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IN SHORT

AVMA ANNOUNCES MEMBERS' ANNUAL MEETING

The 2019 annual meeting of AVMA voting members will be held Friday, Jan. 11, from 8:30–10 a.m. CST at the Chicago Marriott Downtown Magnificent Mile, 540 N. Michigan Ave. As determined by the AVMA Board of Directors, the meeting will be held in conjunction with the regular winter session of the AVMA House of Delegates, during the plenary session of the AVMA Veterinary Leadership Conference.

The meeting will include reports from the treasurer and AVMA staff, a message from the president, speeches by candidates for president-elect, and other information as determined by the House Advisory Committee.

VACCINATING CHICKENS MAY HAVE REDUCED HUMAN ILLNESS

In China, a vaccine administered to chickens may have prevented a wave of human infections with avian influenza, according to a recent article.

In October, researchers with the Chinese Academy of Agricultural Sciences wrote that an inactivated vaccine against H5 and H7 avian influenza strains, administered in September 2017, reduced human infections (Cell Host Microbe 2018;24:558–568). While there were 766 reported human infections with H7N9 from Oct. 1, 2016, through Sept. 30, 2017, only three infections were reported from Oct. 1, 2017, through mid-2018. The authors wrote that vaccinating poultry may have prevented a sixth wave of human infections since 2013.

H7N9 avian influenza viruses have caused at least 1,567 known infections in people in mainland China, Hong Kong, Macau, and Taiwan—and 615 deaths since February 2013.

EARLY TESTS SHOW PROMISE FOR LASSA, RABIES VACCINE

A possible human-use vaccine against Lassa fever and rabies prompted antibody development in tests on mice and guinea pigs.

Preclinical trial results indicate the inactivated vaccine, Lassarab, also protected guinea pigs exposed to Lassa virus 58 days after vaccination, according to an article published Oct. 11 in the journal Nature Communications (available at https://jav.ma/Lassarab) and an announcement from the National Institutes of Health. The vaccine is in development by researchers at Thomas Jefferson University in Philadelphia; University of Minho in Braga, Portugal; University of California-San Diego; and the National Institute of Allergy and Infectious Diseases within the NIH.

The NIH announcement describes Lassarab as a recombinant vaccine candidate that uses a rabies virus vector with added genetic material from the Lassa virus. The vaccine virus expresses surface proteins from both the rabies and Lassa viruses.

Lassa fever is endemic in West Africa, where it spreads through Mastomys rats and bodily fluids of infected people.

WELBORN RECEIVES AAHA DEDICATED SERVICE AWARD

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Dr. Link Welborn

Citation: Journal of the American Veterinary Medical Association 253, 11; 10.2460/javma.253.11.1365

The American Animal Hospital Association awarded the first AAHA Dedicated Service Award in September to Dr. Link Welborn, a past president of AAHA and owner of four small animal hospitals in Florida.

The AAHA Dedicated Service Award is awarded to a veterinarian who is an AAHA member involved in or retired from clinical private or academic practice and who has at least 20 years of commitment and service to AAHA, the profession, the community, and patients as well as excellence in small animal medicine.

Dr. Welborn chaired AAHA task forces that produced revisions to the AAHA Standards of Accreditation for small animal practices, the first AAHA Standards of Accreditation for specialty practices, and the 2011 AAHA Canine Vaccination Guidelines. He was a member of the AAHA-AVMA task force that developed guidelines for canine and feline preventive care (J Am Anim Hosp Assoc 2011;47:306–311). He served as AAHA delegate to the AVMA House of Delegates from 2009–16.

A diplomate of the American Board of Veterinary Practitioners, certified in canine and feline practice, Dr. Welborn earned his veterinary degree in 1982 from the University of Florida.

AAFP grows in service to cats, profession

Offerings from American Association of Feline Practitioners include Cat Friendly Practice program, practice guidelines, annual conference

By Katie Burns

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Attendees interact with a cat in the exhibit hall during the 2018 AAFP Conference, Sept. 27–30 in Charlotte, North Carolina, which brought in a total of 1,467 attendees. (Photos courtesy of AAFP)

Citation: Journal of the American Veterinary Medical Association 253, 11; 10.2460/javma.253.11.1365

The continuing growth of the Cat Friendly Practice program, the release of feline anesthesia guidelines, and a well-attended conference have been among the highlights during the past year for the American Association of Feline Practitioners.

The AAFP, which emphasizes that any veterinarian who sees even one cat is a feline practitioner, grew to 4,000 members in 2018. The Cat Friendly Practice program, a benefit of AAFP membership, increased to 1,171 practices. A survey in December 2017 found a 99 percent satisfaction rate among practices that had earned the designation.

The association published the first feline-specific anesthesia guidelines in the July 1 issue of the Journal of Feline Medicine and Surgery (J Feline Med Surg 2018;20:602–634)—the latest in the series of AAFP Practice Guidelines.

The 2018 AAFP Conference, Sept. 27–30 in Charlotte, North Carolina, brought in a total of 1,467 attendees. These comprised 1,009 veterinarians, 145 veterinary technicians and nurses, 33 practice managers and hospital staff members, 52 students, and 228 exhibitors and guests. In the wake of Hurricane Florence hitting North Carolina, the association collected donations on-site. The conference focused on senior and geriatric care and on emergency medicine and critical care, along with offering a track on practice management for the first time.

In 2019, Dr. Apryl Steele will assume the office of AAFP president (see page 1369).

CAT FRIENDLY PRACTICE PROGRAM

The AAFP established the Cat Friendly Practice program in 2012 to minimize stress associated with veterinary visits for cats, caregivers, and the veterinary team. The association conducts an annual survey of practices that have earned the designation. With 526 respondents, the survey at the end of 2017 found that 98 percent would recommend the program to other veterinary professionals, according to a January announcement about the results.

