Associate Member News Briefs

Boehringer Ingelheim Animal Health expanded its telemedicine offerings today to help veterinarians and pet owners care for animals at a time of social distancing and beyond. The PetPro Tele+™ platform provides an all-in-one telemedicine solution that people can ac- cess online for immediate use. It allows mobile-to-mobile appointments between veterinarians and pet owners who are limiting personal interac- tion to prevent the spread of the virus that causes COVID-19. PetPro Tele+ is a standalone, telemedicine version of PetPro Connect™, a digital ecosystem that Boehringer Ingelheim introduced in select U.S. markets in 2019. In March, as social distancing decreased in-person clinic visits, Boehringer Ingelheim made PetPro Connect available at no cost to veterinarians around the U.S. who need a solution that fully integrates with a practice management system. PetPro Tele+ is available in the United States at www.petproconnect.com/teleplus (link is exter- nal) and soon will be available for download on your preferred mobile device. Boehringer Ingelheim plans to introduce it soon in several other countries. Nxgen announced the merger with payment processor Payroc, and BluePay Processing, LLC. This transaction creates a full-service global merchant acquiring and payment facilitator powerhouse operating in 46 countries, while serving more than 55,000 merchants processing $23 billion in annual bankcard volume. MWI Animal Health announced today a series of technology tools that will enable veterinarian practices to virtually engage with their clients, which has become critically important as the novel coronavirus (COVID-19) spreads and social distancing measures are encouraged. The new offerings will enable enhanced, remote client communication, provide pet parents with peace of mind and help veterinarians remain focused on caring for their patients and improving health outcomes. ALLYDVM Two-Way Texting: During a time when social distancing is key, MWI will offer new and existing customers access to the ALLYDVM twoway texting feature at no cost for a limited time. Petriage Pet Telehealth Services: MWI will offer Petriage’s state-of-the-art telehealth platform to veterinarians and veterinary practices throughout North America. The unique platform enables veterinarians to communicate with clients and even treat household pets remotely. Pawprint: Through a collaboration with MWI, Pawprint will be made available to veterinarian practices across the U.S. to enable curbside operations. The touch-less check-in system allows clients to check-in remotely from their own device. For more information about MWI Animal Health and how to incorporate customer communications into your veterinary practice, please visit www. mwiah.com.

Prescribe

peace of mind.

Powerful protection can also be gentle:

✓ Safe for puppies as young as 8 weeks of age weighing 4 lbs or more

✓ Over 140 million doses of afoxolaner have been prescribed 1

✓ And it’s the only fl ea and tick control product indicated for the prevention of Borrelia burgdorferi infections as a direct result of killing Ixodes scapularis vector ticks

1 Data on fi le.

IMPORTANT SAFETY INFORMATION: NexGard is for use in dogs only. The most frequently reported adverse reactions include vomiting, pruritus, lethargy, diarrhea and lack of appetite. The safe use of NexGard in pregnant, breeding, or lactating dogs has not been evaluated. Use with caution in dogs with a history of seizures or neurologic disorders. For more information, see the full prescribing information or visit www.NexGardClinic.com

Updates Regarding Feline Leukemia Virus and Shelter Medicine

By Peggy Callow, DVM, MVMA Animal Welfare Chair H istorically, cats that tested positive for feline leukemia virus (FeLV) were euthanized upon diagnosis, especially if they ended up in an animal shelter. Now progressive animal shelters are exploring the health, longevity, and adoptability of these cats. The animal shelter Austin Pets Alive! has been the most active, with revolutionary programs that started in 2011 in conjunction with the University of Florida and Dr. Julie Levy. New 2020 retrovirus guidelines have been published by The American Association of Feline Practitioners (AAFP). Based on molecular methods, the possible outcomes of infection following FeLV exposure have been redefined. Outcomes of FeLV infection are now classified as abortive infection (comparable to the former ‘regressor cats’), regressive infection (comparable the former ‘latent infection’, with or without previous ‘transient viremia’) and progressive infection (comparable to the former ‘persistent viremia’). New research suggests that abortive infections could be more common in naturally infected cats. Cats with progressive infections have a poor immune response to the FeLV virus and typically die from FeLVassociated diseases within several years of infection. Cats with regressive infection have a robust immune response that contains the virus, but is unable to fully eliminate it. These are the cats that may test positive at one time and negative at another time on an ELISA. Since the virus is contained but not eliminated, viral shedding usually does not occur after the first antigenemic phase is over. The virus is integrated into the cat’s genome and they could test PCR positive. Reactivation of the virus may occur in regressively infected cats. These cats are at a lower risk of

