Tuesday, January 4, 2011

Common Misdiagnoses (Part 2)

by Jennifer Coates, DVM

In my last post, I talked about difficulties diagnosing dermatological and hormonal diseases in dogs.  Now, let’s take a look at conditions affecting the bones and other parts of the musculoskeletal system.

Limping


If a dog has a painful musculoskeletal condition, he will usually favor his affected leg.

If multiple legs are affected, limping may not be so obvious and the dog may simply appear stiff or reluctant to move. 

During a physical examination, a vet will try to pinpoint where in the body the problem lies (e.g., a dog will react painfully to rotation of a hip but not to flexion and extension of his knee), but some dogs are so stoic that they do not “tell” us where it hurts. In other cases, a dog may react like almost everything we do is painful.  Are these guys just wimpy or do they really hurt all over?  Figuring out how to proceed in these cases can be a bit of a challenge.

X-rays are the next step, but they don’t always provide a clear cut answer either.

In some cases, despite knowing exactly where the problem is, the X-rays look normal and don’t help identify the cause of the limp.

X-rays are good for looking at bones but not as useful if the problem involves ligaments, tendons, muscles or other soft tissues.

On the other hand, if multiple abnormalities are found (e.g., arthritis affecting several joints) it can be difficult to determine which is the primary source of a dog’s pain.  It’s not always what looks the worst on an X-ray!
  
The Effect on Treatment Options and Prognosis

Diagnosing the exact cause of a dog’s limp may not be all that important if medical treatment (anti-inflammatories, pain relief, nutritional supplements, etc.) are the treatment of choice since these will help no matter where the problem is located.

But, if a veterinarian is recommending surgery make sure your dog’s diagnosis is solid.

No one will be happy if a dog undergoes a TPLO for a cruciate ligament rupture if his knee is not the real source his pain.

An accurate diagnosis is also necessary when it comes to knowing what the future holds for your dog.

When a large breed dog has hind end pain, owners and sometimes even vets may assume that hip dysplasia and the osteoarthritis that it causes are to blame. However, another common condition called lumbosacral stenosis shouldn’t be overlooked.

This disease looks a lot like hip dysplasia, but it can also cause neurologic dysfunction of the back legs and incontinence, symptoms that don’t fit with hip dysplasia.

And worst of all is also osteosarcoma.  This deadly form of bone cancer is sometimes confused less serious conditions like osteoarthritis in its early stages.

What this all boils down to is, if you are not comfortable with your dog’s diagnosis, talk to your vet.

If he or she cannot explain the situation to your satisfaction and is unwilling look in another direction, get a second or even a third opinion.  When veterinary medicine gets complicated, it never hurts to have more than one imperfect human brain involved in your dog’s care.

***

Jennifer Coates, DVM graduated with honors from the Virginia-Maryland Regional College of Veterinary Medicine in 1999.  In the years since, she has practiced veterinary medicine in Virginia, Wyoming, and Colorado.  She is the author of several books about veterinary medicine and animal care, including the Dictionary of Veterinary Terms: Vet-speak Deciphered for the Non-veterinarian

Jennifer also writes short stories that focus on the strength and importance of the human-animal bond and freelance articles relating to a variety of animal care and veterinary topics.  Dr. Coates lives in Fort Collins, Colorado with her husband, daughter, and pets.

Related articles:
Common Misdiagnoses (Part 1)
A Word on Second Opinions
It's Your Dog's Health!
Veterinary Drive-Thru: Coming Soon To A Veterinary Hospital Near You!
Does Your Vet Listen To You?
Help! My Dog Is Purple!
A Praise To Our Dog House DVM
A Word On Pain

8 comments

  1. Very true. Really, the more minds working on a problem the better, right? Thanks for another informative post.

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  2. Kristine, it is. Different backgrounds and different opinions allow broader spectrum look and are more likely to arrive to a correct conclusion.

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  3. i'm going to have to come back to read this and your older post because it looks like there's a lot of good information here.

    rufus is a very large [and old] dog and apart from a multitude of medical problems, was diagnosed with cauda equina syndrome last year. the symptoms sound similar to the lumbosacral stenosis you mention, though i have yet to click on the link and fully read.

    thanks for the education!

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  4. Georgia, sorry to hear about Rufus. It is always best to research and/or get a second opinion, even if just to confirm the diagnosis.

    Glad you like my blog, yes, I try to put useful info here.

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  5. Yes, the same thing. Rufus is ancient so not much can be done but palliative care (hope I'm using the right word) now. He was given 6 months to live but made it to this year!

    Reading the post, I cannot stress enough the getting of 2nd and several opinions regarding surgery. Rufus had a major surgery on one of his front legs when he was only about 3. He was a perfectly well dog up till then and we would do kilometres of walks every day. One day, he just fell in the park and couldnt get up again.

    After months of conservative care and getting at least 3 opinions, finally decided to go ahead with surgery. It was conducted by (at that time) the best orthopedic surgeon in Australia. But Rufus was so large, he was over 70kgs then) that the recovery was not good. It took YEARS. He limped and had to wear a bootie during all that time to prevent his nails from bleeding since he couldn't lift the paw. After several followups, we realized there was nothing the surgeon could
    do anymore.

    I think what annoyed me most was that the surgeon had told us that it would probably take 2 to 3 months for him to be walking normally again. To this day, more than 7 years later, Rufus, at best, manages a lopsided walk. I don't know if
    we had a choice about proceeding with surgery. But it is nevertheless a cautionary tale.

    Sorry to have taken up so much space!

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  6. Georgia, I appreciate you sharing! Wow, years for recovery and never really getting all well that's sad :-( What was wrong with the front leg? What surgery did he have done?

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  7. My dog, Judge went to the vet because his chest and legs were swelling. She suggested I go to an internist and have them take a look at it. The internist did an ultrasound and found a mass underneath his armpit and took a fine needle aspiration. The chest swelling contained blood. The results were sarcoma and they suspect hemangiosarcoma, but said they could not be for sure unless they remove the tumor and have a biopsy. First they thought they would need to amputate delay because of the location but a surgeon looked at it and said he is quite sure he could remove the tumor without amputation. My problem is that if it is hemangiosarcoma I would be reluctant to have the surgery because of the low success rate even with surgery and if I knew that it was a different kind of sarcoma the chances would be better for a successful outcome. The surgeon suggested a core needle biopsy to try and find out the kind of sarcoma. He said he took roughly 6 samples all around the mass. The pathology result was Granulation tissue with hemorrhagic debris consistent with the edge of a hematoma. No neoplasms found. The comment section said they cannot rule out cancer at this time because the mass may have formed a hematoma and may have only small areas with cancer cells. Not sure what to do with this info. Could the fna be wrong?

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    Replies
    1. When in doubt, it's always a good idea to seek a second opinion. In this case, though you need to move pretty fast.

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