This month's survey question

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

Preanesthetics in Practice

The results of our survey indicate that the majority of our respondents see preanesthetic testing as part of thorough medical care for their patients. The next critical step in establishing solid preanesthetic protocols in your practice is to get your clients to agree to do the testing! There are two ways to go about this—one is to make preanesthetic procedures mandatory, and the other is to educate your clients on the importance of preanesthetic testing.

IDEXX has tools to help you educate your clients on preanesthetic testing and to help them see the benefits for their pet. Once they understand the potential risks of not testing, they’ll be much more likely to want their pet tested. We also offer suggestions for implementing protocols in your practice. You can use these as a basis of comparison to your own protocols or to put new protocols in place.

Helpful client brochures, posters, educational articles, DVDs and other training materials are available on our new preanesthetic Web site at www.idexx.com/prean. Visit us soon!

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Featured case study:
12-year-old, indoor only domestic long-haired Maine coon cat, Ted
By Peter Kintzer DVM, DACVIM, Boston Road Animal Hospital, Springfield, MA; Laurie Stewart VMD, DACVD, Veterinary Dermatology of New England, Westford, MA

Physical examination
T = 102° F, P = 180 bpm, R = 32 bpm
Ted was quiet, alert, responsive and hydrated. Mild gingivitis was noted. Auscultation of the chest and palpation on the abdomen were unremarkable. Hair thinning, excoriations and miliary dermatitis were seen on the face, neck and flanks. An extensive exudative orange-yellow plaque covered the ventral surface of the body from the axilla to the groin. Brown debris was seen in the aural canals.

Plan
Blood work, skin scraping, cytology of the lesion and otic discharge. Diagnostic imaging and intradermal skin testing were declined for financial reasons.

Skin scraping—negative

Erythron—Mild normocytic, normochromic, nonregenerative anemia with normal red blood cell morphology upon microscopic examination of a blood film.

Leukon—The primary leukocyte changes include leukocytosis with neitrophilia and marked eosinophilia. Instrument findings were confirmed with a blood film evaluation.

Thrombon—Normal

Chemistry profile—hypoalbuminemia

Primary causes of hypoalbuminemia without decrease in globulin include inflammatory disease (negative acute phase protein), protein-losing nephropathy (selective loss of albumin) and liver failure (decreased production). Decreased albumin associated with inflammation is the most likely explanation in this case based upon other laboratory findings.

Presumptive diagnosis
Cutaneous neoplasia, feline eosinophilic granuloma complex (EGC), hypereosinophilic syndrome, allergy/hypersensitivity, chronic otitis.

Plan
Skin biopsy. Dermatophyte culture. Occult heartworm test was declined.

Histopathology
Ulcerative, exudative and marked diffuse perivascular and periadnexal eosinophilic and mononuclear dermatitis. Changes are consistent with syndrome of feline eosinophilic granuloma complex.

Dermatophyte culture negative.

Diagnosis
Eosinophilic granuloma complex, otitis, R/O allergy

Clinical case outcome
Ted was placed on marbofloxacin and triamcinolone. Five weeks later, Ted was more active and sociable and much less pruritic. The lesions on the face, neck and flanks had resolved. The extensive plaque on the ventral abdomen and chest was 80% smaller as well as thinner and drier. Repeat CBC showed an HCt of 37%, WBC 19,610, neutrophils 10,180 and eosinophils 6,960. Repeat chemistry profile was unremarkable. Marbofloxacin was discontinued and the triamcinolone dosage tapered. Five weeks later the patient was minimally pruritic and the lesions were slowly resolving. Additional follow-up lab work was declined by the owner. Triamcinolone was continued.

The eosinophilia appears to have been associated with a marked systemic response to allergy or hypersensitivity. EGC is a feline cutaneous reaction pattern with various potential inciting causes. Underlying allergic disease (atopy, food allergy) is common. Eosinophilia, although not seen in all cats with EGC, is not typically of this magnitude.

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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IDEXX Learning Center

Visit the IDEXX Learning Center to see a full listing of available Webinars, seminars, teleconferences and on-line 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 event to view the details and fill out and submit the form to register.

Here are some of the opportunities available this month:

On-line Training Courses VetTest® Certificate Course: Promote best practices and utilize every new enhancement on the VetTest analyzer. Feline Course One: Building Your Feline Dentistry Practice NEW! Feline Course Two: Testing for and Managing Retrovirus-Positive Cats

Seminars "Twice-a-Year Wellness" for Life: Michael Rehm, DVM Management of Retrovirus-Positive Cats Susan Little, DVM, DABVP Lyme Disease for the Canine Practitioner Steve Levy, VMD

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IDEXX is pleased to announce the launch of its Preanesthetic Web site at www.idexx.com/prean!

Whether your practice requires preanesthetic screening or is still fine-tuning preanesthetic protocols, you’ll find useful information, educational materials for the entire staff and helpful tips to use today when you visit www.idexx.com/prean.

Don’t underestimate the importance of preanesthetic testing! Many practices have implemented mandatory preanesthetic testing programs in order to protect their patients, their clients and themselves from unnecessary risks and worry.

A comprehensive preanesthetic testing program:

• Gives you a clear picture of your patient’s health status
• Allows you to modify your anesthetic protocols, if necessary
• Provides baseline data on your patient for future visits
• Identifies abnormalities and potential health risks
• Provides peace of mind for you, your clients and your staff

See this suggested protocol chart and much more when you visit www.idexx.com/prean.

