"kat" wrote in message
net...

"Dale Atkin" wrote in message
news:wxPfl.7466$PH1.5854@edtnps82...

Please don't do that when you become a vet. I have learned the hard
way
to
*always* always* always* get a copy of the bloodwork.

At the moment, my approach would probably to be to say there were some
mild
abnormalities in x,y,z that I don't believe are significant because of
a,b,c. (Let the client know that I've seen the results, and the reason
they
don't need to be concerned about it).
Its difficult though, because if you *know* as the vet that the deviation
isn't significant, and is likely to mislead the client the 'easy way out'
is
to give your interpretation of the results.

My feeling, given that the diagnosis was hepatic lipidosis, I would
believe
it if someone told me that that by itself would explain the anemia.

That could cost your animal it's life - as it did with my daughter's cat.
There was an underlying cause for the anemia that was not related to the
hepatic lipidosis.


I'm sorry if I've missed it (gone back and I can't find it), did you mention
what the underlying cause of the anemia was determined to be and how that
was determined?

Hind sight is always 20/20 (at least it should be), the question is though,
if your vet in September had told you "your cat is slightly anemic, but that
is likely tied with the hepatic lipidosis..." would you have accepted that
as the cause? Or would you have looked for further diagnostic tests?



(in fact
googling a little I found
http://www.vet.uga.edu/vpp/clerk/turner/index.php
which says "With underlying disease, the packed cell volume can be normal
or
there can be a mild to moderate, normocytic, normochromic,
nonregenerative
anemia most likely due to the anemia of chronic / inflammatory
disease.").


Most likely but not definitely.

Nothing is ever definite.

Perhaps a follow up blood test in x amount
of time should be suggested along with offering up some other
possibilities
for the anemia.

Just as an FYI, Cornell's "Consultant" program comes up with 208 possible
diagnoses that would explain anemia. Should your vet have gone through each
of them (no matter how unlikely)? Or restricted herself to lifely causes?
Given that the anemia was already explained, should they have gone looking
further?

The thing is, you can *always* keep looking. This is how some clients go
home with $30,000 bills. If you want to rule out every cause of every
observed symptom, you'll be at it for a while. Good for the pocket book, bad
for the pet and the client.

It all *fits* with his diagnosis. Did he go over the other enzyme levels
with you, or did he just say "The results confirm hepatic lipidosis"?

It was a she and she did not go over the enzyme results. She also did
not
tell my daughter that she had him tested for FIA (though it was neg)


Could you clarify? Do you object that she tested without permission? or do
you object to them not telling you that they tested?



The first time or two
I didn't think it was that important. Not any more. Frankly I no
longer
respect a vet who doesn't give me a copy (or fax me one if I've gone
home),
explain the results to me and what he/she thinks it means.

I don't think I'd think of giving the client a copy (any more than I'd
think
it was necessary to make copies of all the x-rays, or take recordings of
the
heartbeat, lung sounds, etc, etc). I'd certainly provide a copy on
request
without hesitation (or charge), but I don't think I'd volunteer.


Too bad.

Would you, as a client think it appropriate to have copies of every test
done? Why is blood work special? How are you going to get a copy of a
palpation? An auscultation? Could you really look at an x-ray of something
subtle and have it make sense (and if its not something subtle you're
looking for, why would you want a copy anyways?)

The thing is, even if you have the results, its the *interpretation* that
matters, not the numbers, otherwise the vet's job could be done by a
machine. That's why vets go to school for *years*.

A value that the machine says is 'normal' isn't necessarily 'normal', and a
value the machine says is 'abnormal' isn't necessarily 'abnormal'.

Classic example of this, one of my dogs, is hypothyroid. He shows all the
classic signs of hypothyroidism, but the machine says he's normal (he's
borderline low). We put him on thyroid meds, and loe and behold his signs
improved.

Other indicators, just aren't that valid for certain species (too many
things can throw them off). Very few things in veterinary medicine are cut
and dry. To communicate *all* the complexities involved would require
*years* (I mean this), so you're always left with the choice of how much
information to give, and how much to hold back. Some clinicians draw the
line in a different place than others.

Dale