When to Say Yes to a Diagnostic Test

As veterinarians we have access to so many incredible diagnostic tests. They help us uncover medical issues in our patients that, in the past, we could only guess about. How can you know whether or not to say, “Yes” to your vet when she or he recommends a diagnostic test, whether advanced or more basic? Here are my suggestions:  

© Susannah Kay

 

Begin by talking with your veterinarian about all the potential risks and benefits and pros and cons associated with the recommended testing. What will be involved for your dog or cat (sedation, general anesthesia, time spent in the hospital) and what will be involved for you (time, expense)? Most importantly, before making a decision about whether or not to proceed with recommended testing, be sure to ask yourself the following two questions:   

1. Will the results of the testing have the potential to change what I do next?
2. Will the results of the testing have the potential to provide me with some necessary peace of mind?   

If your answer to one or both questions is, “Yes” then it is certainly reasonable to consider proceeding with the diagnostic testing. However, if your answer to both questions is, “No” the testing is impossible to justify. Not only will it be a waste of your money, why on earth subject your dog or cat to a needless test? Remember, satisfying your veterinarian’s curiosity is definitely not a reason to proceed with any recommended testing!   

Here are a couple of real life examples excerpted from my practice life that illustrate how the answers to these two questions help in the decision-making process. Shasta is a sweet as can be twelve-year-old Golden Retriever mix, brought to see me because of vomiting and anorexia (food refusal). When I noninvasively looked inside her belly with ultrasound I found multiple masses within the liver, stomach, and spleen. As I told Shasta’s mom I was 99% certain I’d identified cancer involving multiple organs. Surgical removal would not be an option (disease too widespread) and the only option for potentially helping Shasta would be chemotherapy, that is, if the cancer were of the type that is responsive to chemotherapy. We discussed performing an ultrasound guided biopsy to “name the enemy” and know whether or not chemotherapy might be of some benefit. Shasta’s mom was clear that, depending on the tumor type, she would wish to give chemotherapy a try. She opted for the biopsy procedure (the biopsy results are pending at the time of this writing). In this case Shasta’s medical advocate opted for diagnostic testing because the results had the potential to change what would happen next.   

Here’s a second example- this time it’s Pixel, an eight-year-old mid-sized mutt who presented for coughing. X-rays of his chest revealed multiple lung masses, and I told Pixel’s family that I could be 90% certain that they were malignant growths. I left the 10% door open to the slim possibility of an unusual infectious disease. We discussed further diagnostics including a computed tomography (CT) scan of the chest cavity and aspirate or biopsy of a mass in order to “name the enemy”. With that information we could know whether or not we might be able to provide effective treatment for Pixel. His family members felt certain that if Pixel had cancer they would not wish to treat it. Additionally, 90% certainty that their boy had cancer was good enough for them. Pixel’s people had all the peace of mind they needed and the results of the testing would be highly unlikely to change what they would do in terms of treating their little boy. Pixel went home on a cough suppressant and pain medication and is doing reasonably well for the time being.   

Have you ever found yourself in a decision-making dilemma concerning diagnostic tests for your pets? If so, would answers to the two questions above have helped you make your choice?  

Best wishes for good health,         

Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook         

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot is available at Amazon.com, local bookstores, and your favorite online book seller.

Advertisements

Tags: , , , , , , , , , , ,

9 Responses to “When to Say Yes to a Diagnostic Test”

  1. Kristin Boggs Says:

    I was in this situation when my Maggie had Cushing’s disease. My vet suggested an ultrasound as he had seen one case over the years of Cushing’s being caused by the adrenal gland rather than the more common pituitary gland. Pituitary Cushing’s can be treated with meds. I wasn’t entirely sure I needed another very expensive diagnostic test, but I trust my vet, and wanted definitive answers for treatment that would work. Sure enough, Maggie had a large tumor on the adrenal gland, only seen by that ultrasound. She was one of the small % of dogs with this type of Cushing’s. She had to undergo an adrenalectomy to remove the entire adrenal gland. If we had not done this, she would have been treated incorrectly with drugs intended to treat pituitary Cushing’s, which would not have helped her, and she most definitely would have gotten much worse. The right diagnostic test gave us the correct diagnosis, which led to correct treatment right away. Maggie is now happy and healthy. I thank goodness every day I got that test done.

