The Team | Summer 2013

Summer 2013 | Vol. 10, No. 3

A WealthEnhancing Resource for Independent Veterinary Practices

Legal Ins and Outs of Zoonotic Diseases 3 | Treating Retained Deciduous Teeth 8

Cardiology on Call 14 | Busting Nutrition Myths 18

Announcing a Breakthrough in Canine Screening.

Better Science for Better Medicine.

>99%

SUPERIOR HEARTWORM DETECTION

MORE INFORMATIVE

Detects 35% more single-worm infections than in-house kits

Indicates both natural exposure and vaccination status

LYME TEST

EARLIER E. CANIS DETECTION

BETTER VALUE FOR YOUR HOSPITAL

Detects exposure one to two weeks earlier than in-house tests

No more fretting about test kit inventory, expiration dates and faint blue dots!

Brought to you by ANTECH’s revolutionary Bio-CD. The ANTECH® Bio-CD platform is a first for the veterinary industry, employing a combination of laser beams and fluorescence to detect antibodies and peptides on a bioactive silicon disc surface.

This automated system, adapted from advanced physics research, gives ANTECH the capability to run highly-multiplexed assays on a single drop of serum.

For more information, visit AntechDiagnostics.com/AccuPlex.

From the Desk of Dennis A. Nelson, dvm Keep a Cardiologist on Call Summer 2013 | Vol. 10 | No. 3

A Wealth-Enhancing Resource for Independent Veterinary Practices

A WealthEnhanc ing Res for Inde ource penden Veterina ry Practic t es

Legal

Ins and Outs of Zoonot

Cardio

ic Diseas

Summer 2013

es 3 | Treating

logy on Call 14 | Bus ting

Nutritio

Retaine

n Myths

d Dec idu

| Vol. 10, No.

3

ous Tee th 8

18

The Team is published to complement Pet Quarterly®, an educational resource for your clients. Look for these articles in the current issue of Pet Quarterly: Lifesaving Cardiac Diagnostic Tests; Bye-Bye Baby Teeth; 10 Ways to Prevent Zoonotic Diseases; Pet Food Myths Unraveled.

Visit us on the web at

www.psi-inc.net

The Team is an educational resource published by Purchasing Services Inc., St. Petersburg, Fla.

Are you making the most of the wealth-enhancing potential of telemedicine?

If not, it is worth looking into. Cardiac telemedicine, for instance, allows you to offer life-saving patient care and tap into the expertise of a veterinary cardiologist at a moment’s notice.

A trained cardiologist can consult with you to confirm Visit www.psi-inc.net for additional a diagnosis of the patient’s educational articles. New articles include: underlying disease or arrhythmia, help you create • C lose the Compliance Gap with Rx Diets a treatment plan and follow• Stem Cell Therapy in Dogs up recommendations, and provide assistance with the entire case management.

Dr. Allison Adams, cardiology specialist for IDEXX Telemedicine Consultants, gives an overview on pg. 14.

On the Web

A lso in this issue: • Treating retained deciduous teeth at the right time can prevent permanent damage and avoid orthodontic intervention down the road. On pg. 8, Dr. Jan Bellows explains why it’s best to remove a retained deciduous tooth within days of diagnosis. He also offers tips on how to spot problems.

• Do you have answers to pet owners’ questions about pet-food myths?

In his article on pg. 18, Dr. Brent Mayabb tackles marketing myths and provides tips for keeping pet-food sales in your clinic. Consider getting your team up to speed. Sales of veterinary-exclusive diets may net over 30 percent profit.

• The legality of zoonotic diseases can be murky. Take precautions to protect your practice from potential litigation in this emerging area.

Dr. Laci Schaible provides insights on pg. 3.

We hope you find some wealth-enhancing ideas in this issue.

Comments are welcome at info@petquarterly.com Visit us on the web at www.psi-inc.net © Copyright 2013. All rights reserved.

The Team magazine does not make any representations as to opinions or facts as presented. Reproduction of contents in any form is prohibited without prior written permission of the publisher.

Postmaster: Send address changes to: The Team, 2951 34th Street South St. Petersburg, FL 33711

Sincerely,

Dennis A. Nelson, DVM Vice President, Operations Purchasing Services Inc.

www.psi-inc.net | the Team | Summer 2013 1

NON-INSURANCE PREVENTIVE HEALTHCARE PLANS

Provide the best veterinary care, without becoming an Insurance PPO.

LEARN ABOUT OUR PROVEN AND TESTED SYSTEM TODAY!

1-888-458-1423 www.preventplans.com

Compounded Veterinary Medicine

State of the art compounding facilities Knowledgeable customer service team Quality custom compounded sterile and non-sterile preparations

Call toll free 800-622-4510 Fax 877-401-5653 Visit us at wellsrx.com orders@wellsrx.com Four locations to serve you nationwide • Wellington, FL

• Ocala, FL

• Pensacola, FL • Dyersburg, TN

Parasites & Dermatology

Zoonosis Safety Zone How to avoid potential litigation if zoonotic diseases spread from your patients.

By Laci Schaible, DVM

As pets have become fully assimilated into many households as true family members, more beds are shared with furry companions, and more kisses are exchanged—all contributing to the potential for zoonotic disease transmission. A 2011/2012 survey by the American Pet Products Association found that 59 percent of small dogs, 44 percent of medium-sized dogs and 32 percent of large dogs sleep in a person’s bed, as well as 62 percent of cats. >>

across the country

www.psi-inc.net | the Team | Summer 2013 3

Parasites & Dermatology

Always consider the zoonotic diseases that could be on your differential list and inform your clients of these.

