2016 WINTER MEETING - Vtvets
2016WINTER MEETINGSunday February 14, 2016Burlington Hilton HotelJennifer Steinberg, DVM, DACVPIdexx LaboratoriesGlen Burnie, MDJennifer-Steinberg@idexx.comCLINICAL PATHOLOGY:A PRACTICE TO IMPROVE YOUR PRACTICEGenerously sponsored by:
HOLD THE DATES!VVMA SUMMER MEETINGFriday, June 24, 2016Burlington Hilton Hotel6 CE Credit HoursVVMA SPAY/NEUTERMEETING AND WET LABSmall Animal Neurology: Alexander de Lahunta, DVMOne Health: A Community Approach to Shared Bacteria– MRSA and Beyond: Meghan Davis, DVM, Ph.D., MPHLarge Animal: Bovine topic TBDStay tuned for more information.Saturday and SundayOctober 8-9, 2016Capital Plaza Hotel, MontpelierVT-CAN!, MiddlesexThanks for being a member!We are pleased to welcome the following members who joinedsince our 2015 Summer Meeting:Elizabeth Brock, Northwest Veterinary Assoc.Brandon Cain, Peak Veterinary Referral Ctr.Marie Casiere, Woodstock Animal HospitalDan ColeEmily Comstock, Vermont Large Animal ClinicKim Crowe, Vermont Technical CollegeAnne Culp, BEVSSabina ErnstAllison Foster, Peak Veterinary Referral Ctr.Diane Gildersleeve, Newbury Veterinary ClinicJustin Goggin, Metropolitan Veterinary RadiologyLisa Kiniry, BEVSGarrett Levin, BEVSPam Levin, BEVSKaitlin Manges, Ark Veterinary HospitalPhilip March, Peak Veterinary Referral Ctr.Thomas Olney, Rockingham Veterinary ClinicPamela Perry, Peak Veterinary Referral Ctr.Emily Picciotto, BEVSCatarina Ruksznis, Large Animal Medical AssociatesAdrienne Snider, Petit Brook Veterinary ClinicKevin Tobey, Elanco Animal HealthLea Warner, VT-NH Veterinary ClinicVVMA Mission:Promoting excellence in veterinarymedicine, animal well-being and publichealth through education, advocacy andoutreachVVMA Vision:To be the preeminent authority onveterinary medicine and animal well-beingin Vermont88 Beech Street, Essex Junction, VT 05452(802) 878-6888www.vtvets.org kathy@vtvets.orgVVMA Values:Integrity, Service, Dedication, Compassion,Inclusivity, Visionary Thinking, Life-LongLearningFor questions or more information on the VVMA, contact Executive Director Kathy Finnie
Vermont Veterinary Medical Associationwith Vermont Department of Health & UVM Medical CenterA Community Approach toShared Bacteria:MRSA and BeyondFriday, June 24,20169:00 – 4:30BurlingtonHilton HotelNational Institute of Allergy and Infectious Diseases (NIAID)Meghan Davis, PhD, MPH, DVMAssistant Professor of Environmental Health SciencesJohns Hopkins Bloomberg School of Public HealthDr. Davis will discuss microbial sharing between animals and peopleand the role of the environment as a reservoir. She will also considerallergies and asthma and their relationship to microbiome and thehygiene hypothesis.Open to veterinarians, physicians, and allied health professionals.Online registration available spring 2016 www.vtvets.org
COMPASSION, EXPERTISE,TRUSTVermont Veterinary CardiologyDon Brown, DVM, PhD, DiplomateACVIM - CardiologyJenny Garber, DVMDiagnostic ImagingBrandon Cain, Practice Limited toRadiologyInternal MedicineMarielle Goossens, DVM, DiplomateACVIMOncologyKendra Knapik, DVM, DiplomateACVIM - OncologyPhysical RehabilitationNancy Zimny PT, CCRTVermont Veterinary Eye CareSarah Hoy, DVM, MS, DiplomateACVONeurologyPhil March, DVM DiplomateACVIM - NeurologySurgeryKurt Schulz, DVM, MS, DiplomateACVSBehaviorPam Perry DVM, Practice Limited toBehaviorDermatologyAllison Foster, DVM, DiplomateACVD158 Hurricane Lane, Williston, VT 05495 P: 802-878-2022 F: 802-878-1524email:info@peakveterinaryreferral.com www.peakveterinaryreferral.com
