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3:54 AM   April 16, 2014
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Phil Zeltzman, author of the Cutting Edge blog
Cutting Edge
Phil Zeltzman, DVM, Dipl. ACVS, CVJ, is a mobile, board-certified surgeon in Allentown, Pa. His website is www.DrPhilZeltzman.com. He is the co-author of "Walk a Hound, Lose a Pound: How You and Your Dog Can Lose Weight, Stay Fit, and Have Fun Together (www.WalkaHound.com). Zeltzman performs surgery on dogs, cats and exotic animals. In 2007, he became a diplomate of the American College of Veterinary Surgeons. Zeltzman is also a certified surgeon for the Tibial Plateau Leveling Osteotomy (TPLO). As an author, Zeltzman's goal is to write meaningful articles, newsletters and books that will make a difference in the lives of pets and their owners. He has published numerous articles in national and international veterinary journals.

March 17, 2014
Marketing 101: Open Letter to New (and Existing) Clients, Part 2
Dear Client,* Welcome to our practice. We are honored that you chose us to help you help your pet. ...More»

February 12, 2014
Marketing 101: Open Letter to New (and Existing) Clients
Dear Client,* Welcome to our practice. We are thrilled to have the opportunity to serve you and help your pet. ...More»

January 31, 2014
What were you born to do?
A surgeon friend of mine posts a quote after his email signature. I can’t help but read it every single time he writes ...More»

December 19, 2013
How I will help out Matt Damon this Christmas
A 14-year-old girl in Zambia was walking to get water for her family ...More»

November 27, 2013
Not ALL of Your Clients are Crazy!
It’s easy to dismiss "unusual” clients as "different.” ...More»

October 15, 2013
A Creative Motivational Tool for Your Team
What to do when there’s nothing to do ...More»

August 30, 2013
A Disaster Turns into a Happy Story
Daisy, a 9-year-old diabetic miniature Schnauzer was diagnosed with a mucocele ...More»

July 29, 2013
The Tortoise and the Hare—Revisited
Remember the classic story of the tortoise and the hare, told by Aesop in ancient Greece around 600 BC, and later by La Fontaine in France? ....More»

July 26, 2013
Interruptions
May I ask a personal question? Nobody has to know the answer. It will remain our little secret. Do you interrupt your clients? ....More»

June 25, 2013
Should You and Your Clinic Have a QR Code?
I don’t know how and where it first started, but it seems like QR codes are everywhere these days. Not sure what a QR code is? ....More»

April 17, 2013
The Art of Treating Otitis Externa
I enjoyed the last dermatology meeting I attended so much that I thought I should sign up for another one. This conference, presented by Brian Palmeiro, a board-certified dermatologist at Lehigh Valley Veterinary Dermatology in Allentown, Pa., was dedicated to the art of treating otitis externa and media. Turns out that the ear has its own self-cleaning mechanism....More»

March 19, 2013
Self-test: what kind of person are you?
Tasha, a 9-year-old female golden retriever, needed surgery to remove a thyroid tumor. Although the tumor was richly vascularized...More»

February 6, 2013
How One of Our Colleagues Changed the Bovine World
After stumbling upon the excellent movie "Secretariat,” I came across another amazing movie: "Temple Grandin.” Here are some highlights...More»

January 8, 2013
Be Successful By Not Making New Year's Resolutions
You’ve read it or heard it before: 25 percent of resolutions are broken in the first week of January...More»

December 18, 2012
Two Giants Died This Year
Besides splurging on silly gifts and empty calories, December is often a month to reflect. As I look back at 2012, I regret the loss of two giants, two legends, two geniuses...More»

November 19, 2012
Watch Your Mouth, Part 3
I’ve talked about what to say and what not to say to clients before, such as in my previous blogs...More»

October 15, 2012
Getting Sick on a Tropical Island = Rip Off
During a recent tropical vacation, one young member of our group became acutely ill the night of our arrival...More»

