2014 May-Jun WA Veterinarian Magazine by Washington State Veterinary Medical Association

May/June 2014 Volume 8 • Issue 3

A Veterinary Guide to Marijuana FEAR FREE™ VET VISITS PART II 8 LEGISLATIVE UPDATE: WHATʼS AT STAKE IN THE 2014 ELECTIONS 12 BOARD APPROVES FUTURE PLAN FOR OUR ASSOCIATION 20

PUBLISHED BY WSVMA: BECAUSE BEING A VETERINARIAN IS MORE THAN JUST A PROFESSION. WSVMA.ORG

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ON POINT Preventive plans in Washington veterinary practices.

PRESIDENT’S MESSAGE Navigating change.

NEWSWIRE The latest veterinary news in Washington State.

FEAR FREE™ VET VISITS PART II How to take the ‘pet’ out of ‘petrified’.

LEGISLATIVE REPORT What’s at stake in 2014.

Cover Story

A VETERINARY GUIDE TO MARIJUANA

Marijuana as a medicine and toxicities due to exposure.

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THE FUTURE OF OUR ASSOCIATION The Executive Board approves an exciting new plan.

RELIEF VETS In-state directory of available relief veterinarians.

CLASSIFIEDS Careers & practice listings.

May/June 2014 • Volume 8 • Issue 3

In June, the WSVMA will send out a brief survey asking for your views on the use of preventive plans in veterinary practice. We’ll be asking if you offer them and if you don’t, to please indicate why. For those of you who offer your clients preventive plans, we want to know how they are or aren’t working for you. We’re also going to ask that you help us survey your clients on their views about preventive plans. We want to know what they think about them and whether they’re interested in purchasing such a plan. By gaining an understanding of what pet owners think about preventive plans, it will help you in determining the importance of implementing them in your practice. As I’m sure you know, preventive plans are bundled services which may include office calls, vaccines, dentals, diagnostic screenings or other services determined appropriate by the practice. Clients enroll for a 12-month period and make low monthly payments, renewing each year. Plans can be tailored for puppies and kittens, or adults/senior dogs and cats. There are numerous benefits to offering monthly preventive plans and they include: •• Creating economic stability for practices with payments coming in year-round •• Bonding clients to your practice •• Helping control costs for pet owners •• Giving clients a better ability to pay •• Increasing client compliance •• Helping pets get better, more dependable care

A Washington State Veterinary Medical Association Publication

Editorial & Publications Committee Dr. Richard DeBowes Dr. John Cannon Dr. Angela Lehman Dr. Jim McCutchan Dr. Donna Mensching Lexi Scott Dr. Debora Wallingford Dr. Saundra Willis

Editorial Comments & Contributions Please send all comments and/or contributions to:

Washington Veterinarian Magazine 8024 Bracken Place SE Snoqualmie, WA 98065 Tel (425) 396-3191 Toll Free (800) 399-7862 Fax (425) 396-3192 info@wsvma.org Editorial comments and contributions must be received no later than the first day of the month prior to publication. Publication months are January, March, May, July, September, and November each year.

Advertising

Please refer to the Classifieds Section for classified advertising details, rates, and deadlines. For commercial advertising rates and deadlines, please contact the WSVMA office at (425) 396-3191 or info@wsvma.org

•• Providing for early disease detection

Layout & Design

The Partners for Healthy Pets initiative is encouraging practices to use preventive plans as another tool to help increase visits to the veterinarian, assist pet owners financially and to help veterinary practices with a dependable stream of revenue. Any tool that has been shown to improve pet health and increase revenue to the practice should be seriously considered by every practice owner.

WSVMA Executive Board

Chris O’Toole chris@breightly.com breightly.com

Executive Vice President Candace Joy

Officers:

The survey will go out to you the first week of June. Please help us by completing the survey and printing out copies of the client survey to put in your reception area. We need at least 1,500 – 2,000 pet owners to complete it. There will be financial incentives to pet owners who complete the survey, courtesy of CareCap. Their names will go into a drawing to receive a certain dollar amount in veterinary care from their own veterinarian.

First Vice President

We’ll report the findings in the fall.

Past President

The WSVMA is launching a new website in late spring. So you don’t miss any of the premier resources available on wsvma.org, watch your inboxes for the announcement and log-in instructions.

Sincerely,

President

Jocelyn Woodd, DVM

President-Elect Erin Hicks, DVM

Lisa Parshley, DVM

James McCutchan, DVM

Michael Anderson, DVM Paul DeMaris, DVM

Snohomish

Region I Region II Region III

Katherine Hickey, DVM

Region IV

Maurine Fritch, DVM

Region V

Stephen Ruark, DVM

RegionVI Region VII Region VIII

Diana Thomé, DVM

Region IX

Diane Pinkers, DVM

Companion Animal Practice

Chantal Rothschild, DVM Robert Holt, DVM

Equine Practice Production Animal Practice

Tamara Walker, DVM

Specialty Practice

William Dernell, DVM

College of Veterinary Medicine

Nashua Compton

Student Representative

AVMA Thomas Meyer, DVM Kim Nicholas, DVM Saundra Willis, DVM

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Olympia

David Gill, DVM

Michael Burdette, DVM

Lakewood

Executive Board:

Brian Toncray, DVM

Candace Joy is the Executive Vice President of the Washington State Veterinary Medical Association. She can be reached at candacejoy@wsvma.org

Spokane

Exec. Board, Dist. XI Rep. Delegate Alternate Delegate

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Navigating ChangeAVMA Leadership Conference

Presidentâ&#x20AC;&#x2122;s Message By Jocelyn Woodd, DVM, WSVMA President

As I look out my kitchen window, I am reminded that change is an unavoidable necessity of life. Patches of bright green grass have replaced the brown, rough lawn that was once hidden beneath piles of heavy snow. Days that were once spent drinking hot chocolate by the warm, comforting fireplace will now be spent taming the relentless bushes and weeds protruding from the gardens that were neat and tidy only a year ago. I welcome spring, as it holds the promise of warm weather and countless glasses of iced cold lemonade. Change is a beautiful aspect of life; it adds excitement and enjoyment to life. Change can also be terrifying; it can bring uncertainty and discomfort. But it is only through change that better things can occur. We must let go of our ties to the past in order to make way for the new. As winter slowly transforms into spring, the WSVMA will also be undergoing its own change in atmosphere. Previously composed of 19 voting members, the Executive Board will be altered to a six-member Board of Directors. Formerly, local associations sent their representatives to the Executive Board. In the future, the general membership will elect the six participants to the Board of Directors. Why have we decided to introduce these changes to the WSVMA? It has come to our attention in recent years that associations are not thriving as they have in the past. This is largely because the Baby Boomer generation that once heavily participated in various associations has been replaced by members of Generation X and Millennials. Many associations have been unable to keep up with the technological advancements that have come to characterize todayâ&#x20AC;&#x2122;s society. As new generations integrate into many associations, it is important that we meet the growing need to combine technology with the brilliance of the human mind. Moving to a Board of Directors rather than an Executive Board will enable these six members to communicate more efficiently. They can employ the methods of video chat, conference calls, and many other technologies in order to create more nimble leadership. The new and improved Board of Directors will mainly focus on five to six strategic long-term goals. These goals will give the WSVMA a redefined method of concentrating time and energy on the most important aspects of veterinary medicine.

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This is an interesting and exciting time for the WSVMA. Often, we confront change with outright disapproval, and forget the amazing benefits that change can bring us. I have had many of my own experiences with change, and I vividly remember the feelings of fear and hesitance as I moved into the unknown. Transitioning from small-animal emergency medicine to ownership of a mixed-animal practice was perhaps one of the biggest career-related changes I have ever had to undergo. It was intimidating and even challenging at times, but looking back I am so happy to have made the change. Similarly, I truly believe that these changes to the WSVMA will greatly improve our overall success, and allow us to better serve the needs of the veterinary community. Just as spring will eventually lead to the hot summer season we have all been waiting for, these changes to the WSVMA will ultimately lead to a more functional and effective organization. The future holds unlimited possibilities for the WSVMA, and we are so excited to begin uncovering this potential through the revamped organizational dynamics of the association.

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that it’s still quite early in the rulemaking process and these changes are not expected to take place until later this year.

White Coat donations for Class of 2018 This year’s White Coat ceremony will take place Thursday, August 21, 2014 at Washington State University’s College of Veterinary Medicine. Each first year veterinary student will be introduced and presented with a white lab coat with their name and the WSVMA logo embroidered on the coat. We need your help to outfit each Washington student. You can sponsor a specific student or make a general donation. If you would like to sponsor a student from your town, call the WSVMA office. There is a form enclosed in this issue for your convenience.

2014-15 WSVMA Member Services Directory available

Veterinary Newswire The Latest Veterinary News in Washington State

New rule addresses reactivation of expired veterinary licenses Up until now, an inactive veterinarian whose license expired beyond three years only needed to pay a fee and attest to completion of continuing education in order to reactivate their license. Concerned about patient safety due to a potential lack of current skills and knowledge, the Veterinary Board of Governors passed a new rule, WAC 246-933-275, to address veterinarians who have not been actively practicing for an extended period of time. Veterinarians who have not been in active practice for more than three years must now successfully complete the North American Veterinary Licensing Examination and meet standard continuing education requirements. If a veterinarian has been in active practice in another state, but their license has been expired in WA for over three years, they must submit verification of unrestricted licensure in another state. They also need to submit documentation of two hundred hours of active practice within each of the previous three years within that state or jurisdiction. Active practice in a foreign country is acceptable if from an AVMA-accredited college of veterinary medicine.

