Case Study: Brachycephalic Airway with a Co-Morbidity of Hiatus Hernia

With the recent increased popularity of brachycephalic dog breeds, and their all too common respiratory problems, it’s not surprising that VetPrac’s upcoming “Fix the Face” workshop filled up quickly. If you’re one of the lucky vets that managed to snare a spot for this year’s workshop, we thought we’d whet your appetite with a few case studies demonstrating the importance of thorough clinical and radiographic investigation prior to surgery, as well as always warning owners about the risk of recurrence of elongation of the soft palate post-resection surgery. Thanks to Dr. Charles Kuntz and Dr. Abbie Tipler for providing these case studies. Both Charles and Abbie are educators at the workshop this year; VetPrac looks forward to welcoming Charles and Abbie back to the education team; they always give 110 % at the workshop and we love having them both in our team.

If you missed out on this years’ workshop, register your interest in future Fix the Face workshops via this Waitlist Link.


Case report by Dr Abbie Tipler: Brachycephalic Airway with a Co-Morbidity of Hiatus Hernia

 

Signalment: 2-year-old male French Bulldog, Charlie

History: 1-year history of daily regurgitation. This had resulted in several bouts of aspiration pneumonia; he had been treated with several courses of antibiotics which seemed to help temporarily. There was no history of airway signs, for example snoring, exercise intolerance, stertorous breathing, cyanotic or collapse episodes and the primary presenting sign was regurgitation with secondary aspiration pneumonia leading to coughing. His airway had been previously assessed as normal.

Physical examination and investigations: On upper airway examination, the soft palate was elongated, the laryngeal saccules were oedematous, and the nares were stenotic.

The workup for Charlie included routine bloods, chest radiographs and upper GI endoscopy.

Chest radiographs revealed signs of aspiration pneumonia.

Upper GI endoscopy revealed fluid pooling in the caudal oesophagus, dilation of the gastro-oesophageal sphincter, oesophagitis, and a mild hiatal hernia.

 

Diagnosis: Aspiration pneumonia secondary to regurgitation with background of hiatus hernia, and elongated soft palate, oedematous laryngeal saccules and stenotic nares.

Decision making: The decision to be made was whether to treat just the airways in the hope that the hiatal hernia would settle with reduced upper airway pressure, or to concurrently repair the hiatal hernia. There is some controversy amongst specialists in the approach to take here.

In this case, given the ongoing aspiration pneumonia, we wanted to give the best chance of a resolution of the regurgitation. There is also current research around the anatomy of the oesophageal hiatus, in French Bulldogs particularly, and it appears that they are particularly prone to anatomical laxity of this region (increasing the risk of upper GI signs).

 

Treatment: Charlie was treated with a further one week of broad-spectrum antibiotics and omeprazole to help treat the aspiration pneumonia and regurgitation prior to surgery, however, given the chronicity of the changes in the lungs and the ongoing regurgitation, it was not expected we could completely resolve this prior to surgery.

Charlie was anaesthetised and we repaired (firstly) the hiatal hernia with a herniorrhaphy, oesophagopexy and gastropexy, and then corrected the airways with a staphylectomy, sacculectomy and nares wedge alarplasty. In general instances, we avoid performing concurrent procedures with airway surgery, however, if we do, we perform the concurrent procedure first. The reason for avoiding concurrent procedures is that we try to reduce the time under anaesthetic so there is the least possible compromise to the lungs during recovery from anaesthesia, which is a risk period. In this instance, however, the regurgitation/aspiration was also a risk to the overall airway recovery. The patient’s recovery was uneventful. All post-operative precautions were taken including careful one-on-one monitoring, micro-dose medetomidine on recovery if stressed/panting, oxygenation as required.

Discharge medications: 6-week course of amoxicillin-clavulanic acid antibiotic at 20mg/kg for the aspiration pneumonia, and 6 weeks of BID omeprazole 1mg/kg.

Recheck at 6 weeks: the aspiration pneumonia had cleared; the patient was no longer regurgitating.

Take-home messages for this case:
Always consider plain film radiographs of the chest prior to airway surgery.
Consider further diagnostics e.g. upper GI endoscopy if there are signs of regurgitation. Hiatal hernias are reasonably common in brachycephalic dogs, however, in many instances the GI signs will resolve when the airways are corrected.
Always examine the upper airway for yourself, as this was an example of where the upper airway had been previously noted to be normal.
Consider post-operative medical management of GI symptoms post airway surgery.

