Alex Sigmund Eye Care

Alex Sigmund, DVM, DACVO, recently spoke at the 2024 Fetch dvm360® Kansas City Conference, leading multiple ophthalmology sessions. The dvm360® editorial team sat down with Sigmund to discuss the relationship of eyedrops, systemic medications, and potential side effects in small animals.

A closer look at eye drops and systemic medications

"The talk was born from the realization that even eye medications can have side effects you might not expect," Sigmund explained. "For example, non-steroidal anti-inflammatory eye drops might seem harmless, but a recent study found that certain anti-inflammatory eye drops can cause gastrointestinal bleeding in some patients."

Speaking from his own experience, he said, "I’ve personally seen dogs experience life-threatening GI bleeds from an eye drop, which was quite shocking." This led him to advocate for a more deliberate approach: "When I’m considering adding a medication, it’s always for a specific reason backed by research, not just uncertainty."

One of the core messages Sigmund wanted to share with attendees was was the importance of intentionality in treatment plans. "Adding a treatment just for the sake of it is never a good idea," he advised. Instead, he encourages veterinarians to establish check-in points for both themselves and their clients to assess progress and ensure the treatment is still necessary. "It’s essential to ensure that you’re still on the right track and not just continuing a treatment out of habit or uncertainty," he noted.

Sigmund’s approach is rooted in real-world experience. He recalled a memorable case involving a cat with conjunctivitis. "The cat had been on a topical antibiotic ointment for months, but the condition wasn’t improving," he said. Sigmund realized that the treatment might be the issue rather than the solution. "When I examined the cat, I didn’t see anything seriously wrong, so we stopped the ointment—and all the symptoms disappeared."

Another case that stands out is that of a Rottweiler on TMS, a common oral antibiotic. "The dog had been on TMS for about 6 months and developed absolute dry eye and hypothyroidism," Sigmund recalls. These conditions, linked to TMS’s glandular toxicity effects, underscored for him the significant impact systemic medications can have on the eyes. "This case reminded me that we need to be cautious about what we prescribe," he said

While some side effects, like those associated with TMS, are well-known within veterinary circles, Sigmund stressed the importance of ongoing vigilance. "TMS causing dry eye in dogs is fairly well-known in my field, but it’s always good to remind people because it’s a commonly used antibiotic in small animal medicine," he pointed out.

Before starting a patient on TMS, Sigmund recommended performing a Schirmer tear test to establish a baseline. "If you see any signs of redness or discharge, stop the antibiotic, redo the Schirmer tear test, and monitor the dog’s recovery," he suggested. This level of attentiveness is crucial to avoid unnecessary complications. "It’s crucial to know what and why you’re treating a condition and to be vigilant about potential side effects," he says.

Failing to consider these factors can have consequences, Sigmund warned. "The issues that can arise are multifactorial," he explained. “Clients who don’t understand the treatment plan or its purpose may become frustrated and non-compliant, leading to delays in proper care. "In my field, this could lead to vision loss or chronic irritation," he said.

Furthermore, unnecessary medications can cause side effects that complicate the pet’s condition rather than improve it. "It’s essential to consider the why, what, and when of any treatment plan," Sigmund said.

Articles

Alex Sigmund, DVM, DACVO, urges veterinarians to consider the often-overlooked side effects of ocular treatments.

Balancing benefits and risks in veterinary ophthalmology 

. Traumatic open wound on an adult horse showing a laceration over the left side of the face and bony fragments protruding from the laceration.

. Corresponding CT image identifying an open, complete, and displaced fracture of the skull involving the left paranasal sinuses.

The presentation of horses for wound evaluation following trauma is a frequent occurrence and one of the most common emergency presentations in equine medicine.

Horses can sustain wounds over any part of their body, with the distal extremities and head region being common locations for injuries. Like in the distal extremities, there is little soft tissue coverage in the head region, and in up to 80% of cases head lacerations can be accompanied by a traumatic fracture of some part of the skull, making them slightly more challenging to manage.

