Thank you for responding to our May survey! Here are the results:

We asked the question: How are you screening animals with nonclinical signs exposed to one of the recalled pet foods for renal disease?

And you responded.

34.8% of you responded that you use a GHP and 8.5% responded that you use a PAP to screen these patients. Your screening protocols are in line with current testing recommendations. For more information about screening and monitoring these patients, we encourage you to visit the IDEXX Pet Food Recall Web page, an invaluable resource for the pet food recall. In addition, there are more than 50 board-certified IDEXX clinical pathologists and internists available to answer your questions or discuss your concerns.

As a member of the veterinary community, we pledge to stand by you and offer our support during this difficult time.

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Special pet food recall case

Featured case study:
Three-year-old spayed female, domestic shorthair cat, Summer
By Shannon Parsons, DVM, DACVIM, Internal Medicine Consultant, IDEXX Laboratories, Inc.
and Denise Wunn, DVM, DACVP, Clinical Pathologist, IDEXX Laboratories, Inc.

History
Summer has been a generally healthy cat with a history of only a few days of PU/PD. She is an indoor cat with a good appetite and no history of vomiting or diarrhea. The other cat in the household is diabetic and the owners were concerned that Summer might also be developing diabetes mellitus based on the clinical signs. Summer was on a prescription diet. Her food appeared on the list of pet foods recently recalled due to potential renal problems. A new bag was just opened.

Physical exam
Summer is bright, alert and responsive. Her body condition score is 6/9. Her kidneys palpate as normal in size, smooth and not painful. The remainder of the physical examination is within normal limits.

Diagnostic plan
Because of the concern about possible toxic exposure to the kidney related to the recent pet food recall and the desire to capture general health baseline laboratory data, blood and urine are collected for a complete blood count, a general health screen chemistry panel and a complete urinalysis.

Erythron—There is a mild increase in the RBC count and this, in combination with the hematocrit and hemoglobin in the high end of the reference interval, support a mild increase in total red blood cell mass. Slight subclinical dehydration should be considered in light of the clinical presenting signs. The red blood cell indices indicate a slightly decreased MCV and an MCH and MCHC in the low end of the reference interval. Without previous measurements to use for comparative purposes, there is a suggestion of a slight decreased red blood cell size and decreased cellular hemoglobin content. These changes are commonly seen in developing iron deficiency and investigation into low-grade chronic blood loss should be considered. This red blood cell indices profile is something that might be seen with cats with inflammatory bowel disease as well as other causes of chronic blood loss. Re-evaluation of the erythron is essential for proper and complete assessment after assuring proper hydration status. (Following fluid therapy, the RBC, HCT and HGB decreased to 9.47 M/µL, 37.3 % and 11.5 g/dL, respectively.)

Leukon—Leukogram changes are minimal with only a mild lymphopenia identified and no significant left shift in the neutrophil series or leukocyte morphologic abnormalities seen on blood film review. The most probable explanation for the mild lymphopenia is glucocorticoid influence (stress).

Thrombon—No significant abnormalities are noted in the thrombon. Platelet numbers are within reference interval limits but it was noted on the blood film review that there was significant platelet clumping and that the reported value was likely an underestimation of the total platelet count in this animal.

Glucose—There is a slight hyperglycemia, which is a common finding in cats with either glucocorticoid influence (stress) as was suggested with the observed lymphopenia or with an epinephrine influence (excitement). The owner’s concern for diabetes must be minimized.

Kidney—The primary renal profile (BUN, creatinine and phosphorus) indicates decreased glomerular filtration rate; BUN and creatinine are mildly increased and phosphorus is in the high end of the reference interval.

Electrolytes/Acid-Base—Electrolyte changes are quantitatively minimal but significant. There is a decreased TCO₂ (bicarbonate) and increased anion gap supportive of a metabolic titrational acidosis. In this case, with decreased glomerular filtration rate, retention of organic acids (phosphates and sulfates) normally excreted by the kidney are the likely cause for the increased amount of unmeasured anions and the resulting compensatory decreased TCO₂. In addition to the metabolic acidosis, there is a potential of slight metabolic alkalosis based upon the very slight decreased chloride relative to sodium. These two electrolytes should follow one another closely and change together during different phases of hydration. When a profile similar to this cat’s is observed, loss (vomiting) or sequestration of chloride should be considered.

