The Friday afternoon schedule of a veterinarian is very predictable. Three or four of the appointments will be for animals that have been sick since Monday. But the weekend is coming and the owner wants to know that their pet will be alright and avoid a visit to an emergency clinic.
The assumption on the pet owner’s part is that symptoms are specific for the hundreds of diseases that pets suffer from, and that the vet should be able to tell exactly what is wrong just by witnessing the symptom or by its description. This is seldom possible. It is even more challenging when the pet’s only symptom is ADR (Ain’t Doin’ Right).
What are "Symptoms"?
Symptoms are not diseases. They are responses to a disease or disorder. Bodies are made up of distinct systems that work in harmony with each other. Every system has a unique way of indicating problems. The symptoms are the same no matter what the condition. Trouble in the stomach and intestines will always result in vomiting and/or diarrhea. Liver, kidney and pancreas problems may also cause vomiting and diarrhea. Problems with the lungs, heart or trachea will always result in a cough. Diseases of the skin will always result in rashes, plaques, pimples and hair loss. Kidney and bladder problems always result in increased water consumption and/or increased urination. Skeletal and joint problems always produce a limp.
Symptoms locate the area of disease but don’t identify the culprit. Any given symptom could be caused by 50-80 conditions. Each condition may require a different treatment. Veterinarians are trained to treat diseases, not symptoms. We may treat symptoms, but not at the expense of treating the disease. So how does the vet find the right treatment? That requires the right diagnostics.
Specific Symptoms Require Specific Diagnostics
The method of diagnosis is based on the system involved. Coughing always requires a chest and tracheal X-ray. This gives the most specific information about the cough. Routine blood work will reveal nothing about the chest. Specific blood tests may be necessary after the X-ray findings, but are not good initial tests for a cough.
Blood tests also give very little direct information about the stomach and intestines. X-rays and ultrasound are more revealing for ailments of the stomach and intestines. Pancreas, liver, and kidney problems can also cause vomiting and diarrhea. Blood tests do tell us more about those organs than an X-ray. That is why an initial diagnostic work-up for vomiting and diarrhea includes both X-rays and blood work.
X-rays are the best diagnostic tool for limping. Fractures, dislocations and arthritis can, in most cases, be immediately identified. Skin requires a different type of diagnostics. Skin scrapings, scotch tape preparations, and cotton swabs rule out obvious sources of rashes and help point to the next best diagnostic test (allergy testing, skin biopsies, cultures, food trials, etc.).
The point of these examples is that determining the cause of a symptom is like a “CSI” case. It is a systematic diagnostic elimination or inclusion of disease possibilities. It is the same procedure Monday through Friday; there is no magic that happens to veterinary hands on Friday afternoon. Friday afternoon is actually a bad time for diagnostic work-ups in many hospitals, since, generally, blood work results won’t be available until Saturday. This means that owners may not get the results until the following Monday. Depending on staffing and appointment load, X-rays may take more time. And if the pet needs an IV catheter and fluid therapy, 2-3 hours on Friday is not enough time to rehydrate. The reality is that most serious cases seen on a Friday will end up at the emergency clinic for further diagnostics and treatment.
Veterinary diagnostics and disease treatment is a process, not a product. Don’t sit on symptoms waiting for some Friday Night Magic from the vet.
Dr. Ken Tudor