The Complex Older Dog: When One Disease Drives Another

This lecture is built around a single organising idea: in the multi morbid patient, conditions do not sit side by side, they drive one another. A dog with lifelong allergic skin disease, managed for years with intermittent steroid, does not simply have a skin problem and a stifle problem. The steroid has changed her muscle mass, her tissue quality, her healing capacity, and her exercise tolerance. The itch has been costing her sleep, and poor sleep has lowered her pain threshold. Follow that chain and the orthopaedic presentation stops looking like bad luck and starts looking like a predictable consequence.