Drop Off Procedure Information and Consent Form

An ACTH stimulation test is a test performed either to diagnose Cushing's or Addison's disease, or to monitor a patient who is currently being treated with medication for Cushing's disease. The test involves a blood draw to measure your pet's baseline cortisol level, an injection of a medication called Cortrosyn (which stimulates release of cortisol from the adrenal glands), and a second blood draw to measure a post-Cortrosyn cortisol level. The comparison between the two numbers allows your veterinarian to make a diagnosis of Cushing's or Addison's disease, or allows them to determine whether a pet is on the correct dose of medication for management of Cushing's disease.

Because your pet is not currently on any medication, we prefer that they be fasted for 12 hours prior to their blood testing. While this is not required for an accurate result, it is preferable. Please talk with your pet's medical care team if your pet cannot be fasted prior to this appointment.

Most pets are in the clinic for several hours for completion of this test.

An ACTH stimulation test is a test performed either to diagnose Cushing's or Addison's disease, or to monitor a patient who is currently being treated with medication for Cushing's disease. The test involves a blood draw to measure your pet's baseline cortisol level, an injection of a medication called Cortrosyn (which stimulates release of cortisol from the adrenal glands), and a second blood draw to measure a post-Cortrosyn cortisol level. The comparison between the two numbers allows your veterinarian to make a diagnosis of Cushing's or Addison's disease, or allows them to determine whether a pet is on the correct dose of medication for management of Cushing's disease.

Pets who are on trilostane should take their medication with a full meal. The ACTH Stimulation Test should be performed 2 to 6 hours after taking trilostane. 

Most pets are in the clinic for at least several hours for completion of this test.

A low dose dexamethasone suppression test (LDDST) is performed to diagnose Cushing's disease in dogs. The test involves three blood draws. An initial blood draw is taken to measure the baseline cortisol level. An injection of a steroid medication called dexamethasone is administered, and blood samples are drawn to measure cortisol levels 4 hours post injection and 8 hours post injection. The comparison between these numbers allows your veterinarian to determine if your pet's adrenal glands have a normal or an abnormal response to dexamethasone.

Pets are with us in the clinic for the majority of the day for this test.

Your pet does not need to be fasted prior to this lab test. Administration of steroid medications (i.e. prednisone, topical steroid ointments) can interfere with the results of this test, so it is very important to inform your veterinarian if your pet has had any of these medications prior to this test.

A bile acids test is performed to evaluate a pet's liver function. This test involves an initial blood draw to measure baseline bile acids levels, followed by feeding a pet. 2 hours after eating, a second blood draw is performed to measure post-prandial (post-eating) bile acids. Normally, the liver released bile acids in response to eating, and then "recycles" the bile acids by reabsorbing them from the blood stream. A pet with liver dysfunction is much less efficient at recycling the bile acids, so the post-prandial bile acids level is usually much higher than in pets who have normal liver function.

It is very important that your pet be fasted for 12 hours prior to their visit. Please bring your pet's favorite pet food with them just in case they don't want to eat the food that we offer them.

 Most pets are with us in the clinic for at least several hours for completion of this test.

A blood glucose curve is a series of blood glucose (blood sugar) measurements taken every 1 to 2 hours throughout the day. This test is performed to determine how well a pet is responding to treatment with insulin for management of diabetes. We can determine both how much your pet's blood sugar changes in response to insulin as well as how long that response lasts. The results of this test help us to determine if a pet is on the right dose and right type of insulin.

Unless you have been instructed otherwise, pets should be dropped off at 8 am for a glucose curve. Please keep your pet's insulin and feeding regimen as close to normal as possible on the day of a blood glucose curve. We can administer insulin and feed your pet if necessary (i.e. if they normally receive insulin and a meal at 10 am, please bring those items with you for us to administer rather than giving them early at home prior to their appointment).  

Most pets are with us in the clinic for the majority of the day for completion of this test.

Radiographs (x-rays) are taken for evaluation of a wide variety of conditions. X-rays can determine the size and shape of many internal organs, can evaluate orthopedic structures for abnormalities such as fractures, dislocations, or arthritic changes, and can screen for the presence of abnormal structures such as masses.

In most cases, we can take x-rays without need for sedation. However, if a pet is very painful or if they are very nervous, it can be difficult to position them appropriately for x-rays. In these cases, we will recommend administering injectable sedation to make the process more comfortable and less stressful for your pet. Because we may administer sedation, please withold food from your pet after 10 pm the evening prior to their appointment. No food should be offered the morning of their appointment. Water is allowed at all times.

