Pet. Insurance. It s Catching on. Can the Industry Sell its Value? Promoting Excellence in Animal Health Sales

Transcription

1 November/December, 2014 Vol. 6, Issue 6 Promoting Excellence in Animal Health Sales Pet Insurance It s Catching on. Can the Industry Sell its Value? Inside: Drowning in Debt p.23 Dental s Potential p.30 Holiday Shipping» p.38

2 It s a soft chew. Kills both fleas and ticks. It s prescription only. Now approved to kill more ticks! NexGard TM (afoxolaner) is the protection you asked for, and patients will beg for. NexGard is FDA-approved to kill fleas, prevent flea infestations, and kill Black-Legged (deer) ticks, Lone Star ticks and American Dog ticks. NexGard is available only with a veterinarian s prescription, and features anti-diversion technology monitored by Pinkerton Consulting & Investigations. TM NexGard and FRONTLINE VET LABS are trademarks of Merial. PINKERTON is a registered trademark of Pinkerton Service Corporation Merial Limited, Duluth, GA. All rights reserved. NEX14TTRADEAD (06/14). IMPORTANT SAFETY INFORMATION: For use in dogs only. The most common adverse reaction is vomiting. Other adverse reactions reported are dry/flaky skin, diarrhea, lethargy, and anorexia. The safe use of NexGard in pregnant, breeding, or lactating dogs has not been evaluated. Use with caution in dogs with a history of seizures.

3 November/December 2014 We know preventive care and wellness drive consumer behavior. It s good for the pet and good for the practice. page 40»» Publisher s letter: Chris Kelly The Benefits of Pet Insurance pg6»» Industry insights: Kirk Augustine Setting the Stage for 2015 Successes pg8»» distribution: The Paper-lite Practice Henry Schein s recent Veterinary Technology Summit focuses on practice management solutions pg10»» Sales: Pat Malone Creating an Open Sales Environment The value in using leadership skills instead of the typical sales tactics to achieve success»» Marketing: Pam Foster Content Marketing Help practices embrace the hottest marketing strategy for 2015 pg14 pg16»» Sales: ATS Time is Your Most Valuable Resource pg18»» Finance: Fritz Wood, CPA, CFP Drowning in Debt Veterinarians are carrying a significant amount of debt from student loans. Here s how you can help. pg23»» TRENDS: Making the Most Out of the Opportunity A Partners for Healthy Pets survey tool helps practices identify the gap between what they think and say, and what their clients hear and understand pg26 Dental s Potential Help your veterinary customers thrive with the right dental equipment and products pg30 Holiday Shipping Dawn Singleton-Olson Help your customers avoid the holiday rush pg38 Veterinary Advantage magazine (ISSN ) is published bi-monthly, PO Box , Marietta, GA Copyright 2014 All rights reserved. Subscriptions: $49.00 per year for individuals; issues are sent free of charge to dealer representatives. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address. POSTMASTER: Send address changes to Veterinary Advantage, PO Box , Marietta, GA Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors. Periodicals Postage Paid at Marietta, GA and at additional mailing offices. Veterinary advantage ««November/December

4 November/December page 60»» COver Pet Insurance Pet insurance is catching on. Can the industry sell its value?»» Sales meeting Taking it Digital Intraoral digital radiography means better patient care and potentially greater practice revenue. Chemistry Analyzers»» TRENDS Cats: No longer silent sufferers AAFP Conference focuses on gastroenterology and endocrinology.»» TRENDS Aging Gracefully Today s senior horses can continue to compete with additional veterinary care and proper nutrition»» COMMUNITY REP Spotlight: Core Values Adhering to traditional principles, Bob Nose has carved out a satisfying, productive career People: A Lasting Legacy Laura Thill Dave Arnold had one goal in mind from the start: making a contribution to veterinary medicine. In Pursuit of Excellence Prescott Animal Hospital is recognized for setting the bar high News 4 November/December 2014»» Veterinary advantage pg40 pg56 pg64 pg60 pg68 pg70 pg74 pg79 pg82»» Product Announcements pg83»» Editor s note: Mark Thill Companion animals and the older person pg89 Editor Mark Thill mthill@vet-advantage.com Managing Editor Graham Garrison ggarrison@vet-advantage.com Senior Editor Laura Thill lthill@vet-advantage.com Contributing Editor Jennifer Ryan jryan@vet-advantage.com Art Director Brent Cashman bcashman@vet-advantage.com Vice President of Sales & Marketing Rick Boggess rboggess@vet-advantage.com Senior Account Executive Kim Long klong@vet-advantage.com Account Executive Doreen Carpenter dcarpenter@vet-advantage.com Executive Vice President of Business Development Kirk A. Augustine kaugustine@vet-advantage.com Vice President Industry Relations Lorne Elder lelder@vet-advantage.com Sales & Marketing Coordinator Paige Kelly pkelly@vet-advantage.com Circulation Laura Gantert lgantert@vet-advantage.com President & Publisher Chris Kelly ckelly@vet-advantage.com Photography by Dan Carmody, Studio 7 Corporate Headquarters 3628 Blakeford Club Dr. Marietta, GA phone fax 2014 editorial board Kim Allen, Henry Schein Animal Health Spencer Breithaupt, MWI Veterinary Supply Scott Handler, DVM, Patterson Veterinary Jeannie Jeffery, Henry Schein Animal Health Jackie King, AVDA Karen Miller, Midwest Veterinary Supply Clay Cass, Merritt Veterinary Supplies John Ryan, MWI Veterinary Supply Michael Stone, Henry Schein Animal Health Mark Ziller, Animal Health International

5 A solution for every ear. Dechra Veterinary Products is one of the leaders in innovative solutions for ear conditions in pets. Some of our original formulations relied on TrizEDTA, which chelates minerals in bacterial cell walls thereby increasing their susceptibility to active ingredients in topical products. Other enhancements in some formulas were the addition of Ceramides. Ceramides aid in moisturizing, repairing and restoring damaged skin. We now have built a portfolio of products listed below that can help you address many common ear conditions. DEChrA OTiC Or FluSh MAlACETiC ultra Otic Cleanser TrizulTrA TM +KETO Flush MAlACETiC Otic Cleanser MAl-A-KET TM Plus TrizEDTA Flush TrizEDTA TM Aqueous Flush Condition Present in the Ear & Benefits of the Dechra Otic Yeast Bacteria Inflammation Pruritus Ketoconazole; Acetic & Boric hydrocortisone hydrocortisone, Acetic & Boric Acid Ceramides Acid Ketoconazole TrizEDTA non-acidic, non-stinging Acetic & Boric Acid Ketoconazole Acetic & Boric Acid Chlorhexidine; TrizEDTA TrizEDTA non-acidic, non-stinging Greasy, Waxy, Moist Acetic & Boric Acid Acetic & Boric Acid For general cleaning consider EPiKlEAn TM Ear Cleanser; for excessive wax consider KlEArOTiC TM Ear Cleanser support@dechra.com 24 Hour Technical Support: Dechra Veterinary Products US and the Dechra D logo are registered trademarks of Dechra Pharmaceuticals PLC. Caution is recommended when using chlorhexidine in the ear when the status of the tympanic membrane is unknown.

6 »» Publisher s Letter The Benefits of Pet Insurance Chris Kelly Evidence exists that insured pets make more regular visits to the veterinarian and generate two times as much spending on care. Chances are your response to first hearing the term pet insurance was similar to mine. Really? That was seven years ago, and I couldn t understand why pets would actually need insurance. But once I thought through the cost of veterinary care especially the new expensive procedures that are being done it made perfect sense. So six years ago, I took the plunge and bought insurance on our dog Riley, a beautiful, pure bred, rescue mutt, for $36/month. While it has been helpful in a couple of situations to date, it has probably not been a breakeven proposition, which I m happy about she has been a healthy dog. As she gets older though, it s comforting to know it s there if needed. Knowing my wife, who would sell our house to pay for Riley s care, pet insurance is also a very prudent financial investment! Skepticism remains about pet insurance, and I believe it s time for all of us to help dispel the myths, because it s good for the pet, the client, as well as the veterinary profession. Not to mention distributors and manufacturers. So we need to get educated on the benefits of pet insurance, and communicate those to our veterinary customers, since clients trust and seek their advice when it comes to the care of their pets. This is especially important during new puppy or kitten visits. Today more than 1 million pets are insured, and that number is expected to grow exponentially over the next few years. Evidence exists that insured pets make more regular visits to the veterinarian and generate two times as much spending on care. That s good for everyone involved in the animal health industry. Perhaps more importantly, it s not like health insurance, which is third party pay. The client pays and then submits the claim to the insurance company, leaving the veterinarian out of the financial picture. This issue kicks off our coverage of pet insurance, and we will provide additional content over the next two issues. We hope you enjoy it. And last but not least, everyone at Vet-Advantage would like to pass along our wishes for a joyous Holiday season! See you in November/December 2014»» Veterinary advantage

7 EASOTIC Otic Suspension (hydrocortisone aceponate, miconazole nitrate, gentamicin sulfate) Anti-inflammatory, antifungal, and antibacterial For Otic Use in Dogs Only CAUTION Federal law restricts this drug to use by or on the order of a licensed veterinarian. BRIEF SUMMARY: Please consult package insert for complete product information. INDICATIONS EASOTIC Suspension is indicated for the treatment of otitis externa in dogs associated with susceptible strains of yeast (Malassezia pachydermatis) and bacteria (Staphylococcus pseudintermedius). CONTRAINDICATIONS Do not use in dogs with known tympanic membrane perforation. EASOTIC Suspension is contraindicated in dogs with known or suspected hypersensitivity to corticosteroids, imidazole antifungals, or aminoglycoside antibiotics. WARNINGS Human Warnings: Not for use in humans. Keep this and all drugs out of reach of children. Humans with known or suspected hypersensitivity to hydrocortisone, aminoglycoside antibiotics, or azole antifungals should not handle this product. Animal Warnings: As a class, aminoglycoside antibiotics are associated with ototoxicity, vestibular dysfunction and renal toxicity. The use of EASOTIC Suspension in a dog with a damaged tympanic membrane can result in damage to the structures of the ear associated with hearing and balance or in transmission of the infection to the middle or inner ear. Immediately discontinue use of EASOTIC Suspension if hearing loss or signs of vestibular dysfunction are observed during treatment (see ADVERSE REACTIONS). PRECAUTIONS Do not administer orally. Concurrent administration of potentially ototoxic drugs should be avoided. Use with caution in dogs with impaired hepatic or renal function (see ANIMAL SAFETY). Long-term use of topical otic corticosteroids has been associated with adrenocortical suppression and iatrogenic hyperadrenocorticism in dogs (see ANIMAL SAFETY). The safe use of EASOTIC Suspension in dogs used for breeding purposes, during pregnancy, or in lactating bitches, has not been evaluated. ADVERSE REACTIONS In a field study conducted in the United States, there were no adverse reactions reported in 145 dogs administered EASOTIC Suspension. In foreign market experience, reports of hearing loss and application site erythema have been received. In most reported cases, the hearing loss and erythema were transient and resolved with discontinuation of EASOTIC Suspension. To report suspected adverse drug events, or for technical assistance contact Virbac at ANIMAL SAFETY Aural administration of EASOTIC Suspension to 12 week old Beagle dogs at 1, 3, and 5 times the recommended dose (1mL/ear/day) for 15 days (three times the treatment length) was associated with alterations of the hypothalamicpituitary-adrenal axis as evidenced by the ACTH stimulation results. Other findings considered to be related to treatment include the development of aural hyperemia; the presence of renal tubular crystals and possibly renal tubular basophilia and atrophy; elevated liver weights; the development of otitis externa and media; and elevations in alanine aminotransferase, alkaline phosphatase, total protein, albumin, and cholesterol levels. STORAGE INFORMATION: Store at temperatures between 20º C-25º C (68º F-77º F), with excursions permitted between 15º C-30º C (59º F-86º F). HOW SUPPLIED: EASOTIC Suspension is supplied in a polyethylene canister, with a soft applicator canula. Distributed by: Virbac AH, Inc., Fort Worth, TX USA NADA , Approved by FDA Virbac Corporation All Rights Reserved. Rev 8/ DAYS OF EASY A unique, new-generation steroid makes otitis externa simpler to treat. The hydrocortisone aceponate in EASOTIC (hydrocortisone aceponate, miconazole nitrate, gentamicin sulfate) Otic Suspension for Dogs enables a quick, 5-day treatment regimen with low risk of systemic side effects. 1 Combine that with an innovative applicator and proven antimicrobial and antifungal agents, and you get a one-of-a-kind treatment for otitis externa. 1 pump 5 days No sweat Talk to veterinarians about this simple, effective treatment today. Visit to learn more. EASOTIC Suspension is contraindicated in dogs with known or suspected hypersensitivity to corticosteroids, imidazole antifungals, or aminoglycoside antibiotics. Do not use in dogs with known tympanic membrane (ear drum) perforation. The safe use of EASOTIC Suspension in dogs used for breeding purposes, during pregnancy, or in lactating bitches has not been evaluated. For otic (ear) use in dogs only. Do not administer orally. Not for use in humans. Humans with known or suspected hypersensitivity to hydrocortisone, aminoglycoside antibiotics, or azole antifungals should not handle this product. For complete product information refer to the product insert. To obtain a package insert, contact Veterinary Technical Product Support at , or visit Reference: 1. Guaguere E, Bensignor E, Carlotti DN, et al. Clinical practice guidelines on the best use of topical glucocorticoids in canine dermatology. Prat Med Chir Anim Comp. 2011;46:S1 S Virbac Corporation. All Rights Reserved. EASOTIC is a registered trademark of Virbac S.A. 10/

8 »» Industry Insights Setting the Stage for 2015 Successes This issue of Vet-Advantage will put 2014 to-bed. Our team is already deep into 2015 planning with our sponsors and aligning topics in the editorial calendars based on DSRs needs and feedback. Critical to this process is our annual readership and distributor experiences survey. Thank you for providing this valuable feedback so we are able to continue aligning our efforts with DSR needs. In the May-June issue I ended my Insights column with the following: Our industry s salespersons must seek to develop their ability to By Kirk Augustine actively listen. Ask for an appointment to listen/ learn what is really on the customers minds and then focus on the small, repeatable things that customers value beyond lowest price. Then before the next call, clear your mind so what you heard does not become a topic you perpetuate (without listening) within your territory. The end-of-year holiday period is a good time to set aside 15 to 20 minutes to have a planned listening session with your best accounts and those whose potential has yet to be realized. Consider sending these accounts three to five questions in preparation for what you might call an EOY (end of year) Review. Such a review session is more successful if you begin by thanking the account for their business and share some key business or purchases that you especially appreciated going your way. Some ideas are offered below for your consideration: Thank You ideas: a) Doctor, I really appreciated being able to service more of your (e.g. heartworm, vaccine, diagnostics) needs. b) Getting to work with your practice manager and team on the new laser machine was a fun experience, thanks for that opportunity. c) I m glad you shared your frustration with the online order system in March Working with you and the purchaser to set up replenishment lists really helped me understand more about your practice processes. The following are some ideas for listening questions: 1. Help me understand how utilizing our online order system has impacted your practice processes. 2. Considering our delivery of orders this year, how are we doing with on-time delivery, error-free orders and so on? 3. If you had to grade my performance as a representative for your practice, how did I do? 4. Looking toward 2015, where should I focus more of my time and effort to service your practice? 5. My inside rep and I have been working more closely on serving my top customers together is this providing you additional value? 6. Are you planning expansions in 2015 by adding staff or services that I can help you prepare for? 7. Besides yourself, the purchaser and the practice manager, are there other staff members I should plan to spend time with during my 2015 calls? Asking your customer for feedback is a key action item that will set the stage for more success and satisfaction in the upcoming year. Active listening remains an opportunity in nearly every account you service. Consider writing down what you discover and share what you heard within your regions. No doubt you will hear some common themes that may well lead to more opportunity for yourself and your team members. Have a Happy and Productive Holiday Season! 8 November/December 2014»» Veterinary advantage

9 Smart Dispense Technology, Single Glove Delivery SINGLE GLOVE DELIVERY: Quick Dispensing No Tugging No Wasted Gloves Look for the seal on Sempermed Products. GLOVES ARE PACKED FLAT: Faster Donning Fewer Wrinkles No Clumping MORE GLOVES PER BOX: Greater Efficiencies Less Packaging Waste Less Storage Space Out-of-the-box thinking. Every. Single. Pull. If it matters to you, it matters to us. That s why we re taking extra steps in our packing process to improve your hand protection experience. Our new Smart Dispense Technology, Single Glove Delivery packaging assures efficient dispensing and easy donning, so you can quickly get to the job at hand. We are people protection. Try it for free. us at GloveInfo@SempermedUSA.com or call Learn more at SmartDispenseGloves.com Follow us on Twitter SempermedUSA.com/Blog Connect on LinkedIn th Street North Clearwater, Florida Phone: / Fax:

10 »» Distribution The Paper-lite Practice Henry Schein s recent Veterinary Technology Summit focuses on practice management solutions People talk about the paperless practice when referring to a highly automated operation. But paper-lite might be a more apt phrase. Regardless of which term is used, the veterinary practice that relies on software to store critical information and relieve staff of tedious, time-consuming chores will probably win in the efficiency stakes. We believe that going paperless offers a definite competitive advantage for a veterinary practice, says Robin Brown, director of training, AVImark. It saves time, it is more efficient, and it is easier to protect data from disasters. It can also help veterinarians practice better medicine by obtaining test results more quickly and documenting patient conditions more fully in the software. Presenter Dr. Andy Roark Brown served as the event chair for Henry Schein s recent Veterinary Technology Summit, held in suburban Chicago. Its second such event, the Summit attracted more than 500 veterinarians, practice managers and other veterinary professionals from around the country. The Summit focused, in large part, on helping attendees take full advantage of Henry Schein s AVImark and ImproMed practice management systems. Sessions included front desk fundamentals, scheduling, reminders, reportwriting, medical records management, accounts receivable, invoicing and wellness plan development; as well as managing staff expectations of software changes. Together, the AVImark program, by AVImark LLC, and ImproMed LLC (which makes the Infinity, Triple Crown, DVM Manager, and Advantage+ software programs) serve approximately 16,000 veterinary practices worldwide, says Brown. AVImark is more widely used by practices with one to four veterinarians, and Infinity has a high percentage of large multi-doctor practices, she adds. In addition to the software-focused sessions, keynote speakers and others addressed a variety of topics, including effective use of social media, blending old and new tactics for more effective practice marketing, boosting client communication and compliance, enhancing and promoting preventive care, expanding dentistry, and improving staff management and leadership. In addition, Henry Schein Inc. Chairman and CEO Stanley M. Bergman and Henry Schein Animal Health President and CEO Kevin Vasquez discussed key trends impacting the animal health industry. 10 November/December 2014»» Veterinary advantage

11 TIMES HAVE CHANGED. Is it time to change your NSAID, too? THEN. NOW. PREVICOX is a registered trademark of Merial Merial Limited, Duluth, GA. All rights reserved. PVX13PB2014TRADEAD (02/14). Important Safety Information: As a class, cyclooxygenase inhibitory NSAIDs may be associated with gastrointestinal, kidney or liver side effects. These are usually mild, but may be serious. Pet owners should discontinue therapy and contact their veterinarian immediately if side effects occur. Evaluation for pre-existing conditions and regular monitoring are recommended for pets on any medication, including PREVICOX (firocoxib). Welcome to the now.

12 »» Distribution Three benefits The term paperless doesn t necessarily mean eliminating all paper, says Brown. Rather, it means eliminating duplicate or time-consuming manual work, such as writing information in a patient record or appointment book and then entering it into a software program. Paperless or paper-lite practices typically rely on their software as the primary place to store critical information, including electronic medical records and patient health information; diagnostic test results, and laboratory requisitions and results; inventory management; financials; and automated reminders and electronic client education materials, she says. Time is money, especially in a service business, and it can be pretty eye-opening to calculate how much time (and therefore money) is being spent on manual tasks. Robin Brown, director of training, AVImark By doing so, she adds, these practices improve efficiency, eliminate human error, and free up staff to focus on more important things. Improve efficiency. Paper and manual methods just take longer, says Brown. We type faster than we write, and when we need to make changes such as moving an appointment on the calendar or updating a patient file it s faster to do it electronically. This applies to pulling/updating/re-filing patient files, receiving and managing inventory manually, scheduling patients, sending reminder cards, and everything else that happens in a busy practice on any given day. Many of these steps or procedures can be automated by software based on parameters set by the veterinarian and/or staff. Some veterinarians are able to see three to four additional patients each day, and even free up space in the clinic, by reducing manual tasks and paper files. Eliminate human error. Missed charges, illegible handwriting in patient files, and incorrect pricing on inventory are all common problems that stem from doing things manually rather than automatically in a practice management software program, says Brown. Utilizing advanced software features, such as an inventory management module, as well as software integrations with third-party vendors like reference labs and credit card processing services eliminates these issues. Free up staff to focus on more important things. Time is money, especially in a service business, and it can be pretty eye-opening to calculate how much time (and therefore money) is being spent on manual tasks, such as pulling paper files, manual invoicing, and manual reminder cards, says Brown. Multiplying the number of hours spent on any of these manual tasks by the average staff salary per hour can add up to some large numbers on an annual basis. Now think about what would happen if those hours could be devoted to seeing more patients each day. That s the real ROI of automating tasks through practice management software. Why not? With all that said, why don t more practices become paperless? It s generally a combination of fear of the unknown, so to speak, as well as being tied up with the day-to-day operations of a busy practice, says Brown. Learning and implementing new software features can be overwhelming and even a bit scary for time-crunched practices that are comfortable doing tasks the old way. Yet our users tell us that once they take the time and effort to learn new features, they wonder how they ever survived without them, and they say they will never go back. It reminds me of when electronic bill-paying started: First, there was resistance, and now, people wonder how they lived without it. 12 November/December 2014»» Veterinary advantage

13 Compromising on your Cushing s treatment could have a compounding effect. Vetoryl (trilostane) Capsules are the only FDA veterinary-approved treatment for pituitary-dependent and adrenal-dependent hyperadrenocorticism. So when you choose Vetoryl Capsules, you can be confident knowing you re not taking unnecessary risks with the health of your patients or your practice. FDA approved for veterinary use Proven safety and efficacy in dogs Consistent strength, purity, and quality in every dose Veterinary technical support, adverse event reporting Legal liability to clinic Vetoryl Capsules are available in doses for all sizes of dogs. Contact your veterinary distributor to order today or visit Dechra-US.com to learn more. Trilostane content of compounded capsules may vary from the prescribed strength, and dissolution characteristics may not match those of the licensed product. The use of compounded trilostane products may therefore negatively impact the management of dogs with hyperadrenocorticism. 1 1 Pharmaceutical Evaluation of Compounded Trilostane Products (Cook, et al, JAAHA 48:4, Jul/Aug 2012) VETORYL is a trademark of Dechra LTD. 2012, Dechra Ltd. NADA , Approved by FDA As with all drugs, side effects may occur. In field studies, the most common side effects reported were poor/reduced appetite, vomiting, lethargy, diarrhea, and weakness. Occasionally, more serious side effects, including severe depression, hemorrhagic diarrhea, collapse, hypoadrenocortical crisis, or adrenal necrosis/rupture may occur, and may result in death. VETORYL Capsules are not for use in dogs with primary hepatic or renal disease, or in pregnant dogs. Refer to the prescribing information for complete details or visit 01AD-VET

14 »» Sales Creating an Open Sales Environment The value in using leadership skills instead of the typical sales tactics to achieve success I recently read a posting on the Harvard Business Review Blog Network by Joseph Grenny entitled 4 Ways Leaders Can Create a Candid Culture. I have long believed that the most successful distribution reps use leadership skills instead of the typical sales tactics to achieve and maintain their level of success. That led me to consider the four action steps in Grenny s post in terms of creating an open sales environment. I pass my observations on for your consideration. By Patrick T. Malone Patrick T Malone is a Leadership Expert and Senior Partner at The PAR Group, an international training and development firm based in Atlanta, Ga. He is the coauthor of the business book Cracking the Code to Leadership and may be reached at patrick.malone@thepargroup.com Praise publicly My research has shown the most successful distribution reps have more successful practices than the average rep. That just doesn t happen by accident. Those reps actively engage in helping their hospitals become more successful, and that doesn t occur without individuals within that practice going above and beyond the norm. There are many opportunities for the rep to acknowledge, in a very public way, when someone in that practice has done something to improve the practice and aide in the success of that rep. Letting that person know you appreciate their efforts is nice, but doing it publically, at a lunch-and-learn or in front of their peers, is nicer still. Prime the pump Too often in our interactions we seek only positive feedback and attempt to avoid the negatives. This may sound strange, but giving your customers permission to complain creates a comfortable relationship that leads to a sustainable competitive advantage. A prime example might be the current saline solution price increases. Acknowledging both the current production shortages and the increasing costs for the available product is a good start, but even better is to acknowledge the accompanying 14 November/December 2014»» Veterinary advantage

15 Your clients waiting room is filled with variety. So is our glove line. FROM THE MAKERS OF SENSI-TOUCH SURGICAL GLOVES. Protect your client with the same care that they look after us, no matter how furry. For samples or to schedule a ride along with your Ansell rep, visit or call (800) and are trademarks owned by Ansell Limited or one of its affiliates Ansell Limited. All Rights Reserved. emotion, i.e. that s frustrating for everyone. The average rep is going into a call hoping the client doesn t ask, while the successful rep is actually encouraging that discussion. Lead by teaching Animal health manufacturers and many reps believe that teaching is limited to a recitation of the features (what it is) and the functions (what it does or does better). While that is an important and essential part of education, the real payoff in teaching is when you describe the benefits (what I will have) of a new product or service. The most successful reps always mention the fact and the feeling when teaching a client about the benefits, i.e. so this new flea and tick control will create higher compliance rates and give you the satisfaction that you are doing the very best for both the animal and its owner. Sacrifice your ego The most successful distribution reps I know have a very well developed ego, which is necessary to deal with all the rejection, but still press ahead with a positive attitude. But that ego is well in check on their calls. Whether it is the receptionist, the technician, the practice manager or the hospital owner, the most successful reps make that person feel as if they are the most important in the room at that point in time. They do that because that receptionist is a decision maker he or she can open the door and provide access for that rep. Technicians or practice managers are decision makers in that they can influence the ultimate buyer. So the most successful reps sacrifice their ego by seeing themselves as the decision-getter and their role as helping the The most successful distribution reps I know have a very well developed ego, which is necessary to deal with all the rejection, but still press ahead with a positive attitude. decision-makers make the biggest committed decision they can handle today. So while Grenny s intention was to help leaders create a more candid culture, I m convinced these four tips will enable sales reps to create a more open sales environment and enhance their sustainable competitive advantage. Of course you are the ultimate decision maker. What do you think? The first person to send me their thoughts and mailing address will receive a free copy of our book Cracking the Code to Leadership. Veterinary advantage ««November/December

16 »» Marketing Content Marketing Help practices embrace the hottest marketing strategy for 2015 There is an epic marketing wave coming in In fact, it s already here. It s called content marketing, and it will be a major key to success for veterinary practices next year and beyond. Businesses of all sizes, including local veterinary practices, must consider using content marketing as a strategic online approach to attract and retain clients and keep in step with the competition. Since it has been proven that pet owners trust veterinarians above all other sources for pet-care information online, content marketing is a great way for practices to establish themselves as the local go-to resource Content marketing is when a veterinary practice uses online content web articles, blog posts, newsletters, how-to videos, case studies and much more to educate pet owners, help them find answers and enjoy their love of animals. Content marketing is designed to help and/or entertain pet owners. By Pam Foster Pam Foster is Managing Editor, Community Content & Media for the NAVC (North American Veterinary Community) and the Marketing Faculty Advisor on its CE website VetFolio.com. Pam is a Certified SEO Copywriter and the co-author of Wildly Profitable Marketing for the Pet Industry. She specializes in helping practices and other veterinary organizations thrive through strategic marketing content, online and offline. Defining content marketing In simple terms, content marketing is when a veterinary practice uses online content web articles, blog posts, newsletters, how-to videos, case studies and much more to educate pet owners, help them find answers and enjoy their love of animals. Content marketing is designed to help and/or entertain pet owners. for local care, services, answers and supplies. Here s how you can help. When you visit the practices in your territory, ask them about their content marketing and if they re planning to produce more content in 2015 to bring in more business. Use the following checklist during your visit to shed light on this important success strategy. 16 November/December 2014»» Veterinary advantage

17 U-40 insulin syringes available for diabetes mellitus in both dogs and cats Help Your Veterinary Practice Grow in 2015 with a Content Marketing Strategy Use this checklist to develop a content marketing strategy for attracting more clients, improving your search engine rankings and leaping ahead of the local competition next year and beyond. Make a list of commonly asked questions in your area. What do pet owners ask your practice all the time? Brainstorm a list of questions with your staff and use that list to create content you can roll out each week. You ll be doing local pet owners a huge favor by helping them understand how to prevent fleas, how to give a cat a pill, how to trim dog toenails, how to keep pets safe in the winter and much more. Answer those questions in blog posts, videos, e-newsletter articles and more. Focus on one topic at a time and provide information in an easy-to-digest format. For instance, present how-to tips in a step-by-step format or bulleted list. Think about making the content easy to scan, and use photos or videos whenever possible for the greatest impression. Make sure the content is local. The only way your local pet owners will see your content is if you make it locally relevant. For instance, a winter pet tips blog post talks about the local weather. This will help local pet owners find the information they need when the thermometer drops and the snow flies. Be sure to tag and title your content for search engine optimization. Make sure the content title includes local words, and add photo captions, a page title tag and a meta description so Google, Bing and other search engines will index and display your content when a local pet owner is searching for answers. your local TV stations, with a link to your content. Besides having your content show up in search-engine results when local pet owners are online, you might receive valuable media coverage on a local TV news broadcast and station website. That s a huge bonus because you can bet that many of your local pet owners are watching the morning or evening news on TV. Veterinary advantage ««November/December

18 »» Sales Time is Your Most Valuable Resource Mike Biggins, ATS As a sales representative, you hear a lot about time management, how to avoid wasting time and how to make the best use of time. And, if you are like most salespeople, time always seems to be in short supply. For those time-crunched people who are looking for some quick suggestions for making the most of their time, I want to offer some things to consider before you take actions that may contribute to lost or wasted time. When deciding how to use my time I begin with a couple of questions: What is the best use of my time right now? Can I put this off, and if I do put it off, what does it impact? Planning your day, week or month should result in a list of prioritized tasks. The old saying is Plan your work, work your plan. Along with these questions, other things to consider are: Is it really necessary for me to do this? Is it appropriate for me to handle this? Can I do this efficiently? The result of the above questions helps establish your priorities. The result might be characterized as a list of: Must Do items Should Do items Nice to Do items Planning your day, week or month should result in a list of prioritized tasks. The old saying is Plan your work, work your plan. Time tools We ve looked at planning, so what about aids used to help keep us focused on the tasks we ve planned? These include and are not limited to: to-do lists, calendars and a variety of computer (technology) tools. It s best to choose tools that fit you and avoid tools that require significant change from you. Recognize that your plan is going to be disrupted in some way. There will be changes due to emergencies, crises and other interruptions. How you choose to respond to these changes determines the impact they have on your plan. For example, if someone is late for an appointment, what should you do? I choose to wait, but not spend an unreasonable amount of time waiting (10 to 15 minutes). Or, if I m interrupted during the course of the day, I go back to the questions about the use of my time, and ask myself if I can put this off. What s important is to assess the situation and the importance of the interruption. Before ending, I think it s appropriate in interject a few words about procrastination. Procrastination is a major time waster and can impact the timely completion and quality of your work. So if you have a tendency to procrastinate, make it a habit to begin early in the day and complete undesirable tasks first. Time is your most valuable resource, so use it wisely. Remember, being disorganized and procrastinating are major time wasters that are completely within your control. For more information on training in this area or other sales training curriculum, visit: or contact Mike Biggins at mike.biggins@ats-solutions.net 18 November/December 2014»» Veterinary advantage

19 That s just my [SUPRESSED IMMUNE SYSTEM. ELEVATED HEART RATE. ABNORMAL RESPIRATORY RATE. GI UPSET. HORMONE CHANGES. INAPPETANCE.] stress coming out. Start a new dialogue about behavior then start new Zylkene. Because your patients aren t just stressed out. They re stressed within. Your clients don t realize behavior problems aren t just stress-related, they re health-related too. You re the life line for answers and new Zylkene is your first line: The only veterinary nutraceutical with alpha-casozepine, a safe and natural ingredient derived from casein, a milk protein with calming properties Clinically proven for behavioral problem management without drowsiness or sedation Indicated for situational stress or chronic anxiety in dogs or cats Palatable, once-daily formulation in three sizes Learn more at vetoquinolusa.com/zylkene or call Relax, you ve got Zylkene is a registered trademark of Vétoquinol Vétoquinol 7/2014

20 »» Sponsored by Merck: Sourced by Merck Animal Health Tick-Tock: Discuss Tick Management in Every Season Tick-borne disease can be a year-round threat The threat of tick-borne disease is expanding. Traditional geographies and seasons may no longer apply when screening for and preventing exposure to tickborne diseases. Including tick management discussions with clients year-round can help keep the issue top-of-mind. Small tick, big problems Ticks can pose serious problems for dogs. They can run the risk of developing bacterial and protozoan infections, anemia or even dermatological conditions. Furthermore, they can use dogs to transmit infection. With exposure to ticks, a dog may become sick, or it can pass on the infection without showing signs of illness, says Rick Alleman, D.V.M., Ph.D., former professor and director of laboratories at the University of Florida, College of Veterinary Medicine. Such infections can be present in the dog for years without making them sick, Dr. Alleman notes. Then, other ticks feed on the dog and can inoculate the dog with other pathogens or acquire pathogens from the dog. This increases the pathogen burden in the dog and in the ticks in the environment. Natural reservoirs for tick-borne diseases, like deer, contribute to the spread of disease, but the dog s role cannot be overlooked especially since dogs have much closer contact with people and homes. Today s pets are frequently traveling with their owners, which may mean ticks are along for the ride. We ve seen problems with tick-borne disease even in areas where it s not endemic, Dr. Alleman says. People traveling with their pets or pet rescues that ship dogs to different parts of the country can import disease to new areas. Veterinarians in all areas should be on the lookout for clinical signs such as fever of unexplained origin, lameness, decreased appetite, swollen lymph nodes, enlarged spleen or bleeding. Helping owners Most pet owners want a simple solution for protecting their pet from ticks, Dr. Alleman notes. New tick management solutions offer owners tick protection without needing to remember a monthly dosing schedule. BRAVECTO (fluralaner) is the first oral chew to deliver up to 12 weeks of flea and tick protection in a single dose. 1* BRA- Examples of Tick-Borne Diseases: Lyme disease Rocky Mountain Spotted Fever Anaplasmosis Babesiosis Ehrlichiosis VECTO kills ticks fast before engorgement, which may help reduce the risk of exposure to diseases ticks may carry. 2 Extending tick protection for up to 12 weeks can help maximize pet owner compliance and reduce protection gaps that occur with monthly flea remedies. 3 BRAVECTO is indicated for the treatment and control of lone star tick infestations for eight weeks in dogs and puppies 6 months of age and older, and weighing 4.4 pounds or greater. It also is labeled to kill black-legged ticks, American dog ticks and brown dog ticks for 12 weeks. *BRAVECTO kills fleas, prevents flea infestations, and kills ticks (black-legged tick, American dog tick, and brown dog tick) for 12 weeks. BRAVECTO also kills lone star ticks for eight weeks. IMPORTANT SAFETY INFORMATION: The most common adverse reactions recorded in clinical trials were vomiting, decreased appetite, diarrhea, lethargy, polydipsia, and flatulence. BRAVECTO has not been shown to be effective for 12-weeks duration in puppies less than 6 months of age. BRAVECTO is not effective against lone star ticks beyond 8 weeks after dosing. Please see the BRAVECTO advertisement for full prescribing information. 1 BRAVECTO [prescribing information]. Summit, NJ: Merck Animal Health; Data on file. Merck Animal Health, Summit, NJ Kidd L, Breitschwerdt EB. Transmission times and prevention of tick-borne diseases in dogs. Compend Contin Educ Pract Vet. 2003;(25)10: Copyright 2014 Intervet Inc., a subsidiary of Merck & Co., Inc. All rights reserved 20 November/December 2014»» Veterinary advantage

21 FLEA AND TICK MANAGEMENT JUST TOOK A GREAT LEAP FORWARD 12-WEEK PROTECTION, * ONE ORAL CHEW 1 That was then. This is now. Order BRAVECTO today contact your Merck Animal Health sales representative or distributor partner. * Bravecto kills fleas, prevents flea infestations, and kills ticks (black-legged tick, American dog tick, and brown dog tick) for 12 weeks. Bravecto also kills lone star ticks for 8 weeks. IMPORTANT SAFETY INFORMATION: The most common adverse reactions recorded in clinical trials were vomiting, decreased appetite, diarrhea, lethargy, polydipsia, and flatulence. Bravecto has not been shown to be effective for 12-weeks duration in puppies less than 6 months of age. Bravecto is not effective against lone star ticks beyond 8 weeks after dosing. Please see Brief Summary on following page. 22 Reference: 1. Bravecto [prescribing information]. Summit, NJ: Merck Animal Health; Available by veterinary prescription only. Copyright 2014 Intervet Inc., a subsidiary of Merck & Co., Inc. All rights reserved. Intervet Inc. d/b/a/ Merck Animal Health, Summit, NJ US/BRV/0514/0026 ww.mypet.com

22 NADA , Approved by FDA BRIEF SUMMARY (For full Prescribing Information, see package insert) Caution: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. Indications: Bravecto kills adult fleas and is indicated for the treatment and prevention of flea infestations (Ctenocephalides felis) and the treatment and control of tick infestations [Ixodes scapularis (black-legged tick), Dermacentor variabilis (American dog tick), and Rhipicephalus sanguineus (brown dog tick)] for 12 weeks in dogs and puppies 6 months of age and older, and weighing 4.4 pounds or greater. Bravecto is also indicated for the treatment and control of Amblyomma americanum (lone star tick) infestations for 8 weeks in dogs and puppies 6 months of age and older, and weighing 4.4 pounds or greater. Contraindications: There are no known contraindications for the use of the product. Warnings: Not for human use. Keep this and all drugs out of the reach of children. Keep the product in the original packaging until use, in order to prevent children from getting direct access to the product. Do not eat, drink or smoke while handling the product. Wash hands thoroughly with soap and water immediately after use of the product. Precautions: Bravecto has not been shown to be effective for 12-weeks duration in puppies less than 6 months of age. Bravecto is not effective against Amblyomma americanum ticks beyond 8 weeks after dosing. Adverse Reactions: In a well-controlled U.S. field study, which included 294 dogs (224 dogs were administered Bravecto every 12 weeks and 70 dogs were administered an oral active control every 4 weeks and were provided with a tick collar); there were no serious adverse reactions. All potential adverse reactions were recorded in dogs treated with Bravecto over a 182-day period and in dogs treated with the active control over an 84-day period. The most frequently reported adverse reaction in dogs in the Bravecto and active control groups was vomiting. Percentage of Dogs with Adverse Reactions in the Field Study Adverse Reaction (AR) Bravecto Group: Percentage of Dogs with the AR During the 182-Day Study (n=224 dogs) Active Control Group: Percentage of Dogs with the AR During the 84-Day Study (n=70 dogs) Vomiting Decreased Appetite Diarrhea Lethargy Polydipsia Flatulence In a well-controlled laboratory dose confirmation study, one dog developed edema and hyperemia of the upper lips within one hour of receiving Bravecto. The edema improved progressively through the day and had resolved without medical intervention by the next morning. For technical assistance or to report a suspected adverse drug reaction, contact Merck Animal Health at Additional information can be found at For additional information about adverse drug experience reporting for animal drugs, contact FDA at FDA-VETS or online at SafetyHealth. How Supplied: Bravecto is available in five strengths (112.5, 250, 500, 1000, and 1400 mg fluralaner per chew). Each chew is packaged individually into aluminum foil blister packs sealed with a peelable paper backed foil lid stock. Product may be packaged in 1, 2, or 4 chews per package. Distributed by: Intervet Inc (d/b/a Merck Animal Health) Summit, NJ Made in Austria Copyright 2014 Intervet Inc, a subsidiary of Merck & Company Inc. All rights reserved R2 22 November/December 2014»» Veterinary advantage

23 Finance ««Drowning in Debt Veterinarians are carrying a significant amount of debt from student loans. Here s how you can help. If you call on veterinarians, you call on a population drowning in debt. Mean educational debt among the nearly 90 percent of 2012 graduates with debt was $151,672 (JAVMA, Vol 241, No. 7, Oct. 1, 2012). Excluding salaries for graduates pursuing advanced education, mean full-time starting salary was $67,535 (see avma.org for Market Research Statistics). An accepted financial rule-of-thumb is that one should not borrow more than their starting salary. With a debt to income ratio of 2.2:1, veterinarians are without peer in the healthcare professions, where 1.1:1 to 1.7:1 are typical (per the Association of American Medical Colleges, American Dental Education Association, and American Association of Colleges of Pharmacy). The profession has a huge, unsustainable problem with no easy or quick fixes. But where there is a problem, there is an opportunity for you to help. Repayment options Unlike most debts, student loans generally must be repaid they are not forgiven in bankruptcy proceedings. Non-payment often results in wages garnished, income tax refunds seized, and even Social Security payments withheld, not to mention ruined credit. Given the average debt, a standard 10-year repayment period would require monthly payments of $1,745, or nearly one-third of pre-tax pay. For most, that s impossible. There is some relief for borrowers grappling with student loan debt. Unfortunately, surveys show that the vast majority of borrowers are unaware of these options. This is where you can add value. There are four main types of federal student loan repayment plans: Standard Repayment (10-year term), Extended Repayment (10- to 30-year term), By Fritz Wood, CPA, CFP Income-Based Repayment (payment size based on income) and Graduated Repayment (initial low payments are increased every two years). If you have customers struggling to make payments, either Income-Based Repayment or Extended Repayment will yield the lowest monthly payment (albeit the highest total interest paid). For example, increasing the term from 10 years to 30 years decreases the monthly payment from $1,745 to $ percent less, or $756 less each month. Extending the payback period will increase the interest paid, but it can buy some much needed breathing room in the short term. Student loans don t have prepayment penalties, so borrowers can pay the loans off more quickly if desired. Veterinary advantage ««November/December

24 »» Finance Resources: Federal Student Aid Information Center Federal Student Aid Ombudsman or Department of Education Debt Collection Service and Default Resolution Group or FinAid s Student Loans Section Forgot your lender? Student Loan Borrower Assistance Project Income-Based Repayment (IBR) bases monthly payments on a percentage of discretionary income, not the amount owed. Discretionary income is the adjusted gross income (see your tax return) minus 150 percent of the poverty line for the family size. IBR caps the monthly payment at 15 percent of discretionary income. The remaining debt and interest will be forgiven after 25 years in repayment. (Note that a new more generous rule takes effect for loans taken out on or after July 1, 2014) The downside: forgiven debt is taxable income. If $100,000 is forgiven, a borrower might owe the IRS $30,000 (assuming a 30 percent tax rate). Encourage your veterinarians to never miss a payment. About one-third of borrowers are late or delinquent with their very first payment on their student loans. For May graduates, the grace period ends and payments must begin in November. Encourage your veterinarians to set up automatic monthly payments. Borrowers with auto-debit are much less likely to miss a payment, and many lenders offer discounts to borrowers who set up auto-debit. Public service loan forgiveness Public service loan forgiveness shortens the forgiveness under IBR to 10 years, and makes it tax free. Only federal Unlike most debts, student loans generally must be repaid they are not forgiven in bankruptcy proceedings. student loans are eligible private student loans are not eligible. A person must be employed full-time for 10 years in a public service job, such as police, fire, EMT, government, military, public education, public health, social work, public interest law, public librarian, and non-profits. Temporary suspension of payments With federal student loans (not private loans), a temporary suspension of loan payments is best for short-term financial difficulty, such as maternity or medical leave, or short-term unemployment. Extended periods of non-payment will generally cause the loan balance to grow much larger, so this decision should be made carefully. Talk to the lender Borrowers struggling or unable to make student loan payments as agreed or required should contact their lender(s) immediately. Borrowers cannot run away from this problem, and the lender will appreciate their reaching out to them. Plus, borrowers who have defaulted on federal loans aren t eligible for any of the programs outlined above, unless they make good on their defaulted loan by rehabilitating it. Increase income Borrowers should create a monthly budget (see www. mint.com). If total mandatory spending exceeds total income and you ve exhausted the options above, a second or third job may be required. If there is nothing available locally in terms of relief work or emergency call, delivering pizzas can net $1,500 a month. Swallowing your pride and ego beats defaulting on student loan debt. 24 November/December 2014»» Veterinary advantage

25 THERE ARE NO GENERIC PETS. (But it s about time their meds were.) For many clients, the price tags on pet meds can be jaw dropping. And sometimes, too many times, they just can t swing it. That s why we offer a line of FDAapproved generics that are just as safe and work just as well as name brands but cost a whole lot less. Learn more about us at PutneyVet.com. Putney Meloxicam Solution for Injection is the therapeutic equivalent of Metacam Solution for Injection available at a more affordable price. It s FDA-approved for veterinary use. It controls pain associated with osteoarthritis in dogs and in cats controls postoperative pain and inflammation associated with certain surgeries when administered prior to surgery. It s available as a 5 mg/ml solution in 10 ml vials, the same size and strength as Metacam Solution for Injection. It s manufactured in an FDA-inspected facility using current Good Manufacturing Practices (cgmp). Every pet deserves Putney Warning: Repeated use of meloxicam in cats has been associated with acute renal failure and death. Do not administer additional injectable or oral meloxicam to cats. Refer to the package inserts on the reverse side for further safety and usage information. METACAM is a registered trademark of Boehringer Ingelheim Vetmedica GmbH.

26 »» Trends Making the Most Out of the Opportunity A Partners for Healthy Pets survey tool helps practices identify the gap between what they think and say, and what their clients hear and understand The staff at The Cat Doctor believes strongly in the value of preventive medicine. But they wanted to know if they were getting the message across to their clients. There was only one way to find out by asking. And that s what the Philadelphia, Pa.-based practice did, using the Opportunity survey tool from Partners for Healthy Pets. Turns out the practice was, indeed, communicating its message well. Still, the survey pointed out room for improvement. Similarly, the doctors and staff at Stratham-Newfields Veterinary Hospital in Newfields, N.H., used Opportunity to find out how well they were communicating the message of prevention to their clients. We walked away knowing that what we were doing was fairly effective; that, as a practice, we had the preventive-care message down fairly tight, says practice manager George Bailey. Still, when people ask me about the benefit [of the survey], I tell them it s wickedly valuable, because it sets a tone among the staff and it even nudges the clients including those who didn t answer the survey that we re serious about preventive care, he says. Opportunity is an online practice survey tool in the Partners for Healthy Pets Practice Resources Toolbox. Through responses to pet owner and healthcare team surveys, practices can uncover communication gaps between the veterinary team and their clients related to the latter s understanding and perceived value of routine preventive healthcare visits. Based on the survey results, practices can take action to improve their communication with clients about preventive healthcare, improve client satisfaction, and bring optimum preventive healthcare to pets. Putting it to the test No feline preventive health visit at The Cat Doctor is complete without 26 November/December 2014»» Veterinary advantage

27 an assessment of the cat s behavior and pain. We ask about litter boxes, intercat behavior, feeding bowls and enrichment, says founder and owner Diane Eigner, VMD. From time to time, she takes clients into the practice s reading room, so they can see the shelves on which the practice s housecats love to perch. The practice s doctors are just as diligent about assessing the cat s mobility and potential pain points during each visit. We thought we discussed behavior at almost every visit, says Eigner. But she wanted to test that belief through a survey. The Cat Doctor carried out the Opportunity process in multiple steps. First, the entire team of veterinarians, technicians, nursing staff and administrative staff completed the survey. Then, all clients were asked to participate. Six months later, the Cat Doctor team and clients repeated the survey, allowing Eigner and her staff to see if any improvement occurred in client perceptions of healthcare delivery in the interim. A key communication gap revealed by the initial survey was the response to the question, During a feline preventive healthcare visit to your practice, is a behavioral assessment performed at every exam, regardless of the pet s age? she explains. In the initial survey, clients concurred slightly less than half the time. In contrast, the healthcare team answered in the affirmative 78 percent of the time. The survey revealed a similar gap in the perception of whether the healthcare team makes a pain assessment at every exam. The staff response indicated that a pain assessment was made nearly 80 percent of the time, but a minority of clients indicated that such an assessment was given. We thought we were clear with our communication, but the survey showed we needed to come up with a new way of delivering the information, says Eigner. After reviewing the survey responses, the staff identified changes that would elevate the behavioral and pain assessment components of the regular healthcare visit. The same process was repeated for other areas designated for improvement. When the follow-up survey was completed six months later, results indicated that the gap between staff and client perceptions had closed significantly. The culture here is a team concept, says Eigner. The survey process was a great way to engage them in improving and reinforcing the message of preventive healthcare. It was very reinforcing to see how satisfied our clients were with our services, but it was also eye-opening, she says. We found, maybe we could do a little bit better. And the fact that it wasn t just coming from me, the practice owner, was valuable. There s an ongoing message in this practice, which is shared among everyone: Every day, we have to bring our A game to the hospital. We can never really be complacent, she says. Conducting the Opportunity survey, asking for the The raison d etre of the Opportunity survey is to help practices become self-aware, that while they may understand the importance of preventive care, their clients may not. George Bailey voice of the client, reinforced the point. And by extending our clients the courtesy of asking their opinion, there is no question that we made a successful practice even better and stronger. Where s the downside? There s little or no downside to surveying clients, regardless of the outcome, says George Bailey. It not only identifies room for improvement, but it reinforces a culture of excellence among the staff, and it pulls clients closer to the veterinary practice. Bailey was pleased at the results of his Opportunity survey. We ended up seeing a high correlation between what we thought about the importance of certain preventive issues, and what the clients were reporting, he says. But going through the process yielded more dividends than he had imagined. If you tell people you re doing a survey about something, they pay extra attention. It goes to the front of their mind. Sometimes even the caring and conscientious veterinary professionals can fall back into believing that preventive care is just about vaccines and parasite control, says Bailey. Veterinary advantage ««November/December

28 »» Trends By extending our clients the courtesy of asking their opinion, there is no question that we made a successful practice even better and stronger. Diane Eigner, VMD To be sure, those are two important components. But we can forget that it s also about preventive diagnostics, which can uncover occult disease. In fact, early detection of disease is a huge component of preventive care. If you re not focusing on that, you are condemning your patients to latestage detection and, perhaps, to less effective treatment. When talking to colleagues from other practices about Opportunity, Bailey hears comments such as this: When we did the survey, we realized we thought we knew how important preventive care was. But our clients still had the view, I only need to bring my cat to the doctor when she s sick, he says. The Opportunity survey tool can stimulate discussion among staff about how the importance of preventive medicine is communicated to clients, he continues. Clients don t know the terms or the vocabulary; it s not on the tip of their tongues. The raison d etre of the Opportunity survey is to help practices become self-aware, that while they may understand the importance of preventive care, their clients may not. Opportunity offers other benefits. Sending out a survey tool that has been professionally developed reinforces to your clients that your practice is in the forefront of technology and information. It makes your practice look good. It also reinforces to clients that the practice team is listening to them. Data shows that consistently growing hospitals are those that put a high premium on relationships, whether those relationships are between doctor and patient, doctor and client, doctor and staff, staff and client, or staff and patient, he says. Sending the Opportunity survey to clients reinforces the idea that they are part of the healthcare team, taking care of their pets together. Sales reps shouldn t miss the opportunity to share news about the Opportunity survey tool and other tools from Partners for Healthy Pets with their customers, adds Bailey. Your accounts may not be doing as effective a job as they think in communicating the message about parasite prevention, he says. Making them aware of the survey tool can heighten that self-awareness, and stimulate sales. Think about your cat s most recent checkup/preventive care visit to our office. Were the following discussed with you or provided as part of the visit? Physical exam Retrovirus test (FELV, FIV) Internal parasite testing (feces tested for worms) Broad-spectrum parasite control (heartworms, intestinal, fleas, ticks) Pain assessment Dental exam and recommendations Behavioral assessment Heartworm test Weight and nutritional assessment and/or recommendations Vaccinations Follow-up plan based on assessments and recommendations Yes No / Don t remember Sample question from Opportunity survey, Partners for Healthy Pets, 28 November/December 2014»» Veterinary advantage

29

30 »» Trends Mary L. Berg, BS, LATG, RVT, VTS (Dentistry), Beyond the Crown Veterinary Education, Lawrence, Kan. Dental s Potential Help your veterinary customers thrive with the right dental equipment and products Veterinarians are missing an opportunity to offer treatment to more than 80 percent of dogs and 70 percent of cats over 2 years of age when they fail to recommend a professional dental cleaning. Almost every patient entering the veterinary practice is a potential dental patient. Annual dental cleanings have been shown to add two to three years to the life of companion animals. What client wouldn t want to spend more time with their loved one? Unfortunately, dentistry is still an under recommended and underserved part of many veterinary practices. This may be due to lack of training of the doctors and staff and lack of proper equipment in the practice. This is your opportunity to recommend quality equipment and supplies to aid the veterinarian in advancing the care they offer their patients. When distributors market dental products to the veterinary practice it is important to recommend the correct and quality products. These products will be revenue builders with the practice when used and maintained correctly. This not only helps the veterinarian provide quality dental care to their patients, but puts the distributor in the good light of quality recommendations. Terminology The terms dentals or prophies should no longer be used in the veterinary field. Dentals is often thought of as an elective or cosmetic procedure, and prophies is short for prophylactics, which means prevention. Very seldom is a professional dental cleaning in a companion animal truly 30 November/December 2014»» Veterinary advantage

31 From the CLINIC COUNTER to the KITCHEN COUNTER. Extend the benefits of in-clinic dental care between visits with proven, professional-grade C.E.T. Oral Hygiene products. 1 8 Proper at-home dental care starts with science and ends with compliance. That s why the C.E.T. Oral Hygiene line offers a range of options backed by clinical data and proven technology that fit easily into pet owners lifestyles Offer your clients professional-grade solutions for the clinic and the home with C.E.T. Oral Hygiene products. References: 1. Clarke DE. Drinking water additive decreases plaque and calculus accumulation in cats. J Vet Dent. 2006;23(2): Clarke DE, Kelman M, Perkins N. Effectiveness of a vegetable dental chew on periodontal disease parameters in toy breed dogs. J Vet Dent. 2011;28(4): Montgomery RE. Aqueous chlorhexidine digluconate extracts from CHX Hextra Rawhide Chews, Data on file, Virbac Corporation. 4. Montgomery RE. The salivary peroxidase system. Dentistry Matters. 1995;7:1,3. 5. Gorrell C, Inskeep G, Inskeep T. Benefits of a dental hygiene chew on the periodontal health of cats. J Vet Dent. 1998;15(3): Hennet P. Effectiveness of an enzymatic rawhide dental chew to reduce plaque in beagle dogs. J Vet Dent. 2001;18(2): Midda M, Cooksey MW. Clinical uses of enzyme-containing dentrifice. J Clin Periodontal. 1986;13: Pader M. Oral Hygiene Products and Practice. New York: Marcel Dekker, Inc.; 1988: Montgomery RE, inventor. Proteinaceous animal chew with dentally therapeutic cation. US patent 6,074,662. June 13, Montgomery RE, inventor; Oraceutical Innovative Properties LLC, assignee. Proteinaceous animal chew with dentally therapeutic cation. US patent 6,737,077. May 18, Virbac Corporation. All Rights Reserved. C.E.T. is a registered trademark of Virbac Corporation. All other trademarks are property of Virbac Corporation or one of its affiliated companies in the US. 10/

32 »» Trends prophylactic. When a thorough oral examination along with dental radiographs is completed on each patient, oral pathology is frequently found, thus making the procedure a medical treatment. Building dentistry within a practice does not mean doing as many dentals as possible every day. Yes, this will increase revenue, but the patients and the staff suffers as the procedures are not done to a standard level of care. The 2013 AAHA Dental Care Guidelines for Dogs and Cats outline the guidelines for the practice of companion animal dentistry by the veterinary professional. The best dental practices do not perform more than three to four procedures in one day per table. Diplomates of the American Veterinary Hospitals record all vaccines, blood work and other healthrelated issues in their medical charts. Is oral health less important? A complete oral examination and chart should be completed on every patient that presents for a dental procedure. Dental College will only schedule three to four procedures in one day. Hospitals record all vaccines, blood work and other health-related issues in their medical charts. Is oral health less important? A complete oral examination and chart should be completed on every patient that presents for a dental procedure. Not only should the chart include the teeth present and missing, it should also indicate the locations and severity of dental disease indicators, such as periodontal pockets, mobility, fraction involvement, gingival recession and loss of attachment. These basic indices will help the veterinarian determine the stage of periodontal disease in the patient. This chart becomes part of the patient history and can be used to track changes in the oral health of the patient throughout its life. Remember, each dog has 42 patients in its mouth and each cat has 30 patients. It is vital to assess and evaluate each of those patients thoroughly to ensure the best treatment options are provided. If your clients are not already charting each oral cavity, provide them with a dental chart and offer training to correctly evaluate the teeth. Equipment Ensuring that the practice has the correct dental equipment and the training to maintain the equipment is vital to their success. The following are important things to remember and recommend: Hand instruments Hand instruments will be used every day. Purchasing quality equipment may cost a little more up front, but the benefits of good equipment outweigh the initial cost. The minimum requirements for hand instruments include a periodontal probe, explorer, hand scalar, curettes, set of elevators, luxators, root tip pick, periosteal elevators, retractors, scissors, small needle holders, extraction forceps and tissue forceps. Many of these instruments come in various kits. Hand instruments must be cleaned and autoclaved between patients. Instruments like scalers, curettes, evaluators, luxators and periosteal elevators need to be sharp to perform effectively. There are various methods to sharpen instruments. The important equipment needed is a flat Arkansas stone, a conical Arkansas stone and sharpening oil. An acrylic stick or a syringe cover can be used to determine if your instrument needs sharpening. If the instrument is applied to the acrylic stick and the instrument sticks into the acrylic or shaves off a thin layer of acrylic, the instrument is sharp. Instruments should be sharpened after each use to ensure they perform effectively. Power scalers Ultrasonic or sonic scalers are useful to remove the supragingival calculus deposits. There are three types 32 November/December 2014»» Veterinary advantage

33 of ultrasonic scalers available: magnetostrictive stacked, magentostrictive with Ferrite rod and piezo, all of which work in a similar manner. The ultrasonic scalers vibrate in the range of 18,000 to 45,000 cycles per second. When used properly, the vibration breaks up or pulverizes the calculus on the tooth surface. These instruments can damage the teeth by mechanical etching and thermal injuries if not used properly. Supragingival scaling uses a steady, generous supply of water to aid in the prevention of overheating the tooth, along with a high power setting. When using the smaller perio tip designed for sub-gingival scaling, less water is needed and the power settings should be decreased. The instrument should be grasped lightly in a modified pen grasp. The hand piece is balanced on the index or middle finger. The instrument, not the hand, must be allowed to do the work. The hand is merely a guide. The hand piece should be used with a light touch with minimal pressure, keeping the tip moving on the tooth. Stopping in any one area can cause damage. In many hospitals, technicians use only one scaler tip for the entire procedure. It s true that this tip is often called the universal tip, and can be used above and below the gumline. But it is not The technician should NEVER put the tip straight down on the tooth, as this will cause thermal damage to the tooth. The hand piece should be held lightly, as the hand is only a guide to the dental scaler. very effective in either case. The use of two different tips a beaver tail and a periodontal tip will be more efficacious. The beaver tail is a board tip that is extremely effective for removing gross calculus deposits on the crowns of the teeth. The periodontal tip is specifically designed to be used below the gumline to clean out the periodontal pockets and furcation areas. The universal tip still has its place in dentistry and can be used supragingivally for small dogs and cats, but it is not very effective subgingivally. Each type of scaler has different areas of efficacy on the tip, but usually, it is the last 3 mm of the tip. The technician should NEVER put the tip straight down on the tooth, as this will cause thermal damage to the tooth. The hand piece should be held lightly, as the hand is only a guide to the dental scaler. The technician should proceed with long, Cardell Touch Veterinary Monitor 10.5 touch screen makes patient set up faster and easier or use the traditional-style buttons located below the screen Redesigned menus and improved controls allow for intuitive navigation Smaller, lighter form factor allows for easy transportation without sacrificing visibility Upgrade to CO2 monitoring at any time by adding a sidestream or mainstream CO2 module Masimo multigas available Enhanced ECG data export capabilities Cardell veterinary specific blood pressure technology

34 »» Trends broad strokes, and avoid taking the tip off and on the tooth repeatedly, as this can cause concussive injury to the pulp of the tooth. Once the gross calculus is removed from the crowns of the tooth, the periodontal tip should be used to go below the gumline to remove debris from the sulcus and the pockets around the tooth. The advantage of using a periodontal tip over a curette is that the ultrasonic action bursts the cell walls of the bacteria, and the water flushes the bacteria and debris from the pocket. The technician should always follow the power scaler with a curette to ensure that all the calculus is removed from the pocket. Practices should make sure to request fine or flour pumice when ordering. (Practices can make their own pumice paste by ordering flour pumice and glycerin, and mixing the two into a thick, cookie dough consistency.) It is not advised to use only the perio tip for the entire dental procedure, as the tip is not designed to remove gross calculus deposits and will add time to the procedure and wear to the instrument. The practice should check the tips often, using the tip guide received at the time of purchase, as the tips do lose efficacy over time. Polishing The teeth must be polished after scaling to smooth out the microetches that are created when scaling. Many practices believe it s acceptable to use either coarse or medium grit pumice for polishing. The problem with that approach is coarse or medium grit pumice creates additional etches on the enamel. Compare pumice to sandpaper: When a very smooth surface is the goal, fine or extra fine sandpaper is used. The same should be true for dental pumice. Practices should make sure to request fine or flour pumice when ordering. (Practices can make their own pumice paste by ordering flour pumice and glycerin, and mixing the two into a thick, cookie dough consistency.) The polisher should be held with a light touch and just enough pressure to gently flare the prophy cup. A disposable soft prophy cup with oscillating action is preferred. The polisher should be set at a low speed and moved in a slow but constant motion over the teeth. Speeds that are too high will generate heat and damage the tooth. Dental delivery units Practices that perform dental extractions must have a dental unit. These units should have the minimum of high speed, low speed hand pieces and an air/water syringe. More advanced units will have a scaler (usually piezo) and suction. Most of these units include their own compressor that powers the hand pieces. Some units may run off of nitrogen. Dental units need to be maintained daily to ensure their long life. The pressure from the compressor tank must be released daily to avoid condensation that could lead to rusting of the tank. Compressors that require oil must have the oil changed on a routine basis, usually yearly. Some hand pieces are oil free, but others must be oiled on a daily basis. Most importantly, the burs used to cut teeth with the high speed bur are disposable and should be used on no more than six teeth and then be replaced. A sharp bur will cut better and not lead to damage to the turbine inside the hand piece. In most practices the following burs are all that are needed for surgical extractions, 699, 701, 701L and the #2 and #4 round bur. Dental radiographs The most beneficial diagnostic tool in the veterinary dentistry is the dental X-ray machine. Even teeth that appear to be normal may have conditions that are not clinically visible. Studies have shown that 42 percent of pathology in animals mouth is found only by radiography. It is important 34 November/December 2014»» Veterinary advantage

35

36 »» Trends The Veterinary Oral Health Council provides a seal of Approval to companion animal dental products that have undergone strict testing protocols to ensure the safety and efficacy of the product. Recommending products with this seal is recommended. to take full survey radiographs of periodontal patients prior to every professional periodontal treatment. It is also recommended to take X- ray prior and post extraction to ensure that the entire tooth root has been removed. Lighting Good illumination is vital to any dental procedure. An adjustable surgical light source is necessary to visualize the oral cavity, not just during the cleaning process but during all dental procedures. Magnification Teeth are tiny and without magnification pathology, plaque and calculus can be missed. A quality pair of magnifying loupes can be an invaluable addition to your dental operatory. Dental tables Wet tables are important to help maintain a drier work area for the patient. The table should be designed to allow the technician or doctor to sit while performing the procedure. Proper ergonomics will aid staff members to perform procedures with less risk of repetitive motion injuries. Patient warming devices There are many options available for pet warming during dental procedures. A dental procedure will drop the core body temperature of a patient very quickly, so maintaining patient temperature is vital. Some warming systems are air blown technology, while others use innovative mesh that creates a warming blanket for the pet. Home care products There are hundreds of dental home care products on the market, but few are safe and efficacious as prevention to oral disease. The gold standard is tooth brushing, but in reality only 1-2 percent of pet owners brush their pet s teeth. It is important to recommend products that have been proven safe and really work. The Veterinary Oral Health Council provides a seal of Approval to companion animal dental products that have undergone strict testing protocols to ensure the safety and efficacy of the product. Recommending products with this seal is recommended. Products like deer antlers, cow hooves and rolled rawhide bones are likely to cause tooth fractures. The dog s mandible does not shift side to side like a human mandible, so when they chew and apply pressure to those hard objects it leads to tooth fractures, which in turn will lead to tooth root abscesses. The best rule of thumb is if you can t easily bend with your hands, it s too hard! Recommending quality equipment and services to your clients will not only increase their dental revenue, but yours as well. 36 November/December 2014»» Veterinary advantage

37 Rapinovet (propofol) Bayer quality, the performance you expect, a price you will love. Maximize your savings with special introductory pricing! From December 1, 2014 through January 31, 2015 Purchase 5 cartons (five 20 ml vials each /a total of 25 vials) on one invoice and receive a 5% discount Purchase 10 cartons (five 20 ml vials each/a total of 50 vials) on one invoice and receive a 10% discount For more information or to order, call your Bayer Sales Representative, Bayer Customer Service at or your preferred distributor. CAUTION: Federal law restricts this drug to use by or on the order of a licensed veterinarian Bayer HealthCare LLC, Animal Health, Shawnee Mission, Kansas Bayer (reg d), the Bayer Cross (reg d) and Rapinovet are trademarks of Bayer. RP142141

38 »» Trends By Dawn Singleton Olson Holiday Shipping Help your customers avoid the holiday rush If you ve worked in animal health sales for more than a year, odds are you ve been through at least one holiday shipping season. The majority of your customers have likely come to expect one day, or at most, two-day shipping for their orders, and many probably put off ordering until as late as possible to make your sameday shipping cut-off. The combination of winter weather, holiday shipping schedules, and year-end manufacturer promotions, combined with the explosion of e-commerce Be aware of the weather where your customers are located. Severe weather may delay cargo flights and prevent ground deliveries. and last-minute retail shipping make it a challenge to meet those expectations and get each and every package to your customers when they need it. A perfect shipping storm Package delivery during the 2013 Christmas holiday was a perfect storm of bad weather, a shortened shopping season, shopper procrastination and online retailers who guaranteed Christmas delivery for orders placed on December 23. The sheer volume of packages overwhelmed the system last year, and your customers orders may well have been among the millions stranded on trailers and delivery trucks that went undelivered before the holiday. According to the Wall Street Journal, this year UPS is spending $500 million to expand buildings, adding 6,000 new loading spots for its vans and increasing seasonal hires as much as 73 percent to 95,000. More than 125 cargo jets up from the usual 85 will land and take off from their Louisville hub nightly. FedEx is increasing seasonal workers by 25 percent to 50,000 and expanding capacity. UPS is lobbying retailers to end free overnight shipping offers on December 23, but most are unlikely to do so. According to financial consultant Deloitte LLC, e-commerce is expected to grow 14 percent this year, and like last year, Thanksgiving falls late, making for another condensed shopping season. What does all this mean for you and your customers? Remind them early and often to prepare for end-ofthe-year purchases, help them meet promotional goals with time to spare, and encourage them not to put off ordering critical products they ll need those final few weeks of December. This is an ideal time to use their purchase history to make sure they have sufficient inventory. Christmas falls on a Thursday this year with normal pickup and delivery service from UPS on Monday and Tuesday and normal delivery of air and ground packages on December 24. FedEx has a similar schedule. Don t let this normal schedule give your customers a false sense of security placing orders that week. December 23 was the busiest day of the year in package volume for UPS last year, with a mind-boggling 31 million packages. Encourage them to order early in the week before the holiday. Be aware of the weather where your customers are located. Severe weather may delay cargo flights and prevent ground deliveries. The good news for the first time, UPS will have normal pickup and delivery the day after Thanksgiving this year one of the busiest days for many clinics. Help your customers to plan ahead and you ll all have a happier, successful holiday season. 38 November/December 2014»» Veterinary advantage

39 DON T JUST GUARD. PROTECT.

40 Pet Insurance Pet insurance is catching on. Can the industry sell its value? Sponsored by: vetpetinsurance.com November/December 2014»» Veterinary advantage

41 The phrase pet insurance is enough to give some veterinarians pause or worse. Little wonder, given all that has transpired and continues to transpire on the human medicine side. But pet insurance providers are working hard to convince veterinarians that insurance won t jeopardize their fees or dictate how they should practice medicine; and that it can, in fact, increase client traffic and revenues. More than 1 million pets are insured in North America, according to the National American Pet Health Insurance Association (NAPHIA). And while that may represent a fraction of U.S. pet owners, insurance providers believe the number will climb steadily. That s because the growing power of the human/animal bond is leading owners to seek more and more expensive treatments and procedures for their pets, they say. Insurance might be the only way many can afford them. The birth of NAPHIA in 2008 itself reflects the growth of the industry. The industry has grown large enough that [pet insurers] understand there s a place for a neutral voice talking about the universal benefits of pet insurance, says Executive Director Kristen Lynch. Other signs of growth include the emergence of private-label (or whitelabel ) brands of pet insurance, an interest on the part of financial services companies in pet insurance, and year-over-year growth in gwp, that is, gross written premiums, she says. More frequent visits Distributors of veterinary products and equipment distributors could be among the beneficiaries. Indeed, Trupanion reports that its policyholders visit veterinary clinics twice as often and spend 59 percent to 144 percent more on veterinary care. Pet owners are now frequently seeking extensive and complex veterinary care, say Dennis Rushovich, senior vice president, and Mary Beth Leininger, DVM, AVP of veterinary relations (and former president of the American Veterinary Medical Association), Hartville Pet Insurance Group. As a result, pet health insurance has assumed greater importance in helping pet owners pay for these higher cost services. Pet owners with ASPCA Health Insurance (a Hartville product) spend twice as much annually on veterinary care than non-insured pet owners, they say. This amount increases to 2.5 times greater per year when wellness care options are added. Increases in spending are a result of pet owners recognition that regular veterinary care is essential Veterinarians can do just about anything a [medical] doctor or surgeon can. They have the technology; they just need people to pay for it. Lorne Elder to their pet s health and well-being, and that pet insurance plans help cover those costs. As with most things, veterinarians have their own opinion about pet insurance, says Mike Cavanaugh, DVM, DAB- VP, CEO of the American Animal Hospital Association. Some embrace it and believe they and their clients receive real value, and others are still fearful of the impact that managed care has had on the human medical profession. But Cavanaugh believes change is imminent. I think pet insurance is going to reach a tipping point in the United States, and I believe we ll see significant growth in the number of pet owners who carry pet insurance, he says. I think with so many good companies offering a wide variety of choices, pet owners have many more options now than they once did. Veterinary advantage ««November/December

42 Pet Insurance Some data has shown that people with pet insurance visit the veterinarian more often and spend more annually at the veterinarian than those without insurance. With regard to these numbers, it seems that the pet insurance industry is having a favorable impact. Buzz If marketplace activity is any indicator, the pet insurance industry is growing stronger every day. Some examples from earlier this year: September 2014: Farmers Insurance and Pets Best Insurance Services LLC join forces, Key Points Trupanion reports that its policyholders visit veterinary clinics twice as often and spend 59 percent to 144 percent more on veterinary care. If marketplace activity is any indicator, the pet insurance industry is growing stronger every day. Traditional insurers are partnering with pet insurers for discounts and agreements on pet policies. I think pet insurance is going to reach a tipping point in the United States. Mike Cavanaugh, DVM, CEO of the AAHA provides pet insurance through its subsidiary agency under the brand names ASPCA Pet Health Insurance, Hartville Pet Insurance and Petshealth Care Plan.) August 2014: PetFirst announces a program with Safeway Inc., in which PetFirst will showcase its pet insurance plans through Safeway s Priority Total Pet Care brand, which currently includes pet food, treats and supplies and pharmaceuticals. Safeway customers who are members of the just for U program will receive an immediate 5 percent discount on their pet insurance policy. August 2014: American Animal Hospital Association (AAHA) announces it will add Veterinary Pet Insurance (VPI) as its newest Preferred Business Provider for pet wellness plans. AAHA says it will endorse a new group of standalone pet wellness plans by VPI called VPI Everyday Care. The VPI plans are designed to support the AAHA/AVMA Preventive Healthcare Guidelines. so that pet owners who purchase a Pets Best policy after referral from a Farmers agent or from the Farmers website receive a 5 percent discount off the regular price. Farmers reports that a recent poll showed that nearly three in 10 Farmers customers with pets expressed an interest in adding pet insurance to their existing policies. September 2014: Petplan enters into a multiyear agreement with AARP to provide exclusive deals for AARP members. August 2014: Fairfax Financial Holdings Ltd., a financial services holding company, agrees to acquire all the outstanding common shares of Pethealth, said to be North America s second largest provider of medical insurance for dogs and cats. (In July 2013, Fairfax acquired Hartville Pet Insurance Group, which Precedent in human medicine Everybody in the veterinary industry needs to know about pet insurance, especially those selling to veterinarians, says Lorne Elder, vice president of industry relations for Veterinary Advantage. They ll know about it soon enough, says Elder, who started Welch Allyn s Special Markets business unit, with its focus on veterinary medicine, military and pharmaceutical clinical/marketing programs. That s because veterinary medicine often follows human medicine. Insurance has been part of the landscape in human medicine for years, and insurance providers have been partnering with medical societies and associations for some time, he points out. That is happening in the veterinary field now. Veterinarians also often adopt technologies used on the human side, though usually a few years later, he says. 42 November/December 2014»» Veterinary advantage

43 Covering more of what you treat every day. Are your clients ready for anything? With VPI, they can choose the pet health insurance option that fits their lifestyle and their budget. Your clients will appreciate that VPI covers exam fees, and they only need to meet a single, annual deductible. Plus, VPI-insured clients visit their veterinarians 50% more often, helping to ensure more healthy patients and a financially healthy practice.* Help your clients be ready for whatever comes next. Recommend pet health insurance from VPI. Learn more at or call 866-VET-4VPI ( ). Ready for anything. *When compared to clients without pet insurance. Source: VPI Consumer Awareness & Usage Study Insurance plans are offered and administered by Veterinary Pet Insurance Company in California and DVM Insurance Agency in all other states. Underwritten by Veterinary Pet Insurance Company (CA), Brea, CA, an A.M. Best A rated company (2013); National Casualty Company (all other states), Madison, WI, an A.M. Best A+ rated company (2014) Veterinary Pet Insurance Company. Veterinary Pet Insurance, VPI and the cat/dog logo are service marks of Veterinary Pet Insurance Company. Nationwide, the Nationwide N and Eagle, and Nationwide Is On Your Side are service marks of Nationwide Mutual Insurance Company. AM

44 Pet Insurance Examples include ultrasound, digital radiography and video endoscopy. Veterinarians can do just about anything a [medical] doctor or surgeon can. They have the technology; they just need people to pay for it. That s the real challenge. Pet owners have a tendency to wait things out [when their pets are sick], he continues. With pet insurance and wellness visits, they don t need to. They don t need to ask themselves, Gee, can I afford what needs to be done? The result could be more sales of high-tech products and equipment, better care for the pet, and more client traffic for the veterinarian. With pet insurance, pet owners can afford much more veterinary care than they could otherwise, according But the historical relationship between humans and animals in the United States has differed, she continues. For years, animals lived in the field or barn, and people saw them as replaceable. Then they moved to the proverbial backyard and now, the home. Today, people see their pets as companions, and they recognize that each pet has a distinct personality and character. The ubiquity of pets on TV, advertising, social media and elsewhere all points to the growing human-animal bond. What s more, there s a growing recognition that the responsible pet parent makes veterinary care a priority. All this points to a strong future for pet insurance. Increases in spending are a result of pet owners recognition that regular veterinary care is essential to their pet s health and well-being, and that pet insurance plans help cover those costs. Dennis Rushovich and Mary Beth Leininger, DVM to Jack Stephens, DVM, founder, and Chris Middleton, president, Pets Best Insurance Services, LLC. Studies point out that the dollar amount at which people opt for economic euthanasia is somewhere around $1,400, they say. If pet insurance covers 80 percent of the bill, veterinary costs can reach $5,000 before hitting that threshold. It extends the consumer s reach about five times in that scenario, they say. And that helps distributors indirectly. Close-knit places If anything can accelerate adoption of pet insurance, it s the strengthening bond between humans and their pets, says Lynch. Europe where pet insurance is much more widely accepted serves as an example. There, people have lived in dense urban areas for years, she says. You have pets living side by side with people in smaller, close-knit places. In these conditions, the human-animal bond has grown steadily over the years. Role of the sales rep Distributor sales reps may play an important role in the future of pet insurance, according to those with whom Veterinary Advantage spoke. Distributor sales reps are often discussing methods for the practice to generate income, say Rushovich and Leininger of Hartville Pet Insurance Group. By having a basic understanding of how pet insurance can increase revenue for a practice, distributor sales reps can incorporate pet insurance as a linkage for their products. For example, pet insurance can help clients afford the cost of diagnostic testing, X-rays, pharmaceuticals, etc. Ultimately, a clinic may increase their order volume or afford to purchase a diagnostic machine if more clients have pet insurance. Everyone wins, including the veterinary practices, pet owners and most important, the beloved pet. As a sales rep, I m in the practice to sell a product and to bring the veterinarian up to date on what s happening in the industry, says Elder. That rep may 44 November/December 2014»» Veterinary advantage

45 RILEXINE (cephalexin) Chewable Tablets for Dogs Antimicrobial for Oral Use in Dogs only CAUTION: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. BRIEF SUMMARY: Please consult package insert for complete product information. INDICATION: For the treatment of secondary superficial bacterial pyoderma in dogs caused by susceptible strains of Staphylococcus pseudintermedius. CONTRAINDICATIONS: RILEXINE Chewable Tablets are contraindicated in dogs with a known allergy to cephalexin or to the ß-lactam (any of the penicillins or cephalosporins) group of antibiotics. WARNINGS: For use in dogs only. Not for use in humans. Keep this drug out of the reach of children. Antimicrobials, including penicillins and cephalosporins, can cause allergic reactions in sensitized individuals. Sensitized individuals handling such antimicrobials, including cephalexin, should avoid contact of the product with the skin and mucous membranes in order to minimize the risk of allergic reactions. PRECAUTIONS: Prescribing antibacterial drugs in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to treated animals and may increase the risk of the development of drug-resistant animal pathogens. The safe use of RILEXINE Chewable Tablets in dogs intended for breeding and in pregnant or lactating bitches has not been evaluated. Positive direct Coombs test results and false positive reactions for glucose in the urine have been reported during treatment with some cephalosporin antimicrobials. Cephalosporin antimicrobials may also cause falsely elevated urine protein determinations. Some antimicrobials, including cephalosporins, can cause lowered albumin values due to interference with certain testing methods. Occasionally, cephalosporins have been associated with myelotoxicity, thereby creating a toxic neutropenia 1. Other hematological reactions observed with cephalosporin therapy include neutropenia, anemia, hypoprothrombinemia, thrombocytopenia, prolonged prothrombin time (PT) and partial thromboplastin time (PTT), platelet dysfunction, and transient increases in serum aminotransferases 2. ADVERSE REACTIONS: The most common adverse reactions in dogs include diarrhea, vomiting, anorexia and lethargy. To report suspected adverse reactions call Virbac at ANIMAL SAFETY: RILEXINE Chewable Tablets were administered orally three times a day to 12-week-old healthy Beagles at 0 mg/kg (placebo), 22 mg/kg (1X), 66 mg/kg (3X), and 110 mg/kg (5X) for 12 weeks, and at 22 mg/kg twice a day for 12 weeks. The most common clinical findings included epiphora, salivation, vomiting and diarrhea among all the dose groups. Three dogs had decreased activity (1 in each from the 22 mg/kg twice a day, 22 mg/kg three times a day, and the 66 mg/kg three times a day groups). These observations were mild and sporadic. There were increases in alanine aminotransferase (ALT) in the 110 mg/kg three times a day group and in the 22 mg/kg twice a day group that increased in a dose-dependent pattern. There was an increase in sorbitol dehydrogenase (SDH) in the 110 mg/kg three times a day group compared to the controls. These changes were minimal and the values remained within expected historical control ranges. There were several decreases in total protein (in the 110 mg/kg three times a day group) and/or globulin (in the 22, 66, and 110 mg/kg three times a day groups) compared to the controls. These changes resulted in occasional increases in albumin/globulin ratios. Although a drug effect cannot be ruled-out, these changes were not clinically relevant. A mild prolongation in prothrombin time (PT) was observed in the 22 mg/kg three times a day group. This was not considered clinically relevant due to the small change that remained within the reference ranges. One dog in the 110 mg/kg three times a day group had moderate amounts of bilirubinuria at the Week 8 and Week 12 samplings. No clinical significance was noted. Cephalexin was not present in any Day 1 samples prior to dosing or in any control animals. After dosing, cephalexin was well absorbed into systemic circulation of the treated dogs. Within gender and dosage level, Week 8 mean trough concentrations were generally higher than the Week 4 and 12 mean trough concentrations (between a 0.9 and 3.6-fold difference). The geometric mean plasma cephalexin trough concentration following three times daily administration of the 110 mg/kg dose was 11.2 μg/ml compared to 2.6 μg/ml and 8.7 μg/ ml following 22 mg/kg and 66 mg/kg, respectively at Week 12. Geometric mean plasma cephalexin trough concentrations following administration of 22 mg/kg twice daily were 0.7, 1.3, and 1.0 μg/ml at Weeks 4, 8, and 12, respectively. STORAGE INFORMATION: Store at 20 C-25 C (68 F-77 F), with excursions permitted between 15 C-30 C (59 F-86 F). HOW SUPPLIED: RILEXINE (cephalexin) Chewable Tablets are supplied in 75 mg, 150 mg, 300 mg, and 600 mg tablets packaged in bottles of 100 and 500 tablets or boxes of 28 blister-packs, 7 tablets per blister pack. NADA , Approved by FDA. Distributed by: Virbac Animal Health, Inc. Fort Worth, TX USA Revision date: 08/2011 References: 1. Birchard SJ and Sherding RG. Saunders Manual of Small Animal Practice, 2nd edition. W.B. Saunders Co. 2000: p Adams HR. Veterinary Pharmacology and Therapeutics, 8th edition, 2001, p Virbac Corporation. All Rights Reserved. RILEXINE is a registered trademark of Virbac S.A. in the United States and Canada. TREATING DOGS WITH PYODERMA IS NO LONGER SUCH A BITTER HUMAN PILL TO SWALLOW. erinary approved cephalexin makes treating superficial pyoderma feel more like g (cephalexin) The first and only veterinary approved cephalexin makes treating pyoderma feel more like giving a treat. Human generic cephalexin may be your clients first-line choice for secondary superficial bacterial pyoderma, but it s a bitter pill to swallow for their canine patients. RILEXINE Chewable Tablets for Dogs is the first and only FDA-approved cephalexin specifically designed for the veterinary market. This unique alternative combines proven palatability with the efficacy veterinarians have come to expect at a value similar to other veterinary-labeled antibiotics. Plus, it comes in 3 convenient tablet sizes that can be easily scored for more precise dosing. When your clients prescribe RILEXINE Chewable Tablets for Dogs, they generate additional revenue for their clinic and create more sales opportunities for you. Talk to veterinarians about the benefits of RILEXINE Chewable Tablets for Dogs so you both can start earning more revenue today! Visit to learn more. Contraindicated in dogs with a known allergy to penicillins or cephalosporins. For oral use in dogs only. Not for use in humans. Individuals sensitive to penicillins or cephalosporins should avoid contact of the product with the skin and mucous membranes. Do not prescribe in the absence of a proven or strongly suspected bacterial infection. Safety in breeding, pregnant, or lactating bitches has not been evaluated. The most common adverse reactions in dogs include diarrhea, vomiting, anorexia and lethargy. For complete product information refer to the product insert. To obtain a package insert, contact Veterinary Technical Product Support at , or visit Show your clients the benefits of RILEXINE Chewable Tablets for Dogs 2014 Virbac Corporation. All Rights Reserved. RILEXINE is a registered trademark of Virbac S.A. in the US. 10/

46 Pet Insurance demonstrate a new device or piece of equipment that provides clinical benefits, but that might add a thousand dollars or more to the pet owner s bill. In that case, the rep might recommend that the veterinary team talk to their clients about pet insurance. The informed rep makes it a point to know two things about pet insurance, says Elder: 1) the cost to the pet owner of the monthly premium, and 2) how much money pet insurance would save the client for any given procedure. Together, those two things give the veterinarian some leverage to sell the procedure to his or her clients. As technology changes, it will become more and more important to know who s going to help pay for it. I have heard veterinarians say they wish pet insurance would go away, but it clearly is not going to do so, says Cavanaugh. As more companies reach pet owners with their advertising and marketing efforts, I believe there will be significant growth in pet owners carrying pet insurance. I urge veterinarians to become familiar with data related to the impact of insurance on the number of visits and annual spend for pet care and use it is an opportunity to provide the best care possible to their patients. Growing pains Veterinarians aren t the only ones who have questioned the value of pet insurance. Pet owners have questions too, and some insurers haven t helped. A lack of uniformity in policy language led regulators in California to propose a bill in May (AB 2056) that would bring uniformity and transparency to such language. Of It s a win-win-win for the consumer, the Department of Insurance, and pet insurance companies that people understand what their coverage is. Kristen Lynch, NAPHIA Executive Director particular concern were disagreements over the meaning and application of the term pre-existing condition, and lack of clarity about exclusions, coverage limits and usual and customary fees. The bill was signed into law by California Governor Jerry Brown in late September. Most pet insurers as well as the North American Pet Health Insurance Association (NAPHIA) support the bill, believing that transparency will only increase consumers trust in their product. It s a win-win-win for the consumer, the Department of Insurance, and pet insurance companies that people understand what their coverage is, says NAPHIA Executive Director Kristen Lynch. The fact that pet insurance has hit the radar of legislators in a state the size of California speaks to the importance of the product. The legislation also marked a coming of age for the industry, as NAPHIA was instrumental in getting legislators to tone down previous onerous provisions in the bill. We are very supportive of the bill, says Katie Grant, CEO, PetFirst. This legislation is suggesting that we have a uniform approach about how we define a pre-existing condition. Any time the consumer has a better understanding of pet insurance, it s better for the industry as a whole. 46 November/December 2014»» Veterinary advantage

47 HARVEST PRP CELLULAR THERAPY Introducing Harvest SmartPrep System: The Gold Standard Harvest Technologies is the leader in developing point-of-care cellular platforms to isolate and concentrate autologous growth factors, stem cells, and accessory cells that may help optimize conditions for healing. A decade ago, we introduced the Harvest SmartPrep System, making the use of autologous growth factors practical for the first time. Today, the Harvest SmartPrep System platform is the gold standard in PRP technology and is now available for canines. A System To Process Optimal Platelet Concentrate For Natural Healing Call your Terumo representative at or visit and click on Find Your Local Terumo Rep. Learn more at NAVC booth #2203 and WVC booth #326 and TERUMO are trademarks owned by Terumo Corporation, Tokyo, Japan, and they are registered with the U.S. Patent & Trademark Offi ce. HARVEST is a trademark owned by Harvest Technologies Corporation, Plymouth, MA. SMARTPREP is a trademark owned by Harvest Technologies Corporation, Plymouth, MA and is registered with the U.S. Patent & Trademark Offi ce. TMP

48 Pet Insurance Veterinary Pet Insurance Veterinary Pet Insurance, or VPI, issued its first policy in 1982, to TV s Lassie. Since then, the company has grown; in fact, it is now part of the Nationwide family of companies. Today, more than 3,800 employers offer VPI pet insurance to their employees as a voluntary benefit. Recently, VPI has taken steps to redefine itself not just as a pet insurance company, but a financial solutions company, says Carol McConnell, DVM, MBA, vice president and chief veterinary medical officer. and wellness drive consumer behavior. It s good for the pet and good for the practice. For its efforts in wellness, in July 2014, VPI became the American Animal Hospital Association s preferred provider for pet wellness plans. All of this is not to say the company is abandoning its traditional insurance offerings, says McConnell. It s still the focus of what we do day to day. But we feel our job is to support the veterinary industry by being more creative with financial products. We know preventive care and wellness drive consumer behavior. It s good for the pet and good for the practice. In January 2013, the company introduced its Preventive and Wellness Services (P&WS) program, designed to help veterinarians create, promote and administer customized preventive plans for their clients. Such plans let clients spread the cost of preventive care over 12 months. We help practice owners figure out how to build their own wellness plans and how to price them, says McConnell. In addition, VPI trains the practice s staff and even assists with the monthly credit card movement. This past summer, VPI introduced VPI Everyday Care, a program that provides three levels of coverage for pet owners, designed to support the AAHA/AVMA Preventive Healthcare Guidelines. All plan levels also cover diagnostic tests. People want to do the right thing by their pets, says McConnell. We just have to make it affordable. Hence, VPI Everyday Care. We think it s important to help out veterinarians in the preventive care space, she says. We know preventive care Employee benefit One sure sign of the growth of pet insurance is its inclusion in employee benefit packages. As a veterinarian, I tended to think of pet insurance as a veterinary topic, says McConnell. But what is now absolutely clear is that this topic far exceeds the veterinary channel. Employers are looking for novel, attractive benefits to offer employees, and veterinary insurance is becoming a popular one. She attributes the interest in part to society s redefinition of the word family, to include pets. The other driving force has little to do with animals, and more to do with personal finances. Americans will continue to buy things, but it has to be in small, incremental payments, she says. That s why many employees welcome their employer deducting the cost of pet insurance directly from their biweekly paychecks. 48 November/December 2014»» Veterinary advantage

49 Short takes: Veterinary Pet Insurance (VPI) Q: How many pet owners carry one of your policies? A: VPI has more than 500,000 insured pets. VPI is a member of the Nationwide Insurance family of companies. Q: Does your plan reimburse based on actual expenses, or do you pre-determine how much you will reimburse the owner for various conditions? A: A policyholder pays the veterinarian after services are rendered, submits a claim to VPI and then is reimbursed for eligible expenses. Q: Is the owner free to choose any veterinarian, or only those in your network? A: There is no network of doctors. You can visit any licensed veterinarian in the world. Q: Do you have cats-only and dogs-only plans, or is yours a one-size-fits-all program? A: VPI Pet Insurance has several plans. VPI s Major Medical Plan (for dogs and cats) is the company s most comprehensive and popular plan, reimbursing for eligible veterinary expenses such as accidental injuries, emergencies and illnesses, including cancer. Deductibles range from $100 to $500. Maximum policy term benefit for Major Medical is $14,000 per year, and benefits renew annually. The Feline Select Plan (just for cats) offers low-cost coverage for the 15 most common cat conditions and includes no annual deductible, chronic condition coverage, freedom to use any veterinarian, anywhere; benefits that renew in full each year and a maximum annual benefit of $9,000. VPI covers birds and exotic pets. Q: Do you reimburse for pharmaceuticals? A: If medication is prescribed by a veterinarian related to a covered injury or illness, the policyholder pays the veterinarian for the medication, submits a claim to VPI and then is reimbursed for eligible expenses. Q: How about prescription pet food or dietary supplements? A: Special diets, pet foods, or dietary or nutritional supplements are not covered. Q: What is your policy on pre-existing conditions? A: VPI, like all pet insurance carriers, does not cover pre-existing conditions. A pre-existing condition is basically any illness or injury a pet had before coverage started. The good news is, not all preexisting conditions are forever. If a policyholder has medical records from the veterinarian showing that the pet s condition has been cured for at least six months, it may be eligible for coverage. Q: How do you handle/reimburse emergency care? A: A policyholder pays the veterinarian after services are rendered, submits a claim to VPI and then is reimbursed for eligible expenses. Q: How about surgery? A: Policyholder pays the veterinarian after services are rendered, submits a claim to VPI and then is reimbursed for eligible expenses. Q: Do you cover hospital stays? A: A policyholder pays the veterinarian after services are rendered, submits a claim to VPI and then is reimbursed for eligible expenses. Q: How do you handle/reimburse hereditary disorders? A: Like congenital and developmental problems, whether the hereditary disorder is visible or not, VPI does not cover it on most of its plans. The VPI Major Medical Plan offers some coverage for hereditary conditions. Q: How do you handle chronic conditions, such as kidney disease or arthritis? A: VPI does cover kidney disease and arthritis. A policyholder pays the veterinarian after services are rendered, submits a claim to VPI and then is reimbursed for eligible expenses. Q: How about cancer care coverage? A: VPI does cover pet cancer. A policyholder pays the veterinarian after services are rendered, submits a claim to VPI and then is reimbursed for eligible expenses. Q: How do you handle preventive care? A: VPI offers Pet Wellness Plans. Veterinary advantage ««November/December

50 Pet Insurance Embrace Pet Insurance Cleveland, Ohio-based Embrace was founded in 2003 by Laura Bennett and Alex Krooglik after they graduated from the University of Pennsylvania Wharton School MBA program. The two were part of the pet insurance team that won the Wharton Business Plan Competition. They sold their first policy in October 2006; it covered Bennett s newly adopted cat, Lily. Today, the company has more than 30,000 policies, with more than 40,000 pets covered. Five years ago, Embrace introduced its Wellness Rewards coverage, which behaves much like a flexible savings account in the human world, says Bennett. The plan covers The point is not to discourage submitting claims. It s to encourage those with currently healthy pets to keep their insurance so that when they need it at some point in the future, they will have their Embrace policy to protect them financially. anything from spay/neuter surgery and routine visits and vaccinations, to PennHip X-rays and prescription diet foods, with no sub-limits, deductibles or waiting periods, she says. More recently, the company expanded all wellness coverage to both levels ($200 and $400 annual benefit), and now includes teeth cleaning; and routine chiropractic, acupuncture, and massage therapy treatments. Among the most recent changes to the Embrace offering is an increase in age limits (up to 14 years old for all pets), a reduced waiting period for accidents from 14 days to two days, and the elimination of lifetime payment restrictions. The company also eliminated coverage restrictions for intra-household fights. We are always taking client feedback into consideration as well, says Bennett. This has led us to expand our dental coverage in our accident and illness plan to include coverage of FORLs [feline tooth resorptions] or illnesses Laura Bennett manifesting as oral diseases, such as FELV [feline leukemia virus], gingivitis, feline bartonella infection, or auto-immune (eosinophilic) stomatitis. In 2013, Embraced added its Healthy Pet Deductible feature, which decreases the pet s annual deductible $50 each year the pet is claim-free. (Wellness Rewards payments don t count for this benefit.) The point is not to discourage submitting claims, says Bennett. It s to encourage those with currently healthy pets to keep their insurance so that when they need it at some point in the future, they will have their Embrace policy to protect them financially. Embrace prides itself on its transparency, and stands behind recent legislation in California to bring uniformity to pet-insurance-policy language, including verbiage regarding pre-existing conditions, says Bennett. The company offers a 30-day, money-back guarantee after enrollment if the pet parent is not 100 percent satisfied with its coverage. We conduct medical history reviews for any pet parent concerned about the impact of their pet s prior health conditions on their coverage, she says. We share with the pet parent in writing any conditions that the pet may have had that could affect coverage. Awareness Veterinary medicine continues to advance, and people are spending more and more on their four-legged family members, says Bennett. Embrace expects veterinary hospitals to see increases in hospital finances as more pets become insured due to owner compliance, and increased spending. This will allow hospitals to practice better and progressive medicine. Incorporating pet insurance as commonly as flea/tick and heartworm medications, vaccine protocol and the importance of spaying and neutering, is very important, she continues. Some veterinarians are still wary of pet insurance, but Embrace covered 91 percent of accident & illness claims in That s a pedigree we are proud of. 50 November/December 2014»» Veterinary advantage

51 SponSorS SponSorS ponsors platinum platinum platinum SponSorS PLATINUM GOld SponSorS GOld GOld platinum GOLD Silver platinum platinum GOld SponSorS Silver Silver GOld GOld Silver bronze We are people protection. Silver Silver SILVER bronze bronze bronze bronze bronze BRONZE

52 Pet Insurance Short takes: Embrace Pet Insurance Q: How many pet owners carry one of your policies? A: Over 30,000 policies, with more than 40,000 pets covered. Q: Does your plan reimburse based on actual expenses, or do you pre-determine how much you will reimburse the owner for various conditions? A: Embrace reimburses a straight percentage of the veterinary bill (70 percent, 80 percent or 90 percent) and allows the pet parent to choose that percentage. Q: Is the owner free to choose any veterinarian, or only those in your network? A: Pet parents can choose any veterinarian, and are also covered while they are traveling with their pet outside of the United States. Q: Do you have cats-only and dogs-only plans, or is yours a one-size-fits-all program? A: We offer one comprehensive accident and illness plan for cats and dogs. There are no tiers or levels. Both cat and dog owners can personalize the coverage levels to meet their own needs. Q: Do you reimburse for pharmaceuticals? A: Take-home medications are covered under our Prescription Drug Coverage, which is included in all plans. (The pet owner can opt out of this coverage, however.) Medications administered in the veterinary hospital are covered under our base accident and illness plan. Q: How about prescription pet food or dietary supplements? A: Prescription diets are covered up to $200 or $400 annually under our Wellness Rewards program. Embrace does not currently cover dietary supplements that are not FDA-approved. Q: What is your policy on pre-existing conditions? A: We do not cover pre-existing conditions. However, Embrace distinguishes between curable and incurable conditions. In order for a condition to be considered curable, the pet must remain symptom- and treatment-free for 12 consecutive months. If a pet parent has any question as to whether a condition is considered curable, incurable or pre-existing, they can always request a Medical History Review, in which we will document their pet s specific coverage in writing. Q: How do you handle/reimburse emergency care? A: Emergency care is handled in the same fashion as any accident or illness claim, with the straight percentage reimbursement chosen by the client. Q: How about surgery? A: Embrace reimburses surgery with a straight percentage reimbursement chosen by the client. Q: Do you cover hospital stays? A: Hospital stays related to accidents and/or illness are covered standard under the Embrace plan. Q: How do you handle/reimburse hereditary disorders? A: All Embrace policies cover hereditary disorders as long as the pet has not been diagnosed or been symptomatic of the disorder prior to policy enrollment. They are reimbursed the straight percentage chosen by the client at enrollment. Q: How do you handle chronic conditions, such as kidney disease or arthritis? A: Chronic conditions are reimbursed the straight percentage chosen by the client up to the annual maximum each year as long as the condition is not pre-existing. With Embrace, chronic conditions do not become pre-existing at renewal. Q: How about cancer care coverage? A: The diagnosis and treatment of cancer is covered standard in the Embrace plan. We reimburse the straight percentage chosen by the client for the diagnosis and treatment, as long as cancer is not a pre-existing condition. Q: How do you handle preventive care? A: Embrace offers two options for preventative care with our Wellness Rewards Program, which act similar to a health savings account. We do not specify line item amounts, such as $30 for office visit or $25 for flea/tick meds. Rather, we reimburse 100 percent of wellness items up to the particular wellness plan s limit of $200 or $400. Clients can spend their Wellness Rewards on multiple items, such as exams and vaccines, or on one service, such as spaying or neutering or teeth cleaning. 52 November/December 2014»» Veterinary advantage

53 Pets Best Insurance Services Pet insurance coverage offered and administered by Pets Best Insurance Services, LLC, is underwritten by Independence American Insurance Company, a Delaware insurance company. The company s plans cover accidents and illnesses, but policyholders can add BestWellness optional coverage for routine care coverage with no deductible for an additional premium. The company was founded by Dr. Jack L. Stephens, who actually founded pet insurance VPI in the United States in Before I started pet insurance, I had five practices in Southern California, recalls Stephens. As a veterinarian, I took pride in delivering high-quality care, but I couldn t afford all the new equipment and diagnostics and drugs on my own income. So he ended up buying equipment he couldn t really afford, something many veterinarians continue to do today, he says. At one point, I applied to and was accepted into medical school and was considering leaving veterinary medicine out of frustration. And that s when I started pet insurance. The Pets Best program has grown since its inception in 2005, in terms of policyholders and coverage offerings. Evolution A little over a year ago, we started covering heredity and congenital conditions, says President Chris Middleton. And we introduced a plan for the 20 most expensive feline conditions, which is still very affordable. We have a cancer-only plan, which is a very affordable option. We have significantly added flexibility, allowing pet owners to customize their plans. For example, owners can decide how much of the veterinarian bill they want reimbursed, and how much they want to pay out of pocket. In September 2014, Farmers Insurance and Pets Best joined forces, so that pet owners who purchase a Pets Best policy after referral from a Farmers agent or from the Farmers website receive a 5 percent discount off the regular price. The agreement speaks to a couple of things, says Middleton. Pet insurance allows veterinarians to do more than treat symptoms; it allows them to dig deeper with better diagnostics and then provide better care. Not everyone can afford MRIs for their pets, Stephens says. But with insurance, it is affordable. Farmers didn t make this decision on a whim, he says. The company is data-driven. Farmers spent a lot of time talking to policyholders about what type of additional coverage they would like to see. Farmers found a strong interest in pet insurance. We see that interest in other areas too, says Middleton. For example, employees are asking their employers to provide an option for pet health insurance. In general, this is driven by consumer interest in pet insurance. Veterinary advantage ««November/December

54 Pet Insurance Challenges remain Overall, the company expects continued growth in the future. But there will be challenges. The economy is always a challenge, says Middleton. We see some correlation between consumer confidence and our business. It s true that the most recent recession probably kept some pet owners from purchasing pet insurance, he says, but it s also true that others purchased coverage because they didn t want to see an important part of the family without it. Meanwhile, veterinarians themselves are more accepting of pet insurance than ever, says Middleton. The data indicates that more and more veterinarians are starting to view insurance as a positive thing. True, they want to make sure pet insurance doesn t go in anywhere near the same direction as human medical insurance, which has had a detrimental impact on reimbursement and revenues. And veterinarians The data indicates that more and more veterinarians are starting to view insurance as a positive thing. Chris Middleton are cautious about which insurers they recommend to their patients. After all, they don t want their clients to have a bad experience with an insurer whom they recommended, he says. But the data shows that pet owners with insured pets generate more money for their veterinarians than those who don t have pet health insurance, he continues. They visit their veterinarian more frequently, and they allow their veterinarian to provide higher levels of care. Slowly, the veterinary industry will become aware of the positive effect of insured pets on practice income and profitability, adds Stephens. Pet insurance allows veterinarians to do more than treat symptoms; it allows them to dig deeper with better diagnostics and then provide better care. Not everyone can afford MRIs for their pets, he says. But with insurance, it is affordable. Short takes: Pets Best Insurance Services, LLC Q: How many pet owners carry one of your policies? A: Pets Best provides insurance to more than 63,000 pets. Q: Does your plan reimburse based on actual expenses, or do you pre-determine how much you will reimburse the owner for various conditions? A: Pets Best provides reimbursements based on the actual cost of treatment. Q: Is the owner free to choose any veterinarian, or only those in your network? A: Pets Best policyholders are able to visit any licensed veterinarian in the world. Q: Do you have cats-only and dogs-only plans, or is yours a one-size-fits-all program? A: Pet owners have varying budgets and coverage needs for different stages of their pets lives, so we don t believe that one pet insurance plan will fit all pet owners. Our plans are: BestBenefit plans, available to dogs and cats. Accident Only plans, available to dogs and cats. Cancer Only plans, available to dogs and cats. Feline Illness plans, only for cats. BestWellness, available to dogs and cats (and can be added to any of the four plans above). Q: Do you reimburse for pharmaceuticals? A: Yes. Pets Best provides 70, 80, 90 or 100 percent reimbursement based on the actual cost. Clients choose the reimbursement level for their plan when they enroll. This is included at no additional cost. 54 November/December 2014»» Veterinary advantage

55 Q: How about prescription pet food or dietary supplements? A: Pets Best does not offer coverage for prescription pet food or dietary supplements. Q: What is your policy on pre-existing conditions? A: If a pre-existing condition becomes cured at any time, then it is automatically eligible for coverage if it should reoccur. If a condition is manifested or present prior to coverage, including the waiting period, then it is ineligible for coverage. Q: How do you handle/reimburse emergency care? A: Pets Best provides 70, 80, 90 or 100 percent reimbursement based on the actual cost. Clients choose the reimbursement level for their plans when they enroll. We don t reduce coverage for emergency care. Q: How about surgery? A: Pets Best provides 70, 80, 90 or 100 percent reimbursement based on the actual cost. Clients choose the reimbursement level for their plans when they enroll. We don t reduce coverage for surgeries. Q: Do you cover hospital stays? A: Yes. Pets Best provides 70, 80, 90 or 100 percent reimbursement based on the actual cost. Clients choose the reimbursement level for their plan when they enroll. We don t reduce coverage for hospital stays. Q: How do you handle/reimburse hereditary disorders? A: Pets Best provides 70, 80, 90 or 100 percent reimbursement based on the actual cost. Clients choose the reimbursement level for their plans when they enroll. Q: How do you handle chronic conditions, such as kidney disease or arthritis? A: Pets Best provides 70, 80, 90 or 100 percent reimbursement based on the actual cost. Clients choose the reimbursement level for their plans when they enroll. Q: How about cancer care coverage? A: Pets Best provides 70, 80, 90 or 100 percent reimbursement based on the actual cost. Clients choose the reimbursement level for their plans when they enroll. Q: How do you handle preventive care? A: Pets Best offers the optional BestWellness plan to cover preventative care. Best Wellness can be added on to any of our plans. There is no deductible or co-pay. The plan covers up to $505 in annual benefits for dogs and up to $565 in annual benefits for cats. Success Breeds Success Pet owners want the best from their vets. You help make it possible. So do we. Pet insurance drives better care and more advanced treatments, making veterinary medicine stronger and helping pets live longer, healthier lives. Get to Know Pet Health Insurance NORTH AMERICAN PET HEALTH INSURANCE ASSOCIATION The North American Pet Health Insurance Association (NAPHIA) members now provide pet health insurance coverage to more than 1 million pets across North America. When we succeed, you succeed.

56 »» Sales Meeting Taking it Digital Intraoral digital radiography means better patient care and potentially greater practice revenue. More and more veterinary practices have adopted digital dental radiography to better care for their patients and maintain a solid foothold in an increasingly competitive market. The equipment calls for an upfront investment on the veterinarian s part, but the return on investment reportedly can be recouped in as little as six months. Taking it digital may also be the most expedient way to adhere to AAHA dental care guidelines. Digital software enables the user to view the image within three to five seconds. In addition, he or she can enlarge the image and apply enhancing features, which may allow the veterinarian to better diagnose pathology, or rule it out. This is not possible using a film-based system. According to AAHA guidelines, radiographs of the entire mouth are necessary to accurately evaluate and diagnose patients undergoing dental procedures. It s considered important to radiograph discolored, fractured, missing, worn and deciduous (baby) teeth, as well as obtain post extraction radiographs. Offering this service not only helps veterinarians provide cutting-edge care for their patients, it can help offset the drop-off of traditional sources of revenue. For instance, as more vaccines have a longer duration of immunity, veterinarians sometimes find themselves providing fewer of them. Similarly, at one time small animal practices provided four or five spays and neuters on a daily basis, but with the rise of low cost spay/neuter clinics, it s becoming common for them to do one or two a week. The how and why There are two different types of digital intraoral receptors: direct radiology (DR) and computed radiology (CR). Direct radiology systems are rigid sensors usually offered in sizes 1 and 2 that plug directly into a laptop or desktop computer. The image appears within three to five seconds of acquisition. Computed radiology technology offers various sizes of phosphor plates, ranging from size 0-4. They are used in the mouth like film and then fed into a laser reader to become digitalized. Digital dental radiography is said to offer a number of advantages over film-based X-ray. First, digital systems can save the practice time. Patients need to be anesthetized in order to complete a thorough oral assessment, X-rays and cleaning. Having to process film prolongs anesthesia time, even when retakes are not necessary. Digital software enables the user to view the image within three to five seconds. In addition, he or she can enlarge the image and apply enhancing features, which may allow the veterinarian to better diagnose pathology, or rule it out. This is not possible using a film-based system. 56 November/December 2014»» Veterinary advantage

57 Earn Big Bucks in Q Earn big incentives when you place these IDEXX instruments during Q4 2014: Up to $1,000* Up to $600* IDEXX Catalyst Dx Chemistry Analyzer IDEXX Catalyst One Chemistry Analyzer IDEXX ProCyte Dx Hematology Analyzer IDEXX LaserCyte Dx Hematology Analyzer Visit idexxdxportal.com for details about this limited-time incentive program. *Visit idexxdxportal.com for details about this limited-time incentive program. Refer to each company s green sheets for exact incentive IDEXX Laboratories, Inc. All rights reserved All /TM marks are owned by IDEXX Laboratories, Inc. or its affi liates in the United States and/or other countries. The IDEXX Privacy Policy is available at idexx.com.

