Knowledge Lab

Welcome to our first episode. We’re really excited to be here together and delve into some cool cases, but I thought first we’d start with some introductions. Brad.

Yeah, it’s a new era. I’m so happy to be here with you, Holly. You’re one of the most exciting,

passionate teachers I’ve ever met.

And so to be a colleague with you on this,

on this podcast journey is such a privilege and I hope we have a lot of fun along the way, but I know we’re going to learn a lot from each other and we have a lot to share with our veterinary colleagues around the country.

So I’m ready for it. I’m ready to jump in.

Awesome.

So just a brief introduction on myself for those who I haven’t met before. I’m Holly Brown and I’m a clinical pathologist. And I did my training at Georgia. I went to Swanwell Practice, I returned for my residency, my PhD there.

I stayed on in a faculty position there for the first part of my career and I still practiced on the weekends because I still just love Swanwell Practice.

And then almost 12 years ago moved up to central Pennsylvania to, to join a large general referral and emergency hospital as an on staff clinical pathologist.

So a pretty unique role, right, for someone with my expertise to get to be in a hospital setting and so close to the patients.

And it really opened my eyes to all of the opportunities we have to maximize diagnostics in particular, patient side. Right. But in the holistic view of what we’re able to do diagnostically,

getting to see the power of that data so close to the patients and how it changes each day, how the conversations go in the exam rooms, how we educate,

how we reach out to our communities.

Just a really fulfilling part of my career. And I’ve always been passionate about education and helping other colleagues get the most from their diagnostic data as well.

And I moved into my role as chief veterinary educator for Antec 2 1/2 years ago. And so now I still consult at the practice to stay really close to the cases, but spend a good amount of my time educating sometime internally, but often externally for Antech through initiatives like this.

The podcast.

My pathway to veterinary medicine was very long and winding and circuitous. And I started working at a rhino barn when I was 15 years old at the Wilds, which is North America’s largest conservation facility.

It’s about 20 miles from where I grew up in Southeast Ohio.

And that planted a seed in my brain from an early age that I wanted to work with, with animals but particularly I thought I was going to be a wildlife veterinarian,

possibly a zoo veterinarian. But as I got further into it, I got interested in zoonotic diseases and public health. I thought I was going to be a virus hunter running through the Congo in a hazmat suit.

And you know, life, life goes in all different unexpected directions and I just go with the flow. And so I started,

you know, thinking about zoonotic diseases the first time I went to Africa in 2001 when I visited Kenya. And I saw that these interfaces between humans and livestock and domestic animals and wildlife are very different depending on what part of the world you’re in.

And of course,

in this globalized world we live in, nothing is, is local anymore. Everything is a possible epidemic or pandemic waiting to happen. And so I, I’ve just always been very interested in that and, and doing my part to educate the public about animal health and especially as it pertains to veterinary public health.

And so I did my, my Master’s of science at,

at the University of Pretoria in South Africa looking at disease ecology in spotted hyenas. And then I eventually came back to the States and I did my veterinary public health MPH at Ohio State right before I started my DVM at Ohio State as well.

So I spent five years at that campus and private practice,

did some, did a little stint at the Smithsonian Global Health program in Washington D.C. and then I found my way to Antec and I’ve been here for four and a half years and that’s been the most exciting part of my career actually because I’ve been able to travel the country and connect with veterinarians and veterinary technicians really in every corner of the country.

And, and now through this podcast, we’re going to be able to reach even more people. And so that’s, that’s, that’s really what my passion is at this stage in life.

I’m 44 years old now and I’m very, I’m very happy that I’ve arrived at this place in my career and I’m grateful that I’ve connected with you, Holly,

and I’m ready to, I’m ready to make an impact.

So let’s dive into case one.

Okay, sounds great.

The first case I’m excited to share with you today is Toby.

So Toby,

he came to us as an 11 year old male neutered beagle,

really beloved in his family. His mom and dad are retired couple and they spend a lot of their time with Toby. He’s next to them most of their days and evenings,

and he has grown old with them. So they got him when they think he was about 4.

