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Creating a State of the Art / State of the Heart Practice

Robin Downing, DVM

Womb to Tomb Care

The veterinary profession is the only medical profession to provide care to its patients from the very beginning of life to the very end - - from womb to tomb. When practicing from the perspective of compassionate care, veterinarians and their health care teams dedicate themselves to always advocating for what is best for the pet - - advocating on behalf of a being that cannot advocate for itself. There are many ways the veterinary health care team can have an impact on the Family-Pet Bond during the cycle of life:

•  Womb

Pre-acquisition counseling for the client helps the family choose a pet that is a "good fit". What kind of lifestyle do they enjoy? Time/work commitments? Children? Travel? Once the species of pet is chosen, it is time to think about breed:

•  Active vs. sedentary

•  Large vs. small

•  Long hair vs. short

•  Must have regular grooming vs. needs no extra grooming

•  Pet Acquisition

Outline wellness and vaccine visits. Provide basic behavior guidance, training, and counseling. Discuss the timing of the neutering procedure. Talk about nutrition. Nutrition is a dramatically underutilized facet of wellness healthcare. There are three factors that influence wellness and longevity - - genetics, environment, and nutrition. Of these three, nutrition is the one we can influence. Every pet has to eat something every single day. Why not take advantage of this fact and actively make nutritional recommendations? There are excellent options available - - choose a line of products you and your doctors believe in, do your homework, and then get to it! Just saying, "Get a good brand of food from the grocery store" is not a nutritional recommendation. Everyone on the veterinary healthcare team should be in tune with what nutritional options the practice endorses.

•  Chronic Disease

Sometimes compassionate care means caring beyond a cure. Chronic diseases provide a special context for caring:

•  Renal disease

•  Diabetes mellitus

•  Heart disease

•  Cancer

•  Tomb

Our relationship with a client can transcend the life of the pet. Our handling of euthanasia can make or break our relationship with clients who've lost a pet. What about suggesting a "buddy pet" for an older pet that will help bridge the transition.

Remember that clients don't come into our hospitals to be presented with a smorgasbord of options ("Shall we use Plan A, Plan B, or Plan C?"). They don't come to our office to make medical decisions ("Do you want your pet to have pre-anaesthesia blood work, or not?" "Do you want us to treat your pet's pain, or not?"). Our clients come to us because they (their pets) have problems they want us to solve. Interestingly enough, when veterinary practice is conducted from a "compassion-driven mentality" where the animal's best interest is at the fore, improved job satisfaction and improved practice revenues simply take care of themselves. Better medicine is better business! So... be problem solvers. Be the pet's best and most effective advocate. Help your team stay centered in compassionate care.

Where Do Practice Teams Start?

Healthcare team members must believe they are making a difference, feel they are contributing, and know that their efforts are recognized. In order to practice effectively, veterinarians and their health care teams must be able to articulate their values and dreams, and communicate their vision to clients.

To create the desired practice culture, certain steps must be taken by the veterinary health care team:

•  Decide what is important - -

What are the core values of the practice? What are the core team values? What mutual values are shared by members of the health care team? Values create the practice's culture, as they are always being demonstrated. Team members soar when their values and the practice's core values mesh.

•  Decide where the practice is going - -

First define values, then define vision. Without a vision, there can be no focus.

•  Decide what the practice stands for - -

This is really the practice's mission statement. If you as a member of the veterinary health care team had to explain to someone during a 30-second elevator ride just what the practice stands for, what would you say? The mission, once identified, should be the single most important idea to all members of the team.

•  Decide to risk - -

The world is changing faster than ever, and change always entails risk. Risk wakes you up.

•  Decide to motivate - -

Because any vision is intangible by itself, it must be translated into emotional benefits. Be shamelessly enthusiastic about the practice vision and your contribution to it. Just remember that one cannot mandate mutual vision - - the people on the team must be believers.

Our goal is to have team members who are so excited about what they do that their energy draws the clients back to them. We want our people to think outside the box and find solutions to improve the success of the services we deliver. We want them to be passionate about their work. Once the practice's core values are clarified and communicated, the team can be assembled, assigned responsibilities, and begin to move "full speed ahead". Leaders on the veterinary health care team demonstrate their commitment to excellence for the practice by pursuing personal excellence. And don't forget, you can do well by doing good. Marsha Sintar said, "Do what you love, the money will follow." The team is only as strong as its weakest link, so remember to be a particularly strong link in the chain by empowering, coaching, and mentoring other team members to achieve their best. The practice climate should foster and reward innovation, initiative, and growth.

