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| PracTice Building Today's Veterinary Practice May/June 2014 76 tvpjournal.com vet-only online pharmacy providers, this feature on its own addresses many of the underlying drivers of clients seek- ing products outside of the practice—convenience, ease of use, and the ability to order products on the client's sched- ule, not the practice's. Integration with Other Client Services. Through the Vet app, a practice can elect to integrate additional services including links to pet insurance providers, review sites, and online patient portals. Marketing Support. in Touch mobile has developed one of the more extensive launch support programs for their product, including practice-team training, in clinic messag- ing, social media promotion tools, website link buttons to the major app stores, as well as ongoing client support. In Our Hands as a custom development project, it is important to under- stand that app development is not an overnight process. That being said, the final product for our practice is clean, professional, and fitting for the patient experience we try to deliver to our pets and their owners. although early in the roll out phase, we have been very proactive about deploying the Vet app in our practice, mak- ing it part of our in-room messaging, email campaigns and newsletters, as well as in our social media pages. Feed- back from clients to date has been positive, with many uti- lizing the app for appointment scheduling and medication refill requests. SUMMArY Over the past 6 months, we have utilized each of the plat- forms described above in a real-world clinical setting, test- ing features, measuring efficacy, and making mistakes along the way. While this list of client experience tools is not exhaustive, we believe each one of them can provide value to the practice team and enhance the overall client experience. Which one is right for you depends on your practice's individual identity, marketing strategy, and area of greatest need. in the next issue, we will discuss tools for finding new clients and improving both new and existing client experi- ences with the veterinary practice. n Travis Meredith, DVM, MBA, Diplo- mate ACT, is Contributing Medical Edi- tor of today's veterinary Practice, and co-owner of Affinity Veterinary Cen- ter, Malvern, Pa, and Vice President of Member Services for Calico Financial. He received his DVM from Texas A&M; University and his MBA from UNC—Chapel Hill. Christine Meredith, VMD, is co- owner of Affinity Veterinary Cen- ter, Malvern, Pa. She received her VMD from University of Pennsylvania School of Veterinary Medicine. Lymph nodes draining in the region of a mast cell tumor can be particularly troubling, because some mast cells are normally found in reactive lymph nodes. When reactive mast cells are recruited to local lymph nodes by cytokines produced by the mast cell tumor (ie, nonmeta- static mast cells), they are expected to infiltrate the node individually. In addition to metastatic mast cells found in lymph nodes meeting cytologic criteria of malignan- cy ( Table 2, page 20), clustering of these cells (into aggregates) can also signify metastatic disease. 4 When in doubt, the lymph node should be surgically removed and submitted for histopathology, perhaps at the time of initial mast cell surgery. Lymph node involvement in mast cell tumors impacts both treatment and prognosis of these tumors. Locoregional treatment of a mast cell tumor with sur- gery, with or without radiation therapy to include a local lymph node, can be very successful unless metastasis has spread beyond the regional lymph node. Melanocytes, characterized by their granules, should not be present in regional lymph nodes and typically rep- resent metastatic disease ( Figure 6, page 22). However, lymph nodes can contain regional melanophages—large round cells with abundant, vacuolated cytoplasm—and this may not represent metastatic disease IN SUMMArY Lymph node cytology can be performed quickly, as a minimally invasive procedure, and results can strongly influence treatment and outcome for cancer patients. Like any other skill, evaluation of cytology from a lymph node takes time and practice. n Parr = Pcr for antigen receptor rearrangement; rBc = red blood cell References 1. williams le, Packer ra. association between lymph node size and metastasis in dogs with oral malignant melanoma: 100 cases (1987- 2001). JAVMA 2003; 222(9):1234-1236. 2. hillers Kr, dernell ws, lafferty Mh, et al. incidence and prognostic importance of lymph node metastases in dogs with appendicular osteosarcoma: 228 cases (1986-2003). JAVMA 2005; 226(8):1364- 1367. 3. tvedten h. atypical mitoses: Morphology and classification. Vet Clin Pathol 2009; 38(4):418-420. 4. Krick el, Billings aP, shofer Fs, et al. Cytological lymph node evaluation in dogs with mast cell tumours: association with grade and survival. Vet Comp Oncol 2009; 7(2):130-138. Kim A. Selting, DVM, MS, Diplo- mate ACVIM (Oncology) & ACVR (Radiation Oncology), is an associ- ate teaching professor at Univer- sity of Missouri. She developed an international searchable database to promote veterinary cancer clini- cal trials at vetcancertrials.org. She completed her DVM and specialty training at Colorado State Uni- versity, with a rotating internship at the Animal Medi- cal Center in New York City. | lymPH nOde cyTOlOgy (Continued from page 22) TVP_2014-0506_PB_Marketing_PART1.indd 76 5/24/2014 11:23:43 AM