2016 Winter Meeting VendorsThank you for your support of our Meeting!4 Legs & A TailTim HoenTimH.4LT@gmail.comAbaxisEcho McDonoughechomcdonough@abaxis.comAventixDavid m (small)ingelheim.com*Boehringer-Ingelheim (large)Elizabeth OlsenElizabeth.olsen@boehringer-Elizabeth Mullikinemullikin1980@gmail.comBurlington Emergency & Vet. SpecialistsWhitney Durivagewhitbier@bevsvt.comCompanion Therapy Laser by LiteCureKevin Gouvinkagdistributing@aol.comHaun GasesJamie BadgerEric .comHenry Schein Animal HealthMartha Rosemrose@henryscheinvet.comHill’s Pet NutritionCynthia Farrell, DVMcynthia farrell@hillspet.com*Idexx LaboratoriesChristina GriffinChristina-griffin@idexx.comIsland Memorial & My Pet’s Final EmbraceJohn Workmanjdworkman@myfairpoint.netMerial LimitedMary Kathryn Edwards marykathryn.edwards@merial.comMidwest Veterinary SupplySamantha SangesSamantha.sanges.@midwestvet.netMWI Veterinary SupplyPaige WillsonLiza malhealth.comNestle PurinaLauren Koronlauren.koron@purina.nestle.comPastore Financial GroupKyle Pressonkpresson@pastorefinancialgroup.comTobin Nadeautnadeau@pastorefinancialgroup.comPatterson Veterinary SupplyGeorge Whitegeorge.white@pattersonvet.comPeak Veterinary Referral CenterHaley LaBonteCindy spitals.com
PENRO Specialty CompoundingNeal Pease, R. PhRo Peasenpease@penro.netropease@penro.netPutney Veterinary GenericsCaitlin Bossio, CVTCaitlin.bossio@putneyvet.comRoadrunner PharmacyPaul NaumCoy rpharmacy.com*Royal CaninKate Andersonkate.anderson@royalcanin.comSchiring Radiographic ImagingJon Nealyjon@schiring.comSedecal USABob Sternburgbsternburg@sedecalusa.comVetri ScienceJana LafayetteDr. Montse iencecorp.comVirbac Animal HealthBrandon McCrumBrandon.mccrum@virbacus.com*VVMA Sponsor
Here to help.Phone consultations for you, referral appointments for your clientsand patients, excellent and honest care for all.24/7 EMERGENCY CAREOVERNIGHT PATIENT MONITORINGSPECIALIST INBurlington Emergency & Veterinary Specialists8 0 2 - 8 6 3 - 2 3 8 7.INTERNAL MEDICINEbevsvt.com2 0 0 C O M M E R C E S T R E E T W I L L I S TO N , V T. 0 5 4 9 5We do extractions for canine and feline periodontaldisease, resorptive lesions, feline stomatitis (fullmouth extractions), place esophagostomy tubeswhen warranted, take digital dental radiographspre and post extractions, do root canal therapy,place crowns, treat base narrow canine teeth withorthodontics, and more. Curious about guidedtissue regeneration to treat periodontal disease?Please call Dr. Sandy Waugh at 802-674-2070 forconsultation or referrals. We love to talk aboutteeth.Windsor Veterinary & Dental Services2326 US Rte 5 NorthWindsor, VT 05089www.vetsinwindsor.comPh:802-674-2070 Fax: 802-674-2155E-Mail: wvds@vetsinwindsor.com
We help veterinarians make informed financial decisions and implement solutions in allstages of their careers.As a member of the VVMA you are entitled to receive: A Complimentary Website to Organize your Finances: Learn More. Access to Complimentary Educational Webinars on Important Financial Topics:o New veterinarians: Noon Webinar, Evening Webinaro Veterinarians in practice: Noon Webinar, Evening Webinaro Veterinarians approaching retirement: Noon Webinar, Evening WebinarCall 1-800-228-4067 or visit: www.pastorefinancialgroup.comLicensed to sell insurance and securities in VT, NY, MA, SC, MT, CT, WA, NH, PA, CA(#0786694), KS, AZ, ME, MI(insurance only), FL,IN, VA . Registered representative of Securities and Investment Advisory Services offered through Hornor, Townsend and Kent, Inc (HTK) –Registered Investment Advisor, Member FINRA/SIPC-VVMA is not affiliated with HTK – 2 Park Avenue, Suite 300, New York, NY 10016212-697-1355. Pastore Financial Group is independent of HTK. A4YK-0407-04E2
