October 31, 2016

(Dr. Dan Thomson) Hey folks, thanks for joining me today on DocTalk. I’m Dr. Dan Thomson. My guest today is Dr. Brian Lubbers who’s the Director of Microbiology here at the Diagnostic Lab. We’re going to talk about something that’s core to animal health programs that is getting their proper diagnosis; things that you can do from the history to sample collection and working with your veterinarian, and much more. Stay tuned after these messages.

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(Dan) Brian, welcome to show. (Dr. Brian Lubbers) Morning, Dan. (Dan) Folks, Dr. Brian Lubbers. It’s a pleasure to have him here on the show. He’s the Director of Microbiology for the Kansas Veterinary Diagnostic Laboratory here at Kansas State University’s College of Veterinary Medicine. He has national and international experience with not only microbiology, but also pharmacology. Been spending a little bit of time on the road, hadn’t you? (Brian) Yes. (Dan) Veterinary Feed Directives got everybody hopping, but especially this doctor – spending time with producers, spending time with decision makers and getting it right. Today’s topic is about getting the right diagnosis. I’m sure you have stories upon stories of cases that come into the Diagnostic Laboratory that are opportunities that we save people’s livelihoods and sometimes when we get the wrong samples and maybe don’t get exactly what we want. (Brian) Yes, and I think too, there’s probably the stories we don’t know, Dan. Which is people that don’t send samples at all. I think that’s really a good place to start. When you talk about getting the right diagnosis, very few things in veterinary medicine can we tell what is going on in this disease just by either looking at the live animal and our overall physical exam, or even if it’s an animal that died just the things that we see on the necropsy. Many of the things that we have and deal with is diseases look very much like the other. I think that’s even more than what we see as far as samples in the laboratory. (Dan) Yes, and I think some of the people have just given up. Call it undifferentiated fever or why saying undifferentiated fever? Just say fever. But I guess that’s really all we know. Let’s start with that physical exam and different things that you see that we need to be doing. (Brian) Sure. It always starts with, especially when we talk about food animals, those are prey species. We want to try to start with observing the animal in the pen or in the pasture. We know that when you bring an animal into the chute, what we see as far as physical characteristics, we’re going to miss some things because they are not displaying their natural behaviors once we get them into that environment. But certainly most veterinarians and most treatment protocols or exam protocols, we do want to look at temperature, we will look at body temperature. But we will look at a whole host of other things, and depending on what you see, certain body systems, we may dig deeper into those so if we think it’s a gastrointestinal or a digestive disease, we’ll start there and look at some things. If we think it’s respiratory, we may look those, but that’s kind of where we start with that physical exam. (Dan) Okay. Also working with a veterinarian, obviously very important. Then, when the animal does die, getting at least some gross pathology with proper samples to get the correct diagnosis. (Brian) Absolutely. I think one of the things too; I think a lot of producers are in the mindset, “Well, if one dies, accidents happen, we’ll just go on.” That’s really important to collect those samples early with that very first case so that you are ahead of the game and not wait for the second or third animal to be affected. (Dan) Absolutely. My dad used to say it was easier for him in veterinary practice to sell a vaccine for a few thousand dollars than to sell a diagnosis for a few dollars. The crippling ramifications it could have on you and your herd, it’s worth getting a veterinarian out there and doing this right. When we come back, more with Dr. Brian Lubbers on some examples of different cases. Thanks for watching DocTalk.

