The following article was sent to me by a client this morning.  Good to finally hear that action is being taken against some of these people…

By BARBARA LEONARD

MINEOLA (CN) – Queens-based pet dealers use bait-and-switch tactics to sell unfit dogs, and violate charities law by “purport(ing) to engage in animal rescue activities,” New York Attorney General Andrew Cuomo says.

Cuomo says the husband and wife’s two businesses, Imported Quality Guard Dogs and the Animal Rescue Unit, “engage in deceptive business practices and false advertising” and violate “the Pet Lemon Law.”

Defendants Robin Schulder and her husband, Perry Reich, falsely claim to be dog breeders, make “numerous misrepresentations” about their animals, and falsify health records of the dogs, Cuomo says. He adds that Schulder practices as a veterinarian without a license, and makes improper use of the title “veterinarian technician.”

Cuomo says his office has received 13 complaints against the couple and their companies. Consumers also have complained to the New York Better Business Bureau, the agriculture department and the American Society for the Prevention of Cruelty to Animals.
The couple operates more than a dozen Web sites that lure consumers with empty promises, such as “all our babies are born in our home,” according to the complaint.

The sites list puppies with pictures, names, weight, sex, age, price and availability, but Schulder delivers a “markedly different” dog, according to the complaint.

Despite their claims, Cuomo says, the couple resells dogs they bought from third parties.

“Numerous customers purchased animals that suffered from illnesses ranging from parvo, coccidian, mange, acute respiratory infection, pneumonia and life-threatening hypoglycemia,” according to the complaint.

Some consumers pay up to $3,000 in veterinary bills “trying to nurse the animals back to health,” but one dog died and two had to be euthanized because of severe medical issues, according to the attorney general.

Cuomo says the couple delivers dogs with visible defects, including deformed limbs and blindness, as well as signs of illness such as coughing, sneezing, bloody stool or vomiting.

When consumers demand reimbursement for veterinary care or try to return a puppy, Cuomo says, Schulder becomes verbally abusive, “lashing out at them with vicious obscenities, and blaming them for their dogs’ illnesses or death.”

Cuomo says that Schulder once answered the door holding a large kitchen knife, and when a veterinarian diagnosed a puppy with congenital blindness, Schulder insisted that the consumer had dropped the puppy on its head.

Cuomo adds that one of their Web sites claims: “‘Some of our puppies are imported from our family-owned kennel in Europe.’ This is an outright lie. Respondents do not have a family-owned kennel in Europe.”

They claim their “No-Kill Animal Shelter” has rescued dogs throughout New York’s five boroughs and has “over 2,000 supporters and donators,” but Cuomo says they “have been unable, however, to produce any records whatsoever identifying any dogs they have rescued, and admit that their ‘animal rescue charity,’ the Animal Rescue Unit Inc., is inactive.”

Cuomo seeks an injunction, accounting, restitution and civil penalties.

While most dog trainers will charge by the hour or by the lesson, his company charges one price for the life of the dog.  If everything I ever need to know I learned in kindergarten …even kindergarten lasted for more than a handful of 30 minute lessons.  Same thing applies to dogs.  And yet dog owners continue to attempt to rehabilitate their humping, jumping, runaway canines in 4-lessons-for-$150.  But what about the well behaved pooch who just needs some finishing work? Maybe those dogs and their owners really do only need a handful of lessons to get the ball rolling.  So can a premium dog training company offer that as an option without diluting their brand or contradicting the values they preach to their premium training clients?

After our conversation, we agreed it could be done, as long as it was marketed smartly and tactfully.  It worked for other companies: Nobu has Nobu Next Door.  Georgio Armani has Armani Exchange.  Saks Fifth Avenue has Saks Off 5^th.  Even Porsche once sold the 924.

