Pet-Specific Care for the Veterinary Team. Группа авторов
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How Common Is It?
In other words, what is the likely prevalence of each risk?
1 Most common
2 Somewhat common
3 Not very common
Sometimes this is easy to determine, but what is statistically likely in one patient may be uncommon in another. Common causes of death or injury in an indoor and an outdoor cat, for example, are completely different. You need to have a signalment, history and background information on a patient, as well as exam findings, to judge risk accurately. The answers to these questions will often determine how likely certain diseases are, what level of understanding the pet's guardian has about care for the pet, and in what direction you need to steer your healthcare plan.
When did the owner acquire the pet and from whom?
Where does the pet go and what does it do?
What does it eat and how much?
What type of care does the pet get at home? Does the owner brush its teeth? Clean its ears? Administer preventive medications regularly and on time?
Some diseases are high risk for a great many dogs and cats. Universal or high‐risk conditions for most pets would include:
dental disease – 80% of pets over age 3 years
obesity – over 50% and climbing every year
risk due to age – a small percentage of young apparently healthy patients will have a disease diagnosed on screening bloodwork whereas a significantly larger percentage of those of senior age will do so. Risks for cancer, heart disease, endocrine disorders, and metabolic problems increase with time. Furthermore, almost all pets will eventually develop arthritis if they live long enough.
With species and breed come other lists of disorders that need to be ranked as common or uncommon, including genetically related diseases. For example, the risk for cardiac issues in a Cavalier King Charles spaniel is virtually 100% if they live long enough, and gastric dilation‐volvulus (GDV) risk is significantly higher in Great Danes than shih tzus.
Moderate‐risk conditions would include orthopedic disorders such as cranial cruciate ligament disease, hip dysplasia or medial patellar luxation, and many ear, eye or skin problems, among others. The actual amount of risk will vary greatly from patient to patient, depending on age, breed, lifestyle, and many other factors. Diabetes mellitus, for example, is a high‐risk disease in an obese cat eating a high‐carbohydrate diet but a lower risk in a normal‐weight cat eating a low‐carb diet.
Low‐risk conditions include many rare genetic disorders or cancers that we barely even consider when diagnosing or screening for diseases. Yet, for an individual patient the rare condition may turn out to be pertinent and worth considering or talking about. Uncommon in a Labrador retriever may be common in a toy poodle or vice versa. A disease uncommon in your part of the country may be much more likely if your patient was recently living or traveling somewhere else. There is no list of common or uncommon conditions that applies to everyone (see Recommended Reading for tools that can be useful in determining how common risks are for particular patients).
When teaching clients about pet healthcare or offering screening tests, another set of criteria comes into play.
2.7.5 How Serious Is the Problem?
The second way to prioritize risk is by seriousness of problem – a higher risk for death or illness.
1 Diseases and problems that could be fatal.
2 Diseases or problems which could cause pain, suffering or chronic damage.
3 Diseases or problems that could cause inconvenience or mild illness.
Gastric dilation‐volvulus is not common except in certain breeds but it can be quickly deadly in affected individuals. Glaucoma is not a common condition in many breeds, but it is extremely painful. Any risk at all for a painful or deadly disease may justify a discussion with a client about signs to watch for and when to call a veterinarian.
Genetic forms of alopecia, on the other hand, cause no pain or suffering for the pet (though they may be extremely distressing to a pet owner) so they may not be on a top 10 list of most important client education topics.
2.7.6 How Diagnosable Is the Problem?
Is there an inexpensive, readily available test to diagnose or screen for the disease? Keratoconjunctivitis sicca (KCS) is not extremely common but it is very inexpensive and easy to screen for, so making a Schirmer tear test (STT) part of a regular screening program would be a sensible thing to do. Offering an echocardiogram to screen for cardiomyopathy for every senior cat, on the other hand, would probably not be sensible, due to high price and low availability, even though hypertrophic cardiomyopathy (HCM) is a relatively common disease in cats. Here is a link to a client education video on screening eye tests for dogs: www.youtube.com/watch?v=d_RGk2UEdgs.
2.7.7 How Preventable Is the Problem?
If prevention is easy, or the disease or problem is serious or deadly, why not prevent it? The odds of any one particular suburban dog contracting canine parvovirus or a cat in Alaska coming down with heartworm disease are low but vaccination and parasite prevention are still widely recommended. Stomach tacking (gastropexy) may be a very reasonable thing to recommend at the time of spaying for a large‐breed dog, even though the odds of most dogs suffering a GDV are low, because the disease is both deadly and preventable. Even if a client declines the stomach tack surgery, we can still teach them what the clinical signs are and why pet health insurance (see 10.16 Pet Health Insurance) might be a good idea. Here is a link to a client education video on GDV: www.youtube.com/watch?v=CrX2BJ7EI‐o.
2.7.8 How Treatable Is the Problem?
Many of the diseases we screen for are easy to treat once we have diagnosed them. Hypothyroidism in dogs and hyperthyroidism in cats would be easy examples. Meningiomas in elderly cats, on the other hand, are very common but not only does diagnosis require a magnetic resonance imaging (MRI), most meningiomas do not cause any clinical signs and would not need treatment. Even if a less expensive test were available, such as a meningioma chemical marker in serum, it might never become part of our standard senior screening, since it is unlikely it would change how we care for the cat.
2.7.9 Refining Risk Assessment
Although it is possible to create complex algorithms factoring in all these criteria, our own brains do much of this automatically. We know that we should be talking to every puppy and kitten owner about vaccinations, parasite control, nutrition, behavior, reproductive control, and zoonoses. We do not think much about nor mention rare recessive genetic conditions because we know we are unlikely to encounter them.
Clients, on the other hand, are by‐and‐large unable to accurately factor risks for their pets. They do not have enough information about the likelihood of each risk, plus many of the risks we would know about, such as blastomycosis or ehrlichiosis, are completely unfamiliar to a client. This is one of the reasons why clients researching their pets' clinical signs on the internet are so frustrating for us. They come up with diagnoses that are extremely unlikely and then may worry unnecessarily, try the wrong home remedy or get upset when we don't think it necessary to test for that disease.
Risk assessment is also difficult for recent veterinary school graduates. It is easy to get lost in the weeds of a long list of rule‐outs. Even for wellness visits, a new graduate may struggle to prioritize. If one has not encountered a puppy of a specific breed before, one may be unsure of what breed‐related