October 2, 2012
When Sally Met Her Banker
Sally’s life just changed quite radically. She had moved to a new town and got a new job at a wonderful vet clinic...More»

September 17, 2012
Excuse My French
Here is the fake story of my life. Please don’t analyze or overanalyze this blog; this little exercise is merely designed to show you that you know much more French words than you think...More»

September 10, 2012
Do You Know Your Clients’ Financial Secrets?
According to a recent and frightening CareerBuilder survey, 40 percent of Americans live paycheck to paycheck. More specifically, 44 percent of women and 36 percent of men are in this situation...More»

August 20, 2012
Animals Do It Better Than Men
Did you know that the Great Wall of China is visible from Space? Well, I'm sorry to tell you that it's a complete urban legend...More»

August 6, 2012
A Look at the Lives of Our Veterinary Forefathers
Imagine dozens of vets gathering once a year, fishing for shad all day, cooking their catch and eating dinner together as one big happy family...More»

July 16, 2012
A Cool Discovery During Horse Racing Season
During the recent horse racing season, I was fortunate to discover an incredibly wonderful, electrifying and riveting movie...More»

July 5, 2012
Watch Your Mouth, Part 2
Following our first installment on the vitally important topic of client communication, here are some more thoughts about things to say and things to ban...More»

June 18, 2012
Radiation Protection Conniption
Dr. McCoy doesn’t mince words. Here is an email he sent to his entire staff about radiation protection...More»

June 4, 2012
6 Ways to Win in Business
In a recent interview, John C. Maxwell described eight ways to lose in business. Rather than paraphrasing what the leadership expert and best-selling author wrote, I thought it would be more positive to describe six ways to win in business...More»

May 21, 2012
The Richest Vet in Babylon
Have you ever heard of the best-selling book "The Richest Man in Babylon”...More»

May 7, 2012
Learn This and Be a Life Saver
If you saw an adult suddenly collapse and become unresponsive, would you know what to do...More»

April 16, 2012
Watch Your Mouth
I am often stunned by what veterinary clients tell me about their experiences with colleagues, general practitioners or specialists. And the same situation seems to occur in human medicine. People, friends, family members often come back from their physicians and they don’t have a clue what they were told...More»

April 3, 2012
How Two Cats Died This Week
I am sorry to say that two cats died unnecessarily this week...More»

March 19, 2012
Why Humans Are Different From Any Other Species
The Mayan civilization self-destructed. For some reason, this is totally fascinating to me...More»

March 6, 2012
A Tetraplegic Recovers Without Surgery
Kelvin, a 50 pound, 4-year-old female spayed Husky mix was in bad shape. She presented with progressive weakness in all four limbs. Her recent history included a mild bout of diarrhea...More»

February 20, 2012
From Tears To Happiness In One Phone Call
Dr. M was heartbroken. Possibly on the verge of tears. And she called me, of all people, to find some comfort...More»

February 6, 2012
What on Earth Are You Thinking?
I have been listening to an audio-book called "Breakthrough Thinking,” in which the authors share some interesting concepts about the way people think...More»

January 17, 2012
From Drill Bits to Practice Philosophy
Finding the right drill bit for a very special job was not an easy task. At first, I visited the usual suspects: Home Depot and Lowes. Nothing...More»

January 5, 2012
How to Enjoy Your Next Christmas Party
Did you enjoy your clinic Christmas party? Or did you dread going? It doesn’t have to be that way. Here are some suggestions to lighten things up at your next clinic party...More»

December 19, 2011
Drug Shortage Frustration – The Reasons for Your Pain
Aminophylline, lidocaine, procainamide, doxorubicin, epinephrine, cisplatin, naloxone, furosemide, acepromazine, furosemide, vincristine, melarsomine (for heartworms), buprenorphine, diazepam, fentanyl, propofol, insulin, cytoxan, and many more...More»

December 5, 2011
Could You Retire with $1 Million?
We have all kinds of fascinating conversations in the OR. Whenever I dare to suggest that people need at least $1 million to retire (some people now say you need much more), I typically get the "have you totally lost your marbles” look...More»

