Veterinary Care Well in Hand for Equine Pan-Am Games

The upcoming Pan Am Games are going to see some of the top equine athletes in the world in these parts, and they’re going to have to be cared for.

Dr. Mike Pownall, of McKee-Pownall Equine Services, has been named veterinary services manager for the equestrian events at the Games.

Excerpt from the Caledon Citizen, See full article here: Veterinary care well in hand for equine Pan Am Games

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Equine SOS

The phone rings. We have just finished laughing about the squirrel outside our window that we have named “Nutty,” guarding his tree from fellow wildlife. We answer. On the other end of the receiver is a teary voice, indicating that there is an emergency that is going to have to take priority over anything else at the moment.

Suddenly, Nutty’s antics aren’t so funny. We stay calm, collect the information and contact a veterinarian to get them out to see the horse ASAP.  You may not be able to hear it, but we are having an emotional reaction too. Our mouths feel pasty, our hearts race, our hands get sweaty and we get a pit in our stomach. We page the vet. Why are they taking so long to answer?  It has really only been 30 seconds, but feels much longer.

If 30 seconds seems so long for us, the call from the client perspective must feel like an eternity – especially when the office is asking questions.  Emergencies are scary, and we recognize how traumatizing it is. Like 911 operators, we have to collect all of the right information so we can relay it to the appropriate people (in our case, it is our veterinarians) and provide you with the most efficient care we can.  We want to prevent unnecessary call backs. In these types of situations, you have enough to worry about, without us calling you back to verify something. The following, is need to know information:

  •  The issue the horse is having, and how long it has been happening.  This is important so that we can determine which vet we send, and how urgently we need to get them there.   The occasional colic has been referred to surgery without any intervention from us, due to the symptoms described over the phone and the length of time the horse had been sick.
  • The physical address of the horse – we would feel awful, if you had a sick horse and we sent the vet to the wrong location!
  • If any first aid has been administered, if so – what? Banamine can mask signs of colic, making a horse appear fine when they are really not.  Coating a laceration with product prior to an exam may affect the ability to stitch it.  Pulling a nail from a foot can cause more damage than has already been done.  We like the vet to be fully prepared, with an idea of what is going on, before stepping foot on the property.  We also, do not want to administer drugs again, if a dose has already been received.
  • A phone number that the vet can reach you at, where you will actually answer. We need to be able to get a hold of you with an ETA, or the vet needs to be able to talk to you should they get lost, or require further information.
  • Is the horse insured? This could change the options available to you.

We all have our own pets.  Most of us have horses.  We have developed relationships with clients over the years, and despite the fact that we (as office staff) may not have ever physically met your horse, we can appreciate your stories about how cute he is when he nickers for his treats, or plays with his jolly ball, or lets his friends free from their paddocks/stalls. Through interactions for routine appointments, we feel like we’ve gotten to know your horse.  When something is not quite right, we feel the anxiety it is causing you and can relate to it, because we know how much your horse means to you.

When the phone rings, we never know how the call is going to play out.  While emergency calls can cause some dread, we are glad that we are available to help treat your horse in these circumstances. It gives us a great deal of satisfaction to be able to play a role in getting a veterinarian to see your horse as fast as possible.

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Can You Hear What the Client is Saying?

Every year the Customer Service Representatives (CSR) from all of our practices get together for a CSR training day.  We discuss topics like emergency situations, how to handle different types of calls, how to respond to certain questions and how to provide the best service we can.  It is nice to get a 3rd party perspective.  This year we brought in Dr. Colleen Best as a guest speaker, to help us learn the ins and outs of communication.  Dr. Best is doing research at the Ontario Veterinary College on the impact communication has on the relationship between a client and a veterinarian – specifically in an equine setting.

Something she said, that resonated with me was, “clinical communication isn’t inherent, and needs to be taught.” To make this point hit home, she introduced some scenarios and we took turns role playing.

We are CSRs. Communication is our bread and butter.  This will be easy!

Or not…

If we talk to people all day every day, how is it possible, that we were stumbling through these scenarios?