Compassionate Care Means Dealing With Chronic Disease and Special Needs Pets

As pets live longer and better, the likelihood of a particular pet to develop a chronic illness of one kind or another increases. These chronic conditions threaten the very Bond we pledge to serve. Examples of special needs pets include those facing:

Amputation

Diabetes Millitus

Congestive Heart Failure

Disfiguring Tumor Removal

Chronic Renal Failure

Enucleation

Paralysis

Aging

Deafness

Blindness

Seizure Disorder

Chronic DJD

DLE (or other immune-mediated disorder)

Cancer (chemotherapy or radiation therapy)

Degenerative joint disease (DJD) or osteoarthritis provides a useful illustration of the concept of advocating on behalf of special needs patients. DJD is a chronic, progressive disease involving deterioration of the structures within the joint causing pain and inflammation. Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain can be explained physiologically, but what is most important is to describe pain and its manifestations in terms that are medically sound and rational, but at the same time do not confound the pet owner. Every pet owner's nightmare is that a pet will suffer pain. One dilemma the veterinary health care team faces, however, is pet owners' frequent inability to recognize pain in their pets when it exists - - particularly chronic pain. Pet owners whose pets are experiencing chronic pain will often use the following comments to describe their pets' behavior - - often unaware that what they are really witnessing is pain.

•  Loss of stamina

•  Reluctance to go up and down stairs

•  Difficulty rising from a down position

•  Slower to "get going" in the morning

•  "Grouchiness"

•  Not wanting to be touched over certain areas of the body - - particularly the back, pelvic area, or the limbs

•  Decreased interaction with human family members.

•  Hearing comments from pet owners like: "I thought my dog was just getting old."

Listen carefully to the owner's historical comments, and then to go one step further by asking open-ended questions of the client to try to get clues about the possible presence of pain.

Communicating About Pain

When creating language for pain in pets it is critical to start with vocabulary that is already in place and familiar to pet owners. Our clients understand words like "ache", "pain", "soreness", "discomfort", "twinge", etc. From there we can extrapolate, adding words, terms, and phrases (that we must be careful to define for our clients) that will expand the client's appreciation and understanding of the presence of pain and our abilities to relieve it. Manipulation of the pet in front of the pet owner for the purpose of demonstrating a pain response is a powerful tool. For most clients, seeing is believing, and for many of them it is the first time they have considered that their animals are in pain.

Because chronic pain from osteoarthritis tends to occur in older pets, pet owners often interpret the signs of pain as the result of "old age". It is critical to communicate that old age is not a disease.

When preventing and managing animal pain, the key is effective communication with the client. Eliciting a pain response from the animal in front of the client is just one of many important steps. We must create clear and precise expectations for the client whenever possible. Creating expectations means answering for clients the following questions:

•  How will I recognize that treatments are working?

•  How long will it be before I begin to notice changes in my pet's behavior and mobility?

•  How much better will my pet feel after we begin medication?

•  Will my pet return to a completely normal state once it is on medication?

•  How long will my pet have to be treated for its pain?

Additional questions that must be answered in this process include:

•  What medicines will be given to my pet?

•  How often must they be administered (i.e., once daily, twice daily)?

•  How much will the medications cost? Per week? Per month? Per year?

•  How will I know if my pet is having an abnormal reaction to the medication?

•  What are the risks (if any) associated with the medications my pet will take?

•  What kind of monitoring is suggested or required to maximize my pet's safety while taking medications long-term? What is the cost for such monitoring?

Lead Your Team into the Future

The above model - - using pain management as our example - - will work no matter what chronic problem we are facing. Think about applying this approach in your own practice.

200 Ideas for a "State of the Art/State of the Heart" Practice

1.  Greet every day in a positive way, looking for the best in every situation.

2.  Offer laser surgery and set your fees accordingly.

3.  Display your practice's mission statement. If you have a vision statement or slogan, use it frequently.

4.  Use colorful cage cards with patient's first and last name as well as description.

5.  Lend a pager to clients with hospitalized pets so you can keep in close contact with them.

6.  Provide your receptionist with a telephone headset so her/his hands are free to write notes, pull files, etc.

7.  Have framed artwork throughout the clinic. Don't hang anything that isn't framed.

8.  Have a clinic brochure available. Mail it to all telephone shoppers.

9.  Use a separate folder for each pet. Have the outside of the folder marked with a pink dot or a blue dot to indicate whether the pet is a boy or girl.

