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*Axiom at BSAVA 2001* Peter J. Webb MRCVS. (MD) and Martin J. Wheeler MAHI. (Director of Graphics & Multimedia) welcoming the President of BSAVA Lynn Turner MA VetMB MRCVS onto the
"Since our last newsletter we have been extremely busy with various activities"
*Comings and Goings*
During this period John Dunn has been away on TVI duties in Cumbria but will be back soon, completely refreshed. This is good news for everybody and it also means we have done our bit in fighting the Foot and Mouth scourge that has hit our community so hard. During this period we have been very lucky to have the services of Kostas Papasouleotis who is the lecturer in clinical pathology at Bristol University and Emma Dewhurst who is the senior clinical scholar in clinical pathology at Bristol University. Both are excellent clinical pathologists and have performed a first rate job while they have been with us. Emma will remain with us until the end of August when she will return to Bristol to continue her studies. This is part of our continuing co-operation with the Universities and we are pleased to be involved with this partnership. Sadly Dr. Torrance has left the business at short notice for personal reasons and we wish him well in whatever he decides to do. We have been very lucky in obtaining the services of Karen Gerber who is the only other board certified clinical pathologist in the UK. She has a special interest in Cytology. Thus we are able to maintain the quality service that we offer to you. The last major change of staff concerns Elizabeth Kanengoni who has taken over as manager of our London facility. Vimal had been with us for six years but felt in need of greater experience in other disciplines. We wish him well in his new career. Elizabeth is well qualified with tremendous experience in haematology including Veterinary haematology. She is however still getting to grips with our computer system and the vagaries of our biochemistry unit in London but these initial teething problems should soon be resolved. Elizabeth is an outstanding haematologist and we are extremely lucky to obtain her services.
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*ISO 9002*
We are proud to announce that we have been re-certified under ISO 9002 for a further 3-year period. Possession of this mark means that we are rigorously inspected every six months with a longer inspection once every 3 years. It is this renewal inspection that we have passed with flying colours. This is a tribute to all members of staff and the high quality of service that we look to achieve.
*Communications*
As part of our effort to get results to you in a timely fashion we have been working with Verifac computers and their Congress information system so that we can send our results back through this system. If you have a Verifac computer system within your practice this means results can go straight back into patient files. If you do not possess a Verifac system but are running on a windows based system then the same software can be used to cut and paste results straight into patient files. If you are interested in this Technology please do not hesitate to contact us in the first instance. As you know, our automated fax system has caused us some grief over the past 12 months. It is certainly working better than before but still not to our satisfaction. Unfortunately in an effort to make this piece of software work correctly some damage has been done to the typefaces and the access number has been moved from its original position. The software people are working on this and I apologise for the temporary poor quality of these reports. One annoying problem is that the phone number 778844 appears as 778811. Unfortunately this goes through to a very kindly old lady who knows nothing about clinical pathology! As she is a kindly lady she understands why this is happening but obviously we need to stop this nuisance. Please note the phone number is 01626 778844; it is an ISDN line, which means there are between 6 and 10 active incoming phone lines on this single number. You will also note that all members of staff have a direct call number and this is listed both on our CD and the printed copies of our price list and so if you wish to speak to someone directly it is probably easier to use the direct line number. Our printed fax line number of 01626 779570 is always very busy but there are other numbers you can use if you can't get through on this line and they are 01626 771447 and 01626 771448. We can also send results back to you by Email; this is quick and efficient and bypasses the wretched fax software so the presentation is better as well! All those who have received our new CD will I am sure see a tremendous improvement on last year's effort. We are already working on the 3rd edition for 2002. This CD will load on the hard drive of an individual PC or indeed a server. It should produce an icon in windows and this icon can be minimised on the tool bar so the programme can remain running in the background during consultations. Not only does this CD-ROM contain our price list but also the various protocols that we have produced, particularly those relating to endocrine evaluation. There are some very basic haematological images included on the CD which you can print, which are intended to be helpful to your veterinary staff who are doing haematology. In addition these images are also available on a A4 poster to pin up on the wall of the practice lab. If you would like a poster and have not received one please contact the office. If by chance your practice cannot operate a CD-ROM (there are some!), or does not have a windows operating computer system, we can provide you with a printed copy of both the price list and the guide. The price list is also available in HTML; Microsoft Word and rich text formats, the latter being particularly useful if you are working on a Unix based system. This information can be supplied to you on a floppy disc or as an email attachment. Please contact the office in the first instance with your requirements. Martin Wheeler our Director of Graphics has been very busy designing our website, the launch of this web site is imminent and can be found at www.axiomvetlab.co.uk or axiomvetlab.com. As this is a public site certain veterinary information would be inappropriate and is not displayed. Over the next few months we will be "playing around" with certain ideas so the site is likely to continually change.
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*Meetings*
We were very pleased to sponsor the Clinical Pathology and Endocrine programmes at the BSAVA Congress. I think all those who attended the lectures would have been pleased with the content, in particular the Paul Canfield sessions on clinical pathology. We were also pleased to sponsor a recent Midlands BSAVA meeting on Endocrinology given by Richard Dixon and Carmel Mooney and we will be sponsoring the annual Western Counties Veterinary Associations Family Day; this year a visit to Paignton Zoo at the beginning of the summer holidays. We are always pleased to consider sponsorship for clin. path meetings although of course there is a limited budget for this so basically first come first served.
