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Training Module 1<br />Fecal Flotation<br />By Jacquelyn H. Burns, DVM<br />Copyright Jacquelyn H. Burns 2011<br />

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Fecal Flotation<br />THE most important laboratory test in veterinary medicine<br />

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What Exactly Does a “Fecal” test for?<br />Parasite ova (eggs) are detected by the fecal<br />The feces is mixed in a salt or sugar solution<br />The eggs are lightweight and the solution is supersaturated (heavy), so the eggs “float” to the top<br />The ova cling to the coverslip that is on the meniscus<br />The coverslip is put on a slide and a tech or the vet read the slide under a microscope<br />

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Why do we do it?<br />Fecal flotations detect<br />Roundworms<br />Hookworms<br />Whipworms<br />Coccidia<br />Sometimes tapeworms<br />Sometimes lungworms<br />Fecal flotations do not always detect:<br />Tapeworms<br />Whipworms<br />Immature roundworms and hookworms<br />Giardia, Trichomonas, Spirochete bacteria<br />Fecal flotations never detect:<br />Heartworms. They require a blood test<br />

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So why do we want a fecal on all first puppy & kitten visits when it is standard for us to give Pyrantel Pamoate (“Strongid”)?<br />“Strongid” is a great product for mild to moderate cases of hookworms and roundworms!<br />The vet wants to screen for Coccidia, which require an additional medicine, Albon, for 10 days<br />The vet wants to see relative numbers of parasite ova<br />Heavier infestations of hookworms may be better treated with Panacur daily for 3 days.<br />If tapeworms are seen, the vet will likely choose Virbantel for puppies or Drontal for kittens<br />

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Some Vets Don’t Do It!<br />At some vet hospitals, they don’t routinely check fecals, they just deworm routinely with a general purpose dewormer<br />We think they risk missing some things or risk failing to assess how serious the situation is!<br />

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It’s VERY important<br />Example: Last week we saw a first puppy visit from a breeder. The breeder paperwork gave 7 dates the puppy had been dewormed with Pyrantel Pamoate, basically once a week from the time it was two weeks old. Guess what? It still had hookworms! <br />In a case like this, the vet is very likely to choose a different deworming strategy for this puppy and to explain worm life cycles to the client<br />

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Some vets do an even more accurate version of the fecal<br />Fecal centrifugation test <br />Feces is mixed in a fecal solution and put in a centrifuge and spun for a certain amount of time before the cover slip is put on and the sample is read<br />It is more accurate—especially with regard to whipworms<br />Worm ova rise to the top from both the spinning and the concentration of the solution<br />

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We routinely check fecals on many different types of patients<br />Sick adult pets <br />Vomiting<br />Diarrhea<br />Vague symptoms or no identified symptoms, especially dogs that are not on heartworm preventative<br />Typically, we would not do a fecal on a pet presented for a respiratory complaint such as coughing or sneezing, skin or ear problems and injuries<br />Annual Wellness Checks<br />All puppy and kitten visits, whether sick or wellness<br />All initial visits for Strays—they almost always have worms<br />

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Ask owner if they brought a fecal specimen<br />Ask early in the visit so that the fecal may be running while you are doing other things to prepare the patient<br />“Mrs. Smith, did you bring a fecal specimen from Fluffy today?”<br />Ask this question even if you know Mrs. Smith brought a specimen. Why? Because saying it reinforces in the clients the importance of bringing the specimen<br />It’s also a good idea to ask the owner if they’ve seen any worms. Sometimes they may have seen tapeworms, and our specimen may read negative for them.<br />

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Obtaining the Fecal Specimen<br />Presented by owner<br />Collected from floor or yard here<br />Obtained by probing the patient<br />Calm, easygoing patient, may be done without restraint or minimal restraint<br />More energetic patient, a second person is needed to restrain the pet<br />Fractious patient – may ask owner to bring specimen back <br />Best if they pre-pay to assure that they comply<br />

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Patients that should not be probed<br />Manx cats and kittens—NEVER PROBE A MANX<br />Pets where the presenting complaint <br />is rectal pain.<br />Pets with rectal trauma<br />Pets with rectal swellings or sores<br />Pets with rectums that are scalded from diarrhea<br />Pets with rectal foreign bodies<br />Pets with rectal tumors<br />

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Rare Patients that we Probe Last<br />Patients known to become very agitated when their temperature is taken, tail is handled or fecal probing is done<br />We do everything else to these patients and take the fecal specimen last<br />That way, the easy things are done first and the thing most likely to make the patient angry is done last.<br />