10.  Keep a variety of current magazines neatly displayed for clients and visitors who spend "extra" time at the clinic.

11.  Provide business cards for each staff member.

12.  Learn names of each client and pet. Your clients will love you for it.

13.  Use a baby monitor to listen for sounds when you can't be right next to a critical care patient's cage.

14.  Have endoscopy available for your patients.

15.  Use afghans, blankets, or towels for bedding in all cages.

16.  Refer to animal cages and dog runs as bedrooms and suites.

17.  Have an Open House to highlight what is done at your practice.

18.  Put a glass door on your isolation room. You can see what is going on and the pet won't feel so isolated.

19.  Provide individual workstations for staff to use.

20.  Give dog angel and cat angel pins to clients when their pet has died.

21.  Have at least one team member be a designated nutrition consultant.

22.  Provide a staff refrigerator.

23.  Develop a web site for the practice.

24.  Take Polaroid pictures of your patients or of your clients with their pets. You'll be amazed at the number of ways you will find to use them.

25.  Present surgery patients with a Purple Heart.

26.  Provide a good music system in the clinic. Appropriate music will provide a calming influence on clients, animals, and staff.

27.  Keep an umbrella or two available in the foyer for rainy days.

28.  Use body language effectively. It is more powerful than words.

29.  Have an x-ray viewer in each exam room as well as in the surgery suite.

30.  Have laser toys available for exercising cats.

31.  Pet food stickers on the outside of a pet's folder and on a cage card make it easy for a team member to know which food to sell the client or which food to feed your boarders and hospitalized patients.

32.  Have ultrasonography available for patients who can benefit from it.

33.  Provide nametags for each staff member.

34.  Select a signature color for the practice. It will make everything you do look more professional.

35.  The receptionist can feed information to the doctor and other team members about the client and patient. It will make the entire team appear to be smarter and more interested in the client and pet.

36.  Sent Get Well cards to sick or injured patients and clients.

37.  Keep an egg timer by the telephone to remind you to keep the conversations succinct, particularly when you are leaving a message on an answering machine.

38.  Train your answering service in how you want telephone calls handled.

39.  Place a coat hook in each exam room for clients to place purses or coats.

40.  Use full spectrum lighting throughout the hospital. You'll find your team will be happier and you will be able to better examine your patients.

41.  Refrigerator magnets are a wonderful way to advertise your clinic and to keep your number handy for emergencies and other calls.

42.  Each pet's folder should contain a problem sheet in a bold color to serve as an index to the medical record.

43.  A postage meter and postage scale will make life easier for the person processing your mail and will make your mail look more professional.

44.  Keep stress relievers-such as squeeze balls and toys like paddleballs or yo-yos-around the clinic. Or install a basketball hoop!

45.  Cross-train all team members.

46.  Develop a referral network of people who can enhance your delivery of professional services.

47.  Keep business cards from your referral network handy at the front desk.

48.  Monitor surgery patients with a doppler, pulse oximeter, ECG, and apnea alert.

49.  In cat bedrooms, provide "kitty cubbies" for privacy and ledges for vertical exercise.

50.  Place bandannas or decorative collar covers on pets.

51.  Rename your boarding operation, "Respite Care".

52.  Place identification bands on all pets that stay at the hospital.

53.  Place tissue glue on eyelids of pets after euthanasia.

54.  Hire a Housekeeping Director or Cleaning Service. You'll be amazed how much better your facility will look.

55.  Have a courtesy telephone.

56.  Set up puppy and kitty kindergarten classes.

57.  Have at least one team member who can communicate through American Sign Language and any foreign language that is the predominant language of your clients.

