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Individualized Approach

Encourage clients to acclimate dogs to safe travel prior to the veterinary visit. Require all clients to restrain dogs on a leash or in a carrier upon entering the practice. Arrange the reception entrance to be dog friendly, and to allow clients to minimize encounters with other pets.
 

Plan appointments to minimize wait and create a quiet, calm environment. Create a strategy to manage timid and fearful dogs to reduce the stress for the patient, the client, and the veterinary team.

Train the veterinary team in low-stress handling techniques. As appropriate, use positive reinforcement (e.g., treats or toys) and minimize distractions. Use quiet, calm body language and a calm voice.6 Pheromones may be helpful for their potential calming effect.7,8 Providing sedation or antianxiety medication for the patient may be appropriate to reduce patient stress and fear, and to provide safety for the veterinary team.9 Consider sending the patient and client home if undue stress or fear results. Reschedule the exam for another time, and provide positive reinforcement techniques instead of the exam.

Use relationship-centered client communication to establish trust. Recognize that the client, as the caregiver and final decision maker, is the most important member of the healthcare team. Clients provide important information regarding the pet’s condition and frequently do the bulk of the work involved in performing prescribed care. Communication with empathy, reflective listening, and attention to body language improves the ability to gain relevant information, increases agreement to treatment plans, and improves outcomes in patient care, clinician effectiveness, and client satisfaction.10,11

In addition to standard body systems review, a thorough history includes asking about the items listed in Table 2, including the daily routine and using open-ended questioning techniques when appropriate. Inquire about behavioral, physical, or other changes since the last visit.

Include a veterinary exam and consultation at each of the routine puppy visits as well as prior to the spay/neuter surgery. Provide a wellness exam and consultation for adult dogs at least annually.12 Consider semiannual wellness exams because a dog’s health status may change in a short period of time. Pets age faster than humans and many medical conditions are not associated with clinical signs; therefore, earlier detection of items such as body weight changes, dental disease, and other concerns allows for earlier intervention. In addition, semiannual exams may allow for more frequent communication with the owner regarding behavior and preventive healthcare. Consider more frequent examinations especially for mature, senior, and geriatric dogs.

Perform a thorough exam including the five vital signs (temperature, pulse, respiration, pain, and nutritional assessment) as well as the items listed in Table 2.13 When possible, use a defined scoring system (e.g., body condition score, muscle condition score).13–18 The exam may also include the following: pain score; heart murmur grade; gait analysis; body mapping for skin masses and skin lesions; evaluation for breed-specific risks; and laboratory testing and/or imaging as appropriate for breed, age, and individual circumstances.19,21,23

TABLE 1: PROPOSED DEFINITION OF LIFE STAGES

 
Stage Definition
Puppy Neonate until reproductive maturity
Junior Reproductively mature, still growing
Adult Finished growing, structurally and socially mature
Mature From middle up to approximately the last 25% of expected lifespan (a window of time around half life expectancy for breed)
Senior From maturity to life expectancy (approximately the last 25% of expected lifespan)*
Geriatric At life expectancy and beyond

*See section in text titled “Individualized Approach to the Veterinary Visit.” Conduct testing based on signalment and findings on physical exam and in history.

Routine tests such as the minimum database (Table 3) may be helpful for the wellness evaluation of any age dog, but are particularly important for the mature, senior, and geriatric patient, allowing early dedtection of disease or trends in clinical or laboratory parameters that may be of concern.4 Performed early in life, these tests may also provide a baseline for interpretation of data obtained at subsequent visits and may establish trends that would be more specific to the individual patient than cumulative laboratory data from many individuals.

Table 3 shows a “±” sign for many tests because there is limited evidence about exactly when to begin testing for each item.5,24–27 Create individualized recommendations based on current evidence, clinical experience, and the dog’s specific breed and circumstances. Individualize the approach for each dog to ensure an effective plan for early disease detection and to maintain optimum health.

There are several hundred distinct canine breeds and many more mixed-breed dogs, each with different genetics and diverse lifestyles.28,29 At least two-thirds of dog breeds have at least one recognized genetic disorder.30 Various resources describe breed-specific normal values and disease predispositions. Understanding these can help guide decisions for testing.31–37 Be aware of whether your diagnostic laboratory includes information about specific breed variations of “normal values.” DNA testing in mixed-breed dogs may offer information to the veterinarian to be watchful for specific breed behavior tendencies or health concerns (e.g., orthopedic, cardiac, ophthalmologic, or drug sensitivity).

There are too many examples to list them all here; however, one example of a breed-specific test would be performing a urine protein-to-creatinine ratio in breeds predisposed to glomerulopathy.38 As other examples, blood pressure measurement or thyroid disease screening may be part of a wellness exam if the breed (or other findings) warrants monitoring these parameters.39 Measurement of blood pressure is discussed in detail elsewhere.40 Thyroid disease screening is also described in many texts.41

Work closely with clients who are involved with breeding programs. Promote responsible breeding practices, and encourage collaboration among breed associations, dog breeders, and university-based canine research programs. Using the current references on breed-specific disorders can reduce perpetuation of disease and promote wellness through careful selection of individuals used for breeding programs. See the current position statements of the AVMA and AAHA regarding procedures such as ear cropping, tail docking, dewclaw removal, and ownership of wolf-dog hybrids.

TABLE 3: MINIMUM DATABASE BY AGE GROUP FOR THE APPARENTLY HEALTHY ANIMAL*

 
Conduct testing based on signalment and findings in physical exam and history PUPPY JUNIOR ADULT MATURE SENIOR GERIATRIC
Fecal Floatation       +    
Arthropod-borne disease (e.g., Rickettsia, Lyme)       +/–    
Heartworm screening per AHS/CAPC (at least annually, and always post-adoption)         +  
CBC (hematocrit, RBC, WBC, differential, cytology, platelets)   +/–     +  
Chemistry screen
At a minimum, include TP, albumin, globulin, ALP, ALT, glucose, BUN, Bilirubin, Creatinine, K+, Phos, Na+, Ca+
  +/–     +  
Urinalysis (Specific gravity, sediment, glucose, ketones, bilirubin, protein, occult blood)   +/–     +  
*See text: “Individualized approach.”

Working and service dogs not only provide companionship, but also important service roles. These dogs must maintain optimum health and specific physical abilities to be available to perform or provide their special use or assistance.42–44 Clients with these high-performing dogs may opt for more frequent evaluations or specific preventive care.45 For optimizing wellness in these valuable service animals, it is vital to share the latest knowledge available.

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