Handling cash and electronic payments options can get wild and woolly. This isn't a detailed how-to but a "Have you thought about this lately ... ?" reminder to check your systems. While sometimes it seems like every twenty something is firing off money to each other (and online vendors) on PayPal and Venmo, brick-and-mortar veterinary hospitals still need to offer a far wider array of client payment options (at least until we all get our cybernetic implants with credit-card chip readers in our foreheads). So, let's get back to basics and offer some pros, some cons and some best practices for managing payment-from cash to apps to everything in between.

Even as we transition into a cashless society, some clients still prefer the option of good ol'-fashioned currency. It wasn't so long ago that cash was the preferred payment method in a veterinary practice; now, estimates are that it runs just 5 to 7 percent of revenue.

No after-the-fact cancellation or transaction disputes.

Some clients live in a cash-only world, so to refuse cash payment is to refuse their business.

Risk of embezzlement. (Could it happen to you? 

 entrant.) A practice grossing $2 million annually is likely sitting on $10,000 dollars a month in cash flowing through the books. That's a tempting target for a potential embezzler, so strict oversight and strong internal controls are crucial.

 Make cash deposits as frequently as possible.

Claim all cash payments as revenue, no matter how tempting to do otherwise.

 Keep your internal controls tight, and 

OK, folks, the dvm360 team loves this article, but if it's too long this second, just do these things:

 and make sure you've set up good internal controls to manage cash, checks, bank deposits and credit card information. This is non-negotiable, unless you want to be 

> Decide what client payment options you accept (cash, check, credit cards, debit cards, third-party payment plans, IOUs) and 

 and understood by > If you do IOUs, don't overdo it, please? Your CPA (like, say, author Tom McFerson) will be super-bummed, you'll have trouble keeping the doors open, and you'll have trouble paying folks a living wage.

Once a main source of payment for a veterinary practice, now personal checks are less than 5 percent of revenue in most facilities. Checks are still written by larger clients (nonprofit groups, for instance) when paying for multiple invoices at one time. Checks are a necessary evil-nobody really wants to accept them anymore, but everyone feels they need to.

 With check verification services, the chances of a bounced check are now significantly reduced.

Fees for verification and immediate deposit can be costly. 

(Here are 10 banking mistakes that can cost you or your veterinary practice big.)

For checks from businesses, verification is more complicated and often requires a trip to the bank.

 Strong internal controls are a necessity, especially if bank trips are required to deposit the checks.

 There is an opportunity for fraud (checks copied and forged, account numbers stolen and used, all by a rogue employee).	 

Allowing a client to walk out the door with only the promise to pay is a payment method offered by practice owners with a soft spot and frowned upon by financial advisors. 

A nice feeling to assist those in financial need. You feel good, the staff feels good, the client absolutely feels good.

Many hard-luck cases are hard-luck for a reason, and you're likely not the only bill they owe around town. Once the client leaves the premises, you'll have little leverage for collection.

Your warm feelings may begin to dissipate as your IOU ages from 30 to 60 to 90 days old.

A client's financial misfortune shouldn't be your problem. Choose wisely whom you extend credit to, realizing that the chance of collection drops by 60 percent once they walk out the door. (If you're going to do this, consider 

 and enforcing it throughout the practice.)

Credit cards and other financing options comprise the lion's share of veterinary practice revenue, often 80 to 85 percent. That usually includes American Express, Discover, Mastercard and Visa.

Fees are dropping and remain competitive. Most practices pay fees of less than 2 percent on credit card transactions.

Funds can hit your account the same day, as opposed to the old days of a three-day wait time.

Fees vary depending on which card is used. (American Express is usually the priciest.)

With multiple clients paying by credit card in a given day, tracking these batched payments into your checking account can be messy and time-consuming.

Payments can be disputed and/or reversed by the client after the fact.

This method of payment drastically reduces the risk of embezzlement, but a rogue employee can still subject the practice and your clients to credit card fraud with stolen numbers and verification codes. Make sure multiple people check payments like this. (Don't forget to 

 for your personal and business needs.)	 	

 A new and growing payment method that lets friends and family members contribute funds towards the payment of a bill. Any fees are typically paid by the client.

 Usually for owners of animals with expensive medical issues, this allows friends, family or the general public to contribute toward the payment of a bill.

 This is a step better than an IOU. Trade services for services. For example, a plumber trades you his killer skills for your veterinary services. Properly accounting for this can be tricky, so check with your accountant and get this stuff in writing.