Respondents also reported the following:

  • • Ninety-two percent stated the program has positively impacted their team morale when handling, treating, and caring for cats. Many practices commented that they are now more confident when working with cats, and their whole team has adopted the use of cat-friendly techniques to reduce stress during the visit.

  • • Ninety-one percent reported an improvement in feline knowledge and care among team members. Many practices noticed a great improvement in staff understanding of feline behavior, feline-friendly handling, and the ability to read a cat's body language.

  • • Eighty percent received positive feedback from clients.

  • • Eighty percent increased visits.

  • • Seventy-nine percent increased practice revenue.

  • • Seventy-five percent reported the acquisition of new feline patients.

  • • Sixty-one percent reported a reduction in injuries when handling cats.

FELINE ANESTHESIA GUIDELINES

“The overarching purpose of the AAFP Anesthesia Guidelines is to make anesthesia and sedation safer for the feline patient,” said Heather O'Steen, AAFP chief executive officer, in a July announcement. “We are committed to improving the health and welfare of all cats and providing this resource to veterinary teams is an important milestone.”

Content has been organized under specific topics: use and care of equipment, preanesthetic assessment, co-morbidities, critical-patient emergencies, anesthesia and sedation, perioperative complications, and anesthetic recovery.

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An attendee at the AAFP conference participates in a workshop on feline-friendly handling, a key aspect of the association's Cat Friendly Practice program.

Citation: Journal of the American Veterinary Medical Association 253, 11; 10.2460/javma.253.11.1365

Drs. Susan M. Gogolski and Sheilah A. Robertson, guidelines co-chairs, said in a joint statement: “By proactively developing an individualized anesthetic plan that considers the uniqueness of each feline patient and recognizing that ‘one size does not fit all,’ the experience for the cat can be improved and the outcome successful. It is our hope that these Guidelines will become the practice's go-to resource and each team member will have a new awareness of all the tools and techniques available to them.”

The anesthesia guidelines, a client brochure, and supplemental resources are available on the AAFP website at www.catvets.com/anesthesia. The entire series of AAFP Practice Guidelines is at www.catvets.com/guidelines.

AAFP CONFERENCE

The 2018 AAFP Conference took place not long after Hurricane Florence made landfall in North Carolina. Although Charlotte is far inland, attendees wanted to know how they could help. The AAFP put up a page on the conference website with suggestions for donating online, and the association collected donations on-site such as toys and cat litter for feline rescue organizations.

The pre-conference day featured a workshop on feline-friendly handling and the annual seminar in partnership with the American Board of Veterinary Practitioners. Each of the three conference days offered two tracks for veterinarians, with the first day also offering the track on practice management and the second and third days offering a track for veterinary technicians.

Dr. Paula Monroe-Aldridge, 2018 AAFP president and a member of the conference planning task force, said the AAFP tries to pick speakers who provide not only the academic side of continuing education but also ideas to implement in practice. The subjects of presentations ranged from Pandora's syndrome and ultrasound techniques to anesthesia and analgesia for older cats and the sedation of critically ill cats.

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An attendee sports cat ears during a session at the AAFP conference. The conference focused on senior and geriatric care and on emergency medicine and critical care, along with offering a track on practice management for the first time.

Citation: Journal of the American Veterinary Medical Association 253, 11; 10.2460/javma.253.11.1365

The association devoted a day and a half to senior and geriatric care, concluding with a Q&A panel of the primary speakers, and a day and a half to emergency medicine and critical care. The track on practice management took on the topics of cat-friendly housing, preventive care, client compliance, and a cat-friendly team mission as well as LGBTQ+ inclusion and mental health in the veterinary profession.

THE PATH FROM A POLYDACTYL CAT TO THE AAFP PRESIDENCY

By Katie Burns

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Dr. Apryl Steele

Citation: Journal of the American Veterinary Medical Association 253, 11; 10.2460/javma.253.11.1365

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Dr. Kelly St. Denis

Citation: Journal of the American Veterinary Medical Association 253, 11; 10.2460/javma.253.11.1365

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Dr. Paula Monroe-Aldridge

Citation: Journal of the American Veterinary Medical Association 253, 11; 10.2460/javma.253.11.1365

Even though her family could not afford to go to a veterinarian, Dr. Apryl Steele decided at a very young age that she wanted to be one. Growing up, her best friend was her polydactyl cat named Thumbs.

At age 9, she started watching surgeries at a veterinary practice. In 2019, she will become president of the American Association of Feline Practitioners.

After graduating from high school in 1989, Dr. Steele started her undergraduate studies at Colorado State University. After a year, a friend convinced her to enlist in the Army. Dr. Steele served in the Army Veterinary Corps during Operation Desert Storm. She went on to earn her veterinary degree from Colorado State University in 1997.

Dr. Steele joined what had been a solo practice. After a couple of years, she purchased a 1 1/2-doctor practice in Denver from a retiring veterinarian. She renamed it Tender Touch Animal Hospital, and the hospital grew into a five-doctor practice. The hospital had been a feline-only practice emphasizing alternative medicine, but Dr. Steele opened up the practice to traditional medicine and dogs. Even so, cats accounted for 60 percent of patients when she sold the practice in 2015.

Along with becoming president of the AAFP, Dr. Steele has been president of the Denver-Area Veterinary Medical Society and Colorado VMA as well as the Animal Assistance Foundation, a Colorado animal welfare organization. As CVMA president, she got to know the Dumb Friends League out of Denver. The CVMA and Dumb Friends League collaborate on efforts to improve animal health.

In 2015, Dr. Steele joined the Dumb Friends League to become the successor to Bob Rohde, who had led the league for decades. She became president and CEO in February. She said, “It took me a while to really even envision myself doing anything other than practicing medicine, but once I started thinking broader about the number of animals I could impact, I took on this challenge and this opportunity.”

