Pet-Specific Care for the Veterinary Team. Группа авторов
Читать онлайн книгу.
rel="nofollow" href="#ub18f84a1-42c0-5896-8d82-bbc9dd8d5149">11.5 Life Planning by Breed). Cats tend to be of more uniform size, so more generalizations can be made based on life stages alone.
Without genetic testing, a personalized care plan will start out with just basic recommendations relevant to all members of a species within the practice locale, as well as predispositions that can be inferred based on breed, conformation, lifestyle, etc. Superimposed on that will be information from health risk assessment (see 2.7 Risk Assessment), which might include pertinent risks on the basis of exposure (travel, boarding, grooming, activities, etc.) and history (preexisting issues detected that could lead to other co‐morbidities in the future). Even without genetic testing, a certain amount of risk information can be inferred on the basis of breed predisposition (see 11.4 Heritable Health Conditions – By Breed). Even in a mixed‐breed, if likely breed composition can be determined, potential genetic risks can be predicted, and certain early detection screening can be added to the personalized care plan. In general, there are also likely to be nutritional recommendations made specific to each pet (see 9.15 Nutritional Counseling).
It's important to remember that while genetic testing provides some objective criteria on which to base further diagnostic recommendations, it is possible to build personalized care plans just from information available based on history, physical examination, signalment, and risk assessment. That alone could prompt recommendations that could populate a personalized care plan (Table 1.3.2, Figure 1.3.1).
Table 1.3.2 Further testing that might be indicated based on perceived risk
| Disorder | Testing indicated |
|---|---|
| Oral care | Periodic periodontal score; radiography; charting; occlusion assessment |
| Orthopedic conditions (hip dysplasia, etc.) | Radiography; distraction; palpation; gait assessment |
| Infectious diseases; parasitism | Heartworm testing, fecal assessment, antigen testing, titers |
| Clotting abnormalities | Buccal mucosal bleeding time, DNA testing (vWD, hemophilia, etc.), activated coagulation time, prothrombin time, activated partial thromboplastin time, thrombin time, clotting factors |
| Baseline values | Periodic hemograms, biochemistries, urinalysis |
| Hypothyroidism | Thyroid profile (e.g., cTSH, free and total T4, T3, autoantibodies, etc.) |
| Glaucoma | DNA testing (some breeds); periodic intraocular pressure determination |
| Keratoconjunctivitis sicca | Schirmer tear test |
| Progressive retinal atrophy | DNA testing (some breeds), electroretinogram, indirect ophthalmoscopy |
| Kidney disease | DNA testing (polycystic kidney disease, hereditary nephropathy, etc.), urinalysis, urea, creatinine, SDMA, imaging, etc. |
| Urolithiasis | Periodic urinalysis; DNA testing (e.g., cystinuria 2,8‐dihydroxyadenine, etc.) |
| Heart disease | DNA testing (some breeds), electrocardiogram, Holter monitoring, wearable technology, biomarkers (troponin 1, NT‐ProBNP, etc.) |
| Hypertension | Periodic blood pressure determination |
| Adverse drug reactions | DNA testing (e.g., mdr1, malignant hyperthermia, etc.) |
| Inflammation | Biomarkers (C‐reactive protein, serum amyloid A, homocysteine[?], etc.) |
| Senior status | Age‐specific screening (laboratory, imaging, cardiac assessment, etc.) |
NT‐ProBNP, N terminal pro B‐type natriuretic peptide; TSH, thyroid‐stimulating hormone.
Figure 1.3.1 Example of a personalized care plan.
While veterinary teams want to provide the right recommendations to pet owners, it is very difficult to accomplish this without having a plan in place to match risk to action items (see 9.7 Continuum of Care and Convergence Schedules).
Rocky Goodwin is a young Doberman pinscher and his owners would like to plan for his anticipated healthcare needs. As part of your assessment, you create a personalized pet care profile for Rocky. The owners are impressed but also a bit worried, because there seems to be a lot that could go wrong with Rocky that they had not considered.
You explain that most of the issues are fairly routine and common for all pets, such as parasite control and vaccinations, but that each pet does carry some unique risks for health issues, and that the best way to deal with these is to diagnose them as early as possible, when there is the best chance for effective management. The owners consent to a lifetime of optimal care for their pet, and decide that pet health insurance is a good mechanism for managing some of their concerns regarding the costs of Rocky's healthcare (see 10.16 Pet Health Insurance).
A personalized pet care plan or profile is just a maintenance schedule of anticipated care expected for a pet over its lifetime.
Other than routine preventive care, early detection screening is added to the plan based on risk factors specific to the individual pet.
The care plan should be dynamic and will be altered as new medical findings (including medication monitoring) are added to the schedule.
The pet care plan can act as a sort of user's manual, alerting the pet owner to care anticipated for a pet over its lifetime.
Genetic screening during puppy and kitten visits can help inform both veterinary teams and pet owners about additional testing to be considered in a pet's future.
1.3.9 Cautions
No matter how vigilant we are, it is impossible to identify all risk factors for an animal, and it is important not to misrepresent this