This month's survey questions

We had some technical difficulties with last month’s survey. We hope you will take it again this month so we can collect the data and report back to you in January. Thank you!
 

Featured case study:
7-month-old female domestic shorthair cat, Poppy
by James R. Irwin, DVM, West County Veterinary Services

Laboratory Data

Figure 1: Peripheral blood film from a cat, monolayer 100x oil objective field of view. Note the band neutrophil form and reactive lymphocyte, both of which are supportive of inflammatory disease.

Diagnostic summary
Preanesthetic laboratory tests revealed normal chemistry and electrolyte panels, however there were abnormalities noted on the CBC. An elevated WBC and neutrophil count was noted. Blood film examination showed 10% bands, rarely seen reactive lymphocytes and no other abnormalities. These findings support the presence of inflammation that is further supported by the slightly increased globulin, which without the CBC results would have been interpreted as an insignificant change. A superimposed glucocorticoid influence is suggested with the lymphocyte count at the extreme low end of the reference interval.

Summary
With an elevated WBC and support for inflammatory disease, it was logical to delay an elective surgery such as this. The kitten was re-examined in an effort to localize the cause of the WBC elevation. There was a molar with adjacent inflamed gingival tissue and marginally inflamed tonsillar tissue. The respiratory tract appeared normal on re-examination. A diagnosis of localized oral infection was made and antibiotics were dispensed. The kitten returned in seven days for re-evaluation. A brief exam showed improvement, the CBC was repeated and the values were improved.

Discussion
While the original findings were not catastrophic, it made sense to delay the procedure. Considering the stressful impact of general anesthesia, abdominal surgery and declaw to such a young animal, it would be foolish to proceed. The owner was most appreciative of our postponement decision and the kitten eventually did well with the procedure.

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.

IDEXX Learning Center

Visit the IDEXX Learning Center to see a full listing of available Webinars, seminars and online training courses from IDEXX. Topics cover 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. Fill out and submit the form to register.

Here are some of the opportunities available this month:

New course! Canine Pancreatitis: Diagnosis and Management With this free online course, veterinarians and technicians will: Identify and understand the presenting signs and risk factors associated with canine pancreatitis. Understand the differences between acute and chronic pancreatitis. Explore the benefits and limitations of the current diagnostic options. Participate in a discussion on common treatment options. Take the course!

Seminars Canine Pancreatitis: Diagnosis and Management Dr. Robert M. DuFort The Most Commonly Misdiagnosed Diseases in Veterinary Medicine Fred Metzger, DVM, DABVP

NAVC 2008  •  January 19-23   Real-Time PCR: Solutions for Routine Diagnostic Challenges Christian Leutenegger, DrVetMed, PhD, FVH Jane Robertson, DVM, DACVIM A Clinical Approach to Fluid Therapy Stephen P. DiBartola, DVM, DACVIM Three Steps to a Healthy and Profitable Practice Ernie Ward, DVM The Most Commonly Misdiagnosed Diseases Fred Metzer, DVM, DABVP Move Over, Rover—Heartworm Is No Longer Just a Dog Disease Tom Nelson, DVM Changing our Ideas in the Diagnosis and Treatment of Pancreatitis David Twedt, DVM, DACVIM A Case-Based Approach to Emerging Tick-Borne Diseases Michael Dryden, DVM, PhD, Matt Eberts, DVM To register, and for times and locations, please visit: idexxlearningcenter.com

Congratulations Dr. Katie Thompson of Lithia, Florida!
We are pleased to award your clinic, the Veterinary Center at Fishhawk, the next-generation IDEXX VetLab® Suite!

We received so many heartwarming stories in response to our VetLab® SuiteStories Contest! Our panel of esteemed judges—twelve veterinarians—chose the story below from hundreds of other thoughtful entries. We thank all of those who entered for taking the time to share their stories with us.

Here is how Dr. Thompson’s story begins—a truly poignant demonstration of the value of immediate information—the kind of information you can get only with the benefit of in-house diagnostics.

"Having practiced veterinary medicine for ten years, the first eight without the benefit of an in-house blood machine, I knew when I opened my own practice that access to metabolic parameters in an accurate and timely manner was essential. The ability to diagnose and treat pathologies correctly and rapidly is one of our clinic's core values. What I didn’t know was that my investment in our new IDEXX LaserCyte, VetTest 8008 and VetLyte systems was going to help me save an old friend."

Read more about Dr. Thompson's story >

Learn more about the Suite Story contest >

Once more, congratulations to Dr. Thompson on winning the
next-generation IDEXX VetLab® Suite!

To learn more about the IDEXX VetLab® Suite of analyzers and IDEXX's commitment to support, visit us at www.idexx.com/vetlab or call
1-800-355-2896.

Study shows benefits of dry-slide technology

In a recent article (Rebar AH and Christian JA. Advanced Diagnostics: Getting reference laboratory results with an in-house blood chemistry analyzer. Clinician’s Brief. 2007), the authors report the findings of their study on the impact of commonly encountered interfering substances (lipid, hemoglobin and bilirubin) on chemistry results.

"It is critical that the impact of interferants on samples be minimized and that in-house blood chemistry analyzers meet basic reference methodology standards for providing consistently accurate results," states the article. In veterinary medicine, a significant percentage of samples are compromised by interfering substances, and these interferants can significantly impact routine chemistry test results.

"The goal of a chemistry analyzer should be to provide accurate and precise results," state the authors. Via a layered design that filters out interferants prior to analysis, dry-slide technology minimizes their impact.

Dry-slide technology is available for reference laboratories with the Johnson & Johnson® Vitros®, and you can get the same quality results in-house with the IDEXX VetTest® Chemistry Analyzer. Read the full article (122 KB).

