of him doing percussion on the dog. However, percussion involves listening to the chest while you're "thumping" it. He didn't use his stethoscope, so he couldn't have been certain of a dull spot, especially with simply touching it. And that's assuming that he even knew what a dog's chest normally felt or sounded like!

3. Hank looked at the dog's medicine, which included antibiotics and antivirals. The vet had prescribed the medicine because of kennel cough. First, we really don't routinely use any kind of antiviral drugs in dogs, as there haven't been much testing or approval. Second, kennel cough is a bacterial disorder, not viral. I don't know any vet who would prescribe antivirals if they suspected a bacterial infection.

4. Hank then proceeded to do minor surgery on the dog. It was never stated what kind of anesthetic he used, and I can't imagine what he would have had in his truck or bag. I also can't imagine that he would have known what dosage to use, as medicines are dosed very differently in human and veterinary medicine. Physiologies are also different, so the doses are rarely the same. He could have easily killed the dog by using the wrong drug or dose.

5. Hank intubated the dog while it was upside down using his laryngoscope. This is how it is done in human medicine, but not in veterinary medicine. In fact, it would be very difficult to do it this way, not the quick, easy procedure that he performed.

6. The entire scenario with him anesthetizing the dog and performing surgery on it was illegal!!! As a veterinary doctor, I am legally only allowed to practice on non-human patients. Human doctors are only allowed to practice on human patients. Hank practiced veterinary medicine without a license, which is very illegal. This is just as bad as if I decided to do surgery on one of my friends. He also did it without proper knowledge of animal anatomy and physiology, which could bring him up on malpractice charges as well. My knowledge of veterinary medicine does not give me equivalent knowledge of humans. In fact, I wouldn't have the faintest idea what dosages of any medicine to use in humans, and certainly would never feel comfortable trying to anesthetize and intubate one.

7. He drained pus from the dog's chest, and then proceeded to fashion a home-made microcsope out of a jeweler's loupe and a lens from what looked like a telescope. He looked at the pus and immediately was able to identify methicillin-resistant staphylococcus. This is ridiculous for several reasons. First, you need 1000x maginfication to really get a good look at bacterial shape and structure. You can't get that maginfication from a loupe and telescope. Second, you really need to stain bacteria in order to identify them properly, which he didn't do. Third, even if he had that magnification, you need a focused light source and immersion oil on the lens to be able to see clearly. His "microscope" was illuminated by a flashlight held at an angle and the end of the scope never touched the "slide" with the pus. Too little light and too far away to tell what he's looking at.

8. Let's assume that he did actually did have a microscope and could clearly see the bacteria. All he would have seen was cocci-shaped bacteria (round dots). Staphyloccoccal species aren't the only ones shaped like this, and there would be no way to tell that they were methicillin resistant based on appearance. To get a proper diagnosis he would have needed a culture of the sample, which can take 5-7 days.

9. And finally, staph infections like this aren't really considered transmittable between dogs and humans, especially as casually as was implied in the show.

So this whole episode was totally bogus. I would be extremely surprised if they bothered consulting a veterinarian with this, as there are a ridiculous number of problems and mistakes.

Okay, that was theraputic. I think I have it out of my system now.