In one study, fractures involving a horse’s head following a kick from another horse comprised 12% of all incidents and were the second most common type of fractures, following splint bone fractures.

 A thorough knowledge of the horse’s anatomy is needed when addressing trauma and lacerations in the head region. Vital structures found in a horse’s head include the eyes, cerebrum, paranasal sinuses, and nasolacrimal duct.

The equine skull is complex and composed of bones including the incisive bone, nasal bone, frontal bone, maxilla, lacrimal bone, zygomatic bone, interparietal bone, parietal bone, temporal bone, sphenoid bone, occipital bone, ethmoid bone, palatine bone, vomer, pterygoid bone, and mandible.

 The most common bones injured in skull fractures are the nasal, frontal, and maxillary bones with the zygomatic process of the frontal bone.

 Additionally, lacerations to the face and subsequent facial bone fractures can be complex and involve various structures such as sinus compartments, the lacrimal duct, orbit, and cerebrum (

. A traumatic laceration of the right side of the face in a foal which could only be closed partially by primary closure.

. Corresponding CT image on the right identifying an open, comminuted displaced fracture of the skull involving the 507 tooth.

, 2 years post injury. Owners were very satisfied with the outcome and cosmetic appearance of the filly. No complications were noted post treatment.

. Corresponding recheck CT of the filly showing good healing of the fracture, which was treated conservatively despite the initially severe displacement.

As they are frequently traumatic in origin, these fractures are often open, displaced, and comminuted with numerous fragments of various sizes. Clinical signs will vary according to the extent of the trauma and can often include multiple lacerations ranging from small abrasions to large, full thickness wounds, nasal epistaxis, emphysema, stertorous breathing, and crepitus. Associated skull fractures should be examined thoroughly to obtain a comprehensive and complete evaluation of the extent of the damages. In addition to a general physical examination, a comprehensive examination including ocular, oral, and neurological evaluations (cranial nerves) should be undertaken.

 Further diagnostics such as an upper airway endoscopy, radiographs, ultrasound, and CT images will often help characterize the full extent of the trauma.

The ample blood supply to and low physical load on this type of injury allow for a good prognosis following treatment even when associated with a skull fracture. Wounds will be treated routinely using a combination of clipping, cleaning, and copious flushing. These wounds are usually moderately to severely contaminated and, therefore, should be debrided accordingly.

 When the wound is associated with a skull fracture, several treatment options can be considered, the majority looking at stabilization of the fracture site. Surgical treatment has been reported to be the best choice for open fractures, while conservative management has reportedly been associated with greater risks of wound infection, delayed wound healing, and sequestrum formation.

 It has also been postulated over the years that inadequate reduction would result in inferior cosmetic outcome, especially if a prominent callus formation is present, but there is little published scientific reference to that regard.

 Various surgical repairs for skull fractures have been described over the years. In some cases, the fractured bone segments may be able to be elevated by sliding an instrument through small holes drilled away from the fracture. Once elevated, some of the fragments may not need further intervention but in some cases internal fixation using cerclage wires and implants such as plate and screws may be necessary to stabilize the fracture. There is also an isolated report describing the use of polydioxanone sutures,

intrasinus bolstering using Foley catheter balloons,

 and the use of titanium rosettes1 to repair such fractures.

Last year, investigators, including this author, analyzed 13 cases that were presented in our practice over the past 4 years.

Cases were included if they underwent CT diagnostics of the head with a history of facial trauma and had a fracture of at least 1 of the facial bones comprising the skull. We only included cases that were treated without internal fixation of the skull fracture. 