Maximizing the use of your reference lab’s clinical pathologist:Help your pathologist help you!Jennifer SteinbergDVM, DACVPCytology: Advantages No special equipment is needed (just a microscope and stain solutions). Fast results:– Slides can be stained within minutes and examined immediately Less invasive and less costly than tissue biopsy. Individual cells can be examined more closely. (They are examined in an intactstate, rather than sectioned.)Cytology: Limitations Cannot assess tissue architecture/cell arrangement as well. Structure is largelydisrupted by the collection procedure. Results are highly dependent on sample quality. This depends on technique, andthe nature of the lesion. Limited number (and variable quality) of slides makes special stains &immunostaining difficult.Cytologic Samples The goal of the cytology sample collection technique is to obtain a thinlayer/monolayer of intact, representative cells to facilitate staining and cytologicexamination. The type of sample collected depends on the nature/location of the lesion and thepreferences of the collector.Submission Guidelines Label slides with a pencil or permanent marker (AKA sharpie)– Frosted slides make this easier Include reasonably descriptive indication of anatomic location Include the relevant clinical history 5 slides per site is usually sufficient Maximum of 10-15 for bone marrow Please do not send more than thatSolid Tissue Cytology-Collection Techniques “Tattoo” or “Pokey-pokey” technique– Needle with no attached syringe is packed with cells by inserting severaltimes into lesion– Offers advantage of producing less hemorrhage and cell disruption Aspiration technique– Cells are aspirated using vacuum force (typically by using a syringe).– For solid tissue FNA, cells should remain in the needle. Make sure torelease suction before pulling the needle out of the lesion.1
Maximizing Diagnostic Yield– Smear cells immediately. (If the slide is allowed to dry before smear isattempted, the cells cannot be spread, and this typically results innumerous small, thick droplets.)– Don’t take the term “squash prep” too literally. Use only the weight of thetop slide for downward pressure. Thickness– Slides that are too thick can be difficult or impossible to interpret.– The cells in thick areas are usually understained.– Morphology of individual cells cannot be effectively examined if they donot spread out on the slide.“Seaweed” Method Place sample on slide Put 2 slides together & pull apart Advantage– Can preserve cell integrity Disadvantage– Preparations are often thick Difficult for optimal stain penetration Cells piled up on top of each other Starfish method– Tends not to damage fragile cells,– Allows a thick layer of tissue fluid to remain around the cells, which mayinterfere with staining.– The tip of a needle is placed in the aspirate and moved peripherally,pulling a trail of the sample with it.2
Tissue Imprint/Scrape AKA “impression smear.” These are typically collected from a tissue biopsysample Gently scraping the cut surface with a scalpel blade & spreading the cellularmaterial on a slide can increase diagnostic yield Before the sample is placed in formalin, blot (to remove excess blood) & thentouch to a slide. Cells from the surface (the interior/cut surface should be used)adhere to the slide. Touch preparations or scrapings from a biopsy or excised tissue Impression smears of ulcerated lesions of limited value – often only seeinflammationDiff-Quik: Friend or Foe? Advantages– Rapid– Inexpensive– Good for viewing Distemper inclusions Disadvantages– Lack of consistency– Prone to contamination– Weakening/Dilution from overuse– No metachromatic reaction-Leaving slide in longer will not helpGetting Good Stain Results Most cytologists prefer to do their own stain on all samples for consistency. Submit unstained (air-dried) slides if possible. Use fresh or filtered stain to avoid contaminating microorganisms. Stain thicker samples for longer periods. “Light” slides can often be re-stained todarken the staining.Lubricant/ultrasound gel All things in moderation Excessive amounts– Obscure visualization– Affect differential staining Try to remove excess prior to aspiratingCystic/Fluid Filled Lesions Fluid is generally of low cellularity– Typically macrophages and lymphocytes– Tissue/neoplastic cells usually do not exfoliate3