Jonathan Stumpf joins WSVMA staff Jonathan Stumpf joined the WSVMA team on March 9 as WSVMA’s newest Program Manager. He’s taking over the position from Chris O’Toole who has moved into providing our marketing needs.

Jonathan comes to WSVMA as the previous Marketing and Communications Director for the North American Hazardous Materials Management Association (NAHMMA). He brings five years of experience in communications and marketing roles with a variety of environmental nonprofits in Seattle. He moved to Seattle in 2008 after completing a Master’s in journalism from the University of Montana. Previous to living in Missoula, MT, he spent the better part of two decades growing up in and around Boulder, CO. He lives in West Seattle with his wife, Suzy, two-and-a-half year old daughter, Eliza, and yellow lab, Maggie. Jonathan’s an avid fisherman and is currently the board chair of the Wild Steelhead Coalition. Jonathan’s main responsibilities include managing WSVMA’s publications and website, social media, member outreach, and overseeing the annual conference and CE events. “I’m thrilled to be part of such a tight-knit staff and well-established association, and I look forward to getting to know the members more,” says Jonathan. “It is an exciting time to join this team and respected community.”

Clarification In the March/April issue of WA Veterinarian, it was reported in Board Briefs that WA Administrative Code is being changed to relax the requirement to TB test every dairy animal over six months of age regardless of state of origin and if coming from a TB-free state, the age requirement would increase to 20 months. WA State Department of Agriculture reports

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The 2014-15 WSVMA Member Services Directory is now available for members to download from the WSVMA website. Choose to print out the entire contents or download and print just the sections you want. Visit wsvma.org and view and download under Members/Member Directory. Member login is required. There are a limited number of printed copies available. Please contact the WSVMA office if interested in purchasing a copy.

In memoriam Dr. Williard B. (Skip) Nelson (IL, ’64) died on February 18, 2014 at the age of 74. Born February 20, 1939 in Chicago, he lived a vibrant and adventurous life as a sailor, musician, veterinarian and colonel in the Army reserve, in which he served for 34 years. His sense of humor and gregarious nature were catalyst to so many of the relationships and adventures he had. Dr. Nelson most recently provided in-home euthanasia services for the Greater Seattle area. Donations in his honor can be made to the Woodland Park Zoo Elephant or Tiger programs. Dr. Gary Schmid (WSU, ‘66) died on February 22, 2014 at Virginia Mason Hospital from advanced pancreatic cancer at age 71. Shortly after graduating WSU, he partnered with Dr Don Mee at the Valley Veterinary Hospital, which came under his ownership for much of the 37 years he practiced veterinary medicine. He was involved in several groups including the WSVMA. Donations can be made in Dr. Schmid’s memory and his love for animals to the College of Veterinary Medicine, PO Box 647010, Pullman, WA 99164.

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Nikki Nitz, CPA, CMA l Simmons Northwest 208.664.3100 l www.simmonsinc.com l northwest@simmonsinc.com

Fear Free™ Veterinary Visits How to take the ‘pet’ out of ‘petrified’ By Marty Becker, DVM

o one should dread a trip to the vet -- not the pet, and not the pet owner. I’ve been working with a team of experts for five years to create Fear Free™ visits for pets and I’m excited to tell you that “taking the ‘pet’ out of ‘petrified™’” is the single most transformative practice initiative I’ve witnessed in 35 years of practice. Practices that have the pet’s emotional wellbeing in one hand and physical well-being in the other are not just striving, but thriving, with practice growth in double digits for four years in a row.

hospital to calm their stomachs (Cerenia) and their minds (Anxitane, Zylkene, alprazolam).

Now let’s imagine life in the Fear Free™ practice. Let’s start at home, and what you’re doing to educate your clients to do before they even make the appointment.

After their wait, pet and owner come into the practice through a separate door, away from other pets. The clinic or hospital is familiar to the pet, because he’s been there many times before to get treats, touch, or both. His memories and associations are all as good as they can be. In fact, in a Fear Free™ practice, even the cats don’t mind a visit, and most dogs actively want to come in and aren’t wild about leaving.

Pet owners will understand their role in bringing a pet to the practice has fundamentally changed. They will be taught how to bring the pet from the living room to the exam room in a calm state. Food is withheld from the pet after 6 p.m. the night before (unless they have a late afternoon appointment the next day, and then they are fed a small meal) so that they come in hungry and respond to food rewards. The owner of a cat or small dog will have invested in a carrier that’s optimal for bringing their pet in and can be taken apart in seconds. It’ll be loaded with towels spritzed in pheromones, covered to reduce stimuli, and put on a flat surface for transport. The owner is taught not to baby-talk their pets in route, and in fact, may borrow from the vet hospital calming music to play in their vehicle. They routinely give their pets prescriptions from the veterinary

Riding a magic carpet of pheromones to a soundtrack of silence or soothing tunes, pets arrive at the clinic hungry. Whereas today, clients bring their pets with them to check-in and wait, in the Fear Free™ practice, the pet may wait in the car until the owner checks in, and then they’ll wait there together until it’s time to go straight to the exam room.

The exam room is full of pheromones. There’s a hot towel impregnated with pheromones on the table, a yoga mat on the floor (I do over half of my exams off the table), and species-specific calming music from a small player fills the air (Through a Dog’s Ear or Through a Cat’s Ear). The veterinarian comes in calm and focused, and doesn’t seem to be in a rush. She’s not in a hurry to start her scientific side. She knows how to handle animals with confidence and skill, knows low-stress handling techniques (Dr. Sophia Yin’s work), and she spots anxiety before it happens so she can head it off. She’s also got treats in her pockets and she knows how to use them. Continued on page 10...

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Continued from page 8... The Fear Free™ veterinarian has a whole tool belt of techniques so the pet doesn’t even realize a shot has happened. In fact, the pet may not have even made it to the exam table. This wonderful, gentle vet examined him in the owner’s lap or on the floor or, in the case of a cat who fancies herself a birder, on a shelf designed just for this purpose.

not bringing them in for care.

The exam room doesn’t smell like disinfectant; it smells like the animal equivalent of a college party with the bong going. The pet just breathes it in, breathes it in, breathes the secret Feliway.

• 38 percent of cat owners said just thinking about a visit to the vet is stressful.

And when it’s over, the owner and the pet walk out of your clinic or hospital feeling more like they’ve had a trip to Baskin-Robbins than to the dreaded veterinarian. Imagine the difference between this visit and that Jaws feeling: the sound that pricks everybody’s ears up and makes them go in the other direction, to run from the water. Embracing Fear Free™ practice is essential, because we must get more pets to get veterinary care on a regular basis. To accomplish this, it’s essential to overcome pets’ and owners’ fear of coming into our practices.

Let these numbers settle in for a second because they’re so important: • 26 percent of dog owners said just thinking about a visit to the vet is stressful.

• 37 percent of dog owners said their beloved dogs hate going to the vet. • A whopping 58 percent of cat owners said their cats hate going to the vet. It’s interesting to note that none of the top ten things the Bayer study said veterinarians could do about the decline in visits by either cats or dogs involved lessening the stress of going to the veterinarian, which is one reason I think we’ve really got to sound the shark alarm about stress-free and fear-free practices now.

Fear changes brains. If your clinic or hospital is a place of stress, of fear, of trauma, of rough treatment, loud noise, cold tables and long needles, you may actually be opening the mental pathways to bad behavior. You may unwittingly be part of the problem.

If we don’t galvanize our profession around something as important and vital as a Fear Free™ veterinary visit, then what should capture our attention, education, enthusiasm and actions? If it’s not the veterinary profession that looks out for the physical and emotional well-being of pets and pet owners, who should, can or will?

And keep in mind euthanasia isn’t the only danger. The Bayer Veterinary Care Usage Study, as I’m sure you know, has been our own version of Jaws since 2009. It builds on survey research showing a consistent downward trend between 2000 and 2009 in visits to our practices.

To top it off, having every pet’s physical well-being in one hand and their emotional well-being in the other guarantees financial success and emotional wealth. You’ll do well by doing good. And isn’t that the most worthy of goals?

While dogs paid more visits to our practices than cats, despite being a smaller portion of the population, both dogs and cats came to see us significantly less often each year. And owners of both dogs and cats reported stress – their stress and their pets’ stress – as a key factor in

— Dr. Marty Becker is “America’s Veterinarian.” He can be reached at vetstreet.com and at facebook.com/drmartybecker.

