MidwestMonthly

June 2022 Making A Difference In Your Practice, Since 1961 Animal Behavior in a Post Covid-19 World Written by Amy L.Pike, DVM, DACVB on page 13 Do Pet Parents REALLY Know That Kittens Need to Scratch? Written by Natalie Marks, DVM, CVJ on page 21 www.midwestvetsupply.com

One in-clinic dose of ZorbiumTM provides 4 days of continuous post-op pain control for at-home comfort. NEW The only FDA-approved long-acting transdermal APPLY buprenorphine for cats HERE Reduces the challenges of administering pain medications at home No need to administer repeat injections or dispense buprenorphine during the critical first few days after surgery Indication: Zorbium is indicated for the control of postoperative pain associated with surgical procedures in cats. Important Safety Information: Before using ZORBIUM (buprenorphine transdermal solution), read the entire package insert including the Boxed Human Warning. Call 1-888-545-5973 for full prescribing information. ZORBIUM contains buprenorphine, an opioid that exposes humans to risks of misuse, abuse, and addiction, which can lead to overdose and death. Use of buprenorphine may lead to physical dependence. The risk of abuse by humans should be considered when storing, administering, and disposing of ZORBIUM. Serious, life-threatening, or fatal respiratory depression may occur with accidental exposure to or with misuse or abuse of ZORBIUM. ZORBIUM should only be administered by veterinarians or veterinarian technicians who are trained in the handling of potent opioids. Accidental exposure to even one tube of ZORBIUM, especially in children, can result in a fatal overdose. ZORBIUM is for topical application in cats only. Following application to the cat, allow a minimum drying time of 30 minutes before direct contact with the application site. Do not administer to cats with a known hypersensitivity to buprenorphine hydrochloride, any inactive ingredients of ZORBIUM, or known intolerance to opioids. Most common adverse reactions during anesthesia were hypothermia, hypotension, and hypertension, and after anesthetic recovery were hypothermia, hyperthermia, and sedation. The safe use of ZORBIUM has not been evaluated in debilitated cats, those with renal, hepatic, cardiac or respiratory disease, pregnant lactating, breeding, in cats younger than four months old or <2.6 lbs or >16.5 lbs. Please see accompanying brief summary for additional product safety information. Extended product information on page 24 & 26. Zorbium, Elanco and the diagonal bar logo are trademarks of Elanco or its affiliates. ©2022 Elanco or its affiliates. PM-US-22-0123

CONTENTS 4 New Products 18 Parasiticide Headquarters 7 Behavior 21 Article | Do Pet Parents REALLY Know 13 Article | Animal Behavior in a Post Covid-19 World That Kittens Need to Scratch? Written by Amy L.Pike, DVM, DACVB Written by Natalie Marks, DVM, CVJ 23 Boarding Supplies IN THIS ISSUE 13 21 Midwest Veterinary Supply is not responsible for pricing, typographical, or graphical errors. All items are subject to availability, all prices and rates are subject to change. Midwest Veterinary Supply is an Equal Opportunity Employer. FELINE GRIMACE SCALE© This tool allows veterinary teams to understand how much pain a cat is feeling based on changes in facial expressions and decide whether a painkiller is needed. ► An overall score is determined based on: • Ear position • Orbital tightening • Muzzle tension • Whiskers position • Head position Download the Feline Grimace Scale Phone App! It is available for free on Android and iOS platforms, in French, English and Spanish. Download the FGS Access the website Phone App www.felinegrimacescale.com Apple Store Google Play Visit: felinegrimacescale.com for more information.

What's LAVERDIA I Dechra New? The first FDA conditionally approved oral tablet for the treatment of lymphoma in dogs. I I193.80000.3 2.5mg, 50ct $100.00 I I193.80002.3 10mg, 50ct $160.00 I I193.80004.3 50mg, 16ct $268.00 I I193.80006.3 50mg, 50ct $800.00 Talk to your Midwest representative about NEW Ceva ThunderEase products. These products are specifically formulated for veterinary practices to help pets adjust to stressful situations. ZORBIUM I Elanco The only FDA-approved long-acting transdermal buprenorphine for cats. Provides 4 days of continuous post-op pain control. I I405.89000.3 0.4ml, 10ct $97.30 I I405.89100.3 1.0ml, 10ct $139.00 CANALEVIA-CV1 I Jaguar Animal Health First FDA approved product for the treatment of chemotherapy-induced diarrhea in dogs. This enteric-coated tablet acts locally and is not absorbed into the blood stream, providing a well-tolerated and non-toxic product. I I562.40001.3 125mg, 60ct $473.68 4 JUNE 2022 | Midwest Monthly • www.midwestvet.net 1-800-643-9378

90 COUNT DOG TREATS I Pets Select™ Chicken Flavored Dog Treats are irresistible, guilt-free snacks. Small but packed full of flavor, these soft chew treats are made with wholesome ingredients that will reward your dog for any occasion. I I I000.50008.2 13.2 kcal/treat 90 Count $7.79 LINT ROLLER I Adhesive sheets to remove hair and debris without sticking to fabrics. Leave your clothes and upholstery damage-free. Great for clinics that offer grooming services or regular every-day use for staff. I I000.40050.2 Lint Roller 4” 60 Sheets $1.89 I I000.40051.2 Lint Roller Refill 4” 60 Sheets $1.57 NARAQUIN I Nutramax www.midwestvet.net • Midwest Monthly | JUNE 2022 5 Dietary phosphate binder + renal support supplement. I I193.12880.3 60ct $15.99 1-800-643-9378

Because NOTHING should come between you and your cat PLUS (selamectin and sarolaner topical solution) REVOLUTION PLUS broadens the scope of protection for cats and kittens against fleas, ticks,* ear mites, roundworms,† hookworms,‡ and heartworms. REV UP Protection Inside and Out. IMPORTANT SAFETY INFORMATION: The safe use of REVOLUTION PLUS has not been established in kittens less than 8 weeks old or in breeding, pregnant or lactating cats. Reported side effects in clinical trials included lethargy and anorexia. Use with caution in cats with a history of neurologic disorders. Sarolaner, one of the ingredients in REVOLUTION PLUS, is a member of the isoxazoline class, which has been associated with adverse reactions such as tremors, ataxia, and seizures. Reactions have occurred in cats with or without a history of neurologic disorders. In humans, REVOLUTION PLUS may be irritating to skin and eyes. See Brief Summary of Prescribing Information on page 8x.xx. *Black-legged or deer tick (Ixodes scapularis), Gulf Coast tick (Amblyomma maculatum), RevolutionPlusDVM.com and American dog tick (Dermacentor variabilis). †Toxocara cati. ‡Ancylostoma tubaeforme. All trademarks are the property of Zoetis Services LLC or a related company or a licensor unless otherwise noted. ©2021 Zoetis Services LLC. All rights reserved. RVP-00384.

Alpar Labs BEHAVIOR Forbid Anticoprophagic Talk to your Midwest representative about NEW Ceva ThunderEase products. These products are specifically Highly palatable protein helps prevent consumption of feces. Simply sprinkle on formulated for veterinary practices to help food, when consumed it will create an pets adjust to stressful situations. unpalatable taste to feces. Ceva I I030.00010.3 Box/12 packets $15.23 Feliway Optimum Diffuser Animal Health Options Features enhanced calming pheromones ProQuiet Tablets to help cats with more signs of stress including: scratching, fears, reactions to changes, urine Helpful for maintaining a healthy nervous spraying, and tension. system and mental attitude. Safe and effective to use daily or can be used as I I153.03000.3 Starter Kit + 30 Day Refill $28.30 needed in stressful situations. I I153.03002.3 30 Day Refill $19.91 I I028.66000.3 60ct $11.99 *Feliway Classic and MultiCat also available Ceva Homeopet Adaptil Pheromone Spray Anxiety Relief Liquid Recommended to control or reduce Homeopathic remedy for relief stress-related behavior in puppies and of general anxiety in pets. adult dogs helping them deal with challenging situations such as; travel, I I325.77990.3 15mL $8.54 kennel stays, moving, thunderstorms, or fireworks. Anxiety Travel Liquid I I153.00015.3 20mL Spray $13.00 Provides relief from motion sickness I I153.00016.3 60mL Spray $26.00 and fear of travel. Adaptil Diffuser Unit I I325.78010.3 15mL $8.54 Uses clinically proven pheromones with Anxiety TFLN Liquid – Thunder/Fireworks/Noise an improved solvent designed to diffuse more consistently throughout the month, Provides relief from fear of: ensuring a constant release of calming fireworks, wind, loud noises, gunshots. pheromones for the full 30 days. I I325.78000.3 15mL $8.54 I I153.00005.3 Starter Kit with 30-Day Refill $19.91 Storm Stress Adaptil Collar A safe and effective fast acting Activated by body heat to release calming remedy that promotes calm behavior pheromones continuously for 30 days. in pets exhibiting fear from storms and noise related phobias. I I153.00009.3 SM Dog $21.80 I I153.00011.3 MED/LG Dog $21.80 I I325.79021.3 21-80lbs $8.54 Feliway Pheromone Spray Jorgensen Contains a synthetic copy of the feline Halti Collar facial pheromone to reassure and comforts cats, helping them cope with environmental Head collar with muzzle for behavior changes or other stressful situations. modification and training use. Used to help prevent vertical scratching, urine spraying, and tension. I I350.78480.2 Size 0 $15.00 I I350.78485.2 Size 1 $15.90 I I153.00605.3 20ml $13.00 I I350.78490.2 Size 2 $15.90 I I153.00606.3 60ml $26.00 I I350.78495.2 Size 3 $21.00 I I153.00608.3 219ml $55.97 I I350.78500.2 Size 4 $20.10 I I350.78505.2 Size 5 $17.00 1-800-643-9378 www.midwestvetsupply.com • Midwest Monthly | JUNE 2022 7

