Are Lasers the Wave-Light of the Future?

New applications and lower prices might allow lasers to replace traditional dental tools

CHICAGO (Academy of General Dentistry) -Would you spend more than $40,000 on equipment that would allow you to complete oral surgeries with virtually no pain or blood and a vastly reduced healing time? Today’s dental laser manufacturers think so, and many dentists are exploring the possibilities that this new technology affords practitioners. An article in the May issue of AGD Impact, the newsmagazine of the Academy of General Dentistry (AGD), provides an explanation of how dental lasers work, what different types of lasers have been developed for dentistry, and why dentists should consider purchasing a laser for their offices.

Since the first dental lasers-approved for soft tissue applications and hardening of composite resin dental fillings-were introduced in 1991, dental lasers have become more sophisticated, varied and applicable for more procedures. Today, there are more than 17 different dental laser applications that can help patients achieve better oral health. They are being used to clean out cavities and root canals, reshape gums, and whiten teeth, among other uses.

But, as with every new technology, there is a period of induction. The market must be educated about why lasers are superior to other equipment. Ohio dentist Louis Malcmacher, DDS, says “The benefits to the patients are many-there is less pain, less trauma, less need for local anesthesia or postoperative pain medication, [and] less fear of drills and of the dentist.” He also highlights benefits for the dentist saying “[dentists can] do more procedures they may have referred out, such as crown lengthening procedures, soft tissue procedures like frenectomies, gingivectomies, and the like, and the laser is a huge practice builder as patients find out the benefits of laser dentistry.”

More procedures and more patients usually equate to more money, which is music to a dentist’s ears. But, there is another obstacle presented to dentists interested in lasers: cost. Gene Antenucci, DDS, a general dentist in Huntington, N.Y., suggests that dentists interested in purchasing a laser should calculate a return on investment, as with any major technology purchase. He says “You have to calculate the dollar value of the laser versus the number of procedures to justify your investment. The return on a laser investment is fairly high.” Also, for users, there is a learning curve.

Although there are no state laws requiring dentists to have training in the use of lasers, it is to the dentist’s benefit to learn about them not only to purchase the right one for their practice, but to maximize their investment and ensure patient safety. The Academy of Laser Dentistry (ALD) has adopted the Curriculum Guidelines and Standards for Dental Laser Education, which recommends attending a Standard Proficiency Course (Category II), including specific laser proficiency and laboratory knowledge. Although manufacturers provide training, not all of their courses are recognized as standard proficiency.

The technology is constantly evolving and improving. Dr. Antenucci expects “to see a lower cost of the laser unit, and a more streamlined unit [in the near future],” and anticipates “improvement in hard tissue laser capabilities, such as it being more efficient with decay removal and tooth preparation.”

And with these advances in technology and reductions in cost, dentists’ may no longer wonder if lasers will replace their current instruments; they will wonder when.


Don’t Let Your Mouth Pollute Your Clean Heart

Levels of Bacteria in Plaque Beneath the Gum Line May Increase Risk for Heart Attacks

CHICAGO (American Academy of Periodontology) -Researchers have found evidence that the amount of bacteria in subgingival plaques, the deep plaques in periodontal pockets and around the teeth, may contribute to an individual’s risk of a heart attack, according to two studies appearing in the Journal of Periodontology. These studies further researchers’ understanding that periodontal bacteria may increase the risk for heart disease.

In one study researchers looked at 150 individuals with periodontal diseases and found that the total number of periodontal bacteria in subgingival plaques was higher in individuals that have suffered from an acute myocardial infarction (heart attack). The second study found that the same DNA from different kinds of periodontal bacteria in plaque was also in the patients’ heart arteries. Researchers believe that these findings may help substantiate what they have long known; if there is a sterile pathway, such as a bloodstream, near a periodontally infected area that the bacteria from this infected area cause inflammation in the gums that opens up pores in the surrounding blood vessels, which enables the bacteria to enter the bloodstream and travel to other parts of the body and cause great harm.

