Veterinary Medicine - November 2008 - (Page PD15)

presentations have underlying disorders, you should anticipate recurrence. Reaching for a stronger medication just temporarily masks the underlying problem, and clients are quick to recognize this. The answer is to start looking more intently for the primary causes. So, tell clients that you’ll attempt symptomatic therapy at ﬁrst with an appropriate product, but also tell them that if the problem recurs when the medication is discontinued, more investigation will be warranted before stronger medications are considered. Underestimating secondary invaders: Most pets with dermatologic issues also have secondary infections (bacterial and/or yeast dermatitis) that need to be addressed. If those secondary infections are not properly managed, it may be difﬁcult—or impossible—to assess the response to other treatments. For routine bacterial infections, consider a convenient product such as cefovecin to reliably control the infection while guaranteeing owner compliance (which is always critical in dermatology cases). Since you’ll probably References/notes from page 13 be dispensing a variety of products, your clients will appreciate that you took care of the infection with an injection, and they have one less thing to do at home. Lacking realistic product and pricing models: Dermatology patients tend to be on medications long-term, so consider which products and pricing models work best for you and your clients to keep that revenue in your practice. It pays to stock products that are appropriately priced and have been researched, safety tested, and labeled for use in the species to which they are being administered. Performing tests out of desperation: As the majority of dermatologic cases have underlying disorders, it makes sense to perform tests to try to identify them, so they may be addressed if possible. However, it is important to have a clear diagnostic plan and to proceed logically. For example, the results from biopsies are more likely to be useful if a thorough history, clinical description and differential diagnoses are provided to the pathologist (pictures are a nice touch as well). Forgetting to mention referrals: The best referral happens as part of a wellconceived plan, not as an afterthought. It helps to prepare clients early on that the ﬁrst course of treatment may not resolve the problem, and if so, that you may try other options or recommend the assistance of a specialist. Clients will appreciate your efforts to inform them now, rather than when they are frustrated, upset, and depleted of funds. Considering clients a nuisance: You are in business to serve the needs of your clients. Due to the nature of dermatologic diseases, you will see most of your dermatologic patients and their owners many times during the year, for many years to come. These are exactly the clients that you should crave for your practice. The next time the pollen count rises and your telephone starts ringing frequently from clients with itchy pets, don’t curse—give thanks! These are probably the most dedicated clients you will have in your practice. 1. Sousa C. Glucocorticoids in veterinary dermatology. In: Bonagura, J, Twedt D, eds. Kirk’s current veterinary therapy (XIV). St. Louis, Mo: Saunders/Elsevier, 2009; 400-405. 2. The lower side of the mid-range of production (0.4 mg of the 0.2 to 1 mg/kg/day range) was used for this calculation. 3. The number (30) is used as a conservative approximation for the 36.5 mg/kg/year annual dose of endogenous steroid (cortisol) produced (0.4 mg/kg/day cortisol)x 365 days ÷ 4 (prednisone’s potency factor). It was selected based on a combination of several publications reporting the side eﬀects of glucocorticoids as related to dose as well as based upon clinical experience. ©2008 Pﬁzer Animal Health. All rights reserved. Cover art: Getty Images To view this publication online, visit www.dvm360.com/c58. SPONSORED BY PFIZER ANIMAL HEALTH 15 http://www.dvm360.com/c58

Table of Contents Feed for the Digital Edition of Veterinary Medicine - November 2008

Veterinary Medicine - November 2008 Contents Leading Off Editors' Guest Just Ask the Expert Letters Practice Makes Perfect Clinical Exposures Practice Matters Idea Exchange Author Guidelines A Challenging Case: Esophageal Leiomyoma in a Dog Osteoarthritis in Cats: What We Now Know About Recognition and Treatment Product Preview CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - November 2008

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