PLUS To report adverse reactions call Zoetis Inc. at 1-888-963-8471. For additional information about adverse drug experience reporting for animal drugs, contact (selamectin and sarolaner topical solution) FDA at 1-888-FDA-VETS or http://www.fda.gov/AnimalVeterinary/SafetyHealth. Brief Summary: See package insert for full Prescribing Information. ANIMAL SAFETY: Margin of Safety Studies: One exploratory and two pivotal margin of safety studies were conducted with REVOLUTION PLUS. In the first study, CAUTION: Federal (USA) law restricts this drug to use by or on the order of a REVOLUTION PLUS was applied topically to kittens eight weeks of age at doses licensed veterinarian. of 12/2 (selamectin/sarolaner) mg/kg (1X), 36/6 mg/kg (3X), 45/7.5 mg/kg (3.75X), and 60/10 mg/kg (5X) every 28 days for eight consecutive doses. One female cat in the INDICATIONS: REVOLUTION PLUS is indicated for the prevention of heartworm 3.75X group was found dead on study day 115. The cause was determined to be disease caused by Dirofilaria immitis. REVOLUTION PLUS kills adult fleas hemorrhage in multiple tissues secondary to a low platelet count. The role of the (Ctenocephalides felis) and is indicated for the treatment and prevention of flea drug in contributing to this event is undetermined. No significant changes related infestations, the treatment and control of tick infestations with Ixodes scapularis to REVOLUTION PLUS were observed among the remaining cats for physical (black-legged tick), Amblyomma maculatum (Gulf Coast tick) and Dermacentor examination, body weight, clinical pathology (hematology, coagulation, and serum variabilis (American dog tick), the treatment and control of ear mite (Otodectes chemistry), gross pathology, histopathology or organ weights. In the second study, cynotis) infestations, and the treatment and control of roundworm (Toxocara cati) REVOLUTION PLUS was applied topically to cats 9 months of age at doses of 1X, 3X, and intestinal hookworm (Ancylostoma tubaeforme) infections for one month in and 5X every 28 days for six consecutive doses. Cosmetic changes at the cats and kittens 8 weeks and older, and weighing 2.8 pounds or greater. application site occurred sporadically in all treatment groups and included wet appearance and dried white material. Hair loss at the dose site was also noted in CONTRAINDICATIONS: There are no known contraindications for the use of two cats in the 1X group and one cat in the 5X group within 1-8 days after the fourth REVOLUTION PLUS. dose administered on day 84. No significant changes related to REVOLUTION PLUS were observed for physical examination, body weight, clinical pathology WARNINGS: Human warnings: Not for human use. Keep this and all drugs out of (hematology, coagulation, and serum chemistry). During an exploratory margin the reach of children. In humans, REVOLUTION PLUS may be irritating to skin and of safety study, one cat in the 60 mg/kg/ 10 mg/kg (selamectin/sarolaner) group eyes. REVOLUTION PLUS and selamectin topical solution contain isopropyl alcohol (5X dose group) experienced piloerection, tremors, and mydriasis approximately and the preservative butylated hydroxytoluene (BHT). Reactions such as hives, 24 hours after receiving the third monthly dose of the combination. Signs resolved itching and skin redness have been reported in humans in rare instances after without treatment within 2 hours. This cat completed the study, receiving accidental dermal contact with selamectin topical solution. Individuals with known 3 subsequent 5X doses with no abnormal observations. Oral safety study: The hypersensitivity to selamectin topical solution should use caution or consult a safety of REVOLUTION PLUS administered orally to kittens was tested in case of health care professional before applying this product on a cat. Wash hands after accidental oral ingestion. Oral administration of the highest recommended topical use and wash off any product in contact with the skin immediately with soap and dose of REVOLUTION PLUS to kittens resulted in transient lower food consumption water. If contact with eyes occurs, then flush eyes copiously with water; if wearing and clinical findings of emesis, soft feces, and salivation. In one male, mild tremor contact lenses, rinse the eyes first then remove contact lenses and continue to was observed and resolved within 3 hours after dosing; the same cat demonstrated rinse for 5 – 10 minutes and seek medical attention. In case of ingestion by a human, reduced activity approximately 6 hours after dosing. Heartworm Positive Cat contact a physician immediately. The safety data sheet (SDS) provides more Safety of Selamectin: Selamectin is the active ingredient in REVOLUTION PLUS detailed occupational safety information. For a copy of the SDS or to report a that prevents heartworm disease in cats; it has been shown that the addition suspected adverse reaction, call Zoetis at 1-888-963-8471. Flammable - Keep away of sarolaner does not interfere with this activity. In a safety study in which from heat, sparks, open flames or other sources of ignition. selamectin topical solution was applied at 4 times the recommended dose to patent heartworm infected cats, no adverse reactions were observed. Field safety: PRECAUTIONS: Sarolaner, one of the ingredients in REVOLUTION PLUS, is a In three well-controlled field studies, REVOLUTION PLUS was used concurrently member of the isoxazoline class. This class has been associated with neurologic with other medications, such as vaccines, cestocidal anthelmintics, antibacterials, adverse reactions including tremors, ataxia, and seizures. Neurologic adverse sedatives, anesthetics, opioid analgesics, corticosteroids, and non-steroidal reactions have been reported in cats receiving isoxazoline class drugs, even in cats anti-inflammatories. No adverse reactions were associated with the concurrent without a history of neurologic disorders. Use with caution in cats with a history of use of REVOLUTION PLUS and other medications. neurologic disorders. The safe use of REVOLUTION PLUS has not been evaluated in kittens less than 8 weeks of age. The safe use of REVOLUTION PLUS has not been STORAGE CONDITIONS: Store at or below 30°C (86°F). evaluated in breeding, pregnant, or lactating cats. HOW SUPPLIED: Available in three separate dose strengths for cats of different ADVERSE REACTIONS: In a field safety and effectiveness study, REVOLUTION PLUS weights (see DOSAGE AND ADMINISTRATION). REVOLUTION PLUS is available in was administered to cats with fleas. The study included a total of 430 cats (282 cartons containing one, three, or six single dose tubes. The amount of liquid in tube treated with REVOLUTION PLUS and 148 treated with imidacloprid + moxidectin varies for each weight range (2.8 - 5.5 lbs, 5.6 - 11 lbs, 11.1- 22 lbs). once monthly for three treatments). Over the 90-day study period, all observations Tubes are never completely filled. of potential adverse reactions were recorded. Reactions reported in the REVOLUTION PLUS group included those presented in the following table. Approved by FDA under NADA # 141-502 Adverse Reactions by Treatment Group Revised: March 2019 Adverse Reaction REVOLUTION PLUS Imidacloprid + Distributed by: (n = 282) moxidectin Zoetis Inc. (n =148) Kalamazoo, MI 49007 Lethargy 12 (4.3%) 1 (0.7%) Skin lesions* 10 (3.5%) 3 (2.0%) 40026551A&P Anorexia 9 (3.2%) 3 (2.0%) Pruritus 7 (2.5%) 3 (2.0%) Conjunctivitis 7 (2.5%) 1 (0.7%) Sneezing 6 (2.1%) 1 (0.7%) Administration site hair changes (alopecia) 5 (1.8%) 0 (0.0%) Administration site lesions (scabbing) 2 (0.7%) 0 (0.0%) *Lesions not associated with application site. In a second field safety and effectiveness study, REVOLUTION PLUS was administered to 124 cats with ear mites. Adverse reactions in cats treated with REVOLUTION PLUS included emesis, dermatitis and eczema, and pruritus. In a third field safety and effectiveness study, REVOLUTION PLUS was administered to 70 cats with hookworms. Adverse reactions in cats treated with REVOLUTION PLUS included diarrhea, anorexia, emesis, and lethargy. Foreign Market Experience: The following adverse events were reported voluntarily during post-approval use of the product in cats in foreign markets: ataxia, seizures, and tremors.

Kong BEHAVIOR Extreme King Kong Pala-Tech Durable, ultra-strong black rubber compound Cease Coprophagia Soft Chews recommended for the most powerful chewers. Use with treats to help reduce boredom and A solution to the unhealthy habit of separation anxiety behaviors. coprophagia. Palatable soft chews simplify daily dosing by giving dogs a treat. I I377.75020.3 Each $14.26 I I551.24020.3 90ct $29.49 Kong Puppy PRN Made with an exclusive teething rubber formula, use with treats to aid in crate training, CoproBan Anti-Coprophagic decrease separation anxiety, promote proper chewing behavior, and deter misbehavior. Roast beef flavored soft chew used to deter coprophagia behavior. It can I I377.46001.3 SM $4.00 also be fed to cats to discourage dogs I I377.46002.3 MED $5.44 from raiding the litter box. I I377.46003.3 LG $7.03 I I193.10530.3 20ct $20.35 Meridian Reconcile Nurture Calm Pheromone Collar Flavored chewable tablet containing fluoxetine Clinically proven to effectively treat hydrochloride. FDA approved for the treatment behavioral problems in pets due to stress, of canine separation anxiety in conjunction with anxiety and phobias such as; travel, a behavior modification plan. thunderstorms, and fireworks. Releases pheromones for up to 60 days. I I193.40002.2 8mg, 30ct $9.47 I I193.40004.2 16mg, 30ct $14.24 I I467.45000.3 15\" Cat $9.33 I I193.40006.2 32mg, 30ct $18.13 I I467.45010.3 28\" Dog $9.33 I I193.40008.2 64mg, 30ct $36.23 Nutramax *Also available in 90 ct Solliquin Buy 4, get one Busy Buddy Twist ‘N Treat FREE Offer valid through June 30, 2022 A chewable behavioral health supplement that helps support balanced behavior Purina and facilitate a calming effect. ProPlan Veterinary Supplements Calming Care I I193.74081.3 SM/Med Dog & LG Cat, 75ct $14.99 I I193.74082.3 Med/LG Dog, 45 ct $14.99 Helps dogs cope with external stressors, maintain positive cardiac activity during Pala-Tech stressful events, and supports a healthy immune system. Calming Extra 578.01538.5 | 6x45ct | $149.94 All-natural, fast acting supplement with ingredients to calm and sooth a pet during Vet Classics times of stress and anxiety. Also helps manage and control nausea in the pet. Safety Zone Calm Spray I I I551.24030.3 Petite Soft Chew (Dog & Cat) 60ct $13.20 Formulated with simulated pheromones I I I551.24032.3 Soft Chew (Dog) 60ct $19.80 to create a sense of well being for pets. The effect is continual comforting residual Buy one, get one FREE (kind for kind) air effective for up to 8 to 10 hours. Offer valid through June 30, 2022 288.70010.3 | 8oz, Dog | $8.74 1-800-643-9378 288.70020.3 | 8oz, Cat | $8.74 www.midwestvetsupply.com • Midwest Monthly | JUNE 2022 9

ALL SUR-VET® SURFLO® CATHETERS GBUEYT9 1& FREE Eaches. No mix and match. Valid from June 1-30, 2022. ADDITIONAL BONUS OFFER GET 1 FREE BOX of ENGAUGE Needles with every 9 and 1 Sur-Vet® Surflo® Catheter purchase. ENGAUGE Hypodermic Needles The ENGAUGE hypodermic needle line provides an additional quality product for cost-conscious customers and further expands our veterinary product portfolio to meet the needs of all veterinary professionals. These products have no components made of natural rubber latex. RX ONLY. The advertisement is directed to veterinarians only, and not to consumers. Refer to product labels and packaging insert for complete warnings, precautions, potential complications, and instructions for use. Products may not have regulatory approval in all countries. Please contact your local sales representative if you have questions about the availability of products in your area. Terumo reserves the right to cancel promotion at any time. , and TERUMO are trademarks owned by Terumo Corporation, Tokyo, Japan, and are registered with the U.S. Patent and Trademark Office. ©2022 Terumo Medical Corporation 4/22. All rights reserved. PM-05310

Vet Classics BEHAVIOR Stop Stool Eating Soft Chews Virbac Stool eating deterrent that contains Anxitane Chewable Tablets a breath freshener. Promotes relaxation in pets exhibiting 288.00649.3 | 60ct | $8.74 nervousness, anxiety or responding to 288.00718.3 | 180ct | $22.57 environmentally-induced stress. Stress Away Chew Tablets I I724.03000.3 30ct, Small Dogs and Cats <20lbs $25.62 I I724.03050.3 30ct, Med & Large Dogs >20lbs $32.30 Helps support the nervous system in reducing stress and tension. Clomicalm Tablets Great for traveling, fireworks, grooming, and thunderstorms. Use as part of a comprehensive behavioral management program to treat separation 288.70030.3 | 30ct, Dog | $10.39 anxiety. May also help with inappropriate barking, destructive behavior, Stress Away Chew Tablets and inappropriate elimination in conjunction with behavior modification. I I288.70200.3 65ct, Dog & Cat $7.48 I I298.22200.3 5mg, 30ct $30.47 Vetoquinol I I298.22202.3 20mg, 30ct $41.39 I I298.22204.3 80mg, 30ct $52.32 Zylkene VeggieDent Zen Chews for Dogs Helps reduce chronic and situational stress in dogs and cats; increases their Multi-functional chew for dental and ability to cope with change. All-natural, mental health. Helps dogs manage non-sedating nutritional supplement everyday stress and freshens breath. without any known side effects. Easy once-a-day administration. I I724.26000.3 XS Dog, 30ct $17.63 I I724.26005.3 SM Dog, 30ct $19.71 I I733.97000.3 75mg, 30ct $20.06 I I724.26010.3 Med Dog, 30ct $22.84 I I733.97002.3 225mg, 30ct $31.56 I I724.26015.3 LG Dog, 30ct $25.96 I I733.97004.3 450mg, 30ct $45.51 Zoetis *Also available in 14ct and 120ct Sileo Vetri-Science Indicated for the treatment Composure Bite Sized Chews of noise aversion in dogs. For pets exhibiting nervousness; I I193.30000.3 0.1mg/mL, 3mL Syringe $18.20 hyperactivity, anxiety or environmentally induced stress. I I740.13420.3 60ct, Dog $18.13 I I740.13440.3 30ct, Cat $5.61 Composure Pro Canine/Feline Chews For dogs and cats in need of serious behavioral, cognitive, and brain function support, as well as supporting sleep efficiency. I I740.13410.3 60ct/bag $17.65 1-800-643-9378 www.midwestvetsupply.com • Midwest Monthly | JUNE 2022 11

Don't miss this tasty, tempting limited-time offer! Buy four (4) bottles of Reconcile® and receive one (1) Busy Buddy® Twist 'n Treat™, size medium, for free. Offer runs from May 1, 2022 through June 30, 2022. Flavored, chewable Reconcile® (fluoxetine hydrochloride) tablets, in conjunction with the BOND™ training program, are clinically proven to help dogs that experience separation anxiety. TALK TO YOUR DISTRIBUTOR REPRESENTATIVE TODAY ABOUT THIS LIMITED-TIME OFFER! Available only while supplies last. Allow a minimum of four weeks for fulfillment. Visit PRNPromoClaim.com for more information and submission instructions. PRN® and Reconcile® are registered Important Safety Information: The most common adverse events in decreasing order of reported frequency are: decreased appetite, trademarks of Pegasus Laboratories, Inc. depression/lethargy, shaking/shivering/tremor, vomiting, restlessness and anxiety, seizures, aggression, diarrhea, mydriasis, vocalization, weight loss, panting, confusion, incoordination, and hypersalivation. Reconcile® chewable tablets are contraindicated for dogs with a history of seizures or when used with MAOIs. Reconcile chewable tablets are indicated for the treatment of canine separation anxiety in conjunction with a behavior modification plan. Federal law restricts this drug to use by or on the order of a licensed veterinarian. Visit Reconcile.com to view full prescribing information.

