The Team | Spring 2013

Spring 2013 | Vol. 10, No. 2

A WealthEnhancing Resource for Independent Veterinary Practices

Starting a Stem-Cell Therapy Program 3 | Breed Dental Treatment Plans 8

Diagnose Masses with Cytology 15 | Compliance for Therapeutic Foods 20

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From the Desk of Dennis A. Nelson, dvm Explore New Profit Centers Spring 2013 | Vol. 10 | No. 2

A Wealth-Enhancing Resource for Independent Veterinary Practices

Is everyone on your team sending a consistent message about therapeutic foods?

Helping clients understand the value of therapeutic pet food will improve their compliance, their pets’ health and your revenue, suggests Dr. Geneva Keene Acor on pg. 20. Therapeutic foods are available to help a wide range of disease Visit www.psi-inc.net for additional conditions, but pet owners educational articles. New articles include: don’t always buy into the • I mproving Dental Health Compliance concept. in Your Veterinary Practice Read Dr. Acor’s suggestions for getting your whole practice • When Flea Control Fails team involved in promoting • Tap the Potential of Senior Care therapeutic foods—and turning them into a profit center for your business.

On the Web

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: Nutrition Know-How; Stem-Cell Breakthroughs; Lumps and Bumps; Dental Care by Breed and Size.

Visit us on the web at

www.psi-inc.net

A lso in this issue: • Stem-cell therapy offers exciting healing options for pets suffering from the pain and swelling associated with arthritis and other joint afflictions. It can also be wealth-enhancing for your business. Read about the latest developments on pg. 3.

• Oral disease is often predictable by breed or breed size.

Dr. Brett Beckman provides an overview of common problems, from gingival overgrowth to cysts and tooth overcrowding, on pg. 8.

• Finding a mass on a pet can be frightening for pet owners.

Use cytology to address—or assuage—client fears and provide the best possible service to your patients, suggests Dr. Michael Canfield in his article on pg. 15. How sharp are your identification skills?

Take his quiz on pg. 16.

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

We hope you find this issue informative and wealth-enhancing for your practice.

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 | Spring 2013 1

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Senior Wellness

A New Way to Heal The benefits of establishing a stem-cell therapy program in your practice.

By Paula Andruss

Regenerative medicine has received a lot of attention in the human medical field, and now

it’s starting to take hold in veterinary medicine as well.

One of the most promising areas of this new discipline is stem-cell therapy for pets, which can offer relief from the pain and swelling associated with arthritis and other joint afflictions. The treatment is improving the quality of life for a growing number of pets while offering veterinary practices a new and solid revenue source. >>

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

Senior Wellness In this type of stem-cell therapy, the animal’s own stem cells are used to reduce pain and inflammation and help repair and regenerate damaged tissue in pets suffering from arthritis, dysplasia and other tendon, joint and ligament issues.

Collecting Cells In the first step of the procedure, the veterinarian collects fat tissue—an area rich in stem cells—from the animal, typically under general

Arthritis on the Rise

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Increase in prevalence of arthritis among dogs from 2006 to 2011 Source: Banfield “State of Pet Health 2012 Report”

The Team Approach Because stem-cell therapy is a new technology, it’s important for the entire practice team to be able to communicate what it is and what it can do. Here’s how each member can contribute:

Veterinarians Make recommendations to pet owners about treatment.

Get comfortable with the technology and what it can do, so you can explain it in layperson’s terms to help pet owners feel confident about the procedure. Collect tissue for stemcell isolation, banking and treatments.

Technicians Deliver more details for a comprehensive message to the pet owner. Assist the veterinarian with tissue collection and animal treatments.

Receptionists Educate clients about stem-cell therapy at the introductory level. Keep informational brochures available in the reception area and be able to discuss them.

Practice Managers Introduce stem-cell therapy to the veterinary practice.

Identify existing patients that might be candidates for the therapy, such as pets already on pain-management drugs.

Identify the practice as a provider of regenerative medicine and promote the practice’s use of stem-cell therapy on your practice website and via emails to existing clients.

4 Spring 2013 | the Team | www.psi-inc.net

anesthesia. That collected tissue is then processed (either in-house or at an outside lab) to further concentrate those cells. Once the stem cells are processed, the veterinarian injects them back into the animal’s affected area under sedation or local anesthesia, depending on the number of joints to be treated and the severity of the joint disease.

