Canine Cushing's Case Files: The ins and outs of detection and treatment-Case file: Your veterinary team's role in identifying dogs with hyperadrenocorticism (Sponsored by Dechra Veterinary Products)

Every day, each member of your veterinary team plays an integral role in helping pets receive regular preventive care, identifying pets that need further veterinary evaluation, and ensuring patients receive appropriate follow-up care. When your technicians and other team members are well trained, they can help keep clients informed about signs of illness in their pets so diagnoses can be reached earlier and treatments initiated sooner.

Teach your team about Cushing's

Educating clients about the signs of disease in older pets is especially important, because clients often attribute clinical signs to "normal" aging, and their pets' health may in fact be deteriorating. For example, pet owners may misinterpret some clinical signs of hyperadrenocorticism (HAC, also known as Cushing's syndrome) such as lethargy and increased urination and drinking as normal, age-related changes. Therefore, team members should understand HAC so they are comfortable communicating with clients about identifying affected pets.

This article reviews basic information about canine HAC that team members should know to help veterinarians at the practice identify potential Cushing's patients. Your team should understand the different types of HAC (see boxed text "What is hyperadrenocorticism?" ), be aware of client comments that signal potential clinical signs of the disease, and help reinforce your message to clients about why multiple diagnostic tests may be needed.

What is hyperadrenocorticism?

Normal aging or "red flags?"

Your practice should already be educating clients about the importance of senior wellness examinations and diagnostic senior testing, which will uncover underlying illnesses in older dogs. The clinical signs of HAC and many other illnesses can develop slowly, and many owners may simply chalk them up to normal aging. This is where you need your team to be your eyes and ears.

Your technicians and receptionists should listen carefully when clients report signs of aging in their pets, and use their expertise to help identify these signs as initial "red flags" for the veterinarian. (See boxed text "Red flags raised during client conversations.") These signs can often have a profound effect on quality of life for the pet and of the owner.

Red flags raised during client conversations

Your team members are often the first to realize there may be a problem and should take the opportunity to engage owners in a conversation about their pet's behavior at home. If owners say that their dog is fine, that he's just acting old, a team member should inquire further about what owners mean by this. Technicians can start this conversation and help set the stage for veterinarians to get owner approval for diagnostic testing.

Explaining initial tests

For pets with clinical signs and physical examination findings suggestive of HAC, team members should know that simple blood and urine tests will be the first step in the diagnostic plan. These baseline tests — a complete blood count, a serum chemistry profile, and a urinalysis — are usually components of senior wellness testing. Certain abnormal results (such as changes in liver enzyme activities, cholesterol or triglyceride concentrations, blood cell counts, and urine concentration) may signal the need for more diagnostic tests to identify HAC.

If the veterinarian suspects HAC based on the pet's clinical signs and baseline test results, then more specific testing is required. Your team can help alleviate apprehensions about testing by educating owners about these tests. They can help explain in plain language what information the results may yield. It is also important for clients to be told that there is not one simple test to confirm the diagnosis of HAC; multiple tests may be required. (See Table.)

Table: Common initial tests to help identify canine hyperadrenocorticism

Explaining tests to distinguish PDH from ADH

Once a diagnosis of HAC has been made, team members can reinforce your message to clients that it is important to determine if the patient has PDH or ADH because this affects a patient's prognosis and treatment planning. Patients with ADH may have malignant tumors on the affected adrenal gland, which may invade local vital structures. In some cases, surgery to remove the affected gland is recommended.

If the initial diagnostic test results do not differentiate between PDH and ADH, then additional tests may be needed. These include abdominal ultrasonography to evaluate the adrenal glands; a high-dose dexamethasone suppression test, which is similar to the LDDS test but uses a higher dose of dexamethasone to assess cortisol suppression; or a computed tomography scan (CT-Scan) or magnetic resonance imaging (MRI) to evaluate the pituitary gland.

Your eyes and ears

Your team members are your adjunct eyes and ears when a client first arrives at your practice. They spend the majority of their time communicating with all your clients, in person and on the phone or via email or social media. And the veterinarian's message carries much more weight when it is consistently and repeatedly delivered by every person the client encounters at your practice.

The veterinary team can be instrumental in identifying those dogs in which signs of old age are attributable to HAC. Hyperadrenocorticism is a complex disease process, but successful management is possible with the help of a dedicated veterinary team.

The next Canine Cushing's Case Files article will continue with a discussion of the team's role in the treatment and monitoring of dogs with HAC and direct you to readymade team training and client education resources for your practice.

Learn more with these online resources

Go to the Dechra Veterinary Products CE Learning Center at www.dechrace.com and choose one of the online CE modules to learn the latest on managing feline hyperthyroidism and canine hyperadrenocorticism. Plus earn free CE!

• Diagnosing and treating canine hyperadrenocorticism

Presented by Audrey K. Cook, BVM&S, MRCVS, DACVIM, DECVIM, and David s. Bruyette, DVM, DACVIM

• Cushing's disease: Inside and out

Rhonda Schulman DVM, DACVIM, and John Angus, DVM, DACVD

• Diagnosing and treating feline hyperthyroidism

Presented by Andrew J. Rosenfeld, DVM, DABVP

Then get your whole team on the same page, by visiting the Team Meeting in A Box section at www.dechrace.com

• Stop getting burned by ear infections

How you handle otitis externa and ear infections can make or break client bonds—and dogs' well-being. Use this Team meeting in a Box to create a team approach to help pet owners and heal patients.

• Coping with Cushing's syndrome

Pets with Cushing's syndrome suffer from a chronic illness that will be managed throughout the pet's life, not cured. This Team Meeting in A Box will help you deliver a successful team-wide approach.

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