Younger clients prefer debit cards, especially those who abhor credit card debt

 A driving force in the emerging cashless society. (Not sold on cashless society? 

You're not the only one, says this university.

 Fees are reasonable, and the payment hits your account quickly.

Occasionally, clients without credit may have trouble paying larger invoices when their bank account is low.

While this is an ideal method for smaller client invoices, be sure to weigh the fees per transaction and consider instituting a minimum.

A third party extends credit to the client when there are no other reasonable payment options. In some situations, a client may not have a checking account or a credit card available to make a payment. The third party will offer the client credit based on a quick application process.

Allows clients without the immediate funds to pay and care for a sick pet.

Gives practices a low-risk payment option for potentially high-risk clients.

Fees aren't cheap, but on larger invoices, they're usually an amount you're willing to swallow.

The application process, while quick, is still a process. The approval needs to be handled before the pet is admitted, which can be awkward.

(Check out many of the current players here.)

 Verify costs, approval rates and timeliness before making a decision on which to offer to clients.

Whether you accept all these forms of payment or just a few of them, think through the pros and cons and see if you want to check up on a better deal you could get for your practice from a banking or credit card vendor, or whether it's time to finally let IOUs go. Get out there, do great work, and get paid-and get your team paid!

Tom McFerson, CPA, ABV, is partner at the veterinary accounting firm Gatto McFerson in Santa Monica, Calif.

Articles

Dont let pet owners, credit card vendors, banks or crooked team members pull the wool over your eyes. Check out the ways clients pay for services rendered and consider how your veterinary hospital stacks up when it comes to managing them.

Don't get fleeced on veterinary client payments

In the age of big box stores selling pet products and internet retailers all up in your business, you may be wondering if it's even worth dedicating precious floor space to the prospect of selling goods to your clients. We put the question of planning for retail space to 

 conference speakers Vicki Pollard, CVT, AIA, and Dave Gasser, AIA.

First of all, the topic of even offering retail must be addressed on a clinic-by-clinic basis. "That question really comes down to the owner's preferences," as Gasser puts it. If the situation is favorable, then how much space do you devote to products? Pollard says that while some online outlets mean to take your business, others can help by cutting down on the number of dusty boxes you have on hand.

"Therefore you can do a smaller retail area and just display one item of each of the products you're selling which can help with efficient planning in your hospital," she says.

Retail revolution: How to thrive (not just survive) in 

If you're going to commit the space and resources to a retail display, be certain the stuff isn't hidden or hard to get to.

"You want it to be in the path of travel from your lobby area toward your exam rooms, or maybe even next to your hospitality space," Pollard says.

With respect to the actual displays, our speakers agree on the need for shelving to be flexible and integrated with the setting. Your displays should be placed "in a way that enhances the overall feel and design of the facility and doesn't feel like an afterthought," according to Gasser. And Pollard believes that in addition, shelving should be adaptable to allow for the swapping of different products.

If you'd like to hear more from Pollard, watch the video below.

At Fetch dvm360 conference, we're the support system you need. With every conference this year, we intend to nurture your mind (meaning quality CE for days) while also encouraging you to take stock of your physical and emotional health. 

Videos

Two architects add their perspectives to the debate.

To bring retail into your veterinary clinic or not?

If you find dermatology products too confusing, too time-consuming, or just a downright waste of your time, then keep reading. We're going to discuss the absolute basic dermatology products you need to be successful and remain efficient. Here are five that should be in your skin care arsenal.

There can be no argument that the most common skin problem of small animal patients is allergy. However, most of your allergy patients present because of infection. Chosen wisely, topical therapy treats infection, prevents infection and also supports your patients' fight against allergy. And antimicrobial shampoo remains the hallmark of topical dermatology therapy. Fetch dvm360 sneak peek:

Dr. Darin Dell, DACVD will provide more love for his favorite derm products in his lecture “Dermatology products for those who don't love dermatology” at the 2019 Fetch dvm360 conference in Baltimore. To register, visit 

You could stock just one shampoo (MiconaHex+Triz-Dechra, Douxo Chlorhexidine-Ceva, or BioHex-VetBiotek) and do well in any situation. These products contain a combination of both antibacterial and antifungal therapy in addition to ingredients that replenish the barrier function of the skin. If your client can't shampoo their pet, don't fret! Steer the conversation to wipes or mousse (same brands and formulations as above), which provide the same benefits but require less work and often less stress. Wipes are great for small areas like paws and facial folds. Mousse is great for larger areas like the axillae or groin.

