April 26, 2016

Recommendations for the Older Animal Wellness Exam

Medical advances are prolonging the life of animals and heightening the need for senior veterinary care. Both the AAHA and the AAFP have published guidelines on senior wellness examinations.
By Amy Karon, DVM, MPH
Physical examination
Studies have shown that owners do not necessarily recognize symptoms of illness. Therefore, even if an owner reports no signs of illness, a senior wellness examination should include a full visual inspection of the animal, a body condition score (BCS), oral exam, thoracic auscultation, ophthalmoscopy, otoscopy, abdominal palpation, range of motion assessment, neurological evaluation, and dermatologic examination.
A rectal examination is also important, particularly for intact male dogs or animals that are straining to defecate. Furthermore, clipping long and ingrown toenails aids mobility and helps prevent infections. Likewise, appropriate dentistry can eliminate pain, reduce the chances of infections, and improve the appetite of stable older pets who can tolerate dental procedures.
Minimum database
The minimum database is a group of core tests that can dramatically improve the detection of occult diseases. The AAHA recommends that veterinarians consider the following for seemingly healthy senior dogs:
  • Complete urinalysis
  • Chemistry screen that includes TP, albumin, globulin, ALP, ALT, glucose, BUN, creatinine, potassium, phosphorus, Na+, and Ca+
  • CBC (hematocrit, RBC, WBC, differential, cytology, platelets)
  • Heartworm screening annually and after adoption

Fecal flotation is also recommended, although some experts note that money may be better spent on deworming.
Common diseases of older cats include chronic kidney disease, hyperthyroidism, diabetes mellitus, inflammatory bowel disease, lymphoma and other cancers, and cognitive disorders. Accordingly, AAFP recommends the following for minimum database for seemingly healthy senior cats:
  • Urinalysis (preferably by cystocentesis)
  • Complete blood count (CBC)
  • Chemistry screen, as above
  • T4
  • Blood pressure

Additional testing
Imaging and other tests depend on the history, physical examination, minimum database, and assessment of the animal’s risk for specific diseases. For example, the AAHA recommends testing dogs for arthropod-borne diseases, such as Lyme and Rickettsia, when exposure is suspected.
For cats with historical or suspected inflammatory bowel disease, measuring pancreatic lipase immunoreactivity (fPLI), feline trypsin-like immunoreactivity (fTLI), B12 and folate concentrations can help guide treatment. Guidance for test interpretation is available at the Texas A&M University, GI Lab website.
N-terminal pro-brain natriuretic peptide (NT-proBNP) is a cardiac biomarker of myocardial stretch (cardiac load) that can help distinguish cardiac and respiratory disease. The results can also help veterinarians determine if known cardiac disease is severe enough to explain an animal’s signs and symptoms. Unfortunately, a point-of-care NT-proBNP assay is not yet available, and levels have been found to vary widely among healthy dogs of various breeds.
Dr. Amy Karon earned her doctorate in veterinary medicine and master’s degrees in public health and journalism from the University of Wisconsin-Madison. She was an infectious disease epidemiologist and “disease detective” (EIS officer) with the Centers for Disease Control and Prevention before becoming a full-time medical writer. She lives in the San Francisco Bay area, where she volunteers for the local Humane Society.

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