CVMA VOICE 2016:4 by CVMAMedia

CV M A VO ICE

Today’s Voice, Tomorrow’s Vision

• CVMA Welcomes New CEO-designate • HB16-1324: Where Are We Now? • CVMA Membership 2017

2016, ISSUE #4 CVMA Voice 201 6 : 4 | PAGE 1

ARE YOU

OVERPAYING FOR YOUR OFFICE LEASE?

Over 80% of healthcare professionals believe they pay too much. We agree. We can help. Our expertise is provided at no cost to our clients, saving them time and money during lease negotiations.

Call today for your free lease or purchase evaluation. DENVER Brad Sheasby | 303.882.5119 brad.sheasby@carrhr.com CARRHR.COM

NORTHERN COLORADO Dan Gleissner | 303.748.7905 dan.gleissner@carrhr.com

SOUTHERN COLORADO Kent Hildebrand | 719.440.0445 kent.hildebrand@carrhr.com

ONLY HEALTHCARE. ONLY TENANTS AND BUYERS. TM

CV M A VO ICE

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

6 CVMA Membership 2017

CVMA: Doing More, Together . . . . . . . . . . . .

2017 CVMA Membership & Benefits . . . . . . .

CVMA Welcomes New CEO-designate . . . . 10 CVMA Convention 2016 . . . . . . . . . . . . . . . . . 12 Bucking Broncos and Different Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Can Underserved Pet Owners Be Profitably Served? . . . . . . . . . . . . . . . . . . . 14 Immigrant Veterinarian Overcomes Incredible Odds to Succeed . . . . . . . . . . . . . . 17 Wellness Risk Factor Study Finds Positive Correlation to VMA Membership . . . . . . . . . 18

Government Affairs . . . . . . . . 21

CVMA Convention 2016

HB16-1324: Where Are We Now? . . . . . . . . .

Veterinary Pharmaceutical Advisory Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Science Update . . . . . . . . . . 24 Pets Exposed to Wildlife . . . . . . . . . . . . . . . 24 National Animal Health Lab Network More Critical than Ever . . . . . . . . . . . . . . . . .

29 Veterinary Team Synergy

In Practice . . . . . . . . . . . . . . . . 26 Who Needs a Manager? . . . . . . . . . . . . . . . . . 26

CVMA Events and Deadlines January 19 Dental Promotions That Boost Compliance Webinar January 19–22 CVMA SkiCE 2017 Breckenridge February 8 PDS: Ophthalmology for the General Practitioner Denver February 16 The Art of Advocacy: Advancing the Profession’s Public Policy Agenda Denver February 16 Phone Scripts That Gain New Clients Webinar March 8 PDS: Feline Internal Medicine Denver March 16 Ways to Increase Productivity When You’re Short Staffed Webinar April 12 PDS: What’s New in Pharmacology Denver April 20 How to Prevent Client Complaints and Bad Reviews Webinar

A Day in the Life of a Modern Veterinarian . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Practice Performance Webinars 2017 . . . . 29 Veterinary Team Synergy . . . . . . . . . . . . . . 29 Can Placebos Benefit the Treatment of Separation Anxiety in Dogs? . . . . . . . . . 30 Compounding Transdermal Medications for Feline Patients . . . . . . . . . . . . . . . . . . . . .

32 Compounding Transdermal Medications for Feline Patients

CVMA News . . . . . . . . . . . . . 36 CVMA Staff Updates . . . . . . . . . . . . . . . . . . . . 36 CVMA Welcomes 2016/17 Executive Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 CVMA CE Southwest . . . . . . . . . . . . . . . . . .

CVMA Chapter Connections . . . . . . . . . . . . 38

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

2 01 6, I ssue # 4

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 (Core and Premium members will receive a mailed print copy and Basic members will have online access only) 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

Sam Romano, DVM President

Traveling the state this past summer on CVMA chapter visits was a life-changing event. Colorado is beautiful, that’s no secret. From the incredibly lush eastern plains to the mountains, the scenery was amazing. The image of cattle grazing in the rain among miles of wind turbines near Limon was incredible. But what makes it especially wonderful are the amazing people—you, your families, and your communities. I’m deeply grateful for your hospitality and the opportunity to talk with you about life and the rapidly changing face of veterinary medicine in our state. As with many experiences, the true impact often takes weeks or months to process. That’s been my case, and the learning, paradigm shifts, and personal awareness has started to materialize. As a small animal practitioner in Denver for 30-plus years, to say I was wearing blinders and unaware of the complex realities facing our profession and state is an epic understatement. Spending time at the capitol, and interacting with regulatory agencies, added additional “rings” to my wakeup call. CVMA staff and members work incredibly hard to improve the lives of all Colorado citizens, animals, and veterinary professionals. A few personal insights gained from my experiences follow. Thank you for taking time to read on. Collaboration is the key to effective, positive change

Student debt is a powerful example. The cost of a veterinary education is having a profound impact on the veterinary landscape (certainly not news to most). However, before now, the issue had no face, no name, and was not personal. That changed big time for me. It was painful to hear deeply personal stories about young people, upon graduation from veterinary school, that were unable to go back to their rural communities due to the burden of heavy educational debt. Back to farms and a lifestyle held firmly for generations. Back to a life they know and love. PAG E 4 | CV M A Vo i ce 2016 : 4

But this isn’t a “Debbie Downer” scenario with no end in sight for impacting student debt. Quite the contrary. It’s a message of hope, and here’s why. Talented, committed individuals from all corners of our profession and state are collaborating to tackle the problem. For example, the AVMA’s Economics of Veterinary Medical Education Summit convened at Michigan State University this past April brought together educators, students, state veterinary associations, legislators, and allied organizations to continue work on tangible solutions to reduce educational debt. But the AVMA is just the beginning. You don’t have to look far for others working incredibly hard to mitigate the problem— the dedicated leaders in the College of Veterinary Medicine and Biomedical Science (CVMBS) at CSU, the USDA, and our state veterinarian, to name a few. As Harry S. Truman said, “It is amazing what you can accomplish if you do not care who gets the credit.” It should be the tagline for all the folks working together on this problem. Collaborative efforts as part of CVMA advocacy is also alive and well at the Colorado State Capitol. A shining example was House Bill 16-1324, Veterinary Access Compounded Pharmaceutical Drugs. The collaborative effort required to craft, and ultimately pass, this bill, was extraordinary. Skilled CVMA lobbyist Mr. Leo Boyle, dedicated legislators Representative Joann Ginal and Senator Jerry Sonnenberg, and numerous CVMA staff and members worked overtime to get it to Governor Hickenlooper’s desk for signature. No small feat—yet one that impacts day-to-day practice for most. Although the compounding bill was signed into law by Governor Hickenlooper, many additional bills did not make it out of committee. All required vigilance by the CVMA. Colorado is a bellwether state for veterinary legislation. We provide a superior level of animal health to our fellow citizens, from production agriculture to companion President’s Post continued on page 11

CV M A VO ICE

BRIEFINGS

CVMA Executive Committee Dr. Sam Romano President Dr. Will French President-elect

Ralph Johnson Executive Director

At this time of year, it’s natural to look back on what’s been done, and forward to what we’d like to do. CVMA has had a great year, with so many accomplishments to be proud of. We have you, our members, to thank for that. Your support and dues dollars help us keep up all the work we do on your behalf, ensuring our continued success and forward movement. Part of being good stewards of your professional association is a commitment to finding the very best ways to understand and respond to issues, challenges, and opportunities that face the practice of veterinary medicine in Colorado. CVMA is fortunate to have a dedicated and experienced Executive Committee in place, providing a strong, balanced foundation for all we do. And in an effort to make our leadership team even more effective and agile, we are proposing evolving the governance model and making some strategic changes. Because today’s fast-paced environment for decisions and policy development requires an agile governance structure, it can be challenging for the current Board of Directors to be an effective fiduciary for CVMA on a twice yearly, 90-minute basis. Fortunately, our current governance system allows the Executive Committee wide authority, which has been exercised diligently, effectively, and without issue. The current model has important attributes and benefits to retain spirit of unity, social fabric, diverse perspective, grassroots communication flow, engagement of chapter leaders, and engagement of organizational liaisons. The Proposal

So, how can we preserve those desirable attributes and benefits while evolving to a more agile decision-making model? We propose that the current Board of Directors becomes the CVMA Leadership Council, and the current Executive Committee becomes the Board of Directors.

Dr. Joy Fuhrman Secretary/Treasurer

In this new structure, the CVMA Leadership Council has formal and informal opportunities for personal development and bi-directional communication with members, while engaging in environmental scanning for emerging issues, professional issue discussions, and strategy formulation to provide advisory recommendations to the board. Meetings of the council would be focused on issues identified by the Leadership Council or referred by the Board of Directors and would occur twice a year at CVMA BIG Ideas Forums, where the president would preside and the board would provide updates on recent actions and issues. The Leadership Council will be composed of: • Chapter representatives (17 total, appointed by each chapter, equal vote) • Organizational liaisons (appointed by the board, voice but no vote) • Board of Directors (elected by members, voice but no vote) With the Leadership Council in place, the CVMA Board of Directors would focus on association health, day-to-day decision making, policy formulation, oversight of the CEO, fiduciary responsibility, budget, dues and rates, legal compliance, and the association bylaws. The CVMA Board of Directors will be composed of: • 7 at-large voting positions elected by members • 1 CEO appointed by the board (non voting) The Advantages

The new governance model clarifies authority, supports agile decision making, sustains a connected community of chapter leaders and organizational liaisons and utilizes that connected community in more engaging, satisfying, and productive ways, while providing personal development opportunities for members of the Leadership Council. Briefings continued on page 13

Dr. Stacee Santi Secretary/Treasurer-elect Dr. Curtis Crawford Immediate Past President Dr. Melanie Marsden AVMA Delegate Dr. Rebecca Ruch-Gallie AVMA Alternate Delegate Mr. Ralph Johnson Executive Director*

Chapter Representatives 1 – Dr. Kimberly Radway 2 – Dr. Wayne Jensen (D) 3 – Dr. Hannah Klein 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 (D) denotes district

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

CVMA Voice 201 6 : 4 | PAG E 5

CVMA: Doing More, Together As we wrap up 2016 and look at all that CVMA has accomplished, we offer to you, our members, a heartfelt thank you. This was an unprecedented year for CVMA and we could not have done it without you! With a record 2,350 members, CVMA’s voice has never been stronger. This was evident as CVMA won a hard-fought battle to pass a monumental piece of legislation this year, significantly changing the landscape for veterinary compounded medications in Colorado. House Bill 16-1324 grants licensed veterinarians the ability to access compounded medications, both controlled and nonscheduled, from in-state or non-resident compounding pharmacies— and maintain those medications for office use or office stock, with an allowance for dispensing up to a five-day dosage of the drug.

support and guidance using proven, successful

Without the strength of our members behind us,

methods. PLUS, Veterinary Growth Partners is now

and without membership dues, we could not ef-

offering a free three-day workshop in Denver for

fectively protect you and your practice. The coming

CVMA and VGP members (a $1,495 value). You can

year will bring new challenges and we are counting

learn more about the services VGP provides on

on your continued support to keep the association

the following pages, or visit colovma.org for more

strong, and our voice stronger.

information.

If you have not done so already, we hope you will

Your support also helps us to continue offering ex-

take a few minutes to renew your membership in

ceptional education to provide you the CE you need.

CVMA. We know you have choices to make about

Whether you prefer joining your colleagues at the

where to spend your dues dollars, so we work hard

annual convention, plugging into a webinar during

to provide you with benefits, support, and services

your lunch break, or taking an afternoon or a week-

unique to you and to Colorado. With 2017 member-

end to focus on specialized content, CVMA has you

ship, CVMA has added more benefits and value to

covered.

help you get the most out of your membership and

And CVMA’s support system is there when you

provide you with valuable new resources to help you

need it, from website content and resources, to

succeed.

digital and printed need-to-know information, to a

As part of our economic and personal well

friendly staff dedicated to working on your behalf.

being initiative, CVMA is partnering with Veterinary

We are your resource and we are here to serve you.

Growth Partners (VGP) to offer Core and Premium

Thank you for your continued support of CVMA

members free enrollment in VGP (a $995 value).

and for your dedication to veterinary medicine in

VGP offers your practice continual, one-on-one

Colorado! n

PAG E 6 | CV M A Vo i ce 2 016 : 4

2017 CVMA Membership & Benefits MOST POPULAR

PREMIUM $615

CORE $369*

BASIC $255

All CVMA memberships include:

Advocacy

Public Outreach

Peer Connections

Members Only Content

Career Center

Personal & Professional Development

VOICE Magazine

Online + Print

Online only

Discount on employment ads in Career Center

25% Discount

20% Discount

10% Discount

WAIVED - 3 years

WAIVED - 1 year

WAIVED

Veterinary Growth Partners fee ($995 value) Practice enrollment fee for Certified Veterinary Assistant program ($325 value) Eligible for Power of Ten Leadership Academy Registration to BIG Ideas Forum

2 FREE

Practice Diagnostic Report ($250 value)

FREE

Personalized Fee Guide ($275 value)

FREE

1 FREE

$100 off any CVMA education offering 10% discount on Core membership for ALL doctors within your practice Additional 10% discount on convention registration for ALL members at your practice Core membership for one non-veterinarian practice manager

FREE

* Discounts available on Core Membership. See FAQs or enrollment form for more information.

NEW THIS YEAR… FREE enrollment in Veterinary Growth Partners for Premium and Core Members Veterinary Growth Partners (VGP) is a membership organization that serves YOU with a proven practice management system, marketing and client communication tools, education resources, staff training, consulting services, and group purchasing for discounts that increase profit and decrease expenses. All of which results in performance improvements in virtually every aspect of your practice. See the VGP information on the following pages for more information.

FREE membership for your practice manager when you choose Premium All premium members now receive a free Core membership for their non-veterinarian practice manager (a $221 value). Simply include a membership form for your practice manager or call CVMA at 303.318.0447 to set up the membership. CVMA Voice 201 6 : 4 | PAGE 7

WITH YOUR VETERINARY GROWTH PARTNERS MEMBERSHIP COMES GREAT REWARDS Veterinary Growth Partners is a membership organization that helps transform practices through proven processes and new innovations. VGP will help you accelerate the vision that you have for your practice, and impact how your practice operates, serves clients, and makes business decisions. All of this results in performance improvements in virtually every aspect of your practice.

Practice Management Tools Innovative tools and expertise to help you grow your practice and make it profitable

Marketing Tools Target new clients and your best with tools that drive growth and measurable ROI

Education & Best Practices CE opportunities in virtual classrooms, live workshops, video shorts & more

Preferred Pricing Save time and money with our negotiated agreements with top industry partners

WHAT MAKES VETERINARY GROWTH PARTNERS DIFFERENT?

