Thursday, October 2, 2014

If You Are Understatnding

Today was bit frustrating, as many of our clients know we are a very busy practice.  I had today a client that was complaing about a 20 minute wait in an exam room as our doctors took care of more urgent cases, such as the kitten with maggots in its eyes that caused this paticular delay to give her pet shots.  Her time was way more important than any other thing that was going on in our office.  Dropping the pet off with us untill a doctor could get to it was not accetable to her.  What we do every day is a balancing act between who is the sickest.  We have a great dedicated Team of Veterinarians, and I am proud of each of them for the dedication they show to our clients and their pets.  

I created this Video to help people understand we aren't havign a party in the back, we are caring for pets in need. When waits are long we do our best to communicate with clients, we ask you do the same and be considerate of the pets that have our doctor’s attention.  They may need it more. These are very heart breaking emotional draining cases and the last thing we need to deal with is clients complaining about a silly 20 minute wait. 

Wednesday, October 1, 2014

It's Official 

See the Exciting News Below



For more information, contact: Amy Drittler, Director of Public Relations for Health Sciences
Office: 423-869-7108             Cell: 865-279-9426     E-mail:



Premier Vetcare 

Becomes Teaching Affiliate for

LMU-College of Veterinary Medicine

Harrogate, Tennessee, September 19, 2014 –Lincoln Memorial University-College of Veterinary Medicine (LMU-CVM) has announced that Premier Vetcare in Smyrna, Tennessee, has qualified to become a member partner of the LMU-CVM Community-Based Veterinary Teaching Hospital system.

Premier Vetcare now becomes one of an exclusive group of qualified clinical course sites in which LMU-CVM fourth-year veterinary students will spend rotations gaining supervised quality clinical experience. Community-based education allows for a mutually beneficial, collaborative partnership between the veterinary college and quality community veterinary professionals. Premier Vetcare met all facility, equipment, medical care and leadership standards necessary to join the Community-Based Veterinary Teaching Hospital system. 

“My staff and I are so humbled that our dedication to quality affordable veterinary care, and our desire to train and mentor veterinary students has been recognized by Lincoln Memorial University-College of Veterinary Medicine.  We are excited to help train the future of our profession, providing them the clinical experiences and mentoring to ensure they find success within the veterinary profession,”  said Dr. Michael Hatcher, Hospital Administrator and owner of Premier VetCare.    

 “Lincoln Memorial University-College of Veterinary Medicine is proud to enter into this partnership with Premier Vetcare and looks forward to many years working together to graduate confident, compassionate and competent new veterinarians,” said Dr. Glenn Hoffsis, dean of LMU-CVM.

You can learn more at

Lincoln Memorial University’s College of Veterinary Medicine is located on the LMU main campus in Harrogate, Tenn., with additional academic facilities in nearby Lee County, Va. LMU-CVM is an integral part of the University’s Division of Health Sciences and provides real-world, community-based education in a collaborative learning environment. For more information about LMU-CVM, call 1-800-325-0900, ext. 7150 or visit us online at

-          30 – 

Thursday, August 21, 2014

Human Pharmacist Are Not Veterinary Pharmasist

Have You Seen This?? - In surveys, 10% of veterinarians said outside pharmacies have filled pet prescriptions INCORRECTLY!!  With 99,720 veterinarians as reported by the AVMA 2013 market Research statistics, that is at least 9,000 medical mistakes by human pharmacists filling pet medications.  What we don't yet know, are the exact numbers each veterinarian that has seen this problem have had.  It is likely much more problematic than we know.

Click here for AVMA Article
But the pet owner says, we (in the veterinary industry) only care about the money we get from selling pharmaceuticals.  Yes, the revenue generated by pharmacy sales does help to provide some financial resources to run and maintain our hospital and pay our staff.  My office exam is $43.00 for a sick pet.  Let's compare that to my child's doctor appoint for an illness not too long ago.  He bills the the insurance company $180.00.  Then, after insurance negotiated fees are applied I owe $125.00.  The  pharmaceuticals we sell through our in-house pharmacies do provide us revenue to help keep our exam fees low.  The human physician only has his exam time to produce revenue so his fees are higher, and understandably so.  So yes, revenue from pharmaceutical sells are one factor to keeping our offices operating, but more importantly, to maintain veterinary care as one of the best bargains in all medical services fields.

