Tuesday, April 5, 2011

Medical Terms That Sound Like A Diagnosis But Really Are Not (Part I)

“Diagnosis that offers neither a solution
or an explanation is not a diagnosis.”

Gregory House, MD

What really is a diagnosis?

According to wikipedia, a diagnosis (from an ancient Greek word that stands for discernment) is the identification of the nature and cause of [an illness].

In other words, getting to the bottom of a problem.

Why is this important?

A good diagnoses answers not only the question of what, but also the question of why.

The why is where the true solution lies.

I spent several days trying to come up with a good way to illustrate my point. And then the right story fell into my lap.

Recently, my mom got a fish tank with a few fish.

About a week ago she mentioned that it seemed that couple of the fish were not eating. She did go the the pet store she got the fish from, but the owner wasn't there, and the clerk told her that they definitely must be eating. Well, perhaps.

The other day she noticed that one of those two fish broke out with some kind of rash.

She took the fish out of the tank, put it in a glass and went to the pet store again. This time the owner was there.

He checked out the fish and told mom to take it back home; he was going to come over that afternoon.

He showed up equipped with an arsenal of vials and diagnostic thingies. He scrutinized the other fish, the tank, and the water chemistry.

Apparently, nitrate levels were off the charts!

Then he interrogated mom and found out that—with best intentions—she was overfeeding the fish! That's what led to the high nitrate levels, which then led to the fish getting sick.

He did treat the water with a liquid from one of his vials. He also treated the water with the sick fish, which he then took with him to see if he can bring it back to health. Then he gave mom detailed feeding and tank care instructions.

I am not an expert on fish, but I assume that the fish probably had ichthyophtirius, or something like that.

What is the point of this story?

Ichthyophtirius certainly sounds like a diagnosis, doesn't it? He could have easily stopped there, couldn't he?

But would that address the REAL problem?

Not for long.

*** 

The mother of all lame diagnoses is idiopathic “one-thing-or-another.”

Such a diagnosis admits three things:
  1. we know that there should be a discernible cause for whatever is wrong (otherwise there would be no need for the qualifying adjective)
  2. we have no idea what the cause is
  3. we gave up trying to figure it out

“Idiopathic, from the Latin word idiot; meaning we're idiots cause we can't figure out what's causing it.”
Gregory House, MD

Such a diagnosis really is an admission of defeat. 

Unfortunately, such a diagnosis often means that present medical science doesn't have the tools to get to the root of the problem.

What if sometimes the answer is hiding in plain sight?

This silly joke comes to my mind:
Patient: “My eye hurts when I drink coffee.”
Doctor: “Next time try taking out the spoon.”

Of course one could attempt to treat the eye somehow or manage the pain .. taking out the spoon, however, is much better solution, don't you think?

That's why getting to the bottom of things is so important.

In defense of idiopathic “one-thing-or-another” diagnoses, I have to say that I met with much worse.

As with Jasmine's chronic diarrhea, where the conclusion—as we were told then—was. that she has a delicate system. Or just recently, when my friend's dog was diagnosed with very sick intestines.

To top it off, both of these conditions got treated!

Quite often, though, you might encounter a medical term that truly does sound like a diagnosis.

Dermatitis, uveitis, otitis … just for a couple of examples. They do indeed describe the problem; in this case inflammation of the skin, eye or ear, respectively.

What do you think, are these final diagnoses?


It's your dog's health,
Jana

Related articles:
Medical Terms That Sound Like A Diagnosis But Really Are Not: One-thing-or-anotheritis

11 comments

  1. They are a diagnosis, but don't necessarily say what caused them. However many diagnosis are all you need because the diagnosis and cause are one.

    Just my 2 cents :)

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  2. Idiopathic diagnoses really get to me! "Allergic rhinitis" and "head colds" kept us from finding the cancer in my dog's nose until it was well rooted. Not to mention the rampant "IBS" in many dogs that is treated with steroids... indefinitely. Should we do a diet change? Oh no, Science Diet Prescription Diet and some daily Pred will take care of it!

    Anyways... before I get too verbose, idiopathic diagnoses as an ending point are unacceptable in my opinion. Treating the symptoms instead of really looking for the cause has killed many a dog. If the dog presents signs of an idiopathic illness, I think that using that diagnosis is appropriate as long as the true root is still being pursued.

