Monday, June 13, 2011

How Pet Owners Can Best Help Veterinarian Make their Diagnoses

Being a cat veterinarian is like being a pediatrician. We can’t ask our patients what’s wrong. We have to figure it out. And nowhere is the role of a cat owner more important than at a veterinarian’s office, where a good history can sometimes mean the difference between life and death. 
Veterinarians are faced with a variety of diagnostic challenges on a daily basis. The ability for a veterinarian to obtain a detailed and complete history is our most important diagnostic tool. When accurately interpreted, this information lays the groundwork for a logical diagnostic and therapeutic plan, and may prevent unnecessary diagnostic testing and needless discomfort to the patient and cost to the owner.

After briefly discussing the primary complaint, veterinarians try to obtain both objective and subjective information when gathering the history. Examples of objective data include the signalment, the environment, diet, and medical history.

Signalment

The signalment consists of the cat’s age, breed, and gender, including whether the cat is neutered or spayed. This is basic, important information. Certain illnesses tend to strike cats at certain age ranges. For example, hyperthyroidism is a glandular condition that causes cats to lose weight, despite a ravenous appetite. It’s an old-age disease, rarely striking cats under the age of eight. A 13-year old cat with weight loss and excellent appetite warrants a blood test to evaluate thyroid function. A four-year old cat with the same signs would be more likely to have something else, such as inflammatory bowel disease or pancreatic insufficiency. Even if you’re not sure of the exact age, an accurate approximation can be very useful for a veterinarian.

Certain breeds are predisposed to certain conditions, and knowing the breed can help veterinarians choose proper diagnostic tests. Persians are prone to polycystic kidney disease; Abyssinians are at high risk for renal amyloidosis; and Maine Coons are susceptible to hypertrophic cardiomyopathy. Veterinarians must not be misled by clients who tell their veterinarian that their cat is a Maine Coon, only to find out that it’s a domestic longhair that “looks just like the Maine Coon in the magazine”.

Gender provides important information as well. A female cat straining to urinate is likely to have cystitis. A male cat straining to urinate could have a urinary obstruction, something that can be life-threatening if not treated promptly. Fortunately, there’s very little guesswork when it comes to determining gender. Just lift the tail and take a look!

Environment

Gathering environmental history is a routine, yet important part of a cat’s history. Free roaming cats or cats that go outdoors are at much higher risk of getting into fights with other cats, and that increases their risk of getting cat bite abscesses or acquiring feline leukemia or FIV. Free-roaming or recently escaped cats may have had access to toxins or have been subject to trauma, which is unlikely in an indoor pet.

Sometimes a travel history is important, although more so with dogs than cats, since cats, if they do travel with the owner to another part of the country, usually aren’t let outdoors, where they are at risk of running away or getting lost. Still, a travel history can be important, especially if the patient has been exposed to diseases endemic to certain regions but not prevalent in the current environment.

Dietary history

A dietary history is more than merely determining which type and brand of food you’re feeding. Granted, knowing the type of diet (dry, moist, semi-moist, table food), the brand name, any types of snacks, the method of feeding (free-choice or individual meals) and the amount is important, but veterinarians also want to know about your cat’s appetite and whether there has been any weight gain or weight loss. It’s helpful if you watch your cat eat. Complete or partial anorexia is a common reason that clients take their cat to the veterinarian. A client that notices that their cat only chews on one side of its mouth, or has stopped eating dry food and now will only eat canned food, is telling the veterinarian that oral pain or discomfort may be the source of the problem, and a thorough oral exam may be the only diagnostic test necessary to obtain the diagnosis.

Preventive health care status and prior medical history

Reviewing the patient’s prior medical record can give valuable information to the veterinarian. If this is your first visit to this particular veterinarian, it is very helpful if you know your cat’s vaccination history, and you cat’s feline leukemia virus and feline immunodeficiency virus status. Medical records detailing the diagnosis or treatment of any prior or ongoing health problems are invaluable, as the primary complaint may be a consequence of a prior medical condition.

Once the above information is obtained, the veterinarian is ready to delve deeper into the primary complaint.


The history surrounding the primary complaint tends to be more subjective, and this information obtained from observant, conscientious owners can be a tremendous asset. Veterinarians know that some owners aren’t as observant as others. Our job is to encourage our clients to describe the cat’s problem from its onset so that an orderly chronology is obtained. Some of the things we’ll want to know is when the cat was last normal, whether the onset of the clinical signs was sudden (acute) or if it developed slowly over time (chronic), and whether the illness has responded to previous treatment or not. For example, an itchy cat that was treated with steroids and did not respond in the past is more likely to have food allergy (poorly responsive to steroids) than flea allergic dermatitis (responds rapidly to steroids).

Depending on what the primary complaint is, a veterinarian may delve even deeper, to further help characterize the problem and better formulate a diagnostic plan. As an example, if a client reports that their cat has diarrhea, the veterinarian may then ask whether there’s any blood or mucus in the stool, whether the cat has been straining in the litterbox, or whether the cat has had any accidents in the house. The more the client answers yes, the more likely that the diarrhea has originated from the large intestine. This narrows down the list of possible causes for diarrhea, and helps the veterinarian formulate a diagnostic and therapeutic plan. Working with breeders has its advantages. Breeders tend to be much more observant than the average cat owner, and often come in with very detailed histories. They know that the cat’s coat should look sleek and glossy, and are more keenly aware when the coat looks a bit rough or unkempt. Most clients are unable or unwilling to take their cat’s temperature at home. Breeders, however, seem to have little problem with this. Information like this can be a big help to a veterinarian. In the exam room, a cat may have a borderline fever, and this can be difficult for a veterinarian to interpret, as cats will have elevated body temperatures when they’re nervous. If a client tells me that their cat had a fever at home, in their comfortable surroundings, then I know that the fever I’m seeing in the exam room is likely to be genuine, and not due to the stress of the examination. As a veterinarian, I encourage my clients to perform their own brief physical exam on their cats on a regular basis. This should include a brief examination of the eyes to see that they’re bright and clear and free of any discharge, the ears should be a healthy pink color inside with no signs of discharge or accumulation of dark-colored wax, and the nose should be damp and velvety to the touch and have no discharge or crusting on the surface. The mouth should be examined regularly, to make sure the gums are pale pink, the teeth aren’t yellowed or covered with tartar, and that there’s no foul odor present. Cat owners should also stroke and pat their cat often, not just because the cat enjoys it, but to also feel for any lumps or bumps that might be present. Feeling along the abdomen for any masses or swellings associated with the mammary glands is also advisable, as mammary tumors, while not as common in cats as in dogs, are much more worrisome in cats.

Behavioral changes can be difficult for veterinarians to interpret. I’ve had many clients bring in their cat because the cat was acting different, although on further questioning, it became apparent that the cat wasn’t actually ill, despite the difference in behavior. Cats who suddenly stop sleeping on the bed even though it’s been their favorite sleeping spot for years, or normally vocal cats who lately have become more quiet may indeed be acting differently, but these are quite likely to be benign behavioral changes. Lethargy, hyperactivity, aggression, growling, and urinating or defecating in inappropriate places, however, are behavioral changes that may indicate an underlying medical problem. When in doubt as to whether any apparently new behaviors are medically significant or not, it’s best to err on the cautious side and report everything to your veterinarian.

Because our patients cannot talk, veterinarians must rely on you, the client, to speak for them. The more observant you are, the more information you can give us. This information can go a long way toward obtaining the proper diagnosis, allowing us to tailor a treatment plan to put your companion quickly on the road to recovery.

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