Hyper-para-whozits? Chasing that elusive diagnosis
“If you hear hoofbeats, think horses, not zebras,” is an old adage most often attributed to Theodore Woodward, MD, a physician, researcher and instructor at the University of Maryland in the 1940s. Most of us who work in the medical fields have heard it and consider it sage advice when formulating a list of possible diagnoses for a patient. My veterinary school instructors expanded it to also add the admonishment that looking for dinosaurs is even more unproductive.
Medical and veterinary school is a time of copious learning — so many strange and interesting and exotic ailments are introduced to the students, it boggles the mind to fathom how much information must be researched, discussed and committed to memory in such a short time.
Much of what we studiously learned is housed in a dusty corner of our brains, perhaps never again to see daylight. Every now and then, however, a particularly difficult case comes in front of us, and we are challenged to reach far, far back in the folds of our gray matter to extract that weird but super-cool diagnosis out of the recesses.
We have no ordinary days in veterinary medicine. Sure, some days I may get lucky and have nothing but cute, healthy puppy and kitten visits all day long. But that’s not usual.
My appointment schedule pretty much NEVER looks the same from the beginning of the day to the end. Appointments are cancelled and added, an emergency surgery may arrive at the end of a long, difficult day and some days (or weeks) are spent puzzling through multiple complicated cases. It keeps life interesting and challenging. No day will be like the last.
Medicine is not always straightforward. Patients don’t always read the book and follow all the expected clinical signs that are hallmarks for particular diseases. Sometimes the test results don’t jive with the symptoms a patient is experiencing.
I find it particularly vexing when we can’t explain all of a patient’s symptoms with just one neat, clean, tidy, diagnosis. Sick patients may have two, three or more separate diseases happening all at the same time — an annoying but regular occurrence in our geriatric cases. Add to this the fact that veterinary patients can’t “use their words” to simply tell you how they’re feeling or where they hurt, and, well, challenge accepted!
I heard someone say once that he’d like a job like that TV doctor, (from “House, MD”) who just gets paid to sit around in his office with his feet up all day, doing nothing. Apparently, this person didn’t actually watch the show. Sure, Dr. Gregory House did spend an inordinate amount of time tossing a ball around in his office, and aggravating his underling residents and interns, but he was also an experienced, brilliant physician. He was being paid to THINK. He was employed for his expertise.
The whole premise of the show was that Dr. House was an out-of-the-box thinker who was good at finding… wait for it… zebras: The bizarre presentations of normal diseases, the exotic illnesses that just shouldn’t be happening, the seemingly impossible, strange, mysterious scenarios that nobody heretofore could unravel and solve.
To make a diagnosis of some odd, uncommon ailment brings relief and feelings of success. My parents’ dog, Westley, after repeated tests, medical trials, surgeries and specialist visits, was diagnosed with hyperparathyroidism — a disease that caused him to have an elevated blood calcium, triggered by a tiny tumor on one of his parathyroid glands. Last year, I diagnosed a patient with pseudohermaphroditism — a rare disorder resulting in a transgender animal possessing a combination of girl and boy parts. We doctors live for that “Aha!” moment.
Some diseases once thought to be exotic illnesses, not prevalent in this area of the country are emerging as bigger health concerns. Lyme disease is now ubiquitous here in Pennsylvania, when 30 years ago, it was considered strange and unlikely. Leptospirosis, a bacterial infection spread by wild rodents, once thought to be found in only developing foreign countries with poor sanitation and tropical weather conditions is now part of our regular rule-outs for dogs with a sudden onset of liver and kidney disease.
But then: Horses. Online medical symptom-checkers are cool, but can cause owners unnecessary angst.
Sometimes a bellyache’s just a bellyache, because dogs eat stupid stuff and cats tend to gorge and purge. And, the chance of that suddenly wicked-itchy, rash being anything but fleas is pretty slim, playing the law of averages.
Here’s my spin on the old “if you hear hoofbeats, think horses” turn of phrase: If you hear hoofbeats, get out of the way. It may just be a pack of five dogs galumphing to the back door for a potty break.
— Daverio is a veterinarian at Williamsport West Veterinary Hospital. Her column is published every other Sunday in the Lifestyle section. She can be reached at firstname.lastname@example.org.