September / October 2009

September / October 2009

An Abaxis Publication For The Veterinary Community

Highlights

Welcome

Special Look: Viral Marketing A lesson from industry applied to the veterinary hospital

ARF and Abaxis Team Up

Welcome to the September/October issue of VetCom brought to you by Abaxis. Our goal at Abaxis® is to be a leader in delivering superior quality products and world-class customer service that meet Veterinary practice requirements every time.

Abaxis donates equipment to ARF

The Black-footed Ferret VetScan assists in conservation efforts

Equine Metabolic Syndrome and Insulin Resistance

In a recent Abaxis VetScan® customer survey, 97% of respondents were happy with how easy VetScan products are to use and were quoted with comments like “The small amount of tech time to set up and run samples is valuable in my busy practice” and “Very easy to use, even the vets can work it!! LOVE IT!!” 99% of respondents agree that Abaxis Products make their practice more efficient.

Project Report from Kruger National Park, South Africa

Thank you for your valuable feedback and thank you for your business.

Abaxis Expands Warehouse

In this issue (see page 6) Abaxis is also pleased to announce the the VetScan i-STAT® 1 with a full range of diagnostic applications in minutes and the point-of-care. The VetScan i-STAT 1 delivers accurate blood gas, electrolyte, chemistry and hematology results in minutes from two drops of whole blood. Please note: Abaxis is servicing and supporting ALL i-STAT customers. Should you have questions regarding the iSTAT or i-STAT 1, please call 1.800.822.2947.

Case Studies: African Grey Parrot Avian/Reptilian Profile Plus rotor

German Shepherd Retired Military Canine

Authorized Distributors Conference Calendar Editorial Staff Don’t Miss A Single Issue Of VetCom!

As always, Abaxis remains committed to Innovation that you can Trust. Sincerely, Valerie Goodwin – Adams Director, Marketing – Animal Health Editor, VetCom Publications

for US customers only

About Abaxis, Inc. The Abaxis Animal Health point-of-care product portfolio consists of the VetScan VS2 chemistry, electrolyte and immunoassay analyzer, the VetScan VSpro, a coagulation analyzer with a combination PT/aPTT test cartridge, the VetScan i-STAT 1, a portable clinical analyzer, the VetScan HM2 (3-part differential), and the VetScan HM5 (5part differential) hematology analyzer. Abaxis has also introduced VetScan Canine Heartworm Rapid Test.

Subscribe today at www.abaxis.com! 888-9300-REV T

Special Look: Viral Marketing

Viral marketing… A lesson from industry applied to the veterinary hospital Abaxis North American Animal Health Business up 32% (Nasdaq: ABAX) Author: Martin Mulroy, Vice President, Marketing and Sales North American Animal Health Abaxis, Inc. At Abaxis, the economic downturn so far has been a boom to our business and is as well an opportunity for the veterinary practice. We attribute much of our success to word of mouth (WOM) or what we call ‘viral’ marketing. The veterinary community is a very tight knit social marketplace, and so is the pet owner marketplace…they too share information by WOM, at the shopping center, in the park and among family and friends.

Abaxis continues to invest in capital expenditures allowing us to keep our costs down, and in turn our reagents pricing (our customers’ operating costs) significantly lower than the competition. Over the years we have ‘retired’ millions of dollars of factory equipment investing in more efficient, more reliable lower operating cost equipment saving Abaxis over time as much as 10X the initial capital investment or our net cost of financing, and we continue to do so.

Today, more than ever, veterinarians are re-evaluating how they stack up to the local competition as it relates to services provided and the total client experience. Practice owners are also carefully reconsidering their actual costs associated with those services, or maybe costs to the business associated with certain services that they don’t offer but are offered by their competitors in the community.

The veterinary hospital discarding equipment with high operating cost and/or poor performance and investing in or financing more efficient and economical instruments by Abaxis will allow it to actually reduce client charges for routine annual blood work if they like. This in turn increases testing compliance and testing volume, allowing for a greater likelihood of early disease detection. This all leads to increased revenue from treatment and procedures and most importantly, better outcomes. Your clients will be impressed and in turn will tell their family and friends about your clinic and the services that you provide. Traffic to your clinic will increase by WOM referrals and the cycle repeats itself.

Abaxis strives to provide exceptional service and support, and our goal is to provide that support instantaneously. The motto in the building and in the field is “whatever it takes” or what we call “WIT”, and trust me; it is not just a slogan, it is an embedded behavior and an integral part of our company wide culture. The animal hospital offering all clients low cost routine laboratory testing (annual wellness for example) with results discussed in minutes is certainly spoken of differently by pet owners at the park than another hospital that selectively offers testing and then call’s the client later that day or worse, a day or two later, because this testing is still being sent out to a commercial laboratory or possibly the equipment used is outdated, slow or not reliable. This not only fails to impress the client, and certainly inconveniences the client, but can often adversely impact outcomes as well. If the hospital does provide testing in house, and has a state of the art laboratory on the premises, they should advertise that they do.

So what do we do now with all these new profits? These incremental profits the business might consider reinvesting in still more services not widely offered locally, being certain to advertise same. If in your locality client visits are down, it may be time to ‘put on your game face”. It is called getting a bigger slice of a smaller pie. Get competitive. Finally, relying solely on the wholesalers’ recommendations in this economic environment is passé. In the animal health industry, manufacturers often restrict distributors to one product line in a category, and distributors typically acquiesce. (Abaxis though does not impose such restrictions). At Abaxis we of course have solid relationships with suppliers and wholesalers, but at the end of the day, we do our own homework.

