Expert Feedback and Support
Call 00800 1234 33 99 Option 1, Option 2 for Internal Medicine consultations.
Our board-certified Internal Medicine consultants are available for consultation. We’re here to help with:
- Internal medicine consultations
- Superior laboratory customer support
Internal Medicine Consultant
Julien graduated from the University of Bern, Switzerland, in 2002. Following a rotating internship in the same institution from 2003 to 2004, he undertook a 10 month research project in dermatology. Julien’s Medicine Residency (from 2005 to 2008) was part of a joint program between the University of Bern and of Louisiana State University in the States following which, he was awarded the status of Diplomate of the American College of Veterinary Medicine in 2008. Julien worked in a Private Referral Centre in South England (Anderson Sturgess Veterinary Specialists), before joining the University of Liverpool as Clinical teacher at the Small Animal Teaching Hospital in 2009. He started to work as a Consultant in Small Animal Medicine for IDEXX in July 2011. Julien’s main interests in medicine include GI disease, nephrology, endocrinology, and haematology.
Internal Medicine Consultant
Internal Medicine Consultant
After graduating from the University of Reading in 1994 with a BSc in Animal Science, Sheila went on to study veterinary medicine at the University of London, graduating in 1998. Sheila then spent five years in small animal practice before undertaking a Residency in Feline and Internal Medicine (funded by the Feline Advisory Bureau) at the University of Bristol. During her three years there, Sheila successfully obtained her RCVS Certificate in Small Animal Medicine and shortly after her residency was appointed as the Head of Small Animal Medicine at the Animal Health Trust where she was based for 2 years before joining IDEXX. Her specialist interests include endocrinology, gastroenterology and all aspects of feline medicine. She acquired her ECVIM Diploma in Internal Medicine in September 2010 and is a recognised European Veterinary Specialist in Internal Medicine. Sheila was awarded the status of RCVS Specialist in Feline Medicine in March 2012. She is also a member of the Feline Advisory Bureau’s Feline Expert Panel. Sheila enjoys horse-riding, mountain biking, dining out and spending time with her 3 cats
Committed to delivering accuracy and more
Head of Clinical Pathology
After qualifying in veterinary medicine at the University of Pisa (Italy) in 1993, Federico served in the Italian Army as a Veterinary Officer for nearly two years before beginning his career as a veterinary practitioner in Tuscany. He became a specialist in small animal medicine in 1998 and joined IDEXX in 2001 as a Veterinary Clinical Pathologist in Wetherby. During a 2003-2004 sabbatical, Federico earned a Masters in bioscience enterprise at the Institute of Biotechnology of the University of Cambridge (England) and rejoined IDEXX as a Senior Clinical Pathologist. He obtained the Diploma of the Royal College of Pathologists in 2007, and the Diploma of the European College of Veterinary Clinical Pathology (DECVP) in 2008. His main areas of scientific interest include cytology, haematology, and canine arthropod-borne diseases.
Morag Dunlop graduated from Glasgow Vet School in 1983 and returned to Glasgow to study for her PhD in equine reproduction after 2 years in mixed practice. This was followed by 3 years working in the Clinical Research Centre in North London where she was involved working on research projects in mouse genetics as well as the care of the laboratory animals. Morag then returned to practice concentrating on small animal work before leaving to join Vetlab as a clinical pathologist and continued to work for IDEXX in 2006.
Alison graduated from the Royal Veterinary College in London in 2000 and spent five years in small animal practice where she developed her interests in pathology, internal medicine and exotic animal medicine before joining IDEXX as a trainee in clinical pathology in 2005. Alison left in 2008 to have a family and returned to small animal practice for several years, before rejoining the company in June 2012 to continue her training. She has a special interest in exotic animal medicine. She has also co-written three veterinary nursing textbooks.