PATHWAY PLANNING

A PRACTICE COACH ASSIGNED TO YOU

Pathway Planning is a system for diagnosing and assessing your hospital’s business health, and creating a treatment plan. Most owners and administrators can easily identify the practice’s problems, but they can’t always create a plan to solve them. Pathway Planning is the answer. It makes your mission, vision, and values an interactive part of everyday strategy and execution.

Our VGP Practice Coaches are talented individuals who have spent many years in veterinary medicine – all have served as successful Practice Managers. They help veterinary hospitals design the future they desire and achieve their goals. As part of your membership, our coaches help you implement best practices as outlined by Pathway Planning’s model in areas of strategic planning, operations, finance, inventory, human resources, marketing, client care, and patient care. It’s like having your own practice consultant at your fingertips!

INTENSIVE LEADERSHIP TRAINING We host frequent free workshops, exclusively for VGP members, on practice and personal improvement skills. All workshops are 3-day interactive programs, hosted by VGP Chief Culture Officer, Shawn McVey.

Renew your 2017 CVMA Membership today to take advantage of all the benefits VGP has to offer!

WHY THIS PARTNERSHIP MATTERS TO YOU As part of CVMA’s economic and personal wellbeing initiative, we are proud to partner with Veterinary Growth Partners (VGP) to provide a new level of support for Colorado veterinarians. To help members create healthy, thriving practices, CVMA is working with VGP to provide you with discounts on resources like Pathway Planning, practice management tools, educational and personal development opportunities, and so much more.

CVMA MEMBERSHIP PRICING LEVELS BASIC

CORE

PREMIUM

$995

$0*

For One Year

For Three Years

Basic CVMA Members are not eligible for any discounts and would pay full price for any VGP programs

Core CVMA Members receive access to VGP programs at no cost for one year ($995 value) and $300 for following years ($2,385 value)

Premium CVMA Members receive access to all VGP programs at no cost for three years ($2,985 value)

With the addition of VGP discounts, your CVMA membership holds more value than ever before. So take the first step in creating a vibrant practice today by becoming a CVMA Premium or Core member. *Participation requires completion of the VGP Practice Health Assessment within the first 60 days of membership. Pricing guaranteed through December 31, 2019.

Renew your 2017 CVMA Membership today to take advantage of all the benefits VGP has to offer! Call: 303.318.0447 | E-mail: Info@colovma.org Renew online: www.colovma.org

UPCOMING FREE VGP MEMBERS ONLY WORKSHOPS Pathway Planning Workshop Coronado, CA, Jan. 13-16, 2017 Boston, MA, Mar. 24-26, 2017 Chicago, IL, June 22-25, 2017

What’s Your EQ? Developing Your Emotional Intelligence Denver, CO, April 28-30, 2017

Commando Conversations: Becoming Conflict Competent San Antonio, TX, Nov. 4-6, 2016

VGP INDUSTRY PARTNERS • Abaxis Veterinary Diagnostics • ANTECH Diagnostics • Datamars • HireRight • iVET360 • KindHealth • Live Oak Bank • MWI Veterinary Supply • Purina • Quadrid Productions • Redstone Payment Solutions • Sound • Stratford Pharmaceuticals • Terumo Medical Products • Trupanion • Veritas • VETgirl • VetStem • Zoetis

2 01 6, I ssue # 4

OF NOTE CVMA Welcomes New CEO-designate Ralph Johnson, Executive Director

In June, I shared in a letter to members the new leadership structure emerging at CVMA and PetAid Colorado. As I announced my plan to retire in mid-2018, a search began for a CEO-designate to bring someone on board that would allow for the outgoing and incoming executives to work side by side for an extended period of time. This approach will acquaint the incoming executive with CVMA’s extensive program of work, issues facing the profession, the breadth of our legislative work, and the regulatory activities that require ongoing attention. It will also immerse the new executive in the network of relationships that are so vitally important to both organizations – with members, legislators, regulators, industry partners, animal welfare leaders, professional associations, media, donors to PetAid, and more. This transition approach will expand the capacity of our team, and is responsive to the goal of sustainability in strategy, relationships, and financial resources. As part of this plan, I am now on a half-time schedule with CVMA and PetAid, a move that was made possible by an opportunity that allows me future engagement and contributions to the veterinary profession. Effective August 1, I assumed the parttime role of the first-ever chief executive officer (CEO) for the Veterinary Medical Association Executives (VMAE). I have been deeply involved in VMAE throughout my tenure at CVMA, and as a result I’ve been able to tap the knowledge of fellow executives throughout the veterinary universe and form an incredible network of professional relationships. It is with great pleasure, then, that I introduce you to Diane Matt, the new CEO-designate of CVMA and PetAid Colorado. She comes to us from WEPAN, the Women in Engineering ProActive Network, where she served as executive director for 12 years. WEPAN is a network of thought- and change-leaders who use research-based strategies to build and sustain equitable cultures in engineering, leading to a richly diverse and innovative engineering workforce. As a Principal Investigator and grant writer, she has proposed and spearheaded numerous transformational National Science Foundation-funded projects to realize WEPAN’s vision of sustainable, systemic inclusion in engineering. Diane’s career has ranged from the world of engineering geology to conducting research in paleo-glaciology in the Canadian Rockies of Alberta, Canada. She has also previously served as manager of environmental affairs for the Denver Regional Transportation District, the executive director for the Associated Landscape Contractors of Colorado, and director of strategic and international alliances for the Geological Society of America.

PAG E 10 | CV M A Vo ice 2016 : 4

Diane has received numerous awards, including the Indiana University 2016 Distinguished Alumni Award, WEPAN Recognition for Service, Colorado Society of Association Executives Annual Award of Excellence, and the Green Industry Person of the Year award. She earned her bachelor’s degree in Geology from Indiana University and master’s degree in geology from the University of Calgary. She resides in Denver. A Conversation with Diane Matt, CVMA CEO-designate

How did you learn about CVMA and PetAid Colorado? CVMA first appeared on my radar when I joined the Colorado Society of Association Executives (CSAE) in the early 80s. Through those connections, and attending CSAE Grey Matters at the CVMA/PetAid offices for many years, I’ve gotten to know Ralph quite well as a valued professional colleague. I’ve heard about the great work CVMA has done for the profession in Colorado, and learned about PetAid Colorado as well. I’ve been impressed with what both have been able to achieve for the veterinarians and the animals of Colorado. What’s exciting to you about veterinary m edicine? I’m a scientist at heart—something I didn’t know until I fell in love with geology as a first-year student at Indiana University. Medicine and science both are fascinating to me—they stick in my head! During my time with Associated Landscape Contractors of Colorado, I built a relationship with CSU Horticulture, so knew about the College of Veterinary Medicine and Biomedical Sciences. Working with CVMA and PetAid is a wonderful opportunity to embark on an exciting learning curve about veterinarians and their work, veterinary medicine itself, and trends, challenges and opportunities in the industry. The scientist in me is intrigued! How will your experience with membership associations contribute to CVMA and PetAid Colorado? Because I’ve had such a rich and varied career trajectory, I’ve learned to think in terms of synthesis. Although it might seem unexpected, I see similar threads running through my work with the Associated Landscape Contractors of Colorado, and the Colorado Chapter of the American Society for Landscape Architects, and the Women in Engineering ProActive Network. CVMA and PetAid have strong networks that support their missions—relationships, partnerships in Colorado, and nationally. Seeing opportunities for collaboration, building relationships, and working toward persistent valuable outcomes, has been a hallmark of my career, and I look forward to bringing that sensibility to this role. Membership organizations are inherently exciting to me. It is a pleasure to support and help lead the development of vision, the growth of leaders, and the improvements that move people toward their dreams. Colorado is such an amazing state to live in, and our geographies—wilderness, rural, suburban and urban—define our state as well as people’s lives, their animal relationships, and members’ expectations for professional connection through CVMA and PetAid. I’m looking forward to the Chapter visits next summer! Continued on next page

CV M A VO ICE

OF NOTE Continued from previous page Do you have any pets? Cats are amazing beings, and I’ve been fortunate to share my life with several, although we currently have no pets. One of the many benefits of working in the same building as PetAid Animal Hospital is getting to see animals every day. My first week in the office, someone brought a barn kitten upstairs. That kitty was the image of my Elsa Mae, who lived to be about 19. She was my daughter’s “lovey,” and I will always remember the day she went with my daughter to her first grade class for show and tell. That patient cat let every kid in the room run their fingers through her fur! And Osalita was a tiny black fluffball who was really my first child. She’s gone now, and still has a special place in my heart as the one who taught me to care for a tiny being. She was a chirping cat, and sometimes I’m sure I catch glimpses of her— just quietly slipping around the hallway corner! n

ANIMAL ALLERGY & DERMATOLOGY OF COLORADO We are excited to offer increased coverage at all locations! Dr. Leigh Gray DVM, DACVD has joined our practice.

We currently offer appointments at Animal Emergency & Specialty Center in Parker, CO Tuesday - Friday each week. We are also offer additional appointments in Longmont, CO at Aspen Meadows Veterinary Specialists twice monthly!

President’s Post continued from page 4 animal medicine, and everything in between. Will this trend continue? Time will tell. Regardless, CVMA will be there to represent your best interests and the wellbeing of the communities we serve. State regulatory agencies play a key role in our profession as well. The Colorado Department of Regulatory Agencies (DORA) and State Board of Veterinary Medicine are well known, as they protect the public interest and supervise our privilege to practice medicine. However, as the connection between animal and human health increases, so will the role of the veterinary professional. An example is the collaboration between the Colorado State Board of Pharmacy and the newly formed Veterinary Pharmaceutical Advisory Committee, created by Senate Bill 16-062. Veterinarians, along with other professionals, will counsel the board on rulemaking relating to veterinary pharmaceuticals. As veterinarians we are indeed part of the growing One Health community. Finally, and perhaps where collaboration and care for each other is most needed, is wellbeing. It’s an oftenused term these days, certainly in veterinary medicine. What is wellbeing? It’s a question I asked often during our state tour. Many, like me, have a hard time placing a finger on it. And yet we know viscerally, deep in our gut and heart, when it’s gone. Veterinarians help feed the world, protect animal welfare, and provide comfort to the pets that comfort us. No doubt, an honor and privilege. And one that comes with a price. The price can be the loss of our health—both physical and mental—along with lost relationships we treasure. We’ve all read stories about the rising suicide rate in our profession. Many like me have experienced the impact firsthand, both

We appreciate your trust in our care and look forward to continued partnerships! www.animalallergycolorado.com

personally and professionally. Losing a trusted partner to suicide was devastating. Personally dealing with depression has been a struggle over the years in private practice. But I wonder . . . For every colleague that confided about having the same problems and reached out for help, how many more were suffering unnecessarily in silence and risking so much? How many fell off my radar over the years? Although agencies such as Peer Assistance Services have our wellbeing at heart, ultimately we are the safety net for each other. Checking in with a colleague who seems to be having difficulty can be lifesaving. A phone call or cup of coffee can go a along way in getting someone back on track. Mentoring veterinary students and participating in the CVMA Send-A-Student program are helpful ways to get those just entering our profession off to a great start as well. Thank you to those in Colorado who helped me along my wonderful journey in veterinary medicine—I couldn’t have done it without you. I’m grateful for the chance to continue paying it forward by serving you. Please feel free to contact me directly if I can be of any assistance. With gratitude, Sam n CVMA Voice 201 6 : 4 | PAG E 1 1

2 01 6, I ssue # 4

OF NOTE CVMA Convention 2016

Many thanks to our 2016 convention sponsors!

CVMA Convention 2016 was a tremendous success on many levels . . . Stellar education, opportunities to connect with friends and colleagues, student and mentor activities, and engaging networking aided in keeping the veterinary community engaged and up to date on the latest in the veterinary industry. With a glorious autumn setting outside and a vibrant trade show inside, over 730 attendees, speakers, and exhibitors participated in an array of social activities and education sessions. The CVMA Convention 2016 conference app made its debut, to the delight of many. The app allowed users to see all that convention had to offer right at their fingertips, anytime they wanted! From viewing and creating your own schedule, to seeing who is exhibiting and sponsoring, the app was a wonderful tool and a great addition to the event. Saturday night fun was had by all with the addition of Casino Night. The tables were full as attendees and guests enjoyed games of craps, blackjack, poker, and the human-sized version of the game Operation. The night was playful and fun and allowed casino goers to enjoy some friendly completion amongst their peers!

Supporting Sponsors

Many thanks to everyone who helped make CVMA Convention 2016 a huge success. We look forward to seeing you at CVMA Convention 2017, September 21–24, in Loveland.