And when he presented,

he was pretty down and out. And mom was concerned. She had shared with us as we discussed some of her concerns in the exam room. She had shared that certainly he was showing his age, and he had been over the past year, year and a half.

And while she thought he was 11,

she also was not sure, right? They estimated his age when. When he arrived in their household as a four year old. So he may have been older. And she. She was thinking that given what a significant decline she had seen mostly in his mobility,

he had significant degenerative joint disease in his hips,

and he really just spent a good amount of his time sleeping. But he had seemed comfortable until earlier that week. So he had been up on the couch with them.

They were watching TV one evening, and as he got off the couch, his. He sort of slipped off and his back legs splayed open,

his front leg sort of splayed as well. They had to assist him in getting back up. And she felt since then, for the past few days, he just was restless.

He felt he had trouble getting comfortable and was really concerned that he had orthopedic pain, right? That he had progressed maybe some of his degenerative joint disease, but really just was feeling sad for him.

She was actually pretty rueful, really, of sort of the age that he was showing. And. And the more she talked about this in the exam room, and she was getting teary, she really was starting to question his quality of life and really whether it was, you know, you hear clients say this,

right? Like, is it still fair? Am I being selfish, you know, or is. Or should we let him go, right? Like, is he. Is he painful? Is it a struggle each day?

What really brought her in that day in particular was that never before had this happened, but he had only eaten half his breakfast and he skipped his full dinner,

right? And so that, that she said, I maybe have gotten to the final straw, right? As we evaluate pets as they’re aging, right, and we’re looking at their quality of life, we think of the things that they love the most and are they still able to do them?

He no longer went on hikes with them. He spent most of his time on his dog bed or on the couch with them.

But he did still always enjoy his meals, right? And so when he stopped enjoying his meals, as I think, is when she got particularly concerned.

So she presents to us and we talk through these considerations and we offer diagnostics Right. So the question being, you know, maybe we should get some more objective information about Toby.

I know you’re concerned about his aging and his sleeping more and then in particular maybe that he’s in pain or uncomfortable right now. But I think that we talk about running diagnostics as sort of looking under the hood.

Right. Let’s getting some objective data to better evaluate really where his body health is at.

On physical exam, he was definitely depressed, but interestingly he was febrile.

So we didn’t expect this given that history, but he had a temperature of 104Fahrenheit and in the exam room he was ambulatory. But he definitely looked weak in the hind end.

He preferred to be down and going through his physical exam. He had pain over the lumbar area,

no CP deficits. He was definitely very tight in extension through his hips. But interestingly, he also had some other joint pain. He was sensitive in his elbows and flexion and extension, um, as well as his stifles.

So a little bit more of a bigger clinical picture, I think, than mom had realized.

So with these diagnostics, we talked about a minimum database. Right. So getting a cbc, we could have any assessment of inflammatory disease. Right. Any signs of inflammation,

any concern of an anemia, of chronic disease. We’d look through his chemistry panel and get a better sense of his organ function. Right. Again, she feels like he’s aging and his body is sort of tiring out.

Right. But again, let’s get something more objective for that.

And, and for sure we also wanted to add in some tick borne disease screening. Right. So we live in central Pennsylvania and we have a lot of ticks and tick borne disease here is not uncommon.

And given that he had an increase in his joint pain and multiple joints that she hadn’t appreciated before this fever and his restlessness and discomfort, we thought screening for tick borne disease and his risk for that was also important.

Well, I think, you know, I, I think when I think about Toby, you know, we have, we have these geriatric patients that come in every day and it’s easy to look at a dog in that state, given that age, and just assume that this is a dog in decline for natural,

from natural reasons or for natural reasons. But we can never underestimate the,

the constant threat that that vector borne diseases pose to our pets. That should always be on our radar because especially in a state like Pennsylvania,

you know, we’ve seen a dramatic change in the last 15 years, really in terms of how warm our winters have gotten. And just the fact that those, those ticks are in and much,

you know, we have a higher prevalence of these ticks now than we, we’ve ever had. And that’s been a, you know, sort of like a slow progressive story that was unfolding.

