Senior Wellness Screening Protocol & Guidance Notes

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1 Senior Wellness Screening Protocol & Guidance Notes Early detection and prevention are the most important reasons why you should screen every pet, every year especially where statistics show 10% of normal pets in annual check-ups have underlying diseases or abnormalities. There is an argument to offer blood sampling on an annual basis to every patient. How often do we take bloods pre anaesthetic in a young clinically health pet and discover an underlying primary kidney or liver problem? Animals like all of us are unable to turn back the effects of aging and there are progressive changes in the body s organ systems. Dogs age according to their breed size i.e. larger dogs have a shorter life spa than their smaller relatives, while cats age at a steadier rate irrespective of breed or size. Companion animals are generally deemed older or geriatric at around 7 years old, and earlier in giant dog breeds. As our pet population ages it is important to; a) establish baseline blood levels for that pet, or b) pick up on age related changes earlier so we can implement veterinary care to improve the pet quality of life Senior Wellness Screening Recommendation Whilst annual screening of all cats and dogs regardless of age would be preferred, this is not presently a realistic expectation. Screening pets over 7 years old on an annual basis is however a much more attainable and realistic goal, especially when a discount can be offered to clients as an incentive - such as during IVC marketing campaigns when group wide costs for such tests are reduced for participating practices. Recommended screening components WELN blood test Urine dipstick and gravity Schirmer tear test Physical exam WELN Profile Protocol Collect 1ml blood into EDTA tube and 1ml into a plain or gel tube Label tubes and submit with separate serum & request form to Laboratory NOTE: Please use code IVC1 when sending to Idexx during Oct 2017-Jan 2018 to receive discounted price as part of IVC T Senior Wellness Campaign. Page 1 of 5

2 Idexx Senior Wellness Screen WELN includes: Comprehensive Haematology, Total Protein, Albumin, Globulin, A:G Ratio, Urea, Creatinine, ALT, ALP, GGT, Calcium, Inorganic Phosphorus, Cholesterol, Glucose, Sodium, Potassium, Chloride, Total T4, SDMA Common conditions in first opinion practice WELN blood sample will highlight: Diabetes Mellitus Cats Estimates of the incidence of diabetes mellitus in cats range from 1:100 to 1:500 (Panciera et al. 1990). All cats are susceptible to diabetes but it is usually seen in middle aged to older cats A higher incidence is seen in neutered males In the UK and Australia, Burmese cats have been reported to have a higher incidence Dogs All dogs are susceptible to diabetes but it is usually seen in middle aged to older dogs A higher incidence is seen in entire bitches. It s estimated that between 1 in 100 to 1 in 500 animals are affected by diabetes mellitus A recent first opinion practice study produced estimates of 0.34% prevalence of canine diabetes mellitus Renal Disease CKD has been shown to be the 7 th most common specific disease Congenital disease results in a transient increase in prevalence in animals <3 yr old, the prevalence increases with advancing age from 5 6 yr In geriatric populations at referral institutions, CKD affects as many as 10% of dogs and 35% of cats 1 in 25 cats in UK practices Prevalence 4% in UK practices It has been known to affect >30 40% of cats over 10 years old Most common cause of death in cats > 5 years old Recent UK study suggests 1 in dogs affected Hyperthyroidism Feline hyperthyroidism is one of the most common endocrine diseases of older cats seen in general practice, estimated to affect around 1 in 300 cats It is seen mainly in middle aged to older cats, typically over 8 years old. The mean age is around 13 years and there is no known sex or breed predisposition for the disease The most common finding on biochemistry is raised alanine transferase which occurs in around 88 percent of hyperthyroid cats, and, less often a raised alkaline phosphase enzyme. Bile acids may be elevated and azotemia may be noted, with urea being more raised than creatinine. It should be noted that hyperthyroidism may mask renal disease due to the increased perfusion of the kidneys, so serum concentrations of urea and creatinine may be normal despite renal disease. Keratoconjunctivtis sicca or dry eye Statistically present in 1/22 dogs Page 2 of 5

