The Role Of Outreach In Honing Endoscopy SkillsApril 17, 2009 Like every other form of new technology, endoscopy is only as good as the practitioner using it. For some, a lack of experience with the equipment can build a roadblock to success. In the relatively short history of the technology in veterinary medicine, some general practitioners have been known to go weeks or even months between chances to use their rigid endoscopy equipment. Those who have used it only for procedures such as lung lobe removals or liver biopsies might have gone as long as six months between surgeries. “If you’re going six months without performing a procedure, it’s easy to lose confidence in your ability,” says Raymond Cox, DVM, founding partner of Deer Creek Animal Hospital in Littleton, Colo. The solution championed by Dr. Cox and several colleagues is to make endoscopy an indispensible tool of their everyday practice. Aided by a study that established a pain advantage, they started using laparoscopic equipment to perform spays. They also took a big step to close the gap on experience and confidence. By reaching out to shelters and rescue groups with an offer to perform procedures for free or at a greatly reduced cost, the veterinary …
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Know What To Say When Fees Are IssueApril 17, 2009 At veterinary practices all across America, perhaps no other task turns more palms sweaty and causes more throats to seize up than telling a client how much a procedure costs. “Most employees I know would prefer to do almost anything than to present an estimate,” says Shawn McVey, MA, MSW, a veterinary management consultant and lecturer. “For veterinarians, there’s almost a shame or embarrassment in talking about fees.” That shame is symptomatic of a bigger problem in veterinary medicine, adds McVey, chief executive officer of Innovative Management Solutions and co-owner of the continuing-education conference Veterinary Specialists in Private Practice. “We’ve done an abysmal job of talking to clients about the value of veterinary care.” McVey’s is among the loudest voices calling for a sea change in the way veterinary practices communicate with clients about the cost of care. He offers tips on overcoming money-related obstacles and advocates scripting responses to acclimate staff. But first, all those at the practice have to undergo “a complete shift in mindset,” he says. “For too long, we’ve been internally focused, comparing ourselves to others rather than to what our clients say they want and …
What's Your Diagnosis? Reasons For LamenessApril 17, 2009 Signalment: 9-month-old male German shepherd History: Patient presented for lameness of the right forelimb and pain on palpation of the humerus and midantebrachium. Questions: 1. What are the primary findings? 2. What do you think is the primary reason for the clinical signs? Radiographic Findings: Increased medullary opacity is noted in the proximal diaphysis of the ulna as well as the mid to distal diaphysis of the radius. The elbow is normal. The line of the medial coronoid process is normal on the lateral view. The humerus is normal. There is no evidence of elbow dysplasia or united anconeal process in this patient. Interpretation: The proximal ulna shows signs of panosteitis. This is likely the cause of the lameness, particularly given the clinical exam findings. The lack of radiographic change in the humerus does not rule out this diagnosis, as the radiographic signs can lag behind the clinical signs. Discussion: When evaluating radiographs of the skeleton of the immature animal, it is necessary to have knowledge of the normal anatomy, in particular, the sites of physes and the normal closure times. The most common reason that the axial skeleton of an immature …
Integrating A Class IV Laser Into The PracticeApril 17, 2009 Veterinarians say Class IV therapeutic laser therapy is an important component in pain treatment, often decreasing or eliminating the need for steroids and pain medication, while adding a therapeutic approach that can be performed largely by technical staff. “Technicians perform about 98 percent of the laser treatments in our practice,” says Charles Eager, a seven-year veterinary assistant at Vulcan Park Animal Care in Birmingham, Ala. “We’ve used the procedure on more than 200 animals, and it’s been well received by our clients." Veterinarians say the laser is an excellent addition to any practice because of its diverse uses. The laser can be used alone to treat a multitude of disorders or as an adjunct to routine procedures or surgeries. Spreading the word that a practice offers laser treatment therapy can be as simple as including the modality on an online listing of services and adding a poster in waiting and exam rooms. “I list the therapeutic laser as a treatment option on my clinic’s website,” says Dennis Woodruff, DVM, of Avondale Veterinary Healthcare Complex in Des Moines, Iowa. “Many people inquire about the treatment when looking for a modality other than anti-inflammatory drugs.” Pricing …
Home Testing Helps Owners, Vets Regulate Diabetic PetsApril 17, 2009 When Shelby developed diabetes several years ago, it was difficult for her owner to regulate the cat’s blood glucose level between visits to the veterinarian. Subsequently, Shelby, an 18-year-old female domestic shorthair, failed to show any signs of improvement and disease management while at home. Much like human diabetics, dogs and cats can benefit from daily monitoring to ensure proper blood glucose levels are maintained and to catch any potentially dangerous fluctuations before they reach a critical stage, some veterinarians say. Since it’s impractical for some owners to take their pets to a clinic for daily or even monthly checkups, veterinarians are discovering that in-home monitoring of blood glucose levels can help diabetic dogs and cats by providing additional information to assist in their prescribed treatment. Sara Ford, DVM, a veterinarian who specializes in treating diabetic animals at the VCA Emergency Animal Hospital and Referral Center in San Diego, evaluated Shelby in December 2006. Dr. Ford determined that the cat was a perfect candidate to have her owner, Helen Phillips, try in-home glucose monitoring using a portable hand-held meter. Not a Cure-All by Itself Many factors beyond a veterinarian’s control can affect an animal’s BG …