If you have questions about implementing a preanesthetic program in your practice, call us at 1-800-248-2483. We’ll be happy to help!

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Vomiting? Anorexia? Abdominal Pain? Introducing the new SNAP® cPL™ (canine pancreas-specific lipase) Test—for a more complete diagnostic picture

For dogs presenting with vomiting, anorexia or abdominal pain, the culprit could be pancreatitis—but pancreatitis has been difficult to diagnose.

Clinical signs are common and nonspecific.
Pet-side diagnostic approaches have not been definitive.

Finally, diagnose or help rule out pancreatitis in a SNAP®

• Use the most accurate pet-side pancreatitis test for clearer direction and added confidence in your diagnostic workup.
• Provide answers and a treatment plan to your clients during the patient visit.
• Monitor your treatment and the long-term health of your canine pancreatitis patient with the Spec cPL® Test from IDEXX Reference Laboratories.

Proven accuracy

• The only pet-side test developed to measure canine lipase levels specific to the pancreas.
• The next generation of IDEXX Reference Laboratories’ Spec cPL® Test, developed in collaboration with Drs. William and Steiner to offer the most sensitive and specific test available—95% correlation to Spec cPL.
• Part of the growing SNAP® family of ELISA tests, trusted worldwide for superior accuracy and ease of use.

Easy to read

• The SNAP® cPL™ Test provides a "normal" or "abnormal" result for pancreatic lipase levels in just 10 minutes.
• In a study involving veterinary technicians, 96% of the results were correctly interpretated.

To order this new test, contact you authorized IDEXX distributor or call
1-800-248-2483.

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New Solutions—Feline Upper Respiratory Disease Panel
Make determining the cause of feline URD as common as the presenting signs.

Cats presenting with signs of feline URD (sneezing, oculonasal discharge, conjunctivitis with or without oral ulceration) are probably common in your practice. But, until now, quick, accurate and affordable diagnostic tests to determine the etiologic agents involved were not readily available.

With the new IDEXX RealPCR™ Feline URD Panel, accurate identification of the causative organisms can be as common as the presenting signs. From a single sample, detect the five most common organisms (318 KB) that can cause upper respiratory disease in cats.

Consider the IDEXX RealPCR™ Feline URD Panel in the cases below:

Syndrome		Typical Patients
Acute URD		Kittens, unvaccinated older cats, FeLV, FIV+ cats
Chronic Conjunctivitis		Kittens w/ acute URD, adult cats w/URD history
Chronic Carrier		Middle-age/older cats recovered from FHC-1 or FCV (80%), most kittens recovered from FHV-1*
Chronic Rhinitis		Adult cats
Severe Ocular Disease		Kittens or cats with FHV-1*

Also diagnose at-risk cats from a shelter with an URD outbreak, cats from a breeding cattery (to detect carriers), cats in households where a new kitten or cat will be introduced, and cats about to be introduced into a new household with other cats.

Add the Feline URD Panel to your IDEXX Reference Laboratories test order form using test code 2512. List price $74.

*Limitations: PCR may not detect silent carriers of FHV-1 and FCV if the cats are not actively shedding the virus. This limitation applies more to FHV-1 than to FCV, because cats with FCV tend to shed the virus continually.

The Feline URD Panel is currently only available in the United States.

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URD samples: More than one way to swab a cat?

Cats presenting with signs of feline URD (sneezing, oculonasal discharge, conjunctivitis with or without coral ulceration) are probably common in your practice.

With the new IDEXX RealPCR™ Feline URD Panel there is a quick and easy way to accurately identify the causative organisms of feline URD.

Submitting samples for the Feline URD Panel is easy. To optimize the diagnostic sensitivity of this panel, please submit samples from both sources listed below together as outlined in this month's tech tip.

Collection materials:

1. Two regular cotton swabs. For example: even two Q-tips or similar swabs from a new package can be used. Alternatively, you can use sterile cotton culturette swabs.
2. A sterile, plain red-top tube.

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Are you missing out on valuable rewards?

As an IDEXX Practice Developer ® member, every time you buy IDEXX products you can earn Practice Developer points, which can be used toward any IDEXX products or services. 1 point = $1.

Your quarterly statement lets you know how many points you’ve earned and highlights specials. You save on everything from Extended Maintenance Agreements and IDEXX VetLab® analyzers to SNAP® tests, Reference Laboratory services and educational opportunities. You can even use your points to purchase Pizza Hut® Gift Certificates for your practice!

Don't miss out! Use your points today!

For more information on Practice Developer, including more ways to redeem your points, visit us at www.idexx.com/practicedeveloper! If you have questions, call us at 1-800-248-2482.

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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 Continuing Education 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!

Questions:

1. Can you identify the nucleated cell present in this field of view?
2. Can you identify the erythrocyte morphologic change demonstrated in the cell indicated with an arrow?
3. Assuming this field of view is representative of the monolayer, which of the following is the BEST interpretation of the anemia in this case?
   • Minimal nonregenerative anemia
   • Moderate nonregenerative anemia
   • Minimal regenerative anemia
   • Moderate regenerative anemia

Figure 1. Peripheral blood film from a dog with chronic pneumonia of unidentified etiology and anemia, monolayer region of blood film, Wright's stain, 100x objective field of view.

Not a Diagnostic Edge subscriber? Subscribe now!

All fields are required for continuing education credit records.

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.

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