Veterinary practice owners can change a belief into evidence - DVM
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Veterinary practice owners can change a belief into evidence
Start gathering patient data and tracking outcomes to stop practicing one-size-fits-all medicine.


For chronic pain, we used green sheets to compare two different therapy plans: tramadol vs. pentazocine and naloxone (Talwin Nx). Our data showed that pentazocine and naloxone work best in most cases.

We've all read that 40 percent of ruptured cruciate knees involve meniscus tears. But only 10 percent of my practice's cases involve meniscus tears. How about those resorptive lesions on the roots of feline teeth? We always hear the statistic that 40 percent of cats have roots with these lesions. But only 10 percent of my cases have these lesions. Lactic acid for horse colic surgery prognosis? In the mid-1980s, my practice collected data on 40 colic cases in which the human assay for lactic acid accurately predicted the outcome. Boy, did that get whacked at the Western Veterinary Conference back then. Today, it's a standard veterinary in-house test.

Here are some more issues we've tracked with green sheets:

  • Vaccines. We tracked vaccinated patients vs. disease incidence. Dogs that came to us with parvovirus infection were unvaccinated or undervaccinated or had owners who'd used over-the-counter vaccines from the feed store. None of them were more than 5 years of age. We also tracked leptospirosis vaccination vs. disease cases and didn't find leptospirosis cases in vaccinated dogs.
  • Tick disease incidence. Fifty percent of the dogs in my locale have antibodies for Rocky Mountain spotted fever and 50 percent have Ehrlichia antibodies. This is important because many in-clinic tests do not test for Rickettsia rickettsii, so now we know to always test for it.
  • Immune nasal diseases. Niacinamide, tetracycline and other combinations are mostly ineffective.
  • Erythrocyte sedimentation rates for dogs. We've tracked thousands of dogs with this test over the decades. If the corrected value is either very high or very low, we know we need to dig deeper because there could be a life-threatening issue hiding. This not-so-common test has a place on the front lines of clinical medicine.

The entire human medical field, including the exemplary Mayo Clinic in Minnesota, have conducted studies to track the outcomes of hundreds of thousands of patients on thousands of issues. A recent medical advisory reported: Skip the prostate-specific antigen (PSA) test. But Mayo Clinic countered with its own advice: Assess the situation individually, patient by patient—there is no one-size-fits-all approach to medicine. Use this methodology in your veterinary practice as a means to provide the best possible care to your patients.

Dr. Michael Riegger, DABVP, is the chief medical officer at Northwest Animal Clinic Hospital and Specialty Practice in Albuquerque, N.M. Contact him by telephone or fax at (505) 898-0407,
, or Find him on AVMA's NOAH as the practice management moderator. Order his books "Management for Results" and "More Management for Results" by calling (505) 898-1491.


Source: DVM360 MAGAZINE,
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