CVMA VOICE 2016:1 by CVMAMedia

CV M A VO ICE

Today’s Voice, Tomorrow’s Vision

• Compounding Drugs: A Changing Landscape • CVMA Strategic Framework • Advocacy: Protecting Veterinary Practice in Colorado

2016, ISSUE #1 CVMA Voice 201 6 : 1 | PAGE 1

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CV M A VO ICE

TABLE OF CONTENTS Inside President’s Post . . . . . . . . . . . 4 Briefings . . . . . . . . . . . . . . . . . 5 Of Note . . . . . . . . . . . . . . . . . . 6

12 Veterinary Volunteers Leave Tails Wagging in Denver Neighborhood

CVMA Chapter Visits . . . . . . . . . . . . . . . . . . .

Compounding Drugs: A Changing Landscape . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CVMA Strategic Framework . . . . . . . . . . . . . 10 Veterinary Volunteers Leave Tails Wagging in Denver Neighborhood . . . . . . . 12 AVMA Update . . . . . . . . . . . . . . . . . . . . . . . . . 13 Pilot Project Starts for Metro Denver C.A.T. . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Transfers and Heartworm: The Young-adult Problem . . . . . . . . . . . . . . . 15

Government Affairs . . . . . . . . 16

Transfers and Heartworm: The Young-adult Problem

Advocacy: Protecting Veterinary Practice in Colorado . . . . . . . . . . . . . . . . . . . . 16 How CVMA Shapes Public Policy in Colorado . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Need to Write Health Certificates on the Go? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Science Update . . . . . . . . . . 22 Colorado Zoonosis Summary . . . . . . . . . . .

CVMA Events and Deadlines April 21 CVMA Media Training Denver April 21 Secrets to Lead Phone Shoppers to Become Clients Webinar April 29 Taking Your Career to the Next Level: Set Yourself Up for Success Denver May 19 Look and Talk Like a Veterinary Professional Webinar June 1 Personal Wellbeing Webinar June 3–5 CE West Palisade June 7 Supercharge Your Team’s Communication Webinar June 16 Take Control of Scheduling Calls Webinar

Predicting the Unpredictable Using Evolving Molecular Technology . . . . . . . . . 24

In Practice . . . . . . . . . . . . . . . . 26

Rx Medication Abuse and Safe Prescribing Practices

Be Speedy When Answering Incoming Calls . . . . . . . . . . . . . . . . . . . . . . . . . 26 Rx Medication Abuse and Safe Prescribing Practices . . . . . . . . . . . . . . . . . . . 28 Why Policies and Procedures Will Help Your Hospital Succeed . . . . . . . . . . . . 29 What is “Science Based” Dog Training and Pet Behavior Consulting? . . . . . . . . . .

CVMA News . . . . . . . . . . . . . 36 Chapter 6 | Denver Area . . . . . . . . . . . . . . . . . 36

CVMA Service Awards

CVMA Service Award Nominations . . . . . . 38

Our Mission

Service Awards 2016 Nominiation Form . . . . . . . . . . . . . . . . . . . . . 39

To enhance animal and human health and welfare, and advance the knowledge and wellbeing of Colorado veterinarians.

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Colorado Veterinary Medical Association

PRESIDENT’S POST

191 Yuma Street Denver, Colorado 80223 303.318.0447 or 800.228.5429 Fax 303.318.0450 info@colovma.org www.colovma.org MANAGING EDITOR Cami Cacciatore PUBLISHER Ralph Johnson The CVMA VOICE is published quarterly to members and once a year to nonmembers free of charge. Information and advice presented in this publication do not necessarily represent the views of CVMA.

Deadlines for Submission All articles, contributions, and display ads must be received in the CVMA office by the dates below. For more information or to obtain a rate schedule, contact the CVMA office at 303.318.0447 or info@cvma.org. Issue Issue Issue Issue

#1 — January 15 #2 — April 15 #3 — July 15 #4 — October 15

Curtis Crawford President

Some ideas look great on the surface. Kind of like the time I was putting Armor All on my old pickup dashboard, saw how shiny and new it made it look, and then decided to try it on the faded vinyl seats and floor mats. Boy, it made them look good. But then the first time I climbed up into that sparkling cab and plopped my butt down, I slid off the edge of that bench seat and ended up sitting on the curb. Why? ‘Cause Armor All not only makes things look shiny and new, it also makes them slicker than snot on a doorknob. (I would have known that if I had read the warnings, but hey, I’m a guy). In medicine, we would call it an adverse reaction, a side-effect, or a complication. In politics, they call it an unintended consequence. Either way, it is a royal pain in the posterior. As I am writing this column, the 2016 Colorado Legislative Session is under way. Lawmakers are considering numerous bills and initiatives that could become the laws that you and I must live with tomorrow. Among the things they must consider: Is this bill really necessary? Would this law actually do what it is intended to do? How are we going to pay for it? Who am I going to upset and who am I going please with this legislation? We charge our elected officials with making these decisions and trust them to do what is right for Colorado. Our legislators do not work within a bubble of isolation. They get their ideas and form opinions based upon what they hear from the citizens of this great state. They desire our input and seek our testimony in committee meetings, forums, letters, visits, and phone calls. They wisely reach out for discussions with experts. The CVMA is proud to be one of those trusted resources that they frequently call upon for advice. Lawmakers and other stakeholder organizations come to us to get the science and facts surrounding the animal and veterinary issues being debated. As I have had the opportunity to participate in some of these law and rulemaking

endeavors, I have learned that the two words “unintended consequences” make a legislator or regulatory administrator stop and pay attention quicker than a shock collar on a distracted hunting dog. Nobody wants to waste their time and efforts on something that stands little or no chance of being enacted, or even worse—something that will exacerbate a situation or create a new problem. While watching for those unintended consequences, the CVMA diligently works to develop or modify important legislation and regulations that protect and enhance your ability to practice veterinary medicine. It is not an easy task. We keep watch on potential bills and proposed rules that may affect us openly or may sneak up and blindside the profession. The CVMA staff and our lobbyist, Leo Boyle, do a terrific job identifying and directing resources towards these issues. We look at implications for the animals, the public, and the profession. Through CVMA efforts, some well-meaning but flawed bills have been deflected from even being introduced. And by very careful consideration and discussion including appointed CVMA committees and taskforces, we work with legislative sponsors and fellow stakeholders to wisely craft only bills that are relevant and necessary. Do you have the individual time and energy to keep that kind of watch on the legislative and regulatory worlds? Do you have a full grasp of each piece of legislation and its potential unintended consequences? Do you have the influence as a single citizen to propose bills and effect changes in the laws of Colorado? Lord knows that I don’t. But as a group of over 2,100 respected veterinary professionals, the CVMA does. Thanks to your participation and dues, every day your CVMA does what you cannot accomplish on your own. That is advocacy in action, one of the shining pillars of the CVMA. So I invite you to participate in CVMA’s Advocacy work. Join in our proactive discussions at the BIG Ideas Forum every spring President’s Post continued on page 9

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BRIEFINGS

CVMA Executive Committee Dr. Curtis Crawford President Dr. Sam Romano President-elect

Ralph Johnson Executive Director

Road trip – It’s just over three miles from the CVMA office to the state Capitol building. Thank goodness for quick access, because this year more than any other in my 16 years at CVMA, we’ve needed to be at the Capitol for meetings to advance our policy agenda. As you’ll see from the article on page 16 about the legislative agenda for this year’s legislative session – which is scheduled to conclude on May 11 – we’ve got our eyes on a number of important bills, but two of them stand out for comment. The first journey was relatively short. Following months of preparation and meetings with a wide array of stakeholders, from animal control officers and dog fanciers to county commissioners and animal agriculture producers, we emerged with language to create a uniform statewide requirement for cats and dogs to be vaccinated against rabies. Despite effective leadership by the Colorado Federation of Animal Welfare Agencies, despite the capable championship of Rep. Joann Ginal (a PhD graduate of the CSU College of Veterinary Medicine and Biomedical Sciences), despite the informed testimony about the increase in rabies incidents from expert veterinary witnesses, despite the absence of objections from stakeholders (who were vocal opponents the last time this effort was mounted), and despite gaining passage for the bill in the House, the bill died in the Senate over objections that passing a law to protect public health by requiring rabies vaccinations for cats and dogs would undermine local authority. Even though we could demonstrate that no local boards of health had acted to address rabies requirements in their area in recent years, Senate leadership would not be swayed. Colorado’s patchwork quilt of requirements for rabies vaccination will persist, with the only statewide requirement being that if and when local boards of health enact rabies vaccination requirements those requirements must comport with the Compendium – a

Dr. Jenelle Vail Secretary/Treasurer

good start, but an inadequate solution to a pressing problem. We will be watchful for opportunity to advance this policy item. The second journey is ongoing. If I were to liken it to an actual road trip, it would be going carefully down a narrow, unpacked, mountain road lit only by moonlight and without guard rails or even directional signs. Such is the landscape for veterinary compounding, but it is a road down which CVMA is compelled to go. Thanks to your responses to the member survey on compounding, it is abundantly clear that veterinarians depend on compounded medications for successful patient outcomes, especially in these days of declining numbers of animal drugs and prolonged periods of manufacturer back orders. It seems the farther we tried to go down the road of formulating legislation to improve veterinary access to compounded medications, the dimmer the moonlight became. We bumped into misinformation, outdated information, overlapping jurisdiction between federal agencies, arcane regulations at the Colorado Pharmacy Board, disgruntled drug suppliers, and unhappy veterinarians. But thanks to groundwork done by the CVMA Task Force on Pharmaceutical Issues (chaired by Dr. Peter Hellyer), we were able to shed some light on the road ahead. And we were fortunate to find a capable and experienced guide in the person of Rep. Joann Ginal – yes, the same Rep. Ginal that sponsored the rabies vaccination bill noted above. With her desire to help veterinarians improve outcomes for animals and her dedication to get it right, we’ve continued to navigate the road forward. The solutions we are proposing in HB161324 are these: • Clarify that the 10% exemption for office use in current law applies to veterinary drugs, thus allowing for in-office administration of compounded medications • Create a new category called office stock, from which a veterinarian could dispense dosages covering up to five days Briefings continued on page 16

Dr. William French Secretary/Treasurer-elect Dr. Peter Hellyer Immediate Past President Dr. Melanie Marsden AVMA Delegate Dr. Rebecca Ruch-Gallie AVMA Alternate Delegate Mr. Ralph Johnson Executive Director*

District Representatives 1 – Dr. Kimberly Radway 2 – TBD 3 – Dr. Merideth Early 4 – Dr. Adam Tempel 5 – Dr. Colleen Carnes 6 – Dr. Heather Reeder 7 – Dr. Debra Stirling 8 – Dr. Dale Davis 9 – Dr. Kayla Henderson 10 – Dr. Marguerite Flett 12 – Dr. Randal Hays 13 – Dr. Connie Stapleton 14 – Dr. Matt Braunschmidt 15 – Dr. Mark Ryan 16 – Dr. Mark Cowan 17 – Dr. Leon Anderson

Student Chapter Representatives Fourth year – Kevin Lavelle Third year – Madeline Anna Second year – Courtney Mael First year – Amy Zug * Ex-officio, non-voting

C H A P TER V I S I TS It’s a two-way street! Well, actually, it’s a conversation. An exchange. A dialog. “It” is the annual CVMA chapter visit. Have some questions about tough professional issues? Something you need to know about CVMA initiatives? Want to better understand what CVMA is doing to serve you and advance the profession? Here are some of the topics on tap for discussion: • How is my life going to change because of the Colorado legislature? • What is CVMA doing to improve veterinary economics and wellbeing? • Are there new learning opportunities on the CVMA horizon? • Chapters and membership tiers – what’s that all about? • How is CVMA impacting public perception of veterinarians?

You’re Invited! Join the conversation with Dr. Sam Romano (CVMA president-elect) and Ralph Johnson (CVMA executive director). Bring your questions and ideas, and have some fun while engaging with colleagues.

It only happens once a year. Be part of it! Thanks to Our Sponsor!

191 YUMA STREET

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E D U C A T I O N

DENVER, CO 80223

303.318.0447

June 7 April 13 June 15 July 7 June 16 June 13 June 8 June 1 June 30 June 6 June 29 June 28 June 2 June 27 May 24 May 31

Schedule updated as of 2.17.16

6:30 PM Hosted dinner with non-alcoholic beverages and presentation Invitations will be sent via email and mail with specific locations and RSVP information for each chapter visit. Questions? Call Tara McChesney at 303.539.7273

Dinner and a brief presentation hosted by:

A D V O C A C Y

Chapter 1 District 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 District 7 Chapter 8 Chapter 9 Chapter 10 Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17

S U P P O R T

3 0 3 . 3 1 8 .0 4 5 0 FAX

L E A D E R S H I P

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OF NOTE Compounding Drugs: A Changing Landscape Peter Hellyer, DVM, MS, DACVA Professor of Anesthesiology, CSU College of Veterinary Medicine and Biomedical Sciences Chair, CVMA Task Force on Pharmaceutical Issues

The CVMA Task Force on Pharmaceutical Issues was convened to gather information resources and develop guidance on a range of pharmaceutical issues in veterinary medicine. The task force is charged to develop information resources for CVMA leadership and members, and to formulate recommendations in regard to education and advocacy initiatives CVMA might undertake on these issues. The task force is housed within the Commission on Advocacy and Outreach. The task force believes the most important pharmaceutical issue facing veterinary medicine today is the changing rules and regulations governing compounding. There has been a lot of information available recently about the changing nature of compounding and this brief article is intended to summarize what we know and direct the reader to more comprehensive information. Compounding is a critical need for veterinarians to be able to effectively treat a wide variety of animals. Many times the correct dose and size of medication is not available in commercially sold drugs. The importance of compounding to CVMA members was highlighted in a 2013 survey conducted by CVMA, authored by Dr. Melanie Marsden, which indicated that 97.5% of respondents (119/122) to the survey utilize compounded drugs in their practice. Emphasizing the importance of compounding to patient care, 64% of the practices used compounded drugs weekly or more often and an additional 24% use compounded drugs at least monthly. Although some veterinary practices compound drugs in the clinic, the trend has been towards issuing a prescription

for a compounding pharmacy to fill. (Survey results are available under “Drug Compounding” on the Issues page at colovma.org.) The FDA rules and regulations covering compounding pharmacies are under review with the intent to regulate the pharmacies more rigorously and hold them to higher standards of sterility. The rules and regulations apply to human compounding pharmacies and to compounding pharmacies that sell veterinary drugs, as well as to veterinarians who compound drugs. Veterinarians can still compound drugs; however, they will need to have the right facilities to ensure sterility and meet FDA regulations. The policies governing compounding are developed by the FDA with stakeholder input. The AVMA is working with the FDA to ensure that veterinarians still have access to compounded drugs in order to meet the needs of our patients. The FDA website provides extensive guidance on compounding; see the sidebar for an excerpt from the FDA website that focuses on the basics of compounding. The Task Force recommends using a compounding pharmacy to prepare a compounded medication. Here are a few points about choosing a legitimate compounding pharmacy (compiled impressions from various sources): • Pharmacy complies with all applicable state and federal regulations and guidelines • Pharmacy in good standing with state boards of pharmacy • Pharmacy compounds per patient-specific prescriptions • Pharmacy sources its ingredients from FDA-licensed facilities • Pharmacy assures potency and stability of its compounds by using proper references and formulations • All compounding technicians are directly supervised by a pharmacist • Pharmacy discloses its cost upon prescription order and sends new prescriptions and refills in a reasonable amount of time n

Excellent Resources on Compounding Developed for Veterinarians AVMA Compounding Reference Material https://www.avma.org/KB/Resources/Reference/Pages/Compounding.aspx

AVMA PLIT http://www.avmaplit.com/risk-awareness-alert/

AAEP Drug Compounding website: http://www.aaep.org/info/drug-compounding

Compounding and the FDA: Questions and Answers http://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/PharmacyCompounding/ucm339764.htm 1. What is “compounding”? In general, compounding is a practice in which a licensed pharmacist, a licensed physician, or, in the case of an outsourcing facility, a person under the supervision of a licensed pharmacist, combines, mixes, or alters ingredients of a drug to create a medication tailored to the needs of an individual patient.

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OF NOTE 2. Is combining two or more drugs considered compounding? Yes, compounding includes the combining of two or more drugs. 3. Why do some patients need compounded drugs? Sometimes, the health needs of a patient cannot be met by an FDA-approved medication. For example: • if a patient has an allergy and needs a medication to be made without a certain dye; or • if an elderly patient or a child can’t swallow a pill and needs a medicine in a liquid form that is not otherwise available. 4. Are compounded drugs approved by the FDA? Compounded drugs are not FDA-approved. This means that FDA does not verify the safety, or effectiveness of compounded drugs. Consumers and health professionals rely on the drug approval process to ensure that drugs are safe and effective and made in accordance with Federal quality standards. Compounded drugs also lack an FDA finding of manufacturing quality before such drugs are marketed. Generally, state boards of pharmacy will continue to have primary responsibility for the day-to-day oversight of state-licensed pharmacies that compound drugs in accordance with the conditions of section 503A of the FDCA, although FDA retains some authority over their operations. However, outsourcing facilities that register under section 503B are regulated by FDA and must comply with CGMP requirements and will be inspected by FDA according to a risk-based schedule. 5. What are the risks associated with compounded drugs? There can be health risks associated with compounded drugs that do not meet federal quality standards. Compounded drugs made using poor quality practices may be sub- or superpotent, contaminated, or otherwise adulterated. Additional health risks include the possibility that patients will use ineffective compounded drugs instead of FDA-approved drugs that have been shown to be safe and effective. 6. Who regulates and inspects facilities that compound drugs? Generally, state boards of pharmacy will continue to have primary responsibility for the day-to-day oversight of state-licensed pharmacies that compound drugs in accordance with the conditions of section 503A of the FDCA, although FDA retains some authority over their operations. For example, the adulteration or misbranding of drugs compounded under section 503A, or false or misleading statements in the labeling or advertising of such drugs, may result in violations of Federal law. Firms that register with FDA as “outsourcing facilities” under section 503B will be regulated by FDA and inspected by FDA according to a risk-based schedule. 7. What is FDA doing to implement the new law? Please see FDA implementation of the Compounding Quality Act. 8. What is an outsourcing facility? The Drug Quality and Security Act, signed into law on November 27, 2013, creates a new section 503B in the FDCA. Under section 503B, a compounder can become an “outsourcing facility.” The law defines an “outsourcing facility” as a facility at one geographic location or address that is engaged in the compounding of sterile drugs; has elected to register as an outsourcing facility; and complies with all of the requirements of section 503B. An outsourcing facility can qualify for exemptions from the FDA approval requirements and the requirement to label products with adequate directions for use, but not the exemption from current good manufacturing practice (CGMP) requirements. Outsourcing facilities: • must comply with CGMP requirements; • will be inspected by FDA according to a risk-based schedule; and • must meet certain other conditions, such as reporting adverse events and providing FDA with certain information about the products they compound.

President’s Post continued from page 4 and fall. Come to the Commission on Advocacy and Outreach meetings held at the same time. Volunteer for one of the task forces that address the relevant issues facing Colorado veterinary medicine. Cultivate a trusting relationship with your local state senator or representative. Comment on CVMA surveys asking your opinion. Talk to your CVMA Chapter Representative

or contact the CVMA office regarding public policy issues you notice. These are the avenues where your solo voice is added to CVMA’s mighty chorus. Together, we can make some beautiful music. And protect each other’s backsides. CVMA. Welcome to the herd. n CVMA Voice 201 6 : 1 | PAG E 9

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OF NOTE CVMA Strategic Framework “If you don’t know where you are going, you’ll end up someplace else.” —Yogi Berra In late October 2014, the CVMA executive committee, district representatives, Power of Ten leaders, past-presidents, and CVMA staff held a strategic planning session to ask some big questions about CVMA and how to keep it relevant, evolving, and productive. It was a chance to revisit why CVMA exists and to envision our future in the next three, five, and even ten years, and to refocus our programs and to listen to member feedback to improve the organization. The planning session took an in-depth look at CVMA’s mission, vision, and impact statements: who we are, who we want to be, and the difference we aim to make. We also examined our organizational structure and guiding pillars: advocacy and outreach, leadership, education, support, and association health. 2015 Goals and Progress

Distilled down, CVMA is doing a lot of great things for its members—but what would make it even better? And how can we provide options to our members, in their learning, in their dues structure, and in the overall structure of CVMA? While we identified several critical strategic issues to address as we move forward, we chose a few specific goals for 2015: • Creating and funding a CVMA political action committee (PAC) • Examining how CVMA offers continuing education • Providing members a more flexible dues and membership structure As evidenced by our new tiered membership models and chapter structure, we made great progress on providing you a more flexible dues and membership structure. And our BIG Ideas Forum | Fall 2015 delved into examining how CVMA offers continuing education with a look at nontechnical skills and how best to deliver learning that suits your needs, both now and in the future. And the Commission on Advocacy and Outreach continues to make strides in setting up a CVMA PAC to enhance our advocacy efforts. Mission Statement

Another important aspect that was explored at the strategic planning session was the CVMA mission statement, which CVMA leaders look to for guidance as they make policy and set priorities. The old mission statement was member centric, but also included animals and human health and welfare, and was more about the “what” of we do. The new mission statement that came out of the planning sessions is shorter and much more focused on our core purpose: To enhance animal and human health and welfare, and advance the knowledge and wellbeing of Colorado veterinarians.

Strategic Framework for 2015 – 2017

All of this framework around our strategic planning and the outcomes from the 2014 session was presented at BIG Ideas Forum | Spring 2015, as well as an approval draft version of our “Strategic Framework and 2015–2017 Strategic Plan” that summarizes and outlines our mission, long-term goals, and Key Result Areas (KRAs), which are summarized below. Our Vision

First, it is important to define our vision, the reasons we feel CVMA exists. We believe that through the efforts of CVMA: The Veterinarian • is empowered to support clients in making the best decisions for the health and welfare of their animals. • enjoys intellectual, financial, emotional and physical wellbeing throughout a satisfying career. • is recognized as having a positive impact on public health. • has a sense of belonging and commitment to CVMA as a high-value professional community. The Profession • is economically sustainable and provides a collegial environment attractive to veterinarians as a rewarding career choice. • continues to be respected as an essential component of a healthy, dynamic community. • is a unified, credible force able to shape a positive legislative and regulatory environment. Students • are able to transition successfully to a productive, satisfying career. • are engaged in their professional community and exposed to resources that can guide them to success. The Animals • thrive as a result of a strong human-animal bond. • are healthier and well cared for. • contribute to a sustainable, robust agriculture sector. Society • trusts the profession for its knowledge and competency. • respects the profession as an advocate for animals and the human-animal bond. • understands and benefits from the veterinarian’s role in protecting public health. • benefits from informed public policy and the development of effective, committed community leaders. Long-term Goals and KRAs

By 2020, the Colorado Veterinary Medical Association will operate at a level of excellence described in the following goals, or Key Result Areas (KRAs): Continued on next page

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OF NOTE Continued from previous page Advocacy and Outreach: To be the vehicle through which veterinarians unite as a powerful voice for the profession and for the health and welfare of animals and the public in the State of Colorado. Issue

Objective

Member Engagement

Members understand the importance of and are actively engaged at the district and state levels in helping shape public policy issues.

Collaboration

CVMA broadens its relationship portfolio and works as partners with groups who are vested in the health and welfare of animals, and in strengthening the human-animal bond.

Political Action

CVMA bolsters its influence with a well-funded PAC.

Community Relations

CVMA commands a positive presence for the Association and for veterinarians in the community, promoting practices that support public health and safety and the wellbeing of animals.

Leadership for the Profession: To foster the development of professionals with the leadership skills to advance the veterinary medical profession, enrich personal and community life, and benefit the Association. Issue

Objective

Leadership Skill Development Tailored training and support help members build the leadership skills necessary for success at each and Training stage of their career. Leadership Opportunities (CVMA and others)

Through CVMA, members are prepared to pursue leadership opportunities that advance the Association and the profession.

