Developers are hoping guidelines are a first step in stopping the downward trend in veterinary visits and improving companion animals’ health.

“Those of us with practices tend to accumulate clients who love us,” says Michael Moyer, VMD, president of the American Animal Hospital Association and owner of Bridgewater Veterinary Hospital, Bensalem, Pa. “Our day-to-day experience is this biased reinforcement of our own behavior, style and content. We begin to believe we’re really nailing it for all pet owners for all time, when in fact, the trend lines of pets not seeing veterinarians are not positive.”

In other words, the world that veterinarians see might not be the real one. They may be taking good care of the pets they see, but what about the growing number of those they don’t see?

For many professionals, the recently published American Animal Hospital Association/American Veterinary Medical Association Canine and Feline Preventive Healthcare Guidelines may serve as a wake-up call. Its authors and sponsor – the Partnership for Preventive Pet Healthcare – hope they will also wake up pet owners to the need to take their pets to the veterinarian regularly, not just when sickness or an emergency arises.

Published last fall, the guidelines offer a succinct framework, or checklist, for preventive canine and feline care.

The guidelines recommend visits for health examinations on at least an annual basis, recognizing that for many pets, more frequent visits may be appropriate, depending on the individual needs of the patient. They also provide detailed diagnostic, therapeutic, prevention, and follow-up plans, to be accompanied by appropriate documentation.

The guidelines are an attempt to pull together two strong trends in veterinary medicine – the strength of expert opinion, and the wisdom of preventive healthcare. The end result, its authors and sponsors hope, is twofold: better health for pets, and better financial health for veterinarians.

Why were they drawn up?

The value of preventive care and early intervention in veterinary (and human) medicine has been well established and acknowledged by the general public, according to the AAHA and AVMA. But the veterinary profession has not been effective in communicating this message to pet owners, hence contributing to a decade-long trend of declining numbers of pet owner visits to veterinarians. And while veterinary professionals themselves may buy into the concept of prevention, they don’t always carry it into practice. Professional guidelines may help.

“Valid clinical guidelines combine scientific evidence with expert opinion,” according to the guidelines’ authors. “As such, they remain one of the best strategies for changing professional behavior and implementing best practices in a clinical setting.”

And the existence of guidelines may fill veterinarians with confidence as they spread the message of prevention to pet owners, according to those with whom Vet-Advantage spoke.

“I don’t know the human medical landscape, but I suspect there are many isolated clinicians, people who are not plugged into the larger network and body of knowledge, because they’re at the end of the distribution of the healthcare chain,” says Moyer, who was on the task force that developed the AAHA/AVMA guidelines. “[The veterinary] model is the same – small delivery business units, and little communication between them.” Universally accepted guidelines might help veterinarians bridge that knowledge and communication gap, and speak with one voice about the value of preventive healthcare.

Template for pet owner education

Veterinary visits and the number of new clients have been declining for some time, predating the current economic crisis, according to the guidelines’ authors. Market research has identified several reasons:

• Proliferation of self-help pet care by owners who search for pet health information on the Internet instead of relying on a veterinarian.

• Difficulties associated with transporting cats to the veterinary clinic, and cats’ resistance to examination or treatment.

• Inadequate understanding by pet owners of the need for routine examination of their pets.

“Poor client compliance with veterinarians’ healthcare recommendations is well-known and broadly undercuts the bene?ts of interventions, such as heartworm testing, dental care, feeding therapeutic diets, senior pet health screenings, and vaccination,” state the guidelines’ authors.

“When I was in practice, vaccines were a hook to get pet owners into the office,” points out Madeleine Stahl, DVM, technical services marketing liaison manager, Merck Animal Health. But two things happened: Pet owners found their pets could get vaccinations in settings other than the veterinarian’s office, and the industry moved to multiyear vaccination protocols. The upshot? Pet owners came to see less reason to visit their vet on an annual basis.

“So we had to re-emphasize the real reason we wanted them to come in regularly – the physical exam and learning about the overall health of the pet, and then discovering where we needed to intervene,” whether it be due to tumors developing, oral health issues, etc., says Stahl.

“But as a profession we’re not the best salespeople. Maybe distributor salespeople could help us as veterinarians have confidence recommending these procedures and tests to pet owners, because they are in the best interest of the pet.”

“These guidelines can serve as templates for pet owner education,” says Ilona Rodan, DVM, DABVP, director of the Cat Care Clinic in Madison, Wis., and a feline behavior consultant. “If vets use these guidelines, we’ll increase the credibility of our profession with consistency of care, and provide all patients with the care they need and deserve.”

Short and sweet

To the authors of the new guidelines, brevity was a must from the beginning.

“We wanted to bring it all together on one page,” says Michael Paul, DVM, a former president of AAHA and one of the task force members who helped put the guidelines together. Paul has plenty of experience in guidelines development, having chaired guidelines committees for canine vaccination, feline health and, as former executive director of the Companion Animal Parasite Council, parasite prevention.

“In my reading, I’ve found scads of guidelines that I wasn’t aware were out there,” he says. “In human medicine, there are dozens of them. No one can possibly know them all.

“I’ve always believed the essence of most guidelines documents can be captured in four or five paragraphs; the rest is clarification and specifics,” he says. The AAHA/AVMA preventive health guidelines – which are based on existing guidelines from a variety of sources – give the basics, the meat of the recommendations, he says. “If [veterinarians] need further substantiation, they can refer to the original guidelines. The value of these guidelines is, they provide a quick and ready point of discussion and food for thought that can be developed as needed.”

“It was understood by those of us working on the [guidelines] that we needed to develop something concise and practice-team friendly,” says Moyer. “Something that could [reside] in the break room, or on a poster, or on a one-page document, so people in the profession could read through them and understand their importance and how they fit into their practice, and then develop ways to implement them. The goal was one page. No more.

“And we couldn’t use a ridiculously small font,” he jokes.

Brevity serves another important purpose, he continues: It makes the guidelines more accessible to pet owners. The guidelines for cats and dogs are just one page each, and visually pleasing, he says. “We hope they can serve as the basis of client education.”

Easy-to-read and easy-to-understand guidelines should generate some pull-through, says Paul. If they are posted in the waiting room, for example, or published in a consumer magazine or website, pet owners might be prompted to ask their vets things like, “How come you never told me this?” he says.

SOAP

The guidelines follow what’s known as the SOAP methodology, where SOAP is an acronym for subjective, objective, assessment and plan.

“It’s a different approach to preventive care, though it’s an approach that is always used for sick animals,” says Rodan. “It’s a logical process to help identify problems, first by getting a history from the client, then doing an examination. The combination of the two allows the veterinarian to make an assessment individualized for that patient. Once we have the assessment, we come up with a plan.”

Rodan hopes that veterinarians will pay special attention to the way they conduct histories, making sure to ask plenty of open-ended questions. One of the most critical questions to ask, especially in a prevention-oriented visit, is “Have you noticed any changes in your pet’s behavior or attitude?” she says.

In the guidelines, the plan is divided into four areas: diagnostic plan, therapeutic plan, prevention plan, and follow-up plan. “Follow-up is critical,” says Rodan. The veterinarian or staff should make sure to follow up after the owner and his pet are at home, to make sure the owner understands the plan, and to answer any questions he might have.

Getting buy-in

Making the new guidelines jump off the page and into reality is a two-step process. The first step is getting veterinarians to buy into them. The second is getting pet owners to do the same.

Although few veterinarians would dispute the need for preventive care, getting them to actually practice it may present some hurdles. Some may simply resist change, others may resent what they feel is intrusion into the way they practice veterinary medicine, while others may fear that practicing preventive medicine may actually erode the profitability of their practice, rather than enhancing it.

“One of the hurdles is that many vets have a preconceived notion of what their clients will or won’t do,” says Christopher Pappas, DVM, director of companion animal technical services, Merck Animal Health. “When you implement new guidelines, you have to get rid of preconceived notions, like, ‘My clients would never pay for that.’ Don’t make that assumption.”

“We know that many practitioners deliver really excellent care,” says Moyer. “We have some terrific training in disease recognition. But if we step back and look at the entire population of pets who could be served, we see a trend where more and more tend to be opting out. They’re not participating in preventive healthcare. Their owners haven’t been persuaded of the value of that transaction. So this is an effort to have more pets receive better care from clinicians who are already doing excellent work, but who may not realize the gap between the clients they see and total universe of clients.”

“This is change, and change is never easy,” says Paul. “Some individuals may see guidelines as meddlesome and even intrusive, rather than supportive.” Others may interpret them as a message that they have been practicing veterinary medicine incorrectly. “That is not the message here,” he says. “The message is, ‘Doctor, you’ve been doing a great job. We want to help you do an even better one.’

“When a professional who has built their craft over a period of years is told, ‘This is what you should be doing,’ one’s response might be, ‘Don’t tell me how to do my job,’” says Nigel Swift, BVetMed, MRCVS, DACVIM, senior associate director, pet professional services, Boehringer Ingelheim Vetmedica Inc. “But if you ask anyone if these guidelines make sense, they’re likely to say, ‘Yes, I do these things generally anyway.’”

In his 19 years of practice, Swift had exam forms, or checklists, for every patient he saw. And with good reason. “Sometimes you get into a conversation with a client, you chat, catch up on their family, and you get off track.” As the visit ends, the veterinarian is asking himself, “Am I absolutely sure I discussed everything I intended to with that client?”

“The primary role of this kind of guideline is to help keep people on track, to make sure they’re not getting sidelined, and that they’re offering everyone what they want to offer.”

“Guidelines are simply guidelines, not legal documents,” says Paul. And they provide valuable support to the veterinarian. When the veterinarian makes a recommendation to a client, she can refer to the expert opinion behind the guidelines, he says. Before guidelines existed, the only rationale veterinarians had for many of their recommendations was, “Because that’s what I said.” That’s no longer the case.

If the entire veterinary community were to implement the preventive care guidelines, the profession would benefit, says Rodan. Today, when price-shoppers call veterinary clinics to inquire about services and prices, they get varying answers to their questions. “One hospital tells them they need parasite prevention, and another says ‘Your indoor cat doesn’t need that,’” she says. “Where is our credibility?

“If we go back to the science, and these guidelines are science-based, we will improve our credibility as a profession as well as the healthcare of the pets. And we won’t be so confusing to the client.”

Besides resulting in better care, preventive health can enhance a practice’s profitability, adds Rodan. “When preventive healthcare is done properly, it’s not only the exam and vaccines, but also the diagnostic testing, the parasite prevention, and the follow-up to abnormal findings.”

Nor should veterinarians fear that prevention-oriented visits will consume too much time out of their schedule, and hence, reduce the profitability of the practice. “Our sick and preventive appointments take the same amount of time, and often the services [associated with] preventive appointments are far more than those for sick,” says Rodan.

Team effort

Implementing the AAHA/AVMA guidelines will have to be a team effort, involving everyone from the veterinarian, to techs, receptionist and manager, according to experts.

“We are hoping that practice teams will look at the guidelines, download them, talk them over at the next staff meeting, and find how they might be able to fold them into their practice routine,” says Moyer.

Office staff are often the first point of contact – either on the phone or at the front desk – for the client or potential client, says Stahl. “If they’re onboard and realize the importance of preventive healthcare measures, that can go a long way. Working with the front-end staff can really bring in a lot of rewards for the clinic.”

Says Paul, “There has to be a consensus position.” Veterinarians, associate veterinarians, technicians, receptionists “must not only know the guidelines exist, but quote them as if they were a statement of fact. And then advocate for that.”

Getting pet owners onboard

With a committed veterinarian and staff, pet owners are more likely to fall into line, according to those with whom Vet-Advantage spoke.

“Pet owners want current and correct recommendations,” says Paul. “These guidelines support the veterinarian, for everyone’s benefit. Overcoming resistance is a matter of explaining them [to the owner], hearing out any opposition, and using their concerns as points to clarify.”

“Clients are most likely to do things that they see their vet is committed to,” says Swift. “Any client can see through a half-hearted recommendation.” The AAHA/AVMA guidelines give the veterinarian a sound basis for his or her recommendations. “Then you have a discussion with the client,” he says. And that discussion might begin with something like, “Let’s be honest – we only have $50 to spend on the dog this week.”

“That’s the financial reality,” says Swift. “Then the onus is on the vet – and to me, this was part of the challenge that made practice rewarding – to understand each client’s situation. [The vet then says,] ‘This is what I consider to be best medicine, now let’s look at your situation.’”

