Dietary Supplements for Pets

2014 September

a veterinary publication

In This Issue of Insider Dietary Supplements for Pets

Trends and Drivers in the se of dietary supplements and ‘nutraceuticals’ for pets and companion and Pet Supplement Market working animals is booming, and its growth mirrors the ‘boom’ in the hu- » Page 2 & 3 man market. Many veterinarians and veterinary practices have added pri- vateU label, brand label, or even their own label supplements and nutraceuticals for Commonly Used sale in-clinic, and certainly have fielded questions from their clients about adding Supplements supplements to their pet’s diet. While much of the research as to the benefits and » Page 4 value of nutraceuticals and supplements is still evolving, it’s clear that consumers have made some decisions as to the value—to the tune of hundreds of millions of The A.C.C.L.A.I.M dollars. In this issue of the INSIDER, we’ll explore what’s driving those (still grow- Method ing) numbers, review some professional organization’s guidances on supplements, » Page 5 and provide some tips, tools and information for you, your practice staff, and your clients. Supplements for Horses, Dogs and Cats » Page 6, 7 & 8

Special Days This Month » Page 8

Resources From the Web » Page 9

Nutritional Supplements in Horses » Page 11, 12, 13 & 15

Continuing Education » Page 16 & 17

Did You Know? » Page 19

INSIDER | SEPTEMBER 2014 Professional Focus Trends and Drivers in the Pet Supplement Market (adapted from Nutraceuticalsworld.com, by L. Phillips Brown DVM, Sr. VP Marketing and Regulatory Affairs Nutri-Vet Animal Health Care Products)

hile the growth rate of the pet industry moder- ated during the recession, most pet owners It really has been a phenomenal decade for the pet indus- value the comfort and health of their dogs and try. Packaged Facts, a Rockville, MD-based market research Wcats more than ever and are willing to buy more than just firm, reported that pet retail sales reached $55 billion in the basics. High-end pet foods, such as organic, grain-free, 2010 and were expected to hit nearly $60 billion by the end refrigerated and raw foods are gaining more shelf space of 2011—a far cry from 2001 total pet sales of $28.5 billion. in outlets that are increasingly catering to the “pet parent.” U.S. retail sales of pet food totaled $18.4 billion in 2010, an Doggie daycare centers that charge $20-35 per eight-hour increase of 2.8% over 2009 sales, and were projected to day and boarding facilities where dogs can sleep in a bed- reach $19 billion in 2011. room with a person are extremely busy. Celebrity endorsed foods and accessories as well as high end “doggie bou- According to Nutrition Business Journal (NBJ), Boulder, CO, tiques” have become commonplace. natural and organic pet foods, pet supplements and other natural and organic pet supplies grew 5.2% in 2010 to reach $3.2 billion, with the animal supplement category alone adding $80 million in new sales dollars to reach $1.6 billion.

Packaged Facts reported the compound annual growth rate (CAGR) of U.S. retail sales of pet supplements and nutraceutical treats for dogs, cats and other small animals was 6.6% between 2006 and 2010 and projected to hit 7.4% during the 2010 to 2015 period. The market researcher also reported the percentage of dog and cat owners who purchased pet supplements and nutraceutical treats increased from 19% and 12%, respectively, in 2005 to 31% and 22% in 2010.

The average household in the U.S. spent $655 on routine visits for dogs to the veterinarian last year, up 47% from a decade ago, according to the APPA.

ANIMAL HEALTH INTERNATIONAL, INC. | www.animalhealthinternational.com 2 INSIDER | SEPTEMBER 2014 cause supplements are no longer just available in pill form; The top-selling supplement group continues to be joint increasingly, functional ingredients are appearing in top- heath, with a 4% growth rate and sales of $690 million, or pers, gravies, foods and snacks. Pet food companies market 45% of total category sales, according to NBJ. The dental their diets as providing more than “nutritional adequacy” by category grew almost 7% to reach $20 million as pet own- adding functional ingredients that help maintain skin and ers looked for ways to prevent one of the leading reasons coat condition, joint flexibility, digestive healthiness and for a visit to the veterinarian. Skin and coat supplements immune strength. grew 8% and accounted for 10% of sales. A recent survey by Nestle Purina Petcare, St. Louis, MO, found that 40% of Product Opportunities dog owners and 50% of cat owners expressed interest in Much like the human vitamin category, pet owners appre- purchasing veterinary medications, foods or supplements ciate the importance of dietary supplements as a comple- to address their pet’s gastrointestinal (GI) condition. Mul- ment—not a replacement—to high quality natural or tivitamin sales continue to decline as condition-specific organic pet foods. Nearly 70% of dog owners are aware of supplements evolve and pet food manufacturers improve vitamins and supplements specifically formulated for ani- their formulas with added functional ingredients. mals, yet this knowledge does not necessarily translate into purchase unless the pet parent has a reason to buy. Sales Drivers & Trends Pets are living longer and subsequently developing age- As pet owners take a more holistic approach to their pet’s related problems similar to their human guardians. People health, veterinary endorsements of supplements are grow- are taking clues from their own ways of staying healthier by ing and increasingly re-enforcing their importance in main- eating better and taking supplements, which is particularly taining overall pet health. Many retailers now partner with important as veterinary healthcare costs rise. The average nearby veterinary facilities to support clinicians’ recom- household in the U.S. spent $655 on routine visits for dogs mendations and in turn provide the clinics with in-depth to the veterinarian last year, up 47% from a decade ago, product information and samples. according to the APPA. Expenditures for cats soared 73% over the same time frame, as parenting a cat became more There has been a fundamental change in how pet owners “respectable.” view their animals, with natural and organic pet foods and supplements finding a broader, more receptive audience. However, the major driving force behind the growth of Health and wellness shoppers offer future business oppor- animal supplements is that pet owners view these products tunities for veterinary practice owners that understand the as natural ways to promote health and wellness, the main importance that proactive pet owners put on keeping their reason Packaged Facts’ March 2011 report, “Pet Food in the animals healthy for a long time. This is not a fad that will U.S., 9th edition,” concluded the outlook was “especially fade away—even in difficult economic times. Knowledge good” for pet supplements and holistic pet foods. Veterinar- combined with well-merchandised, attractive displays that ians have also come to view supplements as reasonable don’t confuse clients are effective in-clinic marketing tools. alternatives to animal drugs and are more willing to recommend them as adjuvant or even replacement therapy.

Mintel’s Global New Products Database reported that 72% of U.S. consumers consider pets as part of the family and want the best for their dogs and cats. It comes as no sur- prise that well formulated supplements with functional ingredients that target specific physiological—and psy- chological—needs of today’s pets are enticing to a whole population of pet parents committed to optimizing the quality of their animals’ lives.

