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winners of the 2020 American Humane Hero Veterinarian and Veterinary Nurse Awards

During the 2020-2021 admissions cycle, the number of veterinary school applicants 

On Episode 25 of The Vet Blast Podcast, Dr. Christman talks with veterinary inventory manager Nicole Clausen about 

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News wrap-up: This week's headlines, plus a new telehealth service

Bringing cats to the veterinarian can be a daunting task for many pet parents—a struggle founder and CEO of Airvet Brandon Werber knows all too well.

“As a [pet] parent to 5 cats, I know how stressful it can be to get a cat to the vet…Many cat parents save vet visits just for the ‘big’ things, resulting in a lack of regular and routine visits to the vet for important things like wellness, preventive care, and routine exams,” he says 

That’s why Airvet is celebrating National Cat Day (today) by encouraging owners to take advantage of their telehealth app. It’s 24-hour teletriage platform, founded in 2018, quickly, conveniently, and easily connects cat parents and veterinarians—avoiding the chase, scratches, and overall stress often experienced when going to the clinic.

“The hope is that by removing all the most common barriers, pet parents will touch base with their veterinarians much more regularly, and we all end up with exactly what we want— happier, healthier cats,” says Werber.

With Halloween around the corner— a big day for pet emergencies—Werber says he expects to see an uptick in Airvet telehealth app use.

“If your pet isn’t feeling well, rather than rushing him or her to an ER, Airvet can link you with a live veterinarian who can help you understand if the issue is truly an emergency.”

To learn more about Airvet’s telehealth app, go 

By educating cat owners about its 24-hour teletriage platform, Airvet hopes to help remove all barriers to care for cats.

Celebrating National Cat Day by getting more cats to the vet

I primarily manage advanced dental cases, many of them involving older dogs or cats. That’s why I tend to get overly excited about new puppy or kitten appointments, because they typically allow technicians to spend extra time reviewing everything, from vaccinations and diet to elimination training.

You might not be as thrilled to see new senior dog or cat patients, especially if they have multiple problems or comorbidities—leaving you with one 20-minute slot at the end of the day to diagnose and treat every ailment. But these animals deserve (and typically need) all the extra time and care we can give them. So, what’s the best way to welcome senior pets into your practice?

We need to get better at defining and identifying senior pets. According to the American Association of Feline Practitioners (AAFP) and the American Animal Hospital Association (AAHA), cats are considered senior at age 11 and geriatric at age 15. Senior dogs are more challenging to identify, because larger dogs age faster than smaller dogs. A giant breed might be considered senior at age 5, but a smaller breed, like a Chihuahua, might be considered senior at age 11.

Additionally, targeting patients for a senior care program is not easy. When a senior pet is identified and acknowledged, client education helps with transitioning these patients into a senior health program. Discussing life stages from an early age with clients can better prepare them for when you start using terms like “senior” and “geriatric.” As your patients reach milestones, additional, more frequent care is needed. Subtle changes may be signs of a potential disease, rather than instances of pets “just getting old.”

For new or current clients who might be unaware of senior pet problems, it is important to provide additional time for more detailed history or focused questionnaires and a thorough physical examination (likely diagnostic testing and in-depth discussion of management or follow-up steps). If your allotted time is too short, a follow-up appointment might be necessary.

When asked, most practices encourage examinations twice a year, along with diagnostic work-ups involving bloodwork and urinalysis. Blood pressure measurement is sometimes mentioned, but often forgotten, and radiographs typically are only taken if there is a specific reason. Because studies have shown that many issues can be identified in apparently healthy pets, these diagnostic tests should be used as baseline levels to detect trends or changes before clinical signs are recognized. There are several guidelines you can use to help monitor disease stages including the 

 (Cardiac Education Group), the International Renal Interest Society’s Staging of 

cognitive dysfunction syndrome evaluation tool

Several questionnaires can also help assess behavior, pain, mobility, and overall quality of life in senior pets. Providing a list of potential issues may also alert the client to a problem they may not have suspected otherwise. Helping clients become more cognizant of gradual changes can help with early detection of many health issues. Try giving clients a senior folder with pockets that can hold veterinary visit information, diagnostic results, and a section for current medications.

Encourage clients to make quarterly or monthly observations of their pets, including how much and what they are eating and drinking, their activity levels, their elimination habits, and behavioral changes. They can take sequential photographs of their pets for body condition scoring comparisons, with a lateral view and a “skyline” view. They can also take photographs of any unusual or suspicious mass or tumor (with an object next to the mass for size comparison)—this will help you determine any rapid changes and help locate the mass for removal.

