Change Is Inevitable; Profitability Is OptionalMay 1, 2012 The only constant in life is change; witness the veterinary profession over the past 50 years. Change has involved all facets of practice from species to quality and scope of medications and available treatment modalities. Reluctance to stay abreast of changes results in an increased chance of becoming obsolete in today’s competitive environment. This is especially true with the relative stagnation generated by an increased number of practices vying for the same limited pet population. To understand today’s problems, one must look back to the inception of veterinary medicine in the United States. Initially the profession’s minds and hands were not emphasized when price was placed on veterinary services. Most pets relax during laser therapy. Often, there was no charge for the diagnosis, only for the treatment. Compounding this problem, there was no charge for the treatment except for the medication. In other words, the profession was saying our time and expertise are worthless but the medication is worth far more than a reasonable markup. In essence, we became a store from the onset. Back in the early ’90s, we emphasized the sale of products. We marketed the practice as “one stop …
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Bond And Beyond Bonus Content: A Brief History Of The Veterinary Hospice MovementApril 30, 2012 EDITORS' NOTE: This is special bonus content for Alice Villalobos' May 2012 column, Keeping Hospice in Veterinary Hands. The veterinary literature advocating for pet hospice as a professional service has been evolving since the 1990s. Two main groups have organized the pet/animal/veterinary hospice movement. Historically, the first group is the Nikki Hospice Foundation, founded in 1996 by thanatologist Kathy Marrachino, Ph.D. Nikki organized the first and second veterinary hospice symposiums in 2008 with some veterinary faculty and in 2009 with almost no veterinary faculty. I was an invited speaker at the 2008 event and Dr. Dani McVety attended the 2009 event. Our thoughts are recorded below. As of Jan. 17, none of the veterinarians listed on the website as part of Nikki’s Board of Directors are still serving. An official statement of the University of California, Davis, Veterinary School says it has severed its relationship with the Nikki group and has nothing to do with the symposiums even though they will be on the Davis campus. This begs the question: Is there any veterinary oversight for organizing the third Veterinary Hospice Symposium scheduled for July? We …
Y/d Feline And Concurrent DiseaseApril 27, 2012 The most common concurrent condition is chronic kidney disease, said Lynda Melendez, DVM, medical director of clinical research at Hill’s Pet Nutrition of Topeka, Kan. About 30 to 40 percent of cats with feline hyperthyroidism also have chronic kidney disease, she said. The most common concurrent condition is chronic kidney disease, said Lynda Melendez, DVM, medical director of clinical research at Hill’s Pet Nutrition of Topeka, Kan. Veterinarians have had nutrition as a new tool for managing feline hyperthyroidism for a little more than six months. Previously, veterinarians typically relied on radioactive iodine, thyroidectomy or anti-thyroid drugs, options that can prove expensive and have varied side effects. Nutrition can also be useful in managing concurrent diseases associated with hyperthyroidism, according to Hill’s Pet Nutrition Inc., which launched its Prescription Diet y/d Feline Thyroid Health in both dry and wet formulations late last year. The most common concurrent condition is chronic kidney disease, said Lynda Melendez, DVM, medical director of clinical research at Hill’s Pet Nutrition of Topeka, Kan. About 30 to 40 percent of cats with feline hyperthyroidism also have chronic kidney disease, she said. “Since [both are geriatric diseases], it’s not at all surprising …
Palliative And Hospice Care Come Of AgeApril 23, 2012 Palliative care and pet hospice are emerging as viable professional options that every practitioner can and should offer the owners of terminally ill pets. Veterinary practices will encounter more issues with terminal diseases, especially cancer, because pets are living longer as family members in very caring homes. High-tech facilities can maintain seriously injured or ill animals for long periods. Modern technology forces pet owners into the dilemma of pulling the plug or enduring costly and potentially futile life support. Instead of offering only this either/or model, veterinarians should give clients the option to take terminal pets home on palliative care to die in the comfort and support of the hospice setting, or as I refer to it, Pawspice. Minimalist Medicine Patriarchal veterinarians relate to their clients authoritatively. They generally tell pet owners what to think and what to do rather than help them decide. They direct, persuade or control clients to elect either aggressive care or euthanasia. This dictatorial approach sends the message, “I am practicing ‘My way or the highway’ medicine.” Many pet owners flee this style of practice, which patriarchal veterinarians might claim is down to earth and practical. On the other …
Reflections On The International Symposium On Veterinary Hospice CareApril 23, 2012 Reflections on the International Symposium on Veterinary Hospice CareReflections on the International Symposium on Veterinary Hospice CarebondbeyondPosted: April 28, 2008By Alice Villalobos, DVM The first pet hospice conference’s purpose was to merge the medical aspects of end-of-life care with the psychosocial and spiritual aspects. According to Kathryn D. Marocchino, Ph.D., president and founder of the Nikki Hospice Foundation, this collaborative meeting was the first of its kind and brought together a diverse group of health care workers. Marocchino organized the symposium at the University of California, Davis. Hospice professionals like Dr. Marrochino, hospice volunteers, nursing and medical staff, psychologists, grief counselors, social workers, bereavement facilitators, death educators, veterinary chaplains, pastoral counselors, animal-health care workers, shelter and SPCA staff, animal communicators, pet cemetery personnel, pet massage therapists and pet-sitters including interested lay people assembled to discuss the medical and emotional aspects of hospice care. This unusual group of human-animal bond oriented people sat side by side with general practitioners, specialists, holistic veterinarians, registered technicians, animal nurses, students, practice managers and philanthropists who maintain private or non-profit pet hospice facilities. Marrochino’s goal was to develop a comprehensive, broad-based approach to veterinary hospice care. This may not …