Kathleen graduated with a degree in Agriculture from Oklahoma State University. She is a 1981 graduate of Oklahoma State University’s College of Veterinary Medicine and received her MS and PhD in Veterinary Pathology is 1984 and 1987, respectively. She is a founding diplomate of the recently established European College of Veterinary Clinical Pathology. Kathleen has served on faculty at Oklahoma State University and Cornell University, as well as working in private laboratories within the United States and United Kingdom. She was Head and Director of the Diagnostic Services, Animal Health Trust before becoming a Senior Clinical Pathologist at IDEXX Laboratories. Kathleen has special interests in equine laboratory medicine, cytology, quality assurance/ quality control, and customer service. She lectures worldwide on a variety of topics in laboratory medicine.
Tim graduated from Edinburgh University in 1985. Between 1985 and 1992 he gained practical experience in mixed practice in the UK and in Southern Africa, graduating with an MSc in Tropical Veterinary Science (with distinction) from Edinburgh University in 1993. Tim has worked as a veterinary clinical pathologist in UK veterinary laboratories since 1994, gaining his Fellowship of the Royal College of Pathologists in Veterinary Clinical Pathology in 2009. Tim joined IDEXX Laboratories in November 2003 and reports on haematology, clinical chemistry, endocrinology, cytology and microbiology cases. Previous research interests have included tropical parasitology, immune responses to bacterial infection, and bacterial enteritis in cats
Michal Neta obtained her Doctor veterinary medicine degree in 2002 from the Koret School of Veterinary Medicine at the Hebrew University of Jerusalem, Israel. She practiced for two years as a general small animal practitioner and in 2005 she continued her training and joined the combined PhD and residency program in clinical pathology at the University of Guelph at the Ontario Veterinary College in Canada. In 2008 Michal obtained board certification in clinical pathology becoming a diplomate of the American College of Pathologists. She had been involved consulting diagnostic pathology while continuing her research work studding clinical, diagnostic and molecular aspects of histiocytic diseases in the dog. In September 2001 Michal completed her PhD and Joined IDEXX as a Clinical Pathologist at the south water site. Her interests are in all areas of clinical pathology but in particular canine histiocytic diseases, haematology and bone marrow diseases.
Larry graduated from Edinburgh University in 1973 as Bachelor of Veterinary Medicine, with distinction. After a short spell in mixed general practice in Fife, he was awarded a University Scholarship and returned to the Royal (Dick) School of Veterinary Studies in Edinburgh to study Diagnostic Veterinary Pathology for 12 months. Following this, three years were spent studying for a PhD in the Department of Veterinary Pathology, Edinburgh University, graduating in 1978. This period involved training in both Veterinary Pathology and Veterinary Microbiology. In late 1977, Larry joined the then Scottish Veterinary Investigation Service in Aberdeen, which later became SAC Veterinary Services. During this time, he gained a wide experience in veterinary laboratory diagnostic work in both farm and companion animals. Field investigational and research work was also undertaken resulting in a wide range of publications covering several disciplines. Papers were presented regularly at International meetings. Larry joined IDEXX in January 1994 as head of the Microbiology Section, which offers comprehensive microbiology support in the investigation of individual clinical cases and herd/flock/stable problems. He also works as a Clinical Pathologist reporting on equine, farm and companion animal cases.
Mariana graduated from the University of Tras-os-Montes e Alto Douro, Portugal in 2006. During her final year she visited the University of Tennessee, Knoxville. She then went back to Portugal to complete an internship in Small Animal Medicine where she developed a special interest for dermatology and oncology. At the end of 2007 she started a residency in Veterinary Clinical Pathology at the University College Dublin, Ireland before joining IDEXX Laboratories at the beginning of 2009, where she will complete her training.
Committed to delivering accuracy and more
Kate qualified from Liverpool University in 1974. SShe was employed firstly in intensive small animal practice and also spent a short term with the Ministry of Agriculture as a TVI during a swine vesicular disease outbreak. Subsequent to a career break for family commitments, Kate has pursued her undergraduate interests in pathology. She joined the professional staff of IDEXX in 1986, where she now concentrates on diagnostic histopathology examinations. Her particular areas of interest include dermatohistopathology and the correlation of cytological and histological investigations
Thelma qualified as veterinary surgeon from the University of Pretoria, South Africa, in 2002. She immediately pursued her interest in veterinary pathology and started as clinical assistant at the Pathology section of the University of Pretoria in 2003. She started doing locums for IDEXX, South Africa during that year and became a full time employee in 2005. She has done most of her training in pathology at IDEXX, which included surgical biopsies and post mortem examinations. She obtained her MMed Vet(Path) degree in 2011. Thelma relocated to the UK in February 2012 and is working for IDEXX UK since then. Her special interests include oncology and bird pathology.