And then it’s like one day you wake up and it’s endemic. And that’s the situation that we’ve seen in Ohio. We didn’t, Ohio’s right next door to Pennsylvania. For those who think Iowa and Ohio are the same place,

they’re not.

But if you’re from Ohio, you know where Ohio is and you know, we didn’t even think we had, you know, it was very common through,

throughout even the early 2000s for veterinarians to tell owners it was okay to take your pets off prevention in the late fall and put them back on in the, in the spring.

And that was,

you know, it was okay when we had much colder winters and it was okay when we didn’t have black legged ticks or deer ticks in our state. But now they’re here,

they’ve arrived and we went from having no Lyme to being an emerging state to being full blown endemic in less than a decade and a half.

And so you have an education deficit with clients around the country. I think that we need to never underestimate where people are doing the best they can for their pets.

But they might think they might have a false sense of security about, about the need for prevention during the winter months.

And I don’t know if that’s what happened in Toby’s case, but I wouldn’t be surprised if it, if it was the situation where perhaps the owner took the,

the, you know,

November to February months off.

And these,

these black legged ticks are able to emerge from their,

from their period of dormancy when it gets into the mid to high 30s and they’re out looking for their first blood meal. I’ve seen them walking on snow. So I think that,

you know, always, especially if we know that there’s been a lapse in prevention,

it’s a, it’s absolutely reasonable. Why,

why Toby.

Toby’s veterinarian had a vector borne disease screening test included as part of this laboratory assessment at this point in time.

Excellent. I couldn’t agree more. And as we started getting his lab data back. Right. So we’ll start with his cbc. And one thing that I’ll talk about frequently on this podcast as we talk about diagnostics is our challenge in veterinary medicine in identifying inflammation and characterizing inflammatory disease in our patients.

Right. So we, there’s the physical exam, of course. Right. And there are signs of inflammation, like pain. Right? Pain, redness, swelling, heat, those things that we think of. He has a fever.

Right. But I also think that it can be really hard to get an objective measurement of that.

Right. So there’s all sorts of behavioral changes that we can also see. We have animals who hide disease very well, who are unlikely to show us if they are in pain,

and we have reactive animals. Right. So it could be a behavioral response and not actually a pain response, et cetera.

So in his case, as it is in many times when we have inflammatory disease, he actually did not have a classic inflammatory leukogram.

So no increase in his total white cell count and no increase in his neutrophils. Right. If we think of a classic inflammatory leukogram in a dog,

it would be a leukocytosis with a neutrophilia plus or minus a monocytosis. Right. In this case, those values all fell within the reference interval.

So it could be overlooked. Understanding that actually it’s.

We need to go beyond the whole numbers, right, to better understand and characterize inflammation. And I’ll talk about that more in subsequent episodes. But in his case, what really popped out, actually, in his leukogram was that he had a glucocorticoid or stress response.

And so this is not a stress, like an excitement stress response. This is a stress of illness. And so in the face of illness and disease processes, then the body has to increase cortisol production to sort of withstand that illness.

And then a consequence of those increased glucocorticoids is that we’ll see a stress leukogram, which is recognized by a lymphopenia. So decreased lymphocytes and decreased eosinophils.

And it’s subtle, right? And it’s hard on some analyzers to pick this up because the low end of the reference interval can be very, very low,

right? So sometimes they’re just both trended to the low end of the reference interval. They don’t always flag low. But when we’re screening an ADR patient ain’t doing right and trying to get some more objective information,

recognizing that trend of decreased lymphocytes and decreased eosinophils as a pair really can really indicate to us that this is a good sick patient test. Right. A good way for us to identify,

indeed, he is going through.