Dr. Steele said the value of involvement in organized veterinary medicine is being able to understand what the profession is facing and being part of the conversation. She said, “When you're in practice doing everything you can every day to do the best for your patients, you aren't able to lift your head up and look around and see what's going to impact you in five or 10 years, in either a positive or a negative way, either to support it or head it off.”

Dr. Steele said the AAFP wants to become the go-to resource for veterinarians, veterinary teams, and pet owners to make cats' lives the best they can be. Beyond the association's Cat Friendly Practice program, the AAFP is reaching out directly to pet owners to provide education about the need for routine check-ups, the value of cats, and creating cat-friendly homes. The association also is focusing on its strategic planning goals to create new resources, education, and opportunities for veterinary professionals and cat caregivers.

“Cats are becoming more valued in our society,” Dr. Steele said, and the AAFP has been growing alongside.

Joining Dr. Steele as AAFP officers are Drs. Kelly St. Denis, Brantford, Ontario, president-elect; Paula Monroe-Aldridge, Tulsa, Oklahoma, immediate past president; and Roy B. Smith, Round Rock, Texas, treasurer.

The continuing conundrum of feline injection-site sarcomas

By Katie Burns

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According to 2013 guidelines from the American Association of Feline Practitioners on vaccination of cats: “The majority of safety and efficacy data comes from licensing studies in which vaccines are administered subcutaneously in the interscapular region. Due to concerns of potential sarcoma development, practitioners may consider giving vaccines in other locations.”

Citation: Journal of the American Veterinary Medical Association 253, 11; 10.2460/javma.253.11.1365

Veterinarians would much rather talk with cat owners about all the advantages of vaccination for cats rather than the extremely rare occurrence of feline injection-site sarcomas.

Estimates suggest that the risk of sarcoma development following vaccination is well below one per 10,000 doses of vaccine, according to the 2013 vaccination guidelines from the American Association of Feline Practitioners. The problem is, as noted by Dr. Apryl Steele, 2019 AAFP president, “There are currently no known management options to prevent or cure FISS.”

Nevertheless, practitioners and researchers have continued working on answers for this aggressive form of cancer ever since a 1991 letter to the editor in the JAVMA suggested a potential association between vaccination of cats for rabies and development of sarcomas. Recent studies have examined areas such as incidence, pathophysiology, diagnostic imaging, prognostic markers, and treatment.

The AAFP guidelines recommend vaccination sites low on the legs rather than in the interscapular region “to facilitate complete tumor removal by limb amputation in the event that FISS develops.” University of Florida researchers published a pilot study soon afterward suggesting that administering vaccines in the distal part of the tail is as effective as administering vaccinations at traditional sites (J Feline Med Surg 2014;16:275–280).

Per the AAFP guidelines, “FISS risk following vaccination likely results from a complex interaction of multiple extrinsic (e.g., frequency and number of vaccines administered over time, composition of the injected product, etc) and intrinsic factors (e.g., genetic predisposition, tissue response following injection, etc).” Cornell University researchers published a study in 2017 finding that a feature of FISS is DNA damage, noting that response mechanisms to DNA damage can promote resistance to chemotherapy (Vet Comp Oncol 2017;15:518–524).

Dr. Karen Stasiak, veterinary medical lead for pet care biologicals at Zoetis Inc., said of FISS, “It is the topic in veterinary medicine that evokes the strongest emotion and opinion, yet the science of it remains muddled at best, and our understanding of even the pathophysiology of the disease state still eludes us.”

Dr. Stasiak earned her veterinary degree and went into small animal practice in 2001, the year that the Vaccine-Associated Feline Sarcoma Task Force issued a groundbreaking report. The AVMA, American Animal Hospital Association, AAFP, and Veterinary Cancer Society had formed the task force in 1996. The report generated more questions than answers, Dr. Stasiak said, but research carried on after the dissolution of the task force, and injection sites became standardized to facilitate tumor removal.

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“Current research indicates that radical surgical resection of injection-site sarcomas, including margins of 5 cm when possible, is associated with the highest response rate and long-term survival,” according to the 2013 AAFP vaccination guidelines. The guidelines recommend regions in green as injection sites for cats. “Those in red are key sites that should be avoided,” according to the guidelines.

Citation: Journal of the American Veterinary Medical Association 253, 11; 10.2460/javma.253.11.1365

The concerns started out with vaccines and expanded to all injections. Trying to tease out the causality of FISS is exceedingly difficult because the incidence is so rare. Dr. Stasiak said, “I do worry that this kind of makes people phobic of injecting things into cats.”

According to the AAFP guidelines, initial studies suggested a risk of sarcoma development of about two per 10,000 doses of vaccine, which increased to 13–36 per 10,000 doses in other studies. Estimates based on larger epidemiologic studies published between 2002 and 2007 suggest that the risk of sarcoma development following vaccination is actually very low, well below one per 10,000 doses of vaccine.

Dr. Stasiak said one recommendation for FISS prevention is to inject cats only as necessary, whether with a vaccine or a microchip. According to the AAFP vaccination guidelines: “The veterinarian should undertake a clinical risk/benefit assessment for each animal and discuss recommended vaccination schedules with the owner so that they can make an informed choice. The assessment should include discussion on the likelihood of exposure, the health and lifestyle of the animal, and the risks related to vaccination.”

Also according to the guidelines, “Although initial reports linked development of sarcomas at vaccination sites with the use of inactivated rabies or FeLV vaccines, and aluminum-based adjuvants, more recent studies found no relationship between vaccine type, brand or use of inactivated versus modified-live vaccines and the risk of subsequent sarcoma formation.”

The AAFP guidelines recommend instructing cat owners to monitor vaccine sites for any swelling or lumps, Dr. Steele said. The 3–2–1 rule is to perform an incisional biopsy if a lump persists for three months or longer after an injection, ever becomes larger than 2 centimeters in diameter, or continues to increase in size one month after an injection.

Dr. Stasiak said FISS treatment causes angst because the mainstay is aggressive surgery. Surgery must be planned carefully, using imaging to understand the full extent of the sarcoma. Treatment also may include radiation and chemotherapy.

