To the Heart of the Matter

To me this is the saddest of cases!

A very nice man brought his 8 year old, female spayed, King Charles Spaniel to our practice. The history was that he previously lost a King Charles to cardiac issues, a problem that commonly effects this breed.  That experienced devastated him and he vowed to do everything in his power to avoid cardiac issues in this next dog if at all possible.

We had been providing care for this dog for a number of years and early on the veterinarian heard an innocent systolic click when listening to the heart.  It was mentioned and this client  sought a cardiac consult and an echocardiogram immediately and spend upwards of $400 on that evaluation annually by a cardiologist.  All was well.  He wanted the best for his baby and he went to any lengths to provide that.

We recommended dentistry for his dog and this brought up a whole host of fears about anesthesia. He was afraid he may lose his dog.  We tried to assure him that with frequent professional care, we could provide the shortest and ultimately safest anesthetic experiences for his sweet baby.  We showed him how we have state-of-the-art monitors and that we have a dedicated anesthetist for the procedure.

He said he would consider this carefully.  

What he did, in an attempt to safe guard his beloved was to seek a second opinion.  He went to another practice.  They witnessed his concern and they offered to provide anesthesia-free dentistry and told him that that would be ultimately safest.  He provided this level of care for his dog twice.  The second time, they told him that they got most of the work done but that Nala was not allowing all of it.

Fast forward to a couple weeks ago.  This client came in for his annual exam.  He related to our veterinarian that his baby was dropping food and was eating very carefully.  This very compliant, gentle dog allowed us to show him that there were multiple mobile teeth and that his baby needed to have a deep cleaning and full mouth radiographs.  

Once we anesthetized this patient and obtained a full set of diagnostic X-rays, we identified 27 teeth that we needed to be extracted because of either greater than 50% bone loss or tooth root abscessation.  This man was horrified.  The work was provided and the pet is doing wonderfully.

What breaks my heart is that this man wanted the best for his dog.  He was not stingy with his money in relation to this dog.  He was misled that providing anesthesia-free dentistry would provide the same care for the dog as we would provide with the aid and expense of anesthesia.  In the long run, this King Charles Spaniel experienced long term periodontal infection and we know that that can negatively affect the heart...the organ he was so worried about in the first place.

Good morning!  I woke up this morning and there was a notification on my PetED Facebook page.  The notification was informing me that someone that I have not met, "liked" the page.  Such a nice feeling. So, I was having my cup of "wake-the-heck up" and found myself staring at PetED's logo and day dreaming.

While in Las Vegas at the Western States Veterinary Conference, I gave a technician one of my cards after we chatted for a bit about dentistry and X-rays at the Technician Fair.  She politely took the card and innocently asked; "If you teach dentistry, why didn't you design a logo around that and why the briefcase?"  So, I thought I would share how I responded about the PetED logo.

First of all, the name of the company; PetED.  It is true that at this point, most of the business is centered around veterinary dentistry.  I am the president and that is my clinical specialty and main focus.  However, I envision a company that has a much larger scope. Having been invited into almost 50 practices to teach dentistry, I am aware that some practices have areas other than dentistry that they would appreciate help expanding or further developing.  One of the common issues that comes up whenever I teach dentistry is anesthesia.  Once practices start doing full mouth radiographs and finding additional pathology, the patients are under general anesthesia longer.  That often necessitates a good look at the practices' anesthetic protocols and practices.  

That led me to know that I wanted the company to be the resource for any of their educational and training needs.  I can't be an expert in all disciplines. Fully embracing that fact, PetED has technicians that I have had the honor and pleasure of getting to know, that are considered experts in other disciplines that can be scheduled to consult for the company.

Why the briefcase?  Well, that is to show that PetED trainers come with materials for you to keep as references when we leave your practice.  If I train technicians how to perform regional nerve blocks, I leave you with pre-calculated dosage charts.  If I teach intraoral radiographs, I leave the practice with a CD of images that show the proper position for each image.  