developing FeLV-associated disease. Abortive infection happens when the FeLV is cleared by the cat’s immune system. These cats do not test positive on ELISA or PCR., but FELV antibodies will be present. Diagnosis of a positive retroviral infection in a cat should not be the sole reason for euthanasia. The public community is voicing a strong opinion that all healthy or manageable animals should be adopted from animal shelters. Many animal shelters and rescues are now knowingly adopting out retroviral positive cats and educating adopters on the disease. We’ve learned that most feline immunodeficiency virus (FIV) positive cats can live a normal lifespan with proper care and management. We are now starting to see that most FeLV positive cats can live long, healthy, happy, lives. The challenge is determining how a cat’s immune system may respond to FeLV infection and how that response influences their lifespan. A single point of care test for FeLV antigen cannot determine which type of infection a cat has (abortive, progressive, or regressive) and how their immune system will respond. The Association of Shelter Veterinarians (ASV) and the American Association of Feline Practitioners (AAFP) recommend that cats should be tested for retrovirus when they are first acquired and during any severe illness. In house ELISA antigen testing on whole blood, serum, or plasma is very reliable. FeLV antigen tests should not be performed on saliva or tears, as sensitivity is low. Most cats will test positive within 30 days of exposure, but not all. Since a positive test will result in life long changes, additional testing is recommended especially for asymptomatic cats. It should be stated that most animal shelters cannot afford multiple screening tests on cats. (continued on page 26)

How is COVID-19 Affecting the Market?

We are getting many calls with questions about COVID-19 and the impact it has on practice value, sales, and acquisitions. So, I thought I would take a few moments to share some thoughts.

Practice Value:

Currently, we are valuing most hospitals as of 12/31/19. Of course, these valuations are not affected by the COVID-19 situation, which presented itself in 2020. What will happen to practice values during 2020? It is simply too early to tell. If the effect on practice profit is short lived (a few months) it will likely be thrown out as an anomaly. If the effect becomes long-term, the value will change in accordance with the rise or decline of the hospital profit and the future risk of the cash flow stream.

For Buyers: We continue to assist independent buyers in purchasing hospitals. I have some acquisitions that were in process prior to COVID-19 and are moving forward without issue. In other instances, we are running into situations where buyers arenʼt sure what they should pay for a hospital under the current circumstances. There is just too much unknown risk at this point, which is a valid concern.

Financing: Many of the lenders are on pause for two reasons.

• Their teams are completely consumed with processing PPP applications and they simply donʼt have the resources to address new hospital acquisitions. • The risk of revenue and profit generated from hospitals is an unknown. They are challenged internally with what risks they are willing and able to tolerate and what they can lend on.

Sellers: In my experience, the corporate purchasers are still making strong offers and want to buy hospitals. It is business as usual for them. I also have seen a surge in inquiries from independent buyers. So, if you want to sell, give us a call!

What is the future risk? Well, that is the magic question! We need more time to answer this accurately.

If you have additional questions or concerns about how COVID-19 might be affecting the value of your practice or a potential sale or acquisition, give us a call! Weʼd be happy to talk with you!

Current Listings in Missouri:

1. Central MO, 1 DVM, SA Px 2. Springfield area, 1 DVM, SA, Px 3. South of St. Louis, 2 DVM, SA Px PENDING **Visit our website for additional details on our listings**

Nikki Nitz, CPA, CMA Simmons Midwest * 877-322-6465 Simmons@SimmonsMidwest.com www.SimmonsInc.com

What does this mean in shelter medicine? Increased information on retroviruses and testing, has led the shelter medicine community to consider if routine testing for all cats entering an animal shelter should either be discontinued or shifted to a targeted testing approach.

