When Should You Go To The Doctor, And When Should You Work It Out For Yourself?

Interesting memory of an almost inevitable misdiagnosis by FitOldDog, during my years as a veterinarian in practice in England in 1968. All from one little West Highland White terrier’s bladder. Coin for size comparison. Photo by FitOldDog using his iPhone.

Hi folks, welcome!

They really are great little dogs – this is not the patient I refer to in the narrative, by the way.

The question presented in the title of this blog post is not always as easy to answer as you might think.

Increasingly, I receive requests for advice on sports injuries and how to exercise safely with aortic disease. Sometimes I can help, simply because of (1) my veterinary medical and pathology training, combined with (2) a background in Ironman training, with (3) extensive study of body awareness, and (4) the fact that I live with aortic disease, in the form of an abdominal aortic aneurysm (AAA), myself. I am extremely cautious with my advice, however.

Furthermore, the best physicians can make mistakes, or symptoms may clearly indicate one condition, whereas in fact it is something completely different, and probably uncommon. 

Great book with interesting ideas to help you communicate with your doctor.

This is why it is critical to stay involved with your medical treatment, and to report any odd symptoms to your health professionals – you may have to work to make them listen sometimes, because they are busy people.

Here are a couple of personal examples:

Veterinary Misdiagnosis:  I’m not remotely embarrassed about this one. In 1968, as a young veterinarian, I was presented with a mature, female West Highland White terrier, with classic symptoms of pyometritis (pus in the womb, basically, but rapidly fatal if untreated), including a history of recently being on heat, off food, fever, malaise, and a large mass in the region of the uterus. I ‘confirmed’ my diagnosis with other members of the practice, and scheduled what I expected to be a routine hysterectomy (remove the pus-laden uterus) that day.

The pyriformis muscle can tighten up in response to certain sports, resulting in a pain in the butt, especially while sitting. If severe, it can cause sciatica due to irritation of the sciatic nerve, making things much worse.

When I opened the abdomen I received a big surprise. The bladder (not the uterus) was very large, completely black (dead), and it contained a mass of large bladder stones (see the image at the top of the post). As we were in no position to carry out a bladder prosthesis, the only option was to put the dog down (weird euphemism). Probably for years, the dog’s bladder had been building up these stones, which were smooth and thus not irritating. One day the dog rolled quickly, the bladder stayed where it was, creating a torsion (twist) at the neck of the bladder, cutting off the blood supply, and the bladder died.

So my classic case of pyometritis turned out to be fatal torsion of the bladder, in spite of my medical training, experience with previous cases of pyometritis in dogs, and the combined years of veterinary practice of multiple older colleagues. Never saw another case before or since.

“Father-of-three died after doctors mistook aneurysm for heartburn and sent him home with Gaviscon.” DailyMail, England, UK. Click image for link to article.

That’s where an ‘obvious’ diagnosis based on symptoms can turn out to be wrong, however experienced you might be. So I kept those stones as a reminder, and I still have them.

Sports Injury Misdiagnosis: I was approached for advice from a friend, a 40-year-old runner, who proceeded to describe classic symptoms of pyriformis syndrome (pain in the butt, especially when sitting), which can be induced by running. I was pretty confident of my diagnosis, but said the usual stuff about seeing a sports physician. In this case my friend made no progress with the usual stretches, pigeon pose, tennis ball pressure, and the like. It eventually turned out to be a rare cancer of the pelvis.

Again, one condition completely mimicked another.

FitOldDog’s son, Nick, having a routine AAA scan, because he is related to FitOldDog. All was well.

So, what’s to do?

Should you go to the doctor every time you have an ache or pain?

You’ll be there every day when you get to my age, if you do. No, you have to (a) make the best judgement call you can, and hope that you, or your medical professionals, get it right, (b) have regular health screens, and (c) live every day to the full, because something is going to get you in the end.

Should you be scared to death?

Nope! Most diagnoses are correct most of the time!

The condition I have, AAA, is sometimes mistaken for back trouble or even severe indigestion, resulting in loss of life due to aortic rupture when a patient is sent home with the wrong diagnosis.

So, get your AAA screen, it may save your life.

I stayed in touch with my health, studied body awareness for years, and came up with my own AAA diagnosis, which was confirmed by my physicians the next day. I consequently had my life-saving treatment in time. A happy ending, less you’re feeling gloomy about my stories today.

-k @FitOldDog