The language you fall into the habit of using as a professional becomes commonplace and you sometimes forget how strange it can seem to people not familiar with the lingo. “Unremarkable” is often used to describe labwork at our clinic, and it means normal, or close enough to normal to not be significant. It is most often used for pre-operative bloodwork, which is run within a month prior to each anesthetic procedure. Usually, especially if the patient is a young, healthy animal presenting for their spay or neuter, the bloodwork comes back completely within normal limits (abbreviated at WNL). Sometimes there will be values that are outside of the lab’s normal range, but they are not a concern for a variety of reasons – ie: mildly high glucose in a cat happens because of stress, which often results from traveling to the clinic and having a blood draw. Or, a mildly increased ALP in a young animal, which results from bone growth. These panels get labeled as unremarkable, and recorded as such in the record.
Unremarkable should not be interpreted as an insult! We love to see unremarkable results. Often if there is a remarkable finding, it leads to a heartbreaking end. Such as – the swab taken of a bleeding lesion which had an astonishing number of cells on cytology – an objectively beautiful slide, highly diagnostic, remarkable enough to share with the entire team – and the interpretation is an incurable, metastatic cancer. Or the young dog with oddly elevated kidney values, just mildly at first, but progressive over a few years until she passed of congenital renal dysplasia long before her time. Fascinating cases because they are unusual, but not the outcome any of us want.
Even more rare is the remarkable lab result that turns the case away from a suspected (and dreaded) poor prognosis. Banshee is an older dog who presented for nose bleeds and nasal congestion, chronically. In a senior dog, these cases are often cancer – a tumor growing in the nose that ruptures and bleeds intermittently. Initial labwork ruled out fungal infection. A tissue sample taken from deep within her nose was taken and submitted for pathology review. However, instead of coming back with cancer, the pathologist diagnosed her with a parasitic nasal worm! This is a very rare condition, with few cases reported in the literature. Banshee’s parasites will be difficult to treat, but carry a much better prognosis than cancer. These are the remarkable results that we wish for all of our patients, if they do not have the luck to be unremarkable.
– Dr Ema Thigpin