What's Your Diagnosis? Reasons For LamenessApril 17, 2009 Signalment: 9-month-old male German shepherd History: Patient presented for lameness of the right forelimb and pain on palpation of the humerus and midantebrachium. Questions: 1. What are the primary findings? 2. What do you think is the primary reason for the clinical signs? Radiographic Findings: Increased medullary opacity is noted in the proximal diaphysis of the ulna as well as the mid to distal diaphysis of the radius. The elbow is normal. The line of the medial coronoid process is normal on the lateral view. The humerus is normal. There is no evidence of elbow dysplasia or united anconeal process in this patient. Interpretation: The proximal ulna shows signs of panosteitis. This is likely the cause of the lameness, particularly given the clinical exam findings. The lack of radiographic change in the humerus does not rule out this diagnosis, as the radiographic signs can lag behind the clinical signs. Discussion: When evaluating radiographs of the skeleton of the immature animal, it is necessary to have knowledge of the normal anatomy, in particular, the sites of physes and the normal closure times. The most common reason that the axial skeleton of an immature …
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Know What To Say When Fees Are IssueApril 17, 2009 At veterinary practices all across America, perhaps no other task turns more palms sweaty and causes more throats to seize up than telling a client how much a procedure costs. “Most employees I know would prefer to do almost anything than to present an estimate,” says Shawn McVey, MA, MSW, a veterinary management consultant and lecturer. “For veterinarians, there’s almost a shame or embarrassment in talking about fees.” That shame is symptomatic of a bigger problem in veterinary medicine, adds McVey, chief executive officer of Innovative Management Solutions and co-owner of the continuing-education conference Veterinary Specialists in Private Practice. “We’ve done an abysmal job of talking to clients about the value of veterinary care.” McVey’s is among the loudest voices calling for a sea change in the way veterinary practices communicate with clients about the cost of care. He offers tips on overcoming money-related obstacles and advocates scripting responses to acclimate staff. But first, all those at the practice have to undergo “a complete shift in mindset,” he says. “For too long, we’ve been internally focused, comparing ourselves to others rather than to what our clients say they want and …
The Role Of Outreach In Honing Endoscopy SkillsApril 17, 2009 Like every other form of new technology, endoscopy is only as good as the practitioner using it. For some, a lack of experience with the equipment can build a roadblock to success. In the relatively short history of the technology in veterinary medicine, some general practitioners have been known to go weeks or even months between chances to use their rigid endoscopy equipment. Those who have used it only for procedures such as lung lobe removals or liver biopsies might have gone as long as six months between surgeries. “If you’re going six months without performing a procedure, it’s easy to lose confidence in your ability,” says Raymond Cox, DVM, founding partner of Deer Creek Animal Hospital in Littleton, Colo. The solution championed by Dr. Cox and several colleagues is to make endoscopy an indispensible tool of their everyday practice. Aided by a study that established a pain advantage, they started using laparoscopic equipment to perform spays. They also took a big step to close the gap on experience and confidence. By reaching out to shelters and rescue groups with an offer to perform procedures for free or at a greatly reduced cost, the veterinary …
Finding Marketing Gold In On-site Blood AnalysisApril 17, 2009 When Kent Adams, DVM, talks about his in-house services, the “house” tends to be miles from his veterinary office. His exam room is often a stall in a client’s barn, and he’s comfortable doing lab analysis off the back of a pickup truck. Such is the life of a large-animal veterinarian providing ambulatory service in the New River Valley of Virginia. Dr. Adams’ extended-cab 4-by-4 is where leading-edge medicine intersects with rural outreach. “There are times when I’ll be standing in a barn at 10 o’clock at night, looking at a horse with a snotty nose, and the client will prompt me, ‘Do you think we need blood work?’” says Adams, one of five doctors at Appalachian Veterinary Services. “That’s when I learn about the rewards of marketing.” Like more than a few of his companion-animal colleagues, Adams finds that a pitch for his on-site and in-the-field laboratory services strikes a chord with potential clients. That’s why he mentions the lab in just about all of his marketing materials. Such services send the message that a practice bases diagnoses on the timeliest information, practitioners say. Especially in highly competitive markets, that can be a …
What’s Your Diagnosis?April 17, 2009 Signalment: Adult domestic shorthair; 1.5 years old History: Vomiting for two days. Anorexia for two days. Painful on palpation of the abdomen. Upper GI study was performed. Two representative images after administration of contrast are presented. Questions to answer: What are the primary findings? What do you think is the primary reason for the clinical signs? Radiographic Findings: There is contrast noted within the stomach and extending in the small intestines. Several loops of small intestine are moderately dilated and there is plication of many of these loops of small intestine. The detail in the abdomen is normal but there also appears to be clumping of these abnormal loops of intestine in the ventral abdomen. Radiographic Interpretation: Dilated, plicated small intestine consistent with mechanical ileus from a linear foreign body obstruction. This is the cause of the clinical signs. Discussion: The most common problem related to the GI tract detected on survey radiography is ileus. By definition, ileus strictly means failure of passage of the intestinal contents. There are two …
