News from Your Equine Health Care Provider | Vol. 11 | Spring 2022
IN THIS ISSUE
Rood & Riddle Acquires a PET Scan Clinician Spotlight
-Dr. Rolf Embertson
Rood & Riddle News Hats Off Day to be held July 30 Dr. Kathleen Paasch -Pre-sale Radiographs
Dr. Katy Dern
-Enteroliths
Dr. Jordan Kiviniemi-Moore -Stoic Horses
RRVP
From the Pharmacy -Meet T.C. Lane
StallSide
Rood & Riddle Acquires PET Scan First Placement in a Private Hospital Rood & Riddle Equine Hospital is pleased to announce the installation of an equine positron emission tomography (PET) scanner at the Lexington, Kentucky, hospital. This modality is used for diagnostic imaging in select lameness cases and can be used in standing, sedated horses. It does not require general anesthesia. The scans result in quantitative, three-dimensional, cross-sectional images that can help accurately pinpoint the location and severity of a problem. Any area on the limb from the foot to the carpus (knee) and tarsus (hock) can be imaged. Two different types of scans can be performed. One looks at areas of increased bone metabolism and is useful to identify subchondral bone disease, signs of impending fracture, suspensory ligament attachment disorders, and osteoarthritis. The other looks at the overall tissue metabolism and is useful in cases of soft tissue injury or laminitis. Rood & Riddle is the fourth location for this standing PET scanner for horses globally and is the site of the first installation at a private practice. “We are excited to introduce this new technology for our patients,” said Dr. Katherine Garrett, Rood & Riddle’s director of Imaging. “PET scans will increase our ability to detect bony injury in horses, which will hopefully lead to improved outcomes.” Orthopedic surgeon Dr. Larry Bramlage states, “We started with radiographs alone, and they depended on celluloid and silver ions for an image. Then, digital radiographs moved us forward in the quality of what we could see. Nuclear scintigraphy was the next step because we could image physiology, not just anatomy. Then, the three-dimensional imaging with computed tomography (CAT) scans and magnetic resonance imaging (MRI) further expanded our capabilities. We have now moved forward to another level with PET scanning, which combines the physiology of nuclear medicine and the three-dimensional capabilities of CAT and MRI into a three-dimensional image of bone physiology. It can also look at the three-dimensional activity of some soft tissues. PET adds significantly to our imaging and understanding of the true status of the equine athlete.” In 2015, Grayson-Jockey Club Research Foundation funded the first-ever research project that performed PET scans on equine athletes and followed that up with additional research funding in 2019. Now, this new cutting-edge research will assist vets coast to coast in identifying lameness problems that are hard to locate. “Grayson has been a longtime supporter of research on the efficacy of PET scans in diagnosing injuries in horses, and we are pleased to see a PET scanner installed at one of the premier equine hospitals in the world,” said Jamie Haydon, president of Grayson. “We are proud to have contributed to the development of a technology that will help countless horses at Rood & Riddle for years to come.” PET scans can identify areas of abnormal bone metabolism, so it’s useful to diagnose osteoarthritis, bone bruising, or inflammation that is not apparent on radiographs (x-rays). This allows us to make a diagnosis earlier and treat the problem more specifically. PET scan is performed with light sedation (not general anesthesia), and the horse can go home the day after the scan. We can image any area from the carpus (knee) or tarsus (hock) distally (see photo). The ring that goes around the horse’s leg will open if the horse moves so the horse is not trapped inside the ring. An example of this technology is below. The following diagnostic images are from the left tarsus (hock) of an off the track Thoroughbred event horse with LH lameness. A lameness exam with nerve and joint blocks localized the problem to the area of the distal tarsal joints or the proximal suspensory ligament. Ultrasound and radiographs were not able to definitively determine the cause of the lameness. The PET scan showed abnormalities in the distal intertarsal joint (yellow arrows) so we were able to conclude that osteoarthritis of the distal intertarsal joint was the problem and treat the horse accordingly. The left images are lateral views (side to side) and the right images are a dorso-plantar views (front to back). The first set of images show the PET scan and the second set of images show the PET scan superimposed on radiographs to show the exact location of the problem in the distal intertarsal joint.
www.roodandriddle.com
Rood & Riddle to Release Legacy Book this Fall Be on the lookout for the new Rood & Riddle book, Rood & Riddle Veterinarians: The Pursuit of Excellence, being released this fall. The book will feature individual chapters from many of our veterinarians. They will discuss their lives, careers, interesting cases, and more! It will be available for purchase at the Rood & Riddle Veterinary Pharmacy. Chelsea Hackbarth, the news editor of the Paulick Report, has been writing the book based on interviews that she conducted with our clinicians. So far Chelsea has interviewed over 30 of our veterinarians. Here is an excerpt from the book featuring Rood & Riddle’s first surgeon, Dr. Rolf Embertson.