September / October 2009 • 2

Special Look: Viral Marketing continued Abaxis’ North American Animal Health business last quarter generated record revenues growing 32% versus year ago while our competitors, including those providing commercial lab services, were generally flat or down. We attribute much of this continued success to the fact that just as we work hard (“Whatever It Takes”) in customer satisfaction and converting clients from the competition to Abaxis the veterinary hospital management must also work hard to retain the existing client base and attract new ones every day. Just as our products and services have a “Wow” factor, the veterinary hospital should strive to their level of service having a “Wow” factor and capitalize on the viral marketing opportunity both Abaxis and its clients share.

Abaxis, should the practice owner invite us in, can provide products and services which will enable new and sustainable growth for the business: increased customer satisfaction, increased traffic, more services provided and procedures rendered, often better outcomes and increased recurring revenue and profits. 7,000+ of your peers are experiencing today the benefits of their partnering with Abaxis. You can “take that to the bank”.

Tony La Russa’s Animal Rescue Foundation Teams Up With Abaxis, Inc.

Abaxis Sales Representative training on the VetScan VS2 and VetScan HM2.

Tony La Russa’s Animal Rescue Foundation (ARF) is very pleased to announce a new partnership with Abaxis, Inc., a Union City, California manufacturer of point of care blood laboratory systems for medical and veterinary use. Abaxis has generously provided ARF’s Clinic with the use of a VetScan VS2 blood chemistry, electrolyte and immunoassay analyzer and VetScan HM2 hematology analyzer with additional support for related supplies. The equipment was recently installed with free training provided for ARF’s Clinic Staff and volunteers. The VetScan system can be operated with minimal training and perform multiple tests on whole blood, serum or plasma at a greatly reduced cost, with precise and accurate test results in minutes.

ARF’s Medical Director, Heather Coburn, DVM states “This equipment allows ARF to quickly obtain very cost-effective blood work when needed for ARF’s shelter animals and to provide more services to local low income clients served through ARF’s Emergency Medical Fund, enabling these families to receive critically needed test results for their pets quickly and inexpensively”. In these challenging economic times, demands for ARF’s programs and services increase daily. Your support will help ARF make a difference in the lives of animals and people. Please visit http://www.arf.net/how-you-can-help/donate/ to make a donation. People rescuing animals … animals rescuing people®.

September / October 2009 • 3

Distributors United States American Veterinary Supply 800-869-2510 DVM Resources 877-828-1026 Great Western Animal Supply 800-888-7247 Hawaii Mega-Cor, Inc. 800-369-7711 IVESCO 800-457-0118 Lextron, Inc. 800-333-0853 Merritt Veterinary Supply 800-845-0411 Nelson Laboratories 800-843-3322 North East Veterinary Supply Co. 866-638-7265 Penn Vet Supply 800-233-0210 TW Medical 888-787-4483 Western Medical Supply 800-242-4415 VWR International, LLC 800-932-5000

Canada Associated Vet Purchasing, Co. 604-856-2146 CDMV 450-771-2368 MidWest Drug 204-233-8155 VetNovations 866-382-6937 Vie et Sante 418-650-7888 Western Drug & Distribution 877-329-9332

Special Look: Conservation Efforts

VetScan Assists in Conservation Efforts: The Black-footed Ferret Contributing Authors:

Heather Branvold MS, DVM Julie Kreeger DVM, PhD The black-footed ferret is one of three ferret species in the world, and the only one native to North America. The other ferret species include the Siberian polecat and the European ferret, from which the domestic ferret is descended. Black-footed ferrets have a characteristic black mask, black feet, and black-tipped tail. The average life span in captivity is 4-6 years, and 1-3 years in the wild.

Black-footed ferrets depend almost exclusively on prairie dogs for food and for shelter in underground burrows. They once occurred across the Great Plains wherever their prairie dog prey existed, from southern Canada to northern Mexico. Over the past century prairie dog populations, and ferrets by extension, have been vastly reduced by conversion of native prairie to cropland, by poisoning of prairie dogs to reduce forage competition with domestic livestock, and by a non-native disease- sylvatic plague. Prairie dog numbers have been reduced by over 95%, and they no longer occur in large, unbroken colonies extending for miles. Black-footed ferrets were considered extinct in the 1960s, until a population was discovered in South Dakota in the mid-1970s. Some of this population was brought into captivity, but breeding efforts were unsuccessful. The wild South Dakota population died out due to disease, and when the last captive animal died in 1979 the ferret was presumed to be extinct- again. However, in 1981 a wild population was discovered near Meeteetse, Wyoming. Unfortunately, this last known, nonreintroduced wild population also succumbed to disease in the mid-1980s, but not before it provided 18 animals to start a successful captive breeding effort. Six facilities now maintain captive ferret populations. These are the National Black-footed Ferret Conservation Center, the National Zoo’s Conservation and Research Center, Cheyenne Mountain Zoo, Louisville Zoological Gardens, the Phoenix Zoo, and the Toronto Zoo. To date, over 6100 ferrets have been produced in captivity. The captive population now totals approximately 280 animals, which ensures the survival of the species and provides animals for reintroduction.

September / October 2009 • 4

Special Look: Conservation Efforts continued The National Black-footed Ferret Conservation Center (FCC), located in northern Colorado, houses the majority of the captive ferrets. Ferrets in captivity are susceptible to a wide variety of infectious and non-infectious diseases. Some common diseases include renal failure and various cancers in older animals, and coccidia and other intestinal pathogens in young and old animals. Physical exams are performed biannually and bloodwork is done routinely at the FCC. Since ferrets are small animals, weighing only 600-1100g, it is preferable to take the smallest amount of blood necessary for analysis, especially if the animal is ill. The Abaxis VetScan chemistry analyzer requires only small amounts of whole blood or serum/plasma, and is therefore used at the FCC for routine bloodwork and for helping to diagnose diseases in sick ferrets. It is important that each captive ferret remains healthy, since they will be released into the wild or remain in captivity to produce young for reintroduction. Since 1991, over 2100 ferrets have been reintroduced into the wild at 18 sites across the western United States and Mexico. At present, ferret numbers in the wild are estimated to be 800-1,000 individuals. Although significant progress has occurred to support ferret recovery, the species will not be recovered until larger numbers of ferrets exist in the wild and routine reintroduction efforts are no longer necessary. Currently, the most challenging obstacle limiting ferret recovery is providing a sufficient quantity and quality of prairie dog habitat to support larger number of ferrets in the wild. Prairie dogs are considered a pest species and are subjected to routine poisoning which thereby reduces or eliminates potential ferret habitat. Additionally, the quality of potential ferret habitat is limited by disease. Sylvatic plague is lethal to both prairie dogs and ferrets. The recent development of several management tools, including a vaccine for ferrets, to ameliorate the impact of this disease has been useful in maintaining some reintroduced ferret populations. More research and field testing of these techniques is underway. Despite the radically altered nature of the environment which reintroduced ferrets face today, the recovery of this species is within reach.

Customer Sampling Medical & Research

Veterinary Facilities

Universities

September / October 2009 • 5

HANDHELD ANALYZER

IMMEDIATE RESULTS, WHERE AND WHEN YOU NEED THEM THE MOST With the VetScan laboratory and the addition of VetScan i-STAT® 1, you can now get a full range of diagnostic applications in minutes at the point-of-care. The Vetscan i-STAT 1 delivers accurate blood gas, electrolyte, chemistry and hematology results in minutes from two drops of whole blood. The VetScan i-STAT 1 is the ideal solution for critical care situations, hospital operating room monitoring, exotic animals, research or for diagnostic and specialty testing needs at the point-of-care. Most importantly, the VetScan i-STAT 1 provides the additional information needed to monitor chronic disease patients, evaluate pre-anesthetic patients and provide diagnostic information for the ill patient in the exam room or treatment room. The VetScan i-STAT 1 uses disposable single use cartridges that contain the necessary reagents to provide reference lab quality results while improving efficiency throughout the animal health continuum of care.

FEATURES • Small sample size - 95 μl or less

• Stores up to 5,000 tests

• Most results in 2 minutes

• Rapid infrared printing through a convenient mini-printer (optional)

• Accurate and reliable results • Low maintenance • Automatic calibration • Automated quality control checks

• Integrated barcode reader • On board glucose strip reader • Features a Cardiac Troponin I Cartridge

• Ergonomic design, handheld versatility, battery operated

BENEFITS • Perfect for either the anemic kitten or fractious cat

• Prior patient results available in the exam room or in the field

• Neither your client or you have to wait for results

• Simple, easy, convenient

• Allows you to make quick and confident treatment decisions • Enhances usability in every clinical situation

• Quick general or emergency assessment with one cartridge

“The addition of the VetScan i-STAT 1 to my practice provides me the ability to monitor and correct acid-base abnormalities in my patients with renal disease, ketoacidosis, etc. This is a vital component of the treatment protocol as well as being recommended by the AAFP guidelines. The VetScan i-STAT 1, along with my VetScan laboratory, allows me to perform these tests while my patients and clients are still in the exam room allowing treatment and medication changes to be discussed face to face, improving my customer service and patient compliance in the most cost effective manner possible.” –Gary D. Norsworthy, DVM, DABVP

Case Study: African Grey Parrot

African Grey Parrot: VetScan Helps in Diagnosis Contributing Author:

Don Harris, DVM Point of care analyzers have become an integral part of veterinary medicine. Exotic pets, in particular, often present in critical condition, and accurate data is immediately needed in order to diagnose and treat the patient appropriately. On June 3, 2008, a 5 year old male African Grey parrot was referred from another veterinary hospital with tentative diagnosis of Proventricular Dilatation Disease. The diagnosis was based on the fact that the bird was demonstrating crop stasis, and radiographs revealed an enlarged, (but not gas filled), proventriculus. No other diagnostics were performed. The bird was deteriorating rapidly, and the referring clinic wanted the bird examined at a facility that had point-of-care diagnostics available.