“It is like setting up a garbage dump on the edge of a river. You wouldn’t be surprised if the lake downstream ended up polluted with the garbage from the dump,” said Vincent J Iacono, DMD and president of the American Academy of Periodontology. “A patient’s bloodstream acts very much like the river in this analogy, in that it carries the bacteria from the periodontal plaques, possibly ‘polluting’ the arteries of the heart with periodontal bacteria, causing inflammation of the arteries which may lead to a heart attack. This potential effect of periodontal bacteria further supports the need for periodic deep cleanings to enhance overall health and wellbeing.”

These studies represent two in a large body of research that investigates the possible link between periodontal diseases and other systemic conditions such as heart disease. “Intervention data is not available to prove a causal relationship between the two. Right now we are currently advising patients that maintaining good periodontal health can only help not hurt,” said Iacono.

Referral to a periodontist in your area and free brochure samples including one titled Ask your Periodontist about Periodontal Disease and Heart Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at

The American Academy of Periodontology is an 8,000-member association of dental professionals specializing in the prevention, diagnosis and treatment of diseases affecting the gums and supporting structures of the teeth and in the placement and maintenance of dental implants. Periodontics is one of nine dental specialties recognized by the American Dental Association.

Guest Column: Infection control By Barry Levy, DDS

In the last issue of Solutions, I discussed the problems with “minimum standards” of infection control and how the dental practice act in California mandated “sterile gloves” for surgical procedures that involve soft tissue or bone.

This is a situation that applies to almost all dentistry that is done in the office. This is especially so if one considers the definition of dentistry as being the treatment of diseases by surgery or other methods.

I explained that while there are questions as to the benefits of this ruling, as well as the costs involved to achieve this goal, those questions are irrelevant.

Those issues become irrelevant because this issue has been defined as a “MINIMUM STANDARD.” What others do or don’t do is irrelevant should you have a problem. It becomes impossible to defend a civil action should you fail to follow the code. I had cited a case that showed how this played out and what the costs were.


I have been personally involved with two cases that relied on this section. I have seen this section applied in board hearings and I have been involved where dentists lost in the civil arena.

The issue that should come to mind should you be sued is – what tactics will an attorney take to win. You have to be prepared for your defense.

The tactic that I have seen attorneys use is to attempt to show that you have not followed the MINIMUM STANDARDS in a particular area, which is mandated and crucial to the patient’s health.

Having shown a dentist’s failure to follow minimum standards of infection control for patient safety, it would not be difficult for a jury to question the care that you did give.

Even if the care is excellent, you have already been tarred and feathered for failing to follow the Minimum Standards of Infection Control and placing your patient at risk.

If you are practicing below the MINIMUM STANDARD, that is demonstrable and very
objective, why should a jury believe that the care you render is acceptable?

There are problems with infection and cross contamination between X-rays and ultrasonic cleaners that we should be aware of. There are standards that must be met so that you can realistically minimize this potential risk to you and your patient.

Let’s address your x-ray procedures if the patient has to be moved to another room when x-rays are to be taken.

Does your assistant remove her gloves and wash her hands prior to leaving the room before going to the x-ray room for this procedure? Does she then wash her hands prior to taking x-rays, and does the door to your x-ray room have protective barriers that are used and removed each time the assistant takes the x-rays and touches the doors to open and close them?

Does this sound silly to you, a waste of time and inefficient? Based on how dentistry was performed for years in the past, you might have answered yes to the previous question.


How long can an infection stay viable outside the host is a legitimate question that should be asked. But the better question to ask is: are you following protocol as defined in the California dental practice act? If yes, you can defend yourself. If not, you might want to think about the potential liability that you could face.

After that, you can ask if the codes are really making the patient safer, or just creating problems to the practice of dentistry and increasing your costs, or the costs to your patients.

According to California Dental code section 1005 B(2) “Medical exam gloves shall be worn whenever there is potential for contact with blood, blood contaminated saliva, or mucous membranes.” I tend to think that the definition would be met when taking x-rays.

CD Code section 1005 B (3) “Health care workers shall wash hands and put on new gloves before treating each patient.” I am certain that all health care workers in your office are putting on gloves prior to treating a patient, though I do question if hands are being washed at all times.