Rolf Embertson Excerpt
Dr. Rolf Embertson first coined the idea that the newly-built Rood & Riddle Equine Hospital should aim to be to equine medicine what the Mayo Clinic is to human medicine. Aided by Embertson’s guidance, Rood & Riddle has become a worldwide leader in specialist veterinary expertise as well as groundbreaking research. He joined the practice as its first surgeon just as the hospital opened for business in 1986, managed the entire surgical department on his own for the first four years, and played a pivotal role in crafting the growing Rood & Riddle reputation.
Dr. Claire Latimer and Dr. Rolf Embertson
Despite the lofty successes of his career, Embertson remains extraordinarily humble. His extremely dry wit most often lends itself to self-deprecating humor, and he’s quick to credit his colleagues for their achievements. Among those most often receiving Embertson’s esteem are the hundreds of interns who have come through the Rood & Riddle hospital; though he is often stern with the young veterinarians, there is little doubt that they all leave the practice with more knowledge, skill, and life experience than when they arrived.
Dr. Rolf Embertson
Former Embertson intern and current Rood & Riddle shareholder Dr. Scott Ahlschewede explained it thus: “You’ve got Bill Rood who is a big personality, and Tom Riddle who’s a hard worker, and Larry Bramlage who’s a big talent, but Rolf Embertson is the glue that holds it all together.” Another measure of Embertson’s dependability is that his secretary, Liz McCutcheon, has been in his employ for over 20 years. “He has such a steady temperament,” McCutcheon said. “He has a great sense of humor, and if something goes wrong, he lets it in and then lets it out. He’s just a great guy.” Embertson and his wife, veterinary ophthalmologist Dr. Claire Latimer, have two children and three grandchildren. They live on a farm in Lexington and enjoy dabbling in the breeding and racing of Thoroughbreds. roodandriddle.com
Save the Date for Hats Off Day! Hats Off to the Horse Industry Day will be
held at the Kentucky Horse Park on July 30, 2022. For the 19th year Rood & Riddle and Industry partners are joining together to put on Hats Off Day, It is the only day of the year that admission to the Horse Park is free. Free admission to the Horse Park is offered all day, with Hats Off Day festivities (all free) starting at 3 p.m. Hats Off Day activities include horse rides for adults and pony rides for children, face painting and arts and crafts stations. Free horse farm and equine industry hats, generously provided by area horse farms and businesses, are given to the first attendees to arrive.
“Hats Off Day continues to educate Kentuckians about our commonwealth’s horse industry, which is the number one equine industry in the country,” said Dr. Tom Riddle, founder of Hats Off Day and co-founder of Rood & Riddle Equine Hospital. “My hope is that people will leave the Horse Park with a better understanding about the importance of our commonwealth’s signature industry.” Stadium activities begin at 6:45 p.m. with exciting demonstrations and the presentation of the 2022 Rood & Riddle Comeback Award followed by the Rood & Riddle Kentucky Grand Prix. We hope you can join us!
Grand Entrance If you have been to the Lexington campus, you may have noticed the new addition to the entrance. A beautiful bronze mare and foal now reside in the grassy island in front of the main building. These representations of an iconic bluegrass scene were given as a gift to the hospital by Dr. Tom Riddle and his wife Margaret in honor of their parents.
Horse Mania LexArts celebrates its 50th Anniversary in 2022 and the Breeders’ Cup is coming back to Lexington. So, 22 years after the original Horse Mania, and with the help of presenting sponsors Keeneland and Maker’s Mark, LexArts decided set up the paddock and bring back painted horses. Rood & Riddle has jumped into Horse Mania 2022 as a sponsor. With over 400 designs to choose from, Rood & Riddle chose artist Jennifer Conrad’s design “Equestrian II”. This is her second Horse Mania horse, her first creation was in 2010. The completed horse will be proudly displayed in front of Rood & Riddle on Georgetown Road.
