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Wednesday, June 30, 2010

Yes, There Is A Real Reason

Today I saw a dog for a behavioral consultation, a particular interest of mine.  He was showing aggression towards the other dog in the house and the owner was concerned.  After a lengthy visit and asking many questions, I determined that besides changing some things in the household and doing behavioral therapy, he would likely benefit from medical therapy.

Whenever we're evaluating for a behavioral problem we want to rule out the possibility of an underlying medical disorder that is leading to the abnormal or unwanted behaviors.  So besides doing a thorough history and physical exam it's common to do routine lab tests, even if the pet otherwise appears healthy.  And when we are considering placing a pet on long-term medication we want to screen for any underlying problems that might make it dangerous to use these drugs.  For both of these reasons I recommended that we do a battery of tests on the dog. The client balked at the cost and was concerned about the necessity of the tests.  After explaining it again, she reluctantly agreed.

And it's a good thing we did, because we discovered a potentially serious liver disorder.  His liver values were significantly elevated on the blood tests (for my vet readers....ALT was 654, and normal range is 10-100; ALKP was also elevated at around 250).  First of all this meant that we couldn't start him on drug therapy because of the potential risk of of complications due to a liver problem.  Second, it meant that he would need to have even more tests, likely with a specialist, to discover what was causing the problems with the liver.  Now when the liver is abnormal, waste chemicals can build up in the blood stream and lead to neurological disorders.  Usually this includes seizures, incoordination, and lethargy, but can also include behavioral changes.  So there is a possibility that the dog's abnormal behaviors are related to a liver disorder.

Now you would think that someone might be glad that we didn't just put their pet on a drug that could end up being harmful, and that we had possibly figured out a reason for the aggression.  However, the owner seemed a little upset when she left and was pretty curt at the end of the visit.  She was probably thinking of how much more money she was going to have to spend getting his problem diagnosed, and not thinking of the potential severity of a liver disease.

This is exactly why vets want to run diagnostic tests.  To just look at the dog you would think he was very healthy, never knowing that there was a hidden problem.  If we had not run the tests and simply tried medication, we could have given him complications due to the drugs, or simply overlooked a serious problem and delayed a true diagnosis.  So when your vet makes recommendations for tests, please understand that it's for a real reason, even if it may not seem obvious to you.  We really do catch problems by practicing quality medicine.