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 disorders should be discussed with the owner or breeder (see 3.13 Breed Predisposition). In many cases, a study may never have been done that would show the prevalence of a specific disorder in a particular breed. Experience is a great teacher, whether the person is a pet owner or a new graduate veterinarian. It is always more difficult to do risk factor analysis for things with which we are less familiar.
Risk assessment is affected by our own biases. For example, we are more likely to diagnose a disease, correctly or incorrectly, that we have recently read about or seen. We are less likely to diagnose or talk with a client about a disease we have never seen, even if we know the clinical signs and likely presentation. The brain is more likely to follow a familiar path. After a personal experience with a certain disease, whether in a patient, a family member or our own pet, we develop blinders to possibilities other than the scenario we already know. For example, if a family member had a bad experience with cancer, a client is less likely to let us treat their pet for cancer. The picture they have of cancer treatment affects how they regard the risks or rewards of treatment.
Also, things that frighten us more become higher risks in our minds, as when we are more worried about air travel than traveling by car, though the risk of a car accident is far higher than that of a plane crash.
All these factors create incentives to utilize logic and systems to help with risk assessment.
2.7.10 Risk Assessment for Well Patients
When deciding what to go over with a client at a wellness visit, it may be useful to divide risks into categories. Look for risks in each and then refine your list into no more than three things to teach about. Risks are often defined by what the pet owner is not doing, such as not giving a monthly heartworm preventive on schedule or not feeding a nutritious brand of cat food. Try these common topics:
age related
breed specific
contagious diseases
oral care
parasites
weight/nutrition.
If a client is already giving recommended heartworm and intestinal parasite preventives as directed, educating about parasites would not be as important as teaching about something the client is not doing, for example leptospirosis vaccination. If the pet is a normal weight but has moderate tartar build‐up, we obviously would be talking about dental care and not obesity management. By looking at each category individually, it is fairly simple to come up with two or three topics to discuss.
Even when we have a scenario where there is too much to discuss – say we are seeing an overweight, older golden retriever with arthritis, bad teeth, and an ear infection – we can usually manage to prioritize. Which topics could wait until the recheck visit? We could choose to talk about otitis and arthritis now and postpone the obesity, senior screening, and dental disease topics until we recheck the ear and the arthritis in two weeks. That would also give us time to get an estimate ready for the dental work needed.
A point scoring system may work better for recommending wellness screening laboratory testing. You would give one, two or three points in each of the categories.
