• How to Successfully Pre-book Appointments • CVMA Practice Diagnostic Report:

CV M A VO ICE
Today’s Voice, Tomorrow’s Vision
• How to Successfully
Pre-book Appointments
• CVMA Practice
Diagnostic Report:
A National
Comparison
• BIG Ideas
Explores
Veterinary
Dentistry
2013, ISSUE #2
CVMA Voice 201 3: 2 | PAG E 1
“W
e were very pleased with the attention
given to our expansion, and we are
extremely satisfied with the overall outcome.
Carr Healthcare Realty was able to get us twice
the space at a lower cost per square foot than we
had anticipated. We would not hesitate to utilize
their services in the future.”
Colin Carr
President
Denver Metro
303.817.6654
[email protected]
Don Gretter, Business Manager
High Plains Veterinary Hospital
At Carr Healthcare Realty…
We provide experienced representation and skilled
negotiating for veterinarians’ office space needs.
Whether you are purchasing, relocating, opening a new
office, or renewing your existing lease, we can help you
receive some of the most favorable terms and concessions
available.
Every lease or purchase is unique and provides substantial
opportunities on which to capitalize. The slightest
difference in the terms negotiated can impact your practice
by hundreds of thousands of dollars. With this much at
stake, expert representation and skilled negotiating are
essential to level the playing field and help you receive the
most favorable terms.
Roger Hernandez
Colorado Springs
Southern Colorado
719.339.9007
[email protected]
Kevin Schutz
Boulder • Northern Colorado
Western Slope • Wyoming
970.690.5869
[email protected]
If your lease is expiring in the next 12 – 18 months, allow
us to show you how we can help you capitalize on your
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Lease Negotiations • Office Relocations • Lease Renewals • Purchases
CV M A VO ICE
TABLE OF CONTENTS
Inside
President’s Post . . . . . . . . . . . 4
Briefings . . . . . . . . . . . . . . . . . 5
Of Note . . . . . . . . . . . . . . . . . . 6
9
9PetCheck
Continues to
Help Hundreds
in Colorado
CVMA Convention 2013 . . . . . . . . . . . . . . . . .
6
Understanding Your Business Better:
CVMA Practice Diagnostics . . . . . . . . . . . . .
7
CVMA Practice Diagnostic Report:
A National Comparison . . . . . . . . . . . . . . . . .
8
9PetCheck Continues to Help Hundreds
in Colorado . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
Veterinary Peer Health
Assistance Program . . . . . . . . . . . . . . . . . . . . . 10
Government Affairs . . . . . . . . 12
12
Measures to
Minimize Influenza
Transmission at
Swine Exhibitions
Measures to Minimize Influenza
Transmission at Swine Exhibitions . . . . . . . . 12
CVMA Events
and Deadlines
August 1
Convention Early Bird
Registration deadline
September 1
Convention Advanced
Registration deadline
September 18
Laser Therapy Symposium
Loveland, CO
September 19–22
CVMA Convention 2013
Loveland, CO
October 25–26
Medical Massage for Animals
Fort Collins, CO
November 1–2
BIG Ideas Forum | Fall 2013
Legislative Update (cont’d ) . . . . . . . . . . . . . . 13
Science Update . . . . . . . . . . . 14
Orthotics and Prosthetics
in Veterinary Practice . . . . . . . . . . . . . . . . . . . 14
Vector-Borne & Zoonoses Update . . . . . . . . 16
In Practice . . . . . . . . . . . . . . . 20
14
Orthotics and
Prosthetics in
Veterinary Practice
PetAid Animal Hospital Referral
Program Making a Difference . . . . . . . . . . . 20
Having a Plan Can Help Drive
Preventive Pet Healthcare . . . . . . . . . . . . . . . 21
How to Successfully Pre-book
Appointments . . . . . . . . . . . . . . . . . . . . . . . .
22
Avoid Jumping to Conclusions
Regarding Animal Behavior . . . . . . . . . . . . . . 23
National Veterinary Accreditation
Renewal Procedures . . . . . . . . . . . . . . . . . . . . 24
It Can Be an Ethical Dilemma . . . . . . . . . . . . 25
CVMA News . . . . . . . . . . . . . 27
20
PetAid Animal
Hospital Referral
Program Making A
Difference
BIG Ideas Forum Explores Veterinary
Dentistry: Part I . . . . . . . . . . . . . . . . . . . . . . . . 27
CVMA Auxillary Launches Food
Animal Project . . . . . . . . . . . . . . . . . . . . . . . . . 30
Colorado Science & Engineering
Fair 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Welcome New CVMA Members! . . . . . . . . . . 31
Our Mission
CVMA exists to enhance
animal health and welfare,
promote the human/
animal bond, protect public
health, advance the
wellbeing of veterinarians,
and foster excellence
in veterinary medicine
through education,
advocacy, and outreach.
2 013 , I ssue #1
Colorado Veterinary
Medical Association
PRESIDENT’S POST
191 Yuma Street
Denver, Colorado 80223
303.318.0447 or 800.228.5429
Fax 303.318.0450
[email protected]
www.colovma.org
Managing Editor
Cami Cacciatore
Publisher
Ralph Johnson
The CVMA Voice is published
quarterly to members and once
a year to nonmembers free of
charge. Information and advice
presented in this publication do
not necessarily represent the
views of CVMA.
Deadlines for Submission
All articles, contributions,
and display ads must be
received in the CVMA office by
the dates reflected below.
For more information or to
obtain a rate schedule, contact
the CVMA office at 303.318.0447
or [email protected]
Issue
Issue
Issue
Issue
#1 — January 15
#2 — April 15
#3 — July 15
#4 — October 15
Randa McMillan, DVM
president
I have been a member
of our CVMA since
I graduated from
veterinary school, and if someone had asked
me what the most important thing CVMA
provided to its members was, I would have
answered “quality continuing education programs.” And while those offerings are always
top notch, I have now come to realize that no
other entity advocates for and protects our
profession on the state level like our Colorado
VMA. In my mind, that is the most important
offering we give to you, our members—the
assurance that somebody “has your back.”
Advocacy is defined as “the act of arguing
in favor of something such as a cause, idea, or
policy.” Advocacy can mean “grassroots” advocacy, which comes from educating a base of
supporters about your cause. It also can mean
going to the state capitol and meeting with
the governor or legislators to educate them
about your cause, or regularly attending the
State Board of Veterinary Medicine meetings
to provide support for our profession. CVMA
does all of these things. Through the annual
CVMA district visits and regular board meetings, we build support and consensus on various important policies and concepts. CVMA
hosts an annual advocacy training session to
educate our membership not only on what is
in the works, but also on the correct protocol
and procedures to use when addressing the
State Board or the legislators. CVMA has
been active this year at the State House, either
defending or arguing against various bills. Our
thanks go out to many members of our board
for testifying, including Dr. Curtis Crawford
for helping defeat the animal control bill and
Dr. Apryl Steele for her testimony on the
tail docking in dairy cattle bill. I testified in
favor of the dog protection bill, and Ralph
helped get the unwanted horse tax check-off
passed. We also owe a big thank you to Dr.
Barb Powers for her role as chair of the Commission on Advocacy and Outreach and her
tremendously beneficial relationship with the
agricultural community. On the regulatory
side, we need to thank Dr. Bill Fredrillgill for
his unwavering attendance at the State Board
meetings. CVMA’s presence here is important, not only as a watch dog, but also as a
source of collaboration with the SBVM.
One of my favorite quotes is from David
Berstein in How to Change the World: “An idea
is like a play. It needs a good producer and
a good promoter, even if it is a masterpiece.
Otherwise the play may never open, or it may
open but, for lack of an audience, close after
a week. Similarly, an idea will not move from
the fringes to the mainstream simply because
it is good; it must be skillfully marketed before it will actively shift people’s perception
and behavior.” This concept of being a “skillful
marketer” for the ideas CVMA supports falls
on the shoulders of the Executive Committee. We, by election, are the point people for
our profession here in Colorado—but every
member needs to be an advocate.
So when should we do advocacy? All the
time! We should never miss an opportunity
to sing the praises of our profession. We
should try to have a presence at community
events where people gather. Every practitioner should invite elected officials to tour
your hospitals and get to know you.
How should we advocate? We need to develop message points on important causes.
You know the image you want to create, so
it’s important that every practitioner uses the
same message. The key to effective advertising is seeing the same message over and over,
and it’s no less important with advocacy:
1.Be polite, be prepared, and be persistent.
2.Make advocacy part of your culture, and
work at it daily.
3.Don’t stop doing advocacy because the
answer to your request is no. It often
takes time to get the desired result.
4.Be sure to say thank you, even if you don’t
get the answer or support you sought.
It is up to all of us to advocate for our
profession. Help out whenever and wherever
you can. CVMA has your back—but it takes
all of us, working together, to protect and
promote the profession. n
CV M A VO ICE
BRIEFINGS
CVMA Executive
Committee
Dr. Randa MacMillan
President
Dr. Peter Hellyer
President-elect
Ralph Johnson
executive director
CVMA and
CACVT
Collaborate
In an effort symbolic of how cooperation by
members of the veterinary team advances the
effective delivery of veterinary healthcare,
CVMA and CACVT are collaborating to
enrich opportunities for continuing education for members of the healthcare team.
In particular, CACVT is merging its standalone Fall conference with the CVMA annual
convention as a result of a mutual commitment to bringing healthcare teams together
for joint learning experiences. In addition
to having full access to all CE sessions at
the convention, veterinary technicians will
also have the opportunity to access wet labs
and interactive lecture sessions designed to
provide technicians practical techniques for
immediate implementation back at the practice. Additionally, the CACVT and CVMA
luncheons have been combined at convention, and will provide the venue for celebrating mutual recognition through presentation
of the CACVT Team of the Year Award and
the CVMA Veterinary Technician of the Year
Award. We look forward to a much greater
presence of and participation by veterinary technicians in all facets of the annual
convention­—because learning, laughing, and
celebrating together will enrich the sense
of community and underscore the mutual
commitment of veterinarians and veterinary
technicians to the best possible patient care.
Legislative Update
As Dr. MacMillan stated so well in her column (page 4), no other entity advocates for
and protects the veterinary profession on the
state level like CVMA. Of the many benefits
membership offers, the most important is
that assurance that “somebody has your back.”
We spend time advocating for or against legislation that affects you, your practice, and
the profession as a whole. During the busy
legislative sessions, countless hours are spent
reviewing and negotiating, working with our
Dr. Erin Epperly
Secretary/Treasurer
lobbyist, finding the right people to question
and comment and testify, making trips to the
capitol—in short, we spend the time and
resources to protect your practice setting so
you don’t have to.
This year was especially active, and CVMA
was involved with several pieces of legislation.
Impound Livestock Veterinarian
­Determination (HB13-1125) – OPPOSE
Defeated by a vote of 7–6 on February 18
SUMMARY: This bill prohibits the impoundment of livestock unless a licensed veterinarian determines in writing based on an
inspection of the livestock that the impoundment is necessary to preserve the life of the
animal.
CVMA opposed HB 1125 because of the
unintended consequences on both people and
livestock. In testimony presented on February 18 to the House Agriculture, Natural
Resources and Energy Committee, CVMA
Secretary/Treasurer-elect Dr. Curtis Crawford presented concerns including lack of
definition, personal safety, timeliness, and
compensation.
Extend Unwanted Horse Tax Checkoff
(HB-1164) – SUPPORT
Signed by the Governor on March 22
SUMMARY: The bill extends by five years the
period during which state income tax return
forms include a line that allows an individual
taxpayer to make a voluntary contribution to
the unwanted horse fund.
CVMA took the lead in getting this bill
sponsored and moving through the legislature. An increasing number of Colorado’s
horses face an uncertain future and taxpayer
donations received through the state income tax checkoff program are channelled
to the Colorado Unwanted Horse Alliance
(CUHA), which works to reduce the number of Colorado’s unwanted horses and to
promote public and private collaboration and
education concerning their welfare, ownership, and disposition.