But the kicker now comes from the following:

“Health care workers shall wash hands after removing and discarding gloves after the treatment of each patient OR BEFORE leaving the operatory.” (Emphasis mine)

CD Code section 1005 (6) “Protective attire must be removed when leaving the
operatories and work areas.”

One might question if taking a patient from the operatory to the x-ray room IS treating a new patient. If you have to take off your gloves when you leave the operatory it would then seem clear that you have to wash your hands and place new gloves before taking the x-rays, which is the treatment of a patient with the potential for touching mucous membranes.

So, are you following the code as written? Should a problem arise in your office, can you defend yourself that you have followed the MINIMUM STANDARDS and you are not practicing in a shoddy, haphazard manner?

When one deals with ultrasonic cleaning of instruments, the consensus was that instruments are placed in the ultrasonic cleaner, then bagged and sterilized. The question to be asked would pertain to the ability of the ultrasonic cleaner to kill bacteria.

If it doesn’t kill bacteria, what are the risks to your staff from the ultrasonic cleaner becoming the focal point for potential infection to your staff from handling the instruments? Do you have to change the ultrasonic solution after each use?

What are your liabilities should a staff member poke herself with an instrument coming out of the ultrasonic? Imagine what could become of an incident such as this.


I am playing devil’s advocate. If I were to be retained by you I would be pointing out these issues and hoping that the other sides aren’t aware of the code sections, or that they wouldn’t think to use them. This was evident in the case that I worked on, because the first law firm dropped the case, when they couldn’t prove causality.

The second lawyer didn’t worry about causality, but only that MINIMUM STANDARDS OF INFECTION CONTROL weren’t followed. It became definitional that malpractice occurred, and the patient had been harmed.

But if I am retained by the patient, or the board is asking me to look into a case, I can tell you emphatically that these issues are high on my list to review.

And I will restate that should a case involve lawyers, it is about winning.

In a civil case it is about getting money for the client, which is a powerful motivator for an attorney on contingency to prevail.

If it is a board action, money is also a powerful motivator because the board can only collect the fees for the investigation when they prevail.

I have previously written that the board will always win. In your board hearing, the trial before a judge, allows only for the judge’s opinion to be expressed. The board can choose to ignore if it wants.

In a study of the board’s decisions, it was shown that the board reversed all judges’ opinions that favored the dentist. Money is a major motivator and, by reversing the judges’ opinions, the board collects from the dentist.


I have also taken the position that sometimes rules are being made by those that don’t practice, and may not even be dentists. If a professional abdicates his professional responsibility to oversee his profession then others will do so, and the results can often be deleterious to that profession.

This is coming to pass with the comments that I hear about the costs to comply and with the facetious remarks that the rules are impossible to comply with and have no basis because one can’t sterilize the mouth prior to treating the patient.

But the rules are changing all over the country. You can take it for what it is worth, but should you wind up with a problem, I hope that you have listened so as to minimize your risk of exposure.

Ask your local dental society to look into the issue prior to problems arising, because by then it might be too late, if it isn’t already so.

Barry Levy DDS

Dr. Levy is on the California Dental Board’s panel of expert witnesses for board investigations, is a guest lecturer at UCLA and UCSF and works as a consultant on dental malpractice issues.

(Note: The California Dental Board is mandated to review its infection control regulations each year. Amendments were considered at a May 14, 2004 hearing. The amendments were approved by the California Dental Board. This has changed some of the code numbers cited, but not the main point of this article. It is suggested that you read and review the changes as the new language specifically cites “A copy of this regulation shall be conspicuously posted in each dental office”)

The rHuPH20 Enzyme

WASHINGTON /PRNewswire-FirstCall/ — Halozyme Therapeutics, Inc. a development stage biopharmaceutical company focused on the development and commercialization of recombinant human enzymes, announced that results from new preclinical studies with Halozyme’s recombinant human PH20 (rHuPH20) hyaluronidase enzyme were presented at the 2005 American Society of Cataract & Refractive Surgery (ASCRS) Symposium on Cataract, IOL and Refractive Surgery, American Society of Ophthalmic Administrators (ASOA) Congress on Ophthalmic Practice Management, and the Clinical and Surgical Staff Program in Washington, D.C.

