Anti-Pain Options AboundSeptember 1, 2009 Relying on an animal’s physical cues to determine its level of pain and educating clients to detect the pain can be a challenge. Experts say the best route to achieving pain control in the non-verbal patient is a thorough and accurate diagnosis coupled with veterinary and client education. Keeping an open mind on all avenues of pain relief is essential. While one patient may have an unfavorable response to a drug or therapy, the same option could alleviate discomfort in another patient. Experts say so many pain control options are available that close to 100 percent of patients can be helped through a multimodal approach. “Pain control has been available in the industry for quite some time, but veterinarians and owners sometimes miss out on opportunities,” says Robert Stein, DVM, CVA, CCRT, Dipl. AAPM. “Quite a few clients don’t let you go all the way with pain control, which is why veterinarians must be educating clients on ways to determine pain in the canine and feline patient and be open-minded in offering a variety of pain control options.” Difficulty in assessing the degree of pain has long been a problem. Clients often don’t …
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Predictive Value Of Glucose MonitoringAugust 31, 2009 Over the past decade, as studies shed new light on blood glucose testing in human and veterinary medicine, veterinarians have responded with varying degrees of enthusiasm and caution. Greet Van den Berghe, M.D., Ph.D., and her team at the Catholic University of Leuven in Belgium, have been studying the topic for the better part of 10 years. Dr. Van den Berghe’s original study, published in the New England Journal of Medicine in 2001, showed that intensive insulin therapy to maintain blood glucose at or below 110 milligrams per deciliter reduced morbidity and mortality among critically ill patients in the surgical intensive care unit. This therapy was compared to the previously standard therapy, which involved responding only when insulin levels exceeded 215 milligrams per decileter and a maintenance of glucose levels between 180 and 200. This new therapy was called intensive insulin therapy. Reid Nakamura, DVM, Dipl. ACVECC, of Red Bank Veterinary Hospital in Red Bank, N.J., says further veterinary research increased the excitement among veterinarians when it showed that patients with higher blood sugar levels had worse outcomes and longer hospitalizations. “In 2008, though, the same Belgian group basically ran the study again on a …
Pet Insurance Is Manageable ChoiceAugust 31, 2009 For U.S. health-care professionals, few terms are more encumbered than “managed care.” Carol McConnell, DVM, MBA, deals with the negative connotations every day, and she doesn’t even work on the human side of the care equation. “Probably the No. 1 concern I hear from veterinarians is that if pet insurance evolves as it has on the human side, insurers will start telling them what they can and can’t do,” says Dr. McConnell, chief veterinary medical officer for Veterinary Pet Insurance Co. of Brea, Calif. “That’s the whole world of managed care.” The reality of pet health insurance is actually a world apart, says McConnell, who is joined by others in the industry, including clinicians, seeking to educate veterinarians about the benefits of building an insured clientele. Unlike human health insurance, a pet health policy provides fee-for-service indemnity coverage, similar to a car, boat or homeowner policy. In fact, when insurers apply for a license with state departments of insurance, they sometimes get lumped in with marine policies “because they don’t know what else to do with us,” McConnell says. “We’re up there with the motor boats.” The upshot is that insured clients pay …
Spreading The WarmthAugust 31, 2009 Like most veterinary technicians, Brad Schaefer tackles a daily to-do list that’s long and varied. Still, there’s no hesitation when he’s asked to name his least-favorite duty. “I’m not a fan of euthanasia cases,” says Schaefer, head veterinary technician at River Road Animal Hospital in Southport, N.C. Luckily, he notes, there’s a task at the other end of the care spectrum. With lightning speed, Class IV laser therapy swings the balance of his day back into positive territory. “It’s definitely great to know there’s something I can do to help a patient—and client—feel better,” Schaefer says. As the use of laser therapy expands, it’s often veterinary technicians who wield the wand of relief. Not only does assigning this task free up veterinarians, thus strengthening a clinic’s return on investment, but it also enriches the techs’ professional lives, practitioners say. The overall workday becomes more enjoyable, those involved note, and the technicians become more committed advocates for veterinary medicine in general and for their home clinic in particular. All Schaefer knows is that when he turns on his clinic’s LiteCure Companion Therapy Laser, more than the patient feels the warmth. “The laser puts …
In-House Lab Equipment Passes TestAugust 31, 2009 What could be more important than making your clients’ clinic experience as convenient as possible? How about better protecting the health of their pets by adding capabilities to your practice? Of course, nothing says you can’t do both, notes Gary D. Norsworthy, DVM, Dipl. ABVP (feline practice). Convenience and cutting-edge care are at the heart of his clinic’s shift to in-house lab analysis. Dr. Norsworthy’s hospital, Alamo Feline Health Center in San Antonio, sees cases of hyperthyroidism and kidney disease every day. That’s a key reason he and his colleagues added an in-house blood analysis system six or seven years ago, he says. The clinic still uses a commercial lab for some of its more comprehensive profiles, but it now does the bulk of its lab work in-house, “And the biggest advantage of our equipment is I can get answers from tests in less than 15 minutes,” Norsworthy adds. That means clients get the convenience of swift test results and a diagnosis without having to make a follow-up trip to the veterinary office. With three doctors and six exam rooms, Alamo Feline Health Center prides itself on its efficiency as well as its …