Education is still the key to selling dietary supplements and it behooves retailers, including Supplements are no longer veterinary practices, to appreciate just available in pill form; in- thoroughly the intended functionality creasingly, functional ingredi- of a particular product as well as its active ents are appearing in toppers, ingredients to sort out which supplements gravies, foods and snacks. are “therapeutic” and which ones are “treats.” This distinction is not as easy as it sounds be-

ANIMAL HEALTH INTERNATIONAL, INC. | www.animalhealthinternational.com 3 INSIDER | SEPTEMBER 2014 Client Focus Commonly Used Supplements (adapted from Nutraceuticalsworld.com, by L. Phillips Brown DVM, Sr. VP Marketing and Regulatory Affairs Nutri-Vet Animal Health Care Product)

onsumers, which of course include your veterinary and thus need be applied to pet foods after cooking. Most practice clients, are increasingly looking for ways veterinarians feel that standalone supplementation is more to eat healthier with foods that contain unique efficacious. Cingredients formulated to provide more than traditional nutrition. This same view is taken when giving consider- Glucosamine and chondroitin are critical components ation to buying dietary supplements and nutraceuticals for of cartilage, but the body’s natural production diminishes their pets. Below is a primer on some of the more widely with age. Many manufacturers formulate these chondro- available and widely used ingredients for you, your practice protective nutrients into their pet foods to help stimulate staff, and your clients. cartilage metabolism and inhibit its degeneration as well as provide anti-inflammatory properties. Prebiotics are non-digestible food ingredients that stimulate the growth of beneficial bacteria that have the Omega 3 fatty acids from fish oil or other marine sourc- potential to improve host health, inhibiting the growth of es contain high levels of eicosapentaenoic acid (EPA) and pathogenic microorganisms. Fructooligosaccharides (FOS) docosahexaenoic acid (DHA) capable of modifying inflam- act by stimulating the growth of Bifidobacterium species matory skin responses of healthy dogs. Pet foods supply in the large intestine. Not much is known about the correct ample omega 6 fatty acids, but not omega 3. Omega 9 fatty and effective dosage levels of prebiotics for dogs or cats, acids have no benefit to dogs or cats. Flaxseed oil contains but preliminary evidence seems to indicate that very low alpha-linolenic acid (ALA), but its conversion by the body levels (0.3% of a dog’s diet) are most effective and produce to EPA and DHA is slow and inefficient, and thus flaxseed the least number of side effects (bloating, gas, etc.) oil does not appear to be as effective as fish oil in reducing inflammation. Probiotics are friendly bacteria, such as Lactobacillus acidophilus, Bifidobacterium bifidum and Lactobacillus Antioxidants such as vitamins C and E, zinc and other bulgaricus, that help to keep harmful bacteria from coloniz- trace elements help neutralize the effects of stress and ing and creating digestive problems, and thus support the environmental irritants. Although dogs—unlike humans— body in fighting illness and disease. If beneficial bacteria manufacture vitamin C, many veterinarians look at it as a become depleted or the balance is disturbed, potentially “conditionally essential” nutrient helpful in times of stress. harmful (pathogenic) bacteria can overgrow. Probiotics Pet owners like to see this vitamin in pet foods as well as are live cultures unstable at temperatures over 75 degrees vitamin E.

ANIMAL HEALTH INTERNATIONAL, INC. | www.animalhealthinternational.com 4 INSIDER | SEPTEMBER 2014 The A.C.C.L.A.I.M. Method (Adapted from Oke SL, McIlwraith CW. Review of the potential indications and contraindications for equine oral joint health supplements, in Proceedings. 54th Annual AAEP Convention 2008) information about their products.

Clinical experience: Look for a company that supports clinical research showing safety and efficacy of its products. Results should be published in peer-reviewed journals to which your veterinarian will have access.

Contents: Ingredients should be clearly noted on the label.

Label Claims: The products should not include unrealistic claims. Stay away from products using words like “cure” or “prevent.” Testimonials aren’t necessarily a bad thing, but a company with only testimonials and no scientific data to support its claims is less likely to be producing a quality supplement.

Administration recommendations: How to administer the supplement to your companion or working animal should be clearly stated on the label. You should be able to determine how much of each active ingredient you’re giving your animal per day.

Identification of lot and expiration date: Choose a joint o which dietary supplements, if any, should your health supplement with a lot number and expiration date clients choose for their pet, companion or working noted on the label. A lot number means that the company animal? In every case, the first step is a consultation has a tracking system in place to ensure product quality. withS you, their veterinarian. No-one, including “Dr. Google”, An expiration date shows that the company has evaluated is more qualified than a veterinary medical professional product quality over time. with an existing relationship with the client and the animal Manufacturer information: Information about the manu- patients in his or her care. facturer should include name, address, phone number, and How you know that the product contains what the label website. You should have a way to contact the company if says it does, plus is safe and effective? Even if the supple- you have a question. ment contains what is listed on the label, are the levels of ingredients included those levels that have been found to company name you recognize be helpful? Sorting through what may seem to be an end- A less array of products to find the optimal product can be a difficult task. C linical experience

The good news is that you can use the product label to ontents your advantage. Just take a few minutes and use the guide C below, known by the acronym ACCLAIM, when looking at supplement labels to help you make your choice. This same L abel Claims guide can be used to evaluate other kinds of supplements, too. Share with your clients and your entire practice staff. A dministration recommendations A company name you recognize: Supplements made by dentification of lot and expiration date established companies that offer educational material to I veterinarians are generally a better choice over companies that you’re not familiar with and that offer no educational M anufacturer information

ANIMAL HEALTH INTERNATIONAL, INC. | www.animalhealthinternational.com 5 INSIDER | SEPTEMBER 2014 Supplements for Horses, Dogs and Cats (source: National Resource Council)

Growing numbers of pet owners are giving their pets dietary supplements in hopes of supporting their health. This increased use of animal dietary supplements has raised concerns regarding the safety of specific supplements and the guidelines for determining safety of dietary supplements for horses, dogs, and cats. This report examines issues in determining safety of animal dietary supplements in general, and the safety of three animal dietary supplements; lutein, evening primrose oil, and garlic, in particular.

ike many people who take multivitamins and other supplements to support a healthy lifestyle, growing numbers of pet owners are also giving supplementsL to their pets for similar reasons. It is estimated that between 10 to 33 percent of dogs and cats in the United States are fed an animal dietary supplement, with some of the same supplements being fed to horses. But are these supplements safe for pets?

The increased use of animal dietary supplements has raised several concerns. Among the issues involved are the safety of specific dietary supplements, the general approaches taken to determine the safety of animal dietary supple- (HSI) was based on the known levels consumed by wild or ments, the monitoring of adverse effects, and the state of domestic animals over long periods of time with no appar- the regulation of animal dietary supplements. ent ill effects. To assist in making decisions about the safety of dietary Despite these limitations, the committee took this opportu- supplements for horses, dogs, and cats, the Food and Drug nity to review the general issues of animal dietary supple- Administration (FDA) asked the Natural Research Council to ment safety. They identified a number of data elements for produce a report on the safety of supplements in general consideration when constructing any framework for assess- and to review three specific supplements (lutein, evening ing animal dietary supplement safety that may be different primrose oil, and garlic) offered for horses, dogs, and cats. from those routinely considered for prescription drugs. A committee of experts, consisting of animal nutritionist, veterinarians, clinical pharmacologists, and toxicologists, was established for this purpose. The committee addressed Regulation of dietary supplements in the safety only; utility or efficacy of animal dietary supplements United States was not part of its task. Dietary supplements for both humans and animals are The committee found that there was a lack of quality safety subject to regulation under the Federal Food, Drug, and data available for the supplements lutein, evening primrose Cosmetic Act (FFDCA). The way in which human dietary oil, and garlic, that would be required to determine safety supplements are regulated was amended by the passage of in drugs and animal food additives. Therefore, the commit- the Dietary Supplement Health and Education Act (DSHEA) tee could only report on historical safe intakes (HSI) and in 1994, but the Food and Drug Administration concluded estimate a presumed safe intake (PSI) for the three animal that the Act does not apply to dietary supplements for dietary supplements (see opposite page). The presumed animals. Thus, dietary supplements for humans and dietary safe intake (PSI) was estimated by reviewing evidence to supplements, despite often being the same substance, giv- determine a level at which the animal health or production en in the same manner, and for the same purpose. Currently efficiency were not impaired. While the historical safe intake the FDA and other regulatory bodies are under pressure

ANIMAL HEALTH INTERNATIONAL, INC. | www.animalhealthinternational.com 6 INSIDER | SEPTEMBER 2014 to resolve the public’s desire to provide some of the same DIETARY SUPPLEMENTS FOR supplements available to humans to their animals. HORSES, DOGS AND CATS Presumed safe intake (PSI) and historical safe intake (HSI) are given in milligrams Assessing Safety of Animal Dietary Supple- per kilogram of body weight (mg/kg BW) ments

The safety of a supplement, additive, or drug is generally assessed in two ways. Controlled studies, such as a study LUTAIN looking at the toxicity of a compound, usually done prior to Lutein is abundant in green and yellow fruits and veg- the compound hitting the market, with the intent of iden- etables. The purported benefits of lutein supplements in tifying potential adverse events (box 2) associated with the humans include: administration of the compound. And surveillance stud- • Treatment or prevention of age-related macular ies, generally post market, done to monitor anticipated or degeneration • Anti-oxidant and anti-cancer effect unanticipated adverse events associated with general use • Protection against UV radiation of the compound. PSI HSI Animal (mg/kg BW) (mg/kg BW) NOTE The committee found that in addition to there being lim- *When eaten as forage or ited safety studies there are many other factors that further Horses 8.3* 8.3* natural sources; no data challenge the assessment of animal supplements safety, exist for supplements including the lack of standardization among active ingre- Dogs 1.8 0.45 dients in the animal supplement market and the lack of a comprehensive adverse event reporting system. Because Cats 7.2 0.85 of these challenges, other types of evidence, found in the evidence pyramid (figure 1), were reviewed and should be reviewed when determining safety of animal supplements such as lutein, evening primrose oil, and garlic. EVENING PRIMROSE OIL Evening primrose oil (EPO) is an oil found in the evening primrose plant. EPO is made up of fatty acids. Two of the fatty acids found Findings and Recommendations in EPO are recognized for their contributions to the maintenance of normal health and metabolism. In assessing animal dietary supplement safety, elements such Animal PSI HSI NOTE as the relevance of the study to safety, dosage, contaminants (mg/kg BW) (mg/kg BW) in the supplements, and size of the study, all need to be con- *Assumes that total fat will sidered when designing and assessing animal dietary supple- Horses 400* 25-80 not exceed 23 percent of ments. Although the use of animal dietary supplements is diet potentially greater than the use of drugs or food additives, *Which is the upper limit Dogs 424* 42-424 minimal safety data were available. Ideally, the committee used in trials would have liked to have adequate data to determine a no *It is likely that cats could observed adverse effect level (NOAEL) for or a safe upper Cats 391* 20-391 limit (SUL) for each of the three supplements. With the tolerate higher levels limited data currently available, the committee could only report historical safe intakes (HIS) and estimate presumed safe intake (PSI) for garlic (except for cats), evening primrose oil, and lutein. GARLIC Garlic has been used in the diet of humans for centuries. Ancient The use of other species (i.e. non-target species) is important medical text from Egypt, Greece, Rome, China, and India include prescribed medical applications of garlic. Today garlic is thought in assessing safety of supplements but is limited. Because of to have numerous health benefits including reducing the risk of limited amounts of data about supplements in the animals cardiovascular disease and cancer, stimulating immune function, of intended use (i.e. target species), research using other and restoring physical strength. species can provide important safety signals. Although Animal PSI HSI NOTE non-target species provide important evidence about (mg/kg BW) (mg/kg BW) safety they do not guarantee safety in the target animals. Horses 90 15 An example is garlic, although considered safe in humans *There is a long history of Dogs 56 22* when taken as a supplement, there is a concern that excess safe use. garlic supplement can cause hemolytic anemia in horses, *The committee was unable Cats N/A* 17 dogs, and cats. The committee has identified several fac- to estimate a PSI for garlic.

ANIMAL HEALTH INTERNATIONAL, INC. | www.animalhealthinternational.com 7 INSIDER | SEPTEMBER 2014 tors that should be considered when selecting appropriate CONCLUSION substitute animals. Factors to be considered include the metabolic and natural dietary pattern similarities between Many people presume that supplements are safer than surrogate and target animals and whether the supplement drugs, but the reality is that there is very limited safety is naturally occurring in both animals’ diet. data on dietary supplements for horses, dogs, and cats to determine safe use. The committee was unable to deter- There is a clear need for a comprehensive adverse event mine an upper limit of safe use for the three supplements, reporting system. Existing systems are deficient and limited lutein, evening primrose oil, and garlic. This shortage of by the difficulty of defining dosages, active ingredients, or data resulted in trying to estimate existing intake levels as consistent adverse signals. Some systems require payment those presumed to be safe. The committee believes these to access (e.g., the poison control center of the American levels are conservative for lutein and evening primrose oil, Society for the Prevention of Cruelty to Animals) or are lim- but probably more on target for garlic because of known ited by membership (e.g., the National Animal Supplement reports of adverse events. Council). Any system should be easily accessible for reporting and retrieving purposes, generate accurate data with Many challenges stand in the way of determining whether a high level of confidence, and build upon the experience or not animal dietary supplements are safe and at what embedded in existing systems. The committee’s analysis of dosage. Supplements considered safe in humans and other these supplements has not uncovered a system for ad- cross-species are not always safe in horses, dogs, and cats. verse reporting that is similar to those in place for drugs. An adverse event reporting system is badly needed. And fi- The committee believes that lack of adverse events being nally, regulations dealing with animal dietary supplements reported to a manufacturer is weak evidence for a lack of are in disarray. Clear and precise regulations are needed to adverse effects having actually occurred. allow only safe dietary supplements on the market. Committee on Examining the Safety of Dietary Supplements for Horses, Dogs, and Current regulations addressing animal dietary supplements Cats: Jim E. Riviere, (Chair), North Carolina State University; Dawn M. Boothe, Auburn University; Gail L. Czarnecki-Maulden, Nestle Purina PetCare PTC; David A. Dzanis, Dza- are in disarray. Clarification is required to clearly differenti- nis Consulting & Collaborations; Patricia A. Harris, WALTHAM Centre for Pet Nutrition; ate between an animal dietary supplement and a food Wouter H. Hendriks, Wageningen University; Claudia A. Kirk, University of Tennessee; additive or animal drug, as well as factors that differentiate Lori K. Warren, Univeristy of Florida; Austin J. Lewis (Study Director); Ruth S. Arieti regulation of human and animal supplements. Any future (Senior Project Assistant). This report brief was prepared by the National Research Council based on the com- animal dietary supplement regulations should take into mittee’s report. For more information or copies, contact the Board on Agriculture and account existing standards set by the American Association Natural Resources at (202) 334-3062 or visit http://dels.nas.edu/banr. Copies of Safety of Feed Control Officials (AAFCO), Codex, and U.S. Pharma- of Dietary Supplements for Horses, Dogs, and Cats are available from the National Academies Press, 500 Fifth Street, NW, Washington, D.C. 20001; (800) 624-6242; www. copeia (USP). nap.edu. Special Days This Month Month and Week - Long Events include: September 21 - 27 • Sea Otter Awareness Week September 21 - 27 • National Farm Safety & Health Week September 21 - 27 • National Deaf Dog Awareness Week September Special Days include: September 4 • National Wildlife Day September 8 • National Iguana Awareness Day September 14 • National Pet Memorial Day September 22 • National Elephant Appreciation Day September 25 • National Teach Ag Day September 28 • World Rabies Day

