Vector-Borne Disease Testing and Effective Client Communication
On my first day seeing patients as a newly minted general practice veterinarian in Buffalo, N.Y., I diagnosed a dog with an unexpected vector-borne disease (VBD): heartworm.
If you're not familiar with Buffalo, it's known for its snowy winter months, but according to the American Heartworm Society, not necessarily for being a hotbed of heartworm transmission. So, when we discovered a positive heartworm test, some of my colleagues were skeptical of whether this was a true positive result. Once I explained that this dog had not been regularly tested for heartworm disease, wasn't on preventives, and was presenting for pigmenturia with all the signs of caval syndrome, we agreed that it actually could be heartworm disease. A quick look at the patient's blood smear, which was riddled with microfilariae, confirmed our diagnosis and precluded the need to repeat the SNAP test. As this case illustrates, testing for vector-borne diseases even in geographic areas where they're not typically common can make sense not just for patients with compatible clinical illnesses, but also for healthy patients as part of their routine wellness visits.
VBD Screening in Healthy Pets
Just as you get your blood pressure and cholesterol checked when you're outwardly healthy, routine screening for early signs of disease in pets is critical to helping them live long and healthy lives. VBD screening is one critical component of this routine preventative care. This can be easy in highly endemic areas, with diseases that are well known: Lyme in New England, or heartworm in the southeast.
However many pet owners might balk at the idea of testing for a vector-borne disease that are less common in their area. But with global warming and the spread of ticks and mosquitoes into new parts of the U.S., the endemic areas for all sorts of vector-borne diseases are rapidly shifting. Veterinarians are also often at the forefront of redefining these endemic areas, given that dogs (and to a lesser extent, cats) share the same recreational environments and exposures as their owners. And unlike humans, dogs are routinely screened for potential exposures. Therefore, if a client is skeptical at first, such as the dog owner back in Buffalo, they may be pleased to learn they're helping understand more about the spread of VBD. There are dogs infected with heartworms in western New York, albeit with lower prevalence than in the highly endemic southern states. If we hadn't tested for it, though, we might have missed the diagnosis entirely.
The idea that some diseases just aren't seen in certain locations is one reason that clients might be hesitant to perform VBD testing, but it's certainly not the only reason. Some other common reasons for push back include:
- Cost of testing
- Lack of understanding what vectors are
- Lack of perceived risk of vector exposure
- Lack of perceived risk of disease severity
- Lack of clinical signs
Understanding That Education Is Key
When it comes to effective VBD screening, client education is key. Once pet owners understand the risks that fleas, ticks, and mosquitoes pose to their pets' health — and then are reminded that even indoor pets can be exposed to these disease-carrying pests — they are usually happy to have their pet screened annually.
Effectively communicating the risks of VBD and the benefit of annual screening can be tough during a short wellness visit, but here are a few tactics that you can try:
- Keep informational pamphlets and resources strategically placed in your practice's waiting room.
- Make use of your outdoor space with posters on the practice windows or sidewalk sandwich boards. And change up the visuals every few months so that clients continue to pay attention and know that your information is current.
- Encourage your front-desk team to ask every client if they need refills on their flea, tick, and heartworm preventives, and ask your technicians to mention vector-borne disease screening as a routine part of an annual exam.
- Leverage other channels at your disposal–like social media–to regularly communicate the value of vector-borne disease screening
By cultivating an understanding of not only the typical geographic ranges of common vectors and the diseases they carry, but also the ways those ranges have changed in recent years, you can develop and refine your clinical intuition. This way, you're better able to determine whether a specific disease is likely, unlikely, or all but impossible for a pet in your practice (without a history of travel). The Companion Animal Parasite Council's parasite prevalence maps are a good starting point, and they're easy to navigate so clients can browse them as well. With your clients well-educated, they'll be ready not only for screening, but also for preventatives. Armed with this basic epidemiological information, you'll have a great starting point for an informed discussion with your clients.