Briefings continued on page 13
Dr. Curtis Crawford
Secretary/Treasurer-elect
Dr. Apryl Steele
Immediate Past President
Dr. John Rule
AVMA Delegate
Dr. Melanie Marsden
AVMA Alternate Delegate
Mr. Ralph Johnson
Executive Director*
District
Representatives
1 –Dr. Christina Peters
2 –Dr. Sara Ahola
3 –Dr. Merideth Early
4 –Dr. Adam Tempel
5 –Dr. Jenelle Vail
6 –Dr. Mac Griffin
7 –Dr. Cor VanderWel
8 –Dr. Dale Davis
9 –Dr. Virginia Stout
10 –Dr. Marguerite Flett
12 –Dr. Randal Hays
13 –Dr. Connie Stapleton
14 –Dr. Matt Braunschmidt
15 – TBD
16 –Dr. Mark Cowan
17 –Dr. Leon Anderson
Student Chapter
Representatives
Fourth year – Ms. Julialea
Donnelly
Third year – Mr. Nathaniel Vos
Second year – Mrs. Julia
Herman
First year – Mr. Kevin Lavelle
* Ex-officio, non-voting
2 01 3, I ssue # 2
story
CVMAcover
Convention
2013
Where Will YOU Be September 19–22?
Summer has just arrived, and
while the last thing on your mind
is the turning of leaves, September will be here before you know
it—and with it CVMA Convention
2013 in Loveland!
With easy access from much of
Colorado, the CVMA convention
is a great place to meet up with
old friends and to make new ones.
Veterinarians, technicians, support
staff, and guests are all welcome—
the more the merrier!
Whether you put the dates in
your phone, on your calendar, or
on a post-it note on the refrigerator, block these dates for education, reconnection, and relaxation:
September 19–22 at the Embassy
Suites in Loveland.
But why wait? You can book
your hotel room or spa treatment
today at www.embassysuites
loveland.com.
Hands-on CE
To everything there is a season…
And autumn in Colorado is the
perfect time to learn. CVMA Convention 2013 offers exceptional CE
opportunities, all in one place.
Wet Labs
Practical Laparoscopic Procedures
for General Practitioners
Off–property (transportation will
be provided)
Sponsored by BioVision
Dental Radiology Wet Lab
Dr. Jan Bellows (for DVMs and
­veterinary technicians)
On-site (space is limited)
PAG E 6 | CV M A Vo i ce 2013: 2
Dental Extraction Lab
Dr. Jan Bellows (for DVMs only)
On-site (space is limited)
Sponsored by Patterson Vet and
Bleed-X
And be sure to join Dr. ­Bellows
for an additional 5 hours of small
animal dental topics during
­convention!
Social Media
Dr. Michael Warren is a practicing
veterinarian and online strategist.
He will show you how to improve
client communication and engagement through online media.
This all-day presentation offers
everything: what makes an effective website, social media 101,
reputation management, and a
two-hour online marketing essentials workshop.
Veterinary Forensics
Dr. Melinda Merck will walk you
through forensic testing, how to
collect evidence, and the special
considerations that must be given
when writing a forensic report.
Technicians Welcome!
CACVT is pleased to announce
that it is partnering with CVMA to
provide a more in-depth education experience for the veterinary
team! The two associations are
working together to offer technicians a Fall education opportunity
at CVMA Convention 2013 with
8 hours of biomedical continuing
education specifically designed
for technicians to provide practical techniques for immediate implementation back at the practice.
This is the perfect opportunity
for technician-specific training­—
and to take advantage of all the
great opportunities CVMA Convention 2013 has to offer. With
your full convention registration, you are eligible to attend
any of the 136 available hours
of CE sessions offered Thursday
through Sunday, as well as attend
the Membership Luncheon and
Awards Celebration, the Steak
Fry and Shirley Clark Project Auction, and many more social and
networking events throughout the
convention.
And Don’t Forget the Fun!
But all work and no fun make for
a dull weekend, so CVMA Convention 2013 has plenty of social activities to bring everyone together
for food, fun, and festivities!
President’s Reception
Join CVMA president Dr. Randa
MacMillan in a celebration of
CVMA and its efforts to support
and further the profession! Every­
one is welcome to attend this
special event. Join your colleagues
while enjoying appetizers and a
cocktail.
Student/Mentor Meetup
Students, take a break from your
studies and have some fun. Members, consider sharing your experience with a CSU student who faces
the same questions and challenges
you once faced. Spend some time
with the next generation of veterinary medicine, and join us for a
unique creative experience! Great
minds don’t always think alike, but
art can often get you on the same
page. Mix and mingle with fellow colleagues and students and
Convention continued on page 7
CV M A VO ICE
OF NOtE
Understanding Your Business Better:
CVMA Practice Diagnostics
Wendy Hauser, DVM
“M
ost people don’t recognize
opportunity when it comes,
because it’s usually dressed in overalls
and looks a lot like work.”
— Thomas Alva Edison
Such was the case that presented itself while I was attending a
pre-conference leadership training course at AAHA’s 2007 Annual Meeting. Fellow participants in this round table format were
bright, inquisitive, and clearly experienced in the art of not only
leadership, but the business of veterinary medicine. As we prepared to leave for lunch, opportunity knocked! The gentleman
sitting next to me invited me to participate in the North American Business Association (NABA), a by-invitation group of veterinarian/practice owners that function as each others’ board of
directors in providing veterinary business support and guidance.
Key to the premise of NABA is the need to be able to clearly
evaluate each hospital’s individual performance as well as their
performance against the NABA group as a whole. Prior to my
involvement with NABA, I appreciated the need to look at key
metrics, but truly did not understand how to apply those metrics
to better my hospital. Enter the OVMA practice diagnostic tools
and fee guides, utilized as “the standard” by NABA. These tools,
now offered by the CVMA (see page 8), were the basis of truly
understanding my business. There is tremendous value in critically
dissecting the financials of your practice in any given year. Wonder
why your net revenue is lower than it should be? The process of
completing the reports and analyzing the results highlights profitdraining areas such as staffing expenses and overstocking of inventory items. Or perhaps the problems are related to a lack of new
clients and declining client visits. This knowledge allows practices
to focus their attention on problem areas that, when rectified, result in increasing practice profitability, stability, and success.
We all understand that to help animals be healthy, our businesses
need to be healthy, too. While there is no lack of resources regarding practice financial management, there is a lack in application of
these practices. I resigned in late March from the hospital where I
worked as an owner and later managing DVM. Since then, I have
spoken with many veterinarians that are eager to successfully transition from practice ownership.Yet, in evaluating their practices,
few owners can reliably provide even basic practice metrics such
as active client numbers, average number of visits per year per patient, and average client transaction (ACT) fees. These owners have
put in years of “sweat equity” that is immeasurable, unrecognizable,
and will be unrewarded. As a profession, I truly thought we were
doing a better job of educating our owners!
The CVMA Perfornamce Analytics tools allow each practice
to compare itself to fellow Colorado participants. Utilization of
this information will allow practices to strategically implement
short- and long-term goals for improved practice performance.
The true value of these tools are realized when practices commit to using them annually. While I have appreciated many benefits from
Practice Diagnostic Reports, the most valuable has been the
trending information gained over the extended time frame. The
data comparison has provided concrete ways to evaluate the
impact of business decisions and new program implementation.
The ­Client Satisfaction Survey establishes a means to measure
how your offerings are meeting the needs of your clients, as well
as what your differentiators are.
I applaud fellow CVMA members who are taking advantage of
these phenomenal tools and challenge each hospital to embrace
this as a necessary business practice. And for those of you who aren’t using the tools, I strongly encourage you to recognize this opportunity, roll up your sleeves,
and have your “sweat equity” rewarded.
Dr.Wendy Hauser is a co-collaborator and co-facilator for CVMA’s Power
of Ten. She is one of three facilitators for AAHA’s newly formed NABA
groups and is on the AAHA Board of Directors. She may be reached at
[email protected]
To learn more about the CVMA Performance Analytics, visit
www.colovma.org and click on “Economic and Personal Well­
being” under the Programs tab. n
Convention continued from page 6
engage in an art-inspired activity designed to bring members
and students together. Make your
mark. Make an impression. Create
a connection.
CVMA/CSU ­Reception
and Steak Fry
Enjoy some toe-tapping music
from the Blue Canyon Boys, offer-
ing pitch-perfect harmonies and
sweet sounding bluegrass music to
entertain you during the reception
as you warm up for the Steak Fry.
Shirley Clark Project Auction
And what would CVMA Convention 2013 be without its signature
event? Raise your hand and raise
the roof, all in support of CVMA
Auxiliary projects. You never
know what treasure you may
find—or friendly rivalry you can
further as you bid on all kinds of
items. From works of art to oneof-a-kind handmade items, it’s
always an action-packed and entertaining evening! n
CVMA Voice 201 3: 2 | PAGE 7
2 01 3, I ssue # 2
OF NOtE
CVMA Practice Diagnostic Report:
A National Comparison
Darren Osborne, MA
OVMA Director of Economic Research
CVMA introduced the Practice Diagnostic Survey to help members better manage their practices. The resulting Practice Diagnostic Report (PDR) provides management information for
veterinarians to make up budgets, critically assess staff levels,
gauge production, compare fees, and measure practice profit to
estimate the value of their practice. It could not have come at a
better time. Never before has there been such a strong need and
desire for improved management. The post-recession headwind
has forced many veterinarians to change the way they practice.
The time has come for CVMA members to dig deep into their
management bag of tricks and protect the bottom line. This is the
opportunity for change.
This report shows the results from the 2012 survey year with
feedback from 42 hospitals from Colorado. More than one hundred
hospitals have signed up for the service and we will be updating
figures as data becomes available. This preliminary data provides
CVMA members with an opportunity to see how their practice
compares to the average and take note of what to change moving
forward. Figures for the U.S. Average come from the Veterinary
Hospitals Managers Association 2012 Practice Diagnostic Report.
Preface to the Data
To account for differences in the number of DVMs per hospital,
much of the material is presented on a per full time equivalent
(FTE) DVM. A FTE represents 2,000 hours of veterinary time. To
determine the number of FTE DVMs in your practice, add all the
veterinary hours and divide by 2,000. For example, if there was
one veterinarian working 2,000 hours per year, then this practice
would have 1 FTE DVM. If a practice had two veterinarians annually working 1,500 hours each and two veterinarians working 500
hours each, then the number of FTEs would be determined by
taking the total number of hours (1,500+1,500+500+500) and
dividing by 2,000 hours – 2 FTEs.
Comparing Clients
To effectively measure the quantity and quality of clients, there
are five client statistics examined: active clients, new clients,
visits per client, revenue per transaction, and revenue per client.
The number of active clients per FTE is a good benchmark since
it measures clients who have been to the veterinary hospital in
the last year but it does nothing to measure the quality of clients.
Since 2008, many hospitals around the country have reported that
their number of active clients has been falling. Data from those
hospitals shows that while the number of clients has been falling,
revenues per client have been steady or growing. This means that
many hospitals are able to keep revenues steady by generating
more revenue from fewer clients.
Colorado veterinary hospitals had slightly fewer active clients
per FTE in 2012 compared to the rest of the country. The average
companion animal hospitals in Colorado had 1,238 active clients
PAG E 8 | CV M A Vo i ce 2013 : 2
compared to an average of 1,284 for the country. A 4% difference
is not significant but revenue per client figures shows an alarming
17% difference between revenue per client in Colorado and the
rest of the country. Pet owners in Colorado spend 17% less than
pet owners around the country. This is even more striking when
the cost of living difference is taken into account; there is a 7%
cost of living premium for Colorado. With a higher cost of living,
consumers in Colorado pay an average of 7% more than the rest
of the country, so it stands to reason that revenue per client in
Colorado should be 7% higher as well.