Figure 1—Low power field (LPF) of view (10x objective field of view) of yellow-brown globular to fan-shaped crystals, commonly with linear striations. (roll-over images to enlarge)

Figures 2 through 5—High power field (HPF) of view (40x objective field of view) of typical crystals described in many cases assoicated with the pet food recall. Crystals are often yellow-brown and range from round to globular to fan-shaped, and upon focusing through the crystal, linear striations are often seen. Crystals reported to date have had variation in size and shape.

Urinalysis—There is no evidence of concentrating ability because the urine specific gravity is less than 1.035. This finding in combination with the increased creatinine is sufficient to allow the use of the term “renal failure.” In addition to this critical information for characterizing renal disease in this patient, there are many crystals noted during the microscopic evaluation of the urine sediment. The crystalluria is typical of many of the urine samples submitted from patients with renal disease associated with the recent pet food recall situation. In a few cases, there has been significant crystalluria to allow chemical analysis and melamine has been identified as a component. The numbers of leukocytes and epithelial cells are most likely insignificant.

Presumptive Diagnosis

1. There is no specific treatment/anecdote recommended for treating these cases.(See Monitoring Guidelines). General recommendations for supportive care of acute tubular necrosis such as hospitalization with IV fluid diuresis, electrolyte monitoring and support, anti-emetic medications, gastrointestinal support with an alkalinizing diet, H2 blockers and gastro-protectants are indicated in severe cases of azotemia. More stable patients may be managed as outpatients with subcutaneous fluids, supportive medications as needed to combat clinical signs and proper diet. Follow-up lab work, including complete blood counts, chemistry panels and urinalyses should be followed for all cases with renal disease as a result of ingesting the recalled foods. Chronic supportive care requirements must be addressed on an individual basis.

2. Summer was hospitalized and treated with supportive care for renal disease:

   1. IV fluids were administered to correct hydration, electrolyte and acid-base abnormalities and for diuresis.
   2. Hills K/D® renal diet was prescribed.

Clinical case outcome
Summer was hospitalized on fluids for several days and then released with a request for re-evaluation in several days when blood work and urinalysis would be repeated. Summer responded to the initial fluid therapy with an observed decreased BUN and creatinine; however, renal concentrating ability has not yet returned to normal. Some of the serial data are reported below along with a trend chart of the serial creatinine values. Although there has been improvement since the time of presentation, there is evidence of significant compromise in renal function. Periodic re-evaluation of this animal is recommended. See current recommendations for both clinical and healthy animals exposed to the different recalled pet foods.

Serial laboratory data

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.

Tell us what you think of this case, or let us know if 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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Answering Your Questions About the Pet Food Recall
Presented by: Dennis B. DeNicola, DVM, PhD, DACVP, Jane Robertson, DVM, DACVIM,
and Fred Metzger, DVM, DABVP

This informative seminar was presented on two occasions on April 24, with more than 1,000 practices participating. If you did not attend, would like to see the presentation again, or wish to share it with other staff members, you can view an archived version.

Several of the pieces referenced in the seminar are available for reference and training in your practice:

• Pet Food Recall Monitoring Guidelines
• Pet Food Recall Frequently Asked Questions
• Pet Food Recall Additional Resources and Information
• Urine Sediment Evaluation Guidelines
• Timeline of Events 75 KB

Check our site often for the most current information and more reference materials to assist your practice with the pet food recall.

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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 and fill out and submit the form to register.

Here are some of the opportunities available this month:

Online Training Courses Feline Course One: Building Your Feline Dentistry Practice NEW! Feline Course Two: Testing for and Managing Retrovirus-Positive Cats VetTest® Certificate Course—Get 50% off! Use promo code DE2007 at checkout.

Webinars Preanesthetic Evaluation: Avoid Anesthetic Nightmares Fred Metzger, DVM, DAVBP Evaluate Your Blood Film in Less Than Three Minutes Dennis DeNicola, DVM, PhD, DACVP

Seminars A Practical Approach to Feline Retroviruses Dr. Denise Kobuszewski Fluid Therapy: Beyond the Basics William D. Saxon Tick-borne Diseases: Diagnosis, Management and CoInfection Dr. Erin Evans

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Coming Soon: IDEXX Introduces the SNAP® cPL™ Test
Vomiting? Anorexia? Abdominal pain?

