On the Mars-VCA merger

The recent JAVMA News story¹ on the acquisition of VCA Antech by Mars quoted Dr. Scott Spaulding, CEO of Badger Veterinary Hospitals and a member of the AVMA Veterinary Economics Strategy Committee, as suggesting that the merger may be a potential positive for the veterinary industry because veterinary medicine is “a capital-intensive business. We have to have facilities and a large enough staff. We also invest heavily in surgical facilities and the latest diagnostic technologies. With $9.1 billion coming into the veterinary industry, I think that it is definitely needed by veterinary medicine and that it will have a tremendous long-term impact.”

Except, I don't believe that it will. The billions from Mars will go to VCA Antech shareholders. That money is not “coming into the veterinary industry,” other than to those few individual veterinarians who just happen to own shares of VCA Antech.

Philip D. McHugh, DVM Durham, NC

Disagreement with characterization of VCA Animal Hospitals

I feel compelled to write a response to the recent JAVMA News article “Veterinarians incorporated,”¹ which discusses the recently announced acquisition of VCA Inc by Mars. I definitely understand the questions and interest surrounding this announcement. However, as a member of the team of medical leaders within VCA, I wanted to address a point made in the article that is inaccurate and misleading. The comment in the article that VCA has “been criticized for implementing programs that some have perceived as taking the decision-making process out of veterinarians' hands or as not always serving the best interests of the animals” is simply misguided. What is the basis for this comment? I believe JAVMA has a greater responsibility to its readers than to print unfounded opinions or perceptions.

I have been with VCA for 12 years and, during this time, have worked to support VCA veterinarians and technicians in many different roles, including directing an emergency–critical care team, being the medical director of a large VCA specialty center, and supporting VCA teams in the Pacific Northwest as a regional medical director. During my time with VCA, I have worked hard alongside other medical leaders to create guidelines that focus on patient safety and patient care, particularly in the areas of anesthesia and pain management. Our focus has always been on education and providing the support veterinarians need to be successful. I work with an amazing team of veterinarians who work incredibly hard on a daily basis to provide the highest standards for patient care while still making their own decisions on how to meet the needs of their patients. I don't think it's fair to make a general statement on how VCA veterinarians practice medicine until you've had the chance to work with them on a regular basis.

In the same news story, Dr. Eileen Jefferson questions whether corporate veterinary practices “match what clients are actively seeking for their animals.” VCA is very proud of the experience we provide pet owners, which was created through direct feedback from our clients themselves. I would invite readers, including Dr. Jefferson, to visit our very diverse group of hospitals and meet the team members and clients prior to forming opinions.

Rochelle Low

Vice President of Medical Operations VCA Animal Hospitals Los Angeles, Calif

Analyzing veterinary economic statistics

I read with great interest the JAVMA News report “Practices busier than ever, except for one time of year,”¹ and was struck by several interesting statements in the article.

First, referring to a report from the Bureau of Labor Statistics, the article states that “overall spending on veterinary services among a sample of U.S. consumers dropped between 2005 and 2014. This means that even though the prices of veterinary services steadily increased over this period, the amount spent with veterinary service providers decreased for this same population.” However, this statement appears to contradict the statement later in the article that “[t]he improved excess capacity estimates are attributable largely to two causes. First, the economy has improved, leading to increased demand by

consumers.” All veterinary practices have recognized for a decade that survival required raising prices to offset decreased demand. Decreased demand for veterinary services would seem to be an indisputable fact that threatens the survival of all of us in practice.

Second, the article states that “the percentage of U.S. practices working at full capacity increased from 35 percent in 2012 to 40 percent in 2014 and 39 percent in 2015.” This implies, however, that the percentage of U.S. practices working at less than full capacity decreased only slightly between 2012 and 2015, with 61 percent of U.S. veterinary practices working at less than full capacity, down from 65 percent in 2012. This is how those of us working in the trenches look at this statistic, and we are experiencing this problem of working at less than full capacity every day.

Third, the article states that “[t]he forecast is that just 5.7 percent of available veterinary services in the U.S. will be unused by 2017 and that that figure will remain flat through the remaining forecast period, which ends in 2025.” Given current events, however, I am certain I would make no practice predictions past the next fiscal quarter and have not personally made any long-term plans.

William Ray Folger, DVM, MS

Houston, Tex

Concern over veterinary portrayals on television

Television programs depicting veterinary practitioners in various practice settings and types have enjoyed great popularity in recent years. Viewers can watch every type of veterinary medicine from treatment of wildlife under field conditions to farm animal practice to modern, hospital-based companion animal practice.

Too often, however, what viewers see doesn't portray the veterinary profession in a good light. Veterinarians performing orthopedic or abdominal surgery without gowns or even surgical masks. Bare-armed bovine and equine pregnancy checks. Indifferent attention to pain control.

One segment I recently was shocked to see depicted a bovine castration with no anesthesia of any kind. The producers of this segment did, however, take care to film the reaction of the patient during the procedure.

As a practitioner of 41 years, I clearly remember efforts in the 1970s and 1980s on the part of the AVMA and American Animal Hospital Association to represent veterinarians to the general public and to our colleagues in human medicine as practitioners of respectable medicine and surgery based on sound scientific principles. Unfortunately, some of these television episodes seem to be a giant step backwards in this endeavor.

Steven B. Metz, DVM

Shelburne, Vt

Remember to check your EIN

Any practice that takes credit card payments could potentially face serious problems should its credit card–processing company file a tax information return with a practice name or Employer Identification Number (EIN; also known as a Taxpayer Identification Number) that doesn't match what is on file with the Internal Revenue Service (IRS). If a mismatch is found, the credit card–processing company will be instructed by the IRS to send the practice a Backup Withholding (“B”) Notice. If you do not receive or do not respond to this notice, the company may be required to withhold 28% of your credit card receipts, and you will not receive this money until you file taxes the following year.

This happened to our clinic this year. Our credit card–processing company claimed to have sent us a B notice. Unfortunately, we never received it and, therefore, never responded. As a result, the company withheld 28% of our credit card receipts. Our bookkeeper discovered the problem, but not until several thousand dollars had been withheld. After spending hours online with the IRS and our credit card–processing company, we discovered that the company does not send B notices as registered mail, because they are not required to do so. Also, they are not required to contact you by telephone or email should they not get a response to the B notice. The company representative said that they send out many B notices, and the IRS said that they get a lot of complaints about this problem. The IRS also said that the credit card–processing companies do not have to forward the withheld credit card receipts to the IRS until December 31 of the year the 28% is withheld. All of our efforts to have the credit card–processing company return our money were in vain, despite the fact that the company admitted the money was ours.

Do not let this happen to you. Contact your credit card–processing company to ensure that the practice name and EIN they have on file matches what you registered with the IRS. The technology to process credit cards is constantly changing, and you may find an easier and less expensive way to have it done.

John Mullins, DVM

Ooltewah, Tenn

Impact of internet and mobile phone use on pet care

Although the internet can be a valuable resource, overuse can be problematic from a mental health perspective. Internet addiction (also known as problematic internet use) has been broadly defined as “an individual's inability to control their internet use, which in turn leads to feelings of distress and functional impairment of daily activities.”¹ Internet addiction can have negative impacts on personal health as well as family and other relationships.² For example, online gaming addicts suffer from various negative health effects such as lack of exercise, inadequate sleep, and poor nutrition,³ and in extreme cases, online gaming addiction has been found to result in child neglect.³

Similar to the increase in internet use, there has also been a dramatic increase in mobile phone use, which is predicted to only escalate in future years.⁴ Research has found that mobile phone use is associated with an increased risk of accidents and injury, which can be directly attributed to distractions caused by mobile phone use, and an increased prevalence of unsafe behaviors.⁵ Furthermore, research has documented potential negative effects of mobile phone use by parents during meal time⁶ and while caring for their children at playgrounds.⁷ This line of research suggests that distractions caused by mobile phones may result in increased attention-seeking behaviors by children, leading to an increased potential for injuries.