Diagnostic imaging identified the fractures to be complete and comminuted in all cases. The skull fractures were unilateral in 10 horses and bilateral in 3 cases. The most common facial bones involved were the maxilla in 9 horses, the nasal bone in 7 horses, and the frontal bone in 4 horses. The nasolacrimal duct was involved in 3 horses and the infraorbital canal in 1 horse. Secondary sinusitis was present in 10 horses with the rostral maxillary, caudal maxillary sinus, and ventral conchal sinus being the most affected. There was an associated fracture of dental structures in 3 horses (

Treatment was strictly conservative in half of the cases, consisting of wound treatment and systemic antibiotics and anti-inflammatories, as needed. In the other half of the cases, some minimal surgical intervention was undertaken and included removal of loose bony fragments and sinus trephine and sinoscopy, fragment removal and sinus flush through a Foley catheter and dental extraction. In most cases, the lacerations were cleaned, debrided, and closed primarily using either simple interrupted or tension-relieving sutures (vertical mattress). In certain cases, given the nature of the laceration, only partial closure was possible leaving a defect to heal by second intention. (

Follow-up information identified a few cosmetic sequelae, and conservative management yielded a good-to-excellent outcome according to owners in most cases (

). Therefore, conservative management should be considered in cases of skull laceration with associated skull fractures as they still carry a good prognosis with limited complications.

Furst AE, Auer JA. Fractures of the head. In: Nixon AJ, ed. Equine Fracture Repair, 2nd edition. Wiley-Blackwell. 2019;770-799. 

Little CB, Hilbert BJ, McGill CA. A retrospective study of head fractures in 21 horses. Aust Vet J. 1985;62(3):89-91. doi:10.1111/j.1751-0813.1985.tb14146.x 

Nixon AJ, ed. Equine Fracture Repair, 2nd Edition. Wiley Blackwell; 2019. 

Ragle CA. Head trauma. Vet Clin North Am Equine Pract. 1993;9(1):171-183. doi:10.1016/s0749-0739(17)30422-4 

Auer JA, Stick JA. Equine Surgery, 5th edition. Elsevier; 2018. 

Crijns CP, Weller R, Vlaminck L, et al. Comparison between radiography and computed tomography for diagnosis of equine skull fractures. Equine Vet Educ. 2019;31(10):543-550. doi:10.1111/eve.12863

Tietje S, Becker M, Böckenhoff G. Computed tomographic evaluation of head diseases in the horse: 15 cases. Equine Vet J. 1996;28(2):98-105. doi:10.1111/j.2042-3306.1996.tb01599.x 

Solano M, Brawer RS. CT of the equine head: technical considerations, anatomical guide, and selected diseases. Clin Tech Equine Pract. 2004;3(4):374-388. doi:10.1053/j.ctep.2005.02.016 

Modransky P, Welker B, Pickett JP. Management of facial Injuries. Vet Clin North Am Equine Pract. 1989;5(3):665-682. doi:10.1016/ s0749-0739(17)30581-3 

Schaaf KL, Kannegieter NJ, Lovell DK. Management of equine skull fractures using fixation with polydioxanone sutures. Aust Vet J. 2008;86(12):481-485. doi:10.1111/j.1751-0813.2008.00369.x 

Dowling BA, Dart AJ, Trope G. Surgical repair of skull fractures in four horses using cuttable bone plates. Aust Vet J. 2001;79(5):324-327. doi:10.1111/j.1751-0813.2001.tb12004.x 

Gardner AK, Santschi EM, Mudge MC, Belknap JK, Metzler AG. Intrasinus bolstering of traumatic maxillary sinus fractures by using Foley catheter balloons in two foals. Vet Surg. 2020;49(6):1255-1261. doi:10.1111/vsu.13433 

Turner AS. Surgical management of depression fractures of the equine skull. Vet Surg. 1979;8(2):29-33. doi:10.1111/j.1532950X.1979.tb00601.x 

Schumacher J, Brink P. Treatment of horses for a facial or oral fistula. Equine Vet Educ. 2011;23(5):242-248. doi:10.1111/j.2042-3292.2010.00183.x 

Perrier M, Looijen M, Manso-Diaz G. Equine skull fractures: a review of 13 cases (2018-2022). Presented at: European College of Veterinary Surgeons; July 6-8, 2023; Krakow, Poland.

