The most dreaded word in medicine

            A quick look at the foreleg of a yellow Labrador indicates that he has a lick granuloma.  I tell the owner that we need to break his habit of licking at that site to allow the inflammation to regress.  The owner has already tried topical products such as bitter apple without any success.  I tell her I have just the right magic in our pharmacy that should get the job done.  I come out of the exam room and tell my technician that I would like to prescribe Baytril Synotic to treat the lick granuloma.  I am told we do not have any Synotic.  I ask when it will be in, and then I receive that dreaded answer.  It is backordered!

            I have come to find that to be the most dreaded word in medical practice.  When you use Propoflo in a good percentage of your induction protocols and then suddenly have to do without for awhile, that can be a tough adjustment.  When injectable Fentanyl is not available you have to rework you pain management.  When immiticide is in limited quantity how do you treat your heartworm positive dogs?  Now that cisapride has joined the list how do you medically manage a megacolon cat?  Some of these drugs will come back into the fold, but others are gone for good.  Sometimes there are adequate alternatives available, other times there are not.  So we are currently scrambling to find a compounding pharmacy that may have a stock pile of cisapride. 

            I am not a pharmacologist or business executive to explain why this occurs.  We are not the only industry that is affected as some of these drugs are used in dentistry and human medicine.  But when this occurs it makes you become resourceful.  You find other sources of the medication.  When that is not feasible you have to get creative and find other ways to treat.  It is easy to get in a comfort zone after a while, to prescribe the same antibiotic, the same pain medication for a litany of situations.  What’s great about medicine is that there are always newer, better medications being developed down the pipeline to improve our medical care.  There are some doctors who are comfortable with what they have been doing before and do not want to change.  But when the opposite happens and that drug that a doctor has become dependent on prescribing is no longer available the doctor has to adjust whether he wants to or not.  Change is never easy, whether it is taking two steps forward or one step back. 

When I hear that a drug I use is no longer available I reflect on how easy it is to take things for granted.  There was a time when Propoflo or Synotic did not exist and veterinarians still managed.  Certainly veterinary medicine has made incredible strides through the years and will continue to do so.  But there are times when the rug is pulled out from underneath us and we have to adjust.  Even though we practice a science there certainly is an art to it and we are forced to think outside the box.  So the next time I hear the word backorder I will still likely get a chill up my spine.  But then I will be forced to think and adjust and every time I do that I will grow a little bit more as a doctor.

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