At our vet, it is standard to have a yearly heart-worm blood test and since blood is being drawn anyway, I add the Chem 27. It is a little more expensive than a CBC but shows much more than just a CBC will and if anything comes up suspect on a CBC, you'll be paying much more to then have a Chem 27 run.
Definitely stool sample and physical exam by vet to look for any abnormalities, check joints, teeth, etc.
We don't do any vaccinations other than rabies any longer. I choose not to titer as a low titer does not mean they have low immunity, nor does a booster vaccination mean immunity will increase. And, you should never be vaccinating any dog with chronic, serious health issues (such as my Sissy).
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