Education: To be the preferred source for multi-modal, practical, and affordable education opportunities that support the continued development and wellbeing of veterinarians in Colorado. Issue

Objective

Education Delivery Formats

Members access educational opportunities through formats that best support delivery of program objectives and match individual member preferences for the learning experience.

Targeted Education Content

Education content is tailored to the individual and practice development needs of members at each stage of their career.

Support: To be a dynamic community through which veterinarians can access peer support, tools, and resources tailored to their needs, interests, and career goals. Issue

Objective

Member to Member Connections

CVMA facilitates the dynamic exchange of expertise, experience, support, and ideas between members.

Tools and Resources

Members have access to tools and resources that help them achieve practice goals and address pressing practice issues.

Career Management

As the member’s career partner, CVMA helps members advance their career through support in such areas as career opportunities, pathways, and transitions.

Association Health: To be an organization designed for innovation and the active engagement of its membership and to operate with the resources (both human and financial) and infrastructure to fulfill the mission in an ever changing professional environment. Issue

Objective

Organization Structure

Veterinarians have access to the services and support they need through the most efficient, effective, and affordable association structure at the local, district, and state levels.

Membership/Dues Structure

The CVMA membership and dues structure provides for maximum engagement by veterinarians and use of the Association’s programs, products, and services.

Member Engagement Portals/Opportunities

CVMA volunteer and leadership opportunities are substantive, rewarding, and sensitive to the time and energy members have to contribute to the Association.

CEO Role, Scope, Focus

The CVMA CEO is able to provide the staff focus and leadership necessary to support the Association in achieving its mission, vision, goals, and changing priorities.

Revenue Streams

Diverse, robust revenue streams provide for long-term CVMA financial stability.

Infrastructure/Technology

CVMA is proactive in building and maintaining the infrastructure necessary to ensure cuttingedge delivery of Association programs, products, and services, and dynamic member engagement opportunities.

Staff Capacity

CVMA staff are committed to the values of the Association and have the depth and breadth of professional expertise required to support fulfillment of the CVMA mission. CVMA Voice 201 6 : 1 | PAG E 1 1

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OF NOTE Veterinary Volunteers Leave Tails Wagging in Denver Neighborhood Coleman Cornelius Director of Marketing & Communications Colorado State University College of Veterinary Medicine

Nearly 100 dogs and cats living with families in need in northeastern Denver recently received vaccinations and physical exams during a veterinary outreach event that signified services to come for the community. A team of volunteers—including six students in the Colorado State University Doctor of Veterinary Medicine Program—provided free veterinary care to pets in the Elyria-Swansea neighborhood, which surrounds the Denver Coliseum and grounds of the National Western Stock Show. CSU and PetAid Colorado organized the pet wellness and vaccine clinic to provide the type of preventive veterinary care that could be a regular offering at the renovated National Western Center in coming years. The university’s College of Veterinary Medicine and Biomedical Sciences plans to partner with PetAid Colorado at the redeveloped center to assist PetAid in delivering its mission of providing subsidized healthcare for vulnerable populations. Discounted veterinary services, such as preventive care, vaccinations, and spay/neuter surgeries, are some of the types of services available

for the pets of local residents in need of financial and other assistance. The partnership would aim to provide improved pet care for a community with few veterinary resources, while also giving CSU veterinary students more opportunities for handson service learning. “The community was very appreciative for the service, and every family member was excited to bring in beloved pets and to learn about ensuring their health,” said Dr. Danielle Straatmann, a veterinarian and director of international student experiences for the university’s DVM Program. The wellness and vaccine clinic was held in December at Focus Points, a family resource center, and was made possible with vaccines donated by Boehringer Ingelheim and supplies donated by MWI Animal Health. Along with PetAid Community Outreach staff, 15 volunteers staffed the wellness and vaccine clinic. The group included CSU veterinary students, CVMA member veterinarians, Spanish-language translators, and employees from CSU; students worked alongside local practicing veterinarians to learn while providing supervised care. CVMA would like to thank members Drs. Erin Kane, Graciela Guzman, Karen Tips, and Danielle Straatmann for their participation in the event. If you are interested in volunteering for 2016 PetAid Community Outreach programs and wellness and vaccine clinics, please contact Tara McChesney at 303.539.7273. n

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OF NOTE AVMA Update Melanie Marsden, DVM, AVMA Delegate Rebecca Ruch Gallie, DVM, AVMA Alternate Delegate

As we bring you news from the January 8 AVMA Board of Directors and House of Delegates meeting held during the annual Veterinary Leadership Conference in Chicago, we’d like to start with an exciting update that our AVMA Future Leaders program participants shared with the Board about their ongoing efforts to address the important issue of wellness. Wellness

The 2015–2016 class of Future Leaders is building on the excellent momentum established by last year’s class, which took up the issue in earnest and set a solid foundation for the future. The latest initiatives from the 2015–2016 class include the development of a “5-Step Countdown to Wellness” toolkit that will be posted on our website and shared with members through AVMA convention programming and other means. The Future Leaders also are assisting in the planning and development of our upcoming AVMA Wellness Roundtable, which will be held later this year.

The revised policy has been posted on the AVMA website. More information on the House of Delegates’ discussion of the matter is posted on the AVMA@Work blog available at avma.org. Stay tuned for email updates from us periodically throughout the year. It is a great honor to represent Colorado. Thank you. n

Community Cats CVMA is also exploring the issue of free-roaming cats in collaboration with the Colorado Federation of Animal Welfare Agencies. We conducted a survey in February and will provide a summary of results in the next issue of the VOICE. We thank those of you who participated in the survey and appreciate your contribution and comments as we address this important issue. And please see the article on the following page regarding Denver’s initiative, Denver C.A.T. (Cats Around Town).

2016 Budget and Priorities

The Board approved the 2016 budget and strategic operating plan, both of which include emphasis on the strategic priorities that our members made clear to us during our extensive survey and scanning process over the past year or so. Those areas include advocacy and public policy, accreditation and certification, and veterinary economics. The Board agreed with the recommendation from our Legislative Advisory Committee and other volunteer entities to take a position of “no action” on the draft version of the Veterinarian Payments Sunshine Act legislation, which you can read more about in an AVMA@Work blog post available at avma.org. Policy on Free-roaming Cats

The AVMA House of Delegates on January 9 approved revisions to the AVMA’s Policy on Free-Roaming Abandoned and Feral Cats to reflect new information, help build consensus, and provide leadership per the management of free-roaming abandoned and feral cats. The revision followed more than two years’ work by the Animal Welfare Committee, which took into account member comments on the matter and also asked the AVMA Committee on Environmental Issues and AVMA Council on Public Health and Regulatory Veterinary Medicine to assist with the review. The welfare of free-roaming abandoned and feral cats and the impact of these cats on wildlife, ecosystems, and public health were central issues during the committee and House of Delegates deliberations. The revised policy represents iterative progress toward resolving the free-roaming unowned cat problem, while recognizing that there is currently not consensus around what an ultimate solution will look like. It also points to the veterinary profession as a key player in developing approaches that are both sciencebased and socially responsible.

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For more information: Please visit www.PeakVeterinaryConsulting.com or contact Dr. Hauser at drhauser@peakveterinaryconsulting.com CVMA Voice 201 6 : 1 | PAGE 1 3

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OF NOTE Pilot Project Starts for Metro Denver C.A.T. Susan Barden, DVM, CVA, CCRT

Metro Denver C.A.T. (Cats Around Town) has started a yearlong pilot program in the north 80219 neighborhood of Barnum to increase the value of cats in the community. Our new headquarters has opened at 110 North Federal Boulevard and is staffed by project manager Anna Murrin. Through block-by-block community outreach and continued presence in the neighborhood, Spanish-speaking volunteers/ staff, mobile spay/neuter clinics, and community events held at the headquarters, we hope to reduce the number of uncared for cats and help residents find needed resources. Over the course of this year we hope to spay/neuter over 1,000 cats utilizing the Dumb Friends League’s Meow Mobile, Spay Today, and the Feline Fix. We will also focus on trap-neuter-return (TNR) for free-roaming cats and provide vaccines and medical care referrals for locally owned cats. Many groups have come together to ensure success of this project—A nimal Assistance Foundation, Denver Animal Protection, American Society for Prevention of Cruelty to A nimals, PetSmart Charities, local cat rescue groups, and CVMA Chapter 6 | Denver Area. Please visit us at denvercats.org to find out more. Metro Denver C.A.T. could use the veterinary community’s assistance to help us succeed. Volunteers are needed for trapping, transport, fostering, neighborhood outreach, surgery day help, and hotline help. Please share this information with your staffs and all those devoted cat clients you see every day! Supplies Needed

We are in need of the following supplies if you’d like to help: • Cat food (one time or bulk – wet, dry, and expired are ok) • Cat litter • Newspaper/puppy pads • Cat safety collars • Cat carriers PAG E 14 | CV M A Vo ice 2016 : 1

• Cat beds • Outdoor cat shelters/straw • Linens (sheets, trap covers, towels) • Paper food trays • Tongue depressors/plastic utensils • Bungee cords • Small kitchen appliances (microwave, mini fridge, coffee maker) • Shelving • Rolling office chair • Other miscellaneous cat care supplies • Cat-related books and décor items Please consider having a donation drive in your hospital for some of the recurrent items that we will need throughout the year. Those of us who have been developing this group over the past two years are very excited to have our first big project that will ultimately help so many cats in this neighborhood. Ultimately, this project could create a template for repeatable success with community cats all over Denver and beyond. Please contact Anna Murrin, project manager, with any questions or offers of help at 303.912.7428 or anna@denvercats.org. n

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OF NOTE Transfers and Heartworm: The Young-adult Problem Apryl Steele, DVM, Vice President for Strategic Initiatives, Dumb Friends League Lesli Groshong, DVM, Chief Shelter Veterinarian, Humane Society of Boulder Valley

Over the last five years, there has been a substantial growth in the number of dogs being transferred into Colorado from other states. In 2014, approximately 24,000 dogs were transferred into Colorado for adoption. Many of the states from which these animals originate are areas where heartworm disease is endemic. In some areas—including the southeastern United States, Kansas, Texas, and Oklahoma—up to 70% of unprotected dogs are infected with the disease. The veterinary and animal welfare communities of Colorado must work together to ensure that heartworm disease is addressed appropriately in these dogs, and to deal with the potential impact the disease could have on local dog populations. Shelters from Colorado’s Front Range have formed a coalition to better understand this issue, develop best practices around these transfers, and inform the veterinary community of the new challenges being faced. Shelters have already asked themselves the question, “Should we simply refuse to transfer in dogs from heartworm-endemic areas?” After much consideration, it became clear that this is not a viable solution. If responsible shelters and rescues refuse to accept animals from heartwormendemic regions, these animals will be shunted to the groups that are not committed to the best outcome for the pet and the owner. Many groups other than shelters are receiving these animals, and while some rescues are performing best practices, others are not. The Colorado Department of Agriculture’s Pet Animal Care Facilities Act (PACFA) is receiving regular complaints from citizens who have incurred significant veterinary expenses to treat heartworm disease after adopting a puppy or dog from a rescue group. In some situations, there is evidence that the rescue group had been informed that the dog was infected with heartworm disease, but this information was either not disclosed to the adopter or the adopter was assured by the rescue that the dog was being treated with the “slow-kill method” and would be fine. In other situations, no heartworm test was performed or the dog was too young to produce a positive result. In some cases, the rescues are unwilling to help with the cost of heartworm treatment. This puts both the pet owner and the treating veterinarian in a very difficult position and can strain the relationship when the client is faced with the realities of the cost of the treatment. The most effective method to mitigate this issue is for shelters and rescues to develop best practices for these transfers. For dogs that have tested POSITIVE prior to transfer or at the receiving shelter, their heartworm disease should immediately be addressed by starting heartworm prevention and doxycycline, as well as making a plan to treat the infection either at the shelter/

foster or post-adoption following American Heartworm Society adulticide guidelines. Most veterinarians are familiar with heartworm disease and its life cycle; however, this disease must be viewed through a special lens as it relates to importing dogs. It is the puppies too young to test and dogs that test NEGATIVE that create a challenge and a reservoir of infection to the pets of Colorado. To that end, all dogs that test NEGATIVE prior to or after transfer, as well as puppies, should be placed on heartworm prevention immediately and re-tested in six months. For dogs that have early larval stages of infection, this will resolve the disease. Dogs with an infection that has advanced to the young-adult stage are concerning. These dogs will test NEGATIVE for heartworm because they do not have an adult worm, and the young adult state is no longer susceptible to preventive ivermectin products. Fortunately, these dogs will not be infectious to our community dogs if they are on prevention because the prevention kills the early larval stages. However, these dogs may still develop an adult infection, and they must be tested six months after being placed on heartworm prevention. This is an important deviation from most Colorado veterinarians’ protocols, and if the six-month heartworm test is not performed, the dog could develop progressive heart and lung disease. Best practices should address POSITIVE dogs with adulticide treatment, and shelters and rescues clearly communicate in the adoption paperwork the expectation of the adopter to protect puppies and dogs testing NEGATIVE. The latter provides a framework of communication for the veterinarian to establish a plan for ongoing preventive care and routine testing. Shelters may consider partnering with drug companies to include coupons or discounts for initial prescriptions of heartworm preventives. Both the veterinary and animal welfare communities have an increased responsibility to ensure best outcomes for all dogs adopted by our community and to protect our native dogs. n

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GOVERNMENT AFFAIRS Advocacy: Protecting Veterinary Practice in Colorado

HB16-1308 Fraudulent Misrepresentation of a Service Animal (support)

The practice of veterinary medicine in Colorado would be vastly different if CVMA didn’t exist to monitor and affect legislation and address public policy issues on behalf of the profession. Last year, we protected Colorado veterinarians by working within the legislative system to pass HB15-1187, Veterinarian Peer Health Assistance Mental Health Exam, providing a tool for the State Board of Veterinary Medicine to use in ordering a licensee to be evaluated (for a mental health or substance use issue) without first having to take a disciplinary action. As CVMA’s president Dr. Crawford asks in his column (see page 4), “Do you have the individual time and energy to keep that kind of watch on the legislative and regulatory worlds? Do you have a full grasp of each piece of legislation and its potential unintended consequences? Do you have the influence as a single citizen to propose bills and effect changes in the laws of Colorado?” One single voice can be lost in the din that is the state legislature. Among party politics and special interest groups and scores of lobbyists, it would be impossible for one person, alone, to be heard. But CVMA—representing 2,000+ members—can effectively cut through the noise and make sure your best interests are represented and our opinions and comments are listened to by those who can help us shape legislation that benefits both veterinary practice and animal welfare in Colorado.

HB16-1324 Compounding (supporting) Under current law, a veterinarian cannot maintain an office stock of compounded drugs, which are drugs that are combined, mixed, or otherwise altered to create a specific drug or formulation, for later distribution or administration to patients. The bill authorizes:

2016 Legislation

The 2016 Colorado legislative season has proven to be particularly challenging, as discussed in Briefings on page 3. Here are the bills CVMA is working to affect this year. The ones of most vital importance – and, per Briefings on page 3, the most active and controversial – have brief descriptions to highlight the purpose of the bill.

• A compounding pharmacy to compound and distribute a drug to a veterinarian without a specific patient indicated to receive the compounded drug; and • A veterinarian to dispense a compounded drug, maintained as part of the veterinarian’s office stock, in an amount not to exceed 5 days’ worth of doses, if a patient has an emergency condition that the compounded drug is necessary to treat and the veterinarian cannot access, in a timely manner, the compounded drug through a compounding pharmacy. SB16-062 Veterinary Pharmaceuticals (supporting) Section 1 of the bill requires the governor to appoint at least 2 members to the state board of pharmacy (board) who are engaged in the practice of, or otherwise professionally interested in, veterinary medicine or animal agriculture. Section 2 removes the sale of veterinary devices from the board’s regulatory purview. Section 3 reduces the civil penalty a person faces for unlawfully distributing a veterinary drug to a civil penalty of $50 to $500 for a single violation and a maximum of $5,000 for multiple violations. SB16-085 Uniform Trust Decanting Act SB16-098 Restore Judicial Discretion in Criminal Sentencing (monitoring) n

HB16-1112 Training Vets to Train Service Dogs Pilot Program (monitoring)

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HB16-1120 Rabies Requirement for Dogs & Cats (supporting) Under current law, local governments may determine whether to require pet owners to vaccinate their pets against rabies through a licensing program. Additionally, when public health and safety are at risk, county or district health departments may order all dogs, cats, other pet animals, or other mammals in the in the county or district to be vaccinated against rabies. The bill imposes a statewide requirement that all dogs and cats that are 4 months old or older be vaccinated against rabies. Dog and cat owners must ensure that their animals are vaccinated within 90 days after assuming ownership, and a licensed veterinarian must administer the vaccination and issue to the owner a rabies vaccination certificate and a tag to be attached to the animal’s collar.

updated on these important issues. Check your

HB16-1124 Registered Brand Inspections (monitoring) HB16-1201 Health Professionals Companion Animals (monitoring) PAG E 16 | CV M A Vo ice 2016 : 1

CVMA’s Bill Tracker Report to stay informed and weekly eVOICE under “Government Affairs” or visit the Issues/Advocacy section of the CVMA website at colovma.org for a link to the tracker.

Briefings continued from page 5 for an animal in an emergency when a compounding pharmacy cannot immediately supply the needed medication • Remove the restriction that only the Colorado pharmacies may provide compounded medications on a non-patientspecific basis, since this restricts access to needed medications (especially compounded medications that are controlled drugs, since at present no Colorado pharmacy is a DEA registered manufacturer therefore allowed to provide controlled medications on a non-patient-specific basis) Continued on next page

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GOVERNMENT AFFAIRS Briefings continued from previous page The bill is written carefully to include appropriate limitations, such as the five-day dosage limitation. As such, the bill has garnered support from the Animal Health Institute, the trade association for animal pharmaceutical companies in Washington, DC – an entity that is typically not prone to support compounding. The bill has also received support from the American Veterinary Medical Association, whose Governmental Relations Division (especially Dr. Ashley Morgan, AVMA’s compounding expert) has shed considerable light on the compounding landscape. The compounding bill has had its first hearing, before the House Health Committee, where Rep. Ginal provided a cogent and compelling introduction, Dr. Will French (CVMA secretary/ treasurer-elect) delivered testimony about the need for compounded medications and some equine compounding perspective, and Dr. Randa MacMillan (a CVMA past president) provided testimony about the need for compounded medications in companion animal medicine. As a result, the committee was UNANIMOUS in its support of the bill. Next stop is House Finance (because there is a small but potentially troubling fiscal note attached to fund pharmacy board inspections and rule making for implementing the bill). Then it’s on to the House floor for action; we are hopeful for passage in the House since Rep. Ginal has been joined in sponsorship by several House colleagues. Then on to the

Senate, where we are fortunate to have secured prime sponsorship by Sen. Jerry Sonnenberg, chair of the Senate Ag Committee (where the bill is likely to be assigned). So we’re on the way – yet in just moments I’ll be meeting, again, with stakeholders from the pharmacy community who are concerned about the bill. Will the inspections of non-resident pharmacies be adequate? (These pharmacies are already providing patient-specific medications into Colorado, but we’ve identified a third-party inspection that the non-resident pharmacy could utilize to reassure Colorado pharmacists and regulators.). Won’t opening the borders of business to non-resident pharmacies have a detrimental effect on local compounding pharmacies? (We think there is opportunity for all in the bill, and that – much like in veterinary medicine – relationships with customers are key, and good customers with good relationships will remain bonded to their supplier.) As the bill progresses, we may ask you to contact your state legislator. We appreciate that you’re busy, and that taking time out to support a legislative initiative is hard to do. And we also appreciate that you expect CVMA to keep advocacy as job #1; that’s why we’re continuing down this particular road, seeking daylight – to create better accessibility for veterinarians to compounded medications, and as a result to improve treatments for your animal patients. n

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GOVERNMENT AFFAIRS How CVMA Shapes Public Policy in Colorado Advocacy is a huge part of what CVMA does on behalf of its members and the profession, representing the collective voice of all veterinarians in Colorado. Integral to CVMA’s legislative efforts is lobbyist, Leo Boyle. CVMA has been working with Leo for more than 17 years, and it is on the strength of this relationship that much of our success is built. We sat down with Leo to discuss what he does for CVMA and how lobbying helps us achieve our goals each legislative season. What does a lobbyist do?

A lobbyist is an educator, an advocate, a defender, a negotiator, and a resource person to advise his/her clients on issues touching relations with various governmental bodies. He/she explains often complex issues and provides information to people who have to make decisions about public policy and pass laws that impact the lives and livelihoods of veterinarians, the owners of animals, and animals themselves. The lobbyist also has to educate his/her clients about the legislative and regulatory process. Making laws and rules is a complicated procedure that requires knowledge of the process, as well as the persons who make the laws and rules. A lobbyist combines the knowledge of how the system works with the hands-on ability to influence and inform the decision makers. Lobbyists have to be concerned about the accuracy and truth of the information they convey to legislators and regulators because false information and distortions will ultimately destroy the credibility of laws and regulation. We live in a society where law makers and regulators are accountable to the public who elect them. So ultimately, a lobbyist must be a truth teller, and he/she must tell the whole truth when presenting information and policy proposals to legislators. Why does CVMA need a lobbyist?

Veterinarians need a lobbyist for the same reason medical doctors, dentists, nurses, lawyers, accountants, and other professions and occupations need a lobbyist. All of these professions have requirements and regulations that outline what they can and cannot do. There are educational requirements and standards of practice that must be met to obtain and retain a license. A lobbyist’s job is to work with the profession and the legislature to assure that the law reflects the current actual practice of the profession and that the law evolves with the profession as education and training expand the scope of practice. Because there is competition and conflict between different professions and interest groups, the lobbyist has to be able to PAG E 18 | CV M A Vo ice 2016 : 1

defend the interests of his/her client and advocate for their interests when there is disagreement between or among professions and interest groups. The lobbyist also has to be able to negotiate on behalf of his/her client when issues must be resolved at the legislature. Of course, this must be done with the advice, input, and agreement of the client. Almost all interest groups have a lobbyist, so lobbyists know one another and contact one another when issues arise that will have to be thrashed out at the legislature. There is an old and true statement that sums it all up: “No man’s life, liberty, or property are safe while the legislature is in session.” It would be suicidal for any interest group interested in protecting its interests not to have a lobbyist. What do you do with and for CVMA?

I go to the Capitol daily when the legislature is in session from early January until mid May. I meet with legislators and other lobbyists to discuss bills that have been introduced or are about to be introduced. I talk with Ralph Johnson and members of the leadership of the profession to determine what the position of the veterinarians should be on proposed legislation. I contact the relevant legislators to explain that position and line up support or opposition. I count votes to see if CVMA will prevail or lose. There are always at least seven different votes in the different houses and committees of the Legislature on any proposed law, so there is an enormous amount of explaining and counting of votes that must be done. When CVMA wants to introduce legislation, I have to contact a legislator and try to convince that Representative or Senator to sponsor the bill. Often, amendments must be drafted and sponsors found to try to add the amendment to a bill making its way through the Legislature. If CVMA wishes to oppose a piece of legislation, I have to educate legislators about why veterinarians oppose the bill and try to find legislators to present our point of view on the floor of the Senate and House as well as in Committee. I work with Ralph to develop presentations to make in committee and to prepare witnesses to testify before the committees that hold hearings on the bill. I also meet with the leadership of CVMA periodically to assist in long range planning for legislative and governmental affairs. What are the unique challenges of lobbying for the veterinary profession and animal health and welfare issues in Colorado?

Legislators in general like the veterinarians they know, but few legislators feel competent to speak on veterinary issues before their peers. This means that it is important for the lobbyist and veterinarians to step in and provide the background to bring the legislators up to speed on issues of concern to the profession. The breadth of issues of concern to the profession is another factor that makes representing veterinarians challenging. What is the most difficult part of your job? The easiest?

The most difficult part of the job is getting the legislators to find the time to sit down and learn about the issues that they will be Continued on next page

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GOVERNMENT AFFAIRS Continued from previous page voting on. The legislative session is short—four months—and the 100 legislators must vote on more than 500 bills, many of them complex, defying easy understanding and comprehension. Legislators work hard, but there are just not enough hours in the day for them to master all the details and complexities of all the issues they must face. Does lobbying happen only during the legislative season? What goes on the rest of the year?

During the months the legislature is not in session, from June until January, many legislators are running for office, raising funds for their campaign. Lobbyists are constantly being solicited for contributions from legislators for their campaign. Most interest groups have PACs—political action committees—that make contributions to candidates. Naturally, this can raise the profile of the contributors. Legislators can and do meet during the interim between sessions to discuss certain pressing issues, but no votes are taken. These sessions are to educate and better inform the legislators about complex issues.

Where would CVMA be in its efforts without a lobbyist?

Where would animal owners be without veterinarians when something has to be done to help or fix an animal? Where would people be without medical doctors and dentists? In our complex modern society, we all need specialists to guide us in areas where we lack expertise. A lobbyist guides his/her clients in an arena where the client has little knowledge and experience. Nor does the client have the time and contacts to successfully conduct ongoing legislative and regulatory oversight. What can members do to help you and CVMA in legislative and lobbying efforts?

One of the best ways to help is to let Ralph and the CVMA office know the names of legislators that you know, often through your practice. The legislator trusts you with their animal; they might also listen to you when you tell them that something should be done regarding an issue that CVMA supports or opposes. But we need to know that you know that legislator. Another good way to help is to contribute to the campaign of candidates who will represent you at the Capitol in Denver. n

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GOVERNMENT AFFAIRS Need to Write Health Certificates on the Go? The new mCVI app works on your mobile devices! Alex Turner, DVM , Traceability Veterinarian Colorado Department of Agriculture, Animal Health Division

In early January, a new app for mobile devices was released for issuing electronic health certificates (CVIs). This new app can be used on Apple iPads, iPhones, and any Android tablet or phone. The Institute for Infectious Animal Diseases (IIAD), a Department of Homeland Security Science and Technology Center of Excellence, along with the Texas Center for Applied Technology (TCAT), a part of the Texas A&M Engineering Experiment Station, announced the expansion of their mobile Certificate of Veterinary Inspection application to multiple platforms to allow compatibility with both iOS and Android devices. With the platform expansion came a new name, mCVI, and a new look. With an easy-to-use, touch screen interface, the mCVI app extends the toolbox of capabilities for Colorado veterinary practitioners, allowing them to easily submit electronic animal health certificates. The app works with or without a data connection or cell service. If a veterinarian is not connected to the internet, the app holds or stores the CVI on the device until an internet connection is available and then the device submits the CVI when the app is reopened. This real-time information sharing is an alternative to email or web-based systems that require fulltime Internet connectivity and helps improve communication between veterinarians and the State Veterinarian’s Office. By using this app, you no longer need to worry about sending in the CVI via snail mail or e-mail; it is submitted automatically to our office once your device has a data connection. The app is easy to use for Large Animal or Small Animal CVI creation and has an intuitive layout on both iOS and Android devices that will look familiar to users of the previous iCVI application for iPads. The app is also available for smartphones and tablets. Each screen walks you through completing the CVI, one field at a time. You can either fill in each field for the consignor and consignee information or you can import the address and phone number from the contacts stored in your device. You can also export the information from the CVI into your device contacts for clients that you see repeatedly for CVI creation. The mCVI will not let you submit the CVI until it has all required fields completed. However, even after you have completed the fields, you are given an opportunity to view the CVI and check it for errors. And there is also a way to edit after submission (which will generate a new CVI number for our office to see) in case the details have changed (like a shipping date or even a destination). The mCVI also allows for fast and accurate animal and ID entry onto the application. You can enter animals individually, or if you have a list of official animal IDs in a spreadsheet, you can import them into the CVI as a CSV file. Once you have entered the animals into your CVI, you have a chance to preview PAG E 20 | CV M A Vo ice 2016 : 1

the final product before you click to submit. Clients appreciate the convenience of having their CVI emailed to them directly, but the ability to print a copy is still available through the same channels that you would use to print other documents from your tablet or phone if a paper copy is requested. If you have any questions about getting started with the mCVI application for your device and about how best to use it in your practice, please feel free to contact either myself (alex. turner@state.co.us) or our Traceability Specialist Dave Dice (dave.dice@state.co.us) here at the State Veterinarian’s office (303-869-9130). The mCVI app is available for free download on the Apple App Store® and Google Play Store® for tablets and smartphones. Quick start guides for iOS and Android devices and more information can be found here: http://iiad.tamu.edu /tools/agconnect-a-suite-of-customizable-data-sharing-tools /agconnect-a-suite-of-customizable-data-sharing-toolsicvi -mobile-app/ n

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SCIENCE UPDATE 2015 Colorado Zoonoses Summary Jennifer House, DVM State Public Health Veterinarian Colorado Department of Public Health & Environment (CDPHE) Rabies

Colorado State University and CDPHE laboratories were able to confirm rabies virus in 119 animals during 2015. The positive animals included 71 bats, 45 skunks, 1 raccoon, and 2 domestic cats. Of these 119 positive animals, 77 were known or strongly suspected of exposing 102 domestic animals and 57 people. For additional information on rabies, including current 2016 statistics, please visit: https://www.colorado.gov/pacific/cdphe /rabies. Laboratory Conﬁrmed Rabies Posi3ve Animals Colorado, 2015 30 25 20 15

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cases) experienced the more severe neuroinvasive presentation, which resulted in 2 deaths. In addition to the human cases of WNV, we also saw veterinary cases. A total of 14 horses from 11 counties (Adams, Alamosa, Boulder, Conejos, Fremont, Huerfano, Jefferson, Larimer, Mesa, Park, and Weld) were found positive by laboratory testing. For additional information on West Nile virus in Colorado, please visit the CDPHE webpage at https://www.colorado.gov /pacific/cdphe/west-nile-virus-data. Plague

West Nile Virus

Colorado continued to see disease from West Nile virus both in humans and animals last year. There were a total of 101 human cases reported among residents of 25 counties. For reporting purposes, West Nile virus disease in people is categorized into two primary clinical presentation groups: neuroinvasive and non-neuroinvasive. During the 2015 season, 57 people (56% of

Equine West Nile Virus Cases Colorado 2005-2015

Colorado reported four human cases of plague in 2015; unfortunately two of those cases did die from the infection. The etiological agent of plague, Yersinia pestis, was also very active in the animal kingdom. Of the 169 animal specimens tested for plague, 23 (13.6%) samples were found to be positive. Of those 23 specimens, 11 were wildlife species including rodents, 4 were flea pools, and 8 were domestic animals (5 cats and 3 dogs). For additional information on plague please visit https://www .colorado.gov/pacific/cdphe/plague.

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SCIENCE UPDATE In 2015, 244 animals were tested for Tularemia, of which 47 (19%) were found to be positive. Those 47 positive specimens included 21 rabbits, 14 rodents, 2 other wildlife species, and 10 domestic animals (5 cats and 5 dogs).

Continued from previous page Colorado Human Plague Cases (n=69) by Year and Disease Type, 1959 to 2015

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Tularemia also continued to cause problems last year with a record number of human cases. In Colorado alone, 52 people were diagnosed as having a clinical illness from infection with Francisella tularensis, the etiological agent of tularemia. These cases presented with a diverse range of symptoms including glandular/ ulceroglandular, pneumonic, gastrointestinal, and typhoidal.

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CVMA Voice 201 6 : 1 | PAG E 2 3

2 01 6, I ssue # 1

SCIENCE UPDATE Predicting the Unpredictable Using Evolving Molecular Technology Christie Mayo, DVM, PhD, Colorado State University Veterinary Diagnostic Laboratories Virology Section Head

Characterization of infectious agents plays a crucial role in veterinary diagnostics. Not only is it critical for the diagnosis, but it also affects management, monitoring and control of infectious diseases. Historically, diagnosticians have demonstrated the microbial origin of diseases by demonstrating the presence of a specific pathogen in a given clinical sample. This approach was first dominated by the culture assay for bacteria and later adapted with virus isolation and electron microscopy for viruses. Within the diagnostic lab, these culture techniques often require specialized media—enriched or selective—culture conditions, defined oxygen tension, defined temperature and particular cell cultivars. Expanding the Classical Options

These specialized conditions and techniques suffer a number of limitations, including the need for dedicated and specialized staff and their intrinsic efficiency in the propagation of fastidious bacteria or slow-growing viruses, some requiring special immunologic stains to enhance recognition, for example, bovine viral diarrhea. Therefore, we have been progressively complementing these “classical” techniques with nucleic acid-based detection technology. Polymerase chain reaction (PCR) is most often used. PCR is the nucleic acid test of choice in the diagnostic lab, as the advantages of this technique are clear: increased speed, automation, sensitivity and specificity. This efficient and high-resolution tool provides the veterinary diagnostic laboratory with the ability to undertake swift and flexible responses to emerging infectious diseases. But even targeted, pathogen-specific diagnostics still have their drawbacks. They beg the question: Are we really prepared to recognize and characterize unexpected or unknown pathogen variants? Preparing to Diagnose the Unknown

In order to circumvent the unexpected and unknown, several strategies have been developed to broaden the range of detection in veterinary diagnostics. Multiplexed PCR assays have been developed to detect a wide range of pathogens within one sample. Bacterial typing has been achieved by sequencing the 16S gene or other regions of the genome that are sufficiently conserved. It is tedious to identify primers conserved, yet sufficiently variable to allow for typing. However, assignment often stops at the level of genus, limiting the often necessary distinction to the species level. At CSU’s Veterinary Diagnostic Lab, we have recently invested in matrix–assisted laser desorption/ionization (MALDI) technology, to expedite the identification of bacterial isolates after culture. This technology uses a principle component of mass spectrometry to analyze biomolecules—DNA, proteins, peptides, and sugars . Although the organism still must first be isolated by standard methods, this new technology is more accurate and can give final identification within hours after established growth on culture. PAG E 24 | CV M A Vo ice 2016 : 1

Colorado State University Veterinary Diagnostic Laboratories’ Illumina MiSeq/NextSeq expertise helps bridge this new technology with meaningful veterinary diagnostics. So, if detection of bacterial isolates by MALDI is still a targeted technique, does that limitation imply we are missing the unexpected or unknown? An alternative strategy, next generation sequencing (NGS), captures genome-specific information and takes advantage of the speed and robust amount of data generated. NGS provides an increased resolution for characterizing pathogens without targeted enrichment or a preconceived idea of what the pathogen may be. Therefore, it is an excellent tool for undiagnosed diseases or cases in which the clinical picture does not completely match the diagnostic test result. This tool also strengthens our unique public mission to improve our understanding of pathogen evolution, adaptation, and virulence determinants in the veterinary community. The principle of NGS for whole-genome pathogen characterization brings diagnostic advantages: In particular, the need to design specific primers to pre-amplify or target pathogens disappears. However, these advantages come at a cost and have several drawbacks, including random amplification of both host and microbial nucleic acid material, making it difficult to tease out the correct amount of information in order to identify the pathogen of interest. Making logical sense of the information also requires refined expertise in both the diagnostic lab and the computer lab. CSU’s VDL is one of few veterinary diagnostic laboratories investing in the equipment and appropriate expertise to bridge this new technology with veterinary diagnostics. As clinicians, private owners, and livestock producers continue to navigate modern veterinary diagnostics, it is important to weigh the pros and cons of this new technology. Our ultimate mission is to combine classic techniques with these modern tools in order to provide an increased understanding of pathogens, their interaction with hosts such as livestock and impact on future disease prevention, control and management strategies. Reprinted with permission from CSU VDL LabLines, Volume 20:2 (Fall/ Winter) 2015 n

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2 01 6, I ssue # 1

IN PRACTICE Be Speedy When Answering Incoming Calls Wendy S. Myers Communications Solutions for Veterinarians