 

CLICK TO READ ANOTHER CASE STUDY BY DR. CHARLES KUNTZ

 

Case Study: Brachycephalic Airway Syndrome with Stenotic Nares

With the recent increased popularity of brachycephalic dog breeds, and their all too common respiratory problems, it’s not surprising that VetPrac’s upcoming “Fix the Face” workshop filled up quickly. If you’re one of the lucky vets that managed to snare a spot for this year’s workshop, we thought we’d whet your appetite with a few case studies demonstrating the importance of thorough clinical and radiographic investigation prior to surgery, as well as always warning owners about the risk of recurrence of elongation of the soft palate post-resection surgery. Thanks to Dr. Charles Kuntz and Dr. Abbie Tipler for providing these case studies. Both Charles and Abbie are educators at the workshop this year; VetPrac looks forward to welcoming Charles and Abbie back to the education team; they always give 110 % at the workshop and we love having them both in our team.

If you missed out on this years’ workshop, register your interest in future Fix the Face workshops via this Waitlist Link.


Case report by Dr. Charles Kuntz: Brachycephalic Airway Syndrome

 

Signalment: Derby is a 4-year-old male neutered Boston Terrier

History: He presented one year ago for increased respiratory noise since he was a puppy. He had exacerbation of clinical signs with exercise and heat.

Physical examination: He had stertorous breathing during examination. There was stenosis of the nares bilaterally. Normal on thoracic auscultation and abdominal palpation.

Diagnosis: Brachycephalic airway syndrome with stenotic nares, redundant soft palate and low-grade laryngeal collapse (eversion of laryngeal saccules). No further diagnostics were performed.

Treatment: The nasal fold was resected using a wedge technique and reconstructed using 4-0 PDS. The soft palate was resected using a 3 stay sure technique and was closed using 3-0 PDS in a simple continuous pattern. Laryngeal saccules were resected using Metzenbaum scissors. The soft palate was iced before and after surgery and methylprednisolone (15 mg/kg) was administered IV.

Discharge medications: Codeine liquid for pain relief and omeprazole for 2 weeks.

One week recheck: He was doing really well. No concerns were stated, and his breathing was much better. He had stopped snoring.

10 months after surgery, he presented for recurrence of clinical signs over the preceding 6-10 weeks. His snoring had deteriorated and was as bad as ever. He sometimes sounded like he is really struggling to breathe.

Physical examination: Mild increase in respiratory noise. Some serious discharge from both nares. Review of owner videos confirmed severe snoring.

Diagnosis: Recurrence of redundant soft palate.

Treatment: Resection of redundant soft palate using 3 stay suture technique, assessment of laryngeal collapse.

Discharge medications: Codeine liquid for pain relief and omeprazole for 2 weeks. Owners counseled to monitor for progression of laryngeal collapse with possible modified laryngeal tie-back if this occurs.

Outcome: Resolution of excessive snoring in the short term (the last recheck was 26th August 2019).

Recurrence of elongation of the soft palate is an uncommon outcome following brachycephalic airway surgery. This illustrates that it is important to let owners know that recurrence is possible, usually due to progression of the laryngeal collapse.

 

CLICK TO READ ANOTHER CASE STUDY FROM DR. ABBIE TIPLER

 

Dr Kat Crosse – From skiing accident to PHD in airway disease in Brachycephalic dogs

VetPrac welcomes Dr Kat Crosse to the education team for the Fix the Face workshop in September 2019. We think she’s the perfect choice for this workshop – she’s currently doing a PhD in airway disease in brachycephalic dogs AND she has a great teaching philosophy!

Kat hails from the UK, and originally intended not to do any small animal work. She can’t remember a time when she didn’t want to be a vet. Her first job was mixed, but mostly large and equine. It became increasingly clear to her, however, that the frustrations of never quite reaching a diagnosis and a lack of ability to treat her large patients made her small animal work seem more and more enjoyable. A moment of “being an idiot on her skis” and tearing her cruciate, with subsequent crate rest with toilet walks only, meant she spent a lot more time in the small animal part of the clinic. It was only then that she started to foster her interest in surgery, and was soon volunteering for “ops days” 5 days a week.