Mark qualified from the University of Nairobi, Kenya in 1972 and first worked as a government veterinary officer in charge of animal disease control in a District before joining Makerere University, Kampala, Uganda as a Graduate Assistant in veterinary pathology in 1973. Under its staff development programme, Makerere University sent him off to Bristol University for training in veterinary pathology where he obtained a PhD in 1976 principally on the basis of his thesis on the epidemiology, pathogenesis, lesions and immune response in Yersisia pseudotuberculosis infection. He subsequently lectured in veterinary pathology at Makerere University up to 1983. Mark obtained a Postgraduate Certificate in Immunology in 1978 from the then World Health Organisation Immunology Research and Training Centre, University of Nairobi. Between June 1983 and March 1985 he held temporary lectureship positions in veterinary pathology at Bristol University and The University of Liverpool before taking up the post of Lecturer in veterinary pathology in the Faculty of Veterinary Science, University of Zimbabwe where he worked for 18 years progressing through the ranks of Senior Lecturer, Associate Professor and Professor. Throughout his University career, Mark’s duties included teaching, research and diagnostic service comprising necropsy with follow-up histopathology and examination of biopsies across animal species. He joined IDEXX Laboratories in November 2003 as anatomical pathologist.
After qualifying from Liverpool University in 1977, Catherine became a lecturer in the Department of Veterinary Pathology, based mainly at Leahurst. She was awarded an FRCVS on the Pathology of Skin Tumours in dogs and cats in 1982, and obtained her MRCPath (Small Domesticated Animals) by examination in 1989. Latterly she has worked mainly in Liverpool. In 1996 she became an FRCPath and in 2000 was promoted to Senior Lecturer. In addition to primary responsibilities for undergraduate teaching and training of pathology residents, Catherine was also Admissions Sub-Dean and Academic Sub-Dean for the Veterinary Faculty. She is a past examiner in Veterinary Pathology for the Royal College of Pathologists and has held external examining appointments at Glasgow, Bristol and Dublin Veterinary Schools. A former national secretary of AVTRW, she is also a past Treasurer and President of the Lancashire Veterinary Association. Catherine joined IDEXX Laboratories in October 2004.
Convenient, flexible laboratory services
We work the way that works for you to provide the most value for your practice—increasing revenue, care standards and client loyalty. It’s why we offer:
- Field consultant support for product demonstrations and staff training
- Free of Charge courier collection of your samples - dependant on clinic location
You can also choose how to receive results: by fax, e-mail or automatic download some practice management systems (dependant on PIMS provider).
Frequently asked questions
If the answer to your question is not in this FAQ section, please feel free to call IDEXX Laboratories at 00800 1234 3399 Option 1 followed by Option 2. Our Internal Medicine team are available for advice on diagnostic testing, interpreting your laboratory results and treatment of your canine and feline patients. For all other species please select Option 1. In addition, our Customer Support and Administration teams can help you with general information questions, including sample submission, and our Laboratory Manager and laboratory technicians can answer questions about specific equipment or test procedures.
Please call IDEXX Laboratories at 00800 1234 3399, Option 1 followed by Option 1. Many additional or specialised tests are available at the laboratory.
Please telephone the laboratory at +44 (0)800 587 0602 Option 1 followed by Option 1. We may be able to help you prioritise the testing or provide alternatives and write your priorities on the request form.
If you use a standard 1.3 ml EDTA (pink-top tube), please fill to the fill line to ensure a good quality sample. Always submit a smear.
At least 0.5 ml of serum is needed.
At least 0.5 ml of serum is needed.
At least 0.6 ml of serum is needed.
For determining the PT/PTT, the ratio of blood to anticoagulant (citrate) is critical (1 part citrate: 9 parts blood). For the 1 ml green-top citrate tubes we provide, each tube requires 1 ml blood. Please fill to the correct level and ensure the tube is within date.
