“Your patients can’t talk—how do you know what’s wrong with them?” It’s a question I’m often asked. I understand why people would be curious, but the fact that my patients cannot speak is not something that I think about. Like every veterinarian, I deduce, detect and read between the lines to reach a diagnosis.
I gather as much information as possible from the humble history and physical exam, knowing that although high-tech equipment and testing may be available, it may also be out of a client’s price range. Some of these approaches might seem quaint to a physician who is able to order a multitude of tests, knowing that the person’s insurance will be billed. Most of my patients do not have insurance, so I must justify every test to a client, while they weigh the expense.
I maximize the information I gather from my senses and have also learned how to interpret my patients’ body language and how to question their caretakers to acquire relevant information. I’ll ask clients for their opinion and gather details from their descriptions: “Charlie cried when you picked him up?” “How were you holding him, exactly?” “Where did you put your hands?”
To check for a painful abdomen, I palpate the area, watching closely for signs of discomfort as I feel for tension in the muscles. Touching can, at times, lead to a diagnosis. For example, lymphoma is a type of cancer that can cause swollen lymph nodes. I still remember the first time I diagnosed it: I was looking at the client as she described her dog’s recent lethargy and lack of appetite when my fingers found the telltale swellings. Lymphoma is not the only cause of enlarged lymph nodes, but it’s a definite concern whenever they are found.
Communication through touch is also a way for me to interact with my patients. In addition to soothing them with my voice, I try to convey a message with my hands. Other senses come into play as well. Hearing, for instance. Recently, Bark editor Claudia Kawczynska was at the vet’s office with one of her dogs; the dog had an alarming cough and Claudia was afraid she was choking. She was surprised when her veterinarian listened to the dog and said, “She’s not choking; it doesn’t sound like a choking cough.”
A cough can have a multitude of causes, ranging from mild (like a kennel cough virus) to severe (congestive heart failure or cancer in the chest). With the benefit of experience, veterinarians know what a choking animal looks and sounds like. We also know which breeds are subject to specific problems. For instance, Yorkiesare prone to collapsing tracheas, and laryngeal paralysis is common in older Labs.
Vision is another sense that comes into play, and veterinarians are always watching, even when we appear to be busy doing some- thing else. During a typical exam, there are at least three of us in the room: the doctor, the patient and the client. At times, it may look like I’m speaking with the client and asking questions (“When did the vomiting start?”), but I’m also observing the patient. Is he anxious? Does he appear to be in pain? Is he walking or standing normally, or hunched as if uncomfortable?
If I know the patient well, it’s even better, because I have an idea of what’s normal for that individual; perhaps a typically rambunctious dog is lying quietly on the floor, which may be customary for some dogs, but is definitely “not him.” If a veterinary technician is present, I’ll solicit her input; perhaps she notices something I’ve missed.
Smell is an important sense; it is sometimes the first indication of infection. Unwrapping a bandage, I might know right away that antibiotics are needed. Yeasty ears have their own smell. We sometimes suspect kidney disease from an animal’s breath; if I smell what’s called uremic breath, I’ll perform blood tests to confirm it. Diarrhea from parvovirus has a distinct smell, even worse than regular diarrhea. (Fortunately, an antidote for all these unpleasant smells exists: puppy breath. No wonder everyone working at the clinic lines up to smell the sweetness of a puppy!)
I encourage my clients to use their senses to assess their animal friends. In fact, I rely on it. As thorough as veterinarians can be with our physical exams, we also trust pet owners to bring matters to our attention. An excellent example of this is finding lumps, as many masses are first seen and/ or felt at home.
Sometimes, while we can tell that something is wrong with an animal, the symptoms are vague. Many vets term these cases ADR,which stands for “aint’ doin’ right.” It was the sort of thing said in the days of James Herriot, when the farmer would inform the veterinarian, “Doc, that cow just ain’t doin’ right.” With these patients, I am especially interested to know if anything has changed in the animal’s environment, diet or behavior. Sometimes, stress can be a factor, and it can be difficult to determine whether a problem has a medical or behavioral cause.
One day, a client called because her little dog, Peanut, was urinating off his regular newspapers. I went to the home to examine him, suspecting a urinary tract infection. When I arrived, I noticed that Peanut’s owner had decorated for Christmas, and his newspapers had been moved to accommodate an enormous planter. We moved the planter, returned his papers to their original spot and Peanut ran over and used them immediately. He had been intimidated by the large, strange object near his toilet area. Now, when I see an ADR animal in December, I routinely ask clients whether they have decorated for the holidays.
A distressed animal is a puzzle or a mystery to be solved. While it’s true that my patients are not able to speak, I’ve found that if I look carefully, they provide many of the clues that can help me put the puzzle together.