  2. Linda Rehkopf Says:

    I have used these guidelines when I needed to find an answer to my Labrador Retriever Sam’s symptoms. Diagnostic testing identified laryngeal paralysis. Sadly, he was not a candidate for tieback surgery. Now, three years later, my 11-year old Lab Gracie has similar symptoms. All her bloodwork was excellent, and I chose not to do the invasive diagnostics for now, but have reserved my right to proceed if/when the dog’s disease takes an unusual or unexpected turn. We keep her comfortable and made some living modifications. She’s still a happy dog.

  3. Mary Palmer Says:

    I think looking at a dogs age as well is very important. Putting a 12 yr old golden through any kind of treatment that would make the dog uncomfortable is beyond what I would do. Looking down the road how much quality time would I be adding to my dogs life and at what price.,.Not monitary, but price of quality of life and for how long. Keeping the dog comfortable for the remainder of its time on earth would be my focus rather than more vet vists and testing.

  4. Barbara Baer Says:

    Excellent and no-nonsense guide for the most difficult decisions. The responses of your readers is very helpful and heartfelt also. We had a beloved lab, Louie, who needed MRIs and surgery on three occasions to determine and correct disk problems. Each time we wondered if we should put him through another surgery, and if we could afford it, and each time we did so with the extraordinary neurosurgeon in Dr. Kay’s practice, we and Louie, were glad of the gift of time, and excellent quality of life, modern medicine and great skill gave us.

  5. Judi Says:

    I’ve used similar ideas twice. My 13yo Belgian shepherd had some suspicious lumps in her groin. Needle biopsy was indeterminate over whether the cancer was skin or mammary. In either case, I wasn’t going to treat. Judging from how things developed over the next 7 months, she probably had mammary cancer. I let her go when she said she was tired of living with it.

    One year ago (to the day, as I write this), my 14yo Aussie had a stroke. Based on physical symptoms, the vet did not think it was simply vestibular syndrome. They said they could do more diagnostics to see if there was a brain tumor, but I wasn’t going to treat even if it was a tumor so skipped those. I allowed the dog to say what she wanted. She was almost back to her previous state in about a month, and she’s still with me today. So far, so good! We’re using TCM to try to avoid another episode.

  6. Linda West Says:

    Thank you for a very helpful article. I have had a hard time rationalizing how I interact with my veterinarian in the way I respond to different health conditions and diagnositic procedures. You have clarified what I intuitively felt but had not been able to verbalize.
    I look forward to your newsletter and recommend it to my friends and clients.

  7. Jana Rade Says:

    Great article. The purpose of diagnostics is treatment. If the treatment options wouldn’t change or the decision wouldn’t change, no point of putting the dog through it. If further diagnostics can make a positive difference in the treatment and outcome, then it makes sense to take it as far as needed.

  8. Amy Says:

    I spent $800 on an MRI of my Karly’s spine because I knew in my heart that it wasn’t the spread of breast cancer that caused her to become suddenly paralyzed. I hoped it would turn out to be a spinal meningitis, but the MRI looked to the vet (and me — I insisted on seeing it) like a large tumor, so I elected to euthanize her. I also insisted on a biopsy and it turned out not to be cancer, but some kind of inflammation. As a diabetic, Karly couldn’t be put on prednisone, so it was the right decision if for the wrong diagnosis. I needed both tests for my peace of mind. Her tail was still wagging the day before her final turn. There was no cancer in her lungs or liver or anywhere else, and her breast cancer tumors hadn’t grown, and her diabetes was under control, so I wanted her to have every chance to recover if it was possible.

  9. Amy Says:

    Thank you, Kristin. My sanctuary foster has a sponsor for his vet care, and she balked at testing for Cushings. Someone else accused my vet of ordering unnecessary tests to run up the vet bill. At 13-1/2 my buddy is very very healthy but let’s say I do a lot of housecleaning. Most cocker spaniels his age are dead, so he’s already a lucky boy. I have known cockers that lived to be 18 and I can’t see not treating Cushings in a dog that’s otherwise healthy. If the group doesn’t come up with the money for testing and treatment, I will be stuck with the choice of paying myself for a dog that’s not mine, or watching him get sicker as the Cushings creates more trouble for him.

Comments are closed.


%d bloggers like this: