You Might Ask: Why Do I Need to Hire a Trainer?

Why do you need to hire a trainer?  Maybe the truth is; you don't! And if that is the case...I want to take this time to congratulate you.  The ability to practice medicine; whether as a veterinarian or a technician, or to manage a veterinary practice AND to stay abreast of new ideas and best practices while maintaining any semblance of a life is a challenge.  

My experience, even in my clinical practice is that we decide we are going to add a service, how we are going to communicate that service, what we are going to charge for it, and who is responsible for it.  We commence to provide that new service and we adjust everything we originally thought or decided, based on feedback.  Trail and error.  Then once we work it out to the point that we no longer have any problems with it and everyone is comfortable, we will do it every day, the same way and we will never question it again until we are forced to.

I will give you an example. For years, feline patients would come into the practice, be admitted for a procedure and be gently and lovingly placed in a cage with a blanket, a kitty litter pan and a catnip pillow.  A few hours later, it would be time to work with some of these cats and it would seem as though "Lovey" was having an allergic reaction to stainless steel.  Some of these cats would go from a lovely little purr bucket to a whirling dervish of teeth and nails.

We would mutter a curse word, don a pair of welders gloves, lock the doors, grab the biggest quilt we could find, call the employee that has earned the title "cat wrangler" and add a little more sedative to the injection or a cancel the procedure due to it no longer being a safe or atraumatic experience. 

Result:  More curse words, one escapee cat, four employees running wildly trying to apprehend the patient and eventually, one very injured employee, a trip to the ER, one completed worker's comp form and a cat that doesn't sedate well due to an extreme catacholamine flood.

Then an outsider came in and witnessed said experience.  She had experienced many of the same type problems before and she realized that the same cat was a doll baby in the exam room for her vaccines.  She suggested that we identify and schedule these patients as a "Do First" experience and sedate them, on the baby scale in the room with the owner.  A no-brainer some may think...but it took an outsider to show us the way out of our rut.  And, the clients love it.  They feel we are taking special care of their baby...and we are!

So, what ruts do you find yourself in?  Are dentistries the bane of everyone's existence?  Are your client service representatives getting yelled at because the client doesn't understand the bill?  Is the surgeon frustrated because they have to fit in carnasseal tooth extractions between surgeries?  Is it frustrating to do be expected to clean teeth and perform anesthesia at the same time?    if so, please know you are not alone.  

You might ask then ,what does the typical in-house dentistry training look like?  For larger practices, we divide the staff in half.  One half of the vets and techs work in a 3 hour wet lab concentrating on proper cleaning, charting, and honing their radiographic skills so that they can offer a full mouth series efficiently.  The other half of the professional staff is running appointments so that the day is not a total loss.

During lunch, we do a communication lecture.  There is no sense learning how to do a skill if you can't get the client to understand its importance enough to comply with your recommendations.  

Then the staff switches roles and the half that ran appointments, now gets to experience the wet lab. 

By the time the day is complete, we also have created a wish list.  This is a list of equipment that will help you provide this new or upgraded service efficiently.  Change also can seem overwhelming and the trainers can set expected timelines for change and equipment purchases.

The anesthesia training day looks slightly different.  The first half of the day is the trainer will observe anesthetic cases to see where the staff strengths are.  She will then provide a lecture over lunch and in the afternoon, a wet lab tailored specifically for your practice based on her observations and a PetED pre-visit survey the practice provides returns to her.

In closing, a trainer provides great opportunities for the staff:

• to think and troubleshoot with "outside-of-the-rut" thinking
• to be able to tweak protocols and procedures to fit within your practice
• to work with your own equipment and environment
• for the entire staff to get the same education at the same time instead of relying on one staff member to return and share all of the information to which they were exposed 
• to provide RACE CE credits* to all staff members simultaneously without the travel, lodging and registration fees for each staff member.
• PetED also has a Willow Grove, PA site where wet labs can be scheduled for small groups.  This enables practices to send employees for training without the need to amend appointments or their surgery schedules.

If you think that your practice could benefit from a  PetED Veterinary Education and Training Resource experience, contact us through the website at www.PetEDVeterinaryTraining.com or we can schedule a free Skype consultation (Skype name: Vickie.Byard). 

*RACE CE credits have only been submitted and approved for the dentistry experiences.  Anesthesia is pending approval.

Only Brush the Teeth You Hope to Keep!

Well, I just got a Facebook message from a technician from New York that asked the question, " is there any special way a pup/dog's teeth should be brushed?"  I was looking for the next topic from which to blog and this was the perfect subject.  It is actually one about which I am very passionate.

I believe that it is important to break this training down into baby steps.  

1.  Find out what your pet perceives as a reward.  Some pets like Pet Poultry Toothpaste. if so, I would use this as the reward and at first just put a dab on your finger for the pet to lick off.  You may need to reward with peanut butter, or a small piece of cheese.

2.  I will ask you to choose a place in your house where you will be apt to do it EVERY day. Plaque begins to lay down after 8 hours after a meal but I can not expect pet owners to do it three times a day.  Most people have a hard time providing that care for themselves despite the fact that is recommended.

3.  Pick a time of the day when you are apt to be able to do it EVERY DAY.  No fair doing it before you go to work one day and then before bed another.

4.  When your pet comes when called to that place and at that time...reward the behavior. So, for me, when I called Crayons, my cranky cat, to the bathroom at 7 am and she showed up, I rewarded that behavior alone.  For cats, attention and fuss may not be perceived as a reward...a treat may.  Dogs tend to like attention, so feel free to speak in a high voice and give a treat as well.  I do nothing further.  I repeat this daily until the pet starts to show up on his/her own looking for the reward.  Note the shift in power...they are now asking for it, you are not forcing it.

This took 2 weeks for Crayons to show up in the bathroom at 7 am.  But, I did not "up the anty" until that time.

4.  Now introduce that TOOTH BRUSH"!   If your pet likes the toothpaste, then load the toothbrush with the toothpaste.  When the pet comes to your chosen place at the chosen time, just let them lick it off the toothbrush.  Some pets may be reticent to do so.  Coax them nicely and reward the behavior when they do so.  

For Crayons...the first day of toothbrush introduction was slow.  She approached it slowly as if it were going to bite her.  But, she smelled the toothpaste (her reward and slowly tested it.  Then everyday she became a little more confident.  After about 2 weeks of this step...she would run into the bathroom at 6:50 am and meow for the toothbrush and toothpaste.  Now, time to step it up.

5.  Now, for cat owners, you may prefer the pet be on a higher surface.  So for me I had to add the step of Crayons jumping onto the bathroom vanity counter.  The first day of this step took forever, but eventually she did it.  When she did, I rewarded her with the toothpaste on the toothbrush (just licking it off).  Eventually, Crayons was sitting on the counter, waiting for her treat at 6:50 am.  For dogs this step is not appropriate.

6.  Now we have to get the pet comfortable with us touching the head/mouth.  So, I put my hand above the pet's head, touching it so lightly that I could barely feel the hair touching the palm of my hand.  Then I redirect their attention to the toothbrush and reward.  I NEVER BREAK their trust.  When they eat the toothpaste off the toothbrush, I take my hand away and reward with a little bit more toothpaste.

The next day I put the tiniest bit more of pressure to the top of the head.  Then every day a little more pressure.  My goal after about 2 weeks is to be able to drop my thumb to the cheek and pull the cheek back a little and DAB the couple teeth you may see with the toothbrush and reward the pet for allowing this.  The next day, I dab the right and the left.  The next day I may use a little brushing action and reward.  Then every day I increase it a little bit and reward.

Eventually, your pet will come to trust you handling their mouth and will actively ask to have this done purely because they want the reward.

I have no pattern I want you to do...back and forth, in a circle, while you are standing on your head....I don't care.  Just get in their and get the food off of the teeth.

Some final thoughts:

• If they don't like the toothpaste, use water on the brush and reward with something else.
• Use pet toothpaste not human.  Human toothpaste is not designed to be consumed.  It has whitening agents, abrasives and foaming agents added.  These can cause GI upset in your pet.
• Use some sort of toothbrush with nylon bristles.  It is the gold standard in human medicine...why would it be different with these teeth?  The finger brush with rubber bristles is good for training but you should switch to nylon bristles eventually.
• Take it as slow as you have to.  Golden retrievers may train very fast while a Yorkie or Pug may take much longer.
• Tooth brushing does not negate frequent professional cleanings but it may decrease the frequency required to maintain your pet's oral health.
• Be honest with your veterinary professional.  if you can't manage the training, your pet is particularly nervous, or you can't find the time to do this, let the veterinary staff know.  This will help them know how frequently they need to recommend professional cleanings.  They will want to tailor the recommendations to your pet individually.

I have put a link here to a video of my brushing my cat's teeth.  It is about 34 seconds long.  She has had this done daily since she was a kitten and she is 17 years old now.  She has never had gingivitis, periodontitis nor any resorptive lesions.  I do clean her teeth about every 18 months.  My veterinary dentistry bills are low.

Crayons Tooth Brushing Video

For the vet professionals out their...here is your homework.  If you have not trained your own pets to tolerate and participate with tooth brushing, I recommend you give it a try.  All it will cost you is 34 seconds and a little patience.

I Can't Believe I am Admitting This!!!!!

True Story! I had already shared this on my Facebook page, but I thought it made a good story for a blog and a chance for you all to get to know me better!

Last week, I had the opportunity to lead an all day dentistry CE event for the Northern San Joaquin Veterinary Medical Association at the Modesto Junior College.  Thank you, Tim McDaniel, CVT and Dr Frankie Bonifacio for inviting me and providing such incredible hospitality.  But, travelling always carries its own challenges and this time was no different.

I landed after a nice, long flight to San Francisco. I fetched my luggage and made my way to the airbus that took me to the rental cars. I signed in and I was led to a lovely, young lady with a clip board. She informed me that all of the compact cars were taken but that she would upgrade me at no further charge to a larger car. No biggie! OK. 

So, we were wandering through the garage and I was in a bit of a hurry. She started naming off the available cars and in my head I think; "Sweetheart...I could care less which car." So, I saw this lovely blue car and blue is my favorite color...done (that's how smart people make decisions). So she took me over to the blue Kia Optima. We inspected the car for damage, I signed and she left me with the perky statement..."The keys should already be in the car".

Well, there were these two "key like" looking things in the console. They had buttons that looked like open lock, lock lock, open trunk and blare horn. But there is no metal key thing sticking out.

I sat there for what seemed like 30 minutes looking at this "key thing" thinking...how do I make the key pop out. Something has to go in the ignition. I looked for other keys. Nothing except a good tour of the car. Do I look like an idiot and ask that sweet 20 some year old blonde girl that has already engaged 3 other customers who have happily crossed over the grated speed bump to their happy California adventures? Are you kidding! No way! Any unexpressed "Y" chromosomes wandering though me, completely forbid my asking this kid that could be a child of mine (except for the rockin' body and blonde hair). 

So, I deduce "Maybe it's Bluetooth".  So, I confidently waved this "key thing" in the vicinity of the dash board....nothing. I pushed all the buttons...doors locked and unlocked, trunk popped open and I scared the bejeezus out of a 90 year old man walking in front of this blue piece of brilliant metal when I pushed the horn button. Still nothing.

Finally, I needed to check out the ignition. Wait..let me find my glasses. There...wait! A button says "ENGINE START STOP". 

It looks like a button. I push it. All of the lights go on but no engine sounds. "Push it again!", the left side of my brain says. Now the car gleefully bids me fair well. I pushed it again...lights went on and it showed me a lovely branch of a blossoming cherry tree and all the gauges move...but no engine sounds. I pushed it again..."Good bye". 

Five cars were inspected and are on their way and now that blonde chick keeps checking me out in the car...to which I smile and act as though I am completely under control, taking a call on my cell before I am on my merry way. Reality...I am embarrassed and warning: Do not come anywhere near me right now or you may be the next thing planted in the San Joaquin Valley.

Finally....through the completely dysfunctional self talk:
Vickie...you make a decision about which car to drive based on the color BLUE!
Vickie...you idiot.
Vickie... if you ask that child for help, she is going to tell all her friends about the 50 some year old moron and it will be on Facebook and that will get 1 million "likes" and someone you know will share it on PetED's wall! You will be found out and everyone will know you are a knucklehead.

Then...by Grace....a piece of random information I hadn't really assimilated when inspecting the car floated from the lovely right side of my brain into a folder in the left side of my brain and in my mind I saw an image from the back of the car saying........
Hybrid. 

I push that ignition button one more time...the car goes through its happy salutations and I hear nothing....nothing. But, I put the car in gear and it moves effortlessly forward. An electric car. OMG! What a simpleton! But, I smile to myself and think...my friends are going to love this. 

You know, dear readers....I shake my head when the "kids" at work don't know who Harvey Korman and Tim Conway are....but at least they would have been on the highway 40 spectacular, sunny minutes before me!