I am a pet owner and I generally avail myself of wellness testing/ro
I agree that watching for "trends" that may show signs of trouble, or change, is a benefit of regular labwork, BUT I wonder how many vets are actually reviewing pets records for such trends, rather than looking at tests in isolation.
It is one thing to observe that regular testing allows such trend analysis. But that doesn't mean that is a rationale for routine testing if the vet is not going to bother looking for trends. Someone needs to be doing that.
My current vets do look at prior lab values but I believe they may be an exception.
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
I applaud Dr. Robbins for taking a stand on wellness testing. It is about time that someone took a critical look at wellness testing in veterinary
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).
I have to agree with the previous poster.
It is like I tell our clients, "99% of the time we don't experience a complication. The tragedy is when that 1% of the time we do, it happens to your pet. In order to help make sure your pet doesn't fall into that 1% catagory, we'd like to perform....[insert wellness, pre-op, diagnostic screening...here]."
Never fails to hook a client every time.
Does evey test need to be done on every patient all the time...that is where consultation and a patient-doctor-client relationship does a risk assessment and tailors the services performed to the needs of the pet. This relationship is very undervalued by both the veterinarian and the client.
And yeah, I have to agree, defensive medicine is a good enough reason for me. 99 of our clients might not care that we didn't do an early renal screening on their pet, and the patient may not need it. But it is that 1 client who ends up in emergency because of end-stage renal disease with their pet, and is then asking us, "Why didn't you pick-up on this earlier!? How come it wasn't diagnosed sooner!?" That one client can make or break a practice's spirit and moral. At least, if the screening is offered and the client is educated, the client can make an informed decision to proceed with the screening or to decline it.
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?
Edited by grouchievet, 2 years ago
I was not going to chime in because this is a pretty hopping discussion, and I agree with all those in favor of routine wellness testing (I have been trained to look for a "like" button :))
Dr. Huston wrote a good blog post about the importance of wellness testing on her website: http://pet-health-care-gazette.com/2011/05/25/wellness-testing-for-dogs-and-cats-is-it-really-necessary/
Several vets have taken the discussion to twitter, and the crowd there is firmly in the "routine wellness testing" camp. I will just add that I have caught so many "silent killers" at a stage where they are still treatable - diabetes, kidney disease (including in my own 14 year old Max the Cat, who is now 15 and still doing great), liver disease...
Think of all the times we do (free) weight checks and it gets owners to take action on pets whose weight has crept up (including my own pets!) Do not let the cost of wellness screens be a deterrent - offer what you believe is best and go from there. I agree with the doctor who said it should be pet and location-specific and we should rely heavily on the vet-client-patient relationship. We can tailor wellness screen and wellness exam recommendations like we do when we risk assess for vaccination schedules.
I do agree with those not in favor of routine wellness screens on one point - we should not just do things because that is how they are done! It is good to think through why we do what we do and do them on purpose. That makes us better advocates for our patients :)
Edited by Finch93, 9 hours ago
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.
This is a profit center not good medicine.
One person commented on routine bloodwork at physicians
How do you change your anesthetic
By the way what is the first change in renal disease...
I get patients who have spent hundreds in pre-anesth
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.
Without a doubt a solid wellness program is an essential part of the practice of good medicine. We know how important it is. Unfortunat
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