Approximately 15%

of itchy pets have atopic dermatitis and are candidates ® for ALLERCEPT

What makes ALLERCEPT® Allergy Assessment and Treatment Program the answer?

Accurate results with patented IgE-specific technology.

NO false positives with Fc receptor.

Free case consultations with Heska’s Veterinary Medical and Technical Consultants.

48-hour turnaround on test results.

Special Offer for PSI Customers

Save an additional 8%–10% when you purchase Heska’s convenience pack of 3 regional or 3 regional/food combination panels. Use your tests anytime throughout 2013.

Call 1-800-GO HESKA (464-3752), option 1 to redeem your special offer today. ©2013 Heska Corporation. All Rights Reserved. HESKA and ALLERCEPT are registered trademarks and Smarter, Together is a trademark of Heska Corporation in the U.S. and other countries.

Source code: ADAL0313BG

At the same time, client complaints against our industry have been on the rise. Data reported in DVM Newsmagazine showed a steady rise in the number of client complaints to state veterinary boards from 1998 to 2007. Consumers of all industries are now trained to speak their voice in the form of online reviews and social media, and filing a complaint to a state board is a simple Google search away for angry clients.

Does this mean you should worry about potential lawsuits from your clients who may contract zoonotic diseases from their pets?

Failure to properly inform a client of a zoonosis threat falls under malpractice, which is regulated by the courts and each state’s board of veterinary examiners.

While the public seems to be growing increasingly aware that diseases can be spread from pets to people, the real risk that zoonotic disease transmission poses to your license and livelihood is currently not supported by a significant number of state board actions, according to Charlotte Lacroix, DVM, an attorney and the owner and chief executive officer of Veterinary Business Advisors, Inc., a New Jersey–based business that provides legal guidance to veterinarians and their advisors nationwide. Negligence under the law can be difficult to prove, and veterinary medicine is minimally regulated compared to other parallel professions.

Still, it pays to take precautions to protect your practice from potential litigation in this emerging area. n Practice the best standard of care. If a zoonotic disease is a differential, inform your clients.

Communicating risks (even potential risks) and documenting this in your medical notes are key to protecting your clients and yourself from the potential negative course

of events that can follow when a pet passes a disease to a human.

For example, if you find a cause for a symptom such as diarrhea early in your diagnostic testing, such as whipworms in a newly adopted puppy, don’t prematurely assume this is the only possible diagnosis. While you may be rightfully worried about appearing to price gouge your clients, if Giardia is a reasonable concern, recommend testing for it and explain why, even in light of a parasite identified on the fecal exam. If your clients decline the testing, encourage them to use proper hygiene to prevent transmission of any unknown zoonotic parasites until you know that the diarrhea has resolved.

As veterinarians, we are protectors of public health. Always consider the zoonotic diseases that could be on your differential list and inform your client of these. If you can’t rule out a zoonotic cause, informing your clients is the right and ethical thing to do. n Document, document, document. Make sure you inform your clients of any potential zoonotic disease. It is our obligation as veterinarians to take the time to verbally tell our clients when there is a zoonotic risk, even when there is not a zoonotic disease diagnosis. This applies as long as the potential zoonosis or zoonoses are differentials and have not been ruled out.

Document this discussion in your patient’s medical records.

You can also provide written handouts disclosing zoonotic risks, but be aware that the number of clients who actually read broad umbrella handouts is pretty low.

If you do give a client a written handout, take the time to also verbally discuss the associated risk, says Lacroix. Document that you provided a handout in the medical records, just as you do the verbal communication. >>

If you recommend testing parasites and your clients decline the testing, encourage them to use proper hygiene to prevent transmission until symptoms resolve.

Experience the Ultra Portable

Harmony Therapy Laser Delivering patented MLS® Laser Therapy Cutting Edge’s Class IV Therapy Laser produces and synchronizes dual wavelengths of 808nm and 905nm that reinforce each other to supply an infinitely more satisfying energy mix and provide revolutionary results. Conquer the dosage dilemma with Harmony, a Class IV Laser with the right combination of power and wavelengths. Provide your patients with deep penetration, quick delivery, and noticeable results without the need for constant operator motion or concern for thermal damage.

Proven Results. Rapid Treatment. Zero Risk.

It’s Smarter.

Learn more at www.vetlasers.info/therapy Contact us for an On-Site Presentation

www.celasers.com

800-889-4184 x114

™

www.psi-inc.net | the Team | Summer 2013 5

Parasites & Dermatology n Offer clients information—not advice—about the disease symptoms in people.

You can offer your clients general information about the possible disease symptoms and processes in people for zoonotic diseases you have determined may be a risk, according to Lacroix, as long as you don’t give any client specific medical advice or a diagnosis, which could be seen as inappropriately practicing human medicine. You should always advise clients to contact their physicians for more information or questions. n Communicate and educate. The best practice to avoid being dragged into a state board investigation or a lawsuit is the same for zoonotic cases as for all other types of malpractice—take measures to avoid client complaints.

Effective client communication and education, along with thorough

Have a discussion about zoonotic diseases with clients. Handouts can help, but not everyone reads them.

medical documentation, are as essential to being a veterinarian today as is practicing medicine to a high standard of care.

All in all, remember to keep public health a priority during each

pet examination so your practice— along with your patients and your clients’ health—will thrive. n Laci Schaible, DVM, is a small animal veterinarian and veterinary author.

Vaccine Clinics: Special Considerations If you work in a vaccine clinic (either full or part time), have all clients sign a waiver form that explains the limitations of the vaccine clinic, as well as its purpose. Spell out clearly in the waiver that the vaccine clinic’s services are not intended to take the place of regular visits to a veterinarian.

