8 At-home glucometer use
Glucometers can now be routinely used for at-home monitoring of diabetic patients. At-home testing is advantageous because
stress-induced increases in blood glucose concentrations are especially a concern in hospitalized cats and may confound the
results of in-hospital glucose curves. Such results may prompt inappropriate increases in insulin dose, potentially resulting
in hypoglycemic crises or the Somogyi effect. Most owners are able to easily perform blood glucose curves at home, and the
results are as effective for managing diabetic patients as glucose curves performed in the hospital.9
9 Preanesthetic testing
Preanesthetic testing (CBC, serum chemistry profile, urinalysis) is unfortunately often overlooked or declined, particularly
in geriatric but overtly healthy patients presenting for elective procedures such as dental prophylaxis. These patients may
have occult diseases, and a diagnosis before anesthesia will minimize the occurrence of unforeseen complications. Additionally,
preanesthetic testing is an opportunity to detect disease processes early when they may be more treatable. Finally, liver
or kidney disease will affect anesthetic protocols, the intensity of intraprocedural monitoring, and intravenous fluid type
and rate.
10 Neurologic examination
Performing a complete neurologic examination is often overlooked in patients presenting with possible neurologic abnormalities.
As with a standard physical examination, a good neurologic examination requires practice and comfort with knowing what is
normal. Localizing a neurologic lesion is required for formulating a differential diagnosis list and dictates the appropriate
diagnostic test and treatment plan. For example, in a patient with cranial nerve abnormalities, prognosis and treatment strategies
for forebrain disease, cervical disease, Horner's syndrome, or peripheral vestibular disease are all vastly different. Only
proper lesion localization will allow you to discuss the next best steps with owners. Even when a referral is sought, the
initial presenting neurologic examination results are extremely useful for documenting the progression of clinical signs,
as neurologic status can change quickly and the rapidity of change may alter a patient's prognosis and management strategy.
Final thought
Some of these 10 essential tests have simply been underused in veterinary practice, and others are newly available. Improve
the quality of your patient care and increase your success rate for obtaining diagnoses and appropriately treating patients
by adding these tests to your armamentarium.
Editors' note: Dr. Pressler is a paid consultant for IDEXX and has received funding from HESKA.
Barrak Pressler, DVM, DACVIM, and Alice A. Huang, VMD, Department of Veterinary Clinical Sciences, School of Veterinary Medicine,
Purdue University, West Lafayette, IN 47907.
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