We were thinking about our answers, and not listening to what our “client” was saying.  Instead of making a personal connection, using helpful filler/catch phrases and engaging the “client”, we were caught prefabricating responses, in an effort to show the presenter our skills.

After a pause, and some discussion about what went wrong, round 2 went much better.

The CSRs, as the initial point of contact, can’t be the advocate for the client if they don’t understand what the client needs.  We can’t really understand what the client needs without listening to what they are saying. One of our goals at McKee-Pownall Equine Services, is to be the voice of the client, and provide the best customer experience we can. To ensure this is our reality, we have to set the bar high and continue to hone our communication skills. Since our interaction is primarily over the phone, we have to understand what the voice on the other end is saying without the benefit of body language, facial expressions and other sight triggers.  Due to the technology we use, we have to solely rely on the words used and tone of voice.

What I learned about myself that day, is that I don’t do as well in the hot seat as I thought.  The veterinarians and technicians complete continuing education courses for practical skills that benefit the client and patient in the field.  We, as CSRs can do the same to benefit the client experience over the phone. By exposing our weaknesses in a group setting, we now all know what we need to work on.

Realizing that the ability to communicate is not something you should just know, made my inadequacies in the scenarios an easier pill to swallow.  I have said it before, and I’ll say it again – there is always room for improvement, and this training day has motivated me to continue to do so.

 

Laura Holmes, Office Manager

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Routine Services – Bundled in a Convenient Package

Everyone has a busy life, and smart businesses are using different methods, to offer convenience to their clients, so it is easier to deal with the business.  One of these methods is to provide packaged services. It is present in the telecommunications industry with bundles for internet/phone and television.  It is present in the auto industry with service/maintenance and warranty packages.  It even pops up in the financial industry with banks offering mortgage, credit and insurance packages.  I could provide a whole page of examples, but I want you to keep reading!

You are probably wondering what this has to do with an equine veterinary practice.

Veterinary medicine has been surviving off of an archaic business model.  Up until recently our governing body in Ontario wouldn’t allow us to offer packages or bundled services.  Things that are considered normal in other sectors of business – are practically unheard of, or cutting edge in our industry.

My horse, Rocky is treated like one of my children. My experience has been that it is much easier to book appointments, access emergency services and obtain patient history for him, than for my human children.  Going through a pregnancy, while working for a vet clinic, gave me plenty of chances to compare the client experience between human and veterinary medicine.  Having a baby meant that I spent countless hours in doctors offices, waiting for labs and  spending time on the phone coordinating appointments.  Once the baby arrived, it was numerous weight checks, nutritional consults and vaccines.  Vaccines were the worst!  Often, the brand name of a vaccine has nothing to do with the disease it is fighting.  Most of the time, I couldn’t pronounce either the drug name or the disease, let alone know how often it needs to be boosted.  I would have appreciated the opportunity to sign up for a program that monitored all of those appointments for me.  It’s a lot to keep track of, and can be quite overwhelming. 

With the recognition, that our clients are busy people we decided to create a Preventative Health Care Plan (PHCP) for your convenience.  We thought about the things that we would want for our horses.  Most people consider routine vaccines, dentistry and worming protocols as standard care.  We wanted to do more, by providing an even higher standard of care.  It is easy to overlook physical exams or baseline blood work, when there are no health issues at the forefront, but by including these services in a PHCP, you will appreciate having something to compare to, should the need arise!  What is exciting about offering this program (from an employee perspective) is that we get to provide a comprehensive health care program for your horse, you get to save some money, you receive reminders for appointments, and your medical records are easily accessible.

We have established that our clients are busy.  We also realize that different styles of owners require different services.  With this in mind, we developed 3 different plans to suit your individual needs.

Don’t become overwhelmed by everyday life. Take advantage of one of the health plan options available to you.  It will make your life easier, and we get to care about your horse as much as you do. Maybe we can learn to pronounce those vaccine and disease names together. 

Laura Holmes – Campbellville Office Manager

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Thank you for calling McKee-Pownall Equine Services

Thank you for calling McKee-Pownall Equine Services – or in this case, checking out our website!  My name is Laura.  You may have spoken with me on the phone or corresponded with me via email.  I am a part of the McKee-Pownall team, but not necessarily in a way that jumps to mind when one thinks of a veterinary practice.