58 »» Sales Meeting Since approximately 80 percent of all patients seen in small animal practices present some form of periodontal disease, every clinic performing proper anesthetic dental cleanings can benefit from having digital dental radiography. Some digital dental imaging software can be integrated with practice management software, eliminating the need for patient data entry and potential data entry errors. DICOM dental images can be stored and moved into the clinic s full-body digital picture archiving communication system, allowing all digital images to be stored in one central location. Notes can be added to digital images and printed out for the pet owners to see, a feature that increases the perception of value of the procedure. Additionally, film-based systems require a chairside developer or a small automatic processor, as well as fixer and developer, which need to be changed frequently. There are reoccurring costs associated with using film, and film storage might present an issue. Today, more veterinarians recommend dental procedures on patients with Stage 1 periodontal disease, when gingivitis can be reversed. (Anything beyond this stage is irreversible.) Different clinics follow different protocols to determine how frequently a patient s mouth should be radiographed. Certain breeds are prone to periodontal disease and may need periodontal therapy and radiographs every six months, whereas other breeds can go much longer. That said, any dental procedure should include dental X-rays. Since approximately 80 percent of all patients seen in small animal practices present some form of periodontal disease, every clinic performing proper anesthetic dental cleanings can benefit from having digital dental radiography. At the same time, veterinarians and their staff should be vigilant about educating their clients about the effects of periodontal disease, and recommending necessary procedures. Being proactive can help ensure they will recover their investment in the equipment more quickly. How to sell Distributor sales reps can approach their veterinarian accounts with several probing questions, such as the following, to help them initiate a discussion about the value of adding intraoral digital radiography and to gauge their need: Doctor, what percentage of your total practice revenue comes from dentistry? What are some of the reasons you have not yet considered investing in dental radiology? When you initially invested in an intraoral X-ray generator, what made you decide to go with film over digital? What is your current protocol for the prevention and treatment of periodontal disease? For clinics currently using a film base setup, ask, Do you feel you have gotten your return on investment? Are you acquiring full-mouth radiographs on all of your patients? If not, why? Do you think if you invested in digital dental radiography you would be able to interpret radiographs better? Would you take more radiographs? Would your procedures take less time? 58 November/December 2014»» Veterinary advantage

59 Price is often a big deterrent to converting veterinarians from film-based X-ray to digital radiography. While veterinarians generally understand that going digital will significantly reduce the length of anesthesia time for their patients, the digital portion of dental radiography is almost twice the cost of a generator. Their initial fear is: What if we don t use the equipment as much as we think we will? What will our return on investment be? How can we be sure this piece of equipment will pay for itself? Will our clients pay for X-rays? What should we charge? A stand-alone sensor retails for $9,000 to $12,000. A complete setup (including an intraoral x-ray generator and a digital sensor or phosphor plate system) retails for $12,000 to $18,000, depending on the manufacturer. That said, the practice only requires a laptop or existing desktop computer to get started, and continuing costs for digital dental are minimal compared with film-based systems. And, often financing can be arranged. Because there is a learning curve with dental radiology, it is important for the clinic to work through a company that offers clinical training for the staff. However, the clinic can recover its investment within six months to a year simply by treating the pathology uncovered by the digital dental radiography. And, once the initial investment is recouped, the clinic should continue to reap the benefits of the equipment for as long as it practices dentistry, both from a patient care and a practice growth perspective. Whether veterinary clinics switch from film to digital, or they need a complete setup (including the X-ray generator), it is important that they develop a standard of care focused on dentistry and ensure the entire staff is aware of and on board with it. In addition, they should educate clients about the importance of treatment and prevention of periodontal disease. Editor s note: Veterinary Advantage Magazine would like to thank Midmark Animal Health for its assistance with this piece. Bovie Medical Corporation 5115 Ulmerton Road Clearwater, FL U.S. Phone Fax sales@boviemed.com Veterinary advantage ««November/December

60 »» Trends Cats: No longer silent sufferers AAFP Conference focuses on gastroenterology and endocrinology Not a day goes by that a feline practitioner doesn t see at least one cat that is vomiting, polydipsic or losing weight, says Heide L. G. Meier, DVM DABVP (Canine/Feline), Truesdell Animal Care Hospital, Madison, Wisc. So it was fitting that feline gastroenterology and endocrinology were the themes of the recent annual American Association of Feline Practitioners Conference in Indianapolis, Ind. More than 850 feline veterinary professionals and others from around the globe converged for four days and shared the latest research, exchanged ideas, and formulated plans on how to elevate the level of feline healthcare worldwide, according to organizers. The 2014 Conference Task Force chose gastroenterology and endocrinology because cats frequently suffer from diseases affecting these organ systems, says Meier, who served as chair of the 2014 AAFP Annual Conference planning task force. A lot of research has been performed in these fields in recent years, new treatments discovered, and cats with gastrointestinal and endocrine disease have a better prognosis. We wanted to share this new knowledge with our members. Among the topics covered at the conference: New data on small bowel and chronic gastrointestinal disease. Feline constipation and pancreatitis. Feline hyperthyroidism. Unique feline hepatic syndromes and liver disease. Understanding and management of feline diabetes. Benefits of the AAFP s Cat Friendly Practice (CFP) designation. Speakers included: Dr. Sharon Center, James Law Professor of Medicine, Cornell University. 60 November/December 2014»» Veterinary advantage

61 Body Suit for Affordable! Dogs & Cats Introducing the new soft and comfortable BUSTER Body Suit for protection and comfort after surgery or in case of skin disease. It is an ideal solution for patients recovering from surgery or minor injuries or with tender areas caused by excessive licking, biting or chewing. BUSTER Body Suit is Perfect for Post operative care Wound care Spay/neuter recovery Hot spots and other skin ailments BUSTER Body Suit Advantages Comfortable, soft and flexible Freedom of movement Easy fitting and removal Double fabric under the belly enabling pads to be inserted in case of fluid loss, incontinence or when the animal is in season Press studs for more security Made from cotton/elastane

62 »» Trends Dr. Audrey Cook, Associate Professor in Small Animal Medicine, Texas A&M University. Dr. Robin Downing, The Downing Center of Pain Management. Dr. Michael Lappin, Professor of Small Animal Internal Medicine, Colorado State University. Dr. Susan Little, Professor and Krull-Ewing Chair in Veterinary Parasitology, Oklahoma State University. Heather Lynch, Tatum Point Animal Hospital. Dr. Gary Norsworthy, Alamo Feline Health Center, San Antonio, Texas. Dr. Mark Peterson, Animal Endocrine Clinic, New York, N.Y. Paula Plummer, Veterinary Technician. Jane Robertson, IDEXX Laboratories. Dr. Catherine Scott-Moncrieff, Professor of Small Animal Internal Medicine, Purdue University. Dr. Kenneth Simpson, Professor of Small Animal Medicine, Cornell University. Dr. Craig Webb, Associate Professor and Head of Small Animal Medicine Section, Colorado State University. Cats stock going up The value of cats as a companion species has appreciated greatly, says Meier. Historically, cats have been silent sufferers of illness. Now, veterinarians are learning to read their clinical signs and diagnose their conditions earlier when treatment has a better prognosis. Some examples: Pancreatitis seems almost ubiquitous in the feline population today, says Meier. While we do not fully understand the pathogenesis of this disorder, supportive care during acute episodes and prevention of progressive inflammation are extremely important. Concurrent inflammatory bowel and liver disease are extremely common. Hepatic lipidosis is a severe metabolic disorder secondary to another primary disease, explains Meier. In the past, it carried a grave prognosis, but research has identified vitamin, fluid, electrolyte, and nutritional therapies that give cats a better chance of survival. Identification and treatment of the primary disease is also a key to successful outcome. Diabetes mellitus is a common, debilitating, and costly disorder in cats, she says. Client education on optimum nutrition and prevention of obesity early in a cat s life may reduce the incidence of this disorder. Most cats initially develop type II diabetes but eventually become insulin dependent. Concurrent illness often causes insulin resistance and needs to be indentified and treated to successfully manage diabetes. Hyperthyroidism can mask chronic kidney disease as well as contribute to it, she says. Cats that become azotemic after treatment for hyperthyroidism have the same survival time as those that remain nonazotemic. However, iatrogenic hypothyroidism following I-131 [radioactive iodine] therapy or surgical thyroidectomy may cause significant worsening of azotemia. Temporary supplementation with levothyroxine may benefit these patients. Idiopathic hypercalcemia is the most common type of hypercalcemia in cats, so this syndrome should be a future focus of research for veterinarians, says Meier. Other known causes of hypercalcemia that need to be investigated are malignancy, primary hyperparathyroidism, renal secondary hyperparathyroidism, and hypervitaminosis D. Dietary therapy, glucocorticoids, and biphosphonates are currently used to reduce the calcium level in cats with idiopathic hypercalcemia. The AAFP s 2015 World Feline Veterinary Conference is scheduled for October 1-4 in San Diego, Calif., at the Manchester Grand Hyatt Hotel. Topics will include sessions on feline diagnostic imaging and oncology. 62 November/December 2014»» Veterinary advantage

63 Dollars & SenseTM a program designed with you in mind Become an A-LIST CUSTOMER to earn even better rebates! You like extra cash. You like the quality and efficacy of Boehringer Ingelheim Vetmedica, Inc. (BIVI) pet vaccines and pharmaceuticals. And you d love to manage your inventory to your clinic s needs. That s why the Dollars & Sense program makes perfect sense for your business. And you can earn DOUBLE rebates when you become an A-List customer! To reach A-List status, simply do one of the following between September 1 and December 31, 2014: 1. Purchase 8 or more trays of ULTRA Duramune and/or ULTRA Fel-O-Vax. OR 2. Purchase 4 or more trays of 1 ml canine vaccines AND 4 or more trays of 1 ml and/or 0.5 ml feline vaccines. Remember, each feline 50-dose tray counts as TWO trays! Canine or Feline Vaccines 1 ml ULTRA Duramune /ULTRA Fel-O-Vax 0.5 ml Vaccines Metacam (meloxicam) Purchase Level Rebate % A-List Customer Purchase Level A-List Rebate % Purchase Level Rebate % Customer A-List Customer $1,250 4% 8% $450 4% $450 4% $2,500 5% 10% $1,000 4% 8% $1,000 5% 10% $4,500 7% 15% $2,000 6% 12% $2,000 7% 15% Program Terms All BIVI pet vaccines (except Antivenin) and METACAM are included in the rebate program. Rebates will be paid to clinics based on distributor purchases. Checks will be sent approximately 8 weeks after program conclusion. Products must ship during promotion period to count toward volume and earn rebates. The BIVI Dollars & Sense program is available only to practicing veterinarians with valid veterinary-client-patient relationships. Rebate earned must be greater than $40 to qualify for payment dose tanks of a qualifying products count as one tray toward meeting A-List requirements. Rabvac and ULTRA Duramune vaccines do NOT count toward A-List qualifier for the 1 ml canine and 1 ml feline requirement. BIVI reserves the right to amend this promotion at any time. Visit BIVIDollarsAndSense.com for details and qualifying products. Contact your BIVI sales representative or call All trademarks are the property of Boehringer Ingelheim Vetmedica, Inc. or are licensed to Boehringer Ingelheim Vetmedica, Inc. by Boehringer Ingelheim Vetmedica GmbH Boehringer Ingelheim Vetmedica, Inc. BI

64 »» Sales Meeting Chemistry Analyzers In-house chemistry testing provides reliable diagnostic answers in just minutes, instead of waiting 24 hours or more for outside lab results. Ask your customers if they have ever had their clients comment on how wonderful it is to receive their pet s bloodwork results in minutes. As opposed to when they visit their physicians, where they may receive a call, a recording or post card from the nurse (not the doctor) a week after the appointment, that the bloodwork is normal or abnormal. 64 November/December 2014»» Veterinary advantage

65 The Vet-Advantage Price Index Helping Veterinarians Optimize Retail Pricing This app helps animal hospitals properly price their retail products and recapture important, high margin business that may have been lost to online retailers and big box stores. It allows users to: Evaluate pricing strategy and find the optimum price points Look at historical pricing data on the largest retail SKUs Set margins or margin dollars with a built-in calculator Improve retailing practices with weekly tips on best practices This app takes the guesswork out of the retail business so vets can stay in the game and better manage this part of their business. It can be found in the Apple App Store at a price of $25. Vet-Advantage takes no role in establishing any of these prices and the information is representative of the market only as a reflection of products that are available in publicly published Internet pricing. Volume discounts from certain sources may/may not be represented depending on how such discounts are presented to search engines used to gather consumer pricing. Now available at the app store

66 »» Sales Meeting Your Opportunity Commissions on $6,000 to $19,995 capital equipment purchases. More importantly, customers will continue ordering reagents needed for running patient tests, which for a busy practice will far exceed the capital equipment purchase. Equipment overview To save precious time when a patient is ill, injured or being prepared for surgery, more and more practices are using in-house lab testing. Testing in-house increases client convenience and compliance. With results in minutes during their scheduled appointment, clients can leave with their treatment and medications, rather than having to schedule a follow-up or return to the practice to pick up a prescription or order it There are many disorders that can go unnoticed during a physical exam that can only be diagnosed through blood chemistries. elsewhere. And, when armed with more information about their animal s condition, owners likely will follow through with recommended treatment plans, ultimately providing vets with more business. The importance of the pre-anesthetic protocol Many practices have a mandatory testing policy based on the patient s age or medical history. If the practice has a mandatory pre-anesthetic policy, it is very difficult to send that bloodwork out to the reference lab for next-day results. The pre-anesthetic policy should be in place on patients of all ages. Being young does not guarantee a safe anesthetic procedure. There are many disorders that can go unnoticed during a physical exam that can only be diagnosed through blood chemistries. Undetected disorders may lead to an anesthetic death, which is a phone call no veterinarian would ever want to make to a client. Also keep in mind that if there is ever a need for an anesthetic procedure, one major aspect of the presurgical physical exam is family history. Since the patient cannot talk, pre-anesthetic blood work becomes very important. A complete pre-surgical workup should always include a full chemistry panel, a complete CBC and Electrolytes. The chemistry analyzer serves as the in-house lab HUB because of the critical data it provides. Chemistry analyzers help veterinarians quickly assess emergency cases, conduct wellness tests to establish a baseline and measure any changes, as well as identify potential risks prior to surgeries/anesthesia. Today s chemistry analyzers offer broad test menus allowing the practice to quickly screen for kidney, liver, pancreatic and many other metabolic diseases. In fact, nearly every chemistry test sent to the outside lab can be run on an in-house chemistry analyzer. These include Blood chemistry tests, electrolytes, urine-protein, creatinine ratios and T4 (Thyroid). Prospects likely to buy the latest chemistry analyzers Any animal practice, animal hospital or animal-related corporation will benefit from a chemistry analyzer. Customers will consider switching to a new or different chemistry analyzer when you show: It s easier and much faster to run tests, and easier and faster to interpret the results. It provides more information for confident decisionmaking, even with complex cases. It complements their work flow and increases staff efficiency. Clinics no longer have to worry about pick up times for samples to go to outside labs, or those samples being compromised. Clinic clues for quality leads When you re visiting a veterinary hospital, look for chemistry analyzers that are outdated or that use older test panels or procedures. Or, see if the staff is waiting for a turn at the chemistry analyzer. Of course, if you don t see a chemistry analyzer or other lab equipment, you ll want to discuss the benefits of inhouse testing with the practice. 66 November/December 2014»» Veterinary advantage

67 Approaching the sales discussion Check-off (qualify): If you re not sure if the practice has an in-house system, establish your direction by asking, Have you recently considered obtaining or upgrading an in-house chemistry analyzer? Confidence: If YES, confirm and support benefits. If NO, assert the benefits with confidence. I m sure chemistry analyzers improve point-of-care decisions and generate incremental revenue. The FIRST oral chew to deliver up to 12 full weeks of flea and tick protection in a single dose 1 * Invitation to neutral: Let s look at wellness and pre-anesthetic testing benefits for your practice. Seek alignment/understanding as the dialogue continues: Can you help me understand How old is your analyzer? What do you like and/or dislike about your chemistry analyzer? What tests do you currently run on it? Does it give you everything you need? Do you require pre-anesthetic or wellness blood testing to reduce risks in your patients? What would greater automation and a computer system interface mean to your practice? How much are you currently paying per month/quarter for Extended Maintenance Agreements? How long have you owned your current analyzers? Are you currently making monthly lease payments? If so, what is your monthly payment and how long do you have left in your current lease? Tell me about your past experiences with service after the sale. When a practice buys a piece of capital equipment from a distribution sales representative, there is an added layer of protection given the importance of the daily relationship across the practice. They can also push to make sure problems are handled quickly if the manufacturer isn t responsive. It s the customer s decision You can decide if this analyzer will help you provide better care and a more favorable financial outcome. Maximizespetownercompliancewhile reducingprotectiongapsthatcanoccur withmonthlyremedies. 4 Bravectopreventsfleainfestations,and justoneeasytoadministerdosecan treatmostfleainfestations. 1 WithBravecto,ticksonthedogare killedwithoutengorgementwhichhelps toreducetheriskofexposuretothe diseasesticksmaycarry. 2 *Bravectokillsfleas,preventsfleainfestations,andkillsticks (blackleggedtick,americandogtick,andbrowndogtick) for12weeks.bravectoalsokillslonestarticksfor8weeks. References: 1.Bravecto[prescribinginformation]. Summit,NJ:MerckAnimalHealth; Dataonfile. MerckAnimalHealth,Summit,NJ GasselM, WolfC,NoackS,WilliamsH,IlgT.Thenovelisoxazoline ectoparasiticidefluralaner:selectiveinhibitionof arthropodg-aminobutyricacid-andl-glutamate-gated chloridechannelsandinsecticidal/acaricidalactivity. InsectBiochemMolBiol.2014;45: KiddL, BreitschwerdtEB.Transmissiontimesandprevention oftick-bornediseasesindogs.compendcontineduc PractVet.2003;(25)10: week duration LeSSenS gaps In protection ThaT may occur with monthly TReaTmenTS 4* IMPORTANT SAFETY INFORMATION: The most common adverse reactions recorded in clinical trials were vomiting, decreased appetite, diarrhea, lethargy, polydipsia, and flatulence. Bravecto has not been shown to be effective for 12-weeks duration in puppies less than 6 months of age. Bravecto is not effective against lone star ticks beyond 8 weeks of dosing. Please see Brief Summary on page Copyright 2014 Intervet Inc., a subsidiary of Merck & Co., Inc. All rights reserved. Intervet Inc. d/b/a Merck Animal Health, Summit, NJ US/BRV/0514/0025 To learn more about Breakthrough BRAVECTO, visit

68 »» equine By Jennifer Ryan Aging Gracefully Today s senior horses can continue to compete with additional veterinary care and proper nutrition A horse is only as old as he feels. Preparing for and managing a horse s golden years can help ensure an animal feels, looks and even performs his best. A senior horse is more about a physiological state rather than a chronological state, says Kathy Williamson, DVM, manager of veterinary services at Purina Animal Nutrition. I ve seen horses that I d categorize as senior that are 7 to 10 years old. Then, others that are 20-plus years old that are perfectly normal. It has more to do with their particular conditions. Veterinary care of those particular conditions is one way senior horses can thrive well into advanced age. A senior horse healthcare program will often include additional exams each year to diagnose and treat problems earlier; alterations in nutritional recommendations; additional dental exams; changes in vaccination schedules; and even a change in deworming programs. Getting older is not the same as retiring. For active horses, aging may mean more veterinary care, not less, to keep horses in the best shape possible. Dental conditions One of the main concerns with senior horses is their teeth, Dr. Williamson says. Significant dental issues can cause weight loss due to an inability to chew food properly. Owners may see the horse being frustrated with their inability to chew what is being offered, because they are hungry or not finding the diet fulfilling, she says. It s important to provide rations formulated for senior horses and their changing dental status. These diets may be easier to chew or made into a mash. Ideally, veterinarians would examine a senior horse for dental changes every six months. More frequent exams can help keep horses eating well. It s actually easier to manage horses with more frequent visits as opposed to letting them go for quite a while and making many corrections at one time, Dr. Williamson says. When you see your horse start to lose muscle condition or mass, and he just doesn t look as good in the spring as he did in the summer, the horse has now told you he has become a senior horse. Roy Johnson, equine technology manager for Cargill Animal Nutrition s Nutrena brand Joint health Even if a horse wasn t performing or working strenuously, normal wear and tear can have adverse effects on joints over time. That s why it s important for a veterinarian to regularly assess a senior horse for lameness so diagnosis and treatment can begin immediately, Dr. Williamson says. Older horses may have some joint health problems, and those horses tend to see more of a shift in behavior as a result of dealing with the pain, she says. Once you alleviate the problem with pain relief, horses can improve tremendously. Horses with joint problems often begin to display a lack of enthusiasm for their typical activities or an inability to complete routine exercises due to pain. Endocrine disease Horses with endocrine disorders like pituitary pars intermedia dysfunction (PPID), or equine Cushing s Disease, have been diagnosed as young as 7 to 8 years old. Yet, the disorder may still classify them as senior due to the additional monitoring necessary. It s estimated that up to 30 percent of horses over the age of 15 have some degree of endocrine dysfunction, says John Tuttle, DVM, senior associate director of equine professional services with Boehringer Ingelheim Vetmedica, Inc. PPID causes the horse s pituitary glands to work overtime. The advanced cases are easy to diagnose with tell-tale visual signs like a hair coat that doesn t shed, abnormal sweating or increased drinking and urination. However, there are more subtle signs that can be easily missed, such as decreased athletic performance, changes in attitude or subtle changes in hair coat shedding, such as patches of longer and lighter hair in the summer or shedding that takes place later than herd mates. While Cushing s Disease is considered a chronic disease, it can be managed, Dr. Tuttle says. We need to be looking for those subtle, early signs of PPID to hopefully head off some of the more severe signs, prolong the use 68 november/december 2014»» Veterinary advantage

69 of these horses and maintain their comfort level. Identifying the disease early can slow down the progression of the disease. Even if a horse diagnosed with Cushing s Disease is not yet classified as senior, many of the same steps will help manage the disease and keep the horse in good condition, he notes. Vaccinations and parasite control As horses begin to age, their immune system begins to age as well. This can affect their response to common vaccinations or infectious diseases, Dr. Tuttle says. It s important to treat older horses based on their risk of exposure. Simple changes can help prevent disease exposure. For instance, a senior horse should be stalled away from a younger horse that travels and competes more frequently. The younger horse is potentially being exposed to many and varied pathogens. Keeping the two animals away from each other minimizes the risk to the older animal. A risk-based assessment is important for senior horses, as their immune system may not be as efficient at responding to vaccinations or fighting off infectious diseases, Dr. Tuttle says. Owners can help by minimizing the potential for exposure to disease by implementing effective biosecurity. For horses that are no longer traveling and competing, veterinarians may want to exclude vaccinations such as rhino and influenza, depending on their risk level. In addition, a more targeted and strategic deworming program may be beneficial for senior horses, says Dr. Williamson. Veterinarians may recommend cutting down on the number of dewormings and identifying issues with resistant parasites, which may contribute to any difficulties the horse has with maintaining body condition, she says. Nutrition Senior horses often may suffer from impaired digestive function. Therefore, their diets are formulated quite Key points Caring for senior horses often means more not less veterinary care More frequent physical and dental exams are often needed Care for joint problems is often a concern for performance horses Monitoring for equine Cushing s Disease can begin as early as 7 years old Vaccinations and parasite control programs may be adjusted Nutritional recommendations should be re-evaluated as horses age Monitoring body condition along with hair coat and muscle mass also is important differently than other horses. Horses need high-quality protein with essential amino acids and higher-quality forages. Senior diets should meet, but not significantly exceed, protein requirements. In addition, their diets should have only a moderate amount of fat. Senior feeds are now available that have been carefully designed to meet specific needs. One of the ways to determine if a horse s nutrition requirements are being met at any age is to assess his body condition, says Roy Johnson, equine technology manager for Cargill Animal Nutrition s Nutrena brand. You don t want them to get obese because if you put excess weight onto a frame that s already having joint problems, it can exaggerate the problem, Johnson says. On the other hand, it s difficult to get weight back on an older horse. Change in body condition is one of the key indicators that a horse has reached senior status, he says. When you see your horse start to lose muscle condition or mass, and he just doesn t look as good in the spring as he did in the summer, the horse has now told you he has become a senior horse, Johnson says. Owners may also consider adding supplements to their horse s ration based on the animal s specific concerns, he says. For example, omega-3 fatty acids can be added to help control inflammation in joints, but some of these supplements can add additional calories. Probiotics and prebiotics also are frequently used to help maintain gut health. Older horses are competing successfully and at much higher levels than they were 15 or 20 years ago, Johnson says. As we have older horses competing, we do have to pay more attention to nutrition and body condition, and give them appropriate veterinary support to keep them comfortable to perform at that high level. Veterinary advantage ««november/december

70 COMMUNITY Rep Spotlight Core Values Adhering to traditional principles, Bob Nose has carved out a satisfying, productive career Success in veterinary sales as in many professions is really pretty simple, no matter how long you ve been at it. When asked what words of advice he would offer a young rep, Bob Nose who has been an outside rep for MWI Veterinary Supply for about 30 years says the core values of MWI sum things up: Customer service, integrity, dedication, innovation and quality. If [young reps] would just work on all of those, that would take care of a lot of it right there. Bob and Sharon Nose After graduating from Eastern Montana College, a teachers college in Billings, Mont., Nose began his career in animal health as a cattle foreman or cow boss in a feed yard in Park City, Mont. The industry had always been on his radar. I always enjoyed sports, recreation and rodeos, he says. He roped in high school, college and for years afterward. Being a cow boss was was quite a job, he says. Seven days a week, on call at night, no vacation. But I loved it. One day, however, he asked his wife, Sharon, if she wanted to move on, maybe buy some furniture. We lived in a 10- by-50 single-wide, he says. So, after three years working in the feed yard, Nose took a position in outside sales for Agri-Lines Corp., a provider of feed supplements, fertilizer and animal health products. It was at Agri-Lines that he met one of his mentors, Richard Rawlings. He was and still is a dear friend, a true friend, and he set the stage for me for a lot of things, explains Nose. In fact, it was Rawlings who introduced Nose to Dr. Millard Wallace Ickes, who founded MWI in (Rawlings would go on to form the feed division within MWI.) 70 november/december 2014»» Veterinary advantage

71 When You Can t Afford To Guess Canine VacciCheck Gives You Semi-Quantitative Results 21 Minute In-Clinic Test To Evaluate The Immune Status To Distemper, Adenovirus and Parvovirus All Three For $20 VacciCheck is a valuable tool that your customers can use to determine a dogs level of immunity to: CANINE DISTEMPER CANINE ADENOVIRUS CANINE PARVOVIRUS It is a useful and reliable tool when used after 18 weeks of age to determine the effectiveness of a puppy s series of active immunizations. WHY AND WHEN TO TITER TEST? For adult dogs, AAHA Canine Vaccination Guidelines recommend revaccination with core vaccines every three years. For those hospitals that have gone to three-year boosters of core vaccines, VacciCheck is a valuable tool to measure the level of immunity in between triennial boosters. Titer testing as an option to annual revaccination becomes a part of the wellness testing of any veterinary hospital. IMMUNOCOMPROMISED DOGS Other times that VacciCheck should be used as an alternative to vaccination would be in dogs that are battling: AUTO-IMMUNE DISORDERS IMMUNO-COMPROMISED DOGS such as those that have either been treated for cancer or been previously treated and are in remission.

72 COMMUNITY Rep Spotlight Dr. Ickes invited Nose to meet him for a job interview in January 1985, and Nose went to work for the young company a month later. Changes Working on MWI s core values has helped Nose thrive through years of change. Two decades ago, there were fewer doctors than today, and most at least in the Mountain states were in mixed practices, he says. They covered a lot of ground. Those doctors did basically all the ordering themselves. A lot of times, I would follow them around in the clinic, I would just say [to young reps], Be yourself, always have something to say, maybe something to tell, do business in a fair and honest way, and try to love everyone. talking about products, maybe writing an order. They didn t sit down too much. Not infrequently, Nose would hop in the truck with the veterinarian to make a call. Sometimes we would visit on the way, and sometimes they were just thinking about what they were going to do on the call, he says. With the older vets, that s the way it was. Over the span of 30 years in the field, Nose has adjusted to the changing demands of his customers. I ve tried to change my role as much as I can, he says. For example, he has learned how to be the go-to person on equipment, which can be a demanding job. And he has learned how to work with new decision-makers, such as office managers. He has welcomed such changes, which he believes have led to better healthcare for animals. Doctors have more time to deal with their customers and to do more consulting work, he says. I believe the clinics had become overloaded, and they re figuring out ways to overcome that. And we re helping them do that. Just as doctors have become consultants to their clients, so too have outside reps become consultants to the doctors and staff, says Nose. I ve worked the service end of things really hard, he says. I ve worked on building relationships, and bringing information of value to my customers. Manufacturers are partners in the process, he adds. I have always found it very important to have an excellent relationship with manufacturers and their reps, he says. It s important they spend time with us. That s how we learn. Nose encourages his clients to take advantage of manufacturers educational programs. Today, Nose s territory is smaller than it was 30 years ago, encompassing parts of western Montana and Wyoming. Because of health reasons, he was at press time planning for a December 2014 retirement. Were it not for the health considerations, I would go longer, he says. But he is grateful for many things, among them the mentorship of Richard Rawlings as well as that of Herb Ingersoll, MWI vice president, with whom Nose has held daily morning phone conferences for 20-plus years. We discuss sales, marketing, and sometimes just doing business in a fair and honest way, he says. Nose encourages young reps to follow MWI s core values, and to strive for balance in their personal and professional lives. Outside of that, I would just say, Be yourself, always have something to say, maybe something to tell, do business in a fair and honest way, and try to love everyone. That last thing is uppermost in Nose s agenda. I m blessed to have Sharon as my wife for 44-plus years, he says. She s an awesome wife and mother. Together, they have two sons, Tyler and Eben, both of whom are married with two kids apiece. 72 november/december 2014»» Veterinary advantage

73 NO TIME TO WAIT WHEN A PET BECOMES HYPOGLYCEMIC The brain needs a steady supply of glucose in order to function properly, as it does not store and create glucose itself. Hypoglycemia is not a disease, but is typically an indication of another underlying health problem. When glucose levels drop to a dangerously low level, symptoms of hypoglycemia can occur and animals should be treated quickly before it becomes life threatening. Hypoglycemia can occur as a result of: An accidental insulin overdose Exertional hypoglycemia Commonly seen in hunting dogs The demands of pregnancy The rapid growth of a newborn pet When this occurs in either a dog or cat, the oral administration of highly palatable HypoglyVed raises blood sugar levels quickly and provides quick energy. Four presentations available. Large Dogs 50 gram Medium Dogs 37.5 gram Small Dogs 25 gram Cats 25 gram One price for all sizes.