Most pets are with us for several hours to the majority of the day for radiology appointments.

An ultrasound is a minimally-invasive diagnostic imaging tool used to evaluate the size, shape, and internal structure of abdominal organs. An abdominal ultrasound evaluates the GI tract (stomach, small intestine, and large intestine), liver, kidneys, urinary bladder, and adrenal glands. In order to perform this imaging, your pet's belly will be shaved. Most pets do not need to be sedated for ultrasounds, but occasionally, some animals are too painful or too nervous to allow the ultrasonographer to scan them. In these cases, we may recommend oral or injectable sedation to help calm your pet.

Unless directed otherwise, pets should be fasted prior to an abdominal ultrasound in order to ensure the best quality of imaging. Please withold food after 10 pm the evening prior to their ultrasound. Water is allowed at all times. 

Please drop your pet off with us between 9 AM and 10 AM, unless you have made specific arrangements otherwise. Pets are usually discharged in the late afternoon to early evening following ultrasound visits.

Cystocentesis is a procedure in which a needle and syringe is used to collect urine directly from the bladder. This sample is less likely to be contaminated with bacteria from the lower urinary tract or skin, and is the preferred sample when evaluating for a bladder infection. We typically use an ultrasound to visualize the bladder for cystocentesis in dogs, and may or may not need to use an ultrasound for cats.

Your pet should be prevented from urinating for at least two hours prior to being dropped off in order to give us the best chance of being able to collect a urine sample. 

The length of time that a pet is in the clinic with us depends on how long it takes them to fill their bladder enough to safely collect a sample, and can sometimes take the entire day. Your pet's care team will call you once their sample has been collected and they are ready to be picked up.

What is a fine-needle aspirate?

A fine-needle aspirate is a minimally invasive procedure that allows us to obtain cells from tissues. Often, the tissue aspirated is a mass (a swelling or tumor). Cells obtained from the aspirate can be placed under a microscope for evaluation. In some cases, this evaluation can differentiate between a benign or malignant (cancerous) mass. It is important to know that fine-needle aspirates are not only done to look for cancer, but to look for other causes of disease (for example, infection) as well. A fine-needle aspirate is not a treatment for disease, but a tool to help diagnose disease. Unfortunately, due to the minimally invasive nature, in some cases the cells obtained from this procedure do not provide enough information to reach a definitive diagnosis. Even if this is the case, the aspirate assessment might help to eliminate (rule out) some potential causes of disease.

How is a fine-needle aspirate performed?

The skin over the area of interest will be cleaned, but it is not usually necessary to shave any hair for this procedure. A small needle similar in size to the needles used to administer vaccinations will be inserted through the skin and into the tissue to collect cells. These cells will be smeared on a microscope slide and either evaluated in the clinic or will be sent off for review by a veterinary pathologist.

What are the risks of performing a fine-needle aspirate?

Complications associated with the aspiration of masses on or under the skin are uncommon and minor. These risks include bleeding or irritation of the skin. Other risks, such as puncture of tissues not intended for sampling, exist but are uncommon. Finally, you need to be aware that the most common “risk” of fine needle aspirate is that the small size of the sample obtained by this minimally invasive technique means the procedure might not lead to a diagnosis, therefore requiring additional diagnostic tests.

Because your pet will be sedated, please withold food beginning at 10 pm the evening prior to the procedure. Do not feed your pet the morning of their procedure. Water may be offered at all times.

What is a skin biopsy or dermal (skin) mass removal?

Skin biopsies or skin mass removals are minor surgical procedures that most pets tolerate well with sedation. These procedures involve removing a small portion of the skin. A skin biopsy is the collection of a small piece of skin for submission to a pathologist. In most cases, a biopsy allows for the diagnosis of immune-mediated skin diseases, infections, or cancer.

A dermal (skin) mass removal is the removal of an entire skin lesion, such as a skin tag or a wart. Depending on the appearance of the lesion, your veterinarian may or may not advise submission of the lesion to a pathologist.

How are these procedures performed?

Both of these procedures can usually be performed while pets are sedated with injectible sedation. Following an injection of a combination of calming medications and pain medications, pets become very relaxed and unaware of any painful stimuli. Sedated pets will be monitored by a veterinary technician and usually some form of monitoring equipment such as a pulse oximeter. The surgical site will be shaved and disinfected, and may have a local numbing medication applied to provide additional pain relief. The skin biopsy or the removal of the skin mass will be performed with a sharp blade, and the skin edges will be closed using stitches or staples. Some, but not all, pets will need to return for suture or staple removal. The incision site and sutures should be protected by keeping your pet in a cone or keeping the incision covered until the sutures are removed. After the procedure is finished, your pet may have some or all of the sedation reversed, or may be allowed to recover from the sedation on their own time. If histopathology is elected, then the sample(s) will be submitted to a veterinary pathologist for a diagnosis.

