firstline Strong veterinary teams, compassionate client and patient care INCLUDES THE Dermatology p4 Back Office Blunders An extraterrestrial exam room situation Can you make euthanasia gentler for both of them? p11 Get smart(er) Use smartphones for heartworm reminders 2 4 steps to lock in wellness diagnostics 2 Free team training: Better than a box of kittens (almost) 3 Don t fear the clippers Use this tiny trick to calm and distract pets 6 It s craft time! This DIY project sorts blood pressure cuffs 6 Be the MVP Take this quiz to find out what your boss loves 8 A delicious recipe for team incentives 20 October 2015 Volume 11 Number 10 dvm360.com
PRACTICE YOUR PASSION Our clients can use CareCredit for any kind of care to increase their pet s quality of life. They use it for any medical situation, wellness care, even at our pet daycare next door. It s not just for sick animals. Rod Winchester, DVM Julington Creek Animal Hospital Accepting CareCredit since 2010 CareCredit can be a big help for people who love their pets and are passionate about their care. When you accept the CareCredit healthcare credit card, clients have helpful financing options for the care their pets need. In fact, 91% of cardholders who made veterinary purchases said they are highly satisfied with CareCredit, 1 and more than 20,000 veterinary practices now accept it. Ready to practice more of your passion for the best care? It s easy to get started today. 1. Cardholder Engagement Study, Q4 2014, conducted for CareCredit by Chadwick Martin Bailey. *A Handy Checklist for annual checkups for cats of all sizes; and A Handy Checklist for annual checkups for dogs of all sizes 2015 CareCredit ENROLL NOW by calling 844-812-8112. ALREADY ENROLLED? Call 800-859-9975 opt 1, then 6. Ask for the special offer FREE Canine and Feline Checklists for your clients.* www.carecredit.com Mention offer code FIRST1015VA
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Content Group Editor/Team Channel Director Portia Stewart pstewart@advanstar.com Content Manager Adrienne Wagner Senior Content Specialist Alison Fulton Assistant Content Specialists Katie James, Matthew Kenwright Medical Editor Heather Lewellen, DVM Technical Editor Jennifer Vossman, RVT Digital Content Director Jessica Zemler Digital Design Director Ryan Kramer Art Director Shawn Stigsell Multimedia Contributor Troy Van Horn Editorial Advisory Board Our board members provide critical insights into the challenges veterinary team members face every day, and they help Firstline provide content that is relevant and useful to all practice team members. Dennis Cloud, DVM Sharon DeNayer Debbie Allaben Gair, CVPM Jennifer Graham Bash Halow, CVPM, LVT Marianne Mallonee, CVPM Shawn McVey, MA, MSW Ciera Miller, CVT Julie Mullins Kyle Palmer, CVT Nancy Potter Oriana D. 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Pearls of practice Sample Script: 4 chances for efective wellness diagnostic recommendations Use these four points of contact to recommend wellness screening to pet owners: 1 On the phone receptionist: Mrs. Smith, we re looking forward to Flufy s visit. Our doctor performs a complete physical exam as well as wellness screening to help give us a more complete picture of Flufy s health. I m emailing you a form that explains the tests we recommend and why they re so important for Flufy s heath. 3 Email a copy of your wellness screening handout, such as the one at dvm360.com/wellnessscreen. Tis is also a good time to broach any wellness plans or pet insurance you recommend. When you take the pet s history technician: So I see our receptionist has given you a copy of our wellness screening handout. Did you think of any other questions you have about the screening? a Smart idea When pet owners visit for the first time with their new pet and you make your parasite prevention recommendations, take the next step: Show them how to schedule a reminder for heartworm and flea and tick preventives in their smartphone. This way when they step out the door you re sending them away with a lasting reminder for their pets care. 2 4 During check-in receptionist: Mrs. Smith, it s so good to see you and Flufy today! Did you have a chance to look over the information we emailed? Mrs. Smith: Yes. receptionist: Great! What questions do you have about the procedures? Mrs. Smith: No. receptionist: No problem. I have another copy for you here. Take a minute to look it over and let me know what questions I can answer. During the physical exam Doctor: Our veterinary team has talked to you a bit about the wellness screening we use to give us a better picture of Flufy s health and help us identify problems just as they emerge, so we can ofer more efective treatment. Getting important baseline data today on Flufy will help us pick up on subtle changes in Flufy s health over time. 2 October 2015 Firstline dvm360.com GeTTyimaGeS/lvcandy
PEARLS of practice Better than a box of kittens (almost) OK, nothing really beats a box of kittens, but free team training is almost as nice just a little less furry (and it doesn t shed). Whether you re the manager, a technician, a receptionist, a veterinarian or a team leader, you ll find all the tools you need to hold successful team training from lesson plans and scripts to activities and client handouts to make each program easy to implement and market to pet owners. Open up these free Team Meeting in a Box training sessions: > Talking tips for tense situations. Does your team argue instead of looking for solutions? Could your team use help handling upset clients? If so, this meeting is for you. Te tools teach how to communicate during conflict. > Stop getting burned by ear infections. How you handle otitis externa and ear infections can make or break client bonds and dogs wellbeing. Use this meeting to create a team approach to help pet owners and heal patients. > Coping with Cushing s syndrome. Pets with Cushing s syndrome suffer from a chronic illness that will be managed throughout the pet s life, not cured. Tis meeting will help you deliver a successful team-wide approach. > Pet insurance education. Myths about pet insurance abound. Tis meeting will dispel them and provide tools for your team members to emerge as experts on educating clients about pet insurance. > Armor yourself to prevent pet bites. Keep people and pets safer with this tips, tools and protocols to prevent pets from biting and use safer, stress-free handling techniques. New this month: > Team Meeting in a Box: Getting to yes with veterinary clients. Team members play a vital role in making strong recommendations that stick with clients. Tis meeting will teach your team members how to make these vital recommendations to clients and provide the tools to deliver a successful team-wide approach so that you get to yes with clients. Team meeting in a BOX dvm360.com Firstline October 2015 3
