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a bi-monthly electronic newsletter for the veterinary community

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a bi-monthly electronic newsletter for the veterinary community Powered By Docstoc
					                                                                                                      • Welcome
                                                                                                      • In the Trenches: NSAID & Liver Dysfunction
                                                                                                                        Diagnosing Addison’s Disease
                                                                                                      • Coming Conferences
                                                                                                      • Events of Note
                                                                                                      • VetScan News & Special Offers
                                                                                                                                                                                                  Volume 3,
                                                                                                      • In Your Opinion                                                                           August 2002

                                                                                                 WELCOME!                                    like and would like to see in          Show that you are fully aware of the
                                                                                                                                             future issues!                         recession and that you have priced your
                                                                                                 Welcome to the August 2002                                                         goods and services accordingly. Don’t
                                                                                                 edition of VetCom. Our clinical, In                                                make the mistake of thinking that the
                                                                                                                                             Guerilla Marketing’s Golden
                                                                                                 the Trenches, discussion this month                                                right price for a recession is the lowest
                                                                                                                                             Rule #46
                                                                                                 highlights two independent topics.                                                 price. Price almost becomes secondary
                                                                                                                                             To succeed at marketing during
                                                                                                 The topic of NSAIDs and liver                                                      during hard times; people are searching
                                                                                                                                             an economic downturn, focus
                                                                                                 enzyme monitoring is introduced,                                                   for value.
                                                                                                                                             your efforts on existing customers      Guerilla Marketing Excellence, Levine, Houghton
                                                                                                 to be followed in more detail in our
                               a bi-monthly electronic newsletter for the veterinary community

                                                                                                                                             and larger transactions.                                                      Mifflin Co
                                                                                                 October issue.                                                                     Evaluating your laboratory capabilities
                                                                                                 Additionally we have included a             Because the cost of marketing to       and services may provide you an
                                                                                                 piece on Addison’s disease                  a brand-new customer is five           excellent source for revenue growth as
                                                                                                 (hypoadrenocorticism) which is              times higher than selling to an        well as the practice of better medicine.
                                                                                                 particularly relevant to us as we are       existing customer, guerilla            According to the Well-Managed
                                                                                                 introducing our NEW Diagnostic              marketers turn their gaze from         Practice Study*, lab services should
                                                                                                 Rotor with SODIUM!                          strangers to friends.                  account for ~ 20% of revenue.
                                                                                                                                             In a recession , when everything       Some ways to expand your laboratory
                                                                                                 I want to thank all our readers for         seems to be shrinking, think in        offerings are to introduce or enhance
                                                                                                 your continued interest, we have            terms of expanding your                Wellness & Senior Care programs.
                                                                                                 over 700 subscribers to date. You           offerings. Do absolutely               Client compliance with these programs
                                                                                                 are a quiet bunch however! I really         everything you can to motivate         is excellent.
                                                                                                 do encourage you to check in                customers to expand the size of
                                                                                                 regarding the In Your Opinion               their purchase.                        FREE to all VetScan customers, the
                                                                                                 topic, send a query to our Ask the
                                                                                                                                                                                    Abaxis Practice Builder program can
                                                                                                 Lab advisor or send me general
                                                                                                 comments on what you like, don’t
                                                                                                                                                                                    *Plug Revenue Leaks and Boost your Income, Vet
                                                                                                                                                                                    Economics, Sep 2001.

                                                                                                 In the Trenches                           compounds have undoubtedly               increase in liver values is an indicator
                                                                                                                                           brought relief to many dogs, the         to discontinue Rimadyl immediately.
                                                                                                   Liver Enzyme Monitoring for             veterinarian and client must remain      Incidents of carprofen-mediated
                                                                                                     Canine NSAIDs Patients                aware of potential adverse effects.      hepatopathy reaction have been shown
                                                                                                                                           In addition to possible                  most commonly to occur within the
                                                                                                 Non-steroidal anti-inflammatory           gastrointestinal ulceration as a         first three weeks of therapy, though
                                                                                                 drugs (NSAIDs) are primarily              result of decreased levels of            may theoretically occur anytime during
                                                                                                 prescribed for their anti-                beneficial prostaglandin in the GI       treatment. Therefore, routine liver
                                                                                                 inflammatory effect and are one of        tract, hepatopathy has been              enzyme monitoring of dogs on
                                                                                                 the most commonly used drugs for          reported in a number of Rimadyl-         Rimadyl would be considered a
                                                                                                 both humans and animals.                  treated dogs, in particular, Labrador    beneficial prophylatic measure.
                                                                                                 Although the mechanism of                 retrievers.
                                                                                                 NSAIDs are not completely                                                          In our next issue, Dr. Brent Hoff, will
                                                                                                 understood, their key method of           Although the prevalence of liver         discuss NSAIDs-induced liver
                                                                                                 efficacy is to inhibit production of      disease is quite low (5.2 cases per
                                                                                                 the hormone-like substances,              10,000 dogs treated, Pfizer Animal
                                                                                                                                           Health, 1999), it can be life-             In this Issue
                                                                                                 prostaglandins. Reduced
                                                                                                 prostaglandin release decreases the       threatening if not treated in a timely
                                                                                                 inflammatory process thereby              fashion. In order to identify dogs at      Welcome                        1
                                                                                                 providing pain relief.                    risk, a chemistry profile                  In the Trenches
Union City, California 94587

                                                                                                                                           accomplished prior to initiating           NSAIDS, Addisons               2
                                                                                                 Two of the most commonly                  Rimadyl therapy will provide the           Coming Conferences             2
3240 Whipple Road

                                                                                                 prescribed NSAIDs for canine              veterinarian with baseline liver           Events of Note                 2
                                                                                                 patients are Rimadyl (carprofen,         enzyme values. Liver enzymes               VetScan News & Offers          3
                                                                                                 Pfizer) and EtoGesic (etodolac,          may then be re-checked following           In Your Opinion                3

                                                                                                 Fort Dodge). Although these               7-14 days of therapy. Significant          Abaxis Contact Info            3
                                                                                                                                                                                      VetScan Authorized             4