When studying through her residency at Massey University, she found huge holes in the understanding of airway disease in brachycephalic dogs. At the same time the population of these dogs was increasing exponentially. She had too many questions that she couldn’t find answers for and she had too many dogs clearly suffering who needed the veterinary profession’s help. The aim of her PhD is to really try to identify what the difference is between the good and bad brachycephalic dogs and by using airway flow dynamics, assess what is the best way to improve their airways.

When teaching, Kat loves the background work of trying to distil the most complex of theories and practices into succinct and easy to understand lessons. “It takes a lot of work to be able to explain something complex in simple terms, and I like the fact this pushes me to really understand the things I am teaching.”

Since finishing her residency at Massey University and becoming a diplomate of the European College of Veterinary Surgeons in 2016 she has worked as a small animal surgeon at Massey University. One extremely worthwhile project at Massey that was coordinated by Kat was a charity outreach clinic in Samoa. She took veterinary students to Samoa, where they performed desexing of local animals. She loved working there and could see the benefits to the Samoan community and the students alike. Unfortunately, the project became a victim of slashed funding. Kat welcomes any donations to allow the project to resume – she would happily take the students back to Samoa if she could access $20,000 per year.

Kat fills her spare time to the brim with either mountain biking, yoga, painting, crafting, hiking, planning pranks on my colleagues, hanging out with her dog Fennel…. the list goes on!

So, if you’re registered for the workshop, take advantage of her superior educational skills, quiz her about her PhD findings, but above all, watch out for her pranks! It should be a fun workshop!

 

Kat can be contacted at k.crosse@massey.ac.nz

 

Independent Vets of Australia presents the Synergy Conference 2019

In veterinary business there are a number of key elements that when given strategic and synergistic attention can have multiplying effects on the results for the practice.

This September 19th to 21st, the Independent Vets of Australia Synergy Conference will be held at Pier One in Sydney.


Over three days this event brings together practice owners, associates and managers to learn how to accelerate practice results through collaboration with key speakers, experts and partners. International speaker and author Dr Peter Weinstein is just one of the key speakers who will present across the three days. With experience in private practice ownership and corporate practice, Dr Peter Weinstein discusses the key influencers which make independent practices excel in competitive environments. Dr Peter Weinstein will cover Education Marketing, Patients for Life, Customer Experience, Corporations and workshops based on his book entitled EMyth The Veterinarian – Why Most Veterinary Practices Don’t Work and What to Do About It.

In addition, a number of experienced guest speakers will share insights and solutions around Managing People, Thriving in Practice, Solutions to the Vet Drought, 2020 Planning & Social Media throughout the event.

Working in (and on) a veterinary practice requires agility, collaboration, and determination. The IVA Synergy Conference is designed to enable practices to identify and establish the strategies that will work synergistically towards a common goal to create success.

 

Full details are available online at ivaconference.com.au.
Early bird tickets available until the 31st of August.

 

 

 

 

Ashlee’s journey: Nursing to Canine Rehabilitation Certification

Looking for a new challenge in your career as a veterinary nurse or technician?

Have you considered the field of canine sports medicine and rehabilitation?

Read on to find out how Ashlee Callander chose this career path. Ashlee is now a senior CCRA (Certified Canine Rehabilitation Assistant) at the Vet Practice in Whittlesea, Victoria, and will join the education team at VetPrac for the Canine Sports Medicine and Rehabilitation Workshop later this month.


How did you first develop an interest in canine sports medicine and rehabilitation?

“I have always had a passion for animals; originally coming from the hairdressing and beauty industry I was looking for something more fulfilling. Being a CCRA gives me the ability to have such a great impact on the animal’s physical state and well-being. I also love educating clients on providing a higher level of care to their furry family members and being able to provide support to them even in the harder times. Rehab isn’t just a job; it takes an immense level of dedication and care to ensure only the best for our animals.”

 

Tell us about the training you’ve undergone to become a certified canine rehab assistant.