PAG E 12 | CV M A Vo ice 2016 : 4

Participating Sponsors

Ames Diversified Services, LLC Bank of America Practice Solutions Dechra Veterinary Products Elanco IT Guru Merial Vet2Pet Zoetis General Sponsors

AVMA PLIT CATALYST Veterinary Practice Solutions ClayPaws Kits Home to Heaven, PC Simmons Education Fund Vetsuccess n

CV M A VO ICE

OF NOTE Bucking Broncos and Different Perspectives Curtis Crawford, DVM CVMA Immediate Past-President

Soxy was given to my brother and me by an uncle who shall forever remain unnamed. She was a rather pretty small bay horse with white socks (thus her name). As a two-year-old, she was halter broke, but it was up to us to make her into something more than a pasture ornament. We were only in elementary school and had never tied into training horses before, but with Dad’s help we began working with her. Eventually the ground work was completed and the day finally arrived to saddle her up. In her trusting, good-natured way, she quickly accepted the saddle as non-threatening and it was time for someone to climb up into that saddle. We flipped a coin. I won!(?) With Mom standing up front holding the reins, Dad helped me to get my little leg up into the stirrup and I started to swing my other leg over the back of the saddle to get astraddle of our faithful steed. I was so excited that I did not realize that I had caught a small loop of baling wire on my boot. So as I climbed on board, I dragged that wire across Soxy’s rump. To say the least, she was not amused. This had never been part of the training process. And Soxy came uncorked. She lunged forward, knocked my beloved mother to the ground, and slammed my tailbone against the cantle of the saddle as I vainly tried to get my off leg into the stirrup. I screwed my eyelids down tight as she crow-hopped up and down all over the now surely lifeless body of the precious woman who had given me life. My hands had a death-grip on the saddle horn and my thighs were squeezing like a python against the saddle swells as the now-empty stirrups slapped Soxy’s side with every jump. After an eternity of unimaginable G-force from the violent bucking, I finally heard my Dad’s voice through the blood pounding in my ears, “Jump, Curt, jump!” I pried one eye open to see the barn fast approaching to the left side of the raging bronc between my legs, so I bailed off to the right towards a deep, soft, dry manure pile. I missed and landed frog legged on my knees and hind end on the barn’s concrete pad as Soxy thundered off down the fence line in a hot run. The pain was excruciating. It felt like I had pulled every groin muscle in not only my body, but also my Dad’s and dead grandfather’s too. My knees throbbed. My bottom had never been spanked like that before. And surely Mom was nothing but a mangled pulp of unrecognizable tissue behind me. But as Dad picked me up, gently brushed me off, and wiped my nose, I saw Mom miraculously rise from the dead and limp out of the corral with just a bruise on her hip. Soxy’s flying hooves had somehow missed crushing her. And I was thankful. I later asked my brother what he thought about that death-defying NFR qualifying ride. He shrugged. “Well, Soxy spooked a little at first and kinda knocked Mom down as she took a couple of little jumps. Then she trotted over to the barn, you fell off, and she walked over to the hay bunk and started eating.” What? That didn’t sound anything like the same near-death experience our mother and I had survived? I suspect that in this

case, the truth is somewhere in the middle. Watching something from the outside and being caught on the inside can give two very different perspectives of the same event. I try to remember that lesson as I deal with clients these days. A dog neuter is old hat for me. Writing up a legally defensible patient record and keeping the DEA Controlled Drug log book current takes more time and energy than the actual surgery. But for the owner of that beloved pet, this is a big deal. The anxiety and concern that arises from what may be a once-in-a-life event for them is very different from the relaxed, routine, daily procedure that I am used to. So taking an extra minute or two to call that owner at the end of the surgery is greatly appreciated by those people who have that special human-animal bond with their pets. The CVMA has recognized that the different age cohorts of our members means different experiences and expectations as well. The concerns and anxieties of recent graduates often don’t align with worries and priorities of the older members like me. Although our educational strengths have historically leaned towards science and veterinary medical topics, we have started adding more depth to the offerings that help make us a better veterinarian and person in other ways. As we work towards building our nontechnical competencies educational offerings, we strive to meet your needs wherever you are on the age and experience scale. Concerned about developing your young leadership skills? Check out the Power of Ten Leadership Academy. Thinking about how you are going to exit from practice ownership? We often bring in speakers to address practice sale and career transitions. The CVMA is committed to all the things that make us successful in practice and keep us content and healthy in our personal lives as well. In the meantime, within our own practices and veterinary communities, try looking at this rodeo of life from the other person’s point of view. Within that humble act comes understanding. Maybe not total agreement, but at least compassion and the ability to better fathom the worries and concerns of the other. We all have our own broncs to ride. If I would wrangle yours for a while, I reckon I would have a little better feeling for your perspective. But this time, I am checking my boot before stepping on board. CVMA. Welcome to the herd. Briefings continued from page 5 Next Steps

The current board discussed this change at CVMA BIG Ideas Forum | Fall 2016 in October and approved the concept. Next, the Executive Committee will develop narrative to describe the model change to members and draft appropriate bylaws amendments. The Board will review the materials at its March 2017 meeting and make a recommendation, which will be put to members to vote on bylaws changes in June 2017. Please feel free to reach out to me, your chapter representative, or any member of the CVMA Executive Committee if you have any questions or concerns about the proposed governance model. And look for your voting information coming this summer. Thank you, and best wishes for a happy, prosperous 2017! n CVMA Voice 201 6 : 4 | PAGE 1 3

2 01 6, I ssue # 4

OF NOTE Can Underserved Pet Owners Be Profitably Served? The growing income divide has marginalized an increasing number of animal owners from accessing veterinary care. Consumer expectations for sophisticated yet affordable care in veterinary medicine have never been higher. Concurrently, the amorphous “standard of care” in veterinary medicine often seems to connote that a “gold standard” is appropriate for every case, irrespective of the owner’s resource limitations. The veterinarian’s passion and desire to make care accessible seems to compete with these external pressures, creating even more stress for veterinary professionals. On Saturday, October 22, CVMA held BIG Ideas Forum | Fall 2016 in Breckenridge to explore ideas and engage in dialog about the demand for veterinary services and models for service delivery that demonstrate how underserved markets can be served—while maintaining a responsible and profitable business. • Do veterinarians have an ethical obligation to underserved markets? • Is there economic opportunity in reaching underserved markets? • What are the barriers in serving these markets? • Can we gain a more detailed understanding of pet owners from a market-based, micro-economic perspective? • What service delivery models can be emulated or created to reach underserved markets in an economically viable way? • Is the standard of care injecting costs into the system that work against providing care for underserved markets? Issue Forum

CVMA invited five Issue Illuminators to present and lead the discussion on serving underserved pet owners, each with a unique viewpoint, from industry to practice to teaching hospital. Roger Haston PetSmart Charities | Phoenix Formerly the executive director of Denver’s Animal Assistance Foundation, Roger Haston is now with PetSmart Charities in Phoenix. Pulling from his extensive experience in the animal welfare arena and his strong economics background, he opened his presentation with the definition of “coopetition” and the concept of competitors cooperating for a mutually beneficial result. The common misconception, he stated, is that animal welfare organizations negatively impact veterinarians. The truth is that the market is far more complex than just the simple demand curve economics. Volume of pet ownership is up, though the percentage of petowning households is down; this bodes well for sustainability of demand for veterinary services. In Colorado, he points out, we have accomplished much toward the goal of getting pet population under control, especially for dogs. This in turn leads to a changing role for shelters (e.g. behavioral health, community resource, etc.), especially as the distinction between owned and unowned animals becomes much grayer, and humane organizations are touching both populations. PAG E 14 | CV M A Vo ice 2016 : 4

While data is helpful, it should be examined for inherent biases when we use it for decision making. For example, AVMA pet ownership data has an inherent bias because it reaches only those pet owners willing to pick up the phone and respond to a survey, which tends to be Caucasian respondents more heavily than their population percentage; APPA data shows a bias toward pet acquisition through rescue/shelter sources; the Pets-for-Life Program reaches a different population and shows different sources of acquisition, with about 75% having no veterinarian contact and almost 90% having had no contact with a humane organization or animal control. What this does tell us is that the familiar, traditional business model for veterinary medicine is stretched because the largest market segment remains untapped. One business model will not work to serve all segments of the market, but offering both—the traditional clinic model and a model that serves the underserved—will succeed when there is a low cost and a high cost offering in the same market. Coopetition between animal welfare groups and private practitioners will generate greater economic value for both. On the animal welfare side, we have made huge progress, but the traditional sheltering system is not addressing some of the key issues and there are large segments that are completely un-serviced. On the private veterinarian side, many practices are economically struggling as the traditional business model is stretched because the largest untapped segments are marginally profitable, and customer acquisition is expensive. He concluded by saying that the companion animal space is highly segmented and there are large segments not being well serviced by the for- or non-profit providers. The solution? Multiple business models are required to serve the companion animal spectrum, and coopetition among the animal welfare groups and private practitioners will generate greater economic value for both. Let the market do the sorting! Brian Forsgren, DVM Gateway Animal Clinic | Cleveland Dr. Forsgren is the founder of Gateway Animal Clinic, a thriving veterinary practice within Cleveland’s poverty-stricken inner city, which focuses on supporting and maintaining the humananimal bond, even in the face of financial hardship. His practice philosophy is unique—to provide access to care for pet owners who have minimal financial resources. Gateway does not require appointments and they see 100 animals a day. The clinic brings in $4.3 million a year. Dr. Forsgren believes that we are at an important juncture in the evolution of care for companion animals. The veterinary profession is the ultimate caretaker of the integrity of the human-animal bond, which is a big task, daunting even—but the complexity of the task does not recuse the profession from dealing with the situation. The profession has, he believes, missed the boat when it comes to basic animal welfare issues, agricultural animal abuse, lab animal welfare and legal reform, the pet euthanasia epidemic of the 60s and 80s, animal abuse and legislation, and spay/neuter. And the newest issue? Economically challenged pet owners. Continued on next page

CV M A VO ICE

OF NOTE Continued from previous page We are facing what he calls “the perfect storm” driven by our poor appreciation of the true epidemiology of community pet animal healthcare needs and the following factors: • Stereotypic vision of the pet healthcare consumer • Cost of care on the rise • Expectations by clients • Complete lack of financial accountability by consumers (e.g., multiple pets) • Education system devaluation of the GP • Veterinary culture and the “gold standard” • New grad debt / salary and skills minimal • Generational and gender impact The profession needs to think about community healthcare needs, including preventive medicine (vaccines/parasites), spay/ neuter, wellness, urgent care, surgical care, and end-of-life care. There needs to be an acknowledgment of the realism in the pet healthcare consumer demographics. While everyone wants the “ideal” veterinary client, there is a huge range of pet owners out there that need to be acknowledged and served. Dr. Forsgren then shared his clinical success strategies: invite them all to the party, case management based on financial reality, leadership within the community on animal issues, access to care by bending around the financial issues, and love animals and love people. He urges practitioners to forget about the fear of lost revenue and do something proactive. In his words: “Open the flood gates and start bailing.” James Wingert, DVM Broadview Animal Clinic | Denver Dr. Wingert purchased Broadview in 1983 and later constructed a new clinic, which received the Merit Award by Veterinary Economics for hospitals built during that year in the U.S. In June of 2016 in preparation for his retirement, he sold the clinic to NVA, but remains on board as Broadview’s managing doctor. Dr. Wingert has always had a commitment to providing affordable healthcare for animals. Dr. Wingert focused his presentation on how he built a successful business model by removing as many barriers (cost, hours, appointments) as possible to clients seeking and receiving care. His clinic takes 50% appointments and 50% walk-ins, seeing 400 to 500 new clients a month (220 to 250), and prices are set on what it costs to run the clinic plus a fair profit. His practice currently has six doctors, compensated from $140–$350K. When he bought his practice in 1983 it was generating $52,000 in revenue; last year was $5.5 million—with a 21 to 23% profit margin. A great veterinarian who is a bad business person will not be successful, he says, so either become one, or have one on staff. Success takes common sense and good models, and you have to know your costs and profit and loss. Plan for equipment purchases and labor costs, and don’t rush into making purchases. Make changes incrementally. Try new ideas for growth and profit. A lucrative model allows for removing barriers to care for those that need help. And you have to select a business model that’s compatible with your philosophy.

When he sold his practice, he found a corporate buyer that would not change his model, ensuring he would still be able to serve his clients and patients in a way he believes in and has great success with. Bruce Louderback, DVM Mission Viejo Veterinary Hospital | Aurora Dr. Louderback established Mission Viejo Veterinary Hospital in Aurora in 1976 and has served his profession in many ways over the years. He was appointed by Governor Bill Owens to sit on the Colorado State Board of Veterinary Medicine from 1999 to 2007. His contributions to the state board led to involvement with the American Association of State Veterinary Boards, where he has served as director, secretary, treasurer, and president. Dr. Louderback opened with how pricing and the cost of veterinary care is driving more clients into the underserved market. Is the standard of care affecting the cost of care and driving it up? The standard of care in human medicine is easily figured out because it’s set by the insurance company and the legal system. In veterinary medicine, multiple factors enter in, including state boards, veterinary schools, production medicine, industry, specialists, etc. State boards are political appointments, and the standard of care can fluctuate based on current board members and their perceptions of standard of care. There is also a lot of discussion about geography—for example should a rural practice be held to the same standard as an urban practice? He went on to discuss veterinary programs and how NAVLE questions are increasingly being written by specialists. Is that affecting the standard of care? AAVSB, through meetings and RACE, help board members establish the standard of care (for example, how to handle standard of care using telemedicine). In turn, then, is veterinary education keeping young veterinarians from pursuing cases because they are unsure of their competency? Dr. Louderback proposes that an academic veterinarian be required to practice in general practice for two years before being allowed to teach clinical medicine. Another factor driving standard of care is production compensation. If the medical director or practice owner is pressing the associate veterinarian for higher average transactions, could this drive behavior? And with industry—lab machines, digital x-ray, infusion pumps—there’s always something that advances the standard of care. Is a high performing veterinarian one who is a good veterinarian or good at production? Emergency clinics almost invariably follow the gold standard of care. While there is nothing wrong with the gold standard if you can afford it, it limits access by underserved markets and results in euthanasia. Specialty clinics are great, but where are the veterinarians who are willing to handle a tough case for someone with limited resources? In his practice, Dr. Louderback uses “practice by waivers” to gain consent for the veterinarian providing the best effort based on what a client can afford. This allows the doctors to provide less-expensive options that can still provide a good outcome for the patient. Underserved markets are in need of care, he concluded, and will find it somewhere. Let’s not use the standard of care to price them out of that care. Underserved continued on page 16 CVMA Voice 201 6 : 4 | PAG E 1 5

2 01 6, I ssue # 4

OF NOTE Underserved continued from page 15 Rebecca Ruch-Gallie, DVM CSU Veterinary Teaching Hospital | Fort Collins Dr. Ruch-Gallie serves as service chief for Community Practice at CSU’s Veterinary Teaching Hospital, where her focuses are on preventive and animal shelter medicine. Her goal is to help animals and their owners stay healthy, with a good quality of life, for as long as possible. She strives to integrate knowledge about the human-animal bond and the behavior and health of shelter animals into daily practice. There is an integrated big picture when discussing barriers to care and the profession’s response. While cost of care is usually what we think, there are other barriers to care, including , culture, geographical location, lack of knowledge about animal care and veterinary services, language, transportation—some of which can be overcome, particularly if the veterinary profession partners with other organizations who are already reaching these populations. The challenge of addressing these lies in how we can address the challenges faced by the profession today. First is the economics of veterinary medicine. The current debt to salary ratio is 2:1 when it should be 1.4:1 or less. This is driven by decreasing public funds for higher education, marginal economy decreasing donations and available grants and higher costs. Add to that the fact that veterinary colleges are expected to train every student in all areas of veterinary medicine, students often graduate with less confidence in general practice. They are learning the very highest standard of care, and while it’s critically important to know what that is, they need to know how to work within their clients’ means and needs when the client can’t afford the highest standard of care. In providing services, particularly preventive medicine, in underserved communities, the profession embraces the OneHealth concept and maximizes overall health in the community. Veterinary medicine is integral to public health and serving underserved populations, including the homeless, furthers public health and the health of local communities. And, finally, she believes, we need to teach students balance in practice and how to be satisfied with what is manageable by the client, even if it’s not everything that can be done. That’s why it’s important to partner with the resources available in the community, to leverage what’s there to do the most good, even with limited options. Panel Discussion and Q&A

How can you make a profit in an underserved area? Eliminate all barriers to care and take the clients no one wants, do the best you can, and offer the best level you can in each circumstance. This approach allows young veterinarians so much experience, it’s a great teaching experience, and can create more and better general practitioners. How can GPs make time to serve on the board of veterinary medicine? A lot of the meetings are on the weekend, and you just have to find a way to make it work. States tend to put more GPs on state boards. Just start at lower levels, work up. PAG E 16 | CV M A Vo ice 2016 : 4

How can we get NAVLE questions generated and vetted by non-specialists? Questions are hard to write and professors and board specialists are more involved than GPs. We need to read the questions, make sure they are still relevant, and fight with the others on the board to change them. New graduates are being taught to offer the gold standard. My fear is not doing everything up to that standard. How do I read people to know who can afford it? It’s always a struggle, but it will come with experience. Provide options at different levels and let them decide. Don’t fear repercussions, just document everything and offer waivers. In human medicine, insurance sets the standard, and it’s not nearly as high as in veterinary medicine. Is culture affecting perception of GPs? How do we instill respect for GPs? Document your clinical reasoning and collaborate, share, and be transparent. Communication is key and critical, with clients, your colleagues, and in the profession. We need to give ourselves the benefit of the doubt, because we don’t always have the whole story. Take an HMO as an example… They tell you all the options and the costs for each, then you decide what you want to do. That’s a good model for veterinary medicine as well. Shelters don’t means test for adoptions, and do the best they can to get a good history and encourage adopters to build a relationship with veterinarians. But then there’s an issue and the veterinarian blames the shelter. What can we do? An example is the CVMA’s Healthy New Pet Guide, which connects new adopters to veterinarians for a free wellness exams. This is a chance for veterinarians to sell themselves to these new clients. But how else can we make sure clients get connected to veterinarians? This is a missed opportunity by veterinarians. They need to be proactive and make the connection to their local shelters to improve the compliance rates. Do outreach to the sheltering community. Do you believe in means testing to provide care? As a professional, I want to be positive and not judge, I don’t believe in roadblocks. The willingness to pay versus means testing is very different. A system that denies one compromises the many who do need it. Don’t means test. Let the market sort itself. We’ve heard some good solutions for the urban setting, but how about rural? How do we look at profitability there? In looking at urban settings, we find efficiencies that can work rurally, like spay/neuter mobile clinics with local veterinarians to make the connections with the community. Build the local Underserved continued on page 17

CV M A VO ICE

OF NOTE Immigrant Veterinarian Overcomes Incredible Odds to Succeed Marjorie A. Wallwey | My Primetime News

That young man passed the English exam. And the veterinary licensing exam. And he’s already paid back his student loan. That young man is Aristophane Atakem. He just opened Liberty Animal Hospital in Westminster.

Reprinted with permission from the July 27, 2016 issue of My Primetime News, the online edition of Prime Time for Seniors Newspapers. Dr. Atakem is a CVMA Chapter 6 | Denver Area member. n Underserved continued from page 16 brand, change the model to leverage with resources from the urban areas.

A French-speaking boy grows up in the war-torn African nation of Chad. He’s bright and eager. He wants to become a doctor. Even with parents who earned master’s degrees, there’s simply no money for college—and there’s no such thing as student loans in Chad. But he won’t give up. He applies for 50 scholarships at colleges and universities around the world. He gets no offers. But he won’t give up. He comes to realize that the challenge of being a veterinarian suits him better. There are two scholarships available in his entire country to go to vet school. He applies and wins one. The vet school is in Senegal—more than 2,000 miles away. But he won’t give up. He moves away from his family, studies diligently, and earns his degree. His dream now is to emigrate to the United States and build a veterinary practice there. He has an uncle who lives in Colorado. That’s more than 5,000 miles away. But he won’t give up. He emigrates to the United States and arrives speaking only French. He moves in with his uncle. The uncle runs a gas station and wants the young man to work for him for $300 a month. When the young man tells his uncle he is determined to follow his dream, his uncle tells him he’s doomed to fail and will never amount to anything. He has to move out. But he won’t give up. He cannot take the veterinary licensing exams until he can read and write English well enough. He takes the English competency test and is unable to pass all of the sections the first time. And the second time. And the third time. But he won’t give up. He connects with Ray Cox, DVM, a distinguished veterinarian and co-founder of Deer Creek Animal Hospital in Littleton. Dr. Cox is so impressed by the young man, he takes him under his wing. Not only does Dr. Cox provide him with an externship and a place to live, he also co-signs the young man’s student loan to solidify his skills at Kansas State University . . .and lends him $20,000 from his own pocket. Then, he trains him to become an expert in performing single-port, minimally-invasive, laparoscopic surgical procedures that are clinically proven to provide for smaller incisions, less pain, increased intra-operative safety, superior intra-operative visualization, and faster recovery.

To the low-cost model providers, how often do you get similar diagnosis with exam versus high-end tests? I’d say 90% are done by a great exam by great clinicians. And patient follow up shows that a good diagnosis versus a lot of testing works well. What is the impact of corporate practice consolidation? What role will it play in these models? It depends. Some will let you keep your model, especially if it’s profitable, which we’ve shown it can be. If keeping your model for your clients is important to you, then you have to find one that will work with you and keep it. n

U.S. WEST REGION, WESTMINSTER CO

Prof. Roy Franc Baas 504.382.5096

roy.baas@outlook.com

Ted Cohn DVM 720-838-5710 tcdvm@comcast.net

We have a FREE Gift for you!

A FREE CONFIDENTIAL PRACTICE FINANCIAL CHECK-UP & ESTIMATE OF PRACTICE MARKET VALUE If you are thinking of selling or buying a DVM practice, we are the firm you should talk to – we pre-screen, prequalify, and value practices making them easier to sell and easy to buy with up to 100% financing at low rates on preferable terms. End of the year is a great time to sell or buy!

Ho, Ho, Ho, Happy Holidays

Contact us today if you want to sell or buy a practice. All contacts and info strictly confidential www.DVMConsultants.com PRACTICE BROKERAGE - SELLERS & BUYERS VALUATIONS, FINANCING, CONSULTATION

Active in CO, AL, AR, LA, MS, OK, TN

CVMA Voice 2016 : 4 | PAGE 1 7

2 01 6, I ssue # 4

OF NOTE Wellness Rick Factor Study Finds Positive Correlation to VMA Membership Elizabeth Strand, PhD, LCSW and Caroline Faust, DVM The University of Tennessee Knoxville, Veterinary Social Work Program

In a recent article published in JAVMA, Nett et al. (2015) found that membership in a veterinary medical association is positively correlated with less mental illness and suicidal ideation. The authors also found that 9.3% of veterinarians were experiencing severe psychological distress at the time of the survey and that 16.8% had contemplated suicide since graduation. These distressing numbers are higher than that of the general US adult population. The number of veterinarians currently in psychological distress nearly doubles when controlling for membership in organized veterinary medicine (9.3% for members of a VMA vs. 17.5% for those that are not). A similar but less pronounced pattern is seen when examining the relationship between currently married, separated/ divorced and never married veterinarians (8.1%, 13.8% and 14.3% respectively). The authors hypothesized that these patterns may be related to the interpersonal relationships in a veterinarian’s life. They go on to cite research that names social support as a positive influence on mental health. Alternate factors associated with psychological distress were working in shelter medicine and being in practice for less than 20 years. It was unclear from the data if it was age, a change in class selection criteria, or another factor that led to increased risk in younger veterinarians.

Other research questions revealed a disconnect between veterinarians and the general population when it comes to perception of those with mental illnesses and the help available. Psychologically stressed veterinarians were significantly less likely than those similarly afflicted in the general population to state that “People are caring towards those persons with mental illness,” and less likely than non-distressed veterinarians to agree that “Mental health treatment is accessible.” This perception of a lack of support may be one factor contributing to higher distress levels. The findings of this study open a pathway to better caring for veterinarians in psychological distress. Veterinary medical associations play an important part in this battle as they provide social support and a vehicle for dissemination of information. Because so many veterinarians in distress perceive that no aid is available, VMAs have the opportunity to step in as helpers. Support systems such as the AVMA’s Early Career Online Community and VIN’s From the Trenches message board provide practitioners with a group with whom they have similar trials, worries, and sometimes even victories. If you are experiencing psychological distress, please seek help. If you have suicidal thoughts, please call the National Suicide Hotline at 1.800.273.TALK.

Citation

Nett, R. J., Witte, T. K., Holzbauer, S. M., Elchos, B. L., C ampagnolo, E. R., Musgrave, K. J., . . . Funk, R. H. (2015). Risk factors for suicide, attitudes toward mental illness, and practice-related stressors among US veterinarians. Journal of the AmericanVeterinary Medical Association, 247(8), 945–955. http://doi.org/10.2460/javma.247 .8.945. n

Go beyond. Perfection is constant transformation. —Nia Peeples Even the most experienced and knowledgeable veterinary owners and practice managers should never stop learning. Transform your management skills, your career, and your practice with AAHA’s Veterinary Management Institute (VMI)—a high-level, veterinary-specific management course that takes even the most seasoned manager’s skills to the next level.

Visit aaha.org/vmi to learn more and enroll. First in-person session February 16–18, 2017.

78th Annual Conference for Veterinarians April 1-2, 2017 Hilton Fort Collins Dr. Rodney Page, director of Colorado State University’s Flint Animal Cancer Center, will provide new insights about canine oncology in a special keynote address on April 1: “The Golden Retriever Lifetime Study – Lessons We Are About to Learn.”

OTHER HIGHLIGHTS · Updates on management of gastrointestinal diseases of small animals, horses, and livestock · Colorado State University DVM Program reunions · A track for veterinary technicians on April 2 The conference provides 16 hours of continuing education approved by the Registry of Approved Continuing Education, American Association of Veterinary State Boards

conference-for-veterinarians.colostate.edu vetce@colostate.edu | (970) 297-1273

Protect your livelihood with all the right coverage through AVMA PLIT. We are the most trusted source of professional, business and personal coverage for every stage of your career.

our expertise is Workers’ Compensation Umbrella Liability

•

Business Property & Liability

•

Commercial Auto

Veterinary License Defense Storage Coverage Homeowners

•

your strength

•

Flood

•

Employment Practices Liability

Data Breach

•

Professional Liability

Professional Extension (Animal Bailee)

Safety & Risk Management • Resources

Renters

•

Embryo & Semen

Personal Auto

•

Personal Excess (Umbrella) Liability For a coverage comparison of your entire insurance portfolio to the PLIT Program, call 800-228-PLIT (7548) or visit avmaplit.com

A partnership with you to provide the best care for them. At VRCC Veterinary Specialty & Emergency Hospital we consider ourselves to be an extension of your practice. Working as a team with you and your clients, we can help provide the finest specialized care for your patients. Our ongoing commitment to communicating with you and your client is key to building positive client and referral relationships. We endeavor to offer the best technology and highest caliber of specialists and technical staff in the Rocky Mountain region as a resource you can depend on.

Cardiology • Dermatology/Allergy • Emergency & Critical Care • Internal Medicine • Neurology/Neurosurgery • Oncology/Radiation • Ophthalmology • Surgery/Orthopedics

3550 S. Jason St. • Englewood, CO 80110 • 303 874 PETS (7387) • VRCC.com

CV M A VO ICE

GOVERNMENT AFFAIRS HB16-1324: Where Are We Now? As previously reported, House Bill 16-1324 Veterinary Access Compounded Pharmaceutical Drugs was signed into law on June 10, and took effect on August 10, 2016. The rules have now officially been adopted by the State Board of Pharmacy, and they have updated and posted the application that pharmacies need to complete and submit to be able to provide compounded pharmaceutical drugs, both controlled and non-scheduled, if they so choose and are properly registered. What It Means

In short, with the passage of HB16-1324, licensed veterinarians can now access compounded medications, both controlled and nonscheduled, from in-state or non-resident compounding pharmacies—and maintain those medications for office use or office stock, with an allowance for dispensing up to a five-day dosage of the drug. Specifically, HB16-1324 clarifies the following: Office use—HB16-1324 makes it clear that the 10% allowance for office use DOES apply to veterinary compounded drugs. This is important because some veterinary compounding pharmacies believed that the provision was exclusive to human medications, and thus would not ship a compounded medication to a veterinarian for office use. Office stock—HB16-1324 allows and defines office stock as “the storage of a compounded drug that was distributed or sold by a registered prescription drug outlet to a veterinarian, without a specific patient indicated to receive the compounded drug, and that the veterinarian may subsequently administer to a patient or dispense to a client.” A veterinarian may dispense a compounded drug from office

stock only if (a) the compounded drug is necessary for the treatment of a patient’s emergency condition AND (b) as determined by the veterinarian, the veterinarian cannot access in a timely manner the compounded drug through a registered prescription drug outlet. Further, a veterinarian may not dispense a compounded drug in an amount greater than the amount required to treat a patient’s emergency condition for five days. The bill requires that a veterinarian shall not administer or dispense a compounded drug from office stock without a valid veterinarian-client-patient relationship in place at the time of administering the compounded drug to an animal patient or dispensing the compounded drug to a client. Resident vs. non-resident pharmacies—HB16-1324 allows any registered prescription drug outlet, whether in-state or nonresident, to provide compounded medications—whether controlled or non-scheduled—to a Colorado licensed veterinarian for office use or office stock. To compound and distribute a controlled substance, the bill requires that a registered prescription drug outlet possess a valid manufacturing registration from the federal Drug Enforcement Agency. “Living in Pueblo,” says Matt Braunschmidt, DVM, Mesa Veterinary Clinic, “it is a large enough city that there are multiple human pharmacies that can compound medicine. However, I like to use a veterinary compounding pharmacy, which means ordering the product. I don’t use a lot of compounding, but I see its advantage, for example, the mega colon/obstipated cat that I may see in a weekend emergency. I like to use cisapride in some of those cases, and it’s nice to be able to get therapy started. Clinics in a rural area benefit because they can get patients started on therapy sooner.” n

PetAid Colorado is the charitable partner of the Colorado Veterinary Medical Association. PetAid serves vulnerable populations exclusively, with programs to help you care for pets and people in need in your community. PetAid Animal Hospital helps income-qualified clients when they cannot afford the care their pets desperately need. Donorsubsidized, generously discounted fees make it possible to end suffering and avoid relinquishment. Our DVM referral program allows us to help your neediest clients at a discount level of 50% based solely on your referral. PetAid Care Grants provide practitioners in rural or frontier counties with funds to supplement charitable care for your patients and owners in need, supporting a one-time surgical or medical intervention for a pet with a good prognosis.