                 dysfunction and share his              dogs. Other predisposed breeds                70% of dogs with
                 recommendations for monitoring         include Great Danes, Rottweilers,             hypoadrenocorticism. These
                 these patients.                        West Highland white terriers, and             abnormalities are related to the
                                                        German shepherds. Clinically the              severity of the dehydration and
                 Brent Hoff D.V.M., D.V.Sc., Dip.       signs may vary from vague ones                other electrolyte abnormalities.
                 Tox. currently holds the position      such as depression, weakness or
                 of Clinical Pathologist/Clinical       lethargy to more profound such as             Normally, the sodium:potassium
                 Toxicologist at the Animal Health      vomiting, diarrhea, shaking and               ratio is 27:1 to 40-1 with a mean of
                 Laboratory, University of              shivering, anorexia, and sensitive            30:1. 90-95% of dogs with
                 Guelph, Guelph, Ontario,               abdomen. Dogs presented in a                  hypoadrenocorticism have an
                 Canada.                                crisis are often in shock with one or         elevated potassium and 80% have a
                                                        more of the above signs present.              decrease in sodium. Ten percent of
                                                        They commonly have bradycardia                dogs with this disease have a
                         *************                  due to hyperkalemia.                          normal sodium:potassium ratio. It
                                                                                                      is important to note that
                                                        The changes in the hemogram are               hypoadrenocorticism is not the only
                 Hypoadrenocorticism                    secondary to glucocorticoid                   disease associated with a low
                 Addison’s Disease in Review            deficiency. Commonly a mild                   sodium:potassium ratio.
                                 Dan Brod, DVM          normochromic, normocytic non-
                                                        regenerative anemia is present. A             The differential diagnoses for
                                                        lymphocytosis and eosinophilia are            hyperkalemia and/or hyponatremia
                 Hypoadrenocorticism is a               present in 10-20% of dogs.                    are:
                 condition in dogs and cats
                 whereby the adrenal gland is           Elevation of creatinine and BUN,                   I.       Hypoadrenocorticism
 Get FREE        deficient in its production of         with urine specific gravity less
Thyro-Tabs      glucocorticoids and
  and an                                                than 1.030 is common in dogs with                  II.      Renal or Urinary tract
                 mineralocorticoids. The                hypoadrenocorticism. The elevated                           disease
    CD           condition can be primary, which        BUN and creatinine are due to                                A. Acute primary
                 is usually iatrogenic, or              hypotension, dehydration and                                renal disease
with purchase    secondary, which is usually from       volume contraction. The low urine                            B. Chronic severe
 of our new      hypothalamic or pituitary failure.     specific gravity is due to medullary                        oliguric or anuric
                                                        wash-out.                                                   renal failure
T4-Cholesterol   Hypoadrenocorticism is usually a                                                                    C. Urethral
   Rotors!       disease of middle-aged female          Hypercalcemia is present in 30% of                          obstruction
                 dogs. The disease has been             the dogs with hypoadrenocorticism.                           D. Uroabdomen
                 recognized most commonly in            Hyperphosphatemia is present in                              E. Post-obstructive
                 standard poodles, Labrador                                                                         diuresis
                 retrievers and Portuguese water                                                                     F. Nephrotic
                 Coming Conferences                   CVC                                       Tufts Animal Expo
                 We’ll See You There!                 Kansas City, MO                           Boston, MA
                 PA VMA                               Aug 16-20, 2002                           Sep 11-14, 2002
                 Hersey, PA
                                                      AAV                                       Chicago VMA
                 Aug 8-11, 2002                       (Assoc of Avian Veterinarians)
                                                                                                Chicago, IL
                                                      Monterey, CA
                 Hospital Design Show                                                           Sep 11, 2002
                                                      Aug 27-29, 2002
                 Kansas City, MO
                 Aug 15-16, 2002                      IVECCS                                    FL VMA
                                                      (Int’l Vet Emergency & Critical Care)     Lake Buena Vista, FL
                                                      San Antonio, TX                           Sep 13-15, 2002
                                                      Sep 5-7, 2002
                 Events of Note
                                                                  Abaxis, Inc.
                  Instituting and Enjoying                       Union City, CA                  Local Abaxis Representatives are
                         A Successful                                                            available to present a one-hour
                     Wellness Program                                   TBD                      presentation on the topic of the
                                                              (early September 2002)             benefits of in-clinic wellness testing
                      Charles Sodikoff, DVM                                                      for local veterinary meetings.
                                                             Contact Marty Munn
                                                               for information                   The program offers a review of
                 Abaxis RACE                                800 822-2947, ext. 1494              veterinarian approaches to wellness
                 Provider Number: 77                                                             and senior testing, published relevant
        VetScan News &                                                                                   At the CVC
         Special Offers                          VetScan Canine Heartworm
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   Introducing the NEW                              through Sep 30, 2002                          Instrument Demonstration
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         PLUS sodium                                                                               Compaq Jornada PDA
                                                           VetScan distributor
              with                               or contact Abaxis for more information.          Personal Digital Assistant
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   Available Late August 2002
                                                        Come See us at the                        Abaxis Practice Builder
         Special Offer                                                                                   Program
     T-4/Cholesterol Rotor
                                                           Veterinary                                 VetScan customers
   With the purchase of our
                                                           Conference                              Get the Abaxis Practice

                                                                                                                                           Comprehensive Diagnostic Profile
  NEW T4-Cholesterol rotors
                                                           in Kansas City                            Builder CD program
     customers receive:                                                                            containing customizable

                                                                                                                                               available late August
                2 bottles                                  Booth 125-127                            educational pamphlets,
          (your choice of dosage)                                                                    authorization forms,

                                                                                                                                                    with sodium
         Thyro-Tabs                                                                                 appointment reminders
    and an educational CD,                                                                                and more!
    Canine Hypothyroidism
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   one offer per clinic while supplies last.

 In Your Opinion                               August’s Question:                              Watch for further discussion of this
 Each month we will ask a clinical,            In Your Opinion,                                topic in next month’s In the Trenches
 or practice management related
 question of our subscribers.                  How do you utilize canine                       Got a Question for the Lab?
                                               cholesterol and triglycerides                   Send it in….
                                               measures in your practice?
                                               Do you foresee greater utilization of           Email me with your replies and
                                               these analytes as current opinion               queries:
                                               appears to be shifting toward
                                               treating hypercholestesterolemia?

