There is nothing quite like the jolt I feel when my CSC (receptionist) comes back to tell me that an emergency is on its way in, and that is especially true with rattlesnake bites being that they are so variable.  There are so many factors – known ones such as the size of the dog and location of the bite; possibly known ones such as the type of snake and time elapsed since the bite; and the unknown factors such as the amount of envenomation and the make-up of the venom. (Fortunately we only have one venomous snake in the Folsom area, but sometimes there is confusion with non-venomous bites).

One of the most important things we can do for our patients is educating their owners on the dangers of snake bites and what to do and even more importantly, what NOT to do.  First off, the timeliness of treatment is critical so it is crucial for the client to get to a hospital as soon as possible, and preferably one that has antivenin available if it ends up being needed.  Other than keeping the patient as quiet and calm as possible and (if applicable) keeping the bite site lower than heart level, they should not provide any first-aid.  They should not apply hot or cold compresses and absolutely not make any cuts, try to suck out the venom or place a tourniquet.

Antivenin is the only treatment that will slow, halt or reverse the effects of the venom.  Other than that we can provide supportive care to reduce the risk of shock with IV fluids and limit pain and the chance of infection.

In addition to educating clients about what happens AFTER a snake bite, we should be doing what we can to prevent things from getting to that point.  As the old adage goes, “An ounce of prevention”… yada yada yada.  There are more and more companies offering snake avoidance training.  We have hosted a “Rattlesnake Avoidance Training” day the past two years and our clients have greatly appreciated it and we’ve had more than a couple account of how their dogs responded (appropriately) even possibly preventing their “parents” from getting bitten. 

Well, I’m not quite sure what to expect for the rest of this season, but I do know that anytime we get a rattlesnake bite victim, I won’t need a Starbucks fix!

1. Introduce yourself with confidence with a warm, friendly smile and always use soft, calm speech.  If you approach a client with overpowering, firm speech then they will tend to back off and not trust you. Trust is the key to keeping a client’s nerves at ease.
2. Talk to your nervous client like you would talk to a good friend. Make them feel at ease and allow them to approach you with what is really making them nervous. If they don’t tell you, then ask them directly what is making them most concerned about the situation. I would stay away from mentioning “being nervous” because nobody really wants to be called nervous, use the words concerned or worried.
3. Address the issue that concerns them most first. A nervous client wants to know or wants an answer right away. If this isn’t possible then explain why it is not, and what you will do to find that answer as quickly as possible.
4. Assure them that their Pet is in good hands.  It’s amazing what these words will do.
5. Assure them that they aren’t the only one to go through this. Tell them it’s ok to be concerned, for this is a sign of a good Pet parent. I sometimes tell them a story about myself going through a similar situation and how I felt.
6. Make sure that you keep them super- informed of what is going on with their Pet.  A couple of hours can feel like 24 to a nervous client.
7. Nervous clients can quickly escalate to irate clients if they aren’t getting the outcome that they expected. Always explain all possible outcomes before they occur to avoid this.  Don’t sugar coat things just because the client is nervous – be honest and direct with the client’s concerns.  The worst possible scenario CAN happen.
8. And most importantly – do NOT get nervous yourself – this will make clients even more uneasy. I would be wide-eyed nervous if I had a fidgety, squirrely doctor talking to me about my precious little Pet.

Over the next few months, the BARK team will focus on the on the topic of Pet overweight and obesity.  They will be conducting additional research on this health topic by evaluating trends and identifying risk factors associated with Pet obesity.  Their aim is to use the findings to better equip doctors with concise, succinct reports that enhance risk communication with their clients.  Since the goal of evidence-based medicine is to enhance clinical expertise in concert with consideration of patient needs and client circumstances, the BARK team will develop evidence-based tools to provide to Banfield hospital associates. For instance, client talking points will be written to incorporate evidence that PetNurses can use to educate clients on the dangers of having an overweight Pet. To integrate with the rest of the veterinary community, this research initiative will also include publishing a Critically Appraised Topic (CAT) report, an exhaustive literature review (quarterly white paper) and results from these studies will appear in future blog postings on this site.

As a veterinarian, how are you addressing this epidemic in your clinic and how do you think we can address the under-diagnosis of overweight and obesity?  What questions do you have and want to see answered regarding this health topic?  How do you educate clients on the prevention of overweight/obesity in their Pets?  Post your inquiries here and we may pick yours to answer by leveraging our nationwide medical e-record database.

If you’d like to subscribe to the Banfield Applied Research and Knowledge (BARK) quarterly white paper, email us at bark@banfield.net and include SUBSCRIBE in the subject line.