PetAid Community Outreach takes veterinary care to the most vulnerable pet owners who can’t access in-clinic care because of disabilities, lack of transportation, or homelessness. We rely on volunteer veterinarians and technicians to make this program

possible and welcome your participation.

Helping more pets, together. Learn how at petaidcolorado.org.

CVMA Voice 201 6 : 4 | PAGE 2 1

2 01 6, I ssue # 4

GOVERNMENT AFFAIRS Veterinary Pharmaceutical Advisory Committee Keith A. Roehr DVM Colorado State Veterinarian

As the State Veterinarian, one of my many duties is to make sure there are measures in place to protect animals, producers, and consumers. This past July, in conjuntion with the Colorado State Board of Pharmacy, the Veterinary Pharmaceutical Advisory Committee was created by Senate Bill 16-062. This committee, consisting of three members, will advise and make recommendations to the Board on applications, complaints, and rulemaking related to veterinary pharmaceuticals, to provide a meaningful impact on the veterinary pharmaceutical community. As mandated by the Senate Bill, I appointed the following three members. Curtis Crawford, DVM of Alpine Veterinary Hospital in Monte Vista, earned his Bachelor of Science degree in Veterinary Science in 1983 and his DVM in 1986 from CSU. Alpine Veterinary Hospital, PC is a rural mixed animal practice in the San Luis Valley with the large animal case work involving mostly horses and

PAG E 22 | CV M A Vo ice 2016 : 4

cow/calf operations, but also includes a small dairy, a goat dairy, a small feedlot, small ruminants, camelids, rodeo, and swine. The practice services a five-county area and serves as the San Luis Valley Fair veterinarian and has served as the Colorado State Fair veterinarian in the past as well. Edward P. (Skip) Schneider of Windsor, has a Bachelor of Science degree in Animal Science from CSU and an associate degree in Agriculture from CSU Pueblo. He is a partner in Carter Creek Cattle Co., a commercial cow/calf operation with about 800 cows located in Colorado, Wyoming, and Nebraska, and has a working relationship with several veterinarians and is a producer member of the Colorado Livestock Association. Marcus Prochazka is a Regulatory Compliance Manager at Animal Health International, Inc. He received his Bachelor of Science in Animal Science & Industry from Kansas State University in 1992 and has served in the regulatory department with AHI for the past 17 years. He has managed multiple elements in operations of veterinary wholesale distributors, pharmacies, and specialty veterinary retail establishments and has collaborated with a network of 60 facilities in 26 states, maintaining continued relationships with the regulatory agencies within those states. n

Specialists you trust. When you need them. DENTISTRY John F. Huff III, DVM, FAVD, DAVDC 303.326.6338 • john.huff@vca.com

EMERGENCY & CRITICAL CARE Leilani Way, DVM, MS, DACVECC 720.975.2841 • leilani.way@vca.com

DERMATOLOGY David Beadleston, DVM, DACVD 720.975.2804 • beadlestond@gmail.com

INTERNAL MEDICINE Douglas Santen, DVM, DACVIM (SAIM) 303.326.6334 • doug.santen@vca.com Ji-Yeun Rha, VMD, DACVIM (SAIM) 303.326.6332 • ji-yeun.rha@vca.com

David Israel, DVM 720.975.2847 • david.israel@vca.com Shaila Raj, DVM, MS 720.975.2832 • shaila.raj@vca.com Molly Comiskey, DVM 720.975.2853 • molly.comiskey@vca.com

Katherine Scott, DVM, DACVIM (SAIM) 720.975.2833 • katherine.scott@vca.com

Jorge Alvarez, DVM 303.326.6321 • jorge.alvarez@vca.com

William Whitehouse, DVM, DAVCIM (SAIM) 720.975.2838 • william.whitehouse@vca.com

Gina Kettig, DVM 303.326.6331 • gina.kettig@vca.com

ONCOLOGY Anne Skope, VMD, MS 720.975.2849 • anne.skope@vca.com

RADIOLOGY Debra S. Gibbons, DVM, MS, DACVR 720.975.2857 • debra.gibbons@vca.com Benjamin Young, DVM, MS, DACVR 720.975.2844 • benjamin.young@vca.com

SURGERY Diana Davila, DVM 720.975.2850 • diana.davila@vca.com

CARDIOLOGY Carrie Ginieczki, DVM, MS, DACVIM 720.975.2804 • coloradoheartvet@gmail.com

Shana O’Donnell, DVM 720.975.2817 • shana.odonnell@vca.com Katherine Hebert, DVM 720.975.2852 • katherine.hebert@vca.com

NEUROLOGY Kelli Kopf, DVM, MS, DACVIM 720.975.2837 • kelli.kopf@vca.com Maggie Vandenberg, DVM, DACVIM 720.975.2814 • maggie.green@vca.com Samantha Emch, DVM, MS, DACVIM 720.975.2801 • samantha.emch@vca.com

Specialty Line: 720.975.2804 vcaaevh.com Fax: 720.975.2854 www.facebook.com/vcaaevh 9770 E. Alameda Avenue, Denver, CO 80247

2 01 6, I ssue # 4

SCIENCE UPDATE updated this past July to assist veterinarians in managing their patients. CDPHE also worked with rabiesaware.org to include the current information on rabies laws in Colorado on their website and participated in a Rabies Challenge presentation at CVMA Convention 2016 held in Loveland in September. For the latest statistics on rabies in Colorado and other related resources, please visit https://www.colorado.gov/pacific/cdphe /rabies. If your district is interested in hosting an in-person training on rabies-related issues in Colorado, please contact CDPHE at 303.692.2700. n

Pets Exposed to Wildlife Jennifer House, DVM, MPH, DACVPM State Public Health Veterinarian Colorado Department of Public Health and Environment

If you had a client bring you a patient that had an encounter with wildlife, do you understand the risks of rabies and how to handle the exposure? Many veterinarians in Colorado do not. Now there are tools to help you. The statewide algorithm for management of domestic animals exposed to wildlife was

CDPHE Rabies Prevention and Control Policy Algorithm for Management of Domestic Animals Exposed to Wildlife

Receive REPORT of wild animal exposure to pet

AND

Is the wild animal a rabies reservoir species? (bat, skunk, raccoon or fox)

Determine vaccination status of pet

If sufficient contact to transmit rabies occurred:

Yes

Consult LPHA or ACO

Is the wild animal available for testing? Yes

Yes

Currently vaccinated

Overdue vaccination booster

(documented)

Booster

Immediate vaccination & 45-day home observation

Immediate vaccination & 45-day home observation*

*Evaluate on a case-by-case basis. Submit for testing.

Yes

Is it positive?

Did sufficient contact occur to transmit rabies?

This is the minimum; additional requirements may exist. Check with ACO or LPHA.

Unvaccinated

(not documented)* No

No Risk.

Make sure pet’s rabies vaccination is current.

Euthanize -or120-day quarantine, 90 at secured facility, 30 at home. Vaccinate at 0, 21, 60 days

Updated July 2016

PAG E 24 | CV M A Vo ice 2016 : 4

*Pets that have no documentation may be considered for prospective serological monitoring. Please consult with LPHA before proceeding.

CV M A VO ICE

SCIENCE UPDATE National Animal Health Lab Network More Critical than Ever Barbara Powers, DVM, PhD, DACVP, CSU VDL Director

The Veterinary Diagnostic Laboratories at CSU are a Level 1 laboratory in the USDA’s National Animal Health Laboratory Network. NAHLN-member labs may be involved in surveillance for early detection of foreign animal disease, surge testing during an outbreak, and testing samples during the outbreak recovery phase. As such, there must be a high degree of confidence in the quality of the laboratories and associated test results. USDA recognizes the value of quality management systems and requires that all NAHLN laboratories have a functional quality management system. Our full accreditation by the American Association of Veterinary Laboratory Diagnosticians allows admittance to the NAHLN without additional requirements related to documentation of a quality management system. NAHLN plays a direct role in protecting a safe, stable and nutritious food supply. It will play an essential role in responding to a biological attack affecting animals or people. An example of the critical surveillance role NAHLN plays was evident during the 2015 highly pathogenic avian influenza outbreak. NAHLN laboratories operated 24 hours a day, seven days a week to test poultry samples. Those quick, reliable tests permitted rapid depopulation of infected flocks, surveillance testing to halt spread of the virus, and testing to permit repopulation of farms and resumption of trade. NAHLN was developed in response to the Public Health Security and Bioterrorism Preparedness and Response Act of 2002. During the past 12 years the NAHLN, composed of federal,

university and state veterinary diagnostic labs, has established the framework of a surveillance and emergency response system that provides critical and ongoing resources for laboratory testing, surveillance and information management, including data analysis and sharing, quality assurance with an auditing system and the development and validation of new tests. Today, it requires increased funding to improve compliance with 2012’s Homeland Security Presidential Directive, which required the department to “develop nationwide laboratory networks for food, veterinary, plant health and water quality that integrate existing Federal and State laboratory resources, are interconnected, and utilize standardized diagnostic protocols and procedures,” according to the directive. That improved compliance with the directive will require expanding surveillance and surge capacity of the NAHLN by increasing the number and level of participating state laboratories. It will require additional development of the infrastructure for electronic transmission of data between sample collectors, laboratories and state and federal databases. It will also call for increasing efficiency and effectiveness of lab personnel training nationwide. NAHLN is essential to the health of U.S. animal agriculture, bioterrorism surveillance, and the U.S. economy. USDA estimates the cash receipts of the U.S. animal industries at $185.68 billion; therefore, even a fully funded level of $30 million would represent only a 0.016 percent federal investment for disease surveillance to protect essential agriculture. Reprinted with permission from CSU LabLines. n

CVMA Voice 201 6: 4 | PAG E 2 5

2 01 6, I ssue # 4

IN PRACTICE Who Needs a Manager? Wendy Hauser, DVM Peak Veterinary Consulting

As a technical services veterinarian, I had the privilege of visiting about 20 veterinary hospitals per week. During these meetings, I met with hospital leadership to discuss what was going well in their practices and identify areas in which my company could provide assistance to help their businesses become “even better yet.” While these meetings occasionally included veterinarians, my territory manager and I met most often with hospital managers. The following are observations based upon these conversations, as well as subsequent interactions with managers in my current role as a veterinary business consultant and speaker. The term “manager” in a hospital is often applied loosely

There are many reasons why there is no consistency across practices in what responsibilities this position represents. The following factors represent the two most common challenges for maximizing the success of practice managers. How managers are selected. Often times, managers are promoted from within as a “reward” for longevity or because it is “easy” and they are not carefully selected for skills, competencies, and potential. The outcome is a mismatch in the needs of the position and the ability of the selected individual to fill those needs. As leaders, we make these decisions based on an innate psychological bias that we as humans possess, which is over-rating capability. As described in his book Great People Decisions, Claudio Fernandez Araoz explains that over-rating capability is “based on two incorrect assumptions. The first is that people can change more quickly, and to a greater degree, than they actually can” and secondly “that a high correlation exists between the motivation to perform and the actual capacity to do so.” He goes on to state that a strong interest in the position and high motivation is not enough to overcome a basic lack of key competencies, attributes, and experience. Managers should be selected based on a variety of factors, including emotional intelligence, their potential (can they continue to grow and adapt in an ever changing business climate, taking on larger challenges with an eye toward planning for the future?), and the alignment of their personal values with the hospital’s core values. When selecting managers, the talents they possess should be carefully compared to the key competencies needed in the position. The role of the manager in the veterinary hospital. The lack of clearly defined managerial priorities can sabotage the ability of a manager to perform even the most basic of responsibilities. In order for a manager to bring value to the role, there must be a clear understanding of the responsibilities the position assumes. Ideally, these competencies are defined prior to undertaking the search for the manager. Once the manager is hired, it is critical that the veterinarians and owners get out of the manager’s way. It is difficult for veterinarian/owners to “let go” and allow the manager to perform the job. I believe there are many reasons for this, including the difficulty in PAG E 26 | CV M A Vo ice 2016 : 4

trusting the person selected with a business tied so intimately to the veterinarian’s personal and professional wellbeing. Simply stated, veterinarians need to work to develop vulnerability-based trust in their managers, viewing them as partners in working toward the continued success of the hospital. When this trust is developed, the tendency of the veterinarian to micro-manage dissipates. Hospital owners do not work to “grow” their managers

Just as with any position, it is critical that veterinarians provide ways for their managers to continue to develop, both professionally and personally. There are several ways to help managers realize their potential. Mentor your manager. Mentoring is defined as an “employee training system under which a senior or more experienced individual (the mentor) is assigned to act as an advisor, counselor, or guide to a junior or trainee. The mentor is responsible for providing support to, and feedback on, the individual in his or her charge.” (www.businessdictionary.com/definition /mentoring.html) This is very different from micromanagement, defined by businessdictionary.com as “close, detailed, and often de-motivating scrutiny of employees’ work on a continuing basis.” Create an agreement between the manager and the veterinarian that holds each person accountable to the other. Take the time to understand what the manager needs to be successful in their position, such as regular meetings with the leadership team to discuss business metrics, team performance, and new opportunities. Create a system so that the veterinarian/owner knows where the manager is focusing his/her time and provide ongoing feedback to the manager. The manager should be involved in the daily operations of the hospital; the veterinarian should be observing from a 30,000 ft. level. Provide educational opportunities for your manager. Seek out ways for managers to grow in their competencies and skills. This investment is one of the most valuable a veterinarian will make for their business and in fulfilling a very important mission of a committed leader: to help followers achieve personal and professional development and fulfillment. There are many educational resources available; see the resources list included with this article for ideas. Encourage networking and collaboration. Support managers in developing a strong professional network. Having other managers and leaders as peer resources provides the opportunity for collective and creative problem solving and insight. Ways to achieve this are to encourage participation in the Veterinary Hospital Manager’s group (www.VHMA.org). Encourage managers to participate in a local manager’s group. Consider joining a business group, such as VMG, that encourages veterinarians and their managers to work together to achieve specific business goals and attend meetings as a team. This is a critical component to realizing goals; if both the veterinarian and the manager are at the table together, they can hold each other accountable for reaching these benchmarks. Continued on next page

CV M A VO ICE

IN PRACTICE Continued from previous page So . . . Who needs a manager?