Catalyst Council's Happy Healthy Cat Month

ANIMAL HEALTH INTERNATIONAL, INC. | www.animalhealthinternational.com 8 INSIDER | SEPTEMBER 2014 Resources From the Web For More Information...

here’s far too many quality resources available to veterinarians, veterinary technicians, practice managers and staff, and to clients and consumers Ton the topic of Dietary Supplements and Nutraceuticals to include in this edition of the INSIDER. We’ve provided some additional web links below:

www.aahanet.org/Library/NutritionalAsmt.aspx 2010 AAHA Nutritional Assessment Guidelines for Dogs and Cats, published in 2010 (July/Aug). Mainly focused on assessment and food for cats and dogs. www.thehorse.com/articles/28184/the-science- behind-equine-nutritional-supplements GREAT article and information on equine nutritional supplements (free registration may be required). www.acvn.org The website for the American College of Veterinary Nutrition www.nutritiontechs.org The website for the Academy of Veterinary Nutrition Techni- cians (AVNT, whose mission is “to advance the area of and promote excellence in the discipline of veterinary nutrition.”) www.nasc.cc The website for the National Animal Supplement Council, an “industry group dedicated to protecting and enhancing the health of companion animals and horses throughout the United States. Founded in 2001, NASC members are industry participants and other stakeholders of the finest animal supplements who are committed to the highest current standards of quality in the industry today” www.fda.gov/AnimalVeterinary/NewsEv- ents/FDAVeterinarianNews- letter/ucm110415.htm A very comprehensive overview from the FDA on the regulations and requirements surrounding the marketing of Dietary Supplements.

ANIMAL HEALTH INTERNATIONAL, INC. | www.animalhealthinternational.com 9 INSIDER | SEPTEMBER 2014 A stride forward

Introducing OSPHOS, the new intramuscular injection from Dechra Veterinary Products

Easily administered Well tolerated* Proven efficacy* No via intramuscular in clinical trials at 6 months Reconstitution injection post treatment required

OSPHOS contains clodronate disodium, a bisphosphonate indicated for the control of clinical signs associated with navicular syndrome in horses. OSPHOS is the only FDA-approved bisphosphonate for use in horses that is labeled for intramuscular injection. Learn more online In a clinical trial evaluating OSPHOS in 86 horses, lameness improved in 74.7% of horses by at least one grade 56 days after www.dechra-us.com treatment. Only 9% of horses displayed clinical signs of being www.equinelameness.com uncomfortable, nervous, colicky and or pawing after receiving OSPHOS. Less than 1% of horses experienced colic Call our 24 hour Tech Support requiring treatment. (866) 933-2472 WITH OSPHOS THE BENEFITS ARE CLEAR . . .

As with all drugs, side effects may occur. In field studies, the most common side effects reported were signs of discomfort or nervousness, colic, and/or pawing. OSPHOS should not be used in pregnant or lactating mares, or mares intended for breeding. Use of OSPHOS in patients with conditions affecting renal function or mineral or electrolyte homeostasis is not recommended. Refer to the prescribing information for complete details or visit www.dechra-us.com. CAUTION: Federal law restricts this drug to use by or on the order of licensed veterinarian.

* Freedom of Information Summary, Original New Animal Drug Application, NADA 141-427, for OSPHOS. April 28, 2014. ANIMAL HEALTH INTERNATIONAL, INC. | www.animalhealthinternational.com 10 INSIDER | SEPTEMBER 2014

Osphos_EquineSolutions_fullpage.indd 1 8/27/14 10:34 AM Equine Focus Nutritional Supplements in Horses (author: Ed Kane, PhD, is a researcher and consultant in animal nutrition. He is an author and editor on nutrition, physiology and veterinary medicine with a background in horses, pets and livestock. Adapted from dvm360. com and DVM360 magazine) Veterinarians must show caution when recommending nutritional supplements.

hat should practitioners consider when evaluating and recommending nutrient supplements for equine patients? In addition to looking at the traditionalW issues of an animal's age, activity level and general health, practitioners should also consider the nutrient's A stride forward perceived benefits, efficacy and bioavailability.

Following is a look at nutritional supplements, including Introducing OSPHOS, nutraceuticals, how they are and aren't regulated and the purported benefits of some of the supplements. the new intramuscular injection from Dechra First, the basics The Nutrient Requirements of Horses from the National Veterinary Products Academy of Sciences is the basis for evaluating nutrient needs of horses. Published in 2007, it provides a thorough review of the various classes of nutrients (e.g., energy, processed grains compressed by rolling, flaking or crimp- carbohydrates, protein and amino acids, fats and fatty acids, ing; pelleted grain mixtures; pelleted forage; textured feeds vitamins, minerals), including estimates of nutrient require- and extruded feeds (cubes, wafers, pellets). Rations are ments for growth, maintenance, reproduction and perfor- usually composed of ingredients that are processed after mance. It also discusses water and water quality, feeds and harvesting. Processing can affect the physical, chemical and microbiological properties of the feedstuff by altering Easily administered Well tolerated* Proven efficacy* No feed processing, feed additives, feed analysis, ration formu- lation and evaluation and the nutritional needs of horses the size, density, nutrient content and texture. Digestibility, via intramuscular in clinical trials at 6 months Reconstitution utilization, intake and acceptance may also be affected. injection post treatment required experiencing various disease states. When feeding horses, management conditions are pivotal; Nutrient supplements defined environmental access to nutrients can influence the feeding The Federal Food, Drug and Cosmetic Act [Title 21, Code OSPHOS contains clodronate disodium, a bisphosphonate indicated of Federal Regulations §321(f)] defines feed additives and for the control of clinical signs associated with navicular syndrome management that's implemented. Horses that live outdoors in horses. OSPHOS is the only FDA-approved bisphosphonate with access to pasture are fed very differently from those in includes items that are intended or reasonably expected to for use in horses that is labeled for intramuscular injection. confinement. become either directly or indirectly a constituent of food or Learn more online In a clinical trial evaluating OSPHOS in 86 horses, lameness that may alter the characteristics of a food. Additives also improved in 74.7% of horses by at least one grade 56 days after www.dechra-us.com In addition to the nutritional requirements responsible for include substances intended for use in the manufacturing, treatment. Only 9% of horses displayed clinical signs of being www.equinelameness.com sustaining normal physiology, nutrient expenditures associ- processing, packaging and storage of a food. Animal diet uncomfortable, nervous, colicky and or pawing after receiving ated with degrees of activity can influence feeding prac- feed additives may be non-nutritive ingredients that stimu- OSPHOS. Less than 1% of horses experienced colic Call our 24 hour Tech Support tices. Horses may be involved in high levels of performance late growth or other aspects of production, improve the requiring treatment. (866) 933-2472 (e.g., racing, polo, dressage, cutting and roping, ranch and efficiency of food utilization or benefit the animal's health WITH OSPHOS THE BENEFITS ARE CLEAR . . . farm work), as well as moderate levels of exercise. Horses or metabolism. at varying levels of exercise require different amounts of energy, as well as other nutrients such as electrolytes and Numerous nutrient supplement compositions are avail- As with all drugs, side effects may occur. In field studies, the most common side effects reported were signs of discomfort or water for intense physical activity and performance. Special able. Such supplements are often mixtures of vitamins and nervousness, colic, and/or pawing. OSPHOS should not be used in pregnant or lactating mares, or mares intended for breeding. minerals, though some include ingredients not commonly Use of OSPHOS in patients with conditions affecting renal function or mineral or electrolyte homeostasis is not recommended. considerations are also given to young and growing horses, Refer to the prescribing information for complete details or visit www.dechra-us.com. breeding stallions and pregnant or lactating mares. part of the natural equine diet. These supplements may include botanicals, herbs, extracts, enzymes, metabolites CAUTION: Federal law restricts this drug to use by or on the order of licensed veterinarian. Horses may be fed fresh and stored forages; grain mixtures; and amino acids. They're sold in the form of tablets, liquids, * Freedom of Information Summary, Original New Animal Drug Application, NADA 141-427, for OSPHOS. April 28, 2014. ANIMAL HEALTH INTERNATIONAL, INC. | www.animalhealthinternational.com 11 INSIDER | SEPTEMBER 2014