Pearls of practice 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), Lone Star tick (Amblyomma americanum), and Brown dog tick (Rhipicephalus sanguineus) 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. 11.3 One 10.1 to 24.0 lbs. 28.3 One 24.1 to 60.0 lbs. 68 One 60.1 to 121.0 lbs. 136 One Over 121.0 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) 17 4.1 25 12.5 Dry/Flaky Skin 13 3.1 2 1.0 Diarrhea (with and without blood) 13 3.1 7 3.5 Lethargy 7 1.7 4 2.0 Anorexia 5 1.2 9 4.5 1 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 1-888-637-4251 or www.merial.com/nexgard. For additional information about adverse drug experience reporting for animal drugs, contact FDA at 1-888-FDA-VETS or online at http://www.fda.gov/animalveterinary/safetyhealth. 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 preand 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 0-118 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 >97% effectiveness against Dermacentor variabilis, >94% effectiveness against Ixodes scapularis, and >93% effectiveness against Rhipicephalus sanguineus, 48 hours post-infestation for 30 days. At 72 hours post-infestation, NexGard demonstrated >97% effectiveness against Amblyomma americanum 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 141-406, Approved by FDA Marketed by: Frontline Vet Labs, a Division of Merial, Inc. Duluth, GA 30096-4640 USA Made in Brazil. NexGard is a registered trademark, and TM FRONTLINE VET LABS is a trademark, of Merial. 2015 Merial. All rights reserved. 1050-4493-03 Rev. 1/2015 BacK office BlUnderS: Is there life on mars? Back Ofce Blunders are based on true tales of unusual client interactions in the exam room (and beyond). A very confused client can blast a diagnosis conversation into the stratosphere, leaving you in thin air. Check it out at dvm360.com/lifeonmars. Ten email your solutions to handle this challenging client with respect to firstline@advanstar.com. client HandoUt: Understand your pet s fear Te client handout at dvm360.com/ understandfear will help you explain how you work to reduce pets fear and even why you may choose to reschedule routine appointments and care if you determine it s in pets best interest. Scan the QR code to watch it now. from your veterinarian Understand your pet s fear our practice is committed to low-stress handling techniques. Here s why and how you can help reduce your pet s stress. A ny time your pet feels threatened, whether that threat is real or imagined, changes occur immediately within his or her body to prepare for fight or flight. Tese changes occur because your pet s nervous system releases a variety of stress hormones that have profound effects across many different systems in the body. Te release of these hormones results in the immediate availability of energy and oxygen intake and decreases blood flow to areas not critical for movement. Tis can also inhibit digestion, growth, immune function, reproduction and pain perception. When your pet is under stress, the memories of any events occurring during that time will be very powerful, and how your pet is handled during veterinary visits may have long-standing consequences for our future ability to handle him or her. Why we choose lower-stress handling When stressors are unremitting and the stress response continues, virtually every system within the body can be pathologically affected to varying degrees cardiovascular, metabolic, reproductive, gastrointestinal, immune and integumentary (skin). Te results can include myopathy (muscle disorders), fatigue, hypertension, decreased growth rates, gastrointestinal distress and suppressed immune function, with subsequent impaired disease resistance. Chronic stress can even lead to structural and functional changes in the brain, and, when extreme conditions persist, permanent damage can result. Why we may stop a visit and ask you to return later When pets show subtle signs of fear or anxiety during a veterinary visit, if we proceed without attempting to ameliorate the stress, we may not change the pet s behavior at that time, but the animal will learn from the experience and will likely behave in a more fractious manner at the next visit. Anything we do to relieve the stress of the visit will pay off in future visits being less difficult for your pet. Remember that frequent, distressing experiences can negatively impact an animal s overall health and well-being. Also, by continuing with a procedure when an animal is showing signs of anxiety, we are teaching the animal that its normal means of communication is meaningless. If we do that, what recourse might that animal have but to develop other less tolerable means of communicating its discomfort? To avoid this scenario, when we identify signs of fear especially during elective procedures we may stop the visit and ask you to return at a later time when the pet is less stressed. Choices may include giving your pet medication for decreasing anxiety before the next visit or training sessions to teach your pet that veterinary procedures can be painless and even fun! Source: VAlArie V. TyneS, DVM, DAcVB GeTTyiMAGeS/AnDriy BAnDurenko 4 October 2015 Firstline dvm360.com
Killing fleas and ticks can be just this easy. With NexGard (afoxolaner), flea and tick control is convenient for pet owners since dogs love taking the soft, beef-flavored chew. 1 POWERFUL flea and tick killing all month long CONVENIENT monthly dosing owners are used to EASY for owners to give 1 and for veterinarians to dispense Prescription only with anti-diversion technology See brief summary on page 04 1 Data on File at Merial. NexGard is a registered trademark, and FRONTLINE VET LABS is a trademark, of Merial. 2015 Merial, Inc., Duluth, GA. All rights reserved. NEX15TRADEADA (01/15). 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.