Working in a vaccine clinic could put you at increased risk for undefined responsibility and liability in preventing zoonotic diseases and transmission. With the high patient volume (often puppies and kittens) and quick pace of veterinary clinics, few veterinarians have time for lengthy discussions with each client, for example, the consequences of not performing biannual fecals and deworming on dogs and cats.

These circumstances could leave you at risk for litigation for cases of zoonotic transmission, for example, if a child contracts a disease from the family dog that you vaccinated. The vaccine clinic is an area where you aren’t clearly protected, unless you have a consent form or a waiver explaining the limitations of the vaccine clinic. If you choose to participate in vaccine clinics, be sure to ask each client for a signed consent form.

6 Summer 2013 | the Team | www.psi-inc.net

Dental Health

Persistent Puppy Teeth How to recognize and treat retained deciduous teeth in your patients.

By Jan Bellows, DVM, Diplomate, American Veterinary Dental College and Diplomate, American Board of Veterinary Practitioners

Once your younger patients start losing their deciduous teeth as their permanent teeth push

their way up to replace them, keep an eye out for retained deciduous teeth. This condition is rare in cats, but common in dogs, especially small breeds.

When your patients’ deciduous teeth miss their cue to depart, you need to help them on their way to prevent further dental problems.

Here’s an overview of retained deciduous teeth and how to treat them.

Deciduous (baby, primary, milk) teeth start erupting through the gums of puppies and kittens around three weeks of age, and adult teeth normally finish erupting by six months. Dogs have 28 deciduous and 42 permanent teeth, while cats have 26 deciduous and 30 permanent teeth. There are no deciduous first premolar or molar teeth. Watch for mixed dentition (Fig 1). >>

1

Mixed dentition—both deciduous and adult incisors and canines are visible

8 Summer 2013 | the Team | www.psi-inc.net

The Team Approach Here’s how the practice team can work together to treat retained deciduous teeth in your patients.

Practice Managers Educate the entire office to make everyone aware that retained deciduous tooth care is important to both your patients and your practice. Make sure the practice is equipped properly with sharp surgical instruments, intraoral radiography and adequate time to perform needed oral surgeries. Price this procedure to cover your expenses, expertise and profit and still be affordable to clients.

Assistants During the initial patient examination, lift the puppy or kitten’s lips to reveal the canine area and look for retained deciduous teeth.

Take a picture of any patient abnormality and compare it to a model or image. This is a powerful way to help educate clients and gain their compliance.

Receptionists Let clients know that their pets’ teeth are similar to our own and need to be examined early in life,

especially around the time of spay or neutering (six months old). At this time, the permanent incisors and adult canines should have erupted.

Be familiar with the small dog breeds especially prone to retained deciduous teeth, such as Maltese, Yorkshire Terriers and Miniature Schnauzers.

removing retained deciduous teeth without fracturing the roots. Request training if needed. Human dental hygienists can provide training in instrument sharpening.

Use intraoral radiography to help visualize the root before surgery and confirm complete extraction after.

Veterinarians Technicians and Surgical Assistants Make sure your surgical instruments are sterile and sharp—this is essential to

Be convinced that immediate removal of retained deciduous teeth is in the puppy or kitten’s best interest and that complete removal of the crown and the roots is the goal.

www.psi-inc.net | the Team | Summer 2013 9

Dental Health

What causes a retained deciduous tooth?

Normally the deciduous tooth root is resorbed during eruption process of the permanent tooth.

A retained deciduous tooth is one that is still present in the mouth after its replacement permanent tooth has erupted.

This usually occurs because something went wrong with

the process of root resorption, resulting in a tooth root that is either incompletely resorbed or did not resorb at all. When this happens, the deciduous tooth occupies the place in the mouth that is meant for the permanent tooth, forcing the permanent tooth to erupt in an abnormal position (Fig 2). Small breeds, especially Maltese and Yorkshire

Terriers, are predisposed to retained deciduous teeth. There may be a genetic predisposition to developing retained deciduous teeth, since it occasionally appears to occur in families of dogs.

2

Retained deciduous canines and the maxillary third incisor

Which deciduous teeth are commonly retained?

The most common teeth to be retained are the upper canine teeth, followed by the lower canine teeth and the incisors. The second through fourth premolars can also be retained.

What problems do retained teeth cause?

If both a deciduous and a permanent tooth are in the same alveolar socket in the jaw, the crowding of the two teeth will increase the likelihood of future problems caused by: n Food that will become trapped between the teeth (Fig 3)

3

Retained fractured deciduous maxillary canine leading to food impaction

10 Summer 2013 | the Team | www.psi-inc.net

n Permanent teeth moved to abnormal positions n Stretching of the tooth’s attachment leading to painful periodontal diseases.

If the retained tooth is a lower canine, the permanent tooth may be forced to erupt on the inside of the lower jaw, causing the tip to penetrate into the roof of the mouth (Fig 4). >>

4

Simmons Southeast Current Practice Listings NEW! FL - Central/Lake Area. Gross approximately $1.4M. State-of-the art facility with all the bells and whistles. Hospital, boarding/grooming facility, and satellite clinic for $2,220K (FL45H) NEW! NC - Western. Location, location! This small animal, 1.25 doctor practice grosses $822K with 90% doctor produced. Sale includes a neighboring home and apartment above practice which are both currently rented. $1,340K (NC12A) FL - North of New Smyrna. Well-established, leased facility. Impressive equipment. 4.5 days per week. Low overhead, very profitable—buyer’s income approximately $155K after all other expense paid. $325K. (FL50A) GA - Blue Ridge Mountains. Uncomplicated but charismatic town. 1.5 doctors, small animal practice grosses $730K. Currently no boarding or grooming and practice is open only 4.5 days per week. Practice and Real Estate $805K. (GA11C) FL - Polk County. Impeccable 3,000SF facility on busy 4-lane highway.

Gross in excess of $2M with continual growth. Small animal, 3 doctors.

Compensation to buyer $380K after-debt service! $2,530K (FL72S)

Lower canine penetrating the upper jaw

1610 Frederica Road * Saint Simons Island, GA 31522 Toll Free: 800.333.1984 * www.simmonsinc.com Email: southeast@simmonsinc.com

Licensed Real Estate Broker in AL, FL, GA, MS, NC, SC, TN

www.psi-inc.net | the Team | Summer 2013 11

Dental Health

When and how are retained teeth treated?

When two teeth are present in a space for one, extraction of the deciduous tooth is called for. No two teeth should be in the same alveolus (socket) at the same time.

Early extraction (Fig 6-13) in these cases will usually allow the permanent tooth to move into its proper position. Delaying extraction (until the dog or cat gets neutered or spayed, for instance) may lead to permanent damage.

Another situation that calls for extraction of deciduous teeth is when they are fractured.

When puppies chomp on hard chews or toys, they can fracture one or more thin-walled deciduous teeth, exposing the pulp. If a fractured deciduous tooth is not carefully extracted, the adult tooth bud may become infected and interfere with normal eruption (Fig 5).

6

Intraoral film showing orientation of retained deciduous and adult canines

8

7

Incision into the sulcus

9

5

Fractured deciduous canine exposing the tooth’s pulp

What happens if there is a delay before the retained tooth is extracted?

When a retained primary tooth is not extracted in a timely manner, it is unlikely that the adult teeth will move into their proper positions without orthodontic intervention. When a wait-and-see approach is taken to see whether a retained deciduous tooth will exfoliate on its own accord, the permanent tooth can become permanently malpositioned, requiring orthodontic movement, crown reduction or extraction. It is best to remove a retained deciduous tooth within days of diagnosis.

Is it safe to wait until the dog or cat is neutered at six to nine months?

Releasing incision along the buccal surface

10

Wing tipped elevator used to create root mobility

12

A sharpened wing tipped elevator used to excise the deciduous tooth’s periodontal attachment

11

Extracted deciduous canine

13

No. A persistent deciduous tooth should be extracted as soon as the permanent tooth starts to erupt in the same alveolar socket. If extraction is performed early, the abnormally positioned permanent tooth usually moves to its normal location. n Dr. Jan Bellows specializes in veterinary dentistry at All Pets Dental in Weston, Fla.

12 Summer 2013 | the Team | www.psi-inc.net

Sutured gingiva

Post-operative film confirming extraction

PSI-QuarterlyAd-April2013(r4)_Layout 1 4/25/13 1:23 PM Page 1

We hear your need for compounded preparations to treat the needs of your unique patients.

Compounded otic preparations available from Wedgewood Pharmacy: ■ Enrofloxacin/Ketoconazole/Triamcinolone Acetonide 1%/2%/0.1% in Anhydrous Lanolin Otic Ointment, 15ml 1-3: $12.00 4-5: $11.00 6+:$ 10.00 ■ Enrofloxacin/Ketoconazole/Triamcinolone Acetonide 1%/2%/0.1% Polox-A-Gel™ Otic, 3ml 1-4: $14.00 5-11: $12.50 12+: $11.25 ■ Ivermectin 0.01% Otic Solution, 10ml 1-2: $27.00 3-5: $22.00 6+: $17.00 ■ Ticarcillin/Clavulanate Potassium/Ketoconazole/Triamcinolone Acetonide 2.5%/0.08%/2%/0.1% in Anhydrous Lanolin Otic Ointment 15ml 1-3: $15.00 4-5: $14.00 6+: $13.00

GET FREE STANDARD SHIPPING* thru 8/31/13!

Visit Order.WedgewoodPetRx.com to review our complete list and to order online with free standard shipping. Use promo code WBPSI613.

Jennifer, Customer Care Manager and Brody

*Limit one per prescriber. Offer expires 8/31/13. Not for use in food-chain animals. Medications compounded by Wedgewood Pharmacy are prepared at the direction of a veterinarian.

Wedgewood Pharmacy does not make claims for the efficacy of its compounded preparations.

PSI members save 10% We Care The Way You Care®

855.578.6553 © 2013 Wedgewood Pharmacy

Suburban Surgical Company, Inc. the DIAMOND of the INDUSTRY THE EXCLUSIVE PROVIDER FOR STAINLESS STEEL EQUIPMENT SOME OF OUR MOST POPULAR ANIMAL CARE PRODUCTS INCLUDE: Regal stainless steel cages Laminated cages Classic stainless steel or Regal case & utility carts Classic stainless steel gurneys or Regal Vet-mate Stainless steel & Masonry pen systems For more than 60 years & three generations, SSCI has designed & manufactured the highest quality stainless steel & laminated equipment available for the animal care market.

Our goal is to provide our customers with the highest quality products, backed by the highest quality service.

Stainless steel scales including the Regal 300 Stainless steel bathing tables & tubs Stainless steel utility, instrument & over instrument tables Stainless steel IV stands, mayo stands, sinks & receptacles Stainless steel & laminated lift, operating, prep-procedure and exam tables

MADE IN



SUBURBAN SURGICAL COMPANY, INC MADE IN THE USA

275 12th street, Wheeling, IL 60090

www.SuburbanSurgical.com

800.323.7366

www.psi-inc.net | the Team | Summer 2013 13

Senior Wellness

Cardiology

on Call Telemedicine offers an alternative to referring cardiac patients outside your clinic.