Animal Behavior in a Post COVID-19 World By Amy L. Pike, DVM, DACVB The end of the pandemic may The area I will address today is the independent behavior, has excessive usher in new challenges within possibility of development of post- attention seeking been rewarded in the behavior field that may pandemic separation anxiety. the past, did the pet have separation be difficult to address, especially if anxiety prior to relinquishment by a the mere mention of behavior sends On our new client questionnaire, former owner, etc). What should we you running for the nearest referral we ask how long the pet is left home be doing to prevent and screen for brochure. alone during the day and I cannot this disorder? tell you how many of those have Our pets may now see a drastic been filled out with some form of the First, if the owners are not already change in lifestyle but my biggest following this past year- “they have doing so, encourage them to post-pandemic behavior concerns lie never been left home alone”. Cue actually leave their pets home alone with those dogs and cats who were my head exploding. Does that mean on occasion. Next, we should be acquired during the pandemic. The that every one of these animals is screening for signs of separation threat of social isolation from loved going to develop separation anxiety? anxiety and its common comorbidities, ones, and the seemingly perfect That’s unlikely. Whether or not a including noise and storm phobias1,2, opportunity to be home caused so particular pet is going to manifest every time we see these pets. This many people to rush out and get a separation anxiety is going to depend can be done by the client care pandemic pet. And while these pets on some innate factors about the representatives when they speak to have likely been emotional life lines pets themselves (Examples- their the owner to make appointments, for many humans during this time, individual emotional resiliency, their via a written questionnaire the owners these dogs and cats have no idea level of pathologic attachment to the fill out in advance (ask your friendly what “normal” is for their families. owner, their underlying predisposition pharmaceutical representatives Couple that with mostly inexperienced to anxiety and panic disorders, etc), because they often have these new pet parents, and I think it’s a environmental factors (Examples- available), by the assistant or nurse potential recipe for disaster. The lack will the owner be allowed to work from when they perform vital signs and take of appropriate socialization and home part-time or start only with half the chief complaint history, or even interactions with other pets and people days, etc), and the pet’s prior learning the clinician while you are performing may set many of these patients up and experiences (Examples- has there the physical exam on the pet or when for a lifetime of fear-based behavior. been appropriate reinforcement for discussing your findings. Owners should 1-800-643-9378 www.midwestvetsupply.com • Midwest Monthly | JUNE 2022 13

be asked if there are any obvious signs such as house References: soiling, destruction, or vocalization (resulting in neighbor 1. Bamberger, Michelle, and Katherine A. Houpt. “Signalment factors, or tenant complaints) when the pet is left home alone. comorbidity, and trends in behavior diagnoses in dogs: 1,644 cases A full physical exam and diagnostics (Minimum database (1991–2001).” Journal of the American Veterinary Medical Association 229.10 of CBC, chemistry panel, urinalysis and fecal) will rule out (2006): 1591-1601. a medical etiology, and videoing the pet when home 2. Overall, Karen L., Arthur E. Dunham, and Diane Frank. “Frequency of non- alone will then confirm the underlying behavioral cause. specific clinical signs in dogs with separation anxiety, thunderstorm phobia, There are subtle presenting symptoms that indicate the and noise phobia, alone or in combination.” Journal of the American Veteri- owner needs to video to confirm if the pet is suffering from nary Medical Association 219.4 (2001): 467-473. separation anxiety such as anorexia when alone, polydipsia 3. Simpson, Barbara Sherman, et al. “Effects of reconcile (fluoxetine) chew- upon owner return (likely the result of lack of drinking and/ able tablets plus behavior management for canine separation anxiety.” or excessive panting), blocking the owner’s exit from the Veterinary Therapeutics 8.1 (2007): 18. home, avoidance of confinement, hyperattachment 4. Landsberg, Gary M., et al. “Effectiveness of fluoxetine chewable tablets in (following owners excessively) and an exuberant greeting the treatment of canine separation anxiety.” Journal of veterinary behavior upon owner return. Any signs of anxiety seen on video are 3.1 (2008): 12-19. too many and need to be addressed immediately. 5. King, J. N., et al. “Treatment of separation anxiety in dogs with clomip- ramine: results from a prospective, randomized, double-blind, placebo-con- Treatment for separation anxiety involves behavior trolled, parallel-group, multicenter clinical trial.” Applied Animal Behaviour modification and, depending on the severity, anxiolytic Science 67.4 (2000): 255-275. products and medication. Instruct the clients to leave the 6. King, J. N., et al. “Results of a follow-up investigation to a clinical trial pet with a delicious snack like a frozen Kong or puzzle toy testing the efficacy of clomipramine in the treatment of separation anxiety in to not only keep them occupied, but also to help associate dogs.” Applied Animal Behaviour Science 89.3-4 (2004): 233-242. the owner’s departure with something amazing. The owners 7. Gaultier, Emmanuel, et al. “Comparison of the efficacy of a synthetic should remain calm and ignore the pet for 20-30 minutes dog-appeasing pheromone with clomipramine for the treatment of separa- prior to leaving so as not to create a heightened state of tion-related disorders in dogs.” Veterinary record 156.17 (2005): 533-538. arousal just prior to departure. Owners should never ever 8. Kim, Young-Mee, et al. “Efficacy of dog-appeasing pheromone (DAP) for punish the pet for house soiling or destruction as it will only ameliorating separation-related behavioral signs in hospitalized dogs.” The serve to increase the anxiety associated with anticipation Canadian Veterinary Journal 51.4 (2010): 380. of the owner’s return. For more client information on the 9. Pike, Amy L., Debra F. Horwitz, and Heidi Lobprise. “An open-label pro- initial training steps for separation anxiety, please visit spective study of the use of l-theanine (Anxitane) in storm-sensitive cli- Reconcile.com. Another great client resource is the newest ent-owned dogs.” Journal of Veterinary Behavior 10.4 (2015): 324-331. edition of Separation Anxiety in Dogs: Next Generation 10. DePorter, T. L., D. L. Bledsoe, and J. R. Conley. “Case report series of clini- Treatment Protocols and Practices. cal effectiveness and safety of Solliquin™ for behavioral support in dogs and cats.” Veterinary Behavior Symposium Proceedings. San Antonio (TX). 2016. The two most commonly used medications for separation 11. McGowan, R. T. S., et al. “Tapping into those ‘gut feelings’: Impact of anxiety are the FDA approved Reconcile® (fluoxetine BL999 (Bifidobacterium longum) on anxiety in dogs.” Veterinary Behavior hydrochloride, a selective serotonin reuptake inhibitor) Symposium Proceedings, Denver, CO. 2018. by PRN Pharmacal3,4 and clomipramine, a tri-cyclic 12. Beata, Claude, et al. “Effects of alpha-casozepine (Zylkene) versus sele- antidepressant5,6. Reconcile and clomipramine may take up giline hydrochloride (Selgian, Anipryl) on anxiety disorders in dogs.” Journal to 4 weeks to see full effect and should always be started at of Veterinary Behavior 2.5 (2007): 175-183. the low end of the dose range to minimize potential for side effects and increased only as needed. In the meantime, About the Author clinicians can prescribe event/situational medications to be given immediately prior to departures. Options for Dr. Pike graduated from Colorado State University School predeparture medications (given 90 minutes to 2 hours of Veterinary Medicine in 2003. After graduation, she was prior to departures) include the serotonin antagonist and commissioned as a Captain into the United States Army reuptake inhibitor, trazodone (2.5-10 mg/kg), the alpha-2 Veterinary Corps. It was taking care of the Military Working Dogs agonist, clonidine (0.01-0.05 mg/kg), the alpha-2-delta returning from deployment that spurred her interests in behavior ligand, gabapentin (20-40 mg/kg), and a benzodiazepine medicine. In 2011, Dr. Pike started a Residency program under like lorazepam (0.01-0.1 mg/kg). Other products which the mentorship of Dr. Debra Horwitz, DACVB. In October 2015, may improve treatment outcomes include the maternal Dr. Pike passed the ACVB certifying examination. appeasing pheromone7,8, l-theanine supplements10, probiotics11, and alpha-casozepine supplementation12. Dr. Pike is owner of the Animal Behavior Wellness Center in Fairfax, VA (a suburb of Washington DC) where she sees referral With all the excitement of us getting back to our behavior cases. Dr. Pike is a clinical instructor for the on-line typical routines, don’t forget that some pets may be education system “E-training for Dogs”, a member of the Fear staying home for the first time ever. And if the mere Free Advisory Committee and a certified animal behavior mention of a dog howling all day and destroying the consultant for IAABC. She was recently named one of the “Top house, or a cat peeing outside a litter box when the Veterinarians of Northern Virginia” by NoVa Magazine for the owner is gone makes you want to quit vet med and third year in a row. work at home in your pajamas, feel free to find me or my colleagues for some advice or a referral (www.dacvb.org/search/custom.asp?id=4709). 14 JUNE 2022 | Midwest Monthly • www.midwestvetsupply.com 1-800-643-9378

JUNE SPECIAL Purchase $800 of any Nutramax Laboratories Veterinary Sciences’ products and receive a Pro-Tekt™^ Mat* Limit three (3) free items per clinic | Excludes equine products Design, logo, and color may vary SAVE THE DAT E REGISTER EARLY TO *All June offers will be governed by the qualifying terms herein. Subject to availability. Nutramax Laboratories -12, 2022SPONSORED BYSAVE $100 Veterinary Sciences, Inc. (Nutramax) reserves the right to substitute with product of equal value. To qualify, purchases SEE YOU IN must be placed between June 1, 2022 and June 30, 2022. Qualifying purchaser must be a licensed veterinarian, with NOVEMBER 10 NASHVILLE a valid veterinary/client/patient relationship located in the 50 U.S. states and D.C. Limit three (3) promotional items per clinic. Excludes equine products. Qualifying purchases must be made through either a qualified distributor or cvmcec.org Nutramax directly. The total sales number shall exclude taxes, shipping and any promotional discounts including free goods. Free goods are not returnable or redeemable for any other product. ^Pro-Tekt™ is a trademark of AHF, LLC. pSource: Survey conducted among small animal veterinarians who recommended animal supplements.

LaverdiaTM-CA1 Special instructions for handling and administering the product It is recommended that Laverdia-CA1 by administered under the (verdinexor tablets) supervision of, or in consultation with, a veterinarian experienced in the use of cancer therapeutic agents. Conditionally approved by FDA pending a Do not store near food, in or near a food preparation area, or with full demonstration of effectiveness under medications intended for use in humans. application number 141-526 Skin contact Antineoplastic Tablets In case of contact with the skin, wash the affected area immediately and For Dogs Only thoroughly with soap and water. Accidental eye exposure CAUTION: Federal (USA) law restricts this drug to use by or on the order Rinse the eyes with large amounts of tap water (use eyewash station if of a licensed veterinarian. Use only as directed. It is a violation of the present) for 10 minutes while holding back the eyelid. law to use this product other than as directed in the labeling. Remove contact lenses. BRIEF SUMMARY (for full prescribing information, see package Seek medical advice immediately and show the package insert or label to insert) the physician. DESCRIPTION: Laverdia-CA1 (verdinexor tablets) is a selective inhibitor Accidental oral exposure or ingestion of nuclear export (SINE) that blocks chromosome region maintenance 1 Seek medical advice immediately and show the package insert or label to (CRM1). the physician. INDICATION: Laverdia-CA1 is indicated for the treatment of lymphoma Animal Safety Warnings in dogs. Laverdia-CA1 can cause severe anorexia. Patients should be carefully CONTRAINDICATIONS: monitored for inappetence, vomiting, diarrhea and dehydration, and Do not use in dogs that are pregnant, lactating or intended for breeding. supportive care should be provided as clinically indicated. Keep Laverdia-CA1 is a possible teratogen and can affect female and male Laverdia-CA1 in a secure location out of reach of dogs, cats, and other fertility. animals to prevent accidental ingestion or overdose. WARNINGS: NOT FOR USE IN HUMANS. KEEP THIS AND ALL PRECAUTIONS: Safe use of Laverdia-CA1 has not been evaluated in MEDICATIONS OUT OF THE REACH OF CHILDREN. CHILDREN dogs with concurrent serious infections; concurrent renal, cardiovascular, SHOULD NOT COME INTO CONTACT WITH LAVERDIA-CA1. Children or hepatic disease; in dogs with diabetes mellitus; in dogs with clinically should not come in contact with the feces, urine, vomit, or saliva of relevant hypercalcemia; in dogs with concurrent malignancy or dogs treated dogs. younger than 7 months of age. Pregnant women, women who may become pregnant, and nursing Laverdia-CA1 can cause hematologic and serum chemistry abnormali- women should not handle or administer Laverdia-CA1 or come in contact ties. Dogs should be frequently monitored for evidence of hematologic with the feces, urine, vomit, or saliva from Laverdia-CA1-treated dogs. and serum chemistry abnormalities when initiating and maintaining treat- Laverdia-CA1 may cause birth defects and can affect female fertility ment with Laverdia-CA1 (see ADVERSE REACTIONS). based on animal studies. The safety and effectiveness of Laverdia-CA1 has not been evaluated Wear protective disposable chemotherapy resistant gloves when handling in conjunction with other chemotherapeutic agents or other treatment Laverdia-CA1 to avoid exposure to drug. modalities for lymphoma. Wear protective disposable chemotherapy resistant gloves to prevent ADVERSE REACTIONS: The most common adverse events reported direct contact with moistened, broken, or crushed Laverdia-CA1 tablets during the course of a US field study supporting reasonable expectation and prevent direct contact with feces, urine, vomit, and saliva during of effectiveness were lethargy, fever, weakness, generalized pain, treatment and for 3 days after the dog has received the last treatment. anorexia, vomiting, diarrhea, polyuria, polydipsia, hematuria, proteinuria, Place all waste material in a plastic bag and seal before general disposal. elevated liver enzymes, bilirubinuria, cough/dyspnea, weight loss, blood Wash hands immediately and thoroughly with soap and water if contact cell abnormalities, subcutaneous edema, and pyoderma. Less common occurs with the feces, urine, vomit, or saliva from Laverdia-CA1 treated adverse reactions seen were protein losing nephropathy, urinary dogs. incontinence, hepatomegaly, elevated bilirubin, icterus, heart murmur, Any items that come in contact with feces, urine, vomit, or saliva should arrhythmia, heart block, blood protein abnormalities, prolonged not be washed with other laundry during treatment and for 3 days after prothrombin time, seizure, tremor, disorientation, corneal opacity, skin the last treatment with Laverdia-CA1. bruising, redness, loss of hair, nasal discharge, epistaxis, lymphadenitis Wear protective disposable chemotherapy resistant gloves when handling and platelet abnormalities. the dog’s toys, food bowl, and water bowl. Wash food and water bowls To report suspected adverse events, for technical assistance or to separately from other items during treatment and for 3 days after the dog obtain a copy of the SDS, contact Dechra Veterinary Products at has received the last treatment. 1-833-264-8483. For additional information about adverse drug If Laverdia-CA1 is accidentally ingested, or if there is significant contact experience reporting for animal drugs, contact FDA at 1-888-FDA-VETS with feces, urine, vomit or saliva of dogs during treatment or within or online at http://www.fda.gov/reportanimalae. 3 days after the last treatment without proper precautions, seek medical DISTRIBUTED BY: advice immediately. It is important to show the treating physician a copy Dechra Veterinary Products of the package insert, label, or client information sheet. 7015 College Boulevard, Suite 525 Overland Park, KS 66211 USA Conditionally Approved by FDA under application number 141-526 Laverdia™ is a trademark of Dechra Limited. R 02 2022 14BR-LAV22005-0222

