The Pulse Of Veterinary Medicine

Vet-To-Vet Conversation With IDEXX

Why I Run Diagnostics on All My ADR Patients

When an owner tells me their pet is sick, I assume it is sick. That may not seem revolutionary, but my point is that just because we don’t think the pet looks or acts sick, and because the patient history the pet owner provides doesn’t set off any particular warning signs, it doesn’t mean that patient hasn’t got something going on. And who would know better that a patient isn’t its normal self than its owner? After all, they’re living with that pet, and they know all their personality traits and habits. So when the owner says, “Max just isn’t himself,” I take their word for it—until I can prove otherwise. And I do that with diagnostics.


Diagnostics tell you what your patients can’t

Diagnostics are the only way we can diagnose many diseases. Even more often, diagnostics are an opportunity to rule out certain disease or identify early warning signs. We rarely get the answers we need using only the history, signalment and physical examination; we get vague and nonspecific findings. We may not find out exactly what’s wrong when we run a CBC and chemistry with electrolytes and urinalysis, but we know what’s not wrong. For example; there’s no evidence of infection, kidney or liver disease and no diabetes. That’s adding a lot of value, because we’re ruling out a lot of important diseases.

When is “normal” normal?

I’ve said it before, and I’ll say it many, many more times: this is why baseline testing is so important. Let’s use Max again. If you’ve been running diagnostics on Max every year, getting that healthy, individual baseline data—hematology, chemistry and electrolytes, urinalysis—you know what is normal for him, so you’re going to be able to see right away if his results are significantly different. Without that baseline (or normal result) to compare to, all you’ve got is a number, which could be any patient’s result. It may appear to be normal because it’s falling within the reference interval, but it’s not normal for Max.

In fact, this one abnormal result for Max could be the beginning of a trend, which you could monitor to determine if the upward trend continued. This could lead to diagnosing kidney disease earlier, resulting in a much better prognosis. Because you have Max’s healthy baseline to compare to, you might see that his creatinine is slightly elevated. Even if it is not a cause for concern today, it is something you’d want to keep an eye on. So you’d have Max back in for testing in 2 weeks and also perform a complete urinalysis.


Personalized care for every patient

We often talk about the classic cases of differing reference intervals; for example, you’d expect the reference interval for a Chihuahua to be different than for a greyhound. But the truth is, every patient is unique, and we can’t know about those differences without diagnostics.

So back to Max. It turns out that his results are perfectly normal. He may have gotten into the trash and eaten something that didn’t agree with him. We’ll keep an eye on him, but I expect him to make a full recovery within a couple of days. The good news is, everything is “normal,” which I’m happy to share with his owners and they are happy to hear. And I can be confident about that because I performed diagnostics. Better yet, I had Max’s “normal” baseline diagnostic data to compare today’s results to.

Fred Metzger, DVM, MRCVS, DABVP

Fred Metzger, DVM, MRCVS, DABVP

Dr. Metzger is a graduate of the Purdue College of Veterinary Medicine, a member of the Royal College of Veterinary Surgeons and a diplomate of the American Board of Veterinary Practitioners. He is an adjunct professor at Pennsylvania State University and serves on the practitioner advisory boards of Veterinary Economics and Veterinary Medicine. Dr. Metzger owns a six-doctor general and referral practice in State College, Pennsylvania.

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