Osphos_EquineSolutions_fullpage.indd 1 8/27/14 10:34 AM pastes, powders and granules.

The American Association of Equine Practitioners (AAEP) endorses the 1996 American Veterinary Medical Associa- tion (AVMA) guidelines, including the use of nutraceuticals. The therapeutic use of micronutrients, macronutrients and other oral nutritional substances is permitted, though veterinarians should be aware of the ingredient content and their benefits, bioavailability, efficacy and safety.

While not applicable to animals, a dietary supplement is defined by the Dietary Supplement Health and Educa- tion Act (DSHEA) as one that "contains one or more of the following dietary ingredients: vitamin, mineral, herb, or other botanical, amino acid or dietary substance for use by man to supplement the diet by increasing the total dietary intake, or a concentrate, metabolite, constituent, extract, or combinations of these ingredients." Under DSHEA, dietary supplement manufacturers are responsible for ensuring Environmental a supplement is safe before it's marketed and providing a access to nutrients reasonable assurance that no ingredient presents a signifi- cant or unreasonable risk of illness or injury. can influence feeding

Manufacturers cannot claim their products prevent, treat management. or cure disease. Within the DSHEA, though limited in its ability to regulate products prior to marketing, the Food and Drug Administration (FDA) is responsible for taking action against any unsafe dietary supplement product after it reaches the market. Generally, manufacturers are to approved ingredients and animal feed additives. not required to register their products with the FDA nor Some manufacturers have introduced animal products get the FDA's approval before producing or selling dietary from their position within the human nutraceutical mar- supplements. Manufacturers must ensure product label in- ket. Many of these products have emerged in the horse formation is truthful and not misleading. Unlike for human market via a bridge from the human supplement market dietary supplements, the Center for Veterinary Medicine with the assumption that all species need the supplement (CVM) has determined DSHEA doesn't apply to animals, sometimes without scientific data supporting its efficacy, animal feeds or to veterinary nutraceuticals. bioavailability and nutritional purpose in horses. Equine practitioners should scrutinize those products before rec- Animal dietary supplements ommending their use in horses. According to the National Research Council, an animal dietary supplement is defined as "a substance for oral con- The National Animal Supplement Council (NASC), formed in sumption by horses, dogs and cats, whether in or on feed 2001, is a nonprofit industry group consisting of manufac- or offered separately, intended for specific benefit to the turers, suppliers, veterinarians, dealers and animal owners animal by means other than provision of nutrients recog- dedicated to protecting and enhancing the health of horses nized as essential or for provision of essential nutrients for and companion animals. The group's aim is to place safety intended effect on the animal beyond normal nutritional standards on animal supplements and on the manufactur- needs, but not including legally defined drugs." ers and to promote the use of safe ingredients in their products. The NASC Quality Seal Program is awarded to those Nutrients and nutrient supplements are regulated by vari- manufacturers that meet the organization's standards (for ous agencies including the FDA's CVM and the individual more information, visit http://www.nasc.cc/). states where the products are sold. Guidance for the state agencies is provided by the Association of American Feed However, NASC does not require companies to perform Control Officials (AAFCO). AAFCO writes and revises model efficacy studies on their products or verify that scientific bills, which include food and drug regulations set forth in research data are available proving the products are effec- the Code of Federal Regulations and are often the basis of tive for the benefit(s) they claim in horses. state feed regulations. The AAFCO official publication, published yearly, includes continuous revisions and additions Note, numerous reputable nutrient supplement companies ANIMAL HEALTH INTERNATIONAL, INC. | www.animalhealthinternational.com 12 INSIDER | SEPTEMBER 2014 OSPHOS® (clodronate injection)

Bisphosphonate For use in horses only.

Brief Summary (For Full Prescribing Information, see package insert)

CAUTION: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian.

DESCRIPTION: Clodronate disodium is a non-amino, chloro-containing bisphosphonate. Chemically, clodronate disodium is (dichloromethylene) diphosphonic acid disodium salt and is manufactured from the tetrahydrate form.

INDICATION: For the control of clinical signs associated with navicular syndrome in horses.

CONTRAINDICATIONS: Horses with hypersensitivity to clodronate disodium should not receive OSPHOS.

WARNINGS: Do not use in horses intended for human consumption.

HUMAN WARNINGS: Not for human use. Keep this and all drugs out of the reach of children. Consult a physician in case of accidental human exposure.

PRECAUTIONS: As a class, bisphosphonates may be associated with gastrointestinal and renal toxicity. Sensitivity to drug associated adverse reactions varies with the individual patient. Renal and gastrointestinal adverse reactions may be associated with plasma concentrations of the drug. Bisphosphonates are excreted by the kidney; therefore, conditions causing renal impairment may increase plasma bisphosphonate concentrations resulting in an increased risk for adverse reactions. Concurrent administration of other potentially nephrotoxic drugs should be approached with caution and renal function should be monitored. Use of bisphosphonates in patients with conditions or diseases affecting renal function is not recommended. Administration of bisphosphonates has been associated with abdominal pain (colic), discomfort, and agitation in horses. Clinical signs usually occur shortly after drug administration and may be associated with alterations in intestinal motility. In horses treated with OSPHOS these clinical signs usually began within 2 hours of treatment. Horses should be monitored for at least 2 hours following administration of OSPHOS.