When I called a veterinary clinic at 10:30 AM on a Saturday as a mystery shopper, the phone rang 17 times. A frazzled receptionist answered, “Vet Clinic. Please hold,” followed by the click of being thrown into Hold Hell for 8 minutes. On Monday, I called the practice manager to discuss the service experience—and potential consequences to the business. What if an existing client had called with a sick pet and hung up after the fourth ring? The pet owner might transfer records to another clinic that was eager to help her sick pet. What if a price shopper called about a new puppy and hung up when no one promptly answered? The hospital would miss income from 8-, 12- and 16-week visits, along with the possibility of a lifetime of care. If you’re slow to answer calls, pet owners might assume that your veterinary hospital is closed or too busy to care. The standard in the service industry ranges from answering 80 percent of calls within 20 seconds to 90 percent of calls answered with 10 seconds.1 A busy signal or more than eight rings is considered a call failure.2 Follow a standard of service to answer calls within three rings. Answering on the first ring is five-star service. You don’t want to disappoint existing clients or lose potential new clients who are calling your hospital. A Communication Solutions for Veterinarians’ phone analysis of 3,000 calls to U.S. and Canadian veterinary clinics found most calls were answered by the second ring.3 Another reason to answer with speed: You may get calls from pet owners who are experiencing medical emergencies with their pets—and seconds could help save lives. In the veterinary profession, we dually operate in the healthcare and service industries. So how can you achieve this goal of answering calls within three rings? Cross-train your entire team in phone skills. If receptionists are flooded with a tsunami of calls, they need to reach out to managers, technicians, and assistants who could pitch in for 5 to 10 minutes until the wave of calls passes. Every employee should be able to assist callers with scheduling exams and quoting prices. Everyone is responsible for the service experience at your veterinary clinic—not just receptionists. When employees back one another up, you’ll satisfy clients while creating teamwork and respect among the team. Install a wireless doorbell for front-desk staff to holler, “HELP!” Animal Hospital of Richboro in Richboro, Pennsylvania, has a wireless doorbell at the front desk with a chime in the treatment area. When receptionists get overwhelmed with calls, they ring the doorbell to alert technicians that they need an extra set of hands. Having an assistant briefly pitch in lets callers experience speedy service and relieves stress on the front-desk team. You can buy wireless doorbells from hardware or home-improvement stores for $20 to $60. PAG E 26 | CV M A Vo ice 2016 : 1

Use headsets. Because receptionists answer hundreds of calls each day, headsets can reduce unnecessary back and neck pain and fatigue caused by cradling phones on shoulders. The American Physical Therapy Association, doctors, chiropractors, and physiotherapists recommend using headsets. Studies show that using a headset instead of holding the phone can improve productivity up to 43 percent.4 Headsets let receptionists use computers efficiently to schedule appointments. Let’s say wearing a headset saves one minute per scheduling call and a receptionist schedules 15 exams today. If you save 15 minutes in productivity, the additional time could be spent on overdue reminder calls that generate even more exams. While wearing a headset and talking with a client, the receptionist could walk to the pharmacy to confirm that the pet owner’s prescription refill is ready while also eliminating the client’s hold time. Wearing a headset enables the microphone to stay in the same position as receptionists move their heads and speak, so voices stay consistent to callers. Noise-cancelling technology in microphones can remove up to 75% of background noise, filtering out sounds of barking dogs and other ringing phones.4 Ask your phone equipment vendor about headsets that are compatible with your system or visit specialty websites such as headsets.com and hellodirect.com. Look for headsets with multi-line function, long battery life, length of range, and comfort. Record telephone calls. Business management guru W. Edwards Deming said, “You can expect what you inspect.” Few veterinarians know what callers experience when contacting their hospitals. No matter how much time and money you spend on marketing your clinic, the moment of truth is when your receptionists answer calls—and welcome or turn away potential clients. One of the best ways to assess your service over the phone is to record calls. Listen to multiple calls to see if receptionists were friendly, good listeners, efficiently answered questions, and turned 70% or more of inquiries into booked appointments. When you record calls, you can share praise or coach when improvements are needed. Continued on next page

CV M A VO ICE

IN PRACTICE Continued from previous page You want callers to have five-star telephone experiences, whether they called on a busy Saturday morning or a calm Wednesday afternoon. You can find more information on phone-skills training programs at www.csvets.com/training/phone-skills.html. The next time your phone rings, answer with Greyhound speed and a Golden Retriever smile. Watch my video on “Why you need to answer calls promptly at your veterinary clinic” at www.youtube.com/csvets. References 1. Call Center Helper Forum. Acceptable wait time? Accessed 01-19-16 at www.callcentrehelper.com/forum/topic/accepatable-waiting -time.

2. Arnould, E.J., Whitepaper: “Retail Telephony: Dynamics and Costs of Inbound Call Failure,” Terry J. Lundgren Center for Retailing, University of Arizona, August 2006. Accessed 01-19-16 at www.fujitsu.com /us/Images/inbound-retail-telephony_whitepaper.pdf. 3. Data on file. Communication Solutions for Veterinarians Inc. 4. Benefits of Headsets. Accessed on 09-23-15 at www.headsets.com /headsets/guide/right1.html.

Wendy S. Myers owns Communication Solutions forVeterinarians in Castle Pines and partners with CVMA to present monthly practice performance webinars to our members (visit colovma.org for more information and the 2016 schedule). She helps teams improve client service, communication skills, and compliance through consulting, seminars, and monthly CE credit webinars. n

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CVMA Voice 2016 : 1 | PAGE 27

2 01 6, I ssue # 1

IN PRACTICE Rx Medication Abuse and Safe Prescribing Practices Laurie Lovedale, MPH, Peer Assistance Services, Inc.

Recent statistics released through the Centers for Disease Control indicate a 400% increase in deaths from prescription painkiller overdoses among women since 1999. There has also been a 265% increase seen among men.1 While men are still more likely to die from a prescription painkiller overdose, the gap between the sexes is closing fast. These statistics naturally lead many to ponder two general questions: “Why is this happening?” and “What can we do about it?” Why Is This Happening?

Painkillers are becoming more readily available. From 2000 to 2009, the number of opioid prescriptions per 100 people increased by 35.2 percent and the number of morphine milligram equivalents prescribed doubled.2 Now, approximately 1 in 25 adults are receiving treatment of chronic pain with opioid pain relievers.3 Many consider prescription painkillers to be safer to use, because they are prescribed by a doctor, nurse practitioner, dentist, or veterinarian. These medications do not carry the same stigma that is attached with illicit drugs such as heroin and cocaine. What Can We Do?

There is no clear-cut solution that will solve this issue, but there are some basic things that you can do to help curb this disturbing trend. Veterinarians can help with this issue when prescribing any controlled substance by talking to their patient’s owners about safe prescription use. Proper use: Educate patient’s owners on the potential negative health consequences that may occur when taking a medication not as prescribed or when a human takes medications prescribed to an animal. Proper storage: Encourage patient’s owners to keep medications locked up so no one living in or entering the house has access, and educate on the importance of not sharing medications prescribed for pets; 70% of non-medical users state they obtain these medications from friends and families, meaning these medications are freely shared or taken from medicine cabinets.4 Proper disposal: Encourage patient’s owners to utilize permanent medication drop boxes located throughout Colorado. Visit www.colorado.gov/cdphe/rxdrug to determine where these drop boxes exist throughout the state. The next best option is to mix unused medications with used kitty litter or coffee grounds, place in a Ziploc bag, and throw it in the trash the day garbage is collected. This epidemic will not disappear overnight, so how do we protect the rights of those who need these medications to relieve pain while also preventing their abuse? First, we have to sound the alarm to our communities that prescription medications are a source of concern. PAG E 28 | CV M A Vo ice 2016 : 1

Second, we must respond collectively to create a cooperative response to the problem. In 2013, Governor Hickenlooper and his staff enlisted the advice and expertise of healthcare professionals, state agencies, law enforcement, prevention, treatment, and educational communities to develop the broad-based Colorado Plan to Reduce Prescription Drug Abuse, with the goal of preventing 92,000 Coloradans from abusing opioids by the year 2016. To achieve this ambitious but critical goal, the Governor formed the Colorado Consortium for Prescription Drug Abuse Prevention, a statewide collaboration of government agencies, healthcare professionals, prevention and treatment providers, university personnel, businesses, and law enforcement. This comprehensive approach created an online continuing education course for veterinary medicine providers. This course helps practitioners in veterinary medicine achieve balance between the benefits and risks of treatment with controlled substances. It also provides practical evidence-based guidance for recognizing and minimizing prescription medication abuse and diversion, without compromising care. Visit the Center for Health, Work and Environment to view this on-line course. http://www.ucdenver.edu /academics/colleges/PublicHealth/research/centers/maperc /training/training/Pages/Preventing-Rx-Drug-Abuse.aspx. Sources 1. Centers for Disease Control Vital Signs (2013). Prescription painkiller overdoses. A growing epidemic, especially among women. 2. Kenan, K., Mack, K., & Paulozzi L. (2012). Trends in Prescriptions for Oxycodone and Other Commonly Used Opioids, 2000-10, United States. Open Medicine, 6(2), 41-47. 3. Ibid 4. Substance Abuse and Mental Health Services Administration, (2013) Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings. Retrieved from http://www.samhsa .gov/data/NSDUH/2012SummNatFindDetTables/NationalFindings /NSDUHresults2012.htm

TheVeterinarian Peer Health Assistance Program (VPHAP) provides consultation and support for veterinarians across the state. For more information or training on the issue of prescription drug abuse or to access VPHAP services please go to our website PeerAssistanceServices.org or call 1.800.369.0039. n

CV M A VO ICE

IN PRACTICE Why Policies and Procedures Will Help Your Hospital Succeed

clients to initiate the development of guidelines by answering the following questions:

Wendy Hauser, DVM Peak Veterinary Consulting

Where would guidelines be most helpful?

In my previous role as a technical services veterinarian, I visited an average of 20 veterinary hospitals per week, where I frequently observed a lack of clearly defined policies and procedures. Each employee was doing his or her best to get a job done, often contradicting the recommendations made by different team members during previous client visits. In some cases, the recommendations were undermined by fellow team members in the same visit, such as the time when a technician recommended wellness blood work for a three-year-old dog. When the veterinarian engaged the client in conversation, the veterinarian said “Your dog is young, you don’t need to do blood work now.” I don’t believe that the veterinarian deliberately sabotaged the veterinary technician’s efforts, but this exchange had the negative effect of demoralizing the technician, thereby impacting her effectiveness and credibility. As a consultant that works closely with veterinary teams, I see the real impact that a lack of clearly defined policies and procedures imparts. It is disruptive not only to a hospital’s culture, but also to the client/hospital relationship. When team members provide conflicting information and recommendations, the client is often confused and frustrated. A key finding in the 2015 AAHA State of the Industry report revealed that effective communication was essential in client retention, with 3 of 10 clients stating that they had left previous practices due to ineffective communication and customer service issues.1 Why aren’t hospitals better at defining policies and procedures? I don’t believe leaders consciously decide not to have clear guidelines; the lack of defined processes evolves due to passivity and lack of awareness. In other words, no one is steering the boat! Implementing clearly defined policies and procedures will: • Build teamwork and increase team member job satisfaction. • Provide a coherent framework for team and client communications. • Allow veterinary hospitals to perform “best practices” medicine. • Establish clear expectations for veterinary team members in how they do their jobs. • Serve as training tools for new employees, both doctors and animal healthcare team members. • Help to support a defined hospital culture. • Provide a process for reviewing what is working well and what could be even better yet. • Provide a consistent client experience. While establishing written processes might seem overwhelming, it is not difficult once the commitment is made. I advise my 1 https://www.aaha.org/graphics/original/professional/resources /library/aaha_state_of_the_industry_2015_fact_sheet.pdf

Policies and procedures are needed throughout the entire hospital. I counsel my clients to start in departments where there is a noticeable lack of consistency. Examples of high yield areas that quickly show positive results of consistent processes that are easy to implement include the following. Customer service representatives: • Client communication such as standardized phone greetings and how medical questions are handled. • Protocols that teach how to establish relational interactions, rather than translational ones, as outlined in CVMA VOICE 2015:4 “‘How Much Is a _____?’ Creating Relational vs. Transactional Interactions.” • How future appointments are addressed. Strategies for implementing the forward booking of appointments were published in the CVMA VOICE 2015:2 (pp. 24-25). Examination room communication: • Preventive care recommendations. 1. Clearly define what diagnostic services are to be offered to each pet. This may be based on age categories such as less than one year, one to seven years, seven or older or for dogs, breed based on size (toy, small, medium, large, giant), and breed-specific diseases. 2. What are the hospital’s vaccination recommendations? How are they communicated to clients? Where are vaccinations administered on the body of the pet and how is that documented? 3. What client education is discussed at each visit? How is consistency ensured (via a checklist? Electronic medical record prompts?) 4. What are the hospital’s recommendations for parasiticides such as prophylactic deworming, heartworm preventives and flea/tick preventives? How are these communicated with the client? 5. How do clients know when they are to return for their next visit? Is it documented in the medical record, on an invoice, or as a future appointment scheduled? • Estimates for additional services: 1. When are estimates for additional services provided? 2. Whose responsibility is it to make the estimate? Are there “canned” estimates for commonly performed services available? 3. Who presents the estimate to the client? 4. How are the additional services scheduled? In the examination room? At the reception desk before the client leaves the hospital? Are callbacks to remind clients to schedule the services entered in the computer? Who calls these clients to remind them to schedule the procedures? Policies continued on page 30 CVMA Voice 201 6 : 1 | PAG E 2 9

2 01 6, I ssue # 1

IN PRACTICE Policies continued from page 29 I recommend asking animal healthcare teams where they feel there is confusion or variability. This technique is a great way to begin to build consensus and consistency. Additional benefits are the buy-in and emotional investment of the team in improving the overall hospital operations. Who designs policies and procedures?