By Allison Adams, DVM, DACVIM (Cardiology)

An estimated 7 million dogs and 8 million in the United States have cardiac disease1,2.

Not all the owners of these animals can afford referral to a cardiologist, and referral to a specialist may not be possible due to logistics or if the patient is too sick to travel.

Telemedicine (providing clinical health care from a distance) is becoming increasing important in general veterinary medicine.

Cardiac telemedicine can provide invaluable help to your clinic when diagnosing and treating cardiac disease in these animals.

Knowing that a dog has underlying mitral valve disease or dilated cardiomyopathy (DCM) or a cat has hypertrophic cardiomyopathy (HCM) may only get you to the next questions: What do I do now? What are the treatment options? When should I recheck this patient?

With telemedicine, a trained cardiologist cats

14 Summer 2013 | the Team | www.psi-inc.net

can consult with you to confirm a diagnosis of the patient’s underlying disease or arrhythmia, help you create a treatment plan and followup recommendations, and provide assistance with the entire case management.

Idexx Laboratories, for example, provides consultation reports on every type of cardiac diagnostic.

Consultation offerings range from ECG screens to a full cardiac workup (echocardiogram, ECG and thoracic radiograph) as a stat service. These services can help you to provide the best possible care for your cardiac patients.

How it Works Cardiology telemedicine has evolved as veterinary medicine has evolved.

In the past,when flat films were the primary means of taking radiographs and few clinics were equipped with ultrasound machines, an ECG was the only easy diagnostic to send to a cardiologist for telemedicine. Today, thousands of clinics are equipped

with digital radiographic systems and ultrasound machines, allowing them to easily send images for a full cardiology consultation.

Each diagnostic has its own place in the cardiac workup. For instance, submit: nA n ECG if you detect arrhythmia. An ECG can also be submitted as part of a pre-operative/geriatric/breedspecific screen or part of a full cardiac workup. nA radiograph if a patient is coughing or has difficulty breathing. Or, submit a radiograph as part of the cardiac workup for patients with a murmur. nA n echocardiogram if a murmur is detected, or if you suspect any cardiac or pericardial disease.

These are the most common reasons to submit these images or ECGs; however, many other indications exist. These diagnostics

can be submitted singly or in combination.

As with radiology cases, a thorough history is key to allow cardiac specialists to provide the best report possible. For example, if a patient is syncopal, a good history should include what the patient was doing right before the event, how long the event lasted, the exact behavior during the event and the behavior of the patient after the event. A thorough and accurate history helps cardiac specialists deliver quality reports and give you the best recommendations for your patients.

Correcting for Human Error Consulting with a cardiac specialist puts another set of trained eyes on crucial diagnostic tests. As in human medicine, anyone who reads radiographs or evaluates any diagnostic test is at risk for missing an abnormality or making the wrong diagnosis. >>

Case Example Time

Duke, a 7-year-old Labrador Retriever, presented at his veterinary clinic for dyspnea and slight cyanosis after exercise. The veterinarian submitted this ECG to Idexx Laboratories to be reviewed by a cardiac specialist.

The Idexx cardiologist discussed the case with the veterinarian and suggested two differentials: ventricular tachycardia vs. atrial fibrillation with a

Duration

conduction disturbance. To differentiate these, the veterinarian administered approximately 4 mg/ kg of Lidocaine, rechecking the ECG after each 2 mg/kg bolus. After the last dose of Lidocaine, the diagnosis of atrial fibrillation was more apparent, with the typical characteristic of an irregularly irregular rhythm and no identifiable “p� waves. www.psi-inc.net | the Team | Summer 2013 15

Senior Wellness In a human study conducted at Michigan State University3, for example, 100 radiologists were asked to review 60 thoracic radiographs. There was a 20 percent disagreement between users; when they were asked to re-read the films later, there was a 5 percent to 10 percent variability from their first reading. Sixty percent of the radiologists missed a missing

clavicle; 58 percent still missed it when they were told that the study was a screening study; only 17 percent overlooked the missing clavicle when they were told the study was a cancer screening study.

Why do we make these errors?

As humans, we are subject to bias and can make several types of perception and cognition errors: For example, there is the

“satisfaction search” error. In this type of error, we stop looking through a radiograph as soon as we find an abnormality.

In a “representativeness” error, our thinking is guided by a prototype. In this type of error, the bias is based upon the breed of animal, or typical physical exam findings. For example, a Cavalier King Charles Spaniel comes in for coughing and has no heart murmur but does have lung crackles.

Because this breed often develops myxomatous mitral valve disease, you may overlook the fact that there is no murmur or cardiomegaly and call the radiograph “pulmonary edema,” even though the pattern is a diffuse peribronchial pattern, which is more consistent with bronchitis.

These are just two of the perception and cognition errors that we can make when interpreting radiographs.

To decrease the number of errors in interpretation: nT ake good quality films with the proper technique and positioning. nE valuate the films in a quiet and dark room. nM ake sure to get an accurate and thorough history. nH ave someone else review the films. nS ystematically look through films the same way each time. n Dr. Allison Adams is a cardiology specialist for IDEXX Telemedicine Consultants.

References: 1. Keene B, et al. “Guidelines for the Diagnosis and Treatment of Canine Chronic Valvular Heart Disease.” American College of Veterinary Internal Medicine (ACVIM) Consensus Statement. 2009.

