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Sunday, October 30, 2011

Determining Lifestyle Risk

As vaccine recommendations and protocols have changed over the years, the profession has moved from recommending a set of vaccines to every pet, to more of a risk-based assessment that takes into account a pet's lifestyle and environment.  It seems to make sense that a pet who isn't at risk for a given disease shouldn't worry about being vaccinated for it.  However, I don't believe it's as clear-cut as many might think. 

Let's take my in-laws as a great example.  They have a chihuahua and recently got a yorkie-chihuahua mix puppy.  These are small dogs who are completely babied and spoiled.  Most of their existence is inside a home, though they do go outside for short periods.  If I saw them in my practice as a regular client, I'd ask about their environment and likely come to the conclusion that these are indoor-only pets with little risk for exposure to leptospirosis or bordetella (kennel cough).  Based on a risk-assessment analysis, these vaccines (both consider non-core by many or most vets) do not need to be given.  However, I know a bit more about the environment of these dogs than the average person.  There is another dog next door to them that stays outside and lives in a fenced yard where there can be nose-to-nose contact, as well as spread of urine along the border.  My in-laws have also seen coyotes in the woods behind their house and though there is a fence eliminating direct contact, there is risk of the coyotes as lepto carriers urinating into the yard and therefore contaminating the soil.  Knowing these things it seems like my in-laws' dogs should certainly be vaccinated for lepto and possibly bordetella.  Would these risks be obvious to someone who hadn't been to their house?

How much of this information do we really get in a routine exam visit?  How many questions do we really ask of the lifestyle?  And how open are we to non-standard options?  I've seen plenty of "fluffy" dogs such as yorkies, shih-tzus, and other traditionally indoor dogs who go hiking and camping with their owners.  These dogs are at higher risk for exposure to lyme and leptospirosis, yet just to look at them you might think that they rarely touch grass and only through careful questioning do you learn the truth.  Also, do owners really share or volunteer all of the information we might need?  Where I practice there is only a low risk for lyme disease, so I don't recommend it for most pets.  But what about the pet who travels with their owners to the northeast where it's frighteningly common?  Will owners even think to tell us that they go to New Hampshire three or four times per year?  Will we think to ask about traveling?  

Now don't misunderstand me.  I actually do support asking the right questions and determining preventative care based on a pet's risks.  And I don't think we should vaccinate every pet with every vaccine "just in case".  But anyone in this profession needs to be very, very careful in their assessment of these risks and ask the detailed questions.  As in the case of my in-laws it might not be so clear-cut and we shouldn't let prejudices for or against vaccines cloud our judgement and decisions that would be best for the pet.

And to pet owners I would strongly recommend having open and honest discussions with your vet about every vaccine available.  Ask your vet what vaccines they carry, which ones are available, and whether or not your pet is at risk for each one.  You might be surprised at what your pet could be exposed to that is potentially preventable.