58.  Honor an Employee of the Month.

59.  Set up a Hospice Care program.

60.  Buy a "Thanks for your business" stamp. Stamp all checks you receive with it.

61.  Buy a "This check is brought to you by our clients" stamp. Stamp all paychecks with it.

62.  Have a stamp with the practice name at the front desk for the cashier to use on checks from clients.

63.  Stamp the back of each check received with "For deposit only" before placing it in the deposit drawer.

64.  Create a lending library for your clients with books, cassettes, and videos about animals and pet care.

65.  Designate at least one team member as a pet loss/bereavement specialist.

66.  Provide dry marker boards in the treatment area and ward rooms.

67.  Establish a Comfort Room©.

68.  Have a rheostat (light dimmer) in at least one exam room to facilitate eye examinations.

69.  Have a drive up window or offer curbside service for client convenience.

70.  Create a clinic newsletter.

71.  Use a battery-operated lift table for large animals. It is quieter and, therefore, less intimidating to pets than a hydraulic one. It will prevent many backaches.

72.  Have a clock in each room in the clinic. It will help you stay on schedule.

73.  Have access to a fully equipped laboratory, preferably in house.

74.  Make pet dentristy service available for all your patients.

75.  Celebrate special occasions, such as, national veterinary technician week, national secretary's day, etc. You can find many things to celebrate. Celebrations are good for team morale.

76.  Deliver precise volumes of IV fluids with an infusion pump.

77.  Create a signature aroma for your facility, for instance, vanilla or spice.

78.  Use playpen bumper pads to protect recovering surgery patients from the hard sides of recovery cages.

79.  Provide a hospitality center for clients in your reception area. Have a water cooler, coffee, snacks for people and pets, etc.

80.  Provide up to the minute diagnostics with up to date x-ray equipment.

81.  Padded positioners provide pets with stress-free x-rays.

82.  Create an outdoor Dog Recreation Area for dogs to exercise, socialize, and potty.

83.  Provide access to acupuncture and other complementary healing modalities.

84.  Provide administrative staff stamps of doctors' signatures to be used on rabies certificates.

85.  Wear "fun" uniforms, such as colorful scrub outfits or smocks, allowing staff to look like a team while still having the ability to express their individuality. The doctors should look like doctors and should be easily recognizable as such.

86.  Install Cable TV in your staff room and in the Comfort Room. Team members enjoy watching it during breaks and at lunchtime. Your clients may enjoy it while waiting for you to complete an extended procedure.

87.  Have a gurney available for the emergency transport of a pet from curbside to treatment area. It also is good for moving large dogs in the clinic.

88.   Put "medical alert" stickers on the front of the animal's folder to alert the team to major medical problems.

89.  Give personal notepads or note cards to each team member for communicating with your clients.

90.  Have a candle with a light aroma burning in the reception area. It will add to the ambiance. If you have clinic cats, there are decorative shades that fit over candles so tails and whiskers don't get singed.

91.  Have a leash hook at the reception area so the client can attach the leash to it allowing them to have their hands free for writing a check. We live in a mountainous state, so we use carabiners. Midwesterners may want to use a boat cleat. We know of one clinic that fastened a doorknob to the top of the reception counter.

92.  If the practice has a membership to a place like Sam's Club, it is very inexpensive to add the names of other team members to that membership. It's a nice perk for your staff.

93.  Everyone who enters your clinic should see a smile on your face. Everyone who telephones your clinic should hear the voice of a smiling person.

94.  An aquarium offers a soothing presence in any practice. Make sure it is properly maintained.

95.  Live plants provide a "homier" atmosphere. Make sure they are properly attended. If you can't keep the plants looking healthy, your clients might wonder about how you'll keep their pets healthy.

96.  For those hospitals where you don't have much natural lighting or where the staff do not have the skill or the time to properly take care of live plants, use artificial plants. Many of these plants are beautiful and look real, plus they are low maintenance items.

97.  Place a "Service Dogs are welcome here" decal on your door.

98.  Have some calming music on tape for telephone callers who have to wait. We don't like the messages on tape because we shouldn't keep someone on the line long enough to hear the entire message. In our clinic we like Native American flute music and New Age instrumentals.

99.  Use color dots for doctors on the outside of each pet's folder. Each doctor may select a color. These dots will let everyone know which doctor(s) have seen that patient. We recommend that no more than three doctors in a practice see a particular client.

100.  A small holding cage in the reception area can provide a cozy, safe place for a cat, ferret, guinea pig, etc. to hang out when they do not arrive at the clinic in a pet carrier.