Could that model ever work for a veterinary hospital?  I sure hope not.  Low-cost veterinary care –unless subsidized by some sort of private or public funding –is often low-quality veterinary care.  Ask any doctor if they can maintain their level of patient care if their operating budget is slashed by 50%.  High profit medical care is only sustainable if there are profits to support it.  Even if doctors donated their time, there are still many other costs to consider: experienced (and well-paid) support staff, medications, laboratory testing, patient monitoring equipment, needles, syringes, fluids, etc…

Let’s look at a simple example of two different veterinarians in the same town who are charging vastly different prices to spay your cat.  One may charge upwards of $275 and the other may quote less than $75.  (These numbers are not entirely made up –I’ve seen this in both the San Francisco Bay are and the New York City Metro area.)  For argument’s sake, let’s assume that both doctors possess the same surgical experience and skills.  What then makes up for the difference?  Can the cheaper veterinarian offer pre-anesthetic blood testing, intravenous fluids, and pain killers at that price?  Is the less expensive hospital utilizing the same level of patient monitors, and are they paying an experienced anesthetist to monitor the cat while the doctor has his hands inside?  On the flip side, how can you know that the more expensive doctor is doing all these things?  The best you can do is ask.

There is indeed a minimum standard of care that every doctor should be providing.  Unfortunately, not everyone agrees on what this minimum level is –and either way, many veterinarians out there don’t make the grade.  Some just don’t care and the rest can’t afford to because they’re not charging enough.

I suppose I can blame my parents for this.  I never got rewarded for getting a 100 on a math or spelling test.  If I got a 98, I knew I’d have to answer the question “Where did the other 2 points go?”  I was expected to do a good job.  And I was punished if I did poorly.  No, they never beat me -they just gave me more work.  Since my mom’s an accountant, it was pretty easy for her to whip up a weekend’s worth of math problems for me.  And I recall some nights of memorizing sections of a dictionary.

Despite all of this, I think I turned out relatively OK.  But I still admittedly have a hard time wrapping my head around praising my staff for doing their job.  Isn’t that what I pay them to do?  If they didn’t do a good job, they wouldn’t be working for me.  About a year and a half ago, I hired a nursing supervisor to help manage my medical staff.  While I was hoping for someone to complement my “flawed” management philosophy, I ended up with a fantastic technician who expects perfection from all of her staff.  Surely there is no abundance of warm fuzzies here.

I’ve also told my staff many times that I HATE the phrase “Don’t sweat the small stuff.”  We get paid to sweat the small stuff so that our clients don’t have to.  Instead I like the phrase “The devil is in the details.” I don’t run laundromat or a shoe store -small errors and oversights can mean the difference between life and death.  All of my staff needs to understand that every single one of their decisions and actions (or inactions) can affect patient care.  Every action carries a consequence, and some consequences are more significant than others.  So if a receptionist misspells diarrhea, or a kennel assistant checks off the wrong box on a checklist, or a technician reached for prednisolone instead of prednisone …I will continue to react quickly to point out their mistakes.  If they can’t handle that, they can certainly try to find a job working for a veterinarian who doesn’t care.

That being said, I have a pretty happy bunch in the hospital and not very much turnover.  Would it kill me to say “good job” more often? Probably not, but it’s so against my nature to do that.  And wouldn’t it mean a lot more if I did praise someone when they really went above and beyond the call of duty?

Here is the problem: Most of the owners of my overweight patients don’t think their pets are overweight.  It’s not that they’re not in denial of the problem (ok, some are) -they’re completely oblivious to it.  A good portion of the owners think their plump playmates look cute when they’re chubby (I’m sure that 1600 pound guy was thinking about how cute he looked while being lifted out of his apartment by a crane).  Another group of owners readily admit to owning a fat dog but still insist on feeding table scraps and treats on top of their expensive low-calorie food (kinda like ordering a Diet Coke with your Big Mac).

Every year, i see at least half a dozen articles in various journals suggesting different techniques to talk to my clients about their pets being overweight.  All of these articles would like me to tiptoe around the issue when the owners themselves are also visibly obese.  I guess I’m not supposed to offend anyone with my medical diagnoses.   And I guess I’m a bad person for ignoring all of this advice because here’s reality as I see it:  My clients pay me for an accurate diagnosis and to be an advocate for their pets.  If I walk into a room and see a 20 pound chihuahua or a 70 pound beagle, I’m going to say something. Period.  And it’s going to be blunt.  It doesn’t matter how big or small the owner is because, honestly, I don’t care.  They can talk all they want about their weight with their own physicians.  Unless you’re covered in hair and walking around on all fours, your medical problems are completely out of my jurisdiction.

Once the problem is identified and accepted, then there’s a basic mathematical issue.  Being 5 lbs overweight may not seem like a big deal, but what if you’re only supposed to weigh 10 pounds (or 5 pounds!)?  Putting the numbers in perspective: if you have a cat whose ideal weight is 10 pounds, but she actually weighs 15 pounds …that’s like a human female being 60+ pounds overweight (if her ideal weight is 120).

So how do we shed the pounds?  Again, I will refer to a very simple equation.  You must burn more calories than you consume in order to lose weight.  If you even eat one more measly calorie than you burn off (via breathing, walking, exercising, etc.), you will never ever ever lose any weight.  Ever.  Of course this is easier said than done, especially considering that obese people/dogs/cats have a harder time feeling satisfied after a meal and have slower metabolisms.  Yes, it’s a slippery slope.

The saving grace with treating your obese pet is that you don’t need to deal with any will power issues.  Yes, you may feel issues of guilt for putting your little friend on a diet, but I can’t help you with that.  And yes, some dogs will begin some very destructive behaviors if they are hungry and “hunting” for food in your garbage cans and cupboards -but good training and judicious use of gates and crates will help with that.  But if you just follow the simple feeding guidelines that are given to you by your veterinarian (NOT the chart printed on the back of the food bag), I can practically guarantee success -and your pets will live longer, happier, healthier lives.

One of our exhibitors at the Expo was a local rescue organization called Last Hope.  I saw at least one client take out his checkbook to contribute to them.  For Animals In The Hospital (FAITH) also had  a table set up at our event, and they collected some much-needed donations.  Another local rescue group was supposed to be in attendance, but canceled at the last minute because the members needed to attend a bigger event in Baltimore.  They inexplicably barred all of their volunteers from attending the Open House to solicit any donations, but we won’t get into that here…

Unless you live in a cave, you have at some point been asked to donate to some charitable organization.  And at least a few of these organizations are animal related.  Who deserves your hard earned dollar? Is there anyone who doesn’t?  What questions should you ask before donating?

1. Does the organization’s mission accurately represent your own values and beliefs?
2. Does the organization (and do its members) operate in a manner that meets your personal moral standards?
3. Where does the money go?  Administrative costs? Research? Directly to animal care?
4. What are the organization’s other sources of funding?
5. Is the organization legitimately registered as a not-for-profit group?
6. Do the leaders of the organization truly live by their mission, or are they there for some other ulterior or self-serving motive?

These are the few I could come up with off the top of my head, but I invite you to leave your own crieteria in the comments section.  And if you have any favorite animal charities, please post their link (or at least a name).  If you have a not-so-good rescue group, please share with us why they’re on your bad list.

But is it really the same surgery?  What do you get for the extra one or two  (or three!) thousand dollars you’ll spend with a surgical specialist?  Here’s what I usually tell my clients: “You may be able to find another general practitioner who can do this surgery for half the cost, but keep in mind that that doctor may only do this type of procedure a few times a year.  A specialist has probably done it a couple of times this week.  Surgeons are also much better trained and equipped to deal with any unforeseen complications that arise during the course of surgery.  Your pet will also be monitored overnight in most cases.”

That speech usually puts my clients more at ease about paying a stranger several thousand dollars to cut open their pet.  As veterinary medicine moves more towards specialization, more and more younger doctors (at least those lucky enough to have specialists in close proximity) will give up on trying to do everything for every animal.  But right now just about every general practitioner will perform some sort surgery during the course of their work week.  It could be limited to spays, neuters and lumps/bumps …but it’s certainly not uncommon to see a general practitioner perform a limb amputation or splenectomy or even a perineal urethrostomy.  I know of one gp in New York City who enjoys brain surgery.  What makes these doctors qualified to do these things?  It’s a combination of things: training, experience, confidence, and the right hospital resources and equipment.  But honestly (and there’s no way to say this nicely) some of these veterinarians are barely qualified to give your pet a rabies vaccine.

I have a few physician friends who are bariatric surgeons.  On their websites, they tout that they’ve done “over 700 bariatric cases” or “approximately 2500 operations overall, including residency & fellowship.”  I think it’s about time pet owners start asking their veterinarians “How many times have you done this procedure?”  It’s then up to you to decide what the magic number is.  At what point does your pet become a bona fide surgical patient rather than “practice” for an inexperienced doctor or, even worse, someone’s “experiment?”