The data were presented at the ASCRS Innovators Session by Herbert E. Kaufman, MD, Boyd Professor of Ophthalmology and Pharmacology & Experimental Therapeutics at the Louisiana State University Health Sciences Center School of Medicine in New

Dr. Kaufman presented preclinical safety and pharmacology animal studies demonstrating that when viscoelastic agents commonly used in cataract surgery were placed in the eyes of animals, injection of Halozyme’s rHuPH20 enzyme into the front of the eye significantly reduced the incidence and severity of intraocular pressure (IOP) rises.

Such pressure “spikes” are believed to occur when viscoelastic materials used in the surgical procedure clog up the eye’s drainage canals and prevent fluid from properly draining out of the eye, a process that can potentially result in permanently dilated pupils,
persistent glare, pain, and discomfort, and retinal and optic nerve vascular occlusion. Dr. Kaufman’s data also showed that injection of rHuPH20 into the front of the eye caused no toxicity to the corneal endothelial cells in the eye.

“These findings further support an innovative new application of the rHuPH20 enzyme and warrant further investigation,” said Gregory Frost, PhD, Halozyme’s Vice President and Chief Scientific Officer. “Minimizing surgical complications from cataract surgery could be helpful for a large number of patients, given that more than 13 million cataract surgeries are performed worldwide every year.”

Halozyme’s hyaluronidase (rHuPH20) is a highly purified, recombinant form of a naturally occurring human enzyme and is being investigated for its ability to break down hyaluronic acid (HA), the space-filling “gel”-like substance that is a major component of tissues throughout the body. The rHuPH20 enzyme can degrade most viscoelastic agents used in clinical practice and therefore could potentially be developed for use as a viscoelastic “antidote” in patients undergoing cataract surgery, in which viscoelastic
agents are used in every case to prevent damage to the cornea.

Treatment For Childhood’s Most Common Eye Disorder

Surprising results from a nationwide clinical trial show that many children age 7 through 17 with amblyopia (lazy eye) may benefit from treatments that are more commonly used on younger children.

Treatment improved the vision of many of the 507 older children with amblyopia studied at 49 eye centers. Previously, eye care professionals often thought that treating amblyopia in older children would be of little benefit. The study results, funded by the National Eye Institute (NEI), part of the National Institutes of Health (NIH), appear in the April issue of Archives of Ophthalmology.

“Doctors can now feel confident that traditional treatments for amblyopia will work for many older children, said Paul A. Sieving, M.D., Ph.D., director of the NEI. “This is important because it is estimated that as many as three percent of children in the United States have some degree of vision impairment due to amblyopia. Many of these children do not receive treatment while they are young,” he said.

Amblyopia is a leading cause of vision impairment in children and usually begins in infancy or childhood. It is a condition resulting in poor vision in an otherwise healthy eye due to unequal or abnormal visual input while the brain is developing in infancy and childhood. The most common causes of amblyopia are crossed or wandering eye (strabismus) or significant differences between the eyes in refractive error, such as, astigmatism, farsightedness, or nearsightedness.

Children in the study were divided randomly into two groups. One group was fitted with new prescription glasses only. The other group was fitted with glasses as well as an eye patch, or the eye patch along with special eye drops, to limit use of the unaffected eye. These children were also asked to perform near vision activities. The patching, near activities, and eye drops force a child to use the eye with amblyopia. Patching was prescribed for periods of two to six hours daily, while the eye drops were administered daily for the children seven though twelve years of age.

The study investigators defined successful vision improvement as the ability to read (with the eye with amblyopia) at least two more lines on a standard eye chart. The study investigators found that 53 percent of children age seven through twelve years who received both glasses and treatment with patches and near activity met this standard, while only 25 percent of those children in this age group who received glasses alone met the standard. For children age 13 through 17 years who were treated with both glasses and patches (these children did not get drops), 25 percent met the standard while 23 percent of children of these ages who received only glasses met the standard.

The study also revealed that among children age 13 through 17 years who had not been previously treated for amblyopia, 47 percent of those who were treated with glasses, patching and near activities improved two lines or more compared with only 20 percent of those treated with glasses alone. Despite the benefits of the treatment, most children, including those who responded to treatment, were left with some visual impairment. They did not obtain “20/20″ vision.

Rates of Success Treating Children With Amblyopia In Clinical Trial.*
Treatment Group ** Optical Correction Group (glasses only)
Ages seven through 12 53 percent 25 percent
Ages 13 through 17, no prior treatments 47 percent 20 percent
Ages 13 through 17 25 percent 23 percent
* The standard for success in the trial was a child’s ability to read at least two more lines on a standard eye chart using the eye with amblyopia. This may not be the maximum possible benefit that can be achieved with treatment.
** Treatment was eye patching, special eye drops, and near vision activities for ages seven through 12; eye patching and near activities for ages 13 through 17.
“This study shows how important it is to screen children of all ages for amblyopia.” said study co-chairman Richard W. Hertle, M.D., Children’s Hospital of Pittsburgh.

Commented co-chairman Mitchell M. Scheiman, O.D., Pennsylvania College of Optometry, “This study shows that age alone should not be used as a factor to decide whether or not to treat a child for amblyopia. The opportunity to treat amblyopia does not end with the pre-school years.”

It is not known, say the authors of the current study, whether vision improvement will be sustained in these children once treatment is discontinued. The NEI is supporting a one-year, follow-up study to determine the percentage of amblyopia that recurs among the children who responded well to treatment, as well as many other clinical studies of amblyopia at eye centers nationwide.

Dr. Sieving also commented that the current study results are “a wonderful example of the adaptability of the human visual system and brain. The NIH is exploring ways to take advantage of this adaptability in order to better understand and treat vision problems and other neurological conditions.”

The study described in this release was conducted by the NEI-funded Pediatric Eye Disease Investigator Group. The Group focuses on studies of childhood eye disorders that can be implemented by both university-based and community-based practitioners as part of their routine practice. The study was coordinated by the Jaeb Center for Health Research in Tampa, Florida. A list of study centers is attached.

For background information regarding amblyopia, please visit
A list of current study centers is available online at

The National Eye Institute is part of the National Institutes of Health (NIH) and is the Federal government’s lead agency for vision research that leads to sight-saving treatments and plays a key role in reducing visual impairment and blindness. The NIH is an agency of the U.S. Department of Health and Human Services.

West Nile Virus Remains Threat For Unprotected Horses

1,341 U.S. Cases Reported in 2004: Equine Health Experts Urge Vaccination

OVERLAND PARK, Kan./PRNewswire/ — Despite extensive media coverage of equine West Nile virus — as well as the availability of a vaccine for horses — the potentially deadly disease continues to threaten equines, with 1,341 new cases reported in 38 different states from January through mid-December in 2004. Equine health experts continue to appeal to horse owners to vaccinate unprotected horses, as well as properly booster previously vaccinated animals to maintain immunity.

The U.S. Department of Agriculture (USDA) recently released statistics that highlighted the disease’s anticipated spread westward, reporting that California, which had only one reported case in 2003, had 536 confirmed cases in 2004, earning it the designation of the leading state for incidence of the disease. According to the California Department of Health Services, 42 percent of the equine West Nile virus cases in 2004 were fatal.
Other states hard hit by West Nile virus last year include Arizona, Texas, Colorado, Nevada, Oregon, Wyoming, Oklahoma, Louisiana and Mississippi.

“With West Nile virus spreading to the West Coast, the disease is now considered endemic in all areas of the country,” said Dr. Tim Cordes, Senior Staff Veterinarian for Equine Diseases at the U.S. Department of Agriculture, Animal and Plant Inspection Service. “We recommend that all horses be vaccinated as a primary means of prevention.”