Dealing With Daily DilemmasAugust 21, 2009 I received some responses regarding my August column about “Food Inc.,” a documentary film released this past summer. No doubt, there are animal welfare issues in the field of food animal production that will put some veterinarians at odds with other veterinarians. Part of my job is to raise awareness of issues that affect our profession and how we serve society. The information quoted in my article came from the documentary. The first Bustad Award Winners’ Reunion took place during the AVMA convention. It was organized by Dr. William McCulloch and hosted by Larry Norvell, president of the Delta Society. No other single event has attracted as many Bustad recipients in one room. From left are: Drs. Jane Shaw from the Argus Center at Colorado State University, James Harris from Tasmania, Brian Forsegren (this year’s recipient) from Cleveland, Caroline Shaffer from Tuskegee, Marv Samuleson with VARL, Dr. Alice Villalobos, Bill McCulloch from Washington, Gen Kato from Japan and Marie McCabe from Arkansas. I recommend that all veterinarians see the movie because some of your clients most likely will see it. California had …
Some Disturbing Food For ThoughtAugust 6, 2009 The Centers for Disease Control and Prevention estimates that food-borne illness affects 76 million Americans annually; 325,000 adults and children become sick enough to be hospitalized and 5,000 die. Reading List “Fast Food Nation,” . “The Omnivore’s Dilemma” and “In Defense of Food,” . “Stuffed and Starved: The Hidden Battle for the World Food System,” Daily headlines often include stories about: Food poisoned with e. Coli and Salmonella. . Pesticides and feedlot runoff causing pollution by methane and greenhouse gas emissions. . Food animal and immigrant labor abuses. . World hunger, malnutrition, obesity and the diabetes epidemic becoming rampant. The documentary film “Food Inc.” shows how industrial food is making people sicker, fatter and poorer, and how it negatively affects the environment, the economy and workers’ rights. David Servan-Schreiber, MD, Ph.D., in his well-documented book “Anticancer,” confronts the hazards of our traditional Western diet. Thirty million Americans are …
Foods Can Play Role In Allergy CareAugust 5, 2009 From elimination diets to hydrolyzed foods, novel proteins to Chinese therapy, many tools serve the quest to identify and treat food allergies in pets. But in the end, doesn’t solving the riddle of a pet’s allergic reactions really come down to the uncertainties of trial and error? Hana, a 7-year-old female Leonberger, was presented to Dr. Signe Beebe in March. Hana was covered with bald patches and sores caused by constant scratching. Beebe treated her using food therapy, Chinese herbs and acupuncture. “I prefer the term ‘therapeutic trial,’ ” says Paul Bloom, DVM, Dipl. ACVD, ABVP (canine and feline specialties). “With such trials in human medicine, aren’t you guessing?” Whatever the terminology, practitioners and pet owners alike agree that the road to a food allergy solution can be twisty and trying. The end place is often a special diet designed to curb the inflammation, itching, biting and scratching that are the telltale signs of allergic reaction. Finding the most effective diet can take more diligence and detective work. “What’s so difficult is that people, including veterinarians, want answers right now,” says Dr. Bloom, owner of the Allergy, Skin and Ear Clinic …
Planning Pet Care Can Help Clients Pay BillsJuly 10, 2009 Follow Veterinary Practice News on Twitter at @vetpetnews. Most veterinarians didn’t go to school to become financial planners. Yet, many spend lots of time discussing finances with their clients. After all, veterinary care costs money, and when that money isn’t available, the pets ultimately suffer. Making a Case for Insurance On the surface, pet insurance may seem like a monthly expense that pet owners could trim in lean times. But Chris Edgar of The Hartville Group Inc., says clients should be reminded that they’ll be even less likely to afford sudden, significant expenses during an economic recession. “The most compelling aspect of pet insurance value remains its service as a means to prevent unexpected veterinary costs, which can total hundreds or thousands of additional dollars,” Edgar says. Jules Benson of Petplan says veterinarians can encourage customers to plan for the health of their pets—and their pocketbooks—in many ways. For example, he says, reminding owners of healthy pets about common conditions that could arise years into the future can help set expectations and …
Why Is Deception So Common?June 30, 2009 It has always bothered me when doctors and nurses blandly tell dying human patients that they will be “OK.” I am also bothered when I hear veterinarians and their support staff tell pet owners that their pet is going to be “all right” despite a poor prognosis looming overhead. We may feel guilty if we take away a person’s hope, but should we lie about reality? Deception is all too common a habit in the human health care field, but should veterinarians also support the false hopes of their clients? Should frank lies come straight from health care professionals who encourage terminal patients to thrash in the gears of the “mindless machinery” of medicine? Is there harm in giving clients the truth about their pet’s actual condition and probable prognosis, at least as a reality check? If veterinarians follow the pediatrician model, we need to inform the “parents” about their pet’s condition. Are physicians and veterinarians too blunt when they inform us with the statistical prognosis? Is there a more compassionate way to say, “You have six months to live”? How can this difficult information be gently delivered to the family without ripping their hearts out and …