Artist Jennifer Conrad’s rendering of “Equestrian II”
Saratoga News Rood & Riddle joins the Show Jumping Hall of Fame as Presenting Sponsor of the Show Jumping Hall of Fame Jumper Classic Series East Conference and as a sponsor of the Hall of Fame’s Induction Dinner, which was held March 6 at The Wanderers Club in Wellington, Florida. The Show Jumping Hall of Fame Jumper Classic Series hosts classes at approximately 80 horse shows across the country and culminates in year-end Championships at the National Horse Show in Lexington, Kentucky, and Blenheim EquiSports’ International Jumping Festival in San Juan Capistrano, California. The Series is designed to give amateur and junior riders the opportunity to compete at higher levels and serves as a proving ground for many riders who aspire to represent the United States in international competition. Many riders who have competed in the Series over the years have gone on to become stars of the sport, including Olympic veterans Peter Leone, Lauren Hough, Reed Kessler, Lucy Davis, Jessica Springsteen, and Daniel Bluman, as well as other international stars such as Georgina Bloomberg, Laura Chapot, Karl Cook, Katie Dinan, Brianne GoutalMarteau, Marilyn Little, Christine Tribble McCrea, Hardin Towell, and Catherine Tyree. “Rood & Riddle is thrilled to partner with the ShowJumping Hall of Fame,” said Dr. Tom Riddle, co-founder of Rood & Riddle Equine Hospital. “The Hall of Fame has a long and proud tradition of promoting the sport of Show Jumping and honoring its legacy, and it is indeed an honor for us to support their efforts.”
Wellington News Rood & Riddle in Wellington supported a benefit for the Kevin Babington Foundation whose mission is to provide funding and support for equestrians who sustain spinal injuries.
In addition to providing financial assistance, the foundation will also strive to educate riders, trainers, and show organizers about the most current safety measures designed to reduce the risk of seriousinjuries which can occur while riding. The event was held at Victoria McCullough’s Mida Farm in February 2022. There was an inviting 1.45m Grand Prix from 10:00 AM – 2:00 PM on Victoria’s world-class grass field followed by an evening reception held in Victoria’shome. The event included a silent auction with many unique items such as aguitar signed by Bruce Springsteen and the E Street Band, and a luxury skybox with catering at a Boston Bruins game accommodating 21 guests, as well as personal lessons from Olympic and world-class equestrians. Rood & Riddle in Wellington is donatied a gift certificate for $3000 in services. David Beisel, the recent winner of the Rood & Riddle Kentucky Grand Prix sustained a neck injury and was a beneficiary from the Kevin Babington Foundation.
Dr. Tom Riddle to Retire in 2022 Dr. Tom Riddle will be retiring in December 2022. To celebrate his career, Rood & Riddle will be hosting his retirement party on Sunday afternoon, September 25, 2022.
If you would like to join us at the celebration of Dr. Riddle’s career, please email Whitney Fields at wfields@roodandriddle.com for more information. Dr. Woodrow Friend will be taking over as Director of Public Relations.
roodandriddle.com
THREE THINGS TO WATCH ON A PRE-SALE RADIOGRAPH by Dr. Kathleen Paasch Ambulatory QUESTION: What are three things you should watch out for on a pre-sale radiograph of a yearling you’re hoping to buy for racing?
Kathleen Paasch DVM
“It would be wonderful if it were as simple as avoiding only three radiographic issues but of course, it’s not that easy.”
“Generally, we are more tolerant of various radiographic abnormalities in yearlings bought to race as opposed to those for re-sale but there are some lesions that are best avoided. The following are three examples of findings that would make a yearling a poor prospect for racing.”
