18 Feb 2019
Kate Parkinson discusses the importance of vaccination, worming, insurance, nutrition, neutering, spaying and gaining owner compliance.
Kate Parkinson
Job Title
Figure 1. A puppy health check should be a positive visit.
The first consultation is an important time in any pet and owner’s life. A positive first visit is an excellent method of client bonding, and visits should be longer than adult consultations and relatively unrestricted by time constraints. Use of a checklist ensures vital information is not missed, while information handouts for clients to take home may be used to increase information retention. A typical first visit should focus on education and preventive health care.
Owners often perceive the first visit to be focused on vaccination, but many other health issues – such as worm and flea treatment, microchipping, neutering, insurance, nutrition, dental care, socialisation and behaviour – must be addressed at this time.
Good communication is required to ensure client compliance. Nurses are invaluable, and may be more patient and knowledgeable in matters such as socialisation than the vet; therefore, they should be enlisted wherever possible, as part of the practice team, to provide an excellent first encounter.
Puppy and kitten checks and vaccinations are a common part of small animal practice, and these consultations can often be a welcome relief for many vets after a stressful euthanasia or complicated medical case.
However, puppy and kitten consultations involve the discussion of numerous issues and can often be complicated in their own right. This article considers some of the issues discussed during a puppy or kitten health check (Figure 1).
The first veterinary visit serves as a friendly introduction to the practice, its style and the vet. Clients often prefer a good relationship with a vet they know and trust (Belshaw et al, 2018), and although this is not always possible in the busy, modern veterinary practice, it is important clients feel sufficient care is taken of themselves and their pets. Enough time should be allocated for these consultations so young animals have a positive first experience and owners do not feel hurried (Figure 2). Nurses are invaluable during this process.
First visits may follow a standardised structure with the focus on educational and preventive health care (Belshaw et al, 2018). A checklist can improve the consistency of the experience (Belshaw et al, 2018). Suggested topics include vaccination, worming, flea treatment, microchipping, insurance, nutrition, neutering, dental care, behaviour and socialisation.
This is a great deal of information to be discussed with owners in one or two visits. The information, therefore, may be reinforced by including a pack or handout with the vaccination card. Subsequent appointments may be booked at this time or written down to act as aids to owner memory. Follow-up telephone calls may also be made to aid communication during this time.
Poor communication skills can be responsible for an owner’s lack of compliance regarding both medical treatment and implementation of behavioural protocols (Halls, 2018). Thankfully, client trust levels regarding first vaccinations seem high. One study of small animal veterinary clients, polled following their pet’s first visit, found their experience reassuring with a high level of trust that the vet would find if any problems existed (Belshaw et al, 2018).
The first visit often involves a vaccination. Vaccines are crucial for protecting the cat population against infectious animals (Gehrig et al, 2018). Core vaccines for kittens are feline calicivirus, feline herpesvirus-1 and feline parvovirus (WSAVA, 2018). Core vaccines for puppies are canine distemper virus, canine adenovirus, canine parvovirus type two and, in the UK, leptospirosis (WSAVA, 2018).
Multiple dosing of these vaccines is recommended, with the final dose delivered, if possible, at 16 weeks or older, and followed with a booster at 6 to 12 months of age. Vaccination with non-core vaccines, such as FeLV and infectious tracheobronchitis, should be discussed and, if appropriate, administered. Distraction of small patients with treats is recommended, as is use of a small gauge needle, such as a 25G.
Vaccination in the UK is common, with one-in-three small animal consults focusing on preventive health care and a significant percentage of this booked for vaccination purposes. In Germany, 77.9 per cent of cats were vaccinated and only 5.4 per cent of cats had never received a vaccine. Visiting a cattery, cat show or travelling abroad had the highest positive impact of vaccination status of German cats (Gehrig et al, 2018).
Young patients should be wormed with broad-spectrum products protecting against roundworms and tapeworms. Puppies should be wormed every two weeks, from two weeks of age to two weeks after weaning, and monthly up to six months (European Scientific Counsel Companion Animal Parasites [ESCCAP], 2017). Kittens should be wormed from three weeks of age, then every two weeks until weaning, and monthly to up six months (ESCCAP, 2017).
During the first consultation, the patient should be checked for evidence of fleas and a product, suitable for its bodyweight, applied. Regular flea control is recommended (ESCCAP, 2018) – especially for households with multiple pets in warm climates.
As from 6 April 2016, it has been a legal requirement that all dogs in England, aged eight weeks or more, must be fitted with a microchip (The National Archives, 2015). This must also be inserted before rabies vaccination is carried out. It is not legally required for cats to be microchipped, although feline microchipping may aid in recovering a lost pet. Biothermal microchips measure temperature as well as acting as a means of identification, but these devices typically underestimate body temperature (Greer et al, 2007).
