October 2006 Issue

Featured case study:
Nine-year-old neutered male dachshund with anorexia and lethargy
by Matthew Eberts, DVM, Lakeland Veterinary Hospital, Baxter, Minnesota

Plan
Because of the acute onset of clinical signs and the vague clinical presentation, a general health screen chemistry profile along with a complete blood count and complete urinalysis were requested in the hope of defining direction for possible further diagnostics.

Erythron—No significant quantitative changes observed. Only mild crenation was observed during the blood film microscopic review.

Leukon—There is a normal leukocyte count with the primary abnormality of a mild lymphopenia. Mild glucocorticoid influence is suggested; however, mild mature neutrophilia is commonly seen accompanying the lymphopenia during a glucocorticoid influence. The lack of the neutrophilia may actually indicate an inflammatory process along with the glucocorticoid influence. No morphologic changes are observed during blood film review and no left shift (presence of immature “band” neutrophil forms) were noted.

Thrombon—There is a mild thrombocytopenia of undetermined cause. The MPV of less than 15 fL suggests there are no significant numbers of large platelet forms, which was confirmed during the blood film microscopic review.

Kidney—There was no indication of decreased glomerular filtration (BUN and Creatinine within reference interval limits); however, there was a 2+ positive urine protein test. In the face of an inactive urine sediment, further investigation was warranted. Repeat urinalysis evaluation to assure reproducibility of this result and subsequent urine protein:creatinine ratio determination would be indicated. Additional evaluation demonstrated no significant proteinuria; however, periodic re-evaluation was recommended.

Liver—No significant abnormalities noted.

Pancreas—No significant abnormalities noted.

Protein profile—No significant abnormalities noted.

Additional Diagnostic Testing
Because of the thrombocytopenia identified, investigation into possible tick-borne infection with a SNAP® 4Dx® Test was performed.

Final Diagnosis
Anaplasma phagocytophilum active infection

Treatment and Outcome

• Doxycycline was prescribed at 50 mg BID x 28 days.
• In 24 hours, Bailey was back to his normal playful and gluttonous behavior!

Discussion

• The SNAP 4Dx Test showed serologic evidence of infection; however, this by itself cannot confirm active infection. In this case, Bailey was showing clinical signs of illness, although they were vague. A CBC showed thrombocytopenia, which is a common component of canine anaplasmosis. The PCR test proved that Bailey had Anaplasma DNA in his bloodstream.
• There is no single test that can diagnose every case of anaplasmosis. A thorough workup, with special attention to the cell counts, is indicated. A CBC should be performed as well as investigation into possible thrombocytopenia, mild anemia and possible leukopenia. Always look at a peripheral blood film to potentially identify the infectious agent. In this case, no organisms were seen in the peripheral blood film.
• When you have a suspicious case, remember to add serology and PCR to your workup.
• The SNAP 4Dx Test offers an accurate, inexpensive method to perform screening serology in-clinic. Results are available immediately.

The recommendations contained in Diagnostic Edge educational materials are intended to provide general guidance only. As with any diagnosis or treatment, you should use clinical discretion with each patient based on a complete evaluation of the patient, including history, physical presentation and complete laboratory data. With respect to any drug therapy or monitoring program, you should refer to product inserts for a complete description of dosages, indications, interactions and cautions.

Do you have a case that you would like to submit? E-mail us at diagnosticedge@idexx.com to get the process started.

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Here’s a tip for getting a urine sample from a kitten.

Keep kittens from eating in the morning if you need a urine sample. Studies have shown that kittens urinate most often right after eating.

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Education and Events

We offer a variety of training events about emerging trends and best practices in veterinary diagnostics in a forum designed to involve, educate and motivate you and your staff. Here are some of the upcoming educational events.

Seminars

• A Practical Approach to Feline Retroviruses
  Erin Evans, DVM

• The Most Commonly Misdiagnosed Diseases in Veterinary Medicine
  Fred Metzger, DVM, DABVP

• Feline Retroviruses: How Real the Threat?
  Richard Ford, DVM, MS, DACVIM, DACVPM

Visit the education and events calendar to view a full list of current offerings, click the date to view the details, fill out and submit the form to register.

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Focus on Wellness Screens During National Pet Wellness Month
by Wendy S. Myers

As your clinic makes plans for National Pet Wellness Month in October, consider revving up your client education on wellness screens. Regardless of a pet’s age, medical history and physical exam findings, every patient needs diagnostic testing to get a baseline and identify possible health problems. Go beyond the basics of heartworm and intestinal parasite testing and offer clients a wellness screen, especially when you’re already drawing blood to test for heartworm and tick-borne diseases.

Why test apparently healthy animals? Because pets instinctively hide signs of illness, a wellness screen can detect problems in pets that appear normal upon physical exam. Think of wellness testing as internal physical exams for pets—you’re checking the function of all internal organs. For example, a pet can lose up to 75% of kidney function before showing any visible signs of sickness. When Dr. Jim Irwin of Sulphur Springs Veterinary Clinic in Manchester, Missouri, conducted an 18-month study of wellness screens on 2,124 patients, he identified some form of disease in 10% of them. Wellness blood work uncovered 226 cases of hypothyroidism, hyperthyroidism, gastrointestinal disease, renal disease, heart disease, diabetes and other ailments. Dr. Irwin published his findings in “Screen Pets Every Year,” Veterinary Economics, April 2001.

Wellness screens also help deliver individualized health care and recommendations. In a multi-pet household, subtle changes in one pet’s drinking or elimination habits may be difficult to pinpoint. Which cat is urinating outside the box? Which dog drinks the most water?

Annual wellness testing lets you spot trends and address changes quickly. Consider two levels of testing, one for pets younger than age seven and more extensive testing for senior pets age seven and older. Use IDEXX brochures on wellness and senior testing and develop sample scripts or talking points your staff can use to help educate clients.

Identifying illness in its earliest stage could add years or even save the lives of pets. The resulting diagnosis from a wellness screen could offer simple solutions to disease management such as therapeutic diets and/or medication. As part of your wellness initiative, also conduct annual wellness screens on staff members’ companions. First-hand experience will help you confidently talk with clients about the benefits of early detection and establishing a baseline.

Have your team put together a plan today and start making National Pet Wellness Month happen every month in your clinic.

Wendy S. Myers owns Communication Solutions for Veterinarians in Denver, Colorado, and provides consulting services on client service, marketing and hospital management. She is the author of two books and four videos. You can reach her at 1-720-344-2347 or visit www.mycommunicationsolutions.com.

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NOW with FREE CE Credit!

Can you correctly answer the following questions pertaining to this picture of a concentrated cellular preparation of abdominal fluid from a dog with acute abdominal pain (Wright’s stain, 100x objective field of view)? Abdominal fluid had a protein content of 3.4 g/dL and a total nucleated cell count of 53,000/µL.

1. Identify the primary nucleated cells present.
2. Classify the process as transudate, modified transudate, exudate or neoplastic effusion.
3. Suggest a possible cause or specific diagnosis.

Step up to take the Interactive Challenge—and now you can step up your CE credits, too! Earn a half-hour of FREE CE credit for each month’s challenge.

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*Each interactive challenge meets the requirements for 0.5 hours of continuing education credit in jurisdictions that recognize AAVSB’s RACE approval; however, participants should be aware that some boards have limitations on the number of hours accepted in certain categories and/or restrictions on certain methods of delivery of continuing education.

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