How to Design a Safe OfficeApril 17, 2009Mark Crootof, DVM, has more than 30 years of practical veterinary experience and has brought his expertise to the business of consulting. With Strategic Veterinary Consulting of Asheville, N.C., Dr. Crootof walks veterinarians through all aspects of the veterinary business, from practice startup to expansion. He says his clients often call on him for office planning to ensure a less hazardous work environment for staff, pet owners and patients alike. Crootof provides some basic tips to keep your practice accident-free. Traffic Flow Crootof says efficient traffic flow throughout the practice decreases injury. Many veterinary facilities segregate dog and cat waiting areas. “Most separate cat owners from dog owners,” Crootof says. Separation keeps animals calmer and helps prevent biting and scratching behavior problems during examination. Crootof recommends using “entrance” doors for moving clients from waiting areas to exam rooms and using different “exit” doors for moving clients back out to the reception and bill-pay areas. “Eliminate congestion by going in and out of different doors,” Crootof says. He explains that some facilities have even started cashing clients out in exam rooms to further reduce reception-area congestion. Less reception-area traffic significantly reduces the likelihood of animals interfacing with one another and ultimately …
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Small Animals Benefit On Whole Foods DietApril 17, 2009 1. Liu H.R., "Health benefits of fruit and vegetables are from additive and synergistic combinations of phytochemicals.” American Journal of Clinical Nutrition, 2003; Vol. 78, No. 3, 517S-520S 2. Raghavan M., et al, “Evaluation of the effect of dietary vegetable consumption on reducing risk of transitional cell carcinoma of the urinary bladder in Scottish Terriers.” Journal of the American Veterinary Medical Association, 2005; Vol. 227, 94-100 3. Remillard R.L., Paragon B.M., Crane S.W., et al: “Making pet foods at home,” in Hand MS, Thatcher CD, Remillard RL, Roudebush P (eds): Small Animal Clinical Nutrition, ed 4. Topeka, KS, Mark Morris Institute, Walsworth Publishing Company, 2000; 163–182. 4. Angelino PD et al, “Residual alkaline phosphatase activity in pasteurized milk heated at various temperatures-measurement with the fluorophos and Scharer rapid phosphatase tests.” Journal of Food Protection, 1999; 62(1):81-85 5. Severi S., et al, “Effects of home-based food preparation practices on micronutrient content of foods.” European Journal of Cancer Prevention, 1998; 7(4): 331-335 6. Yadav SK and Sehgal S, “Effect of home processing on ascorbic acid and beta-carotine content of spinach (Spinacia oleracia) and amaranth (Amaranthus tricolor) leaves.” Plant Foods for Human Nutrition, 1995; 47(2): 125-131 …
What's Your Diagnosis?Evaluating The VasculatureApril 17, 2009Click here to claim one hour of continuing education credit with this article. Signalment: 11-year-old male, castrated Chinese crested dog History: Patient presented on emergency for labored breathing and a wet cough. He had been coughing for about a week. Thoracic radiographs were obtained. Questions to Answer: What are the primary findings? What do you think is the primary reason for the clinical signs? Radiographic Findings: The heart is enlarged and measures just over 3 intercostal spaces wide. The vertebral heart score is approximately 11.5. There is dorsal displacement of the entire trachea, suggestive of ventriculomegaly. There is straightening of the caudal cardiac waist, consistent with left atrial enlargement. The pulmonary vein to the cranial lung lobe is larger than the corresponding artery. A diffuse, interstitial pattern is noted in the caudal dorsal lung fields. Radiographic interpretation: Enlarged heart, particularly the left side, consistent with chronic valvular disease. Enlarged pulmonary veins and an interstitial pattern in the caudal lungs are most consistent with pulmonary edema from congestive left-sided heart failure. The first step …
Ease Of Use And Training Smooths Transition To DRApril 17, 2009 George Myatich, VMD, doesn’t claim to be a technological wizard. But, then, he has found he doesn’t have to be, even as he vaults into the digital age of veterinary medicine. In November, when Dr. Myatich converted his Hidden Valley Animal Clinic of McMurray, Penn., to digital radiography, he ditched his wet system and film cassettes without trepidation, he says. “I’ve been in practice for 34 years, so I’m an old-school veterinarian,” Myatich says. “But since I was first introduced to digital radiography about five years ago, I’ve been rolling around the idea and wanting to take advantage of the benefits.” Getting an image in five to eight seconds was a key benefit that helped hook Myatich on digital. So was the chance to manipulate images to improve the quality or to focus on an area of highest concern. However, he says, it was the ease of the transition to digital radiography that cemented his appreciation for the new technology. “Our technicians were eager to make the change, and it turned out it wasn’t that big of a challenge for any of us. I’m not an Einstein, but everything was fairly straightforward.” Like …
What’s Your Diagnosis? Identifying Peritoneal AirApril 17, 2009 Signalment: 15–year-old female, spayed domestic shorthair with history of gastrointestinal lymphoma. History: Patient presented for labored breathing and lethargy. Thoracic radiographs were obtained. Questions: What are the primary findings? What do you think is the primary reason for the clinical signs? Radiographic Findings: The heart is mildly enlarged and the atria are prominent, suggestive of cardiomyopathy. The pulmonary parenchyma and pulmonary vessels are normal. In the viewable cranial abdomen, there are multiple, free, round gas bubbles noted. Of particular note is the bubble of air noted in the vicinity of the liver on the left lateral view adjacent to the diaphragm. There are other accumulations of air noted as small gas bubbles that are not conforming to the GI tract in the cranial ventral abdomen. The right side of the abdominal side of the diaphragm is visible on the VD view. There is also loss of surface detail noted in the midventral abdomen around the small bowel. Radiographic Interpretation: Free peritoneal air. Possible effusion in the mid-abdomen. Possible mild cardiomyopathy without evidence of heart failure. Visceral Surface Detail: Visualization of structures in the abdominal cavity is due to the differential radiopacity of the …
Investing In High-Quality Cages Can Provide Many Happy ReturnsApril 17, 2009 Life moves fast at Metropolitan Veterinary Referral Services, where a 24-hour intensive-care unit forms the hub of a bustling internal medicine specialty practice. Still, Eric Goullaud, DVM, Dipl. ACVIM, finds time to reflect. The way he sees it, he has no other choice. “Because we are a specialty practice that professes to be the best around, we have had to make significant capital outlays,” says Dr. Goullaud, owner and operator of the Eden Prairie, Minn., hospital. “I bet I have $300,000 to $400,000 invested (in devices and equipment). So return on investment has to be part of the equation.” Before adding technological advances such as ultrasound, digital X-ray and video endoscopy, Goullaud made sure he or others crunched the numbers, multiplying a fair cost for services by a projected number of procedures. Before he invested in the cages that are now the centerpiece of his intensive care unit, his calculations were less exacting. Basically, he knew he had to have them and he knew he wanted the best. It turns out the cages “have to be the most cost-effective thing in the clinic,” he notes. “The return on investment has to be thousands upon …
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., …
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 …
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 …
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 …