Upon examination, I determined that the bird was severely polydipsic, (which I believed explained the distended crop), and polyuric. Radiographs taken here at the time of presentation appeared normal. During physical exam the bird appeared slightly underweight, (404 grams with a full crop), was moderately sluggish, a little unsteady, and had a crop quite distended with water. The owner indicated that she was having to refill the bird’s (“large”) water bowl at least once a day. The owner also indicated that the bird seemed to have a ravenous appetite. At that point, my primary differentials were diabetes mellitus or renal failure. Knowing that it’s never appropriate to jump to conclusions when definitive data is readily available, I chose to simply perform the appropriate laboratory diagnostics, knowing that within a few minutes I would have concrete data that would most likely explain the reasons for the bird’s clinical signs. As I do 99.999999973% of the time, I collected blood for a CBC and chemistry panel. The results were as follows: At this point, my primary differentials were shot to hell. Chems WBC 15,760 The uric acid and the blood glucose AST 1772 Hets 88% were both perfectly normal. The Bile Acids 35 Lymphs 12% profound hyperkalemia was CK above analyzer range PCV 34 something I had never seen before UA 1.6 wbc toxicity 0 in an avian patient. Addison’s Glu 234 polychromasia 2+ disease came to mind, but never having dealt with it in avian Ca 8.7 species, I decided to discuss the Phos 2.8 case with colleagues who had K+ 10.8 experience treating this disease in Na+ 138 domestic animals. No one I spoke with had any experience with Addison’s in birds, and there were no reports of such found in the literature. The consensus was to treat the bird and use response to therapy as confirmation of the tentative diagnosis. A biopsy of the adrenal gland was contemplated but, while technically not that challenging, the owners elected to use the “response to therapy” approach. The bird was started on Florinef, .01mg/ml, 0.2cc BID, (.005mg/kg BID). Prednisone was considered, but it was decided that conservative treatment at first might be the safer approach. The owners, for financial reasons, preferred to treat the bird at home and return every 3-5 days, (in spite of the fact that they lived 3 hours away), for follow-up.

September / October 2009 • 7

Case Study: African Grey Parrot continued Within 24 hours, the bird “felt better”. He was less sluggish, more vocal, more alert, etc. The polydipsia lessened, but didn’t resolve. On the 3rd day, the owners, on my direction, increased the dose of Florinef to 0.3cc Bid. With that, the polydipsia was all but eliminated, and the bird “seemed perfectly normal”. On the 6th day the bird returned for follow-up. Follow-up labwork was almost perfectly normal. The K+ was now 4.7, AST 185, CK 400, and the PCV of 34 was up to 42. The bird’s weight was up to 436 grams, with an EMPTY crop. Three weeks later the patient returned for an additional follow-up. This time, all laboratory parameters were within normal limits, and the bird, according to the owners, was “his old self”. Six months later a telephone call revealed that the bird was still doing perfectly well on the Florinef, but he has not returned for reexamination. The most important points this case demonstrates is the need to remain open minded in the face of any clinical presentation and the importance of obtaining accurate laboratory data as soon as possible. In some cases, minutes count. Rarely is it acceptable with avian patients to wait a day or two to retrieve clinical data that directly influences the therapy. Many times, the patient will expire while waiting to labwork to materialize. To make matters worse, a patients demise can be accelerated by administering inappropriate therapy, directed by clinical signs only. The Abaxis VetScan VS2 Chemistry Analyzer is God’s gift to avian medicine in the sense that it provides the most data for the least sample size, rendering it ideal in the exploration of health in even the smallest avian patients.

2009 Veterinary Conferences Aug. 28-31

CVC Central Kansas City, MO www.cvccentral.com

Sep. 22-25

NEAEP Ledyard, CT www.neaep.net

Oct. 2-4

Alaska VMA Anchorage, AK www.akvma.org

Sep. 10-12

CVC East Baltimore, MD www.thecvc.com

Sep. 23-25

Purdue Annual Fall Conference West Lafayette, IN www.vet.purdue.edu

Oct. 7-10

American College of Veterinary Surgeons Washington, DC www.acvs.prg

Sep. 10-12

IVECCS Chicago, IL www.iveccs.org

Sep. 24-27

Oct. 8-10

Wisconsin VMA Madison, WI www.wvma.org

San Diego VMA San Diego, CA www/sdvma.org

Veterinary Hospital Manager’s Association Portland, OR www.vhma.org

Oct. 12-15 Sep. 25-27

Atlantic Coast Vet Conf. Atlantic City,NJ www.acvc.org

New England VMA Portland, ME www.newvma.org

Southwest Vet Symposium San Antonio, TX www.swvs.org Oct. 14-18

Oct. 1-3

Florida Equine Promoting Exellence Symposium Marco Island, FL www.faep.net

Wild West Vet Conference Reno, NV www.wildwestvc.com

Oct. 16-19

Veterinary Cancer Society Austin, TX www.vetcancersociety.org

Sep. 12-13

Sep. 18-20

Sep. 18-19

Colorado VMA Keystone Convention Center www.colovma.org

September / October 2009 • 8

Equine Metabolic Syndrome (EMS) and Insulin Resistance (IR) Author: Dr. Terry Gerros It is difficult to discuss EMS with talking about IR as they seem intimately associated or occur concurrently. Some feel that EMS is an early manifestation of pituitary pars intermedia dysfunction (PPID) also referred to as Equine Cushing’s Syndrome. It may be more likely that horses and ponies with EMS and IR are predisposed to PPID, but the jury is still out on this.