Among current research efforts, a team at the University of Illinois is studying the approach of placing beads under cats' skin to administer carboplatin to tumors but not to other parts of the body. A team at Washington State University is studying placing radioactive material directly into tumors to shrink them for easier removal by surgery.

Stepping back to look at the big picture, Dr. Stasiak said the risk of FISS does not compare with the risk of many common diseases that are mostly preventable via vaccination.

Back in 2001, the Vaccine-Associated Feline Sarcoma Task Force concluded: “Vaccine-associated feline sarcomas are a conundrum for the veterinary medical profession. We do not understand the attributes of the feline immune system and genome that make cats susceptible to VAFS, yet we must continue to vaccinate cats against key infectious diseases.”

POSSIBLE LINK BETWEEN HOUSEHOLD CHEMICAL, FELINE HYPERTHYROIDISM

A study found that serum from hyperthyroid cats had a higher mean total concentration of per- and polyfluoroalkyl substances, found in household products including stain-repellent fabrics, compared with serum from nonhyperthyroid cats. The concentration of perfluorooctanoic acid was significantly higher in hyperthyroid cats' serum.

Researchers from the California Environmental Protection Agency and Albany Animal Hospital in Albany, California, published the results in October in the journal Environmental Toxicology and Chemistry (Environ Toxicol Chem 2018;37:2523–2529), available at https://jav.ma/catthyroid.

According to the U.S. Environmental Protection Agency: “Certain PFAS chemicals are no longer manufactured in the United States as a result of phase outs including the PFOA Stewardship Program in which eight major chemical manufacturers agreed to eliminate the use of PFOA and PFOA-related chemicals in their products and as emissions from their facilities.”

In the study, researchers reported PFAS concentrations in the serum of two groups of Northern California cats older than 10 years, collected from 21 cats from 2008–10 and collected from 22 cats from 2012–13. The mean total PFAS concentration was lower in the second period than the first period, although PFAS profiles remained similar. The researchers also analyzed PFAS concentrations in human serum collected from 2008–10 in the same geographic area.

Long-chain perfluorinated carboxylic acids, particularly perfluorononanoic acid and perfluoroundecanoic acid, were significantly higher in the cats' serum than in humans. It was the serum from hyperthyroid cats in the second time period that showed a higher mean total PFAS concentration relative to serum from nonhyperthyroid cats. According to the abstract, “This result may indicate a possible link between PFAS levels and cat hyperthyroid, warranting a larger study for further investigation.”

COMPANIES TO PAY $7M FOR PET FOOD FRAUD

By Greg Cima

Two companies will pay $7 million after admitting that they omitted poultry meal from pet foods or replaced it with feather and bone meals.

Wilbur-Ellis Co., which makes ingredients used in the pet food industry, will pay about $4.5 million in restitution and $1 million in criminal forfeitures, according to an Oct. 11 announcement from the Department of Justice. Company officials pleaded guilty in April to introducing adulterated food into interstate commerce, according to documents filed in the U.S. District Court in St. Louis.

Diversified Ingredients Inc., a commodities broker in pet food industries, will pay $1.5 million in restitution and $75,000 in criminal forfeiture. That company's leaders pleaded guilty in July to introducing adulterated and misbranded foods.

The DOJ announcement states that Wilbur-Ellis officials in Rosser, Texas, replaced chicken and turkey meal with cheaper substitutes, such as feather meal and feed-grade chicken bone byproduct meal. They also omitted ingredients, including the turkey meal in a product identified as turkey meal.

Both companies were accused of shipping fraudulent ingredients from January-April 2014.

One employee of each company also has pleaded guilty to misbranding and adulteration charges: Henry R. Rychlik, who was a quality manager responsible for product formulations at the Texas facility, and Collin McAtee, who bought, sold, and shipped foods for Diversified Ingredients. At press time, both were scheduled for sentencing Dec. 14.

Wilbur-Ellis leaders provided a statement that blames the fraud on a former owner of a company Wilbur-Ellis bought in 2011. The former owners of American By-Products Inc. had continued working as managers at the manufacturing facility in Texas.

“For our part, Wilbur-Ellis acknowledges insufficient oversight processes in place at the time,” Wilbur-Ellis officials said in the statement. “While the safety and nutrition of our pet food ingredients were never called into question, we have taken this matter very seriously and have strengthened oversight processes over the past several years.”

Among the former owners listed on a 2011 press release when Wilbur-Ellis bought American By-Products, none have been charged with any crimes.

Daniel D. Doyle, who is an attorney for Diversified Ingredients, said his clients learned about the fraud from the Wilbur-Ellis plant during a lawsuit filed in 2014, when Nestle Purina PetCare Co. had accused Blue Buffalo Co. Ltd. of making false claims about Blue Buffalo's pet food ingredients. He said Diversified Ingredients officials had no intent to defraud people.

Doyle said his clients had relied on their customers to perform quality assurance-related testing, and Diversified Ingredients since has added more quality assurance activities including audits of suppliers.

Nestle Purina's lawsuit is ongoing, as is Blue Buffalo's countersuit that Nestle Purina is making false attacks in an advertising campaign.

FDA MAY CHANGE DRUG USES IN 5-YEAR PLAN

By Greg Cima

Federal authorities plan to expand limits on who can buy antimicrobials for use in livestock and how long they can be used.

Authorities also will increase monitoring of antimicrobial use and resistance in agriculture and promote antimicrobial stewardship across veterinary medicine.

Under the Food and Drug Administration Center for Veterinary Medicine's plan published this fall, “Supporting antimicrobial stewardship in veterinary settings: Goals for fiscal years 2019–2023,” farmers would need a prescription or a similar veterinary feed directive to access any of the antimicrobials that are in drug classes shared with human medicine. Agency officials also plan to develop recommended treatment times for those drugs for which guidance is absent.

