An ounce of prevention goes a long way
By Laura Thill

Healthy animals make great patients. And, as better diagnostic tools become available, more and more vets are focusing on intervening before patients fall ill. Particularly as advances in nutrition and vaccines have contributed to pet longevity, preventive medicine has caught on in animal health as it has for humans.

The concept of animal wellness is “absolutely” catching on, says Christy Redfearn-Shelton, a DVM who practices in North Carolina. “I was in a practice for about 10 years,” she notes. “We were very aggressive in the wellness aspect, and the practice grew from tiny to explosive. Two years ago, I left to join another practice. The previous owner of this practice was not so focused on pet wellness, so we are now moving forward with a program. Although the older clients here are not used to this, our newer clients do want to see it.”

There is a lot of value in knowing patients in health as well as sickness, says Bernadine Cruz, DVM, a member of the American Veterinary Medical Association (AVMA). “Reps should remind their veterinarian customers of the importance of establishing a long-term relationship with clients and patients,” she points out. “That’s the way to ensure their patients stay healthy and that’s what will draw clients back to their practice.”

Indeed, there was a time when pet healthcare focused primarily on administering vaccines and healing the sick. “Many years ago, veterinarians fixed what they could, but there was very little known about preventive medicine,” says Erin Newport, DVM, American Animal Hospital Association (AAHA) veterinary and professional education manager. “Veterinarians today have many tools available to help keep patients healthy, more options in diagnostic equipment and the knowledge not to overuse tools, such as vaccines.”

In fact, vaccine guidelines have changed in recent years, encouraging veterinarians to become more prudent in administering them. Although adverse reactions to vaccines are not the norm, they can occur, and veterinarians increasingly recognize that the patient’s location and lifestyle often can determine the necessity of receiving certain immunizations. (See this month’s Sales Meeting article on vaccines.) “It’s the gold standard to administer vaccines after a wellness check,” says Roberta Lillich, DVM, president of the American Association of Feline Practitioners. For one, a wellness exam can uncover certain issues, she points out. “And, if there are underlying health issues that are affecting a pet’s immune system, then it’s not well-advised to administer certain vaccines. So, if the patient is running a fever, we would want to treat [the illness] first and vaccinate at a later time.”

What’s hot in health
A typical wellness visit generally includes a thorough pet history (based on the client’s input), a weight check, a complete physical exam, a fecal exam to check for parasites, a urinalysis and blood chemistries to check for changes in internal organ function, according to Newport. “Obvious abnormalities [should] be noticed right away during the wellness exam,” she says. “However, if there are no obvious abnormalities, the veterinarian compares all of the results to the previous wellness exam and looks for any slight changes or trends that may indicate an early problem.”

It’s important - and less expensive - to intervene and, if possible, prevent a disease before it occurs, says Lillich. “We can monitor a cat with early renal disease and place it on a special diet,” she says. “But, by the time the owner notices its cat is vomiting and urinating too frequently, it may be too late. We want to intervene before a crisis situation develops.” A comprehensive wellness exam should include the following, she points out:

• Examine oral health.
• Monitor weight for significant changes.
• Listen to the heart and lungs.
• Look at the coat condition and check for hair loss, signs of infection, ticks and fleas, etc.
• Check for good muscle mass.
• Check for stiffness/arthritis in dogs’ joints.

As pets age, they require a more comprehensive exam, complete with a urinalysis, a CBC and other blood work appropriate for each patient. “We screen more frequently when we discover abnormalities to ensure a potential problem doesn’t progress,” she says.

“Metabolic panels generally evolve for aging pets, adds Lorraine Corriveau, DVM, Purdue University, and a member of AVMA. “We look [more closely] at renal values and electrolytes and thyroid panels. Because we are taking a preventive approach to catch a problem early on, we usually see the patient twice a year (Younger pets generally require a wellness check once each year. Puppies and kittens usually come in more frequently during their first year of life to receive vaccines or neutering surgery.)

Fat cats … and dog
It’s hard to say ‘no’ to food - and it’s just as hard for pet owners to say ‘no’ to their pets, say experts. So, it’s understandable that pet obesity is on the rise. “Pet obesity is a symptom of our society,” says Jack Stephens, DVM, president, Pets Best. “People overfeed their pets and don’t exercise them enough. Today, we tend to give our pets more higher calorie food and treats.”

“We definitely see more overweight pets today,” says Redfearn-Shelton. The extra weight not only slows down pets. It can cause a lot of damage to their health as well, she points out. “When I look back at all of the overweight Golden Retrievers with allergic skin disease, I know being overweight was a major contributor,” she says. “And, we rarely see thin cats with inflammatory disease of the bladder.

“Fat cells are known to produce 21 chemicals and hormones that adversely affect pets,” continues Redfearn-Shelton.”I am mostly concerned with prostaglandins, [which, in excess, can cause painful inflammation]. Overweight pets have added prostaglandins and therefore are in greater pain. Being even 2 to 5 percent overweight can make a dramatic difference in the amount of pain a pet feels, especially if it already is osteoarthritic.”

Indeed, a weight gain of two pounds may not sound like a lot to some cat owners, says Lillich. “But, two pounds to a cat is like a 20-pound weight gain in a 100-pound person,” she points out.

Corriveau agrees that pet owners today feed their pets too much, “possibly because it’s comforting for us to see pets eating and happy.” And, today’s busy lifestyle often means less opportunity for exercising pets, she adds. But, overweight pets carry extra weight on their joints, she points out. Other health issues tied to obesity include diabetes, cancer and fatty liver disease. “And, fat takes up space, making it harder for overweight pets to breathe,” she says.