Other questions and issue to consider: What are the most common complications with this surgery?  How will the patient be monitored while under anesthesia? How will the patient be cared for post-operatively and overnight?  What sort of pain management will be used in this case?

For more information on what it takes to become a board certified veterinary surgeon, visit: www.acvs.org/AnimalOwners/WhatisaBoardCertifiedSurgeon/

This time last year, I helped diagnose and treat an outbreak of canine influenza at a nearby dog boarding facility.  We tested several symptomatic dogs via PCR and confirmed influenza as the infectious agent.  In defiance of any media scare (both then and now) none of the cases were fatal.  Zero.  Some got pretty sick, but most presented like your typical kennel cough case.

In general, this virus can present itself in two forms: mild and severe.  The mild form is often self-limiting, and may require only isolation of the dog and supportive care.  I prescribed a 10-day course of Doxycycline to those dogs presenting with mild clinical signs.  With the severe form, dogs tend to be much sicker –their clinical signs include fever, anorexia and lethargy.  Treatment again is largely supportive: rest, nutritional support, and fluid support when needed.  I prescribed a 14-day (or more) course of both Doxycycline and Clindamycin to these dogs.  I used conservative doses of cough suppressants only in cases of severe coughing that affects the patient’s ability to sleep and/or breathe.

Canine influenza is easily killed by most disinfectants and does not survive well outside the host. Household bleach can be used for disinfecting contaminated utensils and the premises. Dilute ½ cup of bleach in 1 gallon of water to make an effective disinfectant solution with a shelf life of about 24 hours.  Regular disinfecting of cages, kennels, feeding utensils etc, and regular hand-washing by people handling infected dogs is advised.

So what issues do I have with the new vaccine?

1. It’s a new product, without a proven track record.  It has been made available under conditional license.  Safety was established in trials involving about 700 dogs.  Not enough to make me feel comfortable using it.
2. It’s an adjuvanted vaccine, making it more likely to cause a post-injection adverse reaction, especially when administered with other vaccines.
3. It’s not an intranasal vaccine, so it will, like just about any injectable vaccine, result in more IgM antibodies than IgA …which translates into less local immunity in the nasal mucosa.  (Yes, this is an over-simplified explanation.)
4. It is only labeled to help control the clinical signs associated with infection.  This means that vaccinated dogs might still get a mild case and could still shed the virus, spreading it to other dogs.
5. Most pet dogs are not at high risk for exposure to canine influenza.  The disease will have its greatest impact in shelter environments or boarding kennels.

I will not be buying the vaccine to use in my hospital anytime soon.  You should speak with your regular veterinarian to see what your dog’s level of risk is.

So what goes into setting the prices at an animal hospital?  For some things, it’s pretty easy.  Medications and products often have a standard markup, often between 100% and 200% in small animal hospitals, plus a nominal pharmacy fee.  Services such as examinations, blood testing, vaccinations and other diagnostic procedures are a whole different ballgame.  These prices vary widely between different hospitals since they’re often determined based on regional and local customary fees.  Or in other words, they’re priced based on what  the local demographics and economy can support.  But sometimes prices can vary widely between neighboring hospitals.

For example, my current examination fee is $59.  That’s cheap compared to some Manhattan veterinary hospitals who are charging $85 to $100+ for an exam, but I’m sure it’s  a lot more than some mid-west practices who get $25-45 per exam.  Is a $100 examination twice as extensive as a $50 one?  Of course not.  In fact, I’m sure there are veterinarians out there charging $100 for an exam who are missing things that a $40 veterinarian would pick up on.  Price is never a good indicator of a doctor’s quality of care -just the cost of living in their hospital’s neighborhood.

Also remember that buying veterinary products and services is not like shopping at the grocery store.  You typically are not just paying for a simple tangible product -you also get client education, product support, dosage calculations, medical history review, and many other “built-in” services.  Well, let’s hope you get all those things.