The briefcase also shows that we are mobile.  We pack up and come to you (although we do have a wet lab site).  The practice could be in our geographic area or we frequently travel to other states as needed.  PetED is not limited to any geographic area. As a matter of fact, I am scheduled to speak to a group in Modesto, California in a few weeks.

The paw prints are pretty self-explanatory.  This is a small animal veterinary resource (although PetED does have access to one of the leading equine technicians in the country).  

The colors?  I wanted to be memorable and that yellow jumps out at you, hopefully catching your attention.  I want you to think of PetED and our trainers when you see that yellow and blue.

And why cartoon-type imaging?  I intentionally chose images and a font that invokes a feeling of fun!  Practice life can get intense but the educational experience does not have to be.  PetED is serious about the materials and the information shared but the trainers PetED has chosen are intentionally ones that are respected but share the information in comfortable and relaxed way.  When a PetED experience is schedule, I want the staff to want to be present that day.  Education should be something to look forward to instead of something to avoid.

Well, as I look out the window and see the very early March buds on some of the trees, I marvel at the miracle of Spring.  This is a time of hope and rebirth.  The seed of PetED was planted in the fall and through the darkness of winter there was a lot of underground work done in preparation for its birth.  My hope is that the PetED trainers will be able to plant the seeds of understanding and inspiration to revitalize how you experience this profession you so passionately sought.

Have a spectacular day!

Vickie

"I didn't say they could extract THAT MANY TEETH!"

Sorry it has taken me a while to post the next blog.  Right after I posted the first, I was in the midst of a whirl wind pet sitting for a dear friend, speaking to a class of sophomore and junior high school students, speaking at Rau Animal Hospital's  client education seminar and preparing to travel to Las Vegas to present at the Western States Veterinary Conference.  The wind has settled and I have poured a cup of coffee to sit and catch up with you.  Can I refill your cup before we chat?

I had the opportunity to speak to a large group of technicians while in Las Vegas about developing a thriving dentistry department.  One of the discussions we had concerned dentistry admissions processes and consent forms.  I shared that when I visit practices often I see that the consent form has three selections from which to sign off:

Some look like this:

If further problems are detected while my pet is under anesthesia (initial all that apply)
__________ Do whatever is needed to give my pet a healthy oral cavity, but not limited to tooth extractions.
__________ Do only what is authorized
__________ Please contact me before doing any additional procedures.  if I can not be reached while my pet is under anesthesia then:
                         ___________ Perform whatever procedures are needed
                         ___________ Do only what I have authorized

I would like to challenge this form of consent.  I understand that this is an attempt to handle problems that occur every day in practices across the country.  Our patient is under anesthesia, the mouth is cleaned, charted and all X-rays have been taken.  We now know that there is much more pathology than originally expected.  A call is placed to the pet's guardian and they can not be reached.  This leaves the veterinarian in a quandary and a state of frustration.  Do we do whatever is needed or not?  With this form of consent many feel they have "informed consent" to proceed with therapy and surgery or at least it gives them guidelines and client expectations under which to proceed. 

I also know from having talked to many employing this type of consent, that clients are still disappointed with the bill.  They feel they did not give consent to spend "that much money" and they are shocked at the number of teeth extracted.   And, unfortunately, it is common practice for the receptionist to present the client with the total bill and it is often she/he that has to take the initial heat...in front of all of the other clients.  So, in many cases, the person that has the least amount of dentistry training on staff, the person that was probably not involved at all, the person that has no power to amend the bill, often bears the brunt of the client's disappointment.  And we wonder why practices find it hard to keep wonderful customer service representatives and why some our front line staff members can get surly with our clients!

So, my question is, if we asked these clients; did we meet your expectations, do you think they would say "YES!"  Do you think they are going to be apt to provide the same services next year?  Do you think these clients are going to recommend this experience?

Did I just say YES?

Thirty two years working as a veterinary technician and what an exciting journey that has been.  