Healthy teeth, healthy heart
There’s much more to a rotten tooth than meets the eye, which is why oral healthcare has increasingly become an integral part of pet wellness programs. “We are recognizing that oral care does affect a pet’s life,” says Lillich. Addressing such issues as cavities, plaque and bad breath means providing pets with a better quality of life, she points out. It’s also key to preventing the spread of bacteria to other areas of the body, she adds.

Redfearn-Shelton’s practice fully supports a thorough oral health program and, in fact, recently added a dental X-ray system. “We explain to our clients that the oral cavity plays a large role in their pet’s health,” she says. “Bacteria can break off and transmit to the heart. A pet with a heart murmur is even more susceptible to this. I [often] rely on my office technicians to help educate clients on oral care while I write up recommendations.” Still, veterinarians must consider each family’s (and pet’s) lifestyle, she adds. “It may not be realistic for a client to brush [his or her] dog’s teeth every day.” But, it’s easy enough to put toothpaste on a dog chew toy, notes Redfearn-Shelton. “And, rawhides today are highly digestible and treated with enzymes to help with oral care and break down bacteria,” she adds.

Lifestyle
Just as for humans, varying lifestyles can determine different pets’ health needs. Certain types of prevention, such as heartworm prevention, are a given for all pets. Yet, even in North Carolina, where the rate of heartworm is close to 100 percent, compliance with heartworm medication is not where it should be, according to Redfearn-Shelton. It’s not uncommon for clients to purchase a package of heartworm medication and give it to their pets every other month, she notes, and veterinarians must be diligent in educating clients on the importance of adhering to a program.

In many ways, however, different pets have different needs. When it comes to flea and tick prevention, Redfearn-Shelton considers the patient’s lifestyle. “We look at the lifestyle of both the pet and its owner,” she says. “Is a dog getting groomed? If so, it may only need flea and tick prevention before it visits the groomer. These medications are very safe, but why put a chemical on a pet if it doesn’t need it?”

At the same time, whereas some pets may not live in an area where certain noncore vaccines are recommended, they may travel to areas of higher risk. “Pets can pick up a disease at a rest stop while traveling,” says Redfearn-Shelton. “And, even in the same county, certain areas may have a greater or less prevalence of Lyme disease. We really have to know each patient’s lifestyle. Does the pet visit the park or a pet groomer?”

To keep abreast the practice’s diverse patient population, Redfearn-Shelton and her colleagues keep patient report cards, which review “all aspects of health, including weight, a review of [health] systems, dental grade and which vaccines we administered that day (and which vaccines the patient may need at a future visit),” she says. “At the bottom of the report, we include the results of the heartworm test, flea and tick tests, etc. Then we include recommendations and discuss oral care at home.”

A healthy body, budget
Indeed, veterinarians pack a lot into their wellness exams, which may make some clients nervous about their affordability. Veterinarians should be sensitive to this, especially in the slow economy. “We do find that some clients want to cut back on wellness checks, but we can’t administer vaccines without the checkup,” says Redfearn-Shelton. “We explain the importance of staying on top of pets’ wellness to catch problems before they occur. We also try to keep clients educated on changes in [preventive] protocols.” Wellness exams are her way of maintaining a strong veterinarian-patient-client bond, she adds. “We try to help our clients by spreading out vaccines and tests to make payments easier.”

Some practices offer value-added services to encourage clients to bring in their pets regularly. “Many veterinarians today are looking for ways to make wellness care more affordable to their clients by offering free vaccines with a paid exam, discounted wellness checks for bringing the pet in when due and, in some cases, free wellness exams with charges for any required testing,” says Newport. “Also, many veterinarians are encouraging clients to purchase health insurance for their pets. Pet owners with pet insurance are more willing to bring in the animals for wellness checks if their plan covers them.”

Having pet insurance puts clients in control of their pets’ health, notes Stephens. “Pet insurance gives clients greater buying power,” he says. Clients with insurance are more likely to take advantage of such technologies as digital radiography, ultrasound and laser surgery, as well as certain medications, he points out. “These services are good for pets, and people want what is best for their pets.”

Generally, however, pet owners are continuing to do a good job of taking caring of their pets, bad economy and all, says Corriveau. “And, prevention is key to saving money,” she notes, as it’s much more expensive to treat a pet after it becomes ill. Besides, there are small, but helpful, ways for pet owners to save money, she points out. “Many people don’t realize it’s not all about price when it comes to pet food,” she says. Certain brands of food may appear to be more expensive, but because they are higher in nutrition (lower in fillers), pets actually require less.

The rep’s role
Veterinarians are becoming more like human doctors, says Stephens. “The veterinarian is a pediatrician, an internist and a surgeon,” he points out. As such, distributor reps should keep them informed of new drugs, new technologies and new ways to pay for costly equipment. “There are a lot more medications available today for heartworm and parasites, high blood pressure, arthritis and anxiety,” he says. “There also are more general products, such as tooth restorations and crowns.”

“Distributor reps can be a valuable source of information and education for veterinarians and their staff,” adds Corriveau. And, because reps work with many different veterinarian practices, they can provide a lot of insight on what does or does not work from one practice to the next, she says.

Vets must dialogue with their clients to emphasize the importance of the veterinarian-patient relationship, says Lillich. So, it’s helpful when reps provide veterinarians with literature and materials that they can share with clients. “When the veterinarian can build and maintain a good relationship with [his or her] clients, they will return,” she says. “This is not only good for the pet’s health, it’s good for the practice as well.”