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January
2007 Issue
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Featured Case Study:
Eight-year-old spayed cockapoo, Misty, has been panting and has gained some weight—she just hasn’t been herself for the past two weeks. From Dr. Peter Kintzer, Boston Road Animal Hospital, Springfield, MA; and Dr. Fred Metzger, Metzger Animal Hospital, State College, PA.
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You won't want to miss what's new from IDEXX! Visit IDEXX at the 2007 NAVC, WVC and Western Conferences—stop by our newly designed booth to see dozens of medical- and business-boosting innovations.
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Announcing the NEW NSAID Monitoring Panel—Available January 18th—A new convenient size! Monitor all your patients on NSAID therapy—this prepackaged panel makes it easy to follow manufacturer’s recommendations.
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Better Assess Respiratory Disorders with the NEW Respiratory/Blood Gas Cassette for the VetStat® Electrolyte and Blood Gas Analyzer—New upgrades to include tHb and SO2 give you better capabilities for assessing respiratory disorders and characterizing metabolic disorders. |
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Streamline your workflow! Connect your VetStat® analyzer to your LaserCyte® analyzer or the IDEXX VetLab® Station.
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Training and Events
- The IDEXX Learning Center provides comprehensive online training to help you and your team keep up with current industry trends, use our diagnostic products and services more effectively, and run a more efficient practice.
- Become a Feline Health Champion for your practice and gain access to free online courses, earn CE Credit and much more!
- Check out the latest list of CE credit-approved training opportunities available this month from IDEXX.
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Interactive Challenge: Now earn FREE CE credit! Test your knowledge by identifying three nucleated cell types from fine-needle aspirates of a dog’s enlarged liver and suggesting a cause for the process.
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Featured case study:
Featured case study: Eight-year-old spayed cockapoo, Misty
by Peter Kintzer, DVM, DACVIM, Boston Road Animal Hospital, Springfield, MA and
Fred Metzger, DVM, DABVP (canine/feline), Metzger Animal Hospital, State College, PA
Plan
Bloodwork (CBC, DHP, electrolytes, T), urinalysis and survey radiographs of the chest.
Erythron—Normal
Leukon—There is a mild leukocytosis characterized by a mature neutrophilia, lymphopenia, eosinopenia and very slight monocytosis most consistent with glucocorticoid secretion (stress leukogram).
Thrombon—Normal
Protein panel—Unremarkable
Liver panel—Mild elevation in ALT suggests very mild hepatocellular damage.
Electrolytes—Unremarkable
Lipase—Mild elevations of lipase may be associated with pancreatitis; however, mild elevations in lipase can be from nonpancreatitic sources. Evaluation of the canine specific pancreatic lipase (Spec cPL) would be indicated to further investigate the potential of pancreatitis.
Renal—The urine is not concentrated (isosthenuria); however, there is no evidence of decreased glomerular filtration rate (within reference interval values for BUN and Creatinine) and no obvious primary renal disease is detectable.
Glucose—Mild hyperglycemia was present without glucosuria.
Thyroid—Low total T is associated with hypothyroidism and nonthyroidal illness (euthyroid sick syndrome).
Diagnostic Imaging
Abdominal radiographs showed moderate hepatomegaly.
Thoracic radiographs were unremarkable except for mild calcification of bronchial walls and spondylosis of the L1–2 and L2–3 disk spaces.
Ultrsound evaluation
Liver appears diffusely slightly hyperechoic. Adrenal glands were upper-normal in size.
Presumptive diagnosis
Hypothyroidism, hyperadrenocorticism or unrecognized respiratory disease.
Diagnostic plan
Low-dose dexamethasone suppression test and free T by ED plus Spec cPL
Final diagnosis
Pituitary Hyperadrenocorticism
Clinic case outcome
The pattern of suppression below 1 ug/dL at four hours with escape from suppression at eight hours on the LDDST is diagnostic for pituitary-dependent hyperadrenocorticism. This pattern is seen in about 25% of cases. If this pattern is not present, additional diagnostic tests are needed to differentiate PDH from hyperadrenocorticism caused by an adrenal tumor. Options include plasma ACTH levels, high-dose dexamethasone suppression testing and diagnostic imaging (ultrasound, CT, MRI). Lysodren therapy was recommended, which resulted in pre- and post-ACTH serum cortisol concentrations in the therapeutic range for Lysodren therapy after 10 days of daily administration (loading dose). Maintenance Lysodren therapy was then instituted. This case also demonstrates that the ALKP is normal in some dogs with hyperadrenocorticism. The low TT can be due to nonthyroidal illness, hypothyroidism or episodic secretion. The free T ED is normal. Low TT levels have been reported in just over 50% of dogs with hyperadrenocorticism.