74 COMMUNITY People A Lasting Legacy Dave Arnold had one goal in mind from the start: making a contribution to veterinary medicine. By Laura Thill If something s missing from your day that extra bit of energy or enthusiasm that lends a charge to the industry it s likely Dave Arnold. The VPL senior vice president s recent retirement has left a hole in the industry for the many colleagues and customers he befriended over his 40-year-long career in animal healthcare products. When he said his good-byes in August, he took with him his passion, persistence and focus, and many point out the industry just isn t the same. Dave Arnold One thing about Dave, he was never afraid to talk to anyone, says Betsy Watkins, the new senior vice president at VPL. Watching him build relationships has taught me the importance of putting yourself out there and meeting new people, especially in this position. Whether picking out a familiar face at a crowded sales meeting or recognizing a long-forgotten industry colleague, he was the first one to strike up a conversation and ask, Do you remember me? I m Dave Arnold. He taught me, [this business is] not only about developing new relationships, but maintaining them as well. Working and connecting with others was one of Arnold s strengths, says Watkins and not only with regard to his customers. Although his role was to supervise and mentor Watkins, she says it felt more like a true team effort. Working together was key, she recalls. We would listen to one another s ideas, and Dave would let me learn from my mistakes. If it didn t go well, he d ask me, So, what exactly went wrong. He would challenge me and validate my thought process. But, it was always OK to voice opinions, and he never criticized her mistakes, she adds. Never any doubt Arnold always had a passion for veterinary medicine, and knew since he was very young that he wanted to work in animal healthcare. From the start, I knew I wanted to make a contribution to veterinary medicine, he says. In my mind, this was the best [career] in the world. Growing up on a farm and having a father who was a veterinarian was key in shaping his dreams, he adds. My two brothers and I went on calls with Dad, he recalls. There s really no better way than that to learn about [the industry]. The fact that he didn t get into veterinary school was not enough to deter Arnold, who later applied his undergraduate pre-veterinary experience to his work in the U.S. Army Medical Service Corps. Upon leaving the Army, he thought, I know the veterinary side of the business in terms of what goes on in the practice. I also knew many of the sales reps who have visited my dad s practice. Working as a sales rep looked to be a great opportunity to stay connected to veterinarian practices and the industry 74 november/december 2014»» Veterinary advantage

75 (Chlorhexidine Gluconate 1% Solution and Ethyl Alcohol 61% w/w) Surgical and Healthcare Personnel Hand Antiseptic with Moisturizers is the only FDA NDA-approved brushless, waterless hand antiseptic that contains two ingredients alcohol for rapid kill and Chlorhexidine Gluconate for persistent, cumulative activity, which is preferred by AORN. Find out more by contacting your local sales representative, visit us at or call us at Complies with AAHA Standard SX20 3M and Avagard are trademarks of 3M. The shape and colors of the Avagard bottle and wall bracket are trademarks of 3M. Used under license in Canada. 3M, All rights reserved.

76 COMMUNITY People at large, he realized. So, in 1973, he joined Pitman Moore and has enjoyed every day living my dream and supporting the profession. His early years at Pitman Moore were an opportunity to learn the sales side of the business a position that morphed into sales training, followed by marketing. In 1988, when J & J sold the company, he received an offer from Veterinary Companies of America (VCA). The opportunity to learn the distribution side, as well as lay down roots in Arizona, proved too much to resist, and for the next two He was always the first one to strike up a conversation and ask, Do you remember me? I m Dave Arnold. He taught me, this business is not only about developing new relationships, but maintaining them as well. Betsy Watkins, senior vice president, VPL years he helped lead VCA s marketing efforts. The experience paved the way for him to launch his own sales and marketing company Companion Animal Marketing Services. His entrepreneurship enabled him to work with both human and animal health companies and distributors, as well as focus on sales training an experience that likely made him attractive to VPL s Farnam division. I joined VPL/Farnam in October 1992, and focused on strategic alliances, Arnold says. I helped bring in quite a few products to the Farnam Companies, as well as to VPL. After four years, he had an opportunity to work for VPL in marketing, and four years after that, he was promoted to president. I ran the business until I retired this year, he says, noting that when the company was acquired in 2007 by Central Garden & Pet, his title became senior vice president of VPL, but his role remained unchanged. We built the business at VPL, from sutures and medical devices to surgical suite products and flea A unifying force I met Dave in 2002, when I joined Farnam, says Tom Kennedy, consultant to Central Garden & Pet. Over the years, the two worked closely to establish Farnam s pharmaceutical direction. Dave is persistent, focused and approachable, he says. He remembers everyone he has ever met. When he is in a crowd of people in the industry, Dave will know the names and most likely remember the topics you discussed last. He keeps track of family and business relationships for all of his friends and colleagues. Arnold could maintain a sense of professionalism under the most strenuous conditions, he points out. In 2004, Dave and several others were stranded for three days by a blizzard in Fort Collins, he says. He proved that he could conduct business even in an extraordinary situation. He remained extremely positive under trying conditions, while simultaneously kicking everyone else s tail at poker. He is passionate about horses and dogs, proud of his extended family and to be a father and a grandfather, he continues. I will miss the energy that Dave brings when he enters the room, his knowledge of the veterinary business and the way that he builds a consensus with people working on projects. Dave is a unifying force. He builds confidence in the people around him. and tick products, he recalls. We also built a strong alliance with BD, offering the company s full line of medical devices to veterinarians. Nothing stays the same It s hard to dispute the extent to which animal healthcare has changed in the past 40+ years. But, perhaps one of the greatest adjustments for Arnold was the need to respond to widespread industry consolidation. There has been a great amount of consolidation especially with 76 november/december 2014»» Veterinary advantage

77 regard to pharmaceutical companies and distribution, he explains. Inevitably, this had a huge impact on the way we got our products, he adds. At the same time, quite a few corporate practices have been established over the last years, which has created challenges as we have learned to work with them. In addition to consolidation, today, the FDA approval process is much longer and requires considerable effort on the part of pharmaceutical companies to bring their products to market, he says. Communication tools have become exceedingly more complex, as laptops, tablets and smartphones have become popular means of staying in touch with customers. I may not Honest, caring and positive You could always count on Dave to be upfront and look for the best opportunities and benefits for VPL and its distributors, says Jeff Danielson, vice president of sales, MWI Veterinary Supply, who has known Arnold for over 16 years. Three words that come to mind when he thinks of Arnold are honest, caring and positive. I have enjoyed Dave s friendship and will miss spending time with him, golfing and fishing. I will miss his positive attitude and friendly smile. know how to do it all, says Arnold, but this is a form of communication and, as such, it s to our advantage to use [these devices]. And, I have always been fascinated by new technology. However, it takes more than an iphone to stay truly connected to others. For people like Arnold, reaching out to others is second nature. Every day, I have tried to network with people in the industry. This has been a great community to work in and there are wonderful distributor reps and managers, as well as my colleagues at VPL. I have made some wonderful friends. I have always believed in win-win relationships, he continues. When working with distributors, [I ve learned] it s important to make certain the programs you put together ensure that everyone will be successful. His company has done its part as well to keep its employees connected to their distributor partners. Fun in the Sun a longtime VPL tradition is an annual incentive trip for distributor sales reps, he explains. The company gives its top qualifying distributor rep partners excursions to such exotic places as Punta Cana, Dominican Republic, Jamaica and Cozumal, Mexico. In addition to attending valuable sessions with industry experts, it s an opportunity for reps to connect with one another and the folks at VPL. On these trips, I have made sure to get to know every single person, Arnold says. It has been a wonderful way to get to know distributor reps and managers. I have always wanted the distributors to succeed, and I have always wanted VPL to succeed. There s one way to make that happen, he points out: by staying connected, communicating and partnering. A natural next step As much as he has enjoyed his career in animal healthcare, making the transition to retirement has been enjoyable. My wife, Cheryl, and I recently bought an Airstream camper, and we are enjoying a lot of camping, hiking and COMMUNITY Veterinary advantage ««november/december

78 COMMUNITY People fishing, he says. I ve been riding my horses and [catching up with] projects around the house. And, I continue to consult for Central Garden & Pet. He also looks forward to spending more time with his children and grandchildren in the coming months. My son, Nate, lives in Pennsylvania and works for Aetna, he says. My daughter, Carrie, teaches at Gilbert Community College in Gilbert, Ariz. And, my daughter, Amy, is a veterinarian. And, I have six grandchildren whom I absolutely love. His family is a close one because he made a point to stay involved, he says. I made sure to be at all of the soccer I have always had a huge passion for veterinary medicine and have known since I was very young that I wanted to work in animal healthcare. Dave Arnold and softball games when the kids were growing up, and we made family vacations a priority every year, he says, listing a range of destinations, from the wilderness in Alaska to Yellowstone, the Grand Canyon, the Grand Tetons and Jackson Hole to name some. Retirement may come easy for Arnold, but his absence is noted at VPL. When I think of Dave, three words that come to mind are passion, optimism and tirelessness, says Watkins. I ll miss his enthusiasm and his ability to push others out of their comfort zone to meet challenges. I ll miss hearing him say, I know we can do this. Trade shows will never be the same Kirk Augustine, executive vice president of business development, Veterinary Advantage Magazine, met Arnold about 20 years ago when he worked at PVPL (Professional Veterinary Products Ltd.) in Omaha. Dave is one of the few leaders that actively engages customers at trade shows, he says. This commitment allowed him to get direct feedback, test concepts or messages, seek/field objections and ultimately train VPL reps and distributor sales reps about the products his company sold. He always appeared to be charged up an energizer if you will, Augustine continues. He has a high drive to bring significance to anything he works on or toward. There was always a sense of core values and principles in Dave s business dealings. Additionally, his willing commitments as a father, volunteer and to his people were always evident. As he moved to lead the VPL organization, his ability to filter or align ideas with the goals he was pursuing seemed to drive a more efficient approach to the markets in which the company participates. Trade shows may never be the same now that Arnold has retired, says Augustine, recalling how he would come out of the booth to shake people s hand, say hello or to engage customers. These are skills that are easy to lose as we allow kiosks and other technologies to become the focus of our customer engagements, he says. One such trade show took place about eight years ago. I had an appointment to visit with Dave and for some reason, he was one of only two people in the VPL booth and could not get away as the veterinarians flooded the trade show area during a seminar break, he recalls. The other person in the booth was new and in no time, I [decided] to help out. Together, Dave, the rep and I engaged VPL customers and prospects at a near-fury pace for the entire break. Dave s energy and confidence in the focus product became easy to replicate after listening to him detail customers three or four times. To help Dave that hour or so in the booth was a highlight as we stood nearly back-to-back discussing the product with customers and feeding off of one-another s dialogue. Meeting with Dave always felt good, Augustine continues. Whether his answer was Yes or No, there was always a laugh, an idea or concept to discuss and, most importantly, Dave always seemed to acknowledge your value as a person. 78 november/december 2014»» Veterinary advantage

79 In Pursuit of Excellence Prescott Animal Hospital is recognized for setting the bar high People COMMUNITY Adversity often has a way of making things better. Those in the veterinary profession know that as much as anyone. When the economy did what it did and that wasn t even 10 years ago veterinary practice really changed, says Nicole Frost, hospital administrator, Prescott (Ariz.) Animal Hospital. Before, it was, We re just going to take really good care of your pet, and everything will work out. But today, the emphasis has to be on taking really good care of the client, she says. Excellent care of the pet will follow. Opened in 1947, Prescott Animal Hospital has been accredited by the American Animal Hospital Association since Earlier this year, the practice received the AAHA-Accredited Practice of the Year Award for the general practice category. (MedVet Medical & Cancer Centers for Pets, Worthington, Ohio, was awarded first place for the referral practice category.) The award recognizes the outstanding achievements of accredited practice teams, and is based on their most recent accreditation score, mission and vision, practice design, practice team composition, continuing education and training, community service, and more. Accreditation An army brat, Frost and her family moved to Prescott when she was in junior high. I was the little girl who wanted to be a veterinarian when she grew up, she says. Her first job, at age 15, was cleaning instruments and cages in a local veterinary hospital. She dropped the idea of practicing veterinary medicine, but not of working in the veterinary field. Given the fact that her mother is in accounting and her stepfather is a certified public accountant, I was indoctrinated in the financial aspects of business, proper bookkeeping and accounting early on, she says. That s probably how I got to where I am now. She joined Prescott Animal Hospital in The staff at Prescott aims for excellence in all things, says Frost. Hence the AAHA accreditation. It demonstrates going above and beyond, and practicing at a level Companion animal team Prescott we are proud of. We wouldn t practice any other way. Accreditation attracts the best professionals and paraprofessionals, as well as clients, she adds. Clients look for accredited practices, she says. Those moving to Prescott from other areas know that AAHA accreditation connotes a certain quality level. The Platinum Rule With clients, the Prescott team follows the Platinum Rule: Treat others the way they want to be treated. The challenge is learning how they want to be treated. We do a lot of work with personality profiles, learning how to communicate not only with each other, but with our clients, the way they want to be communicated to, says Frost. Our clients are highly educated. They know what type of and how much information they need about their pets and their Veterinary advantage ««november/december

80 COMMUNITY People pets care. Some need very little, but others want handouts and follow-up research opportunities. Our goal is to make sure we are meeting each of their needs and expectations. That is what will get us to our ultimate goal, which is treating the patient to our level. It places a greater level of responsibility on the entire team not only to provide excellent client service, but to do so consistently. Excellent medicine, excellent service Nikki Frost All the work on communication has helped Prescott be better tuned in to type of patient care its clients want for their pets, says Frost. That, in turn, has led the practice to invest in advanced technologies, including digital dental radiography, laser therapy and more. Digital radiography not only helps the veterinarian make a better, more thorough diagnosis, but it helps him or her educate the client on treatment options. And therapeutic laser was a modality that clients had been requesting as an alternate therapy. Through VetSource, Prescott offers clients the convenience of shopping at home for necessary products. For the practice, however, it s a matter not just of convenience, but of safety and quality. Our biggest concerns are the [online resellers] that pop up overnight and disappear just as quickly, she says. There s no way to guarantee that the product they ship is authentic or has been handled per the manufacturer s instructions. Frost believes that distributor sales reps can help Prescott continue to up the bar in terms of the quality of medicine and client service it provides. Good pricing is always important, she says. But there s more. We want great support in continuing education, so we can offer that to our team. Distributors who offer education demonstrate they are investing in their customers welfare. We value reps who offer not just a product, but the service to back it up, she continues. It can be disheartening when a distributor rep can only offer Call the manufacturer when problems arise. Frost and staff also appreciate reps who give them a heads-up that some products are unavailable, and who are quick to offer options. We want somebody who is more like a partner with the practice, and who is genuinely concerned about what we do. And it helps if the rep is conscious of the staff s time. We appreciate reps who call ahead and schedule appointments, so that I can make available whoever it is they want to see, whether it s me, the veterinarian, the inventory person. I really feel our practice is good at offering things that are necessary for providing the level of patient care our clients are asking for, says Frost. The Prescott team has no intention of stopping. AAHA Award Winners Prescott Animal Hospital took home first place for American Animal Hospital Association-Accredited Practice of the Year (general practice category) earlier this year. MedVet Medical & Cancer Centers for Pets, Worthington, Ohio, was awarded first place for the referral practice category. AAHA also awarded second, third, and finalist places for the accredited practice awards: Second place, general practice: New Frontier Animal Medical Center, Sierra Vista, Ariz. Third place, general practice: Kew Beach Veterinary Hospital, Toronto, Ont. Finalist, general practice: Jefferson Animal Hospital & Emergency Center, Louisville, Ky. Finalist, referral practice: Saint Francis Veterinary Center, Woolwich Township, New Jersey 80 november/december 2014»» Veterinary advantage

81 SNAP Up The Savings Maximize SNAP savings! Get a $75 incentive for each customer who enrolls in SNAP Up The Savings 2015!* Visit idexxdxportal.com for details about this limited-time incentive program. *Visit idexxdxportal.com for details about this limited-time incentive program. Refer to each company s green sheets for exact incentive IDEXX Laboratories, Inc. All rights reserved All /TM marks are owned by IDEXX Laboratories, Inc. or its affi liates in the United States and/or other countries. The IDEXX Privacy Policy is available at idexx.com.

82 COMMUNITY News Dr. Annelize Roos receives The Second Annual Henry Schein Cares International Veterinary Community Service Award Henry Schein, Inc. announced that Dr. Annelize Roos is the recipient of the second annual Henry Schein Cares International Veterinary Community Service Award.The award was presented at the recent Gala Dinner of the 39th World Small Animal Veterinary Association Congress (WSAVA 2014) in Cape Town, South Africa. Henry Schein Cares is the global corporate responsibility program of Henry Schein. The Henry Schein Cares International Veterinary Community Service Award honors exceptional acts of valor and commitment by veterinarians in the face of adversity. Dr. Roos was honored for her service to animal health and welfare in South Africa and other regions of the world as Director of the South African Veterinary Association Community Veterinary Clinics (SAVA-CVC), a non-profit organization established by the South African Veterinary Association (SAVA), and Principal of EnviroVet CVC, a satellite community veterinary clinic of the SAVA-CVC. Dr. Nigel Nichols, Chief Executive Officer, Provet Group, Henry Schein s Animal Health Business in Australia and New Zealand, presented the award to Dr. Roos, which included a check for $10,000 for donation to the SAVA-CVC. Merial supports infectious disease PhD program at University of Georgia Merial announced it is providing financial awards to three postdoctoral students completing their research at the College of Veterinary Medicine at the University of Georgia. The awards provide graduate research opportunities for veterinary students in the specialty areas of veterinary pathology and microbiology in the field of infectious diseases. Merial has been sponsoring students in this program since Veterinarians that complete this program become proficient and innovative diagnosticians and researchers in the field of emerging and reemerging infectious diseases, said Harry W. Dickerson, Associate Dean for Research and Graduate Affairs at the University of Georgia. With funds provided by Merial to cover competitive stipends, the UGA College of Veterinary Medicine has been able to recruit and train the next generation of veterinary diagnosticians and researchers to enter careers in academia, industry, or government. The recipients of the $40,000 scholarships will focus their studies on a diversity of topics, including pathology, microbiology and avian virology. The recipients are: Sophie Aschenbroich, DVM, DACVP; Mathew Abraham DVM, MS; Carmen Jerry, DVM. Brakke Consulting report profiles veterinary oncology market from A new study from Brakke Consulting offers a look into the #1 killer of dogs and cats: cancer. Oncology is one of the highest interest areas in veterinary medicine today, said Lynn Fondon DVM, a senior consultant at Brakke Consulting. In the past 7 years, the U.S. has gone from zero cancer therapies approved for veterinary use to a half-dozen, with at least a dozen more under development. The study, Cancer in Dogs and Cats, provides information on the incidence of cancer in pets, examines how cancer is diagnosed and treated in veterinary medicine, and offers estimated costs for treatment. The report reviews the FDAapproved cancer treatments that are now on the market; new and developing veterinary cancer products, including therapies and diagnostics, are also presented in the report. For more information, interested companies can visit the Brakke Consulting website at Midmark Animal Health launches year-end promotion Midmark Corporation introduced a year-end promotion within its animal health division that runs until Dec. 31, During the promotion, Midmark is offering rebates up to $750 while helping provide veterinarians with solutions for taking the best care of their patients. Under the terms of the promotion, customers can receive a $350 rebate on the Vet- Pro 1000 and a $500 rebate on the VetPro 5000 Dental Delivery Systems. In addition, customers are eligible to receive a $200 rebate on several models of Matrx anesthesia machines. The highly-advanced Cardell Touch Vital Signs, offered with a $300 rebate, provide veterinarians a fast and intuitive touch screen to monitor patients both safely and efficiently. In addition to these offers, a $750 rebate is available on all Canis Major Lift Tables through Dec. 31, Important promotional dates include: Promotion order period: Oct. 1 Dec. 31, 2014 Last date to take shipment of products: Jan. 31, 2015 Invoice must be dated: Oct. 1, 2014 Jan. 31, 2015 Last date to claim incentives: Feb. 28, 2015 For product inquiries, call the Midmark Animal Health Customer Experience Department at MIDMARK or visit midmarkanimalhealth.com/yearend2014. For questions regarding the promotion, call ext november/december 2014»» Veterinary advantage

83 Veterinary Products Laboratories donates flea and tick treatments to animal shelter organizations Fall marks the peak season for fleas, evidenced by a 70 percent increase in flea prevalence over the previous season. To help stop the spread of fleas and ensure pets are protected this season and all year, Veterinary Products Laboratories (VPL), the makers of Ovitrol X-Tend Flea & Tick Spot On products for Dogs and Cats, has donated $15,000 worth of the flea and tick treatments to five animal shelter organizations located in regions known for having a high prevalence of fleas year-round; a total donation of $75,000. The donation will supply each shelter with enough product to protect 120 pets from fleas and ticks for an entire year. Ovitrol X-Tend Product Donation Recipients: Arizona Humane Society (Phoenix, Ariz.); Humane Society of Greater Miami (Miami, Fla.); Humane Society of Charlotte (Charlotte, N.C.); Seattle Humane Society (Seattle, Wash.); The Greater Birmingham Humane Society (Birmingham, Ala.). We are passionate about helping our shelter partners by protecting pets against fleas and ticks while relieving the expense of preventive care, said Betsy Watkins, director of the VPL division. Providing comfort and protection to animals in need is humbling and we thank each shelter partner for the hard work and time they devote to ensuring the well-being of every pet they help. Industry remembers MWI Veterinary Supply s Amy Crumley Amy Crumley passed away unexpectedly Monday, October 27, 2104 at Lakeside Hospital in Omaha, Neb. Crumley spent nearly 20 years in the animal health field, after graduating as a Licensed Veterinary Technician from the Omaha College of Health Careers. She started her career as an LVT with Millard (NE) Veterinary Clinic, worked as a Sales Specialist for Professional Veterinary Products, and most recently with Micro Beef Technologies/ MWI Veterinary Supply. Crumley s friendliness, generous spirit, and knowledge of animal health earned the respect of her many customers, industry colleagues and co-workers. She was always happy to share her knowledge with others, which included using her skills volunteering to rescue and treat animals in the Gulf following Hurricane Katrina. Her 11-year-old daughter, Sabrina, shares her mother s love of animals and hopes to become a veterinarian. A scholarship fund for Sabrina has been established in Amy s memory: In Memory of Amy Crumley, Midwest Bank, 105 West Elm Street, York, NE COMMUNITY Product Announcements Midmark releases Cardell Touch Monitor Midmark announced the release of the Cardell Touch Monitor. Midmark has designed precision and consistency expected from the Cardell name into a fast, light, and intuitive touch screen vital signs monitor. Above all, an anesthesia monitor should be safe, reliable, and user-friendly. The Cardell Touch is highly advanced, yet easy to use. With veterinary specific algorithms and exclusive Cardell Blood Pressure Technology, the Touch is the latest innovation from the most trusted name in veterinary vital signs monitoring. Features include: 10.5-inch touch screen makes patient set up faster and easier or use the traditional-style buttons located below the screen. Redesigned menus and improved controls allow for intuitive navigation Smaller, lighter form factor allows for easy transportation without sacrificing visibility Upgrade to CO2 monitoring at any time by adding a Respironics sidestream or mainstream CO2 module. Phasein multigas available Enhanced ECG data export capabilities For more information, visit Bayer is proud to introduce See advertisement on page 37 Veterinary advantage ««november/december