The Power to Treat Lymphoma In a pill A novel treatment option for canine lymphoma patients LAVERDIA™-CA1 is conditionally approved by FDA pending a full demonstration of effectiveness under application number 141-526. Important Safety Information For use in dogs only. LAVERDIA™-CA1 (verdinexor) is conditionally approved for the treatment of lymphoma in dogs. NOT FOR USE IN HUMANS. KEEP THIS AND ALL MEDICATIONS OUT OF THE REACH OF CHILDREN. CHILDREN SHOULD NOT COME INTO CONTACT WITH LAVERDIA™-CA1. Pregnant women, women who may become pregnant, nursing women and children should not handle or administer LAVERDIA-CA1 or come into contact with the feces, urine, saliva, or vomit of treated dogs for 3 days following treatment. Laverdia-CA1 can affect male fertility based on animal studies and studies in humans. Wear protective disposable chemotherapy resistant gloves when handling Laverdia-CA1 to avoid direct exposure to moistened, broken or crushed tablets or biological waste from the treated dog (feces, urine, saliva, or vomit). Do not use in dogs that are pregnant, lactating or intended for breeding. LAVERDIA-CA1 is a possible teratogen and can affect female and male fertility. Dogs should be frequently monitored for hematologic and serum chemistry abnormalities. The most commonly reported adverse reactions in dogsinclude anorexia, weight loss, vomiting, diarrhea, and lethargy polyuria, polydipsia, elevated liver enzymes and thrombocytopenia. Please see package insert, visit dechra-us.com, or pg.16 for full prescribing information. For product label, including complete safety information, visit go.dechra-us.com/laverdia-pi, or scan the QR code below. CAUTION: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. Use only as Directed. It is a violation of Federal Law to use this product other than as directed in the labeling. Laverdia™ is a trademark of Dechra Ltd. ©2022 Dechra Veterinary Products. All rights reserved. 14SD-LAV22015-0322

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Do Pet Parents REALLY Know They should be placed in prominent social areas where all that normal cat That Kittens Need to Scratch? exploration is happening, near resting spaces, and comfy beds. Natalie L. Marks, DVM, CVJ Thirdly, until a kitten settles in on a post, In the last twenty-two years of 2. Is Scratching Normal? they should be offered different textures practice, the two most common like cardboard, sisal, fabric, and others. questions I receive from kitten parents Yes! Scratching is a very normal part In a nutshell, veterinary teams should involve how to resolve inappropriate of daily behavior for kittens and cats recommend multiple scratching posts urination and inappropriate scratching. and serves four major functions. One, first, using both vertical and horizontal The first problem tends to be easier it helps to sharpen and remove old or spaces, and varied textures so that to fix for a few reasons: logistical splintering nails. Secondly, it allows kittens choose these when they are modifications are usually financially kittens and cats to mark their territory exploring their new home! Even with feasible to implement and there is both visually and from an olfactory all of this, there will still be clients who typically a motivated family member sense. Third, it is part of the normal say they don’t have time or won’t do who won’t tolerate elimination issues. behavior of stretching/scratching this texture exploration phase and However, the latter can be much after sleeping or waking from a nap. want ONE type of post to try. For these, more of a challenge. As veterinary Finally, it is a necessary part of their you can refer to the 2019 Zhang study teams, we have not set up our pet daily exercise. Yet, most veterinarians (Zhang, L, Plummer, R, McGlone, J, parents for success from the first visit to and veterinary technicians assume Preference of kittens for scratchers, understand that most of what they see this is common knowledge to the Journal of Feline Med and Surg, 2019. at home is normal kitten behavior – it’s pet parent. Vol. 21(8) 691-699) that demonstrated just considered undesirable for the pet that the S-shaped cardboard scratcher parent. Here are three strategies to help Instead of keeping these wrong was most effective. set up our pet parents for success with assumptions, let’s proactively educate their new kitten from the first our clients so that the correct Setting the appropriate expectations expectation is set from the beginning. about must have resources, that day home! This should be part of every initial kitten scratching is normal, and clear steps exam, and if you’re reading this and on how to train a kitten to a scratching 1. MUST HAVE Resources thinking how on earth could you cram post are essential steps towards success any more into that visit, extend your for that kitten in the home. A recent for Every Feline Home kitten visits. These can’t be done in 20 study by Moesta (Moesta A, Keys D and minutes appropriately, and that Crowell-Davis S. Survey of cat owners Is this a discussion point in your first extra time will help establish your on features and preventative measures kitten visit? If it isn’t, this is one to team as the go-to resource for trusted of feline scratching of inappropriate start including right away. There is still education. This also allows you to items)showed 83% of cats presented to the misconception that cats are the establish expectations for that cat’s a small animal practice demonstrated “easy” pet, with the simple requirement life journey, which is rarely done scratching of inappropriate items. of a food and water bowl left out but necessary. WE can change this and do better somewhere and a litterbox that is for our patients and clients. cleaned once a week. When cats are 3. How to Teach Scratching not provided the resources they need, Post Introductions & Training Learn more at: Vetscoop.com they become emotionally unhealthy, bored, destructive, and sometimes This doesn’t, and shouldn’t, be a long Or visit our social sites: fearful and reactive. Not only does that discussion for veterinary teams with pet www.facebook.com/thevetscoop diminish the human -animal bond, but parents. But there are several important www.instagram.com/thevetscoop it also significantly increases the risk of tenets to training that are important relinquishment to shelters. to convey in whatever method is most effective for your team (handouts, From the very first point of video, texts, social posts, kitten communication, or ideally prior to packs, etc.). First, pet parents need to adoption, educate your kitten and cat understand and accept that kittens parents about the basic needs and prefer to live and explore resources of every cat: vertical spaces FIRST and horizontal spaces second. This is counterintuitive • Food (preferably provided to allow to most clients and often is the first predatory play & simulated hunting) roadblock to enhancing the human- animal bond. It should not be a surprise • Water to see kittens climbing, perching, • Toys jumping off high structures, and loving • 3d space (horizontal and vertical) to be up high! Next, we should teach • Litterbox(es) proper placement of scratching posts. • Resting Spaces • Access to Pet Parents) • Scratching Post 1-800-643-9378 www.midwestvetsupply.com • Midwest Monthly | JUNE 2022 21

Take full advantage of your online store! Get your patient’s monthly heartworm and flea and tick preventative delivered straight to their owner’s door with easydoseit! For more information call our support team at 844-654-6876 RECONCILE® ( uoxetine hydrochloride) Chewable Tablets For complete prescribing information, see full package insert. Caution: Federal law restricts this drug to use by or on the order of a licensed veterinarian. Indications: RECONCILE chewable tablets are indicated for the treatment of canine separation anxiety in conjunction with a behavior modi cation plan. Contraindications: RECONCILE chewable tablets should not be used in dogs with epilepsy or history of seizures, nor given concomitantly with drugs that lower the seizure threshold (e.g., phenothiazines). RECONCILE chewable tablets should not be given in combination with, or within 14 days of discontinuing, a monoamine oxidase inhibitor (MAOI). RECONCILE chewable tablets are contraindicated in dogs with a known hypersensitivity to uoxetine HCI or other SSRls. Observe a 6-week washout interval following discontinuation of therapy with RECONCILE chewable tablets prior to the administration of any drug that may adversely interact with uoxetine or its metabolite, nor uoxetine. Human Warnings: Not for use in humans. Keep out of reach of children. In case of accidental ingestion seek medical attention immediately. Precautions: RECONCILE chewable tablets are not recommended for the treatment of aggression and have not been clinically tested for the treatment of other behavioral disorders. Studies in breeding, pregnant or lactating dogs and in patients less than 6 months of age have not been conducted. Seizures may occur in dogs treated with RECONCILE chewable tablets, even in dogs without a history of epilepsy or seizures (see Adverse Reactions). Before prescribing RECONCILE chewable tablets, a comprehensive physical examination should be conducted to rule out causes of inappropriate behavior unrelated to separation anxiety. RECONCILE chewable tablets have not been evaluated with drugs that a ect the cytochrome P450 enzyme system and should be used with caution when co-administered with any drug that a ects this system. Studies to assess the interaction of RECONCILE chewable tablets with tricyclic antidepressants (TCAs) (e.g., amitriptyline, clomipramine) have not been conducted. The minimum washout period to transition dogs from TCAs to RECONCILE chewable tablets has not been evaluated. Data demonstrate that TCAs are cleared 4 days following discontinuation.1,2Adverse Reactions: In two North American eld studies involving 427 dogs, the following adverse reactions were observed at a rate of ≥ 1% in dogs treated with RECONCILE chewable tablets (n=216): calm/lethargy/depression (32.9%), decreased appetite (26.9%), vomiting (17.1 %), shaking/shivering/tremor (11.1 %), diarrhea (9.7%), restlessness (7.4%), excessive vocalization (including whining) (6.0%), aggression (4.2%), otitis externa (2.8%), disorientation (2.3%), incoordination (2.3%), constipation (1 .4%) and excessive salivation (1.4%). Other Adverse Reactions: Seizures: One of 112 dogs in the control group and three of 117 dogs that received RECONCILE chewable tablets experienced the serious adverse reaction of seizures during or after the end of the treatment period. One dog that was treated with RECONCILE chewable tablets experienced two seizures 10 days after the end of therapy and, despite escalating phenobarbital doses, died in status epilepticus approximately six months after the rst seizure. In the second study, one of 99 dogs treated with RECONCILE chewable tablets and one of 99 dogs treated with the control tablet experienced the serious adverse reaction of seizures. Lastly, in a European multi-site study, one dog treated with a daily dose of 0.4 mg/kg for one month experienced one seizure one week after discontinuing therapy. Weight loss: In eld studies, a weight loss ≥ 5% (relative to pre-study body weight) was observed in 58 (29.6%) of dogs treated with RECONCILE chewable tablets and 24 (13.0%) of control dogs. No dogs were withdrawn from clinical studies due to weight loss alone. Dose reduction: Twenty dogs in the RECONCILE chewable tablet group and ve control dogs required a dose reduction due to unacceptable adverse reactions, the majority intermittent and mild, generally anorexia, vomiting, shaking and depression. Lowering the dose eliminated or reduced the severity of these reactions in the RECONCILE chewable tablet group only, while resumption of the full dose resulted in a return of the initial adverse reactions in approximately half the a ected dogs. One dog experienced recurrence of severe adverse reactions, which necessitated withdrawal from the study. Additionally, two dogs required a second dose reduction of RECONCILE chewable tablets. Post Approval Experience (Rev. 2010): The following adverse events are based on post-approval adverse drug experience reporting with RECONCILE® chewable tablets. Not all adverse reactions are reported to FDA CVM. It is not always possible to reliably estimate the adverse event frequency or establish a causal relationship to product exposure using this data. The following adverse events are listed in decreasing order of reported frequency: decreased appetite, depression/lethargy, shaking/shivering/tremor, vomiting, restlessness and anxiety, seizures, aggression, diarrhea, mydriasis, vocalization, weight loss, panting, confusion, incoordination and hypersalivation. For a copy of the Safety Data Sheet (SDS) or to report suspected adverse drug events, contact Pegasus Laboratories at 1-800-874-9764. For additional information about adverse drug experience reporting for animal drugs, contact FDA at 1-888-FDA-VETS or www.fda.gov/reportanimalae. E ectiveness: In one randomized multi-centered, double-blinded, vehicle-controlled study of 8 weeks' duration, 229 dogs were evaluated at 34 investigative sites in the United States and Canada. One hundred seventeen dogs were randomized to 1-2 mg/kg/day of RECONCILE chewable tablets and 112 dogs were randomized to the control group. Both groups underwent concurrent behavior modi cation. In seven of the eight weeks, the percentage of dogs with improved overall separation anxiety scores was signi cantly higher (p < 0.05) among dogs treated with RECONCILE chewable tablets compared to dogs that received the control tablet. At the end of the study, 73% of dogs treated with RECONCILE chewable tablets showed signi cant improvement (p=0.010) as compared to 51% of dogs treated with behavior modi cation alone. Dogs treated with RECONCILE chewable tablets also showed improvement in destructive behavior, excessive vocalization and restlessness over dogs that received the control tablet. In addition, dogs in both groups experienced improvement in inappropriate urination, inappropriate defecation, excessive salivation, excessive licking/grooming, shaking/shivering and depression. Overall separation anxiety severity scores improved more rapidly for dogs taking RECONCILE chewable tablets than those dogs receiving the control tablet. The same e ect was also noted for the individual scores for excessive vocalization and depression. To obtain full product information please call 800-874-9764 or visit Reconcile.com • 10-2017S Approved by FDA under NADA #141-272 • Pegasus Laboratories, Inc. 1 Plumb DC. Amitriptyline. Veterinary Drug Handbook 5th Edition (Pocket Edition). Iowa State Press. Ames, IA. Page 39, 2002. 2Hewson CJ, et.al. The pharmacokinetics of clomipramine and desmethylclomipramine in dogs: parameter estimates following a single oral dose and 28 consecutive daily doses of clomipramine. J Vet Pharmacol Therap 21 :214-222, 1998.