Right. He is suffering from something.

In the rest of his cbc,

he had a low normal hematocrit. And so not flagging as anemic, but again, reference intervals are inherently wide. Right. Made from hundreds of healthy animals. And so for him, I think a very low end hematocrit may indeed be an early sign of a progressing anemia.

And he did have very low reticulocytes, low end reticulocyte hemoglobin, something again, we can address on future episodes. But when those are both at the lower end of the reference interval as well, I see this non regenerative anemia.

And I think for him, I do think that he has signs of significant clinical illness.

Maybe most importantly on his case and was recognized here was a thrombocytopenia.

So he had decreased platelets. Right. And I think that unfortunately, and Brad, you know this from being in practice and being in practices is that I think sometimes we become a little.

We’ve become a little immune to recognizing thrombocytopenias. And the significance, because we see a lot of platelet clumping in our samples,

right? So we have a difficult phlebotomy, repeated stic or whatever,

delay till we fill the EDTA tube. We can get clot formation or even just platelet activation,

right. And in response we get platelet clumping. And so then when we use our automated analyzers, right. To assess a platelet count, it may come back spuriously decreased, Right. Because the platelet clumps have used up.

Some of those platelets, had tied them up.

So I do think it’s important when we have reported thrombocytopenias that we do our due diligence, right. So we don’t overlook them and miss significant thrombocytopenias by doing a blood film, right.

Looking for platelet aggregates at the feathered edge, looking back in the tube. Right. Looking for any signs of clots. And we can use like the wooden dowels to look for clots in the tube as well.

Or for those who had the advanced hematology analyzers that show cytograms. Right. Cytograms can also show you platelet clumping in an automated technology.

And so in this case, they did their due diligence. There were no signs on the cytograms of platelet clumps, no flagging of the data. And when they made a blood film, there were no platelet aggregates at the feathered edge.

When we look at his chemistry, and this is just really brief because actually his chemistry looks unremarkable. Right. So this is really lovely for Toby and his older age because remember, mom felt like his body was just tired,

right. That he was sort of age, his really showing his age. But his organ function looks fantastic. Right. So his renal values look are well within the reference interval. His liver function tests look great.

His liver enzymes are not elevated.

He has normal electrolytes like his normal proteins. Everything is really, really encouraging. And so we were able to sort of put this data together to say to mom, we have some significant changes in this cbc.

I think he is dealing with some inflammatory process. I think he has a stress response of illness. And I think that’s what you’re recognizing clinically because I actually don’t see organ decline in the rest of his chemistry panel.

And that makes me optimistic that we may have something here that we can treat.

Then we get to his vector borne disease screening. Right. So this is the third part of this minimum database that we were doing for him.

And in particular we are curious about any Borrelia antibodies. Right. So we’re looking for Lyme disease, right. Being that this could be a classic presentation with this joint lameness, right?

Multiple joint lameness and a fever and the lethargy and pain that we were seeing.

But indeed he did show no antibodies for Lyme disease.

Right. And with Lyme we know that we’ll see antibody production in about three to four weeks after the tick has bitten the patient, which is why we recommend screening for Lyme approximately four to six weeks after we, we know that, that that tick bite occurred with, with anaplasmosis.

Holly, do you, do you have any information on that? Yeah.

So really different, right? So we know on the Borrelia, just as you were saying, right. If they are presenting with signs of illness, that also takes months for them to show the clinical signs of infection.

And so if he were to have active Lyme disease underlying his clinical signs, we should be able to detect those antibodies.

Right. And our currently available tests,

many of them are specifically focused on the C. Sex peptide. That’s only a reflection of true exposure or infection. Right. That wouldn’t be vaccinal antibodies. And so not seeing them, we can feel pretty comfortable that this is not active Lyme disease.

But it’s really different for anaplasma. Right. And I think that we’ve, most areas who that are endemic for Lyme have gotten used to using our vector borne disease screening appropriately for Lyme, just as I, as we had talked about.

