16 November 2009

On the nature of "health"

Our dog has recently been diagnosed with diabetes. Dogs only get Type 1 diabetes, which results in a complete shut-down of the capacity to produce insulin naturally, and means that he has to receive it by injection. Actually this is famiiar territory for us; out first Westie, William, was diagnosed at the age of eight and died of largely unrelated causes at 13. Rupert, the current Westie member of the family, is almost 13; but of course we ask ourselves whether we have created a diabetes-inducing life-style for our dogs. A.k.a. too many treats?  Frankly, thirteen is not a bad span for a dog, so we're not feeling too guilty about that.

But this does focus some questions about the nature of health. Things have moved on since William's day, twenty years ago, and I'm not sure that they have moved forwards. It may be worth making the point that William's vet for most of his diabetic career was himself a Type 1 diabetic--or it may not.

Principally they have moved on in terms of the prescriptivism of treatment. Then, I used to take William out for a walk in the morning, carrying a ladle, which I learned deftly to slip under him to catch a urine sample at the opportune moment. (He, of course, learned rapidly to delay his first pee as long as possible because I would drag him back home immediately afterwards because not only of our tight morning schedule with three children to get to school but also of the need to have a fresh sample...) I would dip a test strip for a second, wait for a minute, check the colour of the test area, and decide-- a bit up or a bit down or no change. I'd charge the syringe, and jab him (William was much more docile about that than Rupert, who needs a muzzle now--perhaps because I have lost some skill in the intervening 15 years...).

Today the vet tells me that urine testing is not accurate enough. Indeed the packet of test strips agrees that their accuracy is plus or minus 75%; I hope that does not mean that they can be three-quarters wrong in either direction--which is an overall potential 150% error!

She needs to have Rupert regularly for a "glucose curve" assessment, all day. OK, it's 50 a time, but we have insurance so that is not the point. Once a month or so? Last time, we adjusted day by day. (And the control conditions on the first visit were abysmal; we supplied Rupert's usual food, but he was stressed and wouldn't eat, so they fed him chicken instead...)

We did buy a remarkably cheap blood test kit, but that is another invasive procedure for Rupert.

He needs a regulated diet, and regulated exercise, and no extraneous treats... He has been prescribed a dry diet dog food (for which, incidentally, the directions are appalling) which he ignores in the face of his hunger.

Human health care stumbles along informed by Quality Adjusted Life Years as a guide, from which many recoil as a mechanistic approach to the valuation of experience. Animal health care has no taboo against euthanasia, and indeed we have had a previous dog (odd expression) clinically killed. But because it is simply a matter for the "owner" to sign a form and pay a fee, we have no guidance about the quality of life of a dog.

Rupert's not having as much fun as he used to, but he doesn't appear to be in any distress, and he is as capable as ever of bossing us about, so he'll just have to put up with those jabs twice a day.

The World Health Organization has a definition of "health", but I'm not linking to it. You can't handle this with reference to a dictionary.


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