Monthly Archives: March 2011

AAHA Conference Update

View out my hotel window

So many good things to talk about! The topics I want to cover will certainly keep me busy for awhile. I’ll summarize some of the lectures I’ve attended at this AAHA conference in Toronto, and highlights gleaned from them, but first I want to outline my ideas for future blog posts related to the conference:

  • – the first app of its kind (that I know of) that allows you to set up a medical record for your pet (intended for pet owners), search for a veterinarian, look up lost and found pets, and even search adoptable pets–all in the same app. I interviewed the sales person at the booth and will be putting it together sometime after I get home. Personally, I find this very interesting, for reasons I will outline in my future post.
    • Haven’t decided yet if I’ll include the new LifeLearn client education system with this post (offered by the same company), or write about it separately, because that’s something else that I think has tremendous application, and I don’t see any other veterinary service offering anything quite like it, or nearly as high quality.
  • DogLeggs: Therapeutic and Rehabilitative Products. I interviewed Lisa Fair, one of the sales people at the booth, about their products, because I think they fill a unique niche in veterinary medicine that is under-recognized and under-utilized. They don’t teach you in vet school about things like DogLeggs, which make your life sooo much easier AND provide a valuable therapeutic purpose for your patients with special needs.
  • My opportunity to meet with (and have dinner with!) one of my idols, Dr. Robin Downing. Undecided yet as to whether I’ll post pictures…
  • And possibly more on the role of social media marketing in veterinary practices, as this is clearly something I have an interest in, and it has been a point of repeated discussion at the conference.
  • And, if I really feel motivated and have the time, I’d like to cover the Opening Session talk by Steve Little. Good stuff. Milkshakes.

Now for a quick summary of the lectures I’ve attended:

  • Urology: phenomenal series presented by Dr. Doreen Houston!!! I wasn’t planning to stay for all 5 lectures, but I couldn’t pull myself away!
    • Idiopathic Cystitis in Cats–and Dogs? (Parts 1 & 2): Having an excellent speaker (who is also an expert in her field and was awarded the OVMA Veterinarian of the Year Award–for good reason!) walk you through this complicated and frustrating disease miraculously alleviated any feelings of being distraught over the lack of new information in this field. She said everything I already knew: there’s no universally effective treatment, we need to increase our cats’ water consumption, and provide environmental enrichment and stress reduction. But the way she presented it, it felt so revolutionary and invigorating! I LOVED this talk!!
    • Crystals & Stones: An Update on Types, Diagnosis, Management, and Prevention in Dogs (Part 1) and Cats (Part 2): I learned soooo much from this, I can’t begin to summarize it. Sorry for the cop-out. One key point was to be sure to treat a dog or cat with antibiotics (based on culture results) for 1 full month after resolution of struvite stones. In the dog, that may mean dissolving the stone for 2-3 months, and therefore, 3-4 months of antibiotics.
    • Urinary Tract Infections in Dogs & Cats: What’s New in Diagnosis & Management? Key take-home point: always, always culture and do sensitivity testing. That sounds obvious and mundane, but again, the examples she shared and the practice tips she covered were so enlightening. Talked quite a bit about indwelling catheters as well (note: don’t put those patients on prophylactic antibiotics!).
  • Communication
    • Karen Purves presented, “Communicate With Strength: 17 Words that Undermine Your Effectiveness”. She’s a very dynamic, fun speaker who is easy to listen to. Reminded me of stuff I probably already knew, but she also does research on the linguistics of communication and what is most effective (and why), which I find very interesting.

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Journals: Clinican’s Brief

One of my favorite veterinary publications is the NAVC’s Clinician’s Brief. The March 2011 issue features a beautiful pictorial image of what you’re palpating when preparing to perform an epidural.

The issue thoroughly covers one of my most favorite topics in veterinary medicine: pain management. In addition to the well-illustrated and well-written how-to article on performing epidurals, there’s an article by IVAPM president, Dr. Mark Epstein, about news in the “pain management pipeline”.¬† I plan to write a separate post about the IVAPM as an invaluable resource, and why you should join if you are likely to ever encounter an animal in pain. We’ve been performing epidurals on all abdominal and orthopedic (pelvic limb) surgeries for at least the last year, perhaps the last two years. They are not technically difficult in the slightest, and I see no reason why general practitioners shouldn’t be performing them for things like: FHO, TTA (or other ACL surgery repair), patellar luxation repair, hind limb or tail amputation, cystotomy, abdominal exploratory, or c-sections. With this great article, hopefully more general practitioners will start doing these.

