Pet-Specific Care for the Veterinary Team. Группа авторов
individual genetic diseases. Panels of DNA tests are available as well, so we can test for dozens or hundreds of DNA defects with a single sample of blood, saliva or cheek cells (see 3.6 Genetic Testing). These test panels are inexpensive enough to be used widely as screening tools. Unlike other types of testing, such as thyroid screening, a DNA panel typically only needs to be done once in a pet's life.
Some care must be taken when selecting a laboratory for DNA testing. Manufacturers are not required to disclose their testing methodology nor is there any oversight of the laboratory running the test. Direct‐to‐consumer DNA tests are popular, but the results may be suspect. The WSAVA's Canine and Feline Hereditary Disease website (https://wsava.org/committees/hereditary‐disease‐committee/#:~:text=The%20World%20Small%20Animal%20Veterinary,now%20and%20in%20future%20generations) lists available DNA tests by breed, disease and testing laboratory, and provides links to peer‐reviewed citations. Organizations such as the Orthopedic Foundation for Animals (www.ofa.org) and the International Partnership for Dogs (www.dogwellnet.com) can provide advice on available testing. University‐run laboratories are usually highly qualified, though they generally run only individual tests versus panels.
Not every genetic problem is caused by a single gene defect (see 3.3 The Genetics of Disease). Some, such as hip dysplasia, involve multiple genes and a wide range of possible presentations. Instead of a single test, radiographs for hip dysplasia look for the phenotypic evidence, not the genetic defects themselves. Some screening tests for genetic disorders, like ophthalmologist or cardiologist evaluations, or thyroid screening, must be periodically repeated (see 3.4 Predicting and Eliminating Disease Traits).
Genetic testing is especially important for anyone thinking about purchasing a purebred dog or cat, or breeding purebred or mixed‐breed pets (see 3.10 Advising Clients on Selecting an Appropriate Pet). It is the responsibility of everyone who breeds animals to do so carefully and with a good understanding of the genetic risks for their breed or breeds (see 3.11 Integrating Genotypic and Phenotypic Testing). Genetic testing before breeding should be considered a standard of care today. No one should be breeding an animal without screening for genetic diseases. No one should be buying a purebred pet whose parents have not been screened. Many breed associations and clubs have genetic screening information on their websites and some offer screening clinics for common diseases present in their breed.
For the average client with a pet, we are focusing on problems that pet might develop in the future. For breeding, we also have to focus on problems that pet could pass along to its offspring. The testing then becomes more indepth.
3.13.3 Breed‐Specific Risk Assessment
Much of our work in veterinary medicine hinges around the concept of reducing risk (see 2.7 Risk Assessment). Vaccinations reduce the risk of infection, parasite preventives reduce the risk for parasites, senior screening reduces the risk that we will fail to detect a disease process early, and so on. Client education follows risk assessment and management. We teach the clients about topics that pertain to their pet – for which the pet is at risk (see 10.5 Early Detection Campaigns).
When it comes to hip dysplasia in at‐risk breeds, we would want to do screening radiographs and educate pet owners about arthritis diagnosis and treatment (see 3.12 Orthopedic Screening).
Breed‐specific wellness is the next big leap for educating clients once all the basics have been covered. Breed tendencies for disease can jump right to the top of a “diseases or problems that could be fatal” list. For example, cardiomyopathy is common and deadly in boxers but occurs later and in a milder form in some other breeds. The more common and the more severe the risk, the more you need to talk about it early and often, so for a boxer owner annual screening should be a big priority. For a Dalmatian, one might choose something else to talk about, like bladder stones. Instead of electrocardiogram (ECG) screening, one might discuss feeding a special diet and an annual urinalysis.
Practicing high‐quality medicine is all about being a better teacher. This is as simple as putting a handout in every file before the appointment, so we remember to discuss the topic with the client and send them home with written information. Preparing and preloading your patient files ahead of each visit is a very important step.
Have a system. If this is the year you want to educate every client on dental disease, load a dental brochure in every file. If you want to talk about breed‐specific wellness care or healthcare plans, you need to come up with a structure for your program that makes it easy to implement. Specific recommendations and client education topics should be developed and used for every breed.
The following are links to some client education videos that can be helpful in practice. They also serve to illustrate what a breed risk discussion with a client might look like.
Breed risks in bulldogs: www.youtube.com/watch?v=Kgz3xCzlM_c
Eye diseases: www.youtube.com/watch?v=d_RGk2UEdgs
Foreign body (FB) ingestion: www.youtube.com/watch?v=VYNJrVS3u8g
Gastric dilation‐volvulus (GDV): www.youtube.com/watch?v=CrX2BJ7EI‐o
GDV and von Willebrand disease in Dobermans: www.youtube.com/watch?v=7l_gL0_6cOA
Glomerulonephropathy (GN) in wheaten terriers: www.youtube.com/watch?v=eTwyUbiFPbU
Hemangiosarcoma: www.youtube.com/watch?v=9HBPwYG5CW4
Hip dysplasia and arthritis: www.youtube.com/watch?v=VgAJeeSE‐GA
MDR1 testing in herding breeds: www.youtube.com/watch?v=F7D3d3Rgm7U
Intervertebral disc disease (IVDD): www.youtube.com/watch?v=vZqXvkN67rM
3.13.4 Developing a Breed‐Specific Wellness Program
Wellness programs are a lot of work, including program development, fee setting, appointment times, team training, client education, marketing and, lastly, protocols – what will you do with the information once you have it? Actually implementing a program can be challenging – it's complicated and time consuming. The more statistics you know about common disease problems, though, the more you see how early diagnosis and treatment is key to being an effective veterinarian.
Breed‐specific wellness has been building in significance for a long time. Follow this link to a client education video titled What is Breed‐Specific Wellness? www.youtube.com/watch?v=vDvl5L2cRNQ.
It could be started in the most basic fashion with simple laminated sheets for clients to read while waiting for the doctor that explains a single disease that