“1. Significant Changes in the Distal Radiocarpal Bone 2. Large Stifel OCDs 3. Severe Tarsal Arthritis”
Reprinted with permission of the
Dr. Kathleen Paasch: After looking at dozens of sale yearlings you’ve narrowed your list down to a handful. Now for the vetting. It would be wonderful if it were as simple as avoiding only three radiographic issues but of course, it’s not that easy. There are far more than three areas of consideration. And, like radiographs, these issues are not often not black and white but infinite shades of grey. Just as assessment of physical characteristics and pedigrees is subjective, radiographic interpretation (and subsequent recommendations) are also subjective. Generally, we are more tolerant of various radiographic abnormalities in yearlings bought to race as opposed to those for re-sale but there are some lesions that are best avoided. The following are three examples of findings that would make a yearling a poor prospect for racing. 1. Significant Changes in the Distal Radiocarpal Bone: The radiocarpal bone is located on the medially (inside) of the middle carpal joint (knee). It bears a considerable amount of weight and stress at speed. A yearling that already has marked changes here is not a good bet to hold up for racing. 2. Large Stifle OCDs Mention the words ‘stifle OCD’ and many will immediately remove that yearling from consideration. However, stifle OCDs come in various locations and sizes and do not all carry the same degree of risk. Multiple graded stakes horses have had stifle OCDs. That said, large OCDs that involve a significant amount of joint surface should be avoided. 3. Severe Tarsal Arthritis: Many yearlings have mild and insignificant changes to the lower joints of their tarsi (hocks). However, a foal’s tarsal bones can become irreparably crushed and malformed, leading to performance limiting degenerative joint disease as a yearling/adult. These examples are in no way a comprehensive list of findings to avoid. They are extreme examples and radiographic findings are rarely so clear-cut. It is important to note that milder variations of the above may be perfectly acceptable for racing (e.g., small OCDs, mild carpal or tarsal changes). As with other aspects of buying yearlings, radiographic findings often involve a series of compromises. To this end, when purchasing yearlings, buyers should work with a veterinarian whom they trust and who is familiar with their interests and level of risk tolerance. Dr. Kathleen Paasch received her veterinary degree from Washington State University in 1999 and completed an internship with Rood and Riddle Equine Hospital in 2000. She is now a shareholder and ambulatory veterinarian at the hospital, where she specializes in lameness, diagnostic imaging, and acupuncture.
ENTEROLITHS CAN MAKE A ROCKY ROAD TO COLIC?
by Dr. Katy Dern Surgeon QUESTION: How common are enteroliths, and what causes them? Dr. Katy Dern: While many of our colic patients make it clear within a few minutes of presentation to hospital that they will
require surgery — high heart rate, unremitting pain in the face of sedatives and NSAIDS, or clinical signs of devitalized bowel – some patients make it more difficult to determine if surgery is indicated. Horses with enteroliths are often on that list. Enteroliths are calculi (rocks) which form in the right dorsal colon and can cause partial or complete obstruction of the gastrointestinal tract. They are composed of struvite (magnesium ammonium phosphate hexahydrate) and form when mineral deposition occurs in concentric layers around a central nidus. Although this central nidus is sometimes a foreign body (rope or metallic object), in most cases it is indistinguishable from the rest of the calculi. Although we don’t know exactly why some horses form enteroliths and some don’t, we do know that there are certain risk factors for enterolith formation. A review of 900 cases of horses with confirmed enteroliths determined that Arabians, Morgans, and American Saddlebreds are at an increased risk for developing enteroliths. Enteroliths were also found to occur more frequently in horses in California and regions of the Southwest. From a management perspective, the most important aspects of this retrospective analysis and other studies were that most patients with enteroliths had a diet which consisted of more than 50 percent alfalfa hay, and there was a significantly increased incidence of enteroliths in horses which did not have daily access to pasture grazing. If your horses are part of the “at-risk” population, we recommend ensuring that the majority of their diets consist of pasture or grass hay, avoiding alfalfa-based products. Although the exact role of alfalfa in the formation of enteroliths is unknown, it is suspected that the higher protein content can result in a more alkaline pH in the colon, favoring enterolith formation. Alfalfa hay also has higher levels of magnesium and phosphorus, both of which are components of the typical struvite enterolith. Enteroliths usually form in the right