Navigating bones and vital structures requires knowledge of the horse’s anatomy

Equine head wounds and skull fractures

Image courtesy of Kansas State University

An artist's rendering of the new Biomanufacturing Training and Education Initiative facility planned at Kansas State University 

Kansas State University has announced a $7 million federal investment in support of its’ Biomanufacturing Training and Education Initiative. The funding for the program will be directed toward construction of the university’s new Biomanufacturing Core and Training Facility, 1 of 4 state-of-the-art facilities considered integral to the initiative.

The facility, to be built on the university’s campus in Manhattan, Kansas, has an emphasis on production and training. It will be used to support partners in the advancement of diagnostics, prophylactics, and therapeutic countermeasures used to combat infectious animal diseases.

 It will also place a focus on zoonotic and foreign animal diseases, while providing Kansas State research students with crucial, hands-on experience.

“As Kansas continues to grow its’ animal health corridor, Kansas State University is uniquely equipped to train the workforce need for this industry,” Jerry Moran, US Senator for Kansas, said in a news release.

 “I worked to secure federal resources to bolster [Kansas State’s] efforts to build Manhattan into a premier location for biotechnology and biodefense companies looking to expand.”

By focusing on advancements in biomanufacturing, the university hopes to strengthen Kansas’ economy, attracting jobs and industry partners to the state. Currently, according to the Kansas Department of Commerce, the state’s animal health industry contributes more than $2.2 billion to Kansas’ total gross domestic product (GDP), with more than 14,000 Kansans currently employed in animal health related industries. Additionally, Kansas is home to the Animal Health Corridor, which has the largest concentration of animal health companies in the world, accounting for 56% of the total worldwide animal health, diagnostics, and pet food sales.

“We are incredibly grateful to Senator Moran for supporting us to receive this federal funding. With it, [Kansas State] is positioned to have a lasting impact on both the health of Kansans, and the health of the economy,” Richard Linton, Kansas State University President, said.

 “Our work in biomanufacturing not only addresses current health challenges but will also pave the way for future innovation as the next-generation land-grant university.”

The university’s Biomanufacturing Training and Education Initiative features 3 additional facilities as part of its long-term plans:

Biologics Development Module at the Biosecurity Research Institute.

 With emphasis on research, development, and pilot production, this facility will be used to develop diagnostics, vaccines, and therapeutics intended to safeguard food security and public health.2

Biologics Development Module at the College of Veterinary Medicine. 

This facility will focus on research and development, specializing in advanced cell culture techniques and the lyophilization of protein and viral antigens. Additionally, the facility will emphasize protein purification and adjuvant production.2

Biomanufacturing Laboratory and Training Facility. 

This facility will be used for hands-on skill-building in biomanufacturing production, using its advanced biomanufacturing laboratory equipment. Through this training program, the goal is to create a strong pipeline of talent for the biomanufacturing industry.

A safer future for Kansas and beyond: K-State announces $7M in federal funding to drive Biomanufacturing Training and Education Initiative. News release. Kansas State University. August 26, 2024. Accessed August 28, 2024. 

https://www.k-state.edu/media/newsreleases/2024-08/New-federal-funding-supports-KState-Biomanufacturing-Training-and-Education-Initiative.html?_gl=1*1pvudvs*_gcl_au*MTg5MTA5NzcxOC4xNzI0ODY5NzI4

Biomanufacturing Laboratory and Training Facilities. Kansas State University. Accessed August 29, 2024. 

https://www.k-state.edu/biomanufacturing/facilities/

Animal Health. Kansas Department of Commerce. Accessed August 29, 2024. 

https://www.kansascommerce.gov/industry/animal-health/

The $7 million federal investment supports the training and education facility at Kansas State University

