Making a Diagnosis and Choosing An Approach to Illness Go Hand-in-Hand

Sick pets rarely walk in wearing a sign that says “What’s wrong with me is____________.”

Thus while it’s true that some problems are obvious and therefore fairly straightforward to diagnose, many, many others are not. Often “internal medicine” problems are among those "not obvious" and must be definitively diagnosed before any specific treatment can begin. In the face of incomplete information, supportive care is given while the diagnosis is pursued.

Internal medicine problems include the endocrine disorders (glands), digestive disorders (stomach, intestines, liver, pancreas), neurologic disorders (brain, spinal cord, nerves), circulatory disorders (heart, blood vessels, spleen, blood), respiratory disorders (airways, lungs, chest wall), urinary disorders including lower urinary (bladder, urethra) and upper urinary (ureters, kidneys), all forms of cancer and others.

Veterinarians are regularly faced with deducing a pet’s diagnosis from disparate bits of information gleaned from a variety of sources. Those sources include the “history”, which is what you the pet owner tell us about onset, duration, type and severity of symptoms and response to treatment, if any.

After obtaining a history, and still before any testing or specific treatment comes the hands-on physical examination. That examination must be generally thorough, but also specific in concentrating on the areas of concern implied by the history. Beyond those two most important, initial elements, must come appropriate testing and imaging, in an attempt to obtain the correct diagnosis.

The testing and imaging necessary to build the “minimum database” of information for an unknown diagnosis usually includes blood cell analysis, blood chemistry analysis, urine analysis and often screening x-ray images of the chest and abdomen, where many parts of the very many body systems are housed. The chest and abdomen are two complex body cavity areas that commonly include evidence of illness, but also may hide that evidence well enough to make further study a necessity.

Once assembled the minimum database may generally imply what body system the problem involves, but less frequently will it tell us exactly what that problem is. Necessary further testing or imaging choices will then be guided by the results of the minimum database. In such cases empiric treatment (non-specific, palliative treatment in the absence of a diagnosis) makes sense. 

Still such efforts may be met with a lack of improvement, or even the masking of signs, frustration and possibly lost time and funds. It is always better to pursue and then treat precisely for an identified problem.

This all assumes of course that a pet owner is motivated to know the diagnosis and treat it precisely. It is up to both pet owner and attending veterinarian to choose their preferred approach and for each to understand and respect the others intentions. Together they decide if they are each a good match for the other. It is not a given that every client and doctor are that kind of match. Whether seeking a diagnosis or treating empirically, both parties must be on the same page.