Pet insurance allows vets to practise with fewer financial limitations. Insured clients spend more and visit the vet more frequently (Rollo et al, 2015). However, some clients don’t fully understand their policies or exactly what they are paying for, and some debate exists that pet insurance may facilitate overtreatment or extend life to a point that is not in the patient’s best interests (Loeb, 2018). Medical or congenital problems noted during the first examination will not be covered. Nevertheless, the benefits of pet insurance far outweigh the drawbacks to pet, owner and vet. Pet insurance should be discussed and recommended during the first consultation.
Following weaning, young animals should be fed for optimal growth and development. Nutrient deficiency may lead to stunted growth, while nutrient excess may lead to obesity and growth abnormalities. Many good quality complete kitten or puppy foods are commercially available. Food samples may be handed out at the first consultation or included in kitten or puppy packs.
Neutering remains a controversial and increasingly holistic topic. In females, neutering may reduce the risk of mammary neoplasia, although the scientific evidence for this may be weaker than first thought (Arlt et al, 2017). Additionally, it prevents pyometra, decreases the number of unwanted offspring and saves owners the inconvenience of seasons. However, neutering may lead to hormonal incontinence, especially in larger dogs (Byron et al, 2017).
Early neutering may increase the risk of prostatic neoplasia and transitional cell carcinoma in male dogs, hemangiosarcoma in neutered female golden retrievers, and osteosarcoma in female Rottweilers (Dickerson et al, 2018; Graf et al, 2016), as well as cranial cruciate ligament rupture in some breeds (Dickerson et al, 2018).
In males, castration may help to prevent antisocial behaviours and aggression. The decision to spay or neuter any pet should be made after a thorough discussion with the owner regarding the issues involved. Research is ongoing.
Puppies and kittens often enjoy grabbing things with their mouths; therefore, dental care should start early to postpone the need for procedures in the future. The process should begin with frequent gentle handling of the mouth. Once this is readily accepted, a pet-friendly toothpaste should be added, always followed with a treat or reward. A thimble toothbrush may then be introduced – brushing only a few teeth at a time until the animal is comfortable (Ray and Eubanks, 2009).
Early socialisation is recommended for both dogs and cats. Without positive learning experiences when young, animals may find it hard to deal with new experiences later in life. The effectiveness of socialisation is determined by the animal’s own personality type, as well as external factors. The optimal period for kitten socialisation occurs between two and seven weeks of age – often before many kittens are presented to veterinary surgeries (International Cat Care, 2017; Figure 3).
The puppy socialisation period is much longer – from 3 to 12 weeks of age (Blue Cross, 2019) – so puppy parties and practice socialisation schemes may be carried out following the first vaccination. Following this period, anything not encountered is likely to be approached with caution. This is yet another reason to ensure the first veterinary visit is a positive one.
Early socialisation may have a long-standing effect on behaviour (Hammerle et al, 2015). During the first consultation, the puppy’s or kitten’s behaviour should be assessed as appropriate for its life stage. Any problems seen should be addressed early with plenty of positive reassurance. Behavioural problems are the most common cause of euthanasia for dogs under three years of age in the UK (Belshaw et al, 2018), so it is important to solve problems as soon as they arise.
Owner compliance is vital when discussing health advice and making recommendations to owners of young pets; good communication is required to ensure this. Factors affecting compliance include dosing regimen, discussion of which considering the owners’ circumstances, consultation time, disease, month of consultation/treatment, physical risk, social risk and method of administration (Wareham et al, 2018).
Compliance may also be affected by factors outside the vet’s control – for example, time pressure, cost and animal tolerance. Scientific evidence is scarce regarding compliance; however, visual aids backing up recommendations made in the consult room may improve communication and ensure information is retained.
The first consultation is an important method of bonding clients to the practice. Visits should be positive and, as much as possible, relatively unrestricted by time constraints. Use of a checklist may ensure vital information is not missed, while handouts for clients to take home may increase information retention.
A typical first visit should focus on education and preventive health care. Owners often perceive the first visit to be focused on vaccination, but many other health issues – such as worm and flea treatment, microchipping, neutering, insurance, nutrition, dental care, socialisation and behaviour – must be addressed simultaneously. Good communication ensures client compliance.
Nurses are invaluable, and may be more patient and knowledgeable in matters such as socialisation than the vet, so should be enlisted wherever possible to provide an excellent first encounter as part of the practice team.
The author would like to thank Ardmore Veterinary Group, Jess Tuttle, RVN, and Karen Partridge for their assistance and photography, and Simon Bailey, BVetMed, MRCVS, for reviewing the article.