You want answers on the spot—the culprit could be pancreatitis.

Dogs presenting with vomiting, anorexia or abdominal pain may have pancreatitis and should be tested.

The SNAP cPL Test is the only pet-side rapid assay test developed specifically to measure canine pancreatic lipase levels. The SNAP cPL Test is the next generation of the IDEXX Reference Laboratories’ Spec cPL® Test, developed in partnership with Drs. Williams and Steiner from Texas A&M University. This assay offers the most sensitive and specific test available.

Visit www.idexx.com/snapcpl to sign up for e-mail notification when this exciting new test becomes available.

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New from IDEXX Reference Laboratories—Real-Time PCR™
Definitive answers through accurate, fast, real-time PCR

IDEXX’s new Molecular Diagnostics Laboratory, directed by Christian Leutenegger, DrVetMed, PhD, FVH, now offers real-time polymerase chain reaction (PCR) testing, providing you with convenient and affordable access to the accuracy of PCR as part of your routine test menu.

With IDEXX Real-Time PCR™ tests, you can count on:

• The latest innovation in PCR technology. Unlike traditional PCR, real-time PCR is a closed-tube system that delivers shorter assay run times and the virtual elimination of false positives.

• Fast answers. IDEXX makes results available in just one to three days so you can work through your list of differential diagnoses faster.

• Surprising cost savings. IDEXX Real-Time PCR tests and panels cost about the same as our other laboratory tests, making them much more affordable than send-out PCR tests.

For more information about IDEXX Real-Time PCR tests call our Internal Medicine Team at IDEXX Reference Laboratories:
1-888-433-9987, select option 4, then option 2.

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Announcing Coag Dx™ Coagulation Cartridges
Compatible with the SCA2000™ Coagulation Analyzer

Coag Dx Coagulation Cartridges help you identify coagulation problems before surgery and in patients suspected of having a bleeding disorder.

The new cartridges are compatible with the SCA 2000 Coagulation Analyzer and will be compatible with the new IDEXX Coag Dx Analyzer when it is available later this year. The cartridges:

• Utilize veterinary-specific parameters
• Offer validated results for dogs, cats and horses
• Measure coagulation time
• Provide in-house testing for PT and aPTT in seconds
• Analyze fresh or citrated whole blood

Visit www.idexx.com/coagdx to sign up for e-mail notification when this exciting new test becomes available.

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Your exclusive membership benefits

As an IDEXX Practice Developer® member, you can earn points based on your quarterly purchases across specific IDEXX categories. Watch your points accumulate, and redeem them for ANY IDEXX product or service. Plus...

There are no paperwork hassles—we keep track of points for you. Receive quarterly statements showing how many points you have, how many you've earned for the quarter and transactions that occurred during the quarter.

You'll enjoy the privilege of members-only discounts on IDEXX products. Special offers will be included in your quarterly statements.

You can choose any IDEXX product or service. No other veterinary company offers you this breadth of state-of-the-art diagnostic, practice management and therapeutic products and services.

Now there’s an easy tool to help you tally your points! Try out our new Practice Developer points calculator and see how your points can grow!

Questions? Call us at 1-800-248-2482.

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2007 Cornerstone® Users Conference
Learn what integration means for your practice.

This conference is designed to help you use Cornerstone practice management software to maximize your practice’s potential, increase efficiency and provide faster and more effective care for your patients. Meet our certified trainers and your colleagues to learn quick tips and tricks to in-depth procedures that can help you build your practice.

Join us for three days of educational workshops and:

• Learn about key practice management concepts from industry experts Dr. Dennis Cloud, Dr. Jim Guenther, Dr. Jim Wilson and Fritz Wood, CPA, CFP.
• Meet IDEXX staff face-to-face and get help from support, education and development experts in our open laboratory.
• Share best practice ideas with other Cornerstone® users.

See the IDEXX Integrated Practice—Powered by SmartLink™ Technology
The integrated practice approach provides extraordinary value by advancing the way you provide medical care, increasing your staff’s productivity and boosting your practice’s profitability. IDEXX SmartLink Technology provides simple and seamless electronic connections to and from Cornerstone to each of IDEXX’s other offerings. Take a look!