3 Preparation for an Idexx WELN blood test This area may command some debate. In order for discounted screenings to be financially viable, it is important that the bloods be offered at routine vaccinations & consults i.e. routine assessments rather than providing less expensive bloods to those that are having clinical signs suggestive of medical problems. This will spark the starved vs spontaneous sample debate amongst vets and vet nurses. Animals that consume foods within the 24-hour period immediately preceding collection of a blood sample may have temporarily elevated lipid levels, which may be manifested by cloudy or lipaemic serum. Lipaemic serum or plasma may not be a true indicator of the animal s physiological state. Regardless of diet and length of fast, some animals may produce cloudy samples such as adult Schnauzers. If we are adamant that we must have a starved sample, this is feasible and always an option but client convenience and therefore uptake will likely be challenged. That loss of the spontaneous benefits of taking the sample at the time of routine consultation will have a negative impact on the gold standard of care we are striving for with this recommendation to clients. Idexx on non fasted samples; there can be some parameters which are affected more than others but we try hard to remove lipaemia from samples via high speed centrifugation and other techniques. When sampling animals without fasting, you should take into account that certain parameters (cholesterol, triglycerides) will often be outside of the reference interval Solution a) pre warn any patient coming in for a routine consultation that a blood sample may be offered and pets should avoid food for hours prior to sample collection. With all due respect to the busy reception team - this is perhaps something that is a step too far and will not be consistent or delivered with maximum effect. More importantly, pet owners will not comply or be interested in this for a routine screen. b) ignore the starved option and accept that the results are an indicator of problems and perhaps if borderline should be investigated further especially for those practices using in-house machines to perform the sample. In many cases, further investigation will most likely be warranted; elevated Glucose may be qualified by a Fructosamine. There is also the importance to highlight that in addition to Lipaemia, there are more frequent causes of inaccurate laboratory test results: aged sample haemolysis; may falsely elevate CPK, AST, LDH, total protein, phosphorus and uric acid; and falsely decrease GGT, glucose and alkaline phosphatase. icterus; Moderate icterus may result in decreases in creatinine, cholesterol, AST, and total protein insufficient sample quantity drug interference from post therapy sampling or contamination wrong type of commercial sample collection tube exercise & stress Other Wellness Tests - 1 in 8 patients over the age of 8 have hypertension Hypertension is often clinically invisible. As part of our routine screening, it may be something to consider as that going the extra mile service for those pets that we see regularly. Time may be an Page 3 of 5

4 issue & equipment may be a hurdle but again a blood pressure assessment is a valuable additional screen we should strive to offer especially to our older pet generation. - In-house instant spot glucose Elevated glucose results are potentially an unreliable result due to several factors; patient stress, restraint, post food. Falsely normal glucose in a diabetic, or a falsely low glucose in a normal animal can be caused post sampling, from degradation of the glucose due to current processes at Idexx Laboratories. We recommend in-house instant spot glucose sampling using a veterinary glucometer for more accurate results. Summary Fundamentally, a proactive approach to our geriatric patents and their potential health problems through use of the Idexx WELN blood test, a urine sample and schirmer test in conjunction with a routine physical exam, will promote early detection of abnormalities resulting in a recognised elevation in client service, patient care and improved pet quality of life. All these qualities are in the Independent Vetcare Charters which we strive to provide and our raison d etre as a company. Further supporting documentation The BSAVA & AAFP recommend a fully physical examination of a pet by a Vet on an annual basis. However, for senior animals or those on long-term medication, a full examination should be carried out more frequently*. Pets can age the equivalent of four to seven years in each twelve month interval. Therefore, the recognised recommendation is a thorough examination every 6 months. 2 This ties in nicely with the PHC and the Next Appointment Strategies. According to the AAHA senior care guidelines, only about 14% of senior animals undergo regular health screening. 3 An MSD Pet Owner survey carried out in 2016 found that 58% of owners were unaware of the signs of ageing and 45% of owners were unaware that something can be done to help their pet when they are ageing. This is an important aspect to consider when we are looking at proactive Wellness Screens to assess age relate changes. Clinically, clients will in more than half the cases not recognise the signs that there may be something adrift. Owners will often miss the signs of age-related diseases and may dismiss them as normal (careful history taking is important). In one study, 7% of owners said that their dog was drinking more when asked what changes they had seen. When questioned in detail, this figure rose to 58%. 4 You can expect to find new medical problems in up to 80% of cases screened for senior wellness 4. From a commercial perspective Senior health care programmes (such as proactive screening) can generate up to 35% of veterinary turnover 5 Page 4 of 5

5 References for general information: 1 Rehm M. Seeing double. Vet Econ. 2007;48(10): AAHA Senior Care Guidelines for Dogs and Cats. J Am Anim Hosp Assoc 2005;41: AAFP Senior Care Guidelines. J Feline Med Surg 2009;11(9): Davies M Geriatric screening in first opinion practice- results from 45 dogs. J Small Anim Pract 2012; 53: Hoskins JD Geriatrics and Gerontology of the Dogs and Cat nd Ed. Saunders, Missouri. * Middle age would equate to approximately 7 8 years of age for most dogs and cats (except large breed dogs) Page 5 of 5