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ZorbiumTM WARNINGS: ADVERSE REACTIONS: HUMAN SAFETY WARNINGS: In a randomized, multi-centered, double-masked, field study, [buprenorphine transdermal solution] Not for use in humans. Keep this and all medications out of ZORBIUM™ (buprenorphine transdermal solution) (N=113) or reach of children and pets. vehicle control (N=109) was administered to cats prior to For use in cats only elective surgical reproductive sterilization (castration/ 20 mg/mL Human User Safety While Handling ZORBIUM in the Hospital: ovariohysterectomy) in conjunction with forelimb onychectomy. For topical application in cats Protective Covering: Do not come into direct contact with Cats enrolled in the study were 4 months to 5 years of age and Opioid analgesic ZORBIUM. Wear impermeable latex or nitrile gloves, protective weighed 1.1 to 5.7 kg (2.5 to 12.5 lb). Clinical observations and CAUTION: Federal law restricts this drug to use by or on the glasses, and a laboratory coat when applying ZORBIUM. physiological parameters were monitored prior to, during, and order of a licensed veterinarian. Mucous Membrane or Eye Contact During Application: after surgery for 96 hours after sternal recumbency. Before using Zorbium, please consult the product insert, a Direct contact of ZORBIUM with the eyes, oral, or other mucous Supplemental heat and fluids were allowed. There were no summary of which follows: membranes could result in absorption of buprenorphine and the deaths during the study and no cats received an opioid reversal potential for adverse reactions. If accidental eye, oral, or other agent. Three ZORBIUM and 2 vehicle control cats were removed HUMAN SAFETY WARNING mucous membrane contact is made during application, flush the due to hyperthermia suspected to be treatment related. One Abuse Potential area with water and contact a physician immediately. If wearing ZORBIUM cat was removed due to fractious behavior 30 minutes ZORBIUM contains buprenorphine, an opioid that exposes contact lenses, flush the eye first and then remove the following surgery. Adverse reactions were defined as any single contact lens. excursion outside the normal range, as defined: 100.5 – 102.5 ˚F humans to risks of misuse, abuse, and addiction, which Skin Contact During Application: body temperature; 60 – 120 mmHg mean arterial pressure; can lead to overdose and death. Use of buprenorphine Following application to the cat, allow a minimum drying time of 88 – 180 beats per minute for heart rate; 24 – 44 breaths per may lead to physical dependence. The risk of abuse by 30 minutes before direct contact with the application site. If minute for respiratory rate. A summary of adverse reactions humans should be considered when storing, human skin is accidentally exposed to ZORBIUM, wash the during anesthesia (from anesthetic induction through recovery administering, and disposing of ZORBIUM. Persons at exposed area immediately with soap and water and contact a defined as sternal recumbency) is provided in Table 1. increased risk for opioid abuse include those with a physician. Accidental exposure could result in absorption of Table 1. Adverse Reactions During Anesthesia: personal or family history of substance abuse (including buprenorphine and the potential for adverse reactions. drugs or alcohol) or mental illness (e.g. depression). Drug Abuse, Addiction, and Diversion of Opioids: Adverse Reaction* ZORBIUM Vehicle Control (N=113) (N=109) Life-Threatening Respiratory Depression Controlled Substance: Hypothermia Serious, life-threatening, or fatal respiratory depression ZORBIUM contains buprenorphine, a Schedule III controlled Hypotension 37 (32.7%) 29 (26.6%) may occur with accidental exposure to or with misuse or substance with an abuse potential similar to other Hypertension 31 (27.4%) 28 (25.7%) abuse of ZORBIUM. Monitor for respiratory depression if Schedule III opioids. Tachycardia 27 (23.9%) 18 (16.5%) human exposure to buprenorphine occurs. Misuse or Abuse: Sedation 14 (12.4%) 14 (12.8%) abuse of buprenorphine by swallowing, snorting, or ZORBIUM contains buprenorphine, an opioid substance, 12 (10.6%) 7 (6.4%) injecting poses a significant risk of overdose and death. that can be abused and is subject to misuse, abuse, and addiction, which may lead to overdose and death. This risk Oxygen saturation ≤ 90% 6 (5.3%) 2 (1.8%) Accidental Exposure is increased with concurrent use of alcohol and other Bradycardia 4 (3.5%) 2 (1.8%) Because of the potential for adverse reactions associated central nervous system depressants, including other Hyperthermia 3 (2.7%) 4 (3.7%) with accidental exposure, ZORBIUM should only be opioids and benzodiazepines. administered by veterinarians or veterinary technicians ZORBIUM should be handled appropriately to minimize the *Physiological adverse reactions were defined as any single who are trained in the handling of potent opioids. risk of diversion, including restriction of access, the use of excursion outside the normal range at any 10 minute interval Accidental exposure to even one tube of ZORBIUM, accounting procedures, and proper disposal methods, as during the entire duration of anesthesia. especially in children, can result in a fatal overdose of appropriate to the clinical setting and as required by law. After recovery, cats were observed in the hospital and buprenorphine. Prescription drug abuse is the intentional, non-therapeutic underwent physiological assessments that included indirect Risks From Concurrent Misuse or Abuse with use of a prescription drug, even once, for its rewarding mean arterial blood pressure, heart rate, respiratory rate, body Benzodiazepines or Other CNS Depressants psychological or physiological e ects. Buprenorphine has temperature, lung auscultation, heart auscultation, and Concurrent misuse or abuse of opioids with been diverted for non-medical use into illicit channels of assessments of urination, defecation, and appetite. A summary benzodiazepines or other central nervous system (CNS) distribution. All people handling opioids require careful of adverse reactions after anesthetic recovery (sternal depressants, including alcohol, may result in profound monitoring for signs of abuse. recumbency) in all cats is reported in Table 2. sedation, respiratory depression, coma, and death. See Human Safety Warnings for detailed information. Storage and Disposal: Table 2. Adverse Reactions After Anesthetic Recovery: ZORBIUM is a Schedule III opioid. Store in a locked cabinet INDICATION: according to federal and state controlled substance Adverse Reaction* ZORBIUM Vehicle Control (N=113) (N=109) requirements/guidelines. Any unused or expired tubes must be ZORBIUM is indicated for the control of postoperative pain destroyed by a reverse distributor; for further information, Hypothermia 107 (94.7%) 105 (96.3%) associated with surgical procedures in cats. contact your local DEA field o ce or call Elanco US Inc. at Hyperthermia 84 (74.3%) 62 (56.9%) DOSAGE AND ADMINISTRATION: 1-888-545-5973. Sedation 64 (56.6%) 48 (44.0%) This product should only be administered by veterinary Information for Physician: personnel. ZORBIUM transdermal solution contains a mu opioid partial Tachypnea 56 (49.6%) 70 (64.2%) agonist (20 mg buprenorphine/mL). In the case of an emergency, Hypotension 50 (44.2%) 51 (46.8%) ZORBIUM is for administration only once for the surgical provide the physician with this package insert. Naloxone may Hypertension 42 (37.2%) 34 (31.2%) procedure. ZORBIUM should be applied 1 to 2 hours before not be e ective in reversing respiratory depression produced by Bradycardia 34 (30.1%) 45 (41.3%) surgery. A single application provides analgesia for 4 days. buprenorphine. The onset of naloxone e ect may be delayed by ZORBIUM should only be applied topically to the dorsal cervical 30 minutes or more. Doxapram hydrochloride has also been Tachycardia 32 (28.3%) 39 (35.8%) area at the base of the skull. Do not apply if dorsal cervical skin used as a respiratory stimulant. is diseased or injured. The dosage of ZORBIUM is 1.2 – 3.1 mg/lb ANIMAL SAFETY WARNINGS: Anorexia 25 (22.1%) 32 (29.4%) (2.7 – 6.7 mg/kg) administered topically as the entire tube For topical use in cats only. This product should only be contents according to the following dosing table: administered by veterinary personnel. Dysphoria 20 (17.7%) 29 (26.6%) Do not apply ZORBIUM if the application site at the dorsal cervical area has diseased or injured skin. Diarrhea 11 (9.7%) 11 (10.1%) Do not apply ZORBIUM to anatomic areas other than the Pounds of Kilograms of Dose of dorsal cervical area because absorption characteristics may Bradypnea 11 (9.7%) 7 (6.4%) Body Weight Body Weight ZORBIUM be di erent. 0.4 mL (8 mg) pink tube PRECAUTIONS: Leukocytosis 6 (5.3%) 4 (3.7%) 2.6 to 6.6 1.2 to 3 1 mL (20 mg) green tube Following anesthesia and opioid analgesia, body temperature >6.6 to 16.5 >3 to 7.5 should be monitored postoperatively for immediate hypothermia Hyperactivity 2 (1.8%) 9 (8.3%) and subsequent hyperthermia. Hyperthermia can occur and Dose Application persist after the hypothermic e ects of anesthesia have *Physiological adverse reactions were defined as any single Wear impermeable latex or nitrile gloves, protective glasses, and resolved. excursion outside the normal range following anesthetic a laboratory coat to prevent direct solution contact with human The safe use of ZORBIUM has not been evaluated in debilitated recovery (sternal recumbency) through 4 days postoperatively. skin, eyes, or mucosa when handling and applying the solution. cats or cats with renal, hepatic, cardiac, or respiratory disease. Hyperthermia was the only adverse event observed in more than Do not dispense ZORBIUM for administration at home by the pet 10% of cats in the ZORBIUM group after the day of surgery (24 owner (see HUMAN SAFETY WARNINGS). – 96 hours). The percentage of cats in the ZORBIUM group with See product insert for complete dosing and administration hyperthermia decreased over time from 66.4% on Day 0 to information. 28.3% on Day 1, and to 6.2% by Day 4. A summary of adverse reactions (from anesthetic recovery through 96 hours after CONTRAINDICATIONS: recovery) in cats in the ZORBIUM group by study day is reported ZORBIUM is contraindicated in cats with known hypersensitivity in Table 3. to buprenorphine hydrochloride, any of the inactive ingredients of ZORBIUM, or known intolerance to opioids. The safe use of ZORBIUM has not been evaluated in cats that are pregnant, lactating, or intended for breeding. The safe use of ZORBIUM has not been evaluated in cats younger than four months old. The safe use of ZORBIUM has not been evaluated in cats weighing less than 2.6 pounds or more than 16.5 pounds. PA102712X W1b