Pearls of practice Fear-Free in action: Take the scary out of clippers We used a Hansel and Gretel trail of cheerios and a bottle of squeeze cheese to coach a shy pet through a potentially scary veterinary visit. By Dr. Amy Learn This is Sweetie. She is never aggressive, but doesn t like visiting the vet. Usually she puts on the brakes when she enters the room. We didn t want to drag her. So instead we left a trail of cheerios, which she followed down the hallway to the treatment area like Hansel and Gretel. Clippers are one of the scariest things in the world for a shy dog. We decided that this type of scary needed something special. Squeeze cheese did the trick. She was so happy to eat, she stood still with barely any restraint and let us clip the side of her face right near her ear. Tis visit was Fear-Free all the way! Dr. Amy Learn is a veterinarian at Cary Street Veterinary Hospital in Richmond, Virginia. get paid for your great idea Have a pearl to share? Send it to firstline@ advanstar.com. We ll pay $50 for every tip we publish. Get crafty to organize blood pressure cuffs Stop stufng your cufs in that bottomless pit you call a drawer in your veterinary treatment area. We made a cuf holder out of clothespins and some craft materials from Michael s. We use it to keep our blood pressure cufs in good shape and from getting holes. Kiera Cardinale VCA North Coast Animal Hospital Encinitas, California 6 October 2015 Firstline dvm360.com
Dr. Marty Becker is on a mission to make Fear-Free veterinary visits a reality for pets. He s outspoken about the need, and his message is eye-opening. In this symposium, you ll learn how to use Fear-Free concepts to: put animals and owners at ease deliver a higher level of compassionate care earn repeat visits. You will also receive a copy of the new brochure Top 10 Ways to Get Started with Fear-Free Veterinary Visits. Marty Becker, DVM Fear-Free tools to transform patient interactions, boost visits, and enhance your practice. Richard LeCouteur, BVSC, PhD, DACVIM (Neurology), DECVN Te science of fear in animals: It s real. It s damaging. It s our responsibility. Lisa Radosta, DVM, DACVB Fear-Free techniques: Clinical behavioral evidence that they work. Jonathan Bloom, DVM Modern love Making pets happy at the veterinary hospital. FEAR-FREE PRACTICE SYMPOSIUM Saturday, December 5, 2015 *7:15 AM - 12:20 PM San Diego Convention Center Visit TheCVC.com for details. Proud sponsors of the Fear-Free Initiative *Eye Opener Breakfast will open at 6:45 AM.
PROFESSIONAL growth Want to be your boss s favorite? Take this quick quiz to see if you re stacking up the skills that will get you noticed. By Kristine Suszczynski Our hospital has a staff of outstanding team members. My confession: A few stand out from the rest and are my favorites. I understand we re not supposed to use the term favorites, but I m going to use it for the sake of this article. So what s different about my favorite employees? What makes them stand out from all of our other really good employees? Te difference is, they own it. Here are the skills they possess. Take the three-part Own it quiz below and see how you measure up. 1 Possess a feeling of ownership of the practice Check all of the skills you display at work: Maintain correct protocols and medical records. Explain all estimates to clients with care and consideration. Enter all client communications into the computer. Offer outstanding client and patient care. Treat clients like they re friends and treat patients like they re your own. Preserve the integrity of the practice. Hold yourself up to high ideals and standards and help your fellow employees achieve higher standards by working with others. Recognize that what you do is all for the greater good of the practice. SCORE YOURSELF Tally your checks for this box. 0-2 Well, at least you re honest. 3-4 You re on the right track. Just keep swimming! 5-6 Teacher s pet! Just kidding. You re awesome! 8 October 2015 Firstline dvm360.com GETTYIMAGES/RAWPIXEL LTD
PROFESSIONAL growth 2 Confess your mistakes and work through challenges Check all of the skills you display at work: Admit your mistakes and acknowledge that we re all human and we will make mistakes. Don t hide your mistakes or blame others. Instead, say things like, Oh yeah that was me! I totally did that wrong. I guess my panties were on too tight that day. (Yes, a team member actually said that to me. It was very funny, easily changing attitudes about the mistake, and everyone was able to move on). Don t make up answers. If you don t know the answer, don t be scared to say I don t know. Ten quickly follow that with, But I ll find out for you. Express your thoughts, even when it s hard for you. For example if you re having a difficult day, talk to your managers about it. Use them as a source to help think through problems and discuss possible solutions. Realize that your manager is there to help fix the bad things. SCORE YOURSELF Tally your checks for this box. 0-2 Seriously?! OK. Stop the blame game and you can gain a few points back. 3-4 Solid performance. Now push yourself. This certifies that completed the Own It quiz and owned it on, 20. 5 Nobody likes a suck up! Just kidding. Mostly. Firstline Practice Manager Firstline Magazine When you finish, total your score for all three sections. If it s more than 15, visit dvm360.com/ favoriteteam and download your free certificate. dvm360.com Firstline October 2015 9