I believe that EVERY veterinary hospital would benefit from hiring a professional manager. Veterinarians are rarely trained in business and infrequently possess keen interest in this aspect of hospital ownership. Oftentimes, the veterinarian relegates management responsibilities to a low priority item, giving attention to them after completing their primary roles as doctor in the practice. Professional managers are the key to developing a successful veterinary hospital. Their efforts directly impact the ability of the hospital to provide updated facilities, new equipment, and continued staff training. This impacts the client experience, increased adherence to recommendations, and, ultimately, the health of our patients. Doesn’t a veterinary hospital deserve a dedicated caregiver too? About the Author Wendy Hauser, DVM, established Peak Veterinary Consulting in January 2015 after working as an industry Technical Services Veterinarian. With a DVM from OK State in 1988, she has practiced for 28 years as an associate and owner. She is highly engaged in AAHA, serving as a director and Vice President on the AAHA Board of Directors and currently serves as the AAHA delegate to the AVMA House of Delegates. Dr. Hauser is a communications coach at CSU’s CVM. The co-author of The Veterinarian’s Guide to Healthy Pet Plans, she enjoys consulting and presenting workshops on hospital culture, leadership, client relations, and operations. She may be reached at drhauser@peakveterinaryconsulting.com. n

Resources There are many great learning resources for developing managers. Below are a few of my favorites: American Animal Hospital Association (www.aaha.org/professional/education/default.aspx) Veterinary Management School (VMS) • Veterinary Management Institute (VMI) • AAHA Yearly Conference • Coming soon: Peak Executive Transformations (perfect for advanced level managers) • webinars Veterinary Hospital Managers Association (www.vhma.org) • webinars • Certified Veterinary Practice Manager Certification program • Regional and National Conferences Patterson University (www.pattersonvet.com/SignatureSolutions/ Education/Patterson-Veterinary-University) • Virtual (on-line learning) and regional classes

FREE BUSINESS CHECKING

Think big. Work hard. Make plans. Lower Your IT Cost. Become More Eﬀicient. Streamline Your Practice. Line of Business Support

Help Desk

DVMAX AVImark

Anti-Virus and Malware Protection

Cornerstone ImproMed

24/7/365 Remote Monitoring Backup Disaster Recovery and Business Continuity Patch Management

Vendor Management Project Management Remote Access Reporting

Contact us today for a personalized, no cost, no obligation consultation 720.583.7068 | kfallon@cosaindata.com | cosaindata.com Supporting Colorado Vets since 2011

We’ll help you get the job done with smart business banking tools. Running your business is hard, so we make it easier to do your banking. With an Ent Free Business Checking Account you get smart banking tools and immediate access, so you have everything you need to get your banking done and get back to work.

Call a business specialist to get started. (719) 574-1100 ext. 6770 or 800-525-9623 ext. 6770

Ent.com/FreeBusinessChecking

Qualifications apply. Fees may apply for additional services, including exceeding 100 transactions per month. Minimum opening deposit of $100 required. For important account information, visit Ent.com/Legal. Federally Insured by NCUA © Ent Credit Union, 2016

CVMA Voice 201 6 : 4 | PAG E 27

2 01 6, I ssue # 4

IN PRACTICE A Day in the Life of a Modern Veterinarian Staci Santee, DVM

I was recently invited to host the pet sessions at Denver Tech Startup Week, which was so exciting for me because it brings together my two favorite things . . . animals and technology. Thousands of tech entrepreneurs flooded Denver for five days to attend sessions held at various businesses downtown to learn about apps, microbrew kegerators, soccer training, and even how to know when the best time is to get pregnant. The animal sessions were the best though! The presenters, Dr. Steven Dow of Poudre Canyon Therapeutics and Dr. Terry Opgenorth of VetDC, showed cutting-edge ways that entrepreneurs in the veterinary space are trailblazing biomedical innovations in cancer and diseases in animals. They also spoke about the concept of ONE Health, where veterinarians are described as holding the key that unlocks the cures for similar disease in humans, too. It reminded me of what my life was like in 1996. I had just graduated CSU with my shiny DVM degree and had acquired my first job at a progressive, AAHA-accredited small animal hospital. Each day, I would arrive, put on my white doctor coat, and go up front to look at the big book that held all the appointments. I had to write all my charts up by hand. It would take hours. I had to write the directions for the prescriptions on each label. For X-rays, I had to go into the darkroom (the unused bathroom) to dip the slippery films in the three buckets of solutions whose chemical names had slipped my mind, all the while enduring tachycardia to see if the films would even possess an image after I was done. If I wanted to know how a patient was doing in the middle of the night, I had to get in my car and drive 20 minutes to look in the kennel. If I wanted to research a case, I had to look in massive volumes of books in the community doctor office. I carried around a green vinyl pocket book lovingly christened as the “Nerd Book” the first two years. It was a well-known fact this is mandatory for any new CSU graduate who wishes to save lives. Now I am a veterinarian in 2016. A lot has changed. My virtual appointment calendar keeps me informed of my schedule. My technicians and receptionists use templates to chart my records for me so I can just approve them and sign my name. The labels are pre-configured for any prescribed medication in the pharmacy so I only have to click the print button. The X-rays take five seconds and come out perfect every time, allowing me to maintain a normal sinus rhythm. If I want to know how a patient is doing during the night, I open my app and check my virtual camera in the treatment area. If I want to know the latest about a disease, I consult my VetCompanion app that provides me with the latest information on any disease. Technology changes things, that’s for sure. It makes my life so much better. It affords me more time to spend talking to my clients, caring for my patients, and being up to date on the latest

PAG E 28 | CV M A Vo ice 2016 : 4

medical and surgical treatments available. It allows me to get home at a reasonable hour to spend time with my family. And when I message my clients with their blood work from my practice app, I can’t help but notice the permanent dent in my middle finger on my right hand from all the years of writing up medical records before I had access to all this great technology! Dr. Santee is CVMA’s Secretary/Treasurer-elect and the founder ofVet2Pet, a custom veterinary app that helps practices connect and communicate with their clients. n

Award Winning Veterinary Architecture

architecture

•

animals

•

people

800.332.4413 www.animalarts.com

CV M A VO ICE

IN PRACTICE Practice Performance Webinars 2017 CVMA is pleased to announce that it will continue working with Communication Solutions for Veterinarians to offer you monthly webinars that let you train your entire team for an affordable price. Topics include client service, communication skills, and compliance. Live one-hour webinars are the third Thursday of each month at 10:00 AM and 1:00 PM (MT). If your team isn’t available on a webinar date, your enrollment includes the unlimited playback of the recorded session so you can set a training date that fits your schedule. Each webinar is a CVMA member rate of $89 per hospital, a savings of $10 off the regular price, and includes: • Live webinars at 10:00 AM and 1:00 PM (MT) on the third Thursday of each month • Unlimited playback of recorded webinar • Handout • Test • 1 hour of CE credit • CE certificate Please mark your calendars and join us for the 2017 webinars: • January 19 | Dental Promotions That Boost Compliance • February 16 | Phone Scripts That Gain New Clients

Veterinary Team Synergy Rebecca Rose, CVT

At the foundation of every successful veterinary practice is a successful veterinary team. Each team is made up of a kaleidoscope of colors, levels of responsibilities, and passion in the care of veterinary patients and clients. Isn’t it wonderful we have varying backgrounds, skill sets, and focuses within the veterinary hospital?! It truly takes a variety of people and skills to make the team function. It can be a super opportunity for synergy (1+1=3)! As an example, I am a veterinary technician and that has been my career calling since I was very young. Many within the field of veterinary medicine can say that they knew they wanted to work with animals since a young age. Others have migrated to the veterinary community as a second, and sometimes even third, career. Whatever the career path, it takes kennel aides, receptionists, assistants, veterinary technicians, managers, and veterinarians to make the veterinary hospital world “go ‘round.”

• March 16 | Ways to Increase Productivity When You’re Short Staffed • April 20 | How to Prevent Client Complaints and Bad Reviews • May 18 | Be a Telephone Superstar • June 15 | What Millennial Clients Want from Your Veterinary Clinic • July 20 | Managing Bad Clients: Google-seekers, discount divas, and obnoxious smartphone users • August 17 | 5 Golden Rules to Impress Callers • September 21 | 10 Ways to Educate Clients About Dentistry • October 19 | Own the Phone: How to Lead Conversations • November 16 | Best Practices for Financial Conversations • December 21 | 5 Phone Mistakes Receptionists Make Learn more at colovma.org/practice-performance-webinars/, where you can download the 2017 webinar flyer and post it on your employee bulletin board. Hospitals can buy individual sessions at the special CVMA member rate of $89 each, or enjoy greater savings with the annual practice subscription, which includes 12 live or archived webinars and 12 hours of CE credit. The annual membership fee of $990 lets you buy 10 webinars and get 2 free—a savings of $198. When purchasing online, use promo code CVMA to save $10 on individual webinars. n

And within that world, it takes a variety of personalities, education, and motivation to make it all work. Each team member fulfills a specific need, impacts quality of care, gains career satisfaction, and promotes client service. It takes a certain individual to fulfill the job description of a veterinary receptionist–oftentimes gregarious, detail-oriented, curious, and communicative. Kennel aides support the patient’s needs of basic husbandry and TLC. Managers, embracing office duties, human resources, state laws governing small businesses, and communication, are geared for growing teams and companies. Assistants and veterinary technicians are a direct extension of the veterinarian in regard to medical orders and patient care, allowing the veterinarians to focus on their duties (diagnosing, prescribing, treating, and surgery). Team satisfaction is elevated when team members are empowered and supported to do their job to their highest potential. The American Veterinary Medical Association (AVMA) has this to say regarding the veterinary team in their Policy on Veterinary Technology Preamble: “The veterinary profession is enhanced through efficient utilization of each member of the veterinary health care team by appropriate delegation of tasks and responsibilities to support staff.” Through respect and understanding of all the team members, and their role within the veterinary hospital, teams will be successful, offering the best veterinary medicine, patient care, client service, and team satisfaction. Team synergy can be a reality (1+1=3)! n CVMA Voice 201 6 : 4 | PAG E 2 9

2 01 6, I ssue # 4

IN PRACTICE Can Placebos Benefit the Treatment of Separation Anxiety in Dogs? Suzanne Hetts, PhD, CAAB and Daniel Estep, PhD, CAAB Animal Behavior Associates, Inc.

Distress when left alone—so called separation anxiety— continues to be a common behavior problem. Medications such as Reconcile® and Clomicalm® are frequently recommended for separation anxiety, along with behavior modification. Two years ago, researchers associated with The Family Dog Project in Hungary (https://familydogproject.elte.hu/about-us/our-research/) conducted a study to evaluate the possibility of a conditioned placebo effect associated with a medication to relieve the symptoms of separation anxiety. (For additional information about this phenomenon, Google “conditioned placebo.”) This study is of interest because it’s a good example of why research results must be carefully evaluated before deciding what, if any, implications it has for the treatment of behavior problems. As you’ll see, this research raises more questions than it answers. The subjects in the research were 28 dogs (15 male, 13 female, reproductive status not mentioned) from 13 different breeds and 13 mixed breed dogs with an average age of 1.8 years (± 3.1 years). The dogs were randomly assigned to either an experimental group or a control group. The dogs were recruited (the paper didn’t mention how) because their owners reported their dogs displayed significant fearful behavior when left alone in at least three different contexts (not specified). The behavioral symptoms included excessive salivation, destructiveness, and excessive barking. There was a second part to the study, but space limits prevent us from reporting on it here; however, that part doesn’t affect our review. Experimental Methods

The study took place in a small room on a university campus in Budapest, Hungary. In the room were a chair, some dog toys, and two areas marked on the floor for people to stand, each one near a door. The study took place in three phases: a baseline phase, a conditioning phase, and a test phase. The baseline and test phases were identical for the two groups of dogs. The experimental manipulation occurred in the conditioning phase. After a brief acclimation to the room with the owner, the dogs experienced three “episodes” during the baseline and test phases. In the first episode, each dog was left alone in the room for two minutes. This was followed by the second episode where a stranger came into the room for two minutes and if the dog initiated contact, interacted with the dog. A third episode followed when the owner returned to the room for two minutes and, if the dog initiated contact, interacted with the dog (the stranger left when the owner entered the room). A conditioning phase, which covered several weeks, followed the baseline phase. During this phase, there were three trials separated by several days each. Twenty-five minutes before each trial, dogs in the experimental group were given the sedative Sedalin, an oral gel with the active ingredient acepromazine maleate at a dose of 1 ml/35kg body weight. (As PAG E 3 0 | CV M A Vo ice 2016 : 4

an aside, veterinary behaviorists in the U.S. do not recommend acepromazine alone for the treatment of separation anxiety because it is not anxiolytic. It is not clear why these researchers used it and why they maintained it had anxiolytic properties.) Dogs in the control group received a vitamin gel at the same dosage that had no behavioral effects. Each conditioning trial consisted of the same three episodes from the baseline phase, except that the owner stayed with the dog the entire time. The test phase consisted of the same three episodes used in the baseline phase (dog alone, with a stranger, then the owner). Twenty-five minutes before the test phase, dogs in both conditions received the vitamin gel. For the experimental group this represented the test of the placebo effect. If a conditioned placebo effect was at work, it was expected that the experimental dogs would show fewer distressed behaviors than the control dogs during testing, even though both had received only the vitamin. This is because the experience of being given the vitamin was hypothesized to trigger the same responses evoked by the sedative. As we’ll see, it may not be that simple. Behavioral Measures

The researchers measured three categories of behavior for all dogs during the baseline and test phases. One was passive behaviors such as lying down or standing quietly away from the doors. A second was passive behavior next to the doors. And a third was distress behaviors around the door such as scratching, jumping up, and barking or whining. The researchers looked at differences in these behaviors between baseline phase and test phase between the two groups. Passive behaviors away from the doors increased and door-distress behaviors decreased more in the experimental group from baseline and test than they did in the control group. Remember, dogs in both groups only received the vitamin pill prior to the test phase. So the differences in behavior had to be as a result of some process that occurred during the conditioning trials. Because the Sedalin was not on board during the test phase, the researchers claim the behavior differences were due to a conditioned placebo effect. This would mean that the dogs associated being given a pill with the feeling of being sedated and relaxed while in the room, and thus were less distressed during the test even though they had no sedative. But there is another possible explanation. It’s not known whether the same reduction in distress behaviors and increase in passive behaviors during the test phase would have occurred even if the experimental group wasn’t given the placebo vitamin pill prior to the test trial. In other words, the positive effect wasn’t a placebo effect at all but merely the result of having three experiences in the room while being sedated, not left alone, and not being distressed. To answer this question, the experimental dogs should have been tested without being given the placebo vitamin. Practical Implications from This Study

First, and something that behaviorists have known for a long time, is that contextual cues during behavior modification are Continued on next page

CV M A VO ICE

IN PRACTICE Continued from previous page important. One of the common behavior modification techniques for treating separation anxiety is to repeat departure cues—such as jangling keys, putting on jackets—without leaving. For this to be most effective, these cues should occur in the same context as does the actual departure. In other words, repeatedly jangling the keys while the owner is in the basement with the dog watching TV, is a completely different context from jangling the keys near the front door where the departure occurs. So practicing departure cues should occur in the departure context. Second, when using medications that reduce fear or anxiety, it’s important to take advantage of the influence of contextual cues as well. This summer, for example, we gave our thunderphobic Irish setter, Coral, a Valium® when a storm was imminent, and also sat with her in the basement. The sounds of thunder and wind and the lightning flashes were much attenuated in the basement. Coral was much calmer there as the result of both the medication and the less intense storm stimuli in this context. Over the course of the summer, Coral, on her own, began to retreat to the basement at the first indications a storm was approaching and was

much less distressed than previously, even without the medication. This facilitated less frequent use of the Valium®. Finally, if we give the research the benefit of the doubt and allow that a placebo effect is possible, then this would suggest owners should give whichever medication you prescribe for separation anxiety as part of the departure routine for a period of days but without leaving. Then the medication is given in the exact same context (same period of time before leaving, same room, etc.) when the owner does leave. And finally, when the dog’s behavior has improved, and you recommend discontinuing the medication, the owner should continue the medication ritual using a placebo pill that you have recommended. At some point, we would expect extinction of the conditioning to occur and the ritual would no longer have an effect; but if and when this occurs is unknown. More research is needed to know how many trials under each context would be necessary, and whether this procedure would really be effective. If you’d like to read the paper yourself, it can be found at http://familydogproject.elte.hu/Pdf/publikaciok/2014 /SumegiGT2014.pdf n

We’re Good At Heart ONE PRACTICE. MULTIPLE LOCATIONS. COORDINATED, COMPREHENSIVE CARE.

