Yesterday, I gave you a long list of acronyms that I commonly use in veterinary practice. Today, I’m going to talk about one that I probably don’t use as often as I should — DAMN IT. Yes, it’s more than just an expletive to blurt out when something doesn’t go according to plan; DAMN IT is also a useful mnemonic device for doctors. Here’s how it’s put it into action.
A while back, I saw an 18-year-old kitty that had been diagnosed with renal failure a year previously and was being treated for it, albeit not very aggressively. She had been doing well until she became constipated, had blood in her stool, lost her appetite, and was somewhat lethargic. The owner basically told me that she didn’t want to do any more diagnostic testing, but if I could come up with a reasonably-priced treatment plan based only on the findings of a physical exam, she’d consider that option instead of euthanasia.
Arrg! The list of this kitty’s potential problems was pretty long. Was the renal failure worse and the resulting dehydration leading to hard stools that were difficult to pass? Could she have megacolon, parasites, or maybe even an intestinal foreign body? The physical exam was pretty unremarkable: tiny kidneys, an empty colon, a non-painful abdomen, mild dehydration, and everything else was WNL (see yesterday’s post for a definition of that one).
I was having difficulty coming up with a reasonable way to approach this case until I remembered "DAMN IT."
Veterinarians use the DAMN IT acronym to help recall all the potential causes of a pet’s symptoms and to narrow down the list of possible underlying problems. This is essential to developing an efficient plan for diagnosis and treatment.
Each letter stands for a couple (or more) disease categories, for example:
D = Degenerative or Developmental
A = Anomalous or Autoimmune
M = Metabolic, Mechanical, or Mental
N = Nutritional or Neoplastic
I = Inflammatory, Infectious, Ischemic, Immune-mediated, Inherited, Iatrogenic, or Idiopathic
T = Traumatic or Toxic
The chances that a veterinarian will overlook a disease with a high probability of being to blame for a patient’s symptoms is pretty low as long as he or she thinks through each category .
In this cat’s case, my best educated "guess" based on her physical exam, lifestyle, and history was that her renal failure had worsened and needed to be treated more aggressively. So I increased the amount of subcutaneous fluids she was getting, changed her diet, and encouraged her owner to give the gastroprotectants and stool softeners that had been previously prescribed on a regular basis. This treatment plan was ideal because it could potentially improve several of the other possibilities that were on my differential diagnoses list and at the very least, wasn’t going to do the cat any harm.
The next time you hear your veterinarian muttering, "DAMN IT. D… Degenerative, Developmental; A… Anomalous…" you can rest assured that he or she is not having a breakdown.
Dr. Jennifer Coates