According to animal health experts, the interaction of many variables and conditions cause the disease to continue to proliferate. These factors include weather, the environment, migratory bird pathways and mosquito populations. Because the interplay of all these variables is vital for the disease to spread, the risk of exposure and geographic distribution can vary and change significantly from year to year. That is why horse owners are urged to consult with their veterinarian and have their horses vaccinated.
Encouragingly, the overall incidence of the disease has been decreasing over the past two years. In 2003, cases declined by 70 percent from the previous year, and in 2004 they declined again by 75 percent. The declines in equine West Nile virus cases over the past two years can be attributed in part to immunity – from both effective vaccines and the development of natural immunity among the horse population.

Fort Dodge Animal Health developed the first West Nile virus vaccine for horses in 2001. More than 16 million doses of the West Nile- Innovator® vaccine have been administered safely to horses coast to coast since its approval by the USDA. West Nile-Innovator has been proven 94 percent effective in a severe laboratory challenge where horses were exposed to West Nile virus at levels significantly higher than found in nature.

The first cases of equine West Nile virus were detected in 1999, with 25 horses being afflicted with the disease that year. Since then, the USDA has received reports of West Nile virus in all 48 states in the continental United States, with more than 22,600 horses having contracted the disease. Approximately one-third of horses clinically affected with West Nile virus die or are euthanized.

AAEP Issues New Guidelines on WNV Vaccination

Noting the serious effects of West Nile virus, along with the unpredictable geographical risk of exposure to the disease from year to year, the American Association of Equine Practitioners (AAEP) recently released guidelines recommending all horses in North America be immunized against West Nile virus.

The AAEP Guidelines note proper vaccination of previously non- vaccinated horses involves administration of two doses of vaccine three to six weeks apart. In endemic areas, boosters are warranted according to how severe the virus is in the region. Once the first series of vaccinations are complete, horses should be vaccinated semi-annually or more frequently, depending on the risk in the area they are located. Annual revaccination is best completed in the spring, prior to the onset of peak mosquito season.

Horse owners are advised to discuss the AAEP Guidelines with their veterinarian to determine the best vaccination protocol for their region. Many veterinarians in Southern states where mosquitoes are active year- round prefer to vaccinate horses semiannually or more frequently to help ensure uniform protection throughout the year. Further, the Guidelines recommend horses that have been naturally infected with the disease should be vaccinated one year after the acute illness and included in a routine vaccination program.

While the AAEP reported vaccination is the primary method of reducing the risk of infection, it also noted preventive management practices may help minimize the transmission of West Nile virus from infected mosquitoes. Included among these practices is the elimination of standing or stagnant water, the use of anti-mosquito repellants, and keeping horses in barns from dusk to dawn, the prime feeding time for mosquitoes.

Now is the Time to Vaccinate and Booster

West Nile virus typically increases in incidence through the summer months with peak infection rates in August and September. However, many equine health experts strongly advocate horse owners have their animals vaccinated prior to the start of mosquito season. Horse owners with animals already vaccinated should consult with their veterinarian to discuss a routine boostering protocol based on the disease risk in their region.


California VMA Files Lawsuit Against City of West Hollywood

WEST HOLLYWOOD, CA /PRNewswire/ — The California Veterinary Medical Association (CVMA) filed a lawsuit against the City of West Hollywood in Los Angeles County Superior Court in March challenging the city’s ban on animal declawing.

The CVMA contends the ordinance — Municipal Code Chapter 9.49, first adopted by the West Hollywood City Council on April 21, 2003 — is in direct conflict with and preempted by the California Veterinary Practice Act and the Business and Professions Code, which invalidates the West Hollywood measure.

“Just like medical doctors, veterinarians in California are highly regulated by the State of California,” says Dr. Jon Klingborg, president of the CVMA. “We simply cannot have local city councils approving laws that conflict with state law. This restricts pet owners from seeking the best possible treatment and prevents us from practicing veterinary medicine as well.”

Last December, the California Department of Consumer Affairs issued a legal opinion declaring that state law supersedes local law, and the practice of veterinary medicine is governed “solely” by the Veterinary Practice Act and the state Veterinary Medical Board.

Additionally, the legal opinion affirmed that Section 460 of the state’s Business and Professions Code “expressly preempts the City of West Hollywood’s declawing ordinance.”