“My clinic always sees the importance of having educated and accredited staff to provide knowledgeable and correct treatment. My studies have allowed me to spend some amazing time over in the US; I made 2 trips over to complete my certification and placement. During this time, I met some of the kindest, compassionate and amazingly skilled human beings. It is such a great feeling to meet so many people with such dedication to the field and to the quality of our dog’s lives.”

 

What kind of clinic do you work in?

“I work in one of the largest clinics in Australia; we are a 24hr animal hospital that provides everything from basic care to state-of-the-art treatments. These services include CT, MRI, orthopaedic surgery, regenerative medicine and of course our fully certified rehab centre that is currently 6 members strong and growing.”

 

What’s a typical day at your clinic in your role as a rehab assistant?

“Every day is different when it comes to my job! I work with a combination of inpatient post ortho or neuro patients, outpatient post ortho/sporting/geriatric/neuro who come in for a session with their owner and what we call All Day Rehab patients that come and stay with us for the day. Every day is a different balance of each, but there is always a guarantee that it’s going to be a busy day!”

 

What strengths do you bring to your team?

“I love getting creative with our patients’ rehab to be able to get the most out of their exercises. I’m also big on form and ensuring correct posture and gait; it’s not just as simple as getting dogs to do cool tricks. It’s great when our team brainstorms and adds all of our knowledge together, especially when working with a hard case.”

 

What advice do you have for veterinary nurses or technicians that wish to pursue a career in canine rehabilitation?

“It is such a fulfilling career and I love what I do. Ensure that you practice your skills every day and get hands-on every chance you can in your training as good palpation skills are key. You also need to be prepared for the emotional rollercoaster that comes with it. Ensure you and your team support each other physically and emotionally.”

 

When asked about a memorable case she’d been involved with Ashlee replied “It’s hard for me to describe one case that is really memorable for me as on a regular basis we see patients that have been given euthanasia as their best option: the incurable lameness that’s been going on for months if not years or the paralysed dog that no one thinks will walk again. We have been able to prove all these things wrong and significantly turn their lives around and regain an active quality of life. It takes dedication from our team and the owners to nurse these patients back to health. It’s pretty special!”

 

What do you like to do for fun?

“In my winddown time, I love getting out into the fresh air and exploring our beautiful countryside, including doing this on horseback. I have 1 dog, 1 cat, and 3 horses so a lot of my time outside of work is dedicated to them. They are my sanity!”

 

Ashlee Callander can be contacted at The Vet Practice on (03) 9716 2495 or ashlee.callander@thevetpractice.com.au
https://www.thevetpractice.com.au/

To find out more about the training required to become a certified canine rehabilitation veterinary nurse, go to http://www.caninerehabinstitute.com/CCRVN.html

Introverts can Exude Confidence too! Here’s how

Let’s face it, many of us are introverts. Many of us find people who are overly confident as imposing. But the moment we enter a room, people are immediately forming an impression. They’re making snap judgments and perceptions based on how we carry ourselves and how we interact with others. This applies to everyone in any situation from welcoming clients, family functions to networking events, staff meetings, initial consultations, or greeting pet owners at reception. It also occurs internally when you start a new job or enter the business for each shift or team meeting.

Regardless of the situation, people are less inclined to give you attention and respect if you appear uncomfortable or insecure. Within seconds your lack of confidence will discredit your presence and any information you’re about to deliver. No one needs that… what we do is hard enough without adding to it. But it’s a truth.

Body language is an integral part of communication and the way you present yourself is more paramount to a successful outcome than you likely realise.

Here are three tips to appear confident.

Inside Out/Outside In:

 

Some people think you can earn respect by presenting yourself as physically confident. Some people think confidence comes from within. In my experience, both work.

On days when I want to impress, I put on my nicest underwear, smartest outfits and shine my shoes. All actors talk about how they create their characters. Even if you aren’t naturally confident, if you dress the part it will influence your capacity to deliver.

Inside we are all a little bit shy, it’s normal as a social species to be apprehensive in this way. “Will this person/tribe accept me?” is a basic social query. At a reptilian level, the fear is that if they don’t accept me there will be conflict or worse…death. It takes our higher brain to reassure us that approaching strangers or people who we are not close to will not have adverse effects on our basic safety and security.