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Table 3. Adverse Reactions in ZORBIUM Cats (N=113) by Fluid administration (intravenous and subcutaneous) and STORAGE INFORMATION: Day: supplemental heat support after surgery were the most common Store at or below 25 °C (77 °F). Excursions permitted to 30 °C concurrent treatments and were used similarly in both groups. (86 °F). Adverse Reaction* Day 0 Day 1 Day 2 Day 3 Day 4 TARGET ANIMAL SAFETY: HOW SUPPLIED: Twelve Day Target Animal Safety Study: In a 12-day ZORBIUM is available in applicator tubes that deliver a dose Hypothermia 106 (93.8%) 2 (1.8%) 2 (1.8%) 2 (1.8%) 2 (1.8%) laboratory study, ZORBIUM was administered to 32 healthy volume of 0.4 mL or 1 mL (20 mg/mL buprenorphine) in Hyperthermia 75 (66.4%) 32 (28.3%) 18 (15.9%) 14 (12.4%) 7 (6.2%) four-month-old domestic cats (8 cats per group) at 0 mg/kg multi-packs of 10 tubes. Sedation 64 (56.6%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) (vehicle control), 6.7 mg/kg (1X), 13.3 mg/kg (2X), and 20 mg/kg Tachypnea 51 (45.1%) 5 (4.4%) 2 (1.8%) 3 (2.7%) 4 (3.5%) (3X) as a topical application to the dorsal cervical area every 4 Approved by FDA under NADA # 141-547 days for a total of 3 doses. Dose-independent euphoria, mild Hypotension 42 (37.2%) 2 (1.8%) 1 (0.9%) 4 (3.5%) 2 (1.8%) dysphoria, and mydriasis were observed after ZORBIUM Manufactured for: Hypertension 28 (24.8%) 2 (1.8%) 1 (0.9%) 1 (0.9%) 1 (0.9%) administration. Maximum scores (for euphoria, dysphoria, and Elanco US Inc. Anorexia 25 (22.1%) 3 (2.7%) 1 (0.9%) 0 (0.0%) 0 (0.0%) mydriasis) in the ZORBIUM groups reached 3 (mildly dysphoric) Greenfield, IN 46140 USA Bradycardia 24 (21.2%) 3 (2.7%) 2 (1.8%) 3 (2.7%) 5 (4.4%) between 1 – 2 hours after the first dose. On the other 2 dosing ZORBIUM, Elanco and the diagonal bar logo are trademarks of Tachycardia 24 (21.2%) 4 (3.5%) 0 (0.0%) 1 (0.9%) 1 (0.9%) days (Days 4 and 8), maximum scores were 2 (euphoric). Elanco or its a liates. Dysphoria 20 (17.7%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Euphoria in some cats persisted from 36 to 72 hours. © 2021 Elanco or its a liates Bradypnea 8 (7.1%) 2 (1.8%) 0 (0.0%) 0 (0.0%) 1 (0.9%) On dosing day 1, mydriasis was observed in approximately half Rev. Date 02/2022 Hyperactivity 1 (0.9%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 1 (0.9%) the cats administered ZORBIUM by 24 hours after dosing (peaked in all ZORBIUM groups at 8 hours) and was not *Physiological adverse reactions were defined as any single observed between 48 – 93 hours. After the day 8 dose (third excursion outside the normal range following anesthetic dose), it was rarely observed (1 cat in 1X group; 2 cats in 3X at recovery (sternal recumbency) through 96 hours 48 hours; 1 cat in 2X at 72 hours). postoperatively. Cats administered ZORBIUM had higher body temperatures compared to the vehicle control group throughout the study. CONTACT INFORMATION: Following the initial dose, the mean temperatures in cats To report suspected adverse events, for technical assistance, or administered ZORBIUM increased above normal and were up to to obtain a copy of the Safety Data Sheet (SDS), contact Elanco 1.8 ºF greater than the vehicle control group. Increased body US Inc. at 1-888-545-5973. temperature primarily occurred during the first 8 hours after the For additional information about reporting adverse drug initial dose and was observed in the majority of cats experience for animal drugs, contact FDA at 1-888-FDA-VETS or administered ZORBIUM. Elevated temperatures ranged from http://www.fda.gov/reportanimalae. 102.6 °F to 104.5 °F. The highest temperatures occurred at 2 EFFECTIVENESS: hours after the first dose, gradually decreasing by 24 hours. By The e ectiveness of ZORBIUM was demonstrated in cats that 3 days after dose administration, body temperatures in cats underwent elective reproductive sterilization in conjunction with administered ZORBIUM had returned to levels observed in the forelimb onychectomy surgery in a randomized, multi-centered, vehicle control group. After the second and third doses (days 4 double-masked, vehicle-controlled, field study across 12 and 8), mean temperatures in all ZORBIUM groups were again investigative sites. Enrolled cats were between 4 months to 5 higher than in the vehicle control group, but not higher than the years of age and weighed 2.5 to 12.5 pounds (1.1 – 5.7 kg). normal reference range. Cats in the ZORBIUM group received a single dose of 8 mg or 20 Constipation was recorded for 20 cats (1 vehicle control; 3 in 1X; mg of buprenorphine according to body weight (see DOSAGE 4 in 2X; 6 in 3X groups) after the first dose. The constipation was AND ADMINISTRATION). Cats in the vehicle control group mild and transient. Three cats (2 in the 1X group and 1 in the 3X received a transdermal solution of 50 mg/mL padimate O in group) were administered a laxative. ZORBIUM had no clinically ethanol. The dose was administered topically onto the dorsal significant e ects on heart rate or respiratory rate. There were cervical skin 1 – 2 hours prior to anesthetic induction for no clinically relevant changes to serum chemistry, hematology, surgery. For intraoperative analgesia, all cats in the study or urinalysis outcomes. Histopathology evaluations revealed 3re0ceimveindutaessinpgrlieorinttroamaunsecsuthlaertiicnjeicntdiounctioofn,ananadlphaa2-a4g-pooniinstt mild inflammation of skin at the application site. Seven Day Target Animal Safety Study: In a 7-day laboratory metacarpal ring block with lidocaine after induction. The study, ZORBIUM was administered once topically to the dorsal adequacy of pain control was scored through 96 hours after cervical area of 24 healthy adult domestic cats (6 cats/group) at surgery. If pain control was considered inadequate at any time 0 mg/kg (0X; vehicle control), 3.3 (0.5X), 10 (1.5X), or 30 mg/kg following treatment, rescue analgesia was provided (4.5X the maximal dose of 6.7 mg/kg). Cats were observed for 7 immediately. Treatment success was defined as a cat that did days after the single dose. Clinical results were similar to the not require rescue analgesia, need opioid reversal, or experience 12-day margin of safety study, even at the higher dose of 30 an adverse event suspected to be related to treatment through mg/kg, except for transient increases in heart rate in the the entire 96-hour post-recovery period. A cat was considered a ZORBIUM groups compared to the vehicle control group. Mean treatment failure if it had inadequate pain control, required heart rates in ZORBIUM groups were higher than in the vehicle opioid reversal, or experienced an adverse event suspected to control group from 2 hours through approximately 48 hours after be related to treatment. dose administration. Tachycardia (>240 beats per minute) A total of 19 ZORBIUM and 63 vehicle control cats were removed occurred in two cats in the 0.5X group and two cats in the 4.5X from the study due to inadequate pain control. Most of these group for at least one timepoint after dose administration. The failures occurred on the day of surgery in both groups; however, highest heart rate was 260 (in the 0.5X group) and no dose there were 4 ZORBIUM group cats and 5 vehicle control cats relationship was evident. Dose-independent euphoria, mild removed due to inadequate pain control between 1 and 3 days dysphoria, and mydriasis were noted in the ZORBIUM groups. after surgery. Mild constipation and/or abdominal distension were observed E ectiveness was evaluated in 219 cats (112 in the ZORBIUM with ZORBIUM administration. Transient increases in plasma group and 107 cats in the vehicle control group), and field safety chloride and sodium concentrations in the ZORBIUM groups was evaluated in 222 cats (113 cats in the ZORBIUM group and compared to vehicle control group indicated mild dehydration. 109 cats in the vehicle control group). Of the 112 cats in the Cardiovascular Safety Study: In a 12-day cardiovascular ZORBIUM group, 89 were treatment successes; of the 107 laboratory safety study, ZORBIUM was administered to 8 healthy vehicle control cats, 42 were treatment successes. Comparison adult cats (4 cats per group) at 0 mg/kg (vehicle control) and 6.7 of the ZORBIUM group and the vehicle control group mg/kg (1X) as a topical application to the dorsal cervical region demonstrated a statistically significant di erence in the every 4 days for a total of 3 doses. Continuous, direct treatment success rates (p = 0.0003). physiological monitoring (telemetry) was conducted from 2 Hypothermia was common in both groups during surgery. The hours prior to the first dose through 4 days following the third overall mean postoperative body temperature was higher in the (final) dose. Body temperature increases averaged <0.4 ºF in ZORBIUM group than in the vehicle control group. Mean ZORBIUM group cats over vehicle control cats. In the vehicle postoperative body temperatures in the ZORBIUM group were control group, 102.6 °F was the maximum temperature, above the normal range at 4 and 8 hours postoperatively observed at 93 hours after the first dose. In the ZORBIUM group, (mean±SD of 102.7°±1.2 °F and 102.6°±1.0 °F, respectively 103.4 °F was the maximum temperature, observed at 20 hours [normal range: 100.5 – 102.5 °F]). Mean indirect arterial blood after the first dose. Heart rate (HR) increased an average of 15.2 pressure (MAP) was similar between the 2 treatment groups beats/minute in the ZORBIUM group cats compared to vehicle over time. Urination, defecation, appetite, and daily body weights control cats. The maximum heart rate in the ZORBIUM group after surgery were not a ected by ZORBIUM administration. reached 231 beats/minute. In the vehicle control group, the Fifteen cats in the ZORBIUM group had an increased fibrinogen maximum heart rate was 219 beats/minute. Blood pressure at discharge, compared to 2 cats in the vehicle control group. (arterial systolic, diastolic, and mean) in the ZORBIUM group cats was not significantly di erent from the vehicle control cats. There were no clinically significant e ects of ZORBIUM on qualitative electrocardiogram results. PA102712X W1b

