Senin, 03 Januari 2011

Common Misdiagnoses (Part 2)

by Jennifer Coates, DVM

In my last post, I talked about difficulties diagnosing dermatological and hormonal diseases in dogs.  Now, let’s take a look at conditions affecting the bones and other parts of the musculoskeletal system.

Limping


If a dog has a painful musculoskeletal condition, he will usually favor his affected leg.

If multiple legs are affected, limping may not be so obvious and the dog may simply appear stiff or reluctant to move. 

During a physical examination, a vet will try to pinpoint where in the body the problem lies (e.g., a dog will react painfully to rotation of a hip but not to flexion and extension of his knee), but some dogs are so stoic that they do not “tell” us where it hurts. In other cases, a dog may react like almost everything we do is painful.  Are these guys just wimpy or do they really hurt all over?  Figuring out how to proceed in these cases can be a bit of a challenge.

X-rays are the next step, but they don’t always provide a clear cut answer either.

In some cases, despite knowing exactly where the problem is, the X-rays look normal and don’t help identify the cause of the limp.

X-rays are good for looking at bones but not as useful if the problem involves ligaments, tendons, muscles or other soft tissues.

On the other hand, if multiple abnormalities are found (e.g., arthritis affecting several joints) it can be difficult to determine which is the primary source of a dog’s pain.  It’s not always what looks the worst on an X-ray!
  
The Effect on Treatment Options and Prognosis

Diagnosing the exact cause of a dog’s limp may not be all that important if medical treatment (anti-inflammatories, pain relief, nutritional supplements, etc.) are the treatment of choice since these will help no matter where the problem is located.

But, if a veterinarian is recommending surgery make sure your dog’s diagnosis is solid.

No one will be happy if a dog undergoes a TPLO for a cruciate ligament rupture if his knee is not the real source his pain.

An accurate diagnosis is also necessary when it comes to knowing what the future holds for your dog.

When a large breed dog has hind end pain, owners and sometimes even vets may assume that hip dysplasia and the osteoarthritis that it causes are to blame. However, another common condition called lumbosacral stenosis shouldn’t be overlooked.

This disease looks a lot like hip dysplasia, but it can also cause neurologic dysfunction of the back legs and incontinence, symptoms that don’t fit with hip dysplasia.

And worst of all is also osteosarcoma.  This deadly form of bone cancer is sometimes confused less serious conditions like osteoarthritis in its early stages.

What this all boils down to is, if you are not comfortable with your dog’s diagnosis, talk to your vet.

If he or she cannot explain the situation to your satisfaction and is unwilling look in another direction, get a second or even a third opinion.  When veterinary medicine gets complicated, it never hurts to have more than one imperfect human brain involved in your dog’s care.

***

Jennifer Coates, DVM graduated with honors from the Virginia-Maryland Regional College of Veterinary Medicine in 1999.  In the years since, she has practiced veterinary medicine in Virginia, Wyoming, and Colorado.  She is the author of several books about veterinary medicine and animal care, including the Dictionary of Veterinary Terms: Vet-speak Deciphered for the Non-veterinarian

Jennifer also writes short stories that focus on the strength and importance of the human-animal bond and freelance articles relating to a variety of animal care and veterinary topics.  Dr. Coates lives in Fort Collins, Colorado with her husband, daughter, and pets.

Related articles:
Common Misdiagnoses (Part 1)
A Word on Second Opinions
It's Your Dog's Health!
Veterinary Drive-Thru: Coming Soon To A Veterinary Hospital Near You!
Does Your Vet Listen To You?
Help! My Dog Is Purple!
A Praise To Our Dog House DVM
A Word On Pain

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