Diagnostic testing is the mainstay of veterinary medicine. Diagnostics are used to determine the underlying cause of illness and suggest the correct path for treatment. Diagnostic testing may include bloodwork, radiographs (x-rays), ultrasound, fecal exams, auscultation, and even exploratory surgery.
As veterinary students, at least at Purdue University, we learned all diagnostic testing should be justified, therefore not to waste the client’s money. At the same time, diagnostic testing is important to present both the clinician and the pet owner with a diagnosis. With a solid diagnosis, a treatment plan can be decided upon – regardless of whether the treatment method use conventional or alternative modalities.
Sadly, diagnostic testing is often skipped in clinical practice – veterinarians opting to evaluate “response to therapy.” For example, an itchy dog may be started on Apoquel, the “latest and greatest” treatment for the itchy dog. This empirical treatment method may not be without complications.
Consider Addison, an older allergic dog who fought itchy, greasy skin for years.
Her conventional veterinarian recommended Apoquel to “treat” her itch. Addison had been through numerous allergy testing and treatment methods. For her, this medication worked.
Consider Wally, another dog who fought itchy, greasy skin for years. Wally’s condition was worse than Addison’s – he frequently experienced ear and skin infections. Wally had never been evaluated for allergies, instead, he was treated symptomatically with steroids and antibiotics as needed his entire life; his owners would have done the allergy testing had their conventional veterinarian proposed it. Instead, a recent experiment included an Apoquel prescription. Sadly for Wally, the medication did not help; however, the prescription was refilled repeatedly without an evaluation of efficacy.
Third case to consider is Frankie, a 16 month old puppy with intermittent itch and shedding. With zero diagnostics, no discussion as to the underlying cause that a young, hyperactive pup would have itch, he was started on Apoquel. It did not work and may have made the shedding worse due to underlying immune issues.
These three cases illustrate the difference between diagnostics, in the case of Addison, and “trial and error” medicating, as in the latter two examples. As a new medication, Apoquel is quite pricey – judicious diagnostic testing would have determined the underlying condition in Wally and Frankie – small intestinal bacterial overgrowth for both of these boys. Apoquel is inappropriate as treatment for either of these dogs.
We are trained to think “there’s a pill for that” but not all pills work for a given condition, or are without side effects. Therefore, it is most humane to get a proper diagnosis before long-term medications are started. Typically, integrative veterinarians can be counted on to perform full diagnostics – AHVMA.org may suggest someone to help