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Caution: Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. infect humans and cause serious disease (alveolar hydatid disease and hydatid disease, respectively). Owners Description: SENTINEL® SPECTRUM® Chews are available in four strengths in color-coded packages for of dogs living in areas where E. multilocularis or E. granulosus are endemic should be instructed on how oral administration to dogs and puppies according to their weight. Each chewable flavored tablet is formulated to minimize their risk of exposure to these parasites, as well as their dog’s risk of exposure. Although to provide a minimum of 0.23 mg/pound (0.5mg/kg) of milbemycin oxime, 4.55 mg/pound (10mg/kg) of SENTINEL SPECTRUM Chews were 100% effective in laboratory studies in dogs against E. multilocularis and lufenuron, and 2.28 mg/pound (5mg/kg) of praziquantel. E. granulosus, no studies have been conducted to show that the use of this product will decrease the incidence Milbemycin oxime consists of the oxime derivatives of 5-didehydromilbemycins in the ratio of approximately of alveolar hydatid disease or hydatid disease in humans. Because the prepatent period for E. multilocularis may 8m0a%croAc4y(cCli3c2Han45tNheOl7m, iMntWic.555.71) and 20% A3 (C31H43NO7, MW 541.68). Milbemycin oxime is classified as a be as short as 26 days, dogs treated at the labeled monthly intervals may become reinfected and shed Lufenuron is a benzoylphenylurea derivative with the following chemical composition: N-[2,5-dichloro-4- eggs between treatments. B(1e,n1z,2o,y3l,p3h,3en,-yhleuxreaaflucoormopprooupnodxsy,)i-npchleundyinl-gamluifnenoucarorbno, nayrel]-c2la,6ss-difiifelduoarsobinesnezcatmdiedveel(oCp17mHe8nCtI2iFn8hNib2Oito3,rMs (WID5Is1)1. .15). Effectiveness Praziquantel is an isoquinolone anthelmintic with the chemical name 2-(Cyclohexylcarbonyl)-1,2,3,6,7,-11b- Heartworm Prevention: In a well-controlled laboratory study, SENTINEL SPECTRUM Chews (milbemycin hexahydro-4H-pyrazino[2,1-a]isoquinolin-4-one. oxime, lufenuron, praziquantel) were 100% effective against induced heartworm infections when administered Indications: SENTINEL SPECTRUM Chews are indicated for the prevention of heartworm disease caused by once monthly for 6 consecutive months. In well-controlled laboratory studies, neither one dose nor two Dirofilaria immitis; for the prevention and control of flea populations (Ctenocephalides felis); and for the treatment consecutive doses of SENTINEL SPECTRUM Chews provided 100% effectiveness against induced heartworm and control of adult roundworm (Toxocara canis, Toxascaris leonina), adult hookworm (Ancylostoma caninum), infections. adult whipworm (Trichuris vulpis), and adult tapeworm (Dipylidium caninum, Taenia pisiformis, Echinococcus Intestinal Nematodes and Cestodes Treatment and Control: Elimination of the adult stage of hookworm multilocularis and Echinococcus granulosus) infections in dogs and puppies two pounds of body weight or (Ancylostoma caninum), roundworm (Toxacara canis, Toxascaris leonina), whipworm (Trichuris vulpis) and greater and six weeks of age and older. tapeworm (Dipylidium caninum, Echinococcus multilocularis, Echinococcus granulosus, Taenia pisiformis) Dosage and Administration: SENTINEL SPECTRUM Chews should be administerd orally, once every infections in dogs was demonstrated in well-controlled laboratory studies. month, at the minimum dosage of 0.23 mg/lb (0.5 mg/kg) milbemycin oxime, 4.55 mg/lb (10 mg/kg) Flea Prevention and Control: In well-controlled studies, SENTINEL SPECTRUM Chews were effective lufenuron, and 2.28 mg/lb (5 mg/kg) praziquantel. For heartworm prevention, give once monthly for at least in preventing flea eggs from hatching, thus providing control of the development of flea populations 6 months after exposure to mosquitoes (see EFFECTIVENESS). (Ctenocephalides felis). Palatability: In a field study of 117 dogs offered SENTINEL SPECTRUM Chews, 113 dogs (96.6%) accepted Dosage Schedule the product when offered from the hand as if a treat, 2 dogs (1.7%) accepted it from the bowl with food, 1 dog (0.9%) accepted it when it was placed in the dog’s mouth, and 1 dog (0.9%) refused it. Body Milbemycin Lufenuron Praziquantel Number of Animal Safety: In a margin of safety study, 40 ten-week-old puppies (10 per group) were administered either Weight Oxime per per per chewables a sham dose (0X) or doses of 1, 3, or 5X the maximum exposure dose of SENTINEL SPECTRUM Chews once chewable every two weeks for a total of seven treatments. Transient ataxia, lethargy, tremors, and salivation were seen in chewable chewable the 3X and 5X groups following each of the seven doses. Lethargy and ataxia were occasionally reported in sham-dosed (0X) and 1X dogs. Tremors were observed twice post-treatment in the 1X treatment group. 2 to 8 lbs. 2.3 mg 46 mg 22.8 mg One Vomiting was seen in all treatment groups but at a higher incidence in the 3X and 5X groups. At the 5X dose, shallow breathing was noted in two dogs and one dog was unable to stand following two different doses. All 8.1 to 25 lbs. 5.75 mg 115 mg 57 mg One clinical signs resolved within 24 hours. In a second margin of safety study, 64 six-week-old puppies (16 per group) were dosed with either a sham (0X) 25.1 to 50 lbs. 11.5 mg 230 mg 114 mg One or 1, 3, or 5X the maximum exposure dose of SENTINEL SPECTRUM Chews on days 1, 15, 29, and 43. A dose dependent increase in ataxia, decreased activity, tremors, and salivation was seen within 24 hours of treatment. 50.1 to 100 lbs. 23.0 mg 460 mg 228 mg One Splayed hind limbs were observed once in one dog in the 5X treatment group. Vomiting was observed in the 5X treatment group. Over 100 lbs. Administer the appropriate combination of chewables For SENTINEL SPECTRUM Chews, the maximum exposure based on product dosing is 2.5 mg/kg for milbemycin oxime, 50.7 mg/kg for lufenuron and 25.1 mg/kg for praziquantel, which is higher than the To ensure adequate absorption, always administer SENTINEL SPECTRUM Chews to dogs immediately after or minimum effective dose used in the safety studies for milbemycin oxime and lufenuron (see below). in conjunction with a normal meal. Milbemycin Oxime: Two studies were conducted in heartworm-infected dogs treated with milbemycin SENTINEL SPECTRUM Chews may be offered to the dog by hand or added to a small amount of dog food. oxime. Mild, transient hypersensitivity reactions were observed in dogs with high microfilariae counts The chewables should be administered in a manner that encourages the dog to chew, rather than to swallow (see PRECAUTIONS). without chewing. Chewables may be broken into pieces and fed to dogs that normally swallow treats whole. Safety studies in pregnant dogs demonstrated that doses of 0.6X the maximum exposure dose of SENTINEL Care should be taken that the dog consumes the complete dose, and treated animals should be observed a few SPECTRUM Chews, (1.5 mg/kg of milbemycin oxime), administered daily from mating through weaning, minutes after administration to ensure that no part of the dose is lost or rejected. If it is suspected that any of resulted in measurable concentrations of milbemycin oxime in milk. Puppies nursing these females the dose has been lost, redosing is recommended. demonstrated milbemycin oxime-related effects (depression, decreased activity, diarrhea, dehydration, nasal Heartworm Prevention: SENTINEL SPECTRUM Chews should be administered at monthly intervals discharge). A subsequent study, which evaluated the daily administration of 0.6X the maximum exposure dose beginning within one month of the dog’s first seasonal exposure to mosquitoes and continuing until at least of SENTINEL SPECTRUM Chews, from mating until one week before weaning, demonstrated no effects on the 6 months after the dog’s last seasonal exposure (see EFFECTIVENESS). SENTINEL SPECTRUM Chews may pregnant females or their litters. A study, in which pregnant females were dosed once, at 0.6X maximum be administered year-round without interruption. When switching from another heartworm preventative product exposure dose of SENTINEL SPECTRUM Chews before, on the day of, or shortly after whelping, resulted in to SENTINEL SPECTRUM Chews, the first dose of SENTINEL SPECTRUM Chews should be given within a no effects on the puppies. month of the last dose of the former product. Some nursing puppies, at 2, 4, and 6 weeks of age, administered oral doses of 9.6 mg/kg milbemycin oxime Flea Treatment and Prevention: Treatment with SENTINEL SPECTRUM Chews may begin at any time of the (3.8X the maximum exposure dose of SENTINEL SPECTRUM Chews) exhibited tremors, vocalization, and year, preferably starting one month before fleas become active and continuing monthly through the end of flea ataxia. These effects were all transient and puppies returned to normal within 24 to 48 hours. No effects were season. In areas where fleas are common year-round, monthly treatment with SENTINEL SPECTRUM Chews observed in puppies administered 0.5 mg/kg milbemycin oxime (minimum label dose). should continue the entire year without interruption. A rising-dose safety study conducted in rough-coated Collies resulted in ataxia, pyrexia, and periodic To minimize the likelihood of flea reinfestation, it is important to treat all animals within a household with an recumbency in one of fourteen dogs administered milbemycin oxime at 12.5 mg/kg (5X the maximum exposure approved flea protection product, as necessary. dose of SENTINEL SPECTRUM Chews). Prior to receiving the 12.5 mg/kg dose on day 56 of the study, all Intestinal Nematode and Cestode Treatment and Control: Dogs may be exposed to and can become animals had undergone a dosing regimen consisting of 2.5 mg/kg milbemycin oxime on day 0, followed by infected with roundworms, whipworms, hookworms, and tapeworms throughout the year, regardless of season 5.0 mg/kg on day 14, and 10.0 mg/kg on day 32. No adverse reactions were observed in any of the Collies or climate. Clients should be advised of appropriate measures to prevent reinfection of their dog with intestinal treated with doses less than 12.5 mg/kg. parasites. Because the prepatent period for E. multilocularis may be as short as 26 days, dogs treated at the Lufenuron: In a ten-month study, doses of lufenuron up to 2X the maximum exposure dose of SENTINEL labeled monthly intervals may become reinfected and shed eggs between treatments. SPECTRUM Chews (10 mg/kg) caused no overt toxicity. A single dose of 200 mg/kg had no marked effect on Contraindications: There are no known contraindications to the use of SENTINEL SPECTRUM Chews. adult dogs, but caused decreased activity and reduced appetite in eight-week-old puppies. Lufenuron tablets Warnings: Not for use in humans. Keep this and all drugs out of the reach of children. were evaluated with concurrent administration of flea adulticides containing carbaryl, permethrin, chlorpyriphos, Precautions: Treatment with fewer than 6 monthly doses after the last exposure to mosquitoes may not and cythioate. No toxicty resulted from these combinations. Lufenuron tablets did not cause cholinesterase provide complete heartworm prevention (see EFFECTIVENESS). inhibition nor did they enhance cholinesterase inhibition caused by exposure to organophoshphates. Prior to administration of SENTINEL SPECTRUM Chews, dogs should be tested for existing heartworm Two laboratory and two well-controlled field studies were conducted to evaluate reproductive safety of lufenuron infections. At the discretion of the veterinarian, infected dogs should be treated to remove adult heartworms. tablets in breeding dogs. In one of the laboratory studies, in which lufenuron was administered to Beagle dogs SENTINEL SPECTRUM Chews are not effective against adult D. immitis. as three divided doses, equivalent to 17.8X the maximum exposure dose of SENTINEL SPECTRUM Chews Mild, transient hypersensitivity reactions, such as labored breathing, vomiting, hypersalivation, and lethargy (10 mg/kg), the ratio of gravid females to females mated was 8/8 or 100% in the control group and 6/9 or 67% have been noted in some dogs treated with milbemycin oxime carrying a high number of circulating in the lufenuron-treated group. The mean number of pups per litter was two animals higher in the lufenuron microfilariae. These reactions are presumably caused by release of protein from dead or dying microfilariae. versus control groups and mean birth weights of pups from treated females in this study was lower than control Do not use in puppies less than six weeks of age. groups. These pups grew at a similar rate to the control pups. The incidence of nasal discharge, pulmonary Do not use in dogs or puppies less than two pounds of body weight. congestion, diarrhea/dehydration, and sluggishness was higher in the lufenuron-treated pup group than in the The safety of SENTINEL® SPECTRUM® Chews has not been evaluated in dogs used for breeding or in lactating control pup group. The incidence of these signs was transient and decreasing by the end of lactation. females. Studies have been performed with milbemycin oxime and lufenuron alone (see ANIMAL SAFETY). Results from three additional reproductive safety studies, one laboratory and two field studies, evaluating eleven Adverse Reactions: The following adverse reactions have been reported in dogs after administration of breeds of dogs, did not demonstrate any adverse findings for the reproductive parameters measured, including milbemycin oxime, lufenuron, or praziquantel: vomiting, depression/lethargy, pruritus, urticaria, diarrhea, fertility, pup birth weights, and pup clinical signs, after administration of lufenuron up to 1X the maximum anorexia, skin congestion, ataxia, convulsions, salivation, and weakness. exposure dose of SENTINEL SPECTRUM Chews. The average milk: blood concentration ratio was approximately To report suspected adverse drug events, contact Merck Animal Health at 1-800-224-5381. For additional 60 (i.e. 60X higher drug concentrations in the milk compared to drug levels in the blood of treated females). information about adverse drug experience reporting for animal drugs, contact FDA at 1-888-FDA-VETS Nursing puppies averaged 8-9 times higher blood concentrations of lufenuron compared to their dams. or http://www.fda.gov/reportanimalae. Storage Information: Store in a dry place at controlled room temperature, between 59° and 77°F (15-25°C). For technical assistance, call Merck Animal Health at 1-800-224-5318. How Supplied: SENTINEL SPECTRUM Chews are available in four strengths, formulated according to the Information for Owner or Person Treating Animal: Echinococcus multilocularis and Echinococcus weight of the dog. Each strength is available in color-coded packages of six chewable tablets each. granulosus are tapeworms found in wild canids and domestic dogs. E. multilocularis and E. granulosus can Manufactured for: Intervet Inc (d/b/a Merck Animal Health) 2 Giralda Farms Madison, NJ 07940 Approved by FDA under NADA # 141-333 © 2018, 2020 Intervet Inc., a subsidiary of Merck and Co., Inc. All Rights Reserved. Rev. 07/20 302219 - 04

A SPECTRUM OF PROTECTION AGAINST UNSEEN* PARASITES Heartworms Hookworms†RoundwormsWhipworms TapewoImrmmsature Fleas‡ SENTINEL® BRAND PRODUCTS DELIVERS COMPREHENSIVE COVERAGE AGAINST UNSEEN PARASITES. SENTINEL Brand Products offers comprehensive protection against heartworm disease and intestinal parasites plus an added layer of protection against immature flea life stages.1,2 To order SENTINEL Brand Products for your clinic, please contact your Merck Animal Health sales representative. IMPORTANT SAFETY INFORMATION: SENTINEL® SPECTRUM® Chews (milbemycin oxime/lufenuron/praziquantel). Dogs should be tested for heartworm prior to use. Mild hypersensitivity reactions have been noted in some dogs carrying a high number of circulating microfilariae. Treatment with fewer than 6 monthly doses after the last exposure to mosquitoes may not provide complete heartworm prevention. Please see full product information on page 24. SENTINEL® FLAVOR TABS® (milbemycin oxime/lufenuron). Dogs should be tested for heartworm prior to use. In a small percentage of treated dogs, digestive, neurologic, and skin side effects may occur. Please see full product information on page 28 & 30. *SENTINEL SPECTRUM Chews protects against heartworm disease, 4 types of intestinal parasites, and prevents flea eggs from hatching. SENTINEL FLAVOR TABS protects against heartworm disease, 3 types of intestinal parasites, and prevents flea eggs from hatching. †A. caninum. ‡Prevents flea eggs from hatching. References: 1. SENTINEL® SPECTRUM® Chews [product label]. Madison, NJ: Intervet, Inc.; 2020. 2. SENTINEL® FLAVOR TABS® [product label]. Madison, NJ: Intervet, Inc.; 2020. Copyright © 2021 Intervet Inc., d/b/a Merck Animal Health, a subsidiary of Merck & Co., Inc. All rights reserved. US-SEN-210900003 500550