Informing Clients About Quality Of Life And DeathApril 17, 2009 Small animal veterinary practice today parallels the pediatrician model. But veterinary personnel deal with five times more patient illness and death than most health professionals. Despite the predictable frequency of terminal illness and death, many veterinary hospital personnel lack the skill to properly interact with bereft pet caregivers. In addition, the intense exposure to end-of-life care issues and death causes some staff members to develop compassion fatigue, a type of burnout that may not be recognized or understood. The human animal bond is now acknowledged and celebrated as an important part of people's lives and, at times, may be the best relationship a person has. The role of veterinarians is to facilitate that relationship by keeping animals healthy. Veterinarians have an increasing obligation to serve the committed pet owner with improved medical techniques and improved communication regarding quality of life and end-of-life care issues. We also have an increasing obligation to provide support and reverence when a pet dies, and even reach out to comfort the client in the days following the pet's death. But where and how do clinics become proficient grief management? Tools for Staff Some hospitals …
Power Of The Bond Reinvigorates UC DavisApril 17, 2009 The new Veterinary Medical Instructional Facility at the University of California, Davis, was named posthumously in honor of Gladys Valley, who donated the early seed money to the building campaign in the amount of $10.6 million. The VMIF was dedicated on June 15. Alumnus Dr. Michael Floyd donated $1 million. For his spirit of generosity, the central commons area of this remarkable "green" building is named "Floyd Commons" in his honor. VCA Antech supported the VMIF by sponsoring the two largest auditoriums as part of the donor-naming opportunity program. When the Davis class of 1955 celebrated its 50th anniversary, Dr. Bill Wetmore presented a $31,000 class gift and a classroom will be named in its honor. Name plaques appear on classroom tables, suites, study areas, seats and lockers which are dedicated to friends, family members and pets as part of the donor naming and "take a seat" program. You may recall that in 1998, the UC Davis School of Veterinary Medicine was placed on limited accreditation status by the American Veterinary Medical Assn. The university was cited for lack of updated and improved teaching and research facilities despite being widely regarded as No. 1 …
Nature’s Phenomenally Cruel SideApril 17, 2009 On April 25, a great white shark attacked David Martin, DVM, UC Davis class of ’76, around 7 a.m. Dave was swimming 150 yards off shore with nine friends in wet suits. They were triathlon training in Solano Beach, Calif., not far from Dave’s house. Experts think the shark mistook him for a seal. Dave yelled, “Shark!” before he was pulled under. The shark did not stay around. Dave’s friends brought his lifeless body to shore. Dave’s legs had deep bite wounds that severed his femoral arteries and veins. He most likely bled to death within a few minutes. This shocking attack was covered extensively in news outlets. It made me think of other animal attacks that hit the news: the sting ray that killed Steve Irwin; the tiger shark that bit the arm off young Bethany Hamilton while she was surfing; the alligator that attacked a golfer and dislocated his shoulder; the chimp that attacked a visitor at a primate shelter; the tiger bite that ended the Siegfried & Roy show; the bear that killed one of its trainers; the zoo tiger that killed a taunting boy; and the captive orca that attacked its handler at …
Mapping Future Of Cancer ResearchApril 17, 2009 Oncology and pet hospice have been the focus of my practice career since I completed the first-ever, though unofficial, oncology residency program under the guidance of Gordon H. Theilen, DVM, Dipl. ACVIM (oncology), at the University of California, Davis. Veterinary oncology has grown rapidly over the past 15 years because of the amazing foundation set forth by our great forefathers, Dr. Robert Brody, Dr. Greg MacEwen, Dr. Amiya K. Patnaik, Dr. Edward Gillette and my mentor, Dr. Theilen. We are so fortunate to have had the opportunity to celebrate Theilen’s 80th birthday with a first-of-its-kind cancer research symposium at UC Davis. The Theilen Tribute Symposium honored the visionary “One Medicine” career of Theilen. He is considered one of veterinary oncology’s most prolific and internationally appreciated forefathers. He contributed diverse pivotal research in cancer virology, initiated the first veterinary clinical oncology service, contributed the world’s first reference textbook, “Veterinary Cancer Medicine,” and mentored many who became leaders in their respective fields, touching millions of lives worldwide. Theilen based his research and teaching career at UC Davis, where he was influential in the growth of the veterinary and medical facilities. His research work and …
Calif. Vets Face Off On Farm Cruelty MeasureApril 17, 2009California veterinarians are in conflict with one another again. This time, it's over Proposition 2, also known as "The Prevention of Farm Animal Cruelty Act." Proponents are trying to regulate the housing and care of farm animals, especially egg-laying hens. Other efforts are ongoing to provide more humane husbandry for pigs, veal calves and livestock. Most of the general population does not even think about the issues involved in intense food animal production. However, when people are asked how they would vote, they want to be kind. Our profession is being taken to task over this issue because opponents feel that Prop. 2 will force egg production out of California, while proponents feel that eliminating battery cages for egg-laying hens is the right thing to do and that industry can make the adjustment over time. Prop. 2 is supported by the California Veterinary Medical Assn. (based upon the "8 Basic Freedoms" adopted by the CVMA during Dr. Jon Klingborg's presidency) and the Humane Society Veterinary Medical Assn. HSVMA is a well-funded national organization with thousands of members, including the members of the Association of Veterinarians for Animal Rights, who were merged into the group at …