“The animal’s own stem cells are extracted, concentrated and then put back in to treat orthopedic diseases and injuries,” explains Bob Harman, DVM, MPVM and chief executive officer of Vet-Stem, a Poway, Calif.-based stem-cell therapy services provider.

Once the stem cells are reintroduced into the patient’s body, they reduce inflammation and pain and spur a healing process that can regenerate tissues. Initial improvements from the therapy can be seen anywhere from a week to two months after treatment. As the inflammation and pain subside, the animal can move around better, allowing it to start a rehabilitation program.

Treatment can be repeated when the effects start to wear off, typically between 6 and 18 months. While some animals don’t ever need stem-cell therapy again, about half of all animals need a retreatment within a year or two, says Harman, noting that using the Vet-Stem process, extra cells are stored from the original harvest so that animals that do need repeat treatment don’t have to go through sample collection again.

Processing Options While harvesting stem cells is always done in the clinic, the cells can either be processed in-house or sent to an outside stem cell processing lab. Because in-clinic processing needs to be conducted in a sterile environment and requires equipment and staff, most veterinarians choose to send their samples out to providers such as Vet-Stem, says Harman.

Veterinarians wanting to establish a stem-cell therapy program in their practices must first become certified, a process available through online training.

Vet-Stem offers a free, nationally approved online course in regenerative medicine to learn how to implement stem-cell therapy in a veterinary clinic.

“None of us as vets got any

training in regenerative medicine; it’s really new to the industry,” Harman says. “It’s not difficult or expensive, it just takes education.”

A New Profit Center Fees for stem-cell therapy vary depending on the animal and its diagnostic makeup, but a typical cost to pet owners is in the $2,500 to $3,000 range, Harman

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says. Adding a stem-cell therapy program to a clinic can create a new profit center to replace some of the prescription-filling business that many veterinarians have lost to online and big-box pharmacies, Harman adds. “Because it requires veterinary skill, training and service, this is not something that’s ever going to be stolen by big-box retailers,� he says. “Stem-cell therapy is going to keep expanding into more uses, so getting a base for regenerative medicine incorporated into your practice now is a great way to set yourself up for future growth.� n Paula Andruss is a Cincinnati, Ohio-based writer and editor.

Easing Ethical Concerns Some clients may bristle when they hear “stem cell� because of the controversy they’ve heard surrounding those words.

It’s important to make sure they understand that this type of therapy uses the animal’s own adult stem cells, which are typically found in the bone marrow and fat. Unlike embryonic stem cells, there are no ethical concerns around harvesting adult stem cells and reintroducing them back into the patient’s affected area.

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Dental Health

By the Breed Factor canine breed dispositions to oral diseases into your treatment plans.

Common conditions can range from cysts to stomatitis.

By Brett Beckman, DVM, FAVD, DAVDC, DAAPM

Oral disease in pets is not only common, it is also often predictable by breed or breed size.

Understanding the common breed associations with an oral disease can help you establish both a diagnosis and an accurate treatment plan.

Periodontal Disease Periodontal disease (Photo 1) is the most diagnosed disease in domestic pets. It affects far more patients than all other oral diseases combined. Because the disease is so common in our patients, we know a lot about it.

Casual observation of a reasonable number of large breed and small breed dogs in any veterinary hospital will reveal that small dogs tend to have more severe periodontal disease than large dogs. The disease also develops at a much earlier age in small dogs.

Specific breeds aside, small breed dogs generally have shorter maxillas and mandibles with relatively larger teeth in relation to jaw size than most large breed dogs.

This leads to crowding, rotation and malocclusions that predispose small breed dogs to periodontal disease. >>

1

Radiographic changes associated with periodontal disease. Marginal bone height is decreased (large arrow) adjacent to the mandibular left first molar (309). Periapical lucencies (small arrows) indicate non-vitality and are likely secondary to periodontal disease.

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

Common Breedrelated Conditions n

Gingival overgrowth

n

Tooth overcrowding

n

Cysts Lingually displaced mandibular canines

n

n

Eosinophilic stomatitis Mesioversion of the maxillary canines

n

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

Dental Health Since the bone is present in less volume due to larger teeth in smaller jaws, destruction of bone is more rapid and severe.

Some large breeds, especially Greyhounds, are also prone to early and severe periodontal disease.