The truth is, though some hospitals rely too heavily on prescriptions and flea and tick products to maintain the financial health of their practice, most veterinarians are charging fair fees, and are as competitive as possible while still allowing us to keep our doors open to serve our clients.  However, large box store pharmacies have purchasing power that veterinary offices just cannot compete with.  As a practice owner, I would love to shed the hassle, expense, and frustrations of keeping an in-house pharmacy, but we simply can't.  

Human pharmacist are not veterinary pharmacist.  They receive little to no training on animal physiology, and the differences between human and pet dosing.  A continuing education course for a few hours will not provide them the resources to understand the pharmacological do's and don'ts that 4 years of veterinary school and use of the medications teaches veterinarians.  To ensure a pets safety, owners should seek absolutely no advice about pharmaceutical use from a pharmacist, rather only the veterinarian that prescribed the medication--the one that understands the safety and proper dosing of the medication.  The safety measures built into most pharmacy systems to identify safe drug dosing and interactions are built for people.  To my knowledge, I have not seen one pharmacy system that has built in safety alerts that are relevant to the use of medication in pets. Simply put, there are few pharmacists qualified to make alterations or substitutions to any prescription written by a veterinarian.  As a veterinarian, I ask pharmacists to refer questions back to us, and simply admit your ignorance and follow the directions on the RX slip.  If there are questions contact us to ensure the safety of our mutual patient.

So what is a veterinarian to do if he can not trust his patients medications will be filled as ordered?  We keep it in house.  We, as a profession, keep it close to ensure the safety of our patients.  To be sure the medications our pets need are readily available when they need it and not misused.  The next time you are upset that your veterinarian is making it hard to get a medication refill because they insist on an exam, recheck blood work, or whatever the case may be, the first thought should not be, "all they want is my money.". Veterinarians and our staff will tell you few of us are in this profession for is lucrative financial rewards.  Your first thought should be, "they are looking out for the safety and well-being of my pet...maybe there is a reason for the requested exam before refill of medications is approved."  Because that is likely the truth of the matter. 

I have seen what these mistakes can do, and it can be life threatening. Clients of our office enjoy the fact that we often do provide written scripts for human generics when appropriate and simple. There are a handful of medications we use daily that fall into that description, but we also always offer the owner a veterinary labeled drug if possible first.  Though if there are budget restraints, we are happy to provide a prescription for a cheaper human generic if appropriate.  In the summer of 2013, one of my associate veterinarians prescribed an antibiotic for a pet.  My vet knew the pet had already had allergic reactions to Cephalexin in the past, so he scripted a different class of antibiotics. A prescription was written to help the owners afford the medication.  The owner had the medication filled and the pharmacist substituted the script with Cephalexin.  The owner, unaware of the substitution, gave her pet the medication and the pet wound up spending several days in the emergency pet clinic for a severe allergic reaction to the medication. Complaints were made but not much was done to rectify the situation.   

My advise to pet owners considering filling medications by outside pharmacies follows:
  1. If your budget allows, fill you pets scripts with your veterinarian--with a veterinarian labeled medication. These are developed specifically for pets and their unique needs.  Plus, more often than not, labels are designed to make administration as easy as possible.  
  2. Avoid internet purchase of medications, unless offered through your veterinarian.  Online pet pharmacies have become big business.  They strip away billions of dollars out of the veterinary community that could be used to update facilities, pay staff better benefits and salaries, etc.  Don't be fooled!  They are in the business of making money too, and is it worth saving a few dollars to send your money to some large corporation out of state?  Buy local.  The benefits of buying local far outweigh the savings that you think you are getting. When online services are offered by your veterinarian, those are often a collaboration between your local veterinary office and one of their distributors.  With this model, the veterinarian has more access and control to ensure the safety of your pet.  These services can be very convenient to owners, and allows us to reduce overhead by keeping pharmacy stock to only what is needed.  With this collaboration, instead of the hospital ordering and shipping the medication to their office to have you come by and pick up later, the order is drop shipped to the owner on behalf of the veterinary hospital.  This keeps middle men, grey markets, and possible expired or unsafe medications out of the loop.  Then, the revenue generated can be used by your pets veterinary hospital to help support its operations.  In our office that revenue is not much, but its is ear marked for new equipment purchases so that we can offer more services to our clients, improve the level of care we can provide.
  3. If you must get medications from outside your veterinarians office, shop local. It is easier to complain face to face to get an issue resolved than through the internet or a phone call.  If possible, consider using a small local pharmacy over a large retail pharmacy.  
  4. Make sure you know what the medications cost at your vets office before you shop around.  Don't assume your vets office is more expensive.  We find that our pricing is very competitive, usually within a few dollars.  Is the time running all over town and waiting hours for a prescription to be filled or making an online order and waiting days to get it shipped worth a few dollars savings?
  5. Be sure to note what the prescription was written for, how much, and instructions before leaving it with the pharmacist, then compare that to what is filled.  In our office, we print that information on the invoice so  the clients can be assured the medication filled is exactly as we prescribed.
  6. If there are any questions, ask your veterinarian rather than your pharmacist, for those reasons listed above.
  7. Comply with recommended testing and exams. Veterinarians are required to have, by law, a doctor/client/patient relationship prior to prescriptions being authorized and filled. Veterinarians have certain legal and ethical responsibilities to ensure the pet needs the medications, safe and proper dosing are being used, and that the drug is being used for the proper pet. Examination of your pet is critical for us to honor our legal obligation to ensure a proper doctor/client/patient relationship. Beyond the safety concerns, with out examination of your pet we can not be sure that the pet is still in your position, and that medications are not being used for another pet or purpose.  Some medications require us to perform periodic blood testing to ensure they are being used safely, effectively, and not causing more harm than good.  Without those tests, we may have to decline a refill for concern that continued use could be causing harm to your pet.  
  8. Understand, we as a whole, are not trying to be complicated or greedy.  Most in this profession are focused on keeping your pets healthy and happy.      
The trend of owners having pet prescriptions filled by human pharmacies is here to stay, unless state veterinary boards start to address the issue of non trained personal dispensing pharmaceutics to pets. Until pharmacy schools begin training pharmacist for this new role in their jobs we all need to be diligent and watchful of the medications being given to our patients.  