One final note: I recommend using these name brands specifically. Distributor versions often contain lower concentrations of active ingredients. Over-the-counter products from the pet store should be avoided like 

Keep ear wash options simple with just two. I recommend Epi-Otic Advanced (Virbac) for routine cleaning and average ear infections. If you see rod-shaped bacteria on otic cytology, then you need a TrizEDTA product. My favorite is Mal-A-Ket Plus TrizEDTA (Dechra).

Going buggy over mites and dermatophytes? Your options in the new isoxazoline class of parasiticides are all effective at killing skin mites and lice (as well as fleas and ticks). To keep your inventory simplified, consider Bravecto (Merck), which offers oral and topical formulations for both dogs and cats. Another new option is Revolution Plus (Zoetis), which is great for cats. Revolution Plus also prevents heartworm disease.

New on the dermatophyte front is a feline-approved oral itraconazole liquid (Itrafungol-Elanco). For dogs with dermatophytosis, I recommend oral terbinafine. Terbinafine is available as a very affordable generic and has few side effects.

Speaking of dermatophytes, here's a bonus tip (not technically product-related but still valuable for general practitioners): If you've ever been plagued by the “what-if” of scabies mites, you can send off a blood sample to IDEXX for a 

 ELISA test. IDEXX also offers a dermatophyte polymerase chain reaction (PCR) test for those who don't enjoy cultures or waiting. PCR results are typically returned in one to three days.

Last, what would a dermatology discussion be without some mention of therapeutic food? Hill's and Royal Canin both make “skin support” diets. These are not diets for patients with food allergies. Consider these diets for clients who want to do more after you already have a “core” therapy for the patient's atopy.

To diagnose food allergy, I recommend Royal Canin Ultamino (both dog and cat formulations but only dry), Royal Canin Selected Protein KO for dogs (formerly Iams KO), or Royal Canin Selected Protein PR for cats. If you have a client who opposes “big dog food companies,” then consider Rayne Clinical Nutrition (

These products will cover your dermatology basics and allow you to help a multitude of uncomfortable pets and miserable owners. For everything else, feel free to send your patients to me or one of my ACVD colleagues.

Dr. Darin Dell spent six years in general practice and two years in emergency medicine before becoming a diplomate of the American College of Veterinary Dermatology in 2012. He is currently on staff at Wheat Ridge Animal Hospital near Denver, Colorado. Dr. Dell's hobbies include woodworking and mountain biking.

Pustules, crusts and hot spots not your thing? These basic treatment options have you covered for most casesyou can always refer the rest.

Fuss-free derm: 5 products to handle most veterinary skin problems

David Dycus, DVM, MS, CCRP, DACVS-SA, and Matthew Brunke, DVM, DACVSMR, CCRP, CVPP, CVA, are on staff together at Veterinary Orthopedic & Sports Medicine Group in Annapolis Junction, Maryland, and occasionally lecture together at 

. So it was natural that they would both wind up onscreen discussing how surgeons and rehabilitation specialists work together.

The two areas of veterinary medicine are in lockstep in terms of treatment, but there's a more basic component to their coexistence. It boils down this: communication.

Dr. Dycus says for people, the process is surgery, home, therapy. And this is becoming the same for animals. This is where the union of the two specialties comes in: The doctors must be coordinated for future treatment. He gives this example:

"If I do a TPLO versus a lateral suture, we really want to create a patient-centered, specific response as to how we manipulate those tissues," he says.

Sharing this information, then, is essential for the next specialist to do his thing.

Dr. Brunke comes from the opposite perspective of the rehab doctor, but shares the same opinion.

"You guys can do wonderful work in the operating room (that) an owner can undo by not taking care of the dog going forward, or the cat going forward," he says. "So pass that baton of management of the case [to the] rehab doctors."

He goes on to point out that this team approach can then point back to the surgeon in the case of something being amiss.

Watch the video for more from Drs. Dycus and Brunke.

	At Fetch dvm360 conference, we're the support system you need. With every conference this year, we intend to nurture your mind (meaning quality CE for days) while also encouraging you to take stock of your physical and emotional health. 

Sharing of information leads to success stories.

Surgeons and rehab specialists should work together for the best patient care

"I love her, but this is really tough." For years when I prepared for hospice cases, I struggled with the thought, “What more can I tell this owner about their pet?” As a hospice veterinarian, my pet patients are mainly coping with a terminal illness or struggling with geriatric conditions that are impinging on their quality of life. Thankfully, many of my patients are already receiving high-quality care from specialty or primary care veterinarians and are being treated under a good medical protocol. Early on in my seven and a half years as a hospice veterinarian, I realized that my greatest value is not in the medical arena but in discussing with owners how to be a caregiver to their pet and helping them 

. These conversations are priceless to owners, and I've learned to master these appointments.