Common Conditions Breed or breed size can predict pathology for some common conditions.

n Gingival overgrowth is more common in large breed dogs, such as Great Danes, Collies, Dalmatians and especially Boxers (Photo 2).

Gingival overgrowth, also called gingival hyperplasia, is the coronal growth of excess gingival tissue, creating pockets that predispose to periodontal disease and foreign body entrapment (particularly hair) that causes inflammation. Treatment involves removing excess tissue with

2

Severe gingival hyperplasia in a 9-year-old Boxer.

3

Crowding of the incisors has resulted in malposition in this 2½-year-old Shih Tzu.

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a scalpel and careful contouring with dental burs. Those experienced with laser and electrosurgery may use these modalities, taking care not to burn bone. n Tooth overcrowding is more common in small breeds.

Overcrowding results in an alteration of the normal eruption pathway of the teeth, allowing them to come to rest in an abnormal final position in the arcade (Photo 3). This can result in malocclusions and predispose the patient to periodontal disease.

Selective extraction to eliminate overcrowding will prevent periodontal disease. n Cysts occur frequently in small breed dogs, especially brachycephalic breeds. Commonly, patients with cysts are asymptomatic but are missing the mandibular first premolar. Radiographs often disclose a malpositioned unerupted tooth surrounded by a halo lucency (Photo 4). Destruction of the mandible will progress unless the tooth and the cyst are removed.

Adjacent teeth may also need extraction, endodontic treatment or monitoring, depending on the extent of cyst expansion.

4

5

6

A dentigerous cyst is present as a discrete luceny extending from the bone surrounding the left mandibular canine (304) to the left mandibular second premolar (306) (black arrows). The cyst is a result of the unerupted and malpositioned (white arrow) left mandibular first premolar (305) in this small mixed breed dog.

This Rottweiler mix has a lingually displaced right mandibular canine (404) causing palatal trauma and a fistula with hair and debris.

Lesions on the palate and oral mucosa consistent with eosinophilic stomatitis/ plaque are present in this 5-year-old Cavalier King Charles Spaniel.

n Lingually displaced mandibular canines are potentially a problem in any breed; however, large breeds such as German Shepherds and Rottweilers appear to be overrepresented. Although multiple factors contribute to these malocclusions, heredity plays a major role. Trauma to

the palate or the canine tooth are commonly present (Photo 5).

Treatment is aimed at orthodontic tooth movement, extraction or crown reduction and vital pulp therapy. n Eosinophilic stomatitis (plaque, granuloma) affects Cavalier King Charles Spaniels and Siberian

Huskies. Oral discomfort and the extent of the stomatitis vary from diffuse mucositis/stomatitis to distinct plaque-like ulcerations affecting one or multiple areas within the oral cavity and oropharynx (Photo 6). Treatment is frustrating and can range from steroids to extraction of adjacent teeth. >>

The Team Approach Here’s how the whole team can work together to prevent and treat oral conditions while keeping an eye on breed predispositions.

Veterinarians Perform a thorough oral examination in all patients to screen for breed- and size-related oral disease. Provide therapeutic and referral options to pet guardians.

Educate clients and provide recommendations to discourage breeding of affected animals when indicated.

Technicians Use images of size- and breedrelated oral diseases to aid the veterinarian in client education.

Become familiar with breed-related oral diseases to enhance recognition of pathology and aid in charting.

Talk directly to clients and make recommendations for home care for

periodontal disease prevention and management.

Practice Managers Schedule continuing staff education with a veterinary dentist or veterinary dental technician to discuss breedrelated problems. Discuss home-care options with the veterinarian. Order proper home-care products that will benefit patients.

Receptionists Assist clients in finding the closest veterinary dentist for advanced procedures. Become knowledgeable in home-care products so you can assist the doctor and technician in providing recommendations to clients for the proper home care.

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

Dental Health n Mesioversion of the maxillary canines (lance canine) in Shetland Sheepdogs (Photo 7) is another common example of breed-specific predispositions.

Treatment involves referral for orthodontic movement of one or more teeth, depending on the severity of the condition and the location of the canine and adjacent teeth.

COHAT Recommendations Many of these conditions can be diagnosed and treated during a COHAT (Comprehensive Oral Health Assessment and Treatment), which includes fullmouth dental X-rays, periodontal probing, cleaning and polishing, diagnosis and treatment.

