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 …
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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 …
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 …
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 …
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 …
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 …
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 …
Finding Marketing Gold In On-site Blood AnalysisApril 17, 2009 When Kent Adams, DVM, talks about his in-house services, the “house” tends to be miles from his veterinary office. His exam room is often a stall in a client’s barn, and he’s comfortable doing lab analysis off the back of a pickup truck. Such is the life of a large-animal veterinarian providing ambulatory service in the New River Valley of Virginia. Dr. Adams’ extended-cab 4-by-4 is where leading-edge medicine intersects with rural outreach. “There are times when I’ll be standing in a barn at 10 o’clock at night, looking at a horse with a snotty nose, and the client will prompt me, ‘Do you think we need blood work?’” says Adams, one of five doctors at Appalachian Veterinary Services. “That’s when I learn about the rewards of marketing.” Like more than a few of his companion-animal colleagues, Adams finds that a pitch for his on-site and in-the-field laboratory services strikes a chord with potential clients. That’s why he mentions the lab in just about all of his marketing materials. Such services send the message that a practice bases diagnoses on the timeliest information, practitioners say. Especially in highly competitive markets, that can be a …
What’s Your Diagnosis?April 17, 2009 Signalment: Adult domestic shorthair; 1.5 years old History: Vomiting for two days. Anorexia for two days. Painful on palpation of the abdomen. Upper GI study was performed. Two representative images after administration of contrast are presented. Questions to answer: What are the primary findings? What do you think is the primary reason for the clinical signs? Radiographic Findings: There is contrast noted within the stomach and extending in the small intestines. Several loops of small intestine are moderately dilated and there is plication of many of these loops of small intestine. The detail in the abdomen is normal but there also appears to be clumping of these abnormal loops of intestine in the ventral abdomen. Radiographic Interpretation: Dilated, plicated small intestine consistent with mechanical ileus from a linear foreign body obstruction. This is the cause of the clinical signs. Discussion: The most common problem related to the GI tract detected on survey radiography is ileus. By definition, ileus strictly means failure of passage of the intestinal contents. There are two …
Informing Clients About Quality Of Life And DeathApril 17, 2009 Small animal veterinary practice today parallels the pediatrician model. But veterinary personnel deal with five times more patient illness and death than most health professionals. Despite the predictable frequency of terminal illness and death, many veterinary hospital personnel lack the skill to properly interact with bereft pet caregivers. In addition, the intense exposure to end-of-life care issues and death causes some staff members to develop compassion fatigue, a type of burnout that may not be recognized or understood. The human animal bond is now acknowledged and celebrated as an important part of people's lives and, at times, may be the best relationship a person has. The role of veterinarians is to facilitate that relationship by keeping animals healthy. Veterinarians have an increasing obligation to serve the committed pet owner with improved medical techniques and improved communication regarding quality of life and end-of-life care issues. We also have an increasing obligation to provide support and reverence when a pet dies, and even reach out to comfort the client in the days following the pet's death. But where and how do clinics become proficient grief management? Tools for Staff Some hospitals …