Thursday, August 14, 2014

The Skinny On Pet Obesity

Following our first post, I asked what our fans to our Facebook page would like to hear about.  I got a few requests and we will get to them all over time, but thought one particular subject was more pressing, PET OBESITY.  With estimates as high as 70% of pets that fit this definition of malnutrition, it is truly one of the most common diseases we see in our profession.  Any given day, in any given exam room, there are two things I will likely need to discuss with owners, dental disease and/or obesity.  It's sad that one of the fewest compliments I can give my clients is how fit their pet is, and a pet with ideal body score becomes a subject to celebrate.

Just as in people, obesity in pets can be be associated with medical conditions such as diabetes, orthopedic conditions, and more.  With plenty of information on the risk of this form of malnutrition, and its effects on our pets circulating the internet, let us focus on a few key issues not so often mentioned.

Obesity Is a 100% Preventable Disease!!  There are few diseases we encounter that are 100% preventable, but we as pet owners create this disease.  For a multitude of reasons, we simply over feed our pets.  Those reasons can be broken down into three groups: owner guilt, a general lack of understanding, and then laziness.

Guilt plays one of the biggest roles in creating pet obesity.  Pet owners begin to feel guilty for any number of reasons, but most often it comes down to they believe they are not giving the pet the time and attention the owner thinks the pet deserves from them.  We equate how much we love our pet to some magical quantity of food.  The pet seems to enjoy the food, so we give it to them to fulfill our need to be sure the pet understands how much we care for them.  This guilt unfortunately leads to too many high caloric treats, us sharing our food, and over filling the food bowl, all key to creating an overweight pet as it takes in more calories than it burns, day after day after day.

A lack of understanding plays into this problem as well.  With so many recommendations hovering around, pet food and treat advertisements, and every so called "expert opinion," the voice of reason that many veterinarians try to give is often drowned out by all the noise.  I am always amazed at how many of my clients get their nutrition advice from the clerk at the pet store.  They will take the word of the 17 year old stocking the pet food aisle as "The Gospel of Pet Nutrition," and then I have to spend a good portion of my limited time with  clients debunking the myths and misinformation they received.  Even with my education and experience dealing with the issue, my advice often falls on deaf ears, as I fail to convince the owner my educated understanding in pet nutrition is more accurate than the kid that's been working at the pet store for 2 months.  Though pet nutrition is a complicated issue at times, it is really simple.  I will discuss that later.