Serum enzymes can be affected when the sample is stored at room temperature, especially when the serum has not been separated. Depending on the species and breed, potassium may be artefactually increased, especially when haemolysis is present.
Cell morphology is compromised (full blood count) when the sample sits. If a well-made blood smear slide was made at the time of the sample collection, the differential and assessment of the cell morphology and adequacy can still be accurate.
Urine pH, crystals and cell morphology change with delayed handling. The most accurate information is always acquired when the urine is evaluated immediately after collection.
Platelet clumps are formed during phlebotomy, in storage in the EDTA tube, or during preparation of the blood smear. They represent the normal adhesion tendency of platelets and are "artefacts" in that they are not circulating in the patient's blood. The clumping becomes important in interpretation of platelet numbers. When the platelets are not evenly distributed in the sample, the platelet count may underestimate the platelet number. At IDEXX Laboratories, laboratory technicians evaluate a blood smear from every CBC to estimate platelet numbers and note the presence of platelet clumps.
Platelet clumping can be minimised by getting a "clean stick" during phlebotomy, immediately putting the blood into the EDTA tube, and gently mixing the sample. Sometimes this is not enough to prevent platelet clumping. When blood from a patient repeatedly has too many platelet clumps to accurately assess platelet numbers, a blood sample can be drawn into a heparin-flushed syringe before putting the sample into the EDTA (pink-top tube). Platelet clumping is reduced by use of jugular vein samples wherever possible.
A serum IgM and IgG titre is the test of choice to diagnosis active disease. Often, a convalescent titre is needed.
There is no problem measuring cortisol or thyroid hormone concentrations in lipaemic samples. We ultracentrifuge lipaemic samples before performing the assay to obviate that problem. Otherwise, lipaemia will affect test results.
Proper handling of the sample is critical. The blood should be centrifuged as soon as the clot has formed. The serum must be decanted and kept cold. Haemolysis will alter the results. If the sample is haemolysed, a fresh sample should be collected. To help diagnose an insulinoma, the insulin should be measured when the blood glucose is < 60 mg/dl. Serum or plasma (grey-top tube) glucose concentration determination is included in the price for the insulin assay.
For the diagnosis of insulinoma, a simultaneous fluoride oxalate sample should be submitted with the separated serum after a 12-14 hour fast, or when In-Clinic analysis indicated hypoglycaemia is present. Fluoride sample is used to check blood glucose and allow calculation of an amended insulin:glucose ratio.
There are 3 options depending on where the dog is in the oestrous cycle.
- Vaginal cytology: The vaginal epithelium is a good biologic assay for the presence of oestrogen. If the dog is in late pro-oestrus or oestrus, one should see > 60% superficial cells.
- Basal Serum Progesterone: If the dog had signs of oestrous 2 weeks to < 2 months ago, a single serum progesterone concentration may be diagnostic (evidence of luteal structure).
- HCG stimulation test: Progesterone is measured 1-3 weeks after administration of HCG during behavioural oestrus. Protocol for this test is given in our section on Ovarian remnant syndrome.
NB: Progesterone assay must be undertaken on serum samples that have not been collected or stored in gel separation tubes as this will significantly reduce the measured concentration.
HCG stimulation test is also valid for this species. Serum samples for progesterone must not be submitted in gel separation tubes.
Basal testosterone is very often diagnostic and should be assayed initially on a serum sample. In the rare cases in which the result is equivocal, HCG stimulation test can be undertaken in both species.
The plasma relaxin concentration rises after implantation of the canine foetus. If the bitch was bred at the appropriate time in her oestrous cycle, pregnancy can be detected as early as 28 days after the last mating.
