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24 AHS HEARTWORM HOTLINE HEARTWORM HOTLINE so clients can read about the disease before they even enter the examination room. Posters and videos in the waiting area are also useful. Once the client and pet are in the examination room, the veterinary technician takes the lead in discussing heartworm prevention. This discussion should not be overly technical, but rather a common-sense approach to explaining a life-threatening disease, and it can fit into the intake process. In our practice, the technician asks questions about diet, weight trends, lifestyle changes, and parasite prevention. We use a series of exam stickers ( Figure 3 ) to make recording this information easier. One simple way to begin the heartworm prevention conversation is for the technician to simply ask clients if they have ever seen mosquitoes around their home. If the client says yes—and in almost every instance they will—the technician can explain that the mosquito is the vector in the transmission of heartworm disease. We tell clients, "We can't kill every mosquito around your home, but we can prevent against the heartworm larvae that any given mosquito can infect your pet with." The veterinarian can then restate the practice's heartworm and flea control recommendations while summarizing the findings from the intake discussion. If an annual heartworm test is conducted during the visit, both the veterinarian and technician can again reinforce the importance of prevention, as well as explain why the test is needed even if the pet is receiving year-round prevention. In our practice, if the results of the heartworm test are positive, the veterinarian will discuss those results. At checkout, the receptionist can provide one last point of heartworm education, supporting the recommendations of the veterinarian and technician and explaining the value of the recommended products the client is purchasing. Consistent positive affirmation of heartworm prevention, from pet intake to pet discharge, is powerful. By keeping the "Rule of 7" in mind, the veterinary team can remind themselves of the value of repetition. CLIENT RELUCTANCE Some clients refuse to purchase heartworm prevention products—sometimes because of cost and sometimes for other reasons. Pet owners may rationalize that their pets are at low risk because they live indoors or have limited time outside. Others mistakenly believe that a holistic approach will be effective. Still others are concerned about the safety of heartworm preventives. Every one of these objections presents an educational opportunity. Veterinarians can share stories of heartworm cases with tragic outcomes—or display an infected heart in a jar of formalin to prove the reality of heartworms. Although our practice's philosophy leans toward positive education, both approaches can work. FIGURE 3. Chart label used in authors' practice to track recommendations for and use of heartworm prevention. FIGURE 2. Cost comparison between heartworm treatment and prevention. Reproduced with permission from the American Heartworm Society.