Laziness, is what is left when we no longer feel guilty and we understand.  It is just too much work to give a measured amount of food once to twice daily.  Because of our busy lives, we don't have the time or willingness to exercise and play with our pets as much as we would like or should.  When we understand the how and why, yet our pet still gets overweight, it is simple laziness on our part to execute a plan of treatment or prevention.   A key difference between obesity in pets and people is choice.  There are many factors that effect people emotionally and physically that contribute to obesity, but with our pets they do not suffer those concerns.  The pet is driven by only the understanding it needs nutrition.  The majority of pets work on the general understanding that "I need food when offered because tomorrow it may not be there." In general, as I discuss obesity with my clients, I compare pets to other scavenging animals. They are always in search of nutrition--our pets are scavenging from us.  Because even a pack of Yorkies is not going be taking down any type of meaningful prey.  Our pets are not necessarily hungry when they clean their bowl, and beg at the table, rather they simply recognize the opportunity to eat.  Most pets do not understand the idea of moderation and that tomorrow they will get fed.   We, as owners, incorrectly perceive the good appetite as hunger, when it's nothing more than the animal instincts to locate and devour food stuff.  It is a normal cycle in the animal kingdom to bulk and fatten up during times of plenty in preparation for lean times.  For our pets though, the lean times never come, and obesity is created.  Our pets do not have the same ability to choose.  As pet owners, we have to make the effort to make wise choices for our pets.

Keeping them a 5 is easy!!

Veterinarians use body condition scores to describe a pets overall weight as it is compared to its size.  With such a wide variety of sizes in our pets, the weight really means very little to us veterinarians.  Keeping our pets in the middle of a 9 point score is a goal--which means a 5.  Click here to learn more about body condition scores.   The ideal way to feed our pets is in response to it's body condition.  Adjusting the amount of food we give, including treats, based on the condition of the dog.  When the pet is too thin we give more.  Then, if getting a little heavy give less--not that hard.  The misconception your pet must receive the same amount of food in its bowl every day must be abandoned.  Factors like your pets appetite, activity level, and the type of food being fed all must be considered.  If we simply pay attention to the pets body condition, making small adjustments, as needed, is really not that hard.

Let's consider an often repeated scenario.  You are planning a family event at your home.  You know your pet is extremely cute, and you family and friends find it difficult not to pass some extras to this adorable furry family member.  Your pet is likely going to consume the equivalent of several days calories as he/she works the party.  So the thing for us to do is to limit our pets intake.  We can be the doggy treat police, reprimanding our guest if they feed our pet, isolate the pet from the fun, or maybe we just skip the meal the night before, the morning of, and the night of the party.  When our pets consume extra, it's okay to skip a meal or two, or maybe even three.  Keep in mind the feeding schedule of most scavenging animals is sporadic based on the the availability of food.  To prevent obesity in or pets, their overall daily intake of calories must approximately equal how many they burn.