Regardless of where we see your patient — at one of our stationary practices or in your office — our centralized patient record system allows any cardiologist in our practice to access complete records for any patient, anytime. THE CLEAR CHOICE FOR THE BEST CARDIAC CARE. The only practice in Colorado with full-time cardiologists available six days a week Saturday appointments at VRCC Mobile appointments along the Front Range, I-70 Corridor & Colorado Springs 24 hour critical care hospitalization Pacemaker implantation, PDA occlusion & balloon valvuloplasty Always available to discuss cases and assist with anesthesia protocols & emergencies Alpenglow Veterinary Specialty + Emergency Center 3640 Walnut Street, Boulder, CO 303-443-GLOW (4569)

Veterinary Referral Center of Colorado (VRCC) 3550 Jason Street, Englewood, CO 303-874-2094

Practicing with Excellence, Compassion, Integrity, Approachability and Teamwork | RMVCcolorado.com

CVMA Voice 201 6 : 4 | PAGE 31

2 01 6, I ssue # 4

IN PRACTICE Compounding Transdermal Medications for Feline Patients Lauren R. Eichstadt, PharmD, FSVHP Veterinary Pharmacy Resident, Purdue Veterinary Teaching Hospital, Lafayette, Indiana

Abstract Transdermal medications are a desirable route of administration for feline patients. However, before compounding, pharmacists and veterinarians should critically evaluate if the medication is appropriate for administration via the transdermal route.This article discusses points to consider regarding transdermal therapy.Tables summarizing the current literature and medications that should never be used transdermally are included.

when discussing transdermal therapy because transdermal medications should be prepared from active pharmaceutical ingredients (APIs) to avoid the excipients that are present in commercially available dosage forms. However, this wasn’t always legal. In 1968, the Pure Food, Drug, and Cosmetic Act was amended to include veterinary patients. This made all extra-label drug use (ELDU) in veterinary patients illegal. Since compounded products are always considered ELDU, these were illegal as well.1 However, ELDU is necessary for treating veterinary patients so the U.S. Food and Drug Administration created two compliance policy guides (CPGs) that detailed their regulatory priorities with regards to ELDU. These two CPGs were incorporated into the Animal Medicinal Drug Use Clarification Act (AMDUCA) which took effect in 1996. AMDUCA legalized ELDU with certain restrictions. It also legalized compounding for veterinary patients, but did not address compounding from APIs.2 CPG 608.400 was introduced to fill in this gap. It went through multiple versions with the most recent prohibiting compounding from bulk chemicals except for poison antidotes and depopulation in food animals.3 CPG 608.400 became obsolete in May 2015 and was replaced with the draft version of Guidance for Industry (GFI) #230. This document allowed compounding from bulk chemicals for nonfood animals under certain conditions. GFI #230 was open for comment last year, but a finalized version has not been released as of time of writing.4 Currently, compounding transdermal dosage forms for feline patients using APIs is legal as long as the three following conditions are met2: 1. There is a valid veterinary-client-patient relationship (VCPR) in place. 2. There is no approved product (either veterinary or human) that can be used. 3. The veterinarian has determined that risk of lack of efficacy and/or unexpected adverse effects from the compounded medication is outweighed by potential benefit to the patient.

Veterinarians, compounding pharmacists, and pet owners are all in the hunt for a dosage form that would allow easy, stress-free administration. Transdermal medication that can be applied to the pinna of a cat’s ear is the closest we have come to this dosage form. Transdermal medications, in theory, provide systemic drug levels when a medication is applied topically to the thin, hairless, well-perfused skin of the feline ear. Many cat owners would rather have their pet’s medication as a transdermal than a tablet or capsule, and compounding this dosage form is relatively straight forward. However, not everything should be a transdermal medication. From efficacy and legal standpoints, the question that veterinarians should be asking and pharmacists should be answering isn’t, “can we compound this?” but rather “should we compound this.” The legality of compounding for veterinary patients has varied widely over the past 50 years. This history is important PAG E 3 2 | CV M A Vo ice 2016 : 4

The first two requirements are relatively easy to satisfy; however, the lack of studies on transdermal products makes the third requirement more difficult. This is further complicated by the lack of communication between veterinarians and pharmacists. Veterinarians often assume that if a pharmacist is willing to compound a medication then it must be appropriate, and pharmacists often assume that if a veterinarian prescribes a medication in a particular dosage form then it must be appropriate. The result is that no one verifies if a medication is appropriate for transdermal administration. There are many facets to consider when determining if a medication should be administered via the transdermal route including5: • Caregiver and patient safety • Ability of the drug to cross the skin • Efficacy of the transdermal formulation • Plans for monitoring, follow-up, and caregiver education Continued on next page

CV M A VO ICE

IN PRACTICE Continued from previous page These should be determined by a collaborative effort between veterinarian and pharmacist with each contributing in their areas of knowledge. However, both pharmacists and veterinarians are limited by the available literature on transdermal formulation efficacy

and the ideal base in which to prepare transdermal medications. The available literature on in vivo administration is summarized in Table 1, along with recommendations that can be made based on that information. In addition, Table 2 provides a list of medications that should not be considered for transdermal administration.

Table 1. Summary of Available Transdermal Information. Drug

Oral Dose (Cats)

Injectable Dose (Cats)

Evidence-based Transdermal Dosing

Target for Efficacy

Monitoring for Toxicity

Recommendation

Amitriptyline

2.5 – 12.5 mg/ cat SID

N/A

Single dose of 5 mg has poor absorption compared to oral.6

Cessation of undesirable behavior

Dry mouth, gastric distress, constipation, ataxia, tachycardia, weakness, sedation, urinary retention

Insufficient data

Amlodipine

0.625 – 2.5 mg/cat SID

N/A

0.28 mg/kg QD × 7 days immediately following 7 days of oral resulted in blood pressure reduction, but not to the extent of the oral.7

Reduction in blood pressure

Hypotension

May be an acceptable option

Atenolol

6.25 – 25 mg/ cat BID

N/A

6.25 mg BID × 7 days resulted in inconsistent absorption and plasma levels.8

Reduction in pulse

Hypotension, bradycardia, bronchospasm, cardia failure, hypoglycemia

Not recommended

Buspirone

2.5 – 7.5 mg/ cat BID - TID

N/A

- 2.5 mg/kg single dose produced undetectable levels.7 - 4 mg/kg QD × 5 weeks was clinically effective in one study.9

Cessation of undesirable behavior

Sedation, nausea, anorexia, tachycardia

May be an acceptable option

Cyclosporine

7 mg/kg/day

N/A

25 mg QD × 21 days resulted in detectable levels, but most cats didn’t get within 25% of oral levels.10

Resolution of dermatitis

GI distress, lethargy, behavior changes, gingival hyperplasia, flares of latent viral infections

Insufficient data

Dexamethasone

10% to 20% of the prednisolone dose

0.125 mg to 0.5 mg IV or IM every 3 to 5 days

0.05 mg/kg × 1 dose did not result in concentrations equal to oral.11

Cessation of inflammatory signs

Epidermal or cartilage atrophy, signs of hyperadrenocorticism, signs of diabetes mellitus

Not recommended

Fluoxetine

0.5-1 mg/kg/ day

N/A

5 mg/kg and 10 mg/kg × 1 dose showed bioavailability 10% or oral.12

Cessation of undesirable behavior

- Anxiety, irritability, anorexia, hepatotoxicity - Some patients have experienced severe burns on the ear after administration, requiring drug discontinuation

Insufficient data

Transdermal Medications continued on page 34 CVMA Voice 201 6: 4 | PAGE 33

2 01 6, I ssue # 4

IN PRACTICE Transdermal Medications continued from page 33 Oral Dose (Cats)

Drug

Glipizide

Methimazole

Phenobarbital

2.5 mg/cat BID with food

2.5 mg/cat BID

1 – 3 mg/kg BID

Injectable Dose (Cats)

Evidence-based Transdermal Dosing

Target for Efficacy

Monitoring for Toxicity

N/A

5 mg × 1 dose showed bioavailability 20% of oral; highly variable absorption.13

Reduction in blood glucose

GI distress, hypoglycemia, increased ALT

Not recommended

N/A

- 2.5 mg/cat BID and 5 mg/cat QD had most euthyroid in 1 week.14 - 5 mg/cat BID × 28 days was effective.15 - 5 mg/cat and 10 mg/cat QD × 7 days was effective but took longer to reach effective levels compared to oral.16 - 2.5 mg to 5 mg/cat QDBID was effective.17

Reduction in serum T4 levels; clinical symptom improvement

Worsening of vomiting, dermal excoriations, leukopenias, hepatopathies, thrombocytopenia

Recommended

3 mg/kg IV as part of a combination for SE

3 mg/kg BID × 14 days did not result in therapeutic levels; 9 mg/kg BID × 14 days resulted in therapeutic concentration.18

Seizure free; serum plasma concentrations of 10 mcg/mL to 30 mcg/mL

Ataxia, sedation, bone marrow suppression, immune mediated reactions

May be an acceptable option

Recommendation

ALT = Alanine Transaminase; GI = gastrointestinal; IM = intramuscular; IV = intravenous; N/A = not applicable; SE = status epilepticus

Table 2. Medications that Should Not Be Administered Transdermally. Never Use by Transdermal Route Drug Class

Reason to Avoid

Antibiotics

Likely to lead to resistance and lack of efficacy due to low blood levels

Cytotoxic medications

Unnecessary risk to caregiver and likely to cause damage to the ear

Photosensitizing agents

Exposure to sunlight (outside or through a window) may cause irritation

Diagnostic agents

Unpredictable absorption will affect test results

Medications exerting their effect in the gastrointestinal tract

Medication will not reach site of action

Medications toxic to humans

Unnecessary risk to caregiver

Prodrugs metabolized by gut enzymes

Medication will not be metabolized to active form

Medications requiring dosages >25mg

Maximal absorption based on surface area of the ear is 25 mg

Use Cautiously by Transdermal Route Corticosteroids

Likely to cause cartilage atrophy if used long term

Irritating medications

May cause irritation to the ear

Narrow therapeutic index

Unpredictable absorption may lead to ineffective or toxic drug levels

Source: Eichstadt LR, Davidson GS. To compound or not to compound: A veterinary transdermal discussion. IJPC 2014; 18(5): 366–369.

Conclusion

On the surface the transdermal dosage form seems like a great idea for treating feline patients. However, there are many considerations that need to take place before compounding these PAG E 3 4 | CV M A Vo ice 2016 : 4

medications. It is important for both the pharmacist and veterinarian to consult the available literature to determine if the desired therapy will provide the highest quality of care for the patient. Continued on next page

CV M A VO ICE

IN PRACTICE Continued from previous page References 1. U.S. Department of Health and Human Services. U.S. Food and Drug Administration. Regulatory Information: Federal Food, Drug, and Cosmetic Act (FD&C Act). United States Code, Title 21. [FDA Website.] 1968. Available at: www.fda.gov/RegulatoryInformation/Legislation/FederalFoodDrugandCosmeticActFDCAct/default.htm. Accessed June 1, 2016. 2. U.S. Department of Health and Human Services. U.S. Food and Drug Administration. Animal &Veterinary: Animal Medicinal Drug Use Clarification Act of 1994 (AMDUCA). Federal Food, Drug, and Cosmetic Act (FD&C Act). [FDA Website.] 1968. Available at: www. fda.gov/AnimalVeterinary/GuidanceComplianceEnforcement/ ActsRulesRegulations/ucm085377.htm. Accessed June 1, 2016. 3. U.S. Department of Health and Human Services. U.S. Food and Drug Administration. Office of Regulatory Affairs. Center for Veterinary Medicine. Guidance for FDA Staff and Industry: Compliance Policy Guides Manual, Sec. 608.400, Compounding of Drugs for Use in Animals. [FDA Website.] July 2003. Available at: www.fda.gov/OHRMS/ DOCKETS/98fr/03d-0290-gd100001.pdf. Accessed June 1, 2016. 4. U.S. Department of Health and Human Services. U.S. Food and Drug Administration. Center for Veterinary Medicine. Guidance for Industry: Compounding Animal Drugs from Bulk Drug Substances. Draft Guidance #230. [FDA Website.] May 2015. Available at: www.fda.gov/downloads/AnimalVeterinary/GuidanceComplianceEnforcement/GuidanceforIndustry/UCM446862.pdf. Accessed June 1, 2016. 5. Eichstadt LR, Davidson GS. To compound or not to compound: A veterinary transdermal discussion. IJPC 2014; 18(5): 366–369. 6. Mealey KL, Peck KE, Bennett BS et al. Systemic absorption of amitriptyline and buspirone after oral and transdermal administration to healthy cats. JVet Intern Med 2004; 18(1): 43–46. 7. Helms SR. Treatment of feline hypertension with transdermal amlodipine: A pilot study. J Am Anim Hosp Assoc 2007; 43(3): 149–156. 8. MacGregor JM, Rush JE, Rozanski EA et al. Comparison of pharmacodynamic variables following oral versus transdermal administration of atenolol to healthy cats. Am JVet Res 2008; 69(1): 39–44. 9. Chávez G, Pardo P, Ubilla MJ et al. Effects of behavioural variables of oral versus transdermal buspirone administration in cats displaying urine marking. J Appl Anim Res 2016; 44(1): 454–457.

