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

As is true for all healthcare 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 relation 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.

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

Barney’s story

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.

Barney’s veterinarian’s decision

Should Barney’s veterinarian have prescribed treatment for 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’s story

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. That suggested that Rascal was hypothyroid (producing inadequate thyroid hormone).

Rascal’s veterinarian’s decision

The veterinarian hospitalized Rascal for the treatment of his liver disease. And he 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.” A 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.

Question things that don’t make sense

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 healthcare 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?

Related articles:
Interpreting Lab Results in Context: Cookie’s Elevated Kidney Values

Further reading:
Five Red Flag Indicators That It’s Time to Find a New Vet

Categories: DiagnosesDog health advocacyWorking with Veterinarians

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Dr. Nancy Kay

Dr. Nancy Kay wanted to become a veterinarian for just about as long as she can remember. Her veterinary degree is from Cornell College of Veterinary Medicine, and she completed her residency training in small animal internal medicine at the University of California-Davis Veterinary School. Dr. Kay is a board-certified specialist in the American College of Veterinary Internal Medicine and published in several professional journals and textbooks. She lectures professionally to regional and national audiences, and one of her favorite lecture topics is communication between veterinarians and their clients. Since the release of her book, Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life, Dr. Kay has lectured extensively and written numerous magazine articles on the topic of medical advocacy and veterinarian/client communication. She was a featured guest on the popular National Public Radio show, Fresh Air with Terry Gross. Dr. Kay's newest book is called, Your Dog's Best Health: A Dozen Reasonable Things to Expect From Your Vet. Her award-winning blog, "Spot Speaks" is posted weekly (www.speakingforspot.com/blog). Dr. Kay was selected by the American Animal Hospital Association to receive the 2009 Hill�s Animal Welfare and Humane Ethics Award. This award is given annually to a veterinarian or nonveterinarian who has advanced animal welfare through extraordinary service or by furthering humane principles, education, and understanding. Dr. Kay was selected as the 2011 Leo K. Bustad Companion Animal Veterinarian of the Year, an award presented every year by the American Veterinary Medical Association to a veterinarian whose work exemplifies and promotes the human-animal bond. Dr. Kay has received several awards from the Dog Writer�s Association of America. Dr. Kay's personal life revolves around her husband (also a veterinarian), her three children (none of whom aspire to be veterinarians) and their menagerie of four-legged family members. When she's not writing, she spends her spare moments in the garden or riding atop her favorite horse. Dr. Kay and her husband reside in Hendersonville, North Carolina.

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