Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
Leveraging Veterinary Diagnostic Laboratories for Better Patient Outcomes
Curious about what happens to your samples after they leave your clinic? Wonder why some tests come back with "no growth" despite clear clinical signs? This eye-opening conversation with microbiologist Kelli Maddock reveals the world of veterinary diagnostic laboratories and how you can leverage them for better patient outcomes.
Kelli, Guest Editor of JAVMA's supplemental issue "Diagnostic Laboratory Medicine: From Sampling to Test Interpretation," debunks common misconceptions about lab testing while offering practical advice for getting the most accurate results. The difference between a properly collected, promptly delivered sample and one that's "rolled around in your pickup for a week" can be the difference between diagnosis and mystery. Through real-world scenarios and research findings, Kelli demonstrates how proper communication with laboratory professionals directly impacts clinical decision-making.
The episode doesn't just cover technical aspects—it reveals the human element of laboratory medicine. Kelli shares her personal journey from human medicine to veterinary diagnostics, opening listeners' eyes to alternative career paths in veterinary medicine.
Whether you're a student, practicing veterinarian, or laboratory professional, this conversation offers valuable insights into strengthening the partnership between clinicians and diagnostic laboratories. Remember: the laboratory isn't just a service provider—it's your partner in patient care, eager to help you get the best possible diagnostic information. Subscribe, leave a review, and join us next week for another exploration of veterinary medicine's fascinating dimensions.
JAVMA editorial: https://doi.org/10.2460/javma.263.s1.s4
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This is Veterinary Vertex, a podcast of the AVMA Journals. In this episode we chat about the June JAVMA Supplemental Issue Diagnostic Laboratory Medicine From Sampling to Test Interpretation with our guest Kelly Maddock.
Lisa Fortier:Welcome everyone. I'm Editor-in-Chief Lisa Fortier, and with co-host Sarah Wright. Kelly, thank you so much for being with us here today from my home state of North Dakota.
Kelli Maddock :Thanks for having me Excited to be here.
Sarah Wright:All right, let's dive right in. So, kelly, you're the guest editor for the JAVMA supplemental issue. Diagnostic Laboratory Medicine From Sampling to Test Interpretation. What can our readers expect to take away from these articles?
Kelli Maddock :Yeah, I'm so excited to share this special issue. There are some really great things. I have a suspicion that a lot of people maybe especially working veterinarians don't have a lot of interaction with their diagnostic laboratories, especially if they're working with big commercial laboratories. But the information contained in here there's some original research, of course, and then some reviews, and the reviews I think are really helpful for just reminding folks of some really good tips to get the best test results, because we always make the assumption of I give you a sample and no matter what that quality of that sample is going to get me the same test result.
Kelli Maddock :You know, maybe rolled around in your pickup for a week, compared to like fresh off the animal delivered to the lab the same day, there's a huge difference and you can actually miss getting an important test result because that sample is degraded. So a lot of those reviews are really touching on those things that'll make sure that you get that really great sample and some things you could potentially miss if you aren't getting the sample at the right time, the right patient, right site or providing that relevant clinical history. So a lot of things that I think the reviews and the original research touch on are that collaboration and partnership between the laboratory and the clinicians. So a lot of that, the original research I think is really useful. Clinicians so a lot of that, the original research I think is really useful. It's data coming out of the laboratories and using some evidence-based information, supporting either collection requirements or extra tests that might be necessary for a veterinarian to consider.
Lisa Fortier:Yeah, thank you for stepping up to do this, Kelly. I was in academia for 35 plus years and you know, even though our diagnostic lab is half a few steps away, it's still really important that people know how to submit these samples. You know, synovial fluid was the bane of my existence for the longest time, like please stop putting that in the port-a-cult, please stop doing that and putting it in the refrigerator. So, I really really deeply appreciate you stepping up and taking on this challenge of making diagnostic laboratory into a full supplemental issue. It's going to be super important.
Kelli Maddock :I really appreciate that opportunity to do so, because anytime we can get laboratory information out and remind folks that we exist and we want to talk to you and we want to help you get the best results, it's a great opportunity. So thank you.
Lisa Fortier:Yeah, what sparked your interest in diagnostic laboratory medicine?
Kelli Maddock :Journey was kind of windy to the field. I had started out, I was trained in human medicine, loved microbiology and so that was kind of my home. But I ended up getting burnt out at the hospital a lot of hours and shifts, always loved helping but also didn't necessarily want to be in front of patients all the time. So laboratory medicine it was a very appealing way to be able to contribute those skills and love for science and I wound up at the vet lab because of Dr Claire Burbick from. She was at NDSU while I was a med tech and we took training together and she ended up recruiting me and I haven't looked back. I've almost been in vet med for 10 years now, which is more than I'd been in human med. So it's been a good shift and I'm so proud of the diagnostic lab medicine field and what we can do and just love being able to interface with folks and talk about what we do.