WHAT IS EMS? EMS is a term used to describe a group of clinical signs that may accompany pasture-associated laminitis (founder). It is defined by evidence of insulin resistance, obesity or regional fat deposition, and previous or existing laminitis. In the past signs of EMS were attributed to hypothyroidism, but it is now recognized that low resting thyroid levels accompany extrathyroidal illness in the horse.

WHAT IS IR? Broadly defined, IR is a decreased response of tissues to circulating insulin, resulting in decreased uptake of glucose by skeletal muscle, adipose, and liver tissues. Both compensated and uncompensated IR exists in the horse. Compensated (the most common type) IR may be due to reduction in the density of insulin receptors on cell surfaces, malfunction of those cellular receptors, defective internal signaling pathways, or interference with the translocation or function of glucose transporter proteins. Uncompensated IR is thought to develop as a result of compensated IR if pancreatic insufficiency develops. CLINICAL FEATURES: EMS has been identified in many breeds of horses, including the Miniature horses, Morgan, Paso Fino, Norwegian Fjord, Arabian, Quarter Horse, American Saddlebred, Tennessee Walking Horse, Thoroughbred, and Warmbloods. It has also been documented in ponies and donkeys. Most horses are 5 – 15 years of age when laminitis first occurs. Obesity can develop at an earlier age. Physical characteristics include generalized obesity or development of regional fat deposits (cresty neck, fat deposition over the tailhead, prepuce or random distribution of subcutaneous fat over the trunk), or both and laminitis. These horses may be at greater risk to colic due to pedunculated lipomas.

September / October 2009 • 9

OBESITY - EMS - IR Obese horses with EMS are described as easy keepers because they require fewer calories to maintain body weight. This may suggest that there is some genetic susceptibility and these particular animals are more efficient at converting poorer quality forages into energy. Factors that may contribute to the development of EMS included grazing on lush pasture, feeding concentrates and interference with seasonal weight loss. Overfeeding horses promotes obesity. Some concentrates (sweet feeds) induce weight gain and also exacerbate IR. These feeds, rich in starches and simple sugars, create a glycemic response that can be difficult for the IR horse to accommodate. And like beauty, obesity is in the eye of the beholder and breed associations. The grass consumed on pasture may provide too many calories for those horses predisposed to EMS. Pasture grass can be rich in hydrolysable carbohydrates (CHO) such as sugars that are digested and absorbed in the small intestine and fermentable carbohydrates that are primarily digested within the large intestine. Many horses and ponies with EMS remain obese and insulin resistant as long as they free graze on pasture, even when concentrates and hay are eliminated from the diet. In the wild, horses would be expected to lose weight in the winter months when forages are scarce and of poor quality. Our horses today are now fed through the winter to offset any normal weight loss. The relationship between obesity and IR is complex because obese horses and ponies are more likely to be IR, but not all obese horses are IR and insulin resistance can occur without obesity. It is likely though that obese horses are predisposed to IR. Laminitis and Insulin Resistance Laminitis and IR are likely related through three mechanisms: 1) Impaired glucose delivery to hoof keratinocytes. 2) Altered blood flow or endothelial cell function within the hoof vessels, 3) Proinflammatory or pro-oxidative states associated with chronic IR and obesity.

WHAT TRIGGERS LAMINITIS IN HORSES WITH IR? Currently it is suggested that excessive hydrolysable CHO exacerbate IR as it does in humans with type II diabetes mellitus; secondly an alteration in bacterial flora occurs in the large intestine. The change in bacterial populations increases the production of factors inducing laminitis: exotoxins, endotoxins, and vasoactive amines. Therefore we think of IR as a factor that predisposes these animals to pasture-associated laminitis, whereas the disease itself is triggered by the GI disturbance cause by the pasture grass composition. Sugars in the grass increase the gut permeability and allow those factors causing laminitis to be more easily absorbed.

TESTING FOR IR Resting serum insulin concentrations: Hyperinsulinemia is a common feature of IR in horses therefore serum insulin concentration is a useful screening test. While serum insulin levels are elevated with compensated IR, it has limited value in horses with mild IR or with noncompensated disease (pancreatic disease as a result of chronic IR). Blood samples are drawn after horses have been withheld from pasture and fed hay overnight. A resting serum insulin concentration greater than 30 microU/ml is diagnostic for IR. Combined Glucose-Insulin Test: This test is particularly useful for detecting mild or uncompensated IR. The horse is stalled overnight, before testing, and fed free choice hay that night and during the test. An IV catheter should be placed to facilitate administration of glucose and sampling. A baseline blood sample is obtained and the horse given 150 mg/kg body weight (BW) of 50% dextrose, immediately followed by 0.10 units/kg BW of regular insulin. Blood is collected at 1, 5, 15, 25, 35, 45, 60, 75, 90, 105, 120, 135 and 150 minutes after infusion. For field use, the intervals can be adjusted to 0, 15, 30, 45 and 60 minutes.

September / October 2009 • 10

IR is defined by maintaining blood glucose concentrations above baseline for 45 minutes or longer. A handheld glucometer is used to measure glucose levels. If blood glucose drops below 40 mg/dl, administer 120 ml of 50% dextrose to treat insulin induced hypoglycemia.