(Dan) Hey folks, welcome back to DocTalk. Dr. Dan Thomson here with Dr. Brian Lubbers who’s the Director of Microbiology for the Kansas State Veterinary Diagnostic Lab, here in the College of Veterinary Medicine at Kansas State University. We’ve been talking about getting the right diagnosis. We’ve talked about proper history, good physical exam, working with your veterinarian on a necropsy to the proper samples so we can get the proper diagnosis. You have some examples of different things that could go on bovine respiratory disease, diarrheal diseases that maybe we don’t always get the right diagnosis. (Brian) Yes. I think it’s important to realize the reason that diagnosis is so important, is because it affects our treatment decisions and it affects potentially our prevention decisions in the future. If you see a calf in a pen, maybe that calf is a little bit depressed, that calf may be breathing heavy, just doesn’t look right. You get that calf in, it may have a fever, maybe it’s borderline. Really, in my mind I can think, “Okay, the easy diagnosis is bovine respiratory disease. We’re going to treat it with an antibiotic, and we’re going go on with life.” But some of those times you look at that, and that calf may actually be affected by acidosis. An antibiotic certainly won’t help the calf, and may actually cause some resistance issues, both in that particular animal, that group of animals, and maybe for the person consuming that product down the line, and will have no effect on the acidosis. Just something as simple as that looking into two, one kind of syndrome that could be very much be one of two very different diseases. I think it’s important. Certainly, we could do that when we look at necropsy findings. Looking at a set of lungs that’s been infected, maybe it is respiratory disease. What’s the viral component, which again, the antibiotic has no impact. What’s the bacterial component? Really digging into those cases a little more really helps the producer to make better decisions as far as treatment goes. (Dan) Absolutely. Getting that history, understanding how many days those calves have on feed, can also aid in the diagnosis. I think that a lot of times we rely so much on the physical exam, but if you don’t understand or don’t talk about the history of what’s happened leading up to this, really isn’t going to do you much good. (Brian) That’s a really important piece if you’re a producer or a veterinarian that is going to submit samples to the Diagnostic Lab, very rarely do we get those really good histories. Sometimes that is, It takes total difference between us in the lab being able to really nail down the diagnosis or not. Most of the time, if we feel like there’s a piece of information missing, we’ll call the veterinarian, we’ll call the producer, we’ll try to get more information, but providing it upfront certainly can speed your case along and get you that answer a little bit faster too. (Dan) I think that there’s also a disconnect here. You look at our public health offices that provide health. I go in our public health to get my flu shot every year. The Diagnostic Lab is really that, it is a state funded organization to provide service to the producers. They need to be taken advantage of this state supported system for them and their herds. (Brian) Sure. In that kind of theme, one of the things that we do, we certainly provide services for the individual case. Our goal is also to track diseases across the state, so we get an accumulative picture of what’s going on out in the field. (Dan) Perfect. When we come back, we’re going to talk about some examples on diarrheal diseases and cases, right here on DocTalk.

(Dan) Folks, welcome back to DocTalk. Dr. Dan Thomson, with Dr. Brian Lubbers. We work at Kansas State University’s College of Veterinary Medicine, where Dr. Lubbers serves as the Director of Microbiology for the Diagnostic Laboratory here. Brian, let’s jump in to diarrheal disease. I know you have some examples, or different bugs that caused you some concern that we’ll make sure we’re tracking. (Brian) Sure. With the example with BRD, the decision is about treating the individual calf, or the group of animals. Are we giving a drug that’s actually going to work or not. With diarrheal diseases, if you take that calf that has scours, and is seven to 10 days old, the history we talked about how important that was, there are certainly a number of viral and bacterial components that could be causing diarrhea or scours in that age of calf. When we look at getting the right diagnosis there, for me, it then becomes really that public health issue. If this calf is affected, it has diarrhea because of salmonella, or an E coli, or a cryptosporidium, that’s something that you as a producer, you get that scours on your boots, your coveralls, and you take it into your house, and it could certainly cause issues with your family. There are other reasons beyond just the health of the animal. Making some more cost effective, or even effective treatment decisions. Then it becomes about this zoonotic pathogens, so that the bacteria or virus can be transferred from the animal to the person as well. (Dan) The one thing is, is we got people that are bringing calves into their house trying to warm them up, and putting them in the bathtubs, or putting them in their kitchens. We see those pictures on Facebook. I understand some of that in the history, but when you’re dealing with a calf with a salmonella typhimurium that’s antibiotic resistant, we’ve seen cases where put the calf in the bathtub, take the calf back out, fill up the bathtub for junior, he drinks the water and actually dies. And so its really important to understand this. (Brian) Yes, and certainly the overall recommendation is treat them all like they make you sick, but getting that diagnosis can help in that, really determines how, what level of care and comfort do I need to be as far as transmitting those back into my household. (Dan) Yes. Salmonella, campylobacter, the coronaviruses can have both respiratory, reproductive other issues that can go on in the herd that the diarrhea and the calf is just the clinical sign that we saw, there is something else smoldering. (Brian) Yes, and I think it goes back to an individual disease syndrome. When you look at an animal that’s sick, that very rarely will get you down to this particular bacteria or virus, or sometimes it’s nutritional or something else that’s not related to infectious disease. I think we get into this mindset of everything can be treated with something from a bottle and that’s often not the case. But we need the history, we need the right samples, we need all that to really drill down to what is causing that disease in your particular animal or your herd. (Dan) And you have another set of eyes. You get a veterinarian on your farm, they walk through there, you may not understand or you might have forgotten how deep the mud is, you might have forgot the shelter for the calves is not quite as up to snuff as what it used to be. Different things that really go into that management and working together in that Veterinary-Client-Patient relationship can be huge. (Brian) Absolutely. (Dan) Great. When we come back, we’re going to wrap up with Dr. Lubbers on making sure that you get the right diagnosis and the right understanding for the health of your herd.