Kansas biomanufacturing initiative receives federal funding 

Image Credit: © ShutterDivision - stock.adobe.com

It’s not easy to stay at the forefront of research in veterinary dermatology. That’s why, at Fetch Kansas City 2024, an all-star team of dermatologists assembled to discuss what they learned after attending WVC this year. The panel included: Joya Griffin DVM, DACVD, Ashley S. Bourgeois DVM, DACVD, Jason B Pieper DVM, MS, DACVD, and Cristiano von Simson DVM, MBA. They shared their thoughts on what they learned, antibiotic resistance, and how topical therapies can be effective treatment strategies while promoting good antimicrobial stewardship.

Antimicrobial resistance is a growing concern

One of the key topics the panel discussed was the ongoing issue of antimicrobial resistance and antimicrobial stewardship, especially in dermatology. Panelists emphasized the importance of adhering to updated guidelines for antibiotic use. "We all know we have [antibiotic] resistance—it's everywhere," said Pieper. "The big thing is choosing the right antimicrobial agents based on updated guidelines and understanding when to escalate to culture-based treatment." He added that it is vital to choose the right antibiotics empirically and emphasized the necessity of performing cultures when initial treatments fail. The shift towards using topical treatments before systemic antibiotics was also noted as a significant change in practice, reflecting a global trend towards better antibiotic stewardship.

A shift toward topical therapies as a first-line defense

The panel also discussed the important role topical therapies can play in managing skin conditions, particularly in the face of increasing antibiotic resistance. They talked about rethinking the traditional approach of relying heavily on systemic antibiotics, especially for superficial skin infections, and are instead advocating for the use of topicals as a first-line treatment. This shift is driven by concerns not only by antibiotic resistance, but also the desire to minimize side effects of using systemic antibiotics. For instance, the use of chlorhexidine-based shampoos and other topical agents has shown significant promise in managing infections, sometimes even resolving conditions without the need for oral medications, the group said.

Bourgeois told the audience about a case that involved a dog with a resistant staph infection. Despite delays in antibiotic treatment due to logistical issues, the infection improved dramatically with the use of a 3% chlorhexidine shampoo alone. The team was planning on putting the dog on antibiotics, but there was a 2-week delay in the medications arriving by mail. In the meantime, the pet parent used a 3% chlorhexidine shampoo while waiting for the antibiotics. “By the time the antibiotics arrived at the door, the dog was better,” she said.

The discussion also touched on the role of topicals in long-term maintenance, particularly for allergic dogs prone to recurrent infections. Regular use of topical treatments can help manage these conditions, potentially reducing the frequency and severity of flare-ups. I always have my patients on a bathing routine, even when [clients] don't want to do it,” said Griffin. You can switch to the maintenance shampoos that we're talking about that don't contain chlorhexidine. The importance of that, whether it's weekly or bi-weekly, is that we restore allergens from the skin, restore skin barrier functions, and keep [clients] vigilant and looking at the skin.”

A panel of world-class dermatology experts shared the latest trends and treatment methods in their specialty 

Updates in veterinary dermatology, from WVC to Fetch Kansas City 2024

The American Veterinary Medical Foundation (AVMF) provides veterinarians and veterinary students with resources and programs to advance the science and practice of veterinary medicine.

 This year, the AVMF is introducing 2 new scholarships in partnership with the Hoveida Family Foundation—a private philanthropic organization—and Embrace Pet Insurance, according to the American Veterinary Medical Association (AVMA).

Hoveida Family Foundation Research Scholarship

One of the new scholarships being launched this year is the Hoveida Family Foundation Research Scholarship. The scholarship aims to promote scientific and engineering education and research. According to the AVMF, it is also designed to support and inspire future veterinary researchers who will contribute to the health and welfare of domestic and farm animals as well as human communities with a critical shortage of veterinarians.

 This scholarship will grant $4,400 to a veterinary student with a strong interest in pursuing a research career post-graduation.