I answer the phone and perform administrative tasks.  To some – it may not seem that exciting, but I love it.  I love the client interaction.  I love the wealth of knowledge that I have access to.  And I love the satisfaction of a good client/patient outcome. While a good patient outcome 100% of the time would be fantastic, it is not realistic.  Through all the highs and lows of horse ownership, the one thing that we can provide as a constant is excellent customer service.

Here is an example of where I was let down by less than stellar customer service. I had put my money in a bank that had wooed me with a points system and a slew benefits for switching to their services.  On paper it was a great deal, and the employees were all pleasant to deal with.

Then I was faced with the items I did not read in the fine print.  To benefit from the points system, the bank account HAD to be applied for online.  So, I applied online; however, a whole new bank account was created for me.  Now I had 2 bank accounts that served the exact same purpose – and would have to pay the same monthly fee.  I closed the initial account, only to have complications with the automatic payments.  While the request had been made in the system, the process was never completed, which resulted in some missed payments.  The bank was more than happy to charge me some administrative fees, for their error.  After resorting to (what I like to call) “Squeaky Wheel Syndrome”, the issue was sorted out: after 5 weeks, and one more series of missed payments.

I was the one who had to follow up, and I wasn’t very happy about it.

All that this bank had to do to make this a great client experience was:  Take the time to resolve the issue correctly, while keeping me updated.

Simple right?

It seems that the societal norm for customer service is excessive hold times, multiple transfers, speaking to a robot and falling short on expectations set.  I’m not the only one with a story similar to the one above.

Armed with personal experiences, the Customer Service Representatives at McKee-Pownall are given the opportunity to put themselves in the client’s shoes.  The guidelines are easy – Don’t surprise, don’t confuse and keep the communication open. Our mandate is to be the advocate for the client. We know how stressful a visit from the vet can be so we try to make the experience a positive one.

McKee-Pownall Equine Services believe that excellent support staff is a key element to the overall experience a client has with us. By working together, letting people do what they are good at, the vets, techs and CSRs are able to provide the type of service and veterinary care that we would want to experience as clients. A bonus to us is that we enjoy where we work and the people we work with.

The next time you are contacting the office, feel free to drop a line on things you like or wish we did.  We are always open to suggestions and believe that there is always room for improvement.

Laura Holmes ~ Office Manager

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Finding Nutritional Value!

This past year, McKee-Pownall has started doing nutrition consultations for patients with specific medical or performance issues.  We’ve found it to be very helpful to provide some medical guidance for our clients and patients, and rewarding to work together with their current feed supplier to find good solutions for their horses.  The great thing about nutrition consults is that they are always different and provide an interesting challenge to find a solution to help both the horse and the owner.  I have also really enjoyed working with the people in our practice who share a love of nutrition; Dr. Tovah Caldwell and our RVT, Stacey Thompson.  Together, we’ve worked on some diverse issues and made a meaningful difference in our patients’ lives.  Some of the cases our team have worked on:MWP_020910-47

  • Polysaccharide Storage Myopathy (PSSM)
  • Laminitis
  • Low energy
  • Stall rest and the high strung horse
  • Gastric ulcers
  • Tying up
  • Weight reduction/weight gain

I like to focus on cases with a medical issue, so that we can combine what we know about the case, as well as the horse and owner’s particular situation and put this together to make a personalized plan.  It is amazing what a difference good nutrition can make in a medical issue.  Food really can be amazing medicine!  It really makes me happy to reduce pain or put weight on a horse without using a bundle of medications, or to be able to cut back on meds he needed several months ago.  We know this to be true in human nutrition (it’s pretty unlikely that you’ll get six pack abs if you’re eating McDonald’s and ice cream, or even a bunch of pre-processed foods) and it is no less true in horses.  The wonderful thing about horse nutrition is that we can see quick results because horses can’t cheat and sneak an extra helping or a chocolate bar on the sly.  They eat what we supply them!  The interesting thing has also been a paradigm shift, as I look at the horse in a holistic sense.  This approach sits well with me, as I have looked at horses in a big picture way since taking the acupuncture course.  Chinese medicine uses food as medicine as well, and it’s kind of neat to see how Chinese food beliefs actually match up nicely with what we know from science about nutrition today!  As Thanksgiving draws near, here’s to happy eating for all of our horses and humans.  I know I’m going to enjoy some of the medicinal effects of pumpkin pie (pumpkin has great fibre content after all.)