302238-02 - 51743080 The palatable once-a-month prescription tablet that prevents heartworm disease and flea populations in dogs and Some nursing puppies, at 2, 4, and 6 weeks of age, given greatly exaggerated oral doses of milbemycin oxime puppies. SENTINEL® FLAVOR TABS® (milbemycin oxime/lufenuron) also control flea populations and adult (9.6 mg/kg = 19X) exhibited signs typified by tremors, vocalization and ataxia. These effects were all transient and hookworms, and remove and control adult roundworm and whipworm infections in dogs and puppies. puppies returned to normal within 24 to 48 hours. No effects were observed in puppies given the recommended dose Caution of milbemycin oxime (0.5 mg/kg). This product has not been tested in dogs less than 2.2 pounds in body weight. Federal (USA) law restricts this drug to use by or on the order of a licensed veterinarian. A rising-dose safety study conducted in rough-coated collies manifested a clinical reaction consisting of ataxia, Warnings pyrexia and periodic recumbency in one of fourteen dogs treated with milbemycin oxime at 12.5 mg/kg (25X Not for human use. Keep this and all drugs out of the reach of children. monthly use rate). Prior to receiving the 12.5 mg/kg dose (25X monthly use rate) on day 56 of the study, all Description animals had undergone an exaggerated dosing regimen consisting of 2.5 mg/kg milbemycin oxime (5X monthly SENTINEL FLAVOR TABS are available in four tablet sizes in color-coded packages for oral administration to dogs use rate) on day 0, followed by 5.0 mg/kg (10X monthly use rate) on day 14 and 10.0 mg/kg (20X monthly use and puppies according to their weight. (See Dosage Section). Each tablet is formulated to provide a minimum of rate) on day 32. No adverse reactions were observed in any of the collies treated with this regimen up through 0.23 mg/pound (0.5 mg/kg) of milbemycin oxime and 4.55 mg/pound (10 mg/kg) body weight of lufenuron. the 10.0 mg/kg (20X monthly use rate) dose. Milbemycin oxime consists of the oxime derivatives of 5-didehydromilbemycins in the ratio of approximately Safety: Lufenuron m80a%croAc4y(cCli3c2Ha4n5tNhOel7m, MinWtic.555.71) and 20% A3 (C31H43NO7, MW 541.68). Milbemycin oxime is classified as a Lufenuron tablets have been used and tested safely in over forty breeds of dogs, including pregnant females, Lufenuron is a benzoylphenylurea derivative with the following chemical composition: N-[2,5-dichloro-4- breeding males and puppies over six weeks of age. In well-controlled clinical trials, 151 dogs completed (B1e,n1z,2o,y3l,p3h,3en,-yhleuxreaaflucoormopprooupnodxsy,)i-npchleundyinlagmluinfeoncuarrobno,nayrl]e-2c,l6as-dsiififleudoraos-binesnezcatmdiedveel(oCp1m7He8nCt li2nFh8Nib2iOto3r,sM(IWDI5s)1.1.15). treatment with lufenuron tablets. Lufenuron tablets were used safely in animals receiving frequently used Mode of Action veterinary products such as vaccines, anthelmintics, antibiotics and steroids. In a ten-month study, doses up to Milbemycin oxime, one active ingredient in SENTINEL FLAVOR TABS, is a macrocyclic anthelmintic which is 10X the recommended dose rate of 10 mg/kg caused no overt toxicity. A single dose of 200 mg/kg (20X the believed to act by interfering with invertebrate neurotransmission. Milbemycin oxime eliminates the tissue stage recommended dose rate) had no marked effect on adult dogs, but caused decreased activity and appetite in eight of heartworm larvae and the adult stage of hookworm (Ancylostoma caninum), roundworm (Toxocara canis and week old puppies. Mean body weights of male and female puppies were higher in treated versus control group at Toxascaris leonina) and whipworm (Trichuris vulpis) infestations when administered orally according to the the end of the study. In specifically designed target animal safety studies, lufenuron tablets were tested with recommended dosage schedule. concurrent administration of flea adulticides containing carbaryl, permethrin, chlorpyriphos and cythioate. No Lufenuron, the other active ingredient in SENTINEL FLAVOR TABS, is an insect development inhibitor which toxicity resulted from these combinations. Lufenuron tablets did not cause cholinesterase inhibition nor did they breaks the flea life cycle by inhibiting egg development. Lufenuron’s mode of action is interference with chitin enhance cholinesterase inhibition caused by exposure to organophosphates. synthesis, polymerization and deposition. Lufenuron has no effect on the adult flea. After biting a lufenuron- Four reproductive safety studies were conducted in breeding dogs with lufenuron tablets: two laboratory and two treated dog, the female flea ingests a blood meal containing lufenuron which is subsequently deposited in her well-controlled clinical studies. In one of the laboratory studies, where lufenuron was administered to beagle dogs eggs. Lufenuron prevents most flea eggs from hatching or maturing into adults and thus prevents and controls at doses equivalent to 90X (3X daily) the monthly recommended dose of 10 mg/kg, the ratio of gravid females to flea populations by breaking the life cycle. (See Efficacy). females mated was 8/8 or 100% in the control group and 6/9 or 67% in the lufenuron-treated group. The mean Indications number of pups per litter was two animals higher in the treated versus control groups and the mean birth weights SENTINEL FLAVOR TABS are indicated for use in dogs and puppies, four weeks of age and older, and two pounds of pups from treated females in this study was lower than control groups. body weight or greater. SENTINEL FLAVOR TABS are also indicated for the prevention of heartworm disease These pups grew at a similar rate to control pups. There was a higher incidence of four clinical signs in the caused by Dirofilaria immitis, for the prevention and control of flea populations, the control of adult Ancylostoma lufenuron-treated versus control group: nasal discharge, pulmonary congestion, diarrhea/dehydration and caninum (hookworm), and the removal and control of adult Toxocara canis and Toxascaris leonina (roundworm) sluggishness. The incidence of these signs was transient and decreasing by the end of lactation. Results from three and Trichuris vulpis (whipworm) infections. additional reproductive safety studies, one laboratory and two clinical field studies evaluating eleven breeds of Lufenuron controls flea populations by preventing the development of flea eggs and does not kill adult fleas. dogs, did not demonstrate any adverse findings for the reproductive parameters measured including fertility, pup Concurrent use of an adulticide product may be necessary for adequate control of adult fleas. birth weights and pup clinical signs after administration of lufenuron up to 5X the recommended monthly use rate. Without concurrent use of an adulticide, adequate flea control may not be achieved in dogs that Data from analysis of milk from lactating animals treated with lufenuron tablets at 2X and 6X the recommended have repeated exposure to flea infested animals or environments. monthly use rate demonstrates that lufenuron concentrates in the milk of these dogs. The average milk:blood Precautions concentration ratio was approximately 60 (i.e., 60X higher drug concentrations in the milk compared to drug Do not use in puppies less than four weeks of age and less than two pounds of body weight. Prior to levels in the blood of treated females). Nursing puppies averaged 8-9 times higher blood concentrations of administration of SENTINEL FLAVOR TABS, dogs should be tested for existing heartworm infections. Infected lufenuron compared to their dams. dogs should be treated to remove adult heartworms and microfilariae prior to initiating treatment with SENTINEL Dosage FLAVOR TABS. Mild, transient hypersensitivity reactions manifested as labored respiration, vomiting, salivation SENTINEL FLAVOR TABS are given orally, once a month, at the recommended minimum dosage of 0.23 mg/lb and lethargy have been noted in some treated dogs carrying a high number of circulating microfilariae. These (0.5 mg/kg) milbemycin oxime and 4.55 mg/lb (10mg/kg) lufenuron. Dogs over 100 lbs are provided the reactions are presumably caused by release of protein from dead or dying microfilariae. appropriate combination of tablets. SENTINEL FLAVOR TABS immediately break the flea life cycle by inhibiting egg development. However, Administration preexisting flea populations may continue to develop and emerge after treatment with SENTINEL FLAVOR TABS has begun. Based on results of clinical studies, this emergence generally occurs during the first 30-60 days. TO ENSURE ADEQUATE ABSORPTION, ALWAYS ADMINISTER SENTINEL FLAVOR TABS TO DOGS Therefore, noticeable control may not be observed until several weeks after dosing when a preexisting infestation IMMEDIATELY AFTER OR IN CONJUNCTION WITH A NORMAL MEAL. is present. Cooler geographic areas may have longer lag periods due to a prolonged flea life cycle. The concurrent use of an approved adulticide may be employed depending on the severity of the infestation. SENTINEL FLAVOR TABS are palatable Recommended Dosage Schedule If a SENTINEL FLAVOR TABS-treated dog comes in contact with a flea-infested environment, adult fleas may infest and most dogs will consume the tablet the treated animal. These adult fleas are unable to produce viable offspring. The temporary use of an adulticide when offered by the owner. As an Body Weight Milbemycin Oxime Lufenuron product may be necessary to kill these adult fleas. alternative to direct dosing, the tablets Per Tablet Per Tablet Efficacy: Milbemycin Oxime can be hidden in food. Be certain the dog Milbemycin oxime provided complete protection against heartworm infection in both controlled laboratory consumes the entire tablet or tablets. 2 to 10 lbs. 2.3 mg 46 mg and clinical trials. In laboratory studies, a single dose of milbemycin oxime at 0.5 mg/kg was effective in removing roundworms, Administer SENTINEL FLAVOR TABS to 11 to 25 lbs. 5.75 mg 115 mg hookworms and whipworms. In well-controlled clinical trials, milbemycin oxime was also effective in removing dogs immediately after or in conjunction roundworms and whipworms and in controlling hookworms. with a normal meal. Food is essential for Efficacy: Lufenuron adequate absorption of lufenuron. Watch 26 to 50 lbs. 11.5 mg 230 mg Lufenuron provided 99% control of flea egg development for 32 days following a single dose of lufenuron at 10 mg/kg in studies using experimental flea infestations. In well-controlled clinical trials, when treatment with the dog closely following administration 51 to 100 lbs. 23 mg 460 mg lufenuron tablets was initiated prior to the flea season, mean flea counts were lower on lufenuron-treated dogs to be sure the entire dose has been versus placebo-treated dogs. After 6 monthly treatments, the mean number of fleas on lufenuron-treated dogs consumed. If it is not entirely consumed, redose with the full recommended dose as soon as possible. was approximately 4 compared to 230 on placebo-treated dogs. When treatment was initiated during the flea season, lufenuron tablets were effective in controlling flea infestations SENTINEL FLAVOR TABS must be administered monthly, preferably on the same date each month. Treatment on dogs that completed the study. The mean flea count per lufenuron-treated dog was approximately 74 prior to with SENTINEL FLAVOR TABS may begin at any time of year. In geographic areas where mosquitoes and fleas treatment but had decreased to 4 after six monthly doses of lufenuron. A topical adulticide was used in the first are seasonal, the treatment schedule should begin one month prior to the expected onset and should continue eight weeks of the study to kill the pre-existing adult fleas. until the end of “mosquito and flea season.” In areas with year-round infestations, treatment should continue Safety: Milbemycin Oxime through the entire year without interruption. Milbemycin oxime has been tested safely in over 75 different breeds of dogs, including collies, pregnant females, breeding males and females, and puppies over two weeks of age. In well-controlled clinical field studies 786 dogs If a dose is missed and a 30-day interval between dosing is exceeded, administer SENTINEL FLAVOR TABS completed treatment with milbemycin oxime. Milbemycin oxime was used safely in animals receiving frequently immediately and resume the monthly dosing schedule. If SENTINEL FLAVOR TABS replace daily used veterinary products such as vaccines, anthelmintics, antibiotics, steroids, flea collars, shampoos and dips. diethylcarbamazine (DEC) for heartworm prevention, the first dose must be given within 30 days after Two studies in heartworm-infected dogs were conducted which demonstrated mild, transient hypersensitivity the last dose of DEC. reactions in treated dogs with high microfilaremia counts (see Precautions for reactions observed). Safety studies in pregnant dogs demonstrated that high doses (1.5 mg/kg = 3X) of milbemycin oxime given in an exaggerated Adverse Reactions dosing regimen (daily from mating through weaning), resulted in measurable concentrations of the drug in milk. The following adverse reactions have been reported in dogs after giving milbemycin oxime or lufenuron: Puppies nursing these females which received exaggerated dosing regimens demonstrated milbemycin-related vomiting, depression/lethargy, pruritus, urticaria, diarrhea, anorexia, skin congestion, ataxia, convulsions, effects. These effects were directly attributable to the exaggerated experimental dosing regimen. The product is hypersalivation, and weakness. normally intended for once-a-month administration only. Subsequent studies included using 3X daily from mating to one week before weaning and demonstrated no effects on the pregnant females or their litters. A second To report suspected adverse drug events, contact Merck Animal Health at 1-800-224-5318. For additional study where pregnant females were dosed once at 3X the monthly use rate either before, on the day of or shortly information about adverse drug experience reporting for animal drugs, contact FDA at 1-888-FDA-VETS or after whelping resulted in no effects on the puppies. www.fda.gov/reportanimalae. 355630 R4 How Supplied SENTINEL FLAVOR TABS are available in four tablet sizes (see Dosage section) formulated according to the weight of the dog. Each tablet size is available in color-coded packages of 6 or 12 tablets each, which are packaged 10 per display carton. Storage Conditions Store in a dry place at controlled room temperature, between 59° and 77°F (15-25°C). Questions? Comments? Please Call 1-800-224-5318 Visit our website at SentinelPet.com Manufactured for: Intervet Inc (d/b/a Merck Animal Health) 2 Giralda Farms Madison, NJ 07940 Approved by FDA under NADA # 141-084 © 2019, 2020 Intervet Inc., a subsidiary of Merck and Co., Inc. All Rights Reserved. Rev. 07/20

Q2 PPORROTMFOOLTIOION 2022 April–June 2022 Purchase any $2,500.00 combination of the following qualifying Dechra Products and receive a FREE* Dechra Solo Stove® Ranger • Dermatology • Porus® One • Zycortal® Suspension (desoxycorticosterone pivalate injectable suspension) • Osurnia® ( orfenicol, terbina ne, betamethasone acetate) • Surgical Suite Dexmedesed® (dexmedetomidine hydrochloride) Sterile Injectable Solution and Tzed™ (tiletamine and zolazepam for injection) • Systemic Anti-Infectives Cefpoderm® (cefpodoxime proxetil) Tablets are excluded For Veterinary Technical Support, Contact Dechra Veterinary Products at: (866) 933-2472, www.dechra-us.com, [email protected] * Unless otherwise indicated, all qualifying Dechra Veterinary Products must be purchased on a single invoice. Place your order with your distributor and reference the “2022 Second Quarter Promotion.” Dechra will ship promotional items. Dechra reserves the right to not supply promotional items unless a Veterinarian-Client-Patient Relationship (VCPR) can be clearly demonstrated. Promotional items are available only for qualifying orders while supplies last. Valid for US Veterinarians only. Offers valid April 1 – June 30, 2022. Dechra has the right to modify or cancel the terms of this promotion at any time upon written notice. Promotions will not be honored on back orders or out of stock items. Prices are subject to change without prior notice. Please allow 6-8 weeks for delivery of all promotional items. Due to circumstances associated with COVID, delivery may be delayed. For questions, please email [email protected]. To redeem all promotional items, products must be on a single invoice. Clinic will receive one Solo Stove® Ranger. The following orders qualify to receive Solo Stove® Ranger: a minimum purchase of $2,500.00 of qualifying Dechra products. Any additional incremental purchases of $2,500.00 of qualifying products on the same invoice, will receive an additional Solo Stove® Ranger. Five (5) Solo Stove® Rangers maximum. Please talk to your Dechra or Distributor Representative for details about qualifying products Dechra is a registered trademark of Dechra Pharmaceuticals PLC. © 2022, Dechra Ltd. Dechra Veterinary Products, 7015 College Blvd, Suite 525, Overland Park, KS 66211. Porus is a registered trademark of Porus GmbH. Solo Stove® is a registered trademark of Solo Brands DTC. All other trademarks are trademarks of Dechra Veterinary Products, LLC or its af liates. 00QP-DEC22061-0222

21467 Holyoke Avenue Lakeville, MN 55044 Family and employee owned since 1961. Follow us on BUSINESS HOURS Monday - Friday 7:30 a.m. - 5:30 p.m. PLACE AN ORDER: 1-800-MIDWEST (643-9378) EQUIPMENT TEAM 800-362-9226 • [email protected] MIDWEST ONLINE SUPPORT │ www.midwestvetsupply.com 866-770-7044 • [email protected] ONLINE STORES SUPPORT TEAM 844-654-6876 • [email protected] TTOOOOL OOFF TTHHEE CCOOOOLL MMOONNTTHH 2022 Annual Pet Parasite Forecasts The Companion Animal Parasite Council (CAPC) has released the 2022 forecasts for: Heartworm Lyme disease Ehrlichiosis Anaplasmosis This year's edition warns of worsening conditions in most areas. Use these maps to educate pet parents on the risks in your area and support your recommendations for year-round preventative. capcvet.org/articles/2022-forecasts/