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We don’t want to probe any patients if we don’t have to!<br />We are trying to train our clients to bring specimens<br />All pets poop, usually more than once a day<br />Some Clients don’t see where they poop<br />Probing is uncomfortable for many patients. <br />Probing is unpredictable—sometimes patients are “empty” and we don’t get our specimen<br />Probing a resisting patient risks injury to the patient as well as veterinary assistant/techs and even the owner if they won’t stay out of the way.<br />

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To probe<br />Explain to owner what you are doing and that it may be a little bit uncomfortable<br />Some owners actually may prefer to bring a specimen back later<br />Lubricate the probe with K-Y jelly<br />Lift the tail partially and gently insert the probe as far as needed to obtain feces<br />Stop if you meet resistance or if the patient becomes agitated!<br />Sometimes gently rotating the probe helps<br />

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Fecal Probes and K-Y Jelly<br />

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Before Setting Up<br />Observe the specimen!!!<br />Note<br />Color<br />Blood=bright blood originates in the colon<br />Melena (blackish)= digested blood originates upper small intestine or stomach<br />Dyes from pet food<br />Texture<br />Soft, Loose, Cow patty, watery. mucousy<br />Odor<br />Blood in a stool, even if not visible, has a distinctive odor<br />Foreign objects<br />Yarn, cloth, plastic, bits of bone, etc.<br />Parasites such as tapeworm segments<br />

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Scant?<br />In our clinic, we note on the record if the fecal quantity is “scant” meaning very little feces was obtained/available for testing<br />Fecal flotations are most reliable on quantities of 1 gram of feces<br />Smaller amounts are usually tested: <br />If positive, we know we have parasites<br />If negative, we still could have parasites<br />

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Fecal Flotation Solution<br />Our laboratory dispensing bottle, left, is unlabeled. Labels won’t adhere to it and Sharpie ink won’t stay on. It is the only one we use here, so there’s no confusion.<br />The 1 gallon refill bottle, right, stays in the cabinet under the sink in the laboratory.<br />

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Setting up in test tube<br />Fill the test tube halfway with Fecasol (aka Fecamix)<br />Dip the feces-containing end of the probe into the test tube and agitate it to mix the feces into the Fecasol solution<br />Finish filling the tube with Fecasol until it is brimming but almost overflowing. The rounded surface of the liquid is called the meniscus<br />Place a single cover slip on top of the meniscus<br />Set timer for 5 to 10 minutes<br />The vet or a trained tech will read the test<br />

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Setting up the fecal in a test tube<br /><ul><li>Fill test tube half full with fecasol

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Insert the end of the fecal probe containing feces

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Agitate the tube up and down to loosen the feces into the solution (rare specimens may need to be picked out with the end of a cotton-tipped applicator)

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Take out the fecal probe and finish filling the tube to create a meniscus

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Sit a cover slip on the meniscus

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Set the timer for 5 minutes</li></li></ul><li>Set timer for 5 minutes<br />

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Glass Slides and Cover Slips <br />

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Fecalyzer<br />A container given to clients to bring fecal specimens in<br />Fecals may be set up in the Fecalyzer:<br />Fill Fecalyzer partway with Fecasol<br />Agitate the inner greenish part<br />Finish filling to a meniscus with Fecasol<br />Set a cover glass on top<br />Set timer for 5 minutes<br />

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Fecal in test tube<br />Fecal in Fecalyzer<br />

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So what do those + signs mean?<br />You may see it noted in the record here as Rounds +, Hooks +++<br />Many things in veterinary medicine are assigned a semi-quantitative assessment on a scale of 1 to 4<br />+ or +1 means very few ova seen<br />++ or +2 means a moderate number of ova seen<br />+++ or +3 means a lot of ova seen<br />++++ or +4 means that the slide is loaded with ova<br />So a pet with +1 or +2 is very likely to get a routine dewormer such as Pyrantel Pamoate and a pet with +4 is likely to get a more aggressive deworming strategy such as Panacur daily for 3 days.<br />

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What does AOTBF mean?<br />You may see this abbreviation on a chart or on the appointment screen at our hospital<br />It means Asked Owner To Bring Fecal<br />Often owners forget, but sometimes they will tell you that nobody asked them to bring a fecal<br />Often the person bringing the pet in is not the person who called and was told to bring a specimen<br />Some owners are just plain lazy; some are squeamish<br />They should be gently reminded to bring a fecal, but don’t make them feel like a criminal if they forget<br />DNAOTBF means Did Not Ask Owner To Bring Fecal<br />