“We think veterinarians should be the primary source of information about pet healthcare and wellness,” says Moyer. “We’d like to see them regain that prime position in the minds of pet owners.” The Partnership for Preventive Pet Healthcare is planning direct-to-consumer advertising to promote the message about prevention, he points out. But in the meantime, AAHA and AVMA hope that practices will post the guidelines in their waiting rooms or exam rooms. “Pet owners can see that the preventive visit has a framework, and clients should be mentally thinking about this framework as they’re waiting for the healthcare team to tend to their pet’s needs.”

What’s next?

The canine and feline preventive health guidelines are the opening act of what the Partnership hopes will be an ongoing educational effort for the veterinary industry and the public.

“The most important contribution of the new Canine and Feline Preventive Healthcare Guidelines may be their potential to enable pet owners to better understand the value of preventive veterinary care,” state the guidelines’ authors. “Pet owners who realize that preventive care preserves their relationship with their pets are much more likely to become regular users of veterinary medical services, regardless of economic conditions …. This shift in client behavior can be especially important for reversing the current underutilization of veterinary services, particularly by cat owners.”

Of course, veterinary hospitals and clinics must be prepared, says Moyer. “We don’t want to have a campaign that drives consumers to practices that aren’t prepared to address their concerns or that don’t add to their perception of value. We need to prepare our profession first.”

Veterinarians – not known for their expertise in or taste for marketing – will get help from the Partnership, says Moyer. For example, tools will be developed to help practices measure how well they’re doing in terms of offering preventive health services, and to help them get the message out to clients and potential clients. “The ultimate goal of the Partnership is to develop enough resources to go to the public in some mass fashion, in order to drive home the message that regular preventive care visits to the veterinarian are an essential part of your pet’s welfare.”

Another important piece of the puzzle will be educating veterinary students on the value of preventive care, says Rodan. (See related article.) What’s more, preventive care should be a topic of discussion at every major conference, she adds.

Role for distributors

Distributors can be an important part of the process, according to experts. “They can and should,” says Paul. They can distribute the AAHA/AVMA guidelines to all their clinics and facilities, sponsor educational programs for pet owners and veterinarians alike, and support the Partnership.

“There are collaborative opportunities for our industry partners to assist in seconding the message,” says Moyer. There may be market shifts, where prescription products make the transition to over-the-counter status, he adds. “Where they do so, and where those products remain effective, it may be that our profession has to adapt and look at that as part of the natural cycle.” Distributors can help them do so.

Swift suggests that distributors develop and distribute suggested order sheets based on the guidelines, including diagnostic tests, vaccines, etc. Sales reps should also keep their eyes open for further opportunities that the guidelines may present. “If you have a client ordering the feline leukemia virus test but not the vaccine, that’s a missed opportunity, because the client clearly believes that feline leukemia is an issue. Why would you repeatedly test a cat year after year, but not vaccinate it?” Distributors and manufacturers could team up to present “test and vaccinate” promotions, he suggests.

“Manufacturers and distribution have access to a variety of educational tools and programs, and can work together to support the veterinary staff to ensure that everyone is on board, that the message is consistent, and that everyone understands the importance [of preventive healthcare] and ways they can communicate that message to pet owners,” says Ingrid Deuzeman, senior product manager, companion animal biologicals, Merck Animal Health.

“It’s important that each of us understand and appreciate the value of preventive pet healthcare and the value of these guidelines,” says Moyer. “We think healthier patients will be one of the results, as more pets are brought in for routine care, particularly if we can increase compliance among cat owners. [We look forward to] happier, better-educated clients, who understand the value of preventive care and the critical role of the veterinarian and entire team in delivering it.”

KEY POINTS

Veterinary visits and the number of new clients have been declining for some time, predating the current economic crisis

“One of the hurdles is that many vets have a preconceived notion of what their clients will or won’t do,” says Christopher Pappas, DVM, director of companion animal technical services, Merck Animal Health. “When you implement new guidelines, you have to get rid of preconceived notions, like, ‘My clients would never pay for that.’ Don’t make that assumption.”

The AAHA/AVMA guidelines give the veterinarian a sound basis for his or her recommendations. “Then you have a discussion with the client,” he says. And that discussion might begin with something like, “Let’s be honest – we only have $50 to spend on the dog this week.”

“Pet owners who realize that preventive care preserves their relationship with their pets are much more likely to become regular users of veterinary medical services, regardless of economic conditions.” – Guideline authors

Parasite prevention

It’s a message that bears repeating: Every dog and cat should have heartworm testing in accordance with existing guidelines, and at least annual internal parasite testing. Additionally, dogs and cats should receive year-round broad-spectrum parasite control with efficacy against heartworms, intestinal parasites and fleas. That’s what the AAHA/AVMA Canine and Feline Preventive Health Guidelines say. And with good reason. Consider:

• Despite the fact that heartworm and tick borne diseases have been identified in all 50 states, 45 percent of dog owners who made any purchases at all, and 56 percent of cat owners who made any purchases at all, purchased fewer than six doses of preventative medication for their animals, according to AAHA data.

• In 2010, fleas were among the most common parasites found in both dogs and cats, according to the Banfield State of Pet Health 2010 Report. Overall, the prevalence of infestation in dogs has increased 16 percent, with slow but steady growth since 2006. Among cats, the increase has been 12 percent.

• The percentage of dogs getting one-plus doses of heartworm protection in 2009 ranged from 22 percent to 43 percent, depending on the region, according to the AAHA. The number of dogs getting 12 doses was much less. Cats received even fewer doses.

Pat Malone, senior partner, The PAR Group, suggests reps ask the following questions to analyze their customers’ needs, problems or opportunities:

• Are you having a compliance issue around heartworm, flea and tick preventives?

• How important is compliance to you and your clients?

• If you give your clients six months’ worth of preventive, are they returning for a six-month checkup? If not, how many months, on average, are they late?

• What happens if preventives are not given on a monthly basis?

• May I show you a program designed to improve compliance?

Vaccinations a key part of preventive health

Vaccinations are one of the surest means of preventing the outbreak of diseases among pets, which explains why they are a crucial part of the AAHA/AVMA Canine and Feline Preventive Health Guidelines. However, some veterinarians – and their clients – continue to underestimate their value. For distributor reps, this is an opportunity to educate their customers on the benefits of vaccinations and the risks their patients face if left unprotected.

Specifically, the guidelines call for dogs to receive vaccinations against:

• Rabies virus.

• Canine distemper virus.

• Canine parvovirus.

• Canine adenovirus-2.

The guidelines suggest that cats should receive vaccinations against:

• Rabies virus.

• Feline panleukopenia virus.

• Feline herpesvirus-1.

• Calicivirus.

• For kittens, feline leukemia virus.

In addition to the core vaccines outlined by the guidelines, veterinarians should consider the lifestyle of all dogs and cats to determine if additional vaccinations may be required such as Lyme, Lepto4, Flu, and FeLV.

Ironically, the success of vaccinations in reducing the incidence of some conditions – such as parvo or distemper in dogs – has led practitioners and pet owners to underestimate their value, according to experts. And despite popular perceptions, cats still are diagnosed with rabies.

Reps are in a good position to offer their customers some perspective on the need for vaccination, according to experts. Because they visit many clinics each day, including shelters, reps often know what diseases are cropping up even before their customers do. Reps also should ask their manufacturer partners for information about national disease trends. They can share that information with their veterinarian customers, who in turn can share it with pet owners who are going on – or recently returning from – vacation.

Probing questions distributor reps can ask their customers to uncover the need for vaccinations:

• Doctor, may we review your vaccine purchases over the prior 12-month period?

• Has your patient profile changed over the past year?

• How much vaccine do you keep on-hand? Is it enough to satisfy demand?

• Doctor, have you seen the AAHA/AVMA Canine and Feline Preventive Health Guidelines, particularly as they pertain to vaccinations?

• Would you like to post information about the various vaccines available in your waiting room or exam rooms?

• What are pet owners’ concerns about vaccinations?

Vaccinations are an inexpensive way to prevent illness, as the AAHA/AVMA guidelines imply. Reps are in a position to reinforce that message every day.

Preventive health: An insurer’s perspective

VPI Insurance has been “at the table 14 years, promoting veterinary care,” says Carol McConnell, DVM, MBA, vice president and chief veterinary medical officer. That’s how long the company – a sponsor of the Partnership for Preventive Pet Healthcare – has offered its policyholders preventive care “riders,” that is, add-on coverage, for preventive health visits.

Those riders cover such services as wellness exams, vaccinations or titer, FeLV/FIV tests or heartworm tests, fecal tests, deworming, microchipping, flea and/or heartworm preventive, blood screening or X-ray or EKG, urinalysis or ERD, and dental cleaning or spay/neuter.

“We want healthy pets,” says McConnell. “We want them in our veterinary hospitals. And [the preventive care riders] are our way of driving traffic there.”

Do increased wellness visits lead to reduced “sick care” costs? “Intuitively, you would think that’s true,” says McConnell. But because the actual percentage of pet owners who have pet insurance is still small, it’s difficult to prove the point. “As a veterinarian, I absolutely believe it,” she says. “I just haven’t been able to prove it.”

Warm winter meant more fleas and ticks

A study by Cornell University says the warm winter weather led to an explosion in mosquitoes, fleas and ticks, reported CBS Pittsburgh.

“The Centers for Disease Control and Prevention has been predicting this increase in the tick-borne diseases and ticks for quite a few years. I think finally we have seen it,” Teresa Meyer, DVM, of Animal General Hospital, Cranberry, Pa., was quoted as saying. “In the last 12 months, I have seen more ticks than I have in the past 25 years of veterinarian practice in western Pennsylvania. It is huge.”

Searching a pet for ticks is part of every animal exam at Animal General, according to the CBS report. With a record number of cases of human and animal Lyme disease, veterinarians urge patients to take precautions.

“Their kids have gotten tick bites, their pets are getting ticks. They don’t even know what a tick looks like,” Meyer was quoted as saying. “So, I think our area is just beginning to learn about this and unfortunately, the ticks will teach them.”

Veterinary students get the prevention message

The typical veterinary medicine student is like any other grad student. He or she probably dons some Under Armour gear and goes for a jog before or after classes. In between the occasional weekend burger and beer, chances are, he’s fairly mindful of his weight and nutritional intake. “In their mind, our veterinary students are practicing wellness themselves,” says Bennie Osburn, DVM, PhD, DACVP, interim executive director of the Association of American Veterinary Medical Colleges (AAVMC). For veterinary educators, the task is to help those same students see that a focus on wellness is just as important for animals as it is for them.

Last year, in its “Roadmap for Veterinary Medical Education,” the North American Veterinary Medical Education Consortium – an effort spearheaded by the AAVMC – called for a focus on primary care, wellness and prevention in clinical courses. It’s a necessary mindset for companion animal veterinary medicine, says Osburn, who is dean emeritus of the School of Veterinary Medicine at the University of California-Davis. “We’re trying to prevent disease rather than waiting for diseases to occur and then trying to correct them.”

Large-animal precedent

It is a mindset adopted 20 or 30 years ago by large-animal veterinarians, born largely out of economic necessity, says Osburn. “Before that time, [producers] bought many products – vaccines, worming medications and the like – from the veterinarian,” he says. “So veterinarians made a reasonable amount of their living selling those products.” But the market opened up, and many of the essentials became available from the feed store and other sources. “The large animal veterinarian had to find other ways to make a living. That got them started on preventive programs.”

Today, their small-animal counterparts are facing similar challenges. Pet owners today can purchase flea and tick products over the counter. As a result, they’re not visiting the veterinarian as often as they used to. That’s a threat not only to the veterinarian, but to the animals themselves, says Osburn. Just as humans need to visit their doctor regularly for a checkup, so too do animals. But convincing veterinary students – and pet owners – of that takes effort.

Many veterinary schools tend to see animals with severe or advanced conditions, while primary care is typically handled by veterinarians in the community, Osburn points out. As a result, veterinary students are not exposed to primary care. “They’re not dealing with wellness and prevention to the extent that we feel is necessary today.” AAVMC wants to turn that ship around. “We feel it’s important that we get [primary care training] back in our educational programs and that the students actually get experience with it, so they can incorporate it into their approach to practicing veterinary medicine.”

Within the past few years, a number of veterinary colleges have included a primary care portion to the clinical rotation of their students, he says. “Instead of dealing with the most complex of cases, the mindset here is, ‘How do you deal with clients and the cases that come in to the general practice clinics?’”

Twofold challenge

The challenge for veterinary educators is twofold: Not only must they teach their students – future veterinarians – the importance of wellness and prevention, but they must teach those same students how to get that message across to their future clients, that is, pet owners.