But for anaplasma it’s really different because when they present with anaplasmosis, clinical signs of it, it’s acute.

Right. And as you mentioned it takes weeks to show the Lyme antibody. It’s going to take weeks to show the anaplasma antibodies as well and turn these serology test positive.

So not seeing that does not actually exclude infection. Right. Acute anaplasmosis, you will see clinical signs within 1 to 2 weeks. Often they emerge. Right. When it takes many more weeks than that to show a high antibody titer.

Yeah. And I was, I was just going to say that because this is an emerging disease in so many parts of the country,

I always like to shine a light on some of the blind spots that,

that I’ve encountered in the veterinary community as I’ve traveled around. And I think that’s, you know, I think that’s a normal thing. The longer we’ve been out of vet school, the things that we don’t see on the day, on a day to day basis,

some of those, those even really fundamental foundational concepts about a disease process we might have forgotten about and assume that because deer ticks are co infectors of, of Lyme and anaplasma, that the rules apply across the board to both of these pathogens.

And they’re. Yes, they’re coming from the same vector, but we have a very different chronology in terms of antibody production.

Yeah. And I think this is really missed in practice a lot. I think people feel like they are screening for active infection when they’re looking at those anaplasma antibodies, those anaplasma results.

And in truth. Right. In our endemic areas, you are much more likely to have antibodies because of previous exposure. Right. And often if I see clinical signs of vector borne disease.

Right. That I’m concerned, like in this case a tick borne disease that could create a thrombocytopenia, a stress response, a joint lameness, and they already have antibodies to anaplasma that are turning these tests positive.

Right. Then it’s probably not what they have. Right. Is actually use it actually almost the opposite way. Right. And so the real way to screen for active anaplasmosis. Right. Would be through changes in the CBC that may be consistent.

Looking at a blood film to actually try and detect those morulae. And then PCR testing. Right. So PCR testing, we’re actually looking for the parts of the organism. Right. To look for the active infection.

And so that’s just what they did for Toby. Right. Having not seen the Lyme antibodies, but having not excluded anaplasmosis with the no antibody detection on our serology test, they did do a blood film review.

So they did a blood film review, they scanned that and they sent that to the pathologist for review.

In that blood film review, they did confirm the thrombocytopenia, right, that they suspected.

But more importantly, they did find morulae. So rickettsial morulae inside the granulocytes or neutrophils.

Right. So in this case, when we see those rickettsial morulae and I would describe them, or they are described as mulberry like. Now,

I don’t know what a mulberry actually looks like, but I could see very like in that they are, you know,

the bacterial cocci, right? They get into the phagosomes or the organelles of the granulocyte and then they replicate within the organelles. So you get the sort of dit dot appearance, right?

So the spotted sort of appearance that could be berry like.

And so they saw these inclusions. And what’s interesting though is that we actually have two rickettsial diseases that will infect these granulocytes, right? Neutrophils or eosinophils, both anaplasma, facitophylline, which in our area we see far more commonly, but also Ehrlichia ewingi.

So that also will have a similar appearance, right? So then it’s the PCR testing on top of that, right. That can give us the confirmatory diagnosis sent off to the reference lab and did come back indeed as anaplasma facositophalam.

Now, I have an interesting story about this, right? So we have seen anaplasma, you were talking about, you know, the expanding range of the ticks and the diseases that they carry.

And of course there’s now no place like safe of possible risk of exposure with all the traveling that everybody does, et cetera. And when I started practicing in central Pennsylvania, we did not see antibodies to anaplasma and we didn’t see acute anaplasmosis.

And I can only say that with some confidence in that, in our sick patients, especially those that are thrombocytopenic or had signs of tick borne dise disease. I was the one as a clinic pathologist reviewing their blood films, right?

And we were pretty judicious at the practice that I’ve consulted in doing annual screening. So we have that awareness of what’s in our environment and what our pets are at risk for.

