Veterinary (and human) medicine is at least as much of an art as it is a science. What does this mean for dog owners?
You should consider any diagnosis that your dog receives to be a “work in progress.”
No vet would intentionally misdiagnose a dog, but certain diseases are notoriously difficult to pin down.
If you have been told that your dog has any of the following conditions (or any health problem for that matter), but he is not responding to treatment as expected, the disease is progressing in an unusual manner, or your gut is telling you that something just isn’t right, talk to your vet. He or she should be open to reevaluating the situation. If not, get a second opinion.
Dermatological conditions can be frustrating to diagnose. The skin responds to virtually any insult – bacterial infection, parasites, immune disorders, etc. – with the same symptoms, so diagnostic tests are usually necessary to reveal the cause.
Remember though that no test is perfect, false negatives and false positives do occur, so if lab results do not mesh with a dog’s clinical picture they need to be questioned.
To confuse the situation, even more, some skin problems, like bacterial or yeast infections, almost always develop because there is an underlying condition that has disrupted the skin’s normal defensive mechanisms.
If your dog has been diagnosed with a skin infection and it either doesn’t go away with treatment or comes back when treatment is stopped, you and your vet will need to start looking for the reason why.
Allergies are a common underlying cause of recurrent skin problems in dogs.
But, the only way to know for sure that a dog has allergies and what his triggers are is through allergy testing. Intradermal allergy tests are best. Blood testing is another option, but the results are not as accurate.
Many vets (myself included) are willing to diagnose allergies without allergy testing after ruling out other common causes of itchy skin. And this is appropriate as long as owners are aware of the plusses and minuses of this approach. If, however, a dog’s condition doesn’t respond to treatment as expected, the initial diagnosis should be reevaluated.
Getting to the bottom of hormonal diseases can also be difficult. Hypothyroidism is an excellent example.
A low total thyroid level on blood work alone is not sufficient to reach a diagnosis of hypothyroidism.
Dogs must also show some of the typical signs of the disease such as
- weight gain
- low energy levels
- cold intolerance
- hair loss, or skin problems
These issues should improve once thyroid supplementation has been started.
A condition called sick euthyroid syndrome can also cause thyroid hormone levels to fall, but this is not true hypothyroidism and treatment with thyroid supplements is not beneficial.
Cushing’s disease is another tough one.
A vet might suspect its presence after if they find
- elevated alkaline phosphatase (ALP) levels on routine blood work or
- high cortisol levels on a urine test
Still, either a low dose dexamethasone suppression test or an ACTH stimulation test is necessary to confirm the diagnosis.
However, such advanced testing may not be necessary early in the course of the disease because in most cases, Cushing’s disease shouldn’t be treated unless a dog has symptoms that are starting to interfere with its quality of life (e.g., increased appetite, thirst, and urination, skin and coat problems, or a pot-bellied appearance). This is another situation where a big-picture approach is necessary.
Addison’s disease is probably even more frequently misdiagnosed than is Cushing’s.
The typical symptoms – vomiting, diarrhea, weakness, collapse – can occur as a result of a whole laundry list of health problems. In many cases, a fairly distinctive change in blood electrolyte levels occurs with Addison’s disease. But electrolytes are not always included in panels of routine blood work. Also, not every victim of Addison’s has these electrolyte changes.
An ACTH stimulation test is the only conclusive way to determine whether or not Addison’s is responsible for a dog’s clinical signs.
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