Puppies are Cuter when they Don’t “Go” in the House

Puppies are Cuter when They Don’t “Go” in the House

(Keep reading, there is a relevant lesson to be learned)

Cindy Pezza, PMAC

President/CEO Pinnacle Practice Achievement

Last fall my family and I took a trip to the local ASPCA to donate some old blankets and ended up in the dog room so the kids could “just look.”  Two hours, a $500 adoption fee, and a trip to purchase all of the basics (and possibly some not so basics- see picture below), we found ourselves the proud new owners of a 3-month old lab, hound, who knows what else mix named “JAX.”  Adorable didn’t begin to describe him. It seemed as if he looked at us and knew he found his family (well, all of us except maybe for the cats).

The first few days were easy. Jax just wanted to cuddle, pick at his food, and then take a nap. We found that he was not familiar with grass or stairs or going to the bathroom anywhere other than in front of his food bowl. . . I guess that saying don’t _____ where you eat did not apply here (unfortunate one of the side effects of puppies who only know the inside of a shelter pen).  But still, the kids couldn’t get enough of him (well, the cuddling and sleeping part) and they even slept in the living room with him for the first few nights so he wouldn’t be lonely.

After about a week, Jax seemed to wake up a bit, wag his tail more, chase and retrieve toys, eat like he had never seen food before and still wanted to cuddle (adorable, yes). He had taken a special attachment to me (the “Mumma”) and even now as I write this is sleeping with his head on my lap snoring away (making typing very difficult). We took him to the park where he socialized well with other dogs, was excited for attention but not overly jumpy when greeting children and adults and was getting a little more comfortable with the idea of grass and doing his “business” on it, but continued however to “go” in the house with no understanding of the difference.  We reprimanded him (trying not to be overly forceful) when his actions called for it, and praised him loudly when he displayed positive behavior (“going” outside), but it was clear that he needed more than that (as the situation seemed to be unchanged since our first days with him).

After doing some puppy research (and waiting for our obedience and training classes to begin) we found that like anything else, structure was needed to make progress. Jax was then going out every 2-3 hours (except for during the night when we tried to only get up once like he was a baby – most of the time to find a surprise in the morning) and other than some tummy trouble as he transitioned from shelter food to a healthier alternative, he was doing much better.  He had just about mastered the stairs and knew almost immediately which door was ours in the condo development. Jax appeared to be catching on (display even more intelligence once we began his formal training).  He just had some bad habits that took time and patience (and lots of paper towels and sanitizer) to correct.

So . . . Why would I be writing an article about my puppy and have it published in a journal intended for medical practitioners?  I suppose because as a practice management consultant and advocate of implementing protocols and systems for just about everything, it solidified the idea that sometimes when you are too close to (or in) a situation, you aren’t able to clearly see resolutions to problems.

I am constantly approached by physicians trying to discover some variety of  “secret sauce” to make their practices successful.  My answer to them (as it was to myself as I continued to clean puppy messes) is consistency, protocols, and patience.  There are no magic wands to wave, no ruby slippers that deliver us to a powerful Wizard and no short cuts that provide long-term results when it comes to achieving goals. Therefore, if you find yourself caught up in the minutia; constantly making excuses for an employee who isn’t pulling their weight but has “been with you forever” or feeling as if your staff would most likely stage a coup if you made any attempt to change or improve the practice, I suggest taking a step back and looking at the big picture.  Ask yourself, “Will my current practice and all of its moving parts continue the struggle to barely keep a head above water, or will it yield success?”  Be honest with yourself when answering and understand that the most difficult part of any transformation is accepting the problem and asking for help.

You should not feel alone in fighting your battles because there is help available right at your fingertips. . .  www.FILLINYOURPROBLEMHERE. . .If you need help improving your current practice, are thinking of expanding or even opening from scratch and are not quite sure where to begin please visit www.pinnaclepa.com or email info@pinnaclepa.com.  I wish you success and remind you that it all begins with the basics and creating your own plan to housetrain!

Diabetic Care and Prevention

We are all aware of the alarming rate at which Diabetes is increasing in our country. Everyday, as we encounter new patients and continue to care for existing ones, we are faced with the realities of this powerful disease. As medical professionals, we diagnose problems and use our Podiatric knowledge to resolve them. However, what we overlook is the need to focus on the factors contributing to complications and what measures could have been taken to prevent them initially.

For example, if a patient presents with an ulceration just under the first metatarsal head, why not look at the patient’s shoes to make sure they are properly fitted to support that individual foot type. While performing the debridement, discuss with the patient, who may or may not be wearing therapeutic shoes, the importance of offloading pressure from areas of the foot which may easily break down. Make fitting the patient into proper shoegear a preventative goal once the ulceration is well healed.

In our office we make sure that every Diabetic patient with “at risk feet” is properly sized and fitted to approved therapeutic shoes and accommodative inserts. We take the time to explain the necessity of wearing shoegear that fits comfortably and supports well. Our patients are made aware of the benefits offered (but not advertised) by most insurance companies on an annual basis. Some are shocked to find out that with each new calendar year they are eligible to receive one pair of Diabetic shoes and three pair of heat molded or custom inserts. If patients ask why they would be entitled to such a benefit, we explain the cost effectiveness of keeping Diabetic feet in good health rather than treating complications after they arise. Subsequently, it costs Medicare less to pay for Diabetic shoes and inserts for every qualifying patient in your practice once a year than it does for the combined cost of just one amputation.

The same holds true for all conditions related to Diabetes. From regular dental checkups to annual eye exams, Diabetic patients need to recognize the importance of preventative care. It is always a good idea to encourage your staff members to ask routine questions as part of their Diabetic evaluations. “When was the last time you tested your blood sugar and what was the reading?”, or “When was your last eye exam?” These are great ways to assure your patients are taking an active role in their preventative care. Physicians should stress to their patients that ALL health care professionals involved in their care and management are equally important in keeping them on the right track.

In order for this idea of prevention rather than treatment to be realized, constant contact must keep with the specialists, primary care physicians, and Diabetic educators in your area. By informing other doctors of the services you are able to provide for their patients and them in turn for yours , you are doing your part to make this effort a success. So get communicating! Attend breakfast meetings at local hospitals for on staff physicians. Send letters informing the local medical community about new technologies you are utilizing in your office to diagnose Diabetes related problems early. Talk to your own dentist or ophthalmologist to find out how far their Diabetic population reaches. Make sure that primary care and vascular physicians are not referring Diabetic patients elsewhere to be fitted for their therapeutic shoes and/or offloading devices. Educate those highly trained professionals around you, who may not be so well educated when it comes to recognizing complications that first present themselves in the feet.

Always take time to listen to your patients and make sure they are listening to you. In caring for their feet, you are examining all of the ways in which Diabetes can affect their overall health. Make sure they understand the importance of choosing a group of doctors who will work together to make prevention of Diabetic related problems their number one goal. Care for your patients feet and care for their well being. Keep them happy and well educated and they will be patients for life; a long healthy one!


by Cindy Pezza