So when is something too expensive?  There’s a difference between an expensive service that’s simply overpriced and an expensive service that’s worth every penny.  (There’s also a difference between not being able to afford something and not wanting to pay for something).  A good example is an elective surgery such as a cat spay.  My hospital charges $250 to spay a cat under 6 months of age.  We’re more expensive than some area hospitals and cheaper than others.  We include bloodwork, IV fluids and pain-killers, while other hospitals may make those things “optional” (like when airbags used to be optional in cars).  But no matter what we charge, for most general practitioners, an ovariohysterectomy (aka spay) will be the most complex surgery they’ll ever perform in their career.  If we charged for that surgery based on complexity of the procedure (as some other surgery fees are calculated), we’d probably come up with a number well over $1,500 to spay a cat.  However, the general public has been convinced that this is a “routine” procedure that is worth much less.  And let’s face it, how many people would spay their cats if it cost that much?  So while $250 may not be a small amount of money, it’s a pretty good deal for major surgery.

I’ve been criticized in the past by other local veterinarians for not charging enough for my dental procedures.  They cringe when I admit to them that my cost includes full-mouth X-rays of all the teeth.  They say I should charge close to $600 or 700, when I’m only asking for less than $400.  Now, we could talk all day about cost/demand elasticity, but there are really only three big considerations factored into my price 1) I wanted the majority of my clients to be able to afford the service that I place so much importance on.  If I can’t put my equipment and well-trained technician to use …then why have either of them? 2) I want my staff to do lots of dental procedures.  Practice makes perfect. 3) Since at least half of dental disease is hidden under the gum line, I figured that any “discount” of the general cleaning would be offset by the disease and pathology we identify with dental X-rays.  It’s a win-win situation: when you practice good medicine, without shortcuts, and at a fair price …both sides get rewarded.

It’s sometimes tough to remember that most veterinary hospitals are NOT non-profit businesses (even though most hospitals are unintentionally run like non profits, but that’s a whole different blog altogether).  Hospitals need to make a profit in order to expand services, maintain and update equipment and properly compensate their staff and doctors.  The overhead for a small animal practice can be pretty high, and some consultants even break it down to dollars per minute!  I try not to get too caught up in all the little numbers so I don’t forget the big picture stuff:

• We need to pay the mortgage -not on our own homes, but the practice/building itself.  In five years, I’ve just started to scratch the surface of the principal…
• We need to purchase and stock medical supplies and medications -including things that we don’t use very frequently.
• We need to compensate staff and provide them with benefits.  With support staff, you often get what you pay for.  Most veterinary hospitals still do not provide health insurance benefits for their full-time employees -and they wonder why they can’t hire/maintain good staff.
• We need to purchase and maintain equipment.  Medical equipment is never cheap.  Some instruments will directly generate income for me (e.g., my $65,000 digital X-ray unit or $12,000 serum chemistry machine), while others only enable us to continue practicing high quality medicine (e.g., my $5000 anesthetic/vital signs monitor or the $1000 doppler that my tech has on her wish list).
• We have utilities to pay.  We try as much as possible to conserve electricity and water at the hospital, but inevitably, lights will have to turned on, and we run an average of 6 loads of laundry per day.  If anyone would like to donate solar panels to help offset our utility costs, I’m happy to accept them :)
• Nothing lasts forever: every square inch of the hospital and everything contained within it will eventually need repair or replacement.
• The tax man always takes his [un]fair share.

So what else out there does NOT technically require a prescription from a doctor?

• Most topical flea and tick treatments, including Advantage, K9 Advantix and Frontline Plus.  These are over the counter insecticides, regulated by the EPA, not the FDA. However, some of the newer broad spectrum topical insecticides such as Revolution and Advantage Multi do require a script.
• Capstar is over the counter.
• Program tablets and suspension (but not the injectable version) are over the counter
• Hypertonic saline ophthalmic ointment is surprisingly not a prescription medication, but the pharmacists always keep it behind the counter and it really shouldn’t be used except under the direction of a doctor.
• Cosequin, Dasuquin, Welactin, FortiFlora, Viralys and every other nutritional supplement is over the counter
• Insulin is an interesting one -I’ve seen many pharmacies dispense Humulin without a prescription …but you’ll definitely need a script for the syringes and needles.
• Famotidine tablets in their 10mg and 20mg strengths are available over the counter, but the liquid suspension is not.

I’m sure there are more that I can’t think of on a Friday afternoon! Feel free to add to  the list in the comments section.

And remember, always keep your veterinarian in the loop when using ANY medication that he/she is not dispensing directly to you.