When I recently attended the American Geriatrics Society's annual conference, I learned that geriatric physicians consider helping the caregivers an integral part of preserving the patient-family bond. Caregivers face a lot of frustration and depression; they are in desperate need of assistance. I compared this to caregivers of chronically ill pets and can see the similarities-at least in my line of work. The 2017 study I reviewed in my companion article 

Journal Scan: Studying the caregiver burden of owners with very ill pets 

proved what I've seen anecdotally in my career.

Many families struggle with the emotional toll of caring for their sick pet. It is something we are highly sensitive to within our practice. Educating owners and giving them the tools they need to deal with the struggles is vital to a successful relationship with them. I also have to realize that there comes a time when the owner's emotional budget is empty. At that time, the human-animal bond is broken, and often euthanasia is best for everyone. It's important not to judge a family during this time. What you may be able to handle may not match what your clients are able to handle. I reassure the owners that when they are tapped out emotionally, I will be there for them. With that said, my goal is to avoid an emotional burnout-and that is where education and communication are key! There are bountiful resources available for caregivers in the human medicine world but not in the pet world … yet.

 Help pet owners learn as much as possible about their pet's disease, the clinical signs their pet will face and ways to manage those signs. On our website, the pages that talk about the disease and tips to manage them are popular with pet parents and our veterinary peers alike! Even during appointments, families will tell our veterinarians that the 

 For pet owners, turning to support groups or even counselors may be appropriate during this time. If there aren't any in your area, look for 

. Although not identical, they offer wonderful support and ideas on how to manage caregiver fatigue. Always focus on the wonderful care owners are providing rather than the deterioration of the pet-which is sometimes an unavoidable outcome.

 Let owners know that it's not always possible for them to handle all of the responsibilities of caregiving. Encourage them to reach out to friends, family and illness-specific social media groups. 

 is a private online community where owners can create and invite people to join their pet's corral. It offers a calendar for divvying up duties, as well as storytelling tools and other ways to help caregivers find the support they need.

 In human medical caregiving situations, caregivers garner great benefits when they can rely on respite services that give them time to just relax and take care of themselves. This can be a great opportunity for veterinary technicians to get involved. Home care, overnight sitting, treatments, etc., are just the start of ways our technicians can help caregivers. Or you could create a respite program in your clinic!

If we look at human caregiver studies, findings show that caregiver stress also takes an emotional toll on the medical team caring for the patient.

We could theorize that a similar impact occurs in veterinary medicine. If we work to alleviate the stress that caregivers face, we might also ease the stress that is displaced to our veterinary team. This is good not only for the pet owner and your staff, but also, most importantly, for the pet.

Koh KB, Kim CH, Park JK. Predominance of anger in depressive disorders compared with anxiety disorders and somatoform disorders. 

Frostholm L, Fink P, Christensen KS, et al. The patients' illness perceptions and the use of primary health care. 

Hilbert A, Martin A, Zech T, et al. Patients with medically unexplained symptoms and their significant others: illness attributions and behaviors as predictors of patient functioning over time. 

Brodaty H, Hadzi-Pavlovic D. Psychosocial effects on carers of living with persons with dementia. 

Dr. Gardner is a co-founder of Lap of Love Veterinary Hospice, a network of veterinarians around the country whose goal is to empower every owner to care for their geriatric pets. She is also co-editor and contributing author of the textbook 

Treatment and Care of the Geriatric Veterinary Patient

When working with owners of very ill pets, your greatest value may not be in the medical arena. Supporting caregivers through education, communication and these other real-world tips can make this trying time easier for owners, your staff and, of course, the pet.

Helping clients face the caregiver's dilemma: How do I tend to a sick pet without losing myself?

Pyoderma is a straightforward bacterial overgrowth on the skin-or is it? Craig Griffin, DVM, DACVD, of Animal Dermatology Clinic in San Diego and a recent CVC speaker, maintains that while bacterial overgrowth on the skin can lead to pyoderma, they are not the same thing and should be treated differently. Furthermore, pyoderma in adult dogs is a progressive disease perpetuated by a long list of factors. If you don't address those factors, you're staring down the barrel of recurrent pyoderma or antibiotic resistance.

The predominant pathogen that causes pyoderma is 

an overgrowth of normal flora that resides on the mucosal surfaces and hair coats of dogs. 

species have also been identified on culture in dogs with pyoderma. But no matter the pathogen, clinical presentation is usually the same, Dr. Griffin says.

The medical definition of pyoderma is a bacterial skin inflammation marked by pus-filled lesions. So in order to call it pyoderma, you have to have pus, Dr. Griffin says. The classic lesions of pyoderma are pustules, furuncles, fistulas, crusts, papules, nodules and epidermal collarettes, though lichenification may also be a lesion of pyoderma. Diagnosis is confirmed with cytologic examination of the skin that shows neutrophils with bacteria, preferably intracellular.

In contrast, if you have a dog with red, itchy, dry skin and a preponderance of bacteria but 

 neutrophils, then you have a bacterial overgrowth. Because of concerns surrounding methicillin-resistant 

(MRS) species, Dr. Griffin recommends that the treatment for bacterial overgrowth without evidence of inflammation differ from the classic pyoderma treatment.

Veterinarians are well-versed in predisposing conditions such as atopy, obesity, endocrine disorders, inappropriate friction, pressure (callus) and alteration in skin microenvironment from traits such as skin folds-all factors that make a dog more likely to develop pyoderma. Drugs such as corticosteroids may also have an impact, Dr. Griffin suggests.

Perpetuating factors are pathologic changes in the skin due to pyoderma that make the condition more likely to continue. Folliculitis, common in pyoderma, often results in foci of alopecia, exposing the skin to ultraviolet radiation. That radiation or keratin released from follicular rupture may affect the local immune response, the hair follicle structure or cutaneous inflammation, Dr. Griffin says. Another perpetuating factor is fibrosis, which may be less apparent unless it occurs grossly. Perifollicular fibrosis often occurs at the microscopic level, and certain breeds (Doberman pinschers, bull and Staffordshire terriers, rottweilers) seem predisposed to excessive scarring that makes resolution of pyoderma more difficult. Perform a biopsy to identify scarring in these patients.

Dr. Griffin suggests that pyoderma may be a perpetuating factor in itself. He believes that the longer a dog has pyoderma, the more altered the skin barrier becomes and the harder the infection becomes to control. So does the presence of pyoderma result in changes that perpetuate the development of chronic inflammation, leading to more pyoderma? Some clinical observations support this theory, but studies are needed for definitive answers, Dr. Griffin says.

Historically, canine pyoderma was treated using antibiotics chosen empirically and some topical therapy. This approach is no longer always appropriate or even reliable, Dr. Griffin says, especially in regions of the world areas where methicillin and multidrug 

 resistance is becoming more common. One way veterinarians can fight the development of resistant bacterial infections is to adopt new approaches to treating bacterial overgrowth and pyoderma, Dr. Griffin says.

For bacterial overgrowth, localized pyoderma or mild lesions, or to prevent recurrence of pyoderma while you're pursuing diagnostics for underlying conditions, Dr. Griffin says topical therapy alone

without systemic antibiotic therapy-is an appropriate approach.

Multiple studies have shown that topical therapy alone may resolve pyoderma, including cases involving methicillin-resistant 

 (MRSP). More than 50% of these patients can have their infections eliminated, with the most success reported with chlorhexidine-containing shampoos.

In one study, treatment with topical 4% chlorhexidine products showed resolution of clinical signs in all dogs and was found to be as effective in treating superficial pyoderma as systemic therapy with amoxicillin-clavulanic acid.

 Dr. Griffin recommends using topical products containing 3% or higher chlorhexidine with standalone products, or 2% or higher in combination products.

Think your clients will balk? Hear us out

Before you walk away from this article in disgust muttering, “There is 

 my 86-year-old client is going to bathe a 75-pound dog daily,” I exhort you: keep an open mind.

Yes, your clients are likely to tell you that bathing is stressful for all parties involved, and their bathing facilities may be limited. However, if you explain 

 you're telling them to bathe their dogs (to minimize the development of resistant bacteria and reduce impact to the rest of the body) and

 it benefits their pets (speeds healing, decreases the amount of time systemic microbials must be used, removes nasty crusts and makes the hair look healthier), I have found that nine times out of 10 pet owners get it. What's more, they actually do it!

A recent study suggests that, depending on the formulation, residual antibacterial activity can last for a week after an animal is bathed with 2% or 3% chlorhexidine shampoo.1 Depending on the shampoo formulation, hair length, severity of disease, and perpetuating factors, the client may only need to bathe the dog twice a week.