Abaxis Contact
                                               Technical Service          EXT 2                 SALES
                                               technical issues, training
1-800-822-2947                                 rotor credits, software queries                  Eastern Area Sales Director
                                               Linda Lang, Manager                              Marty Mulroy, ext. 1500
VetCom Issues
subscribe, unsubscribe                         Customer Service            EXT 3
questions, comments                            direct orders, local representative              Western Area Sales Director
Pam Conboy, ext. 6604                          and VetScan distributor information              Randy Knick, ext. 1509                           Valerie Campbell, Manager
       Authorized VetScan Distributors
          Distributor              Telephone
       Veterinary Supply          800-869-2510
            Barber                800-552-5698
       DVM Resources              877-828-1026
       Veterinary Supply          800 831-4828                                                   Check Out Our
            Merritt               800-845-0411                                                     Web Site
       Miller Veterinary
            Supply                800-880-1920                                         
            Nelson                800-843-3322
           Penn Vet               800 233-0210
         TW Medical               888 787-4483
        Medical Supply            800-533-8674
             Vetpo                800-253-7280
       Western Medical
            Supply                800-242-4415

                                                                                                     mineralocorticoid deficiencies respond
                                                     IX.       Diabetes mellitus                     very well to injections of DOCP
III.       Severe liver failure                                                                      2.2mg/kg every 25 days. Prednisone
           A. Cirrhosis                              X.        Primary polydipsia                    or prednisolone 0.2mg/kg/day control
           B. Neoplasia                                                                              glucococorticoid deficiency when used
                                                     XI.       Inappropriate ADH                     with DOCP. During stressful periods,
IV.        Severe gastrointestinal                             secretion                             the dosage of glucocorticoids may
           diseases                                                                                  need to be increased 2-10 fold. During
            A. Parasitic infestations                XII.      Drug-induced                          treatment, sodium and potassium levels
            B. Salmonellosis                                    A. Potassium-sparing                 need to be monitored.
            C. Viral enteritis                                 diuretics
            D. Gastric                                          B. Non-steroidal anti-
           dilatation/volvulus                                 inflammatory agents                   Dr. Dan Brod is a practicing
            E. Gastrointestinal                                 C. Angiotensin-converting            veterinarian at the award-winning
           perforation                                         enzyme inhibitors                     Deer Creek Animal Hospital outside of
            F. Severe malabsorption                             D. Potassium-containing              Denver, CO.
            G. Idiopathic hemorrhagic                          fluids

V.         Severe metabolic or                          Feldman EC: Adrenal gland disease. In
           respiratory acidosis                           Ettinger, SJ: Textbook of Veterinary
                                                   Internal Medicine. 4th ed. Philadelphia, WB
VI.        Congestive heart failure                                   Saunders, 1995, p 1584.

VII.       Massive release of
                                                 Confirmation of hypoadrenocortisim is
           potassium to the                                                                               Additional Web Resources:
                                                 determined by an ACTH stimulation test.
           extracellular fluid
                                                 Results of the test with Addison’s will
            A. Crunch injuries                                                                        
                                                 typically be low to normal in the resting
            B. Aortic thrombosis
                                                 sample and fail to stimulate after
            C. Rhabdomyolysis                                                                         
                                                 injection of ACTH. Post-stimulation
               1. Heat stroke
                                                 values are less than 5.0 ug/dl with
               2. Exertional                                                                           
            D. Massive infections
            E. Massive hemolysis
                                                 Treatment is aimed at correcting
                                                 mineralocorticoid, glucocorticoid, fluid
VIII.      Pseudohyperkalemia
                                                 and electrolyte deficiencies.
           A. The Akita breed
                                                 In a crisis situation, dehydration, shock
           B. Severe leukocytosis
                                                 and hyperkalemia all need to be closely
           C. Severe thrombocytosis
                                                 monitored and treated accordingly.
                                                 Long-term management of