10/14/2026
Searching for a good diagnosis
How do veterinarians work up a case? There's a standard plan that we follow: we gather facts. We look at breed, age, lifestyle (indoors? outdoors? hunting in the woods? lounging on the couch? killing and eating mice? snacking on burger and fries?). We take a history (six months ago she had this happen, last week she was throwing up). We look at changes in weight, in diet, (now feeding grain free, not good; switched to canned food from dry).
All this happens before we set hands on our patient. We move from a general history to a more specific information gathering. When was he last normal? When the the limp start? Drinking more water? Less? Lethargic? More agitated than usual?
Then we pass to the physical examination, which is usually more subtle and complicated than it looks on the surface. You think I'm tickling your dog under the chin. I'm feeling lymph nodes. I'm assessing mucous membranes for color, hydration, capillary refill time. When I listen to your friend's heart, the hand on his back leg is not steadying him on the table. It's checking to see if the pulse wave from the heart is reaching the extremities in a regular fashion.
And then we put together a list of problems (weight loss; lameness, vomiting, dehydration, pain). And from there we start to look for plausible causes.
Often a list of three or four things present as the most probable causes; they bring all of the problems into one basket. In an elderly cat, weight loss can be caused by multiple things. Thyroid disease, cancer, diabetes, kidney dysfunction, inflammatory bowel issues. So we sift out symptoms and try to find our path to an answer.
Last week I saw a geriatric sweet skinny cat. He was losing weight, throwing up a little, had some bloody stool. The owner loved him dearly, and while we were trying to be realistic, I also had no desire to give bad news. So I had to keep a very clear head and not let my wishes interfere with the diagnostic tree I followed. None of the early tests were giving a clear answer, and the owner knew he would have to wait a few days to get an idea of what the future would hold for the man and the cat. I told him that I would try as hard as I knew how to find his cat a good disease, and would do everything in my power to put the kitty peg into the good slot.
Early in the morning, a pending lab test returned a very benign diagnosis with a very hopeful outlook for a cure. Everyone's relief was immense. We had managed - through no skill of our own - to get this nice kitty a good answer. The skill lies in finding the right questions to ask, but the answer is not anyone's to choose.
I just sighed and felt so glad for them. Somedays it's just like that, I guess.