*New Tests*
*Guildhay VETSIGN Canine Cardio Screen* As always we are keen to evaluate any new tests that come onto the market to make sure our clients have the best and most up to date information and diagnostic tools at their disposal. In particular we are pleased to be associated with Guildhay and the launch of their test Cardio screen that involves the detection of pro ANP. Pro ANP is released in cardiac hypertrophy and dilatation and so this test is particularly useful for the evaluation of cardiac insufficiency. As this peptide is also released from damaged kidneys we have put together two profiles, the old dog profile and a cardiac monitoring profile, to give us a clearer picture of the source of this peptide. We think this peptide will be a very useful adjunct to the monitoring of geriatric patients and also cardiac disease associated with hypertrophy and dilation. The values are different if serum or plasma is used and to avoid any interpretational difficulties we are recommending that you send in heparinised plasma only. Unseparated serum is particularly inappropriate for this test; it is very likely to give you an erroneously low result. We are also currently evaluating a Canine faecal elastase. This test will be useful in the evaluation of pancreatic insufficiency. As you are aware we no longer perform faecal trypsin analysis. The FPA test is certainly a worthy successor but even that is prone to false negatives particularly if the faeces is somewhat old when it arrives in the surgery. Faeces recovered from lawns especially in the summer are always problematical; hopefully the canine faecal elastase will overcome this but we still have some evaluations to perform. Under Richard's direction we are pleased to offer you a full range of endocrine and thyroid testing in particular Free T4 by dialysis, which is becoming particularly helpful in the evaluation of thyroid function in the dog. We are also working on a comparative project with one of the vet schools on its usefulness in the diagnosis of early cases of hyperthyroidism in the cat. Some of these endocrine investigations also require special transport requirements to the laboratory and if in doubt you should contact the lab first. The lab possesses a number of freezer bottles/cold packs that we lend out to practices in order to get samples back to us in the optimum condition. We only possess a certain number of these packs so you need to ring the office in order to book one before you do the test. These packs are given to practices on a free of charge basis as long as they are returned to us. Please do not keep these packs in your practice for weeks; send then back immediately, there is always a waiting list for them.
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ENDOCRINOLOGY PRACTICE TIPS
*Thyroid hormone replacement therapy in hypothyroid dogs*
The only UK licensed preparation for thyroid hormone replacement therapy (THRT) in dogs is Soloxine. Most dogs can be well clinically controlled using once daily therapy. Monitoring can be performed within 7-10 days after starting treatment or after making a dosage alteration. Monitor therapy with measurement of total T4 rather than free T4. Concurrent measurement of cTSH is recommended to give an indication of longer-term thyroidal control. Adequately treated dogs usually have cTSH results near the lower limit of detection of the assay. Circulating total thyroxine (T4) concentrations fluctuate widely after administering the therapy and so the time of sampling is crucial. Monitoring samples should be collected six hours post-pill since this corresponds to peak circulating T4 concentrations in most dogs. Aim for six hour post-pill total T4 results in dogs receiving SID therapy of approximately 60 nmol/L (i.e. above the "normal" range of 15-40 nmol/L). SUMMARY: To monitor thyroid therapy, collect blood for total T4 and cTSH measurement six hours post-pill 7-10 days after starting treatment. *Mitotane therapy in dogs with hyperadrenocorticism* (Cushing's disease). Initial treatment requires daily "induction phase" of mitotane: usual starting dose is approximately 50mg/kg given once daily. Always give with food. The response to mitotane is highly variable but the average length of the induction phase is 7-10 days in most dogs. Monitor therapy with an ACTH stimulation test. Optimal cortisol values pre and post-ACTH are 50-100 nmol/L. Once adrenal suppression is achieved, the "maintenance phase" should be started. The maintenance dose varies between dogs. Most cases can be controlled with once weekly dosing. Most adverse effects in treated dogs are due to over-treatment and consequent hypocortisolism, or side effects associated with the drug itself. Dogs with side effects should have an ACTH stimulation test to assess adrenal suppression and if present, temporary glucocorticoid replacement therapy is indicated. If signs are due to mitotane toxicity try splitting the dose into two doses given 12 hours or if necessary several days apart. *SUMMARY:* Monitor dogs closely with ACTH stimulation tests. Cortisol results between 50-100 nmol/L usually equate to good clinical control. If side effects occur stop therapy and evaluate for possible hypocortisolism and drug toxicity.
*Allergy*
We continue to perform large numbers of invitro allergy tests but these tests do need careful interpretation and sometimes it is quite difficult to offer an opinion when there is little history supplied with the test. We do have a particular expertise in this area so please use it. The production of immunotherapy sets has improved although it is far from perfect, it is an area in which we are still very active. As you are aware, Heska™ produces the immunotherapy sets and this has not been without its problems in the last twelve months, for which I apologise. A few well-placed kicks with my large number tens has hopefully resolved most of these problems. During the summer period the clinical pathologists that are on duty at any one time could be any of a number of permutations depending on holidays and other commitments. Having a comparatively large number of expert clinical pathologists at our disposal, will ensure the maintenance of our quality service. However, if you do have a favourite clinical pathologist and he/she is not available when you phone we are all very friendly and please do not be concerned about speaking to one of the others.
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