Lisa Fortier:Well, we're fortunate to have you in vet med. Thank you Every time we write an article, and especially when you put together a supplemental issue. I certainly learned a bunch reading all these articles. What did you learn and what was surprising to you when you read this collection of articles that you had curated? I?
Kelli Maddock :absolutely loved that a recurring theme throughout the articles was just communication with the laboratory, regardless of the discipline. We have information from pathologists, toxicologists, coagulopathy, several microbiology articles, but a lot of that just came down to good sample and communication and just really thinking about the whole picture holistically and just having a good open dialogue with the lab and that all just kind of organically came together and I would say that's probably one of the biggest challenges we have in the lab and I'm sure clinicians too. You're busy, you're out in the field. I know rural North Dakota. They're in a truck middle of nowhere, maybe going to have spotty cell phone reception, and they're trying to call the lab and ask about a result. Or what do I collect? Or hey, I might have an anthrax. Can you help me out? So I mean just that communication and connection with the lab is so important and that was a nice recurring theme.
Lisa Fortier:I really like what you said, that it's dialogue. A lot of times people can perceive that laboratory, clinical support, necropsy, those sorts of things are just supporting infrastructures. But you know, for me at least, and I would call the diagnostic lab and ask a question, especially ClinPath they would say did you think about this? Because I've seen a couple other cases and you might not have seen it as the clinician but as the diagnostic laboratory person. So I really like that word, that it's not just one informing the other, one relying on the other for a service. It is truly a bilateral dialogue.
Kelli Maddock :Definitely, and there are just so many little things that can help spark additional information. As a microbiologist, some of your keywords in your history is going to make me choose different culture media that might get a bacterium to grow that wouldn't normally and that's very true of pathologists, even molecular. We might call you and say would you like to add this test on? That might be a little more complete. So it is really helpful and that's not just our little lab in North Dakota making time to chat with our clients because we're little. Most diagnostic labs, I think, would be really happy to talk to their clients and help get that richer test result for the clinician.
Sarah Wright:I think that's one of my biggest takeaways for my diagnostic medicine rotations was don't neglect the history. Don't just put a one line history like. Give them the details they're going to need to help you because ultimately you're going to have a better outcome, hopefully for your patient, a more holistic clinical picture too.
Kelli Maddock :For sure, and more than just I gave you money. Here's a test result that might say mixed bacterial growth, but you call me and I might be able to tell you like maybe it would benefit from collecting a little bit more aseptically. Or it's telling me it's normal, so maybe consider viral. You know some of those different things. It's very helpful.
Sarah Wright:For those of you just joining us, we're discussing the JAVMA Diagnostic Laboratory Medicine Supplemental Issue with our guest, kelly Maddock. So, kelly, what are the next steps for research in diagnostic laboratory medicine?
Kelli Maddock :steps for research in diagnostic laboratory medicine, I think continual investigation into how veterinarians are using laboratory results and then what they either perceive that they're getting and using in clinical practice versus what we're trying to give them. So Diaz-Campos et al had done a paper for this special issue on how veterinarians interpreted antimicrobial susceptibility test reports, and this is something we get all the time in the lab is you only gave me five drugs. This other lab gives me 20. And so she investigated did people have sufficient information to make clinical decisions based on a smaller report with more comments, or did they prefer a longer laundry list of drugs and ended up finding that when the laboratory took more time to have more tailored results, that veterinarians made better treatment decisions that also supported antimicrobial stewardship.
Kelli Maddock :So there is a lot of evidence that the way that we put our reports together and the information we put out it does actually inform clinical decision making and hopefully helps you make better decisions without you having to be the expert and sort through each of the little, each of the drugs on the list and make the best choice. You're busy. You're trying to make these decisions quickly between patients and a good lab report should help you do that quickly should have sufficient information to let you know what potential limitations are. So, yeah, I think there's a lot more that can be done that way, not just in microbiology but in other areas of the field. And then potentially looking at different analytes there's so many things that I think could be replicated from human medicine. Looking at different analytes there's so many things that I think could be replicated from human medicine and just investigating how that actually translates to vet med and just seeing what is actually going to translate and how can we make it better and make it work for our veterinarians.
Lisa Fortier:You teed up my next question perfectly, so you're clearly documenting demonstrating a role for non-veterinarians in veterinary diagnostic medicine.
Kelli Maddock :If for the listeners who might be microbiologists or veterinary students or veterinarians considering a career in diagnostic laboratory medicine, what advice do you have for them, yeah, I would say just getting that experience and just seeing what you like, because even if you don't necessarily want to be in the laboratory, it is really important to know what we're doing. Our laboratory hosts a lot of students as student help or interns, and the one thing I always try to emphasize if you take one thing out of here, is just know that your laboratory likes to talk to you and they want to talk to you. They'd much rather have you call and take a couple minutes to get the right sample rather than them have to call you and say I'm sorry, it's the wrong one. It breaks our heart to not be able to help you and to have a substandard sample. We don't want that.