The VetTest® Chemistry Analyzer employs IDEXX dry-slide technology to give you accurate results in-house in minutes. The Catalyst Dx™ Analyzer, coming in 2008 from IDEXX Laboratories, will also use IDEXX dry-slide technology. For more information on the VetTest or the Catalyst Dx analyzers, go to www.idexx.com/vetlab or call 1-800-355-2896.

RealPCR™ Tests from IDEXX Reference Laboratories
New from IDEXX Reference Laboratories: IDEXX RealPCR™ Canine Distemper Virus (CDV) Test and IDEXX RealPCR™ Canine Respiratory Disease (CRD) Panel

IDEXX’s new Molecular Diagnostics Laboratory, directed by Christian Leutenegger, DrVetMed, PhD, FVH, offers real-time polymerase chain reaction (PCR) testing. Real-time PCR is a closed-tube system that delivers shorter assay run times and virtually eliminates false positives.

In earlier issues of the Diagnostic Edge, we announced two feline PCR tests, the Feline Upper Respiratory Disease (Feline URD) Panel and the Feline Hemotropic Mycoplasma (FHM) Test. Now we are pleased to offer two new canine tests:

IDEXX RealPCR™ Canine Distemper Virus (CDV) Test

Clinical signs of canine distemper virus (CDV)—vomiting, diarrhea, respiratory and even acute and progressive neurologic signs—may be difficult to distinguish from other infectious and noninfectious diseases in young dogs:

The IDEXX RealPCR™ Canine Distemper Virus (CDV) Test is now available to definitively diagnosis distemper infection to:

• Better guide appropriate therapy
• Support isolation of puppy/dog to prevent spread of infection
• Prepare the pet owner for possible development of neurologic consequences
• Help owners and clinicians make informed decisions about therapy versus euthanasia

To order the IDEXX RealPCR CDV Test, use Code 2265.

IDEXX RealPCR™ Canine Respiratory Disease (CRD) Panel

Multiple infectious agents can be a cause of respiratory disease in dogs. Prompt identification and treatment of these agents may lead to less severe clinical signs, can be life-saving and allows for isolation of infected dogs.

The IDEXX RealPCR™ CRD Panel provides rapid, sensitive and specific identification for seven infectious agents—all at once. Individual tests are available and can be ordered:

• IDEXX RealPCR™ Bordetella bronchiseptica Test
• IDEXX RealPCR™ Canine Parainfluenza Virus Type 3 Test
• IDEXX RealPCR™ Canine Adenovirus Type 2 Test
• IDEXX RealPCR™ Canine Respiratory Coronavirus Test
• IDEXX RealPCR™ Canine Herpesvirus-1 Test
• IDEXX RealPCR™ Canine Influenza Virus Test

To order the IDEXX RealPCR CRD Panel, use Code 2524.

For more information on the RealPCR CDV or CRD tests, go to www.idexx.com/realpcr or call our Internal Medicine Team at
1-888-433-9987, option 4, option 2.

Get Passionate About Wellness Testing
by Wendy S. Myers

As veterinary professionals, we understand the importance of routine diagnostic testing, such as intestinal parasite screens, heartworm and tick-borne disease testing. Why not apply the same passion to wellness screens?

Wellness blood work can establish a baseline and detect diseases early. Blood work and urinalysis are even more critical for older pets. I know firsthand. Our cat, Ollie, will celebrate his 20th birthday in July thanks to regular wellness screens and a lifetime of proactive veterinary care. Only 14% of senior animals like Ollie undergo regular health screening as recommended by their veterinarians, according to the 2003 AAHA Study, "A Path to High-Quality Care."

Today 35% of dogs and cats are seniors. If your practice has 10,000 active patients, 3,500 need senior screens. The remaining 6,500 patients are candidates for wellness blood work.

One in four dogs will die of cancer, and cancer is the number one cause of disease-related death in dogs over age two, according to the Morris Animal Foundation. All dogs face a serious cancer threat, and 60% of golden retrievers die of cancer.

To teach clients about wellness screens, explain the benefits, provide brochures and send reminders for future testing. Let clients know your goal is to provide a proactive, tailored approach to their pets’ health care.

At your next staff meeting, discuss how you’ll spark passion for wellness screens. Consider all of your client education venues, including message-on-hold, reminders, footers on invoices, posters, brochures, bulletin boards and clinic Web site. Practice what you preach and get wellness screens for your own pets. Then you can passionately share your firsthand experience with clients.

Wendy S. Myers owns Communication Solutions for Veterinarians in Denver 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.csvets.com.

With FREE Continuing Education Credit!*

Approved in the United States, Australia and parts of Canada!†

Have you taken advantage of every qualifying Interactive Challenge for FREE Continuing Education (CE) credits?

Every Interactive Challenge from June 2006 on has each been worth 0.5 continuing education credit 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:
This is a sediment preparation of cystocentesis-collected urine from an apparently healthy dog. The sample had a refractometry specific gravity of 1.035, trace-positive blood and a strong positive on the leukocyte esterase test pads; no other abnormalities were noted.

1. Identify the structure indicated by an arrow.
    
2. Identify the structures indicated by arrowheads (not all structures are indicated with arrowheads).
    
3. Which of the following is the BEST interpretation of the strongly positive leukocyte esterase test pad?

1. Presence of numerous neutrophils; supportive of inflammation
2. Presence of numerous neutrophils; supportive of sepsis
3. False-negative test result
4. False-positive test result

Figure 1. Urine sediment, unstained, high power field (40x objective) of view.

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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.

Vitros is a registered trademark of Johnson & Johnson. All other trademarks or registered trademarks are owned by IDEXX Laboratories, Inc. or its affiliates in the United States and/or other countries.