“It’s a steep hill to climb,” says Osburn. “It’s one in which we have to better understand the sociology of clients and then begin to use analogies that will be easy for clients to understand.” That may mean encouraging young veterinarians to ask their clients questions such as, “Don’t you visit your physician regularly?” “Are you out running?” “What are you doing to control your weight and prevent diabetes?” In this way, veterinarians can help pet owners see that similar principles apply to their pets.

“In a sense, it’s marketing,” says Osburn. “I think we’ve done a reasonably good job on the large-animal side. Some of those same approaches need to be brought to the companion animal side.”

AAVMC has signaled its interest in prevention by becoming a partner in the industrywide Partnership for Preventive Pet Healthcare. Formed in July 2011, the Partnership is a team of veterinary professionals, academia, and industry leaders whose mission is to ensure that pets receive the preventive healthcare they deserve through regular visits to a veterinarian. For more information on the Partnership, go to www.pethealthpartnership.org.

The feline challenge

Cats need preventive care too. Owners and veterinarians can make sure they get it.

Making sure cats get the preventive care they need can be a problem, cats being the way they are – that is, fearful of strangers and new places. But veterinarians and pet owners can use some commonsense techniques to ensure that cats are seen regularly, says Ilona Rodan, DVM, DABVP, founder and director of the Cat Care Clinic, Madison, Wis., and a feline behavior consultant.

There are two reasons why cats don’t receive needed veterinary care, says Rodan, speaking at a recent webinar on the AAHA/AVMA Canine and Feline Preventive Health Guidelines:

• Owners fail to recognize the value of preventive healthcare.

• Owners don’t want the stress (for the cat and owner) associated with a visit to the vet.

Combined, these two factors have led to a decline in feline visits. Consequently, many cats are suffering needlessly from a variety of diseases, including dental disease, obesity, internal parasites, and flea and tick infestation. Heart and kidney disease, and arthritis are becoming more commonplace in cats as well.

Failure to recognize the signs

“Most owners feel they know their cat well, and will recognize when they are sick,” says Rodan. “But as solitary hunters, cats mask signs of illness and pain.”

Many owners of indoor cats fail to realize that their pets need preventive care, including parasite prevention, vaccinations, etc. “Recent studies have shown that stress can lead to serious healthcare problems among indoor cats, the most commonly recognized ones being feline lower urinary tract disease or interstitial cystitis.”

Veterinary professionals need to educate cat owners about the subtle signs of illness, such as their pet missing the litter box or losing the ability to jump onto the bed. “And we need to get them to recognize why preventive care is so important,” she says.

The feline-friendly visit

Owners and the veterinary staff can reduce the stress of a visit to the vet, says Rodan. The owner can start by making the carrier familiar and comfortable to his pet at home. Rodan suggests that rather than hiding the carrier, the owner leave it in a room in which the cat is comfortable. Try adding soft bedding in it; the cat might like the coziness.

In the exam room, the carrier should be left on the floor or near the owner. If the cat isn’t aggressive, open the carrier door, so the cat can choose whether to stay inside for a while or to climb out. Use treats to entice him or her out of the carrier, but don’t pull or dump the cat out.

The physical exam should be conducted where it is most comfortable for the cat, whether that be on the floor, in the carrier or on the exam table. If the cat is willing, the vet can place the cat on his or her lap, and sit next to or at an angle to the client during the exam.

Samples should be taken in the exam room, which is usually quieter than treatment areas, and out of sight of other people and animals, suggests Rodan.

Before ending the visit, the veterinarian should talk to the owner about the importance of scheduling the next visit. “Scheduling before the client leaves helps the client understand the need for that future visit.”

By Pat T. Malone

How to make prospecting a win-win proposition

Of all the competencies associated with superior sales representatives, prospecting is the weakest link. Most salespeople despise prospecting. “I’m too busy,” “I don’t have any prospects,” “I’ve tried and that doesn’t work” are just a few of the excuses you hear or may have said yourself. Yet effective prospecting is a vital part of every successful reps campaign to gain new business. Becoming a master prospector can spell the difference between being a merely competent distributor representative and a stellar one.

So what holds reps back and how can they succeed more often?

Prospecting deeper

First, reps forget that the most fertile ground for prospecting is their existing accounts. On average, reps have two to three contacts within existing accounts, but there is five to seven times that number of decision influencers/decision makers in an average clinic. So think first about “prospecting deeper” in your existing accounts. Ask yourself: “How can I help more of the DVMs and support staffs in my clinics become more successful?” You will be amazed at the amount of new business you will find in existing accounts by prospecting deeper.

Second, most salespeople fear prospecting because they are set up for failure. If you consider a prospecting call that ends with “no” a loss, then you will inevitably lose far more often than you win. The most effective distributor reps view prospecting as a systematic gathering of information in a “win-win” atmosphere in order to determine if the clinic is qualified.

Out of a thousand possible clinics, perhaps only a few hundred are willing to talk with you, and even fewer are able to buy today. Prospecting is trying to find those clinics that are willing to talk and able to buy without wasting today trying to sell to all the other clinics out there.

Think of it this way: Instead of trying to push your product or service, you are trying to uncover needs and problems that your product or service can help solve. This respectful approach is more likely to spark a prospect’s interest. And it helps you. After all, if the prospect has no need for or interest in what you’re selling, why waste your time with that person?

A qualifying conversation

Here’s how to open a conversation positively and determine if you have a qualified prospect: First, begin with a confidently stated and respectful opening statement. Good opening statements contain:

1. A confidently stated business reason (a benefit for the clinic) for the call.

2. An invitation to talk about the clinic’s business and openness to improvement options.

3. An acknowledgment that the clinic is the decision-maker and in control.

Following a well-presented opening statement, most prospects will open up. Once they are willing to talk, the mission then shifts to whether they’re able to buy. To find out, sound business questions must be used to qualify:

1. Is there a potential need, opportunity or problem your product or service can address?

2. What is the decision-making process and who is involved?

3. Are the appropriate resources available including time, money, space, and technical expertise?

Potential need, opportunity or problem: Just because they are a veterinary clinic and you are a veterinary distributor rep doesn’t mean they have a need. Switching primary distributors or adding a new secondary involves “pain” for the clinic so they will only switch if the “pain” of doing nothing exceeds the perceived “pain” associated with the switch. So focus your questions on the clinic’s current “pain.”

Decision-making: Always ask about the decision-making process first. It is much less threatening to tell you about their buying process than to reveal the actual buyers. Once you know the process it is much easier to fill in the appropriate names.

Resources: While finances are always a consideration, it isn’t the only required resource. It could be refrigerator space, current inventory, existing equipment, contractual agreements, available staff, etc.

Ask all of these questions with respect and listen to the prospect’s responses for both factual content and emotional attitude. This will help you read the prospect’s responses accurately and determine if you have a qualified prospect.

Trying to talk unqualified prospects into becoming qualified is as futile and frustrating as trying to talk rocks into becoming gold. Instead, spend your time searching for the “gold.” If a prospect says no, consider that a win rather than a loss. The faster you get a clinic to disqualify themselves, the faster you can move on to someone else who is willing and able to buy today.

The right attitude, strong opening statements, good qualifying questions and respecting your prospects’ decisions, whether yes or no, will result in greater cooperation and more positive, successful prospecting. It will also move you into the ranks of the stellar distributor reps.

Patrick T. Malone is a Leadership expert and Senior Partner at The PAR Group, a training and development firm based in Atlanta, Ga. He is a co-author of the best selling book Cracking the Code to Leadership and may be reached at Patrick.malone@thepargroup.com

Implementing the ‘open book’ approach to management has been a big change for Nebraska clinic as it transitions to employee ownership.

How many of the veterinarians whom you called on yesterday are comfortable opening the books of their practice to the entire staff? Chances are, not too many. But at Ralston Veterinary Clinic in Ralston, Neb., business is an open book.

That’s because the clinic – located in a suburb of Omaha – is working toward completing its transition to an employee-owned enterprise by the end of the year. Ralston’s administrator, Debbie Newhouse, LVT, CVPM, is an important part of the transition. For her efforts, the Veterinary Hospital Managers Association recently named Newhouse the recipient of this year’s Transforming the Practice Award.

“It has been an eye-opening experience,” says Newhouse, of the education efforts associated with the transformation to employee ownership. “It has helped the staff understand some of the issues involved in trying to grow revenues and keep expenses low.”

Now in its second year, the Transforming the Practice Award identifies and rewards excellence among veterinary hospital managers, and highlights effective strategies in improving practice performance, according to VHMA. Winners are selected based on their success in meeting one or more of four criteria: increase in productivity, increase in revenue, decrease in expenses, and increase in practice value estimates.

 The open book approach

Newhouse began her career in veterinary medicine as an assistant 30 years ago. She became a licensed technician, and later, a practice manager. She joined VHMA in 2005 and became certified in 2009.

She was hired by Ralston in February 2010 to assist the clinic in its transition to employee ownership. Though she had never worked in an employee-owned practice before, she had worked in a shareholder-owned one. (In the shareholder model, shareholders receive dividends based on the performance of the clinic. In the employee-owned model, employees receive shares in the practice, which grow in number and value based on longevity, wages and profitability of the practice.)

One of the big challenges Newhouse has faced in the transition to employee ownership has been implementing the open book approach, she says. Team members had to be taught how to read financial statements, and managers needed to learn how to be more forthcoming in sharing financial information with the staff.

In normal circumstances, managers keep their books private, Newhouse notes. “But in order to become shareholders or owners, [staff] has to understand the consequences of whatever actions are going on in the practice, the industry, the country. All of that affects the business. So we are helping [staff] understand the business part of veterinary medicine, not just the veterinary medicine part.”

As it was designed to do, transforming the practice has encouraged team members to get more involved in figuring out ways to grow revenues and decrease expenses, says Newhouse. One working group, for example, worked on a plan to sell microchips. Another took it upon themselves to devise ways to reduce expenses associated with Ralston’s boarding facility.

One project that the Ralston staff is working on – with assistance from its distributors – is reducing on-hand inventory. “We are working toward more of a just-in-time system,” says Newhouse. “Some people are worried they’ll run out [of supplies], so there’s a learning curve about how much we actually need on hand.” That means examining usage as well delivery times from the distributors.

Distributors can help clinics reduce inventory in several ways, she says. Not only can they offer great pricing, but they can let the practice know if products are on backorder, and what substitutes – if any – are available. “That kind of thing really helps a practice,” she says.

Revenue growth

While cutting expenses, the Ralston team continues to work on growing revenues. “Last year was a great year, in terms of having clients walk in the door,” says Newhouse. “I think a lot of that had to do with changing our marketing strategy.”

Ralston has an active website. On it, the clinic highlights promotions to coincide with events such as Pet Dental Month; and offers clients the ability to order products and monitor their pet’s health online.

One staffer has been assigned to maintain Ralston’s social media efforts. The clinic’s Facebook page is extremely active. “We’re going into our second year,” says Newhouse. “We’ve been working on bumping it up, offering promotions online.

“Social media is the way of the future,” she continues. “We rarely use the phone book anymore.”

Advertising will play a key role for the clinic in the months and years ahead, she adds. “Typically, veterinary hospitals haven’t done a lot of that. But now I think it’s really important to look at different media and decide how you’ll advertise and put your clinic out there. E-mail will remain a key part of the strategy.

“We want to make sure we get lots of e-mails out to our clients about what we’re doing and how it affects their pets, and about preventive medicine.

“The more we can touch the client, the more we can keep them involved.”

World View

World Vets turned Heather McCabe’s attention to the challenges facing animals in developing countries.

In Honduras and scores of other countries, there are no pet boutiques, specialty dog foods or veterinary practices with skilled technicians and surgeons. People there – as in many developing countries – love their animals, but they simply can’t care for them as people can in countries such as the United States. Having twice traveled to Honduras with World Vets, Heather McCabe, Northwest regional manager for MWI Veterinary Supply, knows.

World Vets is a non-government organization providing veterinary aid around the globe in collaboration with animal advocacy groups, foreign governments, U.S. and foreign military groups, and veterinary professionals.

“It’s a far cry from the cute, well-groomed pets I used to work with,” says McCabe. “Internal and external parasites are a given with most pets. Ehrlichiosis, a tick-borne bacterial infection of dogs in Honduras, made most surgical procedures more difficult because of the excess bleeding. Trying to maintain a clean environment without running water, electricity and all the bells and whistles of a veterinary practice proved to be the biggest challenge of all. But you’d be amazed at what you can accomplish with a team of determined veterinary professionals.”

Born in Fort Knox, Ky., McCabe – whose father was a military officer – lived all over the country and in Europe as a kid. She got a bachelor’s of science degree in agriculture, with a major in animal health technology, from Murray State University in Murray, Ky. After graduation, she became a licensed veterinary technician, thinking that some day, she’d go to veterinary school. After she entered the work force, she put that plan aside. But she didn’t put aside her dream of working in the veterinary field.

 Primate Research Center

She took a job as a licensed technician at the University of Washington’s Regional Primate Research Center, with responsibility for anesthesia administered during surgical procedures. After three years, she went to work for Eli Lilly as a tech and associate toxicologist, caring for the animals used in pharmaceutical research. But she knew she wanted something different.

“I wanted to stay in the [veterinary] industry, but I craved more diversity,” she says. “I loved veterinary practice, but didn’t want to be a technician in a practice. Sales appeared to be a profession that had the elements I was seeking.

“I enjoy people as much as animals, and I looked forward to calling on practices. I also liked the independence of sales, rather than being in an office eight hours a day. Sales appeared to be a good fit for my skill set and professional interests.” In fact, she took the position at Eli Lilly in the hope of ultimately getting a sales territory with the company’s animal division, Elanco.

 Pharmaceutical sales

As it turned out, Eli Lilly’s animal health division lacked open territories at the time, so she took a job as a pharmaceutical rep on the company’s human side. She figured she could get some of the sales experience she needed, then move into veterinary sales.

“After a year in human sales, I decided to take a risk and leave the company without a job,” she says. “I started pounding the pavement with animal health companies.” She landed a part-time position, which ultimately became full time, with Fort Dodge Animal Health (now Pfizer Animal Health) in Spokane. Three years later, she took a sales position with Bayer Animal Health in Seattle.

McCabe recalls how different calling on doctors in Seattle was from calling on veterinary practices. “The relationships in veterinary medicine are what define you as a sales rep,” she says. “On the human side, there’s so much you’re dealing with – Medicare, Medicaid. It’s an entirely different sale. You can create relationships and you can work with prescribing physicians, but there are so many hurdles you have to get over to get them to prescribe your product.”

Perhaps the biggest difference between medical sales and veterinary sales is the reception the rep gets from the practice. “The first time I walked into a veterinary clinic, they were so excited to see a rep, I had to look behind me to see who they were talking about,” says McCabe. “Veterinary practices are interested in what you can deliver to them. They rely on vendors to bring a lot of information to them.”

That said, the daily routine of sales reps on the human side and the veterinary side are very similar, she says. “You have goals, objectives, and you have to get into your job every day.”

 The leap to distribution

Though she enjoyed working for Bayer, McCabe accepted a position in November 2003 with MWI Veterinary Supplyin Seattle, where the company was creating a new territory. (Eight months later, the Spokane territory opened up, and she grabbed it.)

MWI has a strong presence in the Pacific Northwest, she says. “And all the MWI reps I worked with were the most professional people I worked with in the industry. The culture of the company was very attractive to me. They seemed to really care about their employees. People didn’t leave MWI; it was a career.”

Making the leap from manufacturer to distributor wasn’t without its moments, she says. “As a manufacturer rep, you should be pretty well educated on your product line and be able to answer the majority of questions,” she says. “But as a distributor rep, there’s the unknown of every call. You can go in with the objective of talking about a certain product, but you might not. So there was the fear of the unknown questions. Could I answer them? Could I be of value to the practice?”

She thrived in her new role. In fact, she was recently promoted to Northwest region manager after spending eight years in her territory. “I was very blessed to be given this opportunity,” she says. “I have a fantastic team. And I’m in a beautiful part of the world.”

World Vets

It was while calling on an account about 30 miles north of Spokane that McCabe learned about World Vets. Its founder – Cathy King, DVM, MS, PhD – owned a small animal practice in Deer Park, Wa. She and Susan Paseman, a veterinary surgical assistant, had founded the organization to address the need for veterinary care in developing countries.

“Cathy told me about World Vets and what she and Susan were doing, and the plans they had for future trips,” explains McCabe. “I was fascinated by the idea of traveling to developing countries to provide much-needed veterinary care, and I asked what I could do to help.” King asked McCabe if, when calling on her accounts, she could pick up World Vets collection boxes filled with donated supplies, then bring them back to Deer Park on her next visit. “That’s how it started.”

As time went on, McCabe got more involved, sending e-mails to industry contacts soliciting donations, and talking to vendors at trade shows about World Vets. “I didn’t want to abuse my position with vendors,” she says. “But I did try to provide a voice for World Vets.”

In her role as a licensed veterinary technician, McCabe has taken two trips for World Vets, both to Honduras, in 2007 and 2008. The organization’s week-long trips usually consist of a team of veterinarians, technicians and assistants, she explains. Several days of clinic include health checks and surgeries, such as spays and neuters. “On the trips I attended, I found my most comfortable spot was pre-anesthesia and prep,” she says. “I had to brush up on my vet tech skills the first day, but found that I comfortably got right back into the groove.” Her spay shaving skills haven’t improved over the years, she admits. “But I still love putting in an IV catheter, and I had no idea I would have been able to do hundreds of them by the light of a headlamp. I was excited to do tech work again and didn’t realize how much I missed it.”

Pets in developing countries

As one might expect, the condition of the animals that the World Vets teams care for is entirely different than what one would see in the United States, says McCabe. The majority are feral dogs and cats. Some pets are owned, but “owned” is a loose term in many developing countries. “It might mean that [the animal] lives on the street outside the home; the [inhabitants] are their caretakers in the sense that the animals eat their trash.”

During her World Vets visits, volunteers scoured the streets to pick up stray animals for treatment. At the end of the day, the World Vets team would release the strays back to the street. “There were a lot of stories about young children who had a puppy or kitten, who walked miles to bring their pets for veterinary care; and their parents didn’t even know they were there,” she says. “And we had taxicabs pull up with dogs in the trunk. The conditions these animals live in can be extreme, and sometimes the stories are difficult to share. That’s why the work of World Vets is so important.

“The residents of Honduras do love animals, but it’s all relative to what they can afford and what is available to them to provide care,” says McCabe. “On our free days after our clinic work, we would usually visit the town. While walking through the streets, we often saw our patients. Some greeted us as old friends, some looked the other way. It was a surreal moment when you realized what they just went through, and that day was just another day looking for their next meal and a safe place to sleep.”

Veterinary care providers face many challenges caring for pets in developing countries, says McCabe. “One of the biggest challenges is responding to the sheer volume of requests for help that come in to World Vets. There are so many areas of the world where access to veterinary care is limited or nonexistent, and there are not always enough resources to go around.” World Vets has teams out almost every week of the year, but there are still many more locations that could use help if the funding were available, she says. “We have to prioritize and focus on areas where we can have the most impact and help the most animals.”

One of the biggest concerns is overpopulation and how countries deal with it – not always in a humane manner. And many livestock in developing nations are overworked and malnourished.

Natural disasters a concern

“Natural disasters are becoming an even bigger concern,” says McCabe. World Vets responded to several major disasters this past year and is continuing to ramp up its disaster response services to respond to the increasing demand. “Not only are animals in harm’s way during these events, but people are putting their own lives in danger making sure their pets are not forgotten. We understand that pets are family members, and rescue work during disasters is about helping both animals and people. It’s very common to find owners who remain in unsafe areas until they know their pet has been rescued as well.”

Funding for World Vets is a constant challenge. The Paris, France-based Brigitte Bardot Foundation helps with specialty projects, such as the World Vets Latin America Training Center in Granada, Nicaragua, explains McCabe. “Not only will this center provide supervised training for Latin American veterinarians and students, but it will provide free spay and neuter surgeries performed by skilled veterinarians.

Although the challenges are great, there is reason for hope, says McCabe. “I’m most hopeful that we’re really seeing a shift in how people treat animals and in their attitude toward them, whether it’s dogs, cats or livestock,” says McCabe. “In places where dogs were just guard dogs or a nuisance in the street, people are now taking ownership of them by feeding them or seeking veterinary care. I don’t think they need to emulate us in the United States; they just have to provide basic nutrition, care, etc.”

 The oral healthcare market is opening up, and that’s good for vets, reps and pets

The statistics tell it all. By the age of two, 80 percent of dogs and 70 percent of cats are estimated to have some form of periodontal disease. That’s more than doggy breath. Periodontal infection has been linked to diabetes, heart attacks, strokes, kidney disease and other disorders.

And there are really only two ways to help pets avoid such infection – good oral healthcare at home, and regular visits to the vet. That spells huge opportunity for Vet-Advantage readers, particularly as the industry prepares for National Pet Dental Health Month in February.

“Dentistry is the biggest growing area for veterinary medicine that I see for the next 10 years,” says Tony Woodward, DVM, Dipl. AVDC, Animal Dental Care, Colorado Springs, Colo. “Probably 80 percent of the dental care that should be administered is ignored.” In fact, says Woodward, a well-run dental department should provide 15 to 20 percent of the gross revenue in a small animal practice. Most practices average only around 3 percent.

All this is good news not only for pets, their owners and their veterinarians, but for sales reps, says Woodward. Though many reps focus on equipment sales, they should also consider the opportunities for recurring monthly income in the form of suture, bone graft, antibiotics, pain meds, etc., he says.

Clients unaware

Recognition by pet owners and the veterinary profession of the importance of oral healthcare is on the rise, according to those with whom Vet-Advantage spoke. Yet there is much room for growth.

“The main challenge is the client,” says Jan Bellows, DVM, Dipl. AVDC, All Pets Dental Clinic, Weston, Fla., and president-elect of the American Veterinary Dental College. “The client oftentimes believes that doggy breath – or cat breath – is an absolute normal thing. They’ve become used to it. But it’s not normal at all. It’s due to periodontal disease, an inflammation of the gum that ends up eating away ligament and bone, leading to loose teeth. And it’s very painful.”

The issue for owners is this: Dogs and cats never show any obvious signs of dental pain, says Woodward. It’s nature’s way of protecting them from natural predators. So owners don’t know anything is wrong. “But when you fix it, owners notice an improvement,” he says.

Many pet owners know about the potential for periodontal disease in their own mouths. But few realize that the periodontal problems in their pets often progress much further than those in humans, adds Woodward. “Our average patient is probably equivalent to a human who hasn’t brushed his teeth in five years. But the connection between oral disease and heart, liver and kidney disease has been demonstrated in dogs. There are microscopic changes in these organs in animals with periodontal disease.”

 Are veterinarians onboard?

To be sure, the problem doesn’t lie solely with pet owners. Not all veterinarians are fully onboard either. Part of that is historical.

“A lot of people think dental care consists of scraping the teeth periodically, and if they’re loose, yanking them out,” says Woodward. “I call it ‘scrape and yank.’ Because they don’t understand it, they can’t educate their clients about it. If you [as a veterinarian] don’t have a good understanding of how to do a procedure and the reason for it, it’s pretty hard to sell it to clients.”

A big reason for this lack of understanding is that veterinary students often receive little or no training on veterinary dentistry, says Woodward. “Most veterinarians don’t have much of an idea about dental disease and how to approach it, because we never had it in school.”

That lack of training tends to perpetuate itself. “Young veterinarians adopt the habits of the first practice where they work,” he says. If that practice isn’t adept at dentistry, the young vet might never get the skills he or she needs.

Adds Bellows, “There are only 110 veterinary dentists in the country, and most of us are in private practice. Only a handful of schools have veterinary dentists on staff.” That means that veterinarians who want to gain dental skills have to pursue them on their own.

Afraid of the cost

Some veterinarians may be reluctant to plunge into dental care because they fear the costs involved to get set up, according to those with whom Vet-Advantage spoke. But those fears are unfounded, they say.

“One of the economic hurdles is the idea that, ‘I can’t afford to do dentistry, I can’t afford all this equipment,’” says Woodward. “Actually, nothing could be further from the truth.” Dentistry is one of those areas where veterinary practices can make money almost immediately, he says. “For under $20,000, you can get totally equipped. If you go from ‘dental nothing’ to ‘dental everything,’ you’re looking at lease payments of $500 a month. Dental cleaning alone will pay for that. There are very powerful economics.”

Another barrier cited by doctors is the poor economy. Pet owners may be reluctant to pursue regular oral exams for their animals when money is tight. But again, that concern may be overstated.

“You’d think [the sour economy] would have an effect on what pet owners do,” says Bellows. “But I haven’t seen it. The general veterinarian is complaining that people are not agreeing to dental procedures as often as they did before. But I have not seen a downturn in business. The referring veterinarians are doing pretty well too.”

Adds Woodward, “A lot of times, [the economy] is used as an excuse for condoning underperformance. When times are tough, tough people get rocking.”

Market is opening up

Despite these hurdles, real or imagined, the market for oral healthcare appears to be opening up. Experts are observing a greater understanding of the need for animal oral healthcare and with it, a willingness to pay for it.

“Veterinarians are in this field because they care about animals,” says Jamie Renner, market manager, Midmark Animal Health. “They want to provide that care. So the next piece is, ‘I understand the need, but I’m not trained to provide the care.’ So there’s an education gap. But there are ways to get that education – wet labs, trade shows, distributor programs. So first, clinicians have to understand and believe in the need; then they need to get educated; then [acquire] the proper equipment. And after that, they still have to educate and get compliance from the client.”

One gauge of the growing awareness of animal oral healthcare is the growing number of veterinary dental specialists in the country. Established in 1988, the American Veterinary Dental College is the clinical specialist organization for veterinary dentists, registered by the American Board of Veterinary Specialties of the American Veterinary Medical Association. Its primary objective is to provide support of training programs for veterinarians who wish to become certified as Diplomates in the College. The first AVDC-approved full-time residency training program was established in 1989. Today, applicants to the College consist of a mixture of veterinarians who are undergoing full-time residency training programs and those who are developing the required knowledge and experience in an alternate pathway part-time program from practice.

Though they are relatively few in number today, the number of Diplomates is growing “by leaps and bounds,” says Woodward, who, like Bellows, is one of them. Today, approximately 114 veterinarians are Diplomates. “When I got in, there were about 70 of us.

“We’re one of the smaller specialist colleges, but also one of the youngest ones,” he says. “The very first group got boarded 20 years ago – so that’s really, really good growth. We have an incredibly deep talent pool. More and more universities have the program. My guess is, 10 years from now, there will be 350 Diplomates. But even a thousand couldn’t keep up with the potential demand.”

Oral health, systemic health

In 2000, “The Surgeon General’s Report on Oral Health” brought home the point that among humans, the mouth is the mirror for general health and well-being. “As the gateway of the body, the mouth senses and responds to the external world, and at the same time reflects what is happening deep inside the body,” the report said. That awareness of the connection between oral health and systemic health is finding its way into veterinary medicine too. And that could have a positive effect on veterinary oral healthcare.

“That understanding makes it easier to convince clients that periodontal disease must be treated,” notes Bellow. “All clients love their animals. By taking care of their animal’s teeth, they hope to control periodontal disease and make the animal happier. That’s what people really want.”

Oral healthcare is one of the areas in veterinary medicine with a direct correlation to human medicine, adds Renner. Sales reps who help their customers get pet owners to make that connection are doing everyone a service. One way to do so is to suggest that doctors remind their clients that even though people brush and floss their teeth every day, they still get a professional exam twice a year. The same principle applies to pets. In fact, the need for regular professional dental exams and treatment is even greater, since pets seldom get regular brushing.

Getting started

Having made the decision to move ahead with dentistry, the veterinarian needs to outfit his or her office. To do so, he or she will need a number of things, including a high-speed and low-speed delivery system for scaling, drilling, polishing, rinsing and drying; X-ray equipment; good lighting; prophy angles and paste; burs; fluoride; and an array of hand instruments. Woodward says the return on investment is quickly earned.

Bellows considers a digital camera to be an essential part of the veterinarian’s tools. In his practice, Bellows uses a wireless, Eye-Fi connection between the camera and a monitor, so that clients can view their pet’s teeth for themselves. They can see the plaque and tartar there, and, with other visual aids, compare it to how healthy teeth should look.

Perhaps one of the most important decisions the veterinarian must make is what kind of radiographic equipment to acquire. That’s true for two reasons: First, without X-ray, the doctor can’t detect disease below the gum line, where the majority of disease exists. And second, visual images can go far to convince pet owners of the necessity for oral treatment.

“Radiographs are an absolute requirement for quality dental care,” says Woodward. “Treating dental conditions without dental radiographs is like treating internal medical conditions without blood work. It cannot be done. If you are not regularly taking dental radiographs, you are leaving painful problems in many of your dental patients.”

Having made the decision to acquire a radiograph, the veterinarian must decide whether it will be a film-based or a digital system.

“Digital radiographs are being embraced more and more,” says Woodward, who has been using a digital system in his practice for seven years. Digital systems offer several advantages. For one, they subject the pet – and staff – to less radiation exposure. Second, they help the practice increase efficiency. Woodward estimates the system saves him at least an hour of busy work every day. “I can look at my images quickly, and I show them to my clients. And I am able to easily network the digital system with the exam room.” And third, digital radiography offers great images, which can be easily blown up for closer examination and sharing with clients.

Bellows says that even though digital systems initially cost more than film-based ones, in the long run, they help the practice save time and money. That’s because with digital, the staff no longer has to process and store film, and can do retakes quickly if necessary. Image quality is good, and images can be e-mailed to clients if necessary.

Most digital X-ray manufacturers would “quote easily” a six-month return on investment, adds Renner. The learning curve is short, and the potential efficiencies great. “When you get proficient, you can do a full-mouth set of X-rays in 10 minutes,” he says. The staff avoids the need to develop film, and they feel much freer to take extra shots, if necessary, than they would with film, because of the speed and ease of digital radiography. Diagnosis is enhanced through digital imaging, he adds. “You can enlarge them or enhance [digital images], as opposed to viewing a static film.”

Anesthesia

Anesthesia equipment and supplies are also a must for the veterinarian providing oral care, according to experts.

The oral exam must be performed under anesthetic, for several reasons, says Bellows. The animal must be still in order for staff to take X-rays, and in order for the vet to gather particulate matter that might otherwise go down the patient’s throat. And what fully awake animal would allow a veterinarian to probe below the gum line for potential periodontal disease?

Bellows cautions against the trend toward so-called “non-anesthetic dentals.” “What that means is, they clean the teeth without anesthesia,” he says. “Unfortunately, they don’t go below the gum line. And if you don’t go below the gum line, you’re missing 60 percent of the disease that’s there. Non-anesthetic dentals are incredibly popular, but the wrong thing to do.”

It’s true that anesthesia may stir up angst among pet owners. “Studies show that the No. 1 reason people don’t want dental care for their pets isn’t the cost, but rather, the fear of anesthesia,” says Renner. “So the clinic staff needs to talk about what they’re doing in terms of anesthesia protocol – pre-anesthesia blood work, patient warming, etc.” Since dental care is often viewed (even if erroneously) as an elective procedure, the staff may have to work hard to educate the client and let them know, “Here’s what we’re doing to ensure that this procedure is as safe as possible.”

Says Woodward, “If you’re monitoring all your parameters, like blood pressure, oxygenation, core body temperature, etc., and you’ve got the equipment to keep body temp up, those are all things that can make anesthesia go better. If you do good anesthesia, there’s almost zero risk. The horror stories you hear about – when you track them down, they’re either not true, or they’re due to some substandard practice.” What’s more, delivering good anesthesia isn’t cheap. The practice needs the right tools, and the right monitoring and patient support equipment. That spells opportunity for sales reps, he says.

Sterilization

As it must with all surgical instruments, the veterinary practice will have to ensure that its staff is properly cleaning and sterilizing instruments between dental procedures, according to those with whom Vet-Advantage spoke. That hasn’t always been the case, though. Many practices clean their dental instruments and throw them in a drawer, says Woodward. “We don’t have AIDS considerations, though there are some viruses in cats similar to AIDS,” he says. “But it’s time to do a better job. It’s time to have sterile instruments.” For that reason, Woodward advises practices to buy sets in autoclaveable cassettes. Those who do so gain in sterility as well as efficiency, he says. “You have a dental surgery pack just as you would a spay pack or general surgery pack. When you open it up, surgeries go much quicker.”

“Interestingly, even though clinics have autoclaves, asepsis protocols and ultrasonic cleaners, I’ve been in few that have practiced the same [cleaning and sterilization] procedures for dental equipment as they do other equipment,” adds Renner. Midmark recommends veterinary practices process instruments the same way a medical practice would process theirs.

Generalists vs. specialists

Important as diagnosis and treatment of oral disease are, veterinarians need to help their clients help prevent oral disease from occurring in their pets, says Bellows. “Brushing is a great idea; it’s called the gold standard,” he says. “But no one does it.”

That being the case, veterinary staff can direct their clients to the Veterinary Oral Health Council, an organization within the American Veterinary Dental College, which issues a “Seal of Acceptance” to recognize products that meet pre-set standards of plaque and tartar retardation in dogs and cats.

General dentists should be able to handle 80 percent of the potential dental work walking through their door, says Woodward. They should be able to provide thorough cleaning, basic periodontal treatment, basic gum surgery, treatment of periodontal pockets and X-rays, he says. They should also be able to perform surgical extractions, that is, extractions of teeth that are solid; and to treat teeth with small fractures.

Root canals are probably best handled by a specialist, he adds. “A root canal is one of the most difficult procedures to do well in veterinary medicine,” he says. Learning how to do it well takes more than a one-day class, as some believe. Other conditions best handled by a specialist include large fractures, malocclusion (misalignment of teeth), oral cancer and caries (cavity) treatment. Many labs formulate crowns, but implants are still a work in progress in veterinary medicine.

“General veterinarians are doing more procedures, especially those with digital X-ray systems,” adds Bellows. They are performing more diagnostics, and they’re extracting teeth properly. Not to be ignored is the role of the technician in a successful practice. Technicians can do just about anything that’s non-surgical. Though they cannot diagnose periodontal disease, they can probe the mouth, perform X-rays and chart key findings. “I couldn’t do what I do without them,” he says.

All of which brings up a final point. Products and equipment are only part of a successful dental program. The entire clinic staff must buy into it as well. And once again, reps can play a role.

“First, the doctors have to figure it out,” says Woodward. “Then the staff has to receive some education.” And that includes everyone from the front desk to the kennel help. “That’s an opening for reps to offer lunchtime seminars on timely topics,” he says. “It’s a great way to make personal relationships.”

Key Points

“Dentistry is the biggest growing area for veterinary medicine that I see for the next 10 years,” says Tony Woodward, DVM, Dipl. AVDC, Animal Dental Care, Colorado Springs, Colo.

The average pet patient is probably equivalent to a human who hasn’t brushed his teeth in five years. But the connection between oral disease and heart, liver and kidney disease has been demonstrated in dogs.

Dentistry is one of those areas where veterinary practices can make money almost immediately, Woodward says. “For under $20,000, you can get totally equipped. If you go from ‘dental nothing’ to ‘dental everything,’ you’re looking at lease payments of $500 a month. Dental cleaning alone will pay for that.”

AAHA anesthesia guidelines for dogs and cats

Anesthesia is an important part of any thorough dental exam or procedure. The American Animal Hospital Association recently published guidelines for anesthetizing dogs and cats.

Although the guidelines are not meant to establish a universal anesthetic plan or legal standard of care, they are intended to provide recommendations for preanesthetic patient evaluation and examination; selection of premedication, induction and maintenance drugs; monitoring; equipment and recovery.

The AAHA guidelines point out that anesthesia includes more than the selection of anesthetic drugs. “A comprehensive individualized anesthetic plan will minimize perioperative morbidity and optimize perioperative conditions,” says the AAHA. “Monitoring, the ability to discern normal from abnormal, and expedient intervention are critical to ensure that potentially reversible problems do not become irreversible. Vigilance and patient support must be maintained during the recovery period.”

Equipment considerations

The guidelines include an anesthetic equipment check list, which directs the staff to check the following:

• CO2 absorbent.

• Oxygen.

• Endotracheal tubes and masks.

• Breathing system.

• Inhalant.

• Waste scavenging equipment.

• Electronic monitoring equipment.

The guidelines also include the following list of anesthesia monitoring tools:

• Electrocardiogram.

• Pulse oximeter.

• Arterial blood pressure monitor.

• Direct intraarterial BP (“Most accurate, but technically difficult to perform.”)

• Noninvasive (Doppler or oscillometric) BP. (“Technically easy, but can be inaccurate.”)

• Thermometer (esophageal probe or periodic rectal temperature with conventional thermometer).

• Anesthetic gas analyzer (measures inspired and expired inhalant concentration).

• Capnometer/capnograph (measures and/or displays CO2 in expired and inspired gas, and respiratory rate).

• Visualization (e.g., eye position, mucous membranes, chest excursion, etc.)

• Palpation (e.g., pulse quality, jaw tone, palpebral reflex).

• Auscultation (heart, lungs): precordial or esophageal stethoscope.

To see the entire set of guidelines, go to https://www.aahanet.org/PublicDocuments/Anesthesia_Guidelines_for_Dogs_and_Cats.pdf.

Twelve basic steps for quality dental care

When you proactively look for and treat dental problems, everyone is a winner, says Tony Woodward, DVM, Dipl. AVDC. “The pet benefits because they feel better, act better, and relate better to their owner. The owner benefits because their pet acts better, their breath is not offensive, and so the human-animal bond is strengthened. The practice benefits from owners that are bonded more closely to their pets and improved financial security. There are no losers in this equation.”

Woodward offers a 12-step cleaning procedure as the foundation from which proper diagnosis and treatment flow.

• Step 1: Patient history and physical exam. Many times, clues in the patient’s history can lead to a specific dental lesion. Further, some systemic diseases can have implications for oral health. Other items worthy of note include the presence of oral/facial enlargements, draining tracts, lymph node enlargement, altered eating behaviors, etc.

 • Step 2: Initial oral survey. Prior to anesthesia in a cooperative patient, or immediately after anesthetic induction, the veterinarian should give the entire oral cavity a “once over” to get an idea of what the case might entail. Some things to look for: odor, pain on manipulation, missing teeth, occlusal abnormalities, etc.

 • Step 3: Supragingival calculus removal. Removal of calculus above the gum line may be the most visible part of the procedure to the owner, but it is the least important part for the patient’s dental health, because much of potential disease lies below the gum. Supragingival calculus removal usually is accomplished with a combination of power equipment (e.g., rotary instrument, sonic scaler, ultrasonic scaler, hydraulic scaler) followed by hand scaling with scalers and curettes.

• Step 4: Subgingival cleaning. This is the most important part of the procedure for the patient. The veterinarian removes calculus, plaque and toxins from the root surfaces, allowing normal re-attachment of periodontal structures to the root. Subgingival scaling involves a combination of power equipment and hand instruments, and may involve three steps: 1) subgingival planing (calculus removal), 2) root planing (smoothing rough surfaces) and 3) subgingival curettage (soft tissue debridement of the inside of the gingival pocket). The use of ultrasonic equipment has gained popularity for subgingival scaling.

 • Step 5: Polishing. Polishing of the tooth surfaces removes small defects and irregularities that occur during the cleaning process. Smoothing the surfaces with a prophy angle and fluoridated prophy paste decreases plaque retention and slows the formation of calculus.

• Step 6: Sulcus irrigation/lavage. The use of an air-water handpiece or curved tip syringe allows the veterinarian to direct irrigant gently into the gingival sulcus, effectively removing loose calculus and polishing materials.

• Step 7: Fluoride application. This strengthens the enamel and helps decrease sensitivity associated with exposed dentin and/or root surfaces.

• Step 8: Complete charting. Full-page dental charts become particularly useful as serial charts are accumulated during the life of the patient. Changes in dental health can be tracked by referring to earlier charts of the same patient.

• Step 9: Radiographs. Eighty percent of clinically relevant dental anatomy cannot be seen by the naked eye, and so cannot be visualized without the use of dental radiographs.

• Step 10: Treatment plan. Most patients will require some additional treatment beyond the basic cleaning. The treatment plan should include needed medication, and the veterinarian should make sure to charge appropriately for his or her professional time and materials.

• Step 11: Home care. At some point during the dental cleaning process, the veterinarian should go over home care options with the owner. Home care modalities include brushing, rinses, gels, chews, dental-specific diets and periodontal vaccines.

 • Step 12: Schedule the next appointment. The practice should let the client know the next time he or she should bring in the pet, and make sure the reminder system is in place and working.

To view the complete “12-Step Cleaning Procedure” by Tony Woodward, DVM, go to http://www.dentalaireproducts.com/downloads/12step_cleaning.pdf.

What’s needed for dental procedures

The American Animal Hospital Association’s Dental Care Guidelines for Dogs and Cats, published in 2005, offers guidelines for materials and equipment, dental cleaning and evaluation, client communication and pet home care.

The guidelines point out that dental procedures cause aerosolization of bacteria and particulate matter. Use of a dedicated space, separate from the sterile surgical suite and preferably in a low-traffic area, is recommended for nonsterile dental procedures.

Appropriate ventilation and anesthetic scavenging systems must also be used. Low-heat, high-intensity lighting and magnification are required to adequately and safely visualize the oral cavity and its structures.

The operating table must allow for drainage and be constructed of impervious, cleanable material. Aspiration of water and debris by the patient must be prevented through endotracheal intubation, suction, and packing the posterior oral cavity with gauze. Proper positioning of the patient and/or use of an inclined table can also help prevent aspiration.

 Materials needed

• Antiseptic rinse.

• Prophy paste/pumice.

• Prophy angle and cups.

• Fluoride.

• Sealant.

• Needles and syringes.

• Intraoral radiographic or digital film in multiple sizes.

• Measures to prevent hypothermia (e.g., towels, blankets, circulating water blanket, hot air blanket, etc.)

• Gauze and sponges.

• Locally applied antimicrobial agent.

• Suture material (4-0 and smaller)

• Bone augmentation material.

• Hemostatic agents (if desired).

• Local anesthetic drugs.

Instruments to include in the dental surgical pack

• Scalers.

• Curettes.

• Probes/explorer.

• Sharpening materials.

• Scalpel.

• Extraction equipment (e.g., periosteal elevators, luxators, periodontal elevators, extraction forceps, root tip picks, root tip forceps).

• Thumb forceps.

• Hemostats.

• Mayo and Metzenbaum scissors.

• Needle holders.

• Mouth mirror.

• Head/eye loupes or other methods of magnification.

Equipment for performing dental procedures

• Equipment to expose and process intraoral dental films.

• A high- and low-speed delivery system for air and water.

• Equipment for sterilizing instruments.

• Low- and high-speed hand pieces (minimum two of each).

• Burs.

• Powered scaler (ultrasonic, subsonic or piezoelectric).

• Suction (optional).

• Fiberoptic light source (optional).

Minimum protective devices to be used during dental procedures

• Cap.

• Hair bonnet.

• Mask.

• Goggles, surgical spectacles or face shield.

• Smock.

• Surgical gloves.

• Earplugs.

• Dosimeter.

• Protection from radiation (e.g., lead shield).

 To view the “AAHA Dental Care Guidelines for Dogs and Cats,” go to https://www.aahanet.org/Library/DentalCare.aspx.

VOHC Seal of Acceptance

The Veterinary Oral Health Council (VOHC) exists to recognize products that meet pre-set standards of plaque and tartar retardation in dogs and cats. VOHC – which is an organization of the American Veterinary Dental College – does not test products itself. However, it does review data from manufacturers’ trials conducted according to VOHC protocols. The VOHC Seal is displayed on products that have been awarded the Seal of Acceptance.

The first VOHC Seal of Acceptance was awarded in June 1998, to Hill’s Pet Nutrition Canine Prescription Diet t/d.

To view information about VOHC, its accepted protocols, and a list of products awarded the VOHC Seal, visit the VOHC website at www.vohc.org.

February is Pet Dental Health Month

Periodontal disease is the most commonly diagnosed problems in dogs and cats. But many pet owners don’t know they can do more to prevent it. That’s the purpose of Pet Dental Health Month.

“It’s estimated that by the age of two, 80 percent of dogs and 70 percent of cats have some form of periodontal disease,” says Dr. Larry Kornegay, president of the American Veterinary Medical Association, a sponsor of Pet Dental Health Month. “Periodontal infections have been linked to diabetes, heart attacks, strokes, kidney disease and other life threatening disorders. During Pet Dental Health Month, the AVMA is encouraging all dog and cat owners to take steps to control plaque on their pet’s teeth and see their veterinarian for dental checkups.”

Sponsors for the 2011 Pet Dental Health Month were the AVMA, Hill’s Pet Nutrition, American Veterinary Dental Society, Academy of Veterinary Dentistry, American Veterinary Dental College, the National Association of Veterinary Technicians, Academy of Veterinary Dental Technicians, and the Veterinary Oral Health Council.

Vet-Advantage readers can direct their
customers to some Web-based resources associated with the Month. They include a video for pet owners on how to brush your dog or cat’s teeth at http://www.youtube.com/watch?v=wB3GIAgrTPE.

]]> http://www.vet-advantage.com/2012/02/cover-story-open-wide/feed/ 0 http://www.vet-advantage.com/2012/02/sales-the-three-second-door-opener/?utm_source=rss&utm_medium=rss&utm_campaign=sales-the-three-second-door-opener http://www.vet-advantage.com/2012/02/sales-the-three-second-door-opener/#comments Thu, 23 Feb 2012 14:41:36 +0000 admin http://www.vet-advantage.com/?p=2298 The Three-Second Door Opener

What to say when you only have three seconds to captivate your prospect

Here’s a shocking truth – Your prospects are giving you just three seconds before their attention wanders off. That’s really all the time you have to open the door to a sale … whether it’s in person, on the phone, in print, in e-mail or on the web.

Why just three seconds? According to the founder of HARO (Help a Reporter Out), the wildly successful PR organization, the world of communications has evolved into three-second moments to either “grab” someone’s attention or remain invisible.

Proctor & Gamble calls it the “Moment of First Truth.” In about three seconds, a person glances at a product and decides whether to pick it up, buy it, or walk away.

Many companies, including veterinary companies, overlook this when trying to captivate their prospects. Unfortunately, their marketing communications and sales pitches focus on their solutions. They don’t start out with a direct, attention-grabbing message of WHY the prospect should care about the product or solution, or HOW it will change the prospect’s life. Quite often, their primary message is something like, “A leading edge solution for serious practitioners.”

Instead, imagine the busy veterinarian stopping to learn how to “Be an itchy dog’s superhero in five minutes flat.”

Three seconds is the time it takes to absorb a sell-sheet headline, e-mail subject line, web-page headline or the beginning of a sales call. In every interaction with your prospects, your messages, visual cues and actions in those three seconds often determine whether you’ve captured their interest or not.

Consider the busy daily life of your prospect – a veterinary practitioner or office manager – juggling the duties of patient care, client education, lab sample processing, staff management issues, practice software upgrades, mailing reminders, CE learning time, stocking the retail shelves, updating their website or social networks, ordering supplies, dropping everything for emergencies, and trying to keep a handle on expenses and profits.

What can you say in three seconds to intrigue or excite your busy prospects so they’ll stop what they’re doing and thinking … give you their full attention… and consider buying from you?

 Five C’s

How do you entice a prospect to listen to your pitch, ask you for more details, stay on your website, read the leave-behind information, watch your demo, give something a trial run, comply with a recommendation, or embrace a new methodology or “best practice” that you’re proposing?

I’ll show you exactly what to say, and how to say it, in my Five C’s to Mastering the Three-Second Door Opener.

In the next five issues of Veterinary Advantage, I’ll explain each of the Five C’s and give you examples so you can create your own clear, strategic three-second messages that grab prospects. These tips will help you stand out from the “noise” in your sales calls and marketing materials, and open more doors to a sale.

Pam Foster, senior marketing communications professional, has 30+ years of experience (13 in the veterinary industry). As a Certified SEO Copywriter, direct-marketing writer and consultant, she helps clients develop strategic message strategies and deliver content within a user experience that drives results, both online and offline. Her work has made a difference to veterinary companies and pet businesses of all sizes. Her websites are PetCopywriter.com and ContentClear.com.

Newer treatment helps improve quality and length of life for dogs suffering from congestive heart failure.

Congestive heart failure in dogs is not to be taken lightly, but it has become much more manageable in recent years. One of the biggest advances in treating the disease is the more frequent use of pimobendan, a positive inotrope (a drug that improves heart function in cases of heart failure, heart attacks and various types of heart disease).

A number of large studies support the use of pimobendan, says Andrew Beardow, DVM, Boehringer Ingelheim. Distributor sales reps can do their customers a service by keeping them apprised of such studies, he points out. One of the largest global clinical studies involving dogs with congestive heart failure – the 2008 QUEST (Quality of Life and Extension of Survival Time) study – found that dogs with congestive heart failure receiving pimobendan plus furosemide (a diuretic used in the treatment of congestive heart failure) had significantly better outcomes than those receiving benazepril (an ace inhibitor) in combination with furosemide. Another study, called the VetSCOPE study demonstrated that Boehringer Ingelheim Vetmedica’s VETMEDIN^®  (pimobendan) was associated with faster and greater improvement in clinical symptoms than benazepril hydrochloride. VETMEDIN was found to reduce the required diuretic dose, as well as reducing the mean heart size. By opening up the blood vessels leaving the heart, the drug reportedly reduces the heart’s workload.

The more distributor sales reps know about congestive heart failure – how it impacts animals and the tools available to address it – the better equipped they are to keep their veterinarian customers informed of cutting-edge treatments.

About the disease

Congestive heart failure is the end result of any of a number of diseases, according to Beardow. When fluid develops in the lungs and the heart weakens to the point that it is unable to pump enough blood to sufficiently meet the body’s needs, heart failure inevitably occurs.

Dogs in particular are susceptible to two degenerative heart diseases that precede congestive heart failure – atrioventricular valvular insufficiency (AVVI) and dilated cardiomyopathy (DCM). The more common of the two – AVVI, or chronic mitral valve disease – is a degenerative disease that typically affects smaller dogs at around nine years of age. The mitral valve is located on the left side of the heart, between the left atrium and the left ventricle. When the left ventricle contracts, the mitral valve must be in the closed position to force blood through the arteries to the rest of the body. Over the years, the mitral valve can wear out and become leaky, and the blood is channeled back into the atrium. Cardiac output is reduced and less blood is circulated throughout the body, eventually leading to congestive heart failure.

AVVI is progressive. In its early stages, dogs may resist exercise, quickly run out of breath and develop a heart murmur. Later, they may develop a soft cough while lying down at night. In the final stages of the disease, the lungs become congested, causing dogs to have trouble breathing. Because the disease generally affects older dogs, pet owners may misinterpret symptoms as a product of age, notes Beardow.

Dilated cardiomyopathy  (DCM) – the second most common cause of canine congestive heart failure – is a disease of the heart muscle that results in the thinning of the heart walls, enlargement of the heart, weakened contractions and less effective pumping ability. Although dilated cardiomyopathy commonly affects larger breeds of dogs at around
seven to nine years of age, it also affects some smaller breeds, such as cocker spaniels. Its symptoms are similar as those of AVVI, although it progresses more quickly.

While cats, too, are susceptible to heart disease, they seldom present early warning signs. They do not present a heart murmur and they sleep a lot whether healthy or sick, there often are no early warning signs. By the time the disease is discovered, it often is in its end stage. The most common heart disease to affect cats is hypertrophic cardiomyopathy, which is associated with the thickening of the heart walls, leading to ineffective pumping.

Tools for diagnosis

A basic cardiac exam begins with a clinical history and a routine physical. A dog’s age and breed can be key in diagnosing congestive heart failure. For instance, middle-aged and older dogs are more susceptible to heart disease and heart failure. Middle-aged dogs are more commonly affected by DCM, whereas older dogs generally are affected by AVVI. Similarly, larger breeds of dogs are more susceptible to DCM, while smaller breeds are more susceptible to AVVI.

In obtaining a clinical history, the veterinarian must determine whether the dog displays changes in activity level or behavior, breathing, or appetite or weight. An acute cough can suggest pulmonary edema, while an intermittent cough may suggest chronic heart disease. The veterinarian also needs to consider the dog’s sleep habits (restlessness is commonly associated with congestive heart failure), radiographic changes, such as heart enlargement, and a persistent heart murmur. Other treatments, such as a heartworm prevention program, should also be noted.

A thorough physical begins with a weight check (weight loss may indicate congestive heart failure) and examination with a good stethoscope, which enables the veterinarian to detect heart murmurs as the blood moves in the wrong direction across the heart. In the case of a leaky valve, the veterinarian can get an idea of which valve is leaky and to what degree. Other symptoms uncovered by a physical exam may include an increased heart rate, jugular distension, abdominal distension and pulse abnormalities. Evaluating mucous membranes in a dog provides an indicator of hydration status, peripheral perfusion and tissue oxygenation.

In conjunction with the history and physical, there are a number of devices available for diagnosing heart disease and congestive heart failure, including the following:

• X-ray and/or radiography. X-ray and radiography provide a silhouette of the heart, enabling the veterinarian to see its size and whether the lungs are congested. However, the interpretation of an x-ray or radiograph is subjective, and if the animal is not positioned just so, the veterinarian may miss important signs. Also, in cats, the heart muscle expands equally on all sides, making it difficult to diagnose based on a silhouette image.

• BNP biomarker. At least one company offers a blood test designed to help diagnose or rule out heart disease in dogs and cats. It reportedly also helps differentiate heart disease from heart failure, and respiratory disease from heart disease. Because the test can be run in the veterinarian’s office, the veterinarian and client are provided with important information during the initial exam. Particularly for cats, who display no early warning signs of heart disease, a BNP test provides a dependable screen.

• Echocardiogram (ECG). Depending on the results of the x-ray or radiograph, the veterinarian will refer the patient to a cardiologist for an ECG, which can determine the existence of a cardiac arrhythmia or abnormal heartbeat.

• Doppler ultrasound. A noninvasive test, Doppler ultrasound measures blood flow and blood pressure by bouncing high-frequency sound waves (ultrasound) off circulating red blood cells. (Although regular ultrasound uses sound waves to produce images, it can’t show blood flow.)

As in the case of many diseases, diagnostic tools such as the above should be used in combination with one another to ensure the most accurate diagnosis. Veterinarians should begin with a general exam, including listening with a stethoscope for a heart murmur, says Beardow. They can follow up with a chest x-ray and a BNP biomarker. “The value of doing a chest x-ray – possibly every year [for high-risk pets] – is that it allows veterinarians to follow their patients closely and detect signs of heart failure early,” he explains. “We can follow the progression of the disease closely and know when the time is right to begin treatment (e.g., drugs).” When necessary, veterinarians should follow up with an ECG, he says. “Many practitioners can do an ECG at their own practice,” he points out, noting that some veterinarians have anesthetic monitors with the capacity for ECG monitoring as well. And while some do have ultrasound, they often reach out to a specialist for this, he adds.

Early treatment is key

Heart disease progresses slowly, according to Beardow. “Many dogs don’t present clinical symptoms for several years,” he says. “But, once clinical signs do develop, veterinarians must quickly begin treatment.”

Heart disease affects 25 percent of dogs over seven years of age, according to experts. In turn, mitral valve disease accounts for 75 percent of all cases of congestive heart failure. Well-informed distributor sales reps can keep their customers up to speed with the newest technology for keeping their patients healthier longer.

Skin Allergies

Skin allergies are more common in pets than one may think.

A simple romp through the park – or even in the backyard – can lead to a host of skin issues for dogs and cats. First and foremost, veterinarians should remind their clients to give their pets flea and tick preventives. But, even well-cared-for animals are at risk for skin allergens, and veterinarians must be prepared with the right tools to address skin problems.

What are they?

Skin allergies can be triggered by several sources, including environmental, parasitic and nutritional. Whereas humans inhale allergens, animals tend to absorb them through their skin, which is more porous and which doesn’t always provide an effective barrier against pathogens. The skin often reacts by becoming itchy and potentially infected when the animal scratches. Licking and biting of open wounds leads to further infection. Similarly, when the animal is bitten by a parasite, it may develop a systemic – or allergic – reaction. If the animal becomes uncomfortable and scratches or licks the affected area, it may become infected.

Although food allergies are less common among pets, veterinarians still need to keep their clients informed. About 20 percent of animals with allergies are found to have nutritional allergies. However, only 10 percent of all dogs have some type of allergy, so determining whether it is nutritionally based – and, if so, what type of food is causing the allergy – calls for some sleuth work. Animals suspected of having food allergies must live on restricted diets consisting of foods they have never before eaten. So, for instance, one veterinarian may prescribe a diet of ostrich and rutabaga. Another may prescribe kangaroo and sweet potato. The goal is to introduce small amounts of allergen to narrow down the source. The most common food allergies include beef, chicken and pork, as well as grains such as corn or wheat.

Regardless of the source, it’s important for pet owners and their veterinarians to recognize – and treat – skin allergies early on, before they have a detrimental effect on the animal. Particularly since skin allergies are commonly inherited (Terriers, Retrievers and Shar Pei are more prone than other breeds), practitioners should remind their clients to be aware.

How to diagnose

The first signs of allergies typically are inflamed, itchy skin and hair loss. Otitis – swelling and inflammation around the animal’s ear – often appears as a secondary symptom of an allergy or pathogen. In addition, the skin may become darker and tougher from repeated licking and biting. Sometimes yeast infections develop, particularly in areas such as folds and earflaps, where it tends to stay warm and moist. Animals may develop irritability or behavioral issues after periods of discomfort.

Diagnosing allergies is all about rule-outs, say experts. Veterinarians must begin by taking a thorough history of the patient. For instance, they must determine whether the pet is an indoor or an indoor/outdoor animal and whether the skin reaction occurs year round. Where does the animal sleep? Are there other pets in the home? And, so on. A basic physical exam should follow.

As part of the physical exam, veterinarians should run a basic diagnostic panel, including a fecal test for internal parasites and an examination for fleas and ticks. If parasites and environmental causes can be ruled out, the veterinarian typically will consider food allergies and place the animal on a special diet for four to eight weeks.

Sometimes, a general practitioner may refer the patient to a dermatologist or allergist, who performs a prick test. The animal is exposed – or pricked – with minimal amounts of potential allergens (much like the human form of the test). In some cases, the specialist may use a blood sample from the animal to test for allergies.

Throughout the process of diagnosing allergies and skin problems, the veterinarian will prescribe topical ointments, sprays, shampoos and wound flushes to keep the animal’s skin as healthy as possible.

Treatments

General practitioners must know when it’s prudent to refer a skin case to a dermatologist. About 300 such specialists practice across the United States today. Under- or over-prescribing medications can have a lasting effect on a pet. In fact, taking too heavy a dose of steroids can be life threatening. That said, mild-to-moderate cases may be handled effectively by a general practitioner.

There are many schools of thought when it comes to treating skin problems. Some veterinarians rely more heavily on anti-inflammatory steroids, which work well for short-term use, according to experts. However, they are associated with negative side effects (e.g., excessive urination or defecation; the development of thin skin; overstimulation of the endocrine system can lead to Cushing’s disease) when used for prolonged periods.

Other allergy treatments for dogs and cats include:

• Cyclosporine, which can suppress the immune response to allergens in dogs and cats, but is reportedly associated with gastrointestinal side effects.

• Allergy shots, which generally are given every six to 12 months.

• Topical products, such as shampoos, conditioners and ointments. Some products are medicated, while others are non-medicated cleansing products

• Diet/nutrition. Amino fatty acids are known to help maintain and restore moisture to the skin.

A newer concept in skin treatment – one that has been borrowed from the human side – is the use of ceramides, which help the animal’s skin develop into a protective barrier to allergens. At least one vendor is looking to simplify pet owners’ lives by adding ceramides to its shampoos and lotions. Skin barrier repair is an asset to animals as they fight allergens, say experts who note that “if the skin does its job, animals can nip the allergic process in the bud.”

Working with your customers

It makes good sense – both health-wise and financially – for veterinarians to treat their patients’ skin allergy problems early on, especially given that they often can address a variety of skin issues with a few products.

The more distributor sales reps know about skin allergies and treatments, the better they can help their veterinarian customers. Vendor lunch-and-learns are one way reps and their customers can stay informed about skin allergies and the newest products available for treating them.

In addition, when meeting with customers, reps should ask some probing questions, including:

• “Doctor, what are the most common skin issues you see among your patients?”

• “What are you currently doing to manage your patients with skin disease/allergies?”

• “Are you finding that your clients are able to use a topical therapy as often as possible?”

• “Are your clients aware that there are convenient sprays available, as well as traditional shampoo products?”

• “Is there anything specific you would like to discuss about skin issues/allergies?”

By taking a proactive approach to their patients’ skin care, veterinarians – and their clients – can prevent many long-term issues for pets.  And, working with their patients on skin problems throughout the animal’s life can be a great way for veterinarians to bond with clients and their pets.

Editor’s Note: Vet-Advantage would like to thank Dechra for its assistance with this article.

Pre-op testing, wellness exams are fueling in-office diagnostics

Selling the benefits of in-office diagnostics? Four words just about sum it up: “convenience” and “better patient care.”

“All of us want convenience,” says Jason Hunsinger, district manager, Mid-Atlantic area, Butler Schein Animal Health. “We’re all short on time. Any time you [as a pet owner] take your pet to your veterinarian, whether he’s sick or in for a wellness exam, and you can get valuable information on the spot, that is worth its weight in gold.”

“If [a clinic] has [testing] capability in-house, they will do more testing, and that will in the end lead to more accurate diagnoses and better medicine,” says Greg Fischer, who covers southern Minnesota for Midwest Veterinary Supply. “And that’s what they’re after.”

Nor can the bottom line be ignored.

“A piece of equipment, whatever it may be, needs to pay for itself,” Fischer continues. “It behooves people like me to show how this can positively impact [the veterinary practice’s] bottom line.”

Veterinarians are facing tough competition on many fronts, including Internet pharmacies, says Tammi Lesser, marketing manager, IDEXX Laboratories. “But diagnostics is something the veterinarian can uniquely provide. And it helps patients live longer.”

Geographic differences

Hematology analyzers, chemistry analyzers, electrolytes and rapid tests have become commonplace in the veterinary clinic. “Most practices are pretty sophisticated,” says Rachel Schultz, practice consultant for the American Animal Hospital Association. Even those that still send many of their tests to an outside lab have in-house capabilities to test critically ill patients on an “I need to know now” basis. Still, Schultz has observed that rural clinics often have more comprehensive in-office labs than metropolitan ones, which have quick, convenient access to outside labs.

There are some geographical differences as well, particularly in the types of tests likely to be administered. “My industry experience comes from being in the Northeast,” says Hunsinger. Clinics in that part of the country are particularly strong in heartworm and parasite testing, he says. “Ten years ago, you saw strong follow-through in offering heartworm tests. Then it transitioned to heartworm/Lyme testing. With the prevalence of Lyme in the Northeast, people are extremely compliant.”

 Pre-op testing

While many veterinarians are convinced of the need for in-office diagnostics for emergency patients, they may not believe they see enough critically ill patients to justify acquiring sophisticated lab equipment, according to those with whom Vet-Advantage spoke. Be that as it may, there’s a good chance those clinics do engage in two other clinical activities that might justify it – pre-op testing and wellness exams.

Clients don’t want to bring their pet in for pre-op testing, then return home to wait for results, then return to the clinic for a procedure, says Schultz. They’d rather all necessary testing be performed the morning of the procedure.

“The pre-anesthesia test gives you insight into the well-being of the animal,” says Lesser. It provides the veterinarian insight into the functioning of the kidney and liver, for example. If the patient is anemic, oxygen levels will be compromised, she points out. The animal’s electrolyte levels may determine how quickly it will recover from anesthesia. Bottom line is, the results of pre-anesthetic testing may result in the clinic altering its protocol, the result being a better outcome for the pet.

Pre-op testing also provides valuable baseline parameters, says Fischer. “Going forward, as that pet gets older, the clinic can refer back to the early blood work and see what their normals were.”

In the not-so-distant past, some clinics feared that if they insisted on pre-surgical blood work, clients might object to the cost and go elsewhere, says Hunsinger. But when they have made testing mandatory, they have found that they don’t lose customers, as they feared they would. “[People] know how important testing is when we go in for procedures,” he says. “Clinics have done a really good job letting their clients know why they should do it for their animals, and how important it is to establish a baseline for the pet’s future health. You’d be hard-pressed to find a practice that didn’t see value in pre-surgical blood work.”

As with so many things in the clinic, the chances of success are greater if everyone in the practice – from the front staff to the doctor – deliver the same message to the client, continues Hunsinger.  “To have any kind of testing protocol work, you need the message to be consistent, from the technician in the room to the doctor. And you need people to be confident in what they’re talking about. If they’re not, the client will see that and question, ‘Is it really worth it to pay for this service?’”

Wellness

While pre-op testing has already proven itself as a driver for in-office lab diagnostics, wellness testing is another. And those to whom Vet-Advantage spoke consider it a strong one. Annual blood work can give the doctor a good look at the well-being of the animal, says Lesser. Hematology and chemistry screens can help the doctor pick up problems, such as renal disease, before the animal presents with symptoms. The prognosis is better, because the doctor can help the client take steps, such as putting his or her pet on a therapeutic diet, that not only will improve the pet’s health, but probably save the owner money in the long run, as he or she avoids expensive treatment down the line. 

Some clinics send preventive tests to outside labs, notes Lesser. “A major objection [to in-house testing] is, ‘It’s not critical that we have that information right away.’” But if the clinic can perform such tests at the beginning of a visit, the doctor can sit down, face to face, with the client before the animal leaves the building to talk about potential issues and their solutions, and schedule a follow-up visit.

“The owner gets the results of the test and satisfaction before they pay their bill,” she says. “The worst thing is when the clinic takes blood and the client is told, ‘We’ll call you if there are any problems, but if you don’t get a callback, everything’s OK.’ When they don’t get that callback, they’re wondering what they paid for.”

Some vets feel it’s important to call the client regardless of the test results. That’s good customer service, but it also eats up valuable time from the veterinarian’s day.

“We’re seeing a 40-percent increase in compliance with pet owners when [the veterinarian] can discuss test results face to face,” says Lesser. The client is more likely to understand what he or she is told, and more likely to commit and comply with the recommended course of treatment. Better that than getting the phone call to bring Fluffy back in, which means missing another day of work, etc.

Stumbling blocks

Not surprisingly, some veterinarians voice concerns about the cost of in-house testing. Not only are they concerned about the cost of acquiring analyzers and supplies, but they believe that in-house testing costs the client more money on a per-test basis than if the clinic sent the work out.

Many times, the comparison isn’t valid, says Lesser. That’s because the clinic may, in fact, be overpricing the cost of its tests. The fact is, reference labs mark up tests far less than most clinics. The solution is not to send out tests, but to adjust the price of tests done in-house, she says.

Another objection is time. Veterinarians may be concerned that in-office testing will consume too much of their techs’ valuable time.

“These pieces of equipment and these tests have made veterinary technicians smile, whether they admit it or not,” says Fischer. “The technology is proven, and because they trust it, they’re free to do other things that are important to the success of that practice.” Typically, techs perform multiple functions within their clinics. “As the technology evolves, it’s quicker, simpler and more accurate,” he says, pointing to hematology screening as an example. In the past, the tech had to look in the microscope and manually count cells, he says. “It’s tedious, and [the tech] might get pulled one way or another, or get asked to do something else. There’s plenty of room for error.”

Some veterinarians believe in-house testing will take up more time than sending tests out to the reference lab, says Lesser. “Our suite of instruments takes about 50 seconds hands-on time for the technician,” she says. Contrast that with the time spent sending out tests – filling out forms, spinning down samples, making callbacks to clients, etc.

Nor do today’s analyzers require a great deal of skill to run in order to obtain top quality results, she adds. They are simple to use, and manufacturers such as IDEXX offer a variety of training opportunities, including online courses. As a result, technicians find that in-house testing is a rewarding part of their job. “They feel they’re engaged in the well-being of the animals,” she says.

Reference lab vs. in-house

AAHA’s Schultz believes that veterinary reference labs still can guarantee higher-quality results than the typical in-house lab, and that clinics would be well-advised to continue to send many of their tests there.

Not everyone agrees. Lesser, for example, says that IDEXX analyzers perform internal quality checks with every run. The clinic is advised to perform external checks regularly, such as once a month, she adds. While it’s true that reference labs perform external checks much more frequently, that’s because their volume is many times higher than that found in the typical clinic.

In fact, it’s a false dichotomy to pit in-house labs against reference labs, according to some. “Testing begets testing,” says Lesser. As clinics run more tests, they uncover more issues, and often end up sending tests to the reference lab that they’re unable to perform in-house. She cites the example of one clinic that, after starting a wellness program for its patients, increased in-house diagnostics 49 percent, and reference lab testing more than 15 percent.

“When I was with IDEXX, one thing you learned was that the in-house lab will never replace the reference lab, and the reference lab will never replace the in-house lab,” says Hunsinger, who worked for IDEXX for nine years before joining Butler Schein. It goes back to the convenience store mentality, he says. “Every town has several 7-Eleven-type stores, but they also have grocery stores. At the end of the day, you’ll see more convenience stores, but you’ll also see supermarkets.”

The sale

Just as veterinarians need to be thinking more about wellness and preventive care, so too should distributor reps, says Lesser. For example, medication monitoring is an area in which reps can focus. “There’s a huge opportunity to look at, ‘What [medications] am I selling, and how can I help [the clinic] build programs that are better for the patient, for the practice and the pet owner?’”

Ideally, the distributor rep and manufacturer rep work as partners in the selling process, says Fischer, who considers his role to be qualifying clinics on behalf of his manufacturer partners, “I get the appointments and [clinics’] agreement to bring in the manufacturer,” he says. “They trust me because they know me.” Despite his 36 years in the industry, Fischer still leaves the sale to the product experts – the manufacturer.

One base he is sure to cover is the ability of the practice to link its new analyzers with the practice’s electronic practice management and medical records systems. He’s high on IDEXX, because its VetLab station laboratory information management system integrates diagnostic results with the clinic’s system. It’s better patient care, he points out. But it also is a huge financial benefit to the practice. “It keeps them from missing charges. Surveys have shown that in a busy clinic, with techs running tests and seeing patients, upwards of 25 percent of lab charges can be missed. You put a pencil to that; it’s a staggering amount of money.”

Clinics express concerns about the money and time spent on developing and operating in-house lab capabilities, says Hunsinger. “That’s where, as sales professionals, we need to work on understanding their current system, uncovering needs they might not even know they have, and then showing them solutions.” New analyzers on the market are more efficient, allowing the clinic to run larger profiles on multiple patients cost-effectively. “If a clinic can see these things, they should be a lot more comfortable bringing in equipment. It comes down to education.

“One of the biggest areas of growth [in the veterinary market] is diagnostics,” continues Hunsinger. I think that will continue for years to come. The biggest challenge [for sales reps] is to understand our customers and any concerns they have, and then address those concerns in a thoughtful way.”

Fischer agrees. He speaks of one customer in rural Minnesota who, according to Fischer, “has blown up the idea that people won’t spend money for things like testing, because they don’t think it’s necessary.” When the vet arrived in town, the practice didn’t even have a tech on staff. Today, the practice has a complete in-house IDEXX lab and digital X-ray unit. “And this is in a town of about 4,000 or 5,000.”                                                                                                                                                               

KEY POINTS

Clients don’t want to bring their pet in for pre-op testing, then return home to wait for results, then return to the clinic for a procedure, says Rachel Schultz, practice consultant for the American Animal Hospital Association. They’d rather all necessary testing be performed the morning of the procedure.

Some veterinarians voice concerns about the cost of in-house testing. But the clinic may, in fact, be overpricing the cost of its tests. Reference labs markup tests far less than most clinics. The solution is not to send out tests, but to adjust the price of tests done in-house, says Tammi Lesser, marketing manager, IDEXX Laboratories.

“We’re seeing a 40-percent increase in compliance with pet owners when [the veterinarian] can discuss test results face to face,” says Lesser. The client is more likely to understand what he or she is told, and more likely to commit and comply with the recommended course of treatment.

Western Medical owner George Dunaians is up to the challenge of bringing his
family-owned company into the future

It’s challenging being a small business in a world of big competitors. “It is the larger distributors vs. the smaller ones,” says George Dunaians, owner of Western Medical Supply. “Ironically, in these times, when politicians are stressing, ‘We must encourage and help small businesses to succeed,’ we are experiencing just the opposite.” Even so, Western – a family-owned company – is thriving, through a combination of customer service and business smarts.

     Western Medical Supply is one of the oldest independent veterinary distributors in California. “For over 44 years, we have served loyal customers throughout California, Arizona and Nevada, with national and international clientele,” says Dunaians.

     “Our customers stay with us because they know we understand their needs,” he continues. “Most of all, they trust us to give them the very best service.” One of them is Betty O’Connor, DVM, San Luis Obispo, Calif. “I have been using Western Medical Supply for over 40 years, and they have been consistently helpful and knowledgeable, and they have a pleasant staff,” she says. O’Connor was recently recognized by Western for her continued support of the company.

     While personalized service is important, it’s not enough to be competitive in today’s business world, says Dunaians. “Most distributors are now nationwide, with warehouses in strategic locations across the country. Manufacturers today are always comparing the amount of business we are doing with their product lines and the ever-changing price margins. Quotas are a factor that often determines if you keep the line or not.”

     To remain competitive, Western has adjusted its business model to be more responsive to its customers’ needs. For example, “as a family owned company, serving a regional area, we are able to make adjustments with our inventory so we can better serve our customers,” says Dunaians.

    “I have always been an optimist. We are still here, and I look forward to reaching our 50th year in business,” he says. “With technology and the Internet leading the way to increased sales, I still feel that our most important asset is a qualified and knowledgeable sales force, as well as the support of our inside staff.”