In a recent study reported at the ACVIM forum in June, researchers from the University of Wisconsin reported that in most dogs, there are no significant difference serum phenobarbital concentrations in samples obtained prior to dosing, or at 3 or 6 hours post pill. The exception was in a dog receiving a high dose (10 mg/kg/day) of phenobarbital. Importantly, the dogs in the study were receiving the same dose of phenobarbital for at least 7 days, and were not receiving any other drugs that may have an effect on serum phenobarbital concentrations (P450 enzyme inhibitors, such as cimetidine). Thus, when you are monitoring therapeutic serum phenobarbital concentrations in dogs, you can collect a sample at any time of the day as long as: 1) the dose has been constant for at least 7 days; 2) the dog is not receiving any drugs that would alter the P450 enzymes; and 3) the dog is receiving < 8 mg/kg/day of phenobarbital.
In general, fluid submissions should comprise an EDTA sample to which 2-3 drops of neutral buffered formal-saline have been added, and air-dried smears.
Air-dried smears are required for cytology of solid lesions. Bone marrow requires air-dried smears made by squash preparation of marrow spicules and an EDTA sample of peripheral blood.
For liquid samples, also be sure to send along some of the fluid in tubes. EDTA (pink-top) is preferred for cytology and a plain tube is required for culture. Do not use serum separator tubes for cytologic specimens.
Neoplastic cells in the urine are best assessed with a cytology evaluation. Routine urinalysis sediment examination is quantitative rather than qualitative. For advice on submission of urine samples for cytology, please see the cytology section.
We have recently introduced the V-Bladder Tumour Antigen test that has been reported to be more sensitive in the detection of transitional cell carcinoma than cytology. This test is performed on fresh urine and can be combined with cytological evaluation.
Providing the pathologist with following information should greatly help in the interpretation of biopsy:
- The distribution and duration of the lesion(s)
- A list of current and previous medications
Before embarking on testing, and before one can interpret the LDDS test, there are 4 important points to keep in mind:
- Stressful disease (sick, poorly controlled diabetics, renal failure, etc) may cause false positive test results. So the patient's stressful disease must be controlled before considering testing for hyperadrenocorticism. Also, potentially stressful procedures should not be performed during the 8 hour test (anaesthesia, sedation, or procedures that will need excessive restraint or cause excessive discomfort to the patient.
If, for some reason, you have chosen to proceed with testing, and the test result is in the reference range, hyperadrenocorticism may be ruled out. But if the test is suggestive of hyperadrenocorticism, it may be a false positive.
- Prednisolone and prednisone, and other corticosteroids (except dexamethasone), cause interference with the assay. The animal should not have received these drugs during the 24 hours prior to sample collection.
- Topical (skin, ears, eyes) steroids may cause iatrogenic hyperadrenocorticism. These dogs may have all the clinical signs and laboratory tests typical of Cushing's disease and the owners may forget to mention to you that they are applying a topical cream. So, do not forget to ask the client if they are using ANY topical medication before embarking on diagnostic testing for hyperadrenocorticism.
- No test is 100% specific and 100% sensitive. At times, additional or repeated testing is needed to confirm your clinical suspicion of hyperadrenocorticism.
The primary reason to perform a LDDS is to confirm a clinical suspicion of hyperadrenocorticism. If the history, physical examination results and initial database are not consistent with hyperadrenocorticism, interpretation of the test result may not be accurate.
- Plasma (ACTH)
- High dose dexamethasone suppression test
- Adrenal ultrasonographic evaluation
Formation of detectable crystalluria is dependent on the temperature, the pH, urine concentration, diet, metabolic abnormalities, drugs and specimen handling. Some of these factors may be quite variable (ex., the postprandial alkaline tide may result in altered urine pH compared to a fasting sample, changing the diet and/or changing the pH in the sample may alter the type of crystal seen). The best method of avoiding artifactual alterations in the urine sediment is to evaluate the urine specimen immediately after collection, with the sample still at body temperature.
There are several possible explanations for this type of result.
- Food was not withheld for the 8–12 hours
- Only 30–50% of the newly formed BA is stored, so there is some secretion of newly formed BA
- There is delayed gastric emptying (highly stressed, or sedated patient)
- Postprandial gall bladder contraction releases a variable amount of bile (5–65%), so that the postprandial sample is "lower than expected"
- Bacterial overgrowth augments the unconjugated BA pool, which enters the systemic circulation more readily
- Mis-identification of samples