Temecula Creek Veterinary CLINICAL SUMMARY

32819 Temecula Parkway, Suite B Animal No. 113105

Temecula, California , 92592 Clinical No. 321855
Record Date 07-06-2020
Ph (951) 395-0398
Attending Vet(s) Dayle Siegel, DVM
Fax (951) 297-9892
Printed At 07-10-2020
Email Temeculacreekvet@gmail.com
Printed By Stephanie Moss

Clinical Summary for Lincoln

Client Details Patient Details

Name Alvarado, Michael Phone 619-227-6900 Name Lincoln Age 9 years 7 months
Address 44514 Leona Court Species Canine (Dog) Sex Male Neutered
Temecula, California, Breed Labrador X
92592

Presenting Problem

Exam. Allergies, licking and itching a lot. O wants blood work done because it has not been done in awhile. Check Teeth -ashley

Physical Exam
07-06-2020 4:26:02pm, Dayle Siegel, DVM

MM Pk, CRT <2 sec, Hydrated.

Eyes: Corneas clear, bright, no discharge present, sclera are normal. PLR’s normal and symmetrical.

Oral Exam: teeth grade 2/4, slab fracture 108

Ears: Pruritic AU, no odor or debris seen

CV: Normal heart rate and rhythm, matching strong pulses, no murmur present.

Resp: Lungs auscult clear in all 4 quadrants, normal respiratory rate and effort.

PLN: All lymph nodes palpate normally for location.

ABD: Soft, non-painful, no obvious evidence of a mass, gut sounds normal, normal intestines.

M/S: Ambulatory all 4 limbs, no evidence of lameness, or crepitation present. Normal gait and movement, normal musculature.

Neuro: Normal cranial reflexes and peripheral reflexes present. Normal gait and mentation.

I: generalized pruritis, particularly inguinal area and back legs, all four feet, shaking ears. Small, marble sized semi firm mass just
below/distal to anus

U/G: Normal external genitalia, no swelling or abnormalities present.

Assessments
07-06-2020 4:27:28pm, Dayle Siegel, DVM

-generalized pruritis, particularly feet, inguinal, rear legs, shaking ears. Responded well to previous allergy treatment

-newly noticed small, raised, interdermal semi firm mass just distal to anus
 Temecula Creek Veterinary
32819 Temecula Parkway, Suite B
Temecula, CA, 92592
(951) 395-0398
TCSAvet@gmail.com

-scooting

Plans
07-06-2020 4:28:30pm, Dayle Siegel, DVM

Exam
CBC, chem 15, T4-sent to lab
anal gland expression-both glands full bilaterally, easily expressed
RX: cephalexin 500 mg: 2 capsules PO BID for 10 days
apoquel 16 mg: 1 PO BID for 5 days, then 1 PO SID

refills on apoquel and miconahex + triz shampoo OK until July 2021 pending lab results
-slab fracture and previous abscess 108 noted. Recommended owner consider dental and xrays of the mouth and may need the tooth
pulled pending radiographs

Diagnostic Request

07-06-2020 3:37:24pm, Dayle Siegel, DVM

CBC Mini Chem 15 T4

Ethos Small Animal Lab

Diagnostic Result

07-08-2020 8:38:43am

07-07-2020 11:15:19am, Dayle Siegel, DVM

CBC Mini Chem 15 T4 - Dayle Siegel, DVM (Ref: US456-DR2390)

Therapeutic / Procedure
07-06-2020 3:37:24pm, Dayle Siegel, DVM

Medication
Date/Time Drug Name Qty Instructions Prescribed By
07-06-2020 SIG: GIVE 2 CAPSULES BY MOUTH EVERY 12
Cephalexin 500mg 40 Dayle Siegel, DVM
3:38:28pm HOURS.
. . .
. .
 Temecula Creek Veterinary
32819 Temecula Parkway, Suite B
Temecula, CA, 92592
(951) 395-0398
TCSAvet@gmail.com

SIG: GIVE 1 TABLET BY MOUTH EVERY 12 HOURS

07-06-2020
Apoquel 16mg 21 FOR 5 DAYS, THEN 1 TABLET BY MOUTH EVERY Dayle Siegel, DVM
3:38:28pm
. . 24 HOURS .
.
.

Dispensed Medication
Date/Time Drug Name Qty Instructions Prescribed By
07-06-2020 SIG: GIVE 2 CAPSULES BY MOUTH EVERY 12
Cephalexin 500mg 40 Dayle Siegel, DVM
3:38:28pm HOURS.
. . .
. .
SIG: GIVE 1 TABLET BY MOUTH EVERY 12 HOURS
07-06-2020
Apoquel 16mg 21 FOR 5 DAYS, THEN 1 TABLET BY MOUTH EVERY Dayle Siegel, DVM
3:38:28pm
. . 24 HOURS .
.
.
 ETHOS Diagnostic Science
10455 Sorrento Valley Road, Ste 100
San Diego, CA 92121
statlab@ethosvet.com
(858) 875-7550 ph
(858) 875-7568 fax

Doctor: Siegel Rcvd: 06-Jul-2020 11:47 pm

Temecula Creek Small Animal Account #: 270
Rptd: 07-Jul-2020 11:15 am
32819 Temecula Parkway Phone: 951-297-9891 Fax:
Temecula, CA 92592