101.  A mini-maintenance closet near the reception area makes it easy and quick to clean up "accidents" and spills.

102.  A play area for children is a terrific asset to any clinic. Since many children have short attention spans in the examination room, a well-equipped play area can keep children entertained for good periods of time.

103.  Place a Big Dog Feeder™ in the bedrooms of large dogs visiting you for Respite Care. They are also excellent for dogs who should have their dishes raised for medical reasons. If you do retail sales, this is an excellent product to stock.

104.  Select and/or develop client handouts to send home with your clients to help explain things you wish to emphasize. There are many available at no cost to you through your veterinary vendors. If you can't find one that says what you want it to say, create your own.

105.  Place a heart-shaped bandage on wounds of injured patients and over the catheter when you are performing euthanasia on a pet.

106.  Have clients call ahead for prescription refills, food sales, etc. so the staff can prepare these orders at less busy times and the client can walk in and pay for them quickly even when things are a little hectic.

107.  Provide ramps for wheelchairs to areas where access is needed. You'll find that in addition to making your facility user-friendly, you will make delivery people extremely happy.

108.  Create a photo album of your extended family-your clients and their pets.

109.  Have at least one "Do not disturb" sign that can be hung on the appropriate door as needed.

110.  Create a staff library of resource books and tapes to keep the staff current in their knowledge.

111.  Create a paperback exchange for team members to swap books from their leisure reading.

112.  Use Clay Paws™ to make paw prints of kitten and puppy patients when they are under anesthesia to be neutered. A paw print of an animal that has died holds special meaning to a pet owner.

113.  Teach your clients about adaptation tools for animals with special needs, such as Paws Way™ products for aging and arthritic pets.

114.  Provide a shuttle (taxi) service for clients with special needs.

115.  Create Show and Tell displays, such as bladder stones and heartworms, to use in client education.

116.  Designate at least one team member as your pet behavior consultant.

117.  Create a pet adoption program.

118.  Provide an in-house gym for your team or buy a group membership to a gym or health club.

119.  Install Stairs for Kitties™ for your clinic cats.

120.  Have team come to work in Halloween costumes. Make holiday times fun celebrations.

121.  Provide a staff lunchroom.

122.  Special mats will help prevent foot/leg fatigue for your staff. We use Stat Mats™ at our clinic.

123.  Provide a microwave oven for heating hot water bottles for cold patients and for heating meals for your staff.

124.  Provide pet insurance for the pets of your team members. Let your clients know about its availability.

125.  Let the team make a list of professional subscriptions they would like to have available at the hospital. The practice should pay for as many of these as it can afford.

126.  Develop support groups for clients who have pet companions with special needs. For instance, if a pet is facing amputation of a limb, let the client meet some amputees that get along fine with a missing limb. This can help dispel the fear of the unknown.

127.  Supply a coffee maker in your staff lunchroom.

128.  Create a Trophy Wall or Wall of Fame to showcase any special achievements of the practice or of any team members.

129.  Provide a photo tour of the clinic through framed photographs, a photo album, or videotape.

130.  Develop wellness protocols for your patients.

131.  Have a designated parking space for the disabled.

132.  Take humor breaks each day.

133.  Provide opportunities for team-based incentives.

134.  A "Thanks" bulletin board with letters, cards, and pictures from clients brightens your day each time you look at it.

135.  A mailbox for each team member makes it easy to see that the same information gets in each person's hands.

136.  Take a team photo or individual photos of each team member and display the photos in an album or on the clinic walls.

137.  Buy healthy snacks for the team.

138.  Take a team field trip/outing just for fun.

139.  Provide cellular phones or pagers for team members away from the facility when you need to be in touch with them.

140.  Put a set of cages on casters to allow more versatility in your hospital space.

141.  Lazy Susan cupboards can offer better use of storage space in corners.

142.  A vented hood in the laboratory controls fecal test odors.

143.  Foot pedal water controls at the scrub sink prevents bruised knees.

144.  Chair rails behind chairs in the reception area and exam rooms control damage to your walls.

145.  Create a pet calendar for your clients for the New Year. Have a contest to decide which animals get to be on the calendar.

146.  Dedicate each book in the clinic library to a pet or client who has died.

147.  Use ear thermometers in exam rooms. The pets will thank you.

148.  Talk about and demonstrate the use of Gentle Leaders™.

149.  An automatic x-ray processor will allow the pet to spend less time under sedation or anesthesia and allows quick answers to difficult questions.