–Do not perform fluid analysis No reference intervals, meaningless numbers Improve diagnostic yield– Remove all fluid, place in red top/EDTA tube– Aspirate remnant “tissue” componentSample storage Do not refrigerate unstained slides until they are dry– Moisture/condensate can lead to cell rupture Place fluids in refrigerator to prolong sample viability– Place a portion in EDTA for cytologic analysis– Place a portion in red top tube for possible culture Use non additive containing RT tubes for fluidsWhy no additive? Crystalline material can obscure visualization of cells particularly in low volume,low cellularity samples.Respiratory Cytology The nose– Diagnostic challenges– Nonsterile environment– Labile epithelium-Proliferating cells can mimic criteria of malignancy– Some lesions do not exfoliate well– Did inflammation cause tissue destruction that lead to epithelialdysplasia/hyperplasia?– Did neoplasia cause tissue destruction resulting in secondaryinflammation/infection? Nasal Flush– Therapeutic-Yes!– Diagnostic-Um Superficial inflammation Disrupted cells-make fresh smears at time of sampling Neoplastic cells usually not encountered Fungal infection? Nasal Swab– Similar issues– Maybe less traumatic to cells Rhinoscopic biopsy– Best way to get diagnostic samples– Can make impression smears from tissue– Be careful!!! Morphologic dx should not read “Normal Brain”Formalin is BAD!!! For cytology, that is– Fumes will penetrate most any packaging– Results in partial fixation that interferes with staining Double-bag biopsy samples Do not even STORE near cytology samples4
In-house HematologyJennifer SteinbergDVM, DACVPBlood Smear Evaluation Assess oxygen carrying capacity Gauge primary hemostatic capabilities Evaluate leukocyte responses Identify potential source of hematologic abnormalities Hematology analyzers are only so “clever”Peripheral Blood Film Preparation 30 – 45 degree angle Fluid controlled motion ResultsBody, Monolayer, Feathered edgeHints for a First-Rate Blood SmearThe longer the monolayer (has a metallic sheen), the easier the differential will beTry to place feathered edge in the middle of the slideAdjust the angle of the spreader slide to compensate for anemia orhemoconcentrationLower slide for hemoconcentrated patientsHigher slide for anemic patientsQualitative RBC assessmentLocate MonolayerEvaluate:5
Density (RBC #)Shape (poikilocytosis)Size (anisokaryosis, macro-/microcytosis)Color (normo/hypochromia)Presence of inclusions?Quantify changes presentCell DistributionNote RBC arrangementRouleaux-arrangement of cells resembling a roll of coins. Common in cats. High total protein. Will disperse w/ salineAgglutination-abnormal clumping of RBCs like clusters of grapes associated with immune mediated diseaseAnemiaMost common abnormalityManifests as a decrease inRBCTypically move in unisonPCV (or Hct)PCV/HCT 3 x HgbHgbClassified by:SeverityPresence or absence of REGENERATIONBy changes in INDICESClassification by RBC sizeMicrocytic Iron deficiency Hepatic shunt Japanese breeds Copper deficiency Some dyserythropoiesisNormocytic Most NR anemia Pre-regen anemiaMacrocytic Regenerative anemia Some dyserythropoiesis PoodlesClassification by RBC colorHypochromicMicrocytic-Iron Deficiency, Copper deficiency, ative anemiasPre-regenerativeHyperchromic-Always artifact, lipemia, hemolysis,6
Regenerative AnemiaIncreased numbers of immature erythrocytesOn Wright stained preparations polychromatophilsNew Methylene blue preparations reticulocytes NMB stains ribosomesMay see nRBCs as wellNucleated RBCsCan be seen in small numbers in healthCan w/ regenerative responsesIf w/o reticulocytosisPb poisoningBone marrow damage Drugs, sepsis, hypoxiaMyeloproliferative dzFeLVMain Categories of Regenerative AnemiaHemorrhageLoss of whole blood results in concurrent loss of plasma proteinsPlatelets may be low (consumption) or high (rebound from production)Dehydration from fluid loss