From the Editor

In this issue of The Practice Solution Magazine you will find several follow up articles from past contributors. One of my favorites is the conclusion of a story of “What I Did Wrong” by Dr Lee Shuwarger of Amarillo, Texas. I hope you enjoy the conclusion of this story as much as I did. If you haven’t already, please visit our last issue (issue 12) for the first part of this entertaining article.

I have also done my best to include articles from other contributors to offer additional advise and thoughts on the current financial climate and what you can do to be more prepared to ride out the storm. One article that is long but fascinating is called “The Financial Crisis: A Look Behind the Wizard’s Curtain”. If you have been wondering how this whole financial debacle came about, take the time to read this article and you will be educated in a way that you may not have expected.

Further, you will find specific articles designed for one of the more important employees in your practice, your receptionist. This often over-looked and under-trained employee holds a very important position in your practice. The receptionist does so much more than just answering the phone. Often, it is the receptionist that will determine if your practice is going to have a productive day or an empty schedule. Invest some time in reading these articles and I am sure you will find some useful tips to pass on to your staff.

As always, you will find articles taken from the World Wide Web that are practice specific and news worthy that help to keep our readers attuned to what is going on in their profession.

Finally a big “Thank you!” goes out to all of the doctors across the U.S. and Canada that have taken time out of their day to discuss their practice issues with our research staff. Your answers are very valuable when determining what is on the minds of the health care field and compiling issues of some interest to our readers.

Cory D. Radosevich

Managing Editor

The Practice Solution Magazine


Veterinary Cardiologist Discovers Gene for Heart Disease

WSU veterinary cardiologist Kathryn M. Meurs discovered a mutant gene in the Boxer breed that causes a type of heart disease that can be fatal in animals and humans. The disease is called Boxer cardiomyopathy. The more formal term is arrhythmogenic right ventricular cardiomyopathy or ARVC.

© 2009 Newswise — Washington State University veterinary cardiologist Kathryn M. Meurs has discovered a mutant gene in the Boxer breed that causes a type of heart disease that can be fatal in animals and humans.

Well known in the Boxer breed community, the disease is called Boxer cardiomyopathy. The more formal term is arrhythmogenic right ventricular cardiomyopathy or ARVC.

This is same type of heart disease that caused the sudden death of 1950s college and pro football great Joe Campanella at age 36, as he played handball with the new head coach of the Baltimore Colts, Don Shula.

In Boxers, the disease can be fatal and frequently occurs when the animals exercise or become excited. Occasionally, they perish from the disease while at rest, too.

“Dr. Meurs’ discovery of both the gene and its location is a tremendous achievement in the cardiology of humans and animals,” said Bryan Slinker, dean of WSU’s College of Veterinary Medicine, and a recognized cardiac disease researcher. “This achievement not only helps Boxer breeders avoid this disease but it also provides an extraordinary advancement to the study of human heart diseases resulting from electrical conduction defects and the resulting heart muscle changes that occur.”

The disease is well known in Boxers because the breed has the highest incidence of this form of heart disease. ARVC is also known to be an inherited disease and breeders sometimes avoided breeding to certain lines of Boxers yet were never completely sure if those lines had an increased risk of disease. Additionally, the disease tends to vary in severity between different dogs; key indications that the disease had a dominant genetic origin.

Meurs began looking at the disease as an extension of her work with inherited heart disease in cats and dogs. This work is somewhat similar to her work with breeds of cats that also suffer heart disease and for which she has also discovered mutant genes. Her lab developed a molecular probe for these mutations so that cat owners now have a mechanism for screening for the disease and breeding away from it.

Using an extremely powerful gene screening mechanism based on a massive computer chip at the Broad Institute at MIT with investigators Kerstin Lindblad-Toh and Evan Mauceli, Meurs looked at thousands of regions of boxer dogs’ DNA simultaneously. The samples were collected with participation by members of the American Boxer Club and the American Boxer Charitable Foundation and were segregated into groups of dogs with the disease and those with no evidence for the disease.

Once computer analysis identified a specific region of interest, Meurs’ lab evaluated thousands of DNA sequences in affected and unaffected dogs and identified a gene mutation in a gene that normally codes for the production of a key cellular adhesive protein. Subsequent studies done by WSU veterinary cardiologist, Sunshine Lahmers, demonstrated that the cellular adhesive proteins were located at the junction between cells in the heart.

Theoretically, the conduction defect is in some way responsible for a rapid, irregular heart beat that does not pump blood efficiently. When blood is not pumped efficiently, there may not be enough circulation maintained in the brain and other organs. This can lead to fainting episodes or even sudden cardiac death.

Over time, the right, lower chamber of the heart, called the right ventricle, begins to be infiltrated by a fibrous fatty tissue and often has decreased contractile ability. This change in the heart’s tissues can spread to the wall between the heart chambers and even the left ventricle.

The structural changes that result in functional impairment is the hallmark sign seen when a post mortem examination is performed on the animal’s heart. Under the microscope, the normal muscle appears solid and dense. The affected heart muscle tissue is riddled with holes where the fibrous fatty tissue has infiltrated stretching it like unorganized lace.

Meurs’ laboratory is now near obtaining a patent on her discovery and is perfecting a genetic testing probe for the gene mutation that will be used as a clinical screening device. Shortly, Boxer owners will have the ability to take a simple cheek swab of their dog and know whether or not it carries the mutant gene. Cost of the screening is expected to be about $70 and available within the next 1-2 months.

“In many cases, after the disease is diagnosed it can be managed with medication for a long enough period of time in a dog’s life that other diseases such as cancer will be the cause of death,” said Meurs. “The medications are not very expensive and there are generic forms available, too. Average monthly costs are probably less than $100.”

Meurs said that, with her lab’s service, Boxer owners and breeders will be able to identify dogs with the mutant gene and are likely to breed away from the disease.

– See more at:

42% of Eyeglass, Contact Lens Buyers Research Using Online, Traditional Media Before Purchase

WESTERVILLE, Ohio- (Business Wire)-April 7, 2009 – Forty-two percent of recent eyeglass and contact lens buyers report influence from online media, the same percentage as traditional media, revealing the increasing power of the Internet on purchase decisions, according to the Spring 2009 Ad-ology Media Influence on Consumer Choice survey.

Among 45-54 year olds, 23.5% were influenced by manufacturer Web sites and 13.2% by search results. In addition to price and quality, the most important factors to this age group were knowledgeable staff (77.7%), product availability (71.9%), and store/optometrists’ variety/selection (71.7%).

Fashion/style-related Web sites influenced 35% of 18-to-24-year old purchasers and 30.5% of 25 to 34 year olds. These two groups were also more influenced by search results or sponsored links than older purchasers, and were more likely to buy online.

Consumers surveyed were almost equally split in regards to where they prefer to purchase eyeglasses and contact lenses. Approximately 49% prefer purchasing from their eye doctor/optometrist’s office, and 46% prefer to buy from an optical store.

“Although just over five percent of U.S. adults said they prefer to buy online, that translates to a market of more than 11 million potential customers,” said C. Lee Smith, president and CEO of Ad-ology Research. “Even those buying from optical stores and opticians are influenced by online information, making store Web sites and online marketing critical,” Smith said.

Other key findings from the survey:

* Approximately 40.8 million Americans adults researched eyeglass styles and contacts online recently

* 18 to 24 year olds were most influenced by social media, with positive reviews “significantly” influencing 14%

* Fashion/style-related Web sites influenced 35% of 18-to-24-year old purchasers

* Of traditional media, television, direct mail, newspapers, and yellow pages had the most influence on U.S. buyers

The Media Influence on Consumer Choice survey is conducted throughout the year by Ad-ology Research to study online, traditional, and social media influence on buying decisions.

The 64-page downloadable report, Media Influence on Consumer Choice: Eye Care and Vision Correction, is available for purchase through, and includes 27 data charts, consumer-spending estimates by market, and additional marketing insights.