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Legislative Report By Greg Hanon, WSVMA Legislative Advocate

he 2014 Washington State Legislature adjourned its 60day session without need of a special session for only the first time since 2008. After weeks of budget negotiations and final hour bill trading, the chambers voted on a supplemental operating budget and several policy bills and then adjourned. There is no plan at this time for a special session before the next regularly scheduled session begins on January 12, 2015. The WSVMA had another successful legislation session this year. No bad legislation was passed. For the first time in several years, we did not have a proactive proposal this year, but did assist with the request for planning money for the new animal disease diagnostic lab at WSU in Pullman. However when the Capitol budget failed to pass this year, no money was made available. Other proposals that surfaced did not pass out of the legislature.

Bi-Partisan Budget Passed The supplemental operating budget, ESSB 6002, passed on a 48-1 vote in the Senate and an 85-13 vote in the House. The budget increases spending by an additional $155 million (out of a $33B biennial budget), with $89 million addressing caseload changes and other adjustments, and appropriates an additional $58 million toward K-12 education spending. The final budget does not include cost-of-living increases for teachers and does not close any tax preferences, both policies that were initially proposed by the House. New tax preferences sought by the Senate, particularly extending R&D tax preferences and data center tax preferences, were also not included. Remarkably, this will make one of only eight states in the nation without incentives for the technology sector.

to run for the Senate seat being vacated by Senator HolmquistNewbry. Other announcements are expected. The battle for control of the State Senate will be of great interest and speculation. The Majority Caucus Coalition (MCC) controls the Senate 26-23 (with the support of two Democrats). Mark Milocia, a former House Democrat, running as a Republican announced to run in Senator Eideâ&#x20AC;&#x2122;s swing district even before she announced her retirement plans. Senate MCC leader Rodney Tom (D-Medina) made the surprise announcement recently that he is not going to run for re-election. Several other races are sure to be competitive.

Looking ahead to the 2015 session The Washington Supreme Court (McCleary Decision) has determined that the legislature has not fully funded K-12 education and that substantial additional revenue needs to be dedicated to educating our children. While the 2013 legislature did make a significant additional investment in education, most observers feel that an additional $4 billion is needed to meet the Supreme Court decision over the next four years. The Governor and House and Senate Democrats have advanced many proposals to increase business taxes the past two years. Expect one of the major issues in 2015 to be responding to proposals to increase taxes on business. At a minimum, increasing the B&O rates, in particular the services rate of the tax or imposing a sales tax on services is sure to be proposed. You may recall the B&O tax rate on veterinary services as increased from 1.5% to 1.8% for three years, before it was returned to the current 1.5% rate. An effort to repeal tax preferences and preferential rates is also sure to be part of the debate.

Of particular importance is that ending reserves will be $897 million for the 2013-2015 biennium.

Much at stake in 2014 elections With the adjournment of the legislative session, the campaign season has officially started. All 98 members of the House of Representatives and half of the Senate are up for re-election in 2014. Candidates can file for office starting April 28 through May 16. Several lawmakers have announced their retirement including Senators Eide and Kline and Representatives Hope and Roberts. Senator Holmquist-Newbry is vacating her seat to run for congress in the fourth congressional district to replace retiring Congressman Doc Hastings. Representative Warnick has announced her intention

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A Veterinary Guide to Marijuana Lisa Parshley, DVM, PhD, DACVIM // Donna Mensching, DVM, MS, DABVT, DABT

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s state after state has passed medical marijuana laws a public dialogue about marijuana has been building in the last 10 years. In the last two years alone our state and Colorado have further amplified this deliberation by legalizing recreational marijuana. Essentially we, the public, are now being forced to evaluate the moral and legal issues surrounding marijuana use. This very public conversation is certain to impact veterinary medicine both negatively and positively. Some of the impact will come from what our clients are hearing and reading and from the increased recreational use of marijuana by humans. The rest of the pressure will come from the new and continuing biomedical research and drug design that has spun off the Cannabis plant. My first recommendation is to understand that public opinion about marijuana is changing, what was not acceptable 10 years ago is today becoming less evil. Next we need to understand that there is a plethora of marijuana information and misinformation available to anyone with a web connection, a radio, and television. We as veterinarians will need to arm ourselves with reasonable, informed, and thoughtful answers to questions like “can I use marijuana to help my cat eat” or “will marijuana work against my dog’s pain.” In this two-part article we hope to provide some of the data needed to give accurate and up to date answers. In this first part I will focus on marijuana as a medicine; what we do know and don’t know. The second part will deal with toxicities due to marijuana exposure written by, Donna Mensching, DVM, MS, DABVT, DABT, a veterinary toxicologist.

Marijuana as medicine Marijuana or cannabis is derived from a plant called Cannabis. Different subspecies or strains are found throughout the world. Each subspecies has differing properties and effects on the body when inhaled or ingested. Some strains have almost no obvious psychogenic effects whereas others have been almost exclusively used in the illicit or therapeutic drug trade. The non-psychogenic strains have been used for centuries to produce fiber (hemp) for clothes and rope. Some of the strains best known for their psychogenic effects have also been those used for centuries to treat a variety maladies from nausea to pain to inflammation. As far back as 2700 BCE use of marijuana or cannabis has been consider medicinal. First recorded reference to marijuana as a medical therapy was in an ancient Chinese medical book written by Emperor Shen-Nung, a trained pharmacist. In this Chinese medical book cannabis is mentioned as a good therapy for constipation, gout, rheumatism, and absent-mindedness. In later writings from Egypt, in the Eber Papyrus (1500 BCE) medical treaties, cannabis is listed as a remedy for pain from hemorrhoids. During this same time period in India cannabis was often used for gastrointestinal upset, pain of childbirth, for general pain, insomnia, and headaches. Writings from ancient Greece highlight yet another use of cannabis; its seeds were used to expel tapeworms. More recently in medieval times Arabic physicians used cannabis for diuresis, vomiting, pain, inflammation, and seizures. Cannabis as a medical therapy first came to the western world in 1841 when Dr. O’Shaughnessy (the father of IV fluids)

introduced it as an effective therapeutic agent against the symptoms of tetanus and pain. Modern day medicinal use of cannabis has been described for, among other things, chemotherapy and cancer induced nausea and vomiting and for chronic pain. Marijuana or cannabis therapy is certainly not new, what is new is all the rational drug design research that is spinning off this very ancient therapy. Over the last decade the search for how and why the cannabis plant works in the body, both good and bad, has led to the discovery of the endogenous cannabinoid system. This is a system that is proposed to be found in all mammals and is consider a part of normal physiology. It is a group of neuromodulatory lipids derived from the arachidonate molecule. These compounds are part of the family of eicosanoids. As you will remember this is a family of molecules produced from Omega-3 and -6 fatty acids and have such family members as prostaglandin, thromboxanes, and leukotrienes. To date at least two endocannabinoid compounds have been described; anandamide (N-arachidonoylethanolamide (AEA) and 2-arachidonoylglycerol (2-AG). The enzymes that produce and degrade the endocannabinoids are fatty acid amide hydrolase or monoacylglycerol lipase. At least two receptors for endocannabinoids, CB1 and CB2, have been discovered. Remember that receptors are proteins located on the surface of cells. By binding their target molecule these proteins can cause cells to react to these compounds. Endocannabinoids receptors have been found in the nervous system (mainly CB1), on immune cells (mainly CB2 and mainly on macrophages, neutrophils, B lymphocytes, and potentially other bone marrow derived cells), and in the female and male reproductive tracts. Therefore, it is expected that these compounds will primarily involve modulating the immune and nervous systems and possibly reproduction. Physiologically endocannabinoids have been found to be involved in a variety of processes including effects on the autonomic nervous system, memory, stress response, immune system responses, appetite, reproduction, pain, mood, thermoregulation, and metabolism. Of the over 460 compounds found in the various strains of cannabis used traditionally for medical therapy, about 80 of these are classified as phytocannabinoids. These are the plant version of the endocannabinoids found in mammalians. Phytocannabinoids are the compounds which many feel are the source of both the psychogenic and medicinal effects of cannabis. They are thought to be working by binding to the endocannabinoid receptors found throughout the body. If this is true it could explain all the previously reported medical and psychogenic effects and may point to as of yet undiscovered uses or spur new drug design. The most psychoactive and one of the medically relevant phytocannabinoid found in cannabis is tetrahydrocannabinol (commonly known as THC). Other potentially important phytocannabinoids include Δ8-tetrahydrocannabinol, cannabidiol (CBD), cannabinol (CBN), cannabicyclol (CBL), cannabichromene (CBC) and cannabigerol (CBG). All of these have less psychogenic effects than THC, but may play as large a role in the overall physiologic impact of cannabis. The most studied phytocannabinoids are THC, CBD, and CBN. It is these three compounds that have been used to produce the currently approved cannabis derived therapeutic products Marinol (Dronabinol), Cesamet (Nabilone), and European Sativex (Nabiximols).