Bisphosphonates affect plasma concentrations of some minerals and electrolytes such as calcium, magnesium and potassium, immediately post-treatment, with effects lasting up to several hours. Caution should be used when administering bisphosphonates to horses with conditions affecting mineral or electrolyte homeostasis (e.g. hyperkalemic periodic paralysis, hypocalcemia, etc.). are not members of NASC but do follow proper labeling The safe use of OSPHOS has not been evaluated in horses less than 4 years of age. The effect of bisphosphonates on the skeleton of growing horses has not been studied; and legitimate good manufacturing practices and have however, bisphosphonates inhibit osteoclast activity which impacts bone turnover and may affect bone growth. their products supported with scientific data showing their Bisphosphonates should not be used in pregnant or lactating mares, or mares intended for benefit and efficacy for use in horses. breeding. The safe use of OSPHOS has not been evaluated in breeding horses or pregnant or lactating mares. Bisphosphonates are incorporated into the bone matrix, from where they are gradually released over periods of months to years. The extent of bisphosphonate incorporation into adult bone, and hence, the amount available for release back into the Various herbal and botanical nutraceuticals are marketed systemic circulation, is directly related to the total dose and duration of bisphosphonate use. Bisphosphonates have been shown to cause fetal developmental abnormalities in by equine supplement manufacturers for multiple pur- laboratory animals. The uptake of bisphosphonates into fetal bone may be greater than into maternal bone creating a possible risk for skeletal or other abnormalities in the fetus. poses. Here is a brief synopsis of some of these items, their Many drugs, including bisphosphonates, may be excreted in milk and may be absorbed purported benefits and their noted application in horses. by nursing animals. Although included in the list of horse products, some of Increased bone fragility has been observed in animals treated with bisphosphonates at high doses or for long periods of time. Bisphosphonates inhibit bone resorption and these nutraceuticals have been scientifically proven only decrease bone turnover which may lead to an inability to repair micro damage within the bone. In humans, atypical femur fractures have been reported in patients on long term for laboratory animals or people. Regardless of the manu- bisphosphonate therapy; however, a causal relationship has not been established. facturer's common claims, most of these are not AAFCO- ADVERSE REACTIONS: The most common adverse reactions reported in the field study were clinical signs of discomfort or nervousness, colic and/or pawing. Other signs approved feed ingredients, nor are they supported by reported were lip licking, yawning, head shaking, injection site swelling, and hives/ research for use in horses. pruritus.

Boswellia serrata: Safe use in pregnant mares hasn't been established, so it should be of concern for breeding mares. It may be a GI irritant.

Distributed by: Dechra Veterinary Products Methylsulfonylmethane (MSM) is used to treat various 7015 College Boulevard, Suite 525 Overland Park, KS 66211, 866-933-2472 illnesses in horses, including chronic muscle soreness, © 2013 Dechra Ltd. OSPHOS is a registered trademark of epiphysitis, acute laminitis, pleuritis, recurring digestive Dechra Ltd. All rights reserved. NADA 141-427, tract disorder and arthritis. While no data exist for its effec- Approved by FDA tiveness, and it's intended as a source of bioavailable sulfur, studies evaluating its potential chondroprotective effect in horses haven't been reported.

ANIMAL HEALTH INTERNATIONAL, INC. | www.animalhealthinternational.com 13 INSIDER | SEPTEMBER 2014 Equine inﬂ uenza virus (EIV) and equine herpesvirus (rhinopneumonitis) cause the most common respiratory diseases in horses — and without a second vaccination, the risk increases.1,2 Don’t take the gamble. Help protect your at-risk horse by vaccinating with FLUVAC INNOVATOR® EHV 4/1 every six months. Download the Equine Inﬂ uenza Calculator on iTunes® or learn more at FluvacInnovator.com/calculator.

*EHV-1 and EHV-4 Join our community 1 Fretz PB, Babiuk LA, McLaughlin B. Equine Respiratory Disease on the Western Canadian Racetracks. Can Vet J 1979;20(2):58-61. /eqstable 2 Manley L, Caceres P. Retrospective Cohort Study of an Equine Inﬂ uenza Outbreak in the Chilean Army in the Metropolitan Region of Santiago, Chile, during 2006, in Proceedings. 12th Symposium of the International Society EQStable™ available in for Veterinary Epidemiology and Economics, Durban, South Africa 2009:64. ® ® the Apple App Store All trademarks are the property of Zoetis Inc., its a¥ liates and/or its licensors. All other trademarks are the property of their respective owners. ©2013 Zoetis Inc. All rights reserved. FLU13013

ANIMAL HEALTH INTERNATIONAL, INC. | www.animalhealthinternational.com 14 INSIDER | SEPTEMBER 2014

FLU13013_FluvacAd_P3_8_5x11.indd 1 1/30/14 9:44 AM Beta-hydroxy beta-methylbutyrate (HMB): Although HMB is used as a supplement to increase performance; prevent muscle damage after strenuous effort; increase strength, endurance, and lean muscle mass and prevent exertional rhabdomyolysis, there are little or no data to support its use in horses.

Devil's claw (Harpagophytum procumbens) is purported as a natural anti-inflammatory and analgesic for providing pain relief to horses and reducing inflammation in equine joints, but there are no supportive data in horses. It is con- traindicated in horses with gastric and duodenal ulcers.

Cat's claw (Uncaria tomentosa): No studies are believed to have been performed in horses, but cat's claw purportedly fights viral infections and toxins and inhibits microorganism growth. Fenugreek (Trigonella foenum-graecum) is noted as a Valerian (Valeriana species): Its composition includes digestive tonic, but it should not be used during pregnancy. valerenic acids (monoterpenes, sesquiterpenes) and iridoid Moreover, there is no data to support its use in horses. glycosides. Several positive benefits are claimed for horses Most of these nutraceuticals are not AAFCO-approved feed for its sedative or tranquilizing properties because of its ingredients. No scientific literature exists that shows nutri- effects on suppressing gamma-aminobutyric acid, but no tional or other benefits in horses or supports their use in known studies have been done in horses. Valerian should horses. Other substances in need of data to support their not be used in conjunction with central nervous system use in horses are outlined in Table 1. depressants or before a horse is anesthetized. Some of these ingredients should be prescribed with Ginseng (Panax species) is commonly studied for its im- precautions. For example, some may be associated with ad- munostimulatory properties. It's been shown to exert an verse reactions to their active ingredients. Some may cause inhibitory effect on IL-1b and IL-6 gene expression; decrease undesirable side effects or may produce effects when given TNF-α production by macrophages; decrease COX-2 ex- with prescribed drugs. Some herbs should be of concern if pression and suppress histamine and leukotriene release fed to pregnant mares since they may stimulate the uterus in mice and rats. As an equine supplement, ginseng is (e.g., licorice root, oregano, sage, vervain, fenugreek). Milk purported for stimulating the immune system, decreasing thistle may interfere with uptake of P450 drugs. And marsh- stress and increasing optimal performance, but there's no mallow root shouldn't be used simultaneously with drugs scientific literature to support its use in horses. absorbed into the intestine, since it may decrease uptake.