What are the risks of this procedure?

Following sedation, pets may be off balance for several hours. Risks of sedation and skin biopsy/skin mass removal are uncommon and minor, but include bleeding, pain at the incision site, and infection or irritation of the skin. Most pets are back to their normal activity level within 24 hours, but some pets may remain excessively sedate for several days. 

Pets are usually with us for this procedure for several hours to the majority of the day depending on their recovery from sedation.

Because your pet will be sedated for this procedure, please withold food after 10 pm the evening prior to their visit. Do not feed your pet the morning of the procedure. Water is allowed at all times.

What is arthrocentesis?

Arthrocentesis, also known as a “joint tap”, is the removal of a very small amount of fluid from inside a joint space. Normal joints contain a small amount of synovial fluid that lubricates the joints as they move; inflammation or infection in the joints can be identified by changes in the fluid. Samples of the synovial fluid obtained by arthrocentesis can be analyzed under a microscope and/or by microbial culture in a laboratory. Arthrocentesis is not a treatment for disease but is meant to help us determine the cause of disease. Arthrocentesis is also used to determine how effective medications have been at treating diseases of the joints. If joint fluid that was formerly abnormal becomes normal, it is likely safe to reduce or even discontinue medications.

How is an arthrocentesis performed?

Although any affected joint could be tested, the most commonly sampled joints include the carpus (the wrist) and the hock (the heel). The fur is clipped and the skin cleaned over the joint(s) that will be sampled. A needle attached to a syringe is introduced into the joint(s) and a fluid sample is obtained. Fluid samples will be submitted for cytology to look at cells under a microscope. Depending on the situation, samples might be submitted for bacterial culture or for other testing. The number and kinds of cells we find, as well as results of special tests, will allow us to determine if joint disease is present, determine what is causing the diseases, and/or to evaluate joint disease control.

What are the potential risks of arthrocentesis?
• Introduction of germs into the joint that can cause infection. Meticulous cleaning and the use of sterile materials minimizes this risk.
• Bleeding within the joint space; although rare, this is most likely in animals with bleeding disorders.
• New or worsened lameness following the procedure; this usually resolves on its own, but pain control medications can be used until then.
• Sometimes, no fluid can be withdrawn from the joint. Usually at least a few joints will produce a usable sample.
• The sample obtained might not be representative of disease. Polyarthritis is arthritis of many joints. It is possible that a joint chosen at random will not be representative of the primary disease process. It is for this reason that we usually sample two to four joints rather than just one.
• The joint fluid can be contaminated with blood, making interpretation difficult. Sedation keeps the pet still, which in turn reduces the risk of blood contamination.
• Finally, you should know that there is a risk that we will not identify a specific cause of your pet’s illness despite performing the arthrocentesis. However, the recommendation for performing arthrocentesis is based on our belief that the features of your pet’s case indicate a greater likelihood of a positive, informative result than a negative result.

Sedation is required for arthrocentesis. Sedation involves the administration of medications that cause your pet to become drowsy and relaxed, but to remain conscious. In general, there are fewer risks associated with sedation than with general anesthesia, but adverse events can occur. Many medications used to induce sedation can be “reversed” by giving other medications to counter the sedative effect, allowing your pet to “wake up” more quickly after the procedure has been completed.

This procedure is usually performed without need for sedation. However, for some pets, sedation can help them be more relaxed during the procedure. In case we need to sedate your pet, we recommend that your pet be fasted. Please do not feed your pet after 10 pm the night prior to the procedure. Water is allowed at all times. 

What is abdominocentesis?

Abdominocentesis is a minimally invasive procedure that allows us to obtain a sample of fluid from your pet’s abdominal cavity (belly). Normally, there is only a tiny amount of fluid free in the abdominal cavity. When there is excessive fluid, evaluation can help us determine the cause for your pet’s illness. This procedure is not a treatment for disease, but a tool to help find a diagnosis for a treatable disease. That said, when there is a very large volume of fluid accumulation, removing some of that volume can make your pet more comfortable and make it easier for him/her to breathe.

How is abdominocentesis performed?

