Treat the Dog. Not the Diagnosis.
How simple is that to say, just ‘treat the dog’. But I have to admit that it is often hard to remember to do just that. When you have an obvious diagnosis, it’s easy to fall into the trap of looking for what you expect to find and treating what you ‘know‘ the problem is.
This is called patterning. Where, you see typical signs that follow a known pattern, and you follow that pattern to the cause and then the treatment. This isn’t always bad, common things happen commonly, so often patterning ends up with the right answer. But trusting the pattern can also lead you astray. I’m yet to meet a dog that has read the textbook on common conditions, and is doing things exactly like the books say they will.
A great example is when we see a dog skipping. If I have an owner describe on the intake form that ‘it almost looks like he skips’, my mind immediately jumps to the patella. In most cases of skipping the problem is the patella, and it is something that is easy to rule in or out. If the patella is rock solid then you go looking further. But what if the patella is loose, well it’s easy to fall into the trap of just blaming that and moving on to the treatment.
In humans we can ask where the pain or discomfort is originating from. In most cases even with children they can point to what is ‘ouchie’. However, our pets can’t tell us, in fact most are stoic and actively try not to tell us if they’re in pain. So, we have to look at all possible causes and then try and get them to tell us, through their movement and responses to stimulus, what is significant.
When I have a dog that is skipping, even if I do find a patella that is loose, it is important to not stop there. There are many things that could be causing the problem, and the optimal treatments plan is deferent for each. There may be a partial cruciate tear, an Iliopsoas strain or even a sacroiliac joint discomfort.
Doing a complete physical exam gives an accurate picture of exactly what is going on and allows a complete treatment program to be designed specifically to treat that dog. For instance, if there is SIJ pain, surgery on the patella will not completely resolve the problem and can lead to apparent surgical failure, even if the surgery was actually a complete success.
It is easy to treat the disease or the symptoms listed on a questionnaire, or what is obvious when you first see the dog. But to get the best results, you need to approach every dog with an open mind, understanding that a primary problem can cause secondary changes which may be more significant to the dogs comfort and happiness than the primary problem. Treating just one of these problems is never going to give results that are as fast or as good as listening to what the dog is trying to tell us and treating the whole dog.