Coming up in the INSIDER:

✓ October - Vet Clinic Surgical Suite & Supplies ✓ November - Equipment & Diagnostics

a veterinary publication

July 2014 April 2014

a veterinary publication May 2014 ✓ December - New Year Planning June

2014 a veterinary publication In This Issue of Insider A Focus on Endoparasites Stress, Anxiety and Boarding he symptoms related to the occurrence of internal and external parasites are In This Issue of Insider ur companion animal friends experience and express many of the same Customer Focus one of the leading reasons owners seek veterinary care and treatment for » Page 2 In This Issue of Insider a veterinary publicationfeelings and conditions we human animals do—both the good and the - their working and companion animals. IdentifyingMites, and treating Ticksthe primary and Fleas…Oh My! Top Five Tips for Cat bad. Joy, excitement, contentment, and affection are all qualities we enjoy causeT and the associated symptomsA Team Approach make up toa good portion of any veterinarian’s Prevention of Zoonotic lfred Lord Tennyson’s poem “Locksley Hall” contains the oft-quoted line “In day. But how much emphasisClient is placed Compliance on prevention? Friendly Boarding Transmission the Spring a youngIn man’s This fancyIssue lightlyof Insider turns to thoughts of love”. In most sharing with our pets and working animals. The downside is that cats, dogs and » Page 2 A Focus on Small Animal andO » Page 4 & 5 veterinary clinics and hospitals, Spring causes veterinary practitioner’s» Page 2 & 3 Despite best efforts by veterinary professionals and the larger veterinary health other companion animals also experience fear, anxiety, suspicion, distress, anger fancyA to lightly turn to other,Discussing less romantic, Small thoughts: Animal Mites, Ticks and Fleas. community, more than 21.5 million dog owners were found to be either not giving Resources from The Web Lyme Disease in Dogs and stress, and they express these feelings in a way that is unpleasant, and some their dogs heartworm preventives or not administering them as recommended byDental Exams with Equine DentistrySpecial Days This Month » Page 7 » Page 3, 4 & 5 While year-round prevention and treatment is the standard of care (particularly in their veterinarian. And an estimated 77 percent of veterinarians currently recom-Clients times harmful, to both the pet and pet owner. the warmer climes of the U.S. south and west), springtime is thever right 80% time of dogs to advise» and Page 70% 3 of cats develop some degree of periodontal mend year-round administration of heartworm preventives, but only half of owners» Page 2 & 3 Continuing Education Flea Allergy Dermatitis your clients on just what’s bugging their furry friends. disease by the age of three years, making dental disease the number one report they follow these instructions.in no FAD disease entity affecting small pets. And yet many pet ownersIn this are issueunaware of the INSIDER, we look at some of the science and studies behind anxi- » Page 8 Special Days This Month Behavior Modification » Page 6 & 7 In this issue of the INSIDER,» wePage look 3 at these common exoparasitesofO the importance and provide of regular dental health checkups. This issue of the INSIDER will give you some tools and information to assist you in ety, stress and other emotions exhibited by companion animals, provide sugges- Did You Know your practice with some topical information, tools, and tips on Mite, Tick and Fleaas an Adjunct to Suggestions for identifying and treating parasites, specifically endoparasites, and about prevention » Page 10 Parasite Prevalence prevalence, prevention and treatment. The veterinary practitioner, veterinary technicians and front-officetions staff to should share all with your clients on how to minimize or alleviate these conditions for and other best practices. Malocclusions and Medication » Page 8 Orthodontics in Dogs take a role in discussing regular dental care and annual exams withtheir each client. pets with chronic issues, and some travel and smart boarding tips which will Question? Comments? » Page 4, 5 & 6 and Cats One fact that is usually a good way to open the discussion (and is quiteimprove the eye- the time spent with their furry friends during the busy summer months. Identification and » Page 4 opener): The average cost to prevent dental disease in pets is $171.82, while aver- Treatment of Mange age cost for treatment of dentalResources disease is $573.71!From the Web in Horses - Prevention AAHA Dental Care and Control of Mange in » Page 7 Guidelines for Dogs and In the issue of the INSIDER, we’ll offer additional discussion points to help explain topics? Want to be on our mailing list, add a friend, or Horses Cats the companion animal dental examination and care process, some thoughts on » Page 9 & 10 » Page 5 feline dentistry, the 2013 AAHA Dental Care Guidelines for Dogs and Cats, and the changing dental needs of yourRecognize equine patients Stress over time. in Continuing Education Feline Dental Care and Horses » Page 11 & 12 Treatment » Page 8, 9 & 10 » Page 6 & 7 Did You Know? be removed from our mailing list? Please email us at » Page 13 Resources From the Web Continuing Education » Page 8 » Page 11 & 12

Equine Dental Needs Change Over Time Did you Know? » Page 9 & 10 » Page 13 INSIDER | APRIL 2014 [email protected] Continuing Education » Page 11 & 12 Veterinary Clinic INSIDER | MAY 2014 Products Did you Know? » Page 13 » Page 14 & 15

INSIDER | JUNE 2014 | JULY 2014 INSIDER

ANIMAL HEALTH INTERNATIONAL, INC. | www.animalhealthinternational.com 15 INSIDER | SEPTEMBER 2014 Continuing Education Events Continuing Education nimal Health International strives to bring you the very best in Continuing Education, presented in a meaningful, practical way which allows you to bring new skills, techniques and knowledge to your practice and your patients right away. To learn more about our Continuing Education Events, please visit Ahttp://www.animalhealthinternational.com/eventsAnimalHealth.html , or contact Animal Health International’s Director of Customer Solutions, Tom Knutson, at [email protected] . In this issue of the INSIDER, please meet one of our instructors, Dr. Victoria Lukasik.

Dr. Victoria Lukasik Diplomate, American College of Veterinary Anesthesia & Analgesia (DACVAA)

Dr. Victoria Lukasik received her undergraduate degree from the University of Arizona and her doctorate in veterinary medicine from Washington State University where she was awarded the Outstanding Senior Student in Medicine and Surgery (across all disciplines) and the Dorothy Eggerman Memorial Compassion Award.

Dr. Lukasik completed her residency in anesthesiology at Cornell University and received her Diplomate status from the American College of Veterinary Anesthesia and Analgesia (DACVAA) in 1997. She has received awards from the American College of Veterinary Anesthesia and Analgesia, American Animal Hospital Association (AAHA), research awards from the National Institutes of Health and the National Cancer Institute, and actively participates on a committee at the National Cancer Institute. In addition, Dr. Lukasik is involved in research at the Arizona Health Sciences Center at the University of Arizona and has published numerous professional articles and contributed to textbooks on the field of anesthesia. She is a nationally and internationally recognized speaker and has been presented with several professional awards, including one for compassion. Lecture & Lab Events: Lecture Events: Monitoring Anesthesia: Breathing and Capnography Anesthesia of Patients with Limited Physiologic Reserve Monitoring Anesthesia: Circulation and Blood Pressure Alternative inductions to Propofol Monitoring Anesthesia: Electrocardiogram Anesthesia of the Geriatric Patient Monitoring Anesthesia: Inadvertent Hypothermia Geriatric Anesthesia Recognizing Patient Trends and Managing Anesthetic Events I Anesthesia of the Geriatric Cat Recognizing Patient Trends and Managing Anesthetic Events II Anesthesia of the Pediatric Patient Management of Anesthetic Events I Anesthesia of Patients with Chronic Renal Failure Management of Anesthetic Events II Sedation of Emergency Patients Balanced Post-operative Analgesia Multimodal Medical Management of Chronic Pain Multimodal Management of Chronic Pain Local Anesthetic Blocks for Canine and Feline Dentistry Acute Pain Management, Trauma and Critical Care in Cats