Kelli Maddock :But for people considering a career in lab medicine, it is a really great way to be able to help people and animals of course without actually necessarily interacting with them, and it is still a really fulfilling career path, always something changing. It is really dynamic. We always assume culture is the same as it was 40 years ago. It is very much not. If your laboratory is keeping up with modern practices, it is not the same as it was, however, many years ago. There are some tried and true methods that will never change, but there's always things that can be optimized and I see that all the time in lab medicine.
Kelli Maddock :In the 15 years I've been in the field I'm still blown away by all the changes and things that I never thought would happen in my time. So it's a really great dynamic field and a really good option, and I know our laboratory has hosted veterinarians that just wanted to come through and tour so that'd be something to reach out. If you have a local lab and just see, you might end up finding out that you have interest in lab medicine and maybe it would be a career shift for you. If you're maybe getting burnt out in the clinical practice not that I want to poach any more veterinarians from there, but it is a really great option and, like in our lab lab, we are having to get more creative. We've got to get people to want to come to North Dakota and we've got to fill roles. We're looking at starting a toxicology residency. We've had to raise our own pathologists, so there are a lot of opportunities within laboratories for veterinarians and not veterinarians alike.
Sarah Wright:Yeah, I love our field. I love how diverse the career paths are and you can do so much. I feel like a lot of people go into small, like small medicine I think they're going to anyways and they start med school. Then you come out and use your eyes. There's open to all different possibilities.
Kelli Maddock :So very, very many different things you can dabble in and get into. I had no idea vet med in microbiology was going to be something I'd get into, and it's perfect.
Sarah Wright:Now Kelly, as you know, as a repeat guest on our podcast, this next set of questions is going to be super important for our listeners. So, out of all the amazing articles in this supplemental issue, what is one piece of information the veterinarian should know about diagnostic laboratory medicine in this issue?
Kelli Maddock :Pretty hard, but we want to talk to you and it is really great if you can call and interact and just call ahead before you're getting that sample. And I would also as frustrating as it can be to have someone tell you you've got to recollect a sample take that as just a learning experience and know that it's because they want you to get the best sample, the best result. There is a reason behind the madness in laboratory medicine. We aren't just trying to make your lives harder, we do want to help and I think that shows through in every article in this supplemental issue in garbage out. So yes, that is one of my favorite ways and actually one of the microbiology papers does, I believe, say specifically garbage in, garbage out. There's really great printable sample sheets that you can use to help you collect good microbiology samples too Awesome.
Sarah Wright:Great. And then, on the other side of the relationship, what's one thing that clients should know about this topic?
Kelli Maddock :Yeah, and I think this can be really challenging. I had an email even just last week with a client frustrated that their veterinarian had asked for a culture and we got a no growth, and so I explained to them that no growth is still supporting whatever your veterinarian is trying to rule out with a diagnosis. So, understanding that there is a lot of value in paying that extra money for a laboratory test, whether it's they're asking you to do a culture once you think you have a UTI, there could be other issues that are causing the animal to have urinary symptoms. So really considering that diagnostics can be worth the money. It isn't just a money grab, there is value for it. It's just understanding the context and looking for those results.
Lisa Fortier:Fantastic. We also know Kelly. As we wind down, we like to ask a personal question and before I do that, I'm hoping to meet Kelly in 3D when I go back for a nephew's wedding in July, so hopefully we can have a coffee together and exchange some great horror stories.
Kelli Maddock :Well, that would be great.
Lisa Fortier:Yeah, I'm looking forward to it. So, Kelly and if you have it with you, please feel free to show it what is the oldest or the most interesting item on your desk or in your desk drawer?
Kelli Maddock :Okay, so these have followed me since I finished my internship. But our fantastic microbiologist handmade little clay bacteria. It's a little bit to help us remember things, but also just being silly. They put it on culture loops and gave it like a bouquet of flowers, but a little ring of Streptococcus, just reminding us strep pyogenes. She always personified bacteria, which would really help you remember things. I've got a little staff. Some people would get Campylobacter, which she always described as Farrah Fawcett and with its flagella it was whipping its hair around. So these are on my desk. I always think of Carol when I see them. They always make me happy.
Lisa Fortier:Anthropomorphizing bacterium. That's a new one for me.
Kelli Maddock :Yeah Well, it's something pretty normal for us microbiologists. So good party trick, yep.
Sarah Wright:You so good party, good party trick. Yep, you make microbiology seems so fun. I love that.
Kelli Maddock :It is super fun, there's no question about it Awesome.
Sarah Wright:Well, thank you so much, Kelly. We appreciate you being the guest editor for this supplemental issue and for also sharing with our listeners some insight into what they can expect to gain from the articles.
Kelli Maddock :Awesome, so excited for everyone to check it out. A lot of really great information inside.
Sarah Wright:And to our listeners. You can read the Diagnostic Laboratory Medicine Supplemental Issue in Jafma. I'm Sarah Wright with Lisa Fortier. Be on the lookout for next week's episode and don't forget to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