2. Abbott J. “Feline Hypertrophic Cardiomyopathy: An Update.” Veterinary Clinics of North America: Small Animal Practice. 2010 July;40(4):684-700.

3. Potchen EJ. “Measuring Observer Performance in Chest Radiology: Some Experiences.” Journal of the American College of Radiology. 2006 June;3(6):423-32.

16 Summer 2013 | the Team | www.psi-inc.net

Spotting the Small Stuff Test your eye for detail with this challenge: How many “f”s do you see in the following sentence?

Finished files are the result of years of scientific study combined with many years of expertise.

Many people who evaluate this sentence only pick up three or four “f”s—but there are six. The reason for this is that our brains will skip over the small words and stitch the sentence together without actually looking at the words. Many small radiographic abnormalities are missed for the same reason. We see and process images about the size of a dime at a time. When looking at radiographs, remember to look at the radiograph systematically and thoroughly every time.

Better medicine together You joined PSI to leverage the collective strength of veterinary practices just like yours. At IDEXX Telemedicine Consultants, we also know how collaboration can lead to better outcomes for you and your patients.

To learn more, call 1-800-726-1212.

IDEXX Telemedicine Consultants radiology l cardiology l specialty services idexx.com/telemedicine © 2011 IDEXX Laboratories, Inc. All rights reserved. • 100104-02 • All ®/TM marks are owned by IDEXX Laboratories, Inc. or its affiliates in the United States and/or other countries. The IDEXX Privacy Policy is available at idexx.com.

www.psi-inc.net | the Team | Summer 2013 17 100104-02 PSI Print ad FINAL.indd 1

11/1/11 2:26 PM

General Wellness

Nutritional Myth Busting Keep pet-food sales in your clinic by helping clients distinguish nutritional fact from fiction.

By Brent Mayabb, DVM

While many clients will follow your

Key Points Pet owners are very proactive in seeking out information about what they feed their pets.

By recommending diets for healthy pets, you can add significant profits, improve compliance and increase your transactions while providing the best preventive care for your patients.

Common pet myths can often prevent a pet owner from taking your recommendation.

Pets need the optimal nutrients for good health, not specific ingredients. Diets should be selected based on the nutrients they provide, not the ingredients that are popular or trendy.

18 Summer 2013 | the Team | www.psi-inc.net

recommendation for a therapeutic diet when their pets are sick, most never consider purchasing food for their healthy pets from your practice.

With the majority of your appointments involving healthy cats and dogs, there are a number of benefits of stocking and dispensing veterinary diets, says Craig Datz, DVM, MS, a boardcertified veterinary nutritionist and nutrition and scientific affairs manager for pet food manufacturer Royal Canin.

One key benefit is that you will know exactly what a pet is eating when medical issues arise.

Another is that sales on veterinary-exclusive diets may net over 30 percent profit by themselves, and they can also lead to other increased sales.

“When people would return to the clinic to pick up more food, staff could talk with them and ask how the pet was doing,” says Datz. “Ideally, we would even pull the medical records to verify the correct diet, and that would give us an opportunity to make sure health care recommendations were up to date including vaccinations; heartworm, flea or tick control; and lab work. It’s surprising how often clients would be unaware that their pets had not been seen for a while, and they would be happy to schedule an appointment if necessary.”

Myths and Misinformation With information readily available from many different sources and “experts,” pet owners have access to a variety of opinions on virtually any aspect of their pet’s health, including nutrition.

There’s a lot of misinformation online that can steer your clients away from your recommendation for the pet foods with the quality, safety and efficacy that you trust to foods offering nothing more than the trend of the day.

“When I do presentations at continuing education meetings, there are often questions about myths and how best to communicate with pet owners who seem to believe everything they find on the Internet,” says Datz. “Most nutrition tracks at major veterinary conferences include the topic of myths and misconceptions.”

Information pet owners find online may also encourage them to buy pet food from a mass-market retailer instead of your clinic. Recommending veterinary-exclusive pet food such as Royal Canin allows you to differentiate yourself by offering a food that’s formulated based on science and research, and it keeps the sale in your clinic.

To be successful in your recommendation, you will need to not only help pet owners understand the nutritional benefit of the food you’re recommending, but also probably handle a few common myths. Marketing campaigns may lead pet owners to believe that one ingredient is good (“Whole chicken should be the first ingredient”) or that another ingredient is bad (“Corn is a filler”), but pets’ needs are actually based on nutrients rather than ingredients.

Let’s examine some of the common myths about pet foods: Myth: Whole meat should be the main source of protein;

by-products are low quality.

Truth: Many reputable pet-food companies use protein

by-products and by-product meals. By-products and byproduct meals (by-products with water and fat removed) provide the same valuable nutrients —such as protein, vitamins and minerals—for a cat or dog as meat provides.

They are also just as digestible.

Royal Canin, for instance, is dedicated to decreasing its use of raw material sources that compete with the human food supply. Chicken by-products and by-products meal found in Royal Canin diets provide one of these alternative sources of nutrients.

Myth: Grains, such as corn, should be avoided in pet food.

Truth: Grains provide valuable nutrients for your

patients. For example, corn is a good source not only of carbohydrates, but also of protein, fat, vitamins and minerals. One concern about grains is that they are more likely to result in food allergies. However, there is no evidence to support claims that grains are more likely to cause health problems such as true allergies.1

Myth: “Natural” diets are healthier for pets.