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For next time…<br />Puppy and kitten owners need to be given a fecal container for their next visit<br />Again, reinforces the need to bring one<br />Fecals may be submitted in non-official containers<br />Aluminum foil, baggies, paper cups, tupperwares<br />Fecals should be relatively fresh<br />OK if they have some cat litter on them but if the specimen is covered it litter and has been for several hours, it may be desiccated and too dry to use<br />

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Direct Fecal Smears<br />To look for motile one-celled parasites and bacteria<br />Giardia<br />Trichomonas<br />Spirochete bacteria<br />Done on many pets from “puppy mills” <br />Jockey Lot or swap meet<br />Breeders<br />Pet stores<br />Rescues and shelters<br />A very small amount of feces is smeared onto a glass slide<br />Add a drop of tap water and mix into the feces to make it watery<br />Top with a cover slip<br />The cover slip should easily be flattened out over the sample<br />If not, there is too much feces under it!<br />

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Other Tests Using Feces<br />Parvo Elisa Test - 10 minute test run here<br />Giardia Elisa Test – 10 minute test sometimes run here (alternative is to send out the test to the lab)<br />Tests sent to Antech Laboratories<br />Fecal Centrifugation tests<br />Parasite identification<br />Diarrhea Panels<br />PCR test = a DNA type test for multiple agents such as bacteria, one-celled parasites<br />Require a Copan swab and at least a gram of fresh feces<br />

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Tests we vets don’t often run on feces<br />Trypsin digestion tests<br />Tests for Exocrine Pancreatic Insufficiency<br />No longer used because TLI blood tests are easier and more accurate<br />Fecal Occult Blood<br />A common test in humans to screen for colon polyps and cancer<br />Not accurate in our patients because they are carnivores<br />

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Our Deworming Products<br />For Coccidia—we have Albon.<br />For Giardia—we have Metronidazole and Panacur. <br />Combination heartworm products also deworm for hookworms and roundworms. Advantage Multi and Tri-heart Plus do this<br />Interceptor and Trifexis deworm for hookworms, roundworms and whipworms<br />

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Quiz:<br />Fecal flotation solution is <br />Kept under the surgery prep sink<br />A concentrated salt solution<br />A flaky mess to deal with<br />Also used as heartworm test buffer<br />If Mrs. Smith consistently forgets to bring a specimen from Chloe, you should:<br />Make her feel like a criminal<br />Ream Chloe with the probe to make her scream so Mrs. Smith will feel guilty<br />Gently remind her to bring a specimen each visit<br />Ask her to bring back a specimen<br />C & D<br />

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Quiz…continued<br />We test all new puppies and kittens because<br />It makes us more money<br />The breeders lie about deworming the puppies they sell<br />We don’t want to miss Coccidia<br />We don’t want to misjudge the severity of the infestation<br />C & D<br />A meniscus is<br />A pad of cartilage in the stifle<br />A device for collecting a fecal specimen<br />The rounded surface of the fecasol in a properly filled test tube<br />A device for measuring the number of ova on a slide<br />

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Quiz…continued<br />Which of the following is not a type of fecal test?<br />Fecal Centrifugation<br />TLI<br />Direct fecal smear<br />Giardia ELISA test<br />++++Hooks, + Rounds on a fecal test result means:<br />No worms seen<br />Heavy roundworm infestation, light hookworm infestation<br />Heavy hookworm ova, light roundworm ova<br />Specimen was too scant to evaluate<br />

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Quiz, continued<br />The fecal flotation detects<br />Adult worms<br />A protein secreted by adult female worms<br />Worm larva<br />Worm ova<br />The fecal flotation always detects<br />Adult Hookworms<br />Tapeworms<br />Whipworms<br />B & C<br />None of the above<br />

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Fecals should be done on all except<br />All sick pets<br />All puppy and kitten visits<br />Annual wellness checks<br />B & C<br />Sneezing cats<br />Quiz…continued<br />Which pets should never be probed?<br />English bulldogs<br />Calico Cats<br />Boxers<br />Manx cats<br />Dogs with rectal trauma<br />D & E<br />

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Slide presentation courtesy of:<br />Jacquelyn H. Burns, DVM<br />Holmes Veterinary Hospital <br /> 1001 Church Street Laurens, SC 29360<br />www.holmesvethospital.com<br /> (864) 984-2365<br />Copyright © Jacquelyn H. Burns 2011<br />