About Ad-ology Research

Ad-ology Research analyzes key marketing and advertising trends in over 400 industries and what motivates end-customers. The company’s research is used by over 2,000 advertising agencies, media properties and product marketing departments across the United States. Ad-ology Research is a division of Sales Development Services (SDS), Inc. – a Westerville, Ohio firm founded in 1989.


Ad-ology Research surveyed an online consumer panel of 1,213 adults in a manner that is 98% representative of the adult population of the United States from January 5-8, 2009. The margin of error for this survey is +/- 2.2 percentage points.

Baltimore Dental Study Offers Model Program to Reduce Tooth Decay in Urban Children

University of Maryland, Baltimore study shows early preventive dental care to toddlers may significantly reduce cavities and cavity-causing bacteria levels in children.


© 2009 Newswise — A new study by researchers at the University of Maryland, Baltimore recommends a model program for urban pediatric clinics that can significantly reduce dental cavities in low socioeconomic infants and toddlers.

The researchers at the University of Maryland Dental School conducted the 26-month study of 219 children, ages six to 27 months, at the University’s Pediatric Ambulatory Care Center, a pediatric primary care clinic serving mostly low-income residents. Oral conditions of very young children were compared with those of older children at their first visit.

A “prevention group” of 109 children, ages six to 15 months, showed more than eight times less cavity-causing oral bacteria and significantly less cavities at their final dental visit, than did a control group of 110 children, ages 18 to 27 months at their first visit who had not received previous preventive care. Each child in the younger group received assessments of dental caries, monitoring of oral bacteria levels, fluoride varnishing, dental health counseling, periodic recalls, and referral to a dentist.

The study showed that if infants and toddlers can be provided with some preventive care, their oral health will be much better at the age of two years old than if they did not receive preventive care, says study leader and Dental School professor Glenn Minah, DDS, PhD.

Outcome measures included number of decayed tooth surfaces, oral counts of cavity-causing bacteria, and caregiver responses to a questionnaire about the child’s diet and home care.

Children who needed immediate treatment for caries were referred for treatment and those with high microbial counts were considered high risk and recalled for additional prevention.

Tooth decay can begin as soon as the first teeth emerge in toddlers, Minah says. And the study confirmed that children with early childhood dental caries are at higher risk for developing new carious lesions at a later age. Early childhood caries is a $3 billion problem annually, according to the researchers.

The desired improvements in dental care for young urban children can happen “by working with the physicians to assess children for caries-risk, screening them for early caries, referring them to dentists, and applying topical fluoride varnish,” says Minah.

He said that the success of the study was largely possible by placing a full-time nurse or dentist with pediatric experience at the clinic who was solely dedicated to oral care, and the use of microbial screenings as a primary caries-risk indicator for the study. The risk assessments and screenings helped the staff identify low-risk subjects and children who were experiencing caries-promoting conditions.

Norman Tinanoff, DDS, MS, program director of the School’s Department of Pediatric Dentistry, says that dental caries in preschool is a big program now and a “rather ignored” program until 10 years ago. The problem was referenced in only two separate sentences in the 2000 report of the U.S. Health and Human Services Department (HHS) Surgeon General’s report on the nation’s health. “Now it has bloomed as a public health problem and a research problem,” said Tinanoff. Dental caries is now recognized by HHS as the most widespread chronic disease and most common unmet health care need of childhood.

The study identified potential drawbacks of the model, such as added costs for laboratory equipment for analysis of the microbial screenings and recalling the young children for follow-up preventive measures.

A more cost-efficient model suggested by the study may be one that assumes every enrolled child is at high risk for tooth decay, providing fluoride varnish at the first visit and at six-month intervals, referring each child for dental treatment when cavities appear, re-examining them for oral problems at each or most medical visits, and emphasizing dental education at each visit. The study is published in the journal Pediatric Dentistry, vol. 30, no. 6.

© 2009 Newswise. All Rights Reserved.