MANAGING OBESITY Easier said than done. Simply put, limit caloric intake and eliminate access to pasture until satisfied with the horses body condition. Concentrates should be eliminated and hay limited to 1.5% of current body weight (i.e. 15# hay for a 1000# horse), lowering it gradually to 1.5% of the ideal body weight over several weeks time. The hay fed should contain less than 12% nonstructural CHO (simple sugars, starch, and fructans) for obese IR horses. For hay greater than 12% NSC you can soak the hay for 30 minutes, drain off the water, then feed that hay. There are now commercially available feeds (Purina Mills) for IR horses. Weighing the hay ensures accurate feeding. Horses should be fed 1000 IU vitamin E because access to green pasture is restricted. Those horses with laminitis should not be exercised until the hoof has stabilized. Otherwise horses with EMS should be exercised daily.

MANAGING INSULIN RESISTANCE IR can be managed by controlling weight, routine exercise and avoiding feeds that exacerbate the condition. Access to pasture is the most difficult component of the diet to control; therefore turnout on pasture must be restricted. Most horses will only need to be withheld from pasture for a few weeks or months although some must be permanently removed. Horses and ponies can have pasture access if limiting grazing time to 1-2 hours per day, turn out in a small grass paddock or with a grazing muzzle. Other supplements which have been used include cinnamon, chromium, magnesium and L-carnitine, but there are no published reports to their efficacy in managing IR or laminitis in horses. Some horses are lean but still exhibit region fat deposition. This can sometimes be the situation when horses are managed through regular exercise or when horses develop PPID. Feeding strategies include: 1) A diet consisting of hay with less than 12% NSC content, a pelleted specialty feed for IR horses (Purina Mills), a balanced vitamin and mineral supplement, and 0.5 cup corn oil, twice daily. 2) Same diet as #1 with molasses-free beet pulp substituted for the pelleted specialty feed, 3) Either of the two diets listed above substituting rice bran for oil. 4) A pelleted specialty feed (Purina Mills) for geriatric horses when the horse is over 20 years old. Use of thyroid supplement: Levothyroxine can be used to induce weight loss and improve insulin sensitivity in horses. It should be used in horses when the animal cannot be exercised or laminitis threatens to cause permanent damage to the hoof tissues. A dosage of 48 mg/day for 3 to 6 months is fed. At this dose, it acts as a metabolic stimulant and induces weight loss without negatively impacting general health. When levothyroxine treatment is discontinued, the dosage should be lowered to 24 mg/day for 2 weeks and then 12 mg/day for 2 weeks. The benefits of treating horses with lower doses for extended periods have not been evaluated scientifically.

September / October 2009 • 11

Case Study: German Shepherd

German Shepherd: VetScan Helps out an Old Vet Contributing Author:

Craig Tockman, DVM Chang, a 9 year old neuter male German shepherd presented for acute onset vomiting. Chang, a retired military dog, had a history of degenerative joint disease in the coxofemoral joints and multiple other injuries, all having resolved. The patient had been evaluated one week earlier for an area of moist dermatitis at another veterinary facility. Chang was somewhat aggressive to that veterinarian and he was not fully evaluated. He was placed on carprofen and released with instructions to keep the area clean and to use antihistamines along with the carprofen.

Physical exam was not difficult and revealed a somewhat thin patient (BCS 4/9). The area of moist dermatitis was resolving with now only mild alopecia in the area. The owner indicated a rawhide had been given several days earlier and they were still giving the carprofen. The CBC showed a mild eosinophilia consistent with an allergic condition causing the moist dermatitis as well as a mild relative monocytosis. Chemistry results indicated significant elevation in ALT and ALP indicating some hepatic issue.

WBC LYM MON NEU EOS BAS

8.59 1.40 0.34 5.31 0.92 0.12

RBC 6.3 HGB 16.2 HCT 41.88 MCV 72 MCH 23.3 MCHC 32.5 RDWc 15.8% PLT 207

17.3% 4.1% 65.6% 11.4% 1.5%

ALB 2.9 ALP 559 ALT 1073 AMY 502 TBIL 0.5 BUN 14 CA++ 10.7 PHOS 5.8 CRE 0.8 GLU 88 NA+ 144 K+ 4.8 TP 6.7 GLOB 3.8

Initial rule-outs included a reaction to the NSAID, non-specific hepatopothy or neoplasia. Paired bile acids, radiology and ultrasound were recommended but due to limited funds, only bile acids were accepted. This was the most logical choice based on the recent history of NSAID administration and no previous history of liver enzyme elevations (a panel had been performed 6 months earlier with no abnormalities noted). Since the patient had been fed that morning, a paired bile acid study was scheduled for the following day.

Bile acid results were within normal limits both pre- and postprandial (Pre-prandial 9, post-prandial <1, normal 0-25 for both). GGT was also fond to be significantly elevated (31, normal 0-7). These results indicated adequate hepatocellular perfusion, no shunting of any sort and adequate hepatic bile flow. A presumptive diagnosis of acute hepatic necrosis or hepatopa thy secondary to NSAID administration was made. The NSAIDs were removed and the patient placed on Amoxicillin triydrate/clavulanate potassium at 375mg b.i.d., Denamarin s.i.d. and a hepatic diet.A recheck at 12 days indicated normal bile acids, ALP and GGT. ALT was slightly high at 122 (normal 10-118) but was also considered resolved. All CBC values also returned to normal. At 3 months post-incident, all values remained completely normal. There are several important lessons from this case. First, we had no idea as to the internal status of the patient prior to the administration of the NSAID. Since the values returned to normal quickly after withdrawal of the medication, we can assume the liver was normal prior to giving the drug, but the lack of that information made diagnosis far more difficult. It is vital to have pre-medication blood values for any medication, but especially those with a known ability to cause idiosyncratic or other type reactions. Lack of blood tests also created liability for the original veterinarian as the NSAID could have been prescribed to a patient with a pre-existing condition. The ability to perform bile acid analysis in the office rather than waiting for commercial lab results allowed a detailed discussion with the client in the exam room. This greatly improved client communication in a potentially litigious situation.