Why are shelters considering this option? • We know that testing a large healthy population for any disease will lead to an increase in false positives. A false positive test for a cat will have drastic results in its length of stay or potentially fatal consequences. • Test results can be difficult to interpret. Negative results should be retested in 30 (FELV) to 60 days (FIV). Ideally all cats should be retested for retroviral diseases 60 days after exposure or the last test. Most cats entering an animal have no known history. FELV is a difficult disease and some positive cats will test negative at a later time, leading to discordant results. • All tests are not created equal, and no test is perfect. The Idexx SNAP has shown to have the highest level of sensitivity and specificity, but not all shelters can afford these tests. • Cost of the tests, supplies used, and staff time can be extensive. Not every shelter has staff experienced in drawing blood and test interpretation. If testing is halted or used in target populations, this would mean an increase in savings. Those savings could result in increased lives saved and spay/neuter operations. • Consequences of a false negative or false positive. A negative could give adopters a false sense of security. Shelters typically do not have staff with medical training available for every adoption to explain every test and result, though adopters should be sent home with all relevant paperwork. We know that adopters don’t always read all the information sent home with their new pet.

What does this mean to the general practitioner? Animal shelters want to have a healthy working relationship with all veterinary clinics in their community, we all care deeply about animals and the human animal bond. Shelters will be looking for feline friendly veterinarians that are open to taking care of healthy positive cats after adoption. Private sector veterinarians should become more familiar with how to care for retroviral positive cats. Many of these cats can live long, healthy, happy, lives with proper care. Positive cats may experience higher rates of dental disease, or respiratory infections. These diseases should be treated just as we would with any negative cat. Positive cats will require more aggressive start to treatment early in the course of disease, as opposed to a “watch and wait” approach. We don’t want to euthanize any positive cat that is currently healthy. Most of these cats will be healthy and treatable until end stages of the disease, and it will be readily apparent when it’s time to euthanize. It should be noted that FELV positive adult cats tend to have a longer life span than young kittens. Does stopping or switching to targeted testing place undue pressure on local veterinarians and adopters? This is a question that can only be answered by an individual animal shelter and community, as every shelter might different resources available or goals. A private practice veterinarian is better suited to explain what test results mean and retesting recommendations, but no one wants to learn of unexpected health concerns in a newly adopted family pet. Shelters do accept returns and issue refunds or exchanges, but that may not alleviate negative feelings. Adopters need to be informed if their new cat was not tested for retroviruses and that testing is recommended with their family veterinarian. At this time the Association of Shelter Veterinarians recommends retroviral testing for all cats being placed up for adoption, housed long term, or sent to foster. If your local animal shelter or rescue has been testing all cats and then suddenly stopped, please don’t assume it is an uneducated decision. We must keep the lines of communication open and know there are valid reasons that testing every cat in a shelter may not be in the best interest of the cats or the resources for that shelter. If you have questions or concerns don’t hesitate to contact the shelters veterinarian, executive director, or board of directors. Shelters are encouraged to discuss any testing changes with their local veterinary community. Virology is extremely fascinating and I expect we will continue to learn new and exciting things regarding retroviruses. Sources: 2020 AAFP Feline Retrovirus Guidelines American Pets Alive! Monica Frenden and Natascha Hamman, webinar Don’t Fear FELV: Feline Leukemia as the next frontier of feline lifesaving UCDavis Koret Shelter Medicine Program: Why are some shelters no longer testing all cats for FeLV and FIV? Author: Dr. Erica Schumacher Seroprevalences of feline leukemia virus and feline immunodeficiency virus infection in cats in the United States and Canada and risk factors for seropositivity. Burling AN, Levy JK, Scott HM, Crandall MM, Tucker SJ, Wood EG, Foster JD. University of Florida, Maddie’s Shelter Medicine Program