84 Package Insert for Dogs ANADA # , Approved by FDA Meloxicam Solution for Injection 5 mg/ml Non-steroidal anti-inflammatory drug for use in dogs and cats only Caution: Federal law restricts this drug to use by or on the order of a licensed veterinarian. WARNING: Repeated use of meloxicam in cats has been associated with acute renal failure and death. Do not administer additional injectable or oral meloxicam to cats. See Contraindications, Warnings, and Precautions for detailed information. Description: Meloxicam is a non-steroidal anti-inflammatory drug (NSAID) of the oxicam class. Each ml of this sterile product for injection contains meloxicam 5.0 mg, alcohol 15%, glycofurol 10%, poloxamer 188 5%, sodium chloride 0.6%, glycine 0.5% and meglumine 0.3%, in water for injection, ph adjusted with sodium hydroxide and hydrochloric acid. Indications: Dogs: Meloxicam Solution for Injection is indicated in dogs for the control of pain and inflammation associated with osteoarthritis. Dosage and Administration: Carefully consider the potential benefits and risk of Meloxicam Solution for Injection and other treatment options before deciding to use Meloxicam Solution for Injection. Use the lowest effective dose for the shortest duration consistent with individual response. Dogs: Meloxicam Solution for Injection should be administered initially as a single dose at 0.09 mg/lb (0.2 mg/kg) body weight intravenously (IV) or subcutaneously (SQ), followed, after 24 hours, by meloxicam oral suspension at the daily dose of mg/lb (0.1 mg/kg) body weight, either mixed with food or placed directly in the mouth. Contraindications: Dogs with known hypersensitivity to meloxicam should not receive Meloxicam Solution for Injection. Warnings: Not for use in humans. Keep this and all medications out of reach of children. Consult a physician in case of accidental ingestion by humans. For IV or SQ injectable use in dogs. All dogs should undergo a thorough history and physical examination before administering any NSAID. Appropriate laboratory testing to establish hematological and serum biochemical baseline data is recommended prior to, and periodically during use of any NSAID in dogs. Owner should be advised to observe their dogs for signs of potential drug toxicity. Precautions: The safe use of Meloxicam Solution for Injection in dogs younger than 6 months of age, dogs used for breeding, or in pregnant or lactating bitches has not been evaluated. Meloxicam is not recommended for use in dogs with bleeding disorders, as safety has not been established in dogs with these disorders. Safety has not been established for intramuscular (IM) administration in dogs. When administering Meloxicam Solution for Injection, use a syringe of appropriate size to ensure precise dosing. As a class, cyclo-oxygenase inhibitory NSAIDs may be associated with gastrointestinal, renal and hepatic toxicity. Sensitivity to drug-associated adverse events varies with the individual patient. Dogs that have experienced adverse reactions from one NSAID may experience adverse reactions from another NSAID. Patients at greatest risk for renal toxicity are those that are dehydrated, on concomitant diuretic therapy, or those with existing renal, cardiovascular, and/or hepatic dysfunction. Concurrent administration of potentially nephrotoxic drugs should be carefully approached. NSAIDs may inhibit the prostaglandins that maintain normal homeostatic function. Such anti-prostaglandin effects may result in clinically significant disease in patients with underlying or preexisting disease that has not been previously diagnosed. Since NSAIDs possess the potential to induce gastrointestinal ulcerations and/or perforations, concomitant use with other anti-inflammatory drugs, such as NSAIDs or corticosteroids, should be avoided. If additional pain medication is needed after the administration of the total daily dose of meloxicam oral suspension, a non-nsaid or noncorticosteroid class of analgesia should be considered. The use of another NSAID is not recommended. Consider appropriate washout times when switching from corticosteroid use or from one NSAID to another in dogs. The use of concomitantly protein-bound drugs with Meloxicam Solution for Injection has not been studied in dogs. Commonly used protein-bound drugs include cardiac, anticonvulsant and behavioral medications. The influence of concomitant drugs that may inhibit metabolism of Meloxicam Solution for Injection has not been evaluated. Drug compatibility should be monitored in patients requiring adjunctive therapy. The effect of cyclo-oxygenase inhibition and the potential for thromboembolic occurrence or a hypercoagulable state has not been studied. Adverse Reactions: Dogs: A field study involving 224 dogs was conducted. Based on the results of this study, Gl abnormalities (vomiting, soft stools, diarrhea, and inappetance) were the most common adverse reactions associated with the administration of meloxicam. The following table lists adverse reactions and the numbers of dogs that experienced them during the study. Dogs may have experienced more than one episode of the adverse reaction during the study. Post-Approval Experience (Rev. 2009): The following adverse reactions are based on post-approval adverse drug event reporting. The categories are listed in decreasing order of frequency by body system: Gastrointestinal: vomiting, diarrhea, melena, gastrointestinal ulceration Urinary: azotemia, elevated creatinine, renal failure Neurological/Behavioral: lethargy, depression Hepatic: elevated liver enzymes Dermatologic: pruritus Death has been reported as an outcome of the adverse events listed above. Acute renal failure and death have been associated with the use of meloxicam in cats. To report suspected adverse reactions, to obtain a Material Safety Data Sheet, or for technical assistance, call For a complete listing of adverse reactions for meloxicam reported to the CVM see: Information For Dog Owners: Meloxicam, like other NSAIDs, is not free from adverse reactions. Owners should be advised of the potential for adverse reactions and be informed of the clinical signs associated with NSAID intolerance. Adverse reactions may include vomiting, diarrhea, lethargy, decreased appetite and behavioral changes. Dog owners should be advised when their pet has received a meloxicam injection. Dog owners should contact their veterinarian immediately if possible adverse reactions are observed, and dog owners should be advised to discontinue meloxicam therapy. Clinical Pharmacology: Meloxicam has nearly 100% bioavailability when administered orally or after subcutaneous injection in dogs. The terminal elimination half life after a single dose is estimated to be approximately 24 hrs (+/-30%) in dogs regardless of route of administration. Drug bioavailability, volume of distribution, and total systemic clearance remain constant up to 5 times the recommended dose for use in dogs. However, there is some evidence of enhanced drug accumulation and terminal elimination half-life prolongation when dogs are dosed for 45 days or longer. Peak drug concentrations of mcg/ml can be expected to occur within 2.5 hours following a 0.2 mg/kg subcutaneous injection in dogs. Based upon intravenous administration in Beagle dogs, the meloxicam volume of distribution in dogs (Vdλ) is approximately 0.32 L/kg and the total systemic clearance is 0.01 L/hr/kg. The drug is 97% bound to canine plasma proteins. Effectiveness: Dogs: The effectiveness of meloxicam was demonstrated in a field study involving a total of 224 dogs representing various breeds, all diagnosed with osteoarthritis. This placebo-controlled, masked study was conducted for 14 days. Dogs received a subcutaneous injection of 0.2 mg/kg meloxicam on day 1. The dogs were maintained on 0.1 mg/kg oral meloxicam from days 2 through 14. Variables evaluated by veterinarians included lameness, weight-bearing, pain on palpation, and overall improvement. Variables assessed by owners included mobility, ability to rise, limping, and overall improvement. In this field study, dogs showed clinical improvement with statistical significance after 14 days of meloxicam treatment for all variables. Animal Safety: Dogs: 3 Day Target Animal Safety Study - In a three day safety study, meloxicam was administered intravenously to Beagle dogs at 1, 3, and 5 times the recommended dose (0.2, 0.6 and 1.0 mg/kg) for three consecutive days. Vomiting occurred in 1 of 6 dogs in the 5X group. Fecal occult blood was detected in 3 of 6 dogs in the 5X group. No clinically significant hematologic changes were seen, but serum chemistry changes were observed. Serum alkaline phosphatase (ALP) was significantly increased in one 1X dog and two of the 5X dogs. One dog in the 5X group had a steadily increasing GGT over 4 days, although the values remained within the reference range. Decreases in total protein and albumin occurred in 2 of 6 dogs in the 3X group and 3 of 6 dogs in the 5X group. Increases in blood urea nitrogen (BUN) occurred in 3 of 6 dogs in the 1X group, 2 of 6 dogs in the 3X group and 2 of 6 dogs in the 5X group. Increased creatinine occurred in 2 dogs in the 5X group. Increased urine protein excretion was noted in 2 of 6 dogs in the control group, 2 of 6 dogs in the 1X group, 2 of 6 dogs in the 3X group, and 5 of 6 dogs in the 5X group. Two dogs in the 5X group developed acute renal failure by Day 4. Bicarbonate levels were at or above normal levels in 1 of the 3X dogs and 2 of the 5X dogs. Histological examination revealed gastrointestinal lesions ranging from superficial mucosal hemorrhages and congestion to erosions. Mesenteric lymphadenopathy was identified in 2 of 6 dogs in the 1X group, 4 of 6 dogs in the 3X group, and 5 of 6 dogs in the 5X group. Renal changes ranged from dilated medullary and cortical tubules and inflammation of the interstitium, to necrosis of the tip of the papilla in 2 of 6 dogs in the 1X group, 2 of 6 dogs in the 3X group, and 4 of 6 dogs in the 5X group. Injection Site Tolerance - Meloxicam was administered once subcutaneously to Beagle dogs at the recommended dose of 0.2 mg/kg and was well-tolerated by the dogs. Pain upon injection was observed in one of eight dogs treated with meloxicam. No pain or inflammation was observed post-injection. Long term use of Meloxicam Solution for Injection in dogs has not been evaluated. Effect on Buccal Mucosal Bleeding Time (BMBT) - Meloxicam (0.2 mg/kg) and placebo (0.4 ml/kg) were administered as single intravenous injections to 8 female and 16 male Beagle dogs. There was no statistically significant difference (p>0.05) in the average BMBT between the two groups. Storage Information: Store at controlled room temperature, F (20-25 C). Protect from light. How Supplied: Meloxicam Solution for Injection: 10 ml vial NDC# Adverse Reactions Observed During Field Study Clinical Observation Vomiting Diarrhea/Soft Stool Inappetance Bloody Stool Meloxicam (n = l09) Placebo (n = 115) In foreign suspected adverse drug reaction (SADR) reporting, adverse reactions related to meloxicam administration included: auto-immune hemolytic anemia (1 dog), thrombocytopenia (1 dog), polyarthritis (1 dog), nursing puppy lethargy (1 dog), and pyoderma (1 dog) Manufactured for: Putney, Inc. Portland, ME USA Made in India Neutral Code No. GO/DRUGS/704 PUTNEY Rev. October november/december 2014»» Veterinary advantage

85 Package Insert for Cats ANADA # , Approved by FDA Meloxicam Solution for Injection 5 mg/ml Non-steroidal anti-inflammatory drug for use in dogs and cats only Caution: Federal law restricts this drug to use by or on the order of a licensed veterinarian. WARNING: Repeated use of meloxicam in cats has been associated with acute renal failure and death. Do not administer additional injectable or oral meloxicam to cats. See Contraindications, Warnings, and Precautions for detailed information. Description: Meloxicam is a non-steroidal anti-inflammatory drug (NSAID) of the oxicam class. Each ml of this sterile product for injection contains meloxicam 5.0 mg, alcohol 15%, glycofurol 10%, poloxamer 188 5%, sodium chloride 0.6%, glycine 0.5% and meglumine 0.3%, in water for injection, ph adjusted with sodium hydroxide and hydrochloric acid. Indications: Cats: For the control of postoperative pain and inflammation associated with orthopedic surgery, ovariohysterectomy and castration when administered prior to surgery. Dosage and Administration: Carefully consider the potential benefits and risk of Meloxicam Solution for Injection and other treatment options before deciding to use Meloxicam Solution for Injection. Use the lowest effective dose for the shortest duration consistent with individual response. Cats: Administer a single, one-time subcutaneous dose of Meloxicam Solution for Injection to cats at a dose of 0.14 mg/lb (0.3 mg/kg) body weight. Use of additional meloxicam or other NSAIDs is contraindicated. (See Contraindications). To ensure accuracy of dosing, the use of a 1mL graduated syringe is recommended. Contraindications: Cats with known hypersensitivity to meloxicam should not receive Meloxicam Solution for Injection. Additional doses of meloxicam or other NSAIDs in cats are contraindicated, as no safe dosage for repeated NSAID administration has been established (See Animal Safety). Do not use meloxicam in cats with pre-existing renal dysfunction. Warnings: Not for use in humans. Keep this and all medications out of reach of children. Consult a physician in case of accidental ingestion by humans. For subcutaneous (SQ) injectable use in cats. Do not use IV in cats. Do not administer a second dose of meloxicam. Do not follow the single, one-time dose of meloxicam with any other NSAID. Do not administer meloxicam oral suspension following the single, one-time injectable dose of meloxicam. When administering any NSAID, appropriate laboratory testing to establish hematological and serum biochemical baseline data is recommended prior to use in dogs and cats. All cats should undergo a thorough history and physical examination before administering meloxicam. Do not repeat the single, one-time dose of meloxicam in cats. Owner should be advised to observe their cats for signs of potential drug toxicity. Precautions: The safe use of Meloxicam Solution for Injection in cats younger than 4 months of age, cats used for breeding, or in pregnant or lactating queens has not been evaluated. Meloxicam is not recommended for use in cats with bleeding disorders, as safety has not been established in cats with these disorders. Safety has not been established for intravenous (IV) or intramuscular (IM) use in cats. When administering Meloxicam Solution for Injection, use a syringe of appropriate size to ensure precise dosing. As a class, cyclo-oxygenase inhibitory NSAIDs may be associated with gastrointestinal, renal, and hepatic toxicity. Sensitivity to drug-associated adverse events varies with the individual patient. Cats that have experienced adverse reactions from one NSAID may experience adverse reactions from another NSAID. NSAIDs may inhibit the prostaglandins that maintain normal homeostatic function. Such antiprostaglandin effects may result in clinically significant disease in patients with underlying or pre-existing disease that has not been previously diagnosed. Patients at greatest risk for adverse events are those that are dehydrated, on concomitant diuretic therapy, or those with existing renal, cardiovascular, and/or hepatic dysfunction. Concurrent administration of potentially nephrotoxic drugs should be carefully approached and monitored. Anesthetic drugs may affect renal perfusion; approach concomitant use of anesthetics and NSAIDs cautiously. Appropriate monitoring procedures should be employed during all surgical procedures. The use of perioperative parenteral fluids is recommended to decrease potential renal complications when using NSAIDs. If additional pain medication is needed after the single, one-time dose of meloxicam, a non-nsaid class of analgesic may be necessary. In one study 1, one cat in each NSAID treatment group had increased intraoperative hemorrhage. Since NSAIDs possess the potential to induce gastrointestinal ulcerations and/or gastrointestinal perforation, concomitant use of meloxicam with other anti-inflammatory drugs, such as NSAIDs or corticosteroids, should be avoided. Consider appropriate washout times when switching from corticosteroid use to meloxicam in cats. As a single use product in cats, meloxicam should not be followed by additional NSAIDs or corticosteroids. The use of concomitantly protein-bound drugs with Meloxicam Solution for Injection has not been studied in cats. Commonly used protein-bound drugs include cardiac, anticonvulsant and behavioral medications. The influence of concomitant drugs that may inhibit metabolism of Meloxicam Solution for Injection has not been evaluated. Drug compatibility should be monitored in patients requiring adjunctive therapy. The effect of cyclo-oxygenase inhibition and the potential for thromboembolic occurrence or a hypercoagulable state has not been studied. Adverse Reactions: Cats: A field study involving 138 cats was conducted. Of the 72 cats receiving meloxicam, six cats (8.3%) experienced post-treatment elevated serum blood urea nitrogen (BUN) levels. The pre-treatment values were in the normal range. Of the 66 cats in the butorphanol treatment group, no cats experienced post-treatment elevated serum blood urea nitrogen levels. Nine cats (12.5%) receiving meloxicam had post-treatment anemia. Pre-treatment, these cats all had hematocrit and hemoglobin values in the normal range. Four cats (6.1%) in the butorphanol treatment group had post-treatment anemia. All but one cat, who had a mild anemia pre-treatment (hematocrit=21% and hemoglobin=7.0 g/dl) had normal pre-treatment values. Twenty-four hours after the injection with meloxicam, one cat experienced pain upon palpation of the injection site. Foreign Experience: Repeated use in cats has been associated with acute renal failure and death. In studies used for the foreign approval of meloxicam in cats, lethargy, vomiting, inappetance, and transient pain immediately after injection were noted. Diarrhea and fecal occult blood have also been reported. Post-Approval Experience (Rev. 2009): The following adverse reactions are based on post-approval adverse drug event reporting. The categories are listed in decreasing order of frequency by body system: Urinary: azotemia, elevated creatine, elevated phosphorus, renal failure Gastrointestinal: anorexia, vomiting, diarrhea Neurologic/Behavioral: lethargy, depression Hematologic: anemia Death has been reported as an outcome of the adverse events listed above. Acute renal failure and death have been associated with the use of meloxicam in cats. To report suspected adverse reactions, to obtain a Material Safety Data Sheet, or for technical assistance, call For a complete listing of adverse reactions for meloxicam reported to the CVM see: Information For Cat Owners: Meloxicam, like other NSAIDs, is not free from adverse reactions. Owners should be advised of the potential for adverse reactions and be informed of the clinical signs associated with NSAID intolerance. Adverse reactions may include vomiting, diarrhea, lethargy, decreased appetite and behavioral changes. Cat owners should be advised when their pet has received a meloxicam injection. Cat owners should contact their veterinarian immediately if possible adverse reactions are observed. Clinical Pharmacology: Meloxicam has nearly 100% bioavailability after subcutaneous injection in cats. The terminal elimination half life after a single dose is estimated to be approximately 15 hrs (+/-10%) in cats. Peak drug concentrations of 1.1 mcg/ml can be expected to occur within 1.5 hours following a 0.3 mg/kg subcutaneous injection in cats. The volume of distribution (Vdλ) in cats is approximately 0.27 L/kg, with an estimated total systemic clearance of L/hr/kg. The drug is 97% bound to feline plasma proteins. Effectiveness: Cats: The effectiveness of meloxicam was demonstrated in a masked field study involving a total of 138 cats representing various breeds. This study used butorphanol as an active control. Cats received either a single subcutaneous injection of 0.3 mg/kg meloxicam or 0.4 mg/kg butorphanol prior to onychectomy, either alone or in conjunction with surgical neutering. All cats were premedicated with acepromazine, induced with propofol and maintained on isoflurane. Pain assessment variables evaluated by veterinarians included additional pain intervention therapy, gait/lameness score, analgesia score, sedation score, general impression score, recovery score, and visual analog scale score. Additionally, a cumulative pain score, which was the summation of the analgesia, sedation, heart rate and respiratory rate scores was evaluated. A palpometer was used to quantify the pain threshold. A substantial number of cats required additional intervention in the 0-24 hour postsurgical period, with the majority of these interventions taking place within the first hour. Therefore, the percentage of cats in each group that received one or more interventions was designated as the primary assessment variable. Approximately half of the cats in each group received a pain intervention as a result of the first (time 0) post-surgical evaluation, i.e., extubation. At this point, the need to provide a pain intervention was not statistically significant between the two groups (p=0.7215). However, the median number of interventions was one per cat in the meloxicam group and two per cat in the butorphanol group and this difference was statistically significant (p=0.0021). The statistical evaluation supports the conclusion that the meloxicam test article is non-inferior to the butorphanol active control. Forty-eight of the 72 cats in the meloxicam group received one or more interventions (66.7%), and 47 of 66 cats in the butorphanol group received one or more interventions (71.2%). The number of interventions administered to the meloxicam group was less than the butorphanol group at 1, 3, 5, 8, 12, and 24 hours post-surgery. Cats receiving meloxicam showed improvement in the pain assessment variables. Animal Safety: Cats: 3 Day Target Animal Safety Study - In a three day safety study, subcutaneous meloxicam administration to healthy cats at up to 1.5 mg/kg (5X the recommended dose) resulted in vomiting in three cats (1 of 6 control cats and 2 of 6 cats in 5X) and loose stools in four cats (2 of 6 control cats and 2 of 6 cats in 5X). Fecal occult blood was detected in ten of the twenty four cats, including two cats in the control group. This was not a dose-related event. Clinically significant hematologic changes seen included increased PT and APTT in two cats (1 of 6 control cats and 1 of 6 cats in 5X), and elevated white blood cell counts in cats having renal or Gl tract lesions. Serum chemistry changes observed included decreased total protein in four of 24 cats (1 of 6 cats in 1X, 2 of 6 cats in 3X and 1 of 6 cats in 5X), concomitant increases in blood urea nitrogen (BUN) and creatinine values in 2 of 6 cats in 5X. Histological examination revealed gastrointestinal lesions ranging from inflammatory cell infiltration of the mucosa of the Gl tract to erosions. Mesenteric lymphadenopathy was identified in 1 of 6 cats in 1X. Renal changes ranged from dilated medullary (2 of 6 cats in 1X, 1 of 6 cats in 3X, and 1 of 6 cats in 5X) and cortical (3 of 6 cats in 1X, 1 of 6 cats in 3X, and 3 of 6 cats in 5X) tubules and inflammation (2 of 6 cats in 1X, 2 of 6 cats in 3X, and 2 of 6 cats in 5X) or fibrosis (2 of 6 cats in 3X and 2 of 6 cats in 5X) of the interstitium to necrosis of the tip of the papilla (5 of 6 cats in 5X). Subsequent oral dosing - In a nine day study with three treatment groups, meloxicam was given as a single subcutaneous injection using doses of 0 mg/kg (saline injection), 0.3 mg/kg and 0.6 mg/kg on Day 0. Meloxicam oral suspension, 1.5 mg/ml or saline was then administered orally once-daily at the same respective dose (0.3 or 0.6 mg/kg) for eight consecutive days. Clinical adverse reactions included vomiting, diarrhea, lethargy, and decreased food consumption in the treated groups, and one day of diarrhea in one control cat. The gross necropsy report includes observation of reddened Gl mucosa in 3 of 4 cats in the 0.3 mg/kg group and 1 of 4 cats in the 0.6 mg/kg group. All saline-treated cats were normal. By Day 9, one cat in both the 0.3 mg/kg group and the 0.6 mg/kg group died and another cat in the 0.3 mg/kg group was moribund. The cause of death for these cats could not be determined, although the pathologist reported pyloric/duodenal ulceration in the cats in 0.6 mg/kg group. The safety studies demonstrate a narrow margin of safety. Injection Site Tolerance - Histopathology of the injection sites revealed hemorrhage and inflammation, myofiber atrophy, panniculitis, fibrin deposition, and fibroblast proliferation. These findings were present in cats in all groups, with the 3X cats having the most present. No safe repeat dose has been established in cats. Storage Information: Store at controlled room temperature, F (20-25 C). Protect from light. How Supplied: Meloxicam Solution for Injection: 10 ml vial NDC# Reference: 1 Slingsby L.S., A.E. Waterman-Pearson. Comparison between meloxicam and carprofen for postoperative analgesia after feline ovariohysterectomy. Jour of Small Anim Pract (2002)43: Manufactured for: Putney, Inc. Portland, ME USA Made in India Neutral Code No. GO/DRUGS/704 PUTNEY Rev. October Veterinary advantage ««november/december

86 CHEWABLE TABLETS Brief Summary: Before using PREVICOX, please consult the product insert, a summary of which follows: Caution: Federal law restricts this drug to use by or on the order of a licensed veterinarian. Indications: PREVICOX (firocoxib) Chewable Tablets are indicated for the control of pain and inflammation associated with osteoarthritis and for the control of postoperative pain and inflammation associated with softtissue and orthopedic surgery in dogs. Contraindications: Dogs with known hypersensitivity to firocoxib should not receive PREVICOX. Warnings: Not for use in humans. Keep this and all medications out of the reach of children. Consult a physician in case of accidental ingestion by humans. For oral use in dogs only. Use of this product at doses above the recommended 2.27 mg/lb (5.0 mg/ kg) in puppies less than seven months of age has been associated with serious adverse reactions, including death (see Animal Safety). Due to tablet sizes and scoring, dogs weighing less than 12.5 lb (5.7 kg) cannot be accurately dosed. All dogs should undergo a thorough history and physical examination before the initiation of NSAID therapy. Appropriate laboratory testing to establish hematological and serum baseline data is recommended prior to and periodically during administration of any NSAID. Owners should be advised to observe for signs of potential drug toxicity (see Adverse Reactions and Animal Safety) and be given a Client Information Sheet about PREVICOX Chewable Tablets. For technical assistance or to report suspected adverse events, call Precautions: This product cannot be accurately dosed in dogs less than 12.5 pounds in body weight. Consider appropriate washout times when switching from one NSAID to another or when switching from corticosteroid use to NSAID use. As a class, cyclooxygenase inhibitory NSAIDs may be associated with renal, gastrointestinal and hepatic toxicity. Sensitivity to drug-associated adverse events varies with the individual patient. Dogs that have experienced adverse reactions from one NSAID may experience adverse reactions from another NSAID. Patients at greatest risk for adverse events are those that are dehydrated, on concomitant diuretic therapy, or those with existing renal, cardiovascular, and/or hepatic dysfunction. Concurrent administration of potentially nephrotoxic drugs should be carefully approached and monitored. NSAIDs may inhibit the prostaglandins that maintain normal homeostatic function. Such anti-prostaglandin effects may result in clinically significant disease in patients with underlying or pre-existing disease that has not been previously diagnosed. Since NSAIDs possess the potential to produce gastrointestinal ulceration and/or gastrointestinal perforation, concomitant use of PREVICOX Chewable Tablets with other anti-inflammatory drugs, such as NSAIDs or corticosteroids, should be avoided. The concomitant use of protein-bound drugs with PREVICOX Chewable Tablets has not been studied in dogs. Commonly used protein-bound drugs include cardiac, anticonvulsant, and behavioral medications. The influence of concomitant drugs that may inhibit the metabolism of PREVICOX Chewable Tablets has not been evaluated. Drug compatibility should be monitored in patients requiring adjunctive therapy. If additional pain medication is needed after the daily dose of PREVICOX, a non-nsaid class of analgesic may be necessary. Appropriate monitoring procedures should be employed during all surgical procedures. Anesthetic drugs may affect renal perfusion, approach concomitant use of anesthetics and NSAIDs cautiously. The use of parenteral fluids during surgery should be considered to decrease potential renal complications when using NSAIDs perioperatively. The safe use of PREVICOX Chewable Tablets in pregnant, lactating or breeding dogs has not been evaluated. Adverse Reactions: Osteoarthritis: In controlled field studies, 128 dogs (ages 11 months to 15 years) were evaluated for safety when given PREVICOX Chewable Tablets at a dose of 2.27mg/lb (5.0 mg/kg) orally once daily for 30 days. The following adverse reactions were observed. Dogs may have experienced more than one of the observed adverse reactions during the study. Adverse Reactions Seen in U. S. Field Studies Adverse Reactions PREVICOX (n=128) Active Control (n=121) Vomiting 5 8 Diarrhea 1 10 Decreased Appetite or Anorexia 3 3 Lethargy 1 3 Pain 2 1 Somnolence 1 1 Hyperactivity 1 0 PREVICOX (firocoxib) Chewable Tablets were safely used during field studies concomitantly with other therapies, including vaccines, anthelmintics, and antibiotics. Soft-tissue Surgery: In controlled field studies evaluating soft-tissue postoperative pain and inflammation, 258 dogs (ages 10.5 weeks to 16 years) were evaluated for safety when given PREVICOX Chewable Tablets at a dose of 2.27 mg/ lb (5.0 mg/kg) orally approximately 2 hours prior to surgery and once daily thereafter for up to two days. The following adverse reactions were observed. Dogs may have experienced more than one of the observed reactions during the study. Adverse Reactions Seen in the Soft-tissue Surgery Postoperative Pain Field Studies Adverse Reactions Firocoxib Group (n=127) Control Group* (n=131) Vomiting 5 6 Diarrhea 1 1 Bruising at Surgery Site 1 1 Respiratory Arrest 1 0 SQ Crepitus in Rear Leg and Flank 1 0 Swollen Paw 1 0 *Sham-dosed (pilled) Orthopedic Surgery: In a controlled field study evaluating orthopedic postoperative pain and inflammation, 226 dogs of various breeds, ranging in age from 1 to 11.9 years in the PREVICOX-treated groups and 0.7 to 17 years in the control group were evaluated for safety. Of the 226 dogs, 118 were given PREVICOX Chewable Tablets at a dose of 2.27 mg/lb (5.0 mg/kg) orally approximately 2 hours prior to surgery and once daily thereafter for a total of three days. The following adverse reactions were observed. Dogs may have experienced more than one of the observed reactions during the study. Adverse Reactions Seen in the Orthopedic Surgery Postoperative Pain Field Study Adverse Reactions Firocoxib Group (n=118) Control Group* (n=108) Vomiting 1 0 Diarrhea 2** 1 Bruising at Surgery Site 2 3 Inappetence/ Decreased Appetite 1 2 Pyrexia 0 1 Incision Swelling, Redness 9 5 Oozing Incision 2 0 A case may be represented in more than one category. *Sham-dosed (pilled). **One dog had hemorrhagic gastroenteritis. Post-Approval Experience (Rev. 2009): The following adverse reactions are based on post-approval adverse drug event reporting. The categories are listed in decreasing order of frequency by body system: Gastrointestinal: Vomiting, anorexia, diarrhea, melena, gastrointestinal perforation, hematemesis, hematachezia, weight loss, gastrointestinal ulceration, peritonitis, abdominal pain, hypersalivation, nausea Urinary: Elevated BUN, elevated creatinine, polydypsia, polyuria, hematuria, urinary incontinence, proteinuria, kidney failure, azotemia, urinary tract infection Neurological/Behavioral/Special Sense: Depression/lethargy, ataxia, seizures, nervousness, confusion, weakness, hyperactivity, tremor, paresis, head tilt, nystagmus, mydriasis, aggression, uveitis Hepatic: Elevated ALP, elevated ALT, elevated bilirubin, decreased albumin, elevated AST, icterus, decreased or increased total protein and globulin, pancreatitis, ascites, liver failure, decreased BUN Hematological: Anemia, neutrophilia, thrombocytopenia, neutropenia Cardiovascular/Respiratory: Tachypnea, dyspnea, tachycardia Dermatologic/Immunologic: Pruritis, fever, alopecia, moist dermatitis, autoimmune hemolytic anemia, facial/ muzzle edema, urticaria In some situations, death has been reported as an outcome of the adverse events listed above. For a complete listing of adverse reactions for firocoxib reported to the CVM see: Information For Dog Owners: PREVICOX, like other drugs of its class, is not free from adverse reactions. Owners should be advised of the potential for adverse reactions and be informed of the clinical signs associated with drug intolerance. Adverse reactions may include vomiting, diarrhea, decreased appetite, dark or tarry stools, increased water consumption, increased urination, pale gums due to anemia, yellowing of gums, skin or white of the eye due to jaundice, lethargy, incoordination, seizure, or behavioral changes. Serious adverse reactions associated with this drug class can occur without warning and in rare situations result in death (see Adverse Reactions). Owners should be advised to discontinue PREVICOX therapy and contact their veterinarian immediately if signs of intolerance are observed. The vast majority of patients with drug-related adverse reactions have recovered when the signs are recognized, the drug is withdrawn, and veterinary care, if appropriate, is initiated. Owners should be advised of the importance of periodic follow up for all dogs during administration of any NSAID. Effectiveness: Two hundred and forty-nine dogs of various breeds, ranging in age from 11 months to 20 years, and weighing 13 to 175 lbs, were randomly administered PREVICOX or an active control drug in two field studies. Dogs were assessed for lameness, pain on manipulation, range of motion, joint swelling, and overall improvement in a non-inferiority evaluation of PREVICOX compared with the active control. At the study s end, 87% of the owners rated PREVICOX-treated dogs as improved. Eighty-eight percent of dogs treated with PREVICOX were also judged improved by the veterinarians. Dogs treated with PREVICOX showed a level of improvement in veterinarianassessed lameness, pain on palpation, range of motion, and owner-assessed improvement that was comparable to the active control. The level of improvement in PREVICOX-treated dogs in limb weight bearing on the force plate gait analysis assessment was comparable to the active control. In a separate field study, two hundred fifty-eight client-owned dogs of various breeds, ranging in age from 10.5 weeks to 16 years and weighing from 7 to 168 lbs, were randomly administered PREVICOX or a control (sham-dosed-pilled) for the control of postoperative pain and inflammation associated with soft-tissue surgical procedures such as abdominal surgery (e.g., ovariohysterectomy, abdominal cryptorchidectomy, splenectomy, cystotomy) or major external surgeries (e.g., mastectomy, skin tumor removal 8 cm). The study demonstrated that PREVICOX-treated dogs had significantly lower need for rescue medication than the control (sham-dosed-pilled) in controlling postoperative pain and inflammation associated with soft-surgery. A multi-center field study with 226 client-owned dogs of various breeds, and ranging in age from 1 to 11.9 years in the PREVICOX-treated groups and 0.7 to 17 years in the control group was conducted. Dogs were randomly assigned to either the PREVICOX or the control (sham-dosed-pilled) group for the control of postoperative pain and inflammation associated with orthopedic surgery. Surgery to repair a ruptured cruciate ligament included the following stabilization procedures: fabellar suture and/or imbrication, fibular head transposition, tibial plateau leveling osteotomy (TPLO), and over the top technique. The study (n = 220 for effectiveness) demonstrated that PREVICOX-treated dogs had significantly lower need for rescue medication than the control (sham-dosed-pilled) in controlling postoperative pain and inflammation associated with orthopedic surgery. Animal Safety: In a targeted animal safety study, firocoxib was administered orally to healthy adult Beagle dogs (eight dogs per group) at 5, 15, and 25 mg/kg (1, 3, and 5 times the recommended total daily dose) for 180 days. At the indicated dose of 5 mg/kg, there were no treatment-related adverse events. Decreased appetite, vomiting, and diarrhea were seen in dogs in all dose groups, including unmedicated controls, although vomiting and diarrhea were seen more often in dogs in the 5X dose group. One dog in the 3X dose group was diagnosed with juvenile polyarteritis of unknown etiology after exhibiting recurrent episodes of vomiting and diarrhea, lethargy, pain, anorexia, ataxia, proprioceptive deficits, decreased albumin levels, decreased and then elevated platelet counts, increased bleeding times, and elevated liver enzymes. On histopathologic examination, a mild ileal ulcer was found in one 5X dog. This dog also had a decreased serum albumin which returned to normal by study completion. One control and three 5X dogs had focal areas of inflammation in the pylorus or small intestine. Vacuolization without inflammatory cell infiltrates was noted in the thalamic region of the brain in three control, one 3X, and three 5X dogs. Mean ALP was within the normal range for all groups but was greater in the 3X and 5X dose groups than in the control group. Transient decreases in serum albumin were seen in multiple animals in the 3X and 5X dose groups, and in one control animal. In a separate safety study, firocoxib was administered orally to healthy juvenile (10-13 weeks of age) Beagle dogs at 5, 15, and 25 mg/kg (1, 3, and 5 times the recommended total daily dose) for 180 days. At the indicated (1X) dose of 5 mg/kg, on histopathologic examination, three out of six dogs had minimal periportal hepatic fatty change. On histopathologic examination, one control, one 1X, and two 5X dogs had diffuse slight hepatic fatty change. These animals showed no clinical signs and had no liver enzyme elevations. In the 3X dose group, one dog was euthanized because of poor clinical condition (Day 63). This dog also had a mildly decreased serum albumin. At study completion, out of five surviving and clinically normal 3X dogs, three had minimal periportal hepatic fatty change. Of twelve dogs in the 5X dose group, one died (Day 82) and three moribund dogs were euthanized (Days 38, 78, and 79) because of anorexia, poor weight gain, depression, and in one dog, vomiting. One of the euthanized dogs had ingested a rope toy. Two of these 5X dogs had mildly elevated liver enzymes. At necropsy all five of the dogs that died or were euthanized had moderate periportal or severe panzonal hepatic fatty change; two had duodenal ulceration; and two had pancreatic edema. Of two other clinically normal 5X dogs (out of four euthanized as comparators to the clinically affected dogs), one had slight and one had moderate periportal hepatic fatty change. Drug treatment was discontinued for four dogs in the 5X group. These dogs survived the remaining 14 weeks of the study. On average, the dogs in the 3X and 5X dose groups did not gain as much weight as control dogs. Rate of weight gain was measured (instead of weight loss) because these were young growing dogs. Thalamic vacuolation was seen in three of six dogs in the 3X dose group, five of twelve dogs in the 5X dose group, and to a lesser degree in two unmedicated controls. Diarrhea was seen in all dose groups, including unmedicated controls. In a separate dose tolerance safety study involving a total of six dogs (two control dogs and four treated dogs), firocoxib was administered to four healthy adult Beagle dogs at 50 mg/kg (ten times the recommended daily dose) for twenty-two days. All dogs survived to the end of the study. Three of the four treated dogs developed small intestinal erosion or ulceration. Treated dogs that developed small intestinal erosion or ulceration had a higher incidence of vomiting, diarrhea, and decreased food consumption than control dogs. One of these dogs had severe duodenal ulceration, with hepatic fatty change and associated vomiting, diarrhea, anorexia, weight loss, ketonuria, and mild elevations in AST and ALT. All four treated dogs exhibited progressively decreasing serum albumin that, with the exception of one dog that developed hypoalbuminemia, remained within normal range. Mild weight loss also occurred in the treated group. One of the two control dogs and three of the four treated dogs exhibited transient increases in ALP that remained within normal range. Made in France Marketed by: Merial Limited, Duluth, GA , U.S.A NADA , Approved by FDA Rev PREVICOX is a registered trademark of Merial Merial. All rights reserved. 86 november/december 2014»» Veterinary advantage