In order for policies and procedures to be embraced, I believe that they need to come from the stakeholders. In my hospital, medical protocols were designed by the doctor team. Technicians and assistants were crucial in identifying and solving communication challenges in the examination room as well as defining expectations in other hospital sections such as hospitalized patient care, anesthesia, surgery, and dentistry. I depended heavily on my manager and on the customer service representatives to design methods to optimize the client experience during appointment scheduling, checking in, and the invoicing processes. All newly created policies and procedures were reviewed by the hospital leadership team. Once the methods were finetuned, the new guidelines were discussed and training occurred during staff meetings.

How do I manage these guidelines?

Policies and procedures are dynamic documents. As medical recommendations change and client expectations evolve, so must your hospital processes. The documents should be reviewed and updated annually by the stakeholders in the hospital to ensure that they still achieve the desired objectives. Another time to modify practices would be if there is an adverse event. Investigate the situation and critically dissect the failure. It is very important to not assess blame during this process and to seek input from those close to the situation. The goal is to determine a process to avoid repeat events. In a team meeting, acknowledge the event and outline steps to prevent future recurrences. What resources are available?

There are many resources available that help in the design and implementation of hospital processes. Below are some of my favorites. AAHA The American Animal Hospital Association (AAHA.org) excels at creating and updating standards that are geared toward developing excellence in every part of a veterinary hospital. Standards of Accreditation: https://www.aaha.org/professional /membership/standards.aspx Sample Protocols: https://www.aaha.org/professional /membership/protocols.aspx?type=traditional Guidelines and Toolkits: https://www.aaha.org/professional /resources/guidelines_and_implementation_toolkits.aspx #gsc.tab=0 NASPHV Compendium of Veterinary Standard Precautions (2015) This recently published compendium is a valuable document in designing policies and protocols regarding veterinary occupational health and safety http://avmajournals.avma.org/doi/abs/10.2460/javma.247 .11.1252 Wendy Hauser, DVM, established PeakVeterinary Consulting in January 2015 after working as an industry Technical ServicesVeterinarian.With a DVM from OK State in 1988, she practiced for 26 years as an associate and owner. She is highly engaged in AAHA in new initiatives and leadership.The co-author of TheVeterinarian’s Guide to Healthy Pet Plans, she enjoys consulting and presenting workshops on hospital culture, leadership, client relations, and operations. n

PAG E 3 0 | CV M A Vo ice 2016 : 1

CV M A VO ICE

IN PRACTICE How Do You Manage a Coughing Dog? With the first diagnosed case of H3N2 canine influenza virus diagnosed in Denver in December, 2015 this is an ideal time to design a hospital policy that addresses infectious disease control in patients presenting for examinations. A sample protocol is below.

“Your Animal Hospital” Outpatient Contagious Disease Control Policy “Your Animal Hospital” will utilize the following protocol to reduce the spread of infectious disease when potentially contagious animals are presented for physical examination. 1. Client Communication When the Customer Service Representative (CSR) schedules an appointment for an ill animal, the CSR should ask if the patient is showing any signs of respiratory illness such as coughing or sneezing. If the client answers “yes,” then: A. The appointment should be “flagged” as a potentially contagious dog in the appointment schedule. B. The clients should be instructed to wait in their car when they arrive at the hospital and to call the CSR to announce their arrival. C. The CSR then informs the technical staff that a potentially contagious pet has arrived and is safely confined in the client’s car, awaiting the staff member to escort them to the appropriate examination room. D. All financial transactions are handled within the examination room, so that the client does not interact with and inadvertently transmit infection via fomites to any waiting clients or patients. 2. Handling the Potentially Contagious Patient A. Healthcare Team • Prior to the examination of the pet, the healthcare team members involved in the care of the patient should don appropriate protective attire, including long surgical gowns to cover as much of their clothing as possible, and shoe covers. • All potential equipment, including venipuncture supplies, should be placed in the room prior to the introduction of the patient. • Every effort should be made to minimize leaving the room once the patient has been introduced. • Healthcare team members should remove and discard their shoe covers into a specific “contagious disease” trash bag immediately prior to exiting the room, donning new shoe covers before re-entering the room. B. Facility • An examination room should be designated to be used when potentially contagious animals are examined. This room ideally has a unique entrance; if not available, then the room closest to the entrance should be used. • The client and patient should be escorted through a preferably empty hospital lobby into the examination room. If the patient is small enough it should be carried into the examination room. If the patient is unable to be carried, a team member should follow the patient through the lobby and disinfect the path the patient took to enter the examination room. A “caution-wet floor” sign must be erected to protect against human falls. • If possible, the patient should be placed directly onto the examination table and kept there throughout the entire in-hospital examination. C. Examination • The examination should be conducted within the confines of the examination room. If any diagnostic samples are to be collected, they should be collected while the patient is in the room. • The exception to the above would be radiographs. If necessary to relocate the patient for radiographs, please refer to the “Inpatient Infectious Disease Control Policy” for safeguards and processes. • Upon completion of the physical examination and diagnostic sample acquisition, treatment recommendations and invoicing, the client and patient should exit the facility in the same manner in which it entered, with the same precautions taken. • Appropriate and frequent hand washing measures should be taken during and after the examination and prior to leaving the room. D. Disinfection • The doctor and team member should remove all protective attire, including the examination gowns, and discard the shoe covers prior to exiting the room, placing the gowns into a separate bag to be taken to the laundry and immediately laundered after cleaning of the room. • The team member that assisted in the examination should be responsible for thoroughly disinfecting the room, after donning a clean surgical gown. All surfaces including tables, chairs, floors, sinks/handles, walls and cabinets (top and sides), and door knobs should be thoroughly cleaned with a broad spectrum bactericidal and virucidal spray and paper towels. All equipment used in the exam will be cleaned and disinfected as well, including stethoscopes, computer keyboards, etc. Items that are porous or non-cleanable must be discarded. The mop head used to apply this solution to flooring is removed and soaked in a bleach solution before washing or discarded.

CVMA Voice 201 6 : 1 | PAGE 31

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IN PRACTICE What is “Science Based” Dog Training and Pet Behavior Consulting? Suzanne Hetts, Ph.D., CAAB and Daniel Estep, Ph.D., CAAB Animal Behavior Associates, Inc.

As you evaluate trainers and behavior consultants to use as referral resources, you may hear some speak about their methods as “science based.” We recently took a closer look at this claim for a webinar presentation for our Behavior Education Network members. We felt the information was also worth sharing with you. There is not a universally accepted definition of what “science based” training means. If we take the term “science based” at face value, then any activity included under this banner should be grounded in findings from scientific research. Broadly, science is a process for learning about nature that is based on systematic, verifiable observations that often lead to testable hypotheses about relationships among things. These lead in turn to more systematic observations that either support, or do not support, the hypothesis being tested. Hypothesis testing often leads to more general explanations called theories. Appropriate interpretation and application of the scientific findings is crucial. Unfortunately, when we look at the way scientific research is often interpreted and applied to dog training and behavior consulting, we find problems all along the way. Some techniques used in dog training and behavior consulting have a better scientific foundation than others. For example, there is good clinical research with people and experimental research with cats and other species that support the claim that counter conditioning and desensitization can be quite effective at reducing fearful behaviors and phobias8,9. So the use of these procedures to modify dog behavior could reasonably be said to have a basis in science. But broader claims such as “Modern behavioral science has proven that dominance and punishment-based techniques…are less effective and more dangerous than science-based positive training” (Bumpass) are exaggerations and over-generalizations of the scientific research that is available. These sorts of misrepresentations of scientific research have become quite common. Examples about Punishment 4

The paper by Herron, Shofer, and Reisner is frequently cited as evidence for the statement that punishment-based techniques cause aggression. That’s not what the paper studied, nor what the paper concluded. The study looked at what were labeled “confrontational” and “non-confrontational” procedures used by pet owners. Confrontational procedures included such things as hitting, kicking, and growling at the dog; prying an item out of a dog’s mouth; alpha rolls; scruff shakes; staring at the dog; and more. These sorts of procedures elicited an aggressive response from about 25% of the dogs they were used on. Dogs that had existing aggression problems were more likely to respond with aggression in reaction to the alpha roll and “no” compared to dogs presenting for other types of behavior problems. Non-interactive forms of punishment such as using sticky tape or a Snappy Trainer® to keep a cat off of a counter were not examined. PAG E 3 2 | CV M A Vo ice 2016 : 1

Example about “Positive” Training Being Better

When it comes to what scientific research says about “positive” training being more effective than other types, the results vary. As with much of scientific research, it depends on the populations studied, the variables investigated, type of data collected, and other factors. For example, one study found the highest aggression scores (tabulated from frequency and number of contexts displayed) reported by dog owners were associated with those who used a combination of positive reinforcement and positive punishment methods1. The authors of this paper are quick to point out that their data are correlational, not causal, yet this fact is frequently neglected. Examples about Remote Shock Collar Training

A study from the U.K. by Cooper and Mills2 is frequently cited as evidence that use of electronic shock collars cause all kinds of problems for dogs. The study looked at only the use of remote shock training collars (not anti-bark collars or those used for electronic containment) to address either chasing livestock or wildlife or not coming when called. The study found no differences in cortisol levels between dogs trained with both remote collars and positive reinforcement and dogs trained with positive reinforcement only. There were no significant differences between groups in stress-related behaviors such as yelping, paw lifting, scratching or shaking, lip licking unrelated to food, tail held low or high, panting, or excited, relaxed, or tense body postures. There were no differences in owner reports of satisfaction with the training among the groups. This study is frequently cited as evidence against the use of all forms of electrical stimulation devices. Another study found dogs trained with shock collars for general obedience tasks showed more stress signals and lowered ear positions than dogs trained without them using other types of harsh methods.6 However, these were police dogs and may not be representative of average pet dogs and the data analyses were questionable. We also don’t know the intensity of the shock used in either study—a variable that would be quite important when drawing conclusions about the use of shock in general. Examples about Use of Terminology

The use of the term “drive” to explain why dogs engage in certain behaviors is still quite prevalent in dog training, even by people who claim to be using “science based” methods. Yet psychologists and ethologists abandoned the idea of “drives” to explain motivation for behaviors in the 1950s and 1960s. But we still hear “prey drive” used to explain why dogs chase anything from birds and squirrels to joggers and children. Research into dog personality and temperament3 found no evidence that the behaviors frequently attached to “prey drive” correlate with each other at all. There is no scientific foundation for “prey drive,” so this aspect of dog training is definitely not science based. “Evidence based” is a term veterinarians are likely familiar with, in reference to veterinary medicine. The dog training world is now starting to use the term as well. People claim to use “evidence-based dog training methods” or provide Continued on next page

CV M A VO ICE

IN PRACTICE Continued from previous page “evidence-based information” about behavior. As you probably know, evidence-based practice came from the human medical field and can be defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” 7 An evidence pyramid is used to evaluate the quality of the evidence about a given practice, technique, or treatment. One such pyramid from Mehtani5 is reproduced below. Most of the evidence for various dog training and behavior consulting techniques does not rise above the expert-opinion or mechanisticbased level. Most of the randomized controlled trials that have been conducted in this area evaluated the use of medications for behavior problems. We are aware of one systematic review regarding the efficacy of pheromone products. Clearly, dog training and pet behavior consulting have a long way to go to achieve the qualities of evidence seen in most areas of medicine, yet phrases such as “proven fact” and “solid evidence” and “shown to be efficacious” can mislead people into thinking the evidence is better than it is.