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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Visit IDEXX at the NAVC, WVC and Western Conference
IDEXX is introducing more new products and services than ever before to help you practice what's possible! You'll have a chance to see the latest medical and business-boosting innovations for your practice, including new diagnostic tools, new ways to streamline your practice workflow, new practice management software enhancements and educational events featuring advances in protocols and care.
The IDEXX Booth features a new level of information integration powered by IDEXX SmartLink™ Technology—See how the entire IDEXX Laboratories product line works together to create a totally new way to practice veterinary medicine.
NEW FROM IDEXX and on display at 2007 conferences! Ask our representatives for a demonstration:
And much more!!! Visit our booth at NAVC, WVC and Midwest in 2007.
 NEW NSAID Monitoring Panel for the VetTest® Chemistry Analyzer
Available January 18th in a smaller, more convenient package!
Easily evaluate chemistry levels to help monitor your patients being treated with non-steroidal anti-inflammatory drug (NSAID) therapy so you can adjust medication as necessary and ensure their health and safety. The panel also allows you to follow current FDA recommendations regarding administering and monitoring of NSAIDs.
- More convenient—In a smaller, more convenient package size so you can preserve precious freezer space and still have all the tests necessary to evaluate baseline status and monitor the effects of NSAID therapy. Each box contains four NSAID monitoring panels.
Customized—Targeted tests—ALT, ALKP, AST, BUN and CREA—offer you an easy, economic solution for NSAID monitoring. - Reliable—As always, rely on your VetTest® Chemistry Analyzer’s proven dry-slide technology for uncompromising accuracy and confidence in your results.
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For more information on the new NSAID Monitoring Panel, call
1-800-248-2483 or visit www.idexx.com/nsaid.
Having the ability to measure tHb and SO allows you to better assess respiratory disorders on your critical patients. Plus, with the calculation of base excess you can better characterize metabolic disorders.
Great value: More capability for the same price as current cassette—a great value for you and more value for your clients Convenient size: Sold in packs of 12 cassettes Eary to run: As with the current cassettes, running the new respiratory cassette is simple Easy to store: Room temperature storage saves refrigerator space
No upgrade necessary—current software version 1.02 and past versions are ready to report additional resutls.
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Minimize data entry and ensure your VetStat® Electrolyte and Blood Gas Analyzer’s results are incorporated in the printout with your other analyzer results.
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When you're ready to run a sample:
Sample run not needed:
Touch the VetStat icon on the IVS/IVLS touch screen and "Stop Waiting" for patient results. Turn the VetStat analyzer off for 30 seconds, then on to remove patient information from the VetStat analyzer screen.
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IDEXX Learning Center
Visit the IDEXX Learning Center to see a full listing of available webinars, seminars, teleconferences and online training courses from IDEXX about emerging trends and best practices in veterinary diagnostics in a forum designed to involve, educate and motivate you and your staff. Click the date to view the details, fill out and submit the form to register.
Here are some of the opportunities available this month:
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NEW Online Training Course
In 2007, IDEXX is offering courses covering a range of topics that will help you advance feline health care in your practice. Become a Feline Health Champion for your practice and gain access to free online courses, CE Credit, and much more!
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 Course One: Building Your Feline Dentistry Practice
Earn credit as you learn more about the importance of good feline dental care. This course will help you:
- Identify the most common and problematic oral diseases affecting cats.
- Apply consistent guidelines when evaluating feline patients.
- Improve your patients’ overall health through a better understanding of feline dentistry.
 Complete the course and earn:
- 1 hour of CE credit
- Certification in Feline Health Management*
- Points for your practice through the IDEXX Practice Developer® program
- FREE scrub top**
Visit felinehealthchampion.com to take the online course. Contact your authorized distributor or IDEXX representative for more details.
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Webinar
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Seminars
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NOW with FREE CE Credit!
Have you taken advantage of every qualifying Interactive Challenge for FREE CE credits?
Every Interactive Challenge from June 2006 on has been worth 0.5 CE credits—that's three credits so far this year—and you get the credits just for participating! Check out the Diagnostic Edge archive and take any qualifying challenges you may have missed. Don't let these fun credits slip away!
Can you correctly identify the three nucleated cell types indicated and suggest a cause for this process?
- Identify the nucleated cell type indicated.
- Identify the nucleated cell type indicated.
- Identify the nucleated cell type indicated.
- Suggest a cause for this process.
 
Figure 1 (A,B,C)—Fine-needle aspirate of an enlarged liver from a dog with moderate increased ALT, ALP and GGT enzymes, Wright’s stain, 50x objective field of view.
Figure 2—Fine-needle aspirate of an enlarged liver from a dog with moderate increased ALT, ALP and GGT enzymes, Wright’s stain, 100x objective field of view
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