The plan is a continuation of agency efforts to require veterinarian oversight of antimicrobials that are in the same drug classes as those used in human medicine. Under threat of regulatory action, pharmaceutical companies agreed to comply with an agency plan that removed over-the-counter access to such drugs delivered in feed and water.

That change, enacted in January 2017, affected about 95 percent, by weight, of all such medically important antimicrobials given to livestock. At the same time, the agreements also forbid use of those drugs for production purposes—such as growth promotion—rather than disease.

The changes proposed in the five-year plan would target the remaining medically important antimicrobials not already under veterinarian oversight, including over-the-counter injectable and intramammary products.

FDA officials also have been searching for ways to limit how long animals receive some approved antimicrobial treatments. A September 2016 Federal Register notice called for ideas on how to create proper and targeted treatment durations for instances when such guidance is absent from the labels, which sometimes contain instructions such as “feed continuously.”

“Establishing defined durations of use for currently approved therapeutics will support FDA's efforts to foster stewardship of medically important antimicrobial drugs in food-producing animals and help preserve the effectiveness of these antimicrobials in animal and human medicine,” the notice states.

The CVM's plan for fiscal years 2019–23 also includes drafting a strategy to promote antimicrobial stewardship in companion animal medicine.

“This includes a strategy to address potential development of antimicrobial resistant bacteria in companion animals,” the plan states. “The development of antimicrobial resistant bacteria may impact the ability to effectively treat bacterial infectious disease in companion animals and increase the potential for transfer of antimicrobial resistant bacteria from companion animals to humans through direct or indirect contact.”

Agency officials also plan to collect more data on antimicrobial uses in agriculture, evaluate antimicrobial resistance patterns in isolates from animals—including farmed aquatic animals—administered antimicrobials in drug classes shared with human medicine, encourage careful use of antimicrobials in all animals, improve access to drug label information for people who work with animals, identify illegal marketing of animal drugs, help other countries create their own stewardship programs, and share more data on antimicrobial use and resistance.

AABP OFFERS WORKSHOPS ON MANAGING RURAL PRACTICES

The American Association of Bovine Practitioners is offering workshops for recent veterinary graduates in rural areas who are looking to buy or build a practice, need help understanding practice finances, or need more instruction on human resources management. The Manage Your Rural Practice for Success workshops consist of two intensive, three-day workshops held a year apart, in St. Louis.

Participants can be from or adjacent to a shortage area designated by the federal Veterinary Medicine Loan Repayment Program or, if not serving in or planning to serve in a VMLRP area, indicate why the area they are serving in should be considered a shortage area. The AABP will award participants a $900 stipend for each workshop to offset travel expenses. Some seats will be available at each workshop for a second person from the primary participant's practice to attend for a fee of $250.

The deadline for applications is 5 p.m. EST on Dec. 15. The full details and online application form are available at www.aabp.org/next_gen.

THE CORPORATIZATION OF VETERINARY MEDICINE

Corporation's involvement in historically entrepreneurial profession generates uncertainty

By R. Scott Nolen

Like many veterinarians, Dr. Colleen Currigan wanted to be her own boss.

“From the day I graduated from veterinary school, my hope was that I might someday own my own feline practice,” she recalled.

After receiving her veterinary degree in 1985 from The Ohio State University, Dr. Currigan spent the next several years making her dream a reality, first as an associate with a feline-exclusive practice in Chicago, then as a house-call practitioner. At last, in 1998, she opened the Cat Hospital of Chicago in a strip mall on the city's North Side.

Dr. Currigan grew her practice into a thriving business with three associate veterinarians and bringing in more than $1 million in revenue annually.

By 2014, Dr. Currigan had begun thinking about her “exit plan,” even though she expected any such exit to be years down the road. She and one of her associates discussed forming a partnership, with the associate eventually buying out Dr. Currigan's share of the clinic. It was not to be, however; and in November of the following year, Dr. Currigan sold the Cat Hospital of Chicago to Companion Animal Practices North America, which owns more than 80 companion animal hospitals nationwide.

She remained with the practice, first as an associate veterinarian and now as hospital director. Overall, the experience has been “very positive,” said Dr. Currigan. “Although I certainly cannot speak for all corporate groups, I can say that CAPNA has been very supportive of its hospitals and of ongoing continuing education and personal development for its veterinarians as well as its hospital team members,” she said.

ONCE UPON A TIME

Corporate-owned veterinary practices have been around for roughly 30 years, ever since VCA Animal Hospitals acquired its first independently owned companion animal clinic in 1987. Currently, VCA operates over 800 clinics throughout North America.

The success of VCA led to the formation of several national and regional chains, such as Banfield Pet Hospital, BluePearl, and Heartland Veterinary Partners. Analysts put the number of corporate veterinary practice groups at now just over 40. Private equity firms, which see companion animal practice as a relatively safe investment offering respectable returns, are funding many of the acquisitions by corporate groups.

Depending on the source, the number of veterinary practices in the U.S. ranges from 28,000 to 32,000, according to the 2017 AVMA Report on the Market for Veterinary Services. Brakke Consulting tracks corporate purchases of veterinary clinics and estimates that about 3,500 are company-owned. John Volk, an analyst with Brakke, says corporations own about 10 percent of general companion animal practices and 40 to 50 percent of referral practices.

What's occurring in veterinary medicine is a common business strategy applied to many industries made up of multiple, small, independently owned companies. “It's called roll up,” Volk explained. “What happens is a larger company comes in and buys up the smaller companies and builds a bigger firm.”

Banfield, VCA, and the rest don't purchase just any practice, says Volk. What they look for is a multiveterinarian business generating at least $1.2 million annually. “Over the years, what companies have found is that if they buy small practices or fixer-uppers, they don't do very well with them,” he said. “And less than half of independent veterinary practices fit that category.”

Corporations aren't purchasing then closing practices as a tactic to drive out competition, added Volk.

