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A Tale of Two Lab Results…

Fintan Browne MVB, veterinary surgeon Blanchardstown Veterinary Hospital, Dublin 15

Recently I had two laboratory results next to each other in my email inbox. They were for two completely different patients (one was a cat and one was a dog) but the value and the implications of the results was very different too. One provided a clear cut diagnosis for the dog patient; this would allow me to give an accurate diagnosis, prognosis and make up a clear treatment plan. The other (for the cat) provided a very different set of results – a broad panel of tests was run and a number had come back inconclusive or just above or below the normal ranges, making it difficult to assess the significance of these results.

The dog was a middle aged pomeranian that had been presented for some hair loss on its belly. It was a mild change but on examining the dog and questioning the owner it made me suspicious of a hormonal imbalance. The dog was overweight despite not being overfed (in fact the owner had another dog that was very lean and fit). This patient was generally sluggish and just seemed vaguely below par. The owner also commented on how she frequently looked “sad” and indeed her facial expression bore this out. These were all subtle symptoms but together they made me suspicious of hypothyroidism (an underactive thyroid gland); hypothyroidism can cause lethargy, weight gain, hair loss and affected dogs are often described as having a “tragic facial expression”. Having discussed this with the owner we decided to take a blood sample to test for her thyroid hormone levels. The results came back conclusive – the dog had indeed very low thyroid hormone levels confirming the diagnosis. Happily this is a very treatable condition and we can expect this dog to make a great recovery. This case was a good example of what is known as “expert intuition” (i.e. an intuitive hunch that is informed by many years of experience and education) and fortunately for the owner a single lab result was all that was required to confirm the diagnosis.

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The cat case was in stark contrast to this however. My intuition did not serve up any single likely diagnosis and the initial laboratory results were equivocal and not particularly helpful. These are the cases that can be very challenging for vets and very frustrating for owners. They can require patient sequential (and often expensive) investigations. One of the key challenges for a vet in this situation is to be able to effectively communicate the meaning of the different test results to the owner and explain how that has progressed our understanding of the case and what the different options are to move the case forward from any point in time (there are usually many different options, and often cost is the deciding factor). This is really where the art of veterinary medicine comes into play and it is as important a skill to master as surgery or any other  medical skill or discipline. Turning a stream of confusing information into a comprehensible narrative for a concerned owner is one of the most challenging and rewarding parts of my job. Very often we are faced with trying to make decisions without enough information for a clear diagnosis – are different tests or treatments appropriate or affordable for this particular patient? Can we guess at the prognosis (the likely outcome) without a clear diagnosis? Often this is where “expert intuition” again comes into play and as vets we become very adept at guiding owners in the absence of a full set of diagnostic results. Medicine is not usually black and white (like in the first case with the Pomeranian) but instead some shade of grey!

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