Truth: “Natural” is defined by American Association

of Feed Control Officials (AAFCO) as solely from plant, animal, or mined sources not having been produced by or subject to a chemically synthetic process; exceptions include artificially synthesized vitamins, minerals or other trace nutrients. This is a very broad definition, allowing many diets to be labeled as “natural.” Most importantly, there are no data to substantiate the claim that “natural” diets are in any way healthier for pets; it is a marketing claim. >>

A Five-Point Plan for Your Team A team approach to nutritional recommendations can be successful, even when individual conversations about nutrition haven’t worked.

1. Veterinarians/Technicians: Get a current diet history while taking the general history of the cat or dog. This helps demonstrate to the client the importance of nutrition as part of the overall health goals for the pet.

2. Veterinarians: Make a specific diet recommendation, based on the findings of the physical exam and any diagnostics. Spend a moment to explain why this specific recommendation is important for the cat or dog.

3. Technicians: After the veterinarian has left the exam room, reinforce the diet recommendation by asking the client if there are any questions about the specific diet recommended.

4. Receptionists: Make sure the client has the correct formula during the checkout process. The reception area can be a hectic place, and this final point of contact serves as the last opportunity in the visit to reinforce the veterinarian’s nutritional recommendation. Always take time to review the diet recommendation with clients before they leave.

5. Follow-up: Follow up with a phone call at around 30 days to check how the pet is doing with the recommended diet. This will solidify not only the recommendation, but also the importance of nutrition as part of the health plan of the cat or dog. www.psi-inc.net | the Team | Summer 2013 19

General Wellness

Sustainable Sourcing Royal Canin’s efforts at developing sustainable pet foods.

By 2020, the human population is projected to reach 8 billion people. The pet population will increase as well, while continued urbanization will result in a decrease in the land that is available for agriculture and food production on a per-person basis.2 The decrease in the availability of resources to feed both people and pets in the future will necessitate finding new sources of nutrients. Royal Canin is already working on not only finding new nutrient sources, but also helping develop sustainable ways to meet the nutritional needs of cats and dogs. The company is dedicated to decreasing its use of raw material sources that compete with the human food supply to less than 50 percent of its total ingredient portfolio by 2020.

An example of this is Royal Canin’s Anallergenic formula. It’s made from protein hydrolyzed from feathers, a protein source that would otherwise be unused. The diet is hydrolyzed to the point of being made of 95 percent amino acids, so allergic reaction to the food is extremely unlikely in food allergy patients. In addition to being able to manage the most difficult food allergy cases, it also uses a source of protein that does not compete with the human food supply.

20 Summer 2013 | the Team | www.psi-inc.net

Vetinsure R

Caring is our policy.

Myth: Organic diets are healthier

for pets.

Are You Paying Too Much For Insurance?

Truth: The term “organic” is

not an assurance of quality; it is merely a description of the process under which plants or animals are grown or raised. As with the term “natural,” there are no scientific data to back up the claim that organic food is healthier for pets. Interestingly, organic diets frequently use flax seed as a source of omega-3 fatty acids, although flax seeds do not contain the omega-3 fatty acids EPA/DHA that are important for reducing inflammation. Veterinary research supporting benefits of omega-3 fatty acids in the management of inflammation in skin infection, arthritis, kidney and heart disease3, have been done evaluating EPA and DHA (found only in certain marine plants and fish). >>

Disasters never clock out.

Neither do we.

We can evaluate your current policies to find coverage gaps, flaws, and inflated rates that are costing you money and leaving your business exposed.

Our customers save an average of 25% even while obtaining a more tailored and comprehensive policy!

Workers Comp Property & Liability Commercial Auto Umbrella

Veterinary Professional License Defense Employment Practices Earthquake/Flood

Call us today!

800.272.1249 w w w . v e t i n s u r e . c o m

In the aftermath of any disaster, time is money.

That’s why BELFOR’s industry experts work around the clock to provide complete, turnkey property restoration solutions. From cleanup and construction to the decontamination of valuable assets, BELFOR provides prompt, efficient solutions that businesses and homes across America turn to most. So in the event of a disaster, trust BELFOR to get you back to business.

www.belfor.com 610.594.5566, toll free 888.629.4768

www.psi-inc.net | the Team | Summer 2013 21

General Wellness Myth: Raw diets are similar to what

pets would eat in the wild.

Truth: Although many pet

owners feel that raw diets are closer to what cats and dogs might eat in the wild, our pets are not wild animals. They have been domesticated, and this has resulted in changes in their physiology, such as adaptation to starch-rich diets4.

No published, peer-reviewed articles support the health claims commonly attributed to raw diets, although there are published reports of stomach/ intestinal inflammation and death in animals eating contaminated raw meat foods5,6. The Food and Drug Administration (FDA) and Centers for Disease Control (CDC) do not advocate a raw meat, poultry or seafood diet for pets. In addition to concerns about bacterial contamination that may affect both pets and pet owners, many raw diets contain bones, which may pose additional risks for intestinal obstruction and perforation.

Help educate clients about the scientific truths about pet foods.

8

8

22 Summer 2013 | the Team | www.psi-inc.net

Truths and Transactions Many of your clients are very interested in understanding more about the foods they give to their pets. That interest is an opportunity to educate them on the best recommendation for their pets, while improving your bottom line through increased compliance and the opportunity for more transactions.

The impact that practice members can have in this area is substantial. By learning more about cat and dog nutrition, they can help you in making and reinforcing recommendations. For access to educational materials, log in to gateway.royalcanin.us and click on the “Royal Canin Academy” icon.