may complicate dataHemolysisCells are removed from circulation, but plasma protein is not lostProtein may be from inflammationSerum may be pink from free hemoglobinBilirubin may from hemoglobin recyclingPlatelet counts varyIntravascularRBC destroyed in vesselsPlasma is pink due to release of hemoglobinHemoglobin loss can occur through kidney (will see hemoglobinuria)ExtravascularRBC consumption by MPSNo hemoglobinemiaIcterus is commonWill see bilirubinuriaNo hemoglobinuriaShape ChangesPoikilocytosis – general term for abnormal shapeSpecific terms may help narrow differential listTarget cell Excess cell membrane compared to normal RBC Some reticulocytes are target cells Can be seen w/ liver dz, splenic dzEchinocyte Nonspecific Metabolic dz7
Artifact Excess EDTA storage time pH changes Rattlesnake/coral snake envenomationSpherocytes Seen with extravascular hemolysis Absence does not preclude IMHA Difficult to identify in cats due to low degree of central pallor Must look in the monolayer to avoid false identificationGhost cells Mostly cell membrane w/small amount of Hgb Complement mediated intravascular hemolysis Hgb leaks through MAC formed pores In vitro/artifact from smearing traumaSchistocytes, Acanthocytes and Keratocyteso Tend to be seen togethero shearing forces in vessels, membrane lipid alterationso HSA, DIC, Vasculitis, Iron deficiency, GNOxidative damageo Heinz bodies denatured hemoglobino Eccentrocytes denatured, adhered membrane Acetominophen, Onions, Zn, benzocaine Small Heinz bodies, common in sick catsLeukocytesNeutrophilsPredominant cell typeIncreases Inflammation/infection Stress/steroids Epinephrine/excitementDecreases Severe inflammation Rickettsial dz MyelosuppressionNeutrophil MorphologyToxicityIndicates disrupted maturationCharacterized by cytoplasmic basophilia Dohle bodies (RER remnants) Foamy cytoplasm Granulation (severe)Left shift bandsInflammatory leukogram8
LymphocytesVariable in number1 small cells seen (smaller than a PMN)Fewer reactive & blastsReactive cells Deeply basophilic cytoplasm Perinuclear clearing Azurophilic granulesLymphocytosisPhysiologic (epinephrine), young animalsFew “benign” causes of lymphocytosis“Magic number” 16,000/μlDogs: E. Canis, Addison’s, NeoplasiaCats: M felis, T gondii, FIV, NeoplasiaAdditional readingAvery A, Avery P. Determining the significance of persistentlymphocytosis. Vet Clin North Am Small Anim Pract. 2007Mar;37(2):267-82The Intermediate CellRoughly the same size neutrophilCan be seen with E. canis infectionsUsually a continuumSmall to intermediateIntermediate to largeMonocytesDifferentiate into macrophages, histiocytes in tissues w/ inflammation, stress/glucocorticoidCan be difficult to differentiate toxic bands from activated monocytesEosinophilsPresent in low numbers in health allergy, parasite infection, Addison’s dz, paraneoplastic, leukemiauncommon difficult to document- Stress responseBasophilsElusiveIf increases occur, usually in conjunction with an increase in eosinophilsCan be associated with mucosal inflammationPlatelet Number EvaluationAlways look for clumpsVery important in catsNumber of platelets per 100x oil objective field of viewMinimum: 8 – 10Maximum: 35 – 40Potential semiquantitation 20,000 x number of platelets seen per 100x objective field of view9
In house CytologyJennifer SteinbergDVM, DACVPSolid Tissue Cytology-Collection Techniques “Tattoo” or “Pokey-pokey” technique– Needle with no attached syringe is packed with cells by inserting severaltimes into lesion– Remove needle, attach pre-evacuated to syringe and express material on toslide– Offers advantage of producing less hemorrhage and cell disruption Slide preparation– Smear cells immediately. (If the slide is allowed to dry before smear isattempted, the cells cannot be spread, and this typically results in numeroussmall, thick droplets.)