Revenue per client is driven by the level of fees, range of services offered, and number of transactions. Colorado veterinary
hospitals have lower revenue per transaction and fewer client
visits per year. These two factors work together to draw down
revenue per client.
CLIENT STATISTICS
Clients per FTE seen per year
New clients per FTE per year
Annual visits per client
Average revenue per transaction
Annual revenue per client
CVMA National
Average Average Change
1,238
231
3.7 $119.37 $424 1,284
209
4.5 $125.80 $511 –4%
11%
–20%
–5%
–17%
Now What?
Better Metrics
Continue to track the obvious figures like revenue per transaction and revenue for the month, but start tracking the number
of active and new clients per month to see if demand is dropping
off. Measuring clients can be a better predictor of future revenue;
looking at revenue figures alone can be dangerous. For example,
a two-doctor hospital can have three big surgeries in one month
that can hide the impact from a drop in demand—demand could
be falling but with $10,000 extra surgery dollars, the revenue
per transaction looks great, revenue per client is skewed up, and
revenue for the month looks fine. All the while, the practice is
shrinking.
Better Revenue
The easiest road to improved client revenues is with higher fees.
The average Colorado hospital has fees that are 2% below the national average. Given the cost of living surplus for the state, fees
could go up 9% and even with that aggressive increase, it would
only bring them in line with the national figures. There are possibilities to increase fees even more in many hospitals.
Better Compliance
Veterinary hospitals that have maintained or increased their active
client numbers have done so by changing their communication
policies. Two postcards and a phone call (voicemail message) does
not work as well as it did five years ago. Successful hospitals are
pre-booking all clients before they leave from their appointment.
Just like your dentist, book the appointment for the next visit.
Even if that next visit is a year away, pre-booking makes it easier
Diagnostic continued on page 9
CV M A VO ICE
OF NOtE
9PetCheck Continues to Help
Hundreds in Colorado
The 2013 9PetCheck was held Saturday and Sunday, April 6 and
7, and CVMA is proud to announce that 51 clinics across Colorado provided nearly 800 complimentary wellness exams and
rabies vaccinations to pets of people in need. The media attention the event received was outstanding and CVMA wants to
thank 9News for being a valuable contributor to the publicity of
not only the event, but in educating the public on the importance
of preventive care and public health. This year’s successful 9PetCheck would not have been possible
without the veterinary clinics that opened their doors and volunteered their time and staff to provide the wellness exams and rabies vaccinations.You allowed CVMA to promote messages about
the importance of preventive care and rabies vaccinations. Thank
you to all of the veterinarians, veterinary technicians, and support
staff that stepped up to make a difference in the community. The
clients the 9PetCheck helped were truly in need of these services
and were profusely grateful to everyone who participated.
“It’s been a wonderful experience to be a part of the 9PetCheck
because this dog is part of my family and his good health means
the world to me,” said Tony Bachicha, who brought his beloved
Bo, an 11-year-old husky/chow mix, to PetAid Animal Hospital
for his wellness exam and rabies vaccinations. “Thank you to everyone who is involved in this program!”
“It has been very expensive to keep my two puppies healthy
so we are so, so thankful to everyone who volunteered for this
event. We want our babies to stay healthy so this couldn’t have
come at a better time. Thanks everyone!” said Latosha, who
brought her pooches Milo and Swiss for their wellness exams and
rabies vaccinations. Both dogs received a clean bill of health!
Not only have the participating CVMA members provided a
great community service, they also helped to educate the public
about the importance of preventive care and public safety. Thanks
to 9News and other media outlets across the state, even people
who couldn’t get an appointment learned how crucial regular
veterinary visits are for the health of their pets.
Diagnostic continued from page 8
to remind clients a year from now and it makes the client’s life
easier because they have one less thing to worry about. There will
be some resistance from staff because this is new, but feedback
from all hospitals that have adopted the pre-booking strategy is
that it works. (See page 22.)
In addition to pre-booking, increasing phone calls to clients is
bringing more clients back to the practice. Curiously, we have
more ways than ever before to communicate with each other,
but we can never get a hold of anyone. One reminder call is not
enough. People are busier than ever with more distractions than
ever. Three reminder phone calls can increase the number of appointments by a noticeable amount immediately.
Here are some of the
media outlets that helped
to spread the word about
this initiative (visit www.
colovma.org for the full
clips): 9News, Colorado &
Company, My Windsor Now,
Broomfield Enterprise, Denver
Post, Pueblo Chieftain, Greeley
Tribune, and Steamboat Pilot.
The appointments could
not have filled so efficiently
and effectively without the 14
volunteers who donated their
time to the 9PetCheck phone
bank. They booked almost
every slot and felt a great
sense of pride after the twoand-a-half hour event.
Thank you to Brad Bettale, Bonnie Yordy, Cami
Cacciatore, Carolyn Gravit, Emily Yocom, Jennifer
Beierle, Jenny Ivy, Melissa
Angel, Michelle Armstrong, Ralph Johnson, Sarah Rumple, Tara
McChesney, Tamara Fox, and T.J. Schreiter.
Here is what one of the phone bank volunteers had to say about
her experience with the event:
“Thank you for this AMAZING experience! It was truly
touching how grateful these people were for the opportunity
to take their animals to see a veterinarian!”
— Jennifer S. Beierle, Member Service Center Assistant,
American Animal Hospital Association
For a full wrap-up, including photos, videos of clients the 9PetCheck helped, and a list of media clips, go to www.colovma.org.
Thank you to ALL veterinarians, veterinary technicians, and support staff that made this event possible. n
Practices in Colorado and practices across the nation are facing some tough economic times. Many pet owners are struggling
financially and this is creating a reluctance to go to the veterinarian. It is time to change the way you practice and the way you
manage.
The results from the first CVMA Practice Diagnostic Survey
show there is work to be done. CVMA has the tools to help
practices succeed. In addition to the Practice Diagnostic Survey,
CVMA has a Client Satisfaction Survey to help practices identify
what clients like and dislike, and the Personalized Fee Guide to
help practices find creative ways to increase fees.
Look to the next issue of the CVMAVoice, where we will continue the
­discussion in the article “Comparing and Controlling Expenses.” n
CVMA Voice 201 3: 2 | PAGE 9
2 01 3, I ssue # 2
Veterinary Peer Health
Assistance Program
Peer Assistance Services, Inc. (PAS) provides services to veterinarians who may be experiencing physical, emotional, psychological,
or substance use problems. The Colorado Board of Veterinary Medicine contracts with PAS and the program is funded by license fees.
The program accepts self-referrals and calls from persons who may
be concerned about themselves or others.The referral may come
from a friend, family member, colleague, supervisor, self, or the
Colorado Board of Veterinary Medicine.The calls are confidential and
you do not need to give your name or the name of the individual.
PAS works to ensure that veterinarians get the help that is
needed so they can either remain in the workforce or re-enter
the field safely. Staff is available during business hours as well as
after hours and weekends by calling our 24-hour information
line (720.291.3209).You can contact us with general questions,
concerns about yourself or a colleague, or to obtain community
resources.You may also contact PAS because you have some questions around behaviors you have observed while working with a
veterinarian, but you are not sure of what to do or what to say.
If you are concerned about someone or yourself and would
like information and help, please contact PAS confidentially at
303.369.0039 for information or to schedule as assessment.
For more information, visit the CVMA website at www
.colovma.org and click on “Concerned Colorado Veterinarians &
Peer Assistance Services” under the Programs tab. n
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2 01 3, I ssue # 2
government affairs
Measures to Minimize
Influenza Transmission
at Swine Exhibitions
Nick Striegel, DVM, MPH
Colorado Assistant State Veterinarian
Colorado Department of Agriculture
In response to a significant increase in
the number of human influenza-A cases
associated with exposure to swine at
exhibitions during 2012, the National
Assembly of State Animal Health Officials (National Assembly)
and the National Association of State Public Health Veterinarians
(NASPHV) co-chaired the Swine Exhibitions Zoonotic Influenza
Working Group. Representatives of the swine industry, swine
exhibitions, swine veterinarians, academia, 4-H, state and federal
animal health agencies, and public health entities met to develop
the document “Measures to Minimize Influenza Transmission at
Swine Exhibitions.” The suggested mitigation measures have been
organized to address activities before, during, and after swine exhibitions; they are further divided into actions that may minimize
risk to swine and risk to humans. Here is an excerpt from the
paper:
It is estimated that 150 million people visit agricultural fairs
each year in North America. Agricultural exhibitions provide
valuable educational venues for the public. Equally important,
the exhibition of swine is an important learning opportunity
for thousands of youth exhibitors, 4-H, and FFA members
across the United States. Showing swine for these youth at
their county or state fair is the culmination of many months of
work dedicated to the care and training of their animal.
Pigs can be infected with human, swine, and avian origin
influenza A viruses. While rare, influenza A viruses can spread
from pigs to people and from people to pigs, but it usually
requires close contact between pigs and people. This has happened in different settings, including agricultural fairs. When
people are infected with swine origin influenza A viruses, it is
termed as a variant virus infection and denoted with a “v” after
the subtype (e.g. H3N2v). In the past 5 years, cases of influenza A H1N1v, H1N2v and H3N2v have been associated with
swine exhibitions. In 2011 there were 12 cases of H3N2v reported from 5 states. In 2012 there were a total of 309 cases of
H3N2v identified in 12 states. The majority of cases reported
exposure to pigs prior to onset of illness and were exhibitors
and others in close contact with pigs at agricultural fairs. Sixteen of these individuals were hospitalized and one death was
reported. Eleven of the 16 hospitalized cases, as well as the
person who died, were people considered to be at high risk
for complications from influenza infections. People at high risk
include children younger than 5 years of age, people 65 years
of age and older, pregnant women, and people with certain
long-term health conditions (like asthma, diabetes, heart disease, chronic respiratory disease, weakened immune systems,
and neurological or neurodevelopmental conditions.)
PAG E 12 | CV M A Vo ice 2013 : 2
These cases led to the formation of the Swine Exhibitions
Zoonotic Influenza Working Group that has developed a set of
measures to minimize influenza virus transmission between
swine, from people to swine, and from swine to people at
swine exhibitions. Influenza viruses are unpredictable and their
impact and circulation can vary by year. It may not be possible
to prevent all transmission of influenza viruses at swine exhibitions. The measures described here are offered for careful
consideration depending on the needs of the specific exhibition and can be implemented in part or in total. They are not
intended to supersede federal, state, or local regulations. These
measures were formulated based on current evidence and the
collective knowledge of the Swine Exhibitions Zoonotic Influenza Working Group. It is expected that this document will be
updated regularly as additional information becomes available.
The suggested measures have been organized to address
activities before, during, and after swine exhibitions. Measures are further divided into actions that may minimize risk
to swine and risk to humans, although there is significant
overlap between those two groups.”
The paper highlights the importance of building a communication network that includes the state animal health agency, state
and local public health officials, exhibition organizers and managers, veterinarians, Extension educators, vocational agriculture
instructors, and other stakeholders. In addition, a key component
to an effective response to influenza related to swine exhibitions
would be developing a complete roster of all participants with
contact information such as cell phone numbers and email addresses. Swine exhibitions can also limit the risk by doing some
creative scheduling of swine events to reduce risk, such as scheduling terminal pig shows after the breeding shows with time to
disinfect between those particular classes of pigs.
Exhibitions should also have a veterinarian who is on call for the
duration of the exhibition to perform daily monitoring of all swine
for clinical signs of influenza, examination of any sick pigs, and
testing when necessary. A preparedness plan should also address
the isolation and treatment protocols of sick pigs and the necessary
increased biosecurity once influenza has been diagnosed.
