Tuesday, October 23, 2012

The Whole Picture: When The Test Results Don't Match What's In Front Of You

by Nancy Kay, DVM    

As is true for all health care professionals, veterinarians sometimes develop tunnel vision. Now and then, they become so focused on test results that they fail to consider whether or not these results actually make sense in relationship to the animal sitting atop their exam room table.

When the patient’s appearance says one thing and test results indicate something different, astute veterinarians know to dig a bit deeper in order to reconcile the discrepancy.  

Recommendations based solely upon test results have the potential to seriously undermine a positive outcome.

Barney

Barney, a 14-year-old Siamese kitty, received a physical exam along with blood and urine testing during his “senior wellness” visit.

Much to everyone’s surprise, the laboratory test results indicated that Barney had advanced stage kidney failure. 

This news was shocking, as Barney appeared so normal at home and he had passed his physical examination with flying colors. The test results simply didn’t make sense.

Should Barney’s veterinarian have prescribed treatment for the kidney failure? 

No way! Rather, this savvy vet collected a second set of blood and urine samples for resubmission to the lab. Lo and behold, this time all of the results were normal. How could this be? Simple, there must have been a mixup of samples at the lab. While such an occurrence is uncommon, it certainly can and does happen.

Fortunately, a heads up veterinarian who focused on the patient as well as the test results prevented this situation from morphing into a medical comedy of errors.

Rascal

A six-year-old mixed breed dog named Rascal was evaluated for vomiting and profound weight loss. His weight had dropped from 65 pounds to 52 pounds over the course of six weeks.


Blood test results identified that this poor dog was in liver failure. 

A thyroid level (part of the blood panel) was lower than normal suggesting that Rascal was hypothyroid (producing inadequate thyroid hormone).

The veterinarian hospitalized Rascal for treatment of his liver disease and started him on a course of thyroid hormone replacement therapy.

Had this veterinarian considered his patient as well as the test results, he would have questioned the accuracy of the hypothyroid diagnosis. After all, the most common symptom of hypothyroidism is weight gain, not weight loss. Rascal was likely experiencing “sick euthyroid syndrome” in which significant illness causes a false positive diagnosis of hypothyroidism (the dog is not truly hypothyroid, but appears so on paper).

Poor Rascal was already much too thin, and the addition of thyroid hormone would only serve to promote more weight loss.

In this case, the veterinarian acted based solely on test results while ignoring the evidence presented by the patient.

While I would love to have you believe that all veterinarians understand the importance of weighing in on the appearance of the patient in conjunction with test results, such is not always the case.

As your pet’s medical advocate, I encourage you to question things that don’t make sense. 

Has your dog been diagnosed with a disease, yet you’ve not observed any of the typical symptoms? Has the X-ray documented an abnormality in your cat’s left front leg, but you are quite certain her right front leg is the one that is painful? As the team captain of your pet’s health care team, speak up and speak out- as loudly and persistently as necessary to make sure that things make sense.

Have you ever been provided with a diagnosis that didn’t make sense? Has nonsensical therapy ever been recommended? If so, how did you respond?

***
Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook


Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

Articles by Dr. Kay:
Reasonable Expectations: The Ability to Discuss Your Internet Research With Your Vet
Finding Dr. Wonderful And Your Mutt's Mayo Clinic: Getting Started
Even The Best Veterinarian Can Make A Mistake
A Different Way to Spay
Making Tough Medical Decisions For Your Dog: Lily's Story
If You Don't Know What A Lick Granuloma Is, Count Your Blessings!
Anesthesia-Free Dental Cleaning 
Talking Teeth 
Urinary Accidents
I Can't Believe He Ate That! Foreign Body Ingestion 
What Caused Murphy's And Ruska'sPneumothorax? 

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