dorsal colon, which has a large enough diameter to accommodate the calculi while still allowing feed to pass through the gastrointestinal (GI) tract. If the enterolith begins to move from the right dorsal colon into the transverse colon, or further abroad into the small colon however, it may become lodged due to the smaller diameter of these parts of the GI tract. In some horses, the enterolith intermittently occludes the transverse colon, causing occasional mild colic signs which resolve with medical management (flunixin meglumine, intravenous fluids, etc). Once the enterolith becomes lodged in the transverse or small colon, it completely blocks the passage of feed material though the GI tract, causing colic signs. Diagnosis of enteroliths in the patients with a history of chronic colic can be challenging. Abdominal radiographs (x-rays) are more reliable in diagnosing enteroliths which are in the large colon versus the small colon – presumably due to the increased diameter of the enteroliths in the large colon. Enteroliths cannot be imaged in an ultrasonographic examination and are rarely detectable on rectal palpation. For these reasons, a definitive diagnosis of enterolithiasis often requires surgery. In the patients with persistent colic signs in which the enterolith has become permanently lodged in the bowel, timely surgical intervention is important. In these cases, the enterolith compresses the bowel wall, decreasing the blood supply and potentially causing weakened areas or areas of necrosis (tissue death), which can lead to fatal rupture of the transverse or small colon. To avoid this tragic outcome, surgery is recommended in horses with persistent pain in the face of sedation and analgesia (flunixin meglumine, etc). Once in surgery, the location of the enterolith is determined and a pelvic flexure enterotomy is performed to completely empty the contents of the large colon. This procedure involves making a small incision in the bowel wall through which to empty the contents, and then instilling fluid into the large colon to help “flush” the enterolith to a location from which it can be safely removed. Multiple incisions are often required to both evacuate the contents of the colon and to remove the enterolith. If the enterolith is lodged in the small colon, an incision will be made into the wall of the small colon to facilitate enterolith removal. In some cases, the enterolith has compressed the bowel wall so severely that tissue death (necrosis) has occurred – in these cases the devitalized area of bowel needs to be removed. Post-operative management involves intravenous antimicrobials, intravenous fluids, and a gradual refeeding program to ensure that the lining of the colon has time to recover from trauma and irritation caused by the enterolith. Fortunately, survival after surgical removal of enteroliths is high, with reports ranging from 92 percent to 96 percent. As with many colic cases, prompt referral and timely surgical intervention are the keys to a good outcome.
Dr. Katy Dern is originally from Colorado and Montana. She attended Washington State University for her undergraduate work, and Colorado State University for her veterinary degree. Following graduation from CSU in 2012, she completed an internship at Peterson and Smith Equine Hospital in Ocala, followed by an internship at Rood and Riddle Equine Hospital. After her internships, Dr. Dern completed a three-year surgical residency at The Ohio State University, while also earning a Master’s of Science Degree. She became board certified in equine surgery in 2018. She was the surgeon at Rood & Riddle’s Saratoga location from 2017 - 2020 and moved to the Lexington location in 2020.
Kathryn Dern DVM, MS, DACVS
“While many of our colic patients make it clear within a few minutes of presentation to hospital that they will require surgery... some patients make it more difficult to determine if surgery is indicated. Horses with enteroliths are often on that list.”
“In the patients with persistent colic signs in which the enterolith has become permanently lodged in the bowel, timely surgical intervention is important. “
“Once in surgery, the location of the enterolith is determined and a pelvic flexure enterotomy is performed to completely empty the contents of the large colon. ”
Reprinted with permission of the
roodandriddle.com
HOW TO PICK UP ON SIGNS OF DISCOMFORT FROM A STOIC HORSE
by Dr. Jordan Kiviniemi-Moore Ambulatory
QUESTION: Some horses can be really “stoic” when they’re experiencing pain or illness. How can an owner pick up on subtle signs of pain in a stoic horse?
Jordan Kiviniemi-Moore DVM
“Stoicism has an evolutionary advantage for horses, as it helps them avoid being singled out by predators.”
“Knowing what is “normal” for a particular horse will help owners pick up on small cues that may indicate an issue.”
“Horses have evolved to eat, watch for predators, run when needed, and keep up with their social group, and most will attempt to maintain and preserve these activities even in the face of discomfort.”