PROFESSIONAL growth 3 Own it individually with your attitude Check all of the skills you display at work: Be proud to work at your hospital. It will show on your face and through your work. Take personal pride in what you do. While every single employee deserves public appreciation, my favorite employees also privately appreciate themselves they don t rely on outside appreciation to know that they re doing a great job. Own your positive and enthusiastic attitude. Only you are responsible for your own attitude. So choose to continue to smile through the difficult times and exhibit no negativity or passive aggressiveness. Use the proper channels to vent if you need to. Never do it in the middle of the treatment room or after you hang up the phone after a conversation with a difficult client. Understand beyond yourself. See the whole picture, and don t take difficult client communications or situations personally. Approach your manager with problems and possible solutions, not just problems. Be kind and considerate to your fellow team members. Give of your time and share your expertise to train new employees because you understand that great training is imperative for a wellfunctioning team. SCORE YOURSELF Tally your checks for this box. Bottom line: My hospital is very lucky with our current team. All of our employees exhibit many of these qualities, and I have a hospital full of favorites. Yay, team! Kristine Suszczynski is the hospital manager at Portland Veterinary Specialists in Portland, Maine. 0-2 Meh. You re probably getting noticed at your practice, but not for the right reasons. 7-8 3-6 We d hire ya! Your kindergarten teacher would be very proud. 10 October 2015 Firstline dvm360.com
client relations Gentle gestures for euthanasia How you handle a pet s euthanasia is one of the most memorable moments you share with clients. So make sure you strike the right note. By Brent Dickinson Short of a walk-in or emergency euthanasia, any time you must euthanize a pet, your veterinary team needs to take special steps to assure the utmost comfort for pets and their owners. At our clinic, we like to schedule a time for these events when we have no other appointments booked. If you re saying to yourself, Our practice simply can t do that you couldn t be more wrong. If you need to perform a euthanasia during standard visiting hours, you may choose to block out the appointment slot immediately following a euthanasia, giving you ample time to perform your duties. Don t worry about the potential of lost income. It s more important to provide for clients in their time of need. Let s not forget, last impressions are just as important as first ones. I ll give you an example. Enter a party with a gift and a smile, then circle the room and entertain everyone in attendance with a friendly, personal greeting. Tey ll think highly of you. Ten, leave the same party drunk, stumbling and slinging profanity. You re unlikely to be invited back. Te same goes for veterinary patients. You can win them over with the best first exam they ve ever experienced, and continue this trend with annual visits. But perform poorly with their pet s final visit, and they ll find someone new and tell their friends. Here are a few pointers to show your gentle side when you re helping clients say goodbye to their beloved pet. GETTYIMAGES/JASON VAN DER VALK dvm360.com Firstline October 2015 11
client relations 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. Body Weight 2 to 8 lbs. 8.1 to 25 lbs. 25.1 to 50 lbs. 50.1 to 100 lbs. Over 100 lbs. Milbemycin Oxime per chewable Dosage Schedule Lufenuron per chewable Praziquantel per chewable Number of chewables 2.3 mg 46 mg 22.8 mg One 5.75 mg 115 mg 57 mg One 11.5 mg 230 mg 114 mg One 23.0 mg 460 mg 228 mg One 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 Virbac at 1-800-338-3659 or the FDA at 1-888-FDA-VETS. Information for Owner or Person Treating Animal Echinococcus multilocularis and Echinococcus granulosus are tapeworms found in wild canids and domestic dogs. E. multilocularis and E. granulosus can infect humans and cause serious disease (alveolar hydatid disease and hydatid disease, respectively). Owners of dogs living in areas where E. multilocularis or E. granulosus are endemic should be instructed on how to minimize their risk of exposure to these parasites, as well as their dog s risk of exposure. Although SENTINEL SPECTRUM was 100% effective in laboratory studies in dogs against E. multilocularis and E. granulosus, no studies have been conducted to show that the use of this product will decrease the incidence of alveolar hydatid disease or hydatid disease in humans. Because the prepatent period for E. multilocularis may be as short as 26 days, dogs treated at the labeled monthly intervals may become reinfected and shed eggs between treatments. Manufactured for: Virbac AH, Inc. P.O. Box 162059, Ft. Worth, TX 76161 NADA #141-333, Approved by FDA 2015 Virbac Corporation. All Rights Reserved. SENTINEL and SPECTRUM are registered trademarks of Virbac Corporation. 02/15 A script for success Make a script to explain the process of euthanasia to the client, and have your entire veterinary team read it until they have it memorized. You should point out the process of cleaning and preparing the injection site, the speed in which you expect the drug to take effect and the possibilities of activity after the process (for example, muscle activity, sighs, eyes not closing and so on). Tis helps clients prepare themselves, as many people aren t comfortable around needles. Or some people expect the process to take half an hour, when it sometimes takes just seconds. All dogs go to heaven Was the pet famous for being aggressive at every visit? Keep your comments to yourself. If the owner mentions the pet s track record, feel free to laugh along or simply agree just don t bring up the time it attempted to remove your coworker s fingers. Remember this is a troubling time for the owner, no matter what your opinion of Fido is. A BrIGht IDEA: Dim the lights When we have a euthanasia in the house we turn off one set of lights in the pharmacy. this alerts staff coming and going to keep their voices down, that there s a sensitive situation occurring. i like it myself because i see it immediately when i come out of my office. Our doors and walls are thin. the last thing clients want to hear when they re so upset is random personal and business chatter. Kim Fish Practice Manager Seville Animal Hospital, Seville, Ohio 12 October 2015 Firstline dvm360.com GETTYIMAGES/IGORR1; JONATHAN KITCHEN