September / October 2009 • 12

Paying too much to run your lab is like air conditioning your house with the windows open.

Save money every day with the lower operating costs of the VetScan Laboratory System. Who says that good medicine and smart business can’t work together? At Abaxis, we’re just as committed to helping you run your practice as we are to devolping reliable, leading edge technology, tools and services that support the highest quality health care. Our VetScan Laboratory and rapid tests provide reference lab quality results, in-clinic, in minutes; all for significantly less cost than competing lab alternatives. If you’re getting blown away by laboratory expenses, take a closer look at the VetScan Laboratory System.

Call us today to schedule a live, on-site demonstration and cost analysis. Tel: 510.675.6500

800.822.2947

Abaxis and VetScan are registered trademarks of Abaxis. © 2009 Abaxis, Inc.

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I N N O VAT I O N YO U C A N T R U ST

PROJECT REPORT: DETERMINATION OF BASELINE HEMATOLOGICAL AND BIOCHEMICAL VALUES FOR FREE-RANGING ELEPHANT AND RHINOCEROS IN KRUGER NATIONAL PARK, SOUTH AFRICA Overview of progress achieved during work with Kruger National Park Veterinary Wildlife Services staff January 23-February 26, 2009. Senior Researchers and Co-Investigators: Michele Miller, DVM, PhD; Dr. Peter Buss; Dr. Markus Hofmeyr; Jenny Joubert; Khosi Maseko Project Objectives: The proposed project addresses antemortem diagnostic testing to assess the health status of free-ranging rhinoceros and elephants to provide a baseline, and further evaluate rhinos that are confined in bomas to determine if there are changes that are associated with health problems. Specific goals will be to develop a better understanding of basic physiological values in free-ranging wildlife in order to have a baseline from which to make comparisons with 1) diseased animals; 2) physiological changes that may occur during captivity and other stresses such as translocation; and 3) examine the differences between and within different freeranging populations due to environmental changes (i.e., seasonal effects, habitat differences, etc.).

Work Procedure: Sera or heparinized plasma samples were used from stored banked samples. All sample collection was performed opportunistically during immobilizations on Field work using VetScan products in Kruger rhinos and elephants that have been scheduled for National Park, South Africa translocations, horn transmitter placement, emergency procedures, or other projects. CBC and chemistry panels were performed at the KNP lab. The veterinary technicians have been trained to perform estimated white blood cell counts from blood smears and differential cells counts. All analyses were performed by the same individual to maintain project continuity. A portable blood chemistry analyzer is available (Abaxis VetScan VS2) that has been field tested on wild ungulates, including white rhino and elephant, and can provide biochemical profile results on serum or plasma within 12 minutes. The VetScan Large Animal rotor was used on both elephants and rhinoceros for analyses.

RESULTS: Samples analyzed from the white rhinos were collected during the 2008 capture season. Chemistry panels were performed on 81 white rhinos and repeated on 25 of these individuals that were boma-confined at the time of release. Hematological analyses were available for 66 individual rhinos. Only chemistry panels were available for the elephant samples since these were opportunistically collected between 2004 and 2008. A total of 71 samples were processed. Data has been entered into a spreadsheet along with demographic data and is in the process of statistical analyses.

Future Directions: White rhino data will be compared with previous data analyzed during the 2006 and 2007 capture seasons. This will provide a larger database especially for investigating gender and age-specific values. In addition, paired sample analyses for bomaconfined individuals will be assessed for potential biomarkers of change that occur during captivity due to stress, diet, or other management changes. The elephant data will also be evaluated in a similar manner to develop a general database of normal values. These values will also be compared to zoo-based values for these species. Eventually, it is the goal of the study to determine if there might be seasonal, age or gender related differences that could be used to examine changes in the ecosystem such as effects of drought on habitat quality, etc. and those created by manipulations such as capture, confinement, and translocation.

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Editorial Staff Valerie Goodwin - Adams Directo,r Marketing - Animal Health VetCom Editor 510-675-6604 [email protected] Craig M. Tockman, DVM Director of Professional Services, Abaxis, Inc. 800-822-2947, ext. 6580 [email protected] Kent Adams, DVM Abaxis Advisory Board Member Equine/Large Animal Practitioner [email protected] Terry C. Gerros, DVM, MS, Diplomate, ACVIM (LA) Abaxis Advisory Board Member Equine Practitioner [email protected] Don J. Harris, DVM Abaxis Advisory Board Member Avian/Exotic Practitioner [email protected]