87 VETORYL CapsuLEs (trilostane) Caution Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. Indications SENTINEL SPECTRUM (milbemycin oxime/lufenuron/ praziquantel) is indicated for the prevention of heartworm disease caused by Dirofilaria immitis; for the prevention and control of flea populations (Ctenocephalides felis); and for the treatment and control of adult roundworm (Toxocara canis, Toxascaris leonina), adult hookworm (Ancylostoma caninum), adult whipworm (Trichuris vulpis), and adult tapeworm (Taenia pisiformis, Echinococcus multilocularis and Echinococcus granulosus) infections in dogs and puppies two pounds of body weight or greater and six weeks of age and older. Dosage and Administration SENTINEL SPECTRUM should be administered orally, once every month, at the minimum dosage of 0.23 mg/lb (0.5 mg/kg) milbemycin oxime, 4.55 mg/lb (10 mg/kg) lufenuron, and 2.28 mg/lb (5 mg/kg) praziquantel. For heartworm prevention, give once monthly for at least 6 months after exposure to mosquitoes. Dosage Schedule Milbemycin Lufenuron Praziquantel Body Oxime per per per Number of Weight chewable chewable chewable chewables 2 to 8 lbs. 2.3 mg 46 mg 22.8 mg One 8.1 to 25 lbs mg 115 mg 57 mg One 25.1 to 50 lbs mg 230 mg 114 mg One 50.1 to 100 lbs mg 460 mg 228 mg One Over 100 lbs. Administer the appropriate combination of chewables To ensure adequate absorption, always administer SENTINEL SPECTRUM to dogs immediately after or in conjunction with a normal meal. SENTINEL SPECTRUM may be offered to the dog by hand or added to a small amount of dog food. The chewables should be administered in a manner that encourages the dog to chew, rather than to swallow without chewing. Chewables may be broken into pieces and fed to dogs that normally swallow treats whole. Care should be taken that the dog consumes the complete dose, and treated animals should be observed a few minutes after administration to ensure that no part of the dose is lost or rejected. If it is suspected that any of the dose has been lost, redosing is recommended. Contraindications There are no known contraindications to the use of SENTINEL SPECTRUM. Warnings Not for use in humans. Keep this and all drugs out of the reach of children. Precautions Treatment with fewer than 6 monthly doses after the last exposure to mosquitoes may not provide complete heartworm prevention. Prior to administration of SENTINEL SPECTRUM, dogs should be tested for existing heartworm infections. At the discretion of the veterinarian, infected dogs should be treated to remove adult heartworms. SENTINEL SPECTRUM is not effective against adult D. immitis. Mild, transient hypersensitivity reactions, such as labored breathing, vomiting, hypersalivation, and lethargy, have been noted in some dogs treated with milbemycin oxime carrying a high number of circulating microfilariae. These reactions are presumably caused by release of protein from dead or dying microfilariae. Do not use in puppies less than six weeks of age. Do not use in dogs or puppies less than two pounds of body weight. The safety of SENTINEL SPECTRUM has not been evaluated in dogs used for breeding or in lactating females. Studies have been performed with milbemycin oxime and lufenuron alone. Adverse Reactions The following adverse reactions have been reported in dogs after administration of milbemycin oxime, lufenuron, or praziquantel: vomiting, depression/lethargy, pruritus, urticaria, diarrhea, anorexia, skin congestion, ataxia, convulsions, salivation, and weakness. To report suspected adverse drug events, contact Novartis Animal Health at or the FDA at FDA-VETS. Manufactured for: Novartis Animal Health US, Inc. Greensboro, NC 27408, USA NADA # , Approved by FDA 2013 Novartis Animal Health US, Inc NAH/SSC/BS/1 1/14 10 mg, 30 mg, 60 mg and 120 mg strengths adrenocortical suppressant for oral use in dogs only Brief Summary (For Full prescribing Information, see package insert.) Caution: Federal (usa) law restricts this drug to use by or on the order of a licensed veterinarian. DeSCription: VETORYL is an orally active synthetic steroid analogue that blocks production of hormones produced in the adrenal cortex of dogs. indications: VETORYL CapsuLEs are indicated for the treatment of pituitary-dependent hyperadrenocorticism in dogs. VETORYL CapsuLEs are indicated for the treatment of hyperadrenocorticism due to adrenocortical tumor in dogs. ContrainDiCationS: The use of VETORYL CapsuLEs is contraindicated in dogs that have demonstrated hypersensitivity to trilostane. Do not use VETORYL CapsuLEs in animals with primary hepatic disease or renal insufficiency. Do not use in pregnant dogs. studies conducted with trilostane in laboratory animals have shown teratogenic effects and early pregnancy loss. WarningS: In case of overdosage, symptomatic treatment of hypoadrenocorticism with corticosteroids, mineralocorticoids and intravenous fluids may be required. Angiotensin-converting enzyme (ace) inhibitors should be used with caution with VETORYL Capsules, as both drugs have aldosterone-lowering effects which may be additive, impairing the patient s ability to maintain normal electrolytes, blood volume and renal perfusion. potassium-sparing diuretics (e.g., spironolactone) should not be used with VETORYL CapsuLEs as both drugs have the potential to inhibit aldosterone, increasing the likelihood of hyperkalemia. Human WarningS: Keep out of reach of children. Not for human use. Wash hands after use. Do not empty capsule contents and do not attempt to divide the capsules. Do not handle the capsules if pregnant or if trying to conceive. Trilostane is associated with teratogenic effects and early pregnancy loss in laboratory animals. In the event of accidental ingestion/overdose, seek medical advice immediately and take the labeled container with you. precautions: Hypoadrenocorticism can develop at any dose of VETORYL CapsuLEs. a small percentage of dogs may develop corticosteroid withdrawal syndrome within 10 days of starting treatment. Mitotane (o,p -DDD) treatment will reduce adrenal function. Experience in foreign markets suggests that when mitotane therapy is stopped, an interval of at least one month should elapse before the introduction of VETORYL CapsuLEs. The use of VETORYL CapsuLEs will not affect the adrenal tumor itself. adrenalectomy should be considered as an option for cases that are good surgical candidates. adverse reactions: The most common adverse reactions reported are poor/reduced appetite, vomiting, lethargy/dullness, diarrhea, and weakness. Occasionally, more serious reactions including severe depression, hemorrhagic diarrhea, collapse, hypoadrenocortical crisis, or adrenal necrosis/rupture may occur, and may result in death. Distributed by: Dechra veterinary products 7015 College Boulevard, suite 525 Overland park, Ks VETORYL is a trademark of Dechra Ltd. 2009, Dechra Ltd. NaDa , approved by FDa (trilostane) Veterinary advantage ««november/december

88 OSPHOS (clodronate injection) CAUTION: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. Description: NEXGARD (afoxolaner) is available in four sizes of beef-flavored, soft chewables for oral administration to dogs and puppies according to their weight. Each chewable is formulated to provide a minimum afoxolaner dosage of 1.14 mg/ lb (2.5 mg/kg). Afoxolaner has the chemical composition 1-Naphthalenecarboxamide, 4-[5- [3-chloro-5-(trifluoromethyl)- phenyl]-4, 5-dihydro-5-(trifluoromethyl)-3-isoxazolyl]-N-[2-oxo-2-[(2,2,2-trifluoroethyl)amino]ethyl. Indications: NEXGARD kills adult fleas and is indicated for the treatment and prevention of flea infestations (Ctenocephalides felis), and the treatment and control of Black-legged tick (Ixodes scapularis), American Dog tick (Dermacentor variabilis), and Lone Star tick (Amblyomma americanum) infestations in dogs and puppies 8 weeks of age and older, weighing 4 pounds of body weight or greater, for one month. Dosage and Administration: NEXGARD is given orally once a month, at the minimum dosage of 1.14 mg/lb (2.5 mg/kg). Dosing Schedule: Body Afoxolaner Per Chewables Weight Chewable (mg) Administered 4.0 to 10.0 lbs One 10.1 to 24.0 lbs One 24.1 to 60.0 lbs. 68 One 60.1 to lbs. 136 One Over lbs. Administer the appropriate combination of chewables NEXGARD can be administered with or without food. Care should be taken that the dog consumes the complete dose, and treated animals should be observed for a few minutes to ensure that part of the dose is not lost or refused. If it is suspected that any of the dose has been lost or if vomiting occurs within two hours of administration, redose with another full dose. If a dose is missed, administer NEXGARD and resume a monthly dosing schedule. Flea Treatment and Prevention: Treatment with NEXGARD may begin at any time of the year. In areas where fleas are common year-round, monthly treatment with NEXGARD should continue the entire year without interruption. To minimize the likelihood of flea reinfestation, it is important to treat all animals within a household with an approved flea control product. Tick Treatment and Control: Treatment with NEXGARD may begin at any time of the year (see Effectiveness). Contraindications: There are no known contraindications for the use of NEXGARD. Warnings: Not for use in humans. Keep this and all drugs out of the reach of children. In case of accidental ingestion, contact a physician immediately. Precautions: The safe use of NEXGARD in breeding, pregnant or lactating dogs has not been evaluated. Use with caution in dogs with a history of seizures (see Adverse Reactions). Adverse Reactions: In a well-controlled US field study, which included a total of 333 households and 615 treated dogs (415 administered afoxolaner; 200 administered active control), no serious adverse reactions were observed with NEXGARD. Over the 90-day study period, all observations of potential adverse reactions were recorded. The most frequent reactions reported at an incidence of > 1% within any of the three months of observations are presented in the following table. The most frequently reported adverse reaction was vomiting. The occurrence of vomiting was generally self-limiting and of short duration and tended to decrease with subsequent doses in both groups. Five treated dogs experienced anorexia during the study, and two of those dogs experienced anorexia with the first dose but not subsequent doses. Table 1: Dogs With Adverse Reactions. Treatment Group Afoxolaner Oral active control N 1 % (n=415) N 2 % (n=200) Vomiting (with and without blood) Dry/Flaky Skin Diarrhea (with and without blood) Lethargy Anorexia Number of dogs in the afoxolaner treatment group with the identified abnormality. 2 Number of dogs in the control group with the identified abnormality. In the US field study, one dog with a history of seizures experienced a seizure on the same day after receiving the first dose and on the same day after receiving the second dose of NEXGARD. This dog experienced a third seizure one week after receiving the third dose. The dog remained enrolled and completed the study. Another dog with a history of seizures had a seizure 19 days after the third dose of NEXGARD. The dog remained enrolled and completed the study. A third dog with a history of seizures received NEXGARD and experienced no seizures throughout the study. To report suspected adverse events, for technical assistance or to obtain a copy of the MSDS, contact Merial at or For additional information about adverse drug experience reporting for animal drugs, contact FDA at FDA-VETS or online at Mode of Action: Afoxolaner is a member of the isoxazoline family, shown to bind at a binding site to inhibit insect and acarine ligand-gated chloride channels, in particular those gated by the neurotransmitter gamma-aminobutyric acid (GABA), thereby blocking pre- and post-synaptic transfer of chloride ions across cell membranes. Prolonged afoxolaner-induced hyperexcitation results in uncontrolled activity of the central nervous system and death of insects and acarines. The selective toxicity of afoxolaner between insects and acarines and mammals may be inferred by the differential sensitivity of the insects and acarines GABA receptors versus mammalian GABA receptors. Effectiveness: In a well-controlled laboratory study, NEXGARD began to kill fleas four hours after initial administration and demonstrated >99% effectiveness at eight hours. In a separate well-controlled laboratory study, NEXGARD demonstrated 100% effectiveness against adult fleas 24 hours post-infestation for 35 days, and was 93% effective at 12 hours post-infestation through Day 21, and on Day 35. On Day 28, NEXGARD was 81.1% effective 12 hours post-infestation. Dogs in both the treated and control groups that were infested with fleas on Day -1 generated flea eggs at 12- and 24-hours post-treatment (0-11 eggs and 1-17 eggs in the NEXGARD treated dogs, and 4-90 eggs and eggs in the control dogs, at 12- and 24- hours, respectively). At subsequent evaluations post-infestation, fleas from dogs in the treated group were essentially unable to produce any eggs (0-1 eggs) while fleas from dogs in the control group continued to produce eggs (1-141 eggs). In a 90-day US field study conducted in households with existing flea infestations of varying severity, the effectiveness of NEXGARD against fleas on the Day 30, 60 and 90 visits compared with baseline was 98.0%, 99.7%, and 99.9%, respectively. Collectively, the data from the three studies (two laboratory and one field) demonstrate that NEXGARD kills fleas before they can lay eggs, thus preventing subsequent flea infestations after the start of treatment of existing flea infestations. In well-controlled laboratory studies, NEXGARD demonstrated >94% effectiveness against Dermacentor variabilis and Ixodes scapularis, 48 hours post-infestation, and against Amblyomma americanum 72 hours post-infestation, for 30 days. Animal Safety: In a margin of safety study, NEXGARD was administered orally to 8- to 9-week-old Beagle puppies at 1, 3, and 5 times the maximum exposure dose (6.3 mg/kg) for three treatments every 28 days, followed by three treatments every 14 days, for a total of six treatments. Dogs in the control group were sham-dosed. There were no clinically-relevant effects related to treatment on physical examination, body weight, food consumption, clinical pathology (hematology, clinical chemistries, or coagulation tests), gross pathology, histopathology or organ weights. Vomiting occurred throughout the study, with a similar incidence in the treated and control groups, including one dog in the 5x group that vomited four hours after treatment. In a well-controlled field study, NEXGARD was used concomitantly with other medications, such as vaccines, anthelmintics, antibiotics (including topicals), steroids, NSAIDS, anesthetics, and antihistamines. No adverse reactions were observed from the concomitant use of NEXGARD with other medications. Storage Information: Store at or below 30 C (86 F) with excursions permitted up to 40 C (104 F). How Supplied: NEXGARD is available in four sizes of beef-flavored soft chewables: 11.3, 28.3, 68 or 136 mg afoxolaner. Each chewable size is available in color-coded packages of 1, 3 or 6 beef-flavored chewables. NADA , Approved by FDA Marketed by: Frontline Vet Labs, a Division of Merial Limited. Duluth, GA USA Made in Brazil Rev. 4/2014 NexGard and FRONTLINE VET LABS are trademarks of Merial Merial. All rights reserved. Bisphosphonate For use in horses only. Brief Summary (For Full Prescribing Information, see package insert) Caution: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. DesCription: Clodronate disodium is a non-amino, chloro-containing bisphosphonate. Chemically, clodronate disodium is (dichloromethylene) diphosphonic acid disodium salt and is manufactured from the tetrahydrate form. indication: For the control of clinical signs associated with navicular syndrome in horses. ContrainDiCations: Horses with hypersensitivity to clodronate disodium should not receive OSPHOS. Warnings: Do not use in horses intended for human consumption. Human Warnings: Not for human use. Keep this and all drugs out of the reach of children. Consult a physician in case of accidental human exposure. precautions: As a class, bisphosphonates may be associated with gastrointestinal and renal toxicity. Sensitivity to drug associated adverse reactions varies with the individual patient. Renal and gastrointestinal adverse reactions may be associated with plasma concentrations of the drug. Bisphosphonates are excreted by the kidney; therefore, conditions causing renal impairment may increase plasma bisphosphonate concentrations resulting in an increased risk for adverse reactions. Concurrent administration of other potentially nephrotoxic drugs should be approached with caution and renal function should be monitored. Use of bisphosphonates in patients with conditions or diseases affecting renal function is not recommended. Administration of bisphosphonates has been associated with abdominal pain (colic), discomfort, and agitation in horses. Clinical signs usually occur shortly after drug administration and may be associated with alterations in intestinal motility. In horses treated with OSPHOS these clinical signs usually began within 2 hours of treatment. Horses should be monitored for at least 2 hours following administration of OSPHOS. Bisphosphonates affect plasma concentrations of some minerals and electrolytes such as calcium, magnesium and potassium, immediately post-treatment, with effects lasting up to several hours. Caution should be used when administering bisphosphonates to horses with conditions affecting mineral or electrolyte homeostasis (e.g. hyperkalemic periodic paralysis, hypocalcemia, etc.). The safe use of OSPHOS has not been evaluated in horses less than 4 years of age. The effect of bisphosphonates on the skeleton of growing horses has not been studied; however, bisphosphonates inhibit osteoclast activity which impacts bone turnover and may affect bone growth. Bisphosphonates should not be used in pregnant or lactating mares, or mares intended for breeding. The safe use of OSPHOS has not been evaluated in breeding horses or pregnant or lactating mares. Bisphosphonates are incorporated into the bone matrix, from where they are gradually released over periods of months to years. The extent of bisphosphonate incorporation into adult bone, and hence, the amount available for release back into the systemic circulation, is directly related to the total dose and duration of bisphosphonate use. Bisphosphonates have been shown to cause fetal developmental abnormalities in laboratory animals. The uptake of bisphosphonates into fetal bone may be greater than into maternal bone creating a possible risk for skeletal or other abnormalities in the fetus. Many drugs, including bisphosphonates, may be excreted in milk and may be absorbed by nursing animals. Increased bone fragility has been observed in animals treated with bisphosphonates at high doses or for long periods of time. Bisphosphonates inhibit bone resorption and decrease bone turnover which may lead to an inability to repair micro damage within the bone. In humans, atypical femur fractures have been reported in patients on long term bisphosphonate therapy; however, a causal relationship has not been established. adverse reactions: The most common adverse reactions reported in the field study were clinical signs of discomfort or nervousness, colic and/or pawing. Other signs reported were lip licking, yawning, head shaking, injection site swelling, and hives/pruritus. Distributed by: Dechra Veterinary Products 7015 College Boulevard, Suite 525 Overland Park, KS 66211, Dechra Ltd. OSPHOS is a registered trademark of Dechra Ltd. All rights reserved. NADA , Approved by FDA 88 november/december 2014»» Veterinary advantage

89 Companion animals and the older person Editor s Note ««We ve all read that companion animals can be a source of comfort and happiness for the elderly or infirm. Given that a bunch of Baby Boomers have already or are about to enter retirement age, it s safe to assume that animals will play a bigger role in human healthcare and well-being, both at home and in assisted living or continuing care facilities. That only spells opportunity for the industry. The health impact of pets on older people is explored in a new report published by the International Federation on Ageing, through an educational sponsorship from Bayer HealthCare. The report, Companion Animals and the Health of Older Persons, provides a comprehensive literature review into the ways pets contribute to the physical and mental health of individuals and the well-being of society. By Mark Thill A subject worth studying The global share of older people (aged 60 years and over) increased from 9.2 percent in 1990 to 11.7 percent in 2013 and will continue to grow as a large proportion of the world population, reaching 21.1 percent by 2050, according to the report. Globally, the number of older persons is expected to more than double, from 841 million people in 2013 to more than 2 billion in 2050 (UNDP, 2013). In light of these projections, there is a clear need for communities and governments to focus not only on policies of health and active ageing, but also on creating environments that enable older people to remain in the community and to live healthier lives. In this context, companion animals and their impact on the health of older persons is a highly significant area of study, according to the authors. There is data to show that animals can improve the health of people. But other data suggests the benefit of animals is neutral. The study points out both. For example, on the plus side: A 1980 study found that outpatients of a cardiac care unit who were pet owners lived longer than non-pet owners. A 1992 study of 5,741 participants attending a free screening clinic found that pet owners had significantly lower cholesterol and blood pressure levels than non-pet owners. Veterinary advantage ««November/December

90 »» Editor s Note A 1999 study from Canada found that older adults who were pet owners reported a slower deterioration of their ability to perform activities of daily living when compared with non-pet owners over a one-year period. Older adult pet owners also reported that their pets particularly dogs helped them stay active, as well as provided a structure and sense of purpose to their days. Epidemiological studies comparing aspects of the health of pet owners and non-pet owners suggest that pet owners have better well-being and selfreported health, visit the doctor less often, and have less pharmaceutical expenditure. A large-scale survey of the Finnish population found pet ownership was associated with poorer perceived health and higher body mass index scores. A 2006 study identified 11 studies that investigated the positive effect of AAT (animal-assisted therapy) on people living with dementia and, more specifically, on the behavioral and psychological symptoms of dementia (BPSD). Six studies showed a marked reduction in agitation and aggression; four studies observed a positive impact on social behavior; and one study examined the impact of AAIs (animal-assisted interventions) on the nutrition of older people. That s all good news. But other studies point to potential negative consequences of pet ownership on human health, or at best, no impact at all. For example: A large-scale survey of the Finnish population found pet ownership was associated with poorer perceived health and higher body mass index scores. In 2003, researchers conducted a community survey in Australia but found no evidence that pet ownership was associated with cardiovascular health benefits. Older adults (individuals between the ages of 60 and 64 years) with pets appeared to have poorer mental and physical health and use more pain medication. This study, containing a sample size of 2,551 older adults, also failed to find a reduction in visits to the general practitioner within this age group of pet owners. Some researchers have tested suggestions that older people will neglect their own healthcare, avoid seeking medical care, or resist medical advice because of their companion animal. In 1992, researchers estimated that up to 70 percent of pet owners ignore advice to find another home for their pet because of allergies; in 1999, researchers reported that older people avoid medical attention because they fear admission to a hospital or residential care, which would mean handing their pet on to someone else or the greater fear that their pet will be put down. One study concluded that there were no significant differences between a pet therapy group and an exercise control group when participants were observed for self-care, level of orientation or disorientation, and demonstrated symptoms of depression, anxiety, irritability or social withdrawal. So, the data is inconclusive. For that reason, the authors suggest ways to improve the science behind studies of pet-human interaction. We ll leave that to the researchers. The report is interesting reading, and it could open the door for discussion between you and the veterinarian, and between the veterinarian and his or her clients. You can download it at loads/2014/09/companion-animals-and-older-persons- Full-Report-Online.pdf 90 November/December 2014»» Veterinary advantage

91 A stride forward Introducing OSPHOS, the new intramuscular bisphosphonate injection from Dechra Veterinary Products Easily administered via intramuscular injection Well tolerated* in clinical trials Proven efficacy* at 6 months post treatment No Reconstitution required OSPHOS contains clodronate disodium, a bisphosphonate indicated for the control of clinical signs associated with navicular syndrome in horses. OSPHOS is the only FDA-approved bisphosphonate for use in horses that is labeled for intramuscular injection. In a clinical trial evaluating OSPHOS in 86 horses, lameness improved in 74.7% of horses by at least one grade 56 days after treatment. Only 9% of horses displayed clinical signs of being uncomfortable, nervous, colicky and or pawing after receiving OSPHOS. Less than 1% of horses experienced colic requiring treatment. WITH OSPHOS THE BENEFITS ARE CLEAR... Learn more online Call our 24 hour Tech Support (866) As with all drugs, side effects may occur. In field studies, the most common side effects reported were signs of discomfort or nervousness, colic, and/or pawing. OSPHOS should not be used in pregnant or lactating mares, or mares intended for breeding. Use of OSPHOS in patients with conditions affecting renal function or mineral or electrolyte homeostasis is not recommended. Refer to the prescribing information for complete details or visit CAUTION: Federal law restricts this drug to use by or on the order of licensed veterinarian. * Freedom of Information Summary, Original New Animal Drug Application, NADA , for OSPHOS. April 28, 2014.

92 Our role is complex Trusted caregiver. Business manager. Decision maker. Midmark Animal Health is more than just equipment, we re partners in your success after the sale. And from October 1 st to December 31 st, we re offering rebates up to $ 750 with our 2014 Year-End Promotion. To learn more, call MIDMARK or visit: midmarkanimalhealth.com/yearend2014. Better Patient Care. Better Business. Midmark Corporation, Versailles, OH MIDMARK