For a complete list of the 15

7

The black arrow points to mesioversion of the right maxillary canine tooth (104) in this Shetland Sheepdog. The white arrow points to the maxillary deciduous 3rd incisor (503) that is preventing complete eruption of 104 and causing palatal displacement of the maxillary 3rd incisor (103).

components of a proper COHAT, visit http://veterinarydentistry.net/ dog-and-cat-teeth-cleaning-cohat/ Recommendations for scheduling a pet’s first COHAT vary from practice to practice. In general, all pets should have their first COHAT at 18 months of age or sooner. Many small breed animals will already have significant periodontal pathology at this age that will require treatment beyond cleaning. Although some large breeds will as well, many will just have gingivitis with no periodontal bone loss.

The variability between these two extremes will dictate the frequency of subsequent COHATS and the aggressiveness of the approach to home care. Ideally, home-care products should consist of those approved by the Veterinary Oral Health Council (www.vohc.org).

Breed size and individual breed predispositions can often provide diagnostic clues leading to proper treatment of specific oral conditions.

Early recognition and treatment of many hereditary or congenital diseases may save patients months or years of unrecognized discomfort or pain. By getting the veterinary team prepared for the possibilities in our varied patient base, we stand a good chance of helping our four-legged friends before these conditions have a chance to progress. n Dr. Brett Beckman is a specialist in veterinary dentistry. He practices in Atlanta, Orlando and Punta Gorda, Fla. www.veterinarydentistry.net.

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

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Parasites & Dermatology

Send in the Cytology When you encounter any mass, use cytology to confirm or correct your clinical impression.

By Michael Canfield, DVM, DACVD

If a pet owner finds a lump or bump on a beloved pet, the typical reaction is understandable anxiety that this could be cancer.

Make another “c” word (cytology) second nature in your practice when you encounter any mass. This lets you address—or assuage—client fears, provide the best possible service to your patients and boost your practice revenue.

Cytology Confirmation Regardless of your clinical impression, cytology should be performed on all masses. If your clinical impression is correct, great.

You can confirm that for the pet owner and then discuss whether surgical intervention is necessary.

Time is of the essence, because some masses are easily resected while they are small and adequate margins are more attainable. We have aspirated masses that owners have reported being present for years, only to find a malignancy that will be difficult to resect.

In addition, some lesions respond more readily to other treatment modalities, such as chemotherapy or radiation, and >>

www.psi-inc.net | the Team | Spring 2013 15

Parasites & Dermatology

Quiz: Test Your First Impressions Based on clinical appearance, would you suspect that each lesion is benign, malignant or infectious?

1

5

8

6

9

7

10

2

3

4

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

11

15

12

16

early diagnosis improves therapeutic outcomes.

When you examine any mass, tell the client, “There is a mass here, and I think we should go ahead and sample the mass today so that we can determine what kind of mass this is.� With this statement, you have expressed concern of the unknown, offered an appropriate diagnostic and suggested a time frame of when to perform the test.

It is certainly possible that the mass is just a lipoma, but if we don’t sample the mass and it turns out to be a subcutaneous hemangiosarcoma, mast cell tumor or fibrosarcoma, we have placed our patient at risk.

If the mass requires surgical intervention, then your practice will benefit by the additional income, your patient will hopefully enjoy a longer life, and your clients will appreciate the extra effort your practice put forward for their pet.

D.I.Y. Cytology

17 13

18 14

(answers on pg. 19)

To perform in-house cytology, a practice must have certain items. These include: precleaned, frosted, slides; a good quality, wellmaintained microscope; stains; needles; and syringes.

You do not have to be a cytopathologist to perform some cytology in-house. Most masses can be easily sampled with a 25-gauge needle. Place the needle into the lesion, then redirect the needle in several directions within the mass.

Remove the needle from the mass and use a 3 ml syringe to gently expel a sample onto preplaced slides.

Smear the sample very gently to avoid damaging it, then let it air-dry prior to staining or packaging. There are excellent cytology textbooks that can serve as a resource when questions arise.

Since every mass should be aspirated and lipomas are quite common, the odds are that you will aspirate lots of lipomas. The practice

>>

www.psi-inc.net | the Team | Spring 2013 17

Parasites & Dermatology will earn more income by providing this service, in addition to practicing better medicine.