Melanie Barham DVM

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Challenges of Supplying Medications

With the advent of online pharmacies in the US, as veterinarians, we are often asked why we don’t carry a certain product, or why prices are sometimes higher in Canada than what is advertised on a US online pharmacy. The simple answer is that Canada and the US do not share drug approval systems; so what is available and approved in the US may not be approved for use in Canada and vice versa. Also the product manufacturers often have separate Canadian and US divisions or suppliers. Believe it or not we share these same frustrations and often ask our suppliers these same questions. It drives us crazy that US veterinarians can purchase some products so much cheaper than we can as their counterparts. Unfortunately, the higher price for us means a higher price for clients.

 A case in point is Adequan: Even though the same product is sold in both Canada and the US, there are many differences. 

US

Canada

10 dose bottle

 

7 dose box

7 dose box

Luitpold is the manufacturer and supplier

Novartis sells in Canada

The selling price to vets is much less expensive in the US than in Canada. In the past we had seen some online pharmacies selling it at a retail price less expensive than we can get it from our suppliers! Fortunately for the past 2 years Novartis, the company we deal with in Canada, has tried to combat cross border shopping of the product and has lowered their prices. We are able to buy in large volumes thereby reducing our costs even further, which we are happy to be able to pass on to our clients. We now sell the 7 dose box the same price at the equivalent product shipped from the US, taking into consideration the cost of shipping the product to Canada.

There is another advantage of buying veterinary medications from a veterinarian and that is that we can advise you on the best medication for a condition and proper dosing levels. For example, recent research from the makers of Adequan has identified that instead of giving a 7 dose starter series followed by monthly injections one can give a horse the initial 7 dose starter series and then repeat that series in 6 months. There is no need for a monthly or biweekly “maintenance” injections. Instead of giving 18 injections a year (7 doses plus once a month) you only need to give 14 shots total per year ( two 7 dose series).

There is a shortage of Adequan in the US that is expected to last until the end of the summer. We have a large inventory of the product that we have available for our clients. Due to our limited supply we must limit purchases to one box per client. If you have any other questions on why some medications cost more in Canada than in the USA please let us know.

Mike Pownall DVM

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Head it Off at the Pass- Preventative Preparations for Show Season

As we prepare for show season, most riders think of extra lessons, fitting up their eventers with conditioning programs and trailering in to school at different arenas and venues and buying new accessories and gear. As a vet, my perspective is a little different, as I think of the ramped up work load as an extra stress/strain on joints and muscles, vaccination, deworming, nutrition and dental floating. Just as people are getting geared up for bikini season with extra training sessions and if we’re lucky, a new wardrobe, so are our horsey companions. However, they aren’t getting prepped to lay on a sandy beach with a cold beer, they’re getting ready to work harder in the summer heat!

As I found when training for a half marathon, in a new training program, your muscles are sometimes sore and problems you never knew you had come to light. Before you know it, you’re finding it difficult to train/compete due to an injury! Before my first ½ marathon, I developed very painful shin splints, and found out I needed orthotics and needed to retrain myself to run in a more ergonomic way, as well as perform exercises on an ongoing basis to strengthen my muscles to avoid further injury. If I had taken the principles I apply to my patients, I could have avoided the agony of sore shins and had a much more comfortable race. A mid-training dynamic exam with a physiotherapist/ sports medicine doc would have revealed these problems and helped me solve them sooner!

