Wellness testing debate

I disagree that wellness testing is not a part of human medicine. I go to my "Well Woman" exam every year.  They check blood tests and other things that have been identified as statiscal likelihoods for my age and gender. Mammograms, PSA, blood pressure testing-all wellness screenings.  We, as veterinarinarians, check things that are statistical likelihoods in our patients as well.  I do not think it is fair to imply that we are attempting to deceive our clients by recommending unnecessary testing.

Wellness testing used appropriately is very important. Dr. Robbins sites the German study that suggests less than 6% of  surgery cases have an alteration in protocol due to pre-screening tests.  That is great if you are an epidemiologist or doing herd health - but for pet owners, each case is unique and special to them. If something is wrong or goes wrong it isn't  "just 6%", it is 100%.  If you can predict and tell us which ones will be that 6% without screening - please point the way! The recent (2010) US health studies on breast cancer screens say that  early screening  helps just a small percent of women ( but a total number still well into the tens of thousands of individuals) suffers from the same epidemiological blindness.  If it is you or your family it is 100% and you will not be  very comforted to know that you child was not tested for hypertrophic cardiomyopathy and died from it, because it just isn't all that common for a teenager who appears healthy to suddenly drop dead from it.

Daily we promote the idea that an once of prevention is worth a pound of cure.  Canine Distemper is not all that common in most urban US locations, and yet we vaccinate when incidence is quite low. The same for Rabies in dogs and cats. If body count is your criteria of significance, there are a large number of health and safety tests, regulations and such that can be disposed of until there is a high enough level to justify the expense (again).

The logic fits but do the results?

Logically one might interpret a graph at one year intervals indicating mild upward changes significant.

In addition to the graph however, one must take into account the age of this particular case. Unfortunately we see fewer pets on a regular basis, in today's economy therefore, taking a history every six months ( about a 4% interval in an average pet's life of 12 years seen every six months) compared to the 'annual' examination , an interval of 8% of a pet's life.

Would one necessarily consider a gradual rise in creatinine without concurrent disease siginificant and if so what is one going to do about it. For 4 to 6 years of a pet's life one may see gradual changes in kidney function or liver function but are we going to change the aging process? Not likely. If there is underlying disease not related to aging we may have a more significant chance of changing a pet's life expectancy. What we have all seen overlooked is the same thing we see overlooked on the human side of medicine. Weight, exercise and life style issues, along with secondary smoke, inappropriate diet because an owner can't help himself maintain conditioning nor can he help his pet in the same way. We have, in the veterinary profession, 'excused' the client, found it uncomfortable to talk to a client who takes up a four foot wide bench about his 12 inch tall, 14 inch wide Yorky that is four years old, smells like a smoking parlor, and eats McDonalds Supersized Number four for dinner every evening, then gets a scoop of Blue Bell ice cream before bedtime.

Is preanesthetic or wellness testing a good idea? Do you cough from the dog or cat's odor of cigarette smoke everytime it comes in to be examined?

Take a look at the discussions which have occurred on VIN over the past 6 to ten years regarding the testing we 'insist' on doing. Use the same common sense in testing which you now (hopefully) use in vaccinination regiments. Did you ever tell a client the truth about vaccinations relative to the way the veterinary profession used to drive people into the clinic? Did you ever consider that once immunity is establshed, subsequent exposure to the 'real' disease enhances the resistance naturally. Unless you are going overseas on a regular basis are you getting polio vaccinations every year? Do we have annual "blood work" done on our children....? As we age in may be beneficial to have more frequent evaluation. On the other hand, most humans seek medical attention when there is disease. On the other hand.. few of our pets can talk. Those that do mimic us. Those that don't, in the care of an alert loving owner ( which all animal caretakes are... .right? ) will benefit from the owner's perspective of it's well being.

What about creatinine? In a 14 year, above average for a pet whose owner has consistently rejected dental care and a veterinarian who consistently rejects the idea on the pretense that annual anesthetic exposures are more harmful than letting the gingivitis lead to periodontal disease.... what about this owner? What about the human doctor who would insist that boarding and grooming in the hospital setting, allowing the dog with parvo, the dog with distemper, the dog with lepto, walk in the same door and down the same hallway to boarding that leads to the treatment area, to the exam rooms .... what about all that.......?  What did you say about preanesthetic and wellness blood panels and cbc? Incidently, did you do a blood smear on every automated blood count panel you ran last week?

Best wishes.

I enjoyed reading the articles from both sides of the debate. Wellness testing definitely has its place in veterinary medicine but there are a couple of questions that leap to my mind. 

Firstly, at what age do we start wellness testing? 1yr, 5yr, 10yrs? I do query whether we are using the clients money wisely by performing preanesthetic bloods on a clinically healthy young animal. Looking for trends is great but as a previous poster noted - at what stage should we intervene and reccomend further diagnostics or medical treatment? Many of my clients want the best for their pets but they are not able to afford expensive tests. Should I still push for these wellness tests on the off chance that I may uncover an illness? 

What should a wellness test consist of? Preanesthetic bloods, FBE, urinalysis, faecal exam, blood pressure measurement? The list could go on and on and we could justify a reason for each of them. I feel the most important thing in an annual health check is to get a thorough history and do a thorough clinical exam. If any tests come back as abnormal we need to see how this fits in with the rest of the exam and not leap to any conclusions. Rather than recommending further expensive work up, it may be more prudent to repeat tests a few weeks later to see if values have changed or if the patient has developed any symptoms.

In my opinion wellness testing is one of the most important tools that veterinarians can use to help keep pets as healthy as possible. Here wellness testing is done on pets who do not appear to be ill. One may ask why tests should be run on animals who are not showing any signs of illness. The reason is that pets cannot tell us when there is a problem and many illnesses can be "silent" in the early stages. One good example of this is the fact that at least 75% of a pet's kidney function must be lost before there will be obvious changes in his or her appearance, habits, and behavior.

With the help of wellness many animals are diagnosed with internal health problems before their owners knew anything was wrong. The main goal of wellness testing is to diagnose illness in the early stages when treatments are most likely to be effective. In many cases by the time a pet is showing obvious signs of a problem the opportunity for a cure or to prevent permanent damage has passed. Another goal of wellness testing is to establish normal baseline test values in healthy animals. Monitoring changes in test results from year to year is another way that we can detect very early changes.

So doing a wellness testing on animals is an important practice which every pet owner should do for the long life and good health of their pet.