Influenza education for exhibitors and their families will increase awareness, help in the early recognition of influenza, and
certainly help to prevent outbreaks of the virus at swine exhibitions. Another area of education should be in the area of bio­
security, which will reduce transmission.
Education of the public is also essential. Some of this can be
done with good signage, but there also needs to be other communication on influenza awareness. People need to know more about
the influenza virus, how to mitigate risk by good hand washing
and sanitation, not eating and drinking in the animal areas, and
not taking strollers, sipping cups, and pacifiers in the animal areas. In addition, the public should be advised on which individuals
are at higher risk for influenza, who to contact if influenza symptoms arise, and when to seek medical care.
To access the entire document, go to www.colorado.gov/ag/
animals and click on the tab for Livestock Health and then click
on Forms and Publications on the left hand side of the page. n
CV M A VO ICE
government affairs
Briefings continued from page 5
Prohibit Routine Dairy Cattle Tail Docking (HB13-1231)
– SUPPORT
Postponed indefinitely
SUMMARY: The bill would prohibit the practice of docking the
tail of any dairy cattle; however, it allows tail docking if the following conditions are met: a licensed veterinarian performs the
tail docking; the tail docking is performed for a therapeutic purpose; anesthesia is used on the animal during the procedure; and
the veterinarian conducts the procedure in a manner that minimizes the animal’s long-term pain and suffering.
CVMA supported HB 1231 for a number of reasons, including
CVMA’s Principles of Animal Welfare, because animal welfare
science indicates negative outcomes result from the practice, and
because organizations such as the American Veterinary Medical
Association, the American Association of Bovine Practitioners,
and the National Mastitis Council have all created public position
statements opposing tail docking in diary cattle.
Dog Protection Act (SB13-226) – ­SUPPORT WITH
CHANGES
Signed by the Governor on May 13
SUMMARY: The bill would require police officers in municipalities and Sherriff’s Offices to receive training from a licensed
veterinarian on canine behavior in order to reduce the number of
incidents where household pets are shot by law enforcement.
Wells Fargo Practice Finance
CVMA worked with the bill sponsor, Senator David Balmer,
to make significant changes to the bill in order to address CVMA
concerns. As a result, CVMA will co-chair the Dog Protection Task
Force comprised of representatives from professional communities including law enforcement, animal care and control, legal,
and animal behavior. The task force is responsible for developing
a training curriculum that helps police officers understand canine
behavior, identifying the skill sets and knowledge base necessary
for an individual to present the training curriculum in person, and
creating an online video to present the curriculum in a way that
can be accessed by law enforcement throughout the state.
Indirect Supervision (HB-1311) – SUPPORT
Signed by the Governor on May 28
SUMMARY: The bill would provide a clarification of the definition
of the veterinary premises in the Colorado Veterinary Practice Act.
CVMA supported the following change: “Veterinary premises”
or “premises” means any A veterinary office, hospital, clinic, or
temporary location in which veterinary medicine is being practiced by or under the direct or immediate supervision UNDER
THE DIRECTION AND SUPERVISION of a licensed veterinarian. This change is necessary to allow the State Board of Veterinary
Medicine to adopt a rule that allows indirect supervision in certain
narrow circumstances (e.g. a veterinary technician administering
medications overnight to a hospitalized patient, without the direct
supervision of a veterinarian as presently required by statute). n
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CVMA Voice 2013: 2 | PAG E 1 3
2 01 3, I ssue # 2
science update
Orthotics and Prosthetics
in Veterinary Practice
Patrice M. Mich, DVM, MS, DABVP, DACVAA, CCRT
OrthoPets Center for Animal Pain Management
and Mobility Solutions
The popular press has reported several interesting cases in which
prosthetic limbs have been successfully applied to veterinary
species including a sea turtle, an elephant, a dolphin, an eagle,
cats, and dogs.1 Once considered a novelty, these devices are
increasingly available. Our clients are seeking innovative options
for their animal companions with limb injury or loss. As of this
writing, there at least 12 companies offering prosthetics as well as
­orthotics (braces) for veterinary species in the U.S. and Canada.2
These devices are available via website ordering (with or without
veterinary consultation) although some companies see patients
directly. Devices available include prosthetic limbs, orthoses, and
assistive devices (wheels, slings, support wraps, etc).
Our clients have recognized there is a gap in veterinary services
in terms of managing limb dysfunction and loss, a gap that has
long been filled in human medicine. While it is true that techniques and materials used in human orthotics and prosthetics
(H-OP) can be translated to veterinary patients, specific modifications for quadruped ambulation and the significantly greater
magnitude of force generated by these patients must be considered. A thorough understanding of the biomechanics and health
issues of animals is essential to avoid injury, delayed healing, or
delayed use of more appropriate therapies. The veterinarian is the
key player in this process.
Orthotics Basics
Orthoses provide protected motion within a controlled range,
prevent or reduce severity of injury, prevent or relieve contracture, allow lax ligaments and joint capsules to shorten, and provide functional stability for an unstable limb segment (Prokop,
2006; Deshales, 2002). These devices should not be seen as a
replacement for surgery, but complementary. Orthoses can be
utilized as pre-op, post-op or “no-op” solutions. In cases where
surgery must be delayed, they can provide interim support, protect the limb, and minimize disuse atrophy; for example, a stifle
orthosis may be used to limit instability in a dog undergoing
chemo­therapy for lymphosarcoma pending definitive surgical repair of cranial cruciate injury. In a post-op situation, orthoses can
provide a safe, effective, and dynamic alternative to serial casting; a good example of this is a dynamic motion-limiting Achilles
orthosis. This device safely reloads the tendon as well as protects
from re-injury as a sports brace (see Figure 1). Additionally, it
can be used for nonsurgical Achilles injuries as mentioned by Dr.
Preston Stubbs in the last issue of the CVMA Voice. Orthoses are
also used when surgery is not an option or is not appropriate;
some examples include patients for whom there is no surgical
repair, who are poor candidates for anesthesia, whose advanced
age is of concern, or where finances are an issue for the owner.
Importantly, these devices do not create dependency or atrophy
unless intended or is an unavoidable consequence of severe injury.
PAG E 14 | CV M A Vo ice 2013 : 2
Prosthetics Basics
In veterinary school we are taught that animals do well on three
legs. This position would seem to obviate the need for prosthetic
limbs relegating this technology to novelty. While it is true that
many patients adapt quickly, this is functional adaptation and not
necessarily the highest quality of life. The short and long-term
structural consequences of a missing limb or limb segment are
now being recognized and defined in part through the efforts of
pain management veterinarians (the American College of Veterinary Anesthesia and Analgesia and the International Veterinary
Academy of Pain Management), sports medicine specialists (the
American College of Veterinary Sports Medicine and Rehabilitation), and rehabilitation therapists (the American Association of
Rehabilitation Veterinarians). Their efforts enable us to understand clearly the biomechanics of quadruped locomotion and the
implications when it is lost. In terms of limb absence or total limb
amputation, these include limited mobility and endurance, increased metabolic demand, weight gain, support limb breakdown
(e.g. carpal hyperextension), chronic neck and back pain, and
premature euthanasia3 (see Figure 2) Because of these significant
consequences consideration must be made for the re-establishment of quadruped structure whenever possible.
Prostheses, like orthoses, are readily accepted by veterinary
patients with congenital limb deformities as well as by those requiring amputation. In human medicine, amputation at the hip
Continued on next page
CV M A VO ICE
science update
Continued from previous page
for a catastrophic ankle injury
would be unthinkable.Yet this
is standard of care in veterinary
medicine. Why is this? In the past
prosthetics were not available and
therefore concern for injury to the
remaining limb segment was valid.
Fortunately, prosthetics coupled
with subtotal amputation, standard
of practice in human medicine,
are recent and successful developments in veterinary medicine (see
Figure 3) Given the consequences
of limb loss in the short and long
term it seems appropriate to “contemplate before we amputate” an
entire limb when only the distal
segment is beyond salvage. Examples include neoplasia, trauma,
and partial agenesis. Preservation of at least 50% of the radius/
ulna or tibia/fibula allows ready application of a prosthetic limb
in species including dogs, cats, goats, llamas, alpacas, and others.
V-OP and the Role of the Veterinarian
Veterinary orthotics and prosthetics are custom-made from
a fiberglass impression of the patient’s limb after a diagnosis,
complete biomechanical evaluation, and therapeutic plan are
established. Device design is unique based on the individual corrective needs, conformation, abilities, and environment of the
patient. Manufacturing requires a firm understanding of quadruped biomechanics and skilled modification to accommodate limb
topography and create appropriate corrective forces. V-OP is a
hands-on therapy; each case should be managed carefully from
diagnosis to device application to physical rehabilitation using a
cohesive team approach. The ideal team includes the pet owner,
the family veterinarian, a certified rehabilitation therapist, and a
V-OP specialist skilled in custom
design, fabrication, and fitting of
devices for the intended species.
The advantages afforded by
custom orthoses and prostheses
include 1) prevention of cast-related
wounds; 2) management of primary
pain generators associated with
functional impairments; 3) improvement of biomechanics, allowing for
greater activity and a significant decrease in compensatory pain; 4) return to active lifestyle, resulting in
decreased obesity and associated
co-morbidities; 5) improvement
in quality of life and functional
independence, both of which can
prevent premature decision to
euthanize; and 6) the availability of treatment options where none
existed before. We are witnessing the development of a new and
exciting therapeutic option for our patients; and, as in the past for
oncology, advanced dentistry, and rehabilitation, veterinarians are
the medical professionals to assess, diagnose, prescribe and manage
therapy with the assistance of professionals knowledgeable in V-OP
specifically. Importantly, V-OP is significantly different from H-OP.
Knowledge of veterinary species is paramount and the role of the
veterinarian cannot be over-stated. There are opportunities to learn
about V-OP at local and national veterinary meetings including at
the 2013 CVMA convention and a continuing education course is
offered through the Canine Rehabilitation Institute (www.caninere
habintstitute.com). n
References
1.http://www.mnn.com/earth-matters/animals/photos/9-inspiring
-animals-that-use-prosthetics/bionic-animals.
2.http://www.animaloandp.com/facilities.asp.
3.Prokop LL. 2006. Upper extremity orthotics in performing artists.
Phys Med Rehabil Clin N Am 17:843-852.
4.Deshales LD. 2002. Upper extremity orthoses. In: CA Trombly,
MV Radomski editor(s). Occupational Therapy for Physical Dysfunction.
5th ed. pp313–49. Baltimore: Lippincott, Williams & Wilkins.
5.Borghese I., Fair, L., Kaufmann, M., and Mich, P.M. 2013. Assistive
devices, orthotics, prosthetics, and bandaging. In Zink, MC and VanDyke, JB (eds) Canine Sports Medicine and Rehabilitation.Wiley-Blackwell)
Introducing Acupuncture
Services
Stacey Anstaett, DVM, CVA is now
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 Cancer pain
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pain relief
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Acupuncture · Cardiology · Dermatology
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(720) 842-5050 · (720) 842-5060 (FAX)
www.aescparker.com
CVMA Voice 201 3: 2 | PAGE 1 5
2 01 3, I ssue # 2
science update
Vector-Borne & Zoonoses Update
Colorado Department of Public Health & Environment
(CDPHE)
A Veterinarian’s Role in Prevention
and Control of Rabies
As rabies continues to spread in skunks in Colorado, the disease
thought of as a “zebra” by most veterinarians suddenly becomes a
major concern. Most veterinarians become aware of the need for
awareness by their clinic’s staff once a client brings a dog or cat into
the clinic that has played with a rabid or un-testable bat or tangled
with a skunk or fox that has tested positive or was not available for
testing. Ensuring that the client is given correct information on
what is required of the owner at the onset of this situation is key to
a smooth response to a domestic animal exposed to rabies.
Telling the owner that just a 10-day quarantine is required leads
to immense confusion for the owner once they speak to local
or state public health officials. Since the quarantine of a domestic animal possibly exposed to rabies is based on the incubation
period of rabies (which ranges from two weeks to six months or
longer), the quarantine is much longer: 45 to 180 days depending on the vaccination status of the animal. (An explanation of the
10-day quarantine/observation period is provided at the end of
this article*). This conflict of information that the owner receives
from veterinary clinic staff, animal control, and public health officials, causes an increase in tense, complicated communications
and time spent by veterinary staff and public health officials in
clarifying the situation for the owner. This conflict can cause the
owner to become noncompliant with the requirements, which
can ultimately lead to endangering the public. The Colorado
Department of Public Health & Environment (CDPHE) is designated by statute to maintain a policy on how domestic animals
shall be managed after a potential exposure to rabies. This policy
is enforced by local public health officials and animal control
agencies. The policy and accompanying algorithm are available on
the CDPHE rabies webpage and also included within the Colorado
Rabies Resource Guide, which was created to improve coordination
by all professionals involved to prevent and control rabies in animals and humans. Please share this guide widely among your staff
and perhaps discuss at a future staff meeting. (The Guide is available on the CDPHE website or through links on the Rabies page
of the Issues section on the CVMA website.)
While the Colorado Rabies Resource Guide is helpful when utilized,
the only way that truly effective coordination occurs in the effort
to prevent and control rabies is when the various stakeholders
know each other and when to call each other. We ask that all veterinarians become aware of how to reach, and when to call, your
local public health agency and animal control agencies in your
area. If you are practicing in a community where there is a current
rabies epizootic in skunks, please take it one step further and take
the opportunity to speak and hopefully meet with your local public health and/or local animal control officials. Some local public
health agencies host a spring time meeting with groups of veterinary staff, animal control, wildlife, and local health officials in one
PAG E 16 | CV M A Vo ice 2013 : 2
room. These are great opportunities to get to know the key players
and first responders to rabies in your area.
For those veterinarians who are already assisting local agencies
with the fight against rabies, we thank you profusely. Some veterinarians in Colorado are already helping their local agencies with
one of the following:
• Donating time to administer rabies vaccine at mass vaccination clinics organized by local animal control or animal
shelters. Vaccine is usually donated by a manufacturer, or distributor, or provided by the animal control agency or shelter.
• In areas where animal control does not exist or does not have
the training or facility, removing heads of skunk, raccoons,
foxes, and other wild carnivores that need to be submitted
for rabies testing
• Making shelter space available for dogs or cats that may have
been exposed to rabies and must be confined in a facility for
the first 90 days of a 180-day quarantine.
In recent months, some clinics have been able to set up a memorandum of understanding between their veterinary clinic and the
local public health agency in exchange for rabies vaccination of a
couple of your staff**.
* In contrast to the long quarantine period times for domestic
animals exposed to rabies, the 10-day quarantine/observation
period of a dog or cat that has bitten a person is based on the
end stage of rabies and on studies in which dogs and cats were
infected and saliva samples were collected prior to onset of clear
neurologic signs until death. The studies determined that most
dogs and cat are already showing neurologic signs once the
rabies virus is being shed in the saliva; a small proportion of animals were shedding rabies up to three day prior to onset of neurologic signs. All of the dogs and cats in the study died by 8 days
after the rabies virus was being shed in the virus. Since both
studies were relatively small studies, the quarantine/observation
period was nationally set at 10 days. Thus, if a dog or cat is still
alive 10 days after the date of bite, the bite victim is reassured
that there was no rabies virus in the saliva at the time of the bite.
** At this time, there is limited supply of human rabies vaccine for
pre-exposure vaccination. The supply of human rabies vaccine
is expected to improve in June.
Rabies Update for Colorado
From January 1 through April 16, CSU and CDPHE laboratories
confirmed rabies infection in 39 animals: 1 bat, 34 skunks, 1 fox,
1 raccoon, 1 horse, and 1 domestic cat. Through investigation by
local public health and animal control officials, 4 humans and 75
domestic animals were considered exposed to these laboratoryconfirmed rabid animals.
Three rabid skunks that were collected in late February and
March originated from the Brighton area of Adams County. The
only other laboratory-confirmed rabid skunk documented from
Adams County was reported in May of 2010 in a rural area of
Continued on next page
CV M A VO ICE
science update
Continued from previous page
extreme northeastern Adams County. This finding heralds a large
geographic movement of this skunk rabies virus in Colorado.
Tri County Health Department issued a press release to increase
awareness among Brighton area residents and to encourage rabies
vaccination of domestic animals.
Most of the recently laboratory-confirmed rabid animals originated in Larimer County, including in Loveland, Masonville, an
area north of Carter Lake, and Berthoud, which indicates a slight
southwest movement of this rabies virus in that portion of Colorado. Larimer County Department of Health and Environment
issued a press release to increase awareness among area residents
and to encourage rabies vaccination of domestic animals. The
press release included a link to a map of rabies in Larimer County
(www.larimer.org/maps/rabies2013.cfm).
In early April, a skunk from the southern edge of Berthoud
near the Boulder County boundary was confirmed with rabies
infection. Boulder County Public Health has issued a press release
in early April to warn residents in northern Boulder County.
Please visit the CDPHE rabies webpage for more information
about rabies in Colorado, including educational materials for
your clients, the latest statistics, and maps ( www.colorado.gov/
cdphe/rabies).
Plague/Tularemia Update
As of April 12, no domestic animals in Colorado tested positive
for plague or tularemia positive this year. CDPHE Laboratory has
tested a total of 7 samples from a dog, 3 squirrels, a rabbit, and
fleas from two sites of prairie dog colonies. All of these samples
were negative for plague and tularemia via PCR. n
Ureteral Obstruction.
Treatable.
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i.r. interdisciplinary specialty approach:
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SarahScruggs,DVM,MS,DACVIM(Cardiology)
INTERNALMEDICINE:
JenniferMessinger,DVM,DACVIM
ONCOLOGY:AnneSkope,VMD,MS(PracticeLimitedtoOncology)
DIAGNOSTICIMAGING:
JasonArble,DVM,MS,DACVR
Referrals&Information:720-975-2804
CVMA Voice 2013: 2 | PAGE 1 7
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James K. Olson, DVM
Dipl ABVP (Feline Specialty)
(303) 663-CATS (2287)
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e-mail: [email protected]
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2 01 3, I ssue # 2
in practice
PetAid Animal Hospital Referral
Program Making a Difference
Julie Smith, DVM, Hospital Director
PetAid Animal Hospital
As announced in March via a mailing to Colorado veterinarians,
PetAid Animal Hospital is once again accepting referrals from
veterinarians statewide to support practitioners in providing
services to pets in need. The referrals started coming in almost
immediately, and by mid May, we have seen 47 cases that have
spent about $15,000 on services. Another $15,000 in donations
from PetAid Colorado donors has been used to cover the discounts these clients have received. Four of these cases have come
from practices outside of the Denver metro area—two from the
Front Range and two from mountain communities. We have had
discussions with many other clinics about referrals that were for
services we couldn’t provide due to their nature or our current
caseload, and a few referred clients never followed up to schedule
appointments with us.
One great example of the program
at work was Beau, a
seven-year-old neutered male cat who
had eaten a string.
His owner had taken
Beau to his regular
veterinarian after he
began vomiting and
acting painful, and
they discovered the
probable intestinal
obstruction with
their diagnostics.
When presented
with the estimate for
surgery, the owner
was unable to afford
the full amount due
to her current economic circumstances. She was referred to us,
and we were able to perform abdominal surgery and remove several inches of string from the stomach and small intestine. Beau
did well after surgery, and his owner was incredibly grateful for
the opportunity her veterinarian gave her through the referral to
PetAid.
If you are considering referring a client to us, here are a few
reminders as to how this program will work best for the clients,
you as the practitioner, and our practice:
• If you are not sure if we perform a certain procedure and/or
also want to confirm if we can see an urgent case, please call
us at 303.722.5800. Any of our client specialists can connect
you with a doctor or relay a message as needed.
• The referral form will help us get the client set up and give
us the best information to make an appointment and provide
PAG E 20 | CV M A Vo ice 2013 : 2
an estimate. Our client specialists can send you a blank one if
needed, or go to www.petaidcolorado.org/dvmreferral and
enter password DVM2013.
• Clients should be told to wait for your practice to give them
more information or for us to call them for an appointment.
We can’t handle walk-in cases and need to be able to set appointment times to give all clients the best service.
• We can usually provide estimates after receiving the referral
form and getting any other clarifying information. This will
allow your client to determine if they can even afford the
services we can provide.
• These referrals should be your clients that you know are
having tough economic times and really can’t afford what is
needed for their pet at this time.
If you are finding this program meaningful to your practice,
or believe you will in the future, please consider supporting the
continued success of the referral program.You may make a donation through our website at www.PetAidColorado.org, or contact
Sharon Brown, Director of Development, at 303.539.7635 to
find out about other methods of support, including becoming a
Safety Net Partner (a program created exclusively for veterinary
practices). n
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Ent is a community-chartered credit union | Federally insured by NCUA
© Ent Federal Credit Union, 2013 • Ent is a registered trademark of Ent Federal Credit Union.
CV M A VO ICE
in practice
Having a Plan Can Help Drive
Preventive Pet Healthcare
The cost of veterinary care
often carries with it a certain
level of sticker shock for pet
owners. But there are ways to
help ease your clients’ financial pain. When it comes to
preventive care, there are ways
to make sure pets stay healthy
while also making it easier for
pet owners to afford that care.
Dogs and cats are visiting
the veterinarian less frequently, and their health status
shows it. A recent report indicated that preventable and
treatable health issues such as diabetes, dental disease, heartworm
disease, and flea infestations in both dogs and cats are on the rise.
This problem is no doubt a source of great frustration to you and
other veterinarians. But there is a promising solution that has
solid appeal among many pet owners: preventive healthcare plans.
A preventive healthcare plan is a comprehensive package of annual veterinary services aimed at keeping a pet healthy that includes
a little extra pet-owner incentive that you can provide—the choice
between a monthly payment plan or lump-sum payment. These
plans typically include one or more complete physical exams for
routine well care, essential vaccines, certain diagnostics such as
heartworm tests and blood work, and internal parasite control.
While the use of preventive healthcare plans may represent
a significant change in your business approach, it also pays dividends to everyone involved—you, the pet, and the pet owner.
First, pets get better, more dependable care. Instead of the current hit-or-miss approach by many clients, pet owners commit to
a program, so pets get the care they need, when they need it. The
frequency of visits also increases, so you have an opportunity to
see pets more often and catch problems early.
Don’t underestimate the importance of how much consumers
like a plan, and that includes pet owners. Monthly payments for
preventive pet care can be worked into their household budget,
eliminating the pain and strain associated with a “big ticket” hit
to the pocketbook. Preventive pet healthcare plans spell out both
the treatment plan and the payment plan.
Thirdly, preventive healthcare plans bond clients more closely
to the practice. Because they have a plan and agree to pay for the
year’s services, they are more diligent and conscientious about
scheduling required services. A nice added bonus is that clients
differentiate your practice as a more client-friendly business, willing to reach across the counter with a show of understanding and
patience when it comes to paying that bill.
To some pet owners, it seems like there’s never a good time to
squeeze a veterinary visit into their regular expenses, especially
when they may feel that the service is somewhat discretionary.
With a preventive healthcare plan, you can help change that, making it easier on pet owners and making it better for the pet.
Among the valuable practice tools available to you through
Partners for Healthy Pets is guidance on the evaluation, selection,
and implementation of preventive healthcare plans. These plans,
as well as the other components of the Partners’ Practice Resources Toolbox, will help enhance both the overall vitality of pets
and your veterinary practice.
Visit www.partnersforhealthypets today to learn about the
Preventive Healthcare Plans tool.You’ll find a helpful overview
introducing you to the concept, as well as some pretty powerful
testimonials from veterinarians just like you who have already
implemented the plan and like the results.You’ll learn how to
design a plan best suited for your individual practice, and the
Preventive Healthcare Plan Implementation Manual will take you
through a step-by-step process of setting up plans, integrating
them into your practice, marketing them to clients, and training
your staff.
Partners for Healthy Pets is dedicated to ensuring that pets received the
preventive healthcare they deserve through regular visits to a veterinarian and is committed to working with you to enhance the health of your
­patients and your practice. Learn more about Partners for Healthy Pets
and explore the Resources Toolbox at www.partnersforhealthypets.org. n
CVMA Voice 201 3: 2 | PAG E 2 1
2 01 3, I ssue # 2
in practice
How to Successfully
Pre-book Appointments
Terra Shastri, OVMA Manager of Business Development
When a client brings his/her pet in for an appointment, consider
pre-booking the client’s next appointment (such as the next annual wellness exam) before the client leaves the practice. This is
a great way to improve client compliance and fill up the appointment book with a minimal investment in staff time. Dentist offices have been doing it for years and there is a reason—it works.
When?
You can pre-book the next appointment anytime the client is at
the front desk—following an appointment or when the client is
in purchasing food or medication. Once you have a pre-booking
system in place, work towards getting the client into the habit of
booking the date and time for next year’s wellness exam before
they leave the practice following this year’s wellness exam. Once the client arrives at reception to pay, schedule the next
appointment prior to reviewing the invoice. Clients are accustomed to this process, and it is important to do it before settling
their balance.
Why Pre-book?
The question really is, why not? Pre-booking the next appointment for a client is an easy way to remove a couple of steps in the
process. Rather than trying to get in contact with a client through
postcard, phone, or email and convince them that they need to
bring Fluffy in for an exam, you have them—and the opportunity
to book—right in front of you. Once the client has pre-booked,
the only task left is to confirm the appointment two weeks ahead
of time. If there are scheduling issues, they can be dealt with at
that time. The key is that the client has committed to the next appointment and confirmation is the only step that follows.
In addition to being a more efficient process, pre-booking also
sends the message to clients about how important appointments
and exams are for their pet. Waiting until “that time of year
again” to book does not emphasize that it is a priority for your
client’s pet.
How?
Initiate the conversation about the next wellness exam appointment booking before settling the client’s bill by saying:
“Mary, we’d like to get Fluffy booked for her next annual wellness
exam. I can schedule you for the same day next May, does this time
usually work for you? We will send you a confirmation notice two
weeks ahead of your appointment.We can take care of any scheduling
issues you might have at that time.”
Or use this for pre-booking a follow-up visit:
“Dr. Lisa would like to see Fluffy six weeks from now as a follow-up.
Does Wednesday December 27 at 5:00 PM or Thursday December 28
at 6:00 PM work better for you? We will call you a day or two ahead
of time to confirm.”
PAG E 22 | CV M A Vo ice 2013 : 2
Determine a reasonable confirmation timeframe for each appointment. If a client has pre-booked a year out, confirm two
weeks prior to the appointment versus when a client books four
to six weeks ahead of time where a confirmation call could be
made two to three days ahead of time.
What if?
There may be some staff resistance to pre-booking because it may
be something they would never do as a client, because of variances in veterinarians’ schedules, or fear that clients may say no. If
a decision has been made that the practice will now pre-book appointments for all clients, introduce it to staff and give them the
tools (scripts). It is also beneficial to appoint a team lead to show
the rest of the team how it is done. When staff insist that they
would never book a year ahead, encourage them to at least try it
(using the script) so they can see how easy it really is.
While doctor schedules may not be set in stone, there are usually certain days of the week that they are available. Follow this
pattern when pre-booking appointments and if an appointment
time has to be rescheduled the following year because the client’s
preferred veterinarian is working a different schedule, this is still
easy to do. The client is still committed to the appointment, and it
is merely a matter of rescheduling.
There will be some clients that ask why or say no to pre-booking one year ahead of time. When a client asks why they need to
pre-book, equip staff with the following script:
“We’ve realized that all of our clients are busy so it can be challenging to get their pets in for their next exam. By booking now, you
know well in advance when Fluffy needs to come in, it saves you the
extra step of calling to book an appointment, and keeps all of us on
track with keeping Fluffy happy and healthy.”
When clients refuse to book a year or six months ahead, continue following the same process of booking them just before
their pet is due.
Why not make pre-booking appointments the “norm” in your
practice? It is easy to do, it promotes better pet health, it fills the
appointment book, and it is something you can start today. n
CV M A VO ICE
in practice
Avoid Jumping to Conclusions
Regarding Animal Behavior
Suzanne Hetts, Ph.D., CVJ and Dan Estep, Ph.D.
Certified Applied Animal Behaviorists
We’ve all had cases—medical or behavioral—in which we think
we know what the problem is just by listening to a voicemail
from the owner or reading an entry in the appointment book. But
jumping to conclusions about causation can result in wrong conclusions, especially if we haven’t taken advantage of all the sources
of information available to us.
We encountered this when advising a trainer in another state
who, at their request, had accompanied the owners to a veterinary visit. The dog (we’ll call him “Smitty”) had bitten the male
owner “Ray” when Ray was petting Smitty as the two lay on the
bed together. Because this behavior was out of character for
Smitty, our trainer friend “Susan” correctly recommended that
Smitty be fully evaluated by his regular veterinarian “Dr. Jones”
for any conditions that could be influencing this sudden behavior
change.
The veterinarian, apparently because of the context of the bite
(on the bed while petting) began to talk to the owners about
Smitty having a “dominance problem.” What the trainer knew—
and the veterinarian did not—was that for the previous two years
that Smitty had lived with Ray and his wife Laura, there had been
no problems with Smitty acquiescing to his owners. They could
take food and toys away, Smitty did not object to any sort of body
handling, and would willingly move from or shift position on the
furniture or bed when asked. All this is inconsistent with a “dominance problem.”
Smitty was a bit fearful, especially toward men, and in fact
after the bite jumped down from the bed immediately and ran
to Laura, cowering. Ray was so surprised by the entire event he
hadn’t had a chance to react at all, so Smitty’s fear was not related to any sort of punishment from Ray. Smitty was reluctant
to approach Ray for several days after the event, and the confrontational approaches the veterinarian was recommending to deal
with the purported “dominance problem” would have made this
fearful dog even worse.
The take-home message here is that veterinarians, dog trainers,
degreed behaviorists, and non-degreed behavior consultants all
have important information in their own area of expertise, which
if shared with one another, can result in a better outcome for pets
and for clients. How could communication have been improved
in this case and the unfortunate result of the owners receiving
conflicting behavior information from the veterinarian and trainer
been avoided? We have three recommendations, although there
are likely more possibilities.
First, Susan could have called the veterinarian (with the owners’ permission) prior to the appointment to give her a summary
of the behavior and training work she’d been doing with Smitty
and his owners. Ideally, Susan could have been sending Dr. Jones
regular progress/behavior reports about Smitty, using the veterinarian’s preferred method of communication (written report via
mail or email, or telephone updates).
Second, Dr. Jones could have asked Susan during the appointment about what Smitty’s behavior problems were, what sort of
behavior and training work she’d done with Smitty, and for Susan’s opinions regarding possible behavioral/non-medical reasons
for the bite. The owners had obviously developed a good deal of
trust in Susan, as they asked her to accompany them to the veterinary appointment, and that relationship deserved respect.
The current state of certification for dog trainers and nondegreed behavior consultants presents problems for veterinarians
and other pet professionals needing to refer clients. There are
no minimum academic degree requirements for attaining any of
the trainer certification credentials, which is one factor that contributes to the enormous variability in knowledge and skill level
among these individuals.
Because of that, our third recommendation (not mutually exclusive from the previous two) is that veterinarians must have a
means to evaluate the knowledge and skill set of non-degreed
individuals they are considering referring behavior and training
problems to. Credentials are important, but by themselves are
not sufficient.
The most information can be obtained by watching the person
work. For that reason, asking a trainer or consultant to deliver
one or more in-service presentations to your practice on a behavior or training related topic can be invaluable. One might be a
straight forward training demonstration, while another might be a
case study on a particular type of problem.
Another relatively easy approach is to share the AVSAB (American Veterinary Society of Animal Behavior) position statements on
dominance and punishment (available at www.AVSABonline.org)
and ask the person you are considering to comment on them.
AVSAB also has a good handout on choosing a trainer that includes sound basic guidelines, but very often you need additional
information to decide who is best suited to refer different types
of behavior and training issues to.
Trainers and behavior consultants vary in their areas of expertise just as,
say, board certified surgeons vary in their experience with different surgical procedures.To help pets, clients, and veterinarians, we are working on
a free Trainer/Behavior Consultant Evaluation Kit containing questionnaires, suggestions for in-service trainings, and policies and procedures to
look for, and guidelines for evaluating the information you receive when
interviewing a trainer or behavior consultant. If you are interested in receiving a free kit via email when they are completed, email us at [email protected]
AnimalBehaviorAssociates.com. n
CVMA Voice 201 3 : 2 | PAGE 2 3
2 01 3, I ssue # 2
in practice
National Veterinary Accreditation
Renewal Procedures
In 2011 the National Veterinary Accreditation Program (NVAP)
was updated to include continuing education requirements for
accredited veterinarians and renewal of accreditation every three
years. A renewal date is provided to each accredited veterinarian upon initial accreditation, or upon the completion of the
“elect to participate” process for accredited veterinarians. For
veterinarians that elected to participate, initial renewal dates
have been randomly assigned throughout 2013, 2014, and 2015
so that renewal activities do not occur all at the same time. If
the NVAP has your correct e-mail address in your accreditation
records, an e-mail reminder of your renewal will be sent to you
at six (6), three (3), and one (1) month prior to your renewal
date. Please note it is essential that if you change your
e-mail address, you notify the Area Office so that we
can update your record to ensure you receive all NVAP
correspondence in a timely manner. If you did not provide
an e-mail address, the NVAP will send a reminder notice via
USPS three (3) months prior to your renewal date. If you do not
know your accreditation renewal date contact the Area Office at
303.231.5385.
There are two options for you to utilize to renew your
accreditation:
AAST for accreditation renewal is available in several formats:
1. On the NVAP website under Training Modules at: http://
www.aphis.usda.gov/animal_health/vet_accreditation/aast
.shtml
You must know your 6-digit National Accreditation Number
(NAN) to access each module Certificate of Completion. If you do
not know your NAN, please contact the Area Office. At the conclusion of each module, be prepared to print your Certificate of
Completion or save it in PDF format to a secure file.You must retain your Certificates of Completion as the information contained
on the certificates will be needed for accreditation renewal when
you submit your application.You may also be requested to display
your Certificates of Completion during periodic training audits.
2. Lectures at veterinary meetings and conventions updated at
the NVAP Presence at Upcoming Conferences website: http://
www.aphis.usda.gov/animal_health/vet_accreditation/
upcoming_conf.shtml
If neither of these options provides sufficient opportunity
for you to complete the modules, please contact the Colorado
Area Office or your local Veterinary Medical Officer for further
assistance. n
1)Online renewal can be found at the following link: http://
www.aphis.usda.gov/animal_health/vet_accreditation/
downloads/renewal_online_process.pdf
2)Alternatively, you may print a copy of the VS Form 1-36A
and forward it to the VS Area Office at 755 Parfet Street,
Suite 136, Lakewood, CO 80215. The VS Form 1-36A can
be found at the following link: http://www.aphis.usda.gov/
animal_health/vet_accreditation/downloads/vs1-36a.pdf
If you perform accredited duties in more than one state, it is
only necessary to renew your accreditation in the state in which
your business address is located. This option can be completed
at any time within six (6) months prior to your renewal date.
Please do not submit anything related to your accreditation renewal prior to six (6) months before your renewal date.
Category I Accredited Veterinarians must complete 3 units of
APHIS-approved supplementary training (AAST) anytime within
their three-year renewal period to renew their accreditation.
Similarly, Category II Accredited Veterinarians must complete
6 units of AAST anytime within their three-year renewal period.
Each module of AAST represents one unit of training, and takes
approximately one hour to complete. The Colorado Board of
Veterinary Medicine has also approved many of the modules as
continuing education for veterinary license renewal. Contact the
Area Office for information on which modules have been approved by the Board. Please do not submit copies or originals of
any AAST Certificates of Completion to APHIS.
PAG E 24 | CV M A Vo ice 2013 : 2
24/7/365 Emergency Care
Emergency Services ~ Critical Care ~ Surgery ~ Oncology
Neurology ~ Dentistry ~ Internal Medicine
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Erin Arnold, DVM
DACVIM-Oncology
CV M A VO ICE
in practice
It Can Be an Ethical Dilemma
Rebecca Rose, CVT
Your veterinary technicians, your team members who have graduated from an AVMA-accredited program, are not taught how to
perform a veterinary dental extraction while in college. In one of
the textbooks for veterinary technician programs, Principles and
Practices of Veterinary Technology, the sentence related to dental extractions states this: “Most states consider extractions oral surgery
that must be performed by the veterinarian.”
While attending an AVMA-accredited program for veterinary
technicians, it is explained that veterinarians are educated and
licensed to diagnose, prescribe, and perform surgery. When a
veterinarian delegates the extraction of a tooth to a veterinary
technician within the state of Colorado, this is when the ethical
dilemma may occur. “Veterinary technicians are placed in the
middle of the equation when their veterinarian asks them to perform a dental extraction,” said CVMA president, Dr. Randa MacMillan, while speaking to a room full of veterinarians and a few
healthcare team members at the BIG Ideas Forum | Spring 2013
(see page 27).
The office of the Colorado Association of Certified Veterinary
Technicians (CACVT) often receives phone calls from its members asking about this specific dental extraction issue—and they
are informed that dental extractions are considered surgery. The
CACVT encourages technicians asked to perform such procedures to have a conversation with their veterinarian.
I personally know of veterinary technicians who have chosen
not to work at a hospital because during the interview process
they were informed that veterinary technicians perform the dental extractions during dental procedures. That’s a tough place to
be, in need of a job and making a conscious choice not to work
because of an ethical dilemma.
Here is yet another statistic to consider. There are roughly
80,200 veterinary technicians within the United States (Bureau
of Labor Statistics 2010). Less than 50 veterinary technicians
throughout the U.S. are credentialed as a Veterinary Technician Specialist in Dentistry. (To learn more, visit the Academy
of Veterinary Dental Technicians at www.avdt.us/about.asp.)
When asking Dr. Ed Eisner (Advisory Committee member on the
AVDT) about the training of dental extractions within the specialty, he stated, “Extractions are considered surgery and are not
within the scope of practice for veterinary technicians.”
According to the State Board of Veterinary Medicine, only
a veterinarian can perform the following: diagnosis, prescription, surgery, or initiating treatment. The Veterinary Practice Act
clearly states that “veterinary medicine” includes veterinary surgery, obstetrics, dentistry, and all other branches or specialties
of animal medicine and that “no person may practice veterinary
medicine in this state if the person is not a licensed veterinarian.”
The point is this: before you place your veterinary technician
in a compromising position of performing a veterinary dental
extraction, ask yourself the following: Who is properly educated
and licensed to perform this oral surgery? And, even more importantly, who is liable and responsible for that procedure being done
in your practice? n
Personalized
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Compassion. Communication. Collaboration.
3640 Walnut Street • Boulder, CO 80301
303-443-GLOW (4569) • AlpenglowVets.com
CVMA Voice 201 3: 2 | PAG E 2 5
Lasting Relationships Often Begin
With A Handshake.
There is a special relationship between
pets and their families. The same is true
about the relationship we have with our
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CV M A VO ICE
CVMA NEws
BIG Ideas Forum Explores
Veterinary Dentistry: Part I
On Saturday, April 27, CVMA welcomed over 100 attendees to
the BIG Ideas Forum | Spring 2013 session in Denver on Veterinary Dentistry: Is there a standard of care?
Frustration, false claims, and murkiness characterize several
aspects of veterinary dentistry, fostering a Wild West frontier
mentality where anything goes. As a result, animals large and
small are failing to receive the level of dental care they need. The
involvement of non-veterinarians who deliver dental services—
ranging from anesthesia-free scaling for dogs and cats to sedation
of horses for teeth floating with power tools—underlie the problem. Further complications include lack of clarity in regulations
governing the practice of veterinary medicine, under-reporting
of violations by unlicensed providers coupled with inadequate
resources for prosecuting them, and differing views within the
veterinary profession about what constitutes appropriate dental
care in animal patients.
CVMA gathered an “all-star” cast to probe deeply into this issue
to address the current landscape, divergent opinions about the
standard of care, and implications for change:
• Tony Woodward, DVM, DAVDC
• Ed Eisner, DVM, DAVDC
• Kate Knutson, DVM, and AAHA president
• Scott Marx, DVM
• Bruce Whittle, DVM, and AAEP Scope of Practice Task Force
• Maulid “Mo” Miskell (panelist), program director for the
Colorado Board of Veterinary Medicine
Tony Woodward DVM, DAVDC
Dr. Woodward addressed “The State of Companion Animal Dentistry in Colorado: How to Improve It” as he described his past
experience and how it was quite typical for a long time: Scrape
the crowns, extract mobile teeth (easy), and “go fast” to avoid
anesthetic risks. Dentals were easy money because techs could do
a lot of it while he did “doctor stuff ” and “scrape and yank” dentistry was considered the standard of care. But the reality was that
he was doing a poor job and sending most of his patients home
in pain: abscessed teeth rarely swell or drain and complicated
crown factures cannot heal. Mobility takes years to develop, and
extractions are surgical, dealing with flaps, bone removal, cutting tissues, vital structures in fields, and closure. He realized that
clinical signs are rare, and dental x-rays are required to truly see
issues—and that his education was incomplete, leading to “unconscious incompetence” as he put it.
Even now, he claimed, half of practices provide poor dental services, half have no dental x-ray, many leave patients in pain, and half
or more let technicians do extractions. Adding to the issue is that
anesthesia-free cleanings are growing and owners can’t tell the difference in the quality of care. Dr. Woodward says practitioners have
to ask why the issue persists, in order to fix it. He offered four reasons: ignorance, apathy, cost of equipment/training, and greed.
To improve pet dental care in Colorado, he believes education is key in three broad areas: educate students, educate
veterinarians and staff, and educate the public. He then circled
back to the four reasons for issues, encouraging a tailored approach to each:
Ignorance—Assume practitioners are willing to learn, enlighten them, show them the opportunity, then show them
the path.
Apathy—Try to educate, empathize, tell them it’s “the right
thing to do” and show them what they are missing; resort to
embarrassment if necessary.
Fear of investment—Show the positive economics of low investment cost and rapid payback and how it can substantially
boost the practice (15 to 20% of a small animal practice
should be dentals).
Greed—Offer no sympathy, expose them for what they are
doing, report them to the State Board, and educate the public to ask who does the oral surgery and if dental x-rays are
done on all patients.
He concluded with the message that there are many practices
providing excellent care, those that try usually succeed, the opportunity truly is staggering, and education is key. While it may
take ruffling some feathers, in the end, everyone wins: practitioners, patients, and clients.
Ed Eisner DVM, DAVDC
Next to speak was Ed Eisner DVM, DAVDC, discussing the recent veterinary State Board updates to the rules pertaining to
dentistry. In response to a call from attorneys, veterinarians, technicians, and other interested parties for more clarity in the rules
defining dentistry, the State Board updated its rule. While Dr. Eisner urges CVMA to support the updated rule, he asks that it also
advocate for a strengthening of the rule.
According to the updated rule, “Dentistry means the diagnosing, treating, correcting, changing, relieving, or preventing abnormalities of the oral cavity or associated structures, including
surgical, nonsurgical, or related procedures, and includes:
a. The application or use of any instrument or device to any
portion of an animal’s tooth, gum, or any related tissue for
the prevention, cure, or relieve of any wound, fracture, inury,
or disease of an animal’s tooth, gum, or related tissue; and
b. Preventive dental procedures including, but not limited to
the removal of calculus, soft deposits, plaque, stains, or the
smoothing, filing, or polishing of tooth surfaces.
The issue, Dr, Eisner says, is the second part of the rule that
says “The practice of dentistry may be delegated to veterinary
personnel under the direct supervision of a licensed veterinarian.”
Dr. Eisner would argue that “direct supervision” means that a licensed DVM be readily available on premises.
At the center of the debate is the proliferation of those offering
“anesthesia-free” scaling for dogs and cats, often done without a
veterinarian on premise (e.g., at grooming facilities). While the
rules state that the practice of dentistry requires establishing and
maintaining a veterinarian-client-patient relationship and creating
BIG continued on page 28
CVMA Voice 201 3: 2 | PAGE 27
2 01 3, I ssue # 2
CVMA NEws
BIG continued from page 27
and maintaining an animal patient record and documenting that
informed consent from the owner, agent, or responsible party
was obtained, this is rarely happening. Dr. Eisner stated that most
clients are innocent about disease and they present their pets for
“tooth cleaning” which is done mostly to improve cosmetics and
esthetics. However, complete dental care is meant to improve
oral health, which requires intra-oral radiographs, subgingival
proving and charting, and treatments such as fluoride, root planning, extractions and other oral surgery for traumatic, neoplastic,
and auto-immune reasons.
Dr. Eisner turned the conversation to the legalities of having
anyone other than a licensed veterinarian performing dental procedures. Legally, there are four tasks a licensed veterinarian cannot
delegate, except to a veterinary student: diagnosis, prescription,
surgery, and initiating treatment. He emphatically reminded the
attendees that tooth extraction is a surgical procedure, referring to
both the American Animal Hospital Association Dental Guidelines
and an American Veterinary Dental College position statement. He
argues that the State Board’s decision in April that veterinarians
can delegate extractions to non-veterinarian personnel because,
if only a dental elevator is used, it is not considered surgery, is
in­accurate and needs to be corrected. He compared it to human
dentistry in Colorado, where law prohibits altering of the structural anatomy of a patient by dental hygienists and expanded chairside assistants; only dentists can extract teeth. Shouldn’t the same
parameters apply to veterinary dentistry as well?
He then shared several slides of actual cases that showed the
intricacies and possible dangers inherent in extractions and dental
surgeries, further making the case that extracting teeth should be
the responsibility of a licenses veterinarian and not be delegated.
“Our clients would be shocked and angered if, after paying for
professional service, were told that a doctor was not even in the
room when their pet’s teeth were extracted, especially if the decision had been made (read as ‘diagnosis’) by someone other than
the doctor!”
Dr. Eisner concluded his presentation by saying that Colorado,
which has more veterinarians and veterinary specialists per capita
than any other state, should be an example of some of the best
veterinary medicine practices in the United States.
Kate Knutson, DVM, AAHA President
The final speaker on the small animal side of the dental issue was
Dr. Kate Knutson, current AAHA president. She referred attendees to the 2013 AAHA Dental Care Guidelines for Dogs and Cats,
recently published in the March/April 2013 issue of the Journal of
the American Animal Hospital Association.
Dr. Knutdson began by asking attendees to picture their last
dental procedure: the surroundings, the setup, the facility, instruments and equipment used, and patient assessment. Her point
was that it should be approached like any other surgery, following
the same strict protocols and preparation.
As commented on by Dr. Woodward, general practitioners
don’t necessarily like dental procedures and they often aren’t approached with the same attitude and concern as other surgical
PAG E 28 | CV M A Vo ice 2013 : 1
and medical procedures. But they should be. One great first step
is to stop referring to them as “dentals” and start talking about
“oral surgery.”