WELCOME TO MARS INC.

Within recent years, Mars Inc. has emerged as the top corporate owner of veterinary practices. The privately held company known for M&Ms as well as Pedigree, Iams, and Nutro pet foods has dramatically grown its Petcare subsidiary with acquisitions such as Banfield, BluePearl, Pet Partners, and most recently VCA, purchased for $9.1 billion in September 2017.

Marta Monetti, vice president of Mars Veterinary Health, said the company owns more than 2,000 veterinary hospitals in the United States and Europe, and employs over 50,000 veterinarians, making it the world's largest practice owner and employer of veterinarians.

“Pet care has been an important part of Mars for more than 80 years, and our growing veterinary business represents Mars Petcare's entry into veterinary care on a global scale to deliver on our purpose: a better world for pets,” said Monetti.

During an appearance at Banfield's Pet Healthcare Industry Summit this past September, Pamela Mars, an heir to the family's candy and pet food fortune and its Petcare division ambassador, described Mars as a family-owned company that followed its passion for pets into the veterinary market in 1994. She and her three sisters each inherited an estimated 8 percent stake in Mars when their father, Forrest Mars Jr., died in 2016.

“We got into this business because we love pets,” not for financial gain, said Mars, who owns three Maine Coon cats and whose net worth is estimated at $6.2 billion. “My view is—and my family shares this—from the minute you get your pet you want that pet to live as long of a healthy, productive, pain-free, wonderful life as possible.”

With that in mind, the company's involvement in the delivery of veterinary care is for “the long haul,” which she acknowledged could be good or bad depending on a person's perspective.

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Dr. Colleen Currigan owned the Cat Hospital of Chicago for over a decade before selling the practice to Companion Animal Practices North America, owner of more than 80 companion animal hospitals nationwide. “I never in a million years dreamed I would ever sell to a corporate group,” said Dr. Currigan, who has remained at the practice as hospital director. (Photo by R. Scott Nolen)

Citation: Journal of the American Veterinary Medical Association 253, 11; 10.2460/javma.253.11.1365

“If you don't like us, bummer, you're stuck with us for a long time. If you like us and think we can make change, we're willing to work with others to make that happen,” Mars said.

Later, she added that the company is willing to work with anyone to make veterinary care affordable for everyone. “Shouldn't everybody be able to have a pet in their life if that's what they want to do?” she asked.

WHAT'S IT ALL MEAN?

The question is how the corporate presence will affect veterinary medicine. It's not just veterinarians asking, either. From software manufacturers to practice management companies, businesses that market to the animal health industry want to know what it means to their bottom line.

The short answer is no one truly knows.

“As a profession, we're behind in our understanding of some of these trends because it's been happening faster than anyone anticipated,” said Matthew Salois, PhD, director of the AVMA Veterinary Economics Division.

Dr. Salois says the AVMA has a much greater understanding about the economies of independently owned veterinary hospitals than it did prior to the division's creation in 2011. The same can't be said for corporate-owned practices.

“We need to gather more and better information on corporate practices, but it's difficult,” said Dr. Salois. “We can survey private practices because they are AVMA members, but corporate entities are more protective of their data.”

The sudden, intense interest in practice consolidation; the growth of large group practices; and the evolving role of the small practice are, according to Dr. Salois, an opportunity for the AVMA to better understand these trends and educate the profession. “By building more partnerships and continuously improving our data and resources across all practice types, we can position ourselves to better address these questions,” he said.

From seller's remorse to client rage, anecdotes about the downside of corporate ownership abound. Yet there is no evidence that corporate-owned veterinary practices are inherently worse—or better, for that matter—than independently owned practices in terms of efficiency, patient care, staff salary and benefits, or client satisfaction. Many corporate practices have been in business long enough that, by now, institutional deficiencies in these areas would be apparent.

“Corporate practices have obviously got enough clients that they're surviving,” said Dr. Karen Felsted, president of Felsted Veterinary Consultants Inc. “You hear all the complaints, but clearly the corporates aren't so bad that they're driving all the clients back to independently owned practices.”

Changes in practice culture are another question. Dr. Currigan says selling the Cat Practice of Chicago to CAPNA was a positive experience but not without the “lumps and bumps” that accompany any transition. “I can honestly say clients haven't noticed any differences, even nearly three years out,” she said. “We are still the same team, with the same cat-friendly practice culture that we've always been.”

Given the small number of veterinary practices that corporations are interested in purchasing, Dr. Felsted isn't worried that independently owned clinics will one day be a minority. “I don't see how corporates can ever own the veterinary profession in the same way that the pharmacy profession is essentially owned—unless somebody can figure out how to do something with the small one-doctor practices,” she said. “There's still going to be a tiny practice in Timbuktu, Texas, that a corporate group doesn't want to buy.”

A SELLER'S MARKET

The traditional model for veterinary practice acquisition is the owner sells to an associate veterinarian, likely groomed to one day take the reins, or to a veterinarian not employed by the clinic. That is no longer the case for select companion animal and referral practices. Those fortunate owners find themselves in a seller's market where companies are willing to pay top dollar for a thriving practice.

“Some veterinarians have made a fortune out of their practices, making probably two and three times what they would have historically gotten, so for them it's been fantastic,” said Dr. Felsted.

But not everyone benefits. “If you're a younger veterinarian wanting to buy one of these high-earning practices, it's incredibly hard to do these days,” she explained, “because either they're already bought up by corporates or the owner wants to sell at a corporate price, and a younger veterinarian can't get financing for that.”

Volk says the traditional model is more common than a corporate buyout. He encourages associate veterinarians to become practice owners and tells them there are a lot of practices available—smaller clinics that corporations aren't interested in or independently owned practices with owners who simply won't sell to a corporation. “They prefer to keep the practice independent and sell to an associate or multiple associates that have been involved in the practice for a number of years,” Volk said.