ANIMAL HEALTH INTERNATIONAL, INC. | www.animalhealthinternational.com 16 INSIDER | SEPTEMBER 2014 2014/2015 Small Animal Dental Lecture and Labs

Dental - Level 1 - 2014 Dental Lecture & Lab w/ Dr. Brook Niemiec October 18-19, 2014 Seattle, Washington Dental Lecture & Lab w/ Dr. Brook Niemiec November 22-23, 2014 Pomona, California Dental - Level 2 - 2014 Dental Lecture & Lab w/ Dr. Brook Niemiec October 25-26, 2014 Austin, Texas Dental Lecture & Lab w/ Dr. Brook Niemiec December 13-14, 2014 Napa Valley, California Dental - Level 1 - 2015 Dental Lecture & Lab w/Dr. Brook Niemiec March 28-29, 2015 El Paso, Texas Dental Lecture & Lab w/Dr. Brook Niemiec April 11-12, 2015 Nashville, Tennessee Dental Lecture & Lab w/Dr. Brook Niemiec June 13-14, 2015 Tampa, Florida Dental Lecture & Lab w/Dr. Brook Niemiec August 22-23, 2015 New Orleans, Louisiana Dental Lecture & Lab w/Dr. Brook Niemiec September 26-27, 2015 Houston, Texas Dental Lecture & Lab w/Dr. Brook Niemiec October 17-18, 2015 Site TBD Dental Lecture & Lab w/Dr. Brook Niemiec November 21-22, 2015 Midwest - IWCC Dental Lecture & Lab w/Dr. Brook Niemiec December 5-6, 2015 Site TBD 2014/2015 Orthopedics Lecture and Labs

Cruciate Management by CBLO October 11-12, 2014 Oquendo Center, Las Vegas, NV Comprehensive Stifle Disease February 5-7, 2015 Oquendo Center, Las Vegas, NV Cora-Based Tibial Leveling Osteotomy (CBlO) February 8-9, 2015 Oquendo Center, Las Vegas, NV Basic Orthopedics March 21, 2015 Midwest/High Plains - IWCC Basic Orthopedics April 25, 2015 New Orleans, Louisiana Basic Orthopedics May 16, 2015 Roanoke, Texas 2014/2015 Anesthesia Lectures and Labs

Anesthesia - Level 1 - 2014 Advanced Anesthesia w/Dr. Victoria Lukasik September 6, 2014 Burbank, California Advanced Anesthesia w/Dr. Victoria Lukasik October 11, 2014 Phoenix, Arizona Advanced Anesthesia w/Dr. Victoria Lukasik November 15, 2014 Austin, Texas Anesthesia - Level 1 - 2015 Advanced Anesthesia Level-1 w/Dr. Victoria Lukasik June 6, 2015 Denver, Colorado Anesthesia - Level 2 - 2015 Advanced Anesthesia Level-2 w/Dr. Victoria Lukasik April 18-19, 2015 Midwest/High Plains - Sioux Falls Advanced Anesthesia Level-2 w/Dr. Victoria Lukasik May 30-31, 2015 Site TBD Advanced Anesthesia Level-2 w/Dr. Victoria Lukasik September 12-13, 2015 Austin, Texas 2014 Equine Lecture and Labs

Advanced Equine Dentistry w/Dr. Jack Easley September 19-20, 2015 Elk River, Minnesota Equine Anesthesia w/Dr. Victoria Lukasik October 3-4, 2015 Site TBD

ANIMAL HEALTH INTERNATIONAL, INC. | www.animalhealthinternational.com 17 INSIDER | SEPTEMBER 2014 Job # PFEQBIOS2076 Role: Name: Initials: Date: Order Role Name: Initials: Date: Order: Desc. WNI P-2 ad Bill# PFEQBIOS3007 Prooﬁ ng GCD Job Type: XX Sub Type: XX Writer Art Buyer Switalski Dimensions: 8.5 x 11 Art Director Account Exec. Folded size: No. of pages: ACD Senior Level AE Piece: Project Mgr. Other Path: Red Production Lead Other Colors: CMYK Production Artist Diane Production Mgr. Dan

OR YOU COULD JUST USE WEST NILE-INNOVATOR® Mosquitoes may be small, but as transmitters of West Nile virus, they can cause big problems for your horse. Talk with your veterinarian about WEST NILE-INNOVATOR ®, the West Nile vaccine that has helped protect more horses than any other. 1

1 Data on ﬁ le, sales report data from 2001 through October 2012, Zoetis Inc. All trademarks are the property of Zoetis, Inc., its a liates and/or its licensors. ©2013 Zoetis Inc. All rights reserved. EQB13005 WestNileInnovator.com/Horse

ANIMAL HEALTH INTERNATIONAL, INC. | www.animalhealthinternational.com 18 INSIDER | SEPTEMBER 2014

Zoetis_PFEQBIOS2076_WNI-8_5x11.indd 1 6/18/13 4:49 PM Job # PFEQBIOS2076 Role: Name: Initials: Date: Order Role Name: Initials: Date: Order: Desc. WNI P-2 ad Bill# PFEQBIOS3007 Prooﬁ ng GCD Job Type: XX Sub Type: XX Writer Art Buyer Switalski Dimensions: 8.5 x 11 Art Director Account Exec. Folded size: No. of pages: ACD Senior Level AE Piece: Project Mgr. Other Path: Red Production Lead Other Colors: CMYK Production Artist Diane Production Mgr. Dan

Did you know that Animal Health International has a growing line of supplements, therapeutic shampoos, otic care and other products specifically formulated, packaged and priced for your clinic to use as your ‘in-house’ brand? We Do! It’s called clinics choice ™, and it’s another way Animal Health International is working to bring value to you, your practice, your clients, and the animals in your care. Ask your Animal Health International Representative to learn more.

ANIMAL HEALTH INTERNATIONAL, INC. | www.animalhealthinternational.com 19 INSIDER | SEPTEMBER 2014

Zoetis_PFEQBIOS2076_WNI-8_5x11.indd 1 6/18/13 4:49 PM PRSRT STD U.S. POSTAGE PAID LOVELAND, CO 822 7th Street, Suite 630 PERMIT NO. 150 Greeley, CO 80631

Our new online ordering site is better than ever! Order online 24 hours a day at your convenience!

Shop online now to: • Access your past orders, invoices, statements and more! • Track your orders • View product sales history on each product page • Create templates for faster ordering • Access Compendium and MSDS information

To view all the great features and start ordering online, please visit http://eSelling.AnimalHealthInternational.com animalhealthinternational.com 822 7th Street, Suite 740 Greeley, Colorado 80631 For eCommerce Support Call: 1 (800) 203-5620 Toll Free 888.787.4483