Dr. Mark Epstein’s article, “The Pain Management Pipeline: Pharmacologic Developments to Watch,” gives readers a glimpse of the future (and the future is now!) in terms of pain management for our patients. Several new, up-and-coming drugs are showing promise, although there’s still a lot more for us to learn. Dr. Epstein reviews some of these newer options, including: tapentadol, mexilitene, orphenadrine, long-acting opioids, and antiglial drugs. I know I’ll be following the IVAPM discussion boards closely to stay abreast of new information, as it becomes available.

This issue also included an interesting discussion on acupuncture, congenital luxation of the radial head in an English bulldog puppy (some very cool pictures of course!), and advice for clients with new puppies. And of course, I always love their “Capsules” section–brief reviews of veterinary articles that may be of interest to their readers but might not otherwise be seen by their readers (because we can’t subscribe to, let alone read, every single veterinary journal out there!). I learned that this “Capsules” concept is how the Clinician’s Brief originally began–and this was their 100th issue!

A supplemental issue of “Exceptional Veterinary Team,” the guide for problem-solving amongst hospital staff, was also included with the March 2011 issue of Clinician’s Brief. I admittedly didn’t read the whole thing, but I read the first article, “Dealing with a Medical Mistake,” by Erin Allen and Dr. Jane Shaw, with great interest. Can you imagine if you accidentally declawed the wrong cat? What would you do? I love its step-by-step guide in how to present bad news to a client in the best possible way, and there’s something reassuring about reading that, no matter how well you present the information, there may be negative consequences, but at least you were truthful, compassionate, and sincerely apologetic through it all. Malpractice suits most often result from a failure to take responsibility, apologize, and communicate openly. Dr. Jane Shaw is also one of the founders and primary educators for the Pfizer Frank Communication training I mentioned in an earlier post.

In case you missed it at the beginning of my post, here’s a link to the March 2011 issue of Clinician’s Brief:

Did you read this issue? What was your favorite part?

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Upcoming AAHA conference

Just a quick post to say how totally excited I am to go to the AAHA conference in Toronto this week!! I am undecided about whether to bring my laptop and try to post while I’m there. I have a feeling I’ll be pretty busy without trying to update this blog, but I’d love to try!

It has admittedly been awhile since I’ve been to an AAHA conference. I think the last one I went to was while I was in vet school, probably in 2001. Yikes, that’s 10 years ago! I seem to “dabble” at various conferences: AVMA, CVC, AAV (one of my favorites), and one time at the NAVC Post-graduate Institute (for behavior). Being the fan that I am of AAHA and promoting high standards for veterinary practice, it only makes sense that I attend it this year! Ok, the fact that our hospital is a finalist for AAHA Practice of the Year is kind of a big deal and might be part of the reason why this is the year I’m going. ūüôā [Insert sounds of sheer excitement!] As I’ve come to realize that this blog is only semi-anonymous, at least as I get my feet wet with this blogging idea, perhaps I’ll share more details about the award itself as those details become available.

Why am I proud to work at an AAHA-accredited practice? Sheesh, why not?? Our entire team is so committed to providing the highest level of care for all our patients. That means a technician is monitoring each and every patient I perform surgery on, we stay current on the latest and most progressive protocols, we ALL attend tons of CE (not just the doctors), our employees are proud to recommend us to their family and friends, and our clients can find comfort in knowing that their pet (and family member) will receive the best care and we’ll take the time to talk to them about any concerns or confusions they may have. It means job satisfaction. It means I love what I do. It means I am so proud of our hospital and our team, and soon we’ll be able to share that with the whole world!!

