Healthy Patients Deserve Diagnostics, Too
There are several reasons for veterinarians to run diagnostics on our patients. Most commonly, we use diagnostics to determine the cause of illness in sick patients. Often, we run diagnostics to determine a patient’s health status before administering anesthesia. We may also perform diagnostic profiles on the ADR or “Ain’t Doing Right” patient, and we run diagnostics to rule out certain diseases in patients that may appear healthy but are described by their owners as “not doing right.”
Running diagnostics to capture individual baselines
There is another reason for diagnostic testing that is, I think, largely underutilized by veterinarians: diagnostic testing to establish a baseline for healthy animals. These diagnostics are critical for any successful preventive health care program. Normal reference intervals vary across your patient population and the only way to get an individual patient’s normal values is to test them while they’re healthy. If you don’t have individual baseline values for your patients, how can you know what’s normal for them? How can you pick up on slight increases or decreases in certain analytes over time? Without this normal baseline on a patient, we don’t have anything to compare to when the animal gets sick, so it’s a critical piece of the diagnostic picture. I like to get a healthy baseline on animals over a year old as that blood work provides me with their adult reference intervals. We include a CBC and full chemistry panel with electrolytes and urinalysis for all patients.
Why aren’t we capturing this important diagnostic information more often?
It may be that we don’t think pet owners want to pay for it, or it may be that we don’t understand the value of baseline testing ourselves. If you’re not buying into the value of a healthy patient’s baseline, it’s not likely you’re going to convince your clients of its value. But the value of these diagnostics should be obvious when you consider their usefulness throughout the life of a patient.
A single result lacks context. This is why trending test results is so important—so that we can see normal and abnormal results, spot trends and make valid results comparisons from one visit to the next. If you’re only comparing individual results against generic reference intervals, you may miss the warning signs for a particular patient.
Take a look at Zeke’s case. There’s a lot of renal disease in cats that we could catch early with trending. By the time a patient is showing signs of renal disease, up to 70% of the kidneys could be damaged, so we want to pick up on even subtle increases as early as possible. Zeke’s creatinine result on the day of this visit, although within reference interval limits, represented a marked change from the baseline values established for Zeke at earlier visits. This prompted his veterinarian to investigate further and resulted in a better prognosis for Zeke.
Talking with pet owners about the importance of healthy baseline analysis
Once your practice adopts a protocol for preventive care that includes gathering baseline results for patients, the next step is gaining pet-owner compliance. If you believe, as I do, that this testing is in the best interests of your patients—and your clients in the long run—then it’s easy to explain your recommendations to pet owners and gain agreement.
Opportunities for testing healthy patients
There are several opportunities for capturing a healthy baseline while educating clients on the health benefits for their pet.
- A dentistry procedure is a great opportunity to establish baseline diagnostics. Almost all animals by age three or four have some dental disease. At Metzger Animal Hospital, we tell our clients, before your pet’s dental procedure, we’re going to do a preanesthetic screen. Let’s get a healthy baseline while we’re at it.
- Presurgery: You’re already doing preanesthetic blood work before surgery, so here’s another great opportunity to capture a baseline.
- Any yearly preventive care visit provides an opportunity for baseline testing; for example, when you’re drawing a dog’s blood for a SNAP 4Dx Plus Test or running a SNAP FIV/FeLV Combo Test on a feline patient, this is a great time to draw extra blood and run a chemistry panel with a CBC on the same patient sample. Pet owners appreciate that you can draw blood just once and get all the diagnostic information you need.
The best reference interval for a pet is its own reference interval when it’s healthy. This baseline provides you with the most accurate results for comparison, allowing you to pick up on even subtle changes and stay ahead of developing diseases. Sharing trending graphs with staff and clients is a powerful way to illustrate this benefit, helping to promote understanding and compliance. See the benefits for yourself, educate your staff and educate your clients. Your patients, and their owners, will thank you.
Here’s a recent conversation I had with my colleague Dr. Dennis DeNicola about the broader value of preanesthetic testing.
Normal reference intervals vary across your patient population and the only way to get an individual patient’s normal values is to test them while they’re healthy.
Fred Metzger, DVM, MRCVS, DABVP
Dr. Metzger* is a graduate of the Purdue College of Veterinary Medicine, a member of the Royal College of Veterinary Surgeons and a diplomate of the American Board of Veterinary Practitioners. He is an adjunct professor at Pennsylvania State University and serves on the practitioner advisory boards of Veterinary Economics and Veterinary Medicine. Dr. Metzger owns a six-doctor general and referral practice in State College, Pennsylvania.