Understanding why your veterinarian may be recommending diagnostics before sending home medications
I get it all of the time. An animal comes in to be seen with some form of illness - perhaps weight loss, coughing, lethargy, you name it. I perform a physical examination and start to go over the list of possibilities. I then explain to owners that I recommend performing diagnostics to help figure out what's going on. And then the dreaded question - "you mean you've looked at him and can't tell what's going on? You're the doctor!"
So why can't I tell just from looking at him?
Animals cannot talk to us. When a pet comes in to visit, we rely on the information an owner has from home about their pet, our physical exam, and diagnostics in order to know what is wrong. Sometimes there are obvious abnormalities, such as a broken toe nail or a small cut. These usually won't require extensive workup, depending on the circumstances. However, when pets come in for non-specific signs such as decreased appetite or lethargy, their physical exam may appear completely normal so we rely on test results to guide our plan.
Some medications can have serious contraindications. Did you know that non-steroidal anti-inflammatory drugs generally should not be used in pets with liver or kidney disease? Or if a pet has an obstruction in the GI tract causing vomiting and we give medications to stop the vomiting without looking into the cause, that obstruction could break through the intestines and lead to severe infection or even death? In some cases, we recommend performing diagnostics so that we can rule out potential conditions or diseases that could be worsened by a medication or cause a medication to not work.
Prevention and early detection are key to giving pets long, healthy lives. Early heart disease can be treated with medications to help slow its progression. Early diagnosis of cancerous masses can help provide treatment options before the disease has the chance to spread. The intestinal obstruction I mentioned above may be surgically removed before causing permanent damage if it is found in time.
Let's see some examples!
Scenario #1: You bring your 4 year old Poodle in for vomiting and diarrhea. On presentation, he appears quiet and is moderately dehydrated. This could be something as simple as an upset stomach from a mild virus, stress, or indiscriminate ingestion. This could be associated with foreign material, such as part of a toy or towel stuck in the intestines or another form of obstruction such as an intussusception where the intestines telescope on themselves and prevent food material moving through the GI tract. We can also see vomiting and diarrhea secondary to endocrine abnormalities. These are changes that occur from inside the body. Diseases like this can include Addison's Disease, which is essentially where the body fails to produce stress hormone and results in severe electrolyte abnormalities that cause GI signs and marked dehydration. Other processes can include kidney disease, liver or pancreas damage, even diabetes can sometimes present this way. Due to numerous disease processes that can cause an upset stomach, I'll usually recommend x-rays to evaluate for any obvious foreign material, obstructive pattern, free fluid, or mass structures in the abdomen. Typically I'll also recommend lab work - this can include basic blood work to evaluate the liver, kidney, electrolyte, inflammatory response, etc. but can also include parasite screening or even testing cortisol levels (the stress hormone I mentioned above) depending on the individual. Sometimes these results all come back normal - if this is the case, we've ruled out numerous different disease processes that are very serious and are left with those that can be treated simply with medical management. If we start with medical management and don't perform diagnostics to rule out those other abnormalities, we may be delaying life-saving treatments or even hiding signs of those diseases, allowing those illnesses to worsen.
Scenario #2: You notice that your cat has been coughing for the last few weeks and it might be getting worse, it certainly isn't getting better. She is still eating and drinking regularly, her activity might be decreased but you tell us she sleeps a lot anyway. Where we're geographically located, my first thought for a coughing cat would be inflammatory airway disease, such as feline asthma. That being said, we can see coughing secondary to infection such as pneumonia, parasites such as heartworm or lungworm, heart disease, cancerous processes, fungal infections, and more. I'll likely recommend x-rays of the chest and potentially an ECG - we know that heart disease in cats often is not detected just by listening to them. On imaging, we're looking for abnormal shape and size of the heart, fluid in or around the lungs, mass structures, or changes to the vessels. I may recommend lab work, such as parasite testing. If we find evidence of heart disease, lab work is often recommended to evaluate the kidneys because many of the medications to manage heart failure can be very hard on the kidneys. Of course, sometimes we can listen to the lungs and make assumptions from what we're hearing, but we can't have a full picture (no pun intended) without imaging and other tests that allow us to see within the animal.
What about when tests are declined? We understand that it is not always feasible to perform all of the diagnostics and we do our best to come up with a treatment plan for every patient with the information that we do have available to us. That being said, we also ask that owners be understanding when we cannot determine exactly what is wrong without diagnostics - sometimes even with diagnostics we may not have a definitive diagnosis, but can still develop a plan for treatment based on what was ruled out. With any treatment plan, I always think it is important to discuss monitoring your pet once you take them home. There may be more monitoring involved in situations where we don't have a diagnosis and unfortunately, if a pet declines, diagnostics are usually going to be first recommended.
Why am I telling you this? Well, if you've had an appointment with me, you know I am big on educating pet owners. I think it is important that owners understand why I make the recommendations that I do. We are routinely told that all of our recommendations are just to make money, and that just isn't true. Sure, this is a business and yes, we need to make money to stay open. But at the end of the day, my recommendations are based on improving animal health, preventing disease, and helping to make sure you have your furry best friend around as long as possible.
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