Patient: Lincoln Owner: Alvarado Patient ID: Accession: 20052532 Final

Age: 9Y Sex: M Neutered: Y Species: Canine Breed: Labrador Retriever

Tests Ordered: Pathologist's Review,Complimentary TSH, Chemistry Mini Plus, CBC w/differential, Total T4
Pending Tests:
Test Result Reference Range Units
Hematology
CBC w/differential
WBC 109.2 H 4.6-15.5 K/uL
RBC 6.36 5.22-8.90 M/ul
HGB 14.8 12.5-20.0 g/dl
HCT 42.6 36-58 %
MCV 67 64-76 fL
MCH 23.2 20.6-25.1 pg
MCHC 34.7 32.2-36.4 g/dl
PLATELET COUNT *** 220-539 K/uL
PLT COMMENTS The automated platelet concentration is erroneously low. A visual platelet estimate
yields ~260-346 K/uL.
As no clumping is evident, the platelet count/estimate is likely accurate.
Platelet morphology is unremarkable.
NEUT 9 L 48-88 %
LYMPHOCYTES 88 H 5-40 %
MONOCYTES 1 0-8 %
EOSINOPHILS 2 0-10 %
NEUT # 9828 2,810-12,759 /uL
LYM # 96096 H 471-3,746 /uL
MONO # 1092 H 0-919 /uL
EOS # 2184 H 0-1,250 /uL
WBC COMMENTS See pathologist's review for description of WBCs.
RBC COMMENTS RBC morphology is unremarkable.
nRBC 0 0-3 /100 WBCs
Pathologists review: A marked lymphocytosis is present consisting predominantly of small to
intermediate sized lymphocytes. These round cells have a small to moderate
amount of pale basophilic cytoplasm. The round nuclei occasionally exhibit a subtle
cleave and are 1.0 to 1.5 times the size of an erythrocyte with stippled chromatin
and no distinct nucleoli. The magnitude of the lymphocytosis and the uniformity of
the lymphocytes are most consistent with chronic lymphocytic leukemia (CLL) or
blood manifestation of small to intermediate lymphoma. Evaluation for
lymphadenopathy, organomegaly (liver/spleen/intestines), and/or a bone marrow
aspirate may be considered. I would also advise flow cytometry on a fresh sample
of peripheral blood, as it will assess phenotype and prognostic information.

Jennifer L. Owen, DVM, PhD, DACVP (Clinical)

Slide reviewed by: Mike Chrisawn, RVT

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 ETHOS Diagnostic Science Rptd: 07-Jul-2020 11:15 am
Patient: Lincoln Alvarado Accession: 20052532
Test Result Reference Range Units

Chemistry
Chemistry Mini Plus
BUN 24 7-31 mg/dL
CREATININE 1.3 0.7-1.7 mg/dL
BUN/CREATININE RATIO 18.5 9 - 33 RATIO
POTASSIUM 4.8 3.8-5.6 mmol/L
SODIUM 147 140-154 mmol/L
NA/K RATIO 30.6 26.0-37.0 RATIO
CO2 23 17-28 mmol/L
GLUCOSE 87 70-125 mg/dL
TOTAL PROTEIN 5.8 5.0-7.6 g/dL
ALBUMIN 3.1 2.6-4.2 g/dL
GLOBULIN 2.7 2.3-4.5 g/dL
A/G RATIO 1.15 0.6-1.4 RATIO
AST 41 5-65 U/L
ALT 114 H 5-110 U/L
ALK PHOS 83 5-150 U/L
GGT 8 0-10 U/L

Endocrinology
Total T4
T4 TOTAL 0.6 L 0.8 - 5.0 ug/dL
Canine interpretation: Best used to rule out a diagnosis of hypothyroidism or
monitor dogs on levothyroxine supplementation.
A normal TT4, especially when >= 2.0 µg/dL, makes hypothyroidism highly unlikely
(<10% chance).
If TT4 is in the upper half (2.5-5.0 µg/dL) or slightly higher than the reference
interval, results should be correlated with the clinical response to treatment.
Monitoring FT4 or cTSH in dogs undergoing treatment for hypothyroidism offers no
additional advantage and is not recommended.

Endocrinology
Complimentary TSH
TSH 1.15 H 0.05 - 0.50 ng/mL
In primary hypothyroid dogs, loss of negative feedback to the pituitary results in
increased canine thyroid stimulating hormone (cTSH) concentration. TSH is used
extensively for the diagnosis and therapeutic monitoring of thyroid disease in
humans, but is not as reliable in dogs. 25-30% of hypothyroid dogs will have a
normal cTSH level and approximately 10% of euthyroid dogs will have increased
cTSH concentrations, limiting its value for the diagnosis of hypothyroidism. The
cTSH should not be used as the sole criterion for diagnosing hypothyroidism, but
rather should be interpreted in the context of the patient history, physical
examination, routine laboratory findings, and TT4 and/or FT4 concentrations.

NOTE: A complimentary TSH (thyroid-stimulating hormone) determination on all canine serum specimens submitted for a
Total T4 or Free T4 (EIA) when EITHER result is below the normal reference range. Please feel free to call ETHOS
Diagnostic Science lab for interpretative assistance.
Reviewed By:
Sarah Harkleroad
Jennifer L. Owen, DVM, PhD, DACVP Clinical Pathology

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