Sometimes, you aspirate a mass, look at the cytology and say to yourself, “I have no clue.” Then is the perfect time to submit the slides to your favorite cytopathologist.

What to Charge Charges for cytology vary from practice to practice, but a typical fee for in-house cytology could be in the $45 to $65 range.

We charge the same price for all in-house cytology, whether it is skin cytology, ear cytology or an aspirate. If we send the sample to the reference lab, we charge the laboratory fee plus the typical markup for the hospital. The idea is that the easier, more common masses will be identified in-house and recommendations made at that time.

If a sample is evaluated in-

house and the clinician is unable to diagnose the tumor or process, we submit the sample to the reference lab and omit the in-house cytology fee as a learning experience for the clinician. One of the slides from

the site is preserved at the hospital so that it can be reviewed again once the cytopathologist’s report is available for comparative purposes.

This allows for the clinician to build his or her skills.

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Consistent Messaging Marketing cytology begins in the front office. If a pet owner tells your front-office staff that a pet has a mass, the response should be, “The doctor will want to get a sample of that mass.� The front-office staff should convey to the team that the owner found a mass and that sampling was suggested. The same message should be reiterated during the examination.

The entire team must learn the value of fine needle aspiration and cytology and be willing to convey this to the pet owners. When a suspected lipoma or dermal mass is diagnosed as a mast cell tumor based on cytology, the importance will become very clear. It happens every day, if we look. n

9. Malignant epitheliotropic lymphoma.

10. Malignant melanoma.

14. Benign sebaceous adenoma.

15. M alignant sebaceous adenocarcinoma.

11. B enign pigmented epidermal plaques. However, the potential to progress to squamous cell carcinoma exists.

16. This furuncle was caused by chronic trauma and infection of ruptured hair follicles.

12. Malignant mast cell tumors.

18. B enign ceruminous cyst adenomas.

13. The ulcerated lesion in the ear canal is a malignant carcinoma.

17. Malignant mast cell tumor.

Dr. Michael Canfield specializes in veterinary dermatology at the Animal Emergency and Referral Center in Fort Pierce, Fla., and the Animal Hospital of Regency Park in New Port Richey, Fla.

Answers to page 16 quiz: 1. Benign histiocytoma.

2. B enign reactive histiocytosis, which resolved with medical management.

3. M alignant histiocytic sarcoma.

4. The lesions are of infectious origin. They are secondary to dermatophytosis.

5. The lesion is of infectious origin, due to cryptococcosis. It resolved with medical treatment.

6. M alignant squamous cell carcinoma.

7. This lesion originally presented as a possible abscess. It is actually malignant, a squamous cell carcinoma involving the ear canal.

8. C anine leproid granuloma of infectious origin. The lesion was caused by a mycobacterial infection.

www.psi-inc.net | the Team | Spring 2013 19

General Wellness

Close the Compliance Gap Help clients understand the value of therapeutic pet food to improve their compliance, their pets’ health and your revenue.

By Geneva Keene Acor, DVM

My cousin is not a typical pet owner. When I visited her recently with

my puppy, she told me she had treats for visiting dogs, but her dog, Muggs, could not have them because they were too high in phosphorus. Muggs is a two-year-old neutered female Boxer with renal disease.

My cousin understands that the therapeutic food that controls Muggs’ disease process and maintains her quality of life relies on not only controlled protein but also phosphorus and sodium levels as well as anti-inflammatory properties of omega-3 fatty acids. Certainly we wish all pet owners were as committed to complying with our recommendations for therapeutic pet foods and understanding their value.

Send a Consistent Message Therapeutic pet foods have been around for decades. In 1948, a pet food was developed to aid in the management of renal disease in dogs. Since that time, research has supported the benefits of certain diet modifications to aid in the management of many diseases in dogs and cats.

Therapeutic foods are intended for use only under the direction or care of a veterinarian and usually are available only through veterinary clinics and hospitals. It is most important that therapeutic foods are used as directed and that the pet’s progress is monitored.

Some foods are used for the life of the pet and are complete and balanced with A study by the American Hospital Association found that pet owners want veterinary practices to recommend the best care for their pets.

Pet owners said they need prompting from their veterinarians.

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

the appropriate nutritional adequacy statements. Other therapeutic foods may be designated for short-term use.

It is important that everyone on the team understands the precautions and communicates clearly and specifically to pet owners the appropriate use and duration of the therapeutic food.

