of the complexity of biological systems, just because there is a genetic mutation that leads to a poorly functional protein doesn't mean that the animal will definitely develop disease. We often describe this as penetrance, the likelihood that a given mutation in an animal will result in clinical disease. Not surprisingly, we don't have enough of this information for many genetic tests, nor for those tests in different breeds. Yet another form of variation is known as expressivity. This refers to the variability in clinical presentation that can be seen in individuals, with some animals with the same genotype being more severely affected, and others less so.
Part of the complexity of such testing is also a great opportunity for veterinary teams. If genetic testing didn't require any expertise or interpretation, there would be little reason for pet owners to want to work with veterinary teams to keep their pets healthy. It is this ability to counsel and coach that makes the veterinary team critical to the success of such programs, and to the evidence‐based creation of personalized care plans.
1.3.8 Putting It All Together
The personalized care plan is just a customized maintenance schedule that helps pet owners see the type of veterinary intervention that is anticipated over a pet's lifetime (see 6.4 Creating a Pet‐Specific User's Manual). Part of that schedule will be based on life stages (see 1.2 Providing a Lifetime of Care); those life stages should reflect the pet's breed or, in the case of mixed‐breed animals, their adult weight (see 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