An area of skin will be shaved and cleaned prior to inserting a small needle into the abdomen. If there is only a small amount of fluid, we may use an ultrasound machine to help guide us to the best spot(s) to collect the fluid. Once the needle is in the abdomen, a syringe is used to draw back fluid. Samples of this fluid will be submitted for evaluation under the microscope. In some cases, the fluid may be submitted for additional testing such as bacterial culture. If there is a large volume of fluid, we will continue to remove fluid even after we have the appropriate diagnostic samples, with the goal of removing enough fluid to make your pet more comfortable. Once we are done, the needle is simply removed. There is no need for sutures (stitches).

What are the potential risks of abdominocentesis?

Abdominocentesis is quite safe. Occasionally, there will be minor bleeding or fluid leakage where the needle was inserted. If the volume of fluid is small, it is also possible that we could nick (cut) an abdominal organ with the needle (this risk is minimized by use of ultrasound guidance, and by keeping the patient very still during the procedure). Another extremely small risk is introduction of germs into the abdomen that might cause an infection called peritonitis.

Because your pet will be sedated for this procedure, please withold food after 10 pm the evening prior to their visit. Do not feed your pet the morning of the procedure. Water is allowed at all times.

What is thoracocentesis?

Thoracocentesis is the removal of fluid or air from the chest cavity. During thoracocentesis, a needle is inserted into the chest cavity to allow for the removal of fluid or air that should not be there. This procedure can be used as a diagnostic tool when a sample of fluid undergoes analysis to help us determine the reason that the fluid built up inside the chest in the first place. Additionally, thoracocentesis can be used to improve an animal’s ability to breathe by removing fluid or air from the chest cavity. A similar procedure in human medicine is re-expansion of a collapsed lung.

How is a thoracocentesis performed?

During thoracocentesis, an area on the chest is shaved and cleaned. A needle or catheter attached to a syringe is inserted through the skin, between the ribs, and into the pleural space. If only a small amount of fluid is present in the pleural space, we can use an ultrasound machine to help guide our needle into a fluid pocket. Once the needle is in place, we pull back on the syringe to aspirate (withdraw) the fluid or air out of the chest. If we are removing air, we simply continue to remove as much air as possible to help the pet breathe. If we are instead removing fluid, multiple samples of fluid will be saved for analysis. The fluid and cells will be examined under a microscope, and the fluid might also be submitted for other tests such as bacterial culture. If the volume of fluid was small, only enough fluid needs to be removed for diagnostic testing. On the other hand, if there was enough fluid to make breathing difficult, we will remove as much fluid as we can do safely, the goal being to allow the lungs to re-expand by removing the fluid that compresses them. Once we finish removing fluid or air, the needle is simply pulled out with no need for sutures (stitches).

Mild sedation will be required regardless of the reason for the procedure. This involves the administration of medications that cause your pet to become drowsy and relaxed, but to remain conscious. In general, there are fewer risks associated with sedation than with general anesthesia, but adverse events, including the risk of death, can occur. Many medications used to induce sedation can be “reversed” by giving other medications to counter the sedative effect, allowing your pet to “wake up” more quickly after the procedure has been completed.

What are the potential risks of thoracocentesis?

• We may not be able to collect enough fluid for all of the planned diagnostic tests. This risk can be reduced by using ultrasound guidance to find pockets of fluid.
• We could lacerate (cut) the lung, which could cause pneumothorax (return of lung collapse). This is an uncommon complication, and it usually resolves on its own. The risk is minimized by keeping the patient still during the procedure, which is the reason we might opt to use sedation.
• We could lacerate (cut) or puncture a blood vessel causing bleeding. Again, keeping the patient still will reduce this risk.
• We could introduce germs into the chest that cause infection. This risk is minimized by shaving the fur and disinfecting the skin at the needle puncture site(s).
• There is also a risk that we might not identify a specific cause of your pet’s illness despite performing the thoracocentesis, or that breathing will not be eased by the procedure. Even if we remove the majority of air or fluid at the time of the procedure, additional air or fluid can reaccumulate quickly unless the cause for the disorder can be corrected.

Some pets require injectable sedation in order to be safely examined or to have specific treatments done (i.e. nail trims, shaving mats). Sedation involves the administration of medications that cause your pet to become drowsy and relaxed, but to remain conscious. In general, there are fewer risks associated with sedation than with general anesthesia, but adverse events can occur. Many medications used to induce sedation can be “reversed” by giving other medications to counter the sedative effect, allowing your pet to “wake up” more quickly after the procedure has been completed.

Because your pet will be sedated for this visit, please withold food after 10 pm the evening prior to their visit. Do not feed your pet the morning of the procedure. Water is allowed at all times.