November 21, 2011
An Epic Battle in the Dark
I’m no tree-hugger, but I was deeply affected by the recent Nor’easter that disfigured our Pennsylvania landscape in late October. I have never seen anything like it...More»

November 7, 2011
Put Gloves On… Reveal Your Soul
I occasionally ask a technician to scrub in and assist me in surgery. Most love the opportunity to "get in the action” up close and personal....More»

October 24, 2011
The Ellis Island of the West
It’s amazing which topics we talk about in the OR: occasionally desperately futile, sometimes insanely funny, and often astonishingly profound...More»

October 21, 2011
Could Your Practice Use a CWO?
Until recently, there were: The CEO, or Chief Executive Officer; the CFO, or Chief Financial Officer; the CIO, or Chief Information Officer; the CTO, or Chief Technology Officer; and a few others (CSO, CCO and CKO anybody?) ... More»

October 11, 2011
A Financial Pearl for Practices
Many colleagues don’t consistently charge for things we use in the OR: monitoring, cautery, suction, heating pad, heated surgery table, Bair hugger, etc. Yet there is no reason for that. ... More»

October 7, 2011
An Inspiring Clinic Visit
I recently visited a well-established practice owned by Dr. H, who, shall we say, is a "mature” veterinarian. It was a very interesting experience. ... More»

September 27, 2011
How I Helped a Technician Become a Millionaire
A few days ago we ended up talking about retirement with two technicians during a TPLO surgery. I have no clue how we ended up talking about it besides the fact that it’s one of my favorite subjects... More»

sept. 26, 2011
What's Inside a Hot Dog?
Can you believe that Americans eat 7 billion hot dogs a year between Memorial Day and Labor Day? Turns out that hot dogs contain a number of strange ingredients ... More»

August 16, 2011
The Modern Seven Wonders
During a recent continuing education seminar in Mexico, I was fortunate to visit Chichen Itza, a giant ensemble of Mayan ruins in the Yucatan peninsula. I was surprised to learn that ... More»

August 3, 2011
The Most Horrific Disease Ever
The "hook” on the cover sounded very exciting: "Cannibals, Killer Viruses, and Other Journeys to the Edge of Science.” But I wasn’t prepared for self-cannibalism ... More»

July 18, 2011
What on earth is evidence-based medicine?
It’s difficult to go to a professional meeting these days, without hearing the words "evidence-based medicine” every few minutes. But what on earth is evidence-based medicine? ... More»

July 05, 2011
Ancient But Magnificent Cities
The "hook” on the cover sounded very exciting: "Cannibals, Killer Viruses, and Other Journeys to the Edge of Science.” But I wasn’t prepared for self-cannibalism ... More»

June 13, 2011
Creative Crooks
Some stories told by some colleagues are simply amazing. Note: What follows is not a guide to being a creative crook, but a gentle warning for colleagues. ... More»

June 6, 2011
Alcohol is Your Friend
No, neither VPN nor myself would ever encourage anyone to drink. Rather, I wanted to discuss the popular alcohol-based hand sanitizers that have now become ubiquitous. You may have some at home, in your car, in your purse, in various  ... More»

May 31, 2011
Trust is Relative
A client was referred for an abdominal ultrasound on her dog, which we shall call India.  Our colleague was concerned about kidney disease A board-certified internist thought that the kidneys were within normal limits, but that the ... More»

May 17, 2011
How Poor Communication Gave Me an Ulcer
Tracker’s ultrasound was pretty conclusive: His elevated liver values were indeed due to a liver mass, and his enlarging abdomen was due to a hemoabdomen. The 12-year-old Australian shepherd’s future didn’t look too bright. ... More»

May 4, 2011
Are you proud of your clinic fridge?
I stumbled upon some notes I had taken in … January 2005 after watching a TV show. The show was "John Stossel Takes on Myths” on 20/20.Ten myths were exposed in classic Stossel style. The last one was ... More»

