Whatâ€™s The Diagnosis?
by: T. J. Dunn, Jr. DVM
This article appeared in a recent issue of Dog World Magazine
I must be delicate with this topic because surely I have been guilty myself. On occasion during my thirty-year career as a small animal practitioner there have been a few cases presented to me where I sent the patient and owners home without a diagnosis. I know it happens daily all across America, and I have been as guilty as the next veterinarian of this misdemeanor. During the last four years of answering thousands of pet health care questions via email I have come to the firm conclusion, though, that it happens far too often.
Here is what happens: A pet is presented to the veterinarian with some sort of malady, the pet is examined, medication is â€œtriedâ€, and the pet owner leaves with no understanding of what the problem was and what the medication is supposed to accomplish. In other words, they did not get a DIAGNOSIS. Plus, they have medication for â€œsomethingâ€.
The pet owner, in response to being asked by a friend â€œWhat did the vet say it was?â€ can only reply â€œIâ€™m not sure… something about her liver, I guess; but sheâ€™s got some pills that are supposed to help. If she isnâ€™t better in a week we need to come back and heâ€™ll try something else.â€
This pet caretaker does not have a diagnosis but what she does have is a lot of trust that the veterinarian knows best and that all will work out well and those expensive little pills will make her dog better. Iâ€™d like to suggest to everyone who reads these words that if you present a sick pet to a veterinarian, before you leave the doctorâ€™s office you obtain a DIAGNOSIS. You have a right and an expectation to have the doctor tell you what is the most probable CAUSE of the dogâ€™s malady. â€œSomething wrong with the liverâ€ is not a diagnosis; you need to know what that â€œsomethingâ€ is! Thereâ€™s a huge difference among various liver disorders such as metastatic cancer, bile duct blockage, fatty infiltration, toxins, and infectious agents… so that word â€œsomethingâ€ really has no meaning. A diagnosis is made when you know what that something is… and it is up to your veterinarian and you to do whatever is required to solve the mystery of the malady.
You must understand, however, that sometimes a diagnosis can only be made through somewhat in-depth diagnostic techniques such as blood chemistry profiles, contrast radiography, ultrasound evaluation and possibly even exploratory surgery. And it is a fact of life that you will be expected to pay for any diagnostic tests that are needed. I know that my own dogs are worth whatever it takes to maintain their health. (Never be timid about getting an estimate of charges before proceeding, though. Nobody likes surprises when it comes to the cost of services.) It may be unreasonable of the pet owner to expect a diagnosis after a ten-minute physical exam unless the malady really is simple and straightforward.
One of the most common situations where the pet owner exits the animal hospital without a diagnosis involves the â€œitchy dogâ€. Far too often, our canine friends suffering from chronic skin problems are presented, examined, given cortisone to â€œstop the itchingâ€, and are seen again in six weeks for the same problem. The diagnosis of a â€œskin allergyâ€ is only a partial diagnosis (and a mis-diagnosis if sarcoptic mites are involved); you need to know to what the dog is allergic in order to have a diagnosis of Allergic Dermatitis. I wonder how many people leave the veterinarianâ€™s office with the idea that their dog is allergic to â€œsomethingâ€ and those pills or injections â€œshould helpâ€? Well, what if your dog is allergic to corn and all you have to do is change to a food that has no corn? Or what if sarcoptic mites are causing all that itching and the cortisone is actually making the situation worse?
Read Dr. Dunn’s published article on DOGS THAT ITCH AND SCRATCH.
You are paying the veterinarian to tell you what is wrong with your dog and to receive suggestions for correcting what is wrong. Before you leave the clinic you need a diagnosis, only then can an effective treatment suggestion be given.
It does happen, too, that your local veterinarian may not have the skill or diagnostic techniques to achieve a diagnosis. Thatâ€™s exactly why Specialists in Veterinary Medicine are fast becoming everyoneâ€™s best friend. I have been very thankful on many occasions that my clients were able to visit a specialist when my diagnostic abilities have been challenged. Ophthalmology, surgery, dermatology, radiology, nutrition and many more disciplines have certified veterinary specialists with advanced training, knowledge and diagnostic equipment at your service; you and your veterinarian should take advantage of a specialist whenever reaching a diagnosis proves to be difficult. You owe it to the patient!
I had to take my own little dog to two specialists (and spent nearly $1,500) in order to confirm what I suspected was a neurological problem; it turned out that through the use of a CT Scan by a Specialist in Veterinary Radiology we were able to pinpoint the defects in the bone development in the skull and spinal column that was contributing to the main problem of hydrocephalus. I have often wondered what the progress of this case would have been if the little patient wasnâ€™t my own but rather was owned by a client. Would they have lost faith in my attempts to reach a diagnosis? Would they have taken it to a specialist? Would I have ever known about those bony defects that only showed up via CT Scan? Would the little patient be happy and alive today, as she is, if there had not been a determination and commitment to obtain a DIAGNOSIS?
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