Smart is 6-in-1 protection. Take parasite protection further with a broad coverage chewable dogs will love. * 1 2 Offer chewy, tasty, and easy coverage against both internal and external parasites. To order, contact your distributor or call your Virbac representative at 1-844-4-VIRBAC (1-844-484-7222). Dogs should be tested for heartworm prior to use. Mild hypersensitivity reactions have been noted in some dogs carrying a high number of circulating microfilariae. Treatment with fewer than 6 monthly doses after the last exposure to mosquitoes may not provide complete heartworm prevention. Please see full product label for more information, or visit www.virbacvet.com. References: 1. Trifexis [product label]. Indianapolis, IN: Elanco; 2014. 2. Heartgard Plus [product label]. Duluth, GA: Merial Inc; 2011. * A. caninum. Prevents flea eggs from hatching; is not an adulticide. 2015 Virbac Corporation. All Rights Reserved. SENTINEL and SPECTRUM are registered trademarks of Virbac Corporation. TRIFEXIS is a registered trademark of Elanco. HEARTGARD and the Dog & Hand logo are registered trademarks of Merial. 8/15 15724 See brief summary on page 12
client relations CHEWABLES CAUTION: Federal (U.S.A.) law restricts this drug to use by or on the order of a licensed veterinarian. INDICATIONS: For use in dogs to prevent canine heartworm disease by eliminating the tissue stage of heartworm larvae (Dirofilaria immitis) for a month (30 days) after infection and for the treatment and control of ascarids (Toxocara canis, Toxascaris leonina) and hookworms (Ancylostoma caninum, Uncinaria stenocephala, Ancylostoma braziliense). DOSAGE: HEARTGARD Plus (ivermectin/pyrantel) should be administered orally at monthly intervals at the recommended minimum dose level of 6 mcg of ivermectin per kilogram (2.72 mcg/lb) and 5 mg of pyrantel (as pamoate salt) per kg (2.27 mg/lb) of body weight. The recommended dosing schedule for prevention of canine heartworm disease and for the treatment and control of ascarids and hookworms is as follows: Color Coding 0n Dog Chewables Ivermectin Pyrantel Foil Backing Weight Per Month Content Content and Carton Up to 25 lb 1 68 mcg 57 mg Blue 26 to 50 lb 1 136 mcg 114 mg Green 51 to 100 lb 1 272 mcg 227 mg Brown HEARTGARD Plus is recommended for dogs 6 weeks of age and older. For dogs over 100 lb use the appropriate combination of these chewables. ADMINISTRATION: Remove only one chewable at a time from the foil-backed blister card. Return the card with the remaining chewables to its box to protect the product from light. Because most dogs find HEARTGARD Plus palatable, the product can be offered to the dog by hand. Alternatively, it may be added intact to a small amount of dog food. The chewable 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 for a few minutes after administration to ensure that part of the dose is not lost or rejected. If it is suspected that any of the dose has been lost, redosing is recommended. HEARTGARD Plus should be given at monthly intervals during the period of the year when mosquitoes (vectors), potentially carrying infective heartworm larvae, are active. The initial dose must be given within a month (30 days) after the dog s first exposure to mosquitoes. The final dose must be given within a month (30 days) after the dog s last exposure to mosquitoes. When replacing another heartworm preventive product in a heartworm disease preventive program, the first dose of HEARTGARD Plus must be given within a month (30 days) of the last dose of the former medication. If the interval between doses exceeds a month (30 days), the efficacy of ivermectin can be reduced. Therefore, for optimal performance, the chewable must be given once a month on or about the same day of the month. If treatment is delayed, whether by a few days or many, immediate treatment with HEARTGARD Plus and resumption of the recommended dosing regimen will minimize the opportunity for the development of adult heartworms. Monthly treatment with HEARTGARD Plus also provides effective treatment and control of ascarids (T. canis, T. leonina) and hookworms (A. caninum, U. stenocephala, A. braziliense). Clients should be advised of measures to be taken to prevent reinfection with intestinal parasites. EFFICACY: HEARTGARD Plus Chewables, given orally using the recommended dose and regimen, are effective against the tissue larval stage of D.immitis for a month (30 days) after infection and, as a result, prevent the development of the adult stage. HEARTGARD Plus Chewables are also effective against canine ascarids (T. canis, T. leonina) and hookworms (A. caninum, U. stenocephala, A. braziliense). ACCEPTABILITY: In acceptability and field trials, HEARTGARD Plus was shown to be an acceptable oral dosage form that was consumed at first offering by the majority of dogs. PRECAUTIONS: All dogs should be tested for existing heartworm infection before starting treatment with