All of these efforts help identify senior pets who need additional care and attention. As we look at these patients more closely and regularly, we can detect issues and diseases at earlier stages, thus helping improve their quality of life and hopefully extending their time with clients.

Having a solid veterinarian-patient relationship during these golden years can help you continue to be your patient’s advocate when it’s time for the client to make the difficult decision of euthanasia. These senior pets have often been loved family members for years and they deserve their final years to be as happy and comfortable as possible.

Heidi Lobprise, DVM, DAVDC, is a veterinary dental expert with Main Street Veterinary Hospital and Dental Clinic in Flower Mound, Texas.

When it comes to providing proper care to older dogs and cats, client education is key in helping to detect early signs of illness. 

Welcoming and caring for senior pets

Buying flea, tick, and heartworm prevention in bulk may seem like a good idea, but according to veterinary inventory manager Nicole Clausen, CSSGB, CCFP, that’s tens of thousands of dollars just sitting on your shelves.

“Be intentional about what you’re stocking and understand what you’re selling [at your practice],” she explains.

In this latest episode of The Vet Blast Podcast, Clausen shares her top 5 tips for cutting inventory costs at your veterinary hospital.

First on the list: Avoid duplicate or unconsolidated products. For example, Clausen says ordering dozens of food products (stews, pates, chunks, vegetables, chicken, etc.) just to appease clients can easily lead to overspending.

“I think a lot of times the perception is that our clients want options—not really, they want our judgment and suggestion for what is best for their pet,” says Clausen.

Secondly, try not to overstock on products. When you’re offered promotional prices at conferences, try to resist the temptation to overbuy, she says. The reality is that many of these extra items sit on the shelf until they expire, she adds.

“If you don’t sell it, it’s not a good deal,” she says. Checking expiration dates and stocking what you’re actually going to use and sell is the best way to go.

Listen below for 3 additional ways to reduce inventory costs at your clinic.

Podcasts

On this episode of The Vet Blast Podcast, Adam Christman, DVM, MBA, talks with veterinary inventory manager Nicole Clausen about 5 easy ways to reduce the costs of goods at your practice.


Episode 25: Top 5 ways to reduce inventory costs

Our team at dvm360.com and Firstline magazine asked practice manager Emily Shiver to answer your questions about life in practice for managers, technicians, assistants, client service receptionists and more. Got a question for her? Email us at firstline@mmhgroup.com.

 How can I start forward booking at my clinic?

When patients have a scheduled appointment and receive a reminder a few days before, they are more likely to commit. That’s why it’s so important to forward book during checkout or any other time you meet or speak with clients. What follows are a few of my top tips for incorporating forward booking at your clinic.

The first step is to educate your team members about all your practice’s benefits so that they can confidently discuss and schedule clients. This may mean breaking the habit of 

 if they can schedule future appointments and just 

Consider the following wording suggestions that work:

“Thank you for stopping in to pick up Jackson’s heartworm prevention. I scheduled an appointment for his upcoming preventive care. We will see you in May!”

“Dr. Sims wants to see Jackson back in 2 weeks. I have Tuesday at 9 a.m. or Thursday at 2 p.m.”

“We loved having Jackson stay with us. We’re quite booked throughout the year. Let’s go over any future dates that he needs to stay with us, and get him booked.”

“Jackson’s haircut looks amazing! I went ahead and scheduled his grooming for the rest of the year.”

“Jackson is a healthy boy. I scheduled your next preventive care visit so we can keep up with this trend. See you in May!”

As you probably noticed above, you can use forward-booking strategies for more than just medical appointments. Every time your client visits your practice — regardless of the reason — it’s an opportunity to secure a return visit.

Here are some forward-booking opportunities we schedule at my practice — categorized by visit type:

Grooming for the entire year, since most pets are on a 4- to 6-week rotation.

To get your team excited about forward booking, try putting together a forward-booking “don’t ask just do” 90-day challenge. You can even involve your drug representatives, who can help with challenge reward ideas.

Skeptics may be concerned that scheduling all these appointments will only result in a ton of “no shows.” From my practice’s experience, this has not been the case because my staff always conveys the value of booking each appointment. It is very attainable to achieve a 50% to 60% forward-booking rate after your 90-day challenge. Good luck!

Emily Shiver, CVPM, CCFP, is practice manager at Cleveland Heights Animal Hospital in Lakeland, Florida.

Are you afraid of forward booking? Do you think it comes off as too pushy or intrusive? Dentists have successfully practiced this strategy for years. One obvious benefit: a sense of security that your client will return to your practice. 

Ask Emily: What is the best way to start forward booking?

Feline “coronavirus” refers to a single virus species but either of 2 pathotypes, distinguished by their individual paths of destruction.

 Feline enteric coronavirus, highly contagious via fecal-oral transmission, is usually asymptomatic but can cause mild diarrhea. Feline infectious peritonitis (FIP), on the other hand, is immune mediated and usually fatal.

The effusive (wet) form of FIP typically causes death days to weeks after onset of clinical signs. The noneffusive (dry) form usually kills in weeks to months.

Feline calicivirus, a common cause of upper respiratory tract disease and oral ulceration in cats, can occur in highly virulent forms that have recently kicked off outbreaks of often fatal systemic disease.

 Like FIP, feline calicivirus has outrun attempts to harness it with antivirals.

These therapeutic voids underscore the need to investigate whether the 2 viruses fall under the treatment umbrella of other types of existing antimicrobials. The human antimalaria drug mefloquine was shown to suppress viral load of feline coronavirus in infected feline kidney cells in vitro, without cytotoxic effects.

Previous studies evaluating the hepatic clearance of mefloquine in cats found no evidence of delayed elimination. Plasma protein binding, they found, is about 99% in both healthy and FIP-infected cats.

 Pharmacokinetic data on mefloquine is available for human adults and infants, as well as dogs,

 but little information is available for cats.

To assess the antiviral potential of mefloquine in cats, its pharmacokinetic profile is prerequisite for developing a dosage plan. Researchers at the University of Sydney School of Veterinary Science investigated the pharmacokinetics of mefloquine in clinically healthy cats dosed at 62.5 mg twice weekly, for a total of 4 doses. The recently published study

 also documented changes in hematologic, biochemical, and physiologic parameters.

Seven healthy adult cats, ranging in age from 3 to 7 years with an average weight of 5.4 kg, were recruited from an animal research facility. Cats were housed individually and dosed orally with mefloquine 62.5 mg (one-quarter of a 250-mg tablet) on days 0, 4 (96 hours), 7 (168 hours), and 10 (240 hours). The first dose was administered without food; subsequent doses were given with food. The cats were monitored for adverse reactions for 2 hours after dosing and then observed for 14 days.

To determine mefloquine plasma concentrations, the investigators collected serial blood samples into lithium heparin tubes from anesthetized cats at 0 (pretreatment), 1, 2, 4, 8, 12, 24, 48, 96, 168, 240, and 336 hours after drug administration. On mefloquine administration days 4, 7, and 10, blood samples were collected prior to dosing.

Mefloquine concentrations were measured by high-pressure liquid chromatography. Several data points were calculated, including peak plasma concentration (Cmax), time to reach Cmax (Tmax), elimination half-life, apparent volume of distribution, and apparent clearance.

Two cats were excluded from statistical analysis due to vomiting, and a third was excluded because of outlier results. Hematology and serum biochemistry values were obtained for 6 cats at 0 (pretreatment), 168, and 336 hours.

The first dose of mefloquine produced an average Cmax of 2.71 µg/ml at 15 hours (Tmax). Spikes in mefloquine plasma concentrations occurred at 168, 240, and 336 hours. The overall highest plasma concentrations (4.06 µg) occurred at 240 hours. The apparent mean volume of distribution was found to be 17.4 L/kg, the apparent systemic clearance was 0.060 L/hr.kg (0-96 hours), and the elimination half-life—based on 24- to 96-hour time points—was 9.3 days (224 hours).

Hematology results were unremarkable for all 6 cats evaluated. Serum biochemistry data showed mild increases in serum symmetric dimethylarginine (SDMA) at 168 and 336 hours, but creatinine concentrations did not rise significantly. Three cats had elevated liver parameters pretreatment, which in 1 cat continued to rise during the study.

Although 2 cats vomited on the first administration of mefloquine, 1 was able to continue the study by being dosed with food.All other cats tolerated the medication well, as the last 3 doses were administered with food.

The only reported use of mefloquine in animals is as an anti-malarial for raptors and penguins.

 In vitro, however, antiviral activity has been demonstrated against feline coronavirus,

 and—in people—dengue type 2 and Zika viruses.

The oral bioavailability of mefloquine in dogs was found to average 78%,7 and peak plasma concentrations in humans were reached at a mean of 17.6 hours.

 The current study found a Tmax of 15 hours, comparable to that in people. Also similar in people

 and the study cats was the apparent mean volume of distribution (17.4 and 19.2 L/kg in cats and humans, respectively). The apparent systemic clearance was more brisk in cats (0.060 L/h/kg) than in people (0.026 L/h/kg), and the corresponding elimination half-life sooner, at 9.3 days in cats vs 20 days in humans.