In 1981, I first worked for a very small veterinary practice.  A mom and pop practice, if you will.  I thought I was happy.  I answered the phones, cleaned cages, ran stool samples and sterilized instruments.  I thought that was what a veterinary technician was supposed to do and not knowing differently, I did that with all my heart. 

Then I was in a bad automobile accident and suffered 2 fractured cervical vertebrae and was told I had to take 8 weeks off to heal.  As the only technician on staff, it became obvious that the practice would need help to function.  I needed to look elsewhere for a new job.

After recuperation  I saw an ad looking for a veterinary technician in a larger practice.  The name of the hiring veterinarian was Dr Fox. After the interview, he offered me the position. I believe my first bit of marketing secured the position for me.  I found a fox horn lapel pin and secured it to my tweed blazer.  The pin was noted and I had just gotten hired not only as a technician in this practice but as the supervisor of all in-patient care.  

Just between you and I, I was ill prepared for this position.  I had not anesthetized a patient since my externship and I had never supervised a soul.  But, I said "yes", knowing I had a lot to learn and I was ready for the challenge.

A few years later, Dr Patricia McManus, director of the Manor College Veterinary Technician program called and asked if our practice could be an externship site. We discussed expectations but I really did not know what I was getting into or if I really wanted to teach.  This would be a lot of work on top of a full time clinical position, but I said "yes".  

Not long after that, program directors changed.  Dr Beth Thompson asked me if I wanted a position as an adjunct instructor.  I really didn't know how much work was required of an instructor and what was involved in course creation and what leading people right out of high school would be like...but, again, I said "yes".

During this time, Dr Fox asked if I wanted to go with him to a dentistry wet lab at the University of Pennsylvania's School of Veterinary Medicine.  I had been performing crude dental cleanings but I had little to no training.  Always willing to learn and grow I said "yes".  

I began to read articles about veterinary dentistry and many were written by Dr Jan Bellows, DVM, Dip AVDC.  I called him and asked if I could work for a week for him for free in return for being able to learn as much as possible about dentistry.  He said "yes".

A few years later, Dr Bellows emailed me and informed me that there was a group of like-minded technicians meeting in Las Vegas to create an academy of veterinary dental technicians so that certified technicians could obtain training and credential as technician specialists in dentistry.  I had never been to Las Vegas and was not the savvy traveler.  Nervous and scared, I said "yes".

As a member of this group, it became obvious that we each would need to become speakers at the national meetings so that others technicians would have additional training in dentistry.  Public speaking was a greater fear for me than spiders and clowns (can't stand either).   Petrified, I said "yes".

After a number of public appearances, I realized that I loved the experience of speaking.  I was invited to speak at Harcum College and the event was sponsored by Pfizer Animal Health (now Zoetis).  Susan Weber, CVT, a former classmate was the attending Pfizer rep.  She approached me after the meeting and asked if I would be interested in teaching in-house for some of their key accounts.  I wasn't sure what all it entailed, but it sounded exciting.  I said "yes'. 

In my career, I have said "yes" many times.  That single word and passionate curiosity has enabled me to speak in 14 states, publish numerous articles and chapters of books, and has let me teach and interact with thousands of people in over 39 practices.  It has also taught me many things about myself I would have never known otherwise.  I have learned I love to teach.  I love to travel. I love to meet new people.  It also taught me that I love to write from my heart and not so much, clinically.  

Now, at this point in my career, there is another calling.  My heart is asking me to take a leap and expand on the joy experienced when I see the light of understanding turn on in another's eyes.  It is calling me to take all that I have learned about myself by the simple act of saying "yes" and expand the scope of my work.  Instead of helping a few pets a day in our dentistry department, I hope to teach many people to be able to help many pets.  

So, once more, I am going to say YES and make a leap of faith with PetEd Veterinary Education and Training Resources. At first, the plan is to provide dentistry training and hold the hand of practices hoping to expand their dentistry services.  But, the vision of PetED is to be the resource for respected  and experienced trainers in a wide range of educational and training needs for the general practice.