It seems ridiculous that sometimes we have to talk to ourselves this way, but if we dig underneath our fears – what we usually find is a juvenile belief about security that has been ignored. So reach deep, soothe quickly by reminding yourself that you have a lot to offer and people want to know what that is. You are special and important. Even if you aren’t Einstein or Hussein Bolt you have something to contribute, you might just need to grow into yourself.

 

Everyone else wants confidence too:

 

Inside we are all a little bit shy. And the other people we meet usually want to impress and be accepted too. Knowing this can help reduce any anxiety or challenges we have trying to reach them. Suddenly, people in the room aren’t intimidating enemies you have to get through to. They are willing participants in the game of social cooperation. And that’s a beautiful idea that opens up possibilities in communication. I try to remember that, especially when someone is defensive. There is always a way to connect. You just have to find it.

 

Eye contact is everything:

 

If communication is about conveying messages that facilitate understanding of ideas, then eye contact is a key to that process. There’s a lot of good science around the neural processing that takes place through our optic system. When we look into another person’s eyes we experience limbic resonance. This is described by the researchers who first wrote about it as “a symphony of mutual and internal adaptation whereby two mammals become attuned to each other’s inner states.” And “the door to communal connection.” The practical implication of this information is that by learning to monitor our own emotions and sense emotional changes in other people, it becomes possible to recognize what people are feeling; and, by learning to navigate and manage our own emotions, we influence the emotions of others. It’s the key to using info in my first two points. When you look confident and project confidence it can be infectious and effective at navigating positive outcome.

 

If you’d like coaching and guidance about achieving these tips in any situation, VetPrac can help. We have online workshops facilitated by respected veterinarians to help you advance your skills beyond the technical expertise.

Join Dr. Sandra Nguyen’s Vet Talk workshop every Tuesday night for 7 weeks to enhance your communication skills not only with clients but your colleagues too. This online classroom kicks off on July 23rd and covers 7 units encompassing everything from understanding the client, to delivering bad news, communication with the health care team, and so much more.

Further to this, Dr. Cathy Warburton is also facilitating How High Achievers Succeed and Keep Succeeding every Thursday night for 6 weeks. This workshop commencing on October 17th spans 6 weeks with resources to develop good habits and scientific evidence about the links between well-being and success. If you’ve ever looked at your colleagues with respect and thought, “I want to do that too!” this is your opportunity to kick things off.

     

 

If you’ve ever walked into a function or consultation room, and felt you didn’t have the skills to impress – both of these workshops are exactly what you need to build your confidence and excel in your career.

Visit the VetPrac website for more details about these opportunities. The online class sizes are limited to 10 to ensure you receive the best experience possible with the personalised attention VetPrac prides itself on. Registrations are open to veterinarians, nurses, administration, support staff, and management.

Your First Step Toward Owning Your Own Practice

The economy is slow… It’s a GREAT time to buy a business.

They always say, “Listen to your mother.” My mother is a pretty clever lady and she once told me that the best time to buy into a business is when the economy is slow. Given the current RBA cash rate of 1%, I can’t remember a time when the economy has been so slow which is definitely good news for buyers.

Many of us never consider purchasing a business. Practice ownership is fraught with the difficulty of personnel management, financial responsibility, and equipment maintenance. But to the lucky few who like the variety of life being a business owner can throw at you – the rewards can be brilliant.

Aside from financial gain, you get to shape a mini-world into a utopian environment with your value system.

If you want to work and operate in a place where people care about each other then, as the boss, you can make that a priority.

If you want to charge lots of money and not compromise on the gold-standard. You can.

If you want to make allowances to those in need and supplement their deficiencies with your generosity. You can because you’re the boss.

Most people know that the veterinary market is relatively stable. We don’t make huge profits on our businesses, but unlike the finance or property sectors, there is significant buoyancy and sustained commitment of our customer base which makes it a good investment. This is why it’s an appealing option for the large equity firms looking to leverage their money. Why not take a leaf out of their book and invest yourself?

It is true that business is hard. And many businesses fall down because of a number of issues that can plague them. But if you never try, how will you know if you could be successful as a business owner too?

Business is not like the life and death world of veterinary practice. Yes, a lot rides on it, but I think the perspective we have in facing real life and death decisions can give us a great deal of strength in business.

