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already gathered during the visit.11 Communication with empathy, reflective listening, and two-way communication by the veterinary team will result in improved clinical outcome as well as pet owner and veterinarian satisfaction.12–14 Historical and physical exam information should be documented in a searchable medical record system which allows easy and clear depiction of important patient parameters (e.g., weight, vital parameters, clinical pathology values) over the life of the patient. This type of system facilitates clear communication between team members and the pet owner. Life Stage–Based Approach to the Consultation and Physical Exam We can’t overemphasize the importance of a thorough individualized consultation and physical exam at every visit using the entire practice team. Life stage information contained in Table 2 can guide the practice team through the relevant components of the visit. The length of the visit should be based on the life stage of the dog. For example, a first puppy exam and a senior exam could require an extended period of time. The physical exam should include the five vital assessments (temperature, pulse, respiration, pain, and nutrition) as well as items listed in Table 2. Reproductive status, pain score, thoracic auscultation, gait analysis, and body mapping should also be included in the exam. Results should be recorded using a standardized scoring system (e.g., for pain evaluation, osteoarthritis staging, pruritus scores) to aid in communication, trend surveillance, and continuity of care.15 Puppies will have frequent visits based on their origin (shelter vs. breeder), reproductive consultation, client education needs, preventive care, and as recommended in the AAHA Canine Vaccination Guidelines, AAHA/American Veterinary Medical Association (AVMA) Preventive Healthcare Guidelines, AAHA Canine and Feline Behavior Management Guidelines, and AVMA/AAHA position statements (these publications are cited in their respective sections of these guidelines). Encourage a consultation and physical exam for young adults semiannually to annually and working dogs semiannually. Use open-ended questions to explore lifestyle-social changes that will affect individual care. Mature adults should have semiannual-to-annual exams, annual minimum database (Table 4), and exploration of biomedical as well as lifestylesocial changes using open-ended questions to aid in early disease detection. The senior dog should have at least semiannual exams and minimum database (Table 4) including similar information gathering as the mature adult with additional importance placed on empathizing with the pet owner and exploring their concerns and goals for their pet. Early detection of disease at the mature adult and senior life stage can be achieved through eliciting the pet owner’s concerns and perspective, thorough physical examination, and observing trends in vital assessments.16 This approach allows for earlier intervention in otherwise healthy-appearing dogs as well as increased lifespan and pet owner satisfaction.12,13,16 Working and service dogs may require more frequent visits as a result of their high-performance nature and genetics.17 These animals not only provide companionship but also fill important TABLE 1 Proposed Canine Life Stage Definitions Stage Definition (Length of Time) Puppy Birth to cessation of rapid growth (w6–9 mo, varying with breed and size) Young adult Cessation of rapid growth to completion of physical and social maturation, which occurs in most dogs by 3 to 4 yr of age Mature adult Completion of physical and social maturation until the last 25% of estimated lifespan (breed and size dependent) Senior The last 25% of estimated lifespan through end of life End of life Terminal stage (depends on the specific pathologies) 2019 Canine Life Stage Guidelines JAAHA.ORG 269 TABLE 2 Canine Life Stage Guidelines Checklist of Items to Discuss, Review, Check, and Perform All Puppy Young Adult Mature Adult Senior General (PE and consultation)* Thorough physical exam should include the 5 vital assessments: TPR, pain, and nutritional assessment (which includes body weight, BCS/MCS) Evaluate congenital disorders Body mapping Transportation advice – safety (restraint), motion sickness, anxiety Microchip/permanent identification Address the special needs of working/service dogs If sedated or anesthetized for any procedure, this is an opportunity for a more comprehensive physical exam (oral, abdominal palpation, orthopedic evaluation, etc.) Boarding/grooming advice Educate owners on signs of early orthopedic disease and OA. Collect pet owner observations of mobility and activity at home. Evaluate for the presence and stage of OA during PE. Consult about any current medications and supplements, nutraceuticals, herbs Frequency visit recommendations Discuss future exam frequency q 3–4 wk 6–12 mo 6–12 mo Educate clients on the need for more frequent examinations (at least every 6 mo) in conjunction with appropriate diagnostic screening tests. Provide or recommend appropriate client education online resources Document and review trends on important clinical parameters in the medical record 270 JAAHA | 55:6 Nov/Dec 2019 TABLE 2 (Continued) All Puppy Young Adult Mature Adult Senior Lifestyle and safety risk assessment
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