Food may enhance oral absorption of mefloquine, as mean plasma concentration was higher when the drug administered with food (4.06 µg/ml) than without (2.71 µg/ml). This difference could also be at least partly explained by the cumulative effect of multiple dosings that had occurred prior to the higher reading.

Given that previous research has shown inhibition of both feline coronavirus biotypes when mefloquine is dosed at 10 µM (Cmax, 3.78 µg/ml),

 the Cmax peak of 2.71 µg/ml reached in the current study following the initial dose of about 12.5 mg/kg suggests that either dosing 

 food or using a higher dose might better achieve the desired inhibitory effect.

Other antimalarials also show potential for treating feline coronavirus. Chloroquine has shown inhibitory effect against FIP virus replication, as well as anti-inflammatory potencyin vitro.

 It also improved clinical signs in cats experimentally infected with FIP, although it increased their serum alanine aminotransferase (ALT). While mefloquine did not increase ALT levels this study, its potency against cats with FIP remains to be seen.

Mefloquine’s other cousin, hydroxychloroquine, which has been investigated for treating people with SARS-CoV-2 (the virus that causes coronavirus disease 2019),

 has shown in vitro antiviral activity against FIP virus when used with recombinant feline interferon-⍵.

The main limitations of this study were the small number of cats included and the short duration for which they were observed for adverse effects. Also, only healthy cats were used, but mefloquine pharmacokinetics may differ between healthy and FIP-infected cats due to the preponderance of acute phase proteins in the latter.

Another limitation was the blood collection protocol used. Anesthetic drugs were given prior to blood collections. It is not possible to separate out their potential contribution to rising SDMA levels, which can signal early kidney compromise, from possible renal impacts of mefloquine.

Hepatic effects were also a little unclear, as 3 of the cats had elevated liver enzymes before treatment. Nevertheless, no significant increases in liver enzymes occurred following mefloquine administration.

Despite these constraints, this study establishes preliminary data for the pharmacokinetic profile of mefloquine in cats and serves as a springboard for planning clinical trials of mefloquine in those with feline coronavirus and calicivirus.

Dr. Capuzzi is a small animal veterinarian and journalist based in the Philadelphia area.

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 2019;11(11):1068. doi:10.3390/v11111068.

Addie D, Belak S, Boucraut-Baralon C, et al. Feline infectious peritonitis. ABCD guidelines on prevention and management. 

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McDonagh P, Sheehy PA, Norris JM. Identification and characterisation of small molecule inhibitors of feline coronavirus replication. 

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Izes AM. Comparative studies of in vitrohepatic metabolism of mefloquine by feline microsomes and those of other selected species. PhD thesis. Camperdown, NSW, Australia: University of Sydney; November 2019.

Schwartz DE, Weber W, Richard-Lenoble D, Gentilini M. Kinetic studies of mefloquine and of one of its metabolites, Ro 21-5104, in the dog and in man. 

Yu J, Kimble B, Norris JM, Govendir M. Pharmacokinetic profile of oral administration of mefloquine to clinically normal cats: a preliminary in-vivo study of a potential treatment for feline infectious peritonitis. 

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Remple JD. Intracellular hematozoa of raptors: a review and update. 

McDonagh P, Sheehy PA, Fawcett A, Norris JM. Antiviral effect of mefloquine on feline calicivirus in vitro

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Fan HH, Wang LQ, Liu WL, et al. Repurposing of clinically approved drugs for treatment of coronavirus disease 2019 in a 2019-novel coronavirus (2019-nCoV) related coronavirus model. 

 2020;133(9):1051-1056. doi:10.1097/CM9.0000000000000797

Balasubramanian A, Teramoto T, Kulkarni AA, Bhattacharjee AK, Padmanabhan R. Antiviral activities of selected antimalarials against dengue virus type 2 and Zika virus. 

 2017;137:141-150. doi:10.1016/j.antiviral.2016.11.015

Palmer KJ, Holliday SM, Brogden RN. Mefloquine. A review of its antimalarial activity, pharmacokinetic properties and therapeutic efficacy. 

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Karbwang J, White NJ. Clinical pharmacokinetics of mefloquine. 

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Taken T, Katoh Y, Doki T, Hohdatsu T. Effect of chloroquine on feline infectious peritonitis virus infection in vitro and in vivo

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Takano T, Satoh K, Doki T, Tanabe T, Hohdatsu T. Antiviral effects of hydroxychloroquine and type I interferon on in vitro fatal feline coronavirus infection. 

To set the stage for probing the human anti-malaria drug mefloquine as an agent for combatting feline corona- and caliciviruses, researchers map out its pharmacokinetic profile in cats. 

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