As Sheryl Sandberg COO of Facebook said, “When life sucks you under, you can kick against the bottom to rise up, find the surface and breathe again.”

I love owning a business and one day I hope to own a vet practice too.

If you’ve ever wanted to create your own utopia, consider joining us in Sydney in November to learn how to start.

EXIT STRATEGIES FOR VET BUSINESS OWNERS
Your business is important so spend the day with us to find out how the processes in exit strategies work from industry professionals.
Download the brochure or Click here to register

 

HOW TO BUY A VETERINARY BUSINESS
Do you want the responsibilities and rewards of business ownership but not sure where to start? Join us for a day of expert advice to get you started.
Download the brochure or Click here to register

 

 

Ilana’s Top Tips for Getting Through Communication Barriers

1. Be Authentic

We are all motivated by different things which align with our individual values. People can smell bullshit and when you try to convince a client of something you don’t believe yourself they feel it. More than that, you will be betraying your own value system and that will eat you up.

 

2. Understand the perspective of your counterpart

Communication is a two-way street, sometimes 3-way! It helps before you try to put your point across to understand where the other people involved are coming from. Taking the time to find out before engaging on a path to getting through to people, can make the experience more collaborative and positive for everyone.

3. Start with the end in mind

Ultimately we communicate to be heard and achieve a goal. If your mind heads into the conversation in battle mode (defense or attack) you are less likely to have a positive outcome.

 

4. Assume the best

If a person shows up for a conversation it’s because they want a positive outcome too. Their consideration of a positive outcome might be different from yours, which is why gaining perspective first can really help lay the path. However, assume more broadly that the person you engage with wants what is best for your patient or business or even for you or them. It builds rapport, trust and increases the chances of successful outcomes

 

5. Listen

Active listening requires work. We have to avoid distractions in our own heads and around us which prevent us from hearing our conversation in its entirety. How can we expect to reach a successful outcome if we have not been present for the whole journey?

6. Help the other person to feel felt

It is not enough to listen, the key to getting through to people is to show and truly understand their feelings. Mirroring body language can help with this, but so can statements acknowledging their position. If you can help a person to feel felt than you can tap into their authenticity and your own and achieve great outcomes.

 

7. Manage your own feelings with kindness and compassion

When someone says or does something we don’t like the natural response is to take offense because it threatens our value system. When we are defending our patients and our values we can get quite upset. The fastest way out of this frustration is not to blame the other person for our frustration. Instead to say to ourselves – “What I feel matters, this person doesn’t understand me and that’s not their fault. To make this interaction work requires me to explain myself better so I can feel felt and get on the same page as the other person/s.”

8. Express your views and knowledge with neutrality

The true challenge –  “How can I gently and kindly convey what is needed without compromising my value system?”. We do not have to let ourselves and our values be pushed around because someone else is pushy. True negotiation and conversation skills come into play when we can hold the other persons’ opinion respectfully and also convey ours receiving the same respect.

 

9. Be gracious

No matter the outcome of the communication experience honor the effort of all parties to enter into the dialogue which has taken time and energy. If you are not successful in getting through in the time allowed, you can always try again in the future if the door to communication is left open.

 

Communication encompasses every waking moment of our lives. We invest a lot of time, effort and money into our medical training but we also need to invest in communication skills because that’s what brings life and substance to our medical techniques and expertise.


VET TALK COMMUNICATION WORKSHOP (7wks online)
Join Dr. Sandra Nguyen every Tuesday night from July 23rd
to enhance your communication techniques in the veterinary practice.
Download the brochure or Click here to register

 

HOW HIGH ACHIEVERS SUCCEED AND KEEP SUCCEEDING (6wks online)
Join Dr. Cathy Warburton every Thursday night from October 17th
for resources to develop positive emotions, overcome adversity and get stuff done
Download the brochure or Click here to register

 

These workshops are open to veterinarians, nurses, administration, support staff, and management. Anyone in the veterinary industry will find great benefit in either of these courses and you’re welcome to contact us if you have any questions.  We hope to see you there!

Vet Tips for TPLO Surgery

TIP 1. Did you know that TPLO can be performed in small breed dogs and cats?