1. Burkholder, W.J. and P.W. Toll, Obesity, in Small Animal Clinical Nutrition,4th edition, M.S. Hand, C.D. Thatcher, R.L. Reimillard, P. Roudebush, M.L. Morris, and B.J. Novotny, Editors. 2000, Mark Morris Institute: Topeka, KS. p. 401–430.
2. Hill, R.C., Conference on “Multidisciplinary approaches to nutritional problems”. Symposium on “Nutrition and health”. Nutritional therapies to improve health: lessons from companion animals. Proceedings of the Nutrition Society, 2009. 68(1): p. 98-102.
3. McGreevy, P.D., et al., Prevalence of obesity in dogs examined by Australian veterinary practices and the risk factors involved. Veterinary Record, 2005. 156(22): p. 695-702.
4. Lund, E., et al., Prevalence and risk factors for obesity in adult dogs from private US veterinary practices. International Journal of Applied Research in Veterinary Medicine, 2006. 4(2): p. 177-186.
5. Lund, E., et al., Prevalence and risk factors for obesity in adult cats from private US veterinary practices. International Journal of Applied Research in Veterinary Medicine, 2005. 3(2): p. 88-96.
6. German, A.J., The growing problem of obesity in dogs and cats. Journal of Nutrition, 2006. 136(7 Suppl): p. 1940S-1946S.

No other Iams foods are affected, and this recall is limited to Iams canned cat food in North America. The Procter & Gamble Company is recalling these specific lots because the product may contain insufficient levels of thiamine (Vitamin B1), an essential nutrient for cats.   Thiamine deficiency in cats can manifest with clinical symptoms including loss of appetite, salivation, generalized weakness, vomiting, weight loss, ventroflexion of the neck, ataxia, tremors, falling, circling and seizures. 

Diagnosis is made by history, physical examination, and response to thiamine supplementation.  Thiamine concentrations can be measured in whole blood (the sample must be frozen and protected from light during collection, storage, and shipment), or in food.   

Treatment requires thiamine, given either by injection or by mouth.  Recommended doses are 100 to 250 mg SC q 12 hrs or 2-4 mg/kg PO q 24 hrs.  Note that injections may sting, and rapid intravenous administration has been associated with anaphylaxis.     

Concerned pet owners who have purchased Iams ProActive Health canned cat and kitten foods with these codes should discard the product – please make sure the contents of the can are destroyed in such a way that no other pets can inadvertently eat the food. For further information veterinarians should call P&G at 800-535-8387.  Clients/Pet owners can call P&G at 877-340-8826.

We found that the prevalence of tapeworms in cats is greater than the prevalence of fleas. This seems counterintuitive since tapeworms are transmitted when cats ingest fleas. This probably means two things – first, that cats probably remove most of their visible flea burden when they’re grooming (which makes it more difficult to diagnose flea infestation) and second, that flea control in cats is probably lower on most people’s list of priorities than ideal.

This is potentially important, as tapeworms are zoonotic. It’s no cause for alarm, as the prevalence of all the internal parasites (tapeworms, hookworms, whipworms and roundworms) is low, but it reinforces the point that year round flea, tick and worm prevention is extremely important.  It also should remind us of our responsibility as health professionals to discuss zoonotic diseases and how prevention can eliminate disease transmission with our clients.

Have you found the same thing out in practice and how do you approach the subject of regular parasite control? We’d love to get your feedback.

If you’d like to subscribe to the Banfield Applied Research and Knowledge (BARK) quarterly white paper, email us at bark@banfield.net and include SUBSCRIBE in the subject line.

People and their Pets share close living (and sleeping!) spaces. The recent 2009 H1N1 flu outbreak with reports of the virus found in people, dogs and cats demonstrates this closeness. Did you know that over three quarters of the emerging infectious diseases are zoonotic? ⁽¹⁾ However, as a recent survey revealed, most veterinarians in the United States aren’t encouraging client practices that could help to reduce zoonotic disease transmission. ⁽¹⁾ The survey also revealed that veterinarians consider it important to educate clients on zoonotic disease prevention, but only a small percentage initiate the discussion. The Centers for Disease Control and Prevention (CDC) provide on their “Healthy Pets Healthy People” website talking points, called Pet-Scriptions, to help veterinarians communicate strategies for zoonotic disease prevention with clients. Understanding whether there are young children or immunocompromised individuals in the family help veterinarians integrate zoonotic disease risk into their medical decision-making and client recommendations. In your own hospital setting, you can encourage frequent hand-washing and wearing gloves to handle feces and other biologic samples.

To help formalize the concepts into practice, the American Veterinary Medical Association launched the One Health initiative, which strives for an “establishment of closer professional interactions, collaborations, and educational opportunities across the health sciences professions, together with their related disciplines, to improve the health of people, animals, and our environment.” The most effective strategies for infectious disease prevention integrate the systems of medicine, veterinary medicine, and public health.

Veterinarians are essential partners in making One Health a reality. Did you know that it was a veterinary pathologist who linked a mysterious disease outbreak between humans and animals, which was later discovered to be West Nile virus ⁽²⁾! We want our clients and their pets to have long, happy lives together. When we talk about zoonotic disease, we are demonstrating our responsibility as health professionals and building trust with our clients. Sharing this information can strengthen both the client-veterinarian bond and the Pet-family bond!

What are the challenges for veterinarians in taking a bigger role in One Health? What are the opportunities? Please let us know what you think.

Further Reading:

• Childs, J.E. & Gordon, E.R. (2009). Surveillance and control of zoonotic agents prior to disease detection in humans. Mount Sinai Journal of Medicine, 76, 421-428.
• Kuehn, B.M. (2010). Human, animal, ecosystems health all key to curbing emerging infectious diseases. Journal of American Medical Association, 303(2), 117-124.

References:

1. Chomel, B.B. & Marano, N. (2009). Essential veterinary education in emerging infections, modes of introduction of exotic animals, zoonotic diseases, bioterrorism, implications for human and animal health and disease manifestation. Scientific and Technical Review, 28(2), 559-565.
2. Kahn, L.H. (2006). Confronting zoonoses, linking human and veterinary medicine. Emerging Infectious Diseases, 12(4), 556-561.

Feel free to copy the tips below and distribute to clients:

Contented Confinement: I suggest that every dog should be trained to accept confinement in a portable kennel as early in life as possible. (Prepare her now for boarding or hospitalization later.) For “gone to work” confinement, the ideal setup is a portable kennel connected to, or inside an indoor “exercise pen” with newspaper or fake grass as a toilet. This setup is safe for 8-10 hours at a time and limits the puppy’s access to everything it might do wrong. The best way to introduce the closed kennel is to pair every entry into the kennel with a toy containing a fresh dab of peanut butter. If the puppy cries later, first do a “Needs Analysis” and if elimination, exercise and other needs have been met, it will be necessary to let the pup learn that tantrums don’t work.

Chew Training: A few chew toys inside the kennel during confinement teach the puppy that these are his items to chew. Other times the owner should actively put these chew toys in the puppy’s mouth and praise any chewing. Start with very easily chewed toys such as Greenies and work up to compressed rawhide that has one end soaked in water to soften it up. Booby trap unacceptable targets with mouth wash or underarm anti-perspirant.

Reward Based Elimination Training: Punishing house soiling teaches, “Don’t eliminate when he’s watching!” This approach makes proper training more difficult because the goal is to BE THERE outside to praise correct elimination. When home, begin with confinement in a closed kennel which inhibits elimination. Take the pup out every few hours when awake, and no food or water inside the kennel overnight. If the puppy does not eliminate, just put her back into the kennel and try later. She will learn the way to get freedom, play and other rewards is to eliminate in the right place. Make her urine or feces so valuable she won’t want to waste it indoors. When she routinely asks to go out, she has earned her indoor freedom.

Leash Training: After successful elimination, suggest the owner take the puppy for a walk as reward. This habit of rewarding elimination on the owner’s property reduces the future need to bring baggies on walks. If an outdoor walk isn’t possible, suggest an “indoor walk” i.e. hold the leash INSIDE the house during post elimination play periods. This is a positive leash association, and makes it easy to catch the pup if mouthing something inappropriate, or if about to eliminate again. In the evenings, use the leash to tether the pup next to people to bond, and to prevent sneaking away to trouble.

Following these simple steps will go a long way in making the “Holiday Puppy” a permanent member of the family.

The answer is “Of course!” We need to be offering the very best we have to every client and every patient at every visit.

The veterinary team and the Pet’s family have the same goal of restoring or maintaining the health of the Pet. I believe we even have the same financial goals. We want our clients in sound financial health so they are able to return again, and they want us in sound financial health so we are here when they need us.

Instead of offering “good/better/best” medical plans and “bargaining” with our client until we meet in the middle, consider offering the very best and using the treatment plan as an open dialogue. Be transparent about what is absolutely mandatory and what is optional for your patient’s well-being and return to health and why each component is important. You may be surprised with what your client will allow you to do when they understand why each portion of the treatment plan is important. However, even a gazillionaire is not going to toss money at you for stuff they think you threw in just for the heck of it.

This is where your relationship with your client becomes important. Clients who trust your integrity and medical expertise will know when you say something is mandatory or even ideal, when you really believe it and when you are probably right.