Special Look: Warehouse Expansion

Abaxis Expands Warehouse Despite a slower global economy, Abaxis has experienced a 110% increase in our shipping volume over the past several months, as a result Abaxis is expanding our shipping operations to assure our customers experience the same great level of service in the future. Our new location is dedicated to handle our customer shipping volume only and will house our finished goods inventory to assure prompt shipment on time every time. Our new facility will include a new expanded cold room operation that has been updated to better serve you. Some highlights of our new facility are: • 28% overall facitity increase from 91,124 sq ft. to 116,824 sq. ft. • 233% increase in shipping space from 7,70 sq. ft. to 25,700 sq. ft. • Walk-in cooler capacity increased to 167,200 cu. ft from 30,000 cu. ft. • Cold Room Storage capacity increased from 750,000 rotors to 2.5 million rotors

Kate An Hunter, DVM Abaxis Advisory Board Member Companion Animal Practitioner [email protected]

Free Win A de! a Upgr

Baerbel Koehler Abaxis Sales and Marketing Manager for Europe, Africa and the Middle East Darmstadt, Germany +49 6151 350 79 0 [email protected]

Submit A Case Study And Win! If you have a case study that includes how your in-clinic laboratory system has made a difference, and your case study is published in VetCom you could win! Send your case studies to: Valerie Goodwin - Adams Abaxis, Inc. 3240 Whipple Road Union City, CA 94587 [email protected]

Enter Today! (Open to owners and principals of veterinary practices, research facilities, academic environments, and pharmaceutical/biotech companies. Instrument being upgraded must be returned to Abaxis.)

September / October 2009 • 15

Get the Most Out of Your VetScan Chemistry Analyzer Comprehensive Diagnostic Profile

Critical Care Plus

Ideal For: Providing a complete diagnostic analysis for preanesthetic testing, general health profile, ill patient diagnostics, geriatric testing, and wellness testing.

Ideal For: Serial testing, re-checks, and monitoring hospitalized patients. An alternative panel to the Prep II rotor for pre-anesthetic testing.

Analytes Include: ALB, ALP, ALT, AMY, BUN, CA, CRE, GLOB, GLU, K+, NA+, PHOS, TBIL, TP

Analytes Include: ALT, BUN, CL-, CRE, GLU, K+, NA+, tCO2

Used For: Wellness testing, pre-anesthetic testing, critical cases, diagnostic testing and ill patient examinations, recheck examination for chronic disease.

Used For: Hospitalized patient monitoring, re-checks (for hyperadrenocorticism, diabetes, renal disease) and preanesthetic evaluation.

Prep Profile II

T4/Cholesterol

Ideal For: Determining of basic health values for younger healthy patients, a basic re-check panel for some disease states and as a low cost pre-anesthetic evaluation.

Ideal For: Routine screening of hypothyroidism in dogs and diagnostic for hyperthyroidism in cats. Titrating and monitoring patients on thyroid hormone replacement therapy or patients being treated for hyperthyroid disease.

Analytes Include: ALP, ALT, BUN, CRE, GLU, TP

Analytes Include: CHOL, T4

Used For: Routine wellness screening for younger patients, lower cost pre-anesthetic screen for younger, apparently healthy patients, monitor and recheck for disease states such as diabetes mellitus and renal disease.

Used For: Screening for hypothyroidism in dogs, diagnosis of hyperthyroidism in cats, monitoring drug, I131 or thyroidectomy therapy.

Mammalian Liver Profile

Avian/Reptilian Profile Plus

Ideal For: Obtaining baseline values prior to administration of and concurrent with the use of NSAIDS as well as monitoring hepatic function and diagnosing liver disease.

Ideal For: Measuring analytes that represent the most important area of concern in avian and reptilian patients.

Analytes Include: ALB, ALP, ALT, BA, BUN, CHOL, GGT, TBIL

Analytes Include: ALB, AST, BA, CA, CK, GLOB, GLU, K+, NA+, PHOS, TP, UA

Used For: Diagnosis and monitoring of liver disease, obtaining baseline values prior to administration of NSAIDS, and monitoring patients concurrent with the use of NSAIDS.

Used For: Ill patient diagnostics, wellness testing, evaluate liver integrity and function, evaluate renal status, measure electrolyte status.

Equine Profile Plus

Large Animal Profile

Ideal For: Routine equine checkups, wellness testing, ill patient diagnostics and pre-purchase examinations.

Ideal For: Health assessment, prognostic indicator and a diagnostic tool for beef and dairy cattle.

Analytes Include: ALB, AST, BUN, CA, CK, CRE, GLU, GGT, GLOB, K+, NA+, TBIL, tCO2 , TP

Analytes Include: ALB, ALP, AST, BUN, CA, CK, GGT, GLOB, MG, PHOS, TP

Used For: Ill patient diagnostics, wellness examinations, patient monitoring, fluid therapy, and re-check examinations. Ideal for both equine ambulatory practitioners and critical care units.

Used For: Accurate diagnosis and prognosis, aid in the choice of therapeutics.

3240 Whipple Road Union City, CA 94587 Telephone: 510-675-6500

Fax: 510-441-6150 [email protected] www.abaxis.com

VetCom is now available online, bringing you the latest in diagnostic insights for the entire clinic and enlightening you with a monthly case study full of interesting information and much, much more. For a printer-friendly version of VetCom to share with your colleagues, visit our website at www.abaxis.com. To sign up for additional Abaxis information please email Valerie Goodwin at [email protected]. You can unsubscribe from our contact database by replying to the e-mail with the word "unsubscribe" in the subject line or simply call (800) 822-2947. For more on our Privacy Policy please visit our website at www.abaxis.com.