Veterinary Version of "House"

The TV series House is entertaining, but the primary reason that I watch it, when I take the time to watch television, is that I enjoy the real life approach they give on how doctors (and yes I am a real doctor!) diagnose illness/disease.  The term we use is an alogrithm, a set of steps for solving a particular problem, in order to rule in or rule out what disease your pet is suffering from.  Here is a real life case that I have been working with for the past month.

Molly is an 11 year old Labrador mix female.  Molly was presented with an inflamed left rear foot.  Her foot was not hot to touch, not painful to touch, and she was not limping.  The skin in the area was oozy and red.    Most commonly when I see this type of lesion the diagnosis is pododermatitis (an skin infection of the foot).  So I started Molly on antibiotics and some steriods.

A week later we rechecked Molly's foot and it was much worse and much larger.  Sometimes dogs get grass awns, thorns or stickers buried under the skin and they fester, like when we get a splinter under our skin.  A radiograph was taken to rule out a possible foreign body or potential of a cancer (due to Molly's age).  The radiographs were normal and showed nothing but soft tissue swelling.  Some foreign bodies will not show up on radiographs.  So it was decided to give it a bit more time to work itself out, and her antibiotics were changed, on the chance that the bacteria in Molly's foot was resistant to the ones she had been on.

Another week and Molly's foot was still angry and not improving.  So we surgically opened the lesion, in hopes to find a foreign body, we flushed the wound in order to flush out any sticker or hair or other foreign matter and a biopsy was performed.  Pathology report on biopsy was inflammatory, no evidence of cancer.

When re-examined in another week, Mollie's foot was bigger and nastier looking than ever.  Still Molly was not lame nor appeared painful.  A comparative radiograph was taken; no changes in bone or other abnormalities noted.  Another biopsy was taken, deeper than the first, and a bacterial culture was taken.  Antibiotics were given at higher doses, pending lab report results.

The next day, Molly returned because her face was swollen on the left side, same side as her affected foot.  Clinically, this resembles an allergic type reaction.  A steroid injection was given and this photo graph was taken several hours after the injection and actually shows an improvement from how she looked when she came in.

The pathologist from Kansas State University called.  He reported that the biopsy showed no evidence of cancer (we sigh in relief) and the cells observed under microscopic examination were eosinophils (white cells that are active during allergic type reactions) and his official diagnosis was Eosinophilic dermatitis.  He had consulted with a K-State dermatologist, who confirmed the diagnosis.  The dermatologist said this particular form of eosinophillic reaction was rare and unique and likened it to "Wells Syndrome" seen in people.  It is unknown what causes this condition, but it is suspected that it is hypersensitivity reaction to any countless number of things such as medication, insect bites, or other foreign antigens.  Treatment of choice is steroid therapy.

Molly has gone home with oral steroids to be given for the next 30-60 days and we are hoping to see a gradual decrease in her symptoms.

This is how your doctor's mind works.  As your veterinarian examines your pet, gathers information from you about your dog and it's environment, like Sherlock Holmes looking for clues that will lead us to a plan and then work through the plan (aka algorithm) (usually starting with the most common) until we rule in and out the possibilities and arrive to our final destination...a diagnosis and treatment plan.

In 30 days, we will give you an update on Molly and her progress.