As in human medicine, health problems in dogs and cats are sometimes missed or diagnosed incorrectly. Arriving at a correct diagnosis involves good teamwork from you and your vet.
As a holistic veterinarian, I spend a lot of time trying to help clients who are seeking a second (or even third or fourth!) opinion about their pets’ care. Since this is such an important function for holistic vets, I want to share some of the more common reasons people seek a second opinion. In some cases it’s due to a missed diagnosis, while in others it involves a misdiagnosis – either way, it happens more often than you might think, especially when it comes to certain conditions.
While we all would love to get a correct diagnosis from the doctor (ideally on the first visit), this is not really practical. The most common reasons for a missed diagnosis include failure on the doctor’s part to do the necessary testing, or an inability on the doctor’s part to help because the client can’t afford the testing or has ideas that differ from the vet’s due to something they read on the internet.
- Let’s take cost first. As much as I want to help every pet, I know some owners simply cannot afford everything that is needed to get a correct diagnosis and prevent a missed diagnosis.
For example, just last week I saw a dog with horrible skin that had been suffering for over a year. The owners originally saw me for the first time three months ago, and on this second visit complained that I never correctly diagnosed the dog. I gently reminded them that they had declined all the testing I recommended so no diagnosis was ever made. On the second visit, they did agree to the recommended testing — but because all the results were normal, further tests still need to be done in order to get a diagnosis.
I have no idea if the dog’s owners will agree to the extra costs, but if they don’t there’s not much I can do since we still have a missed diagnosis. (I’m a big believer in pet insurance for this very reason; though keep in mind that not all insurance is appropriate for holistic care, so do your research before getting a policy.)
- Failure to get a diagnosis the first time around is also a common reason for someone to seek a second opinion. You can’t get a diagnosis if you fail to look for it. Simply put, a thorough exam, history and battery of lab tests must be done for most “sick” pets in order to not miss a diagnosis.
I commonly and easily diagnose diseases in pets for which no diagnosis was ever made by the prior doctor, simply by doing the appropriate lab tests. Often, these tests were never recommended by the previous vet, and the pet was simply (mis)treated with drugs, typically antibiotics and steroids.
Unfortunately, I see a lot of misdiagnosed pets. I’ll share a few of the more commonly misdiagnosed problems, but first let me share why I think there are so many misdiagnoses. I believe there are two reasons why a veterinarian might misdiagnose a pet.
- As mentioned above, the first involves pet owners who, usually for financial reasons, won’t allow the doctor to pursue proper diagnostic testing. The veterinarian is left with making a best guess at a diagnosis, and this guess is not always correct. This approach results in mistreatment, often with steroids, NSAIDS and antibiotics. Funds end up being wasted on useless treatments, and ultimately result in a much higher cost to the owner (not to mention potential suffering for the pet). When I see these dogs and cats, we then have to spend more money performing more testing, giving the correct treatment, and often doing detoxification to offset the former incorrect treatment.
- The second reason for misdiagnoses is that the vet simply doesn’t do the correct testing. Maybe he/she thinks the owner will be upset with the cost, so offers cheaper testing instead. Maybe the doctor thinks he/she can “eyeball” the problem and correctly guess the diagnosis, assuming that testing is not even needed. And finally, some doctors simply misread a lab test and get a totally incorrect diagnosis.
Commonly misdiagnosed conditions
The following conditions can be misdiagnosed by “eyeballing” cases or misinterpreting lab results.
Hypothyroidism is most often misdiagnosed when only a T4 (Total T4) test is done. The FT4 (Free T4) test is much better, but is often not run as it costs more than the T4 test. Both thyroid tests should be run on all sick pets so we don’t overlook this common diagnosis.
Adrenal disease is usually misdiagnosed as liver disease due to a misinterpretation of the blood profile. An elevated ALP almost always indicates adrenal disease, but is commonly misdiagnosed as liver disease. An elevated ALT, meanwhile, points to the liver and not the adrenal glands.
Many pets are diagnosed with arthritis based only on clinical signs. While this is not necessarily wrong, if the dog or cat fails to respond to correct treatment within a few days, radiographs and further testing must be done to rule out other problems such as disk disease, thyroid disease, Lyme disease, and bone cancer.
The most common misdiagnosis occurs when a doctor feels a lump and pronounces it a fatty tumor that does not need treatment. While most lumps in dogs are indeed fatty tumors (most in cats are not), many are also cancerous mast cell tumors. All lumps should be diagnosed via aspiration cytology or biopsy, and considered cancerous until proven otherwise. Tiny lesions can be observed, but must be removed and biopsied if they grow or change in appearance, or cause the dog to scratch.
I see so many pets with “allergies” that don’t have true allergic dermatitis. So many of these animals have thyroid disease, food intolerances, adrenal disease, mange, pemphigus and skin infections caused by various yeasts and bacteria. If your itchy dog or cat fails to respond to treatment with steroids, then allergies are likely not the only concern.
Again, I see many pets with chronic ear infections that are never properly diagnosed and treated. All ear cases should have cytology done for diagnostic testing and a proper ear flushing prior to treatment. Ear infections take several weeks to heal, requiring repeated treatment at home or at the veterinary hospital, and treatment stops when the cytology is negative for bacteria and yeasts. Chronic ear infections should be cultured, since many of these cases are infected with nasty stuff that no longer dies when exposed to routine medications.
Many eye cases are simple to diagnose and treat. However, severe eye diseases such as corneal ulcers and perforations, as well as glaucoma and uveitis, look just like the normal simple eye problems. I consider eye problems an emergency as they can get bad really fast. All eyes that look red, cloudy, itchy or weepy should be seen immediately by your veterinarian. These eyes require, at a minimum, a Schirmer tear test and fluorescein stain for diagnostic testing.
There are three things a veterinarian can do when he/she hears a heart murmur in a “normal” pet: ignore it and tell the owner “we’ll monitor it” (wrong answer); start the pet on heart medication to slow down heart disease (also a wrong answer); or tell the owner that the dog or cat has heart disease and needs diagnostic testing (the only correct answer). Normal dogs and cats rarely get heart murmurs, so they need a complete cardiac evaluation to determine the stage and severity of the heart disease.
How to prevent diagnostic mishaps
Both missed diagnoses and misdiagnoses can be prevented in most cases – as long as two things happen.
First, pet owners must let veterinarians do whatever is necessary to get a proper diagnosis. If cost is an issue, pet insurance should be used to cover up to 90% of the cost of care, and owners must present the doctor with a realistic budget so he/she can then present a realistic diagnostic and treatment plan.
Second, doctors must aggressively pursue diagnostic testing and not simply “wait and watch” as problems worsen. Additionally, dogs and cats that fail to improve with what seems to be the correct therapy must be thoroughly reevaluated.
While this may all seem rather grim, it doesn’t have to be. Working as a team, you and your doctor should be able to correctly diagnose and treat your pet’s health issues. If you are uncomfortable with a diagnosis (or lack of same) then do seek a second opinion. You know your dog or cat best, and you need to be proactive on his behalf!