'Waste management' can be for fun and profit

When I was a very much younger man, high on love and life, in the very cosmopolitan city of brotherly love sometimes called Philadelphia, I was walking back from our bookstore toward the veterinary college. Turning a corner, I fell in step with one of my favorite personalities at the college, Dr. Paul Berg, professor of surgery.

Paul was as interesting as a professor can be while being allowed to retain his credentials. He had been a master plumber before taking a major cut in pay to become a veterinarian. As we walked and talked together, we noticed, in a very prominent location in our path, an 8.5 centimeter high pile of brown material that was not dog or cat generated, as might be expected, but that of homeless homosapien origin.

I remarked that the sight was disgusting, whereupon Dr. Berg stated that "used to be my bread and butter."

I remembered that episode some 33 years after the event and said to myself… "Self …" Veterinarians must be alchemists! We turn feces into dollars!

But we don't do that with any great efficiency, as the recent American Animal Hospital Association Compliance study was quick to demonstrate. But we can and should do it, and often for public health reasons.

Thirty years ago (I know, I'm revealing my incipient senility) 2,000 pets examined at a fabulously expensive $6 office visit each, meant 1,999 poopie samples in the lab at $4 each. (There was always that one snarling beast that resisted the fecal loop like this author with broccoli. We found all kinds of crap in the crap! Giardia, coccidia, all manner of nematodes and pollen and you name it! Then came the heartworm meds that somehow took care of the nematodes, but not the protozoans. Why was that considered good enough to begin avoiding the fecal screening process?

Not too far, anatomically from the fecal orifice (new anatomical name, same stuff!) was the drain hole for the yellow wet stuff. As a diagnostic medium, the yellow wet stuff was superb. You could practice your dipping technique in case you were ever invited to a cocktail party; you could spin it; you could stain it; you could gaze at it through an expensive optical device. You could find stuff!

There were crystals and bacteria and you could make a whole wall chart from the 20 or so rarer events found in the yellow wet stuff. And you knew this was great medicine for two reasons.

Seek and you shall find

First, when you went to your own physician for a checkup, you were given a plastic cup for a donation of your own yellow wet stuff, and you were willing to pay for someone to mess with it and you had to know how to do it yourself before you could turn the dollars you paid as tuition into a license to make a living yourself.

As the years went by, I saw a lesser demand from my colleagues for both squishy brown stuff and yellow wet stuff examinations, and I could not reason why.

In fact, I often found bad stuff in the brown stuff and was able to make my patient more comfortable while protecting my client's kids from inheriting little problems from their pet.

I sent out reminders for annual examinations that had two little zip-lock bags in it, labeled "wet stuff and squishy stuff."

The card containing mailer which talked about at least four dog years having passed in the last one human year, invited the client to use an enclosed chart to see that their 14-year-old Poodle was not really a 98 year old on the one to seven ratio we have allowed our clients to swallow whole, but a much more youthful 71 human comparable years. Then, it gave all the good reasons for coming in and invited to fill the appropriate little ziplockers so we could ensure that their beloved pets did not have little uninvited pets of their own fouling up their internal plumbing.

I figured out the economics recently and it really was a 1,500 times cost return on investment (ROI) as in Table 1.

Doing the math

Buying, labeling and mailing the cards with today's postage cost me less than a buck each and I got back 38 percent on the first reminder.

With those appointments, I averaged 30 bags of brown squishies and 12 yellow wet stuffs presented to my receptionist who had called them the night before to remind them to fill the bags the next morning and asked for them on arrival.

Today, about one in every five pets over 4 years of age gets an ERD (early renal diagnosis) test that is scheduled every other year in the practices where I have monthly consulting contracts.

The results are spectacular! Just the tests alone account for $15 of revenue for every dollar spent on mailing. Many of the brown squishies, 30 percent from dogs under 5 years old have uninvited guests despite heartworm meds. Recall that these meds perform periodic genocide only. The patients still get the infections for up to 30 days at a time.

The yellow wet stuff on dogs over 4 years that show excessive crystals or erythrocytes or teenie weenie little rods or cocci and all that have low specific gravity get an ERD test and a very surprising 30 percent or more need to be treated for early kidney problems with diet and medication.

Good medicine is still good medicine! Some things do not change. Become an alchemist yourself. Your patients will be the healthier for it.