– Don’t take the term “squash prep” too literally. Use only the weight of thetop slide for downward pressure. ALWAYS SPREAD THE CELLS!!! Do not use the technique for blood smearsGetting Good Stain Resultso Use fresh or filtered stain to avoid contaminating microorganisms.o Change stains often to avoid dilution At least once/weeko Stain thicker samples for longer periods. “Light” slides can often be re-stained todarken the staining.Things that make you go hmm o Classic criteria of malignancy Anisocytosis & Anisokaryosis Variable/Increased N:C ratio Multinucleation Increased mitotic activity Large, multiple nucleoli Vacuolizationo Caveats Changes can be seen w/ inflammation and hyperplasia Macrophages & mesothelial cells can be mitotic Multinucleated giant cells in granulomas Rxtv fibroblasts have prominent, multiple nucleolio Do not always denote malignancyReal Criteria of Malignancyo Nuclear moldingo Karyomegalyo Abnormal, prominent nucleoli Large size10
Abnormal shapeo Atypical mitotic figureso MicronucleiLesion Classificationo Round/Discrete cello Mesenchymalo Epithelialo Inflammatory/Infectiouso Non-neoplastic, Non-inflammatoryRound/Discrete Cello Cells usually individualizedo Examples Histiocytoma Mast cell tumor Lymphoma/plasmacytoma Transmissible Venereal Tumor /- MelanomaMesenchymalo Connective tissue origin Bone, Cartilage, Muscle, Stroma, Vessels, Fat /- Melanocyteso Often spindle shapedo Aggregates/bundleso Benign & Malignant variantsEpithelial Tumorso Round to polygonalo Clusters Distinct cell borderso Multiple origins Glands Solid organs MucosaNon-neoplastic, Non-inflammatoryo Cysts Follicular-Can be inflamed Apocrine-Usually fluid filled Sebaceous-Actually uncommon in domestic animalso Hyperplasiao Hamartoma11
Commonly Encountered LesionsRound cell tumorsHistiocytomao Discrete round cellso Mild to moderate anisocytosis and anisokaryosiso Lymphocytic infiltrate-Occurs with regressiono 2 inflammationo Can persist as long as 3 monthsPlasmacytomao Discrete round cellso Variable morphologyo Possible perinuclear clear/Golgi zoneo Frequent binucleate & multinucleated cellso Morphology not related to clinical behavior (dogs)Lymph Node:Reactiveo Heterogeneous Small lymphocytes plasma cells blasts Mitotic figures “Lymphoglandular bodies” Mott cells Russell bodies packeted Ig Seen in reactive/inflammatory lesions, though not specificLymphomao Homogeneouso Blasts: /- nucleolio Small # of smalls & plasma cellso Intermediate lymphoma Difficult Homogeneous 10-12 micron diameter size of a PMNSialoceleo Thick background “lakes” of basophilic mucino Vacuolated macrophages Hemosiderin/hematoidin Multinucleated cells12
Mesenchmal tumorsPerivascular wall tumoro Spindle shaped cellso Often vacuolatedo Variably sized aggregateso Mild anisocytosis and anisokaryosiso Multinucleated cells-crown cellsAdipose tissue/Lipomao Cannot differentiate b/w the two on cytoo Slides appear greasyo Other elements seen Vessels, collagen, macrophageso Different variants Angio-,fibro-, myxolipomao Liposarcomas rareo Inflamed lipoma/chronic steatitis Increased numbers of macrophages & PMNsEpithelial tumorsTrichoblastoma (formerly basal cell tumor) Benign neoplasm of follicular germ cell origin Occur most frequently on the head and neck Cuboidal cells, tightly cohesive clusters, minimal pleomorphismSebaceous Lesionso Adenoma, hamartoma, hyperplasia Cannot differentiate based on cytology All are benign May see basal reserve cellso Sebaceous carcinomas are relatively uncommonPerianal Masseso Perianal/Hepatoid tumor Modified sebaceous Cells resemble hepatocytes Prominent nucleoli Basal reserve cells Most are benign Carcinomas are rare Variably pleomorphic Prepuce, tail, thigho Apocrine anal gland carcinoma Mild atypia Many free nuclei Indistinct cell borders13