And we weren’t seeing antibodies to anaplasma.

But then we started seeing some positive cases, clinical signs, right. And finding those morulae, which is so rewarding because when we find those morulae, right, then we have something to treat, right?

And these animals that have acute anaplasmosis, they, they feel awful when they come in. This is not a chronic disease. It’s acute. And when it hits, it hits hard. These animals go from feeling great often, often we’re talking about a, a, a young healthy lab or someone that’s out hiking and getting exposed to the ticks in their environment.

And they’re very engaged and active. And then within 24 hours of starting to show clinical signs, they look flat out, right? So they have high fevers and a lot of lameness and lethargy, inappetence, vomiting.

A myriad of clinical signs are possible.

So I remember starting to see those cases come to the hospital and I often tell the tale of my experience in the human counterpart to this, and that would be that I have two boys and my oldest had gotten Lyme disease not too many years after we arrived here in central Pennsylvania.

Our family’s at high risk. So like you, Brad, we love hiking. We’re outdoors a lot. We’re camping, we’re biking.

We find ticks on us. A. Right. We have our dogs sleep in our bed, right? She’s out hiking with us, et cetera. We have the shared environment,

yes, as you can imagine.

And so after having seen a couple, a couple years worth of these acute anaplasmosis cases in dogs and seeing how devastated the owners are because really they come in so, so very sick, even even though they treat very successfully.

But I just want to prepare myself. I can be quite a nervous mom sometimes. And I was at the pediatrician at the annual exam and I said, I,

we’ve dealt with Lyme disease, now just prepare me. What’s anaplasmosis gonna look like, right. When one of my kids gets that? And she said, oh, we don’t have it here.

I said, oh, you do,

you do. But you guys don’t do vector borne disease screening at annual exams, right? And so it was for me, now I know you have been in that public health field in that sector for a while and having these conversations, but it was my first time of sitting right in a room of One Health,

right. Of having this conversation where I felt so impactful that I could inform her actually, it’s so been here in center county, right, for a couple years.

What an opportunity for her now to look differently at her patients, right. And run her diagnostics differently.

Yeah. And I’ve had, I’ve had similar conversations with, with my doctors here in in southeast Ohio, after I’ve been exposed, like it’s a very,

you know, I would say at least once a month I find a tick that, I mean, I find them on me every day because I go hiking every day, but I’m usually pretty good about,

you know, getting them off of me before they actually bite me.

But when they do and you have a, an inflammatory reaction to it and it’s very painful and you’re, you’re worried about what,

what may have, may have happened there or how long they’ve been there. Because some of these ticks are very small. We have Asian longhorn ticks that are an invasive species.

They’re very new to the area. They’re, they’re smaller even than the, than the deer ticks.

So,

you know, around on a global scale, they’re, they’re capable of transmitting all types of things. So when you, when you don’t know how long they’ve been attached, it can be,

can be very alarming. It’s for even someone like me who has a, you know, above average level of knowledge on this issue to be able to advocate for myself in a, in a human medical context has, has proven to be quite challenging in terms of being able to get the kind of testing that I think I need.

And so I stress that all the time to the veterinarians that I’m meeting that aren’t screening every patient every year for these diseases. That the only way that we really know how the dynamics are changing, how the epidemiological story is changing in our community is if we have good data.

And in many cases that’s the only data that we have to inform public health. If we don’t know what’s going on in the veterinary world, we’re not going to have data about the rise of ehrlichiosis, anaplasmosis or Lyme in our counties.

And then it’s a whole other story about the diseases like Rocky Mountain spotted fever that aren’t included in our wellness screening.

So we’re facing an uncertain future, but it’s a future that is sure to change. It’s evolving in real time.

And I think that we have to always remember that the value of our vector borne disease screening goes well beyond just the information that we’re getting about the patient that’s sitting in our exam room at this particular point in time that we are trying to build up a reliable set of,

of data about our communities and how the prevalence is changing from one year to the next and,

and whether or not that information is Able to disseminate, get disseminated out into the human medical community is another story.