    I guess this is why they call it "practicing" veterinary medicine though, right? I'm glad I have a vet now that will work with me to get to the bottom of things; if only everyone was so lucky.

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  3. Hi Sisko, thank you for reading and commenting!

    Can you successfully treat them without having to dig deeper?

    Inflammation is part of the body's defense mechanism. The question then is, what is the body trying to fix? Physical trauma? Bacterial infection? Fungal infection? Parasites?

    Stay tuned for part two :-)

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  4. Hi Serissime, thank you for commenting. So sorry about your dog :-(

    Jasmine is actually one of the dogs with IBD. She also got a Science Diet Prescription diet then. And guess what? Turned out that her IBD was due to food allergies, and that the prescription diet she got contained almost all the ingredients she was allergic to!

    We never went with steroids, she is doing fine now with a special diet and TCVM herbs.

    The problem is when the investigation is abandoned in the middle. It's like a murder scene. You have a victim, you figure out the cause of death -- you still have to catch the killer!

    Allergies, unfortunately, are so common that way too often they are jumped to as a conclusion while something else is going on. Even dogs with syringomyelia are often diagnosed with allergies instead.

    LOL I love the note about "practicing" medicine :-)

    I am very happy that you have a vet now that wants to get to the bottom of things. We found one like that two years ago, we are so thankful we did.

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  5. PS: @serissime

    I'd love if if you'd share your "Allergic rhinitis" story on my blog, if you feel up to it.

    Just as a note, chronic inflammation is one of the contributors to cancer. So there is the slight chance that the rhinitis really was at the root of the cancer.

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  6. Jana,
    The analogy of the murder investigation is very apt! And I don't mind at all to share our story, but the rhinitis phase is the shortest and least interesting part.

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  7. Serissime, well, doesn't have to be shortest, I don't think. And interesting or not, seems important to me ...? You could tell about how it started, what symptoms there were, how it was diagnosed, what treatments, whether or not the symptoms progressed or new ones popped up.

    The idea being to prevent this from happening to another dog.

    ReplyDelete
  8. Yes, inflammation and cancer are often just different parts along the same road. As a vet, I hear and take humble note of your points on 'idiopathic' diagnosis, having been guilty of this myself. The point with any diagnosis is...what do you do with the diagnosis and does it change our treatment plan?

    So diagnosing an infection is great but as Jana said you need to look a little deeper than that. Conversely, if the treatments are unlikely to change then there is little to be gained by naming something.

    Case in point is Arthritis. It is a very non-specific diagnosis, it literally means 'inflamed joint'. Why is the joint inflamed? Often we don't know, but short of some surgical interventions the treatments will be the same no matter what is causing the arthritis. So we just keep a broad diagnosis and then see how treatments play out. Hopefully, we will get more targeted treatments in the future.

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  9. Hi Dr. Chris, thank you so much for reading and commenting!

    Yes, you're right that there is no point going deeper if there is nothing to gain in terms of a better treatment. That's why I liked the aquarium fish story, as there, clearly, digging deeper discovered the root issue and it did change the long-term treatment plan. That, ultimately, would be the goal of the diagnostic journey.

    Perhaps even with arthritis or cancer the light bulb will go off and show the real problem. I noticed some arthritis research is done into the proteins of the synovial fluid in arthritic and healthy dogs; it's like following breadcrumbs which one day might bring us all the way home.

    With things like cancer I think it is most difficult. If we indeed discover that the environment and other outside influences, like in the fish tank story, is to blame, can we actually do anything about it?

    If we discover that genetics are to blame, that is a long path to recovery.

    Still though, I'd like to know. Only when we know we can attempt to do something about it.

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  10. Hi Y'all,

    Often the treatment relieves the problem and the person or animal seems to have improved and nothing resurfaces. However in chronic cases I think to keep repeating the same treatment and not looking further is a huge error.

    If I had not kept looking for answers with Hawk, he would still be taking regular series of antibiotics and living on Science Diet ZD Ultra.

    Thanks for a thoughtful post.

    BrownDog's Momma

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  11. Hi BrownDog's Momma, thank you for dropping by!

    Yes, you're right, it reminds me of our old English professor. When grading, he'd always say, "One mistake - no mistake."

    One occurrence - no occurrence. But chronic issues are very different story. Getting to the bottom of things is crucial there.

    Hawk is lucky to have such a dedicated mom!

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