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Battling Internet pharmacies with drug monitoring (Proceedings)

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Apr 01, 2008

Introduction

Early detection leads to earlier intervention. Complete diagnostic efforts are critical because pets frequently have diseases in multiple body systems. Routine monitoring is especially helpful so trends can be followed and diseases recognized as soon as possible. Routine monitoring of clinico-pathologic data is critical in the management of patients on long term medications. Gaining owner compliance is often the most difficult component of veterinary medicine and drug monitoring is no different. Our practice earns compliance which takes very little time and effort but reaps huge rewards for the patient, the client, and the veterinary team.

Physical, physiological, metabolic, and immunologic effects of aging

Aging affects every body system.

Owners may recognize many of the physical changes associated with aging such as obesity and skin changes. Skin becomes thickened hyperpigmented, hyperkeratinized and less elastic. Muscle, bone, and cartilage mass decreases. Dental tartar accumulates calculus forms and periodontal disease occurs with resulting halitosis noticed by many owners.

Physiological effects of aging are medically very important. Hepatobiliary physiologic changes include decreased numbers of hepatocytes, increased hepatic fibrosis and decreased detoxification capabilities. Renal physiologic changes include decreased kidney weight, decreased glomerular filtration rate and renal tubular atrophy. The incidence of urinary incontinence also increases with age. Cardiovascular physiologic changes include increased valvular fibrosis resulting in valvular endocardiosis and decreased cardiac output.

Aging results in a decrease in the basal metabolic rate. Older animals tend to have decreased activity levels resulting in increased body fat percentage. This is especially important because increased body weight results in increased incidence of diseases such as diabetes, cardiovascular, respiratory, orthopedic diseases and perhaps neoplasia.

Immunologic effects include decreased phagocytic function and neutrophil chemotaxis, resulting in decreased immune competence despite normal numbers of lymphocytes. Aging is also associated with an increased incidence of immune-mediated diseases such as immune mediated hemolytic anemia and immune mediated thrombocytopenia.

Pharmacological effects of aging

Senior patients frequently require pharmacological intervention for disease management. Aging effects the absorption, distribution, biotansformation and elimination of most drugs; consequently, seniors have special pharmacologic concerns. Drug dosages may need adjusted for seniors and many drugs avoided if organ function is compromised. Pharmaceuticals biotransformed or eliminated by the liver and kidneys cause special concerns. Pharmaceuticals with special concerns in geriatric patients include: antibiotics, NSAID's, steroids, barbiturates, sedatives, analgesics, diuretics, ACE inhibitors, digitalis derivatives, chemotherapeutics, hormonal drugs, anesthetics and many others. Routine blood profiling increases the safety of drug administration by identifying underlying disease conditions, which may preclude the use of certain pharmaceuticals.

Common diseases requiring long term pharmaceuticals

Diseases common to veterinary patients are frequently the same diseases common to their human counterparts. Clients frequently recognize the common diseases such as diabetes, heart disease, hypothyroidism and cancer.

Common canine senior diseases include degenerative joint disease, obesity, dental disease, cardiovascular disease, cataracts, keratoconjunctivitis sicca, prostatic disease and incontinence. Others commonly encountered include neoplasia, hyperadrenocorticism, hypothyroidism, anemia, hepatopathy, immune-mediated diseases, chronic renal failure and diabetes mellitus.

Common feline senior diseases include, obesity, dental disease, hyperthyroidism, chronic renal failure, cardiovascular disease, neoplasia, anemia, hepatic lipidosis, and diabetes mellitus.

Comprehensive health screening is very important in the early recognition and successful management of many of these diseases.

Achieving client compliance-start early

Client compliance is directly proportional to client knowledge. Clients must be educated by the veterinary staff for success to occur.

Preanesthetic testing makes the transition to drug monitoring more logical as patients age. Baseline results obtained during preanesthetic testing for neutering, dentals, lumpectomies or other anesthetic events provide valuable comparison data for interpretation later in life, plus owners become familiar with the procedure increasing compliance for future profiling.

Educational materials are critical if we expect clients to comply with our recommendations. Report cards summarizing physical exam findings and our medical recommendations are helpful in increasing compliance. Define the senior pet by including age charts on your report card to help educate owners what pets are seniors. Specific brochures explaining the benefits, components and costs of the monitoring program allow owners and other interested parties to continue the education process at home..

Reminder cards help remind clients about vaccines, heartworm testing and other recommended procedures-why not health screenings? Clients are familiar with reminder cards so use them once the senior program has been initiated.

Financial benefits of the senior health program

Drug monitoring is better medically for our patients because it allows earlier detection of diseases or complications. Senior pets represent over 25% of our patients and this number will most likely increase as technology progresses. Senior medicine will become an increasingly important profit center for veterinarians. Increased income results from increased laboratory testing, and reflex testing, increased use of veterinary recommended diets, increased number of dental procedures, increased pharmaceutical income from diseases diagnosed, not to mention the income (vaccine, heartworm testing and preventative, flea products, etc.) derived simply from patients living longer through better medicine.