10. Miller R, Schick AE, Boothe DM et al. Absorption of transdermal and oral cyclosporine in six healthy cats. J Am Anim Hosp Assoc 2014; 50(1): 36–41. 11. Willis-Goulet HS, Schmidt BA, Nicklin CF et al. Comparison of serum dexamethasone concentrations in cats after oral or transdermal administration using Pluronic lecithin organogel (PLO): A pilot study. Vet Dermatol 2003; 14(2): 83–89. 12. Ciribassi J, Luescher A, Pasloske KS et al. Comparative bioavailability of fluoxetine after transdermal and oral administration in healthy cats. Am JVet Res 2003; 64(8): 994–998. 13. Bennett N, Papich MG, Hoenig M et al. Evaluation of transdermal application of glipizide in a Pluronic lecithin gel to healthy cats. AmJ Vet Res 2005; 66(4): 581–588. 14. Boretti FS, Sieber-Ruckstuhl NS, Schäfer S et al. Duration of T4 suppression in hyperthyroid cats treated once and twice daily with transdermal methimazole. JVet Intern Med 2013; 27(2): 377–381. 15. Lécuyer M, Prini S, Dunn ME et al. Clinical efficacy and safety of transdermal methimazole in the treatment of feline hyperthyroidism. CanVet J 2006; 47(2): 131–135. 16. Hill KE, Gieseg MA, Bridges J et al. The pharmacokinetics of methimazole in a novel lipophilic formulation administered transdermally to healthy cats. N ZVet J 2014; 62(4): 208–213. 17. Boretti FS, Sieber-Ruckstuhl NS, Schäfer S et al. Transdermal application of methimazole in hyperthyroid cats: A long-term follow-up study. J Feline Med Surg 2014; 16(6): 453–459. 18. Delamaide Gasper JA, Barnes Heller HL, Robertson M et al. Therapeutic serum phenobarbital concentrations obtained using chronic transdermal administration of phenobarbital in healthy cats. J Feline Med Surg 2014; 17(4): 359–363.

Address correspondence to Lauren R. Eichstadt, PurdueVeterinary Teaching Hospital, 625 Harrison St.West, Lafayette, IN 47907. E-mail: leichsta@purdue.edu Reprinted with permission from the International Journal of Pharmaceutical Compounding 2016; 20(4): 271–274. n

Before sharing this article with members, CVMA asked Gregg Griffenhagen, DVM, MS, DACVAA, Anesthesiologist & Clinical Instructor in the Veterinary Teaching Hospital at CSU’s College of Veterinary Medicine and Biomedical Sciences Department of Clinical Sciences, for his thoughts . . . “I think it is a pretty well-researched article. To me, the take home message is that transdermal compounding shouldn’t be used unless efficacy data is available. The only drugs I know of are amlodipine, buspirone, methimazole, phenobarb, and nitro (although I’m sure there may be others). When people ask about other behavior modifying drugs (amitriptyline comes to mind), it is worth a try, because the drug tastes terrible and if the cat won’t take it, it might be relinquished. Different pharmacies have different compounding formulas. Some may work better than others, and just because the papers show efficacy, that doesn’t mean another pharmacy will have the same success.”

CVMA Voice 201 6: 4 | PAGE 35

2 01 6, I ssue # 4

CVMA NEWS CVMA Staff Updates Fond Farewells

Nancy Cross served as Director of Learning since 2012, running CVMA’s education programs. Nancy’s department worked diligently to provide exceptional CE offerings and stellar service to members during her time with us. She has made the move to retirement, and we wish Nancy and her husband Chris the best as they enjoy more time together and traveling. In her role as Director of Programs and Initiatives, Tara McChesney oversaw PetAid’s Community Outreach and Care Grant programs, and for CVMA, worked closely with CVMA leadership and our members. She also represented CVMA with allied organizations, including the Colorado Unwanted Horse Alliance. In June, Tara and her husband Robert welcomed their son Logan, and she has left CVMA to spend more time with her baby boy. New Role

As our Manager of Member Engagement, Katie Koch dedicated herself to serving our members and growing the association, proving an excellent resource to both staff and membership alike. And while we have been fortunate to have her in this role, we are happy to announce that she has been promoted to fill Tara’s position as Director of Programs and Initiatives. Please help us congratulate Katie on her new position!

New Faces

CVMA is pleased to welcome Kristin Payne as our new Director of Learning. Kristin joins us most recently from the Association of periOperative Registered Nurses in Denver, and she previously worked for the American Academy of Pediatric Dentistry in Chicago. She brings strong association and education and meeting planning experience to CVMA and we invite you to help us welcome Kristin to our association team! CVMA is also pleased to welcome D iane Matt as the new CEO-designate for both CVMA and PetAid Colorado. Diane will be working closely with our Executive Director Ralph Johnson, the boards, and staff as Ralph begins moving toward retirement. Diane comes to us from WEPAN, the Women in Engineering ProActive Network, where she served as executive director for 12 years. She has also previously served as manager of environmental affairs for the Denver Regional Transportation District, the executive director for the Associated Landscape Contractors of Colorado, and director of strategic and international alliances for the Geological Society of America. Please help us welcome Diane to this exciting new role, and be sure to read more about her on page 10! n

CVMA CVA Program Grow Your Team—While Growing Your Bottom Line! CVMA is proud to recognize and certify the designation of CVMA Certified Veterinary Assistant (CVA). The CVMA CVA program provides continuing education for veterinary medical personnel, enabling them to become more informed, skilled, and trusted members of the veterinary medical team. This program was designed to help staff to pursue veterinary medicine as a career, not just a job. Investing in your employees saves your practice from having to deal with less turnover for your practice and costly replacement and re-training efforts! To learn more and to enroll today, visit www.colovma.4act.com. And coming soon: CVA Levels II and III. Did you know? If you are a CVMA Premium or Core member, the $325 enrollment fee for the CVA program is waived as part of your membership level! 2016 CVA Graduates Please join us in congratulating the newest graduate of the CMVA Certified Veterinary Assistant program! Julie Sumlin, CVA I Highland Animal Hospital Centennial, CO

PAG E 3 6 | CV M A Vo ice 2016 : 4

CV M A VO ICE

CVMA NEWS CVMA Welcomes 2016/17 Executive Committee The CVMA 2016/17 Executive Committee was sworn in on September 24 in Loveland during the Celebration Luncheon at CVMA Convention 2016. President, Dr. Sam Romano (Arvada) President-elect, Dr. William French (Sedalia) Secretary/Treasurer, Dr. Joy Fuhrman (Fort Collins) Secretary/Treasurer-elect, Dr. Stacee Santi (Durango) Immediate Past President, Dr. Curtis Crawford (Monte Vista) AVMA Delegate, Dr. Melanie Marsden (Colorado Springs) AVMA Alternate Delegate, Dr. Rebecca Ruch-Gallie (LaPorte)

CVMA CE Southwest Explores Critical Care Challenges and Cat Conundrums Samantha Hoyt CVMA Manager of Learning and Partnerships

In early October, 100 attendees made their way through beautiful fall foliage to Durango for another successful CE Southwest. This unique educational opportunity offers 12 hours of CE and is designed for small animal veterinarians in Southwestern Colorado and surrounding states. The meeting kicked off Saturday, October 8 with nationally recognized feline expert and NAVC’s 2014 Small Animal Speaker of the Year, Susan Little, DVM, DABVP (Feline). Dr. Little’s inspiring and engaging presentation on “Cat Conundrums” included Improving the Safety of Anesthesia for your Feline Patients, Secrets of Feline Medicine, Cats Are Not Small Dogs, Approach to Elevated Liver Enzymes in Cats, and Strategic Approaches to Feline Medicine Cases: Work Smarter, Not Harder! After an outstanding day of learning, attendees gathered outside along the Animas River on a crisp fall evening for some appetizers, drinks, and good conversation. After the reception, the Carver Brewery once again hosted a beer pairing dinner—an event always well attended for its collegiality and connections. On Sunday morning, Geoff Heffner, DVM, DACVECC, an exceptional speaker and assistant professor from Colorado State University, introduced the audience to “Critical Care Challenges” that included common toxicology updates, Revised Clinical Approach to Acute Kidney Injury, Introduction to Renal Replacement Therapy, Updates in Fluid Resuscitation, and Traumatic Coagulopathy. CVMA was very fortunate to have two talented and outstanding speakers for this year’s CVMA CE Southwest. They both captured the interest of attendees and provided a weekend of superior education! And we can’t thank our five fantastic sponsors enough, as their generous support makes this event possible. Once again our presenting sponsor was Zoetis, and our supporting sponsors were

CVMA is the voice of veterinary medicine in Colorado, and our executive committee members are an integral part of making that voice heard. Their service and dedication are appreciated and will strengthen both CVMA and the profession of veterinary medicine. As volunteer leaders, these committee members will serve a vital role in the function of the CVMA. Their service provides an opportunity to affect the future of veterinary medicine in Colorado, and affords an avenue for meeting and collaborating with colleagues around the state. Please help us welcome your new CVMA Executive Committee! n

Blue Buffalo Veterinary Diets, Hill’s Pet Nutrition, IDEXX and MWI Animal Health. Their participation allows us to put on this exceptional event for our members, and we greatly appreciate their generosity. Mark your calendars for next year’s CVMA CE Southwest: October 14-15, 2017. n

I-131 Therapy in Colorado Springs The Gold Standard of Care for Feline Hyperthyroidism 96-98% cure rate after one injection $975 all inclusive price

Carefree Cats Veterinary Hospital Gene Pollard, DVM, RSO Kelsey Moses, DVM, ARSO 4810 Old Farm Drive, Suite 100 Colorado Springs, CO 80917 Clinic: (719) 573-1670 Fax: (719) 573-1778 www.carefreecatsvet.com carefreecats@msn.com

CVMA Voice 201 6 : 4 | PAGE 37

2 01 6, I ssue # 4

CVMA NEWS

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

Professional Development Series (PDS) 2016/17 The CVMA Professional Development Series (PDS) continues in February with topics in clinical education, featuring case-based, interactive sessions with experts sharing their experience and insights—all right here in Denver!

CVMA Chapter 3 | Weld County

February 8, 2017 Ophthalmology for the General Practitioner: Tips from the Trenches Tammy Miller Michau, DVM, MS, MSpVM, DACVO

CVMA is pleased to introduce Dr. Hannah Klein as the new Chapter 3 Representative. Dr. Klein was raised on the Western Slope of Colorado where, from a young age, she was always out with the animals in the barn. Even during her undergraduate work in Equine Science and Biomedical Sciences at CSU, she continued to work with large animals as a veterinary technician. She graduated from CSU CVMBS in 2011. Dr. Klein practices mobile, large animal medicine based out of High Plains Cattle Supply in Platteville, CO. As a Power of Ten graduate, Dr. Klein is passionate about bringing veterinarians together both socially and legally, to support our specialized industry. She can be contacted at hklein.dvm@gmail.com or 970.658.6468. CVMA Chapter 6 | Denver Area

Upcoming Impactions and Meetings The Member Connections Committee is working on a great lineup of new Impactions and events for 2017. Please check your monthly Chapter 6 | Denver Area email for announcements. Events will also be added to the Chapter 6 | Denver Area page at colovma.org. Please come join us, meet other members, and make connections in 2017! Finding Meaning in Veterinary Medicine FMVM meetings will continue in 2017 and will be held at 6:30 PM on the third week of each month alternating between Tuesdays and Wednesdays, and will be hosted by Dr. H. Howells. Look to your monthly Chapter 6 | Denver Area email for upcoming dates and locations. We encourage you to reach out to your area director if you would like to suggest an all-area gathering, or Dr. Jeff Fankhauser, chair of the Member Connections Committee, if you have ideas for future Impactions.

PAG E 3 8 | CV M A Vo ice 2016 : 4

March 8, 2017 Feline Internal Medicine: Using Case Based Examples to Improve Diagnostic and Treatment Success John R. August, BVetMed, MA, MRCVS, DACVIM April 12, 2017 What’s New in Pharmacology: Tackling Old Problems with New Ideas Dawn Merton Boothe, DVM, PhD, DACVIM (Internal Medicine), ACVCP

Visit the PDS page at colovma.org for more information and to register. CVMA Chapter 7 | Colorado Springs Area

On Tuesday, November 8, Dr. James Cook presented on “The Use of Regenerative Therapies to Aid in the Treatment of Joint Disease” in Colorado Springs. Dr. Cook was the November 9 speaker for the CVMA Professional Development Series (PDS) in Denver, and CVMA invited him to come early and present to CSAVS (now CVMA Chapter 7 | Colorado Springs Area). Says Dr. Laura Birkholz, the CE coordinator for Chapter 7, “We had a great turnout for Dr. Cook’s session, with about 30 in attendance. The session was wonderful! All of the feedback I got about the sports medicine talk was extremely positive. Our members felt that Dr. James Cook was engaging and informative. It was a very fun event! We look forward to applying the knowledge we acquired at this event in the exam room. Thank you, CVMA, for making the connection to Colorado Springs from Denver, and providing us with this great CE opportunity. We look forward to working with CVMA to bring more speakers to Colorado Springs in the future!” n

Come Over & Check Out Our New Home! Rocky Mountain

Veterinary neurology NEW addrEss: 3550 south iNca strEEt E N g l E Wo o d, c o 8 0 1 1 0

Dr. Stephen B. Lane, DVM Diplomate (ACVIM)â&#x20AC;&#x201D;Specialty of Neurology Veterinary Neurology / Neurosurgery A proud owner of VRCC, Veterinary Specialty & Emergency Hospital

303.874.2081 www.RockyMountainVeterinaryNeurology.com

Presort Standard U.S. Postage

PAID Jefferson City, MO Permit 210

Ready to enjoy the dog’s life?

It’s Time.

Most veterinarians only buy or sell a practice once. We have specialized in veterinary practice sales for over 39 years. The Simmons team consists of Brokers, Lawyers, CPA’s, Business Experts and Credited Valuation Analysts who are involved in hundreds of veterinary practice transactions every year.

Kathy Morris, CPA, CVA & David King, DVM, CVA Simmons Intermountain 303-805-7627 | kathy@simmonsintermountain.com