Teaching owners to catch when their dogs have bacterial overgrowth on their skin will reduce the development of pyoderma and perpetuating factors, leading to healthier patients and happier clients.

1. Kloos I, Straubinger RK, Werckenthin C, et al. Residual antibacterial activity of dog hairs after therapy with antimicrobial shampoos. 

Cleaning the skin promotes desquamation, which removes surface bacteria and yeast as well as irritants and allergens, normalizes keratinization, and can improve barrier function. Anti-inflammatory ingredients or even just cool water can also be used to help decrease inflammation. Moisturizing and cooling the skin will also decrease pruritus. In general, Dr. Griffin recommends bathing the pet frequently-every other day is preferred though some cases do respond to twice-weekly bathing, especially if topical antiseptic sprays are used between baths. Two times a week is generally effective in preventing recurrent pyoderma and bacterial overgrowth. Daily bathing is required in some cases for complete resolution.

Have a patient with chronic or recurrent bacterial overgrowth secondary to poorly controlled perpetuating factors? Dr. Griffin advises teaching your client to recognize the signs of bacterial overgrowth (mainly odor and possibly red skin, scaling or pruritus) and instructing them to bathe the dog with an antiseptic shampoo before pyoderma develops-or give a standing order to bathe the dog weekly.

Systemic antibiotic therapy is required to treat deep pyoderma, some recurrent pyoderma and pyoderma with perpetuating factors; it's also necessary in cases of poor or non-existent compliance with topical therapies. Here are some guidelines:

> Combine systemic with topical therapy where possible.

> Choose antibiotics based on impression cytology, along with the results of culture and sensitivity testing.

> Keep in mind that most pyoderma therapy should be instituted for at least three to four weeks. If you're using topical therapy as well, use your judgment about whether to decrease the duration of systemic therapy.

When designing a treatment plan for both pyoderma and bacterial overgrowth, Dr. Griffin says, you must identify, reverse or control any perpetuating factors, or your chance of success is limited-and the chance of an irritated client is high. Recurrent or chronic pyoderma? Time to go hunting for perpetuating factors as well as predisposing factors.

Some treatments may need to be directed at reversing pathologic changes in the skin, or the patient may require long-term therapy until the body naturally remodels or reverses those changes. You may need to consider surgical removal of localized fibrotic or granulomatous lesions. Long-term pentoxifylline may help reverse scarring in cases with widespread lesions not amenable to surgical therapy, Dr. Griffin says. Glucocorticoids have been used in some cases with residual granulomas, but Dr. Griffin recommends corticosteroids be used only after antibiotic therapy has eliminated the bacteria and the granulomas are sterile based on culture. The sooner you stop and control perpetuating factors, the better the dog will be long term.

Bryan J, Frank LA, Rohrbach BW, et al. Treatment outcome of dogs with methicillin-resistant and methicillin-susceptible 

Loeffler A, Cobb MA, Bond R. Comparison of a chlorhexidine and a benzoyl peroxide shampoo as sole treatment in canine superficial pyoderma. 

Murayama N, Nagata M, Terada Y, et al. Efficacy of a surgical scrub including 2% chlorhexidine acetate for canine superficial pyoderma. 

Borio S, Colombo S, La Rosa G, et al. Effectiveness of a combined (4% chlorhexidine digluconate shampoo and solution) protocol in MRS and non-MRS canine superficial pyoderma: A randomized, blinded, antibiotic-controlled study. 

At least until you know you need them, that is. For bacterial overgrowth and superficial cases, topical therapy may be all you need for your veterinary patients.

Got a pyoderma? Step away from the systemics

How often does a pet really have just one disease or condition, especially when obesity comes into the equation? CVC speaker Martha Cline, DVM, DACVN, a veterinary nutritionist at Red Bank Veterinary Hospital in Tinton Falls, New Jersey, has already helped us sort through the 

"obesity paradox" that occurs when a patient is overweight and has chronic kidney disease

CVC doodle on best nutrition treatment practices

Now Cline is back with thoughts on obesity and concurrent disease in general. Which takes precedence-helping to treat the disease by feeding a special therapeutic diet or combatting the extra pounds? Cline says that in some cases, weight loss can help improve the quality of life in a patient struggling with another disease. So it comes down to performing a complete nutrition assessment (

Dr. Martha Cline addresses how a veterinary patient's diet comes into play when more than one condition is present.

Vetted May 2019