Geriatric Dog Care
Dr. Douglas Brum
Many of these tests are recommended on geriatric dogs even when they are feeling totally normal. The routine geriatric exam and accompanying diagnostic tests are recommended to ensure that the early stages of disease is discovered, and appropriate preventative measures and treatment plans instituted. The most common diagnostic tests performed by your veterinarian as part of a complete geriatric work-up include: A complete medical history. Any problems or concerns that an owner has about their pet should be discussed; however, it is equally important that the veterinarian ask specific questions that may uncover problems unknown to an owner. Certain problems that an owner may simply attribute to "old age", and just something that they will have to live with, may be signs of underlying disease and be very treatable. Some veterinarians have specific geriatric health history questionnaires that can be filled out by the owner or a health professional. Asking the right questions is very important in obtaining a thorough geriatric health history.
A complete physical examination. Your veterinarian will perform a complete physical examination that may uncover specific problems. The eyes are checked for age related changes. Cataracts may be noted. The ears are checked for signs of infection or allergies. The mouth, gums and teeth are evaluated, with dental disease and gingivitis being common findings. Lymph nodes are palpated (felt) for enlargement. The skin and quality of the hair coat are observed. Skin tumors are a common finding, and a poor hair coat or a lack of grooming may be signs of allergies, parasites, infections or systemic illness. The heart and lungs are ausculted (listened to), and new heart murmurs noted. The abdomen is palpated for any masses or organ enlargements. Finally, the general body condition and weight is recorded.
Complete Blood Count (CBC). A CBC evaluates the red and white blood cell lines. A decrease in the red cells indicates anemia, not an uncommon finding in the aging animal. Red blood cell morphology (shape) is also assessed, and helps determine if the condition is acute, chronic or related to a neoplastic (cancer) condition. The total white blood cell count is also noted, and increases may indicate inflammatory or infectious conditions. The specific types of white cells (neutrophils, lymphocytes, eosinophils, monocytes and basophils) are also counted and are recorded in their relative proportions. Increases or decreases in individual white cell types may provide incite into various disease conditions. Occasionally, abnormal or immature white blood cells are seen, suggesting a potential cancerous process.
Biochemical Profile. The biochemical profile is a very valuable test in the geriatric animal as it evaluates multiple organ systems. The liver and kidney function are evaluated, and the blood sugar is checked. Elevations in the blood sugar may indicate diabetes. Electrolytes are also checked and abnormalities may indicate the need for further diagnostics. The cholesterol may be elevated in certain endocrine problems (thyroid and adrenal disorders). Plasma protein and albumin level are also reported, and decreases might indicate kidney, liver or gastrointestinal disease.
Urinalysis. A urine sample may be obtained in a clean container by the owner prior to the examination, or by the veterinarian. The urine sample helps in diagnosing kidney problems, urinary infections or diabetes. If indicated either by clinical signs or by the microscopic evaluation of the urine, the urine is cultured for bacteria.
Fecal examination for parasites. Since gastrointestinal parasites may be more debilitating in geriatric animals, a yearly fecal exam is recommended. Additionally, some parasites have zoonotic (spread to people) potential, re-enforcing the value of yearly fecal exams. Routine fecal floatation, and specific tests for Giardia are recommended.
Heartworm blood tests. For dogs at risk, heartworm tests is advised. Depending on the area of the country you live in and the type of heartworm preventative your dog is receiving your veterinarian may suggest yearly testing.
The above represent the most routine diagnostic tests that your veterinarian may advise for your senior pet. Based on the history and physical examination findings, common additional testing might include:
Aspiration of skin masses. Probably one of the more common findings on the physical examination is small masses or lumps found on or under the skin. In most cases these are benign tumors or cysts that grow slowly and rarely cause problems. Unfortunately the only way to be sure is to sample the mass. This is most easily accomplished by aspirating the individual mass, and evaluating the recovered cells cytologically (microscopically). Sometimes the number or location of the masses makes sampling impractical. In these cases, your veterinarian can help determine if aspiration is worthwhile. The size and location of all masses should be recorded in the medical record, so that changes in previous masses or the development of new masses can be noted.
Endocrine function tests. Common endocrine problems of the older dogs are thyroid and adrenal disorders. A thyroid panel or a thyroid stimulation test can be done to diagnose hypothyroidism (decreased thyroid function). The most common signs of hypothyroidism are weight gain, lethargy, skin changes and a poor hair coat. Another common endocrine disorder of geriatric dogs is hyperadrenocorticism (Cushing's disease), caused by increased cortisol secretion by the adrenal gland. Dogs with this disease often present with increases in thirst, appetite, urination and or panting. Animals also may present with weight gain, a potbellied appearance and skin changes. Tests to diagnose adrenal disorders include an ACTH stimulation test, and a low dose dexamethasone suppression test.
Radiographs. X-rays may be advised based on the initial tests or physical exam findings. Chest X-rays are part of a heart work-up such as if a new murmur was found. They are also needed for evaluating the lungs, and as a screening test for cancer. Abdominal radiographs might be needed if organ dysfunction is suspected or organ enlargement or masses are palpated.
Blood pressure measurement. Hypertension, or high blood pressure, is being increasingly identified in the geriatric dog. Usually, it is associated with other disease conditions including kidney disease and hyperadrenocorticism.
Cardiac evaluation. If there is indication of potential heart disease (a newly discovered or a worsening murmur, or a nocturnal cough) a more complete cardiac evaluation is indicated. Chest radiographs, an EKG and an echocardiogram will help better define the extent and cause of potential heart disease and whether treatment is necessary.
Abdominal ultrasound. Abdominal ultrasounds offer a non-invasive method of visualizing of masses and organs within the abdomen. Generally, more detail and structure can be obtained with an ultrasound than with radiographs.
At the end of the geriatric visit, a geriatric wellness assessment may be completed and given to the owner.