There are 10 points to consider in keeping your pets thin.
  1. Feed a quality diet.  There are a lot of good diets on the market.  The ideal situation is to feed one that has a statement of AFFCO feed trials.  These foods have been fed to pets that it is labeled for, and those pets have undergone a minimal amount of testing to ensure the diet was healthy and provided sufficient nutrition.  Click here for more information on AFFCO Guidelines.
  2. Loosely  follow the recommendations on the pet food bag.  The recommendations on the dog food label are just that.  They do not take into account the level of snacks, table food given, or the activity level of your pet.  They are a good starting point, but most of my obese patients have owners who were "just feeding what the bag told me to feed."  Another point of interest is that the recommendations on the pet food label are often figured for sexually intact pets.  Most of our pets are sexually altered.  These pets roughly need 25% less of the calories of intact pets.  So by following the label, it means you are already likely giving the average pet 25% more calories a day than it needs.  If your pet is very active, the label will likely be close to correct. However, if your pet is a bit more laid back, and spayed or neutered you must feed less than the label recommended amount.  Start with 25% less of the low end recommendation, and go up from there.  
  3. Do not free feed your pets, rather, feed controlled measured daily amounts.  The recommendation on the bag is usually daily intake, not per feeding.  So be sure to divide the daily ration amount by the number of times a day you feed your pet. The number of times you feed per day is a personal preference, key here is to not over feed the total daily ration of food.  If you have more than one pet, you must monitor this.  So often, a family finds they have a skinny pet and an overweight pet, as one dominates the food bowl(s).  The only time free feed is acceptable is in a single pet household, but no more should be offered in the food bowl than a single days ration.
  4. If your pet does not empty the bowl, don't worry.  Some pets stop when they are full, and it is likely not a sign of illness.  So often, owners start to freak out that the pet did not eat all the food they gave it,  and they start adding stuff on top of the food to entice the pet to eat.  This only adds to the unnecessary calories added to the diet.  It is okay to put a little something special on top, just remember not to use as much kibble if you're adding that little something extra.
  5. Watch the snacks.  Pet treats are extremely calorie rich. Just a few can be 1/2 to a full days caloric need.  In general, I recommend owners consider using fruits and vegetables for dog snacking. They are far more healthy, and no where near as rich in calories as most pet treats.  Plus, we can now share our food with our pet and not feel so guilty.
  6. Watch out for the scraps.  Feeding dinner scaps/people food to your pet is usually considered as unwise, but the truth is we all do it, so let's do it safely.  First is to provide people food in moderation.  Second, never while we eat--save it and prepare it to go with their ration or as snack.  Third, if it's a bunch, skip the daily ration of dog food to account for the added calories.  Lastly, if it was too gross for you to eat it, don't feed it to your dog. (This will help avoid and unintended illness.)
  7. Adjust the amount and type of food stuff based on the body condition of your pet.  Find a photo with a side profile of your pet when it was between 7-12 months old.  At this time your pet was likely nearly fully grown and in its ideal body condition.  Pace that picture on the refrigerator or another area you will look at every day.  Compare that daily to what your dog looks like.  The gradual weight gain of a pet, and the changes it makes in you pets appearance, is easily overlooked, so keeping a good picture to refer to can help you notice changes in your pets body condition before it gets too out of control.  
  8. Forget the fads.  Prior to the  production of commercial diets, nutritional imbalances were common. The majority of commercial foods are fine for pets, but there are so many fads and misinformation that they are best ignored until the veterinary profession weeds out the noise.  Diet fads such as no grains, or holistic, or no by-products (a whole lengthy subject on its own), etc. are used as marketing tools for you to buy one food over another, nothing more. 
  9. Listen to the advise of your veterinarian, not the pet store clerk.  Your veterinarians schooling has taught them the basics of nutrition and how the body uses that nutrition.  They are far more versed on the subject than the store clerk who likely has gotten no more than a few minutes of training on the subject.  Often the staff at the pet stores are being trained by the vendors who teach them the marketing jargon needed to sell their products, not the real science involved, if any.
  10. Exercise your pets.  It's inevitable that  in our society our pets are getting more to eat than they need, and regular exercise can help ensure those few extra calories don't hang around.  Getting out and walking our dogs, playing fetch, swimming, chasing a laser pointer around a room--whatever your pet enjoys has benefits beyond just burning calories. It also strengthens the bond you have with them.
To close, the one key word when preventing pet obesity is moderation.  Work with your pets doctor to keep them lean.  Research has shown that pets kept lean live longer, happier, healthier lives.

Saturday, August 9, 2014


Welcome to our new Blog!

Here, we will be blogging about some tough and not so tough issues facing pet owners and veterinarians. We will touch on subjects for the veterinary clients as well as for the veterinarian.  Who is we?  Myself, Dr. Mike Hatcher; my partner in life and business, Stacey Hatcher; and the occasional guest blog of one of our fine doctors and/or staff of our Veterinary Hospital.

We will try to bring a common sense approach to pet care.  The internet is full of so called "expert opinions," and we find our clients can be overwhelmed by the amount of information, as well as the confusion that comes from all the opposing opinions.  Which Expert is Right?  We will try to break some of that down to what is really important and what is not.  So much of what we see are fads--be it in training, feeding, and/or in veterinary care.  We feel as though there is room for the voice of a bit of common sense, and we will try to bring that voice to our blog.  Having and caring for a pet does not have to be complicated, and actually should be simple.  

I graduated from The University of Tennessee College of Veterinary Medicine in 2001, and  have loved every day of my practice experience.  I have been fortunate to have great mentor-ship early on, that led to many opportunities in my first, and only associate position. Those experiences took my wife and I on our next adventure--to start our own practice in our home town of Smyrna, TN in 2004. Premier VetCare was born, and now nearly 10 years later, what started with Stacey as our single team member, and I as the single doctor, has grown into one of the largest practices in our market (7 Veterinarians on staff and 25 support staff).  We are going to bring our experiences to this blog in an attempt to help the pet owners, and even more importantly, help our fellow colleagues in the profession learn what we have found successful.  The core goal of my career as a veterinarian, practice owner, mentor, and now author, has been improving the lives of the pets we care for.  We hope, through this blog, we can reach out beyond our clinic and continue to improve the lives of pets through their owners and the veterinarians that care for them; bringing a new meaning to premier veterinary care.

We hope you will follow our ramblings and go on this journey with us.