Friday, May 14, 2010

The Veterinarian as Detective

We all wear many different hats throughout the day...spouse, child, parent, co-worker, friend, neighbor, sounding board...and your Veterinarian is no different.

A veterinarian may already know what the diagnosis is when initially presented with a sick patient, owner may have walked into the room just as her cat swallowed the last string on the pot roast sitting on the counter (foreign body), or there may have been vomited plant material near a shredded diffenbachia leaf (the toxins mostly act as oral and GI irritants).

But what about a patient that has vague symptoms, or symptoms that are common to any number of conditions? Simple. We can ask, and we can listen to what we're being told.

Dr. Dolittle could talk to and understand animals in their own language but we can't. Fortunately for us, it's the rare cat that comes to the veterinary clinic unaided by a human who can help tell their story.

I was surprised to learn that Dragnet's detective Sargent Joe Friday never said "Just the facts ma'am." exactly. Nevertheless, that's how we all start our own detective work. It's called the medical history. By listening to the owner, and asking our own questions, we receive the first pieces of a complicated puzzle. For example, a casual remark from an owner about how she found ants at the spot her cat urinated (true story) was just the clue that I needed to check her cat for diabetes (bingo!).

The next step in our detective work comes during our physical exam. It is here where we make use of ALL of our senses to determine what our patients body is telling us.

While Dr. Cal Lightner on TVs "Lie to Me" isn't a detective, he's hired by law enforcement to do detective work in the form of interpreting clues gained through careful observation of body language, voice changes and expressions.

You all know basic cat language. You can distinguish the difference in your cats "feed me" meow from the one that says "I really don't like this car ride." You can recognize the difference between your cats straight up happy tail and a straight up fearful tail.

An experienced Veterinarian often picks up more subtle signals. For example a suddenly "finicky cat" may have a particular and recognizable lip licking that often accompanies nausea even if the cat isn't otherwise viually sick.

Sight, sound, touch,and yes, even smell give us clues.

An experienced Veterinarian will go where most owners dare not to go, into the mouth, to find a broken tooth that is so painful that our patient will eat it's canned food but not kibble. A stethoscope allows us to hear a heart murmur, for example, prompting us to check for heart disease, anemia or high blood pressure. We will palpate the abdomen and may feel an empty colon and that lets us know that our patient is not constipated as the owner had thought, but is empty because the cat isn't eating. We then need to look further to discover why. What was dismissed as "kitty breath", may actually be ketoacidosis, a complication of diabetes; an indication that uremic toxins are building up in the bloodstream due to kidney failure, or an infected tumor.

We've just scratched the surface up to this point and often need more clues to reach a diagnosis. Blood & urine tests, x-rays and in some cases, even more special testing round out our fact gathering. Hmmmm, do I sense another hat here? Just like the archeologist, as we dug deeper, and by doing so discover more about our subject.

We've gathered the facts and have used our observational skills and senses. We've gathered more clues with diagnostic testing. We've generated our differential list. Now we're ready to be the ultimate detective, Sherlock Holmes, and sort though the jigsaw pieces, and to put them all together to reach a diagnosis.

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