Bonus Content: Let’s Regard End Of Life As A Distinct StageApril 23, 2012 EDITORS' NOTE: This is special bonus content for Dr. Villalobos' article, Let's Regard End of Life as a Distinct Stage. To read the full story, click here. Here are three examples of the End of Life stage: 1) Hemangiosarcoma in dogs is often diagnosed at extremely advanced stages after acute collapse from a hemoabdomen crisis. Those with rampant metastases are advised that surgery is unhelpful. These TIPs are immediately in late EoL phase. Most terminally ill patients would be offered the gift of euthanasia at the emergency clinic. Some might be released with a belly wrap, steroids, Yunnan Paio and pain medication with a signed consent form, to go home for hospice care and farewell with home euthanasia. 2) Hemangiosarcoma dogs with hemoabdomen from ruptured splenic lesions that undergo splenectomy may go from crisis to good health following surgery. Overall survival times are 89 days and not much better with treatment. These TIPs are in the middle EoL phase. We are seeking these dogs for a clinical trial using T-Cyte. Contact me at dralicev@aol.com. 3) …
Helping Clients Afford To Say ‘Yes’April 5, 2012 No one better understands the value of the human-animal bond than veterinarians. But as small-business owners with considerable overhead invested, veterinarians know that good practice management calls for responsible fee collection. Technological improvements increase pet owners’ expectations for good outcomes, though advanced procedures and care demand additional equipment and training, which also add to costs. This is where third-party financing can help boost a veterinarian’s bottom line. Practices can make financing available so that patients who don’t have insurance, cash or credit lines, or choose not to use them, can select and pay for the optimal treatment. “The ability of veterinarians to care for pets has grown exponentially with the advancement and availability of technology,” says Mary Beth Leininger, DVM. “We can fix things we couldn’t fix before.” Dr. Leininger is vice president of veterinary relations for ASPCA Pet Health Insurance, a subsidiary of the Hartville Group, with headquarters in Canton, Ohio. “People have a strong connection to their pets,” she says. “They consider them members of the family. So when the pet needs treatment, it is not so much that we have to talk them into the procedure and the cost. …
Warming To The RoleApril 5, 2012 When clinics add laser therapy to their pain-management arsenal, veterinary technicians often become the point people—and the most ardent advocates—of the technological advance. In the beginning, however, it’s not unusual for them to harbor a healthy dose of skepticism. Anneke Van Tricht is among those who took no convincing. In fact, before she’d ever used the Companion Therapy Class IV Laser that is now her veterinary tool of choice, she was sure it would ease patients’ pain and increase their mobility. You might even say she felt it in her bones. Especially in her vertebrae. “I had experienced the benefits of laser therapy on the human side with my own back (injury) five years ago,” said Van Tricht, a veterinary technician at Midway Animal Hospital in Seminole, Fla. “It saved me from surgery. For me, it’s a miracle.” Wielding the hand piece of relief is now one of her favorite tasks, Van Tricht said. Not only does it give her the chance to have a direct effect on patients’ quality of life, it makes her a driver of a significant source of new revenue for the practice. Not all clinic duties carry such rewards, …
Digital Radiography Is Becoming NormApril 5, 2012 Remember when Caparsolate was used to treat heartworms? When halothane was the most common inhalant anesthesia? Or when X-ray film was developed by hand-dipping a metal frame into tanks of solution in a darkroom, then hanging it to dry? New veterinary graduates may have to Google “Caparsolate” and “halothane,” and in the near future they may have a hard time finding a veterinary practice that still develops X-ray film. Digital radiography, which eliminates the darkroom, chemicals and manually filed plastic film, moseyed into veterinary medicine in the early 2000s, hit its stride around 2004, and today is galloping full-tilt into mainstream use. “The technology has gotten better, the software has gotten better and the prices on the client side have gotten better,” said Seth Wallack, DVM, Dipl. ACVR, who practices in San Diego. “The time of the early-adopter of digital is over, and now it’s more mainstream. It’s becoming the norm.” Digital technology is much faster than conventional radiography, and the software allows adjustment of brightness, contrast, zoom and pan on a single exposure. As long as the patient is positioned correctly, most everything else can be fixed by the machine’s controls. “Digital radiography …
Is This Town Too Small?March 30, 2012 Remember the old westerns, where the good guy (or bad guy) would say, “This town ain’t big enough for the two of us.” Something similar is happening in veterinary medicine. The “guys” are boarded specialists versus non-boarded but highly experienced generalists, and I’m not sure which one is the bad guy and which is the good guy. Actually, I’m not convinced that the town is too small for the two of them. Recently at American Animal Hospital Association in Denver, I hosted a table called “Building Referral Relationships,” where up to 10 people who registered in advance got the opportunity to come brainstorm, share and learn from each other about a topic they selected. As people gathered at our table, silly me thought that I needed to find out whose camp they were in, the referrers or the referring. Turns out most of them wore both hats. Several were generalists who may refer a patient on to a specialist in some instances, but they were also highly experienced (particularly orthopedic surgeons) so they received referrals from the community based on their reputation. Quite an interesting discussion took place. It actually reminds me of the struggle the …