“We believe in the power of science education and the impact it can have on the future of our world. By supporting scholarships for the American Veterinary Medical Foundation, the Hoveida Family Foundation aims to help passionate, talented students in need of financial help to pursue their studies in veterinary medicine,” wrote the Hoveida Family Foundation in a news release.

 “We hope this will eventually result in a positive impact on the well-being of domestic and farm animals and our human communities faced with a critical shortage of veterinarians.”

The organization will be accepting applications from September 1, 2024 to September 30, 2024. Applications will be reviewed between October 7, 2024 to October 25, 2024. Awardees will be notified and receive a check disbursement in the fall semester of 2024.

Be currently enrolled and in good academic standing.

Have a demonstrated interest in pursuing a career in veterinary research.

The scholarship created through the partnership of AVMF and Embrace Pet Insurance will award $5,000 to five 3rd- or 4th-year veterinary students who show a commitment to pursuing careers in shelter medicine after graduation.

“Partnering with the American Veterinary Medical Foundation to launch this vital initiative underscores our dedication to the future of veterinary medicine and the support of animals in need,” Brian Macias, CEO of Embrace Pet Insurance, said in a news release.

 “Through scholarships for veterinary students passionate about shelter medicine, we seek to empower a new generation of veterinarians committed to animal welfare.”

Embrace Pet Insurance and the AVMF will be taking applications between September 1, 2024 and September 30, 2024, and will be reviewing applications from October 7, 2024 to October 25, 2024. Like the Hoveida Family Foundation Research Scholarship, award notifications and funds disbursement will be delivered during the 2024 fall semester.

Eligibility criteria for this new scholarship consists of the following

Being 3rd- or 4th-year student in good standing at an AVMA Council on Education-accredited school of veterinary medicine.

Demonstrating an intention to work in shelter medicine upon graduation.

AVMF. American Veterinary Medical Association. Accessed August 28, 2024. https://www.avma.org/about/avmf

Scholarship opportunities for students, grants for researchers available through AVMF. News release. American Veterinary Medical Association. August 26, 2024. Accessed August 28, 2024. https://www.avma.org/news/scholarship-opportunities-students-grants-researchers-available-through-avmf?utm_source=delivra&utm_medium=email&utm_campaign=todays-headlines-news

Introducing the Hoveida Family Foundation Research Scholarship: Advancing veterinary science for a better world. News release. American Veterinary Medical Foundation. August 9, 2024. Accessed August 28, 2024. https://www.avmf.org/news/introducing-the-hoveida-family-foundation-research-scholarship-advancing-veterinary-science-for-a-better-world/

AVMF partners with Embrace Pet Insurance to launch scholarship program for veterinary students committed to shelter medicine. News release. American Veterinary Medical Foundation. August 6, 2024. Accessed August 28, 2024. https://www.avmf.org/news/avmf-partners-with-embrace-pet-insurance-to-launch-scholarship-program-for-veterinary-students-committed-to-shelter-medicine/

The Hoveida Family Foundation Research Scholarship will be awarded to a student passionate about veterinary research and the Embrace Pet Insurance Scholarship will be granted to 5 students interested in shelter medicine

Two new scholarships for veterinary students are announced

 Because our new client numbers are down, I listened to a few recorded calls between client service representatives (CSRs) and phone shoppers. I was horrified to hear a CSR ask the caller, “Do you want to make an appointment, or are you calling around to check prices?” How can I coach CSRs to turn more phone shoppers into new clients?

 You’re wise to notice a decline in new clients so you can immediately reverse the trend. New clients are essential for every hospital because they replace natural attrition caused by patient deaths and clients who leave the practice. When potential clients call your hospital, CSRs should follow the 4 steps below to convert them into clients.

Ask for caller and pet names. When you engage callers, you make connections and build trust. Ask for their names at the beginning of conversations. Let’s say a prospect asks how much puppy shots are. You could say, “I’m happy to provide that information. May I ask your name and your puppy’s name?” If the caller questions why you need names, explain that it’s to get to know them and their pet and so you can share more accurate information. Getting to know callers shows your eagerness for them to become clients. 

