Doctor, Behold Thy Patient as Well as Thy Patient’s Test Results!

Indy. Photo by Lisa Jordan.

As is true for all health care professionals, veterinarians sometimes develop tunnel vision. Now and then, they become so focused on test results that they fail to consider whether or not these results actually make sense in relationship to the animal sitting atop their exam room table. When the patient’s appearance says one thing and test results indicate something different, astute veterinarians know to dig a bit deeper in order to reconcile the discrepancy.  Recommendations based solely upon test results have the potential to seriously undermine a positive outcome.

Here are two examples of how veterinarians might respond to test results that don’t make sense:

Barney

Barney, a 14-year-old Siamese kitty, received a physical exam along with blood and urine testing during his “senior wellness” visit. Much to everyone’s surprise, the laboratory test results indicated that Barney had advanced stage kidney failure. This news was shocking, as Barney appeared so normal at home and he had passed his physical examination with flying colors. The test results simply didn’t make sense.

Should Barney’s veterinarian have prescribed treatment for the kidney failure? No way! Rather, this savvy vet collected a second set of blood and urine samples for resubmission to the lab. Lo and behold, this time all of the results were normal. How could this be? Simple, there must have been a mixup of samples at the lab. While such an occurrence is uncommon, it certainly can and does happen. Fortunately, a heads up veterinarian who focused on the patient as well as the test results prevented this situation from morphing into a medical comedy of errors.

Rascal

A six-year-old mixed breed dog named Rascal was evaluated for vomiting and profound weight loss. His weight had dropped from 65 pounds to 52 pounds over the course of six weeks. Blood test results identified that this poor dog was in liver failure. A thyroid level (part of the blood panel) was lower than normal suggesting that Rascal was hypothyroid (producing inadequate thyroid hormone). The veterinarian hospitalized Rascal for treatment of his liver disease and started him on a course of thyroid hormone replacement therapy.

Had this veterinarian considered his patient as well as the test results, he would have questioned the accuracy of the hypothyroid diagnosis. After all, the most common symptom of hypothyroidism is weight gain, not weight loss. Rascal was likely experiencing “sick euthyroid syndrome” in which significant illness causes a false positive diagnosis of hypothyroidism (the dog is not truly hypothyroid, but appears so on paper). Poor Rascal was already much too thin, and the addition of thyroid hormone would only serve to promote more weight loss. In this case, the veterinarian acted based solely on test results while ignoring the evidence presented by the patient.

While I would love to have you believe that all veterinarians understand the importance of weighing in on the appearance of the patient in conjunction with test results, such is not always the case. As your pet’s medical advocate, I encourage you to question things that don’t make sense. Has your dog been diagnosed with a disease, yet you’ve not observed any of the typical symptoms? Has the X-ray documented an abnormality in your cat’s left front leg, but you are quite certain her right front leg is the one that is painful? As the team captain of your pet’s health care team, speak up and speak out- as loudly and persistently as necessary to make sure that things make sense.

Have you ever been provided with a diagnosis that didn’t make sense? Has nonsensical therapy ever been recommended? If so, how did you respond?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

 

 

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9 Comments on “Doctor, Behold Thy Patient as Well as Thy Patient’s Test Results!

  1. As Dr. Nancy knows, my sweet Mandy (12 yo lab) was treated for several problems in her last months-we visited our local vet at least every 2-3 weeks – I lost focus because of her kidney disease (probably from Nsaids for arthritis). DR X shouldn’t have! She had loss of appetite (a normally voracious lab) spitting up, limping (she had arthritis in her elbow which was x-r’d twice because the limping had become so severe). In a single visit with Dr. Nancy we found that she had an ulcer and osteosarcoma in her SHOULDER. By then it was too advanced to treat and she had already had several small fractures. She was then treated for the ulcers and given STRONG pain meds. The change was inspiring – she had several wonderful days of normal appetite and pain relief until she had an accident that shattered the vulnerable shoulder.