Diseases that May Benefit from Therapeutic Foods Adverse reactions to food (allergy or intolerance) Cognitive Dysfunction Syndrome (brain aging) Dental disease

Evaluating Claims The Association of American Feed Control Officials (AAFCO) does not set nutritional standards for therapeutic foods. However, in the pet-food regulations developed by AAFCO and enforced by state agencies, claims for health benefits must be substantiated by clinical evidence from research or provided by the manufacturer.

When evaluating various therapeutic pet foods, look for the terms “proven” or “clinically proven.” Model regulations state that these terms are not permitted unless “the claim is substantiated by scientific or other empirical evidence.”

If health claims are made, they must be adequately >>

Diabetes mellitus Gastrointestinal disease Heart disease Hyperthyroidism (cats) Kidney disease Liver disease Obesity Osteoarthritis Urinary stones

The Team Approach Is everyone on your practice team involved in helping your practice profit from therapeutic pet foods?

Practice Managers Assess the profitability of therapeutic pet food, not on the basis of a per-bag margin, but on the basis of amount of food per month x 12 months x the expected lifetime of the patient. Consider that therapeutic pet food sales are passive income (not requiring a veterinarian or technician appointment), are recurring and likely extend the life of a pet. They are a profit center as well as being in the pet’s best interest.

Veterinarians Review current therapeutic pet foods in a doctor’s meeting and form a consensus on the primary and secondary recommended brand of therapeutic food for each disease category. Be consistent within the clinic and in recommending the food that best meets the need of the patient. Remember that nutritional recommendations are now considered part of the standard of care for patients. Provide the best information possible when recommending a therapeutic pet food, citing research

studies that support claims of “clinically proven” to differentiate your choice from commercial foods with non-medical claims such as “maintains urinary health.”

Technicians Consider becoming the “go to” person for information on a particular disease category or categories with regard to therapeutic pet food. Review the current research and products with veterinarians and schedule periodic updates for all members of the staff. Follow up with pet owners three days after beginning a therapeutic food to answer questions and address concerns.

a reminder system to email or telephone clients when it should be time to reorder.

Receptionists Review patient records on check in and check out and always ask, “Do you need to order [name of pet]’s special diet today?” If your records indicate that the therapeutic food is not being re-ordered in a timely manner, alert the veterinary technician and the veterinarian to discuss this with the pet owner. Set up

Veterinary Assistants Become knowledgeable about the names of the various therapeutic pet foods, so if you are asked to “bring it from the back,” you will bring the right product and avoid confusion. Offer to carry bags or cases of food to the pet owner’s car as a thoughtful gesture.

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

General Wellness

Treats and Supplements Currently, many treats and supplements carry claims similar to those on therapeutic pet foods. The FDA reminds veterinary professionals and pet owners that “nutraceuticals” or products marketed as dietary supplements may be appealing as “safe” and “natural” remedies for disease; however, these products are not required to submit proof of safety or efficacy. “The consumer should eye with scrutiny any claims that a dietary supplement or nutraceutical is useful for the treatment or prevention of disease, or promises that it will ‘improve’ a condition or make the pet ‘healthier,’” cautions the FDA.

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

substantiated and must have been reviewed by the U. S. Food and Drug Administration (FDA) Center for Veterinary Medicine. Claims may not be false or misleading.

The chart on pg. 21 indicates disease conditions for which therapeutic pet foods are currently available. You may want to list the preferred brands for your clinic or hospital for each of these disease categories.

When evaluating products for your practice, don’t rely just on marketing materials—be sure to request and consider available research to support the preferred brand. Also, note that certain claims are allowed by AAFCO without substantiation. A product may claim that it “cleans teeth and freshens breath” without clinical proof. Also, such terms as “healthy skin and glossy coat” or “maintains urinary health” are allowed, because they are considered related to the normal nutritive value and not health claims.

Three Steps to Compliance Once you have selected therapeutic pet foods to recommend for common disease conditions in your practice, the next step is gaining client compliance for your recommendations.

Compliance has been the subject of many surveys, studies and discussions. Whether it relates to humans or animals; to medications, diets or exercise; the results are always disappointing to doctors and veterinarians.