Dr. Currigan recommends owners begin thinking about selling their practices 10–15 years ahead of time. “Research all of your options: corporate sale, associate buy-in, noncorporate sale, merger with another practice, and so on,” she advised.

“I never in a million years dreamed I would ever sell to a corporate group,” Dr. Currigan continued. “But for me, in the end, after months of due diligence, I realized it was the right decision and the best fit for my future and the future of Cat Hospital of Chicago and its team.”

Malinda Larkin contributed to this story.

AAHA NOW OFFERS NETWORK ACCREDITATION

PetWell Partners, a Houston-based national veterinary practice network, has become the first organization to earn Practice Network Accreditation from the American Animal Hospital Association.

Announced in October, Practice Network Accreditation is a model for assessing and recognizing an organization that owns or operates multiple veterinary practices, according to a press release.

Under this model, the parent company receives accreditation rather than individual practices. To become accredited, an organization must meet standards that are separate from AAHA's traditional medical standards and designed to evaluate business operations at the network level, including medical autonomy, leadership, culture, human capital management, marketing and communications, financial management, and stewardship of the veterinary profession.

For an organization to be eligible, 90 percent or more of its practices must be accredited or pre-accredited according to the AAHA Standards of Accreditation.

“As the trend of corporate ownership increases throughout the profession, there is an opportunity to standardize best practices for delivery of care to improve patient health while helping these companies promote excellence throughout the practices within their network,” said AAHA CEO Michael Cavanaugh in the release.

Founded in 2013, PetWell Partners is a network of more than 30 hospitals, all of which are AAHA-accredited or pre-accredited.

Obituaries AVMA MEMBER | AVMA HONOR ROLL MEMBER | NONMEMBER

BRIDGET M. FELDHAUS

Dr. Feldhaus (Texas A&M ‘12), 32, Seguin, Texas, died July 19, 2018. She was a small animal veterinarian. Dr. Feldhaus is survived by her parents, three brothers, and four sisters.

THOMAS M. FORD

Dr. Ford (Michigan State ‘57), 86, Ann Arbor, Michigan, died Aug. 10, 2018. A diplomate of the American College of Laboratory Animal Medicine, he worked for Abbot Laboratories in Chicago from 1965 until retirement in 1995. Following graduation and after earning his master's in microbiology in 1959 from Michigan State University, Dr. Ford trained in laboratory animal medicine at the university and what was known as the Bowman Gray School of Medicine in Winston-Salem, North Carolina. He then worked in the animal care unit of the University of Michigan before joining Abbott Laboratories. Dr. Ford's wife, Heidi; a son and a daughter; a grandchild; and a sister survive him.

JOHN ‘JACK’ L. GLEASON

Dr. Gleason (Cornell ‘69), 74, Amherst, New Hampshire, died Aug. 15, 2018. A small animal veterinarian, he owned Amherst Animal Hospital prior to retirement. Dr. Gleason served on the New Hampshire Board of Veterinary Medicine for five years.

He was a member of the Amherst Conservation Commission for nine years and New Hampshire Cooperative Extension's Continuing Education Committee for 10 years. With a profound interest in nature, Dr. Gleason served on the board of directors of the New Hampshire Audubon's Nashaway Chapter and was a past Audubon Volunteer of the Year. He served as a natural resources steward, part of a community of volunteers caring for the nature of New Hampshire, and was the steward for the Ponemah Bog Wildlife Sanctuary in Amherst. Dr. Gleason was also a master gardener.

He is survived by his wife, Jan; a son and a daughter; two grandchildren; and three sisters. Memorials may be made to the Dana Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02115, or New Hampshire Audubon Society, 84 Silk Farm Road, Concord, NH 03301.

DANIEL J. HANLEY

Dr. Hanley (Kansas State ‘82), 67, Little Rock, Arkansas, died Aug. 12, 2018. He practiced equine medicine in Arkansas' Pulaski County for 36 years. Dr. Hanley is survived by his wife, Georgette; his mother; and a sister. Memorials, toward the Excellence in Veterinary Medicine Scholarship V93920, may be sent to the Kansas State University Foundation, Kansas State University College of Veterinary Medicine, 1800 Kimball Ave., Suite 200, Manhattan, KS 66502; or memorials may be made to the American Association of Equine Practitioners Foundation, 4033 Iron Works Parkway, Lexington, KY 40511.

LONNY HAYNES

Dr. Haynes (Colorado State ‘87), 71, Denver, died Sept. 14, 2018. Following graduation, Dr. Haynes owned a small animal practice in Denver. He subsequently served as a relief veterinarian with Banfield Pet Hospital in Denver. Dr. Haynes then entered academia, teaching veterinary technician students at the Bel-Rea Institute of Animal Technology in Denver, focusing on surgery. He is survived by his life partner, Peggy Williams; a daughter and a son; five grandchildren; a great-grandchild; and a brother. Memorials, toward a scholarship fund in his name, may be made to Bel-Rea Institute of Animal Technology, 1681 S. Dayton St., Denver, CO 80247.

LEE A. HOLDEN JR.

Dr. Holden (Texas A&M ‘52), 92, Oklahoma City, Oklahoma, died Sept. 3, 2018. He was a co-founder of Britton Road Veterinary Clinic in Oklahoma City, retiring at the age of 90. Dr. Holden served in the Navy during World War II. His wife, Linda; a son and a daughter; and two grandchildren survive him. Memorials may be made to the Wounded Warrior Project, 4899 Belfort Road, Suite 300, Jacksonville, FL 32256.

KEVIN K. KISTHARDT

Dr. Kisthardt (Texas A&M ‘90), 55, Bryan, Texas, died Sept. 2, 2018. During his career, he was in private practice in California; taught at the Oregon State University and Auburn University veterinary colleges; and served as an assistant professor in immunology and large animal medicine at the Tuskegee University College of Veterinary Medicine. Dr. Kisthardt's daughter, mother, and two brothers survive him. Memorials may be made to the Auburn University College of Veterinary Medicine, Auburn, AL 36849.