Sign up by 7/31/07 and save $100 per person!
Three convenient ways to register: Visit www.idexx.com/csconference, e-mail ecfinance@idexx.com or call 1-800-283-8386, option 4.

Conference dates and location: September 30-October 3, 2007, at the Hilton Minneapolis Hotel in downtown Minneapolis, MN.

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Integration: A better way to practice medicine and manage your practice—see for yourself!

See how IDEXX integrates your entire practice, seamlessly meshing diagnostic, management and billing information for easy access. Entire medical records can be viewed at any workstation, charges are not lost and each patient’s complete medical picture can be viewed in one printout.

The IDEXX integrated practice helps you streamline workflows and increase efficiencies for better service, and most important, it offers a better way to practice medicine.

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Better medicine, better management

“Practice owners who integrate their testing instruments into in-house laboratory suites will improve staff productivity and efficiency while increasing revenue and practice profitability.” Fred Metzger, DVM, DABVP

Dr. Metzger’s article, Integrated In-House Diagnostics: Better Medicine, Better Management¹, describes how integrating your in-house diagnostic systems can improve the quality of care you provide while streamlining your practice workflows and increasing revenues. (75 KB)

In his article, Metzger notes that immediate diagnostic testing has medical advantages that reduce treatment complications, improve patient outcomes and decrease client anxieties. But better medicine is just the beginning: Dr. Metzger says it’s also about excellent customer service. In-house laboratory testing will increase client compliance, enhance the veterinarian-client bond and help you provide consistent care.

The value of integrating your in-house information goes beyond good medicine as well, as shown in the diagram. In Dr. Metzger’s words, “Integrated diagnostic systems ensure that every test is invoiced, thus preventing inaccurate records and lost revenue.”

For more information on the IDEXX Integrated Practice talk with your IDEXX sales representative and “take the tour.”

1. Metzger, F. Integrated in-house diagnostics: Better medicine, better management. Diagnostic Insights. 2007.

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He swallowed WHAT?

Here’s a scary story with a happy ending! Debbie Gallof of Centralia Animal Hospital in Chester, Virginia, wrote to us about her puppy, Saige.

“When I first met her, she had the tip of 10 inches of wire clothes hanger sticking out of her mouth. Three hours later, I had a nice memento and a new puppy! She is the brown one on the left.”

Thanks for sharing your story, Debbie! We are very happy to hear that Saige is doing well.

If you have a story you’d like to share with your colleagues in a future issue of the Diagnostic Edge®, e-mail us a copy* of your X-ray or a photograph of the item or the pet, or mail it to:

Diagnostic Edge
c/o Erica Archer
IDEXX Laboratories, Inc.
One IDEXX Drive
Westbrook, ME 04092

Please include your practice name, address, telephone number and a contact number in case we need to get in touch with you.

*Please send JPEG files between 30–100 KB

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With FREE Continuing Education Credit!*

NOW Approved in Australia and Parts of Canada!†

Have you taken advantage of every qualifying Interactive Challenge for FREE CE credits?
Every Interactive Challenge from June 2006 on has each been worth 0.5 continuing education credits in the United States—and you get the credit 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!

Question:
Which of the following BEST identifies the predominating granular structures present in these fields of view (Figures 1 and 2)?

1. Debris
2. Amorphous crystals
3. Bacteria (cocci)
4. Bacteria (rods)

Figure 1: High dry field of view (40x objective field of view) of the sediment in urine from a dog, unstained preparation.

Figure 2: High dry field of view (40x objective field of view) of the sediment in urine from a dog, wet preparation with a drop of new methylene blue stain.

Not a Diagnostic Edge subscriber? Subscribe now!

Thanks for taking the Diagnostic Edge Interactive Challenge!

*Each interactive challenge meets the requirements for 0.5 hour 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.

AAVSB Provider Number 106

^†Interactive Challenges are also approved in Australia for 0.5 AVA Vet Ed Point and from the following Canadian Veterinary Medical Associations: Alberta, Saskatchewan, New Brunswick and Prince Edward Island.

Not a Diagnostic Edge subscriber? Subscribe now!

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