The Proper Care And Repair Of Surgical InstrumentsApril 17, 2009 To Katherine Traland, a licensed veterinary technician, taking good care of surgical instruments just makes sense. “You need to be able to trust that your instruments are going to do what you need them to do. Scissors won’t work correctly if they’re dull; a clamp that does not close properly is going to cause problems,” says Traland, who works at Red Bank Veterinary Hospital in Tinton Falls , N.J . Plus, Traland adds, her practice spends thousands of dollars annually to buy good instruments, “So you want them to last.” Yet many veterinary professionals have received little formal education as to the proper care and repair of surgical instruments, or have formed bad habits over the years, says Alex Vrancich, vice president of Spectrum Surgical Instruments in Stow, Ohio. The good news: It takes only a few minutes daily to properly care for instruments, and good habits are as easy to learn as bad ones. Instrument Care The most crucial step, Vrancich says, is to deal with instruments immediately after use. Even though instruments are made of stainless steel, that in itself is a misleading name; instruments can …
Digital Benefits Shine ThroughApril 17, 2009 When veterinary dentist J.R. “Bert” Dodd converted to digital radiography in his private practice four years ago, it wasn’t because he craved the faster processing or the improved imaging or the cost savings of eliminating film and chemicals, or the easy image archiving. It wasn’t any one of those things. It was all of those things. “I tell veterinarians that a digital oral radiology system is just about the best investment a veterinary hospital can make, and I’ve invested in a lot of equipment over the years,” says Dodd, DVM, Dipl. AVDC. “The system can pay for itself in a short time—six to eight months—and then it becomes all profit,” adds Dr. Dodd, now a clinical associate professor practicing at the veterinary medical teaching hospital at Texas A&M University. “You can diagnose more, and diagnosing leads to more treatment as well as better care.” Adding up all the benefits made digital a no-brainer for Dodd’s individual practice. And now that he’s teaching as well as treating patients, it makes even more sense, he says. “We have so many students here taking pictures, if we were using film, we wouldn’t even have enough developing …
Wait TrainingApril 17, 2009 Pets squirm and clients fidget. Stress levels rise even during short delays. Anything longer and time seems to stand still. Let’s face it, waiting to see the veterinarian doesn’t top anyone’s list of fun things to do. But with some proactive measures, practitioners can turn anxiety and impatience into knowledge and understanding—even added revenue. One solution is vendor-produced video programming pegged to a practice’s specific strengths. Several companies offer customized systems that deliver digital broadband, high-definition programming. Content that’s part education, part entertainment plays on flat-screen digital monitors mounted in reception areas, reinforcing a view of the practice as high-tech and cutting-edge. Perceived waiting time—clients’ No. 1 complaint—is greatly reduced, as are client stress levels, subscribers say. Some companies offer customized programming specific to the wants and needs of a particular practice. Programming can include the credentials of doctors and staff, special services and products, a virtual tour of the hospital, heartworm and flea awareness, and seasonal promotions such as Dental Health Month. Some systems offer subtitles, allowing the sound to be lowered or muted. “Our clients really enjoy watching the educational programming in our reception room,” says Daniel Aja, DVM, past president …
Integrated Systems Herald An Ultrasound Of ChangeApril 17, 2009 About a decade ago, when Allen Kaat first entered veterinary hospital management, “information technology” didn’t go far beyond the traditional files stored in metal cabinets. “There was a computer on the desk, but it was basically a cash register,” says Kaat, hospital director for the 17-doctor Animal Emergency & Referral Center in Northbrook, Ill. These days, Kaat and his colleagues are much closer to the cutting edge of new technology. They’re working to implement management application software that communicates throughout the building, linking to digital equipment that includes ultrasound, digital radiography, fluoroscopy, MRI and CT. “I’m all about integration,” says Kaat, who spent 11 years in the IT industry before shifting into his current role. “When you have a 30,000- to 40,000-square-foot hospital, integration of your modalities with your management application system is critical. The less data entry you do, the better off you’ll be.” Kaat had integration on his mind as he led an 18-month search for the right practice management software to support the emergency and specialty-care hospital, which is seeing growth of about 20 percent a year. He started with a dozen candidates and quickly pared the list to …
Scope Out A Specialty And Grow From ThereApril 17, 2009 When David Weule, DVM, decided to add endoscopy to his small-animal practice, he knew just what he wanted most from the technology. His wish was as clear as the ears on his patients’ heads. Leveraging a consistent, specialized need among patients—in this case otoscopy—is a good way to get started with the technology of endoscopy, say those who make and sell the equipment as well as the practitioners who use it. “I knew it was the next level of diagnostics, and I knew it could give patients and clients the next edge up on better medicine,” says Dr. Weule, owner-operator of Rainbow Veterinary Hospital in Burbank, Calif. “There isn’t a day that goes by when we aren’t using the scope on ears. That’s the thing we do the most, and we’ve gotten really good at it.” Video otoscopy is far from the only use found by Weule (pronounced Wiley) since he added endoscopy equipment two years ago. He has followed another recommendation of experienced users: Plan for the future and prepare to expand your opportunities. After considering his options, Dr. Weule opted for a system from Karl Storz Veterinary Endoscopy in Goleta, Calif., …