As with other human mental health disorders that affect children and companion animals in similar ways, this raises questions as to whether excessive internet or mobile phone use could also be having a detrimental effect on companion animals. It seems likely, for instance, that excessive internet or mobile phone use could lead to an increased risk of companion animal obesity because of a lack of exercise or, in extreme cases, actual neglect. To our knowledge, no cases of companion animal neglect resulting from internet addiction have been reported, but the impact of internet addiction on the provision of companion animal care is something that should be considered by mental health workers and other relevant professionals. In cases that may arise, various interventions have been highlighted that have been shown to help with this disorder.⁸ Future research on this topic would no doubt benefit from collaborative efforts across human mental health and animal health researchers.

James A. Oxley, MRes

Romford, Essex, England

Lori R. Kogan, PhD

Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences Colorado State University Fort Collins, Colo

Bromethalin intoxication in cats

In 2008, the US Environmental Protection Agency (EPA) enacted a policy that placed restrictions on rodenticides sold to consumers in an effort to reduce exposure to children and non-targeted species. As of January 1, 2015, all consumer-use rodenticides conform to this policy. Importantly, the policy prohibits the use of second-generation anticoagulant rodenticides, which has led to increased production of nonanticoagulant rodenticides such as bromethalin.¹

Consequently, human exposure to bromethalin has increased,² along with a parallel increase in companion animal exposure.³ In the past 6 months, we have documented lethal exposures in cats along the east coast of the United States. As a result, we felt it important to draw attention to what is likely a dangerous trend.

Following ingestion, bromethalin is metabolized to an active metabolite, desmethylbromethalin.⁴ Via uncoupling of oxidative phosphorylation, bromethalin leads to widespread CNS edema, causing increased intracranial pressure, neurologic deficits, and death.^4,5 Pathologically, bromethalin results in spongy degeneration of the CNS white matter.^4,5

Signs of toxicosis are divided into acute and chronic. Acute signs manifest 8 to 12 hours after ingestion but can occur as early as 2 to 4 hours.⁴ Signs include pelvic limb ataxia and weakness, tremors, seizures, anisocoria, abnormal nystagmus, coma, and death from respiratory arrest.^4,5 Signs of chronic toxicosis may be delayed by several days and include lethargy and pelvic limb weakness that progresses to paralysis.⁴ Given this delay, bromethalin intoxication may not be provided due consideration. Cats may be at increased risk, with a lower median lethal dose (0.4 to 0.71 mg of the bait formulation/kg [0.18 to 0.32 mg/lb]) than other species, including rodents.^4,5

Following ingestion of a single lethal dose, cats may survive up to 20 days.⁵ Signs resulting from a sublethal dose may be reversible; however, to date, no specific antidote exists.⁴

Postmortem histologic changes in the CNS combined with detection of bromethalin or desmethylbromethalin in tissues, ingesta, or feces establishes a definitive diagnosis. Presumptive bromethalin intoxication is established through witnessing ingestion or observing the green-blue dye incorporated into the product in ingesta or feces. Antemortem diagnosis remains difficult given the compound's rapid elimination from serum and urine. Although the California Animal Health and Food Safety toxicology service offers expedient, inexpensive, and reliable analysis, the turnaround time may not allow for antemortem diagnosis. In our experience, MRI findings can help raise the index of suspicion for poisoned cats, with diffuse white matter hyperintensity throughout the brain and spinal cord seen on MRI images. Diffusion-weighted images and apparent diffusion coefficient maps may serve as biomarkers for intoxication. The combination of neurologic signs and MRI findings (hyperintensity of the CNS white matter on T2 and diffusion-weighted images and hypointensity on apparent diffusion coefficient maps) provides a presumptive diagnosis.

Supportive treatments include activated charcoal, osmotic diuretics, corticosteroids, and lipid emulsion.⁶ Preventing exposure through client education may best serve our companion animals. In short, the EPA may have inadvertently put companion animals, especially cats, at risk. Future lobbying through the AVMA Congressional Advocacy Network for changes in EPA regulations to drive the consumer market toward rodenticides for which antidotes are available should be considered.

Marc Kent, DVM

Department of Small Animal Medicine and Surgery College of Veterinary Medicine University of Georgia Athens, Ga

Eric N. Glass, DVM, MS

Section Head of Neurology/Neurosurgery Compassion First Pet Hospitals Red Bank Veterinary Hospital Tinton Falls, NJ