Dr. Jordan Kiviniemi-Moore: Stoicism has an evolutionary advantage for horses, as it helps them avoid being singled out by predators. As such, horses may conceal substantial levels of pain and carry on without dramatic symptoms, making it easy to miss subtle signs that reflect underlying discomfort. It is also important to recognize that certain common signs such as stiff movement or a squinty eye are in fact a reflection of pain, even if the horse is bright, eating, and otherwise behaving normally. Knowing what is “normal” for a particular horse will help owners pick up on small cues that may indicate an issue. Horse owners may notice subtle changes in behavior such as decreased enthusiasm for feed, slower or reluctant movement, or uncharacteristic separation from the rest of the herd or group of horses. The horse may become “girthy” or fussy when being bridled or saddled, or very reactive under saddle. Such behavior alterations can also occur in the absence of physical discomfort, but ruling out underlying pain and physical causes should be among the first steps in investigating behavior changes or training issues. Additional signs of generalized underlying pain include lethargy, low head carriage or abnormal posture, shifting weight, and bruxism or teeth grinding. The “horse grimace scale” was developed by researchers who correlated pain levels with changes in equine facial expressions such as squinting, stiffly backward ears, and strained mouth and nostrils. This is particularly helpful to assess discomfort following medical procedures or for horses suffering from ongoing issues such as chronic lameness. Subtle signs of pain often correlate with the underlying issue and affected body system. In my practice I most commonly see horses dealing with musculoskeletal and hoof pain, gastrointestinal pain, and ocular pain. Dental pain is also quite common and can be difficult to recognize. Musculoskeletal pain often manifests as an altered gait (i.e., stiffness or limping), failure to keep up with the group of horses, and lying down excessively. Horses suffering from ocular pain may squint one or both eyes or have increased redness or discharge. Of course, the more severe manifestation of gastrointestinal pain is overt colic signs such as rolling, pawing, sweating, and flankwatching, but more subtle signs include decreased appetite, lethargy, and grinding teeth. Horses suffering from dental pain may become fussy with the bit, drop feed, act reluctant to accept treats, or seem to chew predominately on one side of their mouth. Horses have evolved to eat, watch for predators, run when needed, and keep up with their social group, and most will attempt to maintain and preserve these activities even in the face of discomfort. If you notice uncharacteristic behaviors or changes with your horse your veterinarian can help you assess comfort level and also examine for underlying painful conditions. Together you can construct a plan to evaluate problems and optimize performance and quality of life for your horse.
Reprinted with permission of the
Dr. Kiviniemi-Moore grew up in Lexington, Kentucky pleasure riding and dreaming of becoming a veterinarian. Living in central Kentucky presented Dr. Kiviniemi-Moore with wonderful opportunities from local veterinarians who fostered her desire to become one herself. In 2010 she graduated from Transylvania University with a BA in Biology and earned her DVM from Auburn University College of Veterinary Medicine in 2014. She completed a rotating equine internship which included internal medicine, surgery and ambulatory rotations, at the University Of Missouri College Of Veterinary Medicine in 2015. Following this internship, she did an ambulatrory internship at Rood & Riddle with Dr. Woodrow Friend. Her areas of interest include theriogenology and primary care. In 2017 she earned her certification in equine acupuncture.
From the Pharmacy T.C. Trial is the newest Pharmacist at RRVP and is a graduate of Samford
T.C. Trial
University. He lives in Lexington with his wonderful wife of 12 years (who he’s known for 18 years) and their mischievous 3 year old German Shepherd who defines “velcro dog”. When he isn’t learning about the brave new world of veterinary pharmacy his hobbies include; tennis, cooking, music, and traveling. He’s been to 13 countries, 36 states and counting. He counts himself lucky to have found such an amazing place to work and grow.
StallSide Podcast If you haven’t already, make sure you check out Stallside, Rood & Riddle’s healthcare podcast, sponsored by Rood & Riddle Veterinary Pharmacy. The podcast is available on the Rood & Riddle YouTube channel; if you are not a podcast watcher, now is an excellent time to start. Click here to start watching! The audio version of the podcast is available on all major streaming platforms. StallSide Co-Hosts
Recent episodes include interviews with Dr. Larry Bramlage Insights on Veterinary Medicine and the Racing Industry, The New Foal Exam with Dr. Laurie Metcalfe, Dr. John Madigan talks about The Evolution of the Madigan Squeeze, and Dr. Heath Soignier relates How Complementary Therapies Can Benefit Your Horse’s Health. Upcoming episodes will include Dr. Charlie Scoggin discussing ICSI (Intracytoplasmic Sperm Injection), Dr. Peter Morresey interviewing himself, and Dr. Debbie Spike-Pierce speaks on the state of the veterinary industry and how it effects all of us.
Dr. Peter Morresey
Dr. Bart Barber
We have gotten a lot of good feedback from many sources, including clients, veterinary schools, referring veterinarians, and veterinary students. If you have a topic that you would like us to cover, please send your request to stallside@rrvp.com.
Drs. Morresey, Barber and Morrison
rrvp.com