But at least we know what’s going on for our veterinary patients.

Yeah, I think that’s so well said.

You know, fortunately for Toby, like so many of these with acute anaplasmosis, they treat really successfully with doxycycline.

So we did put him on doxycycline. He did spend a night with us. We could give him some fluid support, some pain control,

started him on his doxycycline. He went home to continue his medication and recover.

And when we saw him come back in for his recheck, we didn’t know that Toby could trot in, but he did. He actually came trotting in, tail held high,

mom with the biggest smile,

really delighted, saying he actually feels better than ever.

Right. And so she had sort of wrapped her mind around that this might, she might be saying goodbye to Toby right at the end of his life. And, and actually in being judicious and appropriate with our diagnostic testing, you know, we’re able to give her some answers of something that was actually really treatable.

And she.

I don’t get a lot of communication clients because I’m just a consultant,

so I don’t often talk to him directly. But she found me and sent me an email to say, we’re so grateful he. To recover and for your care and advice, and our senior dogs have so much to offer.

Thanks for not giving up on ours. Which was just the most, like, heartfelt thing when I thought, wow, like, really using those tests wisely saved his life. Like, literally saved his life that night.

You know, from the, from the second we started discussing Toby, I’ve. My mind has been kind of drifting back to all those situations that happened where an owner came in absolutely just at, at peace with the decision that they were coming in to euthanize their pet that day and that they had just made this assumption that it had to be because of old age.

He’s just at that point in life where it’s time to say goodbye.

And how, I mean, if we,

you know, I’ve worked in rural communities where,

where paying for diagnostics has been a real.

You know, it’s a, It’s a real factor that sometimes prevents us from being able to have that,

that, that complete picture before we, before we do euthanize a pet.

And so I’ve, I’ve been just reflecting on situations that I, I’ve been in where,

you know, it just reinforces that there are differentials that, that need to come to the forefront of our mind that,

that we need to explain to owners as, as real possibilities for why a pet might be feeling this way at age 11. There are plenty of of spry 11 year old dogs right now and diagnostics really do make the difference in terms of life and death for so many patients and Toby’s the poster child for that.

Yeah, getting it right matters, right? Those diagnostics and getting that objective data and using it appropriately. Right. Requesting the right test and being judicious in that use and then interpreting it correctly.

And I’m really excited through this podcast to get to reach out to a large audience to help inform them,

to help make these better lives for our pets and their pet owners.

Oh, and I know it. I know that there will be many, many veterinarians who are going to look at that anaplasma negative antibody result on a sick patient much differently now.

My will have been successful then for sure.

Yeah,

I’m really glad that we started here because vector borne disease screening is recommended to be a part of our minimum database as part of every annual wellness exam.

But also we need to know how to interpret that data appropriately. And it’s something that even me think, I look back on it and we didn’t see as much anaplasma here.

But now as those cases are starting to rise,

we need to know that negative result is not the end of the road there.

We have to take another step forward. And so being able to do those blood films and execute that properly, I know that that is not an area that every single veterinarian is well practiced in.

And so we also want to be able to provide that knowledge base for you guys as well. And just a refresher on how to do those in practice and build up your confidence.

And so we’ll be doing some.

What do we want to call them?

We’re going to be doing some companion episodes maybe.

Okay.

So if there’s anything along the diagnostic pathway that you, you’re a little out of practice on and want to get a refresher,

we want to be able to provide that information for you as well. So look for companion episodes that are going to come out following each episode when appropriate, to be able to provide you with that, with that resource.

There’s always the veterinarian in the room that needs a little refresher and a little bit of a confidence boost. And I think that that’s okay. We need to create a space in this profession where we have to acknowledge that we’re not the best at everything.

And there’s always room to grow and improve and there’s no shame in that.

Yeah. And we’re here to support them.