In recent months, the City of West Hollywood has attempted to assume more of the state’s regulatory responsibilities. It passed one ordinance that restricts the rights of veterinarians who practice within the city boundaries and has proposed another. As a membership organization with members in Los Angeles County and the City of West Hollywood, the California Veterinary Medical Association has an obligation to protect the right of all California veterinarians to practice veterinary medicine as regulated by the California Veterinary Practice Act.

“The practice of veterinary medicine should be left to veterinarians with the best interests of the patient and animal owners in mind,” says Dr. Klingborg. “When legislation becomes necessary for such issues as declawing or ear cropping, there is no doubt it should be conducted by the California State Legislature within the confines of the Veterinary Practice Act.”

The CVMA believes the court will declare the City of West Hollywood’s ordinance banning animal declawing as unlawful, invalid, and unenforceable. The CVMA has also asked the court to declare the city’s February 7 proposal to ban such other “non-therapeutic procedures” as tail docking and ear cropping as equally unlawful, invalid, and unenforceable.

Should the court conclude that West Hollywood’s Municipal Code Chapter 9.49 and its provisions are preempted, the CVMA has requested an order commanding the city to rescind the provisions.

“It is unfortunate that the CVMA is forced to pursue this issue through legal action,” says Dr. Klingborg. “But clearly the West Hollywood City Council stands in direct opposition to the rights of veterinarians to practice medicine in the best interest of their patients and clients.”

Noah’s Ark Veterinarians International to Provide Assistance

Noah’s Ark Veterinarians International will be providing emergency veterinary assistance to animal victims. In the wake of the tsunami devastation, Sri Lanka is under an increased threat of disease outbreaks.

Noah’s Ark Veterinarians International (NOAV), a newly formed Israeli/US Veterinary Non profit relief organization, is preparing to set up a fully-equipped, modern veterinary hospital in Sri Lanka in response to appeals from the Sri Lankan health and animal authorities.

NOAV, in partnership with the Ministry of Health and the Veterinary Services of Sri Lanka, is also initiating a program to address the immediate outbreak of Human Rabies due to the conditions following the Tsunami disaster and to assist them in implementing a long term nationwide modernization program to eradicate the disease.

In addition, NOAV volunteers and funding will be assisting in projects dealing with the care and medical relief for wildlife and domestic animals in the area.

According to the Sri Lankan Minister of Agriculture and animal and livestock, more than 30000 Sri Lankan families depend on livestock to generate their household income hence the urgent need for global assistance in resupplying farm livestock, and housing, feeding and medical care for the existing animals that support the regional economy.

NOAV International was founded by Israeli Veterinarian, Dr. Eytan Kriener of “the House of Veterinarian Doctors” Macabim, Israel, in response to the enormous devastation wrought by the tsunami in East Asia.

In early March 2005, a NOAV volunteer flew to the tsunami-hit region to meet with high-ranking officials to discuss how veterinarians could aid the relief effort. Initiating Noah’s Ark Veterinarian’s International relief organization (NOAV) Dr. Kreiner has funded the Sri Lankan Tsunami Project solely through donations from private individuals and leading Israeli corporate sponsors.

El-Al Israel Airlines and Flying Cargo have pledged to fly the hospital equipment food and medicines as far as Bangkok, Thailand. Nestle Purina donations of pet food are stocked at Ben Gurion Airport in Israel, along with medical supplies from Sar-El Medical. The IDF Medical Corps, hospitals and health organizations are all contributing medical equipment. But the mission is still a work in progress.

To complete NOAV International’s medical inventory and logistical requirements to reach Sri Lanka, NOAV is issuing an urgent appeal to all aid and relief organizations, philanthropic institutions and individuals. NOAV is urgently seeking additional equipment and further sources of funding to complete this mission.