HEARTGARD Plus which is not effective against adult D. immitis. Infected dogs must be treated to remove adult heartworms and microfilariae before initiating a program with HEARTGARD Plus. While some microfilariae may be killed by the ivermectin in HEARTGARD Plus at the recommended dose level, HEARTGARD Plus is not effective for microfilariae clearance. A mild hypersensitivity-type reaction, presumably due to dead or dying microfilariae and particularly involving a transient diarrhea, has been observed in clinical trials with ivermectin alone after treatment of some dogs that have circulating microfilariae. Keep this and all drugs out of the reach of children. In case of ingestion by humans, clients should be advised to contact a physician immediately. Physicians may contact a Poison Control Center for advice concerning cases of ingestion by humans. Store between 68 F - 77 F (20 C - 25 C). Excursions between 59 F - 86 F (15 C - 30 C) are permitted. Protect product from light. ADVERSE REACTIONS: In clinical field trials with HEARTGARD Plus, vomiting or diarrhea within 24 hours of dosing was rarely observed (1.1% of administered doses). The following adverse reactions have been reported following the use of HEARTGARD: Depression/lethargy, vomiting, anorexia, diarrhea, mydriasis, ataxia, staggering, convulsions and hypersalivation. SAFETY: HEARTGARD Plus has been shown to be bioequivalent to HEARTGARD, with respect to the bioavailability of ivermectin. The dose regimens of HEARTGARD Plus and HEARTGARD are the same with regard to ivermectin (6 mcg/ kg). Studies with ivermectin indicate that certain dogs of the Collie breed are more sensitive to the effects of ivermectin administered at elevated dose levels (more than 16 times the target use level) than dogs of other breeds. At elevated doses, sensitive dogs showed adverse reactions which included mydriasis, depression, ataxia, tremors, drooling, paresis, recumbency, excitability, stupor, coma and death. HEARTGARD demonstrated no signs of toxicity at 10 times the recommended dose (60 mcg/kg) in sensitive Collies. Results of these trials and bioequivalency studies, support the safety of HEARTGARD products in dogs, including Collies, when used as recommended. HEARTGARD Plus has shown a wide margin of safety at the recommended dose level in dogs, including pregnant or breeding bitches, stud dogs and puppies aged 6 or more weeks. In clinical trials, many commonly used flea collars, dips, shampoos, anthelmintics, antibiotics, vaccines and steroid preparations have been administered with HEARTGARD Plus in a heartworm disease prevention program. In one trial, where some pups had parvovirus, there was a marginal reduction in efficacy against intestinal nematodes, possibly due to a change in intestinal transit time. HOW SUPPLIED: HEARTGARD Plus is available in three dosage strengths (See DOSAGE section) for dogs of different weights. Each strength comes in convenient cartons of 6 and 12 chewables. For customer service, please contact Merial at 1-888-637-4251. ASk the ExpErt: A client wants to schedule a euthanasia on a busy Saturday QAt our clinic we set aside at least a half hour for euthanasia. On Saturdays we book every 15 minutes. What is the best way to tell a client we prefer not to do a euthanasia on Saturdays for their benefit? Start by demonstrating to the pet owner that you understand what they re going through when they re making the call to euthanize their pet. As somebody who cares about your client, say something like, I know this is an important moment. And I m afraid that with all of the commotion that happens on a busy Saturday at our practice that you and your pet aren t going to feel as comfortable as you could. And suggest times for them to come in where you know they will be more comfortable. Ten let them know if they feel they need to have the procedure done on Saturday, that we will do it. Watch the rest of Bash s answer at dvm360.com/ EuthanasiaSchedule. Bash Halow, LVT, CVPM, is a Firstline Editorial Advisory Board member and partner with Halow Tassava Consulting. Scan the QR code to watch now. HEARTGARD and the Dog & Hand logo are registered trademarks of Merial. 2015 Merial, Inc., Duluth, GA. All rights reserved. HGD14TR2015TRADEAD-5 (01/15). 14 October 2015 Firstline dvm360.com
CLIENT relations Silence is golden For heaven s sake, turn off your cell phone. In fact, turn off every phone for a square mile. Tat includes your clinic phones. Tey all have a ringer off mode. Use it from time to time, and have someone on the other side of the building taking calls during this time. Our clinic took this one a step further and had a sign made. It was cheap, and customers, drug reps and even our UPS guy think it s such a nice gesture. Stay well-stocked Offer the following, and never charge for any of it. Bottled water (cold or room temperature). Ask for the client s preference. Don t keep these in any refrigerator that will impart an odor onto the bottles. A comfortable seat: non-rolling, as some people use the chair for standing support in a time of grief. Soft, high-end tissues. No one wants to wipe their tears with cheap, sandpaper tissues. Spend a little money and get the soft, aloe or lotion-infused kind. Teir comfort goes a long way. A nicely-scented candle, like eucalyptus or ylang-ylang, to help offset any pet odors in the practice. Try to light this about half an hour before the appointment, if possible, and keep it up and away from where pets or children could come in contact with it. A guided walk to the restroom, if the client needs to visit. It doesn t hurt to wait just outside, as some people, during emotional distress, can pass out and require assistance. Don t leave a message after the beep Some practices receive the ashes of pets recently cremated so pet owners can pick them up in person, instead of having them shipped. When they arrive, you can call the owners to notify them, but don t leave a message. Sensitive ears like those of young children or emotionally affected adults could be on the other end. Simply call any numbers you have on record until you get in touch with someone. If this doesn t work, send a letter to the home address on record. GETTYIMAGES/STUARTBUR; BERNARD VAN BERG / EYEEM; dvm360.com Firstline October 2015 15