If your client asks, “What is the best technique for my miniature poodle’s CCL rupture?” you can say TPLO with confidence. Our Vet Prac instructors routinely perform TPLO on small breed dogs and cats with excellent results. In fact, we feel that small breed dogs and cats recover faster and with better function following TPLO than extracapsular techniques.

TIP 2. TPLO has been shown to allow for healing of partial CCL tears.

Dr. Beale is one of the coauthors on a paper (Hulse et al., Vet Surg 2010) where second look arthroscopy was performed on dogs that had TPLO for partial CCL tears. Reevaluation found that partial CCL tears are protected and can heal when we perform TPLO before the CCL completely ruptures.

TIP 3. TPLO is a very versatile technique.

TPLO can be performed on animals from very small dogs with 1.5mm screws, and has been performed on a young male alpaca! It can be used in cases of medial patella luxation and excessive tibial plateau slope. The technique is very stable due to its biomechanics and more so with modern locking plate technology. There is a very low major complication rate (3.1%). And, once the tibia is healed, the implants can be easily removed (but is rarely required), without decreasing the efficacy or stability of the repair.

Ultrasound – A Sound ROI for Equine Vets

Don’t you wish you had a machine in your practice that printed money? Well – you do!

An Ultrasound machine used on every equine lameness case will increase the cash flow of your business by $150-600 per case depending on how you decide to price it.

If you do 4 call-outs per day you’ll earn an extra $600-$2400 per day. Which means, if you perform 20 lameness exams per week, you have the potential to make an extra $10,000 per week – just by using what you already have in the practice… Ultrasound! There’s also the added information you’ll have available to you from the diagnostics. It’s a win-win situation.

Let’s take a more conservative approach of 10 lameness exams per fortnight. This can still equate to an extra $2500 per week you were not earning before. Of course, this is conservative but imaging if your practice was seeing a high caseload of lameness exams with 10 scans a day?!… Wouldn’t that be dreamy?

Why would someone charge $150 for the scan when another person would charge $600? It’s a bit like tooth extractions. Here are three reasons:

 

Firstly – How do you value yourself as a professional service provider?
Do you have the skills to use your money maker and are those skills at a novice level? Or have you practiced them with a specialist under controlled conditions so you are confident they are strong, efficient and diagnostic?

 

Secondly – What are you scanning?
We all know there are laypersons out there offering all sorts of services. Anyone can buy an ultrasound machine and make it work for them. The machine might be good or not. They might have the skills, they might not. It’s an annoying reality of animal care these days. Lots of people spruiking without acceptable credentials. However, very few people have the training to scan accurately, to achieve better diagnostic results. But you can. You are a vet. You have the greatest and broadest capacity to give the best results for horse owners. Don’t doubt yourself. Others may know how to perform a direct perpendicular scan of the Suspensory Ligament. But they will not know what they are looking at with an oblique approach. They probably won’t scan the whole structure either. Nor would they have the background knowledge in anatomy and physiology which vets have to make good clinical judgments and provide prognostic and treatment advice for recovery. Others certainly don’t have the medical knowledge either. And those vet skills and techniques are worth charging for. But you can’t use all those skills if you haven’t got good diagnostics. And it’s well known that ultrasound, when applied properly, can give almost good results as MRI in a lot of common cases, AND it requires less anaesthesia and stuffing around (transport) of the patient. That’s worth paying for. Ultrasound is also a great monitoring tool for healing and can be used on repeat consultations to immediately judge the progress of a patient.
On top of that – Scanning a spine or Shoulder or Hip or even parts of the foot is a bucket load harder than scanning the superficial digital flexor tendon. So those anatomical differences might carry a loading fee to accommodate the time and skills required.

 

Thirdly – Do you have clientele and live in a demographic where price matters?
Realistically some of us can make bigger margins on our services because the demographics of our market allows for it.

 

So if you have an ultrasound machine sitting in your hospital and you aren’t using it on every lameness case you might be selling yourself short. Don’t sell yourself short! VetPrac has organised the worlds best lameness ultrasound workshop for equine practitioners this year on July 4-5 and 6-7th.

Register HERE for ‘Distal Limbs‘ July 4-5.

Register HERE for  ‘Proximal Limbs and Spine‘ July 6-7.

CLICK HERE to download the brochure about these workshops.

 

This article has kindly been written by our friends at

 

Proudly supported by: