The Value of a Diagnosis

Jake, a 20-year-old Hanoverian gelding, showed signs of colic and seemed to have difficulty urinating (stretching out as if to urinate, but having only a few drops of urine). His owner, after doing a Google search and armed with powerful drugs provided to her by a friend with an extensive equine pharmacy in her tack room, treated the “colic” with Banamine (flunixin meglumine) and administered a shot of furosemide (a prescription diuretic) to stimulate urination. Jake appeared to feel better but still was not quite right a few hours later, so she administered another dose of Banamine. Jake urinated and his appetite returned, but 24 hours later his condition worsened. Soon he was showing more serious signs of abdominal pain, and he was admitted to an equine hospital.

Stretching as if to urinate is commonly seen in horses with abdominal pain and might not result from urinary problems. In this case the owner administered large doses of anti-inflammatories and dehydrating diuretics without knowing the underlying cause (large colon impaction). This allowed the impaction to worsen and set up another life-threatening condition: kidney failure. There was no communication with a vet and no diagnosis made until it was almost too late to save the horse.

Variations on this scenario are common throughout the horse world today. Owners are trying to manage problems themselves, and they delay calling a vet to avoid emergency visit costs. They often use the internet to inform their decision-making, and horses sometimes suffer as a result.

A medical diagnosis is an attempt to classify a patient’s condition into separate and distinct categories that allow medical decisions about treatment and prognosis to be made. In a 2005 article on veterinary diagnosis, Carl Osborne, DVM, PhD, Dipl. ACVIM, stated that “Just as no two individuals are exactly alike in health, so neither are any two alike in disease.” Vets observe different disease manifestations frequently and must be able to diagnose in the face of uncertainty. This is the “art” of practice. Vets use “differential diagnosis,” which is based on identifying candidate diseases or conditions that might cause a clinical sign. They then eliminate possibilities through diagnostic tests or by judging response to symptomatic treatment. Upon reaching a diagnosis, vets consider treatment choices and select the most appropriate.

Today, we all have access to the same vast body of information via the internet. The problem is how to use that content most effectively. Owners often input their observations as search terms. Google might return a million search results, but these are not organized based on relevance to a situation (and they all aren’t necessarily from reliable sources). In contrast, there is a lot known and written about equine diagnoses. Once your vet provides an accurate diagnosis and some guidance, then the internet can be used to deepen your understanding of your horse’s condition.

Here are some suggestions for diagnosing and treating your horse effectively:

  • Communicate with your vet early. He or she can guide you as to whether you can treat symptomatically or need to pursue a diagnosis. Together, you can discuss your options and their associated costs.
  • Be observant and communicate your observations to your vet effectively. Photos and videos can help your vet quickly determine the best course of action.
  • Learn to perform basic treatments so you can provide required follow-up care.
  • Once you and your vet have chosen a treatment plan, talk about how to assess its effectiveness and how to monitor and communicate your horse’s progress.
  • Ask your vet to recommend resources to help you expand your understanding.

The internet, when it is used appropriately, is a wonderful tool for enlightenment on equine veterinary medicine. But to do your horses justice, recognize the value of a diagnosis and differentiate it from your own observations. The person that can bridge the gap between your observations and a diagnosis is your veterinarian.

Jake survived, but his vet bills were much higher than if he had been diagnosed and treated promptly and properly. He now has only about 25% of his kidney function, must be maintained on a special diet and strict management, and will always require periodic veterinary monitoring.

Douglas O. Thal, DVM, Dipl. ABVP, is an equine veterinarian with 19 years of experience in clinical practice. Thal Equine is his full-service equine hospital near Santa Fe, N.M.

Originally published in the October 2012 issue of The Horse: Your Guide To Equine Health Care.