Naturally, I’m eager to find out if any readers of this blog are also going to the AAHA conference this week. I’ll be arriving Wednesday night. I find out Sunday morning what kind of award we’re getting–but that’s really just minutia. It’s all a huge honor and regardless of whether we’re first, second, third, or honorable mention, we’ll be able to say we’re a nationally recognized hospital, and we’re recognized as an AAHA Practice of the Year finalist!

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What I learned this week


Photo Credit: Pachyblur

For me, doing is learning. Here’s a run-down of what I did this week that seemed noteworthy enough to list:

  • My first ferret fracture repair–a 10-month old ferret broke his R femur via unknown trauma. Placed an IM pin and two cross pins. Caused some splintering of the bone in the process but I was mostly satisfied with the result. Really, really hoping for the best for this little guy.
  • Gastrotomy/foreign body removal on a young Golden Retriever
  • Epidural on the same dog
  • Dealt with the worst chinchilla paraphimosis I’ve ever seen. After removing a fur ring constriction around the base of his penis (under sedation), I just kept him on metacam (and used lots of lubrication), and over the course of about 6 days, it has gone from possibly needing amputation (good thing we didn’t go that route) to returning almost completely back to normal.
  • Performed a molar grind on another chinchilla who has the worst teeth I have ever, ever, ever seen. I’ve been working with him for quite awhile, actually–this was one of our “routine” check-ups. He is also the only chinchilla I have extracted molars on before. I didn’t think he was going to survive this long, but he is such a trooper and his family is so committed to him!
  • Tried (and failed) to troubleshoot technical difficulties at a local CE presentation (as president of the local VMA, I feel a responsibility for making sure everything goes smoothly–this was painfully disappointing). The speaker did a phenomenal job of presenting off-the-cuff and I still learned a ton, including:
    • If a young, healthy dog has elevated liver enzymes but no clinical signs, the first step she recommends is trying a limited ingredient diet.
    • If performing an ultrasound-guided aspirate of the liver, use a 25-gauge needle. She’s never known a case to bleed excessively from that small of a needle, and sedation is not (usually) needed. The FNA can help indicate things like histoplasmosis or other potentially infectious causes.
    • If performing an ultrasound-guided biopsy (under sedation of course) of the liver, ALWAYS do a coagulation profile first. She said everyone at their specialty practice has been burned at one time or another by having a patient bleed excessively after a liver biopsy.
    • Her preferred antibiotics for liver infections are ampicillin or amoxicillin. But she said make sure these are given IV. The bioavailability of ampicillin when given orally is zilch.

I’ve also learned more about college basketball (maybe I’ll post how I did with my bracket when all is said and done), I’ve learned that I’ve got a LOT of work to do on our upcoming open house, and since we set a date for our annual staff retreat (and it’s less than a month away), I need to do some serious brainstorming for that.

What is one thing you learned this week?

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Veterinary Dentistry

I am coming to realize–and this is up for debate–that the future of bread-and-butter income for small animal practice lies not with elective spays and neuters, but with dentistry. Unless a practice has a steady stream of new puppies from breeders or pet stores (and the significance of the latter will hopefully wane in the coming years due to heavy and unrelenting pressure on puppy mills), then most new puppies coming into a practice will already be spayed and neutered by shelters and low-cost spay/neuter clinics. Some general practices continue to offer orthopedic surgeries, such as ACL and patellar luxation repair and FHO’s, but increasingly orthopedic surgeries are referred to specialty practices that limit their services to these types of procedures (and other surgeries).

One area of service that still very much belongs in general practice is dentistry. Sure, there are veterinary dentistry specialists who perform root canals and other endodontic and orthodontic procedures not suitable for general practice, but the opportunity for small animal dentistry in general practice is huge. Our own hospital is a perfect example. It used to be that every week, we performed 10-12+ spays/neuters (and maybe 8 dental procedures) per week. After our relationship with a local pet store came to an end, those (already low) numbers dropped drastically. Now we do 1-4 spays/neuters per week, and 11-16 or so dental procedures per week. With each dental procedure averaging about $500, considerably more than our spays and neuters, dentistry is clearly an important component of a successful veterinary practice.

