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Postcards September 2021 - Cool Cases Illustrating the Importance of Diagnostics

Why do veterinarians recommend additional diagnostics after they complete your pet’s physical exam? Different diagnostics are needed to help obtain additional information that will give additional pieces “to the puzzle” to help solve the problem occurring with your pet. Sometimes treatment recommendations can be made with the physical exam alone, without additional diagnostics. But other times it’s good to have a definitive diagnosis to treat the exact problem instead of just supportive/symptomatic treatments. Take a look at some of the following cases that might not have been treated properly if additional diagnostics had not been performed.

Additional diagnostics vary from sample evaluations, urine cultures, bloodworks, radiographs, and additional imaging such as ultrasounds or CT scans. Aspirates of masses can help reveal whether the mass is of concern and requiring surgery. Ear cytologies can help pinpoint which medication is best to treat an ear infection. Bloodwork can evaluate different organ systems that can’t be fully evaluated alone with just a physical exam. Imaging can reveal things going on inside that might not be palpated during an examination or just may need additional evaluation after being palpated in an exam. Most of this information holds true in human care as well.

So many cases of routine pre-anesthetic bloodworks reveal abnormalities in what is deemed an otherwise healthy animal being presented for an elective procedure such as a spay or neuter. For example, a young adult cat was presented to be spayed and seemed perfectly normal during the routine pre-anesthetic complete physical exam. However, the bloodwork revealed the cat was anemic, low red blood cells, and even had low platelets. With further diagnostics, the cat was found to have an immune mediated condition which could have caused significant complications during the surgery had the surgery been performed without the required pre-anesthetic labwork. The cat was treated with an aggressive steroid regime which the cat responded well and was able to have the surgery at a later date.

One of the most recent cases that comes to mind showing the importance of radiographs was a dental that was recommended by a fellow vet which only had minimal calculus. Initial instinct was to postpone the dental since visually the teeth did not look too bad. However, once the dog was anesthetized and had full mouth dental radiographs, 3 abscessed teeth were found that had to be surgically extracted. The teeth looked perfectly normal even under anesthesia. It wasn’t until the dental radiographs were done that the abscesses could be seen below the gumline. Left in place, this causes severe pain and infection and can lead to kidney or even heart conditions, not to mention the headache a tooth abscess causes.

Plain survey radiographs can be useful for other body systems as well. A puppy had been diagnosed with pneumonia at the emergency clinic 2 weeks prior and was treated with antibiotics. The puppy showed significant improvement, almost back to normal; however, this was an astute owner that knew the importance of follow up radiographs being essential to monitor the condition. The recheck radiographs ended up showing a collapsed lung and an air-filled chest (pneumothorax). A CT scan later revealed the lung had adhered to the thoracic wall and required surgery to remove the affected lung to prevent the air from the damaged lung to continue to leak air into the pleural space of the chest cavity. Luckily the puppy was able to have surgery and recover well, as it was caught in a timely manner versus during a crisis situation.

Ultrasonography is instrumental in furthermore specifically evaluating conditions. An employee’s dog was presented for a routine wellness visit 3 years ago when a very subtle change in the heart rhythm was found along with a minimal heart murmur. An echocardiogram (an ultrasound of the heart) was recommended for further evaluation. The dog was found to have significant heart changes and enlargement which required specific medications targeted to the condition that was only able to be diagnosed with an echo. After six months of targeted therapy, the follow up echo showed significant improvement in the overall heart condition. On a side note, this case was a diet related cardiomyopathy, meaning the heart condition was a result of the dog food the dog had been fed. Dog is doing amazing today!

A couple more interesting ultrasound cases. A dog presented after being hit by a car, needed to have surgery to repair a fractured leg. A week later, the pre-anesthetic exam revealed abnormal heart sounds. An echo revealed the dog had a significantly compromised heart so therefore was not a candidate for anesthesia. Sad case, but at least the owners didn’t lose the dog from anesthesia. The dog is doing well and pain is being managed. Finally, a dog presented for just not doing right and not feeling well. A combination of diagnostics were used to determine the dog’s condition. Initially bloodwork revealed elevation in a couple of liver enzymes and some mild kidney enzyme elevations. An abdominal ultrasound was recommended that revealed the dog had a gallbladder stone that had caused a previous rupture within the gallbladder requiring surgery.

Some of these cases may seem a little extreme, but there are so many other situations where diagnostics can help pinpoint the exact cause of a condition that can be treated with specific targeted therapy versus just supportive treatments. If you are not sure why your veterinarian may recommend specifics tests or diagnostics, don’t hesitate to ask for an explanation of what is being looked for and why the test is important.

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