Is it a common thing for vets to not mention that an animal is anemic when
results indicate it is? Or have we just been really unlucky in our choice
of vets?

Kathy

kat wrote:
Is it a common thing for vets to not mention that an animal is anemic when
results indicate it is? Or have we just been really unlucky in our choice
of vets?

Kathy



Both!

"kat" wrote in message
net...
Is it a common thing for vets to not mention that an animal is anemic when
results indicate it is? Or have we just been really unlucky in our choice
of vets?

How anemic? What was the blood being run for? Were there any clinical signs
of anemia?

The thing about interpreting lab results, is the range of values isn't
always cut and dry as far as what 'normal' means. The machine will tell you
that 'red cells were outside normal range', but what this means is up to
interpretation (its not necessarily indicative of a pathological condition).
If its only slightly outside the 'normal' range, its not likely significant
when dealing with many values (different sources will report different
'normal' ranges). By the same token, a 'normal' value might in fact be
significant depending on where inside the 'normal' range the animal is.

Was the test run 'in house' or did they send it out? Its also possible he
simply didn't believe the results (I've seen blood come back from a healthy
dog that the lab would have you believe was from a dog on death's door
step). If the blood had clotted a bit, it could certainly mess with the
numbers (and the dog wouldn't be anemic, the culprit would be the machine
lying). This can cause a problem if the patient has already left when you
get the results back. Was there any underlying reason to be concerned about
the CBC?

Another example, imagine you took a sample, and the dog was bouncing up and
down like the Easter bunny. I'm willing to bet that you're likely going to
get a mildly elevated glucose. It isn't significant (well it is in so much
as it indicates stress, but not indicative of a pathological process,
diabetes mellitus would typically have much higher than 'borderline' under
these conditions).

This is why they pay the vets the big bucks . To interpret the results,
not to read back verbatim what the machine spits out (what I've seen done
more often is the vet will come out with results in hand and explain step by
step what each thing means, or doesn't, but in a case where the animal has
already gone home, I wouldn't say its unusual to just report 'no significant
findings' in a case like this).

Dale

kat wrote:
Is it a common thing for vets to not mention that an animal is anemic when
results indicate it is? Or have we just been really unlucky in our choice
of vets?

I would not be pleased with that vet, and I'd most likely be
looking for another one. Common? I doubt it. From my own
experience, I've never had a vet who didn't provide me with a
copy of the lab tests, who didn't go over them with me and
explain what they indicated.

FurPaw


--
Don't believe everything that you think.

To reply, unleash the dog.

"Dale Atkin" said in
rec.pets.dogs.health:

what I've seen done
more often is the vet will come out with results in hand
and explain step by step what each thing means, or doesn't,

And this is what I expect (and get) as normal service. Heck,
one of my vets digs up journal articles as part of his
presentation.

--
--Matt. Rocky's a Dog.

"FurPaw" wrote in message
...
kat wrote:
Is it a common thing for vets to not mention that an animal is anemic
when
results indicate it is? Or have we just been really unlucky in our
choice
of vets?

I would not be pleased with that vet, and I'd most likely be
looking for another one.

This happened to my daughter with her cat (twice with two different vets)
and to me with my dog - also a different vet.


Common? I doubt it. From my own
experience, I've never had a vet who didn't provide me with a
copy of the lab tests, who didn't go over them with me and
explain what they indicated.

Wow I want your vet! I've always had to ask for a copy and never once have
they gone over it with me unless I asked specifically.

Kathy

"Dale Atkin" wrote in message
news:2ctfl.7265$PH1.4653@edtnps82...


"kat" wrote in message
net...
Is it a common thing for vets to not mention that an animal is anemic
when
results indicate it is? Or have we just been really unlucky in our
choice
of vets?

How anemic? What was the blood being run for? Were there any clinical
signs
of anemia?

With my daughter's cat back in September the presumptive diagnosis was
hepatic lipidosis. We didn't find out he was anemic at that time until we
asked for a copy of his records recently. Fast forward to two weeks ago and
my daughter had to rush him to a 24 hour clinic because he stopped breathing
and had swollen lymph nodes. They kept him for five days, ran all kinds of
tests and still didn't have a definitive diagnosis when he was released.
Again they never told my daughter that he was anemic and she didn't find out
until she got a copy of his records to take to still another clinic. That
was two different vets and neither one apparently thought it was pertinent
to tell her.

I also had a dog with CRF and I was never told when she was anemic (also a
different vet). I'm starting to think that this is common practice in our
area!




The thing about interpreting lab results, is the range of values isn't
always cut and dry as far as what 'normal' means. The machine will tell
you
that 'red cells were outside normal range', but what this means is up to
interpretation (its not necessarily indicative of a pathological
condition).
If its only slightly outside the 'normal' range, its not likely
significant
when dealing with many values (different sources will report different
'normal' ranges). By the same token, a 'normal' value might in fact be
significant depending on where inside the 'normal' range the animal is.

With my dog her very first blood work came out slightly outside the normal
range (Hemocrit and Hemoglobin) and when she was finally diagnosed and I
showed her new vet the past blood work she remarked that she was probably
dehydrated at that point.


Was the test run 'in house' or did they send it out?

Sent out in all cases.


Its also possible he
simply didn't believe the results (I've seen blood come back from a
healthy
dog that the lab would have you believe was from a dog on death's door
step). If the blood had clotted a bit, it could certainly mess with the
numbers (and the dog wouldn't be anemic, the culprit would be the machine
lying).

I think the vet should tell the client that and let the client decide what
to do about it.


This can cause a problem if the patient has already left when you
get the results back.

Telephone?


Was there any underlying reason to be concerned about
the CBC?

Yes in all but one out of four cases - which was a routine CBC
prior to dental surgery.

Another example, imagine you took a sample, and the dog was bouncing up
and
down like the Easter bunny. I'm willing to bet that you're likely going to
get a mildly elevated glucose. It isn't significant (well it is in so much
as it indicates stress, but not indicative of a pathological process,
diabetes mellitus would typically have much higher than 'borderline' under
these conditions).

This is why they pay the vets the big bucks .

Some are better at it than others - that's been my experience so far.



To interpret the results,
not to read back verbatim what the machine spits out
(what I've seen done
more often is the vet will come out with results in hand and explain step
by
step what each thing means, or doesn't, but in a case where the animal has
already gone home, I wouldn't say its unusual to just report 'no
significant
findings' in a case like this).


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. 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. The client should
always be made aware of the results whether the vet thinks they are
significant or not. It is up to the client to decide if it is something
he/she wants to pursue.

Kathy

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.(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.").

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"?

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.

I think it *very* important that the vet explain the results to you, and
what they most likely indicate, why they indicate that and where you need to
go from there.

Dale

"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.



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



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)


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.


Kathy

"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