Reflecting one medicine when describing medical fields
Regarding the recent excellent report by MacLellan et al1 (“Association of magnetic resonance imaging-based preoperative tumor volume with postsurgical survival time in dogs with primary intracranial glioma”), my only criticism, and it is a nonsubstantive one, is the use of the term “human-medicine neuropathologist” to describe a consultant the authors used for assistance with histologic diagnosis. The use of this term suggests that there are different medicines, at a time when the concept of one medicine-one health has never been more important for the future health of our planet. I think that “physician neuropathologist” is a preferable term, and one that clearly and accurately describes the individual's field and discipline.
Ford W. Bell, dvm
President, Hennepin Health Foundation, Minneapolis, Minn
1. MacLellan JD, Arnold SA, Dave AC, et al. Association of magnetic resonance imaging-based preoperative tumor volume with postsurgical survival time in dogs with primary intracranial glioma. J Am Vet Med Assoc 2018;252:98–102.
Health anxiety by proxy and pet owners
Health anxiety (also known as hypochondriasis) is defined as “a preoccupation with fears of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms.”1 This preoccupation continues even after medical evaluation and advice is sought for > 6 months.2 It has also been found that hypochondriasis can cause an individual to become preoccupied with the health of a partner or child, a condition known as health anxiety by proxy.3 However, there appears to be little information on the potential effect or involvement of animals in health anxiety by proxy. Considering the close relationship between most owners and their pets, we believe that, as is the case with other human mental health conditions (eg, Munchausen by proxy and malingering by proxy), health anxiety by proxy is likely to encompass pet animals. For example, Eastwood et al4 described a case involving an owner who repeatedly visited a veterinary practice with a dog. These visits occurred at least monthly and sometimes even weekly for 10 years, with little or no clinical evidence of illness in the dog. The underlying cause of these visits was unclear, but it could be hypothesized that it involved health anxiety by proxy or a desire for attention.
We believe there is a need for research in this area and similar aspects of human mental health that may affect the health and welfare of pets. Information is also needed on distinguishing between genuine and reasonable concerns and the various mental health disorders that may be associated with early warning signs (eg, repeated veterinary visits). Further, staff education and guidelines for dealing with such cases are important aspects for consideration.
James A. Oxley, mres
Measham, Swadlincote, Derbyshire, England
Lori Kogan, phd
Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences
Colorado State University, Fort Collins, Colo
1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994.
2. Sunderland M, Newby JM & Andrews G. Health anxiety in Australia: prevalence, comorbidity, disability and service use. Br J Psychiatry 2013;202:56–61.
3. Thorgaard MV, Frostholm L, Walker L, et al. Health anxiety by proxy in women with severe health anxiety: a case control study. J Anxiety Disorders 2017;52:8–14.
4. Eastwood B, Oxley J, Feldman MD. A destructive bond. Mental Health Practice 2017;20:13.