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Recent work done by Dr. Palazzo1 and colleagues has demonstrated that the NMDA receptor (a glutamate receptor implicated in chronic pain) and the glutamate receptors (mGluRs) work in concert with CB1 to induce analgesia in mice. The detailed mechanism underlying this effect remains unclear but is being currently studied. This data may suggest a possible mechanism on how cannabis compounds and cannabis could work against chronic pain. It is work like this and from many others that will fully open our understanding of and ultimate use of cannabis based therapies in medicine.

and product. For the three currently approved drugs we only have pharmacologic data for the human species. As veterinarians, we especially need to remember these deficiencies in knowledge. Our clients are and will be pushing us to prescribe these therapies from anecdotal information and based solely on human studies. We need to keep in mind that not one paper has been published that describes appropriate dose ranges for the regulatory approved products much less whole or partial plant products. Only through phase I studies will we be given the data necessary for repeatedly prescribing effective and safe doses. Only through phase II and III studies will we know just how effective the therapies are in domesticated animals and for what diseases or symptoms it appears efficacious. Presently when we prescribe even Marinol we are blindly using another species (human) recommended dose range.

“Over the next several

As of 2012 over twenty cannabis derived phytocannabinoids were the focus of biomedical research and therapy development. These studies include evaluation of the various native cannabis and synthetic cannabis compounds as antiinflammatory agents, appetite stimulants, muscle spasms therapy in multiple sclerosis, and possibly as an anticancer therapy. From these studies the three approved therapies were developed. These drugs are approved for use in intractable nausea and vomiting and in chronic pain. It is expected that other therapeutics will be discovered as research progresses on these compounds, the other compounds found in cannabis, and on the endogenous system implicated.

years, if regulation of the

recreational trade requires

disclosure of THC content of goods sold, our knowledge of dose-related effects is

This leaves us open to prescribing therapies for the wrong diseases, wrong symptoms, and potentially using wrong doses. Using another species dosing range could put us too close to the toxic dose or equally as bad we may not be giving enough to achieve a therapeutic benefit.

likely going to skyrocket.”

As encouraging as these new physiologic and therapeutic discoveries appear we still have many obstacles to overcome prior to routine prescribing of safe, effective, and predictable cannabis derived therapies. For example we have not fully mapped out mechanisms of actions, pharmacokinetics, and pharmacodynamics for most of these compounds. Without this information all the possible effective yet safe therapies remain a dream; a potentially obtainable dream but a dream none the less. Until we are able to fill in the holes in our knowledge we will be limited to the regulatory approved products and use of whole plant or partial plant therapies. Whole or partial plant therapies while at times efficacious will forever be limited by a repeatable inaccuracy in dosing reducing reliable efficacy, varied and at times unpredictable side effects, and unregulated sourcing for the plants

Marijuana Toxicoses The times they are a-changin’ and so are our toxicoses. Although marijuana remains a schedule I controlled substance under federal law, many states have relaxed their laws by decriminilazing cannabis possession and/or legalizing it for medical and/or recreational use. Washington State is leading the way after having passed Initiative 502 in November 2012 which allows people over 21 to legally possess and use of any combination of the following:

1 oz.

of useable plant material

16 oz.

of marijuana in solid form (ex. foodstuff)

72 oz.

in liquid form

Pre-legalization, signs of marijuana toxicity in dogs were typically predictable with an onset from 30-90 minutes post ingestion or within minutes of inhaling smoke and resolving within 24 hours with supportive care alone. Classic signs include depression (>60%), ataxia/incoordination (~59%), vomiting (24%), tremor (18%), mydriasis (11%), hypothermia (9%), weakness (8.5%), bradycardia (8%), disorientation (6.5%), behavioral disorders (6%), hyperesthesia (6%), vocalizing/crying (5%), anorexia (5%), urinary incontinence

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In the future and maybe near future cannabis will provide us with safe and effective therapies for animals. Until we have done the foot work and studies necessary to evaluate their effects in animals I would recommend caution and full disclosure to your clients. Remember, we should know to the best of our ability the safety and therapeutic profile of all therapies we prescribe to our patients. 1. Palazzo et al. Metabotropic and NMDA glutamate receptors participate in the cannabinoid-induced antinociception. Neuropharmacology. 2001 Mar;40(3):319-26.

— Dr. Lisa Parshley is the owner of Olympia Veterinary Cancer Center in Olympia, WA. She can be reached at lisa.parshley@ovccpets. com.

(5%), and tachycardia (4%) (Janczyk et al, 2004). Serious complications could arise from trauma due to poor coordination or aspiration pneumonia potentially if vomiting occurred while sedate, but death was not expected unless these secondary complications occurred. In recent years since legalization, however, there are some notable changes in the trends in canine marijuana exposures. Meola et al (2012) report the following signs in decreasing order of occurrence in 125 dogs with marijuana toxicity: ataxia (88%), mentally dull/obtunded/disoriented (53%), mydriasis (48%), urinary incontinence (47%), hyperesthesia (47%), tremors, shaking, or twitching (30%), and vomiting (27%). Notable are the increased percentages of stimulatory signs, urinary incontinence, and hyperesthesia relative to the 2004 findings. Even more noteworthy are the reports of two fatalities in dogs exposed to baked goods made with marijuana butter in the later publication. These changes in presentation may be a consequence of increased tetrahydrocannabinol (THC) content of modern forms of marijuana. Dried plant material has been noted to vary from 1-10% THC. Forms of marijuana such as sinsemilla (meaning “without seeds”) have been reported to contain 10-18% THC. Unsubstantiated reports of butane hash oil (BHO) claim it can contain up to 90% THC. These changes in presentation may also be due to greater access to larger amounts of THC-containing products. Especially in the solid form, such as brownies, cookies, candies, and cakes, we all know our selfrespecting Labrador Retrievers will not stop at just one. And finally

on the list of possible differences in exposure is increased absorption of THC depending on the vehicle it may be in. Normally, THC has an oral bioavailability in people of 5-20%. Since it is highly lipophilic, ingesting THC in a high-fat vehicle such as butter can significantly increase its absorption (Truven, 2014). These exposures can result in cardiac and respiratory depression to the point of cardiorespiratory arrest. Other potential variables in reported signs of marijuana toxicosis over the years could be increased recognition of the array of previously less common signs by clinicians and increased willingness of owners to present more seriously affected patients to a hospital and to confirm exposure history post relaxation of laws. Relatively few experimental studies have been performed with marijuana in dogs and most accidental veterinary exposures regarding recreational stashes don’t have reliable dose-related information. One study (Beaumont et al, 2009) reports an intragastric THC dosage range from 0.079 – 0.189 mg/kg that resulted in no outward clinical effect. Vomiting was seen in 1/2 of the exposed dogs in that study that received 0.252 mg/kg, however. Teitler (2009) reported giving 2.5 mg of dronabinol (trade name Marinol; synthetic Δ9-THC) to four dogs of unknown body weight. Mild obtundation for 4-6 hours was noted in each dog. Over the next several years, if regulation of the recreational trade requires disclosure of THC content of goods sold, our knowledge of dose-related effects is likely going to skyrocket. This will give clinicians the added benefit of calculating a worst-case-scenario dosage and more reliably predicting the cases that will require significant intervention to prevent life-threatening effects. Minimum lethal dosages have not been well-established in the dog. Fitzgerald et al (2012) report the minimum lethal dosage to be >3 g/kg and reference Thompson et al (1973) who report that dosages between 3 and 9 g/kg in the dog were nonlethal. Eventually, incorporation of data regarding increased absorption with varying vehicles and plasma levels may further aid management of marijuana toxicoses. For now, clinicians should err on the side of caution and assume that any marijuana-intoxicated patient could develop life-threatening complications. Classic decontamination measures such as induction of emesis and administration of activated charcoal are appropriate for asymptomatic patients exposed to marijuana. Monitoring parameters thereafter include heart rate, rhythm, blood pressure, temperature, oxygenation, and central nervous system status. Garrett and Hunt (1977) report that 10-15% of THC is enterohepatically recirculated. Multiple doses of activated charcoal, in theory, would be indicated with a significant ingestion, but concerns for aspiration in a sedate patient must be weighed heavily against the potential benefit. For potentially life-threateningly clinical patients, a course of intravenous lipid emulsion therapy would be preferable to taking the risk associated with multiple doses of activated charcoal. Additional treatment recommendations include the following: •• Intravenous fluid support with crystalloids. •• Thermoregulation (warm fluids and ambient temperature if hypothermic; cooling fluids or bath to 103°F if hyperthermic). •• Benzodiazepines to effect for significant tremors or seizures (rare). •• Antiemetic therapy/NPO status PRN for vomiting. •• Supportive care (rotation, padded bedding) to prevent pressure sores if severely depressed. •• Atropine (0.02 mg/kg IV) to effect for significant bradycardia. •• Minimize external stimuli (sound, movement, light) if hyperesthetic. •• Minimize external stimuli (sound, movement, light) if hyperesthetic. •• Confine disoriented and ataxic animals to prevent secondary trauma. •• Supplemental oxygen (+/-ventilation) if difficulty oxygenating.

may /june 2 0 14

TABLE 1.

been proposed as the reason why false negatives are common.

