 | | | Dr. Mona Miller lives in Lafayette with her young son, two cats and Luka a new puppy. She has worked at Four Seasons Animal Hospital in Lafayette since moving here in 2001. She attended Cal as an undergrad, and received her DVM from U.C. Davis. She can be reached at Four Seasons, 938-7700, or by email to MonaSDVM@aol.com.
| | | | | | Frequently I am asked what purpose is served by performing diagnostic tests on a patient with symptoms of illness. It surprises me because it seems so clear to me that, like human diseases, some veterinary diseases can be easy to diagnose and some can be difficult. It also surprises me when the comment comes up "But my dog/cat has never been sick a day in his life" as if that is insurance that he never will be sick. Similarly, comments about how old a pet is and why bother running "all these expensive tests since he'll only live a couple more years" catch me off-guard.
I encourage my clients to not make assumptions, especially when it comes to matters of diagnostic possibilities, treatment plans and cost, just as I should not make assumptions about my clients. There is huge variation among people as to what is affordable and reasonable. It is the vet's job to provide information, options and guidance to their clients. It is the client's responsibility to inform their vet of their limitations. Thus, from the partnership of vet-client, good health decisions can be made for pets. These decisions should fit within a framework of the client's lifestyle, philosophical ideals and morals, and budget.
Generally, veterinarians take a step-wise approach to diagnostics, starting with a wide view to gain as much broad information as possible and narrowing the tests as results indicate. This often correlates with a financial step-wise approach, starting with relatively less expensive blood, urine, fecal tests and radiographs. It also pairs with a less invasive physiological approach to the pet. The majority of pets can have blood, urine and radiographs taken without sedation or anesthesia. More specific tests can often also be performed while the pet is awake, such as culture of an abscess or ultrasound; although occasionally sedation is recommended for these. Tests that require sedation or anesthesia are often put higher on the diagnostic ladder, such as biopsy procedures, advanced imaging such as CT or MRI scans, or exploratory surgery.
The broad overview approach allows for the veterinarian to uncover abnormalities that might provide a quick diagnosis. Just as importantly, this allows for normal findings to be uncovered. For example, for a cat who is drinking and urinating in larger volumes, a simple and fairly comprehensive blood and urine test can reveal whether diabetes mellitus is present while eliminating thyroid, liver and kidney disease all in one step.
On occasion, just as in human medicine, broad-based diagnostics do not provide the diagnosis, and the test field narrows. More specific tests might be indicated - for example, checking for tick-borne disease, or bacterial presence with a culture/sensitivity, or looking into the interior structure of the liver with ultrasound.
Sometimes clients wonder "why were all those tests run when they didn't show anything?" As I tell my clients, if I had the crystal ball and knew what their pet's disease was, I'd know what test to run to diagnose it! It is important to go through the process of screening for the more common, more easily diagnosed diseases so that nothing is missed, before jumping into too narrow of a test. Additionally, information gathered regarding normal organ function in that patient will affect an overall treatment plan and prognosis.
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Lamorinda Weekly, Moraga CA