Considering how little dentistry I was taught in vet school (uh, none), I experienced a steep learning curve in the real world of veterinary dentistry. Fortunately, I had a great mentor (who now has her own dentistry practice), and I managed to do okay. But dentistry is one area where I always welcome new info (ok, you already know all of veterinary medicine is like that for me), which is why, without further adieu, I highly recommend the following veterinary dentistry resources:

(VIN membership required to access this last one. Make sure to check out the “Dental Morph Videos by Dr. Bellows” under the “Slideshows, Images and Videos” section!)

Dr. Brett Beckman, the man behind the first two listed resources, has quite an impressive background (from his website: “Dr Beckman¬†is immediate past president of the American Veterinary Dental Society. Dr Beckman is¬†the sole¬†veterinarian in the world¬†who has completed¬†extensive¬†training to become¬†regarded as a¬†Fellow in the Academy of Veterinary Dentistry, a Diplomate in the American Veterinary Dental College and a Diplomate in the American Academy of Pain Management. He has published numerous peer-reviewed articles in the field of veterinary dentistry, oral surgery and pain management.¬† He¬†has been honored as a candidate¬†for the American Veterinary Medical Association/Delta Society national award for Veterinarian of the Year for 2004. In 2007 Dr. Beckman was honored as Alumnus of the Year by the Mississippi State University College of Veterinary Medicine.”) He clearly loves learning and teaching, as he does a phenomenal job of disseminating information about veterinary dentistry to the entire world. I think all TLV readers will get a lot out of his postings!


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Communicating clearly: “Let’s see if he has a bladder”

A recent post on A Vet’s Guide to Life, Proper Communication, discussed some important points when it comes to communicating with pet owners. The post started with an email from a vet tech (and vet student hopeful–good luck!) who shared her observations about doctor-client communication. She cited specific examples of conversation snippets that might sound odd or be misinterpreted by a lay person (which most pet owners are, with some exceptions of course).

Here’s one example she used: “Once, she [the veterinarian] told someone with a puppy who was leaking urine that she wanted to ultrasound him in back to ‘see if he had a bladder’–meaning check to see if his bladder was full–so we could get a urine sample. The owner blinked her eyes and said, ‘is it possible that he might not have a bladder?’ to which the doctor replied, ‘sure, especially if he just urinated.'”

This observation illustrates a couple important points:

  1. The veterinarian is oblivious to the fact that her nonchalant explanation, while it makes perfect sense to her, can easily be misinterpreted by someone who interprets a more literal meaning.
  2. The perspective of the vet tech watching this conversation take place is removed enough from the situation to catch this potential problem and identify it as such.

I like learning from these kinds of alternative, fly-on-the-wall perspectives. I think it takes the perspective of someone removed enough from the situation to catch these potential communication gaps. I’m an advocate for video recording exam room etiquette so as to analyze your body language and communication style, but would the vet, if she watched a video of this exchange, even detect that her choice of words could be confusing? I think most vets who are comfortable with their communication style would not notice the lack of understanding on the part of the owner.

I applaud the vet tech who made this observation (and others mentioned in the original post). I think the truly great vets are ones who not only understand the complexities of veterinary medicine, but can communicate complex issues in a way that non-medical pet owners can understand. This is something I struggle with every day, and one of the reasons I started this blog.

For vets interested in expanding their ability to communicate effectively, consider enrolling in the PfizerFrank Communication Training. I haven’t done the actual 2-day workshop at Colorado State University, but we’ve had some in-clinic Frank training which has been very illuminating and helpful.


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Great discussion on the physical consequences of declawing

As a member of the International Veterinary Academy of Pain Management (IVAPM), I enjoy following the many interesting discussions on this favorite topic of mine. Today, a post on the discussion forum caught my attention, and I want you to check it out:

Physical Consequences of Declawing by Dr. Jean Hofve of Little Big Cat

This illustrated post shows how removing P3 shifts P2 into a weight-bearing position, and over time, the tendons contract, the cat walks differently, and arthritis develops. It definitely gives you some things to think about.

Dr. Hofve posted some additional articles/resources on the topic of declawing, which you should also check out:

I have performed declaws myself, but it has been awhile. I do not like doing them, and I try hard to talk people out of it, but I like that I can present this additional information to owners (especially the pictorial guide) and give another perspective.

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