3. Goodloe, L.P. and P.L. Borchelt, 1998. Companion dog temperament traits. Journal of Applied AnimalWelfare Science 4:303-338. 4. Herron, M.E., Shofer,F. S.and I.R. Reisner. 2009. Survey of the use and outcome of confrontational and non-confrontational training methods in client owned dogs showing undesired behaviors. Applied Animal Behaviour Science 117: 47-54 5. Mahtani, K. 2015. The evidence, the expert opinions and the reaction: a teaching example. Blog Post Centre for Evidence Based Medicine, Oxford University. 6. http://www.cebm.net/wp-content/uploads/2015/04/exerciseand-obesity_May-5th-.pdf 7. Matthijs B.H Schildera, and Joanne A.M van der Borg. 2004. Training dogs with help of the shock collar: short and long term behavioural effects. Applied Animal Behaviour Science 85 (3-4): 319–334. 8. Sackett, D.L., Rosenberg, W. M.C., Muir Gray, J.A., Haynes, R.B., Richardson, W.S. 1996. Evidence based medicine: What it is and what it isn’t. British Medical Journal, 312, 71-72. 9. Wolpe, J. 1958. Psychotherapy by reciprocal inhibition. Palo Alto CA: Stanford University Press. 10. Wolpe, J. & Lazarus, A.A. 1966. Behavior Therapy Technique. New York, NY: Pergamon Press. n

Award Winning Architecture

Conclusion

In this article, we’ve attempted to give you a few selected examples of inappropriate claims and misinterpreted scientific research using the “science based” label in dog training and behavior consulting. The important lesson for all of us is to critically evaluate claims of “science based” or “evidence based” procedures or practices. Not infrequently, the terms are used inappropriately, particularly by those that have little or no formal training in science. So if trainers or consultants say to you their methods are “science based” you still need to ask more questions to find out what they actually do. Literature Cited 1. Blackwell, E.J., Twells, C., Seawright, A. & Casey, R.A. 2008. The relationship between training methods and the occurrence of behavior problems, as reported by owners, in a population of domestic dogs. Journal ofVeterinary Behavior, 3, 207-217. 2. Cooper, J., Cracknell, N., Hardiman, J. & Mills, D. 2012. Studies to assess the effects of pet training aids, specifically remote static pulse systems, on the welfare of domestic dogs. Final Report to the U.K. Department for Environment, Food and Rural Affairs. Project AW1402A.

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2 01 6, I ssue # 1

CVMA NEWS

Welcome to your CVMA Chapter 6 | Denver Area update page in the CVMA VOICE! Here you will find items of importance and interest for your chapter. If you have anything you would like to see included here, please send your items, information, or articles to camicacciatore@colovma.org. Transfers and Heartworm Disease

Transfers of dogs into Colorado from heartworm endemic areas are increasing (see article on page 15). As part of the Dumb Friends League’s commitment to a healthy canine community, any animal with heartworm disease transferred to Colorado and adopted through the Dumb Friends League will be treated by the Dumb Friends League at no charge to the adopter. This treatment will follow the American Heartworm Society’s guidelines which dictate doxycycline or minocycline, administration of a heartworm preventive, and a three injection protocol with melarsamine. Due to this treatment protocol, adopted dogs will be returning to the Quebec shelter for injections at days 60, 90, and 91 of treatment. Ideally veterinarians will evaluate for microfilaria one month after the final injection, and it is vital that veterinarians follow up this treatment with a heartworm test six months after completion of this treatment. Please contact Eva DeTolve, Director of Veterinary Services, at 303.751.5772 X7306 with any questions. DFL Reminds Adopters of Rabies Vaccinations, Veterinary Visits

The Dumb Friends League (DFL) is helping to remind adopters to keep their pets’ rabies vaccinations up to date and of the importance of regular wellness exams. The following letter is being sent out to those who adopted one year ago to remind them to visit their veterinarian for rabies vaccinations and annual exams. CVMA thanks DFL for their efforts and for encouraging pet owners to make the most of the veterinary-client-patient relationship! Congratulations! One year ago a special animal was in our care awaiting a forever home at the Dumb Friends League… and then you came along.Thank you for sharing your home and your heart. Prior to adoption, the Dumb Friends League administered a rabies vaccination.This initial rabies vaccination had a one-year duration, and it has now expired. If you haven’t already done so, please help your pet live the longest, healthiest life possible by making an appointment with your PAG E 3 6 | CV M A Vo ice 2016 : 1

veterinarian for an annual examination and a booster rabies vaccination to continue your pet’s protection. Be sure to also use this opportunity to discuss any behavioral or medical questions you have with your veterinarian–most issues are easily addressed with early intervention. As advocates for animals that need a second chance, please accept our heartfelt appreciation for providing a loving home and excellent care to your furry friend. 2016 Healthy New Pet Guide

For more than 20 years, DAVMS members generously provided new pet adopters in the metro area with a free wellness exam through what was called the Free Veterinary Exam booklet. The original booklets were small and basic, but what really mattered was the intention behind them—to provide new pet owners with a way to get their adopted friends off to a healthy start with a DAVMS member veterinarian. In 2008 the booklet moved to a larger format in color with added pages full of helpful information for new pet owners. In 2010 the name was changed to Healthy New Pet Guide to better describe its purpose as we once again expanded the information and resources it provides for new pet owners. With the new chapter structure, CVMA has continued this longstanding program, and this year produced the Denver Area version of the Healthy New Pet Guide, which was delivered at no charge to member shelters of the Metro Denver Animal Welfare Alliance (MDAWA) to distribute to new pet adopters. Year after year, the booklet brings together new pet owners and member veterinarians in what we hope are long, happy, and healthy relationships! We’d like to thank the 139 practices who listed in the 2016 Healthy New Pet Guide. In early February, 34,000 booklets were Continued on next page

CV M A VO ICE

CVMA NEWS Continued from previous page distributed to MDAWA shelters to be given out to new pet adopters this year. If you’d like to see this year’s edition, visit colovma.org under the Publications tab. The Healthy New Pet Guide offers tips on responsible pet ownership, welcoming a new pet, FAQs, summertime safety, and pet first aid. It explains the free veterinary wellness exam, how to choose a veterinarian, and lists participating CVMA Denver Area member clinics for the new pet owners to choose from to start their adopted family member on the road to a healthy lifetime of veterinary care. Those listed will provide a free veterinary wellness exam within 14 days of the date of the adoption of the new pet. The Healthy New Pet Guide has proven very effective in not only offering new pet owners a great way to get their adopted friends off to a healthy start, but also by bringing in new clients to veterinary practices across the Denver area. Thank you again to our participating members for helping make a difference for newly adopted pets in 2016. And we wish you great success with your new clients!

Disc Impaction Sunday, May 15 (8:00 AM) Paco Sanchez Disc Golf Course West 12th Ave & Knox Court Denver, CO 80204 Family Impaction Bring family and friends to check out this blast from the past amusement park in NW Denver. We had a great time at our last Family Impaction at this location. Lakeside Amusement Park 4601 Sheridan Blvd Denver 80212 Sunday June 19 (4:00 to 6:00)

Want to see your chapter updates in the VOICE? Contact your chapter representative with details!

Upcoming Impactions and Meetings

Visit colovma.org to find your representative and

Below you will find a list of upcoming Impactions for the first half of 2016. Please understand that these events are subject to change. So add them to your calendar, but be sure to check the Chapter 6 | Denver Area page at colovma.org, where you’ll find a calendar of events and any updates or changes. Please come join us, meet other members, and make connections in 2016!

contact information.

Finding Meaning in Veterinary Medicine Meetings are held at 6:30 PM on the third week of each month alternating between Tuesdays and Wednesdays as follows, and will be hosted by Dr. H. Howells. Tuesday, April 19 Wednesday, May 18 Trivia Impactions Tuesday, April 26 7:30 PM Caution Brewing Company 1057 S. Wadsworth Blvd. Unit 60 Lakewood, CO 80226 Wednesday, May 25 7:00 PM Dry Dock Brewing Company 15120 E. Hampden Ave. Aurora, CO 80014

Tuesday, June 21 Wednesday, July 20 Thursday, June 29 7:00 PM Goldspot Brewing Company 4970 Lowell Blvd Denver, CO 80221 Wednesday, July 27 7:30 PM World of Beer 7260 W Alaska Dr. (Belmar) Lakewood, CO 80226

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CVMA Voice 201 6 : 1 | PAGE 37

CVMA Service Award Nominations It’s time to say thank you to those in the veterinary profession who have given so much – nominate a colleague for a CVMA Service Award. Do you know someone in your office staff, a veterinary technician, a colleague, an industry representative, or anyone who has given unselfishly to the veterinary profession? Please take a moment to nominate a deserving person for one of CVMA’s annual awards, which will be presented at CVMA Convention 2016. It will mean so much to a person who is working for the benefit of everyone involved in veterinary medicine. The nominations deadline is May 16, but please do it today. For your reference, a list of the previous winners is available at www.colovma.org/serviceawards.

Nominate a Colleague by May 16, 2016

Veterinarian of the Year This award recognizes a distinguished member of the CVMA who has contributed to the advancement of veterinary medicine in Colorado in the areas of organization, education, research, practice, or regulatory service. Such service must be performed during the three calendar years immediately preceding the year the award is received. Distinguished Service This award recognizes an individual who has contributed outstanding service to the advancement of veterinary medicine over an extended period of time in Colorado in any or all aspects of the profession. This individual need not be a veterinarian; however, veterinarians are not excluded from being eligible for this award. Rising Star This award recognizes a CVMA member who has graduated in the last 10 years and during this time has made a significant contribution to veterinary medicine in Colorado in the area of organizational activities (local, state, regional), private practice, regulatory services, education, or research. Outstanding Faculty This award recognizes a Colorado State University faculty member who has provided unselfish assistance to practitioners as a clinician, is a proficient and capable teacher, and/or has made significant contributions to continuing education. Technician of the Year This award recognizes an outstanding veterinary technician in Colorado— whether for exceptional clinical competence, a caring commitment to animal welfare, or for outstanding leadership ability—whose dedication raises the level of excellence in the veterinary profession, the technician’s community, or society as a whole.

Please use the

Industry Partner This award is presented to a company representative considered highly valuable in providing resources to DVMs and in supporting CVMA’s goals and mission.

back of this

Nomination Form on the brochure.

Service Awards 2016 Nomination Form

Name of nominee

Nominated for: (check one)

City

q Veterinarian of the Year q Distinguished Service q Rising Star

q Outstanding Faculty q Technician of the Year q Industry Partner

Name of nominator Address City Phone

State Fax

Zip

E-mail

This completed nomination form must be submitted with the following documentation: Cover letter describing the reasons the nominee should be considered for the award q List of accomplishments (can be included in letter) q

Nominators are encouraged to be as thorough and comprehensive as possible, as these descriptions provide the material from which the Awards Committee must decide the recipient. In addition to the required nomination materials listed above, the following items are useful in the evaluation process: • • • • •

Biography, resume, or curriculum vitae Letters of recommendation Photos and/or video News clippings Any additional supporting documentation A list of previous award recipients is available at www.colovma.org/serviceawards Please submit completed nomination form to: CVMA, 191 Yuma Street, Denver, CO 80223 (fax) 303.318.0450

Nomination Deadline – May 16, 2016

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