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Thursday, April 21, 2011

The Frustration Of Not Knowing

I wish that we as doctors knew everything and could figure everything out.  Unfortunately, we can't.  And it bugs us to no end!

Yesterday I saw a cat for the first time.  The cat wasn't eating, and over a month or two had gone from around 24lbs to 17lbs.  On physical exam he was purring and happy with no obvious physical abnormalities other than an abnormally unkempt coat and some mild dehydration.  We ran a full battery of tests:  blood chemistry panel, CBC, thyroid screen, heartworm test, leukeima test, and AIDS test.  I was expecting to find a leukemia infection, hyperthyroidism, or kidney problems.  When all of the test results were in, my jaw dropped a bit.  There really weren't any significant abnormalities!  The ONLY problem I found was a mild increase in the white blood cells and an analysis of these cells leaned me towards inflammation.  That's pretty non-specific.  So this cat was losing weight rapidly, wasn't eating, and the only thing we could find wrong was some signs of inflammation hiding somewhere inside the body.  All of my normal possibilities went right out the window!  And unfortunately I was left with a thought of "I really don't know what the heck is going on here."

Thankfully this doesn't happen very often.  But it's also not the first time I've been faced with this (in fact, I may have blogged about it previously).  And it never gets easier to deal with.  As doctors we like to be able to find a problem and therefore be able to either fix it or relieve the pet's suffering.  When we know a pet is sick but can't figure out why, it can drive us crazy!  I mean, we know there's SOMETHING wrong, but for the life of us we can't figure out where or why.  With all of our skills, knowledge, and fancy equipment, sometimes easy answers simply elude us.  Not only is this extremely frustrating to us personally and intellectually, but it's bad for the patient as we can't effectively discuss a treatment plan without having a decent idea of what the problem is.

In this particular case I'm worried about cancer hiding somewhere in the body, especially the digestive tract, and have sent the cat to an internal medicine specialist for ultrasound and consultation.  Hopefully they will be able to figure out what is wrong and give the client more specific advice.

Honeslty, this is one of the reasons I really like surgery.  In most surgical cases you have a pretty straightforward situation.  Sure, you can be surprised sometimes and the unexpected does happen when you're exploring the abdomen.  But in most cases you're either cutting something out, sewing something closed, or a combination of the two.  Rarely is there the ambiguity you'll find with internal medicine cases.  It's often said by surgeons, "A chance to cut is a chance to cure."

Any veterinary students reading this, take the lesson to heart.  You simply can't figure out and fix anything.  That WILL happen to you, and you have to learn how to handle it.  Once you learn how to deal with this frustration, be sure and let me know so I can learn from you!


  1. We've just been discussing this kind of thing in our doctoring class, we actually went through a case with our professor where they did all the analytical work and found nothing, they searched and searched for the problem of a dog circling without any other obvious neurological signs other than some drool, turns out the dog ingested a nicotine patch, but if the right questions wouldn't have been asked, they would have never figured out why the dog was circling. They always tell us to think of horses when we hear hoof beats. I know it can be frustrating when you have no idea what is wrong, I imagine it must be difficult to tell an owner after doing all those diagnostics that you still don't know, you you're right, we can't solve anything, we just have to do our best and keep the animal's best interest in mind.

  2. There is a show on natgeo called dogtown. It is the bestfriends shelter. In dogtown they often take in dogs that have mysterious ailments.

    Of course dogtown will finally find out what the problem is.....but not always.

    Dr Mike often says sometimes you just cant figure out what the cause of a problem is. This is coming from a guy in which big expectations are placed.
    So if he can say I don't know what the problem is (after dogtown spends all that money to get the dog there) then I can feel comfortable when my vet cant pinpoint a cause. Doesnt mean Im happy though:>).


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