First Check: Δ9-THC

50 ng/ml

Siemens Dimension: 8ß-11-dihydroxy-Δ9-THC

58 ng/ml

8ß-11-Hydroxy-Δ9-THC

68 ng/ml

11-Hydroxy-Δ8-THC

67 ng/ml

11-Hydroxy-Δ9-THC

77 ng/ml

9-Carboxy-11-nor--Δ9-THC-glucuronide

95 ng/ml

5 Panel One Step Drug of Abuse Urine Test (Meola et al, 2012): Cannabinol

150,000 ng/ml

11-nor-8-THC-9-COOH

50 ng/ml

11-nor-9-THC-9-COOH

50 ng/ml

Δ8-THC

25,000 ng/ml

Δ9-THC

10,000 ng/ml

QuickScreen Pro Multi-Drug Screening test (Teitler, 2009): THCA (aka 11-nor-Δ9-THC-2-carboxylic acid)

50 ng/ml

Diagnosis of marijuana toxicity in dogs classically has been based on the presence of clinical signs consistent with exposure and a reluctant confession by the owner that the dog was exposed to someone else’s recreational stash. State legalization of medicinal and recreational marijuana is breaking down barriers to admission of exposure, but a reliable point-of-care test would be beneficial in cases of unknown or unconfessed exposure. Particularly in light of more complicated, prolonged, and potentially life-threatening toxicoses, confirming marijuana exposure is preferable to pursuing advanced diagnostics such as computed tomography scans and cerebrospinal fluid analysis. Commercially available urine drug screening tests (UDSTs) marketed for people have been notoriously unreliable in detecting THC in canine urine. Several theories have

First, dogs may make a different array of metabolites. THC is metabolized by the lung and liver and then excreted mostly in the feces (45-55%) and less so by the kidneys (15-20%) in both people and dogs. 11-hydroxy-Δ9-THC is the main metabolite of Δ9-THC in human feces. It is further oxidized to 11-nor-9-carboxy-THC, which along with the glucuronide metabolite, account for most of the urinary excretion (Huestis, 2005; Watanabe et al, 2007; Meola et al, 2012). In dogs, 11-hydroxy-Δ9-THC is reported to be further oxidized to 8-hydroxy-Δ9-THC, which has been hypothesized as the cause of the urinary incontinence commonly seen in our canine patients (Meola et al, 2012). A recent visit to a medical marijuana dispensary, however, provided anecdotal confirmation that urinary incontinence occurs in overdose situations in people as well, so the frequency seen in our canine patients may be more a function of dosage rather than differences in metabolism. In addition to novel metabolites not being detected, other theories for false negative canine results include interference of additional metabolites with test antibodies and inappropriately low detection limits. Given the relatively higher percentage of fecal metabolites versus urinary metabolites, use of urine as the preferred sample medium has been questioned. In support of the suggestion to utilize feces as a test medium, Coles et al (2005) reported an extraction method for analyzing THC metabolites from human meconium. Teitler (2009) even reports that gold standard validation with GCMS was also unreliable in dogs. Despite these inconsistencies, several UDSTs have been anecdotally suggested by veterinarians to be more reliable in detecting THC exposures in dogs (Table 1). No large-scale, controlled studies have been performed to validate these findings in dogs, however. Current recommendations remain to include marijuana on the differential diagnosis list when clinical signs are consistent with exposure, to attempt to rule in exposure with accurate history-taking, and to attempt to confirm exposure with both a point-of-care urine drug screen test and the gold standard GC-MS analysis. WA

— Dr. Donna Mensching is the Veterinary Medical Director at the WA Poison Center. She can be reached at dmensching@wapc.org.

REFERENCES

•• Beaumont H, Jensen J, Carlsson A, Ruth M, Lehmann A, Boeckxstaens GE. Effect of Δ9-tetrahydrocannabinol, a cannabinoid receptor agonist, on the triggering of transient lower oesophageal sphincter relaxations in dogs and humans. Br J Pharmacol. Jan 2009;156(1):153-162.

•• Meola SD, Tearney CC, Haas SA, Hackett TB, Mazzaferro EM. Evaluation of trends in marijuana toxicosis in dogs living in a state with legalized medical marijuana: 125 dogs (2005-2010). J Vet Emerg Crit Care. 2012 Dec;22(6):6906.

•• Coles R, Clements TT, Nelson GJ, McMillin GA, and Urry FM. Simultaneous Analysis of the Δ9-THC Metabolites 11-nor-9-Carboxy-Δ9-THC and 11-HydroxyΔ9-THC in Meconium by GC-MS. J Analytical Toxicology, Vol. 29, September 2005, pp. 523-527.

•• Teitler JB. Evaluation of a human on-site urine multidrug test for emergency use with dogs. J Am Anim Hosp Assoc 2009; 45(2):59-66.

•• Fitzgerald KT, Bronstein AC, Newquist KL. Marijuana poisoning. Top Companion Anim Med. Feb;28(1):8-12. •• Garrett ER, Hunt CA. Pharmacokinetics of Δ9-tetrahydrocannabinol in dogs. J Pharm Sci. 1977 Mar 66(3):395-407. •• Huestis, M. A. (2005). “Pharmacokinetics and Metabolism of the Plant Cannabinoids, Δ9-Tetrahydrocannabinol, Cannabidiol and Cannabinol”. Cannabinoids. Handbook of Experimental Pharmacology 168 (168): 657–90. •• Janczyk P, Donaldson CW, Gwaltney S. Two Hundred and Thirteen Cases of Marijuana Toxicoses in Dogs. Vet Human Toxicol 46(1): February 2004, pp. 19-21.

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•• Thompson GR, Rosenkrantz H, Schaeppi UH, Braude MC. Comparison of acute oral toxicity of cannabinoids in rats, dogs, and monkeys. Toxicology and Applied Pharmacology. 25(3);July 1973, pp. 363-72. •• Truven Health Analytics, Inc. Plants—Marijuana, PoisIndex. MICROMEDEX® Healthcare Series Vol. 159 expires 3/2014. •• Tyagi P, Tyagi V, Yoshimura N, Chancellor M. Functional role of cannabinoid receptors in urinary bladder. Indian J Urol. 2010 Jan-Mar; 26(1): 26-35. •• Watanabe K, Yamaori S, Funahashi T, Kimura T, Yamamoto I (March 2007). Cytochrome P450 enzymes involved in the metabolism of tetrahydrocannabinols and cannabinol by human hepatic microsomes. Life Science 80 (15): 1415–9.

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The WSVMA Executive Board approves exciting new plan for the Association By Candace Joy, WSVMA Executive Vice President

our members.

he association membership model is over 100 years old and even though much has changed for organizations like the WSVMA, most associations are continuing to operate much like we started. Is it still working? Not really. The world is changing quickly and it has created unique circumstances that challenge the very way we operate and serve

Technology has dramatically changed the way associations do business. Because of technology, the entire way we think of membership is in flux. One could say that Facebook is the largest association with over 1 billion members – and it’s free. Anyone today can start an association quickly, easily and at no cost. Technological changes have also altered how we communicate and how products and services are delivered to members.

With things moving at light speed, organizations like the WSVMA must transform to be more proactive, nimble and responsive to the professional community we serve. Or we risk the ability to remain a viable organization. A NEW BOARD OF DIRECTORS Over the last year, the Executive Board has been studying these dynamics and asking how the WSVMA can remain relevant and competitive in order to continue serving the membership in the extremely important work that we do for veterinarians and the veterinary community at large. On March 28, 2014, the WSVMA Executive Board voted to adopt a new governance model and strategic management system of directing the organization.

Generational changes have also affected membership organizations. Baby Boomers and the Matures, also known as the Greatest Generation, left school and automatically joined their professional association with their employer paying their dues. But Baby Boomers are beginning to retire in droves, with over 10K of them reportedly leaving the workforce each day. That can put a serious hole in the membership roster.

Over the next nineteen months, the WSVMA will move from a nineteen-member constituency-based Executive Board to a six-member competency-based Board of Directors. The current Executive Board consists of nineteen voting members including four officers, nine regional representatives and four practice type representatives. Instead of quarterly meetings, the new Board will hold monthly electronic meetings, including two in-person meetings per year.

Millennials (ages 18 – 33) are quickly becoming the majority of the workforce and along with Gen X, look at the membership value proposition in a whole new way in comparison to the previous two generations. Millennials don’t just join their professional association for the sake of joining; they expect a return on their investment. They’re more economically challenged, especially when you consider their high student debt, and they’re less trusting of institutions and organizations. Furthermore, they’ve grown up on computers and the term “digital natives” is an apt description of this cohort considering they live their lives online.

Why reduce the size of the Board? Smaller boards improve the effectiveness and efficiency of the association’s governance. In today’s climate, nimbleness and the ability to quickly react to emerging issues is critically important. A smaller Board will have the ability to reach decisions or consensus more efficiently than a larger one. A smaller Board will be able to schedule emergency meetings more easily. A six-member, competency-based board will significantly strengthen the association and the value of membership.

Societal and technological shifts aside, the veterinary profession is rapidly changing and facing numerous challenges, not the least of which are economic.

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Because the existing constituency-based model has overseen the WSVMA for the sum of its existence, it may be difficult to understand how members will be adequately represented if they don’t have a colleague from their area or the same practice type on the Board. Consider that members now communicate and engage in different ways, not just through local meetings. They meet on Facebook, via email, on VIN, soon in WSVMA forums, by text message, and then lastly, face-to-face. Boundaries no longer exist. Having regions or practice types delineated in our Bylaws doesn’t hold the same meaning it did ten years ago and it doesn’t guarantee adequate representation. Members may have questions about whether a smaller board will have enough input and depth to fairly represent the membership’s views. The Board won’t operate in a vacuum. As input is needed on issues, research tools such as surveys, focus groups, roundtables, and advisory groups will be utilized. Research gathering can be targeted and focused on specific issues. With the new six-member Board of Directors, an active environmental scanning process will be an integral part of how the Board conducts business, reviews strategic goals and forms task forces to address issues important to the WSVMA and the profession. Remember in the March/April 2014 issue of WA Veterinarian, Dr. Lisa Parshley described environmental scanning as input received through a constant analysis of data pertaining to your business, or in this case the WSVMA and the veterinary profession. Data we will be analyzing will come from information gained from a variety of sources including news organizations, state and local politics, social media, legislation, regulatory agencies, WSU, related stakeholders, business trends and of course, members themselves. It will be an information flow between the Board and task forces, committees, members and staff. While the Board already uses an active environmental scanning process to make policy decisions, what will change is how this information integrates with our strategic plan.

done to achieve it. A new task force may need to be formed or staff may be put in charge. The budget will also be reviewed as to how it aligns with each particular objective. As we gather the data through our scanning process, objectives will be added under each of the five goals. As objectives are successfully completed, they will be crossed off to make room for new ones. It’s a dynamic process to where the Strategic Plan and all the objectives are constantly monitored and it drives the work of the Board, the membership and staff. As Dr. Parshley noted in her article, “good communication and adequate transparency allows the entire organization to engage in the plan. Communication should be both ways, allowing for good ideas to filter up as well as down. Transparency allows for accountability at all levels of the organization. A good strategic management team drives and fosters the plan through supporting an open atmosphere of strategic thinking.”

With things moving at light speed, organizations like the WSVMA must transform to be more proactive, nimble and responsive to the professional community we serve.

Policy development and dealing with emerging issues will be handled much the same way it is now. The Board seeks out the expertise of our members on a variety of issues. For example, if a ballot initiative arises on tail docking of cattle, the Board will contact and engage with our production medicine members, seek out their expertise, and utilize them to assist the Board with policy development and strategy. STRATEGIC DIRECTION The primary role of any board is to set strategic direction and to evaluate its performance. But how can a board effectively use strategy when most plans get hashed out over a weekend and then sit on the shelf for the next five or ten years? As illustrated in Dr. Parshley’s article last issue, using strategic planning and management as a daily practice guarantees that an organization will be guided, through a dynamic environmental scanning process, to address the issues and serve the members and the profession to the best of its ability. How will strategic planning be implemented in the WSVMA under the new structure? The Board will finalize the vision statement and set five new strategic goals for the organization. Developing the initial objectives for each of the five goals will follow. With the new six-member Board, each member, save the Board Chair, will be responsible for one goal. With each objective, a decision will be made as to who is responsible and what type of work needs to be

This process, combined with the smaller and more nimble Board, will ensure the WSVMA is actively engaging in issues of importance to our members, their patients and clients, and the Washington professional community. It will allow us to solve critical issues with expedience and it will engage the membership as they become part of the planning and implementation of what we do. TRANSITION PROCESS On January 23, the Executive Board approved a new mission statement, which is “to advance the cause of veterinary medicine and to better the lives of those touched by it.” On March 28, the Board began the process of drafting a new vision statement, which will guide the Board in the development of a new set of strategic goals. The goals and the first set of objectives will be completed at the September 25, 2014 meeting in Yakima.

At the June 20, 2014 Executive Board meeting, the Board will finalize the new structure, including the nomination and election process. Necessary changes to WSVMA Bylaws are expected to be approved at the September meeting, with WSVMA policies following thereafter. The transition from the current Executive Board to the new sixmember Board of Directors will take place over the next eighteen months. Board members whose terms expire in October, 2014, will rotate off and those positions will not be filled. So we will hold no elections this year. This will leave a thirteen-member transitional Board to direct the organization over the next year. At the end of October, 2015, the remaining thirteen members will rotate off the transitional Board. Elections for the six new at-large directors will be held in July of next year for terms that start November 1, 2015. As we go down this road, we’ll keep you informed of our progress. We invite members to contact the Board or staff with questions or concerns about the plan. With the world changing so rapidly, it’s clear that we can’t continue to operate with an outdated model. Making changes to how we govern and direct our strategy means we will become a more relevant, proactive, responsive and nimble association. WA

— Candace Joy is the Executive Vice President of the Washington State Veterinary Medical Association. She can be reached at candacejoy@wsvma.org

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Relief Bank Dr. Jessica Allmendinger UC Davis, ‘08 SA Medicine and Surgery,ER (day only) Greater Seattle Area (530) 220-3868 jlallmendinger@gmail.com Dr. Douglas Anderson WSU ‘94 (360) 249-3550 doug270@gmail.com Dr. Veeda Angell WSU ‘04 SA/MA King, Snohomish, Pierce and Thurston Cos. (509) 432-3225 vangell_dvm@hotmail.com Dr. Janice Anthony WSU, ‘03 Small Animal Medicine King and neighboring counties Short notice OK jaadvm@cs.com Dr. Bela Belle Tufts ‘97 ER, SA Medicine/Surgery, PT (425) 770-3193 Dr. Evelyn Bittner MSU ’91 SA Medicine/Surgery Greater Seattle & Eastside area (206) 301-0580 evelynbittner@comcast.net Dr. Frank Bousaid TAMU ‘95 SA, Acupuncture/Chinese Herbal Therapy Eastern Washington including Wenatchee, Moses Lake, Spokane (206) 683-3770 snohobear@gmail.com Dr. Kimber C. Brawley KSU ‘89 SA & Exotics, Medicine/Surgery, some Orthopedics King & Snohomish (425) 367-1288 docb333@aol.com Dr. Stacy Chartrand WCVM ‘01 Small Animal Medicine, Surgery and Emergency and Critical Care Greater Seattle and Eastside (206) 445-9994 stacychartrand@gmail.com Dr. Leah Cloud WSU ‘05 SA Medicine King County (425)223-7618 leahclouddvm@gmail.com Dr. Patricia Dorsey IL ‘84 Cats and Dogs (253) 851-8234 (Gig Harbor) reliefvet@dorsey.cotse.net (preferred contact) Dr. Leah Ferguson Kansas State, ‘02 SAl medicine and surgery Snohomish and King counties (503) 380-4810 leah.jia@gmail.com

Dr. Robyn Fry WSU ‘06 SA Medicine King & nearby Counties (425) 244-5776 robyndvm@gmail.com Dr. Tracy Fuelleman MIN ‘89 SA Medicine Greater Puget Sound area (206) 361-8009 tracydvm@hotmail.com Dr. Catherine Gamber Texas A&M 2011 Small Animal Medicine and Surgery, ER, Exotics Greater Seattle Area (281) 352-3987 catherine.gamber@gmail.com Dr. Michelle Gengler ISU, ‘05 Small Animal North King and Snohomish County Short notice OK (206) 920-0219 genglerdvm@gmail.com Dr. Emma Harvey Edinburgh, Scotland ‘12 SA medicine & surgery, Food animal, equine, exotics Anywhere in WA, Short Notice OK (206) 601-0620 emmarosefiala@gmail.com Dr. Lee Harris WSU, 1974 Pierce, Snohomish and King Counties Small Animal Medicine with Surgery (253) 569-5360 dr.harris@pacificcrestvets.com Dr. David Hildreth MO ‘70 Small Animal (360) 914-1234 dhildr9770@aol.com Dr. William D. Hougham UCD ‘75 SA Surgery and Medicine South King County and Pierce County (360) 825-1981 drbilldvm@gmail.com Dr. Elizabeth Hughs STG ‘09 SA (206) 992-1730 elizabeth.hughs@gmail.com Dr. Brian Hur WSU ‘11 SA, Medicine/Surgery/Dentistry, ER/CC Greater Seattle Area (206) 856-0928 brian.hur@gmail.com Dr. Julie Janiak Colorado State University ‘07 Small Animal Medicine, Surgery, Emergency and Acupuncture Internship trained Greater Spokane Area and nearby counties (970) 420-9556 jagej@hotmail.com

Do You Want to Be in the WSVMA Relief Bank? All you have to do is email or fax the WSVMA offices with your information. If you are a current WSVMA member, your ad is free! Contact classifieds@wsvma.org or fax to (425) 396-3192 to get your ad started!