(Dan) Hey folks, welcome back to DocTalk. I’m pleased to be here and glad that we could snag Dr. Brian Lubbers. He has a busy schedule. He spends a lot of time on the road. Wanted nationally and internationally for talks on beef cattle health and well-being, and pharmacology, and diagnostics, but he serves as our Director of Microbiology here in the Veterinary Diagnostic Laboratory at Kansas State University. Let’s jump into proper samples. (Brian) Sure. (Dan) Because you deal with that on a day-to-day basis. (Brian) Absolutely. When we think, we talk about diagnostics in the Diagnostic Lab; we talk about it as a process. The very first piece of that process is collecting the samples, getting a good history and also shipping those samples Dan. We want to make sure that if you’re sending something to my laboratory, and we’re suspecting a bacteria is involved, we need to grow that bacteria, that bacteria has to be alive when we get it in the lab. Getting that sample here as quickly as possible, keeping it as cool as possible, all helps to support that so that we can get the right diagnosis on our end for the veterinarian or the producer. Certainly, histories, if we get good histories on our submission forms, that helps us. We may decide that this bacteria is more important, more likely and so we may decide it culture a certain direction versus another one. All of those things matter, because if we don’t get the right samples, after that it’s lost, no matter how much we do on our end. (Dan) The timing. Don’t leave an animal set out in the sun and we can’t do anything with it. You got to get on it; you got to get the veterinarian and call. The veterinarian has to get there. (Brian) Yes. In Kansas, in the summer, that window is probably as short as about four hours. It really does need to be, we can certainly work with it up to a certain point. You’re probably talking eight to 12, somewhere in that ballpark. You have a little bit of time, but it’s certainly not days. (Dan) You can move that animal to the shade, You can do some things to help preserve, if the veterinarian is not going to get there until– they may have a call or get there a little bit later, but understand that we are racing the clock. (Brian) Yes. One thing that’s important too, we live in a digital age, Dan, so we always encourage people to take pictures. Everybody’s got a camera in their pocket, take pictures while you’re doing the necropsy, take pictures of the environment. It just gives us a better idea of what’s going on. (Dan) Never thought of that, it’s certainly something that would help with the history, help you better understand the size of the animal, the housing, the environment and everything to that. Anything else on samples? (Brian) I think just the last piece is, we always encourage producers to work with veterinarian. Sometimes that relationship could be the veterinarian is training the producer how to do a necropsy, we can certainly do that, but really the veterinarian is that investigative piece. Once you have that test result, what does that mean, we really want you to work with your local veterinarian because, yes, the pictures help, but they understand your operation way better than we do sitting up here at the College of Veterinary Medicine. (Dan) Big time. The interpretation of the results when they come back and getting things fixed on the farm. (Brian) Absolutely. (Dan) Thanks for being with us, great show. (Brian) Thanks. (Dan) Thank you for being with us on DocTalk. Remember, always work with your local veterinarian and if you want to find out about what we do here, you can find us on the web at www.doctalktv.com. Thanks for joining us on the show today. I’m Dr. Dan Thomson and I’ll see you down the road.

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