According to Merriam-Webster, a diagnosis is the act of differentiating disease from its signs and symptoms.
Did you notice that most medical terminology is more likely to describe a problem instead of explaining it? How does that translate into a successful treatment?
What is and isn’t a diagnosis
A diagnosis that offers neither a solution
Gregory House, MD
or an explanation is not a diagnosis.
A diagnosis is getting to the bottom of a problem and figuring the root cause. A good diagnosis answers not only the question of what but also the question of why.
The why is where the true solution lies.
The solution is at the root of the problem
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.
The symptoms
About a week ago she mentioned that it seemed that a couple of the fish were not eating. She did go to 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.
The problem
The nitrate levels in the tank were off the charts.
The underlying cause
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.
The medical term
I am not an expert on fish, but I assume that the fish probably had ichthyophtirius, or something like that.
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? The real problem was too much food. Everything else stemmed from that.
The mother of all lame diagnoses
The mother of all lame diagnoses is idiopathic “one-thing-or-another.”
Such a diagnosis admits three things:
- we know that there should be a discernible cause
- we have no idea what the cause is
- 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 (Yeah, I love my HouseMD quotes)
Such a diagnosis is an admission of defeat. It often means that present medical science doesn’t have the will or the means to get to the root of the problem.
Answers in plain sight
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.”
I wonder how many treatments for pain in the eye one might need to undergo before somebody figures it out.
Worse than lame
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!
Sounds legit
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. What do you think? How do these measure up as diagnoses?
One-thing-or-anotheritis
There is quite a long list of conditions that fit in this category; from arthritis to vulvovaginitis—yeah, I did have to look that one up—they cover most of the alphabet.
What are they? The suffix -itis stands for inflammation. The word before the suffix indicates the involved organ.
- arthritis is inflammation of one or more joints
- dermatitis inflammation of the skin
- gastroenteritis inflammation of the stomach and intestines
- and so on
These all sound very authoritative, but if you look them up and find out what the medical words stand for, they become less threatening and more understandable. The important question is, are these good enough diagnoses to go on?
And the answer? It depends.
What is inflammation?
To better understand this, let’s take a look at what inflammation is. Inflammation is the immune system’s response to harmful stimuli, such as trauma, pathogens or irritants.
It is the body’s self-defense mechanism to protect itself and initiate the healing process. In fact, without inflammation, wounds and infections would never heal! Ok, wait a minute—if inflammation is such a good thing, how does it become a medical issue then?
The most obvious reason is – it hurts! (or itches in case of dermatitis for example).
More importantly, though, often the immune system needs some help to get the job done. If you get a splinter, you can leave it up to the immune system to force it out—which eventually might work—or you can help it along by taking the splinter out.
Underlying cause of inflammation
And there also lies the answer to our earlier question. The best way to deal with inflammation is by dealing with its underlying cause!
That is sometimes easier said than done though.
The potential causes can be many:
- injuries
- foreign bodies
- invaders real (parasites, fungi, bacteria, viruses)
- or imaginary (allergies or autoimmune disease).
Clearly, some of these are easier to deal with than others.
Injuries and foreign bodies are a pretty straightforward matter. Infections not so much; allergies and autoimmune diseases—those are real nightmares.
Why would your dog’s immune system need help with infections?
That is a good question. The world is full of bacteria and fungi and viruses … isn’t that what the immune system is for?
True, but sometimes the defenses can be overwhelmed. An infection isn’t really the presence of the bacteria, fungi or viruses … infection is when they make it through the fortifications and start taking over.
A battle field
Inflammation is a battle in progress.
The inflammation is the problem that we see—that’s what we want to treat. But what would be the result if we made that happen in this case? We’d be handing the enemy the key to the castle!
What we need to do, is to deal with the enemy.
To complicate matters further, each of these invaders requires different weapons.
“Never bring a knife to a gunfight!” Antibiotics won’t work against fungi or viruses, antifungal medications won’t do anything for a bacterial infection …
Infections are one of the most common causes of inflammation. It is always important to determine what type of infection you’re dealing with.
But things are not always as simple as that.
Otitis
Let’s say your dog was diagnosed with otitis.
Otitis is often used as a synonym for an ear infection, though the word really stands for inflammation of the ear. Infection, however, is usually involved.
Read more about ear infection: Angry Vet On Ear Infections
The most common type of ear infection is “otitis externa” where the infection and inflammation are limited to the outer ear canal. You might have noticed a bad odor or discharge, redness or swelling, head shaking, scratching or rubbing at the ears …
The infection can be bacterial, fungal or parasitic (ear mites).
You don’t want a treatment based on an assumption; you want to know for sure what the cause is because the treatment is different for each type of infection.
What caused the infection?
Now the question is what caused the infection in the first place. A one-time infection can have a simple cause and might not come back after appropriate treatment.
For example, a bacterial infection could have been caused by a foreign body (e.g., a grass awn or Foxtail) or trauma that disrupts the normal protective mechanisms of the ear. (Of course, the foreign body must be removed for the infection to go away).
A yeast infection might follow after antibiotic treatment of bacterial otitis.
When he was grading our papers, our English professor would always say, “One mistake – no mistake,” and give an A on a paper with just one error.
Chronic otitis
Chronic cases, however, are a different story.
In some dogs, the anatomy of the ear itself can make it susceptible to infections. Think Cocker Spaniels with their floppy ears – cute, but they trap dampness and debris inside making them virtual Petri dishes for infection. With some extra care, owners can often manage these types of situations.
However, ear infections can be secondary to other conditions, such as allergies or other systemic diseases!
Dogs suffering from allergies are also susceptible to ear infections. In fact, recurring otitis can be the first warning sign of an allergy problem.
Some hormonal imbalances also lead to frequent infections, including otitis.
For example, Cushing’s disease (hyperadrenocorticism) is caused by the overproduction of the hormone cortisol. High cortisol levels suppress the immune system and make dogs more susceptible to infections. As you can see, as medical and definitive as the term otitis might sound, it requires further qualification and in recurring cases warrants additional investigation for an underlying cause.
Summary
I hope these examples will help you think about your dog’s medical problems effectively. Which means peeling the onion until you get to the root cause. Because that’s where the real solution lies.
If getting to the bottom of things means further testing, than further testing needs to be done.
Related articles:
A Word On Second Opinions
Common Limping Misdiagnoses in Dogs
Allergies in Dogs: Common, Commonly Misdiagnosed, or Both?
Further reading:
Veterinary diagnostics