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 …
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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 …
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 …