Use names at least 3 times during the conversation: 

Use names immediately after the caller provides them. Say, “It’s great to meet you, Kristen. Let me ask you questions about Max so I may share which medical services he will need.” 

Use names when determining which services and products are necessary. Say, “Which vaccines has Max received, and when were they given?” 

Use names when asking for the appointment, which is a friendly approach that also avoids saleslike language. Say, “When can we meet you and Max? Our next available appointments are [date/time] and [date/time]. Which do you prefer?”

Ask questions to determine medical needs. Callers may ask about vaccines, but pets also need examinations, diagnostic tests, and preventives. The caller’s answers will let you tailor the conversation, discussing needed services and products based on your hospital’s standards of care. You also will more accurately quote fees rather than risk over- or underquoting. When talking with a puppy owner, ask the following questions: 

Which vaccines has [pet name] received, and when were they given? 

Have you seen any fleas, or has [pet name] been scratching? 

Explain needed services and products based on the caller’s answers. For example: “For Max’s first veterinary visit, he will have a nose-to-tail exam to check his growth and development. Max will need puppy exams at 12 and 16 weeks of age. Because Max is a Yorkie and will go to a groomer, our doctors advise vaccinating him for distemper/parvovirus and Bordetella, which protects him from a respiratory disease called kennel cough. [Explain your core vaccines.]” Then, continue by saying, “Max will receive an intestinal parasite test to check for worms, including parasites that can be passed from pets to people. We also will give Max medication to deworm him. We will start Max on monthly flea/tick and heartworm preventives for ongoing protection. When Max is 16 weeks old, he will be vaccinated for rabies, which state law requires. Max will get a puppy gift on his first visit, which includes a free dose of a flea/tick and heartworm preventive, a leash, puppy food coupons, handouts on training and raising a healthy puppy, a vaccine record keeper, a measuring cup for pet food, treats for training, and 30 days of free pet insurance. This gift is a value of $100.”

Talk about other new client incentives, such as a complementary new patient exam. Assign the retail dollar value to the baby gift or complementary service, which persuades callers to schedule now. Put puppy/kitten baby gifts in inventory so they will print descriptions on invoices, such as “puppy baby gift, a value of $100,” and a zero fee. Set a reorder point such as 15 units so you know when to stuff more bags and to contact vendors for additional supplies.

Present the services before the fees. Never lead with prices because you then risk callers replying, “OK, thanks. Goodbye.” Leading with the cost of care centers conversations around money, and prospects will decide within seconds whether to schedule an appointment. Instead, educate callers about which medical services and products their pets need, and then share the expected fees. Use the term fees instead of prices. Fees are payment for professional services, whereas prices are the costs of goods. Consumers are more likely to negotiate prices, not fees.

Ask for the appointment. Use the yes-or-yes technique to lead the caller to schedule now. Say, “When can we meet you and Max? Our next available appointments are [date/time] or [date/ time]. Which do you prefer?” Never ask, “Do you want to make an appointment?” This gives prospects an opportunity to say no. 

CSRs create powerful first impressions that drive new client growth. Provide ongoing training to help them improve phone skills such as my online course, “Book Now: Get New Clients to Schedule” (https://csvets.info/ NewClients). Listen to recorded new client calls 30 days after training to reassess CSRs’ skills. Meet with employees individually and listen to their new client call together. Discuss what the CSR did well and improvements to secure the new client appointment. Consider a friendly contest with individual and team rewards for reaching monthly new client goals. Post new client numbers on employee bulletin boards. Seeing goal progress will motivate them to welcome more new clients—and ensure more puppy kisses in their future! 

If you need a script for a challenging client conversation, submit your scenario to info@csvets.com for consideration in future columns.

This script outlines steps for making a good first impression during a conversation with a client