  2. I am big proponent of always checking what you see on your test results against what the patient is telling you – and of rechecking and verifying results that don’t make sense, or one’s that may affect a patient’s life. I think we trust our fallible lab machines too much, and put too much faith in the results.

    Life-or-death decisions are made based on test results all the time, and people need to be aware of the potential for variability and inaccuracy in lab tests. It’s not a problem with any particular testing methodology – it is just the way the universe works.

    Thanks for bringing a neglected but important topic to light, Dr. Kay!!

  3. I went to a vet with an extremely overweight labrador retriever with an obvious and many years old limp to get pain medication for her. Before he prescribe any, he wanted a full set of x rays which would require general anesthetic and make the dog sore for several days because of the manipulation to get the right angles on the films at a cost of nearly $900 or so… so, what you’re saying is that you want to put my dog under, cause her pain and charge me nearly $1,000 so that you can tell me that she’s old, fat, and arthritic? I can see that with my own eyes! Thanks but no thanks. I found another vet. I was raised by a doctor and was taught to be a skeptical consumer of health care. I encourage other people to do the same. Just be alert to the notion that just because a person in a white coat says it’s so doesn’t make it true.

  4. I live with a lab mix named DeDe. She was rescued. She had horrid lick granulomas. After a year of following vets’ advice Jen took the advice of a friend and tried a limited diet. The licking stopped within a week. And yet, despite evidence Online from reputable sources that allergies can be a cause, vets continue to tell Jen that food allergies weren’t what caused this problem; it was stress. It frustrates Jen that she is not listened to and she feels some blame her for DeDe’s ailments.

  5. My older black dog, Venus, was severely arthritic. One day she became hardly able to move and her back raised up into a V. I brought her to a special vet hospital where a specialist saw her. He said she should be tested for cancer and many other ailments, tests that would have caused her enormous pain. I knew we would not be doing surgery, based on her age and health issues. He said, “Well, if you choose not to treat her…”
    In reality, I chose to treat her with time and gentleness. I remembered her getting stuck as she got off the sofa and guessed right, because within a week, she was able to move normally again. A good vet with recommend actions that are FOR the animal, rather than simply doing things TO the animal. What Venus needed was not a battery of painful tests; she just needed time to heal and a companion strong enough to ignore the guilt-tripping doctor.

  6. My 9 year old lab retriever mix Jake’s breath smelled like strong acid. I took him to our vet and they ran routine blood work. It was normal. I took him to the emergence vet clinic because he was getting lethargic. Again blood work was normal. The following week we went back to our regular vet and her partner wanted to run blood glucose test on him. We did and the next morning I got a call explaining that Jake’s blood sugar was 400. I went to the pharmacy and got the insulin and immediatly started him on insulin. Within 24 hours he was like a new dog.

  7. I’ll never forget that day we took Jasmine to the emergency vet because of the fallout of her drug-induced hyperthermia. She could barely get around and started peeing brown.

    They checked her out and did a bunch of diagnostics and told us she was in acute kidney or liver failure and had ruptured intestine. Their suggestion was to put her out of her misery.

    Lucky for Jasmine we requested a referral to the teaching hospital instead. Her kidneys were fine, liver taxed because of what was going on but not “done” and no intestinal rupture, an abdominal abscess instead.

    Questioning what the ER told us saved her life.

  8. The vet insisted that my dog Cinnamon was hypothyroid but I noticed that he was much too thin and could not gain weight. I insisted on a full thyroid panel and sure enough they were giving him too much thyroxine
    I still was not convinced that he needed to even be on thyroid medication, so a year later I had CBC and thyroid panel done to be evaluated by Dr. Jean Dodd. She recommended he be taken off ALL thyroid medication. This vet has fought me on titers as opposed to vaccinating my 14 year old dog, food and other issues. This was the last straw and I am searching for another vet. I am also issuing a complaint to the state as well.

  9. I had one enormous mis-diagnose with my Queensland heeler. They x-rayed the wrong leg & came back with a “he must just have a sprain”, when it fact it was the other leg and it was bone cancer–picked up by a 2nd diagnosis from another vet. 2nd opinions! Get them!