Typically, I encourage as many of my patients as I can to take advantage of a pre-season checkup, which includes a physical exam and a dynamic musculoskeletal exam. I consider myself one part of the horse’s health care team, and I hope to be one of the voices to let the rest of the team know what is going on. I could obviously tell my doctor that my shins were killing me. Horses have all different ways to let us know; whether through actual limping, mild tenderness on palpation, a change in attitude etc. It’s best if the horse has been in at least moderate work prior to the examination so that we can gain the most information. Listening to the heart, lungs, GI tract and looking in the eyes are just part of the physical exam. I have often identified new heart murmurs (potentially dangerous when jumping obstacles!), or cataracts or other ocular abnormalities that would otherwise be unknown, even on horses who have been normal in previous years. Additionally, it allows us a chance to take a dedicated look at the horse in a holistic sense. Is there weight gain/loss? Muscle loss, or uneven development? Is his coat all of a sudden dull and burnt out?

The palpation and dynamic aspects of the exam is an important annual aspect as well, allowing me to monitor ongoing problems and identify new ones prior to investing in expensive show fees. Conformation issues, shoeing changes, or new lumps and bumps and areas of referred pain give me clues to changes or areas of soreness in the body. Sometimes we’ll find some lower back pain prior to true hock pain, or a small splint that has been causing a left drift. The dynamic aspect of the exam is usually performed on the lunge line to start, and involves a thorough look at how the horse behaves in motion. A new way of moving a limb, out of character behavior, or new musculature issues can all be clues to a small underlying soreness. We may perform an under saddle portion, or surcingle exam. Flexions are a part of the exam allowing us to stress a particular joint and see if there is any change to movement. When I look at horses annually, I get to know them pretty well. Sometimes I forget a horse’s face marking, but I can often recall their legs and way of traveling for years! Of course good record keeping is also key!

A common misconception many clients have is that pre-season checkups always end with the recommendation to inject specific joints and a huge bill. Sometimes this is elected, but I tailor my approach to the level of competition of the horse, age, issues we know to be at hand, and what is best for the horse. Understanding your goals for the season helps me make better recommendations. For example, if you were hoping to jump FEI in 3 weeks’ time, leaping over 1.50m fences and continuing with an aggressive schedule for the season with your campaigner with some extra arthritis baggage, I’m going to recommend something different than a young clean horse in his second year of A level or Trillium level competing! Often I will make shoeing recommendations together with the farrier, provide exercises to strengthen an area, recommend a nutrition change, or recommend preventative care such as Adequan, acupuncture or chiropractic to maintain a specific problem. The rider is usually more aware of specific deficits their horse has, so they can work on them with their coach too. All in all, a pre-season examination usually yields good preventative results for most horse rider teams, it allows us to get a handle on how the horse is doing going into the season, and have some idea of what bumps there might be in the road ahead.

Melanie Barham DVM

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Veterinarian or Chiropractor- What hat will I wear today?

Chiropractic Services with Dr. McKee

I want to start today by thanking our clients- I have been intensely gratified by the interest in chiropractic care for your animals and the enthusiastic response that Dr Surasky and I have received now that we are certified practitioners.

This leads to an interesting challenge- who am I exactly? Chiropractic theory and practice has given me a new way to assess and treat patients, and it has also improved my skills as a lameness and performance veterinarian. The challenge now lies in deciding how to proceed with an integrated approach on a case-by-case basis.

Sometimes the decision is made for me when a person who already has a regular veterinarian contacts me purely for chiropractic care and nothing else. Although this is often related to an ongoing lameness or performance issue, my role is very clear. I perform my exam, followed by appropriate adjustments, but it is not ethical for me to “take over” the case or indeed the entire client based on that interaction. I am both humbled and grateful when another veterinarian refers a horse to me for chiropractic, and I would not jeopardize my professional reputation by becoming a “pirate”. “But”, you may ask yourself, “what if you see something that is critically important to the overall case?” This is where openness and communication is key. I should be able to speak to the regular veterinarian about my observations and how they may contribute to the overall diagnosis and management of the horse. This is in the best interest of the patient, yet it preserves the relationship between client, the vet they have known and used for years, and me in the role of chiropractor.