client relations Handle with care Any time you must move either the pet s body (try to avoid this at all costs) or the pet s returned ashes, treat them like a delicate egg. It can be helpful to notify staff that you will be moving such things, so they can stop at doorways and keep their voices to a minimum. If you were picking up your pet s remains, would you want to hear people laughing in the background? Also, never, ever pass a pet s remains over a front desk or any other sort of physical barrier. Walk them around, gently place them in the hands of your clients and then walk them to their car. It takes only a moment of your day, but it will make a big difference to them. Holding an umbrella over them on a rainy day is especially thoughtful. Offer simple memorials after euthanasia At Seville Animal Hospital we try to capture the end of our clients journey with their pet in memorable ways. In addition to the traditional sympathy card and rainbow bridge book marker, we make a paw print impression and we snip a tuft of fur and put in a nice cellophane bag with a poem. Around the holidays we will even put a tuft of fur in a glass Christmas ornament. Losing a pet is never easy. We feel that offering them many keepsakes to memorialize their pet helps ease their pain. Kim Fish Practice Manager Seville Animal Hospital Seville, Ohio In the typical practice, or any given day, we re all busy and running around trying to accomplish all our tasks at hand. It s just another day for us, but for grieving pet owners, it s a day they may never forget. Let s do our best to make sure they have the best possible memories of that day. We owe that to our furry friends that stood by their side. Brent Dickinson is the practice manager at Dickinson-McNeill Veterinary Clinic in Chesterfield, New Jersey. 16 October 2015 Firstline dvm360.com GETTYIMAGES/PIRMIN FÖLLMI / EYEEM
dvm360.com/products Products & Services SHOWCASE DENTAL PRODUCTS lebalab Search Search for the company name you see in each of the ads in this section for FREE INFORMATION! dvm360.com Firstline October 2015 17
MARKETPLACE dvm360.com IDENTIFICATION SYSTEMS TabBand www.tabband.com 800.521.5123 Strong Temporary Collars Content Licensing for Every Marketing Strategy TAGS Outdoor Direct Mail Marketing solutions ft for: Tradeshow/POP Displays Social Media Print Advertising Radio & Television Logo Licensing Reprints Eprints Plaques Get more product information online Researching a purchase? dvm360.com offers hundreds more product listings. Just visit dvm360.com/products Leverage branded content from Firstline to create a more powerful and sophisticated statement about your product, service, or company in your next marketing campaign. Contact Wright s Media to fnd out more about how we can customize your acknowledgements and recognitions to enhance your marketing strategies. For more information, call Wright s Media at 877.652.5295 or visit our website at www.wrightsmedia.com 18 October 2015 Firstline dvm360.com
dvm360.com MARKETPLACE Your go-to source for all things veterinary > Cutting-edge clinical information > Breaking news > Practice-building insights > Team-training tools > Community > The CVC in Kansas City, Washington D.C., and San Diego The definitive source for veterinarians and team members for veterinary news, medicine, business, hospital design, events, and community. And the portal site for dvm360, Veterinary Medicine, Veterinary Economics, and Firstline. Firstline (Print ISSN: 1095-0613, Digital ISSN: 2150-6574) is published monthly by UBM Life Sciences, 131 W. First St., Duluth, MN 55802-2065. Subscription rates: one year $21.00, two years $36.50 in the United States & Possessions; $31.50 for one year, $57.00 for two years in Canada and Mexico; all other countries $42.00 for one year, $78.00 for two years. Single copies (prepaid only) $10.00 in the United States; $14.00 in Canada, Mexico, and $16.00 in all other countries. Periodicals Postage Paid at Duluth, MN and additional mailing offices. POSTMASTER: Please send address changes to Firstline, P.O. Box 6086, Duluth, MN 55806-6086. Canadian G.S.T. number: R-124213133RT001. PUBLICATIONS MAIL AGREEMENT NO. 40612608. Return Undeliverable Canadian Addresses to: IMEX Global Solutions, P. O. Box 25542, London, ON N6C 6B2, CANADA. Printed in the U.S.A. 2015 Advanstar Communication Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including by photocopy, recording, or information storage and retrieval without permission in writing from the publisher. Authorization to photocopy items for internal/educational or personal use, or the internal/educational or personal use of specific clients is granted by Advanstar Communication Inc. for libraries and other users registered with the Copyright Clearance Center, 222 Rosewood Dr. Danvers, MA 01923, 978-750-8400 fax 978-646-8700 or visit http://www.copyright.com online. For uses beyond those listed above, please direct your written request to Permission Dept. fax 440-756-5255 or email: mcannon@advanstar.com. UBM Life Sciences provides certain customer contact data (such as customers name, addresses, phone numbers, and e-mail addresses) to third parties who wish to promote relevant products, services, and other opportunities that may be of interest to you. If you do not want UBM Life Sciences to make your contact information available to third parties for marketing purposes, simply call toll-free 866-529-2922 between the hours of 7:30 a.m. and 5 p.m. CST and a customer service representative will assist you in removing your name from UBM Life Sciences s lists. Outside the U.S., please phone 218-740-6477. Firstline does not verify any claims or other information appearing in any of the advertisements contained in the publication and cannot take responsibility for any losses or other damages incurred by readers in reliance on such content. Firstline cannot be held responsible for the safekeeping or return of unsolicited articles, manuscripts, photographs, illustrations, or other materials. Address correspondence to Firstline, 8033 Flint, Lenexa, KS 66214; (913) 871-3800; e-mail firstline@advanstar.com. To subscribe, call toll-free 888-527-7008. Outside the U.S. call 218-740-6477. dvm360.com Firstline October 2015 19
BY the numbers A recipe for affordable team incentives Consider these sweet (and affordable) incentives to appreciate your veterinary team. You can have your cake and eat it too! Do your team members want more benefits? (Yes.) Do you need to balance the business and the benefits you can afford to offer? (Yes.) Does this recipe sound impossible? It s not. In 2011 team members at my practice, Newberry Animal Hospital in Gainesville, Florida, were asking for more benefits. We already offered: Heath care Dental insurance Life insurance A matching IRA I wasn t sure what else they were looking for, so here s what I whipped up and how I did it. Ingredients: Directions: Step 1 By Katie Hill, CVT, CVPM Get specific when team members ask for more benefits. Ask what they re really looking for. I discovered my team members were looking for special incentives for them and their pets. Step 2 Listen to your team, and then brainstorm affordable options. For our practice, the solution was to offer an additional 20 percent off any blood work we sent to an outside lab and a paid day off work for the team member s birthday. An open mind Imagination Step 3 Sweeten the deal. We allow team members to take their birthday leave eight paid hours anytime during the week of their birthday so they can enjoy a long weekend. Tey simply need to notify me the day before we post the schedule. To this day, when new hires come on board with us they re always thrilled with the birthday pay incentive. Katie Hill, CVT, CVPM, is the practice manager at Newberry Animal Hospital in Gainesville, Florida, and one of the 10 finalists for the Veterinary Economics Practice Manager of the Year award, sponsored by Nationwide. Read more about past Practice Manager of the Year nominees and winners at dvm360.com/pmoy. 20 October 2015 Firstline dvm360.com GETTYIMAGES/IRYNA MELNYK
exceptional continuing education that supports the way you practice veterinary medicine today Register today at TheCVC.com, or call 800.255.6864, ext. 6. You re going to learn and laugh along the way. It s a lot like dealing with real clients. CVC San Diego Speaker, Andrew Roark, DVM, MS about his dvm360 Full Circle sessions The angry client experience. 2015 Advanstar Communications, Inc. CALL 800.255.6864, ext. 6 CLICK TheCVC.com EMAIL cvc@advanstar.com FOLLOW
SAY NOTO HEARTWORMS. NOTO HOOKWORMS. NOTO ROUNDWORMS. Only HEARTGARD Plus (ivermectin/pyrantel) prevents heartworm disease and treats and controls pre-existing hookworms and roundworms with a Real-Beef Chewable dogs love to take. 1-5 SAY YES to HEARTWORMS HOOKWORMS/ ROUNDWORMS PUPPIES @ 6 WEEKS PREFERRED 1-6 SATISFACTION GUARANTEED 7 IMPORTANT RISK INFORMATION: HEARTGARD Plus (ivermectin/pyrantel) is well tolerated. All dogs should be tested for heartworm infection before starting a preventive program. Following the use of HEARTGARD Plus, digestive and neurological side effects have rarely been reported. For more information, please visit www.heartgard.com. HEARTGARD and the Dog & Hand logo are registered trademarks of Merial. All other marks are the property of their respective owners. 2015 Merial, Inc. Duluth, GA. All rights reserved. HGD14TR2015TRADEAD-5 (01/15). 1 Of dogs showing a preference in two studies, all dogs preferred HEARTGARD Plus Chewables to TRIFEXIS (spinosad + milbemycin oxime) beef-flavored chewable tablets; Executive Summary VS-USA-37807 and VS-USA-37808. 2 Of dogs showing a preference in two studies conducted, all dogs preferred HEARTGARD Plus Chewables to SENTINEL (milbemycin oxime-lufenuron) chewable tablets; Executive Summary VS-USA-37809 and VS-USA-37810. 3 Of dogs showing a preference in two studies conducted, all dogs preferred HEARTGARD Plus Chewables to IVERHART PLUS (ivermectin/pyrantel) beef-flavored tablets; Executive Summary VS-USA-37811 and VS-USA-37812. 4 Of dogs showing a preference in two studies conducted, all dogs preferred HEARTGARD Plus Chewables to IVERHART MAX (ivermectin/pyrantel/praziquantel) beef-flavored tablets; Executive Summary VS-USA-37813 and VS-USA-37814. 5 Of dogs showing a preference in one study conducted, all dogs preferred HEARTGARD Plus Chewables to SENTINEL SPECTRUM (milbemycin oxime/ praziquantel/lufenuron) beef-flavored tablet; Executive Summary VS-USA-37801. 6 Opinion Research Corporation, Heartworm Prevention Medication Study, 2012. Data on file at Merial. 7 Data on file at Merial. See brief summary on page 14