Because there is so much incorrect information readily accessible about cat and dog nutrition, to be successful in making food recommendations, it’s important to be prepared to take on the common myths. Let your clients know the scientific truths about pet food, so you can help them choose the best option for their pets. n

Veterinary Care Nutrition Unique nutritional solutions for all stages of a pet’s life

Our life stage approach 4 KEY MOMENTS TO PRESCRIBE NUTRITION

DEVELOPMENT

WEIGHT CONTROL

ADULT

MATURE CONSULT

New client exam adoption/purchase

Well care visit healthy weight maintenance

Well care visit obesity screening and dental cleaning

Maturity checkpoint mature and senior consultations

royalcanin .us

© ROYAL CANIN SAS 2013. All Rights Reserved. Credit Labat, Duhayer

Dr. Brent Mayabb is Manager of Learning & Development for petfood manufacturer Royal Canin.

References 1 Heinze CR. “Pet Food 102: Myths and Misconceptions.” Central Veterinary Conference.

2011 August.

2 Uvin P. “The State of World Hunger.”

Nutrition Reviews. 1994 May;52:151–161. doi: 10.1111/j.1753-4887.1994.tb01411.x 3 Kirk Claudia. “The Use of Long Chain Omega-3 Fatty Acids in Inflammatory Bowel Disease.” NAVC Proceedings. 2007 January; www.ivis.org.

4 Axelsson E, et al. “The genomic signature of dog domestication reveals adaptation to a starch-rich diet.” Nature. 2013; 495:360-364.

5 Stone GG, et al. “Application of polymerase chain reaction for the correlation of Salmonella serovars recovered from greyhound feces with their diet.” Journal of Veterinary Diagnostics and Investigation. 1993;5:378-385.

6 Shaw M, et al. “Streptococcus zooepidemicus in small carnivorous mammals fed uncooked horsemeat.” Journal of Zoo Animal Medicine.

1984;15:161-164.

www.psi-inc.net | the Team | Summer 2013 23

It’s the procedure you perform only once in your career.

So it’s important to have the right people by your side.

You wouldn’t walk into a complicated surgery without an expert team, so why do it for this once-in-a-lifetime event?

Buying or selling a practice is the largest financial transaction of your life. That’s why you should partner with Simmons. As the most experienced brokerage firm in the business, we’ve helped more veterinarians realize their dream than any other firm out there. In fact, we wrote the book on it.

We really did write the book on buying and selling your veterinary practice. Scan the QR code or visit our web site to learn more.

w w w. s i m m o n s i n c . c o m 24 Summer 2013 | the Team | www.psi-inc.net

your future

|

our business ©2013 Simmons, Inc.

Quiz TEST YOUR KNOWLEDGE

Quiz questions are based on articles in the current issues of The Team and Pet Quarterly ®

1 Which types of deciduous teeth are not commonly retained?

A. Upper canines B. Lower canines C. Incisors D. Molars 2 True or False: It is safe to wait to extract a persistent deciduous too th until the time of spay or neuter.

A. True B. False

3 In telemedicine, for a car diac submit an echocardiogram workup, : A. If you detect arrhythmia B. As part of a pre-operative screen C. If you suspect pericardi al disease D. If the patient has difficul ty breathing 4 An estimated ___ million dogs and cats in the United States have car diac disease.

A. 2 C. 10 B. 7 D. 15 5 What two types of huma n errors often lead to a wrong diagnosis on diagnostic tests?

A. Satisfaction search error B. Inconsistency error C. Application error D. Representativeness error

6 What is the estimated pro fit of dispensing veterinary diets?

A. 10 percent C. 30 percent B. 20 percent D. 40 percent 7 Which two statemen ts about pet food are my ths?

A. Whole meat should be the main source of protein.

B. Grains provide valuable nutrients for your patients.

C. Organic diets are healthi er for pets.

D. By-products are just as digestible as meat for a cat or dog.

8 True or false: Failure to pro perly inform a client of a zoonosis threat falls under malpractice.

A. True B. False

9 What type of “worm” is act ually a fungal infection?

A. Hookworm C. Heartworm B. Ringworm D. Roundworm 10 Based on calls to AS PCA’s Poison Control Cente r, which breed topped the list of pets that ingested dangerous materials in 20 12?

A. Jack Russell Terrier B. Beagle C. Labrador Retriever D. Boxer

Answers: 1-D; 2-B; 3-C; 4-D ; www.psi-inc.net | the Team | Summer 2013 25

5-A and D; 6-C; 7-A and C;

8-A; 9-B; 10-C

Putney Enrofloxacin Generic of Baytril® The same high-quality drug Finally — affordable*

FDA Approved for Veterinary Use: Putney Enrofloxacin Flavored Tablets Putney Enrofloxacin is a generic Baytril® available for a better price.

• Beef flavored • Our FDA-approved veterinary generic is available in the same strengths, scoring and bottle counts as Baytril® Taste Tabs®: 22.7 mg # tablets double scored

68 mg

68 mg

136 mg

136 mg

100

22.7 mg 500

50

250

50

200

✓

✓

✓

✓

✓

✓

Committed to quality. Delivering affordability.

www.putneyvet.com

• Full veterinary technical support from Putney When prescribing Enrofloxacin Flavored Tablets for your patients, choose quality and affordability. Choose Putney.

Call Putney at 866-683-0660 to order and ask for your special PSI member pricing PUTNEY VETERINARY GENERICS:

ENROFLOXACIN

CEFPODOXIME PROXETIL

CARPROFEN CAPLETS

BAYTRIL® is a registered trademark of Bayer Aktiengesellschaft. TASTE TABS® is a registered trademark of Bayer HealthCare LLC. *Based on list price. ® PUTNEY and the Putney “P” logo are registered trademarks and service marks of Putney, Inc. ©2013 Putney, Inc. All rights reserved. 0501-1007-13

KETAMINE HCI