Other situations are more complex. We see a lot of lameness and poor performance problems in our caseload, and while some are fairly straightforward, others are the result of multiple subtle issues that finally culminate in an observable problem. Once we get past the easily identifiable head-nods and concrete diagnosis through blocking, we are left with these complicated and challenging cases. Chiropractic has given me additional keys for unlocking this puzzle, but I have to decide where to integrate it into my diagnostic and treatment strategy. Is a series of adjustments alone going to be enough to resolve the problem? Do we have to start with more aggressive interventions? Ultimately I have to devise a program as unique as the individual I am treating.

This is when I manage to squish both hats onto my head. As a veterinarian-chiropractor, I palpate all over the horse’s body and limbs, observe it move under various conditions and challenges, and decide what areas to focus on. As a veterinarian I perform the diagnostic tests and imaging, various therapies ranging from joint injections and PRP/IRAP to shockwave, mesotherapy, and more, and finally set up the ongoing medication and management protocols. As a chiropractor, I perform the adjustments and suggest stretches and exercise programs that will develop the proper musculature and functionality. Finally, I put both hats on again and try to identify how those multiple separate issues have contributed to today’s problem. Whether we start with chiropractic alone, or more aggressive treatments followed up by series of adjustments all depends on the nature of the problem, the circumstances of that particular individual, timing of competitions, and preferences of the owner/trainer. There is often more than one way to effectively address the issue, the key is to create a plan and stick to it, with regular reassessments to make sure we are staying on the right track.

While integrating all I have learned in my chiropractic training into my longstanding experience in equine veterinary medicine can be difficult, it is a challenge that I welcome wholeheartedly. It means that I have more resources to draw upon when trying to do my best for our equine companions.

Melissa McKee DVM

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Animal Chiropractors – Are they all the same?

Dr. Surasky

Well,  final examinations are now over for the 5 week long Animal Chiropractic course that myself and Dr. McKee have been attending.  I am sad that it is over, since the wealth of knowledge and passion the instructors possessed was unending, and I wanted to absorb as much as possible.    Not only was the specific class time intense (12 hour days with oral, written and practical examinations), but the work outside of class  was also intense (case reports, journal articles to read, practice and studying). It got me thinking that with the lack of specific regulations and the lack of “policing”, how can a potential client determine who is qualified to perform chiropractic care on their animals?  Unfortunately, animal chiropractic is  like the farrier industry – the amount of training can vary from none (self-taught), to a weekend course, to an intense course that often includes an apprenticeship or practical component.  Results will  also vary based on the individual performing the treatment.

Let’s look into the different ways you could evaluate a possible candidate to provide chiropractic care for your horse.  First off, find out if they are certified.  There are 2 main groups that provide certification in the area of animal chiropractic care – the College of Animal Chiropractors (COAC) (http://collegeofanimalchiropractors.org/en/), which is an international organization, and the American Veterinary Chiropractic Association (ACVA) (http://www.animalchiropractic.org/). To become certified by either of these two groups, the candidate must be either a human chiropractor (DC) or a veterinarian (DVM).  This ensures the individual has a comprehensive knowledge base to draw from.  As well, they will have complete a regulated course on animal chiropractic that includes both written and practical testing throughout the program. If the candidate has passed the course, they have to write yet another examination in order to be certified.  Finally, to maintain certification a candidate must also complete a specified amount of continuing education every year to ensure they are up to date on the most recent advances and techniques.

If the individual is not certified by the COAC or ACVA, inquire as to how they learned their craft – legitimate courses have extensive information available online, so take a peek to see what was involved.  Speaking from personal experience, a weekend is not enough time to properly learn animal chiropractic even if you are already a veterinarian or a human chiropractor – there is just too much information!

Because of  confidentiality, a certified animal chiropractor is not able to give out clients names for  references, but you can ask other horse owners who they use and if they notice an improvement in their horse.  Finally, try to be there for the adjustment so you can watch it yourself – chiropractic is not adjusting the entire horse- it is adjusting individual segments- so it should not look rough and they should not use any mallets or other external devices.

Although this is not a fail safe method, it can be a good way to ensure the person working on your horse is competent and will do the best job.

Kathryn Surasky, DVM

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