For me on this one. Right. What, what a. I so excited to have a platform. Right. To really be able to talk about how we properly diagnose anaplasmosis. Right. Just because I just see it misdiagnosed all the time.

So just understanding when we are looking at our vector borne disease screening, right. That typically we’re looking at serology.

Right. In our screening tests and serology is gonna reflect their antibody levels. Right. Right. Now whether they have a positive antibody response for anaplasma. Right. If we have antibodies, it means we are exposed at some point.

Right. Enough to mount that response. And almost in all cases you have cleared the infection.

This is a dog that actually does not need treatment based on having anaplasma antibody titers. In contrast, when they have clinical signs of acute anaplasmosis or tick borne disease, the best test to do is actually probably starting with a CBC to look if there are consistent signs,

a thrombocytopenia, that stress response with the decreased lymphocytes and eosinophils, looking at a blood film for those Morulae, sending that to the reference lab pathologist so they can look for those Morulae or PCR testing for active infection.

If we can get that right, I think we are going to save more lives.

And I think before we, we part ways, I just want to reiterate the fact that that low risk or perceived low risk doesn’t mean zero risk for the possibility that a disease could be present in your patient or that a disease could be emerging in your geographic corner of the country.

We’ve seen this play out time and time again. Once upon a time, doctors in New Hampshire did not know that Lyme disease was present. And of course now that’s our poster child as a Lyme hotspot.

Right.

And I told you what happened in Ohio. Holly can attest to what’s been going on in Pennsylvania.

And through my work as a professional services veterinarian at Antac, I’ve worked in Southern California, I’ve worked in South Carolina, Florida,

a lot of clinics that are only doing heartworm testing. And there’s this perception that because they haven’t diagnosed Lyme in the past, that this is not an important test to be running today or they haven’t seen a lot of anaplasmosis.

There’s no reason to be doing a true Rapid 4 or an Acuplex for every patient that that comes in for a wellness exam.

But what we’ve, but what we’re seeing play out in the data that we do have is a rapidly evolving emergence of many of these vector borne pathogens. And I do have some data.

I just wanted to share, I don’t know if it’ll make the podcast or not, Holly, but I, I do want to share that. You know, if we just take a place like California, for example,

we’re seeing this really dramatic, almost inexplicable rise and anaplasmosis prevalence. And most of the counties that have turned bright orange on the Companion Animal Parasite Council map in the last five years are in Southern California where the Bay Area Lyme foundation has, they’ve gone out and screened for deer ticks and in Southern California and they found them in Malibu and Manhattan beach and Newport beach,

places that, that they didn’t think that they had deer ticks. And many of them were Borrelia burgdorferi positive.

But we’re seeing actually a much more rapid rise in anaplasmosis in Southern California than we’re seeing Lyme prevalence increasing.

And if you, you know, between 2020 and 2021, we saw this pretty constant prevalence rate. We had about 3,700 or so 3,800 positive cases in 2020, about 3,900 positive cases the next year, and then in 2022, almost 7,000.

By 2024, we’re up to nearly 14,000 anaplasma positive dogs in Southern California. So I just want to or California as a whole, but many of them are in Southern California.

So I just want to make sure that we reiterate the fact that as we see more testing going on, we are also appreciating that these diseases are a lot more common than common wisdom would have us think.

And we don’t want to be on this hamster wheel of we don’t think it’s here, so we don’t test. And then because we’re not testing, we don’t know it’s here.

Well said.

Well, that’s a wrap on episode one of our new era of Tales from the Lab. Thank you so much, Holly, for being on this journey with me.

For those who are listening, be sure to like and subscribe and please share this episode with your colleagues to help us build this community of diagnostic support because we believe smarter diagnostics informs better care.

Thank you for joining us and making a better world for pets.

Tales from the Lab is a production of Antec Diagnostics. The intent of this podcast is to provide education and guidance with the understanding that any diagnostic testing and treatment decisions are ultimately at the discretion of the attending veterinarian within the established veterinarian patient client relationship.