Body Cavity Fluidso Reactive mesothelial cells Moderate to marked aniso Prominent nucleoli Bi/multinucleation Present in clusters pleomorphism in pericardial & hemorrhagic effusionsSummaryooooAll criteria of malignancy are not created equalNo single criterion denotes malignancyEvaluate cytologic findings in the context of the clinical presentationUtilize/consult your pathologist14
Clinical Pathology in the ER and ICUJennifer SteinbergDVM, DACVPCase #1: 8 year old mixed breed dogHistory of lethargy and decreased appetite.Physical exam revealed single enlarged facial lymph node.15
Case #2: 11 year old MC Rhodesian RidgebackPresented febrile with mildly enlarged lymph nodes.16
Case #3: 5 year old FS Maine CoonHistory of loss of appetite and coughingPhysical exam revealed extreme pallor, HR of 200, RR of 50, Temp of 99 F17
Case #4: 2 year old FS mixed breed K9Patient presented for anemiaPrevious history of splenectomy for traumatic splenic hematomaPhysical exam revealed extreme pallorHR 144 bpm, RR 36 bpm, Temp 100.8 F, CRT 2 secUrine was port wine colored18
Case #5 10 year old FS mixed breed dogHistory of anorexia, lethargy, thin body conditionPE: HR 150 BPM, RR 52 BPM, Temperature 102.4 оF19
Case #6: 6 yr old FS LabradorHistory of acute onset of multiple joint swellings and pain in all extremities, shifting leglameness and heat in all jointsTemperature of 103Was walking normally two days priorNo previous history of lameness20
Case #7: 1 year old FI DLHHistory of 3-5 day progressive dyspnea, loss of appetite, weight loss, abscess onneck approximately1 week prior21
Case #10: 11 year old FS BeaglePresented for acute depression for 3-4 days. History of chronic treatment for IMHA.Recent history of urinary tract infection treated with cefpodoxime.22
Henry Schein Animal Health Martha Rose mrose@henryscheinvet.com Hill’s Pet Nutrition Cynthia Farrell, DVM cynthia_farrell@hillspet.com *Idexx Laboratories Christina Griffin Christina-griffin@idexx.com Island Memorial & My P
Spring Volume 22 Number 3 Summer Volume 22 Number 3 Convention Volume 23 Number 1 1988 Winter Volume 23 Number 2 Spring Volume 23 Number 3 Summer . Spring Summer Fall 2015 Winter Spring Summer Fall 2016 Winter Spring Summer Fall 2017 Winter Spring Summer Fall 2018 Winter Spring Summer Fall . Author: Joan Thomas
Winter Review and Forecast Winter 2015 –2016 Review Winter 2016 –2017 Outlook Presented to the DRBC Flood Advisory Committee on Dec. 7, 2016. Contents should not be published or re-p
Fourth EASCOF, 8 9 November 2016 2016/17 winter outlook - Near normal winter monsoon is expected - Strong intra-seasonal variation Temperature Precipitation Below Normal Near normal Above normal Below Normal Near normal Above normal Winter 30 50 20 50 30 2
WINTER All-Academic Team - March 19, 2013 FOR IMMEDIATE RELEASE NESCAC Winter All-Academic Team Released 871 Winter Student-Athletes Recognized for Academic Excellence HADLEY, Mass. – A total of 871 student-athletes have been named to the 2013 NESCAC Winter All-Academic Team by the conference office today.To be
1 Hot Summer/Cold Winter 1,694 4,735 4.21 4.66 2 Hot Summer/Mild Winter 1,694 3,528 2.78 3.14 3 Mild Summer/Cold Winter 1,163 4,735 3.26 3.59 4 Mild Summer/Mild Winter 1,163 3,528 2.14 2.49 5 Hot Summer/Base Winter 1,694 4,131 3.41 3.81
summer cold rain 0.05 winter hot sun 0.10 winter hot rain 0.05 winter cold sun 0.15 winter cold rain 0.20 P(sun) .3 .1 .1 .15 .65. Inference by Enumeration P(W)? S T W P summer hot sun 0.30 summer hot rain 0.05 summer cold sun 0.10 summer cold rain 0.05 winter hot sun 0.10
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Nutrition is an integral aspect of animal husbandry and the pet food trade now makes up a substantial proportion of the animal care industry. Providing animals with the appropriate feeds in the correct quantities, taking into account factors such as species, breed, activity level and age, requires an understanding of the fundamentals of animal nutrition. A balanced diet is vital to the .
