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

Picture of bladder stones from a dog.

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!

West Highland White Terrier

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. 

Interesting book with very interesting ideas. From: http://goo.gl/TnBCt

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.

Pyriformis muscle is adjacent to the sciatic nerve.

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  Read more: http://www.dailymail.co.uk/health/article-2317043/Father-died-doctors-mistook-aneurysm-heartburn-sent-home-Gaviscon.html#ixzz2yQxl8mnu  Follow us: @MailOnline on Twitter | DailyMail on Facebook

“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 having ultrasound screen for AAA.

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

 

Comments

  1. I had a Westie! Wonderful dog; feisty, courageous, quiet (not a yippy dog), always up for an adventure. After 11 years, she got bile duct cancer and we lost her. I also know that piriformis muscle, and the sciatic nerve pain (before surgery for badly herniated disc; FINALLY my MD at the time got me an MRI, then said ‘wow, you gotta get that fixed’; well, duh). Absolutely we have to manage our health and bodies.

  2. Glenn Jones says:

    Sage advice Kevin. I put up with four years of misdiagnosed angina, including a number of trips to the ER. On one such trip, the doctor told me that I had nothing to worry about as it was not a heart attack. He told me that next time I visited my physician, I should mention that I might have a small split in the aorta. There was no mention that this might actually be serious and could kill me. So my wife and I proceeded on holidays to New Zealand, thinking nothing more about it.

    Upon our return, I visited my physician for something unrelated and mentioned the advice I had received from the ER doctor. My physician went ballistic! He immediately arranged a scan of my aorta to eliminate the possibility of an aortic dissection. He did mention that if I had actually been suffering from such a condition when I visited the ER, I probably wouldn’t still have it -as I would have died in the meantime!

    Thankfully no aortic dissection. After a number of additional trips to the same ER, it turned out to be a blockage of the LAD coronary artery instead. But it just shows what can happen when circumstances conspire with symptoms that could point to any of a number of underlying conditions. Also, doctors aren’t always great communicators.

    So how is the flu going? Also, have you considered joining LinkedIn and maybe building your profile by contributing to relevant discussions and linking with people who can put business your way? It has worked for me, although I am not in the same line od work as you. I don’t Facebook or Twitter, but I have some 350 connections on LinkedIn. Many are local, but quite a few are in other countries.

    Rgds, Glenn

    • Hi Glenn,
      I often wonder about the lives of those who treat physicians like minor gods,and hang on their every word – even the overweight, unhealthy-looking physicians. I’ve walked away from a few. That book I recommend, ‘Your Medical Mind,’ is actually pretty good. The author(s) were on the radio, talked sense, so I bought it.
      I do work with LinkedIn some, as FitOldDog, especially the triathlon group. I tried a number of others, but they just ignored me. Too different, I guess. My business ideas are coming together. I had a lovely review of my Surgery Recovery Guide on Amazon, which buoyed my spirits, and another on my Plantar Fasciitis (PF) e-book, which said that it sucked. These reviews, especially the negative ones, are really helpful. I’m going to rework the PF, product, which is much more than an e-book.
      Currently, I’m reading a truly helpful book, ‘The Reluctant Entrepreneur,’ which is talking good common sense.
      I found your doctor story fascinating – did you read my blog post, ‘Bonking out of Context,’ that I wrote a while ago – boy, talk about physicians missing the diagnosis.
      Veterinarians and medics have always had a love-hate relationship, which I think only the vets notice – makes life more interesting.
      Glad you didn’t dissect, I read about that on Facebook all the time, and it is not good.
      Kind Regards,
      kevin

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Disclaimer: As a veterinarian, I do not provide medical advice for human animals. If you undertake or modify an exercise program, consult your medical advisors before doing so. Undertaking activities pursued by the author does not mean that he endorses your undertaking such activities, which is clearly your decision and responsibility. Be careful and sensible, please.