BRENT M. LEH

Dr. Leh (Illinois ‘12), 32, Edwardsville, Illinois, died Oct. 6, 2018. He worked at Hawthorne Animal Hospital, a practice founded by his grandfather, Dr. Merrill Ottwein (Illinois ‘56), in Glen Carbon, Illinois, where he focused on emergency and critical care medicine. Dr. Leh was a member of the Illinois State VMA. He is survived by his life partner, Molly Harris; his parents; and a brother, three stepbrothers, and a stepsister.

WILLIAM M. MARTIN

Dr. Martin (Oklahoma State ‘74), 73, Glendale, California, died July 25, 2018. He owned Parkview Pet Clinic in Glendale, where he practiced small animal medicine for more than 30 years. Dr. Martin's wife, Cynthia; three daughters and a son; and three grandchildren survive him.

TRACY E. MCFARLAND

Dr. McFarland (California-Davis ‘84), 60, Santa Clarita, California, died Sept. 24, 2018. A feline practitioner, she owned The Cat Doctor and Friends in Santa Clarita. Dr. McFarland was certified in veterinary acupuncture. Her husband, Richard Bultman; two sons; and two sisters survive her.

GEORGE G. METZGER

Dr. Metzger (Iowa State ‘65), 78, Cumberland, Wisconsin, died Oct. 1, 2018. Following graduation, he worked a year in La Crosse, Wisconsin. Dr. Metzger then established Bay East Animal Hospital in Green Bay, Wisconsin, eventually expanding the three-clinic practice into Bellevue, Wisconsin.

With an interest in plant toxicology, he conducted research and taught in the Department of Toxicology at the University of Wisconsin-Madison School of Veterinary Medicine for several years. Dr. Metzger retired in 1999. He was a member of the Wisconsin and Northeastern Wisconsin VMAs and American Animal Hospital Association. Dr. Metzger was also a member of the Blue Hills Genealogical Society, Wisconsin State Historical Society, and The Nature Conservancy.

His wife, Mary; three daughters; six grandchildren and two stepgrandchildren; a great-grandchild; and a sister survive him. Memorials may be made to the First United Methodist Church, 1120 11th Ave., Cumberland, WI 54829; Alzheimer's Disease Research Center, Mayo Clinic, 200 First St. SW, Rochester, MN 55905; or International Crane Foundation, 9445 E11376 Shady Lane Road, Baraboo, WI 53913.

ROBERT K. MILKEY

Dr. Milkey (Cornell ‘52), 91, Granby, Connecticut, died Sept. 12, 2018. Following graduation, he moved to Granby, where he established a practice, initially in mixed animal medicine, focusing later on small animals. In 1957, Dr. Milkey took on a partner and the practice gradually expanded to become what is now known as the Salmon Brook Veterinary Hospital. He was a past president of the Connecticut VMA. Dr. Milkey served in the Marine Corps during World War II.

His two sons, a daughter, five grandchildren, and a brother survive him. Memorials may be made to Farmington Valley Visiting Nurse Association, Attn: Hospice, 8 Old Mill Lane, Simsbury, CT 06070.

RICHARD G. SEAMAN

Dr. Seaman (Ohio State ‘79), 71, Cincinnati, died Sept. 9, 2018. A small animal veterinarian, he owned Delhi Veterinary Clinic in Cincinnati, later taking over Madeira Veterinary Hospital, also in Cincinnati. Dr. Seaman was an Army veteran of the Vietnam War, earning a Bronze Star Medal.

His wife, Judy; a daughter and two sons; six grandchildren; and a brother survive him. Dr. Seaman's son, Dr. Bradley Seaman (Ross ‘05), is a small animal veterinarian in Brooklyn, New York. Memorials may be made to the Cincinnati Society for the Prevention of Cruelty to Animals, 11900 Conrey Road, Cincinnati, OH 45249; or 4 Paws for Ability, an organization placing service dogs with veterans and children with disabilities, 253 Dayton Ave., Xenia, OH 45385; or American Heart Association, 7272 Greenville Ave., Dallas, TX 75231.

MARTIN C. TORRES

Dr. Torres (Michigan State ‘69), 72, Las Vegas, died Sept. 3, 2018. A retired small animal veterinarian, he had owned All Pets Animal Hospital in Salinas, California. During his career, Dr. Torres also practiced in New Jersey and Michigan and taught at Hartnell College in Salinas. He was a founding member of the emergency pet clinic in Monterey County, California, and served as show veterinarian for the Salinas Valley Kennel Club and Santa Cruz Kennel Club for 18 years. Dr. Torres was a past president of the Monterey Bay VMA. He is survived by his wife, Carolyn, and a brother.

FRED L. UHLAND

Dr. Uhland (Illinois ‘61), 83, Ashland, Illinois, died Aug. 25, 2018. He owned Ashland-Pleasant Plains Veterinary Clinic, where he practiced mixed animal medicine for more than 45 years prior to retirement in 2008. Active in his community, Dr. Uhland was a past chief of the Ashland Volunteer Fire Department and served on the Ashland School Board and Ashland Village Board. In 2001, he was named Ashland First Citizen.

Dr. Uhland is survived by three daughters, a son, 12 grandchildren, two brothers, and two sisters. His son, Dr. Carl Uhland (Illinois ‘90) is a veterinary consultant in Saint-Joachim-de-Shefford, Quebec. Dr. Uhland's late wife, Dr. Stephanie A. Uhland (Illinois ‘62), practiced with him at the Ashland practice, and his late daughter-in-law, Dr. Lucie Dutil (Montreal ‘89), was a veterinary epidemiologist. Memorials may be made to the Ashland Volunteer Fire Department, 100 E. Mechanic St., Ashland, IL 62612, or Berea Christian Church, c/o Ed Moretto, 1 Horseshoe Drive, Ashland, IL 62612.

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