She presented a case study that showed how important it is to
perform an awake oral exam, an asleep oral exam, full mouth
radiology (because 40 to 60% of the tooth is below the gum), and
to clean the teeth both supra and subgingivally. She stressed that
like so many other medical conditions, a full procedure is necessary to really see and understand the full scope of any issues.
Also part of the process is explaining to clients the need for full
dental exams under the conditions described above, and how important it is to the overall health and wellbeing of their pets.
Scott Marx, DVM
To begin the discussion of equine dentistry, Dr. Scott Marx presented “Current Issues in Colorado Equine Dentistry.” He restated
the Colorado Practice Act stipulation that veterinary medicine
includes dentistry and that extractions and dental procedures
should only be performed by licensed veterinarians. In addition,
Colorado veterinary medicine rules and regulations state that “no
veterinarian may advertise Specialty Board Certification without
certification by the AVMA in that specialty area. It is unethical to
allow one’s credentials to be used by any organization that engages
in, or has members that engage in, the unauthorized practice of
veterinary medicine.” Further, “No person may practice veterinary
medicine in this state if the person is not a licensed veterinarian.”
This was a preface to his discussion of the prevalence of equine
non-veterinary dental care providers (NVDCPs) in Colorado that
are providing services ranging from floating sharp enamel points
to major dental surgery. Furthermore, Dr. Marx said, quoting a 2010 source, “Legal testimony given by NVDCPs clearly
establishes that they admit to breaking state laws, that they have
no desire to pursue professional education, and the majority of
NVDCPs do not have, nor do they desire to have, a professional
relationship with veterinarians.” Many claim certifications and
professional titles or training from non-AVMA sanctioned “dental
schools” when there are no such programs or titles.
Another issue is that it is illegal for NVDCPs to sedate clients’
horses, yet they do. So the question becomes, who sold them the
drugs to do so? Why are veterinarians selling them the drugs?
And because NVDCPs are not veterinary professionals, often
refer to veterinarians in a derogatory manner to clients, frequently and knowingly work in violation of the state practice act,
make false and ridiculous claims, and often scam the public, Dr.
Marx strongly urged attendees to report NVDCP violations to
the State Board.
So why do clients actually call on NVDCPs? Because veterinarians are not providing dental care or education to clients. Dr. Marx
says that many clients believe that their veterinarians don’t care
about teeth or don’t know anything about teeth. The bottom line?
NVDCPs exist because of inadequate dental care provided by the
veterinary community, forcing clients to seek the “best” dental care
provider regardless of the practice act—and nothing will change
until veterinarians make an effort to improve dental services.
Continued on next page
CV M A VO ICE
CVMA NEws
Continued from previous page
So why are so many veterinarians resistant to doing equine
dentistry? Dr. Marx suggested that veterinarians often overlook
dentistry because they may not have been taught well in school,
they do not think it is important, they think they can make more
money doing something else, they don’t have the right instruments, and they do not sedate horses to appropriate depth.
But there are important reasons for high-quality dentistry: it
improves the quality of care provided for the horse, increases the
services offered to the client, and establishes reliable and significant revenue for the practice.
Dr. Marx concluded by saying that the veterinary community
has a responsibility in providing proper equine dentistry, including veterinary practice act compliance and negating the NVDCP
role in Colorado equine dental care.
Bruce Whittle, DVM
Dr. Whittle picked up where Dr. Marx left off with his presentation “Equine Dentistry: What is the big deal?” as he emphasized
the fact that veterinarians have to either do a better job with
equine dental care or “let it go.”
He began by saying that no one is really clear on what equine
dentistry is and who shold provide it. Everyone is confused, from
the public to the horse industry to the veterinary profession. Feeding the confusion is superior marketing by “lay dentists” (NVDCPs),
veterinarian complacency and division, uninformed veterinarians
supporting NVDCPs, and the failure of the veterinary profession to
educate and advocate. The result? Horses are suffering.
So why are veterinarians confused? Dr. Whittle believes there
are many reasons, including apathy, practitioners believing “floating teeth” is below the dignity of the veterinarian, a lack of understanding of dental principles and the importance of oral health to
overall health, and being misled into believing the “credentials” of
NVDCPs.
He then went into an in-depth explanation of equine dentistry,
explaining teeth floating and where it fits into the different dentistry disciplines. He also stressed why horses need dental care,
the requirements for the performance of equine dentistry, and the
different equine dentistry equipment. He then gave a review of
equine dentistry’s basic principles of form and function, including
the first “law” of equine dentistry: Horse’s teeth are living structures that can be inadvertently killed through indiscretion. He
explained how equine teeth can be “killed” and the factors making
the equine dentition unique, including brachydont vs. hypsodont
dentition, anisognathism, cheek teeth table angles, the equine
temporomandibular joint, enamel (mandibular vs. maxillary cheek
teeth), molar/premolar cingula, and the equine pulp system.
After explaining the complexities of equine dentition, he stated
the many things that can go wrong: how the failure to diagnose
a significant problem while floating teeth can delay proper treatment; overfloating of the teeth can result in indirect or direct
pulpar exposure and pain; improper extraction technique can result in hemorrhaging or retained dental fragments, routine incisor
reductions can result in pulpar exposures, and “underfloating” can
result in potentially life-threatening malocclusions.
Dr. Whittle showed slides of cases where improper dental diagnosis and treatment caused severe issues and death, noting how
difficult it is to assess, diagnose, and treat without proper x-rays,
exam techniques, and training. He urged for a set standard of care:
• Examination facilitated by sedation, visual, probe and explorer, radiography
• Diagnosis based on knowledge of pathology
• Treatment based on knowledge of dental anatomy and physiology according to sound scientific principles
The discussion then turned to the current legal status of teeth
floating/equine dentistry in the U.S., including who should perform dentistry, states that have undergone legislative changes
regarding equine dentistry, and poorly defined parameters and
definitions. In Colorado, he said, the official Rule says that “No
veterinarian may engage in acts that aid and abet the unlicensed
practice of veterinary medicine.” Which means that a Colorado
veterinarian “referring to” or sedating horses for a NVDCP that is
not in their employ is violating Colorado state law.
Unfortunately, there are very few official programs and certifications available and about half of the dentistry schools were
started by veterinarians who decided to train lay people, the
other half were started by lay people who wanted to do what veterinarians do—and there is no accrediting body such as the one
that oversees colleges of veterinary medicine. Dr. Whittle mentioned two specific programs, the Equine Gnathological Training
Institute and the American School of Equine Dentistry.
He wrapped up his presentation by stressing the importance of
veterinarians in the field, and that they should be working toward
seeing the patient as a whole and not just some isolated set of
teeth in a dark hole; following the progression of examination>
diagnosis>treatment; and using prescription pharmaceuticals for
ensuring humane care of patients. It is the responsibility of the
veterinary profession to educate and advocate, and state VMAs
can help forward legislative concerns, since almost all laws regarding the practice of veterinary medicine are determined at the
state level. To that end, Dr. Whittle says, all veterinarians should
be members of their state VMA—because ramifications of any
legislation can affect everyone.
Q&A
Once the speakers finished their presentations, they were all convened for a Q&A panel that also included Maulid “Mo” Miskell,
program director for the Colorado Board of Veterinary Medicine.
That Q&A and follow-up discussion will be presented in the
next issue of the Voice. Stay tuned! n
CVMA Voice 201 3: 2 | PAGE 2 9
2 01 3, I ssue # 2
CVMA NEws
CVMA Auxiliary Launches
Food Animal Project
Colorado Science & Engineering
Fair 2013
Carolyn Rule, CVMA Auxiliary President
The CVMA Auxiliary is pleased to announce the “Fare for Fairs”
recipients at the April 11 Colorado Science and Engineering Fair
held in the Lory Student Center at CSU. Two noteworthy Animal
Sciences projects were selected.
The Junior Division winner was Riley Meisner, a 7th grader from
Sterling. Riley is 13 and attends Sterling Middle School. His project,
“Does Feeding Time Affect Lambing Time” was devised to determine
if the time at which pregnant ewes are fed affects the time at which
they lamb. Riley fed two separate groups of nine ewes, one during
the day from 4:30 AM to 4:30 PM and the other group at night from
4:30 PM to 4:30 AM. Both groups were fed sugar beet tailings and alfalfa hay. Because 82% of the ewes lambed according to his projected
timeframes, Riley’s project proved that the ewes fed in the evening
were the most likely to lamb during the optimum day time.
The Senior Division winner was Montana Cook, a 9th grader
from Walsh. Her project, “Artificial Insemination: Comparing
­Methods of Thawing Bull Semen” showed that thawing the straw
of semen for 30 seconds in a water thermos at 36 degrees C was
more successful than four other methods using longer times for
thawing or colder water.
Judges this year were Dr. Don and Echo Owen, who have been
regulars for many years, and Dr. Ted Cohn and Jo Ostwald. With
several good projects in both divisions, it took some deliberation
to select the winners. Riley and Montana will receive $50 from
CVMA and $50 from the Auxiliary, for a total of $100 each. n
The Auxiliary to the CVMA is offering a new project for food animal medicine, created to encourage veterinarians to move to the
under-served rural areas of Colorado. Our hope is that we can help
clinics that are either trying to hire or sell by offering an additional
incentive to help defray the costs of relocation. The new associate
or buyer does not need to be a recent graduate and can be from
anywhere, as long as s/he has an interest in food animal medicine
and is willing to move into an under-served rural area in Colorado.
The Auxiliary will offer $3,000 to be used as an incentive to
help the new associate/owner with expenses occurred during
relocation.
The recipient will provide veterinary services in food animal
medicine in a Colorado practice that is at least 20% food animal.
The practice owner will apply for the funds after the veterinarian
has a signed contract to either work for or to buy the practice.
There will only be one incentive available per year.
We will try to get more information to you as soon as possible
either through CVMA eNews or future issues of the Voice newsletter. In the meantime, if you have any questions or need more
information, please contact Carolyn Rule, president, at [email protected] or 970.879.2853, or Sharon Powell, chairman,
at [email protected] or 719.346.7442. n
We’re here to help you get world-class specialty care to your patients.
More board certified specialists and diagnostic and
treatment tools than anywhere else in the region.
Appointments are readily available or just walkin and see our Urgent Care Service.
Helping animals, people and the planet.
24/7 Emergency Service and
Urgent Care Walk-In Service
300 W. Drake Road, Fort Collins
csuvth.colostate.edu • (970) 297-5000
PAG E 3 0 | CV M A Vo ice 2013 : 2
CV M A VO ICE
Daniel C. Flanscha
CFP®, CLU, ChFC, LUTCF
President, Financial Advisor
[email protected]
Welcome New CVMA Members!
Please help us welcome these new CVMA members to the
association.
Lifetime Economic Acceleration ProcessTM...
...assists you to
- Strategically position assets
- Utilize the flows of money
- Improve effectiveness
- Use the PS&G ModelTM
- Analyze your present financial position
- Integrate and coordinate assets
- Seek lower risk
- Improve protection against eroding factors
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Loveland, Colorado 80538
Office: (970) 461-0808
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or Registered Investment Advisor.
Nicole Suzanne
Blanchette DVM
Ross University School of Veterinary Medicine ~ 1998
District 6
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AltosVeterinary Clinic
Brian D. Cassell DVM
Zoetis
Beverly Ailin Chua DVM
Animal Care Systems, Inc.
Tufts University ~ 2003
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Wells Fargo Practice Finance
Rocky Mountain Region
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Table MountainVeterinary Clinic
District 7
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Cattails Feline Health Center, PC
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ColoradoVeterinary Clinic PC
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LPC, CACIII, CEAP
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CVMA Voice 2013: 2 | PAG E 31
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