Letters: Doctor Debate: Is wellness testing good medicine?

Dr. David Robbins' comments ("Doctor Debate: Wellness testing—good medicine or not?" May 2011) are interesting but have some flaws in my opinion. To suggest that wellness testing is simply a matter of income generation seems to imply that veterinarians work primarily on profit generation/motivation and less on the practice of good medicine. Savvy veterinarians realize that small changes may indicate a bigger problem brewing. Sure, there will always be veterinarians who skim the lab work and look only for high or low flags instead of at the results of individual tests as well as the panels as a whole to evaluate how each system interrelates. But for those veterinarians who take the time to review the results and compare them (if applicable) to previous test results, this is simply practicing good medicine.

PHILIP J. BRITTAN/GETTY IMAGES

I agree that defensive medicine is not a warranted reason for wellness testing, but I do not believe that we are far from a much bigger arena of litigation than we currently encounter. So I do not see the harm in wellness testing or preanesthetic testing. I personally know that as a 21-year-old healthy veterinary student I was required to have preanesthetic testing before orthopedic surgery, and it was required again a decade later for a subsequent orthopedic surgery after my anterior cruciate ligament ruptured while I was playing softball (I was healthy then, too). I am sure that we all can agree that, given an opportunity, lawyers will inquire why lab work was not performed before any procedure. The assumption exists that a problem could have been avoided by obtaining such information.

As to Dr. Robbins' comment on disease screening, I fully disagree that wellness profiles are not indicated. His statistics seem to overlook that you evaluate lab results in conjunction with the patient's physical examination results. Many dehydrated animals have normal hematocrits until you hydrate them and identify severe anemia. It is imperative that lab work be interpreted based on not only its values but also on how it relates to the patient's physical findings. Microscopic hematuria, which can't be noted by the owner, may reveal urinary calculi and possibly an underlying urinary tract infection. Screening for problems may reveal diseases in which early intervention may be curative or at least allow for better management of the disease.

Finally, the wow factor, as Dr. Robbins refers to it, has bolstered many to look for abnormalities. I am glad to say "Wow!" when I find that liver enzyme activities are elevated, leading to more tests such as ultrasonography, biopsies, or more blood tests. Why? I can sleep much easier knowing that I have eliminated or discovered a reason for the abnormal values. It is better to tell a client that the results are negative or normal than to wish you had done lab work in, for example, an apparently healthy 9-year-old golden retriever with normal physical examination findings that required an emergency splenectomy a short time later because of a slowly bleeding splenic mass that may have been discovered if you had first identified a hematocrit of 32%. We can all relate to the "what if" and "if only" patients we have deemed normal that present a month later for a problem that may have been detected earlier if diagnostic tests had been performed. Sure, we will all have some clients that are irritated at the amount they have spent only to find out their pets are normal, but I believe the value is still present because the results have established those patients' baseline values. Such information may become invaluable in the future as a timeline for identifying disease development.

I am not sure why Dr. Robbins thinks there is potential harm in wellness testing. Is he referring to testing that leads to more invasive procedures? I would estimate (but have no data to support) that more harm occurs from vaccination reactions (mild hives to fatal anaphylaxis) than does from bone marrow aspirates or liver biopsies. I don't see many harmful issues from venipuncture unless it causes a hematoma (which may reveal a bleeding disorder).

I fully concur with Dr. Fred Metzger ("Doctor Debate: Wellness testing—more important than ever!" May 2011) in his statement that vaccinating senior pets and not discussing wellness testing is unprofessional and unethical. I have yet to see, in my 17 years practicing, an older, historically well-vaccinated animal contract diseases such as parvovirus infection, distemper, or upper respiratory viral infections. However, I have seen numerous cases of diabetes, hyperthyroidism, and urinary tract infections in animals whose owners had perceived them as being normal and whose physical examination results did not indicate any clinical manifestation of such disease.

I will continue to advocate for wellness testing in senior patients but fairly indicate that in my experience such testing finds true problems in about 20% of those older patients tested. I urge clients to test. After all, they will suffer much worse "what if" and "if only" anxiety should their pets present later with a disease that may have been detected earlier. As Dr. Robbins stated, knowledge of disease prior to clinical illness may be perceived as extended longevity. I say, why not let the owner believe that early intervention may have been beneficial. I believe that owners will always beat themselves up should there be a problem that could have been detected earlier regardless of whether or not it would have changed the outcome. That is just human nature.

Paula A. Schuerer, DVM, MBA, DABVP

Animal Ark Animal Hospital

Franklin, Tenn.