Keeping Hospice In Veterinary HandsMay 2, 2012 Our focus with this article is on people who compulsively collect old or sick animals and proclaim themselves operators of pet hospice homes or sanctuaries. Unfortunately, most of these self-proclaimed hospice workers use little to no veterinary medical supervision. Their collected animals suffer to death without proper pain management, comfort care or the human-animal bond. They might have started out as good Samaritans, working alone or with a group, rescuing animals and keeping a few, then a few more. Over time, they develop a strong urge to “save” more old and sick animals that were “abandoned.” That urge develops into a compulsive disorder. They collect more and more old, sick and special-needs animals. When their animals die, they exhibit tearful distress, blind denial or experience a pathological enlightenment. Their compulsiveness to collect more animals winds up harming their animals, themselves, their neighbors and their communities. A certain percentage of compulsive collectors of sick and old animals can maintain their operations for a time. But eventually many find themselves overworked, in debt, depressed and overwhelmed. The tipping point is when they acquire more animals than they can properly care for and house. Another tipping point into …
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Construction Loans On The RiseMay 1, 2012 Lenders dedicated to the veterinary community say construction loan requests are up in the first quarter of 2012—in some cases double that from the first quarter of 2011. This increase is in part attributed to veterinarians’ need for additional space and lack of existing practices for sale. Not only are more veterinarians asking about loans, but more banks are willing to lend. While criteria for loan approval differ among lenders, experienced veterinarians able to prove a potential for profit are given consideration. “The down economy has forever altered the criteria by which veterinarians are approved,” says Annemarie Murphy, senior loan officer for Live Oak Bank of Wilmington, N.C. “A big difference is that lenders previously willing to give practitioners who filed bankruptcy a second chance, now are not. But strength of the individual to pay bills that would be acquired with a new practice on the amount of revenue currently generated is a good start.” Murphy says some who filed bankruptcy in the past but were given another loan again filed bankruptcy when practice revenue dropped. This is a risk banks are no longer willing to take. Interest Rates Lenders say interest rates for …
How To Ensure A Successful BuildMay 1, 2012 Before any successful commercial construction project begins, an “A Team” must be assembled: lender, architect, contractor and, of course, the owner. The team will work together to ensure a successful project and support the owner in decision-making. Some critical elements of all construction financings include sufficient capitalization and budget, timelines of the build-out, and the quality and strength of the contractor and architect. When the lender “builds” the project, a number of questions must be answered. Is the contract inclusive? An experienced lender checks contingency, permits, scope of work. What is and is not included as part of the project? Landscaping, security systems and phone generally are not included in the contract. Is the property properly zoned or does it need to be subdivided? What are the timelines on zoning and permits? What fees must be paid? Many municipalities require monies up front to review drawings, go through the planning process and issue permits. What is the deadline for closing on the land or building? Many times, a lender will provide a “bridge” loan to carry the project until the permit is issued. How many months will construction take? An experienced lender will add additional …
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 …
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. …