NOAV needs to raise $75000 to cover the following expenses:
-Funds to cover the costs of additional medical equipment
-Funds to cover round-trip travel and living expenses for rotating Vets and Volunteers
-Funds to move the cargo from Bangkok to Sri Lanka
-Volunteer Veterinarians to rotate in one to two month sessions on location
-Veterinarian Medical Schools Internships, Volunteer students, vet techs and volunteers with interests in animal welfare and care to partner with this effort
-Interns or volunteers to assist with the nonprofit NOAV International fundraising effort in the USA
-Frequent Flyer Miles donations to NOAV International Flight Bank
-Volunteer Veterinarians with international experience in tropical and emergency medicine in voluntary advisory or on site capacity
-Immediate and urgent donation of 6 roundtrip economy plance tickets from Amman, Jordan to Sri Lanka
-The Sri Lankan Mission Project target operations start date is June 2005

From The Editor: Practice Management

Practice management.

Those two words sum up the success or failure of any doctor who owns his or her own practice. Running a practice can sometimes seem to require eight arms and three clones of oneself.

From governmental regulations to hiring and training staff, to handling finances and collections, to figuring out how to properly market, improper practice management can often lead to unwanted stress for the untrained doctor.

In this quarter’s issue of The Practice Solution Magazine, we will have profiles from three doctors in different professions that were less than satisfied with their practices. Dr. Jeff Carden, a dentist from Alabama, Dr. Kathleen Bartos, a veterinarian from Florida, and Dr. Tommasina Pasqua, an optometrist from Michigan, all knew that their practices were not operating as productively as they could be. Dr. Bartos was even on the verge of bankruptcy.

Each of these doctors took their practices from where they were to tremendous successes.

How did they do it? Practice management consultants. These doctors recognized that there was something they did not know in how to run a practice and that perhaps someone else could have a different perspective.

I sat down with each doctor to find out why they continued to use practice management consultants considering that their practices have been doing and continue to do so incredibly well. They had very similar responses and yet they all had very specific problems to solve in the beginning.

I think you’ll find their stories interesting.

In this issue, you’ll also find some gold nuggets of practice management advice for doctors and office managers. We are also continuing to provide industry specific news and Dr. Barry Levy joins us again for a follow up on last quarter’s story regarding minimum standards of infection control for dentists.



Ken DeRouchie
Managing Editor
The Practice Solution Magazine

PROFILE: Dr. Kathleen Bartos and Lou Bartos

How did Halifax Veterinary Clinic go from $0 in collections to over $1 million a year?


Dr. Kathleen Bartos and Lou Bartos

Practice: Halifax Veterinary Clinic

Location: Port Orange, Florida

A general small animal veterinarian, who specializes in veterinary acupuncture, Dr. Kathleen Bartos opened her clinic in July of 1990. Together with her husband Lou as office manager, the Halifax Veterinary Clinic struggled badly for the next five months. By December, they had $0 in collections. That’s right – $0.

Dr. Bartos had graduated from the University of Florida veterinary school in 1986. She worked as an associate for two and a half years and then did relief work for other veterinarians for a year and a half while attempting to build her own practice.

She thought she had the necessary tools to succeed.

But in December of 1990, on the verge of bankruptcy, she and Lou had a serious dilemma: do they invest in the practice more or do they shut down?

Due to Dr. Bartos’ strong desire to help animals, shutting down was clearly not an option.

The Bartos’ quickly decided that they needed help in managing their practice so they hired practice management consultants.

The first piece of advice they were given was to promote the practice and to promote without delay. Since it was December, they sent out holiday specific promotion and, within a month, things swiftly started changing for the better.

Within two months, the Bartos’ had received a 100% return on their investment in the program.

Fifteen years later, Halifax Veterinary Clinic produces over $1 million a year. It has its own in-house blood lab and Dr. Bartos has developed an incredible reputation as an excellent practitioner of veterinary acupuncture.

Even with their great success, The Bartos’ still use consulting services.

“It’s like going to church, if you stop going you feel like you’re missing something. And when we have new staff, we have to get them trained,” said Dr. Bartos. “It’s a successful action,” said Lou.

It may seem like the Bartos’ would have to work all the time in order to be this productive. Not true. They only work 4 days a week giving them plenty of opportunities to enjoy their hobbies of kayaking, hiking and spending time outdoors in other activities. They also have 5 cats and a dog.

At the end of the interview, Dr. Bartos had some advice for veterinarians just graduating. She said, “Don’t miss out on general practice by being a specialist, go into progressive, high quality general practices that are willing to innovate.”