150.  Coffee mugs with your logo are nice presents for your clients and wonderful advertisements for the practice.

151.  Offer Behind the Scenes tours any time you are able to do so when a client or potential client requests one or seems interested.

152.  Microchip pets.

153.  Keep a "good letter" file to boost your spirits when you need a lift.

154.  Provide courtesy "Fireman Save My Pet" decals for each door of each client's house.

155.  Use stand-alone chairs with arms. They are much easier for your senior citizen clients.

156.  Have cubbyholes behind the reception desk to help keep all those things the receptionist uses each day organized and close at hand.

157.  Keep dog treats available in the reception room and exam rooms. Nurses might want to carry some in their uniform pockets.

158.  Refer to your certified technicians as Licensed Veterinary Nurses. People do not always know what a technician does, but they do know what a nurse does.

159.  Install a dishwasher for staff dishes and one for animal dishes.

160.  Keep on hand a list of pet's names for people who have a new pet and can't come up with a name. It will get the creative juices flowing.

161.  Provide new puppy and new kitten checklists.

162.  Guardian angel wall plaques hung in strategic locations provide extra peace of mind for many clients.

163.  Create a lifesaving fund to help your practice carry out additional charitable work.

164.  Place a TLC Alert card on a cage and a stuffed animal in a cage with pets that need even more tender loving care than usual.

165.  Send small children home with a stuffed animal to care for when their pet has to spend a night in the hospital. They bring it back when their pet goes home with them.

166.  Use anatomical models of teeth, hips, knees, etc. as teaching props.

167.  Mail Christmas cards to the pets instead of to the clients.

168.  Send a single red rose in a bud vase to the family when a pet dies.

169.  Make a memorial donation to a group like the Morris Animal Foundation when an animal dies.

170.  Set up a Frequent Buyer Program for clients who buy their pet food at your clinic. When they buy ten bags, they get a small bag free.

171.  Use call back cards or some other system to help you check on animals when you want.

172.  Place stickers on laboratory results sheets to record when and who notified the client.

173.  Use volunteers in your clinic. There are many adults who are eager to volunteer in a clinic. Make use of their special talents.

174.  Be a mentor to people who want to enter the veterinary field or who have recently entered the field.

175.  Wear animal pins on your uniforms. They will brighten someone's day.

176.  Fax laboratory results and other information to clients.

177.  Print your e-mail address on your business cards.

178.  Provide pre-pet counseling to those considering or planning on getting a new pet.

179.  Create some financial options for clients who do not have the cash to pay a large bill-credit cards, programs through groups like Norwest Finance or CareCredit®, etc. where they may offer 90 days same as cash, etc.

180.  Clip newspaper articles about your clients' achievements and send a copy to them with a note of congratulations.

181.  Offer a uniform allowance to your staff.

182.  Write a pet column in your local newspaper.

183.  Have the practice pay the professional dues of team members.

184.  Encourage all staff to actively participate in community activities.

185.  Develop an outdoor area for your team for lunch or just for taking a break.

186.  A VCR is a must for client education.

187.  Cultivate the skill of active listening.

188.  Keep a supply of children's videos to entertain them when they get restless.

189.  Mount air fresheners on the wall where there is an air current. They can emit the signature aroma of your facility at whatever interval you select.

190.  An aviary will provide pleasant sounds for bird lovers as well as fascination for cats.

191.  Each team member will truly appreciate having a private locker for his or her personal belongings.

192.  Celebrate each team member's birthday.

193.  Disclosing solution can vividly show clients that a dental prophylaxis is needed.

194.  The words you use can have a real effect on the client's perception of value; for instance, "ovariohysterectomy" has a higher value than "spay".

195.  Use accents of color, such as "stethoscope diapers" and microscope covers.

196.  A security system and fire alarm system will provide your clients with more peace of mind when their pets are spending the night at the hospital.

197.  You will appreciate having emergency lights the first time the lights go off in the middle of a surgical procedure.

198.  Provide a Thought of the Day or a Joke of the Day each workday.

199.  Be knowledgeable about wheelchairs for pets, such as the K-9 Cart® like Frankie's.

200.  Celebrate the family-pet-veterinary bond each day.


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