Dr. Emily Jewell Liverpool ‘98 SA General Medicine & Surgery Seattle and surrounding, Walla Walla and surrounding (206) 579 – 1012 eajewell@hotmail.com Dr. Kathy Johnson Ohio State `83 SA Snohomish & South Skagit (360) 659-7252 katherine@earthlink.net Dr. Rebecca Johnson OSU / WSU ‘94 SA Medicine Greater Puget Sound area (206) 230-8002 reliefdoc@comcast.net Dr. Darlene King WSU ‘98 Snohomish and King County area (425) 344-7996 dnmking@yahoo.com Dr. Cynthia Knapp Ohio State ‘98 SA North King and South Snohomish Counties cyn.knapp@comcast.net Dr. Kathleen Koppa WSU ‘07 SA Medicine and Surgery King and Snohomish Counties (425) 495-2626 kkoppa@yahoo.com Dr. Carrie La Jeunesse UCD ‘83, WSU ‘84 SA, ER, Medicine and Surgery (360) 731-0493 carrielaj43@yahoo.com Dr. Lori Maness Tufts, ‘92 Whatcom, Skagit and Snohomish Counties (307) 277-8819 Maness.lori@gmail.com Dr. Regina Mansfield WSU ‘85 SA Medicine SE King/ NE Pierce (360) 825-6753 regina.scott.m@gmail.com Dr. Alina McClain Ross ‘06 SA, Ultrasound, Soft Tissue Surgery Northern Western Washington to Seattle Tuesday, Wednesday, Friday and some Sat/Sun (360) 682-6216, (614) 563-9914 ndcrud42@yahoo.com Dr. Cheryl Meyers MSU ‘96 Small Animal Medicine, Surgery & Dentistry Greater Puget Sound area (206) 683-0685 cherylmeyers101@gmail.com Dr. Gary Miller WSU ’84 SA & MA WA, OR, Northern ID, Western MT (509) 248-7398 millerg@bossig.com

Dr. Sue Moriyasu WSU ‘02 SA, high volume spay/neuter King & nearby counties (425) 830-2784 sue.moriyasu@gmail.com

Dr. Priscilla Stockner Min ’70 Clallam, Jefferson and Kitsap Counties (360) 683-4230 priscillastockner@mac.com

Dr. Kathryn Okawa WSU ‘81 SA, Small mammals (425) 870-7088 okawak@aol.com

Dr. Michael Stone OSU ‘99 SA,ER, Medicine/Surgery (253) 988-1200 nwdvmrelief@gmail.com

Dr. Sarah Jane Owens Tufts ‘02 Small Animal, Equine, and Exotics Within 2.5 hours of greater Seattle (206) 661-6005 sarahowens@hotmail.com

Dr. Dorothy Villareal Texas A&M ‘85 SA Medicine and Surgery Kitsap, Clallam, Jefferson and Mason counties (360) 479-9053 docvillareal@live.com

Dr. Pamela Powell WSU ‘82 SA, ER, HQHV spay-neuter WA, ID, OR. Short notice OK. (253) 229-7816 pamvetdr@aol.com Dr. Leslie Pritchard WSU ‘80 N. Snohomish, Whatcom, Skagit, Island Cos. (360) 631-5885 Dr. L. Louise Rutter Cambridge, England ‘95 SA Medicine and Surgery relief work King County, Lake Washington area (425) 999 6765 louiserutter1000@gmail.com Dr. Michael Ryan WSU ‘84 SA Medicine and Surgery Kitsap and West Sound region (360)830-4911 ryanserv@msn.com Dr. Timarie Simmons OK State ‘98 Small Animal Medicine/Surgery and Some Exotics Greater Seattle and Statewide Options (703) 606-3300 timariedvm@yahoo.com Dr. Heather Smith WSU ‘03 SA Medicine/Surgery, Exotics (small mammals) North King/South Snohomish counties (425) 501-8008 heatherlosmith@yahoo.com Dr. Hank Snelgrove, CVA UCD ‘81 Integrative Small Animal Practice: medicine, dentistry, surgery, acupuncture, and TCVM herbal therapy Olympic and Kitsap Peninsulas and Central and Western Washington (360) 301-0096 tsetsibus@olympus.net Dr. Mary Sprague WSU ‘89 SA Medicine King, S. Snohomish Counties (425) 880-4073 dr.sprague@cablespeed.com

Dr. Melissa Walker Cornell ‘04 SA Medicine and Surgery, Integrative Medicine Greater Seattle Area (206) 595-2382 mwalkerdvm@gmail.com Dr. Shelby Watson MN ‘02 Kitsap Peninsula (360) 473-6260 swatson@wavecable.com Dr. Karen Wichert WSU ‘89 SA Medicine and Surgery Snohomish, King Counties (425) 312-3376 karen.wichert.dvm@gmail.com Dr. Evelyn Wilson, WSU ‘90, ABVP canine & feline med. Small animal medicine, surgery, dentistry, E.R. and exotics Snohomish, King, Skagit and Whatcom counties. (360) 631-2400 evwilsonvet@wavecable.com Dr. Heather Woodke WSU 2002 small animal medicine, surgery, ER, mobile small ruminant Western Washington woodkemagpie@comcast.net (509) 990-8854 Dr. Michelle Zachry Purdue ‘02 SA, Medicine/Surgery/Dentistry, ER/CC, Public Health/Food, Shelter King County and surrounding areas (425) 654-3521 reliablevetrelief@gmail.com Dr. Sharon Zito UC Davis, 1984 SA Medicine Seattle/King County Area 3 or more days in a row (619) 733 6875 s.zito@yahoo.com

Classifieds WSVMA 2014 Classified Advertising Rates WSVMA Members

First 30 words Each additional word WSVMA Blind Box (one-time fee) Include ad in next print issue

DVM Wanted, Western Washington Holistic Equine Veterinary practice seeking parttime increasing to full-time equine veterinarian for growing practice in Snohomish County. Acupuncture and Chiropractic certification preferred. Contact info: Dr. Hannah Mueller, 9812 215th Avenue SE, Snohomish, WA 98290; (360) 794-9255; info@cedarbrookvet.com; www. cedarbrookvet.com.

$65.00 $1.00 $5.00 $10.00

No charge for contact information. Rates are for two months on the website. Ad will be included in the next available print issue for an additional $10.00.

Non-Members

First 30 words Each additional word WSVMA Blind Box (one-time fee) Include ad in next print issue

$115.00 $ 1.50 $ 5.00 $20.00

No charge for contact information. Rates are for two months on the website. Ad will be included in the next available print issue for an additional $20.00. Classified ad forms are available upon request. Call (800) 399-7862 or (425) 396-3191 or email classifieds@wsvma.org.

Deadlines for Classifieds

Ads for the July/Aug 2014 issue of the WSVMA Classifieds will be accepted until May 15, 2014. No refunds or changes will be allowed after the deadline has passed. The WSVMA Insight Magazine and WSVMA Classifieds are mailed to all WSVMA members.

Flyers

Flyers are accepted to advertise continuing education events only. These are included on a fee for service basis. Please contact the WSVMA office for additional information regarding rates and schedules. For further information on classified advertising, please contact: WSVMA Office (800) 399-7862 or (425) 396-3191 classifieds@wsvma.org

Ad Categories

DVM Wanted DVM Available Practice For Sale/Lease Miscellaneous

New Ad Deadlines

Technician Wanted Relief Technician Available Hospital Staff Wanted

July/Aug 2014 • May 15, 2014

Accepting resumes for part-time small animal DVM in SW Washington. Interest in reproduction preferred. New facility with digital x-ray, ultrasound, laser therapy, stem cell therapy, etc. Send resume and cover letter to info@wsvma.org, Subject Box 0404. State-of-the-art 24-hour emergency-only hospital (May 2011). Looking for part-time clinician excited about emergency who enjoys challenges. 4-5 overnights per month. Full in-house lab, digital xray, ultrasound, great staff, excellent clientele. Contact Dr. Fleming at (425) 698-3129 or drf@dware.net. Lacey Animal Clinic seeking FT or PT SA DVM. Great staff and equipment. Great hours: M thru F four days a week, benefits. Contact: Michael Doherty, DVM (360) 491-3960, dohertydvm@comcast.net. PT SA DVM wanted for 1-doctor Everett practice. 1-2 days per week, alternate Saturdays. Send CV/resume to everettvet@gmail.com. North Cascade Veterinary Hospital in SedroWoolley, is searching for a full-time veterinarian. We have a beautiful, well-equipped hospital, awesome staff who love working together and have been awarded numerous times as the best vet in Skagit County. We offer percentage-based pay, CE, IRA and other benefits. We are looking for candidates with a strong interest in exotics, naturopathic medicine and acupuncture. Visit us at www.northcascadevet.com. Please send CV/resume to ncascadevethospital@gmail.com or call Andy Porter at (360) 856-1809 for more information. Mukilteo: FT/PT SA vet to join two DVM, noncorporate, family oriented, well-established practice. Ownership possibility. New grads welcome. Benefits. No after hours. Enthusiastic, team oriented environment with great staff. Contact Susan Torgerson, suelyntorg@ comcast.net, (425) 248-3549 Small animal veterinarian wanted to add to fastpaced, 2-doctor practice. Client-oriented, full service general practice. Looking for an enthusiastic doctor with good communication skills and a desire to practice quality medicine while serving others. Great, experienced staff and pleasant working atmosphere. Benefits package available. Possible buy-in potential. Send resume and cover letter to daupperlee@comcast.net or fax to (360) 384-1590 or mail to Whatcom Veterinary Hospital, PO Box 309, Ferndale, WA 98248. VCA Five Corners Animal Hospital is seeking an experienced Emergency Veterinarian to join our AAHA-accredited, 24-hour emergency/critical care and day practice in Seattle, Washington. Competitive salary and comprehensive benefits package. Make inquiries at: Johanna.Baldwin@vcaantech.com. Apply http://www. vcajobs.com/job/posting/4299

w a s h i ngton ve te ri nari an

Part-time position...two days per week plus digital and dental radiology, licensed technicians, in house laboratory Minimal five years of experience. Strong interest in diagnostics. Resume, letter of interest to: oakbayanimal@olympus.net. Feline-only practice: FT/PT DVM. Busy, wellestablished clinic looking for a cat person with strong communication skills, a sense of humor, and the ability to work well under pressure. Leave the barking, drooling, and wrestling behind. p.gawley@comcast.net Certified Veterinary Acupuncturist wanted to join our hospital in Renton. We are a progressive and unique small animal hospital offering Integrative medicine consisting of both Western and TCVM modalities, Reiki, and Lomi. Well-respected in the community, your talents and first-rate client communication skills will further set our hospital apart from others. Email resumes to deniseiaia@yahoo.com. AAHA ER practice in North Puget Sound looking for confident and skilled veterinarian. We offer competitive salary base on production, generous benefits, and a great staff to work with. Contact Carrie Farmer at cfarmer@diamondvet.com or (425) 252-1106.