Sometimes, clients ask for help finding ways to afford the treatment their Pets need. We may have payment plan options, charity information or other helpful resources available. However, keep in mind that our clients’ financial situations are none of our business unless they choose to make them our business. We are no more equipped to guess about the level of care they can afford than we are to guess about the strength of the bond they have with their Pet. If we are focusing on the financial aspects of a case at the cost of focusing on patient care, we will convey that to the client whether we mean to or not.

Recommend the very best for your patient. Explain to your client why the components of the treatment plan you propose are important. You know your patient is getting the best care you have to offer, your client is well cared for and you are being fairly compensated. Win-win situations are possible for the patient, the client and the veterinary team, and are worth striving for with every case.

The ever-present challenge for veterinary professionals is to demonstrate the value delivered. According to a PiperJaffray study of 248 companion animal practices, “While we were impressed with overall growth expectations, we would highlight that nearly 70 percent of the clinics we surveyed believe pet owners are deferring some treatment this year.” The BNResearch PetPoll 2008 concluded that “€¦with household budgets getting tighter due to the economy, clinics can expect more scrutiny and questions related to the cost of veterinary services. If pet owners do not understand the value of the services they are receiving, hospitals are at risk of facing both unsatisfied and lost clients.” Clearly, it’s never been more important to clearly explain the value you deliver.

So, how do you communicate value?

• See patients and clients on-time. Your client’s time is valuable and finite
• Articulate the comprehensive physical exam as conducted
• “Show and Tell” clients what you see, hear and feel
• Spend adequate time with clients, and probe for pet health questions
• Cliché, but true, a picture is worth a thousand words. Show Me!
• Demonstrate the cost of non-compliance:
  • Obesity likely results in osteoarthritis, shortened longevity, expensive NSAIDS and lab tests
  • Periodontal disease only worsens without veterinary intervention. The systemic risks are significant (see Dr. Glickman/Purdue CVM study of 60,000 dogs linking gum disease with heart disease)
  • Heartworm disease, as well as other diseases, is MUCH less expensive to prevent than to treat

Dogs and cats don’t know or care that the economy is weak. Their health care needs remain unchanged. As Dr. Marty Becker has said, “Your job is to be the spokesperson for the pet’s best interest.” Your oath is to protect human and animal health. Be the pet’s advocate, and everybody wins!

First, let me say that it helps the Dumb Friends League (DFL) and the shelter community to have positive working relationships with Banfield, The Pet Hospital, as well as other large practices. Locally, it helps that we have a strong partnership with the Denver Area Veterinary Medical Society. All of us working together benefits the pets and people we serve. Here are a few examples:

Have you noticed the beginning of an advertising shift related to the image of the cat? This is no accident. Two years ago, the DFL and the Hawaiian Humane Society brought together a group of about 50 stakeholders that included industry, academia, marketing, other nonprofit leaders and the veterinary community. They came from all over the country for two days of brainstorming on how to “rebrand Felix”—in other words, to change the perceived value of the cat from negative to positive in everyone’s minds. The intended result is that more cats will receive regular veterinary care, better quality food and be kept safely indoors—plus more will be adopted from shelters. A similar effort started about the same time in California. Shortly thereafter, the two groups formed the national CATalyst Council. Jane Brundt, DVM, is its chair. I am a member. Syndicated columnist and radio host Steve Dale is a member, as are others with national clout.

Two years ago, the DFL worked with our partners in the Colorado Federation of Animal Welfare Agencies to pass legislation that requires mandatory spay/neuters at all Colorado shelters and rescues. Because few shelters have in-house veterinary staff, most are working with local veterinarians to comply with the law, which took effect last January.

The DFL tried another legislative tactic last year—a bill that would have required urban-area cat owners to ID their cats with a tag or microchip. The purpose was to reduce the number of unidentified cats in shelters, thus reducing costs to municipalities of maintaining, adopting or euthanizing these pets. Some lawmakers thought it was frivolous. The bill never made it out of committee—but we are undeterred. We plan to introduce the bill again in 2010.

Last year, the DFL and the DAVMS spearheaded the CHIP YOUR CAT campaign. With 100,000 donated microchips from Bayer resQ and HomeAgain, we offered cat owners a year-long opportunity for free microchip implants and wellness exams at shelters and participating veterinary clinics in our six-county area. While only about 20,000 cat owners took advantage of it, it still represents quite a number of potentially new clients for the veterinarians and thousands of cats that now have identification, making their return home a lot more likely, if they get lost.

Together, we are making inroads. None of us could do this alone. This will be a long-distance marathon, not a sprint. It will take years, but I believe we’re on the right path to addressing our cat/kitten concerns.