According to a 2006 report by the National Community Pharmacists Association, “nearly 75 percent of adults are nonadherent [non-compliant] in one or more ways, such as not filling a new prescription or taking less than the dose recommended by the physician.” Similarly, for therapeutic pet foods, the actual compliance rate is 21 percent, according to The Path to High-Quality Care, a 2003 report from the American Animal Hospital Association (AAHA) Press. The same study provided the following summary: n They [pet owners] expected and wanted the practice to recommend the best care for their pets. n Noncompliance was not about cost; it resulted from the practice’s failure to make a recommendation or to convey the value or importance of a recommended treatment. n Most pet owners who recalled receiving a recommendation reported that they would have followed through on it if they had been prompted to make an appointment or had received a reminder.

To improve compliance for your practice’s recommendations for therapeutic pet foods, see if you can answer “yes” to these three basic questions: 1. Do you believe? Are you knowledgeable about the various therapeutic pet foods and the research that supports their “clinically proven” claims? Have

you used a therapeutic pet food for your own pet or monitored the progress of a patient sufficiently to acknowledge the benefits?

2. Does the pet owner believe?

Have you provided a full explanation to the pet owner of the disease process and how the therapeutic pet food has been developed to aid in the management of the pet’s disease?

Pet owners who understand the recommendation usually become advocates for their pets’ health.

3. Did you follow up? Do you have a process in place in your practice to be sure the recommended therapeutic food is acceptable to the pet and that the pet is having the expected results?

Value Over Time Often we hear discussions about the amount of space and the investment in inventory that are required for providing therapeutic pet food in a veterinary hospital or clinic. >>

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www.psi-inc.net | the Team | Spring 2013 www.preventplans.com

23

General Wellness There is also a perception of low profitability. However, Fritz Wood, a noted financial planner and frequent speaker at veterinary conferences, urges practice managers to consider not the profit on one item or sale, but consider what he references as “earns X turns” or the amount of profit on one sale times the number of times it is “turned” in a year. He contends that this produces a much different picture of the earning power or profitability of therapeutic pet foods.

For my cousin’s dog, Muggs, the therapeutic pet food recommended by her veterinarian has been clinically proven to increase life span by approximately two years for dogs with chronic renal disease and few azotemic episodes. For my cousin and Muggs, having a therapeutic food recommendation is certainly worth it. n Dr. Geneva Keene Acor is an independent consultant in smallanimal nutrition and veterinary practice procedures.

8

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Quiz TEST YOUR KNOWLEDGE

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

1 What dog breeds are partic ularly susceptible to oral cysts?

A. Pugs and Boston Terrier s B. Beagles and Basset Hound s C. Collies and Shetland Sh eepdogs D. English Pointers and We imaraners 2 What dental condition aff ects Cavalier King Charles Spaniels and Siberian Hu skies?

A. Lingually displaced mandi bular canines B. Gingival overgrowth C. Eosinophilic stomatitis D. Mesioversion of the ma xillary canines 3 What disease does not ha ve a therapeutic food available?

A. Hyperthyroidism (dogs) B. Hyperthyroidism (cats) C. Cognitive Dysfunction Syn drome D. Urinary stones 4 Compliance for therap eutic foods is estimated at: A. 15 percent C. 38 percent B. 21 percent D. 45 percent 5 Which type of lesion is of infectious origin?

A. Histiocytoma B. Ceruminous cyst adenom a C. Canine leproid granulom a D. None of the above

6 True or false: Benign pig mented epidermal plaques have the potentia l to progress to squamous cell carcinom a.

A. True B. False 7 In cats, the herpesvi rus typically results in: A. Eye problems C. Lesion s B. Weight gain D. All of the above 8 Which statement about pe t stem-cell therapy is not true?

A. Treatments use the anima l’s own adult stem cells.

B. Stem cells are typically found in the animal’s bone marrow and fat.

C. Therapy can help treat art hritis and dysplasia.

D. Improvement typically tak es a year after treatment.

9 Ingredients on a pet-foo d label are listed in order of: A. Volume B. Weight C. Proteins contained D. None of the above 10 On a pet-food label, what does the guaranteed analysis not guarantee?

A. Minimum level of crude protein B. Minimum level of crude fat C. Exact nutrient levels D. Moisture percentage

C

, 5-C, 6-A, 7-A, 8-D, 9-B, 10-

Answers: 1-A, 2-C, 3-A, 4-B www.psi-inc.net | the Team | Spring 2013 25

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