Practice for Sale or Lease Ada County, Idaho - This +2,000sf SA practice has achieved nearly double-digit growth and strong client growth! ID2. Clark County, Nevada - Highly reputable +2,400sf SA practice on approximately 1/3 acre. Motivated Seller! NV2. (800) 636-4740 or info@psbroker. com. www.psbroker.com Washington – Potential: Puget Sound area, 1 DVM, SA practice. Grossed $380K in 2013. Facility is 3,000 sf and includes additional 2 acres for expansion. Asking $450,000 practice and RE. Simmons Northwest 208.664.3100 (LWA54) Washington – New Listing: NE of Seattle in growing area. Family owned 1 DVM SA practice. Grossed $680k in 2013, $100k+ to buyer after debt. Leasehold. Asking $625,000. Simmons Northwest 208.664.3100 (LWA55) Washington – Possibilities: Seattle Suburbs. 1+ DVM, SA practice, leasehold. Grew revenue to $630k in 2013, increase of $45k. NO price increase! $100k+ to buyer after debt pymts. Asking price $550,000. Simmons Northwest 208.664.3100 (LWA52) Washington – Great Opportunity: Southern Washington. 1+ DVM, SA practice, highly desirable location. Grossed $780K in 2013. Great opportunites to grow revenue and profit. Asking $700,000 for practice. Simmons Northwest 208.664.3100 (LWA53) Oregon – New Listing: Great location just outside Portland. 1 DVM SA practice. Leashold. Grossed $550k+ in 2013. Potential $100k+ to buyer after debt payments. Asking $350,000 Simmons Northwest 208.664.3100 (LOR61) Alaska – Highly Profitable: Alaskan beauty, outdoor recreation. Highly profitable, 1 DVM, SA practice. Leasehold. Grossed $390k in 2013. Potential for $150k+ to buyer after debt pymts. Asking price $350,000. Simmons Northwest 208.664.3100 (LAK06)

Find More Classified Ads Online at wsvma.org Idaho – New Listing: Priced to sell quickly!! 1 DVM mixed animal practice NW of Boise. Very nice facility on one acre. RE and practice only $270,000. Better than a start-up! Simmons Northwest 208.664.3100 (LID29) OR EQ Surgical Specialty facility. Many equine hospitalization stalls, large double surgery 21,000 SF and 15 acres. Contact Karl Salzsieder (360) 636-1228 or Karl@ TPSGsales.com Near Portland, OR - High net, SA high tech 1 vet $500,000 gross rev. yr. Contact Karl Salzsieder (360) 6361228 or Karl@TPSGsales.com North ID- SA, young practice & RE 3200 sq ft. 20% growth per year. Contact Karl Salzsieder (360) 636-1228 or Karl@TPSGsales.com Northwest WA Peninsula- Fast-growing 1 doctor SA grossing nearly $700,000 in 2012. Building lease, with possible option to purchase. Contact Karl Salzsieder (360) 636-1228 or Karl@TPSGsales.com N. of Seattle, WA – Awesome 3,581 SF building, 1 DVM Practice w/ great potential to grow. Needs jump start, financing available. Practice only, $50k sale price. Contact Karl Salzsieder (360) 636-1228 or Karl@TPSGsales.com

Miscellaneous FOR SALE: Bronze statue “Caring Call” by Larry Anderson, number 49/100. Stands 15 inches high and weighs 33 pounds. $2495.00 plus $80 s/h. Please contact Dr. Steve Shaff at (845) 266-8727 or wizarddiana@ hughes.net. Practice Sales Brokerage or Practice Buyer Representation. Increase profitability and Practice Sales price with Management Consulting. Practice Valuation and Employment contracts, buy-sells, startups, litigation support, representation before license board. Contact Karl Salzsieder, DVM, JD, AVA, (360) 5778115 or karl@salzsiederlaw.com.

Relief Technician Available Vet Tech Services – Let our experienced LVT’s keep your hospital running at full capacity. Please call Virginia Jones, LVT at (425) 330-5234

WSAVT Career Center (360) 273-7838 or ludeluh@yahoo.com

SE AK – 1 DVM SA practice. Contact Karl Salzsieder (360) 636-1228 or Karl@TPSGsales.com NV – SA practice & RE. Outside Reno, Rev. 300k. Contact Karl Salzsieder (360) 636-1228 or Karl@ TPSGsales.com Practice and real estate available in Quincy, WA. Well-established 97% SA 3% Equine clinic; employs two licensed technicians. Growing community with new high-tech industries. Contact Dr. Steve Correa (IBA) at (253) 548-4578. Want to buy an established practice for FREE? Ideal opportunity for start-up. Take over 20-year practice for lease payment only. Excellent north Seattle location. Great freeway access. (206) 999-2909 or ahealingvet@ comcast.net

Technician Wanted 24-hour emergency-only hospital, state-of-theart, fully equipped, near paperless, with great doctors, excellent clientele. Need enthusiastic, flexible, eager to learn, emergency-oriented technician (licensed preferred) capable in all areas, for overnight shifts. Contact Dr. Fleming at (425) 698-3129 or drf@dware.net. Looking to add an energetic, fun loving licensed technician. We are a busy 2 doctor small animal clinic in semi-rural Lewis County with easy access from I-5. We expect our technicians to perform all responsibilities a licensed technician is trained to do. A technician that can compartmentalize, has a sense of humor and is just a little twisted will be a good fit for our working environment. We offer competitive pay, paid time off & medical insurance. Please fax or email resume’ and cover letter for consideration to fpac@rainierconnect.com or (360) 330-5590.

Display Ad Index Affiliated Associations of America...............................5

Newport Laboratories.................................................... 13

Architectural Werks, Inc................................................ 12

Omni Practice Group...................................................... 10

Bancard USA...................................................................... 19

PulseVet....................................................11 & Back Cover

Campbell Pet Company................................................ 22

Simmons & Associates Northwest...............................7

Dogwatch..............................................................................3

Summit Veterinary Referral.............................................9

Homestreet Bank................................................................5

Seattle Veterinary Specialists.........................................3

IBA.......................................................................................... 25

Veterinary Group Purchasing Organization.............9

Kitsap Bank......................................................................... 13

WSU..........................................................................................7

Let a professional help you buy or sell your practice. Steve Correa, DVM, MBA Licensed Real Estate Broker

steve@ibainc.com • 1- 800-218-4422

www.vpsg.com may /june 2 0 14

G W! LIN NE HEA RCH NE SEA BO RE

A Sound Approach to managing Cranial Cruciate Ligament (CCL) Disease Offer your clients the CCL Treatment Package to speed recovery – your surgical repair combined with Shock Wave Therapy (SWT). NEW research shows benefits of shock wave therapy in accelerating bone healing post-TPLO.

HIGH-ENERGY FOCUSED SHOCK WAVE THERAPY ACCELERATES BONE HEALING: A BLINDED, PROSPECTIVE, RANDOMIZED CLINICAL TRIAL* Duerr F, Palmer R, et al. Colorado State University, Dept. of Clinical Sciences

• Randomized, blinded, prospective clinical study of client-owned dogs (12 dogs, 13 stifles) presenting for surgical treatment of naturally occurring cranial cruciate ligament disease • Following standard Tibial Plateau Leveling Osteotomy (TPLO) procedure: – Shock Wave Therapy (SWT) group received 2 treatments immediately postoperatively and at time of suture removal (VersaTron4Paws high-energy, focused electrohydraulic device) – Sham control group did not receive SWT treatment

• Results:

– SWT group had significantly more advanced healing at week 4 (p<0.05) compared to Sham group – At 6 and 8 weeks, more advanced bone healing scores in SWT group approached statistical significance (p=0.08 and p=0.06, respectively) compared to Sham group – At 8 weeks, all SWT dogs had healed osteotomies (score > 9), but less than half of the Sham dogs were considered healed

Radiographs were evaluated for osteotomy healing (0-10) during a single session by a Board-Certified Radiologist blinded to group and time point

*Presented at the 2014 World Veterinary Orthopaedic Congress.

VersaTron4Paws.com for more information and to schedule a demo