April 4, 2011
Do you know how to wash your hands?
Pop quiz:  How long do you wash your hands for? I recently came across several sources that answer that question. The real question, to be fair, should be: "How long does soap stay on your hands while you are washing them?”  ... More»

March 21, 2011
A Big Message Stems From Hypothermia
I was called to perform ACL surgery on a (thin) boxer. As I was ready to start surgery, the anesthesia technician and her tech assistant told me that the dog’s temperature was 95 degrees. We talked about various solutions to ... More»

March 7, 2011
The Magic of the Printed Word
Pop quiz: Who invented printing? Or who invented the printing press? In previous blogs, I wrote about a book I’m "listening” to.  In "Great Scientific Ideas that Changed the World,” Professor Steven Goldman describes how book printing ... More»

February 24, 2011
A Big Cat Dilemma
Florence Ollivet, a colleague who consultants for exotic and zoo animals in France and abroad, asked for my opinion about an 80 pound, 6-month-old female tiger. Because you know, I’m such a tiger specialist and all. ... More»

February 7, 2011
Stepping Outside of My Comfort Zone
In my "welcome blog” in October 2009, I promised that I would write about "recent professional meetings.” Well, surprise! I recently attended a dermatology conference, which turned out to be immensely more ... More»

January 17, 2011
How to Influence People … And Clients?
As mentioned in a prior blog, Fritz Wood, CPA*, CFP*, recently gave a presentation in King of Prussia, Pa. on "Surviving and thriving in this economy." ... More»

January 3, 2011
It’s Wonderful to be Wrong
Chynna, a 6-year-old Pit Bull mix, became acutely weak in the hind legs (paraparesis). She had no conscious proprioception (CP) in the right hind leg, decreased CP on the left side, and normal reflexes. This meant that her spinal lesion was ... More»

December 20, 2010
Having Fun at the Supermarkets
Sounds good so far. Sally is not a fanatical pantry-gate-keeper, just a healthy eater. Quoting her colleague John Berardi, Sally writes some rather entertaining information: "If it didn’t come from the ground, a tree or a plant, or if it didn’t have a mother...” ... More»

December 15, 2010
Wanna make money? First make your employees happy
As mentioned in a prior blog, Fritz Wood, CPA*, CFP*, recently gave a presentation in King of Prussia, Penn., on "Surviving and thriving in this economy.” ... More»

November 15, 2010
25 Q-and-A’s for Cutting Edge’s First Anniversary
One year … this little blog started one year ago. My commitment at the time was: "The blog, published on the 1st and 3rd Monday of each month, will deal with a variety of topics, surgical or not, scientific or philosophical, deeply profound ... More»

November 11, 2010
Pearls of Scientific Knowledge 
I’m reading a book about science written by Professor Steven Goldman. It’s titled: "Great Scientific Ideas that Changed the World.” OK, so actually I’m listening to the CDs while I’m driving (I am a mobile surgeon). ... More»

October 18, 2010
DO YOU OWN A SPLEEN? 
Dr. M. is a funny woman.  When she interviews potential technicians, she knows not to ask illegal questions, such as marital status, ethnic origin and age. ... More»

October 4, 2010
Notes from a financial meeting 
I was fortunate to be invited to a seminar given by Fritz Wood in King of Prussia, Pa. Wood, a certified public accountant and certified financial planner, gave an excellent presentation titled "Surviving and thriving in this economy.” ... More»

September 10, 2010
How to Lose a Client in 6 Words 
Fame, a 9-year-old Akita/shepherd mix, had difficulty defecating. Her referring vet noticed a large anal sac tumor. After a brief explanation of anal sac carcinoma, she told Fame’s owners: "You should put her to sleep." ... More»

August 26, 2010
Drugs in Our Collective Back Yard 
One of my favorite movies is "Medicine Man,” unquestionably an ancient movie because it was released in 1992. Sean Connery plays a scientist who finds a cure for cancer in the Amazon jungle. Some would say this movie sucks: There are no special effects, no car chases and no gunshots every 30 seconds. Yet I think it’s a great movie. ... More»

August 9, 2010
Answers From a Place of Authority  
As my English teacher used to say, "Generalizations are risky.” Clearly, the world would be simpler if life’s little problems had easy answers. However, answers are rarely black and white. They come in shades of gray ... More»

July 26, 2010
10 Deadly Sins of Untreated ACLs  
Clients sometimes ask what would happen if we didn’t address a torn anterior cruciate ligament.  Some colleagues suggest conservative treatment as a perfectly valid option. A non-surgeon colleague even wrote elsewhere that since people sometimes don’t need surgery for an ACL tear, then we shouldn’t need it in dogs.  With all due ... More»

July 12, 2010
A Short History of Medicine  
This brilliant story was relayed to me by Karol Mathews, a board-certified criticalist and professor of Emergency and Critical Care Medicine at the University of Guelph vet school (Ontario, Canada). She, in turn, had received it from a physician in Islamabad, Pakistan, who probably got it from someone else. It is interesting how we ... More»

June 21, 2010
When Clients Twist My Arm  
Fecchi, an 8-year-old Sheltie, had a firm, golf ball-sized mass in his left cheek. It was hard to be more specific since we couldn’t even open his jaw. Upon further exam, it looked like the mass was coming from the maxilla and/or the mandible. Clearly, a major reconstructive and possibly disfiguring surgery was necessary to ... More»

June 7, 2010
"We have met the enemy and he is us"  
If there were something larger than Texas, floating in the Pacific Ocean, do you think you would have heard about it?  Have you ever heard about pelagic debris?  How about chemical sludge? Now: have you heard about the thing that is larger than Texas, that floats in the ocean, and that is made of pelagic debris and chemical sludge ... More»

May 24, 2010
Do You Want to Retire Someday?  
Today, I would like to take a step away from medicine and surgery and focus on a topic that affects many veterinary professionals, whatever their positions. I recently read, yet again, some somber statistics about the financial health of Americans. 43 percent of Americans have less than $10,000 in retirement savings, excluding pension and housing equity ... More»

May 11, 2010
Despite Odd Requests, the Client Is Always Right  
Ultrasound revealed a hepatic mass in Colson, an 11-year-old male golden retriever.  Surgery was recommended to excise the mass. The owner is a physician’s assistant who works with a human surgeon. He insisted that a GI endoscopy be performed first. Despite the oddity of the request, we accepted. The scope revealed ulcerative ... More»

April 26, 2010
Is Palliative Surgery Ethical?  
You’ve heard of palliative chemotherapy. Sure, there are cases where we hope for a cure or a remission (think lymphoma). But in many cases, chemo is offered to increase survival despite a grim prognosis. And you’ve heard of palliative radiotherapy. For example, four fractions could be given to a dog with osteosarcoma when amputation is ... More»

April 12, 2010
Reflections of a Modern Dinosaur  
I was very disappointed by the disappearance of the print edition of the Journal of the American Animal Hospital Association.  Remember? That was in December 2003! Since then, several other journals have disappeared from mail boxes. The good news? Fewer unread journals gathering dust in our offices. And fewer killed trees. The bad ... More»

March 29, 2010
I Don't Want to Put Him Through This  
The most common line to decline surgery in my practice is "Yeah, well … I don't want to put him through this.” To be fair, it probably means different things to different people.  The vast majority of the time, I suspect that it means, "There is no way I'm spending that kind of money on this mutt.” Sometimes, it means that the owner is truly ... More»

March 15, 2010
Who cares about the diagnosis?  
Siouxsie is a 9-year-old female standard poodle who presented with dysuria and stranguria. Her diagnostic workup, which included an abdominal ultrasound, revealed an obstructive mass near the neck of the bladder. Traumatic catheterization and cystoscopy were unsuccessful at getting diagnostic biopsies. Exploratory laparotomy was ... More»

March 1, 2010
Feed Them and They Will Come  
Let me share a little secret with you.  "Feed them and they will come” is what speakers and sponsors say about you, dear reader. Please don’t tell anyone. It’s a secret. A referring vet once told me, half-jokingly: "It’s really strange. Young surgeons who have more energy and time, but less experience, are the one giving all the talks. Senior surgeons ... More»

February 16, 2010
Dealing With (Mis)guidance 
"I can’t believe what Dr. A told my client,” a colleague told me recently about an obstipated cat.  "He told her that cats do miserably after colectomy.” The owner went online, read a very different story, and went to Dr. B,  who referred her to us for surgery. This is a very delicate situation. Communication with referring vets is a like a religion. Should I ... More»

February 1, 2010
Anesthesia: It Ain’t Over Till It’s Over 
David Brodbelt, a British board-certified anesthesiologist, undertook a massive thesis known in the anesthesia world as CEPSAF. In the rest of the world, it is called the Confidential Enquiry into Perioperative Small Animal Fatalities. After the thesis was published, some more data has been published in various journals. Our colleague looked at ... More»

January 18, 2010
Who should euthanize Leia? 
"Leia’s owners are ready for euthanasia. Who do you want to do it?” It really was a sad situation. Leia, a 12 year old Jack Russel, had been losing weight over several weeks. She was vomiting and anorexic. Laparotomy confirmed exactly what the referring vet’s ultrasound had indicated: a small intestinal mass and enlarged mesenteric lymph ... More»

January 4, 2010
Changing the world, one patient at a time 
A local colleague, Dr. L, generated quite a stir in our referral community. Her dog Ursula, a 9 -year-old  golden  retriever, was recently diagnosed with hemoabdomen, widespread liver cancer and pulmonary metastasis, probably all due to hemangiosarcoma.  Strangely, Ursula never missed a meal, and her liver values were normal. There wasn’t much to do ... More»

December 21, 2009
Would you have euthanized this patient? 
I just lost a patient.  And I am devastated. Cuddles was a 13-year- old Maltese with right periocular swelling and enophtalmos. MRI revealed a nasal mass causing lysis of the right orbit. The mass extended in the periocular tissues. The owner was clearly informed that the mass was probably malignant. Surgery entailed enucleation and debulking of the ... More»

December 7, 2009
Spay a pet, save a life
Ever have a hard time convincing pet owners to spay their cat or dog?  You might want to share some compelling numbers with them. It actually might help you save your patient’s life. The risk of a dog having mammary tumors is 0.05 percent if she is spayed before the first heat. Then it shoots up to an 8 percent risk after the first heat, and 26 percent after the ... More»

November 16, 2009
How (In)competent Are You?
Some vets are constantly questioning themselves--not because they lack confidence, but rather, because they wonder how they could have done better. Are you confident in your diagnostic and therapeutic capabilities? Here is an interesting way to look at competence: There are four stages in every endeavor, whether you are doing a laparotomy, learning photography ... More»

November 2, 2009
Obesity is just as bad as smoking
The fact that obesity reduces lifespan is a well established fact in dogs and several other animal species. Dr. Kealy* and others have shown, in a classic study, that thin Labs outlive overweight Labs by almost two years (13 years vs. 11 years on average).  I’ve always wondered when physicians would show a similar correlation in people. They finally have. A recent article ... More»

october 19, 2009
Is Losing a Patient Worth $1.77?
I recently  had a skin biopsy performed by a dermatologist. When the results came in, I asked the receptionist to kindly send me a copy of the biopsy report. "Are you aware of the $1.77 fee?” she asked. After I fell off my chair, I managed to ask why there is a fee. And why $1.77? She didn’t have a good answer. She just works there. I considered never going back ever ... More»

october 16, 2009
Welcome to "Cutting Edge”
Welcome to "Cutting Edge,” a blog provided twice a month by Veterinary Practice News and yours truly. The blog will appear on the first and third Mondays of each month, and will deal with a variety